C.I. AC 4413(1) MITCHAM MIT 2 Now a Municipal Borough. Suvm HEALTH REPORT FOR 1933 OF THE Mitcham Urban District BY THE Medical Officer of Health HEALTH REPORT FOR 1933 OF THE Mitcham Urban District BY THE Medical Officer of Health Mitcham: H. G. Mather, Caxton Works, Lower Green. Urban District Council of Mitcham HEALTH REPORT FOR 1933. To the Chairman and Members of the Council. Miss Wilson and Gentlemen, I have pleasure in submitting my Annual Report for the year ended December 31, 1933. The year has been a busy one for all concerned in the Public Health Department. The explosion which occurred in March put a good deal of extra work on the Department, and slum clearance schemes have also occupied a large portion of the time of the officials. From the health point of view the year has been very satisfactory. The population has increased by 1,970 persons, the number of occupied houses showing an increase of 589 houses. The death rate is 8.8 per 1,000, compared with 8.4 per 1,000 last year. The birth rate shows a further decrease, being 16.1 per 1,000 as compared with 18.0 per 1,000 last year. Three hundred and sixty-eight notifications of infectious disease were received, compared with 258 last year. The increase has been mainly in the number of scarlet fever cases. It is very gratifying to observe a further decrease in the infant and maternal mortality rates. Great progress has also been made in improving the housing accommodation of the working classes, and steps have been taken to control the caravan yards. The presentation of this report affords me an opportunity of expressing my appreciation of the support I have received from all members of the Council, and especially those who are members of the committees with which I am directly concerned. Thanks are also gratefully tendered to the chief officials for their unfailing help, to the general practitioners for their support and active interest in the cause of preventive medicine, and to the staff of the Public Health Department, whose loyal co-operation throughout the year is gratefully acknowledged. I am, Yours obediently, A. T. TILL, Medical Officer of Health. Urban District Council of Mitcham. PUBLIC HEALTH COMMITTEE. Chairman Mr. H. F. Cusden Mr. J. R. Beaumont Mr. J. P. Turner Mr. J. Fitch, J.P. Mr. S. J. Humphries Mr. W. Carlton Dr. H. Love Mr. L. F. Rolls Mr. E. J. D. Field MATERNITY AND CHILD WELFARE COMMITTEE. Chairman Me. S. W. Duckett Miss R. K. Wilson Mr. H. Richards Mr. J. Fitch, J.P. Mr. H. F. Cusden Mr. R. A. Brodie Dr. H Love Mr. H. H. Dance Mr. L. F. Rolls 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 R. K. Wilson Dr. H. Love Mr. H. F. Cusden Mr. J. Fitch, J.P. REPRESENTATIVES ON WANDLE VALLEY JOINT SEWERAGE BOARD. Mr. S. L. Gaston, J.P. Mr. J. P. Turner Mr. E. J. D. Field Mr. J. Fitch, J.P. 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 the Ante-natal and Child Welfare Clinics. Florence M. Parsons, M.R.C.S., L.R.C.P. Consulting Gynaecologist. G. F. Gibberd, Esq., M.S., F.RC.S. Consultant in Diseases of Infants. N. L. Lloyd, Esq., M.B., M.R.C.P. 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. A. W. Lock, C.R.S.I. 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 (1, 2, 3) Mrs. H. Parsons (2, 4) Miss M. Burke, (2, 3) Matron of Woodlands Maternity Home. Miss G. Evans (l, 2) 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. Clerks. J. B. A. Roodhouse A. H. Riley REPORT. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 2,935 acres Population, Census 1921 35,119 „ 1931 56,856 Registrar-General's estimate of population mid-year, 1933 60,060 Number of inhabited houses, 1921 7,150 1931 13,187 1933 14,483 Rateable value £353,708 Sum represented by a penny rate £1,368 SOCIAL CONDITIONS. Mitcham has an area of 2,935 acres, and during the last decade has shown very rapid development. In 1923 the population was 36,430, which in 1933 had increased to 60,060. Not only has the residential part of the district increased rapidly but the industrial side has also made great progress. There are a large number of paint and varnish works in the district and also several large chemical and rubber works. A full list of industries is given under the section dealing with Factories and Workshops. Slums in the true sense of the word are practically unknown, i.e., houses without a separate water supply, separate water closet accommodation, separate yard, and no through ventilation. There is a row of back to back houses in the district, but a method of dealing with these is under consideration. Caravan yards exist, but steps are being taken to limit the number of vans and persons in a 8 yard, to secure a proper water supply and water closet accommodation, to obtain a proper drainage of the yard, and to do away with old and dilapidated vehicles of all kinds from being used as dwellings. UNEMPLOYMENT. The amount of unemployment is on the decrease. As far as can be ascertained unemployment does not seem to have exercised any significant influence on the health or physique of children or adults. This is probably due in part to the relief given by the Public Assistance Committee and to the free supply of milk and baby food given to necessitous cases attending the Child Welfare and Ante-natal Clinics. The infectious disease attack rate among the unemployed was 12.8 per 1,000, whilst the attack rate among the employed was 6.2 per 1,000. This does not prove, however, that the unemployed are less resistant to infectious disease, but rather that the home conditions of the unemployed are more favourable to the spread of an infectious disease. In other words, there are usually more persons per room in the houses of the unemployed than in those of the employed. STATISTICS. Live Births. Total. Male. Female. Rate per 1,000 of population. Legitimate 942 492 450 Illegitimate 28 15 13 Total 970 507 463 16.1 Still Births. Total. Male. Female. Rate per 1,000 total births. Legitimate 38 17 21 Illegitimate 2 1 1 Total 40 18 22 41.2 Deaths. Total. Male. Female. Rate per 1,000 of population. 529 256 273 8.8 9 Deaths from disease and accidents of pregnancy and childbirth Rate per 1,000 total births. From puerperal sepsis 1 10 From other causes 1 1.0 Total 2 2.0 Death of infants under one year of age:— All infants per 1,000 live births 37.1 Legitimate infants per 1,000 legitimate live births 36.0 Illegitimate „ „ illegitimate „ 71.4 Deaths from:— Measles (all ages) 1 Whooping cough (all ages) 5 Diarrhoea (under two years of age) 4 VITAL STATISTICS. During the year 970 live births were registered as belonging to this district, of which 507 were males and 463 were females, as compared with 1,049 births last year. The birth rate for the year was equal to 161 per 1,000 of population, as against 18.0 per 1,000 last year. The birth rate for England and Wales was 14.4 per 1,000, as against 15.3 per 1,000 last year. Illegitimate Births. The number of births registered as being illegitimate was 38, as compared with 40 last year. The illegitimate rate was equal to 3.9 per cent. of the total births, as against 3.8 per cent. in 1932. Still Births. The number of still births registered was 40, of which 18 were males and 22 females. Deaths. During the year 529 deaths were registered, of which 256 were males and 273 were females, as compared wich 488 deaths last year. The death rate for the year was equal to 8 8 per 1,000 of the population, as compared with 8.4 per 1,000 in 1932. 10 The death rate for England and Wales was 12.3 per 1,000 for the year 1933 and 12.0 per 1,000 for 1932. Senile Deaths. The number of deaths of persons of 65 years of age and over was 206, of which 94 were males and 112 females. This constitutes 38.7 per cent, of the total deaths, as compared with 40.3 per cent. last year. The birth rates, death rates per 1,000 of population, and the infantile mortality rates for the years 1915-1933 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 18.0 15 3 8.4 12.0 43 65 1933 16.1 14.4 8.8 12.3 37.1 64 11 Deaths Registered during the Year 1933. Cause of Death. Males. Females. Total. Typhoid and paratyphoid ... ... ... Measles 1 ... 1 Scarlet Fever 1 ... 1 Whooping Cough 2 3 5 Diphtheria ... ... ... Influenza 8 12 20 Encephalitis lethargica ... 1 1 Cerebro-spinal Fever 3 ... 3 Tuberculosis of the Respiratory System 26 16 42 Other Tuberculous Diseases 8 2 10 Syphilis ... ... ... General Paralysis of the insane, tabes dorsalis 2 ... 2 Cancer, malignant disease 25 27 52 Diabetes 2 6 8 Cerebral Haemorrhage 13 20 33 Heart Disease 43 71 114 Aneurism ... ... ... Other Circulatory Diseases 15 9 24 Bronchitis 8 5 13 Pneumonia (all forms) 23 14 37 Other Respiratory Diseases 4 1 5 Peptic Ulcer 5 ... 5 Diarrhœa, &c. (under two years) 3 1 4 Appendicitis 2 ... 2 Cirrhosis of the Liver ... 1 1 Other Diseases of the Liver, etc. 1 1 2 Other Digestive Diseases 6 4 10 Acute and Chronic Nephritis 4 9 13 Puerperal sepsis ... 1 1 Other Puerperal causes ... 1 1 Congenital Debility, Premature Birth, Malformations, etc. 10 11 21 Senility 6 15 21 Suicide 2 6 8 Other Violence 9 9 18 Other defined Diseases 24 27 51 Causes ill-defined or unknown ... ... ... Total 256 273 529 Special Causes: — Small Pox ... ... ... Poliomyelitis ... ... ... Polio-encephalitis ... ... ... Inquests. Inquests were held on 43 persons dying within the district and on 22 Mitcham residents who died outside the district, a total of 65. 12 The following table shows the results of the findings of these inquests. Inquests. Number. Deaths from natural causes 32 Deaths from accidents:— Knocked down by motor vehicles 8 ,, ,, pedal cycle 1 Drowning 1 Suffocation 3 Explosion at factory 1 Burns 1 Falls 2 Suicide:— Poisoning by— Coal gas 7 Lysol 1 Drowning 1 Murder:— By strangulation 1 ,, coal gas poisoning 1 Found drowned 2 Chronic alcoholism 1 Suicide cr accident (evidence insufficient) 2 Total 65 Infant Mortality. During the year 36 deaths were registered as occurring in infants under one year of age:— Males. Females. . Legitimate 20 14 34 Illegitimate 1 1 2 Total 21 15 36 as compared with 46 deaths last year. The infantile mortality rate for the year is equal to 37.1 per 1,000 live births, as against 43 per 1,000 last year. The infant mortality rate for England and Wales was 64 per 1,000 for 1933 and 65 per 1,000 for 1932. 13 Maternal Mortality. During the year two deaths were registered as being due to diseases or accidents of pregnancy, compared with five deaths last year. The following is a summary of the causes of death:— 1 was due to post partum haemorrhage. 1 was due to puerperal sepsis. All maternal deaths occurring within the district are enquired into personally by the Medical Officer of Health, and a confidential report is forwarded to the Chief Medical Officer of the Ministry of Health. 14 Birth-rate, Death-rate, and Analysis of Mortality during the year 1933. rate per 1,000 total population Annual Death-Rate per 1000 Population. rate per 1000 Live 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. Live Births. Stillbirths. England and Wales 14.4 0.62 12.3 0.01 0.00 0.05 0.02 0.05 0.06 0.57 0.54 7.1 64 1180 County Boroughs and Great Towns, including London 14.4 0.67 12.2 0.00 0.00 0.06 0.02 0.06 0.08 0.55 0.49 9.4 67 132 Smaller Towns (estimated resident populations 25,000—50,000 at Census 1931) 14.5 0.63 11.0 0.00 0.00 0.04 0.02 0.04 0.04 0.53 0.44 4.9 56 London... 13.2 0.45 12.2 0.00 0.00 0.02 0.02 0.08 0.08 0.51 0.58 11.6 59 Mitcham Urban District 16.1 0.66 8.8 0.00 0.00 0.01 0.01 0.08 0.00 | 0.33 0.43 4.1 37 Puerperal Sepsis. Others. Total. The maternal mortality rates for England and Wales are as follows : per 1,000 Live births 1.79 2.63 4.42 „ „ Total births 1.71 2.52 4.23 „ „ „ Mitcham Urban District : „ „ Live births 1.02 1.02 2.05 ,, ,, Total births 0.99 0.99 1.97 15 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. LABORATORY FACILITIES. Bacteriological examinations 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 239 Sputa for tubercle 146 Total 385 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. HOSPITALS. 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 at their hospital situated at Beddington Corner, Mitcham Junction. For Small Pox Cases.—By an arrrangement with the Surrey County Council cases of small pox are admitted to the Small Pox Hospital, Clandon. AMBULANCES. For General and Accident Cases.—An ambulance has been provided by the Council for the removal of general and accident cases. This ambulance is under the control of the fire brigade superintendent. The total number of cases removed during the year was 737. Of these 238 were street accidents. 16 For Infectious Disease Gases. —The Wandle Valley Joint Hospital Board have provided two motor ambulances for the removal of cases of infectious disease to the Isolation Hospital. MIDWIVES. The Surrey County Council are the local supervising authority for midwives. At present there are 18 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. NURSING IN THE HOME. There are three nursing associations in the district, employing a total of four nurses. During the year 747 cases were visited and the total number of visits paid was 11,672, an average of 15 visits per patient. 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. Parsons attends both sessions. Western Centre, Cavendish Road.—Sessions are held on the first four Tuesdays of each month. Dr. Parsons 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. Parsons attends on the first and fourth Tuesdays. 17 Meopham Road Centre.—Sessions are held on the first four Mondays of each month. Dr. Parsons attends on the first and fourth Mondays. Parish Room, Lower Green.—Sessions are held on the second and fourth Thursdays of each month. Dr. Parsons attends both sessions. Sherwood Park Pavilion.—Sessions are held on the first and third Thursdays of each month. Dr. Parsons attends both sessions. This centre was opened on April 6, 1933, to meet the demands of the rapidly growing East Ward. The clinic is at present held in the pavilion of the Sherwood Park Recreation Ground, but it is hoped that in the near future a more central and suitable place will be found. The centre is much appreciated by the mothers in that area, as previously the nearest centre was Meopham Road. 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 108, the number of mothers attending being 40. Sessions are also held at this centre on Friday afternoons for patients who have booked for the Woodlands Maternity Home. The total attendances of expectant mothers at this clinic was 1060, the number of mothers attending being 241. Meopham Road.—Sessions are held on the second Tuesday of each month. The total attendances of expectant mothers was 89, the number of mothers attending being 46. 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. 35.5 per cent. of the mothers of children bom during the year attended the ante-natal clinics (including Woodlands Maternity Home clinic), as compared with 36.4 per cent. last year. 18 ORTHOPÆDIC CLINIC. Arrangements have been made with the Nelson Hospital, Merton, for children in need of orthopaedic treatment to attend the orthopaedic clinic of this hospital. Daring the year no case needing this special treatment was found. Dental Clinic. Arrangements have been made with the Surrey County Council for the use of the school dental clinic for children attending the welfare centres and women attending the ante-natal clinics. A part time dental surgeon has been engaged for this work. The clinic is held twice monthly and was opened in March, 1933. Since the opening until the end of the year the following amount of work has been undertaken:— Extractions—Local Gas Fillings Scaling Impressions Fitting dentures Inspections Total 16 43 15 2 4 4 34 118 Infant Life Protection. 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:— 19 Number of foster mothers on register : January 1, 1933 42 December 31, 1933 41 Number of children on register: January 1, 1933 48 December 31, 1933 43 Number of children adopted during the year 3 Number of children who have died during the year nil. Number of children on whom inquests were held nil. Number of prosecutions nil. Number of visits paid by the Infant Life Protection Visitor 381 WOODLANDS MATERNITY HOME. The Woodlands Maternity Home, Devonshire Road, Collier's Wood, was established by the Council in 1924. During the year a small shed has been erected to house the various sterilisers. This has given more room in the labour ward and done away with the dampness caused by the steam. New fire extinguishers have been installed and all precautions taken to reduce the risk of fire. 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 exception 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. The following table shows the number of births which have occurred in each year since the opening of the Home:— 20  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 1933 285 Number of maternity beds in the institution (exclusive of isolation and labour beds), 15. Number of maternity cases admitted during the year, 280. Average duration of stay, 14 days. Number of cases delivered by—(a) midwife, 244; (b) doctors, 36. Number of cases in which medical assistance was sought by a midwife in emergency, 54 (33 abnormal conditions, 21 perineal sutures). Number of cases notified as—(a) puerperal fever, nil.; (b) puerperal pyrexia, 3. Number of cases of pemphigus neonatorum, nil. Number of infants not entirely breast-fed while in the institution, 1. Number of cases notified as ophthalmia neonatorum, nil. Number maternal deaths, nil. Number of infants deaths—(i.) stillborn, 7; (ii.) within 10 days of birth, 4. An ante-natal clinic is held every Friday afternoon at the Cavendish Road Welfare Centre, adjoining the home, and patients who have booked for the home are expected to attend. For numbers attending see under Ante-Natal Clinics. 21 REPORT ON MATERNITY AND CHILD WELFARE CENTRES AND DENTAL CLINIC, 1933. By Dr. F. M. Parsons, M.O. to Ante-natal and Child Welfare Centres, Anaesthetist to Dental Clinic. Child Welfake. Child Welfare Sessions are held at six centres, of which one, Sherwood Park, was opened this year. At the Western Road, Parish Room and Sherwood Park Centres, two sessions are held each month, and the doctor attends each one. At the Meopham Road, Cavendish Road and St. Barnabas Centres, four sessions are held each month, and the doctor attends each centre on two occasions. The new centre, Sherwood Park, was opened on April 6 with an attendance of 24. The Centre serves a large and rapidly growing new district. Daring the nine months in which it has been in existence 102 cases have been registered. Of these 54 were babies under one year of age, and 48 were children over one year and under five years of age when they attended the Centre for the first time. The total attendance at this Centre was 454, the average being 28.3. The total attendance of infants under one year was 230, and of children between one and five years 224. The clinic is held in a playing field pavilion, but as the numbers grow, more accommodation will be needed. The total number of attendances of the six Child Welfare Centres during 1933 was 8,553. Of these 880 were new cases, 572 being infants under one year of age, and 308 being children over one and under five years of age. The total number of attendances of children under one year of age was 5,668, and of children between one and five years of age 2,885. At the end of the year there were 428 children under one year and 940 children under five years of age attending the Centres. The average attendance at each Centre was 46. The percentage of infants under one year of age attending the Centres was 64.1 per cent. of the total number of notified births. 22 Supply of Food and Medicines. Packets of dried food, cod liver oil, cod liver oil emulsion and Parish's Food were sold at the Centres. These were supplied free in necessitous cases. Grants of free milk were also supplied where necessary, applications for these being considered each month by the Maternity and Child Welfare Committee. General Remarks. The nutrition, clothing and cleanliness of the children attains a very high standard, and attendance at the Centres is very regular. No cases of gross rickets have been noted, and only very few cases of mild rickets. Children found to be suffering from any pathological conditions were referred to the family doctor or hospital, a letter giving particulars of the conditions found being sent with the patient. Ante-Natal Centres. One session is held each month at the Meopham Road and Cavendish Road Centres, and one session each week in connection with Woodlands Maternity Home. The total number of expectant mothers attending the centres was 327, the total attendances being 1,257. Of the total number of notified births, 35.5 per cent. of the mothers had attended the ante-natal clinics. It is encouraging to note that the patients attended the antenatal clinics with great regularity. The majority of expectant mothers were young primigravidae. Any patient found to be suffering from any pathological condition was referred to her own doctor, or in a few cases to hospital, a letter giving details of the abnormal conditions found accompanying the patient in either case. Letters were sent to midwives who sent patients to the centres, and midwives were invited to attend the Sessions. No patient who was to be confined by her own doctor was examined at the centres unless with the permission of her own doctor. One case of primary hyperpiesis was admitted to Guy's Hospital for treatment from the Woodlands Ante-Natal Clinic. Patients found to be suffering from dental caries were referred to their own dentist or to the Dental Clinic. The old prejudice against the extraction of teeth or any 23 other form of dental treatment during pregnancy dies hard, but an increasing number of expectant mothers avail themselves of the treatment obtainable at the Dental Clinic, with in many cases marked improvement in their general health. Dental Clinic. The Dental Clinic was opened on March 8 at the Western Road Centre. Two sessions are held each month. At the first session the Dentist attends, and inspections, extractions under local anaesthesia, fillings, scalings, impressions and the fitting of dentures are carried out. At the second session the doctor attends to give gas for extractions. The dental clinic is open to children under school age, and to expectant mothers. The total number of patients who attended was 54, the total attendances being 118. Of these, 59 were for extractions, and of these extractions 43 were done under nitrous oxide gas or ethyl chloride anaesthesia and 16 under local anaesthesia. There were 34 attendances for inspection, 15 for fillings, 2 for scalings, 4 for impressions, and 4 for the fitting of dentures. In necessitous cases assistance was granted by the Maternity and Child Welfare Committee towards the cost of new dentures. Florence M. Parsons, M.R.C.S., L.R.C.P. 24 Visits paid by Health Visitors, 1933. Mrs. Way. Miss Knight (temporary part time) Miss Harris Mrs. Parsons. Miss Burke. Total. Primary ante-natal visits 29 3 22 48 74 176 Subsequent ante-natal visits 59 8 42 94 51 254 Primary birth visits 214 26 210 214 197 861 Subsequent visits to infants 454 200 1089 1544 815 4102 Visits to children under five years of age 1171 526 1566 1902 615 5780 Visits re stillbirths 8 — 6 6 7 27 Visits re deaths of infants under one year of age 3 — 5 2 2 12 Visits re oases of ophthalmia neonatorum 1 — — — — 1 Visits re cases of puerperal fever — — — — — — Visits re cases of puerperal pyrexia 3 — — — — 3 Primary visits to cases of tuberculosis 25 1 20 23 17 86 Subsequent visits to cases of tuberculosis 103 39 47 118 25 332 Special visits 448 37 4 — — 489 2518 840 3011 3951 1803 12123 25 report of the infant welfare centres, 1933. Particulars. Western Road Centre, two sessions monthly. West Centre, four sessions monthly. Meopham Road Centre, four sessions monthly. St. Barnabas Centre, four sessions monthly. Parish Room Centre, two sessions monthly. Sherwood Park Centre, two sessions monthly. Total. Number of new cases registered during year of— Children under one year of age 61 140 105 150 62 54 572 Children over one year and under five years of age 64 37 90 43 26 48 308 Number of children in attendance at end of year— Under one year of age 53 112 85 105 44 29 428 Over one and under five years of age 135 159 231 234 108 73 940 Total attendances of children under one year of age 575 1441 1291 1569 562 230 5668 Total attendances of children over one year of age 336 576 595 763 391 224 2885 Total attendances at centres 911 2017 1886 2332 953 454 8553 Average attendances at centres 41.4 46.9 46 55.5 43.3 28.3 45.9 Percentage of infants under one year of age ing centres of total notified births — — — — — — 64.1 Total attendances of expectant mothers — 108 89 — — — 197 Average „ „ „ — 3.6 4.1 — — — 3.9 Number of expectant mothers who attended during year — 40 46 — — — 86 Total number of attendances by expectant mothers at all clinics including Maternity Home - - - - - - 1257 Total number of expectant mothers who attended at all clinics including Maternity Home - - - - - - 327 Percentage of total notified births represented by the number of expectant mothers attending all clinics — — — — — — 35.5 26 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. Complaints were received from a householder that a certain insect was found in the tap water. Specimens were obtained and sent for identification. They were identified as the "water woodlouse " (asellus aquaticus). The Water Board were informed and the main was flushed. No further complaints were received. The trouble was purely local, as only one house was affected, and was probably due to a dead end in the pipe affording a breeding and temporary resting place for these chance invaders. Samples of water were also taken from an artesian well supplying a factory in the district. The water was found to be quite fit for drinking. The well is 350 ft. deep. The analysis of the water is as follows:— Chemical Analysis. Reaction Alkaline. Odour when warmed to 37° C. nil. Total solids dried at 100° C. 32.50 pts. per 100,000. Loss on ignition 6.00 ,, ,, Chlorine 1.80 ,, ,, Nitrites faint trace. Nitrogen as nitrates 0.01 ,, „ Saline ammonia nil. Albuminoid ammonia 0.002 „ ,, Oxygen absorbed in 3 hrs. at 37° C. 0.007 ,, ,, Hardness, total 23.0 ,, „ ,, temporary 14.5 „ ,, „ permanent 8.5 „ ,, Poisonous metals nil. 27 Bacteriological Analysis. On gelatine plates, kept for four days at 20° C., 21 colonies per 1 cc. developed, none of these liquified gelatine. On Agar plates, kept for 24 hours at 37° C. 6 colonies per 1 cc. developed. B. Coli (types) absent in 1 cc.s. Streptococci absent in 5 cc. B. Enteritidis sporogenes absent in 5 cc. DRAINAGE AND SEWERAGE. Extension to Sewage Disposal Works.— On December 9, 1933, the extension to the Wandle Valley Sewerage Board Disposal Works was opened by the Chairman of the Board. The cost of the extensions, which have been completed, is about £115,000. The works included in the extension comprise the provision of screening plant, sewage and sludge pumping station, sedimentation tanks, bacteria beds and humus tanks, as well as storm water tanks and extensions of the arrangements and plant for sludge pressing. The whole of the pumping plant is electrically driven and automatically controlled by means of float switches, in order to ensure that the number of pumps in operation at any time will be in relation to the flow of sewage without the necessity of constant supervision by an attendant. The sludge from all the tanks in the new extension gravitates to a sludge well situated at the new pumping station, and is then pumped back to the sludge press house, where the moisture content is reduced by pressing, to enable it to be readily handled for transport. The press house has been extended and four new presses, each 30 cwt. capacity, have been installed to deal with the additional quantity of sludge collected in the new settling tanks. The whole of the sewage is brought to the works by high-level and low-level systems of sewers. The high-level sewage is passed through screens with mechanical raking gear, but as the low-level sewage is pumped by special Stereophagus pumps, which break up all large solids, it is unnecessary to install screens for this portion of the sewage flow. 28 Soil Sewerage Scheme.—The construction of a new soil sewerage scheme was commenced on August 14, 1933. This scheme drains an area of 962 acres to a new outfall sewer. The estimated cost of the scheme is £50,000. In certain places it has been found necessary to use Cement Fondu concrete, due to the presence of certain mineral salts in the subsoil water. RIVERS AND STREAMS. Visits have been paid to all works suspected of discharging polluted effluent into the surface water sewers. No complaints were received during the year. 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 seven pail closets and one cesspool in use. 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. As the above contract has almost expired, arrangements have been made for this work to be done by direct labour. An enquiry was held on August 1, 1933, by the Ministry of Health, and sanction given for a loan. A Heenan and Froude refuse destructor is in the course of erection, and trials with various types of dust collection vehicles have been made. BURIAL GROUNDS. Tenders have been accepted for the extension of the London Road Burial Ground. The tenders amount to £1,564 16s. 11d. 29 LEGAL PROCEEDINGS. In connection with the administration of the Public Health Acts the following legal proceedings were undertaken during 1933:— particulars. Result. Non-registration of milk retailer and non-registration of a dairy. Fined 40s. and 20s. Seventeen summonses taken out under Sec. 91, Public Heath Act, 1875, against the ownerof certain property. Summonses adjourned for two months; eventually summonses withdrawn on payment of agreed costs. Action in High Court of Justice claiming a declaration that certain structures, caravans, converted omnibuses used as dwellings were temporary buildings within the meaning of Sec. 27, Public Health Acts (Amendment) Act, 1907, and that the Council were entitled to pull them down or remove them. The declaration was made. With reference to the last case mentioned above the following remarks of Mr. Justice Humphreys, before whom the case was heard, may be of interest. His lordship, in giving judgment, said that the first question was whether the structures referred to were temporary buildings within the meaning of Section 27 of the Public Health Acts Amendment Act, 1907. On that point he held that it was impossible for any court now to entertain any doubt, and they were clearly temporary buildings. It was true that they were dwelling houses where people had lived for some time and contained all the ordinary conveniences of life except sanitary conveniences, but that appeared to be a very excellent reason why a local authority should take an interest in the matter, because with the advance of science and sanitation, methods of dwelling which were regarded as quite satisfactory in the time of our ancestors were no longer to be regarded as satisfactory at all. His lordship thought it quite right to say that, in his opinion, there was much to be said in favour of the view of those persons who said that a great deal of trouble, and even of crime, was due to bad housing conditions, and that if a man was made to live like a 30 pig he could only be expected to behave like a pig. It was therefore the duty of the local authority, if they found persons living in conditions not conducive to health but to degradation, to prevent them from dwelling in such conditions. In other surroundings the structures in question might be perfectly suitable residences, but they were at present all cooped up together in a narrow yard, which was unpaved, undrained, and muddy in wet weather, and in which various businesses were carried on. There was only one tap for the use of the whole of the people living in those structures. In those circumstances, if the Council satisfied him that they were entitled to the declarations for which they asked as a matter of law, they had also satisfied him that this was a case where he ought to exercise his discretion, and where it was eminently desirable in the public interest that such a state of things should cease. There would therefore be judgment for the plaintiffs for the declaration sought. SMOKE ABATEMENT. Fifty-three observations were kept on chimneys during the year. In connection therewith four notices were served and the nuisances abated. 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. 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. 31 Infectious Diseases.—Scholars in contact with a case of infectious disease are excluded from school, the period of exclusion being that set out in the memorandum of the County School Medical Officer to the Surrey Education Committee The head teacher of the school concerned is always notified of this exclusion and the reason for same. 32 HOUSING. Inhabited, Houses.—The number of inhabited houses in the district on December 31, 1933, was 14,483, being an increase of 589 houses since the previous year. HOUSING ACT, 1930. Clearance Area No. 2. Seventeen houses in Lewis Road, known as Claremont Cottages, were scheduled as a clearance area. The seventeen families, with a total of 80 persons, will be housed in the new Council housing estate in Pear Tree Close. There was no appeal against the Order, which has been confirmed by the Ministry of Health. Clearance Area No. 4. Four cottages known as 87, 89, 91, 93, Miles Lane, have been scheduled as a clearance area. There are four families residing in these cottages with a total population of 17 persons. The Order has not yet been confirmed by the Ministry of Health. Clearance Area No. 5. Three buildings known as 79, 81, 83, Commonside East, have been scheduled as a clearance area. This is a block of three wooden buildings; the woodwork is all decayed, the floors and ceilings are defective and the attics unusable. There are three families, with a total of nine persons, living in this block. The Order has not yet been confirmed by the Ministry of Health. 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) 2896 (6) Number of inspections made for the purpose 3012 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 220 (b) Number of inspections made for the purpose 264 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 Nil (4) Number of dwelling houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 157 2. Remedy of Defects during 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 151 3. Action under Statutory Powers during the Year:— A. Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930. (1) Number of dwelling houses in respect of which notices were served requiring repairs 16 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 16 (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 550 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 533 (b) By local authority in default of owners Nil C. Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which demolition orders were made 6 (2) Number of dwelling houses demolished in suance of demolition orders 13 34 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 1 (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 35 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 Convictions formal Informal Total Formal Informal Total Milk 64 1 65 8 1 9 ... ... Margarine 3 ... 3 ... ... ... ... ... Sugar 3 ... 3 ... ... ... ... ... Meat 7 ... 7 ... ... ... ... ... Sausages 2 ... 2 ... ... ... ... ... Confectionery & Jam 4 1 5 3 ... 3 ... ... Drugs ... 2 2 ... ... ... ... ... *Other Articles 14 8 22 2 4 6 2 2† Totals 97 12 109 13 5 18 2 2 *Details of Other Articles— Lemonade powder ... 1 1 ... ... ... ... ... Bread ... 2 2 ... ... ... ... ... Icecream 6 ... 6 ... ... ... ... ... Meat pies 2 ... 2 ... ... ... ... ... Mixed fruit salad 1 ... 1 ... ... ... ... ... Mixed fruit 1 ... 1 ... ... ... ... ... Dried mint 4 5 9 2 4 6 2 2 Totals 14 8 22 2 4 6 2 2 †Fines and costs, £4 14s. DAIRIES AND COWSHEDS. There are 37 registered premises within the district, of which 36 are dairies and one cowshed. During the year 129 visits of inspection were paid, and in no instance were defects discovered. Acting on information received, the Chief Sanitary Inspector took an informal sample of milk from a certain retailer. The analysis revealed that whilst the milk was of poor quality it was up to the legal minimum standard. 36 MILK (SPECIAL DESIGNATION) ORDER, 1923. Daring 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 SLAUGHTER HOUSES. There are seven slaughter houses, of which two are registered and five are licensed. During the year 618 visits of inspection were made and in three instances defects were discovered. For details of meat inspection see the Chief Sanitary Inspector's report. BAKEHOUSES. The number of bakehouses in the district is 16. Ninety visits have been paid and no defects were found. PIGGERIES. There are 19 piggeries in the district. One hundred and sixtytwo visits were paid. OTHER FOOD PREPARING PLACES. There are five other premises in which food is prepared for human consumption. All of these have been systematically visited. NUTRITION. Mothers attending the Welfare Centres have been given leaflets containing recipes of economical and nutritious dishes. The health visitors also give advice on this matter when the opportunity occurs. 37 FACTORIES AND WORKSHOPS. There are 162 factories and workshops in the district, of which 94 are factories and 68 are workshops. In addition there are 133 workplaces. During the year 499 visits of inspection were paid. The following is a list of some of the chief industries carried on in the area:— Paint and varnish manufacturers 16 Chemical manufacturing works 4 Rubber works 2 Printing works 5 Joinery works 4 Chocolate and marzipan works 2 Laundries 7 Meter manufacturing works 3 Smelting works and foundries 2 Refrigerator works 2 Margarine and cheese factories 2 Outworkers. There are 94 outworkers in Mitcham. Two hundred and twelve visits of inspection were paid, and, in connection with these, five 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 40 Onion peeling 9 Making of wearing apparel 35 Tailoring 3 Cosaques 1 Embroidery 1 Furrier 1 Leatherwork 1 Boots 1 Confectionery covers 2 Total 94 38 Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 268 2 Nil Workshops (Including Workshop Laundries) 211 4 Nil Workplaces (Other than Outworkers' premises) 20 Nil Nil Total 499 6 Nil 39 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 2 2 ... Want of ventilation ... ... ... Overcrowding ... ... ... Want of drainage of floors ... ... ... Other nuisances 14 13 1 Sanitary accommodation insufficient 2 2 ... unsuitable or defective 2 2 ... not separate for sexes ... ... ... 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 20 19 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. 40 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 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 5 5 Total 5 5 Nil. 41 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 eighteenth annual summary of the work carried out in this district during the year 1933 by myself and Inspectors P. D. O'Grady and A. W. Lock. Total number of visits paid 11186 Number of complaints received and investigated 339 Number of premises inspected 3032 Number of premises revisited 5425 Number of nuisances discovered 1084 Number of nuisances abated without report 900 Number of nuisances abated after report 217 Number of intimatory notices served 1097 Number of statutory notices served 238 Notices followed by legal proceedings 17 Number of revisits to infected houses or houses of smallpox contacts 88 Number of house drains tested 7 Number of drains found defective 5 Number of tests applied to new drainwork 9 Character of Work Done. Houses repaired and cleansed generally 448 Overcrowding cases abated 37 Roofs repaired 137 Damp walls remedied 42 Eaves guttering and spcuting renewed or repaired 86 Water closets renewed, repaired or cleaned 64 Water closet flushing cisterns and flush pipes renewed or repaired 72 Water cisterns cleansed or covered 10 Water supply to houses reinstated 3 Back yards paved or paving repaired 60 Floors repaired 99 Dustbins provide 379 42 Premises where animals improperly kept were removed or improved 2 Offensive accumulations removed 52 Urinals cleansed or repaired 2 Piggeries repaired or improved 7 Houses or parts disinfected and cleansed 354 Smoke nuisances abated 5 Houses at which drains were reconstructed or new provided 3 Drains repaired, cleansed, trapped or ventilated 154 The disastrous explosion which took place at Messrs. Bush's distillery in March resulting in the demolition of 19 houses, the rendering of 14 houses temporarily uninhabitable and seriously damaging a much larger number of houses in the immediate vicinity, entailed a large amount of work in preparing specification of repairs, the service of notices and duplications on the owner of the houses and subsequent legal proceedings in 17 cases. Fortunately the rain held off during the long wait for repairs or many more families would have been forced to vacate their houses. There has also been an appreciable amount of work in gathering particulars in connection with Clearance Areas and Demolition Orders. Caravan yards have received considerable attention during the year. There are 19 such yards in the district, accommodating from one to 14 caravans, and populated by 251 persons. Action was taken in the High Court in connection with one recently formed caravan yard in Lewis Road with a view to its discontinuance, with favourable results (see under legal proceedings on page 29). Action has also been taken under the Surrey County Council Act, 1932, to effect a reduction in the number of caravans in two of the yards in Western Road. Eighty-seven visits have been paid to these yards and nuisances were found on 16 occasions ; these were abated after service of notices or by verbal request. One van was grossly overcrowded, verminous and unfit for human habitation, was vacated and voluntarily destroyed by burning. Seven applications were received and granted for certificates under the Rent Restriction Acts, five being from the explosion area. 43 Food Inspection.- The seven regulated slaughterhouses are visited on all stipulated days of slaughtering and frequently on unstipulated days, but no breach of the Meat Regulations has been observed. With the exception of the horse slaughtering premises, which is rarely used, the cleansing and quarterly limewashing is carried out in accordance with the byelaws. Six hundred and eighteen visits were paid, in the course of which the following quantities of meat on examination were found to be diseased or unwholesome and were surrendered for destruction:- Carcases of pigs, 4,705 lbs. (of which 2,957 lbs. were tuberculous, 396 lbs. dropsical flesh, 968 lbs. fevered, 192 lbs. jaundiced, 152 lbs. emaciated, and 40 lbs. of otherwise unwholesome meat), beef, 79 lbs., unfit on account of bone taint, 815 pigs' lungs, 186 pigs' livers. It is not reasonably possible to see every animal that is killed on account of the varying times that slaughtering takes place. One slaughterman risked sending to the market a carcase that had not been examined here instead of waiting until the morning and telephoning me. The carcase was found to be diseased, was destroyed, and the slaughterman heavily fined. This will act as a deterrent for the future. A box of kippers, 12 lbs., basket of plums, 70 lbs., and a fowl was brought to me for examination by tradesmen and found unfit for human food, and was destroyed and a certificate given to that effect. Disinfection and Disinfestation.—Disinfection has been carried out at 354 houses, either by fumigation or the spraying of a liquid disinfectant, after removal of infectious cases to the Wandle Valley Isolation Hospital or treatment at home. Bedding and clothing is removed for disinfection by superheated steam at the same institution. Sixty-three bug infested rooms were treated with a special fumigant or sprayed with an insecticide to exterminate the vermin. In nearly every case it has been necessary to remove mouldings and a floor board or two temporarily in order to get at the insects and their breeding places. The spraying of ponds and ditches with paraffin to keep down the mosquito nuisance has been carried out as in other years. Petroleum (Consolidation) Act, 1928. Licences have been granted to 76 persons in the district to store petroleum spirit and to three persons to store carbide of calcium. The permissable quantity of spirit which might be stored on their 44 premises is 90,070 gallons; of this quantity 83,580 gallons is stored underground in steel tanks surrounded with concrete and with measuring pumps attached—a most safe method of storage, it having withstood several large fires in this district alone. Shop Acts. Observations have been kept on shopkeepers and warning given in several cases, but not reported, of infringement of the Shops (Hours of Closing) and Shops (Early Closing) Acts. A number of complaints were received and four cases reported to the Public Health Committee and official warnings given. I am, Your obedient servant, CHARLES G. RABBETTS, Senior Sanitary Inspector, 45 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. INFECTIOUS DISEASE NOTIFICATIONS. The total number of certificates of notification received during the year was 368 as compared with 288 last year. Contacts, Suspects, etc. On 65 occasions during the year the Medical Officer of Health was called in consultation by medical practitioners to see patients in their own homes. The sanitary inspectors have paid 402 visits to cases of infectious disease; 314 were primary visits and 88 revisits. 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 Totals January ... 30 4 ... ... 10 ... 3 ... ... 1 48 February ... 15 8 ... 1 7 ... 1 ... 1 ... 33 March ... 12 4 1 2 4 ... ... 1 ... ... 24 April ... 14 2 ... ... 1 ... 1 ... ... ... 18 May ... 18 7 1 1 1 ... ... ... ... ... 28 June ... 17 2 ... 2 3 ... ... ... ... ... 24 July ... 36 1 1 1 1 ... 1 1 ... ... 42 August ... 16 2 ... 4 ... ... ... ... ... 2 24 September ... 10 ... ... 2 2 ... 1 ... ... ... 15 October ... 17 4 ... 8 2 ... 2 ... ... ... 33 November ... 23 2 ... 5 3 ... ... ... ... ... 33 December ... 32 4 ... 5 3 1 ... ... ... 1 46 Total ... 240 40 3 31 37 1 9 2 1 4 368 46 Cases of Infectious Disease Notified During the Year 1933. Disease. Number of Cases Notified. Total Cases Notified in each 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 240 3 6 14 13 37 109 29 10 16 3 ... 64 76 41 59 221 1 Diphtheria 40 2 1 3 4 8 10 4 2 5 ... 1 ... 10 11 4 15 40 ... Typhoid Fever 3 ... ... ... ... ... ... 1 ... 1 1 ... ... ... 2 ... 1 3 ... Erysipelas 31 ... ... ... ... ... ... 5 3 7 6 9 1 8 5 9 9 16 Pneumonia 37 ... ... 1 ... ... 5 1 2 11 7 7 3 4 9 11 13 15 37* Puerperal Fever 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 1 Puerperal Pyrexia 9 ... ... ... ... ... ... ... ... 9 ... ... ... 1 4 1 3 8 1 Ophthalmia Neonatorum 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... Encephalitis Lethargica 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 1 Cerebro-Spinal Fever 4 1 ... ... ... ... 1 ... ... 1 1 ... ... 2 2 ... 4 3 Totals 368 8 7 18 17 45 125 41 18 50 18 17 4 89 109 66 104 310 44 * Includes all forms, many of which are not notifiable. 47 Case rates per 1,000 of population. Disease. England and Walves Mitcham. Small Pox 0.02 0.00 Scarlet Fever 3.21 3.99 Diphtheria 1.18 0.66 Enteric Fever 0.04 0.04 Puerperal Fever 0.05 0.01 Puerperal Pyrexia 0.14 0.14 Erysipelas 0.45 0.51 Case rates per 1,000 total births. Disease. England and Walves Mitcham. Puerperal Fever 3.5 0.99 Puerperal Pyrexia 9.6 8.9 Infectious Disease Notifications, 1922-33. Disease. 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 Small Pox ... ... ... ... ... ... 9 7 ... 4 1 ... Scarlet Fever 178 110 87 106 104 145 102 134 113 105 174 240 Diphtheria 84 35 59 201 87 76 75 133 129 49 32 40 Typhoid Fever 1 2 1 4 2 6 3 4 9 2 3 3 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 3 2 1 5 6 9 4 6 1 7 5 1 Anthrax ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Meningitis 1 ... 6 ... ... 2 1 4 ... ... 1 4 Cholera ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 13 15 11 10 13 14 10 22 22 17 11 31 Measles ... ... ... ... ... ... ... ... ... ... ... ... Acute Diarrhœa ... ... ... ... ... ... ... ... ... ... ... ... Chicken Pox 26 91 35 ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis ... 4 ... ... 1 2 ... ... 1 ... ... ... Ophthalmia Neonatorum 3 6 7 5 12 10 3 3 1 3 4 2 Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... 2 2 ... ... ... 2 1 1 1 Pneumonia 30 19 39 42 30 62 54 57 35 45 52 37 Malaria 8 3 ... 1 1 ... ... ... ... ... ... Puerperal Pyrexia ... ... ... ... 1 14 9 5 6 9 4 9 Totals 347 287 246 376 259 340 270 375 319 242 288 368 School Notifications. The school intimation notices of infectious disease are always compared with the notifications received from the medical 48 tioners. 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. The school notices also give a fairly accurate estimate of the prevalence of non-notifiable infectious diseases, such as chicken-pox, measles, mumps, etc. The numbers so notified are reported on under the various diseases mentioned later in this report. Small Pox. No case of small pox occurred in the district during the year. Twenty-five cases occurred in neighbouring districts, and in connection with these observations were kept on six contacts living in this area. Scarlet Fever. The number of cases notified during the year was 240, this being 66 more than last year. Two hundred and twenty-one cases were removed to hospital. One death was registered from this disease during the year. One hundred and thirty-eight cases occurred in children of school age, i.e., between five years and 15 years of age, and 73 cases occurred in children under school age. In 49 cases of children under school age there were other members of the family attending school and 26 of these cases were directly infected from the school child. In 24 cases of children under school age there were no members of the family attending school; in 12 of these cases the child was infected from a parent or adult brother or sister. In the remaining cases the source of infection could not be found. Diphtheria. Forty cases of diphtheria were notified during the year. Forty cases were removed to hospital. No deaths were 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 239 such examinations have been made. Anti-toxin is also issued free of charge to practitioners who may require it. 49 Diphtheria Immunisation. A certain number of children have bean immunised during the year by private practitioners in the district and some have been immunised by the medical superintendent of the Wandle Valley Isolation Hospital. The question of establishing a clinic for immunisation is under discussion at the present moment. 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. Four deaths from diarrhoea and enteritis under two years of age were registered, as compared with ten deaths in 1932. It has been shown that the mortality from this disease begins to increase when the four foot earth thermometer reaches 56° F., and as this temperature rises so the mortality tends to increase. On July 1, 1933, the four foot earth thermometer registered 56° F., and this temperature gradually rose until on August 31, 1933, the maximum of 61° F was reached. The temperature gradually fell until on October 20 the thermometer again registered 56° F. In spite of this it is gratifying to see that only four deaths were registered. This low mortality is due, probably, in part to the fact that a large proportion of young children attend the Welfare Centres, where the early signs of the disease are recognised and prompt advice given, and also in part to the fact that water-borne sewerage is almost universal in the district, and also that a strict supervision is kept on all the dustbins, ensuring that all of them are sound and have proper fitting lids. 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 ; all the deaths were of males. All the cases were removed to hospital. 50 Cancer. The number of deaths from cancer registered during the year was 52, of which 25 were males and 27 were females, as compared with 68 deaths last year. There was no unusual site distribution of cancer in 1933. 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. 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 Radium Institute, Portland Place, for the radium treatment of cases of cancer under the care of this Council. 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 aud 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 1.51 1933 52 .86 1.52 51 Influenza. During the year twenty deaths from influenza were recorded. Eight were males and 12 were females. 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. Ophthalmia Neonatorum. During the year two cases of ophthalmia neonatorum were notified:- Cases Notified. Treated Vision unimpaired. Vision impaired. Total At Home. In Hospital. blndness. Deaths. 2 1 1 2 — — — Tuberculosis. No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or under section 62 of the Public Health Act, 1925, during the year. During the year 80 new cases of tuberculosis were notified, viz.:- Males. Females. Total. Pulmonary 31 32 63 Non-Pulmonary 14 3 17 Total 45 35 80 The total number of deaths registered as occurring from tuberculosis was, viz.:- Males. Females. Total. Pulmonary 26 16 42 Non-Pulmonary 8 2 10 Total 34 18 52 52 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 year to 5 years 1 1 5 ... ... ... 4 ... 5 years „ 15 „ ... 3 1 1 ... ... ... ... 15 „ „ 25 „ 8 11 2 1 8 4 ... 1 25 „ „ 45 „ 15 13 4 ... 15 10 1 1 45 „ „ 65 „ 7 4 2 1 3 2 2 ... 65 „ and upwards ... ... ... ... ... ... 1 ... Totals 31 32 14 3 26 16 8 2 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 6 Notified tuberculosis deaths 46 Percentage of non-notified T.B. deaths (all forms) 11 per cent. Percentage of non-notified pulmonary T.B. deaths 7.6 per cent. 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 146 such examinations have been made. 53 Chicken Pox. One hundred and eighty eases of chicken pox were notified by the head teachers of the schools in the district. Fifteen of these cases were visited by the Medical Officer of Health, as they occurred during a period when cases of small pox were prevalent in neighbouring districts. Whooping Cough. One hundred and sixty-two cases of whooping cough were notified during the year by the head teachers of schools in this district. Five deaths from whooping cough were registered during the year. Measles. One hundred and thirty cases of measles were notified during the year by the head teachers of schools in the district. One death from measles was registered during the year. Mumps. Twelve cases of mumps were notified by the head teachers during the year. Pneumonia. Thirty-seven cases of pneumonia were notified by practitioners during the year. Twelve of these cases were notified as primary influenzal pneumonia. The total deaths registered as pneumonia was 37. This includes all forms of pneumonia, both primary and secondary. Erysipelas. Thirty-one cases of erysipelas were notified, and 16 cases were removed to hospital. There were no deaths from this cause. Puerperal Fever. One case was notified during the year. The patient was confined at home, the labour was precipitate and the baby born before the doctor or midwife arrived. Patient admitted into hospital. Swabs from throat and nose of contacts were negative, but throat swab from the patient showed hæmolytic streptococci. 54 Puerperal Pyrexia. Nine oases were notified. The notified cases were as follows:— Two cases due to pneumonia. One case due to pleurisy. Two cases due to influenza. One case due to B. Coli abscess of lung. One case due to cystitis. Two cases due to mild mastitis. All cases followed full term pregnancy; eight of the cases were admitted to hospital. All cases recovered. 55 WANDLE VALLEY JOINT HOSPITAL BOARD. Cases admitted to Hospital during Year ended December 31, 1933. Disease Beddington & Wallington Coulsdon & Purley Merton & Morden Mitcham Cases Deaths Cases Deaths Cases Deaths Cases Deaths Diphtheria 16 ... 14 ... 37 2 33 ... Scarlet Fever 54 ... 53 ... 193 1* 204 1‡ Typhoid ... ... 2 ... 1 ... 3 ... Puerperal Fever ... ... ... ... 4 ... 5 ... Erysipelas 3 ... 5 ... 5 ... 9 ... Other Diseases ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... 1 ... Pneumonia 1 ... ... ... ... ... 1 ... Whooping Cough † ... Pneumonia ... ... ... ... 1 ... 4 1 Whooping Cough † ... Appendectomy ... ... ... ... ... ... 1 1 Influenza ... ... ... ... ... ... 1 ... Cerebro-Spinal Meningitis ... ... ... ... ... ... 2 2 T.B. Meningitis ... ... ... ... ... ... 1 1 Pneumoncoccal Meningitis ... ... ... ... ... ... 1 1 Encephalitis Lethargica ... ... ... ... ... ... 1 1 Tonsilitis 5 ... ... ... 9 ... 11 ... Chicken Pox ... ... ... ... 1 ... 1 ... Rubella ... ... ... ... 2 ... 9 ... Enteritis ... ... ... ... ... ••• 1 ... Ulcerated Rhinitis ... ... ... ... ... ... 1 ... Nephritis ... ... ... ... ... ... 1 ... Measles & Pneumonia ... ... 2 ... ... ... 2 ... Babies (no disease) admitted with mother ... ... ... ... 4 ... 3 ... 79 ... 85 ... 257 4 296 8 * Septicaemia. † Osteomyelitis. ‡ Septic Pneumonia. 57 INDEX. PAGE Ambulances 15 Analysis of Mortality 14 Ante-Natal Clinics 17 Area 7 Bakehouses 36 Birth Rates 10, 14 Births, Live 8 — Illegitimate 9 — Still 9 Blindness, Prevention of 51 Burial Grounds 28 Cancer 50 Causes of Deaths 11 Cerebro-Spinal Fever 49 Chicken Pox 53 Clearance Areas 32 Clinics, Ante-Natal 17 — Dental 18 — Orthopædic 18 — Welfare 16 Closet Accommodation 28 Cowsheds 35 Dairies and Cowsheds 35 Death Rates 10, 14 Deaths 8,9,11 Dental Clinic 18 Diarrhoea and Enteritis 49 Diphtheria 48 — Immunisation 49 Disinfection 43 Drainage and Sewerage 27 Encephalitis Lethargica 49 Erysipelas 53 Factories and Workshops 37 - - - Inspection of 38 58 PAGE. Food and Drugs Act (1928) 35 — Inspection and Supervision of 35, 43 — Preparing Places 36 General Provision of Health Services for the Area 15 Health Services 15 — Visiting 16 — Visitors, Visits by 24 Hospitals 15 Houses, Inspection of 32 — Inhabited 32 Housing 32 — Act (1930) 32 — Statistics 32 Infantile Mortality 9, 10, 12 Infant Life Protection 18 Infectious Disease, Cases Notified 46 — — Incidence of 45 — — Prevalence of and Control over 45 — — Notifications 45, 46, 47 — — - School 47 Influenza 51 Inhabited Houses 7, 32 Inquests 11 Inspection and Supervision of Food 35, 43 Laboratory Facilities 15 Legal Proceedings 29 Maternal Mortality 13 Maternity and Child Welfare Centres 16 - - - - -Report on 21 — Home 19 Measles 53 Midwives 16 Milk (Special Designation) Order (1923) 36 Mortality, Analysis of 14 — Infant 9,10,12 — Maternal 12 Mumps 53 Nursing in the Home 16 59 PAGE. Nutrition 36 Ophthalmia Neonatorum 51 Outworkers 37, 40 Parsons, Dr. F. M., Report 21 Patients Admitted to Hospital 55 Personnel 5 Petroleum Act (1928) 43 Piggeries 36 Population 7 Public Cleansing 28 Puerperal Fever 53 — Pyrexia 54 Rateable Value 7 Rivers and Streams 28 Sanitary Circumstances of the Area 26 — Inspector's Report 41 Scarlet Fever 48 Schools 30 Sewerage 27 Shops Acts 44 Slaughter Houses 36 Small Pox 48 Smoke Abatement 30 Social Conditions 7 Statistics 8 — Housing 32 — Vital 9 Still Births 8, 9 Tuberculosis 51 Typhoid Fever 49 Unemployment 8 Vital Statistics 9 Wandle Valley Hospital 55 Water Supply 26 Welfare Clinics 16 — — Attendance at 25 Whooping Cough 53 Woodlands Maternity Home 19