MER 1 Merton and Morden Urban District Annual Report OF THE Medical Officer of Health FOR THE YEAR 1937 AND REPORT OF The Sanitary Inspector Merton and Morden Urban District Annual Report OF THE Medical Officer of Health FOR THE YEAR 1937 AND REPORT OF The Sanitary Inspector PREFACE. To the Chairman and Members of the Merton and Morden Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Animal Report for the year 1937. The district continued to enjoy that good standard of health which it has experienced in past years. As evidenced by the statistical information the year 1937 compares well with its predecessors. Mortality rates generally were low, and as in the past were more favourable than those for the country as a whole. The incidence of the common endemic infections, scarlet fever, diphtheria, measles and whooping cough, was on a comparatively small scale. The only prevalence of an epidemic nature was that of Sonne dysentery in the last two months of the year, which in a mild form attacked the greater part of the London area. Sanitary inspection and administration of the Housing Acts was pursued with the same vigour as before, whilst the same strict control over food and food premises was exercised. The Maternity and Child Welfare service completed another exceptionally busy year. The Council has in this organisation a service which performs work of inestimable value. The appreciation which the residents of the district exhibit by the considerable use which they make of this Scheme is ample testimony to the wisdom of successive Councils in pursuing a policy of steady expansion in this very necessary service. Much has been done for the health of mothers and children. More can still be done. A stage has been reached when the work is outgrowing the accommodation 2 necessary for its performance, and the future concern of the Council will be to secure adequate accommodation so that these activities may continue to exert unimpeded their great influence on the health of the district. I would record again my appreciation of the support given to me by the members of the Council, and of the encouragement of the Public Health and Maternity and Child Welfare Committees in my efforts to serve the best interests of the district. To the members of my staff 1 pay tribute to that loyalty and unstinting assistance which for many years 1 have always received. I am, Mr. Chairman, Ladies and Gentlemen. Your obedient Servant, F. LAWRENCE SMITH, Medical Officer of Health. June, 1938. 3 URBAN DISTRICT COUNCIL of MERTON and MORDEN 1937 PUBLIC HEALTH COMMITTEE. Chairman: Mrs. L. A. Doel Mrs. E. M. Clifton Mr. F. G. Humphreys Mrs. H. Cobbett Mb. E. Knox Capt. E. A. Evans Mr. W. S. Le Gros Clark Mr. F. E. Smith Mr. S. Beven (ex-officio) Mr. G. E. Baker (ex-officio) MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Mr. W. S. Le Gros Clark Mrs. E. M. Clifton Mrs. S. A. Lodge Mrs. H. Cobbett Mr. F. E. Smith Mrs. L. A. Doel Mrs. Hailstone Capt. E. A. Evans Mrs. Noble Co-opted Mr. E. Knox Mrs. Turrell members Mr. S. Beven (ex-officio) Mr. G. E. Baker (ex-officio) REPRESENTATIVES ON THE WANDLE VALLEY JOINT HOSPITAL BOARD. Mr. G. F. Coleman Mr. F. J. Grimme Mr. G. E. Baker (ex-officio) REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD. Mrs. E. M. Clifton Mr. J. Stuart-Ker Mr. J. C. Hudson Mr. G. E. Baker (ex-officio) REPRESENTATIVES ON NELSON HOSPITAL COUNCIL. Mr. G. E. Baker Mr. A. E. Clifton Mrs. H. Cobbett 4 PUBLIC HEALTH STAFF. Medical Officer of Health: a F. Lawrence Smith, M.B., Ch.B., D.P.H. Chief Sanitary Inspector: b J. B. Pointon, M.S.I.A. Sanitary Inspectors: b c F. C. Thomas, M.S.I.A. b J. H. Massey, M.S.I.A. Senior Health Visitor: Miss E. M. Sperry Health Visitors: Miss A. R. Taylor Miss M. McL. Doran Miss E. Williams (resigned 23.3.87) Miss A. Howard (from 1.4.37) Senior Clerk: A. A. Makepeace Clerks : R. J. Mitton H. J. Rogers PART TIME OFFICERS. Assistant Medical Officcr for Child Welfare Clinics: Matthew Orr, M.B., Ch.B. Assistant Medical Officer for Maternity Clinics: Esther Richards, M.B., M.S., F.R.C.S. Assistant Medical Officcr for Diphtheria Immunisation Clinics: T. Elliott, M.B., Ch.B. Bacteriologist: F. Deas, M.R.C.S., L.R.C.P. Consulting Obstetrician under the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulationst 1926, and Public Health, Act, 1936—Part VII.: Aubrey Goodwin, O.B.E., M.D., F.R.C.S. Panel of Honorary Staff of Queen Charlotte's Hospital Anœsthetist to Maternity and Child Welfare Dental Scheme: Mary M. Tulloch, M.B., B.S. Dentist to Maternity and Child Welfare Scheme: H. W. Fynn, L.D.S., R.C.S. (Eng.) a Medical Officer of Health for combined districts of Merton and Morden and Carshalton. b Meat and Food Inspector's Certificate, Royal Sanitary Institute, c Sanitary 'Science Certificate, University of Liverpool. 5 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 3,238 Number of inhabited houses (end of 1937) according to Rate Books 18,240 Rateable Value at 31st December, 1937 £553,627 Sum represented by Id. rate £2,210 Lying in the valley of the Thames and naturally drained by its tributaries the River Wandle and the Pyl and Beverley Brooks, the district is flat. The surface rises gently from the northern or Wimbledon boundary towards the southern limit of the Morden Ward, the whole lying between the 42ft. and 141ft. ordnance datum levels. The subsoil in the northern part is a sandy gravel which merges into the London clay which extends throughout the great part of the district lying to the south. The district continued its steady development. A further 1,369 new houses and 449 flats were erected, the former being mostly of the small owner-occupier type. Further progress was made with a view to creating a new Civic Centre on a site embracing both sides of the London Road in the Morden Ward bordering on and having as its setting Morden Park. Industry. The number of factories and workshops as defined by the Factories and Workshops Act at the end of the year was as follows:— Factories with more than 40 employees 22 Factories with less than 40 employees 60 Total factories 82 Workshops 28 Total factories and workshops 110 6 The number of employees engaged in these premises is approximately 6,000. A list of the various trades carried on in the larger factories is shown in the Sanitary Inspector's Report. Unemployment. The number of Merton and Morden residents registered as unemployed at the Wimbledon Exchange on 17th January, 1938, was as follows:— Men 588 Women 201 Boys 16-17 years 23 Girls 16-17 years 12 Boys 14-15 „ 16 Girls 14-15 „ 19 627 232 Total 859 The total of 859 compares with 544 registered at this Exchange twelve months earlier. Public Assistance. The following information as to Public Assistance is supplied by the courtesy of the Chief Public Assistance Officer of the Surrey County Council. Medical Relief:—Number of persons from the Parishes of Merton and Morden admitted to institutions and hospitals during the year 515 Number of persons from the Parishes of Merton and Morden admitted to mental hospitals during the year 56 Average weekly number of persons in receipt of Medical out-relief 2 Other Relief Number of persons in Parishes of Merton and Morden in receipt of Domiciliary Assistance on:— 1st January, 1937 617 1st July, 1937 592 31st December, 1937 656 Total amount of Domiciliary Assistance afforded during the year £12,688 Climatic Conditions. Rain gauges are installed at the Joseph Hood Recreation Ground and West Barnes Pumping Station, 7 The monthly recordings are as shown below:— RAINFALL, 1937. Joseph hood Recreation Ground. West Barnes Pumping Station. January 3.75 inches. 3.64 inches. February 3.98 „ 4.03 „ March 2.47 „ 2.76 „ April 1.61 „ 1.96 „ May 2.34 „ 2.38 „ June 1.71 „ 1.77 „ July .50 „ .51 „ August 2.78 „ 2.83 „ September 1.87 „ 1.72 „ October 2.66 „ 2.58 „ November 1.32 „ 1.37 „ December 4.36 „ 4.10 „ Total 29.35 „ 29.65 „ 8 SUMMARY OF VITAL STATISTICS FOR 1937. (Registrar General's Figures). Population: Mid. 2937 Registrar General's Estimate 65,530 Births: M. F. Total. Live (Legitimate) 418 373 792 (Illegitimate) 21 20 21 429 383 822 Birth rate 22.3 Stillbirths 13 11 24 Stillbirth Rate per 1,000 total births 28.7 Deaths: 262 225 487 Death Rate 7.4 Infant Mortality: All deaths under 1 year 32 Rate per 2,000 live births 39.4 Deaths of legitimate infants under 1 year 29 Rate per 2,000 legitimate births 36.6 Deaths of illegitimate infants under 2 year 3 Rate per 2,000 illegitimate births 142 Maternal Mortality: Deaths "from Sepsis 2 Deaths from other puerperal causes 1 Maternal death rate 2.38 Zymotic Deaths: Deaths from Measles — Deaths from Whooping Cough 2 Deaths from Diarrhoea (under 2 years) — 7 Principal Zymotic Diseases 6 Zymotic Death Rate (per 1,000 population) 0.09 Deaths from Tuberculosis: All forms 34 Rate per 1.000 population 0.53 Phthisis 33 Rate per 1,000 population 0.52 Deaths from Cancer 93 Rate per 1,000 population 1.4 9 The Registrar General's figures differ very slightly in one or two instances from those compiled from local records. Where statistics in this report are stated for the district as a whole, the Registrar General's figures are given, but where comparative figures, e.g., as between wards, age groups, etc., are shown these are necessarily based on local information, and may differ slightly in the aggregate from the Registrar General's totals. POPULATION. The Registrar General's estimate of the mid-year population is 65,530. My own estimate based on local information is 66,450, distributed in wards as follows:— Wards Houses at mid. 1937 Estimated Population mid. 1937 Abbey 1,210 4,335 Bushey Mead 2,113 7,596 Central 2,388 7,958 Morden 1,336 4,476 Park 2,763 9,870 Ravensbury 1,804 7,485 Raynes Park 1,853 6,536 St. Helier 2,706 11,614 West Barnes 1,880 6,580 Whole District 18,053 66,450 BIRTHS. The number of live births registered during the year was 812, giving a birth rate of 12.3 compared with 12.9 in the preceding year. Of the total 429 were males and 383 females. Twenty-one were illegitimate. Stillbirths numbered 24, 13 being males and 11 females. Two of these were illegitimate. Ward Distribution. For comparative purposes as between wards use is made of the births which occurred during the year and not those registered, since details with regard to 10 those births which are registered outside the district are not available to enable allocation by wards to be made. From the notifications of births and the records of births registered in the district information is available in respect of 790 live and 22 stillbirths, a total of 812 which took place during the year. This number is only slightly less than the total registered births, and hence is sufficiently accurate for comparative purposes. The distribution of these births was as follows:— BIRTHS, 1937—DISTRIBUTION BY WARDS. Wards Live Births Still Births Total Births Birth Rate Abbey 48 48 11.0 Bushey Mead 115 7 122 15.1 Central 114 1 116 14.8 Morden 76 6 82 16.9 Park 92 2 94 9.3 Ravensbury 93 1 94 12.4 Raynes Park 64 1 65 9.7 St. Helier 114 8 117 9.8 West Barnes 74 1 75 11.2 Institutional and Domiciliary Births. A high proportion of the births took place in hospitals and maternity homes, and this tendency is increasing year by year. In the two wards which comprise the St. Helier Estate rather more than two-thirds of the total were domiciliary births, while in the rest of the district less than half took place in private dwellings. Of the 812 total births (live and still) which occurred in the year, 448 took place in hospitals, nursing homes, etc. This represents 55% of the total, which is 4% higher than in 1936. They took place in the following institutions:— Nelson Hospital 207 Kingston County Hospital 91 Other hospitals, institutions, and nursing homes 150 448 11 The following shows the number of institutional births for each ward:— Wards Total Births (Live and Still) Births in Hospitals, Nursing Homes, etc. Percentage of Total Births which occurred in Hospitals, etc. Abbey 48 28 58.3 Bushey Mead 122 74 60.6 Central 115 86 74.7 Morden 82 39 47.5 Park 94 56 59.5 Ravensbury 94 34 36.1 Raynes Park 65 42 64.6 St. Helier 117 41 85.0 West Barnes 75 48 64.0 12 TABLE I. COMPARATIVE STATISTICS, 1937. (R.G.'s Provisional Figures with Corresponding Figures for Merton and Morden added). England and Wales 125 County Boro's and Great Towns including London 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census London Administrative County Merton and Morden Rates per 1,030 Population Mirths:— Live 14.9 14.9 15.3 13.3 12.3 Still 0.60 0.67 0.64 0.54 0.36 Deaths:— All causes 12.4 12.5 11.9 12.3 Crude 7.4 Typhoid and Paratyphoid fevers 0.00 0.01 0.00 Comp 0.00 8.9 Smallpox - - - - - Measles 0.02 0.03 0.02 0.01 - Scarlet fever 0.01 0.01 0.01 0.01 - Whooping Cough 0.04 0.04 0.03 0.06 0.03 Diphtheria 0.07 0.08 0.05 0.05 0.06 Influenza 0.45 0.30 0.42 0.38 0.25 Violence 0.54 0.45 0.42 0.51 0.30 Notifications:— Smallpox 0.00 - 0.00 - - Scarlet fever 2.33 2.56 2.42 2.09 1.06 Diphtheria 1.40 1.81 1.38 1.93 0.33 Enteric fever 0.05 0.06 0.04 0.05 0.01 Erysipelas 0.37 0.43 0.34 0.44 0.15 Pneumonia 1.36 1.58 1.20 1.18 1.35 Rates per l.000) Live Births Deaths under 1 year of age 58 62 55 60 39 Deaths from Diarrhoea and Enteritis under 2 years of age 5.8 7.9 3.2 12.0 Maternal Mortality:— Puerperal Sepsis 0.97 Not Available 1.23 Others 2.26 1.23 Total 3.23 2.46 Rates per 1,000 Total Births (i.e., Live and Still) Maternal Mortality:— Puerperal Sepsis 0.94 Not Available 1.19 Others 2.17 1.19 Total 3.11 2.38 Notifications:— Puerperal fever 13.93 17.59 11.52 4.15 1.19 Puerperal pyrexia 14.34 2.38 13 TABLE II. Showing Births and Deaths with Rates since the Amalgamation of Merton with Morden. Year. Estimated population. Total Births. Birth Rate. Total Deaths. Death Rate. 1913 16,767 400 23.5 166 9.9 1914 17,500 420 24 142 8.2 1915 17,500 402 22.9 169 10.4 1916 16,000 348 27.75 134 8.3 1917 17,000 271 15.75 145 9 1918 17,552 241 14 204 13 1919 18,100 257 14.2 210 11.6 1920 18,200 359 19.8 171 9.4 1921 18,000 322 17.8 138 7.6 1922 18,500 365 19.7 198 10.7 1923 18,750 341 18.1 153 8.1 1924 18,710 311 16.6 170 9.1 1925 18,960 307 16.2 187 9.9 1926 19,980 333 16.7 179 9.0 1927 21,850 352 16.13 200 9.2 1928 25,780 392 15.2 224 8.7 1929 27,430 442 16.1 281 10.2 1930 35,000 452 12.9 241 6.9 1931 41,610 628 15.1 333 8.0 1932 48,550 770 15.8 352 7.2 1933 52,130 644 12.3 416 7.9 1934 55,550 770 13.8 484 8.7 1935 57,440 721 12.5 433 7.5 1936 61,000 789 12.9 443 7.2 1937 65,530 812 12.3 487 7.4 DEATHS. The registered deaths numbered 487, of which 262 were males, and 225 females. This total was arrived at by transfer adjustments in the following manner:— Total deaths registered in the district 328 Less deaths of non-residents (outward transfers) 76 252 Plus deaths of residents occurring outside the district (inward transfers) 235 Total 487 The crude death rate was 7.4 per 1,000 population, compared with 7.2 in the year before. 14 The comparable rate determined by the application of the areal comparability factor (A.C.F.) of 1.21 to allow for age and sex differences of the population was 8.9. This is the figure which should be compared with that for England and Wales which was 12.4. Seasonal mortality is indicated by the deaths for each quarter of the year, which were:—- First quarter 154—second quarter 103—third quarter 91 —fourth quarter 137. The following table shows the death rates for each ward and the mean age at death:— TABLE III. Ward Death Rates and Mean Age at Death. Wards Deaths Death Rate (crude) Mean age at death Abbey 42 9.6 60.95 yrs. Bushey Mead 85 11.1 58.49 „ Central 38 4.7 54.47 „ Morden 31 6.9 46.61 „ Park 83 8.4 56.09 ., Ravensbury 52 6.9 46.92 „ Raynes Park 40 6.1 56.90 „ St. Helier ... 61 5.2 46.49 „ West Barnes 53 8.0 55.96 „ Whole District 485 7.2 54.06 yrs. The wards with the higher mean ages at death are the oldest from the point of view of development, and the variation in these figures is in accord with the probable average age of the respective ward populations. The mean age at death for the whole district for the last four years was as follows:— 1934—48.3 yrs.; 1935—52.7 yrs.; 1936—54.5 yrs.; 1937—54.0 yrs. Deaths in Institutions. Approximately half the deaths took place in hospitals and institutions, the actual number being 251, which represents 51% of the total. They occurred in the following institutions:— 15 Institutions. Nelson Hospital Surrey County Hospitals Isolation Hospitals London and other general Hospitals Tuberculosis Institutions Mental Institutions Deaths. 34 87 6 98 15 11 251 CAUSES OF DEATH. Heart Disease. The number of persons dying of heart disease was 95, which is the greatest number attributable to any single cause, and the death rate for this disease was 1.5 per 1,000 of the population, the same as in the year before. Of the total, 76, representing 80%, were over 55 years of age. There were no deaths under 25 years of age. Cancer. Cancer deaths increased by 19 to 93, of which 42 were males and 51 females. This gives a death rate for cancer of 1.4 per 1,000 population, compared with 1.21 in 1936. The sites affected in these deaths are shown in the following table:— TABLE IV. Deaths from Cancer—Sites Affected. Group Cancer of Male Female Total 45 Buccal Cavity and Pharynx 1 — 1 46 Digestive organs and peritonium— Oesophagus 2 1 3 Stomach 10 9 19 Liver and gall bladder 5 2 7 Intestines 5 9 14 Rectum and Anus 8 4 7 Pancreas 3 — 8 47 Respiratory Organs— Larynx 1 1 Lungs 1 1 2 48 Uterus — 6 6 49 Other female genital organs — 6 6 50 Breast — 12 12 51 Male Genito-Urinary Organs 8 — 8 52 Skin 1 — 1 53 Other Organs— Shoulder 1 1 Brain 2 — 2 Totals 42 51 98 Mean age at death— Males 59.50 yrs. Females 59.59 „ All Persons 59.54 „ 16 The cancer death rates for the last ten years were as follows:- 1928 1.4 per 1,000 population 1933 1.0 per 1,000 population 1929 1.1 ,, ,, ,, 1934 1-2 „ „ ,, 1930 1.2 „ „ ,, 1935 1.0 ,, ,, ,, 1931 0.9 „ „ ,, 1936 1.2 „ „ ,, 1932 1.2 „ „ ,, 1937 1.4 ,, ,, ,, Respiratory Diseases. Influenza was prevalent in 1937, and in accordance with previous experience, this was accompanied by a higher mortality from respiratory diseases. Influenza was responsible for 16 deaths against 10 in the year before and 3 in 1935, whilst the respiratory diseases, excluding influenza, caused 51 deaths as compared with 39 in the year before. The death rate for the respiratory diseases accordingly rises from 0.6 per 1,000 population to 0.8. TABLE V. Deaths from Respiratory Diseases, 1925-37. Year Bronchitis Pneumonia Other Respiratory Diseases Total Death Rate 1925 6 16 1 23 *1.2 1926 6 8 5 19 0.9 1927 10 11 5 26 *1.2 1928 8 14 2 24 0.9 1929 11 20 4 35 *1.2 1930 2 10 8 15 0.4 1931 8 24 4 36 0.8 1932 11 27 3 41 0.8 1933 12 32 6 50 0.9 1934 7 38 4 49 0.8 1935 9 22 6 37 0.6 1936 2 35 2 39 0.6 1937 14 81 6 51 0.8 ("Years of high influenzal mortality) 17 Inquests. Inquests were held on 27 deaths which took place in the district, 12 of which were in respect of persons not resident in the district. The verdicts returned were as follows:— (1) Natural causes 3 (2) Suicide by— Swallowing Lysol 2 Swallowing Disinfectant 1 Potassium cyanide 1 Jumping in front of train 2 Wound of throat 1 Coal gas 2 — 9 (3) Accidental due to— Knocked down by motor car 2 Pedal cyclist colliding with car 2 Knocked down by train at level crossing 1 Thrown from motor cycle while racing 1 Fall 4 Coal gas 1 — 11 (4) Misadventure— Injured by falling steel chimney 1 (5) In accordance with medical evidence Fall in street—manslaughter 1 Riding motor cycle which collided with lamp standard 1 Death following operation from appendicitis 1 3 Total 27 Deaths due to road accidents numbered 5, compared with 14 in the year before. 18 TABLE VI. Causes of Death during the Year 1937—By Age Groups. No. Cause of Death 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— All Ages M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Pers. 1 Typhoid and Paratyphoid Fever . — — — — — — — — — — — — — — — — — — — — — — — — — 2 Measles — — — — — — — — — — — — — — — — — — — — — — — — — 3 Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — — — 4 Whooping Cough — 1 — 1 - - — — — — — 9 2 5 Diphtheria — 1 — — 1 1 1 — — — — — — — — — 1 3 4 6 Influenza 1 1 — — — — — — 1 — — — 2 1 1 — — 1 4 3 1 9 7 16 7 Encephalitis Lethargica — — — — — — — — — — — — — — — — — — — — — — — 1 1 8 Cerebro-Spinal Fever — — — — — — — — — — — — — — — — — 1 — — — — — 1 1 9 Tuberculosis of Respiratory System — — — — — — — — 4 4 3 6 7 1 3 — 3 — 1 1 — — 21 19 33 10 Other Tuberculous Diseases — — — — — — — — — — — — — — — — — — — — — — 1 — 1 11 Syphilis 1 — — — — — — — — — — — — — — — 1 — — — — — 2 — 2 12 General Paralysis of the Insane Tabes dorsalis — — — — — — — — — — — — — — — — — — — — — — — — — 13 Cancer. Malignant Disease — — — — — — 1 — 1 2 3 2 5 11 8 9 16 11 8 6 10 42 51 93 14 Diabetes — — — — — — — — — — — — — 1 — — 1 1 — — — 2 2 4 15 Cerebral Haemorrhage, etc. — 1 — — — — — — — — — — — — 3 1 — 4 1 2 1 3 5 11 16 16 Heart Disease — — — — — _ — — — — 3 1 3 1 5 5 9 5 17 15 13 17 50 44 94 17 Aneurysm — — — — — — — — — — — — — — — 1 — 1 — — 2 — 2 18 Other Circulatory Diseases — — — — — — — — — — — — — 1 1 4 2 8 5 9 3 14 12 96 19 Bronchitis 1 — — — — — — — — — — 1 — — 3 1 1 2 5 7 14 20 Pneumonia (all forms) 4 2 2 — — — 2 — — — 2 1 2 1 9 1 1 1 4 1 9 9 21 9 30 21 Other Respiratory Diseases — — — — — — — — — — — — — — — — — — — — — 1 5 1 6 22 Peptic Ulcer — — — — — — — — — — 1 — — — 3 2 3 1 — — — — 7 q 10 23 Diarrhoea, etc. (under 2 years) — — — — — — — — — — — — — — — — — — — — — — — — — 24 Appendicitis — — — — — — 1 1 — — — — — — 1 — — 9 1 — 3 3 6 25 Cirrhosis of Liver — — — — — — — — — — — — — — — — — 1 1 — — — 1 l 2 26 Other Diseases of Liver, etc. — — — — — — — — — — — — — — — — — — — — — 1 2 3 5 27 Other Digestive Diseases — — — — — — — — — — — — — — — — 3 — 1 2 9 9 9 6 15 28 Acute and Chronic Nephritis — — — — — — — — — 1 — — 2 2 9, 1 1 — 9 3 1 8 7 15 29 Puerperal Sepsis — — — — — — 1 — — — — 1 1 30 Other Puerperal causes — — — — — — — — — — — — — — 1 1 31 Congenital Debility. Premature Births, Malformations, etc. 10 7 — — — — —— — — — — — — 10 7 17 32 Senility — — — — — — — — — — — 1 1 4 6 5 7 19 33 Suicide — — — — 1 1 1 1 1 9 — — 1 4 4 8 84 Other Violence — — — — — — — 3 3 — 4 2 1 — — 1 — 9 9 13 5 18 35 Other Defined Causes 2 — — — 1 — 2 1 — 1 — 1 3 3 2 4 3 3 9 1 1 17 13 30 36 Causes ill-defined or unknown- — — — — — — — — — — — — — — — — — — — — — — — — — All Causes 19 13 2 — 3 2 7 3 10 8 15 13 28 19 35 24 44 40 60 46 38 56 261 224 485 19 MATERNAL MORTALITY. Two deaths were ascribed to maternal causes, one due to sepsis and one to other causes. The maternal mortality rate was 2.39 per 1,000 total births, compared with 2.43 in the year before, and a rate of 3.11 for the country as a whole. The cause of death in each case was:— (1) I. a. Shock following hæmorrhage from retained placenta. (2) I. a. Pulmonary embolism following puerperal septicæmia (5th pregnancy). The first death was in a primipara following a three months abortion. She was suffering from influenza at the time, and it is probable that this induced the abortion. The second death followed a 5th pregnancy, and was caused by a hæmolytic streptococcal infection. Labour was uneventful and the patient received every care. One other death occurred following childbirth, but was occasioned by tuberculosis. TABLE VII. MATERNAL MORTALITY, 1924-37. Year Death rate per thousand total births Sepsis Other causes Total 1924 3.2 3.2 1925 — 6.5 6.5 1926 — — — 1927 — 2.8 2-8 1928 — — — 1929 2.2 — 2.2 1930 — 2.2 2.2 1931 1.6 3.1 4.7 1932 5.1 2.5 7.7 1933 2.9 1.4 4.3 1934 2.5 2.5 5.0 1935 — 2.6 2.6 1936 2.4 — 2.4 1937 1.2 1.2 2.4 Maternal deaths occurring within the area are enquired into personally by the Medical Officer of Health and a confidential report in each case is forwarded to the Maternal Mortality Committee of the Ministry of Health in accordance with the recommendation contained in the Committee's report on Maternal Mortality. 20 INFANT MORTALITY. Nineteen male and 13 female infants, a total of 32, died under one year of age. This gives an infant mortality rate of 39 per 1,000 live births as against a rate of 35 in the previous year. The corresponding rate for England and Wales was 58. Of the total infant deaths 3 were illegitimate children, all males. The neo-natal deaths, i.e., those occurring within one month of birth, totalled 15, representing 46% of the whole. Diseases peculiar to the new born (prematurity, congenital malformations, marasmus, etc.), accounted for 18, and pneumonia for 6. Three were due to infectious diseases, one to whooping cough, one to diphtheria, and one to influenzal meningitis. The infant mortality rates since 1921 are as follows:— Year. Deaths per 1,000 live births. Year. Deaths per 1,000 live births. 1921 70 1930 45 1922 46 1931 48 1923 27 1932 29 1924 51 1933 48 1925 66 1934 53 1926 43 1935 39 1927 36 1936 35 1928 55 1937 39 1929 58 Table VIII shows the infant deaths classified as to age and cause of death. 21 The infant death rates for the individual wards are given below based on the 790 live births which took place during the year which it was possible to allocate by wards. As the total registered live births was 812 these rates will be slightly less than the actual, but will be sufficiently accurate for comparative purposes. Wards Live Births Infant Deaths Deaths per 1,000 live births Abbey 48 2 41 Bushey Mead 116 3 26 Central 114 4 34 Morden 76 6 65 Park 92 5 54 Ravensbury 93 6 64 Raynes Park 64 4 62 St. Helier 114 3 26 West Barnes 74 - - Similar rates based upon the figures in respect of the last 3-year period 1935-37 are as follows:— Wards Live Births 1935-37 Infant Deaths 1935-37 Deaths per 1,000 live births 1935-37 Abbey 135 5 87 Bushey Mead 310 7 23 Central 290 9 31 Morden 173 9 52 Park 270 12 44 Ravensbury 279 15 54 Raynes Park 195 10 51 St. Helier... 333 16 48 West Barnes 240 5 21 22 TABLE VIII.—INFANT MORTALITY DURING THE YEAR 1937. Deaths classified as to cause and age at death. Cause 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 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year Smallpox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - Whooping Cough - - - - - 1 - - 1 Diphtheria and Croup - - - - - - - - 1 1 Erysipelas - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - 1 1 Convulsions - - - - - - - - - - Laryngitis - - - - - - - - - Bronchitis - - 1 - 1 - - - - 1 Pneumonia (all forms) - - - 1 1 1 1 1 2 6 Diarrhoea - - - - - - - - - Enteritis - - - - - - - - - - Gastritis - - - - - - - - - - Syphilis - - - - - 1 - - - 1 Rickets - - - - - - - - - - Suffocation, overlying - - - - - - - - Injury at birth 2 - - - 2 - - 2 Atelectasis 2 - - 2 - - - - 2 Congenital Malformations - - - - - 3 - - - 3 Premature birth 5 - 2 - 7 2 - - 9 Atrophy, Debility and Marasmus 1 - - - -1 1 - - - 2 Other causes - — — 1 1 2 — — — 3 TOTALS 10 — 3 2 15 10 2 1 4 32 Nett births in the year—Males 429, Females 383 : Legitimate 791, Illegitimate 21. Nett deaths in the year of Legitimate Infants 29. Nett deaths in the year of Illegitimate Infants 3. 23 SECTION B—HEALTH SERVICES. Nursing in the Home. In September 1937 the Morden Nursing Association ceased to be a separate body, and its activities were merged with those of the Wimbledon District Nursing Association. The number of Associations serving the district at the end of the year was thereby reduced to three. The Council makes an annual contribution to these Associations, in retui'n for which home nursing facilities are provided for cases referred from the public health services. (1) The Merton Parish Nurse Fund employs one nurse for general nursing, excluding midwifery, and its service covers approximately the ecclesiastical Parish of St. Mary's, Merton Park. The number of cases attended during the year was 250, of which 49 were children under 5 years. Visits made totalled 1,964. (2) The St. Helier District Nursing Association employs one nurse for general nursing only. No midwifery is undertaken. Its activities cover that part of the St. Helier Estate situate in this district, and the smaller part of the Estate situate in Carshalton but lying to the north of the SuttonMitcham Road. The number of cases undertaken in Merton and Morden during the year was 138, of which 24 were children under 5 years of age. Total visits made was 1,992, 214 of these being to children under 5 years. (3) The Wimbledon & District Nursing Association has its headquarters in Wimbledon, but in addition to the Borough of Wimbledon it provides nursing facilities, both general and midwifery, in the western part of this district. The staff' of the Association consists of 3 midwives and 8 general nurses. For duty in Merton and Morden two general nurses are employed, whilst midwifery and maternity nursing is carried on from the central home. The following was the work done in the Merton and Morden district during the year:— Cases undertaken— (a) Children under 5 years 34 (b) Maternity (with a doctor) 16 (c) Midwifery (without a doctor) 56 (d) Total of all descriptions 289 Visits made 4,654 24 Figures in respect of the Morden Nursing Association up to September 1937, when it ceased to exist, are not available. Laboratory Facilities. Laboratory examinations of clinical material in connection with infectious diseases, tuberculosis, and puerperal pyrexia, are undertaken under the Council's scheme by Dr. Deas, at the laboratory of the Nelson Hospital. The following examinations were made during the year Examination. No. performed. Positive resxdt. Swabs for diphtheria bacilli 522 21 Sputum for tubercle bacilli 145 19 Blood for Widal test 4 — Fasces 9 4 Samples of water, milk and food are submitted for examination either to the County Analyst, to the Clinical Research Association, or to the Laboratory of the Royal Surrey County Hospital, Guildford. Use is also made of the facilities afforded by the Ministry of Health Laboratory, Endell Street, W.l, particularly in respect of cases of suspected food poisoning. Ambulance Facilities. Infectious Cases. For the removal of infectious cases two ambulances are provided by the Wandle Valley Joint Hospital Board for use within its administrative area, including this district. No difficulty has been experienced in securing the prompt removal of any infectious case. Non-infectious Cases. For the removal of non-infectious and maternity cases the District Council provides one ambulance. The vehicle will accommodate two stretcher cases and two sitting cases. It is housed at the Fire Station in Kingston Road, S.W.19, and is equipped with the necessary stretchers and blankets and with a CO½ atid oxygen resuscitation apparatus. The engine is electrically heated in cold weather and there is thus no delay in getting away. The ambulance staff consists, in addition to the Honorary Officer in charge, of two part-time driver-attendants with the assistance of the members of the Fire Brigade when necessary. Reciprocal arrangements exist with all neighbouring authorities. The use of the ambulance is free to residents up to a distance of 32 miles. This meets the needs of cases transported to hospitals on the north side of London. 25 The following is a summary of the working of the Council's ambulance service during the year:— AMBULANCE CALLS, 1937. 1937 Calls received from Public Calls received from neighbouring Brigades Total Calls Received Calls transferred to other Authorities Calls answered by Own Ambulance January 78 4 82 5 77 February 53 — 53 1 52 March 56 5 61 2 59 April 53 8 56 1 55 May 59 2 61 1 60 June 53 8 56 3 58 July 51 — 51 5 46 August 53 — 53 1 52 September 65 5 70 — 70 October 67 2 69 2 67 November 66 2 68 4 64 December 79 3 82 3 79 733 29 762 28 734 Street or works accidents accounted for 44 per cent, of the cases removed, the remainder being removals to and from hospitals, institutions, etc. Number of calls for 2 attendants 65 Number of calls for 1 attendant 669 734 Time taken in executing the 734 calls (from leaving station to return) 638 hours. Mileage covered 5,373 Average time per call 52.1 mins. Average distance per call 7.3 miles. Legislation. No Local Acts, Special Orders, General Adoptive Acts or Byelaws applicable to this district came into force during 1937, with the exception of the undermentioned :— (a) Byelaw as to Nuisances by Dogs which came into force on the 1st August, 1937, and was confirmed by the Ministry of Health on the 14th .Tune, 1937. (b) Extended Byelaw re Children's Playgrounds confirmed by the Ministry of Health on the 28th April, 1937, which came into force on the 1st June, 1937. 26 CLINICS AND TREATMENT CENTRES. 1.—Maternity and Child Welfare Clinics (provided by the Council). Centre Clinic Times of Clinic Congregational Hall Morden Road, Merton Infant Welfare Toddlers Wednesdays 2—4 p.m. 4th Wednesday in month 10—12 noon. The Health Centre, Middleton Road, Morden Infant Welfare Toddlers Ante-Natal Dental Post-Natal Tuesdays and Fridays 2—4 p.m. Fridays 10—12 noon. Thursdays 10—12 noon Thursdays 10—12 noon 8rd Saturday in each month, 10—12 noon. The Parish Hall, Central Road, Morden Infant Welfare Fridays 2—4 p.m. The Health Centre, Aston Road, Raynes Park Infant Welfare Toddlers . Ante-Natal Mondays and Thursdays 2—4 p.m. Fridays 10—12 noon Wednesdays 2—4 p.m. Mondays 10— 12 noon. 2.—Diphtheria Immunisation Clinics (provided by the Council). Aston Road, Raynes Park 1st and 3rd Wednesday in month at 10 a.m. The Health Centre, Middleton Road, Morden 2nd and 4th Tuesday in month at 10 a.m. 27 3.—School Clinics (provided by Surrey Education Committee). Aston Road Centre Raynes Park General Medical Tuesdays and Thursdays 9.30—12 noon. Dental Mondays 1)30 12 noon. Tuesdays 9.30—12 noon, 1.46—4 p.m. Wednesdays 9.30 — 12 noon, 1.45—4 p.m. Thursdays 9.30—12 noon. Fridays 1.45—4 p.m. Eye 2nd Friday in month 1.45—4 p.m. 3rd. Tuesday in month 1.45—4 p.m. The Health Centre, Middleton Road, Morden General Medical Mondays and Wednesdays 9.30—12 noon. Thursdays 2—4 p.m. Dental Mondays 9.30—12 noon. Tuesdays 9.30—12 noon. Wednesdays 9.30-12 noon, 1.45—4 p.m. Thursdays 1.45—4 p.m. Fridays 9.30—12 noon 1.45—4 p.m. Saturdays9.30—12 noon Eye Wednesdays 1.45— 4 p.m. 4.—Tuberculosis Dispensaries (provided by Surrey County Council). 30, Worple Road, Wimbledon. Wednesdays, 1.30 p.m. Fridays, 9.30 a.m. 1st Tuesday in month, 5.30 p.m. The Health Centre, Middleton Road, Morden. Mondays, 1.30 p.m. 2nd Monday in month, 5.30 p.m. 5.—Venereal Diseases. The County Council administers the Venereal Diseases Regulations and participates in the London and Home Counties Scheme. Under this arrangement treatment is available at the principal London Hospitals. The sessions are numerous and in some cases continuous, whilst many of these institutions provide in-patient as well as outpatient treatment. 28 HOSPITALS. Smallpox. The Surrey County Isolation Hospital, Clandon—accommodation 28 beds. These premises form the hospital provision for smallpox for the whole of the administrative County of Surrey, and is administered as a county service. No cases were admitted from this district during the year. Infectious Diseases. The Wandi.e Valley Joint Hospital situated at Beddington Corner, Mitcham, maintained conjointly by the following districts :— Beddington and Wallington Borough; Coulsdon and Purley Urban; Merton and Morden Urban; Mitcham Borough. The present accommodation is 128 beds. A scheme of extensions and alterations is in progress at the present time. These include the provision of:— One new 30-bed ward; One new 30-bed ward including 10 cubicles; Extensions to administrative buildings; Operating theatre; New mortuary; Covered ways between blocks; Additional carriageways and entrance gates. It is hoped that this scheme will be completed during the summer of 1938. The bed accommodation which is now 128 will then be raised to 188. 167 cases were admitted from Merton and Morden during the year compared with 162 in the year before. An analysis of the cases admitted from this and the other constituent districts is given in table IX. General and Maternity. 1. The Nelson Hospital for Wimbledon, Merton and District. The accommodation of this voluntary hospital to whose funds the Council makes an annual grant is 86 beds, arranged as follows:— Public Wards Adult beds 36 Children's beds 14 Maternity 12 „ isolation 1 — 63 Private Wards General 15 Maternity 8 — 23 Total 86 29 The following information relating to the hospital's activities during the year is supplied by the courtesy of the Secretary:— (a) General Medical and Surgical Treatment— Total in-patients admitted during 1937 1,162 Number from Merton and Morden 455 Total number of new out-patients 6,005 Number from Merton and Morden 2,352 (b) Maternity Services— Number of patients admitted from all districts during the year— (1) General Wards 257 (2) Private Wards 114 Total 371 Number of patients admitted from Merton and Morden— (1) General Wards 147 (2) Private Wards 74 Total 221 During the year a weekly clinic was instituted at the hospital in connection with the maternity department. This is primarily for children up to the age of one year born in the hospital, and their mothers. The object of the clinic is to advise mothers as to the health and upbringing of their children, and to help them in any difficulties they may encounter. 2. The County Hospitals. Most of the cases receiving hospital treatment in County hospitals are admitted from this district to the Kingston and District Hospital, Wolverton Avenue. For some time the County hospital provision has been inadequate and the new St. Helier Hospital now in course of construction will bring relief to a very difficult situation. Unfortunately it is very unlikely that these new premises will be ready for the admission of patients before the year 1940. Tuberculosis:—The County Sanatorium, Milford—300 beds. During the year 50 cases from this district were admitted to the County Sanatorium. 88 other cases received treatment at other hospitals and institutions under the County scheme. 30 TABLE IX. CASES ADMITTED TO THE WANDLE VALLEY ISOLATION HOSPITAL DURING THE YEAR 1937. Disease lieddington and Wallington Coulsdon and Purley Merton and Morden Mitcham Oases Deaths Cases; Deaths Cases Deaths CaeCf Deaths Diphtheria 4 — 10 — 28* 4 98 2 Scarlet Fever 59 — 48 — 115 — 181 — Typhoid 1 — 18 1 1 1 — — Erysipelas 1 — 2 — 1 — 8 — Other Diseases Tonsillitis 1 — 5 — 2 — 7 — Measles 2 — 1 — 3 — 8 — Whooping Cough 1 — — — 3 — 6 — Rubella — — 1 — 2 — 5 — [nfluenza — — — — — — 1 — Impetigo — — — — 2 — 1 — Cerebro-spinal Meningitis — — — — 1 1 — Pneumonia — — — — — — 2 — Meningitis-Tubercular — — — — — — 1 1 Mumps — — 2 — 2 — 2 — Furunculosis Anaemia — — 1 — — — — — Puerperal Fever — — 1 — — — — — Nephritis 1 — — — — — — — Liver Abscess from Amoebic Dysentery — — — — — — 1 1 Rhinitis and Bronchitis — — — — — — 5 — Adenitis — — — — 1 — 1 — Cellulitis of Ankle — — — — 1 — — — Otitis Media — — — — 1 — 1 — Chicken Pox — — — — 3 — 1 — Anterior Poliomyelitis — — 2 — 1 — 1 — Septic Burn of Foot — — — — — — 1 — Septicaemia — — — — — — 1 — 70 — 86 1 167 6 327 4 "Includes six " carriers." 31 MATERNITY AND CHILD WELFARE. Public Health Act, 1936, Section 203—Notification of Births.—The births notified under Section 203 as adjusted by transferred notifications were:— Live Births 769 Notified by midwives 453 Still Births 22 Notified by doctors and parents 104 Transferred from other districts 234 Total 791 Total 791 The total is 52 more than in 1936, and represents 94% of the births registered during the year. The number of notified births which took place outside the district represents 29% of the total—3% more than in the year before. The Work of the Centres. The welfare activities at the Centres were again continued at a high level. The programme of clinics was increased slightly, and pending the erection of the proposed new clinic in Camborne Road, an additional temporary infant welfare centre was opened in December at the Parish Hall in Central Road, Morden, to relieve the increasing pressure on the Raynes Park clinic, and to provide facilities for the recent development on the Morden Park Estate. An additional weekly infant session was also established during the same month at the Raynes Park Centre. The number of women who attended either ante-natally or post-natally at the maternity clinics rose from 306 to 358. The number who attended for ante-natal supervision increased by 62, and the number who attended for post-natal supervision by 12. Compared with a percentage of 39 in 1936, the number of women who attended the maternity clinics in 1937 represented 44% of the registered births. This is the highest percentage yet recorded for the district. Eight years ago the figure was under 10. The infant welfare clinics established further records during the year. The number of children on the registers was 238 higher at the record total of 2,248, and the total attendances made by children exceeded 20,000 for the first time. 32 New babies attending for the first time numbered 569, which represents 70% of the registered births. The infant welfare clinics now fall into two categories. The ordinary consultation clinics for children of any age up to 5 years, and special toddler clinics, first instituted in 1935, for the annual medical examination of pre-school children in their 3rd, 4th and 5th years. The attendances at both types of clinics are shown separately in tables XI and XII, from which it will be noted that both have been well attended. The average attendance at the infant consultation clinic was 73, a high figure, and the average attendance at the special toddler clinics slightly less than 20, which is as many as can be dealt with adequately at these clinics where a comprehensive medical examination is undertaken. ' The site for the new clinic in Camborne Road has been acquired by the Council, and plans for the building are now being considered. The present programme of clinics is shown on page 27. TABLE X. Attendances at Maternity Clinics, 1937. Centre No. on Register Attendances Sessions Average attendances per session Primary Total MORDEN Ante-Natal 184 154 759 51 15.7 Post-Natal 46 1 46 Individuals 186 155 805 RAYNES PARK Ante-Natal 157 121 565 46 14.0 Post-Natal 60 6 80 Individuals 172 127 645 ALL CENTRES Ante-Natal 841 275 1324 97 14.9 Post-Natal 106 7 126 Individuals 358 282 1450 (A primary post-natal visit is the visit of a post-natal woman who has not attended previously either ante-natally or post-natally, so that the figures for primary attendances of individuals represents1 the number of new cases during the year). 33 TABLE XI. Attendances at Infant Consultation Clinics, 1937. Centre No. on Register Attendances Sessions Average attendances per session Primary Total MERTON U nder 1 yr. 177 51 1,053 62 42.3 1—5 yrs. 4 1,148 MORDEN Under 1 yr. 772 1 221 3,526 98 71.8 1—5 yrs. 88 3,615 RAYNES PARK Under 1 yr. 770 297 5,976 102 92.3 1—5 yrs. 46 3,639 PARISH HALL Under 1 yr. 22 — 22 3 11.8 1—5 yrs. — 12 ALL CENTRES 1,741 569 10,577 255 73.6 1—5 yrs. 188 8,214 *Excluding children known to have attended other centres. TABLE XII. Attendances at Special Toddlers Clinics (2-5 Years), 1937. Centre Routine examinations Observation attendances Total attendances Sessions Average attendances per session Raynes Park 529 593 1,122 51 22.0 Morden 191 214 405 22 18.2 Merton 62 46 107 12 8.9 All Centres 782 858 1,634 85 19.2 34 TABLE XIIL Attendances at all Infant Welfare Clinics, 1937. (Infant Consultation and Special Toddler). Centre No. on Register Attendances Sessions Average attendance per session * Primary Total MERTON Under 1 yr. 214 51 1,053 64 36.0 1—5 yrs. 4 1,255 MORDEN Under 1 yr. 915 221 3,526 120 62.0 1—5 yrs. 88 3,917 RAYNESPARK Under 1 yr. 1,099 297 6,976 153 56.9 1—5 yrs. 46 4,661 PARISH HALL Under 1 yr. 22 — 22 3 11.3 1—5 yrs. — 12 ALL CENTRES Under 1 yr. 2,250 569 10,577 340 60.6 1—5 yrs. 138 9,845 "Excluding children known to have attended other centres. TABLE XIV. Attendances at all Centres over last 10 Years. Year No. of Infants attending during year No. of Women attending Maternity Clinics ATTENDANCES Infants Maternity Grand Total Primary under 1 yr. Total 1928 605 50 386 7,017 202 7,219 1929 657 44 394 8,751 175 8,926 1930 860 49 446 9,767 247 10,014 1931 1,586 190 1,030 15,299 447 15,746 1932 2,047 245 1,089 18,197 647 18,844 1933 1,863 220 825 18,724 540 19,264 1934 1,880 233 545 17,994 590 18,584 1935 1,936 253 654 18,800 622 19,422 1936 2,010 306 561 19,957 1,106 21,063 1937 2,250 358 569 20,422 1,450 21,872 35 36 TABLE XV. CHILDREN ATTENDING CENTRES DURING 1937. By Age Groups. Children born in MERTON CENTRE MORDEN CENTRE RAYNES PARK CENTRE PARISH HALL CENTRE ALL CENTRES Number attended Attendances Average attendances per child Number attended Attendances Average attendances per child Number attended Attendances Average attendances per child Number attended Attendances Average attendances per child Number attended Attendances Average attendances per child 1937 (1st year) 46 460 10.0 206 2,080 10.0 250 2,748 10.9 15 26 1.7 517 5,314 10.2 1936 (1st and 2nd year) 48 853 17.7 195 2,350 12.0 261 4,703 18.0 2 3 1.5 506 7,909 13.5 1935 (2nd and 3rd year) 43 446 10.3 150 1,145 7.6 205 1,553 7.5 4 4 1.0 402 3,148 7.8 1934 (3rd and 4th year) 40 300 7.5 148 896 6.0 159 828 5.2 1 1 1.0 348 2,025 5.8 1933 (4th and 5th year) 24 178 7.4 148 655 4.4 127 532 4.1 — — — 299 1,365 4.5 1932 (5th year) 13 71 5.4 68 319 4.6 97 273 2.8 — — — 178 663 3.7 All ages under 5 214 2,308 10.7 915 7,445 8.1 1,099 10,637 9.4 . 22 34 1.5 2,250 20,424 9.0 TABLE XVI. Number of Children under 1 Year and Expectant Mothers Attending' the Centres in Relation to the Registered Births. Year Registered births Infants under 1 year Mothers who attended either Ante-Natally or Post-Natally. Primary attendances Percentage of registered births Number attended Percentage of registered births 1926 333 124 37 1927 852 168 46 1928 392 386 98 50 12.7 1929 442 394 89 44 9.9 1930 452 446 98 49 10.8 1931 628 1,030 164 190 30.3 1932 770 1,089 141 245 31.8 1933 640 825 128 220 34.3 1934 770 545 70 233 30.2 1935 721 554 77 253 35.0 1936 789 561 71 806 89.0 1937 812 569 70 858 44.0 The Nelson Hospital Clinics. A maternity clinic is held at the Nelson Hospital every Tuesday afternoon in the charge of Mr. Leslie Williams, KR.C.S., for the ante-natal and postnatal examination of women who have booked for admission, or who have been confined in the hospital. An arrangement exists whereby Merton and Morden women attending the hospital clinic may receive dental treatment under the Council's scheme. On 14th January, 1937, an additional clinic was opened by the Hospital Committee in connection with the Maternity Department. This clinic which is held on alternate Thursdays, is attended by Dr. R. II. Dobbs from the Children's Department, University College Hospital, who sees children (with their mothers) subject to the under-mentioned conditions. (1) The clinic will be primarily for children up to the age of one year born in the hospital, and their mothers. (2) Others may attend on the recommendation of their usual medical attendant or the Medical Officer of Health for the district. (3) The clinic will be as nearly as possible for consultative purposes only. The hospital serves Wimbledon, Merton and Morden and to a small extent other neighbouring districts. The following 37 information kindly supplied by the Secretary relates to the activities of the hospital clinics during 1937:— Infant Clinic— Total attendances during the year— (1) By children under 1 year 630 (2) By children 1-5 years 23 Total 0-5 years 653 Number of children who first attended during the year, and who on the date of their first attendance were— All Districts. Merton & Morden only. (1) under 1 year 142 87 (2) 1-5 years 6 Number of children who attended during year and who at end of year were— All Districts. (1) under 1 year of age 102 (2) 1-5 years of age 46 Ante-Natal and Post-Natal Clinic— Ante- Post Number of attendances by natal. natal. women during the year 1,375 35 Number of women who attended during the year 276 12 (156 Merton (6 Merton & Morden) & Morden) When the work of the clinics provided by the Council and the hospital is considered together it will be observed that the percentage of babies born to residents of the district which come under clinic supervision rises to approximately 80, and the number of expectant mothers who receive assistance in the same way represents approximately 63% of the births. Health Visiting.—Home visiting was on a slightly larger scale than in the year before. 6,848 visits were made to mothers and children under 5 years, as shown below, compared with 6,660 in 1936. In addition 345 other visits were made for special purposes in connection with puerperal pyrexia, ophthalmia neonatorum, diphtheria swabbing, etc., whilst a further 338 visits were made to foster children under Infant Life Protection. To expectant mothers first visits 281 total visits 476 To children under one year first visits 892 total visits 2,716 To children 1-5 years total visits 3,656 Visits re puerperal pyrexia, ophthalmia and miscellaneous 345 Visits to foster children re Infant Life Protection 338 Total 7,531 38 Assisted Milk Scheme. The following table shows the number of persons assisted by the provision of fresh milk, and the extent of this assistance in each ward:— TABLE XVII. MILK GRANTS, 1937. Wards. Free Milk. Half-price. Individuals Families Pints Supplied Individuals Families Pints Supplied Abbey 8 8 2,701 6 5 568 Bushey Mead 40 31 5,481 17 14 8,079 Central 3 2 156 — — — Morden 2 2 400 4 3 950 Park 4 8 630 3 3 401 Ravensbury 19 17 3,580 14 12 1,682 Raynes Park 1 1 181 1 1 246 St. Helier 32 25 6,821 19 18 2,382 West Barnes 4 3 1,012 3 2 481 113 92 20,962 67 58 9,789 The quantity supplied during the last seven years was as follows:— Free Milk. Milk at half-price. 1931 15,280 pints 2,940 pints 1932 35,196 „ 4,309 „ 1933 30,245 „ 5,445 „ 1934 17,592 „ 8,236 „ 1935 18,855 „ 6,805 „ 1936 18,242 „ 10,656 „ 1937 20,962 „ 9,789 „ Convalescent Home Treatment. Through the agency of the Invalid Children's Aid Association 5 children were provided with convalescent home treatment, towards the cost of which the Council gave assistance. They were recommended for the following conditions:— Condition. Age of Child. Period of Treatment. *Bronchitis and Asthma 4 years. 14½ weeks. Debility following Pneumonia 4½ „ 19½ „ Cardiac debility and malnutrition 4 „ 15½ „ Debility 4¼ „ 12 „ Debility 4¼ „ 14 „ 75½ „ *Continued from previous year. 39 Orthopædic treatment. Children requiring hospital treatment for orthopædic defects are referred to the Nelson Hospital. The Council defrayed the cost of the attendance of another case for 3½ months at an Orthopædic Centre outside the district. Maternity Hospital Treatment. Under an arrangement with the Nelson Hospital maternity cases requiring in-patient treatment are referred to that institution. Complicated and puerperal pyrexia cases may also be sent to Queen Charlotte's Hospital. It is known that 448 of the notified births took place in hospitals or nursing homes, as compared with 400 in the year before. The proportion of institutional births is steadily increasing, the majority as a result of preference and not of necessity. The maternity cases referred to hospital from the Council's Clinics totalled 38. They were delivered in the following institutions:— The Nelson Hospital 7 The County Hospital, Kingston 28 Other hospitals 3 They were referred for the following reasons:— Obstetrical 16 Medical 3 Home conditions 19 (For cases admitted to hospital under the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, see page 68). Consultant Service. A specialist's opinion may be had in cases of obstructed labour, emergencies of pregnancy, or puerperal pyrexia. Two cases were assisted in this way during the year, one for post-maturity and breech presentation, and one for uterine inertia. Home Helps. Domestic assistance during confinement was arranged for 8 women during the year—free of cost in two instances, and on payment of part cost in six. Sterilised Maternity Outfits. Sterilised Outfits in sealed metal containers are available for use during confinement at the cost price of 6s. 0d. In necessitous cases they are supplied either at half-price or free of cost, Nine outfits were supplied—five at cost price, one at half-price and three free of cost. 40 Dental Scheme. There was a further increase in the work of the dental clinics. 314 mothers and children made 745 attendances as against 308 persons and 667 attendances in the year before. TABLE XVII1. ATTENDANCES AT DENTAL CLINIC, 1937. Centre referred from. No. who attended during year. No. of attendances made. MERTON Mothers 7 19 Children 25 45 Individuals 32 64 MORDEN Mothers 78 207 Children 88 187 Individuals 166 394 RAYNES PARK Mothers 34 124 Children 82 163 Individuals 116 287 ALL CENTRES Mothers 119 350 Children 195 395 Individuals 314 745 Number of sessions 53 Average attendances per session 14.0 The dental operations performed were as follows:— TABLE XIX. DENTAL SCHEME, 1937—Operations Performed. Extractions. Temporary teeth 561 Permanent teeth Fillings. 368 Temporary teeth 80 Permanent teeth 47 Dentures Supplied. No. of cases 31 No. of Local Anaesthetics Given — No. of Gases Given 258 41 Midwives. The Surrey County Council's scheme for a salaried midwifery service under the Midwives Act, 1936, was established in September, 1937. The scheme as far as this urban district is concerned provided for three salaried midwives—two appointed by the County Council and one by the District Council acting as agents for the County Council. The fees for the services of the midwives are:— As maternity nurse 35/As midwife 40/- Provision is made for a reduced fee in necessitous cases. The District Council's midwife commenced duty on September 13th, and the following facts summarise her work up to the end of the year:— Visits made— .By midwife Ante-natal 186 During confinement 416 To midwife Ante-natal 68 Post-natal 59 729 Cases conducted— Primip. Multip. Total. (a) As midwife Live 3 12 15 (b) As maternity Still — 1 1 nurse Live 1 1 2 Still — — — 4 14 18 Medical Aid Forms sent—8 Reasons for sending:— Discharging eyes 1 Rupture of Perineum 2 Pain in leg 1 Feebleness at birth 1 Prolonged 2nd Stage 1 Puerperal Pyrexia (mastitis) 1 Infantile convulsions 1 Number of the midwife's cases which attended the Council's ante-natal clinics 18 Percentage of total midwife's cases 100% 42 The extent to which the Council's midwife secures that her cases come under supervision at the maternity clinics as evidenced by these figures, clearly demonstrates the tremendous advantages to be gained by making salaried midwives officers of the Maternity and Child Welfare Authority. No other arrangement secures such complete co-ordination of the midwife's work with all the other branches of the maternity scheme. Compensation in the sum of 10/- was paid to a midwife in respect of 1 case referred to hospital from the maternity clinic. Voluntary Helpers. The Welfare Centres had the valuable assistance of 30 voluntary helpers during the year, the opening of an additional centre at the Parish Hall in Central Road creating a need for further help of this nature. There has never been any difficulty in securing willing workers for this part of the scheme, and the success of the Centres is in no small measure due to the very keen interest which these ladies take in their self appointed duties. INFANT LIFE PROTECTION. The Statutory provisions of the Children and Young Persons Acts, 1908-32, have been re-enacted in Part VII of the Public Health Act, 1936, which repeals the earlier Acts. The five Health Visitors are Protection Visitors for the purposes of this Act, each in her own district. The main facts relating to the supervision of foster children during the year are as follows:— Registered homes under supervision during the year 50 Registered homes under supervision at end of year 26 New homes registered during the year 20 Children on the register during the year 51 Children on the register at the end of the year 27 Children brought on to the register during the year 31 Children removed out of the district 15 Visits paid to nurse children 338 Children died during the year Nil Legal proceedings Nil 43 SECTION C—SANITARY CIRCUMSTANCES. Water Supply. The district is supplied by the Metropolitan Water Board and by the Sutton District Water Company. Their respective distributive areas are approximately the parishes of Merton and Morden. The quality of the supply as shown by sampling was satisfactory. Drainage and Sewerage. The Surrey County Council's major scheme for the improvement of the Beverley and Pyl Brooks referred to in the report for 1936 was commenced in this district during the year. The Beverley and Pyl Brooks have been widened out and re-graded for their whole lengths, within the urban district, with the exception of the length of the Pyl Brook from West Barnes Crossing to the rear of Kingsway, which it is proposed to culvert as soon as negotiations are completed. Tenders have already been received for this work, and work on re-constructing the existing bridges is proceeding. Local schemes for the relief of flooding in Northway have been prepared, and it is hoped that a cure will be effected. Several open watercourses have been culverted during the past year in conjunction with the development of estates, notably— (a) The watercourse at the rear of West Barnes Pumping Station. (b) The watercourse at the rear of Morden Factory Estate. A length of old soil sewer in Burlington Road which had been found faulty has been reconstructed, and a further length will be shortly undertaken. In Morden Road consequent on the widening of the Bridge at Morden Halt, the soil sewer was found in a very bad condition, and this was also re-constructed. Rivers and Streams. Periodical visits are made for observing the condition of the River Wandle, the Pyl and Beverley Brooks, and the other natural watercourses in the district. The results of these inspections are detailed in the Sanitary Inspector's Report. Closet Accommodation. All closets are of water carriage type drained to sewers, except 4 which are drained to cesspools and 4 Elsan closets on Sports Grounds. 44 Public Cleansing. There is a weekly collection of house refuse. Trade refuse is also collected on payment of a moderate charge. Disposal is by incineration at the Council's destructor, the capacity of which was increased during the year by the addition of two further cells, making six in all. Pour moving floor Morris Dust Vans have been purchased to deal with the collection of refuse, and these vehicles have improved the collection service considerably. The practice of dusting the dust bins with a disinfectant powder was continued. Sanitary Inspection of the Area. The work performed in the sanitary inspection of the district is set out in the Sanitary Inspector's Report which follows :— REPORT OP SANITARY INSPECTOR. Mr. Chairman, Ladies and Gentlemen, I beg to submit the Annual Report which briefly reviews the work of the Sanitary Inspectors during the year 3937. Housing Inspections. The total number of houses inspected during the year for housing defects under the Public Health Acts and Housing Acts was 296. A systematic inspection of working class houses was carried out and in this connection 105 houses in the undermentioned roads were subjected to detailed survey and the necessary particulars recorded in accordance with the Housing Consolidated Regulations:— No. of houses. Crown Road 1 Dorien Road 91 Edna Road 1 High Path 1 Kingston Road 1 London Road 2 Meadow Road 1 Milner Road 1 Nelson Grove Road 2 St. Mary's Road 1 Sandringham Avenue 3 105 45 Notices to execute the necessary repairs were served upon owners of properties as follows:— Intimation Notices. Statutory Notices. Public Health Acts 100 Public Health Acts 14 Housing Act, 1930 108 Housing Act, 1930 10 208 24 The majority of the repairs were executed by the owners as the result of the service of informal notices. No works were undertaken by the Council in default of owners and no legal proceedings were taken duriug the year. Details of the work carried out and of the sanitary improvements effected at dwelling houses are included in the summary at page 51. Disinfestation. The number of houses found upon inspection to be infested with bed bugs was:— Council Houses Other Houses Total 20 14 34 Of the 34 houses infested, 22 were treated by spraying with insecticides and 12 by fumigation with either sulphur-dioxide or other approved proprietary fumigant. The household effects of two families were treated with HCN gas (van disinfestation) before removal into Council houses. Drainage Work. The number of notices served relating to obstructed or defective drains was 148. At 13 houses the drainage systems were entirely reconstructed and at 31 houses extensive repairs to drains were carried out. Smoke and water tests were applied to the drains of houses in 50 instances and obstructions were removed from the drains at 101 houses. Infectious Diseases and Disinfection. For the purpose of obtaining information as to the source of infection and for taking steps to prevent the spread of the disease enquiries were made in respect of 185 cases of notifiable diseases as compared with 180 cases in 1936. Disinfection of rooms was carried out and bedding and clothing removed for steam disinfection after the removal of patients to the Isolation Hospital or on the recovery of each patient treated at home. The number of rooms disinfected was 243. Food Supply. The total number of inspections made to premises where articles of food are prepared or exposed for sale was 565. These premises include butcher's shops, fish shops, greengrocers, provision dealers, cooked meat shops, 46 refreshment houses and bakehouses. Eight infringements of the Public Health (Meat) Regulations, 1924, were discovered, and remedied during the year. Twenty-three premises used for the manufacture of "preserved meat" and forty-four manufacturers, dealers, or vendors of ice-cream were registered during 1937, in accordance with Section 89 of the Merton and Morden Council Act, 1936. Meat Inspection. CARCASES INSPECTED AND CONDEMNED. Cattle Cows Calves Sheep Pigs Number killed None Number inspected None No animals were slaughtered in the district during the year. Practically all meat sold locally conies from wholesale markets outside the district. Slaughter Houses. At the end of 1937 there were 3 private slaughter houses on the Register which are used intermittently for the slaughter of pigs and sheep. One slaughter house is registered and is situated at High Street. Merton, and 2 slaughter houses at Garth Road, Lower Morden are licensed annually. No notices of intention to slaughter were received during 1937 but 28 inspections were made at slaughter houses to ascertain whether any animals were being killed. Milk Supply. At the 31st December, 1937, there were two cow-keepers on the Register, providing accommodation for about 50 cows. The number of retail purveyors carrying on the trade in the district during the year was 56, including 22 retailers whose premises are situated in adjoining districts. One hundred and fourteen inspections were made to cow-sheds, dairies and milk-shops during 1937. Milk (Special Designations) Order, 1936. The following licences were granted to dealers by the Local Authority under the Order, and were in force at 31st December, 1937. Designation. No. "Pasteurised" 18 "Tuberculin Tested" 8 Supplementary Licences. "Pasteurised" 2 "Tuberculin Tested" 3 Licence in respect of Pasteurising Establishment 1 47 Inspections of these licensed premises were carried out at regular intervals during the year in order to see that the conditions of the licences were being observed. Fifteen samples of graded milk were obtained for bacteriological examination and the report on each sample was satisfactory. Two samples were submitted for biological examination with negative results. Food and Drugs (Adulteration) Act, 1928. The abovementioned Act is administered by the Surrey County Council and during 1937 samples were obtained by the County Inspectors and submitted to the public analyst as follows:— Articles. Analysed. Adulterated or Deteriorated. Formal. Informal. Total. Formal. Informal. Total. Milk 35 2 37 1 - 1 Butter 2 — 2 — — — Cream 1 — 1 2 — 2 Meat 7 — 7 — — — Other articles 5 — 5 — — — Totals 50 2 52 3 — 3 Factories and Workshops. The number of inspections made to premises registered under the Factories and Workshops Act was 81. Particulars of the matters dealt with will be found in the table at page 57. The following list indicates the nature of the industries carried on at the larger factories in the district:— Trade. No. Trade. No. Accumulator Makers 1 Electrical Engineering 1 Aero Engines 1 Electric Lamp Manufacturers 3 Breeze Block Manufacturers 2 Engineering 7 Carpentry and Joinery 3 Fibre Board Manufacturers 1 Coach Builders 1 Colour Printers 1 Film Laboratories 1 Furniture Makers I Film Studios 1 Instrument Makers 3 Saw Mills 2 Laundries 7 Seed Merchants 1 Manufacturing Chemists 1 Sewing Machines 1 Meat and Fish Pastes 1 Silk Printers 2 Metal Printers 2 Sports Outfitters 1 Motor Engineers 11 Time Switches 1 Office Equipment 1 Toy Manufacturers 2 Oxygen Manufacturers 1 Timber Merchants 1 Photographic Printers 1 Varnish Makers 1 Printers 3 Wholesale Stationers 1 48 Smoke Abatement. During the year 82 observations were made of factory chimneys for the purpose of detecting offences. Smoke and grit nuisances were discovered in five instances and after appropriate action being taken by the Department amendments were carried out to abate the nuisances. Rats and Mice Destruction. The Rats and Mice Destruction Act, 1919, is administered by the Council, the Surrey County Council having delegated their powers to the local authority. The number of visits made to infested premises during the year was 330. Watercourses. The number of inspections made to watercourses and ditches during the year was 81, and in 5 instances pollutions of the watercourses were detected, and appropriate action was taken and the nuisances remedied. Mosquitoes.—As in previous years paraffin spraying of numerous ditches, ponds and watercourses was again carried out at fortnightly intervals during the breeding season. Offensive Trades. There is one offensive trade carried on in the district, i.e., a fat extractor. The factory is situated at Garth Road, Lower Morden, and was rebuilt and modernised in the year 1935. Operations at this factory were suspended during 1936 and the premises were not in use during the year under review. New Byelaws regulating offensive trades were adopted by the Council in the year 1933. Shops Acts, 1912-1936. The following statement summarises the inspections made, the infringements discovered and other matters dealt with during the year:— No. of Inspections—Day Visits—628. Evening Visits—74. Infringements. (1) Evening closing hours—16. (2) Half-day closing—5. (3) Hours of employment of young persons—17. (4) Insufficient sanitary accommodation—Nil. (5) Seats not provided for female Shop Assistants—Nil. (6) Prescribed notices not exhibited—72. Heating facilities provided at shops—4. 49 Council's Ambulance. The total number of calls received by the ambulance provided by the Council for use in noninfectious cases and accidents was 762, of which 339 were street accidents and the remainder were removals to or from hospitals or institutions. The total mileage during the year was 5,373. The following table shows the calls made upon the ambulance service during the past five years:— Year. Accidents. Hospitals. Total. 1937 339 4'23 762 1936 331 404 735 1935 332 436 768 1934 332 409 741 1933 272 304 576 I am, Ladies and Gentlemen, Your obedient Servant, J. B. POINTON, Chief Sanitary Inspector 16th May, 1938. 50 SUMMARY OF NUISANCES ABATED AND SANITARY IMPROVEMENTS EFFECTED. Ceilings cleansed or repaired 174 Coppers provided or repaired 9 Dampness in premises remedied 55 Drains exposed and repaired 31 Drains reconstructed 13 Defective sashcords renewed 68 Drinking-water cisterns cleaned out 3 Drinking-water cistern covers provided 1 Drinking-water cisterns renewed 3 Dustbins provided 22 Floors repaired 46 Forecourts drained — Fresh-air inlet valves provided and repaired 17 Inspection chamber covers provided 4 Obstructions removed from drains 146 Rain-water pipes renewed or repaired 7 Rooms cleansed 124 Roofs repaired 74 Gutters repaired or renewed 42 Stoppers provided to intercepting traps Sink wastes repaired or renewed 20 Walls repaired 119 W.C. cisterns provided 3 W.C. cisterns repaired 21 Water closets cleansed 22 W.C. approaches screened W.C. pans provided 12 Windows repaired or renewed 82 Yards paved or repaved 36 Stoves renewed or repaired 51 Sinks provided 3 Offensive accumulations removed 5 Water supply provided for domestic use 6 Verminous premises fumigated and cleansed 34 Ventilation provided under floors 8 Sanitary accommodation provided for workshops 1 Miscellaneous 110 Total number of Inspections 6,175 Notices served— Intimation Notices 355 Statutory Notices 25 Outstanding Notices at 31st December, 1937 9 61 Disinfestation. Details of bed bug infestation and the action taken is given in the Sanitary Inspector's report. Fumigation with H.C.N. is carried out by a private contractor. Spraying is done by the department. Particular attention is given to Council houses. The homes of prospective tenants are visited, and where infestation is found or suspected appropriate action is taken to rid the household effects from vermin before they are admitted to the new house. Similarly the Council house is visited when vacated to ensure that it is free from vermin and fit for the incoming tenant. New tenants known to have been verminous at one time are kept under frequent observation. Cemeteries. Plans have now been approved for the layout of part of the 33-acre site in Lower Morden, which was acquired by the Council for burial purposes in 1927. Schools. The public elementary and secondary schools are under the control of the Surrey County Council. The Department works in co-operation with the County School Medical Service in the control of infectious disease and in all sanitary matters affecting the health of school children. Policy is based on the recommendations contained in the "Memorandum on Closure and Exclusion from School 1927" issued conjointly by the Ministry of Health and Board of Education. The sanitary conditions and water supply of the schools are satisfactory. Health Propaganda. The Council participated in the Surrey County Health Campaign which was a conjoined effort by the County Council and the majority of the Authorities of the more urbanised districts. A programme of activities was organised for the period October 1937 to March 1938 to coincide with the National Campaign. A series of five Health Days— one in each month except December was held, when films were shown to school children in local cinemas and meetings were organised in the afternoon for mothers and in the evening for all members of the public, at which addresses were given by experienced speakers with special knowledge of various health topics. These talks, too, were illustrated by films. 52 SECTION D—HOUSING. New Houses. The new houses erected during the year were:— Wards. By the Local Authority. By the London County Council. By other bodies or persons. Total. Flats H'ses Abbey - - 208 — 208 Busbey Mead - - — 33 33 Central - — 47 365 412 Morden - - 28 805 833 Park - - — 13 13 Ravensburv - — 11 129 40 Raynes Park - — 31 104 135 St. Helier - — 124 — 124 West Barnes — — — 20 20 Whole district — — 149 1.369 1,818 The total of 1,818 new dwellings compares with 1.393 erected in the year before. Council's Housing Scheme. The houses erected or acquired by the Council under the various Acts are as follows :— Act. Type Total Cotts. N.P.2 N.P.3 N.P.4 P.3 P.4 Housing Act, 1919 (Assisted Scheme) 2 16 54 8 282 76 438 Housing Act 1924 — — 100 - — — 100 Housing Act 1930 — - 2 - — — 2 Total 2 16 156 8 282 76 540 The position with regard to applications during 1937 was as follows:— Number of eligible applications received by the Council for houses during 1937 81 Total number of eligible applications on the files at 31st December, 1937 161 Number of houses allotted to tenants during 1937 48 (An eligible applicant is one with a family resident in the district). 53 Housing Act, 1936—Overcrowding. At the overcrowding survey conducted under the 1935 Act in May, 1936, 149 dwellings were found to be overcrowded, involving 1,043 equivalent adults. By the beginning of 1937 the number of cases was reduced to 120, involving 824½ equivalent adults. During the year under review the nett reduction in the number of overcrowded families was 88, leaving at 31st December, 1937, 58 overcrowded dwellings housing 3994 equivalent adults yet to be decrowded. Details of the overcrowding and decrowding in the individual wards is shown in the following table:— Wards. Overcrowded at end of 1936 Subsequently, found to be overcrowded Decrowded during the year. Overcrowded at end of 1937. Abbey 10 2 7 5 Bushey Mead 10 (a) 1 9 (e) 2 Central - — — — Morden 5 2 5 2 Park - 3 2 1 Ravenebury 38 (b) 8 (c) 26 (d) 20 (f) Raynes Park — — — St. Helier 57 (b) 10 (b) 39 (b) 28 (b) West Barnes - - — — Whole district 120 26 88 58 (a) Includes 1 Merton and Morden house. (b) All London County Council houses. (c) Includes 5 London County Council houses. (d) Includes 24 London County Council houses. (e) Includes 2 Merton and Morden houses. (f) Includes 19 London County Council houses. The 26 new cases of overcrowding which came to notice during the year occurred in the following manner:— By natural growth of the family in occupation on the appointed day 16 Otherwise than by natural growth of family (including illegal overcrowding) 10 Decrowding was effected in the 88 instances in the following ways:— Family offered alternative accommodation 48 Lodgers or relatives offered alternative accommodation 2 Death of any of occupants 2 Marriage or removal of members of family 26 Family removed out of district 10 54 Alternative accommodation was provided:— In Merton and Morden Council houses in 14 instances. By the London County Council in 36 instances. Inspection and Action Taken. The following is a summarised statement of the work relating to housing carried out under the Housing and Public Health Acts:— 1. Inspection of Dwelling houses during the year:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 296 (b) Number of inspections made for the purposes 296 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 105 (b) Number of inspections made for the purposes 105 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 208 2. Remedy of Defects during the year without Service of formal Notices:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 175 3. Action under Statutory Powers during the Year-.— A.—Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936: (1) Number of dwelling house's in respect of which notices were served requiring repairs 10 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 9 (b) By local authority in default of owners Nil. 55 B.—Proceedings under Public Health Acts (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 14 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 14 (b) By local authority in default of owners Nil. C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936: (1) Number of dwelling houses in respect of which Demolition Orders were made 1 (2) Number of dwelling houses demolished in pursuance of Demolition Orders Nil. D.—Proceedings under Section 12 of the Housing Act, 1936: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil. (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil. 4. Housing Act, 1936—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 58 (ii) Number of families dwelling therein 58 (iii) Number of persons dwelling therein— Aged 10 years and over 352 Under 10 years 95 (b) Number of new cases of overcrowding reported during the year 26 (c) (i) Number of cases of overcrowding relieved during the year 88 (ii) Number of persons concerned in such cases- Aged 10 years and over 513 Under 10 years 135 (d) Number of dwelling houses which have again become overcrowded after Local Authority has taken steps to abate overcrowding Nil. 56 FACTORY & WORKSHOP ACT, 1901. 1. Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections. Written Notices. Occupiers prosecuted. (1) (2) (3) (4) Factories (including Factory Laundries) 49 2 - Workshops (including Workshop Laundries) 32 - Workplaces (other than Outworkers' premises) — — — Total 81 2 — 2. Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. N umber of offences in respect of which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 2 2 — - Want of ventilation — — — - Overcrowding — — — - Want of drainage of floors - - - - Other nuisances — — - - Sanitary accommodation Insufficient 2 2 - - Unsuitable or defective 1 1 - - Not separate for sexes — — - — Offences under the I1 actory and Workshop Acts: — Illegal occupation of underground bakehouse (s. 101) - - - - Other offences — — - - (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921). Total 5 5 - - Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 57 OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. Nature of Work. Instances. Notices served. Prosecutions. (1) (2) (3) (4) Wearing Apparel: — Making, etc. N I L Cleaning and washing Household linen Lace, lace curtains and nets Curtains and furniture hangings Furniture and upholstery Electro-plate File making Brass and brass articles Fur pulling Cables and chains Anchors and grapnels Cart gear Locks, latches and keys Umbrellas, etc. Artificial flowers Nets, other than wire nets Tents Sacks Racquet and tennis balls Paper, etc., boxes, paper bags Brush making Pea picking Feather sorting Carding, etc., of buttons, etc. Stuffed toys Basket making Chocolates and sweetmeats Cosaques, Christmas crackers, Christmas stockings, etc. Textile weaving Lampshades 68 SECTION E—INSPECTION AND SUPERVISION OF FOOD. (See Sanitary Inspector's Report, on page 46). SECTION F—INFECTIOUS ILLNESS. Notification. The following diseases are notifiable in the Urban District:— Cholera. Plague. Cerebrospinal fever. Acute Primary pneumonia. Continued fever. Acute influenzal pneumonia. Diphtheria (including mem- Acute Poliomyelitis. branous croup). Acute Polioencephalitis. Dysentery. Puerperal Pyrexia. Enteric Fever (including Relapsing fever. paratyphoid fevers). Scarlet fever. Erysipelas. Smallpox. Encephalitis Lethargica. Trench fever. Food poisoning. Typhus fever. Malaria. Tuberculosis (all forms). Ophthalmia Neonatorum. Smallpox. No notifications were received. Enteric Fever. One case of typhoid fever was notified in the person of a visitor to the district, a man of 56 years who had temporarily resided in South Croydon at the time when his infection probably occurred, and at the time when that particular part of Croydon was at risk from the infected water supply. The patient was admitted to isolation hospital and succumbed to the disease. Dysentery. In October an unusual incidence of diarrhoea was observed, which persisted into the Spring of 1938. The symptoms were diarrhoea, colicky pain in the abdomen, and in a proportion of cases vomiting. The looseness of the bowels was accompanied in some cases by mucus and blood. The attack which was mildly febrile lasted in the majority a matter of two or three days only. Although on the whole a mild type of illness an occasional case with marked prostration was observed, particularly in the elderly. It affected both sexes and all ages indiscriminately. A series of faecal specimens were examined early in the outbreak, and in six consecutive cases Sonne's bacillus was isolated. This information was circulated to the practitioners in the area with suggestions as to the advice to be tendered to sufferers, to minimise spread of the infection. As a result of this a number of notifications of Dysentery were received during November and December, and into 1938, but in view of the fact that the majority of cases were mild and of short duration, practitioners were in some difficulty in deciding 59 whether any particular patient could justifiably be considered to be suffering from Dysentery. There is no doubt that the number of notifications received, which totalled 19, represented only the severer cases of this infection, and formed only a small part of the total. None of the cases was admitted to isolation hospital, although some received treatment in general hospitals. Enquiries which were made failed to identify any particular food or drink as the primary source of infection, but it is probable that the illness owed its persistence to a large extent to mild ambulatory cases, or to incompletely recovered cases handling food stuffs consumed by other members of the public. Scarlet Fever. The incidence of scarlet fever, again of a mild type, was much the same as in the year before. 129 cases were notified compared with 127 in 1936, giving an incidence rate of 1.96 per 1,000 population, as compared with a rate of 2.33 for the country as a whole. Of the total cases 115 (89 per cent.) were removed to isolation hospital. It was more prevalent in the three wards—Bushey Mead, Ravensbury and St. Helier which have the densest populations. The summer months had the lightest incidence. There were no "return" cases. No person died of scarlet fever during the year. TABLE XX. SCARLET FEVER—MONTHLY DISTRIBUTION. 1937 Wards. Total. Abbey. Bushey Mead. Central. Morden. Park. Ravensbury. Raynes Park. St. Helier. West Barnes. January 1 - - — 4 2 — 3 1 11 February — 1 1 1 4 3 1 — - 11 March — 4 6 1 3 1 - 2 2 19 April — 1 1 2 1 1 - 5 — 11 May - - - - - 3 1 6 - 10 June 1 - 1 — 1 1 - — - 4 July 2 — — 2 1 — 1 — 3 9 August 2 — — 1 1 1 - 1 — 6 September — 1 1 — 1 3 - 1 1 8 October 2 — 1 1 2 7 - 2 3 18 November — 4 1 1 — 2 2 1 1 12 December — - 1 1 1 1 2 1 3 10 Total 8 11 13 10 19 25 7 22 14 129 Monthly mean .66 .91 1.08 .83 1.58 2.08 .58 1.83 1.17 10.7 60 The incidence in the various wards is shown below, together with corresponding figures for 1936. Wards. Cases. Incidence per 1,000 population, 1937 Incidence per 1,000 population, 1936 Abbey 8 1.0 1.1 Bushey Mead 11 1.0 3.3 Central 13 1.0 1.8 Morden 10 2 2 0.9 Park 19 1.9 1.8 Ravensbury 25 3.3 3.2 Raynes Park 7 1.0 0.8 St. Helier 22 1.8 2.2 West Barnes 14 2.8 1.4 TABLE XXI. SCARLET FEVER—MULTIPLE CASES OCCURRING IN DOMESTIC DWELLINGS. Wards. Total cases in houses in each Ward. No. of houses in which occurred. No. of houses with cases. 1 case 2 cases. 3 cases. 4 cases. Abbey 8 6 1 — - 7 Bushey Mea l 11 9 ] — - 10 Central 13 13 — — - 13 Morden 10 10 — — - 10 Park 17 15 1 — - 16 Ravensbury 24 24 — - - 24 Raynes Park 7 7 — - - 7 St. Helier 22 20 1 — - 21 West Barnes 14 9 1 1 — 11 Whole district 126 113 5 1 - 119 (3 further cases occurred in institutions). 61 TABLE XXII. INCIDENCE AND FATALITY OF SCARLET FEVER OYER LAST 20 YEARS. Year. Population. No. of eases. Incidence rate per 1,000 population. No. of deaths. Percentage of deaths to cases. 1918 15,000 * * * * 1919 18,100 20 1.1 ... ... 1920 18,200 65 3.5 ... ... 1921 18,000 120 6.6 ... ... 1922 18,500 120 6.4 ... ... 1923 18.750 65 3.4 ... ... 1924 18,710 75 4.0 ... ... 1925 18,960 74 3.9 1 1.3% 1926 19,980 70 3.5 ... ... 1927 21,850 95 4.3 1 1.05% 1928 25,780 59 2.2 ... ... 1929 27,430 121 4.4 ... ... 1930 35,000 109 3.1 ... ... 1931 41,610 132 3.2 3 2.2% 1932 48,550 118 2.4 ... ... 1933 52,130 219 4.2 ... ... 1934 55,550 335 6.03 ... ... 1935 57,440 149 2.59 ... ... 1936 61,000 127 2.09 1 0.7% 1937 65,530 129 1.96 ... ... *No figures available. Diphtheria. The year 1936 was an exceptionally favourable one in respect of diphtheria prevalence. The year under review improved still further on 1936. Twenty-two cases were notified compared with 28 in the year before, and the incidence rate falls further to 0.33 per 1,000 of the population, which is again a record low one for the district. It compares with a corresponding rate for England and Wales of 1.49. The figures in respect of the various wards show that for 1937 incidence was heaviest in the Park Ward where social conditions are probably the least favourable for the spread of infectious disease. This somewhat unusual feature is no doubt partly due to the influence of artificial immunisation which during the last two or three years has been fairly extensively practised through the public services on the St. Helier Estate, and in those wards which make more use of clinic facilities. Four deaths resulted from diphtheria. One was a male aged 3 years and three were females aged 5 years, 2 years and 11 months. This gives a death rate for diphtheria of 0.06 per 1,000 population compared with a rate of 0.07 for England and Wales. 62 TABLE XXIII. DIPHTHERIA, 1937—WARD INCIDENCE. Wards. Cases. Rate per 1,000 population 1937. Abbey 1 0.2 Bushey Mead 3 0.3 Central 1 0.1 Morden 2 0.4 Park 6 0.6 Kavensbury 3 0.4 Raynes Park — — St. Helier 5 0.4 West Barnes 1 0.1 Whole district 22 0.33 TABLE XXIV. DIPHTHERIA—MONTHLY DISTRIBUTION, 1937. 1937 Wards. Total. Abbey. Bushey Mead. Central. Morden. Park. Kavensbury. Raynes Park. St. Helier. We6t Barnes. January - - — - 1 1 — 1 - 3 February - - - - - - - - - - March - - - - 3 - - - - 3 April - - - - - - - 2 - 2 May - - - - - - - - 1 1 June - 1 - - - - - - - 1 July - - - - - 1 - - - 1 August - - - - - - - - - - September - 1 - - - - - - - 1 October - 1 1 — 2 1 — — - 5 November 1 — — 2 — — - 1 - 4 December - - - - - - - 1 — 1 Total 1 8 1 2 6 3 — 5 1 22 Monthly mean .08 .25 .08 .16 .50 .25 — .41 .08 1.83 63 The number of houses affected and details of multiple cases is shown below. TABLE XXV. DIPHTHERIA—MULTIPLE CASES OCCURRING IN DOMESTIC DWELLINGS, 1937. Wards. Total cases. No. of houses with No. of houses with cases. 1 Case. 2 Cases. 3 Cases. 4 Cases. Abbey 1 1 - — — 1 Bushey Mead 3 3 - - - 3 Central 1 1 - — — 1 Morden 2 2 - — — 2 Park 6 2 - — 1 3 Ravensbury 3 3 - — — 3 Raynes Park — — - — - — St. Helier 5 5 - — - 5 West Barnes 1 1 - — - 1 Whole district 22 18 — - 1 19 TABLE XXVI. DIPHTHERIA—INCIDENCE BY AGE GROUPS. AGE GROUPS Total all Ages Under 1 year 1-2 years 2-3 years 3-4 years 4-5 years 5-10 years 10-15 years 15-25 years 25-35 years 35-45 years Over 45 years Cases 1 — — 2 3 6 4 5 — — 1 22 Seventy-two per cent. of the cases were in children of school or pre-school age. 36,000 units of anti-toxic serum were issued to practitioners during the year, and 522 swabs were examined. Diphtheria Immunisation. The public facilities for protective inoculation were as described in the report for 1935. The most successful approach to parents is made by offering immunisation to their children at the schools. Whilst no scheme can be really effective which does not secure immunisation of a substantial proportion of pre-school children, 64 immunisation sessions held in the schools constitute the best means of protecting the 5-7 year-old groups, and better results could be obtained if the present practice, which is limited to the St. Helier Schools, was extended to the remaining infant departments in the district. The number of persons immunised during the year at the clinics, in schools, and by private practitioners under the scheme is shown in the following tables:— TABLE XXVII. PERSONS IMMUNISED AT CLINICS DURING 1937. Wards. Age Groups Total. 0-5 years 5-15 years 15 and over Abbey 9 3 - 12 Bushey Mead 34 19 — 53 Central 71 40 — 111 Morden 31 8 — 39 Park 22 21 1 44 Ravensbury 32 20 — 52 Raynes Park 40 25 — 65 St. Helier 47 22 — 69 West Barnes 42 15 - 57 Total 328 173 1 502 Total inoculations given at clinics in 1937 = 1,474. TABLE XXVIII. PERSONS IMMUNISED BY PRIVATE PRACTITIONERS 1937. Age Groups Wards 0-5 yeare 5-15 years 15 and over Total Abbey 1 1 — 2 Bushey Mead 4 2 — 6 Central — 1 — 1 Morden — — — — Park 6 1 — 7 Ravensbury — — — — Raynes Park 2 4 — 6 St. Helier — — — — West Barnes 3 2 — 5 Total 16 11 — 27 Total inoculations given by doctors, 1937 = 81. 65 TABLE XXIX. CHILDREN IMMUNISED IN SCHOOLS, 1937. School Incomplete Complete St. Helier No. 1 Infants 4 60 „ „ „ 2 „ 8 47 „ „ „ 3 „ 12 68 „ „ „ 4 „ 5 69 Holy Family R.C. Infants — 20 Total 29 264 Total inoculations given in schools in 1937 = 853. The number immunised at the clinics during the year increased by 119. The fall in the number of school children inoculated to something less than half is explained by the fact that 1936 was the first year in which school inoculation was practised, and the number of potential acceptances in 1937 fell a corresponding amount as only about half the children moved into the next senior department during the year. Since the first immunisation clinic was opened in May, 1934, the following number of persons have been immunised under the scheme:— At Clinics. By Doctors. In Schools. Total. 1934 93 28 — 121 1935 375 19 — 394 1936 383 13 664 1,060 1937 502 27 293 822 2,397 66 TABLE XXX. INCIDENCE AND FATALITY OF DIPHTHERIA, 1919-1937. Year. Population. No. of cases. Incidence rate per 1,000 population. No. of deaths. Percentage of deaths to cases. 1919 18,100 26 1.3 2 7.6% 1920 18,200 47 2.5 3 6 3% 1921 18,000 28 1.5 1 3.5% 1922 18,500 62 3.3 4 6.4% 1923 18,750 39 2.08 1 2.5% 1924 18,710 68 3.6 6 8.9% 1925 18,960 25 1.3 1 8.3% 1926 19,980 24 1.2 2 8.5% 1927 21,850 29 1.3 2 6.8% 1928 25,780 38 1.4 — - 1929 27,430 53 1.9 1 1.8% 1930 35,000 72 2.05 6 8.3% 1931 41,610 80 1.9 6 75% 1932 48,550 30 0.6 — - 1933 52,130 35 0.6 1 2.8% 1934 55,550 82 1.4 8 9.7% 1935 57,440 44 0.76 4 9.0% 1936 61,000 28 0.45 - - 1937 65,530 22 0.33 4 18.1% Cerebro-Spinal Meningitis. Two eases were notified— one a male infant of 13 months was admitted to hospital as a moderately severe type, and responded extremely well to serum treatment. It was discharged as recovered after 17 days. The other, a woman of 56 years, was admitted to isolation hospital but succumbed to the infection. Anterior Poliomyelitis. One case of a boy of 10 years was notified to be suffering from infantile paralysis. He was an in-patient for three months in a London Hospital and is now receiving out-patient treatment. Originally affected with paralysis of the right leg, there now remains some paresis of the foot, Measles. The biennial wave of measles did not coincide with 1937, and a total of 86 cases in school children were reported by the head teachers compared with 586 in the year before. Three cases were admitted to isolation hospital. There were no deaths. Whooping Cough. Whooping cough according to the school returns was slightly less prevalent. Eighty-one cases were reported among school children against 107 in the year before. + Two female infants aged 3 months and 3 years respectively died of the illness. This gives a death rate for this cause of 0.03 per 1,000 population. Three cases were admitted to isolation hospital. Erysipelas. Ten notifications were received. Five cases received hospital treatment, and five were treated at home. The sites affected were the face in 9 instances and the leg in one. There were no deaths. Puerperal Pyrexia. The notifications received under the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations were as follows:— Puerperal Pyrexia 2 Puerperal Fever 1 The incidence rates for these conditions were:— Puerperal Pyrexia 2.38 per 1,000 total births. Puerperal Fever 1.19 „ „ „ „ The following are the main facts concerning these cases:— (1) Puerperal Fever—5th pregnancy. Onset on third day of puerperium—hemolytic streptococcal infection giving rise to septic pelvic thrombosis and pulmonary embolism. Admitted to isolation hospital. Died. (2) Puerperal Pyrexia—3rd pregnancy. Illness due to pleuro-pneumonia. Onset prior to labour. Admitted to hospital. Died. (3) Puerperal Pyrexia—1st pregnancy. Onset 11th day—Cassarian section for breech presentation. Pyrexia due to breast abscess. Recovered. Ophthalmia Neonatorum. Five cases were notified. One was a severe gonococcal infection but recovered after treatment in a special hospital. The remaining four were milder cases, one being a staphylococcal infection. All completely recovered after home treatment. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Death. Notified. Treated At Home In Hosp. 5 4 1 5 — - — 68 Prevention of Blindness. Information as to blindness occurring in children under five years coming to our notice through the Maternity and Child Welfare Scheme is transmitted to the Surrey Voluntary Association for the Blind in accordance with the recommendation contained in Memo. 162,/B.D. No action was taken under Section 66 of the Public Health Act, 1925, nor under Section 176 of the Public Health Act, 1936. Pneumonia. As mentioned earlier in this report the respiratory infections were more numerous in 1937 than in the year before. The number of notifications of pneumonia was correspondingly larger. Ninety cases were notified, of which 39 were stated to be influenzal in origin. This is more than twice the number in the year before. Eleven were babies under 2 years of age. Food Poisoning. Six instances of suspected food poisoning were reported. In three, in each of which only one person was affected, there was not sufficient evidence to establish whether any particular food was the cause. The symptoms in one of these suggested a Sonne infection, and the other two were notified too late for any useful investigation to be undertaken. The patients in all three instances recovered after a sharp attack of diarrhoea and abdominal pain. The suspected foods in two of these cases were:— (1) Fried sole. (2) Duck eggs. The remaining three instances were of a more definite nature. One was the case of a man who presented mild symptoms of botulism. Beginning with diarrhoea and sickness he later developed pains in the joints, with double vision and affection of his speech. Although there were 7 other members in the family he was the only one affected, and there was no single article of food which he alone partook of. Tinned cream and duck eggs had been consumed prior to the onset. There were no remnants which could be examined. The patient recovered. In another instance three members of one family, father, mother and baby, were attacked with sickness, diarrhoea and abdominal pain, the father suffering considerably more than the other two. Salmonella Aertryke was isolated from specimens from the father and baby. There is no doubt that the illness in the mother also was of the same nature. Enquiries elicited the information that the father had partaken of an imported duck egg, which was believed to be the origin of 69 the poisoning. The illness in the mother and baby which was milder was explained by the fact that the mother had eaten a hen's egg and the baby bread, both fried with, and at the same time as, the duck egg. Alternatively it was possible that the mother contaminated her fingers when breaking the duck egg and conveyed the infection to her own food, and that of the baby. All three patients recovered. The remaining instance was known to have affected 7 persons in three families, all of whom had purchased portions of a veal and ham pie from the same purveyor on the same day. The probability is that all these portions were from the same single pie, which itself was one of a batch. The onset varied from 2 to 5 hours after ingestion, and the symptoms were sickness, diarrhoea and abdominal pain. Examination of the remains of the pie revealed numerous staphylococci, and the symptoms were compatible with staphylococcal toxin poisoning. All patients recovered. 70 71 TABLE XXXI. INFECTIOUS DISEASES, NOTIFICATION DEATHS AND DISTRIBUTION, 1937. Disease Cases Notified Case rate per 1,000 Population Deaths among notified cases Percentage of deaths to cases Distribution of cases Wards No. of cases removed to hospital Percentage of cases removed to hospital Abbey Bushey Mead Central Morden Park Ravensbury Raynes Park St. Helier West Barnes Smallpox - - - - - - - - - - - - - - - Scarlet Fever 129 1.96 — — 8 11 13 12 19 25 7 22 14 115 89% Diphtheria 22 0.33 4 18% 1 3 1 6 3 — 5 1 22 100% Enteric Fever 1 0.01 1 100% — — — 1 - - — - - 1 100% 100% Cerebro-Spinal Meningitis 2 0.03 1 50% — — — — 1 — 1 — - 2 Puerperal Pyrexia 2 0.03 1 50% — — — — 1 — — 1 - 2 100% Puerperal Fever 1 0.01 1 100% — — — - 1 — — — - 1 100% Erysipelas 10 0.15 — — — 2 1 — 4 2 — 1 - 5 50% Pneumonia 51 0.77 4 7% 4 7 1 3 7 17 5 6 1 - - Poliomyelitis 1 0.01 — — — — — - — — 1 — - 1 100% Relapsing Fever — — — — - — — - — — — — - - Typhus Fever — — — — — — — - — — — — - - - Dysentery 19 0.28 — — — 8 — 2 2 3 1 3 - - - Encephalitis Lethargica — — — - - — — - — — — — - - - Ophthalmia Neonatorum 5 0.07 — — — 1 — — 2 2 — — - 1 20% Plague — — — — — — — — — — — — - - - Malaria — — — — — — — — - - - - - - - Influenzal Pneumonia 39 0.59 - — 1 2 9 — 2 2 8 3 12 - — *Number admitted to isolation hospital only. TABLE XXXII. NOTIFICATION OF INFECTIOUS DISEASES (other than Tuberculosis) by Age Groups during the year 1937. Disease. TOTAL CASES NOTIFIED. Total Cases at all Ages. Under 1 year 1-2 2-3 3-4 4-5 5-10 10-15 15-25 25-35 35-45 45-65 65 and over Smallpox - - - - - - - - - - - - - Scarlet Fever - 4 6 7 14 65 18 6 4 2 3 - 129 Diphtheria (including Membranous Croup) 1 — — 2 3 6 4 5 — - 1 - 22 Enteric Fever (including Paratyphoid) - - - - - - - - - - 1 - 1 Puerperal Fever - - - - - - - - 1 - - - 1 Puerperal Pyrexia - - - - - - - - 2 - - - 2 Acute Primary Pneumonia 4 3 3 1 1 5 1 3 4 4 16 6 51 Acute Influenzal Pneumonia 3 1 2 - 3 5 3 5 2 5 6 4 39 Cerebro Spinal Fever - 1 - - - - - - - - 1 - 2 Acute Poliomyelitis - - - - - - 1 — - - - - 1 Acute Polio Encephalitis - - - - - — - - - - - - - Encephalitis Lethargica — — — - - — — — — — — - — Dysentery - 1 1 - 1 6 1 2 3 2 2 - 19 Malaria - - - - - - - - - - - - - Ophthalmia Neonatorum 5 - - - - - - - - - - - 5 Erysipelas - - - - - - 1 - - 2 4 3 10 Plague - - - - - — - - - — - - - Relapsing Fever — — - — - — — — — — - — — Typhus Fever — - — — — - - — - - — — - Totals 13 10 12 10 22 87 29 21 16 15 34 13 282 72 TABLE XXXIII. MONTHLY INCIDENCE OF INFECTIOUS DISEASE, 1937. Disease. Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Totals Smallpox - - - - - - - - - - - - - Scarlet Fever 11 11 19 11 10 4 9 6 8 18 12 10 129 Diphtheria 3 - 3 2 1 1 1 - 1 5 4 1 22 Dysentery - - - - - - - - - - 11 8 19 Enteric Fever - - - - - - - - - - 1 - 1 Cerebro-Spinal Meningitis 1 - - - - - 1 - - - - - 2 Pneumonia 13 2 8 3 1 1 2 1 - 5 6 9 51 Influenzal Pneumonia 18 6 2 4 1 - - - - 2 1 5 89 Erysipelas 3 3 1 - - 1 1 - - 1 - - 10 T.B. Pulmonary 8 8 9 7 7 6 3 4 3 6 10 9 80 T.B. Non-Pulmonary - 2 - 2 1 1 1 - 1 - 1 2 11 Ophthalmia Neonatorum - 1 - - 1 - 2 1 - - - 5 Puerperal Pyrexia and Fever 3 - - - - - - - - — — — 3 Poliomyelitis - - - - - — — 1 — — — 1 Encephalitis Lethargica - - - - - - - — - — — — - Malaria — — — — - — - — - - - - - Totals - 60 33 42 29 | 22 14 20 12 14 37 46 44 373 78 TUBERCULOSIS. New cases admitted to the register numbered 134, compared with 107 in the year before. These additions were:— Males. Females. Total Pulmonary 52 59 111 Non-Pulmonary 9 14 23 61 73 134 Eighty-nine were primary notifications, 42 were transferred from other districts, and 3 came to notice otherwise than by notification. The number transferred from other districts was one more than in 1936. During the year 87 names were removed from the register for the following reasons:— Thirteen recovered; 34 removed from the district; 40 died. The numbers remaining on the register at the end of the year were as shown in Table XXXIV. The incidence of notified tuberculosis on the St. Helier Estate at mid-year was 13.05 per 1,000 population, that in the rest of the district 5.6 per 1,000 population. The following table shows the state of the tuberculosis register at the year end and the ward incidence at mid-year:— TABLE XXXIV. TUBERCULOSIS REGISTER AT 31st DECEMBER, 1937, AND REGISTERED NUMBER OF TUBERCULOUS PERSONS PER 1,000 POPULATION AT MID-YEAR. Wards. Registered at December 31st. At Mi d-Year. Pulmonary. Non. Pulmonary. Total. Number on Register. Number on Register per 1,000 population. Abbey 24 5 29 30 6.9 Bushey Mead 54 9 63 61 8.0 Central 15 10 25 22 2.7 Morden 27 3 30 26 5.8 Park 53 6 59 61 6.1 Ravensbury 66 30 96 91 12.1 Raynes Park 29 4 33 34 5.2 St. Helier 115 35 150 139 11.9 West Barnes 24 8 32 32 4.8 Whole district 407 110 517 496 7.4 The total at December 31st is 47 more than at the corresponding date in 1936. 74 Deaths from tuberculosis numbered 40, 39 being due to pulmonary and one to non-pulmonary disease. The death rate for phthisis was 0.50 per 1,000 population, against a rate of 0.57 in the year before. The deaths are classified as to age and sex in Table XXXV. TABLE XXXV. DEATHS DUE TO TUBERCULOSIS, 1937. Ages Years. Pulmonary. Non-Pulmonary. Totals Males. Females. Males. Females. 0— - - - - - 1— — — — — — 5— — — 1 — 1 15— 4 4 - - 8 25— 3 6 - - 9 35— 7 1 - - 8 45— 3 - - - 3 55— 3 — - — 3 65— 1 1 - — 2 Totals 21 12 1 — 34 Three of the 34 deaths were in persons who had not been notified. These represent 9 per cent. of the total tuberculosis deaths. Institutional treatment was provided for 138 persons from this district as follows:— At the County Sanatorium, Milford 50 At other institutions 88 138 Two voluntary Tuberculosis Care Committees working in conjunction with the St. Helier and Wimbledon Dispensaries cover the district. The scope for alleviating distress among tuberculous families is wide. The Public Assistance organisation although of great help in this direction cannot meet all the needs of these unfortunate families. Whilst this aspect of anti-tuberculosis work is carried out on a voluntary basis, it will need all the financial help it can obtain from private sources to fulfil its very necessary functions. The District Council provides a free service for the examination of sputum for tubercle bacilli. During the year 145 specimens were examined with a positive result in 19 instances. No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, which gives power to prohibit the handling of milk by infectious tuberculous persons, nor under Section 172 of the Public Health Act, 1936, which provides for the removal of an infectious person to hospital. 75 TABLE XXXVI. TUBERCULOSIS—New Cases, Age and Sex, Distribution and manner of Admission to Register, 1937. Age Groups. Years. Primary Notifications ("A"). Cases transferred from other districts. Cases brought to notice otherwise than by notification and transfer. Total new cases. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M F M F M F M F M F M F 0-1 - - - - - - - - - - - - - 1-5 — - — — - - - — - - — — — 5-10 1 - — 2 - - 1 2 - - — — 6 10-15 1 - 1 2 - - 2 2 - - 1 — 9 15-20 2 4 — 1 - - 1 — - - — — 8 20-25 10 5 1 1 2 4 — 1 - - — — 24 25-35 9 11 1 — 3 12 — 2 - 1 — — 39 35-45 8 9 1 — 2 5 — — - - — — 25 45-55 9 5 — 1 1 — — — - - — — 16 55-65 2 1 — — 1 1 — — - - — — 5 65 up 1 - - - - - - - - 1 - - 2 Totals 43 35 4 7 9 22 4 7 - 2 1 - 134 89 42 3 76 INDEX PAGE Acreage 6 Ambulance Facilities 25-26, 50 Anterior Poliomyelitis 67 Births 9-10 In each Ward 11 In hospitals or maternity homes 11 Rates 9, 12, 14 Bed Bugs—Eradication of 52 Cancer 9, 16 Deaths from 16 Rate 9 Cemeteries 52 Cerebro-Spinal Fever 67 Clinics and Treatment Centres 27-28 Climatic Conditions 7 Closet Accommodation 44 Deaths 9, 14 Causes of 16-17 Classified causes —by age and sex 19 In each Ward 15 In public institutions 15-16 Rates 9, 14-15 Diphtheria 62 Antitoxin used 64 Immunisation 64-65 Clinics, times and places 27 Children Immunised in Schools 66 Persons Immunised at Clinics 65 Persons Immunised by Private Practitioners 65 Incidence and fatality for 19 years 67 Incidence by age groups 64 Incidence in each Ward with rates 63 Monthly distribution of cases 63 Multiple cases in domestic dwellings 64 Swabs examined 25, 64 Disinfection — 46 Disinfestation 46-52 Drainage and Sewerage 44 Drainage work 46 Dysentery 59-60 Enteric Fever 59 Erysipelas 68 77 INDEX—continued. page Factories and Workshops 6, 48, 57 Inspections made 48, 57 Defects found and remedied 57 Outwork in Unwholesome Premises 58 Food and Drugs (Adulteration) Act, 1928 48 Food Poisoning 69-70 Food Supply 25, 46 Inspections 46 Health Propaganda 52 Health Services 24 Heart Disease 16 Deaths from 16 Hospitals 29-30 Housing:— Council's Schemes 53 Housing Act, 1936—Overcrowding 54 Inspections and Defects 45-46, 55-56 New houses erected 53 Number inhabited 6 Verminous premises 46 Industry 6 Infant Life Protection 43 Infant Mortality 9, 21-22-23 Classified causes of deaths 23 Kates 9,21-22 Infectious diseases 29, 46, 59 Diseases notifiable 59 Disinfection after 46 Enquiries into 46 Monthly Incidence 73 Notification by age groups 72 Notifications, deaths and distribution 71 Inquests 18 Isolation Hospital 29 Admissions to 31 Laboratory Facilities 25 Examination of clinical material 25 Legislation 26 Maternal Mortality 9, 20 Rates 9, 20 Maternity and Child Welfare 32-33 Ante-Natal Clinics 27 Attendances at each Centre by age groups 36 78 INDEX—continued. page Attendances at Infant Consultation Clinics 34 Attendances at Maternity Clinics 33 Attendances at Toddler Clinics 34 Attendances at all Infant Welfare Centres 35 Attendances at Centres over last ten years 35 Attendances in relation to the registered births 37 Committee 4 Consultant advice for maternity 40 Convalescent Home Treatment 39 Dental Scheme 41 Attendances 41 Operations performed 41 Health Visiting 38 Home Helps 40 Hospital provision for maternity 40 Midwives 42-43 Milk Scheme 39 Orthopaedic Treatment 40 Sessions, times and places 27 Sterilised Maternity Outfits 40 Voluntary Helpers 43 Work of the Centres 32 Meat Inspection 47 Measles 67 Milk Supply 47 Milk (Special Designations) Order, 1936 47 Inspections 48 Licences issued 47 Mosquitoes 49 Nelson Hospital 29-30, 37-38 Notification ot' Births 32 Nuisances:— Abated 51 Notices served 51 Nursing in the Home 24 Offensive Trades 49 Ophthalmia Neonatorum 68 Pneumonia 69 Population 9-10 Prevention of Blindness 69 Public Assistance 7 Public Cleansing 45 Public Health Committee 4 Puerperal Fever and Pyrexia 68 Consultant 5 79 INDEX—continued. page Rainfall 8 Rateable value 6 Rats and Mice Destruction 49 Respiratory diseases—deaths from 17 Representatives on:— Nelson Hospital Council 4 Wandle Valley Joint Hospital Board 4 Wandle Valley Joint Sewerage Board 4 Rivers and Streams 44 Road Accidents (deaths from) 18 Sanitary Circumstances 44 Sanitary Inspection 45 Scarlet Fever 60 Incidence and fatality last 20 years 62 Incidence in each Ward with rates 61 Monthly distribution of cases 60 Multiple cases occurring in domestic dwellings 61 Schools 52 School clinics 28 Shops Acts, 1912-1936 49 Slaughterhouses 47 Smallpox . 29, 59 Smoke Abatement 49 Social Conditions of the Area 6 Staff 5 Statistics 6, 9 Comparative 13 Tuberculosis 9, 74 Admissions to Sanatorium 30, 75 Deaths due to 75 Dispensary 28 New cases—by age groups 76 Number on register at year end 74 Unemployment 7 Venereal Diseases 28 Watercourses 49 Water Supply 44 Whooping Cough 67 Zymotic Disease 59 Deaths from 9 Rate 9 80 Printed by J. B. Blackmore & Co., Ltd., 85, Merton High Street, S.W.19.