MER 16 URBAN DISTRICT of MERTON AND MORDEN ANNUAL REPORT of the Medical Officer of Health for the year 1954 AND REPORT OF THE CHIEF SANITARY INSPECTOR URBAN DISTRICT of MERTON AND MORDEN ANNUAL REPORT of the Medical Officer of Health for the year 1954 AND REPORT OF THE CHIEF SANITARY INSPECTOR PREFACE To the Chairman and Members of the Merton & Morden Urban District Council. Mr. Chairman, Ladies and Gentlemen, I wish to present the annual report for the year 1954. 1 should first of all like to pay tribute to Dr. A. W. Johns, your Medical Officer of Health from April, 1940 until 31st August, 1954, when his most unfortunate death occurred, after a short illness, at the early age of 51. His death was a great loss to the community. Dr. Johns was most conscientious and devoted to his work, which he carried out with the greatest zeal and ability. His sense of humour made him well liked by his staff, by all his colleagues who serve the Council and by his Medical Officer of Health colleagues of the County Districts of Surrey. I should like to report that in his last year of office the health of the Urban District has as usual been extremely good, and there have been no special outbreaks of infectious disease. Although the birth rate has declined to its lowest of 10.8, or 11.2 when corrected to compare with the average age and sex population of the country as a whole, the death rate and infant mortality rate have both dropped to the lowest recorded, as have deaths from tuberculosis. One maternal death occurred giving a maternal mortality rate of 1.23 per 1,000 births. Notifications of infectious disease dropped to a very low level in 1954, that for scarlet fever constituting a low record and for measles the lowest since 1939. Measles is apt to occur in two-yearly waves however. It is pleasing to record that there was only one case of poliomyelitis and it was not of great severity but we hope that a population lacking immunity is not being built up to suffer attacks later on. Most gratifying is the absence of diphtheria for the third year in succession, the outstanding example where preventive measures have practically eliminated a deadly disease. 3 Whooping cough notifications were well down in 1954 and we hope that this is due to the increasing inoculation against this disease. New cases of tuberculosis notified have reached a record low level so that the health of the community has improved in nearly every aspect. In conclusion 1 should like to express my thanks to the Chairman and members of the Public Health Committee for their help and co-operation and to the whole staff of the department for their willing and loyal support. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant. A. R. GRAHAM. Acting Medical Officer of Health. July, 1955. 4 URBAN DISTRICT COUNCIL OF MERTON AND MORDEN 1954. PUBLIC HEALTH COMMITTEE Chairman: Mr. M. H. Burrin. Mr. W. J. Crisp. Miss M. R. Smith. Mr. R. K. King. Miss N. K. Watts. Mr. L. F. Pratt. Mrs. A. A. Whiskin. Mr. W. IT. Page (ex-officio). Mrs. L. A. Doel (ex-officio). REPRESENTATIVES ON NORTH-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE Mr. G. J. Beaven. Mr. L. F. Pratt. Mr. M. H. Burrin. Miss M. R. Smith. Mr. J. L. Coombes. REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD Mr. E. K. Clarke, J.P. Mr. G. S. Whitmee. Mr. V. Talbot. Mr. W. H. Page (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, 1954 Medical Officer of Health: A. Wallace Johns. M.R.C.S., L.R.C.P., D.P.H. (To 31.8.54). A. R. Graham, M.B., Ch.B., D.P.H., Barrister-at-Law (Acting from 9.9.54). Chief Sanitary Inspector: abed W. T. Pinches, M.R.San.I. Deputy Chief Sanitary Inspector: abcd G. E. Maton Sanitary Inspectors: a b E. N. Montague, D.P.A. (To 14.11.54). a b C. W. Southerby, a L. H. Thomas. Chief Clerk : A. A. Makepeace. Clerks: Mrs. P. E. Hamp (From 13.12.54). L. G. Phillips. Miss D. Martyn. F. H. White. a Sanitary Inspector's Certificate, San. Insp. Exam. Joint Board. h Meat and Food Inspector's Certificate, Boyal Sanitary Institute, c Smoke Inspector's Certificate, Boyal Sanitary Institute. d Sanitary Science Ceitificate, Boyal 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 22,454 Rateable Value at 31st December, 1954 £705,836 Sum represented by Id. rate £2,830 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 gauges are installed at the Joseph Hood Recreation Ground and West Barnes Pumping Station. The monthly recordings are as shown below:— RAINFALL, 1954. MONTH JOSEPH HOOD RECREATION GROUND WEST BARNES PUMPING STATION Inches Days with 0.01 inch, or more Days with 0.04 inch, or more Inches Days with 0.01 inch or more Days with 0.04 inch, or more January 1. 23 10 10 1.45 15 7 February 2.03 15 13 2.18 18 12 March 3.69 16 13 2.38 17 13 April 0.36 7 3 0.35 6 3 May 3.25 18 15 3.31 22 15 June 2.99 14 13 4.18 16 12 July 2.05 16 11 2.82 20 9 August 2.70 16 14 3.09 18 13 September 2.20 19 15 2.27 20 17 October 2.16 15 10 2.50 16 9 November 3.62 19 17 4.39 25 19 December 1.55 14 6 1.94 15 5 TOTAL 27.83 179 140 30.86 208 134 7 VITAL STATISTICS Prom study of the birth and death rates and infectious disease notifications the health of our community appears to have maintained its usual high level. Although the birth rate, at 10.8, is the lowest ever recorded in the district, it is very gratifying to note that the death rate has again fallen and that our infant mortality rate has reached a record low level. Deaths from tuberculosis numbered only 8, and the rate, at 0.11 per thousand, is our lowest ever. One maternal death occurred giving a maternal mortality rate of 1.23 per thousand births, but it is of some consolation to know that the one death which gave us this rate was unavoidable. It is not possible to give the usual full table of comparable statistics as Form S.D.55, which gave the necessary information. is no longer issued by the General Register Office. Certain figures have, however, been extracted from the Registrar General's Weekly and Quarterly returns, and these are set. out on page 10 to allow comparison between the local statistics and those for the rest of the country. 8 SUMMARY OF VITAL STATISTICS. (Registrar General's Figures). Population: Registrar General's Estimate (MidYear) 73,270 Births: M. F. Total Live (Legitimate) 408 362 770 (Illegitimate) 13 9 22 421 371 792 Stillbirths (Legitimate) 9 9 18 (Illegitimate) — — — 9 9 18 Total Births 430 380 810 Birth Rate 10.8 per 1,000 population Corrected Birth Rate 11.2: per 1,000 population Still Birth Rate 22.2 per 1,000 births Deaths: M. F. Total Total Deaths 328 285 613 Death Rate 8.4 per 1,000 population Corrected Death Rate 9.0 per 1,000 population Infant Mortality: Total deaths under one year 8 Infant Mortality Rate per 1,000 Live Births 10.1 Deaths of Legitimate Infants under 1 year 8 Death Rate per 1,000 Legitimate Births 10.4 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 1.23 Zymotic Deaths: Deaths from Measles Nil Whooping Cough Nil Diarrhoea (under 2 years) 1 7 Principal Zymotic Diseases 1 Zymotic Death Rate (per 1,000 population) 0.01 Deaths from Tuberculosis: All forms 8 Rate per 1,000 population 0.11 Phthisis: 6 Rate per 1,000 population 0.08 Deaths from Cancer: 144 Rate per 1,000 population 2.0 9 TABLE I. COMPARATIVE STATISTICS, 1954. 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 15.2 15.2 14.9 15.2 10.8 Deaths: All causes 11.3 11.1 11.3 10.7 8.4 Typhoid and Paratyphoid fevers 0.00 - - - - Whooping Cough 0.00 0.00 0.00 0.00 — Diphtheria 0.00 0.00 0.00 — — Tuberculosis 0.18 0.20 0.18 0.20 0.11 Influenza 0.04 0.03 0.04 0.02 0.04 Smallpox - — - — — Acute Poliomyelitis (incl. Polioencephalitis) 0.00 0.00 0.00 0.00 Pneumonia 0.41 0.45 0.41 0.48 0.19 Notifications : (Corrected) Typhoid Fever 0.00 - - - - Paratyphoid F ever 0.01 - - - 0.03 Meningococcal Infection 0.03 - - - 0.01 Scarlet Fever 0.97 - - - 1.04 Whooping Cough 2.39 - - - 1.31 Diphtheria 0.00 • - - — Erysipelas 0.12 - - - 0.16 Smallpox - - - — Measles 3.32 - - - 1.01 Pneumonia 0.60 - - - 0.91 Ac. Poliomyelitis : Paralytic 0.03 - - - 0.01 Non-Paralytic 0.01 - - - — Food Poisoning 0.20 - - - 0.15 Rates per 1,000 Live Births. Deaths: All causes under 1 year of age 25.5 25.2 26.6 20 7 10.1 Enteritis and Diarrhoea under 2 years of age 0.8 - - - 1.3 Rates per 1,000 Total Births (Live and still). Still births 23.5 23.3 24.0 19.8 22.2 Notifications: (Corrected) Puerperal Pyrexia 17.74 - - - 38.27 10 POPULATION. The Registrar General's mid-year estimate of the populations of the district was 73,270, an increase of 30 over that for the previous year. The 1951 Census Report for the County of Surrey was issued during the year, and it was noted that the preliminary population figure for Merton and Morden of 74,602 had been increased to 74,730 in the final report. As regards sexes, the totals were 35,277 males and 39,453 females. BIRTHS Seven hundred and ninety-two live births were registered during the year, together with 18 stillbirths, giving a total of 810. This shows a reduction of 76 as compared with our total of live births for 1953 and the birth rate has dropped to 10.8, the lowest ever recorded in the district. The number of illegitimate births registered was 22, the rate dropping to 27.8 per thousand live births, our first reduction in this figure since 1950. Year No. illegitimate live births Rate per thousand live births 1937 21 25.9 1938 31 31.3 1939 27 26.9 1940 29 29.9 1941 40 47.2 1942 39 36.5 1943 57 49.7 1944 49 42.6 1945 63 61.3 1946 45 35.7 1947 38 28.3 1948 42 38.6 1949 37 37.5 1950 23 24.5 1951 28 32.2 1952 28 32.2 1953 28 32.2 1954 22 27.8 11 INSTITUTIONAL AND DOMICILIARY BIRTHS An analysis of the birth notifications received during 1954 shows that 638 of the 810 births occurred in hospitals, institutions and nursing homes. This represents 84% of the total, and is the same as the figure for 1953. Table II, set out on page 13 shows the trend since 1935. The distribution of institutional births is given below:— St. Helier Hospital 364 Nelson Hospital 231 St. Teresa's Hospital 22 Kingston Hospital 17 Other hospitals, institutions and nursing homes 49 683 12 TABLE II. Numbers and percentages of Institutional births, 1935 1954. 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 St. Helier Hospital - - - - - - - - 325 335 341 439 468 372 438 419 419 408 356 364 Nelson Hospital 175 194 207 196 230 214 343 305 236 200 216 209 285 289 300 276 276 266 268 231 Kingston Hospital 41 78 91 103 80 94 69 44 43 22 22 18 17 10 9 10 13 11 19 17 Others 105 128 150 251 248 147 81 219 187 221 194 257 282 184 95 78 77 91 99 71 Total Institutional Births 321 400 448 550 558 455 493 568 791 778 773 923 1052 855 842 783 785 776 742 683 Total Births 721 789 812 990 1005 971 848 1069 1116 1151 1027 1261 1345 1087 985 938 881 887 885 810 % of Institutional to Total Births 45% 51% 55% 56% 57% 47% 58% 53% 69% 67% 73% 72% 76% 77% 83% 83% 89% 87% 84% 84% 13 TABLE III. Showing Births and Deaths with Rates since the Amalgamation of Merton with Morden. Year Estimated population Total Live Births Birth Rate Total Deaths Death Rate Natural Increase 1913 16,767 400 23.5 166 9.9 234 1914 17,500 420 24.0 142 8.2 278 1915 17,500 402 22.9 169 10.4 233 1916 16,000 348 27.75 134 8.3 214 1917 17,000 271 15.75 145 9.0 126 1918 17,552 241 14.0 204 13.0 37 1919 18,100 257 14.2 210 11.6 47 1920 18,200 359 19.8 171 9.4 188 1921 18,000 322 17.8 138 7.6 184 1922 18,500 365 19.7 198 10.7 167 1923 18,750 341 18.1 153 8.1 188 1924 18,710 311 16.6 170 9.1 141 1925 18,960 307 16.2 187 9.9 120 1926 19.980 333 16.7 179 90 154 1927 21,850 352 16.13 200 9.2 152 1928 25,780 392 15.2 224 8.7 168 1929 27,430 442 16.1 281 10.2 161 1930 35,000 452 12.9 241 6.9 211 1931 41,610 628 15.1 333 8.0 295 1932 48,550 770 15.8 352 7.2 418 1933 52,130 644 12.3 416 7.9 228 1934 55,550 770 13.8 484 8.7 286 1935 57,440 721 12.5 433 7.5 288 1936 61,000 789 12.9 443 7.2 346 1937 65,530 812 12.3 487 7.4 325 1938 68,980 990 14.3 509 7.3 481 1939 72,150 1,005 13.9 516 7.2 489 1940 68,540 971 14.2 714 10.4 257 1941 64,920 848 13.06 557 8.58 291 1942 66,590 1,069 16.05 588 8.8 481 1943 65,880 1,146 17.4 575 8.7 571 1944 62,760 1,151 18.3 628 10.0 523 1945 66,050 1,027 15.5 602 9.1 425 1946 73,590 1,261 17.1 568 7.7 693 1947 75,290 1,345 17.86 611 8.1 734 1948 75,220 1,087 14.45 572 7.6 515 1949 75,470 985 13.05 678 8.98 307 1950 75,790 938 12.38 709 9.35 229 1951 74,730 870 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 1954 73,270 792 10.8 613 8.4 179 DEATHS. The number of registered deaths after adjustment by transferable deaths, is given below:— 613 total deaths of which 328 were males and 285 females. The seasonal mortality is indicated by the deaths for each quarter of the year, which were:— First quarter 18Z Second quarter 144 Third quarter 125 Fourth quarter 162 14 Inquests. Inquests were held 011 25 deaths occurring in the district, 12 of which were in respect of residents. The verdicts returned were as follows:— (1) Accidental Deaths- Collision with Motor Vehicles 2 Collision with train 1 Multiple Burns 3 Falls 5 Carbon Monoxide Poisoning 2 Asphyxia, caused by pillow 1 — 14 (2) Suicide by— Coal Gas Poisoning 3 Decapitation by train 1 Asphyxia by Hanging 2 — 6 (3') Misadventure— Post-operative conditions 2 2 — (4) Murder by— Manual strangulation 1 1 — (5) Natural Causes— Pulmonary embolism following thrombosis 1 — 1 (6) Open Verdict— 1 — 1 25 The total number of inquests held were nine less than in the year before. Road accidents were responsible for two of the total accidental deaths, as in the previous year. 15 CAUSES OF DEATH There were G13 deaths registered during the year, of which 328 were males and 285 females. The largest single cause of death was heart disease (212) while deaths from cancer numbered 144. Cancer of the lung and Bronchus showed a slight increase, with the usual predominance of males (34 to 3). Deaths from tuberculosis were down to 8 this year, giving a rate of 0.11, the lowest ever recorded in the district. Respiratory diseases did not take such a heavy toll in the area during 1954, the total of 45 being the lowest since 1942 and the rate the lowest for 15 years. Deaths from influenza were in fact only 3. Deaths due to motor vehicle accidents were about average, and with regard to other deaths of a violent nature, the reduction of the suicide figure to a more normal level was noted with relief after the extremely high figure of 13 during the previous year. There were 8 infant deaths and 1 maternal death. Further details of these can be seen in pages 19 and 20. 16 CANCER DEATH RATE No. of deaths from Cancer for past 10 years. 1945 116 1950 151 1946 126 1951 147 1947 118 1952 154 1948 110 1953 133 1949 152 1954 144 Year. Death rate per 1,000 population. Year. Death rate per 1,000 population. 1945 1.7 1950 2.0 1946 1.7 1951 2.0 1947 1.5 1952 2.1 1948 1.5 1953 1.8 1949 2.0 1954 2.0 TABLE IV. Deaths from Respiratory Diseases, 1935 -1954. Year Bronchitis F'neumonia Other Respiratory Diseases Total Death Rate 1935 9 22 6 37 0.6 1936 2 35 2 39 0.6 1937 14 31 6 51 0.8 1938 15 27 7 49 0.7 1939 5 20 9 34 0.47 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 1954 20 14 11 45 0.61 17 TABLE V. Causes of Death during 1954. No. Cause of Death Males Females Total 1 Tuberculosis, respiratory 5 1 6 2 Tuberculosis, other 1 1 2 3 Syphilitic disease 1 1 2 4 Diphtheria — — — 5 Whooping Cough — — — 6 Meningococcal Infections — — — 7 Acute poliomyelitis — — — 8 Measles — — — 9 Other infective and parasitic diseases - - - 10 Malignant neoplasm, stomach 14 12 26 11 Malignant neoplasm, lung bronchus 34 3 37 12 Malignant neoplasm, breast 1 9 10 13 Malignant neoplasm, uterus — 1 1 14 Other malignant and lymphatic neoplasms 40 30 70 15 Leukaemia, aleukaemia 2 1 3 16 Diabetes — 3 3 17 Vascular lesions of nervous system 30 46 76 18 Coronary disease, angina 76 47 123 19 Hypertension with heart disease 6 8 14 20 Other heart disease 28 47 75 21 Other circulatory disease 11 20 31 22 Influenza 1 2 3 23 Pneumonia 7 7 14 24 Bronchitis 16 4 20 25 Other diseases of respiratory system 8 8 26 Ulcer of stomach and duodenum 9 2 11 27 Gastritis, enteritis and diarrhoea — 1 1 28 Nephritis and nephrosis 2 3 5 29 Hyperplasia of prostate 5 — 5 30 Pregnancy, childbirth, abortion — 1 1 31 Congenital malformations 4 — 4 32 Other defined and ill-defined diseases 16 27 43 33 Motor Vehicle accidents 3 1 4 34 All other accidents 4 5 9 35 Suicide 4 2 6 36 Homicide and operations of war - - — Total all causes 328 285 . 613 18 TABLE VI. MATERNAL MORTALITY, 1935 54. With Comparable Rates for England and Wales. Year Death rate per thousand total births. Sepsis Other causes Total Merton and Morden England and Wales Merton and Morden England and Wales Merton and Morden England and Wales 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 1954 — 0.13 1.23 0.56 1.23 0.69 19 INFANT MORTALITY. There were only 8 deaths registered of infants under one year of age, giving an infant mortality rate of 10.1 per thousand live births. This is the lowest rate ever recorded in the area, and when one studies our figures for the past ten years it is very gratifying to note the reduction of this rate from 33.1 in 1945 to the present day figure. Details of the causes of our infant deaths are given below, and it will be seen that 50% of them were neo-natal deaths. Only in one case was prematurity given as a contributory cause of death—which fact in itself is a testimonial to the care given to premature babies in these enlightened days. There were 18 stillbirths registered—one more than in 1953-—giving a rate of 22.2, which is slightly higher than usual. A table giving the infant mortality and stillbirth rates for the past ten years is given on page 21. Infant Deaths — With causes of death. Sex Age Cause of Death Male 9 weeks Asphyxia, caused by pressure of face in soft pillow. Male 1 week Congenital Pulmonary Stenosis. Male 9 hours Congenital malformation of heart. Male 10 minutes Hydrocephaly. Atelectasis. Female 6 hours Erythroblastosis. Tentorial tear. Female 1 month Gastro-enteritis. Prematurity. Male 8 months Broncho-pneumonia. Male 5 months Congenital Heart Disease. 20 TABLE VII. Infant Mortality and Stillbirth Rates for the past 10 years. Year 1 nfant Mortality _ Rate Stillbirth Rate 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 1954 10.1 22.2 PREMATURE BABIES. There were 37 premature births notified during the year, all of whom survived one month. Below is a summary of the notifications:— (a) At home 5 (b) In hospital or nursing home. 32 The number of those bom at home:— (a) Who were nursed entirely at home 5 (b) Who died during the first 24 hours . — (c) Who survived at the end of one month 5 The number of those born in hospital or nursing home:— (a) Who died during the first 24 hours . — (b) Who survived at the end of one month 32 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 l ull-time and one part-time nurse, as under:— Full-time: Miss Meaton, 233 Cannon Hill Lane. LIB 3119. 21 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 Mitch.am 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 : (Vacancy) 141, Green Lane. MIT 1841. Mrs. Wells, 31, Links Avenue. LIB 5860. Part-time (Relief): Mrs. Randall. The area served by this Association includes the whole of the Merton and Morden part of the St. Helier Estate and a small part of the estate lying in Carshalton and Sutton. 3. The Wimbledon District Nursing Association, which serves Wimbledon and the Raynes Park, Grand Drive and Morden Park Estate areas, employs three full-time nurses and one part-time nurse under the direction of the Superintendent: Superintendent: Miss Willison, 28 Kings Road, S.W.19. LIB. 2020. Full-time : Mrs. E. Anthony, 107 Churston Drive. LIB. 1258. Miss N. Hollo way, „ „ „ „ „ Miss H. E. Coello, „ „ „ „ „ Part-time: Mrs. Talbot, 51 Marina Avenue, New Maiden. Miss Evans retired on the 31st December, 1954, after 20 years of valued service in the district, and this report affords an opportunity to record our appreciation of her past services. 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. 22 Tuberculosis Dispensaries. The provision of treatment and investigation of Tuber miosis is undertaken by the Regional Hospital Board. The County Council are responsible for the preventive side of the work, the Health Visitors and Almoners working in the Chest Clinic at the St. Helier Hospital being employed by the County Council. Three-elevenths of the Tuberculosis Officer's time is allocated to the. preventive side of the work and is also the responsibility of the County Council. The sessions held at the Chest Clinic for Merton and Morden patients are as follows:— Mondays at 2.ft 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). Venereal Diseases. The treatment, both in-patient and out-patient, of venereal disease is the responsibility of the Hospital Board and for our area this treatment is mainly carried out at the St. Helier Hospital, although both Kingston and Croydon General Hospitals are near enough to serve the area as well. The preventive side of the work, domiciliary visiting of contacts, etc., remains the responsibility of the local health authority and the County Council have appointed two health visitors especially for this purpose. Clinics are held at these hospitals as follows: — St. Helier Hospital, Wrythe Lane, Carshalton Males — Mondays 5-7 p.m. Females — Wednesdays 5-7 p.m. Fridays 1.30-3.30 p.m. Croydon General Hospital Males — Tuesdays at 7 p.m. Saturdays at 10.45 a.m. Females — Wednesdays at 2.30 p.m. Thursdays at. 11 a.m. Fridays at 5.30 p.m. Kingston Hospital, Wolverton Avenue, Kin gston-on-Thames Females — Thursdays 5-7 p.m. 23 HOSPITALS Smallpox. Arrangements for the prompt isolation of any ease 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. General and Maternity. 1. The Nelson Hospital. The accommodation of this hospital, which serves Wimbledon, Merton and Morden and parts of Wandsworth, remained unchanged during the year at a total of 121 beds, 47 in the maternity unit and 74 for general medical and surgical patients. The total number of in-patients admitted to the general medical and surgical beds was 1,741, of which 316 were residents of Merton and Morden. With regard to maternity services, 195 patients were admitted from our area out of a total of 1,111. 2, Other Hospitals. Among other hospitals available for use of our residents are St. Helier Hospital, Carshalton, and the Epsom and Kingston Hospitals. St. Helier is used to a very great extent, and a large percentage of our births take place there every year as will be seen from study of Table II on page 13. 24 TABLE VIII. Cases admitted to Isolation Hospitals during the year 1954. Disease (Final Diagnosis) Wandle Valley Grove Others Cases Deaths Cases Deaths Cases Deaths Scarlet Fever 35 — 1 — I — Broncho-pneumonia 3 — — — _ Whooping Cough 4 — — — — — Dysentery 1 — — — — - Mumps 3 — — — - — Gastro-enteritis 2 — 1 — — — Steven Johnson's Syndrome 1 — — — — — Tonsillitis 1 — — — — — Chicken Pox 4 — — — — — Gastric Influenza 1 — — — — — Sunstroke 1 — — — — — Poliomyelitis 1 — — — — — Influenza 1 — — — — — Measles 1 — — — — — Erysipelas 1 — — — 1 — Bronchitis 1 — — — 1 — Meningococcal Infection — — 1 — — — Primary Pneumonia — — — - 4 — Influenzal Pneumonia — — — — 1 — Food Poisoning — — — — 1 — Paratyphoid Fever — — — — 2 — Total 61 — 3 — 11 — MENTAL DISEASE. Cases dealt with under the Lunacy Acts, 1890, in the district of Merton and Morden. There were 39 eases certified under these Acts during the year. Below is given the provisional classification according to the condition on admission. Male Female Total Senile Dementia 2 5 7 Delusional Insanity 2 8 10 Suicidal 1 4 5 Schizophrenia 3 3 6 Hallucinated and Depressed 5 4 9 Epilepsy 2 — 2 Total 15 24 39 25 Of these cases 5 were certified under Section 16, 23 were placed under observation under Section 20, and 11 were removed to hospital under an Urgency Order under Section II. In addition 51 patients (9 male and 42 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. As this Committee had achieved its primary function of focussing the public eye upon the importance of Food Hygiene, it was decided during the year that it could now be disbanded, and this section of health education is now back in the hands of the Public Health Committee. Food and Drugs Act. One hundred and eighty-two samples were submitted to the Public Analyst during- the year, 15 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 - 38. One hundred and four samples of milk were sent to the Public Health Laboratory for bacteriological examination. Seven failed to conform to the prescribed standards. Eighty-three samples of ice cream'were also sent to the Laboratory; further details of these will be found on pages 38-41. Food premises in the area number 418 and are divided into the following categories:— Bakehouses 9 Bakers 24 Butchers 31 Chemists 18 Confectioners 59 Com Chandler 3 Dairies 5 Fishmongers 16 Fish Fryers 16 Greengrocers 49 Grocers 93 Ice Cream Dealers 133 . 48 School Canteens 12 Staff Canteens51 Wholesale Confectioners 3 Wholesale Food Manufacturers 1 Wholesale Grocers 2 26 The total number in the categories is, of course, far 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 1677. 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:— 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 seven different fountains for chemical and bacteriological examination and all proved to be satisfactory. All of these fountains were on the Metropolitan Water Board supply. 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 between 400-ft. and 500-ft. in depth and their capacity between 2,300 galls. and 7,000 galls.per hour. Ice Cream Dealers 133 Ice Cream Vendors (Itinerant) 16 Preserved Pood Manufacturers 33 27 Public Cleansing-. The Council took over the collection of house refuse in October, 1909. It had been previously done under contract. From that time a weekly collection has been maintained with the exception of occasional periods during the War when shortage of labour caused disorganisation. The disposal of screenings by tipping on low lying land at Morden Hall Park, to raise the level of the land, was continued throughout the year. During the year 15,660 tons of house refuse was collected and disposed of. The salvage tonnage for the year was as follows:— Tons. Tons. Paper 923 Bottles and glass 249 Metal 635 Rags 30 Pig Foods 48 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. 28 REPORT OF THE CHIEF SANITARY INSPECTOR. Mr. Chairman, Ladies and Gentlemen, Although the number of inspections made by your Sanitary Inspectors during 1954 showed a decrease of 210 from 9,669 in 1953, the total reached at 9,459 must be regarded as most satisfactory, especially as one Inspector resigned in October on obtaining a higher paid post with another Authority. Moreover, during the summer he spent some little time in making a preliminary survey of insanitary houses in Abbey Ward in preparation for the post-war resumption of slum clearance which received Ministerial encouragement during the year. The following table compares the y ear's total is with those of 1954 under the main headings and while in dicating the general scope of the work points out the shift of emphasis between them:— 1954. 1953. Food Shops, etc 1,677 1,562 Housing—primary visits ... 692 683 „ —reinspections 915 888 „ —overcrowding provisions 119 213 „ —miscellaneous 354 50 Drainage—chokages and repairs ... 1,254 1,534 Rat and Mice destruction ... 558 495 Shops—Welfare provisions 620 528 Infectious Disease enquiries 377 936 Factories, Workplaces and workers ... 514 528 Milk Supply 144 77 Smoke abatement ... 225 607 Rivers and Stream pollution 148 75 Stables and Piggeries 38 110 Miscellaneous (Caravans, dressers, Schools, Building sites, etc.) 1,824 1,383 9,459 9,669 The continued decrease in " overcrowding " visits was an expected result of the Council's housing policy and the decrease in drainage repairs and cleansing was not a surprise. The most noticeable drop, however, is that relating to Infectious Disease Enquiries—falling to a little more than a third of last year. This fortunate occurrence enabled other items to receive more attention but it is significant that in spite of the 7i% increase in visits to Food Shops, etc., it still proved impossible to make at least one visit during the year to each of those premises where routine visits are possible 29 and necessary. Some receive more, others need more, but I feel one visit all round is the minimal target. Periodic inspections are required at the following premises as counted at the end of the yean- Wholesale Food Manufacturers 1 Bakehouses 9 Food Shops and Catering Establishment 418 Off Licences 19 Public Houses 16 Other Shops 238 Factories (Power) 199 Factories (Non-power) 10 Offices 68 Workplaces, etc. 90 I feel it is incumbent on me to include a note of the extent to which the minimal target was not reached:— Number Class of Premises To visit Not visited % Factories 309 93 45 Food Premises 418 130 31 Other Shops 238 88 37 Offices and-Workplaces 158 84 53 HOUSING. A total of 692 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 34 cases where statutory action had to be taken. Legal proceedings were not necessary in respect of any of these cases. These 692 houses were inspected as a result of complaint by the tenant or possibly while calling for another purpose, i.e. Infectious Disease control. It is desirable, however, that a systematic inspection should be going on by way of house-tohouse visiting. Action taken in connection with dwelling houses, as set out in the housing tables on pages 45 and 46 resulted in the following improvements:— 30 Summary of Nuisances Abated and Sanitary Improvements Effected. Ceilings cleansed or repaired 45 Dampness in premises remedied 60 Drains exposed and repaired 12 Drains reconstructed Defective sashcords renewed 26 Dustbins provided 27 Floors repaired 23 Fresh air inlet valves provided and repaired 13 Inspection chamber covers provided 8 Obstructions removed from drains 13 Rain water pipes renewed or repaired IB Roofs repaired 45 Gutters repaired 32 Sink wastes repaired 9 Walls repaired 109 W.C. cisterns provided W.C. cisterns repaired 16 Water closests cleansed 4 W.C. pans provided 9 Windows repaired or renewed 32 Ventilation provided under floors 3 Fireplaces and stoves renewed or repaired 7 Sinks provided — Offensive accumulations removed 7 Water supply repaired for domestic use 12 Verminous premises fumigated and cleansed — Sanitary accommodation for workshops — Miscellaneous ... 74 Notices Served. Intimation notices 198 Statutory notices:— Public Health Act, 1936 34 Housing Act, 1936 4 Moveable Dwellings. Two applications were received for licences to station caravans in the district, one being for renewal of an existing permission. This was granted for a further twelve months but the licensee was soon afterwards 31 rehoused on a Council Estate in the normal allocation. The other related to a caravan to -be used by the Sales Manager/ Caretaker of a Caravan Retailer. It was granted for one year subject to the family having sole use of separate water closet and washing facilities. Overcrowding. Of the 68 cases carried over from the last report, 45 were abated during the year by rehousing. Twentyfour further cases were discovered during 1954 and the location and type of the cases known at the end of the year were as follows:— Merton and Morden Council houses 4 cases L.C.C. estate 31 „ Privately-owned houses 12 ,, 47 Whole houses overcrowded—16 cases. (a) One family occupation 5eases (b) Two or more related families 10 „ (c) Two or more unrelated families 1 „ Part house overcrowded—31 cases. (a) Unrelated families 2 „ (b) Related families (married sons or daughters) 29 „ 47 Certificates of Disrepair. Following the coming into operation of the Housing Repairs and Rents Act, 1954, on the 31st August, 1954, 7 applications for certificates were received and granted by the end of the year. 6 were revoked in the same period, the necessary work having been completed. 32 FOOD SUPPLIES The majority of the shops, works' canteens, etc. inspected were in good condition with adequate food storage, sanitary and washing accommodation, but at 48 premises the following unsatisfactory points were noticed:— Unclean and Defective Premises 28 Unclean Utensils 2 Accumulation of Refuse 9 Defective or Insufficient B'ins 6 Unprotected Food 7 Defective Sanitary Accommodation 3 Washing facilities:— (a) No hot water 16 (b) No soap 3 (c) No towels 6 (d) Non-display of notice re washing hands 2 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 979 lbs. Decomposition and bone taint. Rabbits 46 lbs. Decomposition. Sheeps Livers 30 lbs. Decomposition. Sausages 44 lbs. Decomposition. Ham 4 lbs. Contamination with bleach. Stewing Steak 64 lbs. Contamination with disinfectant. Bacon 28 lbs. Decomposition. Pigs Livers 69 lbs. Decomposition. Meat Roll 180 lbs. Tainted. Fish 50½ stone Decomposition. Milk Powder 14 lbs. Deterioration. Chocolate Milk Powder Infestation by beetle of 260 lbs. cocoa moth. Cheese 135 lbs. Mouldy. Dried Apricots 4 lbs. Fermentation. Oatmeal 84½ lbs. Infestation with grain weevil. 33 Description. Amount. Cause. Turkish Delight 16 lbs. Deterioration. Lemonade Crystals 20½ lbs. Contamination with dirt. Flour 6 lbs. Dirty and contaminated. Margarine 28 lbs. Rancid. Tinned Food 8,582 tins Blown, punctured, decomposed, etc Contaminated Foodstuffs. Five 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 During the war the old registered slaughterhouse at 129 High Street, Merton, was occupied as part of the Trafalgar Pig Club and slaughtering took place on Sundays, both of their own pigs and those of nearby Clubs. The premises were vacated on the 31st March, 1954, and subsequently demolished. Only 8 pigs were slaughtered and were all passed as fit for human consumption. MILK SUPPLY The new Morden Processing Depot of the Express Dairy Co. Ltd. came into operation in April and the many consultations between the firm and your officers over recent years during the planning contributed to a most satisfactory start. Processing was quickly stepped up to 55,000 gallons per day with a daily production of almost 500,000 bottles of various capacities. Weekly inspections of the plant and sampling have gradually been reduced to monthly visits and sampling. It is supplemented, of course, by the normal sampling off the round during delivery. This monthly inspection has proved adequate in conjunction with spot checks on the previous month's temperature recordings and the facility extended by the company of inspecting the records of the sampling done by there own laboratory staff at the Depot. There are no producers of milk registered within the district. 144 inspections were made of dairies and milkshops in 1954, and at the end of the year there were on the register 26 distributors and 5 dairies, of which three were large distribution depots handling only milk in bottles or sealed drums. 34 104 samples of milk were submitted for bacteriological examination during the year and 7 were unsatisfactory; 5 failing the Methylene Blue or keeping quality test and 2 the Phosphatase test which measures the efficiency of pasteurisation. These were all from one firm and were similar to results obtained in other areas in Surrey, with whom close co-operation was maintained. Eventually I gave the firm notice of their liability to prosecution for a breach of the conditions of the licence. While the necessary papers were being prepared the contract to supply premises in this district expired and was not renewed by the County Council Supplies Department. The undermentioned licences to use special designations were granted during 1954. Pasturiser's Licence 1 Dealers Licences. Pasteurised 20 Tuberculin Tested 20 Sterilised 22 Supplementary Licences. Pasteurised 20 Tubeculin Tested 20 Sterilised 20 Details of the chemical analysis of milk samples will be found on page 38. 35 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 Apple Dumpling 2 2 — Butter 4 4 — Cake Mixtures 3 3 — Cheeses, processed 1 - 1 Chicken, devilled 1 1 — Chutney 1 1 - Cocoa 1 1 - Coffee Essence 1 1 Coffee, ground 1 - 1 Condiment, non-brewed 1 1 - Cordials 3 2 1 Crab, potted 3 3 — Curry Powder 1 1 — Dessert 1 1 — Faggots 1 1 — Flour, self-raising 1 1 — Fruit, tinned 2 — 2 Gelatine 1 1 - Glace Cherries 1 1 — Gravy Powder 1 1 — Honey 1 1 — Ice Cream 21 21 - Jelly Crystals 2 — 2 Margarine 1 1 — Margarine, butter blended 3 1 2 Marmalade 2 2 — Meat Pudding 4 4 — Meat, tinned 1 1 — Milk 63 63 — Milk, condensed 1 1 — Milk, separated 1 1 — Mincemeat 1 1 - Mint in Vinegar 1 — 1 Olive Oil 1 1 — Paste, fish 10 10 — Paste, meat 6 6 — Peas, tinned 1 1 — Salmon, potted 1 1 — Sardines 1 1 — Sausages 14 11 3 Sausage Liver 1 1 — Sausage Meat 1 1 — Sausage Rolls 1 1 — Spice, mixed 1 1 — Suet 1 1 — Sweets 5 5 — Tea 1 1 — Thyme, dried 1 — 1 Tomato Sauce 1 1 — Vinegar 1 1 — Yorkshire Pudding Mixture 1 — 1 Total 182 167 15 36 Action Taken. (a) Thyme, dried (1912, informal). Case remnants of insect pupa were found on the top flap of the carton containing this article. No infestation of the article itself was detected, but it was of poor quality in respect of aroma and flavour. There was no further stock at the retailer's premises and no action was possible. (b) Jelly crystals (1934, informal and 1951, formal). Sample No. 1934 contained only 80.1% sugar, also the label did not specify the ingredients in the order of the proportion in which they were used. Subsequent formal sample (1951) contained only 75% sugar. Proceedings were taken against the manufacturers, who were fined £2 2s. Od. for the labelling offence, £5 5s. Od. for the sugar deficiency, and ordered to pay £5 5s. Od. costs. (c) Orange Juice (1935, informal). Contained an excessive amount of tin—2.8 grains per pound. A subsequent formal sample proved to be genuine. (d) Pork Chipolata. Sausages (1938, informal). Contained 62% meat, including fat, instead of 65%. A subsequent formal sample proved to be genuine. (e) Yorkshire Pudding Mixture (1942, informal). Infestation by cereal psocids. Remainder of stock surrendered and destroyed. (f) Fruit salad in syrup (1954, informal). Fruits not specified on the label in order of their proportion. This question was taken up with the packers informally. The taking of a formal sample was impracticable owing to the nature of the sample. (g) Butter-blended margarine (2018, informal, 2019 formal). Contained no butter. Retailer was fined £2, with £1 1s. Od. costs for selling butter blended margarine not of the substance demanded, and £1 with £1 1s. Od. costs for displaying an advertisement regarding butter blended margarine without stating the percentage of butter which it contained. The defendant stated he was misled by the label having the letters B.B.M. which he assumed, erroneously, referred to Butter Blended Margarine. (h) Beef sausages (2021 informal, 2060 formal). Sample No. 2021 contained only 42% meat and 2060 contained 45% meat, instead of 50%. Proposed Court proceedings were dropped as production of warranty by the retailer appeared to be a good defence. 37 (i) Processed Cheeses (2024 informal). Sample consisted of a box of six individual cheese preparations each containing various additions. There was a list inside the box on a loose label, intended to cover all six items. The Analyst's objection was, that in his opinion each individual cheese preparation should have a label showing its ingredients. The manufacturers pleaded exemption under Article 4(3) of the Labelling of Food Order, 1953, by virtue of group 8 of the First Schedule. The case was then referred to the Ministry of Food. (j) Coffee (2032 informal). The label on the container described this article as 100% pure coffee but it was in fact a coffee extract made by drying an infusion of coffee. This matter was taken up with the Manufacturers and the Ministry of Food, and it is understood that this is now the subject of discussions between the Food Manufacturer's Federation and the Labelling and Standards Division of the Ministry. (k) Canned grapefruit segments (2033 informal). Sample contained excessive naringin and a large proportion of tin which affected the taste and made it unfit for human consumption. The wholesaler surrendered the total consignment consisting of 3,200 tins for destruction. (1) Mint in Vinegar (2085 informal). The stalk present was of a tough " woody " nature and its proportion was grossly excessive. A subsequent formal sample was taken early in 1955 and was the subject of Court proceedings. A summary of the fat and non-fatty solids contents of the 53 samnles 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 — 5 8 21 10 5 3 1 — 53 Milk fat (legal standard is 3.0%). Less than 3.0 3.0 | 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 4.1 Total — 1 2 7 7 3 5 8 8 7 4 1 — 53 Ice Cream. The distribution trade continues to be subject to continual change of retailers and at the end of the year there were 133 dealers and 16 itinerant vendors on the register. 38 Most of the ice cream sold is pre-wrapped and 83 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 1 „ „ 5 1 „ „ 6 1 „ Present 7 1 „ Absent 8 1 „ „ 9 1 „ „ 10 11 1 1 „ „ 12 1 „ „ 13 1 „ „ 14 1 „ „ 15 1 „ „ 16 3 Unsatisfactory Present 17 1 Satisfactory Absent 18 3 Unsatisfactory „ 19 3 „ „ 20 3 „ „ 21 1 Satisfactory „ 22 1 „ Present 23 1 „ „ 24 1 „ „ 25 1 „ Absent 26 1 „ „ 27 1 „ „ 28 1 „ „ 29 1 „ „ 30 2 „ „ 31 1 „ „ 32 1 „ „ 33 1 „ „ 34 1 „ „ 35 2 „ „ 36 1 „ „ 37 1 „ „ 38 1 „ „ 39 2 „ Present 40 1 „ Absent 41 2 „ „ 42 1 „ „ 43 1 „ „ 44 1 „ „ 45 1 „ „ 46 1 „ „ 47 1 „ „ 48 1 „ Present 49 1 „ Absent 50 1 „ „ 51 2 „ Present 52 1 „ Absent 53 1 „ „ 54 2 „ „ 55 2 „ Present 56 1 „ Absent 39 No. Provisional Grade Methylene Blue Test Coliform B. Remarks 57 2 Satisfactory Present 58 4 Unsatisfactory „ 59 1 Satisfactory Absent 60 1 „ „ 61 1 „ „ 62 2 „ „ 63 1 „ „ 64 1 „ „ 65 1 „ „ 66 1 „ „ 67 1 „ „ 68 1 „ „ 69 2 „ Present 70 1 „ Absent 71 1 „ „ 72 1 „ Present 73 1 „ Absent 74 1 „ „ 75 1 „ „ 76 4 Unsatisfactory Present 77 1 Satisfactory Absent 78 1 „ „ 79 2 „ Present 80 3 Unsatisfactory „ 81 3 „ „ 82 1 Satisfactory „ 83 1 „ Absent 40 41 The results are summarised as follows :— Grade 1 64 77% „ 2 11 13% „ 3 6 7% „ 4 2 3% 83 100% — — Twenty-one 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% 15% 16% 17% 18% 19% 20% Fat 5% — — 2 2 5 8 4 — — — — — — — — — Non-fatty milk solids 7½% — — — 3 3 6 5 4 — — — — — — — — Sucrose 7½% — — — — — — 2 3 3 6 4 2 1 — — — Total Sugars 10% — — — — — — — 1 3 5 5 2 4 — — 1 GENERAL SANITATION Factories and Workplaces. The number of inspections made to premises registered under the Factories Act, 1937, was 247. Defects relating to sanitary conveniences, ventilation and other sanitary matters were dealt with at 14 premises. The table on page 47 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 continued during the year. Although this will undoubtedly help, no final relief can be expected until the level of the whole park is raised to prevent the possibility of any part being flooded during the breeding season. Rodent Control. 253 complaints of infestation were received during the year and as a result of the inspections of 2254 premises, 276 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 120 manholes were included. Of this total, only one manhole showed a take. 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. Animal Nuisances.—It became necessary on July 13th to apply to the Wimbledon Court for a nuisance Order to control the keeping of 7 goats in a domestic garden in such a manner as to be a nuisance. The Order was granted but the defendant took no steps within the 56 days allowed to abate the nuisance. A further summons being issued, she was fined £2 and costs for the non-compliance and warned as to her liability to a daily penalty. This had the desired effect. 42 Smoke Abatement. Fourteen complaints were received relating to excessive smoke emission from certain factory chimneys. 225 observations were made and action taken to reduce the emmision of smoke although none were serious enough to constitute a legal nuisance. One intimation notice was served. 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 three 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. Eight 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 570 Evening Patrols — Sunday and half-holiday Patrols 42 48 Infringements:— Number of premises at which contraventions were found 55 Number of premises at which prescribed forms were not exhibited 35 Assistants half holiday forms not exhibited 28 Young persons records not maintained 14 Forms regarding seats for females not exhibited 19 Mixed shop notices not exhibited 6 Sunday employment notices not exhibited — Insufficient heating 3 Insufficient ventilation Sanitary accommodation:—Insufficient 1 Dirty 11 Unlighted 2 Half-day closing 1 Absence of seats for females 2 I would like to express my appreciation of the industry shown by the Inspectors, the careful recording by the clerks and the support of the Chairman and members of the Public Health Committee during a busy and difficult time. I am, Ladies and Gentlemen, Your obedient Servant, W. T. PINCHES, Chief Sanitary Inspector. 44 SECTION D — HOUSING Housing and Overcrowding. During the year 180 newhouses were built in the Urban District, 158 by the Council, 9 by other local authorities and 13 by private builders. 325 eligible applications for rehousing were received by the Housing Manager during the year; 341 houses and flats were allocated to tenants during this period. By the end of the year the number of outstanding applications was 2.032. Arising out of rehousing enquiries, 51 complaints of over crowding were received. Of these, 24 were found to be overcrowded within the standards laid down by the Housing Act, 1936. The housing situation in Merton and Morden may be gathered from the following facts:— 1. Inspection of Dwelling Houses during the year:— i. (a) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) 692 (b) Number of inspections made for the purpose 692 ii. (a) Number of dwellinghouses (included under sub-head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and .1932 — (b) Number of inspections made for the purpose — iii. Number of dwellinghouses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 iv. Number of dwellinghouses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 198 2. Remedy of defects during the year without service of formal notice:— Number of defective dwellinghouses rendered fit in consequence of informal action by the Local Authority or their officers 163 45 3. Action under Statutory Powers during the year:— A.—Proceedings under Section 9, 10 and 16 of the Housing Act, 1936:— (i) Number of dwellinghouses in respect of which notices were served requiring repairs — (ii) Number of dwellinghouses which were rendered fit after service of formal notices:— (a) By owners — (b) By local authority in default of owners — B.—Proceedings under Public Health Acts:— (i) Number of dwellinghouses in respect of which notices were served requiring defects to be remedied 34 (ii) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 34 (b) By local authority in default of owners — C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (i) Number of dwellinghouses in respect of which Demolition Orders were made — (ii) Number of dwellinghouses demolished in pursuance of Demolition Orders — D.—Proceedings under Section 12 of the Housing Act, 1936:— (i) Number of separate tenements or underground rooms in respect of which Closing Orders were made 1 (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). 46 FACTORIES ACT, 1937. 1. Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 10 17 – – (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 199 204 12 – (iii) Other Premises in which Section 7 is enforced by the Local Authority 3 26 – – Total 212 247 12 – 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 (8.1.) — — — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — Sanitary Conveniences (S.7) — — — — — (a) Insufficient — 2 — — — (b) Unsuitable or defective 13 20 — — — (c) Not separate for sexes 4 3 — — — Other offences against the Act (not including offences relating to Outwork) 4 — 4 — — Total 21 25 4 — — 47 SECTION F — INFECTIOUS ILLNESS Notification. There were no new regulations brought into force during the year. The following diseases are notifiable in the district:— Acute Encephalitis (Infective) Leprosy Malaria Acute Encephalitis (Post-Infectious) Measles Meningococcal Infection Acute Poliomyelitis (Paralytic) Ophthalmia Neonatorum Plague Acute Poliomyelitis (Non-Paralvtic) Pneumonia, Primary Pneumonia, Influenzal Cholera Puerperal Pyrexia Continued Fever Relapsing Fever Diphtheria (including membranous Croup) Scarlet Fever Smallpox Dysentery Trench Fever Enteric Fever (including paratyphoid fevers) Typhus Fever 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. Scarlet Fever. The number of notifications this year dropped to 76, giving a case rate of 1.04 per thousand population, the lowest ever recorded in the district. Thirty-seven cases were removed to isolation hospital, a slightly higher percentage than 1953. Sixty-two cases occurred in children attending school, of which 10 were from schools outside our area. Of the others, 13 were children under school age and one was an adult. There were no serious outbreaks of scarlet fever in the schools, although one school in the district did account for 14 of our cases during the year, 7 of which occurred over a period of six weeks during the summer, and which might be classed as a minor outbreak. Poliomyelitis. Only one case of poliomyelitis was notified during the year. A child aged 3 years was admitted to isolation hospital as a ease of gastro-enteritis, with a history of vomiting and persistent diarrhoea. Soon after admission it was noticed 48 that he had developed a weakness of the left deltoid, and poliomyelitis was diagnosed. The child was discharged after four weeks with a recommendation for physiotherapy treatment. Whooping Cough. Ninety-six cases of whooping cough were notified during 1954. This is our best figure for several years and it is the first time since 1945 that the number has fallen below 100. The decrease is more than welcome after our record high figure of 414 in the previous year. The average number of notifications yearly,. over the past ten years, is 265, and it is to be hoped that this figure may now continue to fall. It is with satisfaction that we note that once again there were no deaths from this disease. Measles. The figure of 74 notifications of measles is the lowest recorded in the district since 1939, when notification first became compulsory. A table showing the incidence of measles in the district over the past 20 years is given below:— INCIDENCE OF MEASLES, 1935 -1954 Year Cases Deaths Population Remarks 1935 5 — 57,440 School children onlyincluded — disease not being notifiable. Figures based on returns from Head Teachers. 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 1954 74 73,270 Diphtheria. We have now had three successive years without a ease of diphtheria being notified, and nine years without a death. Table XVIII on page 59 gives the incidence and fatality of this disease since 1920. 49 Food Poisoning. There were no serious outbreaks of food poisoning reported during the year. Eleven notifications were received, consisting of five single cases and three family groups of two cases in each family. Fæcal specimens were taken in every case, and in three of the single cases salmonella typhimurium was isolated from the stools, whilst in the other two patients no pathogenic organisms were isolated. The agents identified in the three family groups were Proteus Morgan, Salmonella Typhi-Murium and Salmonella Senftenberg. The latter, which is comparatively rare in England and Wales, was the subject of an investigation by the Director of the Epidemiological Research Laboratory, as several eases had been reported from various parts of the country during the summer months. Details of all notified cases were received from the Research Laboratory, but 110 connection between these and the two cases in our district could be established. Dysentery. Thirteen notifications of dysentery were received, all but one being typed as sonnei. The thirteenth case was notified as Newcastle type. Only five school children were involved and in these instances any possibility of spread of infection was checked by the immediate exclusion from school, and by keeping the children away until two negative specimens were obtained. Paratyphoid Fever. There were two notifications of Paratyphoid 'B', one in February and the other in November. In neither case could the source of infection be traced. Both cases were removed to hospital for treatment. No information could be obtained regarding Vi-phage, as the hospitals concerned failed to send cultures for typing. Meningococcal Infection. A child aged 3½ years was admitted to the Grove Hospital in January with a history of vomiting and pyrexia. The case was diagnosed as Cerebrospinal fever. The child attended a nursery school 'm the area, and all absentees from this school were investigated. No further cases developed. Erysipelas. We received 12 notifications during the year, all of which involved the face. Pour of the patients were males and eight females. Two of the cases were removed to isolation hospital for treatment and the others were treated at their homes. Pneumonia. There were 67 cases of Pneumonia notified. Of this total, 19 were stated to be influenzal in origin. 50 Puerperal Pyrexia. Thirty-one cases of Puerperal Pyrexia were notified, giving a rate of 38.27 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. Twenty-eight cases were in fact notified from this particular hospital. Ophthalmia Neonatorum. Three eases were notified during the year; each child made a complete recovery and vision was unimpaired. CLEANSING STATION There was a decrease in the number of attendances at the Cleansing Station during the year, the total being 9 as compared with 31 in 1953. The details of the attendances during the year are as follows:— Number of cases of Scabies treated 4 Cases of Scabies with concurrent verminous head — Cases of Scabies with Secondary Septic Skin conditions — Number of cases of verminous heads only 5 Total number of attendances at the centre 9 51 TABLE X. Scarlet Fever Monthly Distribution. Month Wards Total  Abbey Bushey Mead 1 Central Morden Park Ravensbury Raynes Park _ i St. Helier West Barnes January 2 2 3 — 1 2 — 1 — 11 February 1 1 1 1 — — — — — 4 March 6 2 2 2 — 2 — 3 1 18 April — — — 3 — — — 1 — 4 May — 1 3 — — — 1 — 5 June — 1 — 2 — 1 — 2 — 6 July 1 — 1 5 — — — 1 — 8 August — — 1 2 — 1 — — — 4 September — — — — — — — — — — October 1 — 1 3 — 2 2 — 1 10 November — — — 3 — — — — 2 5 December — — — — — — — 1 — 1 Total 11 6 10 24 1 8 2 10 4 76 Monthly mean 0.92 0.50 0.83 2.00 0.08 0.66 0.17 0.83 0.33 6.33 The incidence in the various wards was as follows:— Wards Cases Incidence per 1,000 population Abbey 11 2.3 Bushey Mead 6 0.8 Central 10 1.0 Morden 24 2.1 Park 1 0.1 Ravensbury 8 1.3 Raynes Park ... 2 0.3 St. Helier 10 1.0 West Barnes ... 4 0.6 52 53 TABLE XI. Infectious Diseases, Notifications, Deaths and Distribution, 1954. Disease Cases Notified Case Rate per 1,000 population Deaths among notified cases Percentage of deaths to cases Distribution of Cases in Wards No. of cases removed to hospital Percentage of cases removed to hospital Abbey Bushey Mead Central Morden Park Ravensbury Raynes Park St. Helier West Barnes Smallpox — — — — — — — — — — — — — — — Scarlet Fever 76 1.04 — 11 6 10 24 1 8 2 10 4 37 49% Diphtheria — — — — — — — — — — — — — — Paratyphoid Fever 2 0.03 — I — — — 1 — — — 2 100% Meningococcal Infection 1 0.01 — — — 1 — — — — — — — 1 100% Puerperal Pyrexia.. 3! 0.42 — — — — — — 29 1 — 1 — 2 69% Erysipelas 12 0.16 — — — — 3 1 1 1 — 4 2 2 17% Poliomyelitis:— Paralytic 1 0.01 — — — — — — — — — 1 — 1 100% Non-Paralytic — — — — — — — — — — — — — — — Dysentery 13 0.18 — — — ! 7 3 — 1 — 1 — 1 8% Food Poisoning 11 0.15 — — — 3 4 2 — — — 2 — 1 9% Ophthalmia Neonatorum 3 0.04 — — — — 2 — — — 1 — — — — Primary Pneumonia 48 0.65 2 4.2% — 3 10 9 4 2 5 10 5 4 8% Influenzal Pneumonia 19 0.26 1 5.3% — 2 6 1 1 1 1 6 1 1 5.2% Measles 74 1.0! — — 1 27 10 10 5 2 4 5 10 1 1.4% Whooping Cough 96 1.31 — — 2 5 11 31 7 14 6 13 7 4 4.2% 54 TABLE XII. Notification of Infectious Diseases (other than Tuberculosis) by age groups during- the year 1954. 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 — 2 13 52 8 1 — — — — 76 Diphtheria (including Membranous Group) — — — — — — — — — — — Enteric Fever (including Paratyphoid) — 1 — — — — — — 1 — 2 Puerperal Pyrexia — — — — 14 14 3 — — 31 Acute Primary Pneumonia 1 I 1 2 1 1 1 5 26 9 48 Acute Influenzal Pneumonia — — — 4 — 2 1 2 6 4 19 Meningococcal Infection — — 1 — — — — — — — 1 Poliomyelitis: — Paralytic — — 1 — — — — — — — 1 Non-Paralytic — — — — — — — — — — — Dysentery — 1 1 5 — 3 — — 3 — 13 Malaria — — — — — — — — — — — Ophthalmia Neonatorum 3 — — — — — — — — — 3 Erysipelas — — — — — — 1 3 6 2 12 Food Poisoning — ' — — — 2 1 — 1 5 2 II Relapsing; Fever — — — — — — — — — — — Typhus Fever — — — — — — — — — — — Measles 2 20 8 41 2 — 1 — — — 74 Whooping Cough 8 16 33 35 3 1 — — — — 96 Totals 14 41 58 139 16 23 18 !4 47 17 387 55 TABLE XIII. Monthly Incidence of Infectious Diseases, 1954. Disease January February March April May June July August September October November December Total Smallpox Scarlet Fever 11 4 18 4 5 6 8 4 — 10 5 1 76 Diphtheria — — — —- — — — — — — — — — Dysentery 3 4 — 4 — 1 — | — — 1 — 13 Meningococcal Infection 1 — — — — — — — — — — — 1 Primary Pneumonia 7 5 9 4 1 5 3 1 1 3 4 5 48 Influenzal Pneumonia 2 2 3 1 — — — 2 1 2 •3 3 19 Pood Poisoning — 4 1 — 2 — — 3 1 — . — II Erysipelas 1 — 2 4 — 1 — — — 1 — 3 12 T.B. Pulmonary 5 9 5 2 5 3 3 7 6 3 3 2 53 T.B. Non-Pulmonary — — — — — — — — 1 1 — 1 3 Ophthalmia Neonatorum — — — 1 — — — 1 1 — — — 3 Puerperal Pyrexia 2 1 5 1 3 2 4 3 — 2 3 5 31 Poliomyelitis:— Paralytic — — — — — — — — 1 — — 1 Non-Paralytic — — — — — — — — — — — — — Malaria — — — — — — — — — — — — Measles 2 2 7 10 — 4 3 7 4 3 1 31 74 Whooping Cough 12 11 3 5 15 6 13 4 2 5 1 19 96 Paratyphoid Fever — 1 — — — — — — — — 1 — 2 Totals 43 42 56 33 33 29 35 29 19 32 22 70 443 DIPHTHERIA IMMUNISATION Eight hundred and five children in the district received complete primary courses during the year. Of this total, 415 were carried out in the Welfare Centres, 306 by private practitioners and 84 in the schools. In addition, 1,401 children were given boosting injections at school (156 of these being children who are not resident in the area). Of the primary courses given at Welfare Centres, 395 were combined Diphtheria/Pertussis, whilst private practitioners gave 268 such courses. There was a considerable increase in our figures this year, which offset our low numbers for 1953. Fortunately we were able to carry out a full programme of immunisation uninterrupted by the stoppages due to poliomyelitis which were necessitated in 1953. 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. 56 TABLE XIV. Persons Immunised at Clinics, 1954. WARDS AGE GROUPS Total Completed Primary Total Single Boosting Injections 0-5 years 5-15 years Completed Primary Single Boosting Injections Completed Primary Single Boosting Injections Abbey 33 — — 1 33 1 Bushey Mead 45 — — 5 45 5 Central 51 — — 7 51 7 Morden 40 — — 6 40 6 Park 43 — — 6 43 6 Ravensbury 42 — — 1 42 1 Raynes Park 39 — — 6 39 6 St. Helier 75 — 1 4 76 4 West Barnes 45 1 1 1 46 2 413 1 2 37 415 38 TABLE XV. Persons Immunised by Private Practitioners, 1954. WARDS AGE GROUPS Total Completed Primary Total Single Boosting Injections 0-5 years 5-15 years Completed Primary Single Boosting njections Completed Primary Single Boosting Injections Abbey 13 — — 6 13 6 Bushey Mead 25 4 2 5 27 9 Central 48 9 2 16 50 25 Morden 52 9 3 37 55 46 Park 31 — 2 13 33 13 Ravensbury 25 — — 1 25 1 Raynes Park 32 5 6 15 38 20 St. Helier 36 — ; 3 3 39 3 West Barnes 25 1 1 8 26 9 287 28 19 104 306 132 57 TABLE XVII. Number of Children Immunised at School, 1954 School Completed Primary Single Boosting Injections Bushey County Primary 15 186 Poplar Road County Primary 1 54 St. Mary's „ „ — 85 Merton Abbey „ „ 4 45 Hillcross „ „ 2 126 Raynes Park „ „ 16 192 Morden „ „ 4 66 Morden Farm „ „ 15 186 St. Helier No. 1 „ „ 6 67 St. Helier No. 2 „ „ 4 52 St. Helier Ntt 3 „ „ 6 87 St. Helier No. 4 „ „ 5 72 Holy Family R.C. Vol. Primary 6 34 Sacred Heart R.C. Vol. Primary 5 78 Hatfeild County Primary 2 71 Total 91* 1401 * *Includes children attending schools in Merton and Morden but resident in other areas:— Primary 7 Boosters 156 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 — 591 194(1 234 12 50 — 296 1941 700 6 3,198 — 3,904 1942 1,127 16 753 — 1,896 1943 813 64 211 51 1,139 1914 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 1954 415 306 84 — 805 58 TABLE XVIII. Incidence and Fatality of Diphtheria, 1920-1954. Year Population No. of cases Incidence rate per 1,000 population No. of deaths Percentage of deaths to cases 1920 18,200 47 2.5 3 6.3 1921 18,000 28 1.5 1 3.5 1922 18,500 62 3.3 4 6.4 1923 18,750 39 2.08 1 2.5 1924 18,710 68 3.6 6 8.9 1925 18,960 25 1.3 1 8.3 1926 19.980 24 1.2 2 8.5 1927 21,850 29 1.3 2 6.8 1928 25,780 38 1.4 2 - 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 - - - - 1954 73,270 - - - - 59 60 TABLE XIX. Diphtheria, Immunisation. Number of children 0— 5 years immunised January — June. 1954 383 Number of children 5—15 years immunised January — June, 1954 7 Number of children 0— 5 years immunised July — December, 1954 433 Number of children 5—15 years immunised July — December, 1954 8 Total number of children 0— 5 years immunised during the year 816 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 287 Number of children 5—15 years immunised by Private Practitioners during the year 19 Total number of children immunised by Private Practitioners during the year 306 Total number of children immunised in the Clinics during the year 415 Total number of children immunised in the Schools during the year 84 Estimated percentage of 0— 5 years immunised at end of year 54.58 Estimated percentage of 5—15 years immunised at end of year 95.22 Age Distribution of Immunised Children. Age at 31-12-54 i.e born in year Under 1 1954 1 - 4 1950-53 5-9 1945-49 10-14 1940-44 Total under 15 Estimated Population under 1 Estimated Population 1-4 Estimated Population 5-14 Total Estimated Population under 15 Number immunised 42 2,322 4,780 4,696 11,840 786 3,545 9,952 14,283 WHOOPING COUGH IMMUNISATION. In this, the second full year during which whooping cough immunisation has been carried out in the district, 743 primary courses were given, 289 by private practitioners and 454 at the clinics. As has already been mentioned in the paragraph on diphtheria immunisation, 663 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 1 2 3 4 5-9 10-14 Whooping Cough 2 6 6 2 1 4 — 21 Diphtheria/Whooping Cough Combined 148 104 3 3 2 8 — 268 Total 150 120 9 5 3 12 — 289 Given at Clinics. Antigen Age Groups Total Under 1 1 2 3 4 5-9 10-14 Whooping Cough 3 17 17 11 11 — — 59 Diphtheria/Whooping Cough Combined 199 187 3 4 2 — — 395 Total 202 204 20 15 13 — — 454 61 BOOSTING DOSES. Given by Private Practitioners. Antigen Age Groups Total Under 1 1 2 3 4 5-9 10-14 Whooping Cough — — — — — 3 — 3 Diphtheria/Whooping Cough Combined — 1 3 8 13 33 1 59 Total — 1 3 8 13 36 1 62 Given at Clinics. Antigen Age Groups Total Under 1 1 2 3 4 5-9 10-14 Whooping Cough — — — — — — — — Diphtheria/Whooping Cough Combined — — — 9 10 — — 19 Total — — — 9 10 — — 19 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 28 Re-vaccinations 120 Of the above 392 were vaccinated by Private Practitioners. 62 TUBERCULOSIS. Eighty-one new eases were added to the register of tuberculous persons, compared with 122 in .1953. These additions were:— Males Females Total Pulmonary 42 35 77 Non-Pulmonary 1 3 4 43 38 81 Of these 81, 55 were primary notifications, 25 were transferred from other districts, and 1 came to notice in another way. During the year, 100 persons were removed from th register for the following reasons:— Recovered 41 Removed from the district 48 Death 11 After allowing for the additions and deductions, the number remaining on the register at the 31st December, 1954, was distributed as shown in the following table:— TABLE XX. Tuberculosis Register at 31st December, 1954. WARDS Registered at 31st December, 1954 Totals Number on Register at mid-year Pulmonary NonPulmonary Abbey 81 10 91 89 Bushey Mead 67 10 77 81 Central 110 8 118 121 Morden 118 8 126 127 Park 137 15 152 154 Ravensbury 122 20 142 146 Raynes Park 102 9 111 112 St. Helier 179 26 205 210 West Barnes 72 17 89 89 Whole district 988 123 llll 1129 63 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 141 persons in 1954 from Merton and Morden, as follows:— At the County Sanatorium, Milford 23 At other Institutions 118 141 A table has been prepared which shows in comparison the numbers of new cases for the past 10 years. The primary infections are all cases occurring in the district. The total cases include T.B. cases which have moved into the district and are added to our registers. It will be seen from the table that the number of primary notifications has fallen considerably, and that for the first time on record the total number of persons on the register at the end of the year shows a reduction as compared with the previous year. TABLE XXI. Tuberculosis 1945 - 54. 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 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 9? 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 1954 52 3 55 77 4 81 988 123 llll Total 886 96 982 1231 136 1367 — — — Av'ge 88.6 9.6 98 2 123.1 13.6 136.7 — — — The deaths from Tuberculosis during the year number 8, six of which were due to pulmonary disease. One of the deaths was an unnotified case. 64 The deaths are classified by age and sex in the following table:— TABLE XXII. Deaths due to Tuberculosis, 1954. Ages Years Pulmonary Non-Pulmonary Totals Males Females * Males Females 0— — — — — — 1— — — — — — 5— — — — — — 15— — — — — — 25— — — — 1 1 35— 1 — — — 1 45— 1 — — — 1 55— 1 1 — — 2 65— — 1 — 3 Totals 5 1 1 1 8 No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, which give power to prohibit the handling of milk by infectious tuberculous persons, nor under Section 172 of the Public Health Act, 1936, which provides for the removal of an infectious person to hospital. TUBERCULOSIS CARE COMMITTEE The Merton and Morden Care Committee consists of representatives of various organisations, together with three independent members, and, ex-officio, the Medical Officer of Health, Chest Physician, Tuberculosis Health Visitors and the Care Almoner. It supplies voluntary aid to patients and their families as an addition to the statutory assistance which is available, and thereby helps to make life easier for these unfortunate people. The Committee's main source of income is derived from the sale of Christmas Seals, which this year showed a profit of £186 16s. 5d. This, together with various grants, donations and proceeds from local functions, built a total income for the year of £413 9s. 6d. Considerable financial support was again given to the holiday scheme for child contacts. Holidays were held at three different centres and twenty-one children from our area enjoyed healthy holidays. 65 The Committee keeps a stock of bedding and other necessities for loan to needy patients, and also assists patients and their relatives with cash grants and Loans. I am indebted to the Honorary Secretary for supplying me with the information which has enabled me to express this small appreciation of the very valuable work carried out by the Committee. MASS RADIOGRAPHY The Mass Radiography Unit paid three visits to our district during the year, two of which were Public Surveys and one for factory workers only. The public survey held in February covered the Merton and South Wimbledon areas, whilst the November survey was for the benefit of the Morden residents. I am indebted to Dr. F. J. H. Walters, Medical Director of the Mass Radiography Centre, for the following information in connection with these surveys: Location Number of persons examined Abnormalities Awaiting diagnosis Active P.T. Inactive P.T. Nontuberculous M F Total M F Incidence per 1,000 examined M F M F Morden Factory Group 658 822 1480 1 1 1.4 36 37 25 18 - Merton arid S. Wimbledon district 3013 3415 6428 3 3 0.9 123 124 129 73 - Morden district 1675 2196 3871 1 2 0.8 79 86 68 46 1 66 67 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 — 1 — — 1 — — — — — — — 2 5—10 1 — — — — — — — — 1 10—15 1 1 — — — — — — — — — — 2 15—20 3 3 — — 1 — — — — — — — 7 20-25 5 7 1 2 2 — 1 — — — — 18 25-35 2 6 — 1 4 5 — — — — — — 18 35-45 5 2 1 — 3 2 — — — — — — 13 45—55 6 4 — — 3 1 — — — — — — 14 55-65 4 1 — — — — — — — — — 5 65 and over — — — — — — — — 1 — — — 1 Totals 27 25 1 2 14 10 1 1 — — — 81 55 25 i INDEX. PAGE Acreage 7 Acute Poliomyelitis 48 Ambulance Facilities 22 Animal Nuisances .........................42 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 43 Climatic Conditions 7 Clean Food 26 Cleansing Facilities 51 Deaths 14-21 Causes of 16, 18 Rates 9, 10 Diphtheria 49, 57-60 Immunisation 57-60 By age groups 57-60 Children immunised in Schools 58 Persons immunised in Clinics 57-8 Persons immunised by Private Practitioners 57 Incidence and fatality for 35 years 59 Drainage and Sewerage 28 Drainage work 29 Erysipelas 50 68 INDEX—Continued. PAGE Factories and Workplaces 42, 47 Inspections 47 Defects 47 Food and Drugs Act, 1938 26-7, 36-8 Food Poisoning 50 Food Supply 33-41 Inspections 33 Unsound Food 33-34 Health Services 21-6 Heart Disease—Deaths from 16, 18 Hospitals 24-25 Hospital Car Service 22 Housing 30-32, 45-46 Action Taken 30-32, 45-46 Inspections and Defects 45-6 Number inhabited 7 Overcrowding 32, 45 Ice-Cream 38-41 Industry 7 Infant Mortality 20, 21 Causes of death 20 Rates 21 Infectious Diseases 24-25, 48-55 Cases admitted to hospital 24-25 Diseases notifiable 48 Monthly Incidence 55 Notification by Age Groups 54 Notifications, deaths and distribution 53 Inquests 15 Isolation Hospitals 24, 25 69 INDEX—Continued. PAGE Mass Radiography 66 Maternal Mortality 19 Rates 19 Measles 49 Meat Inspection 34 Mental Disease 25-6 Merchandise Marks Acts 43 Milk Supply 34-5 Mosquitoes 42 National Assistance Act 26 Nelson Hospital 24 Neonatal Deaths 20 North-Eastern Divisional Health Sub-Committee 5 Notification of Births 12 Nuisances 31 Nursing in the Home 21-2. Paratyphoid Fever 50 Pneumonia 50 Poliomyelitis 48 Population 11 Premature Births 21 Public Cleansing 28 Public Health Committee 5 Puerperal Pyrexia 51 Rainfall 7 Rateable Value 7 Respiratory Diseases—deaths from 17 70 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 28 Road Accidents—deaths from 16, 18 Rodent Control 42 Sanitary Circumstances 26-44 Sanitary Inspections, Summary of 29 Scarlet Fever 48, 52 Incidence in each Ward with rates 52 Monthly distribution of cases 52 Shops Act, 1950 43-4 Smallpox 24, 48 Smoke Abatement 43 Social Conditions of the Area 7 Staff 6 Statistics 7-10 Comparative 10 Vital 8, 9 Stillbirths 20, 21 Tuberculosis 63-7 Admission to Sanatorium 64 Assistance given 65-6 Care Committee 5, 65-6 Deaths due to 65 Dispensary 23 Mass Radiography 66 New cases—by age groups 67 Number on register at end of year 63 71 INDEX—Continued. PAGE Vaccination 62 Venereal Diseases 23 Vital Statistics 8, 9 Wandle Valley Joint Sewerage Board 5 Water Courses 42 Water Supply 27 Whooping Cough 49 Whooping Cough Immunisation 61-2 Zymotic Disease—deaths from 9 Rate 9 72 Printed by J. B. BLACKMORE & CO., LTD., 85, Merton High Street, London, S.W.19. Tel. LIBerty 3411-2.