AC 4413(3) CARSHALTON URBAN DISTRICT Annual Report OF THE Medical Officer of Health FOR THE YEAR 1958 CAR 23 CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1958 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 1958. For some years past the population has been fairly static and whilst the problems associated with a growing population such as were experienced particularly in the 1930's have no longer to be coped with, others, no less difficult, have now arisen due to the fact that the pressure of natural increase constantly strains the already well filled capacity. The vital statistics for 1958 are generally satisfactory and shew an overall improvement over the year before. The birth rate is higher, infant mortality substantially less and maternal mortality non-existent. The death rate shews a small rise which is not contrary to expectation. As was observed in last year's Report, the average age of the population which was especially low a generation ago, is steadily rising towards the national level and year by year the higher age groups which naturally have the highest death rates, form an increasing proportion of the total. In addition, two institutions for old people have been brought into use in recent years, Woodcote Grove House and part of the Wandle Valley Hospital. Residents are admitted there to end their days from a wide area and their deaths inflate the local mortality rate. A further consequence of the rising age of the population is a progressive increase in the deaths from cancer. Without some significant advance in the treatment of this disease, it is likely to assume a greater proportion of the total mortality as time goes on. The risks attendant upon excessive smoking and other forms of air pollution, are highlighted again by much the highest mortality yet recorded in the district from cancer of the lungs. The situation in respect of infectious disease again gives cause for satisfaction, the more noticeable improvements being, as one would expect, in those diseases which can be attacked by immunisation or vaccination procedures. The district remained free from diphtheria, whooping cough was down to a new low record and only one case of non-paralytic poliomyelitis was reported. 3 Constant supervision exercised over food and food premises is reaping its reward in higher standards of quality and cleanliness for many of the articles of our daily diet. For example every sample of milk, which numbered over 200 during the year, passed the various tests to which this commodity is subjected—qualitative analysis—keeping quality—adequacy of pasteurisation—freedom from tuberculosis—whilst all the 93 samples of ice cream were found to be of the highest grade. If these gains in the field of food control are to be consolidated, there must be no remission in the vigilance which has secured them. For too many years the justifiable measure of satisfaction with which this Report on the public health has been presented, has been dimmed by the knowledge that a menacing situation still exists due to overcrowding. The figures for instances of legal overcrowding are admittedly few and are slowly falling, but between the strict overcrowding standard of the Housing Act and adequate accommodation, there is a vast amount of crowding which remains the greatest single environmental cause of illhealth, particularly of mental illhealth. Nothing can be more calculated to wreck what could and should be a happy marriage, than a young couple being condemned to live with their in-laws, added to which are the adverse effects on physical health due to what Simon the first Medical Officer of London graphically described in an earlier age as "this pestilential heaping of human beings." Progress in public health is a continuous process and like so many perpetual advances it is marked by prominent milestones, occasions when great strides forward are achieved. The Clean Air Act, 1956 may well prove eventually to be such a milestone. For the first time it has been put within the power of Local Authorities to rid the atmosphere of most of that man-made pollution which costs the nation so much, not only in material damage, but in an incalculable amount of mortality and still more morbidity, due to respiratory disease. The financial cost of the creation of smokeless zones may in the first instance seem somewhat heavy, but it is negligible when compared with the cost alone of the hospital treatment of a wide range of chest diseases, which owe their origin to, or are aggravated by, a poisoned atmosphere, to say nothing of the deaths which are occasioned or accelerated by fog and smog each winter. Realisation of the power for good of this statutory measure like many earlier revolutionary reforms is slow, but there is little doubt that public opinion will in the end appraise its value and demand its benefits. I renew my thanks to all members of the staff who by their conscientious and willing efforts have made it possible to present once more so satisfactory a record of health administration. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, F. LAWRENCE SMITH, Medical Officer of Health. July, 1959. 4 PUBLIC HEALTH STAFF Medical Officer of Health : * F. Lawrence Smith, M.B., Ch.B., D.P.H., The Lodge, Honeywood Walk, Carshalton. (Telephone Wallington 5501) Chief Public Health Inspector: † H. J. Spicer, C.R.S.I. Deputy Chief Public Health Inspector: † G. R. Surfleet, C.R.S.I. Public Health Inspectors: † L. W. Rivett, C.R.S.I. † J. P. Dixon, C.R.S.I. † L. A. Biggs, C.R.S.I. Public Health Nurse: Mrs. D. E. Baldock, S.R.N. Chief Clerk: Miss V. St. P. Hotten * Also Divisional Medical Officer, Surrey County Council. † Meat and Food Certificate of the Royal Sanitary Institute. 5 Section A—Natural and Social Conditions of the District Area (in acres) 3,346 Estimated number of inhabited houses (end of 1958) according to Rate Books 17,464* Rateable Value at 31st December, 1958 £829,244 Sum represented by Id. rate £3,379 (*Includes 259 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 County Council have in hand an Improvement Scheme for that part of the river which flows within the County of Surrey. This involves deepening and clearing and is designed to improve the flow along the whole of its course. The County districts through which the river runs will each make an appropriate contribution to the cost. No difficulty was experienced during the year from drying up of either of the ponds, which are fed by the head water springs. The flow from these was sufficient to prevent the stagnation of the upper pond, which has occurred in past years, after periods of prolonged low rainfall. The residential character of the district remains unchanged, most of the inhabitants earning their livelihood outside the area in London and elsewhere. Industrial development is small in amount and is sited in the oldest part of the town, mainly along the banks of the River Wandle. Provided the "green belt" remains inviolable, there is virtually no ground available for housing development, other than very small plots, mostly forming part of existing properties. A substantial part of the district houses a population of the low income groups and is developed to a comparatively high density. The rateable value per head of population at £13. 14. Od. (1st April, 1958), is among the lowest in the County and the lowest in Metropolitan Surrey. 6 SUMMARY OF VITAL STATISTICS FOR 1958. (Based on the Registrar-General's Figures.) Population. Registrar-General's Estimate 60,300 Births. Males Females Total Live (Legitimate) 360 365 725 (Illegitimate) 12 13 25 372 378 750 Birth Rate (per 1,000 population) 12.4 Stillbirths (Legitimate) 6 6 12 (Illegitimate) — — — 6 6 12 Stillbirth Rate per 1,000 total births 15.7 Deaths. 293 273 566 Death Rate (crude) per 1,000 population 9.3 Infant Mortality. All deaths under 1 year 7 4 11 Infant Mortality Rate (per 1,000 live births) 14.6 Deaths of leg. infts. under 1 year 6 4 10 Rate per 1,000 legitimate births 13.7 Deaths of illeg. infts. under 1 year 1 — 1 Rate per 1,000 illegitimate births 83.3 Maternal Mortality. Death from Sepsis — — — Rate per 1,000 births — Death from other causes — — — Rate per 1,000 total births — Maternal Death Rate — Zymotic Deaths. 7 Principal Zymotic Diseases — — — Deaths from Measles — — — Deaths from Whooping Cough — — — Deaths from Diarrhoea (under 2 years) — — Zymotic Death Rate — Deaths from Tuberculosis. All Forms 6 3 9 Rate per 1,000 of population 0.14 Phthisis 5 2 7 Rate per 1,000 of population 0.11 Deaths from Cancer 67 68 135 Rate per 1,000 of population 2.23 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 1958 are supplied through the courtesy of the Exchange Manager and the Youth Employment Officer: Men 198 Women 44 Boys 6 Girls 3 The figures in respect of men and women increased by 91 over those 12 months earlier. POPULATION The Registrar-General's estimate of the home population at mid-year is 60,300 which is 140 less than his estimate of a year before. The natural increase representing the excess of births over deaths is of the order of 200, so the Registrar-General's recent estimate postulates that outward migration between mid-1957 and mid-1958 exceeded inward migration by approximately 340 persons. An examination of the Council's waiting list for housing, indicates that 104 applicants were transferred to housing accommodation outside the area in the period 1st July, 1957 to 30th June, 1958. Assuming an average of 3 persons per family unit, rather more than 300 individuals would have been transferred in this manner. The numbers moving in and out of the district under private arrangements are not known, but the Registrar-General's estimate would seem to assume that the number going out exceeded those coming in by approximately 30. TABLE 1. ESTIMATED HOME POPULATION, MID-1958, BY WARDS. Ward Dwellings at Mid-1958 Estimated Population Mid-1958 St. Helier North 2,177 8,180 St. Helier South 1,698 7,110 St. Helier West 2,123 7,450 North-East 2,797 9,680 North-West 2,198 7,150 Central 1,765 5,720 South-East 2,459 8,470 South-West 2,222 6,540 Whole District 17,439 60,300 8 BIRTHS The number of live births registered during 1958 was 750 which is 56 more than in the year before. Of these 372 were males and 378 females, giving a birth rate of 12.4 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 12.0 per thousand population, which compares with 16.4 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 746 live births and 12 stillbirths occurred in 1958. They were distributed as shewn in the following table. Ward Live Births Birth Rate per 1,000 Population Stillbirths Stillbirth Rate per 1,000 total births St. Helier North 89 10.8 – – St. Helier South 74 14.0 2 26.3 St. Helier West 84 14.0 – – North-East 144 14.8 4 27.0 North-West 109 15.2 – – Central 62 10.8 1 15.8 South-East 101 11.9 3 28.8 South-West 83 12.7 2 23.5 Seventy-five per cent. of all births occurred in hospitals and nursing homes. The percentages of such births for the individual wards were as follows:— St. Helier North St. Helier South St. Helier West North-East .. 67 67 78 73 North-West Central South-East . South-West 80 84 77 77 Out of 758 total births, 574 took place in the following hospitals and nursing homes:— Live Still Total Carshalton, Beddington and Wallington District (War Memorial) Hospital 104 2 106 St. Helier Hospital 369 7 376 Other Surrey Hospitals 80 — 80 Other Hospitals 10 — 10 Private Nursing Homes 2 — 2 Totals 565 9 574 For the last five years more than three-quarters of all births have taken place in Maternity Institutions. 9 TABLE 2. BIRTHS, 1958—DOMICILIARY AND OTHERS—BY WARDS. Ward Born in District Born outside District Grand Total In Hospitals and Nursing Homes In Private Dwellings Total In Hospitals and Nursing Homes In Private Dwellings Total St. Helier North 58 28 86 2 1 3 89 St. Helier South 49(1) 25(1) 74(2) 2 — 2 76(2) St. Helier West 66 18 84 — — — 84 North-East 100(3) 39(1) 139(4) 9 — 9 148(4) North-West 69 20 89 20 — 20 109 Central.. 41(1) 10 51(1) 12 — 12 63(1) South-East 60(2) 24(1) 84(3) 20 — 20 104(3) South-West 39(2) 19 58(2) 27 — 27 85(2) Totals 482(9) 183(3) 665(12) 92 1 93 758(12) (Figures in brackets indicate stillbirths included in totals.) TABLE 3. BIRTH AND DEATH RATES FOR CARSHALTON, 1922-1958. 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 1958 60,300 12.4 9.3 14.6 0.0 10 TABLE 4. COMPARATIVE STATISTICS—1958. England and Wales Carshalton Birth Rate (per 1,000 population) 16.4 12.4 (crude) 12.0 (comp.) Still-birth Rate (per 1,000 total births) 21.6 18.7 Death Rate (per 1,000 population) 11.7 9.3 (crude) 11.8 (comp.) Infant Mortality (per 1,000 live births) 22.5 14.6 Neo-natal Mortality (in first 4 wks. per 1,000 live births) 16.2 13.3 Death Rate from Tuberculosis (per 1,000 population) Respiratory Tuberculosis 0.09 0.10 0.11 0.14 Other Tuberculosis 0.01 0.03 Death Rate from Cancer (per 1,000 population) All forms 2.12 2.23 Cancer of Lung 0.43 0.66 Maternal Mortality (per 1,000 total births) Excluding Abortion 0.35 0.43 — Abortion 0.08 — COMPARATIVE HEALTH STATISTICS, 1934/58. 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 1958 11.7 9.3 22.5 14.6 0.35 0 11 DEATHS The deaths allocated to the district, as adjusted by inward and outward transferable deaths, was 566—293 males and 273 females. This gives a crude death rate of 9.3 per thousand population as against 8.3 in the year before. The "comparable" death rate produced by the application of the Registrar-General'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 11.8. The rate for England and Wales was 11.7. The distribution of the deaths by wards was as follows:— WARD DEATH RATES AND MEAN AGE AT DEATH, 1958. Ward Deaths Death Rate (crude) Mean Age at Death St. Helier North 67 8.1 67.2 yrs. St. Helier South 49 6.8 61.6 „ St. Helier West 67 8.9 64.7 „ North-East 90 9.2 68.9 „ North-West 75 10.4 66.6 „ Central 74 12.9 72.4 „ South-East 76 8.9 68.7 „ South-West 70 10.7 67.3 „ Whole District 568 9.4 67.5 „ Mortality due to cancer at 2.23 per thousand, was the highest yet recorded in the district. It compares with 1.70 in the year before and is slightly higher than the rate for the country as a whole. This increase in part reflects the rising average age of the local population, since malignant disease is primarily an affliction of middle and old age. The increase however could be accounted for by the rise in cancer of the lungs. No fewer than 40 deaths from disease in this situation were assigned by the Registrar-General to this district. This is 10 more than the previous highest in each of the years 1953 and 1954. Almost half the total cancer deaths in men were due to disease of the lungs. DEATHS FROM CANCER OF THE LUNGS 1934-58. 1934 0 1947 21 1935 1 1948 15 1936 3 1949 12 1937 6 1950 23 1938 10 1951 12 1939 9 1952 11 1940 4 1953 30 1941 9 1954 30 1942 4 1955 27 1943 13 1956 18 1944 8 1957 25 1945 12 1958 40 1946 8 12 CANCER DEATHS—WARD DISTRIBUTION, 1958. Ward Cancer Deaths Rate per 1,000 Estimated Population St. Helier North 18 2.20 St. Helier South 11 1.54 St. Helier West 17 2.28 North-East 24 2.48 North-West 14 1.95 Central 14 2.44 South-East 18 2.12 South-West 17 2.60 The classification of the cancer deaths by sites affected is given in Table 5. TABLE 5. CANCER DEATHS, 1958. Group Site Affected Male Female Total Digestive Organs— 142 Parotid 1 — 1 145 Pharynx 1 1 2 150 Oesophagus 1 — 1 151 Stomach 10 10 20 152 Small Intestine 1 — 1 153 Colon 2 4 6 154 Rectum 5 5 10 156 Liver 1 3 4 157 Pancreas 2 1 3 Respiratory System— 162 Lungs and Bronchi 32 6 38 Breast and Genito-Urinary— 170 Breast — 16 16 171/4 Uterus — 3 3 175 Ovary — 7 7 176 Vagina — 1 1 177 Prostate 4 — 4 180 Kidney 2 — 2 181 Bladder 1 — 1 Other Sites— 190/1 Skin 2 1 3 192 Eye 1 — 1 193 Brain 1 4 5 194 Thyroid — 1 1 199 Unspecified — 1 1 201 Lymphatic Tissues — 2 2 67 66 133 Average age at death: Males 63.0 years Females 65.8 years All persons 64.3 years 13 Coronary disease of the heart was again a prominent cause of death, killing twice as many men as women. Tuberculosis was rather more fatal in 1958, but the mortality from this disease still compares very favourably with what it was only a few years ago. The death rates from this cause over 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 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 1948 25 0.40 1958 9 0.14 The distribution of tuberculosis mortality by wards and other details are given in Section F of this report. There was again no death from any of the notifiable infectious diseases other than tuberculosis. Violent causes accounted for the death of twenty-four residents. They were:— Road traffic accidents 8 Accidents in the Home 6 Injury at work 1 Misadventure 1 Asphyxia 1 Inhalation of foreign body 1 Suicide 6 Inquests Inquests were held on 56 persons who died in the district. The following verdicts were returned:— Accidental death Misadventure .. 10 Road Traffic .. 17 Suicide .. .. 10 Multiple Injuries .. 1 Manslaughter .. 1 Fall .. .. 13 Natural Causes .. 1 Inhalation of sweet 1 Open Verdict .. 1 Burns .. .. 1 (poisoning) Seventeen of the total were residents of the district. 14 INFANT MORTALITY Infant mortality fell significantly almost to the record low figure of 1948. Eleven children died in the first year of life giving a mortality rate of 14.6 per thousand related births. This compares with 22.5 for England and Wales. The local rate in the year before was 21.6. Eight of the total infant deaths occurred within the first week of life and were due to prematurity, congenital deformities or birth injury, as a result of which death was unavoidable. The other three were the result of infections producing broncho-pneumonia. TABLE 6. INFANT MORTALITY—WARD DISTRIBUTION. Ward Infant Deaths Rate per 1,000 Live Births St. Helier North – – St. Helier South 2 27.0 St. Helier West 1 11.9 North-East – – North-West 2 18.3 Central – – South-East 4 39.6 South-West 2 24.0 TABLE 7. INFANT MORTALITY DURING THE YEAR 1958. 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 Congenital Malformation 2 — — 2 — — — — 2 Atelectasis 1 — — — 1 — — — — 1 Pneumonia — 1 — 1 2 — 1 — — 3 Birth Injury 4 — — 4 — — — — 4 Totals 8 1 — 1 10 — 1 — — 11 MATERNAL MORTALITY No death attributable to child-birth occurred during the year. 15 16 TABLE 8—CAUSES OF DEATH DURING THE YEAR 1958—BY AGE AND SEX No. Causes of Death 0 — 1 — 5 — 15 — 25 — 35 — 45 — 55 — 65 — 75 — All Ages M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Pns. All Causes Total 7 4 2 1 4 — — 1 1 2 8 2 30 24 84 51 84 43 73 147 293 275 568 1 Tuberculosis, Respiratory — — — — — — — — — — — — 1 — 1 2 2 — 1 — 5 2 7 2 Tuberculosis, other — — — — — — — — — — 1 — — — — 1 — — — — 1 1 2 3 Syphilitic disease — — — — — — — — — — — — — — — 2 — 1 — 2 — 5 5 4 Diphtheria — — — — — — — — — — — — — — — — — — — — — — — 5 Whooping Cough — — — — — — — — — — — — — — — — — — — — — — — 6 Meningococcal Infections — — — — — — — — — — — — — — — — — — — — — — — 7 Acute Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — 8 Measles — — — — — — — — — — — — — — — — — — — — — — — 9 Other Infective and Parasitic Diseases — — — — — — — — — — — — — — 1 — — — — — 1 — 1 10 Malignant Neoplasm, Stomach — — — — — — — — — — — — 2 1 3 3 5 — — 6 10 10 20 11 Malignant Neoplasm, Lung — — — — — — — — — — — — 4 1 16 2 8 2 4 1 32 6 38 12 Malignant Neoplasm, Breast — — — — — — — — — — — — — 2 — 8 — 4 — 2 — 16 16 13 Malignant Neoplasm, Uterus — — — — — — — — — 1 — — — — — 1 — — — 1 — 3 3 14 Other Malignant and Lymphatic Neoplasms — — — — 1 — — — — — — 1 2 6 9 7 10 6 3 11 25 31 56 15 Leukaemia, Aleuksemia — — — — — — — — — — — — 1 1 — — — 1 — 2 1 4 5 16 Diabetes — — — — — — — — — — — — — — — — — — — 3 — 3 3 17 Vascular Lesions of Nervous System 2 1 — — — — — — — — 1 — — 3 5 6 10 4 17 19 35 33 68 18 Coronary Disease, Angina — — — — — — — — — — — — 8 1 17 3 16 4 10 17 51 25 76 19 Hypertension with Heart Disease — — — — — — — — — — — — — — 1 1 2 — — 3 3 4 7 20 Other Heart Disease — — — — — — — — — — — — 1 2 5 2 8 4 17 39 31 47 78 21 Other Circulatory Disease — — — — 1 — — — — — — — 1 — 4 4 5 3 4 19 15 26 41 22 Influenza — — — — — — — — — — — — — — 1 — — — — — 1 — 1 23 Pneumonia 2 1 — — — — — — — — — — 1 1 3 1 4 1 2 10 12 14 26 24 Bronchitis — — — — — — — — 1 — 1 — 1 — 9 3 4 2 7 5 23 10 33 25 Other Diseases of Respiratory System — — — — — — — — — 1 — — 1 — — — 1 2 1 — 3 3 6 26 Ulcer of Stomach and Duodenum — — — — — — — — — — — — — — 1 — 1 — 6 — 8 — 8 27 Gastritis, Enteritis and Diarrhoea — — 1 — — — — — — — — — 1 — 1 — — — — 1 3 1 4 28 Nephritis and Nephrosis — — — — — — — — — — — — — — 1 — — 1 — — 1 1 2 29 Hyperplasia of Prostate — — — — — — — — — — — — — — — — 2 — 1 — 3 — 3 30 Pregnancy, Childbirth, Abortion — — — — — — — — — — — — — — — — — — — — — — — 31 Congenital Malformations 1 1 — — — — — — — — — — 3 — 1 — — — 4 2 6 32 Other Defined and Ill-defined Diseases 2 1 — — — — — — — — 3 — 2 5 2 3 4 5 — 2 13 16 29 33 Motor Vehicle Accidents — — 1 — 2 — — 1 — — 1 — — 1 — — 1 — — 1 5 3 8 34 A11 other Accidents .. — — — 1 — — — — — — — — 1 — 3 — — 2 — 3 4 6 10 35 Suicide — — — — — — — — — — l l — — 1 l 1 1 — — 3 3 6 36 Homicide and Operations of War — — — — — — — — — — — — — — — — — — — — — — — Section B—Health Services. Laboratory Facilities The Public Analyst appointed by the Council is Mr. D. D. Moir, 16, Southwark Street, London, S.E.I, to whom samples of food, drugs and water are submitted. Clinical material in respect of infectious disease is examined by the Hospital Laboratory Service, chiefly at the St. Helier Hospital. Investigation of specimens in cases of food poisoning and the bacteriological examination of milk and water is carried out at the Public Health Laboratory at Epsom. Biological testing of milk for tubercle bacilli is done at the Guildford Public Health Laboratory. The following examinations were made during the year:— Blood 1 Nose and Throat Swabs 12 Faeces Specimens 164 Water (Public Supply): For chemical analysis 2 For bacteriological examination 5 Water (Swimming Bath): For bacteriological examination 8 Food and Drugs: Analysis 290 Bacteriological examination of milk 186 Bacteriological examination of ice cream 93 Biological examination of milk 9 Vaccination and Immunisation The arrangements for the prophylactic treatment of infectious disease which are the responsibility of the County Council as the Local Health Authority under Section 26 of the National Health Service Act, have been steadily expanded as new and successful inoculation techniques have been devised. The diseases for which preventive vaccination or immunisation is now available under the County Council's schemes, include smallpox, diphtheria, whooping cough, tetanus, poliomyelitis and tuberculosis. Except in the case of the last two mentioned diseases, the schemes are directed locally by the Medical Officers of Health of the County Districts. Those in respect of poliomyelitis and B.C.G. are administered by the Divisional Medical Officers. Details of the work done under these arrangements are given in Section F. 17 Clinics and Treatment Centres The following programme of clinics is provided by the County Council and the Hospital Board and are available to residents of the district. Care of Mothers and Young Children. Rochester Road Centre: Infant Welfare Clinic Tues. and Thurs. 2—4 p.m. Maternity Clinic Thursdays 10—12 noon Toddler Clinic Mondays 2—4 p.m. Dental Clinic By appointment Massage Clinic Mons., Tues., Weds., Thurs., Fridays 10—1 p.m. Mons., Tues., Thurs., Fridays 2—5 p.m. Green Wrythe Lane Centre: Infant Welfare Clinic Weds., and Fridays 2—4 p.m. Maternity Clinic Tuesdays 10—12 noon Toddler Clinic Tuesdays 2—4 p.m. Dental Clinic By appointment Alexandra Gardens, Stanley Road Centre: Infant Welfare Clinic Fridays 2—4 p.m. Maternity Clinic Tuesdays 10.3C —11.30 a.m. Toddler Clinic 1st and 3rd Thurs. 2—4 p.m. The Mount Centre: Infant Welfare Clinic Wednesdays 2—3.30 p.m. Maternity Clinic Tuesdays 2—3 p.m. Toddler Clinic 2nd Thursday 2—4 p.m. School Health Service—General Medical Clinics. Rochester Road Centre Mons. and Fridays 9 30—12 noon Alexandra Gardens, Stanley Road Centre Mondays 9. 30—12 noon Green Wrythe Lane Centre Mondays 9 30—12 noon Thursdays 2—4 p.m. 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. Poliomyelitis Vaccination—at special clinics in health centres, schools, factories, etc., by appointment. Tuberculosis Clinics. St. Helier Hospital Mons. and Fridays 2 p.m. Wednesdays 9.30 a.m. 3rd and 4th Mondays (for old cases only) 5.30 p.m. Venereal Disease Clinics. St. Helier Hospital Mondays (Males) 4—6.30 p.m. Wednesdays (Females) 5—7 p.m. 18 Section C—Sanitary Circumstances. Water Supply Except for a small part of the area on the northern boundary comprising approximately 170 dwellings supplied by the Metropolitan Water Board, the district is within the supply area of of the Sutton District Water Company. Water is derived from wells in the chalk situated at Sutton, Cheam and Woodmansterne. If the need arises the supply can be augmented by the Epsom and Ewell Corporation's water undertaking, or by the East Surrey Water Company and by the Metropolitan Water Board. The Company is under a statutory obligation to soften their own supply to 9° of hardness. All dwellings have a piped supply. The water is not considered to be plumbo-solvent. Comprehensive arrangements exist for safeguarding the purity of the water as supplied to the public, including treatment by chlorination. There is a daily check both on the raw and finished waters by the Company's resident chemist. Samples are also taken as a routine by a firm of Consulting Water Chemists on behalf of the Company, and by the Public Health Departments of the District Councils in the Company's distribution area, on an agreed rota. The supply both in quantity and quality was satisfactory during the year. The following summary of the water examinations carried out in the Company's Laboratory, is supplied by courtesy of the Resident Chemist. 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 samples showing B. Coli present in 100 ml. of sample (Type 1) Total No. ColiAero genes Organisms in 100 ml. of sample No. % No. % Sutton Raw 307 53 23 7.5 19 6.2 42 Sutton Finished 308 12 Nil Nil 2 0.7 2 Woodmansterne Raw 307 53 2 0.7 2 0.7 4 Woodmansterne Finished 307 12 Nil Nil 1 0.3 1 Cheam Raw 306 53 4 1.3 7 2.3 11 Reservoir 267 Nil 1 0.4 1 0.4 2 District 274 Nil 2 0.7 2 0.7 4 Total 2,076 183 32 34 66 The Public Health Departments in the area of supply submitted 30 samples for bacteriological and 15 samples for chemical examination during the year. All indicated that the water was pure and wholesome and fit for public supply. Of the 15 chemical analyses made, 3 shewed hardness in excess of 9°. Two of these taken in Epsom in May and November shewed hardness of 18° and they were undoubtedly samples of water taken by the Company from the Epsom and Ewell Corporation's supply to augment their own in that part of the distribution area. The following is the report on a sample taken locally which is fairly representative of this chalk well supply. 19 (a) Physical Examination Colour Faint blue Taste normal Appearance Settled water bright and clear Smell none Trace of white deposit (b) Chemical Examination in parts per million Total solid residue (dried at 180°C.) 210 Chlorine present as chloride 19.5 Ammonia, free 0.01 Ammonia, Albuminoid 0.01 Nitrate nitrogen 11.2 Nitrite nitrogen 0.01 Oxygen absorbed from (a) in 4 hours 0.12 permanganate solution (b) in 15 mins — Hardness, as CaC03—Temporary 78 Permanent 53 Total 131 Alkalinity, as CaCO3 78 Free carbon dioxide, as CO2 — Iron absent Other metals absent Residual chlorine 0.03 Electric Conductivity at 20 °C 290 units pH. 7.3 (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 free from contaminating metals. The slight trace of white deposit which separates from the water on standing consists of chalk only. The bacteriological condition of the water is excellent. As judged by this sample the water is pure and wholesome and is suitable for the public supply. The average hardness of the samples taken by the local authorities excluding the two which were not representative was 8.4°. Drainage and Sewerage The routine work of maintenance of soil and surface sewers was carried out, but there were no major works of reconstruction. A number of soakaways were enlarged in size. Three hundred and sixty-two drainage obstructions affecting 1,116 houses were dealt with during the year. Rivers and Streams The County Council who have the responsibility for its maintenance, execute periodic clearing work on the River Wandle. An improvement scheme, to which all the Surrey Authorities in whose districts the River flows have agreed in principal, is now being prepared by the County Council. This is designed primarily to prevent flooding which mainly affects the districts lower down the River. A certain amount of work will be called for in the Carshalton stretch but this will not be extensive. 20 Closet Accommodation All dwellings have water closets which are connected to the public sewers, except in 17 properties where they are drained to cesspools. The Ministry's sanction has now been received to proceed with the soil sewer extension in the Woodcote Grove area, which the Council first proposed to carry out in 1956. This scheme will do away with a number of the existing cesspools. Public Cleansing The arrangements for collection and disposal of refuse remain as before. Clinker and screenings from the destructor continue to be taken to the Cemetery Board land in lower Morden. The organisation includes the salvage of saleable commodities, such as paper, tins, metals, bottles and rags. 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 1,385 complaints as follows:— Accumulations 26 Animals so kept 7 Burst pipes 11 Dampness 25 Drainage defects 80 Drains obstructed 380 Dustbins 129 Food contaminated 11 Food Hygiene Regulations—Contraventions 2 General defective conditions 68 Insects and Pests 107 Miscellaneous 68 Obnoxious effluvia 26 Overcrowding 5 Refuse collections 27 Rodents 287 Roofs, defective 15 Sewer obstructions 9 Shops Act—Contravention 1 Sink waste pipes 5 Smoke nuisances 24 Unsound food 62 Verminous premises 9 Water supply 1 1,385 Fourteen thousand six hundred and twenty-four visits of inspection and re-inspection were made for the purposes set out below:— Cowsheds 24 Employment Agencies 13 Factories (Mechanical Power) (incl. Laundries 45) 329 Factories (Non-Mechanical Power) 73 Factories (Building Sites) 53 Food and Drugs (incl. Food Bye-laws)1,249 Food poisoning enquiries 10 21 Food premises: Bakehouses 60 Bakers and confectioners 80 Butchers 150 Canteens 34 Canteens—School 60 Chemists 44 Cinema 1 Confectioners (sweets only) 134 Fishmongers 72 General Stores 24 Greengrocers and fruiterers 149 Grocers 336 Licensed premises with catering facilities 18 Licensed premises without catering facilities 33 Milk Storage Depots 5 Ice Cream Vehicles 11 Restaurants and cafes 130 Stalls, food 136 Tea packer 1 Vehicles, food 18 1,496 Hairdressers 83 House drains tested 193 Housing Act 602 Heating Appliances (Fireguards) Act 34 Housing Enquiries 258 Housing Land Charges 924 Infectious Disease Premises 45 Insect Pests 141 Merchandise Marks Act 255 Offices 11 Outworkers premises 62 Pet Animals Act 40 Piggeries 69 Premises re cesspools 19 Public Health Act (Houses) 3,296 Public Health Act re-inspections 3,110 Rag Flock and Other Filling Materials Act 11 Rent Act 39 Rodents 384 Schools 58 Shops 1,371 Smoke observations 253 Tents, Vans, Sheds 2 Urinals 104 Water Sampling 13 14,624 Four hundred and twenty-six informal notices were served concerning the following matters:— Accumulations and deposits .. .. .. .. .. .. 33 Clean Air Act Drainage defects 134 Dustbins .. .. .. .. .. .. .. .. .. 37 Factories Act 10 Food and Drugs Act (incl. Food Bye-laws) .. 49 Food contaminated 10 General defective conditions .. .. .. .. .. .. 98 House Drains Obstructed 1 Miscellaneous 10 22 Overcrowding 12 Rodents 7 Shops Act 15 Verminous Premises 1 Water Supply 2 426 Eighty-one formal notices were served by authority of the Council under the following Acts:— Public Health Act, 1936, Section 24 38 „ „ „ „ Section 39 9 „ „ „ „ Section 45 4 „ „ „ „ Section 75 2 „ „ „ „ Section 93 28 81 As a result of investigations made and notices served, the following work was carried out:— Accumulations removed 19 Brickwork, repaired and/or repointed 5 Ceilings cleansed 10 Ceiling plaster repaired and/or made good 13 Chimney brickwork and pots repaired or renewed 4 flues repaired 2 Damp conditions remedied 22 Damp course renewed 2 Disinfestations 68 Doors and frames repaired, including locks and fasteners 9 Drainage repaired and/or reconstructed 43 houses (515 ft. of drain laid) Drainage inspection chambers repaired 27 inspection chambers provided 3 inspection chamber covers renewed 13 interceptors renewed 3 stoppers or caps refixed and/or renewed 3 soil vents repaired and/or renewed 8 drains tested 53 drains cleared (affecting 1,116 houses) 362 drains sealed off 3 waste gullies repaired, renewed or provided 10 waste pipes, repaired, renewed or provided 8 cesspools emptied 3 Dustbins provided 97 Fences and/or gates repaired or renewed 7 Fireplaces, ranges or stoves repaired or renewed 12 Floors renewed or repaired 11 Glazing and putty renewed 4 Paving repaired and/or made level 3 Roofs repaired and made weatherproof 27 downpipe, guttering repaired and/or renewed 28 Sinks renewed or provided 3 Stairs or steps repaired, renewed or made level 1 Surface water drainage repaired and made to work properly 5 Surface water drainage provided 1 Walls rendered or rendering repaired 8 replastered and/or repaired 17 cleansed and redecorated 10 Wash basins, baths renewed 1 Water Supply pipes renewed 4 23 W.C. pans renewed 10 pan joints renewed 13 seats repaired, renewed or provided 2 flushing apparatus repaired or renewed 11 Windows repaired and/or renewed 22 Disinfection One hundred and twelve rooms and 217 library books were disinfected. Four lots of bedding were sterilised and nine lots destroyed. Vermin Control Persons. The Council have since 1944 maintained a Cleansing Station in Rochester Road, where verminous persons and their personal clothing can be dealt with. Used extensively during the war years particularly for the treatment of scabies infestation, its facilities are now infrequently needed. This is due partly to improved standards of personal hygiene and partly to the development of modern parasiticidal preparations, which can be used effectively in the home. During 1958, 2 families involving 7 persons of whom 4 were schoolchildren made 18 attendances for the treatment of scabies. Nine persons including 7 school children in 4 families made 20 attendances for the treatment of pediculosis infestation. Premises. During the year, sixty-eight premises were treated for the destruction of vermin and insects 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 — — 2 — 1 4 Fleas — — — 3 — — 3 Flies — 8 — 3 — — 11 Maggots .. — — — 1 — — 1 Mites — — — 1 — — 1 Wasps 5 1 — 42 — — 48 6 9 — 52 — 1 68 It will be noted that only four properties were found to be infested with bed bugs. Less than twenty years ago, it was not unusual to deal with up to 30 dwellings for this condition in the year, a large proportion of them by the drastic method of HCN gas fumigation. 24 Clean Air Act, 1956 On the 1st June, 1958, all those provisions of the Clean Air Act which had not already become operative, came into force. Probably the largest contribution the Act makes to freeing the atmosphere from the pollution which is the cause of so much morbidity and mortality, is the power it confers on Local Authorities, to create "smokeless zones," where after the completion of the necessary adaptation of heating appliances, it will be an offence for any chimney to emit smoke. As is well known most of the air pollution experienced in the Greater London conurbation, emanates from domestic chimneys and remedial action in this area will be concerned mainly with private dwellings. In the latter part of the year consideration was being given to the creation of smoke control areas. Such action if successfully pursued to cover the whole of the conurbation offers the greatest prospect of at last removing what is probably the greatest single cause of illhealth, particularly that associated with respiratory disease. The report of the "working party on Sanitary Inspectors" (now designated Public Health Inspectors) set up by the Minister in 1956, has this to say in this connection, "it is clear that the full duties which may be performed by a Sanitary Inspector in relation to atmospheric pollution call for a high degree of technical knowledge and there is a special examination in smoke which many Inspectors take." In anticipation of their extended duties under the Clean Air Act, all the Public Health Inspectors have secured this additional qualification. For many years past the Council have, as a means of assessing the degree of air pollution, provided apparatus for measuring and recording such pollution after receiving the advice of the Department of Scientific and Industrial Research. This takes the form of deposit gauges, filters for assessing smoke concentration and sulphur dioxide content. The three deposit gauges A, B and C from which grit, etc. is calculated on the basis of tons deposited per square mile, were sited at Welbeck Road, Winchcombe Road and Limes Avenue respectively, until on the advice of the Department of Scientific and Industrial Research gauge C was resited in May to Buckhurst Avenue and gauge A was withdrawn in October. The apparatus for the estimation of smoke density and SO2 concentration is sited at The Lodge, Honeywood Walk. The following readings were obtained from this equipment during the year:— Deposit Gauges Gauge Total Rainfall (in inches) Total Solids. Tons per sq. mile Highest Monthly Reading Lowest Monthly Reading Average Monthly Reading *A 23.47 11.57 7.27 9.61 B 28.27 11.80 6.05 8.45 †C 31.05 18.96 6.01 11.53 *Readings discontinued on 1.10.58. †Site changed on 8.5.58. 25 Month Gauge A Gauge B Gauge C Rainfall in ins. Total Solids (Tons per sq. mile) Rainfall in ins. Total Solids (Tons per sq. mile) Rainfall in ins. Total Solids (Tons per sq. mile) January 1.83 9.70 1.83 9.83 1.83 13.62 February 1.96 11.34 1.66 9.22 2.02 18.96 March 0.88 10.31 0.78 9.49 1.12 13.69 April 1.08 9.18 0.91 7.61 1.28 13.53 May 2.58 8.47 2.41 10.00 2.50 15.07 June 4.80 11.34 4.42 9.21 4.80 13.02 July 2.56 7.37 1.94 6.05 2.74 8.66 August 3.41 7.27 3.07 7.04 3.30 8.49 September 4.37 11.57 4.29 8.57 4.50 8.97 October — — 2.90 6.09 2.84 6.50 November — — 1.55 6.49 1.55 6.01 December — — 2.51 11.80 2.57 11.88 Total 23.47 86.55 28.27 101.40 31.05 138.40 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 32.11 4.03 11.28 19.2 0.7 5.8 February 22.07 1.99 8.50 8.2 1.0 3.5 March 17.85 3.82 9.25 12.4 1.7 5.6 April 8.79 0.56 4.83 7.4 0.8 4.0 May 8.21 0.50 1.89 4.2 0.4 1.3 June 6.69 0.50 1.62 3.4 0.2 1.3 July .. 5.11 0.25 1.93 2.7 0.2 1.1 August 6.30 0.49 1.41 3.9 0.2 0.8 September .. 4.26 0.40 1.85 4.2 0.2 1.2 October 19.02 0.53 6.28 10.0 0.2 2.8 November . . 37.46 4.39 17.00 18.6 0.7 6.9 December 36.25 1.16 14.80 20.8 1.5 8.0 Whole year .. 37.46 0.25 6.82 20.8 0.2 3.5 Twenty-four complaints were received and dealt with during the year. Prevention of Damage by Pests Act, 1949 The work of rodent destruction was continued in accordance with a scheme agreed with the Ministry of Agriculture, Fisheries and Food. As from 1st April, 1959, the Ministry's grant towards the cost of this work will be withdrawn, but the power of the Minister is retained in directing the Local Authority as to the manner and extent to which the Local Authority shall exercise their functions under Part I of the Prevention of Damage by Pests Act, to keep the district free from rats and mice. Six thousand nine hundred and seventy-four visits were made by the Rodent Operatives concerning 904 properties and 315 rat and mouse infestations found. Of that number 259 were found in private premises, 46 in business permises, 10 in Council premises. 26 With regard to sewers, two maintenance treatments were carried out, one in May and the other in November. The results are shewn in the following table, together with the three previous years:— May Treatment November Treatment 1955 1956 1957 1958 1955 1956 1957 1958 Manholes baited 186 188 194 198 193 191 199 190 Manholes in which takes of prebait were recorded 56 67 62 80 57 75 83 51 Percentage of manholes showing infestations 30.1 35.6 33.0 40.4 29.5 39.3 42.7 26.8 Percentage in relation to total manholes in district 4.9 5.9 5.7 7.1 5.0 6.6 7.5 4.5 Swimming Baths The only swimming bath in the district is in the ownership of the Council. The water is subjected to precipitation, filtration and chlorination. Testing for adequacy of this purification treatment is not an automatic procedure and both it and the regulation of the plant is a manual operation into which human error can creep. Meticulous attention to this work is called for especially at peak periods in hot weather when the bath is extensively used. Eight samples were submitted for bacteriological examination during the year and whilst all were satisfactory to the extent that no organisms of excretal origin were found, two of the samples taken in July shewed that the number of organisms surviving the chlorination treatment was higher than is desirable. Offices Eleven inspections of offices were made, but no action was necessary. Factories, Workplaces and Outworkers The following table gives a summary of the registers:— Employees Premises Males Females Total Factories— with mechanical power 838 525 1,363 80 without „ „ 45 18 63 21 Workplaces— with mechanical power 38 6 44 32 without „ „ 22 18 40 29 943 567 1,510 162 27 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 Register Number of Inspections Written Notices Occupiers Prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 21 73 – – (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 80 329 10 – (iii) Other premises in which Section 7 is enforced by the Local Authority* (excluding outworkers' premises) 14 53 – – Total 115 455 10 – * Electrical Station (Section 103 (1)), Institutions (Section 104) and sites of Building Operations and Works of Engineering Construction (Section 107 and 108). 2. Cases in which defects were found— (If defects are discovered at the premises on two, three or more separate occasions they are reckoned as two, three or more "cases"). Premises Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness – – – – Overcrowding — – – — Unreasonable temperature — – – — Inadequate ventilation — – – — Defective drainage of floors — – – — Sanitary Conveniences— (a) Insufficient 1 2 – – — (b) Unsuitable or defective 8 2 – – — (c) Not separate for sexes – – – – — Other offences against the Act (not including offences relating to Outwork) 1 1 — — — Total 10 5 — — — 28 Outwork (Sections 110 and 111) Nature of Works Section 110 Section 111 No. of outworkers in Aug. list required by Sect. 110(1) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwhole some premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing Apparel— Making, etc. 15 — — — — – Boxes (cardboard) 1 — — — — – Christmas Crackers 1 — — — — – Lampshades 4 — — — — – Paper Hats 2 — — – Umbrellas 1 – – – – – Wire Brushes 7 — — — — — Total 31 Employment Agencies There are two employment agencies in the district. Both were visited and found to be satisfactory. Shops Act, 1950 There are 507 shop premises on the register and 3,159 inspections were made during the year. Preliminary notices were served with regard to fifteen infringements of the statutory requirements, five for failure to exhibit appropriate notices, three for condition of premises, six for sanitary accommodation and one for Sunday Trading. Nine of the notices have been complied with. Heating Appliances (Fireguards) Regulations, 1953 Thirty-four inspections were made under the Act. No infringements were observed. Merchandise Marks Act, 1926 The Public Health Inspectors are appointed duly authorised officers for the purposes of this Act and continue to execute the provisions of its orders on behalf of the Council. Pet Animals Act, 1951 The number of premises licensed as pet shops remains the same at 6. All were visited periodically and found to be satisfactory. 29 Rag Flock and Other Filling Materials Act, 1951 Eleven visits of inspection were made to the three establishments registered in accordance with Section 2 of this Act. The object of this supervision is to ensure the use of clean materials in upholstered articles and other articles which are stuffed or lined. No action was called for as a result of these visits. The prescribed analysts are—The Chiltern Laboratories Ltd., 48, Abercrombie Avenue, High Wycombe, Bucks. Establishments for Massage and Special Treatment Part IV of the Surrey County Council Act, 1931 requires establishments of this nature to be registered and provides for their inspection. Six premises were registered under these provisions of which four were used for the practice of chiropody and two for massage, etc. All were found to be conducted satisfactorily. National Assistance Acts, 1948—1951 These statutes contain provisions enabling the Medical Officer on behalf of the Council, and with the authority of the Court or Magistrate, to remove to a place of care any person who by reason of old age or infirmity and neglect is living in insanitary conditions. No occasion arose during the year to implement these sections of the Acts. Section 50 Under this section the Council have the duty of arranging for the interment of a person for whom burial is not otherwise being arranged. The occasion to do so did not arise in 1958. Disposal of the Dead In 1943 the Council combined with the Merton and Morden Council in acquiring some sixty acres of land in Lower Morden to serve as a burial ground for both authorities. The Carshalton and Merton and Morden Joint Burial Board was formed and the cemetery was brought into use in 1947. No new space is now available in Carshalton churchyard and the Lower Morden cemetery is now mainly used for the interment of Carshalton residents. In 1956, as reported last year, the North-East Surrey Crematorium Board came into existence and administers the crematorium established in the Battersea cemetery which adjoins the Burial Board's land in Morden. The Carshalton Council is represented on the Crematorium Board together with the Battersea, Sutton and Cheam and Merton and Morden Councils. During the year 147 interments from Carshalton took place out of a total of 390 at the Joint Burial Board's Cemetery. At the crematorium 277 cremations took place of which 13 were from Carshalton. The Council's mortuary in Mill Lane with its comprehensive services including those for the conduct of post mortem examination, received 150 bodies during the year on all of which autopsies were performed. Of the total 46 were admitted from addresses outside Carshalton. For many years the mortuary has been used extensively for the reception of bodies from neighbouring areas mostly on the order of the Coroner and the Council have now made satisfactorily financial arrangements with the Beddington and Wallington and Coulsdon and Purley Councils for the practice to continue. The accommodation at these premises is adequate and the arrangement is an obvious economy. 30 Section D—Housing New Houses During the year 68 new dwellings were completed 49 of which were private dwellings and 19 Council maisonnettes and fiats. The following buildings were in course of erection at the end of the year:— Private dwellings 61 Council Flats 3 Council Maisonnettes 18 Council Bungalows 16 Schemes in various stages of preparation were as follows:— Site No. Site Type of Dwelling No. 36 Culvers House Flats 36 37 Denmark Road Flats 32 38 Denmark Road Flats 48 39 Muschamp Road Flats & Maisonnettes 42 40 Ruskin Road Bungalows 8 87/89 Ruskin Road (conversion) Units for old people 10 Council's Housing Scheme The dwellings in the ownership of the Council at the year end were as follows:— Pre-War Houses 532 Post-War Houses 669 Temporary Bungalows 102 Houses taken over under S.D.A.A. 26 Houses purchased (units of accommodation) 29 Accommodation in Parks, Offices, etc. 18 1,376 The number of requisitioned premises at the 31st December, 1958 was 17 providing accommodation for 24 families. This is 11 less properties under requisition than at 12 months earlier. The Council re-examined the applicants for housing accommodation which numbered approximately 1,000 and divided them into three lists 'A,' 'B' and 'C.' List 'A' comprise those with the highest number of points in the Points Scheme "who might reasonably anticipate assistance from the Council in the foreseeable future." Admission to List 'A' is subject to the family income being below certain limits. List 'B' comprise those with somewhat fewer points "who must not expect an offer of accommodation to be forthcoming unless a change of circumstances affecting pointing 31 promotes their application to List 'A'." List 'C' comprise all the remaining applicants with the lowest points for whom "so far as can be foreseen the Council will not be able to provide accommodation within the Urban District." At the end of the year the 'A' List totalled 88 and the 'B' List 59. One tuberculous family was rehoused during the year. 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) 4,110 (b) Number of inspections made for the purpose 7,220 (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 40 (b) Number of inspections made for the purpose 188 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 40 (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 341 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 1957) 277 3. Action under Statutory Powers during the year. (a) Proceeding under 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 — 32 (b) Proceeding under Public Health Acts. (1) Number of dwelling houses in respect of which formal notices were served requiring defects to be remedied 65 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By Owners 26 (b) By Local Authority 27 4. Housing Act, 1957—Part IV (Overcrowding). (a) (1) Number of dwelling houses overcrowded at the end of the year 33 (2) Number of families dwelling therein 49 (3) Equivalent number of adults dwelling therein 208½ (b) Number of new cases reported during the year 14 (c) (1) Number of cases of overcrowding relieved during the year 27 (2) Number of persons concerned in such cases 193½ (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 14 cases of overcrowding were found and 27 cases were remedied leaving 33 dwellings with 208½ 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 31/12/57 Dwellings found overcrowded during 1958 Dwellings decrowded during 1958 Dwellings remaining overcrowded at 31/12/58 Overcrowded cases remedied during 1958 Formal Action Informal Action Total St. Helier North 19 6 12 13 3 9 12 St. Helier South 4 4 2 6 1 1 2 St. Helier West 12 2 11 3 6 5 11 North-East 3 2 5 — — — North-West 2 — 2 — — — Central 4 — 1 3 1 — 1 South-West — — — — — — South-East 2 — 1 1 1 — 1 Total 46 14 27 33 12 15 27 33 These figures represent the information which comes to the department in the course of routine work and cannot be strictly accurate at any given time. There is no obligation on any one to notify the Authority when overcrowding takes place or when it is abated and only a complete survey carried out simultaneously in every part of the district could ascertain the exact position. The new cases in the last ten years and the known overcrowdec dwellings at the respective year ends were as follows:— Year New Cases Cases at Year End Year New Cases Cases at Year End 1949 160 221 1954 49 105 1950 75 209 1955 26 73 1951 54 217 1956 27 63 1952 79 123 1957 10 46 1953 53 112 1958 14 33 In all the 14 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. 2 London County Council 2 Other Local Authorities 8 Removal of one or more occupants 15 Of the 33 dwellings remaining overcrowded at the end of the year, 21 are owned by the London County Council, 2 by the Carshalton Council and 10 are privately owned. Slum Clearance and Demolition The occupants of the 8 tenement houses of Clearance Area No. 7 in Stanley Road were rehoused and the site cleared in preparation for redevelopment during the year. In April a representation was made to the Council in respect of Clearance Area No. 14 involving 30 terrace type houses and one combined house and shop in St. John's Road. The Council decided to proceed by way of a Compulsory Purchase Order and the Ministry Inquiry was held on the 26th November. One individual house in Wrythe Lane was found to be unfit chiefly as a result of damage to the structure from ground subsidence and an order for demolition was made under Section 17 of the Housing Act, 1957. Housing Repairs and Rents Act, 1954 One certificate of disrepair originally granted under the sections of this Act now repealed was revoked during the year. 34 Rent Act, 1957 The following details show the action which has been taken during the year:— Part I—Applications for Certificates of Disrepair. (1) Number of applications for certificates 29 (2) Number of decisions not to issue certificates Nil (3) Number of decisions to issue certificates:— (a) in respect of some but not all defects 24 (b) in respect of all defects 5 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 16 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule Nil (6) Number of certificates issued 21 Part II—Applications for Cancellation of Certificates. (7) Applications by landlords to Local Authority for cancellation of certificates 4 (8) Objections by tenants to cancellation of certificates Nil (9) Decisions by Local Authority to cancel in spite of tenants' objection Nil (10) Certificates cancelled by Local Authority 3 35 Section E—Inspection and Supervision of Food. Milk Supply Carshalton is a Specified Area for the purposes of the Milk (Special Designations) (Specified Areas) Order, 1951 and hence all milks sold in the district must be "Designated" milk. As a result of the Ministry of Agriculture's Scheme for the eradication of tuberculosis in cattle, Surrey is now an Attested Area and the herds are presumptively free from tuberculosis. Milk Distributors The number of Milk Distributors registered is 20. Designated licences issued during the year were as follows:— Designation Number of Distributors Holding Licences No. of Licences in force on 31/12/58 Principal Licences— Sterilised 13 16 Pasteurised 6 14 Tuberculin Tested 5 13 Supplementary Licences— Sterilised 8 12 Pasteurised 7 11 Tuberculin Tested 7 11 Bacteriological Examination of Milk. One hundred and eighty-six samples of milk were procured and submitted for bacteriological examination. All the milks were sold under the Milk (Special Designations) Regulations and none failed to comply with the prescribed Regulations. Classification of the milk samples and the results of the tests are as follows:— Designation under which sold No. of samples Methylene Blue Test Phosphatase Test Turbidity Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised 125 125 — 125 — — — T.T. Pasteurised 49 49 — 49 — — — Sterilised 12 — — — — 12 — 186 174 174 — 12 — 36 Biological Samples. Nine samples of milk were procured and submitted for animal inoculation tests. All the samples were reported to be free from tubercle bacilli. The eradication of tuberculous infection in cattle made good progress in Surrey during recent years and as mentioned above the County is now an Attested Area. An indication of the progress made in this direction is provided by the fact that the Public Health Laboratory at Guildford, during the last four years failed to isolate tubercle bacilli from any of the 1,500 routine samples examined. This satisfactory situation makes it now possible for the biological testing of milk for tuberculosis to be limited to raw T.T. milk. Milk and Dairies Regulations, 1949—Regulations 19 and 20. No action was called for under Part VII of the Milk and Dairies Regulations, 1949, which empowers the Medical Officer of Health to examine persons handling milk or milk receptacles who are suspected of being infectious or to suspend from work workers found to be infectious or to deal appropriately with any milk supply, where there is evidence of its being the cause of disease or reasonable grounds for believing that it is. Qualitative Analysis. The number of samples of milk submitted to the Public Analyst for qualitative analysis was 187. Of these 36 were "Channel Islands" milk in which the cream content must be not less than 4% instead of the usual legal limit of 3% for ordinary milk. All were found to be genuine samples. The average fat and non-fatty solids of the "Channel Islands" samples was 4.48% and 8.88% respectively; that of the remaining 151 samples 3.65% and 8.62%. Ice Cream Sampling of ice cream was continued and the results classified in accordance with the Grading Scheme described in last year's report. All the 93 samples were found to conform to the highest standard. Although the bacterial cleanliness of this commodity as judged by this method of examination has approached the highest standard in recent years, this is the first occasion that 100% of the samples were of Grade I. 37 The record of these samples since 1947 when the system was first instituted was as follows:— 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 — 1958 93 93 — — Ten samples analysed by the Public Analyst conformed to the statutory standard for composition. Ice Cream (Heat-treatment, etc.) Regulations, 1947-1952. These regulations govern mainly the conditions under which ice cream is manufactured. As there are no manufacturers in the district, the only part of the regulations required to be operated are those requiring ice cream—(a) to be stored at a temperature not exceeding 28°F. and (b) protected from dirt, dust and contamination at all times, and utensils brought into contact with ice cream during manufacture, storage and distribution, to be thoroughly cleansed immediately after use and to be kept clean at all times. All shops handling ice cream are equipped with refrigerators capable of maintaining a temperature below 28F°. and no infringement of the above regulations was observed as a result of the routine visits of inspection. Meat Supervisory duties in connection with meat in the district are limited to those related to its storage and exposure for sale, since there are no slaughterhouses in the area. The quantity of meat seized or suspected as unfit for human consumption during the year was 9,425 lbs. 9 ozs. Analyses of Food and Drugs Samples submitted to the Public Analyst for qualitative analysis numbered 290 as shewn in the following table:— 38 Article No. Adulterated or otherwise irregular Article No. Adulterated or otherwise irregular Almond Flavouring 1 Lemon Curd 1 Almonds Ground Luncheon Meat, Pork 5 5 Antacid Powder 1 Margarine 1 Bacon 1 Marzipan Fruits 1 Baked Beans with Pork Milk 187 Sausage 1 Milk Shake Powder 1 Beef Minced 1 Mincemeat 1 Biscuits Dry 1 Mineral Water 2 Blackcurrant Syrup 1 Mousse 1 Black Pudding 1 Mustard 1 Bread—Slimming 1 Peanut Butter 1 Bronchial Mixture 1 Pickles 1 Browning 1 Pork Roll, Stuffed 1 Butter 2 Prunes in Syrup 1 Cheese 1 Pudding—Ready 1 Chocolate Flav'd. Milk 1 Puff Pastry 1 Christmas Pudding 1 Raspberry Crystals 1 Coffee 1 Rennet Flavoured 1 Compound for 1 Rice Pudding 1 ing Weight 1 Saccharine Tablets 1 Confectionery—Flour 3 1 Sausage 1 Confectionery—Sugar 9 1 Sausage, Pork (canned) 1 Cooking Oil 2 Sausage Rolls 1 Cordial 2 Sausage Saveloy 1 Corned Beef 1 Scampi Curry 1 Cough Sweets 1 Soup, Bird's Nest 1 1 Cream 1 Soup, Oxtail 1 Currants—Washed 1 Steak—Stewed in Gravy 1 Digestion Powder 1 Steakettes Frozen 1 Drinking Chocolate 1 Steak & Kidney Pie 1 Dripping 1 Steak & Kidney Pudding 1 Grape Jelly 1 Stomach Powder 1 Halibut Liver Oil Capsles. 1 Strawberries in Syrup 1 Ham & Chicken 1 Suet 1 Honey 1 Tea 1 Horse-radish Sauce 1 Tomato Puree Cond'sed. 1 Ice Cream 10 Tonic Epitone 1 Jam 1 Vinegar, Malt 1 Jellied Eels 1 Vinegar, Spiced 1 Lard 1 The following 8 samples were reported as adulterated or otherwise irregular : Bird's Nest Soup. The Analyst queried the designation of this soup in view of the fact that bird's nests were only used as a minor garnishing and were not an important ingredient of the stock. The manufacturers stated that their Bird's Nests Soup was made from an authentic Chinese recipe and that a high proportion of edible bird's nest was dissolved during cooking. The true nature of the soup was indicated by the list of ingredients on the label. No action was taken. 39 Chocolate Layer Cake. This cake contained not more than 0.2% of dry fat free cocoa butter instead of 3%. The vendors admitted that the cake was wrongly labelled and their undertaking in future to describe it as "Layer Cake" was accepted. Pork Luncheon Meat (5 samples). The first of these samples was found to contain 64% of meat including fat and in the opinion of the Analyst was much too low to warrant the designation "Pork Luncheon Meat." The importers of this foreign product stated that although there was no statutory standard for meat content, they had arranged with the packers to increase the meat content to 70% and to delete the word "Pork" from the label. Four other samples of Pork Luncheon Meat were secured, a further one from the same importer and three of different brand from the first for comparison. These shewed meat contents of 67%, 77%, 76% and 72%. It was felt that in the absence of a legal standard, these foreign imports appeared likely generally to reduce the existing standard of this commodity and representations were made to the Urban District Council's Association and to the Ministry of Agriculture, Fisheries and Food urging that a statutory standard should be prescribed for this product. The Parliamentary Secretary to the Ministry, subsequently indicated in Parliament in answer to a question, that the Food Standards Committee will in due course be asked to consider and advise about the composition of canned meats. Raspberry (Flavoured) Bar. This was a bar of confectionery containing pieces of cardboard in the substance of the bar. The manufacturers stated that this was the result of cutting the bars on a cardboard base. They thereafter substituted a plastic board to prevent further complaints and no further action was taken. Section 9—Sale of Unfit Food for Human Consumption The following complaints were received of alleged foreign matter in foodstuffs:— Foreign matter in Bread (3) Vegetable Oil in Bread Glass in Bread Roll Maggots in Chocolate Foreign matter in milk Glass in milk Maggots in Mushroom Soup Powder Poppy Seed in Peas Mould on Pork Pie Pan Scale in Salt Pieces of Cardboard in Sweet Appropriate warnings were given where necessary. Inspection of Food The following quantities of food found to be unsound, diseased or unwholesome and unfit for human food were surrendered and destroyed or so disposed of as to prevent them from being used for human food:— 40 lbs. ozs. Baby Food 1 15 Beverage — 12 Butter — 8 Cake 1 13 Cheese 1 1 Confectionery (Sugar) 112 — Cream 114 Essences 6 7 Fat 16 — Fish 277 15 Fruit 189 14 Fruit Juice 5 8 lbs. ozs. Gravy Browning 2 10 Jelly 3 8 Meat 9,425 9 Milk 89 12 Pickles 1 11 Pudding — 10 Rice 11 4 Soup 56 2 Spaghetti 6 12 Strained Food 5 13 Vegetables 409 2 Total weight 4 tons, 14 cwts., 3 qrs., 16 lbs., 8 ozs. 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. 41 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 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 18 4 80 — — — — 1 1 — — — — 1 — — — Bakehouses 3 — 60 — — — — — — — — — — — — — — Butchers 35 31 150 - 2 - 2 1 — 2 4 — — 1 — 1 — Canteens 21 — 94 — — — — — — — — — — — — — — Chemists 17 1 44 — — — — — — — — — — — — — — Cinemas 1 — 1 — — — — — — — — — — — — — Confectioners (Sweets only) 68 54 134 1 1 1 — 1 1 — — — — — 1 — — Fishmongers 15 7 72 — 1 — — 1 — — 1 — — — — 1 — General Stores 4 4 24 — — — — — — — 1 — — 1 — — — Greengrocers and Fruiterers 40 6 149 1 2 3 4 4 2 1 — — 3 1 — 1 Grocers (including corn chandlers) 79 23 337 3 3 — — 1 — 3 1 — — 1 1 1 3 Ice Cream Vehicles variable — 11 — — — — — — — — — — — — — — Licensed Premises (with catering facilities) 5 1 18 — — — — — — — 1 — — — — — — Licensed Premises (without catering facilities) 20 — 33 — — — — — — — 1 — — — — — — Milk Storage Depots 3 — 5 — — — — — — — — — — — — — — Restaurants and Cafes 27 17 130 — — — — 1 — 2 5 — 1 2 — — 1 Stalls, food variable — 136 - - - - - - - - - - - - - - Vehicles, food variable — 18 - - - - - - - - - - - - - - 148 1,496 5 9 4 6 10 4 8 18 — 1 9 3 3 6 42 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 The district continued to be free from variola infection during the year. Vaccination against Smallpox. The scheme of the County Council which is the responsible authority under Section 26 of the National Health Service Act provides both for vaccination and re-vaccination against smallpox for persons of all ages. The primary aim is to secure the protection of all infants in the first few months of life. By agreement with the County District Councils, the scheme is directed locally by the District Medical Officers of Health. Free treatment is available at the Welfare Clinics and can be had free from doctors as part of the General Practitioner services under the Act. Recorded information in respect of pre-school children is sufficiently complete as to provide a reasonably accurate estimate of the vaccinal state of children under five years of age. This shews that 52% of this age group had at some time been successfully vaccinated. 43 The number of persons recorded as having received successful vaccination during the year was as follows:— Age at 31st December, 1958 i.e. born in Under 1 yr 1958 1-4 yrs 1954-7 5-14 yrs 1944-53 15 yrs & over 1943 and earlier Total Primary Vaccinations— By Private Practitioners 59 54 8 39 160 At Clinics 172 123 1 8 304 231 177 9 47 464 Revaecinalions— By Private Practitioners 2 9 79 90 At Clinics — — — 11 11 — 2 9 90 101 In addition, the following unsuccessful attempts at vaccination were made:— Age at 31st December, 1958 i.e. born in Under 1 yr 1958 1 -4 yrs 1954-7 5-14 yrs 1944-53 15 yrs & overl943 & earlier Total Primary 4 1 1 5 11 Revaccination — — 5 9 14 4 1 6 14 25 The estimated number of children under five years of age vaccinated at the end of 1958, was 1,708. Enteric Fever No case of typhoid or paratyphoid fever was notified during the year. The almost complete freedom from these enteric infections, particularly true typhoid, is largely the result of the stringent control of public water supplies and of improved standards of food hygiene. Dysentery Two small outbreaks of Sonne dysentery occurred in March and in May/June. Thirty-six cases were notified and a further 7 came to notice as a result of the investigation into the notified cases. Three were patients in a local hospital. The ease with which this intestinal infection is spread through the family circle is demonstrated by the fact that the 40 domiciliary cases were distributed among only eleven families. One family had 7 of its 8 members affected, another 8 out of 11. Sonne infection is the mildest of the dysenterys and this undoubtedly militates against its control. Many cases never seek medical advice, the diarrhoea which is frequently the sole symptom often being attributed to 44 dietetic indiscretion. It is fairly safe to say that when the disease is prevalent, the recorded extent of the incidence is proportionate to the diligence with which infected persons are sought and bacteriologically investigated. Scarlet Fever Incidence of scarlet fever reached a low record in the year 1956 when only 27 cases were notified. In the two succeeding years it rose to 59 in in 1957 and now to 121 in the year under review. This is very comparable to the prevalence of the post war years though still much lower than before World War II. As has been observed in recent reports, scarlet fever has become progressively milder in character during the first half of the present century and restrictions both on patients and contacts have been drastically reduced. As in the case of Sonne dysentery, there is evidence now that its very mildness creates increased difficulty in controlling its spread. So little importance clinically is now attached to this disease that notification and precautionary action no longer receive the attention which is called for. Coupled with the mildness of the illness is the fact that it responds readily to modern chemo-therapeutic treatment and it is difficult to persuade parents that there is some purpose in reasonable isolation for at least a fortnight when a child is apparently well after only a few days of mild indisposition. Of the total 98 (81 %) patients were nursed at home. This is the highest total so nursed yet recorded. TABLE 10. SCARLET FEVER—DISTRIBUTION OF CASES, 1958. 1958 Ward St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest Total January 3 3 6 February — 1 1 — 1 _ 1 1 5 March 1 1 — 1 — — — 2 5 April — 5 1 1 — 3 10 May 1 1 — 2 — — 1 5 10 June 1 3 3 1 — 8 July 1 4 3 4 — 1 — 1 14 August 1 1 — 1 — — — 3 September 1 1 2 October 3 5 1 2 1 3 15 November 4 4 1 5 2 2 18 December 3 1 — 8 2 3 4 4 25 Totals 15 27 13 24 6 4 12 20 121 Monthly mean 1.25 2.25 1.08 2.00 0.50 0.33 1.00 1.66 10.08 Case rate per 1,000 population 1.83 3.79 1.74 2.47 0.83 0.69 1.41 3.05 2.00 45 TABLE 11. SCARLET FEVER—MULTIPLE CASES, 1958. Ward No. of houses in which occurred Total Houses Total Cases 1 Case 2 Cases 3 Cases 4 Cases St. Helier North 15 15 15 St. Helier South 20 2 1 — 23 27 St. Helier West 8 1 1 10 13 North-East 14 5 — — 19 24 North-West 6 — — — 6 6 Central 2 1 — — 3 4 South-East 12 — — — 12 12 South-West 14 1 — 1 16 20 Whole District 91 10 2 1 104 121 Diphtheria The district continued to experience the freedom from this disease which it has enjoyed for the last eight years. The recent outbreak in Essex accompanied by a fatality is a reminder that this infection can assert itself given the appropriate conditions and that the maintenance of a satisfactory high level of immunisation is our sheet anchor of safety. 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. Every effort is made to secure primary immunisation before the age of twelve months using prophylactic materials which now exclude alum. Treatment is available at all the Infant Welfare Clinics and mothers are thereby not required to make a special clinic attendance for the purpose. These facilities together with those provided by the General Practitioners have, over a period of many years, succeeded in securing the protection of nearly 60% of all children under five years of age. The success of the scheme depends however on the maintenance of the level of the artificially bestowed immunity in each individual by periodic boosting doses and the need for this occurs mainly during school life. With the co-operation of the Head Teachers, this reinforcing treatment is offered each year in the primary schools of the district and the original immunisation rate of approximately 57% in pre-school life is raised to 66% for school children and to 64% for all children 0 to 15 years. Too much importance in this respect cannot be attached to the value of being able to offer treatment actually in the schools. But for this there is no doubt whatever that the percentage of children who have received treatment within the previous five years would be far less than it is. In 1958, 514 resident children received a primary course of treatment as follows:— 46 Age at 31/12/58 i.e. born in year Under 1 year 1958 1 year 1957 2 years 1956 3 years 1955 4 years 1954 5-9 years 194953 10-14 years 194448 Total under 15 yrs. At Council Clinics 104 232 13 12 4 2 367 In Carshalton Schools — — — — — 4 1 5 Private Practitioners 21 92 13 5 6 6 3 146 125 324 26 17 10 12 4 518 Less outward transfers — — — — 1 5 2 8 125 324 26 17 9 7 2 510 Plus inward transfers — — — — — 2 2 4 Carshalton residents 125 324 26 17 9 9 4 514 A further 985 Carshalton children received reinforcing injections during the year. The following table shews the immunisation state of the local child population at the 31st December, 1958:— Number of children at 31st December, 1958, who had completed a course of immunisation at any time before that date (i.e. at any time since 1/1/44). Age at 31/12/58 i.e. Born in Year Under 1 1958 1-4 1954-1957 5-9 1949-1953 10-14 1944-1948 Under 15 Total A. No. of children whose last course (primary or booster) was completed in the period 1954-1958 137 1,998 2,879 2,762 7,776 B. No. of children whose last course (primary or booster) was completed in the period 1953 or earlier 560 1,413 1,973 C. Estimated mid-year child population 725 2,960 8,950 12,635 Immunity Index 100 A/C 18.9 68.1 63.0 61.5 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. 47 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 1958 57 85(63*) 77(61*) 0 0.00 (* Immunised within the last 5 years) Erysipelas Since the introduction of the anti-biotic remedies and the sulpha drugs, the control of this streptococcal infection of the skin has been much more effective. Only one case was notified during the year in an adult male who suffered from an infection of the face. He made a rapid recovery. Pneumonia Only influenzal and primary pneumonia are notifiable. Pneumonia arising secondary to some other illness is not. The incidence of pneumonia is largely an index of the prevalence of respiratory infections and of their severity both of which are largely determined by atmospheric conditions including smog particularly during the winter months. The winter of 1958 was comparatively a mild one and the total of notified pneumonia cases at 22 was not only low, but was the lowest since 1927 when the population of the district was less than one third of its present figure. Seven of the 22 cases were stated to be of influenzal origin. All the cases occurred in the first four months of the year. Five were children 5 years and under, the remainder adults. 48 Measles Conforming to the long experienced pattern of periodicity, prevalence of measles following the relatively high level of incidence in the year before was very low in 1958. Only 83 cases were notified compared with 684 in 1957. This is the lowest annual total for 15 years. It can reasonably be expected that 1959 will see the curve of prevalence rise again. As is usual when incidence is low, the cases were scattered irregularly over the year. There was no epidemic period, although the cases were slightly more numerous in June, July and August. There were no deaths. TABLE 12.—MEASLES WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1958. (Excluding hospital patients non-resident in Carshalton) 1958 Ward St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest Total January — — — — — — — — — February — — — — 1 — — — 1 March 3 1 2 2 — — — — 8 April 1 — — — — — — — 1 June — — 3 — 1 2 3 1 10 July — 1 — 3 1 1 9 — 15 August 1 — 1 8 1 — 6 3 20 September — — — — — — — — — October — — November 1 — — — — — — — 1 December 1 5 — 3 1 1 13 2 26 Totals 7 7 6 16 5 4 31 6 82 Monthly Mean 0.58 0.58 0.50 1.33 0.41 0.33 2.58 0.50 6.83 Case rate per 1,000 population 0.85 0.98 0.80 1.65 0.69 0.69 3.65 0.91 1.35 Whooping Cough Comment was made in last year's report on the effect that immunisation is now having upon the prevalence of whooping cough. Preventive inoculation against this disease was first included in the County Council's Scheme in 1952. From that time acceptance of this treatment grew steadily, but it did not assume significant proportions until 1954. The yearly total of cases shews that immunisation began to exert its effect from that year and the incidence has fallen progressively since. 49 The following figures shew the cases notified during each of the past ten years and the percentage of children under five years of age immunised against whooping cough at the beginning of each year:— Year Percentage of children Immunised Cases Year Percentage of children Immunised Cases 1949 Nil 225 1954 22 154 1950 „ 384 1955 36 101 1951 „ 471 1956 47 73 1952 „ 98 1957 61 75 1953 6 345 1958 62 41 Whilst this substantial fall in notified cases represents a real reduction in prevalence, there probably are a number of cases of highly modified disease which escape detection. It is known that the present whooping cough vaccine whilst bestowing complete immunity in a high proportion of the children inoculated, also confers a large measure of protection, short of 100%, on the remainder and this whilst not preventing infection, renders the ensuing attack so mild that diagnosis is extremely difficult. The present total of 41 cases is much the lowest yet recorded. There was of course no epidemic, prevalence being distributed irregularly over the twelve months. There were no deaths. TABLE 13. WHOOPING COUGH—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1958. (Excluding hospital patients non-resident in Carshalton) 1958 Ward St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest Total January 2 1 1 — 2 — — 1 7 February — 2 — — — — — — 2 March 1 — — — — — — — 1 April — — — — — — — — — May — — — — — 4 — 3 7 June — — — — 1 — 1 4 6 July — — — — — — — 1 1 August 6 — — 1 — — — 7 September 4 — — — — i 1 — 6 October 1 2 — — — — — — 3 November — — — — — — — — — December — — — — 1 — — — 1 Totals 14 5 1 1 4 5 2 9 41 Monthly Mean 1.16 0.41 0.08 0.08 0.33 0.41 0.16 0.75 3.41 Case rate per 1,000 population 1.71 0.70 0.13 0.10 0.55 0.87 0.23 1.37 0.67 Meningococcal Infection No case of meningitis or other form of meningococcal infection was notified. Only 8 such cases have occurred in the last 10 years. The last minor epidemic of this disease was in the first five months of 1940 when 10 cases occurred in that period. Meningococcal meningitis was one of the diseases in which the great therapeutic value of the sulpha drugs was first demonstrated. Their use completely transformed the prognosis of what was a very fatal disease. Success in combating this infection still depends on the prompt application of these new chemical and anti-biotic agents. 50 Poliomyelitis It is a happy augury that during the year which saw a substantial rise in the number of children vaccinated against poliomyelitis, only one case of this disease was notified. Moreover the illness in a boy of years was of the non-paralytic type from which he made an uneventful recovery. Until 1958 the annual average of cases since the epidemic year of 1947 was 7.5. During the twelve years 1947-1958, 83 cases were notified distributed between the sexes and age groups as follows:— POLIOMYELITIS CASES 1947-58 (INCLUSIVE). Males Females Both Sexes Age Group Paralytic Non Paralytic Total Paralytic Non Paralytic Total Paralytic Non Paralytic Total 0—1 1 1 2 — 1 1 2 1—5 4 3 7 11 — 11 15 3 18 5—10 9 3 12 4 5 9 13 8 21 10—15 7 3 10(3) 3 1 4 10 4 14(3) 15—25 2 4 6 2 3 5 4 7 11 25—35 5 — 5(2) 8 — 8(4) 13 — 13(6) 35—45 1 2 3 — — — 1 2 3 45 & over 1 — 1 — — — 1 - 1 All ages 30 16 46(5) 28 9 37(4) 58 25 83(9) (Figures in parenthesis denote deaths) Two points are worth noting. (1) One third of all cases occurred over the age of 15 years. (2) The higher fatality in adults—6 deaths in 17 cases (35 %) in persons over 15 years of age. Poliomyelitis Vaccination. The Ministry of Health's extended scheme for poliomyelitis vaccination to include expectant mothers and all children over six months of age born in 1943 and after, became operative from November, 1957, but owing to practical difficulties could not be put into effect until early in 1958. Work in connection with this scheme during the year under review was largely concerned with vaccinating these children in the extended age groups and expectant mothers. In September, 1958, the Ministry authorised a further 51 extension of the scheme to include all persons born in 1933 and since and to include a third injection after an interval of seven months to those who had already received two. During the last quarter of the year work was concentrated on giving these third injections and treatment of the over 15 year group had barely begun by the end of the year. The number of individuals vaccinated during the year was as follows:— No. who received their 2nd injection No. given a 3rd injection Children over 6 months and born in 1943 to 1958 6,553 2,867 Young persons born 1933 to 1942 31 — Expectant mothers 235 — Special Groups (Ambulance men, Doctors etc 122 — Totals 6,941 2.867 The number vaccinated from the beginning of the scheme up to the 31st December, 1958 was as follows:— No. given 2 injections No. of those in the previous column given a 3rd injection Children 0—15 8,691 2,867 Young Persons 16—25 31 — Expectant Mothers 235 — Special Groups 122 — Totals 9,079 2,867 These figures do not include the staffs of hospitals. Oneparticular experience duringthe year demonstrated very forcibly the value of providing the maximum degree of convenience as a means of inducing the public to accept a preventive medical service. Until well into 1958 the very limited supplies of vaccine precluded the carrying out of treatment in school premises, since in fairness, individuals were offered treatment in the order of registration. However with the more liberal supplies which became available and with the co-operation of the Head Teachers, it was possible to offer the 3rd injections to school children who had previously had two in the schools during school hours. In the programme of school 52 sessions so arranged, a further offer of initial treatment was given to the parents of those children who had not so far sought the treatment which, up to that time, had been given exclusively at special clinics in Health Centres. As a result of this offer to take the service to the children in school, no fewer than 1,440 additional school children were vaccinated and the treatment rate among school children was increased by 85%. Ophthalmia Neonatorum No case of this infection of the eyes in the new-born was notified. Preventive treatment of the eyes at the time of birth and the prompt use of the modern anti-biotic preparations at the first suspicion of inflammation, has been mainly responsible for the reduction in the prevalence of this type of infection to negligible proportions. Puerperal Pyrexia As is to be expected most of the notifications of a rise in temperature in lying-in-women came from the extensive obstetric units of the local hospitals which cater for the maternity needs of a large part of Metropolitan Surrey. The present definition of puerperal pyrexia covers every rise of temperature of 2° within fourteen days of childbirth or miscarriage from every cause, whether related to the childbirth or not. During the year 141 such notifications were received. Three were in respect of domestic confinements and the remaining 138 were hospital deliveries. Of the total 34 were Carshalton mothers. There were no deaths. Food Poisoning Only one isolated case of food poisoning was reported in a child of seven years. It was not possible to ascertain how she contracted the infecting organism—S. typhimurium. The child's older sister became secondarily infected from the patient after an interval of eight days. Both recovered, but it was not possible to get them bacteriogically negative until two months after the onset. 53 TABLE 14. CASES OF NOTIFIABLE INFECTIOUS DISEASE ADMITTED TO HOSPITAL, 1958. Disease Bletchingley Cuddington Wandle Valley Queen Mary's St. Helier Totals Scarlet Fever 1 3 19 — — 23 Dysentery — — — 2 — 2 Pneumonia — 1 — — 1 2 Poliomyelitis (Non-Paralytic) — — — 1 1 TOTALS 1 4 19 2 2 28 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 121 2.00 — 15 27 13 24 6 4 12 20 23 19 Measles 82 1.35 — 7 7 6 16 5 4 31 6 — — Whooping Cough 41 0.67 — 14 5 1 1 4 5 2 9 — — Dysentery 32 0.53 — 11 — — 18 — — 1 2 2 6.25 Pneumonia 22 0.36 — 2 4 6 4 3 1 — 2 2 9.09 Poliomyelitis (Non-Paralytic) 1 0.01 — — — — — 1 — — — 1 100 Erysipelas 1 0.01 1 — — — — — — — — — Puerperal Pyrexia 33 0.54 — 8 3 7 6 3 2 4 — 30 90 Food Poisoning 1 0.01 — — — — — — — — 1 — — 55 TABLE 16. INFECTIOUS DISEASES—Notification by Age Groups, 1958. (Excluding hospital patients non-resident in Carshalton) Disease Total Cases Notified Total Cases at All Ages Under 1 year 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 and over Scarlet Fever — — 1 6 9 79 23 1 — 2 — — 121 Measles 1 6 9 15 17 33 1 — — — — — 82 Whooping Cough — 4 8 5 4 16 4 — — — — — 41 Dysentery 1 3 3 3 1 6 6 1 6 2 — — 32 Pneumonia — 3 1 — — 1 — 1 3 3 7 3 22 Poliomyelitis (Non-Paralytic) — — — — 1 — — — — — — — 1 Erysipelas — — — — — — — — — — 1 — 1 Puerperal Pyrexia 1 26 5 1 — 33 Food Poisoning 1 1 56 TABLE 17. MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1958. (Excluding hospital patients non-resident in Carshalton) Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 6 5 5 10 10 8 14 3 2 15 18 25 121 Measles 1 8 1 — 10 15 20 — — 1 26 82 Whooping Cough 7 2 1 — 7 6 1 7 6 3 — 1 41 Dysentery — 2 13 — 5 11 — — 1 — — — 32 Pneumoni 9 6 5 1 1 — — — — — — — 22 Poliomyelitis (Non-Paralytic) — — — — 1 — — — — — — — 1 Erysipelas — — 1 — — — — — — — — — 1 Puerperal Pyrexia 5 2 — 3 2 1 3 6 3 3 3 2 33 Food Poisoning — — — — 1 — — — — — — — 1 Tuberculosis, Pulmonary 1 1 2 6 3 1 2 3 — 1 4 24 Tuberculosis, Non-Pulmonary — 2 — — — — — — — — — 4 6 57 Tuberculosis The new cases admitted to the tuberculosis register during the year numbered 79, classified as follows:— TUBERCULOSIS—WARD DISTRIBUTION. Cases on Register at 31st December, 1958. Ward Pulmonary Non-Pulmonary Total Incidence per 1,000 population Males Females Males Females St. Helier North 68 64 9 11 152 18.5 St. Helier South 63 52 7 7 129 18.1 St. Helier West 42 64 3 9 118 15.8 North-East 52 55 8 4 119 12.2 North-West 21 24 2 47 6.5 Central 29 26 1 1 57 9.9 South-East 41 22 1 1 65 7.6 South-West 26 22 — 1 49 7.4 Whole District 342 329 29 36 736 12.2 671 65 The total of 736 is 41 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 47. Males Pulmonary 36 Non-pulmonary 4 Females Pulmonary 34 Non-pulmonary 5 Of the total additions, 30 were primary notifications, 44 were transferred from other districts and 5 came to notice in other ways. In the same period, 120 names were removed from the register for the following reasons:— Recovered 48 Death 15 Otherwise (including removals) 57 After allowing for the additions and deductions, the state of the register at the 31st December, 1958, was as shewn in the following table:— The number of tuberculous persons who died during the year was 15, distributed by age groups as follows:— 58 Age, Years Pulmonary Non-Pulmonary Males Females Males Females Total[ 0 — — — — — 1—5 — — — — — 5—15 — — — — — 15—25 — — — — — 25—35 — — — — — 35—45 — — 1 — 1 45—55 1 1 — — 2 55—65 5 2 — 1 8 65—up 4 — — — 4 Totals 10 3 1 1 15 The deaths attributable to tuberculosis were 9 as follows:— DEATHS DUE TO TUBERCULOSIS, 1958. Ward Pulmonary Non-Pulmonary Death Rate per 1,000 population Mean age at Death Male Female Male Female St. Helier North — — — — — — St. Helier South 1 — — — 0.14 64 St. Helier West 1 1 1 0.40 51 North-East 2 — — 0.20 77 North-West 1 1 — — 0.27 56 Central — — — — — — South-East — — — — — — South-West i — — — 0.15 71 Totals 5 2 1 1 0.14 62 Of the 9 persons who died 5 had not been notified. 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. One tuberculous family was rehoused by the Council in 1958. 59 TABLE 18. TUBERCULOSIS. New Cases, Age and Sex Distribution and Manner of Admission to Register, 1958. 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-Pu monary M. F. M. F. M. F. M. F. M. F. M. F. 0—1 — 1—5 — 1 — — — — — — — — — — 1 5—10 1 — — — — — — — — — — — 1 10—15 — — — — — 1 — — — — 1 15—20 2 2 — 1 — 2 1 — — — — 8 20—25 2 — — 1 3 2 — — — — — — 8 25—35 2 5 1 1 7 13 — — — — — — 29 35—45 2 2 1 1 5 2 1 — — — — — 14 45—55 2 1 — 3 1 — — — — — — 7 55—65 1 — — — 3 — — — 1 2 — 1 8 65 up 1 — — — — — — — 1 — — — 2 Totals 13 11 2 4 21 21 2 — 2 2 — 1 79 30 44 5 60 Carshalton T.B. Care Committee This voluntary Committee supported, except for a small grant of £50 from the County Council, by voluntary contributions, continued its beneficient work on behalf of tuberculous patients and their families who number approximately 800 in the Urban District. Its activities are directed to alleviating the large amount of economic distress which is inseparable from long term disablement occasioned by such a chronic disease as tuberculosis in ways not covered by the statutory services and by enlisting the available help provided by the public welfare and other voluntary services. The Annual Report of the Committee indicates the comprehensive nature of the assistance afforded which includes the following:-— Grants and Gifts for—clothing—bedding—fuel—furniture—household equipment—wireless equipment—heating appliances— insurance premiums—fares to visit relatives in hospital—materials for occupational therapy—pocket money for hospital patients, etc. Loans to establish or re-establish businesses and to purchase vehicles for transport. Holidays, which are a prominent feature of the Committee's work. Many families except for their help would be unable to secure any real holiday away from their usual surroundings. Apart from the family groups sent away by the Committee, special arrangements are made to ensure as far as possible that the children of tuberculous families get the benefit of a planned holiday. To this end the Committee bear the cost of residence usually for fourteen days in organised holiday homes. The total payments made by the Committee in 1958/59 was £708 of which £208 was either loan or repayment of loan received from other bodies. The administration costs were £21 and the expenses of the seal sale which produced £250 was £28. The remaining £451 was irrecoverable expenditure on behalf of the patients. METEOROLOGY The following rainfall was recorded at the Council's Pumping Station in Buckhurst Avenue. Rainfall 1958 Amount in ins. Rainfall 1958 Amount in ins. January 1.87 July 2.80 February 2.04 August 3.29 March 0.94 September 4.55 April 1.26 October 3.01 May 2.54 November 1.59 June 4.79 December 2.65 Total 31.33 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. 1958) = 1235.25 million gallons. Minimum Spring flow 0.23 million gallons/day on 1st January. Maximum Spring flow 6.52 million gallons/day on 31st December. 61 INDEX PAGE Acreage 6 Atmospheric Pollution 25 Births— Distribution 10 Institutional 9 Rates 7,9, 10 Cancer 7, 12 Cemeteries 30 Clean Air Act 25 Clinics and Treatment Centres 18 Closet Accommodation 21 Deaths— Classification 6 Distribution 13 Rate 7,9, 10 Diphtheria Immunisation 46 Dysentery 44 Disinfection 24 Disposal of Dead 30 Drainage and Sewerage 20 Employment Agencies Enteric Fever 44 Erysipelas 88 Establishments for Massage, etc. 30 Factories Food— Food and Drugs Act 36 Hygiene 41 Inspection and Supervision 41, 42 Poisoning Health Services Heating Appliances (Fireguards) Regulations, 1953 29 Housing— Council's Scheme 31 Inhabited Houses 6 Inspection Rent Act Repairs and Rents Act, 1954 34 Overcrowding Slum Clearance 34 Ward Distribution 33 Ice Cream 37 Infant Mortality 7, 15 Infectious Diseases 43, 55, 56,57 Inquests 24 Isolation Hospital— Admission to 54 Laboratory Facilities 17 62 PAGE Maternal Mortality 7,15 Measles 49 Meat 38 Meningococcal Infection 50 Merchandise Marks Act, 1926 29 Meteorology 61 Milk Supply 36 Milk and Dairies Regulations, 1949 37 Mortuary 30 Natural and Social Conditions 6 National Assistance Act 30 Offices 27 Outworkers 27 Ophthalmia Neonatorum 53 Pet Animals Act, 1951 29 Pneumonia 48 Poliomyelitis 51 Vaccination 51 Population 7, 8 Public Cleansing 21 Puerperal Pyrexia 53 Rag Flock and Other Filling Materials Act, 1951 30 Rateable Value 6 Rats and Mice Destruction 26 Rivers and Streams 20 Sanitary Circumstances 19 Sanitary Inspection 21 Scarlet Fever 45 Shops Act 29 Smallpox 43 Smoke Abatement 25 Staff 5 Statistics— Comparative 11 Vital 7 Swimming Baths 27 Tuberculosis 7, 14, 58, 59, 60 Care Committee 61 Unemployment 8 Vaccination 17,43,44 Vermin Control 24 Water Supply 19 Whooping Cough 49 Zymotic Diseases— Deaths from 63