Carshalton Urban District Annual Report OF THE Medical Officer of Health FOR THE YEAR 1947 Printed by the "Croydon Times," Ltd., 104, High Street. Croydon. CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1947 1 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 1947. The year under review was the last complete year during which the Council administered several health services, notably Maternity and Child Welfare, which have since passed to the control of the County Council. Future reports will thereby be less voluminous and will deal with a restricted range of subjects, being mainly the health services for which the District Council remains responsible. It is, therefore, with no little satisfaction that I am able to present to you a very satisfactory record of the operation of your health services which is not the least gratifying in its account of those services which you have since relinquished. As measured by its vital statistics, the health of the district maintained the high standard to which we have been accustomed. The crude death rate at 7.8 per thousand population is again well below the national mortality. Infant mortality is the second lowest in our experience and is little more than half that for England and Wales. Maternal mortality, for the third year in succession, was non-existent. Among the causes of death, those associated with the degenerative changes due to advancing years figured most prominently, and the prominence of cancer mortality is to a certain extent the result of the general increase in longevity since this is primarily a disease of middle and old age. Tuberculosis was less fatal than for twenty years, although the recorded incidence of this disease is higher, in great part as a result of better ascertainment. The otherwise very favourable position with regard to infectious disease was marred by the wave of infantile paralysis which swept the country in the summer and autumn. Locally, it gave rise to fifteen cases, five of which proved fatal. Apart from this unusual visitation, prevalence of the common infectious diseases was very satisfactory. For the first time there was no case of diphtheria among the resident population, although four cases were notified from Queen Mary's Hospital. 3 The operation of the Maternity and Child Welfare Scheme reached a new high level and record attendances were made. Sanitary inspection and control of food and drugs under the experienced guidance of the Chief Sanitary Inspector was conducted with usual efficiency, whilst the continuing shortage of labour and material for securing remedial housing work was, in a large measure, successfully countered by the judicious use of statutory powers. The legal provisions for the prevention of overcrowding, in the face of the acute shortage of accommodation are, for the time being, valueless. Only more houses can remedy this evil which affects the mental health of the people no less than their physical wellbeing. I would like once again to place on record my appreciation of the work of my staff, who, with their customary loyalty, have given of their best and without whose untiring efforts much of the progress recorded in these pages could not have been achieved. I am, Your obedient servant, F. LAWRENCE SMITH, Medical Officer of Health. August, 1948. 4 PUBLIC HEALTH STAFF. Medical Officer of Health: F. 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. * H. C. E. Gatehouse, C.R.S.I, (commenced 1.3.47) * G. R. Surfleet, C.R.S.I, (commenced 1.3.47) Senior Health Visitor: Miss R. M. Nash. Health Visitors: Miss A. A. Askew, Miss H. Gray, Miss D. Longland, Miss E. Hereford (commenced 1.1.47) Chief Clerk: B. Lamacraft (resigned 13.4.47) Miss V. Hotten (acting as from 14.4.47) 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.) (resigned 29.9.47) C. H. Kennard, L.D.S. (commenced 6.10.47) in agreement with Surrey County Council. *Meat and Food Certificate of the Royal Sanitary Institute. 5 Section A—Natural and Social Conditions of the District. Area (in acres) 3,346 Number of inhabited houses (end of 1947) according to Rate Books 16,158 Rateable Value at 31st December, 1947 ... £489,872 Sum represented by 1d. rate £2,010 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 ever increasing abstraction from the underground water supply of the London Basin which has been going on in recent years, has almost exhausted these springs. The ponds and water-ways which they feed, which have added so much to the amenities of the district, have for long periods dried up ; an experience unknown not so many years ago. 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. 6 SUMMARY OF VITAL STATISTICS FOR 1947. (Based on the Registrar-General's Figures). Population. Registrar-General's Estimate 61,270 Births. Males. Females. Total Live (Legitimate) 524 484 1,008 (Illegitimate) 16 22 38 540 506 1,046 Birth Rate 17.0 Still-births (Legitimate) 17 11 28 (Illegitimate) 1 - 1 18 11 29 Still-birth Rate per 1,000 total births 26.9 Deaths. 235 244 479 Death Rate (crude) 7.8 Infant Mortality. All deaths under 1 year 13 11 24 Infant Mortality Rate (per 1,000 live births) 22.8 Deaths of leg. infts. under 1 year 13 9 22 Rate per 1,000 legitimate births 21.8 Deaths of illeg. infts. under 1 year - 2 2 Rate per 1,000 illegitimate births 68.9 Maternal Mortality. Death 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 1 2 3 Deaths from Measles - - - Deaths from Whooping Cough - - - Deaths from Diarrhoea (under 2 years) 2 2 - Zymotic Death Rate 0.04 Deaths from Tuberculosis. All Forms 14 11 25 Rate per 1,000 of population 0.40 Phthisis 12 10 22 Rate per 1,000 of population 0.35 Deaths from Cancer. Rate per 1,000 of population 48 37 85 1.38 7 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 fiecessarily been based on our own records, which may, in the aggregate, show slight discrepancies compared with the Registrar-General's totals. UNEMPLOYMENT. The number of unemployed Carshalton residents registered at the Sutton Exchange at the end of the year was Men 120 Women 71 Boys 8 Girls 5 204 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, 1947 68 Total number of persons from Carshalton admitted to Mental Hospitals during 12 months ended 31st December, 1947 ... 86 Other Relief: Number of persons in receipt of domiciliary assistance on:— Men Women Children Total 1st January 89 164 130 383 1st July 94 175 162 431 31st December 81 162 109 352 Total amount of domiciliary relief paid to persons resident in Carshalton during 1947 £17,037 19s. 4d. POPULATION. The population increase over the year before is in the region of 1,500, of which natural increase and the return of Service members accounted for the greater part. 8 The distribution of the population by wards at mid-1947 is estimated as follows TABLE 1. ESTIMATED RESIDENT POPULATION, MID-1947, BY WARDS. Ward. Houses at Mid-1947. Estimated population Mid-1947. St. Helier North 1,990 8.560 St. Helier South 1,677 7,050 St. Helier West 1,897 8,140 North-East 2,586 9,310 North-West 2,134 7,310 Central 1,699 6,080 South-East 2,080 7,350 (Queen Mary's Hospital) 1,100 South-West 1,979 6,660 Whole District 16,042 61,560 BIRTHS. Though slightly fewer than in the year before, the number of live births registered again exceeded 1,000. A total of 1,040 divided as to 540 males and 506 females provides a birth rate of 17.0 per thousand population compared with 17.8 in 1946. 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 registration. From these sources it is known that 1,077 live births occurred in 1947. 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 138 16.1 2 14.2 St. Helier South 123 17.4 3 23.2 St. Helier West 137 16.8 6 40.5 North-East 222 23.8 5 21.5 North-West 156 21.2 6 35.7 Central 102 16.3 1 9.6 South- East (excluding Queen Mary's Hospital) 123 16.7 1 8.0 South-West 76 11.4 4 48.1 9 As in recent years, a substantial proportion of births took place in hospitals and nursing homes, the percentage for the whole district being 55 compared with 60 in the previous year. The percentages for such institutional births in the wards of the district were as follows :— St. Helier North 46 St. Helier South 60 St. Helier West 60 North-East 46 North-West 48 Central 62 South-East 64 South-West 71 Out of 1,105 total births, 608 took place in the following hospitals and nursing homes:— Live. Still. Total. Carshalton, Beddington and Wallington District (War Memorial) Hospital 65 2 67 St. Helier County Hospital 365 17 382 Other Surrey County Hospitals 61 - 61 Other Hospitals 16 2 18 Private Nursing Homes 80 - 80 Totals 587 21 608 TABLE 2. BIRTHS, 1947, 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 52 75(1) 127(1) 12(1) 1 13(1) 140(2) St. Helier South 66(1) 50(2) 116(3) 10 - 10 126(3) St. Helier West 69(6) 56 125(6) 17 1 18 143(6) North-East 74(4) 124(1) 198(5) 29 - 29 227(5) North-West 64(4) 84(2) 148(6) 14 - 14 162(6) Central 51 39(1) 90(1) 13 - 13 103(1) South-East 42(1) 44 86(1) 38 - 38 124(1) South-West 31(3) 23 54(3) 26(1) - 26(1) 80 (4) Totals 449(19) 495(7) 944(26) 159(2) 2 161(2) 1105(28) (Figures in brackets indicate still-births included in totals.) 10 TABLE 3. BIRTH AND DEATH RATES FOR CARSHALTON, 1922-1947. 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 15,050 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 18,450 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 69,510 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 1943 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 1947 CI,270 17.0 7.8 22.8 0.0 (* Maternal mortality expressed as deaths per 1,000 total births includes deaths from abortion up to and including 1940. Thereafter they are excluded.) 11 TABLE 4. COMPARATIVE STATISTICS—1947. 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 20.5‡ 23.3 22.2 22.7 17.0 Still 0.50‡ 0.62 0.54 0.49 0.47 Deaths— All causes 12.0‡ 13.0 11.9 12.8 7.8 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 0.01 Scarlet Fever 0.00 0.00 0.00 0.00 - Whooping Cough 0.02 0.03 0.02 0.02 - Diphtheria 0.01 0.01 0.01 0.01 - Influenza 0.09 0.09 0.08 0.08 0.04 Smallpox 0.00 0.00 0.00 - - Measles 0.01 0.02 0.02 0.01 - Rates per 1.000 Live Births. Deaths under 1 year of age 41† 47 36 37 22 Deaths from Diarrhoea and Enteritis under 2 years of age 5.8 8.0 3.7 4.8 1.9 Rates per 1,000 Civilian Population. Notifications—- Typhoid Fever 0.01 0.01 0.00 0.01 0.03 Paratyphoid Fever 0.01 0.01 0.01 0.01 - Cerebro Spinal Fever 0.05 0.06 0.05 0.05 0.03 Scarlet Fever 1.37 1.54 1.37 1.31 1.59 Whooping Cough 2.22 2.41 2.02 2.80 3.00 Diphtheria 0.13 0.15 0.14 0.14 0.06 Erysipelas 0.19 0.21 0.18 0.22 0.19 Smallpox 0.00 0.00 0.01 0.00 - Measles 9.41 9.13 9.58 5.29 2.40 Pneumonia 0.79 0.89 0.68 0.64 1.15 Rates per 1,000 Total Births (Live and Still). Puerperal Fever 7.16 8.99 6.27 1.21 43.72 Puerperal Pyrexia §6.94 Maternal Mortality— Abortion with Sepsis 0.10 Not available - Abortion without Sepsis 0.06 - Puerperal Infections 0.16 - Other Puerperal causes 0.85 - * A dash (—) signifies that there were no deaths. † Per 1,000 related births. ‡ Rates per 1,000 Total population. § Including Puerperal Fever. 12 COMPARATIVE HEALTH STATISTICS, 1934/47. Death Rate (Civilian) 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. 1934 8.6 11.8 53.5 59.3 3.0 3.8 1935 6.6 11.7 46.0 57.0 2.4 3.4 1936 7.1 12.1 46.7 58.7 5.4 3.1 1937 6.6 12.4 40.0 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 2.1 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 0 1.2 1947 7.8 12.0 22.8 41.0 0 1.0 1934/47 7.7 12.1(av) 36.5 50.9 1.80 3.06 DEATHS. The number of deaths allocated to this district by the RegistrarGeneral was 479, 235 being males and 244 females. The crude death rate at 7.8 per 1,000 population compares with 12.0 for England and Wales. The distribution by wards was as follows :— WARD DEATH RATES AND MEAN AGE AT DEATH 1947. ' Deaths. Death Rate (crude). Mean Age at death. St. Helier North 48 5.6 45.6 yrs. St. Helier South 40 5.6 60.2 „ St. Helier West 43 5.3 52.9 „ North- East 75 8.1 57.4 „ North- West 72 9.8 62.5 „ Central 73 12.0 67.0 „ South- East (excluding Queen Mary's Hospital) 63 8.5 65.4 „ South- West 67 10.0 65.7 „ Whole District 481 7.95 60.5 yrs. 13 Deaths from cancer rose from 65 to 85, and provide a death rate for this cause of 1.38 per 1,000 population compared with 1.08 in the year before. Mortality was rather higher among males than females. One quarter of all cancer deaths were due to disease of the lungs. CANCER DEATHS - WARD DISTRIBUTION, 1947 Ward Cancer Deaths Rate per 1,000 Estimated Population St. Helier North 11 1.28 St. Helier South 5 0.70 St. Helier West 7 0.81 North- East 15 1.61 North- West 9 1.23 Central 16 2.46 South- East 9 1.22 South- West 14 2.12 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 - - - 46 Digestive Organs— Oesophagus 1 - 1 Stomach 7 5 12 Liver 2 1 3 Intestines 3 8 11 Rectum 6 - 6 Pancreas 2 1 3 Peritoneum - 1 1 47 Respiratory Organs— Larynx - - - Lungs and Bronchi 17 4 21 48 Uterus - 3 3 49 Other female genital organs - 4 4 50 Breast 1 6 7 51 Male genital organs 3 - 3 52 Urinary Organs 1 2 3 55 Other organs— Generalised Lymphosarcoma 1 - 1 Parotid 1 - 1 Crainal Carcinomatosis 1 - 1 Malignant Melanoma 1 - 1 Sarcoma of Hip - 1 1 Malignant disease of abdomen — 1 1 48 37 85 Average age at death- Males 64.1 yrs. Females 60.1 „ All persons 62.2 „ 14 Tuberculosis was responsible for the same number of deaths, viz., 25 as in the year before. Mortality at 0.40 per 1,000 population is the lowest for 20 years. The death rates for this disease for the last twenty years were as follows :— Year. Death Rate per 1,000 Population. Year. Death Rate per 1,000 Population. 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 1937 0.63 1947 0.40 The distribution of tuberculosis mortality by wards and other details are given in Section F of this Report. The common infectious diseases accounted for three deaths, one from typhoid fever and two from diarrhoea in babies. The unusual epidemic of infantile paralysis resulted in five deaths. Violence in various forms was responsible for 21 deaths due to the following causes:— Suicide 6 Homicide 2 Road Traffic Accidents 4 Accidents in the home 6 Drowning 1 Fall in the street 1 Accident at work 1 Inquests. Inquests were held on 50 persons whose deaths occurred in the district and the following verdicts were returned :— Accidental Death 42 Suicide 6 Homicide 2 Eighteen of the total were residents of the district. Two deaths were due to road accidents. 15 INFANT MORTALITY. The number of children under 1 year of age whose deaths were registered during the year was 24, of which 13 were males and 11 females. This gives an infant mortality rate of 22.8 per 1,000 live births. It is again a very favourable index, being second only to the previous year's record low and compares with a rate of 41 for the country as a whole. All but two were deaths of legitimate children. Of the total, 50% died in the first week of life and 75% died from prematurity, congenital abnormality or other birth conditions and diseases peculiar to the first year of life. Five (21%) were clearly the result of infections, 3 from pneumonia and 2 from gastro-enteritis. Although infantile paralysis was present in the district as elsewhere in epidemic form during the summer and autumn no case of this disease in a child of under one year of age came to notice. The ward distribution of infant mortality and the causes of death are shown in Tables 6 and 7. TABLE 6. INFANT MORTALITY—WARD DISTRIBUTION. Ward. Infant Deaths. Rate per 1,000 Live Births. St. Helier North 7 50 St. Helier South - - St. Helier West 2 14 North-East 6 26 North-West 2 12 Central 3 .29 South-East 1 8 South-West 3 37 The infant mortality in the various wards in the teu year period 1938/47 was as follows:— WARDS St. H. North St. H. South St. H. West N.E. N.W. C. S.E. S.W. Whole District Live Births 1213 978 1141 1753 1078 771 948 708 8590 Infant Deaths 51 43 38 56 37 16 33 12 286 Infant Mortality (per 1,000 births 42.0 49.0 33.3 31.9 34.3 20.9 34.8 17.0 33.3 MATERNAL MORTALITY. For the third year in succession there was no death attributable to maternal causes. 16 TABLE 7. INFANT MORTALITY DURING THE YEAR 1947. 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 1 - 3 Diarrhoea - - - - - - - - - - Enteritis - - - 1 1 - 1 - - 2 Gastritis - - - - - - - - - - Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Suffocation (overlying) - - - - - - - - - - Injury at Birth 1 - - - 1 - - - - 1 Atelectasis 1 1 - - 2 - - - - 2 Congenital Malformation 3 - - - 3 1 - 2 - 6 Premature Birth 8 - - - 8 - - - - 8 Atrophy, Debility and Marasmus - - - - - - - - - - Other Infantile Diseases - - - - - 1 - - - 1 Other Causes - - - - - - - - 1 1 Totals 13 1 - 1 15 3 2 3 1 24 - 17 TABLE 8.—CAUSES OF DEATH DURING THE YEAR 1947. BY Age 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 13 11 3 2 4 5 9 4 9 5 15 18 26 28 44 19 53 46 60 107 236 245 481 1 Typhoid and Paratyphoid Fevers - - - - - - - - 1 - - - - - - - - - - - 1 - 1 2 Cerebro- Spinal Fever - - - - - - - - - - - - - - - - - - - - - - - 3 Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - 4 Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - 5 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - 6 Tuberculosis of Respiratory System - - - 1 - - 1 3 3 2 2 3 - 1 4 - 1 - 1 - 12 10 22 7 Other Forms of Tuberculosis - - 1 - - - - - - - 1 - - 1 - - - - - - 2 1 3 8 Syphilitic Diseases - - - - - - - - - - - - 1 - - 1 - - 1 - 2 1 3 9 Influenza - - - - - - - - - - - - 1 1 - - - - 1 - 2 1 3 10 Measles - - - - - - - - - - - - - - - - - - - - - - - 11 Ac. Poliomyelitis and Polioencephalitis - - - - 3 - - - - 2 - - - - - - - - - - 8 2 5 12 Ac. Infectious Encephalitis - - - - - - - - - - - - - - - - - - - - - - - 13 Cancer of Buc. Cav and Oesophagus (M) Uterus (F) - - - - - - - - - - - - - 2 - 1 - - 2 - 2 3 5 14 Cancer of Stomach and Duodenum - - - - - - - - - - - 1 2 - 3 1 2 - - 3 7 5 12 15 Cancer of Breast - - - - - - - - - - - 2 - 3 - - 1 - - 1 1 6 7 16 Cancer of all Other Sites - - - - - - 1 - 1 - 4 - 8 4 11 3 7 8 6 8 38 23 61 17 Diabetes - - - - - - - - - - - - - - - - - 1 - - - 1 1 18 Intra- cranial Vascular Lesions - - - - - - - - - - - - 2 2 3 2 11 12 9 25 25 41 66 19 Heart Disease - - - - - 1 1 - - - 4 5 4 2 11 4 17 13 18 37 55 62 117 20 Other Diseases of Circulatory System - - - - - - - - - - - - 2 - 2 2 3 1 I 4 8 7 15 21 Bronchitis - - 1 - - - - - - - 2 - 2 1 2 1 3 1 9 4 19 7 26 22 Pneumonia 2 1 1 1 - - - - 2 - - - 2 2 - 1 2 1 4 10 13 16 29 23 Other Respiratory Diseases - - - - 1 - - - - - - - - 2 1 - - 1 - - 2 3 5 24 Ulcer of Stomach or Duodenum - - - - - - - - - - - - - - - - 1 2 - - 1 2 3 25 Diarrhoea, under 2 years - 2 - - - - - - - - - - - - - - - - - - - 2 2 26 Appendicitis - - - - - - - - - - - - 1 - - - - - 1 - 3 - 3 27 Other Digestive Diseases - - - - - - - 1 - - - 1 1 - 1 - 2 1 1 1 5 5 10 28 Nephritis - - - - - 1 1 - - - - - - 2 2 1 1 - - 2 4 6 10 29 Puerperal and Post Abort. Sepsis - - - - - - - - - - - - - - - - - - - - - - 30 Other Maternal Causes - - - - - - - - - - - - - - - - - - - - - - - 31 Premature Birth 4 3 - - - - - - - - - - - - - - - - - - 4 3 7 32 Congenital Malformation, Birth Injury, Infant Diseases 6 5 - - - - - - 1 1 - - - - - - - - - - 7 6 13 33 Suicide - - - - - - 1 - - - 1 3 - 1 - - - - - - 2 4 6 34 Road Traffic Accidents - - - - - 1 - - 1 - 1 - - - - - - - - 1 2 2 4 35 Other Violent Causes - - - - - 2 1 - - - - - - - 1 1 - 3 - 3 2 9 11 36 All Other Causes 1 - - - - - 3 - - - - 3 - 4 2 - 2 2 6 8 14 17 31 18 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 eight, four whom are midwives included in the County Council's domiciliary midwifery scheme The following information in respect of the work of this Association during 1947 is supplied by courtesy of the Honorary Secretary:— Cases Attended. Visits Paid. General 684 General 8,056 Maternity 80 Maternity 1,378 Midwifery 88 Midwifery 1,863 Casual 263 Ante-natal 885 Post-natal 114 Clinics 196 852 12,755 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 1 5 General 37 779 Clinics - 49 38 833 The nurses of both Associations attend the Council's Clinics. Laboratory Facilities. The facilities in use were the same as in the year before, namely:— Clinical material in connection with infectious disease, puerperal pyrexia and tuberculosis was submitted for examination to the Emergency Public Health Laboratory, St. Helier Hospital, and the Sutton and Cheam Hospital Laboratory. Food and Drugs and water samples were examined by Mr. D. D. Moir, the Council's Public Analyst, whose laboratory is at 16, South wark Street, London, S.E.I. 19. The following examinations were made :— No. Examined. Positive Results. Swabs for diphtheria 67 - Sputum for tubercle 11 - Faeces for enteric, dysentery, etc. 13 1 Blood for Malaria 1 - Water For chemical analysis 3 For bacteriological examination 5 Food and Drugs:— Analysis 280 Bacteriological examination of milk 191 Bacteriological examination of ice cream 84 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 Council maintain two ambulances and one sitting case car at The Grove, Carshalton, to provide a free service for the removal of residents within a twenty miles radius and from County hospitals, The following information, supplied by the Hon. Ambulance Officer, indicates the use made of the service during the year, Calls to Street Accidents, etc. 148 Answered by own ambulances 131 Transferred to other authorities 17 Calls to remove cases from domestic dwellings to nursing homes, hospitals, or vice versa 1,105 Answered by own ambulances 1,006 Transferred to other authorities 99 Calls answered for authorities in other districts 151 Total calls answered 1,404 Distance travelled on calls (miles) 10,603 Average mileage per call (miles) 8.23 Number of occasions on which both ambulances were out at the same time 5 Number of occasions on which a third call was transferred to other services when both vehicles were out or one under repair 116 Greatest number of calls answered in any one day 13 Reciprocal arrangements exist with all neighbouring authorities. The total calls answered was 178 more than in the year before, but the mileage involved was 158 less. 20 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 beds have been much reduced owing to the all too common hospital experience of shortage of staff. The following table shows the cases admitted to Cuddington and other infectious diseases hospitals. TABLE 9. CASES ADMITTED FROM CARSHALTON TO CUDDINGTON HOSPITAL DURING 1947. Disease. Cases. Deaths. Scarlet Fever 58 - Diphtheria 2 - Poliomyelitis 9 3 Measles 4 - Chirkenpox 6 - Whooping Cough 2 - Rubella 3 - Typhoid Fever 1 - Meningitis— Cerebro spinal 2 - Meningitis—T.B. 1 1 Meningismus 1 - Erysipelas 4 - Tonsillitis 5 - Dysentery 2 - Gastro-enteritis 2 - Bronchitis 1 - No apparent Disease 1 - Others 20 1 124 5 Transferred to other hospitals 14 1 138 6 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. 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 1947 :— Total cases admitted 971 Casualties admitted 57 Maternity cases 146 Casualties treated but not admitted 479 X-ray Patients 2,134 21 In-patients were admitted from the following districts :— Carshalton 494 Beddington and Wallington 356 Other Districts 121 971 Physiotherapy Department :—Patients, 642. Attendances, 6,520. 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 Wednesdays 2—4 p.m. Dental Clinic Mons, and Thurs, 10—12 a.m. Fourth Saturday 10—12 a.m. Massage Clinic Mons. and Fridays 2—5 p.m. Tues. and Weds, 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—4 p.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 Fridays 10—12 a.m. The Mount Centre:— Infant Welfare and Maternity Clinic 2nd and 4th Weds. 2—4 p.m. Diphtheria immunisation treatment is available for children under 5 years at all the infant welfare and toddler clinics. MATERNITY AND CHILD WELFARE. Public Health Act, 1936—Section 203. The number of births which were notified, as adjusted by transferred notifications, was as follows:— Live births ... 1,051 Notified by midwives 902 Still births ... 28 Notified by doctors and parents 29 Transferred notifications 148 1,079 1,079 The total is 37 less than in 1946 and represents 103% of the births registered during the year. 22 Health Visiting. Throughout the year five full time Health Visitors were employed on maternity and child welfare duties. In consequence, health visiting was on an increased scale, some 1,400 more visits being made to mothers and children than in the year before. 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 145 Total visits 180 To children under 1 year :— First visits 1,013 Total visits 3,225 To children 1-5 years:— Total visits 4,418 7,823 Clinic Activities. The programme of fixed sessions at the welfare centres was the same as at the end of 1946, except that the toddlers' clinic at the Rochester Road centre was held weekly on Wednesday afternoons, instead of fortnightly, as from the beginning of September. The level of attendances at the clinics during 1947 reached the highest yet recorded, the total approaching 23,000. The number of babies under 1 year who attended for the first time at 788 represents 75% of the notified live births, whilst the new cases of expectant mothers represents 53% of the total births. Children under 5 in attendance at the clinics throughout the year at 3,049 exceeded the previous year's record by 323. The estimated pre-school child population of the district at mid-year was 4,480— hence approximately 70% of the total attended the welfare clinics. Routine Medical Inspection of Toddlers. The programme of special toddler clinics was increased by the institution of weekly sessions at Rochester Road Centre from the beginning of September. The object of these clinics is to provide a general medical overhaul for childre in their third, fourth and fifth years as distinct from the limited scope of the medical consultations held at the infant welfare sessions. More than a thousand children, 186 of whom did not attend the regular infant welfare clinics during the year, and 77 of whom had not attended any clinic at anytime, were examined under these arrangements. Out of 1,024 children examined, 403 had no defects. The remaining 621 were found to have 883 defects, of which 465 were deemed to require treatment and 418 referred for observation. The proportion of children whose examination was completely satisfactory at 40% was the highest yet experienced since these special clinics were established ten years ago. 23 TABLE 10. ATTENDANCES AT MATERNITY CLINICS—1947. Centre. No. on Register. Attendances Sessions. Average attendance per Session. *Primary Total. Rochester Road. Ante-Natal 229 164 1076 100 11.1 Post- Natal 33 3 34 Individuals 232 167 1110 Wrythe Lane Hall. Ante- Natal 403 331 1689 102 16.8 Post- Natal 29 - 29 Individuals 403 331 1718 St. Helier. Ante-Natal 1 1 1 22 0.04 Post-Natal - - - Individuals 1 1 1 Stanley Road. Ante-Natal 101 70 408 52 8.27 Post- Natal 17 4 22 Individuals 105 74 430 The Mount. Ante-Natal 20 12 82 24 3.6 Post- Natal 3 - 3 Individuals 20 12 85 All Centres. Ante-Natal 754 578 3256 300 11.1 Post- Natal 82 7 88 Individuals 761 585 3344 * Primary attendance is the first attendance of a woman in relation to the pregnancy under supervision. A further (»0 Carshalton mothers attended the St. Helier Hospital Ante-Natal Clinic but not the Council's clinics. 24 TABLE 11 ATTENDANCES AT INFANT CONSULTATION CLINICS, 1947. 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 1099 253 253 253 3852 103 48.4 1-5 42 751 28 1135 Wrythe Lane Under 1 895 275 246 274 3898 103 47.2 1-5 25 619 19 971 St. Helier Under 1 259 112 115 111 1548 49 44.4 1-5 5 123 4 622 Stanley Road Under 1 504 122 105 122 2670 50 70.0 1-5 15 363 8 830 The Mcunt Under 1 106 28 25 28 311 24 28.7 1-5 7 74 3 379 All Centres Under 1 2863 790 744 788 12279 329 49.3 1-5 94 1930 62 3937 Totals 2863 884 2674 850 16216 329 49.3 25 TABLE 12. DEFECTS FOUND AT SPECIAL TODDLER EXAMINATIONS—1947. Defect. Recommended for Number which received treatment by Observation. Treatment. Own Dr. Hospital. At Home by Advice. Clinic. Total. Cleanliness - 2 - - 2 - 2 Nutrition 5 19 2 2 10 1 15 Ringworm Skin - - - - - - - Impetigo - 2 - - 2 - 2 Scabies - - - - - - - Other Skin (Non-Tub.) 12 26 2 - 14 - 16 Blepharitis Eyes 1 2 - - 1 - 1 Conjunctivitis - - - - - - - Keratitis - - - - - - - Corneal Ulcer - - - - - - - „ Opacities - - - - - - - Other Conditions - - - - - - - Vision 1 1 - - - - - Squint 14 14 - 13 - - 13 Hearing Ears 1 2 - 1 - - 1 Otitis Media 1 2 - 1 - - 1 Other Diseases - 1 - - - - - Teeth 25 58 4 - 2 40 46 Tonsils 113 25 1 20 - - 21 Adenoids 28 11 - 10 - - 10 Other Conditions 4 2 1 1 - - 2 Enlarged Cervical Glands 51 12 1 7 1 - 9 Speech 6 3 - - 1 - 1 Heart Disease 29 4 - 4 - - 4 Anaemia 4 48 - - 38 - 38 Lungs, Tubercular 9 1 - 1 - - 1 Lungs, non-Tubercular 13 12 4 4 3 - 11 Other Tubercular Diseases 1 - - - - - - Epilepsy - 1 - - - - - Chorea - - - - - - - Other Nervous Conditions 1 - - - - - - Rickets 2 21 - 4 5 2 11 Spinal Curvature - 6 - 2 - - 2 Other Deformities 31 47 1 2 19 16 38 Mental Condition 8 6 - 6 - - 6 Behaviour 3 8 - 1 - - 1 All other Defects 55 129 4 7 66 10 87 Total 418 465 20 86 164 69 339 26 TABLE 13. ATTENDANCES AT SPECIAL TODDLER (2-5 YEARS) CLINICS, 1947. 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 191 138 99 35 463 33 14.0 49 Wry the Lane 179 126 98 6 409 50 8.2 117 Stanley Road 79 63 51 10 203 24 8.4 20 Totals 449 327 248 51 1075 107 10.0 186 TABLE 14. ATTENDANCES AT ALL INFANT WELFARE "CLINICS, 1947. (Infant Consultation and Special Toddler). Year. Number who attended during the year. New cases to the Centres. Attendances. Sessions. Average attendance per Session. Primary. Total. 0-1 3049 790 788 12279 329 37.3 1-5 171 139 5012 436 11.5 Totals 3049 961 927 17291 436 39.6 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. 27 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, 1947. Temporary Teeth. Permanent Teeth. Dentures Supplies. Extracted. Filled. Extracted. Filled. Full. Partial. 80 67 305 218 34 53 Anaesthetics Gas 97 Trilene 28 Local 12 Inspections 287 Other operations Impressions 113 Bites 70 Try-ins 94 Dressings 6 Scalings 77 Repairs 11 Remodelling 6 Dentures supplied:— Full Partial. Free 2 2 Part Cost 6 3 Full Cost 26 48 Total 34 53 28 Attendances at the Dental Clinics were as follows:— DENTAL SCHEME—ATTENDANCES, 1947. Centre Referred from. No. Treated. No. of attendances. Rochester Road. Children 36 76 Mothers 62 268 Individuals 98 344 Wrythe Lane. Children 34 52 Mothers 79 340 Individuals 113 392 St. helier. Children 1 1 Mothers 5 37 Individuals 6 38 Stanley Road. Children 15 25 Mothers 13 61 Individuals 28 86 The Mount. Children - - Mothers 4 9 Individuals 4 9 Day Nursery. Children 1 1 All Centres. Children 87 155 Mothers 163 715 Individuals 250 870 Number of Sessions held 95 Average attendance per Session:— Children 1.6 Mothers 7.5 Individuals 9.1 29 Orthopaedic Treatment. The Massage Clinic for minor orthopaedic defects established at the Rochester Road centre in 1946 was fully attended throughout the year. The number of sessions held was 144. at which the following 61 cases made 1,280 attendances:— Spastic Dyplegia 1 Kyphosis 1 Post-operative Megacolon 1 Muscular contracture in legs 2 Genu- varum 38 Genu- valgum 11 Muscular Atonia 7 By arrangement with the Committee, orthopaedic cases are referred to the out-patient department of the Croydon General Hospital and assistance is available where necessary towards the cost of in-patient treatment and the provision of surgical appliances. Convalescent Treatment. The Council have an arrangement with the Invalid Children's Aid Association for the convalescent treatment of children. They also subscribe to the Surrey Convalescent Homes to provide similar treatment for mothers and babies. Three children under 5 years and one mother and baby received treatment under these arrangements during the year for a total of 30 patient weeks. 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 woman referred from the Council's clinic and admitted to hospital during the year were as follows:— For obstetric and medical reasons. For unsuitable home conditions. Total. Carshalton (War Memorial) Hospital - - - St. Helier County Hospital 71 41 112 Other County Hospitals 3 1 4 74 42 116 Whilst only 116 mothers were referred to hospital for confinement from the clinics it should be noted that 528 Carshalton babies were born in hospital and a further 80 in nursing homes. 30 Premature Babies. The number of premature babies born in the district was 193, of which 168 were born in hospital or 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 19 (ii) who died during the first 24 hours (iii) who survived at the end of one month 16 The number of those born in hospital or nursing home— (i) who died in the first 24 hours 17 (ii) who survived at the end of one month 141 The survival rate at one month was 81%, compared with 86% in the two previous years. The figures shown are for babies born in the district, the majority being births to non-residents in the St. Helier Hospital. The number of premature babies born to residents of the area was 63, which represents nearly 6% of the total live births. 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. Unmarried Mothers and Illegitimate Children. Illegitimate births at 38 were 9 less than in the year before and were 4% of the total. Welfare work in respect of unmarried mothers is carried out by the Sutton and District Girls' Aid Association with whose worker the Council's service works in close co-operation. The Council contributes to the funds of the Association and invariably accepts responsibility for the uncovered balance of cost of maintenance 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 1947:— Unmarried mothers assisted 3 Unmarried mothers provided with special institutional accommodation 2 Unmarried mothers with illegitimate children assisted 2 Illegitimate babies 5 Of these, three are with their mothers and one is adopted. 31 The Council accepted responsibility for the cost of maintenance in Special Homes for three unmarried mothers and their babies for a total of 12i patient weeks. Consultant Service. No call was received during the year for the services of a consultant which are available for the complications of labour and pregnancy. Emergency Maternity Unit. The emergency maternity unit based on the War Memorial Hospital was not used during 1947. Maternity Outfits. Sterilised outfits for use during confinement are available at cost price or less than cost in necessitous cases. Home Helps. For providing domestic assistance in homes during confinement 4 full time and 2 part-time occasional helps were employed in 1947. Assistance in this form was supplied to 55 households. The charges made for the service were in accordance with the scales recommended by the Metropolitan Boroughs Standing Joint Committee adopted by the Council. Midwives. Two midwives are appointed by the District Council under the County Council's midwifery scheme, formulated under the Midwives Act, 1936. The fees fixed by the County Council for the services of the midwives are as follows:— As Maternity Nurse 35/As Midwife 40/- Provision 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 62 160 222 Still births 1 2 3 (2) As Maternity Nurse — Live births 4 4 8 Still births — 1 1 67 167 234 Visits made:— Ante-natal 1,921 Nursings 3,746 Post-natal 448 To ante-natal clinic 142 32 Medical Aid Forms sent by Midwives 69 Delayed Labour 12 Prematurity 4 Torn Perineum 22 Discharging Eyes 5 Abnormal Presentation 7 Ante- Partum Haemorrhage 1 Haemorrhage of Infant 1 Prolapse of Cord 1 Phimosis 6 Precipitate labour 2 Cystocele 1 Malformation of infant 3 Vomiting of Infant 1 Rise of Temperature 1 Hysteria 1 Stillbirth 1 Number of Cases which attended the ante- natle clinic 136 Twenty-eight other midwives resident in the district declared their intention to practise in 1947. Of these, 17 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. The Scheme had the benefit of the services of ten voluntary helpers who regularly attended the welfare clinics throughout the year. As this report covers the last complete year during which the District Council was responsible for the Maternity and Child Welfare Scheme, the occasion should not pass without appropriate acknowledgment being made of the great amount of time and effort which these public spirited ladies have so willingly given in the interests of the mothers and children of the district. With unfailing regularity they have helped with the conduct of the clinics year by year and, in the case of Mrs. Champness and Mrs. Claxton, over a period of nearly thirty years. The notable success which, since its inception, the maternity and child welfare scheme has achieved under the aegis of the District Council has, in no small measure, been due to the willing service of the voluntary helpers. The ladies who helped at the welfare centres were as follows :— Rochester Road Clinic: Mesdames Champness, Claxton, Jennings and Nicholls. Stanley Road Clinic: Mesdames Bonney, Riley, Wedgbury. Wrythe Lane Clinic: Mrs. Slowgrove. The Mount Clinic: Mesdames Abrahams and Collins. 33 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 11 Total number of foster homes supervised 24 Number of the children admitted to the register during the year 12 Number of children removed from the register during the year 11 Total number of children on the register at year end 15 Total number of children on the register during the year 23 Number of children who died during the year — Number of inquests held — Number of visits made to foster homes 110 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 15 (b) Total number of children in respect of whom notice was given under Section 7 (3) during the year 15 (c) Number of children notified under Section 7 (3):— (i) under supervision at the end of the year 8 (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 6,144, which gives an average of 20 for the 306 days the nursery was open. All the 27 mothers were in employment, 20 in a full time capacity and 7 parttime. 34 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 7.30 a.m. to 6 p.m. and on Saturdays 7.30 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 mother, 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 1947 were as follows:— Total attendances—under 2 years 5,580 over 2 years 9.686 15,266 Days open 304 Average daily attendance—under 2 years 18.3 over 2 years 31.8 50.1 Attendances excluding Saturdays— under 2 years 5,514 over 2 years 9,482 14,996 Days open, excluding Saturdays 257 Average daily attendance, excluding Saturdays—under 2 years 21.4 over 2 years 36.9 58.3 DOMESTIC HELPS. The Domestic Help Scheme was established by the Council in 1945 in accordance with Ministry of Health Circular 179/44. The objects of the Scheme are similar to those of the Home Help Scheme for providing domestic assistance during confinement which has been a feature of the Maternity and Child Welfare Service for many years and to which reference has already been made. The Domestic Help Service, however, is wider in its scope and 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. Four full time helps and several parttime and occasional helps were employed under both schemes. Payment to the helps and the scale of contribution was the same in each. Domestic help was supplied to fourteen households for periods varying up to six weeks. These were additional to the 55 families assisted under maternity and child welfare arrangements. 35 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, some 170 dwellings only in the extreme north being supplied by the Metropolitan Water Board. On an agreed rota, water, as received by the consumer, is sampled twice monthly as a routine by the Public Health Departments of the constituents districts in the Company's supply area. The normal sources of supply of the Company are chalk wells situated at Cheam, Sutton and Woodmansterne. These can be supplemented, when necessary, by water from the Metropolitan Water Board, the Epsom and Ewell Corporation and the East Surrey Water Co. The supply has been satisfactory in quality and quantity. The following statement supplied by the Engineer shows the extent of sampling carried out by the Water Company :— No. of Bacteriological Examina tions No. of Full Chemical Analyses Presumptive B. Coli present in 100 cc. (excluding types 1 & 2) B. Coli present in 100 cc. (types 1 & 2) No. % No. % Sutton Raw 307 40 12 4.0 19 6.0 Sutton Finished 315 41 42 13.0 13 4.0 Woodmansterne Raw 311 40 3 1.0 Nil Nil Woodmansterne Finished 313 40 1 0.3 Nil Nil Cheam Raw 308 47 6 2.0 4 1.3 Reservoir 231 Nil 1 0.4 1 0.4 District including New Mains 301 22 11 4.0 5 1.7 The following detailed report of a sample taken by this Department is fairly representative:— Chemical analysis in parts per 100,000. Total solid matter in solution (dried at 180° C.) 21.3 Combined chlorine 1.83 Nitric nitrogen 0.86 Nitrous nitrogen 0.002 Ammonia, free and saline 0.0040 Ammonia, albuminoid 0.0015 Oxygen absorbed from permanganate in 4 hours at 26.7° C. 0.010 Hardness—by acidimetric titration— Temporary 7.2 Permanent 6.5 Total 13.7 PH 7.5 36 Reaction for free chlorine; positive, equivalent to 0.20 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. 1 Number of colonies per ml. developing upon agar in 3 days at 22° C. 0 Organisms of the coliform group absent in 100 ml. Streptococci do. Cl. welchii do. This water is of high organic purity and its bacteriological condition is excellent The water is suitable for the public supply. The waters are not plumbo-solvent. No contamination of note was experienced during the year. All dwelling houses in the district have a direct supply from the public mains. Drainage and Sewerage. The whole of the developed area is soil sewered, except for a small part containing 17 properties in the extreme south-east of the district. Sewage is pumped to the disposal works of the Croydon Corporation in Beddington, except at various points on the fringes of the district where it is more conveniently drained to the sewage systems of neighbouring authorities. Surface drainage is mainly by soakaways in the south where the sub-soil is chalk ; elsewhere the district is surface sewered to the River Wandle. No extensions or replacements of any note were made during 1947. Rivers and Streams. The negotiations referred to in the previous report were concluded with the result that, as from 1st April, 1947, the Surrey County Council took over the maintenance of the River Wandle. Five complaints were received and adequately dealt with. Closet Accommodation. All premises have water closets connected to sewers, except 17 which are connected to cesspools in non-sewered areas. Public Cleansing. A gradual increase in labour strength and delivery of two reconstructed vehicles enabled the refuse collection to be improved until by the end of the year a weekly collection had been practically obtained for the whole district. The disposal works was brought into action again in April after reconstruction and is now giving good service. 37 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 into 2,084 complaints concerning the following:— Drains obstructed 345 Sewers obstructed 10 Drainage defects 204 General defective conditions 254 Dampness 56 Roofs, gutters, etc. 62 Sink waste pipes 12 Water supplies 30 Dustbins 212 Accumulations 41 Refuse Collection 17 Smoke nuisance 13 Rivers, ditches, ponds 7 Unsound food 257 Overcrowding 76 Obnoxious effluvia 10 Verminous premises 27 Scabies 2 Rats and Mice 259 Wasps 34 Ants 7 Beetles 1 Flies 8 Animals 20 Insects, various 8 Dirty Milk Bottles, sour milk 5 Miscellaneous 50 Pig Bins 31 Soakaways 3 Burst pipes 12 Shops 2 2084 A total of 11,286 visits of inspection and re-inspection were made for the following purposes:— Public Health Act (houses) 3,218 Public Health Act reinspections 3,808 Dairies 48 Cowsheds 60 Milk Shops 38 Factories 182 House drains tested 37 Suspected rat infested premises 228 Foodshops and business premises 912 Infectious disease premises 192 Infectious disease contacts 132 Urinals 56 Premises re cesspools 29 Schools 6 38 Offices 56 Bakehouses 23 Stables 14 Smoke observations 11 Outworkers' premises 51 Employment Agencies 9 Piggeries 15 Food Poisoning Enquiries 2 Food and Drugs and other samples 802 Shop premises 392 Animals, slaughter of 4 Housing Enquiries 946 Water Sampling 15 11,286 Nine hundred and fifty-three informal notices were served concerning the following matters:— General defective conditions 440 Rats and mice 1 Accumulations and deposits 20 Obstructed drains 29 Drainage defects 199 Verminous premises 10 Dustbins 69 Water supply 15 Animals 5 Factory Acts 9 Food contamination 1 Unsatisfactory food premises 18 Miscellaneous 3 Burst pipes Overcrowding 113 Shops Acts 13 Smoke nuisance 3 Pollution of Rivers 3 953 One hundred and eleven formal notices were served by authority of the Council under the following acts:— Section 24 Public Health Act, 1936 4 Section 39 „ „ 10 Section 56 „ „ 1 Section 75 „ „ 15 Section 93 „ „ 79 Section 13 Food and Drugs Act, 1938 1 Section 7 Factories Act, 1937 1 111 39 As a result of investigations made and notices served, the following work was carried out:— Brickwork, repaired and/or repointed 3 Ceiling plaster repaired and/or made good (including plaster board) 101 Ceilings cleansed and purified 20 Chimney pots repaired and/or made good 4 stacks repaired and/or made good 3 flues repaired 15 Damp conditions remedied 51 Damp course provided 2 Doors repaired, including locks and fasteners 11 Door frames repaired and/or made good 11 stopping to reveals renewed 11 . weather boards repaired or renewed 4 Drainage repaired and/or reconstructed 35 provided 1 connected to sewer 2 inspection chamber repaired and/or made good 6 inspection chamber covers renewed 17 inspection chambers and covers provided 3 stoppers or caps refixed and/or renewed 1 interceptors renewed 1 interceptors provided 1 fresh air inlet repaired and/or renewed 2 mica flap valve renewed 1 Soil vent repaired and/or renewed 7 drains tested 23 drains cleared (affecting 1189 houses) 339 drains sealed off 2 Waste gullies repaired, renewed or cleared 7 Waste gullies provided 4 Waste pipes, repaired, renewed or provided 18 Disinfestation 23 Dustbins provided 105 Floor boards repaired and/or made good 44 concrete repaired, renewed and/or made level 7 ventilation provided 2 Fire-places repaired and/or made good 14 Fire grates repaired and/or renewed 12 Ranges, stoves repaired and/or renewed 7 Roofs repaired and made weatherproof 139 ridges, hips, valleys repaired and/or renewed 1 flashings repaired and/or renewed 2 Down pipe, guttering repaired and/or renewed 89 cleared out and made to work properly 5 Sinks renewed 3 provided 2 Stair treads repaired, renewed or made level 2 handrails and/or balusters repaired 1 handrails and/or balusters provided 1 Steps repaired and/or renewed 5 Steps provided with handrail 1 Soakaway made to work properly 4 Surface water drainage repaired and made to work properly 2 40 Walls, cement rendered 2 rendering repaired 21 replastered and/or repaired 129 cleansed and redecorated 18 rebuilt 2 Woodwork repaired and/or renewed 1 Windows repaired and/or renewed 24 Window frames repaired and/or renewed 29 Windows made to work properly 4 provided with catches or fasteners 3 sash cords renewed 49 Window sills (external) repaired 6 stopping to reveals 10 W.C. accommodation repaired 1 W.C.s provided 2 W.C. pans renewed 97 pan joints renewed 29 seats repaired, renewed or provided 9 flushing apparatus repaired or renewed 52 Water supply repaired 37 provided 4 Water cisterns repaired 2 Wash basins, baths renewed 1 provided 3 Paving repaired and/or made level 5 provided 2 drained 1 Rats and Mice 267 Glazing panes and putty renewed 3 Ventilation, more provided 3 Accumulations removed 13 Other matters 6 Disinfection. In connection with cases of infectious disease, 175 rooms and 205 library books were fumigated. Sixty-one 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 respect 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 49 202 399 For pediculosis 29 126 242 78 328 641 41 School children included in these totals were :— For scabies 80 For pediculosis 61 Where possible, the practice of treating all members of affected families is followed. Premises. The previous practice of hydrogen cyanide fumigation for premises badly infested by the bed bug has been resumed, and one Council house was treated. Nine properties were treated by insecticidal spraying as follows:— Council Houses 5 Other Houses 4 Four other L.C.C. houses were sprayed by the staff of that Authority Fumigation and spraying is carried out by the Department, using various insecticidal liquids. Two lots of bedding were destroyed during the year. Pest Control. Nine premises were sprayed for the eradication of flies, fleas, etc. Thirty-three wasp nests in, or in proximity to, dwellings were destroyed at the cost of the complainants. Three sprayings for the destruction of mosquito larvae were carried out. Rats and Mice (Destruction) Act, 1919. Ministry of Food Infestation Order, 1943 (S.R. & 0. 680) (Circular N.S. 11 and 12). Under the direction of the Ministry of Food, rodent destruction was again further intensified under Schemes N.S. 11 (Sewer Treatment) and N.S. 12 (Private Premises). With regard to private and business premises, the year's investigations amounted to 11,427. Arising out of these investigations and 259 complaints, 267 infestations were dealt with (251 rat and 16 mouse). One preliminary notice was served. The infested premises were classified as follows:— Rats. Mice. Total. Private Premises 217 7 224 Business Premises 18 1 19 Council Property 16 8 24 251 16 267 With regard to Sewers (N.S. 11) an initial treatment was carried out in the Autumn of 1946, after which the first maintenance treatment was completed in April, 1947, with the following results:— Manholes baited 468 Manholes in which takes of prebait were recorded 31 Percentage of manholes showing infestation 6½% Percentage in relation to total manholes in district 2¾% 42 In view of the apparent rapid decline in infestation following the initial and maintenance treatments, it was decided to carry out a test baiting of 10% of the manholes in the district before undertaking a second maintenance treatment in the Autumn of 1947. This test baiting gave the following results:— Manholes baited 102 Manholes in which takes were recorded 67 Percentage of baited manholes showing infestation 65% The high percentage of takes recorded (65%) was extremely disappointing in the circumstances and necessitated the carrying out of a maintenance treatment of the majority of the manholes in the district. This second maintenance treatment was completed in November, 1947, with the following results:— Manholes baited 904 Manholes in which takes of prebait were recorded 215 Percentage of baited manholes showing rat infestation 23.7% Percentage in relation to total manholes in district 19.8% Smoke Abatement Thirteen complaints were received during the year and dealt with. Shops Act 1912—1936. There were 497 shop premises on the register. Three hundred and ninety-two inspections of shops and business premises were made and informal action was necessary regarding infringements in 13 cases. Section 10 (Health and Comfort). It was necessary to take action in six cases for the provision of sanitary accommodation. Offices. Fifty-six inspections of offices were made but no action was necessary. Swimming Baths. The one privately owned swimming bath was in use during the year and two samples of water were taken, both of which were satisfactory. Disposal of the Dead. The land available in the Churchyard adjoining the Carshalton Parish Church for new graves is now rapidly being exhausted and the time is fast approaching when burials there must be restricted to the re-opening of the existing graves. 43 The Cemetery provided by the Merton and Morden and Carshalton Joint Cemetery Board at Morden, was opened for interments on the 1st April, 1947, and is now well established. During the last nine months of 1947, one hundred and twenty-one interments took place in the latter Cemetery, and of this number eleven only were from the Carshalton district. The fact that the Cemetery is not so conveniently situated as the Churchyard for the majority of the residents, may have had its influence in bringing about this result, but there is no doubt also that the custom so long established of burial in the Churchyard will persist so long as space is available there. So soon as conditions permit, the Cemetery Board desire to proceed with the erection of a Chapel, a residence for the Cemetery Superintendent and other necessary buildings. The absence of a Chapel must inevitably give rise to some inconvenience, and, as a temporary measure, when necessary, the Chapel at the adjoining Cemetery of the Battersea Borough Council is used. The negotiations with several of the adjoining Local Authorities on the question of the provision of a Crematorium have continued, and, as a result, the Battersea Borough Council are now in the process of preparing plans for a Crematorium to be accommodated on land forming part of their Cemetery site at Lower Morden. This adjoins the Cemetery provided by the Joint Board. Modern mortuary facilities with provision for post-mortem examinations are provided at the Council's Mill Lane Mortuary. Establishments for Massage and Special Treatment. Nine massage and similar establishments for special treatment coming within the scope of Part IV of the Surrey County Council Act, 1931, were visited and inspected. Conditions were found to be satisfactory. Employment Agencies. The Employment Agencies are visited by the Authority acting as Agents for the Surrey County Council. There are three on the register, and all were found to be satisfactory. 44 Section D— Housing. New Houses. During the year, 210 new houses of the following types were completed:— "Unity" permanent prefabricated 14 C. U. D. C. "Orlit" permanent prefabricated 16 Traditional 2 Under Licence 5 Private Rebuilds 129 L. C. C. Rebuilds (war damaged) 44 Private Total 210 Council's Housing Scheme. The dwellings in the ownership of the Council at the year end, totalled 75!) houses, flats and temporary bungalows. During the year work continued or was commenced on the undermentioned Contracts:— Site No Site Type. No. in Contract. No. completed during year. 2 Green Wrythe Lane "Orlit" permanent prefabricated 24 16 5 Fellowes Road (No. 1) 10 6 Fellowes Road (No. 2) 8 7 Hackbridge Cottage 16 9 Duke of Edinburgh Road 6 64 3 Clock House Farm " Unity " permanent prefabricated 96 14 Estate (part) 4 Wrythe Lane Maisonnettes 24 19 Connaught Road Traditional houses 2 2 21 Connaught Road ditto 2 188 32 In addition, the following schemes were in varying stages of preparation, but it has not been possible to put them into execution owing to the Government's control of projects involving capital expenditure :— Site No Site. Type. No. in Contract. 3 Clock House Farm Instate (part) Traditional houses 38 10 Denmark Road 2 12 Harrow Road 5 13 Nightingale Road 21 15 Kings wood Drive 11 18 Banstead Road 3 20 Barrow Hedges Estate 44 124 10 Denmark Road Flats 60 11 Alma Road 9 22 Prince of Wales Road 8 — 77 4 Wrythe Lane Maisonnettes 24 225 45 The accommodation under requisition by the Council at December 31st, comprised 217 family units. The number of outstanding approved applications for tenancies at the year end was approxinately 1,800. Inspection and Action taken under Statutory Powers. 1. Inspections of Dwelling Houses during 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.—3,218 3,218 (b) No. of inspections made for the purpose 7,026 (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 772 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 1946) 646 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 109 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 93 (b) By local authority in default of owners 1 46 4. Housing Act, 1936. Part IV—(Overcrowding). (a) (1) Number of dwelling houses overcrowded at the end of the year 274 (2) Number of families dwelling therein 431 (3) Equivalent number of adults dwelling therein 1,990½ (b) Number of new cases reported during the year 122 (c) (1) Number of cases of overcrowding relieved during the year 56 (2) Number of persons concerned in such cases 356 (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 possible during the year. Overcrowding. During the year 122 new cases of overcrowding were found and 56 were remedied, leaving 274 dwellings known to be overcrowded with l,990½ equivalent adults in occupation still to be decrowded at the year end. Details are as follows:— Overcrowded at 31.12.46. Dwellings found overcrowded during 1947. Houses decrowded during 1947. Remaining overcrowded at 31.12.47. Increase during year 1947. Dwellings 208 122 56 274 66 Equivalent Adults 1528 818½ 356 1990½ 462½ The 56 cases of overcrowding were abated during the year by:— Provision of alternative accommodation by:— (a) Carshalton Urban District Council— in pre- fabricated houses 7 in old houses 1 in new houses 2 10 (b) London County Council 33 (c) Other Authorities 1 Left the district 3 By removal of one or more occupants 9 47 The history of known overcrowding since the survey of 1936 is indicated by the following :— Ward. Houses overcrowded at Survey Houses found overcrowded up to Houses decrowded up to Houses remaining overcrowded at Overcrowded cases remedied during 1947. Formal action Informal action Total. 1936. 31.12.47 31.12.47 31.12.47 St. Helier North 40 182 147 75 17 4 21 St. Helier South 40 152 139 53 9 2 11 St. Helier West 45 156 143 58 10 4 14 North- East 17 98 67 48 3 1 4 North- West 10 57 52 15 2 - 2 Central 9 24 25 8 1 1 2 South- West — 6 5 1 - - — South- East 12 45 41 16 2 - 2 173 720 619 274 44 12 56 Of the 274 houses remaining overcrowded at 31/12/47—184 are owned by the L.C.C., 30 by the Carshalton Urban District Council and 60 privately owned. In 106 of the 122 new instances of overcrowding found during the year, there was more than one family in occupation and these were related families in 82 cases, as follows:— Number of Families 1 2 3 4 Total. Related 16 59 21 2 98 Not related ... - 20 4 - 24 16 79 25 2 122 Tents, Vans, Sheds and Similar Structures. No action was required. Cellar Dwellings. No action. Rent and Mortgage Interest Restrictions (Amendment) Act, 1933. Two applications for certificates were received and granted. Factories and Workplaces. There were 105 Factories on the Register, 72 of them using mechanical power. Employees numbered 1,365, of whom 833 were males and 532 females. Action was necessary under the Factories Act in nine instances (8 informal, 1 formal). 48 Section E-Inspection and Supervision of Food. Milk Supply. Cowkeepers. There are three cowkeepers registered in the District, two of whom are licensed by the County 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. The number of registered milk retailers was 10. Milk (Special Designations) Regulations 1936-1946. Licences under these Regulations were issued as follows:Principal Licences-Tuberculin Tested 6 Pasteurised 7 Supplementary Licences-Tuberculin Tested 9 Pasteurised7 Bacteriological Examination of Milk. One hundred and ninety-one samples of milk were procured and submitted for bacteriological examination. All the milks were sold under the Milk (Special Designations) Regulations, and 38 failed to comply with the prescribed Regulation. The results of the tests 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 17 7 10 - - 9 8 T.T. Pasteurised 24 18 6 23 1 - - Pasteurised 92 81 11 90 2 - - Heat Treated 57 49 8 56 1 - - Accredited 1 1 - 1 - - - 191 156 35 170 4 9 8 49 Two Dairymen, who had applied for the renewal of Special Designated milk licences were summoned to appear before the Public Health Committee, under Section 9 of the Milk (Special Designations) Order, 1936, in respect of a number of samples which had not been satisfactory. The Committee gave very careful consideration to the representation made and decided not to revoke or suspend any of the existing licences and to renew such licences. At the same time the Committee gave instructions for a severe warning letter to be sent to both the firms stating that further failures would be regarded as a serious breach of the conditions of the licence. The Committee also agreed to make representations as to the delay in transport of bottled milk to the Milk Marketing Board, Ministry of Food, and the Ministry of Health. Ice Cream. The sampling of Ice Cream was carried on and the following table gives the results:- Grade. No. of Samples. 1 2 3 4 84 14 16 36 18 Food and Drugs Act, 1938. The following 280 samples were procured and submitted for Analysis:- Article. No. Adulterated or otherwise irregular Article. No. Adulterated or otherwise irregular Baking Powder 2 Malted Milk Powder 2 Barley Flakes 1 Meat Paste 2 Bicarbonate of Soda 1 Meat Pie 2 1 Cake Mixture 3 1 Meat Sausage (Pork) 1 Chemical Food 1 Meat Sausage (Beef) 4 2 Cocoa 4 Milk 202 13 Coffee 2 Mustard 2 Coffee and Chicory 1 Oatmeal 1 Colouring Matter 1 Pancake Mixture 1 Curry Powder 2 Pickles (Sweet) 1 Custard Powder 1 Pudding Mixture 4 Drug as Prescribed 1 Pudding Powder (York) 1 Essence 1 Sauce Chop 1 Flavouring 1 Sausage, Pork 1 Fish Paste 3 Sausage, Beef 1 Gelatine 1 Sausage, Whale Meat 1 Gravy Browning 1 Sponge Mixture 4 Gravy Powder 1 Soup, Mixed Vegetables 1 Gravy Thickening 1 Soup Powder 1 Gravy Salt 1 Sweets, Boiled 1 Health Salts 1 1 Stuffing, Sage & Onions 1 Jam 1 Tomato Juice 1 Jelly Crystals 2 1 Vinegar, Malt 4 3 Ketchup 1 Vinegar, Non-Brewed 1 Limade 1 Verox Spread 1 Lemonade Powder 1 Wheat Puffed 1 280 22 50 The following 22 samples (7-8%) were reported as not genuine or irregular:- Jelly Crystals—No. 13. The term jelly crystals means crystals consisting of sugar and gelatine or other jelly forming materials with or without other ingredients intended to be made up with water so as to produce a jelly table sweet. This article contained no sugar and consisted of gelatine with no other ingredients. A solution of this gelatine in water equivalent to one ounce in one pint, did not set to a jelly when kept at 60° F. for sixteen hours. In the Analyst's opinion, edible gelatine of commerce should form a satisfactory jelly when prepared and kept under the above conditions. The Committee accepted an explanation by the Vendor, that a thoughtless mistake had been committeed in labelling and a warning was given. Health Salts—No. 46. The constituents of the sample included the following substances in proportions as under:- Sodii Bicarbonas B.P. (Sodium Bicarbonate) 22% Acidum Tartaricum B.P. (Tartaric Acid) 14% Sodium Tartrate (Anhydrous) 39% Sodii Sulphas B.P. (Sodium Sulphate) 45% Glusidum (Saccharin) 0.25% The formula given on the label submitted with the sample was as follows:- Sodii Bicarbonas B.P. 46.2% Acidum Tartaricum B.P. 34.8% Sodii Sulphas B.P 18.85% Glusidum B.P 0.15% These discrepances may be explained by assuming a process of deterioration of the article during storage, and the effect was, that the article as sold was less than half as effervescent as an article prepared according to the stated formula and that the proportion of sodium sulphate was nearly two and one half times as great as the proportion stated. A warning was issued in this instance as the article had been in stock some considerable time. Milks Nos. 49, 55 and 61. Warnings were issued on the Vendors of these samples as the deficiency in Solids not Fat was only 1%. Ginger Cake Mixture—No. 85. The statement on the label submitted with this sample specified the ingredients of the article as follows: "M" Flour, Milk Substitute, Baking Powder, Ginger, Colouring and Salt. The sample contained no substance which could replace milk in respect of its nutritional qualities, although there was evidence of the presence of a small proportion of an emulsifying or suspending agent which might partially replace milk in respect of this physical property. 51 The label on this mixture was held not to be in accordance with the definition of "appropriate designation" in Section 2 (3) of the Labelling of Food (No. 2) Order, 1944, and the matter was passed on to the Ministry of Food, who accepted an undertaking from the manufacturers for a reprinting of their labels whereby the misleading description of " Milk Substitute " was omitted. Vinegar—No. 118 (Informal Sample) Nos. 178 and 261. No. 118 was a vinegar with a faint trace of carbolic acid brought in by a resident. This was an informal sample and in view of the difficulty in tracing the vendor from whom it was purchased, no action could be taken. Nos. 178 and 261—the Analyst reported that they contained Sodium Chloride (Common Salt) which was not a natural ingredient of Malt Vinegar. It was, however, a "trade practice" and no further action was taken. Beef Sausage Meat—Nos. 162 and 231. No. 162 contained 45% and No. 231 contained 38% instead of 50% beef meat. The Committee accepted satisfactory explanations in both instances and warnings were issued. Meat Pie—No. 177. This sample consisted of 79% pie crust and 21% filling. The percentage of meat in the filling was 30% and in the whole 6.3%. In the analyst's opinion, the filling of a meat pie should contain at least 50% of meat and the proportion of cooked meat should be not less than 10% of the whole. In the absence of a statutory standard no further action was taken. Milk—Nos. 171, 173, 184, 186, 188, 189, 191, 192, 197, and 198. All the above samples were concerned in one extraordinary, extremely complicated and intricate legal case of designated milk in course of delivery to a Hospital in this district, which was shown to have a deficiency in Cream. The initial samples of the milk were taken in course of delivery in the district, those in the second stage were taken in course of delivery to a Dairy at Reading and those in the third and last stage were samples of the milk taken as" Appeal to Cow samples at two farms in Berkshire. It involved three Food and Drugs Act Authorities and the Farmer, the Dairy Company, the Milk Marketing Board and the Ministry of Food. Prosecutions were commenced at Wallington and the Dairy Company were convicted and fined £15 on each of two Summonses with £15 15s. costs. An appeal was however made, which was heard at the Kingston Quarter Sessions early in January, 1948, when judgment and 75 guineas costs were awarded to the Appellant. 52 Foreign Bodies in Food. Complaints were received from residents of foreign bodies being delivered in food stuffs, such as a used finger bandage in a loaf, a portion of metal solder in a bun, a dirty disc in a bottle of milk, bird excreta in a bottle of milk, rat dirt in puffed wheat, cockroach in a loaf, cigarette ends in bread, maggots in a milk bottle, flies in a sausage and wasps in honey. Arising out of these complaints, three prosecutions were taken against the vendors concerned, and in the case of the used finger bandage in loaf, the defendant was convicted and fined £10 with £5 5s. costs. Another vendor summoned for the offences of cigarette end in bread on two occasions was convicted and fined £20 with £3 3s. costs. 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:- Bread 227 lbs. Mixture, Cake, Pudding & Sponge 243 lbs. Cheese 80 „ Oats 163 „ Egg, Dried 5 „ Paste 2 „ Egg. Shell 407 Pickles 13 „ Fish 3,501 lbs. Pudding 52 „ Fruit 404 „ Semolina 2 „ Jam 618 „ Soup 60 „ Macaroni 1 „ Sugar 37 „ Meat 3,839 „ Syrup 4 „ Milk 1,057 „ Sweets 25 „ Mustard 3 „ Vegetables 1,033 „ Total Weight : 5 tons 1 cwt. 2qtrs. 7 lbs. Bakehouses. There are four bakehouses in the district and all have received periodical inspection. No special action with the exception of repairs and cleansing, was called for during the year. 53 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. Cholera. Diphtheria. Membranous Croup. Erysipelas. Scarlatina or Scarlet Fever. Measles. Whooping Cough. Tuberculosis. Dysentery. Acute Influenzal Pneumonia. Acute Polioencephalitis. Typhus Fever. Typhoid Fever. Enteric Fever. Relapsing or Continued Fever. Cerebro-spinal Fever. Acute Poliomyelitis. Ophthalmia Neonatorum. Puerperal Pyrexia. Malaria. Acute Primary Pneumonia. Acute Encephalitis Lethargica. Food Poisoning. Smallpox. The district was again free from Variola infection. Numerous contacts, chiefly of cases in ships arriving in this Country, were kept under supervision. Enteric Fever. Two cases of typhoid fever were notified. One, an adult female, contracted the infection at a South Coast resort, together with two other members of her party, who were not residents of this district. The other, a boy of 10 years, had a mild infection. He, with two other boys, drank polluted water in the vicinity of a sewage farm. All three had symptoms of Gastro-Enteritis in the early stages and the patient proceeded to develop mild typhoid. Both cases recovered after hospital treatment. 54 Dysentery. Eleven cases of Sonne dysentery were notified, ten of which were inmates of Queen Mary's Hospital for Children. The one case of a resident recovered after treatment in the isolation hospital. Scarlet Fever. Incidence of scarlet fever was much the same as in the year before. A total of 98 (83 residents) was notified. The case rates were accordingly: All cases 1.59 per 1,000 population Residents 1.35 per 1,000 population Sixteen per cent were children under 5 years, 60% children of school age, and the remainder over 15 years. The number nursed at home at 24 is the highest proportion so nursed yet recorded. This practice is in conformity with modern views on the treatment of this disease, which hold that given suitable home conditions and an uncomplicated illness, there is nothing to be gained by hospitalisation. Unfortunately, present day overcrowding largely prevents the implementation of this policy. There was one "return" case in which the onset was 17 days after the return from hospital of a previous case. There were no deaths from scarlet fever. TABLE 15. SCARLET FEVER-WARD INCIDENCE AND MONTHLY DISTRIBUTION 1947. (Excluding hospital patients non-resident in Carshalton.) 1947. Ward. Total. St. Helier North. St. Helier South. St. Helier West. NorthEast NorthWest. Central. SouthEast. SouthWest. January 1 1 1 - - - 1 - 4 February - 1 2 - 1 - 2 - 6 March 6 2 1 1 1 2 1 - 14 April - - - 4 - - 1 1 6 May 2 1 3 - 2 - 2 2 12 June 1 - 1 - - - - 1 3 July - - 2 - - - - - 2 August - - - - 1 - 1 - 2 September - - 1 1 1 1 1 1 6 October - - - 3 1 1 - 2 7 November 2 - 1 - 2 - - 1 6 December 2 3 1 1 6 - 1 1 15 Totals 14 8 13 10 15 4 10 9 83 Monthly Mean 1.2 0.66 1.08 0.83 1.25 0.33 0.83 0.75 6.92 Case rate per 1,000 population 1.64 1.13 1.59 1.07 2.05 0.66 1.36 1.35 1.37 55 TABLE 16. SCARLET FEVER—MULTIPLE CASES, 1947. Ward. No. of houses in which occurred. Total Houses. Total Cases. 1 Case. 2 Cases. St. Helier North 12 1 13 14 St. Helier South 6 1 7 8 St. Helier West 9 2 11 13 North-East 8 1 9 10 North-West 15 - 15 15 Central 4 - 4 4 South-East 8 1 9 10 South-West 9 - 9 9 Whole District 71 6 77 83 Diphtheria. For the first time in the history of the district there was no case of diphtheria among the resident popvlation outside the hospitals. Four cases were notified from Queen Mary's Hospital, two among the patients and two in the nursing staff. Incidence rates were accordingly : All cases 0.06 per 1,000 population Residents 0.03 per 1,000 population There were no deaths. The incidence rates among the resident population since 1934 were 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 1.12 1938 33 0.57 1945 15 0.27 1939 14 0.23 1946 4 0.06 1940 45 0.77 1947 2 0.03 The number of swabs examined for diphtheria under the Council's arrangements was 67, none of which was positive. Diphtheria Immunisation. The District Council continued to be responsible in their dual capacity as Welfare and Sanitary Authority for immunisation against diphtheria. 86 Treatment is available at all the infant welfare clinics and most of the primary immunisations are secured under this arrangement. It has the advantage of saving the mother a special journey for the purpose. Every other term a programme of immunisation sessions is ar ranged in the primary schools of the district, where children already treated may receive reinforcing doses after an interval of approximately three years. Both with regard to the pre-school and school child, therefore, advantage is taken of the child's presence for another purpose at the place where treatment is given. This element of convenience is the main contributory factor in the success of the scheme. The procedure employed is mostly the two injection technique of A.P.T. in doses of 0.5 at one month's interval for initial treatment and doses of 0.2 cc. for reinforcing doses. Occasionally T.A.F. is used in special circumstances. During 1947 a further 909 residents were immunised as follows: Age at Year End. Total. Under 1 1-2 2-3 3-4 4-5 5-10 10-15 At Council Clinics 32 584 77 24 11 4 - 732 In Carshalton Schools - - - - 2 82 32 116 Private Practitioners 2 58 5 10 5 2 2 84 34 642 82 34 18 88 34 932 Less outward transfers - 18 4 - 2 13 10 47 Plus inward transfers - 1 - - 3 12 8 24 Carshalton Residents 34 625 78 34 19 87 32 909 A further 700 children received reinforcing doses during the year. The position with regard to immunisation at the year end was as follows: Age at 31.12.47, i.e., Born in Year Under 1 1947. 1 1946. 2 1945. 3 1944. 4 1943. 5 to 9 1938/ 42. 10 to 14 1933/ 37. Total under 15 Number Immunised 37 724 655 759 635 3922 4901 11633 Estimated mid-year population, 1947 4480 10450 14930 Percentage done 63% 84% 78% 67 The figures for children immunised at the 31st December, 1947, are conservative, every child shown as immunised is known to have been treated. Erysipelas. Twelve cases were notified, the site of infection being the face in eight. Five received hospital treatment and all recovered. Pneumonia. The number of cases of primary and influenzal pneumonia notified was 71, all residents of the district. None was admitted to hospital. Measles. The incidence of measles was comparatively light, 148 cases being notified compared with 512 in the year before. All but three were residents of the district. Five children were admitted to hospital and there were no deaths. TABLE 17. MEASLES-WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1947. (Excluding hospital patients non-resident in Carshalton.) 1947. Ward. Total. St. Helier North. St. Helier South. St. Helier West. NorthEast NorthWest. Central. SouthEast. SouthWest. January - - - 2 4 3 2 - 11 February - 2 - 2 - 1 - 1 6 March - 1 2 2 2 - 3 4 14 April - 3 - 5 1 2 8 2 21 May 8 3 4 8 - 2 - 1 26 June 9 5 7 6 2 - 4 - 33 July - 2 2 1 1 1 3 4 14 August 2 - 4 4 1 - - - 11 September 1 - - - - - - 1 2 October - - 1 - - 1 - - 2 November - - - - - - - - - December 1 1 - 2 1 - - - 5 Totals 21 17 20 32 12 10 20 13 145 Monthly Mean 1.75 1.41 1.66 2.66 1.00 0.83 1.66 1.08 12.08 Case rate per 1,000 population 2.45 2.41 2.45 3.54 1.77 1.64 2.72 1.95 2.41 Whooping Cough. Rather fewer cases of Pertussis occurred, 184 (3 non-residents) being notified. Incidence was fairly evenly distributed over the year. No case was fatal. 58 TABLE 18. WHOOPING COUGH-WARD INCIDENCE AND MONTHLY DISTRIBUTION 1947. (Excluding hospital patients non-resident in Carshalton.) 1947. Ward. Total. St. Helier North. St. Helier South. St. Helier West. NorthEast. NorthWest. Central. SouthEast. SouthWest. January 5 1 2 5 1 1 1 2 18 February 1 2 1 4 7 - 1 1 17 March 2 1 2 8 6 - 2 3 24 April - 4 - 1 5 - - 2 12 May 3 - 2 2 3 2 7 2 21 June 4 - - 3 2 4 6 6 25 July 7 1 1 2 6 1 4 2 21 August 6 - 5 1 - 2 2 3 19 September 2 1 2 - - - - - 5 October 1 - - - - - - - 1 November 1 1 7 1 1 - - - 11 December 2 2 - 3 - - - - 7 Totals 34 13 22 30 28 10 23 21 181 Monthly Mean 2.83 1.08 1.83 2.50 2.33 0.83 1.91 1.75 15.08 Case rate per 1,000 population 3.97 1.84 2.70 3.22 3.83 1.64 3.12 3.15 2.99 Cerebro-Spinal Fever. Three cases were notified in male adults of 19, 22 and 55 years. All were admitted to isolation hospital, where the diagnosis was confirmed in the case of two of them. In the third, the youth of 19 in H.M. Forces, the clinical picture resembled that of a series of cases which occurred in the latter half of 1946 in the London area and which have been described as meningo-encephalitis. All three cases recovered after modern chemo-therapy. Anterior Poliomyelitis and Encephalitis. The epidemic wave of Poliomyelitis which swept the country in the summer and autumn, gave rise to 15 cases of this infection in the Urban District. 59 The first case occurred on the 17th May. There followed one case in June, five in July, five in August, one in September, and two in October. Five were fatal. Of the ten who survived, one was an abortive case, which never developed any paralysis, and five recovered completely with no disability. Details of the cases are as follows:- TABLE 19 Case No. M. & F. Age. Onset. Death. Disability (August, 1948). years 1 F. 1 10/12 May 17 - Paralysis right leg-wearing irons. 2 M. 10 June 29 July 6 3 M. 5 July 12 - Difficulty with speech. 4 M. 13 July 16 July 31 5 M. 9 July 21 - Paralysis of trunk and right sidein-patient still. 6 M. 6 July 24 - Complete recovery. 7 F. 30 July 29 Aug. 18 10 F. 1 Aug. 1 - Complete recovery. 8 F. 26 Aug. 4 Aug. 10 9 M. 38 Aug. 10 - Abortive case-no paralysis. 11 F. 14 Aug. 12 - Complete recovery. 12 M. 14 Aug. 16 Aug. 22 13 M. 11 Sept. 23 - Slight weakness of one foot. 14 F. 4 Oct. 10 - Complete recovery. 15 M. 14 Oct. 21 - Complete recovery. In the five fatal cases it will be seen that the interval between onset of illness and death was 6, 7, 8, 15 and 20 days. Careful and complete enquiries were made into each case and the contacts followed up closely. In the course of these investigations, many instances came to notice where contacts had developed, about the same time, symptoms from which they made comparatively rapid recovery without any evidence of paralysis and for which medical assistance had not been sought. There is good grounds for believing that these were reactions to the same infection and were in effect mild abortive cases. Since the infecting agent cannot, in the ordinary way, be isolated, proof is lacking, but the circumstantial evidence is strong. It would seem in such circumstances that, in epidemic times, the distribution of this infection is very much wider than recognised clinical cases indicate and that reaction to it to the extent of producing paralysis is comparatively infrequent. What determines whether infection by the virus proceeds to the severer limits of disability is probably dependent upon several factors among which fatigue should undoubtedly be included. There was no instance where more than one definitely clinically recognisable case occurred in one household. The cases were well distributed throughout the district, except for one small marked focus of infection in the vicinity of Culvers Avenue, where four cases occurred within a radius of 150 yards. 60 The mode of transmission of this illness has not yet been defined with any precision. It is known that the infecting agent is to be found in the naso-pharynx and in the intestinal tract, and hence transmission either by droplet infection from the breath, or by the enteric route would appear to be feasible, and control measures should have these considerations in mind. Ophthalmia Neonatorum. There were again no cases of this eye infection in the new born, whereas in years gone by this dreaded disease was responsible for not a little blindness. Modern chemotherapy in the form of penicillin and the sulpha drugs has robbed this infection of most of its terrors. Puerperal Pyrexia. Notifications of a rise in temperature during child-birth totalled 47. All in respect of women confined in the St. Helier Hospital. Of these, 10 were in respect of residents in Carshalton, 39 were first deliveries and all cases recovered. » 61 62 TABLE 20. INFECTIOUS DISEASES-NOTIFICATIONS, DEATHS AND DISTRIBUTION. (Excluding hospital patients non-resident in Carshalton.) Disease. Cases notified. Case rate per 1,000 population. Deaths Distribution by 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 83 1.37 - 14 8 13 10 15 4 10 9 59 71 Diphtheria 2 0.03 - - - - - - - 2 - 2 100 Measles 145 2.39 - 21 17 20 32 12 10 20 13 5 3.4 Whooping Cough 181 2.99 - 34 13 22 30 28 10 23 21 4 2.2 Typhoid Fever 2 0.03 - - - - 1 - - 1 - 2 100 Dysentery 2 0.03 - - 1 - - - - 1 - 2 100 Cerebro-Spinal Fever 3 0.04 1 1 - - - - - 1 3 100 Poliomyelitis 13 0.21 4 2 1 2 4 2 - 1 1 12 92 Polioencephalitis 2 0.03 1 - - 1 1 - - - - 2 100 Erysipelas 12 0.19 - 2 3 - 2 3 - 2 - 5 41 Pneumonia 71 1.17 - 12 11 3 17 10 6 4 8 - - Puerperal Pyrexia 10 0.16 - 3 2 2 1 1 - 1 - 10 100 63 TABLE 21. INFECTIOUS DISEASES. Notification by Age Groups, 1947. (Excluding hospital patients non-resident in Carshalton.) Disease. Total Cases Notified. Total Cases at all Ages Under 1 year 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 and over Scarlet Fever - 1 3 6 4 27 23 11 6 1 1 - 83 Diphtheria - - - - - - - - 2 - - - 2 Measles 7 24 18 26 13 35 12 4 5 - 1 - 145 Whooping Cough 13 23 26 24 26 55 10 - 2 2 - - 181 Typhoid Fever - - - - - - 1 - - - 1 - 2 Dysentery - - - - - - 1 - 1 - - - 2 Cerebro-spinal Fever - - - - - - - 1 1 - 1 - 3 Poliomyelitis - 2 - 1 - 2 5 - 2 1 - - 13 Polioencephalitis - - - - - 1 1 - - - - - 2 Erysipelas 1 - - - - - - - 1 2 5 3 12 Pneumonia 6 1 - 1 4 8 2 1 4 14 17 13 71 Peuperal Pyrexia - - - - - - - 1 8 1 - - 10 64 TABLE 22. MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1947. (Excluding hospital patients non-resident in Carshalton.) Disease. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 4 6 14 6 12 3 2 2 6 7 6 15 83 Diphtheria - - - - - 1 - - - - - 1 2 Measles 11 6 14 21 26 33 14 11 2 2 - 5 145 Whooping Cough 18 17 24 12 21 25 21 19 5 1 11 7 181 Typhoid Fever - - - - - - 1 - 1 - - 2 Dysentery - 1 - - 1 - - - - - - - 2 Cerebro-spinal Fever - - - 1 1 - - 1 - - - 3 Poliomyelitis - - - - - 1 2 7 - 3 - - 13 Polioencephalitis - - - - - - 2 - - - - - 2 Erysipelas - 2 - - 3 1 - 1 1 - 4 - 12 Pneumonia 19 12 13 4 7 - 2 - - 5 3 6 71 Puerperal Pyrexia - - - - 1 3 - 2 - 1 1 2 10 Tuberculosis Pulmonary 5 16 11 4 4 18 7 1 14 15 10 5 110 Tuberculosis Non-pulmonary 1 1 - - - 1 - - - 4 1 8 Tuberculosis. The new cases admitted to the tuberculosis register during the year numbered 147, classified as follows : Males. Females. Pulmonary 69 Pulmonary 69 Non-pulmonary 5 Non-pulmonary 4 Of the total additions 114 were primary notifications, 29 were transferred from other districts, and 4 came to notice in other ways. For the same period 116 names were removed from the register for the following reasons: Recovered 31 Deaths 27 Otherwise (including removals) 58 After allowing for the additions and deductions, the state of the register at the 31st December, 1947, was as shown in the following table : TUBERCULOSIS—WARD DISTRIBUTION. Cases on Register at 31st December, 1947. Ward. Pulmonary. Non-Pulmonary. Total Incidence per 1,000 population. Males. Females. Males. Females. St. Helier North 57 64 13 9 143 16.7 St. Helier South 44 49 13 13 119 16.8 St. Helier West 58 39 9 15 121 14.8 North-East 48 45 9 7 109 11.7 North-West 32 31 4 4 71 9.7 Central 30 19 7 1 57 9.3 South-East 27 22 5 7 61 8.3 South-West 29 15 3 1 48 7.2 Totals 325 284 63 57 729 12.0. 609 120 The total of 729 is 31 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 31 At other tuberculosis institutions 125 156 65 The number of tuberculous persons who died during the year wis 27, distributed by age groups as follows: Age, Years. Pulmonary. Non-Pulmonary. Total. Males. Females. Males. Females. 0 1 - - - 1 1-5 - 1 - - 1 5-1 5 - - - - - 15-25 1 3 - - 4 25-35 3 3 - - 6 35-45 2 3 - - 5 45-55 - 1 1 1 3 55-65 5 - - - 5 65-75 2 - - - 2 Totals 14 11 1 1 27 The deaths attributable to Tuberculosis were 25, as follows: DEATHS DUE TO TUBERCULOSIS, 1947. Ward. Pulmonary. Non-Pulmonary. Death Rate per 1,000 population. Mean age at Death. Male. Female. Male. Female. St. Helier North 2 2 1 - 0.58 29 St. Helier South 1 1 - 1 0.42 48 St. Helier West 1 4 - - 0.61 31 North-East - 1 - - 0.11 22 North-West 1 1 - - 0.27 44 Central 3 - - - 0.49 53 South-East 4 1 - - 0.68 42 South-West - - 1 - 0.15 41 12 10 2 1 0.40 39 Four deaths of unnotified cases represent 16% 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 11 such examinations were made, No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or under Section 172 of the Public Health Act, 1936. 66 67 TABLE 23. TUBERCULOSIS. New Cases, Age and Sex Distribution and Manner of Admission to Register, 1947. 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 - - - - - 1 - - - 2 1— 5 3 4 - - - - 1 - - - - - 8 5—10 1 2 - 2 1 - - - - - - - 6 10—15 1 2 1 - - - - - - - - - 4 15—20 13 12 1 1 - - - - - - - - 27 20—25 9 15 - - 1 3 - - - - - - 28 25—35 12 10 1 1 7 13 - - - - - - 44 35—45 4 5 - - - 1 - - - - - - 10 45—55 5 2 - - - - - - - - - - 7 55—65 6 - - - 1 - - - 1 - - - 8 65 up - - - - 1 - - - 2 - - - 3 Totals 54 52 4 4 11 17 1 - 4 - - - 147 114 29 4 INDEX PAGE Acreage 6 Ambulance 20 Bakehouses 53 Bed Bug—Eradication of 42 Births- Distribution 9 Institutional 10 Notification of 22 Rates 9-11 Cancer 14 Cemeteries 44 Cerebro-Spinal Fever 59 Child Life Protection 34 Clinics and Treatment Centres 22 Closet Accommodation 37 Convalescent Treatment 30 Day Nurseries 34 Deaths- Classification 18 Distribution 13 Rate 11-13 Dental Scheme 28-29 Diphtheria 56 Immunisation 56 Domestic Helps 35 Dysentery 55 Disinfection 41 Disposal of Dead 43 Drainage and Sewerage 37 Employment Agencies 44 Enteric Fever 54 Erysipelas 58 Establishments for Massage, etc. 44 Factories 48 Food- Inspection and Supervision 49-53 Food and Drugs Act 50 Health Services 19 Health Visiting 23 Hospitals 21 Housing— Council's Scheme 45 Inhabited Houses 6 Inspection 46 Overcrowding 47 Ward Distribution 9 68 PAGE Industry 8-48 Infant Mortality 16-17 Infectious Diseases 54 Inquests 15 Insulin 20 Isolation Hospital 21 Admissions to 21 Laboratory Facilities 19 Maternal Mortality 16 Maternity and Child Welfare- 22 Adoption of Children (Regulation) Act, 1939 34 Attendances at Clinics 24-25-27 Child Life Protection 34 Clinic Activities 23 Consultant Service 32 Convalescent Treatment 30 Day Nurseries 34 Dental Scheme 28-29 Health Visiting 23 Home Helps 32 Hospital Treatment for Maternity 30 Emergency Maternity Unit 32 Illegitimate Children 31 Maternity Outfits 32 Midwives 32 Orthopaedic Treatment 30 Premature Births 31 Supply of Milk and Other Foods 27 Toddler Clinics 26-27 Measles 58 Milk Supply 49 Milk (Special Designations) Order 49 Mortuary 44 Natural and Social Conditions 6 Nursing Associations 19 Offices 43 Ophthalmia Neonatorum 61 Orthopaedic Treatment 30 Pest Control 42 Pneumonia 58 Poliomyelitis 59 Population 8 Premature Births 31 Public Assistance 8 Public Cleansing 37 Puerperal Pyrexia 61 69 PAGE Rateable Value 6 Rats and Mice Destruction 42 Rent and Mortgage Interest Restrictions (Amendment) Act, 1933 48 Rivers and Streams 37 Sanitary Circumstances 36 Sanitary Inspection 37 Scarlet Fever 56 Shops Acts 43 Smallpox 54 Smoke Abatement 43 Staff 5 Statistics- Comparative 12-13 Vital 7 Swimming Baths 43 Tuberculosis 66 Unemployment 8 Unmarried Mothers 31 Vermin Control 41 Voluntary Helpers 33 Water Supply 36 Whooping Cough 58 Zymotic Diseases 54 Deaths from 7 70