AC 44413(3) 2 Library CAR 19 Carsbalton Urban District Annual Report OF THE Medical Officer of Health FOR THE YEAR 1954 CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1954 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 1954. In my report of a year ago I briefly reviewed the many directions in which progress in the health of the district had been made over the previous twenty years, during which time it has been my privilege to serve Carshalton as its Medical Officer of Health. I have, this year, the further satisfaction of being able to report that that progress has been well maintained. There was a welcome rise in the birth rate, the highest since 1948, which, together with a continued favourable death rate, helped to maintain the rate of natural increase at something more than 5 per thousand population, a consideration of some economic significance in these days of an ageing population. This desirable state of affairs was not, however, uniform throughout the district. The South West Ward, exceptionally, had a birth rate of only 7.2, whereas its death rate was 10.1, the first time in the history of the district where there has been a natural decrease in the population. As stated, the crude death rate is again a low one, being 8.0 per thousand population, compared with 11.3 for the country as a whole. It is still significantly less when allowance has been made for the more favourable constitution of the local population. The cancer death rate fell by a fifth, but malignant disease of the lungs continued to take a high toll among male sufferers from cancer. Infant mortality fell again appreciably to the second lowest figure on record, whilst we experienced yet another year free from any maternal death. The year was particularly satisfactory with regard to infectious disease. Scarlet fever and whooping cough each affected less than half the number of persons who contracted these infections in the year before. Measles prevalence was the lowest for seven years. Erysipelas, pneumonia and poliomyelitis were all less prevalent, whilst diphtheria, enteric fever, and cerebro spinal fever were entirely absent. There were no deaths from any of these diseases. New cases of tuberculosis were fewer and the death rate from this disease was only slightly higher than the record low of 1950. The 3 growing acceptance of B.C.G. vaccination against tuberculosis adds yet another weapon to our armoury in the fight against this disease. The domestic child contacts of known cases are receiving this added protection through the chest clinics to an increasing degree and the treatment of 13-year-old schoolchildren has been established by the County Council as a routine procedure in the schools. The value of animal inoculation tests in the detection of tuberculous milk was again demonstrated when this infection was traced to a diseased cow in a local herd. The elimination of this source of tuberculosis is an aim which can and must be achieved by the creation of tuberculosis-free herds. The powers designed to ensure cleanliness and purity of our food and protection from adulteration are wide and comprehensive. The provisions of the new Food and Drugs Amendment Act, 1954, whilst not so far-reaching as one would have hoped, will further strengthen the hands of local authorities in helping to reduce preventable foodborne illness. The wide range of analyses and tests carried out during the year show that the quality of the various foods and drugs offered for sale in the district conform to the required standards to a very high degree. Milk samples were all satisfactory except four, and although these gave analyses slightly below the legal standard, there is little doubt that they were genuine samples of milk. The only other sample which did not comply with the statutory standard was an ancillary food which contained a slight excess, not a deficiency, of the active ingredient. The bacteriological purity of ice cream continued to improve, 95 per cent. of the samples conforming to the highest grade. The health record of 1954 is not, however, one of unalloyed satisfaction and brightness. It has its shadow, not a big one, but a very dark one. Far too many families are still living in overcrowded conditions with consequent detriment to their mental and physical health. Added to this is the task still facing us and too-long deferred by war-time conditions, of clearing away our slum dwellings. The Council can make no greater single contribution to the wellbeing of the district than by tackling this problem with the urgency which it deserves. My thanks are again tendered to my staff for their help and co-operation so freely given, and to the Council for their customary interest and encouragement. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, F. LAWRENCE SMITH, Medical Officer of Health. August, 1955. 4 PUBLIC HEALTH STAFF. Medical Officer of Health: F. Lawrence Smith, M.B., Ch.B., D.P.H. Chief Sanitary Inspector: * H. J. Spicer, C.R.S.I. Deputy Chief Sanitary Inspector: * G. R. Surfleet, C.R.S.I., Sanitary Inspectors: * L. W. Rivett, C.R.S.I. * W. J. Land, C.R.S.I., * J. P. Dixon, C.R.S.I., Public Health Nurse: Mrs. D. E. Baldock, S.R.N. Chief Clerk: Miss V. St. P. Hotten Also Divisional Medical Officer, Surrey County Council. *Meat and Food Certificate of the Royal Sanitary Institute. 5 Section A—Natural and Social Conditions of the District. Area (in acres) 3,346 Number of inhabited houses (end of 1954) according to Rate Books 17,116 Rateable Value at 31st December, 1954 £527,285 Sum represented by 1d. rate £2,138 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. The absence of any sustained period of low rainfall during the year enabled these springs which feed the ornamental ponds and water courses to maintain an adequate flow and so avoid the stagnation which has been experienced on more than one occasion in recent years. Yet another application under the Water Act, 1945, to extract water from the chalk in the vicinity of the district was granted when the Minister's consent was given to the British Electricity Authority to take up to half a million gallons daily from a new bore-hole at their generating station in Croydon. The area is mainly residential, a large proportion of the residents earning their livelihood in Greater London. There is very little industry established within its borders. Except for the public open spaces and the Green Belt it is practically fully developed. The level of housing occupation as revealed by the 1951 Census is the highest of any district in Surrey and it is difficult to see how the substantial need for additional housing accommodation can be met except by development outside the area. Largely developed within the last 25 years, Carshalton has a young population, composed in large measure of families in the lower income groups. As a result, the Rateable Value per head of population is among the lowest in the county. 6 SUMMARY OF VITAL STATISTICS FOR 1954. (Based on the Registrar-General's Figures.) Population. Registrar-General's Estimate 61,610 Births. Males. Females. T otal. Live (Legitimate) 415 385 800 (Illegitimate) 8 16 24 423 401 824 Birth Rate (per 1,000 population) 13.3 Stillbirths (Legitimate) 9 9 18 (Illegitimate) — 2 2 9 11 20 Stillbirth Rate per 1,000 total births 23.6 Death 253 245 498 Death Rate (crude) per 1,000 population 8.0 Infant Mortality. All deaths under 1 year 11 4 15 Infant Mortality Rate (per 1,000 live births) 18.2 Deaths of leg. infts. under 1 year 11 4 15 Rate per 1,000 legitimate births 18.7 Deaths of illeg. infts. under 1 year — — — Rate per 1,000 illegitimate births — Maternal Mortality. Deaths from Sepsis — — — — Rate per 1,000 births — Deaths from other causes — — — Rate per 1,000 total births — Maternal Death Rate — Zymotic Deaths. 7 Principal Zymotic Diseases — — — — Deaths from Measles — — — — Deaths from Whooping Cough — — — — Deaths from Diarrhoea (under 2 years) — — — _ Zymotic Death Rate — Deaths from Tuberculosis. All Forms 8 6 14 Rate per 1,000 of population 0.22 Phthisis 7 4 11 Rate per 1,000 of population 0.17 Deaths from Cancer 56 99 Rate per 1.000 of population 43 1.60 7 The Registrar-General's statistics relating to population and deaths differ slightly from those compiled from local records. The total figures in respect of the district as a whole, which are supplied by the RegistrarGeneral, are set out in this report, but where classification has been made, e.g., by age groups, sex, wards, etc., it has necessarily been based on our own records, which may, in the aggregate, show slight discrepancies compared with the Registrar-General's totals. UNEMPLOYMENT The following figures in respect of persons living in Carshalton registered as unemployed at the Sutton Employment Exchange and the Carshalton Youth Employment Bureau at the end of 1954 are supplied through the courtesy of the Exchange Manager and the Youth Employment Officer: Men. 96 Women 37 Boys 20 Girls 9 POPULATION The Registrar-General's estimate of the home population at mid-1954 is 61,610, compared with 61,680 for mid-1953 and 62,721 enumerated at the census 1951. The following gives the estimated ward populations based on the Registrar-General's totals: TABLE 1. ESTIMATED RESIDENT POPULATION, MID-1954. BY WARDS. Ward. Houses at Mid-1954 Estimated population Mid-1954 St. Helier North 2,164 8,625 St. Helier South 1,698 7,100 St. Helier West 2,094 8,065 North-East 2,753 9,950 North-West 2,149 7,420 Central 1,761 5,970 South-East 2,415 8,095 South-West 2,075 6,385 Whole District 17,109 61,610 8 BIRTHS The number of live births registered during 1954 was 824, which is 52 more than in the year before. Of these, 423 were males and 401 females, giving a birth rate of 13.3 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 12.7 per thousand population, which compares with 13.2 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 816 births and 20 stillbirths occurred in 1954. 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 136 15.7 1 7.3 St. Helier South 89 12.5 4 43.0 St. Helier West 118 14.6 2 16.6 North-East 139 13.9 3 21.1 North-West 99 13.3 2 18.0 Central 80 13.4 1 12.3 South-East 111 13.7 5 43.1 South-West 46 7.2 2 41.6 Seventy-eight 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 St. Helier South 86 St. Helier West 85 North-East 76 North-West 77 Central 92 South-Eas 69 South-West 81 Out of 836 total births, 653 took place in the following hospitals and nursing homes: Live. Still. Total. Carshalton, Beddington and Wallington District (War Memorial) Hospital 78 2 80 St. Helier Hospital 452 13 465 Other Surrey Hospitals 84 2 86 Other Hospitals 16 1 17 Private Nursing Homes 5 — 5 Totals 635 18 653 For the last three years more than three-quarters of all births have taken place in Maternity Institutions. TABLE 2. BIRTHS, 1954, DOMICILIARY AND OTHERS — BY WARDS. Ward. Born in District. Born Outside District. Grand Total. In Hospitals and Nursing Homes. In Private Houses. Total. In Hospitals and Nursing Homes. In Private Houses. Total. St. Helier North 94 36 130 6(1) 1 7(1) 137(1) St. Helier South 78(4) 13 91(4) 2 — 2 93(4) St. Helier West 94(1) 17(1) 111(2) 9 — 9 120(2) North-East 94(2) 32 126(2) 16(1) — 16(1) 142(3) North-West 57(2) 23 80(2) 19 — 19 99(2) Central 53(1) 16 69(1) 12 — 12 81(1) South-East 53(3) 36(1) 89(4) 27(1) — 27(1) 116(5) South-West 22(2) 8 30(2) 17 1 18 48(2) Totals 545(15) 181(2) 726(17) 108(3) 2 110(3) 836(20) (Figures in brackets indicate stillbirths included in totals.) 10 TABLE 3. BIRTH AND DEATH RATES FOR CARSHALTON, 1922-1954. 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 1954 61,610 13.3 8.0 18.2 0.0 11 TABLE 4. COMPARATIVE STATISTICS — 1954. England and Wales Carshalton Birth Rate (per 1,000 population) 13.2 13.3 (crude) 12.7 (comp.) Still-birth Rate (per 1.000 total births) 24.0 23.6 Death Rate (per 1,000 population) 11.3 8.0 (crude) 9.6 (Comp.) Infant Mortality (per 1,000 live births) 25.5 18.2 Pre-natal Mortality (in first 4 wks. per 1,000 live births) 17.7 14.5 Death rate from Tuberculosis (per 1,000 population): Respiratory Tuberculosis 0.16 0.18 0.17 0.22 Other Tuberculosis 0.02 0.05 Death rate from Cancer (per 1,000 population): All Forms 2.03 1.60 Cancer of Lung 0.37 0.48 Maternal Mortality (per 1,000 total births): Excluding Abortion 0.58 0.69 — Abortion 0.11 COMPARATIVE HEALTH STATISTICS, 1934/54 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 0.60 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 1954 11.3 8.0 25.5 18.2 0.58 0 12 DEATHS The deaths allocated to the district, as adjusted by inward and outward transferable deaths, was 498—253 males and 245 females. This gives a crude death rate of 8.0 per thousand population as against 8.4 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 9.6. The rate for England and Wales was 11.3. The distribution of the deaths by wards was as follows: WARD DEATH RATES AND MEAN AGE AT DEATH, 1954. Ward Deaths Death Rate (crude) Mean Age at Death St. Helier North 39 4.5 61.1 yrs. St. Helier South 46 6.4 58.3 „ St. Helier West 53 6.5 61.3 „ North-East 71 7.1 66.4 „ North-West 72 9.7 67.7 „ Central 84 14.0 70.7 „ South-East 67 8.0 68.8 „ South-West 65 10.1 69.4 „ Whole District 497 8.0 66.3 yrs. Although there was a fall from the record high figure for cancer mortality of the year before, the deaths from cancer of the lungs showed no reduction, 30 such deaths being registered, representing 30 per cent. of the total cancer deaths. Fatal disease in this site was nine times more common in men than in women. CANCER DEATHS—WARD DISTRIBUTION, 1954 Ward Cancer Deaths Rate per 1,000 Estimated Population St. Helier North 14 1.61 St. Helier South 14 1.97 St. Helier West 10 1.24 North-East 10 1.00 North-West 11 1.48 Central 12 2.01 South-East 16 1.97 South-West 12 1.88 The classification of the cancer deaths by sites affected is given in Table 5. 13 TABLE 5 Group Site Affected Male Female Total Digestive Organs— 145 Tonsil — 1 1 146 Naso-pharynx — 1 1 150 Oesophagus 1 1 2 151 Stomach 8 7 15 152 Small Intestine — 1 1 153 Colon 5 7 12 154 Rectum 3 5 8 157 Pancreas 4 3 7 Respiratory System- 161 Larynx 2 1 3 162 Lungs and Bronchus 27 3 30 Breast and Genito-Urinary— 170 Breast — 8 8 171/4 Uterus — 2 2 175 Ovary — 1 1 181 Bladder 2 — 2 Other Sites— 191 Chin — 1 1 199 Unspecified 3 — 3 201 Lymphatic Tissues 1 1 2 56 43 99 Average age at death: Males 63.7 years Females 63.3 years All persons 63.5 years Mortality from tuberculosis was on much the same scale as in 1953, 14 such deaths being registered. This gives a death rate of 0.22 per thousand population compared with 0.21 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 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 1944 0.63 1954 0.22 14 The distribution of tuberculosis mortality by wards and other details are given in Section F of this report. There were no deaths from the common infectious diseases. Coronary disease of the heart continued to take an increasing toll of the sufferers from cardiac conditions, 74 deaths being assigned to this cause as against 69 in the year before. Violent causes accounted for the death of 15 residents. They were as follows: Suicide 6 Road Traffic Accidents 3 Accidents in the Home 3 Accidents at Work 2 Other accidents 1 Inquests. Inquests were held on 46 persons who died in the district. The following verdicts were returned: Accidental Death 21 Suicide 10 Misadventure 8 Natural causes 6 Open Verdict 1 Nine of the total were residents of the district. Seven were due to road accidents. INFANT MORTALITY The deaths of 15 children who died under the age of one year were registered, of which 11 were males and 4 females. These provide an infant mortality rate of 18.2 per thousand live births compared with 23.3 in the year before. The comparable rate for England and Wales was 25.5. All were deaths of legitimate children. Eighty per cent. of the deaths occurred in the first month of life. Congenital malformations, prematurity and diseases peculiar to infancy accounted for 13 and infections for two. The ward distribution of infant mortality and the causes of death are shown in Tables 6 and 7. 16 16 TABLE 6. INFANT MORTALITY DURING THE YEAR 1954. 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 7 — — — 7 — — — — 7 Congenital Malformation 1 — — — 1 1 — — — 2 Birth Injury 2 — — — 2 — — — — 2 Accidental Death — — — — — — — — 1 1 Pneumonia 1 — — — 1 — 1 — — 2 Exomphalos — — — 1 1 — — — — 1 Totals 11 — — 1 12 1 1 — 1 15 TABLE 7. INFANT MORTALITY—WARD DISTRIBUTION. Ward. Infant Deaths. Rate per 1,000 Live Births. St. Helier North 1 7.3 St. Helier South 3 33.6 St. Helier West 2 16.9 North-East 3 21.6 North-West 2 20.2 Central 1 12.5 South-East 1 9.0 South-West 2 43.4 MATERNAL MORTALITY There were no maternal deaths. 17 18 TABLE 8—CAUSES OF DEATH DURING THE YEAR 1954—By Age and Sex No. Causes of Death 0 — 1 — 5 — 15 — 25 — 35 — 45 — 55 — 65 — 75 — All Ages M. F M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Prns. All Causes 11 4 — 1 — — 3 1 4 4 7 8 38 20 55 41 60 48 76 116 254 243 497 1 Tuberculosis, Respiratory — — — — — — 1 — — 3 1 — 2 — 1 — 2 1 — — 7 4 11 2 Tuberculosis, other — — — — — — — — — — — — 1 — — 1 — — — — 1 2 3 3 Syphilitic disease — — — — — — — — — — — — — — — — — 1 1 — 1 1 2 4 Diphtheria — — — — — — — — — — — — — — — — — — — — — — — 5 Whooping Cough — — — — — — — — — — — — — — — — — — — — — — — 6 Meningococcal Infections — — — — — — — — — — — — — — — — — — — — — — — 7 Acute Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — 8 Measles — — — — — — — — — — — — — — — -— — — — — — — — 9 Other Infective and Parasitic Diseases — — — — — — — — — — — — — 1 — — — — — — — 1 1 10 Malignant Neoplasm, Stomach — — — — — — — — — — 1 — 1 1 2 3 1 — 3 3 8 7 15 11 Malignant Neoplasm, Lung — — — — — — — — — — 1 — 7 — 7 2 9 1 3 — 27 3 30 12 Malignant Neoplasm, Breast — — — — — — — — — — — 1 — 1 — 3 — 3 — — — 8 8 13 Malignant Neoplasm, Uterus — — — — — — — — — — — — — 1 — 1 — — — — — 2 2 14 Other Malignant and Lymphatic Neoplasms — — — — — — — — 1 — — 1 4 6 4 6 6 2 6 8 21 23 44 15 Leukaemia, Aleukaemia — — — — — — — — — — — — — — — — — — — — — — — 16 Diabetes — — — — — — — — — — — — 1 — — — — 2 1 2 2 4 6 17 Vascular Lesions of Nervous System — — — — — — — — — — — — 1 2 10 8 3 8 12 21 26 39 65 18 Coronary Disease, Angina — — — — — — — — — — 1 1 10 2 9 2 19 12 8 10 47 27 74 19 Hypertension with Heart Disease — — — — — — — — — — — — — — 2 — — 3 1 2 3 5 8 20 Other Heart Disease — — — — — — 1 — — — — 1 3 2 3 4 4 4 19 41 30 52 82 21 Other Circulatory Disease — — — — — — — 1 1 — — — 2 — 2 1 2 2 6 9 13 13 26 22 Influenza — — — — — — — — — — — — — — — — — — — — — — — 23 Pneumonia 2 — — — — — — — — — — — — — 2 — 2 2 5 — 11 5 16 24 Bronchitis — — — — — — — — — — — — 2 1 5 3 4 — 3 4 14 8 22 25 Other Diseases of Respiratory System — — — — — — — — — — — — — — 1 1 1 — 1 1 3 2 5 26 Ulcer of Stomach and Duodenum — — — — — — — — — — — — — — 1 — 2 1 — 1 3 2 5 27 Gastritis, Enteritis and Diarrhœa — — — — — — — — — — — — — — — — — — — — — 3 3 28 Nephritis and Nephrosis — — — — — — — — 1 — — — 1 1 — — — 1 — 1 2 4 6 29 Hyperplasia of Prostate — — — — — — — — — — — — — — 1 — — — 2 — 3 — 3 30 Pregnancy, Childbirth, Abortion — — — — — — — — — — — — — — — — — — — — — — — 31 Congenital Malformations 1 1 — — — — — — — — — 1 1 1 1 — — — — — 3 3 6 32 Other Defined and Ill-defined Diseases 7 3 — — — — — — 1 — — 1 1 1 3 2 3 5 10 18 21 39 33 Motor Vehicle Accidents — — — — — — — — — — — — 1 — 1 — — — — — 2 — 2 34 All other Accidents 1 — — — — — 1 — — — 1 — — — — — — — — — 6 1 7 35 Suicide — — — — — — — — — — 2 1 — — 1 2 — — — — 3 3 6 36 Homicide and Operations of War — — — — — — — — — — — — — — — — — — — — — — — Section B—Health Services. Laboratory Facilities 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 306 Rectal Swabs 5 Blood Specimens 1 Water (Public Supply): For chemical analysis 2 For bacteriological examination 4 Water (Swimming Bath): For bacteriological examination 8 Food and Drugs: Analysis 344 Bacteriological examination of milk 228 Bacteriological examination of ice cream 84 Bacteriological examination of other foods for food poisoning organisms 3 Biological examination of milk 12 Vaccination and Immunisation The County Council is responsible for the scheme of vaccination and immunisation under Section 26 of the National Health Service Act. The service, as now developed, provides for (i) vaccination against smallpox; (ii) immunisation against diphtheria; (iii) immunisation against whooping cough; (iv) Mantoux testing and B.C.G. vaccination against tuberculosis of 13 year-old schoolchildren. By arrangement with the District Councils, local Medical Officers of Health direct the scheme in their respective districts in relation to the first three mentioned diseases, whilst B.C.G. vaccination is carried out under the School Health Service arrangements. Details of the work performed under the supervision of the district Medical Officers of Health, i.e., in respect of the prophylaxis against smallpox, diphtheria and whooping cough, will be found in Section F, dealing with infectious diseases. 19 Clinics and Treatment Centres The following programme of clinics is provided by the County Council and the Hospital Board and are available to residents of the district. Care of Mothers and Young Children. Rochester Road Centre: Infant Welfare Clinic Tues. and Thurs. 2—4 p.m. Maternity Clinic Thursdays 10—12 a.m. Toddler Clinic Mondays 2—4 p.m. Dental Clinic Tuesdays 1.30—4.30 p.m. Thursdays 9.30—12 a.m. Massage Clinic Mons., Tues., Weds., Thurs., Fridays 10—1 p.m. Mons., Tues., Thurs., Fridays 2—5 p.m. Wry the Lane Centre: Infant Welfare Clinic Weds, and Fridays 2—4 p.m. Maternity Clinic Tuesdays 10—12 a.m. Toddler Clinic Tuesdays 2—4 p.m. Stanley Road Centre: Infant Welfare Clinic Fridays 2—4 p.m. Maternity Clinic Tuesdays 10.30—11.30 a.m. Toddler Clinic 1st and 3rd Thursday 2—4 p.m. St. Helier Centre—Green Lane: 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. 20 Section C—Sanitary Circumstances. Water Supply The Sutton and District Water Company supplies water to the whole district except to 170 dwellings in the extreme north which are supplied by the Metropolitan Water Board. The source of supply is normally from wells in the chalk at Sutton, Cheam and Woodmansterne, but it can be augmented, if necessary, by the Metropolitan Water Board, the Epsom and Ewell Corporation and the East Surrey Water Company. The Company is under statutory obligation to soften to 9° of hardness. All dwellings have a piped supply from the mains. The finished water is not plumbo-solvent. Quality and quantity were satisfactory throughout the year. The raw well water is subjected to chlorination and both the raw and finished waters are submitted to bacteriological and chemical testing by the Company's resident chemist, by independent analysts and by the Public Health Departments of the Local Authorities in the supply area on an agreed rota. The following is a summary of the results of the tests carried out by the Company and are supplied by courtesy of the Engineer and Works Manager. Sample. Total No. of Bacteriological Examinations Total No. of full Chemical Analyses No. and % of samples showing Coli-Aerogenes in 100 ml. (excluding B. Coli 1) No. and % of samples showing B. Coli present in 100 ml. of sample Type 1 Total No. ColiAero genes Organisms in 100 ml. of sample No. % No. % Sutton Raw 307 43 10 3.2 13 4.3 23 Sutton Finished 310 13 Nil Nil Nil Nil Nil Woodmansterne Raw 309 45 Nil Nil Nil Nil Nil Woodmansterne Finished 309 13 1 0.3 Nil Nil 1 Cheam 309 44 1 0.3 Nil Nil 1 Reservoir 219 3 Nil Nil 1 0.4 1 District (excluding new mains) 264 Nil 1 0.4 1 0.4 2 New Mains 56 Nil 9 16.2 5 8.9 14 Total 2,083 161 21 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 27 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.) 208 Combined chlorine 19.4 Nitric nitrogen 9.9 Nitrous nitrogen 0.14 Ammonia, free and saline 0.004 Ammonia, albuminoid 0.012 Oxygen absorbed from permanganate in 4 hours at 26.7° C. 0.22 Hardness—by acidimetric titration—Temporary 72 Permanent 58 Total 130 Reaction for free chlorine at time of receipt none Iron and other metals absent pH 7.8 The water was bright and clear and slightly bluish in colour. Bacteriological examination Action by free chlorine during transit of the sample was prevented at the time of sampling Number of colonies per ml. developing upon agar in 2 days at 37° C. 0 Number of colonies per ml. developing upon agar in 3 days at 22° C. 0 Organisms of the coliform group absent in 100 ml. Streptococci absent do. Cl. welchii absent do. This water is of good organic purity and very moderate hardness and salinity. It is attractive in appearance and shows no material alteration in chemical composition as compared with previous samples from the same source. 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 9.32°. compared with 9.06° in the year before. Six exceeded the statutory limit of 9° and five were below. Drainage and Sewerage Routine work was carried out in cleansing sewers, soakaways and gullies in the district. Work was commenced in piping-in the open ditch along Tweeddale Road at a cost of over £11.000. The completion of this project will remove a source of considerable potential nuisance. Sewage is pumped to the disposal works of the Croydon Corporation in Beddington, except at various points on the fringes of the district, where it is more conveniently drained to the sewage systems of neighbouring authorities. 22 Surface drainage in the south is mainly by soakaways in the chalk; elsewhere it is by surface sewers to the River Wandle. Three hundred and sixteen drainage obstructions affecting 1,186 houses were dealt with, mostly in respect of 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 The higher rainfall of 1054 brought a return of some of the natural springs which had failed in the latter part of 1053. No complaints were received during the year in respect of rivers and streams. Closet Accomodation The position with regard to domestic sanitary conveniences remains the same. All dwellings have w.c.'s connected to the sewers except 17 houses in unsewered areas which have water carriage systems connected to 13 cesspools. There are no earth closets. Public Cleansing No alteration has been made in the arrangements for refuse collection , and salvage. Collection is by a fleet of modern vehicles fitted with hydraulic tipping gears. Disposal is by incineration in a six-cell destructor The provision of adequate tipping sites for clinker and screenings within a reasonable distance is becoming a problem. At the present, such tipping is done at the Barrow Hedges site where the ground level is being raised to form future school playing fields, but this work is nearing completion. 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 1,371 complaints as follows: Accumulations 29 Animals so kept 4 Burst pipes 15 Dampness 32 Drainage defects 56 Drains obstructed 327 Dustbins 182 Food contaminated 16 General defective conditions 88 Insects and Pests 104 Milk, contaminated and dirty bottles 2 Miscellaneous 35 Obnoxious effluvia 23 Overcrowding 21 Refuse collections 10 23 Rodents 259 Roofs, defective 17 Sewer obstructions 8 Shops 1 Sink waste pipes 4 Smoke nuisances 12 Unsound food 103 Verminous premises 11 Water supply 12 1,371 Fifteen thousand eight hundred and fifty-nine visits of inspection and re-inspection were made for the purposes set out below: Business premises 193 Cowsheds 25 Employment Agencies 4 Factories (Mechanical Power) (incl. Laundries 43) 209 Factories (Non-Mechanical Power) 86 Food and Drugs (incl. Food Byelaws) 686 Food poisoning enquiries 61 Food premises: Bakehouses 53 Bakers and confectioners 80 Butchers 193 Canteens 36 Canteens—School 77 Chemists 47 Cinema 3 Confectioners (sweets only) 115 Fishmongers 140 General Stores 87 Greengrocers and fruiterers 159 Grocers 275 Licensed premises with catering facilities 31 Licensed premises without catering facilities 26 Ice cream vehicles 22 Milk shops 29 Restaurants and cafes 160 Stalls, food 159 Tea packer 1 Unsound Food: Meat 54 Food other than meat 116 Vehicles, food 33 — 1,896 Hairdressers 70 House drains tested 81 Housing Act 622 Heating Appliances (Fireguards) Act 26 Housing enquiries 511 Housing Land Charges 976 Merchandise Marks Act 224 Offices 20 Outworkers premises 65 Pet Animals Act 31 Piggeries 70 24 Premises re cesspools 2 Public Health Act (Houses) 4,726 Public Health Act re-inspections 3,368 Rag Flock and Other Filling Materials Act 33 Rodents 811 Schools 67 Shops 788 Smoke observations. 123 Tents, vans, sheds 6 Urinals 70 Water sampling 9 15,859 Five hundred and forty-five informal notices were served concerning the following matters: Accumulations and deposits 5 Animals so kept 1 Burst pipes 6 Drainage defects 106 Dustbins 80 Exchange of toys for rags 2 Factories Act 2 Food and Drugs Act (incl. Food Byelaws) 56 General defective conditions 172 Miscellaneous 3 Obstructed drains 3 Overcrowding 57 Rag Flock and Other Filling Materials Act 1 Rodents 7 Shops Act 30 Smoke nuisance 5 Verminous premises 5 Water supply 4 545 Thirty-five formal notices were served by authority of the Council under the following Acts: Public Health Act, 1936, Section 39 5 „ „ Section 45 1 „ „ Section 56 1 „ „ „ „ Section 75 14 „ Section 93 14 35 As a result of investigations made and notices served, the following work was carried out: Accumulations removed 11 Brickwork, repaired and/or repointed 6 Ceilings cleansed and purified 32 Ceiling plaster repaired and/or made good 25 Cement fillets and plinths renewed. 1 Chimney stacks repaired and/or made good 4 flues repaired 2 25 Damp conditions remedied 28 Damp course provided 1 Disinfestations 86 Ditches cleaned 1 Doors and frames repaired, including locks and fasteners 10 Drainage repaired and/ or reconstructed: (643 ft. of drain laid) houses 49 inspection chamber repaired and/or made good 22 inspection chambers provided 1 inspection chamber covers renewed 19 stoppers or caps refixed and/or renewed 4 fresh air inlets repaired and/or renewed 7 soil vents repaired and/or renewed 2 drains tested 25 drains cleared (affecting 1,186 houses) 316 drains sealed off 2 waste gullies repaired or renewed 10 waste pipes repaired, renewed or provided 9 Dustbins provided 154 Fences repaired or renewed 3 Fireplaces ranges or stoves repaired or renewed 16 Floors renewed or repaired 16 Floors ventilation repaired 2 ventilation provided 1 Gates renewed 1 Glazing putty renewed 9 Paving repaired and/or made level 2 drained 1 Roofs repaired and made weatherproof 34 downpipe, guttering repaired and/or renewed 37 Shops, hot water, means of supply provided 5 Sinks renewed 3 Stairs or steps repaired, renewed or made level 2 baluster repaired 2 Surface water drainage repaired and made to work properly 2 Ventilation, more provided 1 Walls, rendered or rendering repaired 2 replastered and/or repaired 84 cleansed and redecorated 98 Wash basins, baths renewed 2 Hot water supply system 16 W.C. accommodation repaired provided pans renewed 21 pan joints renewed 2 seats repaired, renewed or provided 3 lift-up seat provided 2 box seats removed flushing apparatus repaired or renewed. 12 Windows repaired and/or renewed 44 Window cills (external) repaired 9 Miscellaneous items 11 Disinfection One hundred and eleven rooms and 243 library books were disinfected. Five lots of bedding were sterilised and 8 lots destroyed. 26 Vermin Control Persons The conditions of domestic life created by the Second World War was responsible for a large increase in verminous conditions, particularly in scabies infestation. Since then there has been a rapid improvement in this respect and instances of verminous infestation are becoming yearly less frequent. To deal with the suddenly aggravated problem during the war, the Council established a Cleasing Station in adapted premises at Rochester Road, equipped with the usual baths and a steam disinfector, and with the necessary staff to deal with the hundreds of individuals who were treated there annually. These facilities are maintained, but it is gratifying to record that they are now used only occasionally. The modern parasiticides have greatly improved the domestic control of pediculosis and their use by the School Health Service has done a great deal in reducing the number of persons requiring the services of the Cleansing Station. The following persons were dealt with at the Cleansing Station during the year: Families Persons Attendances For scabies 3 5 12 For pendiculosis 16 12 Schoolchildren included in these totals were: For scabies 0 For pediculosis 5 Premises The number of houses treated for bugs and fleas, vermin which is essentially a reflection of the absence of domestic cleanliness, fell to the record low figure of 5, compared with 8 in 1953 and more than 10 in each of the other post war years. This trend is comparable as is to be expected with the steady decline in the evidence of personal infestation During the year, one lot of bedding was destroyed and 86 premises were treated for the destruction of vermin and insect pests as follows: Property Treated by C.U.D.C. Property Treated Total Infestation C.U.D.C. Property S.C.C. Property Privately Owned Property By L.C.C. By Owners Ants 9 1 1 — — 4 Bugs 2 — 2 — — 4 Fleas 1 — — — — 1 Flies — 8 1 — — 0 Mites — 1 1 1 — 3 Moths — — — — — — Silverfish — — 1 — — 1 Wasps 7 — 57 — — 64 12 10 63 1 — 86 27 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 and Atmospheric Pollution Twelve complaints were received and dealt with during the year. It was reported last year that in consequence of increasing quantities of smoke and grit being discharged into the atmosphere, particularly from industrial establishments, arrangements had been made to install 3 deposit gauges at sites selected in consultation with the Director of the Department of Scientific and Industrial Research. These deposit gauges, designed to measure the quantity of solid matter in the air, were operating as from 1st January and were sited at Welbeck School (A), Winchcombe School (B) and Limes Avenue (C). From the beginning of October, apparatus to measure the volume of sulphur dioxide in the air and a filter measuring the intensity of smoke by a colorimetric method were installed in the grounds of the Public Health Department. The following is a summary of the readings obtained: Deposit Ganges Total Solids. Tons per sq. mile Gauge Total Rainfall (in inches) Highest Monthly Reading Lowest Monthly Reading Average Monthly Reading A 24.68 18.02 4.32 9.62 B 25.55 17.58 4.29 9.78 C 25.91 21.98 4.50 12.78 Month Gauge A Gauge B Gauge C Rainfall in inches Total Solids (Tons per sq. mile) Rainfall in inches Total Solids (Tons per sq. mile) Rainfall in inches Total Solids (Tons per sq. mile) January 1.11 14.16 1.02 13.35 *1.29 *79.95 February 1.83 11.56 1.98 11.86 2.05 12.92 March 1.68 11.33 1.68 13.49 1.86 21.98 April 0.19 4.32 0.16 7.07 0.25 7.52 May 2.66 18.02 2.63 17.58 2.60 17.38 June 3.13 9.17 3.77 6.93 2.87 17.72 July ... 2.55 5.67 2.36 4.29 2.47 12.35 August ... 2.24 5.07 2.19 6.56 2.44 4.50 September 1.70 7.04 1.72 6.56 1.81 9.90 October 1.77 5.50 1.81 5.47 1.89 6.74 November 4.22 13.71 4.48 14.73 4.55 17.68 December 1.60 9.91 1.75 9.56 1.83 10.61 * Gauge tampered with. 28 Atmospheric Sulphur Dioxide (Calculated in parts per 100 million) All Days Weekdays (Mon.-Fri.) Weekends[] (Sat. & Sun.) Average Maximum Total S02 Total S02 October 0.08 1.40 1.40 1.32 November 2.62 13.43 69.14 6.85 December 3.13 40.89 85.72 11.42 Total 5.83 45.72 156.26 19.59 Mean 1.94 — 52.08 6.53 Smoke (Calculated in milligrams per 100 cubic metres) All Days Weekdays (Mon.-Fri.) Weekends (Sat. & Sun.) Average Maximum Total Smoke Total Smoke October 4.61 21.65 119.96 23.23 November 13.47 49.62 343.25 47.59 December 10.67 37.35 288.98 41.91 Total 28.75 108.62 752.19 112.73 Mean 9.58 — 250.73 37.57 Prevention of Damage by Pests Act, 1949 The work of pest destruction was continued in conformity with the arrangements agreed with the Ministry of Agriculture and Fisheries. Eight thousand one hundred, and eighty-four visits were made by the Rodent Operatives concerning 1591 properties and 340 rat and mouse infestations found. Of that number 296 were found in private premises, 34 in business premises and 10 in Council premises. With regard to sewers, two maintenance treatments were carried out, one in May and the other in November. The results are shown in the following table, together with those for the three previous years: May Treatment November Treatment 1951 1952 1953 1954 1951 1952 1953 1954 Manholes baited 87 153 195 166 252 266 205 172 Manholes in which takes of prcbail were recorded 34 43 66 65 79 117 73 53 Percentage of manholes showing infestations 39 28 33.8 39.1 31 44 35.6 30.8 Percentage in relation to total manholes in distric 3 3.8 5.8 5.7 7 10.3 6.4 4.7 29 Swimming Baths The one swimming bath in the district was acquired by the Council in 1953. Some difficulty was experienced during the past year in maintaining an adequate degree of purity of the bath water owing to the strain on its limited capacity and obsolescence of its chlorination plant. Steps were accordingly taken to regulate the extent of user and to improve the purification plant. At the end of the season considerable structural alterations were also made with the object of improving the sanitary and other arrangements. Eight samples of water were submitted for bacteriological examination, two of which were unsatisfactory and reflected the difficulties referred to above. Samples taken subsequent to the remedial action indicated showed that the plant was capable of maintaining the water free from any bacterial contamination. Offices Twenty inspections of offices were made, but 110 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 808 536 1344 86 Without „ „ 30 12 47 20 Workplaces— With mechanical power 24 — 24 22 Without „ „ 17 16 33 20 884 564 1448 148 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 on Register Number of Inspections Written Notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 20 86 – – (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 86 209 – – (iii) Other premises in which Section 7 is enforced by the Local Authority* (excluding outworkers' premises) – – – – Total 106 295 2 — * Klectrical 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.") Number of cases in which defects were found Number of cases in which prosecutions were instituted Premises 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 1 2 – – – (b) Unsuitable or defective 1 2 – – – (c) Not separate for sexes – – – – – Other offences against the Act (not including offences relating to Outwork) – – – – – Total 2 5 – – – 31 Outwork (Section 110 and 111) Section 110 Section 111 Nature of Works 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. 21 – – – – — Boxes (cardboard) 2 – — – — — Umbrellas 1 – — – — — Brass and brass articles 1 – — – — — Cosaques, Christmas Crackers, Christmas Stockings, etc. 3 – – – – – Lampshades 3 – — – — — Stuffed Toys 1 – — – — — Total 32 — — — — — Shops Act, 1950 There are 521 shop premises on the register and 2812 inspections were made during the year. Preliminary notices were served with regard to thirty infringements. Local Authorities are still awaiting the amending legislation after the presentation of the Powers report. 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 a likelihood of injury by burning or of ignition of clothing by reason of contact with or proximity to the heating element or flame. Standards were prescribed to which guards must comply and these came into force on October 1st, 1954. Twenty-six inspections were made for purposes of the Regulations and several tests were made. Four electric fires were found not to comply with the standards and were taken off sale. Some difficulty and objection on the part of the retailers arose from the fact that electric fires are not fitted with plugs before sale and one of the tests involves the use of the fire for half an hour, thus consuming clectric current and, not least, that the latter test results in discolouration of the heating element and the insulator, thus converting the appliance in effect into a second-hand article. 32 Merchandise Marks Act, 1926 The Council have continued to execute the provisions of the Orders made under this Act and their five Sampling Officers are appointed as authorised officers for this purpose. Much of the work is done amongst the stall-holders in the district. Pet Animals Act, 1951 Six licences have been granted in respect of premises used as Pet Shops, all of them dealing mainly with fish and birds. The premises have been inspected and found satisfactory. Establishments for Massage and Special Treatment Six establishments, four for chiropody and two for massage, etc., are licensed under Part IV of the Surrey County Council Act, 1931. All were visited and found satisfactory. Employment Agencies There is only one employment agency in the district which was visited and found to be satisfactory. 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. Two formal samples, one of unused cotton felt and one of new teased coir fibre, were procured and found to comply with the regulations. The prescribed analysts are—The Chiltern Laboratories, Ltd., of Station Road, Marlow, Bucks. National Assistance Acts, 1948 and 1951 Provision is made under these Acts to require the removal to places of care of old and infirm people who are so neglected as to become a risk to their own health or to that of others. Owing to the lack of adequate institutional accommodation for the elderly without adequate domestic care, cases of this nature are not infrequently brought to the notice of the Medical Officer of Health by general practitioners. The powers provided under the Acts rarely need to be used to compel old people to accept such care. What is needed is more beds, both in welfare institutions and hospitals for old people in need and willing to occupy them. Disposal of the Dead 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 1954, 373 interments took place there, of which 148 were from Carshalton. No unused burial accommodation is available in Carshalton churchyard. Interment there is now effected only by re-opening existing graves. Negotiations are at present in progress jointly with the Battersea, Sutton and Cheam and Merton and Morden Councils for the provision of a crematorium to serve the four districts. The Council's mortuary in Mill Lane is provided with all modern facilities. The number of bodies received there during 1954 was 109, on all of which autopsies were performed. A large proportion of this number were from other areas. National Assistance Act—Section 50 One burial was arranged by the Council under this section during the year. 33 Section D—Housing:. New Houses During the year the following 04 dwellings were completed: Council Flats 23 Private Dwellings 41 Total 64 Buildings in course of erection at the end of the year were as follow: Council Flats 71 London County Council Flats 9 Private Dwellings 39 Total 119 Council's Housing Scheme The dwellings in the ownership of the Council at the year end were as follows: Pre-War Houses 624 Post-War Houses 547 Temporary Bungalows 102 Houses taken over under S.D.A.A. 34 Houses purchased (units of accommodation) 38 Accommodation in Parks, Offices, etc. 18 1,303 In addition, the following schemes were in various stages of preparation: Site No. Site Type of Dwelling No. in Contract 31 Stanley Road Flats 38 32 Wrythe Lane Flats 32 — Carshalton Playing Fields Houses 6 76 The number of requisitioned premises at the 31st December was 106 providing accommodation for 139 families. The outstanding approved applications for tenancies at the year end totalled 1,500, which is 155 less than a year before. 34 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. — 622 P.H.A. — 4,809 5,431 (b) Number of inspections made for the purpose 8,799 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 to 1932 —- (b) Number of inspections made for the purpose — (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 350 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 1953) 394 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 34 (2) Number of dwelling houses in which defects were remedied after service of formal notices: (a) By owners 38 (b) By local authority in default of owners 3 35 (c) Proceedings Under Sections 11 and 13 of the Housing Act, 1936. (1) Number of dwelling houses in respect of which tion Orders were made (2) Number of dwelling houses demolished in pursuance of Demolition Orders (d) Proceedings under Section 12 of the Housing Act, 1936. (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 4. Housing Act, 1936. Part IV (Overcrowding). (a) (1) Number of dwelling houses overcrowded at the end of the year 105 (2) Number of families dwelling therein 191 (3) Equivalent number of adults dwelling therein 742 (b) Number of new cases reported during the year 49 (c) (1) Number of cases of overcrowding relieved during the year 56 (2) Number of persons concerned in such cases 359½ (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, 49 cases of overcrow ding, according to the standard of the Housing Acts, were found to exist and 56 cases were remedied, leaving 105 dwellings, with 742 equivalent adults in occupation, overcrowded at the end of the year. 36 The known position with regard to statutory overcrowding at the beginning and end of the year was as follows: Ward Dwellings overcrowded at 31.12.53 Dwellings found overcrowded during 1954 Dwellings decrowded during 1954 Dwellings remaining over crowded at 31.12.54 Overcrowded cases remedied during 1954 Formal Action Informal Action Total St. Helier North 30 15 12 33 4 8 12 St. Helier South 30 10 12 28 5 — 7 12 St. Helier West 22 13 12 23 4 8 12 North-East 10 2 6 6 1 5 6 North-West 6 2 4 4 — 4 4 Central 6 4 4 6 2 2 4 South-West — — — — — — —. South-East 8 3 6 5 2 4 6 112 49 56 105 18 38 56 These figures cannot be strictly accurate since only a complete survey could reveal the true position at any particular date. Dwellings may become overcrowded without coming to the notice of the department and there is no obligation on anyone to notify the abatement of overcrowding. Since, however, these sources of error remain fairly constant, the number on the overcrowding register affords a guide—and they cannot be more—to the trend of the level of housing occupation. In 48 out of the 49 new cases of overcrowding families were sharing accommodation with relatives. Abatement of the 56 overcrowded premises was effected in the following ways: Provision of alternative accommodation by: Carshalton U.D.C 10 London C.C. 4 Other Local Authorities 4 Left the District 1 Removal of one or more occupant 35 Increased accommodation 2 Of the 105 dwellings remaining overcrowded at the end of the year, 84 are owned by the London County Coucil, four by the Carshalton Urban District Council and 17 are privately owned. Slum Clearance and Demolition The Order in respect of Clearance Area No. 7, involving eight tenement dwellings in Stanley Road, was confirmed by the Minister in September, 1953. Work of re-development on the site lias not yet commenced, although plans have been completed. 37 Now that many of the restrictions on labour and materials for slum clearance projects have been removed, there is urgent need for resuming the clearance programme which was interrupted by the war. By comparison with many areas, our problem is not large, but it is serious and significant enough for the unfortunate families whose health is prejudiced by having to live in conditions which should no longer be tolerated. Rather more than 1% of all dwellings in the district are unfit for occupation, but small as this proportion is, it means that approximately 200 families are in urgent need of re-housing. Housing Repairs and Rents Act, 1954 This Act, which came into force in August, 1954, makes further provision for the improvement of housing conditions. It has three main features: (1) Local Authorities are required to submit to the Minister proposals for dealing with unfit houses in their district with an indication of the time within which they estimate the programme will be completed. (2) Improved conditions for grants for improvement and conversion of sub-standard houses, with the object of encouraging more owners to apply for grants. (3) Provision for increased rents of controlled houses which are maintained in a good state of repair. Where a landlord claims this "repairs increase", it is open to the tenant, if he feels that the house is not in a sufficiently good condition to justify it, to apply to the Council for a Certificate of Disrepair. It is the duty of the Council, if disrepair does exist, to issue a Certificate of Disrepair, specifying the defects in respect of which it is issued. This is to make it easier for the landlord to see what work of repair he needs to carry out if he wishes to get the certificate revoked. Preliminary surveys were commenced during the year to enable the Council to supply the Minister by the end of August, 1955, with the information he requires as to their proposals for dealing with slum clearance. Four Certificates of Disrepair were applied for and granted up to the end of the year. Rent and Mortgage Interest Restrictions (Amendment) Act, 1933 No applications were received for certificates as to the state of repair of dwelling houses controlled by this Act. 38 Section E— Inspection and Supervision of Food. Milk Supply The district, being a Specified Area for the purposes of the Milk (Special Designations)(Specified Areas) Order, 1951, all milk sold by retail must be "designated milk" and all retailers must be licensed to use a special designation in relation to milk. Milk Distributors The number of registered Milk Distributors is 22. The designated licences issued during the year were as follows: Designation. Number of Distributors holding Licences No. of Licences in Force on 31/12/54. Principal Licences— Sterilised 15 18 Pasteurised 6 9 Tuberculin Tested 6 9 Supplementary Licences— Sterilised 8 12 Pasteurised 7 11 Tuberculin Tested 7 11 Bacteriological Examination of Milk Two hundred and twenty-eight samples of milk were procured and submitted for bacteriological examination. Four 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 173 171 2 172 1 — — T.T. Pasteurised 43 42 1 43 — — — Sterilised 12 — — — — 12 — 9 213 3 215 1 12 — 39 Biological Samples Twenty-one samples of milk were procured and submitted for animal inoculation tests. One gave positive evidence of tuberculosis and in conjunction with the Ministry of Agriculture and Fisheries the infected animal was eliminated from the herd. Milk and Dairies Regulations, 1049—Regulation 20. The powers provided by this Regulation were exercised to deal with milk from a local herd in which a cow had been detected by biological examination to be giving tuberculous milk. Following the elimination of the diseased cow, arrangements were made to sterilise the milk from the herd until further tests covering the remaining beasts were shown to be satisfactory. Analyses The number of samples of milk submitted to the Public Analyst was 230. The analyses show that four of them had less than the statutory limit of 8.5% of solids not fat. The average fat content of all the samples was 3.65% and that of solids not fat 8.77%. Ice Cream The steady improvement in the bacterial purity of ice cream sold in the district was maintained, as the following table, showing the results of the tests made during the year and those of preceding years, indicates: 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 — — 1954 98 94 2 2 — Eleven samples submitted to the Public Analyst satisfied the requirements of the Food and Drugs act and the orders made thereunder 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. The quantity of meat found to be unfit for human consumption was 3,933 lbs. 5 oz. 40 Food and Drugs Act, 1938 The following 344 samples were submitted to the Public Analyst with the following results: Article No. Adulterated or otherwise irregular Article No. Adulterated or otherwise irregular Baking Powder 1 Ice Lolly Mixture 5 Beans (Tinned) 1 Jam 1 Beer 1 Ketchup, Tomato 1 Biscuits 1 Margarine 2 Blackberries in Syrup 1 Marmalade 1 Blackcurrant Syrup 1 Milk 230 4 Breadcrumbs 1 Mincemeat 1 Butter 1 Mineral Water 5 Cake 2 Mint Jelly 1 Cereal (Baby Food) 1 Mixtures (Cake) 1 Cheese Spread 1 Oranges 1 Chicken Rissole 1 Orange Drink 1 Cider ] Olive Oil 1 Chocolate Roll 1 Paste (Meat) 2 Cocoa 1 Peanut Butter 1 Cocoanut Sugar 1 Pepper (White) 1 Coffee and Chicory Piccalilli 1 Extract 1 Pie, Fruit 1 Coffee 1 Pie, Meat 1 Cordial 1 Pork Roll 1 Cream 1 Pudding (Xmas) 1 Crabmeat 1 Salad Cream 1 Custard Powder Sauce 2 Dripping Sausage, Beef 1 Fish Cakes 1 Sausage, Pork 3 Flour (Self Raising) 1 Sausage, Liver 1 Flour (Plain) 1 Semolina 1 Gelatine I Steak and Kidney Glucose 1 Pudding 1 Glucose Drink Soup 2 Halibut Oil Capsules Suet 2 Health Salts 1 1 Sweets 7 Herbs (Mixed) Vegetable Fat 1 Honey 1 Vinegar (Malt) 2 Horseradish 1 Vitamin Capsules 2 1 Ice Cream 11 Yeast and Vegetable Ice Lolly 8 Extract 1 The following six samples were found to be adulterated or otherwise irregular: Milk—Four Samples These were all from different vendors and were deficient in solids other than fat to the extent of 1% in three instances and 2% in the fourth. The explanation given in all was the same—that at that particular lime of the year, viz: February/March, milk direct from the cow 41 not infrequently contains non-fatty solids slightly below the statutory limit. From experience of sampling in recent years, when emphasis appears to be on yield rather than quality, this would appear to be a fact.. Health Salts The analytical results of this sample did not agree with the declaration of contents on the label. It was contended that the discrepancy arose owing to the difficulty in dividing the sample into three identical parts, as is required by the Act. The other two parts were submitted to analysis and it was found that, taken as a whole, the sample conformed with the label. This difficulty with regard to sampling procedure will be obviated by the Food and Drugs Amendment Act, 1954 under which the requirements to divide a sample into three equal parts shall be deemed to be satisfied if three unopened containers of a food or drug are secured and each is dealt with as if it were a part of the sample. Vitamin Capsules These were capsules of halibut liver oil which slightly exceeded the limits of the British Pharmacopoeia standards, both in volume of content and vitamin A activity. The manufacturers indicated that in the light of the analyst's report they were increasing their production of capsules made by a modified procedure which gives less out-graded ones and were insisting on re-grading the capsules to prevent a recurrence. As there had been no prejudice to the consumer, no further action was indicated. Section 9—Sale of Food Unfit for Human Consumption The following complaints of alleged foreign matter in foodstuffs were received: Matchstick in bread Maggot on chocolate Metal nut in bread Disinfectant in marmalade Stone in bread Mould in meat pie Wood shaving in bread Glass in milk (2) Glass in bun Dirty milk bottle Nail in bath bun Beetle in sausage 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: lbs. ozs. lbs. ozs. Baby Food 1 — Milk 452 7 Cake and biscuits 31 — Mincemeat 1 10 Cereals 10 8 Mixture, Cake Pudding 4 — Cheese 205 — Peanut Butter — 8 Cream 3 4 Pickles 3 16 Flour 39 — Pudding 2 4 Fish 329 6 Salad Cream 112 2 Fruit 1,141 4 Sauce 3 9 Fruit Juice 4 15 Soup 57 1 Jam 81 7 Spaghetti 30 — Jelly and Blancmange — 2 Suet — 8 Meat 3,933 5 Vegetables 414 7 Total weight 3 tons 1 cwt. 1 qr. 21bs. 10 ozs. The stocks were disposed of by burning in the Council's Refuse Destructor. 42 43 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 16 4 – 80 2 1 – 1 – – Bakehouses 4 — – 53 1 1 1 1 – – Butchers 36 31 – 193 2 2 5 2 – – Canteens 21 — – 113 1 — — — – – Chemists 17 1 – 47 — — — — – – Cinemas 1 — – 3 – — — — – – Confectioners (sweets only) 72 53 – 115 2 1 — 1 – – Fishmongers 21 7 – 140 2 1 2 — – – General Stores 4 4 – 87 — — — — – – Greengrocers and Fruiterers 44 2 — 159 1 — — 3 1 1 Grocers (including corn chandlers) 82 20 2 275 6 1 1 3 – 1 Ice Cream vehicles variable — — 22 — — — — – – Licensed Premises (with catering facilities) 5 1 — 31 1 — — — – – Licensed Premises (without catering facilities) 21 — — 26 — — — — – – Milk Shops 8 4 — 29 — — — 1 – – Restaurants and Cafes 27 16 — 160 2 1 4 — – – Stalls, food variable — — 159 — — — — – – Vehicles, food variable — — 33 — — — — – – 143 2 1,725 20 8 13 12 1 2 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 All effective means are used to impress upon food handlers and the general public the necessity for a high standard of personal hygiene in the handling and preparation of food. Most of the cases of food poisoning could be prevented by strict attention to this all-important aspect of the problem of food-borne illness. A large proportion of outbreaks of this nature are due to the still not uncommon practice of preparing and cooking food a considerable time before it is consumed, and then re-heating This is particularly so in the case of meat and meat dishes. It is the fact that food poisoning organisms are capable of enormous growth and multiplication if given time, when implanted on a suitable medium, which accounts for this special risk. The practice should be avoided in all catering establishments or only resorted to when there are means for rapid cooling after the initial cooking, and refrigeration during the interval before re-heating. U Section F —Prevalence of and Control over Infectious and other Diseases. The district has, within its boundaries, three General Hospitals, two of which, namely, Queen Mary's Hospital for Children and the St. Helier Hospital, are particularly large institutions which are part of the hospital services of the South-West Metropolitan Hospital Region. Many of the cases notified from these hospitals are admitted there from other districts already suffering from a notifiable disease, but not diagnosed until after admission. In order, therefore, to give a clearer picture of the prevalence of infectious disease in the resident population of the district, separate figures are given in this section which exclude cases of hospital patients who are not residents of the district. The figures given are after correction for original errors in diagnosis. Notification The following diseases are notifiable in the district: Smallpox Dysentery Enteric Fever Cholera Acute Primary Relapsing or Continued Diphtheria Pneumonia Fever Membranous Croup Acute Influenzal Meningococcal Infection Erysipelas Pneumonia Ophthalmia Scarlatina or Acute Poliomyelitis Neonatorum Scarlet Fever Acute Puerperal Pyrexia Measles Polioencephalitis Malaria Whooping Cough Typhus Fever Food Poisoning Tuberculosis Tvphoid Fever Leprosy Smallpox The district was again free from variola infection. 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. 45 The number of persons successfully treated and recorded under these arrangements during 1954 was as follows:— Age at 31st Dec., 1954 Under lyr. 1-4 yrs. 5-14 yrs. 15 yrs. & over. Total. Primary Vaccinations— By Private Practitioners 88 82 9 1 180 At Clinics l30 97 3 — 239 227 179 12 1 419 Revacanations— By Private Practitioners /– 4 13 5 22 At Clinics – 1 — — 1 — 5 13 5 23 In addition the following unsuccessful attempts at vaccination were made: Age at 31st December, 1954 Under 1 yr. 1-4 yrs. 5-14 yrs. 15 yrs. & over. Total. Primary a 3 — — 9 Re-vaccination — 3 – — 3 6 6 — — 12 The estimated number of children under 5 years of age vaccinated at the 31st December, 1954 was 1,686, which represents 45% of that age group. Enteric Fever There were no cases of typhoid or paratyphoid fever. Dysentery Sonne dysentery was prevalent in the first half of the year, 73 cases occuring in the northern part of the district. In conformity with past experience, when introduced into a family it spreads to most, if not all members of the household and the majority of cases come to notice as the result of investigation into domestic contacts. Mention has been made in previous reports of the difficulty in controlling this infection, owing to the fact that its true nature and highly contagious character is seldom recognised. Moreover, its relative mildness provides little incentive to seek medical advice. When such advice is sought, it is rarely investigated bacteriologically and many cases are designated gastro-enteritis, dietetic indiscretion, or other convenient diagnoses. All cases recovered. 46 Scarlet Fever Not for many years was the incidence of scarlet fever so low as in 1934. The number of cases notified was 57 against 125 in the year before. All were residents of the district. This provides an incidence rate of 0.92 per thousand population. The disease was of the same mild nature as we have for so long come to know it and no deaths occurred. More than half the total, viz: 30, were nursed at home. This exceeded the percentage so nursed in the year before which was then the record for domiciliary treatment. There is obviously no evidence that this growing practice of avoiding hospitalisation has increased the risk of spread in this infection. On the contrary, the elimination of the chances of cross infection, which is an inseparable risk of multiple-bed wards, has undoubtedly saved many contacts from this disease. Only in two instances was there a second case in the same household. Although mild in form, there is no reason to believe that the period of infectivity is thereby reduced and parents frequently find it difficult to maintain isolation in the home for an adequate length of time as most children become virtually symptomless in a matter of days and find confinement to one room very irksome. TABLE 10 SCARLET FEVER—DISTRIBUTION OF CASES, 1954 1954 Ward Total St. Helier North St. Helier South St. Helier West NorthEast NorthWest Central SouthEast SouthWest January – 1 – 2 2 1 – – 6 February — — — 4 3 — 2 2 11 March — – 2 2 2 — 1 1 8 April — — — — — 1 — 1 2 May 1 – 2 1 — — — 2 6 June 1 – — 1 — — — 1 3 July 1 1 1 1 — 1 2 – 7 August – – – – – – 1 – 1 September 2 1 — — — — — – 3 October — — — — 1 — 1 – 2 November 1 — — 2 — — — – 3 December — — 1 1 – — 2 1 5 Totals 6 3 6 14 8 3 9 8 57 Monthly Mean 0.50 0.25 0.50 1.16 0.66 0.25 0.75 0.66 4.75 Case rate per 1,000 population 0.69 0.42 0.74 1.40 1.07 0.50 1.11 1.25 0.92 47 TABLE 11 SCARLET FEVER—MULTIPLE CASES, 1954 Ward No. of houses in which occurred Total Houses Total Cases 1 Case 2 Cases 3 Cases St. Helier North 6 – – 6 6 St. Helier South 3 — — 3 3 St. Helier West 6 — — 6 6 North-East 14 — — 14 14 North-West 8 — — 8 8 Central 3 — — 3 3 South-East 7 1 — 8 9 South-West 6 1 — 7 8 Whole District 53 2 — 55 57 Diphtheria No cases occurred during the year, the fifth successive one of freedom from this infection. Diphtheria Immunisation After 5 years with no diphtheria, it becomes increasingly difficult to maintain a sufficiently high level of artificially conferred immunity to guarantee a continuation of this freedom. Parents in recent years have become more concerned to secure protection against whooping cough and the not unsatisfactory level of diphtheria immunisation which is still being achieved is in no small measure due to the fact that it is possible to combine it with the prophylactic treatment of whooping cough. The scheme, as organised locally, aims at giving primary immunisation before the age of one year and to reinforce the treatment by further single boosting injections at the time of entry to school and thereafter at three-yearly intervals until the child reaches secondary school. The index of immunity is now calculated on the number of children under 15 years of age who have received primary or reinforcing treatment within the previous 5 years. On this basis, the last reinforcing injection should not be before the tenth birthday. The facilities for treatment take this consideration into account. It is available free at all the Infant Welfare Clinics for children under 5 years, at the School Clinics and at special sessions conducted in the Primary Schools of the district in alternate terms for children of school age. It may be had also as part of the General Practitioner services established under the National Health Service Act. During 1954, 729 resident children received a primary course of treatment as follows: 48 Age at 31.12.54 Under 1 year 1 year 2 years 3 years 4 years 5-9 years 10-14 years Total At Council Clinics 50 254 54 10 5 5 - 378 In Carshalton Schools — — — — 3 162 3 168 Private Practitioners 19 152 32 8 5 11 — 227 Less outward transfers 69 406 86 18 13 178 3 773 — 4 4 — — 48 1 57 Plus inward transfers 69 402 82 18 13 130 o 716 — 5 — — — — 8 13 Carshalton Residents 69 407 82 18 13 130 10 729 A further 1,454 Carshalton children received reinforcing injection during the year. The immunisation state of the local child population at 3lst December, 1954, was as follows: Number of Children at 31st December, 1954, who had completed a course of immunisation at any time before that dale (i.e. at any time since 1.1.40) Age at 31.12.54 i.e. Born in Year Under 1 1-4 5-9 10-14 Under 15 Total 1954 1953-1950 1949-1945 1944-1940 Last complete course of injections (whether primary or booster) A. 1950-1954 71 2,021 3,721 2,205 8,018 B. 1949 or earlier — - 636 1,134 1,770 C. Estimated mid-year child population 800 3,140 9,020 12,960 Immunity Index 100 A/C 8.9 64.3 65.7 61.8 The percentage of children immunised within the last 5 years was 61.8 compared with 64.5 at the end of 1953. There was, however, as will be seen, a further 13% 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 — — 15 47 0.80 1938 — — 18 33 0.67 1939 — — 19 14 0.23 1940 — — 21 45 0.77 1941 — — 49 26 0.46 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 1954 53 85(66*) 75(62*) 0 0.00 (* Immunised within the last 5 years) Erysipelas Four cases of erysipelas were notified. Three were elderly adults and the fourth a baby of one month who suffered from ophthalmia neonatorum in addition. All were infections of the face and all recovered. Pneumonia Notifiable pneumonia is limited to (a) primary pneumonia, i.e. pneumonia which arises as such and is not a secondary complication of some other infection such as measles, and (b) influenzal pneumonia. During 1954, 28 notifications were received, only two of which were in respect of influenzal pneumonia, a reflection of the fact that there was no severe epidemic of influenza during the year. Measles Until the outbreak of the second World War, the incidence of measles in big centres of population, such as Greater London, showed a very definite biennial periodicity. The large movements of the child population in 1940, however, markedly affected this pattern of prevalence and the expected epidemic of that year did not materialise in the London area. It has not yet resumed its previous wave form, but, to a certain extent, a year of low incidence is still frequently followed by one of larger epidemic proportions. In 1953, the attack rate of measles was relatively high and so a favourable year in 1954 was not unexpected. Only 173 cases—all residents but two—were notified, as compared with 652 in the year before. Experience so far in 1955 shows that the wave of prevalence is again rising. There were no deaths from measles. 50 TABLE 12 MEASLES—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1954 (Excluding hospital patients non-resident in Carshalton) 1954 Ward Total St. Helier North St. Helier South St. Helier West NorthEast North- West Central SouthEast SouthWest January 1 - 4 12 42 11 30 14 114 February — — — 4 10 1 1 — 16 March - - - - - 1 — 2 3 April — — — 3 1 1 — 5 10 May — — — — — — — 1 1 June — — — 1 — 1 — — 2 July — — — — — 3 — — 3 August — — 1 2 — — — — 3 September - - - - - 1 — — 1 October - - - - - - - - - November - - - - - - 3 — 3 December 5 — — 10 - — — - 15 Totals 6 - 5 32 53 19 34 22 171 Monthly Mean 0.50 — 0.41 2.66 4.41 1.58 2.83 1.83 14.25 Case rate per 1,000 population 0.69 — 0.62 3.21 7.14 3.18 4.20 3.44 2.77 Whooping Cough The year under review was also a favourable one from the point of view of whooping cough infection. The total cases notified fell from 345 in the year before to 154, all being resident children except four. All recovered. The County Council's scheme of immunisation and vaccination formulated under Section 26 of the National Health Service Act now includes immunisation against whooping cough. This form of preventive treatment is finding increasing favour with parents and the number of children treated is increasing steadily. As observed earlier, it is possible to combine this treatment with anti-diphtheria prophylaxis. As more infections are successfully brought within the scope of immunisation procedures, such combinations of immunising materials with a corresponding reduction in the number of injections becomes very desirable, if not essential. Recently, B.C.G. vaccination against tuberculosis has been adopted to a limited extent and gives promise of expansion. A successful vaccine against poliomyelitis, too, appears to be within sight. It is easy to appreciate, when schemes of immunisation against this growing list of diseases becomes fully developed, that the organisation of a convenient programme of injections in early childhood may well present a problem. The estimated number of children at 31st December under 5 years of age given immunisation treatment against whooping cough was 1351, representing 36% of the total in that age group. 51 TABLE 13 WHOOPING COUGH—WARD INCIDENCE AND MONTHLY DISTRIBUTION 1954 (Excluding hospital patients non-resident in Carshalton) 1954 Ward Total St. Heliei North St. Heliei South St. Helier West NorthEast NorthWest Central SouthEast SouthWest January - 1 - - - 1 1 1 4 February — — — — 4 — 4 1 9 March 1 3 — 1 — — 1 1 7 April 1 — — 1 1 — 1 — 4 May — 2 1 — — — 1 — 4 June — 2 11 3 — 1 5 4 26 July — 6 16 — — — 1 5 28 August — 1 7 — — — 4 6 18 September 3 1 1 — — — 2 — 7 October 7 1 — 1 — — — — 9 November 13 — — 3 1 1 — 2 20 December 6 1 — 2 - 2 — 3 14 Totals 31 18 36 11 6 5 20 23 150 Monthly Mean 2.58 1.50 3.0 0 0.91 0.50 0.41 1.66 1.91 12.50 Case rate per 1,000 population 3.59 2.53 4.4 1.10 0.80 0.83 2.47 3.60 2.43 Meningococcal Infection There were no cases of cerebro spinal fever or other form of meningococcal infection. Poliomyelitis Only one case of poliomyelitis was notified, compared with 9 in the year before. This was a baby of 29/12 years who returned from a visit to East Anglia in August with symptoms which proved to be those of polio infection. She was admitted to hospital where she received in-patient treatment for 5 months for some paralysis of one leg. Some weakness still persists, causing a slight limp. Encephalitis A child of 2 years was admitted to hospital with a tentative diagnosis of poliomyelitis. After investigation, the case was deemed to be one of encephalitis. Recovery was complete, the baby being discharged from hospital after about 19 days. Ophthalmia Neonatorum Inflammation of the eyes in the newborn was notified in three instances. Two were sixth pregnancies and one the fourth. One was a severe infection involving both eyes and complicated by facial erysipelas. The other two were mild, affecting one eye only. All recovered without any impairment of vision. 52 Puerperal Pyrexia Any rise in temperature of 2° of any duration within 2 weeks of childbirth or miscarriage is notifiable under the Puerperal Pyrexia Regulations, 1951. It includes all febrile conditions, whatever the cause, whether related to childbirth or not. Past experience has shown that most such notifications are to be expected from the large maternity hospital units established within the district which cater for the obstetric needs of a large part of Metropolitan Surrey. The majority of these cases are mothers who are not resident in Carshalton, and hence the calculation of the incidence rate of puerperal pyrexia based on each thousand of Carshalton births, gives an entirely misleading indication as to the risk of this type of pyrexia in the local population. A total of 270 notifications was received, all from maternity hospital units. Seventy-four were residents of Carshalton. One hundred and sixty-six were first confinements. There were no deaths. Food Poisoning Twelve cases of food poisoning were reported. Seven of these were single cases, 6 of them being S. Typhimurium infections and one S. Bovis morbificans. As is usual in these isolated cases, it was not possible to identify the vehicle of infection. Investigation into the domestic contacts of one patient revealed that the other two members of the family were excreting the offending organism but had not been ill. The remaining 5 cases were also due to infection by S. Typhimurium and occurred in two groups of 2 and 3. It was found that the family which provided the two cases kept 3 ducks and a drake as well as hens and, since duck eggs are known to be a not uncommon source of this type of infection, attention was focussed on the ducks. Five eggs were secured from this small flock over a period of 8 days, and two of them were found, on bacteriological investigation, to be heavily infected with S. Typhimurium. Thereupon, the four birds were removed to the Ministry of Agriculture and Fisheries' veterinary laboratory at Weybridge for further investigation. There, one duck was found to give a positive blood reaction to this salmonella and to be excreting the organism. Tests on the other two ducks and the drake were entirely negative, as were those on 40 eggs laid by these two ducks, whereas S. Typhimurium was isolated from the shell of one egg laid by the first-mentioned duck. On post-mortem examination, S. Typhimurium was recovered from the ovary and other organs of the duck which gave the positive tests when alive, but the autopsy on the other three birds was negative. Although on a much smaller scale, this is the second outbreak of S. Typhimurium food poisoning which has occurred locally from a domestic flock of ducks, the previous one being in 1949, when 28 members of a boarding school and religious community were the victims of this infection found to be present in the majority of a flock of 32 ducks. The group of 3 cases were patients in the maternity block of a local hospital. Two were newborn breast-fed babies, 1 day and 4 days old respectively, in different wards, the dates of onset being separated by (i days. The third was a baby of six months, which arose a few days later in the ward to which the first two babies had been transferred. The origin of this infection could not be ascertained. There was obviously no gross contamination of a food commodity and the fact that spread among so many mothers and babies was kept to such very narrow limits was doubtless due to the high standard of nursing technique. All three babies recovered. 53 TABLE 14 CASES OF NOTIFIABLE INFECTIOUS DISEASE ADMITTED TO HOSPITALS, 1954 Disease Cuddington Bletchingley Wandle V allev Queen Mary's St. Helier Totals Scarlet Fever 17 2 8 - - 27 Erysipelas 1 - - - 1 2 Measles 4 1 - - 5 Whooping Cough - - 1 4 - 5 Dysentery 4 - - 1 5 Pneumonia - 1 - 2 3 Ophthalmia Neonatorum - - - - 1 1 Poliomyelitis Paralytic 1 - - - - 1 Encephalitis Infective 1 - - - - 1 Food Poisoning - - - - 4 4 Totals 28 2 11 5 8 54 54 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 57 0.92 — 6 3 6 14 8 3 9 8 27 47 Erysipelas 4 0.06 — — 1 — 1 — 1 1 — 2 50 Measles 171 2.77 — 6 — 5 32 53 19 34 22 3 1.75 Whooping Cough 150 2.43 — 31 18 36 11 6 5 20 23 1 0.66 Dysentery 73 1.18 — 17 ,0 30 11 — 1 3 1 5 6.84 Pneumonia 28 0.45 — 5 3 4 1 — 4 8 3 2 7.14 Ophthalmia Neonatorum 3 0.04 — — 1 — 1 1 — — 1 33 Poliomyelitis, Paralytic 1 0.01 — 1 - - - - - - - 1 100 Encephalitis, Infective 1 0.01 — — — — — 1 — — — 1 100 Puerperal Pyrexia 74 1.20 — 13 11 20 4 12 3 9 2 74 100 Food Poisoning 9 0.14 — 2 2 2 — — — — 3 1 11.1 55 TABLE 16 INFECTIOUS DISEASES Notification by Age Groups, 1954 (Excluding hospital patients non-resident in Carshalton) Disease Total Cases Notified Total Cases at all Ages Under 1 year 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 and over Scarlet Fever 1 — - 2 8 39 4 2 1 — — — 57 Erysipelas 1 - - - - - - - - - 1 2 4 Measles 5 7 20 16 16 104 3 - - - - - 171 Whooping Cough 15 14 10 12 27 68 1 1 1 — 1 — 150 Dysentery 3 6 4 3 2 11 7 5 17 7 7 1 73 Pneumonia — 1 1 — — 2 2 2 3 1 12 4 28 Ophthalmia Neonaturum 3 - - - - - - - - - - - 3 Poliomyelitis, Paralytic - - 1 - - - - - - - - - 1 Encephalitis Infective - - 1 - - - - - - - - - 1 Puerperal Pyrexia - - - - - - - 7 62 5 — — 74 Food Poisoning - - 1 - 2 - - — 2 1 3 — 9 56 TABLE 17 MONTHLY INCIDENCE QF INFECTIOUS DISEASES, 1954 (Excluding hospital patients non-resident in Carshalton) Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 6 11 8 2 6 3 7 1 3 2 3 5 57 Erysipelas - 1 — — — — 1 1 - — 1 4 Measles 114 16 3 10 1 2 3 3 1 - 3 15 171 Whooping Cough 4 9 7 4 4 26 28 18 7 9 20 14 150 Dysentery 3 12 32 11 10 1 3 — 1 - — — 73 Pneumonia 6 4 2 3 — 3 1 4 — — 3 2 28 Ophthalmia Neonatorum — - 2 — — — — 1 — — — — 3 Poliomyelitis, Paralytic — - - — — — — 1 — — — — 1 Encephalitis Infective — - - — — - 1 — — — — — 1 Puerperal Pyrexia 4 2 7 5 9 10 6 8 10 5 3 5 74 Food Poisoning — - - — — 6 2 — 1 — — — 9 Tuberculosis, Pulmonary 7 6 2 5 7 5 3 2 1 3 5 5 51 Tuberculosis, Non-Pulmonfiry - - - - - 1 - - 1 - - - 2 57 Tuberculosis The new cases admitted to the tuberculosis register during the year numbered 102, classified as follows: Males Females Pulmonary 49 Pulmonary 44 Non-pulmonary 4 Non-pulmonary 5 Of the total additions, 53 were primary notifications, 45 were transferred from other districts, and 4 came to notice in other ways. For the same period, 109 names were removed from the register for the following reasons: Recovered 17 Death 15 Otherwise (including removals) 77 After allowing for the additions and deductions, the state of the register at the 31st December, 1954, was as shown in the following table: TUBERCULOSIS—WARD DISTRIBUTION Cases on Register at 31st December, 1954 Ward Pulmonary Non-Pulmonary Total Incidence per 1,000 population Males Females Males Females St. Helier North 79 77 13 9 178 20.6 St. Helier South 70 61 11 10 152 21.4 St. Helier West 65 79 7 11 162 20.0 North-East 64 69 9 4 146 14.6 North-West 31 30 - 3 64 8.6 Central 37 31 4 1 73 12.2 South-East 40 28 3 4 75 9.2 South-West 23 18 — 3 44 6.8 Whole District 409 393 47 45 894 14.5 802 92 The total of 894 is 7 less than at the corresponding date twelve months earlier. The number of patients from Carshalton who received institutional treatment under the arrangements of the South-West Metropolitan Hospital Board during the year was 144. 58 The number of tuberculous persons who died during the year was 15, distributed by age groups as follows: Age, Years. Pulmonary. Non-Pulmonary. Total. Males. Females. Males. Females. 0 - - - - - 1 —5 - - - 1 1 5—15 - - - - - 15—25 1 — - - 1 25—35 — 3 — - 3 35—45 1 — — - 1 45—55 2 — 1 - 3 55—65 2 - - 1 3 85—up 2 1 — - 3 Totals 8 4 1 2 15 The deaths attributable to tuberculosis were 14, as follows: DEATHS DUE TO TUBERCULOSIS, 1954. 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 42 St. Helier South 1 1 — — 0.28 52 St. Helier West — — — — — — North-East 1 1 1 - 0.30 57 North-West 1 — — — 0.13 20 Central — — — 1 0.16 56 South-East I 1 — 1 0.24 32 South-West 2 — — — 0.31 55 Totals 7 4 1 2 0.22 46 Four of these deaths were of unnotified cases. No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or under Section 172 of the Public Health Act, 1936 The Council adopted a points scheme for deciding the order of priority of applicants for housing accommodation. Special "weighting" is provided under this scheme where the existence of tuberculosis in the household creates a risk of infection. Two such families were rehoused out of a total of 34 Council tenancies allotted during 1954. 59 TABLE 18. TUBERCULOSIS. New Cases, Age and Sex Distribution and Manner ok Admission to Register, 1954. Age Group Years. Primary Notifications "A." Cases transferred from other Districts. , Cases brought to notice other than by Notification or Transfer. Total New Cases. Pulmonary. Non-Pulmonary Pulmonary. Non-Pulmonary Pulmonary. Non-Pulmonary M. F. M. F. M. F. M. F. M. F. M. F. 0— 1 - - - - - - - - - - - - - 1— 5 - - - - - - - - - - - 1 1 5—10 1 - - - 2 1 - - - - - 4 10—15 - 2 - - - - - - - - - - 2 15—20 - 5 - - - 3 1 - - - - - 9 20—26 3 4 - - 1 2 - - - - - 10 26—36 5 6 - 2 13 11 1 1 - - - - 39 35—45 6 3 - - 2 1 - - - - - - 12 46—55 10 2 - - 3 2 - - - - 1 - 18 55-65 4 - - - - 1 - - 1 - - 1 7 65 up - - - - - - - - - - - - - Totals 29 22 - 2 19 22 3 1 l - 1 2 102 53 45 4 60 Mass X-Ray One of the Mass X-Ray Units of the South-West Metropolitan Regional Hospital Board last visited the district in 1953. It is not proposed to operate a unit again in Carshalton until November, 1955. Meteorology The following rainfall was recorded at the Council's Pumping Station in Buckhurst Avenue. Rainfall 1954 Amount in ins. January 1.18 February 2.07 March 1.80 April 0.31 May 2.72 June 3.30 July 2.63 August 2.41 September 1.88 October 1.90 November 4.84 December 1.80 Total 26.84 The flow over the weir on the head of the River Wandle in the grounds of the Grove was as follows: Total flow during the year1014.63 million gallons Minimum flow 1.44 million gallons/day on 18/19 January Maximum flow 13.70 million gallons/day on l4th May. 61 ??? INDEX PAGE Acreage 0 Atmospheric Pollution 28 Births— Distribution 9 Institutional 10 Rates 11 Cancer 14 Cemeteries 33 Clinics and Treatment Centres 20 Closet Accommodation 23 Deaths— Classification 18 Distribution 13 Rate 13 Diphtheria 48 Immunisation 19,48 Dysentery 46 Disinfection 26 Disposal of Dead 33 Drainage and Sewerage 22 Employment Agencies 33 Enteric Fever 46 Erysipelas 50 Establishments for Massage, etc. 33 Factories 30 Food— Food and Drugs Act 41 Hygiene 44 Inspection and Supervision 42,43 Poisoning 53 Health Services 19 Heating appliances (Fireguards) Regulations, 1953 32 Housing— Council's Scheme 34 Inhabited Houses 6 Inspection 35 Overcrowding 36 Slum Clearance 37 Ward Distribution 36 Ice Cream 40 Infant Mortality 15,16 Infectious Diseases 45,55,56,57 Inquests 15 Isolation Hospital— Admissions to 54 62 126 PAGE Laboratory Facilities 19 Mass X-ray 61 Maternal Mortality 17 Measles 50 Meat 40 Meningococcal Infection 52 Merchandise Marks Act, 1926 33 Meteorology 61 Milk Supply 39 Milk and Dairies Regulations, 1949 40 Mortuary 33 Natural and Social Conditions 6 National Assistance Act 33 Offices 30 Outworkers 32 Ophthalmia Neonatorum 52 Pet Animals Act, 1951 33 Pneumonia 50 Poliomyelitis 52 Population 7,8 Public Cleansing 23 Puerperal Pyrexia 53 Rag Flock and other Filling Materials Act, 1951 33 Rateable Value 6 Rats and Mice Destruction 29 Rent and Mortgage Interest Restrictions (Amendment) Act, 1933 38 Rivers and Streams 23 Sanitary Circumstances 21 Sanitary Inspection 23,24,25 26 Scarlet Fever 47 Shops Acts 32 Smallpox 45 Smoke Abatement 28 Staff 5 Statistics— Comparative 12 Vital 7 Swimming Baths 30 Tuberculosis 19,58,60 Unemployment 8 Vaccination 19,46 Vermin Control 27 Water Supply 21 Whooping Cough 51 Zymotic Diseases— Deaths from 7 63 135 64 R2/68