Carsbalton Urban district Annual Report OF THE Medical Officer of Health FOR THE YEAR 1953 CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1953 PREFACE To the Chairman and Members of the Carshalton Urban District Council Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report in respect of the year 1953, this being the twentieth yearly review I have presented on the health of the Urban District. After such an interval of time it might not be inappropriate to look back over the last two decades and note what changes have occurred for better or for worse in so far as they are evidenced by statistics. The birth rate in 1934 was 16.5 per thousand population. In the intervening period, like the national index, it has shown a downward trend, though not without a somewhat violent fluctuation due to the second world war. It now stands at 12.5. The death rate, always a favourable one compared with that for England and Wales, is little changed now at 8.4 per thousand from 1934, when it was 8.6. In the last twenty years it has varied within the limits of 6.6 and 9.5 and has always been below 10, whereas the national figure has always been above that level. Since the 1930's we have had the advantage, as a result of rapid development, of a young resident population, probably the youngest in Surrey. With the virtual cessation of housing development within our boundaries, the average age of the population must inevitably increase at an accelerating rate and in future the death rate will have to contend with this factor. What of the causes of mortality, the contenders for pride of place at the head of the list of "the captains of the men of death"—the chief killing diseases? More than any, cancer has more firmly established its position among the leaders and now kills twice as many people as it did twenty years ago. Tuberculosis, on the other hand, has fallen before the continued onslaught of the anti-tuberculosis schemes and is now only half as dangerous a mortal enemy. One of the prices of increasing longevity is the greater risk of dying from degenerative conditions of the heart, a natural process, to some extent, of wear and tear. It is not surprising, therefore, since the mean age at death has risen from below 50 to its present level of 65.9 yrs., that heart disease continues to be the chief cause of death. The greater proportion of such deaths in recent years, due to coronary disease of the heart, may well be a reflection of the increasing stress and tempo of modern life. Perhaps in no field of Public Health do the statistics reveal a more marked advance than in the saving of infant life and the experience of the last twenty years is only a continuation of the rapid progress which followed the institution of Maternity and Child Welfare Schemes. 3 Infant mortality in Carshalton in 1934 stood at 53.5 deaths per thousand live births. In 1953 it was 23.3 and has been under 30 for the last nine years. The risks of maternity have been equally reduced, so much so that no maternal death (excluding abortion) has been registered in the last nine years. Some significant changes have occurred in the realm of infectious disease. Diphtheria has given way before the advance in immunology and has now been virtually eliminated from our midst, whereas twenty years ago more than 50 children annually suffered a long and debilitating illness from this cause and no year was without its diphtheria mortality. The strict protection of our water supplies has made enteric infection a still rarer occurrence, whilst the discovery of the modern anti-biotics and chemotherapeutic agents has robbed many infections of their terrors, especially puerperal fever, meningitis and ophthalmia in the newborn, to mention but a few. Logically enough, those infectious illnesses due to ultra-microscopic viruses on which the sulpha drugs and anti-biotics have little effect are now claiming the attention of preventive medicine in an increasing degree. Influenza and poliomyelitis are notable examples, the latter disease having now assumed annual epidemic proportions unknown in this country before the war. The fight against tuberculosis has been increased by attacks from many new directions. The results of treatment have been improved by new surgical procedures and new drugs, whilst mass radiography and B.C.G. vaccination hold out greater hopes in the field of prevention. Recent developments, too, in the preparation of an effective vaccine against whooping cough are promising, though no means yet have been discovered of preventing measles, which continues to take its annual toll of child health, with unaltering and relentless regularity. The last twenty years have seen the creation of a Ministry of Food. Originally designed to deal with the immediate threat to our food supplies arising from conditions created by the war, it has, during its history, made considerable additions to the statutory powers for controlling the quality and purity of our daily food. The increased range of commodities and types of investigation thereof made by the Council as a Food and Drugs Authority is evidence of these increased powers. The war too introduced an additional risk, apart from the threat of scarcity. The movements of population, particularly from across the Atlantic, introduced into this country many varieties of food poisoning organisms previously unknown to us and this, together with the growing practice of "eating out," has substantially increased the number of outbreaks of food poisoning compared with pre-war times. There is little that can be put to the credit side of war, but it was responsible for one big advance in public health. The organisation of the arrangements for food distribution and the satisfaction of the needs of the priority groups greatly improved the nutritional condition of the great mass of the lower income groups, particularly of the rising generation. There is ample evidence available in the records of our Child Welfare and School Health Services to show that the standard of physical development in children has never been so high as at the present time. One of the notable effects of the war from the public health point of view was the enforced cessation of building development with its 4 consequent increase in the level of housing occupation. The development of the St. Helier Estate during the 1930's increased the proportion of smaller properties with relatively few rooms. The result of this was that whilst the number of persons in private households per dwelling actually fell between the census of 1931 and that of 1951 from 3.76 to 3.63, the number of persons per room rose from 0.71 to 0.80 in the same period; the highest of any district in Surrey. It can fairly be said that in the last twenty years a steady advance has been made on the broad front of public health. Some problems still remain and some new ones have arisen, but many solid achievements lie behind us and we can look forward with hope and confidence provided we never lose sight of the fact that health is our greatest asset which must not be sacrificed to any other consideration. In conclusion, I would like to place on record my appreciation of the encouragement the Council have always afforded me, not least in their keen sense of responsibility as a Public Health Authority. I would, too, express my thanks to all members of my staff who have given me that willing and loyal assistance to which, for so long, I have been accustomed. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, F. LAWRENCE SMITH, Medical Officer of Health. August, 1954. 5 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., resigned 30.9.53 * G. R. Surfleet, C.R.S.I., from 1.10.53 Sanitary Inspectors: * L- W. Rivett, C.R.S.I. * W. J. Land, C.R.S.I., from 27.4.53 * J. P. Dixon, C.R.S.I., from 9.11.53 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. 6 Section A—Natural and Social Conditions of the District. Area (in acres) 3,346 Number of inhabited houses (end of 1953) according to Rate Books 17,059 Rateable Value at 31st December, 1953 £522,340 Sum represented by Id. rate £2,127 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, one head of the river arising from several springs at the outcropping of the chalk near the centre of the district. Owing to the increasing abstraction of water from the underground supplies, the flow from these springs has, for a period of years, become progressively more irregular with periods of failure. There is now a significant risk following times of low rainfall of the ornamental ponds and water courses becoming areas of stagnant mud and of the river pollution becoming more concentrated with a consequent prejudice 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. If the inviolability of the Green Belt and the long-established public open spaces is to be respected, the scope for further development is exhausted except by re-development in greater density. 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. The Census of 1951 reveals that the level of housing occupation at 0.80 persons per room was the highest in the county. 7 SUMMARY OF VITAL STATISTICS FOR 1953. (Based on the Registrar-General's Figures.) Population. Registrar-General's Estimate 61,680 Births. Males. Females. T otal. Live (Legitimate) 384 358 742 (Illegitimate) 16 14 30 400 372 772 Birth Rate (per 1,000 population) 12.5 Stillbirths (Legitimate) 13 10 23 (Illegitimate) — 1 1 13 11 24 Stillbirth Rate per 1,000 total births 30.1 Deaths 275 248 523 Death Rate (crude) per 1,000 population 8.4 Infant Mortality. All deaths under 1 year 10 8 18 Infant Mortality Rate (per 1,000 live births) 23.3 Deaths of leg. infts. under 1 year 9 8 17 Rate per 1,000 legitimate births 30.1 Deaths of illeg. infts. under 1 year 1 — 1 Rate per 1,000 illegitimate births 33.1 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 8 5 13 Rate per 1,000 of population 0.21 Phthisis 7 4 11 Rate per 1,000 of population ... 0.17 Deaths from Cancer 68 58 126 Rate per 1,000 of population 2.04 8 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 1953 are supplied through the courtesy of the Exchange Manager and the Youth Employment Officer: Men 138 Women 54 Boys 22 Girls 11 POPULATION The Registrar-General's estimate of the home population at mid-1953 is 61,680, compared with 62,721 enumerated at the census in 1951. The following gives the estimated ward populations based on the Registrar-General's totals: TABLE 1. ESTIMATED RESIDENT POPULATION, MID-1953, BY WARDS. Ward. Houses at Mid-1953. Estimated population Mid-1953. St. Helier North 2,166 8,640 St. Helier South 1,698 7,115 St. Helier West 2,094 8,080 North-East 2,756 9,965 North-West 2,148 7,435 Central 1,761 5,975 South-East 2,388 8,090 South-West 2,048 6,380 Whole District 17,059 61,680 9 BIRTHS The number of live births registered during 1953 was 772, which is 11 less than in the year before. Of these, 400 were males and 372 females, giving a birth rate of 12.5 per thousand population. The "comparable" birth rate produced by the application of the Registrar-General's comparability factor of 0.96 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 15.5 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 809 births and 24 stillbirths occurred in 1953. They were distributed as shown in the following table. Ward. Live Births. Birth Rate per 1,000 Population. Stillbirths. Stillbirth Rate per 1,000 total births St. Helier North 99 11.4 2 19.8 St. Helier South 88 12.3 4 43.4 St. Helier West 129 15.9 2 15.2 North-East 170 17.0 6 34.0 North-West 84 11.3 3 34.4 Central 71 11.8 5 65.7 South-East 97 11.9 2 20.2 South-West 71 11.1 Seventy-nine 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 79 St. Helier South 80 St. Helier West 75 North-East 81 North-West 87 Central 79 South-East 69 South-West 86 10 Out of 833 total births, 666 took place in the following hospitals and nursing homes: Live. Still. Total. Carshalton, Beddington and Walling- ton District (War Memorial) Hospital 79 3 82 St. Helier Hospital 450 13 463 Other Surrey Hospitals 87 1 88 Other Hospitals 13 2 15 Private Nursing Homes 18 — 18 Totals 647 19 666 The use of hospital facilities for childbirth continues to grow. Four out of five Carshalton babies are now born in maternity institutions whereas twelve years ago less than half that proportion were not born in their own homes. This liberal allocation of hospital accommodation to maternity is thrown into greater relief when contrasted with the inadequate provision available to the aged and infirm needing inpatient treatment. a TABLE 2. BIRTHS, 1953, DOMICILIARY AND OTHERS — BY WARDS. Born in District. Born Outside District. Ward. In Hospitals and Nursing Homes. In Private Houses. Total. In Hospitals and Nursing Homes. In Private Houses. Total. Grand Total. St. Helier North 74(7) 20(2) 94(2) 6 1 7 101(2) St. Helier South 74(3) 17(7) 91(4) — 1 1 92(4) St. Helier West 95(2) 32 127(2) 4 — 4 131(2) North-East 127(4) 31(2) 158(6) 16 2 18 176(6) North-West 51(3) 11 62(3) 25 — 25 87(3) Central 49 (.3) 16 65(3) 11(2) — 11(2) 76(5) South-East 48 30(7) 78(7) 21(7) — 21(7) 99(2) South-West 27 10 37 34 — 34 71 Totals 545(76) 167(5) 712(27) 117(3) 4 121(3) 833(24) (Figures in brackets indicate stillbirths included in totals.) TABLE 3. BIRTH AMD DEATH RATES FOR CARSHALTON, 1922-1953. 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 1953 61,680 12.5 8.4 23.3 0.0 12 TABLE 4. COMPARATIVE STATISTICS—1953 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 Birth Live 15.5 17.0 15.7 17.5 12.5 Still 0.35 0.43 0.34 0.38 0.38 22.4(a) 24.8(a) 21.4(a) 21.0(a) 31.0(a) Deaths — All causes 11.4 12.2 11.3 12.5 8.4 Typhoid and Paratyphoid 0.00 0.00 Whooping Cough 0.01 0.01 0.00 0.00 Diphtheri 0.00 0.00 0.00 — Tuberculosis 0.20 0.24 0.19 0.24 0.21 Influenza 0.16 0.15 0.17 0.15 0.08 Smallpox 0.00 0.00 0.00 Acute Poliomyelitis including( Polioencephalitis) 0.01 0.01 0.01 0.01 Pneumonia 0.55 0.59 0.52 0.64 0.48 Notifications (Corrected.)— Typhoid fever 0.00 0.00 0.00 0.01 Paratyphoid fever 0.01 0.01 0.01 0.01 Meningococcal infection 0.03 0.04 0.03 0.03 0.01 Scarlet fever 1.39 1.50 1.44 1.02 2.04 Whooping Cough 3.58 3.72 3.38 3.30 5.59 Diphtheria 0.01 0.01 0.01 0.00 — Erysipelas 0.14 0.14 0.13 0.12 0.11 Smallpox 0.00 0.00 0.00 — — Measles 12.36 11.27 12.32 8.09 10.57 Pneumonia 0.84 0.92 0.76 0.73 0.81 Acute Poliomyelitis (including Polioencephalitis)— Paralytic 0.07 0.06 0.06 0.07 0.09 Non-paralytic 0.04 0.03 0.04 0.03 0.04 Food Poisoning 0.24 0.25 0.24 0.38 0.22 Rates Per 1,000 Live Births Deaths— All causes under 1 year of age 26.8(b) 30.8 24.3 24.8 23.3 Enteritis and Diarrhoea under 2 years of age 1.1 1.3 0.9 1.1 1.29 Rates Per 1,000 Total Births (Live and Still) N otifications (Corrected)— Puerperal Fever and Pyrexia 18.23 24.33 12.46 28.61 266.3 Maternal Mortality— Abortion with Sepsis 0.06 Other Abortion 0.05 Sepsis of pregnancy, childbirth and the puerperium 0.10 Other complications of pregnancy, childbirth and the puerperium 0.55 (a) Per 1,000 total (Live and Still) Births (b) Per 1,000 related live births 13 COMPARATIVE HEALTH STATISTICS, 1934/53 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 1953 11.4 8.4 26.8 23.3 0.65 0 DEATHS The deaths allocated to the district, as adjusted by inward and outward transferable deaths, was 523—275 males and 248 females. This gives a crude death rate of 8.4 per thousand population as against 8.9 in the year before. The "comparable" death rate produced by the application of the Registrar-General's comparability factor of 1.21 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 11.4. The distribution of the deaths by wards was as follows: WARD DEATH RATES AND MEAN AGE AT DEATH, 1953. Ward Deaths Death Rate (crude) Mean Age at Death St. Helier Nortb 54 6.2 60.8 yrs. St. Helier South 46 6.4 60.7 „ St. Helier West 52 6.4 61.8 „ North-East 74 7.4 62.4 „ North-West 80 10.7 66.4 „ Central 67 11.2 68.4 „ South-East 64 7.9 64.2 „ South-West 84 3.1 69.9 „ Whole District 521 8.4 65.9 yrs. The most significant feature of the death rate in 1953 is the prominence assumed by cancer among the chief single causes of death. Mortality from this disease at 2.04 per thousand population is the highest yet recorded for the district and is due in large part to a big 14 increase in death from cancer of the lungs. No fewer than 30 such deaths were recorded as compared with 11 in the year before and an average of 13.5 in the ten previous years. As will be seen from Table 5 which follows, cancer of this site was nine times more common in the male than in the female. CANCER DEATHS—WARD DISTRIBUTION, 1953 Ward Cancer Deaths Rate per 1,000 Estimated Population St. Helier North 10 1.15 St. Helier South 9 1.26 St. Helier West 15 1.85 North-East 18 1.80 North-West 16 2.15 Central 16 2.67 South-East 23 2.84 South-West 19 2.97 The classification of the cancer deaths by sites affected is given in Table 5. TABLE 5 Group Site Affected Male Female Total Digestive Organs— 142 Parotid 1 — 1 144 Palate 1 — 1 150 Oesophagus 2 3 5 151 Stomach 9 11 20 153 Colon 8 6 14 154 Rectum — 3 3 155 Liver and gall bladde 2 1 3 157 Pancreas 1 4 5 158 Peritoneum Respiratory System— 1 1 2 162 Lungs and Bronchus Breast and Genito-Urinary— 27 3 30 170 Breast — 10 10 171/4 Uterus — 3 3 175 Ovary — 4 4 177 Prostate 6 — 6 179 Penis 1 — 1 180 Kidney — 1 1 181 Bladder Other Sites 2 4 6 191 Skin — 1 1 193 Brain 1 — 1 194 Thyroid — 2 2 196 Bone — 1 1 199 Unspecified 3 1 4 200/5 Lymphatic tissue 2 — 2 Average age at death: Males 63.3 years Females 63.6 years All persons 63. 4 years 16 Mortality from tuberculosis fell still further during 1953, 13 such deaths being registered. This gives a death rate of 0.21 per thousand population compared with 0.24 in the year before. The death rates from this cause for the last 20 years were as follows: Year Death Rate per 1,000 Population Year Death Rate per 1,000 Population 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 1943 0.81 1953 0.21 The distribution of tuberculosis mortality by wards and other details are given in Section F of this report. Except in one case of meningococcal meningitis, there were no deaths from the common infectious diseases. In recent years, coronary disease of the heart has become more prominent among the main causes of death. In 1953 this particular form of cardiac disease accounted for approximately half the total deaths attributed to heart disease. Violent causes accounted for the death of 19 residents. They were as follows: Suicide 9 Motor Vehicle Accidents 2 Accidental Coal Gas Poisoning 1 Accidents in the Home 5 Accidents at Work 2 Inquests. Inquests were held on 56 persons who died in the district. The following verdicts were returned: Accidental Death 33 Suicide 13 Misadventure 3 War Operations 1 Natural causes 5 Open Verdict 1 Sixteen of the total were residents of the district. Six were due to road accidents. 16 INFANT MORTALITY The deaths of 18 children who died under the age of one year were registered, of which nine were males and eight females. These provide an infant mortality rate of 23.3 per thousand live births compared with 28.0 in the year before. The comparable rate for England and Wales was 26.8. All but one were deaths of legitimate children. Two-thirds of the deaths occurred in the first month of life. Congenital malformations, prematurity and diseases peculiar to infancy accounted for 15 and infections for three. 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 3 30.0 St. Helier South 2 22.7 St. Helier West 2 15.5 North-East 4 23.5 North-West 4 47.6 Central 1 14.0 South-East 2 20.6 South-West — — MATERNAL MORTALITY There were no maternal deaths. 17 18 TABLE 7. INFANT MORTALITY DURING THE YEAR 1953. Deaths Classified as to Cause and Age at Death. Cause of Death. Under 1 week. 1—2 weeks. 2—3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total deaths under 1 year. Prematurity 6 - - - 6 _ - - - 6 Congenital Malformation 1 1 1 — 3 — 3 — — 6 Birth Injury 2 — — — 2 — — — — 2 Maternal Haemorrhage 1 — — — 1 — — — — 1 Pneumonia — — — — — — 2 — — 2 Gastro Enteritis — — — — — 1 — — — 1 Totals 10 1 1 — 12 1 5 — — 18 tc TABLE 8—CAUSES OF DEATH DURING THE YEAR 1953—By Age and Sex No. Causes of Death 0 — i — 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. Prns. All Causes 10 8 1 — 4 1 2 2 5 2 7 7 37 23 65 37 67 63 75 105 273 248 521 1 Tuberculosis, Respiratory - - - - - - - 1 1 - 1 1 - - 1 1 4 1 - - 7 4 11 2 Tuberculosis, other - - - - - - 1 — 1 1 1 2 3 Syphilitic disease - - - - 1 1 2 2 4 Diphtheria - 5 Whooping Cough - - 6 Meningococcal Infections - 1 - - - - - 1 1 7 Acute Poliomyelitis - - - — — — — — — — — — — — — — — - - 8 Measles - - - — — — — — — — — — — — — — — — — — — — - 9 Other Infective and Parasiti Diseases - - - - 1 - - - - - - - - - - - - - - - 1 1 10 Malignant Neoplasm, Stomach - - - — — — — — — — — 2 2 1 4 I 2 7 1 9 11 20 11 Malignant Neoplasm, Lung - - - — — — — — — — 1 — 5 — 12 1 7 2 2 27 3 30 12 Malignant Neoplasm, Breast - - - — — — — — 2 4 3 1 10 10 13 Malignant Neoplasm, Uterus - - - — — — — — — — — — — 1 — 2 — — — 3 3 14 Other Malignant and Lymphatic Neoplasms - - - 1 — 3 — — 1 3 2 6 10 5 11 13 8 31 32 63 15 Leukaemia, Aleukaemia - - - — — — — — — — — 1 — — 1 1 1 2 16 Diabetes - - - : 1 — — — — — 2 3 3 17 Vascular Lesions of Nervous System 1 1 - 1 — 3 1 5 4 9 6 6 19 25 31 56 18 Coronary Disease, Angina - - - — — — — — 1 — 7 1 16 3 19 6 5 11 48 21 69 19 Hypertension with Heart Disease - - - — — — — — — 1 1 2 1 3 3 5 8 20 Other Heart Disease - - - - — 1 — 3 2 2 3 3 11 17 27 26 43 69 21 Other Circulatory Disease - - - — — — — — — — — — — 2 3 2 1 6 5 9 9 19 28 22 Influenza - - - — — — 1 1 1 1 1 2 3 5 23 Pneumonia 2 - - 1 — 2 1 2 2 3 2 3 11 13 16 29 24 Bronchitis - - — — 1 5 6 2 6 5 18 7 25 25 Other Diseases of Respiratory System - - - — — — — — — — — — — — — 1 1 1 — 2 1 3 26 Ulcer of Stomach and Duodenum - - - - - -- — — — 2 —. — 1 — 2 5 5 27 Gastritis, Enteritis and Diarrhoea - 1 - 1 - - - - - - 1 1 1 1 — 1 3 4 7 28 Nephritis and Nephrosis - - - - - - - — — — — — 2 — — 3 1 3 3 6 29 Hyperplasia of Prostate - - - - - - - - - - — —k — — 1 — — — 3 4 4 30 Pregnancy, Childbirth, Abortion - - — 31 Congenital Malformations 2 4 - - - - - - - - - 1 — 1 1 1 — 3 7 10 32 Other Defined and Ill-defined Diseases 5 2 1 1 1 — 2 4 2 3 1 3 5 15 15 30 33 Motor Vehicle Accidents - - 1 - 1 - 2 2 34 All other Accidents — — — 2 — 1 1 4 4 4 8 35 Suicide — - 1 1 1 1 1 2 1 1 — 5 4 9 36 Homicide and Operations of Was - — - — — — — — — — - — — — - — — — — — - — — 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. Samples of milk for biological examination for tuberculosis are submitted to the Public Health Laboratory at Guildford. The following examinations were made during the year: Throat and Nose Swabs 6 Faeces Specimens 229 Rectal Swabs 6 Blood Specimens 3 Water (Public Supply): for chemical analysis 2 For bacteriological examination 5 Water (Swimming Bath): For bacteriological examination 1 Food and Drugs: Analysis 345 Bacteriological examination of milk 224 Bacteriological examination of ice cream 84 Bacteriological examination of other foods for food poisoning organisms 3 Biological examination of milk 15 Vaccination and Immunisation The County Council is responsible for the scheme of vaccination and immunisation under Section 26 of the National Health Service Act. By arrangement with the District Councils, District Medical Officers of Health direct these schemes locally on behalf of the County Council. The service, as now developed, provides for (i) vaccination against smallpox, (ii) immunisation against diphtheria, (iii) immunisation against whooping cough. Details of the work done in this connection are shown in Section F of this report dealing with infectious diseases. 20 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. Wry the Dane 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 Dane: 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 and Whooping Cough 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. 21 Section C— Sanitary Circumstances. Water Supply The Sutton and District Water Company supplies water to the whole district except to 170 dwellings in the extreme north which are supplied by the Metropolitan Water Board. The source of supply is normally from wells in the chalk at Sutton, Cheam and Woodmansterne, but it can be augmented, if necessary, by the Metropolitan Water Board, the Epsom and Ewell Corporation and the East Surrey Water Company. The Company is under statutory obligation to soften to 9° of hardness. All dwellings have a piped supply from the mains. The finished water is not plumbo-solvent. Quality and quantity were satisfactory throughout the year. The raw well water is subjected to chlorination and both the raw and finished waters are submitted to bacteriological and chemical testing by the Company's resident chemist, by independent analysts and by the Public Health Departments of the Local Authorities in the supply area on an agreed rota The following is a summary of the results of the tests carried out by the Company and are supplied by courtesy of the Engineer and Works Manager. Sample. Total No. of Bacteriological Examinations Total No. of full Chemical Analyses No. and % of samples showing Coli-Aerogenes in 100 ml. (excluding B. Coli 1 and 2) No. and % of sample showing B. Coli present in 100 ml. of sample Type 1 and 2 Total No. ColiAero genes Organisms in 100 ml. of sample No. 0/ /o No. % Sutton Raw 300 26 19 6.3 16 4.0 35 Sutton Finished 354 19 25 7.1 7 1.9 32 Woodmansterne Raw 309 28 1 0.3 Nil Nil 1 Woodmansterne Finished 310 19 3 0.9 1 0.3 4 Cheam 312 21 3 0.9 5 1.6 8 Reservoir 217 1 2 0.9 Nil Nil 2 District (excluding new mains) 281 Nil 6 2.1 4 1.4 10 New Mains 81 Nil 39 41 9 11.2 48 Total 2,164 114 22 Water as delivered to the consumer is examined monthly by the Counties Public Health Laboratory on behalf of the Company and a further 11 chemical and 22 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.) 180 Combined chlorine 14.2 Nitric nitrogen 4.9 Nitrous nitrogen none Ammonia, free and saline 0.00 Ammonia, albuminoid 0.005 Oxygen absorbed from permanganate in 4 hours at 26.7° C. 0.04 Hardness—by acidimetric titration—Temporary 95 Permanent 34 Total129 Reaction for free chlorine at 4.0 p.m. on the 15th none Iron and other metals absent pH 7.5 The water was bright and clear and was normal in colour. Bacteriological examination Action by free chlorine during transit of the sample was prevented at the time of sampling Number of colonies per ml. developing upon agar in 2 days at 37° C. 0 Number of colonies per ml. developing upon agar in 3 days at 22° C. 3 Organisms of the coliform group absent in 100 ml. Streptococci absent do. CI. welchii absent do. This water is of excellent organic purity and of moderate hardness and salinity and is similar in chemical composition to previous samples from the same source. The water is attractive in appearance and free from contaminating metals. There was no residual chlorine at the time of receipt. The bacteriological condition is excellent 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 9.06°. Seven exceeded the statutory limit of 9° and 4 were below. Drainage and Sewerage In addition to the routine work of cleansing sewers, soakaways and gullies, a new foul sewer has been constructed in Devonshire Road and a small re-arrangement made in the drainage of the properties there. Schemes for the alleviation of flooding in various parts of the district are actively in hand. 23 Sewage is pumped to the disposal works of the Croydon Corporation in Beddington, except at various points on the fringes of the district, where it is more conveniently drained to the sewage systems of neighbouring authorities. Surface drainage in the south is mainly by soakaways in the chalk; elsewhere it is by surface sewers to the River Wandle. Two hundred and seventy-eight drainage obstructions affecting 1,137 houses were dealt with, chiefly concerning 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. During September, the natural spring waters in various parts of the district ceased to flow. Routine cleansing work was maintained on the Tweeddale Road open ditch. The Council's scheme for piping in this watercourse has now received Ministry approval. One complaint was received during the year regarding the River Wandle, which 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 The Council's Engineer and Surveyor is responsible for this service. Collection Refuse is collected by a fleet of modern vehicles suitably designed to meet the requirements of differing types of property and differing types of approach. All are fitted with hydraulic tipping gears. The collection of kitchen waste for pig food has been discontinued, thus removing a potential source of public health nuisance. Disposal After extraction of saleable salvage material, refuse is burnt in a six-cell destructor. A limited amount of tipping is unavoidable and great care is exercised both with regard to suitability of site and control over the method of tipping. 24 Sanitary Inspection The following information supplied by the Chief Sanitary Inspector, under Article 27 of the Sanitary Officers' Regulations, 1935, indicates the action taken in sanitary inspection during the year. Investigations were made with regard to 1,327 complaints as follows: Accumulations 28 Animals so kept 7 Burst pipes 2 Dampness 34 Ditches and ponds 1 Drainage defects 48 Drains obstructed 310 Dustbins 155 Food contaminated 8 General defective conditions 81 Insects and Pests 67 Milk, contaminated and dirty bottles 4 Miscellaneous 21 Obnoxious effluvia 25 Overcrowding 21 Pig bins 5 Refuse collection 14 Rivers 1 Rodents 302 Roofs, defective 25 Sewer obstructions 4 Shops 1 Sink waste pipes 6 Smoke nuisances 24 Unsound food 117 Verminous premises 14 Water supply 2 1,327 Twelve thousand five hundred and thirty-three visits of inspection and re-inspection were made for the purposes set out below: Animals slaughtered and inspected 2 Business premises 67 Cowsheds 13 Employment Agencies 4 Factories (Mechanical Power) 253 Factories (Non-Mechanical Power) 84 Food and Drugs and other samples 582 Food and Drugs—Food Bye laws 25 Food poisoning inquiries 20 Food premises: Apartment houses 2 Bakehouses 43 Bakers and confectioners 50 Butchers 133 Canteens 59 Canteens—school 29 Chemists 18 Cinema 9 Confectioners (sweets only) 95 Fishmongers 68 25 General Stores 38 Greengrocers and fruiterers 120 Grocers 259 Licensed premises with catering facilities 16 Licensed premises without catering facilities 12 Ice cream vehicles 20 Milk shops 34 Restaurants and cafes 90 Stalls, food 43 Tea Packer 1 Unsound Food: Meat 45 Food other than meat 100 Vehicles, food 73 1,357 Hairdressers 41 House drains tested 84 Housing Act 518 Heating Appliances (Fireguards) Act 4 Housing Inquiries 849 Housing Land Charges 888 Merchandise Marks Act 153 Offices 9 Outworkers premises 90 Pet Animals Act 29 Piggeries 38 Premises re cesspools 3 Public Health Act (Houses) 3,501 Public Health Act re-inspections 2,577 Rag Flock and Other Filling Materials Act 62 Rodents 517 Schools 90 Shops 507 Smoke observations 108 Urinals 33 Water sampling 25 12,533 Five hundred and eighty-four informal notices were served concerning the following matters: Accumulations and deposits 11 Animals so kept 3 Drainage defects 161 Dustbins 66 Factories Act 13 Food Bye laws 8 Food and Drugs Acts 37 General defective conditions 169 Merchandise Marks Act 5 Milk Regulations 2 Miscellaneous 3 Obstructed drains 1 Overcrowding 62 Rodents 2 Shops Act 30 Smoke nuisances 4 Verminous premises 6 Water supply 1 584 36 Sixty-two formal notices were served by authority of the Council under the following Acts: Public Health Act, 1936, Section 24 26 „ „ „ „ , Section 39 3 „ „ „ „ Section 45 1 „ „ „ „ , Section 75 10 „ „ „ „ , Section 93 20 Factories Act, 1937, Section 7 2 62 As a result of investigations made and notices served, the following work was carried out: Accumulations removed 5 Brickwork, repaired and/or re-pointed 7 Ceilings cleansed and purified 33 Ceiling plaster repaired and/or made good (including plaster board) 22 Cement plinths, renewed 1 fillets, renewed 3 Chimney stacks repaired and/or made good 7 flues repaired 5 Coppers repaired 1 Damp conditions remedied 68 Damp course provided 1 renewed 3 Disinfestations 52 Ditches cleaned 1 Doors and frames repaired, including locks and fasteners 8 Drainage repaired and/or reconstructed at houses 45 (439 ft. drain laid) inspection chamber repaired and/or made good 11 inspection chambers provided 1 inspection chamber covers renewed 8 stoppers or caps refixed and/or renewed 3 Drainage fresh air inlets repaired and/or renewed 2 soil vents repaired and/or renewed 7 drains tested 36 drains cleared (affecting 1137 houses) 278 drains sealed off 1 waste gullies repaired, renewed or cleared 11 waste pipes, repaired, renewed or provided 6 Dustbins provided 76 Fences repaired or renewed 3 Fireplaces ranges or stoves repaired and/or made good 19 provided 2 Floorboards repaired and/or made good 10 Floors ventilation repaired 2 ventilation provided 2 Gates renewed 1 Glazing panes renewed 2 putty renewed 6 Paving repaired and/or made level 3 drained 2 Roofs repaired and made weatherproof 59 down pipe, guttering repaired and/or renewed 31 Shops, hot water, means of supply provided 5 Sinks renewed 1 Soak away made to work properly 3 27 Stairs or steps repaired, renewed or made level 2 baluster repaired 4 Surface water drainage repaired and made to work properly 7 Ventilation, more provided 1 Walls rendered or rendering repaired 6 replastered and/or repaired 42 cleansed and redecorated 33 rebuilt 4 Wash basins, baths renewed 6 Water supply repaired 6 Weatherboard repaired 1 W.C. accommodation repaired 3 provided 5 pans renewed 9 pans provided 5 pan joints renewed 5 seats repaired, renewed or provided 6 lift-up seat provided 1 box seats removed 1 flushing apparatus repaired or renewed 8 Windows repaired and/or renewed 53 Window sills (external) repaired 8 Woodwork repaired and/or renewed 3 Miscellaneous items 7 Disinfection In connection with cases of infectious disease, 207 rooms, 1 shelter and 339 library books were disinfected. Three lots of bedding were sterilised and three lots destroyed. Vermin Control Persons The Council maintain a Cleansing Station in adapted premises in Rochester Road for the treatment of verminous persons and their personal clothing. This is equipped with baths and a Thresh Steam Disinfector. A trained nurse is in attendance to deal with women and children and a male operator for the men. Instances of infestation are followed up by the nurse by visits to the home where arrangements are made to deal with the family as a unit. 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 20 27 51 For pediculosis 7 22 61 Schoolchildren included in these totals were: For scabies 2 For pediculosis 11 28 As mentioned in the last report, the incidence of verminous conditions, including scabies, has diminished markedly since the war. The ease with which scabies can be transmitted through individuals in the close association of domestic life was exemplified by an outbreak during the year in an old persons' home, when 13 persons out of a total of 23 were found to be infested. Premises During the year, three lots of verminous bedding were stoved and two lots were destroyed and fifty-two premises were treated for the destruction of vermin and insect pests as follows: Infestation Property Treated by C.U.D.C. Property Treated Total C.U.D.C. Property S.C.C. Property Privately Owned Property By L.C.C. By Owners Ants 4 1 – 1 6 Bugs 2 – 2 2 1 7 Fleas – – 1 – – 1 Flies – 10 2 – – 12 Mites – – 1 – – 1 Moths – 1 – – 1 2 Silverfish – – 1 – – 1 Wasps 2 1 19 – – 22 4 16 27 2 3 52 Incoming tenants of Council houses as well as vacated Council premises are visited by the Sanitary Inspectors before letting is effected to ensure that verminous families are not admitted to clean houses and vice versa. Smoke Abatement Twenty-four complaints were received and dealt with during the year. The Council's attention was drawn to an increasing quantity of smoke and grit being discharged into the atmosphere in the industrial part of the district. Three deposit gauges were installed at selected points at the end of the year and investigation will be undertaken in conjunction with the Department of Scientific and Industrial Research, the National Smoke Abatement Society and the London and Home Counties' Smoke Advisory Council. Prevention of Damage by Pests Act, 1949 Rodent destruction was carried out during the year in conformity with the scheme agreed with the Ministry of Agriculture and Fisheries. 29 Nineteen thousand, three hundred and fifty-seven visits were made concerning 1,395 properties and 351 rat and mouse infestations were found. Of that number, 306 were found in private premises, 30 in business premises and 15 in Council premises. With regard to sewers, two maintenance treatments were carried out, one in May and the other in October. The results are shown in the following table, together with those of the three previous years: May Treatment October/November Treatment 1950 1951 1952 1953 1950 1951 1952 1953 Manholes baited 84 87 153 195 173 252 266 205 Manholes in which takes of prebait were recorded 53 34 43 66 51 79 117 73 Percentage of manholes showing infestations 63 39 28 33.8 29 31 44 35.6 Percentage in relation to total manholes in district 4.6 3 3.8 5.8 4.5 7 10.3 6.4 Swimming Baths The only swimming bath in the district was acquired by the Council. The arrangements for the satisfactory control of these facilities have been reviewed. Offices Nine inspections of offices were made but no action was necessary. Factories, Workplaces and Outworkers The following table gives a summary of the registers: Employees Premises Males Females Total Factories— With mechanical power 866 547 1413 88 Without „ „ 33 12 45 18 Workplaces— With mechanical power 21 – 21 20 Without „ „ 13 9 22 18 933 568 1501 144 30 The following tables, set out in the manner prescribed by the Home Office Form 572 (Revised), indicates the inspections made and action taken under the Factories Act. 1. Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises Number of Number on Register Inspections Written Notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 18 84 3 – (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 88 253 10 – (iii) Other premises in which Section 7 is enforced by the Local Authority* (excluding outworkers' premises) – – – – Total 106 337 13 – * Electrical Station (Section 103 (1)), Institutions (Section 104) and sites of Building Operations and Works of Engineering Construction (Sections 107 and 108). 2. Cases in which Defects were found— (If defects are discovered at the premises on two, three or more separate occasions, they are reckoned as two, three or more "cases.") Premises Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness 1 – – – – Overcrowding – – – – – Unreasonable temperature – – – – – Inadequate ventilation – – – – – Defective drainage of floors – – – – – Sanitary Conveniences— (a) Insufficient 4 5 – – – (b) Unsuitable or defective 7 7 – – – (c) Not separate for sexes 1 1 – – – Other offences against the Act (not including offences relating to Outwork) – – – – – 31 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. 23 – – – – – Umbrellas 1 – – – – – Cosaques, Christmas Crackers, Christmas Stockings, etc. 32 – – – – – Total 56 – – – – – Shops Act, 1950 There are 520 shop premises on the register and 1,924 inspections were made during the year. Preliminary notices were served with regard to thirty infringements of the Act. During the year the Home Office and Scottish Department issued suggested provisions for amending Shops legislation with regard to shop closing hours and time off for adult shop assistants. The amending legislation, however, was still under consideration by the Government at the end of the year. Heating Appliances (Fireguards) Regulations, 1953 These regulations came into force on the 1st October and require that fireguards be fitted to gas fires, electric fires and oil heaters of types so designed that they are suitable for domestic use and so constructed that, without a guard, there is likelihood of injury by burning or of ignition of clothing by reason of contact with or proximity to the heating element or flame. Prescribed standards are laid down to which guards must comply. All such appliances must, by October 1st, 1954, comply with these standards. 32 Merchandise Marks Act, 1926 The Act provides that every Local Authority authorised to appoint an Analyst for the purposes of the Food and Drugs Act, 1938, may, so far as relates to any goods being foodstuffs to which an Order in Council (Marking Order) under the Act applies, execute any of the provisions of the Act other than provisions relating to the importation of goods. The Council have continued to execute the provisions of the Orders and their five Sampling Officers are appointed as authorised officers under the Act. Establishments for Massage and Special Treatment Six establishments were licensed under Part IV of the Surrey County Council Act, 1931, four for the practice of chiropody and two for massage, etc. All were found to be satisfactorily conducted. Employment Agencies There is only one employment agency in the district which was visited and found to be satisfactory. National Assistance Act, 1948 and 1951 The difficulty in securing institutional care for the old and infirm who are without adequate attention in their own homes has not diminished. The Medical Officer of Health is invariably approached for help in these cases. He has, however, no powers to resolve these problems until conditions have deteriorated to such an extent that the patient has become so insanitary as to be a health risk to himself or to others in the house. Section 47, which is his only authority in this respect, was designed to compel the removal of an unwilling person who has become insanitary, but such is the scarcity of accommodation that the section, or the threat of it, has probably been used more often to compel an unwilling authority to accept a willing inmate. No legal proceedings were taken under these Acts during the year. Pet Animals Act, 1951 Five licences have been granted in respect of premises used as Pet Shops. All the premises have been inspected and found satisfactory, the pets dealt in being almost exclusively fish and birds. Rag Flock and Other Filling Materials Act, 1951 Three premises used for upholstering are registered in accordance with Section 2 of the Rag Flock and Other Filling Materials Act, 1951. One informal sample of unused cotton felt was procured which did not comply with the Regulations. A preliminary warning was issued and all action was taken by the manufacturers to put the matter right. The prescribed Analysts are—The Chiltern Laboratories, Ltd., of Kingsmead Road, Loudwater, Bucks. 33 Disposal of the Dead No unused burial accommodation is available in Carshalton churchyard. Interment is now effected only by re-opening existing graves. The Carshalton and Merton and Morden Joint Cemetery Board, set up in 1943, acquired some 60 acres of land in Lower Morden for use as a cemetery, which was opened in 1947. During 1953, 379 interments took place there, of which 173 were from the Carshalton district. The Council's mortuary in Mill Lane is provided with all modern facilities. The number of bodies received there during 1953 was 138, on all of which autopsies were performed. The accommodation is being increasingly used for the reception of bodies from other districts, this user now exceeding that from the Urban District itself. National Assistance Act—Section 50 Three burials were arranged by the Council during the year under Section 50 of the National Assistance Act, 1948. 34 Section D—Housing. New Houses During the year the following 52 houses and flats were completed: Council Flats 27 Private Houses 25 Total 52 Buildings in course of erection at the end of the year were as follows: Council Flats 94 Private Houses 21 Total 115 Council's Housing Scheme The dwellings in the ownership of the Council at the year end totalled 1,340 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 „ 38 33 Grove Lane „ 24 132 The accommodation under requisition by the Council at 31st December, 1953, comprised 125 premises providing accommodation for 186 families. The outstanding approved applications for tenancies at the year end totalled 1,655 which was unchanged from the figure twelve months earlier. 35 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. — 518 P.H.A. — 3,588 4,106 (b) Number of inspections made for the purpose 6,683 (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) Namber 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 8 (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 407 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 1952) 254 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 – (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 60 (2) Number of dwelling houses in which defects were remedied after service of formal notices: (a) By owners 49 (b) By local authority in default of owners 1 36 4. Housing Act, 1936. Part IV (Overcrowding). (a) (1) Number of dwelling houses overcrowded at the end of the year 112 (2) Number of families dwelling therein 190 (3) Equivalent number of adults dwelling therein 766 (b) Number of new cases reported during the year 53 (c) (1) Number of cases of overcrowding relieved during the year 64 (2) Number of persons concerned in such cases 433½ (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 53 cases of overcrowding were found to exist and 64 cases were remedied leaving 112 dwellings with 766 equivalent adults in occupation overcrowded at the year end. The known position as to overcrowding at the beginning and end of the year was as follows: Ward Dwellings overcrowded at 31.12.52 Dwellings found overcrowded during 1953 Dwellings decrowded during 1953 Dwellings remaining over crowded at 31.12.53 Overcrowded cases remedied during 1953 Formal Action Informal Action Total St. Helier North 36 14 20 30 9 11 20 St. Helier South 32 13 15 30 2 13 15 St. Helier West 22 11 11 22 7 4 11 North-East 12 3 5 10 – 5 5 North-West 7 3 4 6 1 3 4 Central 6 3 3 6 2 1 3 South-West – – – – – – – South-East 8 6 6 8 1 5 6 123 53 64 112 22 42 64 These figures represent the position in respect of overcrowding only as it comes to the notice of the department in the course of routine work. It does not purport to give the exact extent of overcrowding. Only a comprehensive house-to-house survey could reveal that figure. In 40 out of the 53 new cases of overcrowding families were sharing accommodation with relatives. 37 Abatement of the 64 overcrowded premises was effected in the following ways: Provision of alternative accommodation by: Carshalton U.D.C. 16 London C.C. 4 Other Local Authorities 2 Left the District 3 Removal of one or more occupants 39 Of the 112 dwellings remaining overcrowded at the end of the year, 82 are owned by the London County Council, eight by the Carshalton Urban District Council and 22 are privately owned. Slum Clearance and Demolition Action was continued on Clearance Area No. 7 referred to in the last Annual Report, involving a block of eight tenement dwellings in Stanley Road. One house, No. 101 was dealt with under a Demolition Order and the remaining seven, Nos. 85, 87, 89, 91, 93, 95 and 97, by a Compulsory Purchase Order. The Order was confirmed by the Minister on the 22nd September without modification. After clearance, development of the site will provide 38 units of accommodation. The number of persons to be re-housed from the condemned property at the date of the Enquiry (August, 1953) was 60. Rent and Mortgage Interest Restrictions (Amendment) Act, 1933 No action was necessary during the year. 38 Section E— Inspection and Supervision of Food. Milk Supply The district is a Specified Area for purposes of the Milk (Special Designations) (Specified Areas) Order, 1951. In consequence all milk sold by retailer 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 registered is 22. Designated licences issued during the year were as follows: Designation. Number of Distributors holding Licences No. of Licences in Force on 31/12/53. Principal Licences– Sterilised 14 17 Pasteurised 6 9 Tuberculin Tested 6 9 Supplementary Licences– Sterilised 9 12 Pasteurised 8 11 Tuberculin Tested 8 11 Bacteriological Examination of Milk Two hundred and twenty-four samples of milk were procured and submitted for bacteriological examination. Six failed to comply with the prescribed Regulations. Classification of the milk samples and the results of the tests are as follows:— Designation under which sold. No. of Samples. Methylene Blue Test. Phosphatase Test. Turbidity Test. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. Pasteurised 189 186 3 187 2 – – T.T. Pasteurised 29 28 1 29 – – – Sterilised 6 – – – – 6 – 224 214 4 216 2 6 – 39 Biological Samples Fifteen samples of milk were taken during the year and all failed to reveal evidence of tuberculosis. Milk and Dairies Regulations, 1949—Regulation 20 No action was necessary under these Regulations which enable the Medical Officer of Health 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. Ice Cream Eighty-four samples of ice cream were submitted to bacteriological examination and were graded as shown in the following table, which gives the corresponding figures for the preceding six years: Year No. of Samples Grade 1 2 3 4 1947 84 14 16 36 18 1948 147 52 26 53 16 1949 139 69 33 28 9 1950 155 103 29 16 7 1951 105 80 19 6 – 1952 94 70 17 7 – 1953 84 78 6 – – The progressive improvement in the bacterial purity was continued. For the first year since this system of grading was introduced, all samples conformed to the requirements of the two higher grades. Eleven samples submitted to the Public Analyst were found to satisfy the Ice Cream Order which requires this commodity to have a fat content of 4%, milk solids other than fat 5% and sugar 10%. Ice Cream (Heat Treatment, etc.) Regulations, 1947-1952 There are no manufacturers of ice cream in the district, all the registered retailers drawing their supplies from reputed manufacturers outside the district. All retailers are provided with refrigerator cabinets which maintain a temperature well below 28° F. in accordance with the Regulations. 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 2,813 lbs. of meat were found to be unfit for human food. 40 Food and Drugs Act, 1938 The following 345 samples were submitted to the Public Analyst: Article No. Adulterated or otherwise irregular Article No. Adulterated or otherwise irregular Almonds, Ground 1 Milk, Evaporated 1 Apricots in Syrup 1 Mineral Water 3 Beans 1 Mixture, Pudding 2 Beef Loaf 1 Mixture, Cake and Pudding 2 Beetroot 1 Blancmange Powder 1 Oil Teaseed 1 Bread (white) 1 Onions 1 Butter 1 Paste 2 Butter, Peanut 1 Peas 1 Cake 2 Peel 1 Cake Elour 1 Pepper (white) 1 Cheese Spread 1 Pie, Steak 1 Chocolate Roll 1 Pie, Pork 1 Cocoa 1 Pickles 1 Coffee 1 Potato Crisps 1 Coffee Powder 1 Pudding, Fruit 1 Coffee and Chicory Essence 1 Pudding, Steak and Kidney 2 Cordial 1 Rice 1 Curry Powder 1 Saccharine Tablets 1 Dessert Powder 1 Salts 1 Faggots 1 Salad Cream 2 Fish Cakes 1 Sauce, Mint 1 Flour 1 Sausage, Pork 5 Fruit Juice 4 Soup 1 Ginger, Crystallised 1 Soup Powder 1 Groats 1 Sugar 1 Horseradish Relish 1 Suet 1 Ice Cream 11 Sweets 7 Jelly, Table 1 Tea 1 Ketchup, Tomato 1 Tomatoes 1 Lemonade 1 Vegetable Extract 1 Lemon Curd 1 Vinegar, Malt 3 Luncheon Meat 2 Vitamin Pellets 1 Margarine 2 Vitamin Syrup 1 1 Marmalade 2 Whisky 8 Milk 229 8 Wine, Ruby 1 Milk, Condensed 1 Yeast Yog hourt 1 1 The following nine samples were found to be adulterated or otherwise irregular: Vitamin Syrup A sample of Syrup in which the Vitamin A content was found to be 10.4% less than that stated on the label. 41 In view of the difficulties in guaranteeing and maintaining minimum Vitamin A potencies for fish oil preparations and Vitamin A concentrates in general, no legal action was taken, but the manufacturers agreed to increase the overage used in the manufacture of the product by 36% to ensure that loss during normal storage periods will not bring the Vitamin A content below that stated on the label. Milk A sample of Channel Island Milk which failed to comply with the conditions set out in the Milk (Control and Maximum Prices) (Great Britain) Order, 1947, the butter fat content being 3.74% instead of 4%. In accordance with the Order the Ministry of Food were informed of the Analyst's Report, but no further action was taken by them after receiving the explanation of the Dairy Company concerned. Milk (Seven Samples) The above-mentioned samples with others were taken from a supply produced at a local farm after information had been received from a neighbouring authority regarding the fat content of milk supplied from the farm to a purveyor in their district. Of the seven samples taken, one was deficient in milk fat, three deficient in milk fat and solids not fat and three deficient in solids not fat only, by comparison with the legal standard of 3% fat and 8.5°/! solids not fat. All the samples were taken direct from the cows so that there was no doubt that the milk was genuine though of poor quality. The vendor sought advice from the Ministry of Agriculture and Fisheries via the Surrey County Council Agricultural Executive Committee. Section 9—Sale of Food Unfit for Human Consumption Various complaints were received of alleged foreign matter found in foodstuffs such as:— Mould on bread Mould on crumpets Maggots in bacon Beetle in jam Wire in bun Fly eggs in meat pie Mouse contamination on cake Mouse contamination in dried milk Burnt particles in cake Weevil in dried peas Weevil in candy corn Mouse contamination in mixed peel Dirty milk bottle (2) Circumstances did not justify legal proceedings in any case and appropriate warnings were given where necessary. 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: 42  lbs. ozs. lbs. ozs. Cake and biscuits 13 8 Meat 2,813 2 Cereals and flour 4 3 Milk 460 13 Cheese 106 3 Mincemeat 1 12 Cocoa – 12 Paste, meat – 5 Cream 1 7 Pickles 4 13 Fish 207 11 Sauce 129 1 Fruit 1,512 13 Soup 23 3 Fruit juice and drink 14 11 Spaghetti 3 7 Jam 211 12 Suet 11 8 Macaroni – 8 Syrup 1 – Vegetables 479 14 Total weight 2 tons 13 cwts. 2 qrs. 10 lbs. 6 ozs. The stocks were disposed of by burning in the Council's Refuse Destructor. 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 Education, particularly of food handlers, in food hygiene, was continued on the lines indicated in the previous report. In addition, a series of lectures illustrated by film, strips were given to selected small groups of employees engaged in the food trade. 43 w TABLE 9 INSPECTION OF FOOD PREMISES AND ACTION TAKEN Nature of Business Number of Premises Number registered Section 14 Food and Drugs Act Number registered Section 34 Food and Drugs Act Number of Inspections W.C. accommodation repaired or cleansed Means of hot water supply provided Food preparation rooms repaired or cleansed Food storage rooms repaired or cleansed Sinks or wash basins provided Other defective conditions remedied Bakers and Confectioners 14 4 – 50 – 1 – – – – Bakehouses 5 – – 43 1 – – – – – Butchers 36 31 – 133 – 2 1 2 1 – Canteens 18 – – 88 – – – – – – Chemists 16 – – 18 – – – – – – Cinem 1 – – 9 – – – – – – Confectioners (sweets only) 72 52 – 95 2 – – – – – Fishmongers 20 7 – 68 – – – – – 1 General Stores 4 3 – 38 – – – – – – Greengrocers and Fruiterers 45 2 – 120 1 1 – 3 – 1 Grocers (including corn chandlers) 85 19 2 260 2 – 2 3 – 1 Ice Cream vehicles variable – – 20 – – – – – – Licensed Premises (with catering facilities) 5 – – 16 – – – – – – Licensed Premises (without catering facilities) 21 – – 12 – – – – – – Milk Shops 8 4 – 34 – – – 1 – – Restaurants and Cafes 31 14 – 90 – 1 1 – – – Stalls, food variable – – 43 – – – – – – Vehicles, food variable – – 73 – – – – – – 136 2 1,210 6 5 4 9 1 3 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 Erysipelas Pneumonia Ophthalmia Neonatorum Scarlatina or Acute Poliomyelitis Puerperal Pyrexia Scarlet Fever Acute Polioencephalitis Malaria Measles Typhus Fever Food Poisoning Whooping Cough Typhoid Fever Leprosy Smallpox No cases of variola occurred during the year. Vaccination The scheme for vaccination against smallpox is the responsibility of the County Council under Part III of the National Health Service Act. By agreement with the District Councils it is directed locally by the District Medical Officers of Health. Vaccination is available at the Infant Welfare and School Clinics. Private Practitioners undertaking vaccination are paid 5s. per case for notifying details of the treatment. 40 The number of persons successfully treated and recorded under these arrangements during 1953 was as follows:— Age at 31st Dec., 1953 Under 1 yr. 1-4 yrs. 5-14 yrs. 15 yrs. & over. Total. Primary Vaccinations— By Private Practitioners 106 98 8 29 241 At Clinics 125 98 1 – 224 231 196 9 29 465 Revaccinations— By Private Practitioners 1 6 10 45 62 At Clinics – – – – – 1 6 10 45 62 In addition the following unsuccessful attempts at vaccination were made: Age at 31st December, 1953 Under lyr. 1-4 yrs. 5-14 yrs. 15 yrs. & over. Total. Primary 12 14 1 2 29 Re-vaccination – 5 4 16 25 12 19 5 18 54 Enteric Fever Two cases of typhoid fever were notified in two sisters aged 7 and 11 years. They were infected whilst on holiday on the Continent and developed the illness after return to their home. Both were admitted to hospital and recovered, one of them after a relapse in the sixth week, which necessitated a further course of treatment by chloramphenicol. Dysentery Sixty-five cases of dysentery, nearly all of which were confirmed bacteriologically as Sonne infectious, were notified. Of these, 13 occurred in hospital patients not residents of Carshalton and 52 among residents. Most of them came to notice as a result of investigations into domestic contacts of single notified cases. The ease with which this intestinal infection spreads under the conditions of close personal contact in family life is indicated by the fact that only 14 of the 52 cases among residents were single cases, the remaining 38 occurring in groups of two to five in the same families. All the cases recovered. More than half of them occurred in the first ten days of the year and were a continuation of an epidemic wave which commenced in December, 1952. 46 It is of interest to record that a boy of 12 years in one of the infected families fell ill with symptoms of acute gastro-enteritis and developed acute appendicitis from which he died. In, view of the occurrence of known cases of Sonne dysentery in the house at the time, there seems little doubt that the original gastro-enteritis in this boy was of this nature and the supervening appendicitis must be regarded as a complication of Sonne dysentery. It was not until after the boy had died that the true nature of the cases in the house was established, otherwise bacteriological examination of the boy's gastro-enteritis might well have been undertaken and have revealed the dysentery organism. Scarlet Fever The incidence of scarlet fever has varied but little over the last 10 years. A total of 126 cases was notified in 1953, all but one residents of the district. This provides an incidence rate of 2.04 per thousand population. There were no deaths. Sixty cases, representing 47% of the total, were nursed at home. This is much the highest percentage receiving domiciliary treatment yet recorded and compares with 38% in the year before. The growing practice of nursing scarlet fever at home where accommodation and facilities for reasonable isolation are adequate, has had no adverse effect on the spread of this disease. One of the advantages of this practice is that many cross-infections which arise when cases are nursed in multiple-bed wards are avoided. TABLE 10 SCARLET FEVER—DISTRIBUTION OF CASES,. 1953 1953 Ward Total St. Helier North St. Helier South St. Helier West NorthEast NorthWest Central SouthEast SouthWest January – – 2 – – – 2 2 6 February 2 1 1 – – – 1 1 6 March – 8 6 2 1 3 3 3 26 April – 1 3 1 – 1 7 2 15 May 3 2 1 5 1 3 2 3 20 June 1 1 – – 1 3 – 5 11 July 1 1 2 4 1 1 – – 10 August 1 – 1 – 1 – 1 1 5 September 2 – – 1 – – – – 3 October – – – 1 1 – 1 – 3 November – – – 2 1 2 1 1 7 December 3 1 – 1 6 – 1 1 13 Totals 13 15 16 17 13 13 19 19 125 Monthly Mean 1.08 1.25 1.33 1.41 1.08 1.08 1.58 1.58 10.41 Case rate per 1,000 population ... 1.50 2.18 1.98 1.70 1.74 2.17 2.34 2.97 2.02 47 TABLE 11 SCARLET FEVER—MULTIPLE CASES, 1953 Ward No. of houses in which occurred Total Houses Total Cases 1 Case 2 Cases 3 Cases St. Helier North 13 – – 13 13 St. Helier South 8 2 1 11 15 St. Helier West 12 2 – 14 16 North-East 15 1 – 16 17 North-West 10 – 1 11 13 Central 11 1 – 12 13 South-East 11 1 2 14 19 South-West 17 1 – 18 19 Whole District 97 8 4 109 125 Diphtheria The district was again free from diphtheria for yet another year, the fourth in succession. Diphtheria Immunisation After nearly 20 years' experience, the schcme for diphtheria immunisation has become well organised and established, but it is becoming more difficult in the absence of diphtheria for several years to convince parents that only by maintaining a high level of immunity in the majority of the child population can there be any assurance that our present freedom from this disease will continue. It is as well to remind ourselves that this infection is attended by a significant mortality and, at best, by a long period of incapacity with the liability to permanent after-effects. The scheme, as organised locally, aims at conferring artificial immunity by a primary course of injections, usually two of A.P.T. at an interval of four weeks, by the time the child reaches its first birthday. Thereafter this immunity should be reinforced at school age and subsequently at intervals of three years until the child enters secondary school. This is achieved by offering treatment facilities at the Welfare and School Clinics and by holding immunisation sessions in the schools every alternate term. In our assessment of the level of immunity, emphasis is now wisely laid not on the number of children who, at some time or other, have had immunisation treatment, but on the number under 15 years of age who have received primary or reinforcing injections within the last five years. During 1953, 709 resident children received a primary course of injections as follows: 48 Age at 31.12.53 Under 1 year 1 year 2 years 3 years 4 years 5-9 years 10-14 years Total At Council Clinics 30 296 57 18 10 10 - 421 In Carshalton Schools — — — 2 10 109 10 131 Private Practitioners 9 132 29 6 5 5 1 187 39 428 86 26 25 124 11 739 Less outward transfers — 12 6 1 — 17 3 39 39 416 80 25 25 107 8 700 Plus inward transfers — 1 — — — 4 4 9 Carshalton Residents 39 417 80 25 25 111 12 709 A further 962 Carshalton children received reinforcing injections during the year. The immunisation state of the local child population at 31st December, 1953, was as follows: Number of Children at 31st December, 1953, who had completed a course of immunisation at any time before that date (i.e. at any time since 1.1.39) Age at 31.12.53 i.e. Born in Year Under 1 1953 1-4 1952-1949 5-9 1948-1944 10-14 1943-1939 Under 15 Total Last complete course of injections (whether primary or booster) A. 1949-1953 38 2,120 3,785 2,460 8,403 B. 1948 or earlier — — 538 807 1,345 C. Estimated mid-year child population 800 3,320 8,900 13,020 Immunity Index 100 A/C 4.7 63.8 70 64.5 It will be seen from this table that whilst the percentage immunised within the last five years was 64.5, there was a further 10% who would have some degree of protection from earlier treatment. 49 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 — — 16 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 1953 52 85(70*) 75(64*) 0 0.00 (*Immunised within the last 5 years) Erysipelas Seven cases were notified. All were adults of 48 years and over and suffered from infection of the face. Three of the patients had had previous attacks. All recovered. Pneumonia The prevalence of influenza in the first two months of the year was responsible for an increase in the number of cases of notified pneumonia compared with the year before. Of 50 cases, 28 were due to influenza. More than half the total occurred in the first six weeks of the year. Measles An epidemic wave of measles occurred in the first four months of 1954 with the peak period in March. A total of 652 cases was notified, 624 of them being residents of the district. There were no deaths. 50 TABLE 12 MEASLES—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1953 (Excluding hospital patients non-resident in Carshalton) 1953 Ward Total St. Helier North St. Helier South St. Helier West NorthEast NorthWest Central SouthEast SouthWest January 5 10 17 8 9 2 2 7 60 February 16 7 7 5 13 9 8 3 68 March 55 29 24 87 7 17 22 8 249 April 25 16 15 22 2 2 74 7 163 May 1 3 3 8 1 — 11 3 30 June — — — 2 — — 4 1 7 July 1 — — — 1 — 1 5 8 August - - - - - - 1 — 1 September - - - - - - 1 — 1 October — 1 - - - - - - 1 November — — — — 2 3 — — 5 December — — 1 3 16 9 — 2 31 Totals 103 66 67 135 51 42 124 36 624 Monthly Mean 8.58 5.50 5.58 11.25 4.25 3.50 10.33 3.00 52.00 Case rate per 1,000 population 11.92 9.27 8.29 13.54 6.85 7.29 15.32 5.62 10.11 Whooping Cough Following a year of exceptionally low incidence, the prevalence of whooping cough rose significantly. The number of cases notified at 345 compares with 98 in the year before and an average of 326 in the previous five years. The incidence was spread over the year, but was rather heavier in the first quarter. Of the total, nine were patients in hospital not residents of the district. All recovered. As previously reported, the County Council's scheme now provides for immunisation against whooping cough. Extensive trials are still being conducted by the Medical Research Council into the efficacy of this procedure. Whilst the degree of success is not yet of the same order as in the case of diphtheria immunisation, research, so far, undoubtedly shows that the most recent vaccines have a definite value as prophylactic agents. The number of children under five years of age given this immunisation treatment continues to rise steadily and now approaches 30%. The numbers involved are not yet sufficiently great to expect any significant or permanent effect upon the general incidence of this disease. There is, however, evidence that in many instances, whilst the disease is not entirely prevented, its severity is markedly reduced by this treatment. This attenuation of the attack, however, does create a difficulty in the exercise of control over the spread of the infection. Many cases are so modified in their clinical manifestations, including the suppression of the typical "whoop," that their true nature is not recognised and no attempt at isolation is made. 51 TABLE 13 WHOOPING COUGH—WARD INCIDENCE AND MONTHLY DISTRIBUTION 1953 (Excluding hospital patients non-resident in Carshalton) 1953 Ward Total St. Helier North St. Ilelier South St. Helier West NorthEast NorthWest Central outhEast SouthWest January 8 7 4 4 4 4 21 2 54 February 6 3 1 11 6 5 6 6 44 March 4 1 1 16 6 15 10 4 57 April 3 2 2 10 5 11 3 1 37 May 1 2 2 5 — 1 3 4 18 June 1 — 4 1 2 3 1 — 12 July 7 — 8 8 5 1 — 2 31 August 3 2 3 7 5 3 — 3 26 September 8 2 3 1 — 2 5 1 22 October 6 — 4 - - - - - 10 November 4 2 1 1 — 1 — — 9 December 5 1 — 7 — 1 2 — 16 Totals 56 22 33 71 33 47 51 23 336 Monthly Mean 4.66 1.83 2.75 5.91 2.75 3.91 4.25 1.91 28.00 Case rate per 1,000 population 6.46 3.09 4.07 7.12 4.43 7.86 6.30 3.60 5.44 Meningococcal Infection One case of meningoencephalitis was notified in a boy of three years. The attack, a severe fulminating one, was fatal in forty-eight hours. There was no evidence of contact with any other known case of meningococcal infection. Poliomyelitis Nine cases of poliomyelitis were reported during the year, seven of them during July and August. Five showed evidence of paralysis and three were non-paralytic. Details are as follows: 52 Sex Age Date of Onset Resultant Disability (July, 1954) F 6 yrs. 15th March Complete recovery F 14 yrs. 25th June Some weakness of left shoulder girdle M 4 yrs. 28th June Fairly extensive weakness chiefly in the legs and left arm F 4 yrs. 6th July Minimal weakness of neck and back M 6 yrs. 14th July Weakness of both legs, neck and abdominal muscles. Walks fairly well with aid of sticks F 2 yrs. 16th July Flail right leg and weakness of the left M 16 yrs. 22nd July Non-paralytic. Complete recovery M 4 yrs. 2nd August Non-paralytic. Complete recovery F 19 yrs. 12th August Non-paralytic. Complete recovery Ophthalmia Neonatorum One case of inflammation of the eyes in the newborn was notified. The infection was moderately severe but responded well to domiciliary treatment and recovered without any impairment of vision. Puerperal Pyrexia The altered definition of puerperal pyrexia, due to the Regulations of 1951, brought many more cases of rise of temperature following childbirth within the scope of notification. Any rise of 2°, whether sustained or not, from any cause whatever, whether resulting from as distinct from merely following childbirth or not, is now notifiable. In consequence, many of these cases are of little significance and the case rate based on these notifications is no indication of the extent to which childbirth per se is liable to result in infection. In conformity with expectation and past experience, the great majority of these notifications are in respect of patients in hospitals with maternity units which cater for a large part of Metropolitan Surrey and where the admissions are preponderantly the abnormal or potentially abnormal cases. The inclusion of notifications in respect of a large number of cases of pyrexia in non-resident patients gives an incidence rate which is valueless and misleading when it is calculated, as it is of necessity, on Carshalton births only. The same situation arises in any district which has large maternity hospital units serving an area far beyond its boundaries. A total of 212 notifications was received, all patients in local hospitals. Fifty-four were residents of Carshalton and 124 were first confinements. 53 Food Poisoning Twelve cases of food poisoning were notified. As a result of enquiries it was ascertained that 31 persons suffered symptoms of poisoning. In ten instances one member only of the family was affected. The infecting organism was identified as S. Typhimurium in seven and S. Enteritidis in one. In two other occurrences two people were affected in each. The vehicle of infection was not established with any certainty in any of these cases, but suspicion in three instances attached to tinned ham, spam and inadequately washed lettuce. In June, 17 guests at a wedding luncheon fell ill about five hours after the meal. Investigation indicated that the commodity at fault was tinned ham of Australian origin. The illness was in all probability due to pre-formed toxin and no living organisms were isolated from the patients or from the ham. All patients recovered. It is found that many of the single cases of poisoning due to infection with S. Typhimurium are young children. This may well be explained by the fact that since rodents such as mice and rats are common reservoirs of this infection, the undeveloped sense of personal hygiene in the very young renders them much more liable to the introduction of infection by the mouth. 54 55 TABLE 14 CASES OF NOTIFIABLE INFECTIOUS DISEASE ADMITTED TO HOSPITALS, 1953 Disease Cuddington Bletchingley Western Wandle Valley The Grove Queen Mary's St. Helier Waddon Park War Memorial Totals Scarlet Fever 40 1 - 20 1 2 1 - - - 65 Poliomyelitis Paralytic 2 - 1 — - 2 1 - - - 6 Poliomyelitis Non-Paralytic 1 - - — - 1 — 1 - - 3 Whooping Cough 1 - - 2 - 11 — - 1 - 15 Measles 1 - - — - 25 3 - 1 - 30 Dysentery 1 - - — - 10 2 - - 1 14 Pneumonia 1 - - 1 - 2 - - - 4 Food Poisoning — - - — - 4 4 - - - 8 Meningococcal infection 1 - - — - - - - 1 Enteric Fever 2 - - - - - - - - - 2 Totals 50 1 1 23 1 55 13 1 2 1 148 56 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 125 2.02 — 13 15 16 17 13 13 19 19 64 51 Dysentery 53 0.85 — 15 11 5 10 5 — 2 5 2 3.76 Measles 624 10.11 — 103 66 67 135 51 42 124 36 3 0.48 Whooping Cough 336 5.44 — 56 22 33 71 33 47 51 23 6 1.78 Poliomyelitis, Paralytic 6 0.09 — 2 — 1 — 2 — 1 — 6 100 Poliomyelitis, Non-Paralytic 3 0.04 — — — 1 — — — 2 — 3 100 Food Poisoning 12 0.19 — 5 1 1 1 — 1 3 — 6 50 Erysipelas 7 0.11 — — 1 — — — 1 3 2 — — Pneumonia 50 0.81 — 1 4 7 10 5 3 15 5 2 4 Puerperal Pyrexia 54 0.87 — 11 7 10 11 6 5 2 2 51 94 Ophthalmia Neonatorum 1 0.01 - - - 1 - - - - - - - Meningococcal Infection 1 0.01 - - - - - - 1 - - 1 100 Enteric Fever 2 0.03 - - - - - - - - 2 2 100 Malaria 1 0.01 - - - - - - - 1 - - - 57 table 16 INFECTIOUS DISEASES Notification by Age Groups, 1953 (Excluding hospital patients non-resident in Carshalton) Disease Total Cases Notified Total Cases at all Ages Under 1 year 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-5 45-65 65 and over Scarlet Fever — 4 4 12 7 84 10 3 1 — — — 125 Measles 23 55 78 84 93 271 7 7 5 1 — — 624 Whooping Cough 35 27 48 40 54 120 5 — 4 — 3 — 336 Dysentery 1 2 4. — 1 19 8 3 9 3 2 1 53 Poliomyelitis, Paralytic — — 1 — 2 2 1 - - - - - 6 Poliomyelitis, Non-paralytic — — — — — 1 — 2 — — — — 3 Food Poisoning 1 — — — 2 1 1 — 2 2 3 — 12 Erysipelas - - - - - - - - - 1 4 2 7 Pneumonia — 2 1 2 1 5 — 2 7 6 17 7 50 Puerperal Pyrexia - - - - - - - 3 43 8 — — 54 Meningococcal Infection - - - - - - - - - - - - 1 Enteric Fever - - - - - 1 1 - - - - - 2 Malaria — - - - - - - — 1 — — — 1 58 TABLE 17 MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1953 (Excluding hospital patients non-resident in Carshalton) Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 6 6 26 15 20 11 10 5 3 3 7 13 125 Dysentery 33 2 2 1 2 7 — — 3 — 3 — 53 Measles 60 68 249 163 30 7 8 1 1 1 5 31 624 Whooping Cough 54 44 57 37 18 12 31 26 22 10 9 16 336 Poliomyelitis, Paralytic — — 1 — — — 5 — — — — — 6 Poliomyelitis, Non-Paralytic — — — — — — 1 1 1 — — — 3 Food Poisoning — — - — 1 5 1 1 2 2 — 12 Erysipelas 2 — - 2 — — — — 1 1 — 1 7 Pneumonia 13 19 6 3 2 1 — — 1 1 2 2 50 Puerperal Pyrexia 5 3 6 7 4 5 3 3 4 2 5 7 54 Tuberculosis, Pulmonary 5 6 3 5 6 6 3 6 4 6 3 2 55 Tuberculosis, Non-pulmonary 1 — - 1 2 — — — 1 — — — 5 Ophthalmia Neonatorum — — — 1 — — — — — — — 1 Meningococcal Infection - - - - - - - - - - - - 1 Enteric Fever — — — — — — — — 2 - - - 2 Malaria 1 - - - - - - - - - - - 1 Tuberculosis The new cases admitted to the tuberculosis register during the year numbered 122, classified as follows: Males Females Pulmonary 61 Pulmonary 49 Non-pulmonary 6 Non-pulmonary 6 Of the total additions, 60 were primary notifications, 61 were transferred from other districts, and 1 came to notice in other ways. For the same period, 106 names were removed from the register for the following reasons: Recovered 14 Death 21 Otherwise (including removals) 71 After allowing for the additions and deductions, the state of the register at the 31st December, 1953, was as shown in the following table: TUBERCULOSIS—WARD DISTRIBUTION Cases on Register at 31st December, 1953 Ward Pulmonary Non-Pulmonary Total Incidence per 1,000 population Males Females Males Females St. Helier North 76 85 10 10 181 20.9 St. Helier South 64 57 15 10 146 20.5 St. Helier West 66 69 9 10 154 19.0 North-East 64 72 11 5 152 15.2 North-West 34 29 — 2 65 8.7 Central 37 29 5 1 72 12.0 South-East 39 36 4 6 85 10.5 South-West 24 19 — 3 46 7.2 Whole District 404 396 54 47 901 14.6 800 101 The total of 901 is 16 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 ... 27 At other tuberculosis institutions ... 168 195 59 The number of tuberculous persons who died during the year was 21, distributed by age groups as follows: Age, Years. Pulmonary. Non-Pulmonary. Total. Males. Females. Males. Females. 0 - - - - - 1—5 — — — — — 5—15 — — — — — 15—25 1 2 - — 3 25—35 1 — — — 1 35—45 1 1 — — 2 45—55 1 1 - 1 3 55—65 3 2 — — 5 65—up 5 1 — 1 7 Totals 12 7 — 2 21 The deaths attributable to tuberculosis were 13, as follows: DEATHS DUE TO TUBERCULOSIS, 1953. Ward. Pulmonary. Non-Pulmonary. Death Rate per 1,000 population. Mean age at Death. Male. Female. Male. Female. St. Helier North 1 - 1 - 0.23 45 St. Helier South — 1 - - 0.14 59 St. Helier West — — — 1 0.12 47 North-East 1 - - - 0.10 37 North-West 1 1 - - 0.26 54 Central 1 1 - 0.33 28 South-East — — — - - — South-West 3 1 — — 0.62 67 Totals 7 4 1 1 0.21 48 One of these deaths was of unnotified case. 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, 5 of such families were rehoused out of a total of 39 Council tenancies allotted during 1953. 60 Mass X-Ray One of the Mass X-Ray Units of the South-West Metropolitan Regional Hospital Board visited the district in November, when it was set up in the County Council's Day Nursery premises in Green Wrythe Lane. The following details of its activities and findings are supplied through the courtesy of the Medical Director of the Unit: Male Female Total number examined 1,145 1,802 Pulmonary Tuberculosis—Active 7 3 Pulmonary Tuberculosis—Inactive 49 79 Non-Tuberculous abnormalities 59 58 One case failed to return for full size X-ray examination 61 62 TABLE 18. TUBERCULOSIS. New Cases, Age and Sex Distribution and Manner of Admission to Register, 1953. Age Group Years. Piimury Notifications "A." Ca^es l.-u.^ferreJ from other Districts. 1 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 2 - - 1 - 1 - - - - - 6 5—10 1 - - - 2 - 1 1 - - - - 5 10—15 1 - - - - 1 - - - - - - 2 15—20 5 1 - 2 - 2 - - - - - - 10 20—25 3 12 2 - 1 5 - - - - - - 23 25—35 8 3 - - 17 11 - - - - - - 39 35—45 2 3 - 1 4 5 2 - - - - - 17 45—55 6 1 - - 1 1 - - - - - 1 10 55—65 1 2 - - 2 - - - - - - - 5 65 up 2 - - - 2 - - 1 - - - - 5 Totals 31 24 2 3 30 25 4 2 - - - 1 122 60 v 61 ▼ 1 INDEX PAGE Acreage 7 Births— Distribution 10 Institutional 11 Rates 12 Cancer 15 Cemeteries 34 Clinics and Treatment Centres 21 Closet Accommodation 24 Deaths— Classification 19 Distribution 14 Rate 12, 14 Diphtheria 48 Immunisation 20,48 Dysentery 46 Disinfection 28 Disposal of Dead 34 Drainage and Sewerage 23 Employment Agencies 33 Enteric Fever 46 Erysipelas 50 Establishments for Massage, etc. 33 Factories 30,31,32 Food— Food and Drugs Act 41 Hygiene 43 Inspection and Supervision 42 Poisoning 54 Health Services 20 Heating appliances (Fireguards)Regulations, 1953 32 Housing— Council's Scheme 35 Inhabited Houses 7 Inspection 36 Overcrowding 37 Slum Clearance 38 Ward Distribution 37 Ice Cream 40 Infant Mortality17,18 Infectious Diseases 56,57,58 Inquests 16 Isolation Hospital— Admissions to 55 63 PAGE Laboratory Facilities 20 Mass X-ray 61 Maternal Mortality 17 Measles 50 Meat Meningococcal Infection 52 Merchandise Marks Act, 1926 33 Milk Supply 39 Milk and Dairies Regulations, 1949 40 Mortuary 34 Natural and Social Conditions 7 National Assistance Act 33,34 Offices 30 Outworkers 32 Ophthalmia Neonatorum 53 Pet Animals Act, 1951 33 Pneumonia 50 Poliomyelitis 52 Population 8,9 Public Cleansing 24 Puerperal Pyrexia 53 Rag Flock and other Filling Materials Act, 1951 33 Rateable Value 7 Rats and Mice Destruction 29 Rent and Mortgage Interest Restrictions (Amendment) Act, 1933 38 Rivers and Streams 24 Sanitary Circumstances Sanitary Inspection 25,26,27.28 Scarlet Fever 47 Shops Acts Slum Clearance and Demolition 38 Smallpox 45 Smoke Abatement 29 Staff 6 Statistics— Comparative 13 Vital 8 Swimming Baths 30 Tuberculosis 16,59 Unemployment 9 Vaccination 20,43 Vermin Control 28 Water Supply 22 Whooping Cough 51 Zymotic Diseases— Deaths from 8 64