MER6 Merton and Morden Urban District ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1944 AND REPORT OF The Sanitary Inspector Merton and Morden urban District ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1944 AND REPORT OF The Sanitary Inspector PREFACE. To the Chairman and Members of the Merton and Morden Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Report for the year 1944. As last year in the Annual Report 1 gave a comprehensive account of all the services so as to bring it up to date as a record, this year 1 propose to be content with a brief reference only to the public health services, and any fuller information with regard to its scope can readily be obtained by reference to the 1943 Report. The statistics in the Report must be examined with the fact of the low estimate of total population in mind. The Registrar General has given the population as 62,760, the lowest recorded figure since 1936, attributable to the evacuation consequent upon the flying bomb attacks. This naturally results in an exaggeration of the various statistical rates calculated on the basis of total population. This is perhaps best illustrated by quoting the birth rate as an example. Last year the birth rate was 17.4, this year it has gone up to 18.3. but the total live births on which this rate is calculated have only increased by 5; an increase which, if the estimated population had not been so decreased, would have left the birth rate unaltered. The vital statistics for the year are very satisfactory. The death rate is 10 compared with 11.6 for England and Wales as a whole, and the birth rate is 18.3, while the corresponding figure for England and Wales is 17.6. Standing third among the causes of death is a newcomerother violent causes. A visitor which we are thankful will not re-appear—the factor responsible for upsetting the lives of our residents as well as our statistics. In this unobstrusive fashion is recorded the toll of life in our district taken by V weapons—one of science's greatest achievements—in 1944. Few of the sixty odd thousand residents of Merton and Morden will regret the passing of 1944, the year now under review. In the body of the Report will be found the actual incidence of the various notifiable infectious diseases. It is a remarkable thing that although the incidence of infectious disease throughout the war years has been relatively high, the mortality has been surprisingly low, and the diseases themselves have, in general, run a mild course with an absence of the widespread complications and sequelae which might have 2 been expected under war time conditions. Measles and Whooping Cough, those scourges of infancy, have assumed a different aspect almost. It is a belief widely held that these diseases do not show the same lethal qualities among the socalled better classes. Is it not therefore probable that the improved diet, owing to rationing and public health propaganda, has produced the conditions in all the child community erstwhile found only in the more fortunate section? It is worth noting perhaps in this connection that the value of propaganda may not be immediately apparent, but it may still pay dividends in the end. I would like to place on record my thanks to the members of the Council for their interest in the work of my department, and to express my gratitude that their ambition also is to secure the best health services for our district, thereby rendering my task easier and my work enjoyable. Last but not least, I would thank my own staff, each and every one of them. They are the distributors of the services provided, and the ultimate quality of the service depends almost entirely on their personal interest and devotion. The year 1944 provided unparallelled opportunity for the demonstration of those qualities which it is expected to find in people recruited for such a purpose as ours. I am sure there is no one who is not glad now to have had the opportunity. of serving in such a time, when never was there such need of such service, and never such need of such qualities; such a time as we shall never see again. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, A. WALLACE JOHNS, Medical Officer of Health. July, 1945. 8 URBAN DISTRICT COUNCIL of MERTON and MORDEN 1944 NO. 3 COMMITTEE (SERVICES). Chairman: Mrs. H. Cobbett. Mrs. F. Berner. Mr. S. Beven. Mr. F. H. Brinkworth. Mr. Roberts Brown. Mrs. E. M. Clifton, J.P. Mr. C. C. Cockbain. Mrs. L. A. Doel. Mr. W. E. Gibson. Mr. J. R. Leggett. Mr. W. S. Le Gros Clark. Mrs. S. A. Lodge. Mr. A. T. Piner. Mr. E. Young. Mr. S. F. Franklin, J.P. (Chairman of the Council). Mr. S. W. Billingham (Vicc-Chairman of the Council). REPRESENTATIVES ON THE WANDLE VALLEY JOINT HOSPITAL BOARD. Mrs. H. Cobbett. Mir. F. J. Grimme. Mr. G. F. Coleman. Mr. S. F. Franklin (ex-officio). REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD. Mrs. E. M. Clifton, J.P. Mr. S. F. Franklin. Mr. D. Shadbolt. Mr. S. W. Billingham (Vice-Chairman of the Council). REPRESENTATIVES ON NELSON HOSPTAL COUNCIL. Mr. W. H. Glasscock. Mr. P. Hill. Mr. F. J. GriMme. 4 PUBLIC HEALTH STAFF, 1944. 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: a d C. Jones, M.S.I.A. a c 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: H. J. Herbert. Clerks: Mrs. E. Lang. Mrs. V. Bartlett. A. J. Fletcher. Assistant Medical Officer for Maternity Clinics: Dr. Anthony Partridge, M.R.C.S., L.R.O.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 Clinics: Mary M. Tulloch, M.B., B.S. Dentist to Maternity and Child Welfare Dental Clinics: H. W. Fynn, L.D.S., R.C.S. (Eng.). a Meat and Food Inspector's Certificate, Royal Sanitary Institute. 6 Sanitary Science Certificate, University of Liverpool. c Smoke Inspector's Certificate, Royal Sanitary Institute. d Meat and Food Certificate, Royal Sanitary Association of Scotland. 5 . SECTION A.— STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 3,238 Number of inhabited houses according to Rate Books 20,852 Rateable value at 31st December, 1944 £645,699 Sum represented by Id. rate £2,450 Industry. The number of factories registered under the Factory Act at the end of 1944 was:— Factories with mechanical power':— Employing nore than 40 persons 41 Employing less than 40 persons 95 Factories without mechanical power 15 151 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. Number of persons admitted to Public Assistance Hospitals from Merton and Morden 51 (These figures do not include those admitted direct to hospitals by the local doctors) Number of persons admitted to mental hospitals 45 Total number of persons in receipt of domiciliary assistance on:— 1st January, 1944 229 1st July, 1944 213 31st December, 1944 140 Total amount of domiciliary assistance granted in Merton and Morden in the year 1944-... £7,311 15 1 Medical Relief: No orders have been issued by the Relieving Officer for medical relief, but there are a large number of Supplementary Pensioners who are in possession of Permanent Medical Relief tickets and visit the District Medical Officer as and when required. 6 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, 1944. JOSEPH HOOD RECREATION GROUND WEST BARNES PUMPING STATION Month Inches Days wirth O.lin. or more Days with 0.4in. or more Inches Days with O.lin. or more Days with 0.4in. or more January 1.41 12 8 1.47 10 9 February .75 11 5 .84 15 6 March .08 4 1 .13 8 — April 1.49 7 7 1.66 11 7 May .70 5 4 .86 7 5 June 1.79 12 6 2.01 14 7 July 2.63 13 7 2.73 15 10 August 2.35 9 9 2.29 10 8 September 2.29 14 10 2.66 16 12 October 2.96 19 15 3.16 22 15 November 3.68 22 16 3.85 26 17 December 1.42 14 9 1.82 18 9 TOTAL 21.55 142 97 23.48 172 105 VITAL STATISTICS. Vital Statistics for the year maintain the satisfactorystandard of previous years, the figures comparing very favourably with those of the country as a whole. The birth rate was 18.3 per 1,000 population, with a total number of live births of 1,151. The death rate was 10 per 1,000 population comparing with the corresponding figure for England and Wales of 11.6. The infant mortality rate was 28.7 per 1,000 live births as compared with a figure of 46 for England and Wales. As has been previously mentioned, the effect of what is probably a low population estimate is to raise these figures slightly, and while this gives an exaggerated picture of the birth rate, we can console ourselves with the reflection that the death rate is correspondingly raised. 7 The total deaths from all causes was 628 and the total live births 1,151, giving, therefore, a natural increase of population of 523. The appended table sets out the comparison for the past five years of the local infant mortality rate with that for England and Wales. It will be seen that the local rate is consistently very considerably below that for the whole country; in the last two years approximately half. England and Wales. Merton and Morden. 1940 55 34.3 1941 59 42.5 1942 49 33.9 1943 49 23.5 1944 46 28.7 The number of illegitimate births has dropped slightly and it is to be hoped and anticipated that, when the abnormal conditions through which we have passed in recent years disappear, this problem will become less acute. It is perhaps noteworthy.that the illegitimate infant mortality rate in our district is 40.8 per 1,000 live births, compared with the legitimate mortality rate of 28.1. This bears out the general experience that the chances of survival of an infant born to an unmarried mother is only about half as good as that of a child of a married woman. 8 SUMMARY OF VITAL STATISTICS. (Registrar General's Figures). Population: Registrar General's Estimate 62,760 Births: M. P. Total Live (Leg.) 563 53:9 1,102 (illeg.) 22 27 49 585 566 1,151 Still Births 15 11 26 Birth Rate 18.3 per 1,000 population Still Birth Rate 22.09 per 1,000 births Deaths: M. F. Total 330 298 623 Death Rate 10 per 1,000 population Infant Mortality: Total deaths under 1 year 33 Infant Mortality Rate per 1,000 Live Births 28.7 Deaths of Legitimate infants under 1 year 31 Death Rate per 1,000 Legitimate births 28.1 Deaths of Illegitimate infants under 1 year 2 Death Rate per 1,000 Illegitimate births 40.8 Maternal Mortality: Deaths from Sepsis Nil Deaths from other maternal causes 1 Maternal Death Rate 0.84 Zymotic Deaths: Deaths from Measles 1 Whooping Cough 3 Diarrhoea (under 2 years) 4 7 Principal Zymotic Diseases 9 Zymotic Death Rate (per 1,000 population) 0.14 Deaths from Tuberculosis: All forms 37 Rate per 1,000 population 0.58 Phthisis 35 Rate per 1,000 population 0.55 Deaths fom Cancer 107 - Rate per 1,000 population 1.6 9 TABLE I. COMPARATIVE STATISTICS, 1944. (Registrar General's 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:— Live 17.6 20.3 20.9 15.0 18.3 Still 0.50 0.64 0.61 0.42 0.41 Deaths:— All causes 11.6 13.7 12.4 15.7 10.006 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 0.03 0.03 0.02 0.04 0.05 Diphtheria 0.02 0.03 0.03 0.01 0.02 Influenza 0.12 0.10 0.11 0.08 0.06 Smallpox 0.00 — — — — Measles 0.01 0.01 0.01 0.00 0.02 Notifications:— Typhoid Fever 0.01 0.01 0.01 0.01 0.00 Paratyphoid fever 0.01 0.00 0.01 0.01 0.00 Cerebro-spinal fever 0.05 0.06 0.04 0.06 0.00 Scarlet fever 2.40 2.41 2.67 1.50 3.68 Whooping Cough 2.49 2.49 2.29 2.90 3.18 Diphtheria 0.58 0.67 0.69 0.31 0.12 Erysipelas 0.29 0,32 0.28 0.37 0.35 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 4.16 4.51 3.94 2.98 4.01 Pneumonia 0.97 1.13 0.82 0.93 0.74 Rates per 1,000 Live Births. Deaths under 1 year of age 46 52 44 61 28.7 Deaths from Diarrhoea and Enteritis under 2 years of age 4.8 7.3 4.4 10.1 3.4 Rates per 1,000 Total Births (Live and Still). Notifications:— Puerperal fever 3.61 Puerperal pyrexia 10.34 13.13 9.25 14.14* 5.9 * Including Puerperal Fever. 10 POPULATION. The Registrar General's estimate of the population for 1944 is 62,760. This figure is low compared with an estimate based on occupied dwellings such as is used for local computation of the ward population. The Registrar General has again provided an estimate of the population under five and between five and fifteen. This has been done primarily to secure uniformity in calculation of immunisation figurers, as there is a tendency to wide variation from district to district in locally compiled estimates. The figures for the age group 0—4 inclusive is 4,947 and for the age group 5—14 inclusive is 9,939. BIRTHS. The registered live births totalled 1,151, an increase of 5 over the previous year; and the birth rate has shown a corresponding rise from 17.4 to 18.3 per 1,000 of the population. Of the total live births 585 were males and 566 females. There were 49 illegitimate births; of these 22 were males and 27 females. There were 26 stillbirths; 15 males and 11 females. INSTITUTIONAL AND DOMICILIARY BIRTHS. The tendency of recent years towards increased Institutional confinements continues. Sixty-seven per cent. of the births which occurred in 1944 took place in hospitals or nursing homes, as fodows:— St. Helier Hospital 335 Nelson Hospital 200 Kingston County Hospital 22 Other hospitals, institutions and nursing homes 221 778 11 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 10,767 400 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 10.2 187 9.9 1926 19,980 333 10.7 179 9.0 1927 21,850 352 10.13 200 9.2 1928 25,780 392 15.2 224 8.7 1929 27,430 442 16.1 281 10.2 1930 35,000 452 12.9 241 0.9 1931 41,610 628 15.1 333 8.0 1932 48,550 770 15.8 352 7.2 1933 52,130 644 12.3 410 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 13.9 616 7.2 1940 68,540 971 14.2 714 10.4 1941 64,920 848 13.00 557 8.58 1942 66,590 1,069 16.05 588 8.8 1943 65,880 1,146 17.4 575 8.7 1944 62,760 1,151 18.3 628 10 DEATHS. The number of registererd deaths after adjustment by transferable deaths, is given below:— 628 total deaths, of which 330 were males and 298 females. The seasonal mortality is indicated by the deaths for each quarter of the year, which were:— First quarter 195 Second quarter 132 Third quarter 171 Fourth quarter 130 12 Inquests. Inquests were held in the district on 20 deaths. Verdicts were as follows:— (1) Natural Causes 2 (2) Suicide by— Haemorrhage from cut throat 1 Drowning in bath of water 2 Drowning in river 1 4 (3) Accidental Deaths— Fall in home 5 Accident on Underground 1 Collision with trolley bus 1 Asphyxia caused by bedclothes 1 Electrocution 1 9 (4) Misadventure— Asphyxia due to swallowing regurgitated Barium Meal 1 Overdose of luminal tablets 1 Fall in garden 1 Coronary thrombosis accelerated by administration of trilene anassthesia 1 Septicaemia following puncture of of thumb by thorn 1 5 20 Road accidents were responsible for 2 of the total deaths compared with 3 in 1943. CAUSES OF DEATH. There were 148 deaths from Heart Disease, the highest number of deaths from any single cause; 107 from Cancer, by which this cause maintains second place, and 72 from other violent causes, a most unusual number comprised very largely of deaths from enemy attack; a cause which we gratefully note will not be recorded in any subsequent year. Deaths from Tuberculosis have again fallen slightly compared both with last year's figure and the figures for the past ten years." The appended tables show the numbers of deaths and the death rates from Cancer during the past ten years. It will be noticed that the death rate is the same as last year and that there is no change apparent yet in the upward trend during recent years. 13 CANCER DEATH RATE. No. of deaths from Cancer for past 10 years. 1934 66 1935 50 1936 74 1937 93 1938 89 1939 91 1940 76 1941 85 1942 103 1943 116 1944 107 Death Rate per 1,000 Year. population. 1934 1.2 1935 1.0 1936 1.2 1937 1.4 1938 1.2 Death Rate per 1,000 Year. population. 1939 1.1 1940 1.2 1941 1.3 1942 1.5 1943 1.7 1944 1.7 TABLE III. Deaths from Respiratory Diseases, 1925-44. 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 1980 2 10 3 15 0.4 1981 8 24 4 86 0.8 1932 11 27 8 41 0.8 1933 12 82 6 60 0.9 1984 7 88 4 49 0.8 1985 9 22 6 37 0.6 1986 2 35 2 39 0.6 1987 14 81 6 51 0.8 1938 15 27 7 49 0.7 1939 6 20 9 34 0.4 1940 38 40 15 93 1.8 1941 80 80 6 66 0.9 1942 9 12 20 41 0.62 1943 25 86 9 70 1.05 1944 26 29 7 62 0.98 14 TABLE IV. Causes of Death during the Year 1944. No. Cause of Death. Males Females Total 1 Typhoid and Paratyphoid Fevers 2 Cerebro spinal fever 3 Scarlet Fever 4 Whooping Cough 2 1 3 5 Diphtheria 1 1 6 Tuberculosis Respir. System 27 8 35 7 Other forms of Tuberculosis 2 — 2 8 Syphilitic diseases 5 1 6 9 Influenza 3 1 4 10 Measles — 1 1 11 Ac. Polio-myel. and polioencephalitis — — — 12 Ac. inf. encephalitis 1 — 1 13 Cancer of buc. cav. and oesoph. (M) uterus (F) 4 3 7 14 Cancer of stomach and duodenum 4 9 33 15 Cancer of breast — 14 14 16 Cancer of all other sites 33 40 73 17 Diabetes — 1 1 18 Intra-cranial vascular lesions 21 33 54 19 Heart disease 82 66 148 20 Other dis. of circ. system 7 10 17 21 Bronchitis 21 5 26 22 Pneumonia 21 8 29 23 Other respiratory diseases 5 2 7 24 Ulcer of stom. or duodenum 6 2 8 25 Diarrhoea under 2 years 3 1 4 26 Appendicitis 3 2 5 27 Other digestive diseases 12 5 17 28 Nephritis 5 7 12 29 Puer. and post abort, sepsis — — 30 Other maternal causes — 1 1 31 Premature birth 2 5 7 32 Con. mal. birth inj. inf. dis. 5 8 13 33 Suicide 2 2 4 34 Road traffic accident 1 1 2 35 Other violent causes 38 34 72 36 All other causes 15 26 41 Total all causes 330 298 628 MATERNAL MORTALITY. In the year 1944 one mother only died as a result of childbirth, giving a maternal mortality rate of 0.84. This figure has created a new low record. Last year's figure of 0.85 being the lowest previous figure ever recorded for the district. This figure compares very favourably with the latest published figure for England and Wales, which is 1.84. 15 The trend of the figures for the past few years would suggest that we are succeeding in reducing the catastrophic risk of childbearing. One may well question why should any woman die through childbirth, and it is difficult to select a cause which is inevitably accompanied by such a tragic outcome, and the most obvious reply would be in such circumstances that such a woman should never have been submitted to the risk. Human beings do not, however, show biologically such consistency as is exhibited by scientific phenomena, and while there is no such thing as inevitability, there will always be those who will elect to take the highest risks, nor is it likly that any arrangements devised by humans will ever be entirely free from occasional error. It is, therefore, reasonably certain that a basic maternal mortality will always remain as long as human reproduction remains a natural process. What we can do, however, is by no means unimportant. We can strive to exclude and maintain the exclusion of such causes as can be described as accidental, and what is probably of at least equal importance, we can strive to reduce the maternal morbidity; the toll of permament disability suffered by untold numbers of our mothers. TABLE V. Maternal Mortality, 1924-44. Year Death rate per thousand total births. Sepsis Other causes Total 1924 — 3.2 3.2 1925 — 6.5 6.5 1926 — — — 1927 — 2.8 2.8 1928 — — — 1929 2.2 — 2.2 1930 — 2.2 2.2 1931 1.6 3.1 4.7 1932 5.1 2.5 7.7 1933 2.9 1.4 4.3 1934 2.5 2.5 5.0 1935 — 2.6 2.6 1936 2.4 — 2.4 1937 1.2 1.2 2.4 1938 0.98 1.96 2.95 1939 — 3.93 3.93 1940 1.04 — 1.04 1941 — 2.3 2.3 1942 0.93 1.87 2.80 1943 0.85 — 0:85 1944 — 0.84 0.84 16 INFANT MORTALITY. There were 33 deaths of infants under one year of age, of whom 16 were male and 17 female. Two of these deaths occurred in illegitimate infants. The infant mortality rate for the year is 28.7 per 1,000 live births, a rate which compares very favourably with 49 per 1,000, the last published figure for England and Wales as a whole. While it is always somewhat dangerous to draw dogmatic conclusions from local figures which are relatively small, the infant mortality rate for the district has been consistently low for a good many years, and while perhaps it is wise to hesitate to claim that this is largely due to the standard of public health achievement in the district in case it might be difficult at some future time to repudiate responsibility for a sudden unexpected reverse in these favourable figures, it is generally acknowledged that there is a close association between the two standards. Neonatal Deaths with Causes of Death. Sex. Age. Cause. Female 5 days Prematurity. Female 1 week Prematurity. Male 2 hours Prematurity—twin birth. Male 2 hours Prematurity—twin birth. Male 3 days Ac. Broncho pneumonia—Congenital heart disease. Male 1 month Gastro Enteritis. Female 12 hours Spina bifida. Male 2 days Erythroblastosis foetalis. Female 1 week Prematurity—maternal pre eclampsia. Female 9 hours Congenita] atelectasis—prematurity. Female 4 hours Prematurity—toxaemia of pregnancy (Twins). Female 1 hour Prematurity—toxaemia of pregnancy (Twins). Female 3 days Prematurity. Female 2 weeks Broncho pneumonia following gastro enteritis. Male Newly both Patent inter auricular septum of heart. Male 3 weeks Asthenia and marasmus. Out of the total of 33 infant deaths under one year, 16 or just under half were neonatal deaths, that is they died within a month of birth. It is always of interest to study these deaths and their causes, as one of the outstanding achievements of public health has been to reduce the infant mortality by two- 17 thirds in the past 20 or so years. It is, therefore, particularly interesting to speculate how further reduction can be effected in this loss of infant life. The fact that half of the infant deaths occurred in the first month points to factors associated with childbirth and pre-natal development, so that it is to these problems that attention must be directed to secure further improvement. 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 or maternity nursing is undertaken. The district served is approximately the ecclesiastical parish of St. Mary's. A total of 147 cases involving 1,187 visits were attended during the year 1944; of these 11 cases were children under 5 years of age, to whom 25 visits were made. (2) The St. Helier District Nursing Association employs one nurse for general nursing. No midwifery or maternity nursing is undertaken. Its activities cover the whole of the Merton and Morden portion of the St Helier Estate and in addition that part situated in the Carshalton Urban District lying to the North of Reigate Avenue. During 1944, 226 cases were dealt with by the St. Helier District Nursing Association, 7 of these were children under 5. The total number of visits made was 2,047, of which 43 were in respect of children under 5 years. (3) The Wimbledon District Nursing Association serves Wimbledon and the western part of this district. Two nurses are employed for general nursing in Merton and Morden. The figures relating to cases and visits in this district during 1944 are as follows:— 18 Cases. Visits. Children under 5 years 25 138 Other cases 278 3,850 303 3,988 Laboratory Facilities. The Nelson Hospital appointed Dr. J. M. Lever as their Pathologist and Bacteriologist in succession to Dr. F. Deas who retired during the year. Arrangements for pathological laboratory work continues to be carried out satisfactorily and expeditiously. The following examinations were made during the year:— Examinations. J Jo. performed. Positive result. Swabs for diphtheria bacilli 203 8 Sputum for tubercle bacilli 67 9 Blood for Widal test 2 — Fasces 28 7 Swabs for Dysentery 89 10 Swabs from Puerperal cases 1 — Urine 1 — AMBULANCE FACILITIES. Infectious Cases. Cases of infectious disease, where they are admitted to Isolation Hospital, are conveyed by ambulances of the Wandle Valley Joint Hospital Board. Non-Infectious Cases. During the year 1944 the Council's ambulance was operated by Civil Defence personnel from its base at the Fire Station, Kingston Road. A highly efficient service was maintained and the availability of women personnel enabled us to provide a female attendant on all occasions; this is believed to be a great comfort to certain types of patient, particularly women and maternity cases. In addition, the availability of cars manned by the Civil Defence personnel was a great boon, particularly as ordinary means of transport were so restricted. Conveyance of such types of case as pregnant mothers to hospital for X-ray and other investigation while not regarded in the past as essential, has saved many the discomfort and exhaustion of an awkward and difficult journey, and also expedited the actual arrangements by enabling an appointment to be made for them. The Council has continued its service free to residents up to a reasonable distance. The appended table shows the volume of work done by the ambulance. It does not include journeys done by ambulance cars. Their valuable work referred to above is additional to that shown. 19 AMBULANCE CALLS. Month Calls received from Public Calls received from neighbouring Brigades Total Calls Received Calls transferred to other Brigades Calls answered by Own Ambulance Jan. 106 8 109 13 96 Feb. 107 1 108 4 104 March 121 3 124 5 119 April 101 1 102 26 77 May- 101 - 101 56 45 June 91 - 91 12 79 July 78 1 79 2 77 Aug. 62 3 65 1 64 Sep. 76 3 79 7 72 Oct. 98 3 96 7 89 Nov. 107 9 116 8 108 Dec. 112 6 118 10 108 Total 1155 33 1188 150 1038 Time taken in executing the calls (from leaving Station to return) 849 hours Mileage covered 8,736 miles Average time per call 49.07 minutes Average distance per call 8.4 miles During the war a voluntary service has been established —the Volunteer Car Pool—which has been of the greatest value in dealing with cases, particularly long distance cases that present difficulties in providing the ordinary ambulance service. It is greatly to be hoped that this service will not be discontinued at the end of the war. CLINICS AND TREATMENT CENTRES. 1.—Maternity and Child Welfare Clinics (provided by the Council). Centre Clinic Times of Clinics Sports Pavilion, 216, Grand Drive, Raynes Park Infant Welfare Mondays 10— 12 noon. 2— 4 p.m. Wednesdays 10—12noon Ante-Natal Thursdays at 2 p.m. by appointment. Health Centre, Middleton Road, Morden Infant Welfare Tuesdays 11—12 noon. ,, 2— 4 p.m. Fridays 2—4 p.m. Ante-Natal Thursdays 9.45 a.m. by appointment. Dental 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 noon Fridays 10—12 „ Hope Mission Hall Rodney Place, Merton Infant Welfare Thursdays 10—12 noon 20 DIPHTHERIA IMMUNISATION. 2.—Diphtheria Immunisation Clinics (provided by the Council). In the second half of the year 1944, that is from the beginning of July to the end of the year, as a result of the flying bomb attacks and the evacuation of children, very little immunisation was being carried out. Only 155 under 5 and 94 between 5 and 15 were completed during this period. It is to be expected, therefore, that the total for the year will be below previous years. The actual totals are 438 under five and 241 between 5 and 15. The present policy with regard to immunisation is to concentrate on the 1—2 group. It is obvious that if a high percentage of this group—which in our area should number about a thousand—can be immunised each year, it will only be a matter of a few years before all the under five population can be kept at a high percentage by exclusive attention to this group; and it is this group that should be least protected being in an interim period between the waning inherited acquired immunity by virtue of the stock of maternal blood with which they started life and the minimal development of an active immunity by response to subpathogenic infective stimuli. It is also the practice to advise the boosting dose at about 4½ years of age to raise the protection to its highest level at the moment of leaving the sheltered environment of the home for the wider contact and multiplied opportunities of infection of school life. Immunisation Clinics. 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, Merton Thursdays at 9.45 a.m. Health Centre, Aston Road, Raynes Park Fridays between 10—11 a.m. In addition to these sessions, injections' are given at the ordinary Infant Welfare Sessions. 21 3.—School Clinics (provided lay the Surrey Education Committee). Middleton Road, Morden. General Medical Every Monday and Wednesday, 9.30—12.0. Eye Every Wednesday, 2.0—4.30. Dental Every Wednesday and Friday, 9.30—12.0 & 1.30—4.0. Every Monday, Tuesday and Saturday, 9.30—12.0. Every Thursday, 1.30—4.0. Aston Road, Raynes Park. General Medical Every Tuesday and Thursday, 9.30—12.0. Eye 2nd, 4th and 5th Wednesdays, 9.30—12.0. Dental Every Monday, Tuesday and Thursday, 9.30—12.0 and 1.30—4.0. Every Wednesday and Saturday, 9.30—12.0. Every Friday, 1.30—4.0. 4.—Tuberculosis Dispensaries (provided by the Surrey County Council). St. Helier County Hospital, Wrythe Lane, Carshalton. Morden Patients Monday, 10 a.m. 2nd Monday in month, 5.30 p.m. Friday, 1.30 p.m. Raynes Park Patients Monday, 1.30 p.m. Wednesday, 10 a.m. 1st Monday in month, 5.30 p.m. 5.—Venereal Diseases. The County Council administers the Venereal diseases Regulations and participates in the London and Home Counties scheme. Under this arrangement treatment is available at the principal London Hospitals and at the St. Helier County Hospital. The sessions are numerous and in some.cases continuous, whilst many of these institutions provide in-patient as well as out-patient treatment. HOSPITALS. Smallpox. The Surrey County Isolation Hospital,, Clandon—accommodation 28 beds. During the year the Smallpox arrangements at Clandon were put into operation to provide for isolation and treatment of cases arising from a small outbreak of Smallpox in another county. One patient from Merton and Morden was removed to Clandon. 22 During the year there was carried out a good deal of follow up of contacts on leave from places abroad where there had been Smallpox. Infectious Disease. The Wandle Valley Hospital, as will be seen from the appended table, has dealt with 242 cases from our district. The problem of staff, both nursing and domestic, referred to last year has been even more difficult during the present year, and the shortage of nursing staff, particularly in certain special hospitals, for example sanatoria for Tuberculosis patients, has been the chief factor responsible for shortage of accommodation, even when the actual beds were available. It will be noticed that from our district 172 cases of Scarlet Fever were admitted. It may well be that consideration will have to be given to restriction of the hospitalisation of a disease which can readily be dealt with at home, so as to enable more accommodation to be available for diseases which cannot be dealt with at home. TABLE VI. Cases admitted to the Wandle Valley Isolation Hospital during the Year 1944. Disease. Cases Deaths Diphtheria 7 1 Scarlet Fever 172 — Erysipelas 5 — Tonsillitis 14 — Measles 1 — Influenza 2 — Whooping Cough 7 3 . Rubella 7 — Mumps 1 - Chicken Pox 4 - Puerperal Sepsis 2 - Admitted with Mother 5 Gastro Enteritis 2 Abscess of Neck 1 - Dysentery 8 - Pneumonia 3 - Food Poisoning 1 — Total 242 4 23 General and Maternity. 1. The Nelson Hospital for Wimbledon, Merton and Morden District. The bed complement at this hospital is now termed as 100 casualty beds (with permission to use these for civilian sick patients) plus 20 maternity beds (reserved for civilian patients only). The following information relating to the hospital's activities during the year under review is supplied by the courtesy of the Secretary:— (a) General Medical and Surgical Treatment. Total in-patients admitted 1,415 Number from Merton and Morden 520 Total number of new out-patients 7,123 Number from Merton and Morden 3,972 (b) Maternity Services. Number of patients admitted from all districts during the year:— (1) General Wards 251 (2) Private Wards 125 376 Number of patients admitted from Merton and Morden:— (1) General Wards 135 (2) Private Wards 71 206 2. The County and Public Assistance Hospitals. Under existing arrangements, patients from this district receiving treatment in County Hospitals are admitted, in most instances to the Kingston County Hospital at Wolverton Avenue. Tuberculosis. The County Sanatorium, Milford—300 beds. The Surrey County Council is responsible for the AntiTuberculosis Scheme in the district. The County Sanatorium at Milford constitutes the main institutional provision, and 32 persons were admitted from Merton and Morden during 1944, whilst 103 other persons received treatment in other institutions. In Surrey, as in other counties, the Sanatoria accommodation is inadequate to meet the present demands made upon it. Every effort is being made by using other accommodation and by selection of cases, to mitigate the shortage which, as mentioned before in this Report, is largely contributed to by shortage of nursing staff. 24 MATERNITY AND CHILD WELFARE. Public Health Act, 1936, Section 203—Notification of Births. The births notified under Section 203 as adjusted by transferred notification were:— Live Births 1,029 Still Births 23 1,052 Notified by Midwives 407 Notified by doctors and parents 15 Transferred from other districts 630 1,052 The Work of the Centres. During the year 1944 the scope of the welfare activities at the centres was well maintained. The number of sessions held—ante-natal and infant welfare— was 664. This figure is the greatest number of sessions per year operated in the service. It is a remarkable fact that in spite of the adverse influences which might be expected to reduce the attendances at the centres, the ante-natal clinics have the highest number ever recorded; and 684 mothers attended these clinics. That is to say of 1,177 pregnant mothers resident in our district, which includes those who had their babies outside of the district, 58 per cent. received their ante-natal care in our clinics, and this excludes those who attended hospitals both inside and outside the area and a proportion of those attending St. Helier Hospital. The attendances at the infant welfare clinics were much more affected by the current circumstances, and the attendances both of infants and toddlers fell fairly considerably. In view of the considerable evacuation of children this is to be expected. 26 TABLE VII. Attendances at Maternity Clinics. Centre No. on Register Attendances Sessions Average attendance per Session Primary Total Grand Drive Ante-Natal 266 196 1133 62 | 22.3 Post-Natal 80 8 30 Individuals 296 204 1168 Morden Ante-Natal 261 216 1166 62 22.6 Post-Natal 13 - 18 - Individuals 274 216 1178 Blakesley House Ante-Natal 157 106 694 52 j 11.6 Post-Natal 18 3 18 Individuals 170 109 607 All Centres Ante-Natal 684 518 2892 156 | 18.9 Post-Natal 56 11 66 — Individuals 740 629 2948 156 A primary post-natal visit is the visit of a post-natal woman who has not attended previously either ante-natally or post-natally, so that the figures for primary attendances of individuals represent the number of new eases during the year. 26 TABLE VIII. Attendances at Infants' Consultation Clinics. Centre No. on Register Attendances Average Attendance Sessions per Session "Primary Total Morden Under 1 yr. 594 221 2,516 153 22.9 1-5 years 17 997 Raynes I'ark Under 1 yr. 572 188 2,471 103 89.7 1-5 years 86 1,627 Grand Drive Under 1 yr. 854 282 3,649 148 38.7 1-5 years 26 2,092 Blakeslev House Under 1 yr. 354 88 1,164 52 36.0 1-5 years 7 708 Merton Under 1 yr. 117 33 442 52 14.7 1-5 years 1 327 All Centres Under 1 yr. 2,491 807 10,241 508 31.4 1-5 years 87 5,751 * Excluding children known to have attended other Centres. TABLE IX. Attendances at all Centres over last 10 years. Year No. of Infants attending during year No. of Women attending Maternity Clinics ATTENDANCES Maternity Grand Total Infants Primary under 1 yr. Total 1984 1,880 288 545 17,994 590 18,684 1935 1,986 258 554 18,800 622 19,422 1986 2,010 806 561 19,957 1,106 21,068 1987 2,250 868 569 20,422 1,450 21,872 1938 2,800 469 760 26,235 2,127 27,862 1939 8,090 588 856 24,376 2,896 26,771 1940 2,614 668 705 17,255 2,864 19,619 1941 2,445 595 745 17,956 2,272 20,227 1942 2,781 774 840 21,478 1,841 22,819 1948 2,514 681 908 22,485 2,074 24,609 1944 2,491 740 807 15,992 2,948 18,940 27 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 Percentage of registered births Number attended Peroentage 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 84.3 1934 770 545 70 233 80.2 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 1,069 840 87 774 72.0 1943 1,146 908 79 681 59.3 1944 1.151 807 70 740 64.2 The Nelson Hospital Clinics. A maternity clinic is held at the Nelson Hospital every Tuesday afternoon for the antenatal and post-natal examinations of women who have booked for admission, or who have been confined at 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 every Thursday, and an Ophthalmic Clinic on alternate Mondays. The hospital is a voluntary organisation serving WimbleWimbledon and Merton and Morden district. The following information, kindly supplied by the Secretary, indicates the work of the hospital clinics during 1944. Infant Clinic. From Merton and Morden. Total number of attendances at the infant clinic 989* Total number of first attendances under one year of age 66 28 Total number of children attending during the year:— Under one year 60 Over one year 6 Ante and Post Natal Clinic. Ante-natal. Post-natal. Total number of attendances during the year *1,548 *129 Total number of women who attended during the year 132 69 * all districts. Health Visiting. The table appended shows the scope of the work of the Health Visitors. While it is generally recognised that figures alone are a most unreliable guide to the value of such work, it is noteworthy that throughout a most difficult period, 7,919 home visits were made compared with 8,131 for the previous year. The number of visits to children under one year has increased by 395 compared with 1943. After the demands on the Health Visitors' time by clinic sessions, special visits, and visits under their child life protection responsibilities have been satisfied, visits to new births is always regarded as a first claim. For the past few years such visits have been increasing by from three to four hundred each year. The increasing work has made the appointment of an additional Health Visitor necessary, and it is gratifying to record that for the next year the Council have decided to obtain this assistance for this very essential work. The number of visits made for various purposes was as shown below:— To expectant mothers—first visits 390 total visits 707 To children under 1 year—first visits 1,248 total visits 3,420 To children 1-5 years—total visits 3,428 Visits re puerperal pyrexia, ophthalmia neonatorum and miscellaneous 268 Visits to foster children re child life protection 96 7,919 29 In addition to closely co-operating with our own Day Nurseries, the Health Visitors have attended at the routine medical inspections of nursery children in the schools, to afford assistance to the School Medical Officer and I lead Mistresses of the schools with their more intimate knowledge of these children. At the close of such a year as 1944 I may perhaps bf forgiven the introduction here of a more intimate note on the very personal work of the Health Visitors—to pay tribute to the steadfastness and serenity with which they responded to the difficult and trying conditions, and under which they maintained their traditional standard of service. 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 orthopaedic defects are referred to the Nelson Hospital under the general arrangement with that Hospital for the treatment of children attending the Welfare centres. Maternity Hospital Treatment. In 1944 the Nelson Hospital admitted 206 maternity cases from the Urban district. Complicated cases which were prior to the war accommodated at Queen Charlotte's Hospital, London, by arrangement with that hospital, can now be treated in this disrict. The opening of the Maternity Block at St. Helier Hospital has improved the obstetric facilities in the district very considerably. the obstetric facilities in the district very considerably. The following table shows the use of the maternity accommodation in the district in the year under review. Nelson Hospital 206 Kingston County Hospital 22 St. Helier Hospital 335 Other hospitals 221 784 Emergency Maternity Unit. There was no call made on this unit during the year under review. 30 Consultant Service. A specialist's opinion may be had in cases of obstructed labour, emergencies in pregnancy, or puerperal pyrexia. Home Helps. The revised Home Help scheme operating during the year 1944 has provided domestic assistance for 28 households as compared with 8 only during the previous year. The main features of the new scheme are, the increase in the rate of pay from an all-in payment of 30/- per week to an hourly rate of l/6d.; the arrangements supervised by a Home Help Organiser, and a reduction in the hours worked to those necessary only to carry out the essential domestic work of the house—generally from four to six per day—thus enabling a greater number of married women to take up this work. Enemy attack, evacuation and competition from superior priorities in the labour field have made the year a difficult one both in actual operation and in valuation of experience upon which to base future developments. Sterilised Maternity Outfits. Sterile outfits in sealed containers for use at confinements may be had from the Welfare Centres or from the Council's midwife. They are supplied at cost price, and in necessitous cases at half price or free of cost according to means. During the year 33 outfits Avere supplied at cost price. Dental Scheme. The demand for dental treatment under the Maternity and Child Welfare arrangements, as was to be expected, has shown a slight reduction for the year 1944. Evacuation of potential patients would account mainly for this, but it is probable that during the months of June to October, people who remained were largely preoccupied with more sensational events which tended to discourage attendance for dental treatment. Reference to Table XI on page 32 will show that 232 patients made 702 attendances, and 96 expectant mothers were referred to the dental surgeon during the year. 81 TABLE XI. Attendances at Dental Clinics during1944. Cases referred from— Number who attended during year r of Attendances made MERTON Mothers 2 10 Children 3 6 Individuals 5 16 MORDEN Mothers 83 274 Children 19 35 Individuals 102 309 RAYNES PARK Mothers 19 86 Children 9 19 Individuals 28 105 GRAND DRIVE Mothers 33 108 Children , 26 54 Individuals 59 162 BLAKESLEY HOUSE Mothers 28 84 Children 10 26 Individuals 38 110 ALL CENTRES Mothers 165 562 Children 67 140 Individuals 232 702 The dental operations performed were as follows TABLE XII. Dental Scheme 1944—Operations Performed. Extractions—Temporary Teeth 143 Permanent Teeth 352 Fillings—Temporary Teeth 52 Permanent Teeth 122 Dentures supplied—Number of cases 64 Number of local anaesthetics given 45 Number of Gases given 128 82 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 during the year by the Council's midwife:— Cases conducted: Primip. Multip.  (a) As midwife Live Still 2 18 20 — 1 1 (b) As maternity nurse Live Still 4 4 8 — — — 6 23 29 Visits made: By midwife Ante-natal 409 During confinement 535 To midwife Ante-natal 133 Post-natal 193 1,270 Medical Aid Forms sent:—6 Reasons for sending:— Discharging eyes 2 Rupture of Perineum 2 Laceration of Perineum 1 Macerated foetus 1 Percentage of total midwife's cases which attended the Council's ante-natal clinics—100% According to notices received by the Surrey County Council there were eighteen midwives practising in the district, of whom five were salaried midwives appointed under the County Scheme, and eight members of the staff of the Nelson Hospital. Voluntary Helpers. A gratifying feature of our welfare services in Merton and Morden is the contribution made voluntarily by a loyal and devoted band of women inspired by the motive of service. It is one of the advantages in compiling this annual record of the activities of the public health 88 ment that it affords me an opportunity of expressing my thanks to them, and to draw attention to the value of their work. I have elsewhere respectfully commented upon the constancy of the regular staff of the department and their devotion to duty during a trying and dangerous period, but these worthy folk have carried on unfalteringly and resolutely when there was nothing to tie them to their work but their own pride in its accomplishment, and the consciousness of the value of their service. It is with special pleasure, therefore, that I place on record my appreciation of their work in the welfare service. Child Life Protection. The recent publication of a tragic example of failure to secure proper care for foster children has thoroughly disturbed all those who have a responsibility in this matter, and it is certain that everyone in such a position has since examined and re-examined his own arrangements to analyse whether there exists any possibility of such an occurrence in his own area. There is, of course, such a possibility and that is where a child is boarded out in this area by some other authority. There is a very great shortage of foster homes at the present time and every authority is faced with the same difficulty. It is almost impossible to extend the rota of foster parents. The tabulated details below reveal that there were six foster homes on the register at the end of the year and 7 foster children. Ninety-six visits were paid to these homes, an average of 16 visits to each home. Information from the County Public Health Department is to the effect that there are no children boarded out in our district by the Surrey County Council under public assistance or other arrangements. Further assurances have been received that information would be passed to the department if any such children were boarded out in our area. Registered homes under supervision during year 16 Registered homes under supervision at end of year 6 New homes registered during the year 2 Children on the register at the end of the year 7 Children brought on to the register during the year 2 Children removed out of the district 7 Visits paid to nurse children 96 Children died during the year — Legal proceedings — 34 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 respectively. 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 examinations of the Sutton District Water Company's supply are 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 year 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 Cleansing1. The collection and disposal of house refuse throughout the district is presenting much difficulty because of the shortage of staff. The salvage tonnage for the year under review was as followsTons Tons Paper 295 Bottles and Glass 163 Metals 42 Rags 18 Pig Food 674 86 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 year ended 31st December, 1944. Housing1 Inspections. The total number of houses inspected during the year for "sanitary defects" under the Public Health and Housing Acts was 431. Action taken in connection with defective dwelling houses is set out in the housing table on pages 43 and 44. Notices specifying the necessary work required to remedy sanitary defects were served upon owners of properties as follows:— Intimation notices 326 Statutory notices Housing Act, 1936 7 Public Health Act, 1936 35 Eradication of Bed Bugs. Twenty-nine houses were found. on inspection to be infested with bed bugs, and are classified as follows in accordance with the requirements of the Ministry's Circular:— Council Houses Other Houses Total 7 22 29 Of the 29 houses infested 27 were treated by spraying with- "Vermicine," and two by fumigation with sulphurdioxide together with the use of blow-lamps. In two cases van disinfestation of furniture was carried out. Drainage Work. At 10 houses the drainage systems were entirely reconstructed and at 71 houses extensive repairs to drains were carried out. Smoke and water tests were applied to the drains of houses in 87 instances, and obstructions were removed from drains at 124 houses. Food Supply. The total number of inspections made to premises where articles of food are prepared or exposed for sale was 1,072. At 23 premises improvements in sanitary conditions were effected. Unsound Food. The undermentioned articles of food were found, upon inspection, to be unfit for human consumption; 36 were surrendered and either destroyed or disposed of for animal feeding or salvage:— Description. Cause. Beef, 12 lbs Decomposition Pork, 25 lbs „ 2 carcases 1 carcase fevered, 1 carcase swine erysipelas Chickens, 1 case Decomposition Sausage, 20 lbs. „ Bacon, 118 lbs. „ Fish, 71 stone „ Cheese, 39 lbs. „ Flour, 760 lbs. Contaminated Butter, 127 lbs. Unsound Margarine, 12 lbs. „ Jam and Marmalade, 154 lbs. Broken jar or pierced or blown tin Tea, 10 lbs. Contaminated Cocoa, 31 lbs. „ Vegetables, 24 cwts. Decomposition Fresh Fruit, 1,096 lbs. „ Dried Fruit, 30 lbs. Contaminated Sugar, 3 lbs. „ Breakfast food, 195 pkts. „ Rolled Oats, 112 lbs. „ Pudding Mixture, 52 pkts. „ Suet, 1^ lbs. Decomposition Pickles and Sauces, 4 bots. Broken jars Dried Egg, 9 pkts. Contaminated Confectionery, 191 lbs. „ U.S.A. Meats, 6 lbs., 18 tins Pierced or blown tins 2| „ 33 „ „ „ „ „ 12 oz. 119 „ „ „ „ „ Sausage Meat, 1| lbs., 3 „ „ „ „ „ Tinned Fish, 505 tins „ „ „ „ Fruit, 22 tins Meat, 142 tins „ „ „ Milk, 435 tins „ „ „ Soup, 244 tins „ „ „ „ „ Vegetables, 228 tins „ „ „ „ Foods Damaged by Enemy Action. Bacon, 70 lbs. Cakes, 400 Butter, Margarine and Biscuits, 35 lbs. Lard, 3 cwts. 8 lbs. Cake Mixture, 23 pkts. Cheese, 27 lbs. Pudding Mixture, 53 pkts. Bread, 91 loaves Flour, 4 cwts. 81 lbs. 87 Tea, 83 lbs. Vinegar, 72 bottles Sugar, 5 cwts. 101 lbs. Pickles and Sauces, Coffee Essence, 97 bottles 220 bottles Coffee, 30 lbs. Fruit, 64 lbs. Eggs, 25 Dried Fruit, 233 lbs. Dried Egg, 127 packets Vegetables, 9 cwts. Dried Milk, 102 lbs. Cereals, 22 cwts. 92 lbs. Jam and Marmalade, Rolled Oats, .1 cwt. 99 lbs. 1,327 lbs. Curry Powder, 40 lbs. Confectionery, 108 lbs. Custard and Blanc Mange, Lemonade, 21 bottles 15 lbs. Salt, 49 packets Gelatine, 20 lbs. Mustard, 62 lbs. Semolina, 20 lbs. Bisto, 18 packets Calves Foot Jelly, 28 lbs. Beetox, 23 bottles Tinned Foods, 36 tins Meat Inspection. Practically the whole of the home killed meat is prepared in central abattoirs, but pig clubs established for the war period are allowed to slaughter on their premises if found suitable. Several of the pig clubs in the surrounding districts take advantage of this arrangement and use the registered slaughter-house attached to the Trafalgar Pig Club at 129 High Street, Merton. Carcases Inspected. Cattle Cows Calves Sheep Pigs Number killed — — — — 334 Number inspected — — — — 334 Number found fit for human consumption — — — — 331 One medium and two small carcases were destroyed as unfit for food, the weight being 167 lbs. Milk Supply. At 31st December, 1944, only one cowkeeper remained on the register, providing accommodation for about 50 cows. Practically all the milk supplied to the district is derived from the South Eastern Counties and arrives either by rail or road; 78 inspections were made to cowsheds, dairies and milkshops during 1944. Eighteen samples of milk were submitted for bacteriological examination during the year. One sample of pasteurised milk was reported unsatisfactory, the total bacteria count exceeding the prescribed standard. Thirty licences were granted to dealers under the Milk (Special Designations) Order, 1936, and were in force at 31st December, 1944. 38 Food and Drugs Act, 1938. The following table shows the number and nature of the samples submitted to the Public Analyst:— Article. Total Samples. Genuine. Not Genuine. Prosecutions. Arrowroot 1 1 - - Aspirin Tablets 1 1 Beef Sausages 1 1 __ Butter 5 Q Bloater Paste 1 1 Black Pepper 3 3 Black Pudding 1 1 Batter Flour 3 3 No action taken. Bun and Cake Flour 1 1 — — Bicarbonate of Soda 2 2 — — Boracic Ointment 2 2 — — Black Treacle 1 1 — Bacon 2 2 Baking Powder 2 2 — — Beef Suet 1 1 — Bread 1 1 Boric Acid Ointment 1 1 - Cod Liver Oil 1 1 Cheese 1 1 Custard Powder 1 1 — Curry 1 1 — Crab Paste 1 1 Chooolate Cup 1 1 Coooa 1 1 Coffee Essence with Chicory 1 1 Cake Mixture 1 1 Creamola 1 1 Culinary Flavour Powder 1 1 Dessert Mould 1 1 Epsom Salts 1 1 Ground Ginger 2 2 Ginger Cordial 2 2 Ginger Cake and Pudding - Mixture 1 1 __ Gravy Salt 1 1 Health Salts 1 1 Jam 1 1 Junket Powders 2 1 1 Following up sample proved genuine. (First sample was informal). Lard 1 1 — — Lemon Cheese 2 2 — — • Liver Sausage 1 1 — — Lemon Squash 1 1 — — Luncheon Sausage 1 1 — — Milk 23 23 — — Margarine 1 1 — — Carried forward 82 78 4 — 39 Article. Total Samples. Genuine. Not Genuine. Prosecutions. Brought forward 82 78 4 - Mixed Fruit Drops 1 1 - - Mustard 2 2 — - Mixed Spice 2 2 - Medicinal Liquid Paraffin 1 1 __ - Minced Beef 1 1 - Marmalade 1 1 - - Mincemeat 2 2 No action Mint Drops 1 1 - taken. Mercury Ointment 1 1 - - Ox Tail Soup 1 1 - - Pork Sausages 2 2 - - Pork Sausage Meat 2 2 - - Peppermint Sweets 1 1 - - Pure Coffee 2 2 - - Piccalli 2 2 - - Sardine and Tomato Paste 1 1 - - Salmon and Anchovy Paste 1 1 - - Syrup 1 1 - - Sultanas 2 2 - - Semolina 2 2 - - Sponge 1 1 - - Snow Cake Mixture 1 1 - - Stomach Tablets 1 1 - - Sherbert 1 1 - - 'Steam Pudding Mixture 1 1 - - Soya Flour 1 1 - - Self Raising Flour 1 1 - - Scone Mixture 1 1 - - Salad Dressing Powder 1 1 - - Sulphur Ointment 1 1 - - Tinned Peas 1 1 - - Tinned Beans in Tomato 1 1 - - Tomato Chutney 1 1 Manufacturers' explanation Vinegar accepted. 3 2 1 Manufacturers' explanation accepted. Vitacup 1 1 — Yorkshire Pudding and - Pancake Mixture 1 1 Zinc Ointment 1 1 — - Total 130 122 8 — Results of Analyses of New Milk Samples. 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 - - - - - - 2 8 10 3 — — — 23 40 Milk Fat (Legal Standard is 3.0%). 3.2 3.3 3.4 3.6 3.6 3.7 3.8 3 9 4.0 4.1 4.5 Total — 2 5 S — 7 3 — 2 — 1 23 Factories. The number of inspections made to premises registered under the Factories Act—176. Defects relating to sanitary conveniences, ventilation and other sanitary matters were dealt with at 31 premises. Water Supply. Five samples of water from domestic taps were taken and submitted for chemical or bacteriological examinations. The report on each sample was satisfactory. Watercourses. A number of inspections were made of the watercourses in the district for the purpose of detecting pollutions and samples were obtained and sent for chemical analysis. Mosquitos. A number of complaints were received from residents and paraffin spraying of ditches and stagnant ponds was carried out. Rats and Mice (Destruction) Act, 1919—The Infestation Order, 1943. Under the provisions of the Order, Committees have been set up embracing several local authorities' areas to deal with problems arising from investations and with a view to securing joint action in a number of areas when and where necessary. Most of the trouble in Merton and Morden arises from the keeping of poultry and animals in gardens and yards which, as a wartime measure, was recommended by the Ministry of Food. In some areas a staff is employed entirely in rat destruction, but I am still of the opinion that infestations are not sufficiently heavy in this area to warrant the employment of a full-time staff. All complaints are dealt with by the Inspectors and staff of the Public Health Department. During the year under review 1,487 visits were made to premises where infestations were known or suspected, and 121 premises were cleared. In these cases advice was given to the occupiers and the methods of destruction recommended were supervised. In some cases, where the men of the house were away in the Services, the baiting was carried out by one of the staff. 41 Shops Acts, 1912-1936. The following statement summarises the inspections made, the infringements discovered, and other matters dealt with during the year:— No. of Inspections:—Day Visits 153 Evening Visits — Infringements:— 1. Evening closing hours — 2. Half-day closing 1 3. Hours of employment for young persons — 4. Seats not provided for females — 5. Prescribed notices not correct or exhibited 18 6. Sanitary arrangements unsatisfactory — 7. Reasonable temperature not maintained — Summary of Sanitary Inspections. Housing—primary visits 431 Re-inspections—work in progress 1,321 Re Overcrowding 67 Miscellaneous, housing 151 Drainage Work 1,784 Factories and Workshops 176 Stables and Piggeries 107 Rats and Mice Destruction 1,4,87 Enquiries, infectious diseases, contacts infectious diseases 301 Visits to schools 12 Re disinfections 264 Smoke Abatement 38 Food shops, etc. 1,072 Milk Supply 78 Rivers and Streams, pollutions 122 Complaints investigated 241 Miscellaneous 1,393 I am, Ladies and Gentlemen, Your obedient Servant, J. B. POINTON, Chief Sanitary Inspector. July, 1945, 42 SECTION D—HOUSING. 1. Inspection of Dwelling Houses during the year:— i: (a) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) 431 (b) Number of inspections made for the purpose 431 ii. (a) Number of dwellinghouses (included under sub-head (i) above, which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 — (b) Number of inspections made for the purpose — iii. Number of dwellinghouses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — iv. Number of dwellinghouses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 326 2. Remedy of defects during the year without service of formal notice:— Number of defective dwellinghouses rendered fit in consequence of informal action by the Local Authority or their officers 275 3. Action under Statutory Powers during the year:— A.-—Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936. (i) Number of dwellinghouses in respect of which notices were served requiring repairs ... 8 (ii) Number of dwellinghouses which were rendered fit after service of formal notices:— (a) By owners 7 (b) by local authority in default of owners — 13 B.—Proceedings under Public Health Acts:— (i) Number of dwellinghouses in respect of which notices were served requiring defects to be remedied 12 (ii) Number of dwellinghouses in which defects were remedied after service of formal notices:— (a) By owners 12 (b) By local authority in default of owners — C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (i) Number of dwellinghouses in respect of which Demolition Orders were made — (ii) Number of dwellinghouses demolished in pursuance of Demolition Orders — D.—Proceedings under Section 12 of the Housing Act, 1936:— (i) Number of separate tenements or underground rooms in respect of which Closing Orders were made — (ii) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — SECTION E—INSPECTION AND SUPERVISION OF FOOD. (See Sanitary Inspector's Report, on pages 36—41). 44 SECTION F—INFECTIOUS ILLNESS. Notification. The following diseases are notifiable in the Urban District:— Cholera. Acute Primary pneumonia. Cerebro-spinal fever. Acute influenzal pneumonia. Continued fever. Acute Poliomyelitis. Diphtheria (including mem- Acute Polioencephalitis. branous croup). Puerperal Pyrexia. Dysentery. Relapsing fever. Enteric Fever (including Scarlet fever. paratyphoid fevers). Smallpox. Erysipelas. Trench fever. Encephalitis Lethargica. Typhus fever. Food poisoning. Tuberculosis (all forms). Malaria. Whooping Cough. Ophthalmia Neonatorum. Measles. Plague. Smallpox. There were no notifications of Smallpox during the year. There was, however, an outbreak in another part of London with direct contacts in the district, one requiring to be isolated. In addition, there have been frequent arrivals of Service contacts from abroad requiring to be kept under observation during their stay in the district. Enteric Fever. There have been no notifications of this disease during the year. Dysentery. There were 27 cases of Dysentery notified during the year. Five of these cases were traceable to food poisoning and are not to be regarded as infectious Dysentery. Eight of the remainder occurred at two addresses in members of the same families, five at one address and three at another. It was possible to isolate Bacillus Sonne in four only of these cases and B. Gaertner in one other. There were no deaths among these notified cases. There were, however, four deaths in children under two attributed to Gastro Enteritis, three of whom were under one month and one five months of age. There were 4 deaths in children under two caused by diarrhoea. Scarlet Fever. There were 231 cases of Scarlet Fever during the year; this is 41 less than the previous year. 45 TABLE XIII. SCARLET FEVER—MONTHLY DISTRIBUTION. Wards. Abbey. Bushey Mead. Central. Morden. Park. Ravensbury. Raynes Park. St. Helier. West Barnes. Total. January 1 2 2 2 2 5 - 14 3 31 February 2 — 2 1 3 1 2 21 — 32 March — 7 4 2 2 4 3 17 4 43 April 2 8 2 — G — — 10 6 34 May — 3 6 — 2 2 1 9 1 24 June — 2 1 2 1 — — 17 1 24 July — — 2 2 . 6 10 August — — 1 1 — 1 — 2 1 G September — - — 2 2 1 — 1 — 6 October — 1 — 2 — — 3 — 8 November 1 — — 3 — 1 1 2 — 8 December — 1 1 1 1 — 1 — — 5 Total 6 24 19 18 21 17 8 102 16 231 Monthly mean 0.5 2.0 1.58 1.5 1.91 1.41 0.66 8.5 1.33 19 25 The incidence in the various wards was as follows:—- Wards. Cases. Incidence per 1,000 population. Abbey 6 1.1 Bushey Mead 24 2.9 Central 19 1.6 Morden 18 1.6 Park 21 1.9 Ravensbury 17 2.4 Raynes Park 8 0.99 St. Helier 102 9.3 West Barnes 16 2,1 Diphtheria. There were 8 cases of Diphtheria during the year. This is the lowest figure ever recorded. There was unfortunately one death; this was in a child of ten who had not been immunised. Diphtheria Immunisation. The facilities for Diphtheria Immunisation were continued as in previous years. The numbers of persons immunised at the Clinics, in schools and by private practitioners is shown in the appended Tables. 46 TABLE XIV. Persons Immunised at Clinics during 1944. Age Groups. Wards. 0—5 yrs. 5—15 yrs. 15 & Over Total. Abbey 25 1 — 26 Bushey Mead 45 4 — 4!) Central 86 1 — 87 Morden 93 1 — 94 Park 41 2 — 43 Ravensbury 44 8 — 52 Raynes Park 45 5 — 50 St. Helier 61 5 — 66 West Barnes 42 6 - 48 482 33 — 515 TABLE XV. Persons Immunised by Private Practitioners. Age Groups. Wards. 0—5 yrs. 5—15 yrs. Total. Abbey 7 1 8 Bushey Mead 1 — 1 Central 25 2 27 Morden 4 — 4 Park 6 — 6 Ravensbury 3 — 3 Ravnes Park 1 — 1 'St. Helier 3 — 3 West Barnes 1 1 51 3 54 TABLE XVI. Children Immunised in Schools. School Incomplete Complete St. Helier No. 8 13 ,, ,, ,, 2 — 14 ,, ,, ,,3 11 4 ,, ,, ,, 4 31 78 Raynes Park 8 21 Merton Abbey 10 14 Aragon Road 12 24 London Road 2 5 Holy Family 11 31 Hillcross 2 12 95 216 47 I TABLE XVII. Children Immunised in Day Nurseries. Nursery Complete Middleton Road 5 Manor House 14 Hi eh Path 9 28 The number immunised since the inauguration of the Public Clinics in 1934 is as follows:— At Clinics. By Doctors. In Schools. At Day Nurseries. Total. 1934 93 28 — — 121 1935 375 19 — — 394 1936 383 13 664 — 1,060 1937 502 27 293 — 822 1938 376 22 260 — 658 1939 277 11 303 — 591 1940 234 12 50 — 296 1941 700 6 3,198 — 3,904 1942 1,127 16 753 — 1,896 1943 813 64 211 51 1,139 1944 515 54 216 28 813 TABLE XVIII. Incidence and Fatality of Diphtheria, 1920-1944. Population. Year. 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 1928 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 71,220 32 0.44 2 6.2 1940 68,540 20 0.29 1 5.0 1941 64,920 24 0.36 — - 1942 66,590 15 0.22 1 6.6 1943 65,880 16 0.24 1 6.35 1944 62,760 8 0.12 1 12.5 48 Anterior Poliomyelitis. There have been no cases either of Anterior Poliomyelitis or Acute Polioencephalitis during the year. Measles. There were 252 cases of measles—a considerable drop from previous years since the war. Measles used to present reliable biennial characteristics, but since the war it seems to have lost this feature. It is, however, a mild disease at the present time and one death only was attributed to this cause. Whooping Cough. The numbers of cases of Whooping Cough have also dropped this year, but to a lesser extent, the figure still being high. Again it is fortunate that the disease is less formidable than we usually have reason to expect and it was responsible for three deaths. Erysipelas. There were 21 notifications of this somewhat obsolete disease during the year. While regarded as one of the streptococcal group of diseases allied to Scarlet Fever, its epidemiological importance has become somewhat obscure. Puerperal Pyrexia. There were 8 cases of Puerperal Pyrexia notified, giving a Puerperal Pyrexia rate of 6.8. Of the 8 cases notified 6 occurred in hospital and 2 were domiciliary notifications. Since the war the treatment of these cases has been undertaken for us by the Wandle Valley Hospital; three of these cases were treated there during the year. Ophthalmia Neonatorum. There were three cases of Ophthalmia Neonatorum notified, all were in hospital at the time of notification. Actually two of the cases were domiciled in Wimbledon, and in the case which was resident in this district recovery was complete and vision unimpaired. Pneumonia. There were 46 cases of Pneumonia notified of which 5 were stated to be influenzal in origin. This compared with 27 in the previous year. Food Poisoning. There were no outbreaks of food poisoning during the year. There were, however, five cases apparently unrelated which occurred during the year. In two of these cases fish paste came under suspicion and in one other re-heated mutton. There seems to be some intoxication caused by heating mutton en casserole fashion or stew, as it has come under suspicion on more than one occasion in investigating cases of food poisoning. The usual story is that the meat has been partly cooked the night before and put on again to complete the cooking in the morning prior to serving. 49 TUBERCULOSIS. One hundred and forty new cases were added to the register of tuberculous persons, compared with 151 in 1943. These additions were:— Males Females Total Pulmonary 77 50 127 Non-Pulmonary 9 4 13 86 54 140 TABLE XIX. Tuberculosis Register at 31st December, 1944. Wards, Registered at 31st December, 1944, Total. Number on Register at mid-year. Pulmonary, NonPulmonary. Abbey 40 11 61 49 Bushey Mead 61 11 72 66 Central 43 9 52 48 Morden 87 9 96 80 Park 91 18 109 100 Ravensbury 82 27 109 102 Raynes Park 46 6 52 55 St. Helier 122 28 150 138 West Barnes 48 14 62 60 Whole district 620 133 753 698 The Anti-Tuberculosis Scheme in this district is administered by the County Council. Institutional treatment was 50 Of these 140, 97 were primary notifications, 37 were transferred from other districts, and 6 came to notice in other ways. During the year 80 persons were removed from the register for the following reasons:— Recovered 3 Removed from the district 40 Death 37 After allowing for the additions and deductions, the number remaining on the register at the 31st December, 1944, was distributed as shown in the following table:— provided for 135 persons in 1944 from Merton and Morden, as follows:— At the County Sanatorium, Milford 32 At other Institutions 103 135 The deaths from Tuberculosis number 37, of which 35 were due to pulmonary and 2 to non-pulmonary disease. The deaths are classified by age and sex in the following table:— TABLE XX. Deaths Due to Tuberculosis, 1944. Ages Years Pulmonary Non-Pulmonary Totals Males Females Males Females 0— — — — — — 1— — — 1 — 1 5— — — — — — 15— 3 — — — 3 25— 3 3 — — 6 35— 6 3 1 — 10 45— 11 2 — — 13 55— 3 1 — — 4 65— — — — — — Totals 26 9 2 — 37 Six deaths were m unnotified cases. The district provides a free service for the examination of sputum for tubercle bacilli. During the year 67 specimens were examined with a positive result in 9 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. 51 52 TABLE XXI. TUBERCULOSIS—New Cases, Age and Sex, Distribution and Manner of Admission to Register. Age Groups. Primary Notifications ("A"). Cases transferred from other districts. Cases brought to notice otherwise than by notification and transfer. Total new cases. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. P.ulmonary. Non-Pulmonary. Years. M F M F M F M F M F M F 0-1 — — — — — — — — — — — — — 1-5 1 — 3 — — — — — — — — — 4 5-10 2 1 1 1 — — — — — — — 5 10-15 4 — 1 — — — — — — — — — 5 15-20 9 9 1 2 2 — — — — — — 23 20-25 6 8 — — 2 4 — — 1 — — — 21 25-35 10 9 1 1 5 6 1 — — — — — 33 35-45 14 1 1 1 5 3 1 — — — i — 27 45-55 3 2 — — 2 — — — 3 — — — 10 55-65 4 3 — — 2 1 — — — 1 — — 11 65 up 1 — — — — — — — — — — — 1 Totals 54 33 6 4 19 16 2 — 4 1 1 — 140 97 37 6 DAY NURSERIES. The three Nurseries. Middleton Road, Manor House and High Path were in full operation from the beginning of the year. In addition, the new Nursery in Morden Road on the site bounded by Kenley Road and Morden Road, was completed and arrangements were made to open it on Monday, the J 9th June. Unfortunately on the previous night a flybomb fell in Morden Hall grounds just 011 the side of the river remote from Morden 1 lull itself, and damaged the Nursery extensively. As at that time the number of dwellings being knocked out and rendered uninhabitable was gaining on the capacity to render, first aid repairs to provide some sort of dwelling for the homeless, it was decided that labour and materials could not be diverted to repair the Day Nursery at such a time, so that the career of the new Morden Hall Nursery was ended before it had even begun. At the same time, the Nursery to be built on the site at Camborne Road, acquired and reserved for a Clinic before the war, had reached the plan completion stage. The Ministry, however, decided in view of the new circumstances that any idea of going on with the building must be abandoned. The appended figures will indicate the extent to which these Nurseries were being used prior to the flybomb attack which started in June. Nusery. Average attendance for three months prior to and including June, 1944. Highest attendance on any one day for three months up to June, 1044. Number of Mothers with children on the Register at June, 1944. Middleton Road 46 55 17 under 2; 38 over 2 63 Manor House 39 48 12 under 2; 36 over 2 46 High Path 38 50 17 under 2; 33 over 2 52 With the frequent necessity to repair to the shelter on the receipt of the warning siren, carrying out toilet arrangements for babies in the shelters was something of a nightmare, 53 and it is fortunate that no complications resulted from these adverse conditions; perhaps it was as well that the numbers were so low. It may well be wondered in years to come why we ever carried on the nurseries during this time. It was a fact, however, that mothers who brought their children were influenced by the shelter protection in the nurseries, which, if not of a better standard of safety, was more comfortable. Many of the mothers, in addition to carrying on their domestic responsibilities continued at their work. All three of the nurseries are recognised by the National Society of Day Nurseries for training probationers, and the training on the theoretical side is undertaken by the Wimbledon Technical College. In my introductory letter to this report I mentioned that the ultimate quality of every aspect of our public health services depends on the quality of the staff. Nowhere is this more true than in the Nurseries. From information regarding nurseries in other districts and from congratulatory opinions expressed by visitors, I have formed the opinion that we are entitled to be pleased with our achievement in this respect, and though I am reluctant to single out any section of the Staff for special mention, it would be an omission of fact to fail to put on record that it is due to the quality of the staff, both nursing and teaching, which we have been so fortunate to recruit, that we have been able to carry on these nurseries with so few difficulties and anxieties and with such success. CLEANSING STATION. As will be seen from the appended table, 1,625 attendances were made at the Cleansing Station. This figure compares with 3,108 attendances in 1943. Number of cases of Scabies treated 460 Cases of Scabies with concurrent verminous head 9 Cases of Scabies with Secondary Septic Skin condition 15 Number of cases of Verminous heads only 58 Total number of attendances at the Centre 1,625 54 INDEX PAGE Acreage 6 Ambulance Facilities 19 Acute Poliomyelitis 49 Births 9-ll, 25 In hospitals or maternity homes 11 Rates 7 Bed Bugs—Eradication of 36 Cancer—Deaths from 9, 15 Rate 9 Cerebro-Spinal Fever 15 Child Life Protection 34 Clinics and Treatment Centres 20, 22, 28 Climatic Conditions 7 Closet Accommodation 35 Cleansing Stations 54 4 Deaths 8-15 Causes of 13-15 Rates 7-9 Diphtheria 46 Immunisation 21, 46-48 Clinics, times and places 21 Children Immunised in Schools 47 Persons Immunised at Clinics 47 Persons Immunised by Private Practitioners 47 Incidence and fatality for 25 years 48 Disinfestation 36 Drainage and Sewerage 35 Drainage work 36 Day Nurseries 53 Enteric Fever 45 Erysipelas 49 55 INDEX—continued. PAGE Factories 41 Food and Drugs Act, 1938 39, 40 Food Supply 36 Inspections 37 Unsound Food 37 Health Services 18 Heart Disease—Deaths from 13, 15 Hospitals 22, 24 Housing 43 Inspections and Defects 36, 43 Number inhabited 6 Verminous premises 36 Industry 6 Infant Mortality 7, 17 Rates 8 Infectious diseases 45, 52 Diseases notifiable 45 Inquests 13 Isolation Hospital 22 Laboratory Facilities 19 Examination of clinical material 19 Maternal Mortality 15 Rates 16 Maternity and Child Welfare 25 Ante-Natal Clinics 26, 29 Attendances at each Centre by age groups 27 Attendances at Infant Consultation Clinics 27 Attendances at Maternity Clinics 26 Attendances at all Infant Welfare Centres 27 Attendances at Centres over last ten years 27 Attendances in relation to the registered births 28 Consultant advice for maternity 31 Convalescent Home Treatment 30 56 INDEX—continued. PAGE Maternity and Child Welfare continued— Dental Scheme 31, 32 Attendances 32 Operations performed 32 Emergency Maternity Unit 30 Health Visiting 29 Home Helps 31 Hospital provision for maternity 24, 28 Midwives 33 Orthopaedic Treatment 30 Sessions, times and places 20 Sterilised Maternity Outfits 31 Voluntary Helpers 33 Work of the Centres 25 Meat Inspection 38 Measles 49 Milk Supply 38 Neonatal Deaths 17 Nelson Hospital 11, 28 Notification of Births 25 Nursing in the Home 18 Ophthalmia Neonatorum 49 Population 9, 11 Public Assistance 6 Public Cleansing 35 Public Health Committee 4 Puerperal Pyrexia 49 Rainfall 7 Rateable value 6 Rats and Mice Destruction 41 Respiratory diseases—deaths from 14 Representatives on:— Nelson Hospital Council 4 Wandle Valley Joint Hospital Board 4 Wandle Valley Joint Sewerage Board 4 Road Accidents (deaths from) 15 57 INDE X— continued. PAGE Sanitary Circumstances 35 Sanitary Inspection 42 Scarlet Fever 45 Incidence in each Ward with rates 46 Monthly distribution of cases 46 Shops Acts, 1912-1936 42 Slaughterhouses 38 Smallpox 22 Smoke Abatement 42 Social Conditions of the Area 6 Staff 5 Statistics 6 Comparative 10 Tuberculosis 24 Admissions to Sanatorium 24, 51 Deaths due to 51 Dispensary 22 New cases—by age groups 52 Number on register at year end 50 Venereal Diseases 22 Water Supply 35 41 Whooping Cough 49 Zymotic Disease—Deaths from 9 Rate 9 58 J. B. Blackmore & Co., Ltd., Printers, Wimbledon, S.W.19.