Ac. 4413(3) CARSHALTON URBAN DISTRICT Annual Report OF THE Medical Officer of Health FOR THE YEAR 1956 CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1956 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 1956. The statistics contained within its pages are the yard-sticks by which the public health is measured, and are in the main based upon the same calculations as in former years. In many instances comparable figures for earlier years are given by which to evaluate progress. Many of these indices are for the year under review the best yet recorded in the district and for that reason it is difficult to avoid the repetitive use of superlatives. Whilst the birth rate is the lowest so far experienced, the death rate still remains at a favourable level and thus provides a not unsatisfactory natural increase. There was again no maternal death. No such death has followed child-birth in the last twelve years. Infant mortality fell appreciably and was little higher than the record low figure for 1948. This almost represents the irreducible minimum in the present state of medical knowledge, for the reason that no less than ten out of the total of eleven infant deaths occurred in the first week of life and were due to prematurity, congenital defects and other conditions peculiar to infancy which with some justification have been termed the "unavoidable causes of death." Much has yet to be learned about the prevention of these antenatal conditions, which if existing at birth make failure to survive largely inevitable. An examination of the individual causes of death cannot fail again to shew the increasing part played by cancer of the lungs. Here is scope for preventive action since it cannot now be doubted that tobacco smoke and atmospheric pollution must be reckoned among the responsible factors. 3 With the single exception of poliomyelitis the incidence of infectious disease was generally lower than ever before. Smallpox, diphtheria, enteric fever and ophthalmia neonatorum were non-existent. Scarlet fever prevalence was much the lowest in the history of the district. Whooping cough too reached a record low, whilst the year coincided with the trough in the biennial wave of measles. There was no fatality in respect of these diseases. The cases of poliomyelitis were only one less than in the first major epidemic year of 1947, but there was only one death in 1956 as against five in 1947 and a higher proportion were non-paralytic cases. The first conclusions to be drawn from the effects of the limited initial vaccination scheme against this infection undertaken during the year hold great promise that much of the resultant disability due to this disease can be prevented. Further landmarks in the war against pollution were established, in the case of food by the passing of the Food and Drugs Act, 1955 and its Hygiene Regulations and in the case of the atmosphere by the Clean Air Act. Further evidence that the control exercised over food is becoming increasingly successful, is provided by the absence during the past year of any food poisoning outbreak, by the higher bacteriological and biological standards reached in respect of milk and ice cream and by the very high proportion of completely satisfactory food analyses made by the Public Analyst. A beginning, however, has only been made in tackling the menace of atmospheric pollution and much remains to be done. Progress in this field depends to a great extent on the availability of smokeless fuels and suitable appliances in which to burn them, the will to insist on their use when available and an inspectorate fully trained in those aspects of fuel technology necessary for effective supervision. The continuing shortage of housing accommodation presents probably the greatest handicap to the promotion of public well-being. Much the worst evil which stems from this single cause is the mental and psychological damage inflicted particularly on children and young parents. The disruption of home life with its separation of children and parents and the resulting sense of insecurity engendered in the young, is the major cause in the creation of a high proportion of problem families. This grave danger to the normal development of children can be minimised to some extent where parents are dependable and capable, but when gross shortage of accommodation is coupled with sub-normal parental intelligence the prejudice to the welfare of the children is seriously aggravated. Parental inability to cope with the inimical environment created by serious overcrowding is a factor which should receive earnest consideration in the assessment of need for housing accommodation. I again tender to my staff my thanks for their efficient assistance and loyal support. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, F. LAWRENCE SMITH, Medical Officer of Health. July, 1957. 4 PUBLIC HEALTH STAFF Medical Officer of Health: * F. Lawrence Smith, M.B., Ch.B., D.P.H. Chief Public Health Inspector: † H. J. Spicer, C.R.S.I. Deputy Chief Public Health Inspector: † G. R. SURFLEET, C.R.S.I. Public Health Inspectors : † L. W. Rivett, C.R.S.I. † J. P. Dixon, C.R.S.I. † L. A. Biggs, C.R.S.I. (from 16th May) 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 1956) according to Rate Books 17,044 Rateable Value at 31st December, 1956 £864,238 Sum represented by 1d. rate £3,470 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 last twenty years or so have seen a considerably increased abstraction of water for both industrial and domestic purposes from the chalky strata. The result of this has been that with the lowering of the water table, the flow of the feeder springs is now much more sensitive to the periodic variations in rainfall. Interruption of the flow in varying degree is now more frequent. Fortunately the annual rainfall has been adequate in recent years to prevent a complete cessation of all the springs such as occurred in 1949, when both ponds were reduced to stagnant collections of surface water. An event with not insignificant social implication was the revaluation during 1956 of properties with some alteration in the distribution of rate burden. As a result of the revised assessments, the total rateable value has been increased by approximately 62%. Relatively little industry is established within the area, the district being mainly residential with the majority of its inhabitants earning their livelihood in greater London. Housing density is highest in the northern end where the London County Council Housing Estate of St. Helier makes the predominant contribution to development in this part of the district. Density is somewhat less in the centre of the town and falls markedly in the south due to the existence of considerable green belt land and the Surrey County Council's small-holdings. The census of 1951 shewed that the three St. Helier Wards jointly had 41.9 persons to the acre, the centre of the district represented by the North-East, North-West, and Central Wards 25.8 and in the South, the South-East and South-West Wards 8.0 persons to the acre. The rateable value per head of population is the lowest in Metropolitan Surrey. 6 SUMMARY OF VITAL STATISTICS FOR 1956. (Based on the Registrar-General's Figures.) Population. Registrar-General's Estimate 60,970 Births. Males Females Total Live (Legitimate) 355 338 693 (Illegitimate) 10 10 20 365 348 713 Birth Rate (per 1,000 population) 11.6 Stillbirths (Legitimate) 13 4 17 (Illegitimate) — — — 13 4 17 Stillbirth Rate per 1,000 total births 23.2 Deaths. 276 248 524 Death Rate (crude) per 1,000 population 8.5 Infant Mortality. All deaths under 1 year 7 4 11 Infant Mortality Rate (per 1,000 live births) 15.4 Deaths of leg. infts. under 1 year 6 4 10 Rate per 1,000 legitimate births 14.4 Deaths of illeg. infts. under 1 year 1 — 1 Rate per 1,000 illegitimate births 50.0 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 6 2 8 Rate per 1,000 of population 0.13 Phthisis 6 1 7 Rate per 1,000 of population 0.11 Deaths from Cancer 45 51 96 Rate per 1,000 of population 1.57 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 1956 are supplied through the courtesy of the Exchange Manager and the Youth Employment Officer : Men 108 Women 49 Boys 8 Girls 3 POPULATION The Registrar-General's estimate of the home population at mid-1956 is 60,970. This is 360 less than his estimate for mid-1955 and 1,751 less than the population enumerated at the census in 1951. In the five years since 1951, the Registrar-General has reduced his estimate by 760. During this period the natural increase resulting from the excess of births over deaths was 1,289. This latest estimate means, therefore, that emigration from the district exceeded immigration into the district by more than 2,000 individuals. Whilst outward movement in this period was probably greater than the inward movement, there is no local evidence to support the view that it outweighed the natural increase or that the population is in fact less than it was at the time of the Census 1951. Supporting this contention is the fact that the number of children attending the schools of the education authority born in the years 1942, 1943, 1944 and 1945 increased between the years 1951 and 1956 from 2,607 to 2,676. These four-year groups are of course the only ones which were completely of compulsory school age throughout the whole of the period 1951 to 1956. Although there are other factors which may affect this number of schoolchildren to some extent any variation is primarily the result of movement in and out of the district. Further, the domestic accommodation was increased by the erection of 467 new dwellings and an examination of the electoral registers reveals that the number of voters in 1956 was practically the same as in 1951, there being only a difference of eight in a total of more than 43,000. On the basis of the Registrar-General's estimated total population of 60,970, the estimated number in each ward is as follows:— 8 TABLE 1. ESTIMATED HOME POPULATION, MID-1956, BY WARDS. Ward Dwellings at Mid-1956 Estimated population Mid-1956 St. Helier North 2,170 8,460 St. Helier South 1,698 6,960 St. Helier West 2,107 7,910 North-East 2,716 9,775 North-West 2,129 7,335 Central 1,699 5,865 South-East 2,360 8,040 South-West 2,165 6,625 Whole District 17,044 60,970 The number of dwellings as at mid-1956 is 184 less than shewn in the report of a year ago. This does not mean that the number of dwellings has decreased, it has in fact risen by 42. The figures shewn are the number of dwellings rated separately and the reduction is entirely due to the revaluation which took place in 1956 when a number of properties which previously had been divided into separate assesssments were deemed to be rateable as a whole. BIRTHS The number of live births registered during 1956 was 713 which is 52 less than in the year before. Of these 365 were males and 348 females, giving a birth rate of 11.6 per thousand population. The "comparable" birth rate produced by the application of the Registrar-General's comparability factor of 0.96 to allow for the disparity in the age and sex constitution of the local population and that of the country as a whole is 11.1 per thousand population, which compares with 15.7 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 708 live births and 17 stillbirths occurred in 1956. 9 They were distributed as shewn in the following table. Ward Live Births Birth Rate per 1,000 Population Stillbirths Stillbirth Rate per 1,000 total births St. Helier North 81 9.5 3 35.7 St. Helier South 86 12.3 3 33.7 St. Helier West 77 9.7 — — North-East 123 12.5 4 31.5 North-West 73 9.9 2 26.6 Central 72 12.2 1 13.7 South-East 122 15.1 3 24.0 South-West 77 11.6 1 13.8 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 North-West 78 St. Helier South 80 Central 86 St. Helier West 83 South-East 64 North-East .. 70 South-West 83 Out of 725 total births, 552 took place in the following hospitals and nursing homes :— Live Still Total Carshalton, Beddington and Wallington District (War Memorial) Hospital 102 2 104 St. Helier Hospital 340 12 352 Other Surrey Hospitals 83 2 85 Other Hospitals 9 — 9 Private Nursing Homes 2 — 2 Totals 536 16 552 For the last four years more than three-quarters of all births have taken place in Maternity Institutions. 10 TABLE 2. BIRTHS, 1956—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 58(3) 21 79(3) 5 — 5 84(3) St. Helier South 63(2) 17(1) 80(3) 6 — 6 86(3) St. Helier West 63 13 76 1 — 1 77 North-East 81(4) 38 119(4) 8 — 8 127(4) North-West 39(1) 16 55(1) 20(1) — 20(1) 75(2) Central 52(1) 10 62(1) 11 — 11 73(1) South-East 61(3) 43 104(3) 19 2 21 125(3) South-West 39 13 52 26(1) — 26(1) 78(1) Totals 456(14) 171(1) 627(15) 96(2) 2 98(2) 725(17) (Figures in brackets indicate stillbirths included in totals.) TABLE 3. BIRTH AND DEATH RATES FOR CARSHALTON, 1922-1956. 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 1956 60,970 11.6 8.5 15.4 0.0 11 TABLE 4. COMPARATIVE STATISTICS—1956. England and Wales Carshalton Birth Rate (per 1,000 population) 15.7 11.6 Still-birth Rate (per 1,000 total births) 23.0 23.2 Death Rate (per 1,000 population) 11.7 8.5 (crude) 11.0 (comp.) Infant Mortality (per 1,000 live births) 23.8 15.4 Neo-natal Mortality (in first 4 wks. per 1,000 live births) 16.9 14.0 Death rate from Tuberculosis (per 1,000 population) Respiratory Tuberculosis 0.10 0.11 0.11 0.13 Other Tuberculosis 0.01 0.02 Death Rate from Cancer (per 1,000 population) All forms 2.07 1.57 Cancer of Lung 0.40 0.29 Maternal Mortality (per 1,000 total births) Excluding Abortion 0.46 0.56 — Abortion 0.l0 — COMPARATIVE HEALTH STATISTICS, 1934/56. Crude Death Rate (Civilian) per 1,000 population Infant Mortality per 1,000 live births Maternal Mortality (excluding abortion) per 1,000 total births Year England and Wales Carshalton England and Wales Carshalton England and Wales Carshalton 1934 11.8 8.6 59.3 53.5 3.8 3.0 1935 11.7 6.6 57.0 46.0 3.4 2.4 1936 12.1 7.1 58.7 46.7 3.1 5.4 1937 12.4 6.6 57.7 40.0 2.7 0 1938 11.6 7.6 52.8 46.1 2.7 1.1 1939 12.1 7.1 50.6 35.4 2.5 2.0 1940 14.4 8.7 56.8 43.8 2.1 3.8 1941 13.5 8.4 60.0 40.5 2.2 0 1942 12.3 7.5 50.6 27.5 2.0 2.4 1943 12.1 8.2 49.1 39.3 1.8 4.9 1944 11.6 9.5 45.4 39.2 1.5 1.1 1945 11.4 8.2 46.0 23.2 1.4 0 1946 11.5 7.2 43.0 18.6 1.2 0 1947 12.0 7.8 41.0 22.8 1.0 0 1948 10.8 7.4 34.0 14.5 0.86 0 1949 11.7 8.3 32.0 29.0 0.82 0 1950 11.6 7.8 29.8 28.4 0.72 0 1951 12.5 8.7 29.6 29.0 0.65 0 1952 11.3 8.9 27.6 28.0 0.59 0 1953 11.4 8.4 26.8 23.3 0.65 0 1954 11.3 8.0 25.5 18.2 0.58 0 1955 11.7 7.8 24.9 23.5 0.54 0 1956 11.7 8.5 23.8 15.4 0.46 0 12 DEATHS The deaths allocated to the district, as adjusted by inward and outward transferable deaths, was 524—276 males and 248 females. This gives a crude death rate of 8.5 per thousand population as against 7.8 in the year before. The "comparable" death rate produced by the application of the Registrar-General's comparability factor of 1.3 to allow for differences in the age and sex constitution of the local population as compared with the the country as a whole was 11.0. 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, 1956. Ward Deaths Death Rate (crude) Mean Age at Death St. Helier North 49 5.8 61.3 yrs. St. Helier South 43 6.1 60.7 „ St. Helier West 61 7.7 62.7 „ North-East 71 7.2 63.5 „ North-West 77 10.4 66.1 „ Central 82 13.9 73.1 „ South-East 73 9.1 65.6 „ South-West 68 10.2 68.8 „ Whole District 524 8.6 65.8 „ The death rate from cancer fell from 1.72 to 1.57 the fall being more than accounted for by a reduction in deaths from this disease among males. Cancer of the lung though less than in the year before, was responsible for nearly one fifth of the total cancer deaths. Careful investigation in recent years has established beyond doubt that excessive smoking over a long period is one of the causes of cancer of the lung. Statistical researches in several countries abroad have provided similar conclusions to those in this country. Whilst the individual is and should be entitled to incur this risk if he so chooses, the subjection of those not wishing to do so to the dangers of a tobacco smoke-laden atmosphere in places of public assembly, entertainment and travel is much less defensible. The number of deaths from cancer of the lung since 1934 when such figures were first available are as follows:— DEATHS FROM CANCER OF THE LUNGS 1934-56. 1934 0 1946 8 1935 1 1947 21 1936 3 1948 15 1937 6 1949 12 1938 10 1950 23 1939 9 1951 12 1940 4 1952 11 1941 9 1953 30 1942 4 1954 30 1943 13 1955 27 1944 8 1956 18 1945 12 13 CANCER DEATHS—WARD DISTRIBUTION, 1956. Ward Cancer Deaths Rate per 1,000 Estimated Population St. Helier North 12 1.41 St. Helier South 9 1.29 St. Helier West 13 1.64 North-East 13 1.32 North-West 12 1.63 Central 11 1.87 South-East 18 2.23 South-West 8 1.20 The classification of the cancer deaths by sites affected is given in Table 5. TABLE 5. CANCER DEATHS, 1956. Group Site Affected Male Female Total Digestive Organs— 143 Mouth 1 — 1 150 Oesophagus 1 — 1 151 Stomach 7 6 13 153 Colon 4 5 9 154 Rectum 1 2 3 156 Liver 1 1 2 157 Pancreas 2 1 3 158 Peritoneum 1 1 2 Respiratory System— 160 Antrum — 1 1 162 Lungs and Bronchus 14 4 18 Breast and Genito-Urinary— 170 Breast — 9 9 171/4 Uterus — 7 7 175 Ovary — 3 3 176 Vulva — 1 1 177 Prostate 1 — 1 180 Kidney 1 1 2 181 Bladder 3 2 5 Other Sites— 193 Brain & Nervous Tissue 5 — 5 195 Glands — 1 1 196 Bone 1 1 2 197 Muscle — 1 1 199 Unspecified 1 2 3 200 Lymphosarcoma 1 2 3 45 51 96 Average age at death: Males 59.1 years Females 63.0 years All persons 61.2 years 14 Approximately half of all deaths were due to disease of the heart and circulatory system. In so far as these were the result of the inevitable degenerative changes of old age, it is not an unfavourable feature but of recent years an increasing proportion are dying of coronary disease of the heart particularly men of whom this disease last year killed more than twice the number it did of women. Moreover the average age of death from this cause was 65 years among males as against 72 years in females. This reflects in some degree the increasing stress of modern life. Tuberculosis mortality was again low though higher than in the year before. The death rates from this cause for the last twenty years were as follows:— Year Deaths from Tuberculosis Death Rate per 1,000 Population Year Deaths from Tuberculosis Death Rate per 1,000 Population 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 1946 25 0.41 1956 8 0.13 The distribution of tuberculosis mortality by wards and other details are given in Section F of this report. As in the year before only one death resulted from the notifiable infectious diseases—from poliomyelitis. Violent causes accounted for the deaths of twenty-five residents, they were:— Road traffic accidents 10 Accidents in the Home 4 Drowning 2 Railway Accident 1 Air accident 1 Suicide 6 Homicide 1 Inquests Inquests were held on 54 persons who died in the district. The following verdicts were returned:— Accidental Death 32 Suicide 7 Misadventure 10 Natural causes 3 Open Verdict 1 Homicide 1 Seventeen of the total were residents of the district. Thirteen were due to road accidents. 15 INFANT MORTALITY Eleven deaths of infants under the age of one year gave an infant mortality rate of 15.4 per 1,000 live births which is the second lowest on record for the district and compares with 23.8 for the Country as a whole. A favourable feature of this mortality is the fact that ten of the eleven deaths occurred during the first week of life, all of which were due to what have been described as the "unavoidable" causes of death namely prematurity, congenital deformalities etc., conditions existing at birth which in the main makes survival impossible. Only one death—from pneumonia at five months—occurred in an infant born healthy. All but one were deaths of legitimate children. TABLE 6. INFANT MORTALITY—WARD DISTRIBUTION. Ward Infant Deaths Rate per 1,000 Live Births St. Helier North 1 12.3 St. Helier South 1 12.0 St. Helier West 1 12.9 North-East 2 16.2 North-West 1 13.6 Central — — South-East 2 16.3 South-West 3 38.9 TABLE 7. INFANT MORTALITY DURING THE YEAR 1956. 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 7 — — — 7 — — — — 7 Congenital Malformation 2 — — — 2 — — — — 2 Atelectasis 1 — — — 1 — — — — 1 Pneumonia — — — — — — 1 — — 1 Totals 10 — — — 10 — 1 — — 11 MATERNAL MORTALITY The year was again without a death due to maternity. The large measure of safety which the Maternity Services have bestowed on childbirth is evidenced by the fact that only one such death has been recorded in the district in the last twelve years and that single instance was following abortion, the cause of which was not ascertained. 16 17 TABLE 8—CAUSES OF DEATH DURING THE YEAR 1956—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 Total 7 3 4 — 2 1 3 1 8 3 9 7 35 20 61 37 71 66 76 110 276 248 524 1 Tuberculosis, Respiratory — — — — —. — — — 1 — 1 — — — 1 — 2 1 1 — 6 1 7 2 Tuberculosis, other — — — — — — — — — — — — — 1 — — — — — — — 1 1 3 Syphilitic disease — — — — — — — — — — — — — — 3 — 1 — 1 — 5 — 5 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 — — — — — — — — — — — — 2 1 2 2 2 1 1 2 7 6 13 11 Malignant Neoplasm, Lung — — — — — — — — 1 — — 1 2 — 7 1 4 1 — 1 14 4 18 12 Malignant Neoplasm, Breast — — — — — — — — — — — — — 2 — 4 — 1 — 2 — 9 9 13 Malignant Neoplasm, Uterus — — — — — — — — — 1 — — — 1 — 2 — 3 — — — 7 7 14 Other Malignant and Lymphatic Neoplasms — — 1 — — — — — 1 — 1 — 5 3 8 9 5 11 3 2 24 25 49 15 Leukæmia, Aleukæmia — — — — — — — — — — — — 1 — — — 2 1 1 1 4 2 6 16 Diabetes — — — — — — — — — — — — — 1 — — — — — 1 — 2 2 17 Vascular Lesions of Nervous System — — — — — — — — — — — 2 1 3 5 6 9 11 12 22 27 44 71 18 Coronary Disease, Angina — — — — — — — — 1 — 1 — 10 — 9 5 19 8 11 10 51 23 74 19 Hypertension with Heart Disease — — — — — — — — — — — — — — — — 2 2 1 5 3 7 10 20 Other Heart Disease — — — — — — — — 1 — 2 1 5 2 5 1 2 9 17 28 32 41 73 21 Other Circulatory Disease — — — — — — — — — — — 1 — 2 2 1 2 3 10 8 14 15 29 22 Influenza — — — — — — — — — — — — — — — — — — — — — — — 23 Pneumonia — 1 — — — — — 1 — — — 1 — 1 1 1 2 5 2 4 5 14 19 24 Bronchitis — — — — — — — — — — 1 — 2 1 3 — 8 1 4 8 18 10 28 25 Other Diseases of Respiratory System — — 1 — — — — — — — — — 1 — 4 1 — — 1 1 7 2 9 26 Ulcer of Stomach and Duodenum — — — — — — — — — — — — — — 1 — 3 — 2 4 6 4 10 27 Gastritis, Enteritis and Diarrhœa — — — — — — — — — — — — — — — — — 1 1 — 1 1 2 28 Nephritis and Nephrosis — — — — — — — — — 1 — — — — 2 — — 1 — — 2 2 4 29 Hyperplasia of Prostate — — — — — — — — — — — — — — 1 — 4 — 2 — 7 — 7 30 Pregnancy, Childbirth, Abortion — — — — — — — — — — — — — — — — — — — — — — — 31 Congenital Malformations — — 1 — 1 — — — — — — 1 — — — — — — — — 2 1 3 32 Other Defined and Ill-defined Diseases 7 2 — — 1 — — — 1 — 1 — 3 1 3 3 3 5 4 8 23 19 42 33 Motor Vehicle Accidents — — — — — — 1 — 1 1 1 — 2 — 1 1 1 — 1 — 8 2 10 34 All other Accidents — — 1 — — — 1 — — — — — — —. 2 — — — 1 3 5 3 8 35 Suicide — — — — — — 1 — — — 1 — 1 1 1 — — 1 — — 4 2 6 36 Homicide and Operations of War — — — — — 1 — — — — — — — — — — — — — — — 1 1 Section B—Health Services. Laboratory Facilities No change has been made in the arrangements for laboratory examinations. Mr. D. D. Moir, 16, Southwark Street. London, S.E.I, is the Council's appointed Public Analyst to whom samples of food and drugs and water are submitted. For the examination of clinical material in respect of infectious disease, use is made of the Hospital Laboratory Services mainly at the St. Helier Hospital. Laboratory investigation in cases of food poisoning and the bacteriological examination of milk and water is undertaken by the Public Health Laboratory at Epsom. The biological examination of milk for tuberculosis is done at the Guildford Public Health Laboratory. The following examinations were made during the year: Faeces Specimens 101 Rectal Swabs 2 Throat Swabs 2 Water (Public Supply): For chemical analysis 2 For bacteriological examination 6 Water (Swimming Bath): For bacteriological examination 8 Food and Drugs: Analysis 317 Bacteriological examination of milk 214 Bacteriological examination of ice cream 96 Bacteriological examination of other foods for food poisoning organisms 5 Biological examination of milk 12 Vaccination and Immunisation Schemes of vaccination and immunisation are the responsibility of the County Council under Section 26 of the National Health Service Act. These arrangements were extended during 1956 by the inclusion of antipoliomyelitis vaccination. Schemes have now been formulated for vaccination and immunisation by the County Council against the following diseases—smallpox, diphtheria, whooping cough, tetanus, tuberculosis and poliomyelitis. By arrangement with the district councils local Medical Officers of Health direct the schemes in respect of the four first mentioned diseases. Mantoux testing and B.C.G. vaccination against tuberculosis is at present limited to thirteen-year-old children and is carried out under school health service arrangements. The polio. vaccination scheme is so far directed by the Divisional County Medical Officers. Details of the work carried out under these schemes are given in Section F dealing with infectious disease. 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 By appointment 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, 2nd & 3rd Thurs. 2—4 p.m. Middleton Road, Morden: Infant Welfare Clinic Mondays 2—4 p.m. The Mount Centre: Infant Welfare Clinic Wednesdays 2—3.30 p.m. Maternity Clinic Tuesdays 2—3 p.m. Toddler Clinic 2nd Thursday 2—4 p.m. School Health Service—General Medical Clinics. Rochester Road Centre Mons. and Fridays 9.30—12 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, Whooping Cough and Tetanus 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) 4—6.30 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. The arrangements for ensuring the purity of the public supply include the process of chlorination. Their effectiveness is checked by a comprehensive system of analyses. These are carried out daily on the raw and finished waters by the Company's resident chemist and at intervals by independent water analyst acting for the Company. Sampling is also carried out by the Public Health Departments of the local authorities in the supply area on an agreed rota. The supply was entirely satisfactory both in quantity and purity. The following summary of the examinations carried out in the Company's own laboratory is supplied by courtesy of the resident analyst. 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 100ml. of sample No. % No. % Sutton Raw 315 67 17 5.4 32 10.1 49 Sutton Finished 312 12 8 2.6 2 0.64 10 Woodmansterne Raw 298 67 3 1.1 Nil Nil 3 Woodmansterne Finished 302 12 2 0.67 Nil Nil 2 Cheam 311 67 2 0.64 23 7.4 25 Reservoir 293 Nil 1 0.34 8 2.7 9 District 281 Nil 1 0.36 1 0.36 2 New Mains 47 Nil 22 47.0 2 4.30 24 Total 2,159 225 56 — 68 — 124 The sanitary authorities in the supply area examined 11 chemical and 26 bacteriological samples during the year and all were satisfactory. The following is the report on a sample taken by the Council and is a representative one. (a) Physical Examination Colour Faintly blue Taste none Appearance Settled Water Smell none Bright and Clear but white chalk sediment present 20 (A) Chemical Examination in parts per million Total solid residue (dried at 180°C.) 190 Chlorine present as chloride 18.3 Ammonia, free 0.06 Ammonia, Albuminoid 0.00 Nitrate nitrogen 9.9 Nitrite nitrogen 0.05 Oxygen absorbed from (a) in 4 hours 0.14 permanganate solution (b) in 15 mins. — Hardness, as CaC03—Temporary 72 Permanent 50 Total 122 Alkalinity, as CaC03 72 Free carbon dioxide, as C02 — Iron absent Other metals absent Residual chlorine 0.08 Electric Conductivity at 20 °C. 275 units pH 7.8 (c) Bacteriological Examination Number of colonies developing per millilitre of water:— on agar in 2 days at 37°C. 0 on agar in 3 days at 22 °C. 0 Bacteria of indication enumeration :— Organisms of the coliform group 0 per 100 ml. Streptococci 0 do. CI. welchii 0 do. Remarks This water is of good organic purity and moderate hardness and salinity. The chemical composition is similar to that of part of the Sutton and District Water Company's supply and corresponds to a partly softened deep well water from the chalk. There is a slight sediment of calcium carbonate which rapidly settles and leaves a clear and attractive water. The residual chlorine present indicates continuing precautionary treatment. The bacteriological condition of the sample is excellent. As judged by these samples the water is wholesome and suitable for the public supply. The average hardness of the samples taken by the local authorities was 8.8° compared with 9.18° in the year before. Four exceeded 9° of hardness and seven were below. Drainage and Sewerage Under an arrangement made with the Croydon Corporation sewage is pumped to the disposal works of that authority in Beddington, except at a few points on the fringes of the district, where it is more conveniently drained to the sewerage 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. 21 Apart from the normal programme of sewer dragging and maintenance, work at a cost of approximately £3,000 commenced on the construction of the relief sewer in Woodmansterne Road between its junctions with Beeches Walk and Fullerton Road. This is designed to obviate the flooding which has occurred from time to time in the past in that area when the sewers from Queen Mary's Hospital and that down Woodmansterne Road which converge near Beeches Walk become surcharged after heavy rain. Some constructional work was also undertaken in Sunnymede Avenue in order to reduce the surface water flooding in this road near the junction with Vincent Avenue. Three thousand and ninety-six drainage obstructions affecting 1,430 houses were dealt with during the year, chiefly concerning combined systems. Rivers and Streams The routine work of maintenance of the River Wandle and its expansion was carried out as usual by the County Council. No complaints were received in respect of the River during the year. Closet Accommodation All but seventeen properties have water closets connected to the sewers. A scheme was formulated for an extension of the soil sewer in the Woodcote Grove area which would do away with many of the existing cesspools which are sited in the southern end of the district, but this scheme is held up by the Ministry in withholding loan sanction for the work. There are no earth closets. Public Cleansing No alterations have been made in the arrangements for refuse collection. Disposal too is, as before, by incineration in the Council's six cell destructor with tipping arrangements for clinker and screenings. Jointly with the Merton and Morden Council an agreement was reached with Carshalton and Merton and Morden Joint Cemetery Board to utilise land in the ownership of the Board for lipping purposes. This should meet the tipping needs of both districts for the next three years. Tipping of clinker and screenings was carried out during the year on land in Mill Lane and between Revesby Road and Shaftesbury Road where the existing ground level is being raised to form public open space. Sanitary Inspection The following information supplied by the Chief Public Health 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 1,324 complaints as follows: Accumulations 28 Animals so kept 5 Burst pipes 18 Dampness 21 Ditches and Ponds 1 Drainage defects 50 Drains obstructed 452 Dustbins 69 22 Food contaminated 20 Food Hygiene Regulations—Contraventions 3 General defective conditions 92 Insects and Pests 68 Milk, contaminated and dirty bottles 2 Miscellaneous 53 Obnoxious effluvia 19 Overcrowding 9 Refuse collections 20 Rodents 248 Roofs, defective 27 Sewer obstructions 5 Shops 1 Sink waste pipes 4 Smoke nuisances 29 Unsound food 58 Verminous premises 7 Water supply 15 1,324 Twelve thousand seven hundred and fifty-one visits of inspection and re-inspection were made for the purposes set out below:— Cowsheds 7 Employment Agencies 11 Factories (Mechanical Power) (incl. Laundries 60) 295 Factories (Non-Mechanical Power) 80 Factories (Building Sites) 8 Food and Drugs (incl. Food Bye-laws) 1,057 Food poisoning enquiries 9 Food premises: Bakehouses 69 Bakers and confectioners 79 Butchers 170 Canteens 32 Canteens—School 56 Chemists 42 Cinema 2 Confectioners (sweets only) 141 Fishmongers 93 General Stores 68 Greengrocers and fruiterers 160 Grocers 300 Licensed premises with catering facilities 15 Licensed premises without catering facilities 31 Ice Cream vehicles 16 Restaurants and cafes 122 Stalls, food 144 Tea packer 1 Vehicles, food 28 1,569 Hairdressers 63 House drains tested 79 Housing Act 252 Heating Appliances (Fireguards) Act 31 Housing Enquiries 264 Housing Land Charges 710 Infectious Disease Premises 51 Insect Pests 3 Merchandise Marks Act 210 Offices 28 Outworkers premises 87 Pet Animals Act 33 Piggeries 62 23 Premises re cesspools 40 Public Health Act (Houses) 3,564 Public Health Act re-inspections 2,463 Rag Flock & Other Filling Materials Act 7 Rodents 368 Schools 46 Shops 992 Smoke observations 290 Tents, Vans, Sheds 1 Urinals 60 Water Sampling 11 12,751 Five hundred and seventeen informal notices were served concerning the following matters:— Accumulations and deposits 17 Drainage defects 94 Dustbins 37 Factories Act 14 Food and Drugs Act (incl. Food Bye-laws) 166 Food contaminated 8 General defective conditions 107 Heating Appliances (Fireguards) Act 1 Merchandise Marks Act 1 Miscellaneous 7 Obstructed drains 5 Overcrowding 27 Pet Animals Act 1 Rodents 10 Shops Act 9 Smoke nuisances 7 Verminous premises 1 Water Supply 5 517 Thirty-six formal notices were served by authority of the Council under the following Acts:— Public Health Act, 1936, Section 24 17 „ „ „ „ Section 39 2 „ „ „ „ Section 75 5 „ „ „ „ Section 93 12 36 As a result of investigations made and notices served, the following work was carried out: Accumulations removed 14 Brickwork, repaired and/or repointed 4 Ceilings cleansed 15 Ceiling plaster repaired and/or made good 9 Chimney brickwork and pots repaired or renewed 5 flues repaired 1 27 Damp conditions remedied Disinfestations 47 Doors and frames repaired, including locks and fasteners 12 24 Drainage repaired and/or reconstructed 22 houses (486 ft. of drain laid) inspection chamber repaired and/or made good 23 inspection chambers provided 1 inspection chamber covers renewed 9 stoppers or caps refixed and/or renewed 7 soil vents repaired and/or renewed 4 drains tested 23 drains cleared (affecting 1,430 houses) 396 drains sealed off 1 waste gullies repaired, renewed or provided 7 waste pipes repaired, renewed or provided 2 cesspools provided 1 Dustbins provided 67 Fences repaired or renewed 1 Fireplaces, ranges or stoves repaired or renewed 9 Floors renewed or repaired 12 Glazing and putty renewed 12 Paving repaired and/or made level 5 Roofs repaired and made weatherproof 35 downpipe, guttering repaired and/or renewed 22 Stairs or steps repaired, renewed or made level 1 Surface water drainage repaired and made to work properly 3 Walls rebuilt 1 rendered or rendering repaired 7 replastered and/or repaired 26 cleansed and redecorated 52 Wash basins, baths renewed 2 Water Supply pipes renewed 3 Hot water supply system 2 W.C. pans renewed 4 pan joints renewed 4 seats repaired, renewed or provided 3 flushing apparatus repaired or renewed 5 Windows repaired and/or renewed 15 Window cills (external) repaired 4 Miscellaneous items 13 Disinfection Eighty-five rooms, 2 T.B. Shelters and 218 library books were disinfected. Five lots of bedding were sterilised and three lots destroyed. Vermin Control Persons. The marked improvement in verminous conditions which occurred after the second world war continues to be maintained. Little use was made of the Council's Cleansing Station in Rochester Road where only ten cases from two families with a total of thirty-three attendances were treated during the year. They were all for pediculosis and included six schoolchildren. Premises. The number of premises treated for vermin and pests is shewn in the table which follows. 25 The instances of bug infested dwellings were five only and these were dealt with without recourse to hydrogen cyanide fumigation. 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 Ants 2 — — — — — 2 Beetles 1 — — — — — 1 Bugs 3 — — 2 — — 5 Earwigs 1 — — — — — 1 Fleas — — — 2 — — 2 Flies — 8 — — — — 8 Wasps 1 — — 27 — — 28 8 8 — 31 — — Two lots of bedding were destroyed. The Public Health Inspectors act in co-operation with the Housing Department to ensure that no infested families are admitted to Council properties and that the latter are free of such conditions when re-let. Smoke Abatement and Atmospheric Pollution The slow awakening of the public conscience to the need for reducing the daily toll in health taken by pollution of the atmosphere is reflected in the Clean Air Act which found its way on to the statute book in July although the first provisions did not come into operation until 31st December. The powers and duties of local authorities will be extended by the Act which now forms part of the public health code. Early in 1954 the Council first took steps to estimate the amount of grit being emitted into the atmosphere by the installation of three deposit gauges so sited as to provide information in respect of a part of the district which had been the subject of particular complaint. This was augmented later the same year by the provision of apparatus in the grounds of the Public Health Department for measuring the concentration of atmospheric sulphur dioxide and the intensity of smoke pollution. These arrangements were made after consultation with the Department of Scientific and Industrial Research. The area which was the subject of this special investigation receives in addition to domestic smoke the discharge from a few industrial furnaces, some of which are in the process of conversion from coal to oil fuel. it will be of interest to note how this conversion affects the degree of atmospheric pollution as recorded by the apparatus which has been installed. The following tables give a summary of the investigations undertaken during the year: Deposit Gauges. Gauge Total Rainfall (in inches) Total Solids. Tons per sq. mile Highest Monthly Reading Lowest Monthly Reading Average Monthly Reading A 17.62 14.67 5.33 9.33 B 21.40 12.82 4.59 9.32 C 23.07 20.84 6.75 12.40 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 3.14 12.41 3.14 11.33 3.38 12.82 February 0.11 5.93 0.10 4.59 0.14 8.26 March 0.73 14.67 0.70 12.20 0.98 19.74 April 1.11 13.78 0.98 10.54 1.20 16.67 May 0.13 7.34 0.06 5.10 0.32 6.75 June 2.00 8.77 2.22 8.81 2.54 10.48 July 3.95 10.34 4.41 11.29 4.80 20.84 August 2.84 10.07 3.83 12.82 3.61 16.88 September 1.11 5.33 1.85 8.74 1.99 7.92 October 0.75 7.67 1.06 8.13 1.15 8.29 November 0.37 7.94 0.44 7.48 0.53 7.41 December 1.38 7.70 2.61 10.85 2.43 12.38 Total 17.62 111.95 21.40 111.88 23.07 148.44 Smoke and Atmospheric Sulphur Dioxide. Smoke (Milligrams per 100 cubic metres) s.o.2. (Parts per 100 million) Highest Daily Reading Lowest Daily Reading Average Daily Reading Highest Daily Reading Lowest Daily Reading Average Daily Reading January 59.4 3.0 16.7 29.3 1.6 6.1 February 54.7 12.9 21.5 20.3 3.5 9.6 March 18.1 3.7 10.5 9.0 1.5 4.1 April . 20.6 3.9 10.0 10.2 1.4 6.8 May 8.2 1.0 3.5 5.7 0.6 2.2 June 8.5 1.0 3.7 3.2 0.4 1.5 July 9.0 0.5 3.5 4.4 0.2 1.4 August 5.9 0.5 2.1 4.1 0.3 1.0 September 8.9 0.9 3.3 4.1 0.2 1.6 October 24.9 2.1 10.6 10.4 0.5 3.2 November 46.3 6.2 16.8 22.2 1.8 6.8 December 35.7 2.0 12.0 18.1 0.3 4.8 Whole year 59.4 0.5 9.47 29.3 0.2 4.03 Twenty-nine complaints were received and dealt with during the year. Prevention of Damage by Pests Act, 1949 The work of pest destruction is carried out under a programme agreed with the Ministry of Agriculture, Fisheries and Food, the primary purpose of which is the eradication of rats and mice. In the course of this work 10,364 visits were made by the rodent operatives to 1,380 properties when 298 instances of rat and mouse infestations were found. Of this number 253 were in private domestic premises, 38 in business premises and 7 in Council premises. Two maintenance treatments of the sewers were carried out, one in May and the other in November. The results were as follows with comparable figures for the three preceding years : 27  May Treatment November Treatment 1953 1954 1955 1956 1953 1954 1955 1956 Manholes baited 195 166 186 188 205 172 193 191 Manholes in which takes of prebait were recorded 66 65 56 67 73 53 57 75 Percentage of manholes showing infestations 33.8 39.1 30.1 35.6 35.6 30.8 29.5 39.3 Percentage in relation to total manholes in district 5.8 5.7 4.9 5.9 6.4 4.7 5.0 6.6 Swimming Baths The only swimming bath in the district is in the ownership of the Council who acquired it in 1953. Since that time considerable modifications have been effected for improving the hygienic standard both of the premises and the bath water. User is carefully controlled and kept within the capacity of the purification plant. Eight samples of the bath water taken during the year all proved to be satisfactory. Offices Twenty-eight inspections 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 777 543 1,320 92 without „ „ 30 17 47 17 Workplaces— with mechanical power 30 – 30 29 without „ „ 21 22 43 23 858 582 1,440 161 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 Public Health Inspectors). 28 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 17 80 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 92 295 14 — (iii) Other premises in which Section 7 is enforced by the Local Authority* (excluding outworkers' premises) 6 8 — — Total 115 383 14 — * 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) ] Want of cleanliness 1 2 — — — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation — — — — — Defective drainage of floors — — — — — Sanitary Conveniences— (a) Insufficient — 1 — — — (b) Unsuitable or defective 13 9 — — — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) — — — — — Total 14 12 — — — 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 (2) (3) (4) (5) (6) (7) Wearing Apparel— Making, etc. 30 — — — — — Boxes (cardboard) 3 — — — — — Brass and brass articles 6 — — — — — Christmas Crackers .. 1 — — — — — Lampshades 6 — — — — — Umbrellas 1 — — — — — Total 47 — — — — — Employment Agencies There are two employment agencies in the district. Both were visited and found to be satisfactory. Shops Act, 1950 There are 518 shop premises on the register and 2,966 inspections were made during the year. Preliminary notices were served with regard to nine infringements of the statutory requirements, six for failure to exhibit appropriate notices, one for Sunday Trading and two for sanitary accommodation. All but one notice has been complied with. Heating Appliances (Fireguards) Regulations, 1953 Thirty-one inspections were made under the Act and several tests made. Three electric fires were tested and two 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 An additional licence was granted in respect of Pet Shops bringing the total to six. All deal mostly in fish and birds. They were inspected and found to be conducted satisfactorily. 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 coir fibre was submitted for analysis and complied with the Regulations. The prescribed Analysts are—The Chiltern Laboratories, Ltd., of Station Road, Marlow, Bucks. Establishments for Massage and Special Treatment The number of establishments licensed under Part IV of the Surrey County Council Act, 1931 remained the same at six. Four of these are used for the practice of chiropody and two for massage etc. All were found on inspection to be conducted satisfactorily. National Assistance Acts, 1948—Section 47 National Assistance (Amendment) Act, 1951 These provisions give authority, with the consent of the Court, to remove persons in need of care and attention to hospital or other place such as a residential institution. One essential condition for such action is that the person to be moved shall be living in insanitary conditions and that removal is in the interests of such person or for preventing injury to the health of, or serious nuisance to, other persons. Instances of this nature have occurred from time to time in the past and have arisen primarily from a lack of appropriate institutional accommodation for old and infirm people and less from an unwillingness of neglected old people to accept such help. It was not necessary to apply to the Court for an order under the Acts during 1956. Section 50 The occasion did not arise which would have made it necessary for the Council to arrange for the burial of a person where "no other suitable arrangements have been or are being made." Disposal of the Dead Burial accommodation is provided by the Carshalton and Merton and Morden Joint Cemetery Board on some sixty acres of land in Lower Morden where 171 residents of this district were interred during the year. No unused burial accommodation is available in Carshalton churchyard, interment there now being only by the re-opening of existing graves. 31 The prolonged negotiations between the Battersea Metropolitan Borough Council, the Sutton and Cheam Borough Council and the Urban District Councils of Carshalton and Merton & Morden came to fruition on the 5th July, 1956, when the North-East Surrey Crematorium Board Act, 1956, received the Royal Assent. The Appointed Day was the 1st October, 1956. The Act constituted the Joint Board comprising representatives of the four Authorities and authorised the Board to provide and maintain a Crematorium. In pursuance of the agreement previously reached between the Authorities, the Board acquired two pieces of land forming part of the Battersea Council's cemetery situate at Morden and have initiated the necessary procedure for the conversion of the existing Chapel thereon into a Crematorium. The Council's mortuary in Mill Lane which is fully equipped for postmortem examination, received 127 bodies in 1956 on all of which autopsies were performed. Of the total, 45 were admitted from other districts. 32 Section D—Housing New Houses During the year 33 new dwellings were completed all in private ownership. The following buildings were in course of erection at the end of the year : Private dwellings 35 Council Flats 6 Council Maisonnettes 26 Schemes in various stages of preparation were as follows: Site No. Site Type of Dwelling No. in Contract 13 Nightingale Road Bungalows, Flat and Meeting Room (for aged people) 16 31 Stanley Road Flats & Maisonnettes 38 36 Culvers House Flats 40 37 Denmark Road Flats 34 38 Denmark Road Flats 48 Council's Housing Scheme The dwellings in the ownership of the Council at the year end were as follows: Pre-War Houses 598 Post-War Houses 618 Temporary Bungalows 102 Houses taken over under S.D.A.A. 33 Houses purchased (units of accommodation) 43 Accommodation in Parks, Offices, etc. 18 1,412 The number of requisitioned premises at the 31st December, 1956 was 65 providing accommodation for 110 families. This is 25 less properties under requisition than at 12 months earlier. The outstanding approved applications for tenancies at the year end totalled 1,126, which was 111 less than a year before. 33 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.—252 P.H.A.—3,683 3,935 (b) Number of inspections made for the purpose 6,398 (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 240 2. Remedy of defects during the year without service of formal notices. Number of defective dwelling houses rendered fit in consequence of informal action by local authority or their officers (including houses inspected during 1955) 183 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 33 (2) Number of dwelling houses in which defects were remedied after service of formal notices: (a) By Owners 21 (b) By Local Authority 19 34 4. Housing Act, 1936. Part IV (Overcrowding). (a) (I) Number of dwelling houses overcrowded at the end of the year 63 (2) Number of families dwelling therein 106 (3) Equivalent number of adults dwelling therein 439½ (b) Number of new cases reported during the year 27 (c) (I) Number of cases of overcrowding relieved during the year 37 (2) Number of persons concerned in such cases 266 (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 27 cases of overcrowding were found and 37 cases were remedied leaving 63 dwellings with 439½ equivalent adults in occupation still overcrowded at the year end. The known position in respect of statutory overcrowding at the beginning and end of the year was as follows: Ward Dwellings overcrowded at 31/12/55 Dwellings found overcrowded during 1956 Dwellings decrowded during 1956 Dwellings remaining overcrowded at 31/12/56 Overcrowded cases remedied during 1956 Formal Action Informal Action Total St. Helier North 24 11 10 25 3 7 10 St. Helier South 17 3 10 10 6 4 10 St. Helier West 15 8 10 13 4 6 10 North-East 7 — 3 4 — 3 3 North-West 3 — — 3 — — — Central 5 2 2 5 — 2 2 South-West — 1 — 1 — — — South-East 2 2 2 2 2 — 2 73 27 37 63 15 22 37 As mentioned in previous reports, these figures are based on the information which reaches the department in the course of daily work. For obvious reasons, short of a complete house to house survey, an exact computation of the extent of overcrowding is not possible since there is no machinery whereby every new case of overcrowding and every instance of abatement is reported. As however no new factors have been introduced affecting the sources of information, a comparison with other years has some value in assessing the trend of overcrowding. The new cases coming to notice in each of the last 10 years and the known instances of overcrowding at the end of each of those years were as follows: 35 Year New Cases Cases at Year End Year New Cases at Year End 1947 122 274 1952 79 123 1948 107 289 1953 53 112 1949 160 221 1954 49 105 1950 75 209 1955 26 73 1951 54 217 1956 27 63 In all the twenty-seven new instances of overcrowding, families were found be be sharing accommodation with relatives. Abatement was effected in the following ways: Provision of alternative accommodation by: Carshalton U.D.C. 2 London County Council 6 Other Local Authorities 7 Left the district 1 Removal of one or more occupants 21 Of the 63 dwellings remaining overcrowded at the end of the year, 48 are owned by the London County Council, 2 by the Carshalton Council and 13 are privately owned. Slum Clearance and Demolition A tender was approved towards the end of the year for the erection of the first block of maisonnettes and flats in Stanley Road to rehouse the persons to be displaced from Clearance Area No. 7 referred to in previous reports. Work commenced on this project early in 1957. The Ministry inquiry into the order in respect of Clearance Area No. 8 involving 31 houses in the Mill Lane area had not been held by the end of the year. A phased programme was devised towards the end of 1955 for dealing with approximately 200 properties which were or were likely to become unfit during the succeeding five years. It was recognised that progress would be largely dependent on securing an adequate site on which the early groups of persons to be displaced could be rehoused. The fear that such a site might not be readily available proved to be well founded and this difficulty has not yet been resolved. Housing Repairs and Rents Act, 1954 During the year one application for a certificate of disrepair under " Section 26 was received but not granted. One certificate was revoked. Since the passing of the Act in August, 1954, six certificates of disrepair in all have been granted and in due course revoked upon completion of the necessary work. 36 Section E—Inspection and Supervision of Food. Food and Drugs Act, 1955 This Act which came into force on the 1st July, 1956 consolidates the Food and Drugs Act, 1938, the Food and Drugs (Milk Dairies & Artificial Cream) Act, 1950 and the Food and Drugs Amendment Act, 1954, together with certain other enactments amending and supplementing Part V of the 1938 Act in relation to slaughterhouses and knackers yards. An important provision is the power conferred on the Ministries to make Regulations dealing with different aspects of food. The urgent need for an effective code of practice in the handling, manufacture and storage of food was no doubt responsible for the early appearance of the Food Hygiene Regulations, 1955 which came into operation simultaneously with the consolidating Act. These regulations are now the chief means of controlling the conditions under which food is sold, imported, prepared, transported, stored, purchased, delivered and served. 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 Milk Distributors registered is 19. Designated licences issued during the year were as follows: Designation Number of Distributors Holding Licences No. of Licences in force on 31/12/56 Principal Licences— Sterilised 14 17 Pasteurised 6 9 Tuberculin Tested 5 8 Supplementary Licences— Sterilised 8 12 Pasteurised 6 10 Tuberculin Tested 6 10 Bacteriological Examination of Milk. Two hundred and fourteen samples of milk were procured and submitted for bacteriological examination. All the milks were sold under the Milk (Special Designations) Regulations and three failed to comply with the prescribed Regulations. Classification of the milk samples and the results of the tests are as follows: 37 Designation under which sold No. of samples Methylene Blue Test Phosphatase Test Turbidity Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised 161 160 1 160 1 — — T.T. Pasteurised 45 44 1 45 — — — Sterilised 8 — — — — 8 — 214 204 2 205 1 8 — Biological Samples. Raw milk produced on the 3 farms in the district is submitted to animal inoculation test before being treated in any way. Twelve such examinations were made in the year and all were reported to be free from tuberculosis infection. Milk and Dairies Regulations, 1949—Regulation 20. No action was called for under this section which empowers the Medical Officer of Health to deal with milk which he has reason to believe might be a source of infection to man. Qualitative Analysis. The number of milk samples submitted to the Public Analyst was 211. One, a sample of "Channel Islands" milk, was found to be adulterated or otherwise irregular. Of the total samples, 28 were Channel Islands or South Devon milks which when sold under these designations must contain 4% fat as against the legal limit of 3% for milk not so designated. The average fat and non fatty solids content of the 28 samples of Channel Islands milk was 4.32% and 9.00% respectively. That for the other 183 samples of milk 3.61% and 8.72%. Ice Cream Since 1947 ice cream samples submitted for bacteriological examination have been classified into four grades. These are based on the length of time the samples take to reduce methylene blue. The grades in the order of descending hygienic standard are Grade I taking 4½ hours or more, Grade II taking 2½ to 4 hours, Grade III taking ½ to 2 hours and Grade IV, the poorest standard, reducing methylene blue immediately. The view is held that over at least a six monthly period, 50% of a vendor's samples should fall into Grade I, 80% in Grades I & II, not more than 20% in Grade III and none in Grade IV. The reason for this is that owing to the numerous factors governing the hygienic quality of ice cream, it is unwise to pay too much attention to the results of any single sample. From the table which follows it will be seen that judged by this standard there has been a progressive improvement in the purity of ice cream sold in the district to the point last year where only 1 out of 96 samples failed to reach the highest grade and that one was in Grade II. 38 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 — — 1956 96 95 1 — — Nine 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, 1947-52. There are no manufacturers of Ice Cream in the district, all the registered retailers drawing their supplies from reputed manufacturers outside the district. All retailers are provided with refrigerator cabinets which maintain a temperature well below 28°F. in accordance with the regulations. Meat All meat sold by retail is supplied from 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 2,546 lbs. Analyses of Food and Drugs The following 317 samples of food and drugs were submitted to the Public Analyst with the results indicated: 39 Article No. Adulterated or otherwise irregular Article No. Aldulterated or otherwise irregular Almonds, Ground 3 Indigestion Tablets 1 Almond Marzipan 1 I-So-Gel 1 Apple Pie 1 Lemon Curd 1 Beans in Tomato Sauce 1 Lemon Juice 1 Biscuits 1 Lemonade Powder 1 Blackcurrant Cordial 1 Lobster Fish Paste 1 Blackcurrant Juice 1 Margarine 1 Black Pudding 1 Marmalade 1 Bread 1 Meat Paste 1 Breadcrumbs 1 Meat Pie 1 Broth 1 Meringues 1 Butter 1 Milk 211 1 Caffeine Tablets 1 Minced Beef 1 Cake Mix 1 Mincemeat 1 Cereal 1 Mineral Water 1 Chewing Gum 1 Mint in Vinegar 1 Chicken, Devilled 1 Nut Oil 1 Christmas Pudding 1 Oatmeal 1 Cleaned Currants 1 1 Orange Drink 1 Cleaned Mixed Fruit 1 1 Peas, Garden 1 Cleaned Raisins 1 1 Pepper, White 1 Cockles in Malt Vinegar 1 Peppermint Cordial 1 Cocktail Drink 1 Pineapple Pieces 1 Coffee & Chicory 1 Pork Luncheon Meat & Egg 1 Condensed Milk 1 Confectionery Sugar 10 Quinine Tablets 1 Cooking Fat 1 Rice, Flaked 1 Cold Capsules 1 Sausage, Beef 1 Cordial 1 Sausage, Pork 1 Cough Syrup 1 Sausage, Liver 1 Crab 1 Spice, Mixed Ground 1 Creamed Rice 1 Sponge Pudding 1 Demerara Sugar 1 Steak, Stewed 1 Fish Cakes 1 Steak & Kidney Pudding 1 Fish Fingers 1 Stout 1 Food Colouring, 1 Stuffing, Sage & Onion 1 Artificial 1 Stuffing 1 Glucose. 1 Tapioca.. 1 Ginger, Ground 1 Tea 1 Haliborange Tablets 1 Vinegar 1 Horlicks 1 Vitamin Pellets 1 Ice Cream 9 Yeast Tablets 1 Icing Sugar 1 Yoghurt 1 The following four samples were reported upon unfavourably : "Channel Islands" Milk. This sample contained 3.88% fat as against the 4% required by the Regulations. Legal proceedings were instituted and the vendor who pleaded guilty was fined £5 with 5 guineas costs. Cleaned Currants. Cleaned Mixed Fruit. Cleaned Seedless Raisins. 40 These three samples all the product of the same Packer were found to contain sand and other earthy matter to the extent of 0.07%, 0.20% and 0.02% respectively. There is no statutory standard, but the Public Analyst expressed the view that cleaned dried fruit should not contain more than 0.01% of grit and earthy matter. The Packer undertook to withdraw where possible all existing stocks and to subject future supplies to double cleaning. Section 9—Sale of Unfit Food for Human Consumption Complaints were received of alleged foreign matter in the following foodstuffs: Dirt in bread (2) Dark substance in bread (3) Screw in bread Nail in butter Mould on cake Dirty milk bottle (2) Toy in milk Mould on apricot pie Wood in sausage The circumstances did not justify legal proceedings, but appropriate warnings were given where they were deemed necessary. Inspection of Food The following quantities of food found to be unsound, diseased or unwholesome and unfit for human food were surrendered and destroyed or so disposed of as to prevent them from being used for human food : lbs. ozs. lbs. ozs. Baby Food — 15 Fruit Juice 16 14 Butter 25 — Jam 29 — Cake 1 — Meat 2,546 — Cheese 51 6 Milk 112 10 Cream 4 10 Rice — 15 Fish 307 6 Soup 78 5 Fruit 278 14 Spaghetti Vegetables 5 470 8 Total weight 1 ton, 15 cwts., 8 lbs., 7 ozs. The method of disposal is by burning in the Council's Refuse Destructor. Inspection of Food Premises Action taken as a result of visits of inspection to food premises is shewn in Table 9. 41 42 TABLE 9. INSPECTION OF FOOD PREMISES AND ACTION TAKEN. Nature of Business Number of premises Number of premises registered under Section 16 of Food & Drugs Act Number of inspections made Sanitary accommodation Food storage and preparation rooms Accumulations removed Repaired Cleansed and/or decorated Lighting provided Ventilation provided Wash-basins provided Water supply provided Wash your Hands Notices Repaired Cleansed and/or decorated Lighting provided Washing facilities for food and equipment provided First-aid equipment provided Accommodation for clothing provided Bakers and Confectioners 15 4 79 — — — — 2 3 — — — — — 2 — — Bakehouses 3 — 69 1 1 — — — — — 2 2 — — — 1 — Butchers 36 30 170 — 1 2 — 3 7 — 3 2 — 7 2 6 1 Canteens 21 — 88 — — — — — — — — — — — — — — Chemists 17 1 42 — — — — — — — — — — — — — — Cinemas 1 — 2 — — — — — — — — — — — — — — Confectioners (sweets only) 68 54 141 — — 1 — — 1 — — — — 2 5 4 — Fishmongers 19 8 93 — 2 2 1 1 3 — 1 — — 1 3 1 — General Stores 3 1 68 — — — — — — — — — — — — — — Greengrocers and Fruiterers 39 5 160 1 — 1 — 1 — — 1 5 — 5 6 5 1 Grocers (incl. corn chandlers) 78 25 301 3 4 — — 4 6 — 1 7 1 9 5 8 — Ice Cream vehicles variable — 16 — — — — — — — — — — — — — — Licensed Premises (with catering facilities) 5 1 15 — — — — 1 1 — 1 1 — 1 1 — — Licensed Premises (without catering facilities) 20 — 31 — — — 1 1 1 — — — — — — — — Restaurants and Cafes 26 17 122 — — — — 1 3 — — 3 1 — 3 2 1 Stalls, food variable — 144 — — — — — — — — — — — — — — Vehicles, food variable — 28 — — — — — — — — — — — — — — 146 1,569 5 8 6 2 14 25 — 9 20 2 25 27 27 3 Section F—Prevalence of and Control over Infectious and other Diseases. The district has within its boundaries three General Hospitals two of which, namely Queen Mary's Hospital for Children and the St. Helier Hospital, are particularly large institutions which are part of the hospital services of the South-West Metropolitan Hospital Region. Many of the cases notified from these hospitals are admitted there from other districts already suffering from a notifiable disease, but not diagnosed until after admission. In order, therefore, to give a clearer picture of the prevalence of infectious disease in the resident population of the district, separate figures are given in this Section which exclude cases of hospital patients who are not residents of the district. The figures given are after correction for original errors in diagnosis. Notification The following diseases are notifiable in the district: Smallpox Cholera Diphtheria Membranous Croup Erysipelas Scarlatina or Scarlet Fever Measles Whooping Cough Tuberculosis Dysentery Acute Primary Pneumonia Acute Influenzal Pneumonia Acute Poliomyelitis Acute Polioencephalitis Typhus Fever Typhoid Fever Enteric Fever Relapsing or Continued Fever Meningococcal Infection Ophthalmia Neonatorum Puerperal Pyrexia Malaria Food Poisoning Leprosy Smallpox Variola infection is now a comparatively rare event in this country. Outbreaks when they do occur are invariably the result of infection imported from abroad. No cases occurred in this district during the year nor was there occasion to supervise any contacts of cases occurring elsewhere. Vaccination. The County Council is responsible for the scheme of vaccination against smallpox under section 26 of the National Health Service Act, 1948. The arrangements locally are, however, with the agreement of the District Councils directed by the District Medical Officers of Health. This protective treatment is available as a free service at the infant welfare and school clinics. It can also be secured from doctors providing general practitioner services under the Act. The main object of the scheme is to secure primary vaccination during infancy. This not only confers a measure of immunity at as early an age as possible, but avoids the risks of more severe reaction which are associated with vaccination when first performed in later life. 43 The vaccinal state of the total population is not known with any degree of accuracy, but reasonably accurate records are available in respect of children under five years of age. At the end of 1956, 49% of the children in this age group had been vaccinated. This figure has risen steadily from 25% in 1948 when the arrangements were transferred from the public vaccinators and became part of the present health services provided under Part III of the National Health Service Act. It is now at its highest level since 1948. The number of persons recorded as having received successful vaccination during the year was as follows: Age at 31st December, 1956 Under 1 yr 1-4 yrs 5-14 yrs 15 yrs & over Total Primary Vaccinations— By Private Practitioners 64 85 19 36 204 At Clinics 149 121 1 — 271 213 206 20 36 475 Revaccinalions— By Private Practitioners — 1 13 71 85 At Clinics — 2 I — 3 — 3 14 71 88 In addition, the following unsuccessful attempts at vaccination were made: Age at 31st December, 1956 Under 1 yr 1-4 yrs 5-14 yrs 15 yrs & over Total Primary — 7 7 4 18 Revaccination — — 1 11 12 — 7 8 15 30 The estimated number of children under five years of age vaccinated at the end of 1956, was 1,700. Enteric Fever There were no cases of typhoid or paratyphoid fever. Dysentery No significant outbreak of dysentery occurred in 1956, such as has been experienced from time to time in years past. Control of the dissemination of intestinal infection of this nature is largely a matter of personal hygiene, since it is readily conveyed by infected hands to food and thus from one member of the family to another. With improving standards of domestic hygiene particularly in the handling of food, outbreaks of dysentery, as with all food-borne infection, should become less frequent and less extensive. Fifteen cases occurred in 1956 of which 14 were confirmed bacteriologically as due to the Sonne organism. Eleven occurred in January and affected four families, the remaining four occurred in March (1), 44 July (1) and October (2). The relative mildness of this infection is reflected in the fact that only 9 of the 15 cases were notified by practitioners, the remaining 6 coming to notice in other ways. Scarlet Fever The changing nature of this infection is evidenced by the experience of this disease in the past years. For a number of years, scarlet fever has become progressively milder in character and attended by a much lower degree of morbidity and mortality. At the beginning of the century, cases of septic scarlet fever were not uncommon and resulted in not a few deaths. Today the illness mostly runs a mild course and complications are rare. For these reasons the precautions which are advised for patients and contacts have been markedly relaxed. Schoolchildren are now allowed to return to school after only three weeks in uncomplicated cases and there is no automatic exclusion from school of the domestic contacts. Whilst this relaxation of restriction is entirely justified by the altered conditions, it should be remembered that scarlet fever is still an infectious illness and precautions are still of value in limiting the spread of the infection. The number of notifications received during the year at 27 was by far the lowest yet recorded and is less than half of the previous year's total which itself was a record low figure at that time. Whilst there is no doubt that this represents a true reduction in incidence there is some evidence that because of the mildness of the clinical illness a number of cases failed to be notified. Of the total, 19 were nursed at home and 8 were admitted to isolation hospital. TABLE 10. SCARLET FEVER—DISTRIBUTION OF CASES, 1956. 1956 Ward  St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest January — — — — — — 1 2 3 February — — — — 2 — 2 2 6 March — 2 — — — 1 — — 3 April — 1 2 — — — — 2 5 May 1 — — — — — 1 1 3 June — — — — 1 — — — 1 July — — 1 — 1 — — — 2 August — — — — 1 — — — 1 September — — 1 — — — — — 1 October — — — 1 — — 1 — 2 November — — — — — — — — — December — — — — — — — — — Totals 1 3 4 1 5 1 5 7 27 Monthly mean 0.08 0.25 0.33 0.08 0.41 0.08 0.41 0.58 2.25 Case rate per 1,000 population 0.11 0.43 0.50 0.10 0.68 0.17 0.62 1.05 0.44 45 TABLE 11. SCARLET FEVER—MULTIPLE CASES, 1956. Ward No. of houses in which occurred Total Houses Total Cases 1 Case 2 Cases 3 Cases 4 Cases St. Helier North 1 — — — 1 1 St. Helier South 3 — — — 3 3 St. Helier West 4 — — — 4 4 North-East 1 — — — 1 1 North-West 5 — — — 5 5 Central 1 — — — 1 1 South-East 3 1 — — 4 5 South-West 5 1 — — 6 7 Whole District 23 2 — — 25 27 Diphtheria The absence of this infection continued for a further year, the seventh in succession. Diphtheria Immunisation. Owing to the continued freedom from this disease some concern has been felt in recent years for the maintenance of the necessary level of immunity in the local population conferred by the diphtheria immunisation scheme. The fact that we have had no cases for seven years does not guarantee continued freedom. Only with a satisfactory level of yearly acceptance of this protective treatment can we hope to enjoy the continuation of such freedom. It might have been expected that deflection of attention to the newly instituted scheme of vaccination against poliomyelitis would have prejudiced the acceptance rate for diphtheria immunisation. Actually it appeared to focus public interest on the value of immunisation procedures generally and the anti-diphtheria scheme received an indirect fillip. The arrangements for this prophylactic treatment are the responsibility of the County Council under Section 28 of the National Health Service Act, but with the agreement of the District Councils it is arranged in each sanitary district like smallpox vaccination, by the local Medical Officer of Health. Treatment is offered before the age of twelve months at the Infant Welfare Clinics. It can be had also by doctors providing general practitioner services under the Act. Reinforcing injection is offered as a routine to the children in the primary schools. By reason of the fact that the treatment is given actually in the school, a very satisfactory response to reinforcement is secured as no special clinic attendance is involved. During 1956, 977 resident children received a primary course of treatment as follows: 46 [Age at 31/12/56 Under 1 year 1 year 2 years 3 years 4 years 5-9 years 10-14 years Total At Council Clinics 122 307 54 17 13 10 – 523 In Carshalton Schools – – – 5 14 225 25 269 Private Practitioners 24 151 26 6 8 6 – 221 Less outward transfers 146 458 80 28 35 241 25 1013 – – – – 2 34 8 44 Plus inward transfers 146 458 80 28 33 207 17 969 – – – – – 6 2 8 Carshalton residents 146 458 80 28 33 213 19 977 A further 1,917 Carshalton children received reinforcing injections during the year. The immunisation state of the local child population at 31st December, 1956, was as follows: Number of Children at 31st December, 1956, who had completed a course of immunisation at any time before that date (i.e. at any time since 1/1/42). Age at 31/12/56 i.e. Born in Year Under 1 1956 1-4 1952-1955 5-9 1947-1951 10-14 1942-1946 Under 15 Total A. No. of children whose last course (primary or booster) was completed in the period 1952-1956 146 2,058 3,508 2,540 8,252 B. No. of children whose last course (primary or booster) was completed in the period 1951 or earlier – – 513 1,097 1,610 C. Estimated mid-year child population 750 3,075 9,160 12,985 Immunity Index 100 A/C 19.4 66.9 66.0 63.5 The percentage of children under fifteen years of age immunised within the previous five years was slightly higher than a year before at 63.5%. A further 12.4% immunised more than five years previously would have some lesser degree of residual 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 1956 57 84(66*) 76(64*) 0 0.00 (* Immunised within the last 5 years) Erysipelas Only two cases of erysipelas were notified, one an infection of the face the other of the leg. Both recovered. This is the lowest recorded annual incidence in the district. Pneumonia Of 41 cases notified 10 were stated to be of influenzal origin, a reflection of the fact that no serious influenza epidemics occurred during the year. Three-quarters of the total cases occurred in the first three months of the year. Measles The year 1955 had the highest recorded incidence of measles since notification began in 1939. True to the epidemiological pattern of this infection in the London area, this was followed in 1956 by a year of relatively low prevalence. A total of 326 cases was notified compared with 1,130 in the year before. As is usual when incidence is low, there was no marked wave, cases being spread irregularly over the whole twelve months. 48 TABLE 12. MEASLES—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1956. (Excluding hospital patients non-resident in Carshaltonl 1956 Ward Total St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest January – – – – – 1 – – 1 February – – – 2 – – – – 2 March 23 – – – 1 – – – 24 April 10 1 – 3 – – 1 – 15 May – – – 1 – – 1 – 2 June – 1 – – 7 – 1 – 9 July 1 28 1 9 23 6 – 3 71 August – 9 1 11 13 2 – – 36 September 1 – – 6 – 1 – – 8 October – – 1 2 – – – – 3 November – – – 37 34 36 1 – 108 December – 1 2 17 10 12 5 – 47 Totals 35 40 5 88 88 58 9 3 326 Monthly Mean 2.91 3.33 0.41 7.33 7.33 4.83 0.75 0.25 27.16 Case rate per 1,000 population 4.13 5.74 0.63 9.0 11.9 9.8 1.1 0.4 5.3 Whooping Cough There is little doubt that the practice of immunisation is now having a definite effect on the prevalence of this disease. Although the same near total success cannot be claimed for this technique in the case of whooping cough as it can in the case of diphtheria, a considerable degree of protection can be conferred by the whooping cough vaccines now in use. Even where infection cannot be completely prevented the ensuing attack in the immunised is invariably mild and attended by little risk. Cases notified fell further last year to 73 which again is a new record low for this disease. They occurred in two small waves, one in the spring and the other in the autumn. There were no deaths. The practice of whooping cough immunisation available under the County Council's scheme has been increasing steadily in recent years and now approaches the level reached by that in respect of diphtheria. It is now in the region of 60%, much the best so far. 49 TABLE 13. WHOOPING COUGH—WARD INCIDENCE AND MONTHLY DISTR1RUTION, 1956. (Excluding hospital patients non-resident in Carshalton) 1956 Ward Total St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast SouthWest January – – – – – – – – 8 February 1 3 – – 4 – – – March 1 5 3 2 5 – – 1 17 April – 14 2 – 2 – – – 18 May – 2 – 2 4 1 – – 9 June – 1 1 – – – – – 2 July – – – – – – – – – August – – 1 – – – – – 1 10 September 1 – 1 3 – 2 2 1 October 1 – 2 1 – – 2 – 6 November 1 – – – – – – – 1 1 December – – 1 – – – – – Totals 5 25 11 8 15 3 4 2 73 Monthly Mean 0.41 2.08 0.91 0.66 1.25 0.25 0.33 0.16 6.08 Case rate per 1,000 population 0.58 3.59 1.39 0.81 2.04 0.51 0.42 0.30 1.19 Meningococcal Infection Three cases of meningococcal meningitis were notified. Two were babies one of one year eight months, one of three years and the third an adult woman of 59. Only an occasional single case has occurred in the last eight years, one in each of the years 1955, 1953, 1950 and 1948, so that the occurrence of three cases must be taken as an indication that the infection was slightly more widely spread in the population in 1956. Fortunately the use of the sulpha drugs and anti-biotics has transformed the treatment of what used to be a highly fatal disease. All three patients made an uninterrupted and complete recovery as a result of this modern therapy. Poliomyelitis Poliomyelitis was more prevalent than at any time since the major epidemic of 1947. Fourteen cases were notified of which four were accompanied by some degree of paralysis and one died. Details were as follows : 50 Sex Age Date of Onset Resultant disability in June, 1957 M 32 29th Jan. Bulbar paralysis—died F 6 21st June Non paralytic—no disability F 6 4th July „ „ „ „ M 10 6th July „ „ „ „ F 18 25th July „ „ „ „ M 23 4th Aug. „ „ „ „ F 17 13th Aug. „ „ „ „ M 5 13th Sept. Made good recovery from weakness of shoulder F 5 27th Sept. Non paralytic—no disability F 6 28th Sept. „ „ „ „ M 8 1st Oct. „ „ „ „ F 4 16th Oct. Weakness of left arm—still in hospital M 7 17th Oct. Non paralytic—no disability F 26 14th Dec. Weakness of right arm and leg The Ministry's scheme of vaccination against poliomyelitis began in May, 1956. The process consists of two intra-muscular injections of vaccine at not less than three weeks interval. Owing to the limited rate at which vaccine could be produced in the early stages, treatment was offered first to the children born in the years 1947-1954. By the time the lists were closed in April, 2,494 children had been registered for this treatment out of an estimated total in these age groups of 6,600—an acceptance rate of approximately 40%. Special clinics were instituted where the inoculations were given. They commenced in May and were suspended from the end of June until November when a few children who had previously received only one injection were given their second. By the end of the year 304 children had received the two injections and eleven had received one. Ophthalmia Neonatorum As in the year before no case of inflammation of the eyes in the newborn was notified in 1956. Puerperal Pyrexia For reasons given in previous reports a considerable number of notifications are received annually of instances of rise of temperature in lying-in women. The majority of these notifications are furnished by the St. Helier Hospital whose maternity service caters for a large part of Metropolitan Surrey. During the year under review 173 cases were notified of which 35 were Carshalton mothers. As the number of births which took place in the district was 2,303, the incidence of puerperal pyrexia was 75.1 per 1,000 related births. There were no deaths. Food Poisoning It is encouraging to report that there was no significant outbreak of food poisoning. The six cases reported were all isolated single cases except two who were members of one family. Three patients were infected with S. typhimurium and were the only ones in the three households affected. The vehicle in which the infection was conveyed was not identified. No bacterial agent was isolated from the fourth single case the diagnosis resting on clinical evidence. The two sufferers in the same family were husband and wife who commenced their illness on their return journey from Italy where they were undoubtedly infected. No organism was isolated from either of them and their illness was probably of the toxin type. All recovered. 51 52 TABLE 14. CASES OF NOTIFIABLE INFECTIOUS DISEASE ADMITTED TO HOSPITAL, 1956. Disease Western War Memorial Cuddington Wandle Valley Queen Mary's St. Helier Totals Scarlet Fever – – 7 1 – – 8 Dysentery – – – – 1 – 1 Measles – – 2 2 – – 4 Food Poisoning – – 1 – – 1 2 Meningococcal Infection – – – – 1 2 3 Pneumonia – 1 – – – 2 3 Poliomyelitis, Non-Paralytic – – – – 5 4 9 Poliomyelitis Paralytic 1 – 1 – 2 – 4 Totals 1 1 11 3 9 9 34 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 27 0.44 – 1 3 4 1 5 1 5 7 8 29 Erysipelas 2 0.03 – – – 1 – – – – 1 – — Measles 326 5.34 – 35 40 5 88 88 58 9 3 4 1.22 Whooping Cough 73 1.19 – 5 25 11 8 15 3 4 2 – — Dysentery 15 0.24 – 11 – – 1 – 2 – 1 1 6.66 Pneumonia 42 0.68 – 5 6 13 10 1 3 2 2 3 7.14 Poliomyelitis, Non-Paralytic 10 0.16 – 2 3 2 – – – 3 – 9 90 Poliomyelitis, Paralytic 4 0.06 1 – 1 – 1 1 – 1 – 4 100 Meningococcal Infection 3 0.04 – – – 1 1 1 – – – 3 100 Puerperal Pyrexia 35 0.57 – 9 4 3 10 1 2 4 2 34 97 Food Poisoning 6 0.09 – 1 1 – – – 1 – 3 2 33 54 TABLE 16. INFECTIOUS DISEASES—Notification by Age Groups, 1956. (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 15 5 3 1 – – – 27 Erysipelas – – – – – – – – – – 2 – 2 Measles 6 22 24 35 46 186 7 – – – – – 326 Whooping Cough 1 3 7 6 10 40 4 – 2 – – – 73 Dysentery – – – 2 – 11 – – 2 – – – 15 Pneumonia 2 – 3 – – 2 – 1 5 5 14 10 42 Poliomyelitis, Non-Paralytic – – – – 1 5 1 2 1 – – – 10 Poliomyelitis, Paralytic – – – – 1 1 – – 2 – – – 4 Meningococcal Infection – 1 – 1 – – – – – – 1 – 3 Puerperal Pyrexia – – – – – – – 3 26 6 – – 35 Food Poisoning –– – – – – 2 – – 3 1 – – 6 55 TABLE 17. MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1956. (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 3 5 3 1 2 1 1 2 — — 27 Erysipelas 1 – 1 – – – – – – – – – 2 Measles 1 2 24 15 2 9 71 36 8 3 108 47 326 Whooping Cough – 8 17 18 9 2 Personal 1 10 6 1 1 73 Dysentery 8 3 — 1 – – 1 — – – 2 — 15 Pneumonia 10 14 7 4 3 1 – – – – 1 2 42 Poliomyelitis, Non-Paralytic – – – – – – 3 3 – 4 – — 10 Poliomyelitis, Paralytic – 1 – – – – – – 1 1 – 1 4 Meningococcal Infection – 1 – – – 1 – – – 1 – — 3 Puerperal Pyrexia 3 4 3 5 – 1 3 2 3 2 7 2 35 Food Poisoning –— – – 1 – – – 2 2 —– 1 — 6 Tuberculosis, Pulmonary 2 5 3 7 2 – 6 1 1 2 4 2 35 Tuberculosis, Non-Pulmonary – 1 – – – – 1 - 2 Tuberculosis The new cases admitted to the tuberculosis register during the year numbered 69, classified as follows : Males Females Pulmonary 33 Pulmonary 32 Non-pulmonary 1 Non-pulmonary 3 Of the total additions, 37 were primary notifications, 30 were transferred from other districts and 2 came to notice in other ways. In the same period, 112 names were removed from the register for the following reasons : Recovered 20 Death 17 Otherwise (including removals) 75 After allowing for the additions and deductions, the state of the register at the 31st December, 1956, was as shewn in the following table : TUBERCULOSIS—WARD DISTRIBUTION. Cases on Register at 31st December, 1956. Ward Pulmonary Non-Pulmonary Total Incidence per 1,000 population Males Females Males Females St. Helier North 71 77 10 8 166 19.6 St. Helier South 64 54 6 8 132 18.9 St. Helier West 51 69 6 10 136 17.1 North-East 60 69 7 3 139 14.2 North-West 28 27 – 3 58 7.7 Central 31 25 2 2 60 10.2 South-East 41 32 1 4 78 9.7 South-West 25 19 – 1 45 6.7 Whole District 371 372 32 39 814 13.2 743 71 The total of 814 is 43 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 93. 56 The number of tuberculous persons who died during the year was 17, distributed by age groups as follows : Age, Years Pulmonary Non-Pulmonary Total Males Females Males Females 0 – – – – – 1—5 – – – – – 5—15 – – – – – 15—25 – – – – – 25—35 1 – – – 1 35—45 1 1 – – 2 45—55 1 – – 1 2 55—65 3 1 1 5 65—up 5 2 – – 7 Totals 11 3 1 2 17 The deaths attributable to tuberculosis were 8, as follows : DEATHS DUE TO TUBERCULOSIS, 1956. Ward Pulmonary Non-Pulmonary Death Rate per 1,000 population Mean age at Death Male Female Male Female St. Helier North 1 – – – 0.12 26 St. Helier South 1 – – – 0.14 56 St. Helier West – – – – – North-East 1 – – 1 0.20 45 North-West 1 1 – – 0.27 66 Central – – – – – – South-East 1 – – – 0.12 75 South-West 1 – – – 0.15 71 Totals 6 1 – 1 0.13 56 Two of these deaths were of unnotified cases. No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or under Section 172 of the Public Health Act, 1936. The Council adopted a points scheme for deciding the order of priority of applicants for housing accommodation. Special "weighting" is provided under this scheme where the existence of tuberculosis in the household creates a risk of infection. 57 58 TABLE 18. TUBERCULOSIS. New Cases, Age and Sex Distribution and Manner of Admission to Register, 1956. 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 – – 1 – – – – – – – – 2 1– 5 – 1 – – – 2 – – – – – – 3 5—10 – – – 1 – – – – – – – 1 10—15 1 – – – – – — – – – – – 1 15—20 1 2 – – – 2 – 1 – – – – 6 20—25 3 2 – – 2 1 – – – – – – 8 25—35 5 2 1 – 5 8 – – – – – – 21 35—45 2 3 – – 4 2 – – – – – – 11 45—55 2 3 – – 1 – – – – – – 1 7 55—65 4 2 – – 1 1 – – – – – – 8 65 up – – – – – – – – 1 – – – 1 Totals 19 15 1 2 13 16 – 1 1 – – 1 69 37 30 2 Mass X-Ray The Mass Miniature X-Ray Unit of the Hospital Board did not visit the Urban District during the year. The last time it operated in the area being November/December, 1955. Carshalton T.B. Care Committee This voluntary Committee continued to assist local tuberculous patients and their families as it has done for the last twenty years. Its services are of inestimable value to the successful operation of the antituberculosis scheme, since they give domestic and social relief in innumerable ways not possible under the arrangements of the statutorily constituted bodies. The total disbursements by the Committee during the year was little short of £600. Administrative costs do not include the services of the officers and members which are entirely voluntary. The annual report of the Committee shews that among the many forms of assistance were included the following : Holidays lor patients and their children, a sum of no less than £230 being spent on this item. Grants of clothing and bedding. Help to maintain insurance premiums. Payment of wireless licences, removal expenses, fares to hospital and training centres. Hire purchase payments for domestic equipment and domestic fuel. Grants of pocket money for patients in hospital and materials and text books for occupational therapy. Loans of equipment e.g. typewriters, bed tables, deck chairs, etc. Financial loans to re-establish businesses. In addition to direct help from the funds raised by itself, the Committee enlists all the help available from the many statutory and voluntary agencies who co-operate wholeheartedly in this valuable work. Meteorology The following rainfall was recorded at the Council's Pumping Station in Buckhurst Avenue. Rainfall 1956 Amount in ins. January 3.54 February 0.27 March 0.93 April 1.11 May 0.38 June 2.21 July 4.95 August 3.43 September 1.90 October 1.18 November 0.51 December 2.57 Total 22.98 59 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 693.21 million gallons. Minimum flow 0.28 million gallons/day on 19th December. Maximum flow 3.56 million gallons/day on 5th April. The total flow is less than half that in the year before, although the recorded rainfall was 3 inches more. 60 INDEX PAGE Acreage 6 Atmospheric Pollution 26 Births— Distribution 11 Institutional 10 Rates 7, 10, 11 Cancer 7, 13 Cemeteries 32 Clinics and Treatment Centres 19 Closet Accommodation 22 Deaths— Classification 17 Distribution 14 Rate 7,11,13 Diphtheria 46 Immunisation 46 Dysentery 44 Disinfection 25 Disposal of De 31 Drainage and Sewerage 21 Employment Agencies 30 Enteric Fever 44 Erysipelas 48 Establishments for Massage, etc 31 Factories 28 Food— Food and Drugs Act37 Inspection and Supervision 41,42 Poisoning 51 Health Services 18 Heating Appliances (Fireguards) Regulations, 1953 30 Housing— Council's Scheme 33 Inhabited Houses 6 Inspection 34 Repairs and Rents Act, 1954 36 Overcrowding 35 Slum Clearance 36 Ward Distribution 35 Ice Cream 38 Infant Mortalit 7, 16 Infectious Diseases 43, 53, 54, 55 Inquests 15 Isolation Hospital— Admission to .. .. .. .. .. .. .. .. .. 52 Laboratory Facilities .. .. .. .. .. .. .. .. 18 61 PAGE Mass X-Ray 59 Maternal Mortality 7,16 Measles 48 Meat 39 Meningococcal Infection 50 Merchandise Marks Act, 1926 30 Meteorology 59 Milk Supply Milk and Dairies Regulations, 1949 38 Mortuary 32 Natural and Social Conditions 6 National Assistance Act 31 Offices 28 Outworkers 28 Ophthalmia Neonatorum 51 Pet Animals Act, 1951 30 Pneumonia 48 Poliomyelitis 50 Vaccination 51 Population 7,8,9 Public Cleansing Puerperal Pyrexia 51 Rag Flock and Other Filling Materials Act, 1951 31 Rateable Value Rats and Mice Destruction Rivers and Streams Sanitary Circumstances 20 Sanitary Inspection 22 Scarlet Fever 45 Shops Acts 30 Smallpox Smoke Abatement 26 Staff 5 Statistics— Comparative .. .. '2 I Vital Swimming Baths Tuberculosis 7, 15,56,57.58 Care Committee Unemployment Vaccination 18,43,44 Vermin Control Water Supply Whooping Cough 49 Zymotic Diseases— Deaths from 7 62