Ac 4413 (3) CAR 27 CARSHALTON URBAN DISTRICT Annual Report OF THE Medical Officer of Health FOR THE YEAR 1962 CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1962 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 1962. One very important consideration which must now be taken into account is the fact that the district has reached maturity in that it is virtually completely developed. With very little scope for expansion except by redevelopment at a greater density, the average age of the population increases year by year since outward migration resulting from housing shortage is chiefly by young adults. This will have the effect, other things being equal, of a rising death rate and a falling birth rate. The geriatric problem of caring adequately for old people will also inevitably increase. In the 1930's and 1940's the population increased rapidly, chiefly as a result of the St. Helier Estate and the expansion was mainly by young adults with young families. The emphasis then from the point of view of the public services, was on the young for example maternity and child welfare, education etc., now it is swinging more and more to the needs of the older age groups. The vital statistics for 1962 reflect this trend. The birth rate fell to 12.6 per thousand population from 14.7 in the year before and the crude death rate rose from 9.9 to 10.6, which is the first time it has reached 10 since 1925, though it is still less than the national rate. In this connection it is interesting to note that the lowest local death rates were, as one would expect from the age constitution of the population, in the years 1935 to 1939, the earlier years of the St. Helier Estate when the rate fell to 6.6 in two of those years. Infant mortality in 1962 was little changed and is approximately the same as for England and Wales, but a higher proportion of the total deaths under one year occurred during the first week of life and were due to "unavoidable" causes, such as prematurity, congenital malformations etc. There was no maternal mortality. Cancer claimed a higher proportion of the total deaths, rather more than a quarter and of these cancer of the lungs accounted for 34 of which 8 were women. The year 1962 established a new record low incidence of infectious disease. The district was free entirely from poliomyelitis, meningitis, smallpox, diphtheria and ophthalmia neonatorum, whilst the cases of measles, whooping cough and tuberculosis were the lowest yet recorded. There was no death from any of these infections other than tuberculosis which caused the death of only three persons all over the age of 60 years, the fewest to date. There is no doubt that the vigorous pursuit of the various immunisation schemes makes a large contribution to these gratifying results. 3 The same high standard of attention to sanitation and evironmental conditions was maintained. The satisfactory results of the testing and sampling of foodstuffs is indicative of the close attention paid to this aspect of public health. The Public Analyst's report on 278 samples showed only 1 breach of the regulations, a slight irregularity in the labelling of one product. All milk samples were again faultless and all ice cream was of the highest grade of bacterial purity. The incidence of vermin infestation continued to decrease. The sewers again gave no evidence of rat infestation and the number of premises on which such rodents were found was smaller than for a number of years. The Council's scheme for converting the whole district into one complete smokeless zone under the provisions of the Clean Air Act continued without interruption. The scheme drawn up in 1960 is planned in 10 zones which it is hoped to complete at the rate of one a year. Two zones are now complete and work is proceeding on zones 3, 4 and 5. It is to be hoped that this work will not be held up by the lack of smokeless solid fuel. Slum clearance made a little further headway when 4 small areas involving 42 dwellings were represented as unfit and Orders were made in respect of them by the Minister without modification. Progress in this work is determined by the rate at which alternative accommodation can be provided for the displaced occupants. One of the problems which is likely to become more prominent with the passage of time is that of noise. The Noise Abatement Act, 1960 makes a small contribution to the control of noise, but the chief provision of the Act is to include noise, which is a nuisance, among the statutory nuisances of the provisions of Part III of the Public Health Act. As with some other nuisances this is a question of degree and there is no definition as to what amount of noise constitutes a nuisance. It has been established by observations over many years that in areas where the water supply contained at least one part per million of fluorine, the incidence of dental decay in children was much less than in areas where the water was deficient in this element. Careful and prolonged study has shown that by bringing the fluorine content of the water supply up to this level, a great deal of dental disease can be prevented. There is no scientific evidence that such a procedure has any harmful effects and its introduction in areas such as this would make significant improvement to the dental health of the community. I would again acknowledge the willing help of my staff and thank them for their contribution to the successful results of another year's work. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, F. LAWRENCE SMITH, Medical Officer of Health. July, 1963. 4 PUBLIC HEALTH STAFF Medical Officer of Health: †F. Lawrence Smith, M.B., Ch.B., D.P.H. The Lodge, Honeywood Walk, Carshalton. (Telephone: Wallington 5501) Chief Public Health Inspector: *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 number of inhabited houses (end of 1962) according to Rate Books 17,602* Rateable Value at 31st December, 1962 £884,339 Sum represented by Id. rate £3,603 (*Includes 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 arising from several springs at the outcropping of the chalk near the centre of the district. The flow over the weir in the Grove grounds was slightly less than half that in 1961, but 1961 was a year with an exceptional high flow. Although some of the springs failed during the year for varying periods, not all dried up at any time and some flow was maintained throughout the year. With the ever increasing demand for water both locally and in the London basin generally, if additional supplies are drawn from the underground sources, the prospects are that the ornamental spring fed waters in the centre of the town will suffer increasing depletion. The district is largely residential and to a considerable extent is a dormitory for London. Little industry is established in the area as is evidenced by the fact that under the recent Rating Revaluation only 3% of the total rateable value is in respect of industrial premises whilst 76% is in respect of domestic premises. The lower income groups form a substantial part of the total and although the population fell by more than 5,000 in the intercensal period 1951—1961, the average number of persons per room occupied is the highest but one in Surrey. The three St. Helier wards are the most densely populated, all having more than 0.8 persons per room compared with 0.69 for the district as a whole. The St. Helier north ward which has a substantial number of two bed roomed houses has 10.6% of its population housed at a density of more than 1 ½ persons per room. The fall in population in the last decade is mainly due to the lack of housing development within the area since the district is to all intents and purposes completely built up. The only significant sized vacant plots of land are either in the green belt or are public open spaces. Consequently young married people have to find houses elsewhere leaving a district populated by an increasingly older population. 6 SUMMARY OF VITAL STATISTICS FOR 1962 (Based on the Registrar-General's Figures) Population. Registrar-General's Estimate 56,380 Births. Males Females Total Live (Legitimate) 344 341 685 (Illegitimate) 16 14 30 360 355 715 Birth Rate (per 1,000 population) 12.6 Stillbirths (Legitimate) 2 3 5 (Illegitimate) — — — Stillbirth Rate per 1,000 total births 2 3 5 6.9 Deaths 320 282 602 Death Rate (crude) per 1,000 population 10.6 Infant Mortality. All deaths under 1 year 10 5 15 Infant Mortality Rate (per 1,000 live births) 20.9 Deaths of leg. infants under 1 year 10 5 15 Rate per 1,000 legitimate births 21.8 Deaths of illeg. infants under 1 year — — — Rate per 1,000 illegitimate births — — — — Maternal Mortality. Death from Sepsis — — — Rate per 1,000 births — Death from other causes – – Rate per 1,000 total births Maternal Death Rate — Zymotic Deaths. 7 Principal Zymotic Diseases Deaths from Measles Deaths from Whooping Cough – – – Deaths from Diarrhoea (under 2 years) Zymotic Death Rate — Deaths from Tuberculosis. All Forms 2 1 3 Rate per 1,000 of population 0.05 Phthisis 2 1 3 Rate per 1,000 of population 0.05 Deaths from Cancer 64 63 127 Rate per 1,000 of population 2.42 7 The following statistics relating to mothers and infants are set out in the form specially requested by the Minister:— Live Births Number 715 Rate per 1,000 population 12.6 Illegitimate Births per cent of total live births 4.1% Stillbirths Number 5 Rate per 1,000 total live and stillbirths 6.9 Total live and stillbirths 720 Infant Deaths (Deaths under 1 year) 15 Infant Mortality Rates Total infant deaths per 1,000 live births 20.9 Legitimate infant deaths per 1,000 legitimate live births 21.8 Illegitimate infant deaths per 1,000 illegitimate live births — Neo-natal Mortality Rate (deaths under 4 weeks per 1,000 live births) 18.1 Early Neo-natal Mortality Rate (deaths under 1 week per 1,000 live births) 16.7 Peri-natal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 23.6 Maternal Mortality (including abortion) Number of deaths — Rate per 1,000 total live and stillbirths — The Registrar-General's statistics relating to population, births and deaths differ slightly from those compiled from local records. The total figures in respect of the district as a whole, which are supplied by the Registrar-General, are set out in this report, but where classification has been made, e.g., by age groups, sex, wards, etc., it has necessarily been based on our own records, which may, in the aggregate, show slight discrepancies compared with the Registrar-General's totals. 8 UNEMPLOYMENT The following figures in respect of persons living in Carshalton registered as unemployed at the Sutton Employment Exchange and the Carshalton Youth Employment Bureau at the end of 1962 are supplied through the courtesy of the Exchange Manager and the Youth Employment Officer: Men 122 approx. Women 33 „ Boys 12 Girls 8 The figures are very slightly higher than those of a year ago. POPULATION As is noted above there was a substantial reduction in the population in the 10 years of the last intercensal period, the fall being 5,259. The home population which excludes temporary residents, such as patients in hospital from other areas at mid 1962 is estimated by the Registrar-General as 56,380 which is a reduction on his estimate for the previous year of 110. Figures are now available for the defacto population of the various wards at the official enumeration of 1961 and are shown below. They are the actual number of individuals in the wards on the night of the census including temporary visitors from other areas and from abroad, but do not include residents who were on that night temporarily out of the district. St. Helier North 7021 St. Helier South 6211 St. Helier West 6606 North-East 8949 North-West 6761 Central 5725 South-East 9113 South-West 7098 Total 57484 The figure for St. Helier South ward includes the patients in St. Helier Hospital, most of whom were not residents of Carshalton, approximately 500. The same applies to the South-East ward which includes the patients of Queen Mary's Hospital with approximately the same number of non-residents. To a very much smaller degree deductions have also to be made from the St. Helier North ward in respect of the Wandle Valley Hospital and from the Central ward in respect of the War Memorial Hospital, in order to arrive at the home population. The number of non-residents who were included in the census count was approximately 1,000 which explains why the Registrar-General's estimate of the home population is approximately that number less than the defacto population count at the census. The number of structurally separate dwellings at the census was 17,545 and the population in private households was 55,254. The average number of persons per private dwelling was therefore 3.15, which compares with 3.63 per dwelling at the 1951 census 10 years earlier and 3.89 at the census of 1931 30 years ago. The following table shows the estimated home population of each ward at the middle of 1962 and is an estimated apportionment of the RegistrarGeneral's total figure for the year. 9 TABLE 1 ESTIMATED HOME POPULATION, MID-1962, BY WARDS Ward Dwellings at Mid-1962 Estimated Population Mid-1962 St. Helier North 2,169 6,910 St. Helier South 1,699 5,870 St. Helier West 2,123 6,600 North-East 2,847 8,910 North-West 2,233 6,760 Central 1,813 5,800 South-East 2,492 8,520 South-West 2,258 7,010 Whole District 17,634 56,380 BIRTHS Slightly fewer live births were registered in 1962, the actual number being 715 as against 731 in the year before. Of the total 360 were males and 355 females. This gives a crude birth rate of 12.6 per thousand population. The "comparable" birth rate is the same since the RegistrarGeneral's "comparability" factor in respect of births is 1.0. One very satisfactory feature is the considerable fall in the number of still births which totalled 5 only. This is a record low for the district and compares with an average of 17.3 over the previous 10 years. 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 local Registrar's weekly returns of registrations within the district. From these sources it is known that 721 live births and 6 stillbirths occurred in 1962. They ere istributed 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 68 9.8 St. Helier South 43 7.3 – — St. Helier West 69 10.4 – — North-East 129 14.4 1 7.6 North-West 128 18.8 – — Central 99 17.0 1 — South-East 113 13.2 2 17.3 South-West 72 10.2 2 27.0 Total 721 12.7 6 8.2 Eighty 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 78 North-West 83 St. Helier South 84 Central 82 St. Helier West 85 South-East 76 North-East 76 South-West 82 10 Out of 727 total births, 583 took place in the following hospitals:— Live Still Total Carshalton, Beddington and Wallington District (War Memorial) Hospital 130 3 133 St. Helier Hospital 368 1 369 Other Surrey Hospitals 63 2 65 Other Hospitals 16 — 16 Totals 577 6 583 This high proportion of hospital births has been experienced for many years past. TABLE 2 BIRTHS, 1962—DOMICILIARY AND OTHERS—BY WARDS Ward Born in District Born outside District Grand Total In Hospitals and Nursing Homes In Private Dwellings Total In Hospitals and Nursing Homes In Private Dwellings Total St. Helier North 47 15 62 6 6 68 St. Helier South 35 7 42 1 — 1 43 St. Helier West 53 10 63 6 — 6 69 North-East 93(1) 31 124(1) 6 — 6 130(1) North-West 83 22 105 23 — 23 128 Central 75(1) 18 93(1) 7 — 7 100(1) South-East 67(1) 28 95(1) 20(1) — 20 115(2) South-West 49(1) 13 62(1) 12(1) — 12 74(2) Totals 502(4) 144 646(4) 81(2) — 81 727(6) (Figures in brackets indicate stillbirths included in totals) 11 TABLE 3 BIRTH AND DEATH RATES FOR CARSHALTON, 1922-1962 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 1962 56,380 12.6 10.6 20.9 0.0 12 TABLE 4 COMPARATIVE STATISTICS—1962 England and Wales Carshalton Birth Rate (per 1,000 population) 18.0 12.6 (crude) 12.6 (comp.) Still-birth Rate (per 1,000 total births 18.1 6.9 Death Rate (per 1,000 population) 11.9 10.6 (crude) 12.7 (comp.) Infant Mortality (per 1,000 live births) 20.7 20.9 Neo-natal Mortality (in first 4 weeks per 1.000 live births) 15.1 18.1 Death rate from Tuberculosis (per 1,000 population) Respiratory Tuberculosis .059 .066 0.05 0.05 Other Tuberculosis .007 – Death rate from Cancer (per 1,000 population) All Forms 2.17 2.42 Cancer of Lung 0.51 0 58 Maternal Mortality (per 1,000 total births) Excluding Abortion 0.28 0.35 – – Abortion 0.07 – COMPARATIVE HEALTH STATISTICS, 1934/62 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 1962 11.9 10.6 20.7 20.9 0.28 0 13 DEATHS The number of deaths allocated by the Registrar-General, as adjusted for the outward transfer of non-residents and the inward transfer of residents dying outside the area was 602, 320 being males and 282 females. This gives a crude death rate of 10.6 per thousand population. The "comparable" death rate produced by the application of the Registrar-General's "comparability factor" of 1.2 was therefore 12.7. That for England and Wales as a whole was 11.9. The crude death rate of 10.6 is the first time that the figure of 10 has been reached since 1925. It is to a considerable degree a reflection of the increased age of the population referred to in previous pages, since the falling off in the population is mainly due to the outward migration of young adults seeking separate accommodation which is not available in the district. The distribution of the deaths by wards was as follows:— WARD DEATH RATES AND MEAN AGE AT DEATH, 1962 Ward Deaths Death Rate (crude) Mean Age at Death St. Helier North 79 11.4 66.4 yrs. St. Helier South 66 11.2 66.4 „ St. Helier West 61 9.2 66.9 „ North-East 86 9.6 64.0 „ North-West 72 10.6 65.4 „ Central 79 13.6 66.2 „ South-East 86 10.0 70.0 „ South-West 81 11.5 70.6 „ Whole District 610 10.8 66.9 yrs. Heart disease was again the chief cause of death, no less than l90 of the total being due to this cause. Of this 190 coronary disease of the heart killed 124. Cancer claimed 127 victims of which malignant disease of the lungs accounted for 34. The following table shows the deaths from lung cancer since 1936, the period in which the population remained fairly static. DEATHS FROM CANCER OF THE LUNGS 1936-1962 1936 3 1950 23 1937 6 1951 12 1938 10 1952 11 1939 9 1953 30 1940 4 1954 30 1941 9 1955 27 1942 4 1956 18 1943 13 1957 25 1944 8 1958 40 1945 12 1959 38 1946 8 1960 28 1947 21 1961 35 1948 15 1962 34 1949 12 14 CANCER DEATHS—WARD DISTRIBUTION, 1962 Ward Cancer Deaths Rate per 1,000 Estimated Population M F Total St. Helier North 8 4 12 1.73 St. Helier South 10 7 17 2.88 St. Helier West 7 4 11 1.66 North-East 8 7 15 1.67 North-West 4 16 20 2.95 Central 12 10 22 3.79 South-East 9 5 14 1.64 South-West 7 10 17 2.42 The classification of the cancer deaths by sites affected is given in Table 5. TABLE 5 CANCER DEATHS 1962 Group Site Affected Male Female Total Digestive Organs— 150 Oesophagus 1 2 3 151 Stomach 9 8 17 152 Small Intestine 1 – 1 153 Colon 1 6 7 154 Rectum 4 6 10 155 Gall Bladder and Liver 3 2 5 156 Pancreas 2 – 2 158 Peritoneum 1 — 1 Respiratory System— 161 Larynx — 1 1 162 Lungs and Bronchi 26 8 34 Breast and Genito-urinary— 170 Breast — 15 15 171/4 Uterus – 3 3 175 Ovary — 5 5 177 Prostate 3 — 3 180 Kidney 2 2 4 181 Bladder 4 — 4 Other Sites— 193 Spinal Cord and Brain 3 — 3 196 Bone 1 – 1 199 Unspecified 3 4 7 201 Lymphatic Tissues 1 1 2 65 63 128 Average age at death:— Males 61.3 years Females 65.8 years All persons 63.2 years 15 Mortality from tuberculosis was again very low, three deaths from this cause in all. The figures in respect of the last 20 years were as follows:— Year Deaths from Tuberculosis Death Rate per 1,000 Population Year Deaths from Tuberculosis Death Rate per 1,000 Population 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 1952 15 0.24 1962 3 0.05 The distribution of deaths from tuberculosis by wards and other details are given in Section F of this report. There was again no death from the notifiable infectious diseases other than tuberculosis. Twenty-seven residents lost their lives from violent causes. They were:— Road traffic accidents 6 Fall 8 Burns 1 Accident at work 1 Fall from train 1 Coal gas poisoning 1 Suicide 9 Inquests Inquests were held on 55 persons who died in the district. The following verdicts were returned:— Accidents 16 Suicide 14 Road traffic accidents 8 Coal gas poisoning 1 Falls 9 Misadventure 3 Burns 1 Chronic alcoholism 1 Drowning 1 Natural causes 1 Twenty of these were residents of Carshalton. 16 INFANT MORTALITY Children who died during the first year of life totalled 15 one more than in 1961. This gives an infant mortality rate of 20.9 per thousand live births and compares with the national rate of 20.7. No fewer than 12 of the infant deaths occurred during the first week of life and the same number were due to prematurity, congenital malformation and other so called "unavoidable" causes, i.e., they were born with a condition which rendered them non-viable. The remaining three deaths were caused by pneumonia. TABLE 6 INFANT MORTALITY—WARD DISTRIBUTION Ward Infant Deaths Rate per 1,000 Live Births— St. Helier North – – St. Helier South 1 23.2 St. Helier West 1 14.4 North-East 3 23.2 North-West 3 23.4 Central 5 51.0 South-East 1 8.8 South-West 1 13.8 TABLE 7 INFANT MORTALITY DURING THE YEAR 1962 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 5 – 5 5 Congenital Malformation 2 – – – 2 – – – 1 3 Haemolytic Disease of new born 2 – – – 2 – – – – 2 Pneumonia 1 1 2 1 3 Atelectasis 2 — — — 2 — — — — 2 Totals 12 — – 1 13 — — 1 1 15 MATERNAL MORTALITY There was no death attributable to maternal causes. 17 18 TABLE 8 — CAUSES OF DEATH DURING THE YEAR 1962 — By Age and Sex No. Causes of Death 0 — 1 — 5 — 15 — 25 — 35 — 45 — 55 — 65 — 75 — All Ages M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Pns. All Causes Total 10 5 — 1 3 — 2 2 5 — 10 5 28 18 80 51 92 73 89 136 319 291 610 1 Tuberculosis, Respiratory — — — — — — — — — — — — — — — — 2 1 — — 2 1 3 2 Tuberculosis, other — — — — — — — — — — — — — — — — — — — — — — — 3 Syphilitic disease — — — — — — — — — — — — — — — — 2 — 1 3 3 4 Diptheria — — — — — — — — — — — — — — — — — — — — — — — 5 Whooping Cough — — — — — — — — — — — — — — — — — — — — — — — 6 Meningcoccal Infections — — — — — — — — — — — — — — — — — — — — — — — 7 Acute Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — 8 Measles — — — — — — — — 9 Other Infective and Parasitic Diseases — — — — — — — — — — — — — — — — 1 — — — 1 — 1 10 Malignant neoplasm, stomach — — — — — — — — — — — — 2 — 2 6 2 1 3 1 9 8 17 11 Malignant neoplasm, lung — — — — — — — — — — — — 2 — 16 4 7 3 1 1 26 8 34 12 Malignant neoplasm, breast — — — — — — — — — — — 1 — 2 — 7 — 4 — 1 — 15 15 13 Malignant neoplasm, uterus — — — — — — — — — — — — — — — 1 — 1 — 1 — 3 3 14 Other Malignant and lymphatic neoplasms — — — — 3 — — — — — — — 6 2 9 8 8 9 4 10 30 29 59 15 Leukaemia, aleukaemia — — — 1 — — — — 2 — — — — — — 1 1 3 2 5 16 Diabetes — — — — — — — — — — — — — — — — — — 1 1 1 1 2 17 Vascular lesions of nervous system — — — — — — — — — — — 1 4 — 4 5 9 17 9 17 26 40 66 18 Coronary disease, angina — — — — — — — — 1 — 1 — 9 1 26 9 28 7 19 17 84 34 118 19 Hypertension with heart disease — — — — — — — — — — — — — — — — 1 3 — 3 1 6 7 20 Other heart disease — — — — — — — — — — — 1 — 1 2 3 8 5 18 32 28 42 70 21 Other circulatory disease — — — — — — — — — — — 1 — 1 2 1 4 7 6 9 12 19 31 22 Influenza — — — — — — — — — — — — — — — — — 1 — 2 — 3 3 23 Pneumonia 1 2 — — — — — — — — 3 — — 1 2 4 4 11 19 19 28 47 24 Bronchitis — — — — — — — — — — — — 1 2 13 1 10 3 5 6 29 12 41 25 Other diseases of respiratory system — — — — — — — — — — — — — — 1 1 — 1 — — 1 2 3 26 Ulcer of stomach and duodenum — — — — — — — — — — — — 1 — 2 1 1 1 3 5 4 9 27 Gastritis, enteritis and diarrhoea — — — — — — — — 1 — — — — — 1 — 1 1 3 1 4 28 Nephritis and nephrosis — — — — — — — — — — — — — 1 — — — — 1 — I 1 2 29 Hyperplasia of prostate — — — — — — — — — — — — — — — — 2 — 3 — 5 5 30 Pregnancy, childbirth, abortion — — — — — — — — — — — — — — — — — — — — — — — 31 Congenital malformations 3 — — — — — — — — — — — — — — — — 1 — — 3 1 4 32 Other defined and ill-defined diseases 6 3 — — — — — — 1 — 2 1 1 6 — 1 2 1 2 4 14 16 30 33 Motor vehicle accidents — — — — — — 2 — — — — — — 1 1 1 1 — — 4 2 6 34 All other accidents — — — — — — — — — — 1 — l — — — 1 1 2 6 5 7 12 35 Suicide — — — — — — — 1 — — 3 — i l 1 — I — 1 — 7 2 9 36 Homicide and operations of war — — — — — — — 1 — — — — — — — — — — — — — 1 1 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 60 Water (Public Supply): For chemical analysis 3 For bacteriological examination 5 Water (Swimming Baths) For bacteriological examinations 22 Food and Drugs: Analysis 278 Bacteriological examination of milk 182 Bacteriological examination of ice cream 102 Bacteriological examination of other foods 3 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. 19 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 Relaxation Classes 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. Relaxation Classes By appointment 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 2—4 p.m. 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 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) 4.30—6.30 p.m. Weds. (Females) 5—7 p.m. 20 Section C—Sanitary Circumstances. Water Supply The district is supplied by the Sutton District Water Company with the exception of some 200 dwellings at the northern end which are supplied by the Metropolitan Water Board. The Company draws its supply from wells in the chalk at Sutton, Cheam and Woodmansterne. Its own resources can be augmented if the need arises by the Metropolitan Water Board, the East Surrey Water Company and the Epsom and Ewell Corporation's undertaking. A few private wells exist in the district at the St. Helier Hospital, the Muschamp Road and West Street laundries, at St. Philomena's School and Convent and at the British Industrial Solvents in Mill Lane. The public supply is softened to 9° of hardness which is a statutory requirement and undergoes purification treatment including chlorination. It is not plumbo solvent. The arrangements for purity control include the employment of a full time chemist with a fully equipped laboratory who exercises daily check both on the raw and finished waters. Tests are also carried out periodically for the Company by a firm of independent water chemists. In addition the Public Health Departments of the Districts in the supply area take monthly samples on an agreed rota. 21 As the results of the tests indicate, the supply was completely wholesome. It was also adequate although the use of water continues to increase. The following information supplied by courtesy of the Company gives the results of their laboratory work. Sample Total No. of Bacteriological Examinations Total No. of full Chemical Analyses No. and % of samples showing ColiAerogenes in 100 ml. (Excluding B.Coli 1) No. and % of samples showing B. Coli present in 100 ml. of sample (Type 1) Total No. ColiAero genes Organisms in 100 ml. of sample No. % No. V /o Sutton Raw 307 53 10 3.1 5 1.6 15 Sutton Finished 310 14 3 1.0 2 0.7 5 Woodmansterne Raw 310 53 2 0.7 Nil Nil 2 Woodmansterne Finished 318 12 3 0.9 Nil Nil 3 Cheam 309 53 20 6.5 17 5.5 37 Reservoir 292 4 4 1.4 Nil Nil 4 District 302 7 10 3.3 4 1.3 14 Total 2,148 196 52 28 80 The following is the report on a representative sample as supplied to the consumer. (a) Physical Examination Colour Faint Blue Taste normal Appearance Bright and clear Smell none Electric Conductivity at 20 °C 300 Units (6) Chemical Examination in parts per million Total solids dried at 180°C208 Chlorine in Chlorides as Chlorion 20.5 Nitrite Nitrogen 0.04 Nitrate Nitrogen 10.5 Ammoniacal Nitrogen 0.02 Albuminoid Nitrogen 0.00 Oxygen absorbed in 4 hours at 27 °C 0.10 Alkalinity as CaCO3 57 Hardness as CaCO3—Carbonate 57 Non-carbonate 72 Total 129 Free Carbon dioxide as CO2 — Residual Chlorine 0.03 Iron none Other metals none (c) Bacteriological Examination Number of colonies developing per millilitre of water:— on agar in 2 days at 37 °C. 0 on agar in 3 days at 22 °C. 2 Bacteria of indication enumeration:— Organisms of the coliform group 0 per 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 the chemical composition is similar to that of previous samples from the same source. The residual chlorine indicates that precautionary treatment is being maintained. The bacteriological condition of the water is good. As judged by this examination the water is pure and wholesome and is fit for drinking and domestic use. Drainage and Sewerage The sewage of the district is pumped to the works of the Croydon Corporation in Beddington by way of two 21" mains. The pumps are electrically driven. This arrangement whilst generally satisfactory is subject to two risks which have occurred at very infrequent intervals. The greater one, which occurred recently, is the complete failure of the electirc power supply for a matter of hours with the resultant overflow from the receiving chambers and the flooding of the grounds of a number of houses in Buckhurst Avenue near the Pumping Station by crude sewage which thereafter finds its way by gravitation into the adjacent River Wandle. The other risk is fracture of one of the rising mains which conducts the sewage to Beddington. The chances of both mains being fractured at the same time is extremely remote and has never occurred. The Council have agreed a plan for the installation of stand-by pumping machinery in the form of a diesel engine generator at an estimated cost of £22,000. Leaks on both 21" rising mains were repaired during the year. Two short lengths of new surface water sewers have been laid in Culvers Avenue and a short extension laid to an existing surface water sewer in Wrythe Lane. 22 In the Warnham Court Road/Sussex Road area, two deep underground storage tanks have been excavated in the raw chalk to take the excess surface water from this particular area. In conjunction with these a length of surface water sewer has been relaid in a larger size and three new manholes incorporating the overflow weirs and a soakaway have been constructed. One new soakway has been constructed in Harrow Road. The routine inspection and cleansing of soil and surface water sewers and the maintenance of soakaways was carried out as usual. Two hundred and seventy-eight drainage obstructions affecting 706 houses were dealt with. Rivers and Streams The improvement scheme of the River Wandle being undertaken by the County Council referred to in previous reports, has been delayed somewhat and work which commenced at the County boundary had not reached the Carshalton stretch of the River by the end of the year. It is anticipated that it will be undertaken in the Spring of 1963. Closet Accommodation All dwellings have w.c.'s connected to the sewers except 15 which are separately drained to cesspools. Public Cleansing Collection of refuse remains as before on a weekly basis. A separate collection of trade refuse has been introduced. Disposal of refuse is by incineration at the Council's 6 cell destructor with clinker being tipped at the Council's tip in Carshalton Road. Clinker and screenings surplus to requirements have been disposed of to a Contractor. Arrangements for the salvage of saleable waste such as paper, tins, metals, bottles and jars have been 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 985 complaints as follows:— Accumulations 17 Animals so kept 5 Burst pipes 2 Clean Air Act—Contraventions 24 Dampness 3 Drainage defects 20 Drains obstructed 325 Dustbins 8 Food contaminated 18 Food unsound 43 General defective conditions 31 Insects and Pests 138 Litter Act—Contraventions 1 Miscellaneous 26 Noise Act 4 Obnoxious affluvia 34 Refuse collection 18 Rivers 1 Rodents 236 Roofs, defective 16 Sewer obstructions 4 Sink waste pipes 3 Verminous premise 3 Water supply 5 985 23 Thirteen thousand four hundred and twenty-seven visits of inspection and re-inspection were made for the purposes set out below:— Clean Air Act 3,081 Consumer, Protection Act, 1961 2 Employment Agencies 1 Factories (Mechanical Power) (incl. Laundries 19) 206 Factories (Non-Mechanical Power) 41 Factories (Building Sites) 27 Food and Drugs (incl. Food Byelaws) 982 Food Poisoning Enquiries 2 Food premises: Bakehouses 30 Bakers and confectioners 91 Butchers 178 Canteens 21 Canteens—School 13 Chemists 79 Confectioners (sweets only) 156 Fishmongers 77 General Stores 78 Greengrocers and fruiterers 178 Grocers 306 Licensed premises with catering facilities 54 Licensed premises without catering facilities 37 Milk storage depots 13 Ice Cream Vehicles 11 Restaurants and cafes 88 Stalls, food 152 Tea packer 3 Vehicles, food 40 1,605 Hairdressers 50 House drains tested 56 Housing Act 392 Housing Land Charges 979 Infectious Disease Premises 79 Insect Pests 247 Licensing Act 5 Merchandise Marks Act 148 Offices 27 Outworkers Premises 123 Pet Animals Act 13 Piggeries 25 Premises re cesspools 7 Public Health Act (Houses) 2,424 Public Health Act re-inspections 1,428 Rent Act 14 Rodents 305 Rag Flock and Other Filling Materials Act 2 Schools 17 Shops 1,073 Urinals 43 Water Sampling 23 13,427 Three hundred and sixty-one informal notices were served concerning the following matters:— Accumulations and deposits 13 Animals so kept Clean Air Act Consumer Protection Act, 1961 1 Drainage defects 47 Dustbins 9 24 Factories Act 4 Food and Drugs Act (incl. Food Byelaws) 83 Food contaminated 9 General defective conditions 68 Housing Act 2 Licensing Act 1 Merchandise Marks Act 1 Miscellaneous 5 Noise Act 2 Overcrowding 2 Prevention of Damage by Pests Act 8 Shops Act 99 Verminous premises 4 Water supply 1 361 Eighteen formal notices were served by authority of the Council under the following Acts:— Public Health Act, 1936 Section 39 5 „ „ Section 45 2 „ „ „ „ Section 93 10 Factories Act, 1961 1 18 As a result of investigations made and notices served, the following work was carried out:— Accumulations removed 10 Ceilings cleansed 4 Ceiling plaster repaired and/or made good 4 Chimney flues repaired 1 Damp conditions remedied 8 Disinfestations 97 Doors and frames repaired, including locks and fasteners 2 Drainage repaired and/or reconstructed 6 houses (70 ft. of drain laid) Drainage inspection chambers repaired 20 inspection chamber covers renewed 8 drains tested 25 drains cleared (affecting 706 houses) ... 278 waste gullies repaired, renewed or provided 3 waste pipes, repaired, renewed or provided 3 cesspools emptied 1 Dustbins provided 11 Fireplaces ranges or stoves repaired or renewed 3 Floors renewed or repaired 6 Glazing and putty renewed 1 Roofs repaired and made weatherproof 9 downpipe, guttering, repaired and/or renewed 16 Walls rendered or rendering repaired 1 replastered and/or repaired 3 cleansed and redecorated 3 Water supply renewals or repairs 2 W.C. pans and seats repaired, renewed or provided 2 flushing apparatus repaired or renewed 2 Windows repaired and/or renewed 15 Disinfection Fifty-two rooms, 2 shelters and 457 library books were disinfected. One lot of bedding was sterilized and three lots destroyed. 25 Vermin Control Vermin indicative of lack of cleanliness such as infestation by bugs, fleas and lice is now relatively rare. Most of the work done on premises for insect pests is in respect of wasps nests as is indicated by the details given below. Persons. The Council's Cleansing Station in Rochester Road was established late in 1941 to deal with the greatly increased number of cases of personal infestation associated with war conditions which rendered the exercise of adequate personal hygiene very difficult. In 1942, the first full year of the Cleansing Station's operation, no fewer than 973 individuals were treated there. With the return of peace time conditions the situation rapidly improved until now it is only on rare occasions that the services of the Cleansing Station have to be brought into use. In 1962, two families involving nine persons made twenty-seven attendances at the Cleansing Station. Six were cases of pediculosis and three scabies. Six were school children. Premises. During the year 97 premises were treated for the destruction of vermin and insect pests as follows:— Infestation Property Treated by C.U.D.C. Property Treated Total C.U.D.C. Property L.C.C. Property Privately Owned Property By L.C.C. By Owners Ants - _- 7 7 Bugs 3 - 2 - — 5 Fleas — - 1 — 1 Flies - 1 - 1 Insects 7 - 2 - - 9 Wasps 2 2 70 — — 74 12 2 76 — 7 97 Clean Air Act, 1956 Further progress was made in the Council's Scheme drawn up in 1960 to convert the whole district into one complete smokeless zone. The first zone involving 1,440 premises and 139 acres was completed in October 1961 when the first Smoke Control Order became operative. The second zone involving 2,089 premises and 235 acres was completed by 31st December, 1962. The third zone involving 2,642 premises and 262 acres, work on which commenced in 1961, was continued during 1962 and the operative date for the Order has been fixed by the Minister as 1st October, 1963. In march of 1962 the Council agreed the limits of the fourth area to be undertaken which is one bounded on the north by the centre of Thornton Road and by a line along the rear of the houses on the north side of Westminster Road, on the west by the boundary with the Borough of Sutton & Cheam as far south as a point opposite the junction of Duke of Edinburgh Road and Westminster Road, and by a line along the rear of the houses 26 in Westminster Road to the junction of Wrythe Lane, on the south by a line along the centre of Wrythe Lane to Muschamp Road, and along the centre of Muschamp Road to its junction with Green Wrythe Lane, and on the east by the centre of Green Wrythe Lane to its junction with Thornton Road. This area involves 1,768 premises and covers 131 acres. The work of preliminary survey was completed by October 1962, although application to the Minister for an order was not made until after the end of the year. In December 1962 the Council agreed the limits of the fifth area, which is one bounded on the west by the boundary with the Borough of Sutton & Cheam, on the north, from a point opposite the junction with Duke of Edinburgh Road and Westminster Road, by a line along the rear of the houses on the south side of Westminster Road to the junction of Wrythe Lane thence south along the centre of Wrythe Lane to Muschamp Road and along the centre of Muschamp Road to its junction with Green Wrythe Lane, on the east by a line along the centre of Green Wrythe Lane to the junction with Nightingale Road and Wrythe Green, and on the south by a line along the centre of Wrythe Green Road to its junction with West Street, thence along the centre of Wrythe Lane to the junction of Erskine Road, and along the centre of Erskine Road to the district boundary. This area is contiguous to the No. 4 Area and contains approximately 1,340 properties in 141.36 acres. Owing to the length of time involved in connection with each zone, work on as many as three is being carried on simultaneously at, of course, differing stages. Twenty-four complaints, mostly in respect of bonfires, were received and dealt with during the year. Many years ago the Council installed apparatus for measuring atmospheric pollution. This consists of two deposit gauges, one sited in Winchcombe Road and one in Buckhurst Avenue to measure the fall of grit per square mile, also filters for measuring the amount of smoke in the atmosphere and apparatus for the estimation of the sulphur dioxide content of the air by chemical filtration. This equipment is sited at The Lodge in the centre of the district. The recordings taken during the year were as follows Deposit Gauges Gauge Total Rainfall (in inches) Total Solids. Tons per sq. mile Highest Monthly Reading Lowest Monthly Reading Average Monthly Reading B 17.50 17.33 5.27 11.25 C 20.90 14.73 4.93 9.89 27 Month Gauge B Gauge C Rainfall in ins. Total Solids (Tons per sq. mile) Rainfall in ins. Total Solids (Tons per sq. mile) January 3.07 9.99 2.84 10.24 February 0.47 5.65 0.67 4.93 March 1.30 13.53 1.38 14.73 April 1.58 10.41 1.89 12.45 May 1.26 9.86 1.54 10.93 June 0.12 5.27 0.32 9.09 July 2.05 16.42 2.44 11.61 August * — 1.65 9.06 September 2.68 10.51 2.85 9.50 October 1.58 10.13 1.89 7.55 November 1.42 17.33 1.46 7.89 December 1.97 14.61 1.97 10.69 * Gauge tampered with. Smoke and Atmospheric Sulphur Dioxide Month Smoke Microgrammes per cubic meter S.O.2 Microgrammes per cubic meter Highest Reading Lowest Reading Average Reading Highest Reading Lowest Reading Average Reading January 534 11 89 1098 13 196 February 184 2 66 807 24 160 March 349 23 111 525 49 191 April 124 11 49 251 50 108 May 87 1 21 136 13 48 June 30 1 10 128 6 36 July 48 1 13 115 4 30 August 17 1 5 102 14 33 Sptember 72 1 22 93 15 37 October 324 6 105 289 20 110 November 427 0 111 363 8 121 December 897 32 160 981 39 157 Whole year 897 0 63 1098 4 102 Note: Smoke readings by reflectometer and calculated from tables supplied by D.S.I.R. Prevention of Damage by Pests Act, 1949 Six thousand nine hundred and sixteen visits were made by the Rodent Operatives concerning 497 properties and 254 rat and mouse infestations found. Of that number 227 were found in private premises, 21 in business premises and 6 in Council premises. In earlier years it was found that as a result of bait testing of the sewers, it was necessary to carry out two maintenance treatments of the manholes in the district, one in May and one in November. With the steady reduction in the degree of rat infestation, the November treatment was discontinued in 1959. In 1961 the situation had so far improved in that no evidence of infestation of the sewers was found by bait testing and the May maintenance treatment of the manholes was also discontinued. Last year there was again no evidence of rats in the sewers as revealed by bait testing and accordingly no maintence treatments were carried out during the year. 28 Swimming Baths There are two swimming baths in the area, one at the Highfield Hall in the ownership of the Council, which measures 45ft. by 22ft.. The water is subjected to chlorination on the "breakpoint principle" after precipitation and filtration. Eight bacteriological samples taken at Highfield Hall during the season were all satisfactory. The other bath is at the Barrow Hedges Primary School and was built by voluntary funds. Fourteen samples were taken from this bath and all but one were satisfactory. Offices Twenty-seven inspections of offices were made, but no action was necessary. The Regulations which the Secretary of State has power to make under the Offices Act, have not yet been received. Factories, Workplaces and Outworkers The following table gives a summary of the registers:— Employees Premises Males Females Total Factories— with mechanical power 1047 648 1695 104 without mechanical power 42 1 43 11 Workplaces— with mechanical power 14 3 17 14 without mechanical power 27 14 41 28 1130 666 1796 157 The following tables, set out in the manner prescribed by the Home Office Form 572 (revised), indicates the inspections made and action taken under the Factories Act. 1. Inspections for purposes of provisions as to health (including inspections made by the Public Health Inspectors). Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 11 41 1 - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 104 206 3 - (iii) Other premises in which Section 7 is enforced by the Local Authority* (excluding outworkers' premises) 8 27 Total 123 274 4 — * Electrical Station (Section 103(1) ), Institutions (Section 104) and sites of Building Operations and Works of Engineering Construction (Section 107 and 108). 29 2. CASES IN WHICH DEFECTS WERE FOUND:— (If defects are discovered at the premises on two, three or more separate occasions they are reckoned as two, three or more "cases"). Premises Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness Overcrowding — - — - — Unreasonable temperature — - — - — Inadequate ventilation — - — - — Ineffective drainage of floors — - — - — Sanitary Conveniences— - - - - (a) Insufficient — - — - - (b) Unsuitable or defective 4 8 — - — (c) Not separate for sexes — — — - — Other offences against the Act (not including offences relating to Outwork) ■ Total 4 8 — — — Outwork (Sections 133 and 134) Nature of Works Section 133 Section 134 No. of outworkers in Aug. list required by Sect. 133 (1) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwhole some premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing Apparel— Making, etc. 22 — — - — — Boxes (Cardboard) 2 — - — Christmas Crackers 10 - Lampshades 5 — - Paper Hats 1 — Toys (Stuffed) 5 — Umbrellas 1 Wire Brushes 3 — — — — — Total 49 — — — — — Employment Agencies The one employment agency in the district was visited and found to be satisfactory. 30 Shops Act, 1950 There are 503 shop premises on the register and 2,840 inspections were made during the year. Preliminary notices were served with regard to ninety-nine infringements of the statutory requirements, ninety-three for failure to exhibit appropriate notices, and six for Sunday Trading. One hundred and ten notices have been complied with (including fourteen notices outstanding at 31.12.61). Consumer Protection Act, 1961 (Heating Appliances (Fireguards) Regulations, 1953) Two inspections were made under the Act. One informal notice was served and complied with. Merchandise Marks Act, 1926 The Council have continued to execute the provisions of the Orders and their five Sampling Officers are appointed as authorised officers under the Act. Much of the work is done amongst the stall-holders in the district. Pet Animals Act, 1951 Five licenses have been granted in respect of premises used as Pet Shops, all of them dealing with fish and birds. The premises have been inspected and found satisfactory. Rag Flock and Other Filling Materials Act, 1951 Three premises used for upholstering are registered in accordance with Section 2 of the Rag Flock and Other Filling Materials Act, 1951. One sample of new cotton felt was 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 increased to 7 by the inclusion of one additional massage establishment in January. Of the 7, 4 are for the practice of chiropody and 3 for massage etc. All were visited and found to be satisfactorily conducted. National Assistance Acts, 1948—1951 It was not necessary during the year to use the provisions of these Acts which enable the local authority to remove to a place of care, any person who by reason of old age and infirmity is living in insanitary conditions and is for this reason a risk to their own or other peoples' health. Section 50 There was no occasion for the Council to arrange for the burial of any person for whom no other arrangements were being made. 31 Disposal of the Dead Interments of Carshalton residents take place at the cemetery of the Carshalton and Merton & Morden Joint Burial Board situated in Lower Morden, except for those who are buried outside the area. During the year 383 individuals were buried there of whom 53 were residents of Carshalton. In the adjoining Battersea cemetery, the North-east Surrey Crematorium Board operate a crematorium where in 1962 1,264 cremations took place of which 63 were from Carshalton. The Council maintains a mortuary in Mill Lane which is fully equipped with refrigeration storage and facilities for post mortem examination. They have a financial agreement with the Beddington & Wallington and the Coulsdon & Purley Councils, whereby bodies from both these districts are received into the Mill Lane Mortuary. The number of bodies, on all of which autopsies were performed, admitted during the year was as follows:- Ambulance Removals 41 By the Police 3 Via Local Hospitals 17 From Carshalton Homes 59 From Beddington & Wallington 40 From Coulsden & Purley 67 From Other Districts 6 233 The number is 47 higher than in 1961 and has increased two fold in the last 10 years. 32 Section D—Housing New Houses Dwellings completed during the year numbered 26 all of which were in private ownership. The Council's schemes in their various stages were as follows:— In course of erection at 31st December, 1962. Site No. Site Type of Dwelling No. 36 Culvers House Houses 4 Flats 16 Maisonettes 16 38 DENMARK RD FLATES MAISONETTES 44 Total * go In addition 32 private dwellings were under construction at that date. Schemes in preparation:— Site No. Site Type of Dwelling No. 42 Wandle Mead Bungalows 6 Flats 2 Shop 1 Meeting Room hostel for old people 1 1 Culvers Avenue Redevelopment of site of temporary bungalows 71 43 St. Johns Road Houses 7 Bungalows 10 The scheme on site 42 Wandle Mead is held up pending tribunal decision on the use of land. Council's Housing Scheme The dwellings in the ownership of the Council at the end of the year were as follows:— Pre-War Houses 502 Post-War Houses, Flats and Maisonettes 750 Temporary Bungalows 102 Houses taken over under S.D.A.A. & H.A 25 Houses purchased (units of accommodation) 30 Accommodation in Parks, Offices, etc. 18 1427 33 The applications for Council tenancies are divided into three lists A, B and C. List A comprise those with the highest number of points in the Points Scheme "who might reasonably anticipate assistance from the Council in the forseeable future." Admission to List "A" is subject to the family income being below certain limits. List "B" comprise those with somewhat fewer points "who must not expect an offer of accommodation to be forthcoming unless a change of circumstances affecting pointing promotes their application to List "A"." List "C" comprise all the remaining applicants with the lowest points for whom "so far as can be foreseen the Council will not be able to provide accommodation within the Urban District." At the end of 1962 the "A" List totalled 49, the "B" List 67 and the "C" List 469. In addition to which there were 131 on the Housing for the Aged List and 313 applications unclassified since they were of less than three years duration. Three tuberculous families were rehoused. 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) 2,879 (b) Number of inspections made for the purpose 4,307 (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 42 (b) Number of inspections made for the purpose 168 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 42 (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 114 2. Remedy of defects during the year without service of formal notices Number ot defective dwelling houses rendered fit in consequence of informal action by local authority or their officers (including houses inspected during 1962) 90 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 — 34 (b) Proceeding under Public Health Acts (1) Number of dwelling houses in respect of which formal notices were served requiring defects to be remedied 10 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By Owners 6 (b) By Local Authority — 4. Housing Act 1957—Part IV (Overcrowding) (a) (1) Number of dwelling houses overcrowded at the end of the year 10 (2) Number of families dwelling therein 13 (3) Equivalent number of adults dwelling therein 65 (b) Number of new cases reported during the year — (c) (1) Number of cases of overcrowding relieved during the year 2 (2) Number of persons concerned in such cases 16 (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 no cases of overcrowding were found to exist but 2 cases were remedied, leaving 10 dwellings with 65 equivalent adults in occupation overcrowded at the year end. The 2 cases of overcrowding remedied during the year were due to:— Provision of alternative accommodation by London C. C. 1 Removal of one or more occupants 1 Of the 10 dwellings remaining overcrowded at the end of the year 4 are owned by the L.C.C., 3 by Carshalton Urban District Council and 3 are privately owned. The known position of overcrowding at the beginning and end of the year was as follows:— Ward Dwellings overcrowded at 31.12.61 Dwellings found overcrowded during 1962 Dwellings decrowded during 1962 Dwellings remaining over crowded at 31.12.62 Overcrowding cases remedied during 1962 Formal Action Informal Action Total St. Helier North 2 2 St. Helier South 1 - 1 — 1 — 1 S. Helier West 3 - 1 2 - 1 1 North-East 2 - — 2 - — — North-West — - — — - — — Central 2 - — 2 - — - South-West South-East 2 — — 2 - — — Totals 12 — 2 10 1 1 2 35 As stated in previous reports there is no means of ascertaining the exact figure of overcrowding short of a total survey of the district. The figures recorded above are the result of information which comes to us in the course of routine day to day work, but the number of omissions, if any, can only be small since people in such conditions seldom fail to make their needs known. There is no doubt that with shrinkage of the population over the last decade, the average level of housing occupancy has fallen and the average age of the population has risen. If one could redistribute the population among the available accommodation with complete disregard to the occupant's feelings, the housing problem would be much less acute, but ethical considerations make such a course possible only by agreement. Meantime there is need for further accommodation for the elderly whose families have left home and are at present living in dwellings larger than their requirements. Figures in respect of overcrowding obtained in the manner indicated above for the last 10 years were as follows:— Year New Cases Cases at Year End Year New Cases Cases at Year End 1953 53 112 1958 14 33 1954 49 105 1959 12 27 1955 26 73 1960 5 18 1956 27 63 1961 4 12 1957 10 46 1962 0 10 Slum Clearance and Demolition During the year eight families were rehoused from Clearance Area No. 10 (Orchard Hill) leaving three families still in occupation. The rehousing of these families is expected during the early part of next year. In April representations were made to the Council in respect of the following Clearance Areas:— No. 11—North Street involving 13 houses No. 15—St. James Road involving 6 houses No. 16—Mill Lane involving 6 houses No. 22—William Street involving 17 houses The Council decided to proceed by way of Compulsory Purchase Order in respect of Areas Nos. 15 and 16 and by way of Clearance Orders in respest of Areas Nos. 11 and 22. The Minister has confirmed all the orders without modification. Housing Act, 1961—Houses in Multiple Occupation Part II of this Act contains provision for regulations to be made prescribing a code of management to individual houses, for the provision of reasonable facilities and amenities and for limiting the number of occupants where such houses are in multiple occupation. Such regulations were passed in May 1962. As the Minister of Housing states these are strong powers, but they are designed to deal primarily with the worst type of multi-occupied house where nothing less than strong action would be likely to achieve results. As a result of the regulations, standards were adopted in relation to the following matters:— Natural and artificial lighting, ventilation, water supply, personal washing facilities, drainage and sanitary conveniences, facilities 36 for the storage, preparation and cooking of food and for the disposal of waste water, installations for space heating and the prevention or reduction of overcrowding. In regard to personal washing and sanitary conveniences, the provision of one bath and one water closet for every eight occupants was adopted. The standard for the prevention of overcrowding is that of the Housing Act, 1957 but with the addition of 2 adults and 1 child for rooms of 180 sq. ft.—250 sq. ft. and 2 adults and 2 children for rooms larger than 250 sq. ft. Arrangements have been made for the inspection of these houses to commence during the coming year. 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 1 (b) in respect of all defects 1 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule Nil (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule Nil (6) Number of Certificates issued 2 Part II—Applications for Cancellation of Certificate. (7) Applications by landlords to Local Authority for cancellation of certificates Nil (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 Nil 37 Section E—Inspection and Supervision of Food. The work of inspection and supervision of foods is carried out under the provisions of the Food and Drugs Act, 1955 or under the Regulations and Orders made under the Act. They deal mainly with the standards of constitution, correct labelling and the conditions under which food is prepared, stored and sold. Milk Supply Carshalton in common with the rest of Surrey 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 15. Designated licences issued under the Milk (Special Designation) Regulations, 1960 during the year were as follows:— Designation Number of Distributors Holding Licences No. of Licences in force on 31.12.62 Dealers (Pre-packed Milk) Licences Sterilised 13 21 Pasteurised 10 18 Tuberculin Tested 9 17 Bacteriological Examination of Milk One hundred and eighty-two samples of milk were procured and submitted for bacteriological examination. The milks were sold under the Milk (Special Designations) Regulations and all complied with the prescribed Regulations. Classification of the milk samples and the results of the tests are as follows:— Designation under which sold No. of samples Methylene Blue Test Phosphatase Test Turbidity Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised 89 89 — 89 — — — T.T. Pasteurised.. 84 84 — 84 — — — Sterilized 9 — — — — 9 — 182 173 — 173 — 9 — 38 Milk and Dairies (General) Regulations, 1959—Regulations 18 to 20 These Regulations empower the Medical Officer of Health to take appropriate action with regard to milk handlers, utensils and milk when a particular source of milk production is, or where there are reasonable grounds for believing that it is the cause of disease. The occasion to use these powers did not arise during the year. Qualitative Analysis The number of milk samples submitted to the Public Analyst for chemical analysis was 182 of which 23 were "Channel Islands" milk. The latter is required to have 4% of fat as against 3% for ordinary milk. All were satisfactory except two of ordinary milk in which there was a slight deficiency of non fatty solids. The legal standard for solids not fat is 8.5% and the two samples contained 8.37% and 8.44% respectively. The Hortvet freezing test did not however indicate the presence of added water and there is no doubt that these two samples were genuine milk although of poorer quality than usual. The average fat and non fatty solids content of the 23 samples of "Channel Islands" milk was 4.4% and 8.98% respectively. That for the other 159 samples of ordinary milk 3.56% and 8.70%. Ice Cream One hundred and two samples were submitted to bacteriological examination and as in the last four years all were found to be of Grade I standard. There are four grades in the classification recommended by the Ministry of Health which depend upon the number of bacteria present. Bacteria have the power to decolourise a dye known as methylene blue and the greater the number of bacteria the quicker the dye is decolourised. The grades are as follows:— Grade Time taken to reduce Methylene Blue 1 Fails to reduce in 4 hours 2 2½ to 4 hours 3 ½ to 2 hours 4 Immediately Eight samples were chemically analysed by the Public Analyst for quality and all were satisfactory. Ice Cream (Heat-treatment, etc.) Regulations, 1959 There are no manufacturers of Ice Cream in the district all the registered retailers drawing their supplies from reputed manufacturers outside the district. All retailers are provided with refrigerator cabinets which maintain a temperature well below 28 °F. in accordance with the regulations. Bacteriological Examination of Other Foods One sample of beef puree, one sample of horseflesh and one sample of dog meat were sent to the bacteriologist for examination and found to be satisfactory. 39 Meat There are no slaughterhouses in the district, supplies being derived from depots outside the area. Supervision of this commodity is limited to meat stored and exposed for sale. The quantity of meat disposed of as unfit for human consumption during the year was 1,718 lbs. 14 ozs. Analyses of Food and Drugs The samples submitted to the Public Analyst for analysis and compliance with the labelling requirements were as follows:— Article No. Adulterated or otherwise irregular Article No. Adulterated or otherwise irregular Apricot Preserve 1 Instant Coffee 1 Apples 1 Instant Whip 1 Baking Powder 1 Jam Strawberry 1 Banana Gateaux 1 Jelly Table 1 Batter Mix 1 Jellimonge Strawberry 1 Bitter Lemon 1 Jellied Eels 1 Bisto 1 Lemon Juice 1 Blackcurrant Eclairs 1 Lemon Sorbet 1 1 Bread 1 Limmits 1 Butter 1 Linseed Compound 1 Buttered Chocolate 1 Milk 159 2 Butter Drops 1 Milk—Channel Island 23 Cheese Savoury 1 Milk Chocolate Cream Mice 1 Cheese Spread 1 Chocolate Raisins 1 Milk Shake Syrup 1 Chow Mein 1 Mincemeat 1 Chutney 1 Minced Beef 1 Cocoa 1 Nougat 1 Confectionery Flour 1 Orange Drink 2 Cottage Cheese 1 Peanut Butter 1 Cough Mixture 1 Pea Flour 1 Cracker Barrel Cheddar Cheese 1 Raisins Seedless 1 Rice Creamola 1 Cream 1 Sausages Beef 2 Cream Double Devon 1 Sausages Pork 4 Crispbread 1 Sausage Meat Pork 1 Curry Powder 1 Sausage Rolls 1 Cut Peel, Mixed 1 Scotch Shortbread 1 Desiccated Coconut 1 Slim Easy Rolls 1 Dripping 1 Spam 1 Egg Rusks, Toasted 1 Steak & Kidney Pie 1 Fish Sticks 1 Steak & Kidney Pudding 1 Flour Self-Raising 1 Stewed Steak 1 Fruit Mixed 1 Tea 2 Garlic Spread 1 Tripe 1 Golden Buttermints 1 Vanilla 1 Grapefruit Juice 1 Vi-Daylin 1 Ground Rice 1 Vinegar Malt 1 Halibut Oil Capsules 1 Vitamins A & D Tablets 1 Home Made Cake 1 Vitamin C Tablets 2 Horseradish & Beetroot Sauce 1 Yogurt Strawberry 1 278 3 Ice Cream 8 Ice Cream Dairy 3 40 The three samples reported as being irregular were as follows:— Milk (2 samples) These two samples, as mentioned earlier, were both found to be slightly deficient in solids other than fat but the freezing test did not indicate the presence of added water and there is no doubt they were genuine milk samples. Lemon Sorbet This was a sample of fruit juice and ice cream not labelled correctly in accordance with the requirements of the Labelling of Food Order, 1953. After the manufacturers had had their attention drawn to this irregularity, they declared their intention of discontinuing this product and no further action was necessary. Section 9—Sale of Food Unfit for Human Consumption The following complaints were received of foreign matter in foodstuffs:— Metal in tinned beans Glass in jam Perspex in beefburgers Insect in milk Brush bristles in bread Piece of cauliflower in milk Dark substance in bread Maggots in prunes Glass in bread Cloth fibres in sausages Mould in baby food Mildew in sausages Appropriate action was taken where indicated with the vendor and/or manufacturer, but legal proceedings were not deemed warranted in any case. Inspection of Food The following quantities of food found to be unsound, diseased or unwholesome and unfit for human food were surrendered and destroyed or so disposed of as to prevent them from being used for human food:— lbs. ozs. Butter 17 — Confectionery (Flour) — 8 Fish 18 1 Fruit 153 9 Jam 30 13 Margarine 21 8 Meat 1718 14 Milk 36 14 Rice 2 14 Soup 5 1 Spaghetti 6 8 Vegetables 114 8 Total Weight 18 cwts. 3 qtrs. 26 lbs. 2 ozs. The method of disposal is by burning in the Council's Refuse Destructor. Inspection of Food Premises The inspection made under the Food Hygiene Regulations and other statutory powers relating to food with the results of these visits are shown in Table 9. 41 TABLE 9 INSPECTION OF FOOD PREMISES AND ACTION TAKEN Nature of Business Number of Premises Number of premises registered under Section 16 of Food & Drugs Act Number of inspections made Sanitary accommodation Food storage and preparation rooms Accumulations removed Repaired Cleansed and/or decorated Lighting provided Wash-basins provided Water supply provided Wash your Hands Notices Repaired Cleansed and/or decorated Lighting provided Ventilation provided Washing facilities for food and equipment provided First-aid equipment provided Accommodation for clothing provided Bakehouses 3 - 30 1 1 - 1 1 - 1 1 - - - - - 1 Bakers and Confectioners 19 4 91 1 1 2 1 2 - - 2 - - - 1 1 - Butchers 35 31 178 6 5 - - - 1 11 12 - - - - - 3 Canteens 22 — 34 1 - - - - - - - - - - - - - Chemists 17 1 79 - - - - - - - - - - - - - - Confectioners (Sweets only) 68 55 156 1 1 - - — 1 2 4 - - - 1 - - Fishmongers 13 7 77 1 - - - 1 1 1 1 - - 1 - - - General stores 4 4 78 - - - - - - 1 1 - - - - - — Greengrocers and fruiterers 36 5 178 1 3 - - 1 3 2 2 - - - 2 1 1 Grocers (including corn chandlers) 74 29 309 2 3 1 1 2 — 2 5 - - - - 1 1 Licensed premises (with catering facilities) 5 2 54 - - - - - - - - - - - - - - Licensed premises (without catering facilities) 20 — 37 1 1 - - - - 1 - - - - - - - Milk storage depots 3 - 13 1 1 - - - - - 1 - - - - - - Restaurant and Cafes 21 18 88 — 1 1 - 2 — — 4 - - - 1 - - Stalls, food variable — 152 - - - - - - - - - - - - - - Vehicles, food variable — 40 - - - - - - - - - - - - - - Vehicles, Ice cream variable — 11 - - - - - - - - - - - - - - 156 1605 16 17 4 3 9 6 21 35 - - 1 5 4 6 42 Section F—Prevalence of and Control over Infectious and other Diseases. The district has within its boundaries three General Hospitals two of which, namely Queen Mary's Hospital for Children and the St. Helier Hospital, are particularly large institutions which are part of the hospital services of the South-West Metropolitan Hospital Region. Many of the cases notified from these hospitals are admitted there from other districts already suffering from a notifiable disease, but not diagnosed until after admission. In order, therefore, to give a clearer picture of the prevalence of infectious disease in the resident population of the district, separate figures are given in this Section which exclude cases of hospital patients who are not residents of the district. The figures given are after correction for original errors in diagnosis. Notification The following diseases are notifiable in the district— Smallpox Cholera Diphtheria Membranous 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 cases were notified. The disease is no longer endemic in Britain and cases which occur from time to time are invariably importations from abroad. Vaccination against Smallpox Facilities for this preventive service are the responsibility of the County Council under Section 26 of the National Health Service Act. By agreement with the District Councils the arrangements are directed locally by the District Medical Officers of Health. Until recently the existing practice has been to secure vaccination round about the age of three or four months. This was part of a phased programme involving other vaccination and immunising procedures. The Medical Research Council now report that there is evidence that there is a slight advantage to be gained on the score of liability to local reaction, if the treatment is given in the second year of life instead of the first. Although this new timing is likely to become routine procedure, in the event of significant individual risk such as exposure to infection, this should be disregarded and the individual vaccinated forthwith. In January the disease was introduced into the country and a number of cases occurred mostly in the north of England. As a result of the publicity there was a sudden increase in the requests for vaccination and the numbers so treated in 1962 was more than three times that in the year before. 43 The number of persons recorded as having received successful vaccination during the year was as follows:— Age at 31st December, 1962 i.e. Born in Under 1 yr. 1962 1-4 yrs. 1958-61 5—14 yrs. 1948-57 15 yrs. & over 1947 & earlier Total Primary Vaccinations— By Private Practitioners 60 175 342 69 646 At Clinics 110 270 203 58 641 170 445 545 127 1287 Revaccinations— By Private Practitioners — 8 192 88 288 At Clinics — 2 131 180 313 — 10 323 268 601 In addition, the following unsuccessful attempts at vaccination were made:— Age at 31st December, 1962 i.e. Born in Under 1 yr. 1962 1-4 yrs. 1958-61 5—14 yrs. 1948-57 15 yrs. & over 1947 & earlier Total Primary 1 1 4 1 7 Revaccination — 1 4 2 7 1 2 8 3 14 The estimated number of children under five years of age vaccinated at the end of 1962 was 2,136 out of an estimated total in this age group of 3,660. Enteric Fever For the ninth year in succession there was no case of enteric fever. Dysentery As in the year before there was no significant outbreak of dysentery. A form of this infection due to the Sonne organism which produces a relatively mild illness, has in the past decade given rise occasionally to fairly extensive outbreaks particularly in schools. In such circumstances it is difficult to control, due mainly to the fact that the early cases are unrecognised and are believed by parents to be due to dietetic errors, chills or other convenient and common explanation. Moreover medical advice is frequently not sought for cases of diarrhoea, with the result that adequate hygienic precautions are not taken until the infection has become well established. Six cases were notified during the year, two being members of one family, the other four isolated instances, which as far as could be ascertained had no connection. Of the six, two were children under school age, two were primary school children and two were young adults. All recovered. 44 Scarlet Fever Scarlet Fever continues to decline both in incidence and severity. As has been noted in previous reports, the infecting organism is one which is very vulnerable to anti-biotic treatment or sulpha drug therapy. The number of cases fell further from 46 to 31 in 1962, which is the second lowest recorded total for any year. Only two cases were removed to hospital. Twenty years ago the majority of cases which were anything up to ten times the present number, were admitted to isolation hospital. TABLE 10 SCARLET FEVER-DISTRIBUTION OF CASES, 1962 1962 Ward Total St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast SouthWest January - - 1 2 - - - - 3 February - - 1 1 - - - - 2 March - - - - - - - - - April - 1 - 1 1 - - - 3 May - - - - 1 - - - 1 June - - - - - - - - - July - - 1 1 - - - - 2 August - - - - - 1 - - 1 September - - - - 1 - 1 - 2 October 1 - 1 - 1 - 2 - 5 November 1 - 5 - - - - - 6 December - - - 5 - - 1 - 6 Totals 2 1 9 10 4 1 4 - 31 Monthly Mean 0.16 0.08 0.75 0.83 0.33 0.08 0.33 - 2.58 Case rate per 1,000 population 0.28 0.17 1.36 1.12 0.58 0.17 0.46 - 0.54 TABLE 11 SCARLET FEVER-MULTIPLE CASES, 1962 Ward No. of houses in which occurred Total Houses Total Cases 1 Case 2 Cases 3 Cases 5 Cases St. Helier North 1 - - - 1 2 St. Helier South 1 - - - 1 1 St. Helier West 5 - - 1 6 9 North-East 7 - 1 - 8 10 North-West 4 - - - 4 4 Central 1 - - - 1 1 South-East 2 2 - - 4 4 South-West - - - - - - Whole Distric 21 2 1 1 25 31 45 Diphtheria Immunisation As with smallpox vaccination and other immunising procedures, this scheme is the responsibility of the County Council and the arrangements are directed locally by the District Medical Officers of Health. Facilities for treatment exist at all the Infant Welfare Centres and every endeavour is made to secure the immunisation of all infants during the first year of life. Common practice is to combine the treatment with that for whooping cough and tetanus in the same injections. Protection is not permanently insured by the initial course of injections and the original immunity needs to be reinforced thereafter during school life. This is, and has been, accomplished to a very satisfying degree by our being able to visit the primary schools and offer the reinforcing doses on the school premises. In 1962 the number of babies who received this preventive treatment fell by comparison with the year before. Admittedly we have had no diphtheria for 14 years and this of itself could be expected to induce some apathy on the part of parents. But it is only because in the past we have been able to maintain a relatively high rate of immunisation that we have have enjoyed freedom from this highly fatal disease. If the practice were allowed to fall into disuse, it is only a question of time before diphtheria re-appears in the district. In 1962, 545 resident children received a primary course of treatment as follows:— Age at 31.12.62 i.e. born in year Under 1 year 1962 1 year 1961 2 Years 1960 3 years 1959 4 years 1958 5-9 years 1953/ 57 10-14 years 1948/ 52 Total under 15 yrs. At Council Clinics 132 175 12 9 4 13 2 347 In Carshalton Schools — — - - - 19 1 20 Private Practitioners 46 102 3 5 - 1 5 163 178 277 15 14 5 33 8 530 Less outward transfers 2 2 4 1 9 176 275 15 14 5 29 7 521 Plus inward transfers 13 3 — — — 5 3 24 Carshalton residents 189 278 15 14 5 34 10 545 A further 1062 Carshalton children received reinforcing injections during the year. 46 The following table shows the immunisation state of the local child population at the 31st December, 1962:— Number of children at 31st December, 1962, who had completed a course of immunisation at any time between 1st January, 1948 and 31st December, 1962. Age at 31.12.62 i.e. Born in year Under 1 1962 1—4 19581961 5—9 19531957 10—14 19481952 Under 15 Total A. No. of children whose last course (primary or booster) was completed in the period 19561962 214 2290 2995 2635 8134 B. No. of children whose last course (primary or booster) was completed in the period 1957 or earlier - - 343 1133 1476 C. Estimated child population 720 2940 3760 4130 11550 7890 Immunity Index 100 A c 29.6 77.8 71.3 70.4 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 1962 66 90(71*) 83(70*) 0 0.00 (*Immunised within the last 5 years) 47 Erysipelas Two cases of this infection occurred in middle aged women, one was a typical infection of the face and in the other the leg was affected. One received hospital treatment and both recovered. Pneumonia The incidence of primary and influenzal pneumonia is largely an index to the severity of the winter months experienced in any year. In 1962 only 6 cases, all adults, were notified, none of which was said to be of influenzal origin. This is the lowest total yet recorded. Measles The year 1962 was not a "measles year." This in conformity with the long established pattern in the London area followed a year of heavy incidence. Only 59 cases were notified during the year, as compared with 811 in 1961. There were no deaths. TABLE 12 MEASLES—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1962 (Excluding hospital patients non-resident in Carshalton) 1962 Ward St. Helier North St. Helier South St. Helier West North- East Northwest Central SouthEast Southwest Total January 1 — — — — — 6 5 12 February — — 1 — — — 5 — 6 March — — — — 1 — 1 — 2 April — — — — — — — — — May — — — — 1 — — — 1 June — — — — — — 1 — 1 July — — — — — — — — — August — — 1 — — — 3 1 5 September — — — 1 — — 1 — 2 October 1 — 1 — I — 1 — 4 November — — — 1 — — 6 — 7 December 1 1 2 1 1 1 2 10 19 Totals 3 1 5 3 4 1 26 16 59 Monthly Mean 0.25 0.08 0.41 0.25 0.33 0.08 2.16 1.33 4.91 Case rate per 1,000 population 0.43 0.16 0.75 0.33 0.59 0.17 3.05 2.28 1.04 Whooping Cough Since vaccination against whooping cough was practised on a significant scale, the yearly total of cases notified has been persistently below 100, whereas prior to 1954 it was not uncommon to have epidemic conditions giving 300 to 400 cases a year. The low incidence of this disease at 18 cases in 1962 was also a record figure, the previous low being 32 in 1959. No case was fatal. 48 Whooping Cough Vaccination Arrangements for vaccination against whooping cough, like other immunising schemes, is the responsibility of the County Council. The practice has continued to grow until now a good two thirds of the children under 5 years of age have been protected. The number of children vaccinated during the year was 496. The number of cases and the percentage of pre-school 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 1957 61 75 1951 — 471 1958 62 41 1952 — 98 1959 64 32 1953 6 345 1960 66 81 1954 22 154 1961 69 69 1955 36 101 1962 70 18 1956 47 73 TABLE 13 WHOOPING COUGH—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1962 (Excluding hospital patients non-resident in Carshalton) 1962 Ward Total St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest January — — — — — — — — — February — — — — — — — — — March — — — — — — — — — April — — — — — — — — — May — — — 1 — — — — 1 June — — — — — — — — — July — 2 — 3 1 — — — 6 August — — 1 — — — 3 1 5 September — — — 1 — — 1 — 2 October — — — — — — — 2 2 November — — — — — — — — — December — — — — — 1 — 1 2 Totals — 2 1 5 1 1 4 4 18 Monthly Mean — 0.16 0.08 0.41 0.08 0.08 0.33 0.33 1.5 Case rate per 1,000 population — 0.34 0.15 0.56 0.15 0.17 0.46 0.57 0.31 Meningococcal Infection No case of this nature was reported. 49 Poliomyelitis Vaccination In March of 1962 the Ministry of Health made supplies of oral vaccine of the Sabin type available to Local Health Authorities. Supplies of the original Salk vaccine are still available and is used in some instances, but has largely been replaced by the oral type. The scheme as administered by the County Council is available to all persons over 6 months and under 40 years of age and to special groups such as hospital staffs, ambulance men, etc. The number of individuals in the age group 6 months to 40 years vaccinated during the year was as follows:— Salk Vaccine 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 1962 294 1508 227 Young persons born 1933 to 1942 39 Persons born before 1933 94 Others 4 Totals 431 1508 227 Oral Vaccine No. who received their 3rd dose No. given 3rd reinforcing dose after 2 Salk No. given 4th reinforcing dose after 3 Salk Born in 1943-1962 231 82 423 Born in 1933-42 9 12 Born 1932 and earlier 28 30 Totals 268 124 423 These figures do not include the staffs of hospitals. 50 Ophthalmia Neonatorum As in the year before no case of this infection in the eyes of the new born was notified. Cases of this nature have become very uncommon with better prophylactic treatment of the eyes after birth, largely due to the availability of more effective drugs. Only two cases have occurred in the last 8 years and neither of them gave rise to any impairment of vision. Puerperal Pyrexia The number of notifications of puerperal pyrexia in this district is always substantial. The reason for this is that within the boundaries there is extensive maternity hospital accommodation which caters for a large part of Metropolitan Surrey, in which no fewer than 2,300 births took place during the year. Puerperal pyrexia, for purposes of notification, is defined as any rise of 2° of temperature in a woman within 14 days of childbirth or miscarriage. This covers fever of every type of origin and not merely that due to infection of the genital tract. In 1962, 125 cases were notified, only 18 of which were Carshalton mothers. All occurred in local hospitals and none was fatal. Food Poisoning Only one case of food poisoning was notified. The patient was a nurse at a local hospital and as there were no associated cases, there was no indication as to the vehicle of infection, but it was believed to have been contracted outside the hospital. The responsible organism was S. Typhimurium which yielded to treatment after four days. 51 TABLE 14 CASES OF NOTIFIABLE INFECTIOUS DISEASE ADMITTED TO HOSPITAL, 1962 Disease Cuddington Wandle Valley Queen Mary's St. Helier Totals Pneumonia — — — 1 1 Scarlet Fever — 2 — — 2 Erysipelas — 1 — — 1 TOTALS — 3 — 1 4 52 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 Northwest East Northwest Central SouthEast Southwest Scarlet Fever 31 0.54 — 2 1 9 10 4 1 4 — 2 6.45 Measles 59 1.04 — 3 1 5 3 4 1 26 16 — — Whooping Cough 18 0.31 — — 2 1 5 1 1 4 4 — — Dysentery 6 0.10 — 4 — 1 1 — — — — — — Pneumonia 6 0.10 — — — 2 2 2 — — — 1 16.6 Erysipelas 2 0.03 — — — 1 — — — 1 — 1 50.0 Puerperal Pyrexia 18 0.31 — 2 1 2 8 1 2 2 — 18 100.0 Food Poisoning 1 0.01 — — 1 — — — — — — — — 53 TABLE 16 INFECTIOUS DISEASES—Notification by Age Groups, 1962 (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 — 1 1 1 6 18 4 — — — — — 31 Measles 1 2 6 12 9 24 3 1 1 — — — 59 Whooping Cough 2 1 4 2 1 6 1 1 — — — — 18 Dysentery — — 1 — — I 2 2 — — — 6 Pneumonia — — — — — — — — — 2 3 1 6 Erysipelas — — — — — — — — — — 2 — 2 Puerperal Pyrexia — — — — — — — 5 11 2 — — 18 Food Poisoning — — — — — — — — 1 — — — 1 54 TABLE 17 MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1962 (Excluding hospital patients non-resident in Carshalton) Disease Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 3 2 — 3 — 1 1 2 1 6 6 6 31 Measles 6 12 2 — — 2 — 3 4 4 2 24 59 Whooping Cough — — — — 1 — 5 5 3 2 — 2 18 Dysentery 1 — — — 1 — 1 1 — — — 2 6 Pneumonia — 3 1 1 — — — — — 1 — — 6 Erysipelas 1 — — — — — — — — — — — 2 Puerperal Pyrexia — 6 1 — — — 4 — 2 1 1 3 18 Tuberculosis, Pulmonary 2 3 1 — 2 1 1 1 2 — 1 — 14 Tuberculosis, Non-Pulmonary 1 — 1 1 — — — — — — — — 3 Food Poisoning — — — — — — — — — — — — 1 55 Tuberculosis The new cases admitted to the tuberculosis register during the year numbered 49 classified as follows:— Males Females Pulmonary 33 Pulmonary 11 Non-pulmonary 1 Non-pulmonary 4 Of the total additions, 17 were primary notifications, 30 were transferred from other districts and 2 came to notice in other ways. In the same period, 97 names were removed from the register for the following reasons:— Recovered 60 Death 11 Otherwise (including removals) 26 After allowing for the additions and deductions, the state of the register at the 31st December, 1962, was as shown in the following table:— TUBERCULOSIS—WARD DISTRIBUTION Cases on Register at 31st December, 1962 Ward Pulmonary Non-Pulmonary Total Incidence per 1,000 population Males Females Males Females St. Helier North 50 42 5 6 103 14.90 St. Helier South 38 35 9 5 87 14.82 St. Helier West 22 34 2 4 62 9.39 North-East 33 26 3 6 68 7.63 North-West 14 20 2 1 37 5.54 Central 14 21 2 — 37 6.37 South-East 33 18 1 1 53 6.22 South-West 20 16 — — 36 5.13 224 212 24 23 Whole District 436 47 483 8.56 The total of 483 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 durine the year was 19. The number of tuberculous persons who died during the year was 11, distributed by age groups as follows:— Age Years Pulmonary Non-Pulmonary Total Males Females Males Females 0 — — — — — 1— 5 — — — — — 5—15 — — — — — 15—25 — — — — — 25—35 — — — — — 35—45 1 — — 1 45—55 — — — — 55—65 4 — — 1 5 65—up 3 2 — — 5 Totals 8 2 1 11 56 The deaths attributable to tuberculosis were 3 as follows:— DEATHS DUE TO TUBERCULOSIS, 1962 Ward Pulmonary Non-Pulmonary Death Rate per 1,000 population Mean age at Death Male Female Male Female St. Helier North — — — — — — St. Helier South — 1 — — 0.17 73 St. Helier West — — — — — — North-East — — — — — — North-West 1 — 0.14 68 Central 1 — — — 0.17 61 South-East — — — — — — South-West — — — — — — Totals 2 1 — — 0.05 67 Of the 3 persons who died two 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 steady progress in the fight against tuberculosis during the last decade is indicated by the following details of new cases notified and deaths each year, together with the numbers on the register at each year end:— Year New Cases Deaths Number on Register 1952 80 15 885 1953 60 13 901 1954 53 14 894 1955 36 3 857 1956 37 8 814 1957 29 3 111 1958 30 9 736 1959 28 3 666 1960 21 4 579 1961 27 8 531 1962 17 3 483 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. 3 tuberculosis families were rehoused by the Council in 1962. 57 TABLE 18 TUBERCULOSIS. New Cases, Age and Sex Distribution and Manner of Admission to Register, 1962 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 - - - - - - - - - - - - - 5—10 - - - - - - - - - - - - - 10—15 — — — — 1 — — — - — — - 1 15—20 — — — 1 1 — — — — - — — 2 20—25 — — — — — 1 — — — - — — 1 25—35 — 3 — — 10 3 1 1 - — — — 18 35—45 2 — — 1 4 1 — — - — — — 8 45—55 2 1 - 1 2 2 - - - - - - 8 55—65 6 — — — 2 — — — 1 — — — 9 65 up — — — — 1 — — — 1 — — — 2 Totals 10 4 — 3 21 7 1 1 2 — — — 49 17 30 2 58 Carshalton Chest and Heart Care Committee Originally established in the 1930's to assist tuberculous patients and their families, this voluntary Committee has more recently extended the scope of its activities to include patients with chest and heart diseases referred to it from the Chest Clinics and the local hospital. The ways in which these necessitous families are assisted are too diverse to enumerate, but the Annual Report of the Committee refers inter alia to the following:— Grants of clothing, fuel and heating appliances. Provision of rail or coach fares, holidays, materials for occupational therapy, television licences and grants towards purchase of second hand sets. Christmas gifts and organised parties of children to Christmas entertainments such as a circus, pantomimes etc. The income of the Committee, nearly half of which was from the sale of Christmas seals, was £511 in 1962/63 and the expenditure £587 which includes the sum of £21 for administrative expenses. All members and officers give entirely voluntary service. Carshalton Old People's Welfare Committee With the steadily increasing expectation of life the needs of the aged continue to grow. Established only six years ago this voluntary Committee has had a constant struggle to find the means to implement the many schemes necessary for alleviating the difficulties associated with old age. It has already established a meals on wheels service with the assistance of the WVS, a chiropody service, a home visiting service and in conjunction with the Darby and Joan Club in Cooper Crescent, attendance at the Club's centre for the house-bound. The Committee is generously assisted by the District Council, but there is still considerable scope for expansion of its activities when the additional means are available. METEOROLOGY The following rainfall was recorded at the Council's Pumping Station in Buckhurst Avenue. Rainfall 1962 Amount in ins. Rainfall 1962 Amount in ins. January 3.19 July 2.52 February 0.59 August 1.83 March 1.34 September 2.96 April 2.03 October 1.51 May 1.65 November 1.85 June 0.33 December 2.55 Total 22.35 The water flow over the weir on the head of the River Wandle in the grounds of the Grove was as follows:— Total Spring Flow during the year (Jan.—Dec. 1962) = 920.7 million gallons. Maximum Spring Flow 5.67 million gallons per day during weeks ending 15th, 22nd, 29th March and 5th April. Minimum Spring Flow 0.36 million gallons per day during weeks ending 6th and 13th December. 59 INDEX PAGE Acreage 6 Atmospheric Pollution 28 Births— Distribution 10 Institutional 11 Rates 7, 10, 12 Cancer 7, 14, 15 Cemeteries 32 Clean Air Act 26 Clinics and Treatment Centres 20 Closet Accommodation 23 Deaths- Classification 18 Distribution 15 Rates 7, 12, 14 Diptheria 46 Diptheria Immunisation 46 Dysentery 44 Disinfection 32 Drainage and Sewerage 22 Employment Agencies 30 Enteric Fever 44 Erysipelas 48 Establishments for Massage, etc 31 Factories 29 Food— Foods and Drugs Act 39 Hy0giene 41 Inspection and Supervision 38 Poisoning 51 Health Services 19 Heating Appliances (Fireguards) Regulations, 1953 31 Housing— Council's Scheme 33 Inhabited Houses 6 Inspectio 34 Rent Act 37 Overcrowding 35 Slum Clearance 36 Ward Distribution 10 Ice Cream 39 Infant Mortality 7, 17 Infectious Diseases 43, 53 Inquests 16 Isolation Hospital— Admission to 52 Laboratory Facilities 19 60 PAGE Maternal Mortality 7, 17 Measles 40 Meningococcal Infection 49 Merchandise Marks Act, 1926 31 Meteorology 59 Milk Supply 38 Milk and Dairies Regulations, 1959 38 Mortuary 32 Natural and Social Conditions 6 National Assistance Act 31 Offices 29 Outworkers 29 Old Peoples' Welfare 59 Ophthalmia Neonatorum 51 Pet Animals Act, 1951 31 Pneumonia 48 Poliomyelitis 50 Poliomyelitis Vaccination 50 Population 7, 8, 9 Public Cleansing 23 Puerperal Pyrexia 51 Rag Flock and Other Filling Materials Act, 1951 31 Rateable Value 6 Rats and Mice Destruction Rivers and Streams 23 Sanitary Circumstances 21 Sanitary Inspection 23, 24, 25 Scarlet Fever 45 Shops Act 31 Smallpox 43 Staff 5 Statistics— Comparative 13 Vital Swimming Baths 29 Tuberculosi 7, 16, 56 Care Committee 59 Unemployment 9 Vaccination Vermin Control 26 Water Supply 21 Whooping Cough 48 Zymotic Diseases— Deaths from 61