AC 4413(1)MITZHMA BOROUGH OF MITCHAM REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1934 BOROUGH OF MITCHAM REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1934 Mitcham : H. G. Mather, Caxton Works, Lower Green Borough of Mitcham HEALTH REPORT FOR 1934. To the Mayor, Aldermen and Councillors of the Borough of Mitcham. Sir, Ladies and Gentlemen, I have pleasure in submitting my Annual Report for the year 1934. On November 9, 1934, the Urban District of Mitcham ceased to exist, and the Borough of Mitcham came into being. In order to make my report as complete as possible I have taken into account the figures for the entire year ended December 31, 1934. I wish to place on record my appreciation of the support given me by the members of the Public Health and the Maternity and Child Welfare Committees, and also to the chief officials. To the members of my staff I would once again express my thanks for their loyal assistance and for the efficient manner in which they have performed their duties. I am, Ladies and Gentlemen, Yours obediently, A. T. TILL, Medical Officer of Health. Public Health Department, Town Hall, Mitcham, Surrey. Urban District Council of Mitcham. Committees from April to October, 1934. PUBLIC HEALTH COMMITTEE. Chairman - - - Me. J. Fitch Mr. J. E. Beaumont Miss E. K. Wilson Mr. W. S. Lawrence Mr. H. H. Dance Mr. T. A. East Mr. B. J. D. Field, J.P. Mr. S. W. Duckett Mr. W. G. F Searl MATERNITY AND CHILD WELFARE COMMITTEE. Chairman - - Mr. S. W. Duckett Miss E. K. Wilson Mr. H. Richards Mr. W. S. Lawrence Mr. H. H. Dance Mr. T. A. East Mr. E. J. D. Field, J.P. Mr. W. Dalton Mr. J. Fitch Mr. W. G. F. Searl Co-opted Members. Miss E. C. Chart Mrs. E. J. Chappell Dr. G. M. Stoker Mrs. L. Brightwell REPRESENTATIVES ON WANDLE YALLEY JOINT HOSPITAL BOARD. Miss E. K. Wilson Mr. H. H. Dance Mr. W. G. F. Searl Mr. E. J. D. Field, J.P. REPRESENTATIVES ON WANDLE VALLEY JOINT SEWERAGE BOARD Mr. S. L. Gaston, J.P. Mr. J. P. Turner Mr. E. J. D. Field, J.P. Mr. W. Dalton REPRESENTATIVE ON THE CROYDON AND DISTRICT SMALL POX HOSPITAL BOARD. Mr. H. Richards Borough of Mitcham. Committees from November to December 31, 1934, PUBLIC HEALTH COMMITTEE. Chairman - Councillor W. G. F. Searl Aldermen— Mrs. W. Toynbee Mr. J. Fitch, J.P. Mr. E. J. D. Field Councillors— Miss E. K. Wilson Mr. J. E. Beaumont Mr. J. M. Davies Mr. T. E. Hanson Mr. W. S. Lawrence Mr. D. Bigham MATERNITY AND CHILD WELFARE COMMITTEE. Chairman - - Alderman W. Jeffery Aldermen— Mrs. W. Toynbee Mr. J. Fitch, J.P. Councillors— Mrs. E. Watson * Miss R. K. Wilson Mrs. C. Eandall Mr. A. T. Fabian Mr. G. E. Madgwick Mr. S. G. Silkstone Mr. E. W. L. Wright Co-opted members— Mrs. Brightwell Mrs. Chappell Mrs. Leigh Mrs. Sharp Dr. G. M. Stoker REPRESENTATIVES ON WANDLE VALLEY JOINT HOSPITAL BOARD. Alderman J. Fitch, J.P. Councillors— Mrs. E. Watson Miss E. K. Wilson Mr. J. S. Abraham REPRESENTATIVES ON WANDLE YALLEY JOINT SEWERAGE BOARD. Aldermen— Mr. J. Fitch, J.P. Mr. S. L. Gaston, J.P. Mr. W. Jeffery Councillor T. E. Hanson REPRESENTATIVE ON THE CROYDON AND DISTRICT SMALL POX HOSPITAL BOARD. Councillor 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.R.C.S. Consultant in Diseases of Infants. N. L. Lloyd, Esq., M.B., M.R.C.P. Part time Dental Surgeon. T. T. Oliver, Esq., L.D.S. Consultant in Ear Diseases. R. S. Cann, Esq., M.S. 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 (1, 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 192 35,119 „ 193 56,856 Registrar-General's estimate of population mid-year, 1934 60,560 Number of inhabited houses, 1921 7,150 1931 13,187 1934 14,828 Rateable value £414,889 Sum represented by a penny rate £1,645 STATISTICS. Total. Male. Female. Rate per 1,000 of population. Live Births. Legitimate 923 479 444 Illegitimate 25 13 12 Total 948 492 456 15.6 Total. Male. Female. Rate per 1,000 total births. Still Births. Legitimate 33 20 13 Illegitimate 1 1 — Total 34 21 13 35.8 Total. Male. Female. Rate per 1,000 of population. Deaths. 553 265 288 9.1 8 Deaths from disease and accidents of pregnancy and childbirth:- Rate per 1,000 total births. From puerperal sepsis — — From other causes 2 2.1 Total 2 2.1 Deaths of infants under one year of age:— All infants per 1,000 live births 51.6 Legitimate infants per 1,000 legitimate live births 48.5 Illegitimate „ „ illegitimate „ 120.0 Deaths from:- Measles (all ages) 11 Whooping cough (all ages) 2 Diarrhoea (under two years of age) 8 VITAL STATISTICS. During the year 948 live births were registered as belonging to this district, of which 422 were males and 456 were females, as compared with 970 births last year. The live birth rate for the year was equal to 15.6 per 1,000 of population, as against 16.1 per 1,000 last year, the crude birth rate being 16.2 per 1,000. The birth rate for England and Wales was 14.8 per 1,000, as against 14.4 per 1,000 last year. Illegitimate Births. The number of births registered as being illegitimate was 34, as compared with 38 last year. The illegitimate rate was equal to 2.5 per cent. of the total births, as against 3.2 per cent. in 1933. Still Births. The number of still births registered was 34, of which 21 were males and 13 females; 1 male was illegitimate. Deaths. During the year 553 deaths were registered, of which 265 were males and 288 were females, as compared with 529 deaths last year. The death rate for the year was equal to 9.1 per 1,000 of the population, as compared with 8.8 per 1,000 in 1933. The death rate for England and Wales was 11.8 per 1,000 for the year 1934 and 12 3 per 1,000 for 1933. 9 Senile Deaths. The number of deaths of persons of 65 years of age and over was 205, of which 86 were males and 119 females. This constitutes 37.0 per cent. of the total deaths, as compared with 38.7 per cent. last year. The birth rates, death rates per 1,000 of population, and the infantile mortality rates for the years 1915-1934 are shown in the following table:- Year. Births per 1,000 population. Deaths per 1,000 population. Infant Mortality per 1,000 live births. 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 1934 15.6 14.8 9.1 11.8 51.6 59 10 Deaths Registered during the Year 1934. Cause of Death. Males. Females. Total. Typhoid and paratyphoid ... ... ... Measles 7 4 11 Scarlet Fever ... ... ... Whooping Cough ... 2 2 Diphtheria 4 5 9 Influenza 4 3 7 Encephalitis lethargica ... 1 1 Cerebro-spinal Fever 1 ... 1 Tuberculosis of the Respiratory System 20 21 41 Other Tuberculous Diseases 6 3 9 Syphilis 1 2 3 General Paralysis of the insane, tabes dorsalis ... ... ... Cancer, malignant disease 29 41 70 Diabetes ... 5 5 Cerebral Hæmorrhage 11 7 18 Heart Disease 37 79 116 Aneurism 1 ... 1 Other Circulatory Diseases 7 13 20 Bronchitis 10 8 18 Pneumonia (all forms) 21 23 44 Other Respiratory Diseases 1 5 6 Peptic Ulcer 1 ... 1 Diarrhœa, &c. (under two years) 6 2 8 Appendicitis 1 3 4 Cirrhosis of the Liver 3 1 4 Other Diseases of the Liver, etc 1 3 4 Other Digestive Diseases 9 1 10 Acute and Chronic Nephritis 5 7 12 Puerperal sepsis ... ... ... Other Puerperal causes ... 2 2 Congenital Debility, Premature Birth, Malformations, etc 18 10 28 Senility 5 9 14 Suicide 4 4 8 Other Violence 22 7 29 Other defined Diseases 30 17 47 Causes ill-defined or unknown ... ... ... Total 265 288 553 Special Causes:- Small Pox ... ... ... Poliomyelitis ... ... ... Polio-encephalitis ... ... ... Inquests. Inquests were held on 36 persons dying within the district and on 29 Mitcham residents who died outside the district, a total of 65. 11 The following table shows the results of the findings of these inquests. Inquests. Number. Deaths from natural causes 26 Deaths from accidents:- Knocked down by motor vehicles 15 „ „ „ tram car 2 Drowning 1 Suffocation 1 Burns 2 Falls 6 Suicide:- Poisoning by- Coal gas 4 Spirits of salt 1 Fall from window 1 Drowning 1 Cut throat 1 Murder:— By coal gas poisoning 1 Found drowned Misadventure 1 Natural causes or accident (evidence insufficient) 1 Total 65 Infant Mortality. During the year 49 deaths were registered as occurring in infants under one year of age:- Males. Females. Total. Legitimate 30 16 46 Illegitimate 3 — 3 Total 33 16 49 as compared with 36 deaths last year. The infantile mortality rate for the year is equal to 51.6 per 1,000 live births, as against 37.1 per 1,000 last year. The infant mortality rate for England and Wales was 59 per 1,000 for 1934 and 64 per 1,000 for 1933. 12 Maternal Mortality. During the year two deaths were registered as being due to diseases or accidents of pregnancy, compared with two deaths last year. The following is a summary of the causes of death:- One was due to syncope following rupture of uterus. One was due to secondary ansemia following adherent placenta. 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. Birth-rate, Death-rate, and Analysis of Mortality during the year 1934. - rate per 1,000 total Population Annual Death-Rate per 1000 Population. Rate per 1000 Live Berths. Peecentage of Total Deaths. 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. Certified by Registered Medical Practitioners Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified causes of Death. Live Births. Stillbirths. England and Wales 14.8 0.62 11.8 0.00 0.00 0.09 0.02 0.05 0.10 0.14 0.54 5.5 59 90.4 6.5 2.1 1.0 121 County Boroughs and Great Towns, including London 14.7 0.66 11.8 0.00 0.00 0.12 0.02 0.06 0.11 0.12 0.47 7.4 63 90.5 6.1 2.9 0.5 132 Smaller Towns (estimated resident populations 25,000 -50,000 at Census 1931) 15.0 0.67 11.3 0.00 0.00 0.07 0.02 0.04 0.09 0.14 0.42 3.6 53 91.2 6.1 1.6 1.1 London 13.2 0.50 11.9 0.00 0.00 0.20 0.02 0.07 0.11 0.12 0.56 12.6 67 87.7 6.3 6.0 0.0 Borough of Mitcham 15.6 0.66 9.1 0.00 0.00 0.18 0.00 0.03 0.14 0.11 0.61 8.5 51.6 Puerperal Sepsis. Others. Total. The maternal mortality rates for England and Wales are as follows: per 1,000 Live births 2.03 2.57 4.60 „ „ Total births 1.95 2.46 4.41 „ „ „ Borough of Mitcham: „ „ Live births — 2.1 2.1 „ „ Total births — 2.0 2.0 14 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 borough have been examined during the year:- Swabs for diphtheria 528 Sputa for tubercle 162 Total 690 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 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. Cases of puerperal fever and pyrexia are sent to Queen Charlottes Hospital, Isolation Block. For Small Pox Cases.—By an arrangement 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 861. 15 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. The ambulance service for the district is quite adequate at present. MIDWIVES. The Surrey County Council are the local supervising authority for midwives. At present there are 21 midwives practising in this borough, 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 or 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 borough, employing a total of four nurses. During the year 652 cases were visited and the total number of visits paid was 13,440, an average of 20 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. 16 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 has now been transferred to Sherwood House. The Pavilion served the purpose as a temporary centre, but there was very little waiting accommodation, and in cold or wet weather the premises were not suitable as a centre. The new premises are better equipped and serve a real need for the district. 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 146, the number of mothers attending being 67. 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 1801, the number of mothers attending being 260. Meopham Road.—Sessions are held on the second Tuesday of each month. The total attendances of expectant mothers was 124, the number of mothers attending being 48. 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. 40 per cent. of the mothers of children born during the year attended the ante-natal clinics (including Woodlands Maternity Home clinic), as compared with 35.5 per cent. last year. 17 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. During the year 8 cases were sent to this clinic. 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. During the year the following amount of work was performed:Extractions—Local 22 Gas 52 Fillings 19 Scaling 4 Impressions 6 Fitting dentures 19 Inspections 111 Total 233 X-Ray Examinations. Arrangements have been made with the Wilson Hospital, Mitcham, for the X-Ray examination of women attending the antenatal clinics. The majority of the examinations are made to determine the presentation of the child in doubtful cases, and also to confirm the diagnosis of twins. During the year 18 women attended for this examination. 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. 18 The following are the number of foster mothers and children on the register:- Number of foster mothers on register, December 31, 1934 42 Number of children on register, December 31, 1934 54 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 330 WOODLANDS MATERNITY HOME. The Woodlands Maternity Home, Devonshire Road, Colliers Wood, was established by the Council in 1924. During the year one of the wards has been enlarged and the beds from the small front ward transferred to it. The small front ward has now been turned into a study room for the pupil midwives. 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:- No. of Births. 1924 (August to December) 42 1925 129 1926 240 1927 (10 months) 177 1928 265 1929 298 19  No. of Births. 1930 318 1931 259 1932 239 1933 285 1934 285 Number of maternity beds in the institution (exclusive of isolation and labour beds), 15. Number of maternity cases admitted during the year, 284. Average duration of stay, 14 days Number of cases delivered by—(a) midwife, 249; (6) doctors, 35. 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, 1. 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, 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. 20 REPORT ON MATERNITY AND CHILD WELFARE CENTRES AND DENTAL CLINIC, 1934. By F. M. Parsons, Medical Officer to the Ante-Natal and Child Welfare Centres, Anaesthetist to Dental Clinic. Child Welfare. Child Welfare sessions continue to be held at six centres. At the Parish Room, Sherwood Park and Western Road Centres two sessions are held each month and the doctor attends each one. At the Cavendish Road, Meopham Road and St. Barnabas Centres, four sessions are held each month, and the doctor attends each centre twice during each month. On December 6 the Sherwood Park Clinic moved from the small cricket pavilion, in which it had its birth, to more commodious premises at Sherwood House, which has been reconditioned by the installation of electric fires, radiators and constant hot water to make it a suitable place in which to hold this clinic, which serves a very rapidly growing area. The total number of attendances at the six Child Welfare Centres during 1934 was 9,058. Of these 800 were new cases, 571 being infants under one year of age, and 229 being children over one but under five years of age. The total number of attendances of children under one year of age was 5,858, and of children between one and five years of age 3,200. At the end of the year there were 448 infants under one year and 860 children between one and five years attending the centres. The average attendance at each individual centre was:- Cavendish Road 46 Meopham Road 51 Parish Room 45 Sherwood Park 36 St. Barnabas 56 Western Road 42 giving an average attendance for all centres of 46. The percentage of infants under one year of age attending the centres was 61.3 per cent. of the total number of notified births. 21 Supply op Food and Medicines. Packets of dried food, cod liver oil, cod liver oil emulsion, Brestol and Parrish's Food were sold at the centres and were supplied free in necessitous cases. Grants of free milk were also made 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 continued to attain a very high standard, and attendance at the centres was very regular. Children found to be suffering from any pathological condition were referred to the family doctor or hospital, a letter giving particulars of the conditions found being sent with the patient. Remarks on Pathological Conditions. No cases of gross rickets were noted, and only a few cases of mild rickets. The number of children found to be suffering from dental caries was 62. In all cases dental treatment was advised, and the cases were referred to the family dentist, or to the dental clinic or to hospital. Enlarged tonsils were found in 47 cases. Treatment was advised where this was considered necessary. Arrangements have been made for any orthopaedic cases to attend for consultation at the Nelson Hospital, and during the year twelve cases were referred to the orthopsedic surgeon there. Of the 12 cases referred, 8 actually attended and were treated. There were 13 ophthalmic cases, and 8 of theso were referred for treatment to the Royal Westminster Opthalmic Hospital with very gratifying results. There were 17 cases of skin disease; 2 of these were treated at Charing Cross Hospital and 3 at the Belgrave Hospital. Nævi were found in 12 cases; 3 of these were treated at Charing Cross Hospital. 22 One case of webbed fingers was referred to the Bolingbroke Hospital, where operative treatment will be undertaken when the infant reaches a suitable age. Two cases of malnutrition and two premature infants (twins) were admitted to the Infants Hospital, Vincent Square. To sum up, pathological conditions were found in 183 cases, details of which are given in the following table:— Pathological Condition. Number of cases Remarks. Congenital Conditions— Cardiac disease 2 Hypospadias 1 Mental disease 2 Spina bifida 1 Syphilis 1 Referred to Belgrave Hospital—died. Tongue-tie 5 Webbed fingers 1 Referred to Bolingbroke Hospital. Acquired Conditions— Burns 1 Diphtheria, nasal 1 Admitted to Beddington Isolation Hospital. Dental disease 62 Enuresis 2 Hæmatoma of Sterno-Mastoid 1 Hemiplegia 1 Hernia, right inguinal 1 „ umbilical 4 ,, hydrocele 1 Malnutrition 2 Admitted to Infants Hospital, Vincent Square. Nævi 12 Three treated at Charing Cross Hospital. Nits 3 Carried forward 104 23 Number of cases. Remarks. Brought forward 104 Ophthalmic— Blindness, unilateral 1 Cellulitis eyelids 1 Conjunctivitis 1 Ptosis 2 Strabismus 8 Eight treated at Royal Westminster Ophthalmic Hospital. Orthopædic 12 Eight treated at Nelson Hospital. Otorrhœa 1 Phalanx, fracture of 1 X-Ray at Wilson Hospital. Skin diseases 17 Two treated at Charing Cross Hospital. Three treated at Belgrave Hospital. Threadworms 8 Tonsils, enlarged 47 Total 203 Baby Show. This was held during the week beginning June 25, and proved a great success. There were 295 entries. Five groups were arranged:— Group I. Breast fed infants, ages 4 to 6 months. „ II. Artificially fed infants, ages 4 to 6 months. „ III. Babies of 6 to 12 months. „ IV. Children from 1 year to 2½ years. „ V. Children between 2½ years and 5 years. One prize and two certificates were given in each group. The seven doctors who very kindly gave their services for the difficult task of judging were:—Dr. C. Alice King (Honorary Physician, Queen's Hospital for Children), Dr. Eleanor H. Kelly, Dr. Margaret Cryer, Dr. E. Cardwell, Dr. Laura Goulden Bach, Dr. E. C. McGregor, Dr. J. D. McKinney. Prizes were given to the winners in each group. These prizes were given to the mothers of the winning babies at the Majestic Theatre, Mitcham. After the prize giving all the mothers saw the film "Rules for Jim." 24 The success of Baby Week was in large measure due to the time, care and thought given to the arrangements by Mrs. B. S. Wray, Superintendent Health Visitor, and I most gratefully acknowledge all her work in connection with it. Ante-Natal Centres. One Ante-Natal Clinic is held each month at the Cavendish Boad and Meopham Boad Centres, and one clinic each week in connection with Woodlands Maternity Home. The total number of expectant mothers attending the centres was 375 (an increase of 48 over the number attending in 1933) the total number of attendances being 2,071 (an increase of 814 over the attendances for 1933). The average attendance at each individual centre is shown below:— Centre. Number of Expectant Mothers attending. Number of attendances. Average attendance. Woodlands 260 1,801 36 Cavendish Road 67 146 12 Meopham Road 48 124 11 This gives an average for all centres of 19.6. Of the total number of notified births 40 per cent. of the mothers had attended the ante-natal centres, as compared with 35.5 per cent. in 1933. General Remarks. Expectant mothers are coming to the ante-natal clinics in increasing numbers, and they attend with great regularity. The majority of them are primigravidæ. Any patient found to be suffering from any serious pathological condition was referred to her own doctor, or in some cases to hospital, a letter giving details of the conditions present accompanying the patient in either case. Letters were sent to midwives who referred patients to the centres, and midwives were invited to attend the clinics, the patient's ante-natal form being available for her perusal. No patient who was to be attended by her own doctor was examined at the clinics. 25 Remarks on Pathological Conditions. 142 patients were found to be suffering from dental disease. These were either referred to their own dentist or to the dental clinic, and it may be noted that an increasing number of expectant mothers show willingness to have their teeth put in order before confinement, in many cases having had this done before their first visit to the ante-natal clinic for examination. Malpresentations were found in 17 cases. Of these 11 were corrected at the clinics, while 6 were referred to hospital for version under anæsthesia. There were 35 cases of albuminuria of pregnancy and 5 cases of toxæmia of pregnancy. These 5 cases were so severe that arrangements were made for their immediate admission to hospital. No cases died, and none of them developed eclampsia. One case of ovarian fibroma was treated by Cæsarian section at term with removal of the tumour. Both mother and baby did excellently. Arrangements have been made at the Wilson Hospital for X-Ray of patients where necessary, and 18 cases had an X-Ray during the year, 17 of these being expectant mothers. There was 1 case of threatened miscarriage, and 5 cases of ante-partum hæmorrhage. Two of these were admitted to hospital, while 4 were attended by their own doctors. Pathological Conditions. Number of cases. remarks. Complications of pregnancy— Albuminuria of pregnancy 35 Hæmorrhage— Threatened miscarrage 1 Referred to own doctor for treatment. Ante-partum 5 Two admitted to Guy's Hospital. Three attended by their own doctors. Malpresentations 17 Eleven corrected at centres. Five referred to Guy's Hospital and one to Epsom Hospital for version under anæsthesia. 26 Number of cases. Remarks. Toxæmia of pregnancy 5 Three admitted to Guy's Hospital. Two admitted to Queen Charlotte's Hospital. Varicose veins 16 Gynæological conditions— Cystocele 5 Cystocele and rectocele 2 Leucorrhœa 24 Ovarian fibroma 1 Admitted to Guy's Hospital, Cæsarian Section, and removal of tumour at term. Retroversion 1 Conditions unconnected with pregnancy— Cardiac— Aortic disease 1 Mitral stenosis 1 Mitral incompetence and stenosis 1 Cardiac disease of rheumatic origin 1 Stystolic murmur 14 Extrasystoles 4 Reduplication of mitral second sound 9 Dental 142 Epilepsy 1 Ophthalmic 2 Treated at Royal Westminster Ophthalmic Hospital. Orthopædic— Scoliosis 1 Skin diseases- Acne 1 Lichen 1 Scabies 1 Various 2 27 Dental Clinic. The dental clinic continues to "make good." Two sessions are held each month. At the first session the dental surgeon 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 referred to the dental clinic during the year was 128. Of these 92 actually attended, the total attendances being 233, the average attendance being 11. The work done at the clinic during the year is shown in the following table:— Inspections 111 Extractions, under local anæsthesia 22 „ „ gas or ethylchloride anæsthesia 52 Fillings 19 Scalings 4 Impressions 6 Fitting dentures 19 233 In necessitous cases assistance was granted by the Maternity and Child Welfare Committee towards the cost of new dentures, applications for this assistance being considered each month by the Committee and grants being made according to the scale adopted by the Council. I desire to place on record my thanks to Mrs. E. S. Wray, Superintendent Health Visitor, and to Miss G. M. Evans, Matron of Woodlands, for their invaluable help and loyal co-operation during the past two years. To the Health Visitors and the Nursing Staff of Woodlands I also tender thanks. I also take this opportunity of thanking all the voluntary workers, who give their time and services so generously and faithfully, week by week, at the infant welfare centres. Florence M. Parsons, M.R.C.S., L.R.C.P. 28 Report of the Infant Welfare Centres, 1934. 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 70 119 117 150 68 47 571 Children over one year and under five years of age 49 35 57 36 39 13 229 Number of children in attendance at end of year— Under one year of age 51 100 99 119 48 31 448 Over one and under five years of age 126 167 185 198 106 78 960 Total attendances of children under one year of age 520 1308 1355 1663 573 439 5858 Total attendances of children over one year of age 377 636 767 691 376 353 3200 Total attendances at centres 897 1944 2122 2354 949 792 9058 Average attendances at centres 42.2 46 5.17 56 45.1 36 46 Percentage of infants under one year of age attending centres of total notified births - - - - - - 62.6 Total attendances of expectant mothers ... — 146 124 - — — 270 Average „ „ „ — 12 11 - — — 11.5 Number of expectant mothers who attended during year - 67 48 - - - 115 Total number of attendances by expectant mothers at all clinics including Maternity Home - - - - - - 2071 Total number of expectant mothers who attended at all clinics including Maternity Home - - - - - - 375 Percentage of total notified births represented by the number of expectant mothers attending all clinics — — — — — — 40 29 Visits paid by Health Visitors, 1934. Mrs. Wray. Miss Knight (temporary part time) Miss Harris Mrs. Parsons. Miss Burke. Total. Primary ante-natal visits 25 4 32 36 63 160 Subsequent ante-natal visits 86 5 64 66 43 264 Primary birth visits 226 226 219 226 204 881 Subsequent visits to infants 531 212 871 1276 689 3579 Visits to children under five years of age 1250 546 1682 1745 864 6087 Visits re stillbirths 6 — 2 3 2 13 Visits re deaths of infants under one year of age 4 — 5 8 3 20 Visits re oases of ophthalmia neonatorum 1 — — — — 1 Visits re cases of puerperal fever 1 — — — — 1 Visits re cases of puerperal pyrexia 3 — — — — 3 Primary visits to cases of tuberculosis 14 2 24 26 14 80 Subsequent visits to cases of tuberculosis 107 38 67 137 34 383 Special visits 449 — — — — 449 2703 813 2966 3523 1916 11921 30 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 certain householders in Stanford Road of a bad taste in the water. Samples of water were taken for analysis. The taste was due to naphthaline from the coating of new pipes. The matter was referred to the Water Board, and the defect was remedied. During the summer drought samples of water were taken from a well in order to ascertain whether the water was fit for domestic purposes. The bacteriological report was as follows:— B. Coli absent in 100 ccs. Streptococci absent in 5 ccs. B. Enteritidis Sporogenes absent in 5 ccs. On gelatine plates, kept for four days at 20° C., 40 colonies per cc. developed. Of these 20 liquified gelatine. On Agar plates, kept for 24 hours at 37° C., 25 colonies per cc. developed. No exception could be taken to this water on bacteriological grounds, and as the chemical analysis was satisfactory, this water was used for domestic purposes. DRAINAGE AND SEWERAGE. The new soil sewerage scheme which was commenced on August 14, 1933, was completed during the year. This scheme drains an area of 962 acres to a new outfall sewer. RIVERS AND STREAMS. Visits have been paid to all works suspected of discharging polluted effluent into the surface water sewers. On three occasions pollution was found and in each case the matter was remedied. One complaint was 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. 31 PUBLIC CLEANSING. A weekly collection of house refuse is carried out by direct labour. Five dust collection vehicles, of modern type, are in use under the continuous relay system. The refuse is burnt at the Council's destructor. SMOKE ABATEMENT. One hundred and one observations were kept on chimneys during the year. In connection therewith nine notices were served and the nuisances abated. LEGAL PROCEEDINGS. In connection with the administration of the Public Health Acts the following legal proceedings were undertaken during 1934:— Particulars. Result. Summons taken out under Sec. 91, Public Health Act, 1875, against owner of certain property. Fined £5 and £2 2s. costs. Ditto. Pined £2 and £3 3s. costs. Summons taken out under See. 68, Mitcham Act, against owner of certain property for failure to supply dustbin. Pined £1. 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. 32 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. 33 HOUSING. Inhabited houses.—The number of inhabited houses in the borough on December 31, 1934, was 14,828, being an increase of 345 houses since the previous year, the average number of persons per house being 4.081. The number of inhabited houses in each ward is as follows:— North Ward 3,154 Population 12,881 South „ 2,657 „ 10,851 East „ 5,699 „ 23,275 West „ 3,318 „ 13,551 Total 14,828 HOUSING ACT, 1930. During the year the following clearance orders were confirmed by the Minister of Health:— Clearance Area No. 4. Four cottages known as 87, 89, 91, 93 Miles Road. Clearance Area No. 5. Three buildings known as 79, 81, 83 Commonside East. Clearance Area No. 6. Nine cottages known as 1, 2, 3, 4, 5, 6, 7, 8, 9 Berkeley Place. An objection having been made to this Order a local inquiry was held on April 24, 1934. The Order was confirmed. Clearance Area No. 7. Eight cottages known as 103, 105, 107, 109, 111, 113, 115, 117 Rowan Terrace. An objection having been made to this Order a local inquiry was held on April 24, 1934. The Order was confirmed. Clearance Area No. 8. A row of back-to-back cottages known as 85-143 (odd numbers) Smiths Buildings, Commonside East. An objection having been made to this Order a local inquiry was held on April 24, 1934, The Order was confirmed, 34 Clearance Area No. 9. Eight buildings known as 17, 19, 21, 23, 25, 27, 29 and 31 Church Buildings, Church Road. The occupiers of these houses will be rehoused in the Council Housing Estate in Lewis Eoad. 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) 3360 (b) Number of inspections made for the purpose 3622 (2) (a) Number of dwelling houses (included under sub-head (l) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 232 (b) Number of inspections made for the purpose 274 (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 126 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 126 3. Action under Statutory Powers during the Year:— A. Proceedings under Sections 17, 18 and 33 of the Housing Act, 1930. (1) Number of dwelling houses in respect of which notices were served requiring repairs 4 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 3 (b) By local authority in default of owners 1 35 B. Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 670 (2) Number of dwelling houses in which defects were remedied after service of formal notices (a) By owners 40 (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 2 (2) Number of dwelling houses demolished in suance of demolition orders 2 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 36 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 60 ... 60 3 ... 3 ... ... Margarine 7 ... 7 1 ... 1 ... ... Sugar 6 ... 6 1 ... . 1 ... ... Meat 3 ... 3 ... ... ... ... ... Butter 9 ... 9 ... ... ... ... ... Confectionery & Jam ... ... ... ... ... ... ... ... Drugs ... ... ... ... ... ... ... ... *Other Articles 13 2 15 ... ... ... ... ... Totals 98 2 100 5 ... 5 ... ... *Details of Other Articles— Vinegar 7 1 8 ... ... ... ... ... Sultanas 3 ... 3 ... ... ... ... ... Raisins 3 ... 3 ... ... ... ... ... Dried mint ... ... ... ... ... ... ... ... Pure beef dripping ... 1 1 ... ... ... ... ... Totals 13 2 15 ... ... ... ... ... SLAUGHTER HOUSES. There are seven slaughter houses, of which two are registered and five are licensed. During the year 460 visits of inspection were made and in no instance was a defect discovered. For details of meat inspection see the Chief Sanitary Inspector's report. BAKEHOUSES. The number of bakehouses in the district is 15. Eighty-one visits have been paid and no defect was found. 37 DAIRIES AND COWSHEDS. There are 37 registered premises within the district, of which 36 are dairies and one cowshed. During the year 133 visits of inspection were paid, and in no instance was a defect 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.) 6 Grade A. 1 Certified 5 Pasteurised 5 Pasteuring plant 1 PIGGERIES. There are 17 piggeries in the district. One hundred and seventysix visit3 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. 38 FACTORIES AND WORKSHOPS. There are 173 factories and workshops in the district, of which 104 are factories and 69 are workshops. In addition there are 15 workplaces. During the year 473 visits of inspection were paid. Outworkers. There are 96 outworkers in Mitcham. One hundred and sixtytwo visits of inspection were paid, and, in connection with these, four sanitary notices were served. During the year eight 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 48 Onion peeling 5 Making of wearing apparel 33 Tailoring 2 Surplices 1 Embroidery 1 Furrier 1 Artificial flowers 1 Boots 1 Cardboard boxes 1 Confectionery covers 1 Hairnets and combs 1 Total 96 39 Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 218 4 Nil Workshops (Including Workshop Laundries) 225 15 Nil Workplaces (Other than Outworkers' premises) 30 1 Nil Total 473 20 Nil 40 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 13 13 Want of ventilation ... ... Overcrowding ... ... Want of drainage of floors ... ... Other nuisances 20 20 Sanitary accommodation insufficient 1 1 unsuitable or defective 10 10 not separate for sexes 5 5 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 49 49 Nil Nil * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 41 Outwork in Unwholesome Premises, Section 108. Nature of Work. Instances. Notices served. Prosecutions. Wearing Apparel— Making, &c. 2 2 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 Onion peeling 2 2 Total 4 4 Nil 42 ANNUAL REPORT OF SENIOR SANITARY INSPECTOR. To the Mayor, Aldermen and Councillors of Mitcham. Sir, Ladies and Gentlemen, I beg to submit my annual summary of the work carried out in the Borough during the year 1934 by myself and Inspectors P. D. O'Grady and A. W. Lock. Total number of visits paid 11761 Number of complaints received and investigated 468 Number of premises inspected 3480 Number of premises revisited 5276 Number of nuisances discovered 1234 Number of nuisances abated without report 1098 Number of nuisances abated after report 126 Number of intimatory notices served 1017 Number of statutory notices served 138 Notices followed by legal proceedings 3 Number of revisits to infected houses or houses of smallpox contacts 124 Number of house drains tested 10 Number of drains found defective 5 Number of tests applied to new drainwork 9 Character of Work Done. Houses repaired and cleansed generally 363 Overcrowding cases abated 31 Roofs repaired 139 Damp walls remedied 52 Eaves guttering and spouting renewed or repaired 71 Water closets renewed, repaired or cleaned 80 Water closet flushing cisterns and flush pipes renewed or repaired 83 Water cisterns cleansed or covered 28 Water supply to houses reinstated 6 Back yards paved or paving repaired 38 Floors repaired 83 Dustbins provided 455 Premises where animals improperly kept were removed or improved 1 43 Offensive accumulations removed 56 Urinals cleansed or repaired 3 Piggeries repaired or improved 8 Houses or parts disinfected and cleansed 573 Smoke nuisances abated 6 Houses at which drains were reconstructed or new provided 3 Drains repaired, cleansed, trapped or ventilated 155 Considerable attention has been given to temporary dwellings. There are 18 caravan yards in the district, accommodating 60 caravans and 174 persons, a reduction of 77 on last year's figures. Action under the Surrey County Council Act, 1932, resulted in an appreciable reduction in the number of caravans in three yards; another solitary caravan was removed from a site at Lonesome. An improvement was made in a Fountain Road yard by the erection of an additional watercloset and the yard being paved and drained. Eight caravans were evicted from the Lewis Road yard following High Court proceedings. In all 106 visits were paid to these yards. Three families occupying insanitary sheds were also removed. Only one application under the Rents Restriction Act was applied for and granted. The byelaws relating to houses let in lodgings were applied in three instances to secure to sub-tenants proper domestic services. One hundred and one smoke observations on factory chimneys were made and six nuisances were abated. Complaints regarding the emission of smells from two fish frying establishments were investigated and the nuisances abated by extending the flues well above the roofs. Disinfection and Disinfestation.—Disinfection has been carried out at 573 houses after removal of cases of infectious disease or treatment at home, also class rooms at two schools. Infected bedding and clothing is removed to the Wandle Valley Isolation Hospital for disinfection by steam. One hundred and nine bug infested rooms were fumigated or sprayed with insecticide. Notices were served on occupiers in 37 cases. Ponds and ditches were sprayed with paraffin, as in previous years, to combat the mosquito 44 nuisance. With few exceptions only one application was necessary owing to the drying up of the ponds and ditches during the hot summer. Food Inspection.—Inspections are regularly made to food establishments, particularly butchers and fishshops. 1,226 visits were paid to such places, in addition to 460 visits to the seven regulated slaughterhouses. These include two horse-slaughtering establishments where very little business is done. In the course of the visits the following articles of food were found to be diseased or unwholesome and were surrendered and destroyed and a certificate given to the owner of the condemned food:—Pork, 1,509 lbs., of which 765 lbs. were tuberculous, jaundiced, 160 lbs., pleurisy, 72 lbs., peritonitis, 64 lbs., fevered, 152 lbs., dropsy, 96 lbs., decomposed meat, 80 lbs., meat otherwise unsound, 120 lbs. ; 445 pigs lungs, 130 pigs' livers, the carcase of a tuberculous cow weighing 400 lbs., the liver and other organs. The Inspectors were also called upon to examine at tradesmen's shops 14 lbs. of halibut, 42 lbs. of cod, 60 lbs. kippers, barrel of herrings, eight cases of oranges, and eight sacks of greens, all of which were found to be in such a decomposed state as to be unfit for human food, and were certified as such and destroyed. Three breaches of the Meat Regulations (keeping meat in prohibited places) were detected and the practice stopped. Petroleum (Consolidation) Act, 1928. Licences have been granted to 81 persons in the district to store petroleum spirit, and three to store carbide of calcium. The quantity licensed to be stored totals 97,155 gallons ; of this quantity 90,665 gallons is stored underground in steel tanks surrounded with concrete. Shops Acts. Several complaints have been made of shop-keepers keeping open after proper closing hours. Observations have been made and warnings given, one report was made to the Committee and an official warning given. I am, Your obedient servant, CHARLES G. EABBETTS, 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 560, as compared with 368 last year. Contacts, Suspects, Etc. On 46 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 675 visits to cases of infectious disease ; 551 were primary visits and 124 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 ... 25 7 ... 2 4 ... ... ... ... ... 38 February ... 45 3 ... 3 10 ... 2 ... ... ... 63 March ... 57 3 ... 2 9 ... ... ... ... ... 71 April ... 50 7 ... 3 6 1 1 2 ... ... 70 May ... 31 6 ... 2 4 ... 1 ... ... ... 44 June ... 48 17 ... 7 1 ... 1 ... ... ... 75 July ... 32 3 ... 3 1 ... ... ... ... ... 39 August ... 21 3 ... 2 1 ... ... ... ... ... 27 September ... 16 12 ... 1 ... 1 ... ... ... 30 October ... 2(5 14 ... 2 3 ... ... ... ... ... 45 November ... 19 1 ... 1 3 ... ... ... ... ... 24 December ... 22 7 ... 2 3 ... ... ... ... ... 34 Total ... 392 83 ... 30 45 1 6 2 ... 1 560 46 Cases of Infectious Disease Notified During the Year 1934. 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 392 ... 10 10 23 21 196 75 18 25 14 ... ... 57 227 27 81 344 ... Diphtheria 83 3 1 8 4 9 28 14 4 10 1 1 ... 11 36 25 11 80 9 Typhoid Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 30 ... ... ... ... 1 ... 2 ... 3 7 14 3 9 8 6 7 10 ... Pneumonia 45 3 4 ... 3 5 3 3 ... 7 3 8 2 3 17 7 18 20 44* Puerperal Fever 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... Puerperal Pyrexia 6 ... ... ... ... ... ... ... ... 2 4 ... ... 1 1 ... 4 4 ... Ophthalmia Neonatorum 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 1 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1† Cerebro-Spinal Fever 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 Totals 560 8 15 19 30 36 228 94 25 47 30 23 5 81 289 65 125 461 56 * Includes all forms, many of which are not notifiable. † Transferred death. 47 Disease. Case rates per 1,000 of population. Case rates per 1000 Ward population. England & Wales. Mitcham. North. South. East. West. Small Pox 0.004 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 3.76 6.4 4.42 2.4 9.8 5.9 Diphtheria 1.70 1.8 0.85 2.3 1.1 0.82 Enteric Fever 0.03 0.00 0.00 0.00 000 0.00 Puerperal Fever 0.06 0.01 0.00 0.00 0.00 0.07 Puerperal Pyrexia 0.15 0.09 0.07 000 0.04 0.2 Erysipelas 0 51 0.49 0.7 0.5 0.3 0.5 Disease. Case rates per 1,000 total births. England and Wales. Mitcham. Puerperal Fever 4.0 1.01 Puerperal Pyrexia 9.6 6.1 Infectious Disease Notifications, 1922-34. Disease. 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 Small Pox ... ... ... ... ... ... 9 7 ... 4 1 ... ... Scarlet Fever 178 110 87 106 104 145 102 134 113 105 174 240 392 Diphtheria 84 35 59 201 87 76 75 133 129 49 32 40 83 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 1 Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal 1 ... 6 ... ... 2 1 4 ... ... 1 4 1 Meningitis Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 13 15 11 10 13 14 10 22 22 17 11 31 30 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 2 Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis ... ... ... 2 2 ... ... ... 2 1 1 1 ... Lethargica Pneumonia 30 19 39 42 30 62 54 57 35 45 52 37 45 Malaria 8 3 ... 1 1 ... ... ... ... ... ... ... ... Puerperal Pyrexia ... ... ... ... 1 14 9 5 6 9 4 9 6 Totals 347 287 246 376 259 340 270 375 319 242 288 368 560 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 various diseases mentioned later in this report. Small Pox. No case of small pox occurred in the district during the year, and no contacts of cases were notified as residing in the Borough. Scarlet Fever. The number of cases notified during the year was 392, this being 152 more than last year. Three hundred and forty-four cases were removed to hospital. No death was registered from this disease during the year. The majority of the cases of scarlet fever occurred in the East Ward. This ward not only has the largest ward population, but also contains a younger population, and therefore a population which is more susceptible to infectious disease. The rapid development of, and the influx of population into this ward have been important factors in the spread of this disease. Diphtheria. Eighty-three cases of diphtheria were notified during the year. Eighty cases were removed to hospital. Nine 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 528 such examinations have been made. Anti-toxin is also issued free of charge to practitioners who may require it. The number of cases of diphtheria notified during the year is double the number notified in 1933. This is partly accounted for by the very distressing fact that in several instances medical aid was not called in until the patient was very ill and had infected several members of the household. On inquiries being made into this matter, it was found that in the majority of cases the parents) 49 thought the child was suffering from mumps and did not bother to call in a doctor. The type of diphtheria prevalent was a rather severe faucial form, in which there was considerable swelling of the neck. This swelling was mistaken for mumps by the parents. At the same time, mumps was fairly prevalent in the district, which rather confused the diagnosis, as far as the parents were concerned. In one particular case a child was kept home from school as she did not feel well. In a day or two she had a swelling of the neck, and the parents assumed she was suffering from mumps. It was not until the child was in extremis that a doctor was called. He arrived at the house within half an hour and found the child dead, and on examining the rest of the family he discovered that the mother and seven other children were all suffering from diphtheria. In four other instances a similar sort of history was obtained, though these cases were not as bad as the one just quoted. The head teachers of the schools in the borough were asked to impress on parents the necessity of obtaining medical aid for their children if they were sent home from school because of illness. Diphtheria Immunisation. A diphtheria immunisation clinic was started in November. At the end of December 27 children had attended for immunisation. During the year 53 persons had been immunised by private practitioners. Diphtheria prophylactic is supplied free of cost to medical practitioners. Typhoid Fever. No case of typhoid fever was notified during the year. Diarrhœa and Enteritis under two years of age. Eight deaths were registered during the year. Six were of males and two of females. Encephalitis Lethargica. No case was notified during the year, but one death registered. This was a transferred death, that is, the patient died outside the Borough but, being a Mitcham resident, the death is counted in this district. Cerebro-Spinal Fever. One death was registered from this disease during the year. 50 Cancer. The number of deaths from cancer registered during the year was 70, of which 29 were males and 41 were females, as compared with 52 deaths last year. There was no unusual site distribution of cancer in 1934. 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 ot 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 1.51 1933 52 .86 1.52 1934 70 1.1 1.56 51 Influenza. During the year seven deaths from influenza were recorded. Pour were males and three were females. Last year 20 deaths were registered. 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 At Home. In Hospital Vision unimpaired. Vision impaired Total blindness Deaths 2 1 1 1 — — 1 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 73 new cases of tuberculosis were notified, viz.:— Males. Females. Total. Pulmonary 33 30 63 Non-Pulmonary 6 4 10 Total 39 34 73 The total number of deaths registered as occurring from tuberculosis was. viz.:— Males. Females. Total. Pulmonary 20 21 41 Non-Pulmonary 6 3 9 Total 26 24 50 England & Wales. Mitcham. Death rate from respiratory tuberculosis per 1,000 population 0.63 0.67 Death rate from non-respiratory tuberculosis per 1,000 population 0.12 0.14 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 1 year to 5 years ... ... ... ... ... ... ... 2 5 years „ 15 2 1 ... 2 ... ... ... ... 15 „ „ 25 10 10 2 2 4 8 ... ... 25 „ „ 45 12 17 3 ... 7 8 3 ... 45 „ „ 65 9 2 1 ... 9 5 3 ... 65 „ and upwards ... ... ... ... ... ... ... ... Totals 33 30 6 4 20 21 6 3 New cases coming to the knowledge of the Medical Officer of Health during the year through (a) Death returns, (b) Posthumous notifications:— Age Periods. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total. Pulmonary: males ... ... ... ... ... ... ... ... 2 ... ... 2 Pulmonary: females ... ... ... ... ... ... ... ... 2 ... ... 2 Non-Pulmonary: males ... ... ... ... ... ... ... ... ... ... ... ... Non-Pulmonary: females 1 ... ... ... ... ... ... ... ... ... ... 1 53 The sources from which information as to the above-mentioned cases was obtained are as follows:— No. of Cases. Pulmonary. NonPulmonary. Death returns (a) From Local Registers 2 ... (b) Transferable deaths from Registrar General 1 1 Posthumous notifications ... ... 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 5 Notified tuberculosis deaths 45 Percentage of non-notified T.B. deaths (all forms) 10 per cent. Percentage of non-notified pulmonary T.B. deaths 8 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 Borough for the examination of sputa from cases or suspected cases of tuberculosis, and during the year 162 such examinations have been made. Chicken Pox. One hundred and ten cases of chicken pox were notified by the head teachers of the schools in the district. Whooping Cough. One hundred and twenty-three cases of whooping cough were notified during the year by the head teachers of schools in this district. Two deaths from whooping cough were registered during the year. 54 Measles. Two hundred and ninety-three cases of measles were notified during the year by the head teachers of schools in the district. Eleven deaths from measles were registered during the year. Mumps. One hundred and fifteen cases of mumps were notified by the head teachers during the year. Pneumonia. Forty-five cases of pneumonia were notified by practitioners during the year. Six of these cases were notified as primary influenzal pneumonia. The total deaths registered as pneumonia was 44; this includes all forms of pneumonia, both primary and secondary. Erysipelas. Thirty cases of erysipelas were notified, and ten cases were removed to hospital. There was no death from this cause. Puerperal Eever. One case of puerperal fever was notified; the patient made a good recovery. Puerperal Pyrexia. Six cases of puerperal pyrexia were notified and no death was recorded from this cause. 55 WANDLE VALLEY JOINT HOSPITAL BOARD. Cases admitted to hospital during the year ended December 31, 1934. Disease Beddington & Wallington Coulsdon & Purley Merton & Morden Mitcham Cases Deaths Cases Deaths Cases Deaths Cases Deaths Diphtheria 29 2 21 ... 84 6 73 9 Scarlet Fever 60 ... 78 ... 295 ... 339 ... Typhoid ... ... 2 ... 2 ... ... ... Puerperal Fever 1 ... 1 ... ... ... ... ... Erysipelas ... ... 1 ... ... ... ... ... Other Diseases ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... 3 ... Whooping Cough and Pneumonia ... ... ... ... 2 ... ... ... Whooping Cough and Measles ... ... ... ... 1 1 1 ... Measles and Scarlet Fever ... ... ... ... ... ... 2 2 Measles 2 ... 2 ... 12 1 11 1 Influenza ... ... ... ... ... ... 1 ... Cerebro-Spinal Meningitis ... ... ... ... 1 ... 1 ... Influenzal Meningitis ... ... ... ... ... ... 1 1 Tonsilitis 6 ... 10 ... 22 ... 17 ... Abscess ... ... 1 ... ... ... ... ... Rubella 1 ... 2 ... 3 ... 4 ... Otitis Media ... ... ... ... 1 ... ... ... Pyrexia, following Vaccination ... ... ... ... ... ... 1 ... Laryngitis ... ... 1 ... ... ... 2 ... Babies (no disease) admitted with mother 2 ... 3 ... 1 ... 1 ... 101 2 122 ... 424 8 457 13 57 INDEX. Page Ambulances 14 Analysis of Mortality 13 Ante-Natal Clinics 16 Area 7 Bakehouses 36 Birth Rates 9, 13 Births, Live 8 — Illegitimate 8 — Still 8 Blindness, Prevention of 51 Cancer 50 Causes of Deaths 10 Cerebro-Spinal Fever 49 Chicken Pox 53 Clearance Areas 33 Clinics, Ante-Natal 16 — Dental 17 — Orthopædic 17 — Welfare 15 Closet Accommodation 30 Dairies and Cowsheds 37 Death Rates 10, 13 Deaths 8, 9, 10 Dental Clinic 17 Diphtheria 48 — Immunisation 49 Disinfection and Disinfestation 43 Drainage and Sewerage 30 Encephalitis Lethargica 49 Erysipelas 54 Factories and Workships 38 — — — Defects in 40 — — — Inspection of 39 Food and Drugs Act (1928) 36 — Inspection and Supervision of 36, 44 58 page. Food, Preparing Places 37 General Provision of Health Services for the Area 14 Health Visiting 15 — Visitors, Visits by 29 Hospitals 14 Houses, Inspection of 34 — Inhabited 33 Housing 33 — Act (1930) 33 — Statistics 33, 34 Infantile Mortality 8, 9, 11 Infant Life Protection 17 Infectious Disease, Cases Notified 46 — — Incidence of 45 — — Prevalence of and Control over 45 — — Notifications 46, 47 — — — School 47 Influenza 51 Inhabited Houses 7, 33 Inquests 11 Inspection and Supervision of Food 36, 44 Laboratory Facilities 14 Legal Proceedings 31 Maternal Mortality 12 Maternity and Child Welfare Centres 15 — — — — — Report on 20 — Home 18 Measles 54 Mid wives 15 Milk (Special Designation) Order (1923) 37 Mortality, Analysis of 13 — Infant 8, 9, 11 — Maternal 12 Mumps 54 Nursing in the Home 15 Ophthalmia Neonatorum 51 Outworkers 38, 41 Parsons, Dr. F. M., Report 20 59 PAGE. Patients Admitted to Hospital 55 Personnel, Committees 4, 5 — Staff 6 Petroleum Act (1928) 44 Piggeries 37 Pneumonia 54 Population 7 Prevention of Blindness 51 Public Cleansing 31 Puerperal Fever 54 — Pyrexia 54 Rateable Value 7 Rivers and Streams 30 Sanitary Circumstances of the Area 30 — Inspector's Report 42 Senile Deaths 9 Scarlet Fever 48 Schools 31 Sewerage 30 Shops Acts 44 Slaughter Houses 36 Small Pox 48 Smoke Abatement 31 Social Conditions 7 Statistics 7 — Housing 33, 34 — Vital 8 Still Births 8 Tuberculosis 51 Typhoid Fever 49 Vital Statistics 8 X-Ray Examinations 17 Wandle Valley Hospital 55 Water Supply 30 Welfare Clinics 15 — — Attendance at 28 Whooping Cough 53 Woodlands Maternity Home 18