MER 14 URBAN DISTRICT of MERTON AND MORDEN ANNUAL REPORT of the Medical Officer of Health for the year 1952 AND REPORT OF THE CHIEF SANITARY INSPECTOR URBAN DISTRICT of MERTON AND MORDEN ANNUAL REPORT of the Medical Officer of Health for the year 1952 AND REPORT OF THE CHIEF 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 the year 1952. The health of the district remains good and the vital statistics reproduced within the following pages show, by all recognised standards, the health of the population of the district can compare favourably with that of all the towns available for comparison and with the country as a whole. While these facts are dealt with at some length in the body of the report it may be permissible here to mention those regarded as most indicative of ,a healthy environment. The death rate per thousand population stands at 9.4 as compared with 11.3 for England and Wales. Our infant mortality rate is 17.3 deaths per thousand live births compared with 27.6 for England and Wales, and our deaths of infants from enteritis and diarrhoea is nil as compared with 1.1 for England and Wales. Further, we are able to record that we have had no maternal death. Each year generally brings at least one outstanding event with which it is subsequently associated and often identified for long periods of time; the plague year, the cholera outbreak, the Broad Street pump epidemic, the influenza pandemic of 1918, also the year 1947 in which for the first time we were attacked in this country by the virus of poliomyelitis on a scale hitherto unknown; it may well be that 1952 will not be less famous than these because of the London Smog in December of that year. Even now the full extent of the disaster is only dimly appreciated and it is recorded that the deaths in London during the week ending 13th December had only been equalled on two previous occasions in the past 100 years. We ,are included in the Metropolitan police area, our staffs are accepted as metropolitan for purposes of London Weighting. During the period we shared to the full the Metropolitan atmosphere and we were not among those to experience the 3 fog but escape the toxic factor as some more peripheral of our neighbours seem to have done. The records which establish these facts will be found in the tables and text of this report, to which I should now refer you to avoid the sin of duplication. Attention has been drawn in the text of the report to deaths from accidents in the home. Though these are few in number in our own area it is none the less a surprising fact that more people meet their deaths accidentally in the home than on the roads. We are so bombarded with statistics that we may almost have become conditioned into a state of unreceptivity and these figures relate to fatal accidents. What of the train of permanent disability and disfigurement not recorded at all in published statistics; the personal tragedies the perpetual reminder of avoidable crippling? In the hope of reducing these tragedies efforts are being made to arouse the public conscience. In conclusion I should like to thank the Chairman and members of the Public Health Committee for their helpful cooperation and the staff of the department for the efficiency with which they have carried out their duties. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, A. WALLACE JOHNS, Medical Officer of Health. 4 URBAN DISTRICT COUNCIL OF MERTON AND MORDEN 1952. PUBLIC HEALTH COMMITTEE Chairman: Mrs. L. A. Doel. Mr. M. H. Rurrin. Mr. J. H. Johns. Mr. W. J. Crisp. Mr. A. W. Moore. Mr. C. Hayden. Mr. J. Wynn. Mr. Gr. H. R. Martin (ex-officio). Mr. P. Hill (ex-officio). REPRESENTATIVES ON NORTH-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE Mr. W. G. C. Blackwell, O.B.E. Mr. F. W. Walker. Mr. L. Clifford. Mr. S. York. Mr. S. H. Reeves. REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD Mr. S. W. Billingham, J.P. Mr. S. York. Mr. E. K. Clarke, J.P. Mr. G. H. R. Martin (ex-officio). MERTON AND MORDEN TUBERCULOSIS CARE COMMITTEE Chairman: Mrs. M. E. Shaw, Vice-Chairman: Mrs. F. Spruce. Secretary: Miss M. P. Morriss. Treasurer: Mr. F. S. Buck. 5 PUBLIC HEALTH STAFF, 1952. 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: abed G. E. Maton Sanitary Inspectors: a b E. N. Montague, D.P.A. a b C. W. Southerby. a L. H. Thomas. 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 Certificate, Royal Sanitary Institute. Chief Clerk : A. A. Makepeace. Clerks: R. A. Conolly. Miss D. Martyn. H. J. Herbert. F. H. White. 6 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 3,238 Number of inhabited houses according to Rate Books 22,139 Rateable value at 31st December, 1952 £688,531 Sum represented by 1d. rate £2,805 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. Merton and Morden is an industrial town. This fact has been emphasised in previous reports as it is felt that its dormitory reputation might obscure this fact. it is estimated that 20,000 people are employed in industry in our area, and this fact is impressed upon one by the huge crowds emerging from the factory estate every evening holding up vehicular traffic in the Morden Road. 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, 1952. 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 1.79 16 14 1.61 17 12 February 1.01 11 8 1.13 13 9 March 3.29 19 12 3.48 20 16 April 1.32 13 10 1.46 14 12 May 1.81 12 10 2.84 13 12 June 2.38 11 10 1.86 11 10 July 0.65 4 3 0.70 4 4 August 3.08 15 11 1.99 15 11 September 3.39 16 13 3.35 19 13 October 2.64 14 14 2.66 18 12 November 3.10 17 12 3.23 17 8 December 2.30 19 14 2.88 22 16 TOTAL 26.76 167 131 27.19 183 135 7 VITAL STATISTICS A table comparing the vital statistics for England and Wales, London, the County Boroughs and small towns is set out on page 10 and our figures are added for purpose of comparison. Our figures are generally more favourable than any of the others in the table, but one exception merits examination— deaths from tuberculosis. Up to the present year, ever since deaths from tuberculosis have been included in the comparative figures, our mortality has been the lowest in the table, as the following analysis shows: Year England & Wales 126 County Boroughs 148 Smaller Towns London Merton & Morden 1952 0.24 0.28 0.22 0.31 0.31 1951 0.31 0.37 0.31 0.38 0.22 1950 0.36 0.42 0.33 0.39 0.33 1949 0.45 0.52 0.42 0.52 0.39 1948 0.51 0.59 0.46 0.63 0.46 It may be significant that our figure for 1952 is exactly the same as that for the County of London and five of the excess deaths occurred in the two weeks following the Smog. Also, in seeking to discover the reason for this increase, the interesting fact came to light that the number of tuberculosis persons moving into the district during this year was 20 more than normal. The total of 53 inward transfers is the highest ever recorded. 8 SUMMARY OF VITAL STATISTICS. (Registrar General's Figures). Population: Registrar General's Estimate (MidYear) 73,670 Births: M. F. Total Live (Legitimate) 435 406 841 (Illegitimate) 19 9 28 454 415 869 Stillbirths (Legitimate) 8 10 18 (Illegitimate) — — — 8 10 18 Total Births 462 425 887 Birth Rate 11.8 per 1,000 population Still Birth Rate 20.3 per 1,000 births Deaths: M. F. Total Total Deaths 363 327 690 Death Rate 9.4 per 1,000 population Infant Mortality: Total deaths under one year 15 Infant Mortality Rate per 1,000 Live Births 17.3 Death of Legitimate Infants under 1 year 15 Death Rate per 1,000 Legitimate Births 17.8 Deaths of Illegitimate Infants under 1 year — Death Rate per 1,000 Illegitimate Births — Maternal Mortality: Deaths from Sepsis — Deaths from other maternal causes — Maternal Death Rate per 1,000 Total Births — Zymotic Deaths: Deaths from Measles Nil Whooping Cough Nil Diarrhoea (under 2 years) Nil 7 Principal Zymotic Diseases 2 Zymotic Death Rate (per 1,000 population) 0.03 Deaths from Tuberculosis: All forms 23 Rate per 1,000 population 0.31 Phthisis: 22 Rate per 1,000 population 0.29 Deaths from Cancer: 154 Rate per 1,000 population 2.1 9 TABLE I. COMPARATIVE STATISTICS, 1952. (Registrar General's Figures with Corresponding Figures for Merton and Morden added). England and Wales 160 County Boroughs and Great Towns (including London) 160 Smaller Towns (Residential Populations 25,000 to 50,000 at 1951 Census) London Administrative County Merton and Morden Rates per 1,000 Population Births: Live 15.3 16.9 15.5 17.6 11.8 Still 0.35 0.43 0.36 0.34 0.24 Deaths: All causes 11.3 12.1 11.2 12.6 9.4 Typhoid and Paratyphoid fevers 0.00 0.00 0.00 — 0.00 Whooping Cough 0.00 0.00 0.00 0.00 0.00 Diphtheria 0.00 0.00 0.00 0.00 0.00 Tuberculosis 0.24 0.28 0.22 0.31 0.31 Influenza 0.04 0.04 0.04 0.05 0.07 Smallpox 0.00 — — — 0.00 Acute Poliomyelitis (incl. Polioencephalitis 0.01 0.01 0.00 0.01 0.03 Pneumonia 0.47 0.52 0.43 0.58 0.35 Notifications: (Corrected) Typhoid Fever 0.00 0.00 0.00 0.00 0.00 Paratyphoid Fever 0.02 0.02 0.03 0.01 0.00 Meningococcal Infection 0.03 0.03 0.03 0.02 0.01 Scarlet Fever 1.53 1.75 1.58 1.56 2.23 Whooping Cough 2.61 2.74 2.57 1.66 3.77 Diphtheria 0.01 0.01 0.03 0.01 0.00 Erysipelas 0.14 0.15 0.12 0.14 0.18 Smallpox 0.00 0.00 0.00 — 0.00 Measles 8.86 10.11 8.49 9.23 6.66 Pneumonia 0.72 0.80 0.62 0.57 0.90 Ac. Poliomyelitis : Paralytic 0.06 0.06 0.06 0.06 0.09 Non-Paralytic 0.03 0.03 0.02 0.03 0.03 Food Poisoning 0.13 0.16 0.11 0.18 0.04 Rates per 1,000 Live Births. Deaths: All causes under 1 year of age 27.61 31.2 25.8 23.8 17.3 Enteritis and Diarrhoea under 2 years of age 1.1 1.3 0.5 0.7 0.00 Rates per 1,000 Total Births (Live and still). Notifications: (Corrected) Puerperal Pyrexia 17.87 23.94 25.8 23.8 15.8 † Per 1.000 Related Live Births. 10 POPULATION. Registrar General's estimate, mid-year73,670 The Registrar General's estimate of the population of this district on 30th June, 1952, was 73,670 as compared with the 1951 census figure of 74,602. This shows a decrease of 932 despite the fact that the natural increases for 1951 and 1952 were 160 and 179 respectively. It is perhaps of interest that the natural increase, which showed a steady decline from 734 in 1947 to 160 in 1951, has for the first time since 1947 shown a rise over the previous year's figure. BIRTHS. 869 live births were registered during the year, which, together with the 18 stillbirths, gave a total of 887 births. The figure for live births was one less than that for 1951 but the rate was higher, 11.8 as compared with 11.7. It would appear that the birth rate is now steady after its gradual decline from 17.86 in 1947. The number of illegitimate births was 28, with a rate of 32,2 per thousand live births, exactly as last year. The appended table gives the figures since 1937. Year No illegitimate live births Rate per thousand live births 1937 21 25.9 1938 31 31.3 1939 27 26.9 1940 29 29.9 1941 40 47.2 1942 39 36.5 1943 57 49.7 1944 49 42.6 1945 63 61.3 1946 45 35.7 1947 38 28.3 1948 42 38.6 1949 37 37.5 1950 23 24.5 1951 28 32.2 1952 28 32.2 11 INSTITUTIONAL AND DOMICILIARY BIRTHS. The appended tabular statement shows the distribution of births in our area as between the various maternity departments:— St. Helier Hospital 408 Nelson Hospital 266 St. Teresa's Hospital 26 Kingston Hospital 11 Other Hospitals, institutions and nursing homes 65 776 Seven hundred and seventy six births took place in hospitals or nursing homes out of a total of 887; that is 87% of the total births were institutional as compared with 89% for 1951. A table is reproduced on page 13 giving the general picture since 1935. 12 13 TABLE II. Numbers and percentages of Institutional births, 1935 -1952. 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 St. Helier Hospital - - - - - - - - 325 335 341 439 468 372 438 419 419 408 Nelson Hospital 175 194 207 196 230 214 343 305 236 200 216 209 285 289 300 276 276 266 Kingston Hospital 41 78 91 103 80 94 69 44 43 22 22 18 17 10 9 10 13 11 Others 105 128 150 251 248 147 81 219 187 221 194 257 282 184 95 78 77 91 Total Institutional Births 321 400 448 550 558 455 493 568 791 778 773 923 1052 855 842 783 785 776 Total Births 721 789 812 990 1005 971 848 1069 1146 1151 1027 1261 1345 1087 985 938 881 887 % of Institutional to Total Births 45% 51% 55% 56% 57% 47% 58% 53% 69% 67% 73% 72% 76% 77% 83% 83% 89% 87% 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 7.2 189 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 1952 73.670 869 11.8 690 9.4 179 DEATHS. The number of registered deaths after adjustment by transferable deaths, is given below:— 690 total deaths of which 363 were males and 327 females. The seasonal mortality is indicated by the deaths for each quarter of the year, which were: — First quarter 180 Second quarter 169 Third quarter 110 Fourth quarter 231 14 Inquests. Inquests were held on 22 deaths occurring in the district, 12 of which were in respect of residents. The verdicts returned were as follows:— (1) Accidental Deaths— Collision with motor vehicles 5 Collision with train 2 Fall at home 2 Asphyxia due to inhalation of stomach contents 1 10 (2) Misadventure- Deaths following operations 3 3 (3) Suicide by— Coal gas poisoning 4 Shooting 1 Morphine poisoning 1 Barbiturate poisoning 1 7 (4) Natural causes— Chronic Alcoholism 1 Silico-Tuberculosis 1 2 22 The total number of inquests held were two less than in the year before. Road accidents were responsible for five of the total accidental deaths, compared with four for the previous year. 15 CAUSES OF DEATH. There were 690 deaths during the year, of whom 363 were male and 327 female. The largest single cause of death was once again heart disease (208), including coronary disease, angina and hypertension with heart disease. Cancer came next with 154 deaths, and with a rate of 2.1 per thousand population gives us the highest ever recorded in the district. Of this total, 35 were deaths from cancer of the lung, which once again shows an increase. As usual, there w.as a preponderance of males in this group. Pulmonary tuberculosis caused 22 deaths as compared with 14 last year, but, as has been pointed out elsewhere in this report, the London "Smog" in December was partly to blame for this increase. The other significant increase in the table was in group 33, motor vehicle accidents, which rose from 1 death in 1951 to 7 in 1952. There was only one death which can be attributed to accidents in the home. This subject is of such importance that it is dealt with separately in the text. The 1952 report on deaths in the London area would not be complete without some reference to the catastrophe of the early December fog, which has become known as the 'Smog'. Its effect can be measured by the rise in deaths for the week ending 13th December, the week following the fog, which lasted five days. There were 35 deaths compared with five for the corresponding week for the previous year. Deaths from respiratory diseases rose from 2 for the week ending 6th December to 13 for the week of the fog and in the following week, out of a total of 12 deaths registered 9 were due to respiratory diseases From the 22 deaths from respiratory diseases registered during these two weeks 11 actually occurred whilst the fog persisted, which seems a fair indication of its essential toxic nature. Transferable deaths are not included in these figures. 16 CANCER DEATH RATE. No. of deaths from Cancer for past 10 years. 1943 116 1948 110 1944 107 1949 152 1945 116 1950 151 1946 126 1951 147 1947 118 1952 154 Year. Death rate per 1,000 population. Year. Death rate per 1,000 population. 1943 1.7 1948 1.5 1944 1.7 1949 2.0 1945 1.7 1950 2.0 1946 1.7 1951 2.0 1947 1.5 1952 2.1 TABLE IV. Deaths from Respiratory Diseases, 1933-1952 Year Bronchitis Pneumonia Other Respiratory Diseases Total Death Rate 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 1952 31 26 6 63 0.85 17 TABLE V. Causes of Death during 1952 No. Cause of Death Males Females Total 1 Tuberculosis, respiratory 15 7 22 2 Tuberculosis, other 1 — 1 3 Syphilitic disease 3 1 4 4 Diphtheria — — — 5 Whooping cough — — — 6 Meningococcal Infections — — — 7 Acute poliomyelitis 1 1 2 8 Measles — — — 9 Other infective and parasitic diseases 1 — 1 10 Malignant neoplasm, stomach 13 6 19 11 Malignant neoplasm, lung bronchus 29 6 35 12 Malignant neoplasm, breast 2 14 16 13 Malignant neoplasm, uterus — 6 6 14 Other malignant and lymphatic neoplasms 47 31 78 15 Leukaemia, aleukaemia 1 1 2 16 Diabetes 1 1 2 17 Vascular lesions of nervous system 30 57 87 18 Coronary disease, angina 68 31 99 19 Hypertension with heart disease 13 10 23 20 Other heart disease 28 58 86 21 Other circulatory disease 8 14 22 22 Influenza 2 3 5 23 Pneumonia 14 12 26 24 Bronchitis 15 16 31 25 Other diseases of respiratory system 3 3 6 26 Ulcer of stomach and duodenum 6 6 27 Gastritis, enteritis and diarrhoea 1 2 3 28 Nephritis and nephrosis 3 4 7 29 Hyperplasia of prostate 5 — 5 30 Pregnancy, childbirth, abortion — — — 31 Congenital malformations 5 2 7 32 Other defined and ill-defined diseases 34 34 68 33 Motor vehicle accidents 4 3 7 34 All other accidents 5 3 8 35 Suicide 5 1 6 36 Homicide and operations of war — Total all causes 363 327 690 18 MATERNAL MORTALITY. There were no maternal deaths in the area during the year under review, thus giving us five years out of the past seven with a nil mortality. There has in fact been only one maternal death in the district in the last five years. The usual table is reproduced below, giving a comparison of the maternal death rates of the country as a whole, for the past 20 years, with those of the Urban District. TABLE VI. Maternal Mortality, 1933-1952 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 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 1952 — 0.16 —- 0.56 — 0.72 19 INFANT MORTALITY. Deaths of infants under 1 year of age totalled 15, giving an infant mortality rate of 17.3 per thousand live births. Although this figure shows an increase over the rates for 1950 and 1951 it is well below that for the country as a whole, as will be seen by study of Table I on page 10. Eleven of the 15 were neonatal deaths and in three of these prematurity was a contributory cause of death. There was a marked increase in the number of stillbirths, a total of 18, giving a rate of 20.3 per thousand total births. This is rather disappointing and is the highest figure we have had in the district for 5 years. A table showing the infant mortality and stillbirth rates for the last 10 years is given on page 21. Infant Deaths — With causes of death. Sex. Age. Cause of Death. Male 2 months Asphyxia due to inhalation of stomach contents into air passages. Male 4 hours Polycystic disease of kidneys. Patent inter auricular septum. Male 1 month Broncho pneumonia. Male 3 hours Atelectasis. Prematurity. Male 9 hours Multiple Congenital Deformities. Female 1 day Atelectasis. Extreme Prematurity. Maternal Toxasmia. Female 2 hours Atelectasis. Dextrocardia with transposition of viscera. Male 5 months Acute gastro-enteritis. Female 4 hours Intracranial haemorrhage. Maternal pre-eclamptic toxaemia Female 2 days Atelectasis. Prematurity. Male 2 weeks Peritonitis. Operation for intestinal atresia. Male 1 hour Cerebral haemorrhage. Tentorial tear. Female 2 weeks Septicaemia. Male 4 months Primary malignant glioma, left cerebrum. Male 2 months Meningomyelocele (lumbar). 20 TABLE VII. Infant Mortality and Stillbirth Rates for the past 10 years. Year Infant Mortality Rate Stillbirth Rate 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 1952 17.3 20.3 PREMATURE BABIES. There were 49 premature births notified during the year, Three of these premature babies failed to survive one month. Below is a summary of the notifications:— (a) At home 4 (b) In hospital 45 The number of those born at home:— (a) Who were nursed entirely at home 4 (b) Who died during the first 24 hours — (c) Who survived at the end of one month 4 The number of those born in hospital:— (a) Who died during the first 24 hours 1 (b) Who survived at the end of one month 42 ACCIDENTS AT HOME. In the section on Causes of Death there will be found reference to one death from an accident in the home. This figure is a quite inadequate measure of the seriousness of this problem. The number and frequency of disabling and disfiguring accidents not fatal goes unrecorded in these statistics. Every serious avoidable accident to a child which results in .a permanent disability or disfigurement is a personal tragedy in some home, often a lifelong handicap for the victim and perpetual remorse for the parent. Most of these accidents arise 21 from simple omissions ; failure to put dangerous objects out of reach, vessels with boiling or hot contents, faulty electric connections or amateur installations, absence of adequate fire guards—simple things typified by the prophetic grandfather whom everyone remembers reiterating after every mishap " I knew that was going to happen For purposes of record the department and the Divisional organisation make extensive use of their visits to the homes and in their clinics by personal approach and pictorial display to focus attention on the dangers and the remedies. "While it is not strictly appropriate to the year under review it is perhaps justifiable here to announce that a Home Safety Council has now been formed in the district in order to devote special efforts towards reducing these accidents. This new body has the full and enthusiastic support of the Council, who have an active representation on it and have made a grant of £100 to enable it to carry on its important work. SECTION B. — HEALTH SERVICES. NURSING IN THE HOME. General Nursing. This service, which has now been divisionalised by the County Council, is carried on by the three Associations in the area, all of which are affiliated to the County Nursing Association. Details of the Association's staff and areas covered are as follows:— 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. 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. 22 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. Full-time: Miss Evans, 107 Churston Drive. LIB 1258. Miss Mainwaring, 107 Churston Drive. LIB 1258. Miss Coello, 56 Aston Road, S.W.20. Part-time : Mrs. Talbot, 51 Marina Avenue, New Maiden. The Association serves Wimbledon and the Raynes Park, Grand Drive and Morden Park Estate areas of Merton and Morden. 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). 23 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, Wry the 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 page 25 (Table VIII), Scarlet Fever provides 24 by far the larger proportion of cases for admission to hospital and by far the greater number of our eases was admitted to Wandle Valley Hospital. The trend towards greater home isolation of Scarlet Lever continued during 1952 and a comparative table is produced on page 26 (Table IX) to bring out this feature more clearly. TABLE VIII. Cases admitted to Isolation Hospitals during the year 1952. Disease (Final Diagnosis) Wandle Valley Grove Others Cases Deaths Cases Deaths Cases Deaths Scarlet Fever 52 – 8 – 8 – Measles 2 – – – – – Pneumonia 1 — — — — — Dermatitis — — 1 — — Nephritis — — — — 1 — Poliomyelitis — — 1 — 1 M easles — 1 – Whooping Cough 1 – – – – – 56 — 11 — 10 — 25 TABLE IX. SCARLET FEVER Cases admitted to Hospitals. Disease Year Scarlet Fever 1952 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 — 68 80 72 113 78 98 95 68 172 189 174 70 81 89 143 115 111 134 295 192 Percentage admitted to Hospital — 41 52 58 60 69 72 75 59 75 69 76 79 89 90 89 89 87 91 88 88 Total number of cases — 164 155 121 187 112 137 127 114 231 272 229 88 91 98 161 129 127 149 335 210 26 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 42 cases certified under these Acts during the year. Below is given the provisional classification according to the condition on admission. Male Female Total Senile Dementia 3 9 12 Delusional Insanity 8 4 12 Suicidal 4 3 7 Schizophrenia 3 2 5 Hallucinated and Depressed 1 5 6 Total 19 23 42 Of these cases 8 were certified under Section 16, 27 were placed under observation under Section 20, and 7 were removed to hospital under an Urgency Order under Section 11. In addition 51 patients (22 male and 29 female) were admitted direct to Mental Hospital under Section 1 of the Mental Treatment Act, 1930, as voluntary patients. NATIONAL ASSISTANCE ACT—SECTION 47 During the year 3 cases were under consideration for possible action under Section 47, but solutions to the problems of these old people were found without resorting to legal action. 27 SECTION C — SANITARY CIRCUMSTANCES. Food Advisory Committee. During the year the Committee, which consists of members of the Council, representatives of the trade, and various associations and organisations, continued to apply its efforts in this important phase of Public Health. Propaganda is of course its main function, and the year was started well with a slogan competition, for which 129 entries were received. Sixteen prizes, thirteen of which were donated by traders, were awarded to competitors. The winning slogan, "Food Protection Prevents Infection " was exhibited in poster form at several shops in the district through the kind cooperation of local traders. The poster display stand which was purchased last year was again put to good use. It was displayed at six different fetes and flower shows, at which literature was also distributed to the public. There was no exhibition or Clean Food Week held during the year as the Committee decided on a policy of propaganda spread throughout the year rather than a concentrated effort during a short period. Food and Drug's. One hundred and eighty samples were submitted to the Public Analyst during the year, of which only 6 were reported to tie adulterated or not genuine—a satisfactory result. Details of the items sampled and of action taken regarding non=genuine samples will be found on pages 39 and 40. Once again we made good use of the facilities offered .by the Public Health Laboratory Service. Seventy-two samples of ice cream and eighty samples of milk were submitted for bacteriological examination. All the milk samples conformed to the prescribed standards, but results for ice cream were not so satisfactory as those for the previous year. 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. 28 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. Six samples of water from domestic taps were submitted for chemical or bacteriological examination. The reports on each sample were satisfactory. During August complaints were received that water from the newly erected drinking fountain in John Innes Park tasted " flat Bacteriological and chemical samples were taken and proved satisfactory. Subsequent samples were taken and compared with tap water from the same main ; these again proved satisfactory and no fundamental difference between the two samples was detected. Deep Wells. An additional deep well has been sunk in Morden by the Express Dairy Company at their new bottling premises in Morden Road. The borehole is sunk to a depth of 500-ft., the standing water level is 127-ft. 6-ins. below surface, and the well has an estimated capacity of 2,300 gallons per hour. For those interested in the geological formation on this site, the borehole traverses the various strata in the following order : Topsoil 1-ft., brown day 24-ft., blue clay 213-ft., Reading and Woolwich beds 59-ft. 6-ins., Thanet sand 28-ft. and chalk and flint 103-ft. 6-ins., the remainder being hard chalk. For those interested in the geological features of this part of the area a diagramatic sketch is reproduced on page 31. There are now four 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 2,300 galls, and 7,000 galls, per hour. 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 29 periods during the War when shortage of labour caused disorganisation. There have been improvements to the tipping hoppers at the Refuse Disposal Works. In addition, arrangements were made for the disposal of screenings by tipping on low lying land at Morden Hall Park to raise the level of the land which was subject to flooding. During the year 15,270 tons of house refuse was collected and disposed of. The salvage tonnage for the year was as follows:— Paper Metal Pig Foods Tons. 729 363 841 Bottles and glass Rags Tons. 77 42 Drainage and Sewerage. During the year a surface water relief sewer was laid from the Morden Factory Estate to the Pickle Ditch, to relieve flooding on the Estate. Rivers and Streams, No major works to rivers and streams have been carried out. 30 31 REPORT OF THE CHIEF SANITARY INSPECTOR. Mr. Chairman, Ladies and Gentlemen, In presenting this Annual Report 011 the activities of the Sanitary Inspectors during 1952, I think I can best indicate the general scope of the work by setting out in tabular form the main divisions and the 9,510 inspections made thereunder:— Food Shops, etc. 1,198 Housing—primary visits 826 ,, —reinspections 1,137 „ —overcrowding provisions 258 „ —miscellaneous 339 Drainage—chokages and repairs 1,093 Rat and Mice destruction 777 Shops—Welfare provisions 599 Infectious Disease enquiries 439 Factories and Workplaees 418 Milk Supply 140 Smoke abatement 91 Rivers and Stream pollution 86 Stables and Piggeries 30 Miscellaneous (Caravans, Hairdressers, Schools, Building Sites, etc.) 2,079 9,510 The increase in total inspections is due to the fact that this section of the Health Department was fully staffed for the whole of the year. As a result, the survey of food premises mentioned in the last report was extended to include all premises in the district other than private houses. In giving details of the number of premises in each class within your area, I feel I must draw attention to the fact this survey took nearly eighteen months to complete without any follow-up procedure to see that the requirements land suggestions made were implemented. It is desirable that most of these premises are visited annually and some, such as foodshops, more frequently—even quarterly—and consideration will have to be given to the best way of achieving this object. The analysis of these trade and industrial premises is as follows:— 32 Wholesale Food Manufacturers 5 Bakehouses 8 Food Shops and Catering Establishments 476 Off Licences 14 Public Houses 15 Other Shops 272 Factories (Power) 178 Factories (Non-power) 6 Offices 68 Workplaces, etc. 108 * For details see page 35. HOUSING Much time continues to be spent on this work and a total of 826 houses were inspected for " sanitary defects " under the Public Health and Housing Acts. The main development of the district having occurred in the " thirties few major works of repair were needed and informal action secured the required result in all but 49 cases where statutory action had to be taken. Legal proceedings were unfortunately necessary in six cases, in four of which further summonses were issued for non-compliance with the Nuisance Orders granted by the Wimbledon Court. Action taken in connection with dwelling houses,, as set out in the housing tables on pages 46 - 47, resiilted in the following improvements:— Summary of Nuisances Abated and Sanitary Improvements Effected. Ceilings cleansed or repaired 70 Dampness in premises remedied 95 Drains exposed and repaired 19 Drains reconstructed 4 Defective sashcords renewed 42 Dustbins provided 18 Floors repaired 69 Fresh air inlet valves provided and repaired 4 Inspection chamber covers provided 6 Obstructions removed from drains 11 Rain water pipes renewed or repaired 19 33 Roofs repaired 93 Gutters repaired 87 Sink wastes repaired 12 Walls repaired 206 W.C. cisterns provided 1 W.C. cisterns repaired 13 Water Closets cleansed 5 W.C. pans provided 10 Windows repaired or renewed 52 Ventilation provided under floors 3 Fireplaces and stoves renewed or repaired 26 Sinks provided 1 Offensive accumulations removed 7 Water supply repaired for domestic use 26 Verminous premises fumigated and cleansed — Sanitary accommodation for workshops — Miscellaneous 136 Notices Served. Intimation notices 290 Statutory notices:— Public Health Act, 1936 49 Housing Act, 1936 — Moveable dwellings. Three applications for licences to station caravans in the district were received, one being for renewal of an existing permission for a further twelve months. Of the remaining two, one was refused and the other was not taken up owing to covenant restrictions on the land. Several times during the year caravans occupied by " pseudo gypsies " were found on unfenced vacant land in the east of the district and difficulty was experienced in securing their removal. The owners were eventually persuaded to enclose the land with wire-mesh fencing. Overcrowding". Of the 68 cases carried over from the last report, 40 were abated during the year by rehousing, 53 further cases were discovered during 1952 and the location and type of the cases known at the end of the year were as follows:— 34 Merton and Morden Council houses 9 cases L.C.C. estate 35 yy Haig homes 3 yy Privately-owned houses 34 yy 81 yy Whole houses overerowded—34 eases. yy (a) One family occupation 8 cases (b) Two or more related families 25 yy (c) Two or more unrelated families 1 yy Part house overcrowded—47 cases. yy (a) Unrelated families 10 yy (b) Related families (married sons or daughters) 37 yy 81 FOOD SUPPLIES The systematic survey of all food shops and catering establishments begun in 1951 was practically completed during 1952. The classification of these premises is always a matter of interest and the following table shows the respective numbers of each type :— Bakers 22 Butchers 29 Greengrocers 40 Grocers 82 Ice Cream ... ... 92 Milk 18 Restaurants 51 Works Canteens 18 School Canteens 12 Fishmongers ... 14 Fishf ryers ... 15 Confectionery 63 Wholesale confectionery ... 2 Wholesale grocers 2 Chemists ... ... 1 16 476 35 The majority of the shops, works' canteens, etc., were in good condition with adequate food storage, sanitary and washing accommodation, but at 107 premises the following unsatisfactory points were noticed:— Unclean and Defective Premises 62 Unclean Utensils 8 Accumulation of Refuse 6 Defective or Insufficient Bins 18 Unprotected Food 16 Defective Sanitary Accommodation 12 Washing Facilities:— (a) No hot water 38 (b) No soap 11 (e) No towels 11 (d) Non-display of notice re washing hands 14 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. Came. Beef 431 lbs. Internal putrefaction, bone taint and bruising. Mutton 52 lbs. Putrefaction and taint. Lamb 156 lbs. Putrefaction and taint. Pork 18 lbs. Putrefaction. Veal 15 lbs. Bruising and contamination. Bacon 3 lbs. Glass contamination. Pigs tails 405 lbs. Decomposition and mould. Sheeps livers 81bs Cirrhosis. Ox livers 117 lbs. Decomposition. Sausages 20 lbs. Decomposition. Fish 80 stone Decomposition. Cereals 55 pkts. Weevil infestation. Chocolate Marshmallows 56 Damaged. Mixed Peel 7 lbs. Mould. Milk Whipping Compound 17 lbs. Stale. 36 Description. Ammnt. Cause. Gulls Eggs 360 Decomposition. Prunes 481 lbs. Mould and Maggots. Dried Apricots 56 lbs. Mould and Maggots. Ice Creams 127 Melting and saturation. Almond substitute 6 lbs. Deterioration. Curry 7½ lbs. Deterioration. Dried Raisins 75 lbs. Maggots. Dried Turkish Figs 90 lbs. Maggots. Chocolate Tea Cakes 70 Mould. Ground Bice 18 lbs. Maggots. Rolled Oats 5½ lbs. Maggots. Biscuits 32 lbs. Staleness and deterioration. Sweets 14 lbs. Contamination. Tinned Milk, Meat, Fruit, Fish, etc. 5,657 tins Blown, punctured, posed, sour, etc. 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. 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 — — — — 122 Number inspected — — — — 122 Number found fit for human consumption – – – – 122 Organs condemned. 3 hearts 3 heads 1 mesentery, stomach and intestines 1 foot 1 set of lungs 37 Reason for condemnation. Pericarditis. Tuberculosis. Tuberculosis. Abscess. Congestion. Milk Supply. There are no producers of milk registered within the district, but one new distributor was registered during the year for the sale of milk in sealed receptacles only. 140 inspections were made of dairies and milkshops in 1952 and at the end of the year there were on the register 26) distributors and 5 dairies, of which 3 were large distribution depots handling only milk in bottles or sealed drums. 80 samples of milk were submitted for bacteriological examination during the year and all conformed to the prescribed standards. The undermentioned licences to use special designations were granted during 1952 :—- Dealers Licences. Pasteurised 15 Tuberculin Tested 14 Sterilised 18 Supplementary Licences. Pasteurised 19 Tuberculin Tested 19 Sterilised 19 Details of the chemical analysis of milk samples will be found on page 41. 38 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 Almonds, ground 2 2 - Baking Powder 1 1 — Brawn 1 1 — Chicken, devilled 2 2 — Christmas Pudding 1 1 — Cocoa 1 1 — Coffee Essence 3 3 — Coffee, ground 1 1 - Cordials 2 2 - Cornflour 1 1 - Crab, potted 1 1 Cream, synthetic Crystals, foam 1 1 - 1 1 - Curd, pineapple 1 1 - Curry Powder 1 1 - Custard Powder 3 3 - Eclairs, chocolate cream 1 1 - Fish Cakes 2 2 - Fruit, bottled or tinned 2 2 - Gelatine 2 — 2 Ginger ground 1 1 - Glace Cherries 1 1 - Gravy Powder 1 1 — Ham, devilled 2 2 - Herbs, dried 1 1 - Honey 2 2 - Ice Cream 20 20 - Jams 1 1 — Jelly, table 2 - — Lollies (iced) 4 - — Marmalade 2 2 — Marshmallow Creme 1 1 — Meat, tinned 1 1 — Milk 62 60 2 Milk, condensed 1 1 — Mustard 1 1 — Paste, fish 6 6 - Paste, meat 5 5 — Peas, tinned 2 2 — Pepper 2 2 — Pickles 1 1 — Pies, meal 3 3 — Potato Crisps 1 1 — 39 Article Total Samples Genuine Not Genuine Salad Cream 1 1 - Sausages 14 14 — Sausage, luncheon 1 1 — Sausage Meat 2 2 — Soup, tinned 2 1 1 Sponge and Cake Mixtures 2 2 — Stuffing 1 1 — tomato Ketchup and Sauce 3 2 1 Vinegar 1 1 — Total 180 174 6 Action Taken. (a) Windsor Soup (1525, informal). This sample bore no resemblance to Windsor Soup as ordinarily understood. In addition, the proportion of tin was high, probably indicating lengthy storage. The stock was bought in 1948, before the Ministry of Food Code of Practice came into force, and the retailer was cautioned to check labels before selling old stock. (b) Channel Island Milk (1530, informal). Butterfat content of this sample was only 3.60% instead of not less than 4%. The matter was referred to the milk division of the Ministry of Food in accordance with circular 8/48. (c) Milk (1544, informal). 1% deficient in non-fatty solids (only 8.41%.) The Hortvet Test did not indicate presence of added water. A subsequent formal sample proved to be genuine. (d) Tomato Sauce (1549, informal). The label did not disclose all the ingredients. The wholesaler was notified of the contravention. This was an imported article and the importation question was referred to the Ministry of Food. (e) Gelatine (1576 informal). Failed to satisfy standard for edible gelatine. Setting quality so inferior that 5% solution did not set under the prescribed conditions. A formal sample was taken (f). (f) Gelatine (1578, formal). Failed to satisfy standard for edible gelatine, 3% solution failed to set when cooled to, and maintained at 60°F. The retailer, who had been splitting pre-packed canisters of gelatine, and selling it loose, was cautioned regarding his action. 40 A summary of the fat and non-fatty solids contents of the 59 milk samples is given by the following tables:— Solids not fat (legal standard is 8.5%). Less than 8.5 8.5 8.6 8.7 8.8 8.9 9.0 9.1 9.2 Total 1 3 10 17 12 12 4 - 59 Milk fat (legal standard is 3.0%). Less than 3.0 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3 7 3.8 39 4.0 4 1 Total — 1 4 3 11 8 15 10 4 — 2 - 59 Ice Cream. The distribution trade continues to be subject to continual change of retailers and at the end of the year there were 116 dealers and 16 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 72 samples were obtained and submitted for examination with the following results:— No. Provisional Grade Methylene Blue Test Coliform B. Remarks 1 3 Unsatisfactory Absent 2 3 „ „ 3 2 Satisfactory „ 4 2 „ „ 5 3 Unsatisfactory „ (i 2 Satisfactory „ 7 3 Unsatisfactory „ 8 1 Satisfactory „ 9 1 „ „ 10 1 „ „ 11 1 „ „ 12 1 „ Present 13 1 „ Absent 14 1 „ „ 15 2 „ Present 16 2 „ Absent 17 2 „ „ 18 3 Unsatisfactory Present 19 1 Satisfactory Absent 20 1 „ „ 21 1 „ „ 22 1 „ „ 23 4 Unsatisfactory Present 41 No. 1 Provisional Grade Methylene Blue Test Coliform B. Remarks 24 2 Satisfactory Absent 25 1 „ „ 26 3 Unsatisfactory Present 27 1 Satisfactory „ 28 2 „ „ 29 1 „ Absent 30 2 „ „ 31 2 „ „ 32 1 „ Present 33 2 „ Absent 34 1 „ „ 35 3 Unsatisfactory „ 36 2 Satisfactory „ 37 4 Unsatisfactory Present 38 3 „ Absent 39 4 " Present 40 2 Satisfactory Absent 41 1 „ Present 42 2 „ Absent 43 2 „ „ 44 1 „ „ 45 2 „ „ 46 3 Unsatisfactory Present 47 1 Satisfactory „ 48 1 Absent 49 1 „ Present 50 1 „ „ 51 2 Unsatisfactory „ 52 3 „ 53 2 Satisfactory Absent 54 1 „ „ 55 1 „ Present 56 1 „ Absent 57 1 „ „ 58 1 „ Present 59 1 „ „ 60 2 „ „ 61 1 „ „ 62 2 „ Absent 63 1 „ „ 64 1 „ „ 65 1 „ „ 66 1 „ „ 67 1 „ „ 68 1 „ 69 1 „ Present 70 1 „ Absent 71 1 „ „ 72 2 „ „ 42 The results are summarised as follows:— Grade 1 38 53% „ 2 21 29% „ 3 10 14% „ 4 3 4% 72 100% The three samples placed in grade 4 were of supplies originating in two other Boroughs, and details of the results were transmitted to the respective Councils. Subsequent samples were all grade 1. GENERAL SANITATION Factories and Workplaces. The number of inspections made to premises registered under the Factories Act, 1937, was 195. Defects relating to sanitary conveniences, ventilation and other sanitary matters were dealt with at 57 premises. The table on page 48 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. 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. Morden Hall Park continues to be an intermittent breedingground due to occasional flooding from the River Wandle. Proposals were put forward during the year for raising the level of the Park by utilising spent screenings from the Refuse Works. Although this will undoubtedly help, no final relief can be expected until the level is raised to prevent the possibility of any part being flooded during the breeding season. Rodent Control. 282 complaints of infestation were received during the year and as a result of the inspections of 926 premises, 300 of them were found to be infested. The control method recommended by the Ministry of Agriculture 43 was followed in every case and as a result of 3,219 secondary visits 296 premises were freed from infestation. A 10% test baiting of the Council'-, sewers was made and 131 manholes were included. The " take " was lower than last year at 3% complete and 1.5% partial takes. Two sewer treatments were carried out during the year. 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 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. 75 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. 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. Shopkeepers, generally, make a due compliance with the orders and only eight informal warnings were needed. Fining Materials. The three local manufacturers of stuffed toys and perambulators continued to purchase their supplies under the British Standards Institution certification mark scheme. Eleven samples were taken and were found to comply with the regulations. Shops Act, 1950. The following statement summarises the inspections made, the infringements discovered and other matters dealt with during the year:— No. of Inspections:—Day Visits 654 Evening Patrols 25 Sunday and half holiday Patrols 99 44 Infringements:— Number of premises at which contraventions were found 162 Number of premises at which prescribed forms were not exhibited 147 Assistants half holiday forms not exhibited 96 Young persons records not maintained 38 Forms regarding seats for females not exhibited 88 Mixed shop notices not exhibited 34 Sunday employment notices not exhibited 5 Insufficient heating 17 Insufficient ventilation 2 Sanitary accommodation:— Insufficient 7 Dirty 24 Unlighted 10 Half day closing 2 Absence of seats for females 10 I would like to express my gratitude for the continuing support of the Chairman and members of the Public Health Committee and to record my thanks to the District Inspectors who worked so diligently on the general survey referred to in this report. I am, Ladies and Gentlemen, Your obedient Servant, W. T. PINCHES, Chief Sanitary Inspeclcr. 45 SECTION D. — HOUSING. Housing and Overcrowding. During the year 85 new houses were built in the Urban District, 80 by the Council, and 5 by private builders. 664 eligible applications for rehousing were received by the Housing Manager during the year ; 98 houses and 15 flats were allocated to tenants during this period. By the end of the year the number of outstanding applications had increased to 3,804. Arising out of rehousing enquiries, 77 complaints of overcrowding were received. Of these, 53 were found to be overcrowded within the standards laid down by the Housing Act, 1936. The housing situation in Merton and Morden may be gathered from the following facts 1. Inspection of Dwelling- Houses during the year:— i. (a) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) 826 (b) Number of inspections made for the purpose 826 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 lie 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 290 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 219 46 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) Byloca I authority in default of owners — B.—Proceedings under Public Health Acts (i) Number of dwellinghouses in respect of which notices were served requiring defects to be remedied 49 (ii) Number of dwellinghouses in which defects were remedied after service of formal notices:— (a) By owners 54 (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 Chief Sanitary Inspector's Report, on pages 35-43). 47 FACTORIES ACT, 1937. 1. Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 6 6 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 178 187 29 - (iii) Other Premises in which Section 7 is enforced by the Local Authority 2 2 - - Total 186 195 29 - 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) 2 1 - - - Overcrowding (S.2) — - — — — Unreasonable temperature (S3) - - - - - Inadequate ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) - - - - - (a) Insufficient - - - - - (b) Unsuitable or defective 27 20 - - - (c) Not separate for sexes 2 - - - - Other offences against the Act (not including offences relating to Outwork) 25 - 25 - - Total 57 21 25 — - 48 SECTION F — INFECTIOUS ILLNESS. Notification. The Public Health (Tuberculosis) Regulations, 1952, came into force on 1st May. The regulations revoked the Public Health (Tuberculosis) Regulations, 1930, but made similar provision for the notification of the disease, modified to accord with the structure and administration of the services provided under the National Health Service Acts. The following diseases are 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 notified during the year, and, for the first time for several years, we were not required to undertake surveillance of contacts coming in from abroad. Scarlet Fever. There were 164 cases of Scarlet Fever notified during the year, giving a case rate of 2.23 per thousand population. The tendency to nurse cases at home rather than remove them to isolation hospital was more marked than ever this year. In fact only 68 (41.5%) of the cases were removed to hospital. The steady decline to hospitalisation throughout the last 20 years is brought out in Table IX on page 26. As usual school children provided the majority of cases —124 in all. Three schools in particular accounted for 40 of these, but it was noted that the three schools which made the greatest contribution in 1951 had very few cases this year. 49 Poliomyelitis. This year was not an exceptionally heavy year for notifications of Poliomyelitis. In all we had nine cases notified, of which 7 were paralytic and 2 non-paralytic. It is indeed unfortunate that two of these patients had very severe attacks and failed to survive. Details of the cases are set out on page 53. Whooping Cough. There were 278 cases notified during the year, but fortunately, no deaths. Although the numbers are less than those for 1951 the case rate at 3.77 per thousand population is still rather high. Resistance to this infection either because of high nutritional standards or because of good environment appears to be high and though the manifestations of the disease in some cases are distressing to the parents to have to observe, some comfort may be derived from the low mortality rate and the low morbidity rate, aided perhaps by modern therapeutic agencies. Measles. The number of cases of measles notified (491) was our lowest since 1947, but it could hardly be called a non-epidemic year when we consider that 240 (or nearly 50%) of these were notified during a period of three months— April to June. It is, however, gratifying to see that our case rate at 6.66 was lower than that of the remainder of the country. A table showing the incidence of measles in the district over the past 20 years is given below. INCIDENCE OF MEASLES, 1933 -1952. Year Cases Deaths Population Remarks 1933 14 - 52,130 School children only 1934 523 6 55,550 included — disease 1935 5 — 57,440 not being notifiable. 1936 586 4 61,000 Figures based on 1937 86 — 65,530 returns from Head 1938 403 - 68,980 Teachers 1939 5 - 72,150 1940 459 1 68,540 1941 539 — 64.920 Whole population included from 1940 when disease became notifiable. 1942 936 — 66,880 1943 433 1 66,590 1944 252 1 62,760 1945 760 - 66,050 1946 568 — 73,590 1947 347 — 75,290 1948 1,049 — 75,220 1949 721 — 75,470 1950 523 — 75,790 1951 1,214 — 74,602 1952 491 — 73,670 50 Diphtheria. For the second time on record we had no cases of diphtheria notified in the district. We have in fact had only one case during the past three years. Table XVIII on page 62 shows the decline of this disease since the introduction of immunisation. Food Poisoning'. During the year there were only three notifications of food poisoning. The first case was a man aged 45 who was working in the City. The only food he had which was thought likely to have caused his condition were some sandwiches he had consumed at a restaurant in the City. The Medical Officer of Health of the Corporation of London made investigations from his end, but no other cases were traced. The second case was a woman aged 42. It was not possible to ascertain the cause, and a fecal specimen taken showed no pathogenic organisms present. In the third case, a woman aged 26, salmonella typhimurium was isolated from the feces. Investigation showed that there was mouse infestation at home. Two mice were caught and sent to the Public Health Laboratory for examination, but no organisms were isolated. There were only these isolated cases referred to above. There were no outbreaks of food poisoning. Food Poisoning Contacts. During April and May several cases of food poisoning (Salmonella Bnteriditis Gartner) occurred in an institution just outside the district. All patients discharged from the infected wards were investigated as contacts until the outbreak was cleared. In all, 60 contacts residing in the Merton and Morden area were visited and in four cases, persons were found to have symptoms of diarrhoea and vomiting. In these cases, fecal specimens were sent to the Public Health Laboratory, but on no occasion was any pathogenic organism isolated. Dysentery. There were 11 cases of dysentery notified during the year and in all of these, shigella sonnei was isolated from the feces. In the main they were sporadic cases having no apparent connection, but there was what might be termed a slight outbreak in one of the schools in the area, in which 5 eases were notified, three of the children being in the same class. In all cases concerning schools or nurseries two negative swabs were obtained before the children were allowed to return. 51 Erysipelas. There were 13 notifications of Erysipelas during the year, all of which involved the face. Six occurred in males and seven in females. All were treated at home. Pneumonia. There were 66 notifications of Pneumonia, of which 16 were stated to be influenzal in origin. The number of eases notified in the previous year was 111. Puerperal Pyrexia. There were 14 notifications of Puerperal Pyrexia, giving a rate of 15.8 per thousand births. All these cases occurred in hospital, and the patients recovered. CLEANSING STATION. There was a decrease in the number of attendances at the Cleansing Station during the year, the total being 22 as compared with 38 in 1951. The details of the attendances during the year are as follows:— Number of cases of Scabies treated 3 Cases of Scabies with concurrent verminous head Cases of Scabies with Secondary Septic Skin conditions — Number of cases of verminous heads only 12 Total number of attendances at the Centre 22 52 POLIOMYELITIS, 1952 Case No. Age. (Years) Hospital to which admitted Date of Onset Returned to Registrar General Confirmed by Hospital Hospital Diagnosis Sequel 1. 11 St. Helier 22-1-52 Yes Yes Ac. Poliomyelitis (Paralytic) Patient died in hospital 30-1-52. 2. 6 Kingston 29-6-52 Yes Yes Ac. Poliomyelitis (Paralytic) Partial paralysis of left leg. Child walks with aid of sticks. Still receiving hospital treatment. General health good. 3. 5 St. Helier 23-7-52 Yes Yes Ac. Poliomyelitis (Paralytic) Complete recovery. No residual paralysis. 4. 6 Kingston 30-7-52 Yes Yes Ac. Poliomyelitis (Non-paralvtic) Child has slight paralysis of right leg. Specialist of the opinion that no further treatment is necessary. Full recovery expected. 5. 33 Tolworth 1-8-52 No. No. Nephritis — 6. 30 Tolworth 28-7-52 Yes Yes Ac. Poliomyelitis (Paralytic) Left leg affected. Massage and electrical treatment given. Iron support used for leg but this is now discontinued, although plaster cast splint is worn at night time. 7. 18 St. Helier 7-9-52 Yes Yes Ac. Poliomyelitis (Paralytic) Patient died in hospital 12-9-52. 8. 2 St. Helier 23-9-52 Yes Yes Ac. Poliomyelitis (Paralytic) Partial paralysis of left arm and left leg. Wears iron supports on legs, child attending hospital 4 times a week for treatment. 9. 5 Grove 1-10-52 Yes Yes Ac. Poliomyelitis (Non-paralytic) Complete recovery. 10. 29 Home Case 20-9-52 Yes Yes Ac. Poliomyelitis (Paralytic) Weak right ankle. Electrical treatment given. Foot now quite normal. 53 TABLE X. Scarlet Fever — Monthly Distribution. Month Wards Total Abbey Bushey Mead Central Morden Park Ravensbury Raynes Park St. Helier West Barnes | January — 6 1 2 — 1 — — 1 11 February — 4 — 4 1 — 2 2 1 14 March 1 3 6 3 1 3 1 3 1 22 April — — 1 3 1 1 1 1 — 8 May — — 1 1 — — 1 1 — 4 June 1 — 7 2 2 1 1 — — 14 July — — 7 2 3 1 2 5 — 20 August — 1 - — — — 1 1 3 September 1 1 I 1 1 — — 4 — 12 October 3 3 5 4 — 3 3 - 2 21 November 3 4 2 2 — 3 2 4 1 21 December 1 2 2 3 4 1 - 1 - 14 Total 10 24 32 28 14 14 13 22 7 1164 Monthly mean 0.83 2.00 2.66 2.33 1.17 1.17 1.08 1.83 0.58 13.66 The incidence in the various wards was as follows:— Wards Cases Incidence per 1,000 population Abbey 10 2.1 Bushey Mead 24 3.2 Central 32 3.1 Morden 28 2.5 Park 14 1.5 Ravensbury 14 2.2 Raynes Park 13 1.7 St. Helier 22 2.2 West Barnes 7 1.0 54 TABLE XI. Infectious Diseases, Notifications, Deaths and Distribution, 1952. 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 Raynes Park St. Helier West Barnes Smallpox - - - - - - - - - - - - - — - Scarlet Fever 164 2.23 - - 10 24 32 28 14 14 13 22 7 68 41% Diphtheria — — - - — — — — — — — — — — — Paratyphoid Fever - - - - - - - - - - - - - - - Meningococcal Infection 1 0.01 - - - - 1 - - - - - - - - Pueroeral Pyrexia 14 0.19 - - - - - - 12 1 — — 1 14 100% Erysipelas 13 0.18 - - — — 4 3 3 — 1 2 — — - Poliomyelitis:— - - - - - - - - - - - - - - - Paralytic 7 0.0® 2 28.6% — — 1 2 — — 2 1 1 6 86% Non-Paralytic 2 0.03 — — 1 — — — — — - — 1 2 100% Dysentery 11 0.15 — — — 1 2 5 — — — 1 2 — — Food Poisoning 3 1 0.04 — — — 1 1 — — — — 1 — - - Ophthalmia Neonatorum - - - - - - - - - - - - - - - Primary Pneumonia 50 0.68 2 4% — 7 8 8 7 1 4 11 4 - - Influenzal - - - - - - - - - - - - - - - Pneumonia 16 0.22 1 6.3'% — 4 1 2 4 — 2 - 3 - - Measles 491 6.66 — - 16 29 65 108 76 27 45 98 27 2 0.4% Whooping Cough 278 3.77 — — 4 29 32 46 24 13 47 27 56 1 0.4°' Acute Encephalitis (Post infectious) 1 0.01 - - - 1 - - - — - — — 1 100% 55 TABLE XII. Notification of Infectious Diseases (other than Tuberculosis) by age groups during the year 1952. Disease TOTAL CASES NOTIFIED Total cases at all ages Under 1 year 1-2 3-4 5-9 10-14 15-24 25-34 35-44 45-64 65 and over Smallpox — — — — — — — — — — — Scarlet Fever — 9 35 105 9 5 1 — — — 164 Diphtheria (including Membranous Croup) - — — — — — — — — — — Enteric Fever (including Paratyphoid) — — — — — — — — — — — Puerperal Pyrexia — — — — — 2 11 1 - - 14 Acute Primary Pneumonia 1 1 1 3 3 1 6 5 21 8 50 Acute Influenzal Pneumonia - 3 - 2 — 1 2 1 3 4 16 Meningococcal Infection - - - — — — — — 1 — 1 Poliomyelitis:— - - - - - - - - - - - Paralytic - 1 — 2 1 1 2 — — — 7 Non-Paralytic - — — 2 — — — — — — 2 Dysentery - — — 7 — 1 — — 1 2 11 Malaria - — — — — — — — — — — Ophthalmia Neonatorum - - - - - - - - — — — Erysipelas - — — — — — — 3 8 2 13 Food Poisoning - — — — — — — 1 1 1 3 Relapsing Fever - — — — — — — — — — — Typhus Fever - — — — — — — — — — — Measles 10 78 137 237 15 6 8 — — — 491 Whooping Cough 8 68 76 122 1 4 4 — — — 278 Acute Encephalitis (Post infectious) — — — 1 — — — — — — 1 Totals 19 155 249 481 29 21 34 11 35 17 1051 56 TABLE XIII. Monthly Incidence of Infectious Diseases, 1952. Disease January February March April May June July August September October November December Total Smallpox — — — — — — - — — — — — — Scarlet Fever 11 14 22 8 4 14 20 3 12 21 21 14 164 Diphtheria — — — — — — — — — — — — — Dysentery — 3 — 1 5 — 1 - — — — 1 11 Meningococcal Infection - - - 1 — - - - - - - - 1 Primary Pneumonia 6 13 7 4 4 1 1 1 — 3 2 8 50 Influenzal Pneumonia 4 1 4 3 — — 1 — — 1 — 2 16 Food Poisoning — — — — 1 — — — — — 2 — 3 Erysipelas 2 1 1 1 1 — — — 2 1 — 4 13 T.B. Pulmonary 9 35 7 4 10 8 17 9 7 3 1 17 127 T.B. Non-Pulmonary — 3 — — — 1 — 1 1 — — — 6 Ophthalmia Neonatorum - - - - - - - - - - - - - Puerperal Pyrexia 1 — 1 — 1 1 — — 3 3 2 2 14 Poliomyelitis:— - - - - - - - - - - - - - Paralytic 1 - - - - - 2 1 2 - 1 — 7 Non-Paralytic — — — — — — — 1 - 1 — — 2 Malaria — — — — — — — — — - — — — Measles 14 30 34 40 96 103 31 15 7 14 34 73 491 Whooping Cough 19 30 41 39 38 16 33 25 14 7 9 7 278 Acute Encephalitis (Post infectious) - - - - - - - 1 - - - - 1 Totals 67 130 117 101 160 144 106 57 48 54 72 129 1184 57 DIPHTHERIA IMMUNISATION There were 719 children in the district who received a complete primary course of injections during the year. Of these, 370 were carried out in the Welfare Centres, 300 by private practitioners, and 49 in the schools. In addition 1,746 children were given boosting injections at school (199 of these being children not resident in the area). Primary courses showed a decrease of 85 as compared with last year, but this figure is of course governed by the number of births in the previous year, and the drop was to be expected. The usual propaganda campaign was carried on during the year, stressing to parents the danger of diphtheria, and encouraging them to have their children completely immunised before attaining the age of one year. WHOOPING COUGH IMMUNISATION As from 1st August, 1952, the County Council gave its official blessing to the inauguration of immunisation against Whooping Cough. All general practitioners in the district were circularised, and immunisation was started in the Welfare Centres. Details of 100 primary courses and 12 boosters given since that date are set out below. Fifty-two of the primary courses were given by private practitioners. 58 PRIMARY Antigen Age Groups Total Under 1 1 2 3 4 Whooping Cough 10 9 4 1 7 31 Diphtheria/Whooping Cough combined 21 41 4 2 1 69 Total 31 50 8 3 8 100 BOOSTING DOSES Antigen Age Groups  Under 1 1 2 3 4 Whooping Cough — — — 4 4 Diphtheria/Whooping Cough combined — — 1 2 5 8 Total — — 1 2 9 12 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 643 Re-vaccinations 253 Of the above, 592 were vaccinated by Private Practitioners. 501 of these vaccinations were primary vaccinations in infancy. 59 TABLE XIV. Persons Immunised at Clinics, 1952. 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 33 — — 1 33 1 Bushev Mead 46 1 — 5 46 6 Central 51 8 — 7 51 15 Morden 39 1 1 7 40 8 Park 43 4 — 8 43 12 Ravensbury 40 — — 2 40 2 Raynes Park 21 — — 5 21 5 St. Helier 65 — — 3 65 3 West Barnes 30 — 1 4 31 4 368 14 2 42 370 56 TABLE XV. Persons Immunised by Private Practitioners, 195^. WARDS AGE GROUPS Total Completed Primary Total Single Boosting Injections 0-5 years 5-15 years Completed Primary Single Boosting Injections Completed Primary Single Boosting Injections Abbey 18 — — 2 18 2 Bushev Mead 23 1 3 4 26 5 Central 33 — 3 11 36 11 Morden 74 7 2 28 76 35 Park 32 4 — 7 32 11 Ravensbury 12 — — — 12 — Raynes Park 28 1 1 2 7 30 8 St. Helier 29 1 — 6 29 7 West Barnes 37 — 4 6 41 6 286 14 14 71 300 85 60 TABLE XVII. Number of Children Immunised at Schools, 1952. School Incomplete Completed Primary Single Boosting Injections Bushey County Primary — 7 260 Poplar Road County „ — 3 82 St. Mary's „ „ — — 89 Merton Abbey „ „ — 2 68 Hillcross „ „ — 4 183 Raynes Park „ ,, — 7 247 Morden „ „ — — 101 Morden Farm „ „ — 3 256 St. Helier No. 1 ,, „ — 21 95 St. Helier No. 2 „ „ — — 70 St. Helier No. 3 „ „ — — 78 St. Helier No. 4 ,, „ — — 42 Holy Family R.C. Vol. Primary — 21 104 Sacred Heart R.C. Vol. Primary — 9 71 — 77* 1746* *Includes children attending schools in Merton and Morden but resident in other areas:— Primary 28 Boosters 199 The number immunised since the inauguration of the Public Clinics in 1934 is as follows:— At Clinics By Doctors In Schools At Day Nurseries Total 1934 93 28 — — 121 1935 375 19 — — 394 1936 383 13 664 — 1,060 1937 502 27 293 — 822 1938 376 22 260 — 658 1939 277 11 303 — 591 1940 234 12 50 — 296 1941 700 6 3,198 — 3,904 1942 1,127 16 753 — 1,896 1943 813 64 211 51 1,139 1944 515 54 216 28 S13 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 1952 370 300 49 — 719 61 TABLE XVIII. Incidence and Fatality of Diphtheria, 1920-1952. Year Population No. of cases Incidence 1,000 population rate per No. of deatns 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 — — 1952 73,670 — — — — 62 63 TABLE XIX. Diphtheria Immunisation. Number of children 0— 5 years immunised January, — June, 1952 302 Number of children 5—15 years immunised January — June, 1952 52 Number of children 0— 5 years immunised July — December, 1952 339 Number of children 5—15 years immunised July — December, 1952 5 Total number of children 0— 5 years immunised during the year 641 Total number of children 5—15 years immunised during the year 57 Number of children 0— 5 years immunised by Private Practitioners during the year 286 Number of children 5—15 years immunised by Private Practitioners during the year 14 Total number of children immunised by Private Practitioners during the year 300 Total number of children immunised in the Clinics during the year 370 Total number of children immunised in the Schools during the year 49 Estimated percentage of 0— 5 years immunised at end of year 55.31 Estimated percentage of 5—15 years immunised at end of year 86.23 Age Distribution of Immunised Children. Age at 31.12.52 i.e. born in year Under 1 1952 1 1951 2 1950 3 1949 4 1948 5 to 9 1943-7 10 to 15 1938-42 Total Immunised Estimated (Population 0-5 Estimated Population 5-15 Total Estimated Population up to 15 N umber Immunised 29 505 674 722 725 4,436 4,187 11,278 4,800 10,000 14,800 TUBERCULOSIS. One hundred and eighty seven new cases were added to the register of tuberculous persons, compared with 161 in 1951. These additions were:— Males Females Total Pulmonary 87 88 175 Non-Pulmonary 8 4 12 95 92 187 Of these 187,133' were primary notifications, 53 were transferred from other districts, and 1 came to notice in another way. During the year 88 persons were removed from the register for the following reasons:— Recovered 4 Removed from the district 55 Death 29 After allowing for the additions and deductions, the number remaining on the register at the 31st December, 1952, was distributed as shown in the following table TABLE XX. Tuberculosis Register at 31st December, 1952. Wards Registered at 31st December, 1952 Totals Number on Register at mid-year Pulmonary NonPulmonary Abbey 79 10 89 77 Bushey Mead 70 12 82 86 Central 106 10 116 116 Morden 118 10 128 116 Park 131 19 150 153 Ravensbury 124 24 148 147 Raynes Park 97 10 107 97 St. Helier 178 34 212 210 West Barnes 72 19 91 88 Whole district 975 148 1123 1090 64 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 153 persons in 1952 from Merton and Morden, as follows:— At the County Sanatorium, Milford 21 At other Institutions 132 153 A table has been prepared which shows in comparison the numbers of new cases for the past 10 years. The primary infections are all cases occurring in the district. The total cases include T.B. cases which have moved into the district and are added to our registers. Year Primary Notifications Total New Cases No. on Register at end of year Pul. Non-Pul. Total Pul. Non-Pul. Tota Pul. Non-Pul. Total 1943 103 18 121 127 24 151 569 128 697 1944 87 10 97 127 13 140 6211 133 753 1945 84 20 104 lib 23 139 651 146 797 1946 72 13 85 101 18 119 671 147 818 1947 1948 82 74 14 11 96 85 109 104 21 15 130 119 708 761 153 161 861 922 1949 8fi 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 1952 127 6 133 175 12 187 975 148 1123 Total 956 114 1070 1294 161 1455 — — — Av'ge 95.6 11.4 107.0 129.4 16.1 145.5 — — — The deaths from Tuberculosis during the year number 23, of which 22 were due to pulmonary and 1 to non-pulmonary disease. One of the deaths was an unnotified case. 65 The deaths are classified by age and sex in the following table:— TABLE XXII. Deaths due to Tuberculosis, 1952. Ages Years Pulmonary Non-Pulmonary Totals Males Females Males Females 0— — — — 1— — — 1 — 1 B— — — — — — 15— 1 — — — 1 25— — 1 — — 1 35— 2 1 — — 3 45— 5 3 — — 8 55— 4 1 — — 5 65— 3 1 — — 4 Totals 15 7 1 — 23 No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1952, 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 continued its valuable work, and the very comprehensive report of the Hon. Secretary on the year's work is a record of praiseworthy achievement. Its income is derived from grants from various bodies and from sale of Christmas seals. Once again the public responded very generously in the purchase of seals and the amount raised from this source was £172 5s. 4d. The Committee again gave considerable financial support to a holiday scheme for child contacts. Two camps were held during the year and 24 children from our area attended these camps and spent a very enjoyable holiday. As usual, needy patients were given assistance throughout the year, by cash gifts or loans, and gifts of clothing, bedding, coal and various other household necessities. Extra nourishment for patients on home treatment is another important item looked after by the Committee. 66 It is not possible to give in full the good work carried out by the Committee, but from the few facts given above it will be appreciated that their work is invaluable to the community. 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. 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 1,526 2,187 Pulmonary Tuberculosis, Active 3 4 „ „ Inactive 58 55 Non-Tuberculous abnormalities. Congenital abnormalities of bonythorax 14 13 Emphysema 12 1 Bronchiectasis 1 — Pleural changes 29 12 Non-specific pulmonary infection 1 — Acquired cardiovascular lesions 3 2 Congenital „ „ 1 2 Miscellaneous (i.e., old fractures, postoperative changes, etc.) 10 7 Cases not yet diagnosed (provisional) 23 24 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. 67 68 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 N on-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 1 — — — — — 1 — — — — 4 10—15 2 3 — 1 — — l — — — — — 7 15—20 6 8 — — 1 — — — — — — — 15 20—25 5 6 1 — 2 7 l — — — — — 22 25—35 22 21 1 1 13 11 l — — — — — 70 35—45 4 11 1 — 5 3 l — — — — — 25 45—55 9 5 — — — 1 — — — — — — 15 55—65 9 6 — — 1 1 — — — — — — 17 65 and over 4 1 — 1 1 2 — — — — — — 9 Totals 65 62 3 3 23 25 4 1 — — 1 — 187 133 53 1 INDEX. PAGE Accidents in the Home 21, 22 Acreage7 Ambulance Facilities 23 Acute Poliomyelitis 50, 53 Births 9, 10, 11-14 Institutional and Domiciliary 12, 13 Rates 9, 10, 14 Premature 21 Cancer—Deaths from 16, 17 Rate 17 Cinemas and Licensed Premises 44 Climatic Conditions 7 Clean Food 28 Cleansing Facilities 52 Deaths 14-21 Causes of 16, 18 Rates 9, 10 Diphtheria 51, 58-63 Immunisation 58-63 By age groups 60 Children immunised in Day Nurseries 61 Children immunised in Schools 61 Persons immunised in Clinics 60, 61 Persons immunised by Private Practitioners 60 Incidence and fatality for 33 years 62 Drainage and Sewerage 30 Drainage work 32 Erysipelas 52 69 INDEX—Continued. PAGE Factories and Workplaces 43, 48 Inspections 48 Defects 48 Food and Drugs Act, 1938 28, 39, 40 Food Poisoning 51 Food Supply 35-43 Inspections 35, 36 Unsound Food 36, 37 Health Services 22-27 Heart Disease—Deaths from 16, 18 Hospitals 24-27 Hospital Car Service 23 Housing 33, 35, 46, 47 Action taken 33, 34, 46, 47 Inspections and Defects 46, 47 Number inhabited 7 Overcrowding 34, 35, 46 Ice-Cream 41-43 Industry 7 Infant Mortality 20, 21 Causes of death 20 Rates 21 Infectious Diseases 24-26 49-57 Cases admitted to hospital 25, 26 Diseases notifiable 49 Monthly Incidence 57 Notification by Age Groups 56 Notifications, deaths and distribution 55 Inquests 15 Isolation Hospitals 24, 25 70 INDEX—Continued. PAGE Mass Radiography 67 Maternal Mortality 19 Rates 19 Measles 50 Meat Inspection 37 Mental Disease 7 Merchandise Marks Acts 44 Milk Supply 38, 41 Mosquitoes 43 National Assistance Act 27 Nelson Hospital 27 Neonatal Deaths 20 North-Eastern Divisional Health Sub-Committee 5 Notification of Births 12 Nuisances 33, 34 Nursing in the Home 22, 23 Pneumonia 52 Poliomyelitis 50, 53 Population 11 Premature Births 21 Public Cleansing 29, 30 Public Health Committee 5 Puerperal Pyrexia 52 Rainfall 7 Rateable Value 7 Respiratory Diseases—deaths from 17 71 INDEX—Continued. PAGE Representatives on :— North-Eastern Divisional Health Sub-Committee 5 Tuberculosis Care Committee 5 Wandle Valley Joint Sewerage Board 5 Rivers and Streams 30 Road Accidents—deaths from 16, 18 Rodent Control 43, 44 Sanitary Circumstances 28-47 Sanitary Inspections, Summary of 32 Scarlet Fever 26, 49, 54 Incidence in each Ward with rates 54 Monthly distribution of cases 54 Shops Act, 1950 44, 45 Smallpox 24, 49 Smoke Abatement 44 Social Conditions of the Area 7 Staff 6 Statistics 7-10 Comparative 10 Vital 8, 9 Stillbirths 20, 21 Tuberculosis 64-68 Admission to Sanatorium 65 Assistance given 66, 67 Care Committee 5, 66, 67 Deaths due to 66 Dispensary 23 Mass Radiography 67 New cases—by age groups 68 Number on register at end of year 64 72 INDEX—Continued. PAGE Vaccination 59 Venereal Diseases 24 Vital Statistics 8. 9 W an die V alley J oint Sewerage Board 5 Water Courses 43 Water Supply 28, 29 Whooping Cough 50 Whooping Cough Immunisation 58, 59 Zymotic Disease—deaths from 9 Rate 9 73 Printed by J. B, Blackmore & Co., Ltd. 85, Merton High Street, S.W.19.