Merton & Morden Urban District Council REPORT OF MEDICAL OFFICER OF HEALTH ON THE Sanitary Conditions and Vital Statistics AND Report of Sanitary Inspector For the Year 1925 Merton s Morden Arban District Gouncil HEALTH REPORT FOR 1925. TO THE CHAIRMAN AND MEMBERS OF THE MERTON ANT) MORDEN URBAN DISTRICT COUNCIL. Mr. Chairman, Ladies and Gentlemen, I have the honour of submitting my Annual Report of the year 1925, being the eighteenth since Merton became an Urban District, and the thirteenth since its amalgamation with Morden. The birth-rate for the district was 16.1 per 1.000 of estimated population, as compared with 18.3 per 1,000 for England and Wales. The birth-rate in 1924 was 16.6 and in 1923 18.1 per 1,000 of estimated population. The standardised death-rate was 9.8 per 1,000 of estimated population, as against 12.2 per 1,000 for England anb Wales. The death-rate in 1924 was 9.08 and in 1923 was 8.1 per 1.000 of estimated population. Deaths.—The principal causes oC deaths during the last five years have been as follows:— 1921 1922 1923 1924 1925 Cancer 18 26 16 21 27 Heart Disease 10 29 17 16 21 Arterio Sclerosis 8 11 8 18 6 Bronchitis 7 24 6 14 C Pneumonia 8 13 10 11 16 Cancer maintaining its position as the chief cause of death in the district. 2 The infant mortality rate was 68.4 per 1,000 of registered births, as compared with 75 per 1,000 registered births for England and Wales. The corresponding figures in 1924 were 51.4 and 75. I have to thank all my staff for loyal and able support ; through their efforts all the work has gone on smoothly and satisfactorily. T am, Gentlemen, Your obedient servant, RASHELL DAVISON. Medical Officer of Health. Urban District Council of Merton and Morden, 1925 Public Health Committee. Chairman - - Dr. J. E. C. Bradley. Mr. W. A. Godin Miss M. Anderson „ E. H. Jones Mr. W. P. Minchin „ 10. Knox Mrs. M. E. Sleet „ R. Mears Mr. R. Petiiybridoe (ex-Offi.) Maternity and Child Welfare Committee. Chairman - - Mr. R. Mears. Miss Anderson Mr. E. H. Jones Mrs. Sleet „ W. P. Minciiin Dr. .T. E. C. Bradley „ R. Pethybridoe (ox-Offi.) Mrs. Minchin „ Hollands Co-opted Members. „ Turreijl Welfare Centres Visiting Committee. and Milk, Drugs, etc., Sub-Committee. Nurse Churchill Mrs. Pethybridoe Mrs. Fletcher „ Robinson Nurse Hand „ Sleet Mrs. Hollands „ Thomas „ Iles „ Tcrrell „ Minchin Representatives on the Wandle Valley Joint Hospital Board. Dr. J. E. C. Bradley Mr. R. Pethybridoe (ex-Offi.) Mr. R. Mears Representatives on the Wandle Valley Joint Sewerage Board. Mr. E. H. Jones Mr. R. Pethybridoe (ex-Offi.) „ H. C. Rutter Staff. Medical Officer of Health ... Senior Sanitary Inspector Sanitary Inspector Health Visitor Assistant Nurse at Ante-Natal Clinie Clerk Rasheli, Davison, M.D., M.R.C.S. T. B. Pointon, M.S.I.A. F. C. Thomas, A.R.S.I. Miss M. Musk, M.C.N. Nurse M. ,T. Hand, C.M.B. H. T. Hopper (resigned October). T. Smith (appointed November). Report NATURAL & SOCIAL CONDITIONS OF THE DISTRICT. At the 1921 Census the population for the District amounted to 17,520. The Registrar General's estimate of population at the 30th June, 1925,. is 18,960. 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 whicli 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 the public health. The rateable value of the District is £140 954; and a penny rate represents £496. 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 18 36 76 130 Morden 0 3 4 7 TEMPORARY RELIEF OWING TO UNEMPLOYMENT. Men. Women. Children. TOTAL. Merton 13 13 42 68 Morden 0 0 0 0 SANITARY CIRCUMSTANCES OF THE DISTRICT. Water is supplied by the Metropolitan Water Board and the Sutton Water Company. 6 Rivers and Streams are under the supervision of your Sanitary Inspector. Drainage and Sewerage.—The Wandle Valley Joint Sewerage Board completed, during the year under review, the extension works previously sanctioned, at an estimated cost of £210,000. Closet 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 disposed of at the Dust Shoot, Morden. Schools.— There arc five Schools in the District, of which three arc comparatively new buildings. The routine medical inspection is carried out by the Surrey County Council. Returns are periodically made by the School Teachers of the District as to the prevalence of infectious diseases; and, as occasion arises, the Schools are visited and the Head Teachers informed of the eases 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 Suppply.—The farms and dairies in the District are frequently inspected. Milk.—Bye-laws arc 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 7 the prevention of the milk from contamination. Samples of milk have been taken for the purposes of the detection of pus and dirt, but no action has been required. The approximate number of cows in the sheds at the end of the year was 120. 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 5,068, of which approximately 3,375 are occupied by the working classes. The present population is estimated as being 20,500. 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.—No particular area has been scheduled as unhealthy under the Housing Acts, but, as in previous years, house-to-house inspections have been carried out under the Housing (Inspection of District) Regulations, and in many instances considerable improvements have been effected. Ward. Area in Acres. Number of Houses. Population. March 1909 January 1926 April 1911 Kstimatcd at Jan. 31, 1926 West Barnes 594 261 658 12538 2180 Bushey Mead 405 1346 1952 7550 Park 52'2 540 9(0 3490 Abbey 243 942 1196 5330 Morden 1474 240 362 1202 1650 Total 323S 3329 5068 14140 20500 8 PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. Diphtheria.—Twenty-five eases were notified, a decrease of 43 from last year; 9 were recorded between 5 and 10 years of age. One death was recorded under the age of one year, giving ai death rate of 0.05 per 1,000 of population, and an incidence rate of 1.3 per thousand of population. The Public Health Department sent a circular letter to every practitioner in the District, drawing his attention to the fact that the acme of treatment in this disease was the immediate administration of antitoxin in all doubtful cases. Free antitoxin and a sterilized syringe are always available at the Nelson Hospital, and at the Council Offices during office hours. The monthly incidence was as follows:— 2 in January. l in February. 0 in March. 0 in April. 6 in May. 1 in June. 1 in July. 0 in August. 1 in September. 3 in October. 7 in November. 3 in December. 92 per cent. of the cases were removed to hospital. The figures for the previous years arc as follows— 1914 1915 1910 1917 1918 1919 1920 1921 1922 1923 1924 24 24 19 17 57 26 47 28 62 39 08 The number of swabs examined for the Diphtheria Bacillus was 99. Scarlet Fever.—Seventy-four cases were notified, which equals an incidence rate of 3.9 per 1,000 of estimated 9 population. Again, the infection was of a mild type, as only one death was registered. The figures for the previous years are as follows:— 1914 1015 1916 1917 1918 1919 1920 1921 1922 1923 1924 56 59 20' 12 15 20 65 120 120 65 75 Enteric Fever.—No eases were reported. Measles.—This is no longer a notifiable disease in this district. 'Cue ease was admitted into the Isolation Hospital. Erysipelas.—Six eases were notified and two removed to hospital. Cerebro Spinal Meningitis.-—One ease was notified, and was removed to hospital and died. Encephalitis Lethargica.—Two eases were notified during the year. Tuberculosis.—The Surrey County Council arc 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 11.2 per cent, The number of specimens of sputums examined for the tubercle bacillus was 37. Number of primary Notifications received for Pulmonary Tuberculosis 19 „ „ „ „ other Tubercular Diseases 8 TOTAL ... 27 Total number of patients on books at end of year 105 Number of cases occurring in houses with 6 rooms 15 „ „ „ „ „ 5„ 74 „ „ „ „ „ 4„ 14 „ „ „ „ „ 3„ 8 10 MATERNITY AND CHILD WELFARE. Health Visitor.—Visits were paid by the Health Visitor during the year :— To Expectant Mothers 1) First Visits 105; (2) Total Visits 250 To Infants under 1 year (1) First Visits 239; (2) Total Visits 2077 To Children 1—5 3010 To cases of Tuberculosis 193 Free and Subsidised Milk Scheme. 1920 1921 1922 1923 1924 1925 Total number of cases assisted during year 77 68 48 36 51 40 „ „ „ Infants benefiting by milk assistance 120 248 152 121 102 65 Total number of cases assisted in Abbey Ward 14 „ „ „ „ Park Ward 2 „ „ „ „ Bushey Mead Ward 18 „ „ „ „ Morden Ward 5 „ „ „ „ West Barnes Ward 1 Number of cases assisted for the whole year 2 „ „ „ 11 months 2 „ „ „ 10 „ 1 „ „ „ 9 „ 3 „ „ „ 8 ,, - „ „ „ 7„ 3 „ „ „ 6 „ 5 „ „ „ 5 „ .... ... ... ... 3 „ „ „ 4 „ ... ... ... ... 4 „ „ „ 3 „ 6 „ „ „ 2 4 „ „ „ 1„ 1 TOTAL ... 40 Every case 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 5s. per head, after deducting the rental, 11 have been supplied with varying amounts (according to the nature of the case) of free milk. When the average has been as., 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 exceeded 8s. per head. All applications are still considered by a Special Milk Sub-Committee, 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 twoI 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 49.7 per week. I am pleased to report that the increased attendance at both clinics has been maintained. The experiments on animals by MeCarrison in India, the Mellanbys and Rowland in this country have proved that pregnant mothers fed on food containing a sufficient quantity of Vitamins produce an offspring, healthy and fortified against disease. This method has, as far as our finances permitted, been carried out on the mothers attending our clinics, with the result that our efficiency has also been maintained. Of the twenty-one deaths registered under one year of age, ten were from Prematurity and weakness at birth, eleven from what should be now preventable disease; only one attended regularly our Welfare Centre. A twin contracted 12 first Whooping Cough, then Measles and Pneumonia, a sequence of diseases incompatible in the life of any child. The 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 Subcommittee. 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 Antic-Natal Clinic continues to do useful work. Considering the size of the population dealt with, a very satisfactory attendance is recorded. The Clinic is held once a month at the Mission Hall, Pincott Road, Merton. The average attendance per session at this Clinic was 10. Puerperal Fever.-—No cases were notified. Ophthalmia Neonatorum.—No cases were notified. 13 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 INQUESTS. Diseases and Verdict. Total. Conm. Cerebral Haemorrhage. PM. Natural. Coma. Gangrene of E. Heel, Cellulitis R. Leg, Fracture R. Femur. Fell in dining room. Accidental. 19 Coma. Septic Meningitis, incised wound in head, stone throwing by boys. P.M. Natural. Syncope. Haemorrhage. Pancreatitis. Splenic Anaemia. P.M. Natural Syncope. Valvular Disease of Heart. I'.M. Natural. Syncope. Shock. Fell from bedroom window. P.M. Suicide whilst of unsound mind. Syncope. Shock. Haemorrhage. Rupture of Varicose vein in leg. P.M. Natural. Syncope. Emphysema. Asthma. Result of War Service. P.M. Natural. Syncope. Pericarditis. Lobar Pneumonia. P.M. Natural. Coma. Cerebral Haemorrhage. P.M. Natural. Syncope. Electric Shock whilst engaged on excavation work. P.M. Natural. Shock. Haemorrhage. Fracture R. Leg and other injuries. Knocked down by motor van. P.M. Accidental. Shock. Toxaemia. Scalds on trunk Limbs. Fell into pail of hot water. Accidental. Syncope. Amyotrophic lateral sclerosis. P.M. Natural. Svncope. Hvpertrophy of left heart. Cirrhosis of Liver. P.M. Natural. Pericarditis. Pericardial effusion. P.M. Natural. Syncope. Compound Fracture. Septicaemia caused by accidentally falling from ladder. Syncope. Inanition. Premature Birth. P.M. Natural. Coma. Haemorrhage. Fracture of skull. Knocked down by motor car. Accidental. 14 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 arranged 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 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 1925. 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 17. Nine Midwives are resident in the District. Isolation Hospital.—The Wandle Valley Joint Isolation 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 opened for the reception of patients at the beginning of March, 1899, and since that date 9.967 patients have been admitted. During the year 1925, 558 patients have been admitted, as against:— 526 in 1924 401 in 1923 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 558 patients admitted in the year 1925, 48 died, and 510 were discharged as cured. APPENDICES. TABLE I. YEAR. Population estimated to middle of each Year. Bfrths. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths BeivOnging to the District. Uncorrected Number. Nett. of Nonresidents registered in the District. of Resi ients not registered in the District. Uneder 1 year of Age. At all Ages. Number. Rate. Number. Hate. Number. Hi.to per 100J 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 318 21.75 168 10.5 72 48 17 49 134 8.3 1917 17000 — 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 — 311 18.1 144 7.6 46 55 9 26.3 153 8.1 1924 19200 — 311 16.6 178 95 71 63 16 51.4 170 9.08 1925 20500 — 307 16.1 160 8.4 39 66 21 68.4 187 9.8 TABLE II.—Cases of Infectious Diseases notified during the year 1925. Notifiable Diseases. Cases Notified in whole District. Total Cases Notified in each f ocality. Total cases removed to Hospital. Total Deaths. At all Ages. At all Ages—Years. 1 2 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 g5 Ovei g5 Abbey Ward Park Ward- Bushey Mead Ward. West Barnes Ward. Morden Ward. Cerebrospinal Meningitis 1 1 _ _ _ i _ 1 1 Chicken-pox - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - - - - Diphtheria (including Membranous Croup) 25 1 1 1 2 1 10 8 1 7 3 10 4 1 23 Dysentery — - — — — — — — — — — — — — - — — — — ,— Encephalitis Lethargica 2 - - - - - - - 1 - 1 - - - - 2 - - - - Enteric Fever - - - - - - - - - - - - - - - - - - - - Erysipelas 6 — — — — — 1 1 1 — 3 — 1 1 3 — 1 2 — Malaria - - - - - - - - - - - - - - - - - - - - Ophthalmic Neonatorum — - — — — — - - - - - - - - - - - - - — Plague - - - - - - - - - - - - - - - - - - - - Fneumonia - - - - - - - - - - - - - - - - - - - - Poliomyelitis - - - - - - - - - - - - - - - - - - - - Puerperal Fever - - - - - - - - - - - - - - - - - — — — Relapsing Fever — - — — — — — — — — — — — — - —- — — — — Scarlet Fever 74 - 3 1 2 12 32 13 o 8 — 4 10 43 11 6 70 1 Small-pox - - - - - - - - - - - - - - - - - - - — Tuberculosis :— (a) Pulmonary m.: 16 - — - - - - - - 7 2 7 — 1 7 5 1 2 — 1 F. 9 - — — — — — — 3 4 — 2 — — 3 6 — — — 1 (b) Non-Pulmonary m. 3 - — — — 2 1 — — — — — — 1 — 2 — — — F. 7 - — — — 1 1 — 2 — 1 1 1 1 — 5 1 — — 1 Typhus Fever - - - - - - - - - - - - - - - - - - - - TOTALS 143 1 4 2 4 16 44 22 11 21 4 13 1 15 24 77 17 10 96 2 TABLE III. -Causes of, and ages at, Death during the year 1925. CAUSES OF DEATH. Nett Deaths at the sub-joined ages of " Residents " whether occurring within or without the District. Potal Deaths whether of Residents ' or ' NonResidents in Institutions in the District. All Causes Certified. 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. 1 2 3 4 5 6 7 8 9 10 11 1. Enteric Fever — — — — — - - — — — '2. Small Pox — — — — — — — — — — 3. Measles - - - - - - - - - - 4. Scarlet Fever 1 — — - — — 1 — — 1 5. Whooping Cough 4 1 2 — 1 — — — — 2 6. Diphtheria 1 1 - — — — — — — — 7. Influenza 8 - - - - - - 5 3 — 8. Encephalitis Lethargica 1 - - — — 1 — — ] 9. Meningococcal Meningitis 1 - - — — 1 — — — — 10. Tuberculosis of the Respiratory System 15 - - — — 7 3 5 — 5 11. Other Tuberculous Diseases 3 - - — — 1 1 1 — 4 12. Cancer, Malignant Disease 27 - - - - - 3 14 10 14 13. Rheumatic Fever 1 - - — 1 — — — — — 14. Diabetes 2 - - - - - - 1 1 3 15. Cerebral Hemorrhage 11 - - - - - 1 3 7 6 16. Heart Disease 21 - - — 1 1 1 6 12 10 17, Arterio Sclerosis 6 - - - - - - - 6 4 18. Bronchitis 6 3 - - - - - 1 2 1 19. Pneumonia (all forms) 16 3 - — 1 1 2 3 6 8 20. Other Respiratory Diseases 1 - - - - - - 1 — 1 21. Ulcer of Stomach, or Duodenum - - - - - - - - - — 22. Diarrhoea, &c. (under 2 years) 1 1 - - - - - - - 1 23. Appendicitis and Typhilitis 1 — - — — — — 1 — 3 24. Cirrhosis of Liver 1 — - — — — — 1 — — 25. Acute and Chronic Nephritis 9 — - — — — 2 4 3 8 26. Puerperal Sepsis- - - - - - - - - - - 27. Other Accidents and Diseases of Pregnancy and Parturition 2 - - - - - 1 1 1 28. Congenital Debility and Malformations 12 12 - - - - - - - 2 29. Suicide 1 - - — — — — — 1 — 30. Other Deaths from Violence 4 — - — — — 1 — 3 7 31. Other Defined Diseases 31 — - 1 1 1 6 10 12 30 32. Causes ill-defined or unknown - - - - - - - - - - Special Causes (included above):— Poliomyelitis - - - - - - - - - - Polio Encephaliti - - - - - - - - - - Totals 187 21 2 1 5 12 23 57 66 112 TABLE IV.—Infant Mortality during the year ended 1925. 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 weeks and under 3 months. 3 months and under G months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under One Year. Small-po - - - - - - _ - - Chiclcen-pox — - - - — — - — - — Measles - — - — — - — - — Scarlet Fever — - — - — — - — - — Whooping-cough - - - - — — - 1 - 1 Diphtheria and Croup — - - — — - — - 1 Erysipelas — - — - — — - — - — Tuberculous Meningitis — - - - — — - 1 - 1 Abdominal Tuberculosis — - - — — - — - — Other Tuberculous Diseases — - — - _ — - — - — Meningitis (not Tuberculous) — - — - - — - — - — Convulsions - 1 - - 1 — - — - 1 Laryngitis — - - - — - - — - — Bronchitis - - - 1 1 2 - — - 3 Pneumonia (all forms) — - — - — - 2 1 - 3 Diarrhoea — - — - — — 1 — - 1 Enteritis - - - - — - - — - — Gastritis - - — - — — — — - — Syphilis — - - - — — - — - — Rickets - - - - — — - — - — Suffocation, overlying - - - - — — — — - — Injury at Birth 0 - - — — — — - — Atelectasis 1 - — - 1 — — - 1 Congenital Malformations 1 - - - 1 — — — - 1 Premature Birth 5 - - - 5 1 — — - 6 Atrophy, Debility and Marasmus 1 1 — - 2 — — — - 2 Othec causes — - — - — — — — - — Totals 8 2 — 1 11 3 3 3 1 21 Nett Births in the year:—Males, 150; Females, 157 ; Legitimate, 299; Illegitimate, 8, Nett Deaths in the year of Legitimate Infants, 21. v.—TABLE OP PATIENTS ADMITTED TO ISOLATION HOSPITAL DURING 1925. District. Scarlet Fever. Diphtheria. Pneumonia. Puerperal Fever. Typhoid Fever Erysipelas Tuberculosis. Meas'es. Encephalitis Lethargica. Cerebrospinal gningitis. Totals. * Case Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Casos Deaths Cases Deaths Cases deaths Cases Deaths Cases Death: Cases Deaths Beddington and Wallington 30 — 10 - - - — — _ 4 - — - — - 44 — Coulsdon and Turley 23 — 13 1 — - - — 5 — 2 — — — 2 — — — - 45 1 Mitcham 95 1 198 7 3 2 1 5 1 1 — — — - - 1 1 — — 305 12 Merton and Morden 70 1 23 — — — — — — — 2 — — - 1 — - - 1 1 97 2 Caterham 18 1 7 2 — - — — — ; — — — - - — - - 1 - 26 3 Surrey -- — - — — — — - - — — — 28 20 — — - — — — 28 20 Other Districts 1 — 3 — — — — - 1 — 1 — — - 2 — - 1 — - 8 — Totals 237 3 254 10 3 1 2 1 11 1 10 - 28 20 5 - 1 1 2 1 553 38 †Patient died from acute nephritis. 20 TABLE VI.—(l) Factories, Workshops, and Workplaces. Including Inspection made by Sanitary Inspectors or Inspectors of Nuisancer. Number of Premises. Inspections. Written Notices. Prr seditions. 1 2 3 4 Factories (Including Factory Laundries) 43 5 — Workshops (Including Workshop Laundries) 74 2 — Workplaces (Other than Outworkers, Premises) 20 — - Total 137 7 — (2) Defects found in Factories, Workshops, and Workplaces. Particulars. 1 -No of Defects. Number of Prosecutions. 5 Found. 2 Remedied 3 Referred to H.1NI. Inspector 4 Nuisances under the Public Health Acts : Want of cleanliness 11 11 — - Want of ventilation - - - — Overcrowding 1 1 - Want of drainage of floors - — _ - Other nuisances Sanitary accommodation Insufficient 1 1 - Unsuitable or defective 2 2 - Not separate for sexes 1 1 — — Offences under the Factory and Workshops Acts : - - - - Illegal occupation of underground bakehouses (s. 101) — — — - Other Offences — — — — Total 16 16 — — 21 Report of the Sanitary Inspector Mu. Chairman, Ladies and Gentlemen, I have the honour to report upon the routine work ol tlie Department during the year 1925. Complaints received and investigated numbered 145. The number of Preliminary Notices served was 268 and, after report to the Council, authority was granted for the service of 84 Statutory Notices, of which it was found necessary to serve only 25. In a large number of cases defects have been remedied without the service of notices. Legal proceedings were instituted against the owner of No. 15, Richmond Avenue, and an Order of the Court was obtained for the abatement of the nuisance. HOUSING AND TOWN PLANNING ACTS. During the year, 42 houses in Kingston Road and West Barnes Lane were 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 67 per cent. of the houses 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. FOOD PREPARATION. During the year a considerable number of visits of inspection were made to premises where articles of food were prepared or offered for sale. These premises include 22 sheds, slaughter-houses, butchers' and fishmongers' shops, dairies and milk shops and bakehouses. There are four cowsheds where milk is produced and sixteen dairies and milk shops from which it is retailed. Samples of milk have been taken at various times for bacteriological examination and the report of the Bacteriologist shows that the milk produced and sold in the district is of a very good quality. There are five slaughter-houses situate within the District, four of which are in frequent use, two at Garth Road, Morden, and two at High Street, Merton, the former being licensed and the latter registered. The regulations requiring notice of intention to slaughter have been regularly observed and every carcase has been inspected before being offered for sale. Fishmongers' shops have also been visited and the fish exposed for sale examined. The total number of inspections paid to butchers' and fishmongers' premises was 489. Bakehouses.—There are 8 bakehouses in the District which have been regularly cleansed, as required by statute. The total number of visits paid to these premises was 93. FOOD AND DRUG ACTS. The Surrey County Council administers these Acts. The total number of samples taken for analysis was 59. Two were found t.o be adulterated. Prosecution followed in one case, where 23 per cent, of cream had been abstracted and resulted in a conviction. FACTORIES AND WORKSHOPS. All premises registered under the Factory and Workshops Act have been visited, attention being directed to the provision of ventilation, sanitary accommodation and air space. There 23 are 14 factories and 14 workshops to which 137 visits of inspection were made. MOSQUITO DESTRUCTION. Paraffin spraying was carried out in an effort to prevent the excessive breeding of mosquitoes. Again, it would appear from reports received from persons residing in the vicinity of the breeding grounds that the efforts of the District Council in this direction are very successful. Unfortunately, the heavy expenditure incurred rather curtails the area over which paraffin spraying is carried .out, but it is interesting to note that in the year 1924 the spraying was so beneficial that, in two cases, owners helped to defray the cost of spraying their land in 1925. PETROLEUM ACTS. There are 20 premises licensed for the storage of petroleum in varying quantities from 24 to 2,000 gallons. INCREASE OF RENT &c. ACT. One application was received for a certificate certifying " that the premises were not in all respects reasonably fit for human habitation," and the house was inspected and a certificate issued. 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, etc., and these are from time to time inspected. COUNCIL'S AMBULANCE. The ambulance provided by the Merton and Morden Urban District Council for use in non-infectious cases and accidents has been called upon on 173 occasions during the 24 year 1925, of which 4(J were street accidents and the remainder were removals to or from hospitals or institutions within the district or the neighbourhood surrounding it. This Ambulance service has proved to be an immense benefit to the neighbourhood and is still very much appreciated. HOUSING. Total number of houses erected during the year:— (a) Total 329 (b) Part of Housing Scheme - 1. Unfit Dwelling-Houses. I ns paction. (1) Total number of dwelling-houses inspected for Housing defects (under Public Health or Housing Acts) 264 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations 1910, or the Housing Consolidated Regulations 1925 42 (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 sub-heading) found not to be in all respects reasonably lit for human habitation 250 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 Officers 225 25 Action Under Statutory Powers. (a) Proceedings under Section 3 of the Housing Act, 1925. (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 (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 1o close (n) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied ... ... ... ... ••• 25 (2) Number of dwelling-houses in which defects were remedied : (a) By owners 24 (b) By Council in defaut of owners Nil (c) Proceedings under Section 11, 11 and 15 of the Housing Act, 1925. (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 Nil. (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses have been rendered fit 26 (4) Number of dwelling-houses in respect of which Demolition Orders were made (5) Number of dwelling-houses demolished inl pursuance of Demolition Orders The Table at the end of the Report shows 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, District Inspector, and the Clerk in the Department. I am, Gentlemen, Your obedient servant, J. B. POINTON. Sanitary Inspector. 27 SUMMARY. Visits paid (total) 3,229 Dampness in premises remedied 30 Doors repaired 3 Drains exposed and repaired 5 Drains reconstructed 1 Drinking water cisterns cloancd out and repaired 23 Drinking water cistern covers provided 12 Dustbins provided 31 Floors repaired 8 Fresh air inlet valves provided and repaired 15 Inspection chamber covers provided 6 Intercepting trap stoppers provided 4 Obstructions removed from drains 34 Overcrowding remedied at premises 7 Rain water pipes renewed and repaired 4 Rooms cleansed 213 Rooms cleansed after infectious disease 51 Roofs and gutters repaired or renewed 47 Sink wastes repaired 2 Walls repaired 57 W.C. cisterns, new waste preventors provided 1 W.C. cisterns renewed and repaired 8 Water closets cleansed 21 W.C. flushes renewed and repaired 19 W.C. pans provided Windows repaired 11 Yards paved and re-paved 20 Stoves repaired 11 Sinks provided or repaired 2 Covers provided to manure pits 3 Cffensive accumulations removed .5 Water supplied direct from main service 9 Verminous premises fumigated and cleansed 1 Separate approaches provided to sanitary conveniences at factories 1