Merton & Morden urban District Council HEALTH REPORT FOR 1923. TO THE CHAIRMAN AND MEMBERS OF THE MERTON AND MORDEN URBAN DISTRICT COUNCIL. Gentlemen, I have the honour of submitting my Annual Report of the year 1923, being the sixteenth since Merton became an Urban District and the eleventh since its amalgamation with Morden. The birth-rate for the district was 18.1 per 1,000 of estimated population, as compared with 19.7 per 1,000 for England and Wales. The birth-rate in 1922 was 19.7, and in 1921 17.8 per 1,000 of estimated population. The standardised death-rate was 8.1 per 1,000 of estimated population, as against 11.6 per 1,000 for England and Wales. The death-rate in 1922 was 10.7 and in 1921 was 7.6 per 1,000 of estimated population. The infant mortality rate was 26.3 per 1,000 of registered births as compared with 69 per 1,000 registered births for England and Wales. The corresponding figures in 1922 were 46.5 and 77. This is again the lowest infant mortality rate recorded since the formation of the District, the previous lowest figure being that for 1922. 2 I would direct special attention to the figure of 26.3 per 1,000 registered births, as being most satisfactory and indicating clearly the benefits derived from the Child Welfare work carried on in the District. As was the case in 1922, no great trouble was experienced owing to the presence of flies and gnats in the District. Special attention was again given to preventative measures, including the improvement of the conditions obtaining at the Refuse Shoot. I desire to express my hearty thanks to the Council and their Officers for the help and consideration they have shown me. I should like also to place on record my appreciation of the able assistance rendered by Mr. Pointon and all the members of the Public Health Department Staff. I am, Gentlemen, Your obedient servant, P. N. CAVE, Medical Officer of Health. Urban District Council of Merton and Morden, 1923. Public Health Committee. Chairman - - l)r. J. e. C. Bradley. Mr. W. A. Godin Mr. \V. P. Minchin „ E. H. Jones „ B. Pktuybridce „ E. Knox „ C. R. Cross (Ex. Off.) „ R. Mears • Maternity and Chairman Mrs. Hollands „ Sleet ,, Tukhell Dr. J. E. C. Bradley Mr. W. A. Godin Welfare Committee. Mr. li. Mears. Mr. E. H. Jones „ W. P. Minchin „ R. Petiiybridge ,. C. R. Cross (Ex. Off.) Welfare Centres Visiting Committee. Mrs. Burvill Mrs. Robinson Nurse Churchill ,, Sleet Mrs. Fletcher „ Spicer Nurse Hand ., Thomas Mrs. Hollands „ Turrell ,, Iles „ Vincent „ King „ Webb „ Minchin Miss Wiohtman „ Petiiybridge Milk, Drugs, etc. Sub-Committee. Nurse Churchill Mrs. Minchin Mrs. Fletcher „ Sileet Nurse Hand ,, Turrell Mrs. Hollands „ Webb Representatives on the Wandle Valley Joint Hospital Board. Dr. J. E. C. Bradley. Mr. R. Mears. Mr. C. R. Cross (Ex. Off.) Representatives on the Wandle Valley Joint Sewerage Board. Mr. E. H. Jones Mr. H. C. Rutter Mr. W. P. Minchin (Ex. Off.) Staff. Medical Officer of Health Sanitary Inspector Assitant Sanitary Inspector Health Visitor Assistant Nurse at Ante-Natal Clinic Clerk P. N Cave, M.A., M.D., D.P.H., &e. J. B. Pointon, M.S.I.A. F. C. Thomas, A.R.S.I. Miss J. H. Marshall, C.M.B. Nurse M. J. Hand, C.M.B. A. v. B. Allen. Report. NATURAL & SOCIAL CONDITIONS OP THE DISTRICT. At the 1921 Census the population for the District amounted to 17,520. The District is somewhat flat, having a slight rise towards the Southern or Morden aspect. In the Northern or Merton portion of the District the sub-soil merges into the underlying clay in the East, West, and the whole of the Morden portion. The area is about 3,238 acres, only a portion of which is built upon. The surface is drained by the River Wandle, and the Pyl and Beverley Brooks. The population is composed mainly of the better type of the working classes, and there is no particular occupation which can influence public health. The Rateable value of the District is £125,931; and a penny rate represents £491. The Clerk to the Croydon Union Guardians, Mr. Walker, has supplied me with the following figures relating to Poor Law Relief:— Men. Women. Children. TOTAL. Merton ... 17 44 97 158 Morden ... — 2 1 3 TEMPORARY RELIEF OWING TO UNEMPLOYMENT. Men. Women. Children. TOTAL. Merton ... 36 35 108 179 Morden ... 1 1 2 4 SANITARY CIRCUMSTANCES OP THE DISTRICT. Water is supplied by the Metropolitan Water Board and the Sutton Water Company. Rivers and Streams are under the supervision of your Sanitary Inspector. 6 Drainage and Sewerage.—The Wandle Valley Joint Sewerage Board are still in process of carrying out the extension works previously sanctioned. These works, when completed, will meet the needs of the District both under present conditions and in view of any likely developments. Ci.oset Accommodation.—With few exceptions the whole of the District is provided with Water Closets. Scavenging.—The scavenging of the District is carried out under the direction of your Surveyor. There is a weekly collection of house refuse, which is disp.osed of at the Dust Shoot, Morden. Schools.—There are five Schools in the District, of which three are comparatively new buildings. The routine medical inspection is carried out by the Surrey County Council. Returns are periodically made by (he.School Teachers 01 the District as to the prevalence of infectious diseases; and, as occasions arise, the Schools are visited and the Head Teachers informed of the cases that are to be excluded on account of disease, either of the children themselves or at their homes, and notification is again sent when the children are to return to school. Sanitary Inspection of the District.—The Report of your Sanitary Inspector is appended herewith. FOOD. Milk Supply.—The farms and dairies in the District are frequently inspected. Milk.—Bye-laws are in force under the Dairies, Cowsheds, and Milkshops Order. Attention is paid to the lighting, ventilation, cleanliness, drainage and water supply, so as to ensure as far as possible the proper health of the cows, and the prevention of the milk from contamination. Samples of milk 7 have been taken for the purpose of the detection of pus an'd dirt, but no action has been required. Authority has been delegated to the Public Health Committee by the Council, to take all necessary steps to ensure the proper carrying out of the Regulations in force for the control of the milk supply, in so far as these affect the Local Authority. HOUSING. General Housing Conditions in the District.—The total number of houses in the District at the close of the year under review was 4,592, of which approximately 3,345 are occupied by the working classes. The present population is estimated as being 18,750. There is still a shortage of houses in the District. Fitness of Houses.—Generally speaking, the standard of houses in the District is fair. Unhealthy Areas.—I am not prepared to say, definitely, that there are any unhealthy areas within the District which are so insanitary or unhealthy as to render the houses within such areas unfit for habitation, but there are one or two localities where perhaps the condition of some of the dwellinghouses—owing to extreme age—fall below a reasonable standard. Ward. Area in Acres. Number of Houses. Population. March 1909 January 1924 April 1911 Estimated at Jan. 31, 1924 West Barnes 594 261 472 12938 1765 Bushey Mead 405 1346 1896 7340 Park 522 540 721 2850 Abbey 243 942 1178 5272 Morden 1474 240 325 1202 1525 Total 3238 3329 4592 14140 18752 8 PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. Diphtheria.—Thirty-nine cases were reported with one death, which equals an incidence rate of 2.08 per 1,000 of estimated population, and the death-rate of .05 per 1,000 of population. The monthly incidence was as follows :— 2 in January 2 in February Sin March 3 in April 6 in May 7 in June 3 in July 2 in August 2 in September 3 in October 2 in November 4 in December All the cases were removed to hospital. The figures for the previous years are as follows :— 1914 1915 1916 1917 1918 1919 1920 1921 1922 24 24 19 17 57 26 47 28 62 The number of swabs examined for the Diphtheria Bacillus was 151. Scarlet Fever.—Sixty-five cases were notified, which equals an incidence rate of 3.4 per 1,000 of estimated population. Again, the infection was of a mild type as no deaths were registered. The figures for the previous year are as follows:— 1914 1915 1916 1917 1918 1919 1920 1921 1922 56 59 20 12 15 20 65 120 120 Enteric Fever.—No cases were reported. 9 Measles.—This is no longer a notifiable disease in this District. Chicken Pox.—Owing to the occurrence of a case of Small pox in an adjoining area, this disease was made notifiable under a special Order of the Ministry of Health for a period •of three months, from 22nd October 1923 to 22nd January 1924. Under this Order 47 cases were notified. Tuberculosis.-—The Surrey County Council are responsible for the treatment of cases in this District. All notified cases are, however, visited, and the patients are instructed in the methods of the disinfection of sputum, and opportunity is taken of inspecting the premises. The rooms are disinfected at the termination of a case. The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was 46.1 per cent. The number of specimens of sputum examined for the tubercle bacillus was 29. Number of Primary Notifications received for Pulmonary Tuberculosis 18 n „ „ „ other Tubercular Diseases 3 TOTAL 21 Total number of Patients on books at end of year 105 Number of cases occurring in houses with 6 rooms 2 „ „ „ „ with 5 rooms 14 „ „ „ „ with 4 rooms 5 21 10 MATERNITY AND CHILD WELFARE. Health Visitor.—Visits were paid by the Health Visitor during the year :— To Expectant Mothers (1) First Visits 39 (2) Total Visits 197 To Infants under 1 year (1) First Visits 255 (2) Total Visits 1456 To Children 1—5 ' 267 To cases of Tuberculosis 81 Free and Subsidised Milk Scheme. 1920 1921 1922 1923 Total number of cases assisted during the year 77 68 48 8 36 „ „ Infants benefitting by milk assistanc e 120 248 152 2 121 Total number of cases assisted in Abbey Ward 17 „ ,, „ ,, Park AVard 1 „ „ „ „ Bushey Mead Ward 15 „ „ „ „ Morden Ward . 1 „ „ „ „ West Barnes Ward o Total 36 Total number of eases assisted for whole year 3 „ „ „ „ 11 months — ,, ,, ,, „ 10 „ — ,, ,, ,, „ 9 „ 2 ,, ,, ,, „ 8 „ 3 ,, „ „ „ 7 „ — „ „ ,, „ 6 „ 1 „ „ „ „ 5 „ 1 „ ,, „ ,, 4 „ 1 „ „ „ „ o „ 4 o „ ,, „ ,, A „ 5 „ ,, ,, ,, 1 „ 16 Total 36 Every ease has been investigated as to the means of family relief, and re-investigated monthly. Roughly speaking, families whose weekly average incomes have been less than 6s. per head, after deducting the rental, 11 have been supplied with varying amounts (according to the nature of the ease) of free milk. When the average has been 6s., families have had to pay an amount proportionate to their means, and with few exceptions no families have been supplied with milk at a reduced price where the average income per week exceeded 10s. per head. All applications are still considered by a special Milk SubCommittee which meets once a month to deal with fresh applications and to review all existing cases with a view to recommending their continuation, alteration, or withdrawal. There are two INFANT CONSULTATION CENTRES situated in the two extreme ends of the District, one being held at the Iron Room, St. Saviour's Church, Grand Drive, Raynes Park, and the other at the Mission Hall, Pincott Road, Merton. These meetings are held on alternate weeks. During the year there has been an average attendance of 37 per week. This important branch of Public Health Work is continually increasing, and the results already achieved are most gratifying, not in this District only, but over the whole country. The steady fall in the Infant Mortality Rate is a most satisfactory feature, and almost entirely due to the interest and care that have of late years been focussed on the saving of Infant life. This work, which belongs largely to the realm of preventive medicine is the more valuable in that it tends to enable the infant to develop into a healthy child, and to avoid the appearance of a hopeless cripple and the type of child that is too often a charge to the community for the rest of his or her life. I should like to draw special attention to the Infant Mortality figure for the year under review, which was 26.3. 12 This is quite the lowest on record for the District, and in all probability one of the lowest recorded in England and Wales for the year under consideration. Thej arrangements now in force for supplying those attending the Centres with preparations such as Cod Liver Oil and Malt, and simple medicines, have worked very well. These are supplied at cost price, reduced price or free, according to the circumstances of each individual case, which circumstances are examined and reviewed monthly by a special Sub-Committee. I should like to place on record my high appreciation of the very valuable services of the Voluntary Workers who have helped so loyally and skilfully at the Child Welfare Centres. It is entirely owing to their co-operation and enthusiasm that it has been found possible to get through the amount of work that has been done. The ANTE-NATAL CLINIC continues to do useful work. Considering the size of the population dealt with, a very satisfactory attendance is recorded. This Clinic is held once a month at the Mission Hall, Pincott Road, Merton. The average attendance per session at this Clinic was 4.5. There is still a need for Maternity Beds, and Out-patient and In-patient treatment of children attending the Centres who may be found to be in need of it. Efforts have been made to secure these services, but have not so far succeeded. The Infant Mortality Rate for the year under review was 26.3 per 1,000 net births. There has been a considerable decrease in the number of infant deaths, which is a most gratifying feature. There was one death registered from Epidemic Diarrhcea. 13 INQUESTS. Diseases and Verdict. Total. Shock. Laceration of scalp and laceration of brain am other injuries. Fall in building under construction Accidental. 15 Shock. Syncope. Strangulated left Inguinal Hernia. Intestinal obstruction and inflammation. P.M. Syncope. Septicemia. Accidental injury to finger bj fish bone. Shock Fracture of the skull and laceration of the brain P.M. Accidental. Knocked down by motor van. Syncope. Anesthesia A.E.E. mixture. Operation for the purpose of emptying a gravid abscess. 3i months Foetus. P.M. Misadventure Syncope Hypostatic. Congestion of Lungs. Myocardial degeneration. P.M. Natural. Shock. Laceration of Bowel. Laceration of Pancreas, and other injuries. Coupling of Foden wagon fell upon him whilst at work. P.M. Accidental. Syncope. Acute Pneumonia. Aneurremal Dilation (Aorta). P.M. Natural. Syncope. Fatty degeneration of the Heart. P.M. natural. Coma. Cerebral compression. Fracture of base of skull. Fall on Pebble Hill. P.M. Accidental. Shock. Fracture of skull. Destruction of Brain and other injuries. Knocked down by electric train whilst at work Accidental. Syncope. Want of attention at birth. P.M. Syncope Broncho-pneumonia. Valvular disease of the heart. P.M. Natural. Syncope. Arterio sclerosis. P.M. Natural. Shock. Pulmonary Embolism during the induction of Anaesthesia. P.M. Misadventure. 14 Puerperal Fever,—No cases were notified. Opthalmia Neonatorum.—No cases were notified. Plies.—The fly nuisance, again assumed very minor proportions, but steps similar to those of last year were again taken in an endeavour to mitigate any potential troubles that might arise. As before, two types of leaflets were prepared and issued throughout the district, the one to all householders, and the other to all vendors of food; again a stock of Chloride of Lime was held at the disposal of all persons connected with any business or occupation likely to be associated with the presence of horse manure who were invited to apply for a supply of this, which was furnished on application, together with detailed instructions for its use. SUMMARY OF NURSING ARRANGEMENTS: HOSPITALS, &c. Professional Nursing in the Home—(a.) General. The District is served by three Nursing Associations, which are The South Wimbledon District Nursing Association; The Merton Nursing Fund; and The Morden District Nursing Association. (b) For Infectious Diseases.—The Health Visitor visits such cases as Erysipelas, Tuberculosis and Ophthalmia Neonatorum. With regard to Measles, serious cases with complications are admitted by arrangement, to the Wandle Valley Joint Isolation Hospital, if accommodation is available when these cannot be properly nursed at home. The same holds for cases of Erysipelas. The County Council have arrange'd for the Hospital Treatment of cases of Ophthalmia Neonatorum, on the payment of 14s. 3d. per day by the Council in respect of each case sent 15 from their area. The Council has authorised the sending of any such cases as are in need of Hospital treatment, but no case has had to be sent in 1923, Midwives.—The Control of Midwives is in the hands of the Surrey County Council. The number of Midwives who practised in the District during the year under review was 22. Two Midwives are resident in the District. Ambulance Facilities.—(a) Infectious cases are dealt with by the Ambulances under the control of the Wandle Valley Joint Hospital Board, (b) Non-infectious and accident cases are now dealt with by the Council's own Motor Ambulance. The scale of charges authorised by the Council are as follows:— For each driver or attendant, 3s. for first hour and 2s. for each subsequent hour. Plus Is. per mile travelled as recorded by the Speedometer on the Ambulance (the distance from and to the Council's Ambulance Station to be charged for) for the first 10 miles, and 8d. for every additional mile. For accidents occuring in the street no charge is made. During the year 1923 the Ambulance has been called upon for service on 126 occasions, of which 24 were street accidents. This ambulance service has proved of increasing benefit to the District, and is working well. Isolation Hospital.—The Wandle Valley Joint Hospital, which is situated at Beddington Corner, Mitcham Junction, is the Joint Hospital for the four Urban Districts of Beddington and Wallington, Coulsdon and Purley, Merton and Morden, and Mitcham. The Hospital was opene'd for the reception of patients at the beginning of March, 1899, and since that date, 8,883 patients have been admitted. 16 During the year 1923, 401 patients have been admitted, as against:— 583 in 1922 736 in 1921 651 in 1920 433 in 1919 357 in 1918 213 in 1917 295 in 1916 444 in 1915 Of the 401 patients admitted in the year 1922, 10 died, and 391 were discharged as cured. The case mortality from all causes was 2.4 per cent. Disease. Deaths. Case-Mortality. Scarlet Fever 2 .7 Diphtheria 4 2.9 TABLE OF PATIENTS ADMITTED TO ISOLATION HOSPITAL DURING 1923. Distbict. Scarlet Fever. Diphtheria. Pneumonia. Puerperal Fever. Typhoid Fever Erysipelas Tuberculosis. Measles. Encephalitis Lethargica Influenza. Totals. Cases. Deaths Cases Deaths Cases Deaths Cases j Deaths Cases Deaths Cases Deaths Cases ! Deaths Cases Deaths Cases Deaths Cases joeaths Cases Deaths Beddington and Wallington 22 — 37 - — — 1 1† — 3 — — 1 — 2 — — — 66 1 Ooulsdon and Purley 35 1 23 1 - - - - - - - - - - - - - - - - 59 2 Mitcham 107 — 35 — — — 2 — 1 1 1 - - - - - - - 1 — 147 1 Merton and Morden 54 1 39 3* 1 - - - - - - - - - - - - - - - 95 4 Caterham 11 — 2 - - - - - - - - - - - - - - - - - 13 — Carshalton 1 - - - - - - - - - - - - - - - - - - - 1 — Surrey — — - - - - - - - - - - - - - - - - - - 20 2 Totals 230 2 136 4 1 — 3 1 1 1 6 — 20 2 1 — 2 — 1 — 401 10 * 2 patients died from Nephritis. † Patient died from Tubercular Broncho Pneumonia. APPENDICES. TABLE I. 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 Nonresidents 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 1915 17500 386 402 22.9 167 10.3 49 51 27 67 169 10.4 16196 1916 16000 — 348 21.75 168 10.5 72 48 17 49 134 8.3 1917 17030 — 271 15.75 168 10.5 57 34 24 88.6 145 9 1918 17552 — 241 14 204 13 56 56 23 95.4 204 13 15000 1919 18100 — 257 14.2 219 12.1 52 43 13 50.5 210 11.6 1920 18200 — 359 19.8 180 9.9 40 31 26 72.4 171 9.4 1921 18000 — 322 17.8 190 10.5 52 37 23 71.4 138 7.6 1922 18500 — 365 19.7 182 9.8 47 63 17 46.5 198 10.7 1923 18750 — 341 18 1 144 7.6 46 55 9 26.3 153 8.1 TABLE II.—Cases of Infectious Diseases notified during the year 1923. Notifiable Diseases. At all Ages. Cases Notified in whole District. Total Cases Notified in each Locality. Total cases removed to Hospital. Total Deaths. At all Ages—Years. 1 2 3 ^3 4 5 Under 1 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 Over 65 Abbey Ware Park Ward Bushey Mea Ward. West Barne Ward. Morden Ward. Cerebrospinal Meningitis - - - - - - - - - - - - - - - - - - - - Chicken-pox 28 2 1 1 1 1 19 2 1 — — — 7 1 18 2 - — Cholera - - - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - - - - Diphtheria (including Membranous Croup) 39 - 1 1 3 2 19 5 1 6 1 12 2 21 2 2 39 1 Dysentery — - — — — — — — — — — — — — — — — — — - Encephalitis Lethargica 1 - — — — — — — — 1 — — — — — — — 1 — 2 Enteric Fever - - - - - - - - - - - - - - - - - - - - Erysipelas 7 - - - - - - - - - 1 3 3 2 2 2 — 1 1 Malaria 1 - - - - - - - - - - - - - - - - - - - Ophthalmic Neonatorum - - - - - - - - - - - - - - - - - - - - Plague Pneumonia 2 1 — — — — — — — — — 1 — i — — — 1 1 10 Poliomyelitis - - - - - - - - - - - - - - - - - - - - Puerperal Fever - - - - - - - - - - - - - - - - - - - Relapsing Fever — — — — — — — — — — — — — — — — — — Scarlet Fever 65 — 1 6 6 28 17 3 3 1 — — 37 6 14 3 5 54 — Small-pox - - - - - - - - - - - - - - - - - - - - Tuberculosis :— (a) Pulmonary M 11 2 3 4 2 2 2 5 2 F: 8 — — — — — — 2 3 0 1 4 2 1 i — 10 (b) Non-Pulmonary M. 3 1 1 1 3 IF. -- - - - - - - - - - - - - - - - - - - 3 Typhus Fever — - — — — — — — — — —■ — — — — — — — — TOTALS 165 3 2 3 10 9 67 26 7 17 10 7 4 65 15 64 10 ii 95 26 TABLE III.—Causes of, and ages at, Death during the year 1923. CAUSES OF DEATH. Nett Deaths at the sub-joined ages of " Residents " whether occurring within or without the District. Total Deaths t whether of ' Residents ' or ' NonResidents ' in Institutions in the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. All Causes Certified. 1 2 3 4 5 6 7 8 9 10 11 1. Enteric Fever — — — — — — — — — 2. Small Pox - - - - - - - - - — 3. Measles — — - — — — — — — — 4. Scarlet Fever - - - - - - - - - - 5. Whooping Cough 1 1 — 6. Diphtheria 1 — - — 1 — — — — — 7. Influenza 1 — - — 1 — — — — — 8. Encephalitis Lethargica 3 — - — 1 1 — 1 — 3 9. Meningococcal Meningitis — — - — — — — — — — 10. Tuberculosis of the Respiratory System 10 — - — 1 3 5 1 — — 11. Other Tuberculous Diseases 3 — - 2 — 1 — — — — 12. Cancer, Malignant Disease 16 — - — — — 1 10 5 5 13. Rheumatic Fever 1 — - — 1 — — — — — 14. Diabetes ] - 1 — — 15. Cerebral Haemorrhage 1 - 1 — 1 16. Heart Disease 17 — - — 1 — 3 9 4 4 17. Arterio Sclerosis 8 - 1 7 6 18. Bronchitis 6 - 6 — 19. Pneumonia (all forms) 10 2 - — — 1 — 3 4 1 20. Other Respiratory Diseases 3 — - — — — 1 1 1 — 21. Ulcer of Stomach, or Duodenum - 3 22. Diarrhoea, &c. (under 2 years) 1 1 - — — — — — — — 23. Appendicitis and Typhilitis 4 — - 1 1 — — — 2 5 24. Cirrhosis of Liver 1 - 1 — 25. Acute and Chronic Nephritis 3 — - — — 1 — 1 1 — 26. Puerperal Sepsis - 27. Other Accidents and Diseases of - Pregnancy and Parturition — — - — — — — — — — 28. Congenital Debility and Malformations 3 2 1 — — — — — — — 29. Suicide 30. Other Deaths from Violence 3 — — 1 — — 2 — 4 31. Other Defined Diseases 55 3 1 — — 3 7 13 28 22 32. Causes ill-defined or unknown — — - — — — — — — — Special Causes (included above):— - Poliomyelitis - Polio Encephalitis — — - — — — — — — Totals 152 9 2 3 8 10 17 44 59 54 TABLE IV.—Infant Mortality during the year ending 1923. Nett Deaths from stated causes at various Ages under One Year of Age. CAUSES OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 week and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under One Year. Smal!-pox - - - - - - - Chicken-pox — - - — - - - - - — Measles — - - — - - - - - — Scarlet Fever — - - — - - - - - — Whooping-cough — - - — - - - - 1 1 Diphtheria and Croup — - - — - - - - - — Erysipelas — - - — - - - - - — Tuberculous Meningitis — - - — - - - - - — Abdominal Tuberculosi — - - — - - - - - — Other Tuberculous Diseases — - - — - - - - - — Meningitis (not Tuberculous) — - - — - - - - - — Convulsions — - - — - - - - - — Laryngitis — - - — - - - - - — Bronchitis — - - — - - - - - — Pneumonia (all forms) — - - — - - 1 1 - 2 Diarrhoea — - - —- - - - 1 - 1 Enteritis — - - — - 1 - - - 1 Gastritis — - -- — - - - - - — Syphilis — - - — - - - - - — Rickets — - - — - - - - - — Suffocation, overlying — - - — - - - - - — Injury at Birth — - - — - - - - - — Atelectasis 1 - - — 1 - - - - 1 Congenital Malformations — - - — - - - - - — Premature Birth — - - — - - - - - — Atrophy, Debility and Marasmus 1 - - — 1 - - - - 1 Other causes 1 - — 2 - - - - 2 TOTALS 3 1 - 4 1 1 2 1 9 Nett Births in the year :—Males, 177 ; Females, 164 ; Legitimate, 334 ; Illegitimate, 7, Nett Deaths in the year of Legitimate Infants, 9. 22 Report of the Sanitary Inspector. Mr. Chairman and Gentlemen, I have the honour to submit my Report upon the work carried out in the Public Health Department during the year 1923, under the various Public Health Acts affecting the Department. Complaints received and investigated numbered 97. 348 Preliminary Notices were served and, after report to the Council, authority was granted for the service of 76 Statutory Notices, of which it was found necessary to serve only 29. In a large number of cases, defects have been remedied without the service of notices and in no case was it found necessary to institute legal proceedings. HOUSING AND TOWN PLANNING ACTS. During the year, 89 houses in Prince George's Avenue and Meadow Road was inspected in accordance with the Housing Regulations, 1910, and although in no case was any house found to be in such a condition as to render it uninhabitable, in approximately 75 per cent., defects were found which called for the attention of the owners of the premises. Notices to remedy the ^defects were served under the Public Health Acts. No closing order was made in respect of any premises during the year. POOD PREPARATION. Special attention has been directed to premises where food is produced or prepared. Cowsheds, of which there a,re 6 on the Council's Register, have been frequently inspected, and 23 regularly limewaslied. Three of these premises produce a considerable quantity of milk which is retailed in this and surrounding districts. Samples of milk were taken from each cowshed, and in each case proved to be free from Tubercle and pus, and with small quantities of dirt. In fact, samples were above the average. There are 16 premises at which milk is exposed for sale, and these have been frequently visited and inspected. There are 6 slaughter-houses upon the register, which have been regularly visited. Two at Morden are " licensed," and four at Merton are " registered." The premises have been limewashed at intervals much in excess of the Statutory requirements. Very few bullocks are slaughtered in the District, but a fair number of sheep, pigs and calves are prepared for food either for local consumption or for sale at Smithfield Market. As a rule an Inspector is present at the time when slaughtering takes place. Butchers and Fishmongers are also given special attention, particularly during the summer months, and I invariably find the occupiers of these places are ready to adopt any suggestion I have to make to secure any improvement either in the manner of exposure or in the preparation of the article. The total number of visits to butchers' shops, slaughterhouses and fishmongers during the year was 342. There are 8 bake-houses in the District, of which 6 are situated in Merton and 2 at Morden; all of which have been limewashed or cleansed as required by the Statute at regular intervals. The total number of visits paid to bake-houses was 85. FACTORIES AND WORKSHOPS. All premises registered under the Factories and Workshops Act, have been visited and inspected, attention being directed to the following points:—Provision of ventilation, sanitary accommodation, and air space. There are 14 factories 24 and 14 workshops and workplaces, to which 104 visits of inspection were made. INCREASE OP RENT, &c., ACT. No applications were received for Certificates certifying " that the premises were not in all respects reasonably fit for human habitation." RAG FLOCK ACT. There are no Flock manufacturers in the District. There are, however, several Upholsterers who use Flock for the purpose of making and repairing Chairs, &c., and these are from time to time inspected. PETROLEUM ACTS. There are 12 premises in respect of which licences to store Petroleum were issued. FOOD AND DRUG ACTS. These Acts are administered by the Surrey County Council, as well ias by the Local Authority. 60 samples were taken for analysis. HOUSING. Total number of houses erected during the year (a) Total 102 (b) Part of Housing Scheme ... ... ... — 1. UNFIT DWELLING-HOUSES. Inspection. (1) Total number of dwelling-houses inspected for Housing defects (under Public Health or Housing Acts) 364 25 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 89 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation None (4) Number of dwelling-houses (exclusive of those referred to under the preceding subheading) found not to be in all respects reasonably fit for human habitation 342 2. REMEDY OF DEFECTS WITHOUT SERVICE OF FORMAL NOTICE. Number of defective dwelling-houses rendered fit in consequence of informal action by the Council or their Officer 313 ACTION UNDER STATUTORY POWERS. (a) Proceedings under Section 28 of tlic Housing, Town Planning, &c., Act, 1919:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs (2) Number of dwelling-houses which were rendered fit:— (a) By owners Nil. (b) By Council in default of owners (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close 26 (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 29 (2) Number of dwelling-houses in which defects were remedied:— (a) By owners 29 (b) By Council in default of owners Nil (c) Proceedings under Sections 17 and 19 of the Housing, Town Planning, &c., 1909: (1) Number of representations made with a view to the making of Closing Orders (2) Number of dwelling-houses in respect of which Closing Orders were made (3) Number of dwelling-houses in respect of which Closing Orders were determined, the Nil. dwelling-houses have been rendered fit (4) Number of dwelling-houses in respect of which Demolition Orders were made (5) Number of dwelling-houses demolished in pursuance of Demolition Orders The Table at the end of the Report shews the improvements effected and the nuisances abated. In conclusion I have to record my appreciation of the valuable assistance rendered by Mr. F. C. Thomas, Assistant Inspector, and by Mr. V. Allen, the Clerk to the department. I am, Gentlemen, Your obedient Servant, J. B. POINTON, Sanitary Inspector. 27 SUMMARY. Visits paid (total) 3767 Dampness in premises remedied 17 Doors repaired 2 Drains exposed and repaired 32 Drains reconstructed 3 Drinking water cisterns cleaned out and repaired 42 Drinking water cistern covers provided 33 Dustbins provided 81 Floors repaired 20 Fresh Air Inlet Valves provided and repaired 43 Gulleys renewed 2 Inspection chamber covers provided 15 Intercepting trap stoppers provided 1 Obstructions removed from drains 14 Offensive accumulations removed 2 Overcrowding remedied at premises 2 Rain water pipes renewed 2 Rooms cleansed 344 Roofs and Gutters repaired or renewed 46 Sink gully fenders provided 4 Sink wastes repaired 9 Staircase repaired 1 Ventilation provided under floors 1 Walls repaired 30 W.C. cisterns, new waste preventors provided 8 W.C. cisterns renewed and repaired 8 Water Closets cleansed 24 W.C. flushes renewed and repaired 31 W.C. pans provided 7 Windows repaired 1 Yards paved and repaved 63