MER 3 Merton and Morden Urban District ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1939 AND REPORT OF The Sanitary Inspector Merton and Morden Urban District ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1939 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 the Annual Report for the year 1939. I must apologise for the late appearance of this Report, the earlier publication of which was found to be impracticable as a result of the declaration of War on the 3rd September, and the consequent diverting of the duties of practically the whole of the staff of the department to the war effort. In addition the Registrar General's statistics for the year were received much later than is usual. I have, despite considerable difficulty, endeavoured to present the Report in much the same form as in previous years, both as a volume of reference and as an annual review of the work of the department. Although it falls to me to present this Report to you, it will be appreciated that the work it reviews was carried out under the direction of my predecessor, Dr. F. Lawrence Smith, who left Merton and Morden in March, 1940, to take up an appointment with the Carshalton Urban District Council. I should like to claim your indulgence for taking this opportunity of putting on record my appreciation and sincere thanks for the very willing assistance and guidance he afforded me at the time I assumed my position at Merton and Morden. With regard to Air Raid Precautions, the Casualty Services were organised and completed in accordance with the directions given in the various Circulars and Memoranda from the Government Departments, London Civil Defence Region and the Scheme-making Authority. The year under review, despite the outbreak of the War, was a particularly favourable one from the health point of view. All vital statistics reflect the improvement and compare very favourably with those of previous years and for the country as a whole. It is the practice for Medical Officers of Health to use the Annual Report as a vehicle for drawing attention to, or emphasising some important current feature of preventive medicine or public health. The curtailment of the body of this Report 2 to the essential recording of the work undertaken during the year has deprived me to some extent of the opportunity to do this. One piece of important preventive work is Immunisation against Diphtheria and a national propaganda drive was undertaken to endeavour to secure a great increase in the number of individuals and children protected. There are many who believe that this should be made compulsory, but up to the present, reliance has been placed on propaganda to achieve the desired result. It would appear that it is more difficult to secure attendances of children up to five years of age than the school age groups. This is a great pity because the mortality from Diphtheria. is greatest in infants and younger children. The prolonged exposure of the younger age groups and contact with numbers of individuals other than their own families owing to war conditions in such places as shelters, has given rise to a great deal of anxiety among those engaged in preventive medicine. Happily there does not seem to have been any disastrous consequences, but none the less, this is no justification for complacency, the potential factors are still there and protection of the children by injection is the only real answer to the problem. One other fact I think is worth mentioning as a great advance in this work and that is the substitution of a two injection method for the previous three injections. Only quite recently it was the practice to give five injections in all, a preliminary skin test, three injections of protective substance and later a final skin test. There was some excuse then for failure to have a child protected. Now, there are only two injections at an interval of one month between each injection. In the latter part of 1939, we were forced to embark upon perhaps the biggest social experiment ever carried out in this country, namely the evacuation and transplantation of families from the urban districts to the rural areas. Among many facts which came to light as a result, was the high rate of parasitic infection among sections of the urban population. The prevention of this infestation is more difficult under war conditions, particularly in areas subject to prolonged hostile attack, owing to aggregation of mixed sections of the population and the added difficulties of maintaining cleanliness of the person and of personal linen. Scabies or the " itch " has ceased to be confined to the vagabond, but is to be found mainly as an accidental infection in persons of a high standard of personal cleanliness who are often unaware that the irritating rash is the outward manifestation of the " itch " mite under the skin and attribute it to water, change of diet or to one or other of the satisfying explanations of evanescent rashes. Fortunately, the treatment is simple and the cure can be rapidly secured, when the condition is recognised. 3 In the body of the Report, the public health legislation enacted during the year is included under the various appropriate sections. Special attention might, however, be drawn here to the Food and Drugs Act, 1938, and the Measles and Whooping Cough Regulations, 1939, under which cases of food poisoning, Measles and Whooping Cough respectively became notifiable. In conclusion, I should perhaps apologise for devoting so much space in this preface to detail and for some chronological inconsistency. My excuse, however, is that while it is my primary duty to report to you on the health of the district and the activities of my department during the year under review, I ought not to waste this opportunity of advising the district on important current health matters. I would like to record my appreciation of the encouragement and support afforded to me by the Members of the Council since taking over the appointment as your Medical Officer of Health. To all the members of my staff, on whom I have had to depend for their intimate knowledge of local details and conditions, in no small degree, I wish to record my appreciation and thanks, for their untiring and loyal assistance and to add that it is to their credit that the public health outlook has been maintained in the atmosphere of the past year, and it is to them that what success the department has achieved is due. I am, Mr. Chairman, Ladies and Gentlemen, A. WALLACE JOHNS, Medical Officer of Health. December, 1940. 4 URBAN DISTRICT COUNCIL of MERTON and MORDEN 1 939 PUBLIC HEALTH COMMITTEE. Chairman: Mr. W. S. Le Gros Clark Mrs. E. M. Clifton Mr. F. J. Grimme Mrs. H. Cobbett Capt. A. E. Higgins Mrs. L. A. Doel Mrs. S. A. Lodge Capt. E. A. Evans Mr. G. E. Baker (ex-officio) Mr. G. F. Coleman (ex-ofjicio) 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 members Capt. A. E. Higgins Mrs. Turrell Mr. G. E. Baker (ex-ofjicio) Mr. G. F. Coleman (ex-officio) REPRESENTATIVES ON THE WANDLE VALLEY JOINT HOSPITAL BOARD. Mrs. H. Cobbett Mr. F. J. Grimme Mr. G. F. Coleman Mr. G. E. Baker (ex-officio) REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD. Mrs. E. M. Clifton Mr. S. F. Franklin Mr. G. F. Coleman Mr. G. E. Baker (ex-officio) REPRESENTATIVES ON NELSON HOSPITAL COUNCIL. Mr. G. F. Coleman Mr. F. W. Palmer Mr. D. M. Neil. 5 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. Deputy Chief Sanitary Inspector: b c F. C. Thomas, M.S.I.A. Sanitary Inspectors: b J. H. Massey, M.S.I.A. b d N. Smith, M.S.I.A. (from 28.8.39) Senior Health Visitor: Miss E. M. Sperry Health Visitors: Miss A. R. Taylor Miss M. McL. Doran Miss A. Howard Miss M. E. Black Senior Clerk: A. A. Makepeace Clerks : R. J. Mitton H. J. Rogers (resigned 4.3.39) B. J. Fentiman (from 20.3.39) Mrs. M. M. Makepeace (from 5.9.39) Miss M. J. Hearn (from 18.12.39) 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. Consulting 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 Anesthetist 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. d Smoke Inspector's Certificate, Royal Sanitary Institute. 6 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 3,238 Number of inhabited houses (end of 1939) according to Rate Books 20,750 Rateable Value at 31st December, 1939 £620,675 Sum represented by Id. rate £2,522 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. Industry. The number of factories registered under the Factories Act at the year end was:— Factories with mechanical power:— Employing more than 40 persons 26 Employing less than 40 persons 67 Factories without mechanical power 8 101 The number of employees engaged in these premises is approximately 7,000. A list of the various trades carried on in the larger factories is shown in the Sanitary Inspector's Report. Unemployment. The number of Merton and Morden residents registered at the Wimbledon and Sutton Exchanges as unemployed at the beginning of 1940 was as shown below. They do not, of course, represent the total of unemployed since not all are registered at these two Exchanges. 7 Registered at Wimbledon on 6/1/40. Men 470 Women 547 Boys 17 Girls 18 1,052 Registered at Sutton on 13/1/40. Men 127 Women 95 Boys 19 Girls 35 276 The number registered at Wimbledon campares with 1,109 one year ago and 859 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 Public Assistance hospitals from Merton and Morden 70 Number of persons admitted to mental hospitals 33 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, 1939 660 1st July, 1939 667 31st December, 1939 700 Total amount of Domiciliary Assistance afforded during the year £15,456 The figure given above relating to the number of admissions to hospitals is only in respect of those patients who were referred to hospital by the Relieving Officer. In this connection it should be observed that several of the hitherto Public Assistance Institutions have been appropriated by the County Public Health Department and consequently numerous admissions to hospitals have been made direct under public health arrangements which are not shown in these figures. 8 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, 1939. JOSEPH HOOD RECREATION GROUND. WEST BARNES PUMPING STATION. January 3.54 inches 3.85 inches February 1.09 „ 1.18 „ March 0.95 „ 1.05 „ April 1.97 „ 2.35 May 1.44 „ 1.45 „ June 0.89 „ 0.99 „ July 2.70 „ 3.24 „ August 3.65 „ 3.30 „ September 1.36 „ 1.53 „ October 5.45 „ 5.63 „ November 3.89 „ 3.94 „ December 0.95 „ 0.90 „ Total 27.88 „ 29.41 „ 9 SUMMARY OF VITAL STATISTICS FOR 1939. (Registrar General's Figures). Population: Mid. 1939 Registrar General's Estimate:— For calculation of Birth Rates (a) 72,150 For calculation of Death Rates or the incidence of Infectious Diseases (b) 71,220 Births : M. F. Total. Live (Leg.) 492 486 978 (Illeg.) 13 14 27 505 500 1,005 Birth rate 13.9 Stillbirths 18 12 30 Stillbirth Rate per 1,000 total births 28.9 Deaths : 270 246 516 Death Rate 7.2 Infant Mortality: All deaths under 1 year 30 Rate per 1,000 live births 30.3 Deaths of leg. infants under 1 year 25 Rate per 1,000 leg. births 26.04 Deaths of illeg. infants under 1 year 5 Rate per 1,000 illeg. births 185 Maternal Mortality: Deaths from Sepsis — Deaths from other puerperal causes 4 Maternal death rate 3.93 Zymotic Deaths: Deaths from Measles — Deaths from "Whooping Cough — Deaths from Diarrhoea (under 2 years) 1 7 Principal Zymotic Diseases 3 Zymotic Death Rate (per 1,000 population 0.04 Deaths from Tuberculosis: All forms 47 Rate per 1,000 population 0.65 Phthisis 44 Rate per 1,000 population 0.61 Deaths from Cancer 81 Rate per 1,000 population 1.1 10 TABLE I. COMPARATIVE STATISTICS, 1939. (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 Hates per 1,030 Population Births:— Live 15.0 14.8 15.6 12.3 13.9 Still 0.59 0.59 0.57 0.44 0.42 Deaths:— All causes 12.1 12.0 11.2 11.9 Crude 7.2 Comp. 8.7 Typhoid and Paratyphoid fevers 0.00 0.00 0.00 0.00 — Smallpox — — — — — Measles 0.01 0.01 0.01 0.00 — Scarlet fever 0.01 0.00 0.00 0.00 — Whooping Cough . 0.03 0.03 0.02 0.03 — Diphtheria 0.05 0.05 0.04 0.02 0.02 Influenza 0.21 0.19 0.20 0.18 0.19 Notifications:— Smallpox 0.00 — — — — Scarlet fever 1.89 1.96 1.78 1.53 1.37 Diphtheria 1.14 1.21 1.16 0.98 0.44 Enteric fever 0.04 0.03 0.04 0.03 — Erysipelas 0.34 0.40 0.31 0.37 0.21 Pneumonia 1.02 1.21 0.89 0.99 0.99 Rates per 1,000 Live Births Deaths under 1 year of age 50 53 40 48 30 Deaths from Diarrhoea and Enteritis under 2 years of age 4.6 6.3 3.0 8.2 0.9 Maternal Mortality: Puerperal Sepsis 0.77 Not Available — Others 2.16 3.98 Total 2.93 3.98 Rates per 1,000 Total Births (i.e.. Live and Still) Maternal Mortality Puerperal Sepsis 0.74 Not Available — Others 2.08 3.93 Total 2.82 3.93 Notifications:— Puerperal fever | 14.35 17.26 12.99 3.31 Puerperal pyrexia 14.22 14.4 11 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 has, in view of the prevailing war conditions, provided separately computed population figures appropriate for the calculation of birth rates and the calculation of death rates or incidence of notifiable diseases. The Registrar-General's estimate of the mid-year population is:— (a) For the calculation of birth rates 72,150 (b) For the calculation of death rates or incidence of infectious diseases 71,220 the estimate in respect of 1938 was 68,980. My own estimate, computed from local knowledge, is 77,350. The estimated population of the wards is as follows:— Wards Houses at mid. 1939 Estimated Population mid. 1989 Abbey 1,443 5,200 Bushey Mead 2,183 7,940 Central 3,041 10,240 Morden 2,909 9,780 Park 2,857 10,090 Ravensbury 1,853 7,650 Raynes Park 2,077 7,820 St. Helier 2,896 12,800 West Barnes 1,922 6,880 Whole District 21,180 77,850 BIRTHS. The registered live births totalled 1,005, an increase of 15 over the year before. The birth rate has shown a slight fall from 14.3 to 13.9 per thousand of the population. 12 Of the total live births 505 were males and 500 females. Thirteen males and 14 females were illegitimate. Stillbirths numbered 30, 18 being males and 12 females. One male stillbirth was illegitimate. 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 941 live births and 24 stillbirths took place during the year as compared with a total of 1,005 live and 30 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 64 less than the registered births. BIRTHS, 1939—DISTRIBUTION BY WARDS. Wards Live Births Still Births Total Births Birth Rate Abbey 65 1 66 12.5 Bushey Mead 92 2 94 11.6 Central 151 3 154 14.7 Morden 184 4 188 18.8 Park 111 8 114 11.0 Ravensbury 71 8 74 9.2 Raynes Park 79 3 82 10.8 St. Helier 110 4 114 9.7 West Barnes 78 1 79 11.4 A high rate was again recorded in the Morden Ward and as in the previous year was due to the development which has taken place in that ward. Institutional and Domiciliary Births. The tendency of recent years towards increased Institutional confinements continued. Fifty-seven per cent, of the births which occurred during the year took place in hospitals or nursing homes as follows:— Nelson Hospital 230 Kingston County Hospital 80 Other hospitals, institutions, and nursing homes 248 558 13 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 Percentage of Total Births which occurred in Hospitals, etc. Abbey 66 35 53.0 Bushey Mead 94 74 78.7 Central 154 93 60.4 Morden 188 116 61.7 Park 114 83 72.8 Ravensbury 74 22 29.7 Raynes Park 82 50 60.9 St. Helier 114 41 35.9 West Barnes 79 44 55.7 TABLE II. Showing Births and Deaths with Rates since the Amalgamation of Merton with Morden. Year. Estimated population. Total Births. Birth Rate. Total Deaths. Death Rate. 1913 16,767 400 23.5 166 9.9 1914 17,500 420 24 142 8.2 1915 17,500 402 22.9 169 10.4 1916 16,000 348 27.75 134 8.3 1917 17,000 271 15.75 145 9 1918 17,552 241 14 204 13 1919 18,100 257 14.2 210 11.6 1920 18,200 359 19.8 171 9.4 1921 18,000 322 17.8 138 7.6 1922 18,500 365 19.7 198 10.7 1923 18,750 341 18.1 153 8.1 1924 18,710 311 16.6 170 9.1 1925 18,960 307 16.2 187 9.9 1926 19,980 333 16.7 179 9.0 1927 21,850 352 16.13 200 9.2 1928 25,780 392 15.2 224 8.7 1929 27,430 442 16.1 281 10.2 1930 35,000 452 12.9 241 6.9 1931 41,610 628 15.1 333 8.0 1932 48,550 770 15.8 352 7.2 1933 52,130 644 12.3 416 7.9 1934 55,550 770 13.8 484 8.7 1935 57,440 721 12.5 433 7.5 1936 61,000 789 12.9 443 7.2 1937 65,530 812 12.3 487 7.4 1938 68,980 990 14.3 509 7.3 1939 (a) 72,150 1,005 13.9 — (b) 71,220 516 7.2 14 DEATHS. The number of registered deaths after adjustment by transferable deaths was 516 of which 270 were males and 246 females. The crude death rate was 7.2 per thousand population as against 7.3 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 8.7 which compares with 12.1 for England and Wales. Seasonal mortality is indicated by the deaths for each quarter of the year, which were:— First quarter 159; second quarter 109; third quarter 116; fourth quarter 127. The following table shows the death rates for each ward and the mean age at death:— TABLE III. Ward Death Rates and Mean Age at Death. Wards Deaths Death Rate (crude) Mean age at death Abbey 65 12.5 53.24 yrs. Bushey Mead 61 7.6 58.83 „ Central 52 5.0 55.34 „ Morden 62 6.3 52.87 „ Park 80 7.9 58.51 „ Ravensbury 89 5.5 57.02 „ Raynes Park 49 6.6 62.97 „ St. Helier 59 4.7 40.08 „ West Barnes 44 6.4 57.38 „ Whole District 511 6.6 55.16 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:— 1935—52.7 vrs.; 1936—54.5 yrs.; 1937—54.0 yrs.; 1938—53.9 vrs.; 1939—55.16 vrs. 15 Deaths in Institutions. Half the total deaths registered occurred in hospitals and institutions. Two hundred and fifty-seven, representing 50 % of the whole, took place in the following premises:— Institutions. Deaths. Nelson Hospital 21 Surrey County Hospitals 119 Isolation Hospitals 2 London and other general Hospitals 95 Tuberculosis Institutions 11 Mental Institutions 9 257 CAUSES OF DEATH. Heart Disease. This group of diseases maintains its position as the chief cause of death. It was responsible for 127 deaths giving a death rate for the group of 1.7 per thousand population, as against a rate of 1.5 in 1938. Cancer. Cancer deaths at 81 were nine less than previously and the death rate for this cause fell slightly to 1.1 per thousand population. As before it was the second chief cause of mortality and showed a slightly heavier incidence among women, 42 females dying of the disease as against 39 males. The cancer death rates for the last 12 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 :— Y ear. Death Rate per 1,000 population. Year. Death Rate per 1,000 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 1939 1.1 Respiratory Diseases. Epidemic influenza caused 14 deaths compared with 4 in the previous year. Respiratory diseases, bronchitis, pneumonia, etc., other than those stated to be influenzal, were less fatal, 34 persons dying of these conditions as against 49. The death rate for these diseases was accordingly 0.4 per thousand of the population:— 16 TABLE IV. Deaths from Respiratory Diseases, 1925-39. Year Bronchitis Pneumonia Other Respiratory Diseases Total Death Rate 1925 6 16 1 23 *1.2 1926 6 8 5 19 0.9 1927 10 11 5 26 *1 2 1928 8 14 2 24 0.9 1929 11 20 4 35 *1.2 1930 2 10 3 15 0.4 1931 8 24 4 36 0.8 1932 11 27 3 41 08 1933 12 32 6 50 0.9 1934 7 38 4 49 0.8 1935 9 22 6 37 0.6 1936 2 35 2 39 0 6 1937 14 31 6 51 0.8 1938 15 27 7 49 0.7 1939 5 20 9 34 0.4 (*Years of high influenzal mortality) Inquests. Inquests were held in the district on 33 deaths, 16 of which were in respect of residents. Verdicts were as follows:— (1) Natural causes 9 (2) Suicide by— Coal gas 4 Death through falling in front of train 1 Narcotic poisoning 1 Poisoning by Spirits of Salts 1 Shock following multiple injuries 1 Strangulation by hanging 1 9 (3) Accidental— Chronic myocarditis accelerated by fractured femur 1 Collision with motor car 1 Collision with motor omnibus 1 Carried forward 3 18 17 Brought forward 3 18 Collision with refuge and motor cyclist 2 Death by electrocution 1 Fracture and dislocation of spine 1 Hyposatic pneumonia following fractured humerus 1 Knocked down by motor car 2 Multiple injuries following accident 1 — 11 (4) Misadventure— Shock following extensive scalds of body 1 (5) In accordance with Medical evidence— Collision with motor cycle 1 Fracture of skull 1 Shock from attempted abortion 1 — 3 33 Road accidents were responsible for 9 of the total deaths, the same number as in the previous year. 18 TABLE V. Causes of Death during the Year 1939. No. Cause of Death Males Females Total 1 Typhoid and Paratyphoid Fever _ _ _ 2 Measles —. — — 3 Scarlet Fever — — — 4 Whooping Cough — — — 5 Diphtheria 2 — 2 6 Influenza 4 10 14 7 Encephalitis Lethargica — — — 8 Cerebro-Spinal Fever 1 — 1 9 Tuberculosis of Respiratory System 21 23 44 10 Other Tuberculous Diseases 1 2 3 11 Syphilis 2 — 2 12 General Paralysis of the Insane Tabes dorsalis 1 1 13 Cancer. Malignant Disease 39 42 81 14 Diabetes 5 2 7 15 Cerebral Hemorrhage, etc. 9 18 27 16 Heart Disease 71 56 127 17 Aneurysm 3 1 4 18 Other Circulatory Diseases 18 11 29 19 Bronchitis 2 3 5 20 Pneumonia (all forms) 12 8 20 21 Other Respiratory Diseases 3 6 9 22 Peptic Ulcer 9 2 11 23 Diarrhoea, etc. (under 2 years) 1 1 24 Appendicitis — 1 1 25 Cirrhosis of Liver — — 26 Other Diseases of Liver — 2 2 27 Other Digestive Diseases 3 8 11 28 Acute & Chronic Nephritis 3 2 5 29 Puerperal Sepsis —• — — 30 Other Puerperal causes —• 4 4 31 Congenital Debility, Premature Births, Malformations, etc. 16 6 22 32 Senility 4 6 10 33 Suicide 2 5 7 34 Other Violence 9 5 14 35 Other Defined Causes 29 22 51 36 Causes Ill-defined or Unknown _ _ Diarrhoea (2 yrs. and over) — 1 1 Total all Causes 270 246 516 19 MATERNAL MORTALITY. Four deaths were recorded as being due to maternal causes, in each case death was due to other causes, as distinct from sepsis. The Maternal mortality rate was 3.93 per thousand total births as against a rate of 2.95 in 1938. The rate for England and Wales was 2.82. The cause of death in each case was certified to be:— (1) 1 (a) Uremia. (b) Acute toxic nephrosis. (c) Pregnancy. (2) 1(a) Pulmonary embolism—Puerperal. (b) Post partum hæmorrhage. 2 Natural delivery. (3) 1(a) Peritonitis. (b) Cæsarian Section. (c) Failed forceps and failed extraction. (4) 1(a) Haemorrhage and shock to marginal placenta prævia and Brow presentation. TABLE VI. MATERNAL MORTALITY, 1924-39. Year Death rate per thousand t.otal births Sepsis Other causes Total 1924 — 32 3.2 1925 - 6.5 65 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 1988 0.98 1.96 2.95 1989 - 3.93 3.93 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 fifth year in succession, the district can record a very favourable infant death rate. Thirty deaths of infants under one year took place, which gives a mortality rate of 30 per thousand live births, as against a rate of 39 for the year before. The corresponding rate for the country as a whole was 50. Of the 30 deaths, 22 were males and 8 females. Five were illegitimate children. Neo-natal deaths, i.e. those occurring within four weeks of birth, at 17, represent 56% of the whole. There were no infant deaths under one year of age due to the commoner infectious diseases. Rather more than half (53%) were due to the diseases peculiar to early infancy, prematurity, malformations, marasmus, etc., whilst injury at birth accounted for 3. The infant mortality rates since 1921 are as follows:— Deaths per 1,000 live Deaths per 1,000 live Year. births. Year. 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 1939 30 Table VII shows infantile mortality classified by age and cause. Infant death rates for the various wards are given below based on the total of 941 live births which occurred during the vear and which it was possible to allocate. There are slightly higher than if calculated on the registered births which totalled 1,005. Wards Live Births Infant Deaths Deaths per 1,000 live births Abbey 65 7 107 Bushey Mead 92 1 10 Central 151 4 26 Morden 184 7 38 Park 111 3 27 Ravensbury 71 — - Raynes Park 79 1 12 St. Helier 110 5 46 West Barnes 78 2 25 21 TABLE VII.—INFANT MORTALITY DURING THE YEAR 1939 Deaths classified as to cause and age at death. Cause of Death. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year Smallpox - - - - - - - - - - Chicken-pox — - Measles ___ - - - Scarlet Fever - - - Whooping Cough - Diphtheria and Croup Erysipelas — Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - Other Tuberculous Diseases - - - - - Meningitis (not Tuberculous) - - - _ Convulsions - - 1 - 1 Laryngitis - - Bronchitis - - Pneumonia (all forms) 1 1 2 2 5 Diarrhoea - - - - - - - Enteritis 1 - - 1 2 Gastritis - - - - Syphilis 1 1 Rickets Suffocation, overlying - - - - Injury at birth 2 1 3 3 Atelectasis 2 - - 2 - - - 2 Congenital Malformations - 2 2 2 Premature birth 9 - 9 - - 9 Atrophy, Dobility and Marasmus - — - 1 — 1 Other causes — — — — — — 2 2 — 4 TOTALS 13 3 — 1 17 4 6 2 1 30 Nett births in the year—Males 505, Females 500 : Legitimate 978, Illegitimate 27. Nett deaths in the year of Legitimate Infants 25. 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 179 cases involving 2,645 visits were attended during the year. Of these, 16 were children under five years of age to whom 62 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 155 cases of which 16 were children under 5 years were nursed. The total number of visits made was 2,924 of which 140 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 one midwife is also provided for this district. The figures relating to cases and visits in Merton and Morden during 1939 are as follows:— Cases. Visits. Children under 5 years 57 701 Maternity 14 870 Midwifery 27 Other cases 409 6,412 Total 507 7,983 Laboratory Facilities. There has been no change in the laboratory arrangements for this district. The following examinations were made during the year:— Examination. No. performed. Positive result. Swabs for diphtheria bacilli 556 32 Sputum for tubercle bacilli 128 21 Blood for Widal test 4 — Fasces 9 1 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. For the removal of non-infectious and maternity cases, the District Council provides one ambulance. This vehicle will accommodate two stretcher cases and one sitting case. It is housed at the Fire Station in Kingston Road and is fitted with the necessary stretchers and blankets and with a C.O2and Oxygen resuscitating apparatus. The engine is electrically heated in cold weather and there is thus no delay in getting away. The ambulance staff consists, in addition to the Honorary Officer in Charge, of three full-time firemen drivers. Reciprocal arrangements exist with all neighbouring authorities. The use of the ambulance is free to residents up to a distance of 32 miles; this meets the needs of cases transported to hospitals on the north side of London. The following is a summary of the working of the service in 1939:— AMBULANCE CALLS, 1939. 1939 Calls received from Public Calls received from neighbouring Brigades Total Calls Received Calls transferred to other Authorities Call6 answered by Own Ambulance January 83 3 86 4 82 February 71 3 74 2 72 March 87 7 94 4 90 April 68 4 72 1 71 May 72 5 77 3 74 June 58 7 65 1 64 July 67 3 70 3 67 August 69 6 75 6 69 September 87 1 88 — 88 October 67 1 68 3 65 November 74 4 78 2 76 December 78 2 80 1 79 881 46 927 30 897 Street or works accidents accounted for 33 per cent, of the cases removed, the remainder being removals to and from hospitals, institutions, etc. Number of calls for 2 attendants 530 Number of calls for 1 attendant 367 897 24 Time taken in executing the 897 calls (from leaving station to return) 785 hours. Mileage covered 7,487 Average time per call 52.5 mins. Average distance per call 8.3 miles. Legislation. No Local Acts, Special Orders, General Adoptive Acts or Bye-laws applicable to this district came into operation during the year other than Building Bye-laws made under the Public Health Act, 1936, which were confirmed by the Minister of Health on the 23.rd May, 1939, and came into operation on the 1st July, 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 Wednesdays 2—4 p.m. Toddlers 4th Wednesday in month 10—12 noon. The Health Centre, Middleton Road, Morden Infant Welfare Tuesdays and Fridays 2—4 p.m. Toddlers Fridays 10—12 noon. Ante-Natal Thursdays 10—12 noon Dental Thursdays 10—12 noon Post-Natal 3rd Saturday in each month, 10—12 noon. The Parish Hall, Central Road, Morden Infant Welfare Tuesdays and Fridays 10—12 noon Fridays 2—4 p.m. The Health Centre, Aston Road, Raynea Park Infant Welfare Mondays and Thursdays 2—4 p.m. Fridays 10—12 noon Toddlers Wednesdays 2—4 p.m. Ante-Natal Mondays 10— 12 noon. Every Saturday (except 3rd) in each month, 10—12 noon. Dental Fridays 10—12 noon. 2.—Diphtheria Immunisation Clinics (provided by the Council). Blakesley House, Kingston Road, Merton 1st and 3rd Tuesday 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 Tuesdays and Thursdays 9.80—12 noon. Dental Mondays 9.80-—12 noon. 1.45—4 p.m. Thursdays 1.45—4 p.m. Fridays 9.30 — 12 noon, 1.45—4 p.m. Eye 2nd, 4th and 5th Wednesday in each month 9.80—12 noon. The Health Centre, Middleton Road, Morden Dental Mondays 9.30—12 noon. Tuesdays 9.80—12 noon. 1.45—4 p.m. Wednesdays 9.80 — 12 noon, 1.45—4 p.m. Thursdays 1.45—4 p.m. Fridays 9.80—12 noon, 1.45—4 p.m. 1st, 2nd, 4th and 5th Saturday in each month, 9.30—12noon. Eye Wednesdays 1.45—4 p.m. Infant School, Canterbury Road, Morden. General Medical Mondays and Wednesdays 9.30—12 noon. 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 and Saturdays at 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, Cjandon—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 present accommodation at this hospital is 132 beds. No extensions took place during the year under review. In 1939, 144 cases were admitted from this district compared with 194 in the year before. An analysis of the cases admitted during the year from this and the other constituent districts of the Board is given in Table VIII. General and Maternity. 1. The Nelson Hospital for Wimbledon, Merton and District. The accommodation of this voluntary hospital to whose funds the Council makes an annual grant is 84 beds. These are 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 1939 1,115 Number from Merton and Morden 437 Total number of new out-patients 5,858 Number from Merton and Morden 2,527 27 (b) Maternity Services— Number of patients admitted from all districts during the year— (1) General Wards 263 (2) Private Wards 112 Total 375 Number of patients admitted from Merton and Morden— (1) General Wards163 (2) Private Wards 67 230 The extensions to the Orthopædic and X-Ray Departments referred to in my report for last year have now been completed. 2. The County and Public Assistance Hospitals. Under existing arrangements, patients from this district receiving treatment in County Hospitals are admitted, in most instances, to the Kingston County Hospital at Wolverton Avenue. 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 35 persons were admitted from Merton and Morden during the year, whilst 100 other patients received treatment in other Institutions under the Scheme. 28 TABLE VIII. CASES ADMITTED TO THE WANDLE VALLEY ISOLATION HOSPITAL DURING THE YEAR 1939. Disease Beddington and Waliington Coulsdon and Purley Merton and Morden Mitcham Oases Deaths Cases Deaths Cases Deaths Cases Deaths Diphtheria 9 2 10 — 34 * 2 27 1 Scarlet Fever ... 25 — 48 — 89 — 57 — Typhoid ] 1 — — — — — — Erysipelas 3 — 2 — 4 — 6 — Other Diseases Tonsillitis 3 — 1 — 2 — 5 1 Bronchitis — 1 — — Whooping Cough 2 — 2 — 7 — 28 3 Rubella 5 — — 3 — Enteritis ] — — 1 — Chill 1 — — — Tubercular Meningitis 1 l 1 1 Osteomyelitis — - — 1 — — — Puerperal Pyrexia 3 — 1 — — 4 — Cerebral Haemorrage — — — — 1 — — Anterior Poliomyelitis 2 — — — 1 — — Dermatitis 1 — — — 2 Urticaria — — — 1 — Admitted with mother 2 — 1 — 1 2 Meningitis 1 — — — 1 — — — influenza — 2 1 — No Disease — —— — — 1 — — — 54 3 68 1 144 2 137 6 * Includes two " carriers." 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 924 Notified by midwives 537 Still Births 25 Notified by doctors and parents 76 Transferred from other districts 336 Total 949 Total 949 The total is two less than in 1938 and represents 90% of the births registered during the year. The number of notified births which took place outside the district represents 35% of the total—2% more than in the year before. The Work of the Centres. To meet the continued expansion and development in the district the welfare activities at the Centres were again at a high level, until the outbreak of the war, when it became desirable, as far as possible, to avoid arge collections of mothers and children, and the Toddler Clinics were suspended and replaced by Infant Consultation Clinics in a restricted form. This entailed a slight alteration in the programme involving an additional weekly Infant, session at the Parish Hall in Central Road, Morden. The number of women who attended either ante-natally or post-natally at the Maternity Clinics rose from 469 to 588. The number who attended for ante-natal supervision increased by 121, and the number who attended for post-natal supervision by 27. Compared with a percentage of 42 in 1938, the number of women who attended Maternity Clinics in 1939, represented 58% of the registered births and is the highest percentage yet recorded for the district. Ten years ago the figure was under 10. There was a corresponding increase in the work of the Infant Clinics. The number of infants on the register rose by 290, but as a result of the restriction in the number attending the Clinics, referred to above, the total attendances during the year were 859 below the figure for the previous year. The number of new babies attending for the first time at 856 was 30 106 higher than in the previous year and is equivalent to 85% of the registered live births. The primary attendances at the Toddler Clinics numbered 911 and since 174 visits were made to these clinics for observation purposes, the total attendances at these special sessions was 1,085. In view of the present emergency, the scheme for the erection of a new Clinic in Camborne Road has been temporarily abandoned. The tables which follow show the attendances at the various Clinics, the programme of which is shown on page 25. TABLE IX. Attendances at Maternity Clincs, 1939. Centre No. on Register Attendances Sessions Average attendances per session Primary Total MORDEN Ante-Natal 272 211 1021 62 17.6 Post-Natal 73 — 78 Individuals 272 211 1094 RAYNES PARK Ante-Natal 316 241 1,208 88 15.6 Post-Natal 92 — 93 Individuals 316 241 1,301 ALL CENTRES Ante-Natal 588 452 2,229 145 16.5 Post-Natal 165 166 Individuals 588 452 2,895 (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 X. Attendances at Infant Consultation Clinics, 1939. Centre No. on Register Attendances Sessions Average attendances per session Primary Total MERTON Under 1 yr. †340 105 1,899 50 66.1 1—5 yrs. 35 1,406 MORDEN Under 1 yr. 736 206 2,667 94 58.0 1—5 yrs. 111 2,785 RAYNES PARK Under 1 yr. §1030 316 5,219 112 77.0 1—5 yrs. 54 3,506 PARISH HALL Under 1 yr. †560 229 8,791 96 60.5 1—5 yrs. 69 2,018 ALL CENTRES Under 1 yr. 2,612 856 13,576 352 66.1 1—5 yrs. 269 9,715 * Excluding children known to have attended other centres. †Includes 13 transferred from Raynes Park. †Includes 41 transferred from Raynes Park. § Includes 54 subsequently transferred to Merton and Parish Hall. TABLE XI. Attendances at Special Toddlers Clinics (2-5 Years), 1939. Centre Routine examinations Observation attendances Total attendances Sessions Average attendances per session Merton 55 20 75 10 7.5 Morden 396 54 450 42 10.7 Raynes Park 460 100 560 40 14.0 All Centres 911 174 1,085 92 11.7 32 TABLE XII. Attendances at all Infant Welfare Clinics, 1939. (Infant Consultation and Special Toddler). Centre No. on Register Attendances Sessions Average attendance per session * Primary Total MERTON Under 1 yr. †867 105 1,899 60 56.3 1—5 yrs. 85 1,481 MORDEN Under 1 yr. 941 206 2,667 136 43.3 1—5 yrs. 111 8,235 RAYNESPARK Under 1 yr. §1.276 316 5,219 152 61.0 1—5 yrs. 54 4,066 PARISH HALL Under 1 yr. †560 229 3,791 96 60.5 1—5 yrs. 69 2,018 ALL CENTRES Under 1 yr. 3,090 856 18,576 444 54.9 1—5 yrs. 269 10,800 0—5 yrs. 1125 24,376 | * Excluding children known to have attended other centres, t Includes 13 transferred from Raynes Park. + Includes 41 transferred from Raynes Park. § Includes 54 subsequently transferred to Merton andi Parish Hall. TABLE XIII. 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 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 1988 1,863 220 825 18,724 540 19,264 1984 1,880 283 545 17,994 590 18,584 1935 1,936 253 554 18,800 622 19,422 1986 2,010 806 561 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 27,862 1939 3,090 588 856 24,876 2,895 26,771 33 TABLE XIV. CHILDREN ATTENDING CENTRES DURING 1939. 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 1939 (1st year) † 96(7) 958 9.9 158 1,457 9.2 *283(24) 2,291 8.0 †200(17) 1,811 9.0 737 6.517 8.8 1938 (1st and 2nd year) 117(3) 1,276 10.9 143 1,790 12.5 238(13) 4,042 16.9 183(10) 2,765 15.1 681 9,873 14.4 1937 (2nd and 3rd year) 52(2) 524 10.7 159 997 6.2 227(6) 1,271 5.5 72(4) 529 7.3 510 3,321 6.5 1936 (3rd and 4th year) 42 320 7.6 143 580 4.0 232(6) 949 4.0 52(6) 378 7.2 469 2,227 4.7 1935 (4th and 5th year) 38(1) 220 5.7 185 640 3.4 184(5) 490 2.6 37(4) 215 5.8 444 1.565 3.5 1934 (5th year) 22 82 3.7 153 438 2.8 112 242 2.1 16 111 6.9 303 873 2.8 All ages under 5 367(13) 3,380 9.2 941 5,902 6.2 1,276(54) 9,285 7.2 560(41) 5,809 10.3 3,144 24,376 7.7 * Numbers in brackets in this column transferred to Merton and Parish Hall subsequently, t Numbers in brackets in these columns had previously attended Raynes Park Centre. 34 TABLE XV. Number of Children under 1 Year and Expectant Mothers Attending the Centres in Relation to the Registered Births. Year Registered births Infanta under 1 year Mothers who attended either Ante-Natally or Post-Natally. Primary attendances Percentage of registered births N umber 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 71 306 39.0 1937 812 569 70 358 44.0 1938 990 750 75 469 47.3 1939 1,005 856 85 588 58.5 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 Wimble-don and Mrrton and Morden district. 35 The following information kindly supplied by the Secretary indicates the work of the Hospital Clinics during 1939:— Infant Clinic— From Merton and Morden. From all Districts. (a) Total number of attendances at the Infant Clinic during the year. (1) By children under one year of age 577 (2) By children between the ages of one and five years 3 (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 53 81 (2) between the ages of 1 and 5 years 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 52 79 (2) over one year of age 1 3 Ante-Natal and Post-Natal Clinic— Ante-Natal. Post-Natal. Merton and Morden. All Districts. Merton and Morden. All Districts. (a) Total number of attendances at the Clinics during the year 1,478 106 157 (b) Total number of women who attended at the Clinics during the year 163 263 97 141 These figures taken in conjunction with those in respect of the Council's Clinics show that 90 per cent, of the babies born in the district and 74 per cent, of the expectant mothers received skilled medical supervision under clinic arrangements. Health Visiting. Home visiting during the year was on a smaller scale than in the year before, due partly to the increased programme of Clinics and also the fact that the Health Visitors were temporarily seconded for duties at the First Aid Posts at the outbreak of the war. 6,075 visits were made to mothers and children under 5 years, compared with 7,563 in 1938. In addition, 277 other visits were made for special purposes in connection with Puerperal Pyrexia, Ophthalmia Neonatorum, 36 Measles, etc., whilst a further 201 visits were made to foster children under Child Life Protection. The number of fixed Clinics which the Health Visitors attended during the year was 722 as compared with 687 in 1938. The number of visits made for various purposes was as shown below. To expectant mothers first visits 402 total visits 662 To children under one year first visits 970 total visits 2,539 To children 1-5 years total visits 2,874 Visits re puerperal pyrexia, ophthalmia and miscellaneous 277 Visits to foster childrenre Child Life Protection 201 Total 6,553 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 XVI. Milk Grants, 1939. Wards. Free Milk. Half-price. Individuals Families Pints Supplied Individuals Families Pints Supplied Abbey 31 26 3,997 12 8 2,957 Bushey Mead 61 41 6.696 12 9 3.659 Central 7 5 334 2 2 77 Morden 17 14 1.654 2 2 543 Park 6 6 788 5 4 277 Ravensbury 33 28 3,070 16 14 5,222 Raynes Park 1 1 201 1 1 72 St. Helier 41 32 5,393 24 18 6,045 West Barnes 24 15 3,808 3 o 728 221 168 25.341 77 60 19,580 This quantity compares with 26,161 pints free and 15,223 pints at half-price supplied in the year before. Convalescent Home Treatment. Children requiring treatment are sent to Convalescent Homes through the agency of the Invalid Children's Aid Association, to whom the Council makes a contribution towards the cost of the treatment. 37 Orthopaedic Treatment. Children suffering from orthopædic defects are referred to the Nelson Hospital under the general arrangement with that Hospital for the treatment of infants attending the Welfare Centres. Maternity Hospital Treatment. Out of 965 births which took place during the year, it is known that 558 occurred in hospitals or private Nursing Homes. This is 8 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. Earlier in this report it was shown that the Nelson Hospital admitted 230 cases from the Urban District, the number referred to this and other hospitals from the Council's clinics being as follows:— Nelson Hospital 3 Kingston County Hospital 1 Other Hospitals — 4 They were referred for the following reasons:— Obstetrical 1 Medical 2 Home conditions 1 4 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. 38 The usual period for which this help is supplied during confinement is fourteen days. The number of helps provided was 25, 10 free of cost and 15 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. Nineteen outfits were supplied—twelve at cost-price, four at half-price and five free. Dental Scheme. There was a further increase in the work of the dental clinics. 457 mothers and children made 1,235 attendances as against 421 persons and 873 attendances in the year before. TABLE XVII. Attendances at Dental Clinics, 1939. Cases referred from. No. who attended during year. No. of attendances made. MERTON Mothers 14 39 Children 24 49 Individuals 38 88 MORDEN Mothers 90 279 Children 96 190 Individuals 186 469 RAYNES PARK Mothers 103 347 Children 108 275 Individuals 211 622 ALT, CENTRES Mothers 215 695 Children 242 540 Individuals 457 1235 Number of sessions 99 Average attendances per session 12.4 39 The dental operations performed were as follows:— TABLE XVIII. DENTAL SCHEME, 1939—OPERATIONS PERFORMED Extractions. Temporary teeth 526 Permanent teeth 764 Fillings. Temporary teeth 165 Permanent teeth 80 Dentures Supplied. No. of cases 67 No. of Local Anaesthetics Given 8 No. of Gases Given 341 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 Cases conducted— Primip. Multip. Total. (a) As midwife Live 10 64 74 Still — 3 3 (b) As maternity nurse Live — 3 3 Still — — — 10 70 80 Visits made— By midwife Ante-natal 405 During confinement 1,158 To midwife Ante-natal 165 Post-natal 106 1,834 40 Medical Aid Forms Sent—21. Reasons for sending— Discharging eyes 1 Rupture of Perineum 11 Phlebitis 1 Feebleness at birth 2 Difficult Forceps Delivery 1 Post-partum Hæmorrhage 3 Miscarriage 1 Heart Attack 1 Number of the midwife's cases which attended the Council's ante-natal clinics 96 Percentage of total mdwife's cases 100% 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, one member of the staff of the Wimbledon District Nursing Association practices part-time in Merton and Morden. Voluntary Helpers. The Welfare Centres had the valuable assistance of 36 voluntary helpers during the year. Changes in the personnel from time to time are inevitable, but a substantial proportion of our present helpers have given their time and energy uninterruptedly week in and week out for many years in the service of the mothers and children in the district and the success of the Centres is, in no small measure, due to the very keen interest of those voluntary workers. 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 39 Registered homes under supervision at end of year 23 New homes registered during the year 8 Children on the register at the end of the year 25 Children brought on to the register during the year 6 Children removed out of the district 15 Visits paid to nurse children 201 Children died during the year Nil Legal proceedings Nil 41 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 quality of the supply as shown by the sampling was satisfactory. There are two deep wells in the district, the supplies from which are used mainly for industrial purposes. They also provide the staff's 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. The Surrey County Council's major scheme for the improvement of the Beverley and Pyl Brooks referred to in previous reports, was completed during the year. This work in conjunction with other improvements carried out down stream has been effectual in relieving the surcharge of this waterway. .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. There is a weekly collection of house refuse. Trade refuse is also collected on payment of a moderate charge. Disposal is by incineration at the Council's destructor which is a six cell plant. Sanitary Inspection of the Area. The work of the Sanitary Inspectorate during 1939 is detailed in the report of the Chief Sanitary Inspector which follows:— 42 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, 1939. Housing Inspections. The total number of houses inspected during the year for "Sanitary defects" under the Public Health and Housing Acts, was 317. Details of the work carried out and of the sanitary improvements effected at houses are included in the tabulated statement at page 49. Systematic inspection of working class houses was continued as a routine during 1939, and in this connection 149 houses in the undermentioned roads were subjected to detailed survey and the necessary particulars recorded in accordance with the Housing Consolidated Regulations:— Dane Road 39 Nelson Grove Road 46 Sydney Road 53 Vernon Avenue 5 Other roads 6 149 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 225 Statutory Notices- Public Health Acts 24 Housing Act, 1936 0 48 Eradication of Bed-Bugs. Twenty-three 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:— Council Houses. Other Houses. Total. 13 10 23 Of the 23 houses infested, 20 were treated by spraying with "Vermnicine," 2 by fumigation with "Cimex" and 1 by fumigation with sulphur-dioxide, together with the use of blowlamps. The household effects of two families were subjected to van disinfestation by H.C.N. Gas prior to removal to Council houses, and in three instances the bedding at verminous houses was dealt with by steam disinfection. Drainage work. At 15 houses the drainage systems were entirely reconstructed and at 35 houses extensive repairs to drains were carried out. Smoke and water tests were applied to the drains of houses in 58 instances and obstructions were removed from drains at 83 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 150 cases ot' notifiable diseases as compared with 255 cases in 1938. Disinfection of rooms was carried out and bedding and clothing removed for steam disinfection after the removal of patients to the Isolation Hospital or on the recovery of each patient treated at home. The number of rooms disinfected was 209. Food Supply. The total number of inspections made to premises where articles of food are prepared or exposed for sale was 529. These premises include butchers' shops, fish shops, greengrocers, provision dealers, cooked meat shops, refreshment houses and bakehouses. Four infringements of the Public Health (Meat) Regulations, 1924 were discovered, and remedied during the year. At 5 premises sanitary improvements were effected. Unsound Food. The undermentioned articles of food were found upon inspection to be unfit for human consumption and were surrendered and destroyed:— Description. 153 lbs. Fork 3 lbs. Beef 125 tins Norway Crab 3 Stone Haddock Cause. Decomposition. do. Unsound, do. 44 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 1939 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, and are licensed annually. No notices of intention to slaughter were received during 1939 but 8 inspections were made to ascertain whether any animals were being killed. Milk Supply. At 31st December, 1939, 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. 96 inspections were made to cowsheds, dairies and milkshops during 1939. Nineteen samples of milk were submitted for bacteriological examination during the year. Thirty-two licences were granted to dealers under the Milk (Special Designations) Order, 1936, and were in force at 31st December, 1939. Food and Drugs (Adulteration) Act, 1928. The abovementioned Act was administered by the Surrey County Council up to the end of September. Samples were obtained by the County Inspectors and submitted to the public analyst as follows:— 45 Articles. Analysed. Adulterated or Deteriorated. Formal. Informal. Total. Formal. Informal. Total. Milk 25 3 28 — — — Meat 2 — 2 — — — Jam 3 — 3 1 — 1 Drugs 3 — 3 — — — Other articles 5 — 5 — — — Totals 38 3 41 1 — 1 Food and Drugs Act, 1938. The Local Authority became responsible for the administration of this Act on the 1st October and during the three months ending 31st December, 46 samples were taken and submitted for analysis:— SUMMARY OF SAMPLES. Total Samples Genuine Not Genuine Prosecutions Cautions Milk 28 27 1* — — Beer 5 5 — — — Boric Ointment 2 2 — — — Margarine 3 3 — — — Rice 3 3 — — — Sausage—Beef 3 3 — — — Stomach Powder 1 1 — — — Zinc Ointment 1 1 — — — Total 46 45 1 — — * 1% Added Water. RESULT OF ANALYSES OF NEW MILK SAMPLES Solids not Fat (Legal standard is 8.5%). 8.2 8.3 S 35 8.4 8.4 5 8.5 8.6 8.7 8.8 8 0 9 0 9.1 Total — — 1 — 1 1 9 10 5 1 28 46 Milk Fat (Legal standard is 3.0%). 3.5 3.6 3.7 3.8 3.9 4.0 4.1 4.2 4.3 4.4 4.6 Total 1 4 4 4 7 4 2 1 — — — 1 28 Factories and Workshops. The number of inspections made to premises registered under the Factories Act was 219. Particulars of the matters dealt with will be found in the table at page 55. Smoke Abatement. During the year 22 observations were made of factory chimneys for the purpose of prevention or detection of "Smoke Nuisances." At five factories smoke was found to be emitted in excessive quantities. Notices to abate the nuisances were served and in each case the necessary improvements were carried out to prevent further nuisances. A byelaw regulating the emission of smoke was adopted by the Council in 1930. 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 80 and a total of 546 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. 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 422 Evening visits 54 Infringements. (1) Evening closing hours 5 (2) Half-day closing 2 (3) Hours of employment of "young persons" 2 (4) Seats not provided for females 3 (5) Prescribed notices not correct or exhibited 27 (6) Sanitary arrangements unsatisfactory 3 (7) Reasonable temperature not maintained 5 47 Heating facilities were provided at five shops and minor defects of sanita,ry conveniences and washing facilities were remedied at four 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 927 of which 315 were street accidents and the remainder were removals to or from hospitals or institutions. The total mileage during the year was 7,487. The following table shows the calls made upon the ambulance service during the past five years:— Year. Accidents. Hospitals. Total. 1939 315 612 927 1938 319 527 846 1937 339 423 762 1936 331 404 735 1935 332 436 768 I am, Ladies and Gentlemen, Your obedient Servant, J. B. POINTON, Chief Sanitary Inspector. 29th November, 1940. 48 SUMMARY OF NUISANCES ABATED AND SANITARY IMPROVEMENTS EFFECTED. Ceilings cleansed or repaired 116 Coppers provided or repaired 9 Dampness in premises remedied 107 Drains exposed and repaired 35 Drains reconstructed 15 Defective sashcords renewed 58 Drinking-water cisterns cleaned out 2 Drinking-water cistern covers provided Drinking-water cisterns renewed 3 Dustbins provided 11 Floors repaired 50 Forecourts drained Fresh-air inlet valves provided and repaired 17 Inspection Chamber covers provided 7 Obstructions removed from drains 83 Rain-water pipes renewed or repaired 19 Rooms cleansed 203 Roofs repaired 89 Gutters repaired or renewed 43 Stoppers provided to intercepting traps— Sink wastes repaired or renewed 32 Walls repaired 41 W.C. cisterns provided 1 W.C. cisterns repaired 17 Water closets cleansed 3 W.C. approaches screened W.C. pans provided 9 Windows repaired or renewed 6 Yards paved or repaved 43 Stoves renewed or repaired 44 Sinks provided Offensive accumulations removed 5 Water supply provided for domestic use 6 Verminous premises fumigated and cleansed Ventilation provided under floors 10 Sanitary accommodation provided for workshops 1 Miscellaneous 101 Total No. of Inspections &T,01C Notices served:— Intimation Notices 245 Statutory Notices 24 49 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 erection of a public bath, referred to in my report for 1938, was carried out and completed during the year. 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. 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. 50 SECTION D—HOUSING. New Houses. The new houses and flats erected during the year were as follows :— Wards. By the Local Authority By the London County Council By Private Enterprise Abbey — — — Bushey Mead — — — Central — — 13 Morden — — 344 Park — — 29 Ravensbury — — . 3 Raynes Park — — 1 St. Helier — — 14 West Barnes — — 30 Whole district — — 434 In addition 21 houses and flats were in course of erection at the end of the year. 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 1939 57 Total number of eligible applications on the files at 31st December, 1939 127 Number of houses allotted to tenants during 1939 35 An eligible applicant is one with a family resident in the district. Housing Act, 1936—Overcrowding. During 1939, 18 dwellings were decrowded. In the same period 11 new cases of overcrowding came to notice. The net reduction in overcrowded dwellings during the year was therefore 7. Since the number of overcrowded dwellings at the beginning of the year was 36, the number remaining still overcrowded at the 31st December, was 29. The number of persons occupying theSe 29 dwellings was 2074 equivalent adults. 51 Details of the overcrowding and decrowding in the individual Wards are given in the following table:— Wards. Dwellings overcrowded at end of 1938. Number found to be overcrowded during 1939. Number decrowded during the year. Remaining overcrowded at end of 1939. Abbey 2 — 1 1 Bushey Mead 1 — — 1 Central — — — — Morden — 1 — 1 Park — — —. — Ravensbury 11 (b) 6 7 (a) 10 (b) Raynes Park — — — — St. Helier 22 (b) 4(b) 10 (b) 16 (b) West Barnes — — — — Whole district 36 11 18 29 (a) Includes 6 London County Council Houses. (b) All London County Council Houses. The 11 new eases 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 7 Otherwise than by natural growth of family (including illegal overcrowding) 4 Decrowding was effected in the 18 instances in the following ways:— Alternative accommodation 8 Lodgers or relatives finding alternative accommodation 4 Serving in H.M. Forces 2 Marriage or removal of members of family 1 family removed out of district 3 Alternative accommodation was provided in Council Houses as follows:— By Merton and Morden Council 1 By London County Council 8 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) 317 52 (b) Number of inspections made for the purpose 317 (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 149 (b) Number of inspections made for the purpose 149 (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 211 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 167 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 Nil. (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners Nil. (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 24 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 23 (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. 53 (2) Number of dwelling houses demolished in pursuance of Demolition Orders Nil. D.—Proceedings under Section 12 of the Housing Act, 1936: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil. 4. Housing Act, 1936-—Part IV—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 29 (ii) Number of Families dwelling therein 31 (iii) Number of persons dwelling therein— Aged 10 years and over 183 Under 10 years 49 (b) Number of new cases of overcrowding reported during the year 11 (c) (i) Number of cases of overcrowding relieved during the year 18 (ii) Number of persons concerned in such cases— Aged 10 years and over 99 Under 10 years 37 (d) Number of dwelling houses which have again become overcrowded after Local Authority has taken steps to abate overcrowding 1 FACTORIES ACT. 1.—Inspections. Premises. (1) Number of Inspections. (2) Written Notioes. (3) Occupiers prosecuted. (4) Factories with mechanical power 138 4 — Factories without mechanical power 81 7 — Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) — — — Total 219 11 — 54 2.—Defects Found. Particulars. a) Number of Defects. N umber of defects in respect of which Prosecutions were instituted. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector (4) Want of cleanliness (S.l) 3 3 — — Overcrowding (S.2) 2 2 — — Unreasonable temperature (S.3) — — — — Inadequate ventilation (S.4) 1 1 — — Ineffective drainage of floors (S.6) — — — — Insufficient 5 5 — — sanitary Conveniences (S.7). Unsuitable or defective 11 11 — — Not separate for sexes 1 1 — — Other offences 9 9 — — Total 32 32 — — 55 SECTION E—INSPECTION AND SUPERVISION OF FOOD. (See Sanitary Inspector's Report, on page 44). 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 six years. No notifications were received in 1939. Enteric Fever. For the second year in succession no cases of Typhoid or Paratyphoid Fever were reported. Dysentery. Only one case of Dysentery was reported during the year and this attack of a very mild nature. Scarlet Fever. Scarlet Fever, again of a mild type, was less prevalent than in the previous year. Ninety-eight cases were notified compared with 161 in 1938, giving an incidence rate of 1.37 per thousand population and compares with a rate of 1.89 for the country as a whole. Of the total cases 89 (90 per cent.) were removed to Isolation Hospital. The attack rate was heaviest in the Ravensbury Ward. There were no deaths recorded from Scarlet Fever. 56 TABLE XIX. SCARLET FEVER—MONTHLY DISTRIBUTION. 1939 Wards. Abbey. Bushey Mead. Central. Morden. Park. Ravensbury. Raynes Park. St. Helier. West Barnes. Total. January 1 1 — — 2 2 — 3 1 10 February 1 — 1 — — 3 3 1 1 10 March 1 — 4 1 1 5 — 1 — 13 April 1 — — 2 2 3 1 — 2 11 May 2 4 — 1 — 1 1 — 1 10 June 1 — — — 2 1 — 2 1 7 July 2 4 1 2 2 — — 1 3 18 August — — — — — — 1 — 1 2 September - 1 1 — — 1 — — — 3 October — — 2 — — 1 — — 1 4 November — — — — — — 1 1 — 2 December — — — — 1 4 3 — — 8 Total 9 10 9 6 10 24 10 9 11 98 Monthly mean .75 .93 .75 .50 .83 2.00 .83 .75 .92 8 16 The incidence in the various wards was as follows:— Wards. Cases. Incidence per 1,000 population. Abbey 9 1.73 Bushey Mead 10 1.26 Central 9 .87 Morden 6 .61 Park 10 .99 Ravensbury 24 3.13 Raynes Park 10 1.35 St. Helier 9 .73 West Barnes 11 1.61 57 TABLE XX. SCARLET FEVER—MULTIPLE CASES OCCURRING IN DOMESTIC DWELLINGS. Wards. Total oases in houses in each Ward. No. of houses in which occurred. No. of houses with cases. 1 case 2 cases. 3 cases. Abbey 9 9 — — 9 Bushey Mead 10 8 1 — 9 Central 9 9 — — 9 Morden 6 4 1 — 5 Park 9 7 1 — 8 Ravensburv 24 14 5 — 19 Raynes Park 10 8 1 — 9 St. Helier 9 7 1 — 8 West Barnes 11 9 1 — 10 Whole district 97 75 11 — 86 (1 further case occurred in an institution). TABLE XXI. 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. 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 18,980 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 — — 1939 (b) 71,220 98 1.37 58 Diphtheria. For the fifth year in succession the district has experienced a very low attack rate for Diphtheria. Thirtytwo cases were notified compared with 28 in the year before and the incidence per 1,000 population was 0.44 compared with the rate for the country as a whole of 1.14. In the course of the investigations into cases, two other persons were found to be "carriers" of the infection. One was nasal and one a throat "carrier." Two deaths resulted from Diphetheria, one a boy of eight years and the other a boy of sixteen. This gives a death rate for this district of 0.02 per thousand population compared with a rate of 0.05 for England and Wales. TABLE XXII. DIPHTHERIA, 1939—WARD INCIDENCE. Wards. Cases. Rate per 1,000 population 1939. Abbey 1 .19 Bushey Mead 3 .37 Central 5 .48 Morden — — Park 2 .19 Ravensbury 4 .52 Raynes Park — — St. Helier 14 1.13 West Barnes 3 .43 Whole district 32 .41 59 TABLE XXIII. DIPHTHERIA—MONTHLY DISTRIBUTION, 1939. 1939 Wards. Total. Abbey. Bush^y Mead. Central. Morden. Park. Ravensbury. Raynes Park. St. Helier. West Barnes. January – – – – – 2 – 4 2 8 February – 1 – – – – – – – 1 51 arch – – – – – – – – – – April – – 1 – – – – 2 1 4 May – – 1 – – – – 2 – 3 June – 2 – – – 1 – – – 3 July 1 – 1 – 1 – – – – 3 August – – – – – – – 1 – 1 September – – 1 – – – – 3 – 4 October – – – – – 1 – 2 – 3 November – – 1 – – – – – – 1 December – – – – 1 – – – – 1 Total 1 3 5 – 2 4 – 14 3 32 Monthly mean .08 .25 .41 – .17 .33 – 1.16 .25 2.75 The number of houses affected and details of multiple eases is shown below. TABLE XXIV. DIPHTHERIA—MULTIPLE CASES OCCURRING IN DOMESTIC DWELLINGS, 1939. Wards. Total cases. No. of houses with No. of houses with cases. 1 Case. 2 Cases. 3 Cases. Abbey 1 1 — — 1 Bushey Mead 3 1 1 — 2 Central 5 5 — — 5 Morden — — — — — Park 2 2 — — 2 Ravensbury 4 4 — — 4 Raynes Park — — — — — St. Helier 13 9 2 — 11 West Barnes 3 1 1 — 2 Whole district 31 23 4 — 27 (One further case occurred in an Institution). 60 TABLE XXV. 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 — 3 5 11 7 3 2 — 32 Seventy-five per cent. of the cases were children of school or pre-school age. Fifty thousand units of anti-toxin were issued to practitioners during the year and 556 swabs were examined. Diphtheria Immunisation. The facilities for Diphtheria Immunisation were continued as in previous years. The number of persons immunised at the clinics, in schools and by private practitioners during the yeay under the scheme, is shown in the following tables:— TABLE XXVI. PERSONS IMMUNISED AT CLINICS DURING 1939. Wards. Age Groups Total. 0-5 years 5-15 years 15 and over Abbey 10 1 — 11 Bushev Mead 9 8 — 17 Central 45 11 — 56 Morden 35 8 — 43 Park 17 4 — 21 Ravensbury 20 17 — 37 Raynes Park 14 8 — 22 St. Helier 23 22 — 45 West Barnes 21 4 — 25 Total 194 83 — 277 Total inoculations given at clinics in 1939 = 702. 61 TABLE XXVII. PERSONS IMMUNISED BY PRIVATE PRACTITIONERS, 1939. Wards Age Groups Total 0-5 years 5-15 years 15 and over Abbey — — — — Bushey Meail — — — — Central 2 1 — 3 Morden 2 — — 2 Park — — — — Ravensbury — — — — Raynes Park 8 1 —c 4 St. Helier — -— — — West Barnes 2 — — 2 Total 9 2 — 11 Total inoculations given by doctors, 1939 = 30. TABLE XXVIII. CHILDREN IMMUNISED IN SCHOOLS, 1939. School Incomplete Complete St. Helier No. 1 Infants 1 75 „ 2 8 42 „ 3 8 70 „ 1 5 66 Holy Family R.C.Infants 6 32 Total 18 285 Total inoculations given in schools in 1939 = 852. 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 1939 277 11 303 591 3,646 62 TABLE XXIX. INCIDENCE AND FATALITY OF DIPHTHERIA, 1919-1939. Year. Population. No. of cases. Incidence rate per 1,000 population. No, of deaths. Percentage of deaths to cases. 1919 18,100 26 1.3 2 7.6% 1920 18,200 47 2.5 3 6.3% 1921 18,000 28 1.5 1 3.5% 1922 18,500 62 3.3 4 6.4% 1923 18,750 39 2.08 1 2.5% 1924 18,710 68 3.6 6 8.9% 1925 18.960 25 1.3 1 8.3% 1926 19,980 24 1.2 2 8.5% 1927 21,850 29 1.3 2 6.8% 1928 25,780 38 1.4 — — 1929 27,430 53 1.9 1 1.8% 1930 35,000 72 2.05 6 8.3% 1931 41,610 80 1.9 6 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% 1939 (b) 71,220 32 0.44 2 6.2% Anterior Poliomyelitis. Three cases of Infantile Paralysis were notified during the year and received hospital treatment. There were no deaths. Cerebro-Spinal Meningitis. One case was notified in a male child of 2 years who was removed to hospital, but succumbed to the infection. Measles. The incidence of this biennial disease was again demonstrated by the downward trend of the number of cases during 1939. The school returns show five cases only against 403 in 1938. Under the Measles and Whooping Cough Regulations 1939, Measles became a notifiable disease on the 23rd October, 1939, and to the end of the year five cases were notified. None died of this infection. Whooping Cough. Whooping Cough, according to the school returns, was more prevalent than in the previous year. Two hundred and seventy-five cases were reported among school children as against 44 in 1938. Under the above regulations Whooping Cough became a notifiable disease on the 23rd October, 1939, and three cases were notified to the end of the year. There were no deaths from this disease. 63 Erysipelas. Fifteen notifications were received and of this number five received hospital treatment and ten were treated at home. Sites affected were face 12, arm 1 and leg 2. There were no deaths. Puerperal Pyrexia. Notifications were received in respect of 15 cases of Puerperal Pyrexia, giving an incidence rate of 14.4 per thousand total births. Three were in respect of nonresidents who were confined in this district and the remainder, of residents of Merton and Morden. Of the total, 7 were confined in hospitals and 4 were subsequently removed to hospital after the onset of illness. The Puerperal Pyrexia Regulations, 1939, which came into operation on the 1st April, 1939, did not materially alter the existing requirements, but were made with the object of clarifying the position relating to the notification of cases of Puerperal Pyrexia. Ophthalmia Neonatorum. Two eases of Ophthalmia Neonatorum were notified. One was a severe gonococcal infection, but recovered after treatment in a special hospital. The other a staphylococcal infection completely recovered after home treatment. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Death. Notified. Treated At Home In Hosp. 2 1 1 2 — — — 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. 64 Pneumonia. Seventy-one notifications of Pneumonia were received, of which 19 were stated to be Influenzal in origin. This compared with 49 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. No case of food poisoning was notified during the year. 65 66 TABLE XXX. INFECTIOUS DISEASES, NOTIFICATION DEATHS AND DISTRIBUTION, 1939. Disease Cases Notified Case rate per 1,000 Population Deaths among notified cases Percentage of deaths to cases Distribution of cases Wards No. of cases removed to hospital Percentage of cases removed to hospital Abbey Bushey Mead Central Morden Park Ravensbury Ravnes Park St. Helier West Barnes Smallpox — — — — — — — — — — — — — — — Scarlet Fever 98 1.37 — — 9 10 9 6 10 24 10 9 11 89 90% Diptheria 32 0.44 2 6% 1 3 5 — 2 4 — 14 3 32 100% Enteric Fever — — — — — — — — — — — — — — — Cerebro-Spinal Meningitis 1 0.01 1 100% — — — — 1 — — — — 1 100% Puerperal Pyrexia 15 0.21 — — 1 2 2 3 5 — 1 — 1 4 26% Erysipelas 15 0.21 — — 1 1 2 1 3 1 — 4 2 5 33% Pneumonia 52 0.73 5 9% 4 6 13 2 10 10 — 7 — —* — Poliomyelitis 3 0.04 — — 1 — — — 1 — 1 — — 3 100% Relapsing Fever — — — — — — — — — — — — — — — Typhus Fever — — — — — — — — — — — — — — — Dysentery 1 0.01 — — — — — — — 1 — — — — — Encephalitis Lethargica — — — — — — — — — — — — — — — Ophthalmia Neonatorum 2 0.02 — — 1 — 1 — — — — — — 1 50% Plague — — — — — — — — — — — — — — — Malaria — — — — — — — — — — — — — — — Influenzal Pneumonia 19 0.26 2 10% — 3 3 1 2 1 5 2 2 — * — Measles 5 0.07 — — — — 1 1 2 — 1 — — — — Whooping Cough 3 0.04 — — — 2 — 1 — — — — — — — *Number admitted to isolation hospital only. 67 TABLE XXXI. NOTIFICATION OP INFECTIOUS DISEASES (other than Tuberculosis) by Age Groups during the year 1939. Disease. TOTAL CASES NOTIFIED. Total Cases at all Ages. Under 1 year 1-2 2-3 3-4 4-5 5-10 10-15 1 15-25 25-35 35-45 45-65 65 and over Smallpox — — — — — — — — — — — — — Scarlet Fever — 3 4 6 5 45 14 8 7 5 1 — 98 Diphtheria (including Membranous Group) — 1 — 3 5 11 7 3 2 — — — 32 Enteric Fever (including Paratyphoid) — — — — — — — — — — — — — Puerperal Pyrexia — — — — — — — 1 12 2 — — 15 Acute Primary Pneumonia — 2 — 1 1 9 — 4 5 11 13 6 52 Acute Influenzal Pneumonia 1 — — — 1 1 — 3 3 1 6 3 19 Cerebro Spinal Fever — — 1 — — — — — — — — — 1 Acute Poliomyelitis — — — — — 1 1 — 1 — — — 3 Acute Polio Encephalitis — — — — — — — — — — — — — Encephalitis Lethargica — — — — — — — — — — — — — Dysentery — — — — — — — — — 1 — — 1 Malaria — — — — — — — — — — — — — Ophthalmia Neonatorum 2 — — — — — — — — — — — 2 Erysipelas — — — — — — — — 3 2 8 2 15 Plague — — — — — — — — — — — — — Relapsing Fever — — — — — — — — — — — — — Typhus Fever — — — — — — — — — — — — — Measles — 1 — 1 1 — — 1 — — 1 — 5 Whooping Cough 1 — — — 1 — — — 1 — — — 3 Totals 4 7 5 11 14 67 22 20 34 22 29 11 246 68 TABLE XXXII. MONTHLY INCIDENCE OF INFECTIOUS DISEASE, 1939. Disease. Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Totals Smallpox — — — — — — — — — — — — — Scarlet Fever 10 10 13 11 10 7 18 2 3 4 2 8 98 Diphtheria 8 1 — 4 3 3 3 1 4 3 1 1 32 Dysentery — — — — — — — — — l Enteric Fever — — — — — — — — — — — — — Cerebro-Spinal Meningitis — — — — — — 1 — — — — — 1 Pneumonia 11 9 9 7 5 1 2 2 1 2 — 3 52 Influenzal Pneumonia 4 7 4 2 — — — — — — — 2 19 Erysipelas — — 2 1 1 — 2 3 1 1 2 2 15 T.B. Pulmonary 6 6 10 3 14 6 4 3 9 3 5 8 77 T.B. Non-Pulmonary 1 4 3 2 3 2 1 — — — 1 — 17 Ophthalmia Neonatorum 1 — — — 1 — — — — — — — 2 Puerperal Pyrexia 1 3 1 2 4 1 1 — 1 — — 1 15 Poliomyelitis — — — — — 1 1 1 — — — — 3 Encephalitis Lethargica — — — — — — — — — — — — — Malaria — — — — — — — — — — — — — Measles — — — — — — — — — — 2 3 5 Whooping Cough — — — — — — — — — — 1 2 6 Totals 42 40 42 32 41 21 33 12 19 14 14 30 340 TUBERCULOSIS. One hundred and thirty new cases were added to the register of tuberculous persons compared with 148 in the year before. These additions were:— Males. Females. Total Pulmonary 60 46 106 Non-Pulmonary 13 11 24 73 57 130 Of these 130, 91 were primary notifications, 31 were transferred from other districts and 8 came to notice in other ways. During the year, 148 persons were removed from the Register for the following reasons: Recovered 39 Removal from the district 60 Death 49 After allowing for the additions and deductions, the number remaining on the Register at the 31st December, 1939, was 540, distributed as shown in the following table which also gives the incidence of registered tuberculosis at mid-year:— TABLE XXXIII. TUBERCULOSIS REGISTER AT 31st DECEMBER, 1939. AND REGISTERED NUMBER OP TUBERCULOUS PERSONS PER 1,000 POPULATION AT MID-YEAR. Wards. Registered at December 31st. At Mid-Year. Pulmonary. Non. Pulmonary. Total. Number on Register. N umber on Register per 1,000 population. Abbey 31 7 38 36 6.9 Bushey Mead 51 9 60 64 8.0 Central 28 8 36 35 3.4 Morden 43 3 46 44 4.4 Park 52 8 60 58 5.7 Ravensbury 66 26 92 99 12.9 Raynes Park 37 3 40 41 5.6 St. Helier 100 24 124 139 11.3 West Barnes 34 10 44 44 6.4 Whole district 442 98 540 560 7.2 The total at December 31st was 18 less than at the corresponding date in 1938. 69 The Anti-Tuberculosis Scheme in this district is administered by the County Council. Institutional treatment was provided for 135 persons from Merton and Morden as follows:— At the County Sanatorium, Milford 35 At other Institutions 100 135 The deaths from tuberculosis number 47, of which 44 were due to pulmonary and 3 to non-pulmonary disease. The death rate for pulmonary tuberculosis was 0.61 per 1,000 population compared with 0.72 in the year before. The deaths are classified by age and sex in Table XXXIV. TABLE XXXIV. DEATHS DUE TO TUBERCULOSIS, 1939. Ages Years. Pulmonary. Non-Pulmonary. Totals. Males. Females. Males. Females. 0— — — — — — 1— 1 — — — 1 5— — — 1 — 1 15— 4 7 — — 11 25— 5 6 — 1 12 35— 5 6 — 1 12 45— 3 1 — — 4 55— 4 2 — — 6 65— — — — — — Totals 22 22 1 2 47 Eight deaths equivalent to 17% of the total were in unnotified cases. The District provides a free service for the examination of sputum for tubercle bacilli. During the year 128 specimens were examined with a positive result in 21 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. 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. 70 71 TABLE XXXV. TUBERCULOSIS—New Cases, Age and Sex, Distribution and manner of Admission to Register, 1939. Age Groups. Years. Primary Notifications (" A "). Cases transferred from other districts. Cases brought to notice otherwise than by notification and transfer. Total new cases. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M F M F M F M F M F M F 0-1 — — — — — — — — — — — — — 1-5 — — 1 — — — — — — — — — 1 5-10 — — 1 1 — — — — — — 1 — 3 10-15 1 1 3 1 — — 1 — — — — — 7 15-20 7 4 2 1 — — — 1 — — — — 15 20-25 3 6 — 2 1 1 — 2 1 1 — — 17 25-35 16 10 2 — 7 8 — — — 2 — — 45 35-45 9 5 1 1 1 2 — — 1 — — — 20 45-55 4 2 — 1 — 1 1 — — 1 — — 10 55-65 4 1 — — 1 1 — .— 1 — — — 8 65 up 1 — — — 2 — — 1 — — — — 4 Totals 45 29 10 7 12 13 2 4 3 4 1 — 130 91 31 8 INDEX PAGE Acreage 7 Ambulance Facilities 24, 48 Acute Poliomyelitis 63 Births 10, 13 In each Ward 13 In hospitals or maternity homes 13 Rates 10, 13-14 Bed Bugs—Eradication of 43 Camping Sites 50 Cancer 10 Deaths from 16 Rate 10, 16 Cerebro-Spinal Fever 63 Child Life Protection 41 Clinics and Treatment Centres 25 Climatic Conditions 9 Closet Accommodation 42 Deaths 10, 15 Causes of 16-17 Classified causes—by age and sex 19 In each Ward 15 In public institutions 16 Rates 10, 14-15 Diphtheria 59 Antitoxin used 61 Immunisation 61 Clinics, times and places 25 Children Immunised in Schools 62 Persons Immunised at Clinics 61 Persons Immunised by Private Practitioners 62 Incidence and fatality for 21 years 63 Incidence by age groups 61 Incidence in each Ward with rates 59 Monthly distribution of cases 60 Multiple cases in domestic dwellings 60 Swabs examined 23 Disinfection 44 Disinfestation 43, 50 Drainage and Sewerage 42 Drainage work 44 Dysentery 56 Enteric Fever 56 Erysipelas 64 72 INDEX—continued. page Factories 7, 47, 54-55 Inspections made 47-54 Defects found and remedied 55 Food and Drugs (Adulteration) Act, 1928 45-46 Food and Drugs Act, 1938 46 Food Poisoning 65 Food Supply 44 Inspections 44 Unsound Food 44 Health Services 23 Heart Disease 16 Deaths from 16 Hospitals 27-29 Housing:— Council's Schemes 51 Housing Act, 1936—Overcrowding 51-52 Inspections and Defects 43, 52-54 New houses erected 51 Number inhabited 7 Verminous premises 43 Industry 7 Infant Mortality 10, 21 Classified causes of deaths 22 Rates 10, 21 Infectious diseases 27 Diseases notifiable 56 Disinfection after 44 Enquiries into 44 Monthly Incidence 68 Notification by age groups 67 Notifications, deaths and distribution 66 Inquests 17-18 Isolation Hospital 27 Admissions to 29 Laboratory Facilities 23 Examination of clinical material 23 Legislation 25 Maternal Mortality 10, 20 Rates 10, 20 Maternity and Child Welfare 30 Ante-Natal Clinics 25 Attendances at each Centre by age groups 34 73 INDEX—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 5 Consultant advice for maternity 38 Convalescent Home Treatment 37 Dental Scheme 39 Attendances 39 Operations performed 40 Emergency Maternity Unit 38 Health Visiting 36 Home Helps 38 Hospital provision for maternity 38 Midwives 40 Milk Scheme 37 Orthopaedic Treatment 38 Sessions, times and places 25 Sterilised Maternity Outfits 39 Voluntary Helpers 41 Work of the Centres 30-31 Meat Inspection 45 Measles 63 Milk Supply 45 Nelson Hospital 27-28, 35-37 Notification of Births 30 Nuisances:— Abated 49 Notices served 49 Nursing in the Home 23 Ophthalmia Neonatorum 64 Pneumonia 65 Population 10, 12 Prevention of Blindness 64 Public Assistance 8 Public Cleansing 42 Public Health Committee 5 Puerneral Pyrexia 64 Consultant 6 Rainfall 9 Rateable value 7 Rats and Mice Destruction 47 74 INDEX— continued. PAGE Respiratory diseases—deaths from 16-17 Representatives on:— Nelson Hospital Council 5 Wandle Valley Joint Hospital Board 5 Wandle Valley Joint Sewerage Board 5 Road Accidents (deaths from) 18 Sanitary Circumstances 42 Sanitary Inspection 42 Scarlet Fever 56 Incidence and fatality last 20 years 58 Incidence in each Ward with rates 57 Monthly distribution of cases 57 Multiple cases occurring in domestic dwellings 58 Schools 50 School clinics 26 Shops Acts, 1912-1936 47 Slaughterhouses 45 Smallpox 27, 56 Smoke Abatement 47 Social Conditions of the Area 7 Staff 6 Statistics 7, 10 Comparative 11 Swimming Baths and Pools 50 Tuberculosis 10, 69 Admissions to Sanatorium 28, 70 Deaths due to 70 Dispensary 26 New cases—by age groups 71 Number on register at year end 69 Unemployment 7 Venereal Diseases 26 Water Supply 42 Whooping Cough 63 Zymotic Disease 56 Deaths from 10 Rate 10 75