??? ??? AC4413(3) CARSHALTON CAR 20 CARSHALTON URBAN DISTRICT Annual Report OF THE Medical Officer of Health FOR THE YEAR 1955 67722 CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1955 PREFACE To the Chairman and Members of the Carshalton Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report on the health of the district for the year 1955. This Report like its predecessors continues the record of steady progress in the well-being of the local community which advances in medical knowledge particularly in the field of preventive medicine, and their practical application have made possible. The birth rate was lower than in the year before as was the death rate, the latter again being considerably less than the national figure. Infant mortality rose, but still compares favourably with the rate for England and Wales. Once more there was no maternal death. The most satisfactory feature of the death returns was the precipitous fall in the mortality from tuberculosis, only three deaths being attributable to this disease against an annual average of fifteen in the last five years. Cancer here, as elsewhere, remains the chief single cause of death with malignant disease of the lungs responsible for a high proportion of the total of such deaths. An increase in the prevalence of poliomyelitis marred an otherwise satisfactory position with regard to infectious disease. As has been observed in a previous report, the long established common infectious diseases especially those due to organisms within the visible range of the microscope such as scarlet fever, ophthalmia, diphtheria, enteric fever, etc., have largely been brought under control and now present very little in the way of a public health problem. Our chief concern and threat today in this field are the infections due to those ultra microscopic organisms known as viruses. Of these poliomyelitis has in recent years taken an increasing toll in morbidity and mortality. The results, however, of research in the last year or so on the production of an efficient vaccine hold great promise that this grossly disabling affliction will also yield to the preventive action of an immunisation procedure as diphtheria has done. 3 Much of the illness which still besets us is due to man-made pollution. More determined attempts to deal with food-borne illness have in recent years been made in the raising of food hygiene standards and in improving both the equipment and practices in the catering trades. Public conscience at last seems to be awakening to the enormous price we pay in illhealth, particularly in respiratory disease, for the daily pollution of the atmosphere. The Clean Air Act, 1956 is a beginning of this process of enlightenment and we have a long way to travel before the air we breathe is in any way as pure as the water we drink. For too long a smoke-laden atmosphere has been accepted as a necessary accompaniment of industrial prosperity. Although the district is more favourably placed in this regard than many, it suffers like all urbanised areas from the continuous and insidious effects of domestic smoke. Recognising that this is not a problem which can effectively be dealt with by individual districts alone, it is in keeping with the Council's progressive practice that they have given full support to those bodies, both national and regional, whose pioneering exertions are at long last seeing some reward for their efforts and that they have established apparatus for the collection of data on the extent of atmospheric pollution for the common pool of reliable information without which progress cannot be made. An event which can have great health significance for the future, was the assessment, as required by the Housing Repairs and Rents Act, 1954, of the extent of unfit housing accommodation in the district and the proposals for dealing with it. Some 200 dwellings are, or are likely to be, totally unfit within the next five years. The crucial test as to the contribution this event will make to the well-being of the community, will be found in the determination with which the various planned phases of the scheme are pursued. The difficulties are not few, not least the shortage of an adequate building site to enable the scheme to commence, and doubtless many will arise which cannot be foreseen, but the rewards in terms of health are sufficiently attractive to justify an all-out effort to reach a successful solution of this problem within the limits of time set themselves by the Council. The staff of my department have continued to give that conscientious and untiring assistance to which I have been accustomed for so long and I tender to them once again my sincere thanks. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, F. LAWRENCE SMITH, Medical Officer of Health. July, 1956. 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. (resigned 16-1-55)—post vacant for rest of year) † 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 1955) according to Rate Books 17,238 Rateable Value at 31st December, 1955 £533,172 Sum represented by 1d. rate £2,171 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 flow from the springs is liable to considerable fluctuation depending upon rainfall, but whereas in earlier times the flow was always sufficient to prevent stagnation of the ponds and water courses, the lowering of the water table in recent years due to progressively increased abstraction for various purposes, has increased the frequency with which the springs fail and lengthened their recovery time. The upper pond naturally is the first to suffer in these conditions and the risk to health is aggravated by the fact that it receives the surface drainage of a considerable area of the southern part of the district. The district is largely residential with a high proportion of its residents finding their livelihood in Greater London. There is very little local industry established within the district boundaries as evidenced by the fact that approximately 1,500 employees only are engaged in factories and work places registered under the Factories Act. No significant area of land now remains for development. The southern end of the district contains a substantial part of Green Belt land and smallholdings, but housing density is high in the centre and increases still further as one proceeds northwards. The 1951 census revealed that Carshalton had the highest level of housing occupation of any district in Surrey, the number of persons per room being 0.80 for the whole district and over 1.0 in the three St. Helier wards. Since the London County Council housing estate accommodating mainly families in the lower income groups accounts for nearly 40% of the total population, it is not surprising that the rateable value per head of population is the lowest in Metropolitan Surrey. 6 SUMMARY OF VITAL STATISTICS FOR 1955. (Based on the Registrar-General's Figures.) Population. Registrar-General's Estimate 61,330 Births. Males Females Total Live (Legitimate) 381 361 742 (Illegitimate) 11 12 23 392 373 765 Birth Rate (per 1,000 population) 12.5 Stillbirths (Legitimate) 6 8 14 (Illegitimate) 1 — 1 7 8 15 Stillbirth Rate per 1,000 total births 19.2 Deaths. 254 228 482 Death Rate (crude) per 1,000 population 7.8 Infant Mortality. All deaths under 1 year Infant Mortality Rate (per 1,000 live births) 10 8 18 23.5 Deaths of leg. infts. under 1 year Rate per 1,000 legitimate births Deaths of illeg. infts. under 1 year 10 8 18 24.2 Rate per 1,000 illegitimate births — Maternal Mortality. Death from Sepsis — — — Rate per 1,000 births — Death from other causes — — — Rate per 1,000 total births — Maternal Death Rate — Zymotic Deaths. 7 Principal Zymotic Diseases — — — Deaths from Measles — — — Deaths from Whooping Cough — — — Deaths from Diarrhoea (under 2 years) Zymotic Death Rate — Deaths from Tuberculosis. All Forms 2 1 3 Rate per 1,000 of population Phthisis 2 1 3 0.04 Rate per 1,000 of population 0.04 Deaths from Cancer 62 44 106 Rate per 1,000 of population 1.72 7 The Registrar-General's statistics relating to population, births and deaths differ slightly from those compiled from local records. The total figures in respect of the district as a whole, which are supplied by the Registrar-General, are set out in this report, but where classification has been made, e.g. by age groups, sex, wards, etc., it has necessarily been based on our own records, which may, in the aggregate, show slight discrepancies compared with the Registrar-General's totals. UNEMPLOYMENT The following figures in respect of persons living in Carshalton registered as unemployed at the Sutton Employment Exchange and the Carshalton Youth Employment Bureau at the end of 1955 are supplied through the courtesy of the Exchange Manager and the Youth Employment Officer: Men 83 Women 21 Boys 3 Girls 2 POPULATION The Registrar-General's estimate of the home population at mid-1955 is 61,330, compared with 61,610 for mid-1954 and 62,721 enumerated at the Census 1951. Since mid-1951 the census year, the Registrar-General's estimate of population has been reduced by 400 in the four-year period. During this time the natural increase resulting from the excess of births over deaths, was no less than 1,100. The Registrar-General's estimate of 61,330 postulates that outward migration exceeded inward migration between 1951 and 1954 by 1,500 individuals. This despite the fact that 432 new dwellings have been erected in the district in the last four years. The following gives the estimated ward populations based on the Registrar-General's total of 61,330: TABLE 1. ESTIMATED HOME POPULATION, MID-1955, BY WARDS. Ward Houses at Mid-1955 Estimated population Mid-1955 St. Helier North 2,164 8,525 St. Helier South 1,698 7,025 St. Helier West 2,094 7,975 North-East 2,753 9,845 North-West 2,149 7,335 Central 1,761 5,905 South-East 2,438 8,095 South-West 2,171 6,625 Whole District 17,228 61,330 8 BIRTHS The number of live births registered during 1955 was 765 which is 59 less than in the year before. Of these, 392 were males and 373 females, giving a birth rate of 12.5 per thousand population. The "comparable" birth rate produced by the application of the Registrar-General's comparability factor of 0.96 to allow for the disparity in the age and sex constitution of the local population and that of the country as a whole is 12.0 per thousand population, which compares with 15.0 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 778 live births and 14 stillbirths occurred in 1955. 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 97 11.3 - - St. Helier South 79 11.2 3 36.5 St. Helier West 93 11.6 1 10.6 North-East 143 14.5 1 6.9 North-West 102 13.8 3 28.5 Central 79 13.3 — - South-East 114 14.0 2 17.2 South-West 71 10.7 4 53.3 Seventy-six 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 75 St. Helier South 82 St. Helier West 77 North-East 73 North-West 83 Central 73 South-East 66 South-West 80 9 Out of 792 total births, 600 took place in the following hospitals and nursing homes: Live Still Total Carshalton, Beddington and Wallington District (War Memorial) Hospital 89 4 93 St. Helier Hospital 389 6 395 Other Surrey Hospitals 85 2 87 Other Hospitals 23 - 23 Private Nursing Homes 2 - 2 Totals 588 12 600 For the last 3 years more than three quarters of all births have taken place in Maternity Institutions. TABLE 2. BIRTHS, 1955, DOMICILIARY AND OTHERS—BY WARDS. Ward Born in District Born outside District Grand Total In Hosp. and Nursing Homes In Private Houses Total In Hosp. and Nursing Homes In Private Houses Total St. Helier North 68 24 92 5 - 5 97 St. Helier South 66(3) 15 81(3) 1 — 1 82(3) St. Helier West 65(1) 21 86(1) 8 — 8 94(1) North-East 96(1) 39 135(1) 9 — 9 144(1) North-West 58(2) 18 76(2) 29(1) — 29(1) 105(3) Central 48 20 68 10 1 11 79 South-East 50(2) 39 89(2) 27 — 27 116(2) South-West 37(1) 14(2) 51(3) 23(1) I 24(1) 75(4) Totals 488(10) 190(2) 678(12) 112(2) 2 114(2) 792(14) (Figures in brackets indicate stillbirths included in totals.) 10 TABLE 3. BIRTH AND DEATH RATES FOR CARSHALTON, 1922-1955. 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 1955 61,330 12.5 7.8 23.5 0.0 11 TABLE 4. COMPARATIVE STATISTICS—1955. England and Wales Carshalton Birth Rate (per 1,000 population) 15.0 12.5 Still-birth Rate (per 1,000 total births) 23.1 19.2 Death Rate (per 1,000 population) 11.7 7.8 (crude) 9.4 (comp.) Infant Mortality (per 1,000 live births) 24.9 23.5 Pre-natal Mortality (in first 4 wks. per 1,000 live births) 17.3 18.3 Death rate from Tuberculosis (per 1,000 population) Respiratory Tuberculosis 0.13 0.14 0.04 0.04 Other Tuberculosis 0.01 — Death Rate from Cancer (per 1,000 population) All forms 2.05 1.72 Cancer of Lung 0.38 0.45 Maternal Mortality (per 1,000 total births) Excluding Abortion 0.54 0.64 Abortion 0.10 COMPARATIVE HEALTH STATISTICS, 1934/55. Year Crude Death Rate (Civilian) per 1,000 population Infant Mortality per 1,000 live births Maternal Mortality (excluding abortion) per 1,000 total births England and Wales Carshalton England and Wales Carshalton England and Wales Carshalton 1934 11.8 8.6 59.3 53.5 3.8 3.0 1935 11.7 6.6 57.0 46.0 3.4 2.4 1936 12.1 7.1 58.7 46.7 3.1 5.4 1937 12.4 6.6 57.7 40.0 2.7 0 1938 11.6 7.6 52.8 46.1 2.7 1.1 1939 12.1 7.1 50.6 35.4 2.5 2.0 1940 14.4 8.7 56.8 43.8 2.1 3.8 1941 13.5 8.4 60.0 40.5 2.2 0 1942 12.3 7.5 50.6 27.5 2.0 2.4 1943 12.1 8.2 49.1 39.3 1.8 4.9 1944 11.6 9.5 45.4 39.2 1.5 1.1 1945 11.4 8.2 46.0 23.2 1.4 0 1946 11.5 7.2 43.0 18.6 1.2 0 1947 12.0 7.8 41.0 22.8 1.0 0 1948 10.8 7.4 34.0 14.5 0.86 0 1949 11.7 8.3 32.0 29.0 0.82 0 1950 11.6 7.8 29.8 28.4 0.72 0 1951 12.5 8.7 29.6 29.0 0.65 0 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 1955 11.7 7.8 24.9 23.5 0.54 0 12 DEATHS The deaths allocated to the district, as adjusted by inward and outward transferable deaths, was 482—254 males and 228 females. This gives a crude death rate of 7.8 per thousand population as against 8.0 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 9.4. The rate for England and Wales was 11.7. The distribution of the deaths by wards was as follows: WARD DEATH RATES AND MEAN AGE AT DEATH, 1955. Ward Deaths Death Rate (crude) Mean Age at Death St. Helier North 51 5.9 57.2 yrs. St. Helier South 56 7.9 60.1 „ St. Helier West 45 5.6 63.5 „ North-East 55 5.5 62.6 „ North-West 67 9.1 68.6 „ Central 54 9.1 69.6 „ South-East 69 8.5 62.1 „ South-West 85 12.8 72.0 „ Whole District 482 7.8 65.0 „ The death rate from cancer rose from 1.60 per thousand in 1954 to 1.72 which is the second highest rate recorded for this disease in the district. The peak mortality for cancer was 2.04 in 1953. Malignant disease of the lungs accounted for 27 or one quarter of the total cancer deaths. CANCER DEATHS—WARD DISTRIBUTION, 1955. Ward Cancer Deaths Rate per 1,000 Estimated Population St. Helier North 14 1.64 St. Helier South 16 2.27 St. Helier West 11 1.38 North-East 13 1.32 North-West 11 1.49 Central 12 2.03 South-East 12 1.49 South-West 17 2.56 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— 142 Parotid gland 1 — 1 145 Tonsil 1 — 1 150 Oesophagus 2 — 2 151 Stomach 10 9 19 152 Small Intestine - 1 1 153 Colon 5 4 9 154 Rectum 3 - 3 156 Liver 1 1 2 157 Pancreas 4 1 5 159 Unspecified — 1 1 Respiratory System— 161 Larynx 1 — 1 162 Lungs and Bronchus 21 6 27 Breast and Genito-Urinary— 170 Breast — 11 11 171/4 Uterus — 3 3 175 Ovary — 2 2 177 Prostate 1 — 1 180 Kidney 2 — 2 181 Bladder 1 2 3 Other Sites— 190 Skin — 1 1 193 Brain 4 1 5 196 Bone 2 1 3 199 Unspecified 2 — 2 200 Lymphosarcoma 1 — 1 62 44 106 Average age at death: Males 60.4 years Females 64.4 years All persons 62.0 years The other cause of death which in recent years has, like cancer, been assuming greater prominence is coronary disease of the heart. The number of deaths assigned to this disease in 1955 was 93, an increase of 19 over the year before. It exceeds all other forms of heart disease and is, after cancer, the greatest single cause of mortality. The most notable feature of the death returns for 1955 was the phenomenal fall in mortality from tuberculosis. There has been a progressive although irregular fall in the death rate for this disease over the last 20 years but this index took a sudden plunge downwards in the year under review. Only three deaths were attributable to tuberculosis against an average of 15 in each of the previous five years. 14 The death rates from this cause for the last 20 years were as follows:— Year Deaths from Tuberculosis Death Rate per 1,000 Population Year Deaths from Tuberculosis Death Rate per 1,000 Population 1936 37 0.64 1946 25 0.41 1937 37 0.63 1947 25 0.40 1938 37 0.63 1948 25 0.40 1939 46 0.77 1949 22 0.35 1940 33 0.56 1950 13 0.20 1941 40 0.71 1951 21 0.34 1942 26 0.46 1952 15 0.24 1943 46 0.81 1953 13 0.21 1944 33 0.63 1954 14 0.22 1945 28 0.51 1955 3 0.04 The distribution of tuberculosis mortality by wards and other details are given in Section F of this report. One death only—from poliomyelitis resulted from the notifiable infectious diseases. Violent causes accounted for the death of 17 residents. They were as follows:— Suicide 8 Road Traffic Accidents 2 Accidents in the Home 3 Accidents at Work 1 Drowning 1 Other Accidents 2 Inquests Inquests were held on 40 persons who died in the district. The following verdicts were returned: Accidental Death 17 Suicide 9 Misadventure 9 Natural causes 3 Open Verdict 2 Sixteen of the total were residents of the district. Four were due to road accidents. 15 INFANT MORTALITY The deaths of 18 children who died under the age of one year were registered, of which 10 were males and 8 females. These provide an infant mortality rate of 23.5 per thousand live births compared with 18.2 in the year before. The comparable rate for England and Wales was 24.9. All were deaths of legitimate children. Seventy-seven per cent. of the deaths occurred in the first month of life. Congenital malformations, prematurity and diseases peculiar to infancy accounted for 16 and infections for two. The ward distribution of infant mortality and the causes of death are shown in Tables 6 and 7. TABLE 6. INFANT MORTALITY—WARD DISTRIBUTION. Ward Infant Deaths Rate per 1,000 Live Births St. Helier North 5 51.5 St. Helier South 1 12.6 St. Helier West 1 10.7 North-East — — North-West 1 9.9 Central 3 37.9 South-East 6 52.6 South-West 1 14.0 TABLE 7. INFANT MORTALITY DURING THE YEAR 1955. Deaths Classified as to Cause and Age at Death. Cause of Death Under 1 wk 1—2 wks 2—3 wks 3—4 wks Total under 4 wks 4 wks and under 3 mths 3 mths and under 6 mths 6 mths and under 9 mths 9 mths and under 12 mths Total deaths under 1 year Prematurity 3 - - - 3 - - - - 3 Congenital Malformation 1 - 3 - 4 2 1 - - 7 Birth Injury 1 - — — 1 - — — — 1 Atelectasis 2 1 — — 3 - — — — 3 Pneumonia — 1 — — 1 1 — — — 2 Hemolytic Disease of newborn 2 — - - 2 — — — - 2 Totals 9 2 3 — 14 3 1 — - 18 MATERNAL MORTALITY There were no maternal deaths. 16 TABLE 8—CAUSES OF DEATH DURING THE YEAR—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. Pns. All Causes 10 9 1 2 — 1 3 1 6 5 8 5 29 17 59 33 65 55 72 101 253 229 482 1 Tuberculosis, Respiratory - - - - - - — — — 2 - - - - - - 1 - - - 1 2 3 2 Tuberculosis, other - - - - - - - - - - - - - - - - - - - - - - - 3 Syphilitic disease - - - - - - - - - - - - - - - 1 1 1 — 1 1 3 4 4 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - 5 Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - 6 Meningococcal Infections - - - - - - - - - - - - - - - - - - - - - - - 7 Acute Poliomyelitis - - - - - - - - - - 1 - - - - - - - - - 1 — 1 8 Measles - - - - - - - - - - - - - - - - - - - - - - - 9 Other Infective and Parasitic Diseases - - - - - - - - - - - - - - - - - - - - - - - 10 Malignant Neoplasm, Stomach - - - - - - - - - - - 1 2 — 5 4 1 2 2 2 10 9 19 11 Malignant Neoplasm, Lung - - - - - - - - - - 1 — 2 1 10 1 4 2 4 2 21 6 27 12 Malignant Neoplasm, Breast — — — — — - — — — — — 1 — 6 — 2 — — — 2 — 11 11 13 Malignant Neoplasm, Uterus - - - - - - - - - - - 1 - 1 - 1 - - - - - 3 3 14 Other Malignant and Lymphatic Neoplasms — — 1 — — - 2 — 2 — 1 — 4 3 8 2 7 3 6 7 31 15 46 15 Leukaemia, Aleukaemia - - - - - - - - 1 - - - - - 1 - - - - - 2 — 2 16 Diabetes - - - - - - - - - - - - - - - 1 1 — — 1 1 2 3 17 Vascular Lesions of Nervous System - - - - - - - - - - - - 1 1 8 5 5 12 7 19 21 37 58 18 Coronary Disease, Angina - - - - - - - - - - - - 12 2 19 2 26 8 14 10 71 22 93 19 Hypertension with Heart Disease - - - - - - - - - - - - - - - - 1 1 1 1 2 2 4 20 Other Heart Disease — — — — — - — - — — 1 1 — 1 — 3 7 9 14 39 22 53 75 21 Other Circulatory Disease - - - - - - - - - - - - - - 1 2 2 3 4 2 7 7 14 22 Influenza - - - - - - - - - - - - - - - - - - 1 - 1 - 1 23 Pneumonia 1 2 - - - — - - - - - - - - - - 1 2 4 4 6 8 14 24 Bronchitis - - - - - - - - - - - - 2 — 2 2 3 2 2 5 9 9 18 25 Other Diseases of Respiratory System — — — — — - — — — — — — 1 — — 1 — 2 1 - 2 3 26 Ulcer of Stomach and Duodenum - - - - - - - - - - - - - - 1 — 1 1 1 — 3 1 4 27 Gastritis, Enteritis and Diarrhoea - - - - - - - - - - - - - - - - - - - - - - - 28 Nephritis and Nephrosis - - - 1 - - - - 1 - - - - - - - 1 1 2 1 4 3 7 29 Hyperplasia of Prostate — — — — — - — — — — — — — — — — — — 4 — 4 — 4 30 Pregnancy, Childbirth, Abortion - - - - - - - - - - - - - - - - - - - - - - - 31 Congenital Malformations 3 4 - - - 1 - - - - - - - - - - - - - — 3 - 8 32 Other Defined and Ill-defined Diseases 6 3 - - - - - 1 1 1 3 1 2 — 4 3 3 6 5 2 24 17 41 33 Motor Vehicle Accidents - - - 1 - - - - - 1 - - - - - - - - - - - 2 2 34 All other Accidents — — — — — - 1 — - — — — 1 — — 2 — — — 2 3 4 7 35 Suicide — — — — — - — — — 1 1 — 2 2 — 1 — — — 1 3 5 8 36 Homicide and Operations of War - - - - - - - - - - - - - - - - - - - - - - - 17 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 : Faeces Specimens 320 Rectal Swabs 24 Blood Specimens 1 Water (Public Supply) : For chemical analysis 3 For bacteriological examination 2 Water (Swimming Bath) : For bacteriological examination 6 Food and Drugs : Analysis 340 Bacteriological examination of milk 220 Bacteriological examination of ice cream 98 Bacteriological examination of other foods for food poisoning organisms 2 Biological examination of milk 13 Vaccination and Immunisation Vaccination and immunisation are the responsibility of the County Council under Section 26 of the National Health Service Act. Statutory schemes have now been formulated 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, (v) vaccination against poliomyelitis at present restricted to groups of children selected by the Ministry of Health. By arrangement with the District Councils, local Medical Officers of Health direct the schemes in respect of the three first-mentioned diseases, whilst B.C.G. vaccination and polio, vaccination are carried out under the School Health and County Health arrangements. Details of the work performed under the supervision of the district Medical Officers of Health are given in Section F, dealing with infectious diseases. 18 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 noon Toddler Clinic Mondays 2—4 p.m. Dental Clinic Tuesdays 1.30—4.30 p.m. Thursdays 9.30—12 noon Massage Clinic Mons., Tues., Weds., Thurs., Fridays 10—1 p.m. Mons., Tues., Thurs., Fridays 2—5 p.m. Wrythe Lane Centre : Infant Welfare Clinic Weds, and Fridays 2—4 p.m. Maternity Clinic Tuesdays 10—12 noon 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 Thurs. 2—4 p.m. St. Helier Centre—Green Lane : Infant Welfare Clinic Mondays 2—4 p.m. Maternity Clinic Mondays 10—12 noon 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 noon Wednesdays 2—4 p.m. Stanley Road Centre Mondays 9.30—12 noon Middleton Road Centre, Morden Mons. and Weds. 9.30—12 noon 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. 19 Section C—Sanitary Circumstances. Water Supply The greater part of the district is supplied by the Sutton District Water Company which obtains its water from wells in the chalk situated at Sutton, Cheam and Woodmansterne. These supplies can be augmented if the need arises by the Metropolitan Water Board, the Epsom and Ewell Corporation Water Works and the East Surrey Water Company. The company has a statutory duty to soften to 9° of hardness. A small portion of the northern end of the district comprising about 170 dwellings is supplied by the Metropolitan Water Board. All dwellings have a piped supply. The water is not considered to be plumbo-solvent. When the vulnerability of chalk wells was demonstrated, particularly by the gastro-enteritis epidemic of 1936, comprehensive precautions were instituted to protect the supply including the process of chlorination. The effectiveness of these arrangements is checked by daily examination of the raw and finished waters by the company's resident chemist and periodically by independent Water Analysts acting for the company and by the Public Health Departments of the local authorities in the supply area on an agreed rota. Quality and quantity were satisfactory throughout the year. The following summary shows the results of the company's own examinations and is 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 ColiAerogenes in 100 ml. (excluding B. Coli 1) No. and % of sample 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 311 53 16 5.30 3 0.95 19 Sutton Finished 312 14 2 0.63 i 2 0.63 4 Woodmansterne Raw 309 50 Nil Nil Nil Nil Nil Woodmansterne Finished 309 14 10 3.25 Nil Nil 10 Cheam 312 53 6 1.93 Nil Nil 6 Reservoir 238 Nil Nil Nil Nil Nil Nil District (excluding new mains) 263 Nil 20 7.60 2 0.76 22 Total 2,054 184 The sanitary authorities in the supply area carried out 14 chemical and 24 bacteriological examinations during 1955 and all were satisfactory. The following is a representative analysis: 20 Chemical analysis in parts per million Total solid matter in solution (dried at 180°) 175 Combined chlorine 14.7 Nitric nitrogen 3.3 Nitrous nitrogen none Ammonia, free 0.00 Ammonia, albuminoid 0.01 Oxygen absorbed from permanganate in 4 hours at 26.7 °C 0.03 Hardness—by acidimetric titration—Temporary 96 Permanent 34 Total 130 Reaction for free chlorine at time of receipt none Iron and other metals absent pH 7.5 Electric Conductivity at 20 °C 255 units The water was bright and clear, 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. C1. welchii absent do. This water is of very good organic purity and of moderate hardness and salinity. In chemical composition it is similar to previous samples from the same source. The water is attractive in appearance, free from contaminating metals, and there was no residual chlorine at the time of receipt. The bacteriological condition is excellent and, as judged by these samples, the water is pure and wholesome and suitable for the public supply. The average hardness of the samples taken by the local authorities was 9.18°, compared with 9.32° in the year before. Nine exceeded 9° of hardness and five were below. Drainage and Sewerage Sewage is pumped to the disposal works of the Croydon Corporation in Beddington, except at various points on the fringes of the district, where it is more conveniently drained to the sewage systems of neighbouring authorities. Surface drainage in the south is mainly by soakaways in the chalk; elsewhere it is by surface sewers to the River Wandle. During the year the work of piping-in the open ditch along Tweeddale Road and behind Shaftesbury Road was completed throughout the whole length to its junction with the River Wandle. A small length of 24" surface water sewer was constructed along the Westcroft ditch. Three hundred and twenty-nine drainage obstructions affecting 1,292 houses were dealt with. 21 Rivers and Streams Routine work of maintenance on the River Wandle and its ponds was carried out by the County Council who are the responsible authority. Two complaints were received in respect of the river in Mill Lane and Ruskin Road and were referred to the County authority. Closet Accommodation All properties have main drainage connected to the sewers except 17 in an unsewered part of the south-east ward which are drained to 13 cesspools. Some difficulty was experienced in securing the emptying of a cesspool in this part of the district. Consideration was being given at the end of the year to providing a sewer for this area. There are no earth closets. Public Cleansing The arrangements for public cleansing were as shown in previous reports namely—collection of refuse by a specially designed fleet of vehicles with hydraulic tipping gears, and disposal by incineration in the Council's 6-cell destructor with tipping arrangements for residual clinker and screenings. Tipping at Barrow Hedges to form school playing fields was completed in 1955. That effectively controlled tipping can be carried out without complaint and risk to health, is shown by the successful way in which this project was carried through. Past experience unfortunately provided not a few instances of how necessary this means of disposal needs to be carefully executed and supervised, if public health nuisance in an urban area is to be avoided. Tipping is being continued in Mill Lane to form a future playingfield forthe Public Pleasure Grounds Committeeand a similar process is in progress to level ground in the open space bordering Revesby Road. 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 1,208 complaints as follows: Accumulations 31 Animals so kept 6 Burst pipes 6 Dampness 38 Drainage defects 33 Drains obstructed 354 Dustbins 43 Food contaminated 13 General defective conditions 65 Insects and Pests 74 Milk, contaminated and dirty bottles 5 Miscellaneous 38 Obnoxious effluvia 29 Overcrowding 19 Refuse collections 16 Rivers 2 Rodents 278 Roofs, defective 20 Sewer obstructions 7 Shops 1 21 Smoke nuisance Unsound food 93 Verminous premises 13 Water supply 3 1,208 22 Thirteen thousand three hundred and twenty-nine visits of inspection and re-inspection were made for the purposes set out below: Cowsheds 4 Employment Agencies 12 Factories (Mechanical Power) (incl. Laundries 42) 182 Factories (Non-Mechanical Power) 71 Food and Drugs (incl. Food Bye-laws) 717 Food poisoning enquiries 2 Food premises: Bakehouses 55 Bakers and confectioners 69 Butchers 126 Canteens 39 Canteens—School 74 Chemists 38 Cinema 2 Confectioners (sweets only) 102 Fishmongers 77 General Stores 75 Greengrocers and fruiterers 138 Grocers 249 Licensed premises with catering facilities 9 Licensed premises without catering facilities 23 Ice Cream vehicles 25 Milk shops 35 Restaurants and cafes 115 Stalls, food 125 Tea packer 1 Unsound food: Meat 25 Food other than meat 95 Vehicles, food 31 1,528 Hairdressers 65 House drains tested 88 Housing Act 509 Heating Appliances (Fireguards) Act 32 Housing Enquiries 422 Housing Land Charges 890 Infectious Disease Premises 8 Merchandise Marks Act 154 Offices 17 Outworkers' premises 65 Pet Animals Act 35 Piggeries 63 Premises re cesspools 6 Public Health Act (Houses) 3,307 Public Health Act re-inspections 3,164 Rag Flock and Other Filling Materials Act 23 Rodents 584 Schools 63 Shops 1,087 Smoke observations 162 Tents, Vans, Sheds 20 Urinals 39 Water Sampling 10 13,329 23 Three hundred and ninety-six informal notices were served concerning the following matters: Accumulations and deposits 14 Burst pipes 1 Drainage defects 109 Dustbins 38 Factories Act 11 Food and Drugs Act (incl. Food Bye-laws) 34 General defective conditions 101 Heating Appliances (Fireguards) Act 2 Miscellaneous 3 Obstructed drains 4 Overcrowding 27 Rodents 14 Shops Act 30 Smoke nuisance 4 Verminous premises 4 396 Sixty formal notices were served by authority of the Council under the following Acts : Food and Drugs Act, 1938, Section 13 1 Public Health Act, 1936, Section 24 2 „ „ „ „ Section 39 6 „ „ „ „ Section 45 4 „ „ „ „ Section 75 15 „ „ „ „ Section 93 30 Shops Act, 1950, Section 38 2 60 As a result of investigations made and notices served, the following work was carried out: Accumulations removed 12 Brickwork, repaired and/or repointed 10 Ceilings cleansed and purified 14 Ceiling plaster repaired and/or made good 10 Cement fillets and plinths renewed 1 Chimney brickwork and pots repaired or renewed 9 flues repaired 3 Damp conditions remedied 36 Damp course provided 2 Disinfestations 51 Doors and frames repaired, including locks and fasteners 10 Drainage repaired and/or reconstructed 30 houses (248 ft. of drain laid) provided 2 (140 ft. drain) inspection chamber repaired and/or made good.. 7 inspection chamber provided 2 inspection chamber covers renewed 7 stoppers or caps refixed and/or renewed 9 soil vents repaired and/or renewed 1 drains tested 28 drains cleared (affecting 1,292 houses) 329 waste gullies repaired, renewed or provided 7 waste pipes, repaired, renewed or provided 6 Dustbins provided 62 Fences repaired or renewed 1 Fireplaces ranges or stoves repaired or renewed 10 Floors renewed or repaired 17 24 Gates renewed 1 Glazing and putty renewed 12 Paving repaired and/or made level 2 Roofs repaired and made weatherproof 41 downpipe, guttering repaired and/or renewed 35 Shops, hot water, means of supply provided 4 means of heating supplied 1 Sinks renewed 6 Stairs or steps repaired, renewed or made level 2 baluster repaired 1 Surface water drainage repaired and made to work properly 6 Walls rebuilt 1 rendered or rendering repaired 9 replastered and/or repaired 22 cleansed and redecorated 40 Wash basins, baths renewed 1 Water Supply pipes renewed 6 Hot Water supply system 1 W.C. accommodation provided 2 pans renewed 5 pan joints renewed 7 seats repaired, renewed or provided 3 flushing apparatus repaired or renewed 12 Windows repaired and/or renewed 40 Window sills (external) repaired 6 Miscellaneous items 9 Disinfection One hundred and four rooms, 4 T.B. shelters and 345 library books were disinfected. Five lots of bedding were sterilised and three lots destroyed. Vermin Control Persons. Comment has been made in recent reports on the great improvement which has occurred since the Second World War in the extent of verminous conditions. This has been particularly marked in the parasitic conditions affecting individuals and their personal clothing, mainly pediculosis and scabies. During the war these conditions were so prevalent that the Council established a Cleansing Station at Rochester Road, which dealt with hundreds of individuals annually. This service is rarely needed now and only for the occasional badly infested case. Although this is primarily the result of the greatly reduced prevalence of verminous conditions, it has been assisted by the use of modern parasiticides which can be used effectively in the home and which are available under the Health Services. During 1955 no cases of pediculosis were referred for treatment to the Cleansing Station and only two individuals in one family of whom one was a school child, were treated there for scabies. They made a total of five attendances. Premises. The number of houses treated for bugs and fleas as well as those for insect pests is shown in the following table : 25 Infestation Property Treated by C.U.D.C. Property Treated Total C.U.D.C. Property S.C.C. Property L.C.C. Property Privately Owned Property By L.C.C. By Owners Beetles 1 — — — — — 1 Bugs — — — — 1 — 1 Fleas 4 — — 4 — — 8 Flies — 8 — 2 — — 10 Silverfish 1 — — — — — 1 Wasps 2 — 3 25 — — 30 8 8 3 31 1 — 51 In addition one lot of bedding was stoved for vermin. 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 In order more accurately to estimate the degree of atmospheric pollution, the Council have installed three deposit gauges sited after consultation with the Department of Scientific and Industrial Research, as follows: Gauge (A) at Welbeck School, gauge (B) at Winchcombe School, gauge (C) at Limes Avenue. Apparatus for measuring the sulphur dioxide content of the air and the intensity of smoke was also set up in the grounds of the Public Health Department at the Lodge. The following is a summary of these investigations : Deposit Gauges. Gauge Total Rainfall (in inches) Total Solids. Tons per sq. mile Highest Monthly Reading Lowest Monthly Reading Average Monthly Reading A 17.09 18.77 5.94 11.16 B 16.50 18.22 7.65 10.20 C 16.57 18.70 6.92 11.48 26 Month Gauge A Gauge B Gauge C Rainfall in ins. Total Solids (Tons per sq. mile) Rainfall in ins. Total Solids (Tons per sq. mile) Rainfall in ins. Total Solids (Tons per sq. mile) January 2.16 18.77 1.93 18.22 0.97 10.51 February 1.21 9.84 1.12 7.65 1.42 7.82 March 0.85 14.04 0.80 11.56 0.87 6.92 April 0.45 9.27 0.48 8.63 0.50 13.10 May 2.98 9.17 2.88 9.48 3.09 11.10 June 1.47 16.50 1.31 10.98 0.80 10.23 July Nil 9.31 0.01 8.06 0.06 11.31 August 1.19 11.64 1.00 9.79 1.35 18.70 September 1.55 5.94 1.52 9.56 1.76 7.29 October 2.83 10.84 2.78 8.94 3.01 16.51 November 0.41 7.21 0.65 8.84 0.57 10.30 December 1.99 11.44 2.02 10.47 2.17 13.96 Smoke and Atmospheric Sulphur Dioxide. Smoke (Milligrams per 100 cubic metres) s.o.2. (Parts per 100 million) Highest Reading Lowest Reading Average Reading Highest Reading Lowest Reading Average Reading January 42.09 4.10 13.36 13.43 1.75 4.24 February 60.45 5.07 21.55 11.62 1.11 4.33 March 50.57 4.18 20.44 19.61 1.05 6.60 April 30.10 0.99 7.46 11.30 0.21 2.75 May 9.63 0.23 3.10 3.42 0.23 1.12 June 5.17 1.07 2.14 6.71 0.25 1.50 July 10.30 0.87 3.85 3.71 0.18 1.43 August 12.90 1.29 3.81 4.39 0.28 1.58 September 6.40 0.20 2.27 1.76 0.20 0.60 October 28.21 2.08 11.31 8.34 0.20 3.31 November 48.17 0,98 16.85 13.14 0.68 6.22 December 56.67 2.85 13.57 10.46 0.42 3.84 Twenty-one complaints were received and dealt with during the year. Several residents in the St. Helier South Ward complained of excessive deposit of grit in that area and an exhaustive investigation was made involving the chemical analysis of deposits collected at selected sites in the area. Examination of the reports provided no evidence that such atmospheric deposits as were found emanated from any particular source and the most feasible interpretation of the findings was that domestic smoke was the cause of the complaint. Prevention of Damage by Pests Act, 1949 The work of eradication of rats and mice is carried out in accordance with arrangements agreed with the Ministry of Agriculture, Fisheries and Food. 27 Nine thousand three hundred and four visits were made by the rodent operatives concerning 1,426 properties and 308 rat and mouse infestations were found. Of that number 268 were found in private premises, 34 in business premises, 6 in Council premises. Two maintenance treatments were carried out on the sewers, one in May and the other in November. The results are shown in the following table, together with the three previous years : May Treatment November Treatment 1952 1953 1954 1955 1952 1953 1954 1955 Manholes baited 153 195 166 186 266 205 172 193 Manholes in which takes of prebait were recorded 43 66 65 56 117 73 53 57 Percentage of manholes showing infestations 28 33.8 39.1 30.1 44 35.6 30.8 29.5 Percentage in relation to total manholes in district 3.8 5.8 5.7 4.9 10.3 6.4 4.7 5.0 Swimming Baths The Council acquired the only swimming bath in the district in 1953. Since that time considerable works of improvement have been carried out to the premises and the purification plant. During the year under review additional w.c. accommodation was provided, a new footbath constructed and improvements effected to the chlorination plant. The extent of user is also controlled to prevent overloading of the purification arrangements. Six samples of bath water were taken during the year and all were satisfactory. Offices Seventeen inspections of offices were made but no action was necessary. Factories, Workplaces and Outworkers The following table gives a summary of the registers: Employees Premises Males Females Total Factories— With mechanical power 797 522 1,319 89 without „ „ 36 14 50 21 Workplaces— with mechanical power 26 — 26 23 without „ „ 18 16 34 21 877 552 1,429 154 28 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 the 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 21 62 8 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 89 178 3 — (iii) Other premises in which Section 7 is enforced by the Local Authority* (excluding outworkers' premises) 5 13 — — Total 115 253 11 — * Electrical Station (Section 103 (1)), Institutions (Section 104) and sites of Building Operations and Works of Engineering Construction (Section 107 and 108). 2. Cases in which defects were found— (If defects are discovered at the premises on two, three or more separate occasions they are reckoned as two, three or more "cases"). Premises Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness 2 1 — — — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation — — — — — Defective drainage of floors — — — — — Sanitary Conveniences— (a) Insufficient 3 — — — — (b) Unsuitable or defective 6 5 — — — (c) Not separate for sexes — — — — — Other offences against the Act (not cluding offences relating to Outwork) — — — — — Total 11 6 — — — 29 Outwork (Sections 110 and 111) Nature of Works Section 110 Section 111 No. of outworkers in Aug. list required by Sect. 110(1) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwhole some premmises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing Apparel— Making, etc. 21 — — — — — Boxes (cardboard) 2 — — — — — Brass and brass articles 4 — — — — — Total 27 — — — — — Shops Act, 1950 There are 524 shop premises on the register in respect of which 3,085 inspections were made during the year. Notices were served in respect of thirty infringements of the statutory requirements, 22 for failure to exhibit appropriate notices, two for the absence of means for maintaining a reasonable temperature and six for the absence of suitable and sufficient sanitary conveniences. All but six of these had been complied with by the end of the year. Heating Appliances (Fireguards) Regulations, 1953 Thirty-two inspections and several tests were made under the Act. Thirty-three electric fires were tested and eight were found not to comply with the regulations. Merchandise Marks Act, 1926 The Council have continued to execute the provisions of the Orders and their five Sampling Officers are appointed as authorised officers under the Act. Much of the work is done amongst the stall-holders in the district. Pet Animals Act, 1951 Five 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. 30 Rag Flock and Other Filling Materials Act, 1951 Three premises used for upholstering are registered in accordance with Section 2 of the Rag Flock and Other Filling Materials Act, 1951. One formal sample of unused cotton felt was procured and this complied with the Regulations. The prescribed Analysts are—The Chiltern Laboratories, Ltd., of Station Road, Marlow, Bucks. Establishments for Massage and Special Treatment Six establishments are licensed under Part IV of the Surrey County Council Act, 1931. Four engaged in chiropody and two massage, etc. All were visited and found to be conducted satisfactorily. Employment Agencies There is only one employment agency in the district which was visited and found satisfactory. National Assistance Acts, 1948 and 1951 It was not found necessary to use the powers of these Acts to require the removal of any old or infirm person who as a result of neglect was found to be in insanitary conditions. From time to time the help of the Medical Officer of Health is sought to secure hospital or institutional care of old people who are past caring for themselves and with no one to give them adequate domestic attention. The shortage of institutional accommodation for this purpose remains as great as ever. 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 1955, 421 interments took place there, of which 149 were from Carshalton. No unused burial accommodation is available in Carshalton churchyard. Interment there is now effected only by re-opening existing graves. The negotiations between the four authorities Battersea, Sutton and Cheam, Carshalton and Merton and Morden for the provision of crematorium facilities were carried a stage further in 1955 when a private Bill was lodged in the House of Commons to authorise the constitution of a Joint Board representing the four authorities to provide and maintain a crematorium. All formal action has been taken by the Council in connection with the promotion of this Bill. The Council's mortuary in Mill Lane which is fully equipped for postmortem examinations received 126 bodies during the year on all of which autopsies were performed. Of the total, 48 were admitted from other districts. National Assistance Act—Section 50 One burial was arranged by the Council under this section which places such a duty upon the local authority where no suitable arrangements for disposal are otherwise made. 31 Section D—Housing New Houses During the year the following 130 dwellings were completed: Council Flats 71 London County Council Flats 9 Private Dwellings 50 Total 130 Buildings in course of erection at the end of the year were as follows: Private Dwellings 27 Council's Housing Scheme The dwellings in the ownership of the Council at the year end were as follows : Pre-War Houses 614 Post-War Houses 618 Temporary Bungalows 102 Houses taken over under S.D.A.A. 34 Houses purchased (units of accommodation) 40 Accommodation in Parks, Offices, etc. 18 1,426 The following schemes were in various stages of preparation: Site No. Site Type of Dwelling No. in Contract 13 Nightingale Road Homes for aged 16 31 Stanley Road Flats 38 32 Wrythe Lane Flats 32 — Carshalton Playing Fields Houses 6 36 Culvers House Flats 36 37 Denmark Road Flats 34 38 Denmark Road Flats 72 234 The number of requisitioned premises at the 31st December was 90 providing accommodation for 125 families. The outstanding approved applications for tenancies at the year end totalled 1,237, which is 263 less than a year before. 32 Inspection and Action taken under Statutory Powers 1. Inspection 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.—509 P.H.A.—3,401 3,910 (b) Number of inspections made for the purpose 7,074 (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 229 2. Remedy of defects during the year without service of format notices. Number of defective dwelling houses rendered fit in consequence of informal action by local authority or their officers (including houses inspected during 1954) 288 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 48 (2) Number of dwelling houses in which defects were remedied after service of formal notices: (a) By Owners 39 (b) By Local Authority in default of Owners 1 33 4. Housing Act, 1936. Part IV (Overcrowding). (a) (1) Number of dwelling houses overcrowded at the end of the year 73 (2) Number of families dwelling therein 122 (3) Equivalent number of adults dwelling therein 525 (b) Number of new cases reported during the year 26 (c) (1) Number of cases of overcrowding relieved during the year 58 (2) Number of persons concerned in such cases 395 (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 26 cases of overcrowding were found to exist and 58 cases were remedied, leaving 73 dwellings with 525 equivalent adults in occupation overcrowded at the end of the year. The known position with regard to statutory overcrowding at the beginning and end of the year was as follows: Ward Dwellings overcrowded at 31/12/54 Dwellings found overcrowded during 1955 Dwellings decrowded during 1955 Dwellings remaining overcrowded at 31/12/55 Overcrowded cases remedied during 1955 Formal Action Informal Action Total St. Helier North 33 8 17 24 12 5 17 St. Helier South 28 4 15 17 12 3 15 St. Helier West 23 9 17 15 12 5 17 North-East 6 2 1 7 1 - 1 North-West 4 - 1 3 1 - I Central 6 2 3 5 3 3 South-West - - - - - - - South-East 5 1 4 2 2 2 4 105 26 58 73 40 18 58 As observed in previous reports these figures indicate the position in respect of overcrowding only as it comes to the notice of the department in the course of routine daily work. The position is liable to daily variation and only a simultaneous and complete survey of the whole district could reveal the exact position at any time. 34 The number of new cases of overcrowding is significantly less than in any of the post-war years, the figures for which are as follows: 1946 196 1947 122 1948 107 1949 160 1950 75 1951 54 1952 79 1953 53 1954 49 1955 26 Whilst these figures cannot accurately represent the exact position, the sources of information on which they are based have not changed throughout the period and there is some justification for the view that there is at long last some improvement in the level of overcrowding. In all the 26 new cases, families were sharing accommodation with relatives. Abatement of the 58 overcrowded dwellings was effected as follows : Provision of alternative accommodation by : Carshalton U.D.C. 30 Other Local Authorities 10 Left the district 1 Removal of one or more occupants 17 Of the 73 dwellings remaining overcrowded at the end of the year, 56 are owned by the London County Council, 5 by the Carshalton Urban District Council and 12 are privately owned. Slum Clearance and Demolition It has not yet been possible to start upon the work of rehousing the occupants of Clearance Area No. 7 in Stanley Road, the Order in respect of which was confirmed by the Minister in September, 1953, though plans have been prepared for one new block of flats to be erected on the site and the Council are now in a position to invite tenders. A further representation in respect of Clearance Area No. 8 was made to the Council in December, 1955. This involves 31 houses in the Mill Lane area accommodating approximately 130 individuals. Housing Repairs and Rents Act, 1954 Six certificates of disrepair have been granted by the Council since this Act came into force in August, 1954, four in 1954 and two in 1955. Five of these were revoked during the year upon completion of the necessary repairs. 35 Section E—Inspection and Supervision of Food. Milk Supply The district being a Specified Area for 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 20. The designated licences issued during the year were as follows : Designation Number of Distributors Holding Licences No. of Licences in force on 31/12/55 Principal Licences— Sterilised 14 18 Pasteurised 5 9 Tuberculin Tested 5 9 Supplementary Licences— Sterilised 7 12 Pasteurised 5 10 Tuberculin Tested 5 10 Bacteriological Examination of Milk. Two hundred and twenty samples of milk were procured and submitted for bacteriological examination. Six failed to comply with the prescribed standard of the 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 188 184 4 188 — — — T.T. Pasteurised 26 24 2 26 — — — Sterilised 6 — — — — 6 — 220 208 6 214 — 6 — Biological Samples. Thirteen samples were taken of the milk produced at the three farms in the district before it was treated in any way. These were submitted to animal inoculation tests and showed no evidence of tuberculosis. 36 Milk and Dairies Regulations, 1949—Regulation 20. The powers provided by this section allow the Medical Officer of Health to deal with any milk supply which he has reason to believe might be a source of infection to man, either by prohibiting its use for human consumption or requiring it to be appropriately treated before consumption. It was not found necessary to use this authority during the year. Analyses. The number of samples submitted to the Public Analyst for qualitative analysis was 224. Of these 198 were formal samples including 21 of "Channel Isles" and 8 "South Devon" milks. All were found to be satisfactory. The average fat content of all samples examined was 3.66% and the solids not fat, 8.79%. Ice Cream The high standard of bacterial purity achieved in 1954 was maintained as is shown in the following table, since all samples taken in 1955 were found to be within the two highest grades and the great majority in the first grade. 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 — 1955 98 93 5 — — Ten samples analysed by the Public Analyst conformed to the standards of quality required by the Food and Drugs Act and its Regulations. 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 area. 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 5,753 lbs. 8 ozs. 37 Food and Drugs Act, 1938 The following 340 samples were submitted to the Public Analyst with the following results: Article No. Adulterated or otherwise irregular Article No. Adulterated or otherwise irregular Almonds, Ground 1 Milk 224 Baking Powder 2 Milk Drink 1 Beans, Butter 1 Milk of Magnesia 1 Beans in Tomato Sauce 1 Mincemeat 1 Blackcurrant Juice 1 Nuts 1 Blackcurrant Syrup 1 Olive Oil 1 Blackcurrant Syrup— Oranges 1 Ribena 1 Orange Squash 1 Blancmange Powder 1 Paste, Fish 1 Bread 1 Paste, Ham and Other Meat 1 Butter 2 Cake 1 Pearl Barley 1 Cake Mix 1 1 Peas, Garden 1 Cake and Pudding Mixture 1 Peas, Processed 1 Pease Pudding 1 Cocoa 1 Pickles 1 Coffee 1 Pie Steak 1 Coffee & Chicory 1 Pineapple (Canned) 1 Cordial 2 Potato Crisps 1 Crab Meat 1 Pudding Mix 1 Currants 1 Pudding, Christmas 1 Drink Crystals 1 Raising Powder 1 Dripping, Beef 3 Rice, Baby 1 Evaporated Milk 1 Rice, Creamed 1 Flour 1 Rose Hip Syrup 1 Flour, Self-Raising 1 Salad Cream 1 Fruit Salad 1 Salmon, Pink 1 Gelatine 1 Salt 1 Glucose Barley Sugar 1 Sauce 1 Glucose Drink 1 Sausage, Beef 1 Grapefruit Squash 1 Sausage, Pork 2 Groats, Processed 1 Sausage Meat, Pork 1 Horseradish 1 Semolina 2 Horseradish Relish 1 Soup 2 Honey 1 Spice, Ground Mixed 1 Ice Cream 10 Steak, Stewed 1 Ice Lolly 5 Stuffing, Sage & Onion 1 Ice Lolly Mixture 5 Suet 3 1 Jam .. 1 Sugar Icing 1 Lemon Curd 1 Tenderising Salt 1 Macaroni with Cheese Sauce 1 Tonic Syrup 1 Sweets 7 1 Margarine 1 Wheat Embryo 1 Meat, Minced 1 Medicant, Cough 1 The following three samples were found to be adulterated or otherwise irregular: 38 White Milk Chocolate Cigars. This was a confection made of fat, sugar flavouring and skimmed milk powder. The Public Analyst was of the opinion that the manufacturer was not entitled to use the description "White Milk Chocolate" as no cocoa butter and only skimmed milk powder was used in their manufacture. Legal proceedings were taken and the manufacturer was fined £20 with £5. 5. Od. costs. Shredded Beef Suet. This sample of shredded beef suet was found to contain 78 % beef fat instead of 83% as required by the Food Standards (Suet) Order, 1952. The statutory procedure for sampling at that time required the sample—in this case a carton of shredded suet—to be divided into three parts, one of which is submitted by the Sampling Officer to the Public Analyst. The manufacturers contended that it was not possible to secure an absolute uniform distribution between three portions of the sample of the suet and the flour with which it is coated. This view is supported by a judgment given in a similar case, an extract from which reads as follows : "In shredded suet the methods of coating are not exact or ideal. The quantity of flour blown on any particular shred or shreds, the quantity which adheres, and the quantity which is only loosely adherent and more readly detached, are none of them constant. In consequence, each part of the contents of a container when divided into three parts, may vary very considerably." Two informal samples of this same commodity consisting of a complete carton were subsequently found to comply with the Standards Order. This sampling difficulty has now been removed by the Food and Drugs Amendment Act, 1954 under which the requirement to divide the sample into three parts is deemed to be satisfied if three unopened containers of the food or drug are secured and each is dealt with as if it were part of a sample. White Cake Mix. The carton in which the Cake Mix was sold bore on the front panel a large picture of a cake complete with "butter cream" filling and in the act of being iced with chocolate icing. On one corner of this picture there were also printed the words—"Nothing to add but water", which the Analyst disagreed with because the ingredients were for the cake mixture without "butter cream" or chocolate icing. The specification of the ingredients appeared on the bottom of the carton and was not in a conspicuous and prominent position as is required by the Labelling of Food Order, 1953. The manufacturers contested the statement that the label was misleading, but agreed to the label specifying the ingredients being placed in a more conspicuous position on the package. 39 Section 9—Sale of Food Unfit for Human Consumption Complaints were received as to foreign matter in foodstuffs which included: Insect eggs in milk bottle String in bread Grease in bread Mould in meat pie Warnings were given as appropriate, since the circumstances did not justify legal proceedings. 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. Cake—Biscuits 3 12 Cereals 3 12 Cream 7 7 Cheese 165 — Eggs 11 — Fruit Juice 35 — Jam—Marmalade 48 — Fish 218 5 Fruit 388 11 lbs. ozs. Meat 5,753 8 Milk 381 6 Mincemeat 5 — Pickle — II Pudding 1 4 Soup 39 13 Spaghetti 4 10 Sugar 19 8 Syrup 5 4 Vegetables 471 3 Total weight 3 tons, 7 cwts., 2 qrs., 3 lbs., 2 ozs. These stocks were disposed of by burning in the Council's Refuse Destructor. Inspection of Food Premises Details of the visits of inspection of food premises and the resulting remedial action taken are shown in Table 9. Food Hygiene Although the new Food Hygiene Regulations, 1955, have further strengthened the hands of the Sanitary Authorities in raising the standard of catering practices, freedom from food-borne illness still rests and will always rest, on education of the trade and general public in the principles of food hygiene and their readiness to translate that knowledge into practice. Every practicable means is taken to assist food handlers to this end both by the printed and spoken word through the use of leaflets, posters, codes of practice and informal talks to small groups of food trade employees. It is encouraging to note that in the last year or so the instances coming to our notice of food sold to the public in an unwholesome condition have very materially decreased. 40 41 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 made 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 — 69 — — — — — — Bakehouses 4 — — 55 — — 1 1 — — Butchers 36 31 — 126 3 1 — — — Canteens 21 — — 113 — — — — — — Chemists 17 1 — 38 — — — — — — Cinemas 1 — 2 — — — — — — Confectioners (sweets only) 71 53 — 102 — — — — — — Fishmongers 21 7 — 77 — 2 1 1 — — General Stores 4 4 — 75 — — — — — — Greengrocers and Fruiterers 44 2 — 138 1 1 — 2 — — Grocers (including corn chandlers) 82 20 2 250 4 1 1 2 1 2 Ice Cream vehicles variable — — 25 — — — — — — Licensed Premises (with catering facilities) 5 1 — 9 — — — — — — Licensed Premises (without catering facilities) 21 — — 23 — — — — — — Milk Shops 8 4 — 35 — — — — — — Restaurants and Cafes 26 16 — 115 2 — 3 1 — — Stalls, food variable — — 125 — — — — — — Vehicles, food variable — — 31 — — — — — — 143 2 1,408 10 4 7 7 1 2 Section F—Prevalence of and Control over Infectious and other Diseases. The district has, within its boundaries, three General Hospitals, two of which, namely, Queen Mary's Hospital for Children and the St. Helier Hospital, are particularly large institutions which are part of the hospital services of the South-West Metropolitan Hospital Region. Many of the cases notified from these hospitals are admitted there from other districts already suffering from a notifiable disease, but not diagnosed until after admission. In order, therefore, to give a clearer picture of the prevalence of infectious disease in the resident population of the district, separate figures are given in this Section which exclude cases of hospital patients who are not residents of the district. The figures given are after correction for original errors in diagnosis. Notification The following diseases are notifiable in the district : Smallpox Tuberculosis Enteric Fever Cholera Dysentery Relapsing or Continued Diphtheria Acute Primary Fever Membranous Croup Pneumonia Meningococcal Infection Erysipelas Acute Influenzal Ophthalmia Scarlatina or Pneumonia Neonatorum Scarlet Fever Acute Poliomyelitis Puerperal Pyrexia Measles Acute Malaria Whooping Cough Polioencephalitis Food Poisoning Typhus Fever Leprosy Typhoid Fever Smallpox No cases of variola occurred during the year. Vaccination. The County Council is responsible for the scheme formulated under Part III of the National Health Service Act for providing free vaccination against smallpox. 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. It can also be secured from doctors providing general practitioner services under the Act. Every endeavour is made to induce parents to secure this safeguard against smallpox for children in the first six months of life. Although the chances of contracting this infection in this country are now very small, a high proportion of the population is required to do National Service when vaccination is compulsory, and year by year more people are travelling abroad to places where the risks are much greater. It is known that primary vaccination in infancy is attended by very much less reaction than when done in later life, and although re-vaccination may be necessary in adult years prior to National Service or in the face of special risks such as those of foreign travel or in an outbreak of smallpox, undesirable effects from the treatment on the second occasion are greatly reduced by having had primary vaccination as a baby. 42 Details of the vaccination state of the whole local population is not known, but information in respect of children under five years of age is recorded with a high degree of accuracy. At the end of 1955 slightly more than 46% of the children in this age group are known to have been vaccinated, a figure which has been fairly constantly maintained for the last two or three years. The number or persons recorded during the year as having received successful vaccination was as follows : Age at 31st December, 1955 Under 1 yr 1-4 yrs 5-14 yrs 15 yrs & over Total Primary Vaccinations— By Private Practitioners 81 79 5 29 194 At Clinics 144 117 4 — 265 225 196 9 29 459 Revaccinations— By Private Practitioners — 1 9 56 66 At Clinics — — — — — — 1 9 56 66 In addition, the following unsuccessful attempts at vaccination were made : Age at 31st December, 1955 Under 1 yr 1-4 yrs 5-14 yrs 15 yrs & over Total Primary 4 3 - 2 9 Revaccination 1 2 1 — 4 5 5 1 2 13 The estimated number of children under five years of age vaccinated at the 31st December, 1955, was 1,686. Enteric Fever No cases of typhoid or paratyphoid fever were reported. Dysentery In previous reports mention has been made of the increasing prevalence of this mild intestinal infection due to shigella Sonnei, much of which escapes detection. Experience in past years shows that the number of cases notified is to a great extent related to the diligence with which they are sought since only a small proportion ever seek medical advice. Of those that do, many are treated symptomatically without any bacteriological investigation which would establish the identity of the causative organism. 43 During 1955, 118 cases were notified, most of which occurred in two local outbreaks in opposite ends of the district. The first outbreak involving 45 individuals in 32 families occurred on the Clock House Farm Estate in March and April. Of the 45 cases, 26 were children attending a school outside the district. The second outbreak was on the St. Helier Estate in November and December and affected 61 persons of whom 31 were schoolchildren. The infection first showed itself among the children in the nursery class of the Green Wrythe Lane Primary School, which school was undoubtedly the primary factor in the spread of the infection. The ease with which this illness spreads through members of the family is indicated by the fact that only 21 households were affected, giving an average of three cases per house. Except in one instance, in every family there was at least one notified case attending the Green Wrythe Lane Primary School—the great majority the Infants Department. Only six cases attended the Junior Mixed Department, but in each of these there was a brother or sister with the illness in the Infants Department. These outbreaks were brought to an end by intensive investigation including bacteriological examination of the domestic contacts and by the insistence on strict personal hygiene for the households concerned. There was no evidence whatever that the infection was due to contamination of the food supplied at school meals and it can be safely concluded that it owed its dissemination to defective hand hygiene. Control of intestinal infection of this nature is essentially a matter of washing hands after visiting the toilet and before taking food. In this connection it should be noted that at the Green Wrythe Lane School, as in some others, there is as yet no hot water supply for personal ablution. Children, particularly in Infants School, cannot be expected voluntarily to wash in cold water in the winter months. Steady progress is being made in bringing the sanitary arrangements in schools up to the statutory standards provided by the Regulations made under the Education Act, but this matter of adequate washing and towel facilities is one which calls for priority. Scarlet Fever The incidence of scarlet fever although rather higher than in the year before was again low. Seventy cases were notified, all residents of the district giving an attack rate of 1.14 per 1,000 population. Half the total were nursed at home. The illness was of the now usual mild variety and was not fatal in any instance. There is evidence that in recent years practitioners generally are attaching less importance to the necessity for maintaining reasonable isolation in cases of this infection. Undoubtedly scarlet fever is not the serious disease it was 50 years ago, but it is still an infectious illness and there is no justification for failing to take adequate precautions against its spread. In two instances there were four cases in the same house. 44 TABLE 10. SCARLET FEVER—DISTRIBUTION OF CASES, 1955. 1955 Ward Total St. Helier North St. Helier South St. Helier West North- East Northwest Central South- East Southwest January - 2 - - - - 1 - 3 February 1 1 — 1 - 3 - - 6 March 4 — — - 1 6 - 1 12 April — — 1 2 - 2 2 - 7 May 1 1 — 3 1 - - - 6 June — 1 — 5 3 — — - 9 July - - - - - - - - - August — — — — 1 — — 1 2 September — — — 1 — — — 1 2 October 1 1 1 1 — - 1 — 5 November — — 1 1 — - 3 5 10 December — 1 2 1 — — 2 2 8 Totals 7 7 5 15 6 11 9 10 70 Monthly mean 0.58 0.58 0.41 1.25 0.50 0.91 0.75 0.83 5.83 Case rate per 1,000 population 0.82 0.99 0.62 1.52 0.81 1.86 1.11 1.50 1.14 TABLE 11. SCARLET FEVER—MULTIPLE CASES, 1955. Ward No. of houses in which occurred Total Houses Total Cases 1 Case 2 Cases 3 Cases 4 Cases St. Helier North 3 - - 1 4 7 St. Helier South 7 - - - 7 7 St. Helier West 3 1 - - 4 5 North-East 13 1 - - 14 15 North-West 4 1 - - 5 6 Central 3 2 - - 6 11 South-East 7 1 - - 8 9 South-West 8 1 — — 9 10 Whole District 48 7 — 2 57 70 Diphtheria For the sixth year in succession there were no cases of diphtheria. 45 Diphtheria Immunisation Although one can feel satisfaction at the continued freedom from this infection, the fact that it is becoming increasingly difficult to maintain the original high level of immunisation in the child population, gives grounds for some uneasiness as to how long we can expect this immunity to continue. Outbreaks, limited in extent it is true, do occur from time to time in different parts of the country and only by keeping a satisfactorily high proportion of the population effectively immunised, can we hope to escape any return of this dangerous infection. By arrangement with the District Councils, the scheme is directed locally on behalf of the County Council who are the responsible authority by the District Medical Officers of Health. The aim of the scheme is to secure primary immunisation before the age of one year and to reinforce the protection by further booster injections at not more than five year intervals since the Ministry of Health's "immunity index" is calculated on the percentage immunised within the previous five years. The actual practice in Carshalton has for many years been to secure reinforcement at intervals of not more than three years which increases the margin of safety. There is an increasing tendency to give primary immunisation in the first six months of life. This arises from the desirability of combining it with whooping cough immunisation which the advocates of early treatment believe should be done before six months to prevent the mortality from whooping cough, which is high in the first year of life. It is, however, doubtful whether a public programme of diphtheria immunisation based on this practice is likely to be as effective as the long established one of giving the primary treatment towards the end of the frrst year of life. There is reason to believe that the immunity against diphtheria conferred by immunisation before six months of age, needs reinforcement in a matter of eighteen months to two years and experience shows that it is exceedingly difficult to secure reinforcement on any adequate scale at this age, since it involves an effort on the part of parents in bringing children to a clinic for the purpose. The practice in operation for a long time past secured the first reinforcement in effect when the child was five years old after it had entered school, when most parents were quite willing for it to be done. This established timing of the primary treatment and spacing of booster doses has shown itself to give adequate protection and should not be discarded unless it can be replaced by another which can be as readily applied on the scale necessary for a public scheme and sure of equal success. There is moreover, no reason why the incidence of whooping cough under one year of age should not fall if the main reservoir of infection in the children over that age is eliminated by immunisation, just as it did in the case of diphtheria when immunisation was given at about the age of one year. During 1955, 624 resident children received a primary course of treatment as follows : 46 Age at 31/12/55 Under 1 year 1 year 2 years 3 years 4 years 5-9 years 10-14 years Total At Council Clinics 61 258 39 10 10 7 - 385 In Carshalton Schools — — — 2 3 73 6 84 Private Practitioners 9 120 23 7 3 6 1 169 Less outward transfers 70 378 62 19 16 86 7 638 4 6 1 — — 5 — 16 Plus inward transfers 66 372 61 19 16 81 7 622 — - - - - 1 1 2 Carshalton residents 66 372 61 19 16 82 8 624 A further 933 Carshalton children received reinforcing injections during the year. The immunisation state of the local child population at 31st December, 1955, was as follows : Number of Children at 31st December, 1955, who had completed a course of immunisation at any time before that date (i.e. at any time since 1/1/41). Age at 31/12/55 i.e. Born in Year Under 1 1955 1-4 1951-1954 5-9 1946-1950 10-14 1941-1945 Under 15 Total Last complete course of injections (whether primary or booster) A. 1951-1955 66 1,992 3,636 2,387 8,081 B. 1941-1950 — — 610 1,009 1,619 C. Estimated mid-year child population 800 3,150 9,060 13,010 Immunity Index 100 A/C 8.2 63.2 66.4 62.1 The percentage of children under fifteen years of age immunised within the previous five years was slightly higher than a year before at 62.1 %. A further 12% immunised more than five years previously would have some degree of protection. 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. 47 Year Percentage of Children Immunised Incidence of Diphtheria 0-5 Years 5-15 Years 0-15 Years Cases Attack Rate Per 1,000 Population 1935 - - 7 58 1.13 1936 — — 10 53 0.95 1937 — — 15 47 0.80 1938 — — 18 33 0.57 1939 — — 19 14 0.23 1940 — — 21 45 0.77 1941 — — 49 26 0.45 1942 40 84 71 23 0.40 1943 57 78 72 7 0.12 1944 54 83 75 7 0.12 1945 58 75 70 15 0.27 1946 64 81 76 4 0.06 1947 63 84 78 2 0.03 1948 67 92 81 1 0.01 1949 60 91 81 1 0.01 1950 63 98 85 0 0.00 1951 57 97 84 0 0.00 1952 54 99 84 0 0.00 1953 52 85(70*) 75(64*) 0 0.00 1954 53 85(66*) 75(62*) 0 0.00 1955 52 84(66*) 74(62*) 0 0.00 (* Immunised within the last 5 years) Erysipelas Four cases of erysipelas were notified. Three had a facial lesion and the fourth an infection of the foot. Two had had a previous attack. All recovered. Pneumonia Notification of pneumonia is limited to primary and influenzal pneumonia. Hence the numbers reported do not include cases which arise as a complication of some other condition. The number notified in 1955 at 28 was the same as in the year before, the lowest figure for ten years. It is probable that the early use of the modern anti-biotics and the sulpha drugs aborts the full development of this disease in many patients, and that this accounts for the smaller number of cases in the last year or so. Of the 28 cases, six were stated to be of influenzal origin. More than half the total occurred in the first quarter of the year. Measles Much in conformity with the behaviour pattern of this infection, a high incidence of measles was to be expected in 1955 following a year of low prevalence in 1954. Infection on an epidemic scale began in the second week of January and continued to the middle of the year with the peak period in March and April. A total of 1,138 cases—all residents but eight—was the highest recorded since notification began in 1939. Although no means have yet been found of preventing measles, the risk of its more dangerous complications have been largely removed by modern chemotherapy. There were no deaths. 48 TABLE 12. MEASLES—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1955. (Excluding hospital patients non-resident in Carshalton) 1955 Ward St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest Total January 51 8 4 27 1 2 2 2 97 February 40 3 10 22 3 8 3 3 92 March 42 7 29 98 29 34 55 52 346 April 28 46 73 48 30 19 53 47 344 May 19 33 29 11 13 8 10 10 133 June 8 12 17 9 12 2 13 1 74 July 3 — 4 1 1 — 4 3 16 August 3 1 — 1 — — 10 — 15 September 1 — — 3 4 — — — 8 October November - - 1 - - - - - 1 December 1 — — 1 1 — — 1 4 Totals 196 110 167 221 94 73 150 119 1,130 Monthly Mean 16.33 9.16 13.91 18.41 7.83 6.08 12.50 9.91 94.16 Case rate per 1,000 population 22.9 15.6 20.9 22.4 12.8 12.3 18.5 17.9 18.4 Whooping Cough Whooping cough was less prevalent than in the year before. A total of 101 cases was notified, all residents but three. This is only three more than the record low incidence of 98 cases in 1952. The annual total of whooping cough cases prior to the start of whooping cough immunisation, ranged between 200 and 500 and although it is gratifying that prevalence should have remained unusually low for two years in succession, it would be unsafe to draw any conclusions as to the effect immunisation, to the extent at present practised, is having upon the prevalence of whooping cough. As previously reported, immunisation against this disease is available under arrangements made by the County Council at the Infant Welfare Clinics. At December 31st it is estimated that 47% of the children under five years of age had at some time received this treatment. This is the highest proportion so far achieved. 49 TABLE 13. WHOOPING COUGH—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1955. (Excluding hospital patients non-resident in Carshalton) 1955 Ward Total St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest January 1 - 7 1 - 1 6 3 19 February 1 — 3 — 1 4 7 — 16 March 4 — 1 — 1 - 9 — 15 April 7 — 1 2 1 — 1 1 13 May 2 — 1 — — 3 — — 6 June 3 — — 1 2 2 1 — 9 July - - - - - - - - - August — 1 — 1 — — 2 — 4 September — -— 4 3 2 — — — 9 October — — — — — 1 — — 1 November — — — 1 — 1 — — 2 December — 1 1 — — 2 — — 4 Totals 18 2 18 9 7 14 26 4 98 Monthly Mean 1.50 0.16 1.50 0.75 0.58 1.16 2.16 0.33 8.16 Case rate per 1,000 population 2.11 0.28 2.25 0.92 0.95 2.37 3.21 0.60 1.59 Meningococcal Infection A baby of sixteen months contracted meningococcal meningitis. It made a complete recovery after treatment in isolation hospital with antibiotics and chemotherapy. Poliomyelitis The incidence of poliomyelitis was the highest since the major epidemic of 1947. Twelve cases were notified of which nine were paralytic. Details were as follows : Sex Age Date of Onset Resultant disability in May, 1956 F 4 29th June Good recovery from mild weakness of right leg. M 13 2nd Sept. Non paralytic members of one family. F 4 11th Sept. „ F 9 13th Sept. „ F 17 15th Sept. Moderate degree of weakness of all limbs. F Ad. 20th Sept. Very slight weakness of right foot. F 4 22nd Sept. Drags left foot slightly. F 12 5th Oct. Drags left foot. M 4 11th Oct. No paralysis but slight tightness of neck muscles. F Ad. 24th Oct. Recovery from partial paralysis of palate. M Ad. 31st Oct. Died—bulbar paralysis. M 6 6th Nov. Complete recovery. 50 Ophthalmia Neonatorum Inflammation of the eyes in the newborn which in the early part of the century was responsible for considerable blindness, is nowadays a comparatively rare event and is much more responsive to modern treatment. Only eight cases have been notified in the last eleven years, six of which including the year 1955 were entirely free. Puerperal Pyrexia The number of notifications received annually of a rise of temperature in lying-in women has been high since the time when extensive hospital facilities for maternity were provided in the district, mainly at the St. Helier Hospital which caters for a wide area of Metropolitan Surrey. The number received in 1955 was 160 compared with 270 in the year before. As explained in previous reports, any rise in temperature of 2° within two weeks of childbirth is now notifiable under the Regulations, whatever the cause. A high proportion of these cases are febrile conditions not directly the result of childbirth and only a limited number are due to infection of the genital tract. The incidence of puerperal pyrexia based on the births registered to Carshalton mothers only, which is entirely misleading, was 200.5 per thousand. The rate based upon the number of related births, i.e. the total number of births which occurred in the district was 72.2 per thousand. All cases but one were in respect of hospital confinements. Ninety-five were first pregnancies. There were no deaths. Food Poisoning Eight cases infected with salmonella typhimurium organisms were notified. Two were single cases of young children aged two and five years respectively, in different families occurring at different times of the year. A third case was also an isolated one in a child in a local hospital. As not infrequently happens there were no other associated cases which would help in identifying the vehicle by which this infection was introduced. Again as in many other instances in recent years, it was the youngest member of the family who was affected and the infection probably took place not so much as a result of a contaminated food, but from contaminated fingers, to which the very young are very prone. The remaining five cases were all infants in a children's ward of a local hospital. Here again there was no explosive outbreak due to eating a particular food on any one occasion. This small outbreak was due to the infection of one infant who developed diarrhoea on the 12th April. Three other children in the same ward developed similar symptoms, six days, nine days and nine days later respectively. A fourth child, who was symptomless, was found to have a positive swab for salmonella typhimurium seven days after the original case when all the ward contacts were bacteriologically investigated. How the original case came to be infected was not ascertained and there is no doubt that the other four were secondarily infected from the first. Complete swabbing of the staff concerned failed to detect any infection in those in attendance on the children. The possibilities of transmission of salmonella infection in an infants ward are of course far from negligible. All infections cleared up, as evidenced by bacteriological examination, in two to three weeks. 51 52 TABLE 14. CASES OF NOTIFIABLE INFECTIOUS DISEASE ADMITTED TO HOSPITAL, 1955. Disease Western War Memorial Grove Cuddington Bletchingley Wandle Valley Queen Mary's St. Helier Totals Scarlet Fever — 2 25 1 8 — — 36 Erysipelas — — — 1 — — — — 1 Measles — — — 6 1 7 6 2 22 Whooping Cough — — — — — 1 1 — 2 Meningococcal Infection — — — — - 1 — — 1 Pneumonia — 1 — — - — — 3 4 Poliomyelitis, Non-Paralytic — — — — _ 1 2 — 3 Poliomyelitis Paralytic 4 — — — — — 4 1 9 Totals 4 1 2 32 2 18 13 6 78 53 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 70 1.14 — 7 7 5 15 6 11 9 10 36 51 Erysipelas 4 0.06 — — — 1 — — — — 3 1 25 Measles 1,130 18.42 — 196 110 167 221 94 73 150 119 21 1.85 Whooping Cough 98 1.59 — 18 2 18 9 7 14 26 4 2 2.04 Dysentery 116 1.84 — 54 1 5 — — 1 47 8 — - Pneumonia 27 0.44 — 4 4 10 3 2 2 1 1 4 14.8 Poliomyelitis, Non-Paralytic 3 0.04 - - - - - - - - 3 3 100 Poliomyelitis, Paralytic 9 0.14 1 — 2 1 — 1 1 3 1 9 100 Meningococcal Infection 1 0.01 — 1 - - - - - - 1 100 Puerperal Pyrexia 30 0.48 — 2 5 5 5 5 3 3 2 29 96.6 Food Poisoning 2 0.03 — — - 1 1 — - - — — - 54 TABLE 16. INFECTIOUS DISEASES—Notification by Age Groups, 1955. (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 — 3 4 6 7 46 3 — — — 1 — 70 Erysipelas - - - - - - - - - 1 2 1 4 Measles 28 93 122 124 178 568 8 3 3 1 2 — 1,130 Whooping Cough 6 5 6 14 11 44 3 1 5 3 — — 98 Dysentery 3 7 10 11 7 49 4 — 19 4 2 — 116 Pneumonia — — — — 1 3 — — 3 4 13 3 27 Poliomyelitis, Non-Paralytic — — — - 1 1 1 - - - - - 3 Poliomyelitis, Paralytic — — — — 2 2 1 1 2 1 — - 9 Meningococcal Infection — 1 - - - - - - - - - - 1 Puerperal Pyrexia - - - - - - - 1 26 3 — — 30 Food Poisoning — — — 1 — 1 — — — — — - 2 55 TABLE 17. MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1955. (Excluding hospital patients non-resident in Carshalton) Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 3 6 12 7 6 9 2 2 5 10 8 70 Erysipelas — — — 1 1 — — 1 — 1 — — 4 Measles 97 92 346 344 133 74 16 15 8 — 1 4 1,130 Whooping Cough 19 16 15 13 6 9 — 4 9 1 2 4 98 Dysentery — — 30 16 1 1 3 2 4 1 9 49 116 Pneumonia 3 9 3 4 1 1 — — 1 3 — 2 27 Poliomyelitis, Non-Paralytic — — — — — — — — 3 — — — 3 Poliomyelitis, Paralytic - - - - - - 1 — 2 4 2 — 9 Meningococcal Infection — — — - — — — — 1 — — — 1 Puerperal Pyrexia 3 4 1 5 1 4 3 5 1 1 2 — 30 Food Poisoning — - — - — - 1 — — — 1 — 2 Tuberculosis, Pulmonary 4 3 3 3 4 1 4 2 2 2 1 3 32 Tuberculosis, Non-Pulmonary — — — — 1 1 1 — 1 — — — 4 Tuberculosis The new cases admitted to the tuberculosis register during the year numbered 67, classified as follows : Males Females Pulmonary 32 Pulmonary 30 Non-pulmonary 1 Non-pulmonary 4 Of the total additions, 36 were primary notifications, and 31 were transferred from other districts. In the same period, 104 names were removed from the register for the following reasons : Recovered 35 Death 5 Otherwise (including removals) 64 After allowing for the additions and deductions, the state of the register at the 31st December, 1955, was as shown in the following table : TUBERCULOSIS—WARD DISTRIBUTION. Cases on Register at 31st December, 1955. Ward Pulmonary Non-Pulmonary Total Incidence per 1,000 population Males Females Males Females St. Helier North 71 76 13 9 169 19.8 St. Helier South 69 58 7 9 143 20.3 St. Helier West 59 70 6 10 145 18.1 North-East 65 66 8 3 142 14.4 North-West 32 29 — 3 64 8.7 Central 35 27 2 i 66 11.1 South-East 42 31 3 5 81 10.0 South-West 23 23 — 1 47 7.9 Whole District 396 380 39 42 857 13.9 776 81 The total of 857 is 37 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 109. 56 The number of tuberculous persons who died during the year was 5, distributed by age groups as follows : Age, Years Pulmonary Non-Pulmonary Total Males Females Males Females 0 1—5 — — — — — 5—15 — — — — — 15—25 — — — — — 25—35 - 2 — — 2 35-45 — — — — — 45—55 — — 1 — 1 55—65 1 — — — 1 65—up 1 — — — 1 Totals 2 2 1 — 5 The deaths attributable to tuberculosis were 3, as follows : DEATHS DUE TO TUBERCULOSIS, 1955. Ward Pulmonary Non-Pulmonary Death Rate per 1,000 population Mean age at Death Male Female Male Female St. Helier North 1 - - - 0.11 70 St. Helier South - 1 — — 0.14 29 St. Helier West - — — — — — North-East - — — — — — North-West - — — — — — Central - — — — — — South-East - 1 — — 0.12 30 South-West - — — — — — Totals 1 2 — — 0.04 49 All 3 deaths were of notified 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. Fourteen such families were rehoused out of a total of 98 Council tenancies allotted during 1955. 57 58 TABLE 18. TUBERCULOSIS. New Cases, Age and Sex Distribution and Manner of Admission to Register, 1955. Age Group Years Primary Notifications "A" Cases transferred from Other Districts Cases brought to notice other than by Notification or Transfer Total New Cases Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. M. F. M. F. 0—1 - - - - - - - - - - - - - 1—5 - 2 - - - - - - — — — — 2 5—10 - 1 1 - — — — — — — — — 2 10—15 - — — - - — — — - — — — — 15—20 — 2 — - 1 — — — - — — — 3 20—25 4 4 — 1 1 3 — 1 — — — — 14 25—35 2 4 — 1 6 8 — — — — — — 21 35—45 2 2 — — 4 3 — — — — — — 11 45—55 2 — — 1 — 1 — — — — — — 4 55—65 6 — — — 3 — — — — — — — 9 65 up 1 — — — — — — — — — — — 1 Totals 17 15 1 3 15 15 1 67 36 31 Mass X-Ray One of the Mass X-Ray Units of the Hospital Board was set up in the Assembly Hall and later in the Central Methodist Hall on the St. Helier Estate during November and December. The Unit's activities covered a wide area including the whole of the London Countv Council Estate and was not limited to residents of Carshalton. The following details of the medical findings are supplied by courtesy of the Medical Director of the Unit. The Assembly Hall Male Female Total Total number X-Rayed 735 736 1,471 Pulmonary Tuberculosis, Active 1 1 2 „ „ Inactive 37 35 72 Non-tuberculous abnormalities 51 12 63 Cancer of lung 1 — 1 Not yet diagnosed (this case is a non-tuberculous condition) 1 - 1 Central Methodist Hall Total number X-Rayed 590 806 1,396 Pulmonary Tuberculosis, Active - 2 2 „ „ Inactive 40 33 73 Non-tuberculous abnormalities 26 17 43 Cancer of lung 1 — 1 Not yet diagnosed 1 — 1 Carshalton T.B. Care Committee This voluntary Committee was set up under the sgis of the County Council in 1935 to help in meeting the social and economic needs of tuberculous patients and their families. In a disease where the length of incapacity is measured in months and years, these aspects of the problem are as important if not more so than the work of the medical and curative services. The help afforded by the Committee is of inestimable value in relieving domestic anxiety and sustaining morale without which no tuberculous patient can fully benefit from the comprehensive and protracted treatment which is available under the statutory scheme. The diversity of ways in which the voluntary funds are expended in providing assistance is indicated by the following extracts from the Annual Report of the Care Committee for 1955. Provision of clothing, beds and bedding. Provision of handicraft materials for patients on bed-rest. Grants for insurance premiums, wireless and television licences, garage rent, pocket money while in hospital, fares to enable relatives to visit in hospital, sewing machine repairs, bicycles, removal expenses, loans to establish business. Loans—typewriters for instruction and practice, deck-chairs, back-rests, bed tables, etc. Holidays—grants up to 12 guineas to enable families to enjoy holidays. Twentythree children of T.B. families sent to holiday camps. The Committee members and officers are all voluntary workers and the administrative expenses including the cost of Christmas seals, the sale of which constitutes the main source of income, represents between 6 % and 7% of the annual disbursements, which in 1955 amounted to £650. 59 Meteorology The following rainfall was recorded at the Council's Pumping Station in Buckhurst Avenue. Rainfall 1955 Amount in ins. January 2.30 February 1.50 March 1.06 April 0.29 May 3.70 June 1.63 July 0.24 August 1.55 September 1.88 October 3.19 November 0.60 December 1.94 Total 19.88 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 year 1701.56 million gallons. Minimum flow 0.49 million gallons/day on 28th December. Maximum flow 9.30 million gallons/day on 2nd March. 60 INDEX PAGE Acreage 6 Atmospheric Pollution 26 Births— Distribution 9 Institutional 10 Rates 7, 9, 11 Cancer 7, 13, 14 Cemeteries 31 Clinics and Treatment Centres 19 Closet Accommodation 22 Deaths— Classification 17 Distribution 13 Rate 7, 11, 13 Diphtheria 45 Immunisation 46, 47 Dysentery 43 Disinfection 25 Disposal of Dead 31 Drainage and Sewerage 21 Employment Agencies 31 Enteric Fever 43 Erysipelas 48 Establishments for Massage, etc. 31 Factories 28 Food— Food and Drugs Act 38 Hygiene 40 Inspection and Supervision 40, 41 Poisoning 51 Health Services 18 Heating Appliances (Fireguards) Regulations, 1953 30 Housing— Council's Scheme 32 Inhabited Houses 6 Inspection 33 Repairs and Rents Act, 1954 35 Overcrowding 34 Slum Clearance 35 Ward Distribution 34 61 PAGE Ice Cream 37 Infant Mortality 7, 16 Infectious Disease 42, 53, 54, 55 Inquests 15 Isolation Hospital— Admission to 52 Laboratory Facilities 18 Mass X-Ray 59 Maternal Mortality 7, 16 Measles 48, 49 Meat 37 Meningococcal Infection 50 Merchandise Marks Act, 1926 30 Meteorology 60 Milk Supply 36 Milk and Dairies Regulations, 1949 37 Mortuary 31 Natural and Social Conditions 6 National Assistance Acts 31 Offices 28 Outworkers 28 Ophthalmia Neonatorum 51 Pet Animals Act, 1951 30 Pneumonia 48 Poliomyelitis 50 Population 7, 8 Public Cleansing Puerperal Pyrexia 51 Rag Flock and Other Filling Materials Act, 1951 31 Rateable Value 6 Rats and Mice Destruction Rivers and Streams 62 PAGE Sanitary Circumstances 20 Sanitary Inspection. 22 Scarlet Fever 44, 45 Shops Acts 30 Smallpox 42 Smoke Abatement 26 Staff 5 Statistics— Comparative 12 Vital 7 Swimming Baths 28 Tuberculosis 7, 14, 15,56,57, 58 Care Committee 59 Unemployment 8 Vaccination.. 18, 43 Vermin Control 25 Water Supply 20 Whooping Cough 49, 50 Zymotic Diseases— Deaths from 7 63