LIBRARY URBAN DISTRICT of MERTON AND MORDEN ANNUAL REPORT of the Medical Officer of Health for the year 1951 AND REPORT OF THE SANITARY INSPECTOR - URBAN DISTRICT of MERTON AND MORDEN ANNUAL REPORT of the Medical Officer of Health for the year 1951 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 1951. The outstanding event of the year affecting those engaged in public health was the 1951 census taken on the 8th April. Reference is made to some of the facts which have emerged from the preliminary report which has been issued, in the text of this report. It will be perhaps of interest here to mention three very important general factors which the census shows to be operating in our population structure; there has been a very great acceleration in the centrifugal movement of population in the Greater London area whereby the process of de-population takes place in the City and Central Metropolitan boroughs and development of new large towns goes on at the periphery. The second fact of general importance is that for the first time the census figures reveal an inward migration of population instead of an outward during the preceding intercensal period, and lastly the third general feature which appears to be of such vital importance to us in many aspects of our work, that at a density of 750 persons per square mile, except perhaps for the Netherlands we are more crowded together here than in any other country in the world. This concentration of population obviously carries with it special problems and risks. In common with the rest of the country we enjoyed a respite this year from epidemic infantile paralysis, the new pestilence that since 1947 has spread a cloud over the summer holiday period which, while the numbers involved are small compared with other infectious diseases,, understandably enough creates widespread anxiety. This epidemic manifestation of poliomyelitis is not entirely new as the level of cases in both the years 1926 and 1938 reached twice the average between 1913 and 1946. The 1947 epidemic, however, reached a level of five times as high as in either of the two previous epidemic years 1926 and 1938 and even in non-epidemic years more cases are notified than in any of the years prior to 1947. 3 As regards other infectious disease the year was notable for an epidemic of measles and whooping cough with, however, a nil mortality. Our infant mortality rate again this year, at 14.94 per thousand or less than half that for England and Wales, justifies special mention. In this connection I feel sure a little essay into past history will be of great interest to you and will serve better than any words of mine to illustrate the advance that has been made in environmental hygiene. I quote from the Medical Officer's report for 1908 : " The infant mortality of a district is largely influenced by summer or epidemic diarrhoea. Although 1 death was registered from epidemic diarrhoea, 2 deaths out of 4 were caused by gastro-enteritis or enteritis in the late summer and early autumn. As soon as the earth temperature, 4 feet below the surface, began to register 56 degrees, a temperature which experience has proved to be associated with the disease, the following pamphlet, approved by the Public Health Committee, was delivered to every house in the District. Merton Urban District Council SUMMER DIARRHOEA IN INFANTS Important Notice Summer diarrhoea in children, specially up to two years of age, is a serious disease, parents ought therefore AT ONCE to consult their doctors on the very outset of the complaint. It is caused by germs which live specially in polluted soil, and gain entrance into the body through the mouth by means of contaminated FOOD, MILK, etc. All yards should, therefore, be kept clean and well flushed. Material liable to decompose should be kept away from the premises. Where possible, all babies under one year are to be nursed. If this is impossible, both the milk and the water with which it is diluted should be boiled just before use. All feeding bottles must be kept scrupulously clean. If comforters are given (which is very inadvisable) they •should be kept soaked in clean water when not in use. Under no circumstances give a child a comforter picked up from the floor without first washing. 4 ALL food and milk should be stored in light, airy places, protected from flies and dust, and away from sinks, drains, etc. Do not keep milk in bedrooms. Water cisterns should be inspected and cleaned out. Fruit and vegetables are to be thoroughly cleaned. No tainted food or over-ripe or unripe fruit should be eaten. Issued by the PUBLIC HEALTH COMMITTEE, MERTON URBAN DISTRICT COUNCIL. The infant mortality rate in our district that year was 48 per thousand (it happened to be low that year; it averaged 72 over the next five years), the infant mortality rate for England and Wales for that year, 1908, was 121 per thousand. It is satisfying to note that our death rate still keeps below the general level, it is not so satisfying to note that our birth rate does the same. Reference has been made in the body of the report to the work of the Food Advisory Committee which, by the enthusiastic energy of successive Chairmen, has maintained a widespread interest in a subject which has not perhaps as much inherent public interest and appeal as we could wish. Reference is also made to the district nursing work in the area, the administration of which has now been made the responsibility of the local Committee. In conclusion I would like to take this opportunity of expressing my appreciation for the interest and encouragement shown in the work of the Public Health Department and of this, its annual record. If I may intrude a. personal note here I would also like to place on record 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. 5 URBAN DISTRICT COUNCIL OF MERTON AND MORDEN 1951. PUBLIC HEALTH COMMITTEE Chairman: Dr. E. H. Kelly, J.P. Mr. L. Clifford. Mrs. L. A. Doel. Mr. S. C. A. Miller. Capt. T. P. Mohide. Mr. A. W. Moore. Mr. S. H. Reeves. Mr. C. S. Marsh (ex-officio). Mr. D. Shadbolt (ex-officio). REPRESENTATIVES ON NORTH-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE Mrs. L. A. Doel. Dr. E. H. Kelly, J.P. Capt. T. P. Mohide. Mr. S. H. Reeves. Mr. S. York. REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD Mr. S. W. Billingham, J.P. Mr. S. York. Mr. E. K. Clarke. Mr. C. S. Marsh (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. P. S. Buck. 6 PUBLIC HEALTH STAFF, 1951. Medical Officer of Health : A. Wallace Johns, M.R.C.S., L.R.C.P., D.P.H. Chief Sanitary Inspector: abed W. T. Pinches, M.R.San.I. Deputy Chief Sanitary Inspector: abcd G. E. Maton (From 1-3-51). Sanitary Inspectors: a b E. Kipping (To 8-4-51). a L. H. Thomas. a b E. N. Montague, D.P.A. (From 1-8-51). a b C. W. Southerby (From 24-9-51). Chief Clerk : A. A. Makepeace. Clerks : R. A. Conolly. Miss D. Martyn. H. J. Herbert. F. H. White. a Sanitary Inspector's Certificate, San. Insp. Exam. Joint Board. b Meat and Food Inspector's Certificate, Royal Sanitary Institute, c Smoke Inspector's Certificate, Royal Sanitary Institute. d Sanitary Science Ceitificate, Royal Sanitary Institute. 7 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 3,238 Number of inhabited houses according to Rate Books 22,037 Rateable value at 31st December, 1951 £683,922 Sum represented by Id. rate £2,760 The Urban District of Merton and Morden lies in the valley of the Thames and is one of the areas of the so-called Outer Ring; that is to say part of Greater London within the Metropolitan police district, outside the Administrative County of London and the City of London, and the area is drained by the River Wandle, the Pyl and Beverley Brooks, tributaries of the Thames. The district is generally flat and sheltered, the whole lying between the 42-ft. and 141-ft. ordnance datum levels. With the exception of a belt of sand or alluvium in the NorthEastern part running through Merton Park, the rest of the district has a subsoil of clay. The area is both residential and industrial and, as has been described before, except for a few factories in the older parts of the area and some unavoidable fringes, industry has been planned so as to occupy three main factory sites, leaving the residential parts of the area generally to enjoy the quietness oi their homes remote from the noise and essential traffic of industry. The residential part of the district is part London dormitory and partly and increasingly occupied by residents engaged in industry or business within the area, but a very large number of workers come into the area daily so that the day-time population concentrated in the factory areas is an important factor to be borne in mind in considering any arrangements for the population of the district. The greater portion of housing of the district is owner occupied, but the Council owns and manages a pre-war housing estate of some 500 houses and has built several large four-storey blocks of flats scattered in various parts of the area to meet the post-war housing need. A considerable part of Morden is formed of the St. Helier L.C.C. housing estate. The area is fortunate in having secured the provision of extensive open spaces, in all amounting to 368 acres, in fourteen 8 different parks, so that there is an even distribution of recreational facilities throughout the area. The National Trust owns 70 odd acres of this land and acquisition of the remaining 290 acres is due to the wisdom and foresight of successive Councils. One of the largest of the parks, Morden Park, has up to the present been preserved as a permanently open natural park, providing our suburban residents with the same amenity enjoyed by rural populations who have the countryside at their back doors. It is a matter of the deepest concern to the Council that a wave of youthful vandalism and ill-behaviour threatens to necessitate the railing in of this beautiful parkland. There were 199 factories on the register at the end of the year,, including several large factories, e.g., the Tri-Ang toy factory employing over 4,000 persons. There are, in fact, three factories employing over 500 persons. Climatic Conditions. Rain gauges are installed at the Joseph Hood Recreation Ground and West Barnes Pumping Station. The monthly recordings are as shown below:— . RAINFALL, 1951. MONTH JOSEPH HOOD RECREATION GROUND WEST BARNES PUMPING STATION Inches Days with 0.01 inch, or more Days with 0.04 inch, or more Inches Days with 0.01 inch, or more Days with 0.04 inch, or more January 3.07 20 15 2.49 23 16 February 5.82 24 19 6.40 26 21 March 3.07 20 17 3.31 22 18 April 2.69 15 13 2.73 15 13 May 2.15 17 11 2.36 19 12 June 1.07 9 5 1.11 9 5 July 1.85 11 6 1.66 9 7 August 2.58 19 11 2.54 21 13 September 3.36 13 10 3.31 15 11 October 0.86 10 6 0.83 10 7 November 5.87 23 20 5.41 23 20 December 2.04 16 12 2.14 16 11 TOTAL 34.43 197 145 34.29 208 154 VITAL STATISTICS. The table of comparative statistics for 1951 on page 12 affords the opportunity to examine the local statistical rates with the corresponding figures for the country as a whole, London County, the County boroughs and large towns and the smaller areas. 9 Considering briefly some of the rates which have acquired a traditional significance as a measure of the health of an area; the deaths from enteritis and diarrhoea under two years of age is nil, the most favourable in the table; our infant mortality figure, 11.73 last year, is 14.94 this year, only just one half of the next most favourable in the table, and our death rate from all causes at 9.58 is again the lowest in the table. Further reference to some of these rates is made in the text in the appropriate sections. 10 SUMMARY OF VITAL STATISTICS. (Registrar General's Figures). Population : Census 74,602 Registrar General's Estimate (MidYear) 74,140 Births : M. F. Total Live (Legitimate) 402 440 842 (Illegitimate) 14 14 28 416 454 870 Stillbirths (Legitimate) 8 3 11 (Illegitimate) — — -— 8 3 11 Total Births 424 457 881 Birth Rate 11.73 per 1,000 population Still Birth Rate 12.48 per 1,000 births Deaths : M. F. Total Total Deaths 371 339 710 Death Rate 9.58 per 1,000 population Infant Mortality : Total deaths under one year 13 Infant Mortality Rate per 1,000 Live Births 14.94 Deaths of Legitimate Infants under 1 year 12 Death Rate per 1,000 Legitimate Births 14.25 Deaths of Illegitimate Infants under 1 year 1 Death Rate per 1,000 Illegitimate Births 35.71 Maternal Mortality : Deaths from Sepsis — Deaths from other maternal causes 1 Maternal Death Rate per 1,000 Total Births 1.13 Zymotic Deaths : Deaths from Measles Nil Whooping Cough Nil Diarrhoea (under 2 years) Nil 7 Principal Zymotic Diseases Nil Zymotic Death Rate (per 1,000 population) Nil Deaths from Tuberculosis : All forms 16 Rate per 1,000 population 0.22 Phthisis : 14 Rate per 1,000 population 0.19 Deaths from Cancer : 147 Rate per 1,000 population 2.0 11 TABLE I. COMPARATIVE STATISTICS, 1951. (Registrar General's Figures with Corresponding Figures for Merton and Morden added). England and Wales 126 County Boroughs and Great Towns including London 148 Smaller Towns (Residential Populations 25.000 to 50,000 at 1931 Census) London AdministrativeCounty Merton and Morden Rates per 1,000 Population Births: Live 15.5 17.3 16.7 17.8 11.73 Still 0.36 0.45 0.38 0.37 0.15 Deaths: All causes 12.5 13.4 12.5 13.1 9.58 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 0.31 0.37 0.31 0.38 0.22 Influenza 0.38 0.36 0.38 0.23 0.30 Smallpox 0.00 0.00 0.00 0.00 0.00 Acute Poliomyelitis (incl. Polioencephalitis 0.00 0.01 0.01 0.00 0.00 Pneumonia 0.61 0.65 0.63 0.61 0.42 Notifications: (Corrected) Typhoid Fever 0.00 0.00 0.00 0.01 0.00 Paratyphoid Fever 0.02 0.03 0.02 0.01 0.01 Meningococcal Infection 0.03 0.04 0.03 0.03 0.03 Scarlet Fever 1.11 1.20 1.20 1.10 2.08 Whooping Cough 3.87 3.62 4.00 3.11 5.23 Diphtheria 0.02 0.02 0.03 0.01 0.01 Erysipelas 0.14 0.15 0.12 0.15 0.13 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 14.07 13.93 14.82 14.64 16.27 Pneumonia 0.99 1.04 0.96 0.72 1.49 Ac. Poliomyelitis : Paralytic 0.03 0.03 0 03 0.02 0.01 Non-Paralytic 0.02 0.02 0.03 0.02 0.00 Food Poisoning 0.13 0.15 0.08 0.23 0.09 Rates per 1.000 Live Births. Deaths: All causes under 1 year of age 29.6† 33.9 27.6 26.4 14.94 Enteritis and Diarrhoea under 2 years of age 1.4 1.6 1.0 0.7 0.00 Rates per 1,000 Total Births (Live and still). Notifications : (Corrected) Puerperal Fever and Pyrexia 10.66 13.77 8.08 14.90 6.81 † Per 1,000 Related Live Births. 12 POPULATION. Census 74,602 Registrar General's estimate, mid-year : All ages 74,140 Children 0-2 inclusive 5,286 Children 5-14 „ 9,212 The 1951 census gives the population of Merton and Morden as 74,602. It is pointed out in the report that these figures are provisional and are subject to confirmation later in the substantive census reports. The Registrar General's midyear estimate for 1951 is 74,140, that is all ages including members of the armed Forces. The natural increase, i.e. the excess of births over deaths for the year is 160, the lowest since 1927. The populations, with births and deaths and the natural increase for the year will be found in Table III on page 18. The census reveals that Merton and Morden, like other areas in the outer ring of London, have grown as the Administrative County of London has diminished in population by a continuous decentralising process. This process during the war, that is since 1939, has been greatly accelerated so that the position today is that the population within the County of London is 3,348,336 or 16% less than in 1939 and, as the Registrar General points out, more than a million less than it was at the 1931 census, a loss in the 20 years equivalent in magnitude to the entire population of Birmingham, our largest provincial town. The effect of this centrifugal dispersal of the population of London on our own population is shown by the fact that we are included in the 27 areas with a gain of population in excess of 50% since the 1931 census; our gain is in fact 81% and in the previous intercensal period was 135.2%. Reproduced on page 14 is an extract from Table IV of the preliminary census report 13 showing the population growths in the Surrey part of the outer ring, which will probably be of considerable local interest. 14 Area in Statute Acres (Land and Inland Water) POPULATION Increase (+) or Decrease (—) per cent, in the Intercensal Period 1921 1931 1951 Persons Persons Males Females Persons Males Females 1921-31 1931-51 OUTER RING 386,977 3,003,859 3,818,670 1,794,185 2,024,485 4,997,801 2,352,835 2,644,966 + 27.1 + 30.9 Surrey (Part of) 95,929 597,222 795,235 363,164 432,071 1,071,311 493,559 577,752 + 33.2 + 34.7 Croydon C.B. 12,672 191,468 233,108 107,496 125,612 249,592 115,317 134,275 + 21.7 + 7 1 Barnes M.B. 2,519 34,299 42,440 18,638 23,802 40,558 18,146 22,412 + 23.7 — 4.4 Beddington and Wallington M.B. 3,045 16,451 26,328 12,030 14,298 32,751 15,094 17,657 + 60.0 + 24.4 Epsom and Ewell M.B. 8,427 22,953 35,231 15,762 19,469 68,049 31,391 36,658 + 53.5 + 93.2 Kingston upon Thames M.B. 1,408 39,514 39,825 18,681 21,144 40,168 18,430 21,738 + 0.8 + 0.9 Maiden and Coombe M.B. 3,164 14,495 23,350 10,636 12,714 45,559 21,082 24.477 + 61.1 + 95.1 Mitcham M.B. 2,932 35,122 56,872 27,825 29,047 67,273 32,414 34,859 + 61.9 + 18.3 Richmond M.B. 4,109 37,105 39,276 17,188 22,088 41,945 18,897 23,048 + 5.9 + 6.8 Surbiton M.B. 4,709 20,149 30,178 13,667 16,511 60,675 28,415 32.260 + 49.8 + 101.1 Sutton and Cheam M.B. 4,338 29,733 48,363 22,065 26,298 80,664 36,885 43,779 + 62.7 + 66.8 Wimbledon M.B. 3,212 61,405 59,515 25,999 33,516 58,158 25,716 32,442 — 3.1 — 2.3 Banstead U.D. 12,821 12,468 18,734 8,536 10,198 33,526 15,224 18,302 +50.3 +79.0 Carshalton U.D. 3,346 13,873 28,586 12,988 15,598 62,804 29,455 33,349 + 106.1 +119.7 Coulsdon and Purley U.D. 11,143 23,115 39,795 17,325 22,470 63,770 28,520 35,250 +72.2 +60.2 Esher U.D. 14,847 27,540 32,407 14,377 17,830 51,217 23323 27,894 + 17.7 + 58.0 Merton and Morden U.D. 3,237 17,532 41,227 19,751 21,476 74,602 35,250 39,352 + 135.2 + 81.0 BIRTHS. 870 live births were registered during the year and 11 stillbirths, giving a total of 881 births. There has been a steady steep fall in the number of births in the past five years since the peak year 1947, when there were 1,345 births. The birth rate is 11.73, the lowest ever recorded. Illegitimate Births. There were 28 illegitimate births, a slight increase over last year, but the illegitimate birth rate would seem to have fallen from the high level of the war and immediate post-war years. The appended table shows the levels since 1937. Year No illegitimate live births Rate per thousand live births 1937 21 25.9 1938 31 31.3 1939 27 26.9 1910 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 1951 28 32.2 INSTITUTIONAL AND DOMICILIARY BIRTHS. The appended tabular statement shows the distribution of births in the area as between the various institutions catering for our mothers :— St. Helier Hospital 419 Nelson Hospital 276 St. Theresa's Hospital 15 Kingston Hospital 13 Other hospitals, institutions and nursing homes 62 785 15 785 out of 881 births took place in hospitals or nursing homes; that is 86.7% of the total births. This is a very high figure and is probably due to the excellent accommodation so conveniently situated within and close to the area. The shortage of general hospital beds and of institutional accommodation for T.B. cases has focussed attention on the increasing bed provision for maternity cases and the justification for the allocation of such a large proportion of hospital accommodation for maternity cases at the present time has been challenged in some quarters. Table II, prepared last year, is reproduced on page 17 as it shows the trend in Merton and Morden since 1935. While there are many aspects of this question these figures suggest that where the best type of accommodation and attention is available mothers themselves at any rate seek institutional accommodation. It used to be argued that as every first confinement is a voyage into uncharted seas, all primipara should be admitted to hospital so that any obstetric procedure which became necessary should be readily available. It is of course true, too, that with the present day small families a higher proportion of the births are first births. The housing situation, too, has reduced the proportion of homes convenient for domiciliary confinements. It is, perhaps, naive to suggest that the solution would seem to lie in the provision of more effective general hospital and special hospital beds. In any case anyone with midwifery experience or a preventive outlook must feel grateful that the day of domiciliary surgical obstetric procedure has gone and must hope that it is gone for ever. 16 17 TABLE II. Numbers and percentages of Institutional births, 1935 -1951. 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 St. Helier Hospital – – – – – – – – 325 335 341 439 468 372 438 419 419 Nelson Hospital 175 194 207 196 230 214 343 305 236 200 216 209 285 289 300 276 276 Kingston Hospital 41 78 91 103 80 94 69 44 43 22 22 18 17 10 9 10 13 Others 105 128 150 251 248 147 81 219 187 221 194 257 282 184 95 78 77 Total Institutional Births 321 400 448 550 558 455 493 568 791 778 773 923 1052 855 842 783 785 Total Births 721 789 812 990 1005 971 848 1069 1146 1151 1027 1261 1345 1087 985 938 881 % of Institutional to Total Births 45% 51% 55% 56% 57% 47% 58% 53% 69% 67% 73% 72% 76% 77% 83% 83% 86% TABLE III. 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 1951 74,602 870 11.73 710 9.58 160 DEATHS. The number of registered deaths after adjustment by transferable deaths, is given below:— 710 total deaths of which 371 were males and 339 females. The seasonal mortality is indicated by the deaths for each quarter of the year, which were:— First quarter 236 Second quarter 164 Third quarter 150 Fourth quarter 160 18 Inquests. Inquests were held on 24 deaths occurring in the district, 9 of which were in respect of residents. The verdicts returned were as follows (1) Accidental Deaths— Collision with motor vehicles 4 Fall at home 2 Injuries received whilst working 2 Coal gas poisoning 2 Fire 2 — 12 (2) Misadventure— Peritonitis 1 Cardiac Inhibition following Enema 1 Air Embolism 1 — 3 (3) Suicide by— Collision with train 2 Diving into shallow stream 1 Hanging 2 Shooting 1 Throat Wound 1 — 7 (4) Open Verdict— Coal Gas poisoning 1 (5) Natural Causes— Chronic Alcoholism 1 24 The total number of inquests held were two less than in the year before. Road accidents were responsible for four of the total accidental deaths,, compared with five for the previous year. 19 CAUSES OF DEATH. There were 710 deaths during the year, of whom 371 were male and 339 female. Disease of the heart, including coronary disease and hypertension with heart disease account for 232 of the 710 deaths, the largest single cause. Cancer of all forms comes next with 147 deaths, that is one in every five deaths was due to cancer. Tuberculosis was responsible for only 16 (the lowest figure since 1928, and at 0.22 per thousand population the lowest rate ever recorded for the district). What is called colloquially a " stroke " accounted for 80 deaths and it is an interesting fact which has been mentioned, perhaps, before that of the 80 deaths due to " stroke " there was a preponderance of females, 47 as against 33, whereas coronary disease seems mainly to affect men: out of 93, 60 were males and only about half as many, 33, were women. Cancer of the lung, which there is reason to believe is showing significant increase, was responsible for 30 deaths, of whom only five were in women. It has been suggested that smoking may be a contributory factor in the causation of this disease and the medical profession has been circularised to complete a questionnaire as to the extent of this habit among its members. Certain mineral oils have been suspected of being carcinogenetic and it would be of interest to know whether the City worker constantly inhaling incompletely burnt diesel oil fume is more liable than the countryman who it is reasonable to assume, up to the present at any rate, is not so exposed. It will be seen from Table, V, page 22, that there were 15 deaths of residents from violence, one a motor vehicle accident, 3 suicides and 11 other accidents. Unfortunately the amendment of the classification precludes the extraction from the Registrar General's list of causes, of the deaths from road traffic accidents which was shown in graph form last year. The graph showing the suicide trend is reproduced on page 23. Reference to page 19 gives details of 24 deaths from violent causes occurring in the district. Ulcer of the stomach and duodenum accounted for 7 deaths, of whom only one was female. The sex distribution and the number follows the pattern of previous years. 20 CANCER DEATH RATE. No. of deaths from Cancer for past 10 years. 1942 103 1947 118 1943 116 1948 110 1944 107 1949 152 1945 116 1950 151 1946 126 1951 147 Year. Death rate per 1,000 population. Year. Death rate per 1,000 population 1942 1.5 1947 1.5 1943 1.7 1948 1.5 1944 1.7 1949 2.0 1945 1.7 1950 2.0 1946 1.7 1951 2.0 TABLE IV. Deaths from Respiratory Diseases, 1932-1951. Year Bronchitis Pneumonia Other Respiratory Diseases Total Death Rate 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 1951 36 31 8 75 1.01 21 TABLE V. Causes of Death during year 1951. No. Cause of Death Males Females Total 1 Tuberculosis, respiratory 10 4 14 2 Tuberculosis, other 1 1 2 3 Syphilitic disease 4 – 4 4 Diphtheria — — – 5 Whooping cough – — — 6 Meningococcal Infections – — – 7 Acute poliomyelitis — — — 8 Measles — — – 9 Other infective and parasitic diseases 1 – 1 10 Malignant neoplasm, stomach 6 12 18 11 Malignant neoplasm, lung bronchus 25 5 30 12 Malignant neoplasm, breast — 15 15 13 Malignant neoplasm, uterus — 10 10 14 Other malignant and lymphatic neoplasms 40 34 74 15 Leukaemia, aleukaemia 3 — 3 16 Diabetes 3 2 5 17 Vascular lesions of nervous system 33 47 80 18 Coronary disease, angina 60 33 93 19 Hypertension with heart disease 13 15 28 20 Other heart disease 50 61 111 21 Other circulatory disease 11 8 19 22 Influenza 8 14 22 23 Pneumonia 17 14 31 24 Bronchitis 26 10 36 25 Other diseases of respiratory system 5 3 8 26 Ulcer of stomach and duodenum 6 1 7 27 Gastritis, enteritis and diarrhoea — 1 1 28 Nephritis and nephrosis 2 2 4 29 Hyperplasia of prostate 10 — 10 30 Pregnancy, childbirth, abortion — 1 1 31 Congenital malformations 7 8 15 32 Other defined and ill-defined diseases 25 28 53 33 Motor vehicle accidents — 1 1 34 All other accidents 3 8 11 35 Suicide 2 1 3 36 Homicide and operations of war — — – Total all causes 371 339 710 22 GRAPH SHOWING DEATHS FROM VIOLENCE AND SUICIDE OVER THE PAST 21 YEARS. 23 MATERNAL MORTALITY. The maternal mortality rate for the year is 1.13, and as a result of the occurrence of one death, our mortality free record for the past three years has been broken. Happily this tragic event has only occurred once before in the past six years. Table VI, below, showing the comparable maternal mortality rates for the past 20 years affords the most striking evidence of the dramatic change which has taken place in the child bearing risk. While this state of affairs is due largely to the discoveries of the brilliant few, improvement in accommodation, improved facilities more readily available and more efficient services, such as Blood Transfusion Organisation, have made their contribution and we would be wise to resist the temptation to place any obstacles in the way of full availability of these facilities in our endeavours to solve other temporary difficulties. TABLE VI. Maternal Mortality, 1932-1951. 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 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 1951 0.19 1.13 0.60 1.13 0.79 24 INFANT MORTALITY. The infant mortality at 14.94 deaths per thousand live births is less than half of that for the whole country. Last year it was 11.73, as far as I am aware the lowest ever recorded anywhere. It may be of interest that in view of the publication in an eminent medical journal of an infant mortality rate of 13.6 per thousand, the editor's attention was then drawn to that of Merton and Morden. For some reason the editor of the journal was of the opinion that the numbers involved were not great enough to express correctly a true infant mortality rate. If we total the births and the infant deaths for the past two years and work out the infant mortality rate for the two-year period we have 1,808 births and a total of 24 deaths, which gives an infant mortality rate of 13.26 on the combined figures, a rate which would seem to merit special attention. The age at death of these infants follows the familiar pattern of previous years. Study of the appended list with the causes reveals that all except two of them were neo-natal deaths, that is to say within the first month of life. Deaths in infants outside the carrying over of damage in child birth and congenital deformities have practically disappeared. Of the 11 neo-natal deaths prematurity figures as a cause in six of them,, over 50%. When we discover and understand the mechanism which starts off labour, and can postpone the starting time in these cases for a few weeks only, our infant mortality rate might even reach new low levels. The reduction in the infant mortality rate from 130 per thousand to below 30 in the past three decades has very largely been achieved by improvement in infant care. Any further reduction has got to come in the neo-natal group, and prevention of premature labour and a lowering of the incidence of the developmental defects offer the obvious field for further progress. Infant Deaths — With causes of death. Sex. Age. Cause of Death. Male 1 week Generalised Toxaemia. Broncho-Pneumonia. Female 5 minutes Prematurity. Female 12 hours Congenital Cardiac Defect. Male 2 days Pneumonia. Congenital Heart Disease. Female 2 weeks B. Coli Meningitis. Large Meningomyelocele. 25 Sex. Age. Came of Death. Female 3 weeks Kernicterus. ABO Blood Group incompatibility. Prematurity. Male 1 day Atelectasis. Prematurity. Male 1 day Extreme prematurity. Female 11 months Congenital Morbus Cordis. Male 2 hours Extreme prematurity. Male 6 hours Atelectasis. Prematurity. Female 3 days Congenital Atresia of Oesophagus. Mongol. Female 3 months Hirschsprungs Disease. TABLE VII. Infant Mortality and Stillbirth Rates for the past 10 years. Year Infant Mortality Rate Stillbirth Rate 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 1951 14.94 12.48 PREMATURE BABIES. There were 60 premature births notified during the year, an increase of 10 over the 1950 figure. Eight of these premature babies failed to survive one month. Below is a summary of the notifications:— (a) At home 7 (b) In hospital 53 The number of those born at home:— (a) Who were nursed entirely at home 6 (b) Who died during the first 24 hours 1 (c) Who survived at the end of one month 6 The number of those born in hospital:— (a) Who died during the first 24 hours 3 (b) Who survived at the end of one month 46 26 SECTION E. — HEALTH SERVICES. NURSING IN THE HOME. General Nursing. At the coming into force of the National Health Service Act, 1946, the responsibility for Home Nursing and the domiciliary midwifery service passed to the Surrey County Council. Up to November of this year the administration of these services had been carried out centrally by the County Health Committee, but that Committee, in view of the fact that the closely related services, e.g. Care of Mothers and Young Children, Health Visiting, Domestic Help, etc., had been delegated to the Divisional Health Sub-Committee, decided that it was appropriate to divisionalise the responsibility for the administration of these services also; the scheme provides for the continuation of the active participation of the Nursing Associations as before. 1. The Merton District Nursing Association employs one full-time and one part-time nurse, as under:— Full-time: Miss Meaton, 233 Cannon Hill Lane. LIB 3119. Part-time (Relief): Mrs. Childs, 14 Carlton Park Avenue. LIB 5679. The Association serves an area approximately the ecclesiastical parish of St. Mary's, that is to say the NorthEastern corner of the district from the Wimbledon and Mitcham boundaries to a line through Martin Way, Crown Lane and London Road to Morden Hall. During the year 210 cases were dealt with, the total number of visits being 3,843. Of this total 8 were children under 5 years of age to whom a total of 27 visits were paid. 2. The St. Helier District Nursing Association employs. two full-time nurses and one part-time nurse for general nursing, as under Full-time : Miss Waite, 141 Green Lane. MIT 1841. Mrs. Wells, 34 Arras Avenue. MIT 4611. Part-time (Relief): Mrs. Randall. The area served by this Association includes the whole of the Merton and Morden part of the St. Helier Estate and a small part of the estate lying in Carshalton and Sutton. 3. The Wimbledon District Nursing Association employs three full-time nurses and one part-time nurse under the direction of the Superintendent, as under :— Superintendent: Miss Willison, 28 Kings Road, S.W.19. LIB 2020. 27 Full-time: Miss Evans, 107 Churston Drive. LIB 1258. Miss Mainwaring, 107 Churston Drive. LIB 1258. Miss Coello, 19 Ethelbert Road. Part-time: Mrs. Talbot, 51 Marina Crescent, New Maiden. The Association serves Wimbledon and the Raynes Park, Grand Drive and Morden Park Estate areas of Merton and Morden. The figures relating to cases and visits during the year are as follows :— Cases. Visits. Children under 5 years 42 170 Other cases 663 10,433 705 10,603 Hospital Car Service. Headquarters—Ambulance Department, County Hall, Kingston. KIN 1050. Local Station—St. Helier Hospital. Fairlands 8893. This service, which owes its development to war-time special need, continues to be of very great benefit in the type of case not able to use ordinary transport and not really needing to be stretcher borne. The use of this service is restricted to cases where the request is made by a medical practitioner. The administration is an essential part of the ambulance service and is under the control of the County Medical Officer. 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 2.0 p.m. 1st Monday in the month at 5.0 p.m. (old cases only). 28 Venereal Diseases. The treatment, both in-patient and out-patient, of venereal disease is the responsibility of the Hospital Board and for our area, this treatment is mainly carried out at the St. Helier Hospital, although both Kingston and Croydon General Hospitals are near enough to serve the area as well. The preventive side of the work, domiciliary visiting of contacts, etc., remains the responsibility of the local health authority and the County 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. HOSPITALS. Smallpox. No change has been made in the arrangements for the prompt isolation of any case of smallpox discovered in the district. The arrangement is that the South-East Metropolitan Regional Hospital Board would provide accommodation at the Joyce Green Hospital, Dartford, where there has always been an experienced medical and nursing staff accustomed to the handling and treatment of this disease. Infectious Disease Hospitals. Cases of infectious disease are admitted to hospitals now under the Regional Boards. Cases from our area mainly go still to the Wandle Valley Hospital, but some go to The Grove, Tooting. As will be seen from the tabular statement on nage 30 (Table VIII), Scarlet Fever provides 29 by far the larger proportion of cases for admission to hospital and by far the greater number of our cases was admitted to Wandle Valley Hospital. There is a trend towards greater home isolation of Scarlet Fever and with the advance and simplification recently achieved in the treatment of this disease and the reduction in complications necessitating surgical measures there seems to be no great need to discourage this development. A comparative table is produced on page 31 (Table IX) to bring out the above features more clearly. TABLE VIII. Cases admitted to Isolation Hospitals during the year 1951. Disease (Final Diagnosis) Wandle Valley Grove Others Cases Deaths Cases Deaths Cases Deaths Scarlet Fever 62 — 8 — 10 — Measles 5 — 1 — — — Pneumonia 2 — — — — — Rubella 1 — — — — — Tonsillitis 1 — — — — — Erysipelas 1 — 1 — — — Meningococcal Infection — — — — 2 1 Diphtheria — — — — 1 — Glandular Fever 1 — — — 72 — 11 — 13 1 30 31 TABLE IX. Cases admitted to Hospitals. Disease Year Scarlet Fever 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 No. of Cases admitted to Hospital — 80 72 113 78 98 95 68 172 189 174 70 81 89 143 115 111 134 295 192 Percentage admitted to Hospital — 52 58 60 69 72 75 59 75 69 76 79 89 90 89 89 87 91 88 88 Total number of cases — 155 121 187 112 137 127 114 231 272 229 88 91 98 161 129 127 149 335 219 It is gratifying to record and to take the opportunity of expressing appreciation of the fact that the same friendly interchange of information and cordial relations between these hospitals and the Public Health Department have continued unimpaired in spite of the administrative upheaval. 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. MENTAL DISEASE. Cases dealt with under the Lunacy Acts, 1890, in the district of Merton and Morden There were 41 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 4 9 13 Delusional Insanity 5 6 11 Suicidal 2 7 9 Schizophrenia 2 2 4 Hallucinated and Depressed — 4 4 Total 13 28 41 Of these cases 15 were certified under Section 16, 5 were placed under observation under Section 20, and 21 were removed to hospital under an Urgency Order under Section 11. In addition 60 patients (22 male and 38 female) were admitted direct to Mental Hospital under Section 1 of the Mental Treatment Act, 1930, as voluntary patients. 32 NATIONAL ASSISTANCE ACT. The National Assistance (Amendment) Act, 1951, came into operation on 1st September, 1951. The Act provides for temporary removal,. without delay, of urgent cases needing care and attention, to whom Section 47 of the principal Act applies. There were no cases during the year in which action under the National Assistance Acts was called for. SECTION C — SANITARY CIRCUMSTANCES. Food Advisory Committee. The Food Advisory Committee was formed in 1950 of members of the Council and representative nominees from all the various trade organisations. During the year the Committee, of which Dr. Kelly was Chairman, was enlarged by co-opting members from various associations and non-industrial organisations to widen the interest and achieve a wider and greater opportunity for dissemination of information regarding the Committee's activities and purposes. In January a film show was arranged for the members of the Women's Organisations in the district. Films on Food Hygiene, etc., were shown. The attendance was 85. In November a Portable Health News Stand (or Poster Display Stand) was purchased from the Central Council of Health Education with a view to arranging exhibitions of posters at stores, libraries, factory canteens, fetes, etc. No such exhibitions were, in fact, held during 1951 owing to the time factor, but several have been held in 1952. Towards the end of the year several schools in the area were approached with regard to showing food hygiene films at the schools, for children during the afternoons and for parents in the evenings. Arrangements were in hand at the end of the year for these shows to be given. A Slogan Competition was organised in November, but final judging did not take place until March, 1952, and this will be reported upon next year. Food and Drugs. 166 samples were submitted to the Public Analyst during the year, of which 16 were reported to be adulterated or not genuine. Details are given in the table on pages 42-43, from which it will also be noted that altogether 33 59 different items were taken for sampling, the principal ones being milk, sausages and ice cream. In addition 71 samples of ice cream and 68 of milk were submitted to the Public Health Laboratory Service for bacteriological examination. Details of these appear on pages 41, 45 and 46 of the report. The Milk (Special Designations) (Specified Areas) Order, 1951, was made by the Minister of Food on 27th July, bringing into operation on the 1st October, 1951, in certain areas including the Urban District of Merton and Morden, Section 19(1) of the Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950. This sub-section relates to the compulsory use of special designations for retail sale of milk. Water Supply. The district is supplied by the Metropolitan Water Board and by the Sutton District Water Company. Their respective distributive areas being approximately the parishes of Merton and Morden. The supply of the Metropolitan Water Board is only sampled infrequently as a routine, otherwise samples are taken when circumstances indicate the necessity for local investigation. The Board supplies copies of their official minutes in which the results of the examinations are recorded. Routine examinations of the Sutton District Water Company's supply are undertaken by the Authorities in the supply area upon an agreed rota, which provides for bacteriological and chemical samples each month. The Company, in addition to the examinations undertaken by their own full-time Chemist, arrange for Consulting Chemists to undertake monthly examinations. Copies of the reports of these Consulting Chemists are received by local Medical Officers of Health whilst the records of the Company's own analyses are available for inspection by the Medical Officers. There are three deep wells in the district, the supplies from which are used mainly for industrial purposes. They are drawn from beneath the London clay. The boreholes vary between 400 ft. and 500 ft. in depth and their capacity between 3,300 galls. and 7,000 galls. per hour. Eight 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 34 periods during the War when shortage of labour caused disorganisation. During the year 15,988 tons of house refuse was collected and disposed of. The salvage tonnage for the year was as follows:— Tons. Tons. Paper 642 Bottles and Glass 171 Metal 628 Rags 74 Pig Foods 924 Drainage and Sewerage. No major extensions to sewers have been carried out during the year, but normal maintenance work has been undertaken. Some minor repair works were carried out to a length of sewer discharging into the West Barnes Pumping Station pump well to prevent infiltration of surface water into the soil sewer. Rivers and Streams. No major works to rivers and streams have been carried out during the year. 35 REPORT OF THE CHIEF SANITARY INSPECTOR. Mr. Chairman, Ladies and Gentlemen, I have pleasure in presenting this Annual Report on the work carried out by your Sanitary Inspectors during 1951. Summary of Sanitary Inspections. Housing—primary visits 790 Re-inspections—work in progress 1088 Re overcrowding provisions 434 Miscellaneous, housing 346 Drainage work 587 Factories and Workplaces 195 Stables and Piggeries 14 Rats and Mice destruction 401 Enquiries—infectious diseases 416 Smoke abatement 34 Food shops, etc. 749 Milk supply 94 Rivers and Streams—pollution 36 Miscellaneous 1,571 Housing continued to be one of the main features in spite of the comparative modernity of the district. The total number Of houses inspected for " sanitary defects " under the Public Health and Housing Acts was 790. Informal action secured improvements to most of the houses, it being necessary to take statutory action in only 62 instances and no legal proceedings were instituted. Action taken in connection with dwelling houses, as set out in the housing tables on pages 50-51, resulted in the following improvements:— Summary of Nuisances Abated and Sanitary Improvements Effected. Ceilings cleansed or repaired 114 Coppers provided or repaired — Dampness in premises remedied 96 Drains exposed and repaired 42 Drains reconstructed 18 Defective sashcords renewed 45 36 Dustbins provided 37 Floors repaired 75 Fresh air inlet valves provided and repaired 3 Inspection chamber covers provided 5 Obstructions removed from drains 74 Rain water pipes renewed or repaired 17 Roofs repaired 90 Gutters repaired 54 Sink wastes repaired 14 Walls repaired 265 W.C. cisterns provided 3 W.C. cisterns repaired 14 Water Closets cleansed 5 W.C. pans provided 13 Windows repaired or renewed 53 Ventilation provided under floors 14 Fireplaces and stoves renewed or repaired 34 Sinks provided 1 Offensive accumulations removed 6 Water supply repaired for domestic use 17 Verminous premises fumigated and cleansed 4 Sanitary accommodation for workshops 1 Miscellaneous 149 Notices Served. Intimation notices 315 Statutory notices:— Public Health Act, 1936 62 Housing Act, 1936 Movable Dwellings. An application was received from the occupier of a lock-up shop for a licence to station a caravan at the rear of the premises to accommodate himself, wife and a girl aged 4 years. All the necessary services, including main drainage, being available a licence for one year was granted. Overcrowding. It was possible in December, 1951, to check all the 301 cases known to the Department and existing from 1950 or before. It was found that 266 cases had been abated, mostly by rehousing by this or the London County Council. 33 further cases were discovered during 1951. 37 The location and type of the cases are as follows:— Merton and Morden Council houses 4 cases L.C.C. estate 40 „ Haig homes 3 „ Privately-owned houses 21 „ 68 Whole houses overcrowded—24 cases. (a) One family occupation 4 cases (b) Two or more related families 16 „ (c) Two or more unrelated families 4 „ Part house overcrowded—44 cases. (a) Unrelated families 9 „ (b) Related families (married sons or daughters) 35 „ 68 Food Supply. The systematic survey of all food shops and catering establishments suffered as a. result of the staff shortage but considerable progress was made during the latter months of the year and it is hoped to complete this survey in 1952. The majority of the shops, works' canteens, etc., were in good condition with adequate food storage, sanitary and washing accommodation, but at 25 premises the following unsatisfactory points were noticed :— W.C. opening direct from food store 1 Drain inlet in food store 1 Inadequate or dirty food store 3 Dirty or defective walls, ceilings, floors, etc. 14 Accumulation of refuse 1 Insufficient waste bins 2 Insufficient washing facilities 9 Defective sanitary accommodation 4 Mouse infestation 5 Displayed food without protection 1 One shopkeeper, proposing to open a cafe-restaurant, sought advice as to the legal requirements and carried out a considerable amount of work at the suggestion of the Department. Such prior notice of the conversion of premises enables them to be brought into a sound hygienic state suitable to the trade concerned before business is commenced, to the mutual advantage of everyone concerned. 38 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 531 lbs. Internal decomposition. 34 lbs. Fibrous proliferation. Mutton 12 lbs. Decomposition. Pork 6 lbs. Bruised. Lamb 203 lbs. Internal Putrefaction. Ox-Kidney 4 lbs. Cloudy swelling. Ham 62 lbs. Decomposition and Bone Taint. Rabbits 120 lbs. Decomposition. Calves Heads 297 lbs. Decomposition. Beef Sausage Meat 76 lbs. Decomposition. Pork Sausage Meat 50 lbs. Decomposition. Fish 60 stone Decomposition. Prawns 17 lbs. Decomposition. Dates 100 pkts. Mouldy. Currants 50 lbs. Maggot Infestation. Vanilla Wafers 52 lbs Sourness of Cream Filling. Marshmallow Biscuits 896 Contamination. Custard Powder 8 pkts. Damaged. Chocolate Cakes 142 Staleness. Ground Ginger 3½ lbs. Deterioration. Figs 26 lbs. Decomposition. Table Jellies 15 Decomposition. Shelled Walnuts 13 lbs. Weevil and Mould. Cake Mixtures 42 pkts. Weevil infestation. Prunes 150 lbs. Mould and insect infestation. Cereals 116 pkts. Deterioration. Weevil infestation. Sultanas 60 lbs. Contamination by Oil. Tea 13½ lbs. Mouldy. Chocolate 58 lbs. Contamination. Weevil infestation. Biscuits 28½ lbs. Mouldy and contaminated. 193 pkts. Staleness and deterioration. Tomato Ketchup 7 bottles Unsound. Tinned Meat, Milk, Fruit, Fish, etc. 10,062 tins Blown, punctured, decomposed, sour, unsound. 39 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. where a cocoanut toffee manufactured in the North of England was found to contain a nail, it was possible to secure the installation of a recently marketed cocoanut sifting machine such as had been installed at a local bakery to obviate similar trouble. Co-operation such as this brings greater reward than mere legal action. 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, on most Sundays throughout the year. Carcases Inspected. Cattle Cows Calves Sheep Pigs Number killed — — — — 119 Number inspected — — — — 119 Number found fit for human consumption 119 Organs condemned. Reason for condemnation. 4 heads Tuberculosis. 1 mesentery and intestines Tuberculosis. 1 liver and stomach Small abscesses. 1 pluck, mesentery and spleen Cirrhosis and pneumonia. Milk Supply. There are no producers of milk registered within the district, but three new distributors were registered during the year for the sale of milk in sealed receptacles only. One dairyman discontinued bottling loose milk and the registration of the dairy was cancelled. Plans for a new dairy and milk processing plant at Morden were submitted by the Express Dairy Co. (London) Ltd. The premises are to be used for the processing and bottling of 60,000 gallons of milk daily with a subsequent distribution throughout the South-West of London. At the time of preparing this report it has become evident that the opening planned for September, 1952, will be deferred at least twelve 40 months, but they will then take up considerable time of your officers in supervising the control of the plant and the finished milk. 90 inspections were made of dairies and milkshops in 1951 and at the end of the year there were on the register 25 distributors and 5 dairies, of which 3 were large distribution depots handling only milk in bottles or sealed drums. 68 samples of milk were submitted for bacteriological examination during the year. 1 " Tuberculin Tested" (Pasteurised) and 3 " Tuberculin Tested " samples failed to conform to the prescribed standards. These results were sent on to the other Food and Drugs Authorities concerned and subsequent samples proved to be satisfactory. The undermentioned licences to use special designations were granted during 1951:— Dealers Licences. Pasteurised 15 Tuberculin Tested 12 Sterilised 17 Supplementary Licences. Pasteurised 19 Tuberculin Tested 17 Sterilised 18 Details of the chemical analysis of milk samples will be found on page 45. 41 Food and Drugs. The following table shows the number and nature of the samples submitted to the Public Analyst in accordance with the Food and Drugs Act, 1938, and his classification of them as genuine or otherwise. Article Total Samples Genuine Not Genuine Aspirin Tablets 1 1 — Baking Powder 1 1 — Brawn 1 1 — Butter 1 1 — Camphorated Oil 1 1 — Chicken, devilled 1 1 — Chutney 1 1 — Cocoa 1 1 — Coffee Essence 1 1 — Coffee, ground 1 1 — Cornflour 1 1 — Cream, synthetic 1 1 — Curd, orange 1 1 — Curry Powder 1 — 1 Custard Powder 1 1 — Dripping 1 1 — Flavouring Essence I 1 — Fish Cakes 1 1 — Flour, self raising \ 1 — Flour, soya 1 1 — Friars Balsam 1 1 — Fruit, bottled or tinned 2 2 — Gees Linctus Pastilles 1 1 — Gelatine 1 1 — Ginger ground 1 1 — Gravy Powder 1 1 — Halibut Oil Capsules 4 3 1 Ham, devilled 1 1 — Ice Cream 20 17 3 Jams 2 2 — Jelly, table 1 1 — Lollies (iced) 1 — 1 Margarine 1 1 — Marmalade 1 1 — Milk 46 44 2 Milk, chocolate 1 1 — Milk, condensed 1 1 — Mincemeat 2 2 — Mineral Waters 2 2 — Mint Sauce 1 1 — Mustard 1 1 — Paste, fish 3 3 — Paste, meat 7 7 — 42 Article Total Samples Genuine Not Genuine Pastry, ready mixed 1 1 — Peas, tinned 2 2 — Pepper Flavoured Compound 1 1 — Quinine with Cinnamon 1 — 1 Saccharine 1 1 — Sardine with Pimiento 1 1 — Sausage, liver 1 1 — Sausages 21 18 3 Sausage Meat 3 3 — Savoury Spread 1 — 11 Soup, tinned 1 1 — Spice, mixed 1 I — Stuffing 1 1 — Sweets 4 4 — Tapioca 1 1 — Tomato Ketchup and Sauce 3 — 3 TOTAL 166 150 16 Action Taken. (a) Curry Powder (1471 Informal). A small canister when opened by the analyst was found to be mouldy. Enquiry from the retailer showed that the rest of the consignment had been sold. A fresh supply was examined and found satisfactory. (b) Halibut Oil capsules (1505 Informal). A vitamin A content of 7950 international units per capsule was found on spectroscopic test, being 32,5% in excess of the minimum stated on the label (" not less than 6,000 i.u. per capsule "). The Analyst objected to such an excessive overage as being unnecessary and bad in principle. The Committee decided to take no action. (c) Ice Cream— (i) (1407 Informal) (1422 Formal). 5% milk solids other than fat instead of 7½%. The manufacturer had misunderstood the new regulation and had since revised his recipe. (ii) (1430 Informal). 5½% milk solids other than fat. Similar results were being obtained by other authorities as this particular manufacturer had a wide area of distribution. Action already taken by a nearby County Borough resulted in alteration of the recipe. (d) Lollies. (1444 Informal) consisted of skimmed milk containing not more than 0.1% milk fat although advertised 43 by the retailer as Pure Milk Lollies. The manufacturer sold them only as milk lollies and the retailer offered an explanation stating that he had only sold them for 2 days before sampling took place. A warning letter was sent. (e) Milk (1351 Informal); 1% deficient in non-fatty solids (only 8.38%). (1367 Formal); 8.47% non-fatty solids. Both samples contained no added water (Hortvet test) and it was probable that the milk was as given by the cow. Subsequent samples from same source genuine. It has been a matter of national note and concern that genuine milk has been showing a reduction of N.F. solids reputedly due to poor feeding due to controlled feeding stuffs. (f) Ammoniated tinture of Quinine B.P. and oil of cinnamon (1479 Informal). Reported to contain excessive quinine as compared with B.P.C. formula. A possibility of the title not being an appropriate designation for the purposes of S.II, Pharmacy and Medicine Act, 1941, was referred to the Pharmaceutical Society who decided it was not a contravention. The manufacturers' attention was drawn to the excess of quinine, but no other action was taken. (g) Sausages— (i) (1391 Informal). Pork sausages with only 40% meat. Owing to supply difficulties a formal sample could not be obtained. (ii) (1495 Informal) Pork sausage, 57% meat. (1501 Formal) Pork sausage, 58% meat. Details of these samples were referred to the local Food Executive Officer who took legal proceedings under Defence Regulations resulting in conviction and fine. (h) Savoury Spread (chocolate) (1490 Informal). The remaining stocks were withdrawn from sale owing to staleness and separation of sugar. (i) Tomato Ketchup— (i) (1463 Informal). Label did not disclose all ingredients of sample. Old stock in warehouse and the wholesaler was advised to re-label. (ii) (1488 Informal) and (1514 Formal), Contained 900 pts. and 480 pts. per million respectively of Benzoic Acid. This was an imported article and stocks were withdrawn and re-exported. The attention of the Ministry was drawn to this matter and taken up with the Dominion concerned. A summary of the fat and not-fatty solids contents of the 44 milk samples is given by the following tables:— 44 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 2 — 13 19 9 1 — — — 44 Milk fat (legal standard is 3.0%). Less than 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 40 4.1 4.2 Total 1 — — 11 12 8 3 4 2 2 1 — — 44 45 Ice Cream. The distribution trade continues to be subject to continual change of retailers and at the end of the year there were 106 dealers a.nd 17 itinerant vendors on the register. One person is registered for the manufacture of ice cream but does so only intermittently, when his other supplies fail. Most of the ice cream sold is pre-wrapped and 71 samples were obtained and submitted for examination with the following results:— No. Provisional Grade Methylene Blue Test Coliform B. Remarks 1 Unsatisfactory' Present 2 1 Satisfactory Absent 3 1 ” ” 4 1 ” ” 5 1 ” ” 0 1 ” ” 7 1 ” ” 8 1 ” ” 9 1 ” ” 10 1 ” ” 11 1 ” Present 12 1 ” ” 13 1 ” Absent 14 15 1 1 ” ” 10 1 ” Present 17 1 ” Absent 18 1 ” ” 19 1 ” ” 20 1 ” ” 21 1 ” ” 22 1 ” ” 23 2 ” ” No. Provisional Grade Methylene Blue Test Coliform B. Remarks 24 1 Satisfactory Absent 25 2 ” ” 26 1 ” ” 27 1 ” ” 28 1 ” ” 29 1 ” ” 30 1 ” ” 31 1 ” Present 32 1 ” Absent 33 1 ” ” 34 1 ” ” 35 1 ” ” 36 3 Unsatisfactory Present 37 1 Satisfactory Absent 38 2 ” ” 39 1 ” ” 40 2 ” ” Faecal coli present after pre-incubation. 41 2 ” Present 42 3 Unsatisfactory ” 43 1 Satisfactory Absent 44 1 ” Present 45 1 ” Absent 46 1 ” Present Faecal coli present 47 1 ” Absent 48 2 ” ” 49 1 ” ” 50 2 ” ” Faecal coli present after pre-incubation. 51 1 ” ” 52 1 ” ” 53 9 ” Present 54 1 ” ” 55 2 ” Absent 56 1 ” ” 57 1 ” Present. 58 1 ” Absent 59 1 ” ” 60 1 ” ” 61 2 ” Present 62 1 ” ” 63 1 ” ” 64 1 ” Absent 65 2 ” ” 66 2 ” ” 67 2 ” Present 68 2 ” Absent 69 1 ” ” 70 3 Unsatisfactory ” 71 2 Satisfactory Present 46 The overall picture continues to show improvement and few qualms need be felt regarding local distribution with a record showing 52 samples (73%) in grade 1, 15 samples (21%) in grade 2 and only 4 samples (6%) in grade 3. Factories and Workplaces. The number of inspections made to premises registered under the Factories Act, 1937, was 102. Defects relating to sanitary conveniences, ventilation and other sanitary matters were dealt with at 11 premises. The table on page 52 gives details of action taken during the year. Water Courses. Regular inspections were made of the water courses in the district, particularly of the River Wan die, and Beverley and Pyl Brooks for the purpose of detecting pollutions. Two instances of pollution were discovered during the year and appropriate action was taken. Mosquitoes. A number of complaints were received from residents and spraying of water courses and ditches was carried out particularly in the vicinity of the Council's recreation grounds and open spaces during the breeding season. A large area of Morden Hall Park remained flooded during the Spring and early Summer resulting in considerable breeding. Difficulty is experienced in monthly spraying with D.D.T. or phenol larvicides as the area is leased by the National Trust for grazing and the area of flooding varies with the weather. The most satisfactory method of control would be the raising of the level of the Park and thus obviating the flooding, particularly as there is some evidence that industrial users downstream are damming back the river and thus contributing to the problem. Rodent Control. 297 complaints of infestation were received during the year and as a result of the inspections of 910 premises, 227 of them were found to be infested. The control method recommended by the Ministry of Agriculture was followed in every case and as a result of 3,640 secondary visits 227 premises were freed from infestation. A 10% test baiting of the Council's sewers was made and 228 manholes were included. The " take " was higher than last year at 2.6% complete and 7.5% partial takes, but still low as is to be expected in a comparatively recently developed area. Two sewer treatments were carried out during the year. In the second treatment part of Abbey Ward was treated, at the request of the Ministry's London office, with bread mash and arsenic, but with a complete absence of takes although previous treatments with Zinc Phosphide had been successful. A free service is provided for householders and has resulted in a ready notification of infestations, which have been taken early and quickly cleared. Most business premises employ their 47 own servicing contractors, but in some cases treatments were carried out by the Department and charged at an agreed rate. A piggery in the district which experiences intermittent re-infestation from open country around was treated as a Research Station by the Ministry with satisfactory results. Smoke Abatement. A number of complaints were received relating to excessive smoke emission from certain factory chimneys. 32 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 Act, 1950. The following statement summarises the inspections made, the infringements discovered and other matters dealt with ditring the year:— No. of Inspections:—Day Visits 172 Evening Patrols 5 Day Patrols 26 Infringements:— 1. Evening closing hours 2 2. Half-day closing 1 3. Hours of employment for young persons 4. Seats not provided for females 5. Prescribed notices not correct or exhibited 9 6. Sanitary arrangements unsatisfactory 1 7. Reasonable temperature not maintained — Merchandise Marks Acts. The Council are empowered to enforce the requirements of these Acts as far as the marking of imported foodstuffs is concerned and the Sanitary Inspectors enforce these provisions during their routine visits. The exemption from marking granted during the war was revoked in May, except for butter, and public notice of the changes was given in the local Press. Shopkeepers, generally, make a due compliance with the Orders and only two informal warnings were needed. Filling Materials. During 1951, the Rag Flock and Other Filling Materials Act was passed and came into operation on 1st November. Three local manufacturers of stuffed toys and perambulators, etc., applied for and were granted registration. 48 The Act provides for the keeping of records of filling materials received and used and also for the sampling for cleanliness tests of the many and varied substances covered by the Act. No samples were taken during November or December, 1951, although arrangements were made for such sampling in 1952, in view of the world-wide sale of articles by the local toy-makers. I would like to express my gratitude for the support of the Chairman and members of the Public Health Committee and the encouragement of the Medical Officer of Health during a time when the sanitary administration of the district was difficult, and to record my thanks to the District Inspectors who worked so diligently pending the filling of the two vacant posts. I am, Ladies and Gentlemen, Your obedient Servant, W. T. PINCHES, Chief Sanitary Inspector. August, 1952. 49 SECTION D. — HOUSING. Housing and Overcrowding. During the year 96 new houses were built in the Urban District, 75 by the Council, 16 by other Local Authorities and 5 by private builders. In addition, 4 houses were rebuilt, all by private builders. 552 eligible applications for rehousing were received by the Housing Manager during the year; 20 houses and 78 flats were allocated to tenants during this period. By the end of the year the number of outstanding applications had increased to 3,409. Arising out of rehousing enquiries, 49 complaints of overcrowding were received. Of these, 33 were found to be overcrowded within the standards laid down by the Housing Act, 1936. Detailed inspections and reports to the Public Health and I rousing Committees were made on 99 houses in the Abbey Ward in order to enable consideration to be given as to the best method of dealing with them in the proposed re-development scheme in that area. The housing situation in Merton and Morden may be gathered from the following facts:— 1. Inspection of Dwelling Houses during the year:— i. (a) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) 790 (b) Number of inspections made for the purpose 790 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 315 50 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 273 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) Bylocalauthority in defaultof owners — B.—Proceedings under Public Health Acts:— (i) Number of dwellinghouses in respect of which notices were served requiring defects to be remedied 62 (ii) Number of dwellinghouses in which defects were remedied after service of formal notices:— (a) By owners 66 (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 38-47). 51 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 \V ritten Notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and ti are to be enforced by Local Authorities 15 10 1 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authoritv 182 87 6 - (iii) Other Premises in which Section 7 is enforced by the Local Authoritv 2 5 - - Total 199 102 7 — 52 2. Cases in which defects were found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied To H.M. Inspector By H.M. Inspector Want of cleanliness (S,l) 1 1 - - - Overcrowding (S.2) - - — - — Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) - - - - — (a) Insufficient - 1 - - — (b) Unsuitable or defective 10 10 - - - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) - - - - - Total 11 12 — — — SECTION F — INFECTIOUS ILLNESS. Notification. During the year two fresh sets of regulations came into force. The Puerperal Pyrexia Regulations, 1951, replacing and amending the previous Regulations, came into operation on the 1st August, 1951. The main need for amendment has arisen because the present potency of therapeutic, agents is such that cases of infection were so rapidly being brought under treatment that they never became notifiable as it was necessary under the old Regulations for the temperature to be sustained for 24 hours or recur during that period within 21 days after childbirth. Under the new Regulations any temperature of 100.4 or more within 14 days of childbirth becomes notifiable. The Public Health Leprosy Regulations, 1951, came into force on the 22nd June, 1951. Leprosy is a rare disease in this country and it is almost invariably contracted abroad, often in the service of the Crown. History has created a quite unjustifiable fear of the degree of infectivity of this disease. The notification of the disease will serve to bring to the sufferers now the best possible medical attention and the full benefit of recent advances in the treatment. Also, although the risk of spread is negligible in this country it will afford the opportunity to reduce ttill further even this small risk. The following diseases are now notifiable in the district:— Acute Encephalitis Leprosy (Infective) Malaria Acute Encephalitis Measles (Post-Infectious) Meningococcal Infection Acute Poliomyelitis Ophthalmia Neonatorum (Paralytic) Plague Acute Poliomyelitis Pneumonia, Primary (Non-Paralytic) Pneumonia, Influenzal Cholera Puerperal Pyrexia Continued Fever Relapsing Fever Diphtheria (including Scarlet Fever membranous Croup) Smallpox Dysentery Trench Fever Enteric Fever (including Typhus Fever paratyphoid fevers) Tuberculosis (all forms) Erysipelas Whooping Cough Food Poisoning Smallpox. There were no cases during the year. There was one case of chicken pox in which the possibility of smallpox 53 Was called into question. The diagnosis of chicken pox was subsequently and expeditiously confirmed by a report from the Central Public Health Laboratory on the pathological examination of material from a scraping from a scab. Contacts of Smallpox — surveillance. Maintenance of supervision over- contacts coming into the district had to be carried out in two cases during the year. These were contacts with a case of smallpox on the S.S. "Strathmore" which arrived in Tilbury on the 12th February from Sydney via Bombay. A girl aged 12 embarked at Bombay on the 26th January and became ill on the 28th with suspected smallpox. The contacts were kept under surveillance for the prescribed 16 days. Scarlet Fever. There were 155 cases of Scarlet Fever notified during the year, giving a case rate of 2.08 per thousand population. 75 were nursed at home—48% of the total. The disease was of mild type and reference has been made in the section on Infectious Disease Hospitals on page 30 to the fact that there seems to be diminution in the extent of admission to hospital for this disease. 52% of cases only were so isolated, the lowest percentage on record as a table reproduced in that section shows. 110 of the cases were school children, 10 of these from schools outside the district, 8 were adults and 37 in children under school age. Reference to the table on page 61 shows the ward distribution of the incidence. It will be seen that over a quarter of all the cases during the year came from the Morden Ward. Various parts of the area from time to time seem to suffer the heaviest incidence. In 1944, for example, 102 (or half of all the cases) came from the St. Helier Ward. West Barnes Ward, which had a total of only 7 cases in the three years 1945, 1946 and 1947, had 62 cases in the immediately preceding three years 1942, 1943 and 1944. There are probably several factors operating to produce this result; the first and most important is probably population structure. In the years when particular wards are heavy contributors there is a high child proportion in the population. The other important factor which is probably playing an important part is herd immunity—the level of protection of the group, and as the disease is for practical purposes confined to children this means the level of immunity which the children as a group have achieved. It will be seen that a year or two of high incidence is generally followed by a few years of. low incidence, the immunity level of the group having been raised. 54 The three schools shown below provided 30% of the total cases, the other schools had generally only a single figure level of incidence:— Bushey Infants 20 Morden Farm Infants 16 Raynes Park Infants 15 Total 51 One of the difficulties in school control is still that cases are not detected and isolated early enough. Eight cases this year again were actually in school on the day the rash came out. Paratyphoid B. There was one case of paratyphoid during 1951. Four days prior to onset the lady concerned had returned to England from holiday in France and Italy. The last place she could remember staying was Santa Margharita, Italy, but at the time she was febrile and was not very clear about which particular places she was at at particular dates. However, the source was evidently outside England. Blood culture grew paratyphoid B. She was treated with Chloromycetin and the temperature subsided to normal within 48 hours and she had no further symptoms. She had three negative stools and was discharged well, within three weeks of admission. Poliomyelitis. With regard to the country as a whole, the year 1951 was a non-epidemic year and there was one case in the district notified and one death. Prior to this in 1948, the previous non-epidemic year, we had 8 cases. In the epidemic year of 1947 there were 22 cases, although there were no deaths. The one case this year was in a child of two who was a nonresident. He was admitted to hospital in the district and as the diagnosis was made in the hospital the case was, of course, allocated to this area. The child unfortunately did not recover and the certified cause of death after post-mortem was Polioencephalitis. 55 She was admitted to hospital and there the diagnosis was confirmed by agglutination tests and blood culture. Agglutinations S. Typhosa 0 S. Para B. 0 31.7.51 Agglutinations H Titre 1/1250 0 „ 1/500 to S. Para B. 10.8.51 The numbers in different years contributing to the total have come from different parts of the country. In the epidemic of 1947 the northern region had the highest notification rate whereas in 1948, although prevalence was much lower, Greater London contributed rather more heavily in cases. The number of cases occurring in the area since 1943 is set out below. It can be seen that up to 1947 the disease was rare. There had, however, previously been two years of high prevalence. In 1926 and 1938 the annual number of cases in England and Wales was double the average level for the other years. Since it is established that the virus is capable of intestinal spread, flies, railway tracks, etc., have been suggested as essential links. It has, of course, long been recognised that the disease has a seasonal incidence with a peak in late summer. In view of the probability of intestinal spread it may be of some significance that this is the period of abundance of uncooked fruit and vegetables. Cases of Poliomyelitis since 1943. 1951 1950 1949 1948 1947 1946 1945 1944 1943 1 6 12 8 22 2 2 — 1 Whooping- Cough. There were 390 cases of Whooping Cough during the year and again the mortality from this disease is nil. On page 57 is a table which shows the trend of this disease in our area over the past 45 years. Unfortunately we have not got records of the numbers of cases in the years up to 1930, but it is felt worth while including the-se years as they show the number of deaths and the age distribution. Subsequent to 1930 the figures are available from the school returns and from 1940 onwards the numbers are of notified Whooping Cough, as the disease became notifiable in October, 1939. These figures would appear to show that while there is a very great increase in incidence since 1938 there has been a correspondingly great decrease in the mortality. Out of 1,869 cases over the past seven years there has been only one death. The same thing has happened with measles as a glance at the table on page 58 will show. This phenomenon may be due to a reduction in virulence of the disease, but it is an established fact that malnutrition was a most potent contributory factor to the mortality from infectious disease among children and there has been a noteworthy improvement in this factor over the whole country; the suburban children have, perhaps, a better nutritional standard than either the rural areas or the big cities. 56 WHOOPING COUGH TABLE. Year No. of Deaths Age group of deaths No. of Cases Under 1 year Over 1 & under 2 years Over 2 & under 5 years Over 5 & under 15 years 1908 - - - - - 1909 — - — 1910 — — — — 1911 4 — 2 1 1 1912 1 - — 1 — 1913 3 1 1 — 1 1914 1 1 — - - 1915 — — — — — 1919 — — — — — 1920 — — — — — 1921 3 3 — — — 1922 1 1 — — — 1923 1 1 — — — 1924 — — — — — 1925 4 1 2 — 1 1926 — — — — — 1927 1 — — 1 — 1928 — — - - — 1929 1 1 - - — 1930 3 1 1 1 — 7 1931 1 Age not given — over 1 year 96 1932 2 1 1 over 1 year 57 1933 2 1 1 over 1 year 129 1934 I — Over 1 vear 76 1935 1 1 — — — 87 1936 — — — - — 106 1937 2 1 — 1 — 81 1938 — — — — — 44 1939 — — — — — 275 1940 — — — — — 110 1941 1 1 — — — 409 1942 — — — - — 182 1943 1 1 — - — 252 1944 3 3 — - — 183 1945 — — — - — 77 1946 — - — — — 238 1947 1 1 — - — 232 1948 — — — - — 378 1949 — — — - — 331 1950 — - — — — 223 1951 — - - - - 390 Measles. Measles reached epidemic level during the year. There were 1,214 cases during the year and, as reference to the table reproduced below will show, this is the highest number in any year for which we have records. The disease was, however, mild and, except for dislocation of school attendance., does not appear to have had any serious consequences. There were no deaths. 57 The epidemic started in the winter of the previous year, from 6 cases in September, 32 in October, 59 in November; the numbers had risen to 242 in December, 1950, and had reached the peak figure of 280 in January, 1951. Thereafter the numbers remained high until April (266) and then rapidly petered out. The course of events is brought out clearly in Table XIII on page 64. INCIDENCE OF MEASLES 1932 -1951. Year Cases Deaths Population Remarks 1932 418 2 48,550 School children only 1933 14 — 52,130 included — disease 1934 523 6 55,550 not being notifiable. 1935 5 — 57,440 Figures based on 1936 586 4 61,000 returns from Head 1937 86 — 65.530 Teachers 1938 403 — 68,980 1939 5 — 72,150 1940 459 1 68,540 1941 539 — 64.920 1942 936 — 66,880 1943 433 1 66,590 1944 252 1 62,760 Whole population 1945 760 - 66,050 cluded from 1940 1946 568 — 73,590 when disease 1947 347 — 75,290 came notifiable. 1948 1,049 — 75,220 1949 721 — 75,470 1950 523 — 75,790 1951 1,214 74,602 Diphtheria. There were two cases of throat infection where the possibility that the diagnosis might be Diphtheria had to be considered. In one case it was ultimately accepted that it was Diphtheria, The case of Diphtheria was a nasal infection in a child 2½ years of age, with apparently a secondary throat involvement. The bacteriological results were to some extent conflicting, the first swab result being negative, the second showed a mitis type; the third showed a gravis: type and the fourth was again negative. The second case was in a child of four who had been immunised in infancy. He was not regarded clinically as a case of Diphtheria, but a swab from the thoat showed Diphtheria organisms. Further bacteriological results showed that the organisms were avirulent and atypical. 58 Food Poisoning. There were two outbreaks of food poisoning in canteens which were the subject of special detailed reports during the year. The first occurred in June and the second in December. In the June outbreak there were 352 cases out of 1,540 exposed. The clinical picture was that of an attack of diarrhoea coming on nine to ten hours after consuming the mid-day meal, with absence of vomiting or collapse, the severity of the diarrhoea varying from one or two stools to five or six and in one or two cases more or less continuous diarrhoea throughout the night. This outbreak presented two particular features which are, perhaps, worthy of record. The suspected article of food was minced beef which was made up into a galantine. The interesting point, however, was that it so happened that 190 lbs. of minced beef was delivered to the canteen and 20 lbs. of it not required was returned to the butcher. It was possible then to some extent to compare the fate of the 20 lbs. sent back, which was retailed to the public and prepared by domestic methods. There were no casea of food poisoning as far as we could discover caused by the domestic preparation of the same minced beef. The other interesting find was that the organism incriminated was CI. Welchii. The other outbreak, which occurred in December, produced 171 cases out of a total of 972 exposed. The clinical picture was of a mild diarrhoea with abdominal pain coming on 8-16 hours after consuming the meal, with absence of vomiting or collapse. The suspected meal was stewed steak and gravy and as in the preparation of the gravy flour was added it would have been gratifying to have been able to demonstrate an inoculation of the gravy with soil organisms in the flour, e.g., Welchii, as it is at leact conceivable when the manufacture and origin of flour is considered that this is a possibility. However, the laboratory were only able to grow a few ccliform organisms on blood agar from the specimens of flour sent. Faecal swalxs grew staphylococcus in three of the cases. In both these outbreaks we have the familiar two-stage preparation of the meal as the precipitating factor. There were seven other cares occurring as isolated cases or in family groups. In two of them which occurred singly and separately Salmonella Typhi Murium was isolated from the faeces. In one of these cases, a man of 43, there was a history of duck eggs having been consumed at 5.30 a.m. on the day of onset. Onset occurred at midnight with vomiting and abdominal pains. He was admitted to hospital and an appendicectomy performed, and subsequent bacteriological examination confirmed the presence of Salmonella Typhi Murium. The origin of the ducks eggs was traced back through 59 the local retailer to the wholesaler in Smithfield, but pursuit to the farm was impossible. Erysipelas. There were 10 notifications of Erysipelas during the year, all of which involved the face. Six occurred in males and four in females. Of the 10 cases notified, 7 were treated at home and 3 received hospital treatment. Ophthalmia Neonatorum, Two cases were notified during the year; recovery was complete and vision unimpaired in both instances. Pneumonia. There were 111 notifications of Pneumonia, of which forty-four were stated to be influenzal in origin. The number of cases notified in the previous year was 75. Puerperal Pyrexia. There were six notifications of Puerperal Pyrexia, giving a rate of 6.81 per thousand births. All these cases occurred in hospital, and the patients recovered. CLEANSING STATION. There was a slight increase in the number of attendances at the Cleansing Station during the year, the total being 38 as compared with 22 in 1950. The details of the attendances during the year are as follows:— Number of cases of Scabies treated 15 Cases of Scabies with concurrent verminous head- Cases of Scabies with Secondary Septic Skin conditionsNumber of cases of verminous heads only 9 Total number of attendances at the Centre 38 60 TABLE X. Scarlet Fever — Monthly Distribution. Month Wards Total Abbey Bushey Mead Central Morden Park Ravensbury Raynes Park St. Hcher West Barnes January 2 - 4 2 3 1 1 - - 13 February 1 — 1 1 2 — — 1 1 7 March - — 1 7 1 1 — 2 — 12 April - 1 — - 1 - 1 — — 6 May - 1 3 2 — 4 — — — 10 June - — 1 4 — 1 2 3 1 12 July - 1 1 6 — - 3 — 3 14 August - — 1 6 1 1 — — - 9 September - - - 2 — - 1 — — 3 October - 3 - - 2 1 2 2 1 17 November 2 14 2 2 3 1 4 5 2 35 December — 1 3 - I - 4 2 3 17 Tota1 5 21 17 44 14 10 18 15 11 155 Monthly mean 0.42 1.75 1.42 3.66 1.17 0.83 1.50 1.25 0.92 12.92 The incidence in the various wards was as follows:— Wards Cases Incidence per 1,000 population Abbey 5 0.9 Bushey Mead 21 2.5 Central 17 1.5 Morden 44 3.4 Park 14 1.3 Ravensbury 10 1.4 Raynes Park 18 2.1 St. Helier 15 1.3 West Barnes 11 1.4 61 62 TABLE XI. Infectious Diseases, Notifications, Deaths and Distribution, 1951. Disease Cases Notified Case Bate 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 Eaynes Park St. Helier West Barnes Smallpox - - - - - - - - - - - - - - - Scarlet Fever 155 2.08 — - 5 21 17 44 14 10 18 15 11 80 51.6% Diphtheria 1 0.01 - - - - - - - - - - - 1 100% Paratyphoid Fever 1 0.01 - - - - - 1 - - - - - 1 100% Meningococcal Infection 2 0.03 1 50% 1 — - - - - - - 1 2 100% Puerperal Pyrexia 6 0.08 — — 1 — — — 4 — — 1 — 6 100% Erysipelas 10 0.13 — — — 1 3 — 3 — 1 2 - 3 30% Poliomyelitis:— Paralytic 1 0.01 1 100% — — — — 1 — - — — 1 100% Non-Paralytic — 0.00 - - - - - - - - - - - - - Dysentery 22 0.29 — - — — — 2 7 7 4 1 1 2 9% Food Poisoning 7 0.09 — — — — — 3 — — 1 3 — 1 14% Ophthalmia Neonatorum 2 0.03 - - - - - - - - - 1 - - - Primary Pneumonia 44 0.59 1 2.3% — 4 6 13 3 2 4 9 3 — — Influenzal Pneumonia 67 0.90 1 1.5% 1 4 12 7 5 4 11 6 17 — — Measles 1214 16.27 - - 43 74 135 341 120 99 156 110 136 6 0.5% Whooping Cough 390 5.23 - - 22 32 75 102 21 43 30 33 32 - - 63 TABLE XII. Notification of Infectious Diseases (other than Tuberculosis) by age groups during the year 1951. Disease TOTAL CASES NOTIFIED Total cases at all ages Under 1 year 1-2 3-4 5-9 10-14 j 15-24 25-34 35-44 45-64 65 and over Smallpox - - - - - - - - - - - Scarlet Fever 1 6 35 99 3 7 3 1 — — 155 Diphtheria (including Membranous Croup - 1 - - - - - - - - 1 Enteric Fever (including Paratyphoid - - - - - - - 1 - - 1 Puerperal Pyrexia — — — — — 4 2 — — — 6 Acute Primary Pneumonia - 2 - 3 3 4 7 7 14 4 44 Acute Influenzal Pneumonia 1 1 4 1 1 4 8 26 21 67 Meningococcal Infection - - - - - - 1 - 1 - 2 Poliomyelitis: — Paralytic — 1 — — — — — — — -— 1 Non-Paralytic — — — — — — — — — — — Dysentery 1 4 4 5 — 2 3 — 2 1 22 Malaria — — — — — — - - - - -— Ophthalmia Neonatorum 2 - - - - - - - - - 2 Erysipelas — — — — -— 1 — — 5 4 10 Food Poisoning — — — — 1 — 1 2 3 — 7 Relapsing Fever — — — -— — — — — — — — Typhus Fever — — — — — — — — — — — Measles 32 261 405 490 13 7 5 1 .— -_ 1214 Whooping Cough 21 69 121 162 5 2 8 2 — — 390 Totals 58 345 569 759 26 28 34 22 51 30 1922 64 TABLE XIII. Monthly Incidence of Infectious Diseases, 1951. Disease January February March April May June July August September October November December Total Smallpox - - - - - - - - - - — - — Scarlet Fever 13 7 12 6 10 12 14 9 3 17 35 17 155 Diphtheria — — — — — 1 — — — — — — 1 Dysentery 1 1 5 6 7 - - - - - 1 1 22 Meningococcal Infection 1 - - 1 - - — — — — - - 2 Primary Pneumonia 4 2 6 4 6 3 3 3 — 4 4 5 44 Influenzal Pneumonia 35 16 4 3 2 — — — — 3 3 1 67 Food Poisoning — — — 2 1 3 — — — — 1 — 7 Erysipelas — 1 1 3 — — 1 — — — 1 3 10 T.B. Pulmonary 4 6 11 12 10 7 11 9 8 11 19 10 118 T.B. Non-Pulmonary — — 1 1 — 1 1 — — 1 1 2 8 Ophthalmia Neonatorum - 1 - - 1 - - - - - - - 2 Puerperal Pyrexia 1 — — 2 — — — 1 — - — — 6 Poliomyelitis:— Paralytic 1 - - - - - - - - - - - 1 Non-Paralytic - - - - - - - - - - - - - Malaria - - - - - - — - — - - - - Measles 280 248 229 266 133 31 13 12 — 2 — — 1214 Whooping Cough 81 58 43 43 21 53 37 23 8 13 3 7 390 Paratyphoid Fever - - - - - - - 1 - - - - 1 Totals 421 340 312 349 191 111 80 58 19 53 68 46 2048 DIPHTHERIA IMMUNISATION. From the tables on pages 68 and 69 it will be seen that there were 476 new immunisations done in the clinics; 308 done by private practitioners, 13 in schools and 7 in the day nurseries, a total of children immunised for the first time of 804. This compares favourably with last year's figure of 682, especially bearing in mind that the greater part of the material available, i.e., the 1950 live births were down compared with the material for last year—the 1949 births—by 47. Expressed as a percentage of the 1950 live births the figure is 85.7%, which is a great improvement. It will be seen that 45 children received booster injections in the clinics and 94 by medical practitioners, while 1,537 booster injections were given in the schools. The latter figure includes 277 children attending our schools from other areas. As will be seen by Table XIX on page 69, it is estimated that not less than about 56% of our under-fives are immunised and 86% of the over-fives. The strip table at the bottom of page 69 shows the age distribution of the immunised children at the time the return was made. It does not mean that only 41 children were immunised before reaching 1 year of age. Emphasis on this point is perhaps justified as attention is being focussed on the percentage of immunisation carried out before the first birthday. As far as this is concerned our figures are as follows :— No. of children immunised in 1951 804 Age groups at time of immunisation:— Under 1 year 377 (46.9%) 1-2 years 320 (39.8%) Over 2 years 107 (13.3%) Total 804 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 696 Re-vaccinations 369 Of the above, 761 were vaccinated by Private Practitioners. 518 of these vaccinations were primary vaccinations in infancy. 65 TABLE XIV. Persons Immunised at Clinics during 1951. 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 34 - 2 - 36 - Bushey Mead 51 2 1 3 52 5 Central 61 4 1 7 62 11 Morden 71 2 1 4 72 6 Park 64 4 1 4 65 8 Ravensbury 55 1 1 — 56 1 Raynes Park 38 2 — 3 38 5 St. Helier 54 — — 2 54 2 West Barnes 41 6 1 41 7 469 21 7 24 476 45 TABLE XV. Persons Immunised by Private Practitioners, 1951. 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 10 — 1 2 11 2 Bushey Mead 24 1 1 5 25 6 Central 39 10 1 6 40 16 Morden 64 9 5 18 69 27 Park 38 1 — 12 38 13 Ravensbury 15 1 — 2 15 3 Ravnes Park 46 5 — 10 46 15 St. Helier 35 — — 3 35 3 West Barnes 28 1 1 8 29 9 299 28 9 66 308 94 66 TABLE XVI. Children Immunised in Day Nurseries. Nursery Completed Middleton Road - Morden Road 7 Total 7 TABLE XVII. Number of Children Immunised at Schools, 1951. School Incomplete Completed Primary Single Boosting Injections Bushey County Primary 2 — 207 Poplar Road County „ — — 65 St. Mary's „ ., — 62 Merton Abbey „ „ — - 56 Hillcross „ „ — - 185 Raynes Park „ 5 - 130 Morder „ „ — — 62 Morden Farm „ „ - 13 297 St. Helier No. 1 „ „ 1 — 77 St. Helier No. 2 „ „ - - 71 St. Helier No. 3 „ „ 3 — 98 St. Helier No. 4 „ „ - - 87 Holy Family R.C. Vol. Primary - - 66 Sacred Heart R.C. Vol. Primary 3 - 74 14 13 1,537* *Includes children attending schools in Merton and Morden but resident in other areas:— Boosters 277 67 The number immunised since the inauguration of the Public Clinics in 1934 is as follows:— At Clinics By Doctors In Schools At Day Nnrseries 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 1951 476 308 13 7 804 TABLE XVIII. Incidence and Fatality of Diphtheria, 1920-1951. 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 — — — — 1951 74,602 1 0.01 - - 68 69 TABLE XIX. Diphtheria Immunisation. Number of children 0— 5 years immunised January,— June, 1951 411 Number of children 5—15 years immunised January— June, 1951 21 Number of children 0— 5 years immunised July— December, 1951 366 Number of children 5—15 years immunised July— December, 1951 12 Total number of children 0— 5 years immunised during the year 777 Total number of children 5—15 years immunised during the year 33 Number of children 0— 5 years immunised by Private Practitioners during the year 299 Number of children 5—15 years immunised by Private Practitioners during the year 9 Total number of children immunised by Frivate Practitioners during the year 308 Total number of children immunised in the Clinics during the year 476 Total number of children immunised in the Day Nurseries during the year 7 Estimated percentage of 0— 5 years immunised at end of year 55.90 Estimated percentage of 5—15 years immunised at end of year 86.65 Age Distribution, of Immunised Children. Age at 31.12.51 i.e. born in year Under 1 1951 1 1950 2 1949 3 1948 4 1947 5 to 9 1942-6 10 to 15 1937-41 Total Immunised Estimated Population 0-5 Estimated Population 5-15 Total Population up to 15 Number Immunised 41 563 721 722 908 | 3,864 4,118 10,937 5,286 9,212 14,498 TUBERCULOSIS. One hundred and sixty-one new cases were added to the register of tuberculous persons, compared with 178 in 1950. These additions were:— Males Females Total Pulmonary 74 78 152 Non-Pulmonary 4 5 9 78 83 161 Of these 161, 126 were primary notifications, 33 were transferred from other districts, and 2 came to notice in other ways. During the year 106 persons were removed from the register for the following reasons:— Recovered 18 Removed from the district 65 Death 23 After allowing for the additions and deductions, the number remaining on the register at the 31st December, 1951, was distributed as shown in the following table:— TABLE XX. Tuberculosis Register at 31st December, 1951. Wards Registered at. 31st December, 1951. Totals Number on Register at mid-year Pulmonary NonPulmonary Abbey 56 9 65 62 Bushey mead 71 12 83 77 Central 09 11 110 104 Morden 101 10 111 106 Park 128 18 146 138 Ravensbury 117 24 141 131 Raynes park 77 8 85 77 St. Helier 172 31 203 200 West Barnes 61 19 80 73 Whole district 882 142 1,024 968 70 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 of the work. Institutional treatment was provided for 151 persons in 1951 from Merton and Morden, as follows:— At the County Sanatorium, Milford 18 At other Institutions 133 151 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 eases include T.B. cases which have moved into the district and are added to our registers. It will be seen that the primary notifications of tuberculosis, particularly the pulmonary type, are still well above average. As stated before, 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. TABLE XXI. Tuberculosis 1942-51. Year Frimary Notifications Total New Cases No. on Register at end of year Pul. Non Pul. Total Pul. Non-Pul. Total Pul. Non-Pul. Total 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 1943 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 1951 118 8 126 152 9 161 882 142 1024 Total 922 122 1044 1246 173 1419 - — Av'ge 92.2 12.2 104.4 124.6 17.3 141.9 - - — The deaths from Tuberculosis during the year number 16, of which 15 were due to pulmonary and 1 to non-pulmonary disease. Two of the deaths were in unnotified cases. 71 The deaths are classified by age and sex in the following table:— TABLE XXII. Deaths due to Tuberculosis, 1951. Ages Years Pulmonary Non-Pulmonary Totals Males Females Males Females 0— - - - - - 1— — . — — — — 5— — — 1 — 1 15— — 1 — — 1 25— 1 — — — 1 35— 3 1 — — 4 45— 5 — — — 5 55— 1 1 — — 2 65— 1 1 — — 2 Totals 11 4 1 — 16 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. This Committee continues its valuable work in supplementing the provision of care and after care for the victims of this disease, which so often carries with it distressing economic and social penalties. The Tuberculosis Care Committee mitigates these in numerous ways and takes into consideration the special needs of individual patients and their families, albeit in the strictest possible confidence. I am indebted to the Secretary for details of the work done in Merton and Morden and if space permitted I would like to have reproduced this admirable report in full. For any who would like detailed information, a copy of the report can readily be obtained from the Chairman, Secretary or other officers of the Committee, whose names appear on the fly-leaf of this report. The sources of income available to this Committee are limited, and drawn from the Sunday Cinema Fund, grants from the Surrey County Council and donations from charities, guilds, churches, charitable firms and individuals, and the annual sale of Christmas seals this year raised £146 18s. 3d. 72 The Committee uses these funds to improve conditions for individuals and families. It gives financial support to the Children's Holiday Camp, which provides a holiday for child contacts, and provides various domestic equipment on loan. It provides pocket money allowances to patients in hospital or sanatoria who are not eligible for National Health Insurance benefit or grant from the National Assistance Board or whose families have no income other than that supplied from these sources. It assists with fares for relatives to visit patients in hospital or sanatoria and provides raw materials in certain cases for home industry and has a scheme for assisting with the marketing of the manufactured goods. It also elfects a most invaluable liaison between the patient and the unfamiliar complicated system of agencies which the State has set up to carry out its statutory schemes. MASS RADIOGRAPHY. The Mass Radiography Unit visited this district during the year and was set up at the Baptist Hall, Crown Lane, Morden, for three weeks during October. 73 I am indebted to Dr. Walters, the Medical Director of the Mass Radiography Centre of the South-West Metropolitan Regional Hospital Board, for the following summary of the findings of the Unit:— Male Female Total number examined 1,439 2,374 Pulmonary Tuberculosis, Active 4 7 „ „ Inactive 49 62 Non-tuberculous abnormalities. Congenital abnormalities of bonythorax 7 11 Emphysema 16 2 Bronchiectasis 4 3 Pleural changes 22 8 Interlobar effusion 1 — Acquired cardiovascular lesions 2 8 Miscellaneous (i.e., old fractures, postoperative changes, etc.) 6 2 Cases not yet diagnosed 18 6 It is pointed out that as the service is available to all members of the general public the above figures probably include some persons living outside our area. 74 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 N on-Pulmonary M F M F M F F M F M F 0— 1 - - - - - - - - - - - - - 1— 5 2 1 - - - - - - - - - - 3 5—10 2 4 1 — - - — — — — - — 7 10—15 1 3 — 1 — 1 — - —- — — — 6 15—20 16 7 1 1 - 1 — - - - - - 26 20—25 9 15 1 - 3 - - - - - - - 35 25—35 7 14 1 1 8 5 - 1 - - - - 37 35—45 8 12 - — 2 2 - - 1 — - - 25 45—55 6 3 - 1 1 1 - - - - - - 12 55—65 6 — — 1 - — - — 1 — —. 8 65 and over 1 1 - - - - - - - - - - 2 Totals 58 60 4 4 15 17 — 1 1 1 — — 161 126 33 2 INDEX. PAGE Acreage 8 Ambulance Facilities 28 Acute Poliomyelitis 55, 56 Births 11, 12, 15-18 Institutional and Domiciliary 15-17 Rates 11, 12, 18 Premature 26 Cancer—Deaths from 20-22 Rate 21 Cinemas and Licensed Premises 48 Climatic Conditions 9 Clean Food 33 Cleansing Facilities 60 Deaths 18-23 Causes of 20, 22 Rates 11, 12 Diphtheria 58, 65-69 Immunisation 65-69 By age groups 69 Children immunised in Day Nurseries 68 Children immunised in Schools 67 Persons immunised in Clinics 66 Persons immunised by Private Practitioners 66 Incidence and fatality for 30 years 68 Drainage and Sewerage 35 Drainage work 36 Erysipelas 60 75 INDEX—Continued. PAGE Factories and Workplaces 47, 52 Inspections 52 Defects 52 Food and Drugs Act, 1938 33, 34, 42-4.) Food Poisoning 59 Food Supply 38-47 Inspections 38 Unsound Food 39 Health Services 27-32 Heart Disease—Deaths from 20, 22 Hospitals 29-32 Hospital Car Service 28 Housing 36-38, 50, 51 Action taken 36, 37, 50, 51 Inspections and Defects 36, 50, 51 Number inhabited 8 Overcrowding 37, 38, 50 Ice-Cream 45-47 Industry 8-9 Infant Mortality 25-26 Causes of death 25-26 Rates 26 Infectious Diseases 50-64 Cases admitted to hospital 29-31 Diseases notifiable 53 Monthly Incidence 64 Notification by Age Groups 63 Notifications, deaths and distribution 62 Inquests 19 Isolation Hospitals 29-30 76 INDEX—Continued. PAGE Mass Radiography 73 Maternal Mortality 24 Rates 24 Measles 57, 58 Meat Inspection 40 Mental Disease 32 Merchandise Marks Acts 48 Milk Supply 40, 41 Mosquitoes 47 National Assistance Act 33 Nelson Hospital 32 Neonatal Deaths 25 North-Eastern Divisional Health Sub-Committee 6 Notification of Births 15 Nuisances 36, 37 Nursing in the Home 27-28 Ophthalmia Neonatorum 60 Pneumonia 60 Poliomyelitis 55, 56 Population 13 Premature Births 26 Public Cleansing 34-35 Public Health Committee 6 Puerperal Pyrexia 60 Rainfall 9 Rateable Value 8 Respiratory Diseases—deaths from 21 77 INDEX—Continued. PAGE Representatives on:— North-Eastern Divisional Health Sub-Committee 6 Tuberculosis Care Committee 6 Wandle Valley Joint Sewerage Board 6 Rivers and Streams 35 Road Accidents—deaths from 19 Rodent Control 47-48 Sanitary Circumstances 33-51 Sanitary Inspections, Summary of 36 Scarlet Fever 54-55, 61 Incidence in each Ward with rates 61 Monthly distribution of cases 61 Shops Act, 1950 48 Smallpox 29, 53-54 Smoke Abatement 48 Social Conditions of the Area 8-9 Staff 7 Statistics 9-12 Comparative 12 Vital 11 Stillbirths 26 Tuberculosis 70-74 Admission to Sanatorium 71 Assistance given 72, 73 Care Committee 6, 72, 73 Deaths due to 72 Dispensary 28 Mass Radiography 73 New eases—by age groups 74 Number on register at end of year 70 78 INDEX—Continued. PAGE Vaccination 65 Venereal Diseases 29 Vital Statistics 11 Wandle Valley Joint Sewerage Board 6 Water Courses 47 Water Supply 34 Whooping Cough 56, 57 Zymotic Disease—deaths from 11 Rate 11 79 Printed by J. B. BLACKMORE & CO., LTD., 85, Merton High Street, London, S.W.19. Tel. LIBerty 3411-2.