Ac 4413(3) II CAR 28 CARSHALTON URBAN DISTRICT Annual Report OF THE Medical Officer of Health FOR THE YEAR 1963 CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1963 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 1963. The Registrar-General's estimate of the home population at 56,020 indicates that the outward drift of the population still exceeds inward migration and the natural increase. The vital statistics provide evidence that the favourable trend in public health continues. The death rate, although inevitably increasing slightly with the ageing of the population, is still below the national rate, whilst infant mortality at approximately half that for the country as a whole, is much the lowest recorded in the history of the district. One death was ascribed to maternal causes according to the rules of the International Classification of Causes of Death, although the Coroner's Pathologist held the view that the pregnancy played no part in the fatality. Cancer of the lung continues to be of increasing concern, a record high total of 45 deaths from this cause having occurred in the district during the year. This is all the more regrettable since much of the remedy lies in the hands of the cigarette smoking public. Apart from the expected biennial visitation of measles in epidemic form, the incidence of notifiable infectious disease was again generally low. This low prevalence was of course particularly noticeable in those diseases against which effective immunisation procedures have been devised. Poliomyelitis is now coming under the same degree of control as diphtheria and for the fourth year in succession no case was notified. Progress in the preparation of a measles vaccine appears to be making headway and it would seem to be only a question of time before a successful prophylactic procedure becomes available. The number of new cases of tuberculosis and the total on the register continue to fall, both being only half what they were 10 years ago. The sanitary inspectorate, under the skilled guidance of Mr. Surfleet, maintained the high standard of inspection and supervision of environmental conditions, housing and food. New legislation will give additional valuable powers to establish and maintain higher standards for houses let in multiple occupation and for working conditions in offices. Steady progress is being made in dealing with unfit dwellings which while not being numerous present a problem from the point of view of rehousing the occupants who are to be displaced. But for this difficulty progress could have been more rapid. 3 It is gratifying to record that the scheme for converting the whole district into one complete Smokeless Zone under the Clean Air Act, proceeded according to schedule despite some difficulty now being experienced in the supply of smokeless solid fuel. This report may well be the last I shall submit to the Council and it is the thirtieth I have compiled on the health of the Urban District. Looking back in retrospect I have the satisfaction of knowing that they provide a record of steady and continuous progress in the state of public health. Many agencies have contributed to this satisfying effort including the general practitioners, the hospitals, the County health services and not least the Council's own health service which I have had the privilege to direct. The Council and its Public Health Committee have changed their composition not a few times over the years, but I am grateful for the help and encouragement they have invariably given me. Their duties and mine will in April 1965 pass into other hands with the establishment of the London Borough of Sutton. It is to be hoped that the new organisation will provide opportunities for still further promoting the health and welfare of the local community. In conclusion a word of sincere thanks to my staff. Whatever success the department has achieved has been the result of effective team-work and I have been fortunate in having had the tireless and willing co-operation of all those who have served under my direction. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, F. LAWRENCE SMITH, Medical Officer of Health. July, 1964. 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. (left 31/1/63) J. E. Stacey, C.R.S.I. (from 18/3/63) 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 separate dwellings (end of 1963) according to Rate Books 17,647 Rateable Value at 31st December, 1963 £2,293,155 Sum represented by ld. rate £9,351 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 ponds which are fed by the springs and the ornamental waters at the head of the river are a characteristic feature and amenity of Carshalton. The increasing demands for water for domestic purposes throughout the Metropolitan Area has resulted in a progressive increase in the abstraction of the underground supplies in the London basinand thisconstitutesacontinuous threat to the local ornamental waters. The Water Act 1945 provides the Minister with additional powers to conserve water supplies and to restrict further abstraction in special areas such as Greater London to those additional works for which he is prepared to give a licence. The need for more water in the area supplied by the Sutton Water Company including Carshalton, has continued to increase and the Company now propose to sink a further well approximately three quarters of a mile from the ponds and the springs which feed them. How much this will affect the ponds cannot be anticipated, but there can be little doubt that there would be some diminution of the spring flow with a greater risk of drying up of the ponds. If the threat to public health from stagnation of the ponds and the loss of a greatly prized amenity are to be avoided, some expedient such as re-circulation of the river water from a point downstream is essential. The district is mainly residential, there being little industry established locally. It has a large proportion of lower paid workers and consequently the rateable value per head of population is the lowest but one in Urban Surrey. With virtually no room for expansion, the average age of the population continues to rise and the number to fall. 6 SUMMARY OF VITAL STATISTICS FOR 1963 (Based on the Registrar-General's Figures) Population Registrar-General's Estimate ... ... ... 56,020 Births Males Females Total Live (Legitimate) 319 332 651 (Illegitimate) 26 20 46 345 352 697 Birth Rate (per 1,000 population) 12.4 Stillbirths (Legitimate) 1 1 2 (Illegitimate) — 1 1 Stillbirth Rate per 1,000 total births 1 2 3 4.2 Deaths 354 292 646 Death rate (crude) per 1,000 population 11.5 Infant Mortality All deaths under 1 year Infant Mortality Rate (per 1,000 live births) 5 3 8 11.4 Deaths of leg. infants under 1 year Rate per 1,000 legitimate births 4 3 7 10.7 Deaths of illeg. infants under 1 year Rate per 1,000 illegitimate births 1 1 21.7 Maternal Mortality Death from Sepesis Rate per 1,000 births — — — — Death from other causes Rate per 1,000 total births — 1 1 1.42 Maternal Death Rate 1.42 Zymotic Deaths 7 Principal Zymotic Diseases 1 — 1 Deaths from Measles 1 — 1 Deaths from Whooping Cough — — — Deaths from Diarrhoea (under 2 years) — — — Zymotic Death Rate 0.01 Deaths from Tuberculosis All Forms Rate per 1,000 of population 2 2 4 0.07 Phthisis Rate per 1,000 of population 1 2 3 0.05 Deaths from Cancer 76 65 141 Rate per 1,000 of population 2.51 7 The following statistics relating to mothers and infants are set out in the form specially requested by the Minister:— Live Births Number 697 Rate per 1,000 population 12.4 Illegitimate Births per cent of total live births 6.0% Stillbirths Number 3 Rate per 1,000 total live and stillbirths 4.2 Total live and stillbirths 700 Infant Deaths (Deaths under 1 year) 8 Infant Mortality Rates Total infant deaths per 1,000 live births 11.4 Legitimate infant deaths per 1,000 legitimate live births 10.7 Illegitimate infant deaths per 1,000 illegitimate live births 21.7 Neo-natal Mortality Rate (deaths under 4 weeks per 1,000 live births) 8.6 Early Neo-natal Mortality Rate (deaths under 1 week per 1,000 live births) 7.1 Peri-natal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 11.4 Maternal Mortality (including abortion) Number of deaths 1 Rate per 1,000 total live and stillbirths 1.42 The Registrar-General's statistics relating to population, births and deaths differ slightly from those compiled from local records. The total figures in respect of the district as a whole, which are supplied by the Registrar-General, are set out in this report, but where classification has been made, e.g. by age groups, sex, wards, etc., it has necessarily been based on our own records, which may, in the aggregate, show slight discrepancies compared with the Registrar-General's totals. UNEMPLOYMENT The following figures in respect of persons living in Carshalton registered as unemployed at the Sutton Employment Exchange and the Carshalton Youth Employment Bureau at the end of 1963 are supplied through the courtesy of the Exchange Manager and the Youth Employment Officer: Men 75 approx. Women 17 „ Boys 4 Girls 2 The figures are less than those of a year ago. 8 POPULATION The population continues to fall slightly. The Registrar-General's estimate of the home population is given as 56,020, a further decrease of 360 on the year before. Since this fall is primarily due to the outward migration of young married adults seeking new homes, the average age of the population is rising. The number of people aged 60 years and over which was 7,395 in 1951, rose to 10,223 at the census of 1961, a rise from 11.8% of the total population to 17.8%. The following table shows the estimated home population of each ward at the middle of 1963 and is an estimated apportionment of the Registrar-General's total figure for the year. TABLE 1 ESTIMATED HOME POPULATION, MID-1963, BY WARDS Ward Dwellings at Mid-1963 Estimated Population Mid-1963 St. Helier North 2,169 6,810 St. Helier South 1,699 5,800 St. Helier West 2,123 6,500 North-East 2,837 8,850 North-West 2,234 6,750 Central 1,815 5,790 South-East 2,494 8,510 South-West 2,267 7,010 Whole District 17,638 56,020 BIRTHS The number of births continued to fall slightly. Live births registered during the year numbered 697 of which 345 were males and 352 females. This gives a crude birth rate of 12.4 which when adjusted by the RegistrarGeneral's "comparability" factor of 1.03, gives a comparable rate of 12.5 per thousand population. This is the figure which should be compared with the national rate of 18.2. The number of stillbirths established a new low figure, only three being recorded. This gives a stillbirth rate of 4.2 per thousand total births compared with 17.3 for England and Wales. Information is not available as to the home address of births registered to Carshalton residents occurring outside the district. For computation of ward birth rates, therefore, use is made of the notifications of births received under the Public Health Act, supplemented by the local Registrar's weekly returns of registrations within the district. From these sources it is known that 701 live births and 3 stillbirths occurred in 1963. They were distributed as shown in the following table. 9 Ward Live Births Birth Rate per 1,000 Population Stillbirths Stillbirth Rate per 1,000 total births St. Helier North 57 8.3 — — St. Helier South 49 8.4 — — St. Helier West 64 9.8 1 15.3 North-East 129 14.5 2 15.2 North-West 123 18.2 — — Central 87 15.0 — — South-East 102 11.9 — — South-West 90 12.6 — — Total 701 12.5 3 4.2 Eighty-two 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 89 St. Helier South 82 St. Helier West 86 North-East 83 North-West 76 Central 90 South-East 79 South-West 73 Out of 704 total births, 579 took place in the following hospitals:— Live Still Total Carshalton, Beddington and Wallington District (War Memorial) Hospital 130 — 130 St. Helier Hospital 371 1 372 Other Surrey Hospitals 57 1 58 Other Hospitals 19 — 19 Totals 577 2 579 This high proportion of hospital births has been experienced for many years past. TABLE 2 BIRTHS, 1963—DOMICILIARY AND OTHERS—BY WARDS Ward Born in District Born outside District In Hospitals and Nursing Homes In Private Dwellings Total In Hospitals and Nursing Homes In Private Dwellings Total Grand Total St. Helier North 49 6 55 2 2 57 St. Helier South 41 4 45 3 1 4 49 St. Helier West 43 9 58 7(1) — 7(1) 65(1) North-East 103(1) 22(1) 125(2) 6 — 6 131(2) North-West 76 29 105 18 — 18 123 Central 68 9 77 10 — 10 87 South-East 64 21 85 17 — 17 102 South-West 52 24 76 14 — 14 90 Totals 502(1) 124(1) 626(2) 77(1) 1 78(1) 704(3) (Figures in brackets indicate stillbirths included in totals) 10 TABLE 3 BIRTH AND DEATH RATES FOR CARSHALTON, 1922-1963 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 1963 56,020 12.4 11.5 11.4 1.4 11 TABLE 4 COMPARATIVE STATISTICS—1963 England and Wales Carshalton Birth Rate (per 1,000 population) 18.2 12.4 (crude) 12.5 (comp.) Still-birth Rate (per 1,000 total births) 17.3 4.2 Death Rate (per 1,000 population) 12.2 11.5 (crude) 12.4 (comp.) Infant Mortality (per 1,000 live births) 20.9 11.4 Neo-natal Mortality (in first 4 weeks per 1,000 live births) 14.2 8.6 Death rate from Tuberculosis (per 1,000 population) Respiratory Tuberculosis 0.056 0.063 0.053 0.07 Other Tuberculosis 0.007 0.017 Death rate from Cancer (per 1,000 population) All Forms 2.17 2.51 Cancer of Lung 0.51 0.80 Maternal Mortality (per 1,000 total births) Excluding Abortion 0.22 0.28 1.4 1.4 Abortion 0.06 _ COMPARATIVE HEALTH STATISTICS, 1934/63 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 1963 12.2 11.5 20.9 11.4 0.22 1.4 12 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 646, 354 being males and 292 females. This gives a crude death rate of 11.5 per thousand population. The "comparable" death rate produced by the application of the Registrar-General's "comparability factor" of 1.08 was therefore 12.4. That for England and Wales as a whole was 12.2. The crude death rate of 11.5 compares with 10.6 in 1962. The annual rise in this mortality index is to be expected in a population which continues to grow steadily older. The distribution of the deaths by wards was as follows:— WARD DEATH RATES AND MEAN AGE AT DEATH, 1963 Ward Deaths Death Rate (crude) Mean Age at Death St. Helier North 108 15.8 69.1 yrs. St. Helier South 58 10.0 67.5 „ St. Helier West 88 13.5 67.0 „ North-East 77 8.7 64.8 „ North-West 86 12.7 65.9 „ Central 82 14.1 70.1 „ South-East 79 9.2 68.4 „ South-West 69 9.8 72.2 „ Whole District 647 11.5 68.1 yrs. Although 37 more people died in 1963 than in the year before, they died on an average rather more than one year later in life. Heart disease, as always, was the largest cause of death and in this category coronary disease accounted for no less than 135. The second main killing disease was again cancer with the lungs being the most prominent of the sites affected. The deaths from lung cancer was the highest yet recorded at 45. A noteworthy feature is the higher proportion of females among the victims of this lung disease, no less than one third of the total deaths from cancer of thjs site. There can be little doubt that the increasing habit of cigarette smoking among women has considerable significance in this context. DEATHS FROM CANCER OF THE LUNGS 1936-1963 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 1963 45 13 CANCER DEATHS—WARD DISTRIBUTION, 1963 Ward Cancer Deaths Rate per 1,000 Estimated Population M F Total St. Helier North 10 5 15 2.20 St. Helier South 7 5 12 2.06 St. Helier West 11 6 17 2.61 North-East 12 11 23 2.59 North-West 12 13 25 3.70 Central 10 6 16 2.76 South-East 7 10 17 1.99 South-West 7 8 15 2.13 The classification of the cancer deaths by sites affected is given in Table 5. TABLE 5 CANCER DEATHS 1963 Group Site Affected Male Female Total Digestive Organs— 147 Hypopharynx 1 — I 150 Oesophagus 2 — 2 151 Stomach 8 1 9 152 Small Intestine 3 3 153 Colon 4 9 13 154 Rectum 6 3 9 155 Gall Bladder and Liver 1 2 3 156 Pancreas 1 2 3 Respiratory System— 160 Middle Ear — 1 1 161 Larynx 1 — 1 162 Lungs and Bronchi 31 13 44 Breast and Genito-urinary— 170 Breast — 12 12 171/4 Uterus 6 6 175 Ovary — 4 4 177 Prostate 5 — 5 180 Kidney 1 1 2 181 Bladder 2 1 3 Other Sites— 190 Skin 1 1 193 Brain and Spinal Cord 1 1 199 Unspecified 4 3 7 200 Sarcoma of Thigh 1 — 1 201 Lymphatic Tissues 2 2 4 202 Reticulosis — 1 1 203 Myelomatosis — 3 3 237 Eye 1 — 1 76 64 140 Average age at death:— Males 65.8 years Females 65.2 years All persons 65.5 years 14 Mortality from tuberculosis was again low, four deaths being assigned to this cause. The figures for such deaths since 1943 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 1954 ,4 0.22 1944 33 0.63 1955 3 0.04 1945 28 0.51 1956 8 0.13 1946 25 0.41 1957 3 0.04 1947 25 0.40 1958 9 0.14 1948 25 0.40 1959 3 0.04 1949 22 0.35 1960 4 0.06 1950 13 0.20 1961 8 0.14 1951 21 0.34 1962 3 0.05 1952 15 0.24 1963 4 0.07 1953 13 0.21 The distribution of deaths from tuberculosis by wards and other details are given in Section F of this report. There was one death from measles, the first from the common notifiable infectious diseases for many years. Twenty residents lost their lives from violent causes. They were:— Road traffic accidents 8 Falls 5 Burns 1 Suicide 6 Inquests Inquests were held on 43 persons who died in the district. The following verdicts were returned:— Accidents 10 Road Traffic Accidents 12 Falls 4 Suicide 6 Misadventure 5 Natural causes 4 Open verdict 2 Thirteen of these were residents of Carshalton. INFANT MORTALITY The number of children who died in the first year of life was the lowest yet recorded. They totalled eight and this provides much the lowest infant mortality experienced in the district viz. 11.4 per thousand live births. Five of the eight deaths occurred during the first week of life. Six of the total were due to the "unavoidable" causes, such as prematurity and congenital malformations. Two only were the result of infection. The infant mortality rate for England and Wales as a whole was 20.9. 15 TABLE 6 INFANT MORTALITY—WARD DISTRIBUTION Ward Infant Deaths Rate per 1,000 Live Births St. Helier North 1 17.5 St. Helier South 1 20.4 St. Helier West — — North-East — — North-West 1 8.1 Central 4 45.9 South-East 1 9.8 South-West — — TABLE 7 INFANT MORTALITY DURING THE YEAR 1963 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 4 — — — 4 — — — — 4 Congenital Malformation 1 — — 1 2 — — — — 2 Pneumonia — — — — — — 1 — — 1 Virus Infection — — — — — — — 1 — 1 Totals 5 — 1 6 — 1 1 — 8 MATERNAL MORTALITY The death of one woman who died of pelvic thrombosis was ascribed by the Registrar-General to maternal causes since the deceased was 8 weeks pregnant at the time. The cause of death as certified by the Coroner's pathologist did not include pregnancy. This allocation provides a maternal death rate of 1.4 per thousand deaths. 16 17 TABLE 8 (MALE) — CAUSES OF DEATH DURING THE YEAR 1963 — By Age No Cause of Death Total All Ages Under 4 weeks 4 weeks and under 1 year Age in Years 1 — 5 — 15 — 25 — 35 — 45 — 55 — 65 — 75 &over 1 Tuberculosis, Respiratory 1 — — — — — — — — 1 — — 2 Tuberculosis, other 1 — — — — — — — — 1 — — 3 Syphilitic Disease 1 — — — — — — — — 1 — — 8 Measles 1 — 1 — — — — — 9 Other Infective and Parasitic Diseases 1 — — — — — — — — 1 — — 10 Malignant neoplasm, stomach 8 — — — — — — — — 2 3 3 11 Malignant neoplasm, lung, bronchus 31 — — — — — — — 2 15 11 3 12 Malignant neoplasm, breast — — — — — — — — — — — — 14 Other malignant and lymphatic neoplasms 37 — — 1 — — 1 — 2 12 11 10 15 Leukaemia, Aleukamias 1 — — — — — — — — — — 1 16 Diabetes 3 — — — — — — — — — 2 1 17 Vascular lesions of nervous system 25 — — — — — — — 1 4 8 12 18 Coronary Disease, Angina 96 — — — — — — 3 4 35 33 21 19 Hypertension with heart disease 4 — — — — — — — — 1 1 2 20 Other heart disease 28 — — — — — 2 1 1 5 6 13 21 Other circulatory disease 16 — — — — — — — — 3 6 7 22 Influenza 1 — 1 — — — — — — — — — 23 Pneumonia 17 1 1 1 3 1 10 24 Bronchitis 35 — — — 1 — — 1 — 9 14 10 25 Other diseases of respiratory system 2 — — — — — — 1 — 1 — — 26 Ulcer of Stomach and duodenum 2 — — — — — — — 1 — — 1 27 Gastritis, enteritis and diarrhoea — — — — — — — — — — — — 28 Nephritis and nephrosis 5 — — — — — 1 — — 1 2 1 29 Hyperplasia of prostate 2 — — — — — — — — — — 2 31 Congenital malformations 1 — — — — — — 1 — — — — 32 Other defined and ill-defined diseases 21 2 — — — 1 1 — — 7 5 5 33 Motor Vehicle accidents 5 — — — — 1 1 — 1 1 — 1 34 All other accidents 5 — 1 — — 1 1 — 1 1 35 Suicide 4 — — — — 1 — 1 1 — 1 — Total All Causes 354 3 2 2 3 3 6 9 14 103 105 104 18 TABLE 8 (FEMALE) — CAUSES OF DEATH DURING THE YEAR 1963 — By Age No Cause of Death Total All Ages Under 4 weeks 4 weeks and under 1 year Age in Years 1 — 5 — 15- 25 — 35 — 45 — 55— 65 — 75 &over 1 Tuberculosis, Respiratory 2 — — — — — — — 1 1 2 Tuberculosis, other — — — — — — — — — — — — 3 Syphilitic Disease 1 — — — — — — — — — 1 — 8 Measles — — — — — — — — — — — 9 Other Infective and Parasitic Diseases — — — — — — — — — — — — 10 Malignant neoplasm, stomach 1 — — — — — — — — — 1 — 11 Malignant neoplasm, lung, bronchus 14 — — — — — — — 4 5 3 2 12 Malignant neoplasm, breast 12 — — — — — — — 2 2 4 4 13 Malignant neoplasm, uterus 7 — — — — — — I — 2 2 2 14 Other malignant and lymphatic neoplasms 31 — — 1 — — — 1 3 6 13 7 15 Leukaemia, Aleukæsmias 1 — — — 1 — — — 16 Diabetes 1 — — — — 1 17 Vascular lesions of nervous system 49 — — — — — — — 2 6 13 28 18 Coronary Disease, Angina 39 — — — — — — 1 2 4 16 16 19 Hypertension with heart disease 2 — — — — — — — — — 1 1 20 Other heart disease 39 — — — — — — — — 5 4 30 21 Other circulatory disease 16 — — — — 1 — — 1 2 4 8 22 Influenza — — — — — — — — — — — — 23 Pneumonia 20 1 — — — 4 4 11 24 Bronchitis 19 — — — — — — — 1 4 14 25 Other diseases of respiratory system — — — — — — — — — — — — 26 Ulcer of Stomach and duodenum 3 — — — — — — — — 1 2 — 27 Gastritis, enteritis and diarrhoea 1 — — — — — — — — 1 — 28 Nephritis and nephrosis 3 — — — — — — — — 2 1 — 30 Pregnancy, childbirth, abortion 1 — — — — 1 — — — — — — 31 Congenital malformations 2 2 — — — — — — — — — — 32 Other defined and ill-defined diseases 22 1 — 1 — 1 1 1 1 1 3 12 33 Motor Vehicle accidents 1 — — — — — — — 1 34 All other accidents 3 — — — — — — — — — — 3 35 Suicide 2 — — — — — — — — — 1 1 Total All Causes 292 3 — 3 1 3 1 4 16 43 77 141 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 146 Rectal 3 Urine 15 Water (Public Supply): For chemical analysis 3 For bacteriological examination 5 Water (Swimming Baths): For bacteriological examinations 20 Food and Drugs: Analysis 263 Bacteriological examination of milk 163 Bacteriological examination of ice cream 103 Bacteriological examination of other foods 4 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 Maternity Clinic Toddler Clinic Dental Clinic Massage Clinic Tues. and Thurs. 2—4 p.m. Thursdays 10—12 noon 1st 2nd and 3rd Mons. 2—4 p.m. By appointment By appointment Green Wrythe Lane Centre: Infant Welfare Clinic Maternity Clinic Toddler Clinic Dental Clinic Massage Clinic Relaxation Classes Weds, and Fridays 2—4 p.m. Tuesdays 10—12 noon 1 st 2nd 3rd and 4th Tues. 2—4 p.m. By appointment By appointment By appointment Alexandra Gardens, Stanley Road Centre: Infant Welfare Clinic Maternity Clinic Toddler Clinic Relaxation Classes The Mount Centre, Coulsdon: Infant Welfare Clinic Maternity Clinic Toddler Clinic Fridays Fridays 1st and 3rd Thurs. By appointment Wednesdays Tuesdays 2nd Thursday 2.15—4 p.m. 2—2.15 p.m. 2—4 p.m. —3.30 p.m. 2—3 p.m. 2—4 p.m. School Health Service—General Medical Clinics. Rochester Road Centre Alexandra Gardens, Stanley Road Centre Green Wrythe Lane Centre Wednesdays Fridays Mondays Mondays Thursdays Weds. etc. Middleton Road Centre, Morden Dental, eye and special clinics for child guidance, are provided, attendance at which is by appointment. 2—4 p.m. 2—4 p.m. 9.30—12 noon 9.30—12 noon 2—4 p.m. 9.30—12 noon speech therapy, 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 Venereal Disease Clinics, St. Helier Hospital Mons. and Thurs. 2 p.m. Wednesdays 9.30 a.m. Mondays (Males) 4.30—6.30 p.m. Tuesdays (Females) 5—7 p.m. Fridays (Females) 2—4 p.m. 20 Section C—Sanitary Circumstances Water Supply With the exception of some 200 dwellings in the extreme north of the district, the area is supplied by the Sutton District Water Company. The Company draws its supplies from wells in the chalk sited at Woodmansterne, Sutton and Cheam. Supply can be augmented if necessary by the Metropolitan Water Board, the East Surrey Water Company and the Epsom and Ewell Corporation's undertaking. There are a few private wells at the St. Helier Hospital, the Muschamp Road and West Street laundries, at St. Philomena's School and the British Industrial Solvents in Mill Lane. The Water Company is under statutory obligation to soften the chalky water to 9° of hardness. The water is subjected to a purification process which includes chlorination. It is not plumbo-solvent. Control over the purity of the supply is provided by the Company's own laboratory which is in the charge of a full time chemist/bacteriologist, who makes daily examinations of the raw and finished waters. Tests are also carried out for the Company by an independent firm of water chemists. The Public Health Departments of the Councils in the distribution area also test the supply on an agreed rota at monthly intervals. The supply was completely wholesome and adequate throughout the year. The following information as to the tests carried out by the Company is supplied by courtesy of the Company. Sample Total No. of Bacteriological Examinations Total No. of full Chemical Analyses No. and % of samples showing ColiAerogenes in 100 ml. (Excluding B.Coli 1) No. and % of samples showing B. Coli present in 100 ml. of sample (Type 1) Total No ColiAero genes Organisms in 100 ml. of sample No. % No. % Sutton Raw 308 52 8 2.6 11 3.7 19 Sutton Finished 310 12 2 0.7 2 0.7 4 Woodmansterne Raw 310 52 Nil Nil 3 1.0 3 Woodmansterne Finished 310 12 Nil 3.9 Nil Nil Nil Cheam 310 52 4 1.3 Nil Nil 4 Reservoir 317 4 4 1.3 2 0.7 6 District 301 6 12 4.0 3 1.0 15 Total 2,166 190 30 21 51 21 The following is the report on a representative sample taken by the Council's Public Health Department:— (a) Physical Examination Colour Faint blue Taste normal Appearance Bright and clear Smell none Electric Conductivity at 20 °C 295 reciprocal megohms. (b) Chemical Examination in parts per million Total solids dried at 180°C 230 Chlorine in Chlorides as Chlorion 20.0 Nitrite Nitrogen 0.0 Nitrate Nitrogen 10.5 Ammoniacal Nitrogen 0.00 Albuminoid Nitrogen 0.01 Oxygen absorbed in 4 hours at 27 °C 0.08 Alkalinity as CaCO3 68 Hardness as CaC03— Carbonate 68 Non-carbonate 68 Total 136 Free Carbon dioxide as CO2 — Residual Chlorine Trace 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 0 Bacteria of indication enumeration :— Organisms of the coliform group 0 per 100 ml. Streptococci 0 do. CI. welchii 0 do. Remarks : This water is of good organic purity, attractive in appearance and is free from contaminating metals. It is of very moderate hardness and salinity. The bacteriological condition of the water is excellent. As judged by this examination, the water is pure and wholesome and is suitable for the public supply. Owing to the increasing demands, the Company is now seeking powers to sink another well in Woodmansterne Road from which they hope to extract an average of two million gallons per day. Drainage and Sewerage Sewage is pumped to the disposal works of the Croydon Corporation at Beddington by way of two 21" mains. The pumping machinery is electrically driven and difficulty has been experienced in recent years through breakdown of the electric power. When such a breakdown lasts for more than a few hours as it did on the 26th January, 1963, the pumping station becomes flooded and crude sewage finds its way by gravitation to the adjoining River Wandle. Unfortunately in the absence of any constructed channel it does so by way of the gardens and surrounds of several houses in Buckhurst Avenue. To guard against this risk the Council have authorised the installation of stand-by diesel generators. Meantime a portable generator was hired to cope with any such emergency pending the completion of the new generator. Leaks which occurred at the joints in the 21" mains located in Messrs. Mullards works were repaired and consulting engineers are investigating the cause of the joint failures. An application was made to the Surrey County Council for permission to construct an emergency overflow from the pumping station to the River Wandle, should 22 failures occur in both the 21" rising mains. This was refused by the County Council and the Minister of Housing and Local Government following a private inquiry. Admittedly it is a remote contingency the Council wish to guard against, but should both rising mains be put out of action at the same time nothing can prevent sewage flooding the grounds of houses in Buckhurst Avenue and subsequently finding its way into the river. The following sewerage works were undertaken during the year: a new short length of surface sewer in Strawberry Lane in connection with development in Denmark Gardens and Strawberry Lane—a short length of new soil sewer in Farm Road in connection with private development— reconstruction of a short length of deep soil sewer in Blakehall Road which had collapsed, additional manholes being provided whilst the work was in progress—new surface soakaways constructed in Woodmansterne Road, Gordon Road, Furzedown Road and Beddington Gardens. The usual routine clearing and inspection of soil and surface water sewers, maintenance of soakaways and replacement as necessary of gulley gratings and frames, manhole covers and frames have been carried out. Four hundred and thirty-six drainage obstructions affecting 1,054 houses were dealt with during the year. Rivers and Streams Reference was made in last year's report to the improvement scheme being carried out on the River Wandle by the Surrey County Council which commenced at the County boundary and proceeded up river. Work started in the Carshalton reach during the year on the regrading and realignment of that part of the river located in this district. Another short length of walling has been constructed to the bank of the canal in The Grove. Closet Accommodation All dwellings have water closets drained to the public sewers except 13 which have cesspool drainage. Public Cleansing No changes have been made in the method of refuse collection which provides for a weekly collection of domestic refuse and incineration in the Council's destructor. The separate trade refuse collection service introduced in the previous year was continued. Approval has been given to the construction of a new paper baling shed which it is hoped to commence shortly. The salvage of saleable commodities such as paper, tins, metals, bottles and jars was continued. Destructor clinker has been tipped at the Council's tip in Carshalton Road, Woodmansterne. Screenings surplus to requirements have been disposed of to a private contractor. 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. 23 Investigations were made with regard to 1,208 complaints as follows:— Accumulations 31 Animals so kept 2 Burst pipes 7 Clean Air Act—Contraventions 18 Dampness 10 Drainage defects 23 Drains obstructed 491 Dustbins 11 Food contaminated 14 Food unsound 43 General defective conditions 43 Insects and Pests 126 Litter Act—Contraventions 1 Miscellaneous 26 Noise Act 3 Obnoxious affluvia 48 Overcrowding 3 Refuse collection 13 Rivers 1 Rodents 254 Roofs defective 17 Sewer obstructions 5 Shops Act—Contraventions 2 Sink Waste pipes 2 Verminous premises 4 Water supply 10 1,208 Eleven thousand two hundred and forty-nine visits of inspection and re-inspection were made for the purposes set out below:— Clean Air Act 1,216 Consumer, Protection Act, 1961 1 Employment Agencies 1 Factories (Mechanical Power) (incl. Laundries 14) 185 Factories (Non-Mechanical Power) 24 Factories (Building Sites) 28 Food and Drugs (incl. Food Byelaws) 954 Food Poisoning Enquiries 5 Food premises : Bakehouses 50 Bakers and confectioners 75 Butchers 171 Canteens 17 Canteens—Schools 23 Chemists 43 Confectioners (sweets only) 128 Fishmongers 83 General Stores 79 Greengrocers and fruiterers 163 Grocers 288 Licensed premises with catering facilities 55 Licensed premises without catering facilities 30 Milk storage depots 16 Ice cream Factorie 2 Ice cream Vehicles 11 Restaurants and cafes 122 Stalls, food 109 Tea packer 5 Vehicles, food 20 1,490 Hairdressers 42 House drains tested 36 Housing Act 315 Housing Land Charges 1,190 24 Infectious Disease Premises 57 Insect Pests 282 Licensing Act 22 Merchandise Marks Act 108 Noise 24 Offices 4 Outworkers Premises 80 Pet Animals Act 4 Piggeries 22 Premises re cesspools 1 Public Health Act (Houses) 2,092 Public Health Act re-inspections 1,772 Rent Act 14 Rodents 434 Rag Flock and Other Filling Materials Act 1 Schools 14 Shops 766 Urinals 41 Water Sampling 24 11,249 Three hundred and eighty-five informal notices were served concerning the following matters:— Accumulations and deposits 39 Clean Air Act 6 Drainage Defects 77 Dustbins 8 Factories Act 8 Food and Drugs Act (incl. Food Byelaws) 89 Food contaminated 4 General defective conditions 85 Housing Act 8 Licensing Act 1 Miscellaneous 4 Noise Act 1 Prevention of Damage by Pests Act 6 Shops Act 40 Water supply 9 385 Thirty-one formal notices were served by authority of the Council under the following Acts:— Public Health Act, 1936 Section 24 9 „ „ Section 39 10 „ „ „ „ Section 45 4 „ Section 93 8 31 As a result of investigations made and notices served, the following work was carried out:— Accumulations removed 21 Ceilings cleansed 2 Ceiling plaster repaired and/or made good 2 Chimney Flues repaired 1 Damp conditions remedied 13 Disinfestations 94 Doors and frames repaired, including locks and fasteners 7 Drainage repaired and/or reconstructed 14 houses (55ft. of drain laid) 25 Drainage inspection chambers repaired 32 inspection chamber covers renewed 18 drains tested 12 drains cleared (affecting 1,054 houses) 436 waste gullies repaired, renewed or provided 5 waste pipes, repaired, renewed or provided 5 cesspools emptied 1 drains sealed off 53 Surface water drainage repaired 4 Dustbins provided 7 Fireplaces ranges or stoves repaired or renewed 5 Floors renewed or replaced 3 Glazing and putty renewed 1 Paving repaired 2 Roofs repaired and made weatherproof 16 downpipe, guttering, repaired and/or renewed 23 Walls rendered or rendering repaired 2 replastered and/or repaired 4 cleansed and redecorated 2 Wash basin and baths renewed 2 Water supply renewals or repairs 10 W.C. pans and seats repaired, renewed or provided 8 flushing apparatus repaired or renewed 8 Windows repaired and/or renewed 12 Disinfection Sixty-seven rooms and 530 library books were disinfected. One lot of bedding was destroyed. Vermin Control Persons During the second World War the Council adapted part of the Municipal Institute in Rochester Road as a cleansing station to deal with persons and their personal clothing who had become verminous, particularly as a result of infestation with scabies. With the return of better conditions following the cessation of hostilities, the number of cases requiring to be dealt with at the cleansing station rapidly declined and in recent years it has only been used infrequently. With more effective insecticides, it is now possible to deal with the cases of minor infestation at home. Eight persons attended the cleansing station in 1963, all for the treatment of scabies. Three of these were school children. Premises During the year ninety-four premises were treated for the destruction of vermin and insect pests as follows:— Property Treated by C.U.D.C. Infestation C.U.D.C. Property Privately Owned Property Property Treated by Owners or Occupiers Total Ants - 1 - 1 Bugs 2 — — 2 Fleas 2 1 — 3 Flies 1 - — 1 Insects 1 2 - 3 Wasps 3 81 — 84 9 85 - 94 26 Clean Air Act, 1956 At the end of the year 3 Smoke Control Orders were in operation involving 6,171 premises and 636 acres. The fourth Order involving a further 1,768 premises in 131 acres was confirmed by the Minister in July 1963 and comes into operation on the 1st October, 1964. The survey of the fifth zone referred to in last year's report was completed by the end of 1963 and affects 1,325 premises in an area of 141.36 acres. Eighteen complaints were received and dealt with during the year. The apparatus maintained by the Council for measuring atmospheric pollution consists of 2 deposit gauges sited in Winchcombe Road (B) and Buckhurst Avenue (C), filters for measuring the smoke in the atmosphere and a filtration apparatus for estimating the sulphur dioxide content. The latter two are sited at The Lodge. The recordings taken during 1963 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 22.34 28.36 4.80 11.51 C 22.82 13.16 6.10 9.27 Gauge B Gauge C Month Rainfall in ins. Total Solids (Tons per sq. mile) Rainfall in ins. Total Solids (Tons per sq. mile) January 0.87 15.05 0.59 11.47 February 0.39 13.33 0.39 8.56 March 3.23 28.36 3.27 13.16 April 2.52 14.11 2.49 12.16 May 1.54 8.62 1.66 8.06 June 1.85 10.06 1.69 10.20 July 1.26 4.80 1.38 6.10 August 3.43 8.63 3.55 7.55 September 1.97 6.67 1.97 6.27 October 1.30 6.22 1.38 7.99 November 3.39 12.62 3.82 10.91 December 0.59 9.66 0.63 8.83 27 Smoke and A tmospheric 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 521 37 159.3 659 102 259.0 February 289 54 146.8 574 81 310.6 March 188 15 74.6 393 31 118.0 April 140 8 58.6 341 50 140.5 May 116 2 74.5 226 29 80.3 June 69 43 59.0 283 14 72.9 July 44 0 14.0 130 14 48.5 August 42 3 14.0 274 16 63.8 September 98 16 42.6 179 24 76.1 October 147 23 58.1 216 33 75.4 November 243 13 70.0 324 12 80.5 December 410 30 162.0 603 38 291.0 Whole year 521 0 77.7 659 12 134.7 Note: Smoke readings by reflectometer and calculated from tables supplied by D.S.I.R. Prevention of Damage by Pests Act, 1949 Six thousand eight hundred and eight visits were made by the Rodent Operatives concerning 451 properties and 263 rat and mouse infestations found. Of that number 237 were found in private premises, 22 in business premises and 4 in Council premises. The sewers in the district were bait tested during the month of May and no evidence of rat infestation was found. Swimming Baths There are two swimming baths in the district, one maintained by the Council at the Highfield Hall, the other sited at the Barrow Hedges County Primary School and used as part of the school activities. Both are fitted with purification plants using chlorine as the sterilant. Twelve samples of the bath water from the Highfield Bath and 8 from Barrow Hedges were all entirely satisfactory. Offices Four inspections were made during the year, but no action was necessary. Factories, Workplaces and Outworkers The following premises are registered:— Employees Premises Males Females Total Factories— with mechanical power 961 591 1552 106 without mechanical power 37 - 37 9 Workplaces— with mechanical power 14 3 17 14 without mechanical power 24 12 36 26 1036 606 1642 155 28 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 (1) Number on Register (2) Number of Inspections (3) Written Notices (4) Occupiers Prosecuted (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 9 24 1 - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 106 185 7 - (iii) Other premises in which Section 7 is enforced by the Local Authority* (excluding outworkers' premises) 15 28 — — Total 130 237 8 — * Electrical Station (Section 123(1)), Institutions (Section 124) and sites of Building Operations and Works of Engineering Construction (Section 127). Slaughterhouses, (Section 175(l)(d) and (e)) and Railway Running Sheds (Section 175(2) and (10)). 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"). Number of cases in which defects were found Number of cases in which prosecutions were instituted Premises Found Remedied Referred To H.M. Inspector By H.M. Inspector (0) (2) (3) (4) (5) (6) Want of cleanliness 2 - - - — Overcrowding — — - - — Unreasonable temperature — — - - — Inadequate ventilation — — - - — Ineffective drainage of floors — — - - — Sanitary Conveniences— (a) Insufficient — — - - — (b) Unsuitable or defective 6 4 - - — (c) Not separate for sexes — — - - — Other offences against the Act (not including offences relating to Outwork) - - - - — Total 8 4 — — — 29 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. 15 — - — — - Boxes (Cardboard) 1 — - — — - Lampshades 35 — - — — - Paper Hats 7 — - — — - Toys (Stuffed) 6 — - — — - Umbrellas 1 — - — — - Wire Brushes 2 - — — - Total 67 — — — — — Employment Agencies Only one employment agency is licensed in the district under the Surrey County Council Act 1925. It was visited and found satisfactory. Shops Act, 1950 There are 504 shop premises on the register and 2,338 inspections were made during the year. Preliminary notices were served with regard to forty infringements of the statutory requirements, twenty-seven for failure to exhibit appropriate notices, six for Sunday Trading, five for inadequate heating and two for absence of seats for females. Thirty-eight notices have been complied with (including three notices outstanding at 31/12/62.) Consumer Protection Act, 1961 (Heating Appliances (Fireguards) Regulations, 1953) One inspection was made under the Act and as a result one informal notice was served and complied with. Merchandise Marks Act, 1926 The Council's Public Health Inspectors execute the provisions of the Orders made under this Act. Pet Animals Act, 1951 Five licenses have been issued in respect of premises used as pet shops all dealing with fish and birds. Inspections of all were satisfactory. 30 Rag Flock and Other Filling Materials Act, 1951 Three premises used for upholstering are registered in accordance with Section 2 of the Rag Flock and Other Filling Materials Act, 1951. One sample of new coire fibre was taken and proved to be satisfactory. The prescribed Analyst is Mr. G. S. Ginger of Westfield House, Henleyon-Thames, Oxfordshire. Establishments for Massage and Special Treatment Six establishments are licensed under Part IV of the Surrey County Council Act, 1931, 4 for chiropody and 2 for massage etc. Visits of inspection found that all were being conducted satisfactorily. National Assistance Acts, 1948—1951 It was not necessary to invoke the power provided by these Acts to require any person to be removed to a place of care on account of old age and infirmity and living in insanitary conditions. Nor was it necessary for the Council to arrange under the provisions of these Acts for the burial of a person for whom no such arrangements were otherwise being made. Disposal of the Dead The Council provides a public mortuary in Mill Lane equipped with refrigeration storage and full facilities for post mortem examination. Under financial arrangements with the respective Councils, bodies are received from Beddington & Wallington and Coulsdon & Purley. The number of bodies received during 1963 on all of which autopsies were performed was as follows:— Ambulance Removals 39 Via Local Hospitals 25 From Carshalton homes 63 From Beddington and Wallington homes 38 From Coulsdon and Purley homes 86 From Other Districts 10 261 Interments in the cemetery of the Carshalton, Merton & Morden Joint Burial Board situate in Lower Morden totalled 379 during the year and of these 144 were from Carshalton. At the North-East Surrey Crematorium which adjoins the Joint Board's burial ground, 1471 cremations took place and of these 105 were from Carshalton. 31 Section D—Housing New Houses The dwellings completed during the year numbered 114 as follows:— Private Dwellings 34 Council Dwellings 80 Dwellings in course of erection at 31st December, 1963 were:— Private Dwellings 164 Council Dwellings 17 (Site 43—St. Johns Road) Schemes in course of preparation were as follows:— Site 1 Culvers Avenue — Redevelopment of site of temporary bungalows to provide 238 dwellings. „ 41 The Mount — Probably 15 dwellings. „ 31 Stanley Road — (Stage III) Probably 9 dwellings. „ 45 Mill Lane — Probably 6 dwellings. The Ministry's enquiry into the Council's proposed use of the land in Wandle Mead for the housing of 74 old people resulted in the Council's proposals being rejected. 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 839 Temporary Bungalows 67 Houses taken over under S.D.A.A. and H.A. 25 Houses purchased 31 Accommodation in Parks, Offices, etc. 22 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 fore-seeable 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 fore-seen the Council will not be able to provide accommodation within the Urban District." At the end of 1963 the "A" List totalled 27, the "B" List 44 and the "C" List 452. In addition to which there were 165 on the Housing for the Aged List and 359 applications unclassified since they were of less than three years duration. One tuberculous family was rehoused. 32 Inspection and Action taken under Statutory Powers 1. Inspection of Dwelling Houses during the year (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 2,444 (b) Number of inspections made for the purpose 4,216 (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 1 (b) Number of inspections made for the purpose 8 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (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 173 2. Remedy of defects during the year without service of formal notices Number of defective dwelling houses rendered fit in consequence of informal action by local authority or their officers (including houses inspected during 1963) 131 3. Action under Statutory Powers during the year (a) Proceeding under Sections 9,10 and 12, of the Housing Act, 1957. Number of dwelling houses in respect of which notices were served requiring repairs — Number of dwelling houses which were rendered fit after service of formal notices:— (a) By Owners — (b) By Local Authority in default of owners — (b) Proceeding under Public Health Acts (1) Number of dwelling houses in respect of which formal notices were served requiring defects to be remedied 26 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By Owners 11 (b) By Local Authority 8 4. Housing Act 1957—Part IV (Overcrowding) (a) (1) Number of dwelling houses overcrowded at the end of the year 8 (2) Number of families dwelling therein 9 (3) Equivalent number of adults dwelling therein 55½ (b) Number of new cases reported during the year 3 (c) (1) Number of cases of overcrowding relieved during the year 5 (2) Number of persons concerned in such cases 28½ (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 — 33 Overcrowding During the year 3 cases of overcrowding were found to exist but 5 cases were remedied, leaving 8 dwellings with 55½ equivalent adults in occupation overcrowded at the year end. The 5 cases of overcrowding remedied during the year were due to:— Provision of alternative accommodation by:— Carshalton U.D.C. 3 London County Council 1 Removal of one or more occupants 1 Of the 8 dwellings remaining overcrowded at the end of the year 2 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 31.12.62 Dwellings found overcrowded during 1963 Dwellings decrowded during 1963 Dwellings remaining overcrowded at 31.12.63 Overcrowding cases remedied during 1963 Formal Action Informal Action Total St. Helier North 2 - 1 1 1 - 1 St. Helier South — — — - - - - St. Helier West 2 — 1 1 1 - 1 North-East 2 2 1 3 1 1 North-West - — — - - - - Central 2 — 2 — 2 - 2 South-West - — — — - - - South-East 2 1 — 3 — - — Totals 10 3 5 8 4 1 5 The figures for overcrowding are compiled from the information which comes to hand in the course of day to day administration. Only a complete survey of the district can provide the exact figure. Since however these figures have been obtained by the same means year by year, they are of some significance in showing the trend of overcrowding. As householders in such circumstances rarely fail to make their needs known, the degree of inaccuracy cannot be large. Figures in respect of overcrowding ascertained in the manner mentioned over the last 10 years were as follows:— Year New Cases Cases at Year End Year New Cases at Year End 1954 49 105 1959 12 27 1955 26 73 1960 5 18 1956 27 63 1961 4 12 1957 10 46 1962 0 10 1958 14 33 1963 3 8 34 Slum Clearance and Demolition A closing order was made in respect of one house, the occupants being rehoused by the Council. During the year 43 families from earlier Clearance Areas were rehoused. All the families from Clearance Areas Nos. 10, 11, 15, 16 and 22 referred to in the reports for 1961 and 1962 have now been rehoused and all the sites cleared. Housing Act, 1961—Houses in Multiple Occupation Seven houses were inspected during the year and all were found to be sub-standard mainly due to lack of food storage accommodation and means of escape from fires although some defects of repair were found. The work required to bring the houses up to the required standard is being carried out and work at one house has been completed. Rent Act, 1957 The following details show the action which has been taken during the year:— Part I—Applications for Certificates of Disrepair (1) Number of applications for certificates 1 (2) Number of decisions not to issue certificates Nil (3) Number of decisions to issue certificates (a) in respect of some but not all defects 1 (b) in respect of all defects (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule Nil (5) Numberof undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule Nil (6) Number of Certificates issued 1 Part II—Applications for Cancellation of Certificates (7) Applications by landlords to Local Authority for cancellation of certificates 3 (8) Objections by tenants to cancellation of certificates Nil (9) Decisions by Local Authority to cancel in spite of tenants' objection Nil (10) Certificates cancelled by Local Authority 3 35 Section E—Inspection and Supervision of Food 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 The whole of Surrey including Carshalton is a Specified Area for the purposes of the Milk (Special Designations) (Specified Areas) Order and all milk sold must be "designated" milk. Milk Distributors The number of Milk Distributors registered under the Milk and Dairies (General) Regulations, 1959 is 15. Designated licenses 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 31.12.63 Dealers (Pre-packed Milk) Licences Sterilised 13 20 Pasteurised 10 17 Tuberculin Tested 9 16 Bacteriological Examination of Milk One hundred and sixty-three samples of milk were procured and submitted for bacteriological examination. The milks were sold under the Milk (Special Designations) Regulations and all complied with the prescribed Regulations. Classification of the milk samples and the results of the tests are as follows:— Designation under which sold No. of samples Methylene Blue Test Phosphatase Test Turbidity Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised 146 146 — 146 — — — T.T. Pasteurised 10 10 — 10 — — — Sterilized 7 — — — — 7 — 163 156 — 156 — 7 — 36 Milk and Dairies (General) Regulations, 1959—Regulations 18 to 20 These powers authorise the Medical Officer to take any necessary action in respect of milk handlers, utensils and milk where there is or are reasonable grounds for believing that a particular supply is the source of infection. It was not necessary to use these powers during the year. Qualitative Analysis Samples of milk submitted to the Public Analyst totalled 162 of which 21 were "Channel Island" or "South Devon" milks. The average fat and non fatty content of these special milks was 4.6 % and 8.98 % respectively for the Channel Island samples and 4.25 % and 8.85 % in respect of the South Devon milk. Ice Cream One hundred and three samples of Ice Cream were procured for bacteriological examination of which 102 were Grade I and one Grade II. Ice Cream (Heat-treatment, etc.) Regulations, 1959 All registered retailers draw their supplies of ice cream from reputed manufacturers outside the district. Two are also manufacturer-retailers of soft ice cream. Bacteriological Examination of Other Foods One sample of canned meat, one sample of tinned peas and two samples of cake were sent to the Bacteriologist for examination. Except for one sample of cake in which the findings were of doubtful significance, all were found to be satisfactory. 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 1,381 lbs. 4 ozs. 37 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 other wise irregular Article No. Adulterated or otherwise irregular Apple Juice 1 Macaroni 1 Baby Cough Linctus 1 Mentholated Balsam 1 Beef Roma 1 Milk 162 Beef Sausage 5 Milk—Hot 1 1 Beef Sausage Meat 1 Minced Beef 1 Bitter Beer 3 Minced Stewing Steak 1 Bitter Lemon 1 Mixed Herbs 1 Blackcurrant Drink 1 Olive Oil 1 Butter 1 Onion Sauce Mix 1 Celery Salt 1 Orange Drink 2 Chutney 1 Orange Squash 1 Coconut Mushrooms 1 Peppermint Cordial 1 Cooked Ham 1 Pork Sausage 4 Cooking Fat 1 Pork Sausage Meat 1 Corn Flour 1 Raspberry Jam 1 Cough Syrup 1 Raspberry and Rose Hip Cream Bun 1 Drink 1 Cream Meringue 1 Rice 2 Custard Powder 1 Rice Pudding 1 Custard Tart 1 Rose Hip Syrup 1 Curry Powder 1 Rum Butter 1 Dairy Cream Oyster 1 Salmon Pink 1 Desiccated Coconut 1 Sanatogen 1 Dried Fruit Mixture 1 Sausage Rolls 1 Dripping 1 Shandy 1 Egg Vermicelli 1 Shepherds Pie 1 Evaporated Milk 1 Smoked Cod Roe 1 Fish Cakes 1 Smoked Fillet 1 Flaked Rice 1 Sponge Mixture 1 Ginger Ale 1 Syrup of Glycerine, 1 Grape Fruit (Tinned) 1 Lemon and Honey 1 Ground Nut Oil 2 Steak & Kidney Pudding 1 Hambergers 2 Tea Cake Mixture 1 Honey & Lemon Eclairs 1 Treacle 1 Ice Cream 9 Victoria Plums 1 IceCream(Diary) 2 Vienna Steak 1 Instant Coffee 3 Vinegar 1 King Fling 1 Vinegar (Malt) 2 Lemon Pie Filling 1 Liquid Paraffin 1 Luncheon Meat 1 The one unsatisfactory sample of "hot milk" was procurred from a cafe. It was found to contain 10% of added water due to the fact that the milk was heated by injecting steam. The proprietor gave an undertaking to discontinue this method of heating milk. 38 Section 9—Sale of Food Unlit for Human Consumption The following complaints were received of alleged foreign matter in Food:— Grease in bread (3) Mould in bread String in bread Mould in cake Piece of wood in cheese cake Maggot in bar of chocolate cream Mould on pork pie (2) Fly in steak & kidney pie Insects in packet of soup Appropriate action was taken in each case but legal proceedings were not warranted in any. 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. Cereals 2 3 Confectionery (Flour) 19 4 Cheese 1 15 Cocoa — 8 Cream 153 14 Fat 1 — Fish 269 15 Fruit 129 14 Jam 24 4 Milk 5 15 Meat 1381 4 Rice 1 14 Soup 3 11 Vegetables 308 5 Total Weight 1 ton 2 qrs. 7 lbs. 14 ozs. The method of disposal is by burning in the Council's Refuse Destructor. Inspection of Food Premises The inspections made under the Food Hygiene Regulations and other statutory powers relating to food with the results of these visits are shown in Table 9. 39 40 TABLE 9 INSPECTION OF FOOD PREMISES AND ACTION TAKEN Nature of Business Number of Premises Number of premises registered under Section 16 of Food & Drugs Act Number of inspections made Repaired Sanitary accommodation Wash your Hands Notices Food storage and preparation rooms Accumulations removed Cleansed and/or decorated Lighting provided Wash-basins provided Water supply provided Nail brush and soap provided 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 4 — 50 — — — — — — — 1 1 — — — — — — Bakers and Confectioners 18 6 75 — 1 — — 1 — 1 1 1 — — — — — — Butchers 34 31 171 3 1 — — — — 1 4 1 — — — 1 — 1 Canteens 21 — 40 — — — — 1 — — — 4 — — 1 — — — Chemists 17 1 43 — — — — — — — — — — — — — — — Confectioners (Sweets only) 67 55 130 1 1 — — — — 1 — 2 — — — 4 — — Fishmongers 12 6 83 — — — — — — — 1 3 — — — — — 2 General stores 4 4 79 — — — — — — — — — — — — — — — Greengrocers and fruiterers 35 7 163 4 3 1 — 3 2 — — 3 — — 1 1 — 2 Grocers (including corn chandlers) 73 30 293 3 7 1 — 1 1 1 7 6 — — — 1 1 3 Licensed premises (with catering facilities) 5 2 55 1 2 — — — 1 1 1 3 — 1 — — — — Licensed premises (without catering facilities) 20 — 30 — 1 — — — — — — — — — — — — — Milk storage depots 3 — 16 — — — — — — — — — — — — — — — Restaurant and Cafes 22 17 122 1 1 1 — 1 1 — 1 4 — 1 — 1 1 1 Stalls, food variable — 109 — — — — — — — — — — — — — — — Vehicles, food — 20 — — — — — — — — — — — — — — — Vehicles, Ice cream variable — 11 — — — — — — — — — — — — — — — 159 1490 13 17 3 — 7 5 5 19 28 — 2 2 8 2 9 Section F—Prevalence of and Control over Infectious and other Diseases The district has within its boundaries four 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 This infection was not introduced into the area during 1963. One shipping contact was supervised on arrival from abroad. Vaccination against Smallpox The scheme for vaccination, which is the responsibility of the County Council as the Local Health Authority, is directed locally by the District Medical Officers of Health. Of the children who are treated approximately half are done by the General Practitioners and half at the Welfare Clinics of the Council. Some doubts have been raised in medical circles as to whether routine vaccination in the absence of infection is still advisable on the basis that an outbreak can be controlled by supervision and vaccination of the contacts. Whilst routine vaccination admittedly does not prevent the importation of smallpox with possible spread, it is difficult to believe that the fact that a certain proportion of the population has some degree of immunity does not help in the control of an outbreak. Moreover an adult contact who has been previously vaccinated in infancy does not react so violently to re-vaccination as he does when given primary vaccination. The number of persons vaccinated in 1963 was less than in the previous year, the explanation for which is that the publicity given to a number of cases which occurred in the country in 1962 resulted in a sudden increased 41 demand for vaccination during that year. The number of persons who received successful vaccination during the year was as follows:— Age at 31st December, 1963 i.e. Born in Under 1 yr. 1963 1-4 yrs. 1959-62 5—14 yrs. 1949-58 15 yrs. & over 1948 & earlier Total Primary Vaccinations— By Private Practitioners 38 15 8 1 62 At Clinics 80 52 15 — 147 118 67 23 1 209 Revaccinations— By Private Practitioners — — 6 2 8 At Clinics — — 4 — 4 — — 10 2 12 In addition, the following unsuccessful attempts at vaccination were made:— Age at 31st December, 1963 i.e. Born in Under 1 yr. 1963 1-4 yrs. 1959-62 5—14 yrs. 1949-58 15 yrs. & over 1948 & earlier Total Primary 2 2 — — 4 Revaccination — — — — — 2 2 — — 4 The estimated number of children under five years of age vaccinated at the end of 1963 was 1,805 out of an estimated total of 3,610. Enteric Fever After an interval of 9 years free from enteric fever, an outbreak of para-typhoid B infection type "Taunton" occurred in the spring of 1963. This was a food borne infection, the investigations into which pointed clearly to a single source, that of a bakehouse in the district. The first case occurred on the 22nd February and a succession of 13 further cases was notified thereafter mostly in late March and in April affecting 10 families. Five symptomless carriers were also detected associated with the notified cases. About this time it was ascertained that a few small isolated outbreaks of S para-typhoid B of the same type "Taunton" had occurred in different parts of the country and these had been associated with the consumption of food made with imported Chinese fluid eggs. Inquiries revealed that the local bakehouse concerned was using Chinese fluid eggs and that at the material time had received a tin of eggs from the particular shipping consignment with which the other outbreaks had been connected. There can be little doubt that this was the origin of the infection. All cases recovered, though 3 of them continued to excrete the organism for many weeks after recovery. 42 Dysentery A total of 36 cases of Sonne dysentery were notified. Thirteen of these occurred in 9 resident families and were distributed irregularly over the year and there was no ascertained connecting factor. Of the remainder 22 occurred in a local children's hospital. The infection was introduced there in February and was ultimately eradicated in June. One case was notified from the general hospital and it was probably incubating the infection when admitted for another reason. All were mild cases and all recovered. Scarlet Fever The incidence of scarlet fever was slightly higher in 1963, 41 cases being notified as against 31 in the year before. It is still however very much less prevalent than before the war. Six cases only were admitted to hospital, the remainder being nursed at home. As has been observed in previous reports, scarlet fever is and has been in recent years generally so mild an illness and responds so readily to modern drug treatment that considerable difficulty is experienced in securing a reasonable degree of isolation for what is still a communicable disease. The cases were distributed throughout the year with a rather higher prevalence in the second quarter. There were no deaths. TABLE 10 SCARLET FEVER—DISTRIBUTION OF CASES, 1963 1963 Ward St. Helier North St. Helier South St. Helier West NorthEast Northwest Centra] SouthEast Southwest Total January — — — 1 — 1 1 — 3 February — 1 — — — 1 1 — 3 March 1 1 1 3 April — — — 1 2 1 3 2 9 May — — — — — 1 2 — 3 June — 1 — — 1 — 1 1 4 July 1 3 — — 1 — — 1 6 August — — 1 — — — — 1 September — — 1 — — — — — 1 October — — — — 2 1 — — 3 November — — — 1 — — 1 2 4 December — 1 — — — — — — 1 Totals 1 6 2 3 6 6 10 7 41 Monthly Mean 0.08 0.50 0.16 0.25 0.50 0.50 0.83 0.58 3.41 Case rate per 1,000 population 0.14 1.03 0.30 0.33 0.88 1.03 1.17 0.99 0.73 43 TABLE 11 SCARLET FEVER—MULTIPLE CASES, 1963 Ward No. of houses in which occurred Total Houses Total Cases 1 Case 2 Cases 3 Cases 4 Cases St. Helier North 1 — — — 1 1 St. Helier South 6 — — — 6 6 St. Helier West 2 — — — 2 2 North-East 3 — — — 3 3 North-West 6 — — — 6 6 Central 6 — — — 6 6 South-East 10 — — — 10 10 South-West 1 3 — — 4 7 Whole District 35 3 — — 38 41 Diphtheria The year 1963 was the fourteenth consecutive year of freedom from this infection. Diphtheria Immunisation This established prophylactic treatment is undoubtedly responsible for the continued absence of diphtheria. A duty of the County Council, the scheme is administered locally like smallpox vaccination by the District Medical Officer of Health. Small outbreaks of diphtheria have been re-appearing in recent years in different parts of the country and the only sure means of protection is the maintenance of a reasonably high level of immunisation among the children of the district. Not only is it important to give primary treatment to as many infants as possible, but it is equally so to re-inforce the initial immunity throughout childhood. The local practice is to start treatment in the first year of life and to re-inforce this at intervals throughout primary school life. Success in achieving re-inforcement of the primary treatment is largely attributable to the fact that children can be offered their injections in school, thus saving the parents special journeys to clinic or surgery. In 1963, 644 children received a primary course of treatment as follows:— Age at 31.12.63 i.e. born in year Under 1 year 1963 1 year 1962 2 years 1961 3 years 1960 4 years 1959 5—9 years 1954/ 58 10-14 years 1949/ 53 Total under 15 yrs. At Council Clinics 131 216 40 3 1 4 — 395 In Carshalton Schools — — — — 3 66 19 88 Private Practitioners 63 91 9 — — 3 — 166 194 307 49 3 4 73 19 649 Less outward transfers 6 9 4 — 1 7 4 31 188 298 45 3 3 66 15 618 Plus inward transfers 11 12 1 1 — 1 — 26 Carshalton residents 199 310 46 4 3 67 15 644 A further 1,448 Carshalton children received re-inforcing injections during the year. 44 The following table shows the immunisation state of the local child population at the 31st December, 1963:— Number of children at 31st December, 1963, who had completed a course of immunisation at any time between 1st January, 1949 and 31st December, 1963. Age at 31.12.63 i.e. Born in year Under 1 1963 1-4 19591962 5—9 19541958 10—14 19491953 Under 15 Total A. No. of children whose last course (primary or booster) was completed in the period 19591963 192 2237 3169 2661 8259 B. No. of children whose last course (primary or booster) was completed in the period 1958 or earlier — — 274 1011 1285 C. Estimated child population 700 2910 7870 11480 Immunity Index 100 A c 26.6 76.8 74.0 71.9 The estimated percentage of children immunised at each year end since 1935, when the Council's scheme was inaugurated and the incidence of diphtheria in the resident population is shown in the following table:— 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 1963 67 90(74*) 83(72*) 0 0.00 ('Immunised within the last 5 years) 45 Erysipelas Two cases were notified as in the year before. One was a man of 65 years, the other a child of 8 an inpatient in a local hospital. Pneumonia Thirteen cases of primary and influenzal pneumonia were recorded of which 3 were influenzal in origin. Most of them occurred in the first quarter of the year. Measles In conformity with the biennial pattern of measles incidence in the London area, 1963 was a "measles year". Whereas in 1962 only 59 cases occurred, 1,127 were notified in 1963. Epidemic conditions prevailed in the first half of the year, during which time more than 1,000 occurred. There was one death in a child of 3 years, the first death from measles for 12 years. TABLE 12 MEASLES—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1963 (Excluding hospital patients non-resident in Carshalton) 1963 Ward St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest Total January 3 1 5 9 15 13 24 65 135 February 7 3 25 18 14 7 23 35 132 March 8 14 27 105 91 31 8 6 290 April 14 38 42 53 37 60 82 24 350 May 25 1 4 6 15 10 9 11 81 June 39 — 5 7 7 2 2 2 64 July 2 2 3 2 3 — — 1 13 August — — — — — — — — — September — 1 — — — — — 1 2 October — — — — — — — — — November — — — — — — 3 — 3 December — — — — — — — — — Totals 98 60 111 200 182 123 151 145 1070 Monthly Mean 8.16 5.00 9.25 16.66 15.16 10.25 12.58 12.08 89.16 Case rate per 1,000 population 14.38 10.34 17.07 22.59 26.96 21.24 17.75 20.68 19.10 Whooping Cough The record low figure of prevalence for this infection was in 1962 when 18 cases were notified. In 1963 the number recorded was 24 which compares with annual totals of several hundreds in the days before immunisation was practised. 46 Whooping Cough Vaccination As with other immunising procedures, the local practice is to secure the vaccination of babies against whooping cough in the first year of life. Treatment for protection against this disease is usually combined with that for diphtheria and generally with that for tetanus, all 3 being combined in the same injections. For this reason the percentage of children treated is much the same as for diphtheria immunisation. More than two thirds of the children under 5 years of age are now protected against whooping cough in this way. The number of children vaccinated during 1963 was 556. 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 1963 67 24 TABLE 13 WHOOPING COUGH—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1963 (Excluding hospital patients non-resident in Carshalton) 1963 Ward St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest Total January — — 3 — — — — — 3 February — — — 1 1 — — — 2 March — — — — — — — — — April — — — — — — — — — May — — — — — — — — — June — — — — — — — — — July — — — — — — — — — August — — — — — — — — — September — — — — — — — — — October 1 2 3 — — 4 — 10 November 1 — 1 — — 1 2 — 5 December 1 — — — 1 — 2 — 4 Totals 3 2 7 1 2 1 8 — 24 Monthly Mean 0.25 0.16 0.58 0.08 0.16 0.08 0.66 — 2.00 Case rate per 1,000 population 0.44 0.34 1.07 0.12 0.29 0.17 0.94 — 0.42 47 Meningococcal Infection No case of meningococcal infection was notified. Poliomyelitis The district was again free from this infection for the fourth year in succession. Poliomyelitis Vaccination Since the Sabin type of oral vaccine was made available to Local Health Authorities in 1962, vaccination against poliomyelitis by the use of the injected Salk vaccine has almost completely fallen into disuse and the oral vaccine is now used almost exclusively. The oral vaccine has the advantage over the Salk type in that not only does it cause anti bodies against the virus of polio, to be formed in the blood, which is the sole effect of Salk injections, but it also establishes itself in the intestine and sets up a tissue resistance to subsequent invasion by virulent polio, virus. The scheme, which is the responsibility of the County Council, provides facilities from the age of 6 months to 40 years and in addition for groups at special risk such as doctors, nurses, ambulance personnel etc. The number of individuals treated during 1963 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 1963 21 Young persons born 1933 to 1942 — 78 19 Persons born before 1933 1 Others — Totals 3 78 19 Oral Vaccine No. who received their 3rd dose No. given 3rd reinforcing dose after 2 Salk No. given 4th reinforcing dose after 3 Salk No. given 4th reinforcing dose after 3 Oral No. given reinforcing dose after 2 Salk and 1 Oral Born in 1943-1963 629 43 752 8 9 Born in 1933-1942 27 4 — — — Born 1932 and earlier 37 8 — — — Totals 693 55 752 8 9 These figures do not include the staffs of hospitals. 48 Ophthalmia Neonatorum As in the year before no case of infection in the eyes of the new born was notified. Modern preventive practice at birth including the newer effective anti-infective drugs has largely removed a birth hazard which in past years was responsible for a certain amount of loss of vision. Puerperal Pyrexia For reasons explained in previous reports, a significant number of notifications of a rise of temperature associated with childbirth is received annually from the large maternity departments of local hospitals which cater for an extensive area of Metropolitan Surrey. In 1963, 93 such notifications were received compared with 125 in the year before. All but one were hospital cases and 16 were in respect of Carshalton residents. Food Poisoning No cases were notified but 5 cases came to notice in one household. No infecting organism was isolated either from the patients or the food remnants and it is probable that the illness was due to preformed toxins and not to the living organism. Although it was not possible positively to identify the vehicle of infection, suspicion pointed to the marzipan of some Battenberg cake which had been eaten by all 5 patients. 49 50 TABLE 14 CASES OF NOTIFIABLE INFECTIOUS DISEASE ADMITTED TO HOSPITAL, 1963 Disease Westminster Cuddington Wandle Valley Queen Mary's St. Helier Totals Whooping Cough 1 — 1 — — 2 Measles — — 2 10 2 14 Para Typhoid Fever — — 5 4 3 12 Scarlet Fever — — 4 2 — 6 Erysipelas — — 1 — — 1 Dysentery — — — 1 3 4 TOTALS 1 — 13 17 8 39 51 TABLE 15 INFECTIOUS DISEASES—NOTIFICATIONS, DEATHS AND DISTRIBUTION (Excluding hospital patients non-resident in Carshalton) Disease Cases notified Case rate per 1,000 population Deaths Distribution by Wards No. of cases removed to hospital Percentage of cases removed to hospital St. Helier North St. Helier South St. Helier West NorthEast Northwest Central SouthEast Southwest Scarlet Fever 41 0.73 — 1 6 2 3 6 6 10 7 6 14.6 Whooping Cough 24 0.42 — 3 2 7 1 2 1 8 — 2 8.3 Measles 1070 19.10 1 98 60 111 200 182 123 151 145 14 1.3 Dysentery 10 0.17 — 2 2 1 2 — 2 1 — 4 40.0 Puerperal Pyrexia 17 0.30 — 3 — 1 1 4 5 1 2 16 94.1 Pneumonia 13 0.23 — 1 3 5 1 2 — — 1 — — Para Typhoid Fever 14 0.24 — — — 1 — 3 7 1 2 12 85.7 Erysipelas 1 0.01 — — — — — — 1 — — 1 100.0 52 TABLE 16 INFECTIOUS DISEASES—Notification by Age Groups, 1963 (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 7 5 22 4 1 — — — — 41 Measles 21 94 135 124 152 519 14 5 5 1 — — 1070 Whooping Cough 2 2 — 2 5 10 2 — 1 — — — 24 Dysentery — — 1 — — 3 3 — 2 — 1 — 10 Puerperal Pyrexia — — — — — — — 2 14 1 — — 17 Pneumonia — — — 1 — 1 — — 2 2 4 3 13 Para Typhoid Fever — — — — — 5 3 3 — 2 1 — 14 Erysipelas — — — — — — — — — — — 1 1 53 TABLE 17 MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1963 (Excluding hospital patients non-resident in Carshalton) Disease Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 3 3 3 9 3 4 6 1 1 3 4 1 41 Measles 135 132 290 350 81 64 13 — 2 — 3 — 1070 Whooping Cough 3 2 — — — — — — — 10 5 4 24 Dysentery — — 2 — 3 1 1 — — 1 1 1 10 Pneumonia 1 6 2 — 1 — — 1 1 — — 1 13 Erysipelas — — 1 — — — — — — — — — 1 Puerperal Pyrexia 3 2 1 2 1 1 2 1 — 2 1 1 17 Tuberculosis, Pulmonary — 2 — 1 1 1 2 1 — — 1 — 9 Tuberculosis, Non-Pulmonary — — — — — 1 — — 1 — — — 2 Para Typhoid Fever — — 2 10 1 1 — — — — — — 14 Tuberculosis The new cases admitted to the tuberculosis register during the year numbered 32 classified as follows :— Males Females Pulmonary 16 Pulmonary 13 N on-pulmonary 3 Non-pulmonary 0 Of the total additions, 11 were primary notifications, 18 were transferred from other districts and 3 came to notice in other ways. In the same period, 95 names were removed from the register for the following reasons:— Recovered 59 Death 9 Otherwise (including removals) 27 After allowing for the additions and deductions, the state of the register at the 31st December, 1963, was as shown in the following table:— TUBERCULOSIS—WARD DISTRIBUTION Cases on Register at 31st December, 1963 Ward Pulmonary Non-Pulmonary Total Incidence per 1,000 population Males Females Males Females St. Helier North 45 35 5 6 91 13.36 St. Helier South 31 29 9 5 74 12.75 St. Helier West 26 33 1 4 64 9.84 Ncrth-East 23 20 3 5 51 5.76 North-West 12 17 3 1 33 4.88 Central 12 18 2 — 32 5.52 South-East 26 16 1 1 44 5.17 South-West 17 14 — — 31 2.42 192 182 24 22 Whole District 374 46 420 7.49 The total of 420 is 63 less than at the corresponding date twelve months earlier. The number of patients from Carshalton who received institutional treatment under the arrangements of the South-West Metropolitan Hospital Board during the year was 11. The number of tuberculous persons who died during the year was 9, 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 1 1 — — 2 55—65 1 — 1 — 2 65—up 3 1 — — 4 Totals 6 2 1 — 9 54 The deaths attributable to tuberculosis were 4 as follows:— DEATHS DUE TO TUBERCULOSIS, 1963 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 53 St. Helier West — — 1 — 0.15 56 North-East — — — — — — North-West 1 — — — 0.14 62 Central — 1 — — 0.17 59 South-East — — — — — — South-West — — — — — — Totals 1 2 1 — 0.07 57 Of the 4 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 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 1963 11 4 420 The Council adopted a "points" scheme for deciding the order of priority of applicants for housing accommodation. Special "weighting" is provided under this scheme where the existence of tuberculosis in the household creates a risk of infection. One tuberculous family was rehoused by the Council in 1963. 55 56 TABLE 18 TUBERCULOSIS. New Cases, Age and Sex Distribution and Manner of Admission to Register, 1963 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 — — — — — — — — — — — — — 15—20 — — — — — 1 — — — — — — 1 20—25 1 1 — — — — — — — — — — 2 25—35 1 1 — — 3 3 — — — — — — 8 35—45 — — — — 2 3 — — — — — — 5 45—55 3 — 1 — 1 — — — — — — — 5 55—65 2 — 1 — 1 3 — — — — 1 — 8 65 up — — — — — 1 — — 2 — — — 3 Totals 7 2 2 — 7 11 — — 2 — 1 — 32 11 18 3 Carshalton Chest and Heart Care Committee This voluntary Committee originally constituted as the Carshalton Tuberculosis Care Committee, continued its valuable service in aiding patients referred from the Chest Clinics. This social service functions outside the statutory schemes in ways which the latter cannot adopt. Chest patients are invariably chronic sufferers with prolonged periods of incapacity. Their families are subjected to considerable economic distress in consequence. Help is given in ways too numerous to mention but the following are the commonest forms of assistance:— Grants of clothing, bedding, fuel, and fuel appliances, materials for occupational therapy, radio and television licences. Provision of rail and coach fares, holidays. Christmas gifts—outings for children. Loans for purchase of individual means of transport. Income during the year was £503 and disbursements £424, the latter figure including £18 9s. 4d. administrative expenses. Carshalton Old People's Welfare Committee In the space of 7 years, since it was first established, this voluntary Committee has continued to make steady progress in meeting the many and varied needs of the old people of the district. The importance of having such an organisation is emphasised by the fact that in the last 10 year intercensal period the proportion of people in Carshalton aged 60 years and over has risen from 12% to 18% of the total population. The services so far established include Meals on Wheels with the aid of W.V.S., a chiropody scheme, a home visiting scheme, and with the help of the Darby and Joan Club in Cooper Crescent attendance at the Club's centre for the house-bound who are transported there by the Committee's own vehicle. The Committee is making a special effort by means of a systematic survey of the district to ascertain the existence of the old people of the district and to bring to their notice the many ways in which the Committee can help. A generous grant is made by the District Council and the County Council give financial help in respect of the chiropody scheme. The income of the Committee during 1963 was £1,757 and the expenditure, including the acquisition of a new van, was £2,177. METEOROLOGY The rainfall recorded at the Council's Pumping Station in Buckhurst Avenue was as follows:— Rainfall 1963 Amount in ins. Rainfall 1963 Amount in ins. January 0.61 July 1.37 February 0.46 August 2.74 March 3.30 September 2.44 April 2.38 October 1.29 May 1.70 November 3.77 June 1.68 December 0.56 Total 22.30 57 The flow of water over the weir on the River Wandle in the Grove grounds was as follows:— Maximum Spring Flow 3.78 million gallons/day during weeks ending 30th May and 6th June. Minimum Spring Flow 0.135 million gallons/day during weeks ending 31st January and 7th February. Total Spring Flow 746.8 million gallons 1st January to 31st December, 1963, but excluding the weeks ending 17th and 24th January, 14th, 21st and 28th February and 7th and 14th March for which no recordings are available due to abnormal weather conditions at the time and mechanical faults in the recorder. 58 INDEX PAGE Acreage 6 Atmospheric Pollution 28 Births— Distribution 10 Institutional 10 Rates 7,9,11,12 Cancer 7, 13, 14 Cemeteries 31 Clean Air Act 27 Clinics and Treatment Centres 20 Closet Accommodation 23 Deaths— Classification 17, 18 Distribution 14 Rate 7, 9,11, 12 Diphtheria 44 Diphtheria Immunisation 44 Dysentery 43 Disinfection 26 Disposal of Dead 31 Drainage and Sewerage 22 Employment Agencies 30 Enteric Fever 42 Erysipelas 46 Establishments for Massage, etc. 31 Factories 28 Food— Food and Drugs Act 36 Hygiene 39 Inspection and Supervision 36 Poisoning 49 Health Services 19 Heating Appliances (Fireguards) Regulations, 1953 30 Housing— Council's Scheme 32 Inhabited Houses 6 Inspection 33 Rent Act 35 Overcrowding 34 Slum Clearance 35 Ward Distribution 9 Ice Cream 37 Infant Mortality 8, 15, 16 Infectious Diseases 41-53 Inquests 15 Isolation Hospital— Admission to 50 Laboratory Facilities 19 59 PAGE Maternal Mortality 7, 16 Measles 46 Meat 37 Meningococcal Infection 48 Merchandise Marks Act, 1926 30 Meteorology 57 Milk Supply 36 Milk and Dairies Regulations, 1959 37 Mortuary 31 Natural and Social Conditions 6 National Assistance Act 31 Offices 28 Outworkers 30 Old Peoples' Welfare 57 Ophthalmia Neonatorum 49 Pet Animals Act, 1951 30 Pneumonia 46 Poliomyelitis 48 Poliomyelitis Vaccination 48 Population 7, 8, 9 Public Cleansing 23 Puerperal Pyrexia 49 Rag Flock and Other Filling Materials Act, 1951 31 Rateable Value 6 Rats and Mice Destruction 28 Rivers and Streams 23 Sanitary Circumstances 21 Sanitary Inspection 23, 24, 25 Scarlet Fever 43 Shops Act 30 Smallpox 41 Smoke Abatement 28 Staff 5 Statistics— Comparative 12 Vital 7 Swimming Baths 28 Tuberculosis 7, 15, 54 Care Committee 57 Unemployment 8 Vaccination 19 Vermin Control 26 Water Supply 21 Whooping Cough 46 Zymotic Diseases— Deaths from 7 60 R2/68