BOROUGH OF MITCHAM REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE YEAR 1937 BOROUGH OF MITCHAM REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1937 Mitcham: H. G. Mather, Caxton Works, Lower Green Borough of Mitcham HEALTH REPORT FOR 1937 To the Mayor, Aldermen and Councillors, Borough of Mitcham. Sir, Ladies and Gentlemen, I have pleasure in submitting my annual report for the year ended December 31, 1937. From the report it will be seen that the birth rate is still falling and the death rate is also lower than last year. The number of overcrowded houses has been reduced, but at the end of the year there were still 118 houses overcrowded according to the standards laid down in the Housing Act, 1936. I 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. To the members of my staff I would once again express my thanks for their loyal support and co-operation. I am, Ladies and Gentlemen, Yours obediently, A. T. TILL, Medical Officer of Health. Public Health Dept., Mitcham Court, Mitcham, BOROUGH OF MITCHAM PUBLIC HEALTH COMMITTEE Chairman - - Councillor S. G. Silkstone Aldermen— Mrs. W. Toynbee E. J. D. Field J. Fitch Councillors— Miss R. K. Wilson D. Bigham V. G. Pullen H. Lee, and his Worship the Mayor (Alderman J. P. Turner, J.P.) MATERNITY AND CHILD WELFARE COMMITTEE Chairman - - Councillor G. R. Madgwick Alderman— Mrs. W. Toynbee Councillors— Mrs. E. Watson Miss R. K. Wilson Mrs. C. Randall H. Lee S. G. Silkstone T. E. Penfold W. Curtis Wakeford Co-opted Members— Miss E. C. Chart Mrs. H. M. Hallowes Mrs. C. C. Norman Mrs. D. L. Chappell Dr. G. M. Stoker His Worship the Mayor (Alderman J. P. Turner, J.P.) REPRESENTATIVES ON WANDLE VALLEY JOINT HOSPITAL BOARD His Worship the Mayor Councillors— Miss R. K. Wilson W. Dalton A. H. Bailey REPRESENTATIVES ON WANDLE VALLEY JOINT SEWERAGE BOARD His Worship the Mayor Aldermen— S. L. Gaston, J.P. E. J. D. Field, J.P. Councillor T. A. East 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 K. S. Gutteridge, Cert. S.I.B. Assistant Sanitary and Meat Inspector 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. Parson (2, 4) Miss M. Burke (2, 3) Miss P. M. Leigh (1, 2, 3) Matron of Woodlands Maternity Home Miss G. Evans (1, 2) 1. State Registered Nurse. 2. Certificate of Central Midwives' Board. 3. Health Visitor's Certificate R.San.I. 4. Health Visitor's Diploma. 5. Inspector of Nuisances. 6. Sanitary Inspectors' Exam. Board. 7. Diploma Sanitary Science. 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 midyear, 1937 65,620 Number of inhabited houses, 1921 7,150 „ 1931 13,187 „ 1937 16,822 Rateable Value on December 31, 1937 £462,910 Sum represented by a Id. rate £1,882 STATISTICS. Total. Male. Female. Rate per 1,000 of population. Live Births. Legitimate 918 477 441 Illegitimate 26 18 8 Total 944 495 449 14.3 Total. Male. Female. Rate per 1,000 total births. Still Births Legitimate 29 14 15 Illegitimate 3 1 2 Total 32 15 17 33.8 7  Total. Male. Female. Rate per 1,000 of population. Deaths. 560 283 277 8.5 Deaths from disease and accidents of pregnancy and childbirth:— Rate per 1,000 total births. From puerperal sepsis — — From other puerperal causes 2 2.1 Total 2 Deaths of infants under one year of age:— All infants per 1,000 live births 43.4 Legitimate infants per 1,000 legitimate live births 42.4 Illegitimate infants per 1,000 illegitimate live births 76.9 Deaths from:— Cancer (all ages) 76 Measles (all ages) — Whooping cough (all ages) 3 Diarrhoea (under two years of age) 5 VITAL STATISTICS. During the year 944 live births were registered as belonging to this district, of which 449 were females and 495 were males, as compared with 998 last year. The live birth rate for the year was equal to 14.3 per 1,000 of population, as against 15.4 per 1,000 last year, the crude birth rate being 14.8 per 1,000. The birth rate for England and Wales was 14.9 per 1,000, as against 14.8 per 1,000 last year. Illegitimate Births The number of births registered as being illegitimate was 26, as compared with 22 last year. The illegitimate rate was equal to 2.9 per cent, of the total births, as against 3 per cent, in 1936. 8 Still Births The number of still births registered was 32, of which 15 were males and 17 females. Percentage of Births Occurring in Institutions Year. Total births. Births in hospitals, etc. Percentage of births occurring in institutions. 1929 961 809 32.1 1930 1129 367 32.4 1931 1143 370 32.3 1932 1084 381 35.1 1983 1010 420 41.5 1934 982 428 43.5 1935 969 474 48.9 1936 1033 497 48.1 1937 976 501 51.3 Number of births notified by midwives in 1937 681 „ „ „ doctors and others in 1937 295 Deaths During the year 560 deaths were registered, of which 283 were males, and 277 were females, as compared with 588 deaths last year. The death rate for the year was equal to 8.5 per 1,000 of the population, as compared with 9.1 per 1,000 in 1936. The death rate for England and Wales was 12.4 per 1,000 for the year 1937, and 12.1 per 1,000 for 1936. Senile Deaths. The number of deaths of persons of 65 years of age and over was 244, of which 111 were males and 133 females. This constitutes 43.5 per cent, of the total deaths, as compared with 44.5 per cent, last year. 9 The birth rates, death rates per 1,000 of population, and the infantile mortality rates for the years 1915-1937 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 1926 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 1937 14.3 14.9 8.5 12.4 43.4 58 10 Infant Mortality During the year 41 deaths were registered as occurring in infants under one year of age:— Males Females Total Legitimate 21 18 39 Illegitimate 1 1 2 Total 22 19 41 as compared with 48 deaths last year. The infantile mortality rate for the year is equal to 43.4 per 1,000 live births, as against 48 per 1,000 last year. The infant mortality rate for England and Wales was 58 per 1,000 for 1937 and 59 per 1,000 for 1936. Maternal Mortality. During the year two deaths were registered as being due to diseases or accidents of pregnancy, compared with four deaths last year. The following is a summary of the causes of death:— One death due to post partum haemorrhage. One death from septicaemia due to self-induced abortion. 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 Officer of the Ministry of Health. Inquests. Inquests were held on forty residents dying within the district and on 13 Mitcham residents who died outside the district, a total of 53. In addition the coroner held seven post mortems without inquests. The following table shows the results of the findings of these inquests:— 11 Inquests Number Deaths from natural causes 22 Deaths from accidents:— Knocked down by motor vehicles 8 Knocked down by bicycle 2 Falls 2 Infected wounds 2 Drowning 1 Death from misadventure 4 Self induced abortion 2 Deaths from suicide:— Acetic acid 1 Coal gas poisoning 7 Drowning 1 Fall in front of train 1 Total 53 12 Deaths Registered during the Year, 1937. Cause of Death. Males. Females. Total. Typhoid and paratyphoid ... ... ... Measles ... ... ... Scarlet Fever ... ... ... Whooping Cough 3 … 3 Diphtheria 3 2 5 Influenza 7 8 15 Encephalitis lethargica 1 ... 1 Cerebro-spinal Fever ... 1 1 Tuberculosis of the Respiratory 8ystem 22 23 45 Other Tuberculous Diseases 6 1 7 Syphilis 3 ... 3 General Paralysis of the insane, tabes dorsalis ... ... ... Cancer, malignant disease 33 43 76 Diabetes 5 2 7 Cerebral Hemorrhage 11 14 25 Heart Disease 54 64 118 Aneurism 3 ... 3 Other Circulatory Diseases 16 12 28 Bronchitis 16 8 24 Pneumonia (all forms) 21 17 58 Other Respiratory Diseases 1 4 5 Peptic Ulcer 4 ... 4 Diarrhoea, Ac. (under two years) 2 3 5 Appendicitis 3 1 4 Cirrhosis of the Liver ... 2 2 Other Diseases of the Liver, etc 2 1 3 Other Digestive Diseases 5 12 17 Acute and Chronic Nephritis 3 9 12 Puerperal sepsis ... ... ... Other Puerperal causes ... 2 2 Congenital Debility, Premature Birth, Malformations, etc. 9 10 19 Senility 6 8 14 Suicide 3 9 12 Other Violence 13 5 18 Other defined Diseases 27 15 42 Causes ill-defined or unknown 1 1 2 Total 283 277 560 Special Causes:— Small Pox ... ... ... Poliomyelitis ... ... ... Polio-encephalitis ... ... ... 13 Birth-rates, Death-rates, Analysis of Mortality, England and Wales, London, Maternal Death-rates, and Case-rates for 125 Great Towns and 148 certain Infectious Diseases in the year 1937. Smaller Towns. (Provisional figures based on weekly and quarterly returns.) England and Wales. 125 County Boroughs and Great Towns including London. 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 census). London Administrative County. Mitcham Rates per 1,000 population. Births— Live 14.9 14.9 15.3 13.3 14.3 Still 0.60 0.67 0.64 0.54 0.45 Deaths— All causes 12.4 12.5 11.9 12.3 8.5 Typhoid and Paratyphoid fevers 0.0 0.01 0.00 0.00 0.00 Smallpox — — — — — Measles 0.02 0.03 0.02 0.01 0.00 Scarlet fever 0.01 0.01 0.0 L 0.01 — Whooping cough 0 04 0.04 0.03 0.06 0.04 Diphtheria 0.07 0.08 0.05 0.05 0.07 Influenza 0.45 0.39 0.42 0.38 0.22 Violence 0.54 0.45 0.42 0.51 0.45 Notifications— Small pox 0.00 0.00 — — — Scarlet fever 2.33 2.56 2.42 2.09 29 Diphtheria 1.49 1.81 1.38 1.93 1.3 Enteric fever 0.05 0 06 0.04 0.05 0.00 Erysipelas 0.37 0.43 0.34 0.44 0.24 Pneumonia 1.36 1.58 1.20 1 18 0.48 Rates per 1,000 live births. Deaths under one year of age 58 62 55 60 43 Deaths from diarrhoea and enteritis under two years of age 5.8 7.9 3.2 12.0 5.2 Maternal mortality— Puerperal sepsis 0.97 , Not available 0.0 Others 2.26 2.1 Total 3.23 1 2.1 Rates per 1,000 total births (i.e., live and still). Maternal mortality— Puerperal sepsis 0.94 Not available 0.0 Others 2.17 • 2.0 Total 3.11 2.0 Notifications— Puerperal fever 13.93 17.59 11.52 4.15 1.0 Puerperal pyrexia 14.34 5.1 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 791 Sputa for tubercle 160 Total 951 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 976, of which 461 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. Four municipal midwives are being appointed for this Borough, the Borough Council acting as agents for the Surrey County Council, who are the local supervising authority. 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, ante-natal clinics, etc., and also does the visiting of tuberculous patients and acts as Infant Life Protection Visitor. NURSING IN THE HOME. There are three nursing associations in the Borough. The following are the returns from each association for year ended December 31, 1937:— No. of Nurses. No. of patients visited during 1937. No. of visits paid during 1937. St. Barnabas 1 679 3,324 South and East Wards 3 467 9,509 Christchurch 2* 226 4,581 Totals 6* 1,372 17,414 * One part time. 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 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 Room, 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 Thursday afternoons of each month, and the second and fourth Thursday mornings of each month. Dr. Parsons attends all sessions. Toddlers' Clinics. In March a special monthly session for toddlers was commenced at the Meopham Road Centre, the total attendances being 151. In December a special monthly toddlers' session was commenced at the St. Barnabas Centre, the attendance being 11. 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 100, the number of mothers attending being 38. 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 2,223, 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 105, the number of mothers attending being 57. Town Hall.— Sessions are held on the third Tuesday of each month. The total attendances at this clinic was 245, the number of mothers attending being 79. 17 Forty-nine per cent, of the mothers of children born during the year attended the ante-natal clinics (including Woodlands Maternity Home Clinic), as compared with 47 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, and 134 mothers attended this clinic during the year. This number represents 15 per cent, of mothers who were confined 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 annual report for 1935. During the year 18 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. 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 19 „ Gas 40 Fillings 28 Impressions taken 9 Inspections 69 Advice given re dentures, etc. 26 Scaling 3 Total attendances 194 Number of new cases during 1937, 53. 18 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 34 cases were referred to this clinic, as compared with 20 cases in 1936. 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 22 women attended for this examination, as compared with 23 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, 1937 32 Number of children on register, December 31, 1937 34 Number of children who have died during the year — Number of children on whom inquests were held — Number of registrations withdrawn — Number of prosecutions — Number of visits paid by the Infant Life Protection Visitor 325 19 National Society for Prevention of Cruelty to Children The 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. During the year two cases were referred to the Society as follows:- Neglect 1 Ill-treatment 1 Other wrongs - Total 2 These cases affected the welfare of four children, and 7 visits were made by the Society's Inspector in connection therewith. 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 has occurred in each year since the opening of the Home:- 20 The following table shows the number of births which has occurred in each year since the opening of the Home:- No of Births 1924 (August to December) 42 1925 129 1926 240 1927 (10 months) 177 1928 265 1929 298 1930 318 1931 259 1932 239 1933 285 1934 285 1935 299 1936 314 1937 309 Number of maternity beds in the institution (exclusive of isolation and labour beds), 15. Number of maternity cases admitted during the year, 309. Average duration of stay, 14 days. Number of cases delivered by (a) midwives, 272 (including two twin labours); (b) doctors, 39. Number of cases in which medical assistance was sought by a midwife in emergency, 49. 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, 3; (ii) within 10 days of birth, 2. 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 number attending, see under Ante-Natal Clinics. An extension is being made to the Home in order to provide accommodation for three ante-natal beds. 21 report of the infant welfare and ante-natal centres, 1937. 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 Maternity Home Total Number of new cases registered during year of— 635 Children under one year of age 95 143 89 174 88 46 - - Children over one year and under five years of age 36 36 41 51 28 85 - - 277 Number of children in attendance at end of year— 568 Under one year of age 62 110 85 159 74 78 - - Over one and under five years of age 171 221 197 253 138 164 - - 1144 Total attendances of children under one year of age 754 1630 1068 1940 810 1230 - - 7432 Total attendances of children over one year of age 504 777 569 1151 543 610 - - 4154 Total attendances at centres 1258 2407 1637 3091 1253 1840 - - 11446 Average attendances at centres 22 54 39 70 65 41 - - 54 Percentage of infants under one year of age attending centres of total notified births - - - - - - - - 67% Total attendances of expectant mothers - 100 105 - - - 245 2223 2673 Average attendances of expectant mothers - 9 9.5 - - - 22 42 21 Number of expectant mothers who attended during year - 38 57 - - - 79 302 476 Percentage of total notified births represented by the number of expectant mothers attending all clinics - - - - - - - - 49% 22 Visits paid by Health Visitors, 1937. Mrs. Wray Miss Russell Harris Mrs. Parsons Miss Burke Miss Leigh Total Primary ante-natal visits 33 62 40 50 66 251 Subsequent ante-natal visits 8 66 55 42 66 237 Primary birth visits 60 283 175 146 244 908 Subsequent visits to infants - 809 753 722 717 3001 Visits to children under five years of age 187 1621 1378 836 1476 5498 Visits re stillbirths - 2 3 - 8 13 Visits re deaths of infants under one year of age - 1 - 3 7 11 Visits re cases of ophthalmia neonatorum 2 - - - - 2 Visits re cases of puerperal pyrexia - - - - 2 2 Visits re cases of puerperal fever 2 - - - - 2 Primary visits to cases of tuberculosis 118 - - - - 118 Subsequent visits to cases of tuberculosis 738 - - - - 738 Special visits 658 - - - - 658 1804 2844 2404 1799 2586 11437 23 REPORT ON MATERNITY AND CHILD WELFARE SERVICES Child Welfare Child Welfare Sessions are 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, Sherwood Park and St. Barnabas Centres, four sessions are held each month. The total number of attendances at the six infant welfare centres was 11,486, as compared with 11,115 in 1936. Of these, 912 were new cases, 635 being infants under one year of age, and 277 being children over one but under five years of age. The total number of attendances of infants under one year was 7,432, and of children between one and five years of age, 4,154. At the end of the year there were 568 infants under one year and 1,144 children between one and five years of age attending the centres. The average attendance at each individual centre was:- Cavendish Road 54.7 Meopham Road 39.9 Parish Room 65.2 Sherwood Park 41.8 St. Barnabas 70.2 Western Road 57.0 giving an average of 54.8, as compared with 53.3 in 1936. The percentage of infants under one year of age attending the centres was 67 per cent, of the total number of notified births. Clinics for Toddlers In March it was decided to hold a special clinic for toddlers once a month. Accordingly, the first clinic for toddlers was held at the Meopham Road Centre on March 22, the attendance being 17. The following table shows the attendance at this clinic:- 24 Attendance at Meopham Road Clinic for Toddlers Month Attendance March 17 April 15 May 8 June 27 July 17 September 40 October 16 November 11 The total number of attendances at the eight sessions was 151, giving an average attendance of 18.7. The total number of new cases registered was 33. The Special Clinic for Toddlers was commenced as an experiment, and has proved a great success. The mothers have entered into the spirit of it, and take a real interest in it. The clinic is strictly reserved for children who are between the ages of two and five years. The children are undressed and weighed and examined by the doctor at the first attendance, and are encouraged to come up for re-examination every three months, a date being given to the mother in advance for this purpose. The mothers are beginning to appreciate that by attending on the appointed date "overcrowding " is avoided, and that, therefore, more time can be given to their children by the doctor and health visitors than when large numbers attend. On December 15 a Special Clinic for Toddlers was commenced at the St. Barnabas Centre, with an initial attendance of 11. Supply of Food and Medicines Dried food, cod liver oil, cod liver oil emulsion, Virol and Parrish's Food were sold at the centres, and, in necessitous cases, 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 25 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. General Remarks The nutrition, clothing and cleanliness of the children continued to be of a 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 case being sent with the patient. Pathological Conditions The total number of pathological conditions found was 339. The number of children found to be suffering from dental trouble was 75. This figure includes several cases of broken teeth and every case of caries from the slightest degree to gross decay. 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 small number of cases, to hospital. There were 49 cases of enlarged tonsils. Treatment was advised in those cases where it was considered necessary. There were 34 orthopaedic cases. 32 of these were referred to the Nelson Hospital. Of these, seven failed to attend. One case was referred to Charing Cross Hospital. Ophthalmic conditions were found in seven children. Six of these were referred to the Royal Westminster Ophthalmic Hospital. There were two cases of feeding difficulty which required institutional treatment. One of these was admitted to the Mothercraft Training School, Cromwell House, Highgate, and the other to the Lady Violet Melchett Clinic, Chelsea. Details of the 339 pathological conditions found are shown in the following table:- 26 Pathological Conditions Found in Children. Number of Cases Remarks. Congenital Conditions— Amentia 1 Referred to Charing Cross Hospital. Cardiac Disease 6 Congenital Pyloric Stenosis 1 Admitted with the mother to the Infants Hospital, Vincent Square. Cyst. Dermoid 1 Harelip 1 Operation in Great Ormond Street, Children's Hospital. Mongolian idiocy 1 Referred to Charing Cross Hospital. Mole 1 Nævi 14 Phimosis 66 Tongue, Papilloma of 1 Tongue-tie 9 Testicle, undescended 1 Ophthalmic, Ptosis 1 Orthopfedic— Contracture of Finger 1 Referred to Bolingbroke Hospital. Polydactylism 1 Talipes 3 One case referred to Charing Cross Hospital. Toe, malformation of 1 Acquired Conditions— Adenitis, Cervical 24 Generalised 1 Alopeeia 1 Referred to Charing Cross Hospital. Ansemia 4 Carried forward 140 27  Number of Cases. Remarks Brought forward 140 Breast, Abscess of 1 Bronchitis ... 3 Cardiac, Systolic murmur 4 Referred to Charing Cross Hospital. Cyst. Sebaceous of axilla 1 Dental disease 75 Enuresis 4 Fracture— Of Clavicle 1 Referred to Victoria Hospital for Children, Tite Street. Of Metacarpal of thumb 1 Haemorrhage 2 One admitted to Infants' Hospital,Vincent Square. One treated at Belgrave Hospital. Hernia— Inguinal 1 Umbilical 4 Hydrocele 2 One referred to Bolingbroke Hospital. Jaundice 1 Marasmus 1 Admitted with mother to Wilson Hospital. Nephritis, chronic... 1 Admitted to Charing Cross Hospital. Nits 1 Ophthalmic— All referred to Royal Westminster Ophthalmic Hospital. Epiphora 1 Strabismus Orthopfedic — Genu valgum Hammertoes Pes planus with genu valgum 1 Carried forward 252 28  Number of Cases. Brought forward 252 Pes planus valgus 1 Spine, curvative of 2 Tibia, outward curvative of 22 Otorrhcea 1 Skin diseases— Eczema 1 Scabies 2 Stomatitis 1 Threadworms 5 Tonsils, enlarged 49 Vulva, inflamation of 1 Whitlow 2 Total 339 Ante-Natal Centres One Ante-Natal Clinic is held each month at the Cavendish Road, Meopham Road and Town Hall Centres, and one clinic each week in connection with Woodlands Maternity Home. As the number of patients attending the Woodlands Clinic was so large, an additional clinic was commenced in November. This extra clinic is held once each month. The total number of expectant mothers attending the centres was 476, the total number of attendances being 2,673. Of the total number of notified births, 49 per cent, of the mothers had attended the ante-natal centres, that is, almost half. That the ante-natal work has grown steadily during the past five years will be readily appreciated by a glance at the following table, which gives a comparison of the figures for the years 19331937 inclusive:- 29 Table to show growth of Ante-Natal Work Year. Number of expectant mothers attending the Centres. Total number of attendances. Percentage of total number of mothers of notified births who attended the Centres. 1983 327 1,257 35.5 1934 375 2,071 40.0 1935 433 2,294 45.0 1936 468 2,406 47.0 1937 476 2,673 49.0 The average attendance at each individual centre is shown in the following table:- Table to show average attendance of each centre Number of expectant mothers attending. Number of attendances. Average attendance Woodlands 302 2,223 42.7 Cavendish Road 38 100 9.0 Meopham Road 57 105 9.5 Town Hall 79 245 22.2 This gives an average for all centres of 20.9, as compared with 17.3 in 1936. 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 homes and attended by midwives. Any patient who was to be attended by her own doctor was advised to attend him or her for her ante-natal supervision. 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 acompanying the patient in either case. Letters were sent to 30 midwives who referred patients to the clinics, and midwives were welcomed at the centres, the patients' ante-natal notes being available for their 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 milk were also made. Remarks on Pathological Conditions There were 66 cases of simple albuminuria of pregnancy and three cases of toxaemia of pregnancy. Two of these latter were immediately admitted to the City of London Maternity Hospital. One of these made such satisfactory progress under treatment that she was able to be discharged, and was ultimately delivered in Woodlands as had been arranged. The third patient was referred to her own doctor, who had her admitted to St. James' Hospital. Malpresentations were found in 57 cases. Of these, 29 underwent spontaneous version, 10 were corrected at the clinics, 14 were referred to hospital, and version was performed in nine of these cases. Caesarian Section was done in six cases. The indications for this operation were:- Case. Indication. Remarks. I. Auricular fibrillation. Caesarian Section plus sterilisation was done. II. Asymetrical pelvis. III. Contracted pelvis plus an extended breech presentation. IV. Disproportion. V. Dermoid Cyst in pouch of Douglas. VI. Ovarian Cyst plus an extended breech presentation. The first two patients were delivered in Charing Cross Hospital, the last four in the City of London Maternity Hospital. In each case the mothers made an uneventful recovery, and the baby was live and well, 31 An X-Ray is taken in cases of doubtful presentation or of suspected multiple pregnancy. 20 cases had an X-Ray during the year. One hundred and seventy-eight patients were found to have some form of dental disease, every case of caries from a slight degree to severe decay being included in this number. The majority of patients attended their own dentist, a number were referred to the dental clinic, and a small minority of cases went to hospital. Every case having a systolic blood pressure of 140 or over is included under the term Hyperpiesis. Five hundred and twelve 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 66 Disproportion 1 Admitted to City of London Maternity Hospital for Cfesarian Section. Haemorrhage — Ante partum 1 Admitted to City of London Maternity Hospital. Hyperpiesis 120 Malpresentations— Breech 43 Spontaneous version, 19 cases. Version at clinics, seven cases. Referred to hospital, 14 cases, where version was performed in nine cases. Admitted to City of London Maternity Hospital, one extended breech. Transverse 14 Spontaneous version, ten cases. Version at clinics, three cases. Carried forward 245 32 Number of Cases. Remarks. Brought forward 245 Miscarriage, threatened 1 Pelvis— Asymetrical 1 Admitted to Charing Cross Hospital for Caesarian Section. Contracted, plus 1 Extended breech presentation 1 Admitted to City of London Maternity Hospital for Caesarian Section. Toxaemia of pregnancy 3 Two cases admitted to City of London Maternity Hospital for treatment. One case discharged from there and delivered in Woodlands. One case admitte'd to St. James' Hospital. Varicose Veins— Of legs 42 Of vulva 3 Saphena varix 1 Referred to Bolingbroke Hospital. Ggncecological Conditions— Cystocele 2 Cyst— Dermoid in pouch of Douglas 1 Admitted to City of London Maternity Hospital for Ctesarian Section and removal of cyst. Ovarian plus extended breech presentation 1 Admitted to City of London Maternity Hospital for Caesarian Section. Carried forward 302 33 Number of Cases. Remarks. Brought forward 302 Conditions unconnected with Pregnancy— Anaemia 3 One referred toCharing Cross Hospital. Cardiac— Auricular fibrillation 1 Admitted to Charing Cross Hospital for Caesarian Section and sterilization. Extrasystoles 1 Mitral regurgitation 1 Referred to Charing Cross Hospital. „ stenosis 1 ,, systolic murmur 14 One case admitted to City of London Maternity Hospital. ,, systolic murmur with sinus arhythmia 1 Referred to Charing Cross Hospital. Pulmonary murmur 1 Reduplication of mitral second sound 1 Cataract 1 Referred to Royal Westminster Ophthalmic Hospital. Dental— Caries 144 Pyorrhœea 25 Gingivitis 9 Epistaxis 1 Hernia, left inguinal 1 Psorias 1 Pulmonary fibrosis 1 Teno-synovitis of forearm 1 Thyroid, enlargement of 1 Warts of nose and neck 1 Total 452 34 Post-Natal Centre A Post-Natal Centre is held at the Town Hall each month. Leaflets are given to the patients when they leave 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 patients who attended this clinic are shown in the following table: — Pathological Conditions Found in Post-Natal Cases. Number of Cases. Remarks. Anaemia 2 Cyst, inclusion Cyst of fornix 1 ,, of breast 1 Cystocele 1 Dental— Caries 12 Pyorrhœa 2 Gingivitis 1 Diabetes 1 Referred to Charing Cross Hospital. Hæmorrhage 1 Hyperthyroidism 1 Referred to Charing Cross Hospital. Leucorrhœa 7 Four cases referred to South London Hospital for Women. Migraine 1 Piles 1 Referred to Gordon Hospital. Retroversion . 21 Corrected at clinic, six cases. Referred to hospital, 14 cases. Referred to family doctor, one case. Rupture of perineum 1 Subinvolution 2 Varicose veins of legs 1 Total 57 35 The total number of women who attended the post-natal clinic was 134, the total number of attendances being 152,- giving an average attendance of 13.8. 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 were held each month until February, when it was found necessary to hold three sessions. The total number of patients referred to the dental clinic during the year was 71. Of these 53 actually attended, the total attendances being 194, the average attendance being 6.3. The work done at the dental clinic during the year is shown in the following table:- 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 made according to the scale adopted by the Council. Diphtheria Immunisation Clinic The clinic for diphtheria immunisation is open to patients of all ages. During the year 31 sessions were held, the total number of patients who attended was 280, and the total number of attendance was 833, the average attendance being 27. Work Done at the Dental Clinic Inspections 69 Extractions under local anaesthesia 19 Extractions under general anaesthesia 40 Fillings 28 Impressions 9 Dental adjustments 26 Scaling 3 Total attendance 194 86 Mayfield Convalescent Home On May 1st I visited the Convalescent Home for Mothers, Mayfield, Sussex, and at the time of writing this report I have just revisited it. The Home is sufficiently large for the accommodation of eight mothers and babies. It is a fairly large detached house with a small garden and a large field containing a shelter. On the ground floor are a common room for the mothers (which also serves as their dining room), a nursery (which is also used as a night nursery), matron's office, spare bedroom (in case any mother should be ill and have to be separated from the rest of the household), milk room, washing room and kitchen premises (scullery, pantry, etc.). The common room and nursery are both large, light and airy. On the first floor are a large, light, airy dormitory, containing eight beds, bedrooms for the matron, sister, day and night nurses and two maids, two bathrooms, two lavatories and sluice room. In the dormitory, each mother is provided with a locker or half a chest of drawers, and three cupboards in which suitcases are stored, shoes, etc., kept. The house is tastefully decorated and spotlessly clean, and there are usually flowers in nearly all the rooms. The staff dine in the same room as the mothers and have the same food. I had lunch each time I visited the Home, and the food was good, well cooked and nicely served. The dietary includes an allowance of one pint of milk per head per day and fresh fruit daily, in addition to an abundance of fresh vegetables. The mothers are given a cup of tea at 6 a.m., when they feed their babies. Breakfast is at 8.30 a.m. At 10 a.m., milk or soup is provided. Lunch is at 1 p.m., tea 5 p.m., supper 8.30 p.m., and a cup of cocoa or Ovaltine is served at 9.30 p.m., bedtime. Any mother who wishes to rest longer in bed in the morning can have breakfast taken up to her. The matron is running the Home on proper lines and free from irksome restrictions on the liberty of the patients. There are no rules except that the babies must be fed by the clock, and the mothers are expected as a general rule to be in bed by 9.30 p.m. 37 A doctor attends the Home every Friday and examines each new patient. He attends at other times if necessary. Each mother is weighed on arrival, at the end of each week, and when she leaves. The babies are weighed frequently and test feeds are given when necessary. During the year thirteen mothers benefited by a stay at the Home. All the mothers greatly improved in health and expressed great satisfaction with the Home in every way, and with the treatment and kindness they received while there. The list of mothers with dates of their stay at the Home is shown in the following table, each mother being referred to by her reference letter. Mother. From which Centre. Date of Stay. Number of weeks. Mrs. F. Meopham Road Jan. 7—Jan. 28 3 „ G. „ „ April 8—April 22 2 „ H. Sherwood Park April 22—May 20 4 „ I. Western Road May 20—June 3 2 „ J. „ „ June 3—June 17 2 „ K. Meopham Road June 17—July 15 4 „ L. Sherwood Park July 15—Aug. 12 4 „ M. Western Road Aug. 12—Aug. 26 2 „ N. Cavendish Road Aug. 26—Sept. 9 2 „ O. Town Hall. Oct. 7—Oct. 21 2 „ P. St. Barnabas Oct. 28—Dec. 16 7 „ Q. Meopham Road Nov. 11—Dec. 2 3 ,, R. Parish Room Dec. 2—Dec. 16 2 Mrs. K. went to the Home alone, as her child was above the age for admission. Mrs. O. was an ante-natal case. Mrs. P. unfortunately developed a condition which necessitated a minor operation. After consultation between the doctor who attends the Home, the matron and myself, it was decided to remove her to the Tunbridge Wells Hospital on November 9, where she remained until November 17, when she was re-admitted to the Convalescent Home, where she stayed until she was perfectly rstored to health. In two necessitous cases the railway fares were paid. 38 The Home was closed from January 30 to April 8 as a temporary measure, as it was found that the mothers were not willing to go away while the weather was cold and wet. From September 9 to October 7 the Home was in quarantine for German measles. In conclusion, I should like to thank Mr. T. V. O'Sullivan for the interest he has taken in the cases referred to him from the ante-natal and post-natal clinics, and Mrs. E. S. Wray, Superintendent Health Visitor, and Miss G. M. Evans, Matron of Woodlands Maternity Home, for all the help they have given me during the year. I tender thanks also to the health visitors and nursing staff of Woodlands and to the voluntary workers at the infant welfare centres for their assistance. F. M. PARSONS, m.r.c.s., L.R.c.p. 89 SANITARY CIRCUMSTANCES OF THE AREA WATER SUPPLY With the exception of eight houses in Goat Road, the whole of the Borough is supplied by the mains of the Metropolitan water Board. The houses in Goat Road are supplied from the Sutton Water Company. Occasional samples of water have been taken and all have proved satisfactory. RIVERS AND STREAMS Visits have been paid to all works suspected of discharging polluted effluent into surface water sewers. Three complaints were received and remedied as follows:— In two cases precipitation tanks were installed through which the effluent passed before discharge into sewer. In one case an oil interceptor was installed. 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. 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 Thirty-two observations were kept on chimneys during the year. In connection therewith nine notices were served and the nuisances abated. SWIMMING BATH The water in the swimming bath is under a continuous process of filtration, chlorination and aeration. Bacteriological 40 tests show that the water is very clean. Slipper baths are also provided, and unemployed persons are allowed free use of these baths. ERADICATION OF BED BUGS No. of Council houses found infested during year 98 No. of other houses found infested during the year 18 No. of Council houses disinfested by Council staff 98 No. of Council houses disinfested by contractors nil Methods employed:— 287 rooms treated with sulphur di-oxide. 299 rooms treated with insecticide sprays. (inclusive of rooms treated on more than one occasion.) No. of private houses treated by Council staff nil No. of rooms in private houses disinfested by owners or occupiers after notice 32 The furniture of tenants moving into Council houses from verminous premises is disinfested by hydrogen cyanide. This work is done by a firm of contractors. During the year the furniture from 64 houses was so treated. SHOPS See under Chief Sanitary Inspector's report. 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. 41 Infectious Diseases.—Scholars in contact with a case of infectious disease are excluded from school, the period of the 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. THE ANNUAL REPORT OF THE 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 myself and Inspectors A. W. Lock, L. Gleed and L. R. Rummery (Shops Inspector): — Total number of visits paid 13,094 Number of complaints received and investigated 722 Number of premises inspected 5,454 Number of premises revisited 4,517 Number of houses measured for permitted numbers, Housing Act, 1936 1,300 Number of nuisances discovered 1,065 Number of nuisances abated without reports 1,004 Number of nuisances abated after reports 208 Number of intimatory notices served 1,227 Visits to butchers and other food shops 625 Visits to marine stores 8 Visits to stables 55 Visits to schools 11 Visits to caravan yards 49 Visits to refuse dumps 153 Details of visits to other premises are enumerated in other sections of the report. Character of Work Done Roofs repaired 306 Walls repointed or cement rendered 117 Rainwater gutters and piping repaired or renewed 150 Ventilation under floors provided or improved 54 42 Dampness to ground floor rooms remedied 100 Water service pipes repaired 16 Ventilation of watereloset compartments provided 12 Waterclosets: repairs to roofs, walls, doors and seats 39 Flushing apparatus repaired or renewed 108 Water storage cisterns cleansed or covered 4 Water supply to houses reinstated 1 Back yards and sculleries paved or repaired 66 Flooring of rooms repaired 82 Rooms cleansed and redecorated 482 Repairs to internal plastering of walls and ceilings 246 New scullery sinks provided 6 Repairs to sinks and waste pipes 49 Walls round sinks rendered 1 Window frames and sashes repaired 49 Windows made to open 37 Sashcords provided 324 Drains tested 10 Drains repaired and cleansed 176 New watercloset pans and traps provided 39 Repairs to firegrates 76 Repairs to washing coppers 22 Food cupboards provided 5 New dustbins provided 407 Accumulations removed 42 Rooms disinfected, after infectious disease 400 Nuisance from animals improperly kept abated 2 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-two licences to store petroleum and cellulose solutions were granted, totalling 147,153 gallons. A licence was also issued for 5 cwt. of carbide of calcium to be stored. 43 Food Inspection—Carcases Inspected and Condemned Cattle Cows Calves Sheep Pigs Number inspected 7 16 4 31 5,387 All diseases except Tuberculosis Whole carcases condemned ... 1 ... ... 68 Carcases of which some part or organ was condemned ... 4 ... ... 90 Percentage of the number inspected affected with disease other than Tuberculosis ... 31.25% ... ... 2.93% Tuberculosis only. Whole carcases condemned ... 4 ... ... 5 Carcases of which some part or organ was condemned 4 9 ... ... 486 Percentage of the number inspected affected with Tuberculosis 57.14% 81.25% ... ... 9.11% Surrendered for destruction:—4 stones of crabs, 4 boxes of pears. Shops Acts. Number of shops inspected 1623 Visits in connection with Shops (Sunday Trading Restrictions) Act, 1936 138 Notices served under Section 7, Shops Act, 1934, to keep record of hours worked by young persons and intervals for meals and rest 7 Notices served under Section 10, Shops Act, 1934, to provide washing facilities, w.e. accommodation and to maintain a reasonable temperature 3 Certificates granted exempting provision of w.c. accommodation in special cases 1 Cautions given in cases of breaches of Shops (Hours of Closing) Act, 1928 13 Cautions given in cases of breaches of Hairdressers and Barbers' Shops (Sunday Closing) Act, 1930 1 44 Cautions given in cases of working of young persons in excess of permitted number of hours 3 Cautions given in cases of breaches under Section 30, Shops (Sunday Trading Restrictions) Act, 1936, regarding compensatory holidays in lieu of Sunday employment 4 Cautions given in cases of breaches under Section 1, Shops (Sunday Trading Restrictions) Act, 1936, serving of customers with prohibited articles 1 There were two prosecutions during 1937 following offences under the Shops Acts, as follows:— Particulars. Result. Shops Act, 1934. Section 1. Working young persons in excess of permitted ber of hours. Fined five shillings and two guineas costs. ,, 7. Failing to keep and exhibit Form F (record of hours worked and interval for meals) Ditto. ,, 7. Failing to keep and exhibit Form G (record of overtime worked) Ditto. The manager fined as well as principal five shillings and five shillings costs on each of the above counts. Shops (Hours of Closing) Act, 1928. Service of customers during closing Fined ten shillings hours. and two guineas costs. Yours obediently, K. J. GUTTERIDGE, Chief Sanitary Inspector. 45 HOUSING Inhabited Houses.—The number of inhabited houses in the Borough was 16,822, being an increase of 271 houses since the previous year, the average number of persons per house being 3.90, compared with 3.85 last year. The number of inhabited houses in each ward is as follows:— North Ward 3,182 Population 12,410 South 3,312 12,917 East „ 6,774 „ 26,419 West „ ... 3,554 „ 13,861 Housing Statistics 1. Inspection of Dwelling Houses During The Year :— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 3090 (b) Number of inspections made for the purposes 3340 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 272 (b) Number of inspections made for the purpose 305 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1145 46 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 927 3. Action Under Statutory Powers During the Year:— A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (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 215 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 204 (b) By local authority in default of owners nil C. Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which demolition orders were made 3 (2) Number of dwelling houses demolished in pursuance of demolition orders 4 47 D. Proceedings under Section 12 of the Housing Act, 1936:— (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, 1936 (Part IV)—Overcrowding A. (1) Number of houses overcrowded at end of year 118 (2) Number of families dwelling therein 163 (3) Number of persons dwelling therein 899 B. Number of new cases of overcrowding reported during the year 36 C. (1) Number of cases of overcrowding relieved during the year 193 (2) Number of persons concerned in such cases 704 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 Of the 193 cases of overcrowding relieved during the year, 21 families were rehoused by the Corporation, 88 families moved from overcrowded premises, and in 60 cases, overcrowding was relieved by a reduction of the number in the family due to marriage, death and other causes. In 24 cases, on re-inspection, the premises were found not to be overcrowded, clue to rearrangement of accommodation, etc. 48 INSPECTION AND SUPERVISION OF FOOD FOOD AND DRUGS (ADULTERATION) ACT, 1938 The duties under the Food and Drugs (Adulteration) Act, 1928, are carried out by the Surrey County Council. The following number of samples have been taken during the year from this district:— Articles Analysed Adulterated or Deteriorated Prosecutions Convictions Formal Informal Total Formal Informal Total Milk 45 ... 45 2 ... 2 ... ... Margarine 3 1 4 ... ... ... ... ... Meat 2 ... 2 ... ... ... ... ... Sausages 1 ... 1 ... ... ... ... ... Drugs 1 ... 1 ... ... ... ... ... Other Articles 13 ... 13 2 ... 2 ... ... Totals 65 1 66 4 ... 4 ... ... Details of Other Articles— Suet 1 ... 1 1 ... 1 ... ... Shredded suet 3 ... 3 1 ... 1 ... ... Oranges 1 ... 1 ... ... ... ... ... Bacon 2 ... 2 ... ... ... ... ... Grape fruit squash 1 ... 1 ... ... ... ... ... Dolite 1 ... 1 ... ... ... ... ... White compound 1 ... 1 ... ... ... ... ... Sweet almonds 2 ... 2 ... ... ... ... ... Black currant wine 1 ... 1 ... ... ... ... ... SLAUGHTER HOUSES There are five slaughter houses, of which two are registered and three are licensed. During the year 381 visits of inspection were made. Three requests were made for periodical lime-washing of slaughter houses as prescribed by the Council's byelaws. For details of Meat Inspection see the Chief Sanitary Inspector's report. BAKEHOUSES The number of bakehouses in the district is 15. Sixty-five visits have been paid, and four verbal notices served to limewash bakehouses, all of which were complied with. 49 DAIRIES AND COWSHEDS There are 31 registered premises within the district of which 30 are dairies and one cowshed. During the year 128 visits of inspection were paid and three defects were found and remedied. MILK (SPECIAL DESIGNATION) ORDER, 1936 During the year the Council granted the following number of licences under the above named Order:— Tuberculin Tested 6 Pasteurised 7 Accredited 2 Pasteurising Plant 1 Supplementary Licences— Pasteurised 5 Tuberculin Tested 4 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 Council, 30 samples were taken by District Sanitary Inspectors. The results were as follows:— Designation Number of Samples Remarks Pasteurised 20 All conformed to legal standard. Grade A. T.T 2 Conformed to legal standard. Undesignated 7 All samples were up to standard of pasteurised milk. Carton Milk 1 Standard of pasteurised milk. PIGGERIES There are 13 piggeries in the Borough. 149 visits were paid during the year. 50 OTHER FOOD PREPARING PLACES There are four other premises in which food is prepared for human consumption. All of these have been systematically visited. NUTRITION During the year 2,134 gallons of liquid milk and 7,962 lbs. of dried milk have been supplied free or at cost price to mothers and children under five years of age in the Borough. Several talks on nutrition and demonstrations in cookery have been given to mothers attending the welfare centres. HEALTH PROPAGANDA The cinema van of the Health and Cleanliness Council was engaged for showing health films at Mitcham Fair. The van attracted large crowds, and although it is difficult to judge how many of the spectators learnt the lessons which were taught, it is nevertheless a useful form of propaganda. This Borough participated in the Surrey Health Campaign. A Health Day each month was held during October, November and December. The programme for a Health Day consisted of showing health films to school children at the local cinema during the morning. In the afternoon, a talk on a Maternity Child Welfare subject was given to mothers at the Welfare Centre, and the talk was followed by a cookery demonstration. In the evening a meeting was held for the general public, at which health films were shown and a special speaker addressed the meeting on a particular aspect of public health. 51 FACTORIES AND WORKSHOPS There are 173 factories and workshops in the district, of which 101 are factories and 72 are workshops. In addition there are 14 workplaces. During the year 322 visits of inspection were paid. Outworkers There are 148 outworkers in Mitcham. One hundred and eighty-five visits of inspection were paid and, in connection with these, no defects found. During the year one case of infectious disease was notified as occurring in the house of an outworker. In this case it was not 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 78 Onion peeling 12 Making of wearing apparel 31 Tailoring 3 Millinery 1 Embroidery 3 Confectionery boxes 9 Artificial flowers 2 Boots 1 Brace maker 1 Hair-nets and combs 1 Fishing rod bags 1 Fancy goods 2 Soft toys 2 Loose covers for furniture 1 Total 148 52 Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors. Premises Number of Inspections Written Notices Prosecutions Factories (Including Factory Laundries) 158 — — Workshops (Including Workshop Laundries) 40 — — Workplaces (Other than Outworkers' premises) 124 2 — Total 322 2 — 53 Defects found in Factories, Workshops and Workplaces. Particulars Number of Defects Found Remedied Referred to H.M. Inspector Number of Prosecutions JNuisances under the Public Health, Acts:—* Want of cleanliness 4 4 Want of ventilation ... ... Overcrowding ... ... Want of drainage of floors ... ... Other nuisances 1 1 Sanitary accommodation insufficient 35 35 unsuitable or defective 4 4 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 44 44 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, &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 TOTAL Nil Nil 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 338 as compared with 357 last year. Contacts, Suspects, Etc. On 22 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 523 visits to cases of infectious disease; 368 were primary visits and 155 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-SpinaJ, Fever Poliomyelitis Totals January 8 13 ... ... 15 ... ... ... ... ... ... 36 February 14 2 ... 3 4 ... ... ... ... ... ... 23 March 11 4 ... 5 ... 1 ... ... ... ... 21 April 17 4 ... 1 1 ... ... ... ... ... ... 23 May 17 6 ... 2 ... ... ... ... ... ... 25 June 32 3 ... ... 2 ... 1 ... ... ... ... 38 July 29 7 ... ... 3 ... 1 ... ... ... ... 40 August 15 5 ... ... 1 1 ... 1 ... ... ... 23 September 12 11 ... ... 3 ... 2 ... ... ... ... 29 October 18 7 ... 1 2 ... ... ... ... 1 ... 29 November 14 18 ... 2 1 ... ... ... ... ... ... 35 December 5 9 ... 2 ... ... ... ... ... ... 16 Total 192 89 ... 16 32 1 5 1 ... 1 1 338 56 Disease Case rates per 1,000 Ward population. North South East West Small Pox — — — — Scarlet Fever 2.8 3.0 2.6 3.3 Diphtheria 0.3 2.4 1.4 1.8 Enteric Fever . — — — — Erysipelas 0.1 0.2 0.2 0.2 Pneumonia 0.4 0.4 0.4 0.6 57 Cases of Infectious Disease Notified During the Year 1937. Disease Number op Cases Notified Total Cases Notified in bach Ward Total Cases Removed to Hospital Deaths At all Ages At Ages—Years Under 1 year 1 and under 2 years 2 and under 3 years 3 and under 4 years 4 and under 5 years 5 and under 10 years 10 and under 15 years 15 and under 20 years 20 and under 35 years 35 and under 45 years 45 and under 65 years 65 and over North East South West Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 192 1 8 5 12 26 97 28 8 1 5 ... ... 35 71 39 47 178 ... Diphtheria 89 ... 2 5 4 8 41 14 5 5 3 2 4 38 32 15 89 5 Typhoid Fever ... ... ... ... ... ... ... Erysipelas 16 1 ... ... ... ... 2 1 1 2 4 4 1 2 7 3 4 10 ... Pneumonia 32 1 ... 2 ... 1 5 1 2 7 3 8 1 5 12 6 9 38* Puerperal Fever 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 ... Puerperal Pyrexia 5 ... ... ... ... ... ... ... ... 6 ... ... ... 1 2 ... 2 5 2 Ophthalmia Neonatorum 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... Poliomyelitis 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... Cerebro-Spinal Fever 1 ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... ... ... 1 Dysentery ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 338 4 11 12 16 36 145 46 16 21 15 14 2 48 131 81 78 285 46 * Includes all forms, some of which are not notifiable. 58 Infectious Disease Notifications. 1922-37. Disease 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 Small Pox ... ... ... ... ... ... 9 7 ... 4 1 ... ... ... ... ... Scarlet Fever 178 110 87 106 104 145 102 134 113 105 174 240 392 143 171 192 Diphtheria 84 35 59 201 87 76 75 133 129 49 32 40 83 80 104 89 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 1 Anthra x ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal 1 ... 6 ... ... 2 1 4 ... ... 1 4 1 1 3 1 Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 13 15 11 10 13 14 10 22 22 17 11 31 30 20 22 16 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Diarrhoea ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Chicken Pox 26 91 35 ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis ... 4 ... ... 1 2 ... ... 1 ... ... ... ... ... ... 1 Ophthalmia 3 6 7 5 12 10 3 3 1 3 4 2 2 4 3 1 torum Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis ... ... ... 2 2 ... ... ... 2 1 1 1 ... ... ... ... Lethargica Pneumonia 30 19 39 42 30 62 54 57 35 45 52 37 45 35 36 32 Malaria 8 3 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia ... ... ... ... 1 14 9 5 6 9 4 9 6 4 11 5 Totals 347 287 246 376 259 340 270 375 319 242 288 368 560 293 357 338 Cerebro-Sfinal Fever One case occurred during 1937, and the patient unfortunately died. Influenza During the year 15 deaths from influenza were recorded. Seven were males and eight females. The previous year eight 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. 59 Ophthalmia Neonatorum During the year one case of ophthalmia neonatorum was notified:— Cases Notified. Treated Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. At Home. In Hospital. 1 nil. 1 1 nil. nil. nil. 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 disease, such as chicken pox, measles, mumps, etc. The numbers so notified are reported on under various diseases mentioned later in this report. Cancer The number of deaths from cancer registered during the year was 76, of which 33 were males and 43 were females, as compared with 80 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 1937 was as follows:— Digestive organs 38 cases Genito-urinary organs 12 „ Breast 6 „ Respiratory system 9 „ Other sites 11 „ Total 76 „ The following table shows the number of deaths from cancer, together with the death rate as compared with England and Wales:— 60  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 81 .89 1.18 1920 34 .94 1.16 1921 81 .87 1.21 1922 84 .94 1.22 1928 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 1981 81 1.41 1.48 1932 68 1.0 1.51 1933 52 .86 1.52 1284 70 1.1 1.56 1935 61 1.0 1.58 1936 80 1.2 1.61 1937 76 1.1 1.63 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 83 new cases of tuberculosis were notified, viz.:— Males. Females. Total Pulmonary 37 39 76 Non-Pulmonary 4 3 7 Total 41 42 83 The death rate in each Ward per 1,000 population is as follows:—  Pulmonary Tuberculosis Non-Pulmonary Tuberculosis North 0.7 0.08 South 0.7 0.07 East 0.5 0.1 West 0.8 0.1 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 Non- Respiratory m. F. m. F. M. F. M. F. Under 1 year ... ... ... ... ... ... ... ... 1 year to 5 years ... ... ... 1 ... ... 1 ... 5 years „ 10 „ 3 ... 1 ... 1 ... ... ... 10 „ „ 15 „ ... 1 1 ... 1 1 1 ... 15 ,, ,, 20 „ 4 8 1 ... ... 2 2 1 20 ,, ,, 35 ,, 15 17 ... 1 12 14 2 ... 35 „ „ 45 „ 4 8 1 ... 1 2 ... ... 45 „ „ 65 „ 10 5 ... 1 7 4 ... ... 65 ,, and upwards 1 ... ... ... ... ... ... ... Totals 37 39 4 3 22 23 6 1 The total number of deaths registered as occurring from tuberculosis was viz.:— Male Females Total Pulmonary 22 23 45 Non-Pulmonary 6 1 7 Total 28 24 52 England and Wales Mitcham Death rate from respiratory tuberculosis per 1,000 population 0.70 0.08 Death rate from non-pulmonary tuberculosis per 1,000 population 0.12 0.10 62 New eases 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 2 ... 1 ... 4 Non-Pulmonary: males ... ... ... 2 1 ... ... ... ... ... ... 3 Non-Pulmonary: females ... ... ... ... ... ... ... ... ... ... ... ... The sources from which information as to the above mentioned cases was obtained are as follows:— No. of Cases Pulmonary NonPulmonary Death return - (a) From Local Registers 2 1 (6) Transferable deaths from Registrar General 4 1 Posthumous notifications 1 1 Number of cases removed from register during 1937:— Reason Pulmonary Non-Pulmonary Total Cases Males Females Total M ales Females Total Withdrawal of notification ... ... ... ... ... ... ... Recovery from disease 1 1 1 ... 1 2 Death 22 26 48 6 6 54 Otherwise 15 12 27 3 5 8 35 68 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths is as follows:— Non-notified tuberculosis deaths 10 Notified tuberculosis deaths 42 Percentage of non-notified T.B. deaths (all forms) 19 per cent. Percentage of non-notified pulmonary T.B. deaths 5 „ „ 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 160 such examinations have been made. Tuberculosis Care Committee The Mitcham Tuberculosis Dispensary area comprises the Boroughs of Mitcham and Beddington and Wallington. Functions of the 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—1937 No. of persons assisted during 1937 50 Receiving supplies of milk, butter, eggs, continuously for 12 months 7 „ „ „ for 6-9 months 5 „ „ ,, under 6 months 38 Clothing, bedding, supplied by Care Committee 4 64 Clothing, bedding, supplied through the medium of Committee 7 Employment obtained 3 Tuberculous persons who have received special consideration re housing 6 Coal supplied 2 Christmas comforts supplied 26 Weekly allowance of 10s. for Home Help 1 A Handicraft Centre has also been established and classes are held once a week at the Mitcham Town Hall. Small Pox No case of small pox was notified during the year 1937. Scarlet Fever The number of cases notified during the year was 192, this being 21 more than last year. 178 were removed to hospital. No deaths were registered from this disease during the year. Diphtheria Eighty-nine cases were notified during the year and all the cases were removed to hospital for treatment. Five deaths from this disease were registered during the year. All the contacts are swabbed as a routine measure. Diphtheria Immunisation A diphtheria immunisation clinic is held at the Town Hall every week. During the year 280 children have been immunised. Diphtheria prophylactic is also given to the medical practitioners in the district free of charge, and during the year 21 persons were immunised by doctors obtaining supplies of prophylactic from the Council. Typhoid Fever No cases were notified during the year. Diarrhcea and Enteritis Under Two Years of Age Five deaths were registered during the year: two males and three females. 65 Encephalitis Lethargica One case was notified during the year, and one death registered. Chicken Pox One hundred and seventy-nine cases of chicken pox were notified by the head teachers of the schools in the district. Whooping Cough One hundred and ninety-three cases of whooping cough were notified during the year by the head teachers of the schools in this district. Three deaths were registered. Measles Seventy-two cases of measles were notified during the year by the head teachers of the schools in the district. No deaths were registered. Mumps One hundred and four cases of mumps were notified by the head teachers of the schools in the district. Ringworm Five cases of ringworm were reported by the teachers. Impetigo Eighteen cases of impetigo occurred in school children during the year. Scabies Eight cases of scabies occurred in school children. Erysipelas Sixteen cases were notified. 10 cases were removed to hospital. No deaths from this disease were registered. 66 Puerperal Fever One case was notified during the year. The number of notified cases of puerperal fever relate only to the first thirtynine weeks of the year. Cases occurring afterwards are classed as puerperal pyrexia and included accordingly. Puerperal Pyrexia Five cases were notified and two deaths recorded. Details of these cases are given in the first section of this report. Pneumonia Thirty-two cases of primary pneumonia were notified during the year. The number of deaths from all forms of pneumonia, some of which are not notifiable, was 38. 67 WANDLE VALLEY JOINT HOSPITAL BOARD. Cases admitted to the hospital during the year ended December 31, 1937. Disease Beddington & Wallington Coulsdon & Purley Merton & Morden Mitcham Cases Deaths Cases Deaths Cases Deaths Cases Deaths Diphtheria 4 ... 10 ... 28 4 98 2 Scarlet Fever 59 ... 48 ... 115 ... 181 ... Typhoid 1 ... 13 1 1 1 ... ... Erysipelas 1 ... 2 ... 1 ... 8 ... Tonsilitis 1 ... 5 ... 2 ... 7 ... Measles 2 ... 1 ... 3 ... 3 ... Whooping Cough 1 ... ... 3 ... 6 ... Rubella ... ... 1 ... 2 ... 5 ... Other Diseases Influenza ... ... ... ... ... 1 ... Impetigo ... ... ... ... 2 ... 1 ... Cerebro Spinal ingitis ... ... ... ... 1 1 ... Pneumonia ... ... ... ... ... 2 ... Meningitis-Tubercular ... ... ... ... ... 1 1 Mumps ... ... 2 ... 2 ... 2 ... Farunculosis - Amae- ... ... ... ... mia ... ... 1 ... ... ... 1 ... Puerperal Fever ... ... 1 ... ... ... ... Nephritis 1 ... ... ... ... ... ... Liver Abscess from ... ... Amoebic Dysentery ... ... ... ... ... ... 1 1 Rhinitis & Bronchitis ... ... ... ... ... ... 5 ... Adenitis ... ... ... ... 1 ... 1 ... Cellulitis of Ankle ... ... ... ... 1 ... ... Otitis Media ... ... ... ... 1 ... 1 ... Chicken Pox ... ... ... ... 3 ... 1 ... Anterior Poliomyelitis ... ... 2 ... 1 ... 1 ... Septic Burn of Foot ... ... ... ... ... ... 1 ... Septicaemia ... ... ... ... ... ... 1 ... 70 — 86 1 167 6 327 4 68 INDEX page Ambulances 14 Analysis of Mortality 13 Ante-Natal Clinics 16 Area 6 Bakehouses 48 Bed Bugs, Eradication of 40 Birth Rates 9, 13 Births, Live 6 — Illegitimate 7 — Still 8 Blindness, Prevention of 58 Cancer 59 — Deaths from 60 Causes of Deaths 12 Cerebro-Spinal Fever 58 Chicken Pox 65 Clinics 15 — Ante-natal 16 — Dental 17 — Orthopaedic 18 — Post-natal— 17 — Toddlers 16 — Welfare 15 Closet Accommodation 39 Dairies and Cowsheds 49 Death Rates 9, 13 Deaths 7, 8, 12 Dental Clinic 17 Diarrhoea and Enteritis 64 Diphtheria 64 —Immunisation 64 Encephalitis Lethargica 65 Erysipelas 65 69 PAGE Eradication of Bed Bugs 40 Factories and Workshops 51 Defects in 53 Inspection of 52 Food and Drugs Act (1928) 48 — Inspection and Supervision of 43, 48 Food Preparing Places 50 General Provision of Health Services for the Area 14 Health Propaganda 50 — Visiting 15 — Visitors, Visits by 22 Home Helps 17 Hospitals 14 Houses, Inspection of 45 — Inhabited 45 Housing 45 — Statistics 45 Impetigo 65 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, 57 — — — School 59 Influenza 58 Inhabited Houses 6, 44 Inquests 10 Inspection and Supervision of Food 48 Laboratory Facilities 14 Legal Proceedings 44 Maternal Mortality 10 Maternity and Child Welfare Services, Report on 23 — Home 19 Measles 65 Midwives 15 Milk (Special Designation) Order (1923) 49 — Sampling of 49 Mortality, Analysis of 13 70 PAGE Mortality, Infant 7, 9, 10 — Maternal 10, 13 Mumps 65 N.S.P.C.C 19 Nursing in the Home 15 Nutrition 50 Ophthalmia Neonatorum 59 Orthopaedic Clinic 18 Outworkers 51, 54 Parsons, Dr. F. M., Report 23 Patients Admitted to Hospital 67 Personnel, Committee 4 — Staff 5 Petroleum Act (1928) 49 Piggeries 49 Pneumonia 66 Population 6 Prevention of Blindness 58 Public Cleansing 39 Puerperal Fever 66 — Pyrexia 66 Rateable Value 6 Ringworm 65 Rivers and Streams 39 Sanitary Circumstances of the Area 39 — Inspector's Report 41 Scabies 65 Scarlet Fever 64 Schools 40 Senile Deaths 8 Shops Acts 43 Slaughterhouses 48 Small Pox 64 Smoke Abatement 39 Social Conditions 6 Statistics 6 — Housing 45 — Vital 7 Still Births 8 71 PAGE Sunlight Treatment 17 Swimming Bath 39 Toddlers' Clinics 16 Tuberculosis 60 — Care Committee 63 Typhoid Fever 64 Vital Statistics 7 Wandle Valley Hospital 67 Water Supply 39 Welfare Clinics 15 — — Attendance at 21 Whooping Cough 65 Woodlands Maternity Home19 X-Ray Examinations 18 +