CARSHALTON URBAN DISTRICT Annual Report OF THE Medical Officer of Health FOR THE YEAR 1959 CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1959 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 1959. The statistics in respect of the year provide brief but sure evidence of the generally improving trends which have been manifest for so many years. Comparison from year to year may show but little variation and one has to look back over intervals of decades to appreciate the strides that have been made in public health. The birth rate in 1959 was slightly up on the year before. The death rate was again significantly less than that for the country as a whole and has varied little over the last twenty years, in spite of the fact that during that period there has been an appreciable rise in the average age of the population as a result of the maturing of the St. Helier Estate, which when first established in the 1930s, originally housed a young population. There has however been, as elsewhere, a progressive increase in the extent to which some individual causes of death contribute to the total mortality with corresponding decreases in other directions. Disease of the heart, which includes a high proportion of the degenerative conditions associated with advancing years, accounts for more deaths than any other, approximately one third of the total, and of this group coronary disease takes an increasing share. Cancer shews no signs yet of relinquishing its position as one of the prime killing diseases with malignant disease of the lungs claiming a steadily increasing proportion of all cancer deaths. On the credit side is the marked saving of life from tuberculosis and infectious disease and the improvement in maternal and infant mortality. Apart from measles which staged its usual biennial epidemic wave in 1959, the incidence of infectious disease generally continued at a satisfactory low level. There is no doubt that the progressive reduction in most of the contagious illnesses is largley due to the marked success achieved in perfecting effective immunising procedures. It is no mere coincidence that the ravages of smallpox, diphtheria, whooping cough, tuberculosis and poliomyelitis, have been either eliminated or greatly reduced, whilst measles against which no protective procedure for mass application has yet been found, continues its regular visitation with undiminished force, although the mortality of this highly prevalent infection has been reduced by the better standard of medical and nursing care. There was again no death from any of the notifiable diseases other than tuberculosis which caused only three deaths in 1959, a record low figure. 3 The standard of environmental hygiene continues to rise, fostered by the unremitting work of inspection and supervision. The altered designation of the Sanitary Inspectors to Public Health Inspectors is an appropriate recognition of the ever increasing scope of their activities in the field of health, which itself is only a reflection of the wider ranging functions of the local protective health services. A notable instance is the control of food supplies to which more and more statutory standards and supervision are being applied. The record of this work was particularly good in 1959. All milk samples were shown to be genuine; every sample of ice cream was found to conform to the highest grade from a bacteriological standpoint, whilst only four out of 264 food samples were reported upon adversely by the Public Analyst. Of these four, three were milks which, although containing non-fatty solids slightly below the presumptive standard of the Regulations, were nevertheless genuine milk. The only irregularity in the fourth sample was the ommission from the label on pork sausages of the fact that their contents included salt and spices. Reference was made in last year's Report to the encouraging prospects provided by the Clean Air Act in at long last removing the prime cause of a vast amount of illness and mortality resulting from pollution of the atmosphere. It is a curious anomaly that whilst for so many years contamination of the public water supply and of food would be regarded with justifiable horror and surprise, we are only now beginning to ensure the safety of the other vital necessity, the air we breathe. The Council's prompt adoption of a phased programme for making the whole area a smokeless zone, will prove to be another significant advance in the promotion of the well-being of the district. My last comment should, if these general observations were arranged in order of importance, have come first, since it is the primary function of a Medical Officer to stress the existing or impending threats to health and what needs to be done than to seek satisfaction in what has been achieved justifiable and gratifying as that may be. I refer, of course, to overcrowding and the long existing lack of adequate housing accommodation. Progress in this is slow. Whilst in no way minimizing the responsibilities of the Council, this is a problem which in this district is far from easy to solve owing to the stark fact of the absence of available building sites. This difficulty is a challenge of the first magnitude, but until this problem is solved much mental and physical misery must be borne by many families which otherwise could be removed. Once again I tender to my staff my sincere thanks for their assistance unstintingly given for yet one more year. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, F. LAWRENCE SMITH, Medical Officer of Health. July, 1960. 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, f 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 1959) according to Rate Books 17,526* Rateable Value at 31st December, 1959 £846,248 Sum represented by Id. rate £3,503 (* Includes 257 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. Work had not commenced by the end of the year on the improvement scheme prepared by the County Council for improving the flow of the River. It is expected that operations will start on the Wandsworth/Wimbledon boundary, but in view of the magnitude of the scheme, it is unlikely to involve this district for some considerable time. The long dry spell which commenced in May and continued to October had its inevitable effect during the late summer, when many of the springs including all those which feed the upper pool failed. The district has always been mainly residential in character, industrial development being very limited and of a light nature. Growth within the confines of the district boundaries can now only take place by the redevelopment of existing housing sites to a greater density, if one disregards the few odd individual small plots which can make no significant contribution to the District's pressing housing needs and the green belt land. The lower income groups form a large proportion of the local population. For this reason, and the fact that a large part of the district is developed to a high housing density, the rateable value per head of population at the 1st April, 1959 was £14. 4. Od. which compares with £18. 16. 5d. for the whole of the County and is the lowest in Metropolitan Surrey. 6 SUMMARY OF VITAL STATISTICS FOR 1959. (Based on the Registrar-General's Figures.) Population. Registrar-General's Estimate 60,270 Births. Males Females Total Live (Legitimate) 408 341 749 (Illegitimate) 12 12 24 420 353 773 Birth Rate (per 1,000 population) 12.8 Stillbirths (Legitimate) 5 5 10 (Illegitimate) - - - Stillbirth Rate per 1,000 total births 5 5 10 12.7 Deaths. 315 267 582 Death Rate (crude) per 1,000 population 9.4 Infant Mortality. All deaths under 1 year 12 7 19 Infant Mortality Rate (per 1,000 live births) 24.5 Deaths of leg. infts. under 1 year 11 7 18 Rate per 1,000 legitimate births 24.0 Deaths of illeg. infts. under 1 year 1 - 1 Rate per 1,000 illegitimate births 41.6 Maternal Mortality. Death from Sepsis - - - Rate per 1,000 births - Death from other causes - - - Rate per 1,000 total births - Maternal Death Rate - Zymotic Deaths. 7 Principal Zymotic Diseases - - - Deaths from Measles - - - Deaths from Whooping Cough - - - Deaths from Diarrhoea (under 2 years) - - - Zymotic Death Rate - Deaths from Tuberculosis. All Forms 2 1 3 Rate per 1,000 of population 0.04 Phthisis 2 1 3 Rate per 1,000 of population 0.04 Deaths from Cancer 68 57 125 Rate per 1,000 of population 2.07 7 The following statistics relating to mothers and infants are set out in the form specially requested by the Minister:— Live Births Number 773 Rate per 1,000 population 12.8 Illegitimate Births per cent, of total live births 3.1 % Stillbirths Number 10 Rate per 1,000 total live and stillbirths 12.7 Total live and stillbirths 783 Infant Deaths (deaths under 1 year) 19 Infant Mortality Rates Total infant deaths per 1,000 live births 24.5 Legitimate infant deaths per 1,000 legitimate live births 24.0 Illegitimate infant deaths per 1,000 illegitimate live births 41.6 Neo-natal Mortality Rate (deaths under 4 weeks per 1,000 live births) 18.1 Early Neo-natal Mortality Rate (deaths under 1 week per 1,000 live births) 16.8 Peri-natal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 29.3 Maternal Mortality (including abortion) Number of deaths Rate per 1,000 total live and stillbirths 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. 8 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 1959 are supplied through the courtesy of the Exchange Manager and the Youth Employment Officer : Men 97 Women 22 Boys 5 Girls 1 The figures in respect of men and women fell to approximately half those of 12 months earlier. POPULATION The Registrar-General's estimate of the home population at mid-year is 60,270. This is 30 less than his estimate for a year before and compares with a de facto population as enumerated at the census of 1951 of 62,721 and with an estimated resident population for that year of 61,730. TABLE 1. ESTIMATED HOME POPULATION, MID-1959, BY WARDS. Ward Dwellings at Mid-1959 Estimated Population Mid-1959 St. Helier North 2,177 8,150 St. Helier South 1,698 7,090 St. Helier West 2,123 7,430 North-East 2,839 9,690 North-West 2,211 7,160 Central 1,776 5,730 South-East 2,465 8,470 South-West 2,237 6,550 Whole District 17,526 60,270 BIRTHS The number of live births registered during 1959 was 773 which is 23 more than in the year before. Of these 420 were males and 353 females, giving a birth rate of 12.8 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 12.4 per thousand population, which compares with 16.4 for England and Wales. 9 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 761 live births and 10 stillbirths occurred in 1959. They were distributed as shown in the following table. Ward Live Births Birth Rate per 1,000 Population Stillbirths Stillbirth Rate per 1,000 total births St. Helier North 87 10.6 2 22.9 St. Helier South 72 10.1 1 14.0 St. Helier West 80 10.8 2 25.0 North-East 140 14.4 1 7.1 North-West 98 13.6 2 20.4 Central 72 12.5 - - South-East 117 13.8 2 10.1 South-West 95 14.5 - - Seventy-eight per cent. of all births occurred in hospitals and nursing homes. The percentages of such births for the individual wards were as follows:— St. Helier North 71 North-West 80 St. Helier South 75 Central 90 St. Helier West 81 South-East 70 North-East 80 South-West 81 Out of 771 total births, 605 took place in the following hospitals and nursing homes: Live Still Total Carshalton, Beddington and Wallington District (War Memorial) Hospital 118 1 119 St. Helier Hospital 378 6 384 Other Surrey Hospitals 92 1 93 Other Hospitals 7 - 7 Private Nursing Homes 2 - 2 Totals 597 8 605 For many years more than three-quarters of all births have taken place in Maternity Institutions. 10 TABLE 2. BIRTHS, 1959—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 59(1) 25(1) 84(2) 4 1 5 89(2) St. Helier South 53(1) 18 71(1) 2 - 2 73(1) St. Helier West 61(1) 15 76(1) 6(1) - 6(1) 82(2) North-East 108(1) 27 135(1) 6 - 6 141(1) North-West 61(2) 20 81(2) 19 - 19 100(2) Central 51 7 58 14 - 14 72 South-East 57(1) 35(1) 92(2) 27 - 27 119(2) South-West 53 18 71 24 - 24 95 Totals 503(7) 165(2) 668(9) 102(1) 1 103(1) 771(10) (Figures in brackets indicate stillbirths included in totals.) TABLE 3. BIRTH AND DEATH RATES FOR CARSHALTON, 1922-1959. 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 1959 60,270 12.8 9.4 24.5 0.0 11 TABLE 4. COMPARATIVE STATISTICS—1959. England and Wales Carshalton Birth Rate (per 1,000 population) 16.5 12.8 (crude) 12.4 (comp.) Still-birth Rate (per 1,000 total births) 20.7 12.7 Death Rate (per 1,000 population) 11.6 9.4 (crude) 11.8 (comp.) Infant Mortality (per 1,000 live births) Neo-natal Mortality 22.0 24.5 (in first 4 wks. per 1,000 live births) Death Rate from Tuberculosis 15.8 18.1 (per 1,000 population) Respiratory Tuberculosis 0.07 |0.078 0.041 0.04 Other Tuberculosis 0.008 - Death Rate from Cancer (per 1.000 population) All forms 2.14 2.07 Cancer of Lung 0.46 0.61 Maternal Mortality (per 1,000 total births) Excluding Abortion 0.32 0.38 - Abortion 0.06 COMPARATIVE HEALTH STATISTICS, 1934-59. 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 1959 11.6 9.4 22.0 24.5 0.38 0 12 DEATHS The deaths allocated to the district, as adjusted by inward and outward transferable deaths, was 582—315 males and 267 females. This gives a crude death rate of 9.4 per thousand population as against 9.3 in the year before. The "comparable" death rate produced by the application of the RegistrarGeneral's comparability factor of 1.28 to allow for differences in the age and sex constitution of the local population as compared with the country as a whole was 11.8. The rate for England and Wales was 11.6. The distribution of the deaths by wards was as follows:— WARD DEATH RATES AND MEAN AGE AT DEATH, 1959. Ward Deaths Death Rate (crude) Mean Age at Death St. Helier North 89 10.9 67.2 yrs. St. Helier South 50 7.0 62.0 „ St. Helier West 63 8.4 62.1 „ North-East 91 9.3 63.2 „ North-West 71 9.9 66.8 „ Central 71 12.3 69.6 „ South-East 74 8.7 68.3 „ South-West 74 11.2 67.6 „ Whole District 583 9.6 66.0 „ The cancer death rate in the district reached its highest point in 1958. Last year it fell slightly from 2.23 to 2.07 per thousand population and compares with a rate of 2.14 for the country as a whole. Deaths attributable to cancer of the lungs were only two less than in 1958, which also had the highest recorded mortality for cancer of this site. Fatal lung cancer was again, as for a long time, much more common in men than in women, nearly seven times. As will be seen from the following table, deaths from malignant disease of the lungs is now almost five times greater than it was fourteen years ago, although there has been no significant change in the total population. DEATHS FROM CANCER OF THE LUNGS, 1934-59. 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 1959 38 13 CANCER DEATHS—WARD DISTRIBUTION, 1959. Ward Cancer Deaths Rate per 1,000 Estimated Population M F Total St. Helier North 9 8 17 2.08 St Helier South 7 4 11 1.55 St. Helier West 13 6 19 2.55 North-East 8 16 24 2.48 North-West 10 6 16 2.23 Central 9 7 16 2.79 South-East 6 8 14 1.65 South-West 4 4 8 1.22 The classification of cancer deaths by sites affected is given in Table 5. TABLE 5. CANCER DEATHS, 1959. Group Site Affected Male Female Total 141 Tongue 1 - 1 Digestive Organs— 150 Oesophagus 2 1 3 151 Stomach 8 9 17 153 Colon 1 7 8 154 Rectum 2 3 5 155 Gall Bladder and ducts 3 3 6 156 Liver - 1 1 157 Pancreas 1 2 3 Respiratory System— 161 Larynx 1 - 1 162 Lungs and Bronchi 33 5 38 Breast and Genito-Urinary— 170 Breast - 13 13 171/4 Uterus - 1 1 175 Ovary - 7 7 177 Prostate 2 - 2 180 Kidney - 1 1 181 Bladder 2 1 3 Other Sites— 190/1 Skin 1 - 1 193 Brain 2 2 4 199 Unspecified 6 1 7 201 Lymphatic Tissues 1 2 3 66 59 125 Average age at death: Males 62.7 years Females 62.5 years All persons 62.6 years 14 Deaths from coronary disease of the heart continued to mount, a further twelve such deaths bringing the total in 1959 to 88. All forms of cardiac disease including the coronary variety, were responsible for 164 deaths, approximately 30% of the total mortality. One of the great advances in medicine, particularly in the last decade, has been in the prevention and treatment of tuberculosis. This is reflected in the progressive and marked reduction in the deaths from this infection. Mortality from this disease was down to the low record established in 1957 and is less than one-tenth of what it was only twenty years ago. The figures which follow show the saving of life which has been effected since 1939 from what was once one of the worst scourges which in days gone by took such a heavy toll of young adults: Year Deaths from Tuberculosis Death Rate per 1,000 Population Year Deaths from Tuberculosis Death Rate per 1,000 Population 1939 46 0.77 1950 13 0.20 1940 33 0.56 1951 21 0.34 1941 40 0.71 1952 15 0.24 1942 26 0.46 1953 13 0.21 1943 46 0.81 1954 14 0.22 1944 33 0.63 1955 3 0.04 1945 28 0.51 1956 8 0.13 1946 25 0.41 1957 3 0.04 1947 25 0.40 1958 9 0.14 1948 25 0.40 1959 3 0.04 1949 22 0.35 The distribution of tuberculosis mortality by wards and other details are given in Section F of this report. For the third year in succession there was no death from any of the notifiable infectious diseases other than tuberculosis. Violent causes acounted for the death of twenty residents. They were:— Road traffic accidents 8 Accidents in the Home 3 Railway accident 1 Skin injury (infected) 1 Inhalation of maternal secretions 1 Suicide 6 Inquests Inquests were held on 40 persons who died in the district. The following verdicts were returned :— Accidental death Accident 4 Road Traffic 8 Fall 13 Inhalation of vomit 1 Misadventure 3 Suicide 7 Natural Causes 2 Open Verdict (drowning) 2 Eleven of the total were residents of the district. 15 INFANT MORTALITY One of the great achievements of the present century has been the saving of infant life and within the last twenty-five years infant mortality has been halved. The scope for further reduction automatically becomes less with every degree of progress made. As would be expected an increasing proportion of infant mortality is due to causes, which with some measure of justification have been designated "unavoidable." They are occasioned by prematurity-congenital malformation and asphyxia of the new-born etc., conditions which when existing at birth in effect make survival impossible. Such deaths are only "unavoidable" in our present imperfect understanding of the ante-natal factors to which these conditions owe their origin. Babies dying in the first year of life in 1959 totalled 19 giving an infant mortality rate of 24.5 per thousand live births. This is 8 more infant deaths than in the year before and the increase is mostly accounted for by a greater number dying within twenty-four hours of birth from "unavoidable" causes. Only 2 died of an infection, that of pneumonia. TABLE 6. INFANT MORTALITY-WARD DISTRIBUTION. Ward Infant Deaths Rate per 1,000 Live Births St. Helier North 1 11.4 St. Helier South 2 27.7 St. Helier West 1 12.5 North-East 5 35.7 North-West 2 20.4 Central 1 13.8 South-East 3 25.6 South-West 4 42.1 TABLE 7. INFANT MORTALITY DURING THE YEAR 1959. 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 Congenital 8 - - - 8 - - - - 8 Malformation - - 1 - 1 1 - 1 - 3 Atelectasis 3 - - - 3 - - - - 3 Birth Injury 1 - - - 1 - - - - 1 Accidental 1 - - - - 1 - - - 1 2 Pneumonia - - - - - - 1 1 - 2 Totals 13 - 1 - 14 1 1 2 1 19 MATERNAL MORTALITY There was again no death attributable to child-birth during the year. 16 17 TABLE 8—CAUSES OF DEATH DURING THE YEAR 1959—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 12 7 - 3 2 - 1 1 4 2 10 5 28 19 84 50 82 64 93 116 316 267 583 1 Tuberculosis, Respiratory - - - - - - - - - - - - 1 - 1 1 - - - - 2 1 3 2 Tuberculosis, other - - - - - - - - - - - - - - - - - - - - - - - 3Syphilitic disease - - - - - - - - - - - - - - 1 - - - 1 1 2 1 3 4 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - 5 Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - 6 Meningococcal Infections - - - - - - - - - - - - - - - - - - - - - - - 7 Acute Poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - 8 Measles - - - - - - - - - - - - - - - - - - - - - - - 9 Other Infective and Parasitic Diseases - - - - - - - - - - - - -- - - - - - - - - - - 10 Malignant Neoplasm, Stomach - - - - - - - - - - 2 2 1 - 3 1 1 5 1 1 8 9 17 11 Malignant Neoplasm, Lung — — — — — — — — 1 — 3 — 2 2 18 2 8 - 1 1 33 5 38 12 Malignant Neoplasm, Breast — — — — — — — — — — — 1 — 2 - 6 - 3 - 1 - 13 13 13 Malignant Neoplasm, Uterus - - - - - - - - - - - - - - - - - - - 1 - 1 1 14 Other Malignant and Lymphatic Neoplasms — — — — — — — — — 2 1 — — 4 8 11 9 8 7 6 25 31 56 15 Leukaemia, Aleukaemia - - - - - - - 1 - - - - - - - - - - - - - 1 1 16 Diabetes - - - - - - - - - - - - - - - - 1 - - - 1 - 1 17 Vascular Lesions of Nervous System — 1 - - - - - - - - - - 3 3 4 5 10 7 25 24 42 40 87 18 Coronary Disease, Angina — — — — — — — — 1 — 1 — 9 2 21 5 15 11 9 14 56 32 88 19 Hypertension with Heart Disease - - - - - - - - - - - - - - - 2 3 2 1 2 4 6 10 20 Other Heart Disease — — — - — — — — — — 1 — 1 - 2 4 3 7 16 32 73 43 66 21 Other Circulatory Disease - - - - - - 1 - - - - - - - 2 3 6 4 2 7 11 14 75 22 Influenza - - - - - - - - - - - - - 1 2 2 4 1 2 1 8 5 13 23 Pneumonia 2 - - 2 - - - - - - - - 1 - 3 1 3 2 8 10 17 15 37 24 Bronchitis - - - - - - - - - - - - 3 - 9 3 11 5 10 6 33 14 47 25 Other Diseases of Respiratory System - - - - - - - - - - - - 1 - 2 - 1 - - - 4 - 4 26 Ulcer of Stomach and Duodenum - - - - - - - - - - - - - 1 - - - 1 2 1 2 3 5 27 Gastritis, Enteritis and Diarrhoea - - - - - - - - - - - - - - - - 1 1 - - 1 1 7 28 Nephritis and Nephrosis - - - - - - - - - - - - - - - 1 - - - - - 1 1 29 Hyperplasia of Prostate - - - - - - - - - - - - - - - - - - - - - - - 30 Pregnancy, Childbirth, Abortion - - - - - - - - - - - - - - - - - - - - - - - 31 Congenital Malformations 1 1 - - - - - - - - - - - - - - - - - - 1 2 3 32 Other Defined and Ill-defined Diseases 8 4 - 1 - - - - - - 2 2 2 1 3 3 6 7 6 7 77 75 52 33 Motor Vehicle Accidents - - - - 2 - - - 1 - - - 1 1 2 - - - 1 - 7 1 8 34 All other Accidents 1 1 - - - - - - - - - - - 1 1 - -. - 1 1 3 3 6 35 Suicide - - - - - - - - 1 - - - 3 - 2 - - - - - 6 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 3 Nose and Throat Swabs 6 Faeces Specimens 348 Rectal Swabs 3 Water (Public Supply): For chemical analysis 2 For bacteriological examination 4 Water (Swimming Bath): For bacteriological examination 12 Food and Drugs : Analysis 264 Bacteriological examination of milk 173 Bacteriological examination of ice cream 87 Vaccination and Immunisation The County Council has the responsibility for formulating schemes of vaccination and immunisation under Section 26 of the National Health Service Act. The diseases against which arrangements have been made for such prophylactic treatment are—smallpox—diphtheria—whooping cough —tetanus—poliomyelitis and tuberculosis. The schemes in respect of the first four mentioned diseases are directed locally by the District Medical Officers of Health, by agreement with the County Council; that in respect of poliomyelitis is directed by the Divisional Medical Officers, who also operate the arrangements for Mantoux testing and B.C.G. vaccination against tuberculosis of the thirteen-year-old schoolchildren. More recently the County Council propose to establish a centre in Kingston-upon-Thames for vaccination against yellow fever on the basis of the cost of this service being recovered from the persons availing themselves of it. This will be part of the Ministry's plan to set up about 40 such centres throughout England and Wales. Details of the work done under these arrangements are given in Section F. 18 Clinics and Treatment Centres The following programme of clinics is provided by the County Council and the Hospital Board and are available to residents of the district. Care of Mothers and Young Children. Rochester Road Centre : Infant Welfare Clinic 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., Thurs., Fridays 10—1 p.m. Tues., Thurs. 2—5 p.m. Green Wry the 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 Massage Clinic Mons., Weds., Fridays 2—4 p.m. Alexandra Gardens, Stanley Road Centre: Infant Welfare Clinic Fridays 2—4 p.m. Maternity Clinic Tuesdays 10.30—11.30 a.m. Toddler Clinic 1st and 3rd Thurs. 2—4 p.m. 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 welfare and special clinics in health centres, in schools, factories, etc. Tuberculosis Clinics. St. Helier Hospital Mons. and Fridays 2 p.m. Wednesdays 9.30 a.m. 3rd and 4th Mondays (for old cases only) 5.30 p.m. Venereal Disease Clinics. St. Helier Hospital Mondays (Males) 4—6.30 p.m. Wednesdays (Females) 5—7 p.m. 19 Section C—Sanitary Circumstances. Water Supply Except for a small part of the area on the northern boundary comprising rather less than 200 premises supplied by the Metropolitan Water Board, the district is within the supply area 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. The raw water is subjected to treatment devised on modern lines and extensive arrangements exist for safeguarding the purity of the supply. These include daily testing of the various waters both raw and finished by the Company's resident chemist. Additional samples are taken by a firm of independent water chemists on behalf of the Company and by the Public Health Departments of the Local Authorities in the supply area monthly on an agreed rota. Quantity and quality were adequate during the year. The following details indicate the results of the routine testing carried out by the Company and are supplied by courtesty 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 308 53 4 1.1 9 2.5 13 Sutton Finished 312 12 2 0.5 Nil Nil 2 Woodmansterne Raw Woodmansterne 307 53 Nil Nil Nil Nil Nil Finished 312 12 1 0.3 Nil Nil 1 Cheam Raw 312 53 9 3.0 4 1.3 13 Reservoir 258 Nil 3 1.2 1 0.4 4 District 319 Nil 15 4.8 Nil Nil 15 Total 2,128 183 34 14 48 The Public Health Departments in the supply area submitted 13 samples for chemical and 26 for bacteriological examination during the year. All were satisfactory and also showed hardness less than the 9" to which the Company is statutorily required to soften, except for one which, as evidenced by its general characteristics, was probably a sample of water supplied by arrangement with the Company by the Metropolitan Water Board. The following is the report on a sample taken in the district which is representative of this Company's supply. 20 (a) Physical Examination Colour Faint blue Taste normal Appearance Bright and clear Smell none Electric Conductivity at 20°C. 255 Units pH. 7.4 (b) Chemical Examination in parts per million Total solid residue (dried at 180°C.) 176 Chlorine present as chloride 15.2 Ammonia, free 0.00 Ammonia, Albuminoid 0.00 Nitrate nitrogen 5.9 Nitrite nitrogen — Oxygen absorbed from (a) in 4 hours 0.11 permanganate solution (b) in 15 mins. — Hardness, as CaC03—Temporary 89 Permanent 32 Total 121 Alkalinity, as CaCOa 89 Free carbon dioxide, as C02 — Iron absent Other metals absent Residual chlorine — (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, attractive in appearance and of moderate hardness and salinity. It is similar in chemical composition to previous samples from the same source. The bacteriological condition of the water is excellent. As judged by this examination, the water is pure and wholesome and is suitable for the public supply. Drainage and Sewerage The routine work of cleansing and flushing of soil and surface water sewers, the maintenance of soakaways and repairs to road gullies, frames and manhole covers was carried out by the Engineer and Surveyor's department. A new manhole was constructed on the existing soil sewer in Park Lane between Acre Lane and Park Gate Road. The construction of a relief surface water sewer in Culvers Avenue between Green Wrythe Lane and the River Wandle is now in hand. Three hundred and thirty-one drainage obstructions affecting 1,038 properties were dealt with during the year. Rivers and Streams Routine clearance of the River Wandle and its tributaries, which is the responsibility of the County Council, was carried out by that Authority. The Improvement Scheme for the River Wandle prepared by the County Council and referred to in last year's report, has been agreed by the District Authorities bordering the River and work is expected to commence on the down river reaches in 1960. 21 Closet Accommodation All dwellings are connected to the public sewers except for 17 drained to cesspools in unsewered areas. Most of these are in the Woodcote Grove area, where the Council's scheme for a sewer extension approved by the Minister is now in course of construction. Public Cleansing No changes have been made in the arrangements for refuse collection. Disposal is by incineration at the Council's Destructor with tipping of clinker and screenings on the Cemetery Board's land in Lower Morden. Salvage of saleable commodities, such as paper, tins, ferrous and nonferrous metals, bottles and rags was continued as in previous years. Sanitary Inspection The following information supplied by the Chief Public Health Inspector under Article 25 of the Public Health Officers' Regulations, 1959, indicates the action taken in sanitary inspection during the year. Investigations were made with regard to 1,627 complaints as follows:— Accumulations 33 Animals so kept 8 Burst pipes 12 Clean Air Act—Contraventions 28 Dampness 14 Ditches and Ponds 1 Drainage defects 58 Drains obstructed 382 Dustbins 71 Food contaminated 13 General defective conditions 72 Insects and Pests 403 Litter Act—Contraventions 1 Milk—Contaminated—Dirty Bottles 1 Miscellaneous 46 Obnoxious effluvia 46 Overcrowding 3 Refuse collections 23 Rivers 1 Rodents 326 Roofs, defective 5 Sewer obstructions 7 Sink waste pipes 3 Unsound food 57 Verminous premises 11 Water supply 2 1,627 Fourteen thousand three hundred and forty visits of inspection and re-inspection were made for the purposes set out below:— Clean Air Act 808 Cowsheds 6 Employment Agencies 12 Factories (Mechanical Power) (incl. Laundries 38) 265 Factories (Non-Mechanical Power) 69 Factories (Building Sites) 59 Food and Drugs (incl. Food Bye-laws) 1,061 Food poisoning enquiries 12 22 Food premises: Bakehouses 61 Bakers and confectioners 80 Butchers 148 Canteens 27 Canteens—School 48 Chemists 34 Cinema 2 Confectioners (sweets only) 83 Fishmongers 69 General Stores 23 Greengrocers and fruiterers158 Grocers 297 Licensed premises with catering facilities 24 Licensed premises without catering facilities 42 Milk Storage Depots 5 Ice Cream Vehicles 20 Restaurants and cafes124 Stalls, food 123 Tea packer 1 Vehicles, food 18 1,387 Hairdressers 61 House drains tested 113 Housing Act 246 Heating Appliances (Fireguards) Act 28 Housing Enquiries 149 Housing Land Charges 1,028 Infectious Disease Premises 44 Insect Pests 474 Merchandise Marks Act 161 Offices 19 Outworkers premises 58 Pet Animals Act 24 Piggeries 23 Premises re cesspools 35 Public Health Act (Houses) 3,349 Public Health Act re-inspections 2,963 Rag Flock and Other Filling Materials Act 10 Rent Act 53 Rodents 418 Schools 34 Shops 1,222 Tents, Vans, Sheds 32 Urinals 90 Water Sampling 27 14,340 Four hundred and forty-nine informal notices were served concerning the following matters:— Accumulations and deposits 27 Animals so kept 1 Clean Air Act 74 Drainage defects 92 Dustbins 27 Factories Act 10 Food and Drugs Act (incl. Food Bye-laws) 56 Food contaminated 3 General defective conditions 88 Heating Appliances (Fireguards) Act 1 House Drains Obstructed 1 Miscellaneous 24 23 Overcrowding 10 Rodents 8 Shops Act 25 Water Supply 2 449 Twenty-one formal notices were served by authority of the Council under the following Acts:— Public Health Act, 1936, Section 24 2 „ „ „ „ Section 39 3 „ „ „ „ Section 45 1 „ „ Section 75 2 „ „ „ „ Section 79 4 „ „ „ „ Section 93 9 21 As a result of investigations made and notices served, the following work was carried out:— Accumulations removed 23 Brickwork, repaired and/or repointed 5 Ceilings cleansed 2 Ceiling plaster repaired and/or made good 13 Cement fillets renewed 1 Chimney brickwork and pots repaired or renewed flues repaired 2 Coppers repaired 1 Damp conditions remedied 21 Damp course renewed 2 Disinfestations 316 Doors and frames repaired, including locks and fasteners 11 Drainage repaired and/or reconstructed 45 houses (428 ft. of drain laid) Drainage inspection chambers repaired 21 inspection chambers provided 2 inspection chamber covers renewed 12 stoppers or caps refixed and/or renewed 1 soil vents repaired and/or renewed 8 drains tested 36 drains cleared (affecting 1,038 houses) 331 drains sealed off 2 waste gullies repaired, renewed or provided 5 waste pipes, repaired, renewed or provided 5 cesspools emptied 3 Dustbins provided 63 Fences and/or gates repaired or renewed 9 Fireplaces, ranges or stoves repaired or renewed 12 Floors renewed or repaired 12 Gates repaired or renewed 9 Glazing and putty renewed 10 Houses painted externally 14 Paving repaired and/or made level 4 Roofs repaired and made weatherproof 16 downpipe, guttering repaired and/or renewed 21 Sinks renewed or provided 1 Stairs or steps repaired, renewed or made level 4 Surface water drainage repaired and made to work properly Walls rendered or rendering repaired 1 replastered and/or repaired 20 cleansed and redecorated 4 Wash basins, baths renewed 5 24 Water Supply renewals or repairs 14 W.C. pans renewed 8 pan joints renewed 5 seats repaired, renewed or provided 1 flushing apparatus repaired or renewed 10 Windows repaired and/or renewed 26 Disinfection One hundred and thirty-two rooms and 475 library books were disinfected. One lot of bedding was sterilised and two lots destroyed. Vermin Control Persons. The instances of personal verminous infestation have fallen rapidly since the end of the second world war, as the general standard of personal hygiene progressively improved and with the removal of the various restrictions occasioned by war time conditions on the means of practising personal hygiene. Regretfully we still have the odd incorrigibly verminous family who need constant supervision, but it is rarely necessary to utilise the full services of the Council's Cleansing Station for the purpose. One individual was treated at the Cleansing Station for scabies infestation contracted abroad and made 3 attendances and one elderly woman attended twice for personal cleanliness. No schoolchildren received treatment at the Station. Premises. During the year, two lots of bedding were destroyed and three hundred and sixteen premises were treated for the destruction of vermin and insect pests as follows:— Infestation Property Treated by C.U.D.C. Property Treated Total C.U.D.C. Property S.C.C. Property L.C.C. Property Privately Owned Property By L.C.C. By Owners Ants - - - 1 - - 1 Beetles 1 - 1 - - - 2 Bugs - - - 5 - - 5 Fleas - - - 1 - - 1 Flies 2 9 1 1 - - 13 Wasps .. 28 5 7 254 - - 294 31 14 9 262 - - 316 Clean Air Act, 1956 In April the Council authorised the necessary steps to be taken to secure a Smoke Control Order in respect of the first Smokeless Zone, the area being that bounded by Buckhurst Avenue on the north, Green Wrythe Lane on the West, Nightingale Road on the south and the River Wandle on the east. The area comprises 139 acres, 31 streets, 1,129 private dwellings, 298 Council owned dwellings, 27 shops, 2 factories, one horticultural nursery, one builder's yard and one club. 25 A survey of approximately 10% of the properties in this area was carried out and based on this it was estimated that the total cost of fireplace conversions and adaptations to enable the occupiers of the premises to comply with the requirement not to emit smoke, would be approximately £15,500. The date for the coming into operation of the Smoke Control Order was fixed as 1st April, 1961 and the Minister's provisional clearance to the scheme was received in September. The Council deferred, to a later date in 1960, their consideration of a phased programme to cover the whole district with Smokeless Zones. The work of surveying the remaining 90 % of the properties in this first zone commenced in November and was continued into 1960. Several years ago the Council installed apparatus for measuring atmospheric pollution. At the present time this consists of two deposit guages B and C—previously three but gauge A was discontinued in 1958— for measuring grit and a filter for measuring volumetrically sulphur dioxide and smoke. Deposit gauge B is sited in Winchcombe Road and C in Buckhurst Avenue. The filter apparatus is 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 B 17.66 15.47 4.72 9.07 C 19.60 13.29 5.54 9.75 Month Gauge B Gauge C Rainfall in ins. Total Solids (Tons per sq. mile) Rainfall in ins. Total Solids (Tons per sq. mile) January 1.96 10.65 1.97 11.71 February 0.02 4.72 0.06 8.29 March 2.10 15.47 2.22 13.29 April 1.87 7.79 1.98 9.70 May 0.39 6.46 0.77 7.29 June 0.20 10.17 0.74 12.45 July 1.14 9.18 1.41 10.71 August 0.78 5.03 1.08 5.54 September - 5.65 0.05 7.45 October 2.20 12.14 2.21 9.23 November 3.43 11.39 3.55 10.47 December 3.57 10.17 3.56 10.81 Total 17.66 108.82 19.60 116.94 26 Smoke and Atmospheric Sulphur Dioxide Month Smoke (Milligrams per 100 cubic metres) S.O,2. (Parts per 100 million) Highest Daily Reading Lowest Daily Reading Average Daily Reading Highest Daily Reading Lowest Daily Reading Average Daily Reading January 51.25 2.16 14.21 39.5 1.7 9.9 February 47.95 4.26 12.54 24.6 2.6 8.7 March 14.73 1.12 6.13 9.7 1.7 4.5 April 10.16 1.04 4.48 9.1 1.0 3.0 May 6.49 1.06 2.91 8.9 1.5 3.7 June 5.35 0.21 1.67 4.9 0.2 1.9 July 3.35 0.11 1.29 3.3 0.2 1.4 August 3.56 0.11 1.80 3.6 0.2 1.9 September 9.90 0.87 3.07 12.3 1.8 4.8 October 17.77 0.92 5.29 6.6 0.7 2.4 November 58.27 2.00 13.58 27.8 1.3 6.0 December 31.00 2.00 7.00 15.8 1.2 3.1 Whole year 58.27 0.11 6.12 39.5 0.2 4.2 Twenty-eight complaints were received and dealt with during the year. Prevention of Damage by Pests Act, 1949 Five thousand nine hundred and eleven visits were made by the Rodent Operatives to 868 properties and 291 rat and mouse infestations were found. Of that number 258 were in private premises, 28 in business premises, 5 in Council premises. With regard to sewers, one maintenance treatment was carried out in May. The results are shown in the following table, together with those for the three previous years:— May Treatment November Treatment 1956 1957 1958 1959 1956 1957 1958 1959 Manholes baited 188 194 198 188 191 199 190 - Manholes in which takes of prebait were recorded 67 62 80 7 75 83 51 - Percentage of manholes showing infestations 35.6 33.0 40.4 3.7 39.3 42.7 26.8 - Percentage in relation to total manholes in district 5.9 5.7 7.1 0.6 6.6 7.5 4.5 - The usual November treatment of sewers was ommitted owing to pressure of other work. 27 Swimming Baths The Council owns the only public swimming bath in the district. Constructed many years ago, it is of limited size and care has to be exercised to prevent over use in hot weather. The water provided from the main supply is circulated and subjected to precipitation, filtration and chlorination on the "break point" principle. Twelve samples were taken in the period May to September for bacteriological examination. Five of these indicated that the existing practice in the use of the treatment plant was barely sufficient to keep the bacterial content of the water at less than 10 per ml. "Break point" chlorination was accordingly introduced in August and subsequent samples were entirely satisfactory. The provision of relatively small privately owned swimming baths is an increasing tendency at the present time. Their use can be a risk unless suitable precautions are taken to see that the water is not a means of spreading infection. This may not be of much significance when a small prefabricated bath is used only by members of one family, but when such facilities are provided for groups of individuals as in schools, it is very necessary that the safeguards should be adequate. In the light of this modern tendency to install swimming baths in schools, it is gratifying to note that the Principal School Medical Officer for Surrey has presented a valuable report to the Medical and Special Schools Committee dealing with the hygienic considerations involved. Offices Nineteen inspections of offices were made, but no action was necessary. Factories, Workplaces and Outworkers 28 The following table gives a summary of the registers:— Employees Premises Males Females Total Factories— with mechanical power 1,003 551 1,554 92 without „ „ 32 18 50 17 Workplaces— with mechanical power 29 2 31 28 without „ „ 20 18 38 27 1,084 589 1,673 164 The following tables, set out in the manner prescribed by the Home Office Form 572 (revised), indicates the inspections made and action taken under the Factories Act. 1. Inspections for purposes of provisions as to health (including inspections made by the Public Health Inspectors). Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 17 69 - - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 92 265 10 - (iii) Other premises in which Section 7 is enforced by the Local Authority* (excluding outworkers' premises) 21 59 - - Total 130 393 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— 29 (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 2 1 - - - (b) Unsuitable or defective 4 8 - - - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) 4 1 - - - Total 10 10 - - - 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. 21 - - - - - Boxes (cardboard) 1 - - - - - Christmas Crackers 1 - - - - - Lampshades 9 - - - - - Paper Hats - - - - - - Umbrellas 1 - - - - - Wire Brushes 5 - - - - - Total 38 - - - - - Employment Agencies The two employment agencies in the district were visited and found to be satisfactory. One agency was terminated in April. Shops Act, 1950 There are 509 shop premises on the register and 2,774 inspections were made during the year. Preliminary notices were served with regard to twenty-five infringements of the statutory requirements, thirteen for failure to exhibit appropriate notices, five for condition of premises, five for sanitary accommodation and two for closing hours. Twenty-three notices have been complied with (including six notices outstanding at 31.12.58.). Heating Appliances (Fireguards) Regulations, 1953 Twenty-eight inspections were made under the Act. One informal notice was served and has been complied with. Merchandise Marks Act, 1926 The Council have continued to execute the provisions of the Orders and their five Sampling Officers are appointed as authorised officers under the Act. Much of the work is done amongst the stall-holders in the district. Pet Animals Act, 1951 Five licences have been granted in respect of premises used as Pet Shops, all of them dealing mainly with fish and birds. The premises were inspected and found satisfactory. 30 Rag Flock and Other Filling Materials Act, 1951 Three premises used for upholstering are registered in accordance with Section 2 of the Rag Flock and Other Filling Materials Act, 1951. The prescribed Analysts are—The Chiltern Research Laboratories, Ltd., of 19, Desborough Avenue, High Wycombe, Bucks. Establishments for Massage and Special Treatment Five establishments, three for chiropody and two for massage, etc., are licensed under the Surrey County Council's Acts. All were periodically visited and found to be satisfactory. National Assistance Acts, 1948—1951 The provisions of these enactments enable the Medical Officer of Health, acting on behalf of the Council, to require the removal to a place of care of any person who, owing to age or infirmity and neglect, is found to be living in insanitary conditions. There was no occasion to use these powers during the year. The arrangements for the care of the aged generally are still far short of what is necessary and the attention being given by the Council to their housing needs is a valuable contribution to this problem locally, as is also the activities of the Carshalton Old Peoples Welfare Committee. Although only of recent institution, this voluntary committee is already meeting the needs of old people in many very necessary directions and is worthy of all the support which can be given. Section 50. One burial was arranged during the year by the Council under this section for a person for whom burial was not otherwise being arranged. Disposal of the Dead The Carshalton and Merton and Morden Joint Burial Board, which was formed by the two authorities, acquired some 60 acres of land in Lower Morden to serve as a burial ground for both areas and was brought into use in 1947. During the year 402 interments took place there of which 164 were from the Carshalton district. In 1956 the North-East Surrey Crematorium Board was established to administer a crematorium provided in Battersea's Cemetery which adjoins the Burial Board's cemetery in Lower Morden. The Crematorium Board represents the Councils of Battersea, Sutton and Cheam, Carshalton and Merton and Morden. During 1959, 658 cremations took place of which 37 were from Carshalton. The Council maintains a mortuary fully equipped with refrigeration storage and post mortem examination facilities in Mill Lane. Financial arrangements have been made with the Beddington and Wallington and Coulsdon and Purley Councils for the reception of bodies from both those districts. A total of 175 bodies—on all of which autopsies were performed— was received into the mortuary during the year, 74 of which came from other districts and 45 were admitted via local hospitals, ambulances and the police. 31 Section D—Housing New Houses During the year 98 new dwellings were completed 71 of which were private dwellings and 27 Council bungalows and flats for old people. The following buildings were in course of erection at the end of the year:— Private dwellings 37 . Council Flats 14 Council Maisonnettes 48 Council 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 40 Ruskin Road Bungalows 8 Council's Housing Scheme The dwellings in the ownership of the Council at the year end were as follows:— Pre-War Houses 529 Post-War Houses, Flats and Maisonnettes 683 Temporary Bungalows 102 Houses taken over under S.D.A.A. and H.A. 26 Houses purchased (units of accommodation) 36 Accommodation in Parks, Offices, etc 18 1,394 The number of requisitioned premises at the 31st December, 1959 was 4 providing accommodation for 8 families. This is 13 less properties under requisition than at 12 months earlier. In 1959 the Council re-examined the applications 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 forseeable 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 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 1959 the 'A' List totalled 80 and the 'B' List 52. 32 Inspection and Action taken undei Statutory Powers 1. Inspection of Dwelling Houses during the year. (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 3,743 (b) Number of inspections made for the purpose 6,706 (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 5 (b) Number of inspections made for the purpose 8 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (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 187 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 1958) 166 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 — (b) Proceeding under Public Health Acts. (1) Number of dwelling houses in respect of which formal notices were served requiring defects to be remedied 12 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By Owners 22 (b) By Local Authority — 4. Housing Act, 1957—Part IV (Overcrowding). (a) (1) Number of dwelling houses overcrowded at the end of the year 27 (2) Number of families dwelling therein 46 (3) Equivalent number of adults dwelling therein 176½ 33 (b) Number of new cases reported during the year 12 (c) (1) Number of cases of overcrowding relieved during the year 18 (2) Number of persons concerned in such cases 123 (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 12 cases of overcrowding were found and 18 cases were remedied leaving 27 dwellings with 176½ 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 31/12/58 Dwellings found overcrowded during 1959 Dwellings decrowded during 1959 Dwellings remaining overcrowded at 31/12/59 Overcrowded cases remedied during 1959 Formal Action Informal Action Total St. Helier North 13 4 11 6 5 6 11 St. Helier South 6 2 2 6 - 2 2 St. Helier West 3 1 - 4 - - - North-East 5 2 1 6 - 1 1 North-West 2 1 3 - 3 - 3 Central 3 1 1 3 1 - 1 South-West - - - - - - - South-East 1 1 - 2 - - - Total 33 12 18 27 9 9 18 It is necessary to point out that, as in past years, these figures are based on the information which comes to the notice of the department during the course of daily activities. They cannot, nor do they purport to, represent the exact position in respect of overcrowding. Only a complete and comprehensive survey could give that at any particular time. Since however they are obtained year by year in the same manner, they have some value in indicating the trend of overcrowding. Figures obtained in this way over the last 10 years were as follows:— Year New Cases Cases at Year End Year New Cases Cases at Year End 1950 75 209 1955 26 73 1951 54 217 1956 27 63 1952 79 123 1957 10 46 1953 53 112 1958 14 33 1954 49 105 1959 12 27 As has been the experience for many years, all the new instances of overcrowding were the result of relatives sharing accommodation. 34 Abatement of the 12 dwellings was effected in the following manner:— Provision of alternative accommodation by:— Carshalton U.D.C. 5 London County Council 3 Other Local Authorities 1 Removal of one or more occupants 9 Of the 27 dwellings remaining overcrowded at the year end, 4 were owned by the Carshalton Council, 15 by the London County Council and 8 were privately owned. Slum Clearance and Demolition The Compulsory Purchase Order in respect of Clearance Area No. 14 involving 30 terrace type houses and one combined house and shop in St. John's Road was confirmed by the Minister with slight modification in June 1959. Eleven of these families have been rehoused and 21 still await new accommodation. In December, a certificate was submitted to the Council to the effect that 5 flats owned by the Council at 81 Stanley Road were unfit for human habitation and not capable, at reasonable expense, of being rendered so fit. In view of this certificate and upon the Council resolving to authorise demolition, the Minister did not propose to arrange for an inspection prior to demolition and he indicated that he would be prepared to consider an application for payment of slum clearance subsidy in respect of houses provided to rehouse the tenants of these premises. The five families comprising 13 adults and 7 children under 10 years of age have been rehoused and the buildings have been demolished preparatory to re-development of the site. Rent Act, 1957 The following details show the action which has been taken during the year:— Part /-—Applications for Certificates of Disrepair. (1) Number of applications for certificates 9 (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 4 (b) in respect of all defects 5 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 4 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule Nil (6) Number of Certificates issued 4 Part II—Applications for Cancellation of Certificates. (7) Applications by landlords to Local Authority for cancellation of certificates 12 (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 13 (11) Work done before expiry of Form J 1 (12) Applications outstanding at end of year 2 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. The whole of Surrey is now an "Attested Area" and the herds are presumably free from tuberculosis. Milk Distributors. The number of Milk Distributors registered under the Milk and Dairies (General) Regulations 1959 is 13. Designated licences issued during the year were as follows:— Designation Number of Distributors Holding Licences No. of Licences in force on 31/12/59 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 seventy-three samples of milk were procured and submitted for bacteriological examination. The milks were sold under the Milk (Special Designations) Regulations and all complied 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 113 113 - 113 - - - T.T. Pasteurised 39 39 - 39 - - - Sterilised 21 - - - - 21 - 173 152 - 152 - 21 - 36 Biological Testing of Milk. As mentioned in last year's report the success of the scheme for the eradication of tubercle in cattle in the county no longer justifies the routine biological examination of milk except in the case of raw T.T. milk. All the 3 farms in the district produce T.T. milk but this is subjected to heat treatment before sale to the public. Milk and Dairies (General) Regulations, 1959—Regulations 18 to 20. No action was called for under Part VII of the Milk and Dairies (General) Regulations, 1959, 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 173. Of these 29 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. Three were slightly deficient in non-fatty solids. The average fat and non-fatty solids of the "Channel Islands" samples was 4.35% and 8.94% respectively; that of the remaining 144 samples 3.52 /J and 8.62%. Ice Cream Although the hygienic standard of locally sold ice cream, as judged by the results of bacteriological examination, had been steadily improving in recent years, 1958 was the first year in which all the samples examined conformed to the highest grade. This satisfactory experience was repeated during the year under review, when all 87 samples passed the test of Grade I. The record of these samples since the inception of this system of bacteriological grading in 1947 is as follows:— 37 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 - - - 1959 87 87 - - - Seven samples of ice cream examined by the Public Analyst for qualitative analysis were found to be satisfactory. Ice Cream (Heat-treatment, etc.) Regulations, 1959. There are no manufacturers of ice cream in the district, all the registered retailers drawing their supplies from reputed manufacturers outside the district. All retailers are provided with refrigerator cabinets which maintain a temperature well below 28 °F. in accordance with the regulations. Bacteriological Examination of Other Foods Samples of sweets, one of chicken, one of meat spread and one of ham, all suspected by purchasers of causing illness, were sent to the bacteriologist for examination and were found to be satisfactory. 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 2,385 lbs. 6 ozs. Analyses of Food and Drugs Samples submitted to the Public Analyst for qualitative analysis numbered 264 as shown in the following table:— 38 Article No. Adulterated or otherwise irregular Article No. Adulterated or otherwise irregular Biscuits 2 3 Milk—Channel Islands 29 1 Breakfast Food 1 Milo 1 Beef Mixed 1 Mineral Water 1 Butter 2 Mint Sauce 1 Cereal 1 Mock Salmon Cutlettes 1 Cheese Food 1 Nerve Tonic 1 Cheese Processed 1 Oranges Prepared 1 Cheese Spread 1 Peas Processed 1 Cheese Spread with Peanut Butter 1 Shrimp 1 Pease Pudding 1 Chewing Gum 1 Pork Roll Stuffed 1 Chicken Jelly 1 Raisin Flavoured Cordial 1 Chicken Pie 1 Red Cabbage 1 Chocolate Spread 1 Rice Ground 1 Confectionery Flour 3 Saccharine 1 Confectionery Sugar 8 Salad Cream 1 Cordial 4 Salmon Potted 1 Dandelion Coffee 1 Sausage Beef 2 Drinking Chocolate 1 Sausage Pork 1 Dripping 1 Sausage Pork Canned 1 Evaporated Milk Sausage Meat Pork 1 Fish Cakes I Sparkling Drink 1 Fish Paste 1 Spinach Puree 1 Flour Self-Raising Sponge Fingers 1 Golden Crumbs 1 Sponge Mixture 1 Ground Nut Oil 1 Soup 1 Halibut Oil Capsules 1 Soup Squares 1 Horseradish Relish 1 Steakettes 1 Ice Cream Sultanas 2 Instant Chocolate 1 Tea 2 Iron Jelloids 1 Tomatoes Tinned 1 Mayonnaise 1 Tomato Juice ] Meat Pudding 1 Vegetable Juice 1 Milk 144 Vinegar 1 The following 4 samples were reported upon adversely:— Milk (Three Samples). All these three samples were deficient in non-fatty solids as judged by the Sale of Milk Regulations which require a minimum of 8.5 %, the actual content being 8.42%, 8.44% and 8.37% respectively. The Hortvet freezing test however did not in any case indicate the presence of added water. As is known from past experience, a slight reduction in solids other than fat below the presumptive standard of the Regulations can occur due to feeding difficulties and no action was therefore necessary in these cases, other than to draw the distributor's attention to their relatively poor quality. 39 Canned Pork Sausages. This was an imported product from South Africa. The only irregularity was that the presence of salt and spices which the sausages contained was not indicated on the label, as is required by the Labelling of Food Order 1953. The suppliers gave an assurance to remedy the omission. Section 9—Sale of Food Unfit for Human Consumption The following complaints were received of alleged foreign matter in purchased foods:— Maggots in Bacon Wire in Cheese Moth in Bread Maggots in Milk Wood in Bread Glass in Sultanas Glass in Bun Glass in Tea The evidence as to how and when the alleged contaminants gained access to these commodities varied in considerable degree, but none was sufficient to warrant legal proceedings. Appropriate action was taken with the various vendors. Inspection of Food The following quantities of food found to be unsound, diseased or unwholesome and unfit for human food were surrendered and destroyed or so disposed of as to prevent them from being used for human food:— lbs. ozs. lbs. ozs. Beverages 3 — Meat 2,385 6 Cake 9 8 Meat Paste — 7 Cereals — 10 Milk 12 14 Cheese 17 — Peanut Butter 6 8 Cream 4 8 Pickles — 10 Fish 208 14 Pudding 13 13 Fruit 136 13 Rice 6 15 Fruit Juice 4 15 Sauce — 6 Honey 10 14 Soup 19 — Ice Cream 120 — Spaghetti 3 8 Jam 207 — Vegetables 136 14 Total weight 1 ton, 9 cwts., 2 qrs., 5 lbs., 7 ozs. The method of disposal is by burningin 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 shown in Table 9. 40 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 2 2 — 1 1 1 — 1 — — — — — — Bakehouses 3 — 61 — — — — — — — — — — — — — — Butchers 35 31 148 3 7 2 1 1 4 8 2 Canteens 22 — 75 — — — — — — — — — 1 — — — — Chemists 17 1 34 — — — — — — — — — — — — — — Cinemas 1 — 2 — — — — — — — — — — — — — — Confectioners (Sweets only) 69 55 83 — — — — — — — 1 — — — — — — Fishmongers 14 6 69 — 1 — — — — 1 1 — — — — — — General Stores 4 4 23 — — — — — — — — — — — — — — Greengrocers and Fruiterers 40 6 158 1 1 1 1 1 2 4 — — — — — 4 Grocers (including corn chandlers) 78 27 298 1 2 1 1 1 2 1 3 — — — — — 2 Ice Cream Vehicles variable 20 — — — — — — — — — — — — — — Licensed Premises (with catering facilities) 5 1 24 — — — — — — — 2 — — — — — — Licensed Premises (without catering facilities) .. 20 — 42 1 — — — — — 1 — — — — — 1 Milk Storage Depots 3 — 5 — — — — — — — — — — — — — — Restaurants and Cafes 24 16 124 —— — — — — — 1 2 — — — — — — Stalls, food variable 123 — — — — — — — — — — — — — Vehicles, food variable — 18 — — — — — — — — — — — — — — 151 1,387 7 14 3 4 4 4 9 23 — 1 — — — 9 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 There was no variola infection in the district in 1959. Vaccination against Smallpox. The records in respect of children under five years of age are sufficiently complete to give a close estimate as to the numbers in this age group protected against smallpox by vaccination. The percentage treated at some time in their lives under the age of 5 years at the end of 1959 was approximately 54%, a not unsatisfactory figure in the absence for many years of smallpox in the area and by comparison with the national rate. 42 The number of persons recorded as having received successful vaccination during the year was as follows:— Age at 31st December, 1959 i.e. born in Under 1 yr 1959 1-4 yrs 1955-8 5-14 yrs 1945-54 15 yrs & over 1944 and earlier Total Primary Vaccinations— By Private Practitioners 136 10 8 30 184 At Clinics 273 28 301 409 38 8 30 485 Revaccinations— By Private Practitioners - 2 11 48 61 At Clinics — — — — — — 2 11 48 61 In addition, the following unsuccessful attempts at vaccination were made:— Age at 31st December, 1959 i.e. born in Under 1 yr 1959 1-4 yrs 1955-8 5-14 yrs 1945-54 15 yrs & over 1944 & earlier Total Primary 7 — — 4 11 Revaccination — — — 6 6 7 — ~ 10 17 The estimated number of children under five years of age vaccinated at the end of 1959, was 1,800. Enteric Fever There was again no case of typhoid or paratyphoid fever. The stringent precautions taken in respect of water supplies and the improved standard of food hygiene are the chief contributory factors in this continued freedom from enteric fever. Dysentery Infection by Shigella Sonnei which is responsible for a relatively mild form of dysentery is endemic in this country and there appears to be little doubt that it is never absent from the community. From time to time it assumes local epidemic proportions particularly when it gains access to schools especially the Primary Schools, Nurseries and other aggregations of children not excluding children's hospital wards. Owing to its relative mildness, it is frequently found to be masquerading under various disguises such as diarrhoea, dietic indiscretion, etc., for some time before its true nature is established, by which time it has already become firmly entrenched in the local community or group which it has invaded. Such an outbreak occurred in the district during the spring and early summer of 1959. It affected two widely separated parts of the district; the 43 northern end on the St. Helier estate during the four months April to July and the southern end in the Clockhouse Farm district during the three months May to July. Incidence in both areas was approximately the same about 40 cases in each. A total of 88 cases was notified affecting 56 families. The spread within each household was distinctly less than in the outbreak of 1958 when the average number of cases per affected house was 4 in a smaller outbreak of 40 cases. Scarlet Fever Scarlet Fever is not nowadays the serious infection it was 50 years ago. It has for many years past been a mild disease and as a result less importance is being attached to it by the profession, both from the point of view of the patient and even more so from the standpoint of precautions against its spread. With justification the restrictions both on the patient and the contacts have been progressively relaxed in keeping with the altering situation, but it is still an infectious illness and can occasionally bring serious consequences. As in the case of Sonne dysentery, its very mildness is a considerable handicap in controlling its spread owing to the increasing indifference with which it is regarded. This may well be a partial, if not a complete explanation of the steadily rising incidence of scarlet fever in the area from a low record figure of 26 in 1956 to 59 in 1957, 121 in 1958 and to 144 in 1959. The level of prevalence is still however well below that experienced before the second world war, when an annual total of 300 was not uncommon. Of the total cases 100 representing 69% were nursed at home. TABLE 10. SCARLET FEVER—DISTRIBUTION OF CASES, 1959. 1959 Ward Total St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest January 2 2 5 4 2 2 - 4 21 February 2 1 1 12 — 3 2 2 23 March — 1 2 5 4 4 3 4 23 April — 1 — — 2 3 1 3 10 May — — 4 — 1 1 2 8 June — — — — 5 — 1 2 8 July — — 1 1 — — 6 2 10 August — — 2 — — — 1 — 3 September — — — — 1 — 1 — 2 October 1 1 — — 1 1 - - 4 November 6 2 3 1 — — 2 2 16 December 3 4 — 2 2 1 1 3 16 Totals 14 12 18 25 18 15 18 24 144 Monthly mean 1.16 1.00 1.50 2.08 1.50 1.25 1.50 2.00 12.00 Case rate per 1,000 population 1.71 1.69 2.42 2.57 2.51 2.61 2.12 3.66 2.29 44 TABLE 11. SCARLET FEVER—MULTIPLE CASES, 1959. Ward No. of houses in which occurred Total Houses Total Cases 1 Case 2 Cases 3 Cases 4 Cases St. Helier North 8 3 — 11 14 St. Helier South 12 — — — 12 12 St. Helier West 16 1 — — 17 18 North-East 13 3 2 — 18 25 North-West 14 2 — — 16 18 Central 9 3 — — 12 15 South-East 12 1 — 1 14 18 South-West 15 3 1 — 19 24 Whole District 99 16 3 1 119 144 Diphtheria The district was again free from diphtheria infection for the tenth year in succession. This freedom can only be preserved by the maintenance of a high level of effective immunisation. Effective is the operative word since it is essential to boost the protection afforded by initial treatment in infancy by reinforcing inoculations after an interval of a few years, certainly not more than five, until the age of adolescence is reached. 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. The scheme aims at securing primary protection before the age of one year, reinforcing that protection about the time of entry to school and thereafter at approximately three year intervals, until the child leaves the Junior School. The initial treatment is given either by the private doctor or the welfare clinics and for convenience is usually combined with whooping cough immunisation and frequently with tetanus vaccine also. The list of infections against which protection can now be secured by vaccination or immunisation, grows steadily and whilst it is too much to hope for one all-embracing inoculation, three injections can now be combined, but it is still necessary to plan a child's various injections to secure the maximum degree of protection and the least disturbance to its normal routine especially during the first twelve months of life. For many years the combined efforts of the practitioners and the local health services have succeeded in maintaining a diphtheria immunisation rate of approximately 60% for children under five years of age. This is usually raised a further 10% for children of school age since a number of parents still do not make the necessary effort until their children enter school. Probably the fact that this is made easier for them, in that the service is taken to the child at school, is responsible for the acquiescence of the not too enthusiastic parents. 45 In 1959, 801 resident children received a primary course of treatment as follows:— Age at 31/12/59 i.e. born in year Under I year 1959 1 year 1958 2 years 1957 3 years 1956 4 years 1955 5-9 years 195054 10-14 years 194549 Total under 15 yrs. At Council Clinics 188 244 27 8 6 2 475 In Carshalton Schools — — — 2 12 152 30 196 Private Practitioners 42 99 15 — 2 6 — 164 Less outward transfers 230 343 42 10 20 3 160 24 30 9 835 36 Plus inward transfers 230 343 42 ~ 10 17 136 2 21 799 2 Carshalton residents 230 343 42 10 17 138 21 801 A further 1,559 Carshalton children received reinforcing injections during the year. The following table shows the immunisation state of the local child population at the 31st December, 1959 :— Number of children at 31st December, 1959, who had completed a course of immunisation at any time between 1st January, 1945 and 31st December, 1959. Age at 31/12/59 i.e. Born in Year Under 1 1959 1-4 1955-1958 5-9 1950-1954 10-14 1945-1949 Under 15 Total A. No. of children whose last course (primary or booster) was completed in the period 1955-1959 160 2,011 3,012 2,614 7,797 B. No. of children whose last course (primary or booster) was completed in the period 1954 or earlier - - 556 1,376 1,932 C. Estimated mid-year child population 760 3,035 8,990 12,785 Immunity Index 100 A/C 21.0 66.2 62.5 60.9 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 is shown in the following table:— 46 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 1959 57 84(63*) 76(61*) 0 0.00 (* Immunised within the last 5 years) Erysipelas The number of cases of this skin infection notified, never very large, has declined to a very low level. As in the year before, only one case affecting the face of an elderly woman was reported. The organism responsible for this condition is one which is usually readily destroyed by anti-biotic or sulphonamide treatment. Pneumonia Cases of pneumonia, of which only primary pneumonia and influenzal pneumonia are notifiable, are a fair indication of the prevalence of respiratory illness, although they represent only the more serious and extreme manifestation of chest infection. As expected they occur mostly in the winter months and of the 26 cases notified during the year, 14 were influenzal in origin and all 14 occurred in February and March during a wave of that infection. More than half the total cases were over 50 years of age and the youngest was 11 years. 47 Measles The rhythm of periodicity in the prevalence of measles in the large conurbations varies only occasionally. It usually appears in marked epidemic form every second year, though the "non-epidemic" years are never free from a significant number of cases. This holds true for the greater London area as in the other large cities, although the pattern was certainly upset in 1940 when the expected visitation did not materialize, doubtless due to the large scale evacuation of children from the Metropolis. The biennial fluctuation has however been largely restored for many years past. The year 1958 was a year of comparatively low incidence when only 83 cases were notified in the district. The year under review, as expected, saw a marked rise in the number of cases to 973 confined almost entirely to the first seven months of the year. This two yearly fluctuation is shown by the number of cases occurring in the district in each of the last seven years, which were as follows :— 1953 652 1957 684 1954 173 1958 83 1955 1,138 1959 973 1956 326 The prevalence in 1959 was fairly generally distributed over the area. There were no deaths. TABLE 12.—MEASLES WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1959 (Excluding hospital patients non-resident in Carshalton) 1959 Ward St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast SouthWest Total January 2 54 9 11 9 - 4 7 96 February 3 7 17 14 10 7 8 106 172 March 7 6 10 66 60 35 37 60 281 April 7 2 5 76 10 24 62 10 196 May 6 7 24 7 4 5 17 1 71 June 12 15 18 14 5 - 11 2 77 July 6 17 3 10 9 - 7 1 53 August 10 6 1 — 7 — — — 24 September — 1 — — 1 — — — 2 October — — — — — — — — — November — — — — — — — — — December — — — — — — 1 — 1 Totals 53 115 87 198 115 71 147 187 973 Monthly Mean 4.41 9.58 7.25 16.50 9.58 5.91 12.25 15.58 81.08 Case rate per 1,000 population 6.50 16.22 11.70 20.43 16.06 12.39 17.35 28.54 16.14 48 Whooping Cough The gradual reduction in the prevalence of whooping cough, which followed the public acceptance of whooping cough vaccination to a significant degree, continued in 1959. There was a further fall in the number of cases from 41 in the year before to 32, a new low record. As will be seen from Table 13 the cases were more or less evenly spread over the year and nowhere did it assume epidemic proportions. There were no deaths. Whooping Cough Vaccination. The level of whooping cough vaccination in children keeps pace with that of diphtheria immunisation, i.e. approximately 60%. This is explained by the fact that both treatments are usually given combined in the same injection and parents who accept the one usually accept the other. The number of children who during 1959 completed the initial course of treatment was 631. All but two of them were under the age of 5 years. TABLE 13. WHOOPING COUGH—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1959. (Excluding hospital patients non-resident in Carshalton) 1959 Ward Total St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest January — 1 — — — — — — 1 February.. 1 — — — — — — 1 2 April — — 1 3 — — — — 4 May — — — 2 — — — — 2 June — — 1 1 — — 1 — 3 July — 1 3 — — — — — 4 August 1 — — 1 — — — 2 September 1 — 1 3 — — — — 5 October — — — 1 — — — — 1 November — 1 2 — 1 — — — 4 December — — 3 — — 1 — — 4 Totals 3 3 11 11 1 1 1 1 32 Monthly Mean 0.25 0.25 0.91 0.91 0.08 0.08 0.08 0.08 2.66 Case rate per 1,000 population 0.36 0.42 1.48 1.13 0.13 0.17 0.11 0.15 0.54 Meningococcal Infection One case of meningococcal infection in the form of meningitis was notified in a woman of 62 years. She recovered after hospital treatment with modern therapeutic agents. 49 Poliomyelitis As in the year before there was only one case of poliomyelitis. This was a boy of 13 years who fell ill in June. He had received three anti-polio, injections, two in March and a third in December 1958. The fact that he developed no paralysis and made a rapid recovery after about three days, is consistent with the analysed results of anti-polio, vaccination which shows that paralysis—not infection—is about five times less common in vaccinated than in unvaccinated individuals. Poliomyelitis Vaccination. The Ministry of Health's Scheme during 1959 covered the age range from 6 months to 25 years and provided for a third injection for those already having had two. The numbers over 15 years of age who accepted treatment was not as high as one could wish, though a considerable measure of success was secured when intensive and managerially supported efforts were made in one or two of the local factories and the technical school, when treatment was given on the premises. 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 1959 1,753 — Young persons born 1933 to 1942 2,135 — Expectant mothers 302 — Special Groups (Ambulance men, Doctors etc 1,009 — Totals 5,199 6,804 The number vaccinated from the beginning of the scheme up to the 31st December, 1959 was as follows:— No. given 2 injections No. of those in the previous column given a 3rd injection Children 0—15 10,446 9,671 Young Persons 16—25 2,166 Expectant Mothers 537 Special Groups 1,131 Totals 14,280 9,671 These figures do not include the staffs of hospitals. 50 Ophthalmia Neonatorum There was again no case reported of this infectious inflammation of the eyes in the new-born. The prompt prophylactic use of the newer anti-biotic and chemo-therapeutic agents has reduced the occurrence of this potentially sight destroying condition to negligible proportions. Puerperal Pyrexia The extensive maternity accommodation provided in Carshalton hospitals which serve a large area of Metropolitan Surrey naturally provide the majority of the notifications received under the Puerperal Pyrexia Regulations. It should be remembered that this notification requirement covers every rise of temperature of 2° in women following childbirth or miscarriage, from whatever cause and is not an indication of the extent to which infection of the genital tract occurs during childbirth. A total of 192 cases was notified, of which only two were of women confined at home. The remaining 190 were hospital deliveries. Of the total 41 were Carshalton mothers. Food Poisoning Two cases of food poisoning were reported both from food infected with salmonella typhimurium. One was an isolated case of a housewife who, alone among her household of four, suffered in this way. As is so often the experience with single cases, there was no indication as to the vehicle of infection. The second case was a local resident who, with approximately 200 other individuals, was infected at a social function in a London Borough. 51 52 TABLE 14. CASES OF NOTIFIABLE INFECTIOUS DISEASE ADMITTED TO HOSPITAL, 1959. Disease Waddon Bletchingley Cuddington Wandle Valley Queen Mary's St. Helier Totals Scarlet Fever 2 1 3 36 2 - 44 Dysentery — — — 1 4 1 6 Measles 1 — 3 2 1 - 7 Pneumonia . — — — — — 1 1 Poliomyelitis (Non-Paralytic) — — — 1 — — 1 Meningoccocal Infection — — — — — 1 1 TOTALS 3 1 6 40 7 3 60 53 TABLE 15. INFECTIOUS DISEASES—NOTIFICATIONS, DEATHS AND DISTRIBUTION. (Excluding hospital patients non-resident in Carshalton) Disease Cases notified Case rate per 1,000 population Deaths Distribution by Wards No. of cases removed to Hospital Percentage of cases removed to Hospital St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest Scarlet Fever 144 2.29 — 14 12 18 25 18 15 18 24 44 31 Measles 973 16.14 — 53 115 87 198 115 71 147 187 7 0.71 Whooping Cough 32 0.54 — 3 3 11 11 1 1 1 1 — — Dysentery 88 1.46 — 12 27 3 5 — — 41 — 6 6.81 Pneumonia 26 0.43 — 4 2 8 7 2 — — 3 1 3.84 Poliomyelitis (Non-Paralytic) 1 0.01 - - - - - - - - 1 1 100 Erysipelas 1 0.01 - - - - - - - - - - — Puerperal Pyrexia 41 0.68 — 7 5 5 5 7 3 3 6 39 95 Food Poisoning 2 0.03 - - - - - - - - - - - Meningococcal Infections 1 0.01 - - - 1 - - - - - 1 100 54 TABLE 16. INFECTIOUS DISEASES—Notification by Age Groups, 1959. (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 3 10 18 84 25 2 — _ 1 144 Measles 21 89 90 123 105 511 25 4 4 1 — — 973 Whooping Cough 2 3 7 1 2 13 3 — 1 — — 32 Dysentery 1 4 3 3 5 45 12 1 5 4 2 3 88 Pneumonia — — — — — 1 4 — 2 1 12 6 26 Poliomyelitis (Non-Paralytic) — — — — — — 1 — — — — — 1 Erysipelas — — — — — — — — — - - 1 1 Puerperal Pyrexia — — — — — — — 4 35 2 — — 41 Food Poisoning — — — — — — — — — 1 1 — 2 Meningococcal Infection - - - - - - - - - - 1 — 1 LA LA TABLE 17. MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1959. (Excluding hospital patients non-resident in Carshalton) Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 21 23 23 10 8 8 10 3 2 4 16 16 144 Measles 96 172 281 196 71 77 53 24 2 — 1 973 Whooping Cough 1 2 — 4 2 3 4 2 5 1 4 4 32 Dysentery — — — 16 13 10 45 1 — — — 3 88 Pneumonia 2 11 4 3 2 — — 1 1 1 - 1 26 Poliomyelitis (Non-Paralytic) - - - - - - 1 - - - - - 1 Erysipelas — — — — — — — 1 — — — — 1 Puerperal Pyrexia 3 1 5 7 3 1 4 4 1 4 4 4 41 Food Poisoning — — — — — — — 1 — 1 2 Tuberculosis, Pulmonary 6 1 — 5 1 — 4 2 2 — 3 2 26 Tuberculosis, Non-Pulmonary — — — — 1 — — — — 1 — — 2 Meningococcal Infection - - - - - - - - - - - 1 1 Tuberculosis The new cases admitted to the tuberculosis register during the year numbered 70 classified as follows:— Males Females Pulmonary 35 Pulmonary 33 Non-pulmonary 1 Non-pulmonary 1 Of the total additions, 28 were primary notifications, 41 were transferred from other districts and 1 came to notice in other ways. In the same period, 140 names were removed from the register for the following reasons:— Recovered 65 Death 7 Otherwise (including removals) 68 After allowing for the additions and deductions, the state of the register at the 31st December, 1959, was as shown in the following table:— TUBERCULOSIS—WARD DISTRIBUTION. Cases on Register at 31st December, 1959. Ward Pulmonary Non-Pulmonary Total Incidence per 1,000 population Males Females Males Females St. Helier North 61 58 5 6 130 15.9 St. Helier South 58 49 6 6 119 16.7 St. Helier West 39 57 2 6 104 13.9 North-East 53 44 6 4 107 11.0 North-West 22 26 1 2 51 7.1 Central 20 30 1 — 51 8.9 South-East 37 20 — - 57 6.7 South-West 23 23 — 1 47 7.1 Whole District 313 307 21 25 666 11.4 620 46 The total of 666 is 70 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 50. 56 The number of tuberculous persons who died during the year was 7 distributed by age groups as follows:— Age, Years Pulmonary Non-Pulmonary Total Males Females Males Females 0 — — — — — 1—5 — — — — — 5—15 — — — — — 15—25 — — — — — 25—35 — — — — — 35—45 — — — — — 45—55 1 — — — i 55—65 5 1 — — 6 65—up — — — — — Totals 6 1 — — 7 The deaths attributable to tuberculosis were 3 as follows :— DEATHS DUE TO TUBERCULOSIS, 1959. Ward Pulmonary Non-Pulmonary Death Rate per 1,000 population Mean age at Death Male Female Male Female St. Helier North — 1 — — 0.12 60 St. Helier South — — — — — — St. Helier West — — — — — — North-East 1 — — — 1.03 53 North-West 1 — — — 1.39 56 Central — — — — — — South-East — — — — — — South-West — — — — — — Totals 2 1 — — 0.04 56 Of the 3 persons who died 1 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. No tuberculous family was rehoused by the Council in 1959. 57 58 TABLE 18. TUBERCULOSIS. New Cases, Age and Sex Distribution and Manner of Admission to Register, 1959. Age Group Years Primary Notifications "A" Cases transferred from other Districts Cases brought to notice other than by Notification or Transfer Total New Cases Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. M. F. M. F. 0— 1 — — — — — — — — — — — — — 1—5 1 — — — 1 — — — — — — — 2 5—10 1 — — — — — — — — — — — 1 10—15 — 1 — — 2 2 — — — — — — 5 15—20 1 2 — — — 2 — — — — — — 5 20—25 — 1 — — 3 6 — — — — — — 10 25—35 2 1 1 — 2 10 — — — — — — 16 35—45 1 2 — 1 2 5 — — — — — — 11 45—55 8 — — — 3 — — — — — — — 11 55—65 3 — — — 2 1 — — 1 — — — 7 65 up 2 — — — — — — — — — — — 2 Totals 19 7 1 1 15 26 — 1 — — — 70 28 41 1 Carshalton Chest and Heart Care Committee For nearly 30 years this voluntary body under its original title of the Carshalton Tuberculosis Care Committee has provided invaluable assistance to the many hundreds of families in the district who suffered protracted hardship as a result of tuberculosis, especially where the breadwinner was affected. It still continues this beneficial service to tuberculosis families, but during the year it extended the scope of its activities to include other chest and heart cases referred from the local chest clinics. This extension is not only a desirable service in itself but was facilitated by the steady and increasing success of the anti-tuberculosis schemes, both in the field of treatment and of prevention. Work among the tuberculous will, however, continue to form the major part of the Committee's activities for a long time to come, for it must be remembered that although the new cases and the deaths from this infection are being progressively reduced, the life span of more and more tuberculous patients is being extended and they will need assistance for longer periods. The range of the many forms of help provided by the Committee is too wide to detail in this review, but an examination of the Committee's Annual Report indicates the comprehensive nature of this assistance. It indicates too the surprisingly extensive variety of ways in which the statutory service cannot help, for it is in the very necessary supplementation of the public services, that the existence of this voluntary effort finds more than ample justification. The activities of the Care Committee could be said to have two main objectives—to tide a distressed family over the very difficult and lengthy period during which treatment is undertaken and, what is even more important, to assist the recovered patient to re-establish himself as a self supporting and independent member of the community. In the year under review, a sum of £531, was expended in the interests of patients and their families, whilst the administrative expenses were less than £26. METEOROLOGY The following rainfall was recorded at the Council's Pumping Station in Buckhurst Avenue. Rainfall 1959 Amount in ins. Rainfall 1959 Amount in ins. January 2.08 July 1.48 February 0.05 August 1.10 March 2.18 September 0.07 April 2.05 October 2.18 May 0.78 November 3.65 June 0.72 December 3.69 Total 20.03 The 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. 1959) = 1414.70 million gallons. Maximum Spring Flow 9.00 million gallons per day during the week ending 18th February, 1959. Minimum Spring Flow Nil occurring between week ending 14th October and week ending 9th December. 59 INDEX PAGE Acreage 6 Atmospheric Pollution 25 Births— Distribution 11 Institutional 10 Rates ,8,9,10,11 Cancer 7,13 Cemeteries 31 Clean Air Act 25 Clinics and Treatment Centres 19 Closet Accommodation 22 Deaths— Classification 7 Distribution 14 Rates 7,8,11,12,13,14,15 Diphtheria 45 Diphtheria Immunisation 45 Dysentery 43 Disinfection 25 Disposal of Dead 31 Drainage and Sewerage 21 Employment Agencies 30 Enteric Fever 43 Erysipelas 47 Establishments for Massage, etc 31 Factories 28 Food— Food and Drugs Act 36 Hygiene 40 Inspection and Supervision 40, 41 Poisoning 51 Health Services 18 Heating Appliances (Fireguards) Regulations, 1953 30 Housing— Council's Scheme 32 Inhabited Houses 6 Inspection 33 Rent Act, 1957 35 Overcrowding 34 Slum Clearance 35 Ward Distribution 34 Ice Cream Infant Mortality 7, 16 Infectious Diseases 42, 53, 54, 55 Inquests 15 Isolation Hospital— Admission to 52 60 PAGE Laboratory Facilities 18 Maternal Mortality 7, 16 Measles 48 Meat 38 Meningococcal Infection 49 Merchandise Marks Act, 1926 30 Meteorology 59 Milk Supply 36 Milk and Dairies Regulations, 1959 37 Mortuary 31 Natural and Social Conditions 6 National Assistance Act 31 Offices 28 Outworkers 28 Ophthalmia Neonatorum 51 Pet Animals Act, 1951 30 Pneumonia 47 Poliomyelitis 50 Poliomyelitis Vaccination 50 Population 7, 8 Public Cleansing 22 Puerperal Pyrexia 51 Rag Flock and Other Filling Materials Act, 1951 31 Rateable Value 6 Rats and Mice Destruction 27 Rivers and Streams 21 Sanitary Circumstances 20 Sanitary Inspection 22 Scarlet Fever 44 Shops Act 30 Smallpox 42 Smoke Abatement 25 Staff 5 Statistics— Comparative 12 Vital 7 Swimming Baths 28 Tuberculosis 7, 15, 56,57, 58 Carshalton Chest and Heart Care Committee 59 Unemployment 9 Vaccination 18, 42, 43 Vermin Control 25 Water Supply 20 Whooping Cough 49 Zymotic Diseases— Deaths from 7 61