Library MER 15 URBAN DISTRICT of MERTON AND MORDEN ANNUAL REPORT of the Medical Officer of Health for the year 1953 AND REPORT OF THE CHIEF SANITARY INSPECTOR - URBAN DISTRICT of MERTON AND MORDEN ANNUAL REPORT of the Medical Officer of Health for the year 1953 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. Owing to the most unfortunate death of Dr. A. W. Johns who died on 31st August, 1954, after a severe illness, I wish to present his Annual Report for the year 1953, which he had prepared. From the facts and figures contained in the ensuing pages it will be seen that the health of the district maintained its usual high standard throughout the past year. Our vital statistics—birth, death, infant mortality rates, etc.—by which it is possible to assess a healthy environment, compare favourably with the remainder of the country. A point worthy of special mention this year is the reduction in the number of deaths from pulmonary tuberculosis. The total of only 10 deaths from this disease is the lowest ever recorded for the district, and the death rate at 0.13 per thousand population is well below that for the whole of the country. Another very gratifying figure concerns care of premature babies. As will be seen from a study of the figures given in that section of the report devoted to infant mortality, out of a total of 12 infant deaths, prematurity was a contributory cause in only one instance. Out of the 45 premature babies notified during the year only one failed to survive one month. As regards infectious disease, the numbers of notifications of scarlet fever were about average, whilst those for measles and whooping cough were quite high. These diseases were, however, mild in character and there were no deaths recorded. Once again we were fortunate in having no cases of diphtheria occurring in the district. There were 15 cases of the modern scourge—poliomyelitis—notified, and one of the patients failed to survive the attack: of the others seven had some degree of residual paralysis. Sixteen cases of paratyphoid occurred in the district during the year; the attacks were mild in character and a summary of the outbreaks is given in the section of this report pertaining to infectious disease. 3 Health propaganda continues to be a very important part of our function and in addition to the normal activities of publicising diphtheria immunisation, and campaigning for cleaner food, a Home Safety Council has been formed in the district. Further details of the work of this body are contained in the paragraph on Accidents in the Home. In conclusion, I should like to express to the Chairman and members of the Public Health Committee my appreciation for their encouragement and co-operation throughout the year, and to thank the staff of my department for their loyal support. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, A. R. GRAHAM. Acting Medical Officer of Health. 4 URBAN DISTRICT COUNCIL OF MERTON AND MORDEN 1953 PUBLIC HEALTH COMMITTEE Chairman: Mrs. L. A. Doel. Mr. M. H. Burrin. Mr. S. H. Pethen. Mr. R. K. King. Miss M. R. Smith. Mr. A. W. Moore. Mr. J. Wynn. Mr. P. Hill (ex-officio). Mr. W. H. Page (ex-fficio). REPRESENTATIVES ON NORTH-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE Mr. G. J. Beaven. Mr. J. Wynn. Mr. J. L. Coombes. Mr. S. York. Miss M. R. Smith. REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD Mr. S. W. Billingham, J.P. Mr. S. York. Mr. E. K. Clarke, J.P. Mr. P. Hill (ex-officio). MERTON AND MORDEN TUBERCULOSIS CARE COMMITTEE Chairman: Mrs. M. E. Shaw. Vice-Chairman: Mrs. R. S. Piers. Secretary: Miss M. P. Morriss. Treasurer: Mr. F. S. Buck. 5 PUBLIC HEALTH STAFF, 1953 Medical Officer of Health: A. Wallace Johns, M.R.C.S., L.R.C.P., D.P.H. Chief Sanitary Inspector: a b c d W. T. Pinches, M.R.San.I. Deputy Chief Sanitary Inspector: a h c d G . E. Maton Sanitary Inspectors: a h E. N. Montague, D.P.A. a b C. W. Southerbv. a L. H. Thomas. Chief Clerk: A. A. Makepeace. Clerks: H. J. Herbert (To 17.11.53). L. G. Phillips (Prom 10.8.53). Miss D. Martyn. P. 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 Certificate, Royal Sanitary Institute. 6 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 3,238 Number of inhabited houses according to Rate Books 22,269 Rateable Value at 31st December, 1953 £696,845 Sum represented by 1d. rate £2,805 The Urban District of Merton and Morden dates from the amalgamation of Merton with Morden in 1913. It 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, but outside the Administrative County. The district is generally flat and sheltered, lying between the 42ft. and 141ft. ordnance datum levels; it is drained by the River Wandle, the Beverley and Pyl Brooks, all tributaries of the Thames. The area is both residential and industrial, the industrial area comprising three main factory groups, the largest of which is the Lombard Road Estate on the north-eastern boundary. A large part of the residential property in the area is owner-occupied, but the District Council has a pre-war housing estate of about 500 houses and has built several large blocks of flats to meet post-war housing needs. In addition, a considerable part of Morden is formed of the London County Council's St. Helier housing estate. As regards open spaces, the district is indeed very fortunate in having nearly 370 acres at its disposal. Climatic Conditions. Rain guages are installed at the Joseph Hood Recreation Ground and Morden Hall. The monthly recordings are as shown below:— RAINFALL, 1953 MONTH JOSEPH HOOD RECREATION GROUND MORDEN HALL 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 1.13 13 5 0.94 14 5 February 2.06 8 7 1.14 10 7 March 0.49 6 4 0.49 5 4 April 2.33 16 13 2.18 16 13 May 1.31 11 8 1.55 12 11 June 1.05 12 5 1.20 15 14 July 3.31 20 17 3.38 27 22 August 1.34 7 6 2.45 11 6 September 2.38 13 10 2.18 13 11 October 2.07 14 12 3.05 14 12 November 1.03 11 5 1.02 14 3 December 0.85 9 4 0.60 12 3 TOTAL 19.37 140 96 20.18 163 111 7 VITAL STATISTICS The table of comparative statistics set out on page 10 summarises the main differences between the health of the country as a whole, the London area, the large and small towns and our own district. Our birth rate at 11.8 per thousand remains low, but it is gratifying to find a further decrease in the death rate, which at 8.9 is our lowest figure for five years and is well below the other figures set out in the table. In particular we note that deaths from tuberculosis numbered only 10, giving a rate of 0.13. This compares very favourably with the remainder of the country and is some consolation after the rather high rate of 0.31 per thousand recorded last year. Our infant mortality rate of 13.8 per thousand live births is once again well below average, as also is our stillbirth rate. 8 SUMMARY OF VITAL STATISTICS. (Registrar General's Figures). Population: Registrar General's Estimate (MidYear) 73,240 Births: M. F. Total Live (Legitimate) 450 390 840 (Illegitimate) 17 11 28 467 401 868 Stillbirths (Legitimate) 9 8 17 (Illegitimate) — — — 9 8 17 Total Births 476 409 885 Birth Rate 11.8 per 1,000 population Still Birth Rate 19.2 per 1,000 births Deaths: M. F. Total Total Deaths 324 330 654 Death Rate 8.9 per 1,000 population Infant Mortality: Total deaths under one year 12 Infant Mortality Rate per 1,000 Live Births 13.8 Deaths of Legitimate Infants under 1 year 12 Death Rate per 1,000 Legitimate Births 14.3 Deaths of Illegitimate Infants under 1 year — Death Rate per 1,000 Illegitimate Births — 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) 1 7 Principal Zymotic Diseases 2 Zymotic Death Rate (per 1,000 population) 0.03 Deaths from Tuberculosis: All forms 10 Rate per 1,000 population 0.13 Phthisis: 10 Rate per 1,000 population 0.13 Deaths from Cancer: 133 Rate per 1,000 population 1,8 9 TABLE I. COMPARATIVE STATISTICS, 1953. (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 AdministrativeCounty Merton and Morden Rates per 1,000 Population Births: Live 15.5 17.0 15.7 17.5 11.8 Still 0.35 0.43 0.34 0.38 0.23 Deaths: Ail causes 11.4 12.2 11.3 12.5 8.9 Typhoid and Paratyphoid fevers 0.00 0.00 - - - Whooping Cough 0.01 0.01 0.00 0.00 - Diphtheria 0.00 0.00 0.00 — — Tuberculosis 0.20 0.24 0.19 0.24 0.13 Influenza 0.16 0.15 0.17 0.15 0.19 Smallpox 0.00 0.00 0.00 — — Acute Poliomyelitis (incl. Polioencephalitis) 0.01 0.01 0.01 0.01 0.01 Pneumonia 0.55 0.59 0.52 0.64 0.27 Notifications: (Corrected) Typhoid Fever 0.00 0.00 0.00 0 01 - Paratyphoid Fever 0.01 0.01 0 01 0.01 0.22 Meningococcal Infection 0.03 0.04 0.03 0.03 0.01 Scarlet Fever 1.39 1.50 1.44 1.02 1.99 Whooping Cough 3.58 3.72 3.38 3.30 5.65 Diphtheria 0.01 0.01 0.01 0.00 — Erysipelas 0.14 0.14 0.13 0.12 0.16 Smallpox 0.00 0.00 0.00 — — Measles 12.36 11.27 12.32 8.09 17.20 Pneumonia 0.84 0.92 0.76 0.73 1.23 Ac. Poliomyelitis: Paralytic 0.07 0.06 0.06 0.07 0.15 Non-Paralytic 0.04 0.03 0.04 0.03 0.05 Food Poisoning 0.24 0.25 0.24 0.38 0.03 Rates per 1,000 Live Births. Deaths: All causes under 1 year of age 26.8† 30.8 24.3 24 8 13.8 Enteritis and Diarrhoea under 2 years of age 1.1 1.3 0.9 1.1 1.1 Rates per 1,000 Total Births (Live and still). Notifications: (Corrected) Puerperal Pyrexia 18.23 24.33 12.46 28.61 46.32 † Per 1,000 Related Live Births. 10 POPULATION. The Registrar General's mid-year estimate of the population of the district was 73,240, a decrease of 430 as compared with that for 1952. The 1951 census figure of 74,730 has thus been reduced by 1490, despite natural increases during the period ranging from 160 to 214 annually. BIRTHS Eight hundred and sixty eight live births were registered during the year, together with 17 still births, giving a total of 885. The live birth total is one below that for the previous year, the birth rate remaining the same. It has now remained steady for the past three years after a steady decline since 1947, our peak year. The number of illegitimate births registered were once again 28. This figure has been constant for the past three years, the rate remaining at 32.2 per thousand live births. Year No. illegitimate live births Kate 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 1953 28 32.2 11 INSTITUTIONAL AND DOMICILIARY BIRTHS An analysis of the birth notifications shows that 742 of the 885 births occurred in hospital, institutions and nursing homes. This represents 84% of the total and is again a slight decrease, the peak being reached in 1951 when 89% of the total births took place in the various maternity departments. Table II, set out on page 13 shows the trend since 1935. The distribution of institutional births is given below:— St. Helier Hospital 356 Nelson Hospital 268 St. Teresa's Hospital 24 Kingston Hospital 19 Other hospitals, institutions and nursing homes 75 742 12 TABLE II. Numbers and percentages of Institutional births, 1935 -1953. 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 St. Helier Hospital - - - - - - - - 325 335 341 439 468 372 438 419 419 408 356 Nelson Hospital 175 194 207 1% 230 214 343 305 236 200 216 209 285 289 300 276 276 266 268 Kingston Hospital 41 78 91 103 80 94 69 44 43 22 22 18 17 10 9 10 13 11 19 Others 105 128 150 251 248 147 81 219 187 221 194 257 282 184 95 78 77 91 99 Total Institutional Births 321 400 448 550 558 455 493 568 791 778 773 923 1052 855 842 783 785 776 742 Total Births 721 789 812 990 1005 971 848 1069 1116 1151 1027 1261 1345 1087 985 938 881 887 885 % of Institutional to Total Births 45% 51% 55% 56% 57% 47% 58% 53% 69% 67% 73% 72% 76% 77% 83% 83% 89% 87% 84% 13 TABLE III. Showing Births and Deaths with Rates since the Amalgamation of Merton with Morden. Year Estimated population Total Live Births Birth Bate 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 55.550 770 138 484 8.7 286 1935 57,440 721 12.5 433 75 288 1936 61,000 789 129 443 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 15.5 612 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 74,730 870 11,73 710 8.58 160 1952 73,670 869 11.8 690 9.4 179 1953 73,240 868 11.8 654 8.9 214 DEATHS. The number of registered deaths after adjustment by transferable deaths, is given below:— 654 total deaths of which 324 were males and 330 females. The seasonal mortality is indicated by the deaths for each quarter of the year, which were:— First quarter 243 Second quarter 146 Third quarter 122 Fourth quarter 143 14 Inquests. Inquests were held on 34 deaths occurring in the district, 24 of which were in respect of residents. The verdicts returned were as follows:— (1) Accidental Deaths— Collision with Motor Vehicles 2 Collision with train 1 Coal Gas Poisoning 2 Falls 10 Carbon Monoxide Poisoning 1 16 (2) Suicide by— Coal Gas Poisoning 8 Barbiturate Poisoning 3 Asphyxia by Hanging 3 Sodium Amytol Poisoning 1 Throat Injury 1 16 (3) Open Verdict— Injuries caused by train 1 Barbiturate Poisoning 1 2 34 The total number of inquests held were twelve more than in the year before. Road accidents were responsible for two of the total accidental deaths, compared with five for the previous year. 15 CAUSES OF DEATH. There were 654 deaths registered during the year, of which 324 were males and 330 females. Of this total, 213 were attributed to heart disease (including coronary disease, angina and hypertension with heart disease); this was, as usual, the largest single cause of death. Deaths from cancer, at 133, were the lowest recorded since 1948 and the rate, after remaining at 2.0 or more for the past four years, dropped to 1.8. Despite this decrease, deaths from cancer of the lung were one more than in 1952. Since this classification was first introduced into the short list in 1950 deaths of residents of the district from this distressing disease have increased from 25 to 36 annually. The most significant decrease in the table is that of deaths from tuberculosis. Those from respiratory tuberculosis number 10 only, the lowest on record, whilst for the first time we had no deaths recorded from other forms of this disease. In the past ten years our death rate from pulmonary tuberculosis has been reduced from 0.55 to 0.13 per thousand population. Deaths from motor vehicle accidents showed a welcome decline from 7 in 1952 to 3 this year, but deaths from other accidents were unfortunately quite high. There was a marked increase in suicides, the number reaching the very high figure of 13, which according to our records, is the highest number ever registered in the district. There were 12 infant deaths and one maternal death. These are commented upon further, on pages 19 and 20. 16 CANCER DEATH RATE. No. of deaths from Cancer for past 10 years. 1944 107 1949 152 1945 116 1950 151 1946 126 1951 147 1947 118 1952 154 1948 110 1953 133 Year. Death rate per 1,000 population. Year. Death rate per 1,000 population. 1944 1.7 1949 2.0 1945 1.7 1950 2.0 1946 1.7 1951 2.0 1947 1.5 1952 2.1 1948 1.5 1953 1.8 TABLE IV. Deaths from Respiratory Diseases, 1934 -1953. Year Bronchitis Fneumonia Other Respiratory Diseases Total Death Rate 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 4.0 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 1953 46 20 22 88 1.20 17 TABLE V. Causes of Death during 1953. No. Cause of Death. Males Females Total 1 Tuberculosis, respiratory 7 3 10 2 Tuberculosis, other — — — 3 Syphilitic disease — 1 1 4 Diphtheria — — — 5 Whooping Cough — — — 6 Meningococcal Infections — — — 7 Acute poliomyelitis — 1 1 8 Measles — — — 9 Other infective and parasitic diseases - - - 10 Malignant neoplasm, stomach 11 9 20 11 Malignant neoplasm, lung bronchus 31 5 36 12 Malignant neoplasm, breast — 14 14 13 Malignant neoplasm, uterus — 10 10 14 Other malignant and lymphatic neoplasms 31 22 53 15 Leukaemia, aleukaemia 1 1 2 16 Diabetes 1 2 3 17 Vascular lesions of nervous system 27 42 69 18 Coronary disease, angina 68 42 110 19 Hypertension with heart disease 9 13 22 20 Other heart disease 38 43 81 21 Other circulatory disease 16 18 34 22 Influenza 3 11 14 23 Pneumonia 9 11 20 24 Bronchitis 26 20 46 25 Other diseases of respiratory system 7 1 8 26 Ulcer of stomach and duodenum 6 — 6 27 Gastritis, enteritis and diarrhoea 1 5 6 28 Nephritis and nephrosis 2 3 5 29 Hyperplasia of prostate 2 — 2 30 Pregnancy, childbirth, abortion — 1 1 31 Congenital malformations 2 5 7 32 Other defined and ill-defined diseases 17 28 45 33 Motor Vehicle accidents 2 1 3 34 All other accidents 3 9 12 35 Suicide 4 9 13 36 Homicide and operations of war - — - Total all causes 324 330 654 18 MATERNAL MORTALITY. There was one maternal death in the area during the year under review, giving a maternal mortality rate of 1.13 per thousand births, live and still. 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, 1934-53 With Comparable Rates for England and Wales. Year Death rate per thousand total births. Sepsis Other causes Total llerton and Morden England and Wales Morton and Morden England and Wales Merton and Morden England and Wales 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 24 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 1953 0.16 1.13 0.60 1.13 0.76 19 INFANT MORTALITY. There were 12 deaths registered of infants under one year, giving an infant mortality rate of 13.8 per thousand live births. This is the second lowest rate ever recorded in the district and compares very favourably indeed with the average for the remainder of the country. Prom a study of the details given below it will be seen that 9 of these were neonatal deaths. In only one case was prematurity given as a contributory cause of death. One child died of gastro-enteritis, our first infant death from this cause since 1948. Stillbirths registered were 17—one less than last year— but the rate at 19.2 unfortunately shows no sign of any appreciable reduction, although our rate compares very favourably with the rest of the country. A table showing the infant mortality and stillbirth rates for the past 10 years is given on page 21. Infant Deaths — With causes of death. Sex Age Cause of Death Male 7 hours Atelectasis. Prematurity. Male 6 days Icterus Gravis. Congenitally infective kidney. Female 3 months Aortic Stenosis. Congenital condition. Female 5 weeks Septic Meningitis following Otitis Media. Female 3 days Cerebral Haemorrhage. Male 1 day Atelectasis. Tentorial Tear. Male 1 day Cerebral Haemorrhage. Female 10 hours Atelectasis. Fem ale 1 week Multiple Congenital Deformities. Chronic Nephritis. Ursmia. Male 4 days Bilateral Superenal Haemorrhage Septicaemia. Female 20 hours Neonatal Asphyxia. Congenital Morbus Cordis. Female 4 months Toxaemia. Non-specific Castro-enteritis. 20 TABLE VII. Infant Mortality and Stillbirth Rates for the past 10 years. Year Infant Mortality Rate Stillbirth Rate 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 1953 13.8 19.2 PREMATURE BABIES. There were 45 premature births notified during the year; only one of these babies failed to survive one month. Below is a summary of the notifications:— (a) At home 4 (b) In hospital 41 The number of those born at home:— (a) Who were nursed entirely at home 4 (b) Who died during the first 24 hours 1 (c) Who survived at the end of one month 3 The number of those born in hospital:— (a) Who died during the first 24 hours (b) Who survived at the end of one month 41 ACCIDENTS AT HOME During the latter part of the year a Home Safety Council was formed in the district, its object being " to endeavour to be of practical means of help to the people of Merton and Morden and to bring to their notice by means of propaganda the importance of measures to reduce accidents in the home." This is an independent body which owes its formation, primarily, to a suggestion by one of the local Residents' Associations; it consists of representatives from the majority of the Local Associations and three representatives from the District Council. On invitation, the Gas Board and Electricity 21 Board, the Surrey Fire Brigade and the Metropolitan Police have also appointed representatives. The policy at present is to concentrate propaganda to one particular subject each month. The campaign opened in November, during which month the subject was " Fireguards," whilst December was confined to the dangers of poisoning. Propaganda took the form of leaflets and posters mainly, at the outset, facilities at the Welfare Centres, Council Offices and the offices and showrooms of the Gas and Electricity Undertakings being used. Circulars were sent to all schools in the area giving facts and figures and head teachers were asked to associate themselves with the Council's efforts and to press home the campaign to the children by any means which were considered appropriate. Response from the schools was very good indeed and some schools, which expressed a desire for film strips to show to the children, were supplied with films by the Central Council for Health Education. The work of the Home Safety Council received good publicity from articles in the local Press and at the end of the year arrangements were well in hand for an enthusiastic campaign for 1954. 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 Mertcm District Nursing Association employs one full-time ana 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, 31, Links Avenue. LIB 5850. Fart-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 tlie 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 tlie 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. HOSPITALS Smallpox. Arrangements for the prompt isolation of any case of smallpox discovered in the district continued unchanged. Should the necessity arise, the South-East Metropolitan Regional Hospital Board would provide accommodation at the Joyce Green Hospital, Dartford, where there is an experienced medical and nursing staff accustomed to handling the treatment of this disease. Other infectious disease. Cases from our area are admitted mainly to the Wandle Valley Hospital, the overflow going to The Grove, Tooting; a few other cases are admitted to outlying hospitals including Cuddington and Tolworth Isolation Hospitals. Table VIII on page 25 shows details of the cases concerned, the greatest number of admissions, as usual, being Scarlet Fever. 24 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. Females — Saturdays at 10.45 a.m. 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. General and Maternity. 1. The Nelson Hospital. The accommodation of this hospital, which serves the Wimbledon, Merton and Morden areas, is 121 beds, 47 of which are maternity. Eight hundred and forty-four births took place in this hospital during the year, of which 268 were Merton and Morden babies. During recent years about 30% of our babies have been born in the Nelson Hospital. 2. Other hospitals. Amoung other hospitals available for use of our residents are St. Helier Hospital, Carshalton, and the Epsom and Kingston Hospitals. St. Helier is very widely used, with special emphasis on the Maternity Department, which accounted for 356 (40%) of our births this year. TABLE VIII. Gases admitted to Isolation Hospitals during the year 1953 . Disease (Final Diagnosis) Wandle Valley Grove Others Cases Deaths Cases Deaths Cases Deaths Scarlet Fever 56 - 3 - 7 - Rubella 2 - - - - - Measles 6 - - - 1 - Erysipelas 2 - 1 — - — Whooping Cough 1 — — — — Poliomyelitis. 4 3 - 7 1 Enteritis contact 1 - - - - Sonne Dysentery 2 — — 2 — Paratyphoid "B" 4 1 — 2 — Bronchitis and Asthma 1 — — — — Allergic Urticaria 1 — — — — — Croup and Enteritis 1 — — - - Catarrhal Jaundice 1 — — - - Dietetic Disturbance 1 — Chicken Pox — 2 — Febrile Catarrh — 2 — — — Meningococcal — — — 1 — Infection Tonsillitis — — — 2 — Total 83 — 12 — 22 1 25 MENTAL DISEASE. Cases dealt with under the Lunacy Acts, 1890, in the district of Merton and Morden. There were 38 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 6 9 Delusional Insanity 5 4 9 Suicidal 2 5 7 Schizophrenia 2 2 4 Hallucinated and Depressed 1 7 8 Epilepsy 1 — 1 Total 14 24 38 Of these cases 4 were certified under Section 16, 26 were placed under observation under Section 20, and 8 were removed to hospital under an Urgency Order under Section 11. In addition 57 patients (19 male and 38 female) were admitted direct to Mental Hospital under Section 1 of the Mental Treatment Act, 1930, as voluntary patients. NATIONAL ASSISTANCE ACTS. No cases arose during the year in which it was necessary to contemplate action under Section 47 of the National Assistance Act, 1948, or the National Assistance (Amendment) Act, 1951. SECTION C — SANITARY CIRCUMSTANCES Food Advisory Committee. Members of the Council, representatives of the trade and of various associations and organisations, combine to form this Committee, whose efforts are of course applied mainly to propaganda and endeavouring to educate the public, and the proprietors and employees of food premises, in regard to standards of cleanliness. 26 Our poster display stand again played its part and was exhibited at various Fairs, Fetes and Flower Shows. Six of these functions in all were visited. In addition, a vehicle was entered in the Council's Coronation Carnival Procession. Arrangements were made for delivery of posters to food shops and restaurants in the area and many of these local traders co-operated in disseminating this form of propaganda. Cinema Managers were approached regarding the possibility of arranging for slides to be shown at the local theatres. Unfortunately we were informed that facilities of this nature were only granted for specific National Weeks (e.g. Road Safety Week) and we were unable to proceed further. The twelve Secondary Schools in the district were approached with a view to bringing the objects of the Committee before the school leavers. Seven of the schools cooperated and a short talk to the scholars was followed in each case by a display of three films. The venture proved to be very successful. Food and Drugs Act. Two hundred and ten samples were submitted to the Public Analyst during the year. The overall result was quite satisfactory, only five of these being reported as adulterated or not genuine. Details of the samples and of action taken regarding those reported as non-genuine will be found on pages 36 and 37. Eighty-six samples of milk were sent to the Public Health Laboratory for bacteriological examination and all conformed to the prescribed standards. Eightytwo samples of ice cream were also sent to the Laboratory and the results showed a great improvement over last year; further details of these will be found on pages 38-40. 27 Food premises in the area number 410 and are divided into the following categories:— Bakehouses 9 Milk Shops (other than dairies) 16 Bakers 24 Butchers 31 Off Licences 19 Chemists 18 Public Houses 16 Confectioners 56 Restaurants, Cafes and Snack Bars 50 Corn Chandlers 3 Dairies 5 School Canteens 12 Fishmongers 16 Staff Canteens 49 Fish Fryers 16 Wholesale Confectioners 3 Greengrocers 47 Wholesale Food Manufacturers 1 Grocers 90 Ice Cream Dealers 100 Wholesale Grocers 2 The total number in the categories is, of course, fur greater than the actual number of premises, as at several of them two or more of the above trades are carried on. Inspections of these premises during the year totalled 1639. Details of offences and action taken are included in the Chief Sanitary Inspector's report on page 33. Registrations under Section 89 of the Merton and Morden Urban District Council Act, 1936, at the end of the year were as follows:— Ice Cream Manufactureres 1 Ice Cream Dealers 124 Ice Cream Vendors (Itinerant) 16 Preserved Food Manufacturers 33 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. Seven samples of water from domestic taps were submitted for chemical or bacteriological examination. The reports on each sample were satisfactory. Arrangements are also made to take periodic samples from the drinking fountains in the Council's parks and open spaces. Samples were taken from five different fountains for chemical and bacteriological examination and all proved to be satisfactory. Three of these fountains are on the Metropolitan Water Board supply and the other two draw their supply from the Sutton District Water Co. mains. There are 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 28 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. Prom that time a weekly collection has been maintained with the exception of occasional periods during the War when shortage of labour caused disorganisation. The disposal of screenings by tipping on low lying land at Morden Hall Park, to raise the level of the iand, was continued throughout the year. During the year 14,652 tons of house refuse was collected and disposed of. The salvage tonnage for the year was as follows:— Tons. Tons Paper 936 Bottles and glass 163 Metal 608 Rags 35 Pig Foods 614 Drainage and Sewerage. No major works have been undertaken during the year but normal cleansing routine of the soil sewers has been undertaken from time to time. Rivers and Streams. No major works to rivers and streams have been carried out. 29 REPORT OF THE CHIEF SANITARY INSPECTOR. Mr. Chairman, Ladies and Gentlemen, In presenting this Annual Report on the activities of the Sanitary Inspectors during 1953, I think I can best indicate the general scope of the work by setting out in tabular form the main divisions and the 9,669 inspections made thereunder:— Food Shops, etc 1,562 Housing—primary visits 683 „ —reinspections 888 „ —overcrowding provisions 213 „ —miscellaneous 50 Drainage—chokages and repairs 1,534 Rat and Mice destruction 495 Shops—Welfare provisions 528 Infectious Disease enquiries 936 Factories and Workplaces 528 Milk Supply 77 Smoke abatement 607 Rivers and Stream pollution 75 Stables and Piggeries 110 Miscellaneous (Caravans, Hairdressers, Schools, Building sites, etc) 1,383 9,669 There was a slight increase in the total number of inspections, mainly due to increased visits to food premises, but the need for more frequent visits to these is still apparent. Unfortunately it proved impossible to extend this part of the department's activity without cutting down the time devoted to other routine visits. Periodic inspections are required at the following premises:— Wholesale Food Manufacturers 1 Bakehouses. 9 *Food Shops and Catering Establishments 592 Off Licences 19' Public Houses 16 Other Shops 276 Factories (Power) 190 Factories (Non-power) 9 Offices 68 Workplaces, etc 111 * For details see page 27 30 HOUSING. Much time continues to be spent on this work and a total of 683 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 30 cases where statutory action had to be taken. Legal proceedings were not necessary in respect of any of these cases, although in the four instances reported last year, a special application had to be made to the Wimbledon Court to enforce Nuisance Orders. A great deal of time was expended but the work was ultimately carried out. Action taken in connection with dwelling houses, as set out in the housing tables on pages 46 and 47 resulted in the following improvements:— Summary of Nuisances Abated and Sanitary Improvements Effected. Ceilings cleansed or repaired 52 Dampness in premises remedied 46 Drains exposed and repaired 7 Drains reconstructed 1 Defective sashcords renewed 35 Dustbins provided 41 Floors repaired 20 Fresh air inlet valves provided and repaired 10 Inspection chamber covers provided 5 Obstructions removed from drains 10 Rain water pipes renewed or repaired 12 Roofs repaired 48 Gutters repaired 35 Sink wastes repaired 11 Walls repaired 134 W.C. cisterns; provided — W.C. cisterns repaired 10 Water closests cleansed — W.C. pans provided 9 Windows repaired or renewed 41 Ventilation provided under floors 1 Fireplaces and stoves renewed or repaired 20 Sinks provided 1 Offensive accumulations removed 8 Water supply repaired for domestic use 15 Verminous premises fumigated and cleansed — Sanitary accommodation for workshops 2. Miscellaneous Ill 31 Notices Served. Intimation notices 200 Statutory notices Public Health Act, 1936 30 Housing Act, 1936 — Moveable Dwellings. One application for a licence to station a caravan in the district was received, being for renewal of an existing permission. It was granted for a further twelve months. Several times during the year, caravans occupied by " pseudo gipsies " were found on unfenced vacant land in the east of the district and difficulty was experienced in securing their removal. The owners having been persuaded to enclose the land with wire mesh fencing, the caravans were finally placed in a cul-de-sac on the public highway. Action was taken by the Police to remove them. Overcrowding. Of the 81 cases carried over from the last report, 42 were abated during the year by rehousing. Twentynine further cases were discovered during 1953 and the location and type of the cases known at the end of the year were as follows:— Merton and Morden Council houses ... 8 cases L.C.C. estate ... ... ... ... ... 30 „ Privately-owned houses ... ... ... 30 „ 68 Whole houses overcrowded—27 cases. (a) One family occupation ... ... 5 cases (b) Two or more related families ... 21 „ (c) Two or more unrelated families 1 „ Part house overcrowded—41 cases. (a) Unrelated families ... ... ... 6 „ (b) Related families (married sons or daughters) ... ... 35 „ 68 32 FOOD SUPPLIES The majority of the shops, works' canteens, etc., were in good condition with adequate food storage, sanitary and washing accommodation, but at 84 premises the following unsatisfactory points were noticed:— Unclean and Defective Premises 51 Unclean Utensils 10 Accumulation of Refuse 6 Defective or Insufficient Bins 11 Unprotected Pood 18 Defective Sanitary Accommodation 3 Washing facilities:— (a) No hot water 20 (b) No soap 4 (c) No towels 7 (d) Non-display of notice re washing hands 7 Unsound Food. The undermentioned articles of food were found, upon inspection, to be unfit for human consumption; were surrendered and either destroyed or disposed of for animal feeding or salvage:— Description. Amount. Cause. Beef 1,030 lbs. Internal putrefaction, carcinoma, etc. Pork 29 lbs. Bruising and decomposition. Mutton 3¾ lbs. Caseous lymphadenitis. Veal 4¼ lbs. Mouldy. Lamb 9¼ lbs. Abscess. Bacon 54 lbs. Decomposition. Turkeys 102 lbs. Decomposition. Kidneys 32 lbs. Maggotty and flyblown. Sausages 24½ lbs. Decomposition. Lambs Livers 18 lbs. Decomposition. Meat Pies 32 Mouldy. Fish 59 stone Decomposition. Prunes 17 lbs. Deterioration. Fruit Cake 12 lbs. Mouldy. Fruit Salad 66 jars Fermented. 33 Description. Amount. Cause. Cheese 16 lbs. Mouldy. Biscuits 46 pkts. Contamination. Pigs 14 lbs. Fermentation and Deterioration. Coconut Ice 336 lbs. Mould growth. Crabs 6 lbs. Decomposition. Sugar 16 lbs. Contamination. Chocolate teacakes 19 tins Rancid and Mouldy. Tomato Ketchup 528 btls. Stale. Tinned food 4,442 tins Blown, punctured, decomposed, 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 — — — — 76 Number inspected — — — — 76 Number found fit for human consumption - - - - 76 Organs condemned. Reason for condemnation. 1 heart Pericarditis. 1 spleen Abscess. 2 lungs Pneumonia. 1 head Tuberculosis. 3 mesenteries Tuberculosis. 1 pluck Pleurisy. 1 leg Abscess. 1 Udder Abscess. 34 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. 77 inspections were made of dairies and milkshops in 1953 and at the end of the year there were on the register 27 distributors and 5 dairies, of which 3 were large distribution depots handling only milk in bottles or sealed drums. 86 samples of milk were submitted for bacteriological examination during the year and all conformed to the prescribed standards. The development of the new Morden Processing Depot proceeded and numerous consultations took place with the Directors of the firm regarding the licensing requirements. The plant was due to come into operation in the autumn of 1953, but delays occurred, and pasteurising actually commenced in 1954. The undermentioned licences to use special designations were granted during 1953. Dealers Licences. Pasteurisd 16 Tuberculin Tested15 Sterilised 18 Supplementary Licences. Pasteurised 20 Tuberculin Tested 20 Sterilised 19 Details of the chemical analysis of milk samples will be found on page 38. 35 36 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 - Almonds, ground 3 3 Baking Powder 1 1 Biscuits 1 1 Blancmange Powder 1 1 — Cakes 4 4 Coffee Essence 2 2 Cornflour 1 1 Cornish Pasties 1 1 Crab, potted 3 3 Cream 2 2 Custard Powder 1 1 Dripping 2 1 1 Pish Cakes 1 1 Flavouring Essence 1 1 Fruit, bottled or tinned 3 3 Fruit, dried 1 1 Glace Cherries 1 1 Glucose 1 1 Gravy Powder 1 1 — Ham, devilled 2 2 Honey 1 1 Horseradish 4 3 1 Ice Cream 30 30 Iodine 2 2 Jam 2 2 Jelly 1 1 Meat, tinned 2 2 - Mincemeat 1 1 - Milk 69 69 Nutmeg, ground 2 2 Paste, fish 12 12 Paste, meat 4 4 - Peas, tinned 1 1 - Pepper 1 1 Pies, meat 3 3 Article Total Samples Genuine Not Genuine Quinine, Amm, tincture of 1 - 1 Sage 1 1 — Salmon, potted 1 1 - Sardine, with Pimiento 2 2 - Sausage Rolls 4 4 — Sausages 16 14 2 Sausage Meat 3 3 - Savoury Spread 1 1 Soup, tinned 2 2 Sponge Mixture 1 1 Suet 1 1 Sugar, Muscavado 1 1 Sweets 7 7 - Total 210 205 5 Action Taken. (a) Pork Sausages (1721, informal). Contained added preservative—sulphur dioxide 90 parts per million by weight. A letter was sent to the retailer warning against "splitting" of ready wrapped sausages and failing to supply a statutory declaration regarding preservatives. (b) Pork Chipolata Sausages (1724, informal). Incorrectly described as chipolata sausages. Manufacturer interviewed and advised regarding size/weight ratio. (c) Horseradish (1746, informal). Devoid of aroma and pungency, and worthless for the purposes for which horseradish is used. Formal sample was unobtainable. Packer's address on label was insufficient, but case was referred to the local authority in whose area the packer was believed to operate. (d) Ammoniated Tincture of Quinine (1775, informal). Contained only 1.5;% w/v of anhydrous quinine, instead of a minimum of 1.56% w/v, as required by the B.P.C. A cautionary letter was sent to the retailer. (e) Beef Dripping (1897, informal). Contained 3.5% Oleic Acid, instead of a minimum of 1.5% of free fatty acids. A subsequent formal sample proved to be genuine. 37 A summary of the fat and non-fatty solids contents of the 67 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 11 26 24 4 1 - - 67 Milk fat (legal standard is 3.0%). Less than 3.0 3.0 3.1 3.2 3.3 3.4 3.5 3.7 3.8 3.9 4.0 4.1 Total — — 2 ,3 14 17 7 5 5 1 1 2 67 Ice Cream. The distribution trade continues to be subject to continual change of retailers and at the end of the year there were 124 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 82 samples were obtained and submitted for examination with the following results:— No. Provisional Grade Methylene Blue Test Coliform B. Remarks 1 1 Satisfactory Absent 2 1 ,, ,, 3 1 ,, ,, 4 5 1 1 ,, ,, 6 1 ,, ,, 7 1 ,, ,, 8 1 ,, ,, 9 1 ,, ,, 10 11 1 ,, ,, 12 1 ,, ,, 13 1 ,, ,, 14 1 ,, ,, 15 1 ,, ,, 16 1 ,, ,, 17 1 ,, ,, 18 1 ,, ,, 19 1 ,, ,, 20 1 ,, ,, 21 1 ,, ,, 22 1 ,, ,, 23 1 ,, ,, 38 39 No. Provisional Grade Methylene Blue Test Coliform B. Remarks 24 1 Satisfactory Present 25 2 ,, Absent 26 1 ,, ,, 27 1 ,, ,, 28 ,, ,, 29 1 ,, ,, 30 1 ,, ,, 31 1 ,, Present 32 1 ,, Absent 33 1 Unsatisfactory Present 34 1 Satisfactory Absent 35 1 ,, ,, 36 ,, Present 37 1 ,, Absent 38 1 ,, ,, 39 Unsatisfactory Present 40 1 Satisfactory Absent 41 1 ,, ,, 42 ,, Present 43 1 ,, Absent 44 1 ,, ,, 45 1 ,, ,, 46 1 ,, Present 47 1 ,, Absent 48 1 ,, ,, 49 1 ,, ,, 50 1 ,, ,, 51 1 ,, ,, 52 1 ,, Present 53 1 ,, Absent 54 1 ,, ,, 5S 1 ,, ,, 56 1 ,, Present 57 1 ,, ,, 58 1 ,, Absent 59 1 ,, ,, 60 1 ,, ,, 61 1 ,, Present 62 1 ,, Absent 63 1 ,, ,, 64 1 ,, ,, 65 1 ,, Present 66 1 ,, Absent 67 1 ,, ,, 68 ,, ,, 69 ,, ,, 70 ,, ,, 71 ,, ,, 72 ,, ,, 73 1 ,, ,, 74 1 ,, ,, 75 1 ,, ,, 76 1 ,, ,, 77 1 ,, ,, 78 1 ,, ,, 79 1 ,, ,, 80 1 ,, ,, 81 2 ,, ,, 82 1 ,, ,, Result probably due to Thermoduric Organisms 40 The results are summarised as follows:— Grade 1 75 92% „ 2 5 6% „ 3 2 2:% ,, 4 — — 82 100% Thirty samples were sent to the Public Analyst for chemical examination, results being as follows:— Legal Minimum 5% 6% 7% 8% 9% 10% 11% 12% 13% 14% 16% 16% 17% 18% 19% 30% 21% Fat 5% 1 1 2 1 6 8 8 1 2 - - - - - - - - Non-fatty milk solids 7½% - - 7* 8 8 3 4 - - - - - - - - - - Sucrose 7½% - — — 1 — 1 5 5 9 5 2 1 1 — — — — Total 10% Sugars - - -- - - - - 2 5 5 4 4 7 1 1 - 1 * Two of these samples contained 7.l% and 7.3% respectively. The attention of the manufacturer was drawn to the slight deficiency. GENERAL SANITATION Factories and Workplaces. The number of inspections made to premises registered under the Factories Act, 1937, was 248. Defects relating to sanitary conveniences, ventilation and other sanitary matters were dealt with at 42 premises. The table on page 46 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 Wandle, and Beverley and Pyl Brooks for the purpose of detecting pollutions. Details of pollutions entering from the Council's surface water sewers were received from the Surrey County Council and investigated. 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 breeding ground due to occasional flooding from the River Wandle. The scheme for raising the level of part of the Park by utilising spent screenings from the Refuse Works was commenced during the year. 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. 248 complaints of infestation were received during the year and as a result of the inspections of 1508 premises, 260 of them were found to be infested. The control method recommended by the Ministry of Agriculture was followed in every case. A 10% test baiting of the Council's sewers was made and 143 manholes were included. The " take " was higher than last year at 10% complete and 17% 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. 41 Smoke Abatement. A number of complaints were received relating to excessive smoke emission from certain factory chimneys. 607 observations were made and action taken to reduce the emmision of smoke. A grit nuisance was established to emanate from a laundry, and informal action secured the rearrangement of the steam demand with a cessation of the trouble. 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 in respect of the following articles:— Apples Malt Products Bacon Margarine Butter Meat Currants Oat Products Eggs, dried Raisins Eggs, shell Salmon Ham Sultanas Honey Tomatoes The Sanitary Inspectors enforce these provisions during their routine visits. Shopkeepers, generally make due compliance with the orders and only eight informal warnings were needed. Filling Materials. The three local manufacturers of stuffed toys and perambulators continued to purchase their supplies under the British Standards Institution certification mark scheme. Thirteen 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 477 Evening Patrols 1 Sunday and half holiday Patrols 85 42 Infringements:— Number of premises at which contraventions were found 68 Number of premises at which prescribed forms were not exhibited 47 Assistants half holiday forms not exhibited 33 Young persons records not maintained 12 Forms regarding seats for females not exhibited 23 Mixed shop notices not exhibited 12 Sunday employment notices not exhibited 3 Insufficient heating 10 Insufficient ventilation - Sanitary accommodation:—Insufficient 3 Dirty 8 Unlighted 4 Half day closing 1 Absence of seats for females 5 I would like to express my gratitude for the continuing support of the Chairman and members of the Public Health Committee and the encouragement of the Medical Officer of Health. I am, Ladies and Gentlemen, Your obedient Servant, W. T. PINCHES, Chief Sanitary Inspector. 43 SECTION D. — HOUSING Housing and Overcrowding. During the year 161 new houses were built in the Urban District, 116 by the Council, and 45 by private builders 500 eligible applications for rehousing were received by the Housing Manager during the year; 130 houses and flats were allocated to tenants during this period. By the end of the year the number of outstanding applications was 2,034. Arising out of rehousing enquiries, 52 complaints of over crowding were received. Of these, 29 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 dwelling houses inspected for housing defects (under Public Health or Housing Acts) 683 (b) Number of inspections made for the purpose 683 ii. (a) Number of dwelling houses (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 dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — iv. Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 200 2. Remedy of defects during the year without service of formal notice:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 201 44 3. Action under Statutory Powers during the year:— A.—Proceedings under Section 9, 10 and 16 of the Housing Act, 1936:— (i) Number of dwelling houses in respect of which notices were served requiring repairs — (ii) Number of dwelling houses which were rendered fit after service of formal notices (a) By owners — (b) By local authority in default of owners — B.—Proceedings under Public Health Acts (i) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 30 (ii) Number of dwelling houses in which defects were remedied after service of formal notices (a) By owners 41 (b) By local authority in default of owners — C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (i) Number of dwelling houses in respect of which Demolition Orders were made — (ii) Number of dwelling houses 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 33-40). 45 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, 41 and 6 are to be enforced by Local Authorities 9 5 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 190 242 42 - (iii) Other Premises in which Section 7 is enforced by the Local Authority 1 1 - — Total 200 248 42 - 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 Referred To H.M. Inspector By H.M. Inspector Want of cleanliness; (S.I.) 1 1 - - - Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S 4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) - - - - - (a) Insufficient 2 1 — — — (b) Unsuitable or defective 38 38 - - - (c) Not separate for sexes 3 2 - - - Other offences against the Act (not including offences relating to Outwork) 4 - 4 — — Total 48 42 4 - - 46 SECTION F — INFECTIOUS ILLNESS Notification. The Public Health (Infectious Disease) Regulations, 1953, came into force on the 1st April, revoking the Public Health (Infectious Disease) Regulations, 1927. They correspond with the revoked regulations in requiring notification of malaria, dysentery, acute primary pneumonia and acute influenzal pneumonia. In addition, they extend the precautionary measures against food poisoning by relating these to typhoid fever, paratyphoid fever or other salmonella infections, dysentery and staphylococcal infection likely to cause food poisoning. Under the new regulations it is now possible to prevent persons suffering from these diseases, and persons shown to be carriers, from continuing employment as food handlers and also from entering such employment. Also, the local authority can now authorise the Medical Officer of Health to issue notices in emergency, when he considers such action necessary to check the spread of these diseases. 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, neither were we required to undertake surveillance of any contacts. 47 Scarlet Fever. Notifications during the year totalled 146, giving a case rate of 1.99 per thousand population. Sixty-six cases were removed to isolation hospital, a slightly higher percentage than last year. One hundred and nineteen of the notifications concerned children attending school, 106 from schools in our area and 13 from schools in neighbouring districts. Two schools in particular accounted for 45 cases, both having minor outbreaks during the summer term. There was one return case during the year, a boy of 3½ years contracting the disease a week after his sister had been discharged from hospital as free from infection. Poliomyelitis. Twenty patients were removed to hospital as suspected cases of poliomyelitis. Fifteen of these were established as cases, 11 paralytic and 4 non-paralytic. Unfortunately one of the patients, a little girl aged 9 years died. Apart from this one case the attacks appeared to be less severe than usual, and in only very few cases was there any residual paralysis. Further details are set out on pages 52 and 53. Whooping Cough. There were 414 notifications of whooping cough during the year, our highest number ever recorded since this disease became notifiable in October 1939. Fortunately, although the number of cases appears to be on the increase, once again we had no deaths recorded from this disease. There has in fact been only one death from whooping cough in the district in the past nine years. Tt is amongst the young babies that there is most danger from this disease, and it speaks well for the health and strength of our infant population when we note that the 92 children under one year ot' age who have been notified as suffering from whooping cough during the last six years all managed to survive the attacks. Measles, The number of cases of measles notified (1260) was also our highest on record. The epidemic lasted for five months, from January to May, and then rapidly died out, During the last six months of the year we had only 7 notifications. As has been usual of late, the disease appeared to be quite mild; only 7 of the patients were removed to hospital and there were no deaths. A table showing the incidence of measles in the district over the past 20 years is given on page 49. 48 INCIDENCE OF MEASLES, 1934 -1953. Year Cases Deaths Population Remarks 1934 523 6 55,550 School children only included— disease not being notifiable. Figures based on returns from Head Teachers. 1935 5 — 57,440 1936 586 4 61,000 1937 86 — 65,530 1938 403 — 68.980 1939 5 — 72,150 1940 459 1 68,540 Whole population included from 1940 when disease became notifiable. 1941 539 — 64,920 1942 936 — 66,880 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 — 74,730 1952 491 — 73,670 1953 1,260 - 73.240 Diphtheria. For the second year in succession there were 110 cases of diphtheria notified in the district. We have had only one case in the past four years and. fortunately, no deaths since 1945. Table XVIII on page 61 gives the incidence and fatality of this disease since 1920. Food Poisoning. There were no outbreaks of food poisoning during the year. There were in fact only 2 notifications. These concerned a husband and wife who both developed symptoms at about the same time. As they had both partaken of the same meals and had disposed of any remains it was not possible to find the cause of the illnesses. Faecal specimens were taken and from one stool staph, aureas, coagulase positive, was isolated. Other specimens proved to be negative. Both patients made a complete recovery within 48 hours. Dysentery. Eleven cases of dysentery were notified, all of which were typed as sonnei. Arising out of two of these notifications, a minor outbreak of sonnei dysentery was discovered in one of our schools. Faecal swabs were obtained from twenty-two children at this school who had symptoms and twelve were found to be positive to sonnei. All children with positive swabs were excluded from school until two negatives had been obtained and the spread of infection was checked within a fortnight. 49 Paratyphoid Fever. There were 16 notifications of Paratyphoid 'B' during the year. Three of these eases occurred in one family, there were three single cases, apparently unconnected, and ten eases formed part of an outbreak at a school just outside our area. Cases 1, 2 and 3. These cases, which occurred in June, form the family group. A little girl aged 4½ years was admitted to hospital with a history of five days of general malaise, pyrexia, sickness and diarrhoea. The hospital laboratory isolated salmonella paratyphi from the stools. Upon receiving this information faecal specimens were obtained from the remainder of the family and other contacts. The mother and a brother aged 5 years proved to be positive to salmonella paratyphi although neither of them showed any symptoms. All other contacts had negative specimens. It was not possible to trace the source of infection and the original case turned out to be quite mild. All three cases were free from the organism in six weeks. Results of phage typing showed that the cultures belonged to Vi-phage Type 3A1. Cases 4, 5 and 6. The onset dates in these three cases were 11th, 19th and 27th September. In each case the patient had been removed to hospital with a history of general malaise and temperature and diagnosed after salmonella paratyphi had been isolated from the stools. Although exhaustive enquiries were made, no connection between these cases could be established. Two of them were typed as Vi-phage Type 1. In the other case the hospital had omitted to send cultures for phage typing. Cases 7 -16. Early in October information was received from the Medical Officer of Health of a neighbouring district that there were three confirmed cases of Paratyphoid ' B ' amongst children at a school situated in his area and that arrangements were being made to take fecal specimens from all children and staff at the school. Seventy-four children from our district were attending this school and fæcal specimens were accordingly obtained from all of them. In ten instances salmonella paratyphi were isolated from the stools and the children concerned were excluded from school. Five of these had had symptoms of the disease whilst the other five were symptom free. Three of the cases were removed to isolation hospital as home circumstances did not permit of adequate precautions being taken. By arrangement with the School Medical Officer of the area concerned, none of the cases were allowed to return to school until three negative stools had been obtained. These ten cases all originated at the school, at which, it is understood, there were 25 established cases in all—24 50 children and one member of the staff, an assistant cook. Sixteen of the children had no symptoms. All cultures in this outbreak belonged to an untypable Vi strain, which was subsequently designated by the Central Enteric Reference Laboratory as Type 2 var.l. Erysipelas. We received 12 notifications of this disease during the year, one of which involved the leg, the remainder being facial erysipelas. Six of the patients were males and six females. Three of the cases were removed to isolation hospital for treatment and the others were treated at their homes. Pneumonia. There were 90 cases of Pneumonia notified Of this total, 49 were stated to be influenzal in origin, a figure considerably higher than the normal annual average. The first three months of the year accounted for 37 of these, and the figures are comparable with those of 1951, another abnormal year when, of a total of 67 cases, 51 occurred in the first quarter. Puerperal Pyrexia. Forty-one cases of Puerperal Pyrexia were notified, giving a rate of 46.32 per thousand births. Our rate is high, due mainly to the fact that we have quite a large maternity unit situated in the area and all cases occurring there are allocated to our district. Thirty-nine cases were in fact notified from this particular hospital. The notification rate has of course increased throughtout the country since 1951 when new regulations came into force giving a revised defiinition of Puerperal Pyrexia. Ophthalmia Neonatorum. One case only was notified during the year; the child made a complete recovery and vision was unimpaired. Meningococcal Infection. This case concerned a child aged one year who was admitted to hospital in March as a suspected Meningitis. Diagnosis, based on the clinical picture, was Meningococcal Meningitis; there was very little pathological confirmation. Fortunately the case turned out to be quite mild and the child made a speedy recovery. CLEANSING STATION. There was an increase in the number of attendances at the Cleansing Station during the year, the total being 31 as compared with 22 in 1952. The details of the attendances during the year are as follows:— Number of cases of Scabies treated 13 Cases of Scabies with concurrent verminous head — Cases of Scabies with Secondary Septic Skin conditions — Number of cases of verminous heads only 18 Total number of attendances at the Centre 31 51 52 POLIOMYELITIS, 1953. Case No. Age (Years) Hospital to which admitted Date of Onset Returned to Registrar General Confirmed by Hospital Hospital Diagnosis Sequel 1 9 St. Helier 25-4-53 Yes Yes Ac. Poliomyelitis (Non-paralytic) No paralysis. Complete recovery. 2 5 St. Helier 2-6-53 Yes Yes Ac. Poliomyelitis (Paralytic) Some wastage of left arm; loss of power and restriction of movement Physiotherapy now discontinued. General condition very good, apart from left arm. 3 33 Grove 3-6-53 Yes Yes Ac. Poliomyelitis (Paralytic) Slight limp—right leg. Still attends hospital 3 times weekly for exercises. 4 3 Queen Mary's Hospital for Children 5-7-53 Yes Yes Ac. Poliomyelitis (Paralytic) Unable to follow up. Family has moved from the district. 5 5 Queen Mary's Hospital for Children 7-7-53 Yes Yes Ac. Poliomyelitis (Paralytic) Some residual paralysis. Child still weak and must have plenty of rest. 6 9 Western 8-7-53 Yes Yes Ac. Poliomyelitis (Paralytic) No residual paralysis. Complete recovery. 7 16 St. Helier 29-7-53 No No Sub-arachnoid Haemorrhage - 8 6 Cuddington 3-8-53 No No Sub-arachnoid Haemorrhage - 9 6 Western 3-8-53 No No Tonsillitis - 10 4 Wandle Valley 2-8-53 Yes Yes Ac. Poliomyelitis Complete recovery. II 9 Cuddington 10-8-53 Yes Yes (Paralytic) Ac. Poliomyelitis (Paralytic) Child died 16.8.53. 53 Case No. Age (Years) Hospital to which admitted Date of Onset Returned to Registrar General Confirmed by Hospital Hospital Diagnosis Sequel 12 18 Wandle Valley 16-8-53 Yes Yes Ac. Poliomyelitis (Non-paralytic) No paralysis. Complete recovery. 13 1 Wandle Valley 26-8-53 Yes Yes Ac. Poliomyelitis (Paralytic) Right leg still completely paralysed, left leg slightly affected. Child is still in hospital receiving treatment. 14 6 Tolworth 9-9-53 No No Tonsillitis - 15 4 Wandle Valley 9-9-53 No No Jaundice - 16 6 Queen Mary's Hospital for Children 5-9-53 Yes Yes Ac. Poliomyelitis (Non-paralytic) Complete recovery. 17 1 Grove 8-9-53 Yes Yes Ac. Poliomyelitis (Paralytic) Upper left arm paralysed. Still attending hospital for treatment. General condition not too good. 18 10 Wandle V alley 9-9-53 Yes Yes Ac. Poliomyelitis (Non-paralytic) Complete recovery. 19 6 Grove 5-10-53 Yes Yes Ac. Poliomyelitis (Paralytic) Very slight paralysis of left side of face. Marked improvement lately. 20 8 Tolworth 28-11-53 Yes Yes Ac. Poliomyelitis (Paralytic) Slight paralysis of right leg; still attending hospital once a week for exercises. General condition quite good. TABLE X. Scarlet Fever Monthly Distribution. Month Wards Total Abbey Bushey Mead Central Morden Park Ravensbury Raynes Park St. Helier West Barnes January - - 2 2 1 2 - 3 - 10 February 1 — 2 2 1 1 1 1 9 March 1 3 2 3 1 — 2 2 14 April — — 3 — 1 — - — 4 May 1 1 4 4 3 - 1 2 — 16 June 2 5 14 5 1 1 1 2 31 July — 1 7 14 3 - 4 2 — 31 August - — 3 2 1 — — - — 6 September — 4 3 — — — - — 7 October 1 — 1 2 - - - - - 4 November — 2 2 1 1 — 2 — 8 December - - 2 2 1 1 - - - 6 Total 3 5 33 52 20 8 7 13 5 146 12.15 Monthly mean 0.25 0.42 2.75 4.33 1.66 0.66 0.58 1.08 0.42 The incidence in the various wards was as follows:— Wards Cases Incidence per 1,000 population Abbey 3 0.6 Bushey Mead 5 0.7 Central 33 3.3 Morden 52 4.6 Park 20 2.1 Ravensbury 8 1.3 Raynes Park 7 0.9 St. Helier 13 1.3 West Barnes 5 0.7 54 55 TABLE XI. Infectious Diseases, Notifications, Deaths and Distribution, 1953. 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 146 1.99 3 5 33 52 20 8 7 13 5 66 45% Diphtheria — — — — — — — — — — - — - — — Paratyphoid Fever 16 0.22 — 1 2 8 — — - 1 4 7 44% Meningococcal Infection 1 0.01 - - 1 - - - - - - - - 1 100% Puerperal Pyrexia 41 0.56 — - 1 — — 39 - — — 1 41 100% Erysipelas 12 0.16 - 2 1 5 2 1 - — — 1 3 25% Poliomyelitis: — Paralytic 11 0.15 1 9.1% 1 1 — 3 — 3 1 2 11 100% Non-Paralytic 4 0.05 - — — 1 2 — — 1 — - 3 75% Dysentery 11 0.15 — 1 — — 3 5 — 2 — — 4 36% Pood Poisoning 2 0.03 — — — — 2 - - - - - - - Ophthalmia Neonatorum 1 0.01 - - - - 1 - - - - - - - - Primary Pneumonia 41 056 2 4.9% 1 2 8 11 3 5 1 9 1 2 5% Influenzal Pneumonia 49 0.67 2 4.1% - 3 7 14 2 1 9 1 12 3 6% Measles 1260 17.20 — — 97 171 207 187 131 71 124 113 159 7 0.5% Whooping Cough 414 5.65 — - 16 33 92 60 41 26 35 60 51 1 0.2 % 56 TABLE XII. Notification of Infectious Diseases (other than Tuberculosis) by age groups during the year 1953 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 1 8 19 103 9 6 — — — — 146 Diphtheria (including Membranous Croup) - - - - - - - - - - - Enteric Fever (including Paratyphoid) - - 1 11 1 1 1 1 - - 16 Puerperal Pyrexia ... — — — — — 16 20 5 — — 41 Acute Primary Pneumonia 2 2 2 4 1 - - 4 17 9 41 Acute Influenzal Pneumonia - - 3 3 1 1 3 4 16 18 49 Meningococcal Infection - 1 - - - - - - - - 1 Poliomyelitis : — Paralytic 1 1 2 6 - - 1 - - - 11 Non-Paralytic — — — 2 2 — - — 4 Dysentery — 1 1 4 2 1 1 1 — 11 Malaria — — — — — — — — Ophthalmia Neonatorum 1 - - - - - - - - - 1 Erysipelas — — — — — 1 2 1 8 — 12 Food Poisoning — — — — — 2 — — 2 Relapsing Fever — - — — - — — - — — — Typhus Fever — — — — — — — - — — — Measles 22 226 348 632 19 7 5 1 — — 1260 Whooping Cough 14 73 114 195 11 5 2 — — — 414 Totals ... 41 312 490 960 46 38 37 17 41 27 2009 57 TABLE XIII. Monthly Incidence of Infectious Diseases, 1953. Disease January February | March April May June July August September October November December Total Smallpox - - - - - - - - - - - - - Scarlet Fever 10 9 14 4 16 31 51 6 7 4 8 6 146 Diphtheria — — — — — — - — — — — — - Dysentery — — — 1 1 6 1 — - — - 2 11 Meningococcal Infection - - 1 - - - - - - - - - 1 Primary Pneumonia 15 3 7 2 — 2 3 1 — 1 3 4 41 Influenzal Pneumonia II 17 9 6 2 2 — — — — - 2 49 Food Poisoning — — — — — — — — 2 — - 2 Erysipelas — — 3 4 — — — — — — 2 3 12 T.B. Pulmonary 23 9 - 4 3 5 4 4 5 3 3 5 68 T.B. Non-Pulmonarv 3 1 - — — — — 1 1 1 — - 7 Ophthalmia Neonatorum - - - - - - 1 - - - - - 1 Puerperal Pyrexia 3 1 — 3 ' 1 6 6 2 2 4 2 41 Poliomyelitis: — Paralytic — - — — 2 3 3 1 1 — 1 11 Non-Paralytic — — 1 — — 1 2 — — — 4 Malaria — — — — — — — — - — — Measles 191 341 321 269 100 31 5 — — 1 - 1 1260 Whooping Cough 10 13 18 33 39 90 104 43 20 17 15 12 414 Paratyphoid Fever - - - - - 3 - - 2 11 - - 16 Totals 266 394 373 326 163 183 158 65 42 41 35 38 2084 DIPHTHERIA IMMUNISATION Five hundred and sixty-eight children in the district received complete primary courses during the year. Of this total, 249 were carried out in the Welfare Centres, 239 by private practitioners and 80 in the schools. In addition, 1337 children were given boosting injections at school (177 of these being children who are not resident in the area). Of the primary courses given at Welfare Centres, 126 were combined Diphtheria/Pertussis, whilst private practitioners gave 166 such courses. It will be seen from comparison of this year's figures with those of 1952 that there is a decrease in the number of primary courses given, to the extent of 151. This drop in our figures is due to the fact that immunisation practically ceased during the late summer months, when the incidence of poliomyelitis was at its height. Our usual propaganda campaign was continued during the year by means of Press notices, distribution of leaflets at Clinics, and bookmarks through the medium of the public libraries. 58 TABLE XIV. Persons Immunised at Clinics, 1953. 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 11 — — 2 11 2 Bushey Mead 22 — — 4 22 4 Central 40 1 — 8 40 9 Morden 32 — — 4 32 4 Park 28 — — 7 28 7 Ravensbury 24 — — 2 24 2 Raynes Park 15 1 — 6 15 7 St. Helier 55 — — — 55 — West Barnes 22 2 — 3 22 5 249 4 — 36 249 40 TABLE XV. Persons Immunised by Private Practitioners, 1953. 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 12 — — 2 12 2 Bushey Mead 15 — — 6 15 6 Central 28 5 5 14 33 19 Morden 54 6 2 24 56 30 Park 29 1 2 10 31 11 Ravensbury 8 — 1 5 9 5 Raynes Park 21 — 5 5 26 5 St. Helier 33 1 12 2 35 3 West Barnes 21 — 1 3 22 3 221 13 18 71 239 84 59 TABLE XVII. Number of Children Immunised at Schools, 1953. School Incomplete Completed Primary Single Boosting Injections Bushey County Primary — 11 142 Poplar Road County Primary — 2 110 St. Mary's „ „ — 3 73 Merton Abbey „ „ — 4 77 Hillcross „ „ — 5 119 Raynes Park „ „ — — — Morden „ „ — 7 55 Morden Farm „ „ — 9 131 St. Helier No. 1 „ „ — 4 80 St. Helier No. 2 „ „ — 12 106 St. Helier Na 3 „ „ — 6 111 St. Helier No. 4 „ „ 3 49 Holy Family R.C. Vol. Primary — 8 45 Sacred Heart R.C. Vol. Primary — 6 70 Hatfeild County Primary — — 45 Total — 80 1213* *Includes children attending schools in Merton and Morden but resident in other areas:— Boosters 177 The number immunised since the inauguration of the Public Clinics in 1934 is as follows:— At Clinics By Doctors In Schools At Day Nurseries Total 1934 93 28 — — 121 1935 375 19 — — 394 1936 383 13 664 — 1,060 1937 502 27 293 — 822 1938 376 22 260 — 658 1939 277 11 303 — 591 1940 234 12 50 — 296 1941 700 6 3,198 — 3,904 1942 1,127 16 753 — 1,896 1943 813 64 211 51 1,139 1944 515 54 216 28 813 1945 806 91 105 33 1,035 1946 726 72 488 34 1,320 1947 937 62 233 25 1,257 1948 722 176 246 25 1,169 1949 438 310 138 13 899 1950 349 326 — 7 682 1951 476 308 13 7 804 1952 370 300 49 — 719 1953 249 239 80 — 568 60 TABLE XV1I1. Incidence and Fatality of Diphtheria, 1920 -1953. Year Population No. of cases Incidence rate per 1,000 population No. of deaths Percentage of deaths to cases 1520 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 74,730 —1 0.01 — 1952 73,670 — — — 1953 73,240 — — — 61 TABLE XIX. Diphtheria Immunisation. Number of children 0— 5 years immunised January — June, 1953 330 Number of children 5—15 years immunised January — June, 1953 12 Number of children 0— 5 years immunised July — December, 1953 153 Number of children 5—15 years immunised July — December, 1053 3 Total number of children 0— 5 years immunised daring the year 483 Total number of children 5—15 years immunised during the year 15 Number of children 0— 5 years immunised by Private Practitioners during the year 221 Number of children 5—15 years immunised by Private Practitioners during the year 18 Total number of children immunised by Private Practitioners during the year 239 Total number of children immunised in the Clinics during the year 249 Total number of children immunised in the Schools during the year 80 Estimated percentage of 0— 5 years immunised at end of year 56.06 Estimated percentage of 5—15 years immunised at end of year 82.97 Age Distribution of Immunised Children. Age at 3*12-53 i.e born in year Under 1 1953 1-4 1949-52 5 - 9 1944 48 10 - 14 1939-43 Total under 15 Estimated Population under 1 Estimated Population 1 - 4 Estimated Population 5 - 14 Total Estimated Population under 15 Number immunised 22 2,510 4,558 4,494 11,584 854 3,662 10,910 15,426 62 WHOOPING COUGH IMMUNISATION. In this, the first full year during which whooping cough immunisation has been carried out in the district, 377 primary courses were given, 211 by private practitioners and 166 at the clinics. As has already been mentioned in the paragraph on diphtheria immunisation, 292 of these were combined courses. Details of injections given are set out below. PRIMARY COURSES. Given by Private Practitioners. Antigen Age Groups Total Under 1 2 3 4 5-9 10-14 Whooping Cough 5 22 7 3 1 7 – 45 Diphtheria/Whooping Cough Combined 75 59 9 6 4 13 — 166 Total 80 81 16 9 5 20 — 211 Given at Clinics. Antigen Age Groups Total Under 1 1 2 3 4 5-9 10-14 Whooping Cough 8 21 6 3 2 – – 40 Diphtheria/Whooping Cough Combined 62 49 7 7 1 – – 126 Total 70 70 13 10 3 – – 166 63 BOOSTING DOSES. Given by Private Practitioners. Antigen Age Groups Total Under 1 1 2 3 4 5-9 10-14 Whooping Cough – – – – 1 1 – 2 Diphtheria/Whooping Cough Combined — — — 4 3 31 – 38 Total — – — 4 4 32 – 40 Given at Clinics. Antigen Age Groups Total Under 1 1 2 3 4 5-9 10-14 Whooping Cough – – – – 1 – v 1 Diphtheria/Whooping Cough Combined – – – – 5 – – 5 Total – – – – 6 – – 6 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:— Vaccination 345 Re-vaccinations 228 Of the above, 403 were vaccinated by Private Practitioners. 493 of these vaccinations were primary vaccinations in infancy. 64 TUBERCULOSIS One hundred and twenty-two new eases were added to the register of tuberculous persons, compared with 187 in 1952. These additions were:— Males Females Total Pulmonary 68 46 114 Non-Pulmonary 3 5 8 71 51 122 Of these 122; 75 were primary notifications, 45 were transferred from other districts, and 2 came to notice in other ways. During the year, 115 persons were removed from the register for the following reasons:— Recovered 19 Removed from the district 79 Death 17 After allowing for the additions and deductions, the number remaining on the register at the 31st December, 1953, was distributed as shown in the following table:— TABLE XX. Tuberculosis Register at 31st December, 1953. WARDS Registered at 31st December, 1953 Totals Number on Register at mid-year Pulmonary NonPulmonary Abbey 80 10 90 90 Bushey Mead 69 11 80 82 Central 109 9 118 117 Morden 120 8 128 130 Park 136 16 152 153 Ravensbury 126 23 149 147 Raynes Park 99 9 108 111 St. Helier 183 31 214 216 West Barnes 73 18 91 92 Whole district 995 135 1130 1138 65 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 110 persons in 1953 from Merton and Morden, as follows:— At the County Sanatorium, Milford18 At other Institutions 92 110 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. TABLE XXI. Tuberculosis 1944 - 53. Year Primary Notifications Total New Cases No. on Register at end of year Pul. Non-Pul. Total Pul, Non-Pul. Total Pul. Non-Pul. Total 1944 87 10 97 127 13 140 620 133 753 1945 84 20 104 116 23 139 651 146 797 1946 72 13 85 101 18 119 671 147 818 1947 82 14 96 109 21 130 708 153 861 1948 74 11 85 104 15 119 761 161 922 1949 86 6 92 118 13 131 798 160 958 1950 123 8 131 165 13 178 817 153 970 1951 118 8 126 152 9 161 882 142 1024 1952 127 6 133 175 12 187 975 148 1123 1953 68 7 75 114 8 122 995 135 1130 Total 921 103 1024 1281 145 1426 — – — Av'ge 92.1 10.3 102.4 128.1 14.5 142.6 — — – The deaths from Tuberculosis during the year number 10, all of which were due to pulmonary disease. Two of the deaths were unnotified cases. 66 The deaths are classified by ago and sex in the following table:— TABLE XXII. Deaths due to Tuberculosis, 1953. Ages Years Pulmonary Non-Pulmonary Totals Males Females Males Females 0— – – – – – 1— — – — – — 5— — — — — — 15— — — — — 25— — 1 — — 1 35— 1 – — — 1 45— 4 1 – — 5 55— 1 — — — 1 65— 1 1 – – 2 Totals 7 3 — — 10 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 of supplementing the provision of care of tuberculous patients, and its efforts make life much easier for the victims of this disease. Its income is derived mainly from sale of Christmas Seals, and once again the public responded very generously, the amount raised being £188 12s. 5d. The remainder of the income consists of grants and donations from various bodies and associations. Child contacts are given every assistance to maintain good health, and the Committee gave financial support to the Children's Holiday Scheme organised by the Standing Conference of Surrey Care Committees. Twenty children from this 67 area enjoyed healthy holidays at two camps which were held. Outings and parties were also arranged for the children by various organisations in the district. The Committee continues to keep stocks of bedding and other necessities for loan to patients in need. It makes pocket money allowances to patients in Sanatoria not eligible for sickness benefit and also to other cases in special need. Other loans and gifts of money are also available to patients; and there are a radio and typewriter which are almost continually out on loan. It is of course, impossible in this report to give a complete record of the Committee's activities throughout the year, but from the foregoing information which has been gathered from the Committee's Annual Report, it will be appreciated that its work is of great value to the Community. MASS RADIOGRAPHY. The mass Radiography Unit did not visit our area at all during the year, although it was set up in several adjoining districts and no doubt many of our residents took the opportunity of using its facilities. The nearest point of call was at South Wimbledon, just on our boundary, and the Raynes Park area was strongly canvassed by officials of the Unit in an effort to arouse public enthusiasm. Arrangements were in hand at the end of the year for the Unit to visit Merton area early in 1954 and this will of course be mentioned in a future report. 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 Non-Pulmonary Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F M F M F 0-1 — — — — — — — — — — — — — 1- 5 3 — 1 — 1 2 — — — — — — 7 5-10 — 2 — — — 1 1 — — — — — 4 10-15 1 — — 1 1 1 — — — — — — 4 15-20 4 2 — — — 1 — — — — — — 7 20-25 2 4 — 2 4 2 — — — — — — 14 25-35 7 5 1 — 8 10 — — — — — — 31 35-45 10 3 — — 4 3 — — — — — — 20 45-55 9 6 — 1 3 1 — — — — — — 20 55-65 3 1 — — 1 — — — 1 — — — 6 65 and over 5 1 1 — 1 — — — — 1 — — 9 Totals 44 24 21 5 23 21 1 — 1 1 — — 122 75 45 2 69 INDEX. PAGE Accidents in the Home 21, 22 Acreage 7 Ambulance Facilities 23 Acute Poliomyelitis 48, 52-53 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 42 Climatic Conditions 7 Clean Food 26-27 Cleansing Facilities 51 Deaths 14-21 Causes of 16, 18 Rates 9, 10 Diphtheria 49, 58, 62 Immunisation 58-62 By age groups 59, 62 Children immunised in Schools 60 Persons immunised in Clinics 59-60 Persons immunised by Private Practitioners 59 Incidence and fatality for 34 years 61 Drainage and Sewerage 29 Drainage work 30 Erysipelas 51 70 INDEX—Continued. PAGE Factories and Workplaces 41, 46 Inspections 46 Defects 46 Food and Drugs Act, 1938 27, 36-37 Food Poisoning 49 Food Supply 33-40 Inspections 33 Unsound Food 33-34 Health Services 22-26 Heart Disease—Deaths from 16, 18 Hospitals 24-25 Hospital Car Service 23 Housing 31-32, 44-45 Action Taken 31-32, 44-45 Inspections and Defects 44-45 Number inhabited 7 Overcrowding 31-32, 44 Ice-Cream 38-40 Industry 7 Infant Mortality 20, 21 Causes of death 20 Rates 21 Infectious Diseases 24-25, 47-57 Cases admitted to hospital 24-25 Diseases notifiable 47 Monthly Incidence 57 Notification by Age Groups 56 Notifications, deaths and distribution 55 Inquests 15 Isolation Hospitals 24, 25 71 INDEX—Continued. PAGE Mass Radiography 68 Maternal Mortality 19 Rates 19 Measles 48-49 Meat Inspection 34 Mental Diseases 26 Merchandise Marks Acts 42 Milk Supply 35, 38 Mosquitoes 41 National Assistance Act 26 Nelson Hospital 25 Neonatal Deaths 20 North-Eastern Divisional Health Sub-Committee 5 Notification of Births 12 Nuisances 31 Nursing in the Home 22, 23 Paratyphoid Fever 50, 51 Pneumonia 51 Poliomyelitis 48, 52-53 Population 11 Premature Births 21 Public Cleansing 29 Public Health Committee 5 Puerperal Pyrexia 51 Rainfall 7 Rateable Value 7 Respiratory Diseases—deaths from 17 72 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 29 Road Accidents—deaths from 16, 18 Rodent Control 41 Sanitary Circumstances 26-43 Sanitary Inspections, Summary of 30 Scarlet Fever 48, 54 Incidence in each Ward with rates 54 Monthly distribution of cases 54 Shops Act, 1950 42-43 Smallpox 24, 47 Smoke Abatement 42 Social Conditions of the Area 7 Staff 6 Statistics 7-10 Comparative 10 Vital 8, 9 Stillbirths 20, 21 Tuberculosis 65-69 Admission to Sanatorium 66 Assistance given 67-68 Care Committee 5, 67-68 Deaths due to 67 Dispensary 23 Mass Radiography 68 New cases—by age groups 69 Number on register at end of year 65 73 INDEX—Continued. PAGE Vaccination 64 Venereal Diseases 24 Vital Statistics 8, 9 Wandle Valley Joint Sewerage Board 5 Water Courses 41 Water Supply 28, 29 Whooping Cough 48 Whooping Cough Immunisation 63, 64 Zymotic Disease—deaths from 9 Bate 9 74 Printed by J. B. BLACKMORE & CO., LTD., 85. Merton High Street. London, S.W.19. Tel. LIBerty 3411-2.