MER 9 URBAN DISTRICT of MERTON AND MORDEN ANNUAL REPORT of the Medical Officer of Health for the year 1947 AND REPORT OF THE SANITARY INSPECTOR URBAN DISTRICT of MERTON AND MORDEN ANNUAL REPORT of the Medical Officer of Health for the year 1947 AND REPORT OF THE SANITARY INSPECTOR PREFACE. To the Chairman and Members of the Merton and Morden Urban District Council. Madam Chairman, Ladies and Gentlemen, It is my duty to present to you my Annual Report for the year 1947. This is my Eighth Annual Report to you and it will be the last report in which I shall have the pleasure of presenting it to you in such a comprehensive fashion, as since the 5th July, 1948, many of the services dealt with have become the responsibility of the County Council. At this moment which marks the beginning of a new era, it is not out of place to look back and examine our achievements in the years just behind us. To facilitate study of the relative statistics, I have prepared six graphs which are inserted before the text of this report. These graphs bring out, I think, more clearly than any words, the progress which has been made in our health services. The vital statistics for the year are eminently satisfactory. The Register General has estimated the population at 75,290, the highest figure yet accorded to the district. The total births were 1,374 including still births. The total live births were 1,345 again a record figure. There was one maternal death which makes our maternal mortality rate 0.74 per thousand live births and 41 actual deaths of infants under one year of age gives us an infant mortality rate of 30.4 per thousand. The number of deaths from cancer has dropped slightly from 126 to 118 as has the number from tuberculosis from 42 to 32. This latter fact, together with the fact that fewer cases were added to the register in 1947 than in the previous year, may afford some comfort in our anxiety with regard to the ultimate effect of the present housing conditions on the incidence of this disease. The death rate for the population at 8.1 per thousand is below the average for the past 10 years, in fact our vital statistics place us among the favoured areas of England and Wales. It is profoundly to be hoped that no epidemics of infantile paralysis will recur to deprive the year 1947 of its claim to fame in this respect. The epidemic as is well known was widespread throughout the whole country and we had 22 cases notified in Merton and Morden. Fuller details will be found in the body of the report in Section F. 3 There were 347 cases of measles, a number which while scarcely justifying the description epidemic is a much larger number than we expect to find in a non-epidemic year. It may well be that this is a matter for gratification as the disease is at the present time relatively mild and by maintaining an annual aggregate the immunity of the child population is maintained at a relatively high level. There were 232 cases of whooping cough. Whooping cough at the present time is enemy No. 1 to the child. It is a most debilitating disease for the child and a most distressing experience for the parents to witness. It is to be hoped that information will shortly be available to decide the value of whooping cough vaccine, so that we may consider it as a public preventive measure. The sanitary work of the department has been dealt with in detail in the text of the report. During the year we lost the services of two of our experienced officers and we have not been able to replace them with officers of similar experience. This may not therefore be regarded as the happiest moment to foreshadow expansion but the growth of the district and the necessity to return soon to pre-war standards of hygiene leave us no alternative. This is of course of particular importance in regard to food handling and preparation. In conclusion I would like to take this opportunity to thank the members of the Council for their interest in the work of improving the public health and in the support which they give to the public health department. I would also like to record my personal gratitude to all the public health staff through whose efforts alone, that improvement can be carried into effect. I am, Madam Chairman, Ladies and Gentleman, Your obedient servant, A. W. JOHNS, Medical Officer of Health. September, 1948. 4 URBAN DISTRICT COUNCIL OF MERTON AND MORDEN, 1947. PUBLIC HEALTH COMMITTEE Chairman: Mrs. L. A. Doel. Mr. J. H. Burrows. Mrs. S. A. Lodge. Mr. J. A. Farnham. Mr. G. H. R. Martin. Mr. R. W. Goddard. Mr. F. J. Matthews. Dr. E. H. Kelly, J.P. Mr. A. E. Southard. Mr. A. H. Gray, J.P. (ex-officio). Mrs. H. Cobbett (ex-officio). MATERNITY AND CHILD WELFARE COMMITTEE Chairman: Dr. E. H. Kelly, J.P. Mr. J. H. Burrows. Mr. F. J. Matthews. Mrs. L. A. Doel. Mr. A. E. Southard. Mr. J. A. Farnham. Mrs. A. E. Edwards Mr. R. W. Goddard. Mrs. Merritt co-opted members. Mrs. S. A. Lodge. Mrs. E. L. Kimber Mr. G. H. R. Martin. Mr. A. H. Gray, J.P. (ex-officio). Mrs. H. Cobbett (ex-officio). REPRESENTATIVES ON THE WANDLE VALLEY JOINT HOSPITAL BOARD Mrs. H. Cobbett. Mr. C. S. Marsh. Mr. F. J. Grimme, J.P. Mr. A. H. Gray, J.P. (ex-officio). REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD Mrs. E. M. Clifton, J.P. Mr. D. Shadbolt. Mr. S. F. Franklin. Mr. A. H. Gray, J.P. (ex-officio). REPRESENTATIVES ON NELSON HOSPITAL COUNCIL Mr. J. A. Farnham. Mr. E. W. Warren. Dr. E. H. Kelly, J.P. MERTON AND MORDEN TUBERCULOSIS CARE COMMITTEE Chairman: Mrs. Ft. Cobbett. Vice-Chairman: Mrs. M. E. Shaw. Secretary: Miss N. L. Tayler. Treasurer: Mr. F. S. Buck. 5 PUBLIC HEALTH STAFF, 1947. 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 d e F. C. Thomas, M.R.San.I. Deputy Chief Sanitary Inspector: b d f W. T. Pinches, M.R.San.I. Sanitary Inspectors: c g C. Jones, M.S.I.A. (to 31.8.47). b d f N. Smith, M.S.I.A. (to 31.7.47). b L. H. Thomas (from 29.9.47). Senior Health Visitor: Miss E. M. Sperry. Health Visitors: Miss M. E. Black. Mrs. D. Lewis (from 9.7.47). Miss V. M. Evans (to 30.4.47). Miss E. F. Martin. Miss J. Eve. Miss C. I. Tregurtha Miss A. Howard. (from 10.12.47) Chief Clerk: A. A. Makepeace. Clerks: R. J. Mitton. B. J. Fentiman (to 14.6.47). H. J. Herbert. R. A. Conolly (from I..7.47). Miss E. M. Hyem (from 20.1.47). Ante-Natal Officer: Stanley Arthur Bond, M B., Ch.B., M.R.C.O.G. Anaesthetist 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.). Dental Attendant and Home Help Organiser: Mrs. W. E. Robertson. a Sanitary Inspector's Certificate, Royal Sanitary Institute. b Sanitary Inspector's Certificate, San. Insp. Exam. Joint Board. c Sanitary Inspector's Certificate, Sanitary Association, Scotland. d Meat and Food Inspector's Certificate, Royal Sanitary Institute. e Sanitary Science Certificate, University of Liverpool. f Smoke Inspector's Certificate, Royal Sanitary Institute. g Meat and Food Certificate, Royal San. Assn. of Scotland. 6 7 8 9 10 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 3,238 Number of inhabited houses according to Rate Books 21,416 Rateable value at 31st December, 1947 £667,115 Sum represented by Id. rate £2,760 Lying in the valley of the Thames and naturally drained by its tributaries the River Wandle and the Pyl and Beverley Brooks, the district is flat. The surface rises gently from the northern or Wimbledon boundary toward the southern limit of the Morden Ward, the whole lying between the 42 ft. and 141 ft. ordnance datum levels. The subsoil is sand in the north-eastern part and merges into clay which extends throughout the greater part of the district lying to the south. The Urban District forms part of the London "dormitory area" and the majority of its wage earners earn their livelihood in the County of London. Industry. The number of factories registered under the Factory Act at the end of 1947 was: — Factories with mechanical power:— Employing more than 40 persons 37 Employing less than 40 persons 142 Factories without mechanical power 22 201 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 mental hospitals 79 Total number of persons in receipt of domiciliary assistance on: — 1st January, 1947 289 1st July, 1947 256 31st December, 1947 298 Total amount of domiciliary assistance granted in Merton and Morden in the year 1947 £12,336 9s. 6d. 11 Climatic Conditions. Rain gauges are installed at the Joseph Hood Recreation and West Barnes Pumping Station. The monthly recordings are as shown below: — RAINFALL, 1947. MONTH JOSEPH HOOD RECREATION GROUND WEST BARNES PUMPING STATION Inches Days with o.Iin. or more Days with o.4in. or more Inches Days with o.Iin. or more Days with o.4in. or more January 1.43 17 13 1.57 18 13 February .82 7 4 1.53 15 5 March 4.98 24 20 5.11 27 20 April 1.68 10 9 1.83 13 10 May 1.51 15 12 1.67 18 13 J une 2.03 11 10 2.15 15 12 July 1.19 11 8 1.03 9 8 August .38 5 2 .26 4 3 September 1.25 8 6 1.31 10 5 October .24 4 3 .14 3 1 November 1.15 9 8 1.14 10 7 December 2.37 13 11 2.50 16 12 Total 19.03 134 106 20.24 158 109 VITAL STATISTICS. The comparative statistics set out in Table I, page 15, enables us to see at a glance how our own area has fared during the year 1947 in respect of these factors which may be regarded as indicative of the state of health of a population. The table gives the comparable figures for England and Wales as a whole, the 126 County Boroughs and Great Towns including London, the 148 smaller towns, population 25,000 to 50,000 and for the London Administrative County. For our own interest an additional column has been added giving the local figures. It will be seen that except for a lower birth rate and a higher incidence of whooping cough and pneumonia, all the local figures are more favourable than those in the other columns. Our death rate is 4 per thousand, lower than the best in the other groups, as is our figure for the deaths of infants under 2 years of age from diarrhoea and enteritis, while our stillbirth rate is significantly below the others as is the incidence of puerperal pyrexia. That our more favourable incidence of these infectious diseases is in no way due to less scrupulous notification is shown by the fact that we have the highest incidence of pneumonia, which is probably the least regularly notified of all infectious diseases. 12 The total deaths from all causes was 611 and the total live births 1,345, giving therefore a natural increase in population of 734. The appended table sets out the comparison for the past five years of the local infant mortality rate with that for England and Wales: — England and Wales Merton and Morden 1943 49 23.5 1944 46 28.7 1945 46 33.1 1946 43 22.2 1947 41 30.4 Once again a further decrease in the number of illegitimate births was recorded during the year. Details of the arrangements existing for the care of illegitimate children and their mothers are given on page 39. 13 SUMMARY OF VITAL STATISTICS. (Registrar General's Figures). Population : Registrar General's Estimate 75,290 Births : M. F. Total Live (Legitimate) 644 663 1.307 (Illegitimate) 24 14 33 668 677 1,345 Stillbirths (Legitimate) 13 14 27 (Illegitimate) 2 – 2 15 14 29 Total Births 683 691 1,374 Birth Rate 17.86 per 1,000 population Still Birth Rate 21.1 per 1,000 births Deaths : M. F. Total 308 303 611 Death Rate 8.1 per 1.000 population Infant Mortality : Total deaths under one year 41 Infant Mortality Rate per 1,000 Live Births 30.4 Deaths of Legitimate Infants under 1 year 39 Death Rate per 1,000 Legitimate Births 29.8 Deaths of Illegitimate Infants under 1 year 2 Death Rate per 1,000 Illegitimate Births 52.6 Maternal Mortality : Deaths from Sepsis 1 Deaths from other maternal causes Nil Maternal Death Rate per 1,000 Live Births 0.74 Zvmotic Deaths : Deaths from Measles Nil Whooping Cough 1 Diarrhoea Nil 7 Principal Zymotic Diseases 1 Zymotic Death Rate (per 1,000 population) 0.01 Deaths from Tuberculosis : All forms 32 Rate per 1,000 population 0.42 Phthisis : 26 Rate per 1,000 population 0.34 Deaths from Cancer : 118 Rate per 1,000 population 1.56 14 TABLE I. COMPARATIVE STATISTICS, 1947. 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 Administive County Merton and Morden Rates per 1,000 Population. Births: Live 20.5 23.3 22.2 22.7 17.86 Still 0.50 0.62 0.54 0.49 0.38 Deaths: All causes 12.00 13.00 11.9 12.8 8.1 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 0.02 0.01 Diphtheria 0.01 0.01 0.01 0.01 0.00 Influenza 0.09 0.09 0.08 0.08 0.05 Smallpox 0.00 0.00 0.00 — 0.00 Measles 0.01 0.02 0.02 0.01 0 00 Notifications: Typhoid Fever 0.01 0.01 0.00 0.01 0.00 Paratyphoid Fever 0.01 0.01 0.01 0.01 0.00 Cerebro-spinal Fever 0.05 0.06 0.05 0.05 0.01 Scarlet Fever 1.37 1.54 1.37 1.31 1.81 Whooping Cough 2.22 2.41 2.02 2.80 3.08 Diphtheria 0.13 0.15 0.14 0.14 0.06 Erysipelas 0.19 0.21 0.18 0.22 0.17 Smallpox 0.00 0.00 0.01 0.00 0.00 Measles 9.41 9.13 9.58 5.29 4.60 Pneumonia 0.79 0.89 0.68 0.64 0.91 Rates per 1,000 Live Births. Deaths under 1 year of age 41 47 36 37 30.4 Deaths from Diarrhoea and Enteritis under 2 years of age 5.8 8.0 3.7 4.8 0.0 Rates per 1,000 Total Births (Live and Still). Notifications: Puerperal Fever Puerperal Pyrexia 7.16 8.99 6.27 1.21 *6.94 4.3 * Including Puerperal Fever. 15 POPULATION. The Registrar General has increased our population figure this year by 1,700 to 75,290, the highest figure yet recorded. Reference to Table II on page 18 will show that our population climbed to a peak in 1939 at 72,150 and this fell during the war years until in 1944 it had dropped to 62,760 just above its 1936 level. After 1944 it started to climb again and last year at 73,590 it passed its previous zenith. It has therefore continued its climb to a new record. BIRTHS. The registered live births for the year 1947 total 1,345 of which 38 were illegitimate births. This figure is the highest ever recorded for the district and raises the birth rate to 17.86 per thousand with the exception of the year 1944 when it was 18.3 per thousand. This is the highest recorded since 1923, as reference to Table II will show. This compares with a rate of 20.5 per thousand for England and Wales for the year 1947 which was the highest for 26 years. For many years before the war, the birth rate was below the level necessary to maintain the population. This figure is 21 per cent. above the reproduction rate. It remains to be seen whether the fall in the population predicted by the experts during the thirties will eventuate. These figures may only mean postponement and it may be that another two or three years must elapse before we can see at what level the birth rate is likely to settle to under normal peace time conditions. The number of illegitimate births has fallen from 45 last year to 40 this year. The illegitimate birth rate shows signs of resuming peace time levels. Expressed as rates per thousand live births the appended table shows the trend over the past eleven years. Year No. illegimate live births Rate per thousand live births 1937 21 25.9 1938 31 31.3 1939 27 26.9 1940 29 29.9 1941 40 47.2 1942 39 36.5 1943 57 49.7 1944 49 42.6 1945 63 61.3 1946 45 35.7 1947 38 28.3 16 INSTITUTIONAL AND DOMICILIARY BIRTHS. The notifications show that 1,052 births took place in institutions, hospitals and private nursing homes. This is 129 more than in 1946 and represents 76.5 per cent, of the total. They occurred in the following hospitals, etc.: — St. Helier County Hospital 468 Nelson Hospital 285 St. Luke's Hospital, Guildford 60 Kingston County Hospital 17 Other hospitals, institutions and nursing homes 222 1,052 17 TABLE II Showing Births and Deaths with Rates since the Amalgamation of Merton and Morden. Year Estimated population Total Births Birth Rate Total Deaths Death Rate Natural Increase 1913 16,767 400 23.5 166 9.9 234 1914 17.500 420 24.0 142 8.2 278 1915 17,500 402 22.9 169 10.4 233 1916 16,000 348 27.75 134 8.3 214 1917 17,000 271 15.75 145 9.0 126 1918 17,552 241 14.0 204 13.0 37 1919 18.100 257 14.2 210 11.6 47 1920 18,200 359 19.8 171 9.4 188 1921 18,000 322 17.8 138 7.6 184 1922 18,500 365 19.7 198 10.7 167 1923 18,750 341 18.1 153 8.1 188 1924 18,710 311 16.6 170 9.1 141 1925 18,960 307 16.2 187 9.9 120 1926 19,980 333 16.7 179 9.0 154 1927 21,850 352 16.13 200 9.2 152 1928 25,780 392 15.2 224 8.7 168 1929 27,430 442 16.1 281 10.2 161 1930 35,000 452 12.9 241 6.9 211 1931 41,610 628 15.1 333 8.0 295 1932 48,550 770 15.8 352 7.2 418 1933 52,130 644 12.3 416 7.9 228 1934 55,550 770 13.8 484 8.7 286 1935 57,440 721 12.5 433 7.5 288 1936 61,000 789 12.9 443 7.2 246 1937 65,530 812 12.3 487 7.4 325 1938 68,980 990 14.3 509 7.3 481 1939 72,150 1,005 13.9 516 7.2 489 1940 68,540 971 14.2 714 10.4 257 1941 64,920 848 13.06 557 8.58 291 1942 66,590 1,069 16.05 588 8.8 481 1943 65,880 1,146 17.4 575 8.7 571 1944 62^760 1,151 18.3 628 10.0 523 1945 66,050 1.027 15.5 602 9.1 425 1946 73.590 1,261 17.1 568 7.7 693 1947 75,290 1,345 17.86 611 8.1 734 DEATHS. The number of registered deaths after adjustment by transferable deaths, is given below: — 611 total deaths of which 308 were males and 303 females. The seasonal mortality is indicated by the deaths for each quarter of the year, which were:— First quarter 219 Second quarter144 Third quarter 109 Fourth quarter 139 18 Inquests. Inquests were held on 19 deaths occurring in the district, 12 of which were in respect of residents. The verdicts returned were as follows:— (1) Natural Causes 3 (2) Suicide by— Lysol Poisoning 1 Coal Gas Poisoning 3 — 4 (3) Accidental Deaths— Injury from train collision 1 Collision with motor vehicles 4 Asphyxia by suffocation 1 Asphyxia due to rubber ligature encircling neck 1 Fall in street 1 Fall from tree 1 Fall at home 1 — 10 (4) Misadventure— Bilateral Mastoiditis and Otitis 1 — 1 (5) Other violent causes- Fracture of skull 1 — 1 19 The total number of inquests held were twelve less than in the year before. Road accidents were responsible for four of the total accidental deaths, compared with twelve for the previous year. CAUSES OF DEATH. Heart disease resumes its place at the head of the list of causes of death this year with 163, and cancer, which last year headed the list with 126 is relegated to second place with 118. that being the total for all types of cancer. This is a welcome drop in the number of deaths from this disease and the rate has fallen correspondingly from 1.7 per thousand population last year to 1.5 this year — the lowest rate since 1942. There were 32 deaths from tuberculosis and while this fall in the number of deaths from tuberculosis is very welcome in view of the environmental conditions operating at the present time, it is a sad fact that unlike heart disease and cancer, tuberculosis takes its toll mainly from the younger age groups, 15-35. This is a national racial as well as a personal tragedy. 163 deaths from heart disease is at first sight a formidable figure and is in fact 26.6 per cent of the total deaths, but many of these have had their three score years and ten and octogenarians and 19 even nonagenarians are to be found among them but the 32 deaths from tuberculosis, 19 of whom are under 35 have hardly begun to live and their withdrawal from the community just as they begin to reach their highest productive potential accentuates the seriousness of the mortality from this disease. There were 26 deaths from tuberculosis of the respiratory system, 15 males and 11 females, and there were 6 deaths from non-respiratory tuberculosis of whom 3 were males and 3 females, giving a total number of deaths of 32 as against 42 in 1946 and 45 in 1945. CANCER DEATH RATE. No. of deaths from Cancer for past 10 years. 1938 89 1943 116 1939 91 1944 107 1940 76 1945 116 1941 85 1946 126 1942 103 1947 118 Year. Death Rate per 1,000 population. Year. Death Rate per 1,000 population. 1938 1.2 1943 1.7 1939 1.1 1944 1.7 1940 1.2 1945 1.7 1941 1.3 1946 1.7 1942 1.5 1947 1.5 TABLE III. Deaths from Respiratory Diseases, 1927-1947. Year Bronchitis Pneumonia Other Respirator> Diseases Total Death Rate 1927 10 11 5 26 1.2 1928 8 14 2 24 0.9 1929 11 20 4 35 1.2 1930 2 10 3 15 0.4 1931 8 24 4 36 0.8 1932 11 27 3 41 0.8 1933 12 32 6 50 0.9 1934 7 38 4 49 0.8 1935 9 22 6 37 0.6 1936 2 35 2 39 0.6 1937 14 31 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 30 6 66 0.9 1942 9 12 20 41 0.62 1943 25 36 9 70 1.05 1944 26 29 7 62 0.98 1945 6 22 12 70 1.05 1946 22 17 17 56 0.76 1947 31 25 4 60 0.79 20 TABLE IV. Causes of Death during the year 1947. No. Cause of Death Males Females Total 1 Typhoid and Paratyphoid Fevers — — — 2 Cerebro spinal fever — — — 3 Scarlet Fever — — — 4 Whooping Cough 1 — 1 5 Diphtheria — — — 6 Tuberculosis Respir. System 15 11 26 7 Other forms of Tuberculosis 3 3 6 8 Syphilitic disease 3 4 7 9 Influenza 2 2 4 10 Measles — — — 11 Ac. Poliomyel. and polioencephalitis — — — 12 Ac. inf. encephalitis — 1 1 13 Cancer of buc. cav. and oesoph. (M) uterus (F) 1 8 9 14 Cancer of stomach and duodenum 10 5 15 15 Cancer of breast — 16 16 16 Cancer of all other sites 35 43 78 17 Diabetes 2 4 6 18 Intra-cranial vascular lesions 28 36 64 19 Heart disease 84 79 163 20 Other dis. of circ. system 12 8 20 21 Bronchitis 16 15 31 22 Pneumonia 14 11 25 23 Other respiratory diseases 3 1 4 24 Ulcer of stom. or duodenum 4 — 4 25 Diarrhoea under 2 years — — — 26 Appendicitis — -— — 27 Other digestive diseases 4 7 28 Nephritis 7 5 12 29 Puer. and post abort, sepsis — 1 1 30 Other maternal causes — — — 31 Premature birth 5 3 8 32 Con. mal. birth inj. inf. dis. 16 12 28 33 Suicide 3 3 6 34 Road traffic accident 3 2 5 35 Other violent causes 10 4 14 36 All other causes 27 23 50 Total all causes 308 303 611 MATERNAL MORTALITY. One death of a mother in childbirth in our area gives us this year a maternal mortality of 0.73 per thousand total births. Last year our mortality was nil and for the past five years it has been less than one. This is of course a matter for gratification, but it will be appreciated that as one death raises it this year from nil to 0.73, it would not take many such incidents — another one or two even with our 1,400 births — to produce a 21 figure which would be an acute disappointment. As is mentioned before in dealing with relatively small numbers like this, we can only get a reliable picture if we take them over a period of years. Reference to Table V below enables us to do this and we see that our figures are consistently better than those for the country as a whole and indeed are very satisfactory. TABLE V. Maternal Mortality, 1927-1947. Year Death rate per thousand total births. Sepsis Other causes Total 1927 — 2.8 2.8 1928 — — — 1929 2.2 — 2.2 1930 — 2.2 2 1 1931 1.6 3.1 4.7 1932 5.1 2.5 7.6 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 2.94 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 1945 — 0.97 0.97 1946 — — — 1947 0.73 — 0.73 INFANT MORTALITY. In the past few years the causes of infant deaths have been set cut in detail to give a proper appreciation of the factors responsible. Having reduced this mortality from 130 to 40 per thousand in the past 30 years, it may be felt we have arrived at an irreducible minimum. So far as deaths attributed to lack of infant care is concerned, this is probably to a great extent true, but half of these deaths occur before the end of the first month of life, in the so-called neonatal period and there has been nothing like the same reduction in this group over the past 30 years that there has been in the other group. There has been a growing realisation in recent years that the reduction of these neonatal deaths can only be secured by better ante-natal care and improved obstetric care during labour. The obvious inference has been drawn that this can only be achieved 22 by a higher degree of obstetric specialisation in those undertaking ante-natal care and conducting labours. With regard to the conduct of labour, there are good reasons for doubting whether even if practicable this would be a profitable policy and as regards ante-natal care, it should be remembered that a large proportion of these neonatal deaths and in fact those most likely to be capable of reduction are not due to obstetric faults but to disease during pregnancy or deviation from normal health in the mother, which, if they require specialist attention may well be more within the province of the physician than the obstetrician. Obstetric disasters due to pelvic deformities are practically a thing of the past. It may be a salutary reminder now the health services of the country are so much motivated by the curative side that we do not owe this to progress in obstetrics but mainly to improvements in nutrition. Infant Deaths — With causes of death. Sex. Age. Cause of Death. Male 5 minutes Asphyxia. Male 16 hours Prematurity. Female 2 days Haemorrhage Icterus Neonatorum. Female 2 weeks Congenital potency of intraventricular septum of heart. Male 20 hours Congenital Heart Disease. Male 6 months Gastro-Enteritis Generalised Infantile Siborrhosia Eczema. Male 7 hours Intracranial Haemorrhage. Female 6 hours Atelectasis. Male Newly-born Superarenal Haemorrhage. Male 6 months Convulsions Bronchitis. Female 3 hours Prematurity. Male ½ hour Asphyxia Neonatorum Atelectasis. Male 4 months Asphyxia. Female 5 days Asphyxia. Male 2 months Asphyxia. Male 1 week Atelectasis Prematurity. Male 1 day Spina Bifida. Female 1 month Broncho Pneumonia Prematurity. Female 2 days Foetal Atelectasis. Male 1 day Foetal Atelectasis. Female 1 week Prematurity. Male 1 week Prematurity. 23 Sex. Age. Cause of Death. Female 1 month Lobar Pneumonia Marasmus. Male 1 week Broncho Pneumonia. Male 2 hours Congenital Heart Disease. Male 5 months Asphyxia. Male 2 days Icterus Gravis Neonatorum. Male 1 day Congenital Heart Lesion. Male 2 hours Maternal Hydramnios Premature birth. Female 2 days Congenital patent auricular septum of heart. Female 4 days Icterus Gravis Neonatorum. Female 10 minutes Intracranial Hæmorrhage Birth Injury. Female 2 weeks Pneumonia. Amyotonia congenita. Male 20 minutes Hydrops foetalis. Male 2 months Whooping Cough. Female 8 hours Foetal Atelectasis. Male 12 hours Ac. Pulm Oedema Prematurity. Male 6 days Intestinal obstruction Herniation small bowel through con genital defect in mesentery Inhalation Pneumonia. Female 7 months Pneumococcal Meningitis Brain abscess. Male 3 hours Erythroblastosis Foetalis. Male 2 days Syncope Prematurity PREMATURE BABIES. The problem of prematurity will remain with us until we understand more clearly the mechanism which initiates labour and can prevent the onset before full term by removing the factors responsible. We can take comfort from the fact—to which attention is drawn in another part of this report—that there is an evergrowing tendency towards institutional births and that consequently an increasing proportion of these babies will be born in hospital and so avoid the problem of maintaining satisfactory conditions for them during removal to hospital. Because of the dangers of chill during transport, it would seem that our aim should be to see that any mother who goes into labour before term should be removed to hospital immediately so that the problem of subsequent transport does not arise. In this respect, as in so many others, we are fortunate in Merton and Morden to have such a well appointed hospital with a special unit for the care of these infants to reinforce our 24 domiciliary arrangements. Domiciliary arrangements consist of provision of special equipment, including a specially designed cot and the provision of a specialist in children's diseases. Arrangements have been made also for the prompt notification of the discharge of these infants from hospital to their homes to enable our Health Visitors to give them special attention. Appended is set out in tabular form actual details of cases in our area. It will be seen that the hospital figures are less favourable than the domiciliary ones. It should be remembered, however, that some of the domiciliary cases with unfavourable features tend to find their way to hospital and have the double effect of diluting the domiciliary mortality and swelling that of the hospital. Further, of the births in the hospital, a proportion have been admitted because of complications of pregnancy which adversely affect the chances of the survival of the infant. The total number of premature babies notified during the year were as follows, born: — (a) At home 16 (b) In hospital 22 The number of those born at home: — (a) Who were nursed entirely at home 15 (b) Who died during the first 24 hours 1 (c) Who survived at the end of one month 14 The number of those born in hospital: — (a) Who died during the first 24 hours 4 (b) Who survived at the end of one month 17 25 SECTION B. — HEALTH SERVICES. Nursing in the Home. This particular service too, has now become the responsibility of the County Councils. The three voluntary associations which hitherto have carried on this work in the area, have now all become affiliated to the County Nursing Association. The scope of the work of these Associations for the year 1947 is set out below:— (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 146 cases involving 1,613 visits were attended during the year and of these, 7 cases were children under 5 years of age, to whom 19 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 the year 185 cases were dealt with by the St. Helier District Nursing Association, 7 of these were children under 5 years of age. The total number of visits made was 4,252, of which 27 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 the year are as follows: — Cases Visits Children under 5 years 42 227 Other cases 318 5,115 360 5,342 Laboratory Facilities. The routine laboratory work for the district is undertaken by the Nelson Hospital. The appended table shows the pathological work undertaken during the year:— Examinations No. performed Positive result Swabs for Diphtheria Bacilli 238 5 Sputum for Tubercle Bacilli 52 3 Faeces 40 5 Blood for Widal Test 1 — Urine 3 — 26 AMBULANCE FACILITIES. Infectious Cases. The conveyance of cases of infectious disease to hospital has always been undertaken by the Wandle Valley Joint Hospital Board by means of their own vehicles and staff. Non-Infectious Cases. Accidents and cases of general illness for removal to hospital have been the responsibility of the Merton and Morden Council who provide this service free for residents up to certain limits. The tabulated statement below shows the scope of the work during the year 1947. The extent of the use of the Council's Ambulance Service has steadily grown as is shown by the statement of annual calls given below. In the tabular analysis on this page, it will be seen that this year we accepted 461 calls under the reciprocal arrangements and transferred 226. While, therefore, we appear to have given more than we have received under this reciprocal arrangement, we do not underestimate the value to our residents of this cover for periods when our own vehicles are engaged and the fact that we have been able to assist a neighbour to maintain this service to its public is a source of gratification. As this is the last time that it will be our responsibility to record the work of the ambulance service, I may be forgiven for introducing a more personal note here on this occasion, to express the warm appreciation of those of us responsible for the administration of the service, to drivers and attendants who have consistently maintained such a high standard. It has been a great source of satisfaction to put on record from time to time the messages of gratitude from the public whom they have served and it is equally a matter for gratification to have this opportunity of adding our own appreciation of their work. AMBULANCE CALLS, 1947. Month Calls received from public Calls received from neighbouring Authorities Total calls received Calls transferred to other Authorities Calls answered by own ambulance Jan. 172 26 198 20 178 Feb. 149 19 168 25 143 March 167 28 195 33 162 April 123 39 162 15 147 May 121 35 156 15 141 June 126 88 214 25 189 July 155 36 191 22 169 August 102 23 125 13 112 Sept. 132 21 153 10 143 Oct. 134 36 170 16 154 Nov. 76 48 124 6 118 Dec. 126 62 188 26 162 Total 1.583 461 2,044 226 1,818 27 Time taken in executing the calls (from leaving Station to return) 1,467 hours Mileage covered 15,738 miles Average time per call 48.4 minutes Average distance per call 8.6 miles The Hospital Car Service continued its valuable work during the year. This service lifts a great burden of calls from the ambulances and provides a service to the public, the value of which is only appreciated by the few who have been suddenly faced with the problem of frequent and regular attendance at a hospital. Our grateful thanks are due to those who volunteer to undertake this work and to the Organisers whose ready co-operation maintains the smoothness of the arrangements. 28 CLINICS AND TREATMENT CENTRES. 1.—Maternity and Child Welfare Clinics (provided by the Council). Centre Clinic Times of Clinics Welfare Centre, Grand Drive, Raynes Park. Infant \Velfare Ante-Natal Toddlers Mondays 10—12 noon. Mondays 2— 4 p.m. Wednesdays 10—12 noon. 1st and 3rd Tuesdays in each month at 9.0 a.m. Wednesdays at 1.30 p.m. 1st and 3rd Tuesdays in each month at 2.0 p.m. Welfare Centre, Aston Road, Raynes Park. Infant Welfare Ante-Natal Dental Toddlers Mondays 2—4 p.m. Wednesdays 2—4 p.m. Fridays 10—12 noon. Saturdays at 9.0 a.m. By appointment Friday mornings. 1st and 3rd Fridays in each month at 2.0 p.m. Health Centre, Middleton Road, Morden. Infant Welfare Ante-Natal Dental Toddlers Tuesdays 2—4 p.m. Fridays 2—4 p.m. 2nd and 4th Tuesdays in each month at 9.0 a.m. Thursdays at 9.0 a.m. By appointment Thursday mornings. 1st and 3rd Tuesdays in each month at 10.0 a.m. Baptist Hall, Crown Lane, Morden. Infant Welfare Thursdays 2—4 p.m. Hope Mission Hall. Rodney Place. Merton. Infant Welfare Thursdays 10—12 noon. 2.—School Clinics (provided by the Surrey Education Com nittee). Aston Road, Raynes Park. Minor Ailments Dental ... Eye Tuesdays and Thursdays 9.30 —12 noon. Mondays, Tuesdays and Thursdays 9.30—12 noon. 1.30— 4.0 p.m. Wednesdays 9.30—12 noon. Fridays 1.30—4.0 p.m. Saturdays 9.30—12 noon. Every 2nd, 4th and 5th Tuesday afternoon in the month. Middleton Road Morden. Minor Ailments Dental Eye Every Monday and Wednesday 9.30— 12 noon. Every Tuesday. Wednesday and Friday 9.30—12 noon and 1.30 —4.0 p.m. Saturdays 9.30—12 noon. Every Thursday 1.30—4.0 p.m. Every Wednesday afternoon 2.0 —4.30 p.m. 29 3.—Tuberculosis Dispensaries (provided by the Surrey County Council). St. Helier County Hospital Wrythe Lane, Carshalton. Morden Patients Tuesdays 9.30-12 noon (new cases only). Tuesdays 2-4.30 p.m. (old cases only). Thursdays 2-4.30 p.m. (old cases only). 1st Thursday in month 5-7 p.m. (old cases only). Merton and Raynes Park Patients Mondays 2-4.30 p.m. Wednesdays 10-12 noon. Fridays 10-12 noon. 1st Monday in month 5-7 p.m. (old cases only). 4.—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 outpatient treatment. HOSPITALS. Smallpox. The Surrey County Isolation Hospital, Clandon—accommodation 28 beds. This hospital is organised on a care and maintenance basis ready to be opened up at any time for the reception of cases of Smallpox. There were no such cases during the year. Infectious Disease. The Wandle Valley Hospital under a Joint Hospital Board serves this area together with three other neighbouring areas, Mitcham, Beddington and Wallington and Coulsdon and Purley. The hospital has accommodation for 196 patients, including cubicle isolation for 38. During the year 160 patients from our district have been treated in the hospital. Reference to Table VI shows in detail the conditions for which admission was necessitated. 30 TABLE VI. Cases admitted to the Wandle Valley Isolation Hospital during the Year 1947. Disease Cases Deaths Diphtheria 3 Scarlet Fever 98 — Erysipelas 1 — Tonsillitis or Quinsey 10 — Measles 5 — Influenza 4 — Whooping Cough 4 — Typhoid and Enteritis . 3 1 Meningitis, all types, including T.B. Meningitis 3 1 Puerperal Fever (sepsis) 1 — Admitted with Mother 2 — Infantile Paralysis 16 — Dermatitis 1 — Laryngitis 1 — Chicken Pox 3 — Myalgia 3 — Sub-Arachnoid Haemorrhage 1 1 Urethral Stricture 1 - Total 160 3 General and Maternity. 1. The Nelson Hospital for Wimbledon, Merton and district. The accommodation of this voluntary hospital, to whose funds the Council makes an annual grant, is 116 beds, 26 of which are maternity beds. 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 number of in-patients admitted 2,051 Number from Merton and Morden 379 Total number of new out-patients 10,317 Number from Merton and Morden 4,588 (b) Maternity Services. Number of patients admitted from all districts during the year: — (1) General Wards 438 (2) Private Wards 206 644 31 Number of patients admitted from Merton and Morden: — (1) General Wards 149 (2) Private Wards 62 211 2. The County and Public Assistance Hospitals. In addition to the voluntary accommodation described above, there is available to the district various County Hospitals. St. Helier Hospital with a bed complement approaching 1,000 is only just outside the boundary and both Kingston and Epsom Hospitals are within five miles or so. MATERNITY AND CHILD WELFARE. Public Health Act, 1936, Section 203 — Notification of Births. The births notified under Section 203, as adjusted by transferred notifications, were as follows: — Live Births 1,359 Notified by Midwives 607 Still Births 29 Notified by doctors and parents 11 Transferred from other districts 770 1,388 1,388 The Work of the Centres. The increase in the attendances at the centres has in recent years reached such proportions that a corresponding increase in the number of sessions has been imperative, in order to maintain the standard of the work at the centres. It is obvious that a mother who is worried by the failure of her baby to progress satisfactorily, needs an opportunity for a quiet discussion of her problem and this is impossible in the bustle and noise of an overcrowded clinic. There is a very definite limit too, to the numbers of expectant mothers who can be dealt with in one ante-natal session without the quality of the work suffering. We should try to keep in mind that it is the minor variations from health in pregnancy that are responsible for the avoidable infant deaths that we are all so anxious to reduce. It behoves us therefore, to see that as far as possible no incipient illness in pregnancy goes undetected for want of time for proper and careful examination or because through being fatigued by numbers, there is any lowering of acuity of judgment of the Ante-Natal Doctor. 32 In other ways these high attendance rates are a source of gratification, inasmuch as they tell us that the reputation that these clinics have acquired since their inception, has steadily grown. A simple graph preceding the text of this report shows this fact more clearly than words. The details of all the attendances at the various clinics are shown in the subsequent tables. TABLE VII. Attendances at Ante-Natal Clinics. Clinic No. on Register Attendances Sessions Average per Session Primary Total Morden Ante-Natal 367 266 1,734 75 23.7 Post-Natal 45 — 44 Individuals 412 266 1,778 Raynes Park Ante-Natal 199 101 703 52 13.6 Post-Natal 6 - 6 Individuals 205 101 709 Grand Drive 364 271 1 333 77 18.3 Post-Natal 46 - 80 Individuals 410 271 1,413 All Clinics Ante-Natal 930 638 3,770 204 19.1 Post-Natal 97 - 130 Individuals 1,027 638 3,900 (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 cases during the year.) 33 TABLE VIII. Attendances at Infants' Consultation Clinics. Centre No. on Register Attendances Sessions Average Attendance per Session *Primary Total Morden Under 1 year 1—5 years 561 246 22 3,686 1,043 102 46.3 Raynes Park Under 1 year 1—5 years 811 306 40 5,186 2,528 102 75.6 Baptist Hall Under 1 year 1—5 years 464 155 12 2,786 1,295 51 80.0 Hope Mission Under 1 year 1—5 years 194 61 8 1,151 1,043 51 43.0 Grand Drive Under 1 year 1—5 years 983 338 41 6,367 3,044 151 62.3 All Centres Under year 1—5 years 3,013 1,106 123 19,176 8,953 458 61.4 * 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 Grand Total Infants Maternity Primary under I year Total 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 22,819 1943 2,514 681 908 22,435 2,074 24,509 1944 2,491 740 807 15,992 2,948 18,940 1945 2,697 762 870 22.855 3,292 26,147 1946 2,781 1,082 1,014 24,760 4,554 29,314 1947 3,013 1,027 1,106 28,129 3,900 32,029 34 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 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 4 69 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 1945 1,027 870 84 762 74.2 1946 1,261 1,014 80 1,082 85.8 1947 1,345 1,106 82 1,027 76.3 The Nelson Hospital Clinics. Maternity clinics are 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 Ophthalmic Clinic is held every Friday afternoon and a Paediatric Clinic every Monday afternoon. Additional clinics established during the year include a Gynaecological Clinic which is held every Tuesday afternoon and an Ear, Nose and Throat Clinic on alternate Thursday mornings. The hospital is a voluntary organisation serving Wimbledon, Merton and Morden. The following information relating to the ante-natal and post-natal clinics of the hospital has been kindly supplied by the Secretary, indicating the number of attendances during the year: — 35 Ante-Natal Post-Natal Total number of attendances from all districts during the year 2,358 461 Total number of women who attended during the year: — (a) From Merton and Morden 180 112 (b) From all districts 428 301 Health Visiting. I have drawn attention earlier in this report to the fact that the steady increasing number of births and the steady accumulation of duties which each year is thrown upon the Health Visitors has meant that while their usefulness to the community has thereby correspondingly increased, their capacity to keep on top of what used to be regarded as their primary work, has to some extent suffered. Domiciliary visiting has always been regarded as one of their most important functions and the promptness with which they can attend the newborn baby has always been considered of the first importance. It is, however, a fact that we should recognise that these other duties have so accumulated that they are on longer able to pay these firsts visits with the same promptitude after the receipt of the notification of birth. The Council has recognised the growth of their work and has increased the number of Health Visitors from time to time. Unfortunately, it has been exceedingly difficult to recruit them, but it will be necessary to add to our staff again if the standard of the work is to be maintained. The number of visits made for the various purposes were as shown below: — To expectant mothers—first visits total visits 393 575 To children under 1 year—first visits total visits 1,594 3,887 To children—1-5 years—total visits 4,207 Visits re puerperal pyrexia, ophthalmia neonatorum and miscellaneous 479 Visits to foster children re Child Life Protection 114 9.262 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 Head Mistresses of the schools with their more intimate knowledge of these children. 36 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. The extent to which it has been possible to make arrangements under this provision has been seriously limited by the lack of such accommodation. It is an interesting fact of nursery provision, however, that the conditions which play a large part in producing the debilitated child are generally cogent reasons for accepting a child into the Day Nursery. Many of the types which used to make up the annual convalescent contingent are now part of the Day Nursery population. From time to time when it has been impossible to secure a vacancy in a residential convalescent home, consideration has been given to admission to the Day Nursery as an alternative. It is perhaps appropriate, therefore, to compare the advantages of the Day Nursery and the convalescent home. For the ordinary debilitated child, better food and better environment are the main considerations. How far then is it an advantage or otherwise to keep the child away from home for the whole 24 hour period? May the complete wrench from the home anchorage be more of a drawback than a benefit? There are, of course, obvious types of cases where the removal from home contact is one of the primary reasons for the need for convalescence, there may be others where sleeping conditions are so bad that there is no room for any doubt as to where the advantage lies, but under present conditions and shortage of convalescent accommodation, the part that the Day Nursery can play seems to be worthy of consideration. 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. Since the advent of St. Helier Hospital, cases on the Morden side of our district have generally been referred there for the convenience of the mothers, and because, in so many of these cases subsequent attendance regularly at the Physio-Therapy Department is necessary. These well-equipped, well run special departments of St. Helier Hospital have been of inestimable benefit to our district. Maternity Hospital Treatment. Merton and Morden is particularly fortunate for institutional accommodation specially since the 97 bed maternity unit at St. Helier came into operation. Reference to the tabulated statement on page 17 shows that of the 1,052 institutional births, 468 occurred in St. Helier, 285 in the Nelson and 299 elsewhere. A table is appended giving the cases referred from our clinics:— 37 To the St. Helier County Hospital 108 To other hospitals 8 The reasons for referring these cases were as follows:— For obstetric abnormality 68 For other medical reasons 41 For unsuitable home conditions 7 Puerperal fever cases, if arising in a hospital in the area or in domiciliary practice are treated at the Wandle Valley Isolation Hospital. Last year they admitted one such case from our area. Emergency Maternity Unit, There were no calls made on this unit during the year under review. Consultant Service. An obstetric specialist's opinion is available to any general practitioner in cases of difficulty or complicated labour, for any emergency in pregnancy or in the puerperium. Originally started under the Puerperal Pyrexia Regulations, the scope of this service has been extended to enable any general practitioner to call in the assistance of a specialist, for any danger associated with childbirth which threatens the welfare of the mother. Home Help Scheme. The Home Help Scheme has grown with the increasing availability of suitable women for the work. In the past, the impossibility of recruiting Home Helps has been the limiting factor in the extent to which the scheme was capable of operating. Now that recruitment is somewhat easier, our difficulties in this respect have been correspondingly lightened. At the present time we have two full time and 19 part time home helps and, as will be seen from the appended table, assistance in the home was provided for 90 homes for maternity and child welfare reasons and for 71 homes where justification was old age, sickness or infirmity. It will be remembered that these latter types of cases have only recently been included and that prior to 1944 the Home Help Service was only available to homes where there was a pregnant or parturient mother or children under five years of age. The value of this service is cases of chronic sickness and infirmity cannot be over estimated. The extent of the help given is probably not generally realised any more than the extent of the helplessness of the chronic sick. In many of these cases the Home Help has to wash and bedpan them. This may well be the nucleus of future schemes for the betterment of conditions for the aged, and when we have turned all the Unions and Poor Law Institutions into offices, we shall, 38 with that money, be able to build proper homes for these old folk and their care will be the responsibility of the Home Help Service. Service Full Cost Partial Cost Free of Cost Total Ante and Post-Natal 5 20 - 25 Maternity 3 62 — 65 Domestic 13 53 5 71 Total for year 21 135 5 161 The Care of Illegitimate Children. The actual work in this connection is carried out for us by the Wimbledon, Merton and Morden Moral Welfare Association, who provide both the home where the mothers stay prior to their confinements and subsequently, until rehabilitation is accomplished and also the welfare officer, who exercises supervision over them after their discharge, or to whom cases in need of help are referred in the first instance. The home is the Haygarth Witts Memorial Home at 54, The Ridgway. The Councils of Merton and Morden, Wimbledon and Mitcham accept the financial responsibility for cases in their areas. It is to the everlasting credit of this Association, that they responded so readily to the suggestion that they should again open the home for this work at a most difficult time when they had been deprived of their own premises. During the year our Council has borne the cost of four unmarried mothers in this home at a total cost of £82 15s. Od. Sterilised Maternity Outfits. Sterile outfits 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, 50 outfits were supplied at cost price. Dental Scheme. The dental scheme has been continued on a two sessions per week basis. The future of this service is by no means clear. It was started as an ancilliary to the maternity and child welfare scheme and was intended to ensure that dental treatment necessary for the maintenance of the health of the mother or baby should not be neglected through financial circumstances. 39 Few maternity and child welfare dental schemes have been ambitious enough to attempt to provide a complete dental service for all the mothers, expectant and nursing and all the children under five in the area. This, in approximate terms of population would have meant the provision of a dentist for 6,000—7,000 people. What the future will be with the free dental service available to all is impossible to foresee. 40 TABLE XI. Attendances at Dental Clinics during 1947. Cases referred from Number who attended during year Number of Attendances made MERTON Mothers 4 20 Children 12 22 Individuals 16 42 MORDEN Mothers 127 356 Children 24 53 Individuals 151 409 RAYNES PARK Mothers 64 181 Children 32 61 Individuals 96 242 GRAND DRIVE Mothers 109 302 Children 36 70 Individuals 145 372 BAPTIST HALL Mothers 8 27 Children 14 29 Individuals 22 56 ALL CENTRES Mothers 312 886 Children 118 235 Individuals 430 1,121 The dental operations performed were as follows: — TABLE XII. Dental Scheme 1947 — Operations Performed. Extractions — Temporary Teeth 262 Extractions — Permanent Teeth 606 Fillings — Temporary Teeth 27 Fillings — Permanent Teeth 104 Dentures supplied — Number of cases 112 Number of local anaesthetics given 64 Number of gases given 227 41 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 : Primipara Multipara Total (a) As midwife Live 21 43 64 Still — — — (b) As maternity nurse ... Live 3 3 6 Still — — — 24 46 70 Visits made: By midwife Ante-natal 467 During confinement 1,184 To midwife Ante-natal 295 Post-natal 259 2,205 Medical Aid Forms sent:— 21 Discharging Eyes 3 Feebleness at Birth 2 Phimosis 1 Prolonged First Stage 1 Prolonged Secondary Stage 1 Puerperal Pyrexia 10 Retained Placenta 1 Rupture of Perineum I Uterine Inertia 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 are eighteen midwives practising in the district, of whom five were salaried midwives appointed under the County Scheme and seven members of the staff of the Nelson Hospital. Voluntary Workers. We are fortunate in Merton and Morden in having attached to our clinics a devoted band of women who give freely of their time and energy without reward, other than the satisfaction which they derive from their good works. 42 It is one of the pleasures associated with the labour of compiling this report that it gives me the opportunity to recognise their contribution towards the success of our child welfare services and to express my warm appreciation of their help. Child Life Protection. The new arrangements for the care of all children who are living apart from their parents are now being set up by the Surrey County Council and they are appointing a Children's Officer who will be responsible to them for this work. Whatever supervisory or administrative arrangements may be set up, the two greatest difficulties in foster parentage are suitability and permanency. Of this, by far the greater is to secure permanency of arrangement. It does not need an expert child psychologist to appreciate the mental anxiety of the young child when he is parted from his home—and his foster home is his home—to be transferred to another foster home. In many cases, this happens more than once in the first two or three years of the foster child's life. Our registers reveal that this is by no means rare, in fact, the occurrence of short-stay fostering of not more than a year's duration is distressingly frequent. The tabulated statement below shows that there were 11 foster mothers and 16 foster children under supervision at the end of the year. During the year 114 visits were paid to registered homes in the district, giving an average of 11 visits per home per year. No children were boarded out in this district under the Public Assistance or other arrangements of the Surrey County Council during the vear. The following are the main facts relating to child life protection work during the year: — Registered homes under supervision during the year 18 Registered homes under supervision at the end of year 11 New homes registered during the year 11 Children on register at end of year 16 Children brought on to register during year 11 Children removed out of district during year 4 Visits paid to nurse children 114 Number of children who died during year — Number of cases where legal proceedings were taken — Day Nurseries. The transfer of the Manor House Day Nursery to the Surrey County Council as a nursery school in 1947 reduced the number of nurseries provided and maintained 43 by Merton and Morden Council to two, the High Path Nursery which has since been moved to Morden Road and the Middleton Road Nursery. We have had to run both these nurseries for another year without the essential services of a warden. All our efforts to recruit teachers or child care reserve trained women have been unsuccessful. This is discouraging to everybody interested in the efficient running of the nurseries, for the task of directing the activities of the two to five year old groups is generally beyond the capacity of those with limited experience in this work. This has been mentioned before in previous reports as an urgent problem. There is still no solution in sight, and for those of us who can see gaps in the nursery curriculum as well as the staff who are struggling to maintain an efficient organisation without adequate material, it is a matter for concern and is discouraging. 44 45 TABLE XIII. Day Nurseries — Average Daily Attendances, 1947. Nursery Jan. Feb. March April May June July August Sept. Oct. Nov. Dec. HIGH PATH. Daily average 44 42 45 56 56 50 47 44 47 49 56 51 Highest daily average . 53 48 55 59 61 54 57 53 55 55 62 58 MANOR HOUSE. Daily average 36 33 37 Taken over as Nursery School by Surrey County Council on 1st April. 1947. Highest daily average 46 40 39 MIDDLETON ROAD. Daily average 21 44 58 52 56 52 52 36 43 48 56 38 Highest daily average 46 54 58 58 60 59 60 47 AS 58 60 45 SECTION C. — SANITARY CIRCUMSTANCES. The greatest single adverse sanitary circumstance affecting the welfare of our population to-day is undoubtedly housing. It is no exaggeration to say that the problem has to a large extent paralysed our public health housing procedure and the overcrowding provisions of the 1936 Housing Act cannot be implemented. Compulsory abatement of overcrowding requires alternative accommodation. For this reason Health Departments have had to mark time with regard to unfit housing and accept a policy of "make do and mend". The Public Health Committee and the Department have been very concerned over the unsatisfactory bacteriological results from samples of ice-cream which have been reported from time to time. As there is only one producer in the area the pursuit of the enquiry at the manufacturing end has generally been left with other local authorities, and in every case, we have met with the most enthusiastic co-operation. It is very clear that at the present time we lack a yardstick to measure impurity and to enforce the maintenance of proper standards. In common with many other Public Health Departments, the difficulty of recruiting adequately trained staff has been a matter of some concern, especially in view of the importance of their work in these ersatz times. 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 the 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 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 analyses are available for inspection by the Medical Officers. The quality of the supply as shown by the sampling was satisfactory. 46 There are three deep wells in the district, the supplies from which are used mainly for industrial purposes. They are drawn from beneath the London clay. The boreholes vary between 400 ft. and 500 ft. in depth and their capacity between 3,300 galls, and 7,000 galls, per hour. They furnished a comforting reserve source of supply to the district during the recent war. but some anxiety has recently gained currency with regard to their safety following long periods of drought if the water were to be drunk in its natural state without any treatment. This view has been supported by recent analyses. Drainage and Sewerage. No important extensions to sewerage were carried out during the year. Rivers and Streams. No improvement schemes were carried out during the year but normal cleansing and other maintenance works have from time to time been carried out. Closet Accommodation. All premises have water closets drained to sewers except four which are drained to cesspools. In addition there are four chemical pail closets on Sports Grounds. Public Cleansing. There is a weekly collection of house refuse which is undertaken by dustless collection vehicles provided with moving floors. The service during the year has also been improved by a slight adjustment and re-arrangement of the collection squads. The salvage tonnage for the year under reveiw was as follows:— Tons. Tons. Paper 307 Bottles and Glass 119 Metals 678 Rags 12 Pig Foods 905 Miscellaneous 14 47 REPORT OF THE CHIEF SANITARY INSPECTOR. Madam Chairman, Ladies and Gentlemen, I have pleasure in presenting the Annual Report which summarises the work carried out by your Sanitary Inspectors during the year ended 31st December, 1947. Housing Inspections. As in former years, since the conclusion of hostilities, the shortage of materials and labour available for the maintenance of existing houses made it impossible to proceed to any appreciable extent under the provisions of the Housing Act, 1936. Appropriate action has, however, been taken to deal with defective dwelling-houses in accordance with the nuisance sections of the Public Health Act, 1936 and in this connection 454 houses were repaired and rendered reasonably fit for habitation according to prevailing standards. During the year, two houses, Nos. 48/50, Pincott Road, were represented as incapable of being rendered fit for habitation at "reasonable expense" and the Council resolved to make Demolition Orders in respect of these old cottages. One family was rehoused by the Council and the other found alternative accommodation. The total number of houses inspected for "sanitary defects" under the Public Health and Housing Acts was 658. Action taken in connection with defective dwelling-houses is set out in the housing table on page 56. Summary of Nuisances Abated and Sanitary Improvements Effected. Ceilings cleansed or repaired Coppers provided or repaired Dampness in premises remedied Drains exposed and repaired Drains reconstructed Defective sashcords renewed Dustbins provided Floors repaired Fresh air inlet valves provided and repaired Inspection chamber covers provided Obstructions removed from drains Rain water pipes renewed or repaired Rooms cleansed Roofs repaired Gutters repaired Sinks wastes repaired Walls repaired W.C. cisterns provided W.C. cisterns repaired Water Closets cleansed W.C. pans provided 120 11 142 29 8 16 83 72 7 32 26 18 80 125 62 21 34 3 31 2 45 48 Windows repaired or renewed 74 Fireplaces and stoves renewed or repaired 40 Sinks provided 5 Offensive accumulations removed 17 Water supply for domestic use 24 Verminous premises fumigated and cleansed 2 Ventilation provided under floors 7 Sanitary accommodation for workshops 8 Miscellaneous 88 Notices Served. Intimation notices 568 Statutory notices:— Public Health Act, 1936 214 Housing Act, 1936 7 Drainage Work. At eight houses the drainage systems were entirely reconstructed and at 29 houses, extensive repairs to drains were carried out. Smoke and water tests were applied to the drains of houses in 41 instances, and obstructions were re-, moved from drains at 26 houses. There was a considerable increase in the amount of maintenance work carried out by the Council in connection with defective public sewers—this was mainly due to damage caused by enemy action. Food Supply. The total number of inspections made to premises where articles of food are prepared or exposed for sale was 684. The work involved in connection with the supervision and inspection of food supplies and food premises continues to increase, and the utmost vigilance is required on the part of the food inspectorate to prevent unsound foodstuffs being sold or exposed for sale, and at the same time to avoid any wastage of our limited supplies. At a number of premises, improvements in sanitary conditions were effected. Unsound Food. The undermentioned articles of food were found, upon inspection, to be unfit for human consumption; were surrendered and either destroyed or disposed of for animal feeding or salvage:— Description. Amount. Cause. Beef 1.698 lbs. Bruised, bone taint, internal putrefaction, calloused and unsound after cooking Mutton 9 lbs. Decomposition and caseous lymphadinitis Fish 195 stone Decomposition and putrefaction Bacon 30½ lbs. Decomposition Roes 134 lbs. Decomposition and unsound Brawn 3 lbs. Decomposition Veal 8 lbs. Decomposition Sausages 24 lbs. Decomposition 49 Description. Amount. Cause. Sausage Meat 30 lbs. Unsound Chicken 403 lbs. Decomposition and putrefaction Rabbits 60½ lbs. Unsound Turkey 17¼ lbs. Decomposition Fish Cakes 144 Sour Sultanas 60 lbs. Mouldy Dried Peaches 90 lbs. Mouldy and unsound Chestnuts 84 lbs. Unsound Barley 60 lbs. Grub infested Bananas 71 lbs. Soft and mouldy Cherries 60 lbs. Unsound Butter Beans 3 cwts. Grub infested Dried Peas 115 lbs. Grub infested Maltebars 50 Grub infested Cheese Trimmings 12½ lbs. Unsaleable Jam 32 lbs. Broken jars Dates 60 lbs. Mould and fermentation Mustard 32 pkts. Below standard Fish Paste 1¼ ozs. Broken jar Invalid Jelly 1 jar Mould Granulated Sugar 16i lbs. Contaminated by acid and damaged by water Breakfast Cereals 36 pkts. Damaged by burst water pipes Jelly Crystals 28 pkts. Damaged by burst water pipes Cake Mixture 181 pkts. Damaged by burst water pipes Barley Flakes 6 pkts. Damaged by burst water pipes Steamed Pudding 17 pkts Damaged by burst water pipes Semolina 152 lbs. Unsound, grub infested and ropey Biscuits 10 lbs. Damaged by burst water pipes Dried Egg 58 pkts. Damaged by burst water pipes Cocoa 42 tins Damaged by burst water pipes Bicarbonate of Soda 14 tins Damaged by burst water pipes Beef Cubes 34 Damaged by burst water pipes Marmalade 1 lb. Damaged by burst water pipes Margarine 2 ozs. Rancid Bread 2 lbs. Damaged by burst water pipes Flour 15 lbs. Damaged by burst water pipes Baking Soda 16 lbs. Damaged by burst water pipes Eggs 152 Unsound Spaghetti 28 lbs. Mould Pudding Mixture 14 pkts. Damaged Coffee ½ lb. Damaged Piccalilli 1 jar Sour Soup Powder 1 pkt. Damaged Tinned Meat, Milk, Fish, Vegetables, Fruit, etc. 2,470 tins Blown, opened, pierced, leaking and unsound 50 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. Slaughtering is carried out on Sunday mornings and this necessitates the attendance of a Meat and Food Inspector almost every Sunday during the year. Carcases Inspected. Cattle Cows Calves Sheep Pigs Number killed 202 Number inspected 202 Number found fit for human consumption 202 Milk Supply. There are no producers of milk registered within the urban district. Practically all the milk supplied to the district is derived from the South-eastern Counties and arrives either by rail or road. Forty-one inspections were made to dairies and milk shops during 1947. Twenty-four samples of milk were submitted for bacteriological examination during the year. One sample of Pasteuried milk and two of "Heat Treated" failed to conform to the prescribed standard. Results of Chemical Analyses of New Milk Samples. Solids not fat (legal standard is 8.5%). 8.5 8.6 8.7 8.8 8.9 9.0 9.1 9.2 Total 4 3 9 4 2 — — — 22 Milk fat (legal standard 3.0%). 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 4.1 4.2 Total 1 2 5 4 5 4 1 - - - - 22 The undermentioned licences were granted to dealers under the Milk (Special Designations) Regulations and were in force at 31st December, 1947:— Dealers Licences. Pasteurised 5 Tuberculin Tested 4 Supplementary Licences. Pasteurised 15 Tuberculin Tested 8 51 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 Action Taken Almond Oil 1 1 - - Aspirin Tablets 3 3 Baking Powder 3 3 — Black Pudding 2 2 — Boracic Ointment 1 1 - - Bouilon Extract 1 1 — - Brawn 2 2 - - Bread 2 2 — - Butter 1 1 — - Cake Mixture 1 1 - - Camphorated Oil 2 2 — — Chocolate Spread 1 1 — — Coffee 2 2 — — Cough Mixture 1 1 — — Curry Powder 3 3 — — Epsom Salts 1 1 — — Eucalyptus Oil 1 1 — — Fish Paste 4 4 — — Gelatine 1 1 — — Ginger Beer 1 1 — — Ginger Beer Extract 1 1 — — Ground Ginger 2 2 — — Ground Nutmeg 1 1 — — Ham and Beef Paste 1 1 — — Iodised Throat Lozenges 1 - 1 Manufacturers explanation accepted Lemonade Powder 1 1 - - Limeade 1 1 - - Liquid Paraffin 1 1 — - Macedoine 1 1 - - Margarine 1 1 — Milk 22 22 — - Minestrone Soup 1 1 - - Mint Sauce 1 1 - - Mixed Spice 1 1 - - Parsley Dried 1 1 — - Pepper Black 1 1 — — Pork and Beef Paste 1 1 — - Port Wine 1 1 - - Sauce 1 1 — - Sausage Meat 7 6 1 Warning letter sent Sausages 3 2 1 Warning given Seidlitz Powders 1 1 - Soda Bicarbonate 2 2 - - Sulphur Ointment 2 2 - - Sweets 2 2 - - Tea 1 1 - - Tincture of Iodine 1 1 - - Tomato Chutney - 1 - - Vegetable Soup - 1 - Zinc Ointment 3 3 - - Total 99 96 3 — 52 Ice-cream (Heat Treatment) Regulations, 1947. These regulations came into operation on the 1st May except for the requirements relating to thermometers which will not operate until a date appointed by the Ministry of Health. A complete survey of all registered premises was carried out during the year and the register revised. At the end of the year, there was only one manufacturer of ice-cream on the register and thirty-one dealers and six vendors were registered. Twenty samples were obtained and submitted for examination with the following results:— No. Grade Methylene Blue Test Coliform B. Remarks 1 2 Satisfactory Present 2 3 Unsatisfactory 3 4 ,, ,, Heavy growth of staph, aureus 4 4 ,, ,, Heavy growth of staph, aureus 5 Satisfactory ,, 6 2 ,, Absent 7 1 8 — Choc Ice 9 l Satisfactory ,, 10 2 11 2 Present 12 4 Unsatisfactory n 13 1 Satisfactory Absent 14 4 Unsatisfactory Present 15 3 16 3 ,, 17 2 Satisfactory ,, 18 3 Unsatisfactory ,, 19 2 ,, Absent 20 ,, ,, ,, Hairdressers Establishments. In September, 1947, th: Council adopted byelaws made pursuant to Section 125 of the Surrey County Council Act, 1936 for the purpose of securing the cleanliness of hairdressers' and barbers' shops and of the instruments, towels and materials used in such premises. Factories and Workplaces. The number of inspections made to premises registered under the Factories Act, 1937, was 136. Defects relating to sanitary conveniences, ventilation and other sanitary matters were dealt with at seven premises. The table on page 58 gives details of action taken during the year. Water Supply. Four samples of water from domestic taps were submitted for chemical or bacteriological examination. The reports on each sample were satisfactory. Water Courses. Sixty-eight inspections were made of the water courses in the district, particularly of the River Wandle, and 53 Beverley and Pyl Brooks for the purpose of detecting pollutions and samples were obtained and sent for chemical analysis. Four instances of pollution were discovered during the year and appropriate action was taken. Mosquitoes. A number of complaints were received from residents and spraying of water courses, ditches and stagnant ponds was carried out particularly in the vicinity of the Council's recreation grounds and open spaces during the breeding season. Rats and Mice (Destruction) Act, 1919 — Infestation Order, 1943. The Rats and Mice (Destruction) Act is administered by the Council, the Surrey County Council having delegated their powers to the local authority. A Rodent Operator is employed and a free service is provided for householders but a charge is made according to an agreed scale when work is undertaken at business premises. During the year, 899 visits were made to premises where infestations were known or suspected and at 120 premises the infestations were cleared. Treatment of the Council's sewers in the older parts of the district was carried out and an average number of 70 manholes were treated per day. Periodic treatment of the Council's refuse tip at Garth Road was also carried out during the year. Noise Nuisances. A number of complaints were received from householders, alleging nuisances from excessive noise arising at factory premises. The Council has limited powers under the Merton and Morden Council Act, 1936, to deal with such noise nuisances and at two factories, improvements were made by the occupiers to reduce noise to a minimum. Smoke Abatement. A number of complaints were received relating to excessive smoke emitting from certain factory chimneys. Twenty observations were made and in four instances, the nuisances were satisfactorily abated. Inspections of Cinemas and other Licensed Premises. Periodical inspection of the two cinemas in the district and other licensed premises was made during the year. All the sanitary conveniences at these premises were inspected and found to be generally well maintained. Shops Acts, 1912—1936. The following statement summaries the inspections made, the infringements discovered and other matters dealt with during the year. No. of Inspections:—Day Visits 180 Evening Visits 54 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 19 6. Sanitary arrangements unsatisfactory 2 7. Reasonable temperature not maintained Summary of Sanitary Inspections. Housing—primary visits 793 Re-inspections—work in progress 1,542 Re overcrowding provisions 737 Miscellaneous, housing 407 Drainage work 608 Factories and Workplaces 136 Stables and Piggeries 20 Rats and Mice destruction 899 Enquiries—infectious diseases 233 Smoke abatement 20 Food shops, etc 684 Milk supply 41 Rivers and Streams—pollution 68 Miscellaneous 1,097 7,285 No. of complaints investigated 1,241 I would like to take this opportunity of expressing my appreciation and thanks to the Chairman and Members of the Public Health Committee for their support during the year. I am, Ladies and Gentlemen, Your obedient Servant, F. C. THOMAS, Chief Sanitary Inspector. August, 1948. 55 SECTION D. — HOUSING. Housing and Overcrowding. During the year 82 new houses and 27 flats were built, 201 houses were reconditioned and made habitable. The number of applicants on the waiting list at the end of the year was 3,023. Arising out of rehousing enquiries, 138 complaints of overcrowding were received. Of these, 74 were found to be overcrowded within the standards laid down by the Housing Act, 1936. The housing situation in Merton and Morden may be gathered from the following facts: — 1. Inspection of Dwelling Houses during the year: i. (a) Total number of dwellinghouses inspectea for housing defects (under Public Health or Housing Acts) 793 (b) Number of inspections made for the purpose 793 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 2 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 558 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 438 3. Action under Statutory Powers during the year:— A.—Proceedings under Section 9, 10 and 16 of the Housing Act, 1936: — (i) Number of dwellinghouses in respect of which notices were served requiring repairs 2 56 (ii) Number of dwellinghouses which were rendered fit after service of formal notices:— (a) By owners 4 (b) By local authority in default of owners 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 Section 11 and 13 of the Housing Act, 1936:— (i) Number of dwellinghouses in respect of which Demolition Orders were made 2 (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 49-53). 57 FACTORIES ACT, 1937. 1. Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 22 21 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 179 115 5 - (iii) Other Premises in which Section 7 is enforced by the Local Authority 2 - - - Total 203 136 5 — 2. Cases in which Defects were found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied To H.M. Inspector By H.M. Inspector Want of cleanliness (S.l) 1 1 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — Inadequate ventilation (S.4) — — — — Ineffective drainage of floors (S.6) — — — — Sanitary Conveniences (S.7) (a) Insufficient 2 2 - 1 - (b) Unsuitable or defective 4 4 1 - (c) Not separate for sexes — — Other offences against the Act (not including offences relating to Outwork) - - - - - Total 7 7 — 2 — 58 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 Acute Polio-Encephalitis membranous 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 actual cases of smallpox during the year in the area. There were 8 persons kept under surveillance for the duration of the unexpired part of their contact period who had arrived in this country from an infected area abroad. Enteric Fever. There have been no cases of paratyphoid or typhoid fever in the area for the past five years. We have been particularly fortunate in this respect as it is usual to get an occasional sporadic case from time to time. The last occasion when that happened was in 1941 when we had two such cases. Dysentery. There was one case of dysentery notified this year compared with six last year. Attention has been drawn before to the fact that only those cases which are ill enough to call in a Doctor become notified and there are undoubtedly outbreaks of mild diarrhoea occurring in small groups of the population caused by organisms of the dysentery group which escape the attention of the General Practitioners by being either untreated or self-treated. How far, therefore, the number of notifications of dysentery can be taken to represent the incidence of infections by this intestinal group of organisms it is difficult to say, probably there is no mathematical relationship. As these outbreaks of gastro-enteritis are usually due to food contaminated by carriers or sufferers, it is gratifying to note that there is evidence of awakened interest in the educational side of this public health problem. Scarlet Fever. Last year the observation was recorded that for the past three years, scarlet fever had had a fairly constant 59 incidence from 100 to 130 cases. There were 127 cases last year and this year there are 137, so that this feature of the disease has continued. Fortunately, scarlet fever continues to be a mild disease and the practice is undoubtedly growing of treating these cases at home where arrangements for proper isolation can be made and the parents are anxious to keep the child at home. Diphtheria. There were five cases of diphtheria. This is a record. The previous lowest number ever recorded was in 1934 when there were 8 cases. On page 10 will be found a graph showing the correlation between the increases in immunisation and the fall in incidence of diphtheria. Measles. There were 347 cases of measles as compared with 568 last year, so that if it can be described as an epidemic it was at any rate limited in extent and the disease too, was of the mild type we have become accustomed to expect in recent years. So much so, that one wonders whether preventive measures are justifiable until we have a prophylactic free from risk of serious complications. Whooping Cough. There were 232 cases of whooping cough notified during the year with one death attributed to this condition. This number corresponds very closely to last year's figure of 238. As I have already mentioned, this disease has become one of the prime enemies of the child population and though its mortality remains low, its capacity for debilitation and the subsequent arrest of the satisfactory development of the child, makes the search for a satisfactory prophylactic one of the most urgent problems of preventive medicine. Anterior Poliomyelitis. If this year's epidemic of Acute Poliomyelitis is not repeated, and it is profoundly to be hoped that such will be the case, the year 1947 will always be remembered both by the public and by epidemiologists. An epidemic so widespread was bound to produce some cases of this disease in our own district and there were in fact a total of 22 cases, where the disease was established with a convincing degree of clinical accuracy. There were a further 11 cases notified and admitted to hospital which are not included because the hospital did not confirm the diagnosis and there were 2 admitted to hospital in which an indisputable alternative diagnosis was established, one a case of cerebral haemorrhage in an adult who died and the other a child of 3½ who turned out to be cerebro spinal meningitis. The number of suspected cases not notified by the General Practitioners remains unknown. From the hospital 60 point of view there are obvious reasons for requiring a convincing clinical picture but many of these cases which present the early signs and symptoms of the disease and do not progress to the stage of paralysis are still probably genuine cases of infection with the virus of Acute Poliomyelitis, and from the Medical Officer of Health's point of view are better diagnosed and regarded as Acute Poliomyelitis than dismissed with vague labels such as influenza. Moreover, in the presence of a widespread epidemic, it is not more probable that they are in fact milder manifestations of attack by the same virus rather than obscure conditions such as myalgias and influenzas, or explained away by dragging in even another but similar virus? The onset of the first case in the district is not precisely known but the date of notification was 8th July and the onset of the last case was the 5th November, both of these cases were severe. Ten of these cases suffered paralysis resulting in some permanent disability and necessitating prolonged treatment. Of these cases, 15 were in children of school age and in 3 of them sufficient permanent disability has resulted to necessitate special educational arrangements. Two of them are still long stay cases in St. Nicholas, Pyrford and one in the Royal National Orthopaedic Hospital, Stanmore. It may be of interest to record that the first case in Merton and Morden was returned in the week ending 12th July, the first cases in London were returned in the week ending 31st May by Lambeth, six weeks earlier. Wimbledon's first case was the week ending 18th June and Mitcham's the 29th July. Carshalton had one case the week ending 7th June and not another until the 26th July while Sutton and Cheam had one case the week ending 24th May and the next cases, five in number on the 26th July. There is here a suspicion of centrifugal spread. Cerebro-Spinal Fever. One case which was notified during the year, was admitted to St. Helier County Hospital and recovered after treatment. Erysipelas. Thirteen notifications were received during the year all of which involved the face. Of this number, 12 were treated at home and one received hospital treatment. Food Poisoning. There were 12 cases of food poisoning notified during the year. Six of the cases were in a family group. In one group, four cases and in the other group two. One case was on the staff of a neighbouring school and involved with others in the school. In this case, B. Sonne was isolated from a culture of the stool. 61 The other cases appeared to be isolated cases of gastroenteritis of un-established origin. Most of these cases were of mild type. Some of them had completely recovered at the time of enquiry. In the case where B. Sonne was isolated the diarrhoea was more severe, but there was no vomiting and apparently no serious prostration. All the illnesses were of very short duration. Ophthalmia Neonatorum. Two cases of ophthalmia neonatorum were notified during the year, both of which were in hospital at the time of notification. In each case, recovery was complete and vision unimpaired. Pneumonia. Sixty-nine notifications were received during the year, of which 28 were stated to be influenzal in origin. Seventy notifications were received during the previous year. Puerperal Pyrexia. Notifications were received in respect of 6 cases of puerperal pyrexia, giving a rate of 4.3 per thousand total births. Of the 6 cases, 5 occurred in hospital and one which occurred at home was subsequently admitted to the Wandle Valley Isolation Hospital for treatment. In all cases the patients recovered. CLEANSING STATION. As will be seen from the appended table, 445 attendances were made at the Cleansing Station. This figure compares with 798 attendances in 1946. Number of cases of Scabies treated 162 Cases of Scabies with concurrent verminous head 6 Cases of Scabies with Secondary Septic Skin condition 11 Number of cases of verminous heads only 123 Total number of attendances at the Centre 445 62 TABLE XIV. Scarlet Fever — Monthly Distribution. Wards Total Abbey Bushey Mead Central Morden Park Ravensbury Raynes Park St. Helier West Barnes January 4 4 6 - 3 - 17 February 2 2 2 11 1 3 1 1 - 23 March 3 1 6 12 2 3 3 1 - 31 April — 1 3 4 — — - 4 - 12 May — 1 — 8 2 — 2 1 - 14 June 1 1 5 3 — — — 1 1 12 July — - 1 3 1 1 — 1 - 7 August — - 1 1 — 1 — - - 3 September — 1 1 1 — 1 — — - 4 October — - 2 1 — — — — - 3 November — - — 4 3 — — - - 7 December 1 1 — 1 1 — — — - 4 Total 7 8 25 53 10 15 6 12 1 137 Monthly mean 0.58 0.66 2.08 4.41 0.83 1.25 0.5 1.0 0.08 11.41 The incidence in the various wards was as follows:— Wards Cases Incidence per 1.000 population Abbey 7 1.0 Bushey Mead 8 0.9 Central 25 2.1 Morden 53 4.3 Park 10 0.9 Ravensbury 15 2.1 Raynes Park 6 0.7 St. Helier 12 1.0 West Barnes 1 0.1 63 TABLE XV. Infectious Diseases, Notifications, Deaths and Distribution, 1947. Disease Cases Notified Case Rate per 1,000 population Deaths among notified cases Percentage of deaths to cases WARDS Distribution of Cases No. of cases removed to hospital Percentage of cases removed to hospital Abbey Bushey Mead Central Morden Park Ravensbury Raynes Park St. Helier West Barnes Smallpox 0.00 - - - - - - - - - - - - - Scarlet Fever 137 1.81 - - 7 8 25 53 10 15 6 12 1 101 73% Diphtheria 5 0.06 - - — 3 — — — 1 - - - 5 100% Enteric Fever — 0.00 - - - - - - - - - - - - - Cerebro-Spinal Meningitis 1 0.01 - - - - - - - - - 1 - 1 100% Puerperal Pyrexia 6 0.07 - - — 1 — — 4 1 - - - 6 100% Erysipelas 13 0.17 - - — 1 1 5 5 — - 1 - 1 7.6% Poliomyelitis 20 0.26 - - — 3 5 3 4 - 1 3 1 13 65% Polio Encephalitis 2 0.02 - - - - - - - 2 100% Dysentery I 0.01 - - - - - - - 1 - - - - - Food Poisoning 12 0.15 - - — 1 2 8 — - - 1 - 4 33 % Ophthalmia Neonatorum 2 0.02 2 ? 100% Pneumonia 41 0.54 1 2.4% 1 3 10 11 4 2 3 6 1 - - Influenzal Pneumonia 28 0.37 2 7.1% - 1 6 9 8 - - 4 - - - Measles 347 4.60 — - 24 35 55 55 43 15 37 39 44 5 1 4% Whooping Cough 232 3.08 1 0.4% 6 19 20 74 16 30 13 45 9 4 1.7% 64 TABLE XVI. Notification of Infectious Diseases (other than Tuberculosis) by age groups during the year 1947. Disease TOTAL CASES NOTIFIED Total cases at all ages Under 1 yr. 1-2 2-3 3-4 4-5 5-10 10-15 15-25 25-35 35-45 45-65 65 and over Smallpox — — — — - - - - - — — — — Scarlet Fever — 6 2 7 11 76 19 7 5 1 1 — 137 Diphtheria (including Membranous Croup) — — — — 2 1 2 — — — — 5 Enteric Fever (including Paratyphoid — — — — — — — — — — - Puerperal Pyrexia - — — — — — — 1 2 3 - - 6 Acute Primary Pneumonia 1 1 —0 1 2 2 3 2 4 8 10 7 41 Acute Influenzal Pneumonia 1 — — 1 5 — — 1 7 7 6 28 Cerebro-Spinal Meningitis — 1 — — — — — — — — — — — Poliomyelitis 1 — — 2 — 5 9 2 1 — — — 20 Acute Polio-Encephalitis — — — — — — 2 — — — — — 2 Encephalitis Lethargica - — — — — — — - — — — — — Dysentery - — — — 1 - — — — — — — 1 Malaria - — — - — - — — — — — — — Ophthalmia Neonatorum 2 — — — — — — — — — — — 2 Erysipelas — — — — — — — — 2 l 7 3 13 Food Poisoning — — 1 — — 1 — — 6 1 2 1 12 Relapsing Fever — — — — — — — — — — — — — Typhus Fever — — — — — — — — — — — — — Measles 6 29 37 37 30 159 19 21 5 — 4 — 347 Whooping Cough 18 28 30 32 25 93 3 1 1 1 — — 232 Totals 28 66 70 79 70 343 56 36 27 24 31 17 847 65 TABLE XVII. Monthly Incidence of Infectious Disease, 1947. Disease January February March April May June July August September October November December Total Smallpox — — — — — — — — — — — — — Scarlet Fever 17 23 31 12 14 12 7 3 4 3 7 4 137 Diphtheria — — 1 — _ 1 — 1 — — 2 5 Dysentery — — — — — —. — — 1 — — — 1 Cerebro-Spinal Meningitis 1 — — — — — — — — — — — 1 Pneumonia 12 10 6 6 — 2 — 2 — — 2 1 41 Influenzal Pneumonia 4 10 6 2 1 — — 1 — 1 3 — 28 Food Poisoning — — — — 5 — 1 4 — — — 2 12 Erysipelas 3 1 1 3 — — — — 1 2 — 2 13 T.B. Pulmonary 8 4 4 2 11 11 10 4 5 6 7 8 80 T.B. Non-Pulmonary 2 — 4 1 1 1 — 1 2 1 1 — 14 Ophthalmia Neonatorum — — — 1 — — — 1 — — — — 2 Puerperal Pyrexia — 2 — — — 1 — 2 1 — — — 6 Poliomyelitis — — — — — — 6 9 2 2 1 — 20 Polio Encephalitis — — — — — — — 1 1 — — — 2 Malaria — — — — — — — — — — — — — Measles 46 36 27 35 31 82 42 37 5 1 1 4 347 Whooping Cough 5 11 25 27 27 50 37 23 12 11 3 1 232 Totals 98 97 105 89 90 159 104 88 35 27 25 24 941 66 DIPHTHERIA IMMUNISATION. The response to immunisation in the under five group which had apparently dropped slightly last year, has more than recovered and the present figure of 932 is a record. This is almost entirely due to the efforts of the Health Visitors who have visited the small proportion of parents who require persuasion before they accept and who represent, in annual returns, the difference between the mediocre and the good result. The recommendation to achieve immunity at eight months has begun to meet with some response. It will be seen that 98 children were immunised before reaching one year of age. Expressed as a percentage this represents 10.3 per cent, of the immunisations in the 0-5 year old groups undertaken in our clinics. It will be seen that 932 immunisations of infants were carried out at the clinics in the year. This represents 73.9 per cent, of the 1946 births. For the first time our percentage of the under fives immunised has risen above 50 per cent. In comparing this figure it should perhaps be borne in mind that it is based on completed records of immunisations done. We, in fact, have a card in our files for every one of these children. This figure of 50 per cent. is, therefore, probably on the modest side as it does not include transfers into the area or private immunisation outside the authority's practitioner scheme. It will be seen that the percentage of the school age group immunised is 77.3 per cent. which is considerably higher than the pre-school group and this is found to be the general experience. The frequency of requests for booster doses suggests that the value of immunisation has been established in the minds of the public. It will be noted that 933 booster injections were given in the year. It may not, perhaps, be out of place here to repeat what we regard as the optimum programme:— Firstly.—A first immunisation at eight months to save those lives that are lost from diphtheria before the first birthday; Secondly.—A booster injection at two to three years of age and a further injection just before leaving the home for the school where the opportunities of exposure are suddenly greatly increased; and Thirdly.—One or more further booster injections given during school life. As there is a greater frequency of reactions in the older children, however, it is preferable to have all the necessary immunisation done before the age of the child reaches double figures. 67 TABLE XVIII. Persons Immunised at Clinics during 1947. WARDS AGE GROUPS Total Completed Primary Total Single Boosting Injections 0-5 years 5-15 years Completed Primary Single Boosting Injections Completed Primary Single Boosting Injections Abbey 76 - - - 76 - Bushey Mead 88 1 1 2 89 3 Central 138 3 2 6 140 9 Morden 177 7 — 1 177 8 Park 86 1 —, - 86 1 Ravensbury 64 1 64 1 Raynes Park 80 7 1 3 81 10 St. Helier 119 1 1 3 120 4 West Barnes 104 2 — 3 104 5 932 22 5 19 937 41 TABLE XIX. Persons Immunised by Private Practitioners, 1947. WARDS AGE GROUPS Total Completed Primary Total Single Boosting Injections 0-5 years 5-15 years Completed Primary Single Boosting Injections Completed Primary Single Boosting Injections Abbey l — — — l — Bushey Mead 1 — 1 — 2 — Central 6 — —. — 6 — Morden 2 —. — — 2 — Park 8 — — — 8 — Ravensbury 17 — 1 — 18 2 Raynes Park 6 — 3 — 9 — St. Helier 8 — — — 8 — West Barnes 7 — 1 1 8 1 56 — 6 3 62 3 68 TABLE XX. Children Immunised in Day Nurseries. Nursery Completed Middleton Road 10 High Path 15 Total 25 TABLE XXI. Number of Children Immunised at Schools, 1947. SCHOOL Incomplete Completed Primary Single Boosting Injections Bushey County Primary 5 26 116 Poplar Road County „ 3 3 45 St. Mary's „ „ — 21 52 Merton Abbey „ „ 1 29 30 Hillcross „ „ — 13 47 Raynes Park „ 8 35 113 Morden „ „ 2 4 16 Morden Farm „ „ 4 37 149 St. Helier No. 1 „ „ — 20 41 St. Helier No. 2 „ „ — 32 81 St. Helier No. 3 „ ,, — 16 68 St. Helier No. 4 ,, ,, —. 23 92 Holy Family R.C. Vol. Primary - 7 14 Sacred Heart R.C. Vol. Primary 3 5 25 26 *271 *889 *Includes children attending schools in Merton and Morden but resident in other areas:— Primary 38 Boosters 122 160 69 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 1945 806 91 105 33 1,035 1946 726 72 488 34 1,320 1947 937 62 233 25 1,257 TABLE XXII. Incidence and Fatality of Diphtheria, 1920-1947. 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 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 4 12.5 1945 66,050 12 0.18 1 8.3 1946 73.590 9 0.12 - — 1947 75,290 5 0.06 - - 70 TABLE XXIII. Diphtheria Immunisation. Number of children 0— 5 years immunised January — June, 1947 479 Number of children 5—15 years immunised January — June, 1947 14 Number of children 0— 5 years immunised July — December, 1947 534 Number of children 5—15 years immunised July — December, 1947 230 Total number of children 0— 5 years immunised during the year 1,013 Total number of children 5—15 years immunised during the year 244 Number of children 0— 5 years immunised by Private Practitioners during the year 56 Number of children 5—15 years immunised by Private Practitioners during the year 6 Total number of children immunised by Private Practitioners during the year 62 Total number of children immunised in the Clinics during the year 937 Total number of children immunised in the Day Nurseries during the year 25 Estimated percentage of 0— 5 years immunised at end of year 54.2 Estimated percentage of 5—15 years immunised at end of year 77.3 Age Distribution of Immunised Children. Age at 31.12.47 i.e. born in year Under 1 1947 1 1946 2 1945 3 1944 4 1943 5 to 9 1938-42 10 to 14 1933-37 Total Immunised Estimated Population 0-5 Estimated Population 5-15 Total Population up to 15 Number Immunised 98 721 701 827 631 3,863 3,417 10.258 5,490 9,410 14,900 71 TUBERCULOSIS. One hundred and thirty new cases were added to the register of tuberculous persons, compared with 119 in 1946. These additions were:— Males Females Total Pulmonary 64 45 109 Non-Pulmonary 10 11 21 74 56 130 Of these 130, 95 were primary notifications, 32 were transferred from other districts, and 3 came to notice in other ways. During the year 87 persons were removed from the register for the following reasons: — Recovered 12 Removed from the district 47 Death 28 After allowing for the additions and deductions, the number remaining on the register at the 31st December, 1947 was distributed as shown in the following table: — TABLE XXIV. Tuberculosis Register at 31st December, 1947. Wards Registered at 31st December, 1947 Totals Number on Register at mid-year Pulmonary NonPulmonary Abbey 46 10 56 55 Bushey Mead 71 17 88 84 Central 60 12 72 67 Morden 84 13 97 94 Park 100 20 120 120 Ravensbury 98 24 122 124 Raynes Park 63 5 68 66 St. Helier 138 31 169 163 West Barnes 48 21 69 66 Whole district 708 153 861 839 The Anti-Tuberculosis Scheme in this district is administered by the County Council. Institutional treatment was provided for 72 49 persons in 1947 from Merton and Morden, as follows: — At the County Sanatorium, Milford 2 At other Institutions 47 49 The deaths from tuberculosis number 30, of which 27 were due to pulmonary and 3 to non-pulmonary disease. The deaths are classified by age and sex in the following table: — TABLE XXV. Deaths Due to Tuberculosis, 1947. Ages Years Pulmonary Non-Pulmonary Totals Males Females Males Females 0— — — — — — 1— 1 — 1 — 2 5— — 1 — — 1 15— — 5 — — 5 25— 3 5 1 — 9 35— 2 1 — 1 4 45— 3 — — — 3 55— 5 — — — 5 65— — 1 — — 1 Totals 14 13 2 1 30 Four deaths were in unnotified cases. The district provides a free service for the examination of sputum for tubercle bacilli. During the year, 52 specimens were examined with a positive result in 3 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. Tuberculosis Care Committee. The Merton and Morden Tuberculosis Care Committee continued to carry out its functions during the year. These Committees assist families of the tuberculous in many ways — financially, by extra nourishment, allowances in kind, by lending household articles, beds, bedding, 73 clothing, etc., by arranging through the Public Health Department for domestic help, helping to obtain suitable employment, arranging for occupational therapy and arranging holiday schemes for child contacts in the family, by facilitating the examination of contacts, by mass radiography and ordinary X-ray. Details of such help provided during the year has been furnished by the Secretary, to whom I am indebted for the appended statement of the scope of their work during the year: — In 26 instances, patients were assisted with the help of the W.V.S., the S.S. & A.F.A. and the British Red Cross Society to obtain bedsteads, mattresses and bedding. Grants were made to 17 cases to enable patients, or their dependants, to secure clothing. Six relatives and patients have received help with fares and 18 patients received pocket money when in hospital or sanatoria. Assistance has also been given in the following ways: — Arrears of National Health Insurance and Insurance Premiums. Maintenance of gas fire in bedroom and radio set. Part cost of spectacles. Holiday expenses to dependants. Rent arrears. Provision of invalid chairs, hot water bottles, thermos flasks, bedtables, sorbo air rings, ovaltine, etc. Removal expenses. Text books and stationery provided for correspondence course. Laundry bills paid while patient was on rest treatment. 74 75 TABLE XXVI. Tuberculosis — New Cases, Age and Sex, Distribution and Manner of Admission to Register. Age Groups Years Primary Notifications ("A"). Cases transferred from other districts. Cases brought to notice otherwise than by notification and transfer. Total new cases Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F M F M F 0— 1 — — — — — — — — — — — — — 1— 5 1 — 1 — — — — — 1 — — — 3 5—10 1 1 3 1 — — — — — — — — 6 10—15 3 2 — 1 — — — — — — — — 6 15—20 11 7 — — 3 1 — 1 — — — — 23 20—25 8 6 1 2 — 4 1 2 — 1 — — 25 25—35 10 8 — 1 4 5 — — — — — — 28 35—45 7 4 2 1 2 3 1 1 — — — — 21 45—55 8 — 1 — — 2 — 1 — — — — 12 55—65 3 — — — — — — — — — — — 3 65 up 1 1 — — — — — — 1 — — — 3 Totals 53 29 8 6 9 15 2 5 2 1 — — 130 96 31 3 INDEX PAGE Acreage 11 Ambulance Facilities 27 Acute Poliomyelitis 60-61 Births 14-18, 32 Institutional and Domiciliary 17 Rates 14-18 Cancer—Deaths from14, 19-20 Rate 14, 20 Cerebro-Spinal Fever 61 Child Life Protection 43 Clinics and Treatment Centres 29-30, 35 Climatic Conditions 12 Closet Accommodation 47 Cleansing Facilities 62 Deaths 12-15, 18-21 Causes of 19-21 Rates 12-15 Diphtheria 10, 60 Immunisation 10, 67-71 By age groups 71 Children immunised in Day Nurseries 69 Children immunised in Schools 69 Persons immunised in Clinics 68 Persons immunised by Private Practitioners 68 Incidence and fatality for 28 years 70 Drainage and Sewerage 47 Drainage work 49 Dysentery 59 Enteric Fever 59 Erysipelas 61 Factories and Workplaces 53 Inspections 58 Defects 58 Food and Drugs Act, 1938 52 76 1NDEX—Continued. PAGE Food Poisoning 61 Food Supply 49 Inspections 49-50 Unsound Food 49-50 Hairdressing Establishments 53 Health Services 26 Heart Disease—Deaths from 19, 21 Hospitals 30-32 Housing 48, 56-57 Action taken 56-57 Inspections and Defects 48, 56 Number inhabited 11 Overcrowding 56 Verminous premises 49 Ice-Cream 53 Industry 11 Infant Mortality 12, 22-24 Causes of death 23-24 Rates 12-15 Infectious Diseases 27, 30-31, 59-62 Diseases notifiable 59 Monthly Incidence 66 Notification by Age Groups 65 Notifications, deaths and distribution 64 Inquests 19 Inspections—Cinemas and Licensed Premises 54 Isolation Hospital 30-51 Laboratory Facilities 26 Examination of clinical material 26 Maternal Mortality 21-22 Rates 14. 22 Maternity and Child Welfare 32 Ante-Natal Clinics 33, 36 Attendances at Infant Consultation Clinics 8-9, 34 Attendances at Maternity Clinics 7, 33 Attendances at Centres over last ten years 34 Attendances in relation to the registered births 35 Committee 5 77 INDEX—Continued. PAGE Consultant advice for maternity 38 Convalescent Home Treatment 37 Day Nurseries 43-45 Attendances 45 Dental Scheme 39-41 Attendances 41 Operations performed 41 Emergency Maternity Unit 38 Health Visiting 36 Home Helps 38-39 Hospital provision for maternity 31-32, 37-38 Illegitimate children 13, 39 Midwives 42 Neo-Natal deaths 23-24 Orthopaedic Treatment 37 Premature Births 24-25 Sessions, times and places 29 Sterilised Maternity Outfits 39 Voluntary Helpers 42-43 Work of the Centres 32 Meat Inspection 51 Measles 60 Milk Supply 51 Mosquitoes 54 Nelson Hospital 31, 35 Notification of Births 32 Nuisances—Noise 54 Nursing in the Home 26 Ophthalmia Neonatorum 62 Population 14, 16 Pneumonia 62 Public Assistance 11 Public Cleansing 47 Public Health Committee 5 Puerperal Pyrexia 62 Rainfall 12 Rateable Value 11 78 I N D E X—Continued. PAGE Rats and Mice Destruction 54 Respiratory Diseases—deaths from 20 Representatives on:— Nelson Hospital Council 5 Tuberculosis Care Committee 5 Wandle Valley Joint Hospital Board 5 Wandle Valley Joint Sewerage Board 5 Rivers and Streams 47 Road Accidents—deaths from 19 Sanitary Circumstances 46 Sanitary Inspection 55 Scarlet Fever 59-60 Incidence in each Ward with rates 63 Monthly distribution of cases 63 School Clinics 29 Shops Acts, 1912-1936 54-55 Slaughterhouses 51 Smallpox 30, 59 Smoke Abatement 54 Social Conditions of the Area 11 Staff 6 Statistics 11-14 Comparative 15 Tuberculosis 72-75 Admission to Sanatorium 73 Assistance given 74 Care Commitee 5 Deaths due to 73 Dispensary 30 New cases—by age groups 75 Number on register at year end 72 Venereal Diseases 30 Water Courses 53-54 Water Supply 46, 53 Whooping Cough 60 Zymotic Disease—deaths from 14 Rate 14 79 Printed by RAYNES PARK PRESS, Lambton Road, LONDON, S.W.20. Tel. WIM. 1388.