CAR17 ACC13(3) ARSHATON Carshalton Urban District Annual Report OF THE Medical Officer of Health FOR THE YEAR 1952 CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1952 * PREFACE To the Chairman and Members of the Carshaeton 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 1952. It has been my fortunate experience over the past twenty years to be able to put before you records of the public health which, although showing inevitable fluctuations, have indicated steady progress. The report for 1952 is again in keeping with that trend. Following the post-war peak in 1946 the birth rate fell steadily for the next five years until last year when it made the first recovery, rising to 12.7 per thousand population as compared with 12.3 in the year before. This is 2.6 per thousand less than the rate for the country as a whole. The death rate is again a low one, due in some measure to the fact that the district has a comparatively young population. However, when allowance is made for this consideration which it is, mathematically, by the Registrar General, the "comparable" death rate of the district is still significantly less than that for England and Wales. The infant death rate shows a slight improvement on the year before and is very near the national rate. Once again there was no death attributable to childbirth. If one excludes the single fatality due to abortion, which was the subject of an inconclusive verdict at a Coroner's Inquest, there has been no maternal death for a period of eight years. Tuberculosis claimed many less victims than in the year before and the mortality rate from this disease fell nearly to the record low figure of 1950. There was, too, a further fall in the death rate from cancer, the rate for this disease being the lowest for six years. Malignant disease of the lungs was again responsible for a substantial proportion of the cancer deaths, 15% of the total. The increased risks to road users are reflected in the deaths due to traffic accidents which, at six, was the highest since 1940. The year was a very favourable one from the point of view of infectious diseases. Considerable progress has been made in recent years, by means of immunisation and the newly discovered antibiotics such as penicillin and the sulpha drugs, in the prevention and treatment of the common infections which we have known in the past, such as diphtheria, meningitis, whooping cough, tuberculosis, pneumonia, to mention but a few. These diseases, in the main, are caused by the larger forms of organisms which are readily identifiable under the microscope. 3 The new antibiotics and chemical agents have, however, very much less effect-in some cases none at all—on the ultra microscopic organisms known to us as viruses and science has so far had little success in producing immunising vaccines against these viruses. It would seem that the emphasis in the prevalence of infectious disease is, as a result, gradually shifting to the virus varieties. There is every indication that our infectious disease problems of the future will be more and more concerned with the virus infections of which poliomyelitis and influenza are striking examples. As indicated in recent reports, increasing attention is being paid to the prevention of food-borne illness and it is becoming generally recognised that the solution to this problem lies mainly in raising the standard of food hygiene. The risks of widespread illness inherent in mass catering are underlined again by two significant outbreaks of food poisoning in two of our local hospitals during the year. Legislation to implement the recommendations of the Catering Trade Working Party would be a considerable advance in this direction. The year 1952 was significant for the fact that after a lapse of twelve years the labour and supply of materials position made it possible to resume the work of removing unfit dwellings. Whilst, by comparison with many areas, this is not a great problem in Carshalton, adequate housing accommodation is one of the fundamental necessities of health to be reckoned among the priorities. In once again acknowledging the willing and loyal support given to me by all members of the department, I would like to pay a brief but sincere t???ibute to the late Mr. L. G. Lydiatt who served the Council r.s a Sanitary Inspector for fifteen years and who died in harness on New Year's Day, 1953. He was an able and conscientious officer and a highly esteemed colleague who gave ungrudgingly of his time and energies not only for the good of the community, but in the interests of his fellow workers. He exemplified all that is best in Local Government Service. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, F. LAWRENCE SMITH, Medical Officer of Health. August, 1953. 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. *G. R. Surfleet, C.R.S.I. Public Health Nurse: Mrs. D. E. Baldock, S.R.N. Chief Clerk: Miss V. St. P. Hotten †Also Divisional Medical Officer, Surrey County Council. *Meat and Food Certificate of the Royal Sanitary Institute. 5 Section A—Natural and Social Conditions of the District. Area (in acres) 3,346 Number of inhabited houses (end of 1952) according to Rate Books 16,913 Rateable Value at 31st December, 1952 £516,771 Sum represented by 1d. rate £2,111 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. An adequate rainfall prevented the complete failure of these springs during the year and the district was spared the unfortunate experience of some recent years when the ornamental ponds, which are a feature of considerable amenity to the centre of the district, were converted into stagnant mud patches with their consequent risk to public health. 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. The few remaining small areas of available building land are rapidly being developed and the scope for relieving overcrowding by building within the district is now almost exhausted. A large part of the housing accommodation is occupied by workers in the lower income groups, 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 among the lowest in Surrey. 6 SUMMARY OF VITAL STATISTICS FOR 1952. (Based on the Registrar-General's Figures.) Population. Registrar-General's Estimate 61,630 Births. Males. Females. Total. Live (Legitimate) 385 370 755 (Illegitimate) 15 13 28 400 383 783 Birth Rate (per 1,000 population) 12.7 Stillbirths (Legitimate) 9 8 17 (Illegitimate) 1 — 1 10 8 18 Stillbirth Rate per 1,000 total births 22.4 Deaths 296 254 550 Death Rate (crude) per 1,000 population 8.9 Infant Mortality. All deaths under 1 year 11 11 22 Infant Mortality Rate (per 1,000 live births) 28.0 Deaths of leg. infts. under 1 year 11 11 22 Rate per 1,000 legitimate births 29.1 Deaths of illeg. infts. under 1 year — — — Rateper 1,000 illegitimate births — 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 1 — 1 Deaths from Measles — — — Deaths from Whooping Cough — — . — Deaths from Diarrhoea (under 2 years) 1 — 1 Zymotic Death Rate 0.01 Deaths from Tuberculosis. All Forms 11 4 15 Rate per 1,000 of population 0.24 Phthisis 9 4 13 Rate per 1,000 of population 0.21 Deaths from Cancer 37 37 74 Rate per 1,000 of population 1.20 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 at the end of 1952 are supplied through the courtesy of the Exchange Manager: Men 186 Women 94 Boys 9 Girls 4 POPULATION The Registrar-General's estimate of the home population at midyear is 61,630. This is 100 less than a year ago. At the census in April, 1951, the population was 62,804. Between the census and mid-1952 the natural increase was 290. The Registrar-General's estimate, therefore, assumes that within this fifteen month period outward migration exceeded inward migration by 1,464. Accepting the Registrar-General's figure, the following table gives the estimated distribution of the population based on knowledge of local conditions. TABLE 1. ESTIMATED RESIDENT POPULATION, MID-1952, BY WARDS. Ward. Houses at Mid-1952. Estimated population Mid-1952. St. Helier North 2,164 8,450 St. Helier South 1,698 6,890 St. Helier West 2,022 8,190 North-East 2,754 9,430 North-West 2,150 7,150 Central 1,730 6,080 South-East 2,246 7,770 (Queen Mary's Hospital) 1,100 South-West 2,041 6,570 Whole District 16,805 61,630 8 BIRTHS The number of live births registered during 1952 was 783, which is 25 more than in the year before. Of these, 400 were males and 383 females, giving a birth rate of 12.7 per thousand population. The "comparable" birth rate produced by the application of the Registrar-General's comparability factor of 0.94 to allow for the disparity in the age and sex constitution of the local population and that of the country as a whole is 11.9 per thousand population, which compares with 15.3 for England and Wales. Information is not available as to the home address of births registered to Carshalton residents occurring outside the district. 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 within the district. From these sources it is known that 814 births and 16 stillbirths occurred in 1952. They were distributed as shown in the following table. Ward. Live Births. Birth Rate per 1,000 Population. Stillbirths. Stillbirth per 1,000 total births. St. Helier North 123 14.5 4 32.5 St. Helier South 79 11.4 1 12.6 St. Helier West 136 16.6 3 22.0 North-East 151 16.7 4 25.3 North-West 79 110 — — Central 76 12.5 1 13.1 South-East (excluding Queen Mary's Hospital) 98 12.6 3 30.6 South-West 65 9.8 — — Seventy-five 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 68 St. Helier South 81 St. Helier West 77 North-East 71 North-West 80 Central 75 South-East 70 South-West 84 9 Out of 830 total births, 627 took place in the following hospitals and nursing homes: Live. Still. Total. Carshalton, Beddington and Wallington District (War Memorial) Hospital 80 3 83 St. Helier Hospital 441 11 452 Other Surrey Hospitals 74 1 75 Other Hospitals 11 — 11 Private Nursing Homes 6 — 6 Totals 612 16 627 Mention has been made in previous reports of the growing tendency to institutional confinement. Three-quarters of all Carshalton babies are now born in hospitals and nursing homes and this is common experience. The pros and cons of institutional as against domiciliary confinement are, in normal times, a matter of opinion, but there can surely be no justification for the allocation of such a high proportion of hospital accommodation to maternity when there is an acknowledged shortage of beds for medical and surgical purposes. The needs of the obstetrically abnormal or potentially abnormal are recognised, but no one could maintain that the standard of home conditions and its suitability for domestic midwifery has deteriorated 100 per cent. in the last ten years, which is what the present practice implies. Moreover, the Home Help Service established under the National Health Service Act now provides even better assistance during childbirth where home care is inadequate. Undoubtedly one of the principal factors in this demand for hospital accommodation has been the fact that under the existing scale of allowances it is cheaper to have a baby in hospital than at home. 10 TABLE 2. BIRTHS. 1952. DOMICILIARY AND OTHERS — BY WARDS. Ward. Born in District. Born Outside District. In Hospitals and Nursing Homes. In Private Houses. Total. In Hospitals and Nursing Homes. In Private Houses. Total. Grand Total. St. Helier North 80(4) 40 120(4) 7 — 7 127(4) St. Helier South 66(1) 10 16(1) 4 — 4 80(1) St. Helier West 106(3) 31 137 (3) 2 — 2 139(3) North-East 105(3) 47 152 (3) 10(1) — 10(1) 162(4) North-West 40 16 56 23 — 23 79 Central 45 (1) 19 64(1) 13 — 13 77(1) South-East 54(2) 29(1) 83(3) 17 1 18 101(3) South-West 39 10 49 16 — 16 65 Totals 535 (14) 202(1) 737(15) 92(1) 1 93(1) 830(16) (Figures in brackets indicate stillbirths included in totals.) TABLE 3. BIRTH AND DEATH RATES FOR CARSHALTON, 1922-1952. 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 13.9 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 1952 61.630 12.7 8.9 28.0 0.0 11 TABLE 4. COMPARATIVE STATISTICS—1952 England and Wales. 160 County Boroughs and Great Towns (including London.) 160 smaller Towns (Resident Populations 25,000 to 50,000 at 1951 Census). London Administrative County. Carshalton. * Rates Per 1,000 Home Population. Births— Live 15.3 16.9 15.5 17.6 12.7 Still 0.35 0.43 0.33 0.34 0.29 22.6(a) 24.6(a) 23.0(a) 19.2(a) 22.4(a) Deaths— All causes 11.3 12.1 11.2 12.6 8.9 Typhoid and Paratyphoid 0.00 0.00 0.00 - - Whooping Cough 0.00 0.00 0.00 0.00 - Diphtheria 0.00 0.00 0.00 0.00 - Tuberculosis 0.24 0.28 0.22 0.31 0.24 Influenza 0.04 0.04 0.04 0.05 0.04 Smallpox 0.00 — — — — Acute Poliomyelitis and Polioencephalitis 0.01 0.01 0.00 0.01 - Pneumonia 0.47 0.52 0.43 0.58 0.47 Notifications (Corrected)— Typhoid fever 0.00 0.00 0.00 0.00 — Paratyphoid fever 0.02 0.02 0.03 0.01 — Meningococcal Infection 0.03 0.03 0.03 0.02 - Scarlet fever 1.53 1.75 1.58 1.56 2.07 Whooping Cough 2.61 2.74 2.57 1.66 1.59 Diphtheria 0.01 0.01 0.03 0.01 — Erysipelas 0.14 0.15 0.12 0.14 0.16 Smallpox 0.00 0.00 0.00 — — Measles 8.86 10.11 8.49 9.23 9.02 Pneumonia 0.72 0.80 0.62 0.57 0.48 Acute Poliomyelitis (including polioencephalitis Paralytic 0.06 0.06 0.06 0.06 0.17 Non-paralytic 0.03 0.03 0.02 0.03 0.04 Food poisoning 0.13 0.16 0.11 0.18 0.60 Rates per 1,000 Live Births. Deaths— All causes under 1 year of age 27.6(b) 31.2 25.8 23.8 28.0 Enteritis & Diarrhoea under 2 years of age 1.1 1.3 0.5 0.7 0.01 Rates per 1,000 Total Births (Live and Still). Notifications (Corrected)— Puerperal Fever and Pyrexia 17.87 23.94 10.22 30.77 245.94 Maternal Mortality— Abortion with Sepsis 0.07 — Other Abortion 0.06 — Sepsis of pregnancy, childbirth and the puerperium 0.9 — Other complications of pregnancy childbirth and the puerperium 0.50 — (a) Per 1,000 total (Live and still) Births (b) Per 1,000 relate live births. 12 COMPARATIVE HEALTH STATISTICS, 1934/52. 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 1951 12.5 8.7 29.6 29.0 0.65 0 1952 11.3 8.9 27.6 28.0 0.59 0 DEATHS The deaths allocated to the district, as adjusted by inward and outward transferable deaths, was 550—296 males and 254 females. This gives a crude death rate of 8.9 per thousand population as against 8.7 in the year before. The "comparable" death rate produced by the application of the Registra.-General's comparability factor of 1.25 to allow for differences in the age and sex constitution of the local population as compared with the country as a whole was 10.1. The rate for England and Wales was 11.3. The distribution of the deaths by wards was as follows: WARD DEATH RATES AND MEAN AGE AT DEATH, 1952. Ward. Deaths. Death Rate (crude). Mean Age at death. St. Helier North 50 5.9 53.0 yrs. St. Helier South 46 6.6 60.0 „ St. Helier West 56 6.8 59.6 „ North-East 86 9.1 60.8 „ North-West 81 11.3 68.3 „ Central 84 13.8 73.2 „ South-East (excluding Queen Mary's Hospital) 69 8.8 72.3 „ South-West 77 11.7 69.1 „ Whole District 549 8.9 65.5 yrs. 13 There was a welcome recession in the mortality from cancer. Fifteen fewer deaths at 74 were registered from this cause, giving a rate of 1.20 per thousand population, which is the lowest for six years. CANCER DEATHS—WARD DISTRIBUTION, 1952. Ward. Cancer Deaths. Rate per 1,000 Estimated Population. St. Helier North 8 0.94 St. Helier South 6 0.87 St. Helier West 5 0.61 North-East 17 1.80 North-West 8 1.11 Central 12 1.97 South-East 8 1.02 South-West 10 1.52 The classification of the cancer deaths by sites affected is given in Table 5. TABLE 5. Group. Site Affected. Male. Female. Total. Digestive Organs— 141 Tongue — 1 1 150 Oesophagus 1 — 1 151 Stomach 5 2 7 153 Colon 4 7 11 154 Rectum 3 1 4 155 Liver and gall bladder 1 — 1 157 Pancreas 2 3 5 Respiratory System— 162 Lungs and Bronchus 10 1 11 Breast and Genito-Urinary— 170 Breast — 12 12 171/4 Uterus — 3 3 175 Ovary — 2 2 176 Vagina — 1 1 177 Prostate 6 — 6 181 Bladder 2 — 2 Other Sites— 191 Skin 1 — 1 194 Thyroid — 1 1 195 Glands 2 — 2 196 Bone — 1 1 199 Ear — 1 1 Middle Ear 1 — 1 33 36 74 Average age at death: Males 64.2 years Females 61.9 years All persons 63.1 years 14 Tuberculosis was responsible for 15 deaths, compared with 21 in 1951. As a result the death rate for this disease fell to 0.24 per thousand population. The death rates from tuberculosis for the last 20 years wereas follows: Year. Death Rate per 1,000 Population. Year. Death Rate per 1,000 Population. 1933 0.10 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 1941 0.71 1951 0.34 1942 0.46 1952 0.24 The distribution of tuberculosis mortality by wards and other details are given in Section F of this report. There were no deaths due to the common notifiable infectious diseases. Deaths of residents attributable to violent causes totalled 20. They occurred in the following ways: Suicide 9 Motor Vehicle Accidents 6 Accidental Coal Gas Poisoning 1 Accidents in the Home 4 Inquests Inquests were held on 45 persons who died in the district. The following verdicts were returned: Accidental Death 23 Suicide 12 Misadventure 8 Natural cause 2 Twenty-two of the total were residents of the district. Five were due to road accidents. 15 INFANT MORTALITY The deaths of 22 children who died under the age of one year were registered, of which 11 were males and 11 females. These provide an infant mortality rate of 28.0 per thousand live births compared with 29.0 in the year before. The comparable rate for England and Wales was 27.6. All were deaths of legitimate children. Thirteen of the 22 deaths occurred in the first month of life. Congenital malformations, prematurity and diseases peculiar to infancy accounted for 13 and infections for 9. 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 32.5 St. Helier South 1 12.6 St. Helier West 2 14.7 North-East 7 44.3 North-West 2 25.3 Central 1 13.1 South-East 2 20.4 South-West 3 46.1 MATERNAL MORTALITY There were no maternal deaths. 16 TABLE 7. INFANT MORTALITY DURING THE YEAR 1952. 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 C months. 6 months and under 9 months. 9 months and under 12 months. Total deaths under 1 year. Prematurity 1 - - - 1 - - - - 1 Congenital Malformation 3 — - — 3 1 2 — — 6 Atelectasis 5 — - — 5 — — — — 5 Bronchitis — — - — — 1 — — — 1 Pneumonia 2 1 — — 3 2 — 3 — 8 Encephalitis of Newborn 1 — — — 1 — - - - 1 Totals 12 1 — — 13 4 2 3 — 22 17 13 Table 8.-causes of death during the year 1952. 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 11 11 4 1 2 1 3 3 3 4 13 3 38 22 54 20 64 52 102 128 294 255 254 1 Tuberculosis, Respiratory — — — — — — — — 2 2 2 — — 1 2 — 2 1 1 — 9 4 13 2 Tuberculosis, other — — — — — — 1 — — — 1 — — — — — — — — — 2 — 2 3 Syphilitic disease — — — — — — — — — — — i 1 2 — — — — — 3 1 4 4 Diphtheria — — — — — — — — — — — — — — — — — — — — — — — 5 Whooping Cough — — — — — — — — — — — — — — — — — — — — — — — 6 Meningococcal Infections — — — — — — — — — — — — — — — — — — — — — — — 7 Acute Poliomyelitis — — — — — — — — — 1 — — — — — — — — — — — 1 1 8 Measles — — — — — — — — — — — — — — — — — — — — — — — 9 Other Infective and Parasitic Diseases — 1 — — — — — — — — — — 1 — — — — — — — 1 1 2 10 Malignant Neoplasm, Stomach — — — — — — — — — — — — 1 1 1 — 2 1 1 — 5 2 7 11 Malignant Neoplasm, Lung — — — — — — — — — — — — 5 — 5 1 — — — — 10 1 11 12 Malignant Neoplasm, Breast — — — — — — — — — — — — — 3 — 3 — 5 — 1 — 12 12 13 Malignant Neoplasm, Uterus — — — — — — — — — — — — — — — — — 2 — 1 — 3 3 14 Other Malignant and Lymphatic Neoplasms — — — — — 1 — — — — 2 1 4 2 — 5 9 4 8 5 23 18 41 15 Leukaemia, Aleukaemia — — 2 — — — — — — — 1 — — — — 2 — — — 5 — 5 16 Diabetes — — — — — — — — — — — — — — 1 — — — 1 1 2 1 3 17 Vascular Lesions of Nervous System — — — — — — — — — — — — 2 4 5 3 7 12 10 25 24 44 68 18 Coronary Disease, Angina — — — — — — — — — — — — 8 1 17 2 13 6 15 8 53 17 70 19 Hvpertension with Heart Disease — — — — — — — — — — — — — — — — — 1 — 1 — 2 2 20 Other Heart Disease — — — — — — — — 1 — 1 1 — 3 5 4 7 9 23 43 37 60 97 21 Other Circulatory Disease — — — — — — — — — — — 1 1 1 4 1 1 4 9 5 15 12 27 22 Influenza — — — — — — — — — — — — — — — — 1 — 1 1 1 2 3 23 Pneumonia 4 3 — — — — — — — 1 — — 1 1 — 1 2 1 4 10 11 17 28 24 Bronchitis 1 — 1 — — — — — — — 1 — 6 1 5 1 7 1 8 11 29 14 43 25 Other Diseases of Respiratory System — — 1 — — — — — — — — — — — — — — — 2 1 3 1 4 26 Ulcer of Stomach and Duodenum — — — — — — — — — — — — — — 2 — — — 1 1 3 1 4 27 Gastritis, Enteritis and Diarrhoea 1 — — — — — — 1 — — — — 1 — — 1 1 — 2 2 5 4 9 28 Nephritis and Nephrosis — — — — — — 1 — — — — — — 2 1 — — 3 1 5 3 8 29 Hyperplasia of Prostate — — — — — — — — — — — — — — 1 — 1 — 5 — 7 — 7 30 Pregnancy, Childbirth, Abortion — — — — — — — — — — — — — — — — — — — — — — — 31 Congenital Malformations 3 3 — — 1 — 1 — — — — — 1 — — — — — — — 6 3 9 32 Other Defined and Illdefined Diseases 2 4 — 1 — — 1 1 — — 2 — 3 2 — 3 9 4 4 10 21 25 46 33 Motor Vehicle Accidcnts — — — — 1 — — — — — 1 — 1 — — 1 — — 2 — 5 1 6 34 All other Accidents — — — — — — — — — — — — — 1 — 1 — — 1 2 1 4 5 35 Suicide — — — — — — — — — — 2 — 2 2 1 i — 1 — 8 1 9 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 17 Faeces Specimens 246 Sputum for Tuberculosis 1 Skin Swabs 1 Water (Public Supply): For chemical analysis 3 For bacteriological examination 5 Food and Drugs: Analysis 318 Bacteriological examination of milk 226 Bacteriological examination of ice cream 94 Bacteriological examination of other foods for food poisoning organisms 17 Biological examination of milk 12 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. During the year the County Council's scheme was extended to provide for immunisation against whooping cough. Details of the operation of the scheme are given in Section F of this report, dealing with infectious diseases. 19 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. 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 Mondays 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., Fridays 10—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 Tuesdays 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 10.30—11.30 a.m. Toddler Clinic 1st and 3rd Thursday 2—4 p.m. St. Helier Centre—Green Bane: Infant Welfare Clinic Mondays 2—4 p.m. Maternity Clinic Mondays 10—12 a.m. The Mount Centre: Infant Welfare Clinic Wednesdays 2—3.30 p.m. Maternity Clinic Tuesdays 2—3 p.m. Toddler Clinic 2nd Thursday 2—4 p.m. School Health Service—General Medical Clinics. Rochester Road Centre Mons. and Fridays 9.30—12 a.m. Wednesdays 2—4 p.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 schoolchildren at school clinics. Tuberculosis Clinics. St. Helier Hospital Mons. and Fridays 2 p.m. Wednesdays 9.30 a.m. 3rd and 4th Mondays (for old cases only) 5.30 p.m. Venereal Disease Clinics. St. Helier Hospital Mondays (Males) 5—7 p.m. Wednesdays (Females) 5—7 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 t)° 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 wich Coli Aerogenes Organisms were present in 100 ml. o sample. No. % No. % Sutton Raw 306 44 21 6.8 31 12.0 52 Sutton Finished 334 24 17 5.1 5 1.5 22 Woodmansterne Raw 307 31 Nil Nil Nil Nil Nil Woodmansterne Finished 313 20 12 3.5 3 0.9 15 Cheam 312 47 5 1.0 7 2.3 12 Reservoir 221 Nil Nil Nil Nil Nil Nil District (excluding new Main) 273 Nil 6 2.2 3 1.1 9 New Mains 46 Nil 19 41 Nil Nil 19 TOTAL 2,142 166 21 Water as delivered to the consumer is examined monthly by the Counties Public Health Laboratory on behalf of the Company and a further 12 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 22.0 Nitric nitrogen 12.0 Nitrous nitrogen none Ammonia, free and saline 0.010 Ammonia, albuminoid 0.039 Oxygen absorbed from permanganate in 4 hours at 26.7° C. 0.15 Hardness—by acidimetric titration—Temporary 51 Permanent 69 Total 120 Reaction for free chlorine negative pH 7.5 Iron 0.02 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 has the same general characteristics as previous samples taken from this source. It is of satisfactory organic purity and moderate hardness, and the reaction (pH) is well within the 'neutral' range. There was no residual chlorine at the time of receipt. Although the water itself was bright and clear, slightly bluish in colour and of attractive appearance, there was present a small quantity of rapidly settling insoluble scaly matter, both brown and grey in colour. This scaly matter contained, besides oxide of iron, numerous bacteria of apparently harmless saprophytic types such as accumulate in the scale of pipes from time to to time, and have no adverse significance. The bacteriological condition of the sample taken for bacteriological examination was excellent and none of the scale observed in the chemical sample was detected. The small amount of scale deposit is regarded as being the result of a chance occurrence which might occur at any time, and as judged by these samples the water is pure and wholesome and suitable for the public supply. The average hardness of the samples taken by all the local authorities' Public Health Departments was 8.75°. Three slightly exceeded the statutory limit of 9° and 12 were below. Drainage and Sewerage Construction of the deep manholes to the sewers in Blakehall Road and Grosvenor Avenue were completed during the year. These will greatly facilitate the work of 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. 22 Surface drainage in the south is mainly by soakaways in the chalk; elsewhere it is by surface sewers to the River Wandle. Two hundred and sixty-nine obstructions affecting 891 houses were dealt with, chiefly in combined drainage systems. Rivers and Streams The County Council are responsible for the branch of the River Wandle which flows through the district and the ponds which feed it. Routine cleansing work was carried out on the Tweeddale Road open ditch. This water course, now in a built-up area, constitutes a risk to public health and the Council have taken steps to have it piped in. One complaint in respect of the water course in Ruskin Road was received and was dealt with by the County Council. Closet Accommodation All dwellings have w.c.s connected to the sewers except 17 in unsewered areas which are connected to 13 cesspools. There are no earth closets. Public Cleansing This service is under the direction of the Council's Engineer and Surveyor. Collection. The method of collection was as shown in previous reports by a fleet of modern vehicles suitably designed with side or end loading to meet the special requirements of properties with differing types of approach. All are fitted with hydraulic tipping gears. The collection of waste from blocks of flats, which are becoming an increasing feature of modern housing development, presents special problems. Lifting gear was fitted to one refuse vehicle to facilitate collection from this type of property. Kitchen waste is collected for pig food, the bins for which are cleansed by steam. Disposal. Disposal is effected by incineration after extraction of saleable salvage material in a six-cell Destructor. Quantities to be dealt with at the works increases steadily and during the winter months the plant is working to capacity. Reciprocal arrangements with neighbouring authorities meet the difficulties which arise when the Destructor is out of action for work of maintenance and repair. Clinker and screenings are disposed of by controlled tipping, but during the warm weather when the load on the Destructor is lightest, no screenings are extracted. During the year clinker and screenings were sent to the Barrow Hedges controlled tip where the level of existing ground is being raised to form school playing fields for the Education Authority. 23 Sanitary Inspection The following information supplied by the Chief Sanitary Inspsctor, tinder Article 27 of the Sanitary Officers' Regulations, 1935, indicates the action taken in sanitary inspection during the year. Accumulations 31 Animals so kept 7 Burst pipes 8 Dampness 37 Ditches and ponds 1 Drainage defects 26 Drains obstructed 285 Dustbins 64 Food contaminated 12 General defective conditions 97 Insects and Pests 115 Milk, contaminated'and dirty bottles 7 Miscellaneous 24 Obnoxious effluvia 29 Overcrowding ' 37 Pig bins . 7 Refuse collection 9 Rivers 1 Rodents 305 Roofs, defective 45 Sewer obstruction 2 Shops 3 Sink waste pipes 5 Smoke nuisances 32 Unsound food 114 Verminous premises 10 Water supply 7 1,310 Eleven thousand nine hundred and fifty visits of inspection and re-inspection were made for the purposes set out below: Animals slaughtered and inspected 3 Business premises 206 Cowsheds 40 Employment Agencies 1 Factories (Mechanical Power) 120 Factories (Non-Mechanical Power) 71 Food and Drugs and other samples 577 Food poisoning inquiries 1 Food premises: Apartment houses 1 Bakehouses 61 Bakers and confectioners 71 Butchers 183 Canteens 76 Chemists 17 Cinema 1 Confectioners (sweets only) 107 Fishmongers 80 General Stores 53 Greengrocers and fruiterers 101 Grocers 311 24 Licensed premises with catering facilities 32 Licensed premises without catering facililies 31 Ice cream factories 12 Ice cream vehicles 31 Milk shops 42 Restaurants and cafes 124 Stalls, food 161 Tea Packer 1 Unsound Food: Meat 52 Food other than meat 138 Vehicles, food 105 1,791 Hairdressers 24 House drains tested 61 Housing Act 566 Housing Inquiries 1,312 Infectious disease contacts 56 Infectious disease premises ( o September) 254 Merchandise Marks Act 107 Offices ' 6 Outworkers premises 117 Pet Animals Act 17 Piggeries 32 Premises re cesspools 7 Public Health Act (Houses) 3,229 Public Health Act re-inspections 2,493 Rag Flock and Other Filling Materials Act 14 Rodents 351 Schools 110 Shops 327 Smoke observations 9 Urinals 35 Water sampling 13 11,950 Four hundred and twenty-six informal notices were served concerning the following matters: Accumulations and deposits 10 Animals so kept 1 Drainage defects 55 Dustbins 27 Factories Act 8 Food Byelaws 11 Food and Drugs Acts 18 General defective conditions 185 Merchandise Marks Act 1 Obstructed drains 7 Overcrowding 80 Rodents 7 Shops Act 1 Smoke nuisances 1 Verminous premises 8 Water supply 6 25 Thirty-five formal notices were served by authority of the Council under the following Acts: Public Health Act, 1936, Section 39 2 „ „ „ „ , Section 45 1 „ „ „ „ , Section 75 5 „ „ „ „ , Section 93 18 Factories Act, 1937, Section 7 2 Food and Drugs Act, 1938, Section 13 1 Housing Act, 1936, Section 168 6 35 As a result of investigations made and notices served, the following work was carried out: Accumulations removed 7 Brickwork, repaired and/or repointed 18 Ceilings cleansed and purified 124 Ceiling plaster repaired and/or made good (including plaster board) 87 Cement plinths, renewed 3 fillets, renewed 2 Chimney stacks repaired and/or made good 7 flues repaired 5 Damp conditions remedied 81 Damp course provided 3 Disinfestations 71 Ditches cleaned 3 Doors and frames repaired, including locks and fasteners 24 Drainage repaired and/or reconstructed at houses 17 (169 ft. drain laid) inspection chamber repaired and/or made good 2 inspection chamber covers renewed 4 stoppers or caps refixed and/or renewed 1 fresh air inlets repaired and/or renewed 6 soil vents repaired and/or renewed 1 drains tested 29 drains cleared (affecting 891 houses) 269 drains sealed off 3 waste gullies repaired, renewed or cleared 12 waste pipes, repaired, renewed or provided 7 Dustbins provided 35 Fences repaired or renewed 3 Fire grates repaired and/or renewed 4 Fireplaces repaired and/or made good 11 Floorboards repaired and/or made good 34 Floors ventilation repaired ventilation provided 1 Glazing panes renewed 5 putty renewed 0 Other matters Paving repaired and/or made level 13 drained 4 Ranges, stoves repaired and/or renewed 10 provided 2 Roofs repaired and made weatherproof 79 downpipe, guttering repaired and/or renewed 50 Shops, hot water, means of supply provided Sinks renewed 1 Soakaway made to work properly 3 26 Stair treads repaired, renewed or made level 3 Steps repaired and/or renewed 2 Surface water drainage repaired and made to work properly 3 Ventilation, more provided 1 Walls, cement rendered 1 rendering repaired 7 replastered and/or repaired 89 cleansed and redecorated 94 rebuilt 1 Wash basins, baths renewed 3 Water cisterns repaired 2 Water supply repaired 12 W.C. accommodation repaired 5 pans renewed 4 pans provided 2 pan joints renewed 3 seats repaired, renewed or provided 1 lift-up seat provided 2 box seats removed 1 flushing apparatus repaired or renewed 20 Window frames repaired and/or renewed 17 Windows made to work properly 2 provided with catches or fasteners 3 sash cords renewed 37 Windows repaired and/or renewed 6 Window cills (external) repaired. 23 Woodwork repaired and/or renewed 3 Disinfection In connection with cases of infectious disease, 177 rooms and 320 library books were disinfected. Seventeen lots of bedding were sterilised and ti lots destroyed. Vermin Control Persons. The Council provide facilities in adapted premises at Rochester Road for the cleansing of verminous persons and their personal clothing. The Station is equipped with baths and a Thresh Steam Disinfector. A trained nurse is in attendance to deal with women and children and a male attendant for men. Instances of infestation are followed up in the home as this is invariably a domestic problem affecting the family as a whole and it is useless to deal with individuals without careful investigation and attention to the remainder of the household. 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 2 7 20 For pediculosis 15 40 98 Schoolchildren included in these totals were: For scabies Nil For pediculosis 23 27 In the twelve years that the Cleansing Station has been in existence the use made of it has progressively declined and this reduced activity is a reflection of the falling incidence of vermin infestation in the district. The factor to which the Cleansing Station owed its origin was the sudden and significant rise in 1941 in the incidence of scabies which arose out of the difficulties in maintaining adequate domestic hygiene under war-time conditions. During the three war years 1942/44 more than 1,000 individuals were treated each year at the Cleansing Station. After the war the numbers fell progressively until 1952 when only 7 persons were treated for scabies and 40 for pediculosis. Premises. During the year, one lot of verminous bedding was stoved and 71 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. Total C.U.D.C. Property S.C.C. Property Privately Owned Property L.C.C. Property Privately Owned Property Ants 1 - 1 - - 2 Bugs 7 — 3 2 - 13 Fleas 1 — — — — 1 Flies - 7 - - - 7 Wasps 5 - 43 — — 48 14 7 47 2 — 71 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 Thirty-two 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 the work of rodent destruction was continued throughout the year. Eight thousand five hundred and sixteen visits were made concerning 2,010 properties and 205 rat and mouse infestations found. Of that number 246 were found in private premises, 15 in business premises, 4 in Council premises. 28 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 153 266 Manholes in which takes of prebait were recorded 43 117 Percentage of manholes showing infestations 28 44 Percentage in relation to total manholes in district 3.8 10.3 Swimming Baths The one privately owned swimming bath has been purchased by the Council. A chlorination plant is installed for treatment of the water which is subjected to continuous precipitation and filtration. One sample of water was taken and proved satisfactory. Offices Six inspections of offices were made, but no action was necessary. Shops Act, 1950 There are 524 shop premises on the register and 1,000 inspections were made during the year. A Preliminary Notice was served with regard to the provision of seating for female employees, with the desired effect. 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 was 385 and of this number 177 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 115 bodies were received into the mortuary, on all of which autopsies were performed. National Assistance Act—Section 50. No burials under the provisions of Section 50 of the National Assistance Act were arranged by the Council during 1052. 29 Establishments for Massage and Special Treatment Seven establishments were licensed under Part IV of the Surrey County Council Act, 1931. All were inspected and found to be satisfactorily conducted. Five are used for the practice of chiropody, two for massage, etc. Employment Agencies There is only one employment agency in the district. This was visited and found to be satisfactory. National Assistance Act, 1948 and 1951 Satisfactory arrangements for old people who are beyond caring for themselves continues to be a problem. The sense of family responsibility seems to have diminished in recent years and there appears to be a growing disposition on the part of married sons and daughters to leave the welfare of infirm and aged parents to the social and welfare services. Difficulties are made no less by the present divided responsibility between the Hospital Board and the Welfare Authority as so often those needing attention are not clearly patients requiring hospital treatment or infirm requiring care and attention, but borderline cases, the classification of which is a matter of opinion. Every endeavour is made by invoking the help of the local Health Services in the provision of Home Helps, District Nurses, etc., to avoid the drastic procedure of compulsory removal of old people who, unattended, have drifted into an insanitary condition. Not infrequently compulsory removal, whilst solving the sanitary problem, merely hastens the end of these pathetic cases. It was, however, necessary during the year to use the powers of Section 47 of the National Assistance Act, 1948, as amended by the 1951 Act, to remove two old ladies to accommodation provided by the Welfare Authority. The order under the Amendment Act was for the limited period of three weeks, but it was unnecessary to seek authority for extending this period. Rag Flock and Other Filling Materials Act, 1951 One property used for upholstering is registered in accordance with Section 2 of the Rag Flock and Other Filling Materials Act, 1951. Pet Animals Act, 1951 Four pet shops dealing in fish and birds were licensed by the Council. All were inspected and found to be satisfactorily conducted. 30 Section D—Housing:. New Houses During the year the following 186 houses and flats were completed: Council Flats 108 Private Houses 10 Private Plats 8 Total 180 Buildings in course of erection at the end of the year were as follows: Council Plats 27 Council Shops 9 Private Houses 17 Total 53 Council's Housing Scheme The dwellings in the ownership of the Council at the year end totalled 1,313 houses, flats and temporary bungalows. In addition to the new houses and flats completed during the year and in course of erection, work continued or was commenced, on the following schemes: Site No. Site Type of Dwelling No. in Contract 8 Barrow Hedges Flats 70 31 Stanley Road „ 40 33 Grove Lane „ 24 134 The accommodation under requisition by the Council at 31st December, 1952, comprised 134 premises providing accommodation for 199 families. The outstanding approved applications for tenancies at the year end totalled 1,050 compared with 1,829 at the same date 12 months earlier. 31 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. — 566 P.HA. — 3,290 3,856 (b) Number of inspections made for the purpose 6,349 (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 297 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 1951) 242 3. Action under Statutory Powers during the year. (a) Proceeding under Sections 9, 10 and 16 of the Housing Act, 1936. Number of dwelling houses in respect of which notices were served requiring repairs — Number of dwelling houses which were rendered fit after service of formal notices: (a) By owners 1 (b) By local authority in default of owners (b) Proceeding under Public Health Acts. (1) Number of dwelling houses in respect of which formal notices were served requiring defects to be remedied 26 (2) Number of dwelling houses in which defects were remedied after service of formal notices: (a) By owners 34 (b) By local authority in default of owners 1 32 4. Housing Act, 193G. Part IV (Overcrowding). (a) (1) Number of dwelling houses overcrowded at the end of the year 123 (2) Number of families dwelling therein 208 (3) Equivalent number of adults dwelling therein 850 (b) Number of new cases reported during the year 70 (c) (1) Number of cases of overcrowding relieved during the year 173 (2) Number of persons concerned in such cases 1,172½ (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 79 cases of overcrowding were found to exist and 173 cases were remedied leaving 123 dwellings with 850 equivalent adults in occupation overcrowded at the end of the year. The known position as to overcrowding at the beginning and end of the year was as follows: Ward. Dwellings overcrowded at 31.12.51 Dwellings found overcrowded during 1952 Dwellings decrowded during 1952 Dwellings remaining overcrowded at 31.12.52 Overcrowded cases remedied during 1952. Formal Action Informal Action Total. St. Helier North 58 20 42 36 28 14 42 St. Helier South 52 20 40 32 16 24 40 St. Helier West 48 16 42 22 21 21 42 North-East 19 12 19 12 9 10 19 North-West 12 2 7 7 4 3 7 Central 12 1 7 6 2 5 7 South-West — - — — - - - South-East 16 8 16 8 9 7 16 217 79 173 123 89 84 173 It should be noted that these figures represent the position with regard to overcrowding only insofar as information comes to the notice of the department. Nothing short of a comprehensive house-to-house survey of the whole district such as was originally undertaken under the Housing Act, 1935, could reveal the exact extent of overcrowding. 33 In 66 out of the 79 new eases of overcrowding, families were sharing accommodation with relatives. Abatement of the 173 overcrowded premises was effected as follows: Provision of alternative accommodation by: Carshalton U.D.C. 54 London C.C. 29 Other Local Authorities 6 Left the District 7 Removal of one or more occupants 77 Of the 123 dwellings remaining overcrowded at the end of the year, 90 arc owned by the London County Council, 11 by the Carshalton Council and 22 are privately owned. Slum Clearance and Demolition After a lapse of more than a decade covering the war and post-war years the work of clearing unfit dwellings was resumed. Detailed inspections were made into the condition of a block of 8 tenement dwellings in Stanley Road with a view to clearance and re-development under Part III of the Housing Act, 1936. Rent and Mortgage Interest Restrictions (Amendment) Act, 1933 No action was necessary during the year. Factories and Workplaces In the operation of the Factories Act the department work in co-oparation with H.M. Inspector of Factories. 34 The registers show that the following premises accommodated the number of employees as indicated: Employees. Premises. Males. Females. Total. Factories— with mechanical power 842 536 1,378 91 without „ „ 39 23 62 20 Workplaces— with mechanical power 16 1 17 17 without „ „ 13 4 17 17 910 564 1,474 145 The following tables, set out in the manner prescribed by the Home Office Form 57:2 (Revised), indicates the inspections made and action taken under the Factories Act. 1. Inspections for the 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 Lccal Authorities 20 71 1 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 91 120 7 - (iii) Other premises in which Section 7 is enforced by the Local Authority* (excluding outworkers' premises) - - - - Total 111 191 8 — *Electrical Stations (Section 103 (1)), Institutions (Section 104) and sites of Building Operations and Works of Engineering Construction (Sections li)7 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 - - - - - Overcrowding - - - - — Unreasonable temperature - - - - — Inadequate ventilation - - - - — Defective drainage of floors - - - - — Sanitary Conveniences— (a) Insufficient 2 - - - — (b) Unsuitable or defective 6 4 - - — (c) Not separate for sexes — — - - — Other offences against the Act (not including offences relating to Outwork) — — - - - Total 8 4 — — — Outwork (Sections 110 and 111). Nature of Work. Section 110. Section 111. No. of outworkers in Aug. list required by Sect. 110(1) (c) No. of cases of default in sending lists to the Council. No. of prosecutions for failure to supply lists. No. of instances of work in unwhole some premises. Notices served. Prosecutions. (1) (2) (3) (4). (5) (6) (7) Wearing Apparel— Making, etc. 25 - — - - — Cleaning and washing — - - - - — Locks 1 - — - - — Umbrellas 3 - — - - — Stuffed Toys 7 - — - - — Cosaques, Christmas Crackers, Christmas stockings, etc. 27 - - - - - Artificial Flowers 1 — — - - — Total 64 - - - - - Tents, Vans, Sheds and Similar Structures No action was called for during the year. 36 Section E— Inspection and Supervision of Food. Milk Supply The district has been declared a Specified Area by the Minister for the purposes of the Milk (Special Designations) (Specified Areas) Order, 1951. In consequence, all milk sold by retail must be "designated milk" and all retailers must be licensed to use a special designation in relation to milk. Milk Distributors. The number of Milk Distributors rose to 22 from 17 in the vear before. The designated licences issued during the year were as follows: Designation. Number of Distributors holding Licences No. of Licences in Force on 31/12/52. Principal Licences— Sterilised 14 17 Pasteurised 6 9 Tuberculin Tested 6 9 Supplementary Licences— Sterilised 8 11 Pasteurised 8 11 Tuberculin Tested 8 11 Bacteriological Examination of Milk. Two hundred and twenty-six samples of milk were submitted for bacteriological examination and five failed to comply with the prescribed Regulations. The results of the tests were as follows: Designation under which sold. No. of Samples. Methylene Blue Test. Phosphatase Test. Turbidity Test. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. Pasteurised 188 186 2 187 1 — — T.T. Pasteurised 24 22 2 24 — — — Sterilised 14 - — — — 14 — 226 208 4 211 1 14 — 37 A further 14 samples were examined bacteriologically for suspected food poisoning organisms in connection with food poisoning outbreaks, all with negative results. Biological Examination of Milk. Twelve samples of milk were taken from producers' premises within the district and submitted for examination for tuberculosis by animal inoculation. One of these proved to be tuberculous. The Ministry of Agriculture and Fisheries were informed so that appropriate action with regard to the affected herd could be taken. Milk and Dairits Regulations 1919—Regulation 20 This Regulation enables the Madical Officer of H;alth to prohibit the sale for human consumption of infected milk capable of transmitting infection to man or to require its treatment so as to render it innocuous. Tne only instance of milk of this nature which came to notice was the rtsult of biological examination of the milk from a local farm found positive for tuberculosis, as mentioned above. As immediate investigation into the herd to eliminate the offending animal was undertaken by officers of the Ministry and since all the milk from the farm is effectually pasteurised, no further action was called for. Ice Cream Ninety-four samples of ice cream were procured for bacteriological examination and the following table gives the results: No. of Samples. Grade. 1 2 3 4 94 70 17 7 — The high proportion of samples satisfying the requirements of Grades I and II continues the marked improvement in bacterial purity of this commodity experienced in recent years. Fourteen samples were submitted for chemical analysis by the Public Analyst and all were found to comply with the standard of the Ice Cream Order, 1951, as amended by the Order of 1952 which was operative from the 7th July. This Amending Order reduced the necessaryfat content of ice cream from 5% to 4%, and the milk solids other than fat content from 7½% to 5%, whilst leaving the sugar content as before at 10%. Meat 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 3,000 lbs. of meat were found to be unfit for human food. 38 Food and Drugs Act, 1938 The following 318 samples were submitted to the Public Analyst: Article. No. Adulterated or otherwise irregular. Article. No. Adulterated or otherwise irregular. Baby Food 3 1 Milk 217 2 Beans in Tomato Sauce 1 Milk, Condensed 1 Mint Sauce 1 Beer 1 Mincemeat 3 Bread and Butter 1 Mixture, Cake 2 Chocolate Cup Pudding Chocolate Xmas Pudding 1 Mixture, Sponge 2 Peanut Butter 1 Cocoa 1 Pepper 1 Coffee 1 Rice 2 Cornflour 1 Saccharin 1 Cough Linctus Salad Cream 3 Cream, Synthetic Powder 1 Salt 2 Sausage, Beef 6 Custard Powder 2 Sausage, Liver 1 Fish Cake 1 Sausage, Pork 5 2 Flour 1 Semolina 1 Fruit—Tinned or Bottled 4 1 Soup 2 Steak and Kidney Pie 1 Fruit Juice 1 Frying Oil 1 Stewed Steak 1 Gelatine 1 Stuffing, Sage and Onion 1 Ice Cream 14 Jam 3 Suet 2 Jelly 1 1 Sweets 5 2 Lemonade 1 Swiss Roll 1 Lemon Squash 1 Syrup of Figs 1 Lollie, Milk Tapioca Flakes 1 Marmalade 1 Tea 1 Meat Paste 1 Tomato Puree 1 Meat, Beef Sausage 2 Vinegar 1 Meat, Pork Sausage 1 Weetabix 1 The following nine samples were found to he adulterated or otherwise irregular: Cocoanut Crunch. This was a toffee crunch incorrectly labelled as cocoanut crunch. The price was the sam e in either case and in the circumstances a warning was given. Milk. A sample deficient in milk solids other than fat to the extent of 1%. The freezing test failed to demonstrate the addition of water, and the vendors were warned. Table Jelly. This sample contained 61.9% of sugar as against 63% required by the Food Standards (Table Jellies) Order, 1949. The manufacturers disputed the analyst's method of computing the sugar content. This was referred to the Ministry of Food who upheld the view of the Public Analyst. The manufacturers were warned that future samples of this standard would be the subject of prosecution. 39 Pork Sausages. The article supplied at this purchase was beef sausage. It was argued by the vendor that a declaration to this effect was made at the time of sale. The matter was referred to the Ministry of Food who expressed the view that the vendor should be given the benefit of the doubt. Pork Sausages. The meat equivalent in this sample was found to be 60% instead of 65%. It was an informal sample received from a complainant after purchase in the ordinary way. A formal sample taken subsequently from the vendor was found to be genuine. Butterscotch. This was a butterscotch of Dutch manufacture containing not more than 2.1% of butter fat. Although there is no statutory standard for this commodity, 4% butter fat is recognised in the Code of Practice agreed by the Ministry of Food and the confectionery trade as being the desirable minimum. The matter was referred to the Ministry of Food who made representation to the Dutch Embassy. Baby Food. The protein content of this weaning food was found to be 12% less than that stated on the label. Considerable correspondence with the manufacturers took place in which it was agreed that the discrepancy could very probably be accounted for by the absorption of moisture during storage. The manufacturers agreed to an amendment of the label on future supplies to indicate that the stated composition was approximate only. Milk. This sample contained 6% of added water. A technical irregularity in procedure precluded prosecution. Raspberries in Syrup. A prosecution was undertaken of the manufacturers of this sample of bottled raspberries. The label bore the words stated above and indicated that it was sweetened with "sugar, glucose and sol. gluside." Analysis revealed that the sample contained 60% fruit and 40% of syrup of not more than 14% sugar and saccharin 0.018%. It was successfully contended by the Council that commercial syrup should contain 39 parts of sugar per 100 parts of syrup and that "syrup" should not contain saccharin; further, that the words "sol. gluside" on the label would not be understood by the ordinary person as indicating saccharin. The defendants were convicted and fined £20 and 5 guineas costs. An appeal was lodged but was subsequently withdrawn. Section 9-Sale of Food Unfit for Human Consumption Fourteen complaints were received of foreign matter being found in foodstuffs. The evidence did not justify legal proceedings in any and appropriate warnings were given where the vendors or their suppliers were culpable. 40 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: Cake and biscuits 296 lbs. Meat 2,927 lbs. 9 ozs. Cereals and flour 59 lbs. 1 oz. Milk 820 lbs. 5 ozs. Cheese 72 lbs. 2 ozs. Mincemeat 3 lbs. 14 ozs. Coffee and Chicory 4 ozs. Paste, meat 4 ozs. Egg. dried 2 lbs. Pickles 5 lbs. 9 ozs. Fish 318 lbs. 11 ozs. Pudding and cake Fruit 963 lbs. 15 ozs. mixture 27 lbs. 8 ozs. Fruit juice and drink 3 lbs. 2 ozs. Soup 134 lbs. Jam 72 lbs. 8 ozs. Spaghetti 3 lbs. 8 ozs. Jelly and blancmange 24 lbs. Syrup 11 lbs. 11 ozs. Macaroni 179 lbs. Vegetables 1,140 lbs. 4 ozs. Total weight 3 tons, 3 cwts., 9 lbs., 3 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. Food Hygiene The work of education in food hygiene and particularly of those engaged in the handling of food for the public is a slow and unremitting task. Freedom from injurious contamination is dependent on two main factors, adequate equipment and facilities for the preparation and storage of food and a strict hygienic code of practice and behaviour on the part of the food handler. Necessary as is proper equipment, it is of no avail unless used with a knowledge of the ways in which infection can be introduced and with a constant and conscientious effort to translate that knowledge into hygienic practice. Every opportunity is taken under the various statutory powers by the sanitary staff, both verbally and by informative leaflets, to ensure that not only are food premises well equipped, but that the paramount importance of strict personal hygiene in the handling of food and food equipment is impressed upon management and employees alike. Food is especially vulnerable to contamination when displayed for sale in the open air. In 1950 the Council secured bye-laws to control the conditions of sale of food in this way. Some 300 inspections were made during the year of stalls and vehicles, and notices were served in respect of 13 infringements, as follows: Food storage in roadway 1 No name and address on stall or vehicle 1 Lack of cleanliness or contamination of food 11 41 42 TABLE 9. Inspection of Food Premises and Action Taken. Nature of Business. No. of Premises. No. Selling Ice Cream. No. of Inspections. Means of hot-water supply provided. Food preparation rooms repaired or cleaned. Food storage rooms repaired or Cleaned Refuse bins provided. Other Defective Conditions Remedied. Bakers and Confectioners 15 4 71 - - - 1 2 Bakehouses 5 — 61 - - — — — Butchers 37 — 183 - 1 — — — Canteens 14 — 76 - - - — — Chemists 16 — 17 - - - — — Cinemas 1 1 1 - - — — — Confectioners (Sweets only) 72 49 107 - - - — — Milk Shops 8 4 42 - - - — — Fishmongers 19 — 80 - 2 - — — General Stores 4 3 53 - — - — — Greengrocers and Fruiterers 45 2 101 - — - — — Grocers (and Corn Chandlers) 87 13 311 1 — 2 — — Licensed (with Catering Facilities) 6 — 21 - — — — — Premises (without Catering Facilities) 8 — 18 - — — — — Ice Cream Factories 1 1 12 - — — — — Ice Cream Vehicles Various — 31 - — — — — Licensed Premises 26 — 25 - — — — — Restaurants and Cafes 26 13 124 - 3 — — — Stalls. Food Various — 162 - — — — — Vehicles, Food Various — 105 - — — — — 90 1,601 1 6 2 1 2 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 Tuberculosis Enteric Fever Cholera Dysentery Relapsing or Continued Diphtheria Acute Primary Pneumonia Fever Membranous Croup Acute Influenzal Meningococcal Infection Ervsipelas Pneumonia Ophthalmia Neonatorum Scarlatina or Scarlet Fever Acute Poliomyelitis Acute Polioencephalitis Puerperal Pyrexia Malaria Measles Typhus Fever Food Poisoning Whooping Cough Typhoid Fever L,eprosy Smallpox No cases of variola occurred during the year, although several contacts of cases occurring elsewhere were kept under surveillance for an appropriate 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 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. 43 The number of persons successfully treated and recorded under these arrangements during 1952 was as follows: Age at 31st Dec., 1952 Under 1yr. 1-4 yrs. 5-14 yrs. 15 yrs. & over. Total. Primary Vaccinations— 15v' Private Practitioners 85 92 11 55 243 At Clinics 133 104 3 2 242 218 196 14 57 485 Revaccinations— • Bv Private Practitioners 1 5 17 127 150 At Clinics — 1 1 - 2 1 6 18 127 152 In addition the following unsuccessful attempts at vaccination were made: Age at 31st December, 1952 Under lyr. 1-4 yrs. 5-14 yrs. 15 yrs. & over. Total. Primary 12 8 — 3 23 Re-vaccination — — 3 1 4 12 8 3 4 27 Enteric Fever No cases of typhoid or paratyphoid fever were notified. Dysentery Mild dysentery, due to the Sonne bacillus, has been endemic in the district for many years past. Since this intestinal infection is easily spread by contamination of food and utensils handled by patients, many of whom continue about their normal activities, it frequently assumes epidemic proportions among communities of children whose sense of personal hygiene is not developed. Waves of prevalence are not, therefore, uncommon in nurseries, children's hospitals and similar institutions. A total of 112 cases was notified during the year, all but 3 confirmed bacteriologically as Sonne infections, the unconfirmed ones being diagnosed on clinical grounds only. Eighty-three of the total were residents of the district, the remaining 29 being patients in local hospitals admitted from other districts. The majority of the cases occurred in two outbreaks, one involving 25 children in a local hospital during the summer and the other affecting 26 children and staff of a Day Nursery, together with 14 others among 44 the domestic contacts of these children. This latter outbreak occurred in December and continued into January, 1953. Experience of this Nursery outbreak confirms the view previously expressed that a considerable amount of this mild form of dysentery escapes detection since most of the 14 cases which were home contacts of the Nursery children only came to light as the result of visits by the Health Stall to the homes of the affected Nursery children and 110 doctor had been consulted. No case was fatal. Scarlet Fever The incidence of scarlet fever was slightly higher than in the year before, 128 cases being notified of which 123 were residents of the district. The incidence rates were accordingly: All cases 2.07 per thousand population Residents 1.99 per thousand population The illness was again a mild one and no deaths occurred. Forty-nine, representing 38% of the cases were nursed at home. Scarlet fever is not an entity, but only one of the several manifestations to which the causal streptococcus can give rise. Since the other forms of illness for which this organism is responsible are, in the main, not notifiable, isolation of the patient and quarantining of contacts can have only limited preventive value. It is not uncommon to find a case of "sore throat" but without any rash in close association with a frank case of scarlet fever. The infecting organism is the same in each, but one is notifiable and the other is not. TABLE 10. SCARLET FEVER—DISTRIBUTION OF CASES, 1952. 1952. Ward. Total. St. Ilelie: North St. Ilelier South. St. Ileliei West. NorthEast NorthWest. Central. SouthEast. SouthWest. January 10 - 3 - - - - 1 14 February 7 — 5 — 2 — 1 1 16 March 2 2 1 — — 1 — 1 7 April 5 — 1 — 3 — 1 2 12 May — — 1 2 — — 1 1 5 June 2 1 3 — 1 1 — - 8 July 3 — 7 1 3 — 1 - 15 August 3 - - - - - - - 3 September 2 1 2 1 1 1 — - 8 October 2 2 2 1 1 2 1 1 12 November 2 1 — 2 3 2 2 — 12 December 2 1 — 1 3 — 3 1 11 Totals 40 8 25 8 17 7 10 8 123 Monthly Mean 3.33 0.66 2.08 0.66 1.41 0.58 0.83 0.66 10.25 Case rate per 1,000 population 4.73 1.16 3.05 0.84 2.37 1.15 1.28 1.21 1.99 45 TABLE 11. SCARLET FEVER—MULTIPLE CASES, 1952. Ward. No. of houses in which occurred. Total Houses. Total Cases. 1 Case. 2 Cases. 3 Cases. St. Helier North 31 3 1 35 40 St. Helier South 6 1 - 7 8 St. Helier West 20 1 1 22 25 North-East 8 - - 8 8 North-West 15 1 - 16 17 Central 5 1 - 6 7 South-East 10 - - 10 10 South-West 6 1 — 7 8 Whole District 101 8 2 111 123 Diphtheria The dramatic fall in the prevalence of diphtheria which followed the introduction of diphtheria immunisation has now culminated in a complete absence of this infection from the district for the last three years. However, the limited but severe outbreaks which still occur from time to time in different parts of the country serve to remind us that the infection has not been completely removed from our midst and that only the maintenance of a high level of immunisation can guarantee security from what is a killing disease. Diphtheria Immunisation In the absence of cases of diphtheria it is naturally becoming more and more difficult to maintain the same high level of artificially induced immunity which we have experienced in the past. The crucial test of our efforts in this direction is the proportion of children immunised during their pre-school life. This percentage continues to fall steadily although much of the leeway is made up after entry to school, since many parents defer accepting this protection for their children until they are faced with the added risks of school life. This is a short-sighted policy since, should an outbreak of diphtheria occur, it is the youngest age groups who aie most likely to succumb and fatality from this infection is the highest in the second year of life. The scheme of immunisation is the responsibility of the County Council, but by agreement between the two authorities it is directed in each sanitary district by the local Medical Officer of Health. Facilities are available at the Infant Welfare and School Clinics and a regular programme of immunising sessions is held in the Infant and Junior Departments of the schools every alternate term. The object is to secure primary immunisation by the end of the first year and to reinforce that treatment at three-year intervals until the child passes out of the Primary School group. A.P.T. antigen is used for primary treatment in two doses of 0.5 c.c. at one month's interval, whilst 1 c.c. doses of T.A.F. are usually given for reinforcing injections. 46 During 1952, 733 residents were immunised as follows: Age at Year End. Total. Under 1 1 2 3 4 5-9 10-14 At Council Clinics 23 244 35 10 8 2 - 322 In Carshalton Schools — — — 1 8 208 11 228 Private Practitioners 9 162 25 7 4 8 4 219 32 406 60 18 20 218 15 769 Less outward transfers 2 3 1 1 — 30 3 40 Plus inward transfers — 1 — 2 — 1 - 4 Carshalton Residents 30 404 59 19 20 189 12 733 A further 2,084 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 1,801. The immunisation state of the child population at the end of the year was as follows: Age at 31.12.52, i.e., Born in Year Under 1 1952. 1 1951. 2 1950. 3 1949. 4 1948. 5 to 9 1943/ 47. 10 to 14 1938/ 42. Total under 15 Number Immunised 11 408 579 573 774 4581 4160 11086 Estimated mid-year population, 1952 4300 8800 13100 Percentage done 54% 99% 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 1952 54 99 84 0 0.00 47 Erysipelas Only one case of erysipelas of the leg in an elderly male was notified during the year. The number of notified cases which, in pre-penicillin and sulphonamide days, ranged from 10 to 20 per year, has fallen steadily. It is difficult to believe that there has been any substantial fall in the number of people infected in this way by the streptococcus which continues to flourish in the human host. The more probable explanation is that at the first indication of skin infiamation the modern antibiotics or the sulpha drugs are used with such effective results that the illness is largely aborted and is not deemed sufficiently definite to be notifiable. Pneumonia Pneumonia was less prevalent, 30 cases being notified of which 7 were stated to be of influenzal origin. One-third of the cases were of children under 5 years and one-third of adults of 50 years and over. Measles For many years the prevalence of measles has shown a major wave approximately every alternate year with a minor epidemic in the years between. 1952 followed upon a year of high incidence and in conformity with the usual pattern the number of cases fell to about half that of the year before. The rise in prevalence commenced in February and continued until July, with June as the peak period. The total of cases notified was 556, of which 537 were residents of Carshalton and more than half the total occurred in May and June. Distribution throughout the district was related to the level of immunity in the different parts, resulting from the amount of previous infection. It is safe to say that since there is, as yet, no known means of preventing measles this factor of the level of natural immunity alone determines the extent of the illness in any given area. Efforts at control are, however, anything but useless. Whilst it would seem that every child sooner or later contracts measles, it is important to protect very young babies and those debilitated from some other cause, since an attack of measles in such cases may well prove fatal. Much can be done to defer an attack by the prompt removal of delicate babies from contact with measles and the use of convalescent or adult serum which will provide temporary immunity or, at worst, modify the illness if the child is already infected. None of the measles cases was fatal. 48 TABLE 12. MEASLES—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1952. (Excluding hospital patients non-resident in Carshalton.) 1952. Ward. Total. St. Helier North. St. Helier South. St. Helier West. NorthEast NorthWest. Central. SouthEast. SouthWest. January - 3 - - - - - - 3 February — — — 8 12 5 — — 25 March 1 — 2 7 11 11 1 2 35 April 6 1 — 17 28 15 3 - 70 May 17 10 10 32 17 9 7 5 107 June 21 24 13 34 10 23 67 16 208 July 11 6 6 3 1 2 21 — 50 August 2 - 3 1 1 2 — — 10 September — 3 - - - - - 1 4 October 1 1 — 1 — — 3 — 6 November 4 I 2 1 — — - - 8 December — 2 6 2 — — 1 — 11 Totals 63 52 42 106 80 67 103 24 537 Monthly Mean 5.25 4.33 3.50 8.83 6.66 5.58 8.58 2.00 41.75 Case rate per 1,000 population 7.45 7.54 5.12 11.24 11.18 11.01 13.25 3.65 8.71 Whooping Cough Not for 7 years was the incidence of whooping cough so low as it was in 1952. A total of 98 cases—all but 4 residents—was notified, as compared with 471 in the year before. There was no marked epidemic wave such as was experienced in the first two months of 1951, prevalence being fairly evenly distributed over the year. There were no deaths. As reported last year the County Council extended their scheme of immunisation to include whooping cough and increasing numbers of parents are availing themselves of these facilities for their children. Although the technique has not yet reached that high state of efficiency attained in respect of diphtheria the process is of considerable value and it may well be that the substantial fall in the incidence of whooping cough experienced in 1952 was the result of the natural periodic fall in the curve of prevalence accelerated by the early effects of immunisation. It would seem that parents are nowadays more concerned to secure protection against whooping cough than against diphtheria. This is natural enough since the district has had complete freedom from diphtheria for three years, but the risks of neglecting diphtheria 49 immunisation, which are very real, can largely be overcome by using immunising material which is a combined prophylactic against both diseases. Using the combined process introduces a little difficulty in deciding the optimum age at which it should be done. The considerations are different in the two diseases. For obvious reasons a separate course of injections against each of the two infections should be avoided if possible and the choice of age for combined treatment is a compromise. The greatest degree of advantage would appear to be gained if the course of three injections at monthly intervals for primary immunisation against both diseases is commenced when the child is six months old. This should be followed by reinforcing doses at two years and five years. TABLE 13. WHOOPING COUGH—WARD INCIDENCE AND MONTHLY DISTRIBUTION 1952. (Excluding hospital patients non-resident in Carshalton.) 1952. Ward. Total. St. Helier North. St. Helier South. St. Helier West. NorthEast. Northwest. Central. SouthEast. SouthWest. January - - 2 1 1 - - - 4 February - — — — 1 — — — 1 March - — 1 3 — — — — 4 April - 1 1 — 1 1 — — 4 May 2 - 1 — — 2 — — 5 June - 1 — — 1 — 8 — 10 July 2 — 1 3 2 1 1 — 10 August - - — - - - 4 — 4 September 1 - - - - - 2 — 3 October — — 2 2 — 2 — — 6 November 3 - 1 10 — — 2 — 16 December 1 7 — 8 4 2 4 1 27 Totals 9 9 9 27 10 8 21 1 94 Monthly Mean 0.75 0.75 0.75 2.25 0.83 0.66 1.75 0.08 7.83 Case rate per 1,000 population 1.06 1.30 1.09 2.86 1.39 1.31 2.70 0.15 1.52 Meningococcal Infection No cases were notified for the second consecutive year. Poliomyelitis Until May, the district had been free from poliomyelitis since the previous September. During the last eight months of the year 14 cases occurred at intervals. Of these 11 developed some degree of paralysis and 3 were non-paralytic. This is the highest number since the epidemic year of 1947, when 15 cases were notified. 50 Details are as follows: Case Sex Age Date of Onset Resultant Disability (July, 1953) 1 M 8 yrs. Unknown Weakness of muscles of back and neck. 2 F 34 yrs. 28th April Extensive paralysis. Died after 8 days. 3 M 20 yrs. 5th May Very slight weakness of left foot. 4 M 26 yrs. 21st May Marked weakness of left leg. Walks with sticks. 5 F 4 yrs. 24th May Weakness of left leg. Walks with sticks. 6 F 6 yrs. 24th July Very slight weakness of right leg. Needs no appliance. 7 F 6 yrs. 3rd Aug. Slight weakness of back and left leg. Walks well with a stick. 8 M 16 yrs. 13th Aug. Non-paralytic. Complete recovery. 9 M 6 yrs. 17th Sept. Non-paralytic. Complete recovery. 10 M l0½mths. 23rd Sept. Very slight weakness of right leg. 11 F 30 yrs. 13th Oct. Weakness of right leg below the knee. 12 M 19 yrs. 28th Oct. Very slight weakness of right shoulder. Engages in normal activities. 13 M 26 yrs. 2nd Nov. Marked weakness of left leg. Wears appliance and walks with a stick. 14 F 6 yrs. 20th Nov. Widespread weakness involving most of the body.. Still in hospital eight months later. Although the number of cases was only one less than in 1947 the fatality rate was much lower. One patient out of 14 died in 1952 as against 5 out of 15 in 1947. The cases were scattered throughout the district except for 4 which were grouped in part of the St. Helier South Ward, but were spread, in point of time over May, August, and September. Ophthalmia Neonatorum Two cases were notified. Both were moderately severe infections, but completely recovered after hospital treatment. 51 Puerperal Pyrexia As a result of the introduction of the amended Puerperal Pyrexia Regulations, 1951, the number of pyrexia cases coming within the scope of the Regulations has been greatly increased. As a result, the number of notified cases of rise of temperature in lying-in women rose to 197, of which 58 were Carshalton women. It should be noted that the St. Helier Hospital, which provides the majority of these notifications, has a large maternity unit which caters for a large part of Metropolitan Surrey. Moreover, abnormal maternity has first priority on this accommodation and it is this type of case in which fever is most liable to occur. The incident rate of 245.94 per thousand births as shown in the summary of vital statistics in the first section of this report is, of necessity, calculated on total births to Carshalton mothers only, and is therefore without any significance as an indication of the extent to which confinements are attended by a notifiable rise of temperature. All but one were hospital deliveries and 121 were in respect of first confinements. Food Poisoning Thirty-seven notifications of food poisoning were received. Four of these were single isolated cases, unassociated, as far as could be ascertained, with any others. Of these four, 3 were due to infection by Salmonella Typhimurium, but no causal organism was identified in the fourth. As is usual in the single cases, it is very difficult to identify the source of the infection unless remnants of the infected food are available, which they seldom are. This was so in respect of these four patients, but there was a strong suspicion that almond paste on a cake was the vehicle in one instance. The remaining 33 notifications fell into two groups of 17 and 16 relating to two outbreaks in local hospitals. Between 30th April and 8th May a number of persons were taken ill at a hospital with diarrhoea and abdominal pain, accompanied by a varying degree of temperature, most of them on the 2nd, 3rd and 4th of May. Most of the cases, too, were patients in the hospital, a few only being members of the staff. Bacteriological investigation revealed 21 cases to be suffering from infection from Salmonella enteritidis var Jena. Some 30 other individuals in the hospital were found to have suffered from diarrhoea, but the S. enteritidis was not isolated in their case. In view of the fact that diarrhoea from one cause or another is not infrequent among hospital patients it is difficult to estimate how far these 30 unidentified cases might have been due to the same cause. The cases were distributed over many wards, but not all, in the hospital and the number of people at risk was estimated at 860. A detailed investigation was undertaken of the dietary at the material time and many foodstuffs in use were submitted for bacteriological examination with completely negative results. The hospital patients were fed from a separate kitchen and a close scrutiny was made of the culinary arrangements. Some weaknesses in equipment and practices employed were revealed and these received the prompt attention of the Management Committee. All the kitchen 52 and stores staff were examined bacteriologically and none was found to be carrying pathogenic organisms. The cause of this outbreak was not identified, but ensurance that no food still in use was infected and close attention to kitchen hygiene no doubt were the deciding factors in bringing this outbreak to an end. From a bacteriological point of view it is of interest to note how long the patients continued to excrete the infecting organism. Of the 17, 5 were free in less than 1 week, 4 were free in less than 2 weeks, 5 in less than 3 weeks, 1 in less than 4 weeks, 1 in less than 6 weeks, and 1 in less than 7 weeks. A new born baby who contracted the infection from its mother continued to excrete salmonella for more than 3 months. The second hospital outbreak was also due to a salmonella, but of the type known as Typhimurium which is the commonest variety. On the 11th, 12th and 13th of July not less than 16 adults out of some 350 at risk were taken ill with diarrhoea and abdominal pain. Bacteriological investigation of the affected individuals revealed the causal salmonella, but there were no remnants of the infected food available. Enquiries into the dietary of each case left no doubt, however, that the vehicle of infection was a chicken fricassee eaten at the evening meal of the 10th July. Although the responsible meal only gave rise to 16 notified cases directly, the infection unfortunately was transmitted to a residential infants' nursery established in the hospital premises and 3 days later on the 16th July, 31 of these children developed diarrhoea. S. typhimurium was recovered from 25 of them. The staff was fed from a separate kitchen and bacteriological investigation of the staff working in the kitchen and of others who handled food for the staff or the nursery revealed that 19 were excreting the Salmonella organism. There was evidence that some had had symptoms, but all were free of symptoms when the first specimens were taken. Altogether, including the secondary cases, some 77 individuals suffered from the infection. The illness lasted from 2 to 5 days and all recovered. The chicken fricassee received considerable manual manipulation in the process of preparation. The boiled chickens were cooked one day and stripped manually the next day when a prepared sauce was added, and served to the staff 5 hours later. The probability is that the sauce or the meat was infected by a member of the staff who was either suffering from or carrying Salmonella typhimurium at the time. It should be noted that 19 members of the staff, mostly in the kitchen, were found positive on investigation. Most of these were undoubtedly victims of the outbreak, but it is probable that one or other of them was infected before the outbreak. Certainly one of the staff who was engaged on stripping the chickens was found to be positive after the event and she may have been so before. It would seem that the average incubation period, i.e., time from ingestion to onset of illness, was 27 hours. Sufferers continued to excrete the causal organism for varying periods. Nearly all were free within a month, most of them in from 14 to 21 days. 53 64 TABLE 14. CASES OF NOTIFIABLE INFECTIOUS DISEASE ADMITTED TO HOSPITALS, 1952. Disease Cuddington Bletchingley Western Wandle Valley The Grove Queen Mary's St. Helier Waddon Ottershaw Totas Scarlet Fever 25 3 - 31 9 8 — 2 1 79 Poliomyelitis Paralytic 4 — — - 1 3 2 - — 10 Poliomyelitis Non-Paralytic 2 — — — 1 — — - — 3 Whooping Cough 3 — — — — 4 — — — 7 Measles 5 — — — — 17 2 — — 24 Dysentery — — — — — 28 4 — — 32 Chicken-pox 3 — — — — — — — — 3 Rubella — — 1 2 2 — — — — 5 Pneumonia - - - - - - 1 — — 1 Food Poisoning - - - - - 16 18 — — 34 Tonsilitis 3 - - - - - - - - 3 Others 6 — 2 2 2 - - - - 12 Totals 51 3 3 35 15 76 27 2 1 213 55 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 123 1.99 — 40 8 25 8 17 7 10 8 74 60 Dysentery 83 1.34 — 23 9 25 17 2 2 2 3 3 3 Measles 537 8.71 — 63 52 42 106 80 67 103 24 5 0.93 Whooping Cough 94 1.52 — 9 9 9 27 10 8 21 1 4 4 Poliomyelitis, Paralytic 11 0.17 1 1 2 — 2 2 1 3 — 10 90 Poliomyelitis, Non-Paralytic 3 0.04 — — 2 — — — — — 1 3 100 Food Poisoning 23 0.37 — — 1 1 — 3 — 17 1 20 86 Erysipelas 1 0.01 - - - - - - 1 - - - - Pneumonia 30 0.48 — 1 3 6 5 2 2 10 1 1 3 Puerperal Pyrexia 58 0.94 — 12 8 15 8 5 1 8 1 57 98 Ophthalmia Neonatorum 2 0.03 — — 1 - — — — 1 — — — 56 TABLE 16. INFECTIOUS DISEASES. Notification by Age Groups, 1952. (Excluding hospital patients non-resident in Carshalton.) Disease. Total Cases Notified. Total Cases at all Ages Under 1 year 1-2 2-3 3-1 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 and over Scarlet Fever — 1 8 9 16 74 13 1 1 — — — 123 Measles 11 48 58 62 73 264 - 1 — 1 — — 537 Whooping Cough 8 11 14 18 12 31 - - - - - - 94 Dysentery 5 3 11 4 11 18 4 3 15 6 2 1 83 Poliomyelitis, Paralytic 1 — — - 1 4 — 1 4 — — — 11 Poliomyelitis, Non-paralytic — — — — — 1 — 2 — — — — 3 Food Poisoning - - - - - - - 8 8 3 4 — 23 Erysipelas — — — — — — — — — — 1 — 1 Pneumonia 2 2 3 1 1 1 1 2 4 2 10 1 30 Peurperal Pyrexia - - - - - - - 4 46 8 - - 58 5T TABLE 17. MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1952. (Excluding hospital patients non-resident in Carshalton.) Disease. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 14 16 7 12 5 8 15 3 8 12 12 11 123 Dysentery 3 — 1 — — — 1 - 1 — 2 75 83 Measles 3 25 35 70 107 208 50 10 4 6 8 11 537 Whooping Cough 4 1 4 4 5 10 10 4 3 6 16 27 94 Poliomyelitis, Paralytic — — — — 3 1 — 2 - 2 2 1 11 Poliomyelitis, Non-paralytic — — — — 1 — — 1 1 — — — 3 Food Poisoning — — — — 3 1 — 17 1 1 — — 23 Erysipelas — — — — — 1 - - - - - - 1 Pneumonia 5 1 5 1 — 1 — — 1 6 4 6 30 Puerperal Pyrexia 4 5 4 3 7 2 5 8 5 7 3 5 58 Tuberculosis Pulmonary 3 5 7 7 7 6 8 8 10 3 4 5 73 Tuberculosis Non-pulmonary 1 — — 1 — 2 1 — — 1 1 — 7 Opthalmia Neonatorum — — — 1 - - - - - - 1 — 2 Tuberculosis The new cases admitted to the tuberculosis register during the year numbered 145, classified as follows: Males Females Pulmonary 68 Pulmonary 69 Non-pulmonary 2 Non-pulmonary 6 Of the total additions, 80 were primary notifications, 64 were transferred from other districts, and 1 came to notice in other ways. For the same period, 72 names were removed from the register for the following reasons: Recovered 8 Death 17 Otherwise (including removals) 47 After allowing for the additions and deductions, the state of the register at the 31st December, 1952, was as shown in the following table: TUBERCULOSIS—WARD DISTRIBUTION. Cases on Register at 31st December, 1952. Ward. Pulmonary. Non-Pulmonary. Total Incidence per 1,000 population. Males. Females. Males. Females St. Helier North 75 81 10 12 178 21.0 St. Helier South 66 56 14 10 146 21.2 St. Helier West 67 68 8 9 152 18.5 North-East 63 72 10 6 151 16.0 North-West 32 32 — 2 66 9.2 Central 33 23 5 — 61 10.0 South-East 36 31 4 7 78 10.0 South-West 25 22 2 4 53 8.0 Totals 397 385 53 50 885 14.3 782 103 The total of 885 is 73 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 28 At other tuberculosis institutions 156 184 58 The number of tuberculous persons who died during the year was 17, distributed by age groups as follows: Age, Years. Pulmonary. Non-Pulmonary. Total. Males. Females. Males. Females. 0 - - - - - 1—5 - — — — — 5—15 — — — — — 15—25 1 — — — 1 25—35 2 2 — — 4 35—46 2 1 1 - 4 45—55 - 1 - - 1 55—65 2 — — — 2 65—up 3 2 — — 5 17 Totals 10 6 1 — The deaths attributable to tuberculosis were 15, as follows: DEATHS DUE TO TUBERCULOSIS, 1952. Ward. Pulmonary. Non-Pulmonary. Death Rate per 1,000 population. Mean age at Death. Male. Female. Male. Female. St. Helier North 3 - - - 0.35 40 St. Helier South 2 2 — — 0.58 39 St. Helier West 1 1 1 — 0.36 36 North-East 1 — — — 0.10 87 North-West - 1 1 — 0.27 58 Central 1 — — — 0.16 68 South-East — — — - - South-West 1 — — — 0.15 60 Totals 9 4 2 — 0.24 48 Two of these deaths were of unnotified eases. 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, 22 of such families were rehoused out of a total of 188 Council tenancies allotted during 1952. 69 60 TABLE 18. TUBERCULOSIS. New Cases, Age and Sex Distribution and Manner of Admission to Register, 1952. Age Group Years. Primary Notifications "A." Cases transferred from other Districts. Cases brought to notice other than by Notification or Transfer. Total New Cases Pulmonary. Non-Pulmonary Pulmonary. Non-Pulmonary Pulmonary. Non-Pulmonary M. F. M. F. M. F. M. F. M. F. M. F. 0—1 - - - - - - - - - - - — - 1— 5 2 - 1 - 1 - - - - - - - 4 5—10 2 1 - - - - - - - - - - 3 10—15 1 4 - 1 - - - - - - - - 6 15—20 5 10 - - 1 4 - - - - - - 20 20—25 8 8 - - 1 10 - - - - - - 27 25—35 3 7 - - 19 15 - 1 - - - - 45 35—45 3 3 1 2 6 2 - - - - - - 17 45—55 4 2 - - 2 - - - - - - - 8 55—65 7 1 - 2 - 1 - - 1 - - - 12 65 up 1 1 - - 1 - - - - - - - 3 Totals 36 37 2 5 31 32 - 1 1 - - 145 80 64 1 INDEX PAGE Acreage 6 Births— Distribution 9 Institutional 10 Rates 11 Cancer 14 Cemeteries ... ... ... ... ... ... ... 29 Clinics and Treatment Centres ... ... ... ... 20 Closet Accommodation ... ... ... ... ... 23 Deaths—■ Classification 18 Distribution 13 Rate 11, 13 Diphtheria 46 Immunisation 19,46 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 34,35,36 Food— Food and Drugs Act 39 Hygiene 41 Inspection and Supervision 41 Poisoning 52 Health Services 19 Housing— Council's Scheme 31 Inhabited Houses 6 Inspection 32 Overcrowding 33 Slum Clearance 34 Ward Distribution 33 Ice Cream 38 Infant Mortality 16,17 Infectious Diseases 54,55,56,57 Inquests 15 Isolation Hospital- Admissions to 54 61 PAGE Laboratory Facilities 19 Maternal Mortality 16 Measles 48 Meat 38 Meningococcal Infection 50 Milk Supply 37 Milk and Dairies Regulations, 1949 38 Mortuary 29 Natural and Social Conditions 6 National Assistance Act 30 Offices 29 Outworkers 36 Ophthalmia Neonatorum 51 Pet Animals Act, 1951 30 Pneumonia 48 Poliomyelitis 50 Population 8 Public Cleansing 23 Puerperal Pyrexia 52 Rag Flock and other Filling Materials Act, 1951 30 Rateable Value 6 Rats and Mice Destruction 28 Rent and Mortgage Interest Restrictions (Amendment) Act, 1933 34 Rivers and Streams 23 Sanitary Circumstances Sanitary Inspection 24,25,26 27 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 Tents, Vans, Sheds and similar Structures 36 Tuberculosis 15,58 Unemployment 8 Vaccination 19,43 Vermin Control 27 Water Supply 21 Whooping Cough 49 Zymotic Diseases— Deaths from 7 62