MIT 34 HEALTH REPORT FOR 1923 OF THE Mitcham Urban District BY THE Medical Officer of Health. Urban District Council of Mitcham. HEALTH REPORT FOR 1923. Mrs. Hallowes and Gentlemen,— I beg to present my twenty-sixth Annual Report of the health conditions prevailing during the year 1923 in Mitcham. I am grateful for the help I have received at all times from members of the Council. The Clerk of the Council and all the members of the Public Health staff have been most helpful with their ready co-operation in all my work, and I feel that the continued advancement in improving the health of Mitcham is due to them. The work of the Maternity and Child Welfare Department has been such that the health and condition of all children have reached a high standard, while the mortality rate shows a steady decline except in the case of illegitimate children. I am, Mrs. Hallowes and Gentlemen, Your obedient Servant, C. M. FEGEN. Medical Officer of Health. 24, London Road, West Croydon. Urban District Council of Mitcham. PUBLIC HEALTH COMMITTEE. Chairman - - Mr. R. F. Langley. Mr. A. H. Bailey. Mrs. Hallowes. Mr. E. J. Mizen. Lt.-Col. fl. F.Bidder. Mr. G. T. Heard. Mr. J. Owen, J.P. Mr. B. E. Bucklacid. Mr. C. Higgs. Mr. W. H. Parslow. Mr. H. J. Davis. Mr. H. Hariri. Mr. H. Richards. Mr. J.D.Drewett, J.P. Mr. G. Farewell Jones. Mr. E. E. Snowsill. Mr. J. Fitch. Mr. W. F. Laing. Mr. W. G. Spokes. Mr. S. L. Gaston. Dr. H. Love. Mr. J. P. Turner. Mr. A. T. Gidden. Mr. W. J. Mellhuish. MATERNITY AND CHILD WELFARE COMMITTEE. Mrs. A. H. Bailey. Lady Worsfold. Mr. A. T. Gidden. Mrs. H. F Bidder. Mr. A. H. Bailey. Mr. G. T. Heard. Miss E. C. Chart. Mr. J. D. Drewett, J.P. Mr. G. Farewell Jones. Mrs. Hallowes. Mr. H. J. Davis. Dr. H. Love. Mrs. J. Owen. Mr. J. Fitch. Mr. W. G. Spokes. Mrs. R. Richman. Mr. S. L. Gaston. Mr. H. Richards. REPRESENTATIVES ON THE JOINT HOSPITAL BOARD. Mr. J. D. Drewett, J.P. Mr. J. Owen, J.P. Dr. H. Love. Mr. W. H. Parslow. REPRESENTATIVE ON SMALL POX HOSPITAL BOARD Mr. E. J. Mizen. STAFF. Medical Officer of Health. C. M. FEGEN, d.p.h., etc. Assistant Medical Officer of Health. P. N. CAVE, d.p.h., etc. Senior Sanitary Inspector. C. G. RABBETTS, c.r.s.i. Assistant Sanitary Inspectors. R. R. RICHARDS, c.r.s.i. A. E. HANDLEY. Supt. Health Visitor. Miss E. S. ROGERS, s.i.e.b., c.m.b. Assistant Health Visitor. Miss KNIGHT, c.m.b., s.i.e.B. Nurse Midwife. Miss A. L. HURN, c.m.b. Clerks. S. E. CRISP, c.r.s.i. Miss M. C. BULLOCK. STATISTICS. 1. General. Area (acres), 2914. Population- 1921, 34,711 ; 1923, 36,460. Number of inhabited houses—1922, 7,300 ; 1923, 7449. Rateable value, £150,714. Sum represented by a penny rate, £570. 2. Extracts from Vital Statistics of the Year. Total. M. F. Birth rate. Births Legitimate 762 394 368 1 21.5 Illegitimate 24 9 15 1 Deaths, 343. Deatli Rate, 9.4. Number of women dying in, or in from sepsis ... nil consequence of childbirth. ,, other causes nil Death of infants under one year of age Per 1000 legitimate births 52 Per 1000 illegitimate births 290 Total 59 Deaths from :— Measles (all ages) 1. Whooping Cough (all ages) 5. Diarrhoea (undei two years of age), 8. REPORT. I.—AREA AND POPULATION. The Urban District of Mitcham is divide! into four wards, viz., East, North, South and West, and has a total area of 2,914 acres. At the time of the Census in 1921, the population was 34,711, while for 1923 it is estimated at 36,460. The number of occupied houses in the district was:— In 1915 6,910 „ 1916 6,975 „ 1917 6,998 „ 1918 7,001 „ 1919 7,164 „ 1920 7,177 „ 1921 7,150 „ 1922 7,300 „ 1923 7,449 The number of occupied houses in each Ward was :— East 1,364 North 2,082 South 1,445 West 2,558 The average number of persons per house is 5.0. II.—VITAL STATISTICS. Births. The number of births registered during the year as belonging to this district was 786, of which 403 were males and 383 were females, as against 755 last year. The birth rate for the year was 21.5 per thousand of population, as against 20.9 last year. The birth rate for England and Wales in 1923 was 19.7 per thousand of population. 7 Illegitimate Births. During the year 24 illegitimate births were registered, giving a percentage of total births of 3.0. The following figures show the number of illegitimate births occurring during the past nine years. Number of Illegitimate Births. Percentage. 1915 26 2.9 1916 23 2.7 1917 35 5.7 1918 33 5.3 1919 29 5.3 1920 35 3.5 1921 24 2.9 1922 26 3.4 1923 24 3.0 Registered Births and Birth Rates. Ward. Estimated Population. Births. Birth Rates. Males. Females Total, East 6,700 73 60 133 19.8 North 9,900 81 60 141 14.2 South 7,310 107 103 210 28.7 West 12,550 118 138 256 46 20.4 Births occurring outside district. 24 22 Totals 36,460 403 383 786 21.5 8 Deaths. The number of deaths registered as occurring during the year was 343, as against 398 last year. This number excludes those deaths which occurred inside but belonged to other districts, but includes deaths which occurred outside, but were normally residents of the district. These latter deaths occurred chiefly at the Infirmary and General Hospital at Croydon, the County Asylums at Brookwood and Netherne, and the Isolation Hospital at Beddington Corner. The death rate for the year was 9.4 per thousand of population, as against 11.0 last year. The death rate in England and Wales for 1923 was 116. Infantile Mortality. The number of deaths registered as occurring in infants under one year of age was 47, as against 46 last year, the infantile mortality rate being 59 as against 61 last year. The infantile mortality rate for England and Wales was 69 per thousand births. Causes of Deaths. Reference to Table II. will show the total deaths, together with the cause. The deaths included : 32 from Pulmonary Tuberculosis (26). 2 ,, Enteric Fever. 1 „ Measles (6). 1 ,, Scarlet Fever (2). 5 „ Whooping Cough (2). 45 „ Heart Disease (61). 33 „ Cancer (34). The figures in brackets refer to the number which occurred last year. 9 Birth-rate. Death-rate, and Analysis of Mortality during the year 1923. - Birthrate Per 1000 Total Population. Annual Death-Rate per 1000 Population. rate per 1000 Births. All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under Two Years.) Total Deaths under One Year. England and Wales 19.7 11.6 0.01 0.00 0.14 0.03 0.10 0.07 0.22 0.44 7.7 69 105 County Boroughs and Great Towns, including London 20.4 11.6 0.01 0.00 0.15 0.03 0.12 0.09 0.22 0.40 9.9 72 157 Smaller Towns (1921 Adjusted Populations 20,000—50,000) 19.8 10.6 0.01 _ 0.19 0.02 0.10 0.06 0.21 0.38 6.4 69 London... 20.2 11.2 0.01 0.00 0.08 0.02 0.09 0.13 017 0.45 10.2 60 Mitcham Urban District 21.5 9.4 0.05 0.00 0.02 0.02 0.13 000 0.05 0.38 10.1 59 10 III.—INFECTIOUS DISEASE. The year 1923 has been a very satisfactory one from the point of view of the prevalence of infectious disease, the number of cases notified being 287 as against 347 last year. Eeference to Table I. at the end of the Report will show :— Firstly, the cases notified in the District, with the ages of incidence, and the nature of the infectious disease. Secondly, the number of cases (and nature of disease) in each Ward. Thirdly, the number of cases removed to the Isolation Hospital. Table III. shows the number of cases notified each year since the adoption of the Infectious Disease (Notification) Act, 1889. Scarlet Fever. A large decrease took place in the number of cases of Scarlet Fever notified, viz., 110 as against 178 last year. The majority of the cases occurred in the West Ward, from which 67 were notified. One hundred and three cases, or 97 per cent. of the cases, were removed to the Isolation Hospital. One death was registered as occurring from this complaint. Diphtheria. A very large decrease also took place in the number of cases of Diphtheria, there being only 35 cases notified as against 84 last year. All the cases were removed to the Isolation Hospital. No deaths occurred during the year from Diphtheria. Under the arrangements with the Wandle Valley Joint Hospital Board, any medical practitioner in this district is provided with the necessary outfit to have a bacteriological examination made to confirm, or otherwise, his diagnosis. During the year Dr. Cave examined 157 swabs from this District. 11 Puerperal Fever. Two cases of Puerperal Fever were notified. The confinement in one case was attended at first by relatives of the patient. Both cases were removed to the Isolation Hospital, and were discharged after recovery. Poliomyelitis. Four cases were notified, viz :— E. G., female, aged 2 years, residing in the South Ward Patient died. L. T., male, aged 3 years, residing in South Ward. A. H., female, aged 1¾ years, residing in East Ward. R. W., male, aged 2 years, residing in North Ward. Tuberculosis. During the year 64 new cases of Tuberculosis were notified, of which 43 were pulmonary and 21 were other forms of Tuberculosis. The sanatorium and dispensary treatment of Tuberculosis is carried out by the Surrey County Council. During the year Dr. Cave examined 27 specimens of sputa sent by medical men practising within this District. 12 Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. P. M. F. M. F. M. F. Under 1 ... ... ... ... ... ... ... ... 1 and under 5 ... ... ... 1 ... ... ... 1 5 „ 10 ... ... 4 6 ... ... 1 ... 10 ,, 15 1 3 1 3 1 1 ... ... 15 „ 20 2 3 1 1 1 1 ... ... 20 ,, 25 1 5 ... ... 1 3 ... ... 25 „ 35 7 7 ... ... 5 2 ... ... 35 „ 45 3 2 1 1 4 5 1 1 45 „ 55 2 4 1 ... 3 1 ... ... 55 ,, 65 3 ... ... ... 2 1 ... ... 65 and upwards ... ... 1 ... 1 ... ... 1 Totals 19 24 9 12 18 14 2 3 The cases were distributed amongst the following Wards :— Localisation. Total Cases. East. North. South. West. Pulmonary 43 10 11 10 12 Non-Pulmonary 21 4 3 2 12 Totals 64 14 14 12 24 13 HEALTH VISITORS. Two whole-time Health Visitors are employed in the District and work under the supervision of the Medical Officer of Health. Both carry out their various duties in a very efficient manner. The following Table shows the number of visits paid by the Health Visitors during the year : Reports of Visits paid by Health Visitors for 1923. Miss Rogers. Miss Knight. Total. Primary ante-natal visits 76 9 85 Subsequent ante-natal visits 77 16 93 Primary birth visits 400 298 698 Subsequent visits to infants 1596 1248 2844 Visits to children under five years of age 1743 2256 3999 Enquiries re deaths of infants under one year of age 17 15 30 Enquiries re stillborn births 5 5 10 Visits re cases of ophthalmia neonatorum 5 1 6 Visits re cases of puerperal fever 2 1 3 Visit re case of acute poliomyelitis 1 ... 1 Primary visits to cases of tuberculosis 45 13 58 Subsequent visits to cases of tuberculosis 66 26 92 Visits re cases of pneumonia 2 1 3 Special visits 103 68 171 4138 3955 8093 14 The following table shows the number of children on the registers, together with the attendances, etc.:— Report of Infant Welfare Centres, 1923. Particulars. Zion Schools. The Woodlands. St. Barnabas. Total 1922 1923 1922 1923 1922 1923 1923 Number of Infants on Register January 1st, 1923 164 180 132 168 148 190 538 Number of Infants on Register June 1st, 1923 115 124 110 113 124 132 369 Number of Infants on Register December 31st, 1923 180 145 168 126 194 151 422 Number of new Infants entered on Register 104 138 104 86 99 97 321 No. of Infants who have completed one year of age 62 87 87 76 73 84 237 Infants transferred to other centres 2 2 3 3 4 Infants who have died 1 ... 2 ... 1 2 Number of Infant attendances 982 1113 952 1149 1013 1361 3623 Average attendance 43.66 50.9 43.6 52 4 48 7 62.2 Maximum attendance of any Infant 20 22 20 Maximum attendances at any centre 54 77 69 64 65 79 Number of attendances at Ante-Nat: 1 Clinic 72 70 Average attendance 6.3 NURSE-MIDWIFE. The work carried out by Miss Hurn, the Nurse-Midwife, has proved very acceptable. During the year she has attended 51 confinements. MEDICAL INSPECTION OF SCHOOL CHILDREN. The Education Department of the Surrey County Council carries out the duties of the medical inspection of school children. On occasions the Medical Officer of Health is called in to examine children who are suspected to be suffering from infectious or contagious disease. 15 SCHOOLS. During the year the following visits have been paid to schools :— Number of ordinary visits 101 Number of special visits for infectious or contagious disease 16 Certificates given for school attendance purposes 161 It was not found necessary to close any schools during the year. GENERAL. Water Courses.—Constant supervision is paid to all water courses within the District. Legal Proceedings.—In the following cases it was found necessary to institute legal proceedings to enforce the abatement of nuisances:— Particulars. result. Non-abatement of a nuisance from defective and dirty walls and ceilings. Order made to execute work. Pined 30s., and costs 21s. Non-abatement of a nuisance from defective roofs, walls, dirty interior, etc. (two cases). Order made to execute works. Fined 40s. in each case. Failing to comply with a Closing Order. Order to quit in 14 days. HOUSING, Etc. Number of new houses erected during the year :— (a) Total, 142. (b) With State assistance under Housing Acts 1919 or 1923. i. By Local Authorities — ii. By other bodies or persons 142 16 1. Unfit Dwelling Houses. Inspection. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 2,157 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 217 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 111 2. Remedy of Defects without Service of Formal Notice. Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 98 3. Action under Statutory Powers. A. Proceedings under Section 28 of the Housing, Town Planning Act, 1919 :— (1) Number of dwelling houses in respect of which notices were served 73 17 (2) Number of dwelling houses which were rendered fit:— (a) By owners 67 (b) By Local Authority in default of owners 6 (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. B. Proceedings under Public Health Acts :— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 980 (2) Number of dwelling houses in which defects were remedied :— (a) By owners 965 (b) By Local Authority in default of owners 15 C. Proceedings under Sections 17 and 18 of the Housing Town Planning, etc., Act, 1909 :— (1) Number of representations made with a view to the making of Closing Orders 1 (2) Number of dwelling houses in respect of which Closing Orders were made 1 (3) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses being rendered fit 1 (4) Number of dwelling houses in respect of which Demolition Orders were made Nil. (5) Number of dwelling houses demolished in pursuance of Demolition Orders Nil. 18 SALE OF FOODS AND DRUGS ACTS, ETC. The administration of the Sale of Foods and Drugs Acts, etc., is carried out by the Surrey County Council. The following Table shows the number of samples obtained in this District which were analysed during the year:— Articles Analysed Adulterated or Deteriorated Prosecutions Convictions Formal informal Total Formal Informal Total Milk 73 9 82 13 ... 13 5 3 Tea ... 1 1 ... ... ... ... ... Mustard ... 1 1 ... ... ... ... ... Confectionery and Jam ... 1 1 ... ... ... ... ... Pepper ... 1 1 ... ... ... ... ... Other articles ... 2 2 ... ... ... ... ... Totals 73 15 88 13 ... 13 5 3 AMBULANCE FACILITIES. Infectious Cases.—Two motor ambulances are provided for the removal of infectious cases to the Wandle Valley Joint Isolation Hospital. For General and Accident Cases.— A motor ambulance under the control of the Council is provided for accident cases. Upon application it is also available for the removal of patients to hospitals, etc. This ambulance is under the control of the Fire Superintendent. FACTORY AND WORKSHOP ACTS. During the year 242 visits of inspection were paid to factories and workshops, and in 12 instances it was found necessary to serve notices. REGULATED TRADES. Dairies, Cowsheds and Milkshops.—There are 39 premises registered as either Dairies, Cowsheds or Milkshops in this District. This is two more than the previous year. During the year 114 visits of inspection were paid. Slaughterhouses.—There are seven slaughterhouses within the District. Two hundred and seventy visits of inspection have been paid during the year. 19 Report on the administration of the Factory and Workshop Act, 1901, in connection with Factories, Workshops, Workplaces and Homework. 1. Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 105 8 Nil Workshops (Including Workshop Laundries) 119 4 Nil Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 18 Nil Nil Total 242 12 Nil 20 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. Number of Prosecutions. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts :—* Nil Nil Want of cleanliness 1 1 Want of ventilation Overcrowding Want of drainage of floors Other nuisances 5 5 Sanitary accommodation insufficient 1 1 unsuitable or defective 2 2 not separate for sexes 2 2 Offences under the Factory and Workshop Acts : — Illegal occupation of underground bakehouse (s. 101) Breach of special sanitary. requirements for bakehouses (ss. 97 to 100) Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) Total 11 11 Nil Nil * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 21 3.—Homework. Nature of Work.* Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109,110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (s. 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists † Outworkers † Lists Outworkers. Contractors Workmen. Contractors Workmen. (l) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— making, &c. 14 2 12 15 1 14 Nil cleaning & washing Household linen Lace, lace curtains and nets Curtains & furniture hangings Furniture and upholstery Electro-plate File making Brass & brass articles Fur pulling Cables and chains Anchors and grapnels Cart gear Locks, latches & keys Umbrellas, &c. Artificial flowers Nets, other than wire nets Tents Sacks Racquets and tennis balls Paper, etc., boxes, paper bags Brush making Pea picking Feather sorting Carding, &c., of buttons, &c. Stuffed toys Basket making Chocolates and sweetmeats Cosaques, Christmas crackers, Christmas stockings, &c. Textile weaving total 14 2 12 15 1 14 * If an occupier gives out work of more than one of the classes specified in column 1, and subdivides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. † The figures required in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarily be even numbers, as there will be two lists for each employer—in some previous returns odd numbers have been inserted. The figures in columns 3 and 4 will usually be (approximately) double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated. 22 4.—Registered Workshops. Workshops on the Register at the end of the Year. Number. Workshop-bakehouses 12 Marine Stores 2 Printers 2 Laundries 7 Varnish Works 7 Dressmakers and Tailors 5 Various 15 Total number of Workshops on Register 50 5.—Other Matters. Class. Number. Matters notified to H.M, Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Acts (s. 133, 1901) Nil Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (s. 5, 1901) Notified by H.M. Inspector ... 2 Reports (of action taken) sent to H.M. Inspector Nil Other Nil Underground Bakehouses (s. 101) in use at the end of the year Nil APPENDICES. 24 APPENDICES. ISOLATION HOSPITAL. The Wandle Valley Joint Hospital, which is situate at Beddington Corner, serves the Urban Districts of Beddington and Wallington, Coulsdon and Purley, Merton and Morden, and Mitcham. The Hospital was first opened at the beginning of March, 1899, when 28 beds were provided, viz., 10 beds for Scarlet Fever cases, 10 beds for Diphtheria cases, 4 beds for Typhoid Fever cases, and 4 beds for doubtful cases. In 1904 a contract was entered into by the Rural District Council to considerably extend the accommodation, and in June, 1905, an additional Scarlet Fever pavilion for 22 beds was completed. The hand laundry was converted into a steam laundry, and an additional dormitory was provided in the administrative block. A further enlargement in 1910 included a cubicle block for 12 patients and also quarters for a resident medical officer. Further accommodation was provided in 1922 by the erection of another cubicle block for 16 beds. The nominal number of beds now available is 78, but on many occasions a larger number of patients are being treated. Since the Hospital was opened 8,825 patients have been admitted. The number of patients admitted last year, together with the number of deaths and the case mortality, is :— 25  Cases. Deaths. Case Mortality (per cent.). Scarlet Fever 230 2 0.86 Diphtheria 136 4* 2.94 Pneumonia 1 — 0.00 Puerperal Fever 3 1† 33.33 Typhoid Fever 1 1 100.00 Erysipelas 6 — 0.00 Measles 1 — 0.00 Encephalitis Lethargica 2 - 0.00 Influenza 1 — 0.00 Tuberculosis 20 2 10.00 Total 401 10 2.49 * One patient died from Nephritis. t Patient died from Tubercular-Broncho-Pneumonia. Bacteriological Laboratory. The Hospital is provided with a bacteriological laboratory, and during the year Dr. Cave has made the following examinations:— Number of swabs examined for diphtheria 1,147 Number of specimens of sputa 122 This work was divided amongst the constituent Authorities and amongst the patients at the Hospital as shown by the following table:— Swabs for Diphtheria. Sputa. Beddington and Wallington 97 18 Coulsdon and Purley 93 29 Mitcham 157 27 Hospital Cases 800 48 26 Patients Admitted to Hospital during 1923. District. Scarlet Fever. Diphtheria. Pneumonia. Puerperal Fever. Typhoid Fever. Erysipelas. Tuberculosis. Measles. Encephalitis Lethargica. Influenza. Totals. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Beddington and Wallington 22 ... 37 ... ... ... 1 1* ... ... 3 ... ... ... 1 ... 2 ... ... ... 66 1 Coulsdon and Purley 35 1 23 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 59 2 Mitcham 107 ... 35 ... ... ... 2 ... 1 1 1 ... ... ... ... ... ... ... 1 ... 147 1 Merton and Morden 54 1 39 3‡ 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 95 4 Oaterham 11 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 ... Oarshalton 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Surrey ... ... ... ... ... ... ... ... ... ... ... ... 20 2 ... ... ... ... ... ... 20 2 Totals 230 2 136 4 1 ... 3 1 1 1 6 ... 20 2 1 ... 2 ... 1 ... 401 10 ‡ One patient died from Nephritis. * Patient died from Tubercular-Broncho-Pneumonia. 2? Table I.—Cases of Infectious Disease Notified during the Year 1923. Disease. Number of Cases Notified. Total Cases Notified in each Ward. Total Cases Removed to Hospital. At all Ages. At Ages—Years. Under 1 year. 1 and under 2 years. 2 and under 3 years. 3 and under 4 years. 4 and under 5 years. 5 and under 10 years. 10 and under 15 years. 15 and under 20 years. 20 and under 35 years. 35 and under 45 years. 45 and under 05 years. 65 and over. East. North. South West. Scarlet Fever 110 4 3 4 7 2 49 29 9 1 2 ... ... 13 16 14 67 107 Diphtheria 35 ... 1 1 2 2 9 11 2 7 ... ... ... 7 3 13 12 35 Pneumonia 19 1 ... 1 2 1 1 b 5 2 ... 1 1 7 7 4 ... Chicken Pox 91 4 2 5 7 7 57 7 2 ... ... ... ... 32 13 24 22 ... Erysipelas 15 1 ... ... ... ... 1 1 ... ... 2 ... 3 2 2 8 3 1 Ophthalmia Neonatorum 6 6 ... ... ... ... ... ... ... ... ... ... ... 1 1 2 2 ... Poliomyelitis 4 ... 1 2 1 ... ... ... ... ... ... ... ... 1 1 2 ... ... Malaria 3 ... ... ... ... ... ... ... ... 2 1 ... ... 2 ... ... 1 ... Puerperal Fever 2 ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 1 ... ... Typhoid Fever 2 ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... ... 1 1 Totals 287 16 7 13 19 12 117 49 19 16 8 7 4 60 44 71 112 146 28 TABLE II.—Deaths registered during the Calendar Year 1923, classified by Age and Cause. Causes of Death. Net Deaths at the subjoined Ages of "Residents" whether occurring within or without the District. At all Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. Enterie Fever 2 ... ... ... 2 ... ... ... ... Measles 1 1 ... ... ... ... ... ... ... Scarlet Fever 1 ... ... 1 ... ... ... ... ... Whooping Cough 5 2 ... 2 1 ... ... ... ... Influenza 2 1 ... ... ... ... ... 1 ... Meningococcal Meningitis 1 ... ... ... 1 ... ... ... ... Tuberculosis of Respiratory System 32 ... ... ... 2 ... 16 7 1 Other Tuberculous Diseases 5 ... ... ... 1 ... 2 ... 1 Cancer, malignant disease 33 ... ... ... ... ... 4 13 16 Rheumatic Fever 3 ... ... ... ... ... 2 ... ... Diabetes 3 ... ... ... ... ... 1 1 1 Cerebral Haemorrhage, etc. 21 ... ... ... ... ... ... 7 14 Heart Disease 45 ... ... ... 1 4 6 13 21 Arterio-sclerosis 21 ... ... ... ... ... ... 8 18 Bronchitis 26 3 ... 1 ... ... ... 8 14 Pneumonia (all forms) 20 3 ... 1 ... ... 1 4 8 Other Respiratory Diseases 1 ... ... ... ... ... 1 ... ... Ulcer of Stomach or Duodenum 3 ... ... ... ... ... ... 3 ... Diarrhoea, &c. (under two years) 8 4 ... ... ... ... ... ... ... Appendicitis and typhlitis 2 ... ... ... ... ... ... 1 ... Cirrhosis of Liver 2 ... ... ... ... ... ... 1 1 Acute and Chronic Nephritis 9 ... ... ... ... 1 2 2 4 Congenital Debility, and Malformation, Premature Birth 17 11 ... ... ... ... ... ... ... Suicide 6 ... ... ... ... ... 1 5 ... Other Deaths from Violence 14 2 ... ... ... 1 2 3 4 Other Defined Diseases 57 1 ... 1 ... 3 7 12 27 Causes ill defined or unknown 3 3 ... ... ... ... ... ... ... Total 343 37 8 6 17 16 45 84 130 29 TABLE III.—Ascertained Cases of Infectious Disease since the Adoption of the Notification Act. Disease. 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 Small Pox ... ... ... 1 ... ... ... ... ... ... ... 15 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... Scarlatina ... 29 ... ... 53 29 12 205 64 18 44 43 55 17 39 93 54 76 112 100 97 77 89 88 132 136 52 49 54 97 219 374 178 110 Diphtheria... 5 ... ... 50 22 13 16 32 6 18 18 16 26 105 91 98 75 79 108 100 84 68 49 57 75 41 45 69 71 122 154 84 35 Typhoid Fever 2 ... 12 2 6 9 6 11 4 3 3 3 4 5 8 20 10 11 7 11 36 11 4 3 4 1 2 6 ... 2 4 1 2 Continued Fever ... ... ... ... ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... 3 1 ... ... ... ... 3 1 3 1 6 1 1 2 5 2 6 4 5 2 6 3 2 2 1 ... 2 3 3 2 Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... Cerebro-spinal ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 2 ... ... 1 1 1 3 4 1 1 ... 1 2 1 ... Meningitis Cholera ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 3 ... ... 6 4 9 15 9 ... 9 5 6 7 14 23 25 25 18 20 34 ... 36 20 23 28 21 8 7 17 16 12 13 15 Measles 43 ... ... 83 7 557 129 414 ... 127 470 53 171 434 202 353 147 538 283 ... ... ... ... ... ... 230 582 362 386 ... ... ... ... Acute Diarrhoea ... ... ... ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken Pox ... ... ... ... ... ... ... ... ... ... ... 29 68 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26 ... ... 26 91 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 4 Ophthalmia Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 5 4 2 4 6 2 3 3 6 Polio-encephalitis. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 2 ... ... Lethargica Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 35 20 25 30 19 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 6 4 8 3 Totals 82 4 13 203 70 602 371 530 34 204 540 180 294 607 418 551 339 763 522 248 238 210 164 227 254 356 691 505 658 391 583 347 287 30 ANNUAL REPORT OF SANITARY INSPECTOR To the Chairman and Members of the Urban District Council of Mitcham. Mrs. Hallowes and Gentlemen, I beg to submit my ninth annual report on the work carried out in the district during the year 1923 by myself, Mr. R. Richards and Mr. A. Handley (Assistant Inspector, permanently appointed in October last). This extra assistance has brought the arrears of house-to-house inspection fairly well up to date, and by the exercise of closer supervision, better work is obtained. Only two householders availed themselves of the provisions of the Rents Restriction Acts by applying for certificates of unfitness of their premises. With a view to keeping down the mosquito nuisance as much as possible, the ponds, pools, ditches and other mosquito breeding places were regularly sprayed with paraffin during the summer months. I append a summary of the character of work done in the course of the year:—951 intimatory notices were served. In 319 instances it was necessary to report for authority to serve statutory notice, followed in four instances by legal proceedings before the magistrates, resulting in fines and costs amounting to £2 16s. being imposed. Summary of Sanitary Work carried out in the District during the year ended December 31st, 1923. Total number of visits paid 7662 Number of complaints received and investigated 191 Number of premises inspected 2157 Number of premises revisited 3966 Number of nuisances discovered 1489 Number of nuisances abated without report 756 31 Number of nuisances abated after report 399 Number of intimatory notices served 951 Number of statutory notices served 319 Notices followed by legal proceedings 4 Houses inspected under the Housing and Town Planning Act 217 Number of revisits to infected houses 78 Number of house drains tested 13 Number of drains found defective 10 Number of tests applied to new drainwork 8 Character of Work Done. Houses repaired and cleansed generally 441 Overcrowding abated 14 Roofs repaired 177 Damp walls remedied 9 Eaves guttering and spouting renewed or repaired 165 Water closets renewed, repaired or cleaned 59 Water closet flushing cisterns and flush pipes renewed or repaired 11l Water cisterns cleansed or covered 50 Water supply to houses reinstated 5 Back yards paved or paving repaired 78 Floors repaired 135 Dustbins provided 199 Premises where animals improperly kept were removed or improved 7 Offensive accumulations removed 30 Urinals cleansed or repaired 10 Piggeries repaired or improved 7 Houses or parts disinfected and cleansed 184 Smoke nuisances abated 6 Houses at which drains were reconstructed or new provided 9 Drains repaired, cleansed, trapped or ventilated 179 Slaughterhouses.—There are two registered slaughterhouses and five annually licensed slaughterhouses, one of which is used as a 32 knackers' premises and another for slaughtering horses for exportation for human food. These are visited periodically to see that the byelaws in force, including the use of the " humane killer," are conformed to. 270 visits in all were paid. On no occasion was there any cause for serious complaint. Factories, Workshops and Outworkers.—272 visits have been paid to these premises, including 66 to bakehouses, of which there are 16 in use, six using mechanical power. There are no underground bakehouses. (See Appendix). Dairies, Cowsheds and Milkshops.—Two new premises were registered during the year. At one shop the sale of milk has ceased. 114 visits have been paid to the 37 registered premises. Piggeries.—Pigkeeping has greatly diminished in this district during the last few years. These premises are regulated by a model set of byelaws which are strictly enforced. 190 visits were made. Marine Stores.—There are only two marine stores in the district. To these 76 visits were paid. No complaint has been made respecting them. Food Inspection.—In addition to the inspection of animals and meat carcases being prepared for food at the slaughterhouses, 381 visits were paid to butchers' shops, fishshops and other places where food is sold. Four pigs' heads, 26 stone of fish and a sack of winkles were destroyed after examination and surrender. The necessary disinfection has been carried out at 184 premises after removal or recovery of cases of infectious disease. 4,232 articles of bedding and clothing have been removed to the steam disinfector at the Wandle Valley Joint Isolation Hospital. SHOPS ACTS. As Inspector under the Shops Acts, 1913 to 1921,1 have kept a large number of observations on shopkeepers, especially confectioners and mixed trades. Most activity was in connection with complaint^ 33 as to the irregular closing of shops on Sundays. Printed and verbal warnings were given the tradesmen most concerned throughout the district. PETROLEUM ACTS. As Inspector under the Petroleum Acts I periodically visit the 45 licensed premises for the storage of petroleum spirit and carbide of calcium, of which four were newly licensed during the year. The total amount of spirit permitted to be kept is 28,078 gallons. Several underground storage systems have been installed during the year ; others are considering the adoption of the system, which is to be encouraged. I am, Your obedient servant, Charles 6. Rabbetts, Senior Sanitary Inspector. 34 INDEX. PAGE Ages at Death 28 Ambulance 18 Analysis of Mortality 9 Appendices— Isolation Hospital 24—25 Patients admitted to Hospital 26 Tables L—111 27—29 Inspector of Nuisances Report 30—33 Area 6 Births 6—7 Birth Rates 7, 9 Causes of Death 8, 28 Deaths 8, 28 Death Rates 8—9 Diphtheria 10 Factory and Workshops 18—22 Health Visitors 13 Hospital, Isolation 24—25 Housing, &c. 15 Illegitimate Births 7 Infantile Mortality 8 Infant Welfare Centres 13—14 Infectious Disease 10—12, 24—27 Isolation Hospital 24—25 Legal Proceedings 15 Maternity and Child Welfare 13—14 Medical Inspection of School Children 14 Mortality, Analysis of 9 35 INDEX—Continued. PAGE Nurse-Midwife 14 Petroleum Acts 33 Poliomyelitis 11 Population 6 Puerperal Fever 11 Regulated Trades 18 Sale of Food and Drugs Act 18 Scarlet Fever 10 Schools 15 Shops Act 32 Statistics 5 Tuberculosis 11—12 Unfit Dwelling Houses 16 Vital Statistics 6 Water Courses 15