Zibran MER 17 URBAN DISTRICT of MERTON AND MORDEN ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1962 TELEPHONE: LIBERTY 4636 URBAN DISTRICT OF MERTON AND MORDEN W. D. SWINNEY M.B.. CH.B.. D.P.H. Medical Officer of Health AAM/M. PUBLIC HEALTH DEPARTMENT 116, KINGSTON ROAD MERTON, S.W.19 3rd October, 1963. Sir, ANNUAL REPORT, 1962. I enclose herewith two copies of the Annual Report for the year 1962, in respect of the Urban District of Merton and Morden. I am, Sir, Your obedient Servant, The Chief Medical Officer, Ministry of Health, Alexander Fleming House, ELEPHANT AND CASTLE, LONDON, S.E.1. URBAN DISTRICT of MERTON AND MORDEN ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1962 PREFACE. To the Chairman and Members of the Urban District Council of Merton and Morden Mr. Chairman, Ladies and Gentlemen, I have the honour to present to you my report on the health of the district and matters relating thereto for the year 1962. The report is one which shows that this health has been well maintained during the year but there are some matters on which I wish to comment in this foreword. The Ageing Population One cannot work in a Public Health Department without quickly realising that the social problem which outweighs at the present time all others is that of old people. It is a problem which every year grows greater; more and more old people grow older and older and although medical science has succeeded in prolonging life it has not been so successful in ensuring a continuation of faculties. These old people have often outlived all friends; they may or may not have children or other relatives, but too often those live so far away as to be unable to be of much practical assistance and one must state that, not infrequently, relatives who could lend a helping hand have little or no interest in doing so. They regard this as a function of the Welfare State and not as a duty of their own. It therefore becomes increasingly necessary to provide supporting services for the aged. Very few old people take kindly to the idea of entering any form of institution and would continue in their old familiar home surroundings long after it has become impossible for all supporting services to ensure for them there even the barest minimum of decent comfort. The use of statutory powers for their compulsory removal for care and attention is, I am sure, not the right answer. While some do adapt themselves to new surroundings, many are desperately unhappy, pining for what they have lost—the feeling of independence. Their personal pride has been wounded and the wound goes deep. It is worth every effort to build up social services to a strength which can meet these ever growing demands. The happiness of many will depend on it in their declining years. It must be realised, however, that a point will be reached in many cases where continued home life is impossible no matter what support is given. Present institutional facilities are inadequate to meet these needs. There are long waiting lists for beds in Geriatric Units and Welfare Homes. It is literally a question of waiting for dead men's shoes and in the process 3 the waiters may well die themselves. Our old people deserve more than this from a prosperous society and their plight calls for every effort to be made to ensure not merely their physical care but their continued happiness. Population Statistics It may be surprising that the population of the District continues to fall, even although the decrease was small during 1962. This results from several factors but among them is one reflecting on the complexity of modern life in the greater conurbations—the difficulty of travel, which is steadily increasing. Many people are trying to live nearer to their work whilst others have decided that if travel they must, they might as well make the journey worthwhile and move further from the centre to live in more rural surroundings. This is leading to a drop in populations in "outer ring" London communities such as Merton and Morden, Wimbledon and Mitcham and an increase in populations of districts situated further out, such as Sutton and Cheam and Epsom and Ewell and even further afield. Principal Causes of Death The four principal causes of death bear out what is now generally recognised, that cardiac conditions are the great killer followed, by cancer. The great majority of deaths from cardiac conditions are attributable to coronary artery disease, which is on the increase all over the world, but more markedly in highly developed societies. This appears to be a true disease of civilization, the more highly organised the society the greater is the stress and strain on its human components and the result is more coronary thrombosis. Regrettably, also, the disease is occurring increasingly in younger age groups. Some years ago it was a disease predominantly of the sixties. Now, however, it is not a cause for surprise to encounter death from coronary thrombosis even before the forty-fifth birthday. There is a definite need for more research to give us a fuller understanding of the etiology of this condition so that preventive measures can be taken. Meanwhile this adaptation of Rudyard Kipling's "If" gives food for thought:— "If you can fill the unforgiving minute with sixty seconds-worth of distance run Yours is the world and everything that's in it And a coronary before you're fifty-one" The continuing increase of deaths from carcinoma of the lung and bronchus gives great cause for concern and the District Council has cooperated with Surrey County Council in a campaign to alert teenagers to the believed relationship which has been demonstrated between cigarette smoking and this condition. I do not think, however, that the cigarette is more than a precipitating cause. It is my belief that in the fullness of time it will be found that there is something much more fundamental at the root of cancer in any site, which determines why, of two persons with 4 identical environment, employment, hobbies and habits, one should develop cancer and the other should not. The third most important cause of death, vascular diseases of the nervous system, embraces such conditions as cerebral haemorrhage and cerebral thrombosis. The former, particularly, appears to have at least one characteristic in common with coronary thrombosis—to a great extent it is a disease of civilization. The strain of modern life, the tempo of living in the twentieth century reflect themselves on the blood-pressure. There is too much worry nowadays to be good for us and the ability to relax has been lost by many. Of equal importance as a cause of death are diseases of the respiratory system. What is the number one killer in this category? Bronchitis and Bronchopneumonia are our chief enemies. More often than not the latter does not develop de novo but is superimposed on a chronic bronchitic condition of many years standing. Control of atmospheric pollution should do much to cut down the incidence of what is known in some other parts of the world as "The Englishman's Disease" and it is, I think, safe to say that smoking, particularly of cigarettes, is more certainly contributable to bronchitis than it is to bronchial carcinoma. Maternal Mortality It is gratifying to note that the maternal mortality figure was nil for the year, a figure which reflects great credit on all those responsible for ante-natal and obstetric care for either domiciliary or hospital confinements. Infant and Neo-natal Mortality The time has not yet come when one can report no deaths under these headings, but the figure shows a great improvement over 1961. The great majority of these deaths are the result of congenital abnormalities, incompatible with a life of any long duration and in the present state of medical knowledge such cases can be effectively dealt with only under certain circumstances. There are still types of cases which lie outside the scope of any possible medical or surgical intervention although further continuing research is slowly overtaking this problem and the work of saving infant lives can now be successfully undertaken in cases which only a few years ago would have had to be regarded as beyond all hope of cure. Deaths from other than congenital causes continue to occur, but in decreasing numbers. Modern medicine, with its ever increasing armamentarium of drugs can do wonders but it is regrettable that there is still no preparation fully effective against virus infections which as bacterial infections are mastered appear to be replacing them to an ever increasing extent. It is gratifying to report that despite intensive enquiries no "Thalidomide" baby was born in the district. 5 Infectious Diseases and Immunisation Notifiable diseases continue to occupy a large part of the time of the Department in investigation and enquiry, and many suspect cases, after full investigation, are not confirmed, but one would much rather have an unconfirmed suspected case than an unnotified real case. It is, unfortunately, seldom possible to find the origin of infection in sporadic cases of dysentery and food poisoning unless association with a known case can be demonstrated, and the chief object of the exercise is to prevent further spread of the condition. This is not a practical procedure in the case of measles and no further action is usually taken when this disease is notified. The success of infant inoculation against diphtheria, poliomyelitis and whooping cough is manifest from the total absence of the first two and the low incidence of the last named in the notification list. Unfortunately the success of immunisation is tending to lull certain parents into a feeling of false security, particularly with regard to diphtheria and Health Visitors spend much time convincing such parents that diphtheria is not like the Black Death, interesting historically but of no importance in the present day; that it is, in fact, just below the surface and that immunisation of infants is essential if it is to remain so. The same attitude is not yet apparent with regard to poliomyelitis but it is a much more recent menace to child health than is diphtheria. Parents still fear it. Active immunisation against tetanus (lockjaw) is now offered to children either separately or in conjunction with diphtheria or whooping cough. The great majority of parents are glad to avail themselves of this provision which may well avoid a serious complication of what might have appeared a trivial wound. Parents have the opportunity of having children, who have not yet acquired immunity by natural processes, inoculated against Tuberculosis at the age of 13 years and a gratifyingly high proportion of parents agree to this procedure. It is satisfactory to note that there were no deaths from any of the seven principal zymotic diseases during the year. In conclusion I should like to thank the Health Committee and the Council for their lively interest and their support of the Health Department's work in 1962 and all members of the staff for their willing work at all times. I am, Mr. Chairman, Ladies and Gentlemen, Yours obediently, W. D. SWINNEY, Medical Officer of Health. 6 URBAN DISTRICT COUNCIL OF MERTON AND MORDEN 1962 PUBLIC HEALTH AND CIVIL DEFENCE COMMITTEE Chairman: Miss W. M. Hulme Mrs. W. R. Castle Mr. J. L. Coombes Mrs. E. M. Davis Mr. E. J. Newland Mr. P. L. Pike Miss N. K. Watts Mr. R. W. West Mr. J. Wynn Mr. C. S. Marsh, J.P. (ex-officio) Mr. V. Talbot (ex-officio) REPRESENTATIVES ON NORTH-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE Mr. J. L. Coombes Miss W. M. Hulme Miss N. K. Watts Mr. R. W. West Mr. P. L. Pike REPRESENTATIVES OF THE WANDLE VALLEY JOINT SEWERAGE BOARD Mr. A. V. Brandle Mr. E. K. Clarke, J.P. Mr. J. L. Coombes Mr. C. S. Marsh, J.P. (ex-offieio) MERTON AND MORDEN TUBERCULOSIS CARE COMMITTEE Chairman: Mrs. M. E. Shaw Vice-Chairman: Mrs. E. B. Lawrence Secretary: Miss E. Witton-Booth Treasurer: Mr. F. S. Buck 7 PUBLIC HEALTH STAFF 1962 Medical Officer of Health: * W. D. Swinney, M.B., Ch.B., D.P.H. Chief Public Health Inspector: abcd W. T. Pinches, M.R. San.I. Deputy Chief Public Health Inspector: abc E. N. Montague, D.P.A. Public Health Inspectors: a L. H. Thomas ab A. Watson a F. J. A. Willis (from 24.6.62) Pupil Health Inspectors: F. J. A. Willis (to 23.6.62) J. Klemp (from 1.10.62) Smoke Investigators: L. G. Berg L. A. Rogers Chief Clerk: * A. A. Makepeace Clerks: * Miss F. H. J. Barnes (to 22.12.62) R. Clark (Clerk/Trainee) **Mrs. C. J. Coombes † H. G. Finnimore Mrs. A. J. Hill * Mrs. H. E. Turl a Sanitary Inspector's Certificate, San. Insp. Exam. Joint Board. b Meat and Food Inspector's Certificate, Royal Sanitary Institute. c Smoke Inspector's Certificate, Royal Sanitary Institute. d Sanitary Science Certificate, Royal Sanitary Institute. * Officer of the Surrey County Council. In part-time employment of the Urban District Council of Merton and Morden. † Officer of the Urban District Council of Merton and Morden. In part-time employment of the Surrey County Council. **50% employment by both Authorities. 8 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,238 Population (Census 1961) 67,974 Population 1962 (Registrar-General's Estimate) 67,560 Number of inhabited houses (according to Rate Books) 22,469 Rateable Value (as at 31st December, 1962) £1,370,498 Sum represented by Id. rate £5,566 The Urban District of Merton and Morden lies in the valley of the Thames and is one of the areas of the so-called outer ring; that is to say part of Greater London within the Metropolitan Police district, outside the Administrative County of London and the City of London and the area is drained by the River Wandle, the Py1 and Beverley Brooks, tributaries of the Thames. The district is generally flat and sheltered, the whole lying between the 42-ft. and 141-ft. ordnance datum levels. With the exception of a belt of sand or alluvium in the north-eastern part running through Merton Park, the rest of the district has a subsoil of clay. The area is both residential and industrial and, as has been described before, except for a few factories in the older parts of the area and some unavoidable fringes, industry has been planned so as to occupy three main factory sites, leaving the residential parts of the area generally to enjoy the quietness of their homes remote from the noise and essential traffic of industry. The residential part of the district is part London dormitory and partly and increasingly occupied by residents engaged in industry or business within the area, but a very large number of workers come into the area daily so that the day-time population concentrated in the factory areas is an important factor to be borne in mind in considering any arrangements for the population of the district. The greater portion of housing of the district is owner occupied, but the Council owns and manages a pre-war housing estate of some 500 houses and has built several large four-storey blocks of flats scattered in various parts of the area to meet the post-war housing need. A considerable part of Morden is formed of the St. Helier L.C.C. housing estate. The area is fortunate in having secured the provision of extensive open spaces, in all amounting to 368 acres, in fourteen different parks, so that there is an even distribution of recreational facilities throughout the area. The National Trust owns 70-odd acres of this land and acquisition of the remaining 290 acres is due to the wisdom and foresight of successive 9 Councils. One of the largest of the parks—Morden Park—has, up to the present time, been preserved as a permanently open natural park, providing our suburban residents with the same amenity enjoyed by rural populations who have the countryside at their back doors. There were 212 factories on the register at the end of the year, including several large factories, e.g. the Tri-ang Group of toy factories employing over 3,000 persons. There are, in fact, four factories employing over 400 persons. VITAL STATISTICS Population The Registrar-General's mid-year estimate of the home population at 67,560 shows an estimated decrease of 60 on the previous year, although the natural increase by excess of births over deaths was 70. All rates used in this report are based on the Registrar-General's figures. Births During the year the total number of registered live births for the area was 868, giving a rate of 12.8 per thousand of the population, comparing closely with the figure for the previous year of 12.06. Stillbirths registered during the year numbered 11 (6 males and 5 females), being one less than in the previous year, giving a rate of 12.5 per 1,000 total births. Illegitimate live births registered during the year numbered 52 (27 males and 25 females), compared with 32 in the preceding year. Of the 11 stillbirths registered none was illegitimate. Deaths Deaths registered during the year numbered 798 (437 males and 361 females), giving a rate of 11.8 per 1,000 population. This compares with a total of 772 for 1961, giving a rate of 11.4 per 1.000 population. The four principal causes of death were as follows:— Number of Deaths Percentage of lota! deaths (a) Diseases of the heart and circulatory system 320 40% (b) Cancer 180 22% (c) Vascular lesions of nervous system 87 11% (d) Diseases of the respiratory system 91 11% Totals 678 85% 10 Maternal Mortality No deaths in childbirth, either from puerperal sepsis or other maternal causes, were recorded during the year. A total of six maternal deaths have been recorded in the district over the past ten years. The maternal mortality rate for England and Wales per thousand live and still births was 0.35. Infant Mortality During 1962 there were 12 deaths among infants under one year of age, giving a mortality rate of 13.8 per thousand live births, as compared with 18 deaths in 1961, giving a rate of 22.06 per thousand live births. The number of neo-natal deaths (i.e. those occurring during the first four weeks of life) was 8, giving a neo-natal death rate of 9.2 per thousand live births, as compared with 14 deaths for the preceding year. 11 SUMMARY OF VITAL STATISTICS (Registrar General's Figures) Population: Registrar-General's Estimate (Mid-Year) 67,560 Births: M. F. Total Live (Legitimate) 396 420 816 (Illegitimate) 27 25 52 423 445 868 Stillbirths (Legitimate) 6 5 11 (Illegitimate) - - - 6 5 11 Total Births 429 450 879 Birth Rate 12.8 per 1,000 population Stillbirth Rate 12.5 per 1,000 total births Deaths: M. F. Total Total Deaths 437 361 798 Death Rate (crude)11.8 per 1,000 population Infant Mortality: Total deaths under one year 12 Infant Mortality Rate per 1,000 Live Births 13.8 Deaths of Legitimate Infants under one year 12 Death Rate per 1,000 Legitimate Births 14.7 Deaths of Illegitimate Infants under one year Nil Death Rate per 1,000 Illegitimate Births Nil Maternal Mortality: Deaths from Sepsis Nil Deaths from other maternal causes Nil Maternal Death Rate per 1,000 Total Births Nil Zymotic Deaths: 7 Principal Zymotic Diseases Nil Deaths from Measles Nil Deaths from Whooping Cough Nil Deaths from Diarrhoea (under 2 years) Nil Zymotic Death Rate Nil Deaths from Tuberculosis: Respiratory 2 Non-Respiratory Nil Death Rate (per 1,000 population) 0.03 Deaths from Cancer: 180 Rate per 1,000 population 2.6 12 VITAL STATISTICS—MOTHERS AND INFANTS Live Births: Number 868 Rate per 1,000 population 12.8 Illegitimate Births per cent. of total live births 6.0% Stillbirths: Number 11 Rate for 1,000 total live and stillbirths 12.5 Total live and stillbirths 879 Infant Deaths (deaths under one year) 12 Infant Mortality Rates: Total infant deaths per 1,000 live births 13.8 Legitimate infant deaths per 1,000 legitimate live births 14.7 Illegitimate infant deaths per 1,000 illegitimate live births Nil Neo-Natal Mortality Rate: Deaths under four weeks per 1,000 live births 9.2 Early Neo-Natal Mortality Rate: Deaths under one week per 1,000 live births 8.0 Peri-natal Mortality Rate: Stillbirths and deaths under one week combined per 1,000 total live and stillbirths 20.4 Maternal Mortality (including abortion): Number of deaths Nil Rate per 1,000 total live and stillbirths Nil INSTITUTIONAL AND DOMICILIARY BIRTHS An analysis of the birth notifications received during 1962 shows that 705 of the 879 births occurred in hospitals, institutions and nursing homes. This represents 80% of the total. The distribution of institutional births is given below:— St. Helier Hospital 384 Nelson Hospital 194 St. Teresa's Hospital 70 Kingston Hospital 9 Other hospitals, institutions and nursing homes 48 705 13 PREMATURE BIRTHS There were 52 premature births notified during the year, 46 of whom survived one month. Below is a summary of the notifications:— (a) Born at home 9 (b) Born in hospital or nursing home 43 The number of those born at home:— (a) Who were nursed entirely at home 9 (b) Who died during the first 24 hours 2 (c) Who survived at the end of one month 7 The number of those born in hospital or nursing home:— (a) Who died during the first 24 hours 1 (b) Who survived at the end of one month 39 14 COMPARATIVE STATISTICS, 1962 Births. The live birth rate in Merton and Morden during 1962 at 12.8 per 1,000 population is strikingly below the national figure of 18.0 per 1,000. Merton and Morden is not a depressed area with rife unemployment, which is frequently the cause of a low birth rate, nor is the housing shortage abnormally acute compared with many other areas, although the position is one which everyone would like to see improved. The preliminary report on the 1961 Census does not contain this information, but I think that an analysis of our population in this district will show that the proportion of women past child-bearing age is higher than the average for the Country, which of course finds a reflection in the birth rate. Deaths. The total death rate of 11.8 per 1,000 compares favourably with the national figure of 11.9, but it is noted that the incidence of deaths from the two principal killing diseases is higher in Merton and Morden than in the Country as a whole. This is particularly striking in the case of Carcinoma of the lung and brochus which causes half as many deaths again in the area as it does generally throughout England and Wales. On the other hand, deaths from other pulmonary conditions are of less frequent occurrence, those from Pulmonary Tuberculosis being less than half the national figure. The Maternal Mortality Rate and the Infant Mortality Rate are both causes for satisfaction, although one would like to see the latter even lower still. Notifications. Measles is now by far the commonest notifiable infectious disease and it is the most serious infectious disease of childhood, for which there is still no effective immunisation. Scarlet fever was notified at almost double the national incidence, but this once dreaded infection has lost much of its 'sting' not only because of improved treatment methods but because over the years the causative agent has diminished in virulence. The low incidence of intestinal infections compared with the national average reflects creditably on standards of hygiene in both food shops and in the homes of the district. 15 COMPARATIVE STATISTICS, 1962. England and Wales Merton and Morden Rates per 1,000 Home Population Births: Live 18.0 12.8 Still 0.33 0.16 18.1* 12.5* Deaths: All causes 11.9 11.8 Coronary Disease, angina 2.20 2.97 Malignant neoplasm—lung, bronchus 0.51 0.79 Pneumonia 0.68 0.57 Influenza 0.07 0.04 Tuberculosis—all forms 0.07 0.03 Diphtheria 0.00 — Maternal Mortality 0.35 — Acute Poliomyelitis 0.00 — Whooping Cough 0.00 — Notifications (corrected): Measles 3.95 3.81 Scarlet Fever 0.32 0.62 Tuberculosis— Respiratory 0.38 0.42 Non-respiratory 0.05 0.02 Acute Pneumonia 0.26 0.26 Whooping Cough 0.17 0.23 Puerperal Pyrexia 8.02* 7.9* Erysipelas 0.03 0.04 Dysentery 0.66 0.04 Food Poisoning 0.11 0.04 Diphtheria 0.00 — Acute Encephalitis— Infective 0.00 — Post-infective 0.00 — Enteric or Typhoid Fever 0.00 — Meningococcal Infection 0.01 — Para-typhoid Fever 0.00 — Acute Poliomyelitis— Paralytic 0.00 — Non-paralytic 0.00 Rates per 1,000 Live Births Deaths: Infant Deaths (all causes under 1 year) 21.6 13.8 Diarrhoea and Enteritis (under 2 years) 06 - * Per 1,000 total (live and still) births. 16 CAUSES OF DEATH DURING THE YEAR 1962 No. Cause of Death Males Females Total 1 Tuberculosis, respiratory 2 - 2 2 Tuberculosis, other — — - 3 Syphilitic disease 3 — 3 4 Diphtheria — — — 5 Whooping Cough — — — 6 Meningococcal Infections — — — 7 Acute Poliomyelitis — — — 8 Measles — — — 9 Other infective and parasitic diseases 1 1 2 10 Malignant neoplasm, stomach 9 12 21 11 Malignant neoplasm, lung bronchus 46 8 54 12 Malignant neoplasm, breas — 18 18 13 Malignant neoplasm, uterus — 8 8 14 Other malignant and lymphatic neoplasms 39 40 79 15 Leukaemia, aleukaemia 4 3 7 16 Diabetes 3 4 7 17 Vascular lesions of nervous system 34 53 87 18 Coronary disease, angina 132 69 201 19 Hypertension with heart disease 5 10 15 20 Other heart disease 32 40 72 21 Other circulatory diseases 18 14 32 22 Influenza 3 — 3 23 Pneumonia 17 22 39 24 Bronchitis 32 15 47 25 Other diseases of respiratory system 1 1 2 26 Ulcer of stomach and duodenum 8 1 9 27 Gastritis, enteritis and diarrhoea 1 2 3 28 Nephritis and nephrosis 1 1 2 29 Hyperplasia of prostate 7 — 7 30 Pregnancy, childbirth, abortion — — — 31 Congenital malformations 4 3 7 32 Other defined and ill-defined diseases 19 20 39 33 Motor vehicle accidents 6 3 9 34 All other accidents 5 6 11 35 Suicide 5 7 12 36 Homicide and operations of war — — — Total all causes 437 361 798 17 SECTION B—HEALTH SERVICES Laboratory Facilities The chemical analysis of milk, water and foodstuffs was carried out during the year by the Public Analyst, Mr. D. D. Moir, M.Sc., F.R.I.C., of 16 Southwark Street, London, S.E.1. For the examination of specimens in cases of suspected food poisoning and for the bacteriological examination of milk and water use was made of the Public Health Laboratory at Epsom. Routine laboratory examinations in connection with infectious disease were carried out by the hospital laboratory service of the Nelson and St. Helier Hospitals. Particular thanks are due to the Nelson Hospital laboratory, which with a small staff, is always so obliging, obviating the need for taking specimens further afield. Ambulance Service This service is supervised by the Surrey County Council. The Control Centre for the Metropolitan area of Surrey operates from 163, Kingston Road, New Maiden, Telephone MALden 7733. Hospitals General and Maternity: 1. The Nelson Hospital. This hospital, which serves Wimbledon, Merton and Morden and parts of Wandsworth, has a bed complement 128. This is 5 more than in the previous year, arising as the result of the establishment of a premature baby unit at the hospital. There is, therefore, accommodation for 83 general patients - mainly surgical-and 45 in the maternity unit. The total number of in-patients admitted to the general medical and surgical beds was 1,778, of which 483 were residents of Merton and Morden. With regard to maternity services, 275 patients were admitted from our area out of a total of 1,507. In the out-patient and casualty departments, 4,747 new patients seen at Consultative Clinics made 10,849 re-attendances, making a total in all of 15,596 attendances. The casualty department dealt with 9,892 new cases who made a total of 13,494 re-attendances. 2. Other Hospitals. Among other hospitals available for use of our residents are St. Helier Hospital, Carshalton, and the Epsom and Kingston Hospitals. St. Helier is used to a very great extent and a large proportion of our births take place at this hospital each year. Increasing use is also made of St. George's Hospital, Tooting, formerly called The Grove Hospital. During the year under review, of the 879 births (live and still) notified, 384 or 43.6% of the total, took place in St. Helier Hospital. 18 3. Infectious Disease Cases of infectious disease from this area are admitted mainly to the Wandle Valley Isolation Hospital. Use is made occasionally of Cuddington and Tolworth Isolation Hospitals. Only ten patients were admitted to the Wandle Valley Hospital during the year from this area and, of this number, two only were notifiable infectious diseases and were admitted not because of the severity of the illness but to prevent infection spreading to a baby in the home. A further ward was opened at the Wandle Valley Hospital during the year bringing the total bed complement available now to 160. The new ward is essentially for pre-convalescent Traumatic and Orthopaedic patients being referred, generally from St. Helier Hospital. 4. Smallpox. Arrangements for the prompt isolation of any case of smallpox discovered in the district continued unchanged. Should the necessity arise, the South-East Metropolitan Regional Hospital Board would provide accommodation at the Long Reach Hospital, Dartford, where there is an experienced medical and nursing staff accustomed to handling the treatment of this disease. 19 CLINIC AND TREATMENT CENTRES (Under the control of the Surrey County Council). The following programme of clinics is provided by the County Council and are available to residents of the district:— Care of Mothers and Young Children Grand Drive Centre: Infant Welfare Mondays 10.0-12.0 noon 2.0- 4.0 p.m. „ „ Wednesdays 10.0-12.0 noon Ante-Natal Wednesdays Commencing at 1.30 p.m. Dental Mondays to \ By appointment Fridays Eye Tuesdays Commencing at 2.0 p.m. Speech Therapy Tuesdays p.m. „ „ Wednesdays By appointment „ „ a.m. and p.m. Middleton Road Centre: Infant Welfare Tuesdays 2.0-4.0 p.m. „ „ Fridays 2.0-4.0 p.m. Ante-Natal Thursdays Commencing at 1.30 p.m. Dental Mondays „ Tuesdays By appointment „ Thursdays „ Fridays J Morden Road Centre: Infant Welfare Tuesdays 10.0-12.0 noon „ „ „ 2.0- 4.0 p.m. „ „ Thursdays 2.0- 4.0 p.m. Ante-Natal Fridays Commencing at 10.0 a.m. Dental Mondays to Fridays Eye Wednesdays By appointment p.m. Speech Therapy Thursdays a.m. St. John's Church Hall: Infant Welfare Thursdays 10.0-12.0 noon School Health Service—General Medical Clinics: Grand Drive Centre Tuesdays 10.0-12.0 noon Middleton Road Centre Wednesdays 10.0-12.0 noon Morden Rd. Centre Mondays 10.0-12.0 noon 20 Poliomyelitis Vaccination Available at Welfare and special clinics in health centres, in schools and in factories. Diphtheria, Whooping Cough and Tetanus Immunisation and Vaccination Treatment is available for children under 5 years of age at infant welfare clinics and for school children at the schools and also at the school clinics. Tuberculosis Clinics Cumberland Hospital, Mondays, WedWhitford Gardens, days and Mitcham. Thursdays Commencing at 2.0 p.m. Tuesdays Commencing at 9.30 a.m. 1st and 2nd Commencing at 5.30 p.m. Tuesdays (old cases only) Venereal Disease Clinics St. Helier Hospital, Mondays (Males) 4.0-6.30 p.m. Wrythe Lane, Wednesdays Carshalton. (Females) 5.0-7.0 p.m. 21 SECTION C—SANITARY CIRCUMSTANCES Disposal of the Dead. The Carshalton and Merton and Morden Joint Burial Board formed by the two authorities administers 60 acres of land in Lower Morden as a cemetery for both areas. During the year 385 interments took place there of which 207 were from Merton and Morden. The North-East Surrey Crematorium Board, representing the Councils of Battersea, Sutton and Cheam, Carshalton and Merton and Morden, operates a crematorium sited in the Battersea cemetery grounds at Lower Morden, which adjoins the burial ground referred to above. Cremations there numbered 1,264 in 1962, of which 300 were from Merton and Morden. Drainage and Sewerage. No major improvement schemes have been undertaken during the year but, in addition to the normal maintenance work carried out on soil and surface water sewers, several lengths of defective sewers have been relaid throughout the district. Arrangements are in hand for work to be carried out on a surface water relief sewer in the south-west corner of the district. Food and Drugs. Sixty-three samples were submitted to the Public Analyst during the year, all of which were found to be unadulterated and genuine. Details of the samples will be found on pages 34. One hundred and eighty-three samples of milk were sent to the Public Health Laboratory for bacteriological examination. Two failed to conform to the prescribed standards. Twenty-two samples of ice cream were also sent to the Laboratory, further details of which will be found on page 35. Food premises in the area number 581 and are divided into the following categories:— Bakehouses 2 Milk Depots 3 Bakers 14 Milk Shops (other than Butchers 30 dairies) 30 Chemists 15 Off Licences 17 Confectioners 85 Public Houses 13 Corn Chandlers 3 Restaurants, Cafes Dairies 1 and Snack Bars 55 Fishmongers 11 School Canteens 15 Fish Fryers 10 Staff Canteens 17 Greengrocers 43 Wholesale Confectioners — Grocers 68 Wholesale Food Ice Cream Dealers 135 Manufacturers & Storers 12 Wholesale Grocers 2 The total number in the categories is, of course, far greater than the actual number of premises, as at several of them two or more of the above trades are carried on. Inspections of these premises during the year totalled 1,778. Details of offences and action taken are included in the Chief Public Health Inspector's report on page 29. 22 Registrations under Section 89 of the Merton and Morden Urban District Council Act, 1936, at the end of the year were as follows:— Ice Cream Dealers 135 Ice Cream Vendors (Itinerant) 18 Preserved Food Manufacturers 42 Public Cleansing. Normal operations for the collection and disposal of refuse were continued throughout the year and a total of 16,949 tons was collected from January to December. Repairs carried out to the firebrick lining of the disposal plant and the introduction of a trade waste incinerator have proved to be very effective in dealing with the various types of refuse and trade waste handled at the disposal plant. The tonnage of salvage collected during the year was:— Tons Paper 1,555 Tins 610 Cullet 234 Tons Metal 162 Rags 100 Bottles 8 Rivers and Streams. No major works to rivers and streams was carried out during the year but arrangements are in hand with the Surrey County Council to carry out improvement works on the southern length of the River Wandle in this district. A length of ditch on the east side of Cannon Hill Lane, south of Elm Walk junction, has been piped by Council direct labour. Water Supply. The district is supplied by the Metropolitan Water Board and by the Sutton District Water Company, their respective distributive areas being approximately the parishes of Merton and Morden. The supply of the Metropolitan Water Board is only sampled infrequently as a routine; otherwise samples are taken when circumstances indicate the necessity for local investigation. The Board supplies copies of their official minutes in which the results of the examinations are recorded. Routine examinations of the Sutton District Water Company's supply are undertaken by the Authorities in the supply area upon an agreed rota, which provides for bacteriological and chemical samples each month. The Company, in addition to the examinations undertaken by their own full-time Chemist, arrange for Consulting Chemists to undertake monthly examinations. Copies of the reports of these Consulting Chemists are received by local Medical Officers of Health, whilst the records of the Company's own analyses are available for inspection by the Medical Officers. All dwellings in the district have a piped supply and the water which is both satisfactory in quality and quantity is not regarded as being plumbosolvent. Four samples of water from domestic supply were submitted for chemical or bacteriological examination during the year and the reports 23 indicated that in every instance the samples were pure and wholesome and suitable for public supply. Arrangements are also made to take periodic samples from the drinking fountains in the Council's parks and open spaces. Samples were taken during the year from eight different fountains for chemical and bacteriological examination and all proved to be satisfactory. Six of these fountains were on the supply of the Sutton District Water Company and two on that of the Metropolitan Water Board. 24 25 CLIMATIC CONDITIONS — RAINfALL, 1962. Rain gauges are installed at the Joseph Hood Recreation Ground, West Barnes Pumping Station and Morden Hall. The Monthly recordings taken from these gauges are as follows:— Jan. Feb. Mar. Apl. May June July Aug. Sep. Oct. Nov. Dec. Total Joseph Hood Recreation Ground Total rainfall in inches 2.94 0.64 1.38 1.66 1.91 0.44 2.66 1.82 2.17 1.76 1.69 3.35 22.42 Days with .01" or more 20 12 10 16 17 6 11 12 13 8 17 12 154 Days with .04" or more 16 3 6 12 9 3 8 7 11 6 16 11 108 West Barnes Pumping Station Total rainfall in inches 3.36 0.63 1.39 1.73 2.12 0.43 2.67 2.01 2.46 2.06 1.82 2.94 23.62 Days with .01" or more 19 15 16 18 21 6 12 12 19 11 19 11 179 Days with .04" or more 14 3 8 13 12 4 8 7 12 6 16 10 113 Morden Hall Total rainfall in inches 2.78 0.73 1.32 1.83 1.86 0.33 2.70 1.80 2.66 1.84 1.74 2.73 22.32 Days with .01" or more 21 11 9 17 17 4 12 11 14 9 16 13 154 Days with .04" or more 15 4 7 13 10 3 9 7 13 7 15 10 113 SECTION D. — HOUSING Housing and Overcrowding. During the year 5 new houses and 34 new flats were erected in the district, 19 of the flats by the Council and 15 flats and 5 houses by private builders. 203 eligible applications for rehousing were received by the Housing Manager during the year; 23 houses and flats were allocated to tenants during this period. By the end of the year the number of outstanding applications was 1,154. Arising out of rehousing enquiries, six complaints of overcrowding were received. Of these, one was found to be overcrowded within the standards laid down by the Housing Act, 1957. The housing situation in Merton and Morden may be gathered from the following facts:— 1. Inspection of Dwetlinghouses during the year:— i. (a) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) 134 (b) Number of inspections made for the purpose 134 ii. (a) Number of dwellinghouses (included under head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 — (b) Number of inspections made for the purpose — iii. Number of dwellinghouses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — iv. Number of dwellinghouses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 54 2. Remedy of defects during the year without service of formal notice- Number of defective dwellinghouses rendered fit in consequence of informal action by the Local Authority or their officers 31 3. Action under Statutory Powers during the year:— A.—Proceedings under Section 9, 10 and 12 of the Housing Act, 1957:— (i) Number of dwellinghouses in respect of which notices were served requiring repairs — (ii) Number of dwellinghouses which were rendered fit after service of formal notices:— (a) By Owners — (b) By local authority in default of owners 26 B.—Proceedings under Public Health Acts:— (i) Number of dwellinghouses in respect of which notices were served requiring defects to be remedied 23 (ii) Number of dwellinghouses in which defects were remedied after service of formal notices:— (a) By Owners 23 (b) By local authority in default of owners C.—Proceedings under Section 17 and 23 of the Housing Act, 1957:— (i) Number of dwellinghouses in respect of which Demolition Orders were made 1 (ii) Number of dwellinghouses demolished in pursuance of Demolition Orders — D.—Proceedings under Section 18 of the Housing Act, 1957:— (i) Number of separate tenements or underground rooms in respect of which Closing Orders were made (ii) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 27 FACTORIES ACT, 1961 1. INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors). Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 8 5 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 204 259 20 - (iii) Other premises in which Section 7 is enforced by the Local Authority 6 5 — — Total 218 269 20 — 2. Cases in which defects were found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.l.) - — — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) — — - — — Ineffective drainage of floors (S.6) - — - — — Sanitary Conveniences (S.7) (a) Insufficient - - - - — (b) Unsuitable or defective 5 5 - - - (c) Not separate for sexes Other offences against the Act (not including offences relating to Outwork) 4 - 4 - - Total 9 5 4 — — 28 SECTION E REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR In reviewing the work of the Public Health Inspectorate during 1962, I must record that although most items of environmental hygiene were adequately covered, certain aspects such as food sampling, housing and chimney observations were unavoidably restricted. The Council's policy of undertaking the training of student inspectors achieved its first success when Mr. Willis qualified at his first attempt in July 1962. He was subsequently appointed to fill the vacant post in the 1949 establishment but before these words were written he had resigned in April 1963 to take an appointment elsewhere. Although the number of inspections made during 1962 showed a decrease of 654 from 7,355 in 1961, the total reached at 6,701 must be regarded as most satisfactory. The following table compares the year's totals with those of 1961 under the main headings and while indicating the general scope of the work points out the shift of emphasis between them:— 1962 1961 Food Shops, etc. 1,171 1,101 Housing—primary visits 134 176 Housing—re-inspections 39 37 Housing—overcrowding provisions 14 41 Housing—miscellaneous 84 123 Drainage—chokages and repairs 833 1,337 Rat and Mice destruction 311 243 Shops—Welfare provisions 365 482 Infectious Disease enquiries 13 10 Factories, Workplaces and Outworkers 487 652 Milk Supply 142 127 Smoke abatement 1,128 920 Rivers and Stream pollution 43 36 Stables and Piggeries 10 11 Miscellaneous (Caravans, Hairdressers, Schools, Building sites, etc.) 1,927 2,059 6,701 7,355 Periodic inspections are required at the following premises as counted at the end of the year:— Wholesale Food Manufacturers 2 Bakehouses 6 Food Shops and Catering Establishments 646 Public Houses 18 Other Shops 272 Factories (Power) 204 Factories (Non-power) 8 Offices, Workplaces, etc 271 29 The frequency of change of occupation in the shops and smaller businesses continues to be surprisingly high amounting to some 15% annually in these categories. It is obviously desirable that a fairly frequent inspection of such premises should be made—some authorities suggest biannual or even quarterly visits. This was impossible but the policy adopted by the Public Health Committee in 1957 was adhered to. This involved the further inspection during 1962 of all those premises found unsatisfactory in some respects in 1961 and then a concentration on those formerly satisfactory premises oldest in date of last inspection. While all the premises last inspected and found satisfactory in 1958 were revisited and a start made on those of 1959, this three-year period between inspections can only be a source of considerable concern. HOUSING A total of 134 houses were inspected for "sanitary defects" under the Public Health and Housing Acts. Few major works of repair were needed and informal action secured the required result in all but 23 cases where statutory action had to be taken. Legal proceedings were not necessary in respect of any of these cases. These 134 houses were inspected as a result of complaint by the tenant or possibly while calling for another purpose, i.e. Infectious Disease control. It is desirable, however, that a systematic inspection should be going on by way of house-to-house visiting. Action taken in connection with dwelling houses, as set out in housing tables on pages 26/27 resulted in the following improvements:- Summary of Nuisances Abated and Sanitary Improvements Effected Cleanings cleansed or repaired 5 Dampness in premises remedied 8 Drains exposed and repaired 2 Defective sashcords renewed 4 Dustbins provided 1 Floors repaired 2 Fresh air inlet valves provided and repaired 4 Inspection chamber covers provided 4 Obstructions removed from drains 3 Rain Water pipes renewed or repaired 2 Roofs repaired 10 Gutters repaired 3 Sink wastes repaired 2 Walls repaired 8 W.C. cisterns repaired 2 Water closets cleansed 1 W.C. pans provided 2 Windows repaired or renewed 4 Ventilation provided under floors — Sinks provided 1 30 Offensive accumulations removed 1 Water supply repaired for domestic use 1 Sanitary accommodation for workshops 14 Miscellaneous 8 Notices Served:- Intimation notices 54 Statutory notices Public Health Act, 1936 Housing Act, 1936 23 The Urban District is often regarded as being comprised largely of modern owner-occupier houses but this is not strictly true. There is a widespread area of older property in the northern part of the district and the Smoke Control Surveys are revealing that quite a proportion of the more modern houses are rented. In Morden Ward (developed between the wars) excluding Council Houses and the Haig Homes Estate, some 176 houses or approximately 6% were rented from private owners. The resumption of house-to-house inspections merits a high priority when circumstances permit. Moveable Dwellings. No application was received for licence to station a caravan in the district. Overcrowding The position with regard to statutory overcrowding is still reasonably satisfactory. One case was discovered during the year in addition to the five previous cases. All the occupiers affected were applicants for Council Houses under consideration by your Housing Department. Certificates of Disrepair. Under the 1957 revision of the Rent Act, two applications for certificates were received and granted by the end of the year. One was revoked in the same period, the necessary work having been completed. Thirteen houses were still subject to Certificates of Disrepair although in many instances the tenants are paying the full rent even where the work covered by the Certificate has not been done. The continuing decrease in applications appears to some extent to be due to a mistaken belief that the procedure only applied directly after the 1957 Act was passed. Occupiers complaining of disrepair are advised of the legal position by the Inspectors in suitable cases. 31 FOOD SUPPLIES The majority of the shops, works canteens, etc., inspected were in good condition with adequate food storage, sanitary and washing accommodation, but at 87 premises the following unsatisfactory points were noticed:— Unclean and Defective Premises 35 Unclean Utensils 10 Accumulation of Refuse 7 Defective or Insufficient Bins 7 Unprotected Food 2 Defective Sanitary Accommodation 14 Washing facilities:— (a) No hot water 4 (b) No soap 2 (c) No Towels 1 (d) Non-display of notice re washing hands 13 These were all corrected after informal action, legal proceedings being unnecessary. Unsound Food. The undermentioned articles of food were found, upon inspection, to be unfit for human consumption; were surrendered and either destroyed or disposed of for animal feeding or salvage:— Description Amount Cause Apricot Jam 20 lbs. Broken Containers Beef 350 lbs. Decomposed Chicken 41 lbs. ” Fish 6 stone ” Mushrooms 12 lbs. Mouldy Ox Kidneys 20 lbs. Decomposed Pig Kidneys 39 lbs. Putrefied Pork 154 lbs. Decomposed Rabbit 72 lbs. ” Shelled Walnuts 110 lbs. Moth infested Tinned Foods 9,928 Blown, punctured, or leaking 32 Contaminated Foodstuffs. Seven complaints of food were received relating to baby food and bread roll containing foreign objects, bacon, bread, cake, and baby food of dubious quality, and a chicken with abnormal bone condition. All were carefully investigated and, when appropriate, action was taken—mostly by informal letter. There are no producers of milk registered within the district. 116 inspections were made of milk distributors' premises in 1962 and at the end of the year there were on the register four dairies and forty distributors of milk. Three of the dairies were physically large distribution depots handling only milk in bottles or sealed churns but the fourth is a large pasteurising establishment processing some 60,000 gallons daily with a weekly output of over 5,000,000 bottles. Close supervision was kept over the dairy hygiene and repeated checks were made of the temperature controls, flow rates, recording charts and the results of bacteriological and chemical examinations. No separate samples for bacteriological or chemical examination were made by your officers during the year of the incoming milk from the producers. 183 samples of milk were submitted for bacteriological examination during the year and two were unsatisfactory, failing the Methylene Blue or keeping quality test. These were from two separate firms and were dealt with informally, as they were isolated examples of normally satisfactory milk. The undermentioned licences to use special designations were granted during 1962:— Pasteuriser's Licence 1 Dealer's Licences:- Pasteurised 6 Tuberculin Tested 6 Sterilised 4 Details of the chemical analysis of milk samples will be found on page 34. Food and Drugs. The following table shows the number and nature of the samples submitted to the Public Analyst in accordance with the Food and Drugs Act, 1955, and his classification of them as genuine or otherwise. 33 Article Genuine Genuine Bread 4 — Butter 5 — Fish, potted 3 Meat Pudding 1 Meat, potted 2 — Meat, tinned 5 — Milk 31 Milk, separated 1 — Paste, Fish 7 — Paste, Meat 4 — Total 63 The samples were mainly of foods produced locally and having a sale outside the Urban District. The Public Analyst issues a quarterly summary of unsatisfactory samples submitted to him from the many areas he covers but shortage of staff prevented more time being devoted to this subject which requires a careful appraisal of the adulteration and sophistication possible in order to prepare a sampling programme giving adequate coverage. A summary of the fat and non-fatty solids contents of the 31 samples of milk taken for chemical analysis is given by the following tables:— Solids not fat (Legal standard is 8.5 %) Less than 8.5 8.6 8.7 8.8 8.9 9.1 9.2 Total — 5 12 8 4 1 1 31 Milk fat (legal standard is 3.0%) Less than 3.0 3.4 3.5 3.6 3.7 3.8 4.4 4.5 4.8 5.2 Total — 1 8 9 3 4 2 2 1 1 31 Ice Cream. At the end of the year, there were 150 registered retailers and 4 itinerant vendors. Most of these obtained their supplies from one or more of eight manufacturers but the making of soft ice-cream on mobile vehicles continued to increase in extent. 34 This method is more open to public health hazards and stricter control is necessary. 22 samples were obtained and submitted for bacteriological examination with the following results:— No. Provisional Grade Methylene Blue Test 1 1 Not decolourised after 4 hours 2 1 do. 3 1 do. 4 1 do. 5 1 do. 6 1 do. 7 1 do. 8 1 do. 9 1 do. 10 1 do. 11 1 do. 12 2 Decolourised after 4 hours 13 1 Not decolourised after 4 hours 14 1 do. 15 1 do. 16 2 Decolourised after 3 hours 17 1 Not decolourised after 4 hours 18 4 Decolourised immediately 19 1 Not decolourised after 4 hours 20 3 Decolourised after 1 hour 21 1 Not decolourised after 4 hours 22 1 do. The results are summarised as follows:— Provisional Grade 1 18 81.9% Provisional Grade 2 2 9.1% Provisional Grade 3 1 4.5% Provisional Grade 4 1 4.5% 22 100% No Chemical examinations were made. 35 AIR POLLUTION Continuous progress was made during the year in the implementation of the Council's Clean Air policy. The No. 3 Smoke Control Order (to come into operation on 1st October 1963) was made by the Council on 29th January 1962 and confirmed by the Minister of Housing and Local Government on 14th June 1962. On 1st October 1962 Nos. 1 and 2 Smoke Control Orders became operative, affecting the whole of the Morden Ward. The survey of premises in future control areas proceeded steadily, an attempt being made to interview the occupier of each of the premises within the areas concerned. 1 feel it is largely due to this personal contact and the use I have been able to make of the excellent mobile demonstration units of the Coal Utilisation Council and Solid Smokeless Fuels Federation that there has been once again a complete absence of formal objections to the formation of smoke control areas. In all, 568 visits were made by Smoke Investigators and my Deputy to discuss the implications of proposed Smoke Control Orders, and 1,570 visits to inspect adaptations to fireplaces eligible for grants. Twenty-two cases of infringement of Smoke Control Orders were dealt with informally, as all were first offences. The observation of industrial chimney emissions has continued as part of the normal duties of the Public Health Inspectors, hampered, unfortunately, by depleted staff. Four emissions in excess of the Permitted Period Regulations were observed and resulted in one prosecution, a £2 fine being imposed. Another firm was prosecuted for failing to notify the installation of a new boiler. Examination of plans of new chimneys to serve industrial furnaces has again resulted in increases in the proposed chimney heights being required to prevent a rise in ground level pollution. It is hoped that guidance will soon be forthcoming from the Government to assist your Officers in the difficult task of determining the minimum height of chimneys in the vicinity of tall buildings. Measurement of air pollution has continued throughout the year as part of the nation-wide survey undertaken by local authorities in cooperation with the Department of Scientific & Industrial Research. The daily concentrations of smoke and sulphur dioxide are measured at the Lombard Road Pumping Station of the Sutton & District Water Company, at Grand Drive Clinic, and at Morden Farm County Secondary School, Aragon Road. At the latter site the work is still being undertaken by pupils under the guidance of the Science Master. Measurements obtained from all three sites (which are summarised in the following table) compare favourably with those of similar sites in the Greater London area. 36 TABLE I Sites of Atmospheric Pollution Volumetric Apparatus MONTH LOMBARD ROAD GRAND DRIVE CLINIC MORDEN FARM SCHOOL Smoke Sulphur Dioxide Smoke Sulphur Dioxide Smoke Sulphur Dioxide Highest Lowest Highest Lowest Highest Lowest Highest Lowest Highest Lowest Highest Lowest January 1286 20 1331 120 1409 16 1455 68 1091 34 1460 63 February 431 26 562 44 396 12 582 81 378 18 468 95 March 249 10 458 64 583 28 560 106 505 21 655 126 April 140 10 456 35 164 7 474 83 134 16 204 51 May 131 10 308 33 161 4 281 39 95 5 269 29 June No records, due to local pollution 54 3 252 36 35 3 189 26 July 81 3 358 27 59 5 292 35 59 5 168 22 August 63 6 151 27 63 3 188 19 No records available (School holidays) September 172 8 182 21 95 2 308 0 73 4 142 13 October 410 18 556 90 231 18 258 60 396 14 377 46 November 659 28 759 92 No figures available 615 36 695 110 December 1239 18 2247 54 No figures available 1134 22 1676 70 All the above concentrations are in micrograms per cubic metre. The Deposit Gauge in the ground of Carshalton and Merton & Morden Joint Cemetery, Garth Road in the vicinity of the Refuse Destructor Chimney, continued to reveal an average monthly deposit of 10.3 tons/sq. mile. Until April 1962 a "Control" Gauge had been situated on the roof of Grand Drive Clinic giving an average monthly deposit of 9.8 tons/sq. mile, but this was moved on 2nd April to the roof of the bandstand in Morden Park, in order to obtain a more accurate assessment of the "background" deposit in the district. Since April, the average monthly deposits recorded at this site have been 8.5 tons/sq. mile. The figures are given in detail below:— 37 SOLID MATTER COLLECTED IN DEPOSIT GAUGES (Expressed in tons/square mile/month) Month Carshalton & Merton & Morden Joint Cemetery Board Grand Drive Clinic Bandstand Morden Park January 9.43 10.80 February 6.51 7.70 March 11.81 11.01 April 9.34 10.84 May 10.10 9.67 June 9.50 9.64 July 9.30 8.23 August 5.87 6.13 September 7.27 5.70 October 21.01 7.23 November 9.67 8.41 December 13.83 10.49 10.305 Total Average 9.836 Total Average 8.482 Total Average 38 GENERAL SANITATION Factories and Workplaces. The number of inspections made to premises registered under the Factories Act, 1961, was 487. Defects relating to sanitary conveniences, ventilation and other sanitary matters were dealt with at 20 premises. The table on page 28 gives details of action taken during the year. Water Courses. Regular inspections were made of the water courses in the district, particularly of the River Wandle, and Beverley and Pyl Brooks for the purpose of detecting pollutions. Details of pollutions entering from the Council's surface water sewers were received from the Surrey County Council and investigated. Rats and Mice. 255 complaints of infestation were received during the year and as a result of the inspections of 2,034 premises 258 of them were found to be infested. The control methods recommended by the Ministry of Agriculture, Fisheries and Food were followed in every case. A 10% test baiting of the Council's soil sewers was made and 140 manholes were included. Of this total, 17 manholes showed 'takes' and a poison treatment was carried out immediately afterwards. The Rodent Control Service is free to occupiers of domestic property but a charge is made for work on business premises. The total income from this source was £149 14s. 8d. in the financial year 1962-63, including the sum of £83 6s. 8d., which is paid annually by four firms under contract. Expansion of the service to commercial concerns is restricted only by the labour at my disposal, the two rodent operators being fully engaged with present commitments. Pigeons. The Council are now empowered by Section 74 of the Public Health Act 1961 to reduce the numbers of pigeons in the area. Nuisances from pigeons were the subject of a number of complaints and various experiments were carried out, including netting and trapping, to ascertain the best methods of catching the birds. This work can be very time consuming and it is hampered by the likelihood of adverse public reaction if precautions are not taken. In September 1962 a licence was granted by the Minister of Agriculture, Fisheries and Food, authorising me to use narcotised bait to reduce the numbers of pigeons in approved situations. In the autumn a treatment was successfully carried out, 70 birds being destroyed out of a flock of approximately 90. The need to avoid public reaction necessitated the work being done in the early hours of the morning just after dawn. Insects. Five complaints of vermin (bugs and fleas) were received and dealt with without charge, as were 45 wasps nests. 31 complaints of infestations by other insects including ants, silver fish, and flies, were received and advice given. 39 Pet Animals and Animal Nuisances. Two premises are licensed under the Pet Animals Act, and to inspect these and investigate the conditions under which other animals were kept ten visits were made. Noise Abatement. Ten complaints of noise nuisance were received during the year. With one exception, they related to noise from industrial premises, mainly at night. A considerable time was spent by your Officers in assessing the noise level, determining the cause and in discussion with managements to secure a reduction. This informal action secured an improvement in all cases sufficient to avoid a resort to legal proceedings but not always to the full satisfaction of the complainant. Filling Materials. The two local manufacturers of stuffed toys and perambulators continued to purchase their supplies under The British Standards Institution certification mark scheme. No samples were taken during the year. OTHER ACTS Merchandise Marks Acts. The Council are empowered to enforce the requirements of these Acts as far as the marking of imported foodstuffs is concerned in respect of the following articles:— Apples Bacon Butter Currants Eggs, dried Eggs, shell Ham Honey Malt Products Margarine Meat Oat Products Raisins Salmon Sultanas Tomatoes The Public Health Inspectors enforce these provisions during their routine visits. Shopkeepers, generally made due compliance with the orders and only one informal warning was needed. Shops Acts, 1950. The following statement summarises the inspections made, the infringements discovered and other matters dealt with during the year:— No. of Inspections:— Day visits 406 Evening Patrols 2 Sunday and half-holiday Patrols 10 Infringements:— Number of premises at which contraventions were found 51 40 Number of premises at which prescribed forms were not exhibited 28 Assistants half holiday forms not exhibited 13 Young persons records not maintained 20 Forms regarding seats for females not exhibited 17 Mixed shops notices not exhibited 5 Sunday employment notices not exhibited ... 2 Insufficient heating – Insufficient ventilation – Sanitary accommodation:— Insufficient 2 Dirty – Unlighted – Half-day closing – Absence of seats for females – 41 SECTION F PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES During the year under review 382 cases of infectious disease were notified, compared with 1,285 in 1961 and 353 in 1960. The marked increase in the number of notifications received in 1961 was due, almost entirely, to the high incidence of measles during that year. The following infectious diseases are notifiable in the Urban District:— Cholera Diphtheria (including Membranous Croup) Dysentery Enteric Fever (including paratyphoid fevers) Erysipelas Acute Encephalitis (infective and post-infective) Food Poisoning Leprosy Measles Malaria Meningococcal Infection Opthhalmia Neonatorum Acute Primary Pneumonia Acute Influenzal Pneumonia Acute Poliomyelitis—Paralytic „ „ —Non-paralytic Puerperal Pyrexia Relapsing or Continued Fever Scarlet Fever Smallpox Tuberculosis (all forms) Typhus Fever Whooping Cough Plague Smallpox. There were no cases of Smallpox during the year in this district. There has, however, been a considerable amount of follow-up work done by the department during the year, keeping persons under observation arriving in this Country by air from abroad, from what are known as smallpox contact areas, that is, areas, where smallpox is occurring and though they are not known to be actual contacts of a case, they have had opportunities for such contact. Dysentery. Three cases were notified, all of which were confirmed bacteriologically, in adults. Only one case was notified in the preceding year but in 1960 a total of 16 confirmed cases were recorded. Scarlet Fever. The incidence of scarlet fever at 42 cases was approximately double the figure for the preceding year of 20, while the figure for the year 1960 was 28. Four of the cases were admitted to hospital for treatment. The infection continued to be mild in character and as is usual was most common in children of school age. Acute Poliomyelitis. No cases were notified during the year, either Paralytic or Non-Paralytic, in fact no cases have occurred in the district since 1959, when one case was recorded of a school girl suffering from acute paralytic poliomyelitis. Erysipelas. There were three cases of erysipelas notified during the year, all in females and involving the face in each case. Each of the cases occurred during the winter months. 42 Food Poisoning. There were no outbreaks of food poisoning during the year. There were in fact only three cases notified, the causative organism in each case being Salmonella Newport. All were in adults, an elderly man and two middle-aged women. Although unrelated in any way both women were employed in schools, one as a kitchen assistant at a school in Wimbledon and the other as a school meals helper at a school in Morden. Measles. Although 1962 was not properly an epidemic year for measles, there were 258 cases. The disease generally was mild in character and there were no deaths. Whooping Cough. Only 16 cases of whooping cough were notified in 1962, as against 41 for the preceding year and 138 for the year 1960. It is significant that in the years before whooping cough vaccination was practiced it was common-place for the annual total to run into several hundreds. Malaria. One case of malaria, believed to be contracted abroad, was notified during the year. Patient was subsequently admitted to hospital for treatment. Pneumonia. There were 18 cases of pneumonia, of which three were stated to be influenzal in origin. In 1961 there were 29 cases and in 1960 a total of 36 notifications were received. Puerperal Pyrexia. There were seven notifications of puerperal pyrexia, all of which occurred in hospital, giving a rate of 7.9 per thousand total births. Seven notifications were also received in the preceding year from this hospital situate in the district, which has quite a large maternity unit. All cases occurring at this hospital are allocated to our district, regardless of whether the patient resides in this area or elsewhere. CLEANSING STATION Although the attendances at the Council's Cleansing Station continue to remain at a low level a total of 16 attendances were made during the year, as compared with six for the previous year, as follows:— Number of cases of Scabies treated 8 Cases of Scabies with concurrent verminous head – Cases of Scabies with secondary septic skin conditions – Number of cases of verminous heads only 4 Total number of attendances at the Centre 16 43 DIPHTHERIA IMMUNISATION During the year 665 children received a primary course of immunisation against diphtheria, as follows:— Age Group Total Under 1 1 2 3 4 5–9 10–14 Number Immunised 249 339 18 9 5 28 17 665 In addition to these primary inoculations, 1,117 children received further re-inforcing injections. WHOOPING COUGH IMMUNISATION The following figures show the number of children immunised and those who also received reinforcing doses during the year (the figures include those children who received triple antigen, comprising the prophylaxis for diphtheria, whooping cough and tetanus). Number of children immunised 626 Number of children boosted 53 TETANUS IMMUNISATION Active immunisation against tetanus is available at any of the County Council Clinics or from the general practitioners in the district. During the year under review 742 children completed a primary course of treatment against tetanus and a further 107 children received re-inforcing injections. POLIOMYELITIS VACCINATION During the year special poliomyelitis sessions were held on Monday evenings and Saturday mornings at the Middleton Road, Morden Road and Grand Drive Centres. On the recommendation of the Ministry of Health in the early part of the year oral vaccination was introduced for the routine vaccination of persons eligible, i.e. those over six months but under 40 years of age and persons in other groups regarded as being at 'special risk'. 44 The following table indicates the state of vaccination as it was on the 31st December, 1962:— Age Group (Years of birth) Primary Course Number given third Number given fourth Salk Oral Salk Oral Salk Oral 1943-1962 64 509 1000 646 63 824 1933-1942 19 35 Other Groups 45 157 Totals 128 701 1000 646 63 824 The total number of persons who have received a primary course of vaccination since the inception of the scheme is 24,511, which includes 15,950 in the 1943-1962 age group, 4,661 in the 1933-1942 age group and 3,900 classified under other groups. SMALLPOX VACCINATION As a direct result of the outbreak of Smallpox which occurred in the early part of the year throughout England and Wales, measures were put in hand to secure the vaccination of all persons travelling abroad from this Country, particularly those travelling to the Continent for their holidays and who were required to produce evidence of recent vaccination before being allowed into the Country. This resulted in a marked increase in the number of vaccinations carried out during the year as compared with that of previous years and the following table indicates the extent to which advantage was taken of this service:— Age at date of vaccination Total Under 1 1 2-4 5-14 15 or over Primary Vaccination 474 45 95 568 140 1322 Re-vaccination – 1 33 508 319 861 Totals 474 46 128 1076 459 2183 During the year under review 54% of infants under one year of age received vaccination either at the Surrey County Council's Clinics or from general practitioners in the area. The average over the past five years of infants vaccinated under one year of age is 63 %. 45 46 MONTHLY INCIDENCE OF INFECTIOUS DISEASE, 1962 Disease January February March April May June July August September October November December Total Diphtheria – – – – – – – – – – – – – Dysentery – – – – 2 – – – 1 – – – 3 Enteric Fever – – – – – – – – – – – – – Erysipelas 1 1 – – – – – – – – 1 – 3 Food Poisoning – – – – – 1 2 – – – – – 3 Malaria – – – – – – 1 – – – – – 1 Measles 2 6 11 9 11 24 4 31 2 42 62 54 258 Meningococcal Infection – – – – – – – – – – – – – Ophthalmia Neonatorum – – – – – – – – – – – – – Poliomyelitis— Paralytic – – – – – – – – – – – – – Non-paralytic – – – – – – – – – – – – – Pneumonia– Acute Primary 5 – 1 – 4 – – 1 1 – 2 1 15 Acute Influenzal 2 – – – – 1 – – – – – – 3 Puerperal Pyrexia 1 1 – – – 1 2 2 – – – – 7 Scarlet Fever 3 9 4 3 – 2 1 1 – 3 13 3 42 Smallpox – – – – – – – – – – – – – Tuberculosis— Pulmonary 4 3 3 4 2 3 3 1 1 3 1 1 29 Non-Pulmonary – – 1 – – – – – 1 – – – 2 Whooping Cough 1 7 – 2 – 3 – – 1 1 – 1 16 Totals 19 27 20 18 19 35 13 36 7 49 79 60 382 TUBERCULOSIS Fifty-three new cases were added to the register of tuberculous persons, compared with 55 in 1961. These additions were:— Males Females Total Pulmonary 31 20 51 Non-Pulmonary 1 1 2 32 21 53 Of these 53, 31 were primary notifications, 21 were transferred from other districts and one came to notice in another way. During the year 85 persons were removed from the register for the following reasons:— Recovered 29 Removed from the district 42 Death 14 The provision of treatment and investigation of Tuberculosis is the responsibility of the Regional Hospital Board, the County Council being responsible for the preventive side of this work. No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, which give power to prohibit the handling of milk by infectious tuberculous persons, nor under Section 172 of the Public Health Act, 1936, which provides for the removal of an infectious person to hospital. A table shewing the new cases recorded during the year, their age groups and manner of admission to the register can be seen on page 49 of this report. TUBERCULOSIS AND CHEST DISEASES CARE COMMITTEE This voluntary Committee, originally constituted as the Merton and Morden Tuberculosis Care Committee to assist local tuberculous families, extended the scope of its activities in 1959 to include chest and heart cases other than those of tubercular origin which are referred to it from the chest clinics. It consists of representatives of various organisations together with independent members and, ex-officio, the Medical Officer of Health, Chest Physician, Tuberculosis Health Visitors and the Care Almoner. It supplies voluntary aid to patients and their families as an addition to the statutory assistance which is available and thereby helps to make life easier for these unfortunate people. The Committee's main source of income is derived from the sale of Christmas Seals, which, for the year ended 31st March, 1963, showed a profit of £214 0s. 9d. This, together with various grants, donations and 47 proceeds from local functions, built a total income for the year of £394 16s. 8d. The Committee keeps a stock of bedding and other necessities for loan to needy patients and also assists patients and their relatives with cash grants and loans. Once again during the year considerable financial support was afforded to the holiday scheme for patients and child contacts. I am indebted to the Honorary Secretary for supplying me with the information which has enabled me to express this small appreciation of the very valuable work carried out by the Committee. MASS RADIOGRAPHY SERVICE A "general public" survey, held in two parts, was organised during the year in the Morden area of the district. During the first part of the survey the Mass Radiography Unit was sited at the Central Library in Morden Road where it operated during the week commencing 9th July. During the second part of the survey, which commenced on 10th September, the Unit was sited at four advantageous and selective points throughout the district. In addition to the booked groups and-general public surveys carried out during the year, the Unit has continued with the general practitioner service from Raynes Park and South Wimbledon, as follows:— Grove Hotel Mondays 7.30-8.30 p.m. Car Park, Morden Road. Raynes Park Thursdays 7.30-8.30 p.m. Station, Grand Drive Entrance. I am indebted to Dr. F. J. H. Walters, Medical Director of the Mass Radiography Service, for the following information relating to the persons X-rayed by the Unit in this area during the year:— Location Number of persons examined Abnormalities Active T.B. Primary Lung Cancer M. F. Total M. F. Total M. F. Total District Survey and Other Groups 3496 3064 6560 6 4 10 1 1 2 General Practitioner Service 674 593 1267 4 1 5 4 2 6 Totals 4170 3657 7827 10 5 15 5 3 8 It will be readily understood that the figures reproduced above are not necessarily residents of Merton and Morden but, of course, any member of the public wishing to take advantage of this service. 48 49 TUBERCULOSIS—NEW CASES, AGE AND SEX, DISTRIBUTION AND MANNER OF ADMISSION TO REGISTER. Age Groups Years Primary Notifications ("A") Cases transferred from other districts Cases brought to notice otherwise than by notification and 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 1 2 – – – – – – – – – – 3 10–15 2 – – – – – – – – – – – – 15–20 – – – – – – – – – – – – – 20–25 2 1 – – 1 1 – – – – – – 5 25–35 6 3 – 1 3 3 1 – – – – – – 35–15 1 3 – – 2 5 – – – – – – – 45–55 2 – – – 2 – – – – – – – – 55–65 5 – – – 1 1 – – – – – – 7 65 and over 2 – – – 1 – – – – 1 – – 4 Totals 21 9 – 1 10 10 1 – – 1 – – 53 31 21 1 INDEX PAGE Acreage 9 Acute Poliomyelitis 42 Air Pollution 36-38 Ambulance Facilities 18 Births 10, 12, 13, 15 Institutional and Domiciliary 13 Premature 14 Stillbirths 12, 13 Rates 10,12,13 Cancer 4, 12 . Deaths from 12 Rate 12 Cleansing Facilities 43 Climatic Conditions 25 Deaths 4-5, 10, 12, 15 17 Causes of 4, 5, 10, 17 Rates 10, 12 Diphtheria 16, 44 Immunisation 44 Drainage and Sewerage 22 Drainage work 29 Erysipelas 42 Factories and Workplaces 28, 39 Inspections 28 Defects 28 Food and Drugs Act, 1955 22,33-35 Food Poisoning 43 Food Supply 32-35 Inspections 32 Unsound Food 32 Health Services 18-21 Heart Disease—Deaths from 4, 10,17 Hospitals 18-19 50 I N D E X—Continued PAGE Housing 26-27, 30-31 Action taken 30-31 Inspections and Defects 26-27 Number inhabited 9 Overcrowding 26, 31 Ice-Cream 23 Industry 10 Infant Mortality 11,12,13 Rate 11-13 Infectious Diseases 15, 19, 42-43 Cases admitted to hospital 19 Diseases notifiable 42 Monthly Incidence 46 Isolation Hospitals 19 Mass Radiography 48 Maternal Mortality 11, 12 Measles 43 Merchandise Marks Acts 40-41 Milk Supply 33 Nelson Hospital 18 Neo-natal Deaths 13 Noise Abatement 40 North-Eastern Divisional Health Sub-Committee 7 Notification of Births 12 Nuisances abated 0 Pest Control 39 Pet Animals and Animal Diseases 40 Pneumonia 43 Poliomyelitis 16,42,44 Population 9, 12 Premature Births 14 Public Cleansing 23 Public Health Committee Puerperal Pyrexia 43 Rainfall 25 Rateable Value 9 51 I N D E X—Continued PAGE Representatives on:— North- Eastern Divisional Health Sub-Committee 7 Tuberculosis and Chest Diseases Care Committee 7 Wandle Valley Joint Sewerage Board 7 Rivers and Streams 23 Sanitary Circumstances 22-25 Sanitary Inspections, Summary of 29 Scarlet Fever 42 Shops Act, 1950 40-41 Smallpox 19, 42 Vaccination 45 Social Conditions of the Area 9 Staff 8 Statistics 9-13 Comparative 15, 16 Vital 12, 13 Stillbirths 12, 13 Tetanus Immunisation 44 Tuberculosis 47-49 Assistance given 47-48 Care Committee 7, 47-48 Dispensary 21 Mass Radiography 48 New cases—by age groups 49 Vaccination 45 Venereal Diseases 21 Vital Statistics 10, 13 Wandle Valley Joint Sewerage Board 7 Water Courses 39 Water Supply 23 Whooping Cough 16, 43 Immunisation 44 Zymotic Disease 6, 12 Deaths from 12 Rate 12 52