MER 4 Merton and morden urban District ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEARS 1940-41-42 AND REPORT OF The Sanitary Inspector MERTON AND MORDEN URBAN DISTRICT COUNCIL WITH THE COMPLIMENTS OF THE MEDICAL OFFICER OF HEALTH ANNUAL REPORTS At the request of the Ministry of Health, on grounds of national security, Medical Officers of Health have been asked not to publish tables of local populations or quotations from the Registrar General's figures, which would enable any substantial series of local populations to be reconstructed. As it is possible to reconstruct population figures from a variety of vital statistics, it has been thought wise to issue these reports as confidential documents only, and to conform as far as possible with the Minister's request. Public Health Department, Morden Hall, s.w. 19. Merton and Morden Urban District ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEARS 1940-41-42 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, Since my last full report to you on the health of the district and the work of the Department for the year 1939, the Minister of Health has directed that for reasons of National Security full statistical information should not be presented in these annual reports. Any figures should be regarded as confidential. This report, therefore, is a summary of the health conditions in the district since the last report up to the end of the year 1942 as the figures for that year are now available. It is the custom in the introduction to their annual reports for Medical Officers to pay tribute to the contribution of members of the Public Health Staff, and I have pleasure in recording my appreciation of the value of their efforts in securing that an efficient and unrestricted service has been maintained throughout this difficult period. As however these reports may be of historical interest to future Public Health Officers, it would not be right to omit reference to the greatly increased difficulties that the withdrawal of permanent staff into the Armed Forces has caused. R. J. Mitton joined the Forces on April, 1940; B. J. Fentiman joined the Forces on 15th October, 1941; A. A. Makepeace, after initiating a Temporary Chief Clerk into his duties was called up on the 30th April, 1942. At the time of writing this report the temporary Chief Clerk who took on Mr. Makepeace's duties has in turn left the Department. In spite of these and many other serious difficulties, the scope of the Public Health activities has been largely increased ; and in many ways as a direct result of war conditions. The collection of considerable numbers of the population in Public Shelters including the South Wimbledon Tube Shelter demanded Public Health supervision, and the effect of damage to water mains, main sewers, and to dwelling-houses provided an active period for the Staff of the Department. On the general public health side, during this period a great increase in the number of children immunised against 2 Diphtheria has been achieved and the results in Merton and Morden are among the best in the County of Surrey. Arrangements were put in operation for the treatment and for home visiting and follow up in cases of Scabies. Since the Cleansing Centre at Aston Road was opened in September, 1941, 882 cases of Scabies have been treated there. In November, 1942, the first Day Nursery was opened at Middleton Road, adjoining the Middleton Road Clinic. This Nursery is of the prefabricated hut type and designed to accommodate 60 children. I would like to take this opportunity of expressing my appreciation of the contribution to the public Health work of the district which has been made in increasing measure by the A.R.P. personnel. Contrary to the belief in many quarters, a great deal of help is derived from this source, and it would not be an exaggeration to say that it is only by the existence of this reserve of workers that it has been possible to carry out the expansion of the public health activities which has been necessary during the past 3 years. An example of this is provided by the cleansing station referred to above. This has been carried on entirely without assistance from the permanent nursing staff. Immunisation in the schools, too, has been carried out without any demands on the time of the health visitors by a team of nurses attached to the Mobile Unit. In the propaganda campaign for Diphtheria Immunisation, a large burden of the house to house visiting was carried out by the Nursing Auxiliaries at the First Aid Posts, and it was possible to prepare a register of all children under five years of age in the district from the Food Office records for that purpose with their help. The Ambulance Service, too, is staffed entirely by Civil Defence personnel. Now in addition to these many activities these A.R.P. Nurses are helping in the Day Nurseries. This serves to emphasise the value of the work they are doing and demonstrates that if the scope of public health work continues as at present after this service is disbanded, a very considerable increase in permanent staff will be required to cope with it. In conclusion, I would like to express my gratitude to the Members of the Council for encouragement and consideration and for that support which must always be the mainspring of this as all other Council departments. I am, Mr. Chairman, Ladies and Gentlemen, A. WALLACE JOHNS, Medical Officer of Health. August, 1943. 3 URBAN DISTRICT COUNCIL of MERTON and MORDEN 1940-41 NO. 3 COMMITTEE (SERVICES). Chairman: Mr. W. S.Le Gros Clark. Mr. L. F. Biden. *Capt. A. E. Higgins. Mr. W. T. Carter. Mr. P. Hill. Mr. E. K. Clarke. Mr. E. Knox. Mrs. E. M. Clifton. Mrs. S. A. Lodge. Mrs. H. Cobbett. Mr. W. G. Oliver. Mts. L. A. Doel. **Mr. J. Stuart Ker. Mr. G. F. Coleman. * Died August, 1940—replaced by Mr. C. C. Cockbain. ** Resigned 24th January, 1941. REPRESENTATIVES ON THE WANDLE VALLEY JOINT HOSPITAL BOARD. Mrs. H. Cobbett. Mr. F. J. Grimme. Mr. G. F. Coleman. Mr. G. E. Baker (ex-ofjicio). REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD. Mrs. E. M. Clifton. Mr. S. F. Franklin. Mr. G. MacDonald. Mr. G. E. Baker (ex-officio). REPRESENTATIVES ON NELSON HOSPTAL COUNCIL. Mr. G. F. Coleman. Mr. W. H. Glasscock. Mr. D .M. Neil. 4 1942 NO. 3 COMMITTEE (SERVICES). Chairman: Mr. W. S. Le Gros Clark. Mr. J. E. Leggett. Mr. W. H. Clark. Mrs. E. M. Clifton. Mr. H. Hailstone. Mrs. H. Cobbett. Mr. W. E. Gibson. Mrs. L. A. Doel. Mr. P. Hill. Mr. G. F. Coleman. Mrs. S. A. Lodge. Mr. F. H. Brinkworth. Mr. Roberts Brown. Mr. C. C. Cockbain. Mr. G. MacDonald (ex-officio). Mr. J. C. Hudson (ex-officio). REPRESENTATIVES ON THE WANDLE VALLEY JOINT HOSPITAL BOARD. Mrs. H. Cobbett. Mr. F. J. Grimme. Mr. G. F. Coleman. Mr. G. MacDonald (ex-officio). REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD. Mrs. E. M. Clifton. Mr. S. F. Franklin. Mr. S. Beven. Mr. G. MacDonald (ex-officio). REPRESENTATIVES ON NELSON HOSPTAL COUNCIL. Mr. J. H. Auger. Mr. W. H. Glasscock Mr. J. Grimme. 5 PUBLIC HEALTH STAFF, 1940-41. Medical Officer of Health: A. Wallace Johns, M.R.C.S., L.R.C.P., D.P.H. Chief Sanitary Inspector: a J. B. Pointon, M.S.I.A. Deputy Chief Sanitary Inspector: a b F. C. Thomas, M.S.I.A. Sanitary Inspectors: a J. H. Massey, M.S.I.A. N. Smith, M.S.I.A. Senior Health Visitor: Miss E. M. Sperry. Health Visitors: Miss A. R. Taylor. Miss A. Howard. Miss M. McL. Doran. Miss M. E. Black. Senior Clerk: A. A. Makepeace. Clerks: B. J. Eentiman. Mrs. M. M. Makepeace. Miss M. J. Hearn. Part-time Officers: Matthew Orr, M.B., Ch.B. T. Elliott, M.B., Ch.B. Assistant Medical Officer for Maternity Clinics: Esther Richards, 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. Ancesthetist to Maternity and Child Welfare Dental Scheme: Mary M. Tulloch, M.B., B.S. Dentist to Maternity and Child Welfare Dental Scheme: H. W. Fynn, L.D.S., R.C.S. (Eng.). a Meat and Food Inspector's Certificate, Royal Sanitary Institute. b Sanitary Soience Certificate, University of Liverpool. c Smoke inspector's Certificate, Royal Sanitary Institute. 6 PUBLIC HEALTH STAFF, 1942. Medical Officer of Health: A. Wallace Johns, M.R.C.S., L.R.C.P., D.P.H. Assistant Medical Officer of Health: Evelyn B. G. Ewen, M.B., Ch.B. Edin., D.P.H. Chief Sanitary Inspector: a J. B. Pointon, M.S.I.A. Deputy Chief Sanitary Inspector: a b F. C. Thomas, M.S.I.A. Sanitary Inspectors. C. Jones. a b N. Smith, M.S.I.A. Senior Health Visitor: Miss E. M. Sperry. Health Visitors: Miss A. R. Taylor. Miss M. E. Black. Miss A. Howard. Miss V. M. Evans. Senior Clerk: A. A. Makepeace. Clerks: Mrs. E. Lang. Mr. A. J. Fletcher. R. A. Connolly. Assistant Medical Officer for Maternity Clinics: Dr. Stanley Bond, M.B., Ch.B., M.R.C.O.G. 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. Ancesthetist to Maternity and Child Welfare Dental Scheme: Mary M. Tulloch, M.B., B.S. Dentist to Maternity and Child Welfare Dental Scheme: H. W. Fynn, L.D.S., R.C.S. (Eng.). a Meat and Food Inspector's Certificate, Royal Sanitary Institute. b Sanitary Science Certificate, University of Liverpool. c Smoke Inspector's Certificate. Royal Sanitary Institute. 7 SECTION A.— STATISTICS AND SOCIAL CONDITIONS OF THE AREA. 1940. 1941. 1942. Area (in acres) 3,237 3,237 3,237 Number of inhabited houses according to Rate Books 21,000 21,115 21,115 Rateable value at 31st December £634,749 £641,387 £641,387 Sum represented by 1d. rate £2,522 £2,410 £2,410 Industry. The number of factories registered under the Factories Act at the end of 1940/41/42 was:— 1940/41 1941/42 Factories with mechanical power:— Employing more than 40 persons 40 42 Employing less than 40 persons 67 87 Factories without mechanical power 11 15 118 144 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:— 1940—62 1941—110 1942—236 Number of persons admitted to mental hospitals:— 1940—31 1941—33 1942—84 Average weekly number of persons in receipt of Domiciliary Assistance on:— 1940. 1941. 1942. 1st January 700 361 330 1st July 595 331 298 31st December 365 330 319 Total amount of Domiciliary Assistance afforded during the three years:— 1940—£12,056 1941—£9,730 1942—£9,158 11s. 6d. The figures above relating to the number of admissions to hospitals is only in respect of those patients who were referred to hospitals 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 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, 1940—1941 1942. JOSEPH HOOD RECREATION GROUND WEST BARNES PUMPING STATION 1940 1941 inches. 1942 1940 1941 inches. '1942 January 2.18 2.33 2.37 2.36 2.34 2.82 February 1.32 1.71 0.60 1.48 1.85 0.80 March 2.92 3.31 1.97 2.96 3.31 1.90 April 1.75 1.36 1.02 1.53 1.32 1.07 May 1.08 1.55 2.91 1.07 1.75 2.30 June .76 2.56 1.08 0.77 2.46 1.62 July 2.80 4.01 2.04 2.68, 3.92 1.94 August Nil 4.29 2.13 0.09 4.39 2.04 September 1.34 0.35 1.10 1.40 Nil 1.15 October 2.18 0.77 3.78 2.22 0.08 3.13 November 6.80 2.45 2.04 5.70 2.60 2.19 December .97 1.69 2.38 0.98 1.52 2.66 Total 24.10 26.38 23.42 23.24 25.54 23.62 Joseph Hood Recreation Ground,. 1940 191,1 191,2 No. of days with 0.01" of rainfall or more 129 151 142 No. of days with 0.04" of rainfall or more 101 141 107 West Barnes Pumping Station. No. of days with 0.01" of rainfall or more 140 146 161 No. of days with 0.04" of rainfall or more 104 109 106 9 VITAL STATISTICS. Vital Statistics for these years are very satisfactory. The Birth Rate dropped from 14.2 per 1,000 of the population in 1940 to 13.06 with 123 less actual births. The 1942 figure has, however, shown a gratifying increase and at 16.05 is the highest recorded since 1926, as reference to Table II on Page 17 will show. The number of births was 1,069, the highest figure ever reached for the district. The Death Rate for these years, 1940, 1941, and 1942 are 7.2, 10.4, 8.8 per 1,000 population compared with the corresponding figures for England and Wales as a whole of 14.3, 12.9, and 11.6. The Infant Mortality Rates for these years remain low. The Infant Mortality Rate is the number of deaths of infants under one year per thousand live births. They are set out in the appended table:— England and Wales. Merton and Morden. 1940 55 34.3 1941 59 42.5 1942 49 33.9 The Infant Mortality figure always claims special attention as it is generally regarded as an index of environment and hygiene. Our Infant Mortality has only been lower on two occasions in the past twenty years; in 1923 it was 27, and in 1932 it was 29. Analysis of these deaths always shows a high proportion occurring in the first month of life. Actually, of the 32 infant deaths in 1940, 28 occurred in the first month representing 84 per cent. of the total. These deaths in the first month of life are referred to as neo-natal deaths; and it is in this group of infant deaths that reduction must be looked for before any further considerable reduction in the infant mortality can be achieved in the future. The Infant Mortality Rate for England and Wales has dropped from 130 to 50 in the past thirty years, a tribute to the improvement in Infant Care. The reduction has not, however, been in the neo-natal group, the group of infant deaths associated with childbirth, many of which occur in the first week. Improvement in Infant Care has effected this praiseworthy reduction in the past few decades: our future energies must be directed to improvement in ante-natal and obstetrical care of the mother to effect the further reduction in the total infant mortality by reducing his neo-natal group of infant deaths. 10 SUMMARY OF VITAL STATISTICS FOR 1940, 1941, 1942. (Registrar General's Figures). Population:— Mid. 1940, 1941 and 1942 Registrar General's Estimates:— 1940 1941 1942 68,540 64,920 66,590 Births, 1940. M. F. Total Live (Leg.) 491 451 942 (Illeg.) 17 12 29 508 463 971 Still Births 15 14 29 Birth Rate 14.2 per 1,000 population Still Birth Rate 29 per 1,000 total births Deaths 359 355 714 Death Rate 10.4 per 1,000 population Births, 1941. M. F. Total Live (Leg.) 399 409 808 (Illeg.) 14 26 40 413 435 848 Still Births 18 12 30 Birth Rate 13.06 per 1,000 population Stll Brth Rate 34.2 per 1,000 total births Deaths 309 248 557 Death Rate 8.58 per 1,000 population Births, 1942. M. F. Total Live (Leg.) 540 490 1,030 (Illeg.) 26 13 39 566 503 1,069 Still Births 11 14 25 Birth Rate 16.05 per 1,000 population Still Birth Rate 24 per 1,000 total births Deaths 274 314 588 Death Rate 8.8 per 1,000 population 11  1940 1941 1942 Infant Mortality. Total deaths under 1 year 32 34 35 Infant Mortality Rate per 1,000 live births 34.3 42.5 33.9 Pate per 1,000 live births 29.8 40.7 32 Death of Legitimate infants under 1 year 27 31 33 Deaths of Illegitimate infants under 1 year 5 3 2 Rate per 1,000 Illegitimate births 172 75 51 Maternal Mortality. Deaths from Sepsis 1 — 1 Deaths from other principal causes — 2 2 Maternal death rate 1.04 2.3 2.8 Zymotic Deaths. Deaths from Measles 1 — — Whooping Cough — 1 — Diarrhoea (under 2 years) 2 4 5 7 Principal Zymotic Diseases 4 7 6 Zymotic Death Rate (per 1,000 population) 0.06 0.10 0.05 Deaths from Tuberculosis. All Forms 42 46 47 Rate per 1,000 population 0.61 0.71 0.71 Phthisis 36 42 38 Rate per 1,000 population 0.53 0.65 0.58 Deaths from Cancer 76 85 103 Rate per 1,000 population 1.1 1.3 1.5 12 CLEANSING STATIONS. The Cleansing Station which was included in the architectural design of the Council's Slipper Baths was opened for the treatment of cases in September, 1941. The arrangement was that the Attendant and his wife would carry out the treatment of cases attending the Centre. The original estimate of the attendances for treatment based on peace-time experience was soon so grossly exceeded by the almost epidemic incidence of Scabies that arrangements were made for Nursing Auxiliaries from the First Aid Post to give assistance. This arrangement has worked well. The First Aid Post Trained Nurse has taken over the running of the Centre and undertaken the family follow up of cases attending in order to discover other cases in the family requiring treatment. This side of the work, as is well known, is perhaps the most important feature of the campaign against Scabies; and the follow up is best carried out by the Nurse in daily contact with the disease and thus experienced in its recognition. The following table shows the scope of treatment carried out. 1942 1943 Number of cases of Scabies treated 435 371 Cases of Scabies with concurrent verminous head 64 35 Cases of Scabies with Secondary Septic Skin condition 48 10 Total number of attendances at the Centre 2,049 1,586 Number of follow up visits to the home 158 19 A two application Benzyl Benzoate treatment at the one visit with a further visit after a week was instituted in September, 1942. It has proved very successful and is popular especially with adult patients as it reduces the period of absence from work and also avoids the risk of publishing the reason for their absence from work, as most sick pay regulations allow for brief absence without requiring a medical certificate to explain the cause. This is a point worth noting. In spite of repeated assurance that Scabies is not a disease associated with personal uncleanliness adult patients generally prefer to keep the fact as secret as possible. The Lethane Oil treatment has been used with considerable success in the treatment of verminous heads. There have been no cases of infection by the body louse. 18 TABLE I. COMPARATIVE STATISTICS, 1940. (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 (Residential Populations 25,000 to 50,000 at Census). London Adminis- tive County. Merton and Morden. Rates per 1,000 Population. Births:— 1940 1940 1940 1940 1940 Live 14.6 16.0 15.7 13.7 14.17 Still 0.55 0.64 0.55 0.44 0.42 Deaths:— All causes 14.3 15.8 12.8 17.8 10.4 Typhoid and Paratyphoid fevers 0.00 0.00 0.00 0.00 0.00 Scarelt fever 0.00 0.00 0.00 0.00 — Whooping Cough 0.02 0.02 0.02 0.00 — Diphtheria 0.06 0.07 0.05 0.01 0.01 Influenza 0.32 0.29 0.30 0.18 0.20 Smallpox — — — — — Measles 0.02 0.02 0.02 0.01 0.01 Notifications:— Enteric 0.07 0.06 0.10 0.06 0.04 Paratyphoid fever Cerebro-spinal fever 0.32 0.33 0.29 0.28 0.12 Scarlet fever 1.63 1.53 1.57 0.82 1.33 Whooping Cough 1.34 1.29 1.35 0.22 1.56 Diphtheria 1.16 1.29 1.21 0.61 0.29 Erysipelas 0.33 0.36 0.30 0.35 0.18 Smallpox 0.00 — — — — Measles 10.24 9.23 0.00 1.78 6.55 Pneumonia 1.20 1.37 1.00 0.87 0.92 Rates per 1,000 Live Births. Deaths under 1 year of age 55 61 54 50 32 Deaths from Diarrhoea and Enteritis under 2 years of age 4.6 5.9 4.4 5.8 2.1 Rates per 1,000 Total Births (Live and Still). Maternal Mortaltiy (excluding Abortion) Puerperal Infection No. 147 0.52 — 0.99 Others 1.64 — Not available 1.03 Total 2.16 2.02 Notifications:— Puerperal fever 11.96 13.90 9.73 3.34 9.3 Puerperal pyrexia 13.30 14 TABLE 1. COMPARATIVE STATISTICS, 1941. (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 (Residential Populations 25,000 to 50,000 at Census). London Adminis- tive County. Merton and Morden. Rates per 1,000 Population. Births:— 1941 1941 1941 1941 1941 Live 14.2 14.7 16.4 8.9 13.06 Still 0.51 0.58 0.60 0.33 0.46 Deaths:— All causes 12.9 14.9 13.0 16.3 8.6 Typhoid and Paratyphoid fevers 0.00 0.00 0.00 0.01 — Scarelt fever 0.00 0.00 0.01 0.00 — Whooping Cough 0.06 0.07 0.06 0.04 0.01 Diphtheria 0.07 0.08 0.06 0.03 0.03 Influenza 0.19 0.17 0.20 0.15 0.11 Smallpox — — — — — Measles 0.03 0.03 0.03 0.02 — Notifications:— Enteric — — — — — Paratyphoid fever 0.09 0.12 0.09 0.05 0.08 Cerebro-spinal fever 0.25 0.31 0.20 0.30 0.14 Scarlet fever 1.47 1.49 1.51 1.01 1.36 Whooping Cough 4.39 4.37 4.50 3.50 6.3 Diphtheria 1.25 1.53 1.19 0.93 0.38 Erysipelas 0.30 0.36 0.27 0.50 0.22 Smallpox — — — — — Measles 10.33 8.27 10.47 4.77 8.3 Pneumonia 1.25 1.53 1.04 1.07 1.24 Rates per 1,000 Live Births. Deaths under 1 year of age 59 71 56 68 34 Deaths from Diarrhoea and Enteritis under 2 years of age 5.1 7.5 4.6 6.8 4.8 Rates per 1.000 Total Births (Live and Still). Maternal Mortaltiy (excluding Abortion) Puerperal Infection No. 147 0.48 ) Not available Others 1.75 2.3 Total 2.23 2.3 Notifications:— Puerperal fever 11.91 15.64 9.43 19.3* 4.7 Puerperal pyrexia * Including Puerperal Fever. 15 TABLE I. COMPARATIVE STATISTICS, 1942. (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 (Residentia Populations 25,000 to 50,000 at Census). London Adminis- tive County. ! Merton and Morden. Rates per 1,000 Population. Births:— 1942 1942 1942 1942 1942 Live 15.8 17.3 18.4 14.0 16.05 Still 0.54 0.66 0.62 0.48 0.37 Deaths— All causes 11.6 13.3 12.1 13.9 8.8 Typhoid and Paratyphoid fevers 0.00 0.00 0.00 0.00 0.00 Scarlet fever 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.02 0.03 0.02 0.04 0.00 Diphtheria 0.05 0.06 0.04 0.02 0.01 Influenza 0.09 0.09 0.10 0.07 0.08 Smallpox — — — — — Measles 0.01 0.02 0.01 0.01 0.00 Notifications:— Enteric 0.01 0.01 0.01 0.02 0.01 Paratyphoid fever 0.01 0.01 0.01 0.01 — Cerebro-spinal fever 0.14 0.17 0.12 0.15 0.2 Scarelt fever 2.19 2.49 2.34 1.86 3.4 Whooping Cough 1.73 1.97 1.58 2.72 2.8 Diphtheria 1.05 1.35 0.91 0.76 0.18 Erysipelas 0.30 0.36 0.26 0.43 0.12 Smallpox 0.00 0.00 — 0.00 0.00 Measles 7.46 9.27 7.39 8.62 14.1 Pneumonia 1.07 1.30 0.94 0.94 1.3 Rates per 1,000 Live Births. Deaths under 1 year of age 49 59 46 60 35 Deaths from Diarrhœa and Enteritis under 2 years of age 5.2 7.5 4.8 8.6 5 Maternal Mortaltiy (excluding Abortion) Rates per 1,000 Total Births (Live and Still). Puerperal Infection No. 147 0.42 Not available Total 1.59 Others 2.01 Notifications:— Puerperal pyrexia 12.61 15.94 10.80 3.10 0.165 Puerperal fever 17.69* * Including Puerperal Fever. 16 Institutional and Domiciliary Births. The tendency of recent years towards increased Institutional confinements continues. Forty-seven per cent. of the births which occurred in 1940 and fifty-eight per cent. in 1941. took place in hospitals or nursing homes as follows:— 1940 1941 1942 Nelson Hospital 214 343 305 Kingston County Hospital 94 69 44 Other hospitals, institutions and nursing homes 147 81 219 455 493 568 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 9.0 1918 17,552 241 14 204 13.0 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 25,860 392 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 72,150 1,005 13.9 516 7.2 1940 68,540 971 14.2 714 10.4 1941 64,920 848 13.06 557 8.58 1942 66,590 1,069 16.05 588 8.8 17 DEATHS. The number of registered deaths after adjustment by transferable deaths is given below:— 1940—714 total deaths, of which 359 were males and 355 females. 1941—557 total deaths, of which 309 were males and 248 females. 1942—588 total deaths, of which 274 were males and 314 females. The Seasonal mortality is indicated by the deaths for each quarter of the year which were:— 1940—First quarter 222 Second quarter 120 Third quarter 148 Fourth quarter 224 1941—First quarter 197 Second quarter 124 Third quarter 148 Fourth quarter 137 1942—First quarter 122 Second quarter 18 Third quarter 48 Fourth quarter 80 Inquests. Inquests were held in the district on 30 deaths for 1940, 22 for 1941, and 22 for 1942. Verdicts were as follows:- 1940 (1) Natural causes 6 (2) Suicide by— 5 Coal gas 3 Rifle bullet wound of face 1 Jumping in front of train 1 (3) Accidental— 14 Trichlorethylene Poisoning 1 Knocked down by motor car 3 Shock following extensive burns 1 Falling downstairs 2 Knocked down by train 1 Falling from window 1 Drowning 2 Falling on footway 1 Knocked down by motor cycle 1 Fracture of skull caused by blow 1 (4) In accordance with medical evidence— Murder by coal gas poisoning 3 3 (5) Death by misadventure— Monoxide Poisoning from anthracite burner 1 Death following operation 1 2 30 18 Road accidents were responsible for 4 of the total deaths, compared with 9 in the year before. 1941 Inquests were held in the district on 22 deaths. Verdicts were as follows:— (1) Natural causes 4 (2) Suicide by- Jumping in front of train 1 2 Drowning 1 (3) Accidental— 13 Fractured skull sustained in gymnasium 1 Motor cycle in collision with lorry 1 Fall in street 1 Collision between 2 motor cars 2 Fall in the home 5 Burns by clothing catching alight 1 Fall down lift shaft 1 Collision between pedal cycle and lorry 1 (5) Death by misadventure— 3 Infection from extraction of impacted wisdom tooth 1 Coal gas poisoning 1 Alcoholism (Chronic) 1 22 Road accidents were responsible for 4 of the total deaths being the same number as in 1940. 1942 Inquests were held in the district on 22 deaths. Verdicts were as follows:— (1) Natural causes 5 (2) Suicide by— 5 Coal gas poisoning 1 Cyanide poisoning 1 Potassium Cyanide 1 Unknown narcotic 1 Gunshot wounds of head 1 19 (3) Accidental deaths— 12 Knocked down by railway engine 1 Tetanus after crushing hand in mechanical press 1 Collision with tram car while crossing road Collision with motor car 1 Collision with motor car while riding pedal cycle 1 Infection of finger after wound by fish bone 1 Collision with lorry while travelling in fire tender 1 Collision with lorry while riding pedal cycle 1 Burns when clothing caught fire 1 Pall at work 1 Inhalation of stomach contents in Air passage 1 Burns from fall against copper 1 Road accidents were responsible for 4 of the total deaths, being the same number as in 1940 and 1941. CAUSES OF DEATH. The principal killing diseases are well shown in the brief appended table. Heart disease remains Number One on the list:— 1940 1941 1942 Heart Disease 151 147 124 Other Violence 131 32 16 Cancer 76 85 103 Tuberculosis 42 46 47 The number of deaths attributable to Cancer in 1942 shows a considerable rise over the two years but reference to the appended table seems to suggest no very definite trend. The number is none the less considerably in excess of the figures for previous years as is illustrated by the details as shown below. CANCER DEATH RATE. No. of deaths from Cancer for past 10 years. 1933 54 1938 89 1934 66 1939 91 1935 50 1940 76 1936 74 1941 85 1937 93 1942 103 20 The Cancer Death Rates for the last twelve 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:— Year. Death Bate per 1,000 population. Year. Death Rate per 1,000 population. 1930 1.2 1937 1.4 1931 0.9 1938 1.2 1932 1.2 1939 1.1 1933 1.0 1940 1.2 1934 1.2 1941 1.3 1935 1.0 1942 1.5 1936 1.2 TABLE III. Deaths from Respiratory Diseases, 1925-42. Year Bronchitis Pneumonia Other Respiratory Diseases Total Death Rate 1925 6 16 1 23 1.2 1926 6 8 5 19 0.9 1927 10 11 5 26 1.2 1928 8 14 2 24 0.9 1929 11 20 4 35 1.2 1930 2 10 8 15 0.4 1931 8 24 4 36 0.8 1932 11 27 3 41 0.8 1933 12 82 6 50 0.9 1934 7 88 4 49 0.8 1935 9 22 6 37 0.6 1936 2 85 2 39 0.6 1937 14 81 6 51 0.8 1938 15 27 7 49 0.7 1939 5 20 9 34 0.4 1940 38 40 15 93 1.3 1941 30 80 6 66 0.9 1942 9 12 20 41 — 21 TABLE IV. CAUSES OF DEATH DURING THE YEARS 1940, 1941, 1942. No. Cause of Death. Males Females Total 40 41 42 40 41 42 40 41 42 1 Typhoid and Paratyphoid Fevers - - - - - - - - - 2 Cerebro spinal fever 3 1 2 1 2 1 4 3 3 3 Scarlet Fever - - - - - - - - - 4 Whooping Cough — 1 - - — 1 — 5 Diphtheria 1 - - - 2 1 1 2 1 6 Tuberculosis Respir. System 18 20 18 12 18 36 42 38 7 Other forms of tuberculosis 3 2 20 3 2 3 6 4 Q 8 Syphilitic diseases 2 2 3 2 3 9 1 9 9 Influenza 7 2 2 7 1 3 z 14 6 10 Measles 1 6 2 - - - 1 - 5 11 Ac. Polio. myel. and polio. enceph. - - - - - - - - 12 Ac. inf. enceph. - - - - - - - - 13 Cancer of bue. cav. and oesp oph. / uterus - - 1 - - 6 - - 7 14 Cancer of stomach and duodenum - - 3 - - 5 - - 8 15 Cancer of breast - - - - - 13 - - 1 16 Cancer of all other sites 28 40 48 42 35 76 - 7 17 Diabetes 3 43 9 - 6 1 7 7 3 18 Intra cranial vasular lesions - - 2 - - 37 2 - 60 19 Heart disease 77 75 58 74 72 66 149 147 124 20 Other dis. of circ. system 5 8 9 6 4 10 148 11 19 21 Bronchitis 24 21 9 14 2 2 40 12 21 22 Pneumonia 20 15 10 90 1 14 15 30 21 23 Other resp. diseases 9 10 15 6 1 1 40 30 29 24 Ulcer of stom. & duodenum - 5 6 2 1 4 15 6 10 25 Diarrhoea under 2 years 1 2 42 - 9 9 9 1 5 26 Appendicitis 1 2 2 1 2 1 2 4 5 27 Other digest. dis. 8 1 - 11 1 n 1 3 2 1 28 Nephritis 6 8 10 1 7 2 15 15 18 29 Puer. and post abort, sepsis - 5 8 11 4 7 17 9 15 30 Other maternal causes - - - 1 - 1 1 — 1 31 Premature births 18 — — - — 2 — — 2 32 Con. mal. birth inj. inf. dis. 18 15 11 11 7 15 29 22 26 33 Suicide 2 2 3 3 1 4 5 3 7 34 Road traffic accidents — — 6 — — — — — 6 35 Other violent causes 69 21 7 62 11 9 131 32 16 36 All other causes 22 25 22 22 22 33 44 47 55 Total all causes 359 309 274 355 248 314 714 557 >88 22 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 119 cases involving 2,052 visits were attended during the year 1940, and 130 cases involving 2,087 visits for 1942. In 1940, of these cases 9 were children under 5 years of age to whom 65 visits were made, and in 1942, 49 were children under 5 to whom 78 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 jn addition that part situated in the Carshalton Urban District lying to the North of Reigate Avenue. During 1940 two hundred cases were dealt with by the St. Helier District Nursing Association; 14 of these were children under 5. In 1941 one hundred and ten cases were dealt with, and of these 5 were under 5. In 1942 there were one hundred and seventeen cases, of which 8 were under 5. The total number of visits made was 3,477, of which 116 were in respect of children under 5 years for 1940, and the total number of visits made in 1941 was 2,502, of which 31 were in respect of children under 5 years of age. In 1942, the total number of visits was 1,775, of which 29 were children under 5 years of age. (3) The Wimbledon District Nursing Association serves Wimbledon and the western part of this District. Nurses are employed for general nursing in Merton and Morden. The figures relating to cases and visits in Merton and Morden during 1940, 1941 and 1942 are as follows:— Cases. Visits. 1940 1941 1942 1940 1941 1942 Children under 5 yrs. 42 — 50 388 — 362 Maternity 2 — — 36 — — Midwifery 4 — — 83 — — Other Cases 281 298 348 6,059 6,086 6,448 329 298 398 6,566 6,086 6,810 23 Laboratory Facilities. The arrangements with the Nelson Hospital for carrying out such bacteriological examinations as swabs and sputa continue to work satisfactorily. In addition, the Emergency Medical Service Laboratory at Kingston has proved of great assistance in carrying out more complicated investigations such as material from suspected food poisoning and isolation of the typhoid dysenteriæ group in food or fæces. The following examinations were made during the years under review:— Examinations. No. Performed. Positive Result. 1940 1941 1942 1940 1941 1942 Swabs for diphtheria bacilli 320 304 270 14 17 8 Sputum for tubercle bacilli 100 89 87 11 9 3 Blood for Widal test 8 2 2 1 — — Fasces 12 11 11 1 1 — Swabs for Meningococci 5 9 4 — — — 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 difficulties have 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 two sitting cases. It used to be housed at the Fire Station in Kingston Road, but on the formation of the National Fire Service it was handed over to the Civil Defence to be manned by their personnel and a garage has been built at the Morden Recreation Depot, where it has been kept since. In addition the Civil Defence sitting case cars are available for use for Maternity cases when the ambulance is not available. An application has been made for this to be extended to cases other than maternity as a considerable number of minor cases such as accident cases treated as out-patients and not needing in-patient treatment, could be taken home by sitting case ears thus easing the burden on the accident ambulance. This was, however, refused. 24 AMBULANCE CALLS—1940, 1941, 1942. 1940-11 and 1942 Calls received from Public Calls received from neighbouring Brigades Total Calls Received Calls transferred to other Authorities Calls answered by Own Ambulance 40 41 42 40 41 42 40 41 42 40 41 42 40 41 42 Jan. 83 69 101 2 2 12 85 71 113 1 1 5 84 70 108 Feb. 92 83 85 8 5 2 95 88 87 2 - 5 93 88 82 March 72 64 92 1 3 12 73 67 104 3 3 5 70 65 99 April 68 62 78 2 3 1 70 65 79 - ] 9 70 64 70 May 57 67 86 - 5 2 57 73 88 1 2 33 56 70 55 June 52 55 68 2 3 - 54 58 68 - 8 25 54 50 43 July 56 68 89 2 7 11 58 75 100 - 3 4 58 72 96 Aug. 74 60 76 2 4 6 76 64 82 3 2 3 73 62 79 Sep. 76 51 79 1 1 4 77 52 83 - 15 2 77 37 81 Oct. 72 76 79 1 - 1 73 76 80 2 20 52 71 56 28 Nov. 69 77 79 3 1 - 72 78 79 1 9 79 71 69 — Dec. 67 74 81 2 3 — 69 77 81 3 4 81 66 73 — Total 838 806 993 21 87 51 859 843 1044 16 68 323 843 776 741 1940 1941 1942 Number of calls for 2 attendants 468 584 741 Time taken in executing the calls (from leaving station to return) 675 669 684 Mileage covered 7,231 5,992 6,101 1940 1941 1942 Average time per call 48.04 mills 47.8 mins. 58.0836 mins. Average distance per call 8.6 miles 7.1 miles 8.2334 miles 25 CLINICS AND TREATMENT CENTRES. 1.—Maternity and Child Welfare Clinics (provided by the Council). Centre Clinic Times of Clinic Sports Pavilon, 216, Grand Drive, Raynee Park Infant Welfare Ante-Natal Mondays 10— 12 noon. „ 2— 4 p.m. Wednesdays 10—12noon Thursdays at 2 p.m. by appointment. Health Centre, Middleton Road, Morden Infant Welfare Ante-Natal Dental Tuesdays 10—12 noon, „ 2— 4 p.m. Fridays 2—4 p.m. Thursdays 9.46 a.m. by appointment. Thursdays 10—12 noon First Aid Post, Blakesley House, 246, Kingston Rd. Merton Infant Welfare Ante-Natal Thursdays 2—4 p.m. Saturdays at 9.45 a.m. by appointment. Health Centre, Aston Road, Raynes Park Infant Welfare Dental Wednesdays 2—4 p.m. Fridays 10—12 a.m. Fridays 10—12 a.m. Hope Mission Hall Rodney Place, Merton Infant Welfare Thursdays 10—12 a.m. DIPHTHERIA IMMUNISATION. 2.—Diphtheria Immunisation Clinics (provided by the Council). During 1941 the Diphtheria immunisation sessions were increased from four to twelve per month, the object being to provide these sessions weekly as far as possible at each clinic and obviate any confusion which may have been caused by the bi-weekly arrangement previously in operation. In addition, of course, endeavours were made to stimulate a response in the parents. The time table in operation at the time of writing this report is appended rather than those in operation during the years under review, with the object of increasing the value of the report for reference purposes. During 1940 two hundred and thirty-four children under 5 were immunised and 50 between the ages of 5 and 15. In 1941 a special effort was made to increase the number done in the 26 schools and with the generous help and co-operation of the head teachers 3,198 children between the ages of 5 and 15 were immunised. At the same time 700 under fives completed the course, this latter group being done at special sessions in the Infant Welfare Clinics. In 1942 seven hundred and twenty-seven children under 5 were done and 753 of school age. The number of children immunised at the end of 1942 in the district was 9,724, of whom 2,029 were under 5 and 7,695 of school age. These figures represent an estimated percentage of 44 per cent. of under fives and 77 per cent. of the five to fifteen group. Access to the school age group will always make for greater success among these children, but it should be borne in mind that immunisation of children between birth and one year of age is rarely done, and the 2,029 immunisations of children under five are really immunisations of children between one year and five years, that is, of four not five, age groups. Expressing the total of 2,029 as a percentage of the estimated total number of children between one and five years of age in the district, the figure rises to 55 per cent. Another factor must be taken into consideration in considering these figures and that is as there are about 1,000 children in any one age group, it is necessary to carry out 1,000 immunisations each year to maintain these figures constant and only what is achieved in excess of that number will show as improvement. Sports Pavilion, 216, Grand Drive, Raynes Park Mondays at 9.45 a.m. Health Centre, Middleton Road, Morden Fridays at 2 p.m. Hope Mission Hall, Rodney Place, Men on Thursdays at 9.45 a.m. Health Centre, Aston Road, Raynes Park Fridays between 10—11 am. In addition to these sessions specially set aside for immunisation injections are given at the ordinary Infant Welfare Sessions. 27 3.—School Clinics (provided by Surrey Education Committee) Middleton Road, St, Helier, Morden General Medical Dental Mondays and Wednesdays 9 30 a.m. 2nd and 4th Saturday 9.80 a.m. Tuesdays, Wednesdays and Fridays 9.80 a.m. and 1.30 p.m. Mondays and Saturdays 9.30 a.m. Thursdays 1.30 p.m. Aston Road, Raynes Park General Medical Dental Tuesdays and Thursdays 9.80 a.m. Mondays, Tuesdays and Thursdays 9.30 a.m. and 1.30 p.m. Wednesdays and Saturdays 9.30 a.m. Fridays 1.30 p m. 4.—Tuberculosis Dispensaries (provided by Surrey County Council). St. Helier County Hospial, Wrythe Lane, Carshalton Mondays 1.30 p.m. 2nd Monday in month 5.80 p.m. 5.-r-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 out-patient treatment. St. Helier County Hospital, Wrythe Lane, Carshalton Mondays 10 a.m. 2nd Monday in month 5.80 p.m. 28 DAY NURSERIES. The first day nursery for the district was opened on November 9th, 1942, at Middleton Road. The building is a prefabricated hut consisting of reinforced concrete uprights to which are bolted slabs made of sawdust. The walls are lined internally with fibre board nailed direct to the slabs, and the internal partitions are of hollow tiled blocks flush pointed both sides and distempered to match the remainder of the building. The floor covering is of linoleum stuck to the oversite concrete with the exception of the ablution rooms, where a patent jointless floor is laid. The roof is of corrugated asbestos cement sheets with flat asbestos cement sheet lining. Water heating is by means of a thermostatically controlled three section "Rex" gas fired boiler with a hundred gallon storage cistern. The heating of the nurseries is by means of slow combustion stoves supplied by the Ministry, but in addition, 1 k.w. electric reflector fires are fixed at eaves level in the ablution rooms and corridors. They are fitted in the nurse»ies also, for the rapid warming of rooms in winter and for use if needed in the morning and evening, when fires are not needed throughout the remainder of the day. Toy cupboards and other fittings are made of asbestos wood sheets ½ inch thick, and the towel compartments (1 for each child) are formed of asbestos cement sheeting. Each compartment is 3 ft. 8 inches wide and 6 inches deep and is provided with 3 hooks for hanging the towel, face flannel and hair brush. The sizes of the nurseries are as follows- Length Width Stoves Electric fires Electric Lighting Points Babies 36' 3" 18' 9½" 2 3 3 Toddlers and Teenies 34' 4½" 18' 9½" 3 6 4 The Second Nursery was opened at the Manor House, Watery Lane, on April 12th, 1943. Suitable rooms were selected for ablution rooms and sanitary appliances fitted. Other rooms are furnished as nurseries, the chief adaptation work in these cases being decoration. The Third Nursery is approaching completeion at High Path. This one also is a prefabricated building, but of different construction from the one at Middleton Road, but similar in lay- 29 out. The building is cruciform in shape and has separate Nurseries for toddlers, tweenies and babies. Length Width Stoves Electric fires Electric Lighting Points Babies 32' 6" 19' 3" 1 4 3 Toddlers 36' 0" 19' 3" 2 5 3 Tweenies 29' 6" 19' 3" 2 3 3 External paving is provided at each nursery at the rate of 25 sq. ft. per child. Air raid shelters are constructed of reinforced brickwork with a reinforced concrete roof. HOSPITALS. Smallpox. The Surrey County Isolation Hospital, Clandon—accommodation 28 beds. These premises form the hospital provision for smallpox for the whole of the administrative County of Surrey, and is administered as a County service. No cases were admitted from this district during the years 1940/41/42. 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. This hospital suffered a reduction in accommodation owing to the discontinuance of a cubicle block which reduced the available accommodation under war conditions, to 122 beds. In addition to a numerical reduction in beds this is liable to impose a special strain on isolation facilities. Another factor governing hospital accommodation which has operated to the disadvantage of the Wandle Valley Isolation Hospital has been the shortage of nursing staff. Even under these difficulties however the hospital has maintained its previous service. One ward has been altered to provide for admission of 10 cases of Typhus, in the event of an outbreak of that disease, and arrangements for the delousing and cleansing of contacts for the district has also been provided at the hospital. In 1940, 147 infectious eases were admitted from this district, compared with 144 in the year before. In 1941, 154 cases and in 1942, 247 cases were admitted from this district. General and Maternity. 1. The Nelson Hospital for Wimbledon, Merton and District. The Bed Complement at this hospital is now termed as 100 Casualty Beds (with permission to use these for Civilian sick patients) plus 21 maternity beds (reserved for civilian patients only). 30 The following information relating to the hospital's activities during the years under review is supplied by the courtesy of the Secretary:— (a) General Medical and Surgical Treatment— 1940 1941 1942 Total in-patients admitted 1,258 1,333 1,512 Number from Merton and Morden 422 583 617 Total number of new out-patients 5,677 5,910 7,644 Number from Merton and Morden 2,494 2,311 3,076 (b) Maternity Services. Number of patients admitted from all districts during the year:— (1) General Wards 295 265 292 (2) Private Wards 111 95 140 406 360 432 Number of patients admitted from Merton and Morden:- (1) General Wards 188 170 154 (2) Private Wards 68 49 62 256 219 216 The Anti-Tuberculosis Scheme in this district is administered by the County Council. Institutional treatment was provided for 92 persons in 1940, 75 persons in 1941 and 108 persons in 1942, from Merton and Morden, as follows:— 1940 1941 1942 At the Countv Sanatorium, Milford 34 21 20 At other Institutions 58 54 88 92 75 108 1940. The deaths from tuberculosis number 42, of which 36 were due to pulmonary and 6 to non-pulmonary disease. 1941. The deaths from tuberculosis number 46, of which 42 were due to pulmonary and 4 to non-pulmonary disease. 1942. The deaths from tuberculosis number 46, of which 44 were due to pulmonary and 2 to non-pulmonary disease. 31 The deaths are classified by age and sex in the undermentioned table:— TABLE V. DEATHS DUE TO TUBERCULOSIS, 1940, 1941, 1942. Ages Years. Pulmonary. Non-Pulmonary. TOTALS. Males. Females. Males. Females. 40 41 42 40 41 42 40 41 42 40 41 42 40 41 42 0— — — — — - 1 — - — 1 — — — — 1 1— — — — — — — — 1 1 — 1 - 1 2 1 5— — — 1 '— 1 — 2 — — — — — 2 1 1 15— 5 5 3 1 3 6 — 1 — — 1 - 6 10 9 25— 4 7 1 7 2 6 — — — — — — 11 9 7 35— 5 6 8 3 2 4 — - — — — — 8 8 12 45— 1 5 4 5 1 1 - — — — - 6 6 5 55— 4 5 3 1 2 — — — — - — 5 7 3 65— 1 2 4 2 1 2 — 1 — - - 3 3 7 Totals 20 30 24 19 12 20 2 2 2 1 2 — 42 46 46 1940. Four deaths were in unnotified cases. The district provides a free service for the examination of sputum for tubercle bacilli. During the year 100 specimens were examined with a positive result in 11 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. 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 32 at Milford constitutes the main institutional provision, and 34 persons were admitted from Merton and Morden during the year 1940, whilst 58 other patients received treatment in other Institutions under the Scheme. In 1941, 21 persons were admitted from Merton and Morden, whilst 54 other patients received treatment in other Institutions. TABLE VI. CASES ADMITTED TO THE WANDLE VALLEY ISOLATION HOSPITAL DURING THE YEARS 1940—1941—1942. MERTON AND MORDEN CASES DEATHS 1910 1941 1942 1940 1941 1942 Diphtheria 18 24 12 1 — 1 Scarlet Fever 81 70 174 — — 1 Typhoid 3 6 — — — — Erysipelas 3 2 2 — — — Other Diseases Tonsilitis 1 — 9 — — - Measles 17 11 14 — — — Influenza 4 4 — — — Whooping Cough 2 20 6 — *1 — Rubella 2 1 5 — — — Pneumonia 1 2 — 1 — — Septicaemia 1 2 — 1 — — Meningitis 7 12 9 2 2 3 T.B. Meningitis 1 — 1 1 — 1 Chicken Pox 2 — 1 — — — Boils in Ear — - — — — — Ulcerated Mouth — — — — — — Dermatitis (inc. Scabies) — — — — — — Puerperal Fever 2 2 5 — — 1 Cellulitis of Limb 1 — — **1 — — Admitted with mother 1 — — — — — Abscesses and Septic Sores — — — — — — Poliomyelitis — 2 2 — - — Enteritis — — 2 — - — Heat Rash — — — — - — * Death Whooping Cough with Convulsions. ** Cellulitis of Arm and Cerebral Embolus. 33 TABLE VII. Attendances at Maternity Clinics, 1940—1941—1942. Centre No. on Register Attendances Sessions Primary Total 40 41 42 40 41 42 40 41 42 40 41 42 Grand Drive Ante-Natal 37 187 842 22 161 194 85 687 1036 11 49 56 Post-Natal 2 41 56 2 41 — 2 41 56 — - — Individuals 39 228 898 24 202 194 87 728 1092 - — — Morden Ante-Natal 245 242 863 188 195 194 1031 937 957 61 51 56 Post-Natal 75 45 47 1 45 — 79 45 47 — — — Individuals 320 287 910 189 240 194 1110 982 1004 — — — Raynes Pare Ante-Natal 249 — — 170 — — 1086 — — 81 — — Post-Natal 74 - - - - - 81 — — — - — Individuals 823 — - 170 - — 1167 — — — — — Blakesley House Ante-Natal — 134 626 — 104 143 — 529 769 — 49 51 Post-Natnl — 32 30 — 33 — — 33 30 — — — Individuals - 166 656 — 137 143 — 562 799 — — — All Centres Ante-Natal 531 563 2331 380 460 531 2202 2153 1762 153 146 163 Post-Natal 151 118 133 3 129 — 162 119 153 — — — Individuals 682 681 2464 383 589 531 2364 2272 1995| - — — (A primary post-natal visit is the visit of a post-natal woman who has not attended previously either ante-natally or postnatally, so that the figures for primary attendances of individuals represent the number of new cases during the years under review. 34 TABLE VIII. Attendances at Infant Consultation Clinics—1940, 1941, 1942. Centre No. on Register Attendances Sessions Average Attendances per Session *Primary Total 40 41 42 40 41 42 1940 1941 1942 40 41 42 1940 1941 1942 Morden Under 1 yr. 742 730 709 221 234 194 2338 2548 2644 101 107 153 42.0 44.0 - 1-5 years — — — 9U 71 52 1907 2163 1994 - - - - - - Riynes Park Under 1 yr. 968 258 382 284 71 129 3906 878 1676 205 42 62 31.5 44.0 1-5 years - - — 95 32 30 2562 870 1526 - - — - — Grand Drive Under 1 yr — 875 972 — 269 300 — 3740 4574 — 114 149 — 63.2 1-5 years - — — — - — — - — - - — — — Blakeslev House Under 1 yr. — 582 578 — 171 178 — 1785 2272 - 112 105 — 37.4 1-5 years — — — — 100 53 — 2135 2221 - - — — — Merton Under 1 yr. 267 — 90 53 — 39 837 - 402 66 - 28 28.2 — 1-5 years — - — — — — — - — - - — — — All Centres Under 1 yr. 2614 2445 2731 705 745 840 9896 8951 11568 485 375 492 42.6 47.88 1-5 years 269 342 276 7359 863C 9910 — - - - - * Excluding children known to have attended other Centres. TABLE IX. Attendances at all Centres over last 10 Years. Year No. of Infants attending daring year No. of Women attending Maternity Clinics ATTENDANCES Grand Total Infants Maternity Primary under 1 yr. Total 1933 1,863 220 825 18,724 540 19,264 1934 1,880 233 545 17,994 590 18,584 1935 1,936 253 554 18,800 622 19,422 1936 2,010 306 561 19,957 1,106 21,063 1937 2,250 358 569 20,422 1,450 21,872 1938 2,800 469 750 25,235 2,127 27,362 1939 3,090 588 856 24,376 2,395 26'771 1940 2,614 668 705 17,255 2,364 19,619 1941 2,445 595 745 17,955 2,272 20,227 1942 2,731 774 840 21,478 1,341 27,164 35 TABLE X. Number of Children under One Year and Expectant Mothers attending the Centres in relation to the Registered Births. Year Registered births Infants under 1 year Mothers who attended either Ante-Natally or Post-Natally. Primary attendances J Percentage of registered births Number attended Percentage of registered births 1926 333 124 37 1927 352 168 46 1928 392 386 98 50 12.7 1929 442 394 89 44 9.9 1930 452 446 98 49 10.8 1931 628 1,030 164 190 30.3 1932 770 1,089 141 245 31.8 1933 640 825 128 220 34.3 1934 770 545 70 233 30.2 1935 721 554 77 253 35.0 1936 789 561 71 306 39.0 1937 812 569 70 358 44.0 1938 990 750 75 469 47.3 1939 1,005 856 85 588 58.5 1940 971 705 73 668 68.8 1941 848 745 86 635 75.0 1942 1,069 940 87 774 72.0 The Nelson Hospital Clinics. A maternity clinic is held at the Nelson Hospital every Tuesday afternoon for the antenatal and post-natal examination of women who have hooked 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. The Clinic is held subject to the following conditions:— (1) The clinic is primarily for children up to the age of one year born in the hospital, and their mothers. (2) Others may attend on the recommendation of their usual medical attendant or the Medical Officer of Health for the district. (3) The clinic is as nearly as possible for consultative purposes only. The hospital is a voluntary organisation serving Wimbledon and Merton and Morden district. The following information kindly supplied by the Secretary indicates the work of the 36 hospital Clinics during 1940, 1941 and 1942. The following table shows the accommodation used by mothers in the district for the years under review. 1940. 1941. 1942. Nelson Hospital 256 219 216 Kingston County Hospital 9 17 20 St. Helier's Hospital 9 — 22 Other hospitals - 10 9 274 246 267 Infant Clinic:— From Merton and Morden. 1940. 1941. 1942. (a) Total number of attendances at the Infant Clinic during the years under review (1) By children under one year of age - - 701* (2) By children between the ages of one and five years 7 - - (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 84 51 51 (2) Between the ages of one and five years 2 - Nil (c) Total number of children under five 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 79 50 50 (2) Over one year of age 7 1 1 Ante-Natal and Post-Natal Clinic—- Ante-natal. Post-natal. 1940. 1941. 1942. 1940. 1941. 1942. (a) Total number of attendances at the Clinics during the year 175 172 1,720* 83 100 205* (b) Total number of women who attended at the Clinics during the year — — 172 — — 100 *All districts. 37 The number of visits made for various purposes was as shown below:— 1940. 1941. 1942. To expectant mothers— first visits 330 423 461 total visits 480 730 759 To children under one year— first visits 957 810 904 total visits 2,107 2,494 2,731 To children 1-5 yrs.— total visits 3,834 5,575 5,038 Visits re puerperal pyrexia, ophthalmia and miscellaneous 435 299 243 Visits to foster children re Child Life Protection 145 200 207 7,001 9,298 8,978 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. 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. In 1940 the Nelson Hospital admitted 256 Maternity cases from the Urban district and in 1941 219, and 216 in 1942. Complicated cases which were prior to the war accommodated at Queen Charlotte Hospital, London, by arrangement with that hospital, can now be treated in this district. The opening of the Maternity block at St. Helier's Hospital has improved the obstetric facilities in the district very considerably. Emergency Maternity Unit. There was no call made on this unit during the years under review. Consultant Service. A specialist's opinion may be had in cases of obstructed labour, emergencies of pregnancy, or puerperal pyrexia. Home Helps. Domestic assistance may be provided for expectant and nursing mothers with limited means, during confinement or whilst away from home undergoing treatment. The usual period for which this help is supplied during confinement is fourteen days. The number of Helps provided in 1940 was 25, 1941 was 24, and in 1942 the number was 24. Sterilised Maternity Outfits. Sterile outfits in sealed containers for use at confinements may be had from the Welfare 38 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. 1940. Forty-four outfits were supplied, 37 at cost price, six at half price and one free. 1941. One hundred and thirty-five outfits were supplied 129 at cost price, and six free of cost. 1942. Sixty-three outfits were supplied, 50 at cost price, two at half price, and one free of cost. Dental Scheme. There was a slight decrease in the work of the dental clinics during the years 1940 and 1941. 1942, however, showed an increase of attendances. TABLE XI. Attendances at Dental Clinics during 1940, 1941, 1942. Cases referred from— Number who attended during year Number of Attendances made 1940 1941 1942 1940 1941 1942 MERTON Mothers 7 - 1 12 - 1 Children 12 — 1 31 — 2 Individuals 19 — 2 43 - 3 MORDEN Mothers 92 66 298 291 301 302 Children 68 50 76 136 122 77 Individuals 160 116 374 427 423 379 RAYNES PARK Mothers 78 2 26 267 19 34 Children 54 13 25 151 39 29 Individuals 132 39 51 418 58 63 GRAND DRIVE Mothers - 50 175 - 155 182 Children — 38 92 — 81 91 Individuals — 88 267 - 336 273 BLAKESLEY HOUSE Mothers - 61 208 - 229 229 Children - 28 66 — 80 74 Individuals — 89 274 — 309 303 ALL CENTRES Mothers 177 179 708 570 706 748 Children 134 129 261 318 322 273 Individuals 311 308 969 888 1026 1021 39 The dental operations performed were as follows:— TABLE XII. DENTAL SCHEME, 1940/41/42—OPERATIONS PERFORMED. 1940 1941 1942 Extractions. Temporary teeth 354 406 322 Permanent teeth 481 491 644 Fillings. Temporary teeth 125 73 82 Permanent teeth 101 148 118 Dentures Supplied. No. of cases 61 111 109 No. of Local AnÆsthetics Given 18 30 26 No. of Gases Given 213 214 227 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 years under review:— Cases conducted: Primip, Multip. Total. 1940. 1941. 1942. 1940. 1941. 1942. 1940. 1941. 1942. (a) As midwife Live 11 19 16 67 57 51 78 76 67 Still — — — 2 1 3 2 1 3 (b) As maternity nurse —Live 3 6 7 7 2 7 10 8 14 Still 1 — — 1 — — 2 — — 15 25 23 77 60 61 92 85 84 Visits made: 1940. 1941. 1942. By midwife Ante-Natal 472 421 583 During confinement 1,714 1,552 1,572 To midwife Ante-Natal 154 97 70 Post-Natal 112 48 20 2,452 2,118 2,245 40 Medical Aid Forms Sent:—1940—30; 1941—32; 1942—21. Reasons for sending:— 1940 1941 1942 Phimosis — 1 — Discharging eyes 7 - — Rupture of Perineum 7 7 6 Phlebitis 5 — — Feebleness at birth 4 — — Puerperal Pyrexia 1 — — Bronchitis 1 — — Pemphigus 1 1 — Heart attack 1 — — Rash on mother and infant 1 2 1 Partially retained placenta 1 — 1 Secondary Uterine inertia 1 2 1 Uterine inertia — 2 - Weak general condition and hysteria - 1 - Laceration of perineum — 1 — Prolonged secondary stage — 2 1 Breech in Primipera — 1 1 Abdominal pain — 1 — Sticky eye — 3 — Obstructed labour — 1 — Face presentation — 1 — Asphyxia — 2 — P.P.H. — 1 1 Percentage of total midwife's cases which attended the Council's ante-natal clinics 100% 100% 100% According to notices received by the Council (County) 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 practises part-time in Merton and Morden. Voluntary Helpers. As in previous years the Welfare Centres had the valuable assistance of voluntary helpers during the period under review. Changes in the personnel from time to time are inevitable, but a substantial proportion of our present helpers have given their time and energy uninter- 41 ruptedly week in and week out for many years in the service of the mothers and children in the district. 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 years under review:— 1940 1941 1942 Registered homes under supervision during the year 40 24 19 Registered homes under supervision at end of year 14 16 10 New homes registered during the year 10 8 9 Children on the Register at the end of the year 15 17 15 Children brought on to the register during the year 19 20 15 Children removed out of the district 18 20 12 Visits paid to nurse children 145 219 207 Children died during the year Nil Nil Nil Legal proceedings Nil Nil Nil 42 SECTION C.—SANITARY CIRCUMSTANCES. Water Supply. The district is supplied by the Metropolitan Water Board and by the Sutton District Water Company. Their respective distributive areas are approximately the parishes of Merton and Morden. The supply of the Metropolitan Water Board is only sampled infrequently as a routine otherwise samples are taken when circumstances indicate the necessity for local investigation. The Board supplies copies of their official minutes in which the results of their examinations are recorded. Routine examination of the Sutton District Water Company's supply is undertaken by the Authorities in the supply area upon an agreed rota which provides for bacteriological and chemical samples each month. The Company in addition to the daily examinations undertaken by their own full-time Chemist arrange for Consulting Chemists to undertake monthly examinations. Copies of the reports of these Consulting Chemists are received by local Medical Officers of Health whilst the records of the Company's own analysis are available for inspection by the Medical Officers. The 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 staffs of the factories at which they are situated with drinking water. Drawn from beneath the London clay, both these well waters are of a high degree of organic purity. Drainage and Sewerage. 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 1939. This work, in conjunction with other improvements carried out down stream, has been effectual in relieving the surcharge of this waterway. No alterations were carried out during the years under review. 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. The collection and disposal of house refuse throughout the district is presenting much difficulty because of the shortage of staff, but with the reduction of collection from a week to two weeks, the problem of collection has been mainly overcome. Much of the former contents of 43 dustbins is salvaged in other ways, leaving the bins in ah almost innocuous state. The Salvage Works have been maintained in a good state of efficiency, some women now being employed. The salvage tonnage for the years 1941 and 1942 was as follows:— Tonnage. 1941 1942 Paper 365 642 Metals 522 779 Pig Food 661 814 Bottles and Glass 179 177 Rags 30 26 No new vehicles have been purchased, but a re-conditioned lorry was purchased in 1942. REPORT OF THE CHIEF SANITARY INSPECTOR. Mr. Chairman, Ladies and Gentlemen, I beg to submit an abbreviated Annual Report which summarises the work carried out by your Sanitary Inspectors during the years 1940/1941/1942. It should be recorded that the Chief Sanitary Inspector was seconded to the Fire Brigade Service from the outbreak of war and continued to act as Chief Officer until the end of December, 1941. Housing Inspections. The total number of houses inspected during the two years for "Sanitary Defects " under the Public Health and Housing Acts was:— 1940 1941 1942 375 418 407 Action taken in connection with defective dwellinghouses is set out on page 55. Notices specifying the necessary work required to remedy sanitary defects were served upon owners of properties as follows:— 1940 1941 1942 Intimation Notices 191 190 214 Statutory Notices:— Public Health Acts 16 26 17 Housing Act, 1936 1 9 — Eradication of Bed-bugs. Twenty-eight houses in 1940, twenty in 1941 and twenty in 1942 were found on inspection 44 to be infested with bed-bugs, and are classified as follows in accordance with the requirements of the Ministry's Circular:—• 1940 1941 1942 Council Houses 12 13 12 Other Houses 16 7 13 Total 28 20 25 In 1940, of the 28 houses infested, 21 were treated by spraying with "Vermicine," 1 by fumigation with "Cimex," 5 by fumigation with sulphur-dioxide together with the use of blow-lamps, and one house was treated with hydrogen cyanide gas. In 1941, of the 20 houses infested, 17 were treated by spraying with "Vermicine," 2 by fumigation with sulphurdioxide together with the use of blow-lamps, and one house was treated with hydrogen cyanide gas. In 1942, of the 25 houses infested, 22 were treated by spraying with "Vermicine," 1 by fumigation with siilphurdioxide together with the use of blow-lamps, and two houses treated with hydrogen cyanide gas. Drainage Work. 1940. At 14 houses the drainage systems were entirely reconstructed, and at 32 houses extensive repairs to drains were carried out. Smoke and water tests were applied to the drains of houses in 45 instances and obstructions were removed from drains at 94 houses. 1941. At 10 houses the drainage systems were entirely reconstructed, and at 42 houses extensive repairs to drains were carried out. Smoke and water tests were applied to the drains of houses in 67 instances and obstructions were removed from drains at 152 houses. 1942. At 5 houses the drainage systems were entirely reconstructed and at 31 houses extensive repairs to drains were carried out. Smoke and water, tests were applied to the drains of houses in 65 instances and obstructions were removed from drains at 104 houses. Food Supply. The total number of inspections made to premises where articles of food are prepared or exposed for sale was 1940—875; 1941—1,083; 1942—924. Two infringements of the Public Health (Meat) Regulations 1924, were discovered in 1940, five in 1941 and two in 1942. These were remedied. Improvements in Sanitary conditions were effected to 39 premises in 1941 and 19 in 1942. Unsound Food. The undermentioned articles of food were found, upon inspection, to be unfit for human consumption; 45 were surrendered and disposed of either for animal feeding or salvage:— 1940 Description. Cause of Condemnation. Beef—8 lbs. Bone taint Beef—87½ lbs. Decomposition Beef and Lamb—476 lbs. ” Lamb—3 carcases 120 lbs. ” Lamb—2 joints 4½ lbs. ” Mutton—17½ lbs. ” Mutton—1 leg 5 lbs. ” Sheeps Heads—21 Putrefaction Ox Sweetbreads—29½ lbs. Decomposition Pork—52 lbs. ” Pork—16½ lbs. Tuberculosis Cooked 11 am—28 lbs. Unsound Rabbits—72 ” Turkeys—8 Decomposition Fillet Haddock—8 stones Unsound Dog Fish—6 stones ” Dog Fish—2½ stones ” Cod Fillets—4 stones ” Herrings—3½ stones ” Savoy Cabbages—5 bags ” Tomatoes—6 lbs. ” Pineapple—957 tins ” Grapes—11 lbs. ” Sweets—10 lbs. ” Jam—7 lbs. ” Marmalade—2 lbs. ” Sauce—1 bottle ” At 30 premises sanitary improvements were effected. 1941 Description. Cause of Condemnation. Canadian Eggs—67 Unsound Frozen Eggs—30 lbs. ” Milk—12 tins ” Jam and Marmalade—48 lbs. ” Rabbits—847 lbs. Decomposition English Rabbits—288 ” Ox Liver—10½ lbs. Cysts Coal Fish—7 stone Unsound Corned Beef—38 tins ” Corned Beef—254 6-lb. tins ” Cod Fish—2 stone ” Cod Fillets—10 lbs. ” Smoked Bacon—14½ lbs. ” 46 UNSOUND FOOD—1941. Description. Cause of Condemnation. Bacon—4¾lbs. Bone taint Soup—15 tins Unsound Sardines—79 tins ” Meat Pies—4½ doz. ” Pork Sausage—28 lbs. ” Salmon—316 tins ” Herrings—11 tins ” Witch Soles—2 stone ” Pig's Kidney—1 ” Pineapple—936 tins ” 1942 Description. Cause of Condemnation. Beef—130½ lbs. Tuberculosis Baked Beans—333 Tins Unsound Butter—5½ lbs. ” Corned Beef—57 Tins ” Cheese—65 lbs. ” Calf's Head—1 Decomposition Carrots—28 Tins Unsound Cod—10 stone ” Eggs—60 ” Ham—43 Tins ” Herrings—17 Tins ” Luncheon Meat—17 Tins ” Luncheon Pork—50 Tins ” Margarine—6 lbs. ” Mackerel—21 Tins ” Milk—527 Tins ” Peas—302 Tins ” Pineapple—159 Tins ” Pilchards—60 Tins ” Plums—675 Tins ” Peaches—72 Tins ” Salmon—42 Tins ” Soups—71 Tins ” Sausage Meat—81 Tins ” Sago—2 cwts. ” Lamb—1 carcase 24 lbs. Decomposition Pig—1 carcase 40 lbs. Tuberculosis Tomatoes—68 Tins Unsound Meat Inspection. The establishment of central abattoir schemes since the war has resulted in practically all meat coming into the district from wholesale markets outside the district. 47 No cattle, cows, calves or sheep have been slaughtered in the district during the years under review. The following figures show the number of pigs slaughtered and inspected PIG CARCASES INSPECTED. Number fit for Number killed. Number inspected. human consumption. 1940 17 17 17 1941 14 14 14 1942 45 45 45 Milk Supply. At the 31st December, 1942, only one cowkeeper remained on the register, providing accommodation for about 50 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 1940 was 65, including 22 retailers whose premises are situated in adjoining districts. In 1941 the number of retail purveyors was 61, including 10 retailors. One hundred and six inspections were made to cowsheds, dairies and milkshops during 1940, and one hundred and four during the year 1941, and one hundred and nine during 1942. the following samples of milk were submitted for bacteriological examination during the years under review:— RESULTS OF ANALYSES OF NEW MILK SAMPLES. 1940 . Solids not Fat (Legal Standard is 8.5%). 8.2 8.3 8.35 8.4 8.45 8.5 8.6 8.7 8.8 8.9 9.0 9.1 Total l l — — — 3 10 15 3 1 - — 34 Milk Fat (Legal Standard is 3.0%). 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3 8 3.9 4.0 Total l 1 3 4 8 9 1 2 2 1 2 34 48 RESULTS OF ANALYSES OF NEW MILK SAMPLES. 1941 Solids not Fat (Legal Standard is 8.5%). 8.0 8.1 8.2 8.3 8 4 8.5 8,6 8.7 8 8 8.9 9.0 9.1 Total — — — 1 1 — 4 9 11 8 8 - 42 Milk Fat (Legal Standard is 3.0%). 3.2 3.3 3.4 3.5 3.6 3.7 3 8 3.9 4.0 4.1 Total 7 3 7 6 6 3 3 1 5 1 42 RESULT OF ANALYSES OF NEW MILK SAMPLES. 1942 Solids not Fat (Legal standard is 8.5%). 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 9.0 9.1 9 2 Total — — — 1 1 1 6 7 8 4 1 — — 29 Milk Fat (Legal standard is 3.0%). 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 4.1 4.2 Total l 3 3 5 3 4 5 2 — — 3 29 1940 18 1941 33 — One sample of pasteurised milk was reported unsatisfactory, the total bacteria counts exceeding the prescribed standard, and two samples failed to pass the phosphatase test. 1942 18 — One sample of pasteurised milk was reported unsatisfactory, the total bacteria counts exceeding the prescribed standard, and one sample failed to pass the phosphatase test. Twenty-three licenses were granted in 1940, twenty-two in 1941, and twenty-one in 1942, to dealers under the Milk (Special Designations) Order, 1936. 49 Food and Drugs Act, 1938. The following tables show the number and nature of the samples submitted to the Public Analyst during 1940/41/42:— SUMMARY OF SAMPLES. 1940 Article. Total Samples. Genuine. , Not Genuine. Cautions. New Milk 34 32 2 2 Aspirin Tablets 2 2 - — Baking Powder 2 2 - — Cheese 7 7 - — Coffee 5 5 - - Cooking Fat 2 2 - — Cream 1 1 - — Egg Powder 1 1 - — Egg Substitute Powder 1 1 — Flour (Self-Raising) 5 5 - — Ginger Beer 1 1 - — Jam 1 1 - — Laird 2 2 - - Lime Juice and Soda 1 1 - — Margarine 5 5 - — Marmalade 1 1 - — Oatmeal 1 1 - - Paste—Fish 2 2 - - Paste—Meat 2 2 - - Pearl Barley 2 2 - — Quinine, Tincture of 2 2 - — Rice 1 1 - — Sago 1 1 - — Sausages—Beef 8 8 - — Sausages—Pork 6 6 - — Suet—Beef 2 1 1 1 Sweets (Boiled) 1 1 - - Vinegar 2 2 — — Total 101 98 3 3 50 SUMMARY OF SAMPLES. 1941 Article. Total Samples. Genuine. Not Genuine. Cautions. New Milk 41 39 2 2 Milk (Sterilised) 1 1 - - Baking Powder 2 2 - — Beef Suet 3 3 - - Beer 3 3 - - Coffee 3 3 - - Cake Flour 2 2 - - Camphorated Oil 2 2 - - Cheese (Grated) 1 1 - - Cornflour 1 1 - - Custard Powder 1 1 - - Extract of Cascara 1 1 - - Flour 1 1 - - Gin 2 2 - - Ginger Wine 1 1 - - Ice Cream 1 1 - - Mineral Water 4 3 1 1 Malt Vinegar 1 1 - - Meat Paste 2 2 - - Orange Powder 2 - 2 (Stocks withdrawn) Rice (Ground) 1 1 — - Sausage (Beef) 2 2 - - Sausage (Pork) 2 2 - - Sausage 2 2 - - Sausage Meat 2 2 - - Sardines 1 1 - - Sponge Cakes 1 1 — - Tapioca 1 1 - - Tine. Iodine 1 1 - Tine. Quinine 1 1 - - Vi-Cocoa 1 1 - - Whisky 2 2 - - Worcester Sauce 1 1 — — Total 93 88 5 3 51 SUMMARY OP SAMPLES. 1942 Article. Total Samples. Genuine. Not Genuine. Cautions, New Milk 29 27 2 2 Aspro 1 1 — - Asprin Tablets 1 1 - — Baking Powder 1 1 - — Bisnuthated Magnesia 1 1 - — Butter 5 4 1 1 Beef Sausage Meat 6 6 - - Cheese 2 2 - — Custard Powder 2 2 - — Castor Oil 1 1 — — Cinnamon and Quinine 1 1 — — Chicken and Ham Paste 2 2 - - Coffee 2 2 - - Egg Substitute 3 3 — - Dried Milk 1 1 - - Flavoured Cordials 3 3 - - Fish, paste 6 6 — - Glissa-Rene 1 1 — - Halibut Liver Oil Syrup 1 1 - - Lard 1 1 — - Lemonade powder 1 1 — - Lemon Barley Water 1 1 — - Lemon Curd 1 1 — - Liver Pills 1 1 — - Margarine 5 5 — - Meat Roll 1 1 — - Meat Paste 1 1 - - Meat Extract 1 1 - - Mustard Pickle 1 1 - - Mustard 2 - 2 - Pork Luncheon Meat 1 1 — - Pancake Mixture 1 1 — - Pepper 1 1 — - Jam 3 3 - - Sponge Mixture 1 1 — - Sultanas 1 1 - - Saccharine Tablets 3 3 - - Saccharine Elixir 1 1 — - Sweetened Cake Flour l 1 - - Self Raising Flour Real Egg 1 - 1 - Soda and Mint Tablets 1 1 - - Vinegar 4 3 1 1 Dried Apple Rings 1 1 - - Zinc Ointment 1 1 — - 106 99 7 4 52 Scheme—Gas Contaminated Foodstuffs. In accordance with the Ministry of Food's Circular M.F.G.4 arrangements were made early in 1941 to recruit and train about 40 parttime volunteers from the food trades. During the year a number of practical demonstrations and routine exercises were carried out by the trained personnel. The Deputy Chief Sanitary Inspector was appointed as Gas Contamination Officer and under the general direction of the Medical Officer of Health is primarily responsible for the operation of the scheme, with two qualified Meat and Food Inspectors to assist. The food traders in the district have willingly co-operated and it is to their enthusiasm and voluntary efforts that a comprehensive Food Treatment Service has been established. Factories. The number of inspections made to premises registered under the Factories Act was: 1940 — 280, 1941—278; 1942—418. Defects relating to Sanitary conveniences, ventilation and other sanitary matters were dealt with at 38 premises for 1940, 27 in 1941, and 29 in 1942. Smoke Abatement. During the year 1940, 21 observations were made of factory chimneys for the purpose of prevention or detection of "Smoke Nuisances." At two factories smoke was found to be emitted in excess quantities. Notices to abate the nuisances were served, and in each ease the necessary improvements were carried out to prevent further nuisances. A bye-law regulating the emission of smoke was adopted by the Council in 1930. Water Supply. Six samples of water from domestic taps were taken in the year 1941 and submitted for chemical or bacteriological examination, and seven in 1942. The report on each sample was satisfactory. Watercourses. Inspections are made of the River Wandle and its tributaries for the purpose of detecting pollutions, and samples obtained and sent for chemical analysis. Where pollutions are discovered arising from trade effluents the necessary steps are taken to remedy these conditions. Mosquitoes. A large number of complaints were received from residents, and paraffin spraying of ditches and stagnant ponds was carried out. A.R.P. Shelters. Inspections were made of trench and surface shelters by the Sanitary Inspectors and particular attention was paid to conditions such as ventilation, dampness, flooding, cleanliness and sanitary conveniences. 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 53 authority. The number of premises found to be rat infested in 1940 was 92 and a total of 573 inspections were made. During 1941 the number of premises found to be rat infested was 63, and a total of 593 inspections were made. In 1942, the number of premises was 72 and the inspections made 553. Shops Acts, 1912-1936. The following statement summarises the inspections made, the infringements discovered and other matters dealt with during the years 1940/41/42:— 1940 1941 1942 No. of Inspections:—Day visits 693 211 280 Evening visits 14 2 — (1) Evening closing hours 3 — — (2) Half-day closing 4 2 1 (3) Hours of employment for "young persons" 7 4 - (4) Seats not provided for females — — — (5) Prescribed notices not correst or or exhibited 90 51 52 (6) Sanitary arrangements unsatisfactory - - - (7) Reasonable temperature not maintained 26 11 — Summary of Sanitary Inspections, 1941/1942:— 1941 1942 Housing—Primary visits 418 407 Re-inspections—work in progress 1,001 1,201 Re-Overcrowding 40 83 Miscellaneous, housing- 164 196 Drainage work 916 988 Factories 278 418 Stables and Piggeries 110 61 Rats and Mice Destruction 592 553 Enquiries, infectious diseases 158 — „ contacts, infectious diseases 75 72 Visits to schools 7 5 Re-disinfections 237 — Smoke abatement 26 12 Food Shops, etc. 1,083 924 Milk Supply 104 109 Rivers and Streams, pollutions 87 138 Complaints, investigated 395 422 Miscellaneous 954 1,015 I am, Ladies and Gentlemen, Your obedient Servant, J. B. POINTON, 10th March, 1943. Chief Sanitary Inspector. 54 SECTION D—HOUSING. 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 for the years 1940/41/42:— 1940 19-11 1942 (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 375 418 407 (b) Number of inspections made for the purpose 375 418 407 (2) (a) Number of dwellinghouses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 - - - (b) Number of inspections made for the purpose - - - (3) Number of dwellinghouses found to be in a state so dangerous or injurious to health as to be unfit for human habitation - - - (4) Number of dwellinghouses (exclusive of those referred to under the preceding sub-head) found not to be in all respects resonably fit for human habitation 191 172 214 2. Remedy of Defects during the years 1940/41/42, Service of formal Notices:— Number of defective dwellinghouses rendered fit in consequence of informal action by the Local Authority or their officers 154 147 187 55 3. Action under Statutory Powers during the years 1940/41/42:— A.—Proceedings under Section 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwellinghouses in respect of which notices were served requiring repairs 1 9 - (2) Number of dwellinghouses which were rendered fit after service of formal notices:— (a) By owners 1 9 — (b) By local authority in default of owners - - - B.—Proceedings under Public Health Acts:— (1) Number of dwellinghouses in respect of which notices were served requiring defects to be remedied 16 26 17 (2) Number of dwellinghouses in which defects were remedied after service of formal notices:— (a) By owners 14 24 15 (b) By local authority in default of owners - - - C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwellinghouses in respect of which Demolition Orders were made - - - (2) Number of dwellinghouses demolished in pursuance of Demolition Orders - - - D.—Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separte tenements or underground rooms in respect of which Closing Orders were made - - - (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit - - - 56 SECTION E—INSPECTION AND SUPERVISION OP FOOD. (See Sanitary Inspector's Report, on page 44). SECTION F—INFECTIOUS ILLNESS. Notification. The following diseases are notifiable in the Urban District:— Cholera. Cerebrospinal 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). Whooping Cough. 57 1940 TABLE XIII. SCARLET FEVER—MONTHLY DISTRIBUTION. 1940 Wards. Abbey. Bushey Mead. Central. | Morden. Park. Ravensbury. Ray nee Park. St. HeLier. West Barnes. Total. January – 1 – 1 2 February – – — – 1 1 – — – 2 March 1 – – – 1 2 April 1 – 1 – 1 – 2 3 1 9 May – 4 – – 1 1 14 – 20 June – – — 2 – 3 2 9 – 16 July – – — 2 1 1 2 2 – 8 August – 1 1 — – – — 1 – 3 September – – 3 3 2 2 — 2 – 11 October – – 2 2 1 2 — 2 – 9 November – – 1 – – 1 – – – 2 December 1 — – — — 1 — 4 1 7 Total 3 1 13 9 6 12 7 38 2 91 Monthly mean .25 .08 1.08 .75 .50 1.0 .58 3.17 .17 7.58 The incidence in the various wards was as follows:— Wards. Cases. Incidence per 1,000 population. Abbey 3 .61 Bus'hey Mead 1 .13 Central 13 1.25 Morden 9 .85 Park 6 .61 Ravensbury 12 1.90 Raynes Park 7 ,99 St. Helier 38 3,20 West Barnes 2 .30 53 1941 TABLE XIII. SCARLET FEVER -MONTHLY DISTRIBUTION. 1941 Wards Abbey Bushey Mead Central Morden Park Ravensbury Raynes Park St. Helier West Barnes Total January — 1 2 4 1 3 – 11 February 1 — — – – 1 – 2 – – March — 1 — — 1 1 – 3 – 6 April 1 — — 2 1 – 1 1 1 7 May 1 2 — 2 – 2 – 1 1 9 June — 1 1 — – 1 – 2 – 5 July 1 1 — 1 1 – – 1 – 5 August — — 1 — 1 – – 6 1 9 September — — 2 — – 1 1 4 – 8 October — 1 – 2 – – – 1 1 5 November — — – 1 – 1 2 2 – December 1 3 — 4 — 2 1 1 1 13 Total 5 10 6 16 5 8 4 27 7 88 Monthly mean The incidence in the various wards was as follows:— Ward Cases Incidence per 1000 population Abbey 5 Bushey Mead 10 Central 6 Morden 16 Park 5 Ravensbury 8 Raynes Park 4 St. Helier 27 West Barnes 7 59 1942 TABLE XIII. SCARLET FEVER—MONTHLY DISTRIBUTION. 1942 Wards A bbey Bushey Mead Central Morden Park Ravensbury Raynes Park St Helier West Barnes Total January 1 2 4 3 1 _ 11 February — 5 2 6 — 1 — 3 2 19 Match — 2 4 9 1 — 2 – 3 21 April 2 — 1 3 3 — 1 2 1 13 May — 1 3 3 3 2 1 — — 13 June 2 — 2 1 1 1 1 1 1 10 July 3 — 3 3 — 3 2 1 1 16 August — — — 2 — — — 2 4 September — 2 2 3 2 — 7 1 5 22 October — 1 10 1 2 1 4 1 4 24 November 1 — 17 — 5 6 5 2 3 39 Dece Tiber 2 2 9 2 3 5 5 4 5 37 Totil 11 15 57 36 21 19 28 17 25 229 Monthly mend The incidence in the various wards was as follows:— Ward Cases Incidence per 1000 population Abbey 11 Bushey Mead 15 Central 57 Morden 36 Park 21 Bavensbury 19 Raynes Park 28 St. Helier 17 West Barnes 25 60 TABLE XIV. INCIDENCE AND FATALITY OF DIPHTHERIA, 1920—1941. Year. Population. No. of cases. Incidence rate per 1,000 population. No. of deaths. Percentage of deaths to cases. 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% 1940 68.540 20 0.29 1 5.0% 1941 64,920 24 — — — 1942 86,590 15 – 1 6.6% TUBERCULOSIS—1940, 1941, 1942. 1940. One hundred and eighteen new cases were added to the register of tuberculous persons compared with 130 in the year before. 1941. One hundred and sixteen new cases were added to the register of tuberculous persons compared with 118 in the year before. 1942. One hundred and fifty-one new cases were added to the register of tuberculous persons compared with 116 in the year before. These additions were:— Males Females Totals 1940 1941 1942 1940 194.1 1942 1940 1941 1942 Pulmonary 61 62 77 33 36 50 94 98 127 NonPulmonary 13 11 7 11 7 17 24 28 24 74 73 84 44 43 67 118 116 151 61 1940. Of these 118, 76 were primary notifications, 38 were transferred from other districts, and 4 came to notice in other ways. 1941. Of these 116, 70 were primary notifications, 43 were transferred from other districts, and 3 came to notice in other ways. 1942. Of these 151, 106 were primary notifications, 36 were transferred from other districts, and 9 came to notice in other ways. During the year 1940, 112 persons were removed from the register; during 1941, 109 persons were removed from the Register and during 1942, 78 persons were removed from the Register, for the following reasons:— 1940 1941 1942 Recovered 17 14 7 Removal from the district 53 49 25 Death 42 46 46 After allowing for the additions and deductions the number remaining on the Register at the 31st December, 1940, 1941 and 1942, was distributed as shown in the following table: TABLE XV. TUBERCULOSIS REGISTER AT 31st DECEMBER, 1940, 1941 and 1942. Wards. Registered at 31st December, 1940, 1941 and 1942, Total. Number on Register. Pulmonary, NonPulmonary. 1940 1941 1942 1940 1941 1942 1940 1941 1942 1940 1941 1942 Abbev 29 28 32 8 6 10 37 34 60 35 31 36 Bushey Mead 45 45 44 9 11 11 54 56 55 51 50 50 Central 29 33 35 9 7 8 38 40 43 36 37 41 Morden 52 58 70 6 6 7 58 64 77 45 59 66 Park 53 56 71 9 11 11 62 67 82 64 61 69 R.avensburv 72 69 74 25 25 26 97 94 100 97 95 97 Paynes Park 36 37 45 4 4 5 40 41 50 41 39 45 St. Helier 89 89 100 22 20 20 111 109 120 118 104 97 West Barnes 37 37 43 12 11 14 49 48 57 48 47 49 Whole district 442 452 514 104 101 110 546 553 550 535 523 550 1941/1942. In the year 1941 three deaths were in unnotified cases, and in 1942 five deaths were in unnotified cases. 62 The district provides a free service for the examination of sputum for tubercle bacilli. During the year 1941, 96 specimens were examined with a positive result in 9 instances, and in the year 1942, 87 specimens were examined with a positive result in 3 instances. During the years 1941 and 1942 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. 63 TABLE XVI. TUBERCULOSIS—New Cases, Age and Sex, Distribution and Manner of Admission to Register, 1940. Age Groups. Primary Notifications (" A "). Case6 transferred from other districts. Casee brought to notice otherwise than by notification and transfer. Total new cases. Years. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. SI F M F M F M F M F M F 0-1 – _ — _ 1-5 — – 1 1 – – — — — — — — 2 5-10 1 – 2 — – – — 1 — — 1 — 5 10-15 1 1 4 — 1 – — — — — — — 7 15-20 7 5 1 2 2 – 1 1 — — — — 19 20-25 5 2 2 1 2 — 1 — — — — 13 25-35 8 9 1 1 8 6 1 2 1 — — — 37 35-45 9 2 – — 6 3 — — 1 1 — — 22 45-55 4 2 — — 2 —- — — — — — — 8 55-65 2 — — — 1 — 1 — – — — — 4 65 up 1 – – – – – – – – – – – 1 Totals 38 21 9 6 21 11 3 5 2 1 1 — 118 74 40 4 64 TABLE XVI. TUBERCULOSIS—New Cases, Age and Sex, Distribution and Manner of Admission to Register, 1941. Age Groups. Primary Notifications ("A"). Oases transferred from other districts. Cases brought to notice otherwise than by notification and transfer. Total new oases. Years. Pulmonary. Non-Pulmonary, Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M F M F M F M F M F M F 0-1 – – 1 – – – – – – – – – 1 1-5 — — 2 1 — — — 1 — — 1 — 5 5-10 — — 1 1 — — 1 — — — — — 3 10-15 3 — 1 1 — — – — — —. — — 5 15-20 7 5 3 1 — 5 — 1 — — — 22 20-25 5 4 – – 7 3 1 — 1 — — — 21 25-35 8 8 — — 9 5 – .— — — — — 30 35-45 5 — — 2 1 1 — 9 45-55 6 1 — — 2 — – — — — 9 55-65 2 2 — — 2 2 — — — — — — 8 65 up 1 – – 1 – 1 – – – – — — 3 Totals 37 20 8 5 s 22 17 2 2 2 — 1 – 116 70 43 3 65 TABLE XV J. TUBERCULOSIS—New Cases, Age and-Sex, Distribution and Manner of Admission to Register, 1942. Age Groups. Primary Notifications ("A"). Oases transferred from other districts. Oases brought to notice otherwise than by notification and transfer. Total new oases. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. Years. M F M F M F M F M F M F 0-1 – 1 – – – – – – – – – – 1 1-5 1 — 2 — 1 4 5-10 1 — 1 — 2 10-15 — 3 1 1 1 – 6 15-20 11 7 — 2 1 1 – – 1 23 20-25 12 8 — 2 2 2 2 – 28 25-35 12 7 1 1 6 12 1 1 41 35-45 11 5 2 3 – – – 1 1 23 45-55 8 3 — 1 1 1 1 – 15 55-65 3 — – 2 – – – – – – – 5 65 up – – — 2 – — — — 1 — 1 — 4 Totals 59 34 4 10 15 16 2 6 3 2 1 – 152 107 39 6 66 INDEX pack Acreage 7 Ambulance Facilities 24 Acute Poliomyelitis 22 Births 11 In hospitals or maternity homes 17 Rates 11-17 Bed Bugs—Eradication of 44 Cancer 12 Deaths from 12 Rate 12-20 Cerebro-Spinal Fever 16 Child Life Protection 42 Clinics and Treatment Centres 25 Climatic Conditions 9 Closet Accommodation 43 Cleansing Stations 13 Deaths 18 Causes of 20-22 Classified causes —by age and sex 18 In each Ward In public institutions Rates Diphtheria 26 Antitoxin used Immunisation 26 Clinics, times and places 27 Children Immunised in Schools 27 Persons Immunised at Clinics 27 Persons Immunised by Private Practitioners Incidence and fatality for 21 years 61 Swabs examined 24 Disinfestation 45 Drainage and Sewerage 43 Drainage work 45 Day Nurseries 29 Enteric Fever 16 Erysipelas 10 67 I N D E X—continued. page Factories 53 Inspections made 58 Defects found and remedied 53 Pood and Drugs Act, 1938 50 Food Supply 45 Inspections 45 Unsound Food 45-46-47 Foodstuffs—Gas Contaminated 53 Health Services 23 Heart Disease 20 Deaths from 20 Hospitals 30 Housing 55 Inspections and Defects 44-55 Number inhabited 8 Verminous premises 44-45 Industry 8 Infant Mortality 12 Bates 12 Infectious diseases 30-57 Diseases notifiable 61-57 Monthly Incidence 62, 63, 64 Notifications, deaths and distribution 14, 15, 16 Inquests 18-19 Isolation Hospital 33 Admissions to 33 Laboratory Facilities 24 Examination of clinical material 24 Maternal Mortality 12 Rates 12 Maternity and Child Welfare 34 Ante-Natal Clinics 34 Attendances at each Centre by age groups 34, 35 Attendances at Infant Consultation Clinics 35 Attendances at Maternity Clinics 34 Attendances at Toddler Clinics 37 Attendances at all Infant Welfare Centres 35 68 IN D E X—continued. t»AGli Maternity and Child Welfare continued— Attendances at Centres over last ten years 35 Attendances in relation to the registered births 36 Committee 4-5 Consultant advice for maternity 36-38 Convalescent Home Treatment 38 Dental Scheme 39 Attendances 39 Operations performed 40 Emergency Maternity Unit 38 Health Visiting 38 Home Helps 38 Hospital provision for maternity 31 Midwives 40 Orthopaedic Treatment 38 Sessions, times and places 26-28 Sterilised Maternity Outfits 38 Voluntary Helpers 41 Work of the Centres 26-28 Meat Inspection 47 Measles 14, 15, 16 Milk Supply 48 Nelson Hospital 30 Notification of Births 14, 15, 16 Nuisances:— Abated 45 Notices served 44 Nursing in the Home 23 Ophthalmia Neonatorum Pneumonia 33 Population 11 Public Assistance 8 Public Cleansing 43 Public Health Committee 6-7 Puerperal Pyrexia 16 Consultant 38 Rainfall 9 Rateable value 8 Rats and Mice Destruction 53 Respiratory diseases—deaths from 21 69 i N D E X—continued. page Representatives on: — Nelson Hospital Council 5 Wandle Valley Joint Hospital Board 5 Wandle Valley Joint Sewerage Board 5 Road Accidents (deaths from) 18-19 Sanitary Circumstances 43 Sanitary Inspection 54 Scarlet Fever 58-59-60 Incidence in each Ward with rates 58-59-60 Monthly distribution of cases 58-59-60 Shops Acts, 1912-1936 54 Slaughterhouses 47-48 Smallpox 30 Smoke Abatement 53 Social Conditions of the Area 8 Staff 6, 7 Statistics 8, 9 Comparative 14, 15, 16 Shelters, A.R.P. 53 Tuberculosis 31-65 Admissions to Sanatorium 31, 32 Deaths due to 12-32 Dispensary 28 New cases—by age groups 64-65-66 Number on register at year end 62 Venereal Diseases 28 Water Supply 43-53 Whooping Cough 33 Zymotic Disease 12 Deaths from 12 Rate 12 70