CAR 11 AC4413(3)CARSHAUM Carsbalton Urban District Annual Report OF THE Medical Officer of Health FOR THE YEAR 1946 Printed by the "Croydon Times," Ltd., 104, High Street, Croydon. CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1946 PREFACE To the Chairman and Members of the Carshalton Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1946. It has been my pleasure, year by year, to lay before you a record of the public health of the district which has been consistently satisfactory, and particularly so when measured by national standards. The experience of 1946 provides me with yet another opportunity of doing so. Although somewhat irregular, the general trend has always been progressively towards improvement, so much so that each year one has come to expect at least one, if not more, vital statistics establishing new favourable records. For 1946 the birth rate of 17.8 per thousand population is the highest for 18 years and is provided by a number of births which, for the first time in our history, has exceeded 1,000 per annum. The crude death rate, invariably appreciably lower than that for England and Wales, is again a low one, namely 7.2 per thousand population compared with 11.5 for the country as a whole. Infant mortality reached the remarkably low level of 18 per thousand live births, much the most favourable index of child care yet experienced. It compares with a rate of 41 for England and Wales. More than a thousand women were safely conducted through childbirth without a single maternal death, thus repeating the achievement of the year before. Of the individual causes of death, cancer figured less prominently, the rate falling from 1.6 to 1.0 per thousand. In spite of a higher level in the known incidence of tuberculosis, it is gratifying to note that the mortality from this disease is the lowest for twenty years. The relative steady increase in deaths from diseases of the heart is paradoxically a favourable feature. A limit is set to all forms of life by natural " wear and tear " and the final act in such a process is most frequently exhaustion of that vital organ. The mortality rate for heart disease is mainly due to deaths arising as a result of the degenerative changes associated with advancing years. There was no serious visitation by infectious disease, and the only significant changes were of a favourable nature. Scarlet fever, measles, diphtheria, and dysentery among the resident population were less 3 prevalent; whooping cough and primary pneumonia more so. The district was free entirely of smallpox, typhoid fever, ophthalmia in the newborn, and the infections of the central nervous system, namely poliomyelitis, polio-encephalitis, cerebro-spinal fever and encephalitislethargica. Diphtheria incidence calls for special mention, particularly in view of the intensive efforts which for years have been made to secure the immunisation of the child population. Only four cases occurred among the residents. Of these, one was a hospital nurse and the other three were members of one family. Never in any one year before has diphtheria been limited to one domestic dwelling. Mainly as a result of the substantial increase in the number of births the Maternity and Child Welfare scheme had an exceptionally busy year and its activities were conducted at a new high level. The Council's scheme, like the medical practitioners, nursing organisations and hospitals, constitutes one of the principal agencies in the district for the promotion of maternal and child health. As from July next great changes in these health services affecting mothers and children will be instituted. Under the provisions of the National Health Service Act the Maternity and Child Welfare scheme will pass out of the control of the District Council, which has administered it from its inception, and will become the responsibility of the County Council; the medical practitioners will work under a very different set of conditions; the nursing associations will largely lose their voluntary character, and the hospitals will be vested in the Minister and administered by Boards chosen and appointed by him. This might then be an appropriate opportunity briefly to review the record of our long established arrangements in this special field. The Carshalton Maternity and Child Welfare scheme was born in 1909 when one health visitor was first appointed to visit the homes of babies whose births were notified under the Notification of Births Act, 1907. She was a district nurse employed part-time by the Council, and her duties were to visit on two occasions and advise mothers on infant care and feeding. From this small beginning successive Councils built steadily and wisely until to-day the district has the benefit of a comprehensive scheme which includes five health centres at which 14 welfare sessions per week are conducted, an establishment of six full time health visitors, a day nursery of 74 places and the many and diverse ancillary services set out in the body of this report. How has the health of Carshalton mothers and children fared during this period ? That, of course, is the true test of the effectiveness of the local services. The average annual infant mortality for the ten years immediately prior to the commencement of the scheme was 117 deaths per thousand live births; that for the most recent ten years 38, and, as stated above, that for 1946 was the record low one of 18. Maternal mortality in the decennium 1900 1909 was 2.5 per thousand births; in the last ten years 1.5. How do these local indexes compare with the national figures ? At page 15 will be found comparative statistics for the last ten years, from which it will be seen that our local infant mortality has been consistently less than for England and Wales, and for the whole decennium approximately two-thirds only of the national rate. Maternal 4 mortality, too, over the same period has been approximately threequarters of that for the country as a whole. In the face of these solid achievements one may reasonably doubt the wisdom of substituting for arrangements which have proved so successful a scheme which has yet to prove its worth. The Council have at least the satisfaction of knowing that they are passing over to other hands a highly efficient service of whose record they have every reason to be proud. The difficulties referred to in recent reports in securing the remedy of sanitary defects have in no way diminished, shortage of materials and labour still presenting insuperable obstacles. The dire need for augmenting our national food supplies necessitating the public collection of pig food waste has created a set of circumstances which cannot but be viewed with misgiving by public health officers who know* from experience the potential menace of flies. While it is still necessary to continue this scheme no effort should be spared to minimise the real health risks which are inherent in these arrangements. Supervision of food supplies is assuming an increasing role in sanitary administration. Regulations to fix standards for commodities, particularly those which lend themselves to fraudulent substitution, continue to increase. The necessity for these Orders cannot diminish while ever the supply of the genuine products falls so short of the need. Consequently food sampling during the year showed a substantial increase. One tendency which has been noted is the replacement of stocks of certain commodities with supplies of inferior quality, the result of the usual sources of production being no longer available. One cannot designate these samples as " adulterated " or " non-genuine," but they are not of the standard to which the public has been accustomed in more fortunate times. Overcrowding remains our major health problem and overshadows every other consideration. In previous reports the necessity has been stressed for rehousing most of our homeless families outside the district. The scope for rehousing within the boundaries of the area is very limited and can only solve a small part of our problem. It is true that for the time being the rate of new construction is held up by considerations other than availability of sites, but it would appear to be desirable to ensure that sufficient sites are at our disposal in less populated areas against the time when the supply of labour and material makes more rapid progress possible. I opened this introduction with an expression of satisfaction at being able to submit yet another favourable report. Looking ahead, this pleasure is tempered with some degree of apprehension. We are going through difficult times and must face yet a greater degree of austerity before we are clear of the economic troubles which beset us. Shalt we with the means at our disposal be able to sustain the wellbeing 5 of the community at its present high level or will the handicaps prove too formidable. Time alone will tell. Meanwhile we can but strive unremittingly in the knowledge that success lies mainly in our own exertions. I am, Your obedient servant, F. LAWRENCE SMITH, Medical Officer of Health. August, 1947. 6 PUBLIC HEALTH STAFF. Medical Officer of Health. V. Lawrence Smith, M.B., Ch.B., D.P.H. Chief Sanitary Inspector. * H. J. Spicer, M.R.S.I. Deputy Chief Sanitary Inspector. * H. G. Cripps, C.R.S.I. Sanitary Inspectors. * L. G. Lydiatt, C.R.S.I. * G. E. MATON, C.R.S.I. * J. East, C.R.S.I. (Temporary : resigned 30.3.46). V. A. Vickers, M.R.S.I. (Temporary). Senior Health Visitor. Miss R. M. Nash. Health Visitors. Miss A. A. Askew. Miss M. J. Thomas (resigned 14.5.46). Miss H. Gray Miss D. Longland. Chief Clerk. B. Lamacraft. Part Time Officers. Medical Officers to Maternity and Child Welfare Centres. Ruth C. Townshend, M.B., B.S., D.P.H. Olive G. Potter, M.B., B.S., L.R.C.P., M.R.C.S. Alice C. Caiger, M.B., Ch.B. Eveleen Ashworth, M.B., B.S. C. A. Bentley, C.I.E., M.B., D.P.H. Consulting Obstetrician. W. H. Passmore, M.R.C.S., L.R.C.P. Dentist to the Maternity and Child Welfare Scheme. H. C. Scott, L.D.S., R.F.P.S.(Glas.). Meat and food Certificate of the Royal Saitftary Institute. 7 Section A—Natural and Social Conditions of the District. Area (in acres) 3,346 Number of inhabited houses (end of 1946) according to Rate Books 16,046 Rateable Value at 31st December, 1946 £482,601 Sum represented by Id. rate £1,953 THE Sanitary District, situated about midway between the Thames and the North Downs, is roughly rectangular in shape. It is approximately one mile in width and, commencing at a datum level of 72 at the northern boundary, it extends for some five miles in a southerly direction up the slope of the North Downs to a height of 450 feet above sea level. The subsoil, which is clay in the northern part, changes to a sandy gravel as one proceeds southwards, and then merges into chalk, which covers the southern half of the district. The River Wandle forms the eastern boundary in the northern half and is fed by several springs which arise near the centre of the district at the outcropping of the chalky subsoil. The increasing extraction of water for various purposes from the London Basin has resulted in the flow from these springs becoming increasingly variable, ceasing altogether on occasion after periods of low rainfall. Situated in Metropolitan Surrey, Carshalton is largely a dormitory area, most of its residents being employed in London. With the exception of the southern portion, the district is highly urbanised, the housing density increasing as one approaches the northern boundary. Dwellings are mostly of the working class type, the average rateable value being less than £25. Mainly developed within the last 20 years, particularly as the result of the L.C.C. housing estate of St. Helier, the district has a young population, the average age of its residents being as low as, if not lower than, any in Surrey. 8 SUMMARY OF VITAL STATISTICS FOR 1946. (Based on the Registrar-General's Figures). Population. Registrar-General's Estimate 60,040 Births. Males. Females. Total. Live (Legitimate) 526 499 1,025 (Illegitimate) 29 18 47 555 517 1,072 Birth Rate 17.8 Still-births (Legitimate) 13 9 22 (Illegitimate) 1 – 1 14 9 23 Still-birth Rate per 1,000 total births 20.9 Deaths. 218 217 435 Death Rate (crude) 7.2 Infant Mortality. All deaths under 1 year 11 9 20 Infant Mortality Rate (per 1,000 live births) 18.6 Deaths of leg. infts. under 1 year Rate per 1,000 legitimate births 11 9 20 19.5 Deaths of illeg. infts. under 1 year — — — Rate per 1,000 illegitimate births — Maternal Mortality. Deaths from Sepsis — Rate per 1,000 births — Deaths from other causes — Rate per 1,000 total births — Maternal Death Rate — Zymotic Deaths. 7 Principal Zymotic Diseases 2 Deaths from Measles — Deaths from Whooping Cough — Deaths from Diarrhoea (under 2 years) 1 Zymotic Death Rate 0.03 Deaths from Tuberculosis. All Forms 16 9 25 Rate per 1,000 of population 0.41 Phthisis 10 7 17 Rate per 1,000 of population 0.28 Deaths from Cancer. 24 41 65 Rate per 1,000 of population 1.08 9 The Registrar-General's statistics relating to population and deaths differ slightly from those compiled from local records. The total figures in respect of the district as a whole, which are supplied by the Registrar-General, are set out in this report, but where classification has been made, e.g., by age groups, sex, wards, etc., it has necessarily been based on our own records, which may, in the aggregate, show slight discrepancies compared with the Registrar-General's totals. UNEMPLOYMENT. The war and its after effects have resulted in a dearth of labour in almost every direction and the official figures as to the number of unemployed registered at the Sutton Exchange at the year end has only significance for verv temporary circumstances. They were :— Men 96 Women 30 Boys 27 Girls 5 158 PUBLIC ASSISTANCE. The following information as to public assistance afforded in the district is supplied by the Chief Public Assistance Officer of the Surrey County Council :— Medical Relief: Total number of persons in Carshalton admitted to Public Assistance Institutions or Homes during 12 months ended 31st December, 1946 31 Total number of persons from Carshalton admitted to Mental Hospitals during 12 months ended 31st December, 1946 81 Other Relief: Number of persons in receipt of domiciliary assistance on :— Men. Women. Children. Total. 1st January 86 161 159 406 1st July 73 149 138 360 31st December 89 164 130 383 Total amount of domiciliary relief paid to persons resident in Carshalton during 1946 £14,957 9s. 11d. POPULATION. Following the vicissitudes of the war-time movement of population when the flow was mainly outwards, the number of residents regained and passed its pre-war level. For the first time in its history, the population, according to the Registrar-General's estimate has exceeded 60,000. Between the census of 1931 and the national registration of 1939, the proportion of population aged 5—15 years rose from 11% to 21% of the total, the result of rapid development chiefly by migration into the district of married people with young families. This age group is now eight years older and it is not difficult to explain the large number of young married couples now needing housing accommodation, although the average level of housing occupation at 3.76 persons per dwelling is no higher than it was in 1939. 10 It is now estimated that children under 5 years of age represent 7% and children 5—15 years 17.5% of the total population. The distribution by wards at mid-year was estimated as follows :— TABLE 1. ESTIMATED RESIDENT POPULATION, MID-1946, BY WARDS. Ward. Houses at Mid-1946. Estimated population Mid-1946. St. Helier North 1,987 8,450 St. Helier South 1,660 6,950 St. Helier West 1,874 8,030 North-East 2,511 9,180 North-West 2,119 7,220 Central 1,713 6,010 South-East (Queen Mary's Hospital) 2,090 7,250 1,090 South-West 1,983 6,570 Whole District 15,937 60,750 BIRTHS. For the first time the number of live births registered in the year exceeded 1,000. A total of 1,072 was divided as to 555 males and 517 females. This gives a birth rate of 17.8 per 1,000 population, the highest for eighteen years, and compares with 15.0 in the year before. Still-births numbered 23, giving a rate of 20.9 per 1,000 total births. Information available from the registration of births is not complete as to the home addresses of the parents. For computation of ward birth rates, therefore, use is made of the notifications of birth received under the Public Health Act, supplemented by the Registrar's weekly returns of registrations. From these sources it is known that 1,102 live births occurred in 1946. They were distributed as shown in the following table :— Ward. Live Births. Birth Rate per 1,000 Population. Still Births. Still Birth Rate per 1,000 total births. St. Helier North 151 17.8 6 38.2 St. Helier South 130 18.7 4 29.8 St. Helier West 127 15.8 2 15.5 North-East 212 23.0 4 18.5 North-West 138 19.1 4 28.1 Central 128 21.3 2 15.3 South-East (excluding Queen Mary's Hospital) 127 17.5 2 15.5 South-West 89 13.5 1 11.1 11 The increasing use made of hospital and nursing home accommodation for maternity was again manifested in 1946. The percentage of such non-domiciliary births was, as in the year before, no less than 60% of the whole. The percentages for the various wards were as follows :— St. Helier North 59 St. Helier South 56 St. Helier West 57 North-East 52 North-West 57 Central 72 South-East 60 South-West 70 Of the 1,127 births (live and still), 670 took place in the following hospitals and nursing homes :— Live. Still. Total. Carshalton, Beddingtou and Wellington District (War Memorial) Hospital 85 9 87 St. Helier County Hospital 394 14 408 Other Surrey Country Hospitals 71 1 72 Other Hospitals 15 1 16 Private Nursing Homes* 86 1 87 Totals 651 19 670 TABLE 2. BIRTHS, 1946, DOMICILIARY AND OTHERS — BY WARDS. Ward. Born in District. Born Outside District. Total. In Hospitals and Nursing Homes. In Private Houses. Total. In Hospitals and Nursing Homes. In Private Houses. Total. St. Helier North 74(5) 64(7) 138(6) 19 – 19 157(6) St. Helier South 64(3) 58(7) 122(4) 11 1 12 134(4) St. Helier West 61(7) 54(7) 115(2) 13 1 14 129(2) North-East 92(2) 104(2) 196(7) 20 — 20 216(7) North-West 64(2) 59(7) 123(3) 18(7) 1 19(7) 142(4) Central 70(2) 36 106(2) 24 — 24 130(2) South-East 47 52 99 30(2) — 30(2) 129(2) South-West 29(1) 27 56(7) 34 — 34 90(7) Totals 501(16) 454(6) 955(22) 169(3) 3 172(3) 1127(25) (Figures in brackets indicate still births included in totals.) 12 TABLE 3, BIRTH AND DEATH RATES FOR CARSHALTON, 1922-1046. Year. Population (RegistrarGeneral's) Birth Rate. Death Rate. Infant Mortality Rate. Maternal Mortality Rate. 1922 14,240 19.7 8.8 50 10.6 1923 14,610 18.8 8.6 36 3.6 1924 16,060 18.5 10.1 58 7.1 1925 15,660 20.0 10.0 42 3.2 1926 17,040 17.0 9.3 31 0.0 1927 18,400 16.5 9.1 72 9.8 1928 21,910 15.5 9.0 65 14.7 1929 23,420 18.8 9.4 61 0.0 1930 25,500 17.0 7.6 46 0.0 1931 28,620 16.7 7.5 43.8 8.1 1932 32,280 15.05 7.9 47.3 3.89 1933 35,260 14.9 8.8 64.4 4.23 1934 38,110 16.5 8.6 53.5 4.60 1935 51,000 15.7 6.6 46.0 4.80 1936 57,000 15.7 7.1 46.7 7.57 1937 58,030 15.0 6.6 40.0 0.0 1938 58,730 14.7 7.6 46.1 2.3 1939 a 59,510 13.2 7.1 35.4 3.7 b 59,070 1940 58,340 13.3 8.7 43.8 5.1 1941 56,840 12.2 8.4 40.5 1.4 1942 57,120 14.0 7.5 27.5 2.4 1913 56,600 13.9 8.2 39 4.9 1944 52,300 17.0 9.5 39 1.1 1945 54,230 15.0 8.2 23.2 0.0 1946 60,040 17.8 7.2 18.6 0.0 13 TABLE 4. COMPARATIVE STATISTICS—1946. England and Wales. 126 County Boroughs and Great Towns including London 148 smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census). London Administrative County. Carshalton. *Rates per 1,000 Civilian Population. Births— Live 19.1‡ 22.2 21.3 21.5 17.8 Still 0.53‡ 0.67 0.59 0.54 0.38 Deaths— All causes 11.5‡ 12.7 11.7 12.7 7.2 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 – Scarlet Fever 0.00 0.00 0.00 0.00 – Whooping Cough 0.02 0.02 0.02 0.02 – Diphtheria 0.01 0.01 0.01 0.01 0.01 Influenza 0.15 0.13 0.14 0.12 0.03 Smallpox 0.00 0.00 0.00 – – Measles 0.00 0.01 0.00 0.01 – Rates per 1,000 Live Births. Deaths under 1 year of age 43† 46 37 41 18 Deaths from Diarrhoea and Enteritis under 2 years of age 4.4 6.1 2.8 4.2 0.9 Rates per 1,000 Civilian Population. Notifications— Typhoid Fever 0.01 0.01 0.01 0.01 Paratyphoid Fever 0.02 0.02 0.01 0.01 Cerebro Spinal Fever 0.05 0.05 0.04 0.06 0.01 Scarlet Fever 1.38 1.51 1.33 1.42 1.59 Whooping Cough 2.28 2.48 2.05 2.22 3.19 Diphtheria 0.28 0.32 0.31 0.24 0.21 Erysipelas 0.22 0.25 0.22 0.27 0.16 Smallpox 0.00 0.00 0.00 0.00 — Measles 3.92 4.73 3.70 7.35 8.52 Pneumonia 0.89 1.02 0.74 0.75 1.09 Rates per 1,000 Total Births (Live and Still). Puerperal Fever 8.50 10.35 7.63 1.62 28.31 Puerperal Pyrexia §9.68 Maternal Mortality—- • Abortion with Sepsis 0.13 Not available — Abortion without Sepsis 0.06 — Puerperal Infections 0.18 — Other Puerperal causes 1.06 — a A dash (—) signifies that there were no deaths. † Per 1,000 related births. ‡ Rates per 1,000 Total population. § Including Puerperal Fever. 14 COMPARATIVE HEALTH STATISTICS, 1937—16. Death Rate per 1,000 population. Infant Mortality per 1,000 live births. Maternal Mortality (excluding abortion) per 1.000 total births. Year. Carshalton. England and Wales. Carshalton. England and Wales. Carshalton. England and Wales. 1937 6.6 12.4 41.1 57.7 0 2.7 1938 7.6 11.6 46.1 52.8 1.1 2.7 1939 7.1 12.1 35.4 50.6 2.0 2.5 1940 8.7 14.4 43.8 56.8 3.8 2.2 1941 8.4 13.5 40.5 60.0 0 2.2 1942 7.5 12.3 27.5 50.6 2.4 2.0 1943 8.2 12.1 39.3 49.1 4.9 1.8 1944 9.5 11.6 39.2 45.4 1.1 1.5 1945 8.2 11.4 23.2 46.0 0 1.4 1946 7.2 11.5 18.6 43 0 1.24 1937/46 7.9 12.3(av) 35.0 51 (av) 1.51 2.02 DEATHS. The number of deaths allocated to this district by the RegistrarGeneral was 435, 218 being males and 217 females. The crude death rate at 7.2 per 1,000 population is the lowest since 1939, and compares with 11.5 for England and Wales. The distribution by wards was as follows :— WARD DEATH RATES AND MEAN AGE AT DEATH 1946. Deaths. Death Rate (crude). Mean Age at death. St. Helier North 46 5.4 50.3 yrs. St. Helier South 39 5.6 53.3 „ St. Helier West 39 4.8 51.4 „ North-East 61 6.6 59 „ North-West 78 10.8 64.2 „ Central 62 10.3 64.3 „ South-East (excluding Queen Mary's Hospital) 55 7.6 61.2 „ South-West 57 8.7 71.4 „ Whole District 437 7.27 60.6 yrs. 16 There was a welcome fall in the deaths due to cancer. In the year before, the death rate from this disease had reached its highest level at 1.66 per 1,000 population. For 1946 the rate fell to 1.08, there being 65 deaths from this cause as against 90. CANCER DEATHS—WARD DISTRIBUTION, 1946. Ward. Cancer Deaths. Rate per 1,000 Estimated Population. St. Helier North 7 0.82 St. Helier South 2 0.28 St. Helier West 4 0.49 North-East 10 1.08 North-West 15 2.07 Central 11 1.83 South-East 9 1.24 South-West 7 1.06 The classification of cancer deaths by sites affected is given in Table 5. TABLE 5. Group. Site Affected. Male. Female. Total. 45 Buccal Cavity Tongue – 1 1 Pharynx – 1 1 46 Digestive Organs— Oesophagus 1 1 2 Stomach 6 6 12 Liver — 2 2 Intestines – – 6 Rectum 5 5 10 Pancreas — 1 1 47 Respiratory Organs– Larynx 1 — 1 Lungs and Bronchi 7 1 8 48 Uterus – 4 4 49 Other female genital organs – 1 1 50 Breast – 10 10 51 Male genital organs 2 – 2 52 Urinary Organs 1 – 1 55 Other organs Spine 1 — 1 Skull 1 — 1 Glands — 1 1 • 25 40 65 Average age at death— Males 66.4 yrs. Females 66.3 „ All persons 66.3 „ 16 Tuberculosis mortality was also more favourable, 25 deaths being attributed to this cause compared with 28 in 1945. The proportion due to disease of the lungs was also less than usual, 17 of such deaths giving a death rate of 0.28 per 1,000 population. Mortality from all forms of tuberculosis during the last twenty years was as follows :— Year. Death Rate per 1,000 Population. Year. Death Rate per 1,000 Population. 1927 0.65 1937 0.63 1928 0.43 1938 0.63 1929 0.55 1939 0.77 1930 0.51 1940 0.56 1931 0.66 1941 0.71 1932 0.52 1942 0.46 1933 1.10 1943 0.81 1934 0.60 1944 0.63 1935 0.96 1945 0.51 1936 0.64 1946 0.41 The distribution of tuberculosis mortality by wards and other details are given in Section F of this Report. Deaths from the seven common infectious diseases, namely, scarlet fever, diphtheria, measles, whooping cough, enteric fever, diarrhoea under 2 years and smallpox established a low record in 1945. The mortality from these infections was equally favourable in 1946, there b;ing only two deaths due to these causes, one in respect of diphtheria and one due to diarrhoea under 2 years. Violence in one form or another accouuted for 21 deaths due to the following causes :— Suicide 6 Road Accidents 2 Fall in the Home 6 (Average age 81 yrs.) Fall outside the Home 1 Accidental Coal Gas Poisoning in the Home 1 Drowning 1 Accidental Gun Shot Wound 1 Accidents at work 3 Inquests. Inquests were held on 35 persons whose deaths occurred in the district and the following verdicts were returned :—• Accidental Death 30 Suicide 5 Nine of the total were residents of the district. Six Deaths were due to road accidents. 17 INFANT MORTALITY. The number of children under 1 year of age whose deaths were registered during the year was 20, of which 11 were males and 9 females. This represents an infant mortality of 18.6 per 1,000 live births, a substantial improvement on the figure for 1945, which itself was a record for the district. The corresponding rate for England and Wales was 43. A further satisfactory feature, as in the year before, is the fact that none of these infant deaths was of an illegitimate child, although the number of illegitimate births was the highest yet. Of the 20 infant deaths, 60% died within one week of birth and 75% died within one month. No fewer than 14 died as the result of prematurity, congenital abnormality, other birth conditions such as imperfect expansion of the lungs, or diseases peculiar to the first year of life. The remaining 6 were the result of infections, 5 due to pneumonia and 1 to gastro-enteritis. The first group of deaths are much the most difficult to prevent. They have been designated the unavoidable deaths, since a child having been born in that condition, death within the year is almost inevitable. Prevention of these deaths is bound up with ante-natal development and more knowledge as to the causation of such conditions. Death in the second group, i.e., the infections, is by no means unavoidable since here we are dealing with children born healthy and given correct nurture and a healthy environment should survive. It is not surprising that the gradual reduction of infant mortality experienced in past years has been mainly the result of preventing those deaths which can be avoided by a better knowledge of child care and the control of infection. The ward distribution of infant mortality and the causes of death arc shown in Tables (i and 7. TABLE 6 INFANT MORTALITY—WARD DISTRIBUTION. Ward. Infant Deaths. Rate per 1,000 Live Births. ' St. Helier North 3 19 St. Helier South 5 38 St. Helier West 4 31 North-Fast 1 4 North-West 4 28 Central 2 15 South-East 1 7 South-West – – MATERNAL MORTALITY. As in 1945, there was no death attributable to maternal causes or as the result of abortion. 18 19 TABLE 7. INFANT MORTALITY DURING THE YEAR 1946. Deaths Classified as to Cause and Age at Death. Cause of Death. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total deaths under 1 year. Smallpox - - - - - - - - - - Chickenpox - — — — — - - - - - Measles - —' — - - - - - Scarlet Fever - - - - - - - - - - Whooping Cough - — — — — - - - - - Diphtheria and Croup - —• — — — - - - - - Erysipelas - — — — — - - - - - Tuberculous Meningitis - — — — — - - - - - Abdominal Tuberculosis - — — — - - - - - - Other Tuberculous Diseases - — — - - - - - - - Meningitis (not Tuberculous) - — — — — - - - - - Convulsions - — — — — - — - - - Laryngitis - — — — — - — - - - Bronchitis - — — — — - - - - Pneumonia (all forms) - 1 — — 1 - 2 2 - 5 Diarrhoea - — — — - - - - - Enteiitis - - — 1 1 - - - - 1 Gastiitis - — — — - - - - - - Syphilis - - — — — - - - - - Rickets - — — — — - - - - - Suffocation (overlying) - — — — - - - - - Injury at Birth 1 — — — 1 - - - - 1 Atelectasis 2 — — 1 2 - - - - 2 Congential Malformation 4 — — - 4 - - - - 4 Premature Birth 4 — — 1 5 - - - - 5 Atrophy, Debility and Marasmus 1 — — — 1 - - - - 1 Other Causes — — — — - — 1 — 1 Totals 12 1 - 2 — - 2 3 — 20 20 TABLE 8.—CAUSES OF DEATH DURING THE YEAR 1946. By Aoe and Sex. No. Causes of Death. 0 — 1 - 5 — 15 — 25 — 35 — 45 — 55 — 65 — 75 — All Ages. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Psns All Causes 11 9 3 1 2 3 7 6 6 9 10 7 30 23 50 30 46 47 57 80 222 215 437 1 Typhoid and Paratyphoid Fevers - -- - - - - - - - - - - - - - - - - - - - - - 2 Cerebro-Spinal Fever - - - - - - - - - - - - - - - - - - - - - 1 1 3 Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - 4 Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - 5 Diphtheria - - - - - - - - - - - - - - - - - - - - - 1 1 6 Tuberculosis of Respiratory System - - - - - - - - 2 2 3 3 2 — 2 2 i — — — 10 7 17 7 Other Forms of Tuberculosis — — 1 — — — 3 1 — 1 1 — — 1 — — — — 6 2 8 8 Syphilitic Diseases - - - - - - - - - - - - - - - - - - - - 1 1 2 9 Influenza - - - - - - - - - - - - - - - - - - - 1 1 1 2 10 Measles - - - - - - - - - - - - - - - - - - - - - - - 11 Ac. Poliomyelitis and Polioencephalitis - - - - - - - - - - - - - - - - - - - - - - - 12 Ac. Infectious Encephalitis - - - - - - - - - - - - - - - - - - - - - - - 13 Cancer of Buc. Cav and Oesophagus (M) Uterus (F) - - - - - - - - - - - - - - - - - 2 i 1 1 4 5 14 Cancer of Stomach and Duodenum - - - - - - - - - -- - - 1 1 2 2 1 2 2 1 6 b 12 15 Cancer of Breast - - - - - - - - - - - - - - - - - - - - - 10 10 16 Cancer of all Other Sites - - - - - - - - - - - 1 3 1 7 8 3 4 b 6 18 20 38 17 Diabetes - - - - - - - - - - - - - - - - - 2 — 3 1 6 7 18 Intra-cranial Vascular Lesions - - - - - - - - - - - - 2 2 5 3 b - 8 13 21 24 45 19 Heart Disease - - - - - - - - 1 2 2 2 6 7 11 8 17 18 19 27 56 64 120 20 Other Diseases of Circulatory System - - - - - - - - - - - - - - - 1 4 — 5 4 10 b 15 21 Bronchitis - - - - - - - - - - 1 - - - 3 - 3 1 5 5 12 b 18 22 Pneumonia 5 — 1 — — — — — - - — — 1 — 1 - 3 1 2 2 13 - 16 23 Other Respiratory Diseases 1 - - - - - - - - - - - - - - - - - - - 7 - 7 24 Ulcer of Stomach or Duodenum - - - - - - - - - - - - 3 1 I — 1 1 — — 5 3 8 25 Diarrhoea, under 2 years — 1 - - - - - - - - - - - - - - - - - - - 1 1 26 Appendicitis - - - - - - - - - - - - - - - - - - - - 2 1 3 27 Other Digestive Diseases - - - - - - - - - - - - 1 1 1 — — 2 1 2 3 b 9 28 Nephritis - - - - - - - - - - - 1 2 1 — — 1 - 2 2 7 4 11 29 Puerperal and Post Abort. Sepsis - - - - - - - - - - - - - - - - - - - - - - - 30 Other Maternal Causes - - - - - - - - - - - - - - - - - - - - - - - 31 Premature Birth 2 2 - - - - - - - - - - - - - - - - - - 2 2 4 32 Congenital Malformation, Birth Injury, Infant Diseases 3 6 - - - - - - - - - - - - - - - - - - b 7 12 33 Suicide — — - - — — — — 1 — — — — — 2 I — 1 — 1 3 - 6 34 Road Traff ic Accidents - - - - - - - - - - - - - - - - - - - - 2 - 2 35 Other Violent Causes — 1 - — 1 — 1 1 — — - 1 — 2 1 2 — 1 3 8 6 14 36 All Other Causes - - - 1 - - - 3 1 2 3 - 2 4 7 — 3 4 6 7 22 21 43 Section B—Health Services. Nursing in the Home. Home nursing is provided by two Voluntary Associations, to whose funds the Council make an annual contribution in respect of nursing facilities for cases referred from the public services. The Carshalton District Nursing Association covers the greater part of the urban district, i.e., all but that portion of the St. Helier Estate, lying to the north of the Sutton by-pass. The nursing staff consists of seven, fourfwhom are midwives included in the County Council's domiciliary midwifery scheme. The following information in respect of the work of this Association during 1946 is supplied by courtesy of the Honorary Secretary:— Cases Attended. Visits Paid. General 670 General 8,109 Maternity 62 Maternity 1,088 Midwifery 85 Midwifery 1,692 Casual 526 Ante-natal 1,202 Post-natal 151 Clinics 231 817 12,999 That portion of the St. Helier Estate in Carshalton, lying to the north of the Sutton by-pass is served by the St. Helier District Nursing Association, whose activities cover the Morden section of the St. Helier Estate. One nurse is employed for general nursing and no midwifery is undertaken. The nursing carried out in the Carshalton district by this Association during the year is indicated by the following figures kindly supplied by the Honorary Secretary:— Cases. Visits. Children under 5 years 2 3 General 33 599 35 602 The nurses of both Associations attend the Council's Clinics. Laboratory Facilities. Although the establishment of the Public Health Laboratory Service under the aegis of the Medical Research Council and the Emergency Hospital Service Laboratories, considerably improved laboratory facilities, the existing arrangements are badly in need of rationalisation. At the moment, services are available to local health authorities by the following:— The Public Health Laboratory Service. The Emergency Hospital Laboratory Service. Private laboratories (usually attached to Voluntary Hospitals). The Public Analyst. 21 The first is a free service, the remaining three are not. The extent to which any are utilised depends primarily upon accessibility and the scope of the examinations undertaken, the latter being neither identical nor mutually exclusive in each. The arrangements in operation in this district during the year were as follows Clinical material in connection with infectious disease, puerperal pyrexia and tuberculosis were submitted for examination to the Emergency Hospital Service Laboratories established at the St. Helier County and Sutton and Cheam Hospitals. Food and Drugs and Water samples were examined by Mr. E. Hinks, the Council's Public Analyst, whose Laboratory is at 16, Southwark Street, London, S.E.I. Milk samples were sent to the Public Analyst, and for bacteriological examination to the Epsom P.H. Laboratory. The following examinations were made:— No. Positive Examined. Results. Swabs for diphtheria 112 2 Sputum for tubercle 14 1 Faeces for enteric, dysentery, etc 18 1 Swabs for puerperal sepsis — — Water:— For chemical analysis 2 For bacteriological examination 4 Food and Drugs:— Analysis 265 Bacteriological examination of milk 202 Supply of Insulin. Under Section 177 of the Public Health Act the Council is authorised to supply insulin for the treatment of diabetes "for the poorer inhabitants of the district." Eight cases were provided with insulin free of cost during the year. Ambulance Facilities. Infectious Cases—The removal of infectious cases to isolation hospital is provided by the ambulances of the Cuddington Joint Hospital Board. Non-infectious Cases—The following information, kindly supplied by the Hon. Ambulance Officer, indicates the use made of the Council's Ambulance Service during the year. Calls to Street Accidents, etc. 188 Answered by own ambulances 164 Transferred to other authorities 24 Calls to remove cases from domestic dwellings to nursing homes, hospitals, or vice versa 915 Answered by own ambulances 850 Transferred to other authorities 56 Calls answered for other authorities in other districts 123 22 Total rails answered 1,226 I>istance travelled on calls (miles) 10.761 Average mileage per call (miles) 9.39 Number of occasions on which both ambulances were out at the same time — Number of occasions on which a third call was transferred to other services when both vehicles were out or one under repair 80 Greatest number of calls answered in any one day 10 The service is free to residents for all types of cases for removal within a twenty miles' radius, and to and from county hospitals. The number of calls answered was 130 more than in 1945, involving an additional mileage of 2,714. Reciprocal arrangements exist with all neighbouring authorities. HOSPITALS. The Cuddington Isolation Hospital Board provides isolation hospital accommodation for patients in this district at the Board's hospital in the Borough of Sutton and Cheam. The available accommodation was further reduced due to closure of more wards owing to the lack of staff. Fortunately, the number of cases admitted from all the constitutent districts was 85 less than for the year before. The admissions to the hospital from Carshalton are shown in Table 9. TABLE 9. TASKS ADMITTED FROM CARSHALTON TO CUDDINGTON HOSPITAL from 1st January to 31st December, 1946. Disease. Cases. Died.p Scarlet Fever 73 - No evidence 2 - Diphtheria 4 - Diphtheria Carrier 3 - Measles 4 - Measles + Whooping Cough 1 - Measles+Croup 1 - No evidence 1 - Whooping Cough 3 - No evidence — - Erysipelas 5 - T.B. Meningitis — 1 Meningismus 1 - Mumps 6 - Strep Throat 2 - Chicken Pox 3 Others 8 1 117 3 Hospital accommodation for smallpox is provided on a county basis by the County Council at the Clandon Isolation Hospital. No cases were admitted from this district. 23 General hospital facilities are provided mainly at two local hospitals, the County Hospital of St. Helier, designed for more than 800 beds, and the local War Memorial Hospital of 62 beds. The annual report of the latter provides the following information in respect of 1946 :— Total cases admitted 1,065 Casualties admitted 59 Maternity cases 164 Casualties treated but not admitted 383 X-ray Patients 1,846 In-patients were admitted from the following districts:— Carshalton 563 Beddington and Wallington 393 Other Districts 109 1,065 Massage Department:—Patients, 641. Attendances, 7,434. CLINICS AND TREATMENT CENTRES. The following programme of clinics is provided by the Council under its Maternity and Child Welfare Scheme at the Centres indicated. Rochester Road Centre:— Infant Welfare Clinic Tues. and Thurs. 2—4 p.m. Maternity Clinic Mondays and Thurs. 10—12 a.m. Toddler Clinic 1st and 3rd Weds. 2—4 p.m. Dental Clinic Mondays 10-12 a.m. Fourth Saturday 10—12 a.m. Massage Clinic Mons. and Fridays 2—5 p.m. Wednesdays 10—1 p.m. Wry the Lane Centre:— Infant Welfare Clinic Weds, and Fridays 2—4 p.m. Maternity Clinic Tues. and Fridays 10—12 a.m. Toddler Clinic Tuesdays 2—4p.m. Stanley Road Centre:— Infant Welfare Clinic Fridays 2—4 p.m. Maternity Clinic Tuesdays 10—12 a.m. Toddler Clinic 1st and 3rd Thurs. 2—4 p.m. St. Helier Centre—Green Lane:— Infant Welfare Clinic Mondays 2.30—4 p.m. Maternity Clinic Mondays 2—2.30 p.m. The Mount Centre:— Infant Welfare and Maternity Clinic 2nd and 4th Weds. 2—4 p.m. Diphtheria immunisation treatment is available for children undei 5 years at all the infant welfare and toddler clinics. 24 MATERNITY AND CHILD WELFARE. Public Health Act, 1936- Section 203. The number of births which were notified, as adjusted by transferred notifications, were as follows:— Live births 1,091 Notified by midwives 932 Still births 25 Notified by doctors and parents 21 Transferred notifications 163 The total is 251 more than in 1945 and represents 102% of the births registered during the year. This increase of 30% brings the number of births in the year for the first time in the history of the district to more than 1,000. Health Visiting. One of the five health visitor appointments was vacant for several months of the year. As a result, and since the new births were substantially higher, home visiting had to be on a somewhat lower scale. Compared with pre-war, the number of births, the number of expectant mothers and the number of children attending the clinics have increased by about 25%, added to which there has been a gradual expansion in the clinic programme and this has encroached upon the time at the disposal of the health visitors for home visiting. The result has been a reduction in the average number of visits per year per child under one year from 4.8 in 1939 to 2.4 in 1946, and a fall in the average visits to children of all ages under five from 2.1 to 1.5. It is unlikely, however, that the present high birth rate will be maintained. Nevertheless, the scale of home visiting at present is inadequate. More economical use of health visiting services will be undoubtedly secured when visiting for maternity and child welfare, school health and other health service purposes is merged in one personnel. The visits made excluding those in connection with child life protection referred to later in this report were as follows:— To expectant mothers:— First visits 199 Total visits 228 To children under 1 year:— First visits 955 Total visits 2,658 To children 1-5 years:— Total visits 3,523 6,409 25 1,116 1,116 Clinic Activities. Clinic facilities were augmented during the year by an additional weekly ante-natal clinic and a fortnightly toddler clinic at the Rochester Road centre. The arrangements for massage for minor orthopaedic defects were improved by the setting up of a massage clinic at Rochester Road which is held three times a week on Mondays, Wednesdays and Fridays. The big rise in the birth rate in 104(5 was reflected in the attendances at the ante-natal clinics. More than 000 expectant mothers received clinic supervision during the year, a figure which is approximately 50% higher than the previous highest whilst the new cases represented 60% of the notified births. Close co-operation exists between the Council clinics and the St. Helier Hospital Maternity Services. Most of the routine ante-natal supervision for the high proportion of Carshalton mothers booked for admission to the hospital is performed by the Council's ante-natal clinics. The same factor, viz., the increased birth rate was also responsible for a greater degree of activity at the infant consultation clinics, the figures relating to which also provide new high records. The number of children under one year attending for the first time at 869, compares with 715 in the year before. It represents 80% of the notified live births. The number of children of all ages up to 5 in attendance during the year was the record one of 2,477. 26 * Primary attendance is the first attendance of a woman in relation to the pregnancy under supervision. A further 44 Carshalton mothers attended the St. Helier Hospital Ante-Natal Clinic but not the Council's clinics. TABLE 10. ATTENDANCES AT MATERNITY CLINICS—1946. Centre. No. on Register. Attendances Sessions. Average attendance per Session. Primary Total. Rochester Road. Ante-Natal 263 206 967 78 12.6 Post-Natal 13 1 15 Individuals 264 207 982 VVrythf. Lane Hall. Ante-Natal 457 388 1938 103 19.0 Post-Natal 19 — 19 Individuals 457 388 1957 St. Helier. Ante-Natal 3 1 5 23 0.21 Post-Natal — — Individuals 3 1 5 Stanley Road. Ante-Natal 167 131 759 52 14.9 Post-Natal 16 6 18 Individuals 173 137 777 The Mount. Ante-Natal 19 14 89 23 3.9 Post-Natal 1 — 1 Individuals 19 14 90 All Centres Ante-Natal 909 740 3758 279 13.6 Post-Natal 49 7 53 Individuals 916 747 3811 27 28 TABLE 11. ATTENDANCES AT INFANT CONSULTATION CLINICS, 1946. Centre. Years. Number who attended during year. New Cases to the Centres. Number on register at year end. Attendances. Number of Sessions. Average Attendance per Session. Primary. Total. Rochester Road Under 1 832 291 236 288 4242 102 54.8 1—5 194 550 189 1353 Wrythe Lane Under 1 763 302 205 300 3082 102 40.2 1—5 29 527 24 1025 St. Helier Under 1 213 99 71 99 1299 49 36.6 1—5 4 104 1 496 Stanley Road Under 1 564 156 141 156 1976 51 59.8 1—5 21 388 18 1074 The Mount Under 1 105 28 19 26 358 23 30.9 1—5 6 76 1 353 All Centres Under 1 2477 876 672 869 10957 327 46.6 1—5 254 1645 233 4301 Totals 2477 1130 2317 1102 15258 327 46.6 Premature Births. The number of premature babies born in the district was 182, of which 156 were born in hospital ot nursing homes. Details as to nursing and survival are as follows The number of babies born at home— (i) who were nursed entirely at home 20 (ii) who died during the first 24 hours 2 (iii) who survived at the end of one month 22 The number of those born in hospital or nursing home— (i) who died in the first 24 hours 12 (ii) who survived at the end of one month 135 The survival rate at one month was 86%, the same as in the year before. The figures shown are for babies born in the district, a large number of whom were non-residents born in St. Helier Hospital. Special arrangements for the nursing of premature infants are established at the St. Helier Hospital, where incubators are installed in air-conditioned nurseries. Removal to hospital is effected by ambulance fitted with an electrically heated carrier. Routine Medical Inspection of Toddlers. Special clinics are held at the Rochester Road, Wrythe Lane and Stanley Road centres at which children in their .3rd, 4th and 5th t ears may receive an annual medical overhaul and attendance is by appointment. Partially suspended during the war years, this scheme is now being expanded again and for the first time since its inception, more than 1,000 children were examined in 15)40 under these arrangements. Of the 1,009 children examined, 734 were found to have 854 defects for 435 of which treatment was advised and observation for the remaining 419. A further indication of the value of these clinics is the fact that 249 children were not attending the regular welfare sessions during the year and 76 had never before attended any clinic. The nature of the defects found is shown in Table 12. 29 30 TABLE 12. DEFECTS FOUND AT SPECIAL TODDLER EXAMINATIONS—1946. Defect. Recommended for Number which received treatment by Observation. Treatment. Own Dr. Hospital. At Home by Advice Clinic. Total. Cleanliness 1 2 - - 2 - 2 Nutrition 21 16 - 3 8 — 11 Ringworm - - - - - — - Impetigo I Skin - 2 I 1 - - Scabies — 1 — - - 1 1 Other Skin (Non-Tub.) 10 28 - 1 21 1 23 Blepharitis - 3 - I 2 - 3 Conjunctivitis — - — — - - — Keratitis — - — — - - — Corneal Ulcer 1 Eyes — - — - - — — „ Opacities - 1 - 1 - — 1 Other Conditions — 1 - 1 - - 1 Vision 1 1 — 1 - — 1 Squint 16 13 — 12 - — 12 Hearing 1 - - - - - - Otitis Media Ears — — - - - — - Other Diseases — 1 — — - - — Teeth 29 28 2 2 - 17 21 Tonsils 103 28 1 23 - — 24 Adenoids 28 19 - 18 - — 18 Other Conditions 5 4 - 3 1 - 4 Enlarged Cervical Glands 48 19 - 15 - - 15 Speech 10 5 - 3 - - 3 Heart Disease 26 2 - 2 - - 2 Anaemia 07 - 2 62 - 61 Lungs, Tubercular - - - - - - - Lungs, non-Tubercular 6 13 4 7 1 - 12 Other Tubercular - - - - - - - Diseases - - - - - - - Epilepsy — 1 - - - - - Chorea - - - - - - - Other Nervous - - - - - - - Conditions 3 1 — 1 - — 1 Rickets 12 27 — 4 10 7 21 Spinal Curvature - 6 - 1 3 — 4 Other Deformities 27 24 2 5 10 1 18 All other Defects 52 110 2 15 58 12 87 Mental Condition 16 5 1 2 1 - 4 Behaviour 2 7 — 1 3 - 4 Total 419 435 12 125 183 39 359 TABLE 13. ATTENDANCES AT SPECIAL TODDLER (2-5 YEARS) CLINICS, 1046. Centre. No. of routine medical examinations. Reinspec tion. Total attendances. Sessions. Average attendance per Session. Did not attend Infant Consultation Clinic. 2-3 years. 3—4 years. 4—5 years. Rochester Road ... 142 72 03 19 206 20 14.8 37 Wrythc Lane 246 140 121 — 507 51 9.0 152 Stanley Road 05 71 50 12 237 24 9.8 60 Totais 483 283 243 31 1040 95 10.9 249 Each child attended once for routine examination. TABLE 14. ATTENDANCES AT ALL INFANT WELFARE CLINICS, 1046. (Infant Consultation and Special Toddler). Year. Number who attended during the year. New eases to the Centres. Attendances. Sessions. Average attendance per Session Primary. Total. 0-1 | 2726 870 860 10955 422 25.9 1—5 330 309 5341 12.6 Totals 2726 1206 1178 16296 422 38.5 Supply of Milk and other Foods. Priority supplies of dried milk and vitamin products issued by the Ministry of Food for mothers and children are available at the clinics. Additionally a restricted range of proprietary brands of milk powder and other special baby foods is provided under the Council's own arrangements. 31 Dental Scheme. Dental treatment for mothers and children is provided at dental clinics held at the Rochester Road centre and attended by a part-time dental surgeon. The work performed by this service during the year is indicated by the following information. DENTAL SCHEME—TREATMENT PROVIDED, 1946. Temporary Teeth. Permanent Teeth. Dentures Supplies. Extracted. Filled. Extracted. Filled. Full. Partial. 56 44 442 206 40 85 Anaesthetics Gas 99 Trilene 26 Local 22 Inspections 261 Other operations Impressions 185 Bites 125 Try-ins 139 Dressings 3 Scalings 89 Repairs 10 Remodelling 2 Dentures supplied:— Full Partial. Free 2 1 Part Cost 1 9 Full 37 75 Total 40 85 32 Attendances at the Dental Clinics were as follows:— DENTAL SCHEME—ATTENDANCES, 1946. Centre Referred from. No. Treated. No. of attendances. Rochester Road. Children 11 31 Mothers 62 227 Individuals 73 258 Wrythe Lane. Children 18 24 Mothers 102 423 Individuals 120 447 St. Helier. Children 4 7 Mothers 7 67 Individuals 11 74 Stanley Road. Children 13 28 Mothers 17 91 Individuals 30 119 The Mount. Chi'dren — — Motheis 1 5 Individuals 1 5 Day Nursery. Children 3 4 All Centres. Children 49 94 Mothers 189 813 Individuals 238 907 Number of Sessions held 94 Average attendance per Session:— Children 1.0 Mothers 8.6 Individuals 9.6 33 Orthopaedic Treatment. For many years the Council had an arrangement with a private masseuse for the treatment of minor orthopaedic defects in children. In October a massage clinic was set up at the Rochester Road centre, where three-hour sessions are held three times a week. This enabled more frequent treatment to be given for the cases referred from the Council's welfare clinics. The number of treatments given during the year consequently rose to 1,027, which represents an average of l' j treatments per child to the 41 cases dealt with. The defects for which the children were treated were as follows:— Genu-valgum 31 Genu-varum 2 General muscular weakness 7 Spastic Diplegia 1 Under an arrangement with the management, orthopaedic cases are referred to the Out-Patient Department of the Croydon General Hospital and assistance is available towards the cost of in-patient treatment and the provision of surgical appliances. Convalescent Treatment. The Council has an arrangement with the Invalid Children's Aid Association for the provision of convalescent treatment for children attending the clinics. They also subscribe to the Surrey Convalescent Homes so that mothers and babies may receive this treatment. Four children were admitted to convalescent homes during the year for periods of nine weeks, nine weeks, six weeks and seven weeks respectively. Maternity Hospital Treatment. The St. Helier County Hospital constitutes the major provision for institutional maternity for this district. By agreement, cases may also be admitted to the War Memorial Hospital. The women referred from the Council's clinic and admitted to hospital during the year were as follows — For obstetric For unsuitable . and medical home reasons. conditions. Total. Carshalton (War Memorial) Hospital — 3 3 St. Helier County Hospital 33 34 67 Other County Hospitals 5 36 41 38 73 111 The increasing number of mothers who were referred for unsuitable home conditions is a reflection of the shortage of housing accommodation. It is gratifying to note that, despite the greatly increased number of births, the number of expectant mothers referred to hospital for obstetric 34 or medical abnormality was less than in any of the previous three years. Although 138 cases were sent from the clinics, it should be noted that 670 Carshalton mothers were confined in hospitals and nursing homes (luring the year. The demand for hospital accommodation has risen year by year and still exceeds the beds available. Unmarried Mothers and Illegitimate Children. For reasons uiainlv due to the war, the number of illegitimate children is now about double what it was in pre-war years. It is to be expected for obvious reasons, that mortality among these unwanted children should be much higher than for legitimate infants, and it speaks well for the local arrangements for their supervision and care that there has been no death of an illegitimate child under one year in the last two years, although 02 such births were registered. The Council subscribes to the funds of the Sutton and District Girls' Aid Association with which the Council's child welfare service works in close co-operation. In addition, the Council invariably meets the uncovered balance of cost of accommodation in special homes for the unmarried mothers of the district. The arrangements include:— Admission to the local or an affiliated shelter home before and after the confinement, which is conducted in a convenient hospital. Advice on such matters as affiliation and marriage, negotiation with the putative father. Clinic supervision, obtaining baby clothes, help with adoption and many other relevant matters. The Association's moral welfare worker has supplied the following information relating to this district in 1946:— Unmarried mothers assisted 15 Illegitimate babies 13 of these 4 are now with their mothers. 2 are in homes. 7 are adopted or being adopted. The Council accepted responsibility for the cost of maintenance in special homes of three unmarried mothers and one illegitimate baby for a total of 33.4/7ths patient weeks. Consultant Service. No request was received for the services of a consultant which are available for the complications of pregnancy and labour. Emergency Maternity Unit. The mobile unit for maternity cases based on the War Memorial Hospital was not called upon during the year. Maternity Outfits. Sterilised outfits for use during confinement are supplied at cost price or less than cost price in necessitous cases. Thirteen were issued during the year at cost price. 35 Home Helps. In July the home helps scheme of the Maternity and Child Welfare Service was re-organised, together with the general domestic helps scheme. The rate of pay to the helps engaged was substantially increased and the services of more women were secured as a result. Both schemes are operated as one and the helps are used in either capacity as convenient. Thirty-two homes were provided with assistance during confinement or sickness of the mother during the year. These are exclusive of the domestic helps reported later. Midwives. Two midwives are appointed by the District Council under the County Council's midwifery scheme, formulated under the Midwives Act, 1 936. The fees fixed by the County Council for the services of the midwives are as follows:— As Maternity Nurse 35/As Midwife 40/- Frovision is made for a reduced fee in necessitous cases. The work carried out by this Council's midwives during the year is indicated by the following details:— Cases conducted:— Primip. Multip. Total (1) As Midwife—Live births 33 158 191 Still births 2 13 (2) As Maternity Nurse Live births 2 7 9 Still births — 1 1 37 167 204 Visits made:— Ante-natal 1,786 Nursings 3,484 Post-natal 375 Medical Aid Forms sent by Midwives 49 Uterine Inertia 2 Torn Perineum 17 Delayed Labour 7 Stillbirth 2 Adherent Placenta 2 Discharging Eyes 5 Malformation of Infant 5 Prematurity 2 Abortion 1 Ante-Partum Haemorrhage 2 Illness of infant 2 Rupture of membranes 1 Malpresentation 1 Number of cases which attended the ante-natal clinics 118 36 Twenty-five other midwives resident in the district declared their intention to practise in 1946. Of these, 16 were on the staff of the St. Helier Hospital, 4 on the staff of the War Memorial Hospital, 4 were District Nursing Association Midwives, and one a County Council Midwife. Voluntary Helpers. A voluntary help has always played a part in the welfare scheme, Ten ladies gave their valuable service at the clinics during the year, CHILD LIFE PROTECTION. The Health Visitors act as inspectors under the Child Life Protection provisions of the Public Health Act, 1936. The following details indicate the extent of their activities during the year:— Number of registered foster homes with children at the year end 12 Number of new homes registered during the year 12 Number of foster homes removed from the register during the year 18 Total number of foster homes supervised 29 Number of the children admitted to the register during the year 14 Number of children removed from the register during the year 22 Total number of children on the register at year end 14 Total number of children on the register during the year 36 Number of children who died during the year — Number of inquests held — Number of visits made to foster homes 102 Legal proceedings — Adoption of Children (Regulation) Act, 1939. This Act, which came into operation in 1943, imposed upon the Welfare Authority the duty of visiting and examining children under 9 years of age in the care of adopters and the premises in which the children are kept during the period before an Adoption Order is made by the Court. For this purpose the Health Visitors, by virtue of their appointment as Child Life Protection Visitors under Section 209 of the Public Health Act, act as visitors and supervisors. Powers similar to those in respect of foster children are provided by the Act. The following epitomises the information contained in the "Adoption Act" Register:— (a) Number of persons who gave notice under Section 7 (3) during the year 10 (b) Total number of children in respect of whom notice was given under Section 7 (3) during the year 10 37 (c) Number of children notified under Section 7 (3):— (i) under supervision at the end -of the year 4 (ii) who died during the year — (iii) on whom inquests were held during the year— (d) Particulars of any proceedings taken during the year— DAY NURSERIES. The Carshalton Day Nursery in Camden Road is administered by a voluntary committee assisted by a substantial grant from the Council. It provides day-time care for a maximum of 27 children, 6 under 2 years and 21 over two. The attendances totalled 6,186, which gives an average of 20 for the 305 days the nursery was open. All the 27 mothers were in employment, 15 in a full time capacity and 12 parttime. There was a waiting list of about 50 at the end of the year. The Council's Day Nursery in Green Wrythe Lane was originally established under the auspices of the Ministry of Health as a war-time nursery and later transferred to the Council's Maternity and Child Welfare Scheme. It provides 74 places, 34 under two years and 40 over two and is open daily, Monday to Friday from 7 a.m. to 6 p.m. and on Saturdays 7 a.m. to 1 p.m. All applications are carefully considered to ensure that each has good grounds for acceptance. The majority of mothers are engaged in industry, the fact being confirmed by a statement from the employer. A few children deprived of adequate home care from other causes, e.g., illness of the parent, are admitted for those reasons. There is a lengthy waiting list for admission. Payment by the parents is still, as originally, 1/- per day. The attendances during 1946 were as follows:— Total attendances—under 2 years 5,990 over 2 years 9,538 15,528 Days open 302 Average daily attendance—under 2 years 19.8 over 2 vears 31.6 51.4 Attendances excluding Saturdays— under 2 years 5,708 over 2 years 9,179 14,887 Days open, excluding Saturdays 254 Average daily attendance, excluding Saturdays—under 2 years 22.4 over 2 years 36.1 58.5 33 DOMESTIC HELPS. Early in 1945, in accordance with Ministry of Health Circular 179/44, the Council established a domestic help scheme. The principles of this scheme are the same as those of the home help scheme already set up by the Council under the limited powers in respect of mothers and children. The scope of the former arrangement, however, covers all cases where persons sick or infirm, whether through old age or otherwise, are unable to obtain domestic help of which, under present conditions, they are particularly in need. For some time it was not possible to operate this scheme with any degree of success owing to the shortage of women prepared to do this work. In 1946, as stated earlier in this report, the scheme together with the maternity and child welfare home help scheme was re-organised and payment to the helps substantially increased. The women engaged for this duty act as helps tinder both schemes, the only administrative separation being one of financial allocation. During 1946, 26 domestic helps in addition to the 32 home helps under the maternity and child welfare scheme were provided. 39 Section C—Sanitary Circumstances. Water Supply. The greater part of the urban district is within the supply area of the Sutton and District Water Company, only some 170 dwellings in the extreme north end being supplied by the Metropolitan Water Board. The company employs a full-time chemist/bacteriologist and daily sampling of the raw and finished waters is carried out. By arrangement, water received by the consumer is sampled twice monthly as a routine according to a rota agreed by the local medical officers of the constituent districts. Additional samples are taken when circumstances indicate the desirability. The water, derived from chalk wells, is subjected among other processes to softening by lime and to chlorination, treatment being so arranged as to leave a trace of residual chlorine in the finished product. The following, which is representative, is the report on one of the six samples taken by the Council during the year: - Chemical analysis in parts per 100,000. Total silid matter in solution (dried at 180° C.) 15.8 Combined chlorine 1.45 Nitric nitrogen 0.44 Nitrous nitrogen 0.004 Ammonia, free and saline 0.002 Ammonia, albuminoid 0.001 Oxygen absorbed from permanganate in 4 hours at 26.7° C. 0.006 Hardness—by acidimetric triation—Temporary 8.4 Permanent 3.2 Total 11.6 pH 7.6 Reaction for free chlorine; positive, equivalent to 0.05 part per million. The water was bright and clear and was normal in colour. Bacteriological examination. Action by free chlorine during transit of the sample was prevented at the time of sampling. Number of colonies per ml. developing upon agar in 2 days at 37°C. 0 Number of colonies per ml. developing upon agar in 3 days at 22° C. 1 Organisms of the coliform group absent in 100 ml. Streptococci do. C1. welchii do. This water is of high organic purity and its bacteriological condition is excellent. The water is suitable for the public supply. The supply is not regarded as having any particular plumbo-solvent action. All dwellings have a piped water supply to the house ; none depends on a stand pipe. 40 Drainage and Sewerage. No extensions or replacements have been made during the year. Rivers and Streams. Only normal cleansing and maintenance has been carried out. Negotiations were in progress between the Surrey County Council and the 5 riparian local authorities concerned, with a view to the County Council relieving these authorities of the work of maintenance and carrying out the work themselves by direct labour. One complaint was received and adequately dealt with. Closet Accommodation. All houses have water closets. All are connected to sewers except 18 which are in non-sewered areas. Public Cleansing. Shortage of labour and transport prevented a return to the prewar standards of refuse and salvage collection. It is hoped that these difficulties may soon be overcome. The refuse disposal plant was out of action owing to the necessity for a complete overhaul and reconstruction for the last seven months of the year, during which time disposal was by tipping by arrangement with a neighbouring authority. Sanitary Inspection. The following information, supplied by the Chief Sanitary Inspector, under Article 27 of the Sanitary Officers' Regulations, 1935, indicates the action taken in sanitary inspection during the year. Investigations were made with regard to 1,974 complaints as follows:— Drains obstructed 256 Sewers obstructed 1 Drainage defects 103 General defective conditions 248 Dampness 59 Roofs, gutters, etc. 60 Sink waste pipes 17 Water supplies 16 Dustbins 490 Accumulations 29 Refuse Collection 32 Smoke nuisance 5 Rivers, ditches, ponds 1 Unsound food 133 Overcrowding 150 Obnoxious effluvia 4 Verminous premises 11 Scabies — Head Lice — Rats and Mice 216 Wasps 18 Ants 3 Beetles 3 41 Flics 11 Animals 4 Insects, various 6 Animal food storage - Dirty Milk Bottles, sour milk 9 Miscellaneous 73 Pig Bins 16 1974 A total of 10,326 visits of inspection and re-inspection were made for the purposes set out below:— Public Health Act (houses) 2,487 Public Health Act reinspections 2,726 Housing Act — Housing Act reinspections Dairies 49 Cowsheds 40 Milk Shops 85 Factories 110 House drains tested 90 Suspected rat infested premises 821 Foodshops and business premises 962 Infectious disease premises 131 Infectious disease contacts 266 Urinals 97 Premises re cesspools 14 Schools 6 Offices 52 Bakehouses 29 Stables 27 Smoke observation 12 Outworkers' premises 14 Employment Agencies 8 Piggeries 22 Wasp nests 10 Rivers 1 Food Poisoning Enquiries 1 Food and Drugs and other samples 904 Shop premises 450 Allotments 4 Animals, keeping of4 Housing Enquiries 900 Water Sampling 4 10,326 Informal notices served numbered 913 concerning the following matters:— General defective conditions 364 Rats and mice 17 Accumulations and deposits 8 Obstructed drains 45 42 Sixty-five formal notices were served by authority of the Council under the following Acts:— Section 93, Public Health Act. 1930 40 Section 75 „ „ 12 Section 39 „ „ 2 Section 13, Food and Drugs Act, 1938 2 65 As a result of investigations made and notices served, the following work was carried out:— Brickwork, repaired and/or repointed 6 Ceiling plaster repaired and/or made good (including plaster board) 57 Ceilings cleaned and purified 17 Chimney pots repaired and/or made good 4 stacks repaired and/or made good 2 flues repaired 4 Cement fillets renewed and/or repaired Damp conditions remedied 30 Damp course provided 2 Doors repaired, including locks and fasteners 12 Door frames repaired and/or made good 6 stopping to reveals renewed 2 Drainage repaired and/or reconstructed 35 provided 4 inspection chamber repaired and/or made good 4 inspection chamber covers renewed 13 inspection chambers provided 4 stoppers or caps refixed and/or renewed 3 interceptors renewed 5 interceptors provided 2 fresh air inlet repaired and/or renewed 6 mica flap valve renewed 4 Soil vent repaired and/or renewed 6 drains tested 90 drains cleared (affecting 744 houses) 264 drains sealed off 2 Drainage defects 80 Verminous premises 16 Dustbins 133 Animal food storage - Water supply 13 Animals - Factory Acts 2 Food contamination 6 Unsatisfactory food premises 16 Miscellaneous 9 Burst pipes — Overcrowding 196 Shops Acts 4 Smoke nuisance 2 913 43 Waste gullies repaired, renewed or cleared 14 Waste gullies provided 2 Waste pipe, repaired and/or renewed 16 Disinfestation 24 Dustbins provided 430 Food storage, accommodation provided 1 Floor boards repaired and/or made good 37 concrete repaired, renewed and/or made level 2 ventilation repaired and/or renewed 1 ventilation provided 1 Fire-places repaired and/or made good 20 Fire grates repaired and/or renewed 5 Ranges, stoves repaired and/or renewed 4 Roofs repaired and made weatherproof 73 ridges, hips, valleys repaired and/or renewed 4 flashings repaired and/or renewed 1 Down pipe, guttering repaired and/or renewed 29 cleaned out and made to work properly 6 Sinks renewed 1 provided 1 Stair treads repaired, renewed or made level 4 handrails and/or balusters repaired 2 Steps repaired and/or renewed 2 Soakway provided made to work properly — Surface water drainage repaired and made to work properly 1 Walls, cement rendered 4 rendering repaired 7 replastered and/or repaired 40 cleansed and redecorated 20 rebuilt 3 Woodwork repaired and/or renewed 3 Windows repaired and/or renewed 20 Window frames repaired and/or renewed 4 Windows made to work properly 1 provided with catches or fasteners — sash cords renewed 26 Window sills (external) repaired 5 Windows, fixed, made to open 2 W.C. accommodation repaired 15 W.C.s provided 5 W.C. pans renewed 33 pan joints renewed 6 seats repaired and or renewed 4 flushing apparatus repaired or renewed 27 Water supply repaired 10 Wash basins, baths renewed 1 provided 2 Paving repaired and/or made level 2 Rats and Mice 233 Glazing panes renewed 3 Ventilation, more provided 4 Accumulations removed 31 Other matters 13 Housing repairs, necessitated by enemy action carried out under the supervision of the Engineer and Surveyor are not included in this report. 44 Disinfection. In connection with cases of infectious disease, 143 rooms and 138 library books were fumigated. Twenty-seven lots of bedding were steam disinfected and one lot destroyed. Vermin Control. Persons. For the cleansing of verminous persons and their personal clothing the Council have established a Cleansing Station, equipped with a Thresh Steam Disinfector in Rochester Road. A trained nurse is in attendance to deal with women and children, and a male operator for the men. Financial arrangements have been made with the Education Authority for the treatment of school children. The nurse-in-charge undertakes the following up of the families affected to ensure that treatment is carried to a successful conclusion. The homes are also visited by the Sanitary Inspectors when necessary, and appropriate action in resuect of the premises taken as required. The following cases were dealt with at the Council's Station during the year:— Families. Persons. Attendances. For scabies 145 495 929 For pediculosis 55 204 393 200 699 1,322 School children included in these totals were:— For scabies 163 For pediculosis 116 Where possible, the practice of treating all members of affected families is followed. Premises. It has not yet been possible to resume the pre-war practice of cyauide fumigation for badly infested premises. Sixteen properties were treated by insecticidal spraying as follows:— Council Houses 4 Other Houses 6 L.C.C. Houses (by L.C.C. staff) 6 Fumigation and spraying is carried out by the staff of the department with various insecticidal liquids. D.D.T. in vapour form was tried experimentally in the treatment of premises, but with inconclusive results. Two lots of bedding were destroyed during the year. Pest Control. Ten premises were sprayed for the eradication of flies, fleas, etc. Nine wasp nests in, or in proximity to, dwellings were destroyed at the cost of the complainants. No sprayings for the destruction of mosquito larvae were carried out. 45 Rates and Mice (Destruction) Act, 1919. Ministry of Food Infestation Order, 1943 (S.R. & 0. 680). Under the direction of the Ministry of Food, rodent destruction work was again further intensified, and much more detailed planning had to be executed under Schemes N.S.ll (Sewers) and N.S.I2 (Private premises), the former carrying with it a Government grant of 30% and the latter 60%. Both Schemes were adopted by the Council and approved by the Ministry of Food. The year's investigations amounted to 2,928. Arising out of these investigations and 216 complaints, 245 infestations were found (209 Rats and 36 Mice). 17 Preliminary Notices were served. The infested premises were classified as follows:— Rats. Mice. Total. Private Premises 145 15 100 Business Premises 8 2 10 Council Property 56 19 75 209 30 245 These figures include the operation of Scheme N.S.12 relating to premises. Private Premises Scheme (N.S.l2). The adoption of this Scheme as approved by the Ministry of Food entailed the employment of a Second Rodent Operative for the houseto-house inspection throughout the district. It provides for all private premises to be treated free of charge and the following is an outline of this Scheme:- The Sthenic will consist of the appointment of as additionl Rodent Operative as soon as one can be obtained. One such operative is already employed. A systematic inspection of the whole of the area within the I Urban District, ward by ward, proceeding from the South to the North. This inspection will be done throughout the year ending 31st March, 1947. The whole scheme will be carried out under the supervision of the Chief Sanitary Inspector. The Council will make charges for work done on all business premises and will recover costs from householders whose neglect is, in the opinion of the Council, the cause of the infestation. The work will be performed by direct employees of the Council. Approved action to be taken at all times to deal with rats in the Sewage Disposal Works, Refuse Dumps, Destructors, etc., under the control of the Council, and the Special Sewer Rat Control Campaign to be carried out during the same period ending 31st March, 1947. The cost of service on individual complaints on private premises arising in parts of the Administration area not yet reached, hut intended to be reached during the current fiscal year, to be included. The cost of service on individual complaints already subjected to approved systematic treatment, to be included. Work under this Scheme was proceeding at the end of the year. 46 Sewer Rat Control (Scheme N.S. 11). The following scheme of initial treatment of sewers was carried out during the year and was highly successful. The final maintenance treatment will be executed in the early part of 1947. Survey and Preparation:— (i) Mapping of all manholes in area. (ii) Preliminary loosening of manhole covers prior to treatment. (iii) Treatment Squads: Two squads, each consisting of three men, to be employed. Treatment :— Part 1 Treatment to be commenced on September ltfth, 1946. l'rebaiting with damp sausage rusk (4 oz. per inspection chamber) will be carried out on two consecutive days followed by poison baiting on the third day with damp sausage rusk plus 2½% zinc phosphide (8 oz. for complete take and 4 oz. for partial take). Two separate sections will therefore be dealt with by each squad per week, and with each section averaging at least 70 manholes, all manholes in the area will be treated by Saturday, October 12th, 1946. Part II Treatment will commence on October 14th, 1946. Treatment to be on the same lines as Part I (omitting very large areas showing no take in Part I) but baiting to be carried out with bread mash and poisoning with 10% arsenious oxide. Maintenance Treatment:— One maintenance treatment will be commenced on February 10th, 1947—to consist of one poisoning campaign only with sausage rusk and zinc phosphide on the same lines as Part I of the Initial Treatment. Records:— Recording of baiting to be made on the Ministry of Food Sewer Forms 5 and 6, but no recording will be made on the 4th day in relation to Poison bait takes or number of bodies seen. Smoke Abatement. Five complaints were received during the year and dealt with. Shops Act 1912—1936. There were 588 shop premises on the register, to which 450 inspections were made. Informal action was necessary regarding infringements in two cases. Section 10 (Health and Comfort). It was necessary to take action in two cases for the provision of sanitary accommodation. Offices. Offices were inspected on 52 occasions, but no action was necessary. Swimming Baths. The one privately owned swimming bath was closed throughout the year. 47 Disposal of the Dead. During the course of the year, progress was made with the preparations for the opening of the Cemetery of the Merton and Morden and Carshalton Joint Cemetery Board at Lower Morden. In July, 1946, it was found possible to appoint a Cemetery Superintendent, and in September, a Cemetery Clerk. Several labourers were also engaged, and the Cemetery Superintendent was able to concentrate labour on the work of preparation of flower beds and planting of shrubberies and trees. Every effort was made to open the Cemetery for interment during the year 1946, but, unfortunately, this was not found to be possible owing to the difficulties of obtaining supplies of registers and records and other necessary printed matter. The registers were eventually received in time to enable the Cemetery to be opened on the 1st April, 1947. During the course of the year, active negotiations have been proceeding with several of the adjoining Local Authorities on the question of the provision of a Crematorium, and, in the latter part of the year, a meeting took place between representatives of the Battersea Metropolitan Borough Council, whose Cemetery adjoins that owned by the Joint Board, and representatives of the Joint Board, with the object of reaching a provisional settlement on the question of a site for a Crematorium. Modern and adequate mortuary facilities, with provision for post-mortem examinations, are provided at the Council's Mill Lane mortuary. Establishments for Massage and Special Treatment. In April, the Surrey County Council by resolution, brought Part IV of the Surrey County Council Act, 1931, into force in the Urban District. Under this provision, subject to special exemptions for hospitals, asylums, nursing homes, registered medical practitioners and charitable organisations, no peson may .carry on, without a licence, an establishment for massage, manicure, radiant heat, light, electric vapour or other baths for therapeutic treatment or other similar treatment and the District Council has certain supervisory duties over these establishments under the Act. Licences were granted by the County Council after inspection by their officers and those of the District Council in respect of 8 premises, 6 of which were primarily for the practice of chiropody. Employment Agencies. The Employment Agencies are visited by the Authority acting as Agents for the Surrey County Council. There are three on the register. 48 Section D—Housing:. New Houses. During the year, 103 factory-made temporary bungalows of the "Arcon" type were completed and made available for letting. Council's Housing Scheme. The dwellings in the ownership of the Council at the year end totalled 727 houses, flats and temporary bungalows. In addition to the 103 temporary bungalows completed, work was commenced during the year on contracts for the erection of 162 permanent houses at the following sites:— Site No. Site. Type of House. No. 3 Clock House Farm Estate (part) "Unity" Prefabricated 96 2 Green Wry the Lane "Orlit " do. 24 5 Fellowes Road 10 6 Fellowes Road 8 7 Hackbridge Cottage 16 9 Duke of Edinburgh Road 6 64 19 Connaught Road Traditional 2 162 The accommodation under requisition by the Council at December 31st, comprised 200 family units. The number of outstanding approved applications for tenancies at the year end was approximately 1,500. 49 In addition, the following schemes for a further 220 houses were in course of preparation or under consideration:— Site No Site. Type of Dwellings. No. 3 Clock House Farm Estate (part) Traditional Houses 38 10 Denmark Road 2 12 Harrow Road 5 13 Nightingale Road 21 15 Kingswood Drive 11 18 Banstead Road 3 20 Barrow Hedges Estate 44 121 10 Denmark Road Flats 60 11 Alma Road 12 72 4 Wry the Lane Maisonettes 24 220 Inspection and Action taken under Statutory Powers. 1. Inspections of Dwelling Houses dining the year. (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) H.A.—Nil. P.H.A.—2,487 2,487 (b) No. of inspections made for the purpose 5,213 (2) (a) Number of dwelling houses (included under sub head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 to 1932 — (b) Number of inspections made for the purpose — (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 471 2. Remedy of defects during the year without service of formal notices. Number of defective dwelling houses rendered fit in consequence of informal action by local authority or their officers (including houses inspected during 1945) 360 3. Action under Statutory Powers during the year. (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936. Number of dwelling houses in respect of which notices were served requiring repairs Number of dwelling houses which were rendered fit after service of formal notices :— (a) By owners (b) By local authority in default of owners (b) Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which formal notices were served requiring defects to be remedied 63 (2) Number of dwelling houses in which defects were remedied after service of formal notices :— (a) By owners 42 (b) By local authority in default of owners 1 50 4. Housing Act, 1936. Part IV—(Overcrowding). (a) (1) Number of dwelling houses overcrowded at the end of the year 208 (2) Number of families dwelling therein 311 (3) Number of persons dwelling thereing 1,528 (b) Number of new cases reported during the year 196 (c) (1) Number of cases of overcrowding relieved during the year 76 (2) Number of persons concerned in such cases 581 (d) Particulars of any cases in which dwelling houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding — Slum Clearance and Demolition. No action of this nature was undertaken. Overcrowding. During the year 196 new cases of overcrowding were found and 76 were remedied, leaving 208 dwellings known to be overcrowded w ith 1,528 equivalent adults in occupation still to be decrowded at the year end. Details are as follows:— Overcrowded at 31.12.45. Dwellings found overcrowded during 1946. Houses decrowded during 1946. Remaining overcrowded at 31.12.46. Increase during year 1946. Families 88 196 76 208 120 Equivalent Adults 652 1457 581 1528 876 Twenty-nine of the new cases of overcrowding were illegal. The 76 cases of overcrowding were abated during the year by:— Provision of alternative accommodation by :— (a) Carshalton Urban District Council— Pre-fabricated houses 47 Old houses 6 53 (b) London County Council 6 Left the district 1 By removal of one or more occupants 16 51 The history of known overcrowding since the survey of 1936 is indicated by the following:— Ward. House s overcrowded at Survey 1936. Houses found overcrowded up to 31.12.46 Houses decrowded up to 31.12.46 Houses remaining overcrowded at 31.12.46 Overcrowded cases remedied during 1946. Formal. Informal. Total. St. Helier North 40 147 126 61 11 2 13 St. Helier South 40 132 128 44 11 3 14 St. Helier West 45 134 129 50 15 2 17 North-East 17 73 63 27 13 5 18 North-West 10 49 50 9 2 — 2 Central 9 18 23 4 1 1 - South-West — 6 5 1 — 1 1 South-East 12 39 39 12 6 3 9 173 598 563 208 59 17 76 Of the 208 houses remaining overcrowded at 31.12.46, 152 were owned by the L.C.C., 25 by the Carshalton Urban District Council and 31 privately owned. Overcrowding is still our chief health problem and its extent is greater than the number of cases coming to our official notice indicates. It is ten years since the official housing survey to ascertain the degree of overcrowding was carried out under the Housing Act, 1935, and it is of interest to compare the position then and now. The population in 1936 and 1946 at 60,000 approximately was practically the same. The number of dwellings in 1936 was 15,207 ; in 1946 16,046. Although there were rather more houses after ten years for the same population the number of outstanding applications for Council tenancies rose from 337 in 1936 to 1,547 at the end of 1946. There are two factors which go a long way to explain the apparent anomaly. In 1936 there were opportunities for securing additional tenancies other than through the Council's scheme, whereas in 1946 the only reasonable prospect of so doing was by way of application to the Council's housing scheme. The second is peculiar to Carshalton. In the year 1936 the district had just completed a very rapid and considerable expansion, chiefly as the result of the St. Helier Estate. The effect of this was a marked lowering of the average age of population and a much higher proportion of the 5—15 year age groups. In pre St. Helier days, these groups formed 11% of the total population of the district, but in 1939 at the National Registration they formed 21% of the total and it is probable that the percentage was as high in 1936 after the completion of the St. Helier Estate as it was in 1939. By 1946 these groups were aged 15—25 years and these are the marriageable groups which create the need for additional homes. There was more than one family in occupation in 146 of the 196 new cases of overcrowding, which came to notice during the year, 2 families in 102 instances, 3 families in 43 and 4 families in 1. 52 Of the 146 overcrowded houses with more than one family, the additional family or families were known to be related to the occupier in no fewer than 109, chiefly married sons and daughters. Tents, Vans, Sheds and Similar Structures. No action. Rent and Mortgage Interest Restrictions (Amendment) Act, 1933. No applications were received during the year. Cellar Dwellings. No action. Factories and Workplaces. There were 105 factories on the Register, 65 of them using mechanical power. Employees numbered 1,616 of whom 820 were males and 796 females. Informal action was necessary with regard to two of the factories. 53 Section E— Inspection and Supervision of Food. Milk Supply. Cow\eepers. There are three cowkeepers registered in the District, two of whom are licensed by the Countv Council, to use the term " Accredited Milk." Regular inspections have been made of the farms. Only a very small amount of unpasteurised or raw milk is consumed in the district. Milk Retailers. As a result of the rationalisation of deliveries the number of registered milk retailers fell to 10. Milk (Special Designations) Regulations 1936-1946. Licences under these Regulations were issued as follows:— Principal Licences—Tuberculin Tested 5 Pasteurised 7 Supplementary Licences—Tuberculin Tested 8 Pasteurised 7 Bacteriological Examination of Milk. The number of samples of milk submitted for bacteriological examination was 202. The results were as follows :— Designation under which sold. No. of Samples. Methylene Blue Test. Phosphatase Test. Coliform Bacillus Test. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. Tuberculin Tested 33 22 11 — — 23 10 T.T. Pasteurised 25 24 1 25 0 5 1 Pasteurised 96 85 11 96 0 — — Heat Treated 42 39 3 42 0 40 2 Accredited — — — — — — — Non- designated 6 4 2 4 2 4 2 54 Two dairymen, a substantial proportion of whose samples had failed to satisfy the prescribed tests for designated milks were summoned to appear before the Public Health Committee, when the renewal of their licences was under consideration. The unsatisfactory nature of the samples was attributed to difficulties of transport and other factors outside their control. The Committee were satisfied that difficulties did exist, and after receiving assurances that certain steps would be taken in an endeavour to overcome them, the licences were renewed. The reports on the chemical analyses of milk are shown under the section dealing with food and drugs. Food and Drugs Act, 1938. Defence (Sale of Food) Regulations, 1943. Food Standard Orders. Labelling of Food Orders, etc, The following list indicates the number and nature of the food and drugs sampled during the year:— Article. No. Adulterated or otherwise irregular. Article. No. Adulterated or otherwise irregular. Baking Powder 2 Lemonade 1 Bicarbonate of Soda 1 Lemonade Powder 1 Cake Mixture 3 Margarine 1 Chocolate Cup 1 Malt Cup 1 Chocolate Drink 2 Meat Paste 2 Cinnamon (Ground) 1 Meat, Potted 1 Cocoa 4 Meat Sausage (Beef) 3 Coffee 4 Milk 171 3 Coffee and Chicory 2 1 Nutmeg 1 Coffee and Chicory Essence 4 1 Oatmeal 1 Pancake Mixture 1 Curry Powder 1 Pate de Foie 1 Drug as Prescribed 4 Pickles (Sweet) 1 Fat, Cooking 1 Pickles (Mustard) 1 Fish Paste 2 Pickles (Piccalilli) 1 Flavouring 1 Potato Powder 1 Flour, Batter 1 Pudding Mixture 4 Gelatine 3 1 Pudding Powder Gelatine (Powdered) 1 (Yorkshire) 1 Ginger (Ground) 2 Saccharine 1 Ginger Wine Essence 1 Sage 1 Glycerine 1 Sauce (Butter Flavour) 1 1 Gravy Granules 1 1 Sausage (Beef) 2 1 Gravy Browning 2 Sausage (Pork) 2 Gravy Powder 1 Spice, Mixed 2 Jam 5 Suet (Beef) 1 Jelly Crystals 1 Vinegar (Malt) 4 Junket Powder 1 Vinegar (Non-brewed) 4 1 265 10 55 Of the total, 10 were held to offend the statutory provisions as follows:— Butter Flavoured Sauce—No. 71. The label was not in accordance with the Labelling of Food (No. 2) Order, 1944 and a warning was served on the vendor. Coffee Essence with Chicory—No. 87. This sample contained only 0.12%weight in volume of caffeine as against the standard of 0.25% prescribed by the Order. Legal proceedings were prevented by the accidental destruction of the third portion of the sample. Coffee with Chicory—No. 109. The caffeine content was only 0.18% weight in volume. Prosecution was taken and the case dismissed after the Defendant had successfully pleaded a warranty. Milk—No. 116. This sample contained 2% added water. A warning was given. Milk—No 160. The sample was deficient in fat to the extent of 13%. Prosecution was authorised but withdrawn as a result of a technical error in procedure. Milk—No 161. This sample showed a small proportion of added water and a warning was given. Vinegar (Pickling—Non-brewed)—No. 117. The sample contained 3.6% acetic acid as against the statutory minimum of 4%. Prosecution resulted in a fine of £5 with 3 guineas costs. Gravy Granules—No. 205. This sample was decomposed and contained a large number of dead mites. Further, the package did not comply with the Food (No. 2) Labelling Order. The defendant on prosecution was fined £10 and costs on each of the two summonses. Sausage Meat (Beef)—No. 235. The sample contained 47% of meat instead of 50%. A warning was served. Gelatine—No. 245. Whilst being genuine gelatine this sample was of low. jelly strength judged by usual commercial standards. Warning given. 56 Food Inspection. The following articles of food found to be unsound, diseased or unwholesome and unfit for human food, were surrendered and either destroyed or taken charge of by the Ministry of Food Salvage Department, or so disposed of as to prevent them from being used for human food:— Fish cans 210 Mutton lbs. 3½ Fruit ,, 44 Oatmeal ,, 117 Jam ,, 16 Oranges ,, 224 Marmalade ,, 8 Pork ,, 10 Meat ,, 171 Rabbit ,, 30 Milk ,, 864 Rusks, Nursery ,, 11 Pudding ,, 11 Semolina ,, 60 Soup ,, 34 Sugar ,, 1,560 Vegetables ,, 474 Sweets ,, 17½ Fish Stones 9 Tea ,, 4 Bacon lbs. 18½ Lemon Curd jars 1 Beef ,, 556 Mustard ,, 21 Biscuits ,, 15 Mustard Pickle ,, 201 Bread ,, 734½ Salad Dressing ,, 2 Butter ,, ½ Bengers Food tins 1 Butter Beans ,, 59 Bospur ,, 1 Cheese ,, 155 Honey ,, 6 Cocoa ,, 9¼ Paste ,, 328 Dates ,, 168 Custard Powder pkts. 59 Dried Egg ,, 15 Gravy Powder ,, 43 Dried Fruit ,, 73 Jelly Crystals ,, 26 Dried Peas ,, 3-F Orange Flavouring ,, 6 Flour ,, 240 Pudding and Cake Mixture ,, 166 Flour, Soya ,, 180 Soup Powder pkts. 26 Spiced Anchovies botts. 18 Wheat Flakes ,, 13 Eggs, Shell 432 Bakehouses. The five bakehouses in the district all received periodical inspection. No special action was called for during the year. 07 Section F—Prevalence of and Control over Infectious and other Diseases. The district has, within its boundaries, three General Hospitals, two of which, namely, Queen Mary's Hospital for Children and the St. Helier County, are particularly large institutions which are part of the hospital services for London and the County of Surrey respectively. Many of the cases notified from the St. Helier Hospital are admitted there from other districts already suffering from a notifiable disease, but not diagnosed until after admission. In order, therefore, to give a clearer picture of the prevalence of infectious disease in the resident population of the district, separate figures are given in this Section which exclude cases of hospital patients who are not residents of the district. The figures given are after correction for original errors in diagnosis. Notification. The following diseases are notifiable in the district : Smallpox. Dysentery. Cerebro-spinal Fever. Cholera. Acute Influenzal Acute Poliomyelitis. Diphtheria. Pneumonia. Ophthalmia Membranous Croup. Acute Neonatorum. Erysipelas. Polioencephalitis. Puerperal Pyrexia. Scarlatina or Typhus Fever. Malaria. Scarlet Fever. Typhoid Fever. Acute Primary Measles. Enteric Fever. Pneumonia. Whooping Cough. Relapsing or Acute Encephalitis Tuberculosis. Continued Fever. Lethargica. Food Poisoning. Smallpox. The district was free from variola infection during the year. Enteric Fever. One case of paratyphoid B infection in a child of 13 years was notified. The patient had recently returned from holiday in the West Country and was probably infected there. He recovered after a month in hospital. Dysentery. Of 11 cases of Sonne dysentery, one was a resident of a neighbouring district admitted to St. Helier Hospital with the illness and 9 were patients of Queen Mary's Hospital all notified in one week in April. The remaining one was a resident of the district and recovered from a mild attack after treatment at home. Cerebro-Spinal Fever. There were no cases of meningo-coccal meningitis among the resident population. One case in a baby of one year was admitted to a local hospital with the disease from an adjoining district. 58 Poliomyelitis. Polioencephalitis. Encephalitis Lethargica. No'cases notified. Scarlet Fever. Somewhat fewer cases of scarlet fever occurred. A total of 96 (89 residents) compared with 109 (107 residents) in the year before was notified. The case rates were accordingly : All cases 1.59 per 1,000 population. Residents 1.48 per 1,000 population. Fifteen percent. were children of pre-school age, 73% school children and 12% over 15 years. All but 15 were removed to isolation hospital and there were no deaths. There was one "return" case. TABLE 15. SCARLET FEVER—WARD INCIDENCE AND MONTHLY DISTRIBUTION 1940. (Excluding hospital patients non-resident in Carshalton.) 1940. Ward. Total. St. Helier North. St. Helier South. St. Helier West. NorthEast NorthWest. Central. SouthEast. SouthWest. January 1 2 1 1 1 3 4 13 February 1 1 — — 1 — — 1 4 March 2 — — — 1 — 1 0 10 April 2 1 — 4 — 3 1 5 16 May — 2 5 1 — — — 1 9 Tune 1 1 — — — 1 2 — 5 July 5 1 — 1 — — — 3 10 August — — 1 — — . — — 1 September — 1 2 — 1 — 4 October 1 — — 4 1 1 — 7 November — 1 1 2 — — — — 4 December 1 — — 2 — 3 6 Totals 14 10 9 16 3 5 12 20 89 Monthly Mean 1.2 0.83 0.75 1.33 0.25 0.41 1.0 1.66 7.4 Case rate per 1,000 population 1.65 1.44 1.12 1.74 0.42 0.83 1.65 3.40 1.49 59 TABLE 16. SCARLET FEVER—MULTIPLE CASES, 1946. Ward. No. of houses in which occurred. Total Houses. • Total Cases. 1 Case. 2 Cases. 3 Cases. St. Helier North 12 1 — 13 14 St. Helier South 8 1 — 9 10 St. Helier West 9 — — 9 9 North-East 16 — — 16 16 North-West 3 — — 3 3 Central 5 — — 5 5 South-East 12 — — 12 12 South-West 14 — 2 16 20 Whole District 79 2 2 83 89 Diphtheria. The year 1946 was the most favourable yet in respect of diphtheria prevalence. Of 13 cases notifed, 9 were patients in local hospitals, 1 was a hospital nurse and 3 only were residents of the district. These figures give incidence rates as follows : All cases 0.21 per 1,000 population. Residents 0.06 per 1,000 population. Only one house was affected by diphtheria during the year since the three cases arising outside hospitals all occurred in one family. None of these three patients had been immunised and one died of the illness. All cases were admitted to isolation hospital. The incidence of diphtheria among the resident population since 1934 was as follows: Year Cases Incidence per 1,000 Year Cases Incidence per 1,000 1934 66 1.73 1941 26 0.45 1935 58 1.13 1942 23 0.40 1936 53 0.95 1943 7 0.12 1937 47 0.80 1944 7 0.12 1938 33 0.57 1945 15 0.27 1939 14 0.23 1946 4 0.06 1940 45 0.77 60 TABLE 17. DIPHTHERIA—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1946. (Excluding hospital patients non-resident in Carshalton.) 1946. Ward. Total. St. Helier North. St. Helier South. St. Helier West. NorthEast. NorthWest. Central. SouthEast. SouthWest. January — — — — — — — — — February — — — 1 — — — — 1 March — — — — — — — — — April — — — — — — — — — May — — — — — — — — — Tune — — — 1 — — — — . 1 July — — — 1 — — 1 — 2 August — — — — — — — — — September — — — — — — — — — October — — — — — — — — — November — — — — — — — — — December — — — — — — — — — Totals — — — 3 — — 1 — 4 Monthly Mean — — — 0.25 — — 0.08 — 0.33 Case rate per 1,000 population — — — 0.32 — — 0.13 — 0.06 Five "carriers" of diphtheria infection came to notice, 4 of whom were inmates of Queen Mary's Hospital and 1 a local resident. The number of swabs examined for diphtheria under the Council's arrangements was 112, of which 2 were positive. Diphtheria Immunisation—Circular 194/45. By Circular 194, issued in November, 1945, the Minister transferred the responsibility for the immunisation of children under 5 years of age to the Welfare Authorities. The main reason for this action was the fact that the Health Visitors were the most convenient and useful agents for securing the treatment of pre-school children. Where the Sanitary Authority and the Welfare Authority were one and the same, as in this district, there was no essential change in the administrative arrangements. One seriously doubts the wisdom of the ministerial direction where the two authorities are not the same. Experience of this scheme since 1934 in this district demonstrates the necessity for some local medical officer to direct the ceaseless campaign in all its aspects for treatment of children of all ages. Success rests mainly on the individual enthusiasm and responsibility of such an officer and to divide the 61 responsibility according to age groups cannot but prejudice the success of the scheme as a whole. Moreover, it should not be forgotten that diphtheria immunisation is primarily a means of controlling infectious disease, a function which is essentially one of the Sanitary Authority and the Medical Officer of Health. He more than anyone is concerned with the incidence of diphtheria in his district and should not be denied the opportunity of wielding this powerful weapon. For the last sixteen years the Medical Officer of Health has directed diphtheria immunisation in this district with very gratifying results. In addition to the staff of his Maternity and Child Welfare Service he has had the willing co-operation of the School Medical Service and of the head teachers, but he has provided the unremitting incentive which has resulted in an immunisation rate of 76% for all children under the age of 15 with the majority having had their immunity reinforced after an interval of three to four years. As from July 5th next the County Council, in conformity with the National Health Service Act, will become solely responsible for diphtheria immunisation. It is encourage ing to note that in their proposals for this scheme that Authority propose to continue substantially the main principles on which this work has been conducted so successfully up to the present and to use the services of district medical officers of health for local control with the consent of the local Sanitary Authorities. The administrative arrangements in this district have been developed in the light of lengthy experience. In respect of children under 5 years of age they are substantially the methods advocated in Circular 145, but more comprehensive. The greatest contribution to success lies in making treatment readily accessible to mothers. To this end, special clinic sessions necessitating a special journey for treatment have been discontinued and treatment has been made available at all the infant welfare and toddler clinics which are held on nine half days per week. Under these arrangements 64% of children are immunised before entering school at 5 years of age, and in 11(46 the number treated between the age of 1 and 2 years was 67% of the children in that age group. Twice a year a programme of immunisation sessions is carried out in the infant and junior schools at which children not previously immunised are treated, and those done more than three years previously given a reinforcing dose. A complete card index register of all children up to 15 years is available from the Maternity and Child Welfare and the School Medical Service records, and the school lists are continually revised at monthly intervals. By this procedure children up to the age of 11 are covered and by that age they not only have received initial treatment, but have mostly had two reinforcing doses. It is doubtful whether any additional appreciable anti-genic response is obtainable by further injection in the last years of school life though experience may yet show this to be desirable. The technique used is the two injection procedure of 0.5 cc. A.P.T. for the primary course at one month's interval, with a dose of 0.2 cc. A.P.T. for the reinforcing injections. 63 During the year a further 1,023 residents were immunised as follows:— Age at Year End. . Under 1 1-2 2-3 3-4 4-5 5-10 10-15 At Council Clinks 5 468 121 19 12 9 1 635 In Carshalton Schools — — — 3 3 267 59 332 Private Practitioners — 45 24 3 2 1 — 75 5 513 145 25 17 277 60 1042 Less outward transfers — 5 - - — 44 12 — Plus inward transfers — 8 4 1 3 20 6 42 Carshalton Residents 5 516 149 26 20 253 54 1023 A further 1,590 children received reinforcing doses during the year. The position with regard to immunisation at the year end was as follows: Number of Children who had completed a full course of Immunisation at any time up to 31st December, 1946. Age at 31.12.46, i.e., Born in Year Under 1 1946. 1 1945. 2 1944. 3 194'!. 4 1942. 5 to 9 1937/ 41. 10 to 14 1932/ 36. Total under 15 Number Immunised 6 548 75S 631 663 1044 1193 11143 Estimated mid-year population, 1946 4050 10500 14550 Percentage done 64% 81% 76% Erysipelas. Ten cases were notified. Nine were residents, 5 of whom were removed to isolation hospital. The face was the site affected in every instance. All recovered. Pneumonia. The number of notifications was 66, all residents but one. Of the total, 10 were stated to be influenzal and these all occurred in the first three months of the year except for 1 in December. Two cases were admitted to hospital. 63 Measles. A somewhat smaller epidemic wave of measles affected the district from April to July. The number of notifications at 512 compares with 686 in the year before. All but 16 were residents of the district. There were no deaths. TABLE 18. MEASLES—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1940 (Excluding hospital patients non-resident in Carshalton.) 1946. Ward. Total. St. Helier N'orth. St. Helier South. St. Helier Wesf. East NorthWest. Central. SouthEast. SouthWest. January — — — 1 — — — 1 February — — — — — — 1 — 6 March — 12 4 5 1 — 1 — 23 April 11 12 12 0 3 — — 2 46 May 22 7 18 32 18 7 4 1 109 June 43 5 17 37 17 17 3 7 140 July 35 3 5 41 7 1 15 10 117 August 2 1 1 2 3 1 5 2 17 September 2 — — — — — — 3 5 October 8 1 — 1 — — 4 — 14 November — 1 — 3 — — — — 6 December 1 — — — 1 1 1 2 6 Totals 124 47 57 128 50 27 30 27 496 Monthly Mean 10.33 3.91 4.75 10.00 4.10 2.25 3.00 2.25 41.33 Case rate per 1,000 population 14.0 0.70 7.09 13.9 0.92 4.49 4.96 4.12 8.31 64 Whooping Cough. Pertussis was more prevalent than in the year before, 192 (6 nonresidents) cases being notified as against 106. Incidence was heaviest in the Spring and Autumn. There were no deaths from this infection. TABLE 19. WHOOPING COUGH -WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1916. (Excluding hospital patients non-resident in Carshalton.) 1946. Ward. Total. St. Helier North. St. Helier South. St. Helier West. NorthEast. NorthWest. Central. SouthEast. SouthWest. January 1 1 — 2 — — 2 — 6 February — — — 1 — — 1 4 6 March 2 — — 11 4 1 2 6 26 April 1 — — 16 3 — 1 6 27 May 1 1 3 7 1 — — 2 15 June — — I 4 3 4 — 1 13 July 1 4 2 1 1 — — — 9 August 1 — 1 — 1 — — 1 4 September 4 1 12 7 — — — — 24 October 10 6 9 2 — — — — 27 November 5 7 2 3 4 — — — 21 December 3 — 3 1 — 1 — — 8 Totals 29 20 33 55 17 6 6 20 186 Monthly Mean 2.41 1,66 2.75 4.58 1.41 0.50 0.50 1.66 15.50 Case rate per 1,000 population 3.43 2.87 4.10 5.99 2.35 0.99 0.82 3.04 3.11 Ophthalmia Neonatorum. There were no notifications of this eye infection of the newborn. Puerperal Pyrexia. Rise of temperature during child birth was notified in .'11 woine only 4 of whom were residents of the district. In 28 instances t patient was confined in hospital. All but 2 received hospital treatme and all recovered. 66 The following summarises the main features of these cases : 19 were primigravidae. None were cases of abortion. 28 followed spontaneous delivery. 2 followed instrumental delivery. 1 followed Caesarian section. 5 had sepsis of the genital tract. 9 had urinary infection. 4 had throat infection. 3 had bronchitis (1 post-anaesthetic and 1 after whooping cough). 2 had thronibo-phlebitis. 2 had influenza. 2 had mastitis. 1 had coryza. 18 had some complication or abnormality of pregnancy or labour other than a rise of temperature. 66 TABLE 20. INFECTIOUS DISEASES—NOTIFICATIONS, DEATHS AND DIS TRIBUTION. (Excluding hospital patients non-resident in Carshalton.) Disease. Cases notified. Case rate per 1,000 population. Deaths Distribution bv Wards. No. of cases removed to Hospital. Percentage of cases removed to Hospital. St. Helier North. St. Helier South. St. Helier West. NorthEast. NorthWest. Central. SouthEast. SouthWest. Scarlet Fever 89 1.48 — 14 10 9 16 3 5 12 20 74 83 Diphtheria 4 0.06 1 — — — 3 — — 1 — 4 100 Puerperal Pyrexia 5 0.08 — 1 2 — — 1 — 1 — 3 60 Erysipelas 9 0.14 — 2 — 2 2 3 — — — 5 55 Pneumonia 65 1.08 — 9 6 12 9 12 2 6 9 2 3.0 Dysentery 1 0.01 — — — 1 — — — — — — — Paratyphoid Fever 1 0.01 — 1 1 100 Measles 496 8.26 — 124 47 57 128 50 27 36 27 4 0.8 Whooping Cough 186 3.09 — 29 20 33 55 17 6 6 20 4 2.1 67 TABLE 21. INFECTIOUS DISEASES. Notification by Age Groups, 1946. (Excluding hospital patients non-resident in Carshalton.) Disease. Total Cases Notified. Total Cases at all Ages Under 1 year 1-2 2-3 34 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 and over Scarlet Fever — 1 1 3 9 47 18 — 7 3 — — 89 Diphtheria . — — — — — 1 1 1 1 — — — 4 Puerperal Pyrexia — — — — — — — — 2 3 — — 5 Erysipelas — — — — — — — 1 1 — 5 2 9 Pneumonia 1 — 1 3 3 6 3 3 10 11 18 6 65 Dysentery — — — — — — — — 1 — — — 1 Paratyphoid Fever — — — — — — 1 — — — — — 1 Measles 15 57 48 88 71 205 11 1 — — — — 496 Whooping Cough 17 27 32 25 28 48 6 — 2 — 1 — 186 68 TABLE 22. MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1946. (Excluding hospital patients non-resident in Carshalton.) Disease. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 13 4 10 16 9 5 10 1 4 7 4 6 89 Diphtheria — 1 — — — 1 2 — — — — — 4 Puerperal Pyrexia 1 — — — 1 — — — 1 — 2 — 5 Erysipelas 1 1 — 2 — 2 — — — — 3 — 9 Pneumonia 14 9 5 9 2 5 4 1 6 3 3 4 60 Dysentery — 1 — — — — — — — — — — 1 Paratyphoid Fever — — — — — — 1 — — — — — 1 Whooping Cough 6 6 26 27 15 13 9 4 24 27 21 8 186 Measles 1 6 23 46 109 146 117 17 5 14 6 6 496 Tuberculosis Pulmonary 3 6 3 3 6 1 6 6 5 7 8 13 67 Tuberculosis Non-pulmonary 1 — — 1 2 — 1 1 1 1 1 9 69 Tuberculosis. The new cases admitted to the tuberculosis register during the year numbered 106 classified as follows : Males. Females. Pulmonary 49 Pulmonary 47 Non-pulmonary 8 Non-pulmonary 2 Of the total additions 72 were primary notifications, 30 were transferred from other districts, and 4 came to notice in other ways. For the same period 83 names were removed from the register for the following reasons: Recovered 11 Deaths 31 Otherwise (including removals) 41 After allowing for the additions and deductions, the state of the register at the 31st December, 1946, was as shown in the following table : TUBERCULOSIS—WARD DISTRIBUTION. Cases on Register at 31st December, 1040. Ward. Pulmonary. Non-Pulmonary. Total Incidence per 1,000 population. Males. Females. Males. Females. St. Ilelie r North 56 66 14 8 144 17.0 St. llelier South 44 43 12 17 116 16.6 St. Helier West 51 33 13 16 113 14.0 North-East 40 40 10 8 98 10.6 North-West 36 25 6 6 73 10.1 Central 25 19 7 2 53 8.8 South-East 21 19 6 8 54 7.4 South-West 27 15 4 1 47 7.1 Totals 300 260 72 66 698 11.7 560 138 The total of 698 is 23 more than at the corresponding date twelve months earlier. The Surrey County Council is responsible for the anti-tuberculosis scheme in the area. The number of patients from Carshalton who received institutional treatment under the County scheme during the year was as follows : At Surrey County Sanatorium, Milford 29 At other tuberculosis institutions 128 157 70 The number of tuberculous persons who died during the year was 31, distributed by age groups as follows: Age, Years. Pulmonary. Non-Pulmonary. Total. Males. Females. Males. Females. 0 - - - - - 1—5 - - - - - 5—15 - - - - — 15—25 3 - 2 1 6 25—35 2 3 - 1 6 35—45 4 4 - - 8 45—55 3 - 1 - 4 55—65 2 1 - - 3 65—75 4 — — — 4 Totals 18 8 3 2 31 The deaths attributable to Tuberculosis were 25, as follows : DEATHS DUE TO TUBERCULOSIS, 1946. Ward. Pulmonary. Non-Pulmonary. Death Rate per 1,000 population. Mean age at Death. Male. Female. Male. Female. St. Helier North 3 3 1 - 0.82 30.10 12 yrs. St. Helier South 1 1 1 - 0.43 48. 4/12 ,, St. Helier West 3 3 2 - 0.99 19. 6/12 „ North-East — 1 - 0.11 15 ,, North-West — —- — — - — Central 1 - - 1 0.33 28. 6/12 „ South-East 2 .— 1 1 0.55 28. 3/12 „ South-West — — — — — — 10 7 6 2 0.41 37. 8/12 „ Four deaths of unnotified cases represent 13% of the total deaths from this disease. The Council provides a free service for the examination of sputum for tubercle bacilli. In the past year 14 such examinations were made with a positive result in one. No action was taken under the Public Health (Prevention of Tuberculosis )Regulations, 1925, or under Section 172 of the Public Health Act, 1936. 71 TABLE 23. TUBERCULOSIS. New Cases, Age and Sex Distribution and Manner of Admission to Register, 1946. Age Group Years. Primary Notifications "A." Cases transferred from other Districts. Cases brought to notice other than by Notification or Transfer. Total New Cases. Pulmonary. Non-Pulmonary Pulmonary. Non-Pulmonary Pulmonary . Non-Pulmonary M. F. M. F. M. F. M. F. M. F. M. F. 0—1 - - - - - - - - - - - - - 1— 5 - - - - - - 1 - - - . - - 1 5—10 2 1 - 1 2 - 1 - - - 7 10—15 4 1 - - - - - - - - - 6 15—20 11 10 1 1 1 1 - - 2 - - - 27 20—25 10 5 3 - 1 3 - - - - - 22 25—35 7 5 1 - 3 8 - - 1 - - - 25 35—45 3 3 - - 2 2 - - - - - - 10 45—55 - - - - - 2 - - - - - - 2 55—65 3 - -. - - 2 - - - 1 - - 6 65 up - - - - - - - - - - - - - Totals 38 26 7 1 8 20 1 1 3 1 - - 106 72 30 4 72 INDEX PAGE Acreage 8 Ambulance 22 Bakehouses 57 Bed Bug—Eradication of 45 Births— Distribution 11 Institutional 12 Notification of 25 Rates 11-13 Cancer 16 Cemeteries 48 Child Life Protection 37 Clinics and Treatment Centres 24 Closet Accommodation 41 Convalescent Treatment 34 Day Nurseries 38 Deaths— Classification 20 Distribution 15 Rate 13-15 Dental Scheme 32-33 Diphtheria 60 Immunisation 61 Domestic Helps 39 Dysentery 58 Disinfection 45 Disposal of Dead 48 Drainage and Sewerage 41 Employment Agencies 48 Enteric Fever 58 Erysipelas 63 Establishments for Massage, etc. 48 Factories' 53 Food— Inspection and Supervision 54-57 Food and Drugs Act 55 Health Services 21 Health Visiting 25 Hospitals 23 Housing— Council's Scheme 49 Inhabited Houses 8 Inspection 50 Overcrowding 51 Ward Distribution 11 73 PAGE Industry 10-53 Infant Mortality18-19 Infectious Diseases 58-07-68-69 Inquests 17 Insulin 22 Isolation Hospital 23 Admissions to 23 Laboratory Facilities 21 Maternal Mortality 18 Maternity and Child Welfare— 25 Adoption of Children (Regulation) Act, 1939 37 Attendances at Clinics 27-28-31 Child Life Protection 37 Clinic Activities 26 Consultant Service 35 Convalescent Treatment 34 Day Nurseries 38 Dental Scheme 32-33 Health Visiting 25 Home Helps 36 Hospital Treatment for Maternity 34 Emergency Maternity Unit 35 Illegitimate Children 35 Maternity Outfits 35 Midwives 36 Orthopaedic Treatment 34 Premature Births 29 Supply of Milk and Other Foods 31 Toddler Clinics 29-30 Measiles 64 Milk SBupply 54 Milk (Special Designations) Order 54 Mortuary 48 Natural and Social Conditions 8 Nursing Associations 21 Officers 47 Ophthalmia Neonatorum 65 Orthopaedic Treatment 34 Pest Control 45 Pneumonia 63 Population 10 Premature Births 29 Public Assistance 10 Public Cleansing 41 Puerperal Pyrexia 65 74 PAGE Rateable Value 8 Rats and Mice Destruction 46 Rent and Mortgage Interest Restrictions (Amendment) Act, 1933 53 Rivers and Streams 41 Sanitary Circumstances 40 Sanitary Inspection 41 Scarlet Fever 59 Shops Acts 47 Smallpox 58 Smoke Abatement 47 Staff 7 Statistics— Comparative 14-15 Vital 9 Swimming Baths 47 Tuberculosis 70 Unemployment 10 Unmarried Mothers 35 Vermin Control 45 Voluntary Helpers 37 Water Supply 40 Whooping Cough 65 Zymotic Diseases 58 Deaths from 9 75