AC 4113(3) MITCHAM MITI Now a Municipal Borough HEALTH REPORT FOR 1932 OF THE Mitcham Urban District BY THE Medical Officer of Health HEALTH REPORT FOR 1932 OF THE Mitcham Urban District BY THE Medical Officer of Health Mitch am: H. G. Mather, Caxton Works, Lower Green. Urban District Council of Mitcham HEALTH REPORT FOR 1932 To the Chairman and Councillors. Miss Wilson and Gentlemen, I have much pleasure in submitting to you my Annual Report for 1932. This is the first report presented by me as your first fulltime Medical Officer of Health. On the whole the year has been a very satisfactory one from the health point of view. The population has increased by 2,870 persons. The death rate for the year is 8.0 per 1,000, as compared with 9.8 per 1,000 in 1931. There has been a decrease in the birth rate, being 17.3 per 1,000 for 1932, as compared with 19.2 per 1,000 in 1931. There were 288 notifications of infectious disease, as compared with 242 received in 1931. The increase has been mainly in the number of scarlet fever cases. It is gratifying to observe that the maternal mortality rate is lower, being 4.6 per 1,000 total births, as compared with 6.12 per 1,000 total births in 1931. There has been an increase in the number of deaths of children under two years of age from epidemic enteritis. This was partly due to the very hot spell of weather experienced in August. I should like to take the opportunity that the presentation of this report affords me of expressing my appreciation of the support I have received from all members of the Council and its officers with whom my work has brought me into contact. I would especially desire to express my appreciation of the very excellent staff which Dr. Fegen, your late Medical Officer of Health, left for me, and particularly so in the case of Mr. Rabbetts, the senior Sanitary Inspector, and Mrs. Wray, the Superintendent Health Visitor, both of whom have given me every assistance in obtaining an insight into all the health problems of this district. I am, Miss Wilson and Gentlemen, Your obedient servant, A. T. TILL, Medical Officer of Health. Urban District Council of Mitcham. PUBLIC HEALTH COMMITTEE. Chairman - - Mr. H. F. Cusden Mr. J. Brewer Mr. W. Carlton, J.P. Mr. E. J. D. Field Mr. J. Fitch Dr. H. Love Mr. H. Richards Mr. L. F. Rolls Mr. S. B. Self MATERNITY AND CHILD WELFARE COMMITTEE Chairman - - Mr. 8. W. Duckett Mr. H. F. Cusden Mr. J. S. Abraham Mr. J. Brewer Mr. W. Carlton, J.P. Mr. H. H. Dance Mr. T. A. East Dr. H. Love Miss B. K. Wilson Co-opted Members. Miss E. C. Chart Mrs. E. J. Chappell Mrs. L. Brightwell Dr. G. M. Stoker REPRESENTATIVES ON WANDLE VALLEY JOINT HOSPITAL BOARD. Miss B. K. Wilson Mr. W. Carlton, J.P. Dr. H. Love Mr. H. F. Cusden REPRESENTATIVES ON WANDLE VALLEY JOINT SEWERAGE BOARD. Mr. S. L. Gaston, J.P, Mr. W. Carlton, J.P. Mr. J. P. Turner Mr. E. J. D. Field REPRESENTATIVE ON THE CROYDON AND DISTRICT SMALL POX HOSPITAL BOARD. Mr. H. Richards STAFF. Medical Officer of Health. A. T. Till, M.B., Ch.B., D.P.H., D.T.M. & H. Assistant Medical Officer of Health. Elizabeth C. Loudon, M.B., Ch.B., D.P.H. Part time Medical Officer to Ante-natal and Child Welfare Clinics. Margaret E. Cryer, M.D. Consulting Gynaecologist. G. F. Gibberd, M.S., F.B.C.S. Part time Medical Officer to Woodlands Maternity Home. E. G. Housden, M.D. Chief Sanitary and Meat Inspector. Petroleum Inspector. Shops Act Inspector. C. G. Rabbetts, C.R.S.I. Assistant Sanitary and Meat Inspectors. P. O'Grady, C.R.S.I. J. C. Howard (until 15-8-32) A. W. Lock, C.R.S.I, (from 15-8-32) Superintendent Health Visitor and Infant Life Protection Visitor. Mrs. E. S. Wray (2, 3, 4, 5, 6, 7) Assistant Health Visitors. Miss G. Russell Harris (l, 2, 3) Mrs. H. Parsons (2, 4) Miss M. Burke (2, 3) 1. State registered nurse. 2. Certificate of Central Midwives Board. 3. Health Visitor's Certificate, R. San. I. 4. Health Visitor's Diploma. 5. Inspector of Nuisances. 6. Sanitary Inspectors Exam. Board. 7. Diploma Sanitary Science. Matron of Woodlands Maternity Home. Miss G. Evans, S.R.N., C.M.B. Clerk. J. B. A. Roodhouse Registrar General's estimated population, 58,060. Amended Birth Rate, 18.0 per 1,000. Amended Death Rate, 8.4 per 1,000. REPORT. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 2,935 acres Population, Census 1921 35,119 „ „ „ „ 1931 56,856 1932 60,380 Number of inhabited houses, 1921 7,150 „ „ „ „ 1931 13,187 „ „ „ „ 1932 13,994 Rateable value £339,485 Sum represented by a penny rate £1,325 Total. Male. Female. Rate per 1,000 of population. Live Births. Legitimate 1,009 510 499 Illegitimate 40 20 20 - Total 1,049 530 519 17.3 Total. Male. Female. Rate per 1,000 total births. Still Births. Legitimate 35 18 17 32.3 Illegitimate — — — — Total 35 18 17 32.3 Total. Male. Female. Rate per 1,000 of population. Deaths. 488 240 248 8.0 Deaths from disease and accidents of pregnancy and childbirth:— Rate per 1,000 total births. From puerperal sepsis 2 1.8 From other causes 3 2.7 Total 5 4.6 8 Death rata of infants under one year of age:— All infants per 1,000 live births 43.0 Legitimate infants per 1,000 legitimate live births 44.5 Illegitimate „ „ illegitimate „ 25.0 Deaths from:— Measles (all ages) 1 Whooping cough (all ages) 1 Diarrhoea (under two years of age) 10 VITAL STATISTICS. During the year 1,049 births were registered as belonging to this district, of which 530 were males and 519 were females, as compared with 1,108 births last year. The birth rate for the year was equal to 17.3 per 1,000 of population as against 19.2 per 1,000 last year. The birth rate for England and Wales was 15.3 per 1,000 as against 15.8 per 1,000 last year. Illegitimate Births. The number of births registered as being illegitimate was 40, as compared with 36 last year. The illegitimate rate was equal to 3.8 per cent. of the total births as against 3.2 per cent. in 1931. Still Births. The number of still births registered was 35, of which 18 were males and 17 females. Deaths. During the year 488 deaths were registered, of which 240 were males and 248 were females, as compared with 565 deaths last year. The death rate for the year was equal to 8.0 per 1,000 of the population, as compared with 9.8 per 1,000 in 1931. The death rate for England and Wales was 12 per 1,000 for the year 1932 and 12.3 per 1,000 for 1931. Senile Deaths. The number of deaths of persons of 65 years of age and over was 197, of which 78 were males and 119 females. This constitutes 40.3 per cent. of the total deaths. 9 The birth rates, death rates per 1,000 of population, and the infantile mortality rates for the years 1915-1932 are shown in the following table:— Year. Births. Deaths. Infant Mortality. MITCHAM. England and Wales MITCHAM. England and Wales. MITCHAM. England and Wales. 1915 28.9 21.8 12.7 15.7 78 110 1916 23.0 21.6 10.1 14.3 71 91 1917 18.0 17.8 11.8 14.2 75 96 1918 17.9 17.7 14.8 17.3 77 97 1919 17.0 18.5 10.2 14.0 58 89 1920 27.8 25.4 9.2 12.4 50 80 1921 23.1 22.4 11.1 12.1 70 83 1922 20.9 20.6 11.0 12.8 61 77 1923 21.5 19.7 9.4 11.6 59 69 1924 20.3 18.8 9.2 12.2 55 75 1925 18.2 18.3 9.6 12.2 54 75 1926 21.5 17.8 9 9 11.6 63 70 1927 20.9 16.7 9.8 12.2 45 69 1928 20.4 16.7 8.8 11.7 48 65 1929 19.1 16.3 11.2 13.4 72 74 1930 19.3 16 3 8.2 11.4 49 60 1931 19.2 15.8 9.8 12.3 42 66 1932 17.3 15 3 8.0 12.0 43 65 10 Deaths Registered during the Year 1932. Cause of Death. Males. Females. Total. Typhoid and paratyphoid ... ... ... Measles 1 ... 1 Scarlet Fever ... ... ... Whooping Cough ... 1 1 Diphtheria 1 ... 1 Influenza 2 5 7 Encephalitis lethargica ... 1 1 Cerebro-spinal Fever 2 1 3 Tuberculosis of the Respiratory System 15 15 30 Other Tuberculous Diseases 5 5 10 Syphilis ... ... ... General Paralysis of the insane, tabes dorsalis ... ... ... Cancer, malignant disease 34 34 68 Diabetes 4 5 9 Cerebral Haemorrhage 6 17 23 Heart Disease 37 52 89 Aneurism 1 1 2 Other Circulatory Diseases 6 10 16 Bronchitis 13 13 26 Pneumonia (all forms) 21 15 36 Other Respiratory Diseases 4 1 5 Peptic Ulcer 4 ... 4 Diarrhoea, &c. (under two years) 8 7 10 Appendicitis 3 1 4 Cirrhosis of the Liver 1 1 2 Other Diseases of the Liver, etc. ... 2 2 Other Digestive Diseases ... 5 9 Acute and Chronic Nephritis ... 3 11 Puerperal sepsis ... 2 2 Other Puerperal causes ... 3 3 Congenital Debility, Premature Birth, ... ... ... Malformations, etc. 15 12 27 Senility 8 9 17 Suicide 5 4 9 Other Violence 15 7 22 Other defined Diseases 22 16 38 Causes ill-defined or unknown ... ... ... Total 240 248 488 Special Causes:— Small Pox ... ... ... Poliomyelitis ... ... ... Polio-encephalitis ... ... ... SOCIAL CONDITIONS. The following table taken from the Surrey County Volume, Part 1, of the Census, 1931, will give some idea of the local age and condition distribution of the population in this district. Areas. Average age. Age distribution per 1,000 of each sex (ages last birthday). Number of married women aged less than 45, per 1,000 females of all ages. Number of females per 1,000 males. Males. Females. M. F. 0-4 yrs. 5-19 yrs. 20-39 yrs. over 40 yrs. 0-4 yrs. 5-19 yrs 20-39 yrs. over 40 yrs. Surrey 32.7 35 74 240 327 359 61 208 334 397 Mitcham 29.5 30.8 91 253 373 283 88 236 373 303 Areas. Marital condition distribution per 1,000 of each sex. Males. Females. Single. Married. Widowed and divorced. Single. Married. Widowed and divorced. Surrey 495 473 32 504 412 44 231 1,171 Mitcham 494 481 25 467 465 68 313 1,044 11 12 The housing conditions of the district will be found under the section dealing with Housing on page 31. Infant Mortality. as compared with 47 deaths last year. The infantile mortality rate for the year is equal to 43 per 1,000 live births, as against 42 per 1,000 last year. The infant mortality rate for England and Wales was 65 per 1,000 for 1932, and 66 per 1,000 for 1931. Of the 46 deaths registered this year:— 15 were due to prematurity. 12 „ „ congenital malformation and debility. 6 „ „ diarrhoea and vomiting. 7 „ „ pneumonia or broncho-pneumonia. 6 „ „ other causes. One baby girl, aged three months, died from gastro-enteritis, and at the post mortem it was found that she had atelectasis, the lungs being almost solid. The child weighed 4 lbs. when born and 7 lbs. 14 ozs. when she died. She had never been able to cry properly, and it seems remarkable, considering the condition of the lungs, that the child was able to live so long. Matebnal Mortality. During the year five deaths were registered as being due to diseases or accidents of pregnancy, compared with seven deaths last year. The following is a summary of the causes of death:— 2 were due to puerperal fever. 1 wa3 due to pulmonary embolus. 1 „ haemorrhage. 1 „ shock following Caesarian section. During the year 46 deaths were registered as occurring in infants under one year of age:— Males. Females. Total Legitimate 23 22 45 Illegitimate 1 — 1 Total 24 22 46 Birth-rate, Death-rate, and Analysis of Mortality during the year 1932. Rate per 1,000 total Population annual death-rate pee 1000 population. Rate per 1000 Live Births. All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhœa and Enteritis (under Two Years). Total Deaths under One Year. Live Births. Stillbirths. England and Wales 15.3 0.66 12.0 0.01 0.00 0.08 0.01 0.07 0.06 0.32 0.53 6.6 65 113 County Boroughs and Great Towns, including London 15.4 0.70 11.8 0.00 0.00 0.11 0.01 0.08 0.07 0.28 0.48 8.9 69 126 Smaller Towns (Estimated resident populations 25,000—50,000 at Census 1931) 15.4 0.69 10.8 0.00 0.00 0.06 0.01 0.06 0.03 0.31 0.42 4.5 58 London 14.2 0.51 12.3 0.00 0.00 0.19 0.02 0.08 0.07 0.27 0.53 12.6 66 Mitcham Urban District 17.3 0.57 8.0 0.00 0.00 0.01 0.00 0.01 0.01 0.11 0.36 9.5 43 Puerperal Sepsis. Others. Total. per 1,000 Live Births 1.61 2.63 4.24 The maternal mortality rates for England and Wales are as follows: „ „ Total Births 1.54 2.52 4.06 „ „ Live Births 1.90 2.85 4.76 „ „ „ Mitcham Urban District: „ „ Total births 1.84 2.76 4.61 13 14 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. LABORATORY FACILITIES. Bacteriological examination for this district are carried out at the Wandle Valley Isolation Hospital. The following number of specimens from this district have been examined during the year:— Swabs for diphtheria 284 Sputa for tubercle 122 Total 406 Arrangements have also been made with the Laboratories of Pathology and Public Health for special examination of urine, etc., of patients attending the ante-natal clinics. For General Cases.—The Wilson Cottage Hospital, which is situated within the district, receives accidents and general cases. Other general hospitals available for the district are the Nelson Hospital, Merton, the Croydon General Hospital, and the South London Hospital for Women, Clapham. The large London hospitals are also within easy reach of this district. For Infectious Diseases.—The Council is one of the constituent authorities forming the Wandle Valley Joint Hospital Board, and cases of infectious disease from this area are treated ac their hospital situated at Beddington Corner, Mitcham Junction. For Small Pox Cases.—By an arrangement with the Surrey County Council cases of small pox are admitted to the Small Pox Hospital, Clandon. HOSPITALS. 15 AMBULANCES. For General and Accident Cases.—An ambulance has b6en provided by the Council for the removal of general and accident cases. This ambulance is under the control of the fire brigade superintendent. For Infectious Disease Cases.—The Wandle Valley Joint Hospital Board have provided two motor ambulances for the removal of cases of infectious disease to the Isolation Hospital. MIDWIVBS. The Surrey County Council are the local supervising authority for midwives. At present there are 19 midwives practising in this area, five of whom are on the staff of the Woodlands Maternity Home and who do no district work. HEALTH VISITING. There are four health visitors employed in visiting the mothers and children in this district. The work is so arranged that children under one year of age are visited about once a month, children between one and two years of age are visited every two months, between three years and four years every six months, and between four years and five years once a year. Extra visits are paid if it is thought to be desirable. This scheme is working out fairly well at present. Visits paid by Health Visitors, 1932. Mrs. Wray. Miss Knight until 13-6-1932. Miss Harris from 13-6 1932. Mrs. Parsons. Miss Burke. Total. Primary ante-natal visits 33 27 23 51 96 230 Subsequent ante-natal visits 144 40 52 125 74 435 Primary birth visits 272 83 155 220 218 948 Subsequent visits to infants 698 493 715 1566 1131 4603 Visits to children under five years of age 1373 806 961 2019 431 5590 Visits re stillbirths 6 1 — 3 — 10 Visits re deaths of infants under one year of age 3 1 - — — 4 Visits re cases of ophthalmia neonatorum 3 1 — — — 4 Visits re cases of puerperal fever 3 — — — — 3 Visits re cases of puerperal pyrexia 2 — — — — 2 Primary visits to cases of tuberculosis 28 1 16 27 24 96 Subsequent visits to cases of tuberculosis 141 25 44 107 51 368 Special visits 405 — — — — 405 3111 1478 1966 4118 2025 12698 16 17 CLINICS AND TREATMENT CENTRES. Welfare Clinics. Infant Welfare Centres are held at the following places:— Surrey County Clinic, Western Road.—Sessions are held on the first and third Wednesdays in each month. Dr. Cryer attends both sessions. Western Centre, Cavendish Road.—Sessions are held on the first four Tuesdays of each month. Dr. Cryer attends on the second and third Tuesdays. St. Barnabas Church Hall, Gorringe Park.—Sessions are held on the first four Tuesdays of each month. Dr. Cryer attends on the first and fourth Tuesdays. Meopham Road Centre.—Sessions are held on the first four Mondays of each month. Dr. Cryer attends on the first and fourth Mondays. Parish Room, Lower Green.—Sessions are held on the second and fourth Thursdays of each month. Dr. Cryer attends both sessions. As the number of mothers attending with their children at the Cavendish Road, St. Barnabas and Meopham Road Centres was so large, it was thought advisable to divide them into two groups, one group attending the first and third week and the other group on the second and fourth week. This system is working well and enables the doctor to devote more time to each patient. The following table shows the number of attendances at each centre:— Report of the Infant Welfare Centres, 1932. Particulars. Western Road Centre, two sessions West Centre, four sessions Meopham Road Centre, four sessions St. Barnabas Centre, four sessions Parish Room Centre, two ses-ions Total. monthly. monthly. monthly. monthly. monthly. Number of new eases registered during year of— Children under one year of age 102 126 163 179 61 631 Children over one year and under five years of age 29 20 71 28 18 166 Number of children in attendance at end of year— Under one year of age 78 102 119 141 38 478 Over one and under five years of age 105 140 288 190 125 848 Total attendances of children under one year of age 806 1094 1480 1392 635 5407 Total attendances of children over one year of age 226 620 839 920 353 2958 Total attendances at centres 1032 1714 2319 2312 988 8365 Average attendances at centres 46.4 39.8 53.6 54 44.9 47.5 Percentage of infants under one year of age attending centres of total notified births - - - - - 65.6 Total attendances of expectant mothers — 205 128 — — 333 Average „ „ „ — 18.6 11.6 — — 15.1 Number of expectant mothers who attended during year - 89 50 - - 139 Total number of attendances by expectant mothers at all clinics including Maternity Home - - - - - 1014 Total number of expectant mothers who attended at all clinics including Maternity Home - - - - - 362 Percentage of total notified births represented by the number of expectant mothers attending all clinics — — — — — 36.4 18 19 Ante-natal Clinics. Ante-natal clinics are held at the following places: Cavendish Road, West Centre.—Sessions are held on the first Tuesday of each month. The total attendances of expectant mothers was 205, the number of mothers attending being 89. Meopham Road.—Sessions are held on the second Tuesday of each month. The total attendances of expectant mothers was 128, the number of mothers attending being 50. No doctor's cases are examined at the ante-natal clinics unless the doctor expressly wishes it. Midwives are encouraged to attend the clinics with their patients, and the midwife is notified when one of her patients attends the clinic for the first time and a summary of the ante-natal examination sent to her. 36.4 per cent. of the mothers of children born during the year attended the ante-natal clinics (including Woodlands Maternity Home clinic). WOODLANDS MATERNITY HOME. The Woodlands Maternity Home, Devonshire Road, Collier's Wood, was established by the Council in 1924. During the year several improvements have taken place. A new Terrazzo floor has been put down in the labour ward, surgeons' basins have been installed in the wards on the ground floor, and a new high pressure steriliser has been purchased. The interior of the Home has also been redecorated. Staff. The staff consists of a matron, two sisters, two staff nurses and three pupil midwives. All the staff are State registered nurses and, with the exceiition of the pupil midwives, hold the certificate of the Central Midwives Board. Home. The Home can accommodate 15 patients at a time, but bookings are limited to 26 patients per month. 20 Ante-Natal Clinic.—An ante-natal clinic is held at the Home every week, and all patients who have booked a bed for their confinement are expected to attend. The following table shows the number of births which have occurred in each year since the opening of the Home:— No. of Births. 1924 (August to December) 42 1925 129 1926 240 1927 (10 months) 177 1928 265 1929 298 1930 318 1931 259 1932 239 Number of maternity beds in the institution (exclusive of isolation and labour beds), 15. Number of maternity cases admitted during the year, 238 (239 births, 1 twin labour). Average duration of stay, 14 days. Number of cases delivered by—(a) midwife, 205 ; (6) doctors, 33 (including 12 cases in which patients had booked a doctor). Number of cases in which medical assistance was sought by a midwife in emergency, 59 (29 abnormal conditions, 30 perineal sutures). Number of cases notified as—(a) puerperal fever, nil.; (b) puerperal pyrexia, 4. Number of cases of pemphigus neonatorum, nil. Number of infants not entirely breast-fed while in the institution, 3. Number of cases notified as ophthalmia neonatorum, nil. Number of maternal deaths, nil. Number of infants deaths—(i) stillborn, 6; (ii.) within 10 days of birth, 1, 21 DENTAL CLINIC. Arrangements are being made to start a dental clinic in connection with the Maternity and Child Welfare Centres. CHILDREN ACT, 1908. The Superintendent Health Visitor has been appointed the Infant Life Protection Visitor for this district. Frequent visits during the year are paid to the homes of the foster children. A strict supervision is kept on these homes and no cause was found to remove any infant from the care of the foster mother during the year. The following are the number of foster mothers and children on the register:— Number of foster mothers on register : January 1st, 1932 46 December 31st, 1932 42 Number of children on register : January 1st, 1932 58 December 31st, 1932 48 Number of children adopted during the year 2 Number of children who have died during the year 1 Number of children on whom inquests were held 1 Number of prosecutions Nil Number of visits paid by the Infant Life Protection Visitor 405 REPORT ON MATERNITY AND CHILD WELFARE CENTRES, 1932, by Dr. Margaret Cryer, M.O. to Ante-natal and Welfare Centres. Child Welfare.—Child Welfare sessions are held at five centres. At the Western Road and Parish Room centres, where two sessions are held monthly, the doctor is in attendance at each session. At the remaining three centres, where four sessions are held monthly, the doctor is in attendance twice monthly at each centre. 22 The total number of attendances at the infant consultations during 1932 were 8,365. Of the total attendances 631 were new children under one year of age, while 166 were new children over one year and under five years. The total attendances of children under one year was 5,407 and of children over one year 2,958. There were 478 children under one year in attendance at the centres at the end of the year and 848 over one year. The average attendance at each centre was 47.5 ; the percentage of infants under one year of age attending the centres is 65.6 of the total notified births. A very satisfactory proportion. Supply of Food and Medicines.—Packets of dried food for infants were sold at the clinics at the discretion of the Medical Officer. In a few necessitous cases packets of food were given free when authorised by the doctor in charge. Applications for grants of free milk were submitted to the Maternity and Child Welfare Committee. Small quantities of cod liver oil, cod liver oil emulsion and Parrish's Food were also sold at the clinics. General Remarks,—Children who were found at the clinic to be suffering from any pathological condition were referred to the family doctor or to hospital. A letter giving details of the conditions found was given to each patient for her medical adviser. Arrangements were made for treating cases of marked rickets with ultra violet radiation. In general, nutrition, clothing and cleanliness of the children reached a high standard. The children from one to five years were well nourished. Ante-Natal Consultations.—One clinic is held monthly at the West Centre and Meopham Road Centre, and four sessions are held monthly at the Maternity Home. The total number of expectant mothers who attended the West Centre was 89 and the Meopham Road Centre 50. The relatively smaller number of patients at Meopham Road was probably due to a large number of patients being referred to the Maternity Home Clinic when they had decided to be confined in the Home. 23 The total number of expectant mothers attending the centres was 139, and when the patients attending the Maternity Home is ncluded, the total is 362. The total attendances of expectant mothers at the two centres is 333, with an average attendance of 15 per session. When the Maternity Home is included, the total attendances of expectant mothers is 1,014. Of the total number of births notified, 36.4 of the expectant mothers giving rise to these births were attending the ante-natal clinics. General Remarks.—Patients found at the clinics to be suffering from pathological conditions were referred to their family doctors, with a letter giving details of the conditions found, or to the hospital. Letters were also sent to midwives who sent patients to the clinics, and midwives were welcomed to attend the sessions. All patients who were to be confined by their own doctors were requested to obtain the doctor's permission to attend the sessions. Many young Primipara attended the sessions. (Signed) MARGARET E. CRYER, M.D. 24 SANITARY CIRCUMSTANCES OF THE AREA. WATER SUPPLY. A constant supply of water is supplied to the whole of the district by the mains of the Metropolitan Water Board. DRAINAGE AND SEWERAGE. A new scheme of surface water drainage has been completed. The scheme comprises a complete system of surface water drainage for a total area of 1,753 acres, of which 1,614 acres are within the Urban District of Mitcham, the remaining 139 acres being in the County Borough of Croydon. The scheme became necessary as a result of the considerable development of the district and the consequent making up of roads on the estates leading to flooding in all parts of the district. The total estimated cost is £167,000, of which £69,160 ranks for grant from the Unemployment Grants Committee. I am indebted to the Surveyor for the above facts. RIVERS AND STREAMS. "Visits have been paid to all works which were suspected of discharging polluted effluent into the surface water sewers. On one occasion the River Wandle was found to be polluted. This was investigated by the Sanitary Inspector for the district, the source of pollution was found and the matter remedied. CLOSET ACCOMMODATION. With very few exceptions the whole of the district is on the water carriage system, the houses being drained to the public sewer. At the end of the year there were one cesspool and eight pail closets. PUBLIC CLEANSING. A weekly collection of house refuse is carried out under contract. The refuse is burnt by the contractor in a dust destructor erected on his premises. Practically all premises are provided with a galvanized iron dustbin, there being very few ashpits. 25 Owners of trade refuse must make their own arrangements for the removal of trade refuse. Such an arrangement can be made with the contractor, who will remove trade refuse at the price of 6d. a basket. The cleansing of earth closets and cesspools is carried out by the occupiers of the premises on which they are situated. The scavenging of roads is carried out by direct labour under the supervision of the Surveyor. LEGAL PROCEEDINGS. In connection with the administration of the Public Health Acts the following legal proceedings were undertaken during 1932. Particulars. Result. Nine summonses taken out against the owner of a caravan yard for erecting and setting up temporary buildings without permission from the local authority. Summonses were dismissed on the ground that there was no evidence that the defendant had erected or begun to erect these dwellings. Slaughtering of pigs on unlicensed premises on three separate occasions. Fined 40s. in each case. Failing to comply with notice to abate a nuisance. Order made on an adjourned summons to abate the nuisance within six weeks. SWIMMING BATH. The new Swimming Bath was opened by the Chairman of the Council on November 28th, 1932. The Surveyor has kindly supplied me with the following data :— Construction was commenced in June, 1931, and was cairied out as an unemployment relief scheme. The building is used as a public hall in the winter months, with movable stage and dance floor over the swimming pool. The swimming pool, 100 ft. by 36 ft., has a depth of water yarying from 3 ft. to 8 ft. 6 in., with a diving area 20 ft. long. 26 The floor of the pool is covered with terrazzo and the sides lined with white glazed interlocking bricks. The dressing rooms are between the entrance hall and bath hall, with showers and foot baths adjacent, ensuring that bathers use the shower and foot baths before entering the pool. The filtration plant comprising three vertical pressure filters, giving a maximum rate of 200 gallons per square foot per hour and capable of filtering the whole of the 126,000 gallons in four hours. Aeration is carried out both before and after filtration. Chlorination is by the automatic liquid gas type to Ministry of Health recommendations of 0.2 to 0.5 parts per 1,000,000. Washing accommodation comprises :— Eight slipper baths and one spray bath for men. Six slipper baths and one spray bath for women. Space has been allowed for future extensions. The cost, exclusive of the land and furnishing, was £27,350. SMOKE ABATEMENT. Five complaints of nuisances arising from smoke were investigated and observation kept. All the cases were abated after interviews with the proprietors of the factories concerned. Observations were also kept on other chimneys in the district, and one case was reported to the Council and a notice served and the nuisance was abated. SPECIAL CLASSES OF PREMISES SUBJECT TO CONTROL BY THE LOCAL AUTHORITY. There are no typical houses let in lodgings, hop-pickers, offensive trades or underground sleeping rooms within the district. Caravan yards exist (a total of 15), with a varying number of vans, from one to 24 per yard or colony, the total number of caravans being 88, having a population of 193 adults and 94 children—a total of 287 persons. Many of the caravans are overcrowded, and some are in a dilapidated condition, The word caravan covers not only the 27 conventional type of caravan but also old tram car bodies, old motor lorries, obsolete ambulances and underground railway carriages, etc« Some of the caravans in a yard are only a few inches apart. Many of them are infested with vermin. A large proportion of the inhabitants of these caravans are not of the nomadic class, but through unemployment and lack of housing accommodation at a small rental have to live in these conditions. The majority of the vans are never moved out of the yard and are really permanent dwellings. Some idea of the overcrowding which exists may be gained by the following facts. One yard, 60 feet by 80 feet, contains 16 caravans. The average cubic capacity of each van is 400 cubic feet and the average number of occupants per van is five, equal to 3.5 adults (adult is a person over ten years of age). The rents for a caravan range from 6s. to 10s. per week. A person who owns his own caravan usually pays about 4s. per week for standing room. The conditions in most of the other yards are similar to those quoted above. Each yard is supplied with water from the mains of the Metropolitan Water Board, and there are usually one or more water closets connected with the main sewer. The infectious disease attack rate for the caravan population was 13.9 per 1,000, as compared with the rate of 6.5 per 1,000 for the whole population of the district. RAG AND FLOCK ACTS, 1911 AND 1928. There are no premises in the district in which rag flock is manufactured. SCHOOLS. The supervision of the public elementary schools is under the control of the Education Department of the Surrey County Council. The sanitary fittings, etc., however, are inspected periodically by the Sanitary Inspectors. 28 Water Supply.—All schools have a constant supply of water from the mains of the Metropolitan Water Board. Medical Inspection.—The medical inspection of school children is carried out by the Education Department of the Surrey County Council. Closure of Schools.—No school has been closed by the local authority during the year. 29 INSPECTION AND SUPERVISION OF FOOD. FOOD AND DRUGS (ADULTERATION) ACT, 1928. The duties under the Food and Drugs (Adulteration) Act, 1928, are carried out by the Surrey County Council. The following number of samples have been taken during the year from this district:— Articles. Analysed Adulterated or Deteriorated Prosecutions Conviotions Formal Informal Total Formal Informal Total Milk 56 ... 56 ... ... ... ... ... Cream 2 ... 2 ... ... ... ... ... Butter 2 ... 2 ... ... ... ... ... Meat 4 ... 4 ... ... ... ... ... Sausages 4 4 Marmalade 1 1 2 1 1 2 1 1 Spirits 2 ... 2 ... ... ... ... ... *Other Articles 10 1 11 ... ... ... ... ... Totals 81 2 83 1 1 2 1 1 *Details of Other Articles— Sultanas 1 ... 1 ... ... ... ... ... Bacon 3 ... 3 ... ... ... ... ... Pickles and Sauces 3 ... 3 ... ... ... ... ... Tinned Tomatoes 1 1 2 ... ... ... ... ... Tinned Peas 2 ... 2 ... ... ... ... ... Totals 10 1 11 ... ... ... ... ... † Fined £6 16s. DAIRIES AND COWSHEDS. There are 37 registered premises within the district, of which 36 are dairies and one cowshed. During the year 116 visits of inspection were paid, and in no instances were defects discovered. MILK (SPECIAL DESIGNATION) ORDER, 1923. During the year the Council granted the following number of licences under the above named Order Grade A. (T.T.) 5 Grade A. 1 Certified 5 Pasteurised 6 30 SLAUGHTER HOUSES. There are seven slaughter houses, of which two are registered and five are licensed. During the year 660 visits of inspection were made and in five instances defects were discovered. BAKEHOUSES. The number of bakehouses in the district is 16, this being one less than last year. One hundred and six visits have been paid and on six occasions defects were found. PIGGERIES. There are 23 piggeries in the district. One hundred and two visits were paid. OTHER FOOD PREPARING PLACES. There are four other premises in which food is prepared for human consumption. All of these have been systematically visited. 31 HOUSING. GENERAL OBSERVATION ON HOUSING CONDITIONS IN THE MITCHAM URBAN DISTRICT. The following facts, taken from the Census, 1931, will give some idea of the housing conditions in this district. " Vacant unfurnished houses are at a minimum. There is a high proportion of families to dwellings, namely, 1.19. The number of persons per room is 0.87, which is the highest in the County of Surrey, the county average being 0.72 persons per room. As measured by the conventional two persons per room,' the overcrowded element is at its maximum for the County of Surrey in Mitcham, where 4.99 per cent. of the population falls within this category, but the proportion has been reduced thereto from the materially high figure of 8.65 per cent. registered ten years earlier." Overcrowding is as big a problem in this district as in many other districts, mainly because of the shortage of houses and flats which can be rented at a sum within the means of the families concerned. The Council housing schemes have helped greatly in reducing the overcrowding, but more houses and flats are still needed to accommodate the families living in overcrowded conditions. Fitness of Houses.—In some cases difficulties are experienced in keeping houses in a habitable condition under the Public Health and Housing Acts. In my opinion much money could be saved by owners if small defects were repaired as soon as they appeared, instead of waiting until a large amount of work has to be done in order to render the house fit. There is a type of tenant who unnecessarily causes a great deal of damage to property, and there are not sufficient powers for dealing with this type of tenant. A systematic supervision of houses occupied by the working classes is carried out by means of house to house inspection. Opportunity is also taken to inspect a, house when an official calls 32 to investigate a case of infectious disease. By these means many defects are discovered and steps taken to have them remedied. Inhabited Houses.—The number of inhabited houses at the end of the year was 13,994. This is an increase of 807 houses since last year, the increase being as follows :— East Ward 520 North „ 17 South „ 180 West ,, 90 Total 807 HOUSING ACT, 1930. Fieldgate Lane Clearance Area. A start has been made in the direction of clearing some of the insanitary areas of this district. The nine houses in Fieldgate Lane were scheduled as a clearance area. These houses are all in a damp condition and in a very bad state of repair, and the front rooms are dark, due to the fact that the surrounding wall of the Gas Works is only about seven feet away. The inhabitants, numbering 48 persons, will be housed in the new Council flats at Tamworth Lane. The owners of this property appealed against this Order, and a public enquiry was held by the Minister of Health on October 25th, 1932. The Minister of Health has, however, confirmed the Order. HOUSING STATISTICS. 1. Inspection of Dwelling Houses during the Year :— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 2437 (b) Number of inspections made for the purpose 2671 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 174 (b) Number of inspections made for the purpose 195 33 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation ... ... 6 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 65 2. Remedy of Defects dueing the Year without Service of Formal Notices :— Number of defective dwelling houses rendered fit in consequence of informal action by the local authority or their officers 65 3. Action under Statutory Powers during the Year:— A. Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930. (1) Number of representations made to local rity with a view to serving notices requiring execution of works Nil (2) Number of notices served requiring the execution of works Nil (3) Number of dwelling houses which were rendered fit after service of formal notices :— (а) By owners Nil (b) By local authority in default of owners Nil B. Proceedings under Public Health Acts :— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 556 (2) Number of dwelling houses in which defects were remedied after service of formal notices :— (a) By owners 415 (b) By local authority in default of owners Nil C. Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of representations made to local authority with view to the making of demolition or closing orders 6 34 (2) The number of houses in respect of which an undertaking was accepted under Sub-section (2) of Section 9 of the Housing Act, 1930 Nil (3) Number of dwelling houses in respect of which demolition orders were made 6 (4) Number of dwelling houses demolished in ance of demolition orders Nil D. Proceedings under Section 20 of the Housing Act, 1930 :— (1) Number of separate tenements or underground rooms in respect of which closing orders were made Nil (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit Nil E. Proceedings under Section 3 of the Housing Act, 1925 :— (1) Number of dwelling houses in respect of which notices became operative requiring repairs ... 3 (2) Number of dwelling houses which were rendered fit after service of formal notices :— (a) By owners Nil (b) By local authority in default of owners Nil (3) Number of dwelling houses in respect of which closing orders became operative in pursuance of declarations by owners of intention to close 3 F. Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925:— (1) Number of dwelling houses in respect of which closing orders became operative Nil (2) Number of dwelling houses in respect of which closing orders were determined, the dwelling houses having been rendered fit Nil (3) Number of dwelling houses in respect of which demolition orders became operative Nil (4) Number of dwelling houses demolished in pursu- ance of demolition orders Nil 35 FACTORIES AND WORKSHOPS. There are 128 factories and workshops in the district, of which 87 are factories and 41 are workshops. In addition there are 13 workplaces. During the year 301 visits of inspection were paid. Complaints were received during the year from inhabitants of houses which abutted on to a certain factory of a nuisance arising from cellulose fumes and from fine particles of cellulose. On investigation it was found that the fumes came from the exhaust fans of the cellulose spraying room of the factory. After an interview with the head of the factory and with H.M. Inspector of Factories, it was decided to construct a watertight trough in the ground immediately below the fan outlets, and with short extensions properly curved downwards fitted to the ducts, the fans now discharge into the troughs. No further complaints have been received. outworkers. There are 82 outworkers in Mitcham. One hundred and eightythree visits of inspection were paid, and, in connection with these, three sanitary notices were served. During the year three cases of infectious disease were notified as occurring in the houses of outworkers. In none of these cases was it necessary to make any order under Section 110 of Factories and Workshops Act, 1901. The classes of work undertaken by the outworkers are as follows:— Lampshades 42 Onion peeling 9 Making of wearing apparel 23 Firework cases 1 Cosaques 2 Embroidery 1 Furrier 1 Leatherwork 1 Boots 1 Confectionery covers 1 Total 82 36 Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions . Factories (Including Factory Laundries) 119 2 Nil Workshops (Including Workshop Laundries) 154 1 Nil Workplaces (Other than Outworkers' premises) 28 Nil Nil Total 301 3 Nil 37 Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. Number of Prosecutions. Nuisances under the Public Health Acts :—* Want of cleanliness 7 7 ... Want of ventilation ... ... ... Overcrowding ... ... ... Want of drainage of floors 1 1 ... Other nuisances 6 6 1 Sanitary accommodation insufficient 2 2 ... unsuitable or defective 16 16 ... , not separate for sexes 1 1 ... Offences under the Factory and Workshop Acts : — Illegal occupation of underground bakehouse (s. 101) Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921). Total 33 33 1 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. 38 Outwork in Unwholesome Premises, Section 108. Nature of Work. Instances. Notices served. Prosecutions. Wearing Apparel— Making, &c. Cleaning and washing Household linen Lace, lace curtains and nets Curtains and furniture hangings Furniture and upholstery Electro-plate File making Brass and brass articles Fur pulling Cables and chains Anchors and grapnels Cart gear Locks, latches and keys Umbrellas, &c Artificial flowers Nets, other than wire nets Tents Sacks Racquets and tennis balls Paper, etc., boxes, paper bags Brush making Onion peeling 3 3 Pea picking Feather sorting Carding, &c., of buttons, &c Stuffed toys Basket making Chocolates and sweetmeats Cosaques, Christmas crackers, Christmas stockings, &c. Textile weaving Lampshades Total 3 3 Nil. 39 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. SCHOOL NOTIFICATIONS. The school intimation notices of infectious disease are always compared with the notifications received from the medical practitioners. If any case on the school return is found to be unnotified, investigations are made in order to find out if the patient is receiving medical attention. INFECTIOUS DISEASE NOTIFICATIONS. The total number of certificates of notification received during the year was 288, as compared with 242 last year. The monthly incidence of infectious disease was :— Small Pox. Scarlet Fever Diphtheria Enteric Fever Erysipelas Pneumonia Puerperal Fever Puerperal Pyrexia Ophthalmia Neonatorum Encephalitis Lethargica Cerebro-Spinal Fever s January 1 7 1 1 2 6 ... ... ... ... ... 18 February ... 20 2 ... 1 6 ... ... ... ... ... 29 March ... 11 4 ... 2 7 ... 1 1 ... ... 26 April ... 10 3 ... 1 5 ... ... ... ... 1 20 May ... 8 2 ... ... 3 ... ... ... ... ... 13 June ... 12 1 ... 1 2 1 ... ... ... ... 17 July ... 12 1 ... ... 2 1 ... 1 ... ... 17 August ... 6 2 ... ... 2 1 ... 1 ... ... 12 September ... 20 3 ... ... 1 1 ... 1 ... ... 26 October ... 21 2 ... 1 2 ... 1 ... ... ... 27 November ... 17 4 ... 1 2 1 ... ... ... ... 25 December ... 30 7 2 2 14 ... 2 ... 1 ... 58 Total 1 174 32 3 11 52 5 4 4 1 1 288 40 The incidence of infectious disease in each ward, per 1,000 of the population of the ward, was :— North ward 3.6 South ward 5.5 East ward 4.1 Westward 6.0 These rates are based on the estimated ward population for 1932. The question has arisen as to why there are a larger number of cases notified from the West ward in comparison with the other wards. The actual number of notifications received is no true indication of the prevalence of an infectious disease. The size of the population, the area of the district, the relative susceptibility or immunity to disease of the population, are all factors which play a part in determining the prevalence of an infectious disease in an area. The following table taken from the 1931 Census will help in considering this question :— Area in Population. Persons Persons Ward. acres. Males. Females, Total. per acre. per room. East 993 9,141 9,492 18,633 18.8 0.81 North 236 5,799 6,277 12,076 51.2 0.82 South 1,331 5,651 5,808 11,459 8.6 0.93 West 375 7,226 7,465 14,691 39.2 0.95 From the above table it will be seen that although the West ward has not the largest ward population, yet there are more persons per room. This means that if an infectious disease is introduced it has a far better chance of spreading because of the larger number of persons per room. The North ward has more persons per acre but a lesser number of persons per room than the West ward. The West ward is also bounded on one side by the Borough of Wimbledon and on the other side by the Metropolitan Borough of Wandsworth, and the introduction of infectious diseases from these areas would first of all make itself apparent in the West ward before spreading into the other wards of Mitcham. 41 Cases of Infectious Disease Notified During the Year 1932. Disease. Number of Cases Notified. Total Cases Notified in bach Ward. Total Cases Removed to Hospital. Deaths. 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 65 years. 65 and over. North. East. South West. Small Pox 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... Scarlet Fever 174 ... 3 12 10 14 85 34 4 9 1 1 1 27 57 40 50 159 ... Diphtheria 32 ... 7 1 1 1 6 2 4 6 1 3 ... 5 9 8 10 25 1 Typhoid Fever 3 ... ... ... ... ... 1 ... ... 1 ... 1 ... 1 2 ... ... 3 ... Erysipelas 11 ... ... ... ... ... ... ... 1 3 ... 4 3 4 4 1 2 6 ... Pneumonia 52 1 ... 3 ... ... ... ... 7 9 5 12 1 3 10 17 22 ... 36 Puerperal Fever 5 ... ... ... ... ... ... ... ... 3 2 ... ... 1 2 ... 2 5 2 Puerperal Pyrexia 4 ... ... ... ... ... ... ... ... 3 1 ... ... 1 ... 2 1 2 ... Ophthalmia Neonatorum 4 4 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 2 2 ... Encephalitis Lethargica 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 Cerebro-Spinal Fever 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 3* Totals 288 5 10 16 13 16 103 38 16 34 10 22 5 44 85 68 91 205 43 * Two transferred deaths. 42 Case rates per 1,000 of population. Disease. England and Wales. Mitcham. Small Pox 0.05 0.01 Scarlet Fever 2.12 2.8 Diphtheria 1.08 0.52 Enteric Fever 0.06 0.04 Puerperal Fever 0.05 0.08 Puerperal Pyrexia 0.14 0.06 Erysipelas ... 0.36 . 0.18 Case rates per 1,000 total births. Disease. England and Wales Miteham. Puerperal Fever 3.3 4.6 Puerperal Pyrexia 8.5 3.6 Small Pox. One case of small pox has been notified during the year, and was removed to the Small Pox Hospital, Clandon. The patient was a man aged 50 years, and was vaccinated in infancy. The source of the infection could not be traced. The patient had been away from his place of business for some months as he was suffering from gout, and, apart from an occasional visit to a public house or picture palace, he had not been out of his house. Probably he had come into contact with someone suffering from a mild unrecognised attack of small pox at one or other of these public places. During the year observations have been kept on 59 small pox contacts ; none contracted the disease. Having regard to the high incidence of small pox in the Metropolitan area and the large number of contacts notified as living in this district, Mitcham seems to have been very fortunate in having only one case. The modified type of small pox which is met with in the Metropolitan area apparently has a very low infectivity. 43 Scarlet Fever. The number of cases notified during the year was 174, this being 69 more than last year. One hundred and sixty-five cases were removed to hospital. No deaths were registered from this disease during the year. Ten of the cases were return cases. The interval between the return home of the patient and the illness of the contact varied from 5 to 10 days. In one other instance a patient had been home from hospital 14 weeks before the second case occurred, but it is doubtful whether this was a genuine return case, or whether the infection came from another source. Diphtheria. Thirty-two cases of diphtheria were notified during the year. Twenty-five cases were removed to hospital. One death was registered from this disease. Arrangements have been made by the Council for the examination, free of charge, of swabs taken from suspected cases of diphtheria, and during the year 284 such examinations have been made. Anti-toxin is also issued free of charge to practitioners who may require it. Typhoid Fever. Three cases of typhoid fever were notified during the year. Three cases removed to hospital. No deaths were registered. Diarrhœa and Enteritis under two years of age. Ten deaths from diarrhoea and enteritis under two years of age were registered. The spell of very hot weather during the summer was partly responsible for this. An interesting fact is that over 50 per cent. of the patients who died had a family history of tuberculosis. The numbers are too small to say whether this is a significant fact or merely coincidence. It may be that the child with a family history of tuberculosis is not only less resistant to tuberculosis but also to other infective conditions as well, 44 Epidemic Catarrhal Jaundice. A small outbreak of catarrhal jaundice occurred during the month of June. The number of cases was four, and all were girls, the ages ranging from four years to seven years. Three of the girls lived in one road, the other lived in an adjacent road ; all of them were friends and played together. The first case occurred on June 1st, the second case (sister of original case) occurred June 6th. On June 7th the third case occurred, and on June 14th the last case occurred. All were of a mild type and all the cases had cleared up within three weeks. Encephalitis Lethargica. One case was notified during the year and one death registered. Cerebro-Spinal Fever. Three deaths were registered from this disease during the year; two deaths were of males and one of female. All the cases were removed to hospital. Cancer. The number of deaths from cancer registered during the year was 68, of which 34 were males and 34 were females. There was no unusual site distribution of cancer in 1932. In males, the usual sites—namely, stomach, rectum, intestines, generative organs and liver—were affected ; in females, the generative organs, breast, intestines, stomach and liver were affected. One case of sarcoma of the ovary occurred in a girl aged three years. Cancer is mainly a disease of the digestive system, with the exception of its preference for the generative system in females. Arrangements have been made with the Eadium Institute, Portland Place, for the radium treatment of cases of cancer under the care of this Council 45 The following table shows the number of deaths from cancer, together with the death rate as compared with England and Wales :— Year. Number of Deaths. Death Rate per 1,000 of Population. Mitcham. England and Wales. 1915 26 .77 1.22 1916 21 .63 1.16 1917 17 .50 1.19 1918 25 .72 1.19 1919 31 .89 1.18 1920 34 .94 1.16 1921 31 .87 1.21 1922 34 .94 1.22 1923 33 .90 1.26 1924 42 1.11 1.29 1925 49 1.29 1.33 1926 44 1.14 1.36 1927 46 1.13 1.37 1928 58 1.27 1.42 1929 66 1.33 1.43 1930 73 1.25 1.45 1931 81 1.41 1.48 1932 68 1.0 — Influenza. During the year seven deaths from influenza were recorded. Two were males and five were females. An epidemic of influenza started in September, 1932, and the gastro-enteric type was the prevalent type of the disease at the commencement. Young adults (that is, persons between 16 and 35 years of age) were most affected. As the epidemic progressed the cases suffering from the gastro-intestinal type diminished in number and the febrile and catarrhal types became prevalent. At the same time, the age incidence seemed to change and the majority of persons now effected belonged to the other age groups. Then, towards the end of the epidemic, the young adults group was again attacked, but this time there were very few cases of the gastroenteric type. 46 Prevention of Blindness. By an arrangement with the London County Council cases of ophthalmia neonatorum can be treated at St. Margaret's Hospital, Kentish Town. Blind children are looked after by the Surrey Voluntary Association for the Blind. Only one blind child under the age of five years has been found in Mitcham. This child was born blind. Ophthalmia Neonatorum. During the year 4 cases of ophthalmia neonatorum were notified:— Cases Treated. Vision Vision Total Notified. At Home. In Hospital. unimpaired. impaired. blindness. Deaths. 4 2 2 4 — Tuberculosis. No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or under sections 62 of the Public Health Act, 1925, during the year. During the year 85 new cases of tuberculosis were notified, viz.:— Males. Females. Total. Pulmonary 36 34 70 Non-Pulmonary 6 9 15 Total 42 43 85 The total number of deaths registered as occurring from tuberculosis was 40, viz.:— Males. Females. Total. Pulmonary... 15 15 30 Non-Pulmonary 5 5 10 Tptal 20 20 40 47 The following table shows the number of new cases, the type of disease and the deaths from tuberculosis during the year. Age Periods. New Cases. DEATHS. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. Under 1 year ... ... ... ... ... ... 1 ... 1 year to 5 years ... ... 2 1 ... ... 2 2 5 years „ 15 „ 1 2 1 2 ... ... 1 2 15 „ „ 5 „ 8 14 1 1 3 8 1 1 25 „ „ 45 „ 21 16 3 4 7 5 ... ... 45 „ „ 65 „ 5 2 ... ... 5 2 ... ... 65 „ and upwards ... 1 ... ... ... ... ... ... Totals 35 35 7 8 15 15 5 5 The notification of tuberculosis in this district is fairly efficient, as will be seen by the ratio of non-notified tuberculosis deaths to the total tuberculosis deaths, viz. :— Non-notified tuberculosis deaths 8 Notified tuberculosis deaths 32 Percentage of non-notified T.B. deaths (all forms) 20 per cent. Percentage of non-notified pulmonary T.B. deaths 1.3 ,, Treatment for cases of tuberculosis is under the control of the Surrey County Council. A dispensary has been established at Western Road, Mitcham. Arrangements have been made by this Urban Council for the examination of sputa from cases or suspected cases of tuberculosis, and during the year 122 such examinations have been made. 48 Insect Pests. Mosquitoes.—All pools and ponds where mosquito larvse ara found are sprayed with paraffin during the summer months. Ponds and ditches, the breeding places of this pest, are gradually disappearing from the district, but many householders do not realise that they also can do a great deal towards mitigating this nuisance by getting rid of all breeding places in their gardens, by keeping the guttering on the houses clear from obstruction and by regularly flushing all gulleys, etc., at frequent intervals. Lyctus Caniculatus.— Fifteen new council houses were found to be infested with this beetle, which is a similar type to that commonly known as the larder or warehouse beetle. Not only were these beetles found inside houses, but on the outside walls as well. Insecticides were freely used, and in a few weeks the places were freed from this pest. There has been no return of this nuisance. Animal Pests. Bats.—Fourteen complaints of rat nuisances were investigated ; two were abated by the Council and six cases were referred to the County Eat Destruction Supervising Officer. 49 Patients Admitted to Wandle Valley Hospital During 1932. Disease Beddington & Wallington Coulsdon & Purley Merton & Morden Mitcham Other Districts Staff Total Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Diphtheria 13 ... 17 2 25 ... 25 ... 2 ... ... ... 82 2 Scarlet Fever 41 ... 17 ... 105 ... 159 ... 2 ... 4 ... 328 ... Typhoid 1 ... 4 ... 2 ... 1 ... ... ... ... ... 8 ... Erysipelas 3 ... 1 ... ... ... 6 ... 2 ... ... ... 12 ... Puerperal Fever and Pyrexia 2 1 3 2 2 1 7 ... ... ... ... ... 14 4 Babies (no disease) ... ... 1 ... 2 1* 6 ... ... ... ... ... 9 1 Pneumococal Meningitis 1 1 ... ... ... ... ... ... ... ... ... ... 1 1 Cerebro-Spinal Meningitis ... ... 1 ... 1 1 ... ... ... ... ... ... 2 1 Tubercular Meningitis ... ... ... ... ... ... 1 1 ... ... ... ... 1 1 Infantile Paralysis ... ... 2 1 ... ... ... ... ... ... ... ... 2 1 Sunstroke 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... Tonsillitis 1 ... 3 ... 10 ... 15 1‡ ... ... 7 ... 36 1 Influenza ... ... 1 ... 1 ... 2 ... ... ... 18 ... 22 ... Whooping Cough ... ... ... ... 6 ... 4 1 ... ... ... ... 10 1 Chicken Pox ... ... 1 ... 1 ... ... ... ... ... 1 ... 3 ... Pneumonia 2 1 1 ... 1 ... 3 ... ... ... ... ... 7 1 Measles 4 ... 2 ... 8 1 23 ... ... ... ... ... 37 1 Rubella 3 ... 3 ... 2 ... 3 ... ... ... ... ... 11 ... Angic Neurotic Oedema 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... Infective Rhinitis 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... Pleurisy ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Bronchitis ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Strepto Septicamia ... ... ... ... 1 1 1 ... ... ... ... ... 2 1 Gastro-Enteritis ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Septic Knee ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... Abscess 1 ... ... ... ... ... 1 ... ... ... 2 ... 4 ... Lingual Cyst ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... Totals 75 3 57 5 169 5 258 3 6 ... 36 ... 601 16 * Debility. †One case with Scarlet Fever also. ‡ Septic Tonsillitis. 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 1924 1925 1926 1927 1928 1929 1930 1931 1932 Small Pox ... ... ... 1 ... ... ... ... ... ... ... 15 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 9 7 ... 4 1 Scarlet Fever 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 87 106 104 145 102 134 113 105 174 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 59 201 87 76 75 133 129 49 32 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 1 2 4 1 2 1 4 2 6 3 4 9 2 3 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 3 2 3 3 2 1 5 6 9 4 6 1 7 5 Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spina Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 2 ... ... 1 1 1 3 4 1 1 ... 1 2 1 ... 6 ... ... 2 1 4 ... ... 1 Cholera ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 3 ... ... 6 4 9 15 9 6 9 5 6 7 14 23 25 25 18 20 34 23 36 20 23 28 21 8 7 17 16 12 13 15 11 10 13 14 10 22 22 17 11 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 ... ... ... ... ... ... ... 14 ... ... ... ... ... ... ... 26 ... ... 26 91 35 ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 4 ... ... 1 2 ... ... 1 ... ... Ophthalmia Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 5 4 2 4 6 2 3 3 6 7 5 12 10 3 3 1 3 4 Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 2 ... ... ... 2 2 ... ... ... 2 1 1 Lethargica Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 35 20 25 30 19 39 42 30 62 54 57 35 45 52 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 6 4 8 3 ... 1 1 ... ... ... ... ... ... Puerperal Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 14 9 5 6 9 4 Totals 82 4 13 203 70 602 371 530 34 204 540 180 294 607 418 551 339 763 522 248 238 210 164 227 254 356 691 505 658 391 583 347 287 246 376 259 340 270 375 319 242 288 51 ANNUAL REPORT OF SENIOR SANITARY INSPECTOR. To the Chairman and Members of the Urban District Council of Mitcham. Miss Wilson and Gentlemen, I beg to submit my seventeenth annual summary of the work carried out in this district during the year 1932 by myself and Inspectors P. D. O'Grady, J. C. Howard (7 months) and A. W. Lock (4 months). Total number of visits paid 8804 Number of complaints received and investigated 350 Number of premises inspected 3026 Number of premises revisited 3609 Number of nuisances discovered 927 Number of nuisances abated without report 654 Number of nuisances abated after report 164 Number of intimatory notices served 591 Number of statutory notices served 151 Notices followed by legal proceedings 1 Number of revisits to infected houses or houses of smallpox contacts 95 Number of house drains tested 6 Number of drains found defective 3 Number of tests applied to new drainwork 3 Character of Work Done. Houses repaired and cleansed generally 333 Overcrowding cases abated 41 Roofs repaired 137 Damp walls remedied 36 Eaves guttering and spouting renewed or repaired 86 Water closets renewed, repaired or cleaned 59 Water closet flushing cisterns and flush pipes renewed or repaired 96 Water cisterns cleansed or covered 8 Water supply to houses reinstated 4 Back yards paved or paving repaired 44 Floors repaired 59 Pustbins provided 207 52 Premises where animals improperly kept were removed or improved 4 Offensive accumulations removed 55 Urinals cleansed or repaired 2 Piggeries repaired or improved 3 Houses or parts disinfected and cleansed 270 Smoke nuisances abated 6 Houses at which drains were reconstructed or new provided 2 Drains repaired, cleansed, trapped or ventilated 130 The byelaws relating to houses let in lodgings or occupied by members of more than one family were in four instances applied to ensure the sub-tenants getting proper supply of water and the use of other conveniences where the tenant had cut off access to such services as a means of forcing the sub-tenant out of the house without taking proper legal steps. No applications were received for certificates under the Rent Restriction Acts. Food Inspection.—Six hundred and sixty visits were paid to the seven slaughter houses; two of these are horse slaughter houses and are rarely used. In the course of these visits the following quantities of diseased or unwholesome meat was found and surrendered for destruction :—Carcases of pigs, 4,821 lbs., of which 1,241 lbs. was swine-fevered flesh, 1,990 lbs. tuberculous, 192 lbs. septic mammitis, 152 lbs. parturient fever, 120 lbs. jaundice, and 804 lbs. dropsical flesh (the remaining 262 lbs. was either bruised or affected in some way as to make it unwholesome) ; veal 45 lbs., 133 pigs' livers, 467 pigs' lungs. In no case was any attempt made to conceal any of the meat from the Inspectors, although there was some difficulty in one or two instances in convincing the owner of swinefevered carcases that the meat was unfit for human food. Twenty-eight lbs. of haddocks, 40 lbs. of kippers, 28 lbs. of carrots, 390 lbs. of potatoes, and 400 lbs. of turkeys were also brought to me for examination by tradesmen and found unsound and unfit for human food, and were surrendered for destruction. Disinfection and Disinfestation.—Dibinfection has been carried out at 270 houses after removal of infectious cases to the Wandle Valley Isolation Hospital or recovery at their homes. Six thousand 53 seven hundred and fifty articles of bedding and clothing were removed for disinfection by super-heated steam at the Wandle Valley Isolation Hospital. Seventeen rooms were sprayed with an insecticide to exterminate vermin. In every case the mouldings are removed temporarily in order to get at the insects and their larvae. An unusual nuisance from insects was experienced on the Council's new Meopham Road Housing Estate. A tiny beetle known as lyctus caniculatus, also as warehouse and larder beetles, invaded a large number of houses. Spraying the interior of rooms with insecticide appeared to have little effect, as they swarmed in from the exterior walls, but a liberal spraying of the walls externally and internally with paraffin, oil of winter green and oil of camphor effected a clearance of the pest. Nineteen houses were treated this way. It is believed they were brought to the estate in crates, packages, etc., from the builders' merchants' warehouses. Ponds and ditches were sprayed with paraffin twice, and some three times, during the spring and summer to keep down the breeding of mosquitoes to a certain extent. Petroleum (Consolidation) Act, 1928. Licences have been granted to 72 persons in the district to store petroleum spirit on their premises, and to 3 persons to store carbide of calcium. The permissable quantity of spirit which might be stored totals 88,340 gallons. Carbide of calcium, 15 cwt. 3 qrs. 16 lbs. Ninety per cent. of the petroleum spirit is stored underground in steel tanks surrounded with concrete. Shops Acts. A number of complaints were received, generally from competing tradesmen, of contraventions of the Shops (Hours of Closing) Act, 1928-1930, and Shops (Early Closing) Acts, 1912 and 1913. Observations were kept and the offenders cautioned. One case was reported to the Council and an official warning was given. I am, Your obedient servant, CHARLES G. RABBETTS, Senior Sanitary Inspector. 54 INDEX. page Ambulances 15 Analysis of Mortality 13 Animal Pests 48 Ante-Natal Clinics. 19 Bakehouses 30 Baths 25 Birth Rates 9, 13 Births, Live 7 — Illegitimate 8 — Still 7, 8 Blindness, Prevention of 46 Cancer 44 Causes of Deaths 10 Cerebro-Spinal Fever 44 Children Act (1908) 21 Clearance Area, Eieldgate Lane 32 Clinics, Ante-natal 19 — Dental 21 — Welfare 17 Closet Accommodation 24 Cowsheds 29 Dairies and Cowsheds 29 Death Rates 9,13,45 Deaths 7,8,10 Dental Clinic 21 Diarrhoea and Enteritis 43 Diphtheria 43 Disinfection 52 Drainage and Sewerage 24 Encephalitis Lethargica 44 Epidemic Catarrhal Jaundice 44 Factories and Workshops 35 --- Inspection of 36 56 page Fieldgate Lane Clearance Area 32 Food and Drugs Act (1928) 29 — Inspection and Supervision of 29,52 — Preparing Places 30 General Provision of Health Services for the Area 14 Health Services 14 — Visiting 15 — Visitors, Visits by 16 Hospitals 14, 49 Houses, Fitness of 31 — Inhabited 32 Housing 31 — Act (1930) 32 — Conditions 31 — Statistics 32 Infant Mortality 9, 12 Infectious Disease, Cases Notified 41,50 — — Incidence of 39 — — Prevalence of 39 — — Notifications 39 — — — School 39 Influenza 45 Inhabited Houses . 7,32 Insect Pests 48 Inspection and Supervision of Food . 29 Laboratory Facilities 14 Legal Proceedings 25 Maternal Mortality 12 Maternity and Child Welfare Centres 17 — — — — — Report on 21 — Home 19 Midwives 15 Milk (Special Designation) Order (1923) 29 Mortality, Analysis of 13 — Infant 9, 12 — Maternal 12 Ophthalmia Neonatorum 46 Outworkers 35, 38 56 page Patients Admitted to Hospital 49 Personnel 5 Petroleum Act (1928) 53 Piggeries 30 Population 7 Public Cleansing 24 Rag and Flock Acts 27 Rivers and Streams 24 Sanitary Circumstances of the Area 24 — Inspector's Report 51 Scarlet Fever 43 Schools 27 — Closure of 28 — Medical Inspection 28 — Water Supply 28 Sewerage 24 Slaughter Houses 30 Small Pox 42 Smoke Abatement 26 Social Conditions 10 Special Classes of Premises 26 Statistics 7 — Housing 32 — Vital 8 Still Births 7, 8 Streams 24 Swimming Bath 25 Tuberculosis 46 Typhoid Fever 43 Vital Statistics ... ... ... ... ... ... 8 Wandle Valley Hospital 49 Water Supply 24 Welfare Clinics 17 — — Attendance at 18 Woodlands Maternity Home 19 . .... ' ' *• • "V ' - -.*£}: - ' . ' '' - ■ • ;^rv. ■ .... •'■ • "*v • • ;• • • ,.-v. ur- - .