URBAN DISTRICT of MERTON AND MORDEN ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1963 TELEPHONE: LIBERTY 4636 URBAN DISTRICT OF MERTON AND MORDEN W. D. SWINNEY M.B.. CH.B.. D.P.H. Medical Officer of Health AAM/CR . PUBLIC HEALTH DEPARTMENT 116, KINGSTON ROAD MERTON, S.W.19 19th November 1964. Sir, ANNUAL REPORT 1963 In accordance with the instructions contained in Circular No. 1/64, I enclose herewith four copies of my Annual Report for the year 1963 in respect of the Urban District of Merton and Morden. I am, Sir, Your obedient servant, The Secretary, 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 1963 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 during the year 1963 and wish to begin by commenting upon certain matters of interest and importance. The Ageing Population I do not wish to recapitulate my remarks of last year on this subject - they still stand - but it is not possible to ignore completely what is perhaps one of the greatest problems of present day society and a problem which presents in aggravated form in those old people who have been classified as "The Unclubbables". It is difficult at first sight to understand why certain elderly persons will co-operate whole-heartedly in social welfare schemes for the benefit of themselves and other similarly placed members of our community and derive pleasure and enjoyment in doing so, while others have developed a frame of mind which, if not wholly anti-social, comes very close to it. Clubs are opened - they do not join, entertainments are arranged - they do not attend. The "Meals-on-Wheels" Service could at least partly meet some of their needs, but they are not interested, preferring the cup of tea and a few biscuits to a satisfying, tasty hot meal. Why should this be ? I believe that there are possibly two principal reasons for this, if one ignores the fact that no two persons are alike and responses to the same stimuli are so variable. The first reason is that to some people such provisions are a too-pointed reminder of their increasing dependance on others and of their inability to contribute in any way to the society of which they are members. They see in them something which is artificial and which is not of natural evolution but has been produced specifically to meet conditions which they do not wish to acknowledge. They cannot bring themselves to face the fact they are in any way different from younger people and if not exactly insulted by such an idea they are hurt to think that others should have formed that impression of them. The second reason is closely related to the first. Is it not possible that we are trying to attract the interest of old people to social activities for their welfare too late in life? I believe that intensive field work is necessary to ensure that "aging persons" are brought into the social fold long before they are "old people" and while they are still in possession of faculties which can appreciate and make use of what is provided for them. There is also, I believe, a great need for something on a larger and more ambitious scale than "Darby and Joan" Clubs meeting perhaps for a couple of hours on one or two afternoons each week - I have in 2 mind a comprehensive Day Centre offering comfortable surroundings, meals and snacks, newspapers, periodicals and possibly a lending library, suitable games and all opportunities for social contact and the maintenance of interest in life and the World in general. Such a centre would be open every day of the week and for long hours of the day and might, in time, be a prototype for other similar centres. The cost would be high, but would it be too high? Problem Families Every district numbers in its population families whose standards fall far short of those of their neighbours. They have been called "Problem Families" or "Failing Families" and they stick out like a sore thumb wherever they are encountered. The parents are frequently of low intelligence and many have a mental hospital history. They are shiftless, poor managers, and often delinquent. Standards of child care and household management are of the lowest, debts abound, employment is desultory, meals are wasteful and unnourishing, children's health indifferent and school attendance poor. This is not an over-drawn picture of the chronic problem family and, unfortunately, not an isolated instance. Why have we such family units in the middle of the twentieth century and after close on twenty years of "The Welfare State" ? There is no one answer to that question nor is there one solution to the puzzle of how to help and support them. Each and every family has become a problem for a variety of reasons and usually for more than one reason and they engage the efforts of many types of social workers in trying to resolve their difficulties and what is even more important, in trying to detect the early signs of family failure before the condition has become fully established. It may be of interest to list these, all of whom may attend a Problem Family Conference - a, meeting of interested parties called together to plan a campaign of help and support Public Health Service Medical Officers General Medical Practitioners Health Visitors Social Workers of the Health Department Education Welfare Officers School Head Teachers Probation Officers Psychiatric Social Workers Housing Managers Housing Social Workers Hospital Almoners Representatives of Child Guidance Clinics Children's Department N.S.P.C.C. National Assistance Board Guild of Social Service 3 Welfare Department Women's Voluntary Services Other persons with special knowledge of the families to be discussed. What then does this formidable list hope to achieve and how often are its hopes realised? Basically the goal is to help these families towards the achievement of standards acceptable to the community at large, which they would never reach by their own unaided efforts and by doing so to hold together family units in a greater degree of happiness and a higher standard of security than they have known in the past for the benefit of all, particularly the children whose lives and development are most adversely affected by an unhappy, unstable home. With some families this end is never attained. They require continuing help and support and cannot be relied upon to stand on their own feet. With others, but it must be admitted they are in the minority, permanent good is done and they are saved from lapsing into chronicity. Even one such success well repays in human happiness the time and effort taken and it should be remembered that the benefit is not limited to within the family circle. The close neighbours of problem families can feel the repercussions of sub-standard social behaviour on their own door-steps. Mental Health The complexity of modern life is becoming more and more reflected in the increasing number of cases of mental breakdown in the population. This is much more evident in large cities and conurbations than in rural districts where the acceleration in the pace of living is not yet so marked. In cities, however, it is a matter of considerable worry to all engaged in medical work, whether preventive or curative. Progress will proceed, but how can man adapt himself to life in a world so much more complicated than the one into which he was born ? Some can take it in their stride - some, with difficulty, can make compensatory adjustment, but many, in doing so, break down and need help. Help does not mean only the assistance of physicians, psychiatrists and hospital staffs. Equally important in returning to every-day life as a normal individual a case of mental disturbance are supporting services operating in the community. This is now well realised and such services will have to be expanded and developed to grapple with a problem which shows no signs of decreasing with the passage of time and is certainly not selflimiting. Conclusion I would like to express my thanks to the Chairman and members of the Public Health Committee for their help and co-operation throughout the year and to all members of the staff of the department for their willing and loyal support at all times. I am. Mr. Chairman, Ladies and Gentlemen, Yours obediently, W. D. SWINNEY, August 1964. Medical Officer of Health. 4 URBAN DISTRICT COUNCIL OF MERTON AND MORDEN 1963 PUBLIC HEALTH AND CIVIL DEFENCE COMMITTEE Chairman: Miss N. K. Watts Mrs. W. R. Castle Mr. G. R. Haste Mr. E. H. Ceci (from 16.12.63) Mr. N. Hitchins Mr. B. N. Clifford (from 7.10.63) Mr. E. J. Newland Mr. J. L. Coombes Mr. W. H. Perry, J.P. Mrs. E. M. Davis Mr. P. L. Pike (to 27.9.63) Mr. J. Wynn (to 13.12.63) Mr. E. K. Clarke, J.P. (ex-officio) Mr. V. Talbot (ex-officio) REPRESENTATIVES ON NORTH-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE Mrs. W. R. Castle Mr. N. Hitchins Mr. B. N. Clifford (from 7.10.63) Mr. P. L. Pike (to 27.9.63) Mr. J. L. Coombes Miss N. K. Watts REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD Mr. A. V. Brandle Mr. J. L. Coombes Mr. R. F. Franks Mr. E. K. Clarke,, J.P. (ex-officio) MERTON AND MORDEN TUBERCULOSIS CARE COMMITTEE Chairman: Mrs. M. E. Shaw Vice-Chairman: Mrs. V. S. Donovan Secretary: Mrs. C. M. Starling Treasurer: Mr. F. S. Buck 5 PUBLIC HEALTH STAFF 1963 Medical Officer of Health: *W. D. Swinney, M B., Ch.B., D.P.H Chief Public Health Inspector: abed W. T. Pinches, F.A.P.H.I., M.R.S.H. Deputy Chief Public Health Inspector: abc E. N. Montague, D.P.A. Public Health Inspectors: a b J. H. Brown (from 23.9.63) a b A. Watson a L. H. Thomas a F. J. A. Willis (to 5.5.63) Pupil Health Inspectors: R. Clark (from 1.9.63) J. Klemp Smoke Investigators: L. G. Berg L. A. Rogers (to 3.2.63) W. G. E. Standage (from 1.4.63) Chief Clerk: *A. A. Makepeace Clerks: *Miss M. Brown (from 4.2.63) Mrs. A. J. Hill (to 25.5.63) *Mrs. A. M. Kates (from 1.7.63) **Mrs. C. J. Coombes *Mrs. H. E. Turl † H. G. Finnimore R. Wiles (Clerk/Trainee from 9.9.63) 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 the part-time employment of the Surrey County Council. ** 50% employment by both Authorities. 6 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,238 Population (Census 1961) 67,974 Population 1963 (Registrar-General's Estimate) 67,090 Number of inhabited houses (according to Rate Books) 22,618 Rateable Value (as at 31st December, 1963) £3,955,192 Sum represented by 1d. Rate £5,596 The Urban District of Merton and Morden dates from the amalgamation of Merton with Morden in 1913. It 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, but outside the Administrative County. The district is generally flat and sheltered, lying between the 42ft. and 141 ft. ordnance datum levels; it is drained by the River Wandle, the Beverley and Pyl Brooks, all tributaries of the Thames. 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, the industrial area comprising three main factory groups, the largest of which is the Lombard Road Estate on the north-eastern boundary, The greater portion of housing of the distrct 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 district to meet the post-war housing need. A considerable part of Morden is formed of the London County Council St. Helier Housing Estate. 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 from other areas, chiefly for work in the factories. There were 178 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. The brand names of many products from Merton and Morden factories are house-hold words throughout the land. The district is indeed fortunate in having at its disposal some 368 acres of open spaces, in fourteen different parks, providing an even distribution of recreational facilities throughout the area. 7 VITAL STATISTICS Population The Registrar-General's mid-year estimate of the home population is given as 67,090. This is 470 less than for the previous year and conforms to the trend in the reduction of our local population over the past ten years. All rates used in this report are based on the Registrar-General's figures. Births 868 live births were registered in the area during the year, which is exactly the same number as were registered in the previous year. The birth rate at 12.9 per thousand of the population, comparing closely with the figure for the previous year of 12.8. Stillbirths numbered 12 (7 males and 5 females), being one more than in the previous year, giving a rate of 13.6 per 1,000 total births. Illegitimate live births registered during the year numbered 53 (29 males and 24 females) compared with 52 in the preceding year. Of the 12 stillbirths registered one was illegitimate. Deaths Deaths registered during the year numbered 825 (425 males and 400 females), giving a rate of 12.2 per 1,000 population. This compares with a total of 798 for 1962, giving a rate of 11.8 per 1,000 population. The four principal causes of death were as follows:— Number of Deaths Percentage of total deaths (a) Diseases of the heart and circulalatory system 340 41% (b) Cancer 163 19% (C) Vascular lesions of nervous system 89 10% (d) Diseases of the respiratory system 118 14% 710 86% Maternal Mortality No deaths in childbirth, either from puerperal sepsis or other maternal causes, were recorded during the year. The maternal mortality rate for England and Wales per thousand live and still births was 0.28. Infant Mortality During 1963 there were 15 deaths among infants under one year of age, giving a mortality rate of 17.2 per thousand live births, as compared with 12 deaths in 1962, giving a rate of 13.8 per thousand live births. The number of neo-natal deaths (i.e. those occurring during the first four weeks of life) was 11, giving a neo-natal death rate of 12.6 per thousand live births, as compared with 8 deaths in the preceding year, giving a rate of 9.2 per thousand live births. Natural Increase The natural increase of births over deaths during the year was 43, compared with 70 for the year 1962. 8 SUMMARY OF VITAL STATISTICS (Registrar General's Figures) Population: Registrar-General's Estimate (Mid-Year) 67,090 Births: M. F. Total Live (Legitimate) 395 420 815 (Illegitimate) 29 24 53 424 444 868 Stillbirths Legitimate) 6 5 11 (Illegitimate) 1 — 1 7 5 12 Total Births 431 449 880 Birth Rate 12.9 per 1,000 population Stillbirth Rate 13.6per 1,000 total births Deaths: M. F. Total Total Deaths 425 400 825 Death Rate (crude) 12.2 per 1,000 population Infant Mortality: Total deaths under one year 15 Infant Mortality Rate per 1,000 Live Births 17.2 Deaths of Legitimate Infants under one year 11 Death Rate per 1,000 Legitimate Births 13.4 Deaths of Illegitimate Infants under one year 4 Death Rate per 1,000 Illegitimate Births 75.4 Maternal Mortality: Deaths from Sepsis Nil Deaths from other maternal causes Nil Maternal Death Rate per 1,000 Total Births — Zymotic Disease: 7 Principal Zymotic Diseases 1 Deaths from Measles Nil Deaths from Whooping Cough Nil Deaths from Diarrhoea (under 2 years) 1 Zymotic Death Rate 0.01 Deaths from Tuberculosis: Respiratory 2 Non-Respiratory Nil Death Rate (per 1,000 population) 0.03 Deaths from Cancer: Number of deaths 163 Rate per 1,000 population 2.4 9 VITAL STATISTICS - MOTHERS AND INFANTS Live Births: Number 868 Rate per 1,000 population 12.9 Illegitimate Births per cent, of total live births 6.1% Stillbirths: Number 12 Rate for 1,000 total live and stillbirths 13.6 Total live and stillbirths 880 Infant Deaths (deaths under one year) 15 Infant Mortality Rates: Total infant deaths per 1,000 live births 17.2 Legitimate infant deaths per 1,000 legitimate live births 13.4 Illegitimate infant deaths per 1,000 illegitimate live births 75.4 Neo-Natal Mortality Rate: Deaths under four weeks per 1,000 live births 12.6 Early Neo-Natal Mortality Rate: Deaths under one week per 1,000 live births 10.3 Peri-Natal Mortality Rate: Stillbirths and deaths under one week combined per 1,000 total live and stillbirths 23.8 Maternal Mortality (including abortion): Number of deaths Nil Rate per 1,000 total live and stillbirths — INSTITUTIONAL AND DOMICILIARY BIRTHS An analysis of the birth notifications received during 1963 shows that 730 of the 880 births occurred in hospitals, institutions and nursing homes. This represents 83 % of the total. The distribution of institutional births is given below:— St. Helier Hospital 419 Nelson Hospital 203 St. Teresa's Hospital 46 Kingston Hospital 18 Other hospitals, institutions and nursing homes 44 730 10 PREMATURE BIRTHS There were 53 premature births notified during the year, 47 of whom survived one month. Below is a summary of the notifications:— (a) Born at home 4 (b) Born in hospital or nursing home 49 The number of those born at home:— (a) Who were nursed entirely at home 4 (b) Who died during the first 24 hours — (c) Who survived at the end of one month 4 The number of those born in hospital or nursing home:— (,a) Who died during the first 24 hours 4 (b) Who survived at the end of one month 43 COMPARATIVE STATISTICS, 1963 Births. Once again the live birth rate is well below the national figure - 12.9 per 1,000 population compared with 18.2. The reason for this cannot change in a brief twelve months and until we have an adult population of much lower average age this figure will not undergo substantial change. It is satisfactory to note, however, that the still birth rate of 13.6 per 1,000 total births is also below the national average of 17.2. Deaths. Merton and Morden's death rate in 1963, at 12.2 per 1,000 population, is exactly the same as the national figure, but this total is not reached the same way and it is noted that deaths from coronary disease and from carcinoma of lung, at 3.08 and 0.61 respectively, per 1,000 population are above the national figures of 2.29 and 0.52 respectively, the former also being above the 1962 figure of 2.97 and the latter showing an improvement on the 1962 figure of 0.79. It would not have been surprising if the local death rate had been higher than the national one for 1963, when it is considered that our population is loaded towards the higher age groups in which the extreme weather of the early weeks of the year takes its toll. For another year both the maternal and infant mortality rates are satisfactory by comparison, although the latter is not so good as the 1962 figure of 13.8. Notifications of Infectious Disease. The year 1963 was a measles epidemic year which accounts for the fact that the notification rate was 11.13 per 1,000 compared with 3.81 in 1962. There is little of note in other notification figures but the incidence of puerperal pyrexia at 1.13 per 1,000 total births, compares most favourably with the figure for England and Wales of 7.44 and, taken in conjunction with the maternal and infant mortality rates, reflects most creditably on the practice of these branches of medicine in the district. 11 COMPARATIVE STATISTICS, 1963 England and Wales Merton and Morden Rates per 1,000 Home Population Births: Live 18.2 12-9 Still 0.31 ( 0-17 17.2* t 13-6* Deaths: All causes 12.2 12.2 Coronary Disease, angina 2.29 3.08* Malignant neoplasm - lung, bronchus 0.52 0.61* Pneumonia 0.78 0.62 Influenza 0.07 .08* Tuberculosis - all forms 0.06 0.02 Diphtheria 0.00 — Maternal Mortality 0.28 — Acute Poliomyelitis 0.00 — Whooping Cough 0.00 Notifications (corrected): Measles 12.77 11.13 Scarlet Fever 0.37 0.55 Tuberculosis- Respiratory 0.34 0.29 Non-respiratory 0.05 0.07 Acute Pneumonia 0.30 0.29 Whooping Cough 0.73 0.99 Puerperal Pyrexia 7.44* 1.13* Erysipelas 0.03 0.04 Dysentery 0.67 0.31 Food Poisoning 0.12 0.02 Malaria 0.00 — 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) 21.1 17.2 Diarrhoea and Enteritis (under 2 years) 0.5 1.1 * Per 1,000 total (live and still) births. 12 CAUSES OF DEATH DURING THE YEAR 1963 No. Cause of Death Males Females Total 1 Tuberculosis, respiratory 1 1 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 10 Malignant neoplasm, stomach 14 7 21 11 Malignant neoplasm, lung, bronchus 31 10 41 12 Malignant neoplasm, breast — 20 20 13 Malignant neoplasm, uterus — 2 2 14 Other malignant and lymphatic neoplasms 39 40 79 15 Leukaemia, aleukaemia 5 1 6 16 Diabetes 1 1 2 17 Vascular lesions of nervous system 28 61 89 18 Coronary disease, angina 128 79 207 19 Hypertension with heart disease 5 7 12 20 Other heart disease 31 53 84 21 Other circulatory diseases 12 25 37 22 Influenza 2 4 6 23 Pneumonia 20 22 42 24 Bronchitis 49 15 64 25 Other diseases of respiratory system 5 1 6 26 Ulcer of stomach and duodenum 2 2 4 27 Gastritis, enteritis and diarrhoea 4 4 8 28 Nephritis and nephrosis 5 1 6 29 Hyperplasia of prostate 1 — 1 30 Pregnancy, childbirth, abortion — — — 31 Congenital malformations 4 3 7 32 Other defined and ill-defined diseases 27 24 51 33 Motor vehicle accidents 3 2 5 34 All other accidents 3 10 13 35 Suicide 4 2 6 36 Homicide and operations of war — — — Total all causes 425 400 825 13 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.I. 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. I would like, once more, to place on record my appreciation and thanks to the small staff of the Nelson Hospital laboratory for being so helpful and obliging throughout the year. 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 of 128. There is accommodation for 83 general patients - mainly surgical and 45 in the maternity unit which was enlarged during 1962 by the establishment of a premature baby unit. The total number of in-patients admitted to the general medical and surgical beds was 1,751, of which 473 were residents of Merton and Morden. With regard to the maternity services, 284 patients were admitted from our area out of a total of 1,549. In the out-patient and casualty departments, 4,921 new patients seen at Consultative Clinics made 10,158 re-attendances, making a total in all of 15,079 attendances. The casualty department dealt with 10,317 new cases who made a total of 14,932 re-attendances, making an overall total of 25,249 attendances. 2. Other Hospitals. Among other hospitals available for the 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 being made of St. George's Hospital, Tooting, formerly called The Grove Hospital. 14 During the year under review, 419 of the 880 births (live and still) notified occurred in St. Helier Hospital. This represents 47.6% of the total. 3. Infectious Disease. Cases of infectious disease from this area are admitted mainly to the Wandle Valley Isolation Hospital, although use is occasionally made of Cuddington and Tolworth Isolation Hospitals. Forty-one patients were admitted from this area to the Wandle Valley Hospital during the year, although only six were notifiable infectious diseases. There have been no further extensions of the bed complement at this hospital and the number available remains at 160. 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. 15 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 Clinic: Ante-Natal Wednesdays Commencing at 1.30 p.m. Dental Mondays to Fridays By appointment Eye Fridays Commencing at 2.0 p.m. Infant Welfare Mondays 10.0 - 12.0 noon 99 99 99 2.0- 4.0 p.m. 99 99 Wednesdays 10.0 - 12.0 noon Parentcraft Group Tuesdays Commencing at 2.30 p.m. Relaxation Class Thursdays Commencing at 2.30 p.m. Speech Therapy Wednesdays 10.0 - 12.0 noon 99 99 99 2.0- 4.0 p.m. 99 99 Fridays 2.0 - 4.0 p.m. Middleton Road Clinic: Ante-Natal Thursdays Commencing at 2.0 p.m. Dental Mondays to Fridays By appointment Infant Welfare Tuesdays 2.0 - 4.0 p.m. Fridays 2.0 - 4.0 p.m. Relaxation Class Wednesdays Commencing at 2.30 p.m. Speech Therapy Tuesdays 10.0 - 12.0 noon 99 99 Wednesdays 2.0- 4.0 p.m. Morden Road Clinic: Ante-Natal Fridays 10.0 - 12.0 noon Dental Mondays to Fridays By appointment Eye Wednesdays 2.0- 4.0 p.m. Infant Welfare Tuesdays 10.0 -12.0 noon 99 99 99 2.0- 4.0 p.m. 99 99 Thursdays 2.0- 4.0 p.m. Parentcraft Group Fridays Commencing at 2.30 p.m. Relaxation Class Mondays Commencing at 2.30 p.m. Speech Therapy Thursdays 10.0- 12.0 noon St. John's Church Hall: Infant Welfare Thursdays 10.0 - 12.0 noon 16 School Health Service - General Medical Clinics: Grand Drive Centre Middleton Road Clinic Morden Road Clinic Tuesdays Wednesdays Mondays 10.0 - 12.0 noon 10.0 - 12.0 noon 10.0 - 12.0 noon 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 in the schools and at the school General Medical Clinics. Tuberculosis Clinics: Cumberland Hospital, Whitford Gardens, Mitcham. Mondays, Wednesdays and Thursdays Tuesdays 1st & 2nd Tuesdays Commencing at 2.0 p.m. Commencing at 9.30 a.m. Commencing at 5.30 p.m. (old cases only) Venereal Disease Clinics: St. Helier Hospital, Wrythe Lane, Carshalton. Mondays (Males) Tuesdays (Females) Fridays (Females) 4.30 - 6.30 p.m. 5.0 -7.0 p.m. 2.0 - 4.0 p.m. 17 SECTION C —SANITARY CIRCUMSTANCES Food and Drugs. Fifty-one 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 31-32. One hundred and ninety-eight samples of milk were sent to the Public Health Laboratory for bacteriological examination. One sample failed to conform to the prescribed standards. Twelve samples of ice cream were also sent to the Laboratory, further details of which will be found on page 32. Food premises in the area number 574 and are divided into the following categories:- Bakehouses 3 Milk Shops (other than dairies) Bakers 11 24 Butchers 30 Off Licences 18 Chemists 15 Public Houses 16 Confectioners 68 Restaurants, Cafes and Snack Bars 48 Corn Chandlers 3 Dairies 1 School Canteens 21 Fishmongers 10 Wholesale Confectioners 1 Fish Fryers 10 Wholesale Food Manufacturers & Storers 2 Greengrocers 40 Grocers 65 Wholesale Grocers 4 Ice Cream Dealers 136 Staff Canteens 42 Milk Depots 6 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 1,109. Details of offences and action taken are included in the Chief Public Health Inspector's report on page 26. 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 136 Ice Cream Vendors (Itinerant) 3 Preserved Food Manufacturers 44 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 422 interments took place there, of which 205 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. Cremations during the year numbered 1,471, of which 374 were from Merton and Morden. 18 Drainage and Sewerage. Normal maintenance work has been carried out on soil and surface water sewers. No major improvement schemes have been undertaken but sections of defective sewers and drain connections have been renewed in various parts of the district. The work on the surface water relief sewer, to which reference was made in my report last year, has now been completed. Arrangements are in hand for work to commence shortly on the relaying of a length of surface water sewer in Grand Drive and Meadow Close. Rivers and Streams. No major improvement works were carried out during the year. Arrangements are at present in hand providing for the piping of a length of ditch at the rear of the Cannon Hill Lane houses adjoining the London County Council Technical School Sports Ground. Public Cleansing. Normal operations in public cleansing were continued throughout the year and a total of 15,449 tons of refuse was collected from January to December. Further repairs have been undertaken to the fire brick lining of the refuse disposal plant but no major improvements have been carried out. Smoke alarm equipment has been installed in the main flue to the chimney and also in the trade waste incinerator flue which has assisted in controlling the emission of dense smoke from the plant. The tonnage of salvage collected during the year was Tons Tons Paper 1,639 Metal 141 Tins 695 Rags 65 Cullet 234 Bottles 6 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 on 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 plumbo-solvent. 19 Five samples of water from domestic supply were submitted for chemical or bacteriological examination during the year and the reports 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 four different fountains for chemical and bacteriological examination and all proved to be satisfactory. One of these fountains were on the supply of the Sutton District Water Company and three on that of the Metropolitan Water Board. Climatic Conditions. The early weeks of the year were characterised by weather of almost unparalleled severity. This began in the last few days of 1962 and continued with heavy snowfalls and intense frost which was experienced even as far into the year as the month of March. The severe cold occasioned much hardship, particularly to old people, when fuel supplies, including paraffin, almost completely dried up and with electricity power-cuts and load-shedding and falls in gas pressure there were periods when adequate space-heating could not be maintained. There were, in addition, instances of households being unable to obtain hot meals. Such weather conditions took their toll of the debilitated elderly, as for week after week they continued without appreciable remission, a high proportion of deaths occurring at that time being of very old persons. This was also reflected in the returns for the North East Surrey Crematorium, where the number of cremations carried out in the first quarter of 1963 totalled 547, compared with 394 in 1962 and 323 in 1964. Again the extremely old substantially contributed to this high figure. 20 21 CLIMATIC CONDITIONS —RAINFALL, 1963 Rain gauges are installed at the Joseph Hood Recreation Ground, West Barnes Pumping Station and Morden Hall. The monthly recordings taken from these gauges is as follows Jan. Feb. Mar. Apl. May June July Aug. Sept. Oct. Nov. Dec. Total Joseph Hood Recreation Ground Total rainfall in inches 0.70 0.57 2.71 2.14 1.58 1.77 1.15 2.59 2.63 1.58 3.83 0.59 21.84 Days with .01" or more 12 12 17 18 15 13 9 20 12 13 22 12 175 Days with .04" or more 6 6 15 13 11 12 4 12 10 9 16 3 117 West Barnes Pumping Station Total rainfall in inches 0.88 0.09 2.85 1.89 1.71 1.76 1.26 2.93 2.81 1.54 4.12 0.70 22.54 Days with .01" or more 16 3 20 20 17 14 13 21 17 14 28 14 197 Days with .04" or more 7 1 14 11 10 12 4 16 10 11 18 4 118 Morden Hall Total rainfall in inches 0.73 0.58 2.84 2.21 1.72 1.73 1.42 2.69 2.58 1.36 3.92 0.60 22.38 Days with .01" or more 10 9 17 18 15 13 10 19 13 13 22 10 169 Days with .04" or more 6 6 15 12 10 12 7 14 11 10 18 4 125 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 7 7 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 171 236 13 \ (iii) Other premises in which Section 7 is enforced by the Local Authority 3 13 — — Total 181 256 13 — 2. Cases in which defects were found. Particulars Number of cases in which defects were found No. 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) 1 1 - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient 1 1 - - - (b) Unsuitable or defective 6 6 - - - (c) Not separate for sexes 1 1 - - - Other offences against the Act (not including offences relating to Outwork) 5 — 5 — — Total 14 9 5 — — 22 3. 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 unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing apparel Making, etc. 23 - - - - - Boxes (Cardboard) 1 — — — — — Stuffed Toys 2 — — — — Cosaques, Christmas stockings etc. 4 - — - - - Lampshades 7 - - - - - Total 37 — — — — — 23 SECTION D —HOUSING Housing and Overcrowding. Three new houses, one bungalow and five flats were erected by private builders during the year and a further four flats by another local authority. 195 eligible applications for rehousing were received by the Housing Manager during the year. 80 houses and flats were allocated to tenants during this period (this figure includes 30 families rehoused under the High Path Redevelopment Scheme). There were 1,187 outstanding applications at the end of the year. Arising out of rehousing enquiries, five complaints of overcrowding were received. Upon investigation none 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 Dwelling Houses during the year:- i. (a) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) 182 (b) Number of inspections made for the purpose 182 ii. (a) Number of dwellinghouses (included under sub-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 90 2. Remedy of defects during the year without service of formal notice:- Number of defective dwellinghousas rendered fit in consequence of informal action by the Local Authority or their officers 56 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 - 24 (ii) Number of dwellinghouses which were rendered fit after service of formal notices (a) By Owners - (b) By local authority in default of owners - B.—Proceedings under Public Health Acts (i) Number of dwellinghouses in respect of which notices were served requiring defects to be remedied 20 (ii) Number of dwellinghouses in which defects were remedied after service of formal notices:- (a) By owners 8 (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 - (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 - 25 SECTION E. REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR In reviewing the work of the Public Health Inspectorate during 1963, I must record that although most items of environmental hygiene were adequately covered, certain aspects such as food sampling, housing and chimney observations were again unavoidably restricted to a minimum as a staff vacancy again occurred when the pupil who qualified in June 1962 and was appointed to an existing vacancy, resigned in the Spring to take up another appointment. Mr. Klemp, appointed as a Pupil in September 1962, made excellent progress during the year and Mr. R. Clark was appointed in September 1963 as a second pupil. The following table compares the inspections made during the year under review with those made in 1962. The total at 6,411 is some 290 less, and although regrettable, can be regarded as reasonable coverage of all the various aspects of the sanitary condition of the district. 1963 1962 Food shops, etc 960 1,171 Housing - primary visits 182 134 -re-inspections 48 39 -overcrowding provisions 67 14 -miscellaneous 95 84 Drainage - repairs and blockages 922 833 Rodent control 262 311 Shops - welfare provisions 406 365 Infectious disease enquiries 71 13 Factories, Workplaces and outworkers 484 487 Milk supply 149 142 Smoke abatement 806 1,128 River and Stream pollution 48 43 Stables and piggeries 8 10 Miscellaneous (Caravans, Hairdressers, Schools, Building sites, etc.) 1,903 1,927 6,411 6,701 Periodic inspections are required at the following premises as counted at the end of the year :- Wholesale food manufacturers 2 Bakehouses 3 Food shops and catering establishments 434 Public houses 16 Other shops 231 Factories (power) 171 Factories (non-power) 7 Offices, workplaces etc 272 The frequency of change of occupation in the shops and smaller businesses was again quite high, being about one in every seven. It is obviously desirable that a fairly frequent inspection of such premises 26 should be made- some authorities suggest bi-annual 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 1963 of all those premises found unsatisfactory in some respect in 1962 and then a concentration on those satisfactory premises oldest in date of last inspection. While all the premises last inspected and found satisfactory in 1959 were revisited and a start made on those of 1960, this three-year period between inspections continues to be a source of considerable concern. HOUSING A total of 182 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 desired result in all but 20 cases where statutory action had to be taken. Legal proceedings were taken in connection with the vacating and demolishing of one house. It is desirable that a systematic inspection of houses should be made by house-tohouse visits, but this was not possible with the staff available. The 182 houses examined were inspected on complaint or while visiting for another purpose such as Infectious Disease Control. 110 notices were served as follows- Intimation notices 90 (54 in 1962) Statutory notices Public Health Act 20 (23 in 1962) Housing Act 0 ( 0 in 1962) The Urban District is often regarded as consisting largely of modern owner-occupied houses, but this is not strictly true. Most of the area was developed between the wars, but there is a considerable area of older property in the northern part of the district and the Smoke Control Surveys continue to reveal that some 5% of the more modern houses are rented, and in some cases by two or more families. Moveable Dwellings. No application was received for a licence to station a caravan on land within the district during the year. Overcrowding The position with regard to statutory overcrowding is still reasonably satisfactory, although this standard is quite low in relation to the usual room/occupant ratio. One case was found during the year in addition to the five previous cases. All the occupiers affected were applicants under consideration by your Housing Department. Certificates of Disrepair. Under the provisions of the 1957 Rent Act, four applications for certificates were received during the year and one was granted, undertakings to carry out works being given by the owners in the other three cases. One certificate was revoked, the necessary work having been completed. 27 Twelve 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. Ten houses are the subject of Certificates granted after a failure of an owner to honour an undertaking previously given. The small number of applications is due probably to a mistaken belief that the procedure applied only immediately after the Act was passed and the increase of rent up to twice the gross value was allowed, although the number of houses actually thus subject to Rent Control decreases slightly each year due to deaths and removals giving the owner vacant possession. Occupiers complaining of disrepair are advised of the legal position by the Inspectors whenever appropriate. 28 FOOD SUPPLIES The majority of the shops, works' canteens etc. were in good condition with adequate food storage facilities, sanitary and washing accommodation. The following unsatisfactory points were noticed:- Unclean and defective premises 28 Unclean utensils 4 Accumulations of refuse in rooms or yards 8 Defective or insufficient bins 2 Unprotected food 4 Defective sanitary accommodation 9 Inadequate washing facilities (a) No hot water 3 (b) No soap 1 (c) No towels 1 (d) Non-display of notice regarding washing of hands 17 These were all corrected after informal action, but there appears to be a tendency for some occupiers not to remedy developing unhygienic conditions until an Inspector has drawn attention to them. Most of these items are of a minor nature, but it may be necessary, in appropriate cases of such repeated failure to take legal proceedings, without serving [notices, to impress occupiers with their responsibility to maintain premises at all times in conformity with the Food Hygiene (General) Regulations, designed to be a health safeguard, not a nuisance to occupiers. 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 Almonds, shelled Bacon Chicken Mutton Tinned foods 74 lbs. Weevil infested 88 lbs. Putrefaction 173 lbs. Putrefaction 21 lbs. Putrefaction 10,141 Blown, punctured or leaking Contaminated foodstuffs. Eleven complaints were received and carefully investigated to establish whether there was any negligence justifying legal action being taken. The foods affected were: 1. Bread, mouldy. 2. Bread containing (a) metal (b) insect. 3. Soup powder containing beetle. 4. Strained baby food in a 'blown' can due to age since manufacture - some three years. 29 5. Mineral water smelling of disinfectant. 6. Sugar containing foreign matter. 7. Mineral water containing dirt and other extraneous matter. 8. Pears in syrup alleged to be watery. 9. Sausage rolls, mouldy. 10. Bread, containing pieces of broken thermometer. Legal proceedings were taken in four instances and resulted in the following decisions. No. 5 fined £5 and £3.3.0 costs; No. 8 dismissed; No. 9 fined £10 and £5.5.0 costs; No. 10 fined £2 and £2.2.0 costs. The strained baby food was submitted to the Public Analyst for examination and, in spite of the age of the material, he reported there was no adverse change and that the strained fruit and custard was fit for human consumption. The manufacturers had, however, withdrawn the remaining stocks from the shop for destruction. Milk. There are no producers of milk registered within the district. 123 inspections were made of milk distributors' premises and at the end of the year there were on the register four dairies and forty distributors of milk. Three of the dairies are 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 some 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 made by the laboratory staff employed by the dairy including the incoming raw milks. There was no independent sampling of these raw milk supplies in view of the adequacy of other arrangements. During the year, an experimental plant was set up to subject milk to ultra-high temperature treatment followed by aseptic filling into cartons. After considerable discussion with officials of the Ministry of Agriculture, Fisheries and Food, the dairy company, representatives of the plant and carton manufacturers, and other interested bodies on technical and legal points, approval was given to the project subject to no such milk being used for human consumption outside the Urban District. Many difficulties were experienced during the experimental processing and filling but considerable progress was made, with the result that early in 1964, repetitive runs were possible yielding cartons of milk that tasted fresh and wholesome after storage for up to 89 days at normal room temperatures or in special rooms held at a constant temperature of 91°F. Further work is necessary to ensure production on a commercial basis, but a significant advance in milk processing has been made. 198 samples of milk, from various dealers, were submitted for bacteriological examination during the year and two were reported as unsatisfactory, failing the keeping quality test. These were from two 30 separate firms and were dealt with informally, as isolated examples of normally satisfactory milk. The undermentioned licenses to use special designations were in force during 1963 Pasteuriser's licence 1 Dealers' licences - Pasteurised 38 Tuberculin Tested 33 Sterilised 34 Details of the chemical analysis of milk samples will be found on page 32. The arrangements for washing and scrutinising bottles at the bottling establishment are of a very high order and no complaints were received. One bottle, filled outside the Urban District, was found to contain two stones and, the other local authority not being willing to take action under Article 27, Milk and Dairies Regulations for failure to cleanse the bottle, proceedings were taken under Section 2 of the Food and Drugs Act, (sale not of the substance demanded). A fine of £10 was imposed and costs of £5.5.0 allowed. Food and Drugs sampling 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. Article Genuine Not Genuine Apple dumpling 1 - Butter 4 - Fruit, canned 1 - Meat, canned 1 - Meat pie 2 - Meat, potted 2 - Meat pudding 2 - Milk 21 - Paste, Fish 9 - Paste, Meat 7 - Sausages, Pork 1 - 51 The samples were mainly of food produced locally and having a sale outside the Urban District, in England or abroad. 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 31 appraisal of the adulteration and sophistication possible in order to prepare a sampling programme giving adequate coverage without unnecessary expense. A summary of the fat and non-fatty solids in the 21 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 9.0 Total - 7 8 2 3 1 21 Milk fat (legal standard is 3% or Channel Island milk 4%) Less than 3.0 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.3 4.4 4.7 Total - 1 3 5 2 1 4 1 1 2 1 21 Ice Cream. At the end of the year, there were 136 registered retailers and 3 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. This method is more open to public health hazards and stricter control is necessary. 12 samples were obtained and submitted for bacteriological examination with the following results:- 11 samples failed to decolourise the Methylene Blue test dye within 4 hours and placed in Provisional Grade 1. 1 sample decolourised the dye in 2 hours and ranked as Grade 3. No chemical examinations were made during the year. 32 AIR POLLUTION Continuing progress was made during the year with the implementation of the Council's Clean Air policy. The No. 3 Order came into operation on the 1st October; the No. 4 Order was made on the 22nd April, confirmed on the 30th August and will come into operation on the 1st October, 1964; the No. 5 Order was made on the 22nd July, confirmed on the 11th December and will also come into operation on the 1st October, 1964. The survey of premises in the No. 6 area proceeded steadily, an attempt being made to interview the occupier of each of the premises within the areas concerned. This necessitated many evening or Saturday calls, but I feel that it is largely due to this personal contact and the use of the excellent mobile demonstration units of the Coal Utilisation Council and the Solid Smokeless Fuels Federation that there has once again been a complete absence of formal objections to the formation of smoke control areas. In all, 1,720 visits were made to discuss the implications of proposed Smoke Control Orders, 614 visits to inspect adaptations to fireplaces eligible for grants, 598 visits were made for other explanatory purposes and 1,534 ineffective calls were made. At the end of 1963, some 865.6 acres (one-fourth of the U.D.) were covered by operative orders affecting 4,569 domestic properties and 145 commercial, industrial or other premises. Adaptations were being done in another 320.2 acres involving 1,778 domestic properties and 101 other premises. Fifteen infringements of Smoke Control Orders were dealt with by informal letter and explanation, as all were first offences. The observations of industrial chimney emissions has continued as part of the normal duties of the Public Health Inspectors, hampered, unfortunately, by depleted staff. One emission in excess of the Permitted Period Regulations was observed and the occupiers of the factory concerned were fined £5 with £3.3.0 costs. Trouble was experienced in connection with a small joinery business where trade waste was burned in an open yard creating a nuisance to neighbouring residents. Proceedings for contravention of the Bye-law regulating the hours of such burning resulted in a fine of £5 with £3.3.0 costs and, on a separate application, a Nuisance Order under the Public Health Act was granted. 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. The publication of the long-awaited government memorandum on this subject was of assistance in the difficult task of determining the minimum height of chimneys, but many local factors still need to be assessed particularly regarding 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 co-operation with the Department of Scientific and Industrial Research. The daily concentrations of smoke and sulphur di-oxide were measured at three sites and the monthly deposition of dust, grit and other particles were recorded at two sites. The details are given in the following tables. 33 TABLE 1 Daily concentrations of smoke and sulphur dioxide in micrograms per cubic metre Period commencing 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 Jan. 1st 956 52 761 170 — — — — 1035 50 1359 186 Feb. 5th 428 98 871 293 583 — 683 — 351 72 518 94 March 5th 323 23 420 120 122 19 207 63 180 27 218 69 April 2nd 151 9 449 40 162 12 370 53 171 23 375 40 April 30th 109 6 219 39 67 1 127 29 57 6 135 34 May 28th 154 5 335 27 75 2 251 24 67 4 236 6 July 2nd 64 4 233 27 43 6 103 27 22 4 78 18 July 30th 85 3 196 20 39 3 130 28 — — — — Sept. 3rd 125 27 236 41 73 7 175 37 81 4 158 25 Oct. 1st 192 27 255 20 165 19 203 63 163 14 183 31 Oct. 29th 507 14 371 19 598 4 433 34 281 3 778 37 Dec. 3rd 749 53 911 26 418 98 1994 108 386 62 558 53 TABLE 2 Solid matter collected in Deposit Gauges in tons per square mile Month Carshalton and Merton and Morden Joint Cemetery Board Bandstand Roof Morden Park 1963 1962 1963 1962 January 27.66 9.43 20.98 - February 6.51 - March — 11.81 — — April 10.94 9.34 10.37 10.84 May 11.58 10.10 9.17 9.67 June 8.90 9.50 7.34 9.64 July 5.36 9.30 4.60 8.23 August 10.17 5.87 7.43 6.13 September 7.60 7.27 5.53 5.70 October 10.23 21.01 4.90 7.23 November 8.67 9.67 10.04 8.41 December 8.07 13.83 10.91 10.49 Monthly average 9.93 10.305 8.29 8.482 ANNUAL TOTALS 11911 123.66 99.56 101.784 tons tons tons tons The gauge in the Cemetery ground is North-east of the Refuse Disposal works and hence in line of the prevailing wind. The increase over the other gauge is noticeable but may be due in part to other factors, i.e. the nearby industrial area South of the gauge and the builtup area. 34 GENERAL SANITATION Factories and Workplaces The number of inspections made to premises registered under the Factories Act, 1961 was 484. Defects relating to sanitary conveniences, ventilation and other sanitary matters were dealt with on 13 premises. The table on page 22 gives details of the action taken during the year. Watercourses Regular inspections were made of the watercourses in the district, particularly of the River Wandle, Beverley Brook and Pyl Brook to detect pollutions. Details of pollutions entering from the Council's surface water sewers were notified from time-to-time by the Surrey County Council and investigated. The cause was usually discharges of oil in factory yards, thoughtlessly or by accident, and also wrongful connection of new sink waste pipes on first floors of houses to rainwater hopper heads. They were all put right. Rats and Mice. 308 complaints of infestation were received during the year and as a result of inspection of 1,820 premises, 357 were found to be infested. This is a greater proportion than in 1962 when 258 infestations were found on 2,034 premises. The control methods recommended by the Ministry of Agriculture, Fisheries and Food were followed in every case, mostly by the use of warfarin although some other poison baits were used on occasion. A 10% test baiting of the Council's soil sewers was made in October and 137 manholes were included. Of this total, 11 manholes showed a 'take' and a poison treatment was carried out immediately afterwards using sodium fluoroacetamide (1,080) for which a firm of specialists was engaged. The Rodent Control service is free to occupiers of domestic property but a charge is made for work on business premises. The total income in the financial year 1963/4 from this source was £286. 8s. Od. including the sum of £154. which is paid annually by four firms under contract. Both these amounts are higher than in 1962 but further 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 is empowered by Section 74 of the Public Health Act 1961 to take steps to reduce the number of pigeons in the area. Nuisances from these birds were the subject of a number of complaints and various experiments were carried out, including netting and trapping, to ascertain the best method of catching them. This work can be very time-consuming and it is hampered by the likelihood of adverse public reaction if precautions are not taken and also by the prediliction of some people to lay out food for the birds. 35 As birds were known to be nesting under railway bridges, a trial was made of visiting at 6-7 week intervals during the summer to remove eggs and nestlings. This was quite successful but depended on the availability of a moveable platform used by the Surveyor's Department for other purposes. In addition, a dovecote in the Haig Home estate was visited after dark and birds taken in the light of a powerful torch. The details were as follows:- Place Number of visits Numbers destroyed Adults Nestlings Eggs West Barnes Lane Bridge 3 2 40 53 Wimbledon Chase Bridge 3 — 48 64 Skew Arch Bridge 1 — 11 8 Haig Home Estate 5 13 2 10 The licence granted in 1962 by the Ministry of Agriculture, Fisheries and Food authorising me to use narcotised bait was renewed for 1963. This method was used again but the success of last year was not repeated, due to inclement weather at the time of the operation. Six adults were picked up on two occasions but an experimental use of a new narcotic at the request of the Ministry failed to destroy any birds. Insects. Four complaints of vermin (bugs and fleas) were received and dealt with free of charge, as were 56 complaints of bees and wasps. 22 complaints of infestations by other pests including ants, silver fish, cockroaches and flies were received and advice given. Control measures at County Council premises on request yielded an income of £7. 6s. 0d. during the financial year 1963/4. 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 are kept, fourteen visits were made. Noise Abatement. Thirteen complaints of nuisance were received during the year and in addition to noise from factories included noise from radio sets, ice-cream vehicles, army field generators and a youth club premises. A considerable time was spent by your officers in assessing the noise level, determining the cause and in discussion with the persons responsible to secure a reduction in volume. 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 Institute certification scheme. No samples were taken by the department during the year. 36 OTHER ACTS Merchandise Marks Acts. The Council is empowered to enforce the requirements of these Acts as far as the marking of imported food is concerned. The following articles are the subject of special Orders Apples Malt products Bacon Margarine Butter Meat Currants Oat products Eggs, dried Raisins Eggs, shell Salmon Ham Sultanas Honey Tomatoes The Inspectors enforce the provisions during their routine visits. Shopkeepers generally made due compliance with the law and only one informal warning was needed. Shops Act 1950. The following statement summarises the inspections made, the infringements discovered and other matters dealt with during the year No. of inspections Day visits 354 Evening visits 10 Sunday and half-holiday patrols 20 Infringements Number of premises at which contraventions were found 52 Failure to exhibit forms at premises 37 Including Assistants Half holiday 24 Young persons records 13 Seats for females notice 21 Mixed shop notices 7 Sunday employment notices 7 Insufficient heating Insufficient ventilation 1 Sanitary accommodation Insufficient 1 Dirty 4 37 SECTION F PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES 942 cases of infectious disease were notified during the year, compared with 382 in the previous year and 1,285 in 1961. The fluctuation in the figures from year to year is due, almost entirely, to the biennial prevalence of Measles, which, in the year under review, accounted for 747 of all notifications received. The following infectious diseases are notifiable in the Urban District:- Cholera Plague Diphtheria Acute Primary Pneumonia Dysentery Acute Influenzal Pneumonia Enteric Fever Acute Poliomyelitis Erysipelas Acute Polioencephalitis Food Poisoning Puerperal Pyrexia Leprosy Relapsing or Continued Fever Malaria Scarlet Fever Measles Smallpox Membranous Croup Tuberculosis (all forms) Meningococcal Infection Typhoid Fever Ophthalmia Neonatorum Typhus Fever Paratyphoid Fever Whooping Cough Smallpox. No cases of smallpox occurred in the district during the year. A number of persons arriving in this Country by air from abroad, from areas declared to be endemic, were kept under surveillance for a period of up to fourteen days. Dysentery. Twenty-one cases were notified, all were confirmed bacteriologically. Only three cases were notified in the previous year and one case in 1961. Erysipelas. Three cases were notified during the year, all in females and involving the face in each case. Food Poisoning. There were no outbreaks of food poisoning during the year. Two cases were notified, both occurring in adult males. Measles. 747 cases of Measles were notified during the year, compared with 258 for 1962. The disease continued to remain mild in character and there were no deaths. Ophthalmia Neonatorum. One case was notified during the year. Recovery was complete and vision unimpaired. Pneumonia. There were 38 cases of pneumonia, of which 18 were stated to be influenzal in origin. In 1962 there were 18 cases and in 1961 a total of 29 cases. 38 Puerperal Pyrexia. One case was notified during the year and occurred at home. Upon enquiry patient was found to have had Influenza which could possibly have accounted for the pyrexia. Scarlet Fever. 37 cases were notified during the year, comparing with 42 for the previous year and 20 in 1961. The infection continued to be mild in character and was most common in children of early school age. Whooping Cough. 67 cases were notified in 1963, as compared with 16 in 1962 and 41 in 1961. Acute Poliomyelitis. No cases were notified during the year, either Paralytic or Non-Paralytic. The last case occurring in the district was in 1959. Diphtheria. For the seventh year in succession no cases of Diphtheria have been notified in the district. CLEANSING STATION Although facilities remained available for the treatment of Scabies and Verminous Heads no patients were in need of treatment during the year and it was unnecessary to open up the Council's Cleansing Station at Aston Road, Raynes Park, for this purpose. DIPHTHERIA IMMUNISATION 754 children received a primary course of immunisation during the year, as follows Age Group Total Under 1 1 2 3 4 5-9 10- 15 Number Immunised 295 395 25 2 5 26 6 754 In addition to these primary inoculations, 1,467 children received further re-inforcing injections. WHOOPING COUGH IMMUNISATION The following figures show the number of children immunised and those who also received re-inforcing 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 726 Number of children boosted 314 39 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 778 children completed a primary course of treatment against tetanus and a further 399 children received re-inforcing injections. POLIOMYELITIS VACCINATION Vaccination against Poliomyelitis is available at all infant welfare clinics throughout the district and, in addition, special clinics are held once a month, on a Saturday morning, at the Grand Drive and Morden Road Clinics. With the introduction of oral vaccination in 1962 the demand for Salk Vaccine fell to negligible proportions, being almost exclusively used by the local general practitioners when a single vaccination is called for. The following table indicates the state of vaccination as it was on the 31st December, 1963 Age Group (Years of birth) Primary Course Number given third Number given fourth Salk Oral Salk Oral Salk Oral 1943-1963 17 529 ) 23 12 14 635 1933-1942 2 20 Other Groups 3 54 ) Totals 22 603 23 12 14 635 The total number of persons who have received a primary course of vaccination since the inception of the scheme is 25,136, which includes 16.496 in the 1943-1963 age group, 4,683 in the 1933-1942 age group and 3,957 classified under other groups. SMALLPOX VACCINATION Vaccination against smallpox is provided by the County Council in accordance with their Scheme under Section 26 of the National Health Service Act. Hitherto it has been the practice to secure vaccination of infants at approximately three to four months of age but, having regard to the timing of other immunisation and vaccination procedures, the Mininstry of Health were advised by the Medical Advisory Committee that there was evidence to indicate a slight advantage to be gained, on the score of liability to local reaction, if the treatment were given in the second year of life instead of the first. This new timing of vaccination against smallpox was adopted throughout Surrey during the year, 40 although, in the event of significant individual risk such as exposure to infection, this would be disregarded and the individual vaccinated forthwith. The number of persons recorded as having received successful vaccination during the year was as follows Age at date of vaccination Total 0-3 months 3-6 months 6-9 months 9-12 months 1 2-4 5-14 15 or over Primary Vaccination 8 17 40 16 101 2 12 8 204 Re-vaccination — — — — 1 10 22 49 82 Totals 8 17 40 16 102 12 34 57 286 41 42 MONTHLY INCIDENCE OF INFECTIOUS DISEASE, 1963 Disease January February March April May June July August September October November December Total Diphtheria — — — — — — — — — — — — — Dysentery 1 1 1 3 2 8 5 — — — — — 21 Acute Encephalitis Infective — — — — — — — — — — — — — Post-infective — — — — — — — — — — — — — Erysipelas — 1 — — 2 — — — — — — — 3 Food Poisoning — — — — — — 1 1 — — — — 2 Measles 77 142 89 149 62 71 89 41 6 1 — 20 747 Ophthalmia Neonatorum — — — — — — — — — 1 — — 1 Paratyphoid Fever — — — — — — — — — — — — — Pneumonia Acute Primary 1 6 4 — 2 — — 1 2 — 1 3 20 Influenzal — 14 3 1 — — — — — — — — 18 Acute Poliomyelitis Paralytic — — — — — — — — — — — — — Non-paralytic — — — — — — — — — — — — — Puerperal Pyrexia — — 1 — — — — — — — — — 1 Scarlet Fever 6 7 5 3 4 3 2 — — 1 4 2 37 Smallpox — — — — — — — — — — — — — Tuberculosis Respiratory 1 1 1 5 3 1 — 2 1 2 — 3 20 Non-respiratory 1 — — — — — — — 2 1 1 — 5 Typhoid Fever — — — — — — — — — — — — — Whooping Cough 1 3 5 2 2 — 2 17 3 3 14 15 67 Totals 88 175 109 163 77 83 99 62 14 9 20 43 942 TUBERCULOSIS Forty-three new cases were added to the register of tuberculous persons, compared with 53 in 1962. These additions were Males Females Total Pulmonary Non-Pulmonary 25 2 13 3 38 5 27 16 43 Of these 43, 25 were primary notifications, 17 were transferred from other districts and one came to notice in another way. During the year 69 persons were removed from the register for the following reasons Recovered 30 Removed from the district 25 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 45 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 income is derived from the sale of Christmas Seals, donations, grants and proceeds from local functions. As a number of patients are found to be suffering from lung cancer generous help has 43 been given by the National Society for Cancer Relief in certain specified cases. Help has also been forthcoming from the Alexandra Day Committee. The Committee has given help to patients in many ways to make life a little easier, particularly the chronic bronchitics who become breathless and exhausted on the slightest exertion. 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. Financial help was again afforded to the holiday scheme for patients and child contacts. I am indebted to the Honorary Secretary for supplying me with the above information and the opportunity to record my admiration and appreciation of the very valuable work carried out by the Committee. MASS RADIOGRAPHY SERVICE Although no 'general public' surveys were held in the district during the year under review, the Mobile Chest Radiography Unit of the South-West Metropolitan Regional Hospital Board continued with the general practitioners' service from Raynes Park and South Wimbledon, as follows Grove Hotel Car Park, Morden Road. Mondays 7.30 - 8.30 p.m. Raynes Park Station, Grand Drive Entrance. Thursdays 7.30 p.m. - 8.30 p.m. I am indebted to Dr. F. J. H. Walters, Medical Director of the Service, for the following information relating to persons X-rayed by the Unit in this area during the year Number of persons examined Abnormalities Active T.B. Primary Lung Cancer M. F. Total M. F. Total M. F. Total General Public 2306 1425 3731 1 1 2 5 1 6 General Practitioner Service 827 698 1525 4 2 6 12 — 12 Totals 3133 2123 5256 5 3 8 17 1 18 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. 44 45 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 Non-Pulmonary Pulmonary M. F. M. F. M. F. M. F. M. F. M. F. 0- 1 — — — — — — — — — — — — — 1 - 5 — — — — — 1 — — — — — — 1 5-10 — — — 1 — — — — — — — — 1 10-15 — — — — — — — — — — — — — 15-20 — — — — — — — — — — — — — 20-25 — — — — 1 — — — — — — — 1 25-35 — 2 1 1 6 6 — — — — — — 16 35-45 1 1 — 1 2 — — — — — — — 5 45-55 6 2 1 — — — — — — — — — 9 55-65 7 1 — — 1 — — — — — — — 9 65 and over — — — — — — — — 1 — — — 1 Totals 14 6 2 3 10 7 — — 1 — — — 43 25 17 1 INDEX PAGE Acreage 7 Acute Poliomyelitis 39 Air Pollution 36-37 Ambulance Facilities 14 Births 8-11 Institutional and Domiciliary 10 Premature 11 Stillbirths 9-10 Rates 8-10 Cancer 8-9 Deaths from 8-9 Rate 9 Cleansing Facilities 39 Climatic Conditions 20-21 Clinic and Treatment Centres 16-17 Deaths 8-9, 11,13 Causes of 8,13 Rates 8-9 Diphtheria 12,39 Immunisation 39 Drainage and Sewerage 19 Drainage work 26 Dysentery 12,38 Erysipelas 12,38 Factories and Workplaces 7,22-23,35 Inspections 22 Defects 22 Outwork 23 Food and Drugs Act, 1955 18,31-32 Food Poisoning 12,38 Food Supply 29-32 Inspections 29 Unsound Food 29 Health Services 14-17 Heart Disease - Deaths from 8,13 Hospitals 14-15 Housing 24-25,27-28 Action taken 27-28 Inspections and Defects 24-25 Number inhabited 7 Overcrowding 24,27 46 INDEX—Continued PAGE Ice-Cream 18,32 Industry 7 Infant Mortality 8-10 Rates 8-10 Infectious Diseases 11,15,38-39 Cases admitted to hospital 15 Diseases notifiable 38 Monthly incidence 42 Isolation Hospitals 15 Laboratory Facilities 14 Mass Radiography 44 Maternal Mortality 8-10 Measles 12,38 Mental Health 4 Merchandise Marks Acts 37 Milk Supply 30-31 Nelson Hospital 14 Neo-Natal Deaths 10 Noise Abatement 36 North-Eastern Divisional Health Sub-Committee 5 Notification of Births 9 Nuisances abated 27 Ophthalmia Neonatorum 38 Pest Control 35-36 Pet Animals and Animal Diseases 36 Pneumonia 12,38 Poliomyelitis 12,39-40 Vaccination 40 Population 2, 7-9 Premature Births 11 Problem Families 3 Public Cleansing 19 Public Health and Civil Defence Committee 5 Puerperal Pyrexia 12,39 Rainfall 20-21 Rateable Value 7 Representatives on North-Eastern Divisional Health Sub-Committee 5 Tuberculosis and Chest Diseases Care Committee 5 Wandle Valley Joint Sewerage Board 5 Rivers and Streams 19 Sanitary Circumstances 18-21 Sanitary Inspections, Summary of 26 Scarlet Fever 12,39 47 IN DEX—Continued PAGE Shops Act, 1950 37 Smallpox 15,38 Vaccination 40-41 Social Conditions of the area 7 Staff 6 Statistics 8-10 Comparative 11-12 Vital 9-10 Stillbirths 9-10 Tetanus Immunisation 40 Tuberculosis 43-45 Assistance given 43-44 Care Committee 5,43-44 Dispensary 17 Mass Radiography 44 New cases - by age gr&ups 45 Vaccination 40-41 Venereal Diseases 17 Vital Statistics 8-10 Wandle Valley Joint Sewerage Board 5 Water Courses 35 Water Supply 19 Whooping Cough 12,39 Immunisation 39 Zymotic Disease 9 Deaths from 9 Rate 9 48 Printed by RAYNES PARK PRESS LTD. LAMBTON ROAD LONDON . S.W.20