AC. 4413(3) ??? Copy 1 Mr Swenson 2 Library CAR 25 CARSHALTON URBAN DISTRICT Annual Report OF THE Medical Officer of Health FOR THE YEAR 1960 CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1960 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 1960. An event of considerable significance as affecting the vital statistics of the area which has occurred since the close of the year was the Census of 1961. The detailed analysis of this official enumeration will not be available for some time but the preliminary figures for total population are known and these show that the local population now stands at approximately 57,400 which is some 5,000 less than the de facto population at the Census of 1951. This fall from 62,731 in 1951 is indicative of the maturing of the district, particularly of the St. Helier Estate. The age constitution of the local population has undoubtedly been undergoing a progressive change since the area became built up with the result that there has been in the last decade a steady increase in the average age and it now approximates more closely to that of the population of the country as a whole. Consequently when the full details of the recent Census are known there will probably be a change in the future "comparability factors" supplied by the Registrar General which are applied to local birth and death rates to make them comparable with the national figures. At present the comparable rates are heavily weighted on the basis of Carshalton's population being substantially younger than the national population. This was valid 10 years ago but in the light of the preliminary Census returns it is now very doubtful. Allowing for such discrepancies the statistics for 1960 are nevertheless very satisfactory. The birth rate is the lowest yet recorded in the district, due, doubtless, in considerable measure to the fact that the young married people are unable to find homes in the district and have to seek them elsewhere. The death rate, as for many years past, is substantially less than the national rate, whilst the infant mortality index is again a favourable one. One maternal death was recorded. Heart disease maintained its position as "captain of the men of death", being responsible for one-third of the total deaths, whilst cancer of the lung continued to entrench itself as a major killing disease. The successful inroads made in recent years into tuberculosis prevalence and mortality were sustained. The incidence of infectious disease was particularly low, due in large measure to the absence of measles in epidemic proportions, a further satisfactory feature being the complete freedom from poliomyelitis for the first time since the epidemic year of 1947. Accompanying this low prevalence of infectious illness was the total absence of fatality from any of the common notifiable diseases. 3 Sanitation and environmental hygiene were the first aspects of public health to receive statutory attention, that great measure the Public Health Act, 1875, being the charter upon which the present highly organised sanitary service is based. It is not surprising, therefore, that the local records reveal a continuing high standard of this facet of the public health. Water, food, drainage, cleansing, nuisances and allied matters all now come under the closest supervision and the many tests and examinations employed in the process indicate how successful these safeguards have become. The provision of clean air has at long last been added to this list of essential services and a promising beginning has been made to ridding the atmosphere of its man-made pollution. There is a trite saying that the price of freedom is eternal vigilance; it was never truer than in relation to the risks to public health. In one respect, however, success continues to elude us. It is in the solution of the evils associated with overcrowding. The key to this is more houses and until they are available the present slow progress will mean not only that the Council's slum clearance programme will continue to lose ground but many hard-pressed families will see no chance of relief for a long time to come. During the year Mr. H. J. Spicer retired from his post of Chief Public Health Inspector. He had served the Council for 35 years and my report would not be complete without paying a tribute to the long and valuable contribution which he made to the health and wellbeing of the district. To all members of my staff I once again express my grateful thanks for their willing and loyal assistance. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, F. LAWRENCE SMITH, Medical Officer of Health. July, 1961. 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. (retired 17.6.60) *G. R. Surfleet, C.R.S.I. (from 17.6.60) Deputy Chief Public Health Inspector: *G. R. Surfleet, C.R.S.I. (till 17.6.60) *J. H. Willis, C.R.S.I. (from 1.10.60) Public Health Inspectors: *L. W. Rivett, C.R.S.I. *J. P. Dixon, C.R.S.I. *L. A. Biggs, C.R.S.I. (left 13.12.60) Public Health Nurse: Mrs. D. E. Baldock, S.R.N. Chief Clerk: Miss V. St. P. Hotten † Also Divisional Medical Officer, Surrey County Council * Meat and Food Certificate of the Royal Sanitary Institute. 5 Section A—Natural and Social Conditions of the District. Area (in acres) 3,346 Estimated number of inhabited houses (end of 1960) according to Rate Books 17,614* Rateable Value at 31st December, 1960 £870,222 Sum represented by 1d. rate £3,578 (*Includes 258 combined with business premises for rating.) The Sanitary District, situated about midway between the Thames and the North Downs, is roughly rectangular in shape. It is approximately one mile in width, and commencing at a datum level of 72 at the northern boundary, it extends for some five miles in a southerly direction up the slope of the North Downs to a height of 450 feet above sea level. The subsoil, which is clay in the northern part, changes to a sandy gravel as one proceeds southwards, and then merges into chalk, which covers the southern half of the district. The River Wandle forms the eastern boundary in the northern part, one head of the river arising from several springs at the outcropping of the chalk near the centre of the district. The County Council is responsible for the maintenance of the River and its expansions and has, as stated in previous reports, prepared an improvement scheme for improving the flow along its Surrey length. Work on the scheme will commence at the Wandsworth/Wimbledon boundary and in its progress up the River will not involve Carshalton at the head of these waters until it reaches its final stages. In the absence of any sustained dry periods, the flow from the springs was reasonably maintained through the year and as a result of the heavy rainfall in the autumn all the springs came back into action, temporarily no doubt. Largely a dormitory town, most of the workers earn their livelihood outside the district in London and elsewhere. Only a few light industries are established within its boundaries and the registered factories and work-places employ less than 2,000 individuals. Housing development has now virtually reached saturation point and growth, whilst the sanctity of the green belt is respected, can only take place by redevelopment to a higher density, a practice which has increased insteadily as in other parts of built up suburbia. The fact that the rateable value per head of population at £14. 8. 0d. is the lowest in Metropolitan Surrey is a reflection of the relatively high level of housing density and of the large proportion of residents within the lower income groups. 6 SUMMARY OF VITAL STATISTICS FOR 1960 (Based on the Registrar-General's Figures) Population. Registrar-General's Estimate 60,430 Births. Males Females Total Live (Legitimate) 331 333 664 (Illegitimate) 15 12 27 346 345 691 Birth Rate per( 1,000 population) 11.4 Stillbirths (Legitimate) 10 8 18 (Illegitimate) — — — 10 8 18 Stillbirth Rate per 1,000 total births 25.3 Deaths. 286 258 544 Death Rate (crude) per 1,000 population 9.0 Infant Mortality. All deaths under 1 year 10 4 14 Infant Mortality Rate (per 1,000 live births) 20.2 Deaths of leg. infts. under 1 year 9 4 13 Rate per 1,000 legitimate births 19.5 Deaths of illeg. infts. under 1 year 1 — 1 Rate per 1,000 illegitimate births 37.0 Maternal Mortality. Death from Sepsis — 1 1 Rate per 1,000 births 1.41 Death from other causes — — — Rate per 1,000 total births — Maternal Death Rate 1.41 Zymotic Deaths. 7 Principal Zymotic Diseases — — — Deaths from Measles — — — Deaths from Whooping Cough — — — Deaths from Diarrhœa (under 2 years) — — — Zymotic Death Rate — Deaths from Tuberculosis. All Forms 3 1 4 Rate per 1,000 of population 0.06 Phthisis 3 1 4 Rate per 1,000 of population 0.06 Deaths from Cancer 64 55 119 Rate per 1,000 of population 1.96 7 The following statistics relating to mothers and infants are set out in the form specially requested by the Minister: — Live Births Number 691 Rate per 1,000 population 11.4 Illegitimate Births per cent. of total live births 3.8% Stillbirths Number 18 Rate for 1,000 total live and stillbirths 25.3 Total live and stillbirths 709 Infant Deaths (deaths under 1 year) 14 Infant Mortality Rates Total infant deaths per 1,000 live births 20.2 Legitimate infant deaths per 1,000 legitimate live births 19.5 Illegitimate infant deaths per 1,000 illegitimate live births 37.0 Neo-natal Mortality Rate (deaths under 4 weeks per 1,000 live births) 15.9 Early Neo-natal Mortality Rate (deaths under 1 week per 1,000 live births) 14.4 Peri-natal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 39.4 Maternal Mortality (including abortion) Number of deaths 1 Rate per 1,000 total live and stillbirths 1.4 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 1960 are supplied through the courtesy of the Exchange Manager and the Youth Employment Officer: Men 102 Women 26 Boys 4 Girls 2 The figures are very comparable to those of 12 months before. POPULATION The Registrar-General's estimate of the home population at midyear 1960 is 60,430. This is 160 more than his estimate at the corresponding date 12 months earlier. The de facto population at the census of 1951 was 62,721. There is no doubt that particularly during the last few years of the last decade there has been a progressive fall in the population of the District. This is confirmed by the preliminary results of the 1961 census which were available when these notes were compiled. From knowledge of local conditions there is every probability that the decrease will ultimately be found to have been mainly on the St. Helier estate. In the 1930's when this estate was first developed it rehoused a very young population. In the course of 30 years it has matured, the children have married and sought homes of their own with the result that the average age of the estate residents is now appreciably higher than it was in its early years and the level of occupancy is significantly lower. TABLE 1. ESTIMATED HOME POPULATION, MID-1960, BY WARDS Ward Dwellings at Mid-1960 Estimated Population Mid-1960 St. Helier North 2,169 8,130 St. Helier South 1,699 7,090 St. Helier West 2,123 7,420 North-East 2,838 9,680 North-West 2,227 7,200 Central 1,802 5,800 South-East 2,495 8,550 South-West 2,246 6,560 Whole District 17,599 60,430 BIRTHS The number of live births registered during 1960 was 691 which is 82 less than in the year before. Of these 346 were males and 345 females, giving a birth rate of 11.4 per thousand population, the lowest yet recorded for the district. 9 The "comparable" birth rate produced by the application of the Registrar-General's comparability factor of 0.97 to allow for the disparity in the age and sex constitution of the local population and that of the country as a whole is 11.0 per thousand population, which compares with 17.1 for England and Wales. Information is not available as to the home address of births registered to Carshalton residents occurring outside the district. For computation of ward birth rates, therefore, use is made of the notifications of births received under the Public Health Act, supplemented by the Registrar's weekly returns of registrations within the district. From these sources it is known that 687 live births and 18 stillbirths occurred in 1960 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 77 9.4 – – St. Helier South 51 7.1 4 72.7 St. Helier West 68 9.1 1 14.4 North-East 135 13.9 4 28.7 North-West 103 14.3 2 19.0 Central 77 13.2 2 25.3 South-East 100 11.7 4 38.4 South-West 76 11.5 1 12.9 Seventy-six per cent. of all births occurred in hospitals and nursing homes. The percentages of such births for the individual wards were as follows:— St. Helier North 79 St. Helier South 78 St. Helier West 68 North-East 74 North-West 80 Central 77 South-East 70 South-West 81 Out of 705 total births, 536 took place in the following hospitals and nursing homes:— Live Still Total Carshalton, Beddington and Wallington District (War Memorial) Hospital 121 3 124 St. Helier Hospital 322 13 335 Other Surrey Hospitals 63 1 64 Other Hospitals 12 1 13 Private Nursing Homes – – – Totals 518 18 536 For many years more than three-quarters of all births have taken place in Maternity Institutions. 10 TABLE 2. BIRTHS, 1960—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 56 16 72 5 – 5 77 St. Helier South 43(4) 12 55(4) – – – 55(4) St. Helier West 42 22 64 5(1) – 5(1) 69(1) North-East 98(4) 35 133(4) 6 – 6 139(4) North-West 73(2) 20 93(2) 11 1 12 105(2) Central 54(2) 18 72(2) 7 – 7 79(2) South-East 51(3) 31 82(3) 22(1) – 22(1) 104(4) South-West 42(1) 14 56(1) 21 – 21 77(1) Totals 459(16) 168 627(16) 77(2) 1 78(2) 705(18) (Figures in brackets indicate stillbirths included in totals) TABLE 3. BIRTH AND DEATH RATES FOR CARSHALTON, 1922-1960. 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 39.3 4.9 1944 52,300 17.0 9.5 39.2 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 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 1960 60,430 11.4 9.0 20.2 1.4 11 TABLE 4. COMPARATIVE STATISTICS—1960. England and Wales Carshalton Birth Rate (per 1,000 population) 17.1 11.4 (crude) 11.0 (comp.) Still-birth Rate (per 1,000 total births) 19.7 25.3 Death Rate (per 1,000 population) 11.5 9.0 (crude) Infant Mortality (per 1,000 live births) 21.7 11.1 (comp.) 20.2 Neo-natal Mortality (in first 4 weeks per 1,000 live births) 15.6 15.9 Death rate from Tuberculosis (per 1,000 populatino) Respiratory Tuberculosis 0.068 0.075 0.06 0.06 Other Tuberculosis 0.007 — Death rate from Cancer (per 1,000 population) All Forms 2.15 1.96 Cancer of Lung 0.48 0.46 Maternal Mortality (per 1,000 total births) Excluding Abortion 0.31 0.39 1.41 1.41 Abortion 0.08 — COMPARATIVE HEALTH STATISTICS, 1934/60. 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 0.32 0 1960 11.5 9.0 21.7 20.2 0.31 1.4 12 DEATHS The deaths allocated to the district, as adjusted by inward and outward transferable deaths, was 544—286 males and 258 females. This gives a crude death rate of 9.0 per thousand population as against 9.4 in the year before. The "comparable" death rate produced by the application of the Registrar-General's comparability factor of 1.28 to allow for differences in the age and sex constitution of the local population as compared with the country as a whole was 11.1. The rate for England and Wales was 11.5. The distribution of the deaths by wards was as follows: — WARD DEATH RATES AND MEAN AGE AT DEATH. 1960. Ward Deaths Death Rate (crude) Mean Age at Death St. Helier North 78 9.5 60.3 yrs. St. Helier South 55 7.7 62.5 „ St. Helier West 59 7.9 62.1 „ North-East 75 7.7 65.5 „ North-West 63 8.7 65.8 „ Central 77 13.2 69.1 „ South-East 71 8.3 70.9 „ South-West 64 9.7 72.0 „ Whole District 542 8.9 66.1 „ Six fewer deaths from cancer in 1960 caused a slight fall in the rate to 1.96 per thousand population. Malignant disease of the lung killed 28 individuals during the year, of whom 26 were males. This is 10 less than in the year before, but represents nearly a quarter of all cancer deaths. The following table shows the deaths from lung cancer since 1936. This covers the period in the development of the district during which there has been but little variation in the total population. DEATHS FROM CANCER OF THE LUNGS, 1936-1960. 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 1947 21 1960 28 1948 15 13 CANCER DEATHS—WARD DISTRIBUTION, 1960. Ward Cancer Deaths Rate per 1,000 Estimated Population M F Total St. Helier North 8 5 13 1.59 St. Helier South 13 3 16 2.25 St. Helier West 4 6 10 1.34 North-East 9 13 22 2.27 North-West 4 6 10 1.38 Central 7 10 17 2.93 South-East 9 4 13 1.52 South-West 9 7 16 2.43 The classification of the cancer deaths by sites affected is given in Table 5. TABLE 5. CANCER DEATHS, 1960. Group Site Affected Male Female Total 141 Tongue 1 — 1 Digestive Organs: 150 Oesophagus — 2 2 151 Stomach 10 11 21 152 Small Intestine — 1 1 153 Colon 5 4 9 154 Rectum 2 1 3 155 Gall bladder and ducts — 1 1 157 Pancreas 4 2 6 158 Peritoneum — 2 2 Respiratory System: 162 Lungs and bronchi 26 2 28 Breast and Genito-Urinary: 170 Breast — 10 10 171/4 Uterus — 4 4 175 Ovary — 6 6 176 Vulva — 1 1 177 Prostrate 3 — 3 181 Bladder 2 1 3 Other Sites: 190/1 Skin — 1 1 193 Brain 3 1 4 195 Adrenal Glands 1 — 1 196 Bone — 1 1 199 Unspecified 3 2 5 200/5 Lymphatic Tissues 3 1 4 63 54 117 Average age at death:— Males 64.3 years Females 62.2 years All persons 63.3 years 14 Rather more than 30% of all deaths were due to heart disease in one form or another. Coronary disease of the heart was twice as fatal in males, whilst this position was reversed in the case of other forms of cardiac illness. Tuberculosis mortality was again low, only four deaths being assigned to this cause. Three of the deaths were in persons fifty years old and over; the fourth, the only female to die of tuberculosis, was aged 30. With the continuing success of the anti-tuberculosis scheme, both in the preventive and curative fields, it is to be expected that fatality will as time goes on be mainly the result of senile illness. The progressive decline in fatal tuberculosis is demonstrated by the following figures for deaths from this disease over the last 20 years:— Year Deaths from Tuberculosis Death Rate per 1,000 Population Year Deaths from Tuberculosis Death Rate per 1,000 Population 1941 40 0.71 1951 21 0.34 1942 26 0.46 1952 15 0.24 1943 46 0.81 1953 13 0.21 1944 33 0.63 1954 14 0.22 1945 28 0.51 1955 3 0.04 1946 25 0.41 1956 8 0.13 1947 25 0.40 1957 3 0.04 1948 25 0.40 1958 9 0.14 1949 22 0.35 1959 3 0.04 1950 13 0.20 1960 4 0.06 The distribution of tuberculosis mortality by wards and other details are given in Section F of this report. There was again during the year, the fourth in succession, no death from notifiable infectious disease other than tuberculosis. Violent causes accounted for the death of 23 residents. They were:— Road traffic accidents 7 (all male) Railway accident 1 Accidental fall 1 Drowning 2 Inhaled vomit 1 Accidental gas poisoning 1 Burns 1 Asphyxia from plastic bag 1 Suicide 8 Inquests Inquests were held on 58 persons who died in the district. The following verdicts were returned:— Accidental death Accidental gas poisoning 2 Accidents 3 Road Traffic 16 Falls 14 Lack of attention at birth 1 Misadvanture 4 Open verdict 2 Suicide 12 Natural causes 4 Seventeen of the total were residents of the district. 15 INFANT MORTALITY Deaths of infants during the first year of life fell in 1960 to 14 from 19 in the year before. The infant mortality rate consequently was down to 20.2 per thousand live births compared with 24.5 in the previous year. The national rate for infant deaths during the year was 21.7. Those dying from the so-called "unavoidable" causes peculiar to infancy totalled 11 out of the 14 when death occurred during the first week of life. The remaining three died of infection of one sort or another. TABLE 6. INFANT MORTALITY—WARD DISTRIBUTION. Ward Infant Deaths Rate per 1,000 Live Births— St. Helier North 5 64.9 St. Helier South 1 19.6 St. Helier West 1 14.7 North-East 2 14.8 North-West 3 29.1 Central — — South-East 1 9.9 South-West 1 13.1 TABLE 7. INFANT MORTALITY DURING THE YEAR 1960. 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 2 1 — — 3 — — — — 3 Congenital Malformation 1 — — — 1 — — — — 1 Atelectasis 4 — — — 4 — — — — 4 Birth Injury 1 — — — 1 — — — — 1 Anaemia 1 — — — 1 — — — — 1 Pneumonia — — — — — — 1 — — 1 Hepatitis — — — — — — — 1 — 1 Meningitis — — — — — — 1 — — 1 Hyaline Membrane 1 — — — 1 — — — — 1 Totals 10 1 — — 11 — 2 1 — 14 MATERNAL MORTALITY After an interval of 2 years a death from maternal causes was recorded. This occurred in hospital from pelvic sepsis following Cæsarean section. 16 TABLE 8. — CAUSES OF DEATH DURING THE YEAR 1960 — 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 10 4 1 — 1 1 7 — 1 3 8 7 25 23 84 43 86 54 63 121 286 256 542 1 Tuberculosis, Respiratory — — — — — — — — — 1 — — 1 — — — 1 — 1 — 3 1 4 2 Tuberculosis, other — — — — — — — — — — — — — — — — — — — — — — — 3 Syphilitic disease — — — — — — — — — — — — — — — — 1 1 1 1 2 2 4 4 Diphtheria — — — — — — — — — — — — — — — — — — — — — — — 5 Whooping Cough — — — — — — — — — — — — — — — — — — — — — — — 6 Meningococcal Infections — — — — — — — — — — — — — — — — — — — — — — — 7 Acute Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — 8 Measles — — — — — — — — — — — — — — — — — — — — — — — 9 Other Infective and Parasitic Diseases — — — — — — — — — 1 — — — — — — — — — — — 1 1 10 Malignant neoplasm, stomach — — — — — — — — — — — 2 1 — 4 2 1 4 4 3 10 11 21 11 Malignant neoplasm, lung — — — — — — — — — — — — 3 — 15 — 6 2 2 — 26 2 28 12 Malignant neoplasm, breast — — — — — — — — — — — 1 — 4 — 3 — 1 — 1 — 10 10 13 Malignant neoplasm, uterus — — — — — — — — — — — — — 2 — 1 — — — 1 — 4 4 14 Other Malignant and Lymphatic Neoplasm — — — — — — — — — — 2 3 4 5 5 7 12 6 4 6 27 27 54 15 Leukæmia, Aleukæmia — — 1 — 1 — — — — — 1 — — 1 — — — — — — 3 1 4 16 Diabetes — — — — — — — — — — 1 — — — 1 — — 2 1 — 3 2 5 17 Vascular Lesions of Nervous System — — — — — — — — 1 — — — 2 2 4 4 9 6 5 27 21 39 60 18 Coronary Disease, Angina — — — — — — — — — — — — 7 1 17 6 24 7 9 11 57 25 82 19 Hypertension with Heart Disease — — — — — — — — — — — — — 1 2 2 — 1 — 4 2 8 10 20 Other Heart Disease — — — — — — — — — — — 1 1 2 — 7 9 8 15 44 25 62 87 21 Other Circulatory Disease — — — — — — — — — — — — — 1 5 1 5 6 4 4 14 12 26 22 Influenza — — — — — — — — — — — — — — — — — — — — — — — 23 Pneumonia 1 — — — — 1 — — — — — — — — 1 1 3 2 7 4 12 8 20 24 Bronchitis — — — — — — — — — — — — 2 — 13 1 8 — 4 3 27 4 31 25 Other Diseases of Respiratory System — — — — — — — — — — 1 — — — — — 1 1 — — 2 1 3 26 Ulcer of Stomach and Duodenum — — — — — — — — — — — — 1 — 1 1 — — 1 2 3 3 6 27 Gastritis, Enteritis and Diarrhœa — — — — — — — — — — — — — — — 1 — 1 — 2 — 4 4 28 Nephritis and Nephrosis — — — — — — — — — — — — — — — — — 1 1 1 1 2 3 29 Hyperplasia of Prostate — — — — — — — — — — — — — — 1 — 3 — 1 — 5 — 5 30 Pregnancy, Childbirth, Abortion — — — — — — — — — 1 — — — — — — — — — — — 1 1 31 Congenital Malformations 1 — — — — — — — — — — — — — 1 — — — — — 2 — 2 32 Other Defined and Ill-defined Diseases 8 4 — — — — 2 — — — — — 1 1 9 5 2 3 3 6 25 19 44 33 Motor Vehicle Accidents — — — — — — 2 — — — 2 — 2 — 1 — — — — — 7 — 7 34 All Other Accidents — — — — — — 2 — — — — — — 2 2 — — 1 — 1 4 4 8 35 Suicide — — — — — — 1 — — — 1 — — 1 2 1 1 1 — — 5 3 8 36 Homicide and Operations of War — — — — — — — — — — — — — — — — — — — — — — — Section B—Health Services. Laboratory Facilities Mr. D. D. Moir, 16, Southwark Street, S.E.1, is the Public Analyst appointed by the Council to whom samples of food, drugs and water are submitted. For the examination of specimens in cases of suspected food poisoning and for the bacteriological examination of milk and water, use is made of the Public Health Laboratory at Epsom. Routine laboratory examinations in connection with infectious disease are carried out by the Hospital Laboratory Service, chiefly at St. Helier Hospital. The following examinations were made during the year:— Throat Swabs 2 Rectal Swabs 5 Urine 1 Fæces Specimens 382 Water (Public Supply): For chemical analysis 3 For bacteriological examination 4 Water (Swimming Bath): For bacteriological examination 12 Food and Drugs: Analysis 276 Bacteriological examination of milk 172 Bacteriological examination of ice cream 84 Bacteriological examination of other foods 1 Vaccination and Immunisation Schemes for preventive inoculation against infectious disease are the responsibility of the County Council under Section 26 of the National Health Service Act. The diseases against which such prophylactic treatment is provided are—smallpox, diphtheria, whooping cough, tetanus, poliomyelitis and tuberculosis. In the case of the four first mentioned infections the arrangements are directed locally by the District Medical Officers of Health by agreement between the Councils. Vaccination against poliomyelitis and B.C.G. vaccination against tuberculosis is in the hands of the Divisional Medical Officers. Protection against yellow fever can be secured on payment at a centre established in Kingston-on-Thames as part of the Ministry's scheme which sets up a number of these special centres throughout the country. Vaccination against tropical diseases other than smallpox are not normally provided free under the National Health Service Act, but can be obtained at the following centres:— The London School of Tropical Medicine, St. Mary's Hospital, Paddington (vaccination against yellow fever). B.O.A.C., Airways House, Victoria, S.W.I (vaccination against yellow fever). The work done under the County Council's arrangements is 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 By appointment Green Wrythe Lane Centre: Infant Welfare Clinic Weds, and Fridays 2—4 p.m. Maternity Clinic Tuesdays 10—12 noon Toddler Clinic Tuesdays 2—4 p.m. Dental Clinic By appointment Massage Clinic By appointment 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 The district is supplied by the Sutton District Water Company except for approximately 200 dwellings on the northern boundary which are served by the Metropolitan Water Board. The Sutton Company's supplies are derived from wells in the chalk sited at Sutton, Cheam and Woodmansterne and by arrangement they can be augmented by water from the Metropolitan Water Board, the East Surrey Water Company and the Epsom and Ewell Corporations undertaking. The supply having naturally a high content of temporary hardness, the Company is under a statutory obligation to soften the raw water to produce a finished product with not more than 9° of hardness. All dwellings in the district have a piped supply and the water is not regarded as being plumbo-solvent. Extensive and comprehensive arrangements exist for ensuring and maintaining the purity of the supply which include chlorination. The Company employs a full-time chemist equipped with laboratory facilities in addition to which testing is carried out periodically for the Company by a firm of independent water chemists and also by the public health departments of the Councils in the supply area on an agreed rota. Quality and quantity were satisfactory during the year, but the growth of the area of supply would appear to be creating a need for additional sources of supply. The Company in exploring the possibilities have discussed with the Councils concerned the question of increasing the abstraction from the Cheam wells. Since in 1936 these particular wells suffered a gross accidental pollution the proposal must be examined with great care. Much however has happened since 1936, particularly in the institution of effective safeguards against a repetition of the catastrophe of 25 years ago. Throughout this period, following the complete overhaul of the purification and of the testing and warning arrangements, the supply from the Cheam wells has been satisfactory and there is reason to believe that the present practice can be relied upon either to cope with an unforeseeable pollution or to prevent the water contaminated by such pollution from reaching the consumer. The following details of the tests carried out in the Company's own laboratory are supplied by courtesy of the Company. 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 310 53 9 3.0 14 4.5 23 Sutton Finished 314 12 5 1.6 Nil – 5 Woodmansterne Raw 306 53 4 1.3 Nil – 4 Woodmansterne Finished 311 12 4 1.3 Nil – 4 Cheam Raw 312 53 7 2.4 8 2.6 15 Reservoir 348 15 6 1.7 4 1.2 10 District 308 6 14 4.6 1 0.3 15 Total 2,209 204 49 27 76 20 Copies of the reports of 36 examinations carried out during the year by the firm of independent chemists for the Company have been received at approximately monthly intervals. Twelve of these were in respect of the Sutton finished water and a similar number were in respect both of the Woodmansterne finished and the Cheam raw waters. All were reported as wholesome and fit for the public supply except one raw sample which was stated to be fit for treatment for the public supply. The Public Health Authorities in the supply area arranged the examination of 17 chemical and 28 bacteriological samples of the water as it was delivered to the consumer and all were satisfactory. The following is the report on a sample which is representative of this type of water. (a) Physical Examination Colour Faint blue Taste normal Appearance Bright and clear Smell none Electric Conductivity at 20°C 275 Units pH 7.4 (b) Chemical Examination in parts per million Total solid residue (dried at 180°C.) 210 Chlorine present as chloride 20.5 Ammonia, free 0.00 Ammonia, Albuminoid 0.005 Nitrate nitrogen 10.5 Nitrite nitrogen trace Oxygen absorbed from (a) in 4 hours 0.06 permanganate solution (b) in 15 mins. — Hardness, as CaCO3—Temporary 54 Permanent 66 Total 120 Alkalinity, as CaCO3 54 Free carbon dioxide, as CO2 — Iron absent Other metals absent Residual chlorine none (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. 1 Bacteria of indication enumeration: — Organisms of the coliform group 0 in 100 ml. Streptococci 0 do. Cl. welchii 0 do. Remarks This water is of good organic purity, moderate hardness and salinity and attractive in appearance. It is free from contaminating metals and 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 An extension to the soil sewer on the Woodcote Grove Estate has been carried out and the relief surface water sewer in Culvers Avenue referred to in last year's report has been completed. Regular clearing and inspection of the sewers and maintenance of the soakaways was carried out as routine and repairs executed to gullies, frames and manhole covers by the Engineer's Department. Two hundred and sixty-seven drainage obstructions affecting 938 houses were dealt with mostly in combined systems. 21 Rivers and Streams The work of maintenance involving clearance of the River Wandle and its tributaries is the responsibility of the County Council and was carried out by that Authority. Closet Accommodation With the laying of the new sewer in the Woodcote Grove Area, two of the houses in the vicinity were connected to it. This leaves 15 houses still drained to cesspools. The remainder in the district are connected to the sewers. Public Cleansing The arrangements for collection and disposal of refuse remained unchanged. The latter provided in the main for incineration in the Council's 6-cell destructor, supplemented as necessary by the controlled tipping of clinker and screenings on cemetery land at Green Lane, Morden, until July and thereafter at Carshalton Road, Woodmansterne. The destructor was closed down for the second fortnight in July for a major overhaul which included the following:— (i) provision and fitting of dust extraction plant; (ii) provision and fitting of overband magnetic separator; (iii) provision and fitting of new electric motors, together with renewal of all wiring; (iv) provision of 3-phase electrical supply; (v) motorising feed chute to cells. The Council continue to salvage saleable commodities such as paper, tins, metals, bottles and rags. 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 1,126 complaints as follows: — Accumulations 17 Animals so kept 1 Burst pipes 2 Clean Air Act—Contraventions 6 Dampness 8 Drainage defects 31 Drains obstructed 312 Dustbins 12 Food contaminated 5 General defective conditions 36 Insects and Pests 267 Litter Act—Contraventions 1 Milk—Contaminated—Dirty Bottles 1 Miscellaneous 79 Overcrowding 1 Refuse collections 17 Rodents 240 Roofs, defective 15 Sewer obstructions 3 Sink waste pipes 1 Unsound food 57 Verminous premises 13 Water supply 1 1,126 22 Eleven thousand nine hundred and three visits of inspection and re-inspection were made for the purposes set out below:— Clean Air Act 1,286 Cowsheds 4 Employment Agencies 4 Factories (Mechanical Power) (inc. Laundries 29) 247 Factories (Non-Mechanical Power) 49 Factories (Building Sites) 50 Food and Drugs (inlcuding Food Byelaws) 1,176 Food Poisoning Enquiries 3 Food premises: Bakehouses 33 Bakers and confectioners 47 Butchers 144 Canteens 20 Canteens—School 37 Chemists 21 Confectioners (sweets only) 95 Fishmongers 92 General Stores 14 Greengrocers and fruiterers 127 Grocers 284 Licensed premises with catering facilities 19 Licensed premises without catering facilities 20 Milk storage depots 28 Ice Cream Vehicles 12 Restaurants and cafes 115 Stalls, food 103 Tea packer 2 Vehicles, food 15 1,228 Hairdressers 52 House drains tested 61 Housing Act 265 Heating Appliances (Fireguards) Act 18 Housing Land Charges 937 Infectious Disease Premises 49 Insect Pests 411 Merchandise Marks Act 129 Offices 21 Outworkers Premises 60 Pet Animals Act 14 Piggeries 53 Premises re cesspools 15 Public Health Act (Houses) 2,316 Public Health Act re-inspections 2,088 Rent Act 16 Rodents 303 Schools 31 Shops 918 Tents, Vans, Sheds 2 Urinals 79 Water Sampling 18 11,903 Four hundred and thirteen informal notices were served concerning the following matters:— Accumulations and deposits 22 Clean Air Act 2 Drainage defects 125 Dustbins 14 Factories Act 14 Food and Drugs Act (inculding Food Byelaws) 67 23 Food contaminated 8 General defective conditions 105 Heating Appliances (Fireguards) Act 4 Miscellaneous 10 Overcrowding 3 Rodents 7 Shops Act 32 413 Eighteen formal notices were served by authority of the Council under the following Acts:— Public Health Act, 1936, Section 24 - „ „ „ „ Section 39 3 „ „ „ „ Section 45 — „ „ „ „ Section 75 — „ „ „ „ Section 79 1 „ Section 93 14 18 As a result of investigations made and notices served, the following work was carried out: — Accumulations removed 17 Brickwork, repaired and/or repointed 2 Ceilings cleansed 3 Ceiling plaster repaired and/or made good 3 Cement fillets renewed 1 Chimney brickwork and pots repaired or renewed 3 Damp conditions remedied . 20 Damp course renewed 1 Disinfestations 192 Doors and frames repaired, including locks and fasteners 4 Drainage repaired and/or reconstructed 30 houses 173 ft. of drain laid) Drainage inspection chambers repaired 28 inspection chamber covers renewed 8 stoppers or caps refixed and /or renewed 2 drains tested 24 drains cleared (affecting 938 houses) 267 drains sealed off 2 waste gullies repaired, renewed or provided 7 waste pipes, repaired, renewed or provided 5 cesspools cmbtied 2 Dustbins provided 18 Fences and/or gates repaired or renewed 2 Fireplaces ranges or stoves repaired or renewed 2 Floors renewed or repaired 6 Glazing and putty renewed 3 Paving repaired and/or made level 1 Roofs repaired and made weatherproof 25 downpipe, guttering repaired and/or renewed 21 Stirs or steps repaired, renewed or made level 1 Surface water drainage repaired and made to work properly 6 Walls rendered or rendering repaired 1 replastered and/or repaired 11 cleansed and redecorated 11 24 Water supply renewals or repairs 4 W.C. pans renewed 4 pan joints renewed 2 seats repaired, renewed or provided 2 flushing apparatus repaired or renewed 6 Windows repaired and for renewed 18 Disinfection Eighty rooms and 186 library books were disinfected. One lot of bedding was sterilised and four lots destroyed. Vermin Control Persons. The incidence of personal vermin infestation has fallen to a very low level. The Council maintains a Cleansing Station in Rochester Road for dealing with the more severe manifestations of this condition, but it is used now but rarely. Two families involving 8 individuals made 20 attendances for personal hygiene there during the year and of these 7 were school children. A factor which helps to obviate the necessity for using the Cleansing Station facilities is the effectiveness of the modern parasiticidal preparations which can be used at home. Premises. During the year, one lot of bedding was stoved, one lot destroyed and one hundred and ninety-two 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 Bugs 5 — — 2 1 — 8 Fleas — — — 2 — — 2 Flies — 8 — 2 — — 10 Insects 1 — — — — — 1 Mosquitoes — — — 1 — — 1 Silver Fish 1 - - - - - 1 Wasps 14 1 7 146 — — 168 22 9 7 153 1 — 192 Clean Air Act, 1956 In February the Council agreed a programme of Smoke Control Areas designed to cover the whole district in a period of ten years. The public health inspectorate is responsible for the day-to-day administration of this scheme and have the assistance, for purposes of survey and checking the necessary works, of a newly appointed technical officer. On the 6th December the Minister's approval to the first Smoke Control Order referred to in the last Annual Report was received and by the end of the year 7 applications for approval of works had been received. In May the work of preparing the second Smokeless Zone was commenced. This area which adjoins the No. 1 Smoke Control Area comprises 235 acres and 2,085 premises, is bounded by Buckhurst Avenue on the south, the centre of Green Wrythe Lane on the west, the district boundary on the north and the River Wandle on the east. 25 Six complaints with regard to smoke were received and dealt with during 1960. The apparatus installed by the Council for measuring atmospheric pollution gave the following results:— Deposit Gauges Gauge Total Rainfall (in inches) Total Solids. Tons per sq. mile Highest Monthly Reading Lowest Monthly Reading Average Monthly Reading B (Winchcombe Rd.) 27.80 14.49 8.13 10.29 C (Buckhurst Ave.) 29.97 15.37 7.79 10.74 Month Gauge B Gauge C Rainfall in ins. Total Solids (Tons per sq. mile) Rainfall in ins. Total Solids (Tons per sq. mile) January 1.80 8.98 1.83 8.93 February 1.57 8.81 1.60 9.16 March 1.60 11.73 1.82 12.39 April 0.73 8.13 0.94 10.44 May 1.56 11.87 1.89 9.94 June 0.69 9.48 1.00 15.14 July 2.86 9.73 3.24 9.59 August 2.22 9.21 2.49 7.79 September 3.06 9.38 3.46 9.70 October 4.85 14.49 4.70 12.22 November 3.93 10.06 3.93 8.16 December 2.93 11.56 3.07 15.37 Total 27.80 123.43 29.97 128.83 Smoke and Atmospheric Sulphur Dioxide. Month Smoke Milligrams per 100 cubic meters S.O. (Parts per 100 million) Highest Daily Reading Lowest Daily Reading Average Daily Reading Highest Daily Reading Lowest Daily Reading Average Daily Reading January 47 2 13.00 20.3 2.0 7.30 February 34 2 10.56 12.1 2.2 6.80 March 14 1 7.30 10.3 1.5 5.20 April 28 2 6.50 13.2 1.9 4.10 May 7 1 3.40 8.6 1.7 4.30 June 4 1 2.00 5.9 0.5 2.20 July 5 1 2.10 3.4 0.7 1.40 August 4 1 1.80 3.0 0.4 1.26 September 12 1 3.60 4.0 0.2 1.70 October 18 1 8.00 5.6 0.7 2.70 November 37 1 8.50 13.4 1.1 3.60 December 40 1 13.00 23.0 1.3 10.90 Whole year 47 1 6.65 23.0 0.2 4.3 Note. Smoke readings by reflectometer and calculated from tables supplied by D.S.I.R. 26 Prevention of Damage by Pests Act, 1949 Six thousand seven hundred and ninety-seven visits were made by the Rodent Operatives concerning 831 properties and 307 rat and mouse infestations found. Of that number 274 were found in private premises, 27 in business premises and 6 in Council premises. With regard to sewers, one maintenance treatment was carried out in May and the results are shown in the following table, together with the three previous years:— May Treatment November Treatment 1957 1958 1959 1960 1957 1958 1959 1960 Manholes baited 194 198 188 161 199 190 — — Manholes in which takes of prebait were recorded 62 80 7 4 83 51 - - Percentage of manholes showing infestations 33.0 40.4 3.7 2.5 42.7 26.8 - - Percentage in relation to total manholes in district 5.7 7.1 0.6 0.3 7.5 4.5 - — The sewer maintenance treatment which was carried out in May revealed so very few rat infested manholes that the next maintenance treatment was deferred until the following year. Swimming Baths There is only one public swimming bath in the district which is in the ownership of the Council. It measures 45ft. by 22ft. and the depth of the water increases from 3ft. at one end to 6ft. at the other. The water supplied from the mains is subjected to precipitation, filtration and chlorination on the "break-point" principle, and is completely replaced at the beginning of each season. The water was sampled both at the shallow and deep ends on 6 occasions during the swimming season. All 12 samples were free from coli bacilli and 11 had total bacterial counts of less than 10 per ml, the twelfth having a total count of 20. It will, therefore, be seen that since breakpoint chlorination was instituted in 1959 the condition of the water has been entirely satisfactory. Owing to the relatively small size of this bath its use has to be carefully regulated to ensure that the capacity of the purification plant is not overloaded. A relatively new development is the establishment of private swimming baths associated with schools. One such bath has been provided by voluntary effort on the part of the staff and parents at the Barrow Hedges Primary School at an approximate cost of £2,000. This provides a valuable amenity to the life of the school and has been established only after careful consideration of the technical and public health considerations involved. Offices Twenty-one inspections of offices were made but no action was found to be necessary. When the new Offices Act comes into operation in 1962 the regulations to be made thereunder will provide a valuable 27 guide as to the desirable standards, particularly as to what will be considered overcrowding. This question of adequate accommodation for the staffs employed is probably the one which requires the most urgent attention. Factories, Workplaces and Outworkers The premises coming within the provisions of the Factories Act included on the registers are as follows:— Employees Premises Males Females Total Factories — 95 with mechanical power 1005 552 1557 without mechanical power 31 18 49 16 Workplaces — with mechanical power 31 2 33 28 without mechanical power 20 18 38 27 1087 590 1677 166 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). Number on Register (2) Number of Inspections (3) Written Notices (4) Occupiers Prosecuted (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 16 49 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 95 247 14 - (iii) Other premises in which Section 7 is enforced by the Local Authority* (excluding outworkers' premises) 13 50 - - Total 124 346 14 — * Electrical Station (Section 103 (1)), Institutions (Section 104) and sites of Building Operations and Works of Engineering Construction (Section 107 and 108). 2. Cases in which defects were found:— (If defects are discovered at the premises on two, three or more separate occasions they are reckoned as two, three or more "cases".) 28 Premises Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied To H.M. Inspector By H.M. Inspector (0 (2) (3) (4) (5) (6) Want of cleanliness - - - - - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation — — - - — Ineffective drainage of floors - - - - - Sanitary Conveniences — (a) Insufficient 3 1 - - — (b) Unsuitable or defective 11 8 - - - (c) Not separate for sexes — — - - - Other offences against the Act (not including offences relating to Outwork) - 2 - - - TOTAL 14 11 - - - 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) 3 — — — — - Christmas Crackers 9 — — — — - Lampshades Paper Hats 5 3 — — — — - Toys (Stuffed) 1 — — — — - Umbrellas 1 — — — — - Wire Brushes 3 — — — — - Total 46 — — — — - Employment Agencies The one employment agency in the district was visited and found to be satisfactory. Shops Act, 1950 There are 514 shop premises on the register and 2,289 inspections were made during the year. 29 Preliminary notices were served with regard to thirty-two infringements of the statutory requirements, fifteen for failure to exhibit appropriate notices, three for condition of premises, nine for sanitary accommodation, two for closing hours and three for failure to provide seats for females. Thirty notices have been complied with (including eight notices outstanding at 31.12.59). Heating Appliances (Fireguards) Regulations, 1953 Eighteen inspections were made under the Act. Four informal notices were served and have 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 Four licences have been granted in respect of premises used as Pet Shops, all of them dealing mainly with fish and birds. The premises have been inspected and found satisfactory. Rag Flock and Other Filling Materials Act, 1951 Three premises used for upholstering are registered in accordance with Section 2 of the Rag Flock and Other Filling Materials Act, 1951. The prescribed Analysts are—The Chiltern Research Laboratories Ltd., of 23, West Wycombe Road, High Wycombe, Bucks. Establishments for Massage and Special Treatment An additional establishment for the practice of electrolosis was added in November to the register of establishments licensed under Part IV of the Surrey County Council Act, 1931, and brought the total of such premises used for special treatment to 6. Of the remaining 5, chiropody is practiced at 3 and massage at 2. All were visited and found to be conducted in a satisfactory manner. National Assistance Acts, 1948—1951 The occasion did not arise during 1960 to invoke the powers under these Acts which provide for the compulsory removal to a place of care of any person who by reason of old age or infirmity is living in insanitary conditions and is for this reason a risk to their own or other people's health. Such is the shortage of institutional beds for old people that several neglected old people were found very near the border line of this criterion before adequate arrangements for their care could be made. As stated in earlier reports, the need is not so much to compel old and helpless people to enter suitable homes, but to find homes for those who are in dire need of them. Section 50 Two funerals were arranged by the Council for persons for whom no other arrangements were being made. 30 Disposal of the Dead The Carshalton and Merton and Morden Joint Burial Board formed by the two authorities administers 60 acres of land in Lower Morden as a cemetery for both areas. During the year 386 interments took place there of which 161 were from Carshalton. The North-East Surrey Crematorium Board, representing the Councils of Battersea, Sutton and Cheam, Carshalton and Merton and Morden operates a crematorium sited in the Battersea cemetery grounds at Lower Morden which adjoins the burial ground of the Carshalton and Merton and Morden Board mentioned above. Cremations there numbered 771 in 1960 of which 50 were from Carshalton. The District Council maintains a mortuary in Mill Lane which is equipped with refrigeration storage and full post mortem facilities. By agreement it is used for the reception of bodies from the neighbouring districts of Beddington and Wallington and Coulsdon and Purley as well as from the local Urban District. The number admitted during the year was 192 as follows: — Ambulance removals 33 By police 3 Via local hospitals 25 From Carshalton homes 46 From Beddington & Wallington 25 From Coulsdon & Purley 54 From other districts 6 192 31 Section D—Housing. New Houses During the year 61 new dwellings were completed, 47 of which were private dwellings and 14 Council flats and maisonettes. The following buildings were in course of erection at the end of the year: — Private dwellings 42 Council Flats 12 Council Maisonettes 20 Council schemes in various stages of preparation were as follows: — Site No. Site Type of Dwelling No. 36 Culvers House Flats 36 38 Denmark Road Flats 44 42 Wandle Road Bungalows 26 Flats 2 Shop 1 Meeting Room 1 Flatlets in hostel block 36 Council's Housing Scheme The dwellings in the ownership of the Council at the year end were as follows:— Pre-War Houses 518 Post-War Houses, Flats & Maisonettes 727 Temporary Bungalows 102 Houses taken over under S.D.A.A. & H.A. 26 Houses purchased (units of accommodation) 31 Accommodation in Parks, Offices, etc. 18 1,422 There were no requisitioned premises in hand at the 31st December, 1960, the last 4 being released during the year. 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 1960 the 'A' List totalled 77 and the 'B' List 50. 32 Inspection and Action taken under Statutory Powers 1. Inspection of Dwelling Houses during the year. (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 2,657 (b) Number of inspections made for the purpose 4,745 (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 28 (b) Number of inspections made for the purpose 97 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 28 (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 226 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 1959) 165 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 16 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By Owners 17 (b) By Local Authority 4 4. Housing Act, 1957—Part IV (Oveercrowding) (a) (1) Number of dwelling houses overcrowded at the end of the year 18 (2) Number of families dwelling therein 26 (3) Equivalent number of adults dwelling therein 114 33 (b) Number of new cases reported during the year 5 (c) (1) Number of cases of overcrowding relieved during the year 14 (2) Number of persons concerned in such cases 100 (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 5 cases of overcrowding were found and 14 cases were remedied leaving 18 dwellings with 114 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 31.12.59 Dwellings found overcrowded during 1960 Dwellings decrowded during 1960 Dwellings remaining overcrowded at 31.12.60 Overcrowded cases remedied during 1960 Formal Action Informal Action Total St. Helier North 6 - 2 4 - 2 2 St. Helier South 6 - 3 3 3 3 St. Helier West 4 1 2 3 - 2 2 North-East 6 1 3 4 1 2 3 North-West - - - - - - - Central 3 — 1 2 1 — 1 South-West - - - - - - - South-East 2 3 3 2 — 3 3 27 5 14 18 5 9 14 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 same 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 1951 54 217 1956 27 63 1952 1953 79 53 123 112 1957 1958 10 14 46 33 1954 49 105 1959 12 27 1955 26 73 1960 5 18 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 14 dwellings was effected in the following manner: — Provision of alternative accommodation by:— Carshalton U.D.C. 3 London County Council 1 Other Local Authorities 1 Left district 1 Removal of one or more occupants 8 Of the 18 dwellings remaining overcrowded at the year end, 4 were owned by the Carshalton Council, 10 by the London County Council and 4 were privately owned. Slum Clearance and Demolition The re-housing of the 21 families still in occupation at the end of 1959 in Clearance Area No. 14 (St. John's Road) was continued during 1960 and should be completed early in 1961. In September representations were made to the Council in respect of the following Clearance Areas:— No. 10—Orchard Hill—involving 11 houses. No. 24—Levett's Rents, Wrythe Lane—involving 9 houses. In October a similar representation was made in respect of Area No. 17 (Mill Lane) involving 8 houses. The Council decided to proceed by way of a Compulsory Order in respect of Area No. 10 (Orchard Hill) and by way of a demolition order in respect of the other two. Rent Act, 1957 The following details show the action which has been taken during the year:— Part I—Applications for Certificates of Disrepair. (1) Number of applications for certificates 1 (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 Nil (b) in respect of all defects 1 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 2 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule ... Nil (6) Number of Certificates issued 1 Part II—Applications for Cancellation of Certificates. (7) Applications by landlords to Local Authority for cellation of certificates 1 (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 1 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 15. Designated licences issued during the year were as follows:— Designation Number of Distributors Holding Licences No. of Licences in force on 31.12.60 Principal Licences — Sterilised 13 16 Pasteurised 9 18 Tuberculin Tested 8 17 Supplementary Licences — Sterilised 6 10 Pasteurised 5 9 Tuberculin Tested 5 9 Bacteriological Examination of Milk One hundred and seventy-two 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 99 99 — 99 — — — T.T. Pasteurised 59 59 — 59 — — — Sterilised 14 — — — 14 172 158 — 158 — 14 Biological Testing oj Milk With the success of the campaign for the eradication of tubercle from the herds in Surrey, it is no longer necessary to carry out biological testing of milk except when T.T. milk is sold in the raw state. The three farms in the district produce T.T. milk but all is heat-treated before sale. 36 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 171. Of these 19 were "Channel Islands" and "S. Devon'" milk in which the cream content must be not less than 4% instead of the usual legal limit of 3% for ordinary milk. All were satisfactory. The average fat and non-fatty solids of the "Channel Islands" and "S. Devon" samples was 4.4% and 9.0% respectively; that of the remaining 154 samples 3.52% and 8.62%. Ice Cream For the two previous years all samples of ice cream without exception conformed to the highest standard of bacteriological purity. This desirable result was repeated again in 1960 when all 84 samples were classified by the laboratory as being of Grade I. The following is the analysis of the result of sampling since this system of bacteriological grading was first instituted in 1947:— 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 — - — 1960 84 84 — - — Seven samples of ice cream were analysed by the Public Analyst for quality and were reported as satisfactory. fee 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 area. All retailers are provided with refrigerator cabinets which maintain a temperature well below 28°F. in accordance with the regulations. 37 Bacteriological Examination of Other Substances One sample of corned beef was sent to the bacteriologist for examination and 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 1,808 lbs. 6 ozs. Analyses of Food and Drugs Samples submitted to the Public Analyst for qualitative analysis numbered 276 as shewn in the following table:— Article No. Adulterated or otherwise irregular Article No. Adulterated or otherwise irregular Apple Pie 1 Milk—Channel Islands 17 Beefburgers 1 Milk—South Devon 2 Butter 2 Minced Beef 1 Chicken Luncheon 1 Minced Beef with Gravy 1 Chicken & Veal Pie 1 Chocolate for Diabetics 1 Mincemeat Mineral Water 1 Confectionery Flour 1 Mousse Lemon 1 1 Confectionary Sugar 8 Peanut Butter 1 Coffee 1 Pork Pie 5 Coffee & Chicory Essence 1 Prunes in Syrup 1 Puppodums 1 Cordial 2 1 Ravioli in Tomato Sauce 1 Cordial Diatetic 1 Cough Balsam 1 Rice Milk Pudding 1 Cough Drops 1 Sage & Onion Stuffing 1 Crab Dressed 1 Dripping 1 Salmon 1 Fish Cakes 2 Salmon with Butter 1 French Mustard 1 Sausages—Beef 2 Fruit Malt Loaf 1 Sausages—Pork 2 Fruit Pudding 1 Semolina 1 Fruit Salad 1 Soup 2 Ginger Stem 1 Soup Cream 1 Glucose 1 Spaghetti 1 Glucose Syrup 1 Spaghetti creamed 1 Ground Nut Oil 1 Steak Pie 5 1 Halibut Oil Capsules 1 1 Steak & Kidny Pie 6 1 Steak & Kidney Pudd. 1 Ice Cream 7 Strawberries in Svrup 1 Instant Chocolate 2 Tea . 1 Instant Tea 1 Tea cake mixture 1 1 Lard 1 Tomatoes 1 Lemon Juice 1 Tripe 4 2 Licorice Root 1 Vinegar Malt 1 Margarine 1 Marmalade 2 1 Milk 154 276 9 38 The 9 samples reported as being irregular were as follows:— Steak and Kidney Pie. Steak Pie. Both these informal samples were taken at the request of the Food Standards Committee which is considering whether statutory regulation is necessary or practicable in regard to the composition of meat pies. One sample contained 14.6% meat (calculated on the whole pie) and the other 15% meat. In both cases the Public Analyst regards the meat content as being too low but did not quote a minimum in view of the investigation being made by the Food Standards Committee. Halibut Liver Oil Capsules. The date of preparation as required by the British Pharmacopeia was on the bottom of the container and not clearly stamped. The manufacturers agreed to add to the label on the container a note drawing the attention of the purchase that the date of preparation is stamped on the bottom of the container. Marmalade. A sample submitted to the Public Analyst upon complaint by a resident that the marmalade purchased from a local shop contained grit. Analysis of the marmalade proved that it contained two small stones and a small lump of rust. The manufacturers were unable to account for their presence and the circumstances did not warrant further action. Dietetic Orange Squash. This sample was labelled "New Dietetic Orange Squash specially prepared for Diabetics and others on sugar free diets. Licensed under the Soft Drinks Order, 1947 for the use of persons suffering from Diabetes." The Public Analyst pointed out that the word "New" implied a recent product and that no licence is required as the Soft Drinks Order 1947 was revoked in 1953. New labels had been printed and these would be used as soon as existing stocks were exhausted. Lemon Dairy Mousse. The label on this sample did not comply with the labelling of Food Order in that it was not clear and legible. Also, the term "Vegetable Thickener" was used instead of a specific name or description of the ingredient. The Manufacturers stated that on the new labels being printed the term "Locust Bean Gum" would be used instead of Vegetable Thickener. Tea Cake Mixture. A sample of sweetened flour together with raising ingredients, glace cherries and colouring matter. The article did not include on the label 39 of the container a statement of the ingredients. Also it was an incomplete cake mixture requiring the addition of egg, butter and margarine and milk. The Vendor was prosecuted under the labelling of Food Order, 1953, and fined £50 with £5 5s. 0d. costs. Tripe. The sample was found to contain 0.9% of Sodium Carbonate and considered unfit for consumption. The Vendor was prosecuted and fined £10 with £10 10s. Od. costs. Tripe. This sample was procured from a different Vendor to that of the sample above and as the Sodium Carbonate content was only 0.17% no legal action was taken. The firm of Tripe Dressers concerned stated that the excess soda was due to insufficient washing and that they were taking precautions to ensure that thorough washing was carried out in future. Section 9—Sale of Food Unfit for Human Consumption The following complaints of alleged foreign matter in foodstuffs purchased locally were received:— Dark substance in bread Finger bandage in bread Maggot in bread Mould in bread Foreign substance in ginger beer Plastic toy in milk Tripe containing excessive soda Appropriate warnings were given where the circumstances justified such action. Legal proceedings were taken as noted above in respect of a formal sample taken after the complaint in respect of the purchase of tripe. 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. Biscuits 30 8 Fruit Juice 5 6 Cereals 26 — Jam 15 — Cream 2 5 Jelly 2 8 Cheese 1 8 Milk 50 8 Coffee — 3 Meat 1808 6 Confectionery sugar . 18 10 Pickles — 4 Eggs 27 — Rice 13 14 Fat 25 8 Sauce 2 2 Fish 131 11 Soup 13 7 Fruit 259 13 Vegetables 95 — Total Weight 1 ton, 2 cwts. 2 qrs. 9 lbs. 9 ozs. The method of disposal is by burning in the Council's Refuse Destructor. Inspection of Food Premises The inspections made under the Food Hygiene Regulations and other statutory powers relating to food with the results of these visits are shewn in Table 9. 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 Bakehouses 3 — 33 - - - - - - - - - - - - - - Bakers and Confectioners 20 4 47 — 1 - - — 1 — 1 - - - - - - Butchers 35 31 144 2 4 - 1 1 — 4 6 - - - - - 1 Canteens 22 — 57 1 1 - - - - - 1 - - - - - - Chemists ... 17 1 21 - - - - - - - - - - - - - - Confectioners (Sweets only) 69 55 95 1 1 - - 3 - - - - - - - - - Fishmongers 14 6 92 — 2 - 1 - - - - - - - 2 - 1 General Stores 4 4 14 - - - - - - - - - - - - - - Greengrocers and Fruiterers 39 6 127 2 3 - - — 1 1 3 - - - 1 - 1 Grocers (including corn chandlers) 78 28 286 1 6 - - 1 3 4 5 - - 1 — - 1 Ice Cream Vehicles variable - 12 - - - - - - - 1 - - - 1 - - Licensed Premises (with catering facilities) 5 2 19 - - - - - - - - - - - - - - Licensed Premises (without catering facilities) 20 — 20 - - - - - - - - - - - - - - Milk Storage Depots 3 — 28 - - - - - - - - - - - - - - Restaurants and Cafes 24 18 115 — 3 - 1 — 4 2 3 - 1 - — 1 1 Stalls, food variable — 103 - - - - - - - - - - - - - - Vehicles, food variable — 15 - - - - - - - - - - - - - - 155 1,228 7 21 — 2 3 12 11 21 — 1 1 4 1 5 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 oft he prevalence of infectious disease in the resident population of the district, separate figures are given in this Section which exclude cases of hospital patients who are not residents of the district. The figures given are after correction for original errors in diagnosis. Notification The following diseases are notifiable in the district: — Smallpox Tuberculosis Enteric Fever Cholera Dysentery Relapsing or Continued Diphtheria Acute Primary Fever Membranous Group Pneumonia Meningococcal Infection Erysipelas Acute Influenzal Ophthalmia Scarlatina or Pneumonia Neonatorum Scarlet Fever Acute Poliomyelitis Puerperal Pyrexia Measles Acute Malaria Whooping Cough Polioencephalitis Food Poisoning and Typhus Fever suspected food Typhoid Fever poisoning Leprosy Smallpox No case of smallpox occurred in the area. There are no known foci of variola infection in this country. Any cases which are reported are invariably the result of importation from overseas. Vaccination against Smallpox. The arrangements for vaccination against smallpox are the responsibility of the County Council under Section 26 of the National Health Service Act, but by arrangement between the Councils they are directed locally by the District Medical Officer of Health. The practice is to secure protection for every child by primary vaccination during infancy usually before the sixth month. Re-vaccination is mostly practised when individuals are proceeding abroad to infected countries or to countries which require recent vaccination before permission to enter is granted, or to contacts of known or suspected cases usually aboard ship arriving from the East. Records of primary vaccination in childhood are sufficiently complete to form a reliable estimate of the number given this protection under the age of 5 years. The percentage so treated has been maintained for many years at the not unsatisfactory level of slightly less than 60%. 42 The number of persons recorded as having received successful vaccination during the year was as follows: — Age at 31st December, I960 i.e. Born in Under 1 yr. I960 1—4 yrs. 1956-9 5—14 yrs. 1946-55 15 yrs. & over 1945 & earlier Total Primary Vaccinations — By Private Practitioners 79 82 13 28 202 At Clinics 146 138 6 1 291 225 220 19 29 493 Revaccinations —- By Private Practitioners — — 4 45 49 At Clinics — — — 3 3 — — 4 48 52 In addition, the following unsuccessful attempts at vaccination were made:— Age at 31st December, 1960 i.e. Born in Under 1 yr. 1960 1-4 yrs. 1956-9 5—14 yrs. 1946-55 15 yrs. & over 1945 & earlier Total Primary — 2 1 — 3 Revaccination — 1 — 17 18 - 3 1 17 21 The estimated number of children under five years of age vaccinated at the end of 1960, was 1,800. Enteric Fever No case of typhoid or paratyphoid fever was notified for the seventh successive year. The last cases reported were two sisters who contracted the infection abroad in 1953. If only we could secure the same degree of purity of the air we breathe as we have done of our food and public water supplies, what a saving in respiratory illness we would enjoy! The great reduction in enteric fever, mainly as a result of the stringent control of water supplies, is a striking example of what can be done by protecting from pollution basic necessities of life. Dysentery Notifications of dysentery especially that due to Shigella Sonnei have been more numerous in recent years. This is undoubtedly due in the main to a greater awareness of the true nature of this inflammatory condition of the intestinal tract. Relatively mild in its nature much of this illness most certainly passed undetected or masqueraded under various descriptions such as intestinal chill — gastro enteritis — food poisoning, etc. It still does, but more intensive investigation and more frequent recourse to laboratory examination now brings to light the nature of this infection in an increasing number of cases. An outbreak of Sonne dysentery occurred in the first quarter of the year associated with Barrow Hedges Primary School and, as is not 43 infrequent, it had become well established before the first cases were notified. Some 78 cases distributed among 50 households occurred either among the children and staff of this school or among the domestic contacts of the school children. The main lines of preventive action were concentrated on the school which was the chief factor in the outbreak and they included the following:— The imposition of a strict code of personal hygiene in the school. All kitchen staff and kitchen practices were scrutinized, the latter being amended as necessary to ensure there was no risk of transmission of the infection through food or utensils. All W.C. seats, chain handles and W.C. door-knobs were swabbed with disinfectant three times a day. Insistence on every child or member of staff rinsing their hands in disinfectant solution after visiting the toilet and the washing of hands before dinner. New absentees from school who presented suspicious symptoms were visited and arrangements made for specimens from them. All were excluded from school until the results of the examination of the specimens were known. The practitioners in the district were informed of the position by letter and a suggested practice to ensure co-operation and liaison was made and observed. Children were allowed to return to school only after a negative specimen report, provided they were symptomless. In the case of the one food handler, three consecutive negative reports were obtained. In this way the outbreak was brought under control and a sharp reduction in the new cases brought about in the course of a fortnight, but as in other outbreaks, odd cases continued to occur for several weeks and a few, although recovered from symptoms, continued to excrete the organism for a week or two longer than the average which were bacteriologically positive for about ten days. A further 12 cases occurred in the second quarter of the year as isolated domestic outbreaks in different parts of the district, and were unassociated with the Barrow Hedges outbreak. These too were due to the Sonne organism. The last seven months of the year was free from this infection as far as the resident population was concerned, though a single case occurred in a hospital patient during November. Scarlet Fever The incidence of scarlet fever at 76 cases was approximately half that of the year before. As with Sonne dysentery, the very mildness of the illness creates its own problems in relation to its control. One has to contend with a sense of unimportance on the part of the profession and the public alike. As a result it is difficult to maintain the view that being an infectious condition, certain precautions are still necessary and that some degree of restriction must be imposed both on the patient and his contacts. With the decrease in the virulence of this infection, these restrictions have been progressively relaxed over the years and unless complications 44 continue to prolong infectivity, it is rarely necessary to exclude patients from school for more than three weeks and contacts may continue to attend school provided they remain well. Contacts in special categories such as food handlers, chefs, waitresses and the like, require of course more stringent supervision and restriction and the modern practice is to decide these in each case according to the individual circumstances and not to work to any rule of thumb. The practice adopted of recent years of nursing these cases of scarlet fever at home where reasonably possible was continued, and as high a proportion as 75% were managed in this way during the year. TABLE 10. SCARLET FEVER—DISTRIBUTION OF CASES, 1960 1960 Ward Total St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest January 7 2 1 2 - - 2 2 16 February 1 2 1 2 1 1 3 2 13 March 3 1 2 4 2 1 2 — 15 April — 1 — 2 — 3 1 2 9 May — 2 1 - — 1 1 1 6 June — - - 1 - 1 2 - 4 July — 1 1 1 1 - 1 — 5 August — — — — 1 1 — — 2 September 1 - - - - - - - 1 October 1 - - - - - - - 1 November - - - - - - 2 — 2 December — — 1 — — — — 1 2 TOTALS 13 9 7 12 5 8 14 8 76 Monthly Mean 1.08 0.75 0.58 1.00 0.41 0.66 1.16 0.66 6.33 Case rate per 1.000 population 1.59 1.26 0.94 1.23 0.69 1.37 1.63 1.21 1.25 TABLE 11 SCARLET FEVER—MULTIPLE CASES, 1960 Ward No. of houses in which occurred Total Houses Total Cases 1 Case 2 Cases 3 Cases St. Helier North 10 - 1 11 13 St. Helier South 9 — — 9 9 St. Helier West 7 — — 7 7 North-East 10 1 — 11 12 North-West 5 — — 5 5 Central 8 — — 8 8 South-East 12 1 — 13 14 South-West 8 — — 8 8 Whole District 69 2 1 72 76 45 Diphtheria There was again no case of diphtheria. It would not have been surprising if the outbreaks which occurred in the metropolitan area during 1960 had resulted in odd cases occurring in this district as a result of our industrial contact with London. The recent outbreaks in various parts of the country emphasise the necessity for maintaining our sheet anchor of protection by reinforcing the immunity bestowed on the children of the district during infancy by way of diphtheria immunisation. Diphtheria Immunisation As with smallpox vaccination the arrangements for immunisation against diphtheria are in the hands of the County Council, but local direction of the scheme is done by the District Medical Officers. The practice is to secure primary immunisation before the age of one year and to reinforce that protection on entry to school and thereafter at three yearly intervals until the child leaves the Junior School at about the age of 11. As was to be expected, the publicity given to the outbreaks scattered throughout the country, already referred to, which occurred during 1960, stimulated many more parents to secure this protection for their children and the numbers treated showed a further gratifying increase over the not unsatisfactory figures of recent years. As a result approximately 64% of children under 5 years had been immunised by the 31st December, as against a percentage of 57 at the same date twelve months earlier. In view of the fact that most babies are treated towards the end of the first year of life, the maximum percentage possible under 5 years of age is approximately 80 and it is against this level that the number treated should be viewed. Continued freedom from diphtheria is not only dependent on the numbers given primary treatment, but equally upon the extent to which the initial immunity is reinforced at appropriate intervals. Local practice includes a tour of the primary schools of the district each year where reinforcing or initial treatment is offered and carried out on the school premises. This procedure is markedly successful in maintaining a relatively high level of this artificially conferred immunity among the children of school age and amounts to approximately 70%. In 1960, 821 resident children received a primary course of treatment as follows: Age at 31.12.60 i.e. born in year Under 1 year I960 1 year 1959 2 years 1958 3 years 1957 4 years 1956 5-9 years 195155 10-14 years 194650 Total under 15 yrs. At Council Clinics 166 239 25 10 7 11 - 460 In Carshalton Schools - - — 2 13 152 28 195 Private Practitioners 55 104 9 8 2 8 1 187 221 343 34 20 22 171 31 842 Less outward transfers — — — — 2 18 2 22 221 343 34 20 20 153 29 820 Plus inward transfers - - - - - 1 — 1 Carshalton residents 221 343 34 20 20 154 29 821 46 A further 1,385 Carshalton children received reinforcing injections during the year. The following table shows the immunisation state of the local child population at the 31st December, 1960: — Number of children at 31st December, 1960, who had completed a course of immunisation at any time between 1st January, 1946 and 31st December, 1960. Age at 31.12.60., i.e. Born in Year Under 1 1960 1—4 19561959 5—9 19511955 10-14 19461950 Under 15 Total A. No. of children whose last course (primary or booster) was completed in the period 19551960 224 2155 3205 2883 8467 B. No. of children whose last course (primary or booster) was completed in the period 1955 or earlier - - 633 1758 2391 C. Estimated mid-year child population 730 3005 8930 12665 Immunity Index 100 A/C 30.6 71.0 68.1 66.8 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 shewn in the following table:— 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 0.00 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 1960 64 94(68*) 85(67*) 0 0.00 (*Immunised within the last 5 years) 47 Erysipelas Two cases of this skin infection were notified in both of which the face was affected. As mentioned in last year's report, this is an infection which responds very successfully to modern chemotherapy and the prompt exhibition of antibiotics or the sulphonamides, will almost certainly abort what would otherwise be a much more extensive condition. One case was an old lady inpatient of a local hospital who developed her illness whilst under steroid therapy for rheumatoid arthritis. Both cases recovered. Pneumonia Primary and Influenzal pneumonia are the only forms of this illness which are notifiable. They are inevitably more prevalent during influenza epidemics and during winter weather when respiratory infections are commonest. They can largely be regarded as an index to the prevalence at any time of acute respiratory disease. The winter months of 1960 were unusually mild and in consequence the number of notifications fell to the very low figure of 8, only one of which was stated to be in respect of influenza. An interesting feature was that half of the cases were young adults between the ages of 23 and 36. When pneumonia is particularly prevalent, specially during flu epidemics, the brunt of the infection usually falls on the very old and the very young. Measles A low incidence of measles in 1960 could have been predicted almost with certainty. In keeping with its biennial nature in Greater London, prevalence, after a marked epidemic in 1959, fell to the astonishingly low figure of 67 cases, which is the lowest since 1944. This total is less than the number notified on many occasions in one week during epidemic times. Most of the cases occurred in the last quarter of the year and were a prelude to the anticipated epidemic of 1961. TABLE 12. -MEASLES WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1960 (Excluding hospital patients non-resident in Carshalton) 1960 Ward Total St. Helier North St. Helier South St. Helier West NorthEast Northwest Central Southeast South West January - - - - - - - - - February — — — — 1 — — — 1 March 1 — 2 — — — — — 3 April - - - - - - 1 — 1 May - - - - - — - - — June - - - - - - - - — July — — — 2 — — 1 - 3 August — - - - - - - - — September 1 — 1 2 2 — - - 6 October - - 3 14 - 1 - - 18 November - - 2 16 2 3 2 - 25 December 3 — 1 4 1 — 1 - 10 TOTALS 5 — 9 38 6 4 5 — 67 Monthly Mean 0.41 — 0.75 3.16 0.50 0.33 0.41 - 5.58 Case rate per 1.000 population 0.61 - 1.21 3.92 0.83 0.68 0.58 - 1.10 48 Whooping Cough The cases of whooping cough notified during the year numbered 81. Although higher than in the three previous years it is still a low figure compared with the years before whooping cough vaccination was practiced to a significant extent and when it was common for the annual total to run into several hundreds. Whooping Cough Vaccination This form of protective treatment is usually given in combination with diphtheria immunisation and with possibly the extra addition of anti tetanus treatment. The number under 5 years of age who completed the full course of three injections against whooping cough, whether given separately or in combination during the year, was 601 and the number of children under 5 years known to have been vaccinated against whooping cough at the 31st December was 68.4% of this age group. TABLE 13. WHOOPING COUGH—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1960. (Excluding hospital patients non-resident in Carshalton) 1960 Ward Total St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest January - - 1 1 - - 1 1 4 February 3 - 2 - - - - - 5 March 1 2 2 - - - - - 5 April 1 - - - - - 1 — 2 May — — — 2 — — 1 — 3 June — — — - — — — - - July 1 2 2 5 — — — 2 12 August 2 - 4 2 3 — 2 - 13 September 1 3 - 4 - 3 1 - 12 October 2 2 2 - - 1 - - 7 November 3 1 3 2 1 - 1 4 15 December - - - 2 - — - 1 3 TOTALS 14 10 16 18 4 4 7 8 81 Monthly Mean 1.16 0.83 1.33 1.50 0.33 0.33 0.58 0.66 6.75 Case rate per 1,000 population 1.72 1.41 2.15 1.86 0.55 0.68 0.81 1.21 1.34 Meningococcal Infection Two cases of "spotted fever" were notified, one a girl of 5 years, the other a baby of 16 months. Both were confirmed bacteriologically as meningococcal meningitis and recovered after hospital treatment. The first occurred in March and the second in December, and as far as could be ascertained they were isolated cases having no connection with one another. 49 Poliomyelitis Although the prevalence of this virus infection had been declining since vaccination was first introduced, 1960 was the first year since the epidemic of 1947 when no cases were notified. Poliomyelitis Vaccination. Early in February the Ministry of Health gave authority for the extension of the Scheme of polio, vaccination for priority groups to include all persons who have not at the time of application reached the age of 40 and also to the following special groups:— Persons going to visit or reside in a country outside Europe, other than Canada or the United States of America. Practising dental surgeons, dental students, dental hygienists, student hygienists, dental surgeons' chairside assistants, and their families. Practising nurses not working in hospitals (those working in hospital are already eligible) and their families. Public health staff who might come into contact with poliomyelitis cases, and their families. Authority was also given to general practitioners in December to vaccinate persons outside the above mentioned priority groups, the vaccine for these being supplied through the National Health Service Pharmaceutical Services on prescription. The number of individuals vaccinated during the year either through the Authority's service or by general practitioners was as follows:— No. who received their 2nd injection No. given a 3rd injection Children over 6 months and born in 1943 to 1960 753 5105 Young persons born 1933 to 1942 227 Persons born before 1933 984 Others 67 Totals 2031 5105 The number vaccinated from the beginning of the scheme up to the 31st December, 1960, was as follows:— No. given 2 injections No. in previous column given 3rd injection Born in 1943-1960 11199 11909 Born in 1933-1942 2393 Born 1932 and earlier 984 Special groups 1378 Totals 15954 11909 These figures do not include the staffs of hospitals. 50 Ophthalmia Neonatorum Only one case of this inflammatory infection in the eyes of the newborn was notified. This again is an infection which usually responds readily to modern treatment and the prompt application of the newer drugs and anti biotics, either as a precaution or at onset is successful in preventing all but the odd cases. This was a mild case which made a rapid recovery without impairment of vision. Puerperal Pyrexia Any rise of temperature of 2° in a woman occurring within two weeks of childbirth or miscarriage is notifiable as puerperal pyrexia, whether due to infection of the genital tract or not. As there is within the Urban District extensive maternity hospital accommodation catering for a large part of metropolitan Surrey, it is to be expected that this institutional service will provide a substantial number of notifications of this nature. The priority groups admitted for hospital confinement either have some obstetric abnormality or are potentially abnormal and for this reason the puerperal pyrexia rate is higher than it would be in a normal cross section of parturient women. During 1960, 154 cases were notified all in respect of hospital patients except 4. Twenty-eight of the total were Carshalton mothers. Food Poisoning Out of a total of 40 cases of food poisoning notified, 37 were in respect of an outbreak at one of the local hospitals. The food served to those affected was from the patients' kitchen and all the sufferers were patients in the hospital. Although there was no certain proof, the circumstantial evidence pointed strongly to veal puree as the vehicle of infection. This food has of necessity to be subjected to considerable manipulation in that after boiling it is first minced and then the minced meat put through puree machines. There was then an interval of two to three hours before the puree was eaten. No specific pathogenic organisms were isolated either from the patients or from the veal remnants, but the latter shewed a heavy contamination with a diverse variety of organisms and the probable explanation is that this general contamination during processing resulted in bacterial decomposition of the veal during the interval before it was consumed. All cases were relatively mild and the only symptom, that of diarrhoea, lasted on the average for about 24 hours. All cases recovered. This is yet another example of the special risks that are attendant upon manipulating food, especially meat dishes, particularly when an interval elapses before they are consumed. Of the remaining three cases notified, two were members of the same family in whom the cause of their illness pointed to canned beef. Staphylococcus aureus coagulase positive was isolated in moderate growth from remnants of the beef, but no pathogens were isolated from the patients. It is probable that both were affected by the toxins of the organism preformed in the beef. The relatively short onset and the fact that vomiting was marked supports this view. The remaining case was a youth who, with his sister, suffered gastrointestinal symptoms after eating mushrooms which was the most likely cause, although proof was lacking. 51 52 TABLE 14. CASES OF NOTIFIABLE INFECTIOUS DISEASE ADMITTED TO HOSPITAL, 1960. Disease Cuddington Wandle Valley Queen Mary's St. Helier Totals Scarlet Fever 3 16 — — 19 Dysentery — — — 1 1 Measles 1 — — — 1 Erysipelas — 1 — — 1 Whooping Cough 1 2 2 — 5 Meningococcal Infection — — 2 - 2 Ophthalmia Neonatorum — — 1 - 1 Food Poisoning — — — 1 1 TOTALS 5 19 5 2 31 53 TABLE 15. INFECTIOUS DISEASES—NOTIFICATIONS, DEATHS AND DISTRIBUTION. (Excluding hospital patients non-resident in Carshalton) Disease Cases notified Case 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 76 1.25 — 13 9 7 12 5 8 14 8 19 25 Measles 67 1.10 — 5 — 9 38 6 4 5 — 1 1.49 Whooping Cough 81 1.34 — 14 10 16 18 4 4 7 8 5 6.17 Dysentery 94 1.57 — 4 — 1 — 4 3 11 71 1 1.06 Pneumonia 8 0.13 — — 1 3 — 3 — 1 — — — Ophthalmia Neonatorum 1 0.01 — — 1 - - - - - - 1 100 Erysipelas 2 0.03 — — 1 — — — 1 — — 1 50 Puerperal Pyrexia 28 0.46 — 6 2 3 11 2 3 1 — 24 85 Food Poisoning 3 0.04 — — — 1 — — — 2 — 1 33 Meningococcal Infection 2 0.03 — 1 — — 1 — — — — 2 100 54 TABLE 16. INFECTIOUS DISEASES—Notification by Age Groups, 1960. (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 & over Scarlet Fever — — — 6 6 53 11 - - - - - 76 Measles 1 10 10 15 7 23 — — 1 — — — 67 Whooping Cough 5 12 8 6 7 28 12 1 1 — 1 — 81 Dysentery 3 3 3 3 5 53 12 2 4 4 2 — 94 Pneumonia — 1 — — — — 1 — 3 1 — 2 8 Ophthalmia Neonatorum 1 - - - - - - - - - - - 1 Erysipelas - - - - - - - - - 1 — 1 2 Puerperal Pyrexia - - - - - - - 4 20 4 — — 28 Food Poisoning — 1 - - - - - - - 1 — 1 3 Meningococcal Infection — 1 - - - 1 - - - - - - 2 55 TABLE 17. MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1960. (Excluding hospital patients non-resident in Carshalton) Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 16 13 15 9 6 4 5 2 1 1 2 2 76 Measles — 1 3 1 — — 3 — 6 18 25 10 67 Whooping Cough 4 5 5 2 3 — 12 13 12 7 15 3 81 Dysentery 2 62 18 9 3 - - - - - - - 94 Pneumonia 1 4 — — — 1 — — — — 1 1 8 Ophthalmia Neonatorum - - - - 1 - - - - - - - 1 Erysipelas - - 1 - - 1 - - - - - - 2 Puerperal Pyrexia 3 7 2 2 3 1 3 1 2 2 — 2 28 Food Poisoning 2 - - 1 - - - - - - - - 3 Tuberculosis, Pulmonary 2 — 2 — 1 — 2 4 — — 1 2 14 Tuberculosis, Non-Pulmonary — — — 1 — — 3 2 — — 1 — 7 Meningococcal Infection - - 1 - - - - - - - - 1 2 Tuberculosis The new cases admitted to the tuberculosis register during the year numbered 54 classified as follows: — Males Females Pulmonary 23 Pulmonary 22 Non-pulmonary 3 Non-pulmonary 6 Of the total additions, 21 were primary notifications, 31 were transferred from other districts and 2 came to notice in other ways. In the same period, 141 names were removed from the register for the following reasons:— Recovered 86 Death 11 Otherwise (including removals) 44 After allowing for the additions and deductions, the state of the register at the 31st December, 1960, was as shewn in the following table:— TUBERCULOSIS—WARD DISTRIBUTION. Cases on Register at 31st December, 1960 Ward Pulmonary Non-Pulmonary Total Incidence per 1,000 population Males Females Males Females St. Helier North 59 48 5 8 120 14.7 St. Helier South 45 38 7 7 97 13.6 St. Helier West 32 47 2 4 85 11.4 North-East 45 36 5 4 90 9.2 North-West 20 24 2 2 48 6.6 Central 16 27 1 — 44 7.5 South-East 36 22 1 — 59 6.9 South-West 17 19 — — 36 5.4 Whole District 270 261 23 25 579 9.5 531 48 The total of 579 is 87 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 29. 56 The number of tuberculous persons who died during the year was 11, distributed by age groups as follows:— Age Years Pulmonary Non-Pulmonary Total Males Females Males Females 0 - - - - - 1—5 - — — — — 5—15 - — — — — 15—25 - — - — — 25—35 1 1 - - 2 35—45 - - — — - 45—55 1 — — — 1 55—65 3 — — — 3 65—up 4 1 — — 5 Totals 9 2 - - 11 The deaths attributable to tuberculosis were 4 as follows:— DEATHS DUE TO TUBERCULOSIS, 1960. Ward Pulmonary Non-Pulmonary Death Rate per 1,000 population Mean age at Death Male Female Male Female St. Helier North — — - - - - St. Helier South 2 — — — 0.28 58 St. Helier West 1 — — — 0.13 76 North-East — — — - - — North-West — 1 — - 0.14 30 Central — — — — - - South-East — — - - - - South-West — — — - — — Totals 3 1 - — 0.06 55 Of the 4 persons who died 2 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. Six tuberculous families were rehoused by the Council in 1960. 57 58 TABLE 18. TUBERCULOSIS. New Cases, Age and Sex Distribution and Manner of Admission to Register, 1960 Age Group Years Primary Notifications "A" Cases transferred from other Districts Cases brought tonotice 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 30—Mec M F 0— 1 - - — - - - - - - - - - - 1—5 — 1 — — — — — — — — — — 1 5—10 — — — — — — — — — — — — — 10—15 — — — — 2 — — — — — — — 2 15—20 1 — — — — 1 — — — — — — 2 20—25 — 1 1 — — 2 — 1 — — — — 5 25—35 1 3 — 1 8 8 — 1 — 1 — — 23 35—45 — — 1 1 2 1 — — — — — — 5 45—55 2 — 1 — — 3 — — — — — — 6 55—65 2 — — 2 2 — — — — — — — 6 65 up 2 1 — — — — — — 1 — — — 4 Totals 8 6 3 4 14 15 — 2 1 1 — — 54 21 31 2 Carshalton Chest and Heart Care Committee This voluntary Committee, originally constituted some 30 years ago as the Carshalton Tuberculosis Care Committee to assist local tuberculous families, extended the scope of its activities in 1959 to include chest and heart cases other than those of tubercular origin which are referred to it from the chest clinics. As expected, the help afforded to the non-tuberculous has steadily increased since this additional work was undertaken and there is no doubt that considerable scope exists for further useful service to this type of case when it is appreciated that the non-tuberculous cases attending the chest clinics are several times more numerous than those with this particular infection. The annual report of the Committee shows the diversity of ways in which patients and their families are assisted, ways in which the statutory health and welfare services are unable to help. They include grants for fuel, clothing, materials for occupational therapy, radio and television, fares to hospital, insurance premiums, Christmas gifts, etc., etc. A long-established feature of the Committee's activities is the provision of holidays for patients and their families which, but for this Committee, could not be enjoyed. The children from affected households are particularly remembered at Christmas time when an outing is arranged to some festive entertainment, pantomime, circus or the like, for about 80 children. Special help is not infrequently given on a substantial scale for re-establishing business or providing mechanised transport to work. Disbursements in these many ways amounted in 1960 to approximately £600, whilst the administrative expenses are less than £20. All service by Committee members and officers is entirely voluntary. Carshalton Old People's Welfare Committee No section of the community is probably more in need of a better service than the old and infirm. The provision of residential care for the aged, both by the hospital and welfare services, is so inadequate that not only must the fullest possible use be made of the statutory domiciliary service but there is urgent need of voluntary help in innumerable directions. It was with this dire need in mind that the Old People's Welfare Committee was launched in the district in 1957. The Darby and Joan Clubs in the town were already doing excellent work for the ambulant aged, but there are many who are bed- or house-bound or who are not disposed to join in communal activities who need help. This voluntary Committee is still in its infancy. It has already set up a meals-on-wheels service, a chiropody service and a home visiting service but there still remains great scope for further help to the old. There is need, for example, of a service of sitters-in, both day and night, of a service to give temporary relief to hard-pressed relatives, of day centres, and many other ways in which the lot of this pathetic section of the community can be relieved. This cannot be achieved without funds. The District Council makes a generous donation each year to the Committee, and the County Council, as the health and welfare authority, has shown itself in fullest sympathy with all these voluntary schemes and invariably gives its encouragement and assistance, but there remains need for financial assistance on a much wider scale. 59 METEOROLOGY The following rainfall was recorded at the Council's Pumping Station in Buckhurst Avenue. Rainfall 1960 Amount in ins. Rainfall 1960 Amount in ins. January 1.92 July 2.93 February 1.66 August 2.60 March 1.85 September 3.16 April 0.89 October 4.99 May 1.82 November 4.07 June 0.97 December 2.67 Total 29.53 The water flow over the weir on the head of the River Wandle in the grounds of the Grove was as follows:— Spring Flow during the year (Jan.—Dec. 1960) = 938 million gallons. Maximum Spring Flow 8.7 million gallons per day during the week ending 28th December, 1960. Minimum Spring Flow 0.405 million gallons per day during the week ending 20th January, 1960. 60 INDEX PAGE Acreage 6 Atmospheric Pollution 26 Births— Distribution 10, 11 Institutional 10 Rates 9, 10, 11 Cancer 7, 13, 14 Cemeteries 31 Clean Air Act 25 Clinics and Treatment Centres 19 Closet Accommodation 22 Deaths— Classification 7,17 Distribution 15 Rates 7, 11,13 Diphtheria 46 Diphtheria Immunisation 46,47 Dysentery 43 Disinfection 25 Disposal of Dead 31 Drainage and Sewerage 21 Employment Agencies 29 Enteric Fever 43 Erysipelas 48 Establishments for Massage, etc. 30 Factories 28 Food— Food and Drugs Act 38 Hygiene 40 Inspection and Supervision 36, 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 35 Overcrowding 34 Slum Clearance 35 Ward Distribution 34 Ice Cream 37 Infant Mortality 7, 16 Infectious Diseases 42, 53, 54, 55 Inquests 15 Isolation Hospital— Admission to 52 61 PAGE Laboratory Facilities 18 Maternal Mortality 7, 16 Measles 48 Meat 38 Meningococcal Infection 49 Merchandise Marks Act, 1926 30 Meteorology 60 Milk Supply 36 Milk and Dairies Regulations, 1959 37 Mortuary 31 Natural and Social Conditions 6 National Assistance Act 30 Offices 27 Old Peoples' Welfare 59 Outworkers 28 Ophthalmia Neonatorum 51 Pet Animals Act, 1951 30 Pneumonia 48 Poliomyelitis 50 Poliomyelitis Vaccination 50 Population 7, 9 Public Cleansing 22 Puerperal Pyrexia 51 Rag Flock and Other Filling Materials Act, 1951 30 Rateable Value 6 Rats and Mice Destruction 27 Rivers and Streams 22 Sanitary Circumstances 20 Sanitary Inspection 22 Scarlet Fever 44,45 Shops Act 29 Smallpox 42 Smoke Abatement 25 Staff 5 Statistics— Comparative 12 Vital 7 Swimming Baths 27 Tuberculosis 7,15,56,57,58 Care Committee 59 Unemployment 9 Vaccination 18,43 Vermin Control 25 Water Supply 20-21 Whooping Cough 49 Zymotic Diseases— Deaths from 7 62