BOROUGH OF MITCHAM REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1936 BOROUGH OF MITCHAM REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1936 Mitcham: H. G. Mather, Caxton Works, Lower Green Borough of Mitcham HEALTH REPORT FOR 1936 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, 1936. The birth rate is slightly lower than last year, namely, 15.4 per 1000, whilst the death rate shows a rise to 9.1 per 1000. The infant mortality rate again shows a decrease. The housing problem has received great attention during the year, and it is satisfactory to note that the number of persons per house is less than the previous year, an indication of less overcrowding. I wish to 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. I should also like to express my appreciation of the excellent services rendered to the Borough by Mr. C. G. Rabbetts, the late Chief Sanitary Inspector, who retired in September. His thorough knowledge of the district and his helpful co-operation have been of great assistance to me in particular and to the Borough in general. To the members of my staff I would once again express my thanks for their loyal assistance and co-operation. I am, Ladies and Gentlemen, Yours obediently, A. T. TILL, Medical Officer of Health. Public Health Department, Town Hall, Mitcham, Borough of Mitcham. 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. Bingham 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. B. 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 VALLEY JOINT HOSPITAL BOARD. Councillor J. M. Davies, J.P. Alderman J. Fitch, J.P. Councillors Mrs. E. Watson, J. S. Abraham REPRESENTATIVES ON WANDLE VALLEY 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. Florence M. Parsons, M.R.C.S., L.R.C.P. Consulting Gynaecologist. J. V. O'Sullivan, Esq., M.D., 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, (until September, 1936). K. S. Gutteridge, Cert. S.I.B. (from September, 1936). Assistant Sanitary and Meat Inspectors. A. W. Lock, Cert. S.I.B. L. Gleed, Cert. S.I.B. 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 (until June, 1936) (2, 3, 8) Miss P. M. Leigh (1, 2, 3) (from June, 1936) 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. 8. Sick Children's Registered Nurse. Clerks. J. B. A. Roodhouse. A. H. Riley, M.I.H. 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 1936 64,401 Number of inhabited houses, 1921 7,150 1931 13,187 „ 1936 16,551 Rateable value on December 31, 1936 £445,815 Sum represented by a 1d. rate £1,765 STATISTICS. Live Births. Total. Male. Female. Rate per 1,000 of population. Legitimate 976 528 448 Illegitimate 22 12 10 Total 998 540 458 15.4 Total. Male. Female. Rate per 1,000 total births. Still Births. Legitimate 35 20 15 Illegitimate — — — Total 35 20 15 35.2 7 Rate per 1,000 Total. Male. Female. of population. Deaths. 588 307 281 9.1 Deaths from disease and accidents of pregnancy and childbirth:— Rate per 1,000 total births. From puerperal sepsis 1 1.0 From other causes 3 3.0 Total 4 4.0 Deaths of infants under one year of age:— All infants per 1,000 live births 48.0 Legitimate infants per 1,000 legitimate live births 48.1 Illegitimate „ „ illegitimate „ 00.0 Deaths from:— Measles (all ages) 5 Whooping cough (all ages) 3 Diarrhoea (under two years of age) 2 VITAL STATISTICS. During the year 998 live births were registered as belonging to this district, of which 458 were females and 540 were males, as compared with 969 last year. The live birth rate for the year was equal to 15.4 per 1,000 of population, as against 15.6 per 1,000 last year, the crude birth rate being 16.0 per 1000. The birth rate for England and Wales was 14.8 per 1000, as against 14.7 per 1,000 last year. Illegitimate Births. The number of births registered as being illegitimate was 22, as compared with 21 last year. The illegitimate rate was equal to 3.0 per cent. of the total births, as against 2.1 per cent. in 1935. 8 Still Births. The number of still births registered was 35, of which 20 were males and 15 females ; none 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 1936 1033 497 48.1 Number of births notified by midwives in 1936 742 „ „ „ doctors and others in 1936 291 Deaths. During the year 588 deaths were registered, of which 307 were males and 281 were females, as compared with 485 deaths last year. The death rate for the year was equal to 9.1 per 1000 of the population, as compared with 7.7 per 1,000 in 1935. The death rate for England and Wales was 12.1 per 1,000 for the year 1936 and 11.8 per 1,000 for 1935. Senile Deaths. The number of deaths of persons of 65 years of age and over was 262, of which 120 were males and 142 females. This constitutes 44.5 per cent. of the total deaths, as compared with 42.6 per cent. last year. 9 The birth rates, death rates per 1,000 of population, and the infantile mortality rates for the years 1915-1936 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 1936 15.4 14.8 9.1 12.1 48.0 59 10 Infant Mortality. During the year 48 deaths were registered as occurring in infants under one year of age:— Males. Females. Total. Legitimate 31 17 48 Illegitimate — — — Total 31 17 48 as compared with 48 deaths last year. The infantile mortality rate for the year is equal to 48 per 1,000 live births, as against 49.5 per 1,000 last year. The infant mortality rate for England and Wales was 59 per 1,000 for 1936 and 57 per 1,000 for 1935. Maternal Mortality. During the year four deaths were registered as being due to diseases or accidents of pregnancy, compared with three deaths last year. The following is a summary of the causes of death:— One was due to pneumococcal septicaemia. One was due to ruptured uterus following impacted breech. Two were due to toxaemias of pregnancy. All the cases were treated in hospital. 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. Inquests. Inquests were held on 43 residents dying within the district and on 15 Mitcham residents who died outside the district, a total of 58. The following table shows the results of the findings of these inquests:— 11 Inquests. Number. Deaths from natural causes 32 Deaths from accidents:— Knocked down by motor vehicles 4 Knocked down by tram car 1 Asphyxia 2 Pall from bicycle 2 Other falls 1 Electrocution 1 Lightning stroke 1 Caught in machinery 1 Drowning 1 Burns 3 Death from misadventure 1 Deaths from manslaughter 2 Pound drowned 1 Overlaying 1 Deaths from suicide:— Hanging 1 Coal gas poisoning 3 Total 58 In addition the coroner ordered eight post mortems without inquest. 12 Deaths Registered during the Year, 1936. Cause of Death. Males. Females. Total. Typhoid and paratyphoid ... 1 1 Measles 2 3 5 Scarlet Fever ... ... ... Whooping Cough 1 2 3 Diphtheria 2 2 4 Influenza 4 4 8 Encephalitis lethargica ... ... ... Cerebro-spinal Fever 1 ... 1 Tuberculosis of the Respiratory System 20 18 38 Other Tuberculous Diseases 4 2 6 Syphilis ... ... ... General Paralysis of the insane, tabes dorsalis 1 ... 1 Cancer, malignant disease 38 42 80 Diabetes 6 4 10 Cerebral H‘morrhage 13 16 29 Heart Disease 57 69 126 Aneurism 1 1 2 Other Circulatory Diseases 12 12 24 Bronchitis 10 11 21 Pneumonia (all forms) 27 10 37 Other Respiratory Diseases 1 ... 1 Peptic Ulcer 5 1 6 Diarrhoea, &c. (under two years) 1 1 2 Appendicitis 5 4 9 Cirrhosis of the Liver ... 1 1 Other Diseases of the Liver, etc ... 1 1 Other Digestive Diseases 11 10 21 Acute and Chronic Nephritis 6 3 9 Puerperal sepsis ... 1 1 Other Puerperal causes ... 3 3 Congenital Debility, Premature Birth, Malformations, etc 12 11 23 Senility 12 18 30 Suicide 3 1 4 Other Violence 17 7 24 Other defined Diseases 35 22 57 Causes ill-defined or unknown ... ... ... Total 307 281 588 Special Causes:— Small Pox ... ... ... Poliomyelitis ... ... ... Polio-encephalitis ... ... ... 13 Birth-rates, Death-rates, Analysis of Mortality, Maternal Death-rates, and Case-rates for certain Infectious Diseases in the year 1936. England and Wales, London, 122 Great Towns and 143 Smaller Towns. (Provisional figures based on weekly and quarterly returns.) England and Wales. 122 County Boroughs and Great Towns including London. 143 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 census). London Administrative County. Mitcham Rates per 1,000 population. Births— Live 14.8 14.9 16.0 13.6 15.4 Still 0.61 0.67 0.64 0.53 0.54 Deaths— All causes 12.1 12.3 11.5 12.5 9.1 Typhoid and Paratyphoid fevers 0.01 0.01 0.00 0.01 0.01 Smallpox — — — — — Measles 0.07 0.09 0.04 0.14 0.07 Scarlet fever 0.01 0.01 0.01 0.01 — Whooping cough 0 05 0.06 0.04 0.06 0.04 Diphtheria 0.07 0.08 0.05 0.05 0.06 Influenza 0.14 0.14 0.15 0.14 0.12 Violence 0.52 0.45 0.39 0.52 0.43 Notifications— Smallpox 0.00 0.00 — — — Scarlet fever 2.53 2.18 2.48 2.57 2.6 Diphtheria 1.39 1.31 1.26 1.69 1.61 Enteric fever 0.06 0.05 0.06 0.06 0.07 Erysipelas 0.40 0.38 0.35 0.44 0.33 Pneumonia 1.11 1.10 0 96 0.99 0.55 Rates per 1,000 live births. Deaths under one year of age 59 63 55 66 48 Deaths from diarrhoea and enteritis under two years of age 5.9 8.2 3.4 14.4 2.0 Maternal mortality— Puerperal sepsis 1.40 Not available 1.0 Others 2.41 3.0 Total 3.81 4.0 Rates per 1,000 total births (i.e., live and still). Maternal mortality— Puerperal sepsis 1.34 Not available 0.9 Others 2.31 2.9 Total 3.65 3.8 Notifications— Puerperal fever 3.27 3.46 2.80 3.03 1.9 Puerperal pyrexia 9.64 9.52 7.57 11.15 10.0 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 519 Sputa for tubercle 171 Total 690 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 the 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 Charlotte's 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 cases. This ambulance is under the control of the fire brigade superintendent. The total number of cases removed during the year was 939, of which 445 were accident cases. 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. 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 four nursing associations in the borough. The following are the returns from each association for year ended December 31,1936:— No. of Nurses. No. of patients visited during 1936. No. of visits paid during 1936. St. Barnabas 1 134 2,156 South and East Wards 3 446 8,604 Christchurch 1* 212 3,736 Furzedown and Links 59 791 Totals 5 881 15,287 * These two nursing associations share one nurse between them. 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. 16 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 Hail, 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 Room, Lower Green.—Sessions are held on the second and fourth Thursdays of each month. Dr. Parsons attends both sessions. Sherivood House.—Sessions are held on the first and third Thursday afternoons of each month, and the second and fourth Thursday mornings of each month. Dr. Parsons attends all 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 67, the number of mothers attending being 32. 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 2,073, the number of mothers attending being 314. Meopham Road.—Sessions are held on the second Tuesday of each month. The total attendances of expectant mothers was 108, the number of mothers attending being 55. Town Hall.—Sessions are held on the third Tuesday of each month. The total attendances at this clinic was 158, the number of mothers attending being 67. 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 pf 1s, During the year 35 forms were received from midwives, 17 Forty-seven per cent. of the mothers of children born during the year attended the ante-natal clinics (including Woodlands Maternity Home clinic), as compared with 45 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. Seventy-six mothers attended this clinic during the year. 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 Home Help scheme, details of which were given in my last annual report. During the year 13 mothers availed themselves of this scheme. Sunlight Treatment. Arrangements have been made with the Wilson Hospital for giving sunlight treatment at a cost of 2s. per treatment per patient. No patients were sent during the year. 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 20 cases were referred to this clinic, as compared with 20 cases in 1935. Dental Clinic. 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 37 Fillings 22 Impressions taken 13 Inspections 71 Advice given re dentures, etc. 50 Total attendances 210 Number of new cases during 1936, 64. 18 X-Ray Examinations. Arrangements have been made with the Wilson Hospital, Mitcham, for the X-ray examination of women attending the ante-natal clinic. 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 23 women attended for this examination, as compared with 18 last year. 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 31,1936 38 Number of children on register, December 31, 1936 43 Number of children who have died during the year nil. Number of children on whom inquests were held nil. Number of registrations withdrawn 1 Number of prosecutions nil. Number of visits paid by the Infant Life Protection Visitor 332 National Society for Prevention of Cruelty to Children. This Society does very valuable work in the Borough, and there is very close co-operation between the officials of the Public Health Department and the officers of the Society. 19 During the year the Society dealt with 17 cases as follows:— Neglect 14 111 treatment 1 Other wrongs 2 Total 17 These cases affected the welfare of 45 children, and 84 visits were made by the Society's Inspector in connection therewith. Thirteen of the cases had a satisfactory conclusion and four still remain under supervision. Six cases were reported by members of the general public, and eight cases by officials. I should like to take this opportunity of thanking the Inspector for the very prompt, efficient and tactful way he deals with the cases. Several cases of neglect were due to children being left alone in the house whilst the parents went to the cinema. Many parents do not realise what serious harm can be done to a child by this method of neglect. 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 puDil 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. Homb. The Home can accommodate 15 patients at a time, but bookings are limited to 26 patients per month. The following table shows the number of births which have occurred in each year since the opening of the Home:— 20  No. of Births. 1924 (August to December) 42 1925 129 1926 240 1927 (10 months) 177 1928 265 1929 298 1930 318 1931 259 1932 239 1933 285 1934 285 1935 299 1936 314 Number of maternity beds in the institution (exclusive of isolation and labour beds), 15. Number of maternity cases admitted during the year, 314. Average duration of stay, 14 days. Number of cases delivered by—(a) midwife, 278; (b) doctors, 36. Number of cases in which medical assistance was sought by a midwife in emergency, 76 (41 abnormal conditions, 35 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, 2. Number of cases notified as ophthalmia neonatorum, nil. Number of maternal deaths, nil. Number of infants' deaths—(i.) stillborn, 7, (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. 21 Baby Week. A successful Baby Week was held during the month of July. Baby competitions were held at the various centres. A Garden Party was held and the prizes presented to the winning babies by the Mayoress. The opportunity was also taken for the distribution of health propaganda, leaflets, etc. 22 Report of the Infant Welfare and ante-Natal Centres, 1936. 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, four sessions monthly Town Hall Woodlands Total Number of new cases registered during year of— Children under one year of age 92 176 137 163 88 56 — — 712 Children over one year and under five years of age 58 23 47 33 21 35 - - 217 Number of children in attendance at end of year— Under one year of age 77 139 108 124 79 51 - — 578 Over one and under five years of age 143 167 209 229 111 141 - — 1000 Total attendances of children under one year of age 619 1671 1512 1837 858 885 - - 7382 Total attendances of children over one year of age 455 577 753 1021 325 602 - - 3733 "Total attendances at centres 1074 2218 2265 2858 1183 1487 - — 11115 Average attendances at centres 49 55 55 65 56 40 - — 53 Percentage of infants under one year of age attending centres of total notified births - - - - - - - - 73% Total attendances of expectant mothers - 67 108 - - - 158 2073 2406 Average attendances of expectant mothers - 6 10 - - - 14 39 17 Number of expectant mothers who attended during year - 32 55 - - - 67 314 468 Percentage of total notified births represented by the number of expectant mothers attending all clinics - - - - - - - - 47% 23 Visits paid by Health Visitors, 1936. Mrs. Wray Miss Russell Harris Miss Bowen (until June, 1936) Mrs. Parsons Miss Burke Miss Leigh (from May, 1936) Total Primary ante-natal visits 27 45 14 38 44 25 193 Subsequent ante-natal visits 9 43 25 54 36 20 187 Primary birth visits 11 268 125 231 147 140 922 Subsequent visits to infants 13 954 526 1320 724 411 3948 Visits to children under five years of age — 1678 1016 2026 932 1065 6717 Visits re stillbirths — 5 4 3 1 7 20 Visits re deaths of infants under one year of age — 4 3 13 3 6 29 Visits re eases of ophthalmia neonatorum 3 1 — — — — 4 Visits re cases of puerperal fever 3 — — — — — 3 Visits re cases of puerperal pyrexia 2 — — — — — 2 Primary visits to cases of tuberculosis 97 — — — — — 97 Subsequent visits to cases of tuberculosis 772 — — — — — 772 Special visits 668 — — — — — 668 1605 2998 1713 3685 1887 1674 13562 24 REPORT ON MATERNITY AND CHILD WELFARE SERVICES. Dr. F. M. Parsons, the Assistant Medical Officer, has made the following report on the Maternity and Child Welfare Services:— Child Welfare. Child Welfare sessions continue to be held at six centres, thus serving every part of the Borough. At the Parish Room and Western Road Centres two sessions are held each month. At the Cavendish Road, Meopham Road and St. Barnabas Centres four sessions are held each month. At the Sherwood Park Centre, where formerly two sessions were held each month, an increased number of sessions was felt to be urgently needed, and arrangements were therefore made to open a morning session there. This was done on April 4, 1936, and two morning sessions have been held there each month since that date, in addition to two afternoon ones. This morning clinic was in the nature of an experiment, and grew so rapidly and has proved so successful that it gives the answer to the critics who say that " mothers will not bring their babies to a morning clinic," and I am including in this report the figures for the Sherwood Park morning clinics for the first six months, showing how from a small beginning the clinic grew. Showing Growth of Sherwood Park Morning Clinic. Date. Number of attendances. April 9, 1936 4 „ 23 „ 9 May 14 ,, 25 28 „ 21 June 11 ., 26 „ 25 „ 24 July 9 27 „ 23 „ 28 Sept. 10 ,, 29 „ 24 „ 30 Oct. 8 ,, 27 „ 22 „ 29 25 The total number of attendances at the six infant welfare centres was 11,115 as compared with 9,833 in 1935 and 9,058 in 1934. Of these 929 were new cases, 712 being infants under one year of age, and 217 being children over one but under five years of age. The tooal number of attendances of infants under one year of age was 7,382, and of children between one and five years of age 3,733. At the end of the year there were 578 infants under one year and 1,000 children between one and five years attending the centres. The average attendance at each individual centre was:— Cavendish Road 54.8 Meopham Road 55.2 Parish Room 56.3 Sherwood Park 40.1 St. Barnabas 64.9 Western Road 48.8 giving an average for all centres of 53.3, as compared with 50 in 1935 and 46 in 1934. The percentage of infants under one year of age attending the centres was 73 per cent, of the total number of notified births, that is, nearly three-quarters of the total number of notified births. This is a very high proportion. In 1935 this percentage was 66, in 1934 it was 61.3. Supply of Food and Medicine. Packets of dried food, cod liver oil, cod liver oil emulsion, Virol. Brestol, and Parrish's Food were sold at the centres, and in necessitous cases were supplied free. Arrangements were such that necessitous children needing dried food other than that supplied at the clinics could obtain this free. Grants of free milk were made where necessary, applications for this help being considered each month by the Maternity and Child Welfare Committee. No necessitous case, however, 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. 26 General Remarks. The nutrition, clothing and cleanliness of the children continued to be of very high standard, and the children attended the centres very regularly. Mothers were 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. Baby Competition. A Baby Competition was held from Monday, June 22, to Thursday, June 25. There were 328 entries. The competitors were divided into five groups at each centre, groups I. and II. being amalgamated. One prize and three certificates were awarded to each group to the four candidates who obtained the highest number of marks. Nine doctors very kindly gave their services as judges, and I take this opportunity of thanking them for the help they gave on this occasion. By the courtesy of the "News of the World" a Garden Party for the mothers and babies who entered for the competition was held in the "News of the World" ground on July 16. This was attended by 350 mothers with their babies, and very much enjoyed by them. The prizes and certificates were given away on this occasion. The Mayoress, Mrs. J. M. Davies, very kindly took the chair and presented the prizes. Pathological Conditions. The total number of pathological conditions found was 303. The number of children found to be suffering from dental caries was 70. (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 clinio or, in a small minority of cases, to hospital. 27 There were 17 cases of enlarged tonsils. Treatment was advised in those cases where it was considered necessary. There were 30 orthopaedic cases. Twenty-one of these eases were referred to the Nelson Hospital (of these 18 actually attended), three cases were referred to the Bolingbroke Hospital and one case to Charing Cross Hospital. One case was already receiving treatment at the Belgrave Hospital for Children, and one case at the Royal National Orthopaedic Hospital. Ophthalmic conditions were found in nine ohildren. One emergency case was referred to the Royal Eye Hospital, and three cases were treated at the Royal Westminster Ophthalmic Hospital. Skin lesions, including naevi, were found in 30 cases. These were referred to the family doctor or to hospital for treatment. Details of the 303 pathological conditions found are shown in the following table:— Pathological Conditions Found in Children. Congenital Conditions— Number of Cases. Remarks. Cardiac disease 3 Cyst., Dermoid 2 Nasal 1 Hare lip and cleft palate 1 Hydrocele. Bilateral with inverted right testicle 1 Hypospadias 1 Lipoma of neck 1 Mental disease— Amentia 1 Referred to Charing Cross Hospital. Mongolian idiocy 2 One referred to Charing Cross Hospital. Nævi 20 Nævo-lipoma of tongue 1 Referred to Bolingbroke Hospital, Orthopaedic— Equinus. Spastic 1 Referred to Nelson Hospital. Carried forward 35 28  Numbe of Cases Remarks. Brought forward 35 Phalanges— Contraction of 1 Referred to Bolingbroke Hospital. Undevelopment of l Talipes— Galcaneo- valgus 2 One referred to Charing Cross Hospital, one to Nelson Hospital. Equino- varus 3 One treated at Belgrave Hospital, one at Royal National Orthopaedic Hospital. Thumb Trigger 1 Operated upon in Guy's Hospital. Toes, Malformation of 2 One referred to Bolingbroke Hospital. Torticollis 2 Referred to Nelson Hospital Phimosis 50 Raynaud's disease 1 Referred to Charing Cross Hospital. Testicle, undescended 1 Tongue-tie 11 Vagina, Imperforate 1 Referred to Grosvenor Hospital. Acquired Conditions— Anaemia 6 Adenitis, Cervical 13 General 1 Breast, Abscess of 1 Bronchitis Bronchial-pneumonia 1 Cardiac, Haemic murmur 1 Convulsions Cyst., Sebaceous of scalp 1 Referred to Wilson Hospital. Dental disease— Alveolar abscess 1 Carried forward 142 29  Number of Cases Remarks. Brought forward 142 Caries 70 Enamel deficiency 2 Enuresis 2 Fracture— Green-stick of lower end radius and ulna 1 X-ray at Wilson Hospital. Ganglion 2 Haematoma— Cephalo- hæraatoma of scalp 1 Hæmatoma of scalp 1 Hernia— Left inguinal 1 Referred to Bolingbroke Hospital. Umbilical 9 Hydrocele 1 „ „ Infectious Diseases— Diphtheria carrier 1 Removed to Wandle Valley Isolation Hospital. Marasmus 2 One admitted to Infants Hospital, Vincent Square. Ophthalmic— Acute conjunctivitis and haemorrhage into orbit 1 Referred to Royal Eye Hospital. Strabismus 7 Three treated at Royal Westminster Ophthalmic Stye 1 Hospital. Orthopaedic— Genu valgum 6 Outward curvature of tibia 8 Outward curvature of tibia with genu valgum and pes valgus 1 All referred to Nelson Hospital. Pes planus valgus 1 Valgus of ankles 1 Carried forward 261 30  Number of Cases. Remarks. Brought forward 261 Otorrhoea 3 Rickets 3 Skin diseases— Dermatitis 1 Flexural eczema 1 Referred to Charing Cross Hospital. Impetigo 1 Pemphigus 1 Referred to Infants Hospital, Vincent Square. Seborrhoea 4 Urticaria 3 Stomatitis 2 Thread worms 5 Tonsils, enlarged 17 Whitlow 1 Total 303 Ante-natal Centres. One Ante-natal Clinic is held each month at the Cavendish Road, Meopbam Road and Town Hall Centres, and one clinic each week in connection with Woodlands Maternity Home. The total number of expectant mothers attending the centres wa3 468, the total number of attendances being 2,406. Of the total number of notified births, 47 per cent, of the mothers attended the ante-natal centres, that is, almost one half. Some idea of how this important branch of the work has grown may be obtained by a comparison of the figures for the past four years which are shown in the following table:— Showing Growth of Ante-natal Work. Year. Number of expectant mothers attending the centres. Total number of attendances. Percentage of mothers of total number of notified births who attended the centres. 1933 327 1,257 35.5 1934 375 2,071 40.0 1935 433 2,294 45.0 1936 468 2,406 47.0 31 The average attendance at each individual centre is shown in the following table:— Showing Average Attendance at Each Centre. Centre. Number of expectant mothers attending. Number of attendances. Averags attendance. Woodlands 314 2,073 39.0 Cavendish Road 32 67 6.0 Meopham Road 55 108 9.8 Town Hall 67 158 14.3 This gives an average attendance for all centres of 17.3. General Remarks. Expectant mothers continued to attend the ante-natal clinics in increasing numbers and with great regularity. The principle already adopted was maintained, the clinics being strictly reserved for those cases entering Woodlands or hospital or who were to be confined in their own homes and attended by midwives. 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 clinics, and midwives were welcomed at the centres, the patient's ante-natal notes being available for her perusal. "Extras" in the form of cod liver oil emulsion, Virol or Parrish's Food were supplied free to necessitous and debilitated mothers, and grants of free milk were also made. In April I gave the Maternity and Child Welfare Committee a report on "The provision of free meals for expectant and nursing mothers," and, following this, arrangements were made for a supply of free dinners in necessitous cases. Remarks on Pathological Conditions. There were 48 cases of albuminuria of pregnancy and five cases of toxaemia of pregnancy. Two of these latter were immediately 32 admitted to Woodlands and one to the City of London Maternity Hospital. Two were treated by their own doctors, who subsequently sent them into hospital. There was one case of placenta previa, which was admitted to the City of London Maternity Hospital. Malpresentations were found in 44 cases. Of these 22 underwent spontaneous version, nine were corrected at the clinics, and eight were referred for version to hospital. In five of these eight cases, version was carried out successfully, but in three cases it was found to be impossible, and each of these was delivered as an extended breech presentation. An X-ray of any patient is taken in cases of doubtful presentation or of suspected multiple pregnancy. Twenty-two cases had an X-ray during the year. One hundred and ninety-five patients were found to have some form of dental disease, every case of caries from a slight degree to severe caries being included in the figures. The majority of patients attended the family dentist, a number were referred to the dental clinic, and a very small minority of cases went to hospital. 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 ninety pathological conditions were found altogether, details of which are given in the following table:— Pathological Conditions Found in Expectant Mothers. Number of Cases. Remarks. Complications of Pregnancy— Albuminuria of pregnancy 48 Contracted pelvis 1 Haemorrhage— Placenta previa 1 Admitted to City of London Maternity Hospital. Hyperpiesis 59 Carried forward 109 33 Number of Cases. Remarks. Brought forward 109 Malpresentations— Breech 36 Spontaneous version, 19 cases. Version at clinics, four cases. Version at hospital, five cases. Failed version at hospital, three cases. One mother died in Wilson Hospital on fourth day after delivery, following hysterectomy for ruptured uterus. Transverse 7 Spontaneous version, three cases. Version at clinic, four cases. Oblique 1 Version at clinic. Toxæmia of pregnancy 5 Admitted to Woodlands, two cases. Admitted to City of London Maternity Hospital, one case. Treated by family doctor and subsequently admitted to hospital, two cases. Varicose Veins— Of abdomen 1 Of legs 49 Of vulva 4 Saphena varix 1 Referred to Bolingbroke Hospital. Gyncecological Conditions— Cervical polyp 1 Operated upon at City of London Maternity Hospital. Cystocele 3 Fibroid. Pedunculated 1 Admitted to City of London Maternity Hospital for delivery. Carried forward 218 34 Number of Cases. Bermarks. Brought forward 218 Leucorrhœa 17 Ten cases referred to South London Hospital for Women for special investigation. Prolapse 1 Eectocele 2 Conditions unconnected with Pregnancy— Anaemia, Hypochromic 1 Referred to Charing Cross Hospital. Cardiac conditions— Aortic diastolic murmur Aortic functional systolic murmur with apical 1 murmur 1 Extrasystoles 2 Mitral stenosis 2 One case admitted to City of London Maternity Hospital for delivery. Mitral stenosis and aortic regurgitation 1 Died in Wilson Hospital on 15th day after delivery. Mitral systolic murmur 25 Reduplication of mitral second sound 10 Coccydynia 1 Referred to Bolingbroke Hospital. Corneal opacity 1 Dental— Caries 167 Pyorrhoea 21 Gingivitis 7 Epilepsy 2 Epistaxis 1 Hernia, inguinal 2 One referred to Bolingbroke Hospital. Carried forward 483 35  Number of Cases. Remarks. Brought forward 483 Skin— Acne 2 Pood poisoning rash 1 Admitted to Guy's Hospital. Scabies 1 Referred to Charing Cross Hospital. Spinal curvature 1 Admitted to City of London Maternity Hospital. Thyroid- Toxic enlargement of thyroid 1 Referred to Bolingbroke Hospital. Tonsils, enlarged 1 Total 490 Post- Natal Centre. A Post- Natal Clinic is held at the Town Hall each month. Leaflets are given to the patients when they leave the Woodlands Maternity Home, and to the patients attending the various antenatal clinics, giving them information about this clinic and the purpose for which it is intended. The pathological conditions found on examination of the patients who attended this clinic are shown in the following table:— Pathological Conditions Found in Post-Natal Cases. Number Cases Remarks. Post- Natal Conditions— Albuminuria 1 Cystocele 1 Leucorrhœa 3 One referred to South London Hospital for Women for special investigation. Rectocele 2 One referred to South London Hospital for Women. Carried forward 7 36  Number of Gases. Remarks. Brought forward 7 Retroversion 10 Corrected at clinic, seven cases. Referred to South London Hospital for Women, two cases. Referred to Guy's Hospital, one case. Retroversion with cystocele 1 Referred to South London Hospital for Women. Retroversion with prolapse 1 Retroversion corrected at clinic. Patient referred to South London Hospital for Women for treatment of prolapse. Rupture of perineum 1 Referred to consultant for perineorrhaphy. Prolapse 1 Total 21 Dental Clinic. The dental clinic is open to children under five years of age, and to expectant and nursing mothers, the patients being referred from the infant welfare, ante-natal and post-natal clinics. Two sessions are held each month. The total number of patients referred during the year was 72. Of these 64 actually attended, the total attendances being 210, the average being 9.1. The work done at the clinic during the year is shown in the following table :— Work Done at Dental Clinic. Inspections ... 71 Extraction under local anaesthesia ... 17 Extractions under gas or ethyl chloride 37 Fillings 22 Impressions ... 13 Dental adjustments ... 50 Total attendance ... 210 37 In necessitous cases assistance was granted by the Maternity and Child Welfare Committee towards the cost of new dentures, application for this help being considered each month by the Committee and grants being made in accordance with the scale adopted by the Council. Conferences. In July I attended the National Conference on Maternity and Child Welfare, which was held in Liverpool, with Councillor Mrs. C. Randall, and afterwards gave the Maternity and Child Welfare Committee a report on the proceedings. I also attended a weekend conference in London in December, at which some very interesting papers were read, and discussions took place on various aspects of child psychology. Convalescent Home for Mothers, Mayfield, Sussex. A bed was reserved at the Convalescent Home for Mothers, Mayfield, from September, for mothers with babies under nine months of age who were in poor health and in need of a holiday. During the period September 17 to December 17 three mothers enjoyed a holiday there. It is, however, too early to give a report on the working of this scheme. I take this opportunity of thanking Mr. J. V. O'Sullivan for the interest he has taken in the cases referred to him from the ante-natal and post-natal clinios. Once again I have to thank Mrs. E. S. Wray, Superintendent Health Visitor, and Miss G. M. Evans, Matron of Woodlands Maternity Home, for their unfailing and invaluable help and loyal co-operation at all times. My thanks are due also to the health visitors and nursing staff of Woodlands, and to all the voluntary workers who give their services so generously, week after week, at the infant welfare centres. F. M. PARSONS, M.R.C.S., L.R.O.P. 38 SANITARY CIRCUMSTANCES OF THE AREA. WATER SUPPLY. A constant supply of water is supplied to the whole of the district by the mains of the Metropolitan Water Board. DRAINAGE AND SEWERAGE. A new sewer from Goat Road to the sewage works is now under construction. This will prevent the flooding which has taken place at Beddington Corner. A scheme for sludge digestion has also been approved by the Ministry of Health. RIVERS AND STREAMS. Visits have been paid to all works suspected of discharging polluted effluent into the surface water sewers. No complaints were received during the year. CLOSET ACCOMMODATION. With very few exceptions the whole of the district is on the water carriage system, the houses being drained to the public sewer. At the end of the year there were four pail closets and three cesspools in use. PUBLIC CLEANSING. A weekly collection of bouse refuse is carried out by direct labour. Six 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. Seventy-one observations were kept on chimneys during the year. In connection therewith four notices were served and the nuisances abated. SWIMMING BATH. The water in the swimming both 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. 39 ERADICATION OF BED BUGS. Number of Council houses disinfested during 1936 80 Methods employed— 177 rooms treated with sulphur dioxide gas. 131 rooms treated with insecticide sprays. Number of private houses disinfested by Council staff 8 Methods employed— 8 rooms treated with sulphur dioxide gas. t 14 rooms treated with insecticide sprays. Number of private houses disinfested— (a) Owners after notice 12 (b) Occupiers after notice 6 One van load of furniture from a Council house was treated with cyanide gas. The above analysis of methods employed is inclusive of rooms treated on more than one occasion during the year, and also rooms in which more than one method has been used on one occasion. SHOPS. See under Chief Sanitary Inspector's report. LEGAL PROCEEDINGS. In connection with the administration of the Public Health and other Acts the following legal proceedings were undertaken during 1936:— Particulars. Result. Summons under Petroleum (Consolidation Act, 1928) Case dismissed. Summons under P.H.A., 1875 Sec. 91 Fined £5 and 8s. 6d. costs. „ „ „ 114 Fined £3 and £10 costs. Summons under Town Planning Act Fined £2. SCHOOLS. The supervision of the public elementary schools is under the control of the Education Department of the Surrey County Council. 40 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. ANNUAL REPORT OF CHIEF SANITARY INSPECTOR. To the Mayor, Aldermen and Councillors of Mitcham. Sir, Ladies and Gentlemen, I beg to submit a summary of the visits and works carried out in the Borough by my predecessor, Mr. C. G. Rabbetts, myself and Inspectors A. W. Lock, L. Gleed and L. R. Rummery (Shops Inspector) Number of complaints received and investigated 435 Number of premises inspected 3233 Number of premises revisited 5010 Number of nuisances discovered 1349 Number of nuisances abated without report 1242 Number of nuisances abated after report 124 Number of intimatory notices served 1141 Notices followed by legal proceedings 2 Number of visits re infectious disease 435 Number of drains tested 21 Visits to factories and workshops 285 Visits to outworkers 145 41 Visits to dairies 140 Visits to slaughterhouses 405 Visits to butchers' shops, fish shops 727 Visits to piggeries 147 Visits to bakehouses 97 Visits to marine stores 8 Visits to stables 57 Visits to schools 21 Visits to caravan yards 49 Smoke observations 71 Bug infested rooms sprayed or fumigated 330 Character of Work Done Houses repaired and cleansed generally 541 Roofs repaired 447 Damp walls remedied 115 Eavesi guttering and spouting renewed or repaired 140 Water closets renewed, repaired or cleansed 95 Water closet flushing cisterns and flush pipes renewed or repaired 76 Water cisterns cleansed or covered 13 Back yards paved or paving repaired 07 Floors repaired 109 Dustbins provided 388 Premises where animals improperly kept were removed or improved 2 Offensive accumulations removed 54 Piggeries repaired, improved or cleansed 9 Houses or parts disinfected and cleansed 384 Smoke nuisances abated 3 Drains repaired, cleansed, trapped or ventilated 77 All ponds and ditches in the Borough where mosquito breeding was possible were sprayed with paraffin twice early in the year Petroleum (Consolidation) Act 1928—Ninety-five licences to store petroleum spirit and cellulose solutions were granted, totalling 136,268 gallons A licence was also issued for 5 cwt of carbide of calcium to be stored 42 Food Inspection.—Carcases examined : 13 beasts, 3 calves, 80 3heep, 4,591 pigs. Condemnations.- Carcases and Organs. Beast Pigs. Sheep. Tuberculosis 2 3 Emaciation, oedema 34 ,, unmarketable 8 Jaundice 4 Inflammatory conditions 2 Fevered 19 Pleurisy peritonitis 17 Decomposition 3 Part Carcases. Pigs. Bruising 2 Inflammatory conditions 6 Mammitis 12 Tuberculosis— Beast Organs Pigs. Sheep. Heads 3 152 Lungs 3 113 Hearts 113 Livers 113 Spleens 113 Mesenterys 116 Cirrhosis livers 2 51 Parasitic livers 3 Strongylosis lungs 3 Pneumonia lungs 30 Fish surrendered for destruction: Codfish, 222 lbs.; herring roes, 14 lbs. Shops Acts. Number of shops inspected 1,511 Notices served Section 7, Shops Act, 1934, to keep records of hours worked by young persons, intervals for rest and meals 4 Notices served Section 10, Shops Act, 1934, to provide water closet accommodation and washing facilities 1 43 Notices served Shops Acts, 1912-34, to provide seats for female assistants and complied with 1 Certificates granted exempting provision of sanitary conveniences in special cases 2 Cautions given in cases of breaches of Shops (Hours of Closing) Act, 1928 17 Ditto Hairdressers and barbers shop (Sunday Closing) Act, 1930 3 Ditto Working young persons in excess of permitted number of hours 3 Yours obediently, A J GUTTERIDGE, Chief Sanitary Inspector CREMATION In June, 1936, the Crematorium at the Streatbam Park Cemetery, which is situated within this Borough, was opened At the end of the year 191 cremations had taken place 44 HOUSING Inhabited Houses—The number of inhabited houses in the borough was 16,551, being an increase of 830 houses since the previous year, the average number of persons per house being 385 compared with 394 last year. The number of inhabited houses in each ward is as follows:— North Ward 3,131 Population 12,054 South ,, 3,276 12,613 East ,, 6,583 25,345 West ,, 3,561 13,710 HOUSING ACT, 1930 During the year the following clearance order was confirmed by the Minister of Health after holding a local inquiry:— Clearance Area No 12 Fifty-four houses known as 1-51 and 2-56 (inclusive), Queens Road HOUSING ACT, 1936 The owner of 43 houses in Bath Road took advantage of Sec 51, Housing Act, 1936, and submitted a schedule of works of improvement which was accepted by the local authority The work is still in hand, but certificates have already been granted for 12 houses Housing Statistics 1 Inspection op Dwelling Houses during the Year:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 2808 {b) Number of inspections made for the purpose 2969 (2) (a) Number of dwelling houses (included under sub-head (l) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 356 {b) Number of inspections made for the purpose 400 45 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 (4) Number of dwelling houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 1141 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 966 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 Nil (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By local authority in default of owners Nil B. Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 118 (2) Number of dwelling houses in which defectswere remedied after service of formal notices:— (a) By owners 120 (b) By local authority in default of owners Nil C. Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which demolition orders were made 6 (2) Number of dwelling houses demolished in suance of demolition orders 2 46 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 Housing Act, 1935—Overcrowding A (1) Number of houses overcrowded at end of year 275 (2) Number of families dwelling therein 377 (3) Number of persons dwelling therein 2,075 B Number of new cases of overcrowding reported during the year 17 C (l) Number of cases ef overcrowding relieved during the year 7 (2) Number of persons concerned in such cases 52 D Particulars of any cases in which dwelling houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding Nil 47 INSPECTION AND SUPERVISION OF FOOD. FOOD AND DEUGS (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 has been taken during the year from this district:— Articles Analysed Adulterated or Deteriorated Prosecutions Conviotions Formal Informal Total Formal Informal Total Milk 51 2 53 3 3 ... ... Butter 4 ... 4 1 ... 1 ... ... Lard 1 ... 1 ... ... ... ... ... Meat 1 ... 1 ... ... ... ... ... Cocoa 3 1 4 ... ... ... ... ... Spirits 2 2 ... ... ... ... ... 'Other Articles 3 1 4 ... ... ... ... ... Totals 65 4 69 4 ... 4 ... ... 'Details of Other Articles— Ginger beer 1 1 Liver 1 1 Ground almonds 2 2 Totals 3 1 4 ... ... ... ... SLAUGHTER HOUSES. There are five slaughter houses, of which two are registered and three are licensed. During the year 405 visits of inspection were made and the following contraventions of the various Acts were found:— One contravention of Article 12, Public Health (Meat) Regulations, 1924, viz., storage of articles in slaughter house other than those required for the slaughter of animals and processes connected therewith. One contravention of Byelaw 8 of the Council's byelaws relating to slaughter houses, viz,, two dogs found in slaughter house. 48 One contravention of Byelaw 7 of the Council's byelaws relating to slaughter houses, viz, uncleanly condition of floor of slaughter house after slaughter The above were remedied after verbal notice Three requests were made for periodical limewashing of slaughter houses as prescribed by the Council's byelaws Galvanised iron bins were provided at one slaughter house for the temporary storage of offal For details of meat inspection see the Chief Sanitary Inspector's report BAKEHOUSES The number of bakehouses in the district is 15 Ninety-seven visits have been paid, and 11 verbal notices served to limewash bakehouses, all of which were complied with DAIRIES AND COWSHEDS There are 31 registered premises within the district, of which 30 are dairies and one cowshed During the year 140 visits of inspection were paid and no defects were found MILK (SPECIAL DESIGNATION) ORDER, 1923 During the year the Council granted the following number of licences under the above-named Order:— Grade A (TT) 7 Grade A 4 Grade A Pasteurised 3 Certified 6 Pasteurised 15 Pasteurising plant 1 DIRTY MILK BOTTLES On two occasions during the year complaints were received of milk being delivered in dirty bottles In both cases the bottles were sent for examination and the analyst reported that the dirt, which was adherent to the sides of the bottles, was hard to remove and was insoluble in water. 49 On making enquiries at the dairy it was found that the bottles had been passed through the washing machine and had escaped the notice of the examiner. The manager of the dairy stated that householders used empty milk bottles for many purposes. Bottles that had contained varnish, floor polish, paint, cement, etc., were often returned to the dairy. As it is impossible to clean such bottles they are broken up to prevent them from being put into circulation again. Bottles which are not grossly contaminated are sometimes missed and put through the washing plant, and in some cases the moisture on the bottle makes it very difficult to see particles of dirt which may be adherent on the sides. All householders oxpect milk to be delivered in clean bottles and should therefore not make use of the bottles for any other purpose. Care also should be taken to see that empty bottles are not left on pavements or in places where, not only are they liable to be broken and become a source of danger, but also are liable to become fouled by dogs. Public opinion plays a large part in securing a pure food supply ; surely it is not too much to ask for public co-operation with suppliers and dealers, and so help forward this vital public health function. SAMPLING OF MILK. In addition to the number of samples of milk taken for examination by the Foods and Drugs Inspectors of the Surrey County County, 32 samples were taken by District Sanitary Inspectors. The results were as follows:— Designation Number of Samples Remarks Pasteurised 15 14 conformed to legal standard. 1 contained 640,000 bacteria per c.c. Grade A. T.T. 1 Conformed to legal standard. Grade A. Pasteurised 1 „ „ „ Undesignated 15 13 were up to standard of pasteurised milk. 1 contained 144,400 bacteria per c.c. 1 „ 258,400 „ „ 1 50 PIGGERIES. There are 13 piggeries in the Borough. One hundred and fortyseven visits were paid 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. 51 FACTORIES AND WORKSHOPS. There are 163 factories and workshops in the district, of which 96 are factories and 67 are workshops. In addition there are 14 workplaces. During the year 285 visits of inspection were paid. Outworkers. There are 91 outworkers in Mitcham. One hundred and fortyfive visits of inspection were paid and, in connection with these, no defects found. During the year four 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 30 Onion peeling 10 Making of wearing apparel 33 Tailoring 3 Millinery 1 Embroidery 2 Furrier 1 Artificial flowers 2 Boots 2 Brace maker 1 Hair-nets and combs 1 Fishing rod bags 2 Fancy goods 1 Soft toys 2 Total 91 52 Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors. Premises Number of Inspections Written Notices Prosecutions Factories (Including Factory Laundries) 189 3 1 Workshops (Including Workshop Laundries) 62 5 Nil Workplaces (Other than Outworkers' premises) 34 3 Nil Total 285 11 1 53 Defects found in Factories, Workshops and Workplaces. Particulars Found Number of Defects Remedied Referred to H. M. Inspector Number of Prosecutions Nuisances under the Public Health Acts:— Want of cleanliness 6 6 Want of ventilation ... ... Overcrowding ... ... Want of drainage of floors ... ... Other nuisances 10 8 Sanitary accommodation insufficient ... ... unsuitable or defective 17 16 , 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 33 30 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. 54 Outwork in Unwholesome Premises, Section 108. Nature of Work Instances Notices served Prosecutions Wearing Apparel— Making, Ac. 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 1 1 Total 1 1 Nil 55 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. INFECTIOUS DISEASE NOTIFICATIONS. The total number of certificates of notification received during the year was 357, as compared with 293 last year. Contacts, Suspects, Etc. On 18 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 729 visits to cases of infectious disease; 294 were primary visits and 435 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 ... 28 9 ... 7 6 ... ... ... ... ... 50 February ... 9 8 ... ... 3 ... ... ... ... 1 21 March ... 20 4 ... 4 6 ... ... ... ... 1 35 April ... 9 2 ... 2 8 ... 1 ... ... ... 22 May ... 10 ... ... 1 6 1 1 1 ... ... 20 June ... 15 2 1 ... 2 ... 2 ... ... ... 22 July ... 11 10 1 1 1 ... 3 1 ... ... 28 August ... 7 5 ... 1 1 ... 1 1 ... ... 16 September ... 18 2 2 2 1 ... 1 ... ... ... 26 October ... 16 13 1 2 ... ... ... ... ... 1 33 November ... 24 32 ... 2 ... 1 2 ... ... ... 61 December ... 4 17 ... ... 2 ... ... ... ... ... 23 Total ... 171 104 5 22 36 2 11 3 ... 3 357 56 Case rates per 1,000 Ward population. X Disease. North. South. East. West. Small Pox 0.00 0.00 0.00 0.00 Scarlet Fever 1.6 2.2 2.8 3.6 Diphtheria 0.9 1.7 2.5 0.5 Enteric Fever 0.08 0.07 0.11 0.00 Erysipelas 0.49 0.15 0.35 0.35 Pneumonia 0.66 0.71 0.27 0.86 Oi ^3 Cases op Infectious Disease Notified During the Year 1936. 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 171 ... 2 8 12 14 94 22 8 10 ... 1 ... 20 72 29 50 149 ... Diphtheria 104 4 5 8 7 6 47 19 2 5 1 ... ... 11 62 23 8 104 4 Typhoid Fever 5 ... ... ... ... ... ... ... ... 3 1 1 ... 1 3 1 ... 4 1 Erysipelas 22 1 ... ... ... 1 ... ... ... 3 8 9 ... 6 9 2 5 17 ... Pneumonia 36 2 2 ... ... 1 5 1 2 5 7 8 3 8 7 9 12 16 37* Puerperal Fever 2 ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... 1 2 1 Puerperal Pyrexia 11 ... ... ... ... ... ... ... ... 11 ... ... ... 2 6 2 1 8 3 Ophthalmia Neonatorum 3 3 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 1 ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever 3 1 ... ... ... ... 1 1 ... ... ... ... ... ... 1 1 1 3 1 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 357 11 9 16 19 22 147 43 13 38 17 19 3 48 163 67 79 304 47 * Includes all forms, many of which are not notifiable. 58 Infectious Disease Notifications. 1922-36. Disease 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 Small Pox ... ... ... ... ... ... 9 7 ... 4 1 ... ... ... ... Scarlet Fever 178 110 87 106 104 145 102 134 113 105 174 240 392 143 171 Diphtheria 84 35 59 201 87 70 75 133 129 49 32 40 83 80 104 Typhoid Fever 1 2 1 4 2 6 3 4 9 2 3 3 ... 3 5 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 3 2 1 5 6 9 4 6 1 7 5 1 1 2 2 Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Meningitis 1 ... 6 ... ... 2 1 4 ... ... 1 4 1 1 3 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 13 15 11 10 13 14 10 22 22 17 11 31 30 20 22 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Diarrhoea ... ... ... ... ... ... ... ... ... ... ... ... ... 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 3 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 36 Malaria 8 3 ... 1 1 ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia ... ... ... ... 1 14 9 5 6 9 4 9 6 4 11 Totals 347 287 246 376 259 340 270 375 319 242 288 368 560 293 357 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 171, this being 28 more than last year. One hundred and forty-nine cases 59 were removed to hospital. No deaths were registered from this disease during the year. Diphtheria. One hundred and four oases of diphtheria were notified during the year. One hundred and four cases were removed to hospital. Four 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 519 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 132 children have been immunised. Diphtheria prophylactic is also given to the medical practitioners in the district free of charge, and during the year 25 persons were immunised by their own doctors. Typhoid Fever. Five cases of typhoid fever were notified during the year. Four cases were due to paratyphosus B. infection, and one case was due to a mixed infection of B. typhosus and para. B. There was one death. Diarrhœa and Enteritis under Two Years of Age. Two deaths were registered during the year; one male and one female. Encephalitis Lethargica. No case was notified during the year. Cerebrospinal Fever. Three cases were notified during the year, and one patient died. 60 Influenza. During the year eight deaths from influenza were recorded. Four were males and four females. The previous year four 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 three cases of ophthalmia neonatorum were notified:— Cases Treated Vision Vision Total Notified. At Home. In Hospital. unimpaired. impaired. blindness. Deaths 3 2 1 3 — - - Cancer The number of deaths from cancer registered during the year was 80, of which 38 were males and 42 were females, as compared with 68 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 1936 was as follows:— Digestive organs 37 cases Genito-urinary organs 14 „ Breast 4 ,, Respiratory system 7 ,, Other sites 18 ,, Total 80 The following table shows the number of deaths from cancer, together with the death rate as compared with England and Wales:— 61  Death Rate per 1,000 of Population. Year. Number of 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 61 1.0 1.58 1936 80 1.2 1.61 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 72 new cases of tuberculosis were notified, viz.:— Males. Females. Total. Pulmonary 24 40 64 Non-Pulmonary 5 3 8 Total 29 43 72 The death rate in each Ward per 1,000 Ward population is as follows:— 62  Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. North 0.41 0.00 South 0.63 0.08 East 0.67 0.11 West 0.51 01.4 The total number of deaths registered as occurring from tuberculosis was, viz:— Males. Females. Total. Pulmonary 20 18 38 Non-Pulmonary 4 2 6 Total 24 20 44 England & Wales. Mitcham. Death rate from respiratory tuberculosis per 1,000 population 0.70 0.59 Death rate from non-respiratory tuberculosis per 1,000 population 0.12 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 year to 5 years ... ... 1 ... ... ... 1 1 5 years „ 10 „ 1 ... 3 ... ... ... ... ... 10 „ „ 15 ,, ... 1 ... ... ... 1 1 ... 15 „ „ 20 ,, 1 5 ... 1 5 3 ... ... 20 ,, ,, 35 ,, 13 23 1 1 13 7 1 1 35 ,, ,, 45 ,, 6 6 ... ... 1 4 1 ... 45 ,, ,, 65 ,, 3 4 ... ... 1 2 ... ... 65 „ and upwards ... ... ... ... ... ... ... ... Totals 24 40 5 3 20 18 4 2 63 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 ... 1 ... ... 3 Pulmonary: females ... ... ... ... ... ... ... ... 1 ... ... 1 Non-Pulmonary: males ... 1 ... ... ... ... ... ... ... ... ... 1 Non-Pulmonary: females ... ... ... ... ... 1 ... ... ... ... ... 1 The sources from which information as to the above-mentioned cases was obtained are as follows:— No. of Cases Pulmonary NonPulmonary Death returns (a) Prom Local Registers 1 1 (b) Transferable deaths from Registrar General 3 1 Posthumous notifications ... ... Number of cases removed from register during 1936:— Reason Pulmonary Non-Pulmonary Total Cases Males Females Total Males Females Total Withdrawal of notification ... ... ... ... ... ... ... Recovery from disease 1 ... 2 ... ... ... 2 Death 19 17 36 3 2 5 41 64 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. Tuberculosis Care Committee. The Mitcham Tuberculosis Dispensary area comprises the Borough of Mitcham and the Urban District of Beddington and Wallington. Functions of Committee. (1) To alleviate want or distress amongst tuberculous people, providing, where necessary, extra nourishment, clothing, bedding, coal, surgical appliances, travelling expenses and help in the home. (2) To care for the families of patients in sanatoria so that their changed economic circumstances shall not result in impaired health, and that the sufferer shall not be harassed by undue anxiety. Assistance to patients:— Number of persons assisted during 1936 42 ,, ,, ,, receiving supplies of milk, butter, eggs, continuously for 12 months 9 „ „ „ „ „ 9 „ 4 6 „ 4 ,, „ ,, ,, ,, shorter periods 15 Clothing supplied and paid for by Care Committee 2 ,, ,, through medium of Care Committee 6 Medical comforts, dressings, etc. 2 Fares paid 1 65 Rent paid 1 Employment obtained 5 Tubercular patients who have received special consideration re housing 14 Persons who have been offered but have refused accommodation 7 Coal supplied weekly during winter months 2 Christmas comforts supplied to 24 Mitcham Borough. Population (estimated) 64,000. Number of cases on register December 31, 1936 564 Percentage 0.88. Beddington and Wallington. Population (estimated) 32,014. Number of cases on register December 31, 1936 146 Percentage 0.45. Whole of Tuberculosis Dispensary Area. Population (estmated) 96,014. Number of cases on register December 31, 1936 710 Percentage 0.73. Chicken Pox. Two hundred and eighty-five cases of chicken pox were notified by the head teachers of the schools in the district. Whooping Cough. One hundred and forty-three cases of whooping cough were notified during the year by the head teachers of schools in this district. Three deaths were registered, one male and two females. Measles. Seven hundred and ten cases of measles were notified during the year by the head teachers of schools in the district. Five deaths from measles were registered during the year, two males and three females. 66 Mumps. Eight cases of mumps were notified by the head teachers during the year. Ringworm. Nine cases were notified during the year by the head teaohers. Impetigo. Twelve cases occurred in the schools during the year. Scabies. Seven cases were notified by head teachers during the year. Erysipelas. Twenty-two cases of erysipelas were notified, and seventeen cases were removed to hospital. There was no death from this cause. Puerperal Eever. Two cases of puerperal fever were notified; there was one death. Puerperal Pyrexia. Eleven cases of puerperal pyrexia were notified and three deaths were recorded from this cause. Pneumonia. Thirty-six 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 37. This includes all forms of pneumonia, both primary and secondary. Only primary forms are notifiable. 67 WANDLE VALLEY JOINT HOSPITAL BOARD. Cases admitted to the hospital during the year ended December 31, 1936. Disease Beddington & Wallington Coulsdon & Purley Merton & Morden Mitcham Cases Deaths Cases Deaths Cases Deaths Cases Deaths Diphtheria 11 ... 38 1 27 ... 103 4 Scarlet Fever 47 1§ 96 ... 111 ... 149 ... Typhoid 1 ... 2 ... 5 ... 4 1† Erysipelas ... ... 3 ... 2 1† 7 1* Tonsilitis 4 ... 6 ... 1 ... 5 ... Measles 3 ... 2 ... 11 1|| 6 ... Other Diseases Chicken Pox ... ... ... ... 1 ... ... ... C.S.M. Mastoidectomy Septicæmia ... ... 1 1 ... ... 2 ... Ulcerated Stomatitis 1 ... ... ... ... ... 1 ... Tubercular Meningitis ... ... ... ... ... ... 1 1 Enteritis 1 ... 1 ... ... ... ... ... Whooping Cough ... ... ... ... 2 ... 3 3 Babies admitted with mother ... ... 1 ... ... ... ... ... Rubella ... ... 3 ... 1 ... ... ... Rheumatic Fever ... ... ... ... ... ... 1 ... Pemphigus ... ... 1 ... ... ... ... ... Mother (no disease) ... ... 1 ... ... ... ... ... Pneumonia ... ... ... ... 1 ... ... ... 68 l 155 2 162 2 282 10 * Erysipelas with cerebral embolus. † Typhoid with para typhoid. ‡ Erysipelas with nephritis. § Streptococcal Meningitis following scarlet fever. || Convulsions from measles. 68 INDEX page Ambulances 14 Analysis of Mortality 13 Ante-Natal Clinics 16 Area 6 Bakehouses 48 Bed Bugs, Eradication of 39 Birth Rates 9, 13 Births, Live 6 — Illegitimate 7 — Still 8 Blindness, Prevention of 60 Cancer 60 — Deaths from 61 Causes of Deaths 12 Cerebro-Spinal Fever 59 Chicken Pox 65 Clinics 15 — Ante-natal 16 — Dental 17 — Orthopaedic 17 — Post-natal 17 — Welfare 15 Closet accommodation 38 Cremation 43 Dairies and Cowsheds 48 Death Rates 9, 13 Deaths 7, 8, 12 Dental Clinic 17 Diarrhoea and Enteritis 59 Diphtheria 59 — Immunisation 59 Drainage and Sewerage 38 Encephalitis Lethargica 59 Erysipelas 66 69 PAGE Factories and Workshops 51 — — — Defects in 53 — — — Inspection of 52 Food and Drugs Act (1928) 47 — Inspection and Supervision of 42, 47 Food Preparing Places 50 General Provision of Health Services for the Area 14 Health Visiting 15 — Visitors, Visits by 23 Home Helps 17 Hospitals 44 — Inhabited 44 Housing 44 — Act (1930) 44 — Statistics 44 Impetigo 66 Infantile Mortality 7, 9, 10 Infant Life Protection 18 Infectious Disease, Cases Notified 57 — — Incidence of 55 — — Prevalence of and Control over 55 — Notifications 55, 58 — — — School 58 Influenza 60 Inhabited Houses 6, 44 Inquests 10 Inspection and Supervision of Food 47 Laboratory Facilities 14 Legal Proceedings 39 Maternal Mortality 10 Maternity and Child Welfare Services, Report on 24 — Home 19 Measles 65 Midwives 15 Milk (Special Designation) Order (1923) 48 — Sampling of 49 Bottles, Dirty 48 70 PAGE Mortality, Analysis of 13 Mortality, Infant 7, 9, 10 — Maternal 10, 13 Mumps 66 Nursing in the Home 15 N.S.P.C.C 18 Ophthalmia Neonatorum 60 Orthopaedic Clinic 17 Outworkers 51, 54 Parsons, Dr. F. M., Report 24 Patients Admitted to Hospital 67 Personnel, Committee 4 — Staff 5 Petroleum Act (1928) 41 Piggeries 50 Pneumonia 66 Population 6 Prevention of Blindness 60 Public Cleansing 38 Puerperal Fever 66 — Pyrexia 66 Rateable Value 6 Ringworm 66 Rivers and Streams 38 Sanitary Circumstances of the Area 38 — Inspector's Report 40 Scabies 66 Scarlet Fever 58 Schools 39 Senile Deaths 8 Sewerage 38 Shops Acts 42 Slaughterhouses 47 Small Pox 58 Smoke Abatement 38 Social Conditions 6 Statistics 6 - Housing 44 71 PAGE Statistics, Vital 7 Still Births 8 Sunlight Treatment 17 Swimming Bath 38 Tuberculosis 61 — Care Committee 64 Typhoid Fever 59 Vital Statistics 7 X-Ray Examinations 18 Wandle Valley Hospital 67 Water Supply 40 Welfare Clinics 15 — — Attendance at 22 Whooping Cough 65 Woodlands Maternity Home 19