CARSHALTON URBAN DISTRICT Annual Report OF THE Medical Officer of Health FOR THE YEAR 1961 CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1961 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 1961. Statistically much the most important feature is the large reduction in the mid-year estimate of population furnished by the Registrar-General as a result of the census taken in April. Apart from its very adverse effect on the finances of the district in the loss and repayment of grant, it has of course a marked influence on the various statistical rates which are calculated on it. Largely for this reason for example, the birth rate shows a rise from 11.4 to 14.7 per thousand population. To arrive at the "comparable" rates which are the figures for comparison with the national statistics, the Registrar-General supplies annually "comparability factors" by which the actual crude rates have to be multiplied. This is to make allowance for the difference in the age and sex constitution of the local population and that of England and Wales as a whole. The RegistrarGeneral is evidently aware, as we have been aware for some time, that the reduction in the total population is at the expense of the younger age groups, in that, after many years without change, he has now increased the comparability factor for the birth rate and decreased the factor for the death rate. The crude death rate still remains substantially less than the national figure. Heart disease again heads the list of killing diseases and cancer of the lungs again took a heavy toll, four times greater than it did 20 years ago. There is some significance for heavy smokers in the fact that of the eight deaths which occurred from tuberculosis, seven were men with an average age of 70 years. 1961 was another favourable year from the point of view of infectious disease. We had the expected measles epidemic in the first half of the year, but there were no deaths. There was no smallpox, no diphtheria, no enteric fever, only two cases (one imported) of dysentery, whilst the incidence of scarlet fever and whooping cough was again gratifyingly low. None of these infections was fatal. Sanitation and environmental hygiene received the same close attention from the Public Health Inspectors to which we are accustomed in spite of staff difficulties and the increased duties arising out of the Clean Air Act. Food and food practices were subjected to the usual thorough supervision and the satisfying results of sampling and testing are very acceptable rewards for this unremitting task. All samples of milk were satisfactory; all samples of ice cream were of the highest grade of bacteriological purity and there were no cases of food poisoning. The sewers showed no evidence of rat infestation and the Council's Cleansing Station was not brought into use at any time during the year. 3 Progress in removing slum dwellings was carried a stage further when the Minister confirmed Orders in respect of three small areas comprising a total of 27 dwellings. The programme of this work is far behind schedule and is held up only by the slow rate of providing alternative accommodation. By contrast, the progressive work of creating annual smokeless zones under the Clean Air Act, until the whole area is covered, is well on time table. It is hoped that progress will remain unhindered and that it may be brought to a satisfactory conclusion as originally planned by 1970. I would again express my sincere thanks to all members of the staff for their untiring and loyal assistance for yet another year. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, F. LAWRENCE SMITH, Medical Officer of Health. July, 1962. 4 PUBLIC HEALTH STAFF Medical Officer of Health: fF. Lawrence Smith, M.B., Ch.B., D.P.H. The Lodge, Honeywood Walk, Carshalton. (Telephone: Wallington 5501) Chief Public Health Inspector: *G. R. Surfleet, C.R.S.I. Deputy Chief Public Health Inspector: •J. H. Willis, C.R.S.I. Public Health Inspectors: *J. P. Dixon, C.R.S.I. *C. R. Southgate, C.R.S.I. *W. E. Featherstone, C.R.S.I. Public Health Nurse: Mrs. D. E. Baldock, S.R.N. Chief Clerk: Miss V. St.P. Hotten † Also Divisional Medical Officer, Surrey County Council. * Meat and Food Certificate of the Royal Sanitary Institute. 5 Section A—Natural and Social Conditions of the District. Area (in acres) 3,346 Estimated num ber of inhabited houses (end of 1961) according to Rate Books 17,597* Rateable Value at 31st December, 1961 £874,471 Sum represented by Id. rate £3,580 (*fncludes 256 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 rising from several springs at the outcropping of the chalk near the centre of the district. The recorded flow of the River Wandle over the weir in the Grove was more than double that of the year before. There was therefore, no stagnation during the year in either of the ponds which form the head waters of this branch of the Wandle. Most of the workers of the district earn their livelihood in London and elsewhere, there being little local industry established within the confines of the area. It is for this reason, largely a dormitory town, with a considerable proportion of its inhabitants travelling daily to work in other districts. Development has, to all intents and purposes, reached its limit in the horizontal plane, there being virtually no further land except for small infilling plots available for building. Whilst the limits of the "green belt" are respected, growth can only be effected by re-development and building upwards. Density is largest in the northern part of the area where the L.C.C. Estate of St. Helier, provides accommodation for a considerable population of the lower income groups. Largely for this reason, the rateable value per head of population is the lowest in Metropolitan Surrey. 6 SUMMARY OF VITAL STATISTICS FOR 1961 (Based on the Registrar-General's Figures) Population Registrar-General's Estimate 56,490 Births Mates Females Total Live (Legitimate) 379 321 700 (Illegitimate) 12 19 31 391 340 731 Birth Rate (per 1,000 population) 14.7 Stillbirths (Legitimate) 8 3 11 (Illegitimate) — — — 8 3 11 Stillbirth Rate per 1,000 total births 15.0 Deaths 312 251 563 Death Rate (crude) per 1,000 population 9.9 Infant Mortality. All deaths under 1 year 8 6 14 Infant Mortality Rate (per 1,000 live births) 19.1 Deaths of leg. infts. under 1 year Rate per 1,000 legitimate births 8 6 14 20.0 Deaths of illeg. infts. under 1 year Rate per 1,000 illegitimate births — Maternal Mortality. Death from Sepsis — — — Rate per 1,000 births - Death from other causes — 1 1 Rate per 1,000 total births 1.34 Maternal Death Rate 1.34 Zymotic Deaths. 7 Principal Zymotic Diseases — Deaths from Measles — — Deaths from Whooping Cough — — — Deaths from Diarrhoea (under 2 years) — — — Zymotic Death Rate — Deaths from Tuberculosis. All Forms 7 1 8 Rate per 1,000 of population 0.14 Phthisis 7 1 8 Rate per 1,000 of population 0.14 Deaths from Cancer 65 47 112 Rate per 1,000 of population 1.98 7 The following statistics relating to mothers and infants are set out in the form specially requested by the Minister:— Live Births Number 731 Rate per 1,000 population 14.7 Illegitimate Births per cent, of total live births 4.2% Stillbirths Number 11 Rate per 1,000 total live and stillbirths 15.0 Total live and stillbirths 742 Infant Deaths (deaths under 1 year) 14 Infant Mortality Rates Total infant deaths per 1,000 live births 19.1 Legitimate infant deaths per 1,000 legitimate live births 20.0 Illegitimate infant deaths per 1,000 illegitimate live births Neo-natal Mortality Rate (deaths under 4 weeks per 1,000 live births) 16.4 Early Neo-natal Mortality Rate (deaths under 1 week per 1,000 live births) 16.4 Peri-natal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 30.9 Maternal Mortality (including abortion) Number of deaths 1 Rate per 1,000 total live and stillbirths 1.34 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 1961, are supplied through the courtesy of the Exchange Manager and the Youth Employment Officer: Men 103 Women 23 Boys 8 Girls 5 The figures show little change from those of a year ago. POPULATION The census of April, 1961, provided information which enabled the Registrar-General more accurately to estimate the mid-year population. For several years there have been local indications that the population was declining accompanied by an increase in the average age. These were confirmed by the latest census returns which showed that in the intercensul period 1951-1961, the de facto population of the district fell from 62,721 to 57,462. The Registrar-General's estimate of the mid-1961 home population is 56,490, which compares with his estimate of 60,430 in 1960. This significant drop in the official estimate has had considerable adverse financial repercussions in the loss and repayment of government grant. Although the population fell in the intercensul period by more than 5,000, the number of private households increased by 264. There was, therefore, a distinct fall in the average size of households, the most probable explanation of which, is the outward migration of young married people. The percentage increase between 1951 and 1961 in the number of private dwellings at 6.4 per cent, is the second lowest in the County of Surrey, where the overall increase was 23 per cent. TABLE 1. ESTIMATED HOME POPULATION, MID-1961, BY WARDS Ward Dwellings at Mid-1961 Estimated Population Mid-1961 St. Helier North 2,169 6,880 St. Helier South 1,699 6,190 St. Helier West 2,123 6,770 North-East 2,853 8,900 North-West 2,236 7,120 Central 1,808 5,800 South-East 2,490 8,330 South-West 2,251 6,500 Whole District 17,629 56,490 BIRTHS The number of live births registered during 1961 was 731—males 391, females 340. This is 40 more than in the year before and so with a considerable drop in the estimate of population, the birth rate shows a considerable rise to 14.7 per thousand population from 11.4 in 1960. 9 The "comparability factor" supplied by the Registrar-General for application to the crude birth rate has in the light of the census return, been amended from 0.97, at which it stood for many years, to 1.0. This is a reflection of the view that there are now fewer young adults of child bearing age. The "comparable" birth rate is therefore the same as the actual at 14.7 per thousand population and compares with the national rate of 17.4. 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 734 live births and 11 stillbirths occurred in 1961. 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 66 9.5 1 14.9 St. Helier South 56 9.0 2 34.4 St. Helier West 89 13.1 2 21.9 North-East 121 13.5 2 16.2 North-West 107 15.0 1 9.2 Central 90 15.5 1 10.9 South-East 117 14.0 — — South-West 88 13.6 2 22.2 Eighty-one 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 76 North-West 84 St. Helier South 77 Central 84 St. Helier West 82 South-East 76 North-East 84 South-West 79 Out of 745 total births, 603 took place in the following hospitals and nursing homes:— Live Still  Carshalton, Beddington and Wallington District (War Memorial) Hospital 148 2 150 St. Helier Hospital 358 8 366 Other Surrey Hospitals 69 — 69 Other Hospitals 18 — 18 Totals 593 10 603 For many years more than three quarters of all births have taken place in Maternity Institutions. 10 TABLE 2 BIRTHS, 1961—DOMICILIARY AND OTHERS—BY WARDS Ward Born in District Born outside District In Hospitals and Nursing Homes In Private Dwellings Total In Hospitals and Nursing Homes In Private Dwellings Total Grand Total St. Helier North 50(1) 16 66(1) 1 1 67(1) St. Helier South 40(2) 13 53(2) 5 — 5 58(2) St. Helier West 68(1) 16(1) 84(2) 7 — 7 91(2) North-East 96(2) 19 115(2) 8 — 8 123(2) North-West 74(1) 16 90(1) 17 1 18 108(1) Central 69(1) 14 83(1) 8 — 8 91(1) South-East 69 28 97 20 — 20 117 South-West 50(2) 17 67(2) 21 2 23 90(2) Totals 516(10) 139(1) 655(11) 87 3 90 745(11) (Figures in brackets indicate still-births included in totals) TABLE 3 BIRTH AND DEATH RATES FOR CARSHALTON, 1922-1961 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 0.0 1951 61,730 12.3 8.7 29.0 1.2 1952 61,630 12.7 8.9 28.0 0.0 1953 61,680 12.5 8.4 23.3 0.0 1954 61,610 13.3 8.0 18.2 0.0 1955 61,330 12.5 7.8 23.5 0.0 1956 60,970 11.6 8.5 15.4 0.0 1957 60,440 11.5 8.3 21.6 1.4 1958 60,300 12.4 9.3 14.6 0.0 1959 60,270 12.8 9.4 24.5 0.0 1960 60,430 11.4 9.0 20.2 1.4 1961 56,490 14.7 9.9 19.1 1.3 11 COMPARATIVE HEALTH STATISTICS, 1934/61 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 1961 12.0 9.9 21.4 19.1 0.27 1.3 12 TABLE 4 COMPARATIVE STATISTICS—1961 England and Wales Carshalton Birth Rate (per 1,000 population) 17.4 14.7 (crude) Still-birth Rate (per 1,000 total births) 18.7 14.7 15.0 (comp.) Death Rate (per 1,000 population) 12.0 9.9 (crude) 11.7 (comp.) Infant Mortality (per 1,000 live births) 21.4 19.1 Neo-natal Mortality (in first 4 weeks per 1,000 live births) 15.5 16.4 Death rate from Tuberculosis (per 1,000 population) Respiratory Tuberculosis .065 0.072 0.14 o. 14 Other Tuberculosis .007 Death rate from Cancer (per 1,000 population) All Forms 2.16 1.98 Cancer of Lung 0.49 0.62 Maternal Mortality (per 1,000 total births) Excluding Abortion 0.27 0.34 1.34 l.34 Abortion 0.07 DEATHS The deaths allocated to the district, as adjusted by inward and outward transferable deaths, was 567—315 males and 252 females. This gives a crude death rate of 9.9 per thousand population as against 9.0 in the year before. The "comparable" death rate produced by the application of the Registrar-General's "comparability factor" of 1.19 to allow for differences in the age and sex constitution of the local population as compared with the country as a whole was 11.7. The rate for England and Wales was 12.0. The "comparability factor" for application to the death rate like that for the birth rate has been revised in the light of the census returns. For many years it remained at 1.28. The new factor therefore postulates that the age constitution of the local population has increased and there is not the same necessity to "weight" the death rate so heavily as there was when the population was younger to make it comparable with that for England and Wales. The distribution of the deaths by wards was as follows:— WARD DEATH RATES AND MEAN AGE AT DEATH, 1961 Ward Deaths Death Rate (crude) Mean age at St. Helier North 86 12.5 64.9 yrs. St. Helier South 55 8.8 66.6 „ St. Helier West 56 8.2 64.6 „ North-East 81 9.1 66.2 „ North-West 77 10.8 68.7 „ Central 55 9.4 73.0 „ South-East 82 9.8 66.6 „ South-West 75 9.9 84.1 ,, Whole District 567 10.3 65.7 „ Cancer deaths at 112 were 7 fewer than in 1960, but malignant disease of the lungs claimed a higher proportion at 35. Of those who died of this lung disease all were males but two. The following table shows the deaths from lung cancer since 1936, a period in which the population remained fairly steady. DEATHS FROM CANCER OF THE LUNGS, 1936-1961 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 1961 35 13 CANCER DEATHS—WARD DISTRIBUTION, 1961 Ward Cancer Deaths Rate per 1,000 Estimated Population M F Total St. Helier North 9 7 16 2.32 St. Helier South 8 11 19 3.06 St. Helier West 7 3 10 1.46 North-East 11 7 18 2.02 North-West 9 3 12 1.68 Central 4 2 6 1.03 South-East 4 6 10 1.20 South-West 13 6 19 2.90 The classification of the cancer deaths by sites affected is given in Table 5. TABLE 5 CANCER DEATHS, 1961 Group Site Affected Male Female Total 141 Tongue 1 1 142 Salivary Gland 1 — 1 Digestive Organs: 150 Oesophagus 2 1 3 151 Stomach 10 8 18 153 Colon 2 5 7 154 Rectum 3 1 4 155 Gall bladder and ducts 1 1 157 Pancreas 2 2 4 Respiratory System: 162 Lungs and bronchi 33 2 35 Breast and Genito-Urinary: 170 Breast — 12 12 171/4 Uterus — 2 2 175 Ovary — 1 1 177 Prostate 3 — 3 180 Kidney 1 1 2 181 Bladder 3 1 4 Other Sites: 193 Brain 1 1 194 Thyroid Glan — 1 1 196 Bone 1 — 1 199 Orbit 1 1 Auditory Canal — 1 1 201 Lymphatic tissues 1 2 3 203 Myelomatosis 2 2 4 65 45 no Average age at death: Males 64.3 years Females 64.6 years All persons 64.5 years 14 Heart disease in one form or another was, as always, the chief cause of mortality, 173 deaths being attributable to this group of diseases. Of these 173, 88 were caused by coronary disease of the heart. Tuberculosis accounted for 8 deaths. This is 4 more than in the year before, but is still only one third of the mortality prevailing a few years ago. Of the 8 deaths, 7 were males with an average age of 70 years. In this connection it is of interest to note that the report of the Royal College of Physicians on "Smoking and Health" states "Since the introduction of streptomycin and other drugs that are effective against tuberculosis, the rate of decline of death rates has been rapid and rather fewer new cases have been notified; but this favourable trend has been much less marked in elderly men. The continued high toll in this age and sex group in which heavy smoking is most likely to show its effect, is the most striking feature of recent tuberculosis statistics." Tuberculosis mortality in the last 20 years was as follows:— Year Deaths from Tuberculosis Death Rate per 1,000 Population Year Deaths from Tuberculosis Death Rate per 1,000 Population 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 1951 21 0.34 1961 8 0.14 The distribution of tuberculosis mortality by wards and other details are given in Section F of this report. Again for the fifth successive year there was no death from any of the notifiable infectious diseases other than tuberculosis. Twenty-six residents met their end from violent causes. They were:— Road traffic accidents 9 (all male) Multiple injuries 2 Fall 4 Burns 1 Asphyxia 1 Suicide 9 Inquests Inquests were held on 48 persons who died in the district. The following verdicts were returned:— Accidental death Accidents 12 Misadventure 5 Road Traffic 14 Suicide 7 Falls 4 Natural Causes 5 Burns 1 Twenty-two of the total were residents of the district. 15 INFANT MORTALITY The number of children who died in the first year of life was the same as in the year before—14. This gives an infant mortality rate of 19.1 per thousand live births which compares with the rate of 21.4 for England and Wales as a whole. Twelve of the total died within one week (10 within twenty-four hours) of birth and were due to the so called "unavoidable" deaths, such as prematurity and congenital abnormality. Of the other two, one died of accidental asphyxia whilst suffering from pneumonia, the other as a result of injuries from an accidental fall. TABLE 6. INFANT MORTALITY—WARD DISTRIBUTION. Ward Infant Deaths Rate per 1,000 Live Births St. Helier North 3 45.4 St. Helier South 1 17.8 St. Helier West North-East 4 33.0 North-West 1 9.3 Central 1 11.1 South-East 2 17.1 South-West 2 22.7 TABLE 7. INFANT MORTALITY DURING THE YEAR 1961. 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 8 8 8 Congenital Malformation 3 - - - 3 - - - - 3 Asphyxia - - - - - 1 - - - 1 Pneumonia 1 — — — 1 — — — — 1 Fall - - - - - - 1 - - 1 Totals 12 — — — 12 1 1 — — 14 MATERNAL MORTALITY One death from maternal causes was recorded. A mother of 46 years died from pulmonary embolism one week after being delivered of a premature still born baby. 16 —J TABLE 8 CAUSES OF DEATH DURING The YEAR 196-By Age and Sex No. Causes of Death o — 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 8 6 — — 2 1 6 2 2 3 10 3 16 19 71 40 93 59 107 119 315 252 567 1 Tuberculosis, Respiratory — — — — — — — — — 1 — — — — — — 7 — — — 7 1 8 2 Tuberculosis, Other - - - - - - - - - - - - - - - - - - - - - - - 3 Syphilitic disease - - - - - - - - - - - - - - - - - - - 2 1 1 3 4 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - 5 Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - 6 Meningococcal Infections - - - - - - - - - - - - - - - - - - - - - - - 7 Acute Poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - 8 Measles - - - - - - - - - - - - - - - - - - - - - - - 9 Other Infective and Parasitic Discases - - - - - - - - - - - - - - - - - - - - 1 — 1 10 Malignant neoplasm, stomach - - - - - - - - - - - - - - 3 2 6 3 1 3 10 8 18 11 Malignant neoplasm, lung - - - - - - - - - - - - 2 1 14 1 12 — 5 — 33 2 35 12 Malignant neoplasm, breast — 1 — — — 1 — 5 — 2 — 2 — 11 11 13 Malignant neoplasm, uterus — — — — — 1 — — — 1 — — — — — 2 2 14 Other Malignant and lymphatic neoplasm - - - - - - - - - - 4 1 — 4 7 1 7 6 4 6 22 22 44 15 Leukaemia, aleukarmia - - - - - - - - - - - - - - - - 1 - - - 1 — 1 16 Diaetes - - - - - - - - - - 1 - - - - - - - 1 1 2 2 4 17 Vascular lesions of nervous system - - - - - 1 - - - - 1 - - - 10 4 8 11 19 19 38 35 73 18 Coronary disease, angina - - - - - - - - 2 — 1 — 2 1 13 8 20 11 17 13 55 33 88 19 Hypertension with heart disease — — — — — — 1 — 2 — 1 — 4 — 4 20 Other heart disease - - - - - - - - - - 1 - - 3 8 6 6 6 19 32 34 47 81 21 Other circulatory disease - - - - - - - - - - 1 — 3 1 2 1 6 6 9 7 21 15 36 22 Influenza - - _ — — — — — — — — 2 — — — 2 2 23 Pncumonia 1 - - - - - - - - - - - - - 2 1 4 5 10 10 17 16 33 24 Bronchitis - - - - - - - 1 - - - - - - 4 1 5 — 12 1 21 3 24 25 Other diseases of respiratory system ... - - - - - - - 1 - - - - - - - - - - - 1 2 2 4 26 Ulcer of stomach and duodenum - - - - - - - - - - - - - - - - - - - 1 1 1 2 27 Gastritis, enteritis and diarrhoea - - - - - - - - - - - - - - - - - - - - - 3 3 28 Nephritis and nephrosis - - - - - - - - - - - - - - - - - - - 1 — 3 i 29 Hyperplasia of prostate - - - - - - - - - - - - - - - - - - - - - - 1 30 Pregnancy, childbirth, abortion - - - - - - - - - - - - - - - - - - - - - 1 1 31 Congenital malformations 3 1 - - - - - - - - - - - - - - - - - - 4 2 6 32 other kefined and ill-defined disecases 3 4 - - 2 - - - - - - - 3 4 2 3 6 3 7 17 23 31 54 33 Motor vehicle accidents - - - - - - - - - - - - - - - - - - - - 8 — 8 34 All other accidents 1 1 - - - - - - - - - - 2 1 — — — 1 — 1 3 5 8 35 Suicide - - - - - - - - - - 1 — 3 1 1 — — 2 1 — 6 3 9 36 Homicide and operations of war - - - - - - - - - - - - - - - - - - - - - - - Section B—Health Services. Laboratory Facilities The Public Analyst appointed by the Council is Mr. D. D. Moir, whose laboratories are at 16, Southwark Street, S.E.I. To him are sent samples of food, drugs and water for examination under the Food and Drugs Act and all relevant Acts, Regulations and Orders. The bacteriological examinations for food poisoning and of milk, water and ice cream are carried out at the Epsom Public Health Laboratory. For the routine laboratory examination of clinical material in respect of infectious disease, use is made of the Hospital Laboratory Services mainly at St. Helier Hospital. The following examinations were made during the year:— Faeces Specimens 28 Water (Public Supply): For chemical analysis 2 For bacteriological examination 5 Water (Swimming Baths): For bacteriological examinations 14 Food and Drugs: Analysis 234 Bacteriological examination of milk 186 Bacteriological examination of ice cream 98 Bacteriological examination of other foods 2 Vaccination and Immunisation The responsibility for schemes of vaccination and immunisation rests on the County Council in accordance with section 26 of the National Health Service Act. The diseases against which this protective treatment is provided by the County Council are smallpox, diphtheria, whooping cough, tetanus, poliomyelitis and tuberculosis. By arrangement with the district councils, the schemes in respect of the first four mentioned infections is directed locally by the District Medical Officers of Health. The scheme in respect of poliomyelitis is in the hands of the Divisional Medical Officers, whilst B.C.G. vaccination against tuberculosis is carried out as part of the School Health Service. Protection against yellow fever can be had on payment at a special centre established in Kingston-on-Thames. Vaccination against other tropical diseases can be obtained at the following centres:— The London School of Tropical Medicine, St. Mary's Hospital, Paddington. B.O.A.C. Airways House, Victoria, S.W.I. 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 2.15—4 p.m. Maternity Clinic Fridays 2—2.15 p.m. Toddler Clinic 1st and 3rd Thurs. 2—4 p.m. The Mount Centre, Coulsdon: 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. Wednesdays 2—4 p.m. Rochester Road Centre 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 school children 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 All dwellings, except for approximately 200 in the northern end of the district which are supplied by the Metropolitan Water Board, are provided with a mains supply of water from the Sutton District Water Company. The Company's source of supply are wells in the chalk sited at Sutton, Cheam and Woodmansterne. This can be augmented, if the need arises, by water from the Metropolitan Water Board, the East Surrey Water Company and the Epsom and Ewell Corporation's undertaking. The following establishments have their own private wells mainly for industrial use. The St. Helier Hospital, Muschamp Road Laundry, West Street Laundry, St. Philomena's School and Convent, British Industrial Solvents Ltd. Every structurally separate dwelling has a piped supply direct to the dwelling and there are no stand pipes. The finished water is not 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. Both quantity and quality were satisfactory throughout the area. To meet the growing needs of the supply area, the Company is taking the necessary powers under the Water Act, 1945, to increase their abstraction from the Cheam wells and a public inquiry has been held. The district council having been satisfied as to certain safeguards, withdrew their objection to the proposal. The following information relating to the tests carried out at the Company's own laboratory are supplied by courtesy of the Company. Total No. of Bacteriological Examinations Total No. of full Chemical Analyses No. and % of samples showing ColiAerogens in 100 ml. (Excluding B.Coli 1) No. and % of samples showing B.Coli present in 100 ml. of sample (Typel) Total No. ColiAero genes Organisms in 100 ml. of sample No. % No. % Sutton Raw 311 53 6 1.9 16 5.2 22 Sutton Finished 311 12 3 1.0 2 0.6 5 Woodmansterne Raw 311 53 1 0.3 Nil Nil 1 Woodmansterne Finished 310 12 1 0.3 1 0.3 2 Cheam Raw 311 53 9 2.9 21 7.0 30 Reservoir 308 12 3 1.0 4 1.1 7 District 294 12 11 3.7 Nil Nil 11 Total 2,156 207 34 44 78 20 Twenty-four reports from a firm of independent chemists employed by the Company on samples of the finished water pumped into supply from the Sutton and Woodmansterne stations, 12 from each were all satisfactory. The public health departments of the five local authorities in the supply area took 13 chemical and 27 bacteriological samples of water as it reached the consumer and these too were also satisfactory. The following is the report on a representative sample taken in the Urban District:— (a) Physical Examination Colour Faint blue Taste normal Appearance Bright and clear Smell none Electric Conductivity at 20°C 300 Units pH 7.6 (b) Chemical Examination in parts per million Total solid residue (dried at 180°C.) 235 Chlorine present as chloride 19.5 Ammonia, free 0.00 Ammonia, Albuminoid 0.00 Nitrate nitrogen 13.7 Nitrite nitrogen 0.02 Oxygen absorbed from (a) in 4 hours 0.08 permanganate solution (b) in 15 mins. - Hardness, as CaCOa—Temporary 67 Permanent 69 Total 136 Alkalinity, as CaC03 67 Free carbon dioxide, as COa - Iron none Other metals none Residual chlorine 0.08 (c) Bacteriological Examination Number of colonies developing per millilitre of water:— on agar in 2 days at 37°C 0 on agar in 3 days at 22°C.0 Bacteria of indication enumeration:— Organisms of the coliform group 0 in 100 ml. Streptococci 0 do. CI. welchii 0 do. Remarks This water is attractive in appearance, of good organic purity and is free from contaminating metals. It is of moderate hardness and salinity. The residual chlorine indicates that adequate precautionery treatment is being maintained. The bacteriological condition of the water is excellent. As judged by this examination, the water is pure and wholesome and is suitable for the public supply. Drainage and Sewerage The sewage of the district is pumped to the treatment works of the Croydon Corporation in Beddington. Surface drainage in the southern part of the district is mainly by soakaways into the chalk, in the northern part it is drained to the River Wandle. In addition to the routine maintenance, clearing and inspection of the sewers and soakaways by the Engineer's Department, the following modifications were made during the year:— A short length of high level soil sewer between numbers 93 and 97, Woodmansterne Road was relayed. 21 New soakaways were constructed in conjunction with the road widening scheme at Little Woodcote Lane and Woodmansterne Lane. A damaged section of the 21 in. rising main sewer at Mullards Works was removed and replaced following a fracture. Three hundred and two drainage obstructions affecting 861 houses were dealt with. Rivers and Streams Maintenance work on the River Wandle and its expansions is the responsibility of the County Council. Work on the improvement scheme for the River referred to in previous reports has progressed upwards from the County boundary and it is anticipated will be undertaken in the urban district during 1962 and 1963. Closet Accommodation All dwellings have w.c.s connected to the sewers except 15 which are separately drained to cesspools. Public Cleansing There is a weekly collection of refuse which is disposed of by incineration at the Council's 6 cell destructor. Clinker and screenings were tipped at the tip in Carshalton Road, Woodmansterne. Existing arrangements for the salvage of saleable waste such as paper, metals, bottles and jars were continued. 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 1073 complaints as follows:— Accumulations 12 Animals so kept 7 Burst pipes 3 Clean Air Act—Contraventions 15 Dampness 12 Drainage defects 30 Drains obstructed 342 Dustbins 11 Food contaminated 12 Food unsound 69 General defective conditions 26 Insects and Pests 138 Milk—Contaminated—Dirty Bottles 1 Miscellaneous 30 Obnoxious effluvia 26 Overcrowding 4 Refuse collection 13 Rivers 1 Rodents 299 Roofs, defective 6 Sewer obstructions 9 Sink waste pipes 2 Verminous premises 5 1,073 22 Twelve thousand four hundred and forty-five visits of inspection and re-inspection were made for the purposes set out below:— Clean Air Act 2,148 Employment Agencies 3 Factories (Mechanical Power) (incl. Laundries 31) 214 Factories (Non-Mechanical Power) 35 Factories (Building Sites) 27 Food and Drugs (incl. Food Byelaws) 1,183 Food Poisoning Enquiries 4 Food premises: Bakehouses 32 Bakers and confectioners 62 Butchers 213 Canteens 15 Canteens—School 15 Chemists 24 Confectioners (sweets only) 62 Fishmongers 85 General Stores 45 Greengrocers and fruiterers 146 Grocers 303 Licensed premises with catering facilities 11 Licensed premises without catering facilities 25 Milk storage depots 23 Ice Cream Vehicles 5 Restaurants and cafes 124 Stalls, food 240 Tea packer 3 Vehicles, food 26 1,459 Hairdressers 43 House drains tested 43 Housing Act 154 Heating Appliances (Fireguards) Act -3 Housing Land Charges 919 Infectious Disease Premises 54 Insect Pests 271 Merchandise Marks Act 241 Offices 7 Outworkers Premis 161 Pet Animals Act 12 Piggeries 15 Premises re cesspools 10 Public Health Act (Houses) 2,328 Public Health Act re-inspections 1,735 Rent Act 9 Rodents 310 Rag Flock and Other Filling Materials Act 2 Schools 13 Shops 968 Urinals 54 Water Sampling 20 12,445 Three hundred and three informal notices were served concerning the following matters:— Accumulations and deposits 30 Animals so kept 3 Clean Air Act 6 Drainage defects 63 Dustbins 8 Factories Act 8 Food and Drugs Act (incl. Food Byelaws) 65 23 Food contaminated 11 General defective conditions 63 Miscellaneous 9 Overcrowding 5 Pet Animals Act 1 Rodents 5 Shops Act 23 Verminous premises 1 Water supply 2 303 Twenty-nine formal notices were served by authority of the Council under the following Acts:— Public Health Act, 1936 Section 39 5 „ „ „ „ Section 56 11 „ „ „ „ Section 75 1 „ „ „ „ Section 93 10 Factories Act, 1937 1 Prevention of Damage by Pests Act 1949 1 29 As a result of investigations made and notices served, the following work was carried out:— Accumulations removed 20 Ceilings cleansed 1 Ceiling plaster repaired and/or made good 1 Chimney brickwork and pots repaired or renewed 3 Damp conditions remedied 5 Disinfestations 102 Doors and frames repaired, including locks and fasteners 2 Drainage repaired and/or reconstructed 8 houses (48 ft. of drain laid) Drainage inspection chambers repaired 15 inspection chamber covers renewed 8 stoppers or caps refixed and/or renewed 1 drains tested 15 drains cleared (affecting 861 houses) 302 drains sealed off 42 waste gullies repaired, renewed or provided 3 waste pipes, repaired, renewed or provided 3 cesspools emptied cesspools abolished 1 Dustbins provided 5 Fences and/or gates repaired or renewed 1 Fireplaces ranges or stoves repaired or renewed Floors renewed or repaired 4 Glazing and putty renewed Paving repaired and/or made level 11 Roofs repaired and made weatherproof 12 downpipe, guttering repaired and/or renewed 10 Stairs or steps repaired, renewed or made level 4 Surface water drainage repaired and made to work properly Surface water drainage provided 11 Walls rendered or rendering repaired 2 replastered and/or repaired 4 cleansed and redecorated 4 2 Water supply renewals or repairs 2 W.C. seats repaired, renewed or provided 1 flushing apparatus repaired or renewed 7 Windows repaired and/or renewed 8 Disinfection Fifty-six rooms and 434 library books were disinfected. One lot of bedding was sterilised and three lots destroyed. Vermin Control Persons. The instances of personal infestation with vermin have now for a number of years, been gratifyingly few. The Council's Cleansing Station in Rochester Road which was used extensively during the war for the treatment of scabies and pediculosis, is now only used occasionally for the odd family which is so affected. The year 1961 was the first in which no cases were dealt with at the Cleansing Station since it was opened. Premises. During the year 102 premises were treated for the destruction of vermin and insect pests as follows:— Property Treated by C.U.D.C. Property Treated Infestation C.U.D.C. Property s.c.c. Property L.C.C. Property Privately Owned Property By L.C.C. By Owners Total Ants — 1 - — 1 Bugs 2 - 1 1 - — 4 Fleas — - — 1 - — 1 Flies — 9 — 1 - — 10 Mosquitoes 1 — — — - — 1 Wasps 2 — 4 75 - — 85 5 9 5 83 — 102 Clean Air Act, 1956 The Council's programme drawn up in February 1960 is designed to create smokeless zones at the rate of one per year until the whole district is covered in a period of 10 years. The first Smoke Control Order became operative on the 1st October, 1961. This involved work of fireplace adaptations at 229 Council houses and up to the end of 1961 489 grant payments were made for the same purpose in respect of privately owned dwellings. A number of grants are still outstanding. In July, 1961 the Council made their second Smoke Control Order to come into operation on the 1st October, 1962. The limits of this area were as set out in the report for 1960. The survey of the second area was completed during the year and work was commenced on the survey of the third area which adjoins the second and is bounded on the north by the district boundary with the Merton and Morden Urban District, west of the intersection of Green Wrythe Lane and Bishopsford Road, on the west by the boundary with the Borough of Sutton & Cheam as far south as Westminster Road, on the south by a line along the rear of the houses on the north side of Westminster Road along the centre of Thornton Road to its junction 25 with Green Wrythe Lane and on the east by the centre of Green Wrythe Lane from its intersection with Thornton Road to the northern boundary of the district in Bishopsford Road. Fifteen complaints were received and dealt with during the year. The apparatus installed by the Council for measuring atmospheric pollution gave the following results:— Deposit Gauges. Gauge Total Solids. Tons per sq. mile Total Rainfall (in inches) Highest Monthly Reading Lowest Monthly Reading Average Monthly Reading B 20.64 12.08 5.88 9.15 (Winchcombe Rd.) C 23.32 14.37 7.01 10.36 (Buckhurst Ave.) Gauge B Gauge C Month Rainfall in ins. Total Solids Tons per sq. mile) Rainfall in ins. Total Solids Tons( per sq. mile) January 2.61 11.12 2.64 10.33 February 2.23 9.32 2.31 8.76 March 0.36 7.24 0.59 7.01 April 1.22 7.24 1.26 10.06 May 0.95 5.88 1.34 8.15 June 0.83 10.64 1.54 14.37 July 1.06 6.80 1.26 12.05 August 1.77 9.93 2.21 13.46 September 1.77 8.37 2.01 7.96 October 2.88 10.44 2.84 9.74 November 2.28 10.72 2.44 10.31 December 2.68 12.08 2.88 12.10 Total 20.64 109.78 23.32 124.30 Smoke and Atmospheric Sulphur Dioxide. Month Smoke S.O.2 Microgrammes per cubic meter Microgrammes per cubic meter Highest Daily Reading Lowest Daily Reading Average Daily Reading Highest Daily Reading Lowest Daily Reading Average Daily Reading January 183 12 55 678 36 149 February 144 12 54 171 35 81 March 315 55 111 94 25 56 April 128 11 37 414 36 127 May 69 7 24 196 43 88 June 92 17 38 203 14 60 July 21 1 7 58 14 30 August 20 1 4 48 7 16 September 35 1 11 122 8 29 October 193 1 35 78 8 33 November 190 7 66 122 19 57 December 480 10 157 555 41 166 Whole Year 480 1 50 678 7 74 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 five hundred and eighty-one visits were made by the Rodent Operatives concerning 692 properties and 340 rat and mouse infestations were found. Of that number 302 were found in private premises, 34 in business premises and 4 in Council premises. The sewers in the district were bait tested during the month of May and as no evidence of rat infestation was found the usual maintenance treatments were unnecessary. The results of maintenance treatments since 1958 are shown in the following table:— May Treatment November Treatment 1958 1959 1960 1961 1958 1959 1960 1961 Manholes baited 198 188 161 190 Manholes in which takes of prebait were recorded 80 7 4 — 51 — — Percentage of manholes showing infestations 40.4 3.7 2.5 — 26.8 — — Percentage in relation to total manholes in district 7.1 0.6 0.3 — 4.5 — — For the last two years the usual November treatment was omitted and only the May treatments were carried out, owing to the reduction in infestation. The year 1961 was the first since the scheme began in 1946 after consultation with the Ministry of Agriculture, Fisheries and Food when no evidence of sewer infestation was discovered at either of the twice yearly testings. Swimming Baths There are two swimming baths in the district; a public one in the Highfield Hall owned by the Council and the other sited in the grounds of Barrow Hedges School and forms part of the school activities. The Council bath measures 45 ft. by 22 ft. and varies in depth from 3 ft. to 6 ft. Water is supplied to it from the mains and is subjected to precipitation, filtration and chlorination on the "break point" principle. In order to avoid overloading, the user is strictly controlled. Eight samples of water were examined from the Highfield Baths and all were entirely satisfactory. Three out of 6 samples taken from the Barrow Hedges School Bath showed that the dosage of chlorination was inadequate. At one period during the summer the chlorination plant developed a fault which was no doubt the cause of the unsatisfactory samples. Bathing was suspended until the plant had received satisfactory attention. Offices The Offices Act 1960 came into operation on the 1st January, 1962. The main provision, that of Regulations made by the Secretary of State to be made under the Act, are still awaited. 27 Seven inspections under existing powers were made during the year, but no action was found necessary. Factories, Workplaces and Outworkers The premises in the district coming within the scope of the Factories Act and included on the registers of such buildings were as fo.lows:— Employees Males Females Total Premises Factories— with mechanical power 1003 603 1606 100 without mechanical power 38 1 39 9 Workplaces— with mechanical power 13 3 16 13 without mechanical power 24 14 38 27 1078 621 1699 149 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 of Premises Number on Register Inspections Written Notices Occupiers Prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 9 35 4 - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 100 214 4 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) • 11 27 — Total 120 276 8 — 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  Number of cases in which defects were found Number of cases in which prosecutions were instituted Premises Found Remedied To H.M. By H.M. In (1) spector spector (2) (3) (4) (5) (6) Want of cleanliness _ Overcrowding — — - — Unreasonable temperature — — - — Ineffective ventilation - — Defective drainage of floors — — - — Sanitary Conveniences— - (a) Insufficient 1 1 - — (6) Unsuitable or defective 7 7 - — (c) Not separate for sexes — — - — Other offences against the Act (not including offences relating to Outwork) — TOTAL 8 8 — — — Outwork (Sections 110 and 111) Section 110 Section 111 Nature of Works 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 No. of instances of work in unwhole some premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing Apparel— Making, etc. 26 - - — - — Boxes (cardboard) 5 - - — - — Christmas Crackers 9 Lampshades 6 - - — Paper Hats 3 _ - — Toys (Stuffed) 1 - Umbrellas 1 - — — - — Total 51 — — — — — Employment Agencies The one employment agency in the district was visited and found to be satisfactory. Shops Act, 1950 The Public Health Inspectors act as Inspectors for purposes of the Shops Act. There are 500 shops on the register and 2878 visits of inspection were made during the year. Opportunity was taken at a number of these visits to inspect for other statutory purposes, such as the Food and Drugs Act. 29 Preliminary notices were served with regard to twenty-three infringements of the statutory requirements, sixteen for failure to exhibit appropriate notices, four for sanitary accommodation and three for Sunday Trading. Nineteen notices have been complied with (including ten notices outstanding at 31.12.60). Heating Appliances (Fireguards) Regulations, 1953 Three inspections were made under the Act. One informal notice was served and complied with. Merchandise Marks Act, 1926 Five Public Health Inspectors are appointed as authorised officers for purposes of this Act. A great deal of this work is done among 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 Others 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. Two samples of coir fibre were taken and proved to be satisfactory. The prescribed Analysts are—The Chiltern Research Laboratories Ltd., of 23, West Wycombe Road, High Wycombe, Bucks. Establishments for Massage and Special Treatment The number of premises licensed under Part IV of the Surrey County Council Act, 1931 was 6, of which 3 were for the practise of chiropody, two for massage etc. and one for electrolysis. The last named business was discontinued during the year. All were visited and found to be conducted satisfactorily. National Assistance Acts, 1948—1951 These enactments provide inter alia for the removal to a place of care of any person who by reason of age or infirmity is living in insanitary conditions and is for this reason a risk to their own or other people's health. There was no occasion to use this power during the year. The chief difficulty, as stated in earlier reports, is not to compel individuals to enter homes, but to find sufficient accommodation for those who are in urgent need of it. Section 50 There was no necessity, during the year, for the Council to arrange for the burial of any person for whom no other arrangements were being made. 30 Disposal of the Dead During 1961, 360 interments of which 140 were from Carshalton, took place at the cemetery of the Carshalton and Merton & Morden Joint Burial Board, which is situated in Lower Morden. The North East Surrey Crematorium Board representing the Councils of Battersea, Sutton & Cheam, Carshalton and Merton & Morden operates a crematorium in the Battersea Burial Ground which adjoins the cemetery of the Joint Burial Board. During the year 1028 cremations took place of which 51 were from the Carshalton district. The Council maintains a mortuary in Mill Lane which is equipped with refrigeration storage and full facilities for post mortem examination. The number of bodies, on all of which autopsies were performed, admitted during the year was as follows:— Ambulance removals 28 By the police 1 Via local hospitals 10 From Carshalton homes 52 From Beddington & Wallington 35 From Coulsdon & Purley 47 From other districts 13 186 The Council has a financial arrangement with the Beddington, Wallington and Coulsdon and Purley Councils for the reception of bodies from those areas. 31 Section D—Housing New Houses Dwellings whose erection was completed during the year totalled 78 as follows:— Private dwellings 42 Council Flats 8 Council Bungalows 8 Council Maisonettes 20 The Council schemes in various stages of preparation were as follows:— Site No. Site Type of Dwelling No. 36 Culvers House Houses 4 Flats 16 Maisonettes 16 38 Denmark Road Flats 22 Maisonettes 22 42 Wandle Mead Bungalows 26 Flats 2 Shop 1 Meeting Room 1 Hostel for Aged 1 1 Culvers Avenue Bungalows 22 Flats 37 Houses 20 Maisonettes 92 43 St. John's Road Houses 7 Bungalows 10 Council's Housing Scheme The dwellings in the ownership of the Council at the end of the year were as follows:— Pre-War Houses 515 Post-War Houses, Flats & Maisonettes 721 Temporary Bungalows 102 Houses taken over under S.D.A.A. & H.A. 25 Houses purchased (units of accommodation) 29 Accommodation in Parks, Offices, etc. (units) 18 1,410 All requisitioned properties have been released. The applications for Council tenancies are divided into three lists A, B & 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 1961 the "A" List totalled 58, the "B" List 55 and the "C" List 492, in addition to which there were 283 applications unclassified since they were of less than three years duration. 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) 2,535 (b) Number of inspections made for the purpose 4,270 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 to 1932 — (b) Number of inspections made for the purpose - (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation - (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 120 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 1960) 72 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 22 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By Owners 19 (b) By Local Authority - 4. Housing Act 1957—Part IV (Overcrowding) (a) (1) Number of dwelling houses overcrowded a. the end of the year 12 (2) Number of families dwelling therein 18 (3) Equivalent number of adults dwelling therein 81 33 (b) Number of new cases reported during the year 4 (c) (1) Number of cases of overcrowding relieved during the year 10 (2) Number of persons concerned in such cases 60½ (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 4 cases of overcrowding were found to exist and 10 cases were remedied, leaving 12 dwellings with 81 equivalent adults in occupation overcrowded at the year end. Of the 4 new instances of overcrowding, three familes were found to be sharing accommodation with relatives. The 10 cases of overcrowding remedied during the year were due to:— Provision of alternative accommodation by:— C.U.D.C 3 L.C.C 2 Left the district 1 Removal of one or more occupants 4 Of the 12 dwellings remaining overcrowded at the end of the year 6 are owned by the L.C.C., 3 by Carshalton Urban District Council and 3 are privately owned. The distribution of the cases of overcrowding at the beginning and end of the year was as follows:— Ward Dwellings overcrowded at 31.12.60 Dwellings found overcrowded during 1961 Dwellings decrowded during 1961 Dwellings remaining overcrowded at 31.12.61 Overcrowded cases remedied during 1961 Formal Action Informal Action Total St. Helier North 4 2 2 1 1 2 St. Helier South 3 1 3 1 2 1 3 St. Helier West 3 2 2 3 1 1 2 North-East 4 — 2 2 1 1 2 North-West — — — — — — — Central 2 1 1 2 — 1 1 South-West — — — — — — — South-East 2 — — 2 — — — 18 4 10 12 5 5 10 It must be remembered that these figures represent the cases which come to the notice of the department in the course of daily activities. They do not purport to give the exact position in respect of overcrowding, but as there has been no variation in the method of collecting them, they are useful in indicating the trend of overcrowding. 34 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 1952 79 123 1957 10 46 1953 53 112 1958 14 33 1954 49 105 1959 12 27 1955 26 73 1960 5 18 1956 27 63 1961 4 12 35 Slum Clearance and Demolition The rehousing of the tenants from Clearance Area No. 14 St. John's Road involving 30 houses was completed during the year and the houses demolished. The Minister confirmed Clearance Order No. 17 Mill Lane in respect of 8 houses and Clearance Order No. 24 Levetts Rents in respect of 8 houses referred to in the Report for 1960. By the end of the year all families from these two areas had been rehoused and the properties demolished. In July the Minister confirmed the Compulsory Purchase Order in respect of Area No. 10 Orchard Hill comprising 11 houses, but the rehousing will not take place until 1962. 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 2 (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 graph 5 of the First Schedule 2 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schdule Nil (6) Number of Certificates issued Nil Part II—Application for Cancellation of Certificates. (7) Applications by landlords to Local Authority for cancella tion 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 Section E-Inspection and Supervision of Food Milk Supply The whole of Surrey is now an attested area, consequently Carshalton is a specified area for the purposes of the Milk (Special Designations) (Specified Areas) Order, 1951 and all milk sold in the district must be "designated" milk. Milk Distributors The number of Milk Distributors registered under the Milk and Dairies (General) Regulations 1959 is 13. Designated licences issued under the Milk (Special Designations) Regulations 1960 during the year were as follows:— Designation Number of Distributors Holding Licences No. of Licences in force on 31.12.61 Dealers (Pre-packed Milk) Licences Sterilised 12 20 Pasteurised 8 16 Tuberculin Tested 7 15 Bacteriological Examination of Milk One hundred and eighty-six 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 No. of samples Methylene blue test Phosphatase Test Turbidity Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory U isfactory Pasteurised 94 94 — 94 — — — T.T. Pasteurised 82 82 — 82 — — — sterilised 10 — — — — 10 — 186 176 — 176 — 10 — 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. 36 Qualitative Analysis The number of milk samples submitted to the public analyst for chemical analysis was 189 of which 24 were "Channel Island" milks. The latter are required to have 4% fat as against the legal minimum of 3% for ordinary milk. All complied with the prescribed standards. The average fat and non fatty solids content of the 24 "Channel Island" and "South Devon" milks was 4.4% and 8.91% respectively. That of the 165 ordinary milks 3.57% and 8.66%. Ice Cream Ninety-eight samples of ice cream were examined for bacteriological purity and as in the past three years all were found to be of the highest grade—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 — 1961 98 98 - — — Twelve samples of ice cream were analysed by the Public Analyst for quality and were reported as satisfactory. Ice Cream (Heat-treatment, etc.) Regulations, 1959 There are no manufacturers of Ice Cream in the district all the registered retailers drawing their supplies from reputed manufacturers outside the district. All retailers are provided with refrigerator cabinets which maintain a temperature well below 28°F. in accordance with the regulations. Bacteriological Examination of Other Substances One sample of Meat Pudding and one sample of Creamed Rice were sent to the bacteriologist for examination and found to be satisfactory. 37 Meat There are no slaughterhouses in the district hence supervision of this commodity is restricted to storage and exposure for sale. The quantity of meat disposed of as unfit for consumption during the year was 2604 lbs. 7 ozs. Analyses of Food and Drugs The samples submitted to the Public Analyst for analysis under the Food and Drugs Act and examination under related enactment, were as follows:— Article No. Adulterated or otherwise wise ireegular Article No. Adulterated or otherwise wise irregular Butter Flour Mixture 1 Marzipan 1 Butter 3 Milk 165 Chandy 1 Milk, Channel Island 24 Cheese Spread 1 Mincemeat 1 Chili Con Carne 1 Minced Meat 1 Chocolate Spread 1 Minced Meat Loaf 1 Chop Suey with Chicken 1 1 Mineral Water 1 Christmas Pudding 1 Nutmegs, ground 1 Coffee, French 1 Oil, Cooking 1 Colouring 1 Orange Drink Confectionery, Sugar 5 Paste, Chicken 1 Cordial 2 Pastry, Puff 1 Cornflour 2 Peanut Butter 1 Corned Beef 1 Pepper, White 1 Corn Oil 1 Pork Luncheon Meat 1 Crab 1 Pork Pie 1 Cream 1 Potato Salad 1 Creamed Rice 2 Rhubarb in Syrup 1 Curry Indian Prawns 1 Salmon 1 Curried Chicken with Saveloys 1 mushrooms 1 Sausage, Beef 2 Dripping 2 Sausage, Beef, preserved 2 Fish Cakes 1 Sausage Meat, Pork 1 Fruit Liquid Pectin 1 Soup 4 Gin 3 Steak & Kidney Pie 1 Glucodin 1 Stuffing, Sage & Onion 1 Ground Nut Oil 2 Suet, Beef 1 Hamburger 1 Summerade Crystals 1 Herring Fillets in Sweet Corn Tomato Sauce 1 Tomato Puree 1 Honey 2 Tripe 1 1 Ice Cream 10 Vegetable Salad 1 Ice Cream Dairy 2 Vinegar, Malt 1 Ice Cream Ready Mix ... 1 1 Walnuts, Pickled 1 Instant Coffee 2 Whisky 3 Jam, Plum 1 Lard 2 Lemon Juice 1 Liquid Paraffin 1 The three samples reported as being irregular were as follows:— Chop Suey with Chicken. One of the ingredients of this article—mono sodium glutamate—was described on the label as M.S.G. and this abbreviated description is not an adequate description for the purpose of the Labelling of Food Order, 1953. 38 The manufacturers altered the label to comply with the Order and no further action was taken. Ready Mix Ice Cream. The label indicated that a "vegetable stabiliser" was used in the manufacture. This was an inadequate description. The manufacturers reprinted the labels on which the specific name of the stabiliser—sodium alginate—was declared. Tripe. This was a sample which contained 0.8% of sodium carbonate used in the processing of the tripe. This was deemed to be excessive as other samples of this commodity taken in the district contained less than 0.1 % of soda. Legal proceedings were taken. The vendor was convicted and fined £10 with £24 5s. 0d. costs. Section 9—Sale of Food Unfit for Human Consumption The following complaints of alleged foreign matter in food were received:— Bandage in Bread Mould on Apple Turnover Dark substance in Bread Mould on Steak & Kidney Pie (2) Glass in Bread Mould on Pork Pie Plastic substance in Bread Stones in Luncheon Meat Silver paper in Bread Glass in Rice Metal in Biscuit Legal proceedings were taken in respect of two complaints—Stones in Luncheon Meat and Glass in Rice. The Vendors in both cases were fined £50 and costs. Appropriate warnings were given where circumstances justified such action in the other cases. Unsound Food The following quantities of food found to be unsound, diseased or unwholesome and unfit for human food were surrendered and destroyed or so disposed of as to prevent them from being used for human food:— lbs. ozs. lbs. ozs. Cake 45 10 Milk 3 2 Cream 2 8 Meat 2604 7 Chicken Curry — 8 Pudding 4 3 Cheese 1 8 Rice 2 0 Coffee — 12 Soup 1 8 Fish 143 4 Spaghetti — 14 Fruit 163 1 Vegetables 178 12 Jam 58 8 Total Weight 1 ton, 8 cwts. 2 qrs. 18 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 shown in Table 9. 39 40 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 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 Accumulations removed Bakehouses 3 32 - - - - - - - - - - - - - - Bakers and Confectioners 19 4 62 - - - - - - - - - - - - - - Butchers 35 32 213 - - - 1 1 1 2 1 - - - - - 1 Canteens 22 - 30 - - - - - - - - - - - - - - Chemists 17 1 24 - - - - - - - - - - - - - - Confectioners (Sweets only) 69 55 62 - 2 - - - 2 - 1 - - - - - - Fishmongers 14 7 85 1 1 - - 1 1 - - - - - - - 1 General Stores 3 3 45 - - - - - - - - - - - - - - Greengrocers and Fruiterers 39 5 146 - - - - - - - - - - - - - - Grocers (including corn chandlers) 77 30 306 1 3 - 4 1 4 4 5 - - - 1 1 - Licensed premises (with catering facilities) 5 2 11 - - - - - - - - - - - - - - Licensed premises (without catering facilities) 20 — 25 - - - - - - - - - - - - - - Milk Storage Depots 3 — 23 - - - - - - - - - - - - - - Restaurants and Cafes 22 19 124 - 1 - - - - - 1 - 1 - - 1 1 Stalls, food variable - 240 - - - - - - - - - - - - - - Vehicles, food variable - 26 - - - - - - - - - - - - - - Vehicles, Ice cream variable - 5 - - - - - - - - - - - - - - 158 1459 2 7 - 5 3 8 6 8 - 1 - 1 2 3 Section F—Prevalence of and Control over Infectious and other Diseases The district has within its boundaries three General Hospitals two of which, namely Queen Mary's Hospital for Children and the St. Helier Hospital, are particularly large institutions which are part of the hospital services of the South-West Metropolitan Hospital Region. Many of the cases notified from these hospitals are admitted there from other districts already suffering from a notifiable disease, but not diagnosed until after admission. In order, therefore, to give a clearer picture of the prevalence of infectious disease in the resident population of the district, separate figures are given in this Section which exclude cases of hospital patients who are not residents of the district. The figures given are after correction for original errors in diagnosis. Notification The following diseases are notifiable in the district:— Smallpox Cholera Diphtheria Membranous Group Erysipelas Scarlatina or Scarlet Fever Measles Whooping Cough Anthrax Tuberculosis Dysentery Acute Primary Pneumonia Acute Influenzal Pneumonia Acute Poliomyelitis Acute Polioencephalitis Typhus Fever Typhoid Fever Enteric Fever Relapsing or Continued Fever Meningococcal Infection Ophthalmia Neonatorum Puerperal Pyrexia Malaria Food Poisoning and suspected food poisoning Leprosy Smallpox No case of smallpox was notified in the area. Vaccination against Smallpox. Vaccination against smallpox is provided by the County Council in accordance with their Scheme formulated under Section 26 of the National Health Service Act. By arrangement with the District Councils it is directed locally by the District Medical Officers. The usual practice is to endeavour to secure the inoculation of infants about the third or fourth month of life. Since the repeal of the Vaccination Acts the service is optional, but for many years the percentage of children under 5 years of age successfully vaccinated has been maintained at not far short of 60% —a figure which compares very favourably with the national experience. With the more frequent importations of smallpox into this country in recent months, there has naturally been a keener appreciation of the benefits of this protection procedure against what is a major killing infection, with the result that the vaccination rate in pre school children has now risen to over 60%. 41 The number of persons recorded as having received successful vaccination during the year was as follows:— Age at 31st December, 1961 i.e. Born in Under 1 yr. 1961 1-4 yrs. 1957-60 5—14 yrs. 1947-56 15 yrs. & over 1946 & earlier Total Primary Vaccinations— By Private Practitioners 82 80 25 29 216 At Clinics 168 164 5 2 339 250 244 30 31 555 Revaccinations— By Private Practitioners — 4 11 74 89 At Clinics — — — 3 3 — 4 11 77 92 In addition, the following unsuccessful attempts at vaccination were made:— Age at 31st December, 1961 i.e. Born in Under 1 yr. 1961 1-4 yrs. 1957-60 5—14 yrs. 1947-56 15 yrs. & over 1946 & earlier Total Primary 1 3 - 1 5 Revaccination — 1 2 15 18 1 4 2 16 23 The estimated number of children under five years of age vaccinated at the end of 1961 was nearly 2,000 out of an estimated total in this age group of 3,400. Enteric Fever For the eighth year in succession there was no case of typhoid or para typhoid fever. Dysentery One or more outbreaks of mild dysentery due to infection by the Sonne organism have been fairly frequent annual events in recent years. It is therefore satisfying to report that no such outbreak occurred in 1961. Only two cases of dysentery were notified, two isolated instances, neither of which were found to have any associated cases. Neither of these two cases were due to the Sonne organism. One was caused by Sh Flexner Type III a more severe type of infection and an unusual one these days in this country. It was a baby of 2½ who had recently arrived in this country from Brazil where he had symptoms before leaving. There is little doubt that the infection was contracted before arriving here. He recovered after a month in hospital. The other case in a child of 5 years was more of the nature of food poisoning, the infection, that of S. Typhimurium being one which is commonly associated with food poisoning. She too recovered after a relatively short illness. 42 Scarlet Fever Reference has been made in recent reports to the decline in the yearly recorded cases of scarlet fever. This type of infection is one which responds very readily to the newer drugs and antibiotics coupled with which is the fact that the infection for many years now has been generally of a very mild nature. Not only is there a real reduction in the incidence of this disease but doubtless much of it escapes detection because of its mildness and fails to be notified. These considerations are largely responsible for the fact that in 1961 only 46 cases were notified, the second lowest recorded total in this district. Only 11 cases were removed to hospital, the remainder being treated at home. TABLE 10. SCARLET FEVER—DISTRIBUTION OF CASES, 1961 1961 Ward Total St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest January — — 1 2 2 1 — 2 8 February - - - - - - - 4 4 March 2 — 4 1 — — — 1 8 April 2 — 1 — 2 — 1 — 6 May 1 - - - - - 1 — 2 June — 1 2 1 — 1 — — 5 July — — — 1 — — — — 1 August 1 1 - - - - - - 2 September 1 - - - - - - - 1 October 1 — — — — 1 — — 2 November - - - - - 3 1 — 4 December — — — 1 1 — 1 — 3 TOTALS 8 2 8 6 5 6 4 7 46 Monthly Mean 0.66 0.16 0.66 0.50 0.41 0.50 0.33 0.58 3.83 Case rate per 1,000 population 1.16 0.32 1.18 0.67 0.70 1.03 0.48 1.07 0.81 TABLE 11. SCARLET FEVER—MULTIPLE CASES, 1961 Ward No. of houses in which occurred Total Houses Total Cases 1 Case 2 Cases 3 Cases St. Helier North 6 1 - 7 8 St. Helier South 2 — — 2 2 St. Helier West 6 1 — 7 8 North-East 6 - — 6 6 North-West 5 - - 5 5 Central 4 1 — 5 6 South-East 4 — — 4 4 South-West 7 — — 7 7 Whole District 40 3 — 43 46 43 Diphtheria The year 1961 was again free from diphtheria in this district, the last case having occurred in 1948. Not every district has been so fortunate and outbreaks though small compared with pre war times do occur from time to time in various parts of the country. Diphtheria Immunisation The freedom from diphtheria which the district has enjoyed for so long is attributable to the degree of success achieved in maintaining a reasonably satisfactory level of immunisation. It is not enough to immunise in infancy. Reinforcing inoculations thoughout childhood are necessary and we are fortunate in being able to offer these reinforcing injections in the Primary Schools of the district, thus obviating a special journey to a clinic or surgery for the purpose. The practice is to secure primary immunisation before the age of 1 year usually in combination with anti whooping cough and tetanus immunisation and this can be secured when the mother is already attending the Infant Welfare Clinic. Boosting doses are given at school soon after entry and again at approximately three year intervals until the child leaves the junior school at about the age of 11 years. The immunisation rate in pre school children is nearly 70% and this is further increased in the school age group to approximately 80%. These arrangements are the responsibility of the County Council under the National Health Service Act, but they are directed by the District Medical Officer of Health. In 1961, 796 resident children received a primary course of treatment as follows:— Age at 31.12.61 Under 1 year 1 year 2 years 3 years 4 years 5-9 years 10-14 years Total under 15 yrs. i.e. born in year 1961 1960 1959 1958 1957 195/2 56 1947/ 51 At Council Clinics 173 223 18 15 3 10 1 443 In Carshalton Schools - - - - 6 86 27 119 Private Practitioners 69 108 12 10 9 6 4 218 242 331 30 25 18 102 32 780 Less outward transfers 2 1 — — — 7 7 17 240 330 30 25 18 95 25 763 Plus inward transfers 11 4 2 1 1 6 8 33 Carshalton residents 251 334 32 26 19 101 33 796 A further 1065 Carshalton children received reinforcing injections during the year. The following table shows the immunisation state of the local child population at the 31st December, 1961:— 44 Number of children at 31st December, 1961, who had completed a course of immunisation at any time between 1st January, 1947 and 31st December, 1961. Age at 31.12.61 i.e. Born in Year Under 1 1^1 5—9 10—14 Under 15 Total 1961 19571960 19521956 19471951 A. No. of children whose last course (primary or booster) was completed in the period 19571961 256 2257 3122 2562 8197 B. No. of children whose last course (primary or booster) was completed in the period 1956 or earlier - - 279 1647 1926 C. Estimated mid-year child population 730 2920 8400 12050 Immunity Index 100 A/C 35.1 77.2 67.7 68.0 The estimated percentage of children immunised at each year end since 1935, when the Council's scheme was inaugurated and the incidence of diphtheria in the resident population is shown in the following table:— Year Percentage of Children Immunised at year end Incidence of Diphtheria 0-5 Years 5-15 Years 0-15 Years Cases Attack Rate Per 1,000 Population 1935 - - 7 58 1.13 1936 — — 10 53 0.95 1937 — — 15 47 0.80 1938 — — 18 33 0.57 1939 — — 19 14 0.23 1940 — — 21 45 0.77 1941 — — 49 26 0.45 1942 40 84 71 23 0.40 1943 57 78 72 7 0.12 1944 54 83 75 7 0.12 1945 58 75 70 15 0.27 1946 64 81 76 4 0.06 1947 63 84 78 2 0.03 1948 67 92 81 1 0.01 1949 60 91 81 1 0.01 1950 63 98 85 0 0.00 1951 57 97 84 0 0.00 1952 54 99 84 0 0.00 1953 52 85(70*) 75(64*) 0 0.00 1954 53 85(66*) 75(62*) 0 0.00 1955 52 84(66*) 74(62*) 0 0.00 1956 57 84(66*) 76(64*) 0 0.00 1957 57 87(66*) 78(64*) 0 0.00 1958 57 85(63*) 77(61*) 0 0.00 1959 57 84(63*) 76(61*) 0 0.00 1960 64 94(68*) 85(67*) 0 0.00 1961 69 91(68*) 84(68*) 0 0.00 (*Immunised within the last 5 years) 45 Erysipelas Two cases of this skin infection were notified in middle aged women. The arm was the site affected in one the neck in the other. This infection is another of those which respond well to the new drugs and many cases are undoubtedly aborted by chemotherapy in the early clinical stages. Pneumonia Cases of pneumonia, secondary to other conditions, are not notifiable only the primary and influenzal types being included among the notifiable diseases. The number of such notifications is a fairly reliable indication of the extent to which respiratory infection occurs in the district, particularly during the winter months, periods when coughs, bronchitis and influenza are prevalent being always accompanied by a rise in the notifications of pneumonia. As in 1960 the winter months of 1961 were particularly mild and in the absence of any marked influenza epidemic, it is not surprising that the incidence of pneumonia was again low at only 15 cases, 3 of which were stated to be of influenzal origin. Pneumonia usually affects the extremes of life, the very young and the old, but it is interesting to note that all cases in 1961 were adults, a fact which does credit to the standard of infant care. Measles The long established biennial rhythm in the prevalence of measles in the greater London area continues. The year 1960 had only 67 cases, hence an epidemic in 1961 was, in conformity with pattern, to be expected. This duly materialised in the first 6 months and a total of 811 notifications was received during the year. There were no deaths. This yearly alternation in prevalence is shown by the following figures of cases in the last 8 years:— 1954 173 1958 83 1955 1138 1959 973 1956 326 1960 67 1957 684 1961 811 TABLE 12.—MEASLES WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1961 (Excluding hospital patients non-resident in Carshalton) 1961 Ward Total St. Helier North St. Helier South St. Helier West NorthEast Northwest Centtral SouthEast Southwest January 2 4 2 5 9 5 3 8 38 February 11 1 15 6 8 3 8 43 95 March 55 36 35 10 17 2 8 20 183 April 43 34 31 56 34 2 31 9 240 May 68 12 19 46 8 2 14 2 171 June 8 5 5 11 4 7 5 2 47 July 2 — 1 2 2 6 5 — 18 August — — — 1 3 8 4 — 16 September — — — — — 2 — — 2 October - - - - - - - - — November - - - - - - - - — December - - - - - - - 1 1 TOTALS 189 92 108 137 85 37 78 85 811 Monthly Mean 15.7 7.66 9.0 11.4 7.08 3.08 6.50 7.08 67.58 Case rate per 1,000 population 27.47 14.86 15.95 15.39 11.93 6.37 9.36 13.07 14.35 46 Whooping Cough In the days before vaccination against whooping cough was practised, the yearly total of cases frequently ran into several hundreds but since 1955 the annual incidence has been less than 100. As in other recent years, in the absence of any defined epidemic, incidence was fairly evenly spread over the 12 months. The cases moreover were relatively mild and none was fatal. Whooping Cough Vaccination This practice which is the responsibility of the County Council did not begin to assume significant proportions until 1954. Since that year the number of children under 5 years vaccinated against this infection has risen steadily to the present level of approximately 70%. The vaccine is usually given in combination with diphtheria and tetanus immunising material as a triple antigen. The number of cases and the percentage of preschool children vaccinated at the beginning of each year since 1950 was as follows:— Year Percentage of children vaccinated Cases Year Percentage of children vaccinated Cases 1950 — 384 1956 47 73 1951 — 471 1957 61 75 1952 - 98 1958 62 41 1953 6 345 1959 64 32 1954 22 154 1960 66 81 1955 36 101 1961 69 69 TABLE 13. WHOOPING COUGH—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1961. (Excluding hospital patients non-resident in Carshalton) 1961 Ward Total St. Helier North St. Helier South St. Helier West NorthEast NorthWest Central SouthEast Southwest January - 1 — 5 1 — 2 - 9 February — 1 — 2 3 — 1 — 7 March — — 1 2 1 — — 4 8 April 1 — 3 1 — 2 4 7 18 May 1 — — 1 2 1 1 8 14 June 4 — — — — 1 — - 5 July 1 - - - - - - - 1 August - - - - - - - - - September - — 1 — — — — - 1 October 1 - 1 1 — — - - 3 November - - 1 1 1 - - - 3 December - - - - - - - - - TOTALS 8 2 7 13 8 4 8 19 69 Monthly Mean 0.66 0.16 0.66 1.08 0.66 0.33 0.66 1.58 5.75 Case rate per 1,000 population 1.16 0.32 1.03 1.46 1.12 0.68 0.96 2.90 1.22 47 Meningococcal Infection One case of meningococcal meningitis occurred in a girl of 17 years who was a resident of premises used as a private old peoples home. She was removed to hospital where she made an uneventful recovery. No further cases developed as a result of contact. Poliomyelitis As in the year before no case of poliomyelitis was notified. Poliomyelitis Vaccination That part of the Ministry of Health scheme operated by the County Council provides vaccination against poliomyelitis for individuals in the following priority groups and those between the ages of 6 months and 40 years—certain groups who are at special risk such as practitioners and practising nurses—public health staffs, dentists, ambulance staffs etc. Individuals outside these priority groups may be vaccinated by the general practitioners with vaccine supplied through the pharmaceutical service. The number of individuals in the priority groups vaccinated during the year under the County Council's arrangements was as follows:— No. who received their 2nd injection No. given a 3rd injection No. given a 4th injection Children over 6 months and born in 1943 to 1961 11371 1869 4121 Young persons born 1933 to 1942 178 Persons born before 1933 553 Others 17 Totals 1885 1869 4121 The number vaccinated from the beginning of the scheme up to the 31st December, 1961 was as follows:— No. given 2 injections No. given a 3rd injection No. given a 4th injection Born in 1943-1961 12336 13778 4121 Born in 1933-1942 2568 Born 1932 and earlier 1551 Special groups 1384 Totals 17839 13778 4121 These figures do not include the staffs of hospitals. 48 Ophthalmia Neonatorum For a long time more careful attention at birth and prophylactic treatment has reduced the incidence of this infection of the eyes of the new-born to small proportions. The introduction of the newer drugs and antibiotics has reduced it still further. No case was reported in 1961. Only two cases have occurred in the last 7 years and neither has resulted in any impairment of vision. Puerperal Pyrexia The regulations require that any rise of temperature of 2 degrees in a woman within 14 days of childbirth or miscarriage, shall be notified irrespective of the origin of the fever. A substantial proportion of all notifications, therefore, are not of puerperal origin. Most cases, as is to be expected, are lying-in women in the extensive maternity accommodation provided in the hospitals of the district which cater for a large area of Metropolitan Surrey, since the main criterion for admission to this accommodation is existing or potential medical abnormality. A total of 166 cases was reported, all hospital cases but 3. Thirty were Carshalton mothers. Food Poisoning The year 1961 was not only free from any outbreak of food poisoning, but no single isolated cases were notified. Illness of this description is mainly the result of defective food hygiene particularly of faulty handling when food such as cream filled cakes or processed meat is manipulated in the course of preparation. Such shortcomings give rise only to the occasional case when they are restricted to the ordinary domestic household, but can give rise to extensive illness when they occur in large catering establishments. 49 50 TABLE 14. CASES OF NOTIFIABLE INFECTIOUS DISEASE ADMITTED TO HOSPITAL, 1961. Disease Cuddington Wandle Valley Queen Mary's St. Helier Totals Scarlet Fever 4 4 1 — 9 Dysentery — — 1 1 2 Measles 1 4 4 — 9 Whooping Cough 1 — 1 — 2 Meningococcal Infection — — — 1 1 TOTALS 6 8 7 2 23 51 TABLE 15. INFECTIOUS DISEASES—NOTIFICATIONS, DEATHS AND DISTRIBUTION. (Excluding hospital patients non-resident in Carshalton) Disease Cases notified Case rate per 1,000 population Deaths Distribution by Wards No. of cases removed to hospital Percentage of cases removed to hospital St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest Scarlet Fever 46 0.81 — 8 2 8 6 5 6 4 7 10 21.7 Measles 811 14.35 — 189 92 108 137 85 37 78 85 9 1.11 Whooping Cough 69 1.22 — 8 2 7 13 8 4 8 19 2 2.89 Dysentery 2 0.03 1 1 — — 2 100 Pneumonia 15 0.26 — 2 4 5 — 2 — 2 — — - Erysipelas 2 0.03 — — — 1 — — 1 — — — - Puerperal Pyrexia 30 0.53 — 5 4 4 6 6 1 3 1 30 100 Meningococcal Infection 1 0.01 - - - - - - - - 1 1 100 52 TABLE 16. INFECTIOUS DISEASES—Notification by Age Groups, 1961. (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 5 5 8 19 2 — 1 — — — 46 Measles 22 106 94 104 180 279 18 1 4 3 — — 811 Whooping Cough 7 12 7 8 11 17 3 1 2 1 — — 69 Dysentery 1 1 - - - - - - - - - - 2 Pneumonia - - - - - - - - - 5 6 4 15 Erysipelas - - - - - - - - - - 2 — 2 Puerperal Pyrexia - - - - - - - 7 19 4 - — 30 Meningococcal Infection - - - - - - - - - - - - 1 53 TABLE 17. MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1961. (Excluding hospital patients non-resident in Carshalton) Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 8 4 8 6 2 5 1 2 1 2 4 3 46 Measles 38 95 183 240 171 47 18 16 2 — — 1 811 Whooping Cough 9 7 8 18 14 5 1 — 1 3 3 — 69 Dysentery 1 — — — — — — — 1 — — — 2 Pneumonia — 4 2 2 1 2 2 — 1 1 — — 15 Erysipelas — — 1 — — — — — — — — 1 2 Puerperal Pyrexia 2 3 1 3 3 1 1 7 2 5 1 1 30 Tuberculosis, Pulmonary — 4 — 5 3 3 1 2 3 1 1 1 24 Tuberculosis, Non-Pulmonary — 1 — — — 1 — — — — — 1 3 Meningococcal Infection 1 — — — — — — — — — — - 1 Tuberculosis The new cases admitted to the tuberculosis register during the year numbered 64 classified as follows:— Males Females Pulmonary 32 Pulmonary 27 Non-pulmonary 3 Non-pulmonary 2 Of the total additions, 27 were primary notifications, 34 were trans. ferred from other districts and 3 came to notice in other ways. In the same period, 112 names were removed from the registerfor the following reasons:— Recovered 69 Death 14 Otherwise (including removals) 29 After allowing for the additions and deductions, the state of the register at the 31st December, 1961, was as shown in the following table:— TUBERCULOSIS—WARD DISTRIBUTION. Cases on Register at 31st December, 1961. Ward Pulmonary Non-Pulmonary Total Incidence per 1,000 population Males Females Males Females St. Helier North 57 43 5 7 112 16.27 St. Helier South 40 38 8 6 92 14.86 St. Helier West 30 42 2 4 78 11.52 North-East 37 30 3 5 75 8.42 North-West 19 21 2 2 44 6.17 Central 12 23 2 - 37 6.37 South-East 30 22 1 - 53 6.36 South-West 21 19 — — 40 6.15 246 238 23 24 Whole District 484 47 531 9.39 The total of 531 is 48 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 32. 54 The number of tuberculosis persons who died during the year was 14, distributed by age groups as follows:— Age Years Pulmonary Non-Pulmonary Total Males Females Males Females 0 — — — — — 1- 5 — — — — — 5-15 — — — — — 15-25 — — — — — 25-35 — 1 — — 1 35—45 — — — — — 45-55 2 — — — 2 55-65 2 1 - - 3 65—up 7 1 — — 8 Totals 11 3 — — 14 The deaths attributable to tuberculosis were 8 as follows:— DEATHS DUE TO TUBERCULOSIS, 1961. Ward Pulmonary Non-Pulmonary Death Rate per 1,000 population Mean age at Death Male Female Male Female St. Helier North 2 - - - 0.28 69 St. Helier South 2 - - - 0.32 72 St. Helier West - - - - - - North-East - - - - - - North-West 1 - - - 0.14 74 Central 1 - - - 0.17 70 South-East - 1 - - 0.12 27 South-West 1 — — — 0.15 66 Totals 7 1 — — 0.14 65 Of the 8 persons who died none 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. 7 tuberculosis families were rehoused by the Council in 1961. 55 Carshalton Chest and Heart Care Committee This voluntary committee continued its beneficent work in caring for patients with chest and heart diseases and their families in the many diverse ways for which there is no provision in the statutory schemes. Originally constituted to deal with tuberculosis sufferers it extended the scope of its activities in 1959 to include patients with other chest complaints referred to it by the Chest Physicians of the hospitals. Its welfare functions are primarily economic and social since the majority of families coming within its purview are in very straitened circumstances owing to the prolonged nature of the disability. The help given during the year included the following:— Grants for clothing, bedding, fuel, materials for occupational therapy, means of transport, materials for home decoration, gardening implements and tools and television licences. Fares to hospital for near relatives. Holidays for patients and their families. Christmas gifts. Except for a grant of £100 from the County Council, all funds are raised by voluntary effort. Disbursements for the benefit of patients totalled £443 16s. 9d. and the administration expenditure was £17 2s. l0d. There were of course no salaries or honoraria. Carshalton Old Peoples Welfare Committee The year 1961 saw a further expansion of the work of this relatively new Committee. Since its formation in 1957 a great deal of voluntary effort has made it a very important factor of service to the old people of the district though there remains plenty of scope for further development as and when the necessary financial and personal help is available. Among its present activities are a home visiting service, a chiropody service and meals on wheels. More recently an arrangement has been made with the Darby and Joan Club in Cooper Crescent, whereby housebound aged individuals can be transported to and from the Club on one day a week, an Austin Wagon having been purchased by the Committee for the purpose. The District Council make a grant in respect of the meals service and the County Council assist in the case of the chiropody service. 56 57 TABLE 18 TUBERCULOSIS, New Cases, Age and Sex Distribution and Manner of Admission to Register, 1961. Age Group Years Primary Notifications "A" Cases transferred from other Districts Cases brought to notice other than by Notification or Transfer Total New Cases Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F M F M F 0— 1 - - - - - - - - - - -- - - 1— 5 — — — — — 1 — — — — — — 1 5—10 — — — — — 1 — — — — — — 1 10—15 — — — — — — — — — — — — — 15—20 2 — — — — — — — — - — — 2 20—25 1 1 1 1 1 5 — 1 — — — — 11 25—35 1 2 — — 4 3 — — — — — — 10 35—45 4 3 1 — 4 4 — — — — — — 16 45—55 1 1 — — 3 2 1 — — — — — 8 55—65 3 1 — — 2 1 — — — — — — 7 65 up 3 1 — — — 1 — — 3 — — — 8 Totals 15 9 2 1 14 18 1 1 3 — — — 64 27 34 3 METEOROLOGY The following rainfall was recorded at the Council's Pumping Station in Buckhurst Avenue. Rainfall 1961 Amount in ins. Rainfall 1961 Amount in ins. January 3.11 July 1.51 February 2.37 August 2.16 March 0.19 September 1.97 April 1.74 October 2.79 May 1.32 November 2.62 June 1.34 December 3.34 Total 24.46 The water flow over the weir on the head of the River Wandle in the grounds of the Grove was as follows:— Total Flow during the year (Jan.—Dec. 1961) = 2076.38 million gallons. Maximum Spring Flow 12.96 million gallons per day during the week ending 2nd March, 1961. Minimum Spring Flow 1.76 million gallons per day during the weeks ending 30th November—7th December, 1961. 58 INDEX PAGE Acreage 6 Atmospheric Pollution 26 Births- Distribution 10 Institutional 10 Rates 7, 10, 11 Cancer 7,13,14 Cemeteries 31 Clean Air Act 25 Clinics and Treatment Centres 19 Closet Accommodation 22 Deaths— Classification 17 Distribution 14 Rate 7,11,13 Diphtheria 44 Diphtheria Immunisation 44 Dysentery 42 Disinfection 25 Disposal of Dead 31 Drainage and Sewerage 21 Employment Agencies 29 Enteric Fever 42 Erysipelas 46 Establishments for Massage, etc. 30 Factories 28 Food- Food and Drugs Act 38 Hygiene 39 Inspection and Supervision 36, 39, 40 Poisoning 49 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 9 Ice Cream 37 Infant Mortality 7,16 Infectious Diseases 41,51,52,53 Inquests 15 Isolation Hospital— Admission to 50 59 page Laboratory Facilities 18 Maternal Mortality 7,16 Measles 46 Meat 38 Meningococcal Infection 48 Merchandise Marks Act, 1926 30 Meteorology 58 Milk Supply 36 Milk and Dairies Regulations, 1959 36 Mortuary 31 Natural and Social Conditions 6 National Assistance Act 30 Offices 27 Old Peoples Welfare 56 Outworkers 28 Ophthalmia Neonatorum 49 Pet Animals Act, 1951 30 Pneumonia 46 Poliomyelitis 48 Poliomyelitis Vaccination 48 Population 7,9 Public Cleansing Puerperal Pyrexia 49 Rag Flock and Other Filling Materials Act, 1951 30 Rateable Value 6 Rats and Mice Destruction Rivers and Streams Sanitary Circumstances 20 Sanitary Inspection Scarlet Fever 43 Shops Act Smallpox 41 Smoke Abatement Staff 5 Statistics— Comparative 12 Vital 7,8 Swimming Baths 27 Tuberculosis 7,15,54,55 Care Committee 56 Unemployment 9 Vaccination 18,42 Vermin Control 25 Water Supply 20 Whooping Cough 47 Zymotic Diseases— Deaths from 7 60