CARSHALTON URBAN DISTRICT Anuual Report OF THE Medical Officer of Health FOR THE YEAR 1957 CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1957 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 1957. As usual its early pages deal with vital statistics which constitute the mathematical expression of the state of the public health in terms of fertility, numbers and mortality. They are the indices by which progress in public health is measured and without which sanitary reforms and the Public Health Acts would not have been possible. The district has entered upon a phase which is entirely new and that is in relation to its numerical constitution. Until the last year or so the district continued to grow and its population to increase with a varying rate of increment. Recently however there is evidence that the progressive increase in population has been brought to a halt and for the time being at any rate the trend has been slightly reversed. This is due to several factors, chiefly the gradual ageing of the population from its low level of 25 years ago and a falling birth rate, the virtual absence of scope for further development within the district and the abatement of overcrowding by movement of population to the new towns and elsewhere. The birth rate in 1957 was the lowest in the history of the district and only the fact that it still enjoys a very favourable death rate, provides a not unsatisfactory natural increase. Of the total mortality the continuing high rate for cancer of the lungs remains a disturbing feature. If the association with long practised excessive smoking is valid, and there appears to be little doubt of it, this high rate will inevitably continue for some years until either the disease is prevented by restriction of the smoking habit or by the elimination if possible of the carcinogenic agent in cigarettes or until a cure for the disease is found once it is established. After an interval of twelve years during which time more than 10,000 Carshalton babies were born without the loss of a single mother, it is sad to report that a maternal death occurred in 1957. This was a true case of septic infection which in earlier times took a considerable toll of women in childbirth. The discovery of penicillin and other anti-biotic agents provided a greatly improved means of combating maternal infection, but with the passage of time many strains of organisms have developed resistance to these once all-powerful bacteriocides. The organism which killed this mother was such a one. Control over the spread of infectious illness was maintained with an encouraging degree of success. With the exception of measles for which no 3 effective prevention has yet been found, the incidence of infectious diseases during 1957 can be regarded with satisfaction. Poliomyelitis cases fell to four. There is little doubt that the vaccination scheme is beginning to have some influence on the effects of this disabling affliction. There were no deaths from any of the notifiable infectious diseases. The Food Hygiene Regulations have added appreciably to the effective control over the conditions under which food is prepared, stored and sold and inspection and supervision of food is claiming an increasing share of the time of the public health staff. An outbreak of food poisoning did occur during the year in a large institution as they do from time to time, but it should be observed that all the evidence pointed to the infection having been conveyed by canned meat imported from abroad and there was nothing to suggest any breach of hygienic practice in this country. The relief of overcrowding remains disappointingly slow. Progress is certainly being made and the number of such cases is falling steadily, but there is still a disturbingly high number of families who, whilst not legally overcrowded, are in dire need of adequate accommodation. Unfortunately in the present state of inadequate new construction, their claims have to compete with those living in unfit premises for whom rehousing is equally urgent. Public health is undoubtedly influenced to a considerable degree by the services provided by local authorities which include those devoted to sanitation and environmental hygiene and the personal health services such as maternal and child welfare and school health. The present review of local government organisation can therefore have a big effect for better or worse on the contribution which the local authority services make to the general well-being. So much of this work is of a personal and human nature that if economy of administration proves to be the criterion by which the future pattern is determined, there will be a grave risk to efficiency. The administration of the services established under Part III of the National Health Service Act, suffer at present from inadequate provision for the utilization of local interest and knowledge and there is need for increased participation in the local direction of these services by locally elected representatives who have a close and detailed knowledge of local needs and an informed opinion as to what measures are likely to be effective with the people they represent. The crux of this question is what constitutes the optimum unit of administration. This has to reconcile two conflicting considerations; it must be large enough to work economically and small enough to maintain effective local interest and close contact with the public. In a health service the latter is the more important. My thanks to the staff of the department are again rendered for their willing and effective assistance. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, F. LAWRENCE SMITH, Medical Officer of Health. July, 1958. 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 : Inspector : † G. R. SURFLEET, C.R.S.I. Public Health Inspectors : Inspector : † L. W. Rivett, C.R.S.I. Inspector : † J. P. Dixon, C.R.S.I. Inspector : † L. A. Biggs, C.R.S.I. Public Health Nurse: Mrs. D. E. Baldock, S.R.N. Chief Clerk: Miss V. St. P. Hotten * Also Divisional Medical Officer, Surrey County Council, Inspector : † 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 1957) according to Rate Books 17,450* Rateable Value at 31st December, 1957 £827,019 Sum represented by Id. rate £3,328 (*Includes 254 combined with business premises for rating.) 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 more intermittent flow from the springs which feed this head of the river which has resulted from the lowering of the underground water table due to increased abstraction for various purposes, denudes the upper pond of fresh water for considerable periods in times of low rainfall. On these occasions this pond contains only surface water drained from roads in the vicinity and is often liable to stagnation. Although several of the springs failed during the year some flow was maintained into the lower pond. The district is mainly residential, little industry being established within its boundaries. Housing accommodation for workers in the lower income groups forms a large part of its development, the London County Council Estate of St. Helier making a big contribution in this respect. Density is greatest in the north of the district and decreases as one proceeds towards the southern end where there is considerable amount of undeveloped green belt land. As a consequence of this type of housing development, the district has the lowest rateable value per head of population in Metropolitan Surrey. The rateable value of the district which at the end of 1956 was £864,238 fell to its present figure primarily as the result of the reduced rating of shops and shops with other premises. 6 SUMMARY OF VITAL STATISTICS FOR 1957. (Based on the Registrar-General's Figures.) Population. Registrar-General's Estimate 60,440 Births. Males Females Total Live (Legitimate) 337 329 666 (Illegitimate) 13 15 28 350 344 694 Birth Rate (per 1,000 population) .. 11.5 Stillbirths (Legitimate) 12 3 15 (Illegitimate) 1 — 1 13 3 16 Stillbirth Rate per 1,000 total births 22.5 Deaths 263 241 504 Death Rate (crude) per 1,000 population 8.3 Infant Mortality. All deaths under 1 year 8 7 15 Infant Mortality Rate (per 1,000 live births) 21.6 Deaths of leg. infts. under 1 year .. 8 7 15 Rate per 1,000 legitimate births 22.6 Deaths of illeg. infts. under 1 year Rate per 1,000 illegitimate births – – – – Maternal Mortality. Death from Sepsis Rate per 1,000 births – 1 1 1.40 Death from other causes Rate per 1,000 total births – – – – Maternal Death Rate 1.40 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 1 2 3 Rate per 1,000 of population 0.04 Phthisis 1 2 3 Rate per 1,000 of population 0.04 Deaths from Cancer 63 40 103 Rate per 1,000 of population 1.70 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 1957 are supplied through the courtesy of the Exchange Manager and the Youth Employment Officer: Men 116 Women 35 Boys 5 Girls 4 POPULATION The Registrar-General's estimate of the home population at mid-year is 60,440. This is 530 less than his estimate for the year before and compares with 62,721 at the Census in 1951 and an estimated home population of the same year of 61,730. In the period since the Census, 544 new dwellings have been erected in the district and the excess of births over deaths was 1,500. The reduction of 1,290 in the Registrar-General's estimate over the past six years therefore means that outward migration has exceeded inward movement by 2,790. Outward movement has undoubtedly been greater than inward, but there was little evidence that it was significantly in excess until the last year or so. In 1957 the movement to Crawley New Town and elsewhere increased and there has been a lowering in the level of occupation where one would naturally most expect it—in the more densely populated wards of St. Helier. At the time of the Census in 1951, the number of persons per Local Government Elector in the St. Helier South ward was 1.69. A recent survey of the houses in Westminster Road in that ward, shows that the number in that road is now 1.30. Westminster Road cannot of course be completely representative of the whole ward, but the changes in it affords an indication of the increased average age of the population in a part of the district which in its early days, 25 years ago rehoused a young population. On the basis of the Registrar-General's estimated total of 60,440, the estimated population of each ward is as follows :— 8 TABLE 1. ESTIMATED HOME POPULATION, MID-1957, BY WARDS. Ward Dwellings at Mid-1957 Estimated Population Mid-1957 St. Helier North 2,177 8,220 St. Helier South 1,698 7,140 St. Helier West 2,123 7,480 North-East 2,790 9,700 North-West 2,194 7,150 Central 1,791 5,800 South-East 2,450 8,450 South-West 2,206 6,500 Whole District 17,429 60,440 The number of dwellings is 385 more than shewn a year before. The total of 17,429 dwellings for mid-1957 includes 254 which are attached to, and rated with, business premises. This category of dwelling was not included in the total shewn in the 1956 report. BIRTHS The number of live births registered during 1957 was 694 which is 19 less than in the year before. Of these 350 were males and 344 females, giving a birth rate of 11.5 per thousand population. The "comparable" birth rate produced by the application of the Registrar-General's comparability factor of 0.97 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 16.1 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 704 live births and 17 stillbirths occurred in 1957. They were distributed as shewn in the following table. 9 Ward Live Births Birth Rate per 1,000 Population Stillbirths Stillbirth Rate per 1,000 total births St. Helier North 87 10.5 – – St. Helier South 74 13.6 2 26.3 St. Helier West 89 11.9 3 32.6 North-East 132 13.6 1 7.5 North-West 86 12.0 2 22.7 Central 57 9.8 I 17.2 South-East 100 11.8 3 29.1 South-West 79 12.1 5 59.5 Seventy-seven 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 73 St. Helier South 79 St. Helier West 76 North-East 72 North-West 92 Central 86 South-East 62 South-West 85 Out of 721 total births, 559 took place in the following hospitals and nursing homes:— Live Still Total Carshalton, Beddington and Wallington District (War Memorial) Hospital 100 2 102 St. Helier Hospital 341 8 349 Other Surrey Hospitals 93 5 98 Other Hospitals 6 1 7 Private Nursing Homes 3 — 3 Total 543 16 559 For the last five years more than three-quarters of all births have taken place in Maternity Institutions. 10 TABLE 2. BIRTHS, 1957—DOMICILIARY AND OTHERS—BY WARDS. Ward Born in District Born outside District Grand Total In Hosp. and Nursing Homes In Private Dwellings Total In Hosp. and Nursing Homes In Private Dwellings Total St. Helier North 58 23 81 6 – 6 87 St. Helier South 57(2) 16 73(2) 3 – 3 76(2) St. Helier West 64(2) 22(1) 86(3) 6 – 6 92(3) North-East 85(1) 37 122(1) 11 – 11 133(1) North-West 59(2) 7 66(2) 22 – 22 88(2) Central 41 8 49 9(1) – 9(1) 58(1) South-East 38(1) 37 75(1) 28(2) – 28(2) 103(3) South-West 49(2) 12 61(2) 23(3) – 23(3) 84(5) Totals 451(10) 162(1) 613(11) 108(6) – 108(6) 721(17) (Figures in brackets indicate stillbirths included in totals.) TABLE 3. BIRTH AND DEATH RATES FOR CARSHALTON, 1922-1957. 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 1957 60,440 11.5 8.3 21.6 1.4 11 TABLE 4. COMPARATIVE STATISTICS—1957. England and Wales Carshalton Birth Rate (per 1,000 population) 16.1 11.5 Still-birth Rate (per 1,000 total births) 22.4 22.5 Death Rate (per 1,000 population) 11.5 8.3 (crude) 10.6 (comp.) Infant Mortality (per 1,000 live births) 23.0 21.6 Neo-natal Mortality (in first 4 wks. per 1,000 live births) 16.5 20.1 Death rate from Tuberculosis (per 1,000 population) Respiratory Tuberculosis 0.09 0.10 0.04. 0.04 Other Tuberculosis Death Rate from Cancer (per 1,000 population) 0.01 0.00 All forms 2.09 1.70 Cancer of Lung 0.42 0.41 Maternal Mortality (per 1,000 total births) Excluding Abortion 0.39 ■0.47 1.4 1.4 Abortion 0.08 -– COMPARATIVE HEALTH STATISTICS, 1934/57. 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 1957 11.5 8.3 23.0 21.6 0.39 1.4 12 DEATHS The deaths allocated to the district, as adjusted by inward and outward transferable deaths, was 504—263 males and 241 females. This gives a crude death rate of 8.3 per thousand population as against 8.5 in the year before. The "comparable" death rate produced by the application of the RegistrarGeneral's comparability factor of 1.28 to allow for differences in the age and sex constitution of the local population as compared with the country as a whole was 10.6. The rate for England and Wales was 11.5. The distribution of the deaths by wards was as follows :— WARD DEATH RATES AND MEAN AGE AT DEATH, 1957. Ward Deaths Death Rate (crude) Mean Age at Death St. Helier North 50 6.0 62.1 yrs. St. Helier South 48 6.7 58.8 „ St. Helier West 59 7.8 59.0 „ North-East 72 7.4 64.1 „ North-West 66 9.2 67.0 „ Central 76 13.1 71.2 „ South-East 70 8.2 64.6 „ South-West 61 9.3 70.0 „ Whole District 502 8.3 65.1 „ The deaths from cancer were rather higher at 103 giving a mortality rate for this cause of 1.70 per thousand of population, the increase being accounted for by the greater number due to cancer of the lungs. The great disparity in the mortality from lung cancer as between the sexes was again evidenced in 1957, fatal disease being ten times more common in the males. DEATHS FROM CANCER OF THE LUNGS 1934-57. 1934 0 1935 1 1936 3 1937 6 1938 10 1939 9 1940 4 1941 9 1942 4 1943 13 19448 194512 1946 8 1947 21 1948 15 1949 1950 3 1951z2 1952 1 1953 0 1954 0 1955 7 1956 8 1957 5 13 CANCER DEATHS—WARD DISTRIBUTION, 1957. Ward Cancer Deaths Rate per 1,000 Estimated Population St. Helier North 14 1.70 St. Helier South 17 2.38 St. Helier West 10 1.33 North-East 14 1.44 North-West 10 1.39 Central 14 2.41 South-East 12 1.42 South-West 12 1.84 The classification of the cancer deaths by sites affected is given in Table 5. TABLE 5. CANCER DEATHS, 1957. Group Site Affected Male Female Total Digestive Organs— 142 Parotid gland 1 – 1 150 Oesophagus 1 1 2 151 Stomach 11 9 20 153 Colon 4 3 7 154 Rectum 6 2 8 156 Liver 1 1 2 157 Pancreas – 3 3 158 Peritoneum – 1 1 Respiratory System— 161 Larynx 3 – 3 162 Lungs and Bronchus 23 2 25 Breast and Genito-Urinary— 170 Breast – 6 6 171/4 Uterus – 2 2 175 Ovary – 3 3 177 Prostate 3 – 3 178 Testis 1 – 1 180 Kidney 1 – 1 181 Bladder 2 2 4 Other Sites— 192 Eye – 1 1 193 Brain & Nervous Tissue – 1 1 199 Unspecified 4 1 5 201 Lymphatic Tissues 2 2 4 63 40 103 Average age at death: Males 61.2 years Females 62.6 years All persons 61.7 years 14 The group of diseases responsible for the greatest number of deaths is that related to the heart and circulation. These conditions in 1957 accounted for half the total deaths. Coronary disease of the heart itself killed 82 people of whom men outnumbered women by two to one. The fatality from tuberculosis continued its downward trend. Only three deaths were due to this disease, a record low shared with the year 1955. 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 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 1947 25 0.40 1957 3 0.04 The distribution of tuberculosis mortality by wards and other details are given in Section F of this report. No death resulted from any of the notifiable infectious diseases. Violent causes accounted for the deaths of eleven residents. They were :— Road traffic accidents 3 Accidents in the Home 1 Drowning 1 Injury on Railway 1 Accidental asphyxia 1 Suicide .. .. .. .. .. 4 Inquests Inquests were held on 45 persons who died in the district. The following verdicts were returned:— Accidental Death 32 Suicide 3 Misadventure 5 Natural causes5 Eight of the total were residents of the district. Sixteen were due to road accidents. 15 INFANT MORTALITY The number of children who died in the first year of life numbered fifteen which gives an infant mortality rate of 21.6 per thousand live births compared with 15.4 in the year before and with 23.0 for England and Wales. All but one of the fifteen deaths occurred in the first four weeks of life and all but one were due to prematurity, congenital deformities and other conditions peculiar to the newborn—the so-called "unavoidable" causes of death. TABLE 6. INFANT MORTALITY—WARD DISTRIBUTION. Ward Infant Deaths Rate per 1,000 Live Births St. Helier North 1 11.4 St. Helier South 2 27.0 St. Helier West 3 33.7 North-East 3 22.7 North-West 1 11.6 Central – – South-East 3 30.0 South-West 2 25.3 TABLE 7. INFANT MORTALITY DURING THE YEAR 1957. Deaths Classified as to Cause and Age at Death. Cause of death Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks Total under 4 weeks 4 weeks and under 3 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 1 –– – – 1 – –– — 1 Accidental – 1 – – 1 – –– — 1 Congenital Malformation 4 – 1 – 5 – – 5 Atelectasis 3 – — 3 – – — 3 Pneumonia 1 – – — 1 – – 1 2 Birth Injury 3 – – — 3 – – — 3 Totals 12 1 1 — 14 – – 1 15 MATERNAL MORTALITY After twelve years without a death attributable to childbirth, one such fatality occurred in 1957 in a mother of forty years who died from puerperal septicaemia despite hospital treatment with modern therapeutic agents. The infecting organism—staphylococcus aureus—is one of which many strains are known to have required resistance to the anti-biotics in presentday use. 16 17 TABLE 8–CAUSES OF DEATH DURING THE YEAR 1957–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. PnsH. All Causes Total 8 7 2 4 2 3 3 3 1 6 4 5 21 16 60 37 79 53 83 105 263 239 502 1 Tuberculosis, Respiratory – – – – – – – – – 1 – – – – 1 1 – – – – 1 2 3 2 Tuberculosis, other – – – – – – – – – – – – – – – – – – – – – – – 3 Syphilitic disease – – – – – – – – – – – – – – – – – – – 1 – 1 1 4 Diphtheria – – – – – – – – – – – – – – – – – – – – – – – 5 Whooping Cough – – – – – – – – – – – – – – – – – – – – – – – 6 Meningococcal Infections – – – – – – – – – – – – – – – – – – – – – – – 7 Acute Poliomyelitis – – – – – – – – – – – – – – – – – – – – – – – 8 Measles – – – – – – – – – – – – – – – – – – – – – – – 9 Other Infective and Parasitic Diseases – – – – – – – – – – – – – – – – – – – – – – – 10 Malignant Neoplasm, Stomach – – – – – – – – – – – 1 1 2 5 – 4 1 1 5 11 9 20 11 Malignant Neoplasm, Lung – – – – – – – – – 1 – – 4 – 9 – 7 1 3 – 23 2 25 12 Malignant Neoplasm, Breast – – – – – – – – – – – ––– – 3 – 1 – 2 – – – 6 6 13 Malignant Neoplasm, Uterus – – – – – – – – – – – – – – – 2 – – – – – 2 2 14 Other Malignant and Lymphatic Neoplasms – – – 1 – – 1 – – 1 2 – 5 2 8 7 8 2 5 8 29 21 50 15 Leuksmia, Aleukaemia – – – – – – 2 – – – – – – – 1 – – – – – 3 – 3 16 Diabetes – – – – – – – – – – – – – – 45 – – – 1 – 3 3 17 Vascular Lesions of Nervous System 1 – – – – – – 1 – – – – – – 3 5 7 11 12 17 23 34 57 18 Coronary Disease, Angina – – – – – – – – – – 1 – 1 1 6 1 14 14 31 13 53 29 82 19 Hypertension with Heart Disease – – – – – – – – – – – – – 1 2 2 – 5 2 8 10 20 Other Heart Disease – – – – – – – – – – – 2 3 1 5 5 8 9 12 34 28 51 79 21 Other Circulatory Disease – – – – – – – – – – – – – 4 3 3 3 6 6 13 19 22 Influenza – – – – – – – – 1 – 1 – 1 1 – 1 – 1 – 3 3 6 23 Pneumonia 1 1 – 3 – 1 – – – – – – – 1 3 4 3 2 4 8 15 23 24 Bronchitis – – – – 1 – – – – – – – 2 1 9 1 14 2 5 5 31 9 40 25 Other Diseases of Respiratory System – – 1 – – – – – – – – – – – 4 – – – – – 5 – 5 26 Ulcer of Stomach and Duodenum – – – – – – – – – – – – 1 – – – – – 1 – 2 – 2 27 Gastritis, Enteritis and Diarrhoea – – – – – – – 1 – – – – 1 1 1 1 – – 1 3 3 6 28 Nephritis and Nephrosis – – – – – – – – – – – – – 1 1 1 2 1 3 29 Hyperplasia of Prostate – – – – – – – – – – – – – – 1 – – – 3 – 4 – 4 30 Pregnancy, Childbirth, Abortion – – – – – – – – – – 1 – – – – – – – – – –1 1 31 Congenital Malformations 3 2 1 – – – – – – – – – – – – – – 1 – 5 2 7 32 Other Defined and Ill-defined Diseases .. 2 4 – – – 2 – – – 1 1 – 1 2 4 3 5 3 3 3 16 18 34 33 Motor Vehicle Accidents – – – – – – – 1 – – – – 2 – – – – – – – 2 1 3 34 All other Accidents 1 – – – 1 – – – – – – – 1 – 1 3 1 4 35 Suicide – – – – – – – 1 – 1 – – – 2 – – – – – – – 4 4 36 Homicide and Operations of War – – – – – – – – – – – – – – – – – – – – – – – Section B—Health Services. Laboratory Facilities Mr. D. D. Moir, 16, Southwark Street, London, S.E.1, 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 investigations 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 23 Water (Public Supply): For chemical analysis .. .. .. 3 For bacteriological examination .. .. 5 Water (Swimming Bath) : For bacteriological examination .. .. 10 Food and Drugs : Analysis .. .. .. .. .. 303 Bacteriological examination of milk .. 195 Bacteriological examination of ice cream .. 9 Biological examination of milk 12 In addition, bacteriological investigation was carried out by Queen Mary's Hospital's own laboratory on 31 samples of food and on specimens from 121 individuals in connection with the outbreak of food poisoning at that institution. Vaccination and Immunisation Schemes of vaccination and immunisation are the responsibility of the County Council under Section 26 of the National Health Service Act. With the inclusion of vaccination against poliomyelitis in 1956 the diseases against which this form of protective treatment is now provided are as follows: smallpox — diphtheria — whooping cough — tetanus — poliomyelitis and tuberculosis. The scheme in respect of the four first-mentioned infections is directed locally by the District Medical Officers of Health by arrangement with the District Councils. Polio, vaccination so far is directed by the Divisional Medical Officers of the County Council, whilst Mantoux testing and B.C.G. Vaccination for tuberculosis, at present limited to thirteenyear-old schoolchildren (except when given as part of the chest clinic services), is provided under the School Health Service Scheme. The smallpox vaccination scheme which was previously mainly directed to the protection of infants was extended during the year to provide for the primary vaccination of adults and the re-vaccination of both children and adults. Details of the work done in connection with these schemes are given in Section F. 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 Maternity Clinic Toddler Clinic Dental Clinic Massage Clinic Tues. and Thurs. Thursdays Mondays By appointment Mons., Tues., Weds., Thurs., Fridays Mons., Tues., Thurs., Fridays 2—4 p.m. 10—12 noon 2—4 p.m. 10—1 p.m. 2—5 p.m. Wrythe Lane Centre : Infant Welfare Clinic Maternity Clinic Toddler Clinic Weds, and Fridays Tuesdays Tuesdays 2—4 p.m. 10—12 noon 2—4 p.m. Stanley Road Centre : Infant Welfare Clinic Maternity Clinic Toddler Clinic Fridays 2—4 p.m. Tuesdays 10.30—11.30 a.m. 1st and 3rd Thurs. 2—4 p.m. Middleton Road, Morden : Infant Welfare Clinic Mondays 2—4 p.m. The Mount Centre : Infant Welfare Clinic Maternity Clinic Toddler Clinic Wednesdays Tuesdays 2nd Thursday 2—3.30 p.m. 2—3 p.m. 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 Wednesdays 3rd and 4th Mondays (for old cases only) 2 p.m. 9.30 a.m. 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. Following the water epidemic of 1936, very comprehensive arrangements were devised for ensuring the future standard of the public supply. Treatment of the raw well water was modernised and intensified to be able to deal with any foreseeable accidental pollution, whilst a fuller scheme of testing was instituted to enable the earliest warning to be given of any deterioration in the purity of the supply. The services of the Company's resident chemist provide a daily check on the raw and finished waters. This is supplemented by analyses conducted by independent water analysts at intervals and by sampling by the Public Health Officers of the District Councils in the supply area on an agreed rota. Quality and quantity were satisfactory in 1957 as for many years past. One sample only barely failed to comply with the required statutory standard of softening viz. 9° of hardness. The following summary of water examinations is provided by courtesy of the Company's 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 100 ml. of sample No. % No. % Sutton Raw 307 52 9 3.0 8 3.0 17 Sutton Finished 312 12 3 1.0 2 1.0 5 Woodmansterne Raw 306 52 1 0.3 Nil Nil 1 Woodmansterne Finished 310 12 1 0.3 Nil Nil 1 Cheam Raw 311 52 18 6.0 Nil Nil 18 Reservoir 284 – 1 0.3 Nil Nil 1 District 300 – 9 3.0 1 0.3 10 Total 2,130 180 42 – 11 – 53 The sanitary authorities of the districts served by the Company examined 13 chemical and 27 bacteriological samples during the year and all were satisfactory. The following is the report on one of the two complete examinations arranged by the District Council. 20 (a) Physical Examination Colour Light blue Taste none Appearance Bright and clear Smell none (b) Chemical Examination in parts per million Total solid residue (dried at 180°C.) 200 Chlorine present as chloride 18.5 Ammonia, free 0.01 Ammonia, Albuminoid 0.00 Nitrate nitrogen 9.2 Nitrite nitrogen 0.14 Oxygen absorbed from (a) in 4 hours 0.10 permanganate solution (b) in 15 mins – Hardness, as CaC03—Temporary 57 Permanent 54 Total 111 Alkalinity, as CaCO3 57 Free carbon dioxide, as C02 – Iron absent Other metals absent Residual chlorine 0.15 Electric Conductivity at 20 °C 265 units pH. 7.6 (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 „ CI. welchii 0 „ Remarks This water is of good organic purity, moderate hardness and salinity and is attractive in appearance. It shows no significant alteration in chemical composition as compared with previous samples from the same source. The residual chlorine indicates adequate precautionary treatment. The bacteriological condition of the water is excellent. As judged by this sample the water is pure and wholesome and suitable for the public supply. The average hardness of the samples taken by the local authorities was 8.3° compared with 8.8° in 1956 and 9.18° in 1955. Drainage and Sewerage Construction of the soil relief sewer in Woodmansterne Road referred to in last year's report was completed. 311 Drainage obstructions affecting 943 houses were dealt with during the year. Rivers and Streams The County Council has the responsibility for maintaining the flow and purity of the River Wandle under the powers of its 1925 Act. The usual work of maintenance was carried out during the year. 21 Closet Accommodation Soil drainage is everywhere by water closets to the sewers except for 17 properties where the w.c.'s are drained to 13 cesspools in unsewered areas. The scheme proposed by the Council for an extension of the sewer in the Woodcote Grove area which will do away with many of the existing cesspools, still awaits the Ministry's loan sanction. Public Cleansing The arrangements for refuse collection and disposal were as shewn in previous reports. Clinker and screenings from the destructor have been tipped at various sites in the district and also at the Carshalton and Merton and Morden Joint Cemetery Board's land in Maiden. 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 1,198 complaints as follows:— Accumulations 27 Animals so kept 8 Burst pipes 15 Dampness 19 Drainage defects 41 Drains obstructed 346 Dustbins 51 Food contaminated 20 Food Hygiene Regulations—Contraventions 5 General defective conditions 85 Insects and Pests 98 Milk, contaminated and dirty bottles 6 Miscellaneous 38 Obnoxious effluvia 23 Overcrowding 10 Refuse collections 16 Rodents 272 Roofs, defective Sewer obstructions 16 Sink waste pipes 2 Smoke nuisances 8 Unsound food 74 Verminous premises 7 Water supply 3 1,198 Fourteen thousand one hundred and seventy-five visits of inspection and re-inspection were made for the purposes set out below:— Cowsheds 28 Employment Agencies 17 Factories (Mechanical Power) (incl. Laundries 63) 318 Factories (Non-Mechanical Power) 68 Factories (Building Sites) 93 Food and Drugs (incl. Food Byelaws) 1,219 Food poisoning enquiries 3 22 Food premises: Bakehouses 59 Bakers and confectioners 89 Butchers 188 Canteens 57 Canteens—School 59 Chemists 54 Cinema 4 Confectioners (sweets only) 132 Fishmongers 88 General Stores 70 Greengrocers and fruiterers187 Grocers 347 Licensed premises with catering facilities 11 Licensed premises without catering facilities 33 Milk Storage Depots 23 Ice Cream Vehicles 12 Restaurants and cafes 140 Stalls, food 127 Tea packer 1 Vehicles, food 23 1,704 Hairdressers 81 House drains tested 101 Housing Act 378 Heating Appliances (Fireguards) Act 29 Housing Enquiries 184 Housing Land Charges 1,063 Infectious Disease Premises 33 Insect Pests 152 Merchandise Marks Act 196 Offices 20 Outworkers premises 86 Pet Animals Act 34 Piggeries 109 Premises re cesspools 25 Public Health Act (Houses) 3,266 Public Health Act re-inspections 2,746 Rag Flock & Other Filling Materials Act20 Rent Act 41 Rodents 452 Schools 65 Shops 1,200 Smoke observations 312 Tents, Vans, Sheds27 Urinals 88 Water Sampling 17 14,175 Three hundred and nineteen informal notices were served concerning the following matters:— Accumulations and deposits 16 Animals so kept 1 Burst pipes 1 Drainage defects 83 Dustbins 25 Factories Act 4 Food and Drugs Act (incl. Food Byelaws) 38 Food contaminated 10 General defective conditions 100 Miscellaneous 5 Overcrowding 7 Pet Animals Act1 23 Rodents 9 Shops Act 17 Smoke nuisance 1 Water Supply 1 319 Fourteen formal notices were served by authority of the Council under the following Acts:— Public Health Act, 1936, Section 39 1 Section 45 2 „ „ „ Section 75 4 „ „ „ Section 93 6 Factories Act, 1937 Section 7 1 14 As a result of investigations made and notices served, the following work was carried out:— Accumulations removed 25 Brickwork, repaired and/or repointed 4 Ceilings cleansed 12 Ceiling plaster repaired and/or made good 12 Chimney brickwork and pots repaired or renewed 2 flues repaired 3 Damp conditions remedied 27 Disinfestations 68 Doors and frames repaired, including locks and fasteners 3 Drainage repaired and/or reconstructed 19 houses (260 ft. of drain laid) Drainage New 2 inspection chambers repaired 29 inspection chamber covers renewed 11 stoppers or caps refixed and/or renewed 8 soil vents repaired and/or renewed 5 drains tested 24 drains cleared (affecting 943 houses) 311 drains sealed off 2 waste gullies repaired, renewed or provided 4 waste pipes, repaired, renewed or provided .. .. 6 cesspools emptied 3 Dustbins provided 49 Fireplaces, ranges or stoves repaired or renewed .. .. .. 8 Floors renewed or repaired 7 Food Storage Accommodation provided .. .. .. .. 1 Glazing and putty renewed 17 Paving repaired and/or made level 1 Roofs repaired and made weatherproof .. .. .. .. 18 downpipe, guttering repaired and/or renewed .. 11 Sinks renewed or provided .. .. .. .. .. .. 5 Stairs or steps repaired, renewed or made level .. .. .. 3 Surface water drainage repaired and made to work properly .. 5 Walls rendered or rendering repaired .. .. .. .. 1 replastered and/or repaired .. .. .. .. 10 cleansed and redecorated 43 Wash basins, baths renewed .. .. .. .. .. 1 Water Supply pipes renewed 9 , Hot water supply system 5 W.C. pans renewed .. .. .. .. .. .. .. 6 pan joints renewed 3 seats repaired, renewed or provided .. .. .. 3 flushing apparatus repaired or renewed 6 Windows repaired and/or renewed .. .. .. .. .. 17 24 Disinfection Seventy-one rooms, 1 T.B. Shelter and 330 library books were disinfected. Five lots of bedding were sterilised and five lots destroyed. Vermin Control Persons. The Council maintains a cleansing station in Rochester Road for dealing with individuals infested with pediculosis or scabies and their personal clothing. During 1957 there were no cases of pediculosis treated there, but 25 members of 5 families, of whom 11 were schoolchildren, made 120 attendances for the treatment of scabies. One of these families consisting of 11 individuals became reinfested after an interval of 5 months and received 2 courses of treatment during the year. Premises. During the year, sixty-eight premises were treated for the destruction of vermin and insect pests as follows :— Infestation Property Treated by C.U.D.C. Property Treated Total C.U.D.C. Property S.C.C. Property L.C.C. Property Privately Owned Property By L.C.C. By Owners Bugs 1 3 4 Flies 8 1 9 Wasps 8 2 — 44 54 Weevil 1 ~ 1 9 11 — 48 — — 68 Clean Air Act, 1956 This comprehensive statutory measure gives local authorities new powers and duties for the prevention of air pollution. The first provisions to be brought into force on the 31st December, 1956 were those dealing, inter alia, with— Installation of new furnaces Pollution from spoil banks Height of Chimneys Research and Publicity Smoke Control Areas Making of Byelaws Under these provisions new furnaces shall be, so far as practicable, smokeless and regulations may be made by the Minister to require the installation of meters for recording the density of smoke from furnaces. Smoke control areas can with the consent of the Minister be declared by local authorities in which it will be an offence to emit smoke. The cost of adaptations of private dwellings to avoid such an offence will be partly met by the local authority and may be assisted by an exchequer grant. Churches and charities may be assisted in this respect at the discretion of the local authority. The local authority may make Byelaws to require the provision 25 in new buildings of such arrangements for heating and cooking as are calculated to prevent the emission of smoke. A local authority may themselves undertake or contribute to the cost of research into air pollution and provide publicity and information on the subject. Eight complaints in respect of atmospheric pollution were received and dealt with during the year. For several years the Council have provided deposit gauges for recording the quantity of grit being emitted into the atmosphere at three selected sites in the district, the readings from which are calculated intermsof tons per square mile. Additional apparatus is also installed at The Lodge for measuring the density of smoke pollution and the concentration of SOa in the atmosphere. The deposit gauges are sited as follows :— Gauge A—Welbeck Road Gauge B—Winchcombe Road Gauge C—Limes Avenue The recordings made from this annaratus were as follows :— Deposit Gauges Gauge Total Rainfall (in inches) Total Solids. Tons per sq. mile Highest Monthly Reading Lowest Monthly Reading Average Monthly Reading A 16.35 16.17 5.27 9.00 B 19.31 14.93 5.91 8.95 C 21.22 18.19 4.27 12.24 Gauge A Gauge B Gauge C Month 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 1.02 9.57 1.58 8.67 1.18 10.87 February 1.86 7.13 2.73 5.99 2.86 9.66 March 0.39 6.04 0.64 7.00 0.72 6.88 April 0.07 6.30 0.06 5.91 0.24 4.27 May 0.53 7.74 0.98 9.56 1.19 11.74 June 0.33 9.71 0.54 10.17 0.98 18.19 July 0.97 5.27 1.99 8.29 2.48 13.05 August 2.98 16.17 2.76 14.93 2.86 17.35 September .. 2.34 7.70 2.41 6.97 2.67 10.17 October 1.64 7.13 1.57 6.56 1.61 12.65 November .. 2.43 11.74 2.34 11.53 2.44 15.94 December .. 1.79 13.51 1.71 11.86 1.99 16.14 Total 16.35 108.01 19.31 107.44 21.22 146.91 26 Smoke and Atmospheric Sulphur Dioxide Month 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 26.26 1.96 9.57 12.4 1.3 4.7 February 28.77 2.01 12.14 9.5 1.1 3.9 March 17.06 2.90 7.06 6.4 1.0 2.8 April 15.62 3.02 7.58 7.6 1.8 4.3 May 8.66 2.07 4.97 6.6 0.7 3.5 June 6.90 0.50 3.11 7.6 0.7 3.0 July 4.14 0.50 1.48 4.2 0.4 1.3 August 6.49 0.51 2.20 3.4 0.4 0.9 September 8.80 1.00 3.48 3.2 0.4 1.3 October 23.79 2.01 10.38 9.6 0.7 3.6 November 23.78 1.56 10.70 11.5 0.6 4.7 December 60.04 2.01 14.42 23.5 1.8 6.8 Whole year 60.04 0.50 7.20 23.5 0.4 3.4 Prevention of Damage by Pests Act, 1949 As in past years rodent destruction was carried out according to a programme agreed with the Minister of Agriculture, Fisheries & Food. Eight thousand six hundred and ninety-five visits were made by the Rodent Operatives concerning 1,427 properties and 322 rat and mouse infestations found. Of that number 268 were found in private premises, 43 in business premises, 11 in Council premises. Two maintenance treatments of the sewers were carried out, one in May and the other in November and the other in November. The results are shown in the following table, together with the three previous years :— May Treatment November Treatment 1954 1955 1956 1957 1954 1955 1956 1957 Manholes baited 166 186 188 194 172 193 191 199 Manholes in which takes of prebait were recorded 65 56 67 62 53 57 75 83 Percentage of manholes showing infestations 39.1 30.1 35.6 33.0 30.8 29.5 39.3 42.7 Percentage in relation to total manholes in district 5.7 4.9 5.9 5.7 4.7 5.0 6.6 7.5 Swimming Baths The one swimming bath in the district at the Highfield Hall is owned by the Council who acquired it from a private owner in 1953. The purification plant subjects the water to continuous precipitation, filtration and chlorination. Routine daily testing for free chlorine checks the effectiveness of this apparatus. 27 Ten samples were submitted for bacteriological examination. Two of these taken on the same day in July indicated that the purification plant was on that day being overloaded. The operation of the plant was suitably adjusted and the schedule of testing times modified to cover more adequately the expected periods of maximum user in the summer. Further bacteriological tests taken subsequently were entirely satisfactory. Offices Twenty inspections of offices were made, but no action was called for. Factories, Workplaces and Outworkers The following table gives a summary of the registers :— Employees Premises Males Females Total Factories— with mechanical power 770 547 1,317 93 without „ „ 30 17 47 17 Workplaces— with mechanical power 34 34 30 without „ „ 22 22 44 24 856 586 1,442 164 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). Premises Number on Number of Inspec- Written Occupiers (1) (2) (3) (4) (5) (i) Factories in which Sections 1,2, 3, 4 and 6 are to be enforced by Local Authorities 17 68 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 93 318 4 (iii) Other premises in which Section 7 is enforced by the Local Authority* (excluding outworkers' premises) 6 93 — — Total 116 479 4 — * Electrical Station (Section 103 (1)), Institutions (Section 104) and sites of Building Operations and Works of Engineering Construction (Section 107 and 108). 28 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 Referred Found Remedied To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness Overcrowding — — Unreasonable temperature — — Inadequate ventilation — — Defective drainage of floors — — Sanitary Conveniences— (a) Insufficient 1 — — (b) Unsuitable or defective 3 5 — (c) Not separate for sexes — — — Other offences against the Act (not including offences relating to Outwork) — — — — — Total 4 5 — — — Nature of Works Section 110 Section 111 No. of outworkers in Aug. list required by Sect. 110(1) (C) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwhole some premmises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing Apparel— Making, etc. 27 — — Boxes (cardboard) 2 — — Brush making 3 — — Christmas Crackers .. 2 — Lampshades 5 * Total 39 — — — — — 29 Employment Agencies There are two employment agencies in the district. Both were visited and found to be satisfactory. Shops Act, 1950 There are 508 shop premises on the register and 3,126 inspections were made during the year. Preliminary notices were served with regard to seventeen infringements of the statutory requirements, five for failure to exhibit appropriate notices, six for condition of premises, four for sanitary accommodation and two for accumulations. All the notices were complied with. Heating Appliances (Fireguards) Regulations, 1953 Twenty-nine inspections were made and several heating appliances tested. All were found to comply with the required standards. 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 Six licences have been granted in respect of premises used as Pet Shops, all of them dealing mainly with fish and birds. The premises have been inspected and found satisfactory. Rag Flock and Other Filling Materials Act, 1951 Three premises used for upholstering are registered in accordance with Section 2 of this Act. Twenty visits of inspection were made with the object of ensuring "the use of clean filling materials in upholstered articles and other articles which are stuffed or lined." No circumstances were found which required action under the Act. No sampling of filling material was done during the year. Establishments for Massage and Special Treatment The number of establishments of this nature 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 to be satisfactorily conducted on the routine visits of inspection. 30 National Assistance Acts, 1948—1951 No occasion arose during the year which required the use of the statutory powers of these Acts which can secure the compulsory removal to suitable places of care of persons living in insanitary conditions as a result of old age or infirmity and neglect. Section 50 The occasion did not arise for the Council to arrange for the burial of any person under Section 50 of the 1948 Act. Disposal of the Dead The Carshalton and Merton and Morden Joint Burial Board provides burial accommodation at their Lower Morden Cemetery for the residents of the two Urban Districts. During the year 163 interments were from Carshalton. No unused accommodation is available in the parish churchyard, interment there now being only by the re-opening of existing graves. Following the constitution of the North-East Surrey Crematorium Board, work proceeded on the adaptation as a crematorium of the former chapel in the Battersea Cemetery in Lower Morden and was brought into use in May, 1958. The Joint Board consists of representatives of the Battersea, Sutton and Cheam, Carshalton and Merton and Morden Councils and was brought into being in October, 1956 by the North-East Surrey Crematorium Act. The Council provide mortuary and post-mortem examination facilities at their fully equipped mortuary in Mill Lane. During 1957, 134 bodies were received into the mortuary on all of which autopsies were performed. The number admitted from other districts was 57. During the last five years, more than half the admissions were from districts other than Carshalton. 31 Section D—Housing New Houses During the year 77 new dwellings were completed 45 of which were private dwellings and 32 Council maisonnettes. The following buildings were in course of erection at the end of the year :— Private dwellings .. .. .. .. 40 Council Flats .. .. .. .. .. 4 Council Maisonnettes.. .. .. .. 16 Council Bungalows .. .. .. .. 16 Schemes in various stages of preparation were as follows :— Site No. Site Type of Dwelling No. 31 Stanley Road Flats & Maisonnettes 20 36 Culvers House Flats 36 37 Denmark Road Flats 32 38 Denmark Road Flats 48 39 Muschamp Road Flats & Maisonnettes 42 Council's Housing Scheme The dwellings in the ownership of the Council at the year end were as follows :— Pre-War Houses .. .. .. .. 547 Post-War Houses .. .. .. .. 649 Temporary Bungalows .. .. .. 102 Houses taken over under S.D.A.A. .. 28 Houses purchased (units of accommodation) 58 Accommodation in Parks, Offices, etc. .. 18 1,402 The number of requisitioned premises at the 31st December, 1957 was 28 providing accommodation for 50 families. This is 37 less properties under requisition than at 12 months earlier. The outstanding approved applications for tenancies at the year end totalled 1,028, which was 98 less than a year before. 32 Inspection and Action taken under Statutory Powers 1. Inspection of Dwelling Houses during the year. (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) .. 3,770 (b) Number of inspections made for the purpose .. .. 6,516 (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 .. 82 (b) Number of inspections made for the purpose .. .. 378 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation .. .. .. .. .. 70 (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 .. 211 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 1956) 206 3. Action under Statutory Powers during the year. (a) Proceeding under Sections 9,10 and 16 of the Housing Act, 1936, and Sections 9,10 and 12, of the Housing Act, 1957. 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 12 (2) Number of dwelling houses in which defects were remedied after service of formal notices :— (a) By Owners .. .. .. .. .. 10 (b) By Local Authority .. .. .. .. — 33 4. Housing Acts, 1936 and 1957—Part IV (Overcrowding). (a) (1) Number of dwelling houses overcrowded at the end of the year .. .. .. .. .. .. .. 46 (2) Number of families dwelling therein .. .. .. 76 (3) Equivalent number of adults dwelling therein .. .. 305 (b) Number of new cases reported during the year .. .. 10 (c) (1) Number of cases of overcrowding relieved during the year .. .. .. .. .. .. .. 27 (2) Number of persons concerned in such cases .. .. 189 (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 10 cases of overcrowding were found and 27 cases were remedied leaving 46 dwellings with 305 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 31/12/56 Dwellings found overcrowded during 1957 Dwellings decrowded during 1957 Dwellings remaining overcrowded at 31/12/57 Overcrowded cases remedied during 1957 Formal Action Informal Action Total St. Helier North .. 25 4 10 19 5 5 10 St. Helier South .. 10 — 6 4 3 3 6 St. Helier West .. 13 4 5 12 1 4 5 North-East 4 1 2 3 1 1 2 North-West 3 — 1 2 1 — 1 Central 5 1 2 4 1 1 2 South-West 1 — 1 — — 1 1 South-East 2 — — 2 — — — 63 10 27 46 12 15 27 These figures, as previously explained, cannot represent the exact extent of overcrowding, since that can only be ascertained by a complete housing survey of the whole district carried out at any particular time. Incomplete as they may be, they do indicate over a period the trend in the level of housing occupation which has undoubtedly fallen in the last few years as a result of new construction and movement to the new towns and elsewhere. 34 The new cases in the last ten years and the known overcrowded dwellings at the respective year ends were as follows :— Year New Cases Cases at Year End Year New Cases Cases at Year End 1948 107 289 1953 53 112 1949 160 221 1954 49 105 1950 75 209 1955 26 73 1951 54 217 1956 27 63 1952 79 123 1957 10 46 In all the 10 new instances of overcrowding, families were found to be sharing accommodation with relatives. Abatement was effected in the following ways :— Provision of alternative accommodation by :— Carshalton U.D.C. .. .. .. .. 5 London County Council .. .. .. 1 Other Local Authorities .. .. .. 6 Left the district .. .. .. .. .. 3 Removal of one or more occupants .. .. 12 Of the 46 dwellings remaining overcrowded at the end of the year, 34 are owned by the London County Council, 3 by the Carshalton Council and 9 are privately owned. Slum Clearance and Demolition The erection of the first block of flats and maisonnettes for rehousing, inter alia, the occupants of Clearance Area No. 7 Stanley Road commenced and was well advanced by the end of the year. The Ministry inquiry into the order in respect of Clearance Area No. 8 Mill Lane was held on the 30th July, 1957. The order was confirmed without modification and all the occupants of the area were rehoused and the site cleared by the end of the year. Housing Repairs and Rents Act, 1954 Those sections of this Act dealing with certificates of disrepair in connection with proposed rent increases were repealed in July by the Rent Act 1957. During the year one certificate of disrepair was issued under the 1954 Act and is still outstanding. Rent Act, 1957 Provision is made in this Act similar to that repealed in the Housing Repairs and Rents Act, 1954 for the issue of certificates of disrepair in connection with rent increases unless the landlord gives an undertaking to 35 carry out such defects complained of by the tenant and agreed by the Council as being reasonably required to be remedied having due regard to the age, character and locality of the dwelling. Although this procedure is concerned with the justification for rent increase by reason of fitness of the property, there still remains the duty of the local authority under the Housing Act, 1936 and the Public Health Acts to secure the remedying of housing defects. These powers are used to secure any necessary work when the landlord fails to do so under the procedure of the Rent Act. The following details shew the action taken under the Act in 1957 :— Applications for Certificates of Disrepair. Number of applications for certificates 41 Number of decisions not to issue certificates .. .. Nil Number of decisions to issue certificates :— (a) in respect of some but not all defects .. .. 32 (b) in respect of all defects 9 Number of undertakings given by landlords under para. 5 of First Schedule .. .. .. .. .. .. 26 Number of undertakings refused by local authority under proviso to para. 5 of First Schedule Nil Number of certificates issued 4 (A further 10 issued in 1958) Repairs executed within 3 weeks of notice on Form J 1 Applications for Cancellation of Certificates. As the first certificates of disrepair were sent out in mid-November, repairs had not been completed by the end of the year. Consequently no applications by landlords for cancellation had been received by the 31st December, 1957. 36 Section E—Inspection and Supervision of Food. Food and Drugs Act, 1955 The bulk of the supervision exercised by the local authority over food is now carried out under the provisions of the Food and Drugs Act, 1955 and the regulations made thereunder. This Act is a consolidating measure of various previous enactments. The chief advance made under it is provided by the Food Hygiene Regulations made by the Ministries of Agriculture, Fisheries, and Food and Health in exercise of the powers conferred on them by the Act. These contain a number of new provisions in respect of the hygienic handling of food and the construction and maintenance of premises, stalls, vehicles, etc., where food is handled. Milk Supply All milk sold in the district must be "designated" milk since Carshalton is a Specified Area for the purposes of the Milk (Special Designations) (Specified Areas) Order, 1951. Milk Distributors The number of Milk Distributors registered is 18. Designated licences issued during the year were as follows :— Designation Number of Distributors Holding Licences No. of Licences in force on 31/12/57 Principal Licences— Sterilised 12 15 Pasteurised 6 9 Tuberculin Tested 5 8 Supplementary Licences— Sterilised 8 12 Pasteurised 6 10 Tuberculin Tested 6 10 Bacteriological Examination of Milk. One hundred and ninety-five samples of milk were procured and submitted for bacteriological examination. All the milks were sold under the Milk (Special Designations) Regulations and five failed to comply with the prescribed Regulations. 37 Classification of the milk samples and the results of the tests are as follows :— Designation under which sold No. of samples Methylene Blue Test Phosphatase Test Turbidity Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised 122 121 1 120 2 — — T.T. Pasteurised 56 55 1 55 1 — — Sterilised 17 — — — — 17 — 195 176 2 175 3 17 — Biological Samples. Twelve samples of raw milk were taken from the three farms in the district before it was treated in any way. All were reported to be free from tubercle infection as a result of animal inoculation tests. 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 Public Analyst examined 203 samples of milk and of these 41 were samples of Channel Islands milk. All the latter were satisfactory. Of the remaining 162 samples 8 were found not to comply with the statutory standard of 3 % fat and 8.5 % non fatty solids. The average content of the 41 samples of Channel Islands milk was— fat 4.45%—non fatty solids 8.96%. Such milk is required to have a minimum of 4% fat for purposes of the milk (Control and Maximum Prices) Order by reason of which the producers receive a premium. The average quality of the other milk samples was—fat 3.64%—non fatty solids 8.69%. Ice Cream For purposes of assessing the bacterial cleanliness of ice cream, samples are classified into four grades. The grade is determined by the length of time the sample takes to reduce the colour of the dye methylene blue. This time is in inverse proportion to the number of bacteria present, i.e. the more bacteria present the shorter the time taken to decolourize the dye. Grade I is the highest taking the longest time and Grade IV is the lowest. For many years the standard achieved by the samples submitted to these tests has risen steadily. The following table records the results of this grading since the system was instituted in 1947. As will be seen the high standard is being maintained. 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 — — 1957 93 91 1 1 – Nine samples analysed by the Public Analyst conformed to the statutory standard. Ice Cream (Heat-treatment, etc.) Regulations, 1947-1952. There are no manufacturers of Ice Cream in the district, all the registered retailers drawing their supplies from reputed manufacturers outside the district. All retailers are provided with refrigerator cabinets which maintain a temperature well below 28 °F. in accordance with the regulations. Meat Inspection of meat is limited to that stored or exposed for sale since there are no slaughterhouses in the district and all meat sold by retail is brought into the area from depots outside. The quantity of meat seized or suspected as unfit for human consumption was 4,998 lbs. 3 ozs. Analyses of Food and Drugs The following 303 samples of food and drugs were submitted to the Public Analyst with the results indicated:— 39 Article No. Aldulterated or otherwise irregular Article No. Aldulterated or otherwise irregular Alka Seltzer 1 Meat Patties 1 Almonds Ground 2 Medicine 1 Cake Mix 1 Mentholated Balsam 1 Chutney 1 Mincemeat 2 Coconut Desiccated 1 Mint Jelly 1 Coffee & Chicory Extract 1 Mineral Water 1 Confectionery Sugar 10 Mustard 1 Cordial 4 1 Milk 203 6 Cornflour 1 Olive Oil 1 Christmas Pudding 1 Orangeade Powder 1 Crab—Dressed 1 Pastry Puff 1 Crab-meat 1 Pastry Puff Mix 1 Cream 1 Peas 1 Currants 2 Pepper 1 Dates 1 Pie Filling 1 Desiccated soup 1 Pineapple Slices 1 Dessert—Table 1 Pork Roll 1 Drinking Chocolate 1 1 Pudding Mix 1 Dripping 2 Raisins 1 Egg 1 1 Rose Hip Syrup 1 Fruit Mixed 1 1 Salad Cream 1 Fruit Mixed, cleaned 1 1 Salt 1 Flour Self-Raising 2 Sauce 2 Gelatine 2 Sausage, Pork 3 Ground Nut Oil 1 Sausage-meat, Pork 3 Herbs Mixed 1 Semolina 1 Honey 1 Soup 2 Ice Cream 9 Sponge Mix 1 Kipper Fillets 1 Steak & Kidney (canned) 1 1 Lemon Juice 1 Sultanas, cleaned 1 Liver Sausage 1 Vinegar, Malt 2 Marzipan 1 Vitamin "A" capsules 1 Margarine 2 Wine, White 1 Yeast Tablets 1 The following twelve samples were reported upon unfavourably:— Mixed Fruit (2 samples). As reported in 1956, samples of currants, raisins and mixed fruit all the products of one producer and sold as "cleaned" were submitted to the Analyst during that year and were found to contain an excess of grit and earthy matter. A further sample of mixed fruit from this source taken in 1957 after negotiations with the producer as a result of which he undertook to withdraw certain stocks and to double clean those from a particular source, shewed that in spite of the altered processing it was not possible to reduce the sand and earthy matter to the low limit indicated as desirable by the Analyst for dried fruit labelled "cleaned." A sample of mixed fruit from another packer also shewed an excess of earthy matter. Arising out of these cases the Ministry of Agriculture, Fisheries and Food and other bodies were approached with a view to a legal standard for permissible 40 sand and earthy matter in mixed fruit being introduced. The Ministry informed the Council that— "the question of the adoption of a Standard for Dried Fruit described on the packages or otherwise as "cleaned" has now been discussed with the National Dried Fruit Trade Association and other representatives of the dried fruit trade, who have taken the matter away for further consideration, with particular reference to the possibility of:— (a) omitting the word "cleaned" from the label on the container of the dried fruit; and (b) inserting a slip inside the container stating that the fruit has been cleaned but advising further washing of it by the consumer before use." The matter was still under consideration at the end of the year. Milk (6 samples). These samples were among eight taken from an accredited herd of cows at the request of a local farmer who suspected that, owing to feeding difficulties, his cattle were giving milk below the statutory standard. All the samples were taken straight from the cow and six were found to be deficient —two in both fat and solids not fat and four in non-fatty solids only. The Committee were satisfied that they were samples of genuine milk, i.e. as the cow gave it and as further samples taken as soon as the cows were turned out to grass were reported satisfactory on analysis, no action was called for. The quality of the six poor samples was as follows:— Milk Fat Non Fatty Solids Legal Standard 1 3.77% 8.25% 1 Fat—3.0% Non Fatty Solids—8.5 % 2 4.20% 8.40% 3 2.88% 8.44% 4 2.78% 8.30% 5 3.04% 8.30% 6 3.35% 8.33% Steak and Kidney. This sample of canned steak and kidney was reported as containing 80% of meat by the Public Analyst, who expressed the view that a reasonable minimum meat content for such a product is 95 %. The manufacturers agreed to alter the label to include the words "with gravy." Orange Cordial Drink. This was a portion of an orange drink which a purchaser alleged to be unfit for human consumption. Analysis shewed that there were no foreign ingredients or impurities, but that it had deteriorated through prolonged or poor storage. 41 Drinking Chocolate. The label described this article as "Hot Drinking Chocolate Creamy as Milk Chocolate." The Analyst reported that it contained sugar, cocoa, salt and other flavouring but no milk or milk product. Although the manufacturers did not accept the contention that the words "Creamy as Milk Chocolate" were misleading, they agreed to omit the words when further supplies of the labels were printed. Egg- A resident purchased six eggs from a local grocer. He complained that after cooking they smelt and tasted of disinfectant. A portion of one cooked egg and its shell were submitted to the Analyst who reported the eggs had become contaminated with vapour of a phenolic or associated nature probably as a result of the treatment of the hen house with water proofing or wood preservative material. The vendor, the wholesalers and Packing Station were notified. Section 9—Sale of Unfit Food for Human Consumption The following complaints were received of alleged foreign matter in foodstuffs:— Dark Substance in Bread (2) Screw in Bread Metal Staple in Bread Wood in Bread Hair in Jam Wood in Jam Dirty Milk Bottles (6) Old Bottle Cap in Bottle of Milk Sweet in Bottle of Milk Vegetable Oil in Milk Bandage in Tomatoes The circumstances did not warrant legal proceedings and each was dealt with by appropriate warnings where necessary. Inspection of Food The following quantities of food found to be unsound, diseased or unwholesome and unfit for human food were surrendered and destroyed or so disposed of as to prevent them from being used for human food :— lbs. ozs. lbs. ozs. Cake 5 6 Meat 4,998 3 Cereals 26 0 Milk 109 2 Cream 1 8 Macaroni 4 – Cheese 29 8 Pudding — 6 Coffee — 8 Rice — 15 Fruit Juice 11 5 Soup 27 6 Jelly — 5 Spaghetti 6 8 Fish 351 11 Vegetables 447 15 Fruit 283 7 Total weight 2 tons, 16 cwts., 32 lbs., 1 oz. The method of disposal is by burning in the Council's Refuse Destructor. Inspection of Food Premises The inspections made under the Food Hygiene Regulations and other statutory powers relating to food with the results of these visits, are shewn in Table 9. 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 Ventilation provided Washing facilities for food and equipment provided First-aid equipment provided Accommodation for clothing provided Bakers and Confectioners 15 4 89 1 – 2 – 3 5 – 1 2 – – 4 5 3 – Bakehouses 3 – 59 – – – – – – – – – – – – – – – Butchers 36 29 188 1 3 2 5 3 3 2 4 1 1 8 4 5 4 Canteens 21 – 116 – – – – – – – – – – – – – – – Chemists 17 1 54 – 1 – – – – – – – – – – – – – Cinemas 1 – 4 – – – – – – – – – – – – – – – Confectioners (sweets only) 68 54 132 1 2 2 1 – 2 2 – 1 1 1 Fishmongers 17 7 88 – – – – 1 1 1 – – – – – – 1 1 General Stores 4 3 70 – – – – – – – – – – – – – – – Greengrocers and Fruiterers 39 5 187 1 1 1 – 2 – – – 2 1 2 Grocers (incl. corn chandlers) 79 25 348 1 4 6 1 2 5 4 4 3 – 3 6 2 1 3 Ice Cream vehicles variable – 12 – – – – – – – – – – – – – – – Licensed Premises (with catering facilities) 5 1 11 – 1 1 – – – – – – – – – Licensed Premises (without catering facilities) 20 — 33 – – – – – – – – – – – – – – – Milk Storage Depots 3 – 23 – – – – – 1 – – – – – – – – – Restaurants and Cafes 27 17 140 – 2 1 – 2 3 1 3 3 – – 3 1 1 – Stalls, food variable – 127 – – – – – – – – – – – – – – – Vehicles, food variable — 23 – – – – – – – – – – – – – – – 146 1,704 4 12 13 2 15 22 12 11 14 1 4 22 15 13 10 43 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 and suspected food poisoning Leprosy Smallpox No case of smallpox occurred. This infection was introduced into the London area from the West Indies during the summer, but there were no Carshalton contacts. Vaccination against Smallpox. The County Council who are responsible for the scheme of vaccination against smallpox under Section 26 of the National Health Service Act sought and received Ministry approval to modification of the original scheme under which the Council are now authorised to extend their arrangements to include the primary vaccination of adults and the revaccination of children and adults. Previously the scheme was primarily directed to the protection of infants. With the agreement of the County District Council, the service is directed locally by the District Medical Officer of Health. The chief aim is 44 to secure the protection of infants in the early months of life. Treatment is provided as a free service at the infant welfare clinics and by doctors giving general practitioner services under the Act. Records as to the vaccinal state of the children under five years of age are sufficiently complete as to be of statistical value. These shew that at the end of 1957 50% of the children in those age groups had been vaccinated against smallpox at some time in their lives. Although one could wish for a higher level of immunity than that afforded by this percentage, it can be regarded as not unsatisfactory in the absence of smallpox in the locality for so many years. The outbreaks which occur from time to time in different parts of the country as a result of imported infection, serve to remind us that we are liable at any time to invasion by a disease which has lost nothing of its fatality with the passage of time and the advances of medical treatment. The number of persons recorded as having received successful vaccination during the year was as follows:— Age at 31st December, 1957 i.e. born in Under 1 yr 1957 1-4 yrs 1953-6 5-14 yrs 1943-52 15 yrs & over 1942 and earlier Total Primary Vaccinations— By Private Practitioners 54 93 25 66 238 At Clinics 154 151 8 — 313 208 244 33 66 551 Revaccinations— By Private Practitioners 1 6 26 144 177 At Clinics — — — — — 1 6 26 144 177 In addition, the following unsuccessful attempts at vaccination were made:— Age at 31st December, 1957 i.e. born in .. Under 1 yr 1957 1-4 yrs 1953-6 5-14 yrs 1943-52 15 yrs & over 1942 & earlier Total Primary 7 4 1 12 Revaccination — — 1 9 10 7 4 1 10 22 The estimated number of children under five years of age vaccinated at the end of 1957, was 1,656. Enteric Fever The high level of supervision and control of public water supplies which is now practised is responsible for the virtual abolition of typhoid fever which in the past has been mainly a water-borne infection. Only four cases of true typhoid have occurred in the district since the water epidemics 45 of 1936 and 1937 in the Sutton District and Croydon respectively. Of these four cases (two in 1947 and two in 1953), three were infected whilst on holiday on the continent of Europe and the fourth, a boy, contracted the infection from drinking contaminated water in the vicinity of the Beddington Sewage Farm. Paratyphoid fever is in its nature more allied to food poisoning and is not infrequently contracted from infected food both solid and liquid. It is, as a result, comparatively more prevalent than true typhoid though it is rare now for it to give rise to extensive outbreaks. One case was notified during 1957 in a woman of thirty-three years. The source of the infection (type Taunton) was not established, but it was probably in Battersea where the patient had visited at the material time a family of relatives all of whom had recently suffered from "diarrhoea." The patient was discharged well from Isolation Hospital after a month's treatment. Dysentery Since 1950 the yearly incidence of dysentery has increased throughout the country due almost entirely to the comparatively mild variety caused by the Sonne organism. It is now endemic in that we are never entirely free from odd cases, but it is subject to periodic epidemic outbursts. A bowel infection which is spread mainly by lack of the practise of personal hygiene, it is particularly liable to attack communities of children such as nurseries and infant schools. Outbreaks of this nature have occurred in recent years in the district and they are so explosive in their onset that most of the individuals at risk are already infected by the time the first cases are recognised. Children infect one another in the course of school life and each then proceeds to transmit the illness to most, if not all, the members of his close family circle. Insistence on strict attention to personal hygiene especially in the washing of hands after the use of the toilet and before food for all contacts and due precautions in the nursing of patients succeed in bringing these outbreaks to an end. Though mild and attended by only a very low mortality, it can be fatal to otherwise debilitated people and very young babies. There was no prevalence in the district during the year. Two cases were notified. One was a child admitted to a local hospital for treatment from another area already suffering from the illness. The other was a National Service man who arrived in this country with the illness after service abroad. Neither case arose in the district. The child suffered from a Sonne infection, the service man from the more severe and rarer illness due to the Shiga organism. Both recovered. Scarlet Fever The cases of scarlet fever at 59 were approximately twice as many as in the year before, which year established a record low incidence for this illness. Even so, by comparison with the years prior to 1954 prevalence was very low. Up to 1954 the annual notifications always exceeded 100 being frequently over 200 in the pre-war years. In the last few decades the virulence of this infection has undergone a progressive diminution. It is moreover due to an organism which is particularly susceptible to modern chemo-therapeutic treatment which 46 includes the anti-biotics and the sulpha drugs. In consequence, restrictions, both on cases and contacts, have justifiably been considerably relaxed though precautions are still of value in limiting the spread of this infection. Of the 59 cases 35 were nursed at home. Such is the decreasing importance attached to this illness that when several of these cases were visited the patient was found to have the freedom of the house and no attempt at isolation was being made. TABLE 10. SCARLET FEVER—DISTRIBUTION OF CASES, 1957. 1957 St Helier North St. Helier South Ward Southwest Total St. Helier West NorthEast Northwest Central SouthEast January – – – – 3 – – 1 4 February — 1 — — 1 — — — 2 March 2 1 — 1 1 — — 1 6 April 1 — 1 1 — — — — 3 May 5 2 — — 1 1 — — 9 June 4 – – – – – – – 4 July 4 — — — 2 2 1 — 9 August — — — — — — — — — September 1 2 — 2 4 — — — 9 October 2 — — 2 1 1 — — 6 November 3 — — — — 1 1 — 5 December — — 1 — — — — 1 2 Totals 22 6 2 6 13 5 2 3 59 Monthly mean 1.83 0.50 0.16 0.50 1.08 0.41 0.16 0.25 4.91 Case rate per 1,000 population 2.67 0.84 0.26 0.61 1.81 0.86 0.23 0.46 0.97 TABLE 11. SCARLET FEVER—MULTIPLE CASES, 1957. Ward No. of houses in which occurred Total Houses Total Cases 1 Case 2 Cases 3 Cases St. Helier North 15 2 1 18 22 St. Helier South 6 — — 6 6 St. Helier West 2 — — 2 2 North-East 6 — — 6 6 North-West 11 1 — 12 13 Central 5 — — 5 5 South-East 2 — — 2 2 South-West 3 — — 3 3 Whole District 50 3 1 54 59 47 Diphtheria The district continued to enjoy freedom from this disease as it has done for the previous seven years. Diphtheria Immunisation. The immunisation scheme against diphtheria is the responsibility of the County Council, but as with smallpox vaccination it is, with the agreement of the District Council directed locally by the District Medical Officer of Health. Statistics have been produced which would appear to indicate that there is some relation between the prophylactic injections given against diphtheria, whooping cough, etc. and the precipitation of paralysis in a child suffering from poliomyelitis in the limb in which the injection was given. Concern for this association has led to certain modifications in the practise of immunisation. These statistics referred to indicate that what association there is relates chiefly to the use of alum precipitated preparations especially those used in combination e.g. diphtheria and whooping cough prophylactics. Official policy as a result now provides for alum precipitated preparations to be discontinued, a simple enough matter since alternative plain suspensions can be used with equal effectiveness. But it also provides that combined injections shall not be given in the six months April to September, the time when polio is likely to be more prevalent. There is a serious risk of attaching too much importance to this statistical association and thereby unjustifiably prejudicing the benefits of diphtheria prevention. No case of paralysis in a polio patient arising within a reasonable time after a prophylactic injection has occurred in this district although several thousand children have been immunised since polio became epidemic in 1947. In the absence of any immediate threat from diphtheria and considering the added difficulties associated with the new restrictions on immunisation practise, it is satisfactory that the level of diphtheria immunisation should have been maintained at so high a figure as 63.5 % the same as a year before. In 1957, 651 resident children received a primary course of treatment as follows:— Age at 31/12/57 i.e. born in year Under 1 year 1957 1 year 1956 2 years 1955 3 years 1954 4 years 1953 5-9 years 194852 10-14 years 194347 Total under 15 yrs. At Council Clinics 115 246 33 20 7 4 – 425 In Carshalton Schools — — — 2 5 74 20 101 Private Practitioners 10 104 13 4 6 8 — 145 Less outward transfers 125 350 46 26 18 86 20 671 — — — — 2 9 10 21 Plus inward transfers 125 350 46 26 16 77 10 650 — — — — — 1 — 1 Carshalton residents 125 350 46 26 16 78 10 651 48 A further 1,099 Carshalton children received reinforcing injections during the year. The following table shews the immunisation state of the local child population at the 31st December, 1957:— Number of Children at 31st December, 1957, who had completed a course of immunisation at any time before that date (i.e. at any time since 1/1/43). Age at 31/12/57 i.e. Born in Year Under 1 1957 1-4 1953-1956 5-9 1948-1952 10-14 1943-1947 Under 15 Total A. No. of children whose last course (primary or booster) was completed in the period 1953-1957 130 2,032 3,317 2,605 8,084 B. No. of children whose last course (primary or booster) was completed in the period 1952 or earlier – – 543 1,335 1,878 C. Estimated mid-year child population 730 3,046 8,950 12,720 Immunity Index 100 A/C 17.8 66.8 66.1 63.5 The following table shows the estimated percentage of children immunised at each year end since 1935, when the Council's scheme was inaugurated and the incidence of diphtheria in the resident population. Year Percentage of Children Immunised at year end 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 1957 57 87(66*) 78(64*) 0 0.00 (* Immunised within the last 5 years) 49 Erysipelas No cases of this infectious skin disease were notified. Although the prevalence of this infection has steadily declined in recent years, this is the first in which there were no reported cases. As with scarlet fever the infecting organism is a streptococcus which is particularly vulnerable to the new therapeutic agents, such as penicillin and this fact undoubtedly is in a large measure responsible for the decline in notifications. No doubt many cases, when they present early signs of infection of the skin, are subjected to prompt anti-biotic treatment which, by rapidly subduing the organism, aborts the attack and prevents the development of the typical clinical picture. Pneumonia Except when it results from influenza, pneumonia is only notifiable as a primary condition there being no statutory requirement to notify this illness when it is secondary to some other infection such as measles, whooping cough, etc. Thirty-six notifications were received of which half were stated to be influenzal. Two thirds occurred in the last quarter of the year. Measles Following a year of low prevalence, the expected increase in the incidence of measles materialized in 1957. This is in accord with the long experienced biennial periodicity of this infection in the London area. The total of notifications received was 684 compared with 326 in 1956. It began to assume epidemic proportions early in January, reached a peak in March/April and subsided by the end of May. More than 600 of the 684 cases occurred during these first five months of the year. There were no deaths. TABLE 12.—MEASLES WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1957. (Excluding hospital patients non-resident in Carshalson) 1957 Ward Total St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest January – – 7 23 6 21 16 8 81 February 2 7 7 28 12 13 68 9 146 March 52 27 46 36 8 6 12 6 193 April 38 26 33 41 9 3 4 6 160 May 6 1 6 15 3 3 4 2 40 June 4 1 3 5 4 1 — 2 20 July 17 1 3 3 2 — 2 — 28 August 5 1 — — — — 1 4 11 September – – – – – 1 — 1 2 October — — — — 1 1 — — 2 November – – – – – – – – – December – – – – – – – – – Totals 124 64 105 151 45 49 107 38 683 Monthly Mean 10.33 5.33 8.75 12.58 3.75 4.08 8.91 3.16 56.91 Case rate per 1,000 population 15.08 8.96 14.03 15.56 6.29 8.44 12.66 5.84 11.30 50 Whooping Cough It was reported last year that the cases of whooping cough had fallen to the record low figure of 73. This favourable experience was repeated in 1957 when the number of notified cases was only two more at 75. There can now be little doubt that this improving trend is associated with the growing acceptance of whooping cough immunisation. The County Council first included whooping cough immunisation in their schemes of vaccination and immunisation formulated under Section 26 of the National Health Service Act in 1952. Since that time the increase in acceptance of this service has grown steadily until now it has reached a level comparable with that for diphtheria immunisation. At the end of 1957, 62% of the children under five years of age had received this prophylactic treatment. As is usual when prevalence is low, the cases were spread irregularly over the year, but there was a slightly heavier incidence in the third quarter. There were no deaths. TABLE 13. WHOOPING COUGH—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1957 (Excluding hospital patients non-resident in Carshalton) 1957 Ward Total St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest January 1 1 2 2 6 February.. 2 — 4 6 March — 1 1 1 — 2 — — 5 April — — — 1 — 1 — — 2 May — — — 2 — — 2 June 1 4 — 3 — — — — 8 July 1 1 — 6 1 — — — 9 August 1 2 3 13 — — — — 19 September 2 1 1 9 — — — — 13 October — — 1 — — 1 — 2 November – – – – – – – 1 1 December – – – – – – 1 — 1 Totals 6 10 5 36 1 7 4 5 74 Monthly Mean 0.50 0.83 0.41 3.00 0.08 0.58 0.33 0.41 6.16 Case rate per 1,000 population 0.72 1.40 0.66 3.71 0.13 1.20 0.47 0.76 1.22 Meningococcal Infection One case of meningococcal infection was notified in a boy of six years who developed meningitis. He was admitted to hospital where he made a complete recovery. 51 Poliomyelitis Polio was less prevalent in the district. Four cases were notified compared with 14 in the year before. The number has varied each year between one and a maximum of fifteen in the first epidemic year of 1947. The average number of cases since that year has been 7.5, so comparatively 1957 had a low attack rate. All four cases were accompanied by some degree of paralysis. Details were as follows:— Sex Age Date of Onset Notes and Resultant disability in May, 1958 M 27 16th March Complete recovery after weakness of left arm. M 7 31st July Bulbar type—some paralysis of palate, face and neck from which he has completely recovered. M 45 13th August Bulbar paralysis with serious involvement of respiration. Still has extensive weakness affecting both shoulders, right arm and chest. Treatment continuing. F 19 4th November Initially had weakness of right arm and left leg. Now recovered except for very slight weakness of arm. In May, 1957, the Ministry of Health's Scheme of anti-polio vaccination was extended to include children born in 1955 and 1956 and in November it was further extended to include children born in the years 1943 to 1946 inclusive, children born in 1957 on reaching the age of six months and expectant mothers. This makes the priority groups for which this treatment is now available as follows:— Children born in 1943 to 1956 inclusive. Children born in 1957 on reaching the age of six months. Expectant mothers. Progress in carrying out vaccination was limited by the rate at which vaccine became available and it was not possible to start on the treatment of the extended groups until after the turn of the year. The number of children who received their second injection of vaccine during the year was 1,985. In addition, 140 children had received one injection by the 31st December, 1957. The number of individuals who by the end of 1957 had received two injections at any time (i.e. in 1956 or 1957) was as follows:— Age at 31/12/57. i.e. Born in the years 0-4 yrs. 1953-57 5-9 yrs. 1948-52 10-14 yrs. 1943-47 15 yrs. & over Before 1943 Total Number given 2 injections 520 1,329 289 104 2,242 Estimated midyear Population 3,770 8,950 Percentage children vaccinated 13.8 18.0 52 Ophthalmia Neonatorum This infection of the eyes of the newborn is a rare occurrence in these days of modern chemo-therapy. Only one case was notified—a mild attack following a domestic confinement which cleared rapidly with the help of penicillin and left no defective vision. Puerperal Pyrexia Extensive hospital maternity services catering for a large part of Metropolitan Surrey are established in the district. Well over 2,000 confinements are conducted in these institutions yearly although less than 700 Carshalton babies are born each year. Since medical abnormality existing or potential is the chief reason for admission to the maternity units, it is to be expected that an unusually high proportion of these births will be accompanied by some rise of temperature in the mother and the number of notifications of puerperal pyrexia correspondingly high. During 1957, the number of such notifications was 173, all but one of which were in respect of hospital confinements. Thirty-eight of the total were in respect of Carshalton mothers. All the notified cases recovered. Food Poisoning Fifty-one cases of food poisoning were notified. Of these one was notified as a suspected case, but investigation did not find anything to incriminate food as the cause. Another was a tramp who presented himself at a local hospital with symptoms suggestive of a toxin type of food poisoning. He quickly recovered. Any food which may have been involved was purchased in Ipswich and it was impossible to trace the shops where it was bought. A third case was also an isolated one in a two-year-old child who contracted a Salmonella Typhimurium infection and it was not possible to incriminate any food. The remaining 48 cases were in respect of an outbreak affecting the staff of a local hospital. The exact extent of the outbreak could not be ascertained owing to the difficulty of deciding the cause of an amount of indefinite abdominal discomfort which is normal expectation in the relatively large number of individuals at risk which was approximately 400. The number affected was probably in the region of 60 to 70, although only in 34 was the offending organism isolated. The agent was Salmonella Typhimurium and although there was no conclusive evidence as to the vehicle in which it was conveyed, the circumstantial evidence pointed strongly to canned beef of Australian origin and that the infection was present in one tin of several used before being opened. The sufferers fell into two groups of about equal size, (1) those in which diarrhoea was an early and pronounced symptom—these made a relatively rapid recovery in about three days, and (2) those where diarrhoea was slight, but in whom constitutional disturbance was marked, and these suffered depression and malaise for a very much longer time. 53 TABLE 14. CASES OF NOTIFIABLE INFECTIOUS DISEASE ADMITTED TO HOSPITAL, 1957. Disease Godstone Western Cuddington Wandle Valley Queen Mary's St. Helier Totals Scarlet Fever — — 10 12 2 — 24 Dysentery — — — 1 — — 1 Measles 1 — 1 3 1 1 7 Food Poisoning — — — — 48 1 49 Meningococcal Infection — — — — 1 — 1 Pneumonia — — — — — 3 3 Encephalitis (Post Infectious) — — — — 1 1 2 Poliomyelitis (Paralytic) — 3 — — 1 — 4 Paratyphoid Fever — — — 1 — — 1 Whooping Cough — — 1 3 — — 4 TOTALS 1 3 12 20 54 6 96 54 TABLE 15. INFECTIOUS DISEASES—NOTIFICATIONS, DEATHS AND DISTRIBUTION. (Excluding hospital patients non-resident in Carshalton) Disease Cases notified Case rate per 1,000 population Deaths Distribution by Wards No. of cases removed to Hospital Percentage of cases removed to Hospital St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest Scarlet Fever 59 0.97 — 22 6 2 6 13 5 2 3 24 40 Ophthalmia Neonatorum 1 0.01 — — — — — — — 1 — — — Measles 683 11.30 — 124 64 105 151 45 49 107 38 7 1.02 Whooping Cough 74 1.22 — 6 10 5 36 1 7 4 5 4 5.40 Dysentery 1 0.01 — — — 1 — — — — — 1 100 Pneumonia 36 0.59 — 7 8 9 5 2 1 2 2 3 8.33 Encephalitis (Post Infectious) 2 0.03 — — — — — — 1 — 1 2 100 Poliomyelitis (Paralytic) 4 0.06 — — — — 1 1 — 1 1 4 100 Meningococcal Infection 1 0.01 — 1 — — — — — — — 1 100 Puerperal Pyrexia 38 0.62 — 10 1 9 6 5 2 1 4 37 97 Food Poisoning 51 0.84 — 1 1 — — — — 49 — 49 97 Paratyphoid Fever 1 0.01 – – – – – 1 – – – 1 100 55 TABLE 16. INFECTIOUS DISEASES—Notification by Age Groups, 1957. (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 — 2 5 9 9 27 5 1 1 — — — 59 Ophthalmia Neonatorum 1 – – – – – – – – – – – 1 Measles 11 63 80 88 92 328 13 4 3 1 — — 683 Whooping Cough 6 7 7 13 11 27 1 — 2 — — — 74 Dysentery – – – – – – – – 1 – – – 1 Pneumonia — 2 1 — — — 2 1 8 3 11 8 36 Encephalitis (Post Infectious) 1 – – – – – – 1 – – – – 2 Poliomyelitis (Paralytic) – – – – – 1 — 1 1 — 1 — 4 Meningococcal Infection – – – – – 1 – – – – – – 1 Puerperal Pyrexia – – – – – – – 4 29 5 — — 38 Food Poisoning — — 1 — – 1 — 20 22 3 4 — 51 Paratyphoid Fever – – – – – – – – – – – – 1 56 TABLE 17. MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1957. (Excluding hospital patients non-resident in Carshalton) Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 4 2 6 3 9 4 9 — 9 6 5 2 59 Ophthalmia Neonatorum – – – – – – – – – 1 — 1 Measles 81 146 193 160 40 20 28 11 2 2 — — 683 Whooping Cough 6 6 5 2 2 8 9 19 13 2 1 1 74 Dysentery – – – – – – – – – – – – 1 Pneumonia 3 4 2 — — — 1 — 3 15 3 5 36 Encephalitis (Post Infectious) – – – – – – – – – – – – 2 Poliomyelitis (Paralytic) — — 1 — — — — 2 — — 1 4 Meningococcal Infection – – – – – – – – – 1 — — 1 Puerperal Pyrexia 1 1 6 1 4 2 1 3 2 7 5 5 38 Food Poisoning — — 1 — — – — 49 1 — — — 51 Tuberculosis, Pulmonary 1 4 – 3 5 1 5 3 — — — 3 25 Tuberculosis, Non-Pulmonary 1 — 1 — — 1 — — — — — 1 4 Paratyphoid Fever – – – – 1 – – – – – – – 1 57 Tuberculosis The new cases admitted to the tuberculosis register during the year numbered 73, classified as follows:— Males Females Pulmonary 33 Pulmonary 35 Non-pulmonary 1 Non-pulmonary 4 Of the total additions, 29 were primary notifications and 44 were transferred from other districts. The new cases arising in the district at 29 is the lowest yearly total yet recorded. In the same period, 110 names were removed from the register for the following reasons :— Recovered 31 Death 8 Otherwise (including removals) 71 After allowing for the additions and deductions, the state of the register at the 31st December, 1957, was as shewn in the following table:— TUBERCULOSIS—WARD DISTRIBUTION. Cases on Register at 31st December, 1957. Ward Pulmonary Non-Pulmonary Total Incidence per 1,000 population Males Females Males Females St. Helier North 69 70 10 8 157 19.0 St. Helier South 66 52 6 7 131 18.3 St. Helier West 49 66 4 9 128 17.1 North-East 57 67 7 4 135 13.9 North-West 25 26 — 2 53 7.4 Central 27 24 1 1 53 9.1 South-East 46 27 — 4 77 9.1 South-West 22 20 — 1 43 6.6 Whole District 361 352 28 36 777 12.8 713 64 The total of 777 is 37 less than at the corresponding date twelve months earlier. The number of patients from Carshalton who received institutional treatment under the arrangements of the South-West Metropolitan Hospital Board during the year was 59. 58 The number of tuberculous persons who died during the year was 8, distributed by age groups as follows:— Age, Years Pulmonary Non-Pulmonary Total Males Females Males Females 0 – – – – – 1—5 — — — — — 5—15 — — — — — 15—25 — 1 — — 1 25—35 – 2 — — 2 35—45 — 1 — — 1 45—55 – – – — — 55—65 1 1 — 1 3 65—up 1 — — — 1 Totals 2 5 — 1 8 The deaths attributable to tuberculosis were 3, as follows:— DEATHS DUE TO TUBERCULOSIS, 1957. Ward Pulmonary Non-Pulmonary Death Rate per 1,000 population Mean age at Death Male Female Male Female St. Helier North – – – – – – St. Helier South — — — — — — St. Helier West — — — — — — North-East — — — — — — North-West 1 1 — — 0.27 45 Central — — — — — — South-East — 1 — — 0.12 57 South-West — — — — — Totals 1 2 — — 0.04 49 All three deaths were of notified cases. No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or under Section 172 of the Public Health Act, 1936. The Council adopted a points scheme for deciding the order of priority of applicants for housing accommodation. Special "weighting" is provided under this scheme where the existence of tuberculosis in the household creates a risk of infection. Two tuberculous families were rehoused by the Council in 1957. Mass X-Ray The Mass 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. 59 TABLE 18. TUBERCULOSIS. New Cases, Age and Sex Distribution and Manner of Admission to Register, 1957. Age Group Years Primary Notifications "A" Cases transferred from other Districts Cases brought to notice other than by Notification or Transfer Total New Cases Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. M. F. M. F. 0—1 — — — — — — — — — — — — 1- 5 — — — — 1 — — — — — — — 1 5—10 — — — — — — — — — — — — — 10—15 1 — — 1 — — — — — — — — 2 15—20 1 5 — — 1 1 — — — — — — 8 20—25 2 4 — — 3 4 — — — — — — 13 25—35 3 — 1 1 9 11 — 1 — — — — 26 35—45 1 — — – 3 5 — – — — — — 9 45—55 3 2 — – 2 1 — — — — — — 8 55—65 1 — — 1 — 2 — — — — — — 4 65 up 2 — — — — — — — — — — — 2 Totals 14 11 1 3 19 24 — 1 – — — — 73 29 44 — 60 Carshalton T.B. Care Committee Established more than 20 years ago this voluntary Committee has, in the many and varied ways which are beyond the scope of the official schemes, provided help to Carshalton tuberculous patients and their families which for many years have numbered more than 800. Although both incidence of new cases and mortality from this disease are responding very satisfactorily to modern medical techniques, the falling death rate from this cause has the effect, until this infection is finally eradicated, of increasing the number of tuberculous families all of whom may need the economic and social assistance of the Care Committee. This is due to the increased expectation of life for the tuberculous now achieved by more successful treatment. Except for a small grant of £50 from the County Council in whom the statutory responsibility for care and after care is vested, the whole income is raised by voluntary effort mainly by the sale of Christmas seals. This source of income is now however seriously threatened since many other charities have recently adopted the seals sale scheme as a means of raising funds. In 1957, disbursements by way of help to patients and their families exceeded £600. The help provided as indicated in the Committee's annual report was of the following nature:— Provision of clothing—household goods—bedding—food—training equipment—courses of instruction. Fares to visit relatives in hospital. Pocket money whilst in hospital. Loan of typewriters and other occupational equipment. Provision of holidays, especially for children. Christmas presents and outings. The Committee also in addition to its direct assistance makes the necessary inquiries and secures all the help which is available from the various statutory bodies and other voluntary associations. Meteorology The following rainfall was recorded at the Council's Pumping Station in Buckhurst Avenue. Rainfall 1957 Amount in ins. Rainfall 1957 Amount in ins. January 1.53 July 2.44 February 2.77 August 2.99 March 0.69 September 2.55 April 0.24 October 1.65 May 1.32 November 2.61 June 1.00 December 1.95 Total 21.74 The spring water flow over the weir on the head of the River Wandle in the grounds of the Grove was as follows :— Total Spring flow during the year (Jan.—Dec. 1957) = 843.63 million gallons. Minimum Spring flow 0.18 million gallons/day on 10th December. Maximum Spring flow 5.85 million gallons/day on 5th April. 61 INDEX PAGE Acreage 6 Atmospheric Pollution 25 Births— Distribution 11 Institutional 10 Rates 7, 10, 11 Cancer 7, 13 Cemeteries 31 Clean Air Act 25 Clinics and Treatment Centres 19 Closet Accommodation 22 Deaths— Classification Distribution 14 Rate 7, 11, 13 Diphtheria 48 Immunisation 48 Dysentery 46 Disinfection 25 Disposal of Dead 31 Drainage and Sewerage 21 Employment Agencies 30 Enteric Fever 45 Erysipelas 50 Establishments for Massage, etc 30 Factories Food— Food and Drugs Act Inspection and Supervision 42, 43 Poisoning 53 Health Services 18 Heating appliances (Fireguards) Regulations, 1953 30 Housing— Council's Scheme Inhabited Houses 6 Inspection 33 Rent Act Repairs and Rents Act, 1954 Overcrowding 34 Slum Clearance Ward Distribution 34 Ice Cream 38 Infant Mortality 7, 16 Infectious Diseases 44, 55, 56, 57 Inquests 15 Isolation Hospital— Admission to 54 Laboratory Facilities 62 PAGE Mass X-Ray 59 Maternal Mortality 7, 16 Measles 50 Meat 39 Meningococcal Infection 51 Merchandise Marks Act, 1926 30 Meteorology 61 Milk Supply 37 Milk and Dairies Regulations, 1949 38 Mortuary 31 Natural and Social Conditions 6 National Assistance Act 31 Offices 28 Outworkers 28 Ophthalmia Neonatorum 53 Pet Animals Act, 1951 30 Pneumonia 50 Poliomyelitis 52 Vaccination 52 Population 7, 8, 9 Public Cleansing 22 Puerperal Pyrexia 53 Rag Flock and Other Filling Materials Act, 1951 30 Rateable Value 6 Rats and Mice Destruction 27 Rivers and Streams 21 Sanitary Circumstances 20 Sanitary Inspection 22 Scarlet Fever 46 Shops Act 30 Smallpox 44 Smoke Abatement 25 Staff 5 Statistics— Comparative 12 Vital Swimming Baths 27 Tuberculosis 7, 15,58,59,60 Care Committee 61 Unemployment 8 Vaccination 18, 44, 45 Vermin Control 25 Water Supply 20 Whooping Cough 51 Zymotic Diseases— Deaths from 63