MER 12 URBAN DISTRICT of MERTON AND MORDEN ANNUAL REPORT of the Medical Officer of Health for the year 1950 AND REPORT OF THE SANITARY INSPECTOR < - URBAN DISTRICT of MERTON AND MORDEN ANNUAL REPORT of the Medical Officer of Health for the year 1950 AND REPORT OF THE SANITARY INSPECTOR PREFACE. To the Chairman and Members of the Merton & Morden Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report for 1950. In the following pages will be found the facts and figures by which we can measure the state of health of our own community — the people of Merton and Morden. By comparing these figures with those for similar towns and with the country as a whole we can judge to what extent we have been able to make our environment a healthy one, at least within the limits imposed by such national factors as climate, national prosperity, racial habits and so on. If we look at our Vital Statistics for a moment, our maternal mortality is Nil, as it has been for the past three years, and our facilities for the care of pregnancy and childbirth, we are proud to be able to say, are of the highest standard, so that in the first essential of a healthy community, the care of motherhood, we are among the most fortunate areas. Our infant mortality rate stands at the lowest level ever reached at 11.73 per thousand — a figure which is likely to be the lowest for any area in the whole country and which compares with 29.8 per thousand for England and Wales as a whole. So that as a place in which to rear infants it has its points. The death rate at age 1-4 was 729 per million compared with a rate of 2,175 per million for the country as a whole. As regards Infectious Disease, with the exception of Scarlet Fever and Pneumonia the incidence is lower than that for the whole country, and with the exception of these two diseases and measles in London Administrative County our incidence is lower than that for London County, the 126 County Councils and Great Towns, the 148 smaller towns, as well as for England and Wales as a whole. Our death rate at 9.35 per thousand population, though the highest since 1944, is still lower than the comparable rates, and elsewhere I have recorded that 98 of our old people survived their 80th birthday, 14 passed their 90th birthday, and one old lady missed her centenary by only 2 years, having the misfortune to sustain an accident. 3 Among other points to which I should like to draw your particular attention is the improved survival rate for premature babies. Last year 24% failed to survive one month as compared with 8% this year. Reference to the table on page 57 shows that there has been no death from diphtheria for the past 5 years, and for the first time on record there have been no cases. There has been a fall, however, in the number of children immunised. The number of immunisations in children under 5 years was 682 as against 761 last year, and this would be a matter for serious concern if it portended a diminished enthusiasm for immunisation. It should be remembered, however, that there were 102 fewer births in 1949 as compared with 1948 so that there was less material available. Expressed as a percentage of the previous year's births the 1949 figure of immunisations was 70% as against 69% this year. It will be seen that there were 438 infants vaccinated. It could be deduced from this figure that some 55 per cent or more of infants are not vaccinated. Parents with memories of the old cross hatch vaccination with often very large scars do not perhaps realise that generally it is the aim of present day vaccination to keep local reaction to a minimum, and with the recent anxiety in a nearby coastal town fresh in their memories together with the fact that re-vaccination in a child previously vaccinated in infancy in the face of exposure to the disease is a much more comfortable procedure than where they have never been vaccinated before. It is necessary for me, in view of newspaper reports of deaths from smallpox in the recent epidemic, to mention that this disease still carries a distressing death risk. In the words of our late King George V, "If preventable, why not prevent it ?". I have endeavoured to pick out one or two of the salient points from the text of the report for special mention. It now only remains for me to express my appreciation for the continued interest and encouragement that the Council takes in the work of their Health Department, and to the Chairman and the Public Health Committee — the mainspring of our Public Health machinery. I should like to take this opportunity also to express my gratitude to the staff of my Department for their loyal support and co-operation. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, A. WALLACE JOHNS, Medical Officer of Health. 4 URBAN DISTRICT COUNCIL OF MERTON AND MORDEN 1950. PUBLIC HEALTH COMMITTEE Chairman-. Dr. E. H. Kelly, J.P Mr. L. Clifford. Mr. F. E. Kempsell. Mrs. E. L. Kimber. Mr. A. W. Moore. Mr. S. H. Reeves. Mr. F. W. Walker. Mr. S. C. A. Miller (ex-officio). Mr. C. S. Marsh (ex-officio). REPRESENTATIVES ON NORTH-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE Mr. L. Clifford. Mrs. L. A. Doel. Dr. E. H. Kelly, J.P. Mrs. E. L. Kimber. Mr. A. W. Moore. REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD Mr. S. W. Billingham, J.P. Mr. E. K. Clarke. Mr. D. Shadbolt. Mr. S. C. A. Miller (ex-officio). MERTON AND MORDEN TUBERCULOSIS CARE COMMITTEE Chairman: Mrs. H. Cobbett, J.P., C.C. Vice-Chairman: Mrs. M. E. Shaw. Secretary: Miss M. P. Morriss. Treasurer: Mr. F. S. Buck. 5 PUBLIC HEALTH STAFF, 1950. Medical Officer of Health: A. Wallace Johns, M.R.C.S., L.R.C.P., D.P.H. Chief Sanitary Inspector: a c d F. C. Thomas, M.R.San.I. (To 31-8-50). b e e f W. T. Pinches, M.R.San.I. (From 8-12-50). Deputy Chief Sanitary Inspector: b e e f W. T. Pinches, M.R.San.I. (To 7-12-50). Sanitary Inspectors: b e e f G. E. Maton. b c E. Kipping. b L. H. Thomas. Chief Clerk: A. A. Makepeace. Clerks: R. A. Conolly. Miss D. Martyn H. J. Herbert. F. H. White 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. d Sanitary Science Certificate, University of Liverpool. e Smoke Inspector's Certificate, Royal Sanitary Institute. f Sanitary Science Certificate, Royal Sanitary Institute. 6 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 3,238 Number of inhabited houses according to Rate Books 21,938 Rateable value at 31st December, 1950 £675,628 Sum represented by Id. rate £2,730 The Urban District of Merton and Morden, now one of the largest Urban Districts in the country, owes its origin to the separation of the Parishes of Merton and Morden from the Croydon Rural District Council; first Merton in 1907 to form the Merton Urban District Council, and later Morden, in 1913, amalgamated with Merton to form the present Urban District. Their combined populations at that time was 16,767 persons, and there were 3,646 houses in the area, of which 86 were empty. The growth of the district has been by the building of houses and the impetus given to building by important local events. Study of the table on page 16 showing the population growth reveals the effect of these events on the fillip given to the rising population. From the year 1913 until 1926 the rise is gradual — an average of 230 per year. The population had grown from 17,000 to 20,000 and the houses from 3,646 to 5,689: that year 621 houses had been built by private enterprise according to the Medical Officer's report for that year, and he further observes that the Council were contemplating building a further 100 non-parlour type houses on the Whatley Estate. The Council in 1922 and 1923 had erected 436 houses, but throughout these years the observation is recorded "there is a shortage of houses in the district". In 1926 the extension of the City and South London tube to Morden was completed and in 1929 the L.C.C. housing estate at Morden was begun. During those 13 years building by private enterprise and by local authority effort was going on side by side. Over 15,000 houses had been built and the population had reached the peak figure of 72,150 in 1939—a figure which was not regained until 1946. From that year the population figures resumed their upward trend, and they have not yet reached their final peak. Such is the residential development of Merton and Morden. But it would be erroneous to assume that the district is a purely residential one; it is in fact the largest industrial town in the County of Surrey and it is owing to the forethought and care given to the planning of the factory sites that this fact remains unobtrusive. There are several large factories in the area, e.g. the Tri-Ang toy factory employing over 4,000 persons. There are in fact three factories employing over 500 persons. In addition to 7 planning the factory areas so that they are as remote as possible from the residential parts of the area the Authority has secured the preservation of recreational facilities and open spaces for the population by the dedication of some 360 acres of land for public parks. The Council Offices are themselves situated in Morden Hall Park, a beautiful site close to the busy centre of Morden and within easy walk of the biggest of the factory sites, available for recreation to many thousands who live and work close by and through which the River Wandle wends its way to the Thames and the sea. It is a tragedy that a district which has so carefully planned its own amenities should have them ruined by the municipal undertaking of a neighbouring Authority, which, it seems, must happen if the Croydon Council carry out their threat to withdraw their effluent from the River Wandle to cool the electrical equipment in their new Power Station. 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, 1950. MONTH JOSEPH HOOD RECREATION GROUND WEST BARNES PUMPING STATION Inches Days with 0.01in. or more Days with 0.04in. or more Inches Days with 0.01in. or more Days with 0.04in. or more January .90 7 3 1.00 9 4 February 2.75 18 17 4.18 19 17 March .69 10 7 .82 11 7 April 3.29 19 15 3.29 19 15 May 1.67 12 9 1.83 13 10 June 1.59 10 8 1.54 12 8 July 3.29 19 14 3.87 22 21 August 1.77 18 13 2.14 21 16 September 2.54 22 17 3.01 23 19 October .40 8 4 .46 9 7 November 4.64 21 14 5.02 22 17 December 1.79 18 10 1.82 20 10 Total 25.32 182 131 28.98 200 151 VITAL STATISTICS. The Vital Statistics figures which the Registrar General supplies to us each year show again this year a fall in the number of births from 985 to 938, an increase in the number of deaths from 678 to 709 and a consequent fall in the natural increase from 307 to 229. None the less, our population is estimated at 8 75,790, which shows a continuation of its upward trend which was only halted during the war years. In view of the picture presented by the vital statistics its continued growth must be due to migration. It is refreshing to turn from these discouraging figures, which are mostly beyond our control, to the statistics which measure, as far as it is measurable, our skill in the management of our environment. These are in no way discouraging: on the contrary, as reference to the summary on page 11 will show, and as 1 have already mentioned, our maternity mortality is Nil, our infant mortality is 11.73 per thousand live births. Our death rate is 9.35 per thousand population, our deaths from enteritis and diarrhoea under 2 is Nil and our incidence of diphtheria for the year is Nil. These, perhaps the most important figures for comparing the health of a population, are more favourable — and in some instances so by a considerable margin — than those for all the comparable populations, including the country as a whole, set out in the table for comparison. 9 SUMMARY OF VITAL STATISTICS. (Registrar General's Figures). Population: Registrar General's Estimate 75,790 Births: M. F. Total Live (Legitimate) 479 436 915 (Illegitimate) 9 14 23 488 450 938 Stillbirths (Legitimate) 13 5 18 (Illegitimate) — — — 13 5 18 Total Births 501 455 956 Birth Rate 12.38 per 1,000 population Still Birth Rate 18.83 per 1,000 births Deaths: M. F. Total Total Deaths 361 348 709 Death Rate 9.35 per 1,000 population Infant Mortality: Total deaths under one year 11 Infant Mortality Rate per 1,000 Live Births 11.73 Deaths of Legitimate Infants under 1 year 10 Death Rate per 1,000 Legitimate Births 10.93 Deaths of Illegitimate Infants under 1 year 1 Death Rate per 1,000 Illegitimate Births 43.48 Maternal Mortality: Deaths from Sepsis Nil Deaths from other maternal causes Nil Maternal Death rate per 1,000 Live Births Nil Zymotic Deaths: Deaths from Measles Nil Whooping Cough Nil Diarrhoea (under 2 years) Nil 7 Principal Zymotic Diseases 1 Zymotic Death Rate (per 1,000 population) 0.01 Deaths from Tuberculosis: All forms 25 Rate per 1,000 population 0.33 Phthisis: 24 Rate per 1,000 population 0.32 Deaths from Cancer: 151 Rate per 1,000 population 1.99 10 TABLE I. COMPARATIVE STATISTICS, 1950. (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 Rates per 1,000 Population. Births: Live 15.8 17.6 16.7 17.8 12.38 Still 0.37 0.45 0.38 0.36 0.24 Deaths: All causes 11.6 12.3 11.6 11.8 9.35 Typhoid and Paratyphoid fevers 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.01 0.01 0.01 0.01 0.00 Diphtheria 0.00 0.00 0.00 0.00 0.00 Tuberculosis 0.36 0.42 0.33 0.39 0.33 Influenza 0.10 0.09 0.10 0.07 0.05 Smallpox — — — — — Acute Poliomyelitis (incl. Polioencephalitis) 0.02 0.02 0.02 0.01 0.01 Pneumonia 0.46 0.49 0.45 0.48 0.33 Notifications: (Corrected) Typhoid Fever 0.00 0.00 0.00 0.01 0.00 Paratyphoid Fever 0.01 0.01 0.01 0.01 0.00 Meningococcal Infection 0.03 0.03 0.02 0.03 0.01 Scarlet Fever 1.50 1.56 1.61 1.23 1.60 Whooping Cough 3.60 3.97 3.15 3.21 2.95 Diphtheria 0.02 0.03 0.02 0.03 0.00 Erysipelas 0.17 0.19 0.16 0.17 0.13 Smallpox 0.00 0.00 — — 0.00 Measles 8.39 8.76 8.36 6.57 6.91 Pneumonia 0.70 0.77 0.61 0.50 0.99 Ac. Poliomyelitis:- Paralytic 0.13 0.12 0.11 0.08 0.07 Non-Paralytic 0.05 0.05 0.06 0.05 0.01 Food Poisoning 0.17 0.16 0.14 0.25 0.13 Rates per 1,000 Live Births. Deaths: All causes under 1 year of age 29.8t 33.8 29.4 26.3 11.73 Enteritis and Diarrhoea under 2 years of age 1.9 2.2 1.6 1.0 0.00 Rates per 1,000 Total Births (Live and Still). Notifications: (Corrected) Puerperal Fever and Pyrexia 5.81 7.43 4.33 6.03 6.28 † Per 1,000 Related Births. 11 POPULATION. (Registrar General's figures 75,790). The most recent available estimated figure for our population is 75,790, which is again above the estimated figure for last year and represents the highest population figure ever recorded for the area. Next year, when the census return is available, we shall have the first actual population figure since 1931. The natural increase of population, that is to say the excess of births over deaths, was 229, the lowest figure since 1933. In 1947 it had reached the high level of 734, so that in three years it has dropped to one-third of its peak level. BIRTHS. There were 938 registered live births in the area during the year and there were 18 stillbirths, making a total of 956 births. The number of registered live births at 938 is a further drop on last years' figure, which was the lowest since 1941, and the birth rate at 12.38 approximates the lowest figures ever recorded at 12.3 in 1933 and 1937. Our total live births have fallen by over 400 in the past three years; that is to say they are less than two-thirds of what they were three years ago. Illegitimate Births. There were only 23 illegitimate births as compared with 37 last year. The illegitimate birth rate has now once more reverted to pre-war levels. Its peak was in 1945 at 63. The appended table shows the comparision since 1937. 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 1949 37 37.5 1950 23 24.5 12 INSTITUTIONAL AND DOMICILIARY BIRTHS. The notifications show that 783 births took place in institutions, hospitals and private nursing homes. This is 59 less than 1949 and represents 83.5 per cent of the total, as compared with 83.2 per cent for the previous year. It will be seen that although a smaller number of births took place in Institutions this year (783 as compared with 842 last year), the percentage at 83.5 remains constant. This of course is because the total number of births this year is lower, and it shows that there is yet no diminution of the trend towards Institutional births. It should of course not be forgotten that it is not until the housing situation improves that we shall know normal demand on accommodation. At the present moment, when priority claims on hospital beds are receiving a great deal of discussion, it is of interest perhaps to consider the trend of institutional confinements in an area like Merton and Morden. Appended is a table showing the figures and percentages since records were first made, and two further tables showing the Ward distribution of the institutional births. It will be seen that in the years before the war the percentage of institutional births was round about 50 to 55%, and in the past five years at about 80%. The jump from 50-55% to 80% seems to have been made when the Maternity block at St. Helier came into use. The other interesting fact that is revealed by these figures of Ward distribution is that the heaviest concentration of institutional births before the war was in the Raynes Park area, but since St. Helier accommodation became available St. Helier and Morden Wards provide comparable numbers. It would seem justifiable to draw two deductions from these facts: first, that the demand on institutional maternity accommodation grows with the provision of first class accommodation, and secondly that it centres round the beds and tapers off as the distance increases. 13 These births occurred in the following hospitals and institutions:— St. Helier Hospital 419 Nelson Hospital 276 St. Theresa's Hospital 3 Kingston Hospital 10 Other hospitals, institutions and nursing homes 75 783 14 TABLE II. Numbers and percentages of Institutional births, 1935 -1950. 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 St. Helier Hospital — — — — — — — — 325 335 341 439 468 372 438 419 Nelson Hosiptal 175 194 207 196 230 214 343 305 236 200 216 209 285 289 300 276 Kingston Hospital 41 78 91 103 80 94 69 44 43 22 22 18 17 10 9 10 Others 105 128 150 251 248 147 81 219 187 221 194 257 282 184 95 78 Total Institutional Births 321 400 448 550 558 455 493 568 791 778 773 923 1052 855 842 783 Total Births 721 789 812 990 1005 971 848 1069 1146 1151 1027 1261 1345 1087 985 938 % of Institutional to Total Births 45% 51% 55% 56% 57% 47% 58% 53% 69% 67% 73% 72% 76% 77% 83% 83% 15 TABLE III. Comparison of years 1935 and 1950, showing percentage of Institutional births on Ward basis. Abbey Bushey Mead Central Morden Park Ravensbury Raynes Park St. Helier West Barnes Total Births 1935 40 87 72 52 84 100 76 122 73 Institutional Births 1935 13 49 40 30 55 31 46 23 34 % of Institutional Births 1935 32% 58% 55% 58% 65% 31% 60% 19% 46% Total Births 1950 48 103 107 169 99 99 96 138 79 Institutional Births 1950 38 83 96 138 88 84 79 119 58 % of Institutional Births 1950 79% 81% 90% 82% 88% 84% 82% 86% 73% TABLE IV. Showing Births and Deaths with Rates since the Amalgamation of Merton with Morden. Year Estimated population Total Live 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 1949 75,470 985 13.05 678 8.98 307 1950 75,790 938 12.38 709 9.35 229 DEATHS. The number of registered deaths after adjustment by transferable deaths, is given below: — 709 total deaths of which 361 were males and 348 females. The seasonal mortality is indicated by the deaths for each quarter of the year, which were:— First quarter 207 Second quarter 170 Third quarter 148 Fourth quarter 184 16 Inquests. Inquests were held on 26 deaths occurring in the district, 16 of which were in respect of residents. The verdicts returned were as follows:— (1) Accidental Deaths— Collision with motor vehicles 5 Fall at home 7 Fall from train 1 Coal Gas poisoning 2 Inhalation of stomach contents following anaesthesia 1 — 16 (2) Suicide by— Aspirin poisoning 1 Barbituric acid poisoning 2 Coal Gas poisoning 5 Collision with train 1 Seconal Sodium poisoning 1 — 10 26 The total number of inquests held were four more than in the year before. Road accidents were responsible for five of the total accidental deaths, compared with five for the previous year. CAUSES OF DEATH. There were 709 deaths during the year 1950 in Merton and Morden, of whom 361 were males and 348 females. Disease of the heart, comprising the three groups directly attributable to that organ, viz., coronary disease and angina, hypertension and other heart disease, total 223 deaths, the largest number of deaths from any single cause in the list in Table VI. If we add vascular disease of the nervous system and other circulatory disease the deaths from vascular disease reached the total of 316, or 45% of the total from all causes. The next largest single cause is Cancer, which is responsible for 151 deaths. These two groups — vascular disease and Cancer — account for two-thirds of the total deaths. Cancer is perhaps the most important as it is incontestably due to a pathological process, whereas hidden among these deaths from Heart Disease are probably quite a large number of deaths from degenerative processes associated with age. 17 Deaths from coronary disease of the heart have been increasing over the past ten years and it is of interest that out of 96, only 31 were female and 65 were male: this is a complete reversal of the position in vascular disease of the brain, where out of a total of 74, 56 were in the female and only 18 male. Of the 151 deaths from Cancer, in 25 the site was in the bronchus or lung. Only two of these 25 were female. Statistics show that there has been an increase in the mortality from this cause in recent years. There does not seem to have been any occupational influence discernible among these 25 deaths; scrutiny of the death returns shows that they had a wide diversity of occupation. There were 25 deaths only from T.B. This is again a reduction in the number of deaths from this disease. Further reference is made to this subject on page 61. Ninety-eight persons survived to 80 years of age or over. Of these 17 only were certified as having died from old age. Fourteen old people celebrated their 90th birthday; in only three of these was old age given as the cause of death. There were 9 deaths during the year from road traffic accidents, none of them involving children. It may be of interest, also, since gastric and duodenal ulcer are believed to be more common in recent years, that there were five deaths where one or other of those diseases was given as the cause. Two of them were attributed to gastric ulcer and three to duodenal ulcer. Only one of these deaths was in a person under 55 years of age. There has been an increase in the number of deaths from violence in the Groups 33, 34 and 35 in TableVI. Suicides number 8 as against 7 last year, road traffic accidents were responsible for 9 as compared with 4 last year, and deaths attributed to all other violent causes this year number 16 as against 13 last year. The graph on page 21 shows the analysis of deaths from these causes over the past 20 years. 18 CANCER DEATH RATE. No. of deaths from Cancer for past 10 years. 1941 85 1946 126 1942 103 1947 118 1943 116 1948 110 1944 107 1949 152 1945 116 1950 151 Year. Death Rate per 1,000 population. Year. Death Rate per 1,000 population. 1941 1.3 1946 1.7 1942 1.5 1947 1.5 1943 1.7 1948 1.5 1944 1.7 1949 2.0 1945 1.7 1950 2.0 TABLE V. Deaths from Respiratory Diseases, 1931-1950. Year Bronchitis Pneumonia Other Respiratory Diseases Total Death Rate 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 1949 29 24 6 59 0.78 1950 34 25 5 64 0.84 19 TABLE VI. Causes of Death during the year 1950. No. Cause of Death Males Females Total 1 Tuberculosis, respiratory 13 11 24 2 Tuberculosis, other 1 — 1 3 Syphilitic disease 3 1 4 4 Diphtheria — — — 5 Whooping cough — — — 6 Meningococcal Infections — — — 7 Acute poliomyelitis 1 — 1 8 Measles — — — 9 Other infective and parasitic diseases 1 — 1 10 Malignant neoplasm, stomach 11 10 21 11 Malignant neoplasm, lung bronchus 23 2 25 12 Malignant neoplasm, breast 1 16 17 11 Malignant neoplasm, uterus — 8 8 14 Other malignant and lymphatic neoplasms 42 38 80 15 Leukaemia, aleukaemia 4 1 5 16 Diabetes 5 1 6 17 Vascular lesions of nervous system 18 56 74 18 Coronary disease, angina 65 31 96 19 Hypertension with heart disease 17 7 24 20 Other heart disease 34 69 103 21 Other circulatory disease 11 8 19 22 Influenza 3 1 4 23 Pneumonia 13 12 25 24 Bronchitis 24 10 34 25 Other diseases of respiratory system 2 3 5 26 Ulcer of stomach and duodenum 5 2 7 27 Gastritis, enteritis and diarrhoea 2 3 5 28 Nephritis and nephrosis 4 5 9 29 Hyperplasia of prostate 6 — 6 30 Pregnancy, childbirth, abortion 31 Congenital malformations 1 4 5 32 Other defined and ill-defined diseases 30 37 67 33 Motor vehicle accidents 7 2 9 34 All other accidents 8 8 16 35 Suicide 6 2 8 36 Homicide and operations of war — — — Total all causes 361 348 709 20 TOP GRAPH - DEATHS FROM VIOLENCE 21 MATERNAL MORTALITY. The maternal mortality rate for the year 1950 is once again Nil. It has been pointed out before that dealing with small figures such as those provided by our population, a single death is reflected in the mortality rate by more than 1 per thousand. For this reason we have published the rates for the past 20 years. These figures will be found in the Table below. It will be seen that we have had a Nil mortality 4 times in the past ten years and that only twice in that period has it been above 1. In the 20 years ended this year there have been 39 maternal deaths and 19,468 births (live and still). This gives an overall rate for the period of 2.05 per thousand births. TABLE VII. Maternal Mortality, 1931-1950. 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 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 1949 — 0.22 — 0.76 — 0.98 1950 - 0.12 - 0.74 - 0.86 22 INFANT MORTALITY. There were 11 deaths of infants; that is to say, children under one year of age. This gives an infant mortality rate of 11.73, the lowest ever recorded for the district. Analysis of the causes of these deaths as listed below emphasize once more the fact that infant mortality today has its root and origin in obstetrics. It will be seen that once more all except one of the infant deaths are neo-natal deaths; that is, occurring in the first month of life. With the exception of a death at three months of age all the others died within five days of birth. Four of the 10 neonatal deaths were due to prematurity, two to birth injuries, two to developmental defects, one to haemolitic disease of the newborn, and one to broncho-pneumonia, so that six of these deaths, or 60% must ultimately be regarded as preventable deaths in the sense that improved obstetric skill, including ante-natal care, might have prevented them. The improvement in ante-natal care sufficient to prevent those deaths due to developmental defects can only come about as our knowledge of the aetiology of the conditions expands. The dieticians, with the knowledge they have gained of the principles of adequate nutrition, the knowledge which has been put over to the public by the Public Health staff of this country, have removed almost entirely pelvic deformities as a cause of obstructed labour, the discoveries of the Sulpha drugs and of the antibiotics Penicillin and its allied preparations have removed the risk of sepsis, the other of the two dreaded sequelae of childbirth, so that a revolution has taken place in our attitude to childbirth. The idea that a mother in labour is in any way in jeopardy of her own life is becoming a thing of the past. It is now time that the infant was put in the same secure position. The Public Health Service is proud of the fact that by the improvement of environment and improvement in infant management the infant mortality has fallen from 130 per thousand to about 30 per thousand in the past 30 years. But this reduction has taken place largely in the ages over one month; there has not been anything like the same reduction in the neo-natal group. Infant Deaths — With causes of death. Sex. Age. Cause of Death. Male 3 days Kernicterus. Haemolytic Disease of Newborn. Male 3 days Cerebral Haemorrhage. Male 11 hours Prematurity. Male 8 hours Congenital Atelectasis. Prematurity. Male 2 days Broncho Pneumonia. Female 2 hours Atelectasis. Extreme Prematurity. 23 Sex. Age. Cause of Death. Male 5 days Broncho Pneumonia. Multiple Congenital Abnormalities. Male 2 days Sub Arachnoid Haemorrhage. Bilateral Tears of Tentorium Cerebellum. Male 8 hours Prematurity (30 weeks pregnancy). Female 1 hour Multiple Foetal Deformities. Patent Intraventricular Septum. Congenital Cyst Kidneys. Micocephaly. Male 3 months Gastritis. Broncho Pneumonia. TABLE VIII. Infant Mortality and Stillbirth Rates for the past 10 years. Year Infant Mortality Rate Stillbirth Rate 1941 42.2 34.2 1942 33.9 24 1943 23.5 23.5 1944 28.7 22.09 1945 33.1 24.6 1946 22.2 23.9 1947 30.4 21.1 1948 24.8 18.9 1949 24.3 14.01 1950 11.73 18.83 PREMATURE BABIES. There were 50 premature births notified during the year. Although this is a decrease of 4 as compared with 1949 it is still a much higher figure than the years 1947 and 1948. It is of great interest to note, however, that only 4 of these babies failed to survive one month, that is, 8% as compared with 24% for the previous year. The total number of premature babies notified during the year were as follows, born :— (a) At home 4 (b) In hospital 46 The number of those born at home: — (a) Who were nursed entirely at home 3 (b) Who died during the first 24 hours 1 (c) Who survived at the end of one month 3 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 43 24 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 1950 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. (2) The St. Helier District Nursing Association employs two full-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 Carshalton Urban District lying to the north of Reigate Avenue. During the year 280 cases were dealt with by the St. Helier District Nursing Assosciation, the total number of visits being 4,281. (3) The Wimbledon District Nursing Association serves Wimbledon and the western part of this district. Two full-time nurses and two part-time nurses are employed for general nursing in Merton and Morden. The figures relating to cases and visits in this district during the year are as follows: — Cases Visits Children under 5 years 15 80 Other cases 553 10,484 568 10,564 Hospital Car Service. This most valuable service was continued during the year, relieving the ambulances of a great burden of 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 Tuberculosis Dispensaries. The provision of treatment and investigation of Tuberculosis is undertaken by the Regional Hospital Board. The County Council are responsible for the preventive side of the work, the Health Visitors and Almoners working in the Chest Clinic at the St. Helier Hospital being employed by the County Council. Three-elevenths of the Tuberculosis Officer's time is allocated to the preventive side of the work and is also the responsibility of the County Council. The sessions held at the Chest Clinic for Merton and Morden patients are as follows :— Mondays at 2.0 p.m. Wednesdays at 9.30 a.m. Fridays at 2 p.m. 1st Monday in the month at 5 p.m. (old cases only). Venereal Diseases. The treatment both in-patient and out-patient, of venereal disease is the responsiblity 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 Council have appointed two health visitors especially for this purpose. 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 10.45 a.m. Females Wednesdays at 2.30 p.m. Thursdays at 11 a.m. Fridays at 5.30 p.m. Kingston Hospital, Wolverton Avenue, Kingston-on-Thames Females Thursdays 5-7 p.m. 26 HOSPITALS. Smallpox. By arrangement with the South East Metropolitan Regional Hospital Board, any cases of smallpox occurring in this district are to be admitted to the Joyce Green Hospital, Dartford, Kent. Fortunately once again we had no reason to take advantage of this arrangement. Infectious Disease. Whereas before the National Health Service Act it was exceptional for cases of infectious disease from our area to be admitted elsewhere than to the Wandle Valley Hospital, which, under the Wandle Valley Joint Board served this area together with the neighbouring areas of Mitcham, Beddington and Wallington, and Coulsdon and Purley, now a considerable number of these cases are admitted to other of the Regional Board's hospitals, particularly the Grove Hospital, Tooting. Table XI, which used to show the extent of the work done on our behalf by the Wandle Valley Hospital, has therefore been amended to show the hospital admissions of infectious disease. TABLE IX. Cases admitted to Isolation Hospitals during the year 1950. Disease (Final Diagnosis) Wandle Valley Grove Others Cases Deaths Cases Deaths Cases Deaths Scarlet Fever 38 16 18 Measles 3 — 1 — 1 — Influenza 1 - - - - - Dermatitis 2 - - - - - Tonsillitis 1 - - - - - Erysipelas 3 — 1 — — — Non-specific Erythema — — 2 — 1 — Poliomyelitis — — 2 — 4 1 Glandular Fever — — — — 1 — Pityriasis Rosea — — 1 — — — Meningococcal Fever 1 — 1 — — — Totals 49 — 24 — 25 1 General and Maternity. 1. The Nelson Hospital. The accommodation of this hospital, which serves the Wimbledon, Merton and Morden area is 121 beds, 47 of which are maternity beds. 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. 27 MENTAL DISEASE. Cases dealt with under the Lunacy Acts, 1890, in the district of Merton and Morden. There were 32 cases certified under these Acts during the year. Below is given the provisional classification according to the condition on admission. Male Female Total Senile Dementia 3 9 12 Delusional Insanity 4 3 7 Suicidal 3 2 5 Mental Deficiency 1 — 1 Schizophrenia 2 1 3 Hallucinated and Depressed 2 2 4 Total 15 17 32 Of these cases 19 were certified under Section 16, 9 were placed under observation under Section 20, and 4 were removed to hospital under an Urgency Order under Section 11. In addition 68 patients (28 male and 40 female) were admitted direct to Mental Hospital under Section 1 of the Mental Treatment Act, 1930, as voluntary patients. NATIONAL ASSISTANCE ACT. Two cases compelled consideration of the necessity to operate Section 47 of the National Assistance Act during the year. In one it was found that the old lady concerned was deluded, and it was decided that it was more appropriate to take action under the Lunacy Acts. She was accordingly certified and removed to Netherne Hospital. In the other case, an old lady living alone in insanitary conditions, it was necessary to secure removal to an institution, and an application was made to the Court for an Order under Section 47. The Order was obtained and she was admitted to a Home for Old People under the Welfare Authority arrangements. SECTION C. — SANITARY CIRCUMSTANCES. Clean Food Campaign. During the week 24th-30th June a Clean Food Exhibition was held in the Merton Public Hall; the stands were provided by the Infestation Control Division of the Ministry of Agriculture and Fisheries. In addition to some of the multiple Food Manufacturing firms several local traders 28 sented on the Food Advisory Committee staged exhibits. The Exhibition was opened by Commander Campbell, of Brains Trust fame, and Mr. S. C. A. Miller, the Chairman of the Council, who was also the Chairman of the Food Advisory Committee. The Education Authority consented to the attendance of organised parties of school children, and the Head Teachers co-operated fully, both at the Exhibition itself, at the film shows and lectures and by organising an Essay Competition for groups of children afterwards. There were 1,665 attendances during the week, and as this was one of the first efforts of its kind and could not be held in a central situation it was felt that the interest shown and the opportunities of disseminating Clean Food propaganda justified the work and expense entailed. The Model Byelaws, relating to handling, storage and preparation of food, came into operation in August, 1950. While it is important that there shall be no diminution in efforts to secure a positive attitude to improvement in food handling, these Byelaws give the Council the power to require the standards that the Guilds established by some authorities have been attempting to secure in the absence of legislative powers. Food and Drugs Act. It will be seen that 167 samples were submitted to the Public Analyst during the year. This represents 2.2 per thousand, slightly more than the 2 per thousand which was arbitrarily regarded as the proper figure at the time the Act was passed. It will be remembered that at that time there was no difficulty over obtaining a wide diversity of foodstuffs available for sampling. Since that time, too, there has been a great increase in the time necessarily devoted to the supervision of Ice Cream and during the year 64 samples were submitted for chemical and bacteriological examination. The increasing number of articles of food that now have standards laid down for their composition has been of great value in securing satisfactory quality and it will increasingly strengthen our position with regard to many articles of every day diet over which we used to have very little effective control. 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 29 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. Seven samples of water from domestic taps were submitted for chemical or bacteriological examination. The reports on each sample were satisfactory. Public Cleansing. The Council took over the collection of house refuse themselves in October, 1909. It had been previously done under contract. From that time a weekly collection has been maintained with the exception of occasional periods during the War when shortage of labour caused disorganisation. During the year 15,506 tons of house refuse was collected and disposed of. The salvage tonnage for the year was as follows :— Tons. Tons. Paper 740 Bottles and Glass 126 Metal 504 Rags 17 Pig Foods 910 Drainage and Sewerage. No major sewerage or drainage schemes have been undertaken by the Council during the year. The normal cleansing and flushing of sewers has been carried out so far as practicable having regard to the shortage of labour for this work. Rivers and Streams. No major works to rivers and streams have been carried out during the year, but normal cleaning and maintenance of waterways has been carried out by the Surrey County Council. 30 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, 1950. Housing Inspections. The total number of houses inspected for " sanitary defects" under the Public Health and Housing Acts was 912. Informal action secured improvements to most of the houses, it being necessary to take statutory action in only 99 instances. Building materials were in greater supply and the shortage of labour experienced in repair work proved the main obstacle to the speedy execution of repairs. Difficulty has still been experienced in dealing with the older parts of the district as the continued low rental has precluded action under the repair section of the Housing Acts. A greater incidence of overcrowding was noticed during the year, 66 cases being found compared with 31 in 1949. The total number of cases known to exist at the end of the year was 314. One application was received for a certificate in accordance with the Rent Restrictions Acts, 1920-1939 that the house was not in tenantable repair, and after the inspection, the certificate was issued. Action taken in connection with defective dwelling houses is set out in the housing table on pages 42 and 43. Summary of Nuisances Abated and Sanitary Improvements Effected. Ceilings cleansed or repaired 250 Coppers provided or repaired — Dampness in premises remedied 118 Drains exposed and repaired 13 Drains reconstructed 1 Defective sashcords renewed 51 Dustbins provided 66 Floors repaired 125 Fresh air inlet valves provided and repaired 7 Inspection chamber covers provided 10 Obstructions removed from drains 20 Rain water pipes renewed or repaired 34 Rooms cleansed 6 Roofs repaired 112 Gutters repaired 55 Sink wastes repaired 19 Walls repaired 508 W.C. cisterns provided 2 31 W.C. cisterns repaired 32 Water Closets cleansed 11 W.C. pans provided 19 Windows repaired or renewed 120 Fireplaces and stoves renewed or repaired 57 Sinks provided 5 Offensive accumulations removed 13 Water supply repaired for domestic use 23 Verminous premises fumigated and cleansed 5 Ventilation provided under floors. 10 Sanitary accommodation for workshops 4 Miscellaneous 184 Notices Served. Intimation notices 479 Statutory notices: — Public Health Act, 1936 99 Housing Act, 1936 — Drainage Work. At 6 houses the drainage systems were entirely reconstructed and at 55 houses extensive repairs to drains were carried out. Smoke and water tests were applied to the drains of houses in 105 instances, and obstructions were removed from drains at 88 houses. Food Supply. The systematic survey of all food shops and catering establishments commenced in 1949 was continued during the year, and 1,093 inspections were made for all purposes. Improvements in conditions were effected in several premises. Impetus to the drive for cleaner food was given by the calling together of all food traders by the Council in March when it was decided to set up a Food Advisory Committee " to sponsor and encourage the best practice in the distribution and handling of food ". As a first step to publicity, a Clean Food Exhibition was held at the Merton Public Hall in collaboration with the Ministry of Agriculture (Pest Infestation Division), and considerable interest aroused. Further follow-up meetings, films shows, and lectures had to be curtailed and this promising work deferred owing to a deterioration in the staffing position. It was unfortunate that the new Byelaws regulating the Handling, Wrapping, and Distribution of Food came into force at this moment when the resources of the Department were fully extended and the additional enforcement impracticable except to a very limited extent. At the time of preparing this report, the position has been retrieved and various projects to publicise the need for care in handling food are under consideration. 32 Unsound Food. The undermentioned articles of food were found, upon inspection, to be unfit for human consumption; were surrendered and either destroyed or disposed of for animal feeding or salvage: — Description. Amount. Cause. Beef 1,071 lbs. Putrefaction, bruising and bone taint. Mutton 32 lbs. Contamination, caseous lymphadenitis. Bacon 119 lbs. Putrefaction and taint. Lamb Livers 40 lbs. Mould. Oxtails 27 lbs. Contamination. Ox Sweetbreads 16 lbs. Decomposition. Fish 185 stone Decomposition. Cereals 67 pkts. Affected by mites and mould. Sponge and 792 pkts. Mildewed, deterioration. Cake Mixture Sweets 4 lbs. Glass particles. Meat Pies 19 Mouldy and stale. Potatoes 4 lbs. Unsound. Eggs 135 Mouldy. Cake 16 lbs. Mouldy. Sausages 80 lbs. Mouldy. Fish Paste 295 jars Putrefaction and Mould. Luncheon Meat 4 lbs. Putrefaction. Chocolate Vermicelli 4 lbs. Staleness. Cheese 18 pkts. Contamination. Shrimps 3 gall. Decomposition. Prawns 25 lbs. Decomposition. Biscuits 40 lbs. Contamination. Dried Milk 112 lbs. Mice contamination. Currants 4 lbs. Mouldy. Sauce 960 bottles Stale. Roasted Peanuts 13½ lbs. Contamination. Pearl Barley 56 lbs. Weevil infestation. Macaroni 6 lbs. Staleness. Prunes 304 lbs. Mouldy. Figs 42 lbs. Maggot infestation. Tinned Meat, Milk, Fish, Vegetables, Fruit, etc. 12,443 tins Blown, punctured, leaking, mouldy, sour and unsound. Contaminated Foodstuffs. Several complaints of foreign objects in cakes, bread, jam, and other foods were received. All were carefully investigated and, where appropriate, action was taken — mostly by informal letter. In one case however where rodent excreta was found in salted peanuts, the manufacturers were prosecuted and a fine of £5 and £10 costs imposed. 33 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 this and surrounding districts take advantage of this arrangement and use the slaughter house attached to the Trafalgar Pig Club at 129, High Street, Merton. [ Carcases Inspected. Cattle Cows Calves Sheep Pigs Number killed — — — — 155 Number inspected — — — — 155 Number found fit for human consumption — — — — 154 Organs condemned. Reason for condemnation. 1 Carcase and Offals |Tuberculosis 6 Heads Offal Swine Erysipelas Milk Supply. There are no producers of milk registered within the urban district. 4 distributors were registered and one ceased during the year. Two dairymen discontinued bottling loose milk. At the end of the year there were on the register 6 dairies and 23 distributors. Practically all the milk supplied to the district is derived from the South-eastern Counties and arrives either by rail or road. One hundred and thirty-five inspections were made to dairies and milk shops during 1950. Fifty-one samples of milk were submitted for bacteriological examination during the year. All conformed to the prescribed standard. Results of Chemical Analyses of New Milk Samples. Solids not fat (legal standard is 8.5%). Less than 8.5 8.5 8.6 8.7 8.8 8.9 9.0 9.1 9.2 Total 1 1 8 19 19 9 2 — — 59 Milk fat (legal standard 3.0%). Less than 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 2 3 4 10 16 9 4 6 4 1 — — — 59 34 The undermentioned licences were granted to dealers under the Milk (Special Designations) Regulations and were in force at 31st December, 1950:— Dealers Licences. Pasteurised 13 Tuberculin Tested 12 Sterilised 15 Supplementary Licences. Pasteurised 18 Tuberculin Tested 16 Sterilised 17 35 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 Almond Oil 1 1 - Aspirin Tablets 2 2 — Baking Powder 2 2 — Black Pudding 1 1 — Boracic Ointment 1 1 — Brawn 1 1 Bread 1 1 Butter 2 1 1 Camphorated Oil 1 1 — Chutney 1 1 — Cocoa 1 1 — Coffee Essence 1 1 — Coffee, ground 2 2 — Cordial 1 1 — Cough Mixture 1 1 — Cream, synthetic 1 .1 — Curry Powder 1 1 — Custard Powder 2 2 — Dripping 2 2 — Eucalyptus Oil 1 1 — Flavouring Essence 1 1 — Flour, Self Raising 2 2 — Friars Balsam 1 1 — Gelatine 1 1 Ginger, Ground 1 1 — Gravy Powder 1 1 Health Salts 2 2 — Herbs, Dried 1 1 — Horse Radish Cream 2 2 Iodine, Tincture of 1 1 Jam 2 2 Jelly, Table 2 2 Lemonade Crystals 1 1 Marmalade 2 2 Meat Pressed 2 2 Medicinal Paraffin 1 1 Milk, Condensed 2 1 1 Milk 62 57 5 Mineral Waters 1 1 — Mint Sauce 1 1 — Mustard 1 1 — Nutmeg, Ground 1 1 — Paste, Fish 6 6 — Paste, Meat 4 4 — Peas, Tinned 2 2 — Pepper 1 1 — Pickles 2 2 — Potato Crisps 1 1 — Quinine, Tincture of 1 1 — Rennet 1 1 — Saccharine 1 1 — Salad Cream 1 1 — Sauce, Fruit 1 1 — 36 Article Total Samples Genuine Not Genuine Sausages 4 4 Sausage Meat 1 1 - Savoury Spread 3 3 - Seidlitz Powder 1 1 - Sodium Bicarbonate 1 1 - Soup Powder 1 1 - Soup, Tinned 3 3 - Spice, Mixed 1 1 - Sponge and Cake mixture 3 1 Stuffing 3 3 - Suet 2 1 1 Sweets 1 1 - Tomato Ketchup 2 2 - Vinegar, Malt 1 1 - Zinc Ointment 2 2 - Total 167 158 9 Action Taken. (a) Butter (1302 Formal) contained 16.3% water instead of 16%. Insufficient to justify action. (b) Condensed Milk (1187 Informal). Contents of several tins found to be mouldy and returned to Condensed Milk Pool at request of Ministry of Food. (c) Milk— (i) (1217 Formal). Deficiency equal to 1% added water, Subsequent samples genuine. (ii) (1262 Informal). Deficiency equal to abstraction of 11% of the Milk Fat. Subsequent formal sample (1274) showed deficiency equal to abstraction of 10% of the Milk Fat. Proceedings were instituted against the Dairy Co. who sued the Farmer. The latter was able to prove that the milk was as given by the cow. (iii) (1263 Informal). Channel Island Milk containing 3.88% fat. Subsequent Formal sample 1275 contained 3.65% Milk Fat. These were genuine milk but below the 4% standard prescribed by the Milk (Control of Maximum Prices) Order. They were referred to the Ministry of Food. (d) Sponge and Cake Mixture (1188 Informal). Deterioration due to age. Carbon Dioxide figure only 0.2% instead of 0.4%. Stock was surrendered and destroyed. (e) Suet (1220 Informal). Contained 81% beef fat instead of 83%. Subsequent formal sample (1228) was genuine. 37 Ice-cream (Heat Treatment) Regulations, 1947. These regulations came into operation on the 1st May, 1947. At the end of the year, there was only one manufacturer of ice-cream on the register and 94 dealers and 18 vendors were registered. 64 samples were obtained and submitted for examination with the following results:— No. Grade Methylene Blue Test Coliform B. Remarks 1 3 Unsatisfactory Absent 2 1 Satisfactory " 3 3 Unsatisfactory Present 4 1 Satisfactory Absent 5 1 " " 6 3 Unsatisfactory 7 1 Satisfactory " 8 2 " " 9 2 " " 10 2 " " 11 3 Unsatisfactory " 12 1 Satisfactory Present 13 4 Unsatisfactory " 14 1 Satisfactory Absent 15 4 Unsatisfactory Present 16 3 " Absent 17 3 " " 18 3 " Present 19 1 Satisfactory " 20 1 " " 21 1 " Absent 22 1 " " 23 1 " Present 24 1 " " Faecal coli present 25 1 " " Faecal coli present 26 1 " Absent 27 3 Unsatisfactory Present 28 2 Satisfactory Absent 29 2 " Present 30 1 " Absent 31 3 Unsatisfactory Present 32 3 " " Faecal coli present 33 1 Satisfactory Absent 34 3 Unsatisfactory Present Faecal coli present 35 1 Satisfactory " 36 3 Unsatisfactory Absent 37 3 „ Present 38 2 Satisfactory " 39 2 " Absent 40 3 Unsatisfactory " 41 4 " " 42 3 " Present 43 2 Satisfactory " 44 2 " Absent 45 2 " " 46 1 " " 47 2 " " 48 2 " Present Faecal coli present 49 1 " Absent 38 No. Grade Methylene Blue Test Coliform B. Remarks 50 1 Satisfactory Present 51 3 Unsatisfactory " 52 2 Satisfactory Absent 53 2 " Present 54 2 " " 55 2 " " 56 1 " Absent 57 1 " " 58 1 " Present 59 1 " Absent 60 1 " " 61 1 " " 62 1 " Present 63 1 " Absent 64 2 " Present Although considerable work undoubtedly remains to be done in this field of food control there was a definite improvement in the bacteriological standard during the year as can be seen by comparing the present figures with those of 1949. Grade 1949 1950 1 18 (37%) 28 (44%) 2 9 (18%) 17 (27%) 3 17 (35%) 16 (25%) 4 5 (10%) 3 ( 4%) 49 64 Factories and Workplaces. The number of inspections made to premises registered under the Factories Act, 1937 was 174. Defects relating to sanitary conveniences, ventilation and other sanitary matters were dealt with at 17 premises. The table on page 44 gives details of action taken during the year. Water Courses. Twenty-three 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. Three 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. 39 Rodent Control. The main feature of the year was the repeal of the Rats and Mice (Destruction) Act, 1919, and the coming into force of the Prevention of Damage by Pests Act. The appointment of an additional operator, full-time, with the existing operator who is engaged 25% on disinfection, etc., allowed the additional powers conferred by the Act to be put into full operation. A 10% test of the Council sewers was made and 355 manholes were baited. Only 3.7% complete takes and 3.4% partial takes of bait were recorded as was to be expected in a comparatively recently developed area. Two poisoning treatments of the sewers were done during the year. A Free Service is provided for householders and the additional publicity has resulted in an increased number of complaints of rodent infestation or movement being made. This increase is common to other districts and is only to be expected. Most business premises employ their own contractor but in some cases, treatments were carried out by the Department and charged for on an agreed scale. Smoke Abatement. A number of complaints were received relating to excessive smoke emitting from certain factory chimneys. 49 observations were made and action taken to reduce the emission of smoke although no legal nuisances were found to exist. 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 summarises the inspections made, the infringements discovered and other matters dealt with during the year. No. of Inspections :—Day Visits 355 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 1 5. Prescribed notices not correct or exhibited 30 6. Sanitary arrangements unsatisfactory 7. Reasonable temperature not maintained 40 Summary of Sanitary Inspections. Housing—primary visits 912 Re-inspections—work in progress 1,756 Re overcrowding provisions 181 Miscellaneous, housing 475 Drainage work 954 Factories and Workplaces 312 Stables and Piggeries 34 Rats and Mice destruction 787 Enquiries—infectious diseases 340 Smoke abatement 49 Food shops, etc 1,093 Milk supply 135 Rivers and Streams—pollution 23 Miscellaneous 2,079 I would like to take this opportunity of expressing my thanks to the Chairman and Members of the Public Health Committee for their support during the year, and their encouragement during a trying period. I am, Ladies and Gentlemen, Your obedient Servant, W. T. PINCHES, Chief Sanitary Inspector. August, 1951. 41 SECTION D. — HOUSING. Housing and Overcrowding. During the year 97 new houses were built in the Urban District, 87 by the Council, 4 by other Local Authorities and 6 by private builders. It is interesting to note that by the end of 1950 the total of new houses and houses rebuilt since the War had reached 1,000. 467 eligible applications for rehousing were received by the Housing Manager during the year; 61 houses and 47 flats were allocated to tenants during this period. By the end of the year the number of outstanding applications had increased from 2,979 to 3,338. Arising out of rehousing enquiries, 181 complaints of overcrowding were received. Of these, 66 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— 1. Inspection of Dwelling Houses during the year:— i. (a) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) 912 (b) Number of inspections made for the purpose 912 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 479 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 422 42 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 ... — B.— Proceedings under Public Health Acts: — (i) Number of dwellinghouses in respect of which notices were served requiring defects to be remedied 99 (ii) Number of dwellinghouses in which defects were remedied after service of formal notices: — (a) By owners 100 (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 31-41). 43 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 17 16 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 178 158 9 (iii) Other Premises in which Section 7 is enforced by the Local Authority 2 Total 197 174 9 — 2. Cases in which defects were found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied To H.M. Inspector By H.M. Inspector Want of cleanliness (S.l) 1 1 — 1 — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — Sanitary Conveniences (S.7) (a) Insufficient 3 1 — 1 — (b) Unsuitable or defective 11 15 1 (c) Not separate for sexes — Other offences against the Act (not including offences relating to Outwork) 2 1 1 - - Total 17 18 1 3 — 44 SECTION F — INFECTIOUS ILLNESS. Notification. The Public Health (Acute Poliomyelitis, Acute Encephalitis, and Meningococcal Infection) Regulations, 1949, (S.I. 2259/49) came into force on 1st January, 1950. These revoked the Regulations of 1912, 1918 and 1919 governing notification of Cerebro-Spinal Fever, Acute Poliomyelitis, Acute Polio-Encephatlitis and Acute Encephalitis Lethargica, introduced nomenclature consistent with the international standard classification of diseases, and slightly extended the scope of clinical conditions notifiable under the head of acute encephalitis. The following diseases are now notifiable in the district:— Acute Encephalitis (Infective) Acute Encephalitis (Post-Infectious) Acute Poliomyelitis (Paralytic) Acute Poliomyelitis (Non-Paralytic) Cholera Continued Fever Diphtheria (including membranous Croup) Dysentery Enteric Fever (including paratyphoid fevers) Erysipelas Food Poisoning Malaria Measles Meningococcal Infection Ophthalmia Neonatorum Plague Pneumonia, Primary Pneumonia, Influenzal Puerperal Pyrexia Relapsing Fever Scarlet Fever Smallpox Trench Fever Typhus Fever Tuberculosis (all forms) Whooping Cough Smallpox. There were no cases of smallpox in our area during the year. There were however 5 contacts of this disease, coming into the country from abroad, who had to be kept under surveillance until the expiry of the incubation period. Diphtheria. For the first year on record there were no cases of Diphtheria. There were two cases admitted to hospital for observation and diagnosis; both were in young adults. The first was a young girl of 18, and after repeated negative swabs was diagnosed as tonsillitis, and the second a young man of 21, which eventually turned out to be a case of Glandular Fever. Scarlet Fever. There were 121 cases of Scarlet Fever during the year, of which 51, or 42%, were nursed at home. Of the cases kept at home, in no case did a second case arise in the house. There were 70 cases sent to hospital and there were three instances of second cases in the same house, one of which was a return case. 45 There is a gratifying fall in the incidence of Scarlet Fever for the year 1950 and it is particularly gratifying to be able to record that the incidence in a particular Ward has fallen to normal proportions. It will be remembered that last year the possibility of one of our schools in that area being the avenue for the dissemination of the infection was under careful consideration. It will also be remembered that I drew attention to the fact that in that school there were 12 cases of Scarlet Fever actually in the school at the stage of the rash, which is at least two days after the infection, and I then pointed out that it was useless for us to institute a search for obscure sources of infection such as carriers while such an obvious source persisted. I am happy to be able to state that analysis of the records for this year shows that there were only two cases. One child was still sent to school with obviously recognisable Scarlet Fever, and none of these cases were in that particular school. Measles. There were 523 cases of Measles during the year. This year should not have been a year of prevalence if the disease had maintained its biennial character, but as was pointed out last year, this phenomena has largely disappeared and a high incidence has been kept up for the past 10 years, as reference to the table below will clearly show. The disease has been mild and there have been no deaths. INCIDENCE OF MEASLES 1931-1950. Year Cases Deaths Population Remarks 1931 7 - 41,510 School children only included — disease not being notifiable. Figures based on returns from Head Teachers. 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 1949 721 — 75,470 1950 523 — 75,790 46 Whooping Cough. There were 223 cases of Whooping Cough during the year with a mortality of nil. While this distressing condition does not carry a high mortality it has long been recognised as one of the most important contributions to ill-health and debility in childhood, particularly among the less robust of the infant population, and its baleful influence can be seen long after the actual attack. It is therefore particularly disappointing that no preventive injection of unassailable reliability like the Diphtheria injection has yet been found to combat this disease. Food Poisoning. There were 10 notifications of food poisoning during the year, all of which were confined to families or were single cases. Four cases were from one family and it was not possible to ascertain the actual foodstuff which was the cause of the outbreak. Swabs were taken, but no Pathogenic organisms were isolated. Two cases occurred in another family, and again it was not possible to pin-point the cause. Swabs in these cases were unobtainable. The other four cases were all single infections and in two of them, the swabs were negative. In the third case, Salmonella Typhi-Murium and Shotmulleri were isolated and the infection in this case was attributed to a duck egg said to have been eaten two days prior to onset. In the fourth case, Salmonella Typhi- Murium was isolated and the suspected food was whelks eaten at a seaside resort. The Medical Officer of Health of that Local Authority was informed, but enquiries there did not bring to light any further cases. Poliomyelitis. There were 9 cases of suspected Polimyelitis during the year, 8 of which were notified as such. In three of these the diagnosis was not confirmed. These three unconfirmed cases were in adults. Of the six cases, five devoloped some form of paralysis and one escaped altogether. Follow up of all these patients recently to establish whether they were receiving any treatment which might be necessary revealed the fact that only two had any residual paralysis, and both were attending the St. Helier Physiotherapy Department. There was one death among these cases. More details of these cases are shown in the table set out on page 49. Erysipelas. There were 10 notifications of Erysipelas during the year, 8 of which involved the face. Four occurred in males and six in females. Of the 10 cases notified, 6 were treated at home and 4 received hospital treatment. 47 Ophthalmia Neonatorum. One case was notified during the year; recovery was complete and vision unimpaired. Pneumonia. There were 75 notifications of Pneumonia, of which seventeen were stated to be influenzal in origin. The number of cases notified in the previous year was 74. Puerperal Pyrexia. There were six notifications of Puerperal Pyrexia, giving a rate of 6.28 per thousand births. All these cases occurred in hospital, and 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 22 as compared with 128 in 1949 and 229 in the year before. The details of the attendances during the year are as follows:— Number of cases of Scabies treated 7 Cases of Scabies with concurrent verminous head Cases of Scabies with Secondary Septic Skin conditions Number of cases of verminous heads only 6 Total number of attendances at the Centre 22 48 4^ ANTERIOR POLIOMYELITIS, 1950. Case No. Age. (Years) Hospital to which admitted Date of Onset Returned to Registrar General Confirmed by Hospital Hospital Diagnosis Sequel 1 8 Grove 12/1/50 Yes Yes Ac. Poliomyelitis (Paralytic) Now completely recovered. Patient has no permanent paralysis. 2 18 Wandle Valley 17/7/50 No No Virus Meningitis - 3 23 Western 10/8/50 No No Pyrexia of unknown origin - 4 11 St. Helier 5/9/50 Yes Yes Ac. Poliomyelitis (Paralytic) General health now good, but patient has slight permanent paralysis of deltoid muscle. 5 14 St. Helier 19/9/50 Yes Yes Ac. Poliomyelitis (Paralytic) Died 22/9/50. 6 6 Grove 22/9/50 Yes Yes Ac. Poliomyelitis (Non-Paralytic) Patient now fully recovered. 7 47 St. Helier 6/11/50 No No Not known - 8 3 St. Helier 18/11/50 Yes Yes Ac. Poliomyelitis (Paralytic) Patient now in fairly good health. Has partial facial paralysis—improving rapidly. 9 4 St. Helier 26/11/50 Yes Yes Ac. Poliomyelitis (Paralytic) Patient still has paralysis of left-leg below the knee. Attends hospital for radient heat and exercises. Having iron fitted to left leg. TABLE X. Scarlet Fever — Monthly Distribution. Month Wards Total Abbey Bushey Mead Central Morden Park Ravensbury Raynes Park St. Helier West Barnes January 1 - 3 8 - 3 - 1 1 17 February 1 1 L 4 4 6 2 - 2 22 March - - 1 4 2 5 1 2 1 16 April 3 1 2 2 2 - 1 - - 11 May 1 1 - 5 1 1 1 2 - 14 June - - 1 3 1 3 1 1 3 13 July - - - 1 1 - 1 2 - 5 August 2 1 1 - - - 1 1 - 6 September - - 1 - - - - 2 1 4 October 1 - - 1 2 - - 2 - 6 November - - - 2 1 1 - - - 4 December - - 1 1 - - - 1 - 3 Total 9 4 12 31 14 19 10 14 8 121 Monthly mean 0.75 0.33 1.00 2.58 1.17 1.58 0.83 1.17 0.66 10.07 The incidence in the various wards was as follows:— Wards Cases Incidence per 1,000 population Abbey 9 1.7 Bushey Mead 4 0.5 Central 12 1.0 Morden 31 2.4 Park 14 1.3 Ravensbury 19 2.7 Raynes Park 10 1.2 St. Helier 14 1.3 West Barnes 8 1.0 50 51 TABLE XI. Infectious Diseases, Notifications, Deaths and Distribution, 1950. 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 121 1.60 - - 9 4 12 31 14 19 10 14 8 70 58 % Diphtheria - - - - - - - - - - - - - - - Enteric Fever - - - - - - - - - - - - - - - Meningococcal Infection 1 0.01 - - - - - - - - - - - 1 100% Puerperal Pyrexia 6 0.08 - - - - - - 5 - 1 - - 6 100% Erysipelas 10 0.13 - - - - 1 2 3 - 2 - 2 4 40% Poliomyelitis— Paralytic 5 0.07 1 20% - - 1 1 - - 2 1 - 5 100% Non-Paralytic 1 0.01 - - - - - - 1 - - - - 1 100% Dysentery 1 0.01 - - - - - - - - 1 - - 1 100% Food Poisoning 10 0.13 - - - 1 1 7 1 - - - - 1 10% Ophthalmia Neonatorum 1 0.01 - - - - 1 - - - - - - - - Primary Pneumonia 58 0.77 1 1.7% 1 2 8 12 6 5 9 5 10 - - Influenzal Pneumonia 17 0.22 1 5.9% - 3 3 5 2 1 - 1 2 - - Measles 523 6.91 - - 13 70 151 48 72 51 38 68 12 3 0.57% Whooping Cough 223 2.95 - - 10 25 40 33 22 17 26 24 26 - - 52 TABLE XII. Notification of Infectious Diseases (other than Tuberculosis) by age groups during the year 1950. Disease TOTAL CASES NOTIFIED cases at all ages Under 1 year 1-2 3-4 5-9 10-14 15-24 25-34 35-44 45-64 65 and over Smallpox — — — — — — — — — — — Scarlet Fever — 7 30 66 9 4 4 — — 1 121 Diphtheria (including Membranous Croup) - - - - - - - - - - — Enteric Fever (including Paratyphoid) - - - - - - — — — — — Puerperal Pyrexia - — — - - 2 4 — — — 6 Acute Primary Pneumonia 1 3 2 5 - 3 3 8 17 16 58 Acute Influenzal Pneumonia 1 1 1 2 1 - 2 1 4 4 17 Meningococcal Infection - 1 - - - - - - - - 1 Poliomyelitis— Paralytic - — 2 1 2 - - — — — 5 Non-Paralytic - — — 1 — - - — — — 1 Dysentery - 1 — — — - - — — — 1 Malaria - — — — — - - — — — — Ophthalmia Neonatorum 1 - - - - - - - - - 1 Erysipelas - - — 1 1 - 2 2 3 1 10 Food Poisoning - —- — — 1 1 2 4 2 — 10 Relapsing Fever - — — — — - — — — — — Typhus Fever - — — — — - — — — — — Measles 9 88 153 260 4 6 3 — — — 523 Whooping Cough 12 67 69 68 3 2 2 — — — 223 Totals 24 168 257 404 21 18 22 15 26 22 977 53 TABLE XIII. Monthly Incidence of Infectious Disease, 1950. Disease January February March April May June July August September October November December Total Smallpox - - - - - - - - - - - - — Scarlet Fever 17 22 16 11 14 13 5 6 4 6 4 3 121 Diphtheria - — — — — — — — — — — — - Dysentery - - 1 - - - - - - - - - 1 Meningococcal Infection - - - - - - 1 - - - - - 1 Primary Pneumonia 11 10 — 2 6 3 4 — 2 8 8 4 58 Influenzal Pneumonia 1 4 3 1 1 — 2 — 1 2 — 2 17 Food Poisoning 4 - - - - - 5 - - - 1 — 10 Erysipelas 3 2 1 1 — 1 - — 1 1 — — 10 T.B. Pulmonary 14 11 11 10 11 14 8 6 11 4 15 8 123 T.B. Non-Pulmonary 1 1 — 1 — 2 1 — 1 — — 1 8 Ophthalmia Neonatorum - - - - - - - - - - - - 1 Puerperal Pyrexia — — — 3 1 — — — — 1 1 — 6 Poliomyelitis— Paralytic 1 - - - - - - - 2 — 1 1 5 Non-Paralytic - - - - - - - - - - - - 1 Malaria — — — — — — — — — — — — — Measles 9 16 44 31 28 21 22 13 6 32 59 242 523 Whooping Cough 19 13 6 4 15 9 15 13 18 29 44 38 223 Totals 80 79 82 64 76 63 63 38 48 83 133 299 1108 DIPHTHERIA IMMUNISATION. An increasing proportion of the immunisations are being done by the private practitioners. It will be seen that this year 326 out of a total 682 were so done. Incidentally, the total number of immunisations being done has fallen during the past few years, and while this may to some extent be because the number of births has also fallen it is a position that we must keep constantly under review. A considerable proportion of these immunisations are combined, that is to say, they contain the antigens of both Whooping Cough and Diphtheria. NOTE.—Since this report was written the Medical Research Council have published the report on their investigation and this has provided reliable evidence of the efficacy of Whooping Cough Immunisation. VACCINATIONS. The National Health Service Act, 1946, did away with compulsory vaccination in infancy and our success now depends on the public enthusiasm for the measure as a precaution against Smallpox. During the year the following number of vaccinations were carried out: Vaccinations 549 Re-vaccinations 131 Of the above 450 were vaccinated by Private Practitioners. 438 of these vaccinations were primary vaccinations in infancy. 54 TABLE XIV. Persons Immunised at Clinics during 1950. 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 18 - - - 18 - Bushey Mead 36 — — 1 36 1 Central 40 1 — 1 40 2 Morden 56 6 — 1 56 7 Park 31 1 — 1 31 2 Ravensbury 24 — — — 24 — Raynes Park 42 1 — 2 42 3 St. Helier 62 — — — 62 — West Barnes 38 1 2 2 40 3 347 10 2 8 349 18 TABLE XV. Persons Immunised by Private Practitioners, 1950. 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 13 - - 1 13 1 Bushey Mead 22 1 — 1 22 2 Central 30 2 — 1 30 3 Morden 71 8 1 6 72 14 Park 57 3 4 3 61 6 Ravensbury 16 — — 1 16 1 Raynes Park 44 — — 7 44 7 St. Helier 36 — 2 2 38 2 West Barnes 30 2 - 3 30 5 319 16 7 25 326 41 55 TABLE XVI. Children Immunised in Day Nurseries. Nursery Completed Middleton Road - Morden Road 7 Total 7 TABLE XVII. Number of Children Immunised at Schools, 1950. School Incomplete Completed Primary Single Boosting Injections Bushey County Primary 4 - 238 Poplar Road County „ — — 139 St. Mary's „ „ 1 — 131 Merton Abbey „ „ 4 — 92 Hillcross „ „ - —- 200 Raynes Park „ „ 5 — 153 Morden „ „ 7 — 97 Morden Farm „ „ — — 210 St. Helier No. 1 „ „ 2 — 66 St. Helier No. 2 „ „ 5 — 115 St. Helier No. 3 „ „ 5 — 217 St. Helier No. 4 „ „ 9 — 97 Holy Family R.C. Vol. Primary 3 - 48 Sacred Heart R.C. Vol. Primary 5 — 106 50 — 1909* 'Includes children attending schools in Merton and Morden but resident in other areas:— Boosters 317 56 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 1949 438 310 138 13 899 1950 349 326 — 7 682 TABLE XVIII. Incidence and Fatality of Diphtheria, 1920-1950. 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 1 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 - - 1949 75,470 2 0.02 - - 1950 75.790 - - - - 57 58 TABLE XIX. Diphtheria Immunisation. Number of children 0— 5 years immunised January — June, 1950 413 Number of children 5—15 years immunised January — June, 1950 11 Number of children 0— 5 years immunised July — December, 1950 288 Number of children 5—15 years immunised July — December, 1950 6 Total number of children 0— 5 years immunised during the year 701 Total number of children 5—15 years immunised during the year 17 Number of children 0— 5 years immunised by Private Practitioners during the year 319 Number of children 5—15 years immunised by Private Practitioners during the year 7 Total number of children immunised by Private Practitioners during the year 326 Total number of children immunised in the Clinics during the year 349 Total number of children immunised in the Day Nurseries during the year 7 Estimated percentage of 0— 5 years immunised at end of year 54.81 Estimated percentage of 5—15 years immunised at end of year 85.07 Age Distribution of Immunised Children. Age at 31.12.50 i.e. born in year Under 1 1950 1 2 3 4 5 to 9 10 to 15 Total Immunised Estimated Population 0-5 Estimated Population 5-15 Total Population up to 15 1949 1948 1947 1946 1941-5 1936-40 Number Immunised 25 563 710 903 806 3,724 4,097 10,828 5,486 9,194 14,680 TUBERCULOSIS. One hundred and seventy eight new cases were added to the register of tuberculous persons, compared with 131 in 1949. These additions were: — Males Females Total Pulmonary 92 73 165 Non-Pulmonary 7 6 13 99 79 178 Of these 178, 131 were primary notifications, 42 were transferred from other districts, and 5 came to notice in other ways. During the year 153 persons were removed from the register for the following reasons:— Recovered 12 Removed from the district 89 Death 52 After allowing for the additions and deductions, the number remaining on the register at the 31st December, 1950, was distributed as shown in the following table:— TABLE XX. Tuberculosis Register at 31st December, 1959. Wards Registered at 31st December, 1950. Totals Number on Register at mid-year Pulmonary NonPulmonary Abbey 48 9 57 54 Bushey Mead 63 13 76 72 Central 90 12 102 95 Morden 98 11 109 113 Park 122 20 142 135 Ravensbury 104 26 130 130 Raynes Park 71 8 79 79 St. Helier 166 34 200 197 West Barnes 55 20 75 76 Whole district 817 153 970 951 The provision of treatment and investigation of Tuberculosis is the responsibility of the Regional Hospital Board, the County Council being responsible for the preventive side 59 of the work. Institutional treatment was provided for 120 persons in 1950 from Merton and Morden, as follows:— At the County Sanatorium, Milford 24 At other Institutions 96 120 A table has been prepared which shows in comparison the numbers of new cases for the past 10 years. The primary infections are all cases occurring in the district. The total cases include T.B. cases which have moved into the district and are added to our registers. It will be seen that there has been an increase in the primary notifications of tuberculosis, particularly the pulmonary type. This is probably due to some extent to the greater number of cases coming to light as the result of the work of the Mass Radiography Unit, but none the less it is a matter for some anxiety. TABLE XXI. Tuberculosis 1941-50. Year Primary Notifications Total New Cases Number on Register at end of year Pul. Non-Pul. Total Pul. Non-Pul. Total Pul. Non-Pul. Total 1941 57 13 70 98 18 116 452 101 553 1942 93 14 107 127 24 151 514 112 626 1943 103 18 121 127 24 151 569 128 697 1944 87 10 97 127 13 140 620 133 753 1945 84 20 104 116 23 139 651 146 797 1946 72 13 85 101 18 119 671 147 818 1947 82 14 96 109 21 130 708 153 861 1948 74 11 85 104 15 119 761 161 922 1949 86 6 92 118 13 131 798 160 958 1950 123 8 131 165 13 178 817 153 970 Total 861 127 988 1192 182 1374 — — — Average 86.1 12.7 98.8 119.2 18.2 137.4 — — — The deaths from Tuberculosis during the year number 25, of which 24 were due to pulmonary and 1 to non-pulmonary disease. Five of the deaths were in unnotified cases. 60 The deaths are classified by age and sex in the following table:— TABLE XXII. Deaths due to Tuberculosis, 1950. Ages Years Pulmonary Non-Pulmonary Totals Males Females Males Females 0- - - - - - 1- — — 1 — 1 5- — — — — — 15- 2 1 — — 3 25- — 2 — — 2 35- 4 2 — — 6 45- 3 2 — — 5 55- 4 3 — — 7 65- 1 1 Totals 14 10 1 — 25 No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, which give 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 Committee 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. The Committee again gave considerable financial support to the holiday scheme, and 26 children from this district attended the two camps, held during the year and spent a very enjoyable holiday in ideal surroundings. Twelve relatives were granted the cost of fares to visit patients in hospitals and sanatoria, and four patients were provided with pocket money. Other monetary gifts included grants to two patients for the cost of occupational therapy materials, and to one patient for the cost of a refresher course in shorthand and typewriting. The removal expenses of one patient were paid, 61 another was provided with money for shoe repairs, two married women were granted money to pay their weekly laundry bills, and another was supplied with coal. Several other special grants were made, parcels of secondhand clothing received from individuals and local organisations were distributed to needy families, and in ten cases the Committee purchased Christmas gifts for children. MASS RADIOGRAPHY. Although the Mass Radiography Unit did not hold a session for the General Public within our district during the year, there were, however, several sessions held in surrounding districts, at which, no doubt, many of our residents attended. In addition, sessions were held in the large factory groups in our area, and in these groups alone there were in fact a total of 2,190 attendances. These 2,190 persons would not, of course, all be Merton and Morden residents, but it can be seen from the foregoing facts that, as mentioned previously in this report, the increase in the number of notifications of Pulmonary Tuberculosis is probably due to the greater numbers coming to light through the work of the Mass Radiography Unit. 62 63 TABLE XXIII. 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 - - - - - - - - - 1 1— 5 - 2 1 - - - - - - - 1 — 4 5—10 - - 1 — — — — — — — — — 1 10—15 1 2 1 - - - - - - - - - 4 15—20 15 10 — — 1 3 — 1 — — — — 30 20—25 14 7 — — 2 4 — 1 1 — — — 29 25—35 13 23 — — 10 6 - - - - - - 52 35—45 11 7 — 1 6 4 — — 1 — — — 30 45—55 6 1 1 2 — — 1 1 — 1 — — 13 55—65 7 1 — - — 1 — — — — — — 9 65 and over 2 1 - - 1 — - — 1 — — — 5 Totals 69 54 5 3 20 18 1 3 3 1 1 — 178 V 131 42 5 INDEX PAGE Acreage 7 Ambulance Facilities 25 Acute Poliomyelitis 47, 49, 51-53 Births 10-16 Institutional and Domiciliary 13-15 Rates 16 Premature 24 Cancer—Deaths from 17-20 Rate 19 Cinemas and Licensed Premises 40 Climatic Conditions 8 Clean Food 28, 29 Cleansing Facilities 48 Deaths 16-21 Causes of 17, 18, 20 Rates 16 Diphtheria 45 Immunisation 54-58 By age groups 58 Children immunised in Day Nurseries 56 Children immunised in Schools 56 Persons immunised in Clinics 55 Persons immunised by Private Practitioners 55 Incidence and fatality for 30 years 57 Drainage and Sewerage 30 Drainage work 32 Dysentery 51-53 Erysipelas 47 64 I N D E X-—Continued. PAGE Factories and Workplaces 7, 39, 44 Inspections 39 Defects 44 Food and Drugs Act, 1938 29, 36-37 Food Poisoning 47 Food Supply 29, 32 Inspections 34 Unsound Food 33 Health Services 25 Heart Disease—Deaths from 17-18, 20 Hospitals 27 Hospital Car Service 25 Housing 42-43 Action taken 31, 42, 43 Inspections and Defects 31-32 Number inhabited 7 Overcrowding 42 Ice-Cream 38 Industry 7, 8 Infant Mortality 10, 23, 24 Causes of death 23-24 Rates 10, 24 Infectious Diseases 45-53 Cases admitted to hospital 27, 51 Diseases notifiable 45 Monthly Incidence 53 Notification by Age Groups 52 Notifications, deaths and distribution 51 Inquests 17 Isolation Hospital 27 Mass Radiography 62 Maternal Mortality 22 Rates 10, 22 Measles 46 65 I N D E X-—Continued. PAGE Meat Inspection 34 Mental Disease 28 Milk Supply 34 Mosquitoes 39 National Assistance Act 28 Nelson Hospital 27 Neonatal Deaths 23-24 Notification of Births 12, 13 Nuisances 31 Nursing in the Home 25 Ophthalmia Neonatorum 48 Population 12 Pneumonia 48 Premature Births 24 Public Cleansing 30 Public Health Committee 5 Puerperal Pyrexia 48 Rainfall 8 Rateable Value 7 Rodent Control 40 Respiratory Diseases—deaths from 19 Representatives on:— North-Eastern Divisional Health Sub-Committee 5 Tuberculosis Care Committee 5 Wandle Valley Joint Sewerage Board 5 Rivers and Streams 30 Road Accidents—deaths from 17, 20-21 Sanitary Circumstances 28-30 Sanitary Inspections, Summary of 41 Scarlet Fever 45-46, 50 Incidence in each Ward with rates 50 Monthly distribution of cases 50 Shops Acts, 1912-1936 40 66 I N D E X-—Continued. PAGE Smallpox 27, 45 Smoke Abatement 40 Social Conditions of the Area 7-8 Staff 6 Statistics 8-10 Comparative 11 Stillbirths 24 Tuberculosis 59-63 Admission to Sanatorium 60 Assistance given 61-62 Care Committee 5, 61 Deaths due to 18, 60-61 Dispensary 26 Mass Radiography 62 New cases—by age groups 63 Number on register at end of year 59-60 Vaccination 54 Venereal Diseases 26 Water Courses 39 Water Supply 29 Whooping Cough 47 Zymotic Disease—deaths from 10 Rate 10 67 Printed by RAYNES PARK PRESS, Lambton Road LONDON, S.W.20. Tel. WIM. 1388.