BOROUGH OF MITCHAM MEDICAL OFFICER OF HEALTH BOROUGH OF MITCHAM REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1935 Mitchant: H. G. Mather, Caxton Works, Lower Green Borough of Mitcham HEALTH REPORT FOR 1935 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 ended December 31, 1935. The year has been a fairly satisfactory one from the health point of view. The birth rate is exactly the same as last year, namely, 15.6 per 1000, whilst the death rate has fallen to 7.7 per 1000. The infant mortality rate also shows a fall. The number of infectious disease notifications shows a striking decrease, especially in the number of cases of scarlet fever. The housing problem has received very serious consideration throughout the year. Four clearance orders have been confirmed by the Ministry of Health, and other areas have been inspected with a view to making a clearance area. I wish to place on record my appreciation of the support given me by all members of the Council, and especially those on the Public Health and on the Maternity and Child Welfare Committees, and also to the chief officials. To the members of my staff I express my thanks for their loyal assistance and for the efficient manner in which they perform their duties. I am, Ladies and Gentlemen, Yours obediently, A. T. TILL, Medical Officer of Health. Public Health Department, Town Hall, Mitcham, Surrey, Borough of Mitcham. Committees from November, 1934, to November, 1935. PUBLIC HEALTH COMMITTEE. Chairman - Councillor W. G. P. Searl Aldermen— Mrs. W. Toynbee J. Fitch, J.P. E. J. D. Field Councillors— Miss R. K. Wilson J. R. Beaumont J. M. Davies T. E. Hanson W. S. Lawrence D. Bigham MATERNITY AND CHILD WELFARE COMMITTEE. Chairman - - Alderman W. Jeffery Aldermen— Mrs. W. Toynbee J. Fitch, J.P. Councillors— Mrs. E. Watson Miss R. K. Wilson Mrs. C. Randall A. T. Fabian G. R. Madgwick S. G. Silkstone 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 R. K. Wilson, J. S. Abraham REPRESENTATIVES ON WANDLE YALLEY JOINT SEWERAGE BOARD. Aldermen J. Fitch, J.P., S. L. Gaston, J.P., W. Jeffery Councillor T. E. Hanson REPRESENTATIVE ON THE CROYDON AND DISTRICT SMALL POX HOSPITAL BOARD. Councillor H. Richards Committees from November to December 31, 1935. PUBLIC HEALTH COMMITTEE. Chairman - - Alderman J. Fitch, J.P. Aldermen— Mrs. W. Toynbee E. J. D. Field W. Jeffery Councillors— Miss E. K. Wilson D. Bigham F. P. Howard C. H. Mills W. G. F. Searl J. M. Davies, J.P. MATERNITY AND CHILD WELFARE COMMITTEE. Chairman - Councillor Mrs. C. Randall Aldermen— Mrs. W. Toynbee A. T. Fabian Councillors— Mrs. E. Watson Miss R. K. Wilson T. E. Hanson H. Lee G. R. Madgwick S. G. Silkstone J. M. Davies, J.P. Co-opted members— Mrs. Ericson Mrs. Leigh Mrs. Mills Mrs. Stokes Dr. G. M. Stoker REPRESENTATIVES ON WANDLE YALLEY JOINT HOSPITAL BOARD. Councillor J. M. Davies, J.P. Alderman J. Fitch, J.P. Councillors Mrs. E. Watson, J. S. Abraham. REPRESENTATIVES ON WANDLE YALLEY JOINT SEWERAGE BOARD. Councillor J. M. Davies, J.P. Aldermen S. L. Gaston, J.P , W. Jeffery, C. Woods. REPRESENTATIVE ON CROYDON AND DISTRICT SMALL POX HOSPITAL BOARD. Councillor T. E. Hanson. 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 Aot Inspector. C. G. Rabbetts, C.R.S.I. Assistant Sanitary and Meat Inspectors. P. O'Grady, C.R.S.I. (until May 30, 1935). A. W. Lock, C.R.S.I. L. Gleed, C.R.S.I. (from June 17, 1935). Assistant Shops Act Inspector. L. R. Rummery. 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) Miss E. M. Bowen (from June 18, 1935) (2, 3, 8) Matron of Woodlands Maternity Home. Miss G. Evans (1, 2) 1. Slate 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. 8. Sick Children's Registered Nurse. 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, 1935 62,070 Number of inhabited houses, 1921 7,150 „ „ „ 1931 13,187 „ „ „ 1935 15,721 Rateable value £432,644 Sum represented by a 1d. rate £1,733 STATISTICS. Live Births. Total. Male. Female. Rate per 1,000 of population. Legitimate 936 472 464 Illegitimate 33 25 8 Total 969 497 472 15.6 Still Births. Total. Male. Female Rate per 1,000 total births. Legitimate 19 9 10 Illegitimate 2 1 1 Total 21 10 11 21.6 8  Total Male. Female. Rate per 1,000 of population. Deaths. 485 238 247 7.7 Deaths from disease and accidents of pregnancy and childbirth:— Rate per 1,000 total births. From puerperal sepsis — — From other causes 3 3.0 Total 3 3.0 Deaths of infants under one year of age:— All infants per 1,000 live births 49.5 Legitimate infants per 1,000 legitimate live births 47.4 Illegitimate ,, „ illegitimate „ 60.6 Deaths from:— Measles (all ages) — Whooping cough (all ages) — Diarrhoea (under two years of age) 2 VITAL STATISTICS. During the year 969 live births were registered as belonging to this district, of which 472 were females and 497 were males, as compared with 948 last year. The live birth rate for the year was equal to 15.6 per 1,000 of population, as against 15.6 per 1,000 last year, the crude birth rate being 15.9 per 1,000. The birth rate for England and Wales was 14.7 per 1,000, as against 14.8 per 1,000 last year. Illegitimate Births. The number of births registered as being illegitimate was 21, as compared with 34 last year. The illegitimate rate was equal to 2.1 per cent. of the total births, as against 2.5 per cent. in 1934. 9 Still Births. The number of still births registered was 21, of which 10 were males and 11 females; 1 male and 1 female were illegitimate. Percentage of Births Occurring in Institutions. Year. Total births. Births in hospitals, etc. Percentage of births occurring in institutions. 1929 961 309 32.1 1930 1129 367 32.4 1931 1143 370 32.3 1932 1084 381 35.1 1933 1010 420 41.5 1934 982 428 43.5 1935 969 474 48.9 Number of births notified by mid wives in 1935 691 ,, ,, ,, doctors and others in 1935 278 Deaths. During the year 485 deaths were registered, of which 238 were males and 247 were females, as compared with 553 deaths last year. The death rate for the year was equal to 7.7 per 1,000 of the population, as compared with 9.1 per 1,000 in 1934. The death rate for England and Wales was 11.8 per 1,000 for the year 1935 and 11.8 per 1,000 for 1934. Senile Deaths. The number of deaths of persons of 65 years of age and over was 207, of which 92 were males and 115 females. This constitutes 42.6 per cent. of the total deaths, as compared with 37 per cent. last year. 10 The birth rates, death rates per 1,000 of population, and the infantile mortality rates for the years 1915-1935 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 1935 15.6 14.7 7.7 11.8 49.5 57 11 Infant Mortality. During the year 48 deaths were registered a3 occurring in infants under one year of age:- Males. Females. Total. Legitimate 23 23 46 Illegitimate 2 — 2 Total 25 23 48 as compared with 49 deaths last year. The infantile mortality rate for the year is equal to 49.5 per 1,000 live births, as against 51.6 per 1,000 last year. The infant mortality rate for England and Wales was 57 per 1,000 for 1935 and 59 per 1000 for 1934. Maternal Mortality. During the year three 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 eclampsia. One was due to haemorrhage and shock following placenta praevia. One was due to pulmonary embolus ten days after birth of child. All maternal deaths occurring with 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. General and Infant Mortality Rates for each Ward for Year 1935. General Mortality rate per 1,000 Ward population. Infant Mortality per 1,000 live Births per Ward. North 8.0 14.7 South 7.1 13.0 East 6.4 13.8 West 11.1 23.1 12 Inquests. Inquests were held on 38 residents dying within the district and on 33 Mitcham residents who died outside the district, a total of 71. The following table shows the results of the findings of these inquests. Inquests. Number. Deaths from natural causes 36 Deaths from accidents:— Knocked down by motor vehicles 7 Septicaemia following injury 4 Suffocation 3 Falls 11 Suicide:— Poisoning by— Lysol 1 Coal gas 4 Cyanide 1 Fall over cliff 1 Hanging 1 Murder 1 Misadventure 1 Total 71 13 Deaths Registered during the Year, 1935. Cause of Death. Males. Females. Total. Typhoid and paratyphoid Measles Scarlet Fever 1 1 Whooping Cough Diphtheria 1 1 2 Influenza 3 1 4 Encephalitis lethargica 1 1 5 Cerebro-spinal Fever Tuberculosis of the Respiratory System 15 20 35 Other Tuberculous Diseases 3 6 Syphilis 1 1 General Paralysis of the insane, tabes dorsalis 2 2 Cancer, malignant disease 34 34 68 Diabetes 3 3 6 Cerebral Haemorrhage 9 10 19 Heart Disease 50 55 105 Aneurism 2 2 Other Circulatory Diseases 6 9 15 Bronchitis 7 8 15 Pneumonia (all forms) 19 16 35 Other Respiratory Diseases 3 3 Peptic Ulcer 3 3 Diarrhoea, &c. (under two years) 2 2 Appendicitis 3 3 Cirrhosis of the Liver 2 1 3 Other Diseases of the Liver, etc 3 3 Other Digestive Diseases 8 11 19 Acute and Chronic Nephritis 3 6 9 Puerperal sepsis Other Puerperal causes 3 3 Congenital Debility, Premature Birth, Malformations, etc 15 14 29 Senility 3 14 17 Suicide 6 2 8 Other Violence 11 10 21 Other defined Diseases 25 17 42 Causes ill-defined or unknown 1 1 2 Total 238 247 485 Special Causes: — Small Pox Poliomyelitis Polio-encephalitis 14 Birth-rate, Death-rate, and Analysis of Mortality during the year 1935. - Rate per 1,000 total Population annual death-rate per 1000 population. Rate per 1ooo 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 14.7 0.62 11.7 0.00 0.00 0.02 0.01 0.04 0.08 0.18 0.52 5.7 57 121 County Boroughs and Great Towns, including London 14.8 0.68 11.8 0.00 0.00 0.04 0.01 0.04 0.09 0.16 0.45 7.9 62 140 Smaller Towns (estimated resident populations 25,000 —50,000 at Census 1931) 14.8 0.64 11.2 0.00 0.00 0.03 0.01 0.03 0.07 0.17 0.41 3.8 55 London 13.3 0.52 11.4 0.00 0.00 0.00 0.01 0.04 0.06 0.11 0.51 11.2 58 Borough of Mitcham 15.6 0.66 7.7 0.00 0.00 0.00 0.01 0.00 0.03 0.06 0.33 2.0 49.5 Puerperal Sepsis Others. Total. The maternal mortality rates for England and Wales are as follows: per 1,000 Live births 1.68 2.42 4.10 „ ,, Total births 1.61 2.32 3.93 „ „ „ Borough of Mitcham: „ „ Live births 3.0 3.0 „ „ Total birth 3.0 3.0 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 borough have b6en examined during the year:— Swabs for diphtheria 528 Sputa for tubercle 163 Total 691 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. The ambulance service for the district is quite adequate at present, and the following arrangements have been made:— For General and Accident Cases.— An ambulance has been provided by the Council for the removal of general and accident 16 cases. This ambulance is under the control of the fire brigade superintendent. The total number of cases removed during the year was 863, of which 395 were accident cases. 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. MIDWIVES. The Surrey County Council are the local supervising authority for midwives. At present there are 18 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 five health visitors employed in visiting the mothers and children in this district, The superintendent health visitor is responsible for the general supervision of the welfare centres, antenatal clinics, etc., and also does the visiting of tuberculous patients and acts as Infant Life Protection Visitor. NURSING IN THE HOME. There are three nursina associations in the boroueh. The following are the returns from each association for year ended December 31, 1935:— No. of Nurses. No. of patients visited during 1935. No. of visits paid during 1935. St. Barnabas 1 206 1,246 South and East Wards 3 401 7,636 Christchurch 1 196 3,698 Totals 5 803 12,580 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. 17 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. Meopham Road Centre.—Sessions are held on the first four Mondays of each month. Dr. Parsons attends all sessions. Parish Boom, Lower Green.—Sessions are held on the second and fourth Thursdays of each month. Dr. Parsons attends both sessions. Sherwood House.—Sessions are held on the first and third Thursdays of each month. Dr. Parsons attends both sessions. 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 111, the number of mothers attending being 49. . 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 1995. the number of mothers attending being 302. Meopham Road.—Sessions are held on the second Tuesday of each month. The total attendances of expectant mothers was 128, the number of mothers attending being 46. Town Hall.—In order to provide ante-natal facilities for expectant mothers living in the southern part of Mitcham, a clinic is now being held at the Town Hall. The first session was held on May 21, 1935. The total attendances at this clinic was 60, the number of mothers attending being 36. All midwives are given a supply of forms on which the findings at ante-natal examinations of their patients at the Council's clinics are recorded. The midwife completes the form, giving details of the confinement, and upon receipt of the form the Council pay the fee of 1s. 13 Forty-five per cent. of the mothers of children born during the year attended the ante-natal clinics (including Woodlands Maternity Home clinic), as compared with 40 per cent. last year. Post-natal Clinic. A post-natal clinic is now held at the Town Hall on the fourth Tuesday of each month. The first session was held on November 26, 1935, the number of mothers attending being three. Home Helps. In order that mothers may be relieved of the worry of housekeeping during confinement and the lying-in period, the Council have a panel of women who will act as Home Helps during this period. The following rules have been laid down:— 1. That every care will be taken in the selection of home helps as far as character is concerned, but the Council cannot accept responsibility for the conduct of the home help. 2. That the time of employment be not more than 48 hours per week. 3. That no nursing duties be undertaken by the home help. 4. That the duties consist of general home management, including cooking, the care of children and any necessary washing. 5. Patients are not expected to provide meals for the home help (but probably some arrangement could be made for her to cook her own food). The home help is paid 25s. per week, the patient paying a proportion according to the following scale:— Income per head per week (after Charge deduction of rent). per week. Up to four children in family 7s. 6d. Free Over four children in family 5s. Free Up to four children in family 10s. 12s. 6d. Over four children in family 7s. 6d. 12s. 6d. 19 The charge for those whose income exceeds above scale is 25s. per week. The scheme was started in May, 1935. At the end of the yearthere were 12 women on the panel, and five families had made use of a home help. Orthopedic 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 20 cases were referred to this clinic, as compared with eight cases in 1934. Dental Clinic. In March, 1933, arrangements were made with the Surrey County Council to use the school dental clinic for persons requiring dental treatment under the Maternity and Child Welfare Scheme. This arrangement was terminated in September, 1935, when the Borough Council opened a dental clinic at Cavendish Road Welfare Centre. A part time dental surgeon is engaged for the work, and the clinic is held twice monthly. During the year the following amount of dental work has been undertaken:— Extractions—Local 17 „ Gas 56 Fillings 18 Scaling 1 Impressions taken 11 Inspections 81 Advice given re dentures, etc. 40 Total attendances 224 Number of new cases during 1935, 70. X Ray Examinations. Arrangements have been made with the Wilson Hospital, Mitcham, for the X-ray examination of women atttending the ante-natal 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, as compared with 18 last year. 20 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:— Number of foster mothers on register, December 31,1935 39 Number of children on register, December 31, 1935 46 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 359 WOODLANDS MATERNITY HOME. The Woodlands Maternity Home, Devonshire Road, Colliers Wood, was established by the Council in 1924. 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. The Home is a recognised training school for midwives. 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:— 21  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 1934 285 1935 299 Number of maternity beds in the institution (exclusive of isolation and labour beds), 15. Number of maternity cases admitted during the year, 296. Average duration of stay, 14 days. Number of cases delivered by—(a) midwife, 264; (b) doctors, 32. Number of cases in which medical assistance was sought by a midwife in emergency, 66 (38 abnormal conditions, 28 perineal sutures). Number of cases notified as—(a) puerperal fever, nil ; (b) puerperal pyrexia, nil. Number of cases of pemphigus neonatorum, nil. Number of infants not entirely breast-fed while in the institution, 4. Number of cases notified as ophthalmia neonatorum, nil. Number of maternal deaths, nil. Number of infants deaths—(i.) stillborn, 3 ; (ii.) within 10 days of birth, 3. 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, 22 Report of the Infant Welfare and ante-Natal Centres, 1935. 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. Town Hall Woodlands Total. Number of new cases registered during year of— Children under one year of age 82 120 116 159 93 65 — — 635 Children over one year and under five years of age 35 48 40 34 40 40 - - 237 Number of children in attendance at end of year— Under one year of age 65 105 82 109 74 47 — — 482 Over one and under five years of age 126 188 196 225 125 127 — — 987 Total attendances of children under one year of age 704 1223 1567 1879 663 664 - - 6700 Total attendances of children over one year of age 275 575 584 821 340 538 - - 3133 Total attendances at centres 979 1798 2151 2700 1003 1202 — — 9833 Average attendances at centres 44 42 52 66 46 55 — — 51 Percentage of infants under one year of age attending centres of total notified births - - - - - - - - 66 Total attendances of expectant mothers - 111 128 - - - 60 1995 2294 Average attendances of expectant mothers - 10 12 - - - 8 38 17 Number of expectant mothers who attended during year - 49 46 - - - 36 302 433 Percentage of total notified births represented by the number of expectant mothers attending all clinics - - - - - - - - 45 23 Visits paid by Health Visitors, 1935. Mrs. Wray. Miss Russell Harris Miss Knight (until May, 1935). Mrs. Parsons. Miss Burke. Miss Bowen (from June, 1935). Total. Primary ante-natal visits 15 47 9 37 40 39 187 Subsequent ante-natal visits 55 45 4 62 42 21 229 Primary birth visits 80 314 5 165 112 136 812 Subsequent visits to infants 439 955 303 1141 726 614 4178 Visits to children under five years of age 615 1582 610 1791 1024 1276 6898 Visits re stillbirths 3 4 — 5 4 2 18 Visits re deaths of infants under one year of age 3 7 — 1 5 6 22 Visits re cases of ophthalmia neonatorum 4 — - — — — 4 Visits re cases of puerperal fever 4 — — — — — 4 Visits re cases of puerperal pyrexia 3 — — — — — 3 Primary visits to cases of tuberculosis 46 15 1 11 17 6 96 Subsequent visits to cases of tuberculosis 452 34 23 73 71 11 664 Special visits 542 — — — — — 542 2261 3003 955 3286 2041 2111 13657 24 REPORT ON MATERNITY AND CHILD WELFARE CENTRES AND DENTAL CLINIC, 1935. By Dr. 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, thus serving every part of the Borough. 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. At the Cavendish Road and St. Barnabas Centres the doctor attends twice each month. Since May, 1935, the doctor has attended each of the four sessions at the Meopham Road Centre. At the Sherwood Park Centre an increased number of sessions is urgently needed. This Centre serves a very rapidly growing area, and the existing accommodation at Sherwood House, to which the clinic was moved on December 6, 1934, has already proved insufficient for the large numbers of mothers and children who attend there. This difficulty could be overcome by doubling the number of sessions held there. The total number of attendances at the six infant welfare centres was 9,833, as compared with 9,058 in 1934. Of these, 872 were new cases, 635 being infants under one year of age and 237 being children over one but under five years of age. The total number of attendances under one year of age was 6,700, and of children between one and five years 3,133. At the end of the year there were 482 infants under one year and 987 children between one and five years attending the centres. The average attendance at each individual centre was:— Cavendish Road 41.8 Meopham Road 52.4 Parish Room 45.5 Sherwood Park 54.6 St. Barnabas 65.8 Western Road 44.5 giving an average for all centres of 50, as compared with 46 in 1934. 25 The percentage of infants under one year of age attending the centres was 66 per cent. of the total number of notified births, which must be regarded as a very high proportion. In 1934 this percentage was 61.3. Supply of 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. Arrangements were made whereby necessitous children needing dried food other than that supplied at the clinics could obtain this free. Grants of free milk were also made where necessary, application for these being considered each month by the Maternity and Child Welfare Committee. In this connection, it will be noted, no necessitous case is kept waiting until the Committee sits, each case being considered and the order given by a certificate from the Medical Officer pending the decision of the Committee. General Remarks. The nutrition, clothing and cleanliness of the children continued to attain an exceedingly high standard, and attendance at the centres was very regular. Mothers are encouraged to bring their children to the clinics for advice. Children found to be suffering from any pathological condition were referred to the family doctor or hospital, a letter giving particulars of the condition being sent with the patient. Remarks on Pathological Condition. The number of children found to be suffering from dental caries was 71. (For the purposes of this report every case of caries from the slightest degree to gross caries is included.) Dental treatment was advised in all cases, and the children were referred to the family dentist or to the dental clinic or in a very few cases to hospital. Enlarged tonsils were found in 36 cases. Treatment was advised in those cases where it was considered necessary. Nineteen orthopaedic cases were referred to the Nelson Hospital and one to Charing Cross Hospital. Of the nineteen cases referred to the Nelson Hospital, seventeen actually attended. 26 Ophthalmic conditions were found in 18 children. Eleven of these required hospital treatment, which was given at the Royal Westminster Ophthalmic Hospital with very good results. Skin lesions, including nævi, were found in 31 cases. Five of these were referred to Charing Cross Hospital for treatment. To sum up, 315 pathological conditions were found, details of which are given in the following table:— TABLE I. Pathological Conditions. Number of cases. Remarks. Congenital Conditions— Accessory auricles 2 Cardiac disease 2 Cleft palate 1 Referred to Bolingbroke Hospital. Hare lip and cleft palate 1 Hypospadias 3 One referred to Charing Cross Hospital. Mental disease 3 Two cases of Mongolian idiocy referred to Charing Cross Hospital. Nævi 10 Two treated at Charing Cross Hospital. Phimosis 65 Tongue-tie 3 Webbed toes 2 One referred to Bolingbroke Hospital. Acquired Conditions — Abscess of breast 1 Anæmia 3 Axillary sores 1 Cervical glands, enlargement of 13 Convulsions 2 One died of an intercurrent disease. Dental disease— Caries 71 Enamel deficiency 4 Carried forward 187 27  Number of Cases. Remarks. Brought forward 187 Enuresis 5 Hæmatoma of scalp 1 Hæmatoma of sterno-mastoid 2 Hernia— Right inguinal 1 Umbilical 5 Three referred to Belgrave Hospital. One operated on in Wilson Hospital. Double hernia and hydrocele 1 Admitted to Belgrave Hospital for operation. Hirschsprung's disease 1 Admitted to Charing Cross Hydrocele 1 Hospital for operation. Infectious diseases— Rubella 1 Varicella 1 Marasmus 4 Two admitted to Vincent Square Hospital, one of whom died. Nits 3 Ophthalmic- Conjunctivitis 1 Myopia 1 Treated at Royal Westminster Ophthalmic Hospital. Strabismus 11 Ten treated at Royal Westminster Ophthalmic Stye 5 pital. Orthopaedic — Congenital dislocation of hip 1 Referred to Charing Cross Hospital. Gena varum 9 Gena valgum 8 Referred to Nelson Hospital. Pes planus 2 Otorrhœa 3 Rickets 1 Carried forward 255 28  Number of Cases. Remarks. Brought forward 255 Skin diseases— Dermatitis 5 Eczema 3 Infantile eczema 6 One referred to Charing Cross Hospital. Impetigo 1 Pemphigus 1 Eingworm 2 One referred to Charing Cross Hospital. Urticaria 3 Threadworms 3 Tonsils, enlarged 36 Total 315 Ante-natal Centres. One Ante-natal Clinic is held each month at the Cavendish Road and Meopham Road Centres, and one clinic each week in connection with Woodlands Maternity Home. A new clinic was opened at the Town Hall on May 21, and this one also is held once a month. The doctor attends each of these clinics. The total number of expectant mothers attending the centres was 433 (compared with 375 in 1934 and 327 in 1933), the total number of attendances being 2,294 (compared with 2,071 in 1934 and 1,257 in 1933). The average attendance at each individual centre is shown in Table II.:— TABLE II. Centre. Number of Expectant Mothers attending. Number of attendances. Average attendance. Woodlands 302 1,995 40 Cavendish Road 49 111 10 Meopham Road 46 128 13 Town Hall 36 60 9 This gives an average for all centres of 18. Of the total number of notified births, 45 per cent. of the mothers had attended the ante-natal centres, as compared with 40 per cent. in 1934 and 35.5 per cent. in 1933, 29 General Remarks. Expectant mothers continued to attend the ante-natal centres in increasing numbers and with great regularity. The principle adopted in previous years was maintained, the clinics being kept strictly for those cases entering Woodlands or hospital or being attended by midwives in their own homes. No patient who was to be attended by her own doctor was allowed to attend. Any patient found to be suffering from any serious pathological condition was referred to her own doctor or, in certain cases, to hospital, a letter giving details of the condition present accompanying the patient in either case. Letters were sent to midwives who referred patients to the centres, and midwives were welcomed at the clinics, the patient's ante-natal form being available for their perusal. Remarks on Pathological Conditions. There were 41 cases of albuminuria of pregnancy and four cases of severe toxæmia of pregnancy. Three of the latter were immediately admitted to hospital and one to Woodlands. Three responded well to treatment and the condition of mother and baby was satisfactory. The fourth case responded well to treatment, but the baby only lived 36 hours, and the mother died suddenly on the tenth day from a pulmonary embolus, after having made up to that time a good convalescence. One case of colitis was admitted to Guy's Hospital for the treatment of this condition before confinement. There were five cases of ante-partum haemorrhage and one of threatened miscarriage. One case was admitted to Woodlands and one to York Road Lying-in Hospital. The remaining cases were very slight and were treated in their own homes by their own medical attendants. Malpresentations were found in 31 cases. Thirteen of these were corrected at the clinics, ten underwent spontaneous version, and four were referred to Guy's Hospital for version. Advantage is taken of the modern method of X-ray of any patient in cases of doubtful presentation or of suspected multiple pregnancy. In all 18 cases had an X-ray during the year. One hundred and fifty-two patients had some form of dental disease, caries, whether slight, moderate or severe, gingivitis and 30 pyorrhoea all being included under this heading. The patients were referred to their own dentists or to the dental clinic. For the purposes of this report every case having a systolic blood pressure of 140 or over is included under the term hyperpiesis. Four hundred and six pathological conditions were found altogether, details of which are given in Table III. TABLE III. Pathological Conditions Complications of Pregnancy— Number of Cases. Remarks. Albuminuria of pregnancy 41 Contracted pelvis 2 One admitted to Guy's Hospital. Glycosuria of pregnancy 1 Haemorrhage— Threatened miscarriage 1 Ante-partum 5 One admitted to Woodlands. One admitted to York Road Lying-in Hospital. Hyperpiesis 76 Malpresentations— Breech 28 Transverse 3 Thirteen corrected at centres. Ten underwent spontaneous version. Four referred to Guy's Hospital for version. Toxæmia of pregnancy 4 One admitted to Woodlands and two admitted to Queen Charlotte's Hospital; responded well to treatment. One admitted to Guy's Hospital; baby died 36 hours after birth, mother died suddenly on 10th day from pulmonary embolus. Varicose veins— Of legs 26 Of vulva 2 Carried forward 189 31  Number of Cases. Remarks. Brought forward 189 Gynæcological Conditions — Cystocele 4 Fibroids 1 Leucorrhœa 19 Papillomata of vulva 1 Vulval sores 1 Conditions unconnected with pregnancy— Anaemia 1 Bazin's disease 1 Cardiac conditions— Mitral stenosis 4 Systolic murmur 11 Reduplication of mitral second sound 15 Colitis 1 Admitted to Guy's Hospital. Dental 152 Diabetes 1 Epistaxis 1 Goitre 1 Laryngitis 1 Ophthalmic— Congenital macular degeneration of choroid 1 Detachment of retina 1 Total 406 Post-Natal Centre. On November 26, a Post-natal Clinic was opened at the Town Hall. Three patients attended the first session. Leaflets have been written which are given to the ante-natal patients, giving them information about this clinic and the purpose for which it is intended. Dental Clinic. The dental clinic is open to children under school age and to expectant and nursing mothers, the patients being referred either from the infant welfare or from the ante-natal centres. Two sessions are held each month. 32 The total number of patients referred during the year was 104. Of these 70 actually attended, the total attendances being 224, the average being 10. The work done at the clinic during the year is shown in the following table:— Inspections 81 Extractions under local anaesthesia 17 Extractions under gas or ethyl chloride 56 Fillings 18 Scaling 1 Impressions 11 Advice re dentures 40 Total attendance 224 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. It was with the greatest regret that the resignation of our consultant, Mr. G. P. Gibberd, was received, and I take this opportunity of thanking him for the unfailing interest he has taken in the cases referred to him from the ante-natal centres. Again I have to thank Mrs. E. S. Wray, Superintendent Health Visitor, and Miss G. M. Evans, Matron of Woodlands, for their invaluable help and loyal co-operation. My thanks are due also to the health visitors and nursing staff of Woodlands. Sister Powell, of Woodlands, has been greatly missed at the Maternity Home and at the ante-natal clinic, and I take the opportunity of expressing appreciation of the devoted and selfless care she gave to the mothers and babies, and of wishing her a speedy return to normal health. We have lost several of our voluntary workers during the past year, some of whom have left the district. Other new helpers have come forward to assist. To all of these I tender my sincere thanks for all their generous help at the centres. F. M. PARSONS, m.r.c.s., l.e.c.p. 33 SANITARY CIRCUMSTANCES OF THE AREA. WATER SUPPLY. A constant supply of water is supplied to the whole of the district by the mains of the Metropolitan Water Board. DRAINAGE AND SEWERAGE. A scheme is being prepared for the construction of a new sewer from Goat Road to the works. A scheme is also in preparation for sludge digestion from a portion of the sewage works serving a population of 67,000, and will be capable of extension to treat the sludge from the whole of the works. A further scheme for partial bio-aeration is being considered for the south side works. RIVERS AND STREAMS. Visits have been paid to all works suspected of discharging polluted effluent into the surface water sewers. On one occasion pollution was found and 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 four pail closets and three cesspools in use. 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 seven observations were kept on chimneys during the year. In connection therewith sixteen notices were served and the nuisances abated. 34 SWIMMING BATH. The water in the swimming bath is under a continuous process of filtration, chlorination and aeration. Bacteriological tests show that the water is very clean. During the summer season 109,546 persons used the swimming bath. Slipper baths are also provided, and unemployed persons are allowed free use of these baths. LEGAL PROCEEDINGS. In connection with the administration of the Public Health and other Acts the following legal proceedings were undertaken during 1935:— PARTICULARS. Result. Summons under Shops (Hours of Closing) Act. Ditto. Case dismissed. Pined 20s. 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. 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. 35 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 1935 by myself and Inspectors A. W. Lock, L. Gleed and P. D. O'Grady (resigned). Total number of visits paid 9870 Number of complaints received and investigated 419 Number of premises inspected 2785 Number of premises revisited 4636 Number of nuisances discovered 1272 Number of nuisances abated without report 1316 Number of nuisances abated after report 155 Number of intimatory notices served 1167 Number of statutory notices served 189 Notices followed by legal proceedings. Nil. Number of revisits to infected houses 183 Number of house drains tested 13 Number of drains found defective 2 Number of tests applied to new drainwork 6 Character of Work Done. Houses repaired and cleansed generally 544 Overcrowding cases abated 15 Roofs repaired 304 Damp walls remedied 20 Eaves, guttering and spouting renewed or repaired 169 Water closets renewed, repaired or cleaned 91 Water closet flushing cisterns and flush pipes renewed or repaired 56 Water cisterns cleansed or covered 21 Water supply to houses reinstated 2 Back yards paved or paving repaired 103 Floors repaired 142 Dustbins provided 513 Premises where animals improperly kept were removed or improved 2 36 Character of Work Done. Offensive accumulations removed 72 Urinals cleansed or repaired 3 Piggeries repaired or improved 8 Houses or parts disinfected and cleansed 349 Smoke nuisances abated 19 Houses at which drains were reconstructed or new provided 4 Drains repaired, cleansed, trapped or ventilated 206 House to house inspection has been carried out as time permitted, having regard to other duties to be performed; 2,566 houses were inspected, which number includes 434 under the provisions of the Housing Acts. Caravan yards, of which there are fourteen, were kept under close observation. Four were vacated during the year. The caravans number 55 and are occupied by 45 families, giving a total population of 172. Two families removed to dwelling houses and their caravans were voluntarily destroyed, but their sites were unfortunately occupied by other caravans. Three applications were received for certificates under the Rents Restriction Act; two were granted and one refused. One hundred and seven smoke observations of half-hour duration were kept on factory chimneys. Sixteen notices were served on owners of factories calling attention to breaches of the Council's byelaw which limits the emission of black smoke from a chimney to two minutes in the aggregate within any continuous period of thirty minutes. At least five factory owners have taken steps to obviate nuisances by either installing larger boilers or smoke preventing appliances. Disinfection and Disinfestation.— Disinfection has been carried out at 349 houses following removal of patients to the Wandle Valley Isolation Hospital or other institutions. Infected bedding was removed and treated by dry steam at the Wandle Valley disinfecting station. Two hundred and seventy-two bug infested rooms were fumigated or sprayed with insecticide, picture rails, mouldings and portions of flooring being removed in most instances to facilitate the extermination of the vermin. Notices were served on occupiers in 21 cases to carry out disinfestation. An invasion of cockroaches and crickets in a newly built-up road in Eastfields 37 caused a considerable amount of annoyance and anxiety to the residents of the houses during the summer. They were difficult to find in the daytime, but at night were very much in evidence. A liberal spraying with paraffin and creosote of the footpaths front and rear of the houses and heaps of loose material on ground in the vicinity, the laying of a specially prepared bait, and ultimately the making up of the road and footpaths at the front of the houses, effected abatement of the nuisance. All ponds, ditches or other places in the Borough where mosquito breeding was possible were sprayed with paraffin twice early in the year. Food Inspection.— Periodical inspections were made of butcher shops, fish shops and other places where food is sold. Seven hundred and seventy-nine such visits of inspection were made ; no unwholesome food was discovered. The Inspectors were called in to examine the following articles of food: rabbits, 9; codfish, 112 lbs.; haddocks, 28 lbs.; tomatoes, 14 lbs. All were found unfit for human food and, certified as such, was destroyed. Three hundred and ninety-seven visits were paid to the five registered or licensed slaughterhouses in the Borough, and on examination of the slaughtered animals the following amount of food was found to be diseased or unwholesome and unfit for human food and was surrendered for destruction: carcases of pigs, 5,274 lbs. (of which 2,582 lbs. was affected with tuberculosis, 228 lbs. septic poisoning, 381 lbs. jaundice, 360 lbs. peritonitis, 524 lbs. dropsy, 326 lbs. inflammation, 654 lbs. emaciated, 73 lbs. bruised, 87 lbs. swine fever); 59 pigs' livers, tuberculosis; 84 pigs' livers, cirrhosis; 286 pigs' lungs; 200 lbs. beef, dropsy; 36 lbs. beef, tuberculosis; one set of cow's lungs. Two breaches of the Pood Regulations were discovered (keeping fruit and vegetables in unwholesome places), and one breach of the Meat Regulations (improper storage of meat). In each of the cases the practice was immediately stopped. Petroleum (Consolidation) Act, 1928. Licences were granted to 91 persons in the Borough to store petroleum spirit and cellulose solutions, and two to store carbide of 38 calcium. The quantity licensed to be stored totalled 131,183 gallons, a considerable increase on the previous year, due to the operation of the Cellulose Solutions Regulations, 1934. The amount of carbide of calcium licensed to be stored was 12 cwt. Shops Acts. To assist me in carrying out the duties in connection with the administration of the Shops Act which came into force on December 31, 1934, Mr. L. R. Rummery was appointed as Inspector. A new register of shopkeepers was made and a card index file of trades and records of same has been compiled. Number of shops inspected 583 Number of shops revisited 376 Notices served Section 7, Shops Act, 1934, to keep records of hours worked by young persons, intervals for rest and meals 19 Notices served Section 10, Shops Act, 1934, to provide water closet accommodation for female assistants, and complied with 1 Notices served Shops Acts, 1912-34, to provide seats for female assistants, and complied with 2 Certificates granted exempting provision of sanitary conveniences in special cases 6 Cautions given in cases of breaches of the Shops (Hours of Closing) Aot, 1928 17 Ditto, Hairdressers and Barbers' Shop (Sunday Closing) Act, 1930 1 Prosecutions were instituted in two cases for offences under the Shops (Hours of Closing) Act. In the first case the defendant was fined 20s. The second case was dismissed. I am, Your obedient servant, CHARLES G. RABBETTS, Senior Sanitary Inspector. 39 HOUSING Inhabited Houses.— The number of inhabited houses in the borough on December 31, 1935, was 15,721, being an increase of 893 houses since the previous year, the average number of persons per house being 3.948 compared with 4.081 last year. The number of inhabited houses in each ward is as follows:— North Ward 3,158 Population 12,469 South 3,379 „ 13,341 East „ 6,236 „ 24,620 West „ 2,948 „ 11,640 Total 15,721 62,070 HOUSING ACT, 1930. During the year the following clearance orders were confirmed by the Minister of Health after holding a local inquiry :— Clearance Area No. 10. Two houses known as 13 and 15, Western Eoad. Clearance Area No. 10A Eight houses known as 17, 19, 21, 23, 25, 27 and 29, Western Road and 145, Love Lane. Clearance Area No. 11. Nine houses known as 31, 32, 33, 34, 35, 36, 37, 38 and 39, Commonside West. Clearance Area No. 11a. Four houses known as 41, 42, 44 and 46, Commonside West. Housing Statistics. 1. Inspection of Dwelling Houses during the Year:— (l) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 2566 (b) Number of inspections made for the purpose 3821 40 (2) (a) Number of dwelling houses (included under sub-head (l) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 204 (b) Number of inspections made for the purpose 230 (3) Number of d welling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 130 (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 176 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" 162 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 12 (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 9 (work still in hand) B. Proceedings under Public Health Acts:- (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 762 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 60 (6) By local authority in default of owners Nil 41 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 8 (2) Number of dwelling houses demolished in suance of demolition orders 8 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 42 INSPECTION AND SUPERVISION OF FOOD. FOOD AND DRUGS (ADULTERATION) ACT, 1928. The duties under the Food and Drugs (Adulteraton) Act, 1928, are carried out by the Surrey County Council. The following number of samples has been taken during the year from this district:— Articles. Analysed Adulterated or Deteriorated Prosecutions Convictions formal Informal Total Forma] Informal Total Milk 50 4 54 Cream 3 3 Lard 1 1 Meat 9 9 Drug 2 7 9 1 1 2 1 Other Articles 6 1 7 1 1 Totals 71 12 83 2 1 3 1 'Details of Other Articles— Vinegar 3 3 1 1 Sultanas 2 2 Raisins 1 1 Pat mixture 1 1 Totals 6 1 7 1 1 SLAUGHTER HOUSES. There are five slaughter houses, of which two are registered and three are licensed. During the year 397 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. Ninety-eight visits have been paid, and one statutory notice served to limewash bakehouse. DAIRIES AND COWSHEDS. There are 33 registered premises within the district, of which 32 are dairies and one cowshed. 43 During the year 153 visits of inspection were paid and one notice served to cleanse premises. 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.) 7 Grade A. 1 Grade A. Pasteurised 1 Certified 4 Pasteurised 6 Pasteurising plant 1 SAMPLING OF MILK. In addition to the number of samples of milk taken for examination by the Food and Drugs Inspectors of the Surrey County Council, 14 samples were taken by the District Sanitary Inspectors. The results were as follows:— Date. Dairy. Grade. Bacteria. per C.C. Chemical Examination. 26- 4-35 M.D. Ungraded 7,950 Water 87%, fat 4%, solids not fat 9%. 17- 9-35 s.c. (Carton) „ 55,000 Water 87.6%, fat 3.7%, solids not fat 8.7%. 20- 4-35 R.A. Pasteurised 1,610 — 21- 6-35 „ „ 13,370 Water 87.85%, fat 3.4%, solids not fat 8.75%. 9- 7-35 „ „ 68,150 — 16-10-35 „ „ 11,560 — 9- 7-35 E.D. „ 10,127 — 9- 7-35 H.R. Grade A. T.T. 4,580 — 9- 7-35 U.D. Pasteurised 5,947 — 16-10-35 D.D. Ungraded 48,530 — 16-10-35 B.D. (Carton) „ 5,260 — 16-10-35 s.s. Pasteurised 11,570 — 16-10-35 H.B. Ungraded 481,000 — 16-10-35 W.J.H. „ 3,850 — 44 PIGGERIES. There are 13 piggeries in the district. One hundred and seventyfour visits were paid. Four large piggeries were demolished during the year. OTHER FOOD PREPARING PLACES. There are four other premises in which food is prepared for human consumption. All of these have been systematically visited. 45 FACTORIES AND WORKSHOPS. There are 168 factories and workshops in the district, of which 101 are factories and 67 are workshops. In addition there are 15 workplaces. During the year 445 visits of inspection were paid. Outworkers. There are 110 outworkers in Mitcham. One hundred and ninety-six visits of inspection were paid, and, in connection with these, two sanitary notices were served. During the year two 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 51 Onion peeling 10 Making of wearing apparel 37 Tailoring 2 Surplices. 1 Embroidery 3 Furrier 1 Artificial flowers 1 Boots 2 Brace maker 1 Hairnets and combs 1 110 46 Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 282 16 Nil Workshops (Including Workshop Laundries) 153 6 Nil Workplaces (Other than Outworkers' premises) 10 1 Nil Total 445 23 Nil 47 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 12 12 Want of ventilation Overcrowding Want of drainage of floors... Other nuisances ... 15 15 Sanitary accommodation insufficient 3 3 unsuitable or defective 11 11 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 41 41 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. 48 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 Onion peeling 2 2* Total 2 2 Nil * Verbal notices. 49 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. INFECTIOUS DISEASE NOTIFICATIONS. The total number of certificates of notification received during the year was 293, as compared with 560 last year. Contacts, Suspects, Etc. On 21 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 430 visits to cases of infectious disease ; 247 were primary visits and 183 revisits. The monthly incidence of infectious disease was:— Small Pox. Scarlet Fever Diphtheria Enteric Fever Erysipelas Pneumonia Puerperal Fever Puerperal Pyrexia Ophthalmia Neonatorum Dysentery Cerebro-Spinal Fever Totals January ... 13 16 ... 2 4 ... ... ... ... ... 35 February ... 12 14 1 3 6 ... 1 1 ... ... 38 March ... 18 5 ... ... 3 ... 1 ... ... ... 27 April ... 8 9 1 2 9 1 ... ... ... ... 30 May ... 5 5 ... 3 4 ... 1 ... ... ... 18 June ... 10 4 ... 2 2 ... 1 ... ... 1 20 July ... 9 1 ... ... ... ... ... 1 ... ... 11 August ... 8 7 ... 2 1 ... ... 1 ... ... 19 September ... 9 1 1 1 1 ... ... ... ... ... 13 October ... 19 2 ... 2 2 1 ... 1 ... ... 27 November ... 14 11 ... 3 2 ... ... ... ... ... 30 December ... 18 5 ... ... 1 ... ... ... 1 25 Total ... 143 80 3 20 35 2 4 4 1 1 293 50 Disease. Case rates per 1,000 of population. Case rates per 1,000 Ward population. England & Wales. Mitcham. North. South. East. West. Small Pox 0.00 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 2.96 2.3 1.8 1.5 2.9 2.3 Diphtheria 1.60 1.2 2.3 1.4 0.9 0.8 Enteric Fever 0.04 0.04 0.1 0.1 0.00 0.00 Erysipelas 0.42 0.3 0.4 0.2 0.3 0.1 Pneumonia 1.15 0.5 Disease. Case rates per 1,000 total births. England and Wales. Mitcham. Puerperal Fever 3.60 2.0 Puerperal Pyrexia 9.44 4.1 51 Cases of Infectious Disease Notified During the Year 1935. 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 tinder 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 143 ... 5 11 9 12 75 20 2 6 1 2 ... 23 72 21 27 132 1 Diphtheria 80 ... 3 10 4 5 40 8 2 4 2 2 ... 29 22 20 9 80 2 Typhoid Fever 3 ... ... ... ... ... 1 ... ... ... 1 1 ... 2 ... 1 ... 3 ... Erysipelas 20 1 ... ... ... 1 ... ... ... 7 3 6 2 6 9 3 2 6 Pneumonia 35 2 ... 1 1 ... 4 ... 1 7 4 6 6 3 16 7 9 12 35* Puerperal Fever 2 ... ... ... ... ... ... ... ... 2 ... ... ... 1 ... 1 ... 2 Puerperal Pyrexia 4 ... ... ... ... ... ... ... 1 2 1 ... ... ... 1 2 1 4 ... Ophthalmia Neonatorum 4 4 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 2 4 ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 ... Dysentery 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... Totals 293 7 8 22 14 18 121 33 6 28 12 17 7 67 120 55 51 244 38 * Includes all forms, many of which are not notifiable. 52 Infectious Disease Notifications, 1922-35. Disease. 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 Small Pox ... ... ... ... ... ... 9 7 ... 4 1 ... ... ... Scarlet Fever 178 110 87 106 104 145 102 134 113 105 174 240 392 143 Diphtheria 84 35 59 201 87 76 75 133 129 49 32 40 83 80 Typhoid Fever 1 2 1 4 2 6 3 4 9 2 3 3 3 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 3 2 1 5 6 9 4 6 1 7 5 1 1 2 Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Meningitis 1 ... 6 ... ... 2 1 4 ... ... 1 4 1 1 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 13 15 11 10 13 14 10 22 22 17 11 31 30 20 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Diarrhœa ... ... ... ... ... ... ... ... ... ... ... ... ... 1 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 4 Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... 2 2 ... ... ... 2 1 1 1 ... ... Pneumonia 30 19 39 42 30 62 54 57 35 45 52 37 45 35 Malaria 8 3 ... 1 1 ... ... ... ... ... ... ... ... ... Puerperal Pyrexia ... ... ... ... 1 14 9 5 6 9 4 9 6 4 Totals 347 287 246 376 259 340 270 375 319 242 288 368 560 293 School Notifications. The school intimation notices of infectious disease are always compared with the notifications received from the medical practitioners. If any case on the school return is found to be unnotified, investigations are made in order to find out if the patient is receiving medical attention. 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 143, this being 249 less than last year. One hundred and thirty-two cases were removed to hospital. One death was registered from this disease during the year. 53 Most 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. The majority of the cases were of a very mild type, so much so, in fact, that many cases were missed owing to the transient nature of the rash and the mildness of the attack. These missed cases accounted for quite a number of secondary cases occurring in the same household. Diphtheria. Eighty cases of diphtheria were notified during the year. Eighty cases were removed to hospital. Two 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. Diphtheria Immunisation. A diphtheria immunisation clinic is held at the Town Hall every fortnight. During the year 126 children have been immunised. Diphtheria prophylactic is also given to the medical practitioners in the district free of charge, and during the year 22 persons were immunised by their own doctors. Typhoid Fever. Three cases of typhoid fever were notified during the year. All cases were due to infection paratyphosus B. infection. In no case could the source of the infection be found. There were no deaths from this disease during the year. Diarrhoea and Enteritis under Two Years of Age. Two deaths were registered during the year; both were males. Encephalitis Lethargica. No case was notified during the year. 54 Cerebro-Spinal Fever. One case was notified during the year, and the patient recovered. Influenza. During the year four deaths from influenza were recorded. Three were males and one was a female. The previous year seven 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 four cases of ophthalmia neonatorum were notified:— Cases Treated Vision Vision Total Notified. At Home. In Hospital. unimpaired. impaired. blindness. Deaths. 4 1 3 4 — — — Cancer, The number of deaths from cancer registered during the year was 68, of which 34 were males and 34 were females, as compared with 70 deaths last year. Cancer is mainly a disease of the digestive system, with the exception of its preference for the generative system in females. The site distribution for 1935 was as follows:— Digestive organs 33 cases Genito-urinary organs 9 „ Breast 5 „ Respiratory system 14 „ Other sites 7 „ Total 68 Arrangements have been made with the Radium Institute, Portland Place, for the radium treatment of cases of cancer under the care of this Council. 55 The following table shows the number of deaths from cancer, together with the death rate as compared with England and Wales:— Number of Death Rate per 1,000 of Population. Year. Deaths. 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 1935 68 1.0 1.58 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 87 new cases of tuberculosis were notified, viz.:— Males. Females. Total. Pulmonary 41 30 71 Non-Pulmonary 8 8 16 Total 49 38 87 56 The total number of deaths registered as occurring from tuberculosis was, viz.:— Males. Females. Total. Pulmonary 15 20 35 Non-Pulmonary 3 3 6 Total 18 23 41 England & Wales. Mitcham. Death rate from respiratory tuberculosis per 1,000 population 0.60 0.56 Death rate from non-respiratory tuberculosis per 1,000 population 0.11 0.09 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 1 ... ... 1 1 1 year to 5 years ... ... 1 ... ... ... 1 1 5 years „ 10 „ ... 1 2 1 ... ... ... ... 10 „ „ 15 „ ... ... ... 1 ... ... ... ... 15 „ „ 20 5 4 1 1 8 13 ... ... 20 „ „ 35 „ 19 18 2 1 1 2 ... 1 35 „ „ 45 „ 7 1 ... 2 4 4 1 ... 45 „ „ 65 10 4 1 1 ... ... ... ... 65 „ and upwards ... 1 ... ... 2 1 ... ... Totals 41 30 8 8 15 20 3 3 57 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 ... ... ... ... ... ... ... ... ... ... 1 1 Pulmonary: females 1 ... ... ... ... ... 1 ... 3 ... ... 5 Non-Pulmonary: males 1 1 ... ... ... ... ... ... ... ... ... 2 Non-Pulmonary: females 1 ... ... ... ... ... ... ... 1 ... ... 2 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 1 1 (b) Transferable deaths from Registrar General 5 2 Posthumous notifications ... 1 Number of cases removed from register during 1935:— Reason. Pulmonary. Non- Pulmonary. Total Cases. Males Females Total Males Females Total Withdrawal of notification 1 1 2 ... ... … 2 Recovery from disease ... ... ... ... ... ... ... Death 17 23 40 2 3 5 45 58 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths is as follows:— Non-notified tuberculosis deaths 10 Notified tuberculosis deaths 31 Percentage of non-notified T.B. deaths (all forms) 24 per cent. Percentage of non-notified pulmonary T.B. deaths 14 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 163 such examinations have been made. Report Presented to Public Health Committee on Home Conditions of Tuberculosis Patients. To the Chairman and Members of the Public Health Committee. Ladies and Gentlemen, Acting on your instructions given to me at the last Committee meeting I have prepared the following report on the home conditions of patients suffering from tuberculosis who are living in this Borough. The number of cases on the register at the end of the last September quarter is set out below, together with the number for the corresponding quarter in 1934. Number of cases on register at quarter ending September 30, 1935:— Males. Females. Total. Pulmonary 193 203 396 Non-Pulmonary 78 68 146 Number of cases on register at quarter ending September 30, 1934:— Males. Females. Total. Pulmonary 194 185 379 Non-Pulmonary 76 64 140 59 I have examined the home visit returns for this year and have abstracted the following information:— There are 155 tuberculosis patients sharing bedrooms with other persons, and 114 of these patients sleep in a bed with another person. In 56 instances arrangements could be made, and have been suggested to the patients, whereby by some arrangement of the home they could have a separate bedroom, or at least a separate bed. In some cases this rearrangement has been made, in other cases it has been difficult to convince the patient that it is necessary to do so, and in four cases the patients have definitely refused to make any such arrangement. From these facts it will be seen that there are some 100 patients who are living in conditions where they cannot have a separate sleeping room. There are a number of examples in Mitcham where several members of a family have become infected with tuberculosis, and I believe that in some instances this has been due to the fact that the tuberculosis patient has infected the healthy person sharing his bedroom or bed. During the day time, if proper precautions are taken, there is little fear of infection, but the chances of infection are greatly increased if a healthy person sleeps in the same bed with an infected person. Where a husband or wife is the infected person it is very difficult in some cases to persuade them to sleep apart, and as mentioned before, four persons have definitely refused to do so. Whilst I agree with the theory that it would be a good plan to have special houses or flats for this type of person, I am bound to admit that any suggestion of segregation in any form will have an adverse effect. Even if such a scheme were made, I believe that in a number of cases patients would still share a bedroom. Under the Public Health (Tuberculosis) Regulation, 1930, all notifications of persons suffering from tuberculosis must be confidential; therefore no scheme should be put into operation which immediately marks out a person or family as suffering from tuberculosis. In my opinion, I think it would be a better plan to ask the Housing Committee to give special consideration to applications from families in which there is a tuberculous patient, and also to 60 give priority to tuberculous families when dealing with the abatement of overcrowding under the Housing Act, 1935; and perhaps it could be made a condition of the tenancy that the tuberculous person should sleep in a separate room, although I believe it would be impossible to be absolutely sure that this was being done. Nevertheless, this condition might have a moral effect, and be of some educational value. In any case a patient suffering from tuberculosis should have the opportunity of sleeping in a separate room. Your3 obediently, A. T. TILL, Medical Officer of Health. The Housing Committee agreed to accept the suggestions made in the report. Chicken Pox. Sixty-four cases of chicken pox were notified by the head teachers of the schools in the district. Whooping Cough. One hundred and two cases of whooping cough were notified during the year by the head teachers of schools in this district. Measles. Twenty-two cases of measles were notified during the year by the head teachers of schools in the district. No death from measles was registered during the year. Mumps. Two hundred and thirty-three cases of mumps were notified by the head teachers during the year, The majority of the cases were of a very mild character, and minor cases probably account for the large number of children infected. Pneumonia. Thirty-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 35; this includes all forms of pneumonia, both primary and secondary. 61 Erysipelas. Twenty cases of erysipelas were notified, and six cases were removed to hospital. There was no death from this cause. Puerperal Fever. Two cases of puerperal fever were notified; there were no deaths. Puerperal Pyrexia. Four cases of puerperal pyrexia were notified and no death was recorded from this cause. 62 WANDLE VALLEY JOINT HOSPITAL BOARD. Cases admitted to hospital during the year ended December 3i, 1935. Disease Beddington & Wallington Coulsdon & Purley Merton & Morden Mitcham Cases Deaths Cases Deaths Cases Deaths Cases Deaths Diphtheria 18 ... 52 2 47 5 82 2 Scarlet Fever 83 ... 78 ... 134 ... 130 1‡ Typhoid ... ... ... ... 5 1† 2 ... Erysipelas 3 ... 2 ... 1 ... 7 1§ Other Diseases Measles ... ... 2 ... ... ... ... ... Rubella ... ... ... ... 3 ... 1 ... Influenza ... ... ... ... ... ... 1 ... Tonsilitis 8 1 5 ... 13 ... 11 1 Pneumonia 1 ... 1 ... ... ... ... ... Tubercular Meningitis ... ... ... ... ... ... 1 l Whooping Cough and Pneumonia ... ... ... ... 2 l 2 ... Bronchitis 1 ... ... ... ... ... ... ... Rhinitis ... ... ... ... ... ... 1 ... No disease ... ... ... ... 1 ... ... ... Babies (no disease) admitted with mother ... ... ... ... 1 ... ... ... Septicaemia 1 ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... 1 1¶ C.S.M ... ... ... ... ... ... 2 l Nephritis ... ... ... ... 1 ... ... ... Rheumatism ... ... 1 ... ... ... ... ... Septic Bursitis ... ... ... ... ... ... 1 ... Pemphigus ... ... ... ... ... ... 1 ... Enteritis ... ... 1 ... ... ... ... ... Malta Fever ... ... 1 ... ... ... ... ... Otitis Media ... ... ... ... ... ... 1 ... 116 1 143 2 209 7 244 8 * Tonsilitis with chronic bronchitis. † Typhoid with broncho pneumonia. ‡ Scarlet fever and enteritis. § Erysipelas with cerebral embolus. || Streptococcal septicaemia. ¶ Cerebral tumour. 63 INDEX Page Ambulances 15 Analysis of Mortality 14 Ante-Natal Clinics 17 Area 7 Bakehouses 42 Birth Rates 10,14 Births, Live 8 — Illegitimate 8 — Still 9 Blindness,.Prevention of. 54 Cancer 54 — Deaths from 55 Causes of Deaths 13 Cerebro-Spinal Fever 54 Chicken Pox 60 Clearance Areas 39 Clinics, Ante-natal 17 — Dental 19 — Orthopaedic 19 — Post-natal 18 — Welfare 1.6 Closet accommodation 33 Dairies and Cowsheds 42 Death Rates 10,14 Deaths 8,9,13 Dental Clinic 19 — — Report on 24 Diarrhoea and Enteritis 53 Diphtheria 53 — Immunisation 53 Disinfection and Disinfestation 36 Drainage and Sewerage 33 Encephalitis Lethargica 54 Erysipelas 61 64 PAGE. Factories and Workshops 45 — — — Defects in 47 — — — Inspection of 46 Food and Drugs Act (1928) 42 — Inspection and Supervision of 37,42 Food Preparing Places 44 General Provision of Health Services for the Area 15 Health Visiting 16 — Visitors, Visits by 23 Home Helps 18 Hospitals 15 Houses, Inspection of 39 — Inhabited 39 Housing 39 — Act (1930) 39 — Statistics 39 Infantile Mortality 8, 10, 11 Infant Life Protection 20 Infectious Disease, Cases Notified 51 — — Incidence of 49 — — Prevalence of and Control over 49 — — Notifications 49,52 — — — School 52 Influenza 54 Inhabited Houses 7,39 Inquests 12 Inspection and Supervision of Food 37,42 Laboratory Facilities 15 Legal Proceedings 34 Maternal Mortality 11, 14 Maternity and Child Welfare Centres 16 — — — — — Report on 24 — Home 20 Measles 60 Midwives 16 Milk (Special Designation) Order (1923) 43 — Sampling of 43 Mortality, Analysis of 14 65 PAGE. Mortality, Infant 8,10,11 — Maternal 11,14 Mumps 60 Nursing in the Home 16 Ophthalmia Neonatorum 54 Outworkers 45,48 Parsons, Dr. F. M., Report 24 Patients Admitted to Hospital 62 Personnel, Committees 4,5 — Staff 6 Petroleum Act (1928) 37 Piggeries 44 Pneumonia 60 Population 7 Prevention of Blindness 54 Public Cleansing 33 Puerperal Fever 61 — Pyrexia 61 Rateable Value 7 Rivers and Streams 33 Sanitary Circumstances of the Area 33 — Inspector's Report 35 Senile Deaths 9 Scarlet Fever 52 Schools 34 Sewerage 33 Shops Acts 38 Slaughterhouses 42 Small Pox 52 Smoke Abatement 33 Social Conditions 7 Statistics 7 — Housing 39 — Vital 8 Still Births 9 Swimming Bath 34 Tuberculosis 55 — Report to Public Health Committee 58 66 PAGE. Typhoid Fever 53 Vital Statistics 8 X-Ray Examinations 19 Wandle Valley Hospital 62 Water Supply 33 Welfare Clinics 16 — — Attendance at 22 Whooping Cough 60 Woodlands Maternity Home 20