AC4413(3) CARSHALTON CAR 16 Carshalton Urban District Annual Report OF THE Medical Officer of Health FOR THE YEAR 1951 Printed by E. N. MASON & SONS, LTD., COLCHESTER & LONDON. CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1951 I 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 1951. The year under review has, generally speaking, maintained the overall steady improvement in public health which, like the country as a whole, the district has experienced since the great sanitary reforms of the last century. The birth rate continued the downward trend which followed the post war peak of 1946. The death rate was again appreciably less than that for the country as a whole and remains so when corrected to allow for the favourable age and sex constitution of the local population. Infant mortality is little changed from the year before and approximates to the national figure. Since 1944 there had been no maternal death. In the past year there was again no death following childbirth * but one death was recorded following abortion, the cause of which was not elicited at the inquest which was held. Tuberculosis mortality in 1951 had to contend with a particularly favourable death rate for this disease in the year before. By comparison it rose significantly but not to the level which had existed prior to 1950. The new cases notified, however, showed a decrease of 40% compared with 1950. Cancer remains one of the main causes of death and the rate has varied little over the past 10 years. It was slightly lower in 1951 than in the previous year. Deaths attributed to cancer of the lung have risen considerably throughout the country in the last 30 years and it is difficult to say how far this increase may have been the result of more accurate diagnosis. The local statistics show that in the last 15 years the percentage of the total cancer deaths attributed to disease of the lungs, has more than doubled. Another disease which in recent years has figured more prominently among the main causes of death, is coronary disease of the heart. Thirteen per cent of all deaths in the district were , assigned to this cause in 1951. The incidence of the common infectious diseases continues to reflect the selective effects of the more recent preventive measures such as immunisation, the use of the sulpha drugs and the modern antibiotics such as penicillin. Measles and whooping cough were as prevalent as usual but there is now hope that the recent advances in the use of immunising vaccines will at least help to reduce the ravages of the 3 latter disease. There was again a complete absence of diphtheria and enteric fever. Scarlet fever and erysipelas were less prevalent. A sharp outbreak of mild dysentery in the spring emphasises yet again the necessity for better standards of hygiene in relation to food and food utensils. The control of food both from the point of view of quality and cleanliness, has in recent years received increasing legislative attention. Numerous regulations to protect the public from fraud and disease have been issued by the Ministry of Food and their administration now absorbs a greatly increased share of the time of your Sanitary Inspectors. There is no doubt that the closer supervision exercised in this field of public health backed by these statutory powers is producing beneficial results. One may quote for example the fact that in 1951 for the first time on record not one sample of milk out of more than 200 examined failed to comply with the legal standard for quality prescribed by the Food & Drugs Act. Further, the cleanliness of ice cream as judged by bacteriological examination is now higher than at any time, the number of samples coming within the two higher grades having risen steadily from 35% to 94% in the course of the past five years. For all too many years progress in public health has been severely handicapped by the lack of adequate housing accommodation with its accompanying evils of overcrowding. Thirteen years ago the last war brought to a sudden halt the Council's progressive programme of slum clearance and whilst by comparison with many districts we have only a small number of unfit dwellings, it has not yet been possible to make any headway in this very necessary sanitary action. I would like again to place on record my thanks to all members of the department for their loyal and willing service. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, F. LAWRENCE SMITH, Medical Officer of Health. August, 1952. 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. * L. W. Rivett, C.R.S.I. (commenced 1.1.51) * 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 1951) according to Rate Books 16,749 Rateable Value at 31st December, 1951 £510,036 Sum represented by 1d. rate £2,065 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. The increasing tendency to failure of these springs resulting from the growing abstraction of water from the London Basin has for many years past given rise to considerable concern, both on the grounds of amenity and public health. The ponds and ornamental waters fed by these springs are some 6 acres in extent, whilst the river flows for a distance of nearly 3½ miles through the district. In December, a public enquiry was held into an application of the Croydon Borough Council to install increased pumping facilities at the Surrey Street wells of their water undertaking. The opportunity was taken at this enquiry, together with neighbouring authorities, of impressing on the Minister's Inspector the grave concern which was felt by the Council at the increasing depletion of the underground water resources which directly, or indirectly, affect the maintenance of the water courses of the district. 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. A limited amount of housing development, restricted by the Green Belt, has taken place during the last 3 years at the southern extremity on the Clockhouse Farm Estate. Except for a very few small scattered areas of ground, the district is fully developed if the existing open spaces, so essential to public health, are to be preserved. 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 1951 (Based on the Registrar-General's Figures) Population. Registrar-General's Estimate 61,730 Births. Males. Females. Total. Live (Legitimate) 356 372 728 (Illegitimate) 12 18 30 368 390 758 Birth Rate (per 1,000 population) 12.3 Stillbirths (Legitimate 12 10 22 (Illegitimate) 1 - 1 13 10 23 Stillbirth Rate per 1,000 total births 29.4 Deaths 266 272 538 Death Rate (crude) per 1,000 population 8.7 Infant Mortality. All deaths under 1 year 9 13 22 Infant mortality Rate (per 1,000 live births) 29.0 Deaths of leg. infts. under 1 year Rate per 1,000 legitimate births 9 13 22 30.2 Deaths of illeg. infts. under 1 year Rate per 1,000 illegitimate births - - - - Maternal Mortality. Death from Sepsis 1 Rate per 1,000 births 1.2 Death from other causes - Rate per 1,000 total births - Maternal Death Rate 1.2 Zymotic Deaths. 7 Principal Zymotic Diseases - 1 1 Deaths from Measles - 1 1 Deaths from Whooping Cough - - - Deaths from Diarrhoea (under 2 years) Zymotic Death Rate 0.01 Deaths from Tuberculosis. All Forms 11 10 21 Rate per 1,000 of population 0.34 Phthisis 9 10 19 Rate per 1,000 of population 0.30 Deaths from Cancer 46 43 89 Rate per 1,000 of population 1.44 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 RegistrarGeneral, 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 7th January, 1952, are supplied through the courtesy of the Exchange Manager :— Men 219 Women 80 Boys 18 Girls 12 POPULATION. The Registrar-General's estimate of the home population at the 30th June, 1951, is 61,730. This is 420 less than his estimate at midyear, 1950 and 580 less than 2 years ago. Natural increase resulting from the excess of births over deaths in the last 2 years was 540, and it is difficult to believe that outward migration has exceeded inward migration by more than 1,000. The population of the district enumerated at the Census on the 8th April, 1951, was 62,804, of which 29,455 were males and 33,349 females. These figures compare with 28,586 persons (12,988 males and 15,598 females) at the Census of 1931 and show an intercensal increase of 119.7%. Accepting the Registrar General's figures, the following table gives the estimated distribution based upon our knowledge of local conditions. TABLE 1. ESTIMATED RESIDENT POPULATION, MID-1951, BY WARDS. Ward. Houses at Mid-1951 Estimated population Mid-1951 St. Helier North 2,164 8,510 St. Helier South 1,698 6,940 St. Helier West 2,023 8,250 North-East 2,682 9,250 North-West 2,146 7,180 Central 1,721 6,100 South-East 2,240 7,800 (Queen Mary's Hospital) 1,100 South-West 2,033 6,600 Whole District 16,707 61,730 8 BIRTHS. The number of live births registered during the year fell from 808 in the year before to 758, thus continuing the progressive decline from the post-war peak year of 1946. Of the total births, 368 were males and 390 females, giving a birth rate of 12.3 per thousand of population. The "comparable" birthrate produced by the application of the Registrar-General's comparability factor of 0.94 to allow for differences in the age and sex constitution of the population was 11.5 per thousand population, which compares with the rate for England and Wales of 15.5. 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 births received under the Public Health Act, supplemented by the Registrar's weekly returns of registrations. From these sources it is known that 757 live births and 24 stillbirths occurred in 1951. 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 139 16.3 4 28.7 St. Helier South 85 12.2 4 47.1 St. Helier West 97 11.7 4 41.2 North-East 133 14.3 3 22.5 North-West 90 12.5 3 33.3 Central 57 9.3 2 35.1 South-East (excluding Queen Mary's Hospital) 97 12.4 2 20.6 South-West 59 8.9 2 33.9 Seventy-one per cent of all births occurred in hospitals and nursing homes. The percentages of such births for the individual wards were as follows:— St. Helier North 63 St. Helier South 84 St. Helier West 75 North-East 68 North-West 67 Central 73 South-East 72 South-West 77 9 Out of 781 total births, 557 took place in the following hospitals and nursing homes :— Live Still Total Carshalton, Beddington and Wallington District (War Memorial) Hospital 59 3 62 St. Helier Hospital 383 11 394 Other Surrey Hospitals 73 3 76 Other Hospitals 15 2 17 Private Nursing Homes 8 - 8 Totals 538 19 557 The number of institutional confinements continues high, the percentage having more than doubled in the last 10 years. Although this period has been exceptionally free from maternal mortality, one wonders whether this practice has not gone too far. There is admittedly an aGute shortage of hospital beds for some classes of patients, particularly elderly chronics, many of whom require constant nursing attention and are without adequate home care. In these circumstances, it is open to question whether the present generous allocation of beds to maternity is making the best contribution to the medical care of the sick population who need in-patient hospital facilities. 10 TABLE 2. BIRTHS, 1951, 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 87(4) 53 140(4) 3 - 3 143(4) St. Helier South 71(3) 14(/) 85(4) 4 - 4 89(4) St. Helier West 72(2) 25 97(2) 4(2) - 4(2) 101(4) North-East 81(/) 44(1) 125(2) 11(0) - 11(/) 136(3) North-West 44(/) 29(1) 73(2) 19(0 1 20(/) 93(3) Central 35(/) 16 51 (/) 8(0 - 8(/) 59(2) South-East 45(/) 27(/) 72 (2) 26 1 27 99(2) South-West 21 (/) 14(0 35(2) 26 - 26 61(2) Totals 456(14) 222(5) 678(19) 101(5) 2 103(5) 781(24) (Figures in brackets indicate stillbirths included in totals). TABLE 3. BIRTH AND DEATH RATES FOR CARSHALTON, 1922-1951. Year Population (RegistrarGeneral's) Birth Rate Death Rate Infant Mortality Rate Maternal Mortality Rate 1922 14,240 19.7 8.8 50 10.6 1923 14,610 18.8 8.6 36 3.6 1924 15,050 18.5 10.1 58 7.1 1925 15,660 20.0 10.0 42 3.2 1926 17,040 17.0 9.3 31 0.0 1927 18,450 16.5 9.1 72 9.8 1928 21,910 15.5 9.0 65 14.7 1929 23,420 18.8 9.4 61 0.0 1930 25,500 17.0 7.6 46 0.0 1931 28,620 16.7 7.5 43.8 8.1 1932 32,280 15.0 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 1951 61,730 12.3 8.7 29.0 1.2 11 TABLE 4. COMPARATIVE STATISTICS—1951. England and Wales 126 County Boroughs and Great Towns (including London) 148 smaller Towns (Resident Populations 25,00C to 50,000 at 1931 Census) . London Administrative County Carshalton  Rates Per 1,000 Home Population. Births— Live 15.5 17.3 16.7 17.8 12.3 Still 0.36 0.45 0.38 0.37 0.37 Deaths— All causes 12.5 13.4 12.5 13.1 8.7 Typhoid and Paratyphoid 0.00 0.00 0.00 - Whooping Cough 0.01 0.01 0.01 0.01 - Diphtheria 0.00 0.00 0.00 0.00 - Tuberculosis 0.31 0.37 0.31 0.38 0.34 Influenza 0.38 0.36 0.38 0.23 0.08 Small pox 0.00 0.00 0.00 - - Acute Poliomyelitis and Polioencephalitis 0.00 0.01 0.01 0.00 - Pneumonia 0.61 0.65 0.63 0.61 0.37 Notifications (Corrected)— Typhoid fever 0.00 0.00 0.00 0.01 - Paratyphoid fever 0.02 0.03 0.02 0.01 - Meningococcal infection 0.03 0.04 0.03 0.03 - Scarlet fever 1.1l 1.20 1.20 1.10 1.76 Whooping Cough 3.87 3.62 4.00 3.11 7.63 Diphtheria 0.02 0.02 0.03 0.01 Erysipelas 0.14 0.15 0.12 0.15 0.04 Smallpox 0.00 0.00 0.00 - - Measles 14.07 13.93 14.82 14.64 16.31 Pneumonia 0.99 1.04 0.96 0.72 0.87 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0.03 0.03 0.03 0.02 0.01 Non-paralytic 0.02 0.02 0.03 0.02 0.03 Food poisoning 0.13 0.15 00.8 0.23 0.11 Rates Per 1,000 Live Births. Deaths— All causes under 1 year of age †29.6 33.9 27.6 26.4 29.0 Enteritis & Diarrhoea under 2 years of age 1.4 1.6 1.0 0.7 . Rates Per 1,000 Total Births (Live and Still) Notifications (Corrected)— Puerperal Fever and Pyrexia 10.66 13.77 8.08 14.90 103.71 Maternal Mortality— Abortion with sepsis 0.09 1.28 Other abortion 0.05 - Sepsis of pregnancy childbirth and the puerperium 0.10 Other complications of pregnancy childbirth and the puerperium 0.55 * A dash (—) signifies that there was none. f Per 1,000 related live births, 12 COMPARATIVE HEALTH STATISTICS, 1934/51. Year Crude Death Rate (Civilian) per 1,000 population Infant Mortality per 1,000 live births Maternal Mortality (excluding abortion) per 1,000 total births 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 1951 12.5 8.7 29.6 29.0 0.65 0 DEATHS. The deaths allocated to the district numbered 538—266 males and 272 females. This is 51 more than in 1950 and gives a crude death rate of 8.7 per thousand population as against 7.8 in the year before. The " comparable " death rate produced by the application of the Registrar-General's factor of 1.25 to allow for age and sex differences in the population compared with the country as a whole was 10.8 per thousand population. The rate for England and Wales was 12.5. The comparability factor is exceptionally high due to the very low average age of the population, which is probably the lowest in Surrey. The distribution of the deaths by wards was as follows:— WARD DEATH RATES AND MEAN AGE AT DEATH, 1951. Ward Deaths Death Rate (crude) Mean Age at death St. Helier North 59 6.9 54.8 yrs. St. Helier South 44 6.3 64.5 „ St. Helier West 55 6.6 59.0 „ North-East 83 8.8 61.5 „ North-West 79 11.0 65.9 „ Central 76 12.4 71.7 „ South-East (excluding Queen Mary's Hospital) 66 8.4 62.3 „ South-West 78 11.8 68.6 „ Whole District 540 8.9 64.0 yrs. 13 The death rate from cancer fell from 1.62 to 1.44 per thousand population, there being 9 fewer deaths from this cause. CANCER DEATHS—WARD DISTRIBUTION, 1951. Ward Cancer Deaths Rate per 1,000 Estimated Population St. Helier North 13 1.52 St. Helier South 9 1.29 St. Helier West 8 0.97 North-East 15 1.62 North-West 9 1.25 Central 15 2.45 South-East 14 1.79 South-West 6 0.92 The classification of the cancer deaths by sites affected is given in Table 5. TABLE 5. Group Site Affected Male Female Total Digestive Organs— 150 Oesophagus 1 2 3 151 Stomach 12 5 17 153 Colon 3 10 13 154 Rectum 3 3 6 155 Liver and Gall Bladder 2 1 3 157 Pancreas 2 - 2 Respiratory System— 161 Larynx 1 - 1 162 Lungs and Bronchus 10 2 12 Breast and Genito-Urinary— 170 Breast - 10 10 171/4 Uterus - 3 3 175 Ovary - 3 3 176 Vulva - 1 1 177 Prostate 4 - 4 181 Bladder 2 - 2 Other Sites and unspecified— 193 Brain and Nerves 1 - 1 196 Bone 1 - 1 198 Glands 1 - 1 199 Unspecified 1 2 3 Lymphatic and Haematopoetic tissues— 200 Reticulo Sarcoma - 1 1 201 Hodgkins Disease 1 - 1 203 Myelomatosis - 1 1 45 44 89 Average age at death:— Males 59.0 years Females 55.5 years All persons 52.1 years 14 Tuberculosis was responsible for 21 deaths, compared with 13 in 1950. As a result the death rate for this disease rose to 0.34 per thousand population. The death rates from tuberculosis for the last 21 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 1951 0.34 The distribution of tuberculosis mortality by wards and other details are given in Section F of this report. Two deaths, one from measles and one from enteric fever, were caused by the common notifiable infectious diseases. Deaths of residents attributable to violent causes totalled 13. They occurred in the following ways :— Suicide 7 Motor Vehicle Accidents 2 Drowning 1 Accidental Coal Gas Poisoning 2 Accidents in the Home 1 Inquests. Inquests were held on 35 persons who died in the district. The following verdicts were returned:— Accidental Death 19 Suicide 5 Misadventure 6 Natural causes 5 Eleven of the total were residents of the district. None was due to road accidents. 15 INFANT MORTALITY. The deaths of 22 children who died under the age of one year were registered, of which 9 were males and 13 females. These provide an infant mortality rate of 29.0 per thousand live births compared with 28.4 in the year before. The comparable rate for England and Wales was 29.6. All were deaths of legitimate children. Fifteen of the 22 deaths occurred in the first month of life. Congenital malformations, prematurity and diseases peculiar to infancy accounted for 19 and infections for 3. 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 4 29 St. Helier South 2 23 St. Helier West 2 20 North-East 5 37 North-West 2 22 Central - - South-East 4 41 South-West 3 50 MATERNAL MORTALITY. One death resulted from septic abortion, the cause of which was not disclosed by the evidence at the inquest. 16 17 TABLE 7. INFANT MORTALITY DURING THE YEAR 1951. 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 - - - - - 2 - - - 2 Prematurity 5 — — — 5 — — - 5 Congenital Malformation 1 1 1 1 4 1 1 1 - 7 Atelectasis 3 — — — 3 — - - - 3 Birth Injury 1 — — 1 — — — - 1 Haemorrhagic disease of newborn 1 — — — 1 — — - - 1 Erythroblastosis 1 — — 1 — 1 - 2 Pyelitis - - - - - 1 — — — 1 Totals 12 1 1 1 15 4 2 1 22 18 TABLE 8—CAUSES OF DEATH DURING THE YEAR 1951. 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. Persons All Causes 9 13 2 3 1 3 2 2 4 7 15 11 38 18 57 32 65 50 74 134 267 273 540 1 Tuberculosis, respiratory - - - - - - - 1 2 4 1 3 2 2 2 — 2 — — — 9 10 19 2 Tuberculosis, other - - - - - - - - - - - - - - - - - - - - 2 — 2 3 Syphilitic disease - - - - - - - - - - - - 1 - - - 1 1 — 1 2 2 4 4 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - 5 Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - 6 Meningococcal Infections - - - - - - - - - - - - - - - - - - - - - - - 7 Acute Poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - 8 Measles - - - - - - - - - - - - - - - - - - - - - 1 1 9 Other Infective and Parasitic Diseases — 1 - - - - - - - - - - - - - - - - - - - 2 2 10 Malignant Neoplasm, stomach - - - - - - - - - - - - 5 — 4 1 2 1 2 3 13 5 18 11 Malignant Neoplasm, Lung - - - - - - - - - - - - 4 — 2 1 3 1 1 — 10 2 12 12 Malignant Neoplasm, Breast — — — — — — — — — — — 2 — 3 — 2 — 2 — 1 — 10 10 13 Malignant Neoplasm, Uterus - - - - - - - - - - - - - - - - - - - 1 — 3 3 14 Other Malignant and Lymphatic Neoplasms - - 1 - 1 - - - — — 4 2 2 4 5 3 3 2 7 12 23 23 46 15 Leukaemia, Aleukaemia - - - - - - - - - - - - - - - - - - - - - 1 1 16 Diabetes - - - - - - - - - - - - - - - - - - - - - 2 2 17 Vascular lesions of nervous system - - - - - - - - - - - 1 4 — 6 7 9 5 12 21 31 34 65 18 Coronary Disease, Angina — — — — — — — — 1 — 3 — 8 1 10 — 14 12 7 12 43 25 68 19 Hypertension with Heart Disease — — — — — — — — — — — — — 1 — 2 1 — — 2 1 5 6 20 Other Heart Disease - - - - - - - - - - - - 2 1 3 4 12 9 19 48 36 62 98 21 Other Circulatory Disease - - - - - - - - - - - - 1 — 2 2 2 5 b 4 11 11 22 22 Influenza - - - - - - - - - - - - - - - - - - - 2 3 2 5 23 Pneumonia 1 1 — 2 - - - - - - - - 2 — 4 — 2 3 3 7 12 13 25 24 Bronchitis - - - - - - - - - - - - 1 — 5 4 7 2 3 3 lb 9 25 25 Other Diseases of Respiratory System — — — — — — — — — — 2 — 2 1 — — — — 1 2 5 3 8 26 Ulcer of Stomach and Duodenum - - - - - - - - - - - - - - 2 - - 1 — 1 2 2 4 27 Gastritis, Enteritis and Diarrhoea - - - - - - - - - - - - - - - - - - - 2 — 2 2 28 Nephritis and Nephrosis - - - - - 1 - - - - - 1 1 1 2 — 1 — — — 4 3 7 29 Hyperplasia of Prostrate - - - - - - - - - - - - - - - - - - - - - - 9 30 Pregnancy, Childbirth, Abortion - - - - - - - - - - - 1 - - - - - - - - - 1 1 31 Congenital Malformations 1 4 - - - - - - - - - - - - - 1 - - 1 — 2 5 7 32 Other Defined and Illdefined diseases 1 7 7 1 — - 2 — 1 — — 1 — 2 1 7 3 3 4 6 10 27 28 55 33 Motor Vehicle Accidents - - - - - - 1 - - - 1 - - - - - - - - - 2 - 2 34 All Other Accidents — - - - - - - - - - 1 - - - - 1 - 1 - 1 1 3 4 35 Suicide — - - - - - - - - 2 l I 1 l l - - - - - 3 4 7 36 Homicide and Operations of War - - - - - - - - - - - - - - - - - - - - - - - Section B—Health Services. Laboratory Facilities. Routine clinical material in connection with infectious diseases, puerperal pyrexia and tuberculosis is examined at the Emergency Public Health Laboratories at the St. Helier and Sutton and Cheam Hospitals. Laboratory investigations into suspected food poisoning and bacteriological examination of milk and water are carried out at the Epsom Public Health Laboratories. Food, drugs and water samples are submitted to the Council's analyst, Mr. D. D. Moir, 16, Southwark Street, London, S.E.I. No facilities exist under the local Public Health Laboratory Service for the biological testing of milk samples for tuberculosis and these are submitted to the Royal Surrey County Hospital, Guildford. The following examinations were made during the year:— Throat and Nose Swabs 6 Faeces Specimens 687 Urine Specimens 16 Sputum for T.B. 1 Water (Public Supply):— For chemical analysis 2 For bacteriological examination 6 Food and Drugs:— Analysis 328 Bacteriological examinatioruof milk 226 Bacteriological examination of ice-cream 105 Bacteriological examination of other foods 3 Biological examination of milk 15 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—4 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. Middleton Road Centre, Morden Mons. and Weds. 9.30—12 a.m. Dental, eye and special clinics for child 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 Wednesdays 2 p.m. 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) 5—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. Quality and quantity were satisfactory throughout the year. The raw well water is subjected to chlorination and both the raw and finished waters are submitted to bacteriological and chemical testing by the Company's resident chemist, by independent analysts and by the Public Health Departments of the Local Authorities in the supply area on an agreed rota. The following is a summary of the results of the tests carried out by the Company and are supplied by 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 100m. of sample No. % No. % Sutton Raw 298 53 13 40 78 260 91 Sutton Finished 309 24 1 0.3 Nil Nil 1 Woodmansterne Raw 295 44 1 0.3 2 0.6 3 Woodmansterne Finished 298 24 Nil Nil 1 0.3 1 Cheam 312 59 Nil Nil Nil Nil Nil Reservoir 226 Nil Nil Nil 5 2.2 5 District (excluding New Main) 277 2 4 1.8 3 1.3 7 New Mains 34 Nil 9 26.6 2 5.8 11 TOTAL 2049 206 21 Water as delivered to the consumer is examined monthly by the Counties Public Health Laboratory on behalf of the Company and a further 13 chemical and 26 bacteriological samples were examined by the Public Health Departments in the supply area. All were satisfactory. The following is a representative analysis:— Chemical analysis in parts per million. Total solid matter in solution (dried at 180°C.) 220 Combined chlorine 20.9 Nitric nitrogen 12.0 Nitrous nitrogen 0.08 Ammonia, free and saline 0.030 Ammonia, albuminoid 0.035 Oxygen absorbed from permanganate in 4 hours at 26.7°C. 0.14 Hardness—by acidimetric titration—Temporary 54 Permanent 73 Total 127 Reaction for free chlorine:—positive, equivalent to 0.09 pH 8.3 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 good organic purity and very moderate hardness. The changes noted in the previous chemical sample taken on the 19th April, 1951, have been very largely reversed, although the temporary hardness is still slightly higher than the permanent. The reaction (pH) although slightly alkaline is now at a satisfactory level. The residual chlorine indicates that treatment is being maintained. The bacteriological condition is excellent and, as judged by these samples, the water is pure and wholesome and suitable for the public supply. Drainage and Sewerage. No extensions or replacements have been made to the sewerage system, but a private drain has been laid which connects the buildings in the War Memorial Sports Ground into the drainage system of Carshalton West County Secondary School and subsequently into the Council's sewerage system. A start has been made in the construction of two deep manholes in Blakehall Road and two deep manholes in Grosvenor Avenue on one of the trunk sewers to facilitate maintenance. 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. Three hundred and one drainage obstructions, affecting 1,082 houses were dealt with. 22 Rivers and Streams. No specific improvements or cleansing other than normal routine have been undertaken. This work is now normally carried out by the Surrey County Council. The springs in the Grotto Canal, the Hog-Pit, Lady Margarets Pool and in the Convent, functioned again after a long period of inactivity. One complaint was dealt with during the year. Closet Accommodation. All dwellings have w.c.'s connected to the sewers, except 17 in unsewered areas which are drained to cesspools. There are no earth closets. Public Cleansing. This service is under the direction of the Council's Engineer and Surveyor. Collection. No alterations were made in the method of collection, but a redistribution of collecting areas was made to enable each refuse collecting vehicle to be controlled by a ganger. This has resulted in an increase in efficiency of refuse collection generally. The fleet of collection vehicles was further modernised by the addition of two vehicles manufactured by Shelvoke & Drewry Ltd., one of 12 cu. yd. capacity (side loading) and the other of 7 cu. yd. capacity (end loading) for the specific purpose of collecting refuse in " backs " or rights of way. The seven vehicles now normally used in refuse collection are now up-to-date and are all fitted with hydraulic tipping gears. A spare vehicle is still kept in service should a breakdown of the regular vehicles occur. Kitchen waste is collected for pig food, the bins for which are cleansed by steam. Disposal. No major variations in the methods of disposal of refuse and salvage were made. During July, the Works were shut down for approximately five weeks in order that the Destructor cells could be re-lined in " Plibrico." and the two lower sections of the chimney lining rebuilt in fire bricks. Refuse during this period was disposed of to a chalk pit on land to the south east of the Oaks Corner by controlled tipping. During the remainder of the year, screenings have been disposed of to the Croydon tip at Mitcham and clinker to the Watercress Beds in Mill Lane. A contract of approximate value £6,700 was started to extend the area round the Refuse Disposal Works, as this was hitherto inadequate. The contract included provision for a Sludge Drying Bed, concrete paving over the extended area and where none previously existed, a concrete retaining wall to enable easy loading and storage of clinker to be made, the provision of storage areas for scrap metals, and the provision of a roadway round the works so that vehicles do not have to go on the highway to reach the weighbridge. The work was completed early in 1952. 23 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. Accumulations 29 Animals so kept 5 Burst pipes 4 Dampness 65 Ditches and ponds 1 Drainage defects 36 Drains obstructed 349 Dustbins 90 Food contaminated 23 General defective conditions 117 Insects and Pests 102 Milk, contaminated and dirty bottles 5 Miscellaneous 20 Obnoxious effluvia 43 Overcrowding 41 Pig bins 12 Refuse collection 15 Rivers 1 Rodents 267 Roofs, defective 60 Sewer obstructions 10 Shops 6 Sink waste pipes 13 Smoke nuisances 9 Unsound food 139 Verminous premises 10 Water supply 8 1,480 Eleven thousand, four hundred and twenty-nine visits of inspection and re-inspection were made for the purposes set out below:— Business premises 13 Cowsheds 57 Employment Agencies 2 Factories (Mechanical Power) 106 Factories (Non-Mechanical Power) 46 Food and Drugs and other samples 639 Food poisoning enquiries 8 Food premises: Bakehouses 30 Bakers and confectioners Butchers 152 Canteens 23 Chemists Confectioners (sweets only) 72 Fishmongers 61 General Stores Greengrocers and fruiterers Grocers 280 Hotels with catering facilities 22 Hotels without catering facilities 9 Ice cream factories 20 Ice cream vehicles 10 Licensed premises 20 Milk shop Restaurants and cafes 135 Stalls, food 33 24 Tea packer 2 Unsound Food: Meat 57 Food other than meat 159 Vehicles, food 207 — 1,617 Hairdressers 24 House drains tested 39 Housing Act 171 Housing enquiries 851 Infectious disease contacts 119 Infectious disease premises 313 Merchandise Marks Act 179 Offices 6 Outworkers premises 23 Piggeries 32 Premises re cesspools 1 Public Health Act (Houses) 3,687 Public Health Act re-inspections 2,778 Rag Flock and Other Filling Materials Act 5 Rodents 300 Schools 14 Shops 341 Smoke observations 21 Urinals 29 Water Sampling 8 11,429 Five hundred and eighty-eight informal notices were served concerning the following matters :— Accumulations and deposits 10 Drainage defects 91 Dustbins 55 Factories Act 11 Food and' Drugs Act 52 General defective conditions 281 Merchandise Marks Act 8 Miscellaneous 4 Obstructed drains 1 Overcrowding 49 Rodents 9 Shops Act 8 Smoke nuisance 2 Verminous premises 2 Water supply 5 Seventy-seven formal notices were served by authority of the Council under the following Acts:— Public Health Act, 1936, Section 39 5 „ ,, „ „ Section 56 2 „ „ „ „ Section 75 5 „ „ „ „ Section 93 61 „ „ „ „ Section 277 1 Food and Drugs Act, 1938, Section 13 1 Shops Act, 1950, Section 38 1 Housing Act, 1936, Section 9 1 77 As a result of investigations made and notices served, the following work was carried out:— Accumulations removed 21 Brickwork, repaired and/or repointed 25 Ceilings cleansed and purified 238 new provided 2 25 Ceiling plaster repaired and/or made good (including plaster board) 177 Cement plinths, renewed 3 Chimney pots repaired and/or made good 2 stacks repaired and/or made good 7 Flues repaired 11 Coppers repaired 1 Damp conditions remedied 114 Damp course renewed 2 provided 1 Disinfestations 20 Ditches cleaned Door cills repaired 2 Doors and frames repaired, including locks and fasteners 53 Drainage repaired and/or reconstructed 17 inspection chamber repaired and/or made good 6 inspection chamber covers renewed 14 stoppers or caps refixed and/or renewed 4 Drainage fresh air inlets repaired and/or renewed 5 soil vents repaired and/or renewed 8 drains tested 25 drains cleared (affecting 1082 houses) 301 drainage provided 1 waste gullies repaired, renewed or cleared 16 waste pipes, repaired, renewed or provided 24 Dustbins provided 72 Fences repaired or renewed Fire grates repaired and/or renewed Fireplaces repaired and/or made good 21 Floorboards repaired and/or made good 38 Floors concrete repaired, renewed and/or made level 3 ventilation repaired 3 Food storage provided 1 Glazing panes renewed 12 putty renewed 19 Other matters 10 Paving repaired and/or made level 12 provided 2 drained 2 Ranges, stoves repaired and/or renewed 12 provided 2 Roofs repaired and made waterproof 144 downpipe, guttering repaired and/or renewed 72 downpipe, guttering provided 1 cleared out and made to\vork properly 12 Shops, forms provided 4 seats provided 2 hot water, means of supply provided 9 Sinks provided 1 Soakaway made to work properly 1 provided 4 Stair treads repaired, renewed or made level 1 handrails and/or balusters repaired 3 handrail provided 2 Steps repaired and/or renewed 3 Surface water drainage repaired and made to work properly 5 Ventilation, more provided 11 Walls, cement rendered 3 rendering repaired 15 replastered and/or repaired 158 cleansed and redecorated 187 rebuilt 14 Wash basins, baths renewed 2 Water cisterns repaired 1 Water supply repaired 11 W.C. accommodation repaired 7 pans renewed 8 pans provided 4 Pan joints renewed 6 26 seats repaired, renewed or provided 3 lift-up seat provided 8 flushing apparatus repaired or renewed 26 flushing apparatus provided 4 W.C.'s provided 4 Weatherboards repaired 12 Window frames repaired and/or renewed 52 Windows made to work properly 18 provided with catches or fasteners 3 sash cords renewed 57 Windows repaired and/or renewed 4 Window cills (external) repaired 7 Woodwork repaired and/or renewed 12 Disinfection. In connection with cases of infectious disease, 174 rooms, 3 shelters and 364 library books were disinfected. Twenty lots of bedding were sterilised and six lots destroyed. Vermin Control. Persons. Verminous persons and their personal clothing can be disinfected at the Council's Cleansing Station in Rochester Road. These are adapted premises which, although comparing unfavourably with modern standards, provide very useful service. The equipment includes a Thresh Steam Disinfector. A trained nurse is in attendance for women and children and a male attendant to deal with adult males. The nurse-in-charge follows up cases in their own homes and deals with the family as a unit, whilst the Sanitary Inspectors visit when attention to the premises is necessary. financial arrangements exist with the Education Authority in respect of the treatment of schoolchildren. The following persons were dealt with at the Cleansing Station during the year:— Families. Persons. Attendances. For scabies 3 10 16 For pediculosis 6 9 21 9 19 37 School children included in these totals were:— For scabies 5 For pediculosis 9 Premises. During the year, two lots of verminous bedding were stoved, one lot destroyed and seventy-one premises were treated for the destruction of vermin and insect pests as follows:— 27 Infestation Sprayed by G.U.D.C. Sprayed by L.C.C. Sprayed by Owners G.U.D.G. Property L.C.C. Property Privately Owned Property L.C.C. Property Privately Owned Property Ants 1 - 2 Beetles - - 1 - - Bugs 8 - 2 3 - Fleas 4 - 2 - - Lice - - 1 - - Moths - - i - - Silverfish - - i - - Wasps 7 - 38 - - 20 - 48 3 - 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. Nine 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. Eight thousand seven hundred and forty-eight visits were made and 332 rat and mouse infestations found. Of that number 289 were found in private premises, 18 in business premises, 22 in Council premises and 3 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 87 252 Manholes in which takes of prebait were recorded 25 69 Percentage of manholes showing infestations 39 31 Percentage in relation to total manholes in district 3 7 Swimming Baths. The one privately owned swimming bath was in use during the year, and one sample of water was taken, which proved satisfactory. Offices. Six inspections of offices were made but no action was necessary. 28 Shops Act, 1950. There are 514 shop premises on the register and 1691 inspections were made during the year. Preliminary notices were served with regard to 8 infringements. Seats for female shop assistants were provided in two shops ; nine shops were provided with washing facilities and two shops were provided with improved ventilation. 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 389, and of this number 172 were from the Carshalton 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. Modern mortuary facilities with provision for post-mortem examinations are provided at the Council's Mill Lane Mortuary. During the year 97 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. Seven establishments licensed under Part IV of the Surrey County Council Act, 1931, were inspected during the year. Five were used for the practice of chiropody" and two for massage. All were found to be satisfactory. Employment Agencies. The only licensed employment agency was visited by Officers of the Authority, acting as agents for the Surrey County Council and was found to be satisfactory. National Assistance Act—Section 47. It was not found necessary to invoke the powers of this section to secure the removal of any sick or infirm person living in insanitary conditions. The chief difficulty is not to obtain the agreement to this course of action of persons, particularly old people, who find themselves in these circumstances, but to find accommodation for them. The outlook for old people who are beyond caring for themselves and who either have no relatives or any willing to care for them is nowadays bleak indeed. The passing of the old Relieving Officer has been a tragic blow to the welfare of the aged and infirm. In the days when the County Council were both the Hospital and the Welfare Authority, the Relieving Officer had the facilities of both the hospital and the welfare institution at his disposal and he invariably managed to make satisfactory arrangements between the two for those without adequate home care. Now the disposal of these cases is all too frequently the subject of unresolved argument as to whether they are the responsibility of the Hospital Board or of the Welfare Authority. Rag Flock and Other Filling Materials Act, 1951. One application for registration of premises used for upholstering was granted in accordance with Section 2 of the Rag Flock & Other Filling Materials Act, 1951, 29 Section D— Housing. New Houses. During the year 103 houses and flats of the following types were completed:— Council Houses 21 Council Flats 82 Private Houses under Licence 13 Total 116 Houses in course of erection at the end of the year were as follows:— Council Flats 174 Private Houses under Licence 5 Total 179 Council's Housing Scheme. Dwellings in the ownership of the Council at the year end totalled 1,068 houses, flats and temporary bungalows. In addition to the new houses and flats completed and in course of erection, work continued, or was commenced during the year on the undermentioned Contracts:— Site No. Site Type No. in Contract 8 & 20 Barrow Hedges Flats 70 25 The Mount Traditional houses Flats 27 11 30 Whitethorn Avenue „ 10 31 Stanley Road „ 18 136 The accommodation under requisition by the Council at 31st December, 1951, comprised 146 premises, providing accommodation for 218 families. The number of outstanding approved applications for tenancies at the year end was approximately 1,829. 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.—171 P.H.A.—3,726 3,897 (b) Number of inspections made for the purpose 6,675 30 (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 446 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 1950) .... 416 3. Action under Statutory Powers during the year. (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936. Number of dwelling houses in respect of which notices were served requiring repairs 1 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 65 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 62 (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 217 (2) Number of families dwelling therein 377 (3) Equivalent number of adults dwelling therein 1,483£ (b; Number of new cases reported during the year 54 (c) (1) Number of cases of overcrowding relieved during the year 46 (2) Number of persons concerned in such cases 302½ (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 — 31 Overcrowding. During the year, 54 cases of overcrowding were found to exist and 46 cases were remedied, leaving 217 dwellings with 1,483½ equivalent adults in occupation overcrowded at 31st December, 1951. The known position as to overcrowding at the beginning and end of the year was as follows:— Ward Dwellings overcrowded at 31.12.50 Dwellings found overcrowded during 1951 Dwellings decrowded during 1951 Dwellings remaining overcrowded at 31.12.51 Overcrowded cases remedied during 1951 Formal Action Informal Action Total St. Helier North 53 11 6 58 6 6 St. Helier South 51 10 9 52 7 2 9 St. Helier West 49 15 16 48 10 6 16 North-East 22 5 8 19 7 1 8 North-West 12 3 3 12 2 1 3 Central 9 4 1 12 1 - 1 South-West - - - - - - - South-East 13 6 3 16 3 - 3 209 54 46 217 36 10 46 In 41 of the 54 new cases of overcrowding, families were sharing accommodation with relatives. Abatement in the 46 instances was effected as follows:— Provision of alternative accommodation by:— Carshalton U.D.C. 35 London C.C. — Other Local Authorities. 1 Left the District. 2 Removal of one or more occupants. 8 Of the 217 dwellings still overcrowded at the year end, 157 were owned by the London County Council, 20 by the District Council and 40 were privately owned. Slum Clearance and Demolition. No action was undertaken during the year. Rent and Mortgage Interest Restrictions (Amendment) Act, 1933. No action was necessary. Factories and Workplaces. Co-operation with H.M. Inspector of Factories has proceeded during the year. 32 The following table gives a summary of the registers:— Employees Premises Males Females Total Factories— with mechanical power 699 495 1,194 79 without „ ,, 31 12 43 17 Workplaces— with mechanical power 15 - 15 15 without ,, „ 18 3 21 21 763 510 1,273 132 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 (1) Number on Register (2) Number of Inspections (3) Written Notices (4) Occupiers Prosecuted (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 17 46 3 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 79 106 8 - (iii) Other premises in which Section 7 is enforced by the Local Authority* (excluding outworkers' premises) - Total 96 152 11 - * Electrical Station (Section 103 (1) ), Institutions (Section 104) and sites of Building Operations and Works of Engineering Construction (Sections 107 and 108). 33 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 4 4 - - - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation 2 2 - - - Defective drainage of floors 1 1 - - - Sanitary Conveniences— (a) Insufficient 4 4 - - - (b) Unsuitable or defective - - - - - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) - - - - - Total 11 11 - - - Outwork (Sections 110 and 111). Nature of Work (1) Section 110 Section 111 No. of outworkers in Aug. list required by Sect. 110(1) (c) (2) No. of cases of default in sending lists to the Council (3) No. of prosecutions for failure to supply lists (4) No. of instances of work in unwhole some premises (5) Notices served (6) Prosecutions (7) Wearing Apparel— Making, etc. 27 - - - - - Cleaning and washing - - - - - - Brass and Brass Articles 2 - - - - - The making of boxes or other receptacles or parts thereof made wholly or partially of paper - - - - - - Stuffed Toys 26 - - - - - Cosaques, Christmas Crackers, Christmas stockings, etc. 61 - - - - - Artificial Flowers 1 - - - - - Total 117 - - - - - 34 Section E—Inspection and Supervision of Food. Milk Supply. On October 1st, 1951, the Milk (Special Designations) (Specified Areas) Order, 1951, made by the Minister of Food came into force. It required that all milk sold by retail within "certain specified areas, including Carshalton, shall be designated milks and all retailers selling milk in the areas specified will need to be licensed to use a special designation in relation to milk. It so happened that immediately prior to that date we had no evidence that undesignated milk was being sold in the district. Milk Distributors. The number of Milk Distributors registered is 17. Designated licences issued during the year were as follows:— Designation Number of Distributors holding Licences No. of Licences in Force on 31/12/51 Principal Licences— Sterilised 9 12 Pasteurised 7 10 Tuberculin Tested 6 9 Supplementary Licences— Sterilised 8 11 Pasteurised 8 11 Tuberculin Tested 7 10 Bacteriological Examination of Milk. Two hundred and twenty-six samples of milk were procured and submitted for bacteriological examination. All the milks were sold under the Milk (Special Designations) Regulations and 4 failed to comply with the prescribed Regulations. 35 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 183 182 1 181 2 - - T.T. Pasteurised 27 26 1 27 — — — Sterilised 16 — — — — 16 — 226 208 2 208 2 16 — Fifteen samples were submitted for biological examination and all failed to reveal evidence of tuberculosis. Milk and Dairies Regulations 1949—Regulation 20. No action was required by the Medical Officer of Health under Regulation 20 to prevent infection being conveyed in specific instances through the milk supply. Ice Cream. The results of the bacteriological examination of ice cream samples were as follows:— No. of Samples Grade 1 2 3 4 105 80 19 6 - It is gratifying to record that the proportion of samples with the specified requirements of Grade I and II has steadily risen during the past 5 years. The percentage of samples in these grades being as follows:— 1947—35%, 1948—53%, 1949—74%, 1950—85%, 1951—94%. For the first time a minimum standard quality was legally prescribed by the Food Standards (Ice Cream) Order, 1951, which came into force on the 1st March, 1951. This requires that ice cream shall contain 5% fat—not necessarily cream—10% sugar and 7½% milk solids other than fat. Eighteen samples were submitted to the public analyst during the year and all but one were reported as genuine. Meat and Other Foods. All meat sold by retail is supplied from Ministry of Food depots outside the district. No slaughtering within the district is carried on as far as is known. Inspection of meat, therefore, is limited to that displayed for sale or held by retailers prior to sale. Approximately 2,000 lbs. of meat were found to be unfit for human food. 36 Food and Drugs Act, 1938 The following 328 samples were submitted to the public analyst:— Article No. Adulterated or otherwise irregular Article No. Adulterated or otherwise irregular Arrowroot 1 Meat pie 1 Baking Powder 2 Meringue Mixture 1 Barley, Pearl 1 Milk 215 Beer 1 Milk, Condensed 1 Beans with Tomato Sauce 1 Milk, Powder 1 Mincemeat 1 Bicarbonate of Soda 1 Mixture, cake 4 Bickie Pegs 1 Mixture, Ginger Pudding 1 Butter 3 Butter, Peanut 1 Mixture, sponge 2 Chutney 1 Orangeade 1 Cocoa 2 Paste, fish 2 Coffee 1 Paste, Meat 1 Coffee extract 1 Peas, Processed 2 Coffee and Chicory 1 Pepper Compound 1 Pickle, Mustard 1 Cornflour 1 Rice, ground 1 Cream, synthetic 1 Rissole, Nut 1 Custard Powder 5 Salad Cream 1 Gydrax 1 Salt 1 Doughnut 1 Sandwich Spread 1 Fat, Cooking 1 Sauce, Tomato Ketchup 1 Fish Cakes 1 Flour, Self-raising 1 Sauce, Worcester 1 Ginger 1 Sausage, Beef 2 Gravy Powder 1 Sausage, Pork 3 Halibut Oil Capsules 2 Stuffing, Parsley and Thyme 2 Ice Cream 18 1 Jam 2 Stuffing, Sage and Onion 11 Lemon Curd 1 Macaroni, Quick 1 Soup 2 Margarine 2 Spice, Mixed 1 Marshmallow Cream 1 Sweets 1 Meat 1 1 Tea 2 Meat, beef sausage 1 Vinegar, malt 2 Meat, luncheon 1 Whisky 8 Only two of the samples were found to be adulterated or otherwise irregular. Ice Cream. This sample showed a deficiency of 33% in the milk solids other than fat. In view of the explanation given by the manufacturer the Committee authorised a strong warning to be given. Meat. This proved to be horse flesh. The vendor was convicted under Section 38 of the Food and Drugs Act and fined £10, with £3/17/0 costs. 37 Milk (Control and Maximum Prices) (Great Britain) Order, 1947 The Department co-operates with the Ministry of Food in the administration of this order. Three samples of South Devon milk which failed to comply with the special standard of 4% fat, which entitles such milk to be sold at a higher price than ordinary milk, were reported to the Ministry. The three samples were deficient in fat to the extent of 2%, 4% and 4% respectively. Proceedings were taken by the Ministry of Food in the first two cases and in each the vendor was fined 5 guineas with 3 guineas costs. Section 9—Sale of Food Unfit for Human Consumption. Some 24 significant complaints were investigated of foreign matter found in various foodstuffs. Appropriate warning was given where the evidence against the vendor or his suppliers was insufficient and legal proceedings were taken in the following two cases:— Wire in Bun. The vendor was convicted and fined £10 with 3 guineas costs. Cigarette End in Bread. The vendor was fined 5 guineas 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 19 lbs. 4 ozs. Mincemeat 14 ozs. Butter 3 lbs. Mustard 3 ozs. Cake and biscuits 6 lbs. 4 ozs. Paste, fish 6 lbs. 10 ozs. Cereals and flour 220 lbs. 5 ozs. Paste, meat 13 lbs. 8 ozs Cheese 22 lbs. 10 ozs. Pickles 12 lbs. 10 ozs. Coffee and chicory 1 lb. Pudding 10 lbs. 8 ozs. Fat 12 lbs. Pudding and cake mixture 28 lbs. 9 ozs. Fish 749 lbs. Frizzets 8 ozs. Sauce 19 lbs. Fruit 1,163 lbs. Salad cream 223 lbs. 3 ozs. Fruit juice and drink 15 lbs. 4 ozs. Semolina 37 lbs. Jam 180 lbs. 2 ozs. Soup 56 lbs. 4 ozs. Jelly and blancmange 11 ozs. Spaghetti 57 lbs. 7 ozs. Lard 200 lbs. Stuffing 3 lbs. Macaroni 14 lbs. Sugar 33 lbs. Meat 1,997 lbs. 9 ozs. Sweets 8 lbs. Milk 723 lbs. 3 ozs. Syrup 11 lbs. 6 ozs. Milk, whipping compound 150 lbs. Tea 122 lbs. Vegetables 960 lbs. 6 ozs. Total weight: 3 tons, 3 cwts., 25 lbs., 4 ozs. Inspection of Food Premises. Details of the visits of inspection of food premises and the resulting remedial action taken are shown in Table 9. 38 39 TABLE 9. Inspection of Food Premises and Action Taken. Nature of Business. Number of Premises No. Selling Ice Cream Number of Inspections Defective Drainage Remedied Means of hot-water supply provided Ventilation provided Food preparation rooms repaired or cleansed Food storage rooms provided Refuse bins provided Other defective conditions remedied Sinks or wash-basins provided Bakers and Confectioners 15 4 44 - - - - - - - Bakehouses 5 - 30 - - - 1 - - 1 - Butchers 37 - 152 - - - 3 - 1 1 - Canteens 16 - 23 - - - - - - - - Chemists 16 - 7 - - - - - - - - Cinemas 1 1 - - - - - - - - - Confectioners (Sweets only) 72 47 72 - 5 - - - - - - Milk Shops 8 4 17 - 1 - - - - - - Fishmongers 19 - 61 - 1 - 1 1 - - - General Stores 4 3 9 - - - - - - - - Greengrocers and Fruiterers 45 2 148 1 - - - - 1 - - Grocers (and Corn Chandlers) 83 10 280 2 2 1 3 1 - 3 2 Hotels (with Catering Facilities) 5 - 22 - - - - - - 1 - Hotels (without Catering Facilities) 8 - 9 - - - - - - - - Ice Cream Factories 3 - 20 - - - - - - - - Ice Cream Vehicles Various - 10 - - - - - - - - Licensed Premises 26 - 20 - - - - - - - - Restaurants and Cafes 26 11 135 1 - 1 1 - - 2 - Stalls, Food Various - 133 - - - - - - - - Vehicles, Food Various - 207 - - - - - - - - 82 1,399 4 9 2 9 2 2 8 2 Food Hygiene. Full use was made of the various statutory powers designed to promote the hygiene of food preparation, handling and storage. Codes of practice relating to food premises and catering businesses adopted by the Council are issued to all food traders and on change of ownership. These incorporate not only the obligatory requirements of the regulations, but standards of practice and equipment which are generally accepted as being desirable. Leaflets of advice to food handlers and notices reminding them of the necessity for the washing of hands are distributed as occasion requires. Printed display notices in the terms suggested by the Ministry of Food were supplied to all food establishments advising the public not to take dogs into shops where food is sold. An event of great significance during the year was the issue of the Report of the Catering Trade Working Party which was appointed by the Ministry of Food in 1948 to advise as to the precautions to secure cleanly conditions in the catering trade. This very comprehensive report at last sets up a minimum or a " standard" code and a desirable or "target" code for this industry. Whilst these recommendations have not yet been supported by legislation, the report has considerable educational value and does provide an authoritative standard against which the adequacy of existing arrangements can be measured. One aspect of food hygiene which merited particular attention was the cleansing of drinking glasses in public houses and licensed clubs. Towards the end of the year an approach was made to the landlords of 13 licensed houses and 10 licensed clubs inviting their co-operation to secure the use of cleansing and sterilising agents in the washing of beer glasses and similar utensils on the lines suggested by the Catering Trade Working Party Report. This was followed by personal visits by the Sanitary Inspectors when advice was tendered as to methods and materials. The matter was still being pursued at the end of the year and was attended by a large measure of success. Byelaws with regard to Handling and Sale of Food in the Open Air. Byelaws 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 were adopted by the Council in December, 1950. During the course of the past year all stalls and vehicles observed within the district were inspected from the point of view of the byelaws. Twentythree notices were served in respect of the undermentioned infringements and all have been complied with. Food storage in roadway 2 No name and address on stall or vehicle 16 Lack of cleanliness or contamination of food 5 40 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 these hospitals 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 Group. Acute Puerperal Pyrexia. Erysipelas. . Polioencephalitis. Malaria. Scarlatina or Typhus Fever. Acute Primary Pneumonia. Scarlet Fever. Typhoid Fever. Food Poisoning. Measles. Enteric Fever. Leprosy. Whooping Cough. Relapsing or Tuberculosis. Continued Fever. Smallpox. No cases of variola infection occurred. Vaccination. The arrangements for vaccination under the County Council's scheme are directed locally by the district Medical Officers of Health following agreements between 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 5s. per case is payable for notifying details of treatment. 41 The number of persons successfully treated and recorded under these arrangements during 1951 was as follows :— Age at 31st December, 1951 Under 1 yr. 1-4 yrs. 5-14 yrs. 15 yrs. & over Total Primary Vaccinations— By Private Practitioners 110 120 45 130 405 At Clinics 123 102 9 - 234 233 222 54 130 639 Revaccinations— By Private Practitioners 3 4 26 178 211 At Clinics - - 4 - 4 3 4 30 178 215 In addition the following unsuccessful attempts at vaccination were made :— Age at 31st December, 1951 Under 1 yr. 1-4 yrs. 5-14yrs. 15 yrs. & over Total Primary 5 7 1 1 14 Re-vaccination - 3 5 13 21 5 10 6 14 35 Enteric Fever. There were no cases of typhoid or paratyphoid fever. Dysentery. Sonne dysentery was especially prevalent in the first 5 months of the year. The infection began to assume epidemic proportions towards the end of January and continued until mid May. Out of a total of 264 cases, 58 were patients in Queen Mary's Hospital and a further 21 members of the staff of that institution. The remaining 185 were residents of the district. The disease was in the mild form commonly associated with this particular type of organism. A large proportion of the cases came to notice as the result of enquiries by the Department into the domestic and school contacts of cases which had been detected at a day nursery and it was found that many of these patients had not thought their diarrhoeic symptoms severe enough to seek medical advice. This conforms with previous experience. The disease is characterised by 2 or 3 days diarrhoea, sometimes less, and there is no doubt that owing to its relative mildness much of the infection escapes notice. This in turn makes it extremely difficult to exercise any effective control over the infection since it is very contagious and is easily spread, particularly through members of the same family, unless the strictest personal hygiene is practised. None of the cases was fatal. 42 Scarlet Fever. This endemic infection was less prevalent, the number of notified cases falling to 109 from 151 in the year before. Of the total, 100 were residents of the district. The incidence rates were accordingly : All cases 1.76 per thousand population. Residents 1.62 per thousand population. As for many years past, the illness was in a mild form and there were no deaths. Thirty-six, representing 33% of the total cases were nursed at home. TABLE 10. SCARLET FEVER—DISTRIBUTION OF CASES, 1951 1951 Ward St. Helier North St. Helier South St. Helier West NorthEast North West Central SouthEast SouthWest Total January 1 - 2 - - 1 2 - 6 February 2 1 4 — 1 1 1 2 12 March 1 3 - 4 1 - - - 9 April 1 1 - 2 2 - 2 - 8 May - 2 2 2 3 2 - 1 12 June 2 - 2 - - - - - 4 July - - 1 - - - 1 - 2 August - - 1 - - - - - 1 September 1 - - - - - - 1 2 October - 7 - 3 3 - 2 - 15 November 3 4 1 2 1 - - - 11 December 7 - 5 1 2 1 2 - 18 Totals 18 18 18 14 13 5 10 4 100 Monthly Mean 1.50 1.50 1.50 1.16 1.08 0.41 0.83 0.33 8.33 Case rate per 1,000 population 2.11 2.59 2.18 1.51 1.81 0.81 1.28 0.60 1.62 TABLE 11. SCARLET FEVER—MULTIPLE CASES, 1951. Ward No. of houses in which occurred Total Houses Total Cases 1 Case 2 Cases 3 Cases St. Helier North 14 2 - 16 18 St. Helier South 18 - - 18 18 St. Helier West 14 2 - 16 18 North-East 7 2 1 10 14 North-West 11 1 - 12 13 Central 5 - - 5 5 South-East 10 - - 10 10 South-West 4 - - 4 4 Whole District 83 7 1 91 100 43 Diphtheria. Although, as a result of immunisation, the incidence of diphtheria had been falling progressively since 1934, the year 1950 was the first in which there was complete freedom from this illness in the district. It is gratifying to be able to report that 1951 maintained this record. Provided immunisation can be sustained at a satisfactory level, there is no reason why diphtheria should again be a public health problem. The present freedom from this risk, however, carries with it its own danger since it is difficult to maintain public interest in a preventive measure in the absence of immediate threat. Although, immunisation apart, diphtheria, like many other infections, is capable of showing cycles of prevalence and virulence, there is no doubt that the intensive work of immunisation during the past decade has been the deciding factor in the present decline of diphtheria. It can be held in check only by a high level of immunisation and any falling off in public response will inevitably invite a return of this dangerous infection in significant prevalence. Diphtheria Immunisation. The scheme for diphtheria immunisation, which is the responsibility of the County Council, is by agreement directed by the Medical Office of Health of the District Council. The arrangements were as described in previous Reports, 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 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 1951, 738 residents were immunised as follows :•— Age at Year End Total Under 1 1 2 3 4 5-9 10-14 At Council Clinics 35 327 47 8 3 3 - 423 In Carshalton Schools - - - 1 5 53 12 71 Private Practitioners 12 172 46 10 8 7 5 260 47 499 93 19 16 63 17 754 Less outward transfers 3 5 1 1 - 9 1 20 Plus inward transfers - 1 - - - 3 - 4 Carshalton Residents 44 495 92 18 16 57 16 738 A further 882 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 854. 44 The immunisation state of the child population at the end of the year was as follows :— Age at 31.12.51, i.e., Born in Year Under 1 1951 1 1950 2 1949 3 1948 4 1947 5 to 9 1942/ 46 10 to 14 1937/ 41 Total under 15 Number Immunised 42 527 569 772 872 4257 4346 11385 Registrar General's Estimated mid-year population, 1951 4852 8789 13641 Percentage done 57% 97% 84% 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 1949 60 91 81 1 0.01 1950 63 98 85 0 0.00 1951 57 97 84 0 0.00 Erysipelas. Three cases were notified of infection of the face. Sulphonamides and the new anti-biotics have considerably shortened the attacks in this disease and robbed it of most of its severity. Pneumonia. Cases of primary and influenzal pneumonia notified totalled 54, of which 28 were stated to be influenzal. More than half occurred in the' first two months of the year. 45 Measles. The periodic epidemic wave of infection which started in November, 1950, continued to the end of April, 1951. Out of a total of 1,007 cases notified during the year, 917 occurred in the first 4 months. Forty seven of the total were patients in local hospitals, the remaining 960 being residents. There was one death in a baby of 18 months. TABLE 12. MEASLES—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1951. (Excluding hospital patients non-resident in Carshalton). 1951 Ward St. Helier North St. Helier South St. Helier West NorthEast NorthWest Central SouthEast SouthWest Total January 14 9 18 24 18 19 8 31 141 February 28 9 21 27 23 12 8 31 159 March 122 34 60 51 62 45 16 44 434 April 35 17 22 27 11 18 14 9 153 May 4 3 6 11 5 1 5 1 36 June 9 1 1 1 1 — — — 13 July 6 — — 1 1 1 — 2 11 August 4 — 1 1 - 1 — — 7 September 1 2 - - - - - - 3 October - 1 - - - - - - 1 November - - - - - - - - - December - — — 1 — 1 — — 2 Totals 223 76 129 144 121 98 51 118 960 Monthly Mean 18.58 6.33 10.75 12.00 10.08 8.16 4.5 9.83 80.00 Case rate per 1,000 population 26.20 10.95 15.63 15.56 16.85 16.06 6.53 17.87 15.55 Whooping Cough. The incidence of pertussis was again high, 471 cases, including 7 hospital patients, being notified. As in the case of measles, most of the prevalence was concentrated in the first quarter of the year, it being a continuation of the epidemic incidence which began late in 1950. There was no death. Now that diphtheria has been largely overcome, whooping cough plays the leading role among the common infectious diseases as the cause of child mortality and morbidity. Reference was made in the last annual report to the very encouraging results of controlled experiments, conducted under the auspices of the Medical Research Council, into the use of vaccines for prophylaxis against whooping cough. As the Chief Medical Officer of the Ministry of Health has observed— " Quite apart from mortality, this disease in its acute stages produces an amount of distress to the patient and parents which, added to the loss of sleep from the nocturnal frequency of paroxysms, constitutes a harrowing experience for patients and family alike. Mitigation of such suffering may be considered a worthy aim of vaccine prophylaxis." 46 Since the turn of the year, the County Council, with commendable promptitude, have sought and obtained sanction to extend their scheme of immunisation under Section 26 of the National Health Service Act to include arrangements for preventive immunisation against whooping cough. TABLE 13. WHOOPING COUGH—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1951. (Excluding hospital patients non-resident in Carshalton). 1951 Ward St. Helier North St. Helier South St. Helier West NorthEast North- West Central SouthEast SouthWest Total January 38 7 13 42 12 17 5 8 142 February 14 16 15 31 20 7 4 2 109 March 2 13 18 15 24 7 3 1 83 April 5 8 7 9 4 2 — 1 36 May 3 — 3 4 1 1 3 2 17 June 6 1 3 2 1 1 2 1 17 July 5 1 3 4 — 1 2 — 16 August 4 2 5 1 — — — — 12 September 1 1 1 - - - - - 3 October — — — — 2 — — - 2 November 2 2 1 1 2 4 - 5 17 December 1 1 6 1 — 1 — — 10 Totals 81 52 75 110 66 41 19 20 464 Monthly Mean 6.75 4.33 6.25 9.16 5.50 3.41 1.58 1.66 38.66 Case rate per 1,000 population 9.51 7.49 9.09 11.88 9.19 6.72 2.43 3.03 7.51 Meningococcal Infection. Cerebro-spinal fever has never assumed epidemic proportions in the district. Odd cases have occurred from year to year but none was notified in 1951. Poliomyelitis. Three cases of "infantile paralysis" were notified. These compare with 4 in 1950, 3 in 1949, 3 in 1948 and 15 in the peak year of 1947. In two of the three cases, a young adult of 17 and a girl of 11, the infection was not accompanied by any paralysis and recovery was uneventful. The third, a girl of 3 years was afflicted with extensive paralysis affecting considerable parts of all four limbs. She is still receiving in-patient hospital treatment. Ophthalmia Neonatorum. For yet another year, the sixth in succession, no case of this infection of the eyes in the new-born was notified. 47 Puerperal Pyrexia. The definition of puerperal pyrexia was amended by the Puerperal Pyrexia Regulations, 1951, to cover a rise of temperature of two degrees of any duration within 14 days of childbirth or miscarriage. The effect of this has been to increase substantially the number of notifications by the inclusion of many cases with transient fever which were not previously notifiable. As was to be expected therefore, the number of such nocifications in 1951 increased, rising to 81 from 41 for the year before. All but 3 were notified from St. Helier Hospital. Forty five were first confinements and 19 were residents of Carshalton. Food Poisoning. Seven cases of food poisoning were notified, all single isolated cases bearing no relation to one another as far as could be ascertained, either in point of time or origin. In 6 the responsible infecting organism was identified.—5 salmonella typhimurium and 1 salmonella enteritidis. The vehicle of infection was not definitely determined in any instance but there was reason to believe that the following commodities were responsible in 5 of the cases:— S. typhimurium—chicken salad, roast beef, iced lolly, colonial egg. S. enteritidis—luncheon meat. All patients recovered. 48 49 TABLE 14. Cases of Notifiable Infectious Disease Admitted to Hospitals, 1951. Disease Cuddington War Memorial Bletchingley Western Wandle Valley The Grove South Middlesex Queen Mary's Tolworth St. Helier South Western Ottershaw Totals Scarlet Fever 18 - 2 2 33 14 - - 1 - 4 - 74 Poliomyelitis Paralytic - - - - - - - - - - - - 1 Poliomyelitis Non-Paralytic - - - - - - - 1 - 1 - - 2 Erysipelas - - - - - - - - - 1 - - 1 Whooping Cough 1 - - - 1 - - 4 1 1 - - 8 Measles 4 - - - 6 8 2 3 1 - - - 24 Dysentery 2 - - - - - - - 1 1 - 1 5 Chicken-pox 2 - - - - 2 - - - - - - 4 Mumps 1 - - - 3 - - - - - - - 4 Pneumonia — 1 - - - - - - - - - - 1 Food Poisoning - - - - - - - - - 3 - - 3 Tonsilitis 2 — — — 1 2 — - - - - - 5 Others 4 - - 1 2 4 - - 2 - - 13 Totals 34 1 2 4 46 30 2 8 6 7 4 1 145 50 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 100 1.62 — 18 18 18 14 13 5 10 4 64 64 Dysentery 206 3.33 — 28 82 27 22 18 — 24 5 3 1.44 Measles 960 15.5 1 223 76 129 144 121 98 51 118 10 1.04 Whooping Cough 464 7.51 — 81 52 75 110 66 41 19 20 8 1.72 Poliomyelitis, Paralytic 1 0.01 - - - - - - - 1 — 1 100 Poliomyelitis, Non-Paralytic 2 0.03 - - - - - - 1 1 — 2 100 Food Poisoning 7 0.11 1 1 2 1 1 1 — — 3 42 Erysipelas 3 0.04 - - - - - - 1 2 — 1 33 Pneumonia 54 0.87 - 6 6 5 8 3 6 12 8 1 1.85 Puerperal Pyrexia 24 0.38 - 3 — 9 5 3 1 1 2 21 87 51 TABLE 16. INFECTIOUS DISEASES. Notification by Age Groups, 1951. (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 — — 6 18 13 52 3 4 4 100 Measles 13 91 118 135 195 355 35 9 9 — — — 960 Whooping Cough 33 47 60 83 75 141 10 3 7 3 1 1 464 Dysentery 1 11 11 19 17 66 23 20 24 9 4 2 206 Poliomyelitis, Paralytic — — — 1 — — — — — — — — 1 Poliomyelitis, Non-Paralytic — — - — — — 1 1 — — — — 2 Food Poisoning — — 2 1 — 1 — 1 1 1 — — 7 Erysipelas — — — — — — — — 1 1 1 — 3 Pneumonia 1 1 — 1 — 3 — 1 9 5 19 14 54 Puerperal Pyrexia — — — — — — — — 23 1 — — 24 52 TABLE 17. MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1951. (Excluding hospital patients non-resident in Carshalton). Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 6 12 9 8 12 4 2 1 2 15 11 18 100 Dysentery 2 33 121 29 11 7 3 — — — — — 206 Measles 141 159 434 153 36 13 11 7 3 1 — 2 960 Whooping Cough 142 109 83 36 17 17 16 12 3 2 17 10 464 Poliomyelitis, Paralytic — — — — — — — — 1 — — — 1 Poliomyelitis, Non-Paralytic 1 — — — — — — - 1 - - - 2 Food Poisoning - — — 1 — — 1 1 2 — 2 — 7 Erysipelas — — — 2 — — — I — — _ — 3 Pneumonia 11 20 7 2 1 2 5 - 3 2 1 — 54 Puerperal Pyrexia 2 — 1 — 2 — — 2 3 6 4 4 24 Tuberculosis Pulmonary 5 12 5 4 2 5 2 4 4 4 6 3 56 Tuberculosis Non-Pulmonary 1 — — — 2 - — — 1 — — 1 5 Tuberculosis. \ The new cases admitted to the tuberculosis register during the year numbered 106, classified as follows :— Males. Females. Pulmonary 48 Pulmonary 50 Non-pulmonary 3 Non-pulmonary 5 Of the total additions, 61 were primary notifications, 42 were transferred from other districts, and three came to notice in other ways. For the same period, 139 names were "removed from the register for the following reasons :— Recovered 25 Death 26 Otherwise "(including removals) 88 After allowing for the additions and deductions, the state of the register at the 31st December, 1951, was as shown in the following table :— TUBERCULOSIS—WARD DISTRIBUTION. Cases on Register at 31st December, 1951. Ward Pulmonary Non-Pulmonary Total Incidence per 1,000 population Males Females Males Females St. Helier North 69 74 12 13 168 19.7 St. Helier South 60 60 14 10 144 20.7 St. Helier West 62 51 8 8 129 15.6 North-East 55 60 10 6 131 14.1 North-West 35 34 1 2 72 10.0 Central 28 20 6 1 55 9.0 South-East 30 28 4 4 66 8.4 South-West 23 17 3 4 47 7.1 Totals 362 344 58 48 812 131 706 106 The total of 812 is 33 less 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 39 At other tuberculosis institutions 155 194 53 The number of tuberculous persons who died during the year was 26, distributed by age groups as follows :— Age Years Pulmonary Non-Pulmonary Males Females Males Females Total 0 - - - - - 1—5 — — — — - 5—15 — - — — — 15—25 — 2 1 — 3 25—35 3 5 - 8 35—45 1 3 1 — 5 45—55 4 1 - — 5 55—65 2 — - — 2 65—75 3 — - - 3 Totals 13 11 2 - 26 The deaths attributable to tuberculosis were 21, as follows :— DEATHS DUE TO TUBERCULOSIS, 1951. Ward Pulmonary Non-Pulmonary Death Rate per 1,000 population Mean age at Death Male Female Male Female St. Helier North 2 - - - 0.23 43 St. Helier South — 2 1 — 0.43 37 St. Helier West 1 1 — — 0.24 44 North-East 2 3 — — 0.54 38 North-West 1 1 — — 0.27 40 Central 2 1 - 0.49 53 South-East 1 2 1 — 0.51 35 South-West — - — — — — Totals 9 10 2 0-33 40 Three 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 19 of such families were rehoused out of a total of 118 Council tenancies allotted during 1951. 54 55 TABLE 18. TUBERCULOSIS. New Cases, Age and Sex Distribution and Manner Of Admission To Register, 1951. 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 N on-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 1 - 1 - - - - - - - - - 2 10—15 - - 1 - - - - - - - - - 1 15—20 5 4 - - 2 2 - - - - - - 13 20—25 8 11 - - 3 8 - - - - 1 - 31 25—35 2 3 - 2 5 12 - 2 - - - - 26 35—45 2 8 - - 2 - - - - - - - 12 45—55 5 1 - - 4 - - - - - - - 10 55—65 3 1 - - 1 - - - - - - - 5 65 up - - - 1 - - - - 2 — — — 3 Totals 28 28 2 3 18 22 — 2 2 - 1 - 106 y 61 42 3 INDEX PAGE Acreage 6 Bed Bug—Eradication of Births— Distribution Institutional 10 Rates 9, 10, 11 Byelaws Cancer 14 Cemeteries Clinics and Treatment Centres 19, 20 Closet Accommodation Deaths— Classification 18 Distribution Rate 11,13 Diphtheria Immunisation Dysentery Disinfection Disposal of Dead Drainage and Sewerage Employment Agencies Enteric Fever Erysipelas Establishments for Massage, etc. Factories Food— Poisioning Inspection and Supervision 35,38,39 Food and Drugs Act Hygiene 40 Health Services Hospital Housing— Council's Scheme Inhabited Houses Inspection Overcrowding Ward Distribution Ice Cream Industry 33 Infant Mortality 16, 17 Infectious Diseases 41, 49, 50, 51 Inquests Isolation Hospital 56 PAGE Admissions to 49 Laboratory Facilities 19 Maternal Mortality 16 Measles 46 Meningococcal Infection 47 Milk Supply 35 Milk (Special Designations) Order 38 Mortuary 29 Natural and Social Conditions 6 National Assistance Act 29 Offices 28 Ophthalmia Neonatorum 47 Pneumonia 45 Poliomyelitis 47 Population 8 Public Cleansing 23 Puerperal Pyrexia 48 Rateable Value 6 Rats and Mice Destruction 28 Rent and Mortgage Interest Restrictions (Amendment) Act, 1933 32 Rivers and Streams 23 Sanitary Circumstances 21 Sanitary Inspection 24 Scarlet Fever 43 Shops Acts 29 Slum Clearance and Demolition 32 Smallpox 41 Smoke Abatement 28 Staff 5 Statistics- Comparative 12, 13 Vital 7 Swimming Baths 28 Tuberculosis 15 Unemployment 8 Vaccination 19, 41 Vermin Control 27 Water Supply 21 Whooping Cough 46 Zymotic Diseases— Deaths from 7 57