AC 4413(3) CARSHALTON Surney CAR 15 Carshalton Urban District Annual Report OF THE Medical Officer of Health FOR THE YEAR 1950 Printed by the "croydon Times," Ltd., 104, High Street, Croydon. CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1950 1 PREFACE To the Chairman and Members of the Carshalton Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report on the health of the district for the year 1950. This record, with its supporting statistical evidence, constitutes yet another chapter of the generally favourable trend which the health of the district has for so long experienced. The birth rate was slightly less than in 1949, thus continuing the fall from the post-war peak of 1946. The death rate, which for the last fifty years has been consistently and significantly less than that for the country as a whole, was again a comparatively low one at 7.8 per thousand population. In the early 1930's this rate was materially assisted by the rapid increase in the population resulting from the development of the St. Helier Estate, since this sponsored migration into the district consisted mainly of the younger age groups which have relatively low death rates. Although the average age of the local population is still approximately three years less than that for the" whole of Surrey, now that the district is for all practical purposes fully developed, it is now tending to increase as the constitution of the population slowly approximates to that of the country as a whole. Apart from other influences, this factor in itself has the effect of progressively increasing the death rate and will do so until the disparity in the age constitution disappears. The death rate for England and Wales was 11.6. Infant mortality at 28.4 per thousand live births was much the same as in the previous year and compares with a rate of 29.8 for England and Wales. It is gratifying to be able to report once more that there was no maternal mortality. This was the sixth year in succession in which no death was attributable to childbirth. A statistical variation which will be equally welcomed is a further and substantial fall in the death rate from tuberculosis. Compared with the previous year this mortality at 0.20 per thousand population is nearly halved. This, considered in conjunction with the fact that the number of new cases of tuberculosis increased by 13 and that the number of known cases at the year end was 48 more than in 1949, supports the view that the improved means for the early diagnosis of this disease, including mass radiography, is enabling the curative services to play a more effective role in the war against this scourge. With the steadily increasing average age of survival it is to be expected that a higher proportion of people will die as a result of senile degenerative changes and of those diseases particularly associated 3 with later life. This is reflected in the mortality from heart disease and cancer which in 1950 accounted for 37 per cent, and '20 per cent, respectively of the total mortality. Prevalence of the common infectious diseases, especially measles and whooping cough, which so far have largely defied all efforts at prevention, was much in accord with expectation. 1950 was a "measles" year and prevalence was high. Whooping cough, too, was more prevalent. Medical research into the production of an effective vaccine seems at last to hold out a definite promise that a means of preventing this latter disease by inoculation is coming within sight. Recent Annual Reports have evidenced the striking effect of diphtheria immunisation on the incidence of diphtheria. The year now reviewed has the distinction of being the first in which there was a complete absence of this infection. The growing tendency to communal feeding in such places as school and works canteens and restaurants brings the risk of food poisoning into greater prominence. Faults in the practice of personal hygiene on the part of food handlers, so often the cause of outbreaks of this nature, have much greater scope for damage to the public health when the food handlers are employees of large catering establishments than when their activities are limited to the domestic kitchen. The work of supervising food and food premises by your sanitary staff increases year by year with the steady stream of Regulations issued by the Ministry of Food. The numerous instances of careless manufacture, adulteration and deterioration of food revealed in this and earlier Reports show how necessary it is that unremitting vigilance should be given to this aspect of public health. The present times have not inaptly been described as the " Age of Anxiety." Certainly, nothing could do more to relieve mental stress in a great number of residents than a solution of the housing problem. The evils that flow from overcrowding are incalculable and they touch every aspect of physical, mental and moral health. The preventive health services can derive little encouragement from the fact that the number of unsatisfied housing applicants with local qualifications is no less than it was four years ago. I tender once again to all members of the departmental staff my sincere thanks for the efficient and willing support they have given me in the operation of the Council's Health Service and for their unfailing loyalty. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, F. LAWRENCE SMITH, Medical Officer of Health. August, 1951. 4 PUBLIC HEALTH STAFF. Medical Officer of Health : †F. Lawrence Smith, M.B., Ch.B., D.P.H. Chief Sanitary Inspector : *H. J. Spicer, C.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. (resigned26.10.50) *G. R. Surfleet, C.R.S.I. Public Health Nurse : Mrs. D. E. Baldock, S.R.N. Chief Clerk : Miss v. Hotten *Meat and Food Certificate of the Royal Sanitary Institute. †Also Divisional Medical Officer, Surrey County Council. 5 Section A—Natural and Social Conditions of the District. Area (in acres) 3,346 Number of inhabited houses (end of 1950) according to Rate Books 16,650 Rateable Value at 31st December, 1950 ,£504,589 Sum represented by 1d. rate ^2,072 THE Sanitary District, situated about midway between the Thames and the North Downs, is roughly rectangular in shape. It is approximately one mile in width and, commencing at a datum level of 72 at the northern boundary, it extends for some five miles in a southerly direction up the slope of the North Downs to a height of 450 feet above sea level. The subsoil, which is clay in the northern part, changes to a sandy gravel as one proceeds southwards, and then merges into chalk, which covers the southern half of the district. The River Wandle forms the eastern boundary in the northern part and arises from several springs at the outcropping of the chalk near the centre of the district. During the summer, consideration was given to the prejudice to amenity and health which results from the failure of these springs with consequent stagnation and drying up of the ornamental ponds which are a feature of the district. The exceptional rainfall of the winter with subsequent reactivation of the springs, however, provided a temporary respite. The Council had occasion again to join with other local authorities and the River Wandle Protection Association in opposing proposals under the Water Acts, 1945-48, further to deplete the underground water supplies by increasing abstraction. The district is to a large extent a dormitory area for London. Except for the southern part, where a considerable area is included in the Green Belt, it is highly urbanised, the housing density increasing as one proceeds northwards. Consequently for all practical purposes there is no scope for further housing development within the boundaries of the district. The greater part of the housing accommodation is occupied by the working classes, the London County Council's Estate comprising 5,600 dwellings, making a large contribution to this type of development. The average rateable value per head of population is the lowest but one in Surrey. 6 SUMMARY OF VITAL STATISTICS FOR 1950. (Based on the Registrar-General's Figures.) Population. Registrar-General's Estimate 62,150 Births. Males. Females. Total. Live Legitimate 405 377 782 Illegitimate 14 12 26 419 389 808 Birth Rate (per 1,000 population) 13.0 Stillbirths Legitimate) 8 5 13 Illegitimate) 1 — 1 9 5 14 Stillbirth Rate per 1,000 total births 17.3 Deaths 265 222 487 Death Rate (crude) per 1,000 population 7.8 Infant Mortality. All deaths under 1 year 15 8 23 Infant Mortality Rate (per 1,000 live births) 28.4 Deaths of leg. infts. under 1 year Rate per 1,000 legitimate births 14 8 22 28.1 Deaths of illeg. infts. under 1 year Rate per 1,000 illegitimate births 1 I 38.5 Maternal Mortality. Death from Sepsis — — Rate per 1,000 births — Death from other causes — — Rate per 1,000 total births — Maternal Death Rate — — — Zymotic Deaths. 7 Principal Zymotic Diseases 4 — 4 Deaths from Measles 1 — 1 Deaths from Whooping Cough ... 1 — 1 Deaths from Diarrhoea (under 2 years) 2 2 Zymotic Death Rate 0.06 Deaths from Tuberculosis. All Forms 11 2 13 Rate per 1,000 of population 0.20 Phthisis 7 1 8 Rate per 1,000 of population 0.12 Deaths from Cancer 56 43 99 Rate per 1,000 of population 1.59 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 following figures in respect of persons living in Carshalton registered as unemployed at the Sutton Employment Exchange and the Carshalton Youth Employment Bureau on 8th January, 1951, are supplied through the courtesy of the Exchange Manager:— Men 140 Women 36 Boys 38 (including 36 school leaversl Girls 53 (including 45 school leavers) POPULATION. The home population, as computed by the Registrar-General at mid-year, was 62,150, which is 160 less than the estimate twelve months earlier. The number under 15 years of age was 13,645, representing 22 per cent. of the total. Distribution of population by wards at 30th June, 1950, was estimated as follows:— TABLE 1. ESTIMATED RESIDENT POPULATION, MID-1950, BY WARDS. Ward. Houses at Mid-1950. Estimated population Mid-1950. St. Helier North 2,170 8,620 St. Helier South 1,699 7,030 St. Helier West 2,021 8,360 North-East 2,689 9,360 North-West 2,156 7,280 Central 1,696 6,040 South-East 2,187 7,710 (Queen Mary's Hospital) 1,100 South-West 2,011 6,650 Whole District 16,629 62,150 8 BIRTHS. The number of live births in 1950 fell to 808 from 825 in the year before, providing a birth rate of 13.0 per thousand population compared with 13.2 in 1949. Of the total, 419 were males and 389 females. The "comparable" birth rate produced by the application of the Registrar-General's comparability factor of 0.94 to allow for differences in the constitution of the population was 12.2 By comparison, the rate for England and Wales was 15.8. 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 weeklv returns of registrations. From these sources it is known that 837 live births and 16 stillbirths occurred in 1950. 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 137 15.8 2 14.6 St. Helier South 85 12.0 1 11.7 St. Helier West 121 14.4 4 33.0 North-East 143 15.2 4 28.0 North-West 99 13.5 — — Central ... 96 15.8 5 52.1 South-East (excluding Queen Mary's Hospital) 88 11.4 South-West 68 10.2 Three-quarters of all births occurred in hospitals and nursing homes. The percentages of such births for the individual wards were as follows:— St. Helier North 67 St. Helier South 84 St. Helier West 80 North-East 68 North-West 78 Central 80 South-East 71 South-West 86 9 Out of 853 total births, 646 took place in the following hospitals and nursing homes:— Live. Still. Total. Carshalton, Beddington and Wallington District (War Memorial) Hospital 68 2 70 St. Helier Hospital 440 11 451 Other Surrey Hospitals 88 — 88 Other Hospitals 17 — 17 Private Nursing Homes 19 1 20 Totals 632 14 646 The proportion of institutional births at 75 per cent. of the total is much the highest yet recorded in the district and is twice what it was ten years ago and three times that of fifteen years ago. This increasing tendency to institutional confinements is shown by the following percentages since 1935:— Y ear % Year % 1935 25 1943 41 1936 29 1944 60 1937 37 1945 60 1938 36 1946 60 1939 38 1947 55 1940 33 1948 60 1941 33 1949 66 1942 44 1950 75 10 TABLE 2. BIRTHS, 1950, DOMICILIARY AND OTHERS — BY WARDS. Ward. Born in District. Born Outside District. Grand Total. In Hospitals and Nursing Homes. In Private Houses. Total. In Hospitals and Nursing Homes. In Private Houses. Total. St. Helier North 89(7) 46(7) 135(2) 4 4 139(2) St. Helier South 70(7) 13 83(7) 3 — 3 86(7) St. Helier West 89(4) 24 113(4) 10 2 12 125(4) North-East 89(4) 47 136(4) 11 — 11 147(4) North-West 56 21 77 22 — 22 99 Central 65(3) 20(7) 85(4) 16(7) — 16(7) 101(5) South-East 39 23 62 24 2 26 88 South-West 24 8 32 35 1 36 68 Totals 521(13) 202(2) 723(15) 125(7) 5 130(7) 853(16) (Figures in brackets indicate stillbirths included in totals.) TABLE 3. BIRTH AND DEATH RATES FOR CARSHALTON, 1922-1950. Year. Population (RegistrarGeneral's) Birth Rate. Death Rate. Infant Mortality Rate. Maternal Mortality Rate. 1922 14,240 19.7 8.8 50 10.6 1923 14,610 18.8 8.6 36 3.6 1924 15,050 18.5 10.1 58 7.1 1925 15,660 20.0 10.0 42 3.2 1926 17,040 17.0 9.3 31 0.0 1927 18,450 16.5 9.1 72 9.8 1928 21,910 15.5 9.0 65 14.7 1929 23,420 18.8 9.4 61 0.0 1930 25,500 17.0 7.6 46 0.0 '931 28,620 16.7 7.5 43.8 8.1 I»32 32,280 15.0 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 1949 62,310 13.2 8.3 29.0 0.0 1950 62,150 13.0 7.8 28.4 0.0 11 TABLE 4. COMPARATIVE STATISTICS—1950 England and Wales 126 Count) 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 Home Population. Births— Live 15.8 17.6 16.7 17.8 13.0 Still 0.37 0.45 0.38 0.36 0.22 Deaths— All causes 11.6 12.3 11.6 11.8 7.8 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 — Whooping Cough 0.01 0.01 0.01 0.01 0.01 Diphtheria 0.00 0.00 0.00 0.00 — Tuberculosis 0.36 0.42 0.33 0.39 0.20 Influenza 0.10 0.09 0.10 0.07 0.03 Smallpox — — — — — Acute Poliomyelitis and Polioencephalitis 0.02 0.02 0.02 0.01 — Pneumonia 0.46 0.49 0.45 0.48 0.22 Notifications (Corrected)— Typhoid fever 0.00 0.00 0.00 0.01 — Paratyphoid fever 0.01 0.01 0.01 0.01 0.03 Meningococcal Infection 0.03 0.03 0.02 0.03 0.01 Scarlet fever 1.50 1.56 1.61 1.23 2.42 Whooping Cough 3.60 3.97 3.15 3.21 6.17 Diphtheria 0.02 0.03 0.02 0.03 — Erysipelas 0.17 0.19 0.16 0.17 0.14 Smallpox — 0.00 0.00 0.00 — Measles 8.39 8.76 8.36 6.57 13.99 Pneumonia 0.70 0.77 0.61 0.50 0.65 Acute Poliomyelitis (including polioencephalitis Paralytic 0.13 0.12 0.11 0.08 0.03 Non-paralytic 0.05 0.05 0.06 0.05 0.03 Food poisoning 0.17 0.16 0.14 0.25 0.01 Rates per 1,000 Live Births. Deaths— All causes under 1 year of age 29.81 33.8 29.4 26.3 28.4 Enteritis & Diarrhoea under 2 years of age 1.9 2.2 1.6 1.0 2.4 Rates per 1,000 Total Births (Live and Still). Notifications (Corrected)— Puerperal Fever and Pyrexia 5.81 7.43 4.33 6.03 49.51 Maternal Mortality— Abortion with Sepsis 0.09 — Other Abortion 0.05 — Oomplication of pregnacyand delivery 0.54 Sepsis of childbirth and the puerperium 0.03 Other complications of the puerperium 0.15 * A dash (—) signifies that there was none. †Rates per 1,000 total population. ‡ Per 1,000 relate live births. 12 COMPARATIVE HEALTH STATISTICS, 1934/50. Crude Death Rate (Civilian) per 1,000 population. Infant Mortality per 1,000 live births. Maternal Mortality (excluding abortion) per 1,000 total births. Year. 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 1949 11.7 8.3 32.0 29.0 0.82 0 1950 11.6 7.8 29.8 28.4 0.72 0 DEATHS. The number of deaths allocated to the district was 487, of which 265 were males and 222 females. This gives a crude death rate of 7.8 per thousand population compared with 8.3 in the year before. The " comparable " death rate arrived at by the application of the Registrar-General's comparability factor of 1.26" to allow for differences in the age and sex composition of the population was per thousand population. This is the figure to be compared with the death rate for England and Wales of 11.6. The distribution of the deaths by wards was as follows:— WARD DEATH RATES AND MEAN AGE AT DEATH 1950. Ward. Deaths. Death Rate (crude). Mean Age at death. St. Helier North 41 4.7 51.9 yrs. St. Helier South 36 5.1 52.1 „ St. Helier West 48 5.7 54.3 „ North-East 88 9.4 59.3 North-West 70 9.8 67.3 „ Central 67 11.0 68.1 .. South-East (excluding Queen Mary's Hospital) 63 8.0 65.4 „ South-West 76 11.5 66.3 „ Whole District 489 8.0 61.9 yrs. 13 The death rate from cancer was higher at 1.62 per thousand population as against 1.33 in 1949, there being 99 deaths attributed to this cause. CANCER DEATHS—WARD DISTRIBUTION, 1950. Ward. Cancer Deaths. Rate per 1,000 Estimated Population. St. Helier North 8 0.92 St. Helier South 5 0.71 St. Helier West 11 1.32 North-East 21 2.35 North-West 11 1.51 Central 9 1.49 South-East 14 1.81 South-West 20 3.00 The classification of the cancer deaths by sites affected is given in Table 5. TABLE 5. Group. Site Affected. Male. Female. Total. Buccal Cavity and Pharynx— 145 Pharynx 1 — 1 Digestive Organs— 150 Oesophagus 2 — 2 151 Stomach 9 6 15 153 Colon — 6 6 154 Rectum 10 4 14 155 Liver 1 — 1 157 Pancreas 2 1 3 Respiratory System— 162 Lungs and Bronchus 19 4 23 164 Mediastinum — 1 1 Breast and Genito-Urinary— 170 Breast 1 11 12 171 4 Uterus — 4 4 175 Ovary — 3 3 177 Prostate 1 — 1 180 Kidney 2 — 2 181 Bladder 2 — 2 Other Sites and unspecified— 192 Eye — 1 1 193 Brain and Nerves 1 — 1 194 Thyroid — 1 1 199 Unspecified 2 1 3 Lymphatic and Hæmatopoetic tissues— 201 Hodgkins Disease 1 — 1 202 Reticulosis 1 — 1 203 Myelomatosis 1 — 1 56 43 99 Average age at death— Males 60.3 years Females 64.0 years All persons 61.8 years 14 Tuberculosis accounted for 13 deaths as against 22 in 1949. The death rate for this disease thereby fell to 0.20 per thousand population. 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. 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 1939 0.77 1949 0.35 1940 0.56 1950 0.20 The distribution of tuberculosis mortality by wards and other details are given in Section F. of this Report. The common infectious diseases were responsible for 2 deaths, one from whooping cough and one from measles. There were no deaths from infantile paralysis or any of the other infectious diseases. Violence in one form or another caused the death of 14 residents in the following ways:— Suicide 4 Drowning 1 Road Traffic Accidents 3 Accidents in the Home 5 Coal Gas Poisoning 1 Inquests. Inquests were held on 51 persons who died in the district. The following verdicts were returned:— Accidental Death 34 Suicide 8 Open Verdict 1 Misadventure 3 Natural Causes 5 Eighteen of the total were residents of the district. Eleven deaths were due to road accidents. 15 INFANT MORTALITY. The deaths of 23 children who died under the age of one year were registered, of which 15 were males and 8 females. These provide an infant mortality rate of 28.4 per thousand live births compared with 29.0 in the year before. The comparable rate for England and Wales was 29.8. All but one were deaths of legitimate children. Twelve of the 23 deaths occurred in the first month of life, all in the first week. Congenital malformations, prematurity and diseases peculiar to infancy accounted for 16, infections for 6, and accident for 1. The ward distribution of infant mortality and the causes of death are shown in Tables 6 and 7. TABLE 6. INFANT MORTALITY—WARD DISTRIBUTION. Ward. Infant Deaths. Rate per 1,000 Live Births. St. Helier North 2 14 St. Helier South 4 47 St. Helier West 3 24 North-East 9 62 North-West 1 10 Central 1 10 South-East 1 11 South-West 2 29 MATERNAL MORTALITY. There was no death attributable to maternal causes. This is the sixth successive year with no maternal death. 16 17 TABLE 7. INFANT MORTALITY DURING THE YEAR 1950. 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 — — — — — 1 2 — — 3 Enteritis — — — — — — — — 1 1 Prematurity 6 — — — 6 — — — — 6 Whooping Cough — — — — — — 1 — — 1 Congenital Malformation 1 — — — 1 4 — 1 — 6 Atelectasis 3 — — — 3 — — — — 3 Accidental Inhalation of Material 1 — — — 1 — — — — 1 Birth Injury 1 — — — 1 — — — — 1 Staphylococcal Pyæmia — — — — — 1 — — — 1 Totals 12 — — — 12 6 3 1 1 23 18 TABLE 8.—CAUSES OF DEATH DURING THE YEAR 1950. 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 15 8 2 1 5 2 4 5 4 5 10 8 44 18 68 28 52 56 60 94 264 225 489 1 Tuberculosis, Respiratory — — — — — — — 1 1 — — — — — 2 — 3 — 1 — 7 1 8 2 Tuberculosis, other — — 1 1 1 — 1 — 1 — — — — — — — — — — — 4 1 5 3 Syphilitic disease — — — — — — — — — — — — — 1 — — — — — 1 — 1 4 Diphtheria — — — — — — — — — — — — — — — — — — — — — — — 5 Whooping Cough 1 — — — — — — — — — — — — — — — — — — — 1 — 1 6 Meningococcal Infections — — — — — — — — — — — — — — — — — — — — — — — 7 Acute Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — 8 Measles — — — —- 1 — — — — — — — — — — — — — — — 1 — 1 9 Other Infective and Parasitic Diseases 1 — — — 1 — — — — — — — — — — — — — — — 2 — 2 10 Malignant Neoplasm, Stomach — — — — — — — — — — — —2 3 — 4 1 1 3 1 — 9 6 15 11 Malignant Neoplasm, Lung — — — — — — — — 1 — 2 2 4 — 11 1 1 1 — — 19 4 23 12 Malignant Neoplasm, Breast — — — — — — — — — — — 1 — 3 1 2 — 4 — 1 1 11 12 13 Malignant Neoplasm, Uterus — — — — — — — — — — — — — — — 1 — 2 — — — 4 4 14 Other Malignant and Lymphatic Neoplasms — — — — — — — — — — 2 — 4 2 10 5 4 4 7 7 27 18 45 15 Leukemia, Aleukaemia — — — — — — — — — — — — — — — 1 — 1 — — — 3 3 16 Diabetes — — — — — — — — — — — — — — — — — — — 1 — 1 1 1.7 Vascular Lesions of Nervous System — — — — — — — — — — — — 2 1 4 3 10 8 8 8 24 20 44 18 Coronary Disease, Angina — — — — — — — — — — 3 — 10 1 15 3 6 9 6 11 40 24 64 19 Hypertension with Heart Disease — — — — — — — — — — — — 3 1 2 2 2 3 2 2 9 8 17 20 Other Heart Disease — — — — — — — — — 2 1 — 3 2 4 5 11 10 20 40 39 59 98 21 Other Circulatory Disease — — — — — — — — — — — — 1 1 1 1 2 2 2 4 6 8 14 22 Influenza — — — — — — — — — — — — 1 1 — — — — — — 1 1 2 23 Pneumonia 1 2 — — — — — — — — — — — — 1 — 1 2 2 5 5 6 14 24 Bronchitis — — — — — — — — — — — — 3 — 6 — 4 1 4 5 17 6 23 25 Other Diseases of Respiratory System — — — — — — — 1 — — — 1 3 — 1 — — — — — 4 2 6 26 Ulcer of Stomach and Duodenum — — — — — — — — — — — — 2 — 1 — 4 1 — — 7 1 8 27 Gastritis, Enteritis and Diarrhoea 2 — — — — — — — — — — — — — — — — — 1 1 3 1 4 28 Nephritis and Nephrosis — — — — — — — — — 1 — — 2 — — — 1 1 — 1 3 3 6 29 Hyperplasia of Prostate — — — — — — — — — — — — — — 1 — 1 — 4 — 6 — 6 30 Pregnancy, Childbirth, Abortion — — — — — v — — — — — — — — — — — — — — — — 31 Congenital Malformations 3 2 — — 1 1 — — — — — 1 — — — — 1 — 1 5 5 10 32 Other Defined and llldefined Diseases 7 3 — — — 1 — 3 — 2 2 1 2 4 2 2 — 1 1 7 14 24 38 33 Motor Vehicle Accidents — — — — — — 2 — 1 — — — — — — — — — — 3 — 3 34 All other Accidents — 1 1 — 1 — — — — — — — — — — 1 — 2 1 — 3 4 7 35 Suicide — — — — — — 1 — — — — — — ] 1 — 1 — — — 3 1 4 36 Homicide and Operations of War — — — — — — — — — — — — — — — — — — — — — — — Section B—Health Services. Laboratory Facilities. The laboratory arrangements in use during the year were as set out in the Report for 1949. These provided for the examination of clinical material in connection with infectious disease, food poisoning, puerperal pyrexia and tuberculosis at the Emergency Public Health Laboratories at the St. Helier and Sutton and Cheam Hospitals and, in special circumstances, at the Epsom Public Health Laboratory. Food, drugs and water samples were examined by the Public Analyst employed by the Council, Mr. D. D. Moir, 16, Southwark Street, London, S.E.I. The following examinations were made during the year:— Throat and Nose Swabs 29 Eye Swab 1 Water (Public Supply):— For chemical analysis 2 For bacteriological examination 4 Water (Swimming Bath):— For bacteriological examination Food and Drugs:— Analysis 319 Bacteriological examination of milk 219 Bacteriological examination of ice-cream 155 Bacteriological examination of other foods 10 Vaccination and Immunisation. By agreement between the County and District Councils the Medical Officers of Health continue to direct the arrangements for diphtheria immunisation and vaccination in their respective districts, although these services are the responsibility of the County Council under Section 26 of the National Health Service Act. Details of the operation of the scheme are given in Section F of this Report dealing with infectious diseases. Clinics and Treatment Centres. The following programme of clinics is provided by the County Council and the Hospital Board and are available to residents of the district. 19 Care of Mothers and Young Children. Rochester Road Centre:— Infant Welfare Clinic . Tues. and Thurs. 2—4 p.m. Maternity Clinic Thursdays 10—12 a.m. Toddler Clinic Wednesdays 2—4 p.m. Dental Clinic tuesdays ' 1.30—4.30 p.m. Thursdays 9.30—12 a.m. Massage Clinic Mons., Tues., Weds., Thurs., Fri. 10 a.m.—1 p.m. Mons., Tues., Thurs., Fridays 2—5 p.m. Wrythe Lane Centre:— Infant Welfare Clinic . Weds, and Fridays 2—4 p.m. Maternity Clinic Tues. and Fridays 10—12 a.m. Toddler Clinic Tuesdays 2—4 p.m. Stanley Road Centre:— Infant Welfare Clinic Fridays 2—4 p.m. Maternity Clinic ... Tuesdays 10—12 a.m. Toddler Clinic ... Thursdays 2—4 p.m. St. Helier Centre—Green Lane:— Infant Welfare Clinic . Mondays 2—1 p.m. Maternity Clinic ... Mondays 10—12 a.m. The Mount Centre:— Infant Welfare and Maternity Clinic ... Wednesdays 2—4 p.m. Toddler Clinic ... 2nd Thursday 2—4 p.m. School Health Service—General Medical Clinics. Rochester Road Centre ... Mons., Weds., and Fridays 9.30—12 a.m. Stanley Road Centre ... Mondays 9.30—12 a.m. Middjeton Road Centre, Morden ... ... Mons. and Weds. 9.30—12 a.m. Dental, eye and special clinics for chikl guidance, speech therapy, etc., are provided, attendance at which is by appointment. Diphtheria Immunisation and Vaccination. Treatment is available for children under 5 at infant welfare clinics and for school children at school clinics. Tuberculosis Clinics. St. Helier Hospital Mons. and Fridays 2 p.m. Wednesdays 9.30 a.m. 3rd and 4th Mons. (for old cases only) 5.30 p.m. Venereal Disease Clinics. St. Helier Hospital ... Mondays (Males) 5—7 p.m. Weds. (Females) 4.30—7 p.m. Fri. (Females) 1.30—3.30 p.m. 20 Section C— Sanitary Circumstances. Water Supply. The Sutton and District Water Company supplies water to the whole district except to 170 dwellings in the extreme north which are supplied by the Metropolitan Water Board. The source of supply is normally from wells in the chalk at Sutton, Cheam and Woodmansterne, but it can be augmented, if necessary, by the Metropolitan Water Board, the Epsom and Ewell Corporation and the East Surrey Water Company. The Company is under statutory obligation to soften to 9° of hardness. All dwellings have a piped supply from the mains. The finished water is not plumbo-solvent. There was no evidence of contamination and the quality and quantity were satisfactory throughout the year. Purification is controlled by a comprehensive system of sampling (1) by the Company's resident chemist; (2) by periodic examination by independent analysts employed by the Company and (3) by the public health departments of the sanitary authorities in the supply area on an agreed rota. The following is a summary of the examinations carried out by the Company's resident chemist during the year and is supplied by the courtesy of the Engineer and Works Manager. Sample. Total No. of Bacteriological Examina tions. Total No. of Full Chemical Analyses. No. of Tests in which Coli Aerogenes Organisms were present in 100 ml. of Sample (excluding B. Coli 1 & 2). No. of Tests in which B. coli were present in 100 ml. (Types 1 & 2.) Total No. of Tests in which Coli Aerogenes Organisms were present in 100 ml. of sample. No. % /o No. % Sutton Raw 300 25 20 6.70 32 10.7 52 Sutton Finished 306 24 3 0.97 7 2.30 10 Woodmansterne Raw 303 26 2 0.67 Nil Nil 2 Woodmansterne Finished 301 25 2 0.67 Nil Nil 2 Cheam 310 26 2 0.65 1 0.33 3 Reservoirs 219 Nil 2 0.92 2 0.92 4 District (excluding new Mains) 276 Nil 5 1.82 2 0.72 7 New& Repaired Mains 33 Nil 18 4.90 Nil Nil 18 TOTAL 2051 126 21 Monthly samples of the finished water pumped into supply from both the Sutton and Woodmansterne stations were taken by the Counties Public Health Laboratory and all were reported upon satisfactorily. A further 11 chemical and 20 bacteriological samples were taken by the public health departments in the supply area and were satisfactory. The following is the report on a representative sample: Chemical analysis in parts per million. Total solid matter in solution (dried at 180° C.) 177 Combined Chlorine 14.0 Nitric nitrogen 4.6 Nitrous nitrogen none Ammonia, free and saline.. none Ammonia, albuminoid 0.002 Oxygen absorbed from permanganate in 4 hours at 26°.7 C. 0.03 Hardness—by acidimetric titration—Temporary 88 Permanent 24 Total 112 Reaction for free chlorine negative pH 7.6 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 one of high organic purity and very moderate hardness and salinity. It is practically neutral in reaction and free from contaminating metals. There was no residual chlorine at the time of receipt. The bacteriological condition is excellent and the water is pure and wholesome and suitable for the public supply. Drainage and Sewerage. The whole of the sewerage system to the Surrey County Council Smallholdings at Woodcote were taken over by the Council during the year, the actual lengths of sewers taken over being as follows:— 1,170 ft. of 4 in. soil sewer. 3,434 ft. of 6 in. soil sewer. 1,314 ft. of 8 in. soil sewer. 887 ft. of 9 in. soil sewer. 460 ft. of 10 in. soil sewer. 1,545 ft. of 12 in. soil sewer. In addition, 1,060 ft. of 6 in. soil sewer was constructed from the head of the soil sewer on the Smallholding to Woodcote Grove House, and subsequently taken over by the Council. 23 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 in the south is mainly by soakaways in the chalk; elsewhere it is by surface sewers to the River Wandle. 263 drainage obstructions, affecting 728 houses, were dealt with, chiefly concerning combined drainage systems. Rivers and Streams. No special work other than normal routine maintenance was carried out. The County Council, who are now responsible for the branch of the River Wandle which flows through the district, installed a rectangular weir and a Lea recording apparatus in the lower reaches within the Grove grounds for recording the flow from the springs which feed the ponds. The first recordings were taken in April. No complaints were received by the Public Health Department during 1950. Closet Accommodation. All premises have w.c.s connected to the sewers except seventeen in an unsewered area connected to cesspools. Public Cleansing. The Council's Engineer and Surveyor is responsible for the direction of this service which, during, and since, the last war, has increasingly included salvage operation of waste materials. No alterations were made in the method of refuse collection as operated during the previous year, but the fleet of collection vehicles was further modernised by the addition of two vehicles manufactured by Shelvoke and Drewry, each of 12 cu. yd. capacity. The introduction of these new vehicles has made it possible for a spare vehicle to be constantly in reserve should a breakdown of the regular vehicles occur. Disposal of refuse is by incineration in the Council's 6-cell destructor. During 1950 further improvements were made by the acquisition of a Chaseside Shovel for use in loading clinker, waste paper and rag bales, enabling the latter to be increased to 3 cwts. Arrangements were made to dispose of screenings to the Croydon Tip at Mitcham and clinker to the old Watercress Beds in Mill Lane. Kitchen waste is collected for pig food, the bins for which are cleansed regularly by steam. 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. 23 Investigations were made with regard to 1,445 complaints as follows:— Accumulations 40 Animals so kept 8 Burst pipes 5 Dampness 38 Ditches and ponds 1 Drainage defects 53 Drains obstructed 320 Dustbins 183 Flies 1 Food contaminated 34 General defective conditions 127 Insects 35 Milk, dirty bottles Miscellaneous 26 Obnoxious effluvia 28 Overcrowding 52 Pig bins 9 Rats and mice 244 Refuse collection 14 Roofs, defective 24 Sewer obstruction 8 Shops Sink waste pipes 6 Smoke nuisance 24 Unsound food 121 Verminous premises 19 Wasps 14 Water supply 6 1,445 Eleven thousand two hundred and .fifty-eight visits of inspection and re-inspection were made for the purposes set out below:— Business premises 36 Cowsheds 26 Employment Agencies 3 Factories (Mechanical Power) 128 Factories (Non-Mechanical Power) 62 Food and Drugs and other samples 715 Food poisoning inquiries 6 Food premises : Bakehouses 54 Bakers and confectioners 62 Butchers 199 Canteens 66 Chemists 12 Confectioners (sweets only) 106 Fishmongers 99 General Stores 17 Greengrocers and fruiterers 102 Grocers 291 Hotels with catering facilities 22 Hotels without catering facilities 6 Ice cream factories 35 24 Ice cream vehicles 38 Licensed premises 5 Milk shops57 Restaurants and cafes 156 Stalls, food 100 Unsound Food : Meat 54 Food other than meat 102 Vehicles, food 177 1,760 House drains tested 56 Housing Act 289 Housing Inquiries 704 Infectious disease contacts 94 Infectious disease premises 211 Offices 16 Outworkers premises 79 Piggeries 49 Premises re cesspools 10 Public Health Act (Houses) 2,692 Public Health Act re-inspections 3,575 Rodents 226 Schools 28 Shops 349 Smoke observations 48 Urinals 84 Water sampling 12 11,258 Five hundred and ninety-two informal notices were served concerning the following matters:— Accumulations and deposits 53 Burst pipes 2 Drainage defects 81 Dustbins 56 Factories Act 3 Food and Drugs 27 General defective conditions 278 Miscellaneous 4 Obstructed drains 2 Overcrowding 64 Rodents 1 Shops Act 10 Smoke nuisance 2 Verminous premises 6 Water supply 3 592 Ninety-five - formal notices were served by authority of the Council under the following Acts>— Section 24, Public Health Act, 1936 ... ... ... ... 10 Section 39, „ „ 4 Section 45, „ „ 1 Section 56, „ „ 3 Section 75, „ „ ... ... 0 Section 93, „ „ 64 Section 277, „ „ ... 2 Section 13, Food and Drugs Act, 1938 2 95 25 As a result of investigations made and notices served, the following work was carried out:— Accumulations removed 18 Brickwork, repaired and/or repointed 29 Ceilings cleansed and purified 235 new provided 9 Ceiling plaster repaired and/or made good (including plaster board) 205 Cement fillets, renewed 1 plinths, renewed 1 Cesspools, repaired 2 Chimney pots repaired and/or made good 9 stacks repaired and/or made good 8 flues repaired 17 Damp conditions remedied 163 Damp course renewed 1 Disinfestations 41 Door cills repaired 2 Doors repaired, including locks and fasteners 46 Door stoppings to reveals renewed 1 Drainage repaired and/or reconstructed 25 inspection chamber repaired and/or made good 6 inspection chamber covers renewed 10 interceptor provided 1 stoppers or caps refixed and/or renewed 2 fresh air inlets repaired and/or renewed 2 soil vents repaired and/or renewed 5 drains tested 37 drains cleared (affecting 728 houses) 263 drains sealed off 6 drainage provided 1 waste gullies repaired, renewed or cleared 11 waste gullies provided 1 waste pipes, repaired, renewed or provided 13 Dustbins provided 100 Fences repaired or renewed 1 Fire grates repaired and/or renewed 1 Fireplaces repaired and/or made good 30 Floorboards repaired and/or made good 52 concrete repaired, renewed and/or made level 6 ventilation repaired 3 Food storage provided 3 Glazing panes renewed 18 putty 43 Other matters 10 Paving repaired and/or made level 20 provided 1 drained 5 Ranges, stoves repaired and/or renewed 14 Roofs repaired and made weatherprood 111 downpipe, guttering repaired and/or renewed 55 cleared out and made to work properly 11 Shops, forms provided 12 temperature maintained 3 seats provided 1 light, more provided 2 hot water, means of supply provided 25 Sinks renewed or repaired 3 provided 3 26 Soakaway made to work properly 2 Stair treads repaired, renewed or made level 2 handrails and/or balusters repaired 4 handrail provided 1 Steps repaired and/or renewed 7 Surface water drainage repaired and made to work properly 9 Ventilation, more provided 7 Walls, cement rendered 4 rendering repaired 6 replastered and/or repaired 174 cleansed and redecorated 208 rebuilt 2 underpinned 1 Wash basins, baths renewed 2 provided 3 Water cisterns repaired 2 Water supply repaired 17 W.C. accommodation repaired 3 pans renewed 14 pans provided 1 pan joints renewed 4 seats repaired, renewed or provided 16 lift-up seat provided 1 flushing apparatus repaired or renewed 35 flushing apparatus provided 1 W.C.s provided 5 Weatherboards repaired 1 Windows made to oped 2 Window frames repaired and/or renewed 103 Windows made to work properly 14 provided with catches or fasteners 3 sash cords renewed 76 Windows repaired and/or renewed 3 Window cills (external) repaired 26 stopping to reveals 2 Woodwork repaired and/or renewed 9 Disinfection. In connection with cases of infectious disease, 218 rooms and 326 library books were disinfected. Eighteen lots of bedding were sterilised and two lots destroyed. Vermin Control. Persons. The cleansing of verminous persons and their personal clothing can be carried out at premises adjoining the Rochester Road Clinic. This is an adapted building which, whilst it provides a useful service, is much below the generally accepted standard for premises of this nature. It is fitted with a Thresh Steam Disinfector, has a trained nurse in attendance to deal with women and children and a male operator for adult males. The nurse in charge also has the duty of following up verminous cases in their own homes to ensure that the family as a unit is adequately dealt with. The homes are visited also by the Sanitary Inspectors as necessary when attention to the premises is required. 27 Financial arrangements exist with the Education Authority in respect of treatment of schoolchildren. The following persons were dealt with at the Cleansing Station during the year:— Families. Persons. Attendances. For scabies 5 16 28 For pediculosis 18 46 96 23 62 124 School children included in these totals were:— For scabies 6 For pediculosis 35 Premises. During the year, two lots of verminous bedding were stoved and forty-one premises were treated for the destruction of vermin and insect pests as follows:— Infestation. Sprayed by C.U.D.C. Sprayed by L.C.C. Sprayed by Owners. C.U.D.C. Property L.C.C. Property Privately Owned Property L.C.C. Property Privately Owned Property Ants 1 – 2 – – Bugs 2 – 4 1 4 Fleas 1 – 1 — — Wasps 2 2 20 — — Weevil — — 1 – — 6 2 28 1 4 Incoming tenants of Council houses as well as vacated Council premises are visited by the Sanitary Inspectors before letting is effected to ensure that verminous families are not admitted to clean houses and vice versa. Smoke Abatement. Twenty-four complaints were received and dealt with during the year. Prevention of Damage by Pests Act, 1949. Under the direction of the Ministry of Agriculture and Fisheries rodent destruction was carried out during the year. 28 Eight thousand four hundred and ninety-two visits were made and 348 rat and mouse infestations found. Of that number 322 were found in private premises, 15 in business premises, 10 in Council premises and 1 in agricultural premises. With regard to sewers, two maintenance treatments were carried out, one in May and the other in November with the following results:— May Treatment. November Treatment. Manholes baited 84 173 Manholes in which takes of prebait were recorded 53 51 Percentage of manholes showing infestations 63 29 Percentage in relation to total manholes in district 4.6 4.5 Shops Act, 1950. This Act came into force on the first day of October, 1950, and consolidates the Shops Acts 1912 to 1938 with certain other enactments relating to shops. The Act covers not only hours of employment but also arrangements for the health and comfort of shop workers. There are 500 shop premises on the register and 1,890 inspections were made during the year. Preliminary notices were served with regard to 10 infringements. Two shops were provided with improved lighting; three shops were provided with means of maintaining a reasonable temperature, and three shops were provided with improved ventilation. Seats for female shop assistants were provided in one shop and twenty-five shops were provided with washing facilities. Offices. Sixteen 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 four samples of water were taken, all of which were satisfactory. Disposal of the Dead. The number of interments in the Carshalton and Merton and Morden Joint Cemetery Board's Cemetery at Morden during the year under review was 405, and of this number 160 were from the Carshal- 29 ton district. The Churchyard adjoining the Carshalton Parish Church continues to be used for burials, but this is mainly for the re-opening of existing graves. Negotiations for the establishment of a crematorium at Lower Morden to serve the districts of the Battersea Metropolitan Borough Council, Wimbledon Borough, Sutton and Cheam Borough, and that covered by the Carshalton and Merton and Morden Joint Cemetery Board, have continued. A conference of local interested parties was held in May, when the question of the creation of a Joint Board to administer the proposed crematorium was again discussed. At that meeting the Board agreed in principle to the constitution of a Joint Board (if necessary, by promoting special legislation) constituting representatives of the Battersea Borough Council, the Sutton and Cheam Borough Council and the Carshalton and Merton and Morden Joint Cemetery Board. It is recognised that some time must elapse before a building can be provided, but, nevertheless, necessary steps preparatory to the constitution of a Joint Board are proceeding. Modern mortuary facilities with provision for post-mortem examinations are provided at the Council's Mill Lane Mortuary. During the year 64 bodies were received into the mortuary, on all of which autopsies were performed. National Assistance Act—Section 50. The Council was responsible for three burials under Section 50 of the National Assistance Act, 1948. Establishments for Massage and Special Treatment. There was no change in the number of establishments, viz.: eight licensed under Part IV of the Surrey County Council Act, 1931, which were inspected during the year. All were found to comply with the statutory requirements. Six were used for the practice of chiropody and two for massage, etc. Employment Agencies. Two employment agencies licensed by the County Council were visited and found to be satisfactory. Barbers and Hairdressers. In September the Common Seal of the Council was affixed to Byelaws made by the Council pursuant to Section 125 of the Surrey County Council Act, 1936, for the purpose of securing the cleanliness of any premises in the Urban District of Carshalton used for the purpose of carrying on the business of a hairdresser or barber and of the instruments, towels and materials used in such premises. These were confirmed by the Minister of Health in November and came into force on 1st January, 1951. 30 Section D- Housing. New Houses. During the year 54 houses and flats of the following types were completed:— Council Houses 17 Council Flats 21 Private Houses under Licence 15 Rebuilt War-Damaged House (private) 1 Total 54 Houses in course of erection at the end of the year were as follows:— Council Houses 21 Council Flats 112 Private Houses under Licence 2 Total 135 Council's Housing Scheme. Dwellings in the ownership of the Council at the year end totalled 953 houses, flats and temporary bungalows. During the year work continued, or was commenced, on the undermentioned Contracts:— Site No. Site. Type. No. in Contract. No. completed during year. 3 Clock House Farm Estate (part) Traditional houses 38 17 10 Denmark Road Flats 72 — 11 Alma Road ” 9 9 12 Harrow Road ” 6 6 18 Banstead Road ” 6 6 23 Lavender Road ” 10 — 17 Station Approach ” 30 — 171 38 31 In addition, the following schemes were in varying stages of preparation with a view to work being commenced during the year beginning 1st January, 195:— Site No. Site Type No. in Contract 24 Lynwood Avenue Flats 84 26-29 The Mount and Grove Lane ” 60 25 The Mount ” 11 30 Whitethorn Avenue ” 10 8 & 20 Barrow Hedges Flats Traditional Houses 70 28 31 Stanley Road Flats 18 281 The accommodation under requisition by the Council at 31st December, 1950, comprised 149 premises, providing accommodation for 221 families. The number of outstanding approved applications for tenancies at the year end was approximately 1,874. 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.—148 P.H.A.—2,729 2,877 (b) No. of inspections made for the purpose 0,471 (2) (a) Number of dwelling houses (included under 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 435 32 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 1949) 399 3. Action under Statutory Powers during the year. (a) Proceedings under Sections 9, 10 and 10 of the Housing Act, 1936. Number of dwelling houses in respect of which notices were served requiring repairs — Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners — (b) By local authority in default of owners (b) Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which formal notices were served requiring defects to be remedied 90 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 70 (b) By local authority in default of owners 4 4. Housing Act, 1936. Part IV (Overcrowding). (a) (1) Number of dwelling houses overcrowded at the end of the year 209 (2) Number of families dwelling therein 352 (3) Equivalent number of adults dwelling therein 1,427 (b) Number of new cases reported during the year 75 (c) (1) Number of cases of overcrowding relieved during the year 87 (2) Number of persons concerned in such cases 597 (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 — Overcrowding. During the year 75 cases of overcrowding were found to exist and 87 cases were remedied, leaving 209 dwellings with 1,427 equivalent adults in occupation overcrowded at 31st December, 1950. 32 The known position as to overcrowding at the beginning and end of the year was as follows:— Ward. Dwellings overcrowded at 31.12.49 Dwellings found overcrowded during 1950 Dwellings crowded during 1950 Dwellings remaining overcrowded at 31.12.50 Overcrowded cases remedied during 1950. Formal Action Informal Action Total. St. Helier North 56 18 21 53 14 7 21 St. Helier South 47 13 9 51 4 5 9 St. Helier West 51 12 14 49 5 9 14 North-East 34 11 23 22 6 17 23 North-West 8 10 6 12 1 5 6 Central 8 7 6 9 6 6 South-West — 1 1 1 1 South-East 17 3 7 13 3 4 7 221 75 87 209 34 53 87 In 51 of the 75 new eases of overcrowding, families were sharing accommodation with relatives. Abatement in the 87 instances was effected as follows : — Provision of alternative accommodation by— Carshalton U.D.C. If, London C.C. ... ... ... ... ... 17 Other Local Authorities ... ... ... l Left the District ... ... ... ... ... 25 Removal of one or more occupants ... ... 28 Of the 209 dwellings still overcrowded at the year end, 151 were owned by the London County Council, 19 by the District Council and 39 were privately owned. Slum Clearance and Demolition. No action of this nature was undertaken during the year. Tents, Van, Sheds and Similar Structures. No action. Rent and Mortgage Interest Restrictions (Amendment) Act, 1933. No action necessary. 34 Factories and Workplaces. The Register of Factories and Workplaces has been brought up to date in consultation with H.M. Inspector of Factories. The following is a summary of the Registers:— Employees. Premises. Males. Females. Total. Factories— with mechanical power 714 486 1,200 77 without „ „ 75 4 79 20 Workplaces— with mechanical power 12 — 12 12 without „ „ 23 2 25 23 824 492 1,316 132 The following tables, set out in the manner prescribed by the 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 20 62 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 77 128 3 — (iii) Other premises in which Section 7 is enforced by the Local Authority* (excluding outworkers' premises) — — — — Total 97 190 3 — * Electrical Stations (Section 103 (1)), Institutions (Section 104) and sites of Building Operations and Works of Engineering Construction (Sections 107 and 108.) 35 2. Cases in which Defects were found— (If defects are discovered at the premises on two, three or more separate occasions they are reckoned as two, three or more " cases.") Premises. Number of cases in which defects were found. Number of cases in which prosecutions were instituted. Found Remedied. Referred To H.M. Inspector. By H.M. Inspector. (1) (2) (3) (4) (5) (6) Want of cleanliness 1 1 — — — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation — — — — — Defective drainage of floors — — — — — Sanitary Conveniences— (a) Insufficient 2 2 — — — (b) Unsuitable or defective — — — — — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) — — — — — Total 3 3 — — — 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 inst mces of work in unwhole some premises. Notices served. Prosecutions. (1) (2) (3) w (5) (6) (7) Wearing Apparel— Making, etc. 44 — — — — — Cleaning and washing — — — — — — Brass and Brass Articles 10 — — — — — The making of boxes or other receptacles or parts thereof made wholly or partially of paper 4 — — — — — Stuffed Toys 2 — — — — — Cosaques, Christmas Crackers, Christmas stockings, etc. 23 — — — — — Diary Manufacturing 1 — — — — — Total 84 — — — — — 36 Section E— Inspection and Supervision of Food. Milk Supply. Up to the end of the year the district had not been specified under the Food and Drugs (Milk, Dairies and Artificial Cream) Act, 19,50, but although undesignated milk could still be sold, we had NO evidence that any undesignated milk was being retailed in the district. The bulk of the milk supplied in the district is pasteurised or effectively heat treated, the only raw milk sold being a relatively small amount of tuberculin tested. Milk Distributors. The number of registered distributors was 17. Designated licences issued during the year were as follows:— Designation. Number of Distributors holding Licences No. of Licences in Force on 31/12/50. Principal Licences— Sterilised 9 12 Pasteurised 6 9 Tuberculin Tested 6 9 Supplementary Licences— Sterilised 7 10 Pasteurised 9 12 Tuberculin Tested 8 11 Bacteriological Examination of Milk. Two hundred and nineteen samples of milk were procured and submitted for bacteriological examination. All the milks were sold under the Milk (Special Designations) Regulations and 5 failed to comply with the prescribed Regulations. 37 Classification of the milk samples and the results of the tests are as follows:— Designation under which sold. No. of Samples. Methylene Blue Test. Phosphatase Test. Turbidity Test. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. Pasteurised 175 171 4 175 — — — T.T. Pasteurised 27 26 1 27 — — — Sterilised 14 — — — 14 — Heat Treated 3 3 — 3 — — — 219 200 5 205 — 14 — Ice Cream. The results of the sampling of ice cream were as follows:— No. of Samples. Grade. 1 2 3 4 155 103 29 16 7 Meat and Other Foods. All meat sold by retail is supplied from Ministry of Food depots outside the district. As far as is known NO slaughtering took place in the district and consequently no inspection of carcases was carried out. Ten other food substances were submitted for bacteriological examination in connection with the investigation of suspected food poisoning or following visible evidence of contamination by foreign matter. Organisms of pathogenic significance were found in two, viz., ham and ham bones. These are referred to in that Section of the Report dealing with food poisoning. 38 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. Aspirin 1 Macaroni Milk Pudding 1 Barley Crystals 1 Batter Mixture 1 Malted Milk 1 " Bournvita " 1 Margarine 1 Bread 1 1 Meat Paste 1 Brine 1 Milk 217 2 Butter Mixture, Cake 1 Camphorated Oil 1 Mixture, Pastry 1 Caramel Dessert 1 Mixture, Sponge Pudding 1 Cheese 1 Cinnamon 1 Mustard Mixture 2 Chocolate Dessert Mutton (Salt) 1 Powder 1 Peas 3 Coffee and Chicory 1 Peanut Butter 1 " Creamy Whip " 1 Peel (Mixed cut) 1 Custard Powder Pork Brawn 1 Dripping, Beef 1 Pudding, Golden 1 Epsom Salts 1 Sage and Onion Stuffing 2 Fat 1 Pish Paste 2 Salad Cream 1 Flour 1 Sauce, Savory 1 Forcemeat 1 Sausage, Beef 4 Friars Balsam 1 „ Pork 7 1 Galantine 1 „ Meat Pork 1 Gelatine 1 Savory Spread 1 Gravy Salt 1 Soup 2 Ice Cream 9 Squash, Honey and Lemon 1 Jam 2 Jam, Diabetic 1 Sweets 6 Jelly 1 Tomato Ketchup 1 Jelly Crystals 1 Vinegar, Malt 4 1 Lard 1 Vinegar, Lemon, Culinary 1 Non-brewed 1 Luncheon Meat 1 " Vitacup " 1 Macaroni 1 Whisky 3 The following five samples were reported by the Analyst as adulterated or otherwise irregular : — Milk. A sample of milk deficient in milk fat corresponding to the abstraction of one per cent. of the milk fat. The vendor's explanation of the cause of the deficiency was accepted by the Committee, who decided to take no action. 39 Milk. A sample of milk deficient in milk fat corresponding to the abstraction of seven per cent. of the milk fat. The vendor's explanation of the cause of the deficiency was accepted by the Committee, who decided to take no action. Pork Sausage. This sample contained sulphur dioxide to tlie extent of 190 parts per million. Preservative was found to be declared on label. No further action. Bread. A loaf of bread certified to contain tobacco. A prosecution under Section 9 was taken in this case, and the vendor was convicted and fined the sum of £25 with 3 guineas costs. Malt Vinegar with Caramel. This sample of vinegar contained added salt, which is not a natural ingredient of malt vinegar, to the extent of 0.8 per cent. No action was taken as the vinegar was bottled before the 1st October, 1950, and the manufacturer had a dispensation from the Ministry of Food, granted under Section 17 of the Labelling of Food Order, 1946. The 1940 Order was revoked as and from the 1st November, 1950, by the Labelling of Food Order, 1950. Section 9.—Sale of Food Unfit for Human Consumption. Complaints were received of foreign matter in foodstuffs, such contamination being significant in 25 instances. They were mostly concerned with bread, cakes and milk in which such articles as glass, metal, tobacco, etc., were found. Arising out of these complaints, warnings were given to the vendors in appropriate cases and legal proceedings under Section 9 of the Act were taken in the following 7 cases:— Bread containing Mould. The foreign matter in this specimen was held to have been incorporated in the dough before baking. The vendors were prosecuted and fined £7 and 3 guineas costs. Bread containing Wood Splinter. Vendors prosecuted and fined £5 and 3 guineas costs. Bread containing Tobacco. Vendors prosecuted and fined £35 and 3 guineas costs. Bread containing Metal. Vendors prosecuted and fined 3 guineas and 3 guineas costs. 40 Cake containing a Finger Bandage. Vendors prosecuted and fined 3 guineas and 2 guineas costs. Doughnut containing a Nail. Vendors prosecuted and fined £10 and 3 guineas costs. Bread containing Grease. Vendors prosecuted and fined ,£10 and 3 guineas costs. Inspection of Food. The following quantities of food found to be unsound, diseased or unwholesome and unfit for human food were surrendered and destroyed or so disposed of as to prevent them from being used for human food:— Baby Food 5 lbs. 3 ozs. Mint sauce 4 lbs. 6 ozs. Bread 49 lbs. 8 ozs. Paste, fish . 379 lbs. 10 ozs. Cereal and Flour ... 492 lbs. 5 ozs. Pickles 34 lbs. 6 ozs. Cheese 3 lbs. Pudding 3 lbs. 2 ozs. Egg, Shell 602 Salad dressing 10 lbs. 1 oz. Fish 1,449 lbs. 10 ozs. Sauce 4 lbs. 7 ozs. Fruit 1,221 lbs. 9 ozs. Semolina 3 lbs. 12 ozs. Fruit juice and drink 90 lbs. Soup 81 lbs. 3 ozs. Jam 163 lbs. 4 ozs. Spaghetti ... 8 lbs. 15 ozs. Jelly and blancmange 8 lbs. Suet 1 lb. Mayonnaise 9 lbs. 3 ozs. Sugar 7 lbs. 8 ozs. Meat 1,890 lbs. 3 ozs. Sweets 9 lbs. 14 ozs. Milk 894 lbs. 8 ozs. Syrup 2 lbs. Mincemeat 4 lbs. 6 ozs. Vegetables 1,240 lbs. 15 ozs. Mixture cake, puddin ; 7 lbs. Total weight : 3 tons, 12 cwts., 14 lbs., 14 ozs. Inspection of Food Premises. Details of the visits of inspection of food premises and the resulting remedial action taken is shown in Table 9. Food Hygiene. On 17th November the Ministry of Food confirmed Byejaws made by the Council under Section 15 of the Food and Drugs Act, 1938, for securing the observance of sanitary and cleanly conditions and practices in connection with the handling, wrapping and delivery of food sold or intended for sale for human consumption, and in connection with the sale or exposure for sale in the open air of food intended for human consumption. These came into operation on 18th December, 1950. 41 42 TABLE 9. Inspection of Food Premises and Action Taken. Nature of Business. No. of Premises. No. Selling Ice Cream. No. of Inspections. Defective Drainage Remedied. Sinks or wash-basins provided. Means of hot-water supply provided. Means of maintaining reasonable temperature provided. Ventilation provided. Food preparation rooms repaired and/or cleansed. Food storage room provided. Refuse bins provided. Other Defective Conditions Remedied. Bakers and Confectioners 15 4 62 — — 1 — — — — — — Bakehouses 5 — 54 — — — — — — — — — Butchers 37 — 199 1 — 2 — — — — — Canteens 16 — 66 — — — — — 1 1 — — Chemists 16 — 12 — — — — — — — — — Cinemas 1 1 — — — — — — — — — — Confectioners (Sweets only) 72 46 106 — — 1 — — — — — 1 Milk Shops 8 3 57 — — — — — — — — — Fishmongers 19 — 99 — — 4 — — — — — — General Stores 4 2 17 — — — — — — — — — Greengrocers and Fruiterers 44 1 102 — — 3 2 — — — — 2 Grocers (and Corn Chandlers) 85 12 291 1 — 10 1 2 — — 1 1 Hotels (with Catering Facilities) 5 — 22 — — — — — 1 — — — Hotels (without Catering Facilities) 8 — 6 — — — — — — — — — Ice Cream Factories 3 — 35 1 — — — — — — — — Ice Cream Vehicles Various — 38 — — — — — — — — — Licensed Premises 26 — 5 1 — — — — — — 1 — Restaurants and Cafes 27 11 156 3 2 4 — 1 1 — 1 1 Stalls, Food Various — 100 — — — — — — — — — Vehicles, Food Various — 177 — — — — — — — — — 80 1,604 7 2 25 3 3 3 1 3 6 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. Dysentery. Meningococcal Infection. Cholera. Acute Influenzal Acute Poliomyelitis. Diphtheria. Pneumonia. Ophthalmia Neonatorum. Membranous Croup. Acute Puerperal Pyrexia. Erysipelas. Polioencephalitis. Malaria. Scarlatina or Typhus Fever. Acute Primary Pneumonia. Scarlet Fever. Typhoid Fever. Acute Encephalitis Measles. Enteric Fever. Lethargica. Whooping Cough. Relapsing or Food Poisoning. Tuberculosis. Continued Fever. Leprosy. Smallpox. No cases of variola infection were notified. Several contacts of cases occurring on board ocean going vessels were kept under surveillance for the prescribed period. Vaccination. The arrangements for vaccination under the County Council's scheme are directed locally by the district Medical Officers of Health following agreements between the County Council and the District Councils. Vaccination is available at the Infant Welfare and School Clinics and may be done by the general practitioners to whom a fee of os. per case is payable for notifying details of treatment. 43 The number of persons successfully treated and recorded under these arrangements during 1950 was as follows:— Age at 31st Dec., 1950 Under 1 yr. 1-4 yrs. 5-14 yrs. 15 yrs. & over. Total. Primary Vaccinations— By Private Practitioners 121 93 29 24 267 At Clinics ... 162 88 7 — 257 283 181 36 24 524 Revaccinations— By Private Practitioners — 5 17 86 103 At Clinics — — 3 — 3 — 5 20 86 111 In addition the following unsuccessful attempts at vaccination were made:— Age at 31st December, 1950 Under 1 yr. 1-4 yrs. 5-14 yrs. 15 yrs. & over. Total. Primary 10 8 — — 18 Re-vaccination — 1 7 10 18 10 9 7 10 36 The number of children vaccinated during the first year of life at 283 represents 34% of the births which occurred during the year. This is an increase of 9 over the similar percentage in 1949. At the end of 1950 the infant welfare records show that 38% of the children under 5 years of age were vaccinated as compared with 34% at the end of 1949. The vaccination rate varies considerably in different parts of the district. Generally it is highest in the southern end, where it reaches 58%, and lowest in the northern part where it falls to 28%. Enteric Fever. There were no cases of typhoid fever, but two of paratyphoid. Both were Para. B. infections, one in a student hospital nurse and the other in a hospital patient. Both recovered. Dysentery. Seven cases of dysentery were notified, five of which were patients in Queen Mary's Hospital. Of the two cases in residents, one was a 44 Sonne infection in an adult male, the other a Flexner infection, the patient being infected en route to this country from Australia, probably in Rome. There were no deaths. Scarlet Fever. The incidence of scarlet fever rose by approximately 50% from the year before and the number of cases notified was 151, of which 130 were residents of the district. The incidence rates were:— All cases 2.42 per 1,000 population Residents 2.18 per 1,000 population All were mild cases and there were no deaths. Forty-six, representing 30% of the total were nursed at home. TABLE 10. SCARLET FEVER—DISTRIBUTION OF CASES, 1950. 1950. Ward. Total. St. Helier North. St. Helier South. St. Helier West. NorthEast NorthWest. Central. SouthEast. SouthWest. January 3 1 1 1 — 1 1 1 9 February 2 1 — 4 2 1 3 1 14 March 2 1 1 1 — 2 1 1 9 April 1 — 3 1 1 — 3 1 10 Mav 3 — 4 5 3 1 1 — 17 June 3 1 — 3 2 — — — 9 July — 1 2 2 3 — 1 — 9 12 August 2 2 3 1 2 — 2 — September — 2 — 1 — 1 — 4 October 1 — 1 5 2 4 — 15 November 1 3 1 1 5 1 — 12 December — 1 2 3 6 2 — 1 15 Totals 18 8 22 27 23 16 16 5 135 Monthly Mean 1.50 0.66 1.83 2.25 1.91 1.33 1.33 0.41 11.25 Case rate per 1,000 population 2.08 1.13 2.63 2.88 3.15 2.64 2.07 0.76 2.21 45 TABLE 11. SCARLET FEVER—MULTIPLE CASES, 1950. Ward. No. of houses in which occurred. Total Houses. Total Cases. 1 Case. 2 Cases. 3 Cases. St. Helier North 18 — — 18 18 St. Helier South 6 1 — 7 8 St. Helier West 16 3 — 19 22 North-East 25 1 — 26 27 North-West 19 2 — 21 23 Central 14 1 — 15 16 South-East 12 2 — 14 16 South-West 5 — — 5 5 Whole District 115 10 — 125 135 Diphtheria. No case of diphtheria was notified during the year either in the resident population or among hospital patients resident elsewhere. Although, as a result of the immunisation scheme, the annual incidence of diphtheria had fallen to negligible proportions in the last few years, this is the first year in which there was a complete absence of this infection. Prevalence among the resident population since 1934 covering the whole period during which the immunisation scheme has been in operation was as follows:— Year Cases Incidence per 1,000 Population Year Cases Incidence per 1,000 Population 1934 66 1.73 1943 7 0.12 1935 58 1.13 1944 7 0.12 1936 53 0.95 1945 15 0.27 1937 47 0.80 1946 4 0.06 1938 33 0.57 1947 2 0.03 1939 14 0.23 1948 1 0.01 1940 45 0.77 1949 1 0.01 1941 26 0.45 1950 0 0.00 1942 23 0.40 The number of swabs examined for diphtheria was 29. Diphtheria Immunisation. The scheme for diphtheria immunisation, which is the responsibility of the County Coucil, is by agreement directed by the Medical Officer of Health of the District Council. The arrangements were as described in the previous Report, namely, facilities at the infant welfare and school clinics and a programme of immunisation sessions held in the infant and junior schools of the district in alternate terms. The object is to secure initial treatment by the age of one year and 46 to reinforce this by further single injections before, or on entry to, school and thereafter at three-year intervals until the child leaves the junior school. Under this procedure the majority of children now receive initial treatment in infancy and two or three reinforcing injections during school life. The technique is to give two doses of 0.5 c.c. A.P.T. at one month's interval for primary treatment and 0.2 c.c. A.P.T. or 1 c.c. T.A.F for reinforcing injections according to the age of the child. During 1950, 740 residents were immunised as follows:— Age at Year End. Total. Under 1 1 2 3 4 5-9 10-14 At Council Clinics 24 317 41 11 9 5 – 407 In Carshalton Schools — — 1 3 6 114 20 144 Private Practitioners 7 159 24 8 8 9 — 215 31 476 66 22 23 128 20 766 Less outward transfers — 1 — — — 22 4 27 Plus inward transfers — — — — — — 1 1 Carshalton Residents 31 475 66 22 23 106 17 740 A further 1,567 children received reinforcing injections in the area. After allowing for transfers in and out of the district the figure for Carshalton residents so treated was 1,534. The immunisation state of the child population at the end of the year was as follows:— Age at 31.12.50, i.e., Born in Year Under 1 1950. 1 1949. 2 1948. 3 1947. 4 1946. 5 to 9 1941/ 45. 10 to 14 1936/ 40. Total under 15 Number Immunised 31 504 757 886 910 4005 4609 11702 Registrar General's Estimated mid-vear population, 1950 4912 8733 13645 Percentage done 63% 98% 85% The following table shows the estimated percentage of children immunised at each year end since 1935, when the Council's scheme 47 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 1949 60 91 81 1 0.01 1950 63 98 85 0 0.00 Erysipelas. Nine cases of erysipelas, were notified, all residents but one who was a patient in a nursing home for old people. The face was the site affected in six instances. One patient died, the elderly nursing home case. Pneumonia. The number of cases of pneumonia which were notified was approximately the same as the year before. Four of the total were influenzal and occurred during prevalence of that infection in February and March. Measles. Following a year of relatively low incidence, the prevalence of this infection was approximately twice that in 1949. Of 870 cases notified, 842 were Carshalton children, the remainder being patients in hospital. The disease was most prevalent in the first four months of the year and, after a period of almost complete absence in the summer, it assumed epidemic proportions again in the last five weeks of the year to continue into 1951. There was one death in a child of 7 years. 48 table 12. MEASLES—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1950. (Excluding hospital patients non-resident in Carshalton.) 1950. Ward. St. Helier North. St. Helier South. St. Helier West. NorthEast NorthWest. Central. SouthEast. SouthWest. Total. January 21 27 10 71 2 1 3 1 136 February 12 49 9 37 21 — 3 2 133 March 4 12 12 40 19 2 6 — 95 April 5 5 21 7 6 1 7 — 52 May 2 1 15 1 3 6 16 12 56 Tune 2 — — 3 1 1 28 6 41 July 1 — 3 — 1 — 1 1 7 August 1 — — 1 — — — 1 3 September — — — 1 — — — 1 2 October — 1 — 1 — 1 14 — 17 November 1 1 — 15 6 27 40 24 114 December 7 4 1 67 19 23 19 45 185 Totals 56 100 71 244 78 62 137 93 841 Monthly Mean 4.66 8.33 5.91 20 33 6.50 5.16 11 41 7.75 70.08 Case rate per 1,000 population ... 6.49 14 22 8 49 26 0 10 7 10 26 17 7 13.9 13.77 Whooping Cough. Pertussis was more prevalent in 1950, 384 cases being notified, all but one residents of the district. Much the heaviest incidence occurred during the last quarter of the year when a sharp rise in the attack rate occurred in November and, like measles, continued into 1951. There was one death in a baby of four months. In the last ten years or so investigations have been carried out into the possibility of providing vaccine treatment for the prevention or treatment of whooping cough. Until recently these researches have not been very successful. More recently, however, field experiments using a variety of different types of modern vaccines have been carried out in several large centres of population in this country under the auspices of the Medical Research Council and the results have been the most promising to date. They do not yet show the same striking effect of the present-day diphtheria prophylactics but the results of the experiments are definitely significant and particularly more so in the 49 case of some brands of vaccine than in others. There is little doubt that progress in this direction is being made and we may well have reached the stage where inoculation can now be used with reasonable assurance that it will reduce the risks of whooping cough. TABLE 13. WHOOPING COUGH—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1950. (Excluding hospital patients non-resident in Carshalton.) 1950. Ward. St. Helier North. St. Helier South. St. Helier West. NorthEast. NorthWest. Central. SouthEast. Southwest. Total. January 1 1 1 - - - - 3 February 1 1 3 - - - - - 5 March — — 2 1 1 — — 1 5 April 2 — 1 2 — — — 1 6 May 11 — 2 — 7 1 1 1 23 June 8 1 2 — — 3 — 1 15 July 7 3 1 3 3 — 1 — 18 August 4 6 — 4 2 1 5 3 25 September 3 9 5 6 12 2 2 — 39 October — 4 1 6 4 4 2 4 25 November 2 7 5 4 7 15 29 11 80 December 31 4 19 25 4 9 28 19 139 Totals 69 36 42 52 40 35 68 41 383 Monthly Mean 5.75 300 3 50 433 3.33 2.92 5.66 3.42 31.92 Case rate per 1,000 population 8.00 5.12 502 5.55 5.49 5.79 8.82 6.16 6.26 Meningococcal Infection. One case of meningococcal infection was notified posthumously. The patient was a baby of two years admitted to hospital from another district already suffering from the illness. It died after a short illness of two days. Poliomyelitis. Four cases were notified. One was a baby of two years who developed a "dropped foot another was a man of 35 years who recovered without any signs of paralysis; the third was a boy of fourteen who also had no paralysis; the fourth was a boy of thirteen who developed slight weakness of one leg. Three of the cases occurred in August, the remaining one in December. All survived. 50 Ophthalmia Neonatorum. Thanks largely to modern chemotherapy, no case of this eye infection in the new-born has been notified in the district since 1945. Puerperal Pyrexia. In keeping with previous experience, the St. Helier Hospital provided us with the majority of notifications of a rise of temperature during child-birth. The number of cases notified at 41 was six less than in the year before. They were all patients in hospital except one. Seven were residents of Carshalton. Twenty-three were in respect of first confinements. Food Poisoning. One case of food poisoning was notified in a member of H.M. Forces on leave. Illness was due to infection with Salmonella typhimurium. There were no associated cases and the origin of the infection was not traced. He recovered after a fortnight in hospital. In June, a woman was admitted to hospital after collapsing in the street. Enquiry showed that she and two other members of a family of four fell ill some four hours after the suspected meal. The other two patients were also admitted to hospital. All recovered in a matter of hours and bacteriological investigation undertaken in the case of one of them gave negative results. Commodities consumed prior to the illness included cold boiled ham, an examination of the remnants of which revealed a heavy growth of staphylococcus aureus-coagulase positive. The incident had the features of poisoning by pre-formed bacterial toxin which is the usual mode of poisoning due to this organism. In June, also, some 70 schoolchildren out of 300 at risk were taken ill with symptoms of gastro-enteritis. Circumstantial evidence pointed to the school dinner supplied approximately twelve hours previously. Bacteriological investigation of several patients failed to give any significant result. Similar examination of the remnants of the meal showed that the bones from some ham which had formed part of the meal were heavily contaminated by Cl.Welchii. Although this organism is a normal inhabitant of the intestinal tract, the Central Public Health Reference Laboratory reported that the strains isolated from the ham bones gave reactions similar to those of other strains isolated from suspected food poisoning outbreaks. All the children recovered after about twelve hours' illness. Hospital Treatment for Infectious Disease. Hospital accommodation for cases of infectious disease is now the responsibility of the Hospital Boards. Medical Officers of Health have now no authority to require the admission of any infectious person whatever the risk to the community. The difficulties met with by the general practitioners in finding hospital accommodation for patients with uncomplicated infectious illness is increasingly reflected in their acquiescing to patients being nursed at home in conditions which are by no means satisfactory from the point of view of isolation. The number of cases admitted to various hospitals in the SouthWest Metropolitan Region is shown in Table 14. 51 63 TABLE 14. Admission to Isolation Hospitals, 1950. Disease. Cuddington. Croydon. Bletchingley. West Kent. Bromley and Beckenham. Western. Wandle Valley. The Grove. Park. Brook. South Middlesex. Queen Mary's. Tolworth. St. Helier. South Western. Godstone. Totals. Scarlet Fever 18 5 5 2 1 1 42 19 - 1 1 - 3 - 2 3 103 Scarlet Fever and Chicken-Pox 1 - - - - - - - - - - - - - - - 1 Encephalitis Post Infectious - - - - - - - - - - - - - - - - 1 Poliomyelitis Paralytic - - - - - - - - - - - - - - - - 2 Poliomyelitis Non-Paralytic 1 - - - - - - - - - - - - - - - 2 Paratyphoid "B" - - - - - - - - - - - - - - - - 2 Erysipelas 1 — — — - - 1 1 - - - 1 - - - - 4 Whooping Cough — — — - - - 1 2 - - 1 - - - - - 4 Measles 6 1 1 — - - 18 3 2 - - - 1 1 - - 33 Dysentery — — — — - - - 2 2 - - - 1 - 1 - 6 Measles and Pneumonia — 1 - - - - - - - - - - - - - - 2 Chicken-pox 10 5 — — 1 3 - - - - - - - - - - 19 Mumps 4 — — — - 1 - 2 — - - - - - - - 7 Pneumonia 1 — — — - — — - - - - - - - - - 1 Food Poisoning - - - - - - - - - - - - - - - - 1 Tonsilitis 1 - - - - - 1 1 1 - - - - - - - 4 Others 4 — — - — 2 3 1 - - - 1 — - - 11 Totals 47 12 6 2 2 5 65 36 6 1 2 1 7 5 3 3 203 table 15. 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 135 2.17 - 18 8 22 27 23 16 16 5 89 65 Dysentery 2 0.03 — — — — — — — — 2 1 50 Measles 841 13.5 1 56 100 71 244 78 62 137 93 8 0.95 Whooping Cough 383 6.16 1 69 36 42 52 40 35 68 41 3 0.78 Encephalitis, Post Infectious 1 0.01 - - - - - - - - 1 1 100 Poliomyelitis, Paralytic 2 0.03 — 1 — — 1 — — — — 2 100 Poliomyelitis, Non-Paralytic 2 0.03 — — — 1 1 — — — — 2 100 Food Poisoning 1 0.01 — 1 — — — - — — — l 100 Erysipelas 9 0.14 1 — — 2 2 3 1 - 1 4 44 Pneumonia 41 0.66 — 3 5 3 7 9 6 3 5 2 4.88 Puerperal Pyrexia 7 0.11 — 1 — 1 2 — 1 — 2 6 85 Paratyphoid "B" 1 0.01 — — 1 — — — — - - 1 100 54 TABLE 16. INFECTIOUS DISEASES. Notification by Age Groups, 1950. (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—15 45-65 65 and over Scarlet Fever — 2 7 17 11 81 11 3 1 2 135 Measles 17 65 90 90 113 441 16 5 4 — — - 841 Whooping Cough 20 34 48 56 63 154 3 — 5 — — - 383 Encephalitis, Post Infectious — — — — — — 1 — — — — - 1 Poliomyelitis, Paralytic — 1 — — — — 1 - - - - - 2 Poliomyelitis, Non-paralytic — — — — — — 1 — 1 — — — 2 Ford Poisoning — — — — — — — 1 — — — - 1 Erysipelas — 1 — — — — — — 2 2 3 1 9 Pneumonia 3 2 1 3 — 4 2 3 7 2 8 6 41 Peurperal Pyrexia — — — — — — — 1 5 1 - — 7 Paratyphoid "B" - — — — — — — — 1 — - - 1 55 TABLE 17. MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1950. (Excluding hospital patients non-resident in Carshalton.) Disease. Jan. Feb. Mar. April. May. June. July- Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 9 14 9 10 17 9 9 12 4 15 12 15 135 Dysentry — - 1 — 1 — — — — — — — 2 Measles 136 133 95 52 56 41 7 3 2 17 114 185 841 Whooping Cough 3 5 5 6 23 15 18 25 39 25 80 139 383 Encephalitis Post Infectious 1 - - - - - - - - - - - 1 Poliomyelitis, Paralytic — — — — — — — — 1 — — 1 2 Poliomyelitis, Non-paralytic — — — — — — — 2 — — — — 2 Food Poisoning — — — — . — 1 — — — — — — 1 Erysipelas 1 1 2 1 — 1 — — — 1 1 1 9 Pneumonia 6 13 4 2 3 4 1 — 1 3 2 2 41 Puerperal Pyrexia — 2 — 2 — 1 — — 1 — 1 — 7 Tuberculosis Pulmonary 4 7 5 4 7 6 10 9 9 9 4 12 86 Tuberculosis Non-pulmonary ... 2 — — 2 3 2 2 3 1 — — — 15 Paratyphoid "B" — — — — — — — — — - 1 — 1 Tuberculosis. The new cases admitted to the tuberculosis register during the year numbered 145, classified as follows:— Males Females Pulmonary 70 Pulmonary 56 Non-pulmonary 10 Non-pulmonary 9 Of the total additions, 101 were primary notifications, 38 were transferred from other districts, and six came to notice in other ways. For the same period, 97 names were removed from the register for the following reasons:— Recovered 14 Death 21 Otherwise (including removals) 62 After allowing for the additions and deductions, the state of the register at the 31st December, 1950, was as shown in the following table:— TUBERCULOSIS—WARD DISTRIBUTION. Cases on Register at 31st December, 1950. Ward. Pulmonary. Non-Pulmonary. Total Incidence per 1,000 population. Males. Females. Males. Females. St. Helier North 69 80 14 11 174 20.1 St. Ilelier South 59 62 18 11 150 21.3 St. Helier West 65 53 10 9 137 16.3 North-East 52 57 12 8 129 13.7 North-West 37 28 2 3 70 9.6 Central 31 23 7 2 63 10.4 South-East 28 30 6 6 70 9.0 South-West 25 18 3 6 52 7.8 Totals 366 351 72 56 845 13.8 717 128 The total of 845 is 48 more than at the corresponding date twelve months earlier. The number of patients from Carshalton who received institutional treatment under the arrangements of the South-West Metropolitan Hospital Board during the year was as follows:— At Milford Sanatorium, Surrey 48 At other tuberculosis institutions 117 165 56 The number of tuberculous persons who died during the year was 21, distributed by age groups as follows:— Age, Years. Pulmonary. Non-Pulmonary. Total. Males. Females. Males. Females. 0 - - - - - 1—5 — 1 1 2 5—15 — 1 1 — 2 15—25 — 2 1 — 3 25—35 2 — — — 2 35—45 — — — — — 45—55 2 1 — — 3 55—65 5 — — 5 65—75 4 — — — 4 Totals 13 4 3 1 21 The deaths attributable to tuberculosis were 13, as follows:— DEATHS DUE TO TUBERCULOSIS, 1950. Ward. Pulmonary. Non-Pulmonary. Death Rate per 1,000 population. Mean age at Death. Male. Female. Male. Female. St. Helier North 2 1 - 0.34 48 St. Helier South - - 1 0.14 1 St. Helier West 1 - - 0.11 65 North-East 1 - 2 - 0 32 33 North-West — - — - - — Central 1 - ] - 0.33 15 South-East 1 1 — — 0.25 49 South-West 1 - — — 0.15 69 Totals 7 1 4 1 0.65 40 Six of these deaths were of unnotified cases. No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or under Section 172 of the Public Health Act, 1936. The Council adopted a points scheme for deciding the order of priority of applicants for housing accommodation. Special "weighting" is provided under this scheme where the existence of tuberculosis in the household creates a risk of infection. In consequence six such families were rehoused out of a total of 41 council tenancies allotted during 1950. 57 at oo TABLE 18. TUBERCULOSIS. New Cases, Age and Sex Distribution and Manner of Admission to Register. 1950. Age Group Years. Primary Notifications "A." Cases transferred from other Districts. Cases brought to notice other than by Notification or Transfer. Total New Cases. Pulmonary. Non-Pulmonary Pulmonary. Non-Pulmonary Pulmonary. Non-Pulmonary M. F. M. F. M. F. M. F. M. F. M. F. 0—1 - 1 - - - - - - - - - - 1 1— 5 1 2 2 1 - - - - - - - 1 7 5—10 2 1 - 1 - - - - - - - - 4 10—15 - - 2 1 - - - - - 1 1 - 5 15—20 7 9 2 - 1 2 - - - - 1 22 20—25 10 9 1 1 5 2 - - - 1 - - 29 25—35 6 12 - 2 11 12 - 1 1 - - - 45 35-15 7 1 1 - 2 1 - - - - - - 12 45—55 10 2 - - 1 - - - - - - - 13 55—65 4 - - 1 - - - - - - - - 5 65 up 2 - - - - - - - - - - - 2 Totals 49 37 8 7 20 17 - 1 1 2 2 1 145 101 38 Y 6 INDEX PAGE Acreage 6 Bed Bug—Eradication of 28 Births- Distribution 9 Institutional 10 Rates 9,10,11 Byelaws 30 Cancer 14 Cemeteries 29 Clinics and Treatment Centres 19, 20 Closet Accommodation 23 Deaths— Classification 18 Distribution 13 Rate 11, 13 Diphtheria 46 Immunisation 46 Dysentery 44 Disinfection 27 Disposal of Dead 29 Drainage and Sewerage 22 Employment Agencies 30 Enteric Fever 44 Erysipelas 48 Establishments for Massage, etc. 30 Factories 35 Food— Poisoning 51 Inspection and Supervision 37, 41, 42 Food and Drugs Act 39 Hygiene 41 Health Services 19 Hospital 51 Housing— Council's Scheme 31 Inhabited Houses 6 Inspection 32 Overcrowding 33 Ward Distribution 34 Ice-Cream 38 Industry 35 Infant Mortality 16, 17 Infectious Diseases 43, 53, 54, 55 59 PAGE Inquests 15 Isolation Hospital 51 Admissions to 52 Laboratory Facilities 19 Maternal Mortality 16 Measles .48, 49 Meningococcal Infection 50 Milk Supply 37 Milk (Special Designations) Order 37 Mortuary 30 Natural and Social Conditions 6 National Assistance Act 30 Offices 29 Ophthalmia Neonatorum 51 Pneumonia 48 Poliomyelitis 50 Population 8 Public Cleansing 23 Puerperal Pyrexia 51 Rateable Value 6 Rats and Mice Destruction 28 Rent and Mortgage Interest Restrictions (Amendment) Act, 1933 34 Rivers and Streams 23 Sanitary Circumstances 21 Sanitary Inspection 23 Scarlet Fever 45 Shops Acts 29 Slum Clearance and Demolition 34 Smallpox 43 Smoke Abatement 28 Staff 5 Statistics— Comparative 12, 13 Vital 7 Swimming Baths 29 Tuberculosis 15, 16 Unemployment 8 Vaccination 19, 43 Vermin Control 27 Water Supply 21 Whooping Cough 49 Zymotic Diseases— Deaths from 7 60