Medical Officer of Health on the Sanitary Conditions and Vital Statistics, Report of Sanitary Inspector FOR THE YEAR 1913. Submitted to the Council 27th February 1914 Wimbledon: W.H Stoakley & Co, 11 Sr George,s Road MAR 028 CONTENTS. pages. Physical Features and Social Conditions 5 Sanitary Circumstances of the District— Water Supply 6 Streams 6 Sewerage and Drainage 6 School Inspection 6—7 Foods—Milk, Meat 7 Housing 8 Sanitary Administration 8 Hospital Administration 8—9 Prevention of, and Control over, Acute Infectious Diseases 9—10 Prevalence of, and Control over, Pulmonary Tuberculosis 10—11 Infant Mortality 11 General Mortality 12 Appendices— Statistical Tables 14—18 Factory and Workshops 19—20 Sanitary Inspector's Report 21—27 Summary 28 Merton & Morden Urban District Council. HEALTH REPORT FOR 1913. TO THE CHAIRMAN AND MEMBERS OF THE MERTON AND MORDEN URBAN DISTRICT COUNCIL. Gentlemen, I have the honour of submitting for the year 1913 my Sixth Annual Report, being the sixth since Merton became an Urban District and the first after its amalgamation with Morden. The latter having become part of the united District for only nine months of the year, I have thought it advisable for the purposes of statistics to separate the two in so far as the birth and death rates are concerned, and work on the assumption that the rates in Morden would have been the same for the first three months as for the rest of the year. For the first time the death rate has been corrected in such a manner that a somewhat fairer comparison can be made with the rest of the country. This is due to the fact that from the data available at the Census of 1911 a factor has been obtained by the Registrar General which, when multiplied by the rate obtained in the ordinary way, gives a result which allows for differences in age and sex distribution. For obviously a district having a large proportion of young adults an d females shews a more favourable return than "he actualities warrant. The factor for correction for Merton is 1.0327, and means that in its composition it has a somewhat greater proportion of people between the favourable ages of say 5 and 45, whose death rate is naturally lower than those above or below those ages. For Morton the birth rate was 24.6 per thousand of estimated population, being 1.4 per thousand higher than 1912. For Morden the birth rate was 10 per thousand. The birth rate for England and Wales was 23.9 per thousand. The corrected or standardized death rate for Merton was 10.3 per thousand for estimated population, being 3.3 per thousand higher than the uncorrected death rate for 1912. The death rate for Morden was 8.3 per thousand of estimated population. The standardized death rate for England and Wales was 13.4 per thousand. The Infant Mortality for Merton was 72 per thousand registered births. For England and Wales Infant Mortality was 109 per thousand births. My thanks are due to the Council and their Officers for the help they have afforded in enabling me to compile some of my figures, specially in relation to the unoccupied houses and rentals generally. I need hardly allude to Mr. Pointon's work, which has as usual been of the greatest assistance. I am, Gentlemen, Your obedient servant, DAVID A. BELILIOS. Medical Officer of Health. REPORT. Physical Features and General Character of the District.—The District is somewhat flat, having a slight rise towards the Southern or Morden aspect. In the Northern or Merton portion the sub-soil consists of loamy gravel, which thins out and merges into the underlying clay in the East, West, and the whole of the Southern or Morden portion. The acreage of the combined District is about 3,237 acres, only a small portion being built upon. The surface is drained by the River Wandle, the Pyl and Beverley Brooks. SOCIAL CONDITIONS. The rentals of the houses, which will be given in some little detail, will supply a clue to the class of inhabitants in the District. Suffice it to say that the majority belong to the working classes. Mr. List, Clerk to the Croydon Union Guardians, has supplied me with the following figures. The number of cases does not embrace the number of persons actually relieved. Cases. Workhouse 42 Infirmary 63 Outdoor Relief 75 The Rev. Mr. Jagger, the Rector of Merton, has again kindly supplied me with regard to the gratuitous relief in his Parish. He says that " poverty has not beein so evident or pressing among our parishioners during the last year. . . . My impression also is that there has been less unemployment.' He has not had "quite so many applications for admission to Hospitals and Convalescent Homes." Out-patients' letters for the London Hospitals have been needed, principally for children. 6 SANITARY CIRCUMSTANCES OF THE DISTRICT. The water is supplied by the Metropolitan Water Board and the Sutton Water Company. Rivers and Streams are under the supervision of your Sanitary Inspector. The ditches axe periodically cleared out by the Surveyor's Staff. Drainage and Sewerage.—The level? vary from about 145 ft. above Ordnance Datum to 42 ft. Separate systems are provided. Practically the whole of the built-on portion of the District is sewered. Closet Accommodation.—The vast majority of houses are provided with water closets. There are, however, not more than two houses in Morden with cesspools. Scavenging.—^ A weekly collection is effected, In the interests of public health, for the poorer parts of the District it would be well for the Council to consider the question of a more frequent collection, especially in the Summer. Sanitary Inspection of the District.—The Report of your Sanitary Inspector is appended. Schools.—There are now five Public Elementary Schools, one being a temporary structure. The action taken in relation to the health of the scholars for preventing the spread of infectious disease consists principally in the exclusion for definite periods of all children from homes whence the cases have been notified, and my examination in the School of all children who are in the same room as the infected case, with the object of excluding any undiscovered cases. I have found this rule useful, especially in Diphtheria. A system of intercommunication exists between the teachers and myself, so that information is given me with regard to other than the notifiable cases. 7 During the Spring an extensive epidemic of Measles prevailed, and I found it necessary to advise the Authority to close the Infants' Departments of the Aston Road, Raynes Park and Morden Schools, and also the Abbey Road School. Although School closure may not have an appreciable effect in checking the spread of an infection like Measles in an essentially urban area like Merton, it provides the careful mother with a chance of keeping her children away from infection, and to this extent closure may do some good. FOOD. Milk Supply.—The cowsheds are situated as follows 1. Morden Hall Farm. 2. Cannon Hill Farm. 3. Broadwater Farm, Kingston Road. 4. West Barnes Farm, West Barnes Lane. 5. 6 in Morden. Byedaws are in force under the Dairies, Cowsheds and Milkshops Order, so as to ensure proper lighting, ventilation, cleanliness and water supply. Samples of milk have been taken for the detection of pus and dirt. Meat.- There are registered five slaughter-houses, and Bye-laws provide for their cleanliness, water supply, etc. All places where foods are prepared, stored, or exposed for sale, such as bakehouses, slaughter-houses and dairies, have been visited frequently during the year. Mr. Pointon and your Assistant Sanitary Inspector (Mr. Thick) visit as far as they are able at the time of the slaughtering of animals, and surrender of carcases and parts of carcases are accepted. 8 Sale or Food and Drugs Acts.—The duties under these Acts are carried out by the Surrey County Council. Housing.—The information required under Art. XIX (14) (r) and the tabular statement is appended. As regards the sufficiency of houses, the following figures, supplied to me by the Rate Department, will show that there are fewer houses empty than at any time since the District obtained Urban Powers. Only about 80 houses were unoccupied. In Rating, Empty. Up to £16 Rental. From £16 to £26 West Barnes Ward 369 16 32 303 Bushey Mead 1495 31 282 1063 Park Ward 608 21 111 112 Abbey 1146 12 445 569 Morden 242 6 160 29 3860 86 1030 2076 Mr. Jerram, your Surveyor, exercises supervision over the new buildings. He informs me that he has given 80 certificates for habitation. New buildings erected have been : 106 in 1912, 115 in 1911, 143 in 1910, 144 in 1909, and 222 in 1908. Roads Made Up.—Manor Gardens and High Path (part). Workshops and Work Places.—The information required by the Home Office is appended. SANITARY ADMINISTRATION OF THE DISTRICT. Staff.—Owing to the increased work in the District due to its growth, and the new duties imposed by Parliament, and various Orders of the Board, the Council appointed Mr. Thick, your Assistant Sanitary Inspector. He assumed his duties in August, and has performed his work in an efficient manner. Hospital Accommodation is available for Scarlet Fever, Diphtheria, Enteric, Erysipelas, and Small-Pox. We have been able to send all the required cases to Beddington Corner 9 The Adoptive Acts in force are:—The Public Health Amendments Act, 1907, Part VIII (Eire Brigade), Part VII (Police), Part IX (Sky Signs), Parts I, II, III, and in Part IV, Sections 52, 53, 54, 55, 57, 58, 59, 60, 61, 62, 63, 64, 65, 67 and 6S, Part V, Part VI and Section 95; Public Health Amendment Act, 1890, Part III; Infectious Diseases Prevention Act, 1890; Private Street Works Act, 1892. Bacteriological work undertaken has been in connection with Diphtheria, Typhoid and Tuberculosis. PREVENTION OF, AND CONTROL OVER, ACUTE INFECTIOUS DISEASES. Diphtheria.—Twenty-four cases were notified, as against 33 in 1909, 27 in 1910, 27 in 1911, and 18 in 1912. Of the 24 notified cases 17 were attacked in the last three months of the year. Five of these attended the Aston Road Temporary School and four Raynes Park School. In spite, however, of repeated examinations of the children and the bacteriological examination of swabs of suspected children, no carrier was discovered. Seven cases occurred in three houses. Scarlet Fever. Twenty-five cases were notified, as against 18 in 1908, 62 in 1909, 11 in 1910, 16 in 1911, and 34 in 1912. Seventeen cases were removed to the Isolation Hospital. Enteric Fever.—There was one notified case (give causes). Measles.—In common with the rest of the country there was a widespread epidemic of Measles in the early part of the year, and 406 cases were notified, with 8 deaths, all under 5 years of age. Although notification of the disease is in force, it, in my opinion, has very little, if any, effect in preventing the spread of infection. In contrast with other diseases coming under the Infectious Diseases Notification Act, it lends itself to very little administrative control, partly owing to the disease being infectious at the pre-eruptive period, viz., before the 10 diagnosis is usually made. The result is that by the time the first batch of notifications arrive, a larger number is incubating the complaint and further propagating it in a wider circle, so that the first question that arises is that of efficient isolation. Is it possible? In my opinion1, the only way isolation can possibly become effective is by the provision of accommodation, not only for the sufferers but of all those who are probably infectious. This latter is wholly impracticable, not only on medical but also on legal grounds. So far as I am aware, I know of no Sanitary Authority undertaking the isolation of Measles in Hospitals on any large scale, and it is significant that most of the authorities who have enforced notification have given up the practice. The other important measure which follows notification is disinfection. It is admitted by most that purely domestic measures suffice in Measles, so that from this point of view notification is unnecessary. But should disinfection be attempted in the ordinary way the Council would be faced with the necessity of providing additional plant and help at all epidemic periods. Under the circumstances, would it be justified? During' the period under review I frequently visited the Schools in the District to weed out the suspicious cases, but 1 was finally obliged to advise closure of the Infants' Departments. Pamphlets were also distributed in the District. PREVALENCE! OF, AND CONTROL OVER, PULMONARY TUBERCULOSIS. On receipt of a notification, the case is visited, and particulars are taken as to the premises and where the patient sleeps, the number of people, and general sanitary condition of the house, etc. Pocket spittoons are provided in necessitous cases, and advice is given as to the methods by which danger of infection to others can be avoided. The patients have been subsequently visited. 11 I understand a Dispensary is likely to be established this year at Wimbledon, where the systematic examination of contacts will be available for those willing to undergo an examination. TUBERCULOSIS. Number of Notifications received for Phthisis 25 do. do. do. do. for other Tubercular Diseases 11 Total 36 Number of Patients whose Postal Address is now in th9 district 20 Number of Patients who have received Hospital Treatment 17 Number of Patients who have received Sanatorium Treatment ONCE 13 Number of Patients who have received Sanatorium Treatment TWICE 3 Number of Patients in Hospital or Sanatorium at present date 6 Number of Patients who have had' neither Hospital or Sanatorium Treatment 3 Number of cases occurring jn houses with S rooms 2 ,, ,, ,, ,, 6 ,, 1 ,, ,, ,, ,, 5 ,, 15 ,, ,, ,, ,, 4 ,, 1 ,, ,, ,, ,, 3 ,, 1 Total 20 INFANT MORTALITY. Out of the 28 registered deaths of infants under 12 months of age, 16, or nearly 57 per cent., were due to such causes as premature births (7), malformations (2), inefficient expansion of lungs (1), and atropy, debility and marasmus (6). The question of appointing a Health Visitor for the District was considered by the Public Health Committee and by the Council, and it was decided not to make any appointment, at any rate for the present. Mainly owing to the favourable weather conditions pre vailing during the Summer, only 3 deaths were recorded as being- due to diarrhceal diseases. 12 GENERAL MORTALITY Out of 157 deaths belonging to the combined District of Merton and Morden, 30 were over 70 years of age, 11 between 70 and 75, 9 between 75 and 80, 7 between 80 and 85, and 3 over 85. The disease which caused the largest number of deaths was Cancer (18), with Pulmonary Tuberculosis next with 12 deaths, and Measles with 8. Bronchitis, Pneumonia and other forms of respiratorv diseases caused 15 deaths. TABLE A. Birth Rate, Death Rate, and Analysis of Mortality, 1912. Annual Rate per thousand living. Deaths under 1 year per 1000 registered births. Births. Deaths. Enteric Fever. Small Pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Diarrhoea & Enteritis (under 2 yrs.) per 1000 births. England and Wales 23 9 13.7 0.04 o.oo 0.28 0.06 0.14 0.12 23.41 109 96 Great Towns 25.1 14.3 0.04 0.00 0.34 0.07 0.17 0.13 29.33 117 145 smaller ,, 23.9 12.8 0.05 0.00 0.30 0.05 0.13 0.11 24.73 112 England and Wales, less the 241 towns 22.3 13.1 0.04 0.00 0.20 0.05 0.12 0.11 14.39 96 Merton 24.6 6.3 ... ... 0.47 ... 0.17 ... 10 72 APPENDICES. TABLE I.—Vital Statistics of Whole District during 1913 and Previous Years. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett. Of Non-residents registered in the District. Of Residents not registered in the District. Under 1 year of age. At all ages. Number. Rate Number. Rate. Number. Rate per 1000 nett births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1908 10453 335 ... 337 85 8.1 Nil 15 17 48 100 9.5 1909 11302 336 ... 277 100 8.8 13 13 17 50 100 8.8 1910 12152 336 ... 27 6 116 9.5 14 13 29 87 115 9.4 1911 13000 339 ... 27 148 11.3 16 24 33 94 156 12 1912 14933 337 ... 232 107 7.1 30 28 23 68 105 7 1913 Merton 15567 383 388 24.6 146 9.3† 9.6‡ 30 40 28 72 156 10† 10.3‡ Morden 1200 12 12 10 10 8.3 ... ... Nil. ... 10 8.3 † Uncorrected. ‡ Corrected. Merton Area of District in acres (exclusive of area covered by water) 1,762. Total population all ages Number of separate occupiers 12,938 3,065 At Census 1911. Morden Area of District in acres, 1,475. Total population, 1,202. No. of separate occupiers 258. At Census 1911. 14 TABLE II.—Cases of Infectious Disease notified during the Year 1918. Notifiable Disease. Cases Notified in whole District. Total Cases Notified in each Locality. No. of Cases removed to Hospital from each Locality. At all ages. At Ages—Years. 1 2 3 4 5 1 2 3 4 5 6 Abbey Ward. Park Ward. Bushey Mead. West Barnes. j Morden. Abbey Ward. Park Ward. Bushey Mead. West Barnes. Morden. Total Cases removed to Hospital. Under 1. 1 to 5. 5 to 15. 15 to 25. 15 to 45. 45 to 65. 65 and upwards. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 24 ... 7 13 1 3 ... ... 2 2 14 4 2 ... ... ... ... ... 15 Erysipelas 9 ... ... ... 3 5 ... 1 3 ... 5 1 ... ... ... ... ... ... 2 Scarlet fever 25 ... 4 18 2 1 ... ... 9 7 8 1 ... ... ... ... ... ... 17 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 Relapsing fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 2 ... ... ... ... 2 ... ... 1 1 ... ... ... ... ... ... ... ... 1 Cerebro-spinal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 25 ... ... 2 5 16 2 ... 4 3 15 1 2 ... ... ... ... ... ... Other forms of Tuber- 10 ... 1 3 4 2 ... ... 2 ... 7 ... 1 ... ... ... ... ... ... Measles 406 19 160 214 11 2 ... ... 116 60 214 5 11 ... ... ... ... ... ... Totals 502 19 172 250 26 31 3 1 137 73 263 13 16 ... ... ... ... ... 36 The Isolation Hospital is situated at Beddington Corner (joint Hospital with Croydon Rural). The joint Small-pox Hospital is situated at North Cheam (joint with Wimbledon, Croydon Borough, Croydon Rural, and Penge Urban Districts). Number of Diseases that can be concurrently treated—Small-pox, Enteric, Scarlet Fever, Diphtheria and Erysipelas. 15 TABLE III.—MERTON.—Causes of, and Ages at, Death during Year 1913. 1 Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. 11 Causes of Death. Total Deaths whether of "Residents " or " Nonresidents " in Institutions in the District. 2 3 4 5 6 7 8 9 10 All ages. Under 1 year. 1 & under 2. 2 & under 5. 5 & under 15. 15 & under 25. 25 & under 45 45 & under 65 65 & upwards All deaths are certified. Enteric fever ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Measles 8 ... 4 ... ... ... ... ... ... 1 Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping-cough 3 1 1 ... 1 ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Influenza 4 ... 1 ... ... 1 ... 2 ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) 12 ... ... ... ... 4 8 ... ... ... Tuberculous Meningitis I ... ... ... 1 ... ... ... ... ... Other tuberculous diseases 1 ... ... ... ... ... ... ... ... ... Cancer, malignant disease 16 ... ... ... ... ... 3 5 7 6 Rheumatic fever ... ... ... ... ... ... ... ... ... ... Meningitis 3 ... 1 ... ... ... 2 ... ... 1 Organic Heart Disease 5 ... ... ... 1 1 ... 1 2 2 Bronchitis 7 2 1 ... ... ... ... ... 4 1 Pneumonia (all forms) 6 ... 2 ... ... 1 1 2 ... 2 Other diseases of Respiratory organs 2 ... ... ... ... ... ... ... 2 1 Diarrhœa and Enteritis (including Gastritis) 5 3 1 ... ... ... ... ... 1 ... Appendicitis and Typhlitis 1 ... ... ... ... 1 ... ... ... 2 Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... Alcoholism 1 ... ... ... ... ... 1 ... ... 1 Nephritis and Bright's Disease 5 ... ... ... ... ... ... ... 4 1 Puerperal fever 1 ... ... ... ... 1 ... ... ... ... Other accidents and diseases of Pregnancy and Parturition 1 ... ... ... ... ... 1 ... ... ... Congenital Debility and Malformation, including Premature Birth 15 15 ... ... ... ... ... ... ... ... Violent Deaths, excluding Suicide 3 ... ... 1 1 ... ... ... 1 1 Suicides 1 ... ... ... ... ... 1 ... ... ... Other defined Diseases 46 6 4 ... 2 ... 6 9 19 15 Diseases ill-defined or unknown ... ... ... ... ... ... ... ... ... ... Totals 147 28 15 6 6 9 23 20 40 34 16 h-» -a TABLE ILL—MORDN.—Causes of, and Ages at, Death during Year 1913. 1 Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. 11 Total Deaths whether of "Residents " or " Nonresidents " in Institutions in the District. Causes of Death. All deaths are certified. 2 3 4 5 6 7 8 9 10 All ages. Under 1 year. 1 & under 2. 2 & under 5. 5 & under 15. 15 & under 25. 25 & under 45. 45 & under 65. 65 & upwards. Enteric fever ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) 1 ... ... ... ... ... 1 ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Other tuberculous diseases ... ... ... ... ... ... ... ... ... ... Cancer, malignant disease 2 ... ... ... ... ... ... 1 .1 ... Rheumatic fever ... ... ... ... ... ... ... ... ... ... Meningitis ... ... ... ... ... ... ... ... ... ... Organic Heart Disease 1 ... ... ... ... ... ... 1 ... 1 Bronchitis l ... ... ... ... ... ... ... 1 ... Pneumonia (all forms) l ... ... ... ... ... 1 ... ... ... Other diseases of Respiratory organs l ... ... ... ... ... ... 1 ... ... Diarrhoea and Enteritis (including Gastritis) ... ... ... ... ... ... ... ... ... ... Appendicitis and Typhlitis ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... Alcoholism ... ... ... ... ... ... ... ... ... ... Nephritis and Bright's Disease ... ... ... ... ... ... ... ... ... ... Puerperal fever ... ... ... ... ... ... ... ... ... ... Other accidents and diseases of Pregnancy and Parturition ... ... ... ... ... ... ... ... ... ... Congenital Debility and Malformation, including Premature Birth ... ... ... ... ... ... ... ... ... ... Violent Deaths, excluding Suicide ... ... ... ... ... ... ... ... ... ... Suicides l ... ... ... ... ... ... 1 ... ...... Other defined Diseases 2 ... ... ... ... 1 ... ... 1 ... Diseases ill-defined or unknown ... ... ... ... ... ... ... ... ... ... Totals 10 ... ... ... ... 1 2 4 3 1 M 00 TABLE IV.—Merton and Morden.—Infantile Mortality during the Year ending 1913. Nett Deaths from stated Causes at various Ages under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. All Causes—Certified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... 1 ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... 1 ... 1 Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis {not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... 1 ... ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 ... ... 1 2 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... Diarrhoea ... ... ... ... ... ... 1 ... ... 1 Enteritis ... ... ... ... ... ... ... 1 1 2 Gastritis ... ... ... ... ... 1 ... ... ... 1 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations 1 ... ... ... 1 ... 1 ... ... 2 Premature Birth 7 ... ... ... 7 ... ... ... ... 7 Atrophy, Debility and Marasmus ... ... ... ... ... 3 "i 2 ... 6 Other causes ... ... ... ... ... 1 ... 2 ... 3 10 ... ... ... 10 6 3 7 2 28 Population (estimated to middle of 1913), 16,767. Births in the year -.—Legitimate—Merton, 378; Morden, 12. Illegitimate—Merton, 10. Deaths iri the year of legitimate infants, 24 ; Illegitimate infants, 4. 19 FACTORY AND WORKSHOPS. By the Factory and Workshops Act, 1901, I am required to " report specifically on the administration of this Act in workshops and workplaces," and to send a copy to the Home Secretary, The details will be found appended. In my personal visits, I saw that there was sufficient airspace, ventilation, and proper sanitary conveniences separated for the sexes. Mr. Pointon visits the places regularly, so that no conditions inimical to health may arise. Annual Report of tlie Medical Officer of Health for the year 1913 for the Urban District of Merton on the administration of the Factory and Workshops Act, 1901, in connection with Factories, Workshops, Workplaces and Homework. 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Number of Written Premises. Inspections. Notices. FACTOKIES (including Factory Laundries) ... 44 — WORKSHOPS (including Workshop Laundries) 63 2 WORKPLACES 1 — Total 108 2 20 2— DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES N umber of Defects. Particulars. Pound. Remedied. Nuisances under the Public Health Acts:—* Want of cleanliness 2 2 Want of ventilation - - Overcrowding — — Want of drainage of floors — — Other Nuisauces — — insufficient 1 1 Sanitary accommodation unsuitable or defective 1 1 (. not for separate sexes — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) Breach of special sanitary requirement for bakehouses, ss. 97 to 100 Other offences, excluding offences relating to outwork which are included in Part 3 of this report Total 4 4 3.—HOMEWORK. OUTWORKERS' LISTS, SUCTION 107. List? received from Employers Nil Lists received from other Councils 10 4.—REGISTERED WORKSHOPS Workshops on the Register (s. 131) at the end of the year. Bakehouses 8 Laundries 5 Silk Printers 2 Block Cutters 2 Cycle Makers 2 Total number of Workshops on Register 19 * Including those specified in Sections 2, 3, 7 and 8 oi the Factory and Workshops Act as remediable under the Public Health Acts The whole of Part III of the Public Health Acts Amendment Act, 1890, is in force. 21 Sanitary Inspector's Report. Mr. Chairman and Gentlemen, I beg to present my report upon the work carried out during the year 1913, under the various Acts and Orders affect ing the Public Health Department. Systematic inspection of the houses in various streets in the district has been carried out, in accordance with the orders of the Local Government Board. Two hundred and sixty-six notices were issued, of which number 22 were statutory, and issued by instruction of the Council. In a considerable number of cases verbal intimation was sufficient to secure the abatement of nuisances. In no case was it found necessary to institute legal proceedings. The drainage systems of 11 houses have been reconstructed, and repairs carried out at 14. In August last, Mr. F. J. Thick commenced his duties as Assistant Inspector, and has proved to be an efficient and trustworthy officer. In consequence of this appointment, it has been possible to increase the number of premises visited in the course of house to house inspection, and a considerable amount of work carried out and supervised where nuisances or defects were found to exists. A tabulated summary of the inspections made, and defective conditions remedied, will be found at the end of this report. 22 HOUSING INSPECTION. During the year two hundred and seventy-seven houses were inspected under the Housing Regulations, attention beintr directed to the points especially mentioned in the Local Government Board's Order. In no case, was it found necessary to apply to the Council for Closing Orders, but in 203 of the premises inspected, defects were found to exist, which necessitated some action, in order to secure the remedying of the various defective conditions. In this district there are a very few houses which have basements, and I think that it can be accepted, that there are no rooms to which Section 17, Sub-section 7, of the Housing and Town Planning Act, 1909, applies. Occasionally cases of premises being overcrowded are discovered, and are at once remedied. The streets in which inspections were made are as follows:—High Path, Abbey Road, Vernon Avenue, Dorien Road and Edna Road. In 14 instances it was found that the houses, which originally were intended to house one family, were occupied by two or more families. These cases are often only discovered by severe cross-questioning by the inspecting officer, or by information received from other sources. I am sorry to have to express the opinion that I do not always get the truth with regard to the number of persons sleeping in a house. The only way in which this could be accomplished would be to strengthen the existing bye-laws, relating to houses let in lodgings, and to establish a register, and adopt a system of evening inspection. During the year the yards of 63 houses have been paved with impervious material, where previously the yards were composed merely of ashes, clinkers, or just ordinary earth. The 23 paving being constructed in such a manner as to permit of the effectual drainage. Four whole houses and one hundred and twelve rooms were discovered to be in a dirty condition, and these have been cleansed. HOUSE REFUSE REMOVAL. Approximately 3,900 tons of house and garden refuse have been collected and disposed of at the tip at the Merton Park Estate Company's Brickfield. The number of inhabited houses has so increased that it was found necessary to purchase another collecting van. The Council pay an annual rent for the shoot at Morden, and the cost has been partly covered by the receipt of a small sum in respect of the privilege of sorting and selling old rags, bottles, tins, etc. I have recently been able to secure an increased sum in respect of this privilege, which will entirely cover the rent which the Council now have to pay. The fixed ashpit has now been practically abolished in this district, the portable galvanised bin having been recognised as a more hygenic arrangement. A weekly collection is made at every house in the district. but it would perhaps be better, for the general community, to institute a bi-weekly or even a daily collection, in the poor-class streets of the district, particularly during the summer months. This procedure is adopted in several Boroughs and Urban Districts, and it cannot be denied that the practice is beneficial in many ways. The ashbin in many cases is placed under or near the 24 dows of the houses, and the smell arising from the decomposing contents of these bins must be injurious. When one considers how many of the younger children are compelled to spend the greater portion of their time in the back yards, often playing in close proximity to the dust bin, it is a matter for congratulation that our child mortality is not greater. Disinfecting powder is carried on the collecting vans, aind every time a bin is emptied a quantity of powder is sprinkled into the empty bin. May I take this opportunity, to again remind the Council that the accommodation at the refuse tip will not last a great while longer. There is no available place elsewhere, and the time has arrived when it is absolutely necessary to consider the question of the provision of some other method of disposal. There are three alternatives, which may be considered: — (1) Loading into railway trucks and consigning to Rural Farms and Brickfields; (2) The purchase of one of the large ponds at the Merton Brickfields, pumping the water out and filling it up with refuse. This would provide accommodation for a number of years. (3) The provision of a Refuse Destructor. The latter is certainly the best method if a site could be obtained at a reasonable figure. One of the chief points for consideration in the purchase of a site, would be its close proximity to a railway, by which mear.s siding could be laid into the works and would help to reduce the working expenses, by providing facilities for cheap cartage of coal, and an equally cheap method of removal of the resulting clinker, for which there is frequently a great demand. The clinker might also be used in the manufacture of concrete 25 paving slabs. Tbere are several towns where plant has been laid down for this purpose and has resulted in a pecuniary benefit to the town. SLAUGHTERHOUSE AND FOOD INSPECTION. Slaughtering has been fairly regularly carried on in the various Slaughterhouses in the district. The number of animals killed has not been so large as in previous .years, owing to the high price of live stock. There are five Slaughterhouses in the district, of which four are registered, and one is licenced annually. They are situated as follows: — Address. Occupier. 27, High Setreet William Harris Registered 61, High Street H. Mitchell Do. 129, High Street G. Smith Do. Morden Hall Farm 0 J. and A. K. White Do. Garth Road, Morden J. W. Stephens Licenced Two hundred inspections were made at irregular intervals, frequently while the killing was going on, and examinations made, sometimes resulting in the discovery of disease. Practically the whole of the food prepared is consigned to the Corporation Meat Market at Smithfield, and every precaution is taken to ensure that the whole carcase, as well as every organ is entirely sound and free from disease. When any organ or part of a carcase is discovered to be affected, it is at once destroyed. In addition to the inspection at Slaughterhouses, attention is given to the food exposed in Butchers', Fishmongers', Fruiterers', and all shops where food is exposed for sale, or being prepared for sale. 26 The inspection of these shops at irregular intervals, particularly on Saturday nights, is of great assistance in the prevention of exposure of unsound food. I seldom have trouble in the discharge of this part of my duties, as generally speaking, the traders give me every assist anoe and often ask my opinion and advice, as to the wholesomeness of any parcel of food, which seems to them in any way doubtful. DAIRIES, COWSHEDS AND MILKSHOPS. There are seven persons registered as Cowkeepers, and 14 as Dairymen or Purveyors of Milk. The premise are inspected at irregular intervals, and very rarely is it found necessary to caution the occupiers with regard to dirty utensils. Occasionally it is necessary to draw attention to the condition of cowsheds, in order to get them limewashed more frequently than the statute demands, but I seldom have to ask twice. There are several small general shops where milk is exposed for sale, and it is very necessary to visit these frequently, and while we are bound to register these persons if they comply with the regulations, every effort is made to discourage the continuance of the sale of milk in these places Sometimes it is found that in the shop, "where the milk is on the serving counter," there is stored such articles as paraffin, soap, candles, potatoes, onions, and all such things as go to make up the stock of a general shop. FOOD AND DRUGS ACT. The work under the various Acts relating to Food Adulteration, is carried out by the Surrey County Council. The following table shews the number of samples analysed and the prosecutions and convictions which followed, during the year ending December 31st, 1913 : — 27 PETROLEUM ACT. There were applications for licences to store petroleum spirit received, seven being for the renewal of the existing licences, and one for the granting of a new licence. The quantities authorised to be stored varied from 40 gallons to 2,000 gallons. In the latter case the building for storage was especially constructed in concrete and galvanized iron, partially underground, and practically fireproof. The whole of the licences were for storage of petrol for use in motor cars. One licence was also issued for the storage of Calcium Carbide, in quantity not exceeding half a ton. From this, Aceteleyne Gas is generated and used, on account of it® great heat, in the fusion of metals at the Aircraft Factory in the High Street. In conclusion, I desire to thank the other Officers of the Council for the valuable assistance which has frequently been accorded me. I am, Gentlemen, Your obedient servant. J. B. POINTON. Articles. Analysed. Prosecutions. Convictions. Milk 22 1 Butter 12 — Margarine 3 3 3 Totals 37 4 3 28 SUMMARY. Total Visits paid 2815 "Whole Houses Cleansed 4 Rooms Cleansed 112 Premises Cleansed after Infectious Disease 45 Drains Repaired 14 ,, Reconstructed 11 O Removed from Drains 10 Inspection Chambers Provided 14 Roofs and Gutters Repaired 39 Cisterns Provided with Covers 42 Water Closets Repaired 29 Yards Paved or Paving Repaired 63 Sinks Repaired 9 Ventilation under Floors Provided 25 Damp Courses Inserted 22 Scullery Floors Repaired 9 Offensive Accumulations Removed 7 Fresh Air Inlets Provided or Repaired 23