MER 10 URBAN DISTRICT of MERTON AND MORDEN ANNUAL REPORT of the Medical Officer of Health for the year 1948 AND REPORT OF THE SANITARY INSPECTOR URBAN DISTRICT of MERTON AND MORDEN ANNUAL REPORT of the Medical Officer of Health for the year 1948 AND REPORT OF THE SANITARY INSPECTOR PREFACE To the Chairman and Members of the Merton and Morden Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report for 1948. It is a matter of gratification to me, as it must be to you, to be able to record year after year that the vital statistics by which the health of a population is measured as regards our own area are considerably more favourable than the average for England and Wales. If one studies the table of comparative statistics on page 13 it will be seen that in every instance our mortality figures are well below the average for the country as a whole. As has been mentioned before, it is particularly gratifying that this is true of those special figures which are regarded to some extent as indicative of the environmental standards. The death rate from enteritis and diarrhoea under two years of age gives us a mortality less than a third of the national average, and our infant mortality rate in Merton and Morden is 24.8 per thousand as compared with 34 per thousand for England and Wales. Our maternal mortality rate this year is Nil, as it was two years ago. On page 20 the maternal mortality rates for the past 20 years are set out to afford comparison. Our birth rate has fallen sharply from 17.86 last year to 14.45 this year, and the number of live births has dropped from 1,345 last year to 1,087 this year—a replacement of population loss of 258. There were 572 deaths in the area and our death rate continues at a relatively low level, 7.6 per thousand population, the comparable figure for the country being 10.8. The analysis of the diseases which are responsible for these 572 deaths will be found on page 19 and it is perhaps of particular interest to mention here that disease of the heart remains the biggest single cause and that, although cancer continues to keep its position as the second, the actual number of deaths from cancer has dropped again this year to 110. Last year it was 118 and the previous year it was 126. Tuberculosis claimed 35 deaths as against 30 last year; these deaths are further analysed and classified on page 73. Measles alone of the infectious diseases reached epidemic proportions and, as is mentioned elsewhere, presentday measles is a mild disease. There were no cases of typhoid or smallpox and over the year 8 cases of poliomyelitis, as compared with 22 last year. 3 It is perhaps appropriate to record the passing of the National Assistance Act, 1948, which may be regarded to some extent as complementary to the Health Act and the Children's Act, 1948, the so-called "Children's Charter", and while the responsibility for the over-all administration of these Acts is not now placed directly on the local authority the Council has been given an important share in the day-to-day administration by representation on the local Sub-Committees. Quite certainly no consideration of the factors influencing the health and welfare of the local community would be complete without having regard to these measures. The coming into operation of the National Health Act, 1946, on the 5th July, 1948, effected the transfer of the personal Health Service to the County Council and it is for this reason, in accordance with the suggestions of the Minister of Health in his Annual Circular to Medical Offiers of Health on the matters that should be dealt with in their Annual Reports for 1948, that the report on this service applies only to the first half of the year. The sanitary work of the department, the prevention of nuisances, the supervision of food manufacture, storage and distribution, and the responsibilities placed on us under the Housing Acts have been ably carried out under the direction of the Chief Sanitary Inspector, Mr. F. C. Thomas, and a summary of the work of the sanitary inspectors will be found in the body of the report. Housing remains the chief adverse environmental factor in the coummunity at present and its seriousness cannot be exaggerated; it effects permeate every aspect of the lives of a considerable proportion of our population, its short-term effects are distressing and apparent: what its long-term effects may be only the future will reveal. At the end of the year under review there were 3,564 persons on the waiting list for houses. In conclusion, I would like to take this opportunity of thanking the members of the Council for their continued interest in the work of the Public Health Department and for their encouragement to me. I would also like to take this opportunity of thanking all the Public Health staff for their loyal devotion to the Department, its aims and its purposes. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, A. W. JOHNS, Medical Officer of Health. September, 1949. 4 URBAN DISTRICT COUNCIL OF MERTON AND MORDEN 1948. PUBLIC HEALTH COMMITTEE Mrs. L. A. Doel. Chairman: Mr. J. H. Burrows. Mr. J. A. Farnham. Mr. R. W. Goddard. Dr. E. H. Kelly, J.P. Mrs. E. L. Kimber. Mrs. S. A. Lodge. Mr. G. H. R. Martin. Mr. F. J. Matthews. Mr. E. W. Warren. Mrs. H. Cobbett, J.P. (ex-officio). Mr. F. H. Brinkworth (ex-officio). MATERNITY AND CHILD WELFARE COMMITTEE Chairman: Dr. E. H. Kelly. J.P. Mr. J. H. Burrows. Mrs. L. A. Doel. Mr. J. A. Farnham. Mr. R. W. Goddard Mrs. E. L. Kimber. Mrs. S. A. Lodge. Mr. G. h. R. Martin. Mr. F. J. Matthews. Mr. E. W. Warren. Mrs. A. E. Edwards Mrs. G. Merritt Mrs. E. Hales Co-opted members. Mrs. H. Cobbett, J.P. (ex-officio). Mr. F. H. Brinkworth (ex-officio). REPRESENTATIVES ON NORTH-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE Mr. J. H. Burrows. Mr. J. A. Farnham. Mr. R. W. Goddard. Dr. E. H. Kelly, J.P. Mr. F. J. Matthews. REPRESENTATIVES ON THE WANDLE VALLEY JOINT HOSPITAL BOARD Mr. A. H. Gray. Mr. F. J. Grimme, J.P. Mr. C. S. Marsh. Mrs. H. Cobbett, J.P. (ex-officio). REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD Mrs. E. M. Clifton, J.P. Mr. S. F. Franklin (To June, 1948). Mr. D. Shadbolt. Mr. S. W. Billingham, J.P. (From July, 1948). Mrs. H. Cobbett, J.P. (ex-officio). REPRESENTATIVES ON NELSON HOSPITAL COUNCIL Mr. J. A. Farnham. Dr. E. H. Kelly, J.P. Mr. E. W. Warren. MERTON AND MORDEN TUBERCULOSIS CARE COMMITTEE Chairman-. Mrs. H. Cobbett, J.P. Vice-Chairman: Mrs. M. E. Shaw. Secretary. Miss M. P. Morriss. Treasurer: Mr. F. S. Buck. 5 PUBLIC HEALTH STAFF, 1948. 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 c d F. C. Thomas, M.R.San.I. Deputy Chief Sanitary Inspector: beef W. T. Pinches, M.R.San.I. Sanitary Inspector: b L. H. Thomas. Temporary Assistant Sanitary Inspectors: b E. L. Taylor (To 21.2.48). J. E. Robbins (From 23.2.48 to 8.5.48). b T. F. H. Free (From 25.5,48 to 18.7.48). b C. L. Connor (From 19.8.48). Senior Health Visitor: Miss E. M. Sperry. Health Visitors: Miss M. E. Black. Miss J. W. Eve. Miss A. Howard. Mrs. D. Lewis Miss E. F. Martin. Miss C. I. Tregurtha Chief Clerk: A. A. Makepeace. Clerks: R. A. Conolly. H. J. Herbert. Miss E. M. Hyem. R. J. Mitton. Ante-Natal Officer: Christine M. Stacey, M.R.C.O.G., M.B., B.S. 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 Organisers Mrs. W. E. Robertson. a Sanitary Inspector's Certificate, Royal Sanitary Institute. b Sanitary Inspector's Certificate, San. Insp. Exam. Joint Board. c Meat and Food Inspector's Certificate, Royal Sanitary Institute. 11 Sanitary Science Certificate, University of Liverpool. e Smoke Inspector's Certificate, Royal Sanitary Institute. f Sanitary Science Certificate, Royal Sanitary Institute. 6 MATERNITY AND CHILD WELFARE CENTRES. Voluntary Workers. Name. Length of Service. Mrs. D. Buist 1 year Mrs. L. Cathie 20 years Mrs. W. B. Curtis 1 year Mrs. A. Edwards 16 years Mrs. W. Eve 5 years Mrs. G. Everett 5 years Mrs. M. L. Flemming 2 years Mrs. F. Gough 1 year Mrs. M. Hughes 3 years Mrs. A. Hulatt 1 year Mrs. J. Jacobs 4 years Mrs. E. McCubbine 11 years Mrs. L. Newall 2 years Mrs. A. M. O'Hare 19 yeare Mrs. L. Patch 5 years Mrs. M. Phillips 4 years Mrs. C. Taylor 1 year Mrs. P. Thomas 18 years Mrs. V. M. Williams 2 years 7 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 3,238 Number of inhabited houses according to Rate Books 21,721 Rateable value at 31st December, 1948 £664,676 Sum represented by Id. rate £2,742 The Urban District of Merton and Morden results from the amalgamation of Merton with Morden in 1913. That year the populations were recorded separately, Merton 15,567 and Morden 1,200. The total area is given as 3,238 acres, to which Merton had contributed 1,473 acres. There were 3,560 houses in rate and 86 empty. Of these there were 1,030 houses occupied with a rental up to £16 per annum and 2,076 with a rental from £16 to £26. Attention is drawn in the annual report for that year that there were only 86 houses unoccupied, the smallest number since the district acquired urban powers. From 3,560 in 1913 to 20,750 houses in 1939 is rapid development, most of which took place from 1921 to 1939. Side by side with this growth of population and its consequent housing the development of industry begins and it is to the credit of the local authority that they so planned this industrial development that it preserves all the amenities for the residential population. Moreover, as development went on they acquired open spaces and preserved playing space for the recreational activities of the population. The district is fortunate in the extent of its open spaces, in all amounting to 368 acres, 70 odd acres belong to the National Trust and the remainder, some 290 acres, belonging to the Council, represent 14 different public parks which are under the control of the Open Spaces Superintendent. Much of this land is, of course, at the moment under allotment cultivation, but when it is all released there will hardly be any resident in the district without a park or playing space on his doorstep. The fact that Merton and Morden, owing to its situation close to London, commenced its development as a residential dormitory area is probably responsible for this description continuing to be applied to it long after it had ceased to be accurate and this has tended to obscure its industrial achievement. It is, in fact, one of the biggest industrial areas in the County of Surrey. That this is not apparant to any but those quite familiar with the area is due to the unobtrusive siting of the 8 factory estates and to the fact that the factories themselves are of modern design and construction and have none of the unpleasant characteristics associated with the old type of factory area. There are four factory areas, the largest being the Lombard Road Estate on the north-eastern boundary, the Shannon Corner Estate on the north-western boundary, a small group in the Merton Abbey area and a similarly small group in the southeastern corner of the district. Among these industrial concerns are to be found such world famous names as James Carter and Sons, Seed Merchants; Tri-ang Toys; Bradbury Wilkinson & Co. and the New Merton Board Mills, to name only a few. Industry. There were 194 factories registered under the Factory Act at the end of the year, as follows:— Factories with mechanical power:— Employing more than 40 persons 51 Employing less than 40 persons 122 Factories without mechanical power 21 194 It may be of interest to note that of the fifty-one factories employing more than 40 persons, one factory employs more than 2,000, three others employ 500 or more and a further twenty-seven factories employ more than 100 persons. Climatic Conditions. Rain gauges are installed at the Joseph Hood Recreation Ground and West Barnes Pumping Station. The monthly recordings are as shown below:— RAINFALL, 1948. MONTH JOSEPH HOOD RECREATION GROUND WEST BARNES PUMPING STATION Inches Days with o.oiin. or more Days with 0.04in. or more Inches Days with o.oiin. or more with 0.04in. or more January 2.79 22 16 3.22 24 16 February 1.39 15 9 1.51 14 9 March .61 5 4 .74 5 4 April 1.10 12 9 1.16 11 7 May 2.05 9 9 2.14 12 9 June 2.21 14 14 2.32 16 16 July .93 9 6 1.06 11 7 August 3.48 13 12 3.61 15 11 September .88 10 6 1.19 10 8 October 2.40 10 9 2.73 12 9 November 1.47 8 7 1.67 13 7 December 2.20 15 14 3.22 21 13 Total 21.51 142 115 24.57 164 116 9 VITAL STATISTICS. The summary of vital statistics on page 12 seems to confirm that the post.war fillip in the birth rate is already beginning to peter out, as it did following the last war. In fact the raised birth rate following the present war has not been so well sustained as last time. It may well be that the acuteness of the housing problem has been a contributory factor. It is perhaps of interest that the birth rate for Merton and Morden has fallen more steeply than the other rates shewn in the table. The live birth rate for England and Wales has fallen from 20.5 to 17.9, the 126 great towns from 23.3 to 20.0, the 148 smaller towns from 22.2 to 19.2 and the London Administrative County from 22.7 to 20.1, while the rate for Merton and Morden has fallen from 17.86 to 14.45. It will be seen that the infant mortality rate for Merton and Morden is 24.8 per 1,000 compared with 31 per 1,000 for London and 34 for England and Wales as a whole and that deaths from diarrhoea under 2 years of age are less than half that of any of the others. This is a gratifying figure as it is always regarded to some extent as one of the yardsticks whereby the sanitary conditions of areas can be compared. One of the Australian delegates at a recent conference said that he would take a great deal of pride in having his city described as a good place in which to bring children up. We need not, therefore, apologise for drawing attention to this figure, one of the few statistical proofs of what would otherwise have to remain a matter of faith. It may be observed that the table also shows that we have the highest rate for some of the infectious diseases, for example, whooping cough and measles, but we are compensated, to some extent, by the fact that our death rate from whooping cough is as low as the lowest. In this connection it should be, perhaps, borne in mind that measles and whooping cough are diseases in which the doctor is not always called in and the extent to which this occurs still varies in certain areas, so that the number of measles and whooping cough notifications may be a more reliable guide as to the standard of parental care rather than of the actual incidence of the disease. Our still.birth rate once more is the lowest shewn in the table, 0.27 per 1,000, as compared with 0.42 per 1,000 for England and Wales as a whole, or, in simpler terms, 36% better. This figure is closely associated with those factors affecting the welfare of the mother both during pregnancy and during labour and further, closely follows the trend of the maternal mortality figure, which, for the year under review is nil. 10 The total deaths from all causes at 572 and the total live births at 1,087 gives a natural increase in population of 515, a considerable drop from last year's figure of 734. Thus, though there were 39 less deaths, there were 258 less births. The following table sets out over the past five years the local infant mortality rate as compared with that for England and Wales: — England and Wales Merton and Morden 1944 46 28.7 1945 46 33.1 1946 43 22.2 1947 41 30.4 1948 34 24.8 There were 42 illegitimate births as against 40 for the previous year. Details of the arrangements existing for the care of illegitimate children and their mothers are given on page 36. 11 SUMMARY OF VITAL STATISTICS. (Registrar General's Figures). Population : Registrar General's Estimate 75,220 Births : M. F. Total Live (Legitimate) 517 528 1,045 (Illegitimate) 21 21 42 538 549 1,087 Stillbirths (Legitimate 8 13 21 (I llegitimate) — — — 8 13 21 Total Births 546 562 1,108 Birth Rate 14.45 per 1,000 population Still Birth Rate 18.9 per 1,000 births Deaths: M. F. Total 309 263 572 Death Rate 7.6 per 1,000 population Infant Mortality : Total deaths under one year 27 Infant Mortality Rate per 1,000 Live Births 24.8 Deaths of Legitimate Infants under 1 year 22 Death Rate per 1,000 Legitimate Births 2104 Deaths of Illegitimate Infants under 1 year 5 Death Rate per 1,000 Illegitimate Births 119 Maternal Mortality: Deaths from Sepsis Nil Deaths from other maternal causes Nil Maternal Death rate per 1,000 Live Births — Zymotic Deaths: Deaths from Measles Nil Whooping Cough 1 Diarrhoea (under 2 years) 1 7 Principal Zymotic Diseases 3 Zymotic Death Rate (per 1,000 population) 0.04 Deaths from Tuberculosis: All forms 35 Rate per 1,000 population 0.46 Phthisis: 34 Rate per 1,000 population 0.45 Deaths from Cance: 110 Rate per 1,000 population 1.46 12 TABLE I. COMPARATIVE STATISTICS, 1948. (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 Administrative County Merton and Morden Births: Live Still Deaths: All causes Typhoid and Paratyphoid fevers Whooping Cough Diphtheria Tuberculosis Influenza Smallpox Acute Poliomyelitis and Polioencephalitis neumonia Notifications: (Corrected) Typhoid Fever Paratyphoid Fever Cerebro-spinal Fever Scarlet Fever Whooping Cough Diphtheria Erysipelas Smallpox Measles Pneumonia Acute Poliomyelitis Acute Polioencephalitis Rates per 1,000 Population. 17.9* 0.42* 10 8* 0.00 0.02 0 00 051 0 03 0.01 0.41 0.01 0.01 0 03 1.73 3 42 0 08 0.21 9.34 0.73 0.04 0 00 20.0 0.52 11.6 0 00 0 02 0 00 0 59 0 03 0.01 0.38 0.00 0.01 0 03 1.90 3.51 0 10 0.23 9.75 0.84 0.05 0.00 192 0.43 10.7 0.00 0 02 0.00 0.46 0 04 0.01 0.36 0.01 0.01 0.02 1.82 3 31 0 09 0.21 8 84 0 60 0 04 0 00 20.1 0.39 11.6 000 001 001 0.63 0 02 0 00 0.54 0.00 0.01 0 03 1 37 3 13 0.10 0.22 9 17 0 57 0 04 0.00 14.45 0.27 7.6 0.00 001 0.00 0.46 0 02 0.00 0.19 0.00 0 00 0 00 1 48 5 02 0 03 0 19 13.94 0 53 0.10 0.00 Deaths: All causes under 1 year of age Enteritis and Diarrhoea under 2 years of age Rates per 1,000 Live Births. 34† 3.3 39 45 32 2.1 31 2.4 24.8 0.92 Rates per 1,000 Total Births (Live and Still). Notifications: (Corrected) Puerperal Fever and Pyrexia 6.89 8.90 4.71 7.34‡ 1.80 * Rates per 1,000 Total Population. t Per 1,000 Related Births. ‡ Puerperal Fever Alone— London 0.61. 13 POPULATION. The estimated figure for the population of Merton and Morden for mid-year 1948 is 75,220. Last year's figure of 75,290 was the highest ever recorded for the district and it is something of a disappointment to find that Registrar General has estimate a decrease of 70. Whilst present day methods of estimation are probably much more accurate than ever before, it should be remembered that these figures are estimates and that there are features which make them difficult to reconcile with local facts. It will be interesting to examine these figures of the intermediate inter-census years when the next census comes to be taken. It is an interesting speculation whether our population has reached, or nearly reached, its peak. This year, after the addition of last year's natural increase of 734, the highest ever recorded for the district, our population is estimated at a lower figure than for last year. This would suggest that last year our population was at its zenith. BIRTHS. There were 1,087 registered live births in 1948, of which 1,045 were legitimate and 42 illegitimate. As has been pointed out, this is a very considerable drop from the 1,345 live births registered last year and the birth rate has consequently dropped from 17.86 to 14.45 per thousand. The illegitimate rate at 38.6 per thousand live births compares with 28-3 for the previous year. The following table gives an indication of the trend over the past twelve 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 1948 42 38.6 14 INSTITUTIONAL AND DOMICILIARY BIRTHS. The notifications show that 855 births took place in institutions, hospitals and private nursing homes. This is 197 less than 1947 and represents 77.1 per cent, of the total, as compared with 76.5 per cent for the previous year. These births occurred in the following hospitals and institutions:— St. Helier Hospital 372 Nelson Hospital 289 St. Luke's Hospital, Guildford 15 Kingston Hospital 10 Other hospitals, institutions and nursing homes 169 855 15 TABLE II Showing Births and Deaths with Rates since the Amalgamation of Merton with Morden. Year Estimated population Total Births Birth Rate Total Deaths Death Rate 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 7.2 346 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 1948 75,220 1,087 14.45 572 7.6 515 DEATHS. The number of registered deaths after adjustment by transferable deaths, is given below:— 572 total deaths of which 309 were males and 263 females. The seasonal mortality is indicated by the deaths for each quarter of the year, which were:— First quarter 159 Second quarter 134 Third quarter 117 Fourth quarter 162 16 Inquests. Inquests were held on 15 deaths occurring in the district, 9 of which were in respect of residents. The verdicts returned were as follows:— (1) Accidental Deaths— Collision with motor vehicles 6 Fall at home 1 Gunshot wound 1 Injury from train collision 1 9 (2) Misadventure— Asphyxia by inhalation 2 2 (3) Suicide by— Asphyxia due to hanging 1 Coal gas poisoning 2 Collision with train 1 4 15 The total number of inquests held were four less than in the year before. Road accidents were responsible for six of the total accidental deaths, compared with four for the previous year. CAUSES OF DEATH. The table on page 19 gives the causes of death for the year 1948. It will be seen that heart disease maintains first place as a cause of death with 170, Cancer following next in order with 110. Intra-cranial vascular lesions is responsible for 66 and, as this disease is probably one of the most reliably certified causes, its place on the list is likely to be maintained. Tuberculosis comes fourth in the list with 35 deaths, a slight increase over the last year, when there were 32 deaths from this disease. It will be seen that of the 35 deaths, 21 were males and 14 were females, all of these deaths, with the exception of one, being from Pulmonary Tuberculosis. These deaths are further analysed into their age groups in Table XXV. on page 73. It is gratifying to record that the number of deaths from Cancer has steadily fallen since 1946. It is, however, a salutary thought that deaths from this disease represent over one-fifth of the deaths from all causes. 17 CANCER DEATH RATE. No. of deaths from Cancer for past 10 years. 1939 91 1944 107 1940 76 1945 116 1941 85 1946 126 1942 103 1947 118 1943 116 1948 110 Death Rate per 1,000 Year. population. 1939 1.1 1940 1.2 1941 1.3 1942 1.5 1943 1.7 Death Rate per 1,000 Year. population. 1944 1.7 1945 1.7 1946 1.7 1947 1.5 1948 1.5 TABLE III. Deaths from Respiratory Diseases, 1928-1948. Year Bronchitis Pneumonia Other Respiratory Diseases Total Death Rate 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 36 22 12 70 1.05 1946 22 17 17 56 0.76 1947 31 25 4 60 0.79 1948 30 15 9 54 0.72 18 TABLE IV. Causes of Death during the year 1948. No. Cause of Death Males Females Total 1 Typhoid and Paratyphoid Fevers - - - 2 Cerebro spinal fever — — — 3 Scarlet Fever 1 — 1 4 Whooping Cough — 1 1 5 Diphtheria — — — 6 Tuberculosis Respir. System 21 13 34 7 Other forms of Tuberculosis — 1 1 8 Syphilitic disease 4 2 6 9 Influenza 1 1 2 10 Measles — — — 11 Ac. Poliomyel. and polioencephalitis - - — 12 Ac. inf. encephalitis — 1 1 13 Cancer of buc. cav. and oesoph. (M) uterus (F) 7 2 9 14 Cancer of stomach and duodenum 11 8 19 15 Cancer of breast — 12 12 16 Cancer of all other sites 45 25 70 17 Diabetes 1 — 1 18 Intra-cranial vascular lesions 28 38 66 19 Heart disease 85 85 170 20 Other dis. of circ. system 10 7 17 21 Bronchitis 18 12 30 22 Pneumonia 8 7 15 23 Other respiratory diseases 5 4 9 24 Ulcer of stom. or duodenum 5 1 6 25 Diarrhoea under 2 years — 1 1 26 Appendicitis — — 8 27 Other digestive diseases 4 4 28 Nephritis 4 3 7 29 Puer. and post abort, sepsis — — — 30 Other maternal causes — — — 31 Premature birth 2 2 4 32 Con. mal. birth inj. inf. dis. 10 11 21 33 Suicide 6 1 7 34 Road traffic accident 6 2 8 35 Other violent causes 8 3 11 36 All other causes 19 16 35 Total all causes 309 263 572 MATERNAL MORTALITY. It is very gratifying once again to record a "Nil" return for maternal deaths. We had a Nil return in 1946 and one death in 1947 which gave us, last year, a maternal mortality rate of 0.73 per thousand total births. This year it is again zero. A table is produced on the next page showing the maternal mortality rates for the district for the past 20 years and the comparable rates for England and Wales as a whole. This table demonstrates very clearly the consistently more favourable mortality 19 rates enjoyed by Merton and Morden. If this table is compared with that on page 13, shewing the stillbirth rates, it will give further emphasis to this fact, for it is certain that the factors adversely affecting the chances of the mother's survival during childbirth are the same factors that are responsible for stillbirths. Both are a measure of obstetric efficiency and, of the two, the stillbirth rate is the more sensitive. Further, if we .examine the neo-natal infant mortality rate, i.e. those who failed to survive the first month of life and who have probably only just escaped being stillbirths—and indeed, there are many who could not survive the first few hours—we find that all these rates are significantly better than the comparable rates for England and Wales, which is the final average of all the areas in the country. TABLE V. Maternal Mortality, 1928-1948. With Comparable Rates for England and Wales. Year Death rate per thousand total births. Sepsis Other causes Total Merton and Morden England and Wales Merton and Morden England and Wales Merton and Morden England and Wales 1928 1.58 - 2.17 - 3.75 1929 2.2 1.51 - 2.13 2.2 3.64 1930 — 1.54 2.2 2.06 2.2 3.60 1931 1.6 1.41 3.1 2.02 4.7 3.43 1932 5.1 1.33 2.5 2.12 7.6 3.46 1933 2.9 1.49 1.4 2.23 4.3 3.72 1934 2.5 1.59 2.5 2.21 5.0 3.80 1935 — 1.34 2.6 2'06 2.6 3.41 1936 2.4 1.18 — 2.01 2.4 3.19 1937 1.2 0.79 1.2 2.01 2.4 2.79 1938 0.98 0.70 1.96 1.99 2.94 2.70 1939 — 0.63 3.93 1.94 3.93 2.57 1940 1.04 0.55 — 1.69 1.04 2.24 1941 — 0.48 2.3 1.78 2.3 2.26 1942 0.93 0.42 1.87 1.60 2.80 2.02 1943 0.85 0 39 — 1.45 0.85 1.84 1944 — 0.28 0.84 1.24 0.84 1.52 1945 — 0.24 0.97 1.23 0.97 1.47 1946 — 0.31 — 1.12 — 1.43 1947 0.73 0.26 — 0.92 0.73 1.18 1948 — 0.24 — 0.78 — 1.02 INFANT MORTALITY. Once more I have set out the causes of infant deaths in detail to demonstrate the fact that it is in improved obstetric care now that any further considerable reduction of this infant 20 mortality lies It was in the neo-natal period—that is within the first month—that 23 out of the total 27 deaths occurred. Last year it was 34 out of 41 and in the previous year 28 out of a total of 28. The welfare authorities have succeeded in bringing the mortality down from 130, 30 years ago, to its present 30-40 per thousand. This reduction took place almost entirely in the group over a month old, there having been no corresponding reduction in the neo-natal group. It may be of interest that the infant mortality in Merton and Morden in 1898 was 212 per thousand live births, or 21 percent. of infants born that year did not survive their infancy. Today our infant mortality is 24 8 per thousand and only on two occassions has this been lower. Infant Deaths — With causes of death. Sex. Age. Cause of Death. Female 5 days Icterus Gravis Neonatorum. Female 1 month Prematurity. Congenital Syphilis Male 1 day Atelectasis. Prematurity. Male 2 days Prematurity. 24 weeks maturity at birth Female 4 months Gastro-Enteritis Male 1 month Kernicterus Male 3 days Kernicterus Erythroblastosis Foetalis. Male 2 days Atelectasis Right Lung Cerebral Oedema due to cardiac failure Male 1 day Prematurity. Male 30 minutes Cerebral Haemorrhage Torn Tentorium Cerebelli Female 9 months Cerebral compression Hydrocephalus Female 1 month Hydrocephalus Meningitis Porencephaly Female 3 months Broncho Pneumonia Pertussis Female 1 day Prematurity. Female 3 weeks Aspiration Broncho Pneumonia Congenital Tracheo Oesophageal Fistula 21 Sex. Age. Cause of Death. Male 6 months Respiratory failure Broncho Pneumonia Acute Otitis Media Female 6 days Prematurity. Maternal Toxaemia Nephritis (Maternal) Female 12 hours Prematurity. Female Newly-born Asphyxia and Pulmonary Atelectasis due to inhalation of maternal secretions into air passages Male 5 days Atelectasis Male 15 hours Congenital Atelectasis Female 3 weeks Meningitis Spina Bifida. Male Newly-born Asphyxia due to inhalation of maternal secretions Inattention at birth Female 6 hours Asphyxia. Atelectasis. Congenital patent inter auricular septum Male 8 days Haemorrhagic Broncho Pneumonia Male 1 month Pneumonia. Female 1 day Prematurity. PREMATURE BABIES. It will be seen from the appended tabular statement that there were 37 premature babies notified during the year, as compared with 38 for last year. It will be remembered that, for the purposes of notification, a premature baby is one which is 5½ lbs. or less and the midwife or doctor in attendance at the birth is required to notify us of the birth. One of the effects of this will undoubtedly be to form a more reliable estimate of the extent to which prematurity is responsible for the infant mortality. Of the 37 cases, 32 were born in hospital as against 22 out of the 38 last year. If this is indicative of a greater tendency to refer these cases to hospital prior to the birth of the baby it will be likely to result in a saving of many of these infant lives because it is the transport of these to hospital after the birth that has such an adverse effect on their chances of survival and it has always seemed so much more sensible to transport them in their natural habitat before birth than to go infinite 22 trouble to design an insulated and heated conveyance for the purpose. When it is recognised by every person called to a mother in labour before term that to get her to hospital before the baby is born is the optimum line of treatment, a higher proportion of these very premature babies born at home will be saved. This is not to say that all premature babies should be nursed in hospital but it would secure, however, that all the small 4 lb. and under babies avoid the dangers of transport to hospital. The total number of premature babies notified during the year were as follows, born:— (a) At home 5 (b) In hospital 32 The number of those born at home:— (a) Who were nursed entirely at home 5 (b) Who died during the first 24 hours — (c) Who survived at the end of one month 5 The number of those born in hospital:— (a) Who died during the first 24 hours 2 (b) Who survived at the end of one month 28 23 SECTION B. — HEALTH SERVICES. Nursing in the Home. There are three Associations carrying on this work in the area, all affiliated to the County Nursing Association, the County Council now being responsible for this service. Details of the work carried out by these Associations during 1948 are as follows:— (1) The Merton District Nursing Association employs one nurse for general nursing, no midwifery or maternity nursing being undertaken. The district this Association serves is approximately the ecclesiastical parish of St. Mary's. A total of 305 cases involving 2,246 visits were attended during the year and of these, 25 cases were children under 5 years of age, to whom 84 visits were made. (2) The St. Helier District Nursing Association employs one full-time and two part-time nurses 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 Carlshalton Urban District lying to the north of Reigate Avenue. During the year 192 cases were dealt with by the St. Helier District Nursing Association, 7 of these being children under 5 years of age. The total number of visits made was 4,697, of which 24 were in respect of children under 5 years. (3) The Wimbledon District Nursing Association serves Wimbledon and the western part of this district. Two full-time nurses and one part-time nurse are employed for general nursing in Merton and Morden. The figures relating to cases and visits n this district during the year are as follows: — Cases Visits Children under 5 years 39 167 Other cases 373 6,303 412 6,470 Laboratory Facilities. The routine laboratory work for the district is undertaken by the Nelson Hospital. The scope of the pathological work undertaken during the period from 1st January to 4th July, 1948, is as follows: — Examinations No. performed Positive result Swabs for Diphtheria Bacilli 108 1 Sputum for Tubercle Bacilli 14 1 Faeces 3 — Blood for Widal Test 1 — Urine 2 — Rectal 2 — 24 AMBULANCE FACILITIES. Infectious Diseases. The removal of infectious cases, undertaken until 5th July, by the Wandle Valley Joint Hospital Board, have now become the responsibility of the County Council. The number and nature of the cases admitted to this hospital during the year are shewn in the table set out on page 29. Non-Infectious Cases. As in the case of the above service, the removal of non-infectious cases has also become the responsibility of the County Council, the Merton and Morden Council being responsible only until 5th July for the removal to hospital of accidents and cases of general illness. The following table shows the scope of the work undertaken by the ambulance service of the district from the beginning of the year until 4th July, 1948:— AMBULANCE CALLS. (From 1/1/48 to 4/7/48). Month Calls received from public Calls received from neighbouring Authorities Total calls received Calls transferred to other Authorities Calls answered by own ambulance Jan. 131 68 199 18 181 Feb. 110 67 177 15 162 March 174 57 231 22 209 April 159 51 210 15 195 May 161 44 205 21 184 June 124 46 170 17 153 July (1st to 4th) 12 5 17 1 16 Total 871 338 1209 109 1100 Time taken in executing the calls (from leaving Station to return) 904 hours Mileage covered 10,562 miles Average time per call 44.9 minutes Average distance per call 8.7 miles Hospital Car Service. This most valuable service was continued during the year, relieving the ambulances of a great burden at calls by providing transport for out-patients requiring hospital treatment. The service, under the auspices of the British Red Cross and St. John Ambulance Brigade, is conducted on a voluntary basis by public-spirited persons who put themselves and their vehicles at the disposal of the organisation. A charge of 6d. per mile is made to cover partly the actual running cost. 25 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 Welfare Mondays 10—12 noon. Mondays 2—4 p.m. Wednesdays 10—12 noon. Ante-Natal 1st and 3rd Tuesdays in each month at 9.0 a.m. Wednesdays at 1.30 p.m. Welfare Centre, Aston Road, Raynes Park. Infant Welfare Mondays 2—4 p.m. Wednesdays 2—4 p.m. Fridays 10—12 noon. Ante-Natal Saturdays at 9.0 a.m. Dental By appointment Friday mornings. Health Centre, Middleton Road, Infant Welfare Tuesdays 2—4 p.m. Fridays 2—4 p.m. Morden. Ante-Natal 2nd and 4th Tuesdays in each month at 9.0 a.m. Thursdays at 9.0 a.m. Dental By appointment Thursday mornings. Hope Mission Hall, Rodney Place, Merton. Infant Welfare Thursdays 10—12 noon. Baptist Hall, Crown Lane, Morden. Infant Welfare Thursdays 2—4 p.m. 2.—School Clinics (provided by the Surrey Education Committee). Aston Road, Raynes Park. Minor Ailments Tuesdays and Thursdays 9.30 —12 noon. Dental Mondays, Tuesdays and Thursdays 9.30—12 noon. 1.30— 4.0 p.m. Wednesdays 9.30—12 noon. Eye Tuesdays 1.30—4.0 p.m. Middleton Road Morden. Minor Ailments Mondays and Wednesdays 9.30 —12 noon. Dental Mondays, Wednesdays and Fridays 9.30—12 noon and 1.30 —4.0 p.m. Tuesdays 9.30—12 noon. Thursdays 1.30—4.0 p.m. Eye Wednesdays 1.30—4.0 p.m. 26 3.—Tuberculosis Dispensaries. Since 5th July, as a result of the changes brought about by the National Health Service Act, 1946, the provision of treatment and investigation of Tuberculosis is undertaken by the Regional Hospital Board. The County Council remain responsible for the preventive side of the work and the Health Visitors and Almoners working in the Chest Clinic at the St. Helier Hospital are employed by the County Council. Threeelevenths of the Tuberculosis Officer's time is allocated to the preventive side of the work and is the responsibility of the County Council. The sessions held at the Chest Clinic are as follows:— 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 treatment, both in-patient and out-patient, of venereal disease has now become a responsibility of the Hospital Board and for our area this treatment is mainly carried out at the St. Helier Hospital, although both Kingston and Croydon General Hospitals are near enough to serve the area as well. The preventive side of the work, domiciliary visiting of contacts, etc., remains the responsibility of the local health authority and the County Conucil have appointed two health visitors especially for this purpose. 27 Clinics are held at these hospitals as follows:— St. Helier Hospital, Wrythe Lane, Carshalton Males — Mondays 5-7 p.m. Females — Wednesdays 5-7 p.m. Fridays 1.30-3.30 p.m. Croydon General Hospital Males — Tuesdays at 7 p.m. Saturdays at 2.30 p.m. Females — Wednesdays at 2.30 p.m. Thursdays at 11 a.m. Fridays 3-5 p.m. and 5.30-7.30 p.m. Kingston Hospital, Wolverton Avenue, Kingston-on-Thames Females — Thursdays 5-7 p.m. 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 cases admitted from this area during the year. Infectious Disease. Until 5th July, 1948, the Wandle Valley Hospital under a Joint Hospital Board, served 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 120 patients from our district have been treated in the hospital. Table VI shows in detail the conditions for which admission was necessitated. 28 TABLE VI. Cases admitted to the Wandle Valley Isolation Hospital during the Year 1948. Disease Cases Deaths Diphtheria 2 — Scarlet Fever 78 — Erysipelas 2 — Tonsillitis 7 — Measles 11 — Influenza and Pleurisy 1 — Whooping Cough 4 — Enteritis 1 — Meningitis 1 — Puerperal Pyrexia 1 — Infantile Paralysis 4 — Otitis Media 1 — Septicaemia 2 — Pneumonia 2 1 Sunstroke 1 — Carcinoma of Throat 1 — Disseminated Sclerosis 1 — Total 120 1 General and Maternity. 1. The Nelson Hospital. The accommodation of this hospital, which serves the Wimbledon, Merton and Morden area is 106 beds, 26 of which are maternity beds. The following The following information relating to the hospital's activities during the year is supplied by the courtesy of the Secretary:— (a) General Medical and Surgical Treatment. Total number of in-patients admitted 2,535 Number from Merton and Morden 759 Total number of new out-patients 12,022 Number from Merton and Morden 5,531 (b) Maternity Services. Number of patients admitted from all districts during the year:— (1) General Wards 490 (2) Private Wards 172 662 29 Number of patients admitted from Merton and Morden:— (1) General Wards 179 (2) Private Wards 45 224 2. Other Hospitals. Other hospitals available for the use of residents of the district include the St. Helier Hospital situate just beyond the boundary of our district in the Carshalton area and the Epsom and Kingston Hospitals which are within a matter of five miles or so. All of the hospitals to which reference is made in this report passed to the control of the Regional Hospital Board on 5th July, 1948. 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 1,072 Notified by Midwives 519 Still Births 21 Notified by doctors and parents 9 Transferred from other districts 565 1,093 1,093 The Work of the Centres. Reference to Table VIII on page 32 shows the extent of the work at the Infant Welfare Centres. The table confirms what has been reported to the Committee from time to time during the year with all our clinics. The Baptist Hall and the Raynes Park Clinic have been too well attended. Various measures were considered for remedying this position. An additional session for the Baptist Hall, where the greatest attendance was, seemed the best solution but proved impracticable and, eventually, it was decided to put on an additional session at the Raynes Park Clinic which has, subsequently, had the desired result. The figures shewn in the tables refer only to the first half of the year and they do not, therefore, provide a comparision with previous years. As was to be expected however, with the 30 greatly reduced number of births for 1948, the figures for the whole year calculated on the figures for the half year presented, show a fall in attendances. In view of the increasing scope and extent of the examinations carried out at the Ante-Natal Clinics, this is perhaps a good thing if the numbers are kept within manageable proportions. It will be noticed that at one of these Clinics the attendance figures are considerably below the others, this is because the time consuming new cases are referred to this Clinic and, now that it has become a routine operation to withdraw blood intravenously for the midwives cases at their first attendance, the time spent on each patient has consequently increased. TABLE VII. Attendances at Ante-Natal Clinics. (From 1/1/48 to 4/7/48). Clinic No. on Register Attendances Sessions Average per Session Primary Total Morden Ante-Natal 107 91 633 16.3 Post-Natal 12 -— 20 40 Individuals 119 91 653 Raynes Park Ante-Natal 66 44 230 9.03 Post-Natal 7 — 5 26 Individuals 73 44 235 Grand Drive Ante-Natal 103 66 570 16.1 Post-Natal 18 — 29 37 Individuals 121 66 599 All Clinics Ante-Natal 276 201 1433 14.4 Post-Natal 37 — 54 103 Individuals 313 201 1487 (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.) 31 TABLE VIII. Attendances at Infants' Consultation Clinics. (From 1/1/48 to 4/7/48). Centre No. on Register Attendances Sessions Average Attendance per Session *Primary Total Morden Under 1 year 408 132 2001 52 48.7 1—5 years 16 536 Raynes Park Under 1 year 629 135 2788 56 75.8 1—5 years 22 1462 Baptist Hall Under 1 year 1—5 years 368 83 16 1737 886 27 97.1 Hope Mission Under 1 year 136 23 373 27 32.4 1—5 years 2 502 Grand Drive Under 1 year 855 170 3248 73 56.7 1—5 years 25 1896 All Centres Under year 2396 543 10147 235 65.6 1—5 years 81 5282 * 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 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 1948 3,065 720 954 28,548 2,673 31,221 32 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 75 469 47.3 1939 1,005 856 85 588 58.5 1940 971 705 73 668 68.8 1941 848 745 86 635 75.0 1942 1,069 840 87 774 72.0 1943 1,146 908 79 681 59.3 1944 1,151 807 70 740 64.2 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 1948 1,087 954 88 720 66.2 The Nelson Hospital Clinics. Maternity clinics are held at the Nelson Hospital every Monday, Tuesday and Thursday afternoon with a special clinic for new patients on Friday mornings, providing for the ante-natal and post-natal examination of women who are booked for admission or have been confined at the hospital. Booking Clinics are held every Friday afternoon and a Mothercraft Class every Wednesday afternoon. An arrangement exists whereby Merton and Morden women attending the hospital clinics may receive dental treatment under the Council's Scheme. Other clinics held at the hospital are as follows:— Children's Clinic Monday afternoons Ear, Nose and Throat Alternate Thursdays (mornings and afternoons) Fracture Clinic Fridays at 12 noon Gynaecological Tuesday afternoons Medical Tuesdays at 12 noon Fridays at 2 p.m. 33 Ophthalmic Friday afternoons Orthopaedic Monday and Friday mornings Paediatric Monday afternoons Surgical Monday mornings Wednesday afternoons Saturday mornings Varicose Veins Tuesday afternoons The following information relating to the number of attendances at the ante-natal and post-natal clinics of the hospital during the period from 1st January to 4th July, 1948, has been kindly supplied by the Secretary:— Total number of attendances from all districts 1,622 Total number of women who attended:— (a) From Merton and Morden 149 (b) From all districts 452 Health Visiting. The work of health visiting has been well maintained during the year under review, mainly for the reason that we have been fortunate in that our establishment of health visitors has been maintained at nearly full strength. For the first half of the year before the appointed day for the transfer of health services under the National Health Service Act on 5th July, we had seven health visitors on the staff undertaking maternity and child welfare work only the absence through sickness for that part of the year amounted to 89 days, representing a loss of the equivalent of half a health visitor, or leaving us for the period with 93% of the established strength. For the second half of the year with the addition of two school nurses, we had an establishment of nine health visitors. Sickness during this period amounted to 89 days, reducing our effective strength again by half a health visitor, or leaving us for the period with 94% of the establishment, so that for the year we were approximately 94%, the result of which is to show a gratifying output as the following details of the visits made clearly shows:— To expectant mothers — first visits 318 total visits 576 To children under 1 years— first visits 1,555 total visits 5,251 To children 1-5 years — total visits 6,659 Visits re puerperal pyrexia, ophthalmia neonatorum and miscellaneous 577 Visits to foster children re Child Life Protection 216 13,279 34 It has been the practice of the health visitors in the past, in addition to closely co-operating with our own Day Nurseries, to attend at the routine medical inspection of nursery children in the schools, to afford assistance to the School Medical Officer and Head Teachers with their more intimate knowledge of these children. Convalescent Home Treatment. Prior to the transfer of the health services to the County Council, children in need of convalescent treatment were referred to the Invalid Children's Aid Association, to whom the District Council made a contribution towards the cost of treatment. Orthopaedic Treatment. We are fortunate in Merton and Morden in having two hospitals equipped with Physiotherapy departments. It has become the practice to refer children from the Morden area to the St. Helier Hospital to facilitate regular attendances. Our old arrangement where we send these cases to the Physiotherapy department of the Nelson Hospital continues to cater for the Merton part of the area. Maternity Hospital Treatment. Complicated cases requiring in-patient treatment are referred to hospitals locally, while cases complicated by pyrexia have received treatment at the Wandle Valley Isolation Hospital. 80 such cases from the Council's Maternity Clinics were referred during the year to the following institutions: — To the St. Helier Hospital 74 To other hospitals 6 The reasons for referring these cases were as follows:— For obstetric abnormality 38 For other medical reasons 17 For unsuitable home conditions 25 Of 855 institutional births, 372 occurred in St. Helier Hospital, 289 in the Nelson Hospital and 194 in other hospitals, institutions or nursing homes, representing 77.1 per cent. of the total births. Emergency Maternity Unit. No calls were made during the year for the service of this unit. Consultant Service. A specialist's opinion may be had in cases of obstructed labour, emergencies in pregnancy, or puerperal pyrexia. Home Help Scheme. Until this service was transferred to the County Council on the appointed day, the Council employed an 35 Organiser, one full-time home help and 50 part-time workers to cope with the ever increasing demand for this service in the home. The recruitment of home helps to meeet this demand has been very satifactory and, compared with the previous year, represents a considerable expansion in the growth of the scheme. It will be seen from the table given hereunder that, during the year under review, assistance was provided for 139 homes for maternity and child welfare reasons and for 227 homes where justification was old age, sickness or infirmity. The figures from 5th July to the end of the year show a slight decrease in the number of cases where assistance was provided for reasons of maternity and child welfare, whereas the number of cases where assistance was provided for domestic reasons shows a considerable increase. This is due to the fact that a greater number of expectant mothers have been admitted to hospital, while chronic cases of sickness have been sent home from hospital and provided with the services of a home help. HOME HELP SCHEME, 1948. Full Cost Partial Cost Free of Cost Total for Year Service 1st Jan. to 4th July 5th July to 31st Dec 1st Jan. to 4th July 5th July to 31st Dec 1st Jan. to 4th July 5th July to 31st Dec Ante and Post-Natal 10 5 33 22 1 71 Maternity 2 3 34 28 1 — 68 Domestic 11 11 71 103 7 24 227 Total 23 19 138 153 9 24 366 The Care of Illegitimate Children. The arrangements outlined in a previous report were continued during the year, the Wimbledon, Merton and Morden Moral Welfare Association providing a home where mothers can stay prior to their confinements and for a period following, until rehabilitation is accomplished. Before the transfer of this service, the Councils of Merton and Morden, Wimbledon and Mitcham, accepted financial responsibility for cases in their respective areas. During the period to 5th July, the District Council accepted financial responsibility in respect of five unmarried mothers admitted to this Home at a total cost of £92 12s. 8d. Sterilised Maternity Outfits. Sterile outfits for use at confinements are available from the welfare centres or from the 36 County Council Midwives. Until the introduction of the new health service these outfits were supplied at cost price, or in necessitous cases at half-price or free of cost according to means, but since 5th July, these outfits have been issued free on application. During the year 22 outfits were supplied at cost price and 66 outfits were issued free of charge. Dental Scheme. The figures shewn in the following tables refer only to the first half of the year and consequently do not provide a comparision with previous years. The dental clinics have been continued on a basis of two sessions per week and it will be seen that during the six months under review 200 mothers and children made 531 attendances at the Clinics. 37 TABLE XI. Attendances at Dental Clinics, (From 1/1/48 to 4/7/48). Cases referred from Number who attended during year Number of Attendances made MERTON Mothers 2 4 Children 5 14 Individuals 7 18 MORDEN Mothers 52 139 Children 14 23 Individuals 66 162 RAYNES PARK Mothers 24 102 Children 24 44 Individuals 48 146 GRAND DRIVE Mothers 38 134 Children 35 56 Individuals 73 190 BAPTIST HALL Mothers 2 3 Children 4 12 Individuals 6 15 ALL CENTRES Mothers 118 382 Children 82 149 Individuals 200 531 The dental operations performed were as follows:— TABLE XII. Dental Scheme (From 1/1/48 to 4/7/48) Operations Performed. Extractions —Temporary Teeth 109 Extractions — Permanent Teeth 261 Fillings — Temporary Teeth 15 Fillings — Permanent Teeth 54 Dentures supplied — Number of cases 57 Number of local anaesthetics given 32 Number of gases given 103 38 Midwives. The services of the midwife appointed by the District Council under the County Council's scheme for a salaried midwifery service were continued until 5th July, when, with other officers of the staff, she was transferred to the staff of the County Council. This service has since become a free one and no charge is made for the services of a midwife. Prior to the appointed day the scale of fees laid down by the County Council were as follows:— As maternity nurse 35/- As midwife 40/- with provision for a reduction in the fee in necessitous cases. The following details of work undertaken by the Midwife relate only to the period from 1st January to 4th July, 1948. Cases conducted : Primipara Multipara Total (a) As midwife Live 13 15 28 Still — — — (b) As maternity nurses I ive 1 — 1 Still — — — 14 15 29 Visits made: By midwife Ante-natal 206 During confinement 530 To midwife Ante-natal 154 Post-natal 129 1,019 Medical Aid Forms sent—10 Delayed labour 1 Dicharging Eyes 1 Jaundiced infant 1 Premature infant 1 Rigidity of Perineum 1 Rupture of Perineum 4 Thrombo-Phlebitis 1 Percentage of total midwife's cases which attended the Council's ante-natal clinics—100%. From notices received by the Surrey County Council there were seventeen midwives practising in the district, of whom five were salaried midwives appointed under the County Scheme and nine membres of the staff of the Nelson Hospital. Voluntary Workers. Up to the present time in Merton and Morden we have always had the help in our Clinics of a voluntary band of workers. From time to time we have feared that the supply might cease and at times they have not been 39 forthcoming in certain parts of the area, so that there have been difficulties in some of the clinics. Some of those that are working with us at this moment have been with us for many years and I welcome this opportunity to pay tribute to their constancy and their devotion and to express my gratitude for the work they do for us. While their work remains unrewarded it is by no means unrecognised. Their names appear with those others of us, hewers of wood and drawers of water, on page 7. of this report. Child Life Protection. It will be seen from the tabulated statement below that this important part of the health visitors' work has not decreased as a result of the setting up of a special Children's Committee. Under the present arrangements the special knowledge and experience of the health visitors in this work continues to be utilised by making every fostering conditional on a satisfactory report on the home conditions by a health visitor in the first place. So that, whereas their responsibilities were previously confined to the "under nine" age groups, they now report on all age groups. This has resulted in an increase in their work, 216 visits having been paid this year as compared with 114 last year. The following are the main facts relating to child life protection work during the year:— Registered homes under supervision during the year 15 Registered homes under supervision at the end of year 9 New homes registered during the year 13 Children on register at end of year 13 Children brought on to register during year 20 Children removed out of district during year 18 Visits paid to nurse children 216 Number of children who died during year Nil Number of cases where legal proceedings were taken Nil Day Nurseries. The two Nurseries, Middleton Road and Morden Road, each of 60 places, have continued to be maintained during the year. At the end of the year there were 49 on the waiting list at the Middleton Road Nursery and 76 at the Nursery at Morden Road. While the need for nurseries at their present cost on educational grounds alone—in view of the difficulties of recruiting adequately trained staff—may be disputed, it is difficult to see what alternative provision can be found for the child of the husbandless woman striving to rear her family by her own efforts. Table XIII shows that the Nurseries are running at full pressure, in fact so pressing is the demand for accommodation that, from time to time, the highest total attendance is sometimes in excess of the recognised number of places. 40 TABLE XIII. Day Nurseries — Average Daily Attendances, (From January to June, 1948). Nursery Jan. Feb. March April May June Middleton Road Daily average 45 54 47 50 59 47 Highest daily attendance 51 57 53 53 64 53 Morden Road Daily average 51 45 39 50 56 59 Highest daily attendance 56 59 47 55 61 65 41 SECTION C. — SANITARY CIRCUMSTANCES. In any consideration of needs for improvement of the sanitary circumstances of the area, using this term in its wider significance and not merely confining it to drainage and sewerage and thinking in terms of what has now come to be called environmental health, the one urgent need that leaps to the mind is houses. Houses for the immediate need of the long waiting lists and, not until that has been achieved or we have gone some way towards achieving it, will Medical Officers of Health be able to resume their traditional and statutory housing responsibilities. Food and Drugs Act. Maintenance of supervision over food has been extensively carried out, as reference to the detailed work on pages 45-48 of this report will show. The increasing availability of normal ingredients of ice-cream has added considerably to this aspect of public health work and, when it is realised that there are 60 ice-cream premises registered in the district, it will be readily understood that discriminative sampling of their products is the only practical method with the staff at our disposal. The extent and results of the sampling carried out during the year will be found on page 48. Water Supply. The district is supplied by the Metropolitan Water Board and by the Sutton District Water Company. Their respective distributive areas being 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. 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. 42 Public Cleansing. It may be of interest to recall that from 1908 refuse collection and disposal has been carried out by the Council directly, prior to that date it was contracted out. In the year 1913 at the time of the formation of our present district, our records show that 3,900 tons of house and garden refuse were collected and disposed of at the tip at Merton Park Brickfield. The record further states that the Council pay an annual rent for the shoot at Merton and the cost has been partially recovered by the receipt of a small sum in respect of the privilege of sorting and selling old rags, bottles, tins, etc., and the further observation is made that a twice weekly or even daily collection in the poorer streets of the districts, particularly during the summer months, would be better for the community. Three facts of outstanding interest are contained in this record (a) totting, which might be described as unofficial salvage, was being practised at that time; (b) garden refuse does not seem to have been excluded from house refuse, an arrangement which, today, would free us of the nuisance of garden fires—the only method at the present time available and (c) a more frequent collection than weekly was recommended even at that date. At the present time there is a weekly collection and during the year under review 15,324 tons of house refuse was collected and disposed of. Drainage and Sewerage. No major sewerage or drainage schemes have been undertaken by the Council during the year. Rivers and Streams. The ditch on the north side of Approach Road, Raynes Park, was piped by the Railway Executive during the year and a short length of the Pickle Ditch culverted by the Surrey County Council. 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. 43 The salvage tonnage for the year was as follows:— Tons. Tons. Paper 398 Bottles and Glass 145 Metals 601 Rags 55 Pig Foods 876 REPORT OF THE CHIEF SANITARY INSPECTOR. Mr. 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, 1948. Housing Inspections. The total number of houses inspected for "sanitary defects" under the Public Health and Housing Acts was 821. Action taken in connection with defective dwelling-houses is set out in the housing table on page 53. Summary of Nuisances Abated and Sanitary Improvements Effected. Ceilings cleansed or repaired 298 Coppers provided or repaired — Dampness in premises remedied 71 Drains exposed and repaired 24 Drains reconstructed 2 Defective sashcords renewed 33 Dustbins provided 17 Floors repaired 84 Fresh air inlet valves provided and repaired 12 Inspection chamber covers provided 10 Obstructions removed from drains 30 Rain water pipes renewed or repaired 12 Rooms cleansed 44 Roofs repaired 100 Gutters repaired 55 Sink wastes repaired 18 Walls repaired 321 W.C. cisterns provided 2 W.C. cisterns repaired 29 Water Closets cleansed 3 W.C. pans provided 41 Windows repaired or renewed 131 Fireplaces and stoves renewed or repaired 63 Sinks provided 1 Offensive accumulations removed 17 Water supply for domestic use 27 Verminous premises fumigated and cleansed 2 Ventilation provided under floors 32 Sanitary accommodation for workshops 2 Miscellaneous 194 Notices Served. Intimation notices 548 Statutory notices:— Public Health Act, 1936 97 Housing Act, 1936 — 44 Drainage Work. At 12 houses the drainage systems were entirely reconstructed and at 57 houses extensive repairs to drains were carried out. Smoke and water tests were applied to the drains of houses in 121 instances, and obstructions were removed from drains at 75 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 1,139. The work involved in connection with the supervision and inspection of food supplies and food premises continues to increase. 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 865-½ lbs. Putrefaction and decomposition Sweets 80 lbs. Glass splinters Mixed Pickles 4 jars Broken and mouldy Fish 343½ stone Decomposed, putrefied and unsound Rabbits 60 lbs. Decomposition Australian Crayfish 30 lbs. Unsound Potatoes 18 cwts. Rotten Dried Egg Powder 4 pkts. Mouldy Oranges 73 lbs. Rotten Shell Eggs 36 Rotten Bacon 2 stone Decomposition Lamb 6 lbs. Decomposition Tripe 1,135 lbs. Decomposition Orange Squash 1 bottle Rancid Sauce 1 bottle Broken Preserved Plums 1 bottle Mouldy Bottled Gherkins 17 lbs. Mouldy Cod Fat 3½ lbs. Unsound Soup Powder 22 lbs. Grub Infested Porridge Oats 108 lbs. Grub infested Currants 60 lbs. Grub infested Mars Chocolate 3 bars Contaminated Fish Cakes 72 Decomposed Sweet Biscuits 10 lbs. Contaminated Speckle Eggs 13 lbs. Contaminated Melts and Roes 20 lbs. Decomposition 45 Description. Amount. Cause. Cooking Fat 7 lbs. Contaminated Colouring 38 bottles Deterioration Flavours (various) 59 bottles Deterioration Ground Ginger 28 lbs. Deterioration Mustard Pickles 36 jars Deterioration Mixed Spice 28 lbs. Deterioration Mustard 1 jar Deterioration Dehydrated Potato Powder 30 lbs. Contaminated Macaroni 16 lbs. Contaminated Semolina 14 lbs. Contaminated Figs 6 lbs. Fermentation Barley Flakes 3 lbs. Weevil infested Weetabix 2 pkts. Mouldy Custard Powder 2 pkts. Mouldy Corned Mutton 648 lbs. Malodour Tinned Meat, Milk, Fish, Vegetables, Blown, punctured, leaking. Fruit, etc. 3,195 tins mouldy, sour and unsound 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. 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 Pies Number killed — — — — 166 Number inspected — — — — 166 Number found fit for human consumption — — — — 166 Organs condemned. Reason for condemnation. 1 liver Cirrhosis 1 liver Tuberculosis 1 liver Bacterial necrosis 1 head Tuberculosis 1 head Abscess Milk Supply. There are no producers of milk registered within the urban district. 46 Practically all the milk supplied to the district is derived from the South-eastern Counties and arrives either by rail or road. Sixty-eight inspections were made to dairies and milkshops during 1948. Forty-four samples of milk were submitted for bacteriological examination during the year. Eight samples of Tuberculin Tested, one of Pasteurised and one of Tuberculin Tested Pasteurised Milk 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 — 1 6 7 1 3 1 1 20 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 — 3 4 2 3 2 3 2 1 — — — 20 The undermentioned licences were granted to dealers under the Milk (Special Designations) Regulations and were in force at 31st December, 1948: — Dealers Licences. Pasteurised 11 Tuberculin Tested 3 Supplementary Licences. Pasteurised 7 Tuberculin Tested 8 47 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 Ammoniated Tincture of Quinine 2 — 2 Manufacturers explanation 1 accepted Aspirin Tablets 1 — — Baking Powder 2 2 — — Black Pudding 1 1 — — Boric Acid Ointment 1 1 — — Brawn 2 2 — — Cake Mixture 2 2 — — Cocoa 1 1 — — Coffee and Chicory Essence 1 — 1 Stocks drawn before formal sample could be taken Creamola Pudding 2 2 — — Eucalyptus Oil 1 1 — — Faggots 2 2 — — Fish Paste 4 4 — — Flavourings 2 2 — — Friars Balsam 1 1 — — Gelatine 2 2 — — Ginger Beer 2 2 — — Glauber Salts 2 1 1 Subsequent formal sample genuine Grape Fruit Squash 1 1 — — Lemonade Crystals 1 1 — — Lemon Squash 1 1 — — Liver Sausage 6 6 — — Luncheon Sausage 2 2 — — Malt Vinegar 3 1 2 Dispensation from Ministry of Food Marmalade 1 1 — — Meat Pie 3 3 — — Meat Soup 1 1 — — Medicinal Liquid Manufacturer Paraffin 2 — 2 fined £20 with 30 guineas costs Medicated Sweets 12 9 3 Unable to tain formal samples Manufacture ceased Milk 20 20 — — Minced Beef 2 2 — — Pickled Onions 1 1 — — Pressed Chitterlings 1 1 — — Sauce 3 3 — — Sausage Meat 1 1 — — Sausages 5 5 — — Sodium Bicarbonate 1 1 — — Spaghetti in Meat Sauce 1 1 — — Sponge Mixture 1 1 — Sulphur Tablets 1 1 — Zinc Ointment 1 1 — Total 102 91 11 48 Ice-cream (Heat Treatment) Regulations, 1947. These regulations came into operation on the 1st May, 1947, except for the requirements relating to thermometers which will not operate until a date appointed by the Ministry of Health. At the end of the year, there was only one manufacturer of ice-cream on the register and sixty dealers and fifteen vendors were reaistered. 57 samples were obtained and submitted for examination with the following results:– No. Grade Methylene Blue Test Coliform B. Remarks 1 1 Satisfactory Absent 2 1 „ Present 3 2 „ „ 4 1 „ „ 5 1 „ „ 6 3 Unsatisfactory „ 7 2 Satisfactory Absent 8 2 „ „ 9 1 „ Present 10 1 „ „ 11 2 „ „ 12 1 „ „ 13 2 „ „ 14 3 Unsatisfactory „ 15 1 Satisfactory Absent 16 2 „ „ 17 2 „ „ 18 3 Unsatisfactory „ 19 2 Satisfactory Present 20 1 „ Absent 21 3 Unsatisfactory Present 22 1 Satisfactory Absent 23 2 „ Present 24 1 „ Absent 25 1 „ „ 26 3 Unsatisfactory present 27 3 „ „ 28 3 „ Absent 29 1 Satisfactory Present 30 4 Unsatisfactory „ Faecal coli present 31 4 „ „ Faecal coli present 32 3 „ „ 33 2 Satisfactory „ 34 3 Unsatisfactory „ 35 3 „ „ 36 3 „ „ 37 3 „ „ 38 2 Satisfactory „ 39 3 Unsatisfactory „ 40 3 „ „ 41 3 „ „ 42 3 „ „ Faecal coli present 43 3 „ „ 44 2 Satisfactory „ 45 2 „ Present 46 2 „ „ 47 2 „ „ 48 2 „ „ 49 1 „ „ 50 4 Unsatisfactory „ 51 1 Satisfactory „ 52 2 „ „ 53 4 Unsatisfactory „ 54 1 Satisfactory Absent 55 4 Unsatisfactory Present 56 1 Satisfactory Absent 57 3 Unsatisfactory „ 49 Factories and Workplaces. The number of inspections made to premises registered under the Factories Act, 1937 was 221. Defects relating to sanitary conveniences, ventilation and other sanitary matters were dealt with at 25 premises. The table on page 55 gives details of action taken during the year. Water Supply. Five samples of water from domestic taps were submitted for chemical or bacteriological examination. The reports on each sample were satisfactory. Water Courses. Thirty-four inspections were made of the water courses in the district, particularly of the River Wandle, and Beverley and Pyl Brooks for the purpose of detecting pollutions and samples were obtained and sent for chemical analysis. Two 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 722 visits were made to premises where infestations were known or suspected and at 127 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. 25 observations were made and in 4 instances, the nuisances were satisfactorily abated. 50 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 396 Evening Visits — Infringements: — 1. Evening closing hours — 2. Half-day closing 2 3. Hours of employment for young persons — 4. Seats not provided for females — 5. Prescribed notices not correct or exhibited 14 6. Sanitary arrangements unsatisfactory 3 7. Reasonable temperature not maintained — Summary of Sanitary Inspections. Housing—primary visits 886 Re-inspections—work in progress 2,280 Re overcrowding provisions 618 Miscellaneous, housing 452 Drainage work 1,051 Factories and Workplaces 219 Stables and Piggeries 21 Rats and Mice destruction 767 Enquiries—infectious diseases 233 Smoke abatement 25 Food shops, etc 1,139 Milk supply 68 Rivers and Streams—pollution 34 Miscellaneous 1,143 8,936 No. of complaints investigated 1,034 51 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, 1949. 52 SECTION D. — HOUSING. Housing and Overcrowding. During the year 336 new houses and flats were built and 110 were reconditioned and made habitable. The number of applicants on the waiting list at the end of the year was 3,564. Arising out of rehousing enquiries, 105 complaints of overcrowding were received. Of these, 50 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 inspected for housing defects (under Public Health or Housing Acts) 821 (b) Number of inspections made for the purpose 821 ii. (a) Number of dwellinghouses (included under sub-head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 – (b) Number of inspections made for the purpose — iii. Number of dwellinghouses found to be in a state so dangerous or injurious to health as to be unfit for human habitation – iv. Number of dwellinghouses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 548 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 464 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 – (ii) Number of dwellinghouses which were rendered fit after service of formal notices:— (a) By owners – (b) By local authority in default of owners – 53 B.—Proceedings under Public Health Acts:— (i) Number of dwellinghouses in respect of which notices were served requiring defects to be remedied 97 (ii) Number of dwellinghouses in which defects were remedied after service of formal notices:— (a) By owners 70 (b) By local authority in default of owners – C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936: — (i) Number of dwellinghouses in respect of which Demolition Orders were made – (ii) Number of dwellinghouses demolished in pursuance of Demolition Orders – D.—Proceedings under Section 12 of the Housing Act, 1936:— (i) Number of separate tenements or underground rooms in respect of which Closing Orders were made – (ii) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit – SECTION E — INSPECTION AND SUPERVISION OF FOOD. (See Sanitary Inspector's Report, on pages 45-49). 54 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 21 27 – – (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 173 192 13 – (iii) Other Premises in which Section 7 is enforced by the Local Authority 2 2 – – Total 196 221 13 – 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) 5 5 – 1 – Overcrowding (S.2) – – – – – Unreasonable temperature (S.3) – – – – – Inadequate ventilation (S.4) – – – – – Ineffective drainage of floors (S.6) – – – – – Sanitary Conveniences (S.7) (a) Insufficient 1 1 – – – (b) Unsuitable or defective 17 17 – 2 – (c) Not separate for sexes – – – – – Other offences against the Act (not including offences relating to Outwork) 2 2 2 – – Total 25 25 2 3 – 55 SECTION F — INFECTIOUS ILLNESS. Notification. The following diseases are notifiable in the District:— Cholera Cerebro-Spinal Fever Continued Fever Diphtheria (including membranous Croup) Dysentery Enteric Fever (including paratyphoid fevers) Erysipelas Encephalitis Lethargica Food Poisoning Malaria Ophthalmia Neonatorum Plague Acute Primary Pneumonia Acute Influenzal Pneumonia Acute Poliomyelitis Acute Polio-Encephalitis Puerperal Pyrexia Relapsing Fever Scarlet Fever Smallpox Trench Fever Typhus Fever Tuberculosis (all forms) Whooping Cough Measles Smallpox. There were no notifications of Smallpox in our district during the year but a considerable amount of followup work has been undertaken by the department in keeping persons under observation who have arrived in this Country from areas abroad where Smallpox has occurred and who, although they may not be known to be actual contacts of a case, have had opportunities for such contact. Enteric Fever. No cases of Typhoid or Paratyphoid Fever were notified during the year, in fact there have been no such cases since 1941, when two were notified. Dysentery. There was only one actual notification in respect of Dysentery received during the year but, in the case of food poisoning the cause was, in some instances, proved bacteriologically to be a disenteric infection and it is probable that many more of the cases of food poisoning are, in fact, cases of Dysentery. That they do not come to be notified as such is probably mainly due to the fact that Bacillary Dysentery, as a clinical disease, is associated with the organisms Schiga and Flexner, whereas Sonne is associated with gastro-enteritis which is still extensively regarded as a clinical entity, separate and distinct from Dysentery. If gastro-enteritis was made a notifiable disease, as such, it would possibly bring to light a much larger number of these infections. Food Poisoning. There were sixteen cases of food poisoning notified during the year. All were either single cases or a small 56 family group occurring in one household. Steps are taken, wherever possible, to discover the source but it is generally found in this type of illness that they have recovered before we have an opportunity of making any investigations and it is rarely possible to establish the bacterial cause, even by rectal swabbing, which is invariably carried out where possible. There has been no outbreak during the year affecting a group such as a canteen. These isolated attacks of illness of short duration are probably much more common than these notifications show, but for the benefit of posterity, who may wonder about this present-day problem, it should be recorded that the initial quality of most kinds of fresh meat today is incomparably inferior to pre-war standards. The essential indigestibility of much of the meat may well play some part in the frequency of these digestive disturbances. The type of outbreak occurring in a canteen, where perhaps twenty or more persons are affected, is probably in quite a different category and, from time to time, we are asked to investigate such an outbreak in one of our factory canteens. Fortunately they have been rare—none during this particular year—but we have, in the past, been able to bear out the common experience that "two-stage" cooking of meat is frequently found to have been practised. To raise a generation so fastidious that they cannot leave the W.C. without washing the hands in soap and water should be our first ambition and the problem of the more especial care by those engaged in the trade would be greatly simplied. The future of food hygiene is in the schools, by education side by side with the provision of facilities for carrying the teaching into practice. As far as the more especial problem of the food handlers in the trade are concerned, a hygiene educated, food fastidious public in normal times would stimulate improved methods in the trade and also most probably demand more effective weapons for food control. Diphtheria. Once again a record was created for this disease, three cases only occurring during the year, as compared with last year's record number of five cases. There were no deaths from this disease during the year. Scarlet Fever. There were 112 cases of Scarlet Fever as compared with 137 last year. The disease was, as in recent years, mild in character. It will be seen that there was one death from this disease during the year but this is an unusual event. It was, in fact, in a child of four years of age who developed acute nephritis in the third week of his illness, from which he died. He was believed to have had a previous nephritis with permanent damage to the kidneys. It is none-the-less a worry to most parents because of the risk of complications and, while Scarlet Fever generally today 57 is a mild disease, it is responsible for a good deal of disruption of education among school children, both among the cases themselves and among the contacts. In considering measures for controlling Scarlet Fever one gets the impression that there is a small reservoir or potential reservoir of infection always present in the schools and that there is a tendency for the disease to subside during the holidays and the long summer recess. It is interesting, looking back through old reports, how often the schools were closed for Measles, Whooping Cough and even for Mumps. School closure rarely seems to have been used as a control measure against Scarlet Fever. One very important factor in "keeping the pot boiling" is, I am sure, the delay in excluding cases from the classroom. Whether the modern mother is so determined not to coddle the child that she disregards the early minor manifestations of illness, whether they are not so aware of deviations from wellness, or whether in some cases because of a desire that the child should not miss school is a matter for speculation, but it is astonishing how high a proportion of children are sent to school while in the infective stage of the disease. I have analysed the interval between the last attendance in school and the appearance of the rash in 69 cases of Scarlet Fever among the school children during the year under review. Of the 69 cases: — 16 were not in school for 5 days or more before appearance of rash; 4 were not in school for 4 days or more before appearance of rash; 12 were not in school for 3 days or more before appearance of rash; *23 were not in school for 2 days or more before appearance of rash; 12 attended school on the day the rash came out; 1 attended school for a further day after appearance of the rash; 1 attended school for a further 2 days after appearance of the rash. * This seems to be the commonest time for the initial malaise to have been observed. It is the large group of 12 who were in school on the day the rash appeared that one suspects is responsible for "keeping the pot boiling." When it is remembered that the rash in Scarlet Fever appears on the second day of the disease, it is clear that these 12 children had opportunities of spreading the infection for two days. In fairness to parents one must add the obvious excuse that if parents were to keep a child at home every time he looked a bit off colour there would be a great risk of unnecessary absences. 58 However, there is the problem! Perhaps a more widespread use of the clinical thermometer might help to solve some of the difficulty. Measles. The Measles and Whooping Cough (Amendment) Regulations, 1948, came into operation on 1st April, 1948. The effect of the Regulations is_ to retain the compulsory notification of Measles and Whooping Cough which was introduced by the Regulations of 1940 as a temporary measure during the war. The fee for notification becomes the statutory fee of 2/6d. instead of the 1/- in the 1940 Regulations. There were 1,049 cases of Measles during the year, as compared with 347 last year and 568 for the previous year. It is a matter for gratification that out of this very large number of cases there is not a single death attributed to this disease. I have prepared a table showing the incidence of Measles for previous years. Up to 1939 the biennial character of the disease is well shown and the column showing the mortality from the disease demonstrates the great change that has taken place in the past decade. When it is remembered that the numbers up to 1939 were confined to school children our present rate of incidence, also bearing in mind an increase in population, is no higher than in the pre-war years. There is even a trace still of its biennial character. It may well be that this characteristic was obscured when the under five group came to be included. The present low mortality would hardly justify any preventive measure that carried any risk of its own and, until a serum can be prepared without the possibility of producing such serious complications as homologous serum jaundice and while the disease remains so mild, there would seem to be a limited scope for the widespread use of Measles prophylactics. It may be of interest that Measles was being notified in Merton and Morden as far back as 1908, under the Infectious Diseases Notification Act, 1889, the Council having decided to make this disease notifiable in accordance with their powers under the Act. In 1909 alone it is reported that Measles was responsible for 153 out of a total 258 notifications of infectious disease, at the same time as the question of the continuation of notification was being discussed by the Council on the grounds of expense. That year there was one death from the disease. In 1912, an epidemic year, there were again 406 cases with eight deaths of "under-five year olds" and the question of the value of notification again under consideration. The opinion seemed to be that notification was of little value because it was ineffective in securing speedy isolation in epidemic circumstances and further, the cost of disinfection was a financial burden. It is interesting to note that isolation was still regarded as the primary method of control of an epidemic like Measles. 59 INCIDENCE OF MEASLES 1930-1948. Year Cases Deaths Population Remarks 1930 295 3 35,000 School children only included — disease not being notifiable. Figures based on returns from Head Teachers. 1931 7 – 41,510 1932 418 2 48,550 1933 14 – 52,130 1934 523 6 55,550 1935 5 – 57,440 1936 586 4 61,000 1937 86 – 65,530 1938 403 – 68,980 1939 5 – 72,150 1940 459 1 68,540 Whole population included from 1940 when disease became notifiable. 1941 539 – 64,920 1942 936 – 66,590 1943 433 1 66,880 1944 252 1 62,760 1945 760 – 66,050 1946 568 – 73,590 1947 347 – 75,290 1948 1,049 – 75,220 Whooping Cough. There were 378 cases of Whooping Cough notified during the year with no deaths from this disease. This compares with 232 for last year and 238 for the year before. With Diphtheria now under control, preventively as well as curatively, Measles and Scarlet Fever having assumed mild characteristics and their complications, when they occur, amenable to treatment by Penicillin and the sulpha drugs, as indeed are the other rarer but more formidable childish infections, Whooping Cough has stepped into the forefront as the enemy of children. Although its fatility rate is not perhaps so high, its capacity for damage is serious and it is a distressing ordeal for parents to witness in their child. That is no doubt why, even though no guarantee can be offered of successful protection with any present immunising agent, there is still a large demand among the parents for injections against Whooping Cough. The problem has two aspects, firstly, as a public health measure, we feel that we ought to have sound evidence of its efficacy before recommending its use on the scale we should desire and, secondly, the parents' point of view which might be expressed as "I don't care whether it is only a one in a thousand chance of protection, I will leave nothing undone to prevent my child contracting Whooping Cough". That is a powerful argument which surely must justify our making such provision which, incidentally, we do. In the meantime we eagerly await the result of the vaccine trials which are taking place. Apparently the low incidence of Whooping Cough as soon as the trials began have delayed the publication of the reports. Meanwhile, in another way, hope for relief has 60 appeared, one of the new antibiotics having been shown in laboratory tests to be lethal to H. Pertussis — the organism responsible. Anterior Poliomyelitis. There were 13 notifications of Acute Poliomyelitis, all of whom were admitted to hospital. The diagnosis was confirmed in eight of these cases and amended in five instances. The table set out on the following page will show in greater detail the story of their illness and its sequel. Of the eight established cases four developed a degree of permanent paresis. There were no deaths in any of these cases. Erysipelas. There were 15 notifications of Erysipelas during the year, 14 of which involved the face and one of the left leg. Six occurred in males and nine in females. Of the 15 cases notified, 12 were treated at home and three received hospital treatment. Ophthalmia Neonatorum. Four cases were notified during the year, one of which was in hospital at the time of notification. In each case recovery was complete and vision unimpaired. Pneumonia. There were 40 notifications of Pneumonia, of which seven were stated to be influenzal in origin. The number of cases notified in the previous year was 69. Puerperal Pyrexia. There were two notifications of Puerperal Pyrexia, giving a rate of 1.80 per thousand births. Each of these cases occurred in hospital, one being subsequently admitted to the Wandle Valley Isolation Hospital for treatment. In both cases the patients recovered. CLEANSING STATION. There was a further decrease in the number of attendances at the Cleansing Station during the year, the total being 229 as compared with 445 in 1947 and 798 in the year before. The details of the attendances during the year are as follows:— Number of cases of Scabies treated 40 Cases of Scabies with concurrent verminous head 2 Cases of Scabies with Secondary Septic Skin conditions 6 Number of cases of verminous heads only 110 Total number of attendances at the Centre 229 61 62 ANTERIOR POLIOMYELITIS, 1948. Case No. Age. (Years) Hospital to which admitted Date of Onset Returned to Registrar General Confirmed by Hospital Hospital Diagnosis Sequel 1 9 Wandle Valley 3/1/48 Yes Yes Ac. Poliomyelitis No paralysis left and now in good health. 2 8 Wandle Valley 21/2/48 No No Septicaemia 3 28 Wandle Valley 15/4/48 No No Disseminated Sclerosis 4 1 St. Helier 23/6/48 Yes Discovered in hospital Ac. Poliomyelitis Paralysis of left leg, still attending hospital for exercises and treatment. Having baths at home. 5 9 Cuddington 15/7/48 Yes Yes Ac. Poliomyelitis No paralysis left, now full recovered. 6 2 Cuddington and Queen Mary's, Carshalton 24/8/48 Yes Yes Ac. Poliomyelitis Now recovered from paralysis of legs and arms. Chest muscles still weak. Attending hospital once a month for massage and exercises. 7 26 Wandle Valley 27/8/48 Yes Yes Ac. Poliomyelitis Left arm completely paralysed. Attending hospital twice weekly for treatment. 8 3 Wandle Valley 15/9/48 Yes Yes Ac. Poliomyelitis Paralysed in right leg and hip, leg at present in irons. Attending hospital three times a week for exercise and massage treatment. 9 3 Wandle Valley 29/9/48 No No Bronchitis 10 10 Wandle Valley 29/9/48 Yes Yes Ac. Poliomyelitis Paralysis of throat, recovered after treatment in hospital. 11 5 Wandle Valley 5/10/48 Yes Yes Ac. Poliomyelitis Slight paralysis of left arm. Attending hospital twice weekly for heat treatment and exercises. Arm still in splint. 12 12 St. Helier 26/10/48 No No Remained undiagnosed, possibly Disseminated Sclerosis 13 10 Wandle Valley Removed 9/11/48 No No Ac. Rheumatism TABLE XIV. Scarlet Fever — Monthly Distribution. Month Wards Total Abbey Bushey Mead Central Morden Park Ravensbury Raynes Park St. Helier West Barnes January 2 – 1 1 – 1 2 2 1 10 February 1 – – 2 1 1 – – 1 6 March – – 3 2 1 – 1 1 – 8 April – 2 5 1 – – 1 – – 9 May 1 4 – 3 – – – – – 8 June – 3 1 2 1 – – – – 7 July – 3 2 1 1 1 5 – – 13 August – 1 – 1 1 – – – – 3 September – – 1 1 – – – 1 1 4 October – – – 7 1 4 – 1 1 14 November – – – 3 1 2 1 2 2 11 December – 1 1 16 1 – – – – 19 Total 4 14 14 40 8 9 10 7 6 112 Monthly mean 0.33 1.17 1.17 3.33 0.66 0.75 0.83 0.58 0.50 9.33 The incidence in the various wards was as follows:— Wards Cases Incidence per 1,000 population Abbey 4 0.7 Bushey Mead 14 1.7 Central 14 1.2 Morden 40 3.2 Park 8 0.7 Ravensbury 9 1.3 Raynes Park 10 1.2 St. Helier 7 0.6 West Barnes 6 0.8 63 64 TABLE XV. Infectious Diseases, Notifications, Deaths and Distribution, 1948. Disease Cases Notified Case Rate per 1,000 population Deaths among notified cases Percentage of deaths to cases Distribution of Cases in Wards 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 – – – – – – – – – – – – – – – Scarlet Fever 112 1.48 1 0.89% 4 14 14 40 8 9 10 7 6 83 74% Diphtheria 3 0.03 – – – 1 – – 1 – 1 – – 3 100% Enteric Fever – – – – – – – – – – – – – – – Cerebro-Spinal Meningitis – – – – – – – – – – – – – – – Puerperal Pyrexia 2 0.03 – – 1 – – – 1 – – – – 1* 50% Erysipelas 15 0.19 – – – 2 2 3 1 – 1 5 1 3 20% Poliomyelitis 8 0.10 – – – 1 1 1 3 1 – 1 – 8 100% Polio Encephalitis – – – – – – – – – – – – – – – Dysentery 1 0.01 – – – – – – 1 – – – – – – Food Poisoning 16 0.21 – – 1 2 2 10 1 – – – – 2 12.5% Ophthalmia Neonatorum 4 0.05 – – 1 – 1 – 1 – – – 1 – – Pneumonia 33 0.44 1 3.33% 2 3 4 10 3 3 3 5 – 2* 6.1% Influenzal Pneumonia 7 0.09 2 28.57% 1 – 1 1 1 – 2 1 – – – Measles 1049 13.94 – – 40 97 200 225 103 117 46 169 52 11 0.1% Whooping Cough 378 5.02 – – 12 36 73 84 26 16 37 61 33 4 1.1% * Number admitted to Isolation Hospital only. 65 TABLE XVI. Notification of Infectious Diseases (other than Tuberculosis) by age groups during the year 1948. Disease TOTAL CASES NOTIFIED Total cases at all ages Under 1 year 1-3 3-5 5-10 10-15 15-25 25-35 35-45 45-65 65 and over Smallpox – – – – – – – – – – – Scarlet Fever – 4 19 62 15 7 3 1 1 – 112 Diphtheria (including Membranous Croup) – – 1 – – – – 2 – – 3 Enteric Fever (including Paratyphoid) – – – – – – – – – – – Puerperal Pyrexia – – – – – – 1 1 – – 2 Acute Primary Pneumonia 1 – 2 3 – 1 3 5 13 5 33 Acute Influenzal Pneumonia – – – – – – – – 5 2 7 Cerebro-Spinal Meningitis – – – – – – – – – – – Poliomyelitis – 1 1 4 l – l – – – 5 Acute Polio-Encephalitis – – – – – – – – – – – Encephalitis Lethargica – – – ––– – – – – – – – Dysentery – – – – – – 1 – – – 1 Malaria – – – – – – – – – – – Ophthalmia Neonatorum 4 – – – – – – – – – 4 Erysipelas – – – – – – – 6 8 1 15 Food Poisoning 1 3 2 1 – 1 1 4 2 1 16 Relapsing Fever – – – – – – – – – – – Typhus Fever – – – – – – – – – – – Measles 29 225 295 474 22 3 1 – – – 1,049 Whooping Cough 19 91 113 142 5 4 2 – 2 – 378 Totals 54 324 433 686 43 16 13 19 31 9 1,628 66 TABLE XVII. Monthly Incidence of Infectious Disease, 1948. Disease January February March April May June July August September October November December Total Smallpox – – – – – – – – – – – – – Scarlet Fever 10 6 8 9 8 7 13 3 4 14 11 19 112 Diphtheria 2 – – – – – –– 1 – – – – 3 Dysentery – – – – – 1 – – – – – – 1 Cerebro-Spinal Meningitis – – – – – – – – – – – – – Pneumonia 3 3 10 3 4 2 1 – 1 4 1 1 33 Influenzal Pneumonia – 1 2 2 – – – – 1 – – 1 7 Food Poisoning – – 1 2 – 2 1 – 4 6 – – 16 Erysipelas 2 – 1 2 – 3 1 2 2 – 1 1 15 T.B. Pulmonary 6 9 5 6 7 6 9 4 4 5 9 4 74 T.B. Non-Pulmonary 1 1 1 – – 3 2 – – 1 – 2 11 Ophthalmia Neonatorum – 2 – – – – – 1 – 1 – – 4 Puerperal Pyrexia – – – – – – 1 – – – 1 – 2 Poliomyelitis 1 – – – – – 1 1 2 2 1 – 8 Polio Encephalitis – – – – – – – – – – – – – Malaria – – – – – – – – – – – – – Measles 37 258 225 234 169 68 23 14 5 3 3 10 1,049 Whooping Cough 2 11 19 23 24 39 57 48 42 27 43 43 378 Totals 64 291 272 281 212 131 109 74 65 63 70 81 1,713 DIPHTHERIA IMMUNISATION. Diphtheria Immunisation is now so thoroughly accepted by parents that our present efforts are not so much to secure immunisation as to secure earlier immunisation in accordance with the most up-to-date views on the subject. For the past two years we have been advocating immunising at eight months to save those lives that are lost from Diphtheria before the first birthday, then a booster at two or three years of age, followed by one or more further boosters so that the child shall have its highest degree of protection during its early years of life. It is of particular importance for him to have a high degree of protection on entering school for the first time, when he has suddenly extended his opportunities for exposure to infection. The measure of our success in this direction is somewhat disappointing as will be seen in Table XXIII on page 71. It will be seen that we immunised 73 children in the under one age group as against 98 last year. The number of single boosting injections given in the Clinics was 52 and the number given in the Schools was 1,651. Taking into consideration that we are mainly confining our boosting in the schools to the children under ten, this represents very nearly 40 per cent, of all the school children in the district. There were 1,169 children immunised during the year, of whom 905 were one year or under, as against 819 last year. There were 832 children immunised between the ages of one and two. In 1947 there were 1,345 live births and there were 41 deaths of infants under one year of age. If we regard the difference of 1,304 as an estimate of the available material, we might deduce that we have immunised 64 per cent, of our available infants during this year. It should perhaps be mentioned once more that this is based on actual records. There may well be a considerable number immunised by private practitioners, for whom we have no record, especially as the private practitioner under the National Health Service Act no longer need apply to the department for free immunising material but can obtain it on prescription. Another factor which convinces us that there are more infants immunised than we have cards for is the demand for Whooping Coush and Diphtheria combined injections. This, at the time of writing, is now available but for the vear 1948 anv narent wantine the combined iniections applied to the private practitioner. We have reason to believe that there were a considerable number of infants immunised aeainst Diphtheria in that way. 67 TABLE XVIII. Persons Immunised at Clinics during 1948. 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 42 4 – 1 42 5 Bushey Mead 68 – 8 4 76 4 Central 109 5 1 1 110 6 Morden 153 1 – 8 153 9 Park 64 1 2 2 66 3 Ravensbury 57 – – 5 57 5 Raynes Park 61 3 1 3 62 6 St. Helier 86 1 – – 86 1 West Barnes 70 9 – 4 70 13 710 24 12 28 722 52 TABLE XIX. Persons Immunised by Private Practitioners, 1948. 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 2 – – – 2 – Bushey Mead 16 – – 3 16 3 Central 26 2 1 – 27 2 Morden 40 12 2 7 42 19 Park 20 1 1 – 21 1 Ravensbury 17 – 1 1 18 1 Raynes Park 20 1 – 1 20 2 St. Helier 20 1 – – 20 1 West Barnes 10 – – – 10 – 171 17 5 12 176 29 68 TABLE XX. Children Immunised in Day Nurseries. Nursery Completed Middleton Road 11 Morden Road 14 Total 25 TABLE XXI. Number of Children Immunised at Schools, 1948. School Incomplete Completed Primary Single Boosting Injections Bushey County Primary 3 52 211 Poplar Road County „ 3 5 57 St. Mary's „ „ 2 43 206 Merton Abbey „ „ 2 11 20 Hillcross „ „ 3 9 74 Raynes Park „ „ 1 22 186 Morden „ „ 1 13 42 Morden Farm „ „ 4 34 219 St. Helier No. 1 „ „ 9 13 196 St. Helier No. 2 „ „ 6 38 95 St. Helier No. 3 „ „ 1 19 82 St. Helier No. 4 „ „ 4 18 117 Holy Family R.C. Vol. Primary 4 31 72 Sacred Heart R.C. Vol. Primary 3 40 74 46 348* 1,651* "Includes children attending schools in Merton and Morden but resident in other areas:— Primary 102 Boosters 270 372 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 1948 722 176 246 25 1,169 TABLE XXII. Incidence and Fatality of Diphtheria, 1920-1948. 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 – – 1948 75,220 3 0.03 – – 70 71 TABLE XXIII. Diphtheria Immunisation. Number of children 0— 5 years immunised January — June, 1948 426 Number of children 5—15 years immunised January — June, 1948 319 Number of children 0— 5 years immunised July — December, 1948 452 Number of children 5—15 years immunised July — December, 1948 13 Total number of children 0— 5 years immunised during the year 878 Total number of children 5—15 years immunised during the year 332 Number of children 0— 5 years immunised by Private Practitioners during the year 171 Number of children 5—15 years immunised by Private Practitioners during the year 5 Total number of children immunised by Private Practitioners during the year 176 Total number of children immunised in the Clinics during the year 722 Total number of children immunised in the Day Nurseries during the year 25 Estimated percentage of 0— 5 years immunised at end of year 58.07 Estimated percentage of 5—15 years immunised at end of year 83.1 Age Distribution of Immunised Children. Age at 31.12.48 i.e. born in year Under 1 1948 1 1947 2 1946 3 1945 4 1944 5 to 9 1939-43 10 to 15 1934-38 Total Immunised Estimated Population 0-5 Estimated Population 5-15 Total Population up to 15 Number Immunised 73 832 791 717 834 3,694 3,768 10,709 5,591 8,973 14,564 TUBERCULOSIS. One hundred and nineteen new cases were added to the register of tuberculous persons, compared with 130 in 1947. These additions were:— Males Females Total Pulmonary 51 53 104 Non-Pulmonary 4 11 15 55 64 119 Of these 119, 85 were primary notifications, 27 were transferred from other districts, and 7 came to notice in other ways. During the year 58 persons were removed from the register for the following reasons:'— Recovered 8 Removed from the district 25 Death 25 After allowing for the additions and deductions, the number remaining on the register at the 31st December, 1948 was distributed as shown in the following table:— TABLE XXIV. Tuberculosis Register at 31st December, 1948. Wards Registered at 31st December, 1948 Totals Number on Register at mid-year Pulmonary NonPulmonary Abbey 47 10 57 55 Bushey Mead 67 18 85 87 Central 66 14 80 76 Morden 93 14 107 102 Park 109 21 130 122 Ravensbury 106 24 130 121 Raynes Park 67 8 75 73 St. Helier 156 32 188 183 West Barnes 50 20 70 70 Whole district 761 161 922 889 The provision of treatment and investigation of Tuberculosis became the responsibility of the Regional Hospital Board on the 5th July, the County Council remaining responsible for the preventive side of the work. Institutional treatment was 72 vided for 49 persons in 1948 from Merton and Morden, as follows:— At the County Sanatorium, Milford 3 At other Institutions 46 49 It was a matter for general concern after the first world war that there were an unprecedented number of deaths from this disease in young women in the 20's. It is a matter for some consolation that this position has not recurred. It may well be that the advantages of the "new look" may not be confined to the trade, as many will remember that in the previous post-war years the opposite of the "new look" was the fashion. The deaths from Tuberculosis during the year number 35, of which 34 were due to pulmonary and 1 to non-pulmonary disease. Four of the deaths were in unnotified cases. The deaths are classified by age and sex in the following table:— TABLE XXV. Deaths Due to Tuberculosis, 1948. Ages Years Pulmonary Non-Pulmonary Totals Males Females Males Females 0– – – – – – 1– – – – – – 5– – 1 – 1 2 15– 2 5 – – 7 25– 4 2 – – 6 35– 3 1 – – 4 45– 5 3 – – 8 55– 7 – – – 7 65– – 1 – – 1 Totals 21 13 – 1 35 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 responsibility for maintaining the health of tuberculous persons in the district is undertaken by the Merton and Morden Tuberculosis Care Com. 73 mittee who assist patients, dependents and relatives in many ways, both financially and in kind, to secure extra nourishment, beds, bedding, clothing and household articles. They arrange for the provision of domestic help, assist in securing suitable employment, occupational therapy and rehabilitation and in the holiday schemes for child contacts in the family. I am indebted to the Secretary for the following information relating to the activities of the Committee during the year under review:— In many 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. Twelve relatives and patients have received help with fares and twenty-four patients received pocket money when in hospital or sanatoria. Grants were made to eight cases to enable patients, or their dependents, to secure clothing. The Committee has also assisted patients and their families in the following ways:— By payment of arrears of health and life insurance premiums. Maintenance of gas fire in bedroom and radio set. Part cost of spectacles. Holiday expenses to dependents. Provision of invalid chairs, thermos flasks, bedtables, sorbo air rings, back rests, floor covering, ovaltine, etc. Camp holidays for child contacts. Materials for occupational therapy. Christmas gifts for children. 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 — — — — 2 5—10 2 1 — 2 — 1 —- — — — — — 6 10—15 1 4 1 1 - - - - - - - - 7 15—20 7 11 1 - - - - - - - - - 19 20—25 6 7 - - 2 4 - - - - - - 19 25—35 7 5 - 1 3 7 - 2 - 1 - - 26 35—45 6 6 2 1 3 1 - - - 1 - 1 21 45—55 6 - - 1 2 1 - - - 1 - - 11 55—65 3 1 - 1 - - - - 2 - - - 7 65 and over - - - - - - - - - 1 - - 1 Totals 39 35 4 7 10 14 - 3 2 4 - 1 119 85 27 7 INDEX PAGE Acreage 8 Ambulance Facilities 25 Acute Poliomyelitis 61-62 Births 12-16, 30 Institutional and Domiciliary 15 Rates 12-16 Cancer—Deaths from 12, 17-18 Rate 12, 18 Child Life Protection 40 Clinics and Treatment Centres 26-28, 33 Climatic Conditions 9 Closet Accommodation 43 Cleansing Facilities 61 Deaths 10-13, 16-19 Causes of 17-19 Rates 10-13 Diphtheria 57 Immunisation 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 29 years 70 Drainage and Sewerage 43 Drainage work 45 Dysentery 56 Enteric Fever 56 Erysipelas 61 Factories and Workplaces 50 Inspections 55 Defects 55 Food and Drugs Act, 1938 48 Food Poisoning 56 76 I N D E X-—Continued. PAGE Food Supply 45 Inspections 45-46 Unsound Food 45-46 Health Services 24 Heart Disease—Deaths from 17, 19 Home Help Scheme 35-36 Hospitals 28-30 Hospital Car Service 25 Housing 44, 53-54 Action taken 53-54 Inspections and Defects 44, 53 Number inhabited 8 Overcrowding 53 Ice-Cream 49 Industry 9 Infant Mortality 10, 20-22 Causes of death 21-22 Rates 10-13 Infectious Diseases 25,28-29,56-66 Cases admitted to hospital 29 Diseases notifiable 56 Monthly Incidence 66 Notification by Age Groups 65 Notifications, deaths and distribution 64 Inquests 17 Inspections—Cinemas and Licensed Premises 51 Isolation Hospital 28-29 Laboratory Facilities 24 Examination of clinical material 24 Maternal Mortality 19-20 Rates 12, 20 Maternity and Child Welfare 30 Ante-Natal Clinics 31, 32 Attendances at Infant Consultation Clinics 32 Attendances at Maternity Clinics 31 Attendances at Centres over last ten years 32 Attendances in relation to the registered births 33 Committee 5 77 I N D E X—Continued. PAGE Consultant advice for maternity 35 Convalescent Home Treatment 35 Day Nurseries 40-41 Attendances 41 Dental Scheme 37-38 Attendances 38 Operations performed 38 Emergency Maternity Unit 35 Health Visiting 34 Hospital provision for maternity 35 Illegitimate children 11, 36 Midwives 39 Neo-Natal deaths 21-22 Orthopaedic Treatment 35 Premature Births 22-23 Sessions, times and places 26 Sterilised Maternity Outfits 36 Voluntary Workers 7, 39 Work of the Centres 30 Measles 59-60 Meat Inspection 46 Milk Supply 46-47 Mosquitoes 50 Nelson Hospital 29, 33 Notification of Births 30 Nuisances—Noise 50 Nursing in the Home 24 Ophthalmia Neonatorum 61 Population 10, 14 Pneumonia 61 Public Cleansing 43 Public Health Committee 5 Puerperal Pyrexia 61 Rainfall 9 Rateable Value 8 Rats and Mice Destruction 50 Respiratory Diseases—deaths from 18 78 IN D E X-—Continued. PAGE Representatives on:— Nelson Hospital Council 5 North-Eastern Divisional Health Sub-Committee 5 Tuberculosis Care Committee 5 Wandle Valley Joint Hospital Board 5 Wandle Valley Joint Sewerage Board 5 Rivers and Streams 43 Road Accidents—deaths from 17 Sanitary Circumstances 42-43 Sanitary Inspection 51 Scarlet Fever 57-59 Incidence in each Ward with rates 63 Monthly distribution of cases 63 School Clinics 26 Shops Acts, 1912-1936 51 Slaughterhouses 46 Smallpox 28, 56 Smoke Abatement 50 Social Conditions of the Area 8 Staff 6 Statistics 8-12 Comparative 13 Tuberculosis 72-75 Admission to Sanatorium 73 Assistance given 74 Care Commitee 5 Deaths due to 73 Dispensary 27 New cases—by age groups 75 Number on register at end of year 72 Venereal Diseases 27-28 Water Courses 50 Water Supply 42, 50 Whooping Cough 60 Zymotic Disease—deaths from 12 Rate 12 79 Printed by RAYNES PARK PRESS, Lambton Road, LONDON, S.W.20. Tel. WIM. 1388.