CAR 13 ??? Carshalton Urban District Annual Report OF THE Medical Officer of Health FOR THE YEAR 1948 Printed by the " Croydon Times," Ltd., 104, High Street, Croydon. CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1948 1 PREFACE To the Chairman and Members of the Carshalton Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to submit my Report on the health of the district and on the Services administered under your jurisdiction for its promotion during the year 1948. The scope of this survey has been varied to meet the new conditions created by the National Health Service Act, 194(3. Certain functions, notably Maternity and Child Welfare and Diphtheria Immunisation, passed on July 5th to the County Council. The Report with regard to the first of these covers, therefore, the period from January 1st to July 4th. As regards Diphtheria Immunisation, you are aware that the Council agreed with the County Council for your Medical Officer to continue to direct this scheme after July 5th as he had done previously, and for that reason I have supplied figures for this service covering the whole of the calendar year although your statutory responsibility ceased at mid-year. The vital statistics for 1948 show that the health of the district continues the favourable trend to which we have been accustomcd for so long. Here and there relapses occur, but the general picture is one of steady improvement. The death-rate, again under 8 per thousand population, is substantially less than the national figure. Infant mortality fell to the record low rate of 14.5 per thousand live births. This is phenomenal and compares with the rate of 34 for the country as a whole. Equally gratifying to report is the fact that for a further year, the fourth in succession, there was no maternal death. In these four years more than four thousand mothers were safely conducted through childbirth without the loss of a single life. Among the causes of death, cancer was as prominent as ever, but 1948 shares with its predecessor the lowest mortality from tuberculosis for twenty years. Although measles and whooping cough were particularly prevalent during the year, there were no deaths from either or from the other common infectious diseases, scarlet fever, enteric fever and diphtheria. The district is undoubtedly now reaping the benefit of the Council's 3 diphtheria immunisation scheme which has been energetically pursued since its inception in 1935. Provided immunisation can be maintained at its present satisfactory level, diphtheria, as a health problem, will almost cease to exist. Poliomyelitis was in evidence during the year, but on a much reduced scale. With attention focussed on the epidemic of 1947 it is apt to be overlooked that this is an endemic disease and that odd cases from time to time are normal expectation. The closing record of the Maternity and Child Welfare Scheme under the aegis of the District Council will give considerable local satisfaction. The Service at the time of its transfer on July 5th had reached a high standard of efficiency and its clinic facilities were being used by more than 85% of the babies and more than 50% of the expectant mothers. This satisfaction will be underlined by the knowledge that the year which saw the transfer of the Scheme experienced the record low infant death-rate and the fourth successive year of freedom from maternal mortality. The promotion of environmental hygiene and sanitation is an unremitting task, patiently and thoroughly pursued throughout the year by the Sanitary Inspectors under the able direction of the Chief Inspector. This field of public health was the first to be developed with such dramatic results in the last century and it is only in the soil of a healthy environment that the more recently developed personal health services can reach their fullest fruition. Food control is receiving ever increasing statutory attention and the administration of the growing volume of regulations and orders now forms a major part of the Inspectors' work. The greatest breach in our health defences is still the urgent need for housing accommodation. Despite all our efforts, the amount of known overcrowding, which is only an index to the total problem, grows from year to year, and the present rate of progress does little more than meet the needs of the yearly natural increase. No serious inroad has yet been made into the accumulated shortage arising from the many years of enforced cessation of building. In conclusion, I would express my appreciation of the help and loyalty which has been so unstintingly given to me by the staff. Their personal enthusiasm for their work makes the greatest contribution to whatever success your Public Health Department has achieved. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, F. LAWRENCE SMITH, Medical Officer of Health. August, 1949. 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. * G. R. Surfleet, C.R.S.I. Senior Health Visitor: Miss R. M. Nash. Health Visitors: Miss A. A. Askew, Miss H. Gray, Miss D. Long land, Miss E. Hereford (resigned 4.2.48), Miss E. Young (commenced 12.1.48), Miss H. M. Rogers (commenced 3.5.48). Chief Clerk: Miss V. Hotten (acting). 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 Ash worth, M.B., B.S. C. A. Bentley, C.I.E., M.B., D.P.H. Anne B. Price, B.Sc., M.B., Ch.B., D.T.M. & H. Consulting Obstetrician: W. H. Passmore, M.R.C.S., L.R.C.P. Dentist to the Maternity and Child Welfare Scheme: C. H. Kennard, L.D.S. (in agreement with Surrey County Council)- ♦Meat and Food Certificate of the Royal Sanitary Institute. •[Also Divisional Medical Officcr, Surrey County Council. 5 Section A—Natural and Social Conditions of the District. Area (in acres) 3,340 Number of inhabited houses (end of 194S) according to Rate Books 16,597 / Rateable Value at 31st December, 1948 £501,542 Sum represented by Id. rate £2,025 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 tip 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 part and arises from several springs at the outcropping of the chalk near the centre of the district. The depletion of the underground water supplies in the London Basin, which has increased in recent years, has seriously reduced the flow of the river and has resulted in the complete drying up for lengthy periods of the ponds which were a source of considerable amenity to the district. 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, chiefly as a result of the rapid development in the years before World War II, including the L.C.C. housing estate of St. Helier. Carshalton has a young population, the average age being probably the lowest in Surrey. 6 SUMMARY OF VITAL STATISTICS FOR 194S. (Based on the Registrar-General's Figures). Population. Registrar-General's Estimate 62,020 Births. Males. Females. Total Live (Legitimate) 473 463 936 (Illegitimate) 15 11 26 488 474 962 Birth Rate 15.5 Stillbirths (Legitimate) 8 8 16 (Illegitimate) — — — 8 8 16 Still-birth Rate per 1,000 total births 16.3 Deaths. 245 218 463 Death Rate (crude) 7.4 Infant Mortality. All deaths under 1 vear 10 4 14 Infant Mortality Rate (per 1,000 live births) 14.5 Deaths of leg. infts. under 1 year 10 4 14 Rate per 1,000 legitimate births 14.9 Deaths of illeg. infts. under 1 year — — —. Rate per 1,000 illegitimate births — 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 — 1 Deaths from Measles — — — Deaths from Whooping Cough — — — Deaths from Diarrhoea (under 2 years) 1 1 Zymotic Death Rate 0.01 Deaths from Tuberculosis. All Forms 18 7 25 Rate per 1,000 of population 0.40 Phthisis 18 6 24 Rate per 1,000 of population 0.38 Deaths from Cancer. 51 47 98 Rate per 1,000 of population 1.58 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 necessarily 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 163 Women 61 Bovs 10 Girls 11 245 POPULATION. The estimated population rose by about 700, due mainly to natural increase. The distribution by wards at mid-1948 is estimated as follows : TABLE 1. ESTIMATED RESIDENT POPULATION, MID-194 8. BY WARDS. Ward. Houses at Mid-1948. Estimated population Mid-1948. St. Helier North 2,036 8,670 St. Helier South 1,697 7,100 St. Helier West 2,009 8,420 North-East 2,631 9,420 North-West 2,152 7,350 Central J,707 6,100 South-East 2,115 7,450 (Queen Mary's Hospital) 1,100 South-West 2.003 6,720 Whole District 16,350 62,330 BIRTHS. Rather fewer live births were registered, a total of 962 comparing with 1,046 in the year before. This provides a birth rate of 15.5 per thousand population as against 17.0 in 1947. 8 Information available from the registration of births is not complete as to the home addresses of the parents. For computation of ward birth rates, therefore, use is made of the notifications of birth received under the Public Health Act, supplemented by the Registrar's weekly returns of registrations. From these sources it is known that 1,025 live births and 16 stillbirths occurred in 1948. They were distributed as shown in the following table:— Ward. Live Births. Birth Rate per 1,000 Population. Stillbirths. Stillbirth Rate per 1,000 total births. St. Helier North 135 15.5 1 7.3 St. Helier South 101 14.2 1 8.7 St. Helier West 161 19.1 4 24.2 North-East 222 23.5 2 8.9 North-West 129 17.5 2 15.2 Central 93 15.2 2 21.0 South-East (excluding Queen Mary's Hospital) 105 14.0 3 27.7 South-West 79 11.7 1 12.5 Nearly two-thirds of all births occurred in hospitals and nursing homes, the actual percentage for the whole district being 60. That for the individual wards was as follows:— St. Helier North 56 St. Helier South 56 St. Helier West 57 North-East 57 North-West 63 Central 67 South-East 55 South-West 70 Out of 1,025 total births, 625 took place in the following hospitals and nursing homes:— Live. Still. Total. Carshalton, Beddington and Wallington District (War Memorial) Hospital 70 2 72 St. Helier County Hospital 395 6 401 Other Surrey County Hospitals 69 — 69 Other Hospitals 24 — 24 Private Nursing Homes 59 — 59 Totals 617 8 625 8 TABLE 2. BIRTHS, 1948, DOMICILIARY AND OTHERS — BY WARDS. Born in District. Born Outside District. Ward. In Hospitals and Nursing Homes. In Private Houses. Total. In Hospitals and Nursing Homes. In Private Houses. Total. Total. St. Helier North 66(7) 59 125(2) 10 10 135(2) St. Helier South 45 43(2) 88(2) 13 — 13 101(7) St. Helier West 81(2) 63(7) 144(3) 16 — 16 160(3) North-East 102(2) 92 194(2) 27 2 29 223(2) North-West 68(2) 45(2) 113(2) 15 1 16 129(2) Central 44(7) 29(2) 73(2) 20 — 20 93(2) South-East 32(3) 43 75(3) 30 — 30 105(3) South-West 32 23(2) 55(2) 24 — 24 79(2) Totals 470(10) 397(5) 867(25) 155 3 158 1025(75) (Figures in brackets indicate stillbirths included in totals.) TABLE 3. BIRTH AND DEATH RATES FOR CARSHALTON, 1922-1948. Year. Population (RegistrarGeneral's) Birth Rate. Death Rate. Infant Morta'itv 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 59,510 13.2 7.1 35.4 3.7 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 61.270 17.0 7.8 22.8 0.0 1948 62,030 15.5 7.4 14.5 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.) TABLE 4. COMPARATIVE STATISTICS—1948. England and Wales. 120 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 17.9$ 20.0 19.2 20.1 15.5 Still 0.421 0.52 0.43 0.39 0.25 Deaths— All causes 10.8J 11.6 10.7 11.6 7.4 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 — Whooping Cough 0.02 0.02 0.02 0.01 —■ Diphtheria 0.00 0.00 0.00 0.01 — Tuberculosis 0.51 0.59 0.46 0.63 0.40 Influenza 0.03 0.03 0.04 0.02 — Smallpox — — — — — Acute Poliomyelitis and Polioencephalitis 0.01 0.01 0.01 0.00 0.04 Pneumonia 0.41 0.38 0.36 0.54 0.27 Rates per 1,000 Live Births. Deaths under 1 year of age 34† 39 32 31 14 Deaths from Diarrhoea and Enteritis under 2 years of age 3.3 4.5 2.1 2.4 1.0 Rates per 1,000 Civilian Population. Notifications— Typhoid fever 0.01 0.00 0.01 0.00 — Paratyphoid fever 0.01 0.01 0.01 0.01 — Cerebro Spinal fever 0.03 0.03 0.02 0.03 0.01 Scarlet fever 1.73 1.90 1.82 1.37 1.72 Whooping Cough 3.42 3.51 3.31 3.13 5.88 Diphtheria 0.08 0.10 0.09 0.10 0.06 Erysipelas 0.21 0.23 0.21 0.22 0.25 Smallpox — — — — — Measles 9.34 9.75 8.84 9.17 15.23 Pneumonia 0.73 0.84 0.60 0.57 0.90 Acute Poliomyelitis 0.04 0.05 0.04 0.04 0.06 Acute Polioencephalitis 0.00 0.00 0.00 0.00 _ Rates per 1,000 Total Births (Live and Still). Puerperal Fever and Pyrexia 6.89 8.90 4.71 §7.34 48.05 Maternal Mortality— Abortion with Sepsis 0.11 Not available — Abortion without Sepsis 0.05 — Puerperal Infections 0.13 — Other Puerperal causes 0.73 — * A dash (—) signifies that there were no deaths. † Per 1,000 related births. ‡ Rates per 1,000 total population. § In London Puerperal Fever alone was 0.61. 11 COMPARATIVE HEALTH STATISTICS, 1934/48. Death Rate (Civilian) per 1,000 population. Infant Mortality per 1,000 live births. Maternal Mortality (excluding abortion) per 1,000 total births. Vear. England and Wales. Carshalton. England and Wales. Carshalton. England and Wales. Carshalton. 1934 11.8 8.6 59.3 53.5 3.8 3.0 1935 11.7 6.6 57.0 46.0 3.4 2.4 1936 12.1 7.1 58.7 46.7 3.1 5.4 1937 12.4 6.6 57.7 40.0 2.7 0 1938 11.6 7.6 52.8 46.1 2.7 1.1 1939 12.1 7.1 50.6 35.4 2.5 2.0 1940 14.4 8.7 56.8 43.8 2.1 3.8 1941 13.5 8.4 60.0 40.5 2.2 0 1942 12.3 7.5 50.6 27.5 2.0 2.4 1943 12.1 8.2 49.1 39.3 1.8 4.9 1944 11.6 9.5 45.4 39.2 1.5 1.1 1945 11.4 8.2 46.0 23.2 1.4 0 1946 11.5 7.2 43.0 18.6 1.2 0 1947 12.0 7.8 41.0 22.8 1.0 0 1948 10.8 7.4 34.0 14.5 0.86 0 DEATHS. The number of deaths allocated to this district by the RegistrarGeneral for 1948 was 463, of which 245 were in respect of males and 218 females. The crude death rate was 7.4 per thousand population as compared with 10.8 for the country as a whole. The distribution by wards was as follows:— WARD DEATH RATES AND MEAN AGE AT DEATH 1948. Ward. Deaths. Death Rate (crude). Mean Age at death. St. Ilelier North 48 5.5 52.3 yrs. St. Helier South 44 6.2 58.6 „ St. Helier West 44 5.2 55.9 ,. North-East 78 8.2 59.7 „ North-West 59 8.0 65.2 „ Central 64 10.4 68.0 „ South-East (excluding Queen Marv's Hospital) 73 9.8 64.2 „ South-West 55 8.2 63.4 „ Whole District 465 7.4 61.5 yrs. 12 Mortality from cancer was higher, 98 deaths being attributable to this disease as against 85 in the year before. This provides a death rate for this cause of 1.58 per thousand population. CANCER DEATHS—WARD DISTRIBUTION, 1948. Ward. Cancer Deaths. Rate per 1,000 Estimated Population. St. Helier North 3 0.34 St. Helier South 17 2.39 St. Helier West 10 1.19 North-East 21 2.22 North-West 11 1.49 Central 16 2.62 South-East 12 1.61 South-West 8 1.18 The classification of the cancer deaths by sites affected is given in Table 5. TABLE 5. Group Site Affected. Male. Female. Total 45 Buccal Cavity— Cheek 1 — 1 Tongue 2 1 3 Tonsil 1 — 1 Pharynx — 1 1 46 Digestive Organs— Oesiphagus 2 — 2 Stomach 10 7 17 Liver 3 2 5 Intestines 5 1 6 Rectum 2 2 4 Pancreas 1 — 1 Peritoneum 1 2 3 47 Respiratory Organs— Larynx — 1 1 Lungs and Bronchi 14 1 15 48 Uterus — 5 5 49 Other female genital organs — 5 5 50 Breast — 11 11 51 Male genital organs 2 — 2 52 Urinary Organs 3 3 6 53 Skin — 1 1 54 Brain — 1 1 55 Other organs— Thyroid — 1 1 Carcinomatosis 3 1 4 Eye — 1 1 Spine 1 — 1 51 47 98 Average age at death— Males 60.l yrs. Females 63.5 „ All persons 61.7 „ 13 Tuberculosis was responsible for the same number of deaths, viz., 25 as in the two previous years, giving as a result of the increase in population the lowest death rate for this disease for twenty years. The death rates from tuberculosis for the last twenty years were as follows:— Year. Death Rate per 1,000 Population. Year. Death Rate per 1,000 Population. 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 1938 0.63 1948 0.40 The distribution of tuberculosis mortality by wards and other details are given in Section F of this Report. Only one death, from infantile diarrhoea, resulted from the seven common infectious diseases. Infantile paralysis caused three deaths, all in adults, as against five in 1947. Violence in one form or another accounted for 24 deaths of residents due to the following causes:— Suicide 10 Drowning 5 Road Traffic Accidents 3 Accidents in the Home 5 average age 80 yrs. Accidents at Work 1 Inquests. Inquests were held on 46 persons who died in the district. The following verdicts were returned:— Accidental Death 26 Suicide 14 Open Verdict 1 Misadventure 4 Natural Causes 1 Twenty-four of the total were residents of the district. Three deaths were due to road accidents. 14 INFANT MORTALITY. The number of children under 1 year of age whose deaths were registered was 14, of whom 10 were males and 4 females. This gives an infant mortality rate of 14.5 per thousand live births and establishes a new low record, the previous best being 18.6 in 1946. The comparable rate for England and Wales was 34. All were deaths of legitimate children. Nine of the 14 deaths occurred in the first month of life and 10 were due to prematurity, congenital malformations or other diseases peculiar to infancy. Only 4 (3 from pneumonia and 1 from gastroenteritis) were due to obvious infection. The ward distribution of infant mortality and the causes of death are shown in Tables 6 and 7. TABLE 6. INFANT MORTALITY—WARD DISTR1BUTION. Ward. Infant Deaths. Rate per 1,000 Live Births. St. Helier North 4 29 St. Helier South — — St. Helier West 2 12 North-East 2 9 North-West 1 7 Central 2 21 South-East 2 19 South^West 1 12 MATERNAL MORTALITY. For the fourth year in succession there was no death attributable to maternal causes. 15 16 TABLE 7. INFANT MORTALITY DURING THE YEAR 1948. 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. Pneumonia — — — — — 3 — — — 3 Gastro Enteritis — — 1 — 1 1 Prematurity 2 — — 2 — — 2 Birth Injury — 1 — — 1 — — 1 Asphyxia Neonatorum 2 – — — 2 —: — 2 Congenital Malformation 1 1 — 2 1 3 Icterus Neonatorum 1 – — 1 1 Adrenal Haemorrhage — – — — — — 1 — — 1 Totals 6 2 1 9 3 2 — — 14 17 TABLE 8.—CAUSES OF DEATH DURING THE YEAR 1948. 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 9 4 — 2 2 3 7 3 8 9 12 21 32 24 52 24 63 33 61 96 246 219 465 1 Typhoid and Paratyphoid Fevers – – – – – – – – – – – – – – – – – – – – – – – 2 Cerebro-Spinal Fever – – – 3 Scarlet Fever – – – – – – – – – – – – – – – – – – – – – – 4 Whooping Cough ' __ 5 Diphtheria - — _ 6 Tuberculosis of Respiratory System – 1 2 3 5 4 5 3 1 – 18 6 24 7 Other Forms of Tuberculosis 1 – – – – – – – – – 1 1 8 Syphilitic Diseases — – – 9 Influenza — — — 10 Measles – — — 11 Ac. Poliomyelitis and Polioencephalitis __ 2 1 2 1 3 12 Ac. Infectious Encephalitis – — — – 1 — — — 1 1 1 2 13 Cancer of Buc. Cav and Oesophagus (M) Uterus (F) – – – – – – – – – – – – 1 1 — 1 2 2 3 1 6 5 11 14 Cancer of Stomach and Duodenum – – — — — — 1 2 2 5 1 2 1 1 2 10 7 17 15 Cancer of Breast – – – – – – – – – – – – 2 4 2 1 11 11 16 Cancer of all Other Sites 1 6 8 4 7 6 13 4 6 4 35 24 59 17 Diabetes – __ – – – 3 – 1 – 4 4 18 Intra-cranial Vascular Lesions – – — — — — — — — 1 — 1 2 2 3 1 7 10 23 22 28 50 19 Heart Disease – — — — — 1 — 1 1 2 3 6 2 16 3 21 9 22 33 69 56 125 20 Other Diseases of Circulatory System – — — — — — — — — — — 1 3 2 4 1 4 4 11 8 19 21 Bronchitis – — — 1 1 — 1 1 1 3 1 4 2 1 4 10 10 20 22 Pneumonia 3 1 – – – – – – – – – 2 1 3 1 3 3 12 5 17 23 Other Respiratory Diseases – — — – 1 1 – – – 1 – 2 1 4 5 24 Ulcer of Stomach or Duodenum — — — — — 1 2 3 - 1 7 7 25 Diarrhoea, under 2 years — 1 – – – – – – – – – – – 1 1 26 Appendicitis — — — — – – 27 Other Digestive Diseases — — — — 1 — – 1 1 1 1 1 1 3 4 7 28 Nephritis — 1 2 2 2 2 2 7 9 29 Puerperal and Post Abort. Sepsis – – – – – – – – 30 Other Maternal Causes – – – – – – – – 31 Premature Birth 1 1 – – – – – – – – – – – – – – – – – – 1 1 2 32 Congenital Malformation, Birth Injury, Infant Diseases 5 2 – – – 1 – – – – – – – – – – – – – – 5 3 8 33 Suicide – – – – __ 2 1 1 4 – – 1 – 1 – 5 5 10 34 Road Traffic Accidents – – 1 – – – – – ] – – – – – – 1 2 1 3 35 Other Violent Causes – – – – – 1 2 1 1 – – – 1 – – – 1 – 1 3 6 5 11 36 All Other Causes — 1 — 1 – 1 – 1 – — – 1 – 3 4 3 4 3 8 6 17 22 39 Section B—Health Services. Nursing in the Home. Home nursing is provided by two associations to whose funds the Council made an annual grant until the 5tli July, when arrangements for home nursing became the responsibility of the County Council. 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 of whom are midwives. The following information in respect of the work of this Association during 1948 is supplied by courtesy of the Honorary Secretary:— Cases Attended. Visits Paid. General 767 General 9,913 Maternity 59 Maternity 1,209 Midwifery 60 Midwifery 1,514 Children under 5 yrs. 54 Ante-natal 1,005 Expectant Mothers 138 1,078 13,641 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 bv 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, the Sutton and Cheam Hospital Laboratory, and in special circumstances to the Epsom Public Health Laboratory. Food and Drugs and water samples were examined by Mr. D. D. Moir, the Council's Public Analyst, whose laboratory is at 16, Southwark Street, London, S.E.I. 18 this Association during the year is indicated by the following figures kindly supplied by the Honorary Secretary:— Cases. Visits. Children under 5 years 2 31 General 32 406 34 437 The following examinations were made:— Throat and Nose Swabs 82 Faeces examination 1 Cerebro-spinal Fluid 1 Water :— For chemical analysis 2 For bacteriological examination 5 Food and Drugs:— Analysis 319 Bacteriological examination of milk 207 Bacteriological examination of ice-cream 147 Supply of Insulin. After 5th July, the Council no longer had authority to supply insulin to necessitous cases, this function being transferred to the Hospital Board. During the first half of the year four cases were provided with insulin free of cost. Ambulance Facilities. In conformity with the National Health Service Act this service was transferred to the County Council on the 5th July. As far as the public was concerned the transfer involved little change in view of the fact that the District Council had, for several years, provided a free service. As from the 5th July, all the four hospitals within the urban district were taken over by the South-west Metropolitan Hospital Board ; none was disclaimed by the Minister. The Cuddington Isolation Hospital, which provided isolation facilities for this district, was similarly transferred. This change has had one disadvantage as far as control of infectious disease is concerned. The facilities at Cuddington are not now limited to the districts of the former Hospital Board and cases of infectious illness arising in this area now find their way into any of the isolation hospitals in the region of the Hospital Board. As a result, that close personal local contact between the hospital medical staff and the Medical Officer of Health has largely been lost and the Medical Officer has not the same prompt facilities of informing himself of the exact nature of many cases admitted to hospital as infectious illness. Table 9 show; the patients admitted from Carshalton to Cuddington Hospital and those transferred to other isolation hospitals up to the 4th July. HOSPITALS. 19 TABLE 9. CASES ADMITTED FROM CARSHALTON TO CUDD1NGTON HOSPITAL 1ST JANUARY—4TH JULY, 1948. Disease. Cases. Deaths. Scarlet Fever 40 Diphtheria 1 — Measles 6 — Glandular Fever 1 — Whooping Cough 1 — Meningitis—Cerebro Spinal 2 — Erysipelas 5 — Tonsilitis 2 — Bronchitis 1 — Others 9 — Transferred to other hospitals 68 — 1 — 69 — Hospital accommodation for smallpox is provided at the Clandon Isolation Hospital. No cases were admitted from this district. CLINICS AND TREATMENT CENTRES. The following programme of clinics provided by the D str et Council under its Maternity and Child Welfare Scheme was continued by the County Council alter the transfer of powers on 5th July. Rochester Road Centre Infant Welfare Clinic Maternity Clinic Toddler Clinic Dental Clinic Massage Clinic Wry the Lane Centre:— Infant Welfare Clinic Maternity Clinic Toddler Clinic Stanley Road Centre:— Infant Welfare Clinic Maternity Clinic Toddler Clinic St. Helier Centre—Green Lane:— Infant Welfare Clinic Maternity Clinic The Mount Centre:— Infant Welfare and Maternity Clinic Tues. and Thurs. 2—4 p.m. Mons. and Thurs. 10—12 a.m. Wednesdays 2—4 p.m. Mons. and Thurs. 10—12 a.m. Fourth Saturday 10—12 a.m. Mons. and Fridays 2—5 p.m. Tues. and Weds. 10—1 p.m. Weds, and Fridays 2—4 p.m. Tues. and Fridays 10—12 a.m. Tuesdays 2—4 p.m. Fridays 2—4 p.m. Tuesdays 10—12 a.m. 1st and 3rd Thurs. 2—4 p.m. Mondays 2.30—4 p.m. Fridays 10—12 a.m. 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. 20 MATERNITY AND CHILD WELFARE. Public Health Act, 1936—Section 203. The number of births notified up to and including 4th July as adjusted by transferred notifications, was as follows Live births 499 Notified by mid wives 409 Stillbirths 8 Notified by doctors 27 Transferred notifications 71 507 507 Health Visiting. An increasing number of births and the widening scope of the Service made it necessary to augment the staff of Health Visitors and this was increased to six in May. Health visiting was, as a result, on an improved scale compared with the year before. The visits made by the Health Visitors up to the 4th July, were as follows :— First Visits Total Visits To expectant mothers 140 158 To children under 1 year 326 1,693 To children 1-5 years 2,550 Child Life Protection 45 Adoption (Regulation) Act 14 Miscellaneous 857 5,317 Clinic Activities. In March a separate ante-natal session was established at the Methodist Central Hall, Green Lane, and is held on Thursday mornings. Attendances at the infant clinics were on a higher scale than in the previous year, the average attendance per session up to the 4th July, rising from 49.3 to 53.8. The number of babies attending for the first time during the half year, represented no less than 86% of the births in that period compared with 75% for the whole of 1947. The lower birth-rate was reflected in a somewhat reduced number of mothers attending the ante-natal clinics, but the percentage in relation to the total births for the period was unchanged at 53. Routine Medical Inspection of Toddlers. Special sessions for the routine medical inspection of children in their second, third and fourth years, are held at three of the welfare centres, Rochester Road, Wrythe Lane and Stanley Road. The number of such examinations carried out in the half-year was 637, which was at a higher rate than ever before. Of this number, 417 children were found to have 491 defects, rather more than half of which were recommended for treatment. An analysis of the defects found is given in Table 12. 21 TABLE 10. ATTENDANCES AT MATERNITY CLINICS. Januarv 1st—July 4th, 1948 Centre. No. on Register. Attendances. Sessions. Average attendance per Session. *Primary. Total. Rochester Road— Ante-Natal 128 84 493 51 9.7 Post-Natal 4 1 4 Individuals 133 85 497 Wrythe Lanf. Hall— Ante-Natal 224 126 652 52 12.7 Post-Natal 7 — 7 Individuals 224 126 659 St. IIelier— Ante-Natal 62 31 145 24 6.2 Post-Natal 4 — 4 Individuals 62 31 149 Stanley Road:— Ante-Natal 38 20 147 26 4.7 Post-Natal 12 2 17 Individuals 40 22 164 The Mount— Ante-Natal 13 7 47 12 4.0 Post-Natal 1 — 1 Individuals 13 7 48 All Centres— Ante-Natal 465 268 1,484 165 9.1 Post-Natal 28 3 33 Individuals 472 271 1,517 * Primary attendance is the first attendance of a woman in relation to the pregnancy under supervision. 22 23 TABLE 11. ATTENDANCES AT INFANT CONSULTATION CLINICS, January 1st to July 4th, 1948 Centre. Years. Number who attended during ha'f year. New Cases to the Centres. Attendances. Number of Sessions. Average Attendance per Session. Primary. Total. Rochester Road Under 1 835 167 150 2,214 53 59.8 1—5 35 27 956 Wrythe Lane Under 1 498 156 154 2,189 52 52.2 1—5 15 15 526 St. Helier Under 1 201 57 57 889 24 48.8 1—5 2 2 282 Stanley Road Under 1 - 301 64 63 1,065 26 61.4 1—5 8 5 533 The Mount Under 1 92 19 15 177 12 28.7 1—5 6 — 168 All Centres Under 1 | 1,927 463 439 6,534 167 53.8 1—5 66 49 2,465 Totals 0—5 1,927 529 488 8,999 167 53.8 TABLE 12. DEFECTS FOUND AT SPECIAL TODDLER EXAMINATIONS—1948.' Defect. Recommended for Number which received treatment by Observation. Treatment. Own Dr. Hospital. At Home by Advice. Clinic. Total. Cleanliness - - - - - - - Nutrition 7 14 - - 14 - 14 Ringworm skin - - - - - - - Impetigo - - - - - - - Scabies - - - - - - - Other Skin (Non-Tub.) 3 7 1 1 5 - 7 Blepharitis Eves 1 3 - 1 1 - 2 Conjunctivitis - 1 - 1 - - 1 Keratitis - - - - - - - Corneal Ulcer - - - - - - - „ Opacities - - - - - - - Other Conditions 1 1 - 1 - - 1 Vision - - - - - - - Squint 13 4 - 6 - - 6 Hearing Ears. - 1 1 - - - 1 Otitis Media 2 6 2 2 2 - 6 Other Diseases 1 3 2 1 - - 3 Teeth 10 24 1 - - 27 28 Tonsils 45 17 2 8 2 - 12 Adenoids 24 14 1 10 - - 11 Other Conditions 5 3 1 1 1 - 3 Enlarged Cervical 26 4 1 1 3 - 5 Speech 2 1 - - 1 - 1 Heart Disease 12 3 - 2 - - 2 Anaemia 3 30 - 2 24 - 26 Lungs, Tubercular - - - - - - - Lungs, non-Tubercular 12 8 3 3 1 - 7 Other Tubercular Diseases 1 1 - - 1 - 1 Epilepsy - - - - - - - Chorea 1 - - - - - - Other Conditions 3 3 1 1 3 - 5 Rickets - 4 2 - - 1 3 Spinal Curvature - - - - - - - Other Forms. 14 42 - 4 22 13 39 All other Defects 35 69 6 8 22 21 57 Mental Condition 2 2 - 1 - 1 2 Behaviour - 3 - - 2 1 3 Total 223 268 24 54 104 64 246 24 TABLE 13. ATTENDANCES AT SPECIAL TODDLER (2-5 YEARS) Clinics. 1st JANUARY—4th JULY, 1948. Centre. No. of routine medical examinations. Re- inspection. Total attendances. Sessions. Average attendance per Session. 2—3 years. 3—4 years. 4—5 years. Rochester Road 133 84 79 29 325 25 13.0 Wrythe Lane 105 79 64 3 251 26 9.6 Stanley Road 35 39 19 3 96 13 7.4 Totals 273 202 162 35 672 64 10.5 TABLE 14. ATTENDANCES AT ALL INFANT WELFARE CLINICS. (Infant Consultation and Special Toddler). 1st JANUARY—4th JULY, 1948 Year. Number who attended during the year. New cases to the Centre. Attendances. Sessions. Average attendance per Session. Primary. Total. 0—1 | 2,030 463 439 6,534 167 39.1 1—5 143 126 3,137 230 13.6 Totals 2,030 606 565 9,671 230 42.0 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. 25 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 half year is indicated by the following information. 26 DENTAL SCHEME—TREATMENT PROVIDED 1st JANUARY—4th JULY, 1948 Temporary Teeth. Permanent Teeth. Dentures Supplied. Extracted. Filled. Extracted. Filled. Full. Partial. 52 11 165 124 12 13 Anaesthetics Gas 77 Local 4 Inspections 123 Other operations Impressions 69 Bites 28 Try-ins 48 Dressings 8 Scalings 16 Repairs 10 Dentures supplied:— Full Partial. Free - - Part Cost 1 - Full Cost 11 13 Total 12 13 Attendances at the Dental Clinics were as follows :— DENTAL SCHEME—ATTENDANCES 1st JANUARY—4th JULY, 19-18 Centre Referred from. No. Treated. No. of attendances. Rochester Road. Children 22 33 Mothers 34 138 Individuals 56 171 Wrythe Lane. Children 6 22 Mothers 24 145 Individuals 30 167 St. Helier. Children 2 2 Mothers 6 17 Individuals 8 19 Stanley Road Children 7 11 Mothers 11 31 Individuals 18 42 The Mount. Children - - Mothers 1 4 Individuals. 1 4 Day Nursery. Children 2 2 All Centres. Children 39 70 Mothers 76 335 Individuals 115 405 Number of Sessions held 52 Average attendance per Session:— Children 1.3 Mothers 6.4 Individuals 7.7 27 Orthopaedic Treatment, The Massage Clinic at the Rochester Road centre was fully attended. 58 children with the undermentioned orthopaedic defects making 628 attendances up to 4th July:— Post-operative Megacolon 1 Genu-varum 7 Genu-valgum 24 Pes Planus 11 Valgus Ankles 1 Muscular Atonia 13 Muscular Contracture of Legs 1 By arrangement with the Committee, orthopaedic cases were referred to the out-patient department of the Croydon General Hospital and assistance was available where necessary towards the cost of in-patient treatment and the provision of surgical appliances. One such appliance was provided free of cost during the first half of the year. Convalescent Treatment. The Council had an arrangement with the Invalid Children's Aid Association for the convalescent treatment of children. They also subscribed to the Surrey Convalescent Homes to provide similar treatment for mothers and babies. Three children were sent to convalescent homes under these arrangements during the first six months of the year. Maternity Hospital Treatment. Most of the women in the district provided with hospital accommodation for their confinement, are admitted to the St. Helier Hospital. The Council had an agreement under which cases may also be sent to the Carshalton War Memorial Hospital. The women referred from the Council's clinics and admitted to hospital during the first half of the year, were as follows:— For obstetric For unsuitable and medical home reasons. conditions. Total. Carshalton (War Memorial) Hospital — — — St. Helier County Hospital 32 16 48 Other County Hospitals 1 2 3 33 18 51 Whilst only 51 mothers were referred to hospital for confinement from the clinics, it should be noted that 268 Carshalton babies were born in hospitals and nursing homes during the half-year. 28 Premature Babies. The number of premature babies born 1st January to 4th July, whose mothers are normally resident in the district was 27. The number born in the district irrespective of the home address was 88. Of these, 72 were born in hospitals and nursing homes and 16 in private houses. Details as to nursing and survival are as follows:— The number of babies born at home— (i) who were nursed entirely at home . 15 (ii) who died during the first 24 hours (iii) who survived at the end of one month 15 The number of those born in hospital or nursing home— (i) who died in the first 24 hours 5 (ii) who survived at the end of one month 67 The survival rate at one month of 93% for the first half of 1948 compares with 81% in 1947 and 86% in 1946. Most of these premature births occurred in the St. Helier Hospital, which provides maternity facilities not only for Carshalton, but for a large part of Surrey. The 27 premature babies born to residents represents 5.3% of the live births in the half year. Special arrangements for the nursing of premature infant; re 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 were less than 3% of the total in 1948, which is the lowest percentage since 1941. For the care of unmarried mothers and their babies, the Council's service worked in co-operation with the Sutton and District Girls' Aid Association. The Council contributed to the funds of the Association and invariably accepted responsibility for the uncovered balance of cost of treatment in Special Homes for such cases. Three unmarried girls wrere assisted in this way by the Council during the first six months of the year. 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 1948. 29 Maternity Outfits. Sterilised outfits for use during confinement are available at cost price or less than cost in necessitous cases. Home Helps. Four full-time and 9 part-time women were employed to serve, both as Home Helps during confinement and as Domestic Helps in cases of general sickness. Twenty-three maternity cases up to 4th July, were assisted in this way at a cost determined by the income scales recommended by the Metropolitan Boroughs Joint Standing Committee. 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 first six months of the year is indicated by the following details Cases conducted:— (1) As Midwife—Live births Primip. Multip. Total 9 72 81 Stillbirths - 1 1 (2) As Maternity Nurse:— Live births 3 7 10 Stillbirths - - - 12 80 92 Medical Aid Forms sent by Midwives 21 Delayed Labour 2 Torn Perineum 8 Discharging Eyes 3 Abnormal Presentation 2 Post-Partum Haemorrhage 1 Foetal Distress 1 Adherent Placenta 1 Early rupture of Membranes 2 Fainting during Labour . 1 Voluntary Helpers. Voluntary work has always been a feature of the Council's clinic arrangements. The 12 ladies who gave regular attendance continued their services after the 5th July, when the scheme became the responsibility of the County Council. 30 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 up to July 4th:— Number of registered foster homes with children at July 4th, 1948 14 Number of new homes registered during the half-year 4 Number of foster homes removed from the register during the half-year 3 Total number of foster homes supervised 17 Number of the children admitted to the register during the half-year 4 Number of children removed from the register during the half-year 3 Total number of children on the register at July 4th 15 Total number of children on the register during the half-year 17 Number of children who died during the half year Number of inquests held Number of visits made to foster homes 45 Legal proceedings — Adoption of Children (Regulation) Act, 1939. This Act, imposes 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 half-year 1 (b) Total number of children in respect of whom notice was given under Section 7 (3) during the half-year 1 (c) Number of children notified under Section 7 (3):— (i) under supervision at the end of the half- year 6 (ii) who died during the half-year — (iii) on whom inquests were held during the half-year — (d) Particulars of any proceedings taken during the half- year — 31 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 2. The attendances up to 4th July totalled 2,861, which gives an average of 18.8 for the 152 days the nursery was open. 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.i'., illness of the mother, are admitted for those reasons. There is a lengthy waiting list for admission. Payment by the parents was at July 4th, as originally, 1/- per day. The attendances during the period 1st January—4th July, 1048, were as follows:— Total attendances—under 2 years 2,786 over 2 years 4,861 7,647 Days open 154 Average daily attendance—under 2 years 18.1 over 2 years 31.5 49.6 Attendances excluding Saturdays— under 2 years 2,780 over 2 years 4,801 7,581 Days open, excluding Saturdays 12!) Average daily attendance, excluding Saturdays—under 2 years 21.5 over 2 years 37.2 58.7 DOMESTIC HELPS. The same staff of helpers used as Home Helps under the Maternity and Child Welfare Scheme, is employed to give domestic assistance in cases of general illness or infirmity. The number of households provided with this help, exclusive of maternity cases, during the first half of the year was 38, the householders contribution to the cost being fixed by the same income scales as used by the maternity scheme. 32 Section C—Sanitary Circumstances. Water Supply. All but some 170 dwellings in the extreme north of the district supplied by the Metropolitan Water Board, are provided with a direct piped supply of water by the Sutton and District Water Company, mainly from its wells in the chalk at Sutton, Cheam and Woodmansterne. The Company is under statutory obligation to soften to 9° of hardness. Supplementary supplies can, if necessary be obtained from the Metropolitan Water Board, the Epsom and Ewell Corporation and the East Surrey Water Company. The supply was satisfactory in quantity and quality and no contamination of significance was observed. The following statement supplied by the Engineer shows the extent of sampling carried out by the Water Company during 1948:— Sample Total No. of Bacteriological Examina tions Total No. of Full Chemical Analyses Presumptive B. Coli present in 100 m . (excluding types 1 & 2) B: Coli present in 100 m. (types 1 & 2) No. % No. % Sutton Raw 314 27 9 2.9 7 2.2 Sutton Finished 311 27 11 3.5 3 1.0 Woodmansterne Raw 310 24 Nil Nil Nil Nil Woodmansterne Finished 313 25 Nil Nil Nil Nil Cheam 335 77 6 1.8 Nil Nil Reservoir 231 Nil 5 2.2 Nil Nil District including New Mains 312 29 9 2.9 Nil Nil Sampling of water as received by the consumer, is done by the Health Departments of the districts in the Company's supply area on au agreed rota. The following is a representative chemical and bacteriological report on such an examination:— Chemical analysis in parts per 100,000. Total solid matter in solution (dried at 180° C.) 21.9 Combined chlorine 1.80 Nitric nitrogen 0.86 Nitrous nitrogen 0.001 Ammonia, free and saline 0.0040 Ammonia, albuminoid 0.0020 Oxygen absorbed from permanganate in 4 hours at 26.7° C. 0.020 Hardness—by acidimetric titration—Temporary 7.9 Permanent 5.3 Total 13.2 pH 7.6 33 Reaction for free chlorine; positive, equivalent to 0.2 part per million. The water was bright and clear and was normal in colour. Bacteriological examination. Action by free chlorine during transit of the sample was prevented at the time of sampling. Number of colonies per ml. developing upon agar in 2 days at 37° C. ... 0 Number of colonies per ml. developing upon agar in 3 days at 22° C. ... 0 Organisms of the coliform group absent in 100 ml. Streptococci do. CI. 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. Drainage and Sewerage. No extensions or replacements were made to the drainage or sewerage systems. The whole of the developed area is soil-sewered, except for a small part containing 17 properties in the southern end 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 1948. Rivers and Streams. In April, 1947, the County Council took over the maintenance of the River Wandle. No specific improvements or cleansing, other than normal routine, were undertaken during the year. Five complaints were received and 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. Early in 1948, the weekly collection of house refuse, which during the war had been on a fortnightly basis, was re-introduced. Later in the year the separate collection of salvage was discontinued, with the introduction of trailers towed by the normal refuse collection vehicles. These trailers enabled weekly collection of salvage to be undertaken by the refuse collectors. Special collections of salvage from trade 34 premises was still carried out by a separate vehicle. In November, 1948, the first new 12 cu. yd. capacity Dennis refuse collection vehicle was put into service. The Refuse Disposal Plant, which was overhauled in 1947, operated satisfactorily during the year, and no alterations or modifications were made to the plant. Two new 4-ton Ford hydraulic tippers were purchased and put into use for clearance of clinker and screenings. A steam cleansing plant was purchased and put into use for the cleaning and sterilising of bins used for the collection of kitchen waste. These bins were cleansed during the summer months at intervals of approximately 4 days. 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 2,292 complaints concerning the following:— Drains obstructed 287 Sewers obstructed 9 Drainage defects 52 General defective conditions 209 Dampness 42 Roofs, gutters, etc. 42 Sink waste pipes 3 Water supplies 17 Dustbins 764 Accumulations 40 Refuse Collection 22 Smoke nuisance 10 Rivers 5 Ditches and ponds 1 Unsound food 207 Overcrowding 86 Obnoxious effluvia 19 Verminous premises 29 Rats and Mice 278 Wasps 64 Ants 4 Beetles 6 Flies 3 Animals 10 Insects, various 11 Dirty Milk Bottles 2 Milk contam nation 1 Milk, sour 1 Miscellaneous 52 Pig Bins 12 Soakaways 1 Burst pipes 1 Shops 2 2,292 35 Eleven thousand, six hundred and fifty-visits of inspection and re-inspection were made for the following purposes:— Public Health Act (houses) 3,394 Public Health Act reinspections 4,036 Dairies 96 Cowsheds 72 Factories 202 House drains tested 39 Suspected rat infested premises 221 Foodshops and business premises 1,677 Infectious disease premises 183 Infectious disease contacts 90 Urinals 83 Premises re cesspools11 Schools 20 Offices 38 Bakehouses 23 Stables 2 Smoke observations 22 Outworkers' premises 45 Employment Agencies 4 Piggeries 43 Food Poisoning Enquiries 17 Food and Drugs and other samples 698 Animals, slaughter of 7 Housing Enquiries 618 Water Sampling 9 11,650 Nine hundred and seventy-seven informal notices were served concerning the following matters:— General defective conditions 343 Cowsheds 1 Rats and mice 3 Accumulations and deposits 42 Obstructed drains 18 Drainage defects 82 Verminous premises 12 Dustbins 272 Water supply 9 Animals 2 Factory Acts 10 Food contamination 1 Unsatisfactory food premises 35 Miscellaneous 1 Burst pipes 2 Overcrowding 117 Shops Acts 24 Smoke nuisance 3 977 36 One hundred, formal notices were served by authority of the Council under the following Acts:- Section 24 Public Health Act, 1936 12 Section 39 ,, „ 3 Section 56 „ „ 1 Section 75 „ „ 21 Section 93 „ „ 57 Section 13 Food and Drugs Act, 1938 1 Section 7 Factories Act, 1937 2 Section 10 Shops Act, 1934 2 Section 66 Housing Act, 1936 1 100 As a result of investigations made and notices served, the following work was carried out:— Accumulations removed 21 Brickwork, repaired and/or repointed 21 Ceiling plaster repaired and/or made good (including plaster board) 177 Ceilings cleansed and purified 46 Ceilings, new provided 18 Chimney pots repaired and/or made good 7 stacks repaired and/or made good 14 flues repaired 14 Damp conditions remedied 82 Damp course provided 3 renewed 2 Doors repaired, including locks and fasteners 22 Door frames repaired and/or made good . 16 stopping to reveals renewed 2 weather boards repaired or renewed 2 Drainage repaired and/or reconstructed 12 provided 1 inspection chamber repaired and/or made good 26 inspection chamber covers renewed 28 inspection chambers and covers provided 27 stoppers or caps refixed and/or renewed 30 fresh air inlet repaired and/or renewed 34 soil vent repaired and/or renewed 38 drains tested 21 drains cleared (affecting 794 houses) 254 drains sealed off 1 waste gullies repaired, renewed or cleared 12 waste gullies provided 1 waste pipes, repaired, renewed or provided 9 Disinfestation 63 Dustbins provided 90 Fences repaired or renewed 2 Food storage provided 1 ventilated 1 Floor boards repaired and/or made good 52 concrete repaired, renewed and/or made level 8 ventilation provided 2 ventilation repaired or renewed 1 ventilation curbed 1 37 Fire places repaired and/or made good 12 Fire grates repaired and/or renewed 11 Paving repaired and/or made level 9 provided 2 drained 4 Ranges, stoves repaired and/or renewed 14 provided 1 Roofs repaired and made weatherproof 109 ridges, hips, valleys repaired and/or renewed 1 flashings repaired and/or renewed 1 down pipe, guttering repaired and/or renewed 64 down pipe provided 2 down pipe cleared out and made to work properly 36 Shop forms provided 7 temperature maintained 2 miscellaneous matters remedied 29 Sinks renewed or repaired 2 provided 2 Stair treads repaired, renewed or made level 3 handrails and/or balusters repaired 11 string repairs 1 Steps repaired and/or renewed 7 Soakaway made to work properly 4 Surface water drainage repaired and made to work properly 14 Walls, cement rendered 2 rendering repaired 19 replastered and/or repaired 141 cleansed and redecorated 48 repaired 1 rebuilt 3 Woodwork repaired and/or renewed 6 Windows repaired and/or renewed 31 frames repaired and/or renewed 24 made to work properly 8 provided with catches or fasteners 1 sash cords renewed 20 sills (external) repaired 16 stopping to reveals 16 fixed, made to open 6 glazing panes and putty renewed 26 W.C. accommodation repaired 3 provided 3 pans renewed 28 provided 2 pan joints renewed 15 seats repaired, renewed or provided 18 flushing apparatus repaired or renewed 30 flushing apparatus provided 3 Water supply repaired 22 provided 2 cisterns repaired 1 Wash basins, baths renewed 2 provided 1 Ventilation, more provided 5 Other matters 5 38 Disinfection. In connection with cases of infectious disease, 196 rooms and 200 library books were disinfected. Thirty-four lots of bedding were steam disinfected and two lots 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 24 74 166 For pediculosis 32 91 192 56 165 358 School children included in these totals were:— For scabies 40 For pediculosis 66 Where possible, the practice of treating all members of affected families is followed. Premises. During the year, 63 premises and one lot of furniture were treated for the destruction of vermin and insect pests as follows:— Infestation. Sprayed by C.U.D.C. Sprayed by L.C.C. HCN Process. C.U.D.C Property. L.C.C. Property. Privately Owned Property. L.C.C. Property. C.U.D.C. Property. Privately Owned Property. Furniture. Beetles 1 - - - - - - Bugs 4 - 5 6 1 1 1 Cockroaches 1 - 1 - - - - Fleas 2 - - - - - - Flies 1 - - - - - - Moths 1 - - - - - - Wasps 3 2 34 - - - - 13 2 40 6 1 1 1 39 Rats and Mice (Destruction) Act, 1919. Under the direction of the Ministry of Agriculture & Fisheries, rodent destruction was carried out during the year. Eight thousand, three hundred and forty visits were made and 424 rats and mouse infestations found. Of that number, 374 were found in private premises, 26 in business premises and 24 in Council premises. With regard to sewers, two maintenance treatments were carried out, one in March and the other in September, with the following results:— March Treatment. September Treatment. Manholes baited 320 222 Manholes in which takes of prebait were recorded 40 92 Percentage of manholes showing infestations 1.2 41.5 Percentages in relation to total manholes in district 3.5 8 Smoke Abatement. Ten complaints were received and dealt with during the year. Shops Act, 1912—1938. Six hundred and six inspections of shops were made and informal action was necessary regarding infringements in 24 cases. There were 530 shop premises on the register at the end of the year. Section 10 (Health and Comfort). It was necessary to take action in two cases for the provision of sanitary accommodation. Offices. Thirty-eight 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. Reference was made in my report for the year 1947, to the provision by the Carshalton and Merton and Morden Joint Cemetery Board of the Cemetery at Morden. The number of interments in the Cemetery in the year under review was 237 and of this number, 68 were from the Carshalton district. The Church-yard adjoining the Carshalton Parish Church continues to be used for new burials, but the space available is rapidly diminishing. 40 During the year the Cemetery Board have sought the approval of the Ministry of Health for the erection of a residence and office for the Superintendent, but the proposals have not reached a stage when they could be approved by the Department. The position with regard to the provision of a Crematorium has been somewhat clarified as a result of discussions which have taken place in the Surrey County Districts' Association concerning general provision in the County. The approved scheme is intended to serve as a guide for the establishment of Crematoria in the County and provides for the grouping of the authorities concerned. Carshalton has been grouped with Wimbledon Borough, Sutton and Cheam Borough and the Merton and Morden Urban District Councils, together with the Battersea Metropolitan Borough Council, and, as indicated in my last report, the Battersea Borough Council have produced approved plans for a Crematorium to be accommodated on the land forming part of their Cemetery site at Lower Morden. At the end of the year these plans were still being considered by the various Councils concerned. Modern mortuary facilities with provision for post-mortem examinations are provided at the Council's Mill Lane Mortuary. Establishments for Massage and Special Treatment. Eight establishments coming within the scope of Part IV of the Surrey County Council Act, 1931, were visited and inspected. Six were for the practice of Chiropody and two for massage, etc. All were found to be satisfactory. Employment Agencies. The Employment Agencies are visited by the Authority acting as Agents for the Surrey County Council. There were three on the register, and all were found to be satisfactory. 41 Section D—Housing. New Houses. During the year, 215 new houses of the following types were completed:— " Unity " permanent prefabricated 60 C.U.D.C. "Orlit " permanent prefabricated 48 Traditional (Ma's n.ttes) 26 Under Licence 2 Private Rebuilds (war damage 1) 14 L.C.C. Rebuilds (war damaged) 65 Private Total 215 Council's Housing Scheme. The dwellings in the ownership of the Council at the year end, totalled 893 houses, flats and temporary bungalows. During the year work continued on the undermentioned Contracts:— Site No. Site. Type. No. in Contract. No. completed during year. 2 Green Wry the Lane "Orlit" permanent prefabricated 24 Fellowes Road (No. 1) 10 Fellowes Road (No. 2) 8 Hackbridge Cottage 16 Duke of Edinburgh Rd. 6 64 48 3 Clock House Farm Estate (part) "Unity" permanent prefabricated 96 60 4 Wrythe Lane Maisonettes 24 24 21 Connaught Road " 2 2 186 134 In addition, the following schemes were in varying stages of preparation with a view to work being commenced during the period of one year beginning on the 1st July, 1948. 42 Site No. Site. Type. No. in Contract. 3 Clock House Farm Estate (part) Traditional Houses 38 10 Denmark Road Flats 72 11 Alma Road ,, 9 12 Harrow Road ,, 0 18 Banstead Road „ 6 131 The accommodation under requisition by the Council at December 31st, 1048, comprised 153 premises, providing accommodation for 231 families. The number of outstanding approved applications for tenancies at the year end was approximately 1,850. 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.—3,394 3,394 (b) No. of inspections made for the purpose 7,430 (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 723 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 1947) 694 43 3. Action under Statutory Powers during the year. (a) Proceedings under Sections 9, 10 and 1(5 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 Heai/th Acts. (1) Number of dwelling houses in respect of which formal notices were served requiring defects to be remedied 94 Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 89 (b) By local authority in default of owners 5 4. Housing Act, 1936. Part IV—(Overcrowding). (a) (1) Number of dwelling houses overcrowded at the end of the year 287 (2) Number of families dwelling therein 480 (3) Equivalent number of adults dwelling therein 2,212½ (b) Number of new cases reported during the year 107 (c) (1) Number of cases of overcrowding relieved during the year 94 (2) Number of persons concerned in such cases 523 (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. Action of this nature was still in abevance. Overcrowding. During the year 107 new cases of overcrowding were found and 94 were remedied, leaving 287 dwellings known to be overcrowded with 2,212½ equivalent adults in occupation still to be decrowded at the year end. Details are as follows:— Overcrowded at 31.12.47. Found overcrowded during 1948. De- crowded during 1948. Remaining overcrowded at 31:12.48. Net Increase during year 1948. Dwellings 274 107 94 287 13 Equivalent Adults 1,9901 745 523 2,2121 222 44 The 94 cases of overcrowding were abated during the year in the following manner:— (a) Provision of alternative accommodation by:— Carshalton Urban District Council 41 London County Council 49 (b) Left district 1 (c) By removal of one or more occupants 3 The history of knoxn overcrowding since the housing survey of 1936 is indicated by the following:— Ward. Dwellings overcrowded at Survey 1936. Dwellings found overcrowded up to 31.12.48 Dwellings decrowded up to 31.12.48 Dwellings remaining overcrowded at 31.12.48 Overcrowded cases remedied during 1948. Formal Informal Total. St. Ilelier North 40 212 167 85 20 20 St. Ilelier South 40 172 155 57 16 - 16 St. Helier West 45 172 166 51 22 1 23 North-East 17 119 84 52 15 2 17 North-West. 10 62 58 14 5 - 5 Central 9 33 32 10 7 1 8 South-West - 7 7 - 2 - 2 South-East 12 50 44 18 3 - 3 173 827 713 287 90 4 94 Of the 287 dwellings remaining overcrowded at 31/12/48, 190 are owned by the L.C.C., 30 by the Carshalton Urban District Council and 67 privately owned. In 88 of the 107 cases of overcrowding found during 1948, there was more than one family in occupation and, from information available, it would appear that in 78 of these the families were related. Number of Families in occupation. 1 2 3 4 Total. New cases of overcrowding 19 55 28 5 107 Number of cases where families related - 48 25 5 78 Tents, Vans, Sheds and Similar Structures. No action. Cellar Dwellings. No action. 45 Rent and Mortgage Interest Restrictions (Amendment) Act, 1933. No action was necessary during the year. Factories and Workplaces. There were 122 Factories and Workplaces on the Register, 83 of them using mechanical power. Employees numbered 1,302, of whom 800 were males and 502 females. The following table classifies those employed Employees. Premises. Males. Females. Total. Factories— with nechanical power 647 484 1,131 70 without „ „ 122 17 139 23 Workplaces— with mechanical power 13 - 13 13 without „ „ 18 1 19 16 800 502 1,302 122 Action under the Factories Act was necessary with regard to 10 of the factories (8 informal, 2 formal). The following table, set out in the manner prescribed by Home Office Form 572 (Revised), indicates the inspections made and action taken under the Factories Act. 1. Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises. Number on Register Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 22 38 4 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 72 164 6 - (iii) Other premises in which Section 7 is enforced by the Local Authority* (excluding outworkers' premises) - - - - Total 94 202 10 -— * Electrical Stations (Section 103 (1)), Institutions (Section 104) and sites of Building Operations and Works of Engineering Construction (Sections 107 and 108.) 46 2. Cases in which Defects were found— (If defects are discovered at the premises on two, three or more separate occasions they should be reckoned as two, three or more " cases.") Premises. Number of cases in which defects were found. Number of cases in which tions were instituted. Found Remedied. Referred To H.M. Inspector. By H.M. Inspector. (1) (2) (3) (4) (5) (6) Want of cleanliness 2 2 - - - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation - - - - - Defective drainage of floors - - - - - Sanitary Conveniences— (a) Insufficient 5 5 - - - (b) Unsuitable or defective - - - - - (c) Not separate for sexes 3 2 - - - Other offences against the Act (not including offences relating to Outwork) - - - - - Total 10 9 - - - Outwork (Sections 110 and 111). Nature of Work. Section 110. Section 111. No. of outworkers in Aug. list required by Sect. 110(1) (c) No. of cases of default in sending lists to the Council. No. of prosecutions for failure to supply lists. No. of instances of work in unwhole some premises. Notices served. Prosecutions. (1) (2) (3) (4) (5) (6) (7) Wearing Annarel— Making, etc. 66 - - - - - Cleaning and washing - - - - - - Cosaques, Christmas crackers, Christmas stockings, etc. 40 - - - - - Total 115 - - - - - 47 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. The results of the chem'cal analyses of milk are shown under the section dealing with Food and Drugs Act. Milk (Special Designations) Regulations 1936-1946. Licences under these Regulations were issued as follows— Principal Licences—Tuberculin Tested 7 Pasteurised 7 Supplementary Licences—Tuberculin Tested 10 Pasteurised 9 Bacteriological Examination of Milk. Two hundred and Seven samples of milk were procured and submitted for bacteriological examination. All the milks were sold under the Milk (Special Designations) Regulations, and 17 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. 1 'nsatisfactory. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. Tuberculin Tested 3 2 1 - 2 1 T.T. Pasteurised 44 40 4 44 - - - Pasteurised 105 100 5 104 1 - - Heat Treated 53 47 6 53 - - - Accredited 2 2 - - - 2 - 207 191 16 201 1 4 1 48 Ice Cream. The results of the examination of 147 samples of ice cream were as follows:— No. of Samples. Grade. 1 2 3 4 147 52 26 53 16 Meat and Other Foods. Only 6 pigs were slaughtered in the district and these were inspected and passed for food. Food and Drugs Act, 1938. The following 319 samples were procured and submitted for analysis:— Article. No. Adulterated or otherwise irregular. Article. No. Adulterated or otherwise irregular. Apple Juice 1 Jam 3 1 Aspirins 1 Jelly 1 Baking Powder 1 Jelly Crystals 2 Bevmo 1 Kaola 1 Black Pudding 2 Kilkof 1 Brawn 1 Lemonade 1 Butter 1 Linctus 1 Cake Mixture 4 Malt Extract Tablets 1 Camphorated Oil 1 Margarine 2 Castor Oil 1 Meat Pork Press 1 Chocolate Cup 1 Meat, Potted 1 Cocoa 1 Meat Sausage, Beef 1 Cocom 1 Milk 225 5 Coffee 2 Pepper, White 1 Coffee & Chicory Esscncc 2 Pinicle Pellets 1 Cordial 1 Potato Powder 1 Confex 1 Pudding Mixture 3 Crunchets 1 Salad Dressing 3 Custard Powder 1 Salts, Epsom 1 Brink Powder 2 Sausage, Beef 3 Fat, Cooking 2 Sausage, Breakfast 1 Flavouring 1 Sausage, Liver 1 Fish Paste 7 Sausage, Luncheon 2 Frizets 2 Savouries 1 Fruit Pectin 1 Sauce 1 Gelatine 1 Sponge Mixture 1 Gravy Browning 1 Spice, Pickling 1 Gin 1 1 Sweets, Boiled 2 Ice Cream 3 Syrup of Figs 1 Tea 1 Vinegar, Malt 2 Tevs 1 1 Vinegar, Non-Brewed 3 1 Vinegarette 1 319 9 49 The following nine samples (2.8%)—were reported as adulterated or irregular:— Milk—No. 88. Very slight deficiency in milk solids other than milk fat and very slight variation of the freezing point. Warning given. V.O. Geneva Gin (Bols)—No. 99. (Informal). Sample was not gin and not drinkable as a beverage. An endeavour made to procure a formal sample without success. ( "Tevs"—No. 125. Sample reported to be deteriorated tablets or cachous due to long storage. Warning given. Milks—Nos. 144, 146, 147, 148. The above samples with four others which were satisfactory, were taken from a supply of milk produced at a local farm, after information had been received from a neighbouring authority. Taken in course of delivery, they were certified respectively to be 12%, 6%, 9% and 11% deficient in milk fat. The vendor gave notice under the 3rd Schedule of the Act, requiring samples to be taken from a corresponding milking of the cows. Six such samples were procured from the cows and four were certified to be deficient in milk fat, and one of them slightly deficient in milk solids. The matter was taken up by the Ministry of Agriculture and no further action was taken by this authority. Vinegar (Non-brewed)—No. 231. This sample contained 3.9% of acetic acid against the accepted standard of 4%. A warning was given. Plum Jam—No. 307. This sample contained 68% of soluble solids against the accepted 68½% standard. A warning was given. Foreign Matter in Food. Complaints were received with regard to the undermentioned foreign matter found in food:— Piece of wall tile in a loaf of bread. Glass in a bun. Screw in a loaf of bread. Glass in jam. Grease in a loaf of bread. String in a loaf of bread. Wood splinter in a loaf of bread. Safety pin in margarine. Cigarette end in loaf of bread. Maggot in milk. Beetles in chocolate table cream. Mineral Oil sold for cooking fat. 50 As a result of these occurrences, the Committee decided to send a communication to all confectioners in the district, stressing the need for the greatest care in the preparation and manufacture of articles of food designed for human consumption, and warning them that a most serious view would be taken of any further instances. 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 4 lbs. Milk 513 lbs. Bovril 1 lb. Mixture, Cake, Pudding & Sponge 188 lbs. Cake 25 lbs. Mineral Oil 10 bot. Cereals 70 lbs. Paste 3 lbs. Cheese 21 lbs. Pickles 13 lbs. Custard Powder 56 lbs. Pudding 6 lbs. Egg, Dried 8 lbs. Salad Dressing 1 lb. Eggs, Shell 375 Semolina 15 lbs. Fat 1 lb. Soup 47 lbs. Fish 2,540 lbs. Squash, Lemon 2 lbs. Fruit 950 lbs. Sweets 11 lbs. Jam 389 lbs. Tea 1 lb. Meat 1,378 lbs. Vegetables 597 lbs. Total weight: 3 tons, 1 cwt., 8 lbs. Bakehouses. There are four bakehouses in this district and all have received periodical inspection. No special action on bakehouses with the exception of repairs and cleansing was called for during the year. 51 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 Hospital, are particularly large institutions which are part of the hospital services of the South-West Metropolitan Hospital Region. 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. No cases of Variola infection were reported. Six contacts of cases occurring in ships arriving in this country were kept under observation. Vaccination. Under the County Council's scheme for vaccination, formulated under Section 26 of the National Health Service Act, the district Medical Officers of Health will be responsible for the direction of the arrangements in their respective sanitary districts. Vaccination is available at all infant welfare clinics or may be done by general practitioners to whom an approved fee will be paid. 52 From 5th July to the end of the year the following individuals were vaccinated:— Successful:— Under 1 yr. 1-4 yrs. 5-14 yrs. 15 yrs. & over. Total. Primary Vaccination 121 8 5 7 141 Re-vaccination 4 1 5 9 19 125 9 10 16 160 Unsuccessful Under l yr. 1-4 yrs. 5-14 yrs. 15 yrs. & over. Total. Primary Vaccination 4 — 1 — 5 Re-vaccination 1 — — 1 2 5 — 1 1 7 Records of the extent to which vaccination was practised in the district before the 5th July, are not available. It is not possible, therefore, to estimate the percentage of the local population who are now vaccinated. Information, however, from the scheme for the care of mothers and young children indicates that at 31st December, 1948, less than 30% of the children under 5 years were vaccinated. Enteric Fever. There were no cases of typhoid or para-typhoid fever. Dysentery. One case of dysentery due to Sonne infection was notified in a patient of one year in Queen Mary's Hospital. It recovered after a month in isolation hospital. A local girl of 8 years was also notified, but the diagnosis was not confirmed bacteriologically. She recovered after a few days' illness. Scarlet Fever. Rather more cases of scarlet fever occurred, one hundred and seven (103 residents) as against 98 (83 residents) in the year before. The incidence rates were accordingly:— All cases 1.72 per 1,000 population Residents 1.66 per 1,000 population 53 The infection was mild in all instances and there was no death. The number nursed at home at 39, represents 36% of the total and is the highest proportion so nursed yet recorded. Slightly more than half were children of school age. TABLE 15. 1948. Ward. Total. St. Helier North. St. Helier South. St. Helier West. NorthEast NorthWest. Central. SouthEast. SouthWest. January 2 1 4 2 2 1 - 2 14 February 2 - 2 2 4 4 1 1 16 March 2 3 - 3 2 1 1 1 13 April 1 — 1 2 — 1 — — 5 May 3 — 2 1 1 1 — — 8 Tune — — 3 1 — 1 1 - 6 July — 3 2 1 1 1 1 — 9 August — 3 1 1 — — — — 5 September 2 1 1 1 — — — — 5 October 1 1 2 1 — — 2 — 7 November 1 1 1 3 — — — 2 8 December 1 1 1 2 1 - - 1 7 Totals 15 14 20 20 11 10 6 7 103 Monthly Mean 1.25 1.16 1.66 1.66 0.91 0.83 0.50 0.58 8.58 Case rate per 1,000 population 1.73 1.97 2.37 2.12 1.49 1.64 0.80 1.04 1.65 TABLE 16. SCARLET FEVER—MULTIPLE CASES, 1948. Ward. No. of houses in which occurred. Total Houses. Total Cases. 1 Case. 2 Cases. 3 Cases. St. Helier North 13 1 - 14 15 St. Helier South 9 1 1 11 14 St. Helier West 18 1 — 19 20 North-East 16 2 — 18 20 North-West 11 — — 11 11 Central 7 — 1 8 10 South-East 4 1 — 5 6 South-West 5 1 — 6 7 Whole District 83 7 2 92 103 54 Diphtheria. Four cases of diphtheria were notified; three were patients in Queen Mary's Hospital and one a local girl of 12 years. Incidence was as follows:— All cases 0.06 per 1,000 population Residents 0.01 per 1,000 population. The case of the resident was clinically a mild tonsilitis, but her throat swab showed a positive "gravis" infection and the persistence of this accounted for her protracted stay of three months in isolation hospital. The incidence of diphtheria among the resident population since 1934, the year before immunisation was first practised in the district, was as follows:— Year Cases Incidence per 1,000 Population Year Cases Incidence per 1,000 Population 1934 66 1.73 1941 26 0.45 1935 58 1.13 1942 23 0.40 1936 53 0.95 1943 7 0.12 1937 47 0.80 1944 7 0.12 1938 33 0.57 1945 15 0.27 1939 14 0.23 1946 4 0.06 1940 45 0.77 1947 2 0.03 1948 1 0.01 The number of swabs examined for diphtheria during the year was 82. Diphtheria Immunisation. As a result of the National Health Service Act, the responsibility for diphtheria immunisation was transferred to the County Council on 5th July, 1948. By agreement between the County and District Councils, this work has continued to be directed by the District Councils' Medical Officers of Health and there has, in consequence, been no dislocation of the administrative arrangements which have proved so successful in the past. Immunisation is available at all the infant welfare clinics and the arrangement previously established, whereby the general practitioners participate in the scheme on payment, was continued after 4th July, but the co-operation of the practitioners is being prejudiced by the long delay in deciding the payment to be made under the new arrangements. This question has now been outstanding for more than a year, during which time the practitioners have received no fees. Every other term, a programme of immunisation sessions is arranged in the primary schools of the district, where children not previously immunised can be treated, and where reinforcing injections are given after an interval of three years. 55 Immunising materials normally used at the clinics and in the schools are A.P.T. in two doses of 0.5 c.c. at one month's interval for primary treatment and 1 c.c. T.A.F. for reinforcing injections. During 1948, 1,059 residents were immunised as follows:— Age at Year End. Total. Under 1 1 2 3 4 5-9 10-14 At Council Clinics 45 609 65 18 12 4 - 753 In Carshalton Schools - - - 2 6 178 28 214 Private Practitioners 9 76 23 1 1 - - 110 54 685 88 21 19 182 28 1077 Less outward transfers 2 9 1 - 1 26 3 42 Plus inward transfers 1 3 1 - - 14 5 24 Carshalton Residents 53 679 88 21 18 170 30 1059 A further 972 children received reinforcing treatment in the area. Allowing for inward and outward transfers, the figure for Carshalton residents so treated, was 948. The number of children immunised against diphtheria is now over 80% and is higher than ever before. The position with regard to immunisation at the year end was as follows:— Age at 31.12.48, i.e., Born in Year Under 1 1941. 1 1947. 2 1946. 3 1945. 4 1944. 5 to 9 1939/ 43. 10 to 14 1934/ 38. Total under 15 Number Immunised 55 766 860 687 781 3879 4958 * 11986 Estimated mid-year population, 1948 4700 9580 14280 Percentage done 67% 92% 81% 56 The following table shows the estimated percentage of children immunised at each year end since 1935, when the Council's scheme was inaugurated and the incidence of diphtheria in the resident population: Year. Percentage of Children Immunised. Incidence of Diphtheria. 0-5 Years. 5-15 Years. 0-15 Years. Cases. Attack Rate per 1,000 Population. 1935 - - 7 58 1.13 1936 — — 10 53 0.95 1937 — — 15 47 0.80 1938 — — 18 33 0.57 1939 — — 19 14 0.23 1940 — — 21 45 0.77 1941 — — 49 26 0.45 1942 40 84 71 23 0.40 1943 57 78 72 7 0.12 1944 54 83 75 7 0.12 1945 58 75 70 15 0.27 1946 64 81 76 4 0.06 1947 63 84 78 2 0.03 1948 67 92 81 1 0.01 Erysipelas. Sixteen cases were notified, eight of which received hospital treatment. All but one were residents. The face was the site affected in 11 of these and two of the infections were in respect of the same person, whose condition relapsed ten clays after discharge from hospital. All recovered. Pneumonia. Notifications of pneumonia at 56 were 15 less than in the year before. Those of influenzal origin numbered four. Two-thirds of the total werp adults of twenty or over. Measles. Following a year of low incidence, it was expected that 1948 would conform to the accepted pattern of the periodicity of measles in the London area and show a high prevalence of this infection. The rising wave commenced in February, reached its peak in March and continued at a gradually falling level until August. A total of 955 cases were notified, 918 of which were residents of the district. This is the highest yearly total recorded since 1939, when the disease was first notifiable. In spite of this high prevalence, there was not a single death. 57 Unfortunately, there is, as yet, no known means of preventing this infection. This, however, does not justify a fatalistic attitude. Many lives can be saved if the illness is deferred beyond the very early years of life when mortality is highest. Young babies and debilitated children, who have been exposed to infection, can be given either temporary immunity or, at worst, an attenuated attack by the prompt use of convalescent or adult serum. TABLE 17. MEASLES—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1948. (Excluding hospital patients non-resident in Carshalton.) 1948. Ward. Total. St. Helier North. St. Helier South. St. Helier West. NorthEast NorthWest. Central. SouthEast. SouthWest. January - - - 2 5 - - - 7 February 12 20 23 10 9 1 — - 75 March 51 29 25 62 25 17 6 11 226 April 36 9 11 56 33 17 3 6 171 May 15 6 38 32 27 9 6 5 138 June 14 7 36 43 15 9 7 5 136 July 4 4 3 32 7 19 11 11 91 August 1 4 4 3 2 15 13 19 61 September 1 - - - - - - - 1 October — — — — 1 — - - 1 November — — — — — — - — — December 3 1 1 3 1 2 — — 11 Totals 137 80 141 243 125 89 46 57 918 Monthly Mean 11.41 6.66 11.75 20.25 10.41 7.41 3.83 4.75 76.50 Case rate per 1,000 population 15.8 11.2 16.7 25.7 , 17.0 14.5 6.17 8.48 14.7 Whooping Cough. Pertussis was more prevalent, 365 cases being notified. All were residents but two. An endemic disease in urban districts, it had an epidemic wave superimposed during 1948, with its peak in mid-summer. There were no deaths. 58 TABLE 18. WHOOPING COUGH—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1948. (Excluding hospital patients non-resident in Carshalton.) 1948. Ward. Total. St. Helier North. St. Helier South. St. Helier West. NorthEast. NorthWest. Central. SouthEast. SouthWest. January - - - 5 3 - - - 8 February 2 — 1 6 4 6 2 — 21 March 4 — 3 2 — 7 6 1 23 April 6 — 2 6 6 — 7 2 29 May 6 1 2 4 1 4 3 1 22 June 3 6 8 8 1 2 2 3 33 July 13 10 15 13 7 1 3 2 64 August 9 9 10 31 1 2 4 1 67 September 1 3 3 14 2 1 - 2 26 October 1 — 1 7 1 3 7 1 21 November — 1 3 1 4 2 5 4 20 December 1 — 9 3 4 2 6 4 29 Totals 46 30 57 100 34 30 45 21 363 Monthly Mean 3.83 2.50 4.75 8.33 2.83 2.50 3.75 1.75 30.25 Case rate per 1,000 population 5.30 4.22 6.76 10.6 4.62 4.91 6.04 3.12 5.82 Cerebro-Spinal Fever. Only one case of meningo-coccal meningitis was reported in a child of nine years. She recovered completely after chemotherapy in hospital. Anterior Poliomeylitis and Encephalitis. The epidemic wave of infantile paralysis of 1947 was fortunately not repeated in 1948. Four cases were notified, one of which was a patient in St. Helier Hospital, admitted there for treatment from Morden already suffering from the disease. The incidence of this disease was, therefore, 0.04 per 1,000 population. One case was an adult woman of thirty years, who died after five days' illness. Another was a child of four, who is still undergoing treatment for some residual weakness of one leg. The third case, was a boy of fourteen years, who had extensive paralysis below the waist. He is still in an orthopaedic hospital, but can now walk with the aid of sticks. 59 Ophthalmia Neonatorum. There were again no eases of this eye infection of the new born. Modern chemotherapy has almost abolished this disease. Puerperal Pyrexia. Notifications of a rise in temperature during childbirth at 47, were the same as in the year before. As previously explained, most of these notifications come from the St. Helier Hospital, which has a large maternity department catering for a large part of Surrey and where the abnormal or potentially abnormal cases form the priority group for admission. Fourteen of the total were in respect of residents of Carshalton and 34 were first pregnancies. All recovered. Food Poisoning. Two adult members of a family were taken suddenly ill with sickness and diarrhoea two or three hours after an evening meal, at which tinned veal was eaten. Bacteriological investigation in hospital showed that both patients suffered from bacillus typhi-murium infection. Both recovered. None of the meat remnants or the empty tin were available for examination and so the suspicion which attached to the tinned meat could not be confirmed. In March, a number of school children and teachers were taken ill with intestinal symptoms following the mid-day meal, supplied from one of the school canteens. After some hours of sickness and diarrhoea they all recovered. Bacteriological investigation into the available commodities eaten and of the patients failed to identify any infection, but the inquiries served to remedy some defects in the technique of the catering arrangements. 60 TABLE 19. 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 103 1.65 — 15 14 20 20 11 10 6 7 64 62 Diphtheria 1 0.01 — — — — — — — 1 — 1 100 Measles 918 14.7 — 137 80 141 243 125 89 46 57 8 0.87 Whooping Cough 363 5.82 — 46 30 57 100 34 30 45 21 2 0.55 Dysentery 1 0.01 — — 1 — — — — — — — — Cerebro-Spinal Fever I 0.01 — — 1 — — — — — — 1 100 Poliomyelitis 3 0.04 — 1 — — — — — — 2 3 100 Food Poisoning 2 0.03 — — — — 2 — — — — 2 100 Erysipelas 16 0.25 — 1 2 — 5 1 3 4 — 8 50 Pneumonia 56 0.90 — 6 4 3 15 10 6 9 3 — — Puerperal Pyrexia 15 0.24 — 3 1 6 — 2 — — 3 14 93 61 TABLE 20. INFECTIOUS DISEASES. Notification by Age Groups, 1918 (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 14 12 36 20 9 6 2 — — 103 Diphtheria — — — — — — 1 — — — — 1 Measles 32 101 115 120 115 388 33 8 5 I — — 918 Whooping Cough 26 49 46 46 69 115 7 1 2 2 — — 363 Dysentery — — — — — 1 — — — — — — 1 Cerebro-spinal Fever — — — — — 1 — — — — — 1 Poliomyelitis — — — — — 1 1 — 1 — — — 3 Food Poisoning — — — — — — — — 2 — — — 2 Erysipelas 1 — — — — — — — 3 — 9 3 16 Pneumonia 3 3 3 — — 7 2 2 3 9 15 9 56 Peuperal Pyrexia — — — . — — — — 2 11 2 — — 15 6 2 TABLE 21. MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1948. (Excluding hospital patients non-resident in Carshalton.) Disease. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 14 16 13 5 8 6 9 5 5 7 8 7 103 Diphtheria — — — — — 1 — — — — — — 1 Measles 7 75 226 171 138 136 91 61 1 1 — 11 918 Whooping Cough 8 21 23 29 22 33 64 67 26 21 20 29 363 Dysentery — — 1 — —— — — — — — — 1 Cerebro-spinal Fever — 1 — — — — — — — — — — 1 Poliomyelitis — — — — — — 1 — 1 1 — — 3 Food Poisoning — — — — — — 2 — — — — — 2 Erysipelas 2 3 — 1 1 — — 2 1 2 1 3 16 Pneumonia 8 7 6 5 2 1 — — 3 3 6 15 56 Puerperal Pyrexia 1 1 1 1 1 3 1 1 — 2 1 2 15 Tuberculosis Pulmonary 7 7 7 4 9 8 8 6 8 5 8 5 82 Tuberculosis Non-pulmonary — 1 — 1 — — 2 1 1 — 1 — 7 63 Tuberculosis. The new cases admitted to the tuberculosis register during the year numbered 147, classified as follows: Males. Females. Pulmonary 66 Pulmonary 67 Non-pulmonary 8 Non-pulmonary 6 Of the total additions 89 were primary notifications, 58 were transferred from other districts. For the same period 106 names were removed from the register for the following reasons: Recovered 26 Deaths 28 Otherwise (including removals) 52 After allowing for the additions and deductions, the state of the register at the 31st December, 1948, was as shown in the following table : TUBERCULOSIS—WARD DISTRIBUTION. Cases on Register at 31st December, 1948. Ward. Pulmonary. Non-Pulmonary. Total Incidence per 1,000 population. Males. Females. Males. Females. St. Helier North 59 69 12 9 149 16.6 St. Helier South 56 56 12 12 136 19.1 St. Helier West 57 46 12 12 127 15.0 North-East 47 48 10 9 114 12.1 North-West 37 31 3 4 75 10.2 Central 27 21 8 56 9.18 South-East 26 25 6 6 63 8.45 South-West 29 15 3 3 50 7.44 Totals 338 311 66 55 770 12. 3 649 121 The total of 770 is 41 more than at the corresponding date twelve months earlier. The Surrey County Council was responsible for the anti-tuberculosis scheme in the area until 5th July, when under the National Health Service Act, the curative aspects of the service were transferred to the South-west Metropolitan Hospital Board. The number of patients from Carshalton, who received institutional treatment under these arrangements during the year was as follows At Surrey County Sanatorium, Milford 35 At other tuberculosis institutions 115 150 64 The number of tuberculous persons who died during the year was 28, distributed by age groups as follows: Age, Years. Pulmonary. Non-Pulmonary. Total. Males. Females. Males. Females. 0 — — — — — 1—5 — 1 — — 1 5—15 1 — — — 1 15—25 3 1 — — 4 25—35 1 4 — — 5 35—45 6 — — — 6 45—55 5 — — — 5 55—65 4 1 — — 5 65—75 1 — — — 1 Totals 21 7 — — 28 The deaths attributable to Tuberculosis were 25, as follows: DEATHS DUE TO TUBERCULOSIS, 1948. Ward. Pulmonary. Non-Pulmonary. Death Rate per 1,000 population. Mean age at Death. Male. Female. Male. Female. St. Helier North 4 1 — — 0.46 40 St. Helier South 1 1 — — 0.28 33 St. Helier West 5 — — — 0.59 37 North-East 4 3 — — 0.74 34 North-West — — — — — — Central — — — — — — South-East 3 1 — 1 0.67 39 South-West 1 — — — 0.14 40 18 6 — 1 0.40 37 All the deaths were of persons who had been notified. The Council provided a free service for the examination of sputum for tubercle bacilli. No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or under Section 172 of the Public Health Act, 1936. 65 TABLE 22. TUBERCULOSIS. New Cases, Age and Sex Distribution and Manner of Admission to Register, 1948. Age Group Years. Primary Notifications "A." Cases transferred from other Districts. Cases brought to notice other than by Notification or Transfer. Total New Cases. Pulmonary. Non-Pulmonary Pulmonary. Non-Pulmonary Pulmonary . Non-Pulmonary M. F. M. F. M. F. M. F. M. F. M. F. 0—1 — — — — — — — — — — — — — 1—5 — 2 — 1 — — — — — — — — 3 5—10 2 2 — — 5 1 2 — — — — — 12 10—15 2 3 — 1 1 — — — — — — — 7 15—20 4 12 1 — — 2 1 — — — — — 20 20—25 10 11 — 1 8 6 1 1 — — — — 38 25—35 8 8 — — 10 11 1 — — — — — 38 35—45 3 5 1 1 2 2 — — — — — — 14 45—55 7 1 — 1 1 1 1 — — — — — 12 55—65 1 — — — 1 — — — — — — — 2 65 up 1 — — — — — — — — — — — 1 Totals 38 44 2 5 28 23 6 1 — — — — 147 89 58 — 66 INDEX PAGE Acreage 6 Ambulance 19 Bakehouses 51 Bed Bug—Eradication of 39 Births— Distribution 8 Institutional 9 Notification of 21 Rates 9-10 Cancer 13 Cemeteries 41 Cerebro-Spinal Fever 59 Child Life Protection 31 Clinics and Treatment Centres 20 Closet Accommodation 3-1 Convalescent Treatment 28 Day Nurseries 32 Deaths— Classification 17 Distribution 12 Rate 10-12 Dental Scheme 26-27 Diphtheria 55 Immunisation 55-56 Domestic Helps 32 Dysentery 53 Disinfection 39 Disposal of Dead 40 Drainage and Sewerage 34 Employment Agencies 41 Enteric Fever 53 Erysipelas 57 Establishments for Massage, etc. 41 Factories 46 Food— Poisoning 60 Inspection and Supervision 48-51 Food and Drugs Act 49 Health Services 18 Health Visiting 21 Hospitals 19 Housing— Council's Scheme 42 Inhabited Houses 6 Inspection 43 Overcrowding 44 Ward Distribution 8 67 PAGE Industry 8-46 Infant Mortality 15 Infectious Diseases 52 Inquests 14 Insulin 19 Isolation Hospital 19 Admissions to 20 Laboratory Facilities 18 Maternal Mortality 15 Maternity and Child Welfare— 21 Adoption of Children (Regulation) Act, 1939 31 Attendances at Clinics 22-23-25 Child Life Protection 31 Clinic Activities 21 Consultant Service 29 Convalescent Treatment 28 Day Nurseries 32 Dental Scheme 26-27 Health Visiting 21 Home Helps 30 Hospital Treatment for Maternity 28 Emergency Maternity Unit 29 Illegitimate Children 29 Maternity Outfits 30 Midwives 30 Orthopaedic Treatment 28 Premature Births 29 Supply of Milk and Other Foods 25 Toddler Clinics 21 Measles 57 Milk Supply 48 Milk (Special Designations) Order 48 Mortuary 41 Natural and Social Conditions 6 Nursing Associations 18 Offices 40 Ophthalmia Neonatorum 60 Orthopaedic Treatment 28 Pneumonia 57 Poliomyelitis 59 Population 7-8 Premature Births 29 Public Cleansing 34 Puerperal Pyrexia 60 68 PAGE Rateable Value 6 Rats and Mice Destruction 40 Rent and Mortgage Interest Restrictions (Amendment) Act, 1933 46 Rivers and Streams 34 Sanitary Circumstances 33 Sanitary Inspection 35 Scarlet Fever 53 Shops Acts 40 Smallpox 52 Smoke Abatement 40 Staff 5 Statistics— Comparative 11-12 Vital 7 Swimming Baths 40 Tuberculosis 64 Unemployment 8 Unmarried Mothers 29 Vaccination 52 Vermin Control 39 Voluntary Helpers 30 Water Supply 33 Whooping Cough 58 Zymotic Diseases 52 Deaths from 7 69