library ^ttertoit and ^ttordeit Krbait "district ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1938 AND REPORT OF The Sanitary Inspector Merton and Morden Urban District ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1938 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 Annual Report for the year 1938. The year under review provides yet another series of those favourable annual statistics to which the district is accustomed. Contributing to this result we have the benefit of an extensive development fashioned on modern and well planned lines and of a young population composed to a large extent of those age groups which furnish low death and morbidity rates. Nevertheless when allowance is made for the composition of the population by the application of the areal comparability factor, mortality remains at a persistently low level. The high child population again on the other hand in itself increases the chances of the transmission of infectious illness yet the prevalence of these diseases is on the average definitely less than the general experience. To refer to 1938 in particular, the comparable death-rate is again under 9.0 per thousand of the population and infant mortality less than 40 per thousand births, but perhaps the most heartening feature of the statistics is the sharp rise in the birth-rate to 14.3 per thousand live births from 12.3 in the year before. The natural increase is now at a rate of no less than 7.0 per thousand population since the birth-rate is almost double the death-rate. With regard to infectious illness, control measures here as elsewhere, made little impression on the prevalence of mild Scarlet Fever. Hospital isolation has failed to reduce it and it may be that hospital treatment when practised largely on the multiple bed ward system actually assists the dissemination of this infection. Diphtheria, in marked contrast, has undoubtedly yielded considerably to immunisation procedure though much more can be done by extended use of this prophylactic measure. Sanitary circumstances received the same close supervision as hitherto. The standard of housing, generally very good, is however, being improved by the steady elimination of poor and defective conditions and by unremitting attention to ageing properties. 2 Food control will be more effectively and more economically administered when the Council take over the powers and duties of the Food and Drugs Authority in October next. The Maternity and Child Welfare Scheme continued to expand rapidly. Its activities showed the biggest increase of any year since its inception and the additional accommodation which will be provided by the proposed Centre in Camborne Road is urgently needed. If this project is delayed much longer the high standard of this essential service will be endangered. I trust that after perusal of these pages it will be agreed that there is no evidence that the Public Health Services have not been effectively maintained. Yet as the Council are aware, the staff in this, as in other departments, has been very extensively engaged on A.R.P. duties. The results indicated in this volume have been achieved, in so far as they are affected by public administration, under arduous circumstances and at no small effort. I am indeed grateful to all the members of my staff for their untiring assistance and for the willing manner in which they shouldered extra responsibilities and additional duties both in and out of office hours during a difficult year. To a Medical Officer who has hitherto mainly devoted his efforts to helping his fellow-beings to guard against those influences inimicable to life and health, which they have not yet been able to control, it is a matter of some regret that he should have to divert so much of his energy to protecting man from the possible results of his own folly. I am, Your obedient Servant, F. LAWRENCE SMITH, Medical Officer of Health. July, 1939. 8 URBAN DISTRICT COUNCIL of MERTON and MORDEN 1938 PUBLIC HEALTH COMMITTEE Chairman: Mr. W. S. Le Gros Clark Mrs. E. M. Clifton Mr. F. J. Grimme Mrs. H. Cobbett Mr. E. Knox Mrs. L. A. Doel Mrs. S. A. Lodge Capt. E. A. Evans Mr. G. E. Baker (ex-officio) Mr. G. F. Coleman (ex-officio) MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Mrs. L. A. Doel Mr. W. H. Clark Mr. W. S. Le Gros Clark Mrs. E. M. Clifton Mrs. S. A. Lodge Mrs. H. Cobbett Mrs. Hailstone Capt. E. A. Evans Mrs. Noble Co-opted Mr. E. Knox Mrs. Turrell ) members Mr. G. E. Baker (ex-ojficio) Mr. G. F. Coleman (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. S. F. Eranklin Mr. G. F. Coleman Mr. G. E. Baker (ex-officio) REPRESENTATIVES ON NELSON HOSPITAL COUNCIL. Mr. V. H. Auger Mr. G. F. Coleman Mr. A. E. Clifton 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: be F. C. Thomas, M.S.I.A. b J. H. Massey, M.S.I.A. Setiior Health Visitor: Miss E. M. Sperry Health Visitors: Miss A. R. Taylor Miss M. McL. Doran Miss A. Howard Miss M. E. Black (from 4.4.38) Senior Clerk: A. A. Makepeace Clerks : R. J. Mitton H. J. Rogers PART TIME OFFICERS. Assistant Medical Officers for Child Welfare and Diphtheria Immunisation Clinics: Matthew Orr, M.B., Ch.B. T. Elliott, M.B., Ch.B. Assistant Medical Officer for Maternity Clinics: Esther Rickards, M.B., M.S., F.R.C.S. Bacteriologist: F. Deas, M.R.C.S., L.R.C.P. Considting Obstetrician under The Puerperal Pyrexia Regulations 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 Ancesthetist 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 1938) according to Rate Books 19,955 Rateable Value at 31st December, 1938 £595,361 Sum represented by Id. rate £2,380 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 proposal to create a Civic Centre on land in London Road referred to in my last report was given further consideration. Until suitable and adequate accommodation for the Council's staff is provided, local administration must necessarily suffer from the present inconvenient arrangements whereby the Departments are housed in three separate buildings, two of which are designed as domestic dwellings. Industry. The number of factories registered under the Factories Act at the year end was:— Factories with mechanical power:— Employing more than 40 persons 24 Employing less than 40 persons 70 Factories without mechanical power 28 122 The number of employees engaged in these premises is approximately 6,400. Twelve factories with mechanical power were added to the register during the year and all use electricity for power purposes. 6 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 at the Wimbledon and Sutton Exchanges as unemployed at the beginning of 1939 was as shown below. They do not, of course, represent the total of unemployed since not all are registered at these two Exchanges. Registered at Wimbledon on 12/1/39. Men 749 Women 293 Boys 38 Girls 29 1,109 Registered at Sutton on 9/1/39. Men 103 Women 45 Boys 17 Girls 7 172 The number registered at Wimbledon compares with 859 one year ago and 544 two years ago. 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 admitted to hospital from Merton and Morden 406 Number of persons admitted to mental hospitals 37 Average weekly number of persons in receipt of medical out-relief 3 Other Relief:—Number of persons in receipt of Domiciliary Assistance on:— 1st January, 1938 656 1st July, 1938 667 31st December, 1938 660 Total amount of Domiciliary Assistance afforded during the year £14,182 The number of admissions to hospitals shown above is more than 100 less than a year ago. In this connection it should be observed that several of the hitherto Public Assistance Institutions were appropriated by the County Public Health Department during the year and consequently numerous admissions to hospital were made direct under public health arrangements which are not shown in these figures. 7 Climatic Conditions. Rain gauges are installed at the Joseph Hood Recreation Ground and West Barnes Pumping Station. The monthly recordings are as shown below:— RAINFALL, 1938. JOSEPH HOOD RECREATION GROUND. WEST BARNES PUMPING STATION. January 2.12 inches ... 2.11 inches. February .50 „ ... .35 „ March .40 „ ... .39 „ April .09 „ ... .09 „ May 1.36 „ ... 1.24 „ June .54 „ ... .22 „ July 1.32 „ ... 1.03 „ August 2.81 „ ... 2.23 ., September 2.37 „ ... 2.09 „ October 2.13 ... 2.25 „ November 4.01 „ ... 3.71 „ December 1.92 „ ... 2.90 „ Total 19.57 „ ... 18.61 „ 8 SUMMARY OF VITAL STATISTICS FOR 1938. (Registrar General's Figures). Population: Mid. 1938 Registrar General's Estimate 68,980 Births M. F. Total. Live (Leg.) 453 506 959 (Illeg.) 17 14 31 470 520 990 Birth rate 14.3 Stillbirths 16 11 27 Stillbirth Rate per 1,000 total births 26.5 Deaths: 268 241 509 Death Rate 7.3 Infant Mortality: All deaths under 1 year 39 Rate per 1,000 live births 39.3 Deaths of leg. infants under 1 year 34 Rate per 1,000 leg. births 35.4 Deaths of illeg. infants under 1 year 5 Rate per 1,000 illeg. births 161 Maternal Mortality: Deaths from Sepsis 1 Deaths from other puerperal causes 2 Maternal death rate 2.94 Zymotic Deaths: Deaths from Measles — Deaths from Whooping Cough — Deaths from Diarrhoea (under 2 years) 5 7 Principal Zymotic Diseases 7 Zymotic Death Rate (per 1,000 lation) 0.10 Deaths from Tuberculosis : All forms 53 Rate per 1,000 population 0.76 Phthisis 47 Rate per 1,000 population 0.68 Deaths from Cancer 89 Rate per 1,000 population 1.2 9 TABLE I. COMPARATIVE STATISTICS, 1938. (R.G.'s Provisional Figures with Corresponding Figures for Merton and Morden added). England and Wales 126 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 Bates per 1.030 Population Births:— Live Still 15.1 0.60 15.0 0.65 15.4 0.60 13.4 0.48 14.3 0.39 Deuths:— All causes Typhoid and Paratyphoid fevers Smallpox Measles Scarlet fever Whooping Cough Diphtheria Influenza 11.6 0.00 0.00 0.04 0.01 0.03 0.07 0.11 11.7 0.00 0.05 0.01 0.03 0.07 0.10 11.0 0.00 0.00 0.03 0.01 0.02 0.06 0.11 11.4 Crude Comp 0.00 0.06 0.01 0.03 0.05 0.06 7.3 8.8 0.02 0.05 Notifications:— Smallpox Scarlet fever Diphtheria Enteric fever Erysipelas Pneumonia 0.00 2.41 1.58 0.03 0.40 1.10 0.00 2.60 1.85 0.03 0.46 1.28 0.00 2.58 1.53 0.04 0.39 0.98 2.05 1.90 0.05 0.46 0.98 2.33 0.40 0.20 0.71 Deaths under 1 year of age Deaths from Diarrhoea and Enteritis under 2 years of age Rates per 1,000 Live Births 53 5.5 57 7.8 51 3.6 57 13.1 39 5.0 Maternal Mortality:— Puerperal Sepsis Others Total 0.89 ) 2.19 3.08 ) Not Av ailable 1.01 2.02 3.03 Maternal Mortality:— Puerperal Sepsis Others Total Rates per 1,000 Total Births (i.e., Live and Still) 0.86 2.11 2.97 Not Av ailable 0.98 1.96 2.95 Notifications:— Puerperal fever Puerperal pyrexia 14.42 18.08 12.51 3.53 15.46 9.83 10 The Registrar General's figures relating to population and deaths differ in some instances from those compiled from local information. Where classification, e.g. on ward basis, as between age groups, etc. has been attempted in this report, it is necessarily based on local information. These tables may in the aggregate differ from the totals given by the Registrar General. POPULATION. The Registrar General's estimate of the mid-year resident population is 68,980. This is 3,450 higher than his estimate for 1937. My own estimate, computed from local knowledge is 72,850. More than 1,800 new dwellings were erected in the year June 1937 to June 1938 and at three persons per house only would add 5,400 to the population. With regard to the population of the existing dwellings, it is probable that the density per house has not decreased although it is recognised that the general experience in the country as a whole is the reverse. In support of this it should be observed that Merton and Morden had the youngest population of any district in Surrey at the census of 1931 and its inhabitants are to a very great extent young adults of the reproductive age groups. Moreover, the relief of overcrowding has been a negligible factor affecting population density as the amount of decrowding which has been effected since 1936 involved less than 1% of the families in the district. The young age group composition of the population is supported by the fact that although the Registrar General has allowed for an increase of only 3.6% in his estimate of the population, the live births increased by more than 20%. In the section of this report dealing with housing, the results of a recent survey of seven complete streets on the St. Helier Estate are given. These show that during the last four years the number of individuals in the 347 houses surveyed has changed by less than 1%. 11 The estimated population of the wards is as follows:— Wards Houses at mid. 1938 Estimated Population mid. 1988 Abbey 1,146 5,210 Bushey Mead 2,141 7,790 Central 2,828 9,500 Morden 2,112 7,010 Park 2,802 9,900 Ravensbury 1,851 7,650 Raynes Park 2,010 7,090 St. Helier 2,807 11,990 West Barnes 1,888 6.710 Whole District 19,885 72,850 BIRTHS. The registered live births totalled 990, an increase of no less than 178 over the year before. The birth rate rises from 12.3 to 14.3 per thousand of the population. Of the total live births 470 were males and 520 females. Seventeen males and 14 females were illegitimate. Stillbirths numbered 27, 16 being males and 11 females. Two of the female stillbirths were illegitimate. The total births (live and still) at 1,017 exceeded 1,000 for the first time in the history of the district. Ward Distribution. District Medical Officers of Health have no information as to the home addresses of the registered births which occurred to residents outside the district and hence for comparative purposes as between wards, use is made of the births which occurred during the year. This information is taken from the notifications of birth and from the returns of the births registered locally. These records show that 945 live births and 23 stillbirths took place during the year as compared with a total of 990 live and 27 stillbirths registered during the same period. The distribution is given in the table below. The birth-rates shown in this table are slightly lower than if based upon the registered births inasmuch as the total on which they are computed is 45 less than the registered births. 12 BIRTHS, 1938—DISTRIBUTION BY WARDS. Wards Live Births Still Births Total Births Birth Rate Abbey 74 2 76 14.2 Bushey Mead 108 — 108 13.8 Central 159 3 162 16.7 Morden 138 4 142 19.6 Park 87 2 89 8.7 Ravensbury 69 1 70 9 0 Raynes Park 89 4 93 12.5 St. Helier ... 108 4 112 9.0 West Barnes 113 3 116 16.8 The high rate for the Morden Area is noteworthy as this is the ward which has experienced the greatest recent development. Institutional and Domiciliary Births. The tendency of recent years towards increased Institutional confinements continued. Fifty-six per cent, of the births which occurred during the year took place in hospitals or nursing homes as follows:— Nelson Hospital 196 Kingston County Hospital 103 Other hospitals, institutions, and nursing homes 251 550 The numbers in respect of the various wards were as shown in the following table:— Wards Total Births (Live and Still) Births in Hospitals Nursing Homes, etc Percentnge of Total Births which occurred in Hospitals, etc. Abbey 76 37 48.6 Bushey Mead 108 55 50.9 Central 162 109 67.2 Morden 142 82 57.7 Park 89 62 69.6 Ravensbury 70 16 22.8 Raynes Park 93 61 65.1 St. Helier 112 55 49.1 West Barnes 116 73 62.9 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 33.3 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 1938 68,980 990 14.3 503 7.3 DEATHS. The number of registered deaths after adjustment by transferable deaths was 509 of which '268 were males and 241 females. The crude death rate was 7.3 per thousand population as against 7.4 of the year before. The comparable death rate arrived at by the application of the areal comparability factor of 1.21 to allow for age and sex differences of the local population and that of the country as a whole was 8.8 which compares with 15.1 for England and Wales. Seasonal mortality is indicated by the deaths for each quarter of the year, which were:— First quarter 149; second quarter 127; third quarter 119; fourth quarter 110. 14 The following table shows the death rates for each ward and the mean age at death:— TABLE III. Ward Death Rates and Mean Ag'e at Death. Wards Deaths Death Rate (crude) age at death Abbey 55 10.5 61.78 yrs. Bushey Mead 64 8.2 57.60 „ Central 52 5.4 48.86 „ Morden 44 6.2 49.38 „ Park 85 8.5 58.27 „ Ravensbury 57 7.4 46.79 „ Raynes Park 41 5.7 60.09 „ St. Helier 54 4.5 47.74 „ West Barnes 53 7.9 52.96 „ Whole District 505 6.9 53.99 yrs. The lower average age at death in the more recently developed wards, Morden, Central, St. Helier and Ravensbury, is mainly a reflection of the lower average age of their populations and does not indicate that the chances of longevity are any less than in the older parts of the district. The mean age at death for the whole district for the last five years was as follows:— 1934—48.3 yrs.; 1935—52.7 yrs.; 1936—54.5 yrs.; 1937—54.0 yrs.; 1938—53.9 yrs. Deaths in Institutions. More than half the total deaths occurred in hospitals and institutions. Two hundred and seventy-nine, representing 54% of the whole, took place in the following premises:—- Institutions. Deaths. Nelson Hospital 31 Surrey County Hospitals 136 Isolation Hospitals 2 London and other general Hospitals 93 Tuberculosis Institutions 6 Mental Institutions 11 279 15 CAUSES OF DEATH. Heart Disease. This group of diseases maintains its position as the chief cause of death. It was responsible for 108 deaths giving a death rate for the group of 1.5 per thousand population, the same as in 1937. In 19 instances, the disease took the form of endocarditis with valvular lesions but the remaining 89 were due to degeneration of the myocardium associated with senile changes or other chronic concurrent illness. Cancer. Cancer deaths at 90 were three less than previously and the death rate for this cause fell slightly to 1.2 per thousand population. As before it was the second chief cause of mortality and showed a heavier incidence among women, 55 females dying of the disease as against 35 males. The following table classifies these deaths by the sites affected:— TABLE IV. Deaths from Cancer—Sites Affected. Group Cancer of Male Female Total 45 Buccal Cavity and Pharynx 1 - 1 46 Digestive organs and peritoneum— Oesophagus 4 — 4 Stomach 4 6 10 Liver and gall bladder 1 2 3 Intestines 5 9 14 Rectum and Anus 8 6 14 Peritoneum 1 2 3 47 Respiratory Organs— Mediastinum 1 — 1 Larynx — — — Bronchus 1 2 3 Lungs 4 3 7 48 Uterus — 6 6 49 Other female genital organs — 4 4 50 Breast — 11 11 51 Male Genito-Urinary Organs 1 — 1 52 Skin 1 - 1 53 Other Organs— Thyroid 1 1 2 Brain 1 — 1 Kidney (female) — 2 2 Unspecified 1 - 1 Totals 35 54 89 1G The mean age at death increased by 2 years over that for the year before. The cancer death rates for the last 11 years are given below. They show no definite trend but were it not for the fact that during this period the district has grown rapidly, chiefly by migration into it of young persons who have not yet reached the cancer age, the figures would probably have been less favourable:— Death Rate Death Rate per 1,000 per 1,000 Year. population. Year. population. 1928 1.4 1934 1.2 1929 1.1 1935 1.0 1930 1.2 1936 1.2 1931 0.9 1937 1.4 1932 1.2 1938 1.2 1933 1.0 Respiratory Diseases. Epidemic influenza was not so prevalent as in 1937. It caused 4 deaths compared with 16 in the previous year. Respiratory diseases, bronchitis, pneumonia, etc. other than those stated to be influenzal, were also less fatal, 49 persons dying of these conditions as against 51. The death rate for these diseases was accordingly 0.7 per thousand of the population:— TABLE V. Deaths from Respiratory Diseases, 1925-38. Year Bronchitis Pneumonia Other Respiratory Diseases Total Rate 1925 6 16 1 28 *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 85 *1.2 1930 2 10 8 15 0.4 1931 8 24 4 36 0.8 1932 11 27 8 41 0.8 1933 12 32 6 60 0.9 1934 7 88 4 49 0.8 1935 9 22 6 87 0.6 1936 2 35 2 89 0.6 1987 14 81 6 51 0.8 1938 15 27 7 49 0.7 ('Years of high influenzal mortality) 17 Inquests. Inquests were held in the district on 38 deaths, 15 of which were in respect of residents. Verdicts were as follows:— (1) Natural causes 9 (2) Suicide by— Coal gas 4 Nicotine poisoning 1 Lysol poisoning 1 6 (3) Accidental— Knocked down by motor car 7 Fall in home 1 Fall from tree 1 Burns 1 Electrical burns 1 Fumes from car exhaust 1 Fall from a building 1 Septicaemia from a needle in hand 1 Asphyxia by cot pillow 1 — 15 (4) Misadventure—• Death accelerated by anaesthetic for appendix operation 1 (5) In accordance with medical evidence— Gastro-enteritis of unknown origin 1 Collision with motor lorry Sepsis following confinement 1 Pancreatitis following spinal anaesthesia 1 Silicosis complicated by tuberculosis 1 Chronic alcoholism 1 7 38 Road accidents were responsible for 9 of the total compared with 5 in the year before. 18 19 TABLE VI. Causes of Death during the Year 1938—By Age Groups. No. Cause of Death 0— 1— 2— 5— 15— 25— 35— 45— 55— bo— 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 - - - - - - - - - - - - - - - - - - - - - - - - - 5 Diphtheria — — — — 1 — — 1 — — — — — — — — — — — — — — 1 1 2 6 Influenza — — — — — — — — — — — — 2 — — 1 — — — — — 1 2 2 4 7 Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - - - - - - - 8 Cerebro-Spinal Fever - - - - - - - - - - - - - - - - - - - - - - - - - 9 TuberculosisofRespiratorySystem — — — — 1 — — — 3 4 5 2 4 9 7 4 2 2 1 3 — — 23 24 47 10 Other Tuberculous Diseases — — — 1 — 1 1 — — 1 — 1 — — — — — — 1 — — — 2 4 6 11 Syphilis - - - - - - - - - - - - - - - - - - - - - - - - - 12 General Paralysis of the Insane Tabes dorsalis - - - - - - - - - - - - - - - - 1 - - - - 1 1 1 2 13 Cancer. Malignant Disease - - - - - - - - - - - 3 3 2 5 9 13 19 9 14 5 7 35 54 89 14 Diabetes — — — — — — — — — — — — — — 1 — 1 1 1 1 — 1 3 3 6 15 Cerebral Haemorrhage, etc. - - - - - - - - - - - - - - - 1 1 2 2 3 6 5 9 11 20 16 Heart Disease — — — — — — — 1 2 — 2 1 3 — 9 4 10 5 21 10 16 24 63 45 108 17 Aneurvsm — — — — — — — — — — — 1 — — — — — — — — — 1 — 2 2 18 Other Circulatory Diseases - - - - - - - - - - - - 2 — 2 1 3 1 8 2 4 2 19 6 25 19 Bronchitis — — — — — — — — — — — — — — 1 — 5 — — 2 3 10 3 13 20 Pneumonia (all forms) 1 2 1 — — 1 — — — — 1 — 1 1 4 1 2 1 8 3 — 5 13 14 27 21 Other Respiratory Diseases - - - - - - - - - - - - - - - - - - - - - 2 5 2 7 22 Peptic Ulcer — — — — — — — — 1 — — — 1 — — — — — 3 — — — 5 — 5 23 Diarrhoea, etc. (under 2 years) 3 1 — 1 - - - - - - - - - - - - - - - - - - 3 2 5 24 Appendicitis — — — — — 1 — 2 — — — — 2 — 1 — 1 — 1 — — — 5 3 8 25 Cirrhosis of Liver - - - - - - - - - - - - - - - - - - - - - - 5 1 6 26 Other Diseases of Liver — — — — — — — — — — — — — 1 1 — — — 1 — 1 1 3 4 27 Other Digestive Diseases 2 — — — — — — — 1 — 1 — — — 1 1 2 1 3 1 — 9 5 14 28 Acute and Chronic Nephritis - - - - - - - - - - 2 - 1 - - — 1 1 — 3 1 1 5 5 10 2!) Puerperal Sepsis — — — — — — — — — — — 1 — — — — — — — — — — — 1 1 30 Other Puerperal causes - - - - - - - - - - - - - - - - - - - - - - - 2 2 31 Congenital Debility, Premature Births, Malformations, etc. 14 13 - - - - - - - - - - - - - - - - - - - - 14 13 27 32 Senility — — — — — — — — — — — — — — — — — — 2 — 1 7 3 7 10 33 Suicide — — — — — — — — — — — — 1 1 1 1 1 — — — — 2 3 5 34 Other Violence 1 — — — 2 2 1 2 — 3 — 2 1 — 1 1 — — 2 2 2 15 7 22 35 Other Defined Causes 1 — — 1 1 1 2 — 1 1 1 2 1 1 1 1 2 1 4 4 2 13 15 28 36 Causes Ill-defined or Unknown- — — — — — — — — — — — — — — — — — — — — — — — — — All Causes 22 16 1 2 5 4 4 7 10 6 15 11 25 16 36 26 46 36 60 50 42 65 266 39 505 MATERNAL MORTALITY. Three deaths were recorded as being due to maternal causes, 1 due to sepsis and 2 to other causes. The Maternal mortality rate was 2.95 per thousand total births as against a rate of 2.38 in 1937. The rate for England and Wales was 2.97. The cause of death in each case was certified to be:— Sepsis. (1) Pelvic cellulitis following a tear into the rectum during forceps delivery of a dead full term child (first pregnancy). P.M. Other Causes. (2) 1(a) Obstetric shock. 1(b) Retained placenta. (3) 1(a) Heart failure. 1(b) Toxaemia. 1(c) Ilydatidiform Mole. P.M. TABLE VII. MATERNAL MORTALITY, 1924-38. 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 1938 0.98 1.96 2.95 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. For the fourth year in succession, the district can record a very favourable infant death rate. Thirty-nine deaths of infants under one year took place, which gives a mortality rate of 39 per thousand live births, the same figure as for the year before. The corresponding rate for the country as a whole was 53. Of the 39 deaths, 23 were males and 16 females. Five were illegitimate children. Neo-natal deaths, i.e. those occurring within four weeks of birth, at 22, represent 58% of the whole. There were no infant deaths under one year of age due to the commoner infectious diseases. Rather more than half (54%) were due to the diseases peculiar to early infancy, prematurity, malformations, marasmus, etc. whilst injury at birth accounted for 5. 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 1938 39 Table VIII shows infant mortality classified by age and cause. Infant death rates for the various wards are given below based on the total of 945 live births which occurred during the year and which it was possible to allocate. These are slightly higher than if calculated on the registered births which totalled 990. Wards Live Births Infant Deaths Deaths per 1,000 live births Abbey 74 8 40 Bushey Mead 108 4 36 Central 159 8 50 Morden 138 5 36 Park 87 5 57 Ravensbury 69 5 72 Raynes Park 89 — — St. Helier 108 3 27 West Barnes 113 5 44 21 22 TABLE-VIII.—INFANT-MORTALITY-DURING-THE-YEAR-1938. 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-und-er-1-year Smallpox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet-Fever - - - - - - - - - - Whooping-Cough - - - - - - - - - - Diphtheria-and-Croup - - - - - - - - - - Erysipelas - - - - - - - - - - Tuberculous-Meningitis - - - - - - - - - - Abdominal-Tuberculosis - - - - - - - - - - Other-Tuberculous-Diseases.. - - - - - - - - - - Meningitis-(not-Tuberculous) - - - - - - - - - - Convulsions 1 - - - 1 1 - - - 2 Laryngitis - - - - - - - - - - Bronchitis - - - - - - - - - - Pneumonia-(all-forms) - - - - - 1 1 1 - 3 Diarrhoea - - - - - - - - - - Enteritis - - - - - 1 1 2 - 4 Gastritis - - - - - - - - - - Syphilis - - - - - - - - - - Rickets. - - - - - - - - - - Suffocation,-overlying - - - - - 1 - - 1 Injury-at-birth 4 1 - - 5 - - - - 5 Atelectasis 1 2 - 3 - - - - 3 Congenital-Malformations 1 - 1 - 2 1 1 - - 4 Premature-birth 6 1 3 - 10 r 1 - - 12 Atrophy,-Debility-and-Marasmus - - - - - 2 - - - 2 Other-causes — 1 — — 1 1 — — — 2 TOTALS 13 5 4 — 22 9 4 3 — 38 .Nett-births-in-the-year—Males-470,-Females-520-:-Legitimate-959,-Illegitimate-31.-Nett-deaths-in-the-year-of-Legitimate-Infants-34. Nett-deaths-in-the-year-of-Illegitimate-Infants-5. SECTION B.—HEALTH SERVICES. Nursing in the Home. Three voluntary Associations provide nursing facilities in the District. The Council makes an annual contribution to the funds of each and arrangements have been agreed for nursing assistance to be available for cases referred through the Council's Health Services. (1) The Merton Parish Nurse Fund employs one nurse for general nursing. No midwifery nor maternity nursing is undertaken. The district served is approximately the ecclesiastical parish of St. Mary's. A total of 232 cases involving 3,164 visits were attended during the year. Of these, 45 were children under 5 years of age to whom 239 visits were made. (2) The St. Helier District Nursing Association employs one nurse for general nursing. No midwifery nor maternity nursing is undertaken. Its activities cover the whole of the Merton and Morden portion of the St. Helier Estate and in addition that part situated in the Carshalton Urban District lying to the north of Reigate Avenue. During the year 148 cases of which 28 were children under 5 years were nursed. The total number of visits made was 3,275 of which 92 were in respect of children under 5 years. These figures refer to this district only. (3) The Wimbledon District Nursing Association serves Wimbledon and the western part of this district. Three nurses, two full-time and one part-time are employed, for general nursing in Merton, and part-time service by three midwives is also nrovided for this district. The figures relating to cases and visits in Merton and Morden during 1938 are as follows:— Cases. Visits. Children under 5 years 70 602 Maternity 24 ] 1,577 Midwifery 51 Other cases 385 7,327 Total 530 9,506 Laboratory Facilities. There has been no change in the laboratory arrangements for this district. The following examinations were made during the year— No. Positive Examination. performed, result. Swabs for diphtheria bacilli 626 20 Sputum for tubercle bacilli 118 15 Blood for Widal test 2 — Fseces 5— 28 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. The Council provides one ambulance for the removal of non-infectious cases. Since the close of the year the old vehicle has been replaced by a new 20 h.p. Austin Model to carry two stretcher cases. It is housed at the Fire Station, Kingston Road and is equipped with a resuscitation apparatus. The engine is electrically heated when not in actual use. The ambulance staff consists, in addition to the Honorary Officer in Charge, of three full-time firemen-drivers. Reciprocal arrangements exist with all neighbouring districts. The use of the ambulance is free to residents up to a distance of 32 miles. The following is a summary of the working of the service in 1938:— AMBULANCE CALLS, 1938. 1938 Calls received from Public Calls received from neighbouring Brigades Total Calls Received Calls transferred to other Authorities Calls answered by Own Ambulance January 66 2 68 – 68 February 53 2 55 1 54 March 64 2 66 8 58 April 66 8 69 1 68 May 54 4 58 3 55 June 78 2 80 1 79 July 68 8 71 2 69 August 60 2 62 8 59 September 68 – 68 1 67 October 77 6 83 2 81 November 62 8 70 4 66 December 94 2 96 7 89 810 36 846 33 818 Street or works accidents accounted for 37 per cent. of the cases removed, the remainder being removals to and from hospitals, institutions, etc. Number of calls for 2 attendants 63 Number of calls for 1 attendant 750 813 24 Time taken in executing the 813 calls (from leaving station to return) 718 hours. Mileage covered 6,817 Average time per call 52.9 mins. Average distance per call 8.2 miles. Legislation. The Council adopted a byelaw to control the burning of trade refuse which was sealed by the Minister of Health in December, 1938, to come into force on the 1st January, 1939. 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 3rd Saturday in each month, 10—12 noon. The Parish Hall, Central Road, Morden Infant Welfare Tuesdays 10—12 noon 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. Every Saturday (except 3rd) in each month 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. 25 3.—School Clinics (provided by Surrey Education Committee). Aston Road Centre Raynes Park General Medical Dental Eye Tuesdays and Thursdays 9.30—12 noon. Mondays 9.30—12 noon. Tuesdays 9.30—12 noon, 1.45—4 p.m. Wednesdays 9.30 — 12 noon, 1.45—4 p.m. Thursdays 9.30—12 noon. Fridays 1.45—4 p.m. 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 Dental Eye Mondays and Wednesdays 9.30—12 noon. Thursdays 2—4 p.m. Mondays 9.30—12 noon. Tuesdays 9.30—12 noon. 1.45—4 p.m. 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. Saturdays 9.30—12 noon 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. 26 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 Wandle 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 extensions referred to in the report for 1937 as being in progress were completed during the year. Two new 30 bed wards were erected. One of these, which has 10 beds in cubicles was brought into use in November and raises the present accommodation to 160. The other new ward has not yet been furnished. A thoroughly equipped operating theatre was provided whilst other completed extensions and improvements include:— (1) Provision of corridor connection between two wards. (2) Alterations to the administrative block providing quarters for the Assistant Medical Officer and Matron. Twenty-four additional nurses bedrooms together with lecture and recreation rooms. (3) Enlargement of the main kitchen and provision of modern equipment. (4) Provision of a new mortuary. The number of cases admitted from this district was 196 compared with 167 in the year before. All the cases admitted from all the constituent districts is given in Table IX. 27 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 was reduced from 86 to 84 beds by the conversion of two private wards into bath-rooms. The beds are now arranged as follows:— Public Wards Adult beds 36 Children's beds 14 Maternity 12 „ isolation 1 — 63 Private Wards General 13 Maternity 8 — 21 Total 84 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 1938 1,128 Number from Merton and Morden 461 Total number of new out-patients 5,617 Number from Merton and Morden 2,366 (b) Maternity Services— Number of patients admitted from all districts during the year— (1) General Wards 289 (2) Private Wards 110 Total 399 Number of patients admitted from Merton and Morden— (1) General Wards 152 (2) Private Wards 72 Total 224 Extensions are in progress to the Orthopedic and X-Ray Departments. 2. The County and Public Assistance Hospitals. Under existing arrangements, patients from this district receiving treatment in County Hospitals are admitted mostly to the Kingston and District Hospital, Wolverton Avenue. Until the completion of the new St. Helier Hospital, the position in this part of the County with regard to in-patient accommodation must remain very difficult. 28 Tuberculosis:—The County Sanatorium, Milford—300 beds. The Surrey County Council is responsible for the AntiTuberculosis Scheme in the district. The County Sanatorium at Milford constitutes the main institutional provision and 47 persons were admitted from Merton and Morden during the year, whilst 112 other patients received treatment in other institutions under the Scheme. TABLE IX. CASES ADMITTED TO THE WANDLE VALLEY ISOLATION HOSPITAL DURING THE YEAR 1938. Disease Beddington and Wallington Coulsdon and Purley Merton and Morden Mitcham Cases Deaths Cases Deaths Cases Deaths Cases Deaths Diphtheria 15 – 10 – 31* 2 77 1 Scarlet Fever 38 – 59 – 143 – 128 – Typhoid – – 1 – – – 1 – Erysipelas 4 – 1 – 6 1† 2 1 Other Diseases Tonsillitis 1 – 1 – 2 – 4 – Measles – – 4 – 5 – 8 – Whooping Cough – – – – 2 – 1 – Rubella 1 – 1 – 2 – 8 – Enteritis 1 – – – – – 1 – Pneumonia 1 – — – 1 – – – Cancer of the Bowel 2 1 – – – – – – Chill – – – – 1 – – – Chicken-Pox 1 – – – – – 2 – Tubercular Meningitis 1 1 – – – – 1 1 Septicaemia — – – – 1 – – – Rheumatism — – 1 – – — — – Puerperal Sepsis — – 1 – – — — – Malta Fever — – 1 – – – – – Anterior Poliomyelitis 4 – 1 – – – 2 – Mumps 1 – – – – – – – Impetigo – – – – – – – – Admitted with mother — – 1 – – – 1 – Streptococcal Meningitis 1 1 – – – – – Influenza – – – – – – 2 – 71 8 82 – 194 3 234 3 * Includes three " carriers." † Wimbledon Resident. 29 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 930 Still Births 21 Total 951 Notified by midwives 502 Notified by doctors and parents 105 Transferred from other districts 344 Total 951 The total is 160 more than in 1937 and represents 93% of the births registered during the year. The number of notified births which took place outside the district represents 33% of the total—4% more than in the year before. The Work of the Centres. The history of the Maternity and Child Welfare Scheme in the district has been one of continued expansion and increase not merely keeping pace with the rapid development but outstripping it in growth. The year 1938 added another chapter to this story. The activities of the Maternity Clinics were further increased by the attendance of 111 more mothers than in the year before. The total who attended either for ante-natal or post-natal supervision was 469 representing 42% of the registered births compared with a percentage of 44 in 1937. There was a corresponding increase in the work of the Infant Clinics. The number of infants on the register rose by 550 and the attendances by 4,813. The number of new babies attending for the first time at 750 was 181 higher and is equivalent to 75% of the registered live births. The special Toddler Clinics also experienced a busier year. The number of toddlers increased to 1,123 and since 451 visits were made to these Clinics for observation purposes, the total attendances at these special sessions was 1,574. The increase in clinic activity represented by these figures is the greatest for any one year since the inception of the scheme, including the years of the St. Helier Estate development. 30 Unfortunately it was not possible to make much progress during 1938 with the new clinic in Camborne Road but there is now every reason to hope that this project can be pushed ahead. The tables which follow show the attendances at the various clinics, the programme of which is shown on page 25. TABLE X. Attendances at Maternity Clinics, 1938. Centre No. on Register Attendances Sessions Average attendances per session Primary Total MORDEN Ante-Natal 220 168 925 60 16.6 Post-Natal 57 2 71 Individuals 222 170 996 RAYNES PARK Ante-Natal 247 203 1,048 63 17.9 Post-Natal 79 – 83 Individuals 247 203 1,131 ALL CENTRES Ante-Natal 467 371 1,973 123 17.2 Post-Natal 188 2 154 Individuals 469 373 2,127 (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 represents the number of new cases during the year). 31 TABLE XI. Attendances at Infant Consultation Clinics, 1938. Centre No. on Register Attendances Sessions Average attendances per session Primary Total MERTON Under 1 yr. 262 81 1,351 51 53.5 1—5 yrs. 26 1,882 MORDEN Under 1 yr. †761 181 3,843 97 73.5 1—5 yrs. 81 3,290 RAYNES PARK Under 1 yr. ‡995 347 6,461 149 73.4 1—5 yrs. 63 4,483 PARISH HALL Under 1 yr. §271 141 1,889 48 59.3 1—5 yrs. 74 962 ALL CENTRES Under 1 yr. 2,240 750 13,544 345 68.5 1—5 yrs. 244 10,117 * Excluding children known to have attended other centres. † Includes 32 subsequently transferred to Parish Hall. ‡ Includes 17 subsequently transferred to Parish Hall. § Includes 49 transferred from Raynes Park and Morden. TABLE XII. Attendances at Special Toddlers Clinics (2-5 Years), 1938. Centre Routine examinations Observation attendances Total attendances Sessions Average attendances per session Merton 75 24 99 11 9.0 Morden 378 136 514 44 11.6 Raynes Park 670 291 961 51 18.8 All Centres 1,123 451 1,574 106 14.8 32 TABLE XIII. Attendances at all Infant Welfare Clinics, 1938. (Infant Consultation and Special Toddler). Centre No. on Register Attendances Sessions Average attendance per session * Primary Total MERTON Under 1 yr. 299 81 1,351 62 45.6 1—5 yrs. 28 1,481 MORDEN Under 1 yr. 1979 181 3,848 141 54.2 1—6 yrs. 81 3,804 RAYNES PARK Under 1 yr. 11,300 347 6,461 200 59.5 1—5 yrs. 63 5,444 PARISH HALL Under 1 yr. §271 141 1,889 48 59.9 1—5 yrs. 71 962 ALL CENTRES Under 1 yr. 2,800 750 13,544 451 55.9 1—5 yrs. 244 11,691 0—5 yrs. 994 25,235 * Excluding children known to have attended other centres. † Includes 32 subsequently transferred to Parish Hall. ‡ Includes 17 subsequently transferred to Parish Hall. § Includes 49 transferred from Raynes Park and Morden. TABLE XIV. Attendances at all Centres over last 10 Years. Year No. of Infants attending during year No. of Women attending Maternity Clinics ATTENDANCES Grand Total Infants Maternity Primary under 1 yr. Total 1929 657 44 394 8,751 175 8,926 1930 850 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 1,936 253 554 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 1938 2,800 469 750 25,235 2,127 27,362 33 TABLE XV. CHILDREN ATTENDING CENTRES DURING 1938. 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 1938 (1st year) 77 839 . 10.8 *158(1) 1,714 10.8 *313(4) 3,167 10.1 †l28(5) 1,424 11.9 671 7,144 10.6 1937 (1st and 2nd year) 57 808 14.1 203(7) 2,686 13.2 241(5) 4,164 17.2 55(12) 770 14.0 544 8,428 15.4 1936 (2nd and 3rd year) 53 495 9.3 176(13) 1,196 6.7 244(5) 2,279 9.3 37(18) 313 8.4 492 4,283 8.7 1935 (3rd and 4th year) 46 291 6.3 184(5) 996 5.3 204(3) 1,115 5.4 28(8) 191 6.8 454 2,593 5.7 1934 (4th and 5th year) 44 286 6.4 184(5) 824 4.4 174 775 4.4 21(5) 136 6.4 418 2,021 4.8 1933 (5th year) 22 113 5.1 74(1) 231 3.1 124 405 3.2 2(1) 17 8.5 221 766 3.4 All ages under 299 2.832 9.4 979(32) 7.647 7.8 1,300(17) 11,905 9.1 271(49) 2,851 10.5 2,800 25,235 8.9 * Numbers in brackets in these columns transferred to Parish Hall subsequently. † Numbers in brackets in this column had previously attended either Morden or Raynes Park Centres previously. 34 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 352 168 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 39.0 1937 812 569 70 858 44 0 1938 990 750 75 469 47.3 The Nelson Hospital Clinics. A maternity clinic is held at the Nelson Hospital every Tuesday afternoon in the charge of Mr. Leslie Williams, F.R.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. An Infant Clinic is also held on alternate Thursdays and is attended by Mr. R. H. Dobbs of the Children's Department, University College Hospital. The Clinic is held subject to the following conditions:— (1) The clinic is 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 is as nearly as possible for consultative purposes only. The hospital is a voluntary organisation serving Wimbledon and Merton and Morden District. The following information kindly supplied by the Secretary indicates the work of the Hospital Clinics during 1938:— 35 From Merton Infant Clinic— and From all Morden. Districts. (a) Total number of attendances at the Infant Clinic during the year. (1) By children under one year of age 787 (2) By children between the ages of one and five years 1 2 (b) Total number of children who first attended at the Clinic during the year, and who on the date of their first attendance were (1) under one year of age 63 118 (2) between the ages of 1 and 5 years 1 2 (c) Total number of children under 5 years of age who attended at the Clinic during the year and who at the end of the year were (1) under one year of age 55 98 (2) over one year of age 9 22 Ante-Natal and Post-Natal Clinic— Ante-Natal. Post-Natal. Merton and All Merton and All Morden. Districts. Morden. Districts. (a) Total number of attendances at the Clinics during the year 1,426 51 89 (b) Total number of women who attended at the Clinics during the year 169 252 43 75 These figures taken in conjunction with those in respect of the Council's Clinics show that 82 per cent. of the babies born in the district and 62 per cent. of the expectant mothers received skilled medical supervision under clinic arrangements. Health Visiting. An additional Health Visitor was appointed in April bringing the staff of Visitors up to five. The number of fixed clinic sessions which the Visitors attended during the year was 687 as compared with 538 in 1937, an increase of 149. It will be seen, therefore, that in spite of the additional appointment, the aggregate time available for home visiting was not increased thereby when account is taken of the increased number of infants. 36 The number of visits made for various purposes was as shown below. To expectant mothers first visits 354 total visits 658 To children under one year first visits 1,008 total visits 2,821 To children 1-5 years total visits 4,084 Visits re puerperal pyrexia, ophthalmia and miscellaneous 315 Visits to foster children re Child Life Protection 381 Total 8,259 The present level of visiting allows of an average of approximately four visits a year to children under one who visit the clinics and of something less than three per year to children over that age. 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, 1938. Wards. Free Milk. Half-price. Individuals Families Pints Supplied Individuals Families Pints Supplied Abbey 24 20 3,575 11 10 1,176 Bushey Mead 44 31 7,414 21 17 4,231 Central 4 8 381 — — — Morden 13 10 1,648 4 3 373 Park 6 5 415 3 3 422 Ravensbury 32 27 4,584 15 12 3,960 Raynes Park 5 3 248 1 1 250 St. Helier 41 36 6,058 28 22 4,583 West Barnes 10 7 1,838 7 4 228 179 142 26,161 90 72 15,223 This quantity compares with 20,962 pints free and 9,789 pints at half-price supplied in the year before. 37 Convalescent Home Treatment. By arrangement with the Invalid Children's Aid Association, 14 children received treatment in Convalescent Homes. A total of 112½ patient weeks was provided in respect of the following conditions:— No. of Treatment in respect of. Weeks. Debility following Gastro-Enteritis 10 Debility following Tonsillitis 7 Debility following Osteomyelitis 20 Nervous Debility 9 General Debility 6 Debility following Tonsillitis 12 Debility following Bronchitis and Bronco-Pneumonia 4 Debility following Bronchitis 4 General Debility 8 General Debility 1½ Chronic Debility 6 Rheumatism 8 *Debility following Whooping Cough 4½ *Debility following Tonsillitis 12½ Total No. of Weeks Treatment 112½ * Continued in 1939. Orthopsedic Treatment. Children suffering from orthopaedic defects are referred to the Nelson Hospital under the general arrangement with that Hospital for the treatment of infants attending the Welfare Centres. Assistance was given in one case towards the cost of surgical boots. Maternity Hospital Treatment. Out of 968 births which took place during the year, it is known that 550 occurred in hospitals or private Nursing Homes. This is 102 more than in the year before. Under the arrangement with the Nelson Hospital, Maternity cases may be admitted from the Council's services to that Institution. Complicated and Puerperal Pyrexia cases may also be admitted to Queen Charlotte's Hospital. 88 Earlier in this report it was shown that the Nelson Hospital admitted 224 cases from the Urban District, the number referred to this and others hospitals from the Council's clinics being as follows:— Nelson Hospital 1 Kingston County Hospital 16 Other Hospitals 1 18 They were referred for the following reasons:— Obstetrical 5 Medical 10 Home conditions 3 18 (For cases admitted to hospital under the Puerperal Pyrexia Regulations, see Page 69). Emergency Maternity Unit. In accordance with the suggestion of the Ministry of Health contained in Circular 1622 the Council entered into an arrangement with the Nelson Hospital for establishing an Emergency Maternity Unit to deal with maternity emergencies in the patient's own home where the case is not fit to be removed to Hospital. The Hospital Council provides the Unit which is staffed by doctors and midwives of the hospital and the District Council pays an agreed fee for each occasion it is called out. To secure the services of the Unit, the practitioner communicates with the hospital. It has not been called upon as yet. Consultant Service. A specialist's opinion may be had in cases of obstructed labour, emergencies of pregnancy, or puerperal pyrexia. One case was assisted in this way during the year. Home Helps. Domestic assistance may be provided for expectant and nursing mothers with limited means, during confinement or whilst away from home undergoing treatment. The usual period for which this help is supplied during confinement is fourteen days. The number of helps provided was 18, 5 free of cost and 13 on part payment. Sterilised Maternity Outfits. Sterile Outfits in sealed metal containers for use at confinements may be had from the "Welfare Centres or from the Council's midwife. They are supplied at cost-price and in necessitous cases at half-price or free of cost according to means. Six outfits were supplied—two at cost-price, one at halfprice and three free. 39 Dental Scheme. Extended use was again made of the facilities for dental treatment. The increase in the cases attending the Dental Clinics was 107. A total of 421 individuals attended, were referred from the following centres and made the following attendances. TABLE XVIII. Attendances at Dental Clinic, 1938. Centre referred from. No. who attended during year. No. of attendances made. MERTON Mothers 12 39 Children 17 31 Individuals 29 70 MORDEN Mothers 72 236 Children 127 241 Individuals 199 477 RAYNES PARK Mothers 80 164 Children 113 162 Individuals 193 326 ALL CENTRES Mothers 164 439 Children 257 434 Individuals 421 873 Number of sessions 65 Average attendances per session 13.4 The dental operations performed were as follows:— TABLE XIX. DENTAL SCHEME, 1938—Operations Performed. Extractions. Temporary teeth 722 Permanent teeth 622 Fillings. Temporary teeth 74 Permanent teeth 49 Dentures Supplied. No. of cases 35 No. of Local Anaesthetics Given 8 No. of Gases Given 356 40 Midwives. One midwife is appointed by the District Council under the Surrey County Council's Scheme for a salaried midwifery service. The fees fixed by the County Council are:— As maternity nurse 35/- As midwife 40/- Provision is made for a reduction in the fee in necessitous cases. The following figures indicate the work undertaken by the Council's midwife during the year:— Gases conducted— Primip. Multip. Total. (a) As midwife Live 7 55 62 Still — — — (b) As maternity nurse Live — 4 4 Still — — — 7 59 66 Visits made— By midwife Ante-natal 721 During confinement 1,411 To midwife Ante-natal 175 Post-natal 248 2,555 Medical Aid Forms Sent—22. Reasons for sending:— Discharging eyes 7 Rupture of Perineum 9 Phlebitis 1 Feebleness at birth 1 Difficult Forceps Delivery 1 Delayed Labour 1 Adherent Placenta 1 Pemphigus 1 Number of the midwife's cases which attended the Council's ante-natal clinics 66 Percentage of total midwife's cases 100% 41 The fact that in 1938 as in the year before, the Council's midwife was able to secure the attendance of all her cases at the ante-natal clinics confirms the view expressed in last year's report that the arrangement whereby a salaried midwife is an officer of the Maternity and Child Welfare Authority is the most effective means of securing the greatest measure of medical supervision for expectant mothers in the district. According to notices received by the County Council there were 16 midwives practising in the district, four of whom were salaried midwives appointed under the County Scheme and five members of the staff of the Nelson Hospital. In addition, three members of the staff of the Wimbledon District Nursing Association practise in Merton and Morden. Voluntary Helpers. As in previous years, the scheme had the benefit of the very valuable assistance of a band of voluntary workers who now number 39. Only long experience in the organisation of such voluntary service by tactful Health Visitors can produce the degree of efficiency attained by the local scheme. Child Life Protection. The Health Visitors are appointed Inspectors under the Child Life Protection provisions of the Public Health Act, 1936. Strict control is exercised over foster homes and particular attention is paid to the welfare of foster children. The following are the main facts relating to the administration of these provisions during the year:— Registered homes under supervision during the year 40 Registered homes under supervision at end of year 30 New homes registered during the year 16 Children on the register at the end of the year 31 Children brought on to the register during the year 40 Children removed out of the district 14 Visits paid to nurse children 381 Children died during the year Nil Legal proceedings Nil Slipper Baths and Cleansing Station. Plans and specifications were prepared for a block of Slipper Baths providing twelve baths for adults and two for children at Aston Road, Raynes Park. Incorporated in the building is a self-contained section for cleansing persons suffering from scabies and other verminous conditions. Since the end of the year a start was made on the construction which it is anticipated will be completed in July, 1939. 42 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 supply of the Metropolitan Water Board is only sampled infrequently as a routine otherwise samples are taken when circumstances indicate the necessity for local investigation. The Board supplies copies of their official minutes in which the results of their examinations are recorded. Routine examination of the Sutton District Water Company's supply is undertaken by the Authorities in the supply area upon an agreed rota which provides for bacteriological and chemical samples each month. The Company in addition to the daily examinations undertaken by their own full-time Chemist arrange for Consulting Chemists to undertake monthly examinations. Copies of the reports of these Consulting Chemists are received by local Medical Officers of Health whilst the records of the Company's own analysis are available for inspection by the Medical Officers. The report on the chemical and bacteriological examination of a sample taken from a domestic tap in Morden on the 19th May, 1938, was as follows:— (1) CHEMICAL. Parts per 100,000 Grains per Gallon. Total solids (dried at 120°C) 18.5 13.0 Combined chlorine (as Cl) 2.10 1.47 Equivalent to Sodium Chloride (NaCl) 3.47 2.43 Nitric nitrogen (Nitrates) 1.00 0.70 Nitrous nitrogen (Nitrites) Nil Nil Ammoniacal nitrogen Nil Nil Albuminoid nitrogen 0.0006 0.0004 Oxygen absorbed in 4 hours at 27°C 0.004 0.003 Lead or Copper Nil Nil Temporary hardness (equivalent to CaCO3) 5.0 3.5 Permanent hardness (equivalent to CaCO3) 6.0 4.2 Total harness (equivalent to CaCO3) 11.0 7.7 (II) BACTERIOLOGICAL. The average number of organisms producing visible colonies on gelatine plates, incubated at 20°C for three days is found to be 2 per c.c. The average number of organisms producing visible colonies on agar plates, incubated at 37.5°0 for two days is found to be less than 1 per c.c. 43 B. coli not found in 100 c.c. Streptococci not found in 30 c.c. Cl. Welchii (spores) not found in 100 c.c. REMARKS. The results show this water to be of a high degree of organic and bacterial purity and quite satisfactory for drinking purposes. There are two deep wells in the district, the supplies from which are used mainly for industrial purposes. They also provide the staffs of the factories at which they are situated with drinking water. Drawn from beneath the London clay, both these well waters are of a high degree of organic purity. Drainage and Sewerage. Further progress was made with the Surrey County Council Scheme for the improvement of the Pyl and Beverley Brooks referred to in my last report. The Pyl was widened on the Battersea Cemetery land and the Beverley at West Barnes Lane. The latter stream was culverted near Rookwood Avenue whilst bridges at Garth Road and Blakes Lane were reconstructed. The culverting of the Pyl from West Barnes Crossing to Kingsway is in hand. Local measures undertaken for the relief of flooding include the provision of a further surface water sewer in Cannon Hill Lane to relieve Northway and the adjoining area. Faulty lengths of the old soil sewer in Burlington Road have been reconstructed. Rivers and Streams. The River Wandle, the Pyl and Beverley Brooks and the other natural watercourses are visited periodically. The results of these inspections are given in the Sanitary Inspector's Report on Page 51. Closet Accommodation. All premises have water closets drained to sewers except four which are drained to cesspools. In addition there are four chemical pail closets on Sports Grounds. Public Cleansing. House refuse is collected weekly. Trade Refuse is also collected on payment of a moderate charge. Disposal is by incineration at the Garth Road destructor which is a six cell plant. One additional 8 cubic yard Morris Collection vehicle was acquired during the year. The practice of dusting bins with a disinfectant powder was continued. Sanitary Inspection of the Area. The work of the Sanitary Inspectorate during 1938 is detailed in the report of the Chief Sanitary Inspector which follows:— 44 REPORT OF CHIEF SANITARY INSPECTOR. Mr. Chairman, Ladies and Gentlemen, I beg to submit the Annual Report which summarises the work carried out by your Sanitary Inspectors during the year ended 31st December, 1938. Housing Inspections. The total number of houses inspected during the year for " Sanitary defects " under the Public Health and Housing Acts, was 312. Details of the work carried out and of the sanitary improvements effected at houses are included in the tabulated statement at page 53. Systematic inspection of working class houses was continued as a routine during 1938, and in this connection 125 houses in the undermentioned roads were subjected to detailed survey and the necessary particulars recorded in accordance with the Housing Consolidated Regulations:— Edna Road 89 Gore Road 24 Kingston Road 4 Wandle Road 2 Other roads 6 125 The majority of the repairs and improvements made 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 it was not found necessary to institute any legal proceedings. Notices specifying the necessary work required to remedy sanitary defects were served upon owners of properties as follows:— Intimation Notices 183 Statutory Notices— Public Health Acts 25 Housing Act, 1936 5 Housing Act, 1936—Overcrowding Provisions. The total visits made in connection with the overcrowding provisions of the Housing Act were 706. Certificates stating the " permitted number" of persons allowed to occupy "dwellings" were issued to owners and agents in respect of 423 new "dwellings" which had been erected and tenanted during 1938. In making 45 routine inspections of houses, opportunity is taken of verifying that the prescribed information is accurately inserted in the tenants' rent books. In 30 instances it was discovered that the "permitted number" had not been inserted in the prescribed form. A letter to each owner concerned proved sufficient to rectify the omission. The number of dwellings overcrowded at the end of the year, the new cases reported, and cases relieved during 1938, are shown in the Table of Housing Statistics, para. 4, at page 58. Notices to abate overcrowding which had occurred since the "appointed day" were served in five instances. Eradication of Bed-Bugs. Twenty-six houses were found on inspection to be infested with bed-bugs and are classified as follows in accordance with the requirements of the Ministry's Circular 1728:— Council Houses. Other Houses. Total. 14 12 26 Of the 26 houses infested, 18 were treated by spraying with " Vermicine," 4 by fumigation with " Cimex " and 2 by fumigation with sulphur-dioxide, together with the use of blowlamps. One house owned by the L.C.C. was treated with H.C.N. Gas and the treatment of the remaining house was pending at the end of the year. The household effects of two families were subjected to van disinfestation by H.C.N. Gas prior to removal to Council Houses, and in four instances the bedding at verminous houses was dealt with by steam disinfection and in one case was destroyed. In connection with applications for tenancies of Council Houses, 62 inspections of household effects and of premises were made, and in 13 instances evidence of vermin infestation was found. Drainage work. At 16 houses the drainage systems were entirely reconstructed and at 34 houses extensive repairs to drains were carried out. Smoke and water tests were applied to the drains of houses in 59 instances and obstructions were removed from drains at 160 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 255 cases of notifiable diseases as compared with 185 cases in 1937. 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 46 each patient treated at home. The number of rooms disinfected was 303. Food Supply. The total number of inspections made to premises where articles of food are prepared or exposed for sale was 578. These premises include butcher's shops, fish shops, greengrocers, provision dealers, cooked meat shops, refreshment houses and bakehouses. Nine 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 fifty manufacturers, dealers, or vendors of ice-cream are registered, in accordance with Section 89 of the Merton and Morden Council Act, 1936. At 7 premises sanitary improvements were effected. Unsound Food. The undermentioned articles of food, were found upon inspection to lie unfit for human consumption and were surrendered and destroyed:— Description. 3 Stone Skate. 50 doz. heads celery. 6 cwts. potatoes. 2 chickens. 2½ stone cod. 26 lbs. Pork. 18 Hungarian Turkeys. 17 Tins Corned Beef. 5 Stone filletted Cod. 5 Tins Corned Beef. Cause. Unsound. do. do. Decomposition. Unsound. Decomposition, do. do. Unsound. Decomposition. 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 comes from wholesale markets outside the district. Slaughter-houses. At the end of 1938 only 2 private slaughter-houses remained on the Register which are used intermittently for the slaughter of pigs and sheep. These slaughter-houses are situated at Garth Road, Lower Morden, 47 and are licensed annually. The use of the registered slaughterhouse at High Street, Merton, was discontinued during the year, the building being adapted for other purposes. No notices of intention to slaughter were received during 1938 but 12 inspections were made to ascertain whether any animals were being killed. Milk Supply. At 31st December, 1938, only one cowkeeper remained on the register, providing accommodation for about 25 cows. Practically the whole of the milk supplied to the district is derived from the South-Eastern Counties and arrives either by rail or road. The number of retail purveyors carrying on the trade in the district during the year was 47, including 20 retailers whose premises are situated in adjoining districts. 105 inspections were made to cowsheds, dairies and milkshops during 1938. Milk (Special Designations) Order, 1936. The following licences were granted to dealers under the Order, and were in force at 31st December, 1938:— Designation. No. of Licences. "Pasteurised" 16 " Tuberculin Tested" 7 Supplementary Licences. " Pasteurised" 3 " Tuberculin Tested" 5 Licence in respect of Pasteurising- Establishment 1 Inspections of these licensed premises are made at regular intervals during the year, in order to see that the conditions of the licences are being observed. Milk Samples. The following tables summarise the results of the bacteriological examinations of 56 samples of milk taken during the year. Fourteen of the samples were obtained from schools supplying free milk to the children. PASTEURISED MILK—32 SAMPLES. Examination. Over 100,000 per mil. Under 100,000 per mil. Present. Absent. Satisfactory. Unsatisfactory. Total bacteria 0 32 — — — — Bacillus Coli. — — 0 32 — — Methylene blue test — — — — 32 0 Phosphatase test — — — — 3 0 48 The prescribed standard under the Order is that "Pasteurised" Milk must not contain more than 100,000 bacteria per millilitre. The 32 pasteurised milk samples contained bacteria per millilitre as follows:— Under 1,000 3 1,000- 5,000 11 5,000- 10,000 10 10,000- 20,000 5 20,000- 30,000 3 30,000- 50,000 0 50,000-100,000 0 Over 100,000 0 32 ORDINARY MILK—24 SAMPLES. Examination. Over 100.000 per mil. Under 100,000 per mil. Present. Absent. Satisfactory. Unsatisfactory. Total bacteria 3 21 – – – – Bacillus Coli – – 9 15 – – Methylene blue test – – – – 12 2 Two samples of milk were examined biologically for the presence of the tubercle bacillus with negative results. The 24 ordinary milk samples contained bacteria per millilitre as follows:— Under 5,000 3 5,000- 10,000 5 10,000- 20,000 4 20,000- 30,000 4 30,000- 50,000 2 50,000-100,000 3 Over 100,000 3 24 There is no prescribed standard for total bacteria in ordinary raw milk and it is satisfactory to note that of the 24 samples examined, 21 contained total bacteria of under 49 100,000 per millilitre. It should, however, be borne in mind that practically all the milk sold in this district has been subjected to commercial pasteurisation. Food and Drugs (Adulteration) Act, 1928. The abovementioned Act is administered by the Surrey County Council and during 1938 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 33 – 33 – – – Butter 4 – 4 – – – Cheese 1 – 1 – – – Sugar 3 – 3 – – – Other articles 6 1 7 2 1 3 Totals 47 1 48 2 1 3 Factories and Workshops. The number of inspections made to premises registered under the Factories Act was 154. Particulars of the matters dealt with will be found in the table at page 59. The following list indicates the nature of the industries carried on at the large factories in the district:— Trade. No. Trade. No. Automatic Machine Makers 1 Printers 3 Electrical Engineering 1 Accumulator Makers 1 Electric Lamp Manufacturers 3 Aero Engines 1 Breeze Block Manufacturers 2 Engineering 7 Fibre Board Manufacturers 1 Carpentry and Joinery 3 Coach Builders 1 Film Laboratories 1 Colour Printers 1 Film Studios 1 Furniture Makers 1 Saw Mills 2 Geyser Makers 1 Seed Merchants 1 Instrument Makers 3 Sewing Machines 1 Laundries 7 Silk Printers 2 Manufacturing Chemists 1 Sports Outfitters 1 Heating Engineers 1 Time Switches 1 Meat and Fish Pastes 1 Tool Makers 1 Metal Printers 2 Toy Manufacturers 2 Motor Engineers 12 Timber Merchants 1 Office Equipment 1 Varnish Makers 1 Oxygen Manufacturers 1 Wholesale Stationers 1 Photographic Printers 1 Conditions in Offices. The vast majority of offices in this district are in connection with new factories which have been erected as a result of the industrial development of the 50 district during the past ten years, and are modern and up-todate office buildings. Seven inspections were made at offices during the year but no conditions were found to exist which called for action under the provisions of the Public Health Act, 1936. So far as is known, there are no offices in the district where clerical workers are employed under conditions prejudicial to health. Smoke Abatement. During the year 62 observations were made of factory chimneys for the purpose of prevention or detection of " Smoke Nuisances." At three factories smoke was found to be emitted in excessive quantities and at one factory a nuisance from the emission of grit was discovered. Notices to abate the nuisances were served in three instances and in each case the necessary improvements were carried out to prevent further nuisances. At one factory additional boiler plant was installed. A bye-law regulating the emission of smoke was adopted by the Council in 1930. Burning of Trade Refuse. Numerous complaints have been received during the past three years relating to the burning of trade refuse in the yards and passages of adjoining shop premises and in order to secure more effective control in this matter the Council adopted a byelaw in December, 1938, prescribing the times and days of the week that trade refuse may be burned. 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 premises found to be ratinfested was 51 and a total of 319 inspections were made during the year. The action taken during "Rat Week" followed the same lines as in previous years. "Red Squill" rat biscuits are kept in stock in the Department and are sold to ratepayers at cost price. Pollution of Watercourses. The number of inspections made of watercourses and ditches was 97. Pollutions of the Beverley Brook by sewage effluent and of the Pickle Brook by trade effluent were investigated during the year. In both instances the pollution occurred outside the boundaries of this district and representations were made to the responsible local authorities to secure improvements in the standard of effluents discharged into these two watercourses. A number of samples were taken from watercourses, and one submitted for chemical analysis failed to comply with the suggested standard recommended by the Royal Commission on Sewage Disposal. 51 Offensive Trades. Only one offensive trade is 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 1935. Operations at this factory were suspended during 1936 and the premises were not in use during the year under review. Byelaws regulating offensive trades were adopted by the Council in 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 350 Evening visits 68 Infringements. (1) Evening closing hours 7 (2) Half-day closing 2 (3) Hours of employment of "young persons" 3 (4) Seats not provided for females – (5) Prescribed notices not correct or exhibited 47 (6) Sanitary arrangements unsatisfactory 6 (7) Reasonable temperature not maintained 3 Heating facilities were provided at two shops and minor defects of sanitary conveniences and washing facilities were remedied at six shops. Council's Ambulance. The total number of calls received by the ambulance provided by the Council for use in noninfectious cases and accidents was 846 of which 319 were street accidents and the remainder were removals to or from hospitals or institutions. The total mileage during the year was 6,817. The following table shows the calls made upon the ambulance service during the past five years:— Year. Accidents. Hospitals. Total. 1938 319 527 846 1937 339 423 762 1936 331 404 735 1935 332 436 768 1934 332 409 741 I am, Ladies and Gentlemen, Your obedient Servant, J. B. POINTON, Chief Sanitary Inspector. 29th March, 1939. 52 SUMMARY OP NUISANCES ABATED AND SANITARY IMPROVEMENTS EFFECTED. Ceilings cleansed or repaired 208 Coppers provided or repaired 7 Dampness in premises remedied 58 Drains exposed and repaired 34 Drains reconstructed 16 Defective sashcords renewed 26 Drinking-water cisterns cleaned out 5 Drinking-water cistern covers provided 2 Drinking-water cisterns renewed 2 Dustbins provided 15 Floors repaired 13 Forecourts drained – Fresh-air inlet valves provided and repaired 5 Inspection chamber covers provided 3 Obstructions removed from drains 121 Rain-water pipes renewed or repaired 10 Rooms cleansed 169 Roofs repaired 46 Gutters repaired or renewed 14 Stoppers provided to intercepting traps Sink wastes repaired or renewed 15 Walls repaired 67 W.C. cisterns provided 4 W.C. cisterns repaired 2 Water closets cleansed 15 W.C. approaches screened W.C. pans provided 13 Windows repaired or renewed 37 Yards paved or repaved 21 Stoves renewed or repaired 11 Sinks provided 3 Offensive accumulations removed 8 Water supply provided for domestic use 1 Verminous premises fumigated and cleansed 8 Ventilation provided under floors 2 Sanitary accommodation provided for workshops Miscellaneous 50 Total No. of Inspections 5,901 Notices served:— Intimation Notices 183 Statutory Notices 30 Outstanding Notices at 31st December, 1938 14 53 Camping Sites. There are no sites in the District used as camping grounds. Swimming Baths and Pools. There are no swimming baths in the District at the present time. The Council have under consideration plans for the erection of a public bath. Disinfestation. Details of the premises found to be bug infested and the manner in which they are treated are given in the Sanitary Inspector's Report. When hydrogen cyanide is used, the work is undertaken by a private firm under contract. The Council's staff carry out the other methods employed. The homes of prospective tenants of Council houses are visited and where found to be verminous, appropriate action is taken to cleanse the household effects before removal, either by hydrogen cyanide fumigation or less drastic methods, depending on the degree of infestation. Tenants known to have been verminous are kept under frequent supervision. Cemeteries. Work is now in progress in laying out 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. 54 SECTION D—HOUSING. New Houses. The new houses erected during the year were:— (a) By the Local Authority Nil. (b) By other Local Authorities ... Nil. (c) By Private Enterprise 1,424 as follows:— Wards. Flats. Houses. Total Dwellings. Abbey 28 – 28 Bushey Mead 10 – 10 Central 82 238 320 Morden 89 744 833 Park 13 26 39 Ravensbury – – – Raynes Park 57 52 109 St. Helier 83 – 83 West Barnes – 2 2 Whole district 362 1,062 1,424 The total is 394 less than those erected in the year before. Council's Housing Scheme. The number of houses erected or acquired by the Council under statutory powers is 540, as shown in the report for 1937. The position with regard to applications for tenancies was as follows:— Number of eligible applications received by the Council for houses during 1938 58 Total number of eligible applications on the files at 31st December, 1938 144 Number of houses allotted to tenants during 1938 30 (An eligible applicant is one with a family resident in the district). Housing Act, 1936—Overcrowding. During 1938, 42 dwellings were decrowded. In the same period, 20 new cases of overcrowding came to notice. The net reduction in overcrowded dwellings during the year was therefore 22. Since the number of overcrowded dwellings at the beginning of the year was 58, the number remaining still overcrowded at the 31st December, was 36. The number of persons occupying these 36 dwellings was 246½ equivalent adults. 55 Details of the overcrowding and decrowding in the individual Wards are given in the following table:— Wards. Dwellings overcrowded at end of 1937. Number found to be overcrowded during 1938. N umber decrowded during the year. Remaining overcrowded at end of 1938. Abbey 5 – 3 2 Bushey Mead 2 – 1 1 Central – – – – Morden 2 1 3 – Park 1 – 1 – Ravensbury 20 (a) 11 (b) 20 (a) 11 (b) Raynes Park – – – – St. Helier 28 (b) 8 (b) 14 (b) 22 (b) West Barnes – – – – Whole district 58 20 42 36 (a) Includes 19 London County Council Houses. (b) All London County Council Houses. The 20 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) 4 Decrowding was effected in the 42 instances in the following ways:— Alternative accommodation 21 Lodgers or relatives finding alternative accommodation 2 Death of any of occupants 2 Marriage or removal of members of family 11 Family removed out of district 6 Alternative accommodation was provided in Council Houses as follows:— By Merton and Morden Council Nil. By London County Council 20 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) 312 56 (b) Number of inspections made for the purpose 312 (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 125 (b) Number of inspections made for the purpose 125 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (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 183 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 154 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 houses in respect of which notices were served requiring repairs 5 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 5 (b) By local authority in default of owners Nil. B.—Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were' served requiring defects to be remedied 25 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 24 (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 Nil. 57 (2) Number of dwelling houses demolished in pursuance of Demolition Orders Nil. D.—Proceedings under Section 12 of the HousingAct, 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—Part IV—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 36 (ii) Number of families dwelling therein 36 (iii) Number of persons dwelling therein— Aged 10 years and over 209 Under 10 years 75 (b) Number of new cases of overcrowding reported during the year 20 (c) (i) Number of cases of overcrowding relieved during the year 42 (ii) Number of persons concerned in such cases— Aged 10 years and over 224 Under 10 years 72 (d) Number of dwelling houses which have again become overcrowded after Local Authority has taken steps to abate overcrowding Nil. FACTORIES ACT. 1.—Inspections. Number of Premises. Inspections. Written Notices. Occupiers prosecuted. (1) (2) (3) (4) Factories with mechanical power 111 1 – Factories without mechanical power 43 1 – Other Premises under the Act (including works of building and engineering construction but not including out-workers' premises) – – – Total 154 2 – 58 2.—Defects Found. Particulars. Number of Defects. Number of defects in respect of which Prosecutions were Found. Remedied. Referred to H.M. Inspector (1) (2) (3) (4) (5) Want of cleanliness (S.1) 4 4 – – Overcrowding (S.2) – – – – Unreasonable temperature (S.3) – – – – Inadequate ventilation (S.4) 1 1 – – Ineffective drainage of floors (S.6) – – – – Sanitary Conveniences S(.7). Insufficient 1 1 – – Unsuitable or defective 3 3 – – Not separate for sexes 1 1 – – Other offences – – – – Total 10 10 – – OUTWORK IN UNWHOLESOME PREMISES. (Section 108 of Act of 1901; Section III of Act of 1937). 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 59 SECTION E—INSPECTION AND SUPERVISION OF FOOD. (See Sanitary Inspector's Report, on page 47). SECTION F—INFECTIOUS ILLNESS. Notification. The following diseases are notifiable in the Urban District:— Cholera. Cerebro-spinal fever. Continued fever. Diphtheria (including membranous croup). Dysentery. Enteric Fever (including paratyphoid fevers). Erysipelas. Encephalitis Lethargica. Food poisoning. Malaria. Ophthalmia Neonatorum. plague. Acute Primary pneumonia. Acute influenzal pneumonia. Acute Poliomyelitis. Acute Polioencephalitis. Puerperal Pyrexia. Relapsing fever. Scarlet fever. Smallpox. Trench fever. Typhus fever. Tuberculosis (all forms). Smallpox. The district has been free of smallpox infection for five years. No notifications were received in 1938. Enteric Fever. No cases of Typhoid or Paratyphoid Fever were reported. It is 12 years since an incidence of " Nil " was recorded. Dysentery. Four cases were notified, none of which was confirmed bacteriologically. Three were children aged 2, 4 and 7 respectively, who suffered with diarrhoea for a few days and had practically recovered by the time they came to our notice. It is difficult to say whether they were due to dysenteric organisms or not. The fourth, a youth of 17, also suffered from a mild attack lasting less than a fortnight. Scarlet Fever. Scarlet Fever was rather more prevalent than in the year before but was of the same mild type. One hundred and sixty-one cases were notified giving an incidence rate of 2.33 per thousand population compared with 2.41 for the country as a whole. The attack rate was heaviest in the St. Helier Wards. There were no deaths recorded from Scarlet Fever. 60 TABLE XX. SCARLET FEVER—MONTHLY DISTRIBUTION. 1938 Wards. Total. Abbey. Bushey Mead. Central. Morden. Park. Ravensbury. Raynee Park. St. Hel.ier. West Barnes. January 1 1 – 1 1 – 4 3 1 12 February 1 2 3 – 2 1 2 2 – 13 March 1 – 4 1 2 6 1 3 2 20 April 1 1 – 2 2 1 4 1 – 12 May – 1 2 4 2 1 2 2 – 15 June – 1 2 1 1 – – 3 1 9 July – 3 1 2 2 3 3 4 2 20 August – – – 1 2 – – 2 – 5 September – – 2 – – 2 – – – 4 October 1 3 2 5 1 3 – 5 3 23 November 1 – – 1 1 5 – 4 – 12 December – 1 1 1 1 7 – 3 1 16 Total 6 14 18 19 17 29 16 32 10 161 Monthly mean .50 1.17 1.50 1.58 1.41 2.41 1.33 2.66 .83 13.4 The incidence in the various wards was as follows:— Wards. Cases. Incidence per 1,000 population. Abbey 6 1.1 Bushey Mead 14 1.7 Central 18 1.8 Morden 19 2.7 Park 17 1.7 Ravensbury 29 3.7 Raynes Park 16 2.2 St. Helier 32 2.6 West Barnes 10 1.4 61 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. Abbey 6 6 – – 6 Bushey Meal 14 10 2 – 12 Central 18 18 – – 18 Morden 19 19 – – 19 Park 15 15 – – 15 Ravensbury. 28 24 2 – 26 Raynes Park 16 11 1 1 13 St. Helier 32 26 3 – 29 West Barnes 10 10 – – 10 Whole district 158 139 8 1 148 (3 further cases occurred in institutions). TABLE XXII. INCIDENCE AND FATALITY OF SCARLET FEVER OVER LAST 20 YEARS. Year. Population. No. of cases. Incidence rate per 1,000 population. No. of deaths. Percentage of deaths to cases. 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 ... ... 1938 68,980 161 2.33 – – 62 Diphtheria. For the fourth year in succession the district has experienced a very low attack rate for diphtheria. Twenty-eight cases were notified compared with 22 in the year before and the incidence per 1,000 population was 0.41 compared with the rate for the country as a whole, of 1.58. In the course of the investigations into cases, two other persons were found to be "carriers" of the infection. A third was detected by routine swabbing prior to admission to a convalescent home. Two were nasal and one a throat "carrier." Two deaths resulted from diphtheria, a boy of four years and a girl of eight. Both died on the fifth day of the illness. This gives a death rate for this district of 0.02 per thousand population. TABLE XXIII. DIPHTHERIA, .1938—WARD INCIDENCE. Wards. Cases. Rate per 1,000 population 1938. Abbey 1 0.1 Bushey Mead 5 0.6 Central 5 0.5 Morden 4 0.5 Park – – Ravensbury 3 0.3 Raynes Park – – St. Helier 5 0.4 West Barnes 5 0.7 Whole district 28 0.38 63 TABLE XXIV. DIPHTHERIA—MONTHLY DISTRIBUTION, 1938. 1938 Wards. Total. Abbey. Bushey Mead. J Central. Morden. Park. Ravensbury. Raynes Park. St. Helier. We6t Barnes. January – 1 1 – – 1 – – 2 5 February 1 1 – 1 – – – – – 3 March – – – 2 – – – – – 2 April – – 4 1 – 1 – – – 6 May – – – – – 1 – – – 1 June – 1 – – – – – – – 1 July – – – – – – – – – – August – – – – – – – – – – September – 1 – – – – – – – 1 October – – – – – – – 1 2 3 November – – – – – – – – 1 1 December – 1 – – – – – 4 – 5 Total 1 5 5 4 – 3 – 5 5 28 Monthly mean .08 .33 .50 .33 – .25 – .41 .08 233 The number of houses affected and details of multiple cases is shown below. TABLE XXV. DIPHTHERIA—MULTIPLE CASES OCCURRING IN DOMESTIC DWELLINGS, 1938. 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 5 5 – – – 5 Central 5 2 – 1 – 3 Morden 4 – – – 1 1 Park – – – – – – Ravensbury 3 3 – – – 3 Raynes Park – – – – – – St. Helier 5 5 – – – 5 West Barnes 5 3 1 – – 4 Whole district 28 19 1 1 1 22 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 15 6 1 3 2 28 It is interesting to note that no child under the age of four years contracted this infection during the year. Seventy-five per cent, of the cases were children of school-age. Ten thousand units of anti-toxin were issued to practitioners and the number of swabs examined totalled 626. Diphtheria Immunisation. The facilities for Diphtheria Immunisation were continued as before. Fewer parents took advantage of this service than in the previous year. This is much to be regretted but is, from experience, to be expected after a few years of low incidence. The number of people who die of diphtheria in this country exceeds the maternal deaths on which so much attention is focussed, yet we have in immunisation a safe and cheap remedy which can eliminate diphtheria as a cause of death and reduce the morbidity therefrom to negligible proportions. Some 3,000 deaths could be saved annually in England and Wales if immunisation were universally practised. 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:— 65 TABLE XXVII. PERSONS IMMUNISED AT CLINICS DURING 1938. Wards. Age Groups Total. 0-5 years 5-15 years 15 and over Abbey 12 8 – 20 Bushey Mead 25 5 – 30 Central 57 30 – 87 Morden 21 19 1 41 Park 17 10 – 27 Ravensbury 25 4 – 29 Raynes Park 29 19 1 49 St. Helier 32 10 – 42 West Barnes 36 15 – 51 Total 254 120 2 376 Total inoculations given at clinics in 1938 = 1,076. TABLE XXVIII. PERSONS IMMUNISED BY PRIVATE PRACTITIONERS 1938. Wards Age Groups Total 0-5 years 5-15 years 15 and over Abbey – – – – Bushey Mead 1 – – 1 Central 4 1 – 5 Morden 1 1 – 2 Park 1 2 – 3 Ravensbury – – – – Raynes Park 5 1 – 6 St. Helier – – – – West Barnes 3 2 – 5 Total 15 7 – 22 Total inoculations given by doctors, 1938 = 66. 66 TABLE XXIX. CHILDREN IMMUNISED IN SCHOOLS, 1938. School Incomplete Complete St. Helier No. 1 Infants 2 51 „ „ „ 2 „ 2 57 „ „ „ 3 „ 1 58 „ „ „ 4 „ 9 50 Holy Family R.C.Infants 1 29 Total 15 245 Total inoculations given in schools in 1938 = 679. The number immunised since the inauguration of the Public Clinics in 1934 was as follows:— 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 1938 376 22 260 658 3,055 67 TABLE XXX. INCIDENCE AND FATALITY OF DIPHTHERIA, 1919-1938. Year. Population. No. of cases. Incidence rat-e 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 7.5% 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% 1938 68,980 28 0.40 2 7.1% Acute Poliomyelitis. No case of Infantile Paralysis was notified. Cerebro-Spinal Meningitis. One case was notified in a young adult male. He was removed to hospital and died after three weeks illness. Measles. 1938 was a "Measles" year in the London District. The returns of the head teachers show that 403 cases occurred among school-children compared with 86 in the year before. The disease is not notifiable in the Urban District. Five cases were admitted to hospital. None died of this infection. Whooping Cough. The incidence of this disease among school-children according to the reports of the head teachers was approximately half that in 1937. Forty-four cases were reported against 81 in the year before. Two children were admitted to hospital. There were no deaths. 68 Erysipelas. Fourteen notifications were received. Seven of the eases were admitted to hospital and 7 were treated at home. The site affected was the face in every instance. There was one death. Puerperal Pyrexia. Notifications were received in respect of 10 cases of Puerperal Pyrexia, giving an incidence rate of 9.83 per thousand total births. The main facts relating to these cases are as follows:— Para. Day of Onset. Clinical Notes. Admitted to Hospital. Result. 1. 5th. Confined in a London Hospital. Yes. Recovered. 1. 3rd. Confined in HospitalForceps deliveryPelvic Cellulitis. Yes. Died. 1. 17th. Breast Abscess. Yes. Recovered. 1. 5th. Mild case. No. Recovered. Multi . 7th. Abortion. Yes. Recovered. 1. 4th. Confined in HospitalForceps. Yes. Recovered. 1. 14th. Confined in a London Hospital. Yes. Recovered. 1. 10th. Confined in HospitalSapraemia. Yes. Recovered. 1. 3rd. Occipito - posterior Forceps - Hæm: Strep: Infection. Yes. Recovered. 1. 10th. Temperature for a few days only, due to "cold." No. Recovered. All these cases, with the exception of one, were Primiparous women. Ophthalmia Neonatorum. Nine cases were notified. One was a baby born in the London area. Of the other 8, one was a severe infection of both eyes and was admitted to a special hospital. The remaining 7 were mild cases which responded to home treatment. 69 Cases. Notified. Treated Vision Unimpaired. Vision Impaired. Total Blindness. Death. | At Home In Hosp. 9 7 2 9 – – – 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. Forty-nine cases were notified, 7 of which were stated to be influenzal. This compares with 90 in the year before. The Council has an arrangement with the Local Nursing Associations for the home nursing of pneumonia cases where necessary. Food Poisoning. Enquiries were instituted in three instances of suspected food poisoning. The first was the case of a man who had died with symptoms suggestive of food poisoning. Bacteriological examination of the organs failed to detect any bacterial infection as the cause of death. In the second occurrence, two members of a family, both of whom had partaken of a meat pie, suffered with acute gastro-intestinal symptoms for some hours. There were no remnants of the pie of which examinations could be made and no other complaints were received in respect of the other pies in the same batch. Both patients recovered. The third case was one in which an adult and his nephew suffered from severe enteritis for several days after partaking of meat patties at a cafe outside the district. Both patients complained of the taste of these patties at the time of consumption but no confirmatory evidence was obtained with regard to other patties sold at the same time. Both patients recovered. 70 71 TABLE XXXI. INFECTIOUS DISEASES, NOTIFICATION DEATHS AND DISTRIBUTION, 1938. Disease Gases 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 Ravnes Park St. Helier West Barnes Smallpox – – – – – – – – – – – – – – Scarlet Fever 161 2.33 – – 6 14 18 19 17 29 16 32 10 143 88% Diphtheria 28 0.40 2 7% 1 5 5 4 – 3 – 5 5 28 100% Enteric Fever – – – – – – – – – – –– – – – Cerebro-Spinal Meningitis 1 0.01 1 100% – – 1 – – – – – – 1 100% Puerperal Pyrexia 10 0.14 1 10% 2 – 3 1 1 – 2 1 – 8 80% Erysipelas 14 0.20 1 7% 2 – 1 – 2 1 3 5 – 7 50% Pneumonia 42 0.60 3 7% 1 1 2 – 9 12 – 17 – – * – Poliomyelitis – – – – – – – – – – – – – – – Relapsing Fever – – – – – – – – – – – – – – – Typhus Fever – – – – – – – – – – – – – – Dysentery 4 0.05 – – – – – – – – 1 3 – – – Encephalitis Lethargica – – – – – – – – – – – – – – Ophthalmia Neonatorum 9 0.13 – – – 1 2 1 2 1 – 2 – 2 22% Plague – – – – – – – – – – – – – – – Malaria – – – – – – – – – – – – – – – Influenzal Pneumonia 7 0.10 – – – 2 – – 1 1 – 1 2 – – *Number admitted to isolation hospital only. 72 TABLE XXXII. NOTIFICATION OF INFECTIOUS DISEASES (other than Tuberculosis) by Age Groups during the year 1938. 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 – 1 3 6 14 87 27 13 6 2 2 – 161 Diphtheria (including Membranous Group) – – – – 1 15 6 1 3 2 – – 28 Enteric Fever (including Paratyphoid) – – – – – – – – – – – – – Puerperal Pyrexia – – – – – – – 4 4 2 – – 10 Acute Primary Pneumonia 2 – 3 – 2 7 3 2 5 13 5 – 42 Acute Influenzal Pneumonia – 1 – 1 – 1 – 1 – 1 2 – 7 Cerebro Spinal Fever – – – – – – – – 1 – – – 1 Acute Poliomyelitis – – – – – – – – – – – – – Acute Polio Encephalitis – – – – – – – – – – – – – Encephalitis Lethargica – – – – – – – – – – – – – Dysentery – – 1 – 1 1 – 1 – – – – 4 Malaria – – – – – – – – – – – – – Ophthalmia Neonatorum 9 – – – – – – – – – – – 9 Erysipelas – 1 – – – – 1 – 1 3 6 2 14 Plague – – – – – – – – – – – – – Relapsing Fever – – – – – – – – – – – – – Typhus Fever – – – – – – – – – – – – – Totals 11 3 7 7 18 111 37 22 20 23 15 2 276 73 TABLE XXXIII. MONTHLY INCIDENCE OP INFECTIOUS DISEASE, 1938. Disease. Jan. Feb. Mar. April May June . July Aug. Sept. Oct. Nov. Dec. Totals Smallpox – – – – – – – – – – – – – Scarlet Fever 12 13 20 12 15 9 20 5 4 23 12 16 161 Diphtheria 5 3 2 6 1 1 – – 1 3 1 5 28 Dysentery 1 1 – – – 2 – – – – – – 4 Enteric Fever – – – – – – – – – – – – – Cerebrospinal Meningitis – – – – 1 – – – – – – – 1 Pneumonia 5 2 10 2 9 – 1 1 1 2 2 7 42 Influenzal Pneumonia 2 1 2 – – 1 – – – – 1 – 7 Erysipelas 2 1 – 1 – 1 2 – 2 1 2 2 14 T.B. Pulmonary 5 8 12 5 9 5 5 6 6 8 9 2 80 T.B. Non-Pulmonary 8 1 – – 1 2 3 1 – – 6 – – Ophthalmia Neonatorum 2 – 1 3 – – – 1 – 1 1 – 9 Puerperal Pyrexia 1 – 1 2 – 3 – – 2 – – 1 10 Poliomyelitis – – – – – – – – – – – – – Encephalitis Lethargica – – – – – – – – – – – – Malaria – – – – – – – — – – – _ – Totals 38 30 48 31 36 24 31 14 16 38 34 33 373 TUBERCULOSIS. One hundred and forty-eight new cases were added to the register of tuberculous persons compared with 134 in the vear before. . These additions were:— Males. Females. Total Pulmonary 70 53 123 Non-Pulmonary 9 16 25 79 69 148 Of these 148, 95 were primary notifications, 46 were transferred from other districts and 7 came to notice in other ways. During the year, 107 persons were removed from the Register for the following reasons:— Recovered 12 Removal from the district 41 Death 54 After allowing for the additions and deductions, the number remaining on the Register at the 31st December, 1938, was 558, distributed as shown in the following table which also gives the incidence of registered tuberculosis at mid-year:— TABLE XXXIV. TUBERCULOSIS REGISTER AT 31st DECEMBER, 1938. AND REGISTERED NUMBER OF TUBERCULOUS PERSONS PER 1,000 POPULATION AT MID-YEAR. Wards. Registered at Decemb 3r 31st. At Mi d-Year. Pulmonary. Non. Pulmonary. Total. Number on Register. Number on Register per 1,000 population. Abbey .31 5 36 33 6.3 Bushey Mead 55 10 65 60 7.7 Central 23 9 32 25 2.6 Morden 34 6 40 30 4.2 Park 51 8 59 65 6.5 Ravensbury 71 33 104 92 12.0 Raynes Park 35 4 39 39 5.4 St. Helier 115 33 148 138 11.5 West Barnes 26 9 35 34 5.0 Whole district 441 117 558 516 7.0 The total at December 31st was 41 more than at the corresponding date in 1937. 74 The incidence of notified tuberculosis on the St. Helier Estate at mid-year was 11.35 per 1,000 population and that in the rest of the district 5.5 per 1,000 population. The Anti-Tuberculosis Scheme in this district is administered by the County Council. Institutional treatment was provided for 159 persons from Merton and Morden as follows:— At the County Sanatorium, Milford 47 At other Institutions 112 159 The deaths from tuberculosis number 54 of which 50 were due to pulmonary and 4 to non-pulmonary disease. The death-rate for pulmonary tuberculosis was 0.72 per 1,000 population compared with 0.50 in the year before. The deaths are classified by age and sex in Table XXXV. TABLE XXXV. DEATHS DUE TO TUBERCULOSIS, 1938. Ages Years. Pulmonary. Non-Pulmonary. Totals. Males. Females. Males. Females. 0— — 1— 1 — — 2 3 5— — — 1 — 1 15— 3 4 — 1 8 25— 5 2 — 1 8 35— 4 9 — — 13 45— 7 4 — — 11 55— 2 2 — — 4 65— 1 3 1 — 5 Totals 23 24 2 4 53 Eight deaths equivalent to 14% of the total were in unnotified eases. The District provides a free service for the examination of sputum for tubercle bacilli. During the year 118 specimens were examined with a positive result in 15 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 Two Voluntary Care Committees share in the responsibility for maintaining the health of tuberculous persons in this district. The majority of the funds which are raised by these Committees are expended in providing nourishment for patients suffering from this infection. For the restoration to, and the maintenance of, a reasonable state of health for these sufferers, an adequate diet is an absolute essential and should constitute the sheet anchor of treatment. It is a reflection on our present-day public health services that in the majority of districts this essential measure should be left to the public assistance organisations or be dependent upon voluntary funds in so far as patients not undergoing institutional treatment are concerned. 70 TABLE XXXVI. TUBERCULOSIS—New Cases, Age and Sex, Distribution and manner of Admission to Register, 1938. Age Groups. Primary Notifications (" A "). Cases transferred from other districts. Cases brought to notice otherwise than by notification and transfer. Total new cases. Years. 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 2 — — 2 — — - — — - — - 4 5-10 1 — 2 — 1 — - — — — — — 4 10-15 1 — 2 — — — - - 3 15-20 4 9 1 4 4 2 3 — — — 27 20-25 6 3 — 1 — 7 1 1 — 1 1 21 25-35 12 9 — 1 3 4 — 2 — — 1 32 35-45 13 4 — 1 3 4 — — — — - - 25 45-55 5 4 1 7 — 2 1 - - 20 55-65 4 1 2 1 - - - 8 65 up - 1 1 - — 1 — — - 1 — — 4 Totals 48 31 5 11 20 19 4 3 2 3 — 2 148 95 46 7 77 INDEX PAGE Acreage 6 Ambulance Facilities 24-25, 52 Acute Poliomyelitis 68 Births 9, 12 In each Ward 13 In hospitals or maternity homes 13 Rates 9, 13-14 Bed Bugs—Eradication of 46 Camping Sites 54 Cancer 9 Deaths from 16-17 Rate 9, 17 Cemeteries 54 Cerebro-Spinal Fever 68 Child Life Protection 42 Clinics and Treatment Centres 25-26 Climatic Conditions 8 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 Rates 9, 14-15 Diphtheria 63 Antitoxin used 65 Immunisation 65 Clinics, times and places 25 Children Immunised in Schools 67 Persons Immunised at Clinics 66 Persons Immunised by Private Practitioners 66 Incidence and fatality for 20 years 68 Incidence by age groups 65 Incidence in each Ward with rates 63 Monthly distribution of cases 64 Multiple cases in domestic dwellings 64 Swabs examined 23 Disinfection 46 Disinfestation 46, 54 Drainage and Sewerage 44 Drainage work 46 Dysentery 60 Enteric Fever 60 Erysipelas 69 78 I N D E X—continued. PAGE Factories 6, 50, 58-59 Conditions in Offices 50 Inspections made 50, 58 Defects found and remedied 59 Outwork in Unwholesome Premises 59 Food and Drugs (Adulteration) Act, 1928 50 Food Poisoning 70 Food Supply 47 Inspections 47 Unsound Food 47 Health Services 23 Heart Disease 16 Deaths from 16 Hospitals 27-29 Housing:— Council's Schemes 55 Housing Act, 1936—Overcrowding, 45,55 Inspections and Defects 45, 56-59 New houses erected 55 Number inhabited 6 Verminous premises 46 Industry 6 Infant Mortality 9, 21-22 Classified causes of deaths 22 Rates 9, 21 Infectious diseases 27, 46 Diseases notifiable 60 Disinfection after 46 Enquiries into 46 Monthly Incidence 73 Notification by age groups 72 Notifications, deaths and distribution 71 Inquests 18 Isolation Hospital 27 Admissions to 29 Laboratory Facilities 23 Examination of clinical material 23 Legislation 25 Maternal Mortality 9, 20 Rates 9, 20 Maternity and Child Welfare 30-31 Ante-Natal Clinics 25 Attendances at each Centre by age groups 34 79 IN D E X—continued. PAGE Attendances at Infant Consultation Clinics 32 Attendances at Maternity Clinics 31 Attendances at Toddler Clinics 32 Attendances at all Infant Welfare Centres 33 Attendances at Centres over last ten years 33 Attendances in relation to the registered births 35 Committee 4 Consultant advice for maternity 39 Convalescent Home Treatment 38 Dental Scheme 40 Attendances 40 Operations performed 40 Emergency Maternity Unit 39 Health Visiting 36 Home Helps 39 Hospital provision for maternity 38 Midwives 41 Milk Scheme 37 Orthopaedic Treatment 38 Sessions, times and places 25 Sterilised Maternity Outfits 39 Voluntary Helpers 42 Work of the Centres 30 Meat Inspection 47 Measles 68 Milk Supply 48 Milk (Special Designations) Order, 1936 48 Inspections 48 Licences issued 48 Nelson Hospital 28, 35-36 Notification of Births 30 Nuisances: — Abated 53 Notices served 53 Nursing in the Home 23 Offensive Trades 52 Ophthalmia Neonatorum 69 Pneumonia 70 Population 9, 11-12 Prevention of Blindness 70 Public Assistance 7 Public Cleansing 44 Public Health Committee 4 Puerperal Pyrexia 69 Consultant 5 80 IN D E X—continued. PAGE Rainfall 8 Rateable value 6 Rats and Mice Destruction 51 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 43 Sanitary Inspection 44 Scarlet Fever 60 Incidence and fatality last 20 years 62 Incidence in each Ward with rates 61 Monthly distribution of cases 61 Multiple cases occurring in domestic dwellings 62 Schools 54 School clinics 26 Shops Acts, 1912-1936 52 Slaughterhouses 47 Slipper Baths and Cleansing Station 42 Smallpox 27, 60 Smoke Abatement 51 Social Conditions of the Area 6 Staff 5 Statistics 6, 9 Comparative 10 Swimming Baths and Pools 54 Trade Refuse (Burning of) 51 Tuberculosis 9, 74 Admissions to Sanatorium 29, 75 Deaths due to 75 Dispensary 26 New cases—by age groups 77 Number on register at year end 74 Unemployment 7 Venereal Diseases 26 Watercourses 51 Water Supply 43 Whooping Cough 68 Zymotic Disease 60 Deaths from 9 Rate 9 81