BOROUGH OF MITCHAM REPORT OF THE MEDICAL OFFICER 0F HEALTH FOR THE YEAR 1938 BOROUGH OF MITCHAM REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1938 Mitcham: H. G. Mather, Caxton Works, Lower Green Borough of Mitcham HEALTH REPORT FOR 1938 To the Mayor, Aldermen and Councillors Sir, Ladies and Gentlemen, I have pleasure in submitting my annual report for the year 1938. The arrangement of the report follows that outlined in Circular 1728 of the Ministry of Health. There was no cause of sickness or invalidity that was specially noteworthy in the Borough during the year; in fact, the number of notifications of infectious diseases shows a decrease of 53 over last year, the main decrease being in the number of scarlet fever cases. The vital statistics compare very favourably with those of recent years, and show no excessive mortality from any particular cause. The birth rate of 15.1 per 1,000 is an increase on last year, whilst the death rate of 8.3 per 1,000 is the lowest recorded with the exception of the year 1935. The Maternity and Child Welfare services worked satisfactorily during the year, and most of the clinics show a great increase in the amount of work undertaken. I record my appreciation of the support given me by all members of the Council, and especially the members of the Public Health and 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 Department, Mitcham Court, Mitcham. BOROUGH OF MITCHAM PUBLIC HEALTH COMMITTEE Chairman Councillor H. Lee His Worship the Mayor (Alderman S. L. Gaston, J.P.) Aldermen— E. J. D. Field, J.P. Mrs. W. Toynbee Councillors— H. L. Gauntlett T. J. Higgs J. E. Hill Rev. T. King V. G. Pullen Miss R. K. Wilson MATERNITY AND CHILD WELFARE COMMITTEE Chairman Councillor G. R. Madgwick His Worship the Mayor Aldermen— E. J. D. Field, J.P. Mrs. W. Toynbee Councillors— A. T. Gidden Rev. T. King Mrs. C. Randall Mrs. E. Watson Miss R. K. Wilson Mrs. H. M. Hallowes Co-opted Members— Miss E. C. Chart Mrs. D. L. Chappell Mrs. C. C. Norman Mrs. C. J. Ericson Dr. G. M. Stoker REPRESENTATIVES ON WANDLE VALLEY JOINT HOSPITAL BOARD His Worship the Mayor Alderman A. H. Bailey Councillors— Miss R. K. Wilson W. Dalton REPRESENTATIVES ON WANDLE VALLEY JOINT SEWERAGE BOARD His Worship the Mayor Aldermen— E. J. D. Field, J.P. J. P. Turner 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. Persons, 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 W. H. B. Magauran, M.D., F.R.C.S. Consultant in Disease of the Eye A. J. Cameron, F.R.C.S., D.O.M.S. Chief Sanitary and Meat Inspector. Petroleum Inspector Shops Act Inspector K. J. Gutteridge, Cert. S.I.B. Assistant Sanitary and Meat Inspectors A. H. Riley, 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 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. 0. Sanitary Inspectors' Exam. Board. 7. Diploma Sanitary Science. 8. Sick Children's Registered Nurse. Clerks J. B. A. Roodhouse L. J. Bellingham Miss M. Stirling 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, 1938 66,020 Number of inhabited houses, 1921 7,150 1931 13,187 1938 17,115 Rateable Value, 1938 £480,918 Sum represented by a 1d. rate £1,915 STATISTICS. Total. Male. Female. Rate per 1,000 of population. Live Births. Legitimate 971 503 468 Illegitimate 29 11 18 Total 1,000 514 486 15.1 Total. Male. Female. Rate per 1,000 total births. Still Births Legitimate 28 14 14 Illegitimate — — — Total 28 14 14 27.2 7 Deaths. Total. Male. Female. Kate per 1,000 of population. 554 291 263 8.3 Deaths from disease and accidents of pregnancy and childbirth :— Rate per 1,000 total births. Prom puerperal sepsis— — From other puerperal causes 8 2.9 Total 3 Deaths of infants under one year of age:— All infants per 1,000 live births 38 Legitimate infants per 1,000 legitimate live births 88 Illegitimate infants per 1,000 illegitimate live births Deaths from:— Cancer (all ages) 103 Measles (all ages) 1 Whooping cough (allages) 1 Diarrhcea (under two years of age) 9 VITAL STATISTICS. During the year 1,000 live births were registered as belonging to this district, of which 486 were females and 514 were males, as compared with 944 last year. The live birth rate for the year was equal to 15.1 per 1,000 of population, as against 14.3 per 1,000 last year, the crude birth rate being 15.5 per 1,000. The birth rate for England and Wales was 15.1 per 1,000, as against 14.9 per 1,000 last year. Illegitimate Births The number of births registered as being illegitimate was 29, as compared with 26 last year. The illegitimate rate was equal to 2.8 per cent. of the total births, as against 2.9 per cent. in 1937. 8 Still Births The number of still births registered was 28, of which 14 were males and 14 females. percentage of Births Occurring in Institutions Year. Total births. Births in hospitals, etc. Percentage of births occurring in institutions. 1929 961 309 32.1 1830 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 1937 976 501 51.3 1938 1028 569 56.3 Number of births notified by midwives in 1938 683 ,, „ ,, doctors and others in 1938 345 Deaths During the year 554 deaths were registered, of which 291 were males, and 263 were females, as compared with 560 deaths last year. The death rate for the year was equal to 8.3 per 1,000 of the population, as compared with 8.5 per 1,000 in 1937. The death rate for England and Wales was 11.6 per 1,000 for the year 1938, and 12.4 per 1,000 for 1937. The birth rates, death rates per 1,000 of population, and the infantile mortality rates for the years 1915-1938 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 86 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 1937 14.3 14.9 8.5 12.4 43.4 58 1938 15.1 15.1 8.3 11.6 88.0 53 9 10 Infant Mortality During the year 38 deaths were registered as occurring in infants under one year of age: — Males Females Total Legitimate 21 17 38 Illegitimate — — — Total 21 17 38 as compared with 41 deaths last year. The infantile mortality rate for the year is equal to 38 per 1,000 live births, as against 43 per 1,000 last year. The infant mortality rate for England and Wales was 53 per 1,000 for 1937 and 58 per 1,000 for 1937. Maternal Mortality During the year three deaths were registered as being due to diseases or accidents of pregnancy, compared with two deaths last year. The following is a summary of the causes of death:— One death due to toxaemia of pregnancy. One death due to rheumatic heart. One death due to sub acute yellow atrophy of liver. 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 48 residents dying within the district and on nine Mitcham residents who died outside the district, a total of 57. In addition the coroner held thirteen post mortems without inquests. The following table shows the results of the findings of these inquests:— 11 Inquests Number Deaths from natural causes 20 Deaths from accidents:— Knocked down by motor vehicles 7 Knocked down by bicycle 5 Falls 6 Scalds 1 Drowning 1 Death from misadventure 3 Electrocution 1 Deaths from suicide:- Carbolic acid 1 Lysol 1 Coal gas poisoning 5 Drowning 1 Hanging 2 Cut throat 1 Murder 1 Found drowned 1 Total 57 12 Deaths Registered during the Year, 1938 Cause of Death. Males. Females. Total. Typhoid and paratyphoid ... ... ... Measles ... 1 1 Scarlet Fever ... ... ... Whooping Cough ... 1 1 Diphtheria ... 1 1 Influenza 4 2 6 Encephalitis lethargica ... 1 1 Cerebro-spinal Fever 2 ... 2 Tuberculosis of the Respiratory System 24 15 39 Other Tuberculous Diseases 2 ... 2 Syphilis 3 1 4 General Paralysis of the insane, tabes dorsalis ... 1 1 Cancer, malignant disease 50 53 103 Diabetes 2 ... 2 Cerebral Haemorrhage 5 14 19 Heart Disease 66 66 132 Aneurism 3 ... 3 Other Circulatory Diseases 12 10 22 Bronchitis 12 3 15 Pneumonia (all forms) 21 12 33 Other Respiratory Diseases 4 5 9 Peptic Ulcer 4 1 5 Diarrhoea, &c. (under two years) 5 4 9 Appendicitis 2 1 3 Cirrhosis of the Liver 1 ... 1 Other Diseases of the Liver, etc. 2 1 3 Other Digestive Diseases 5 12 17 Acute and Chronic Nephritis 4 4 8 Puerperal sepsis ... ... ... Other Puerperal causes ... 3 3 Congenital Debility, Premature Birth, Malformations, etc. 10 8 18 Senility 4 11 15 Suicide 4 6 10 Other Violence 15 6 21 Other defined Diseases 23 20 43 Causes ill-defined or unknown 2 2 Total 291 263 554 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 1938. England and Wales, London, 126 Great Towns and 148 Smaller Towns. (Provisional figures based on weekly and quarterly returns.) England and Wales. 126 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 15.1 15.0 15.4 13.4 15.1 Still 0.60 0.65 0.60 0.48 0.42 Deaths— All causes 11.6 11.7 11.0 11.4 8.3 Typhoid and Paratyphoid fevers 0.00 0.00 0.00 0.00 0.0 Smallpox 0.00 — 0 00 — — Measles 0.04 0.05 0.03 0.06 0.01 Scarlet fever 0.01 0.01 0.01 0.01 0.00 Whooping cough 0.03 0.03 0.02 0.03 0.01 Diphtheria 0.07 0.07 0.06 0.05 0.01 Influenza 0.11 0.10 0.11 0.06 0.09 Notifications— Smallpox 0.00 0.00 0.00 — 0.00 Scarlet fever 2.41 2.60 2.58 2.05 2.27 Diphtheria 1.58 1.85 1.53 1.90 0.96 Enteric fever 0.03 0.03 0.04 0.05 0.01 Erysipelas 0.40 0.46 0.39 0.46 0.12 Pneumonia 1.10 1.28 0.98 0.98 0.65 Rates per 1,000 live births. Deaths under one year of age 53 57 51 57 38 Deaths from diarrhoea and enteritis under two years of age 5.5 7.8 3.6 13.1 9 Maternal mortality— Puerperal sepsis 0.89 — Others 2.19 Not available 3.00 Total 3.08 3.00 Rates per 1,000 total births (i.e., live and still). Maternal mortality— Puerperal sepsis 0.86 Not available 2.90 2.90 Others 2.11 Total 2.97 Notifications— Puerperal fever 14.42 18.08 12.51 3.53 - Puerperal pyrexia 15.46 3.8 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 486 Sputa for tubercle 103 Total 589 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 951, of which 470 were accident cases, and 481 private removals. 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 lor midwives. At present there 10 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 have been 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 Infants 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, 1938:— No. of Nurses. No. of patients visited during 1938. No. of visits paid during 1938. St. Barnabas 1 192 3,297 South and East Wards 3* 470 8,857 Christchurch 2* 229 4,048 Totals 6 891 16,202 * 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 Toddlers' clinics are held once a month at each of the following centres:—Meopham Road, St. Barnabas, and Sherwood House, the total attendances being 667. The number of toddlers attending was 187. 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 160, the number of mothers attending being 65. 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 2,427, the number of mothers attending being 258. Meopham Road.—Sessions are held on the second Tuesday of each month. The total attendances of expectant mothers was 124, the number of mothers attending being 45. Mitcham Court.—Sessions are held on the third Tuesday of each month. The total attendances at this clinic was 245, the number of mothers attending being 95. 17 The municipal midwives also hold a clinic at Mitcham Court On Wednesday afternoons. The total attendance was 191, and the number of mothers attending was 40. 51.3 per cent. of the mothers of children born during the year attended the ante-natal clinics (including Woodlands Maternity Home Clinic), as compared with 49 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 126 mothers attended this clinic during the year. This number represents 12 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 28 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 three times a month. During the year the following amount of dental work has been undertaken: — Extractions—Local 22 „ Gas 76 Fillings 45 Impressions taken 3 Inspections 141 Advice given re dentures, etc. 20 Scaling 3 Total attendances 310 Number of new cases during 1938, 131. 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 27 cases were referred to this clinic, as compared with 34 cases in 1937. 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 21 women attended for this examination, as compared with 22 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, 1938 34 Number of children on register, December 31, 1938 40 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 261 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 16 cases were dealt with by the Society as follows:— Neglect 9 Ill-treatment 3 Other wrongs 1 Advice 3 Total 16 These cases affected the welfare of 48 children, and 63 supervision visits and 47 other 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 recognised as a Part II. 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  Number 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 1938 297 Number of maternity beds in the institution (exclusive of isolation and labour beds), 15. Number of maternity cases admitted during the year, 297. Average duration of stay, 14 days. Number of cases delivered by (a) midwives, 249; (b) doctors, 48. Number of cases in which medical assistance was sought by a midwife in emergency, 53. 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, 6. 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. An extra ante-natal clinic is held on the first Thursday morning of each month. Report of the Infant Welfare and Ante-Natal Centres, 1938. 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 Mitcham Court Woodlands Maternity Home Midwives Clinic, Mitcham Court Total Number of new cases registered during year of— Children under one year of age 104 181 99 202 91 105 — — — 782 Children over one year and under five years of age 49 49 65 57 20 30 _ 270 Number of children in attendance at end of year— Under one year of age 77 155 87 157 72 88 — — — 636 Over one and under five years of age 258 368 375 378 224 225 — — — 1828 Total attendances of children under one year of age 714 1680 1170 2616 834 1231 _ _ 8245 Total attendances of children over one year of age 622 801 643 912 511 538 _ — 4027 Total attendances at centres 1336 2481 1813 3528 345 1769 — — — 12272 Average attendances at centres 60 57 44 84 61 42 — — — 57 Percentage of infants under one year of age attending centres of total notified births — — — — — — — — — 79% Total attendances of expectant mothers — 160 124 _ _ _ 239 2427 191 3141 Average attendances of expectant mothers — 14 11 _ — _ 21 38 21 21 Number of expectant mothers who attended during year 65 45 95 258 40 503 Percentage of total notified births represented by the number of expectant mothers attending all clinics — — — — — — — — — 51% Toddlers Clinics Number on register — — 47 97 — 43 — — — *187 Total attendance — — 246 227 — 194 — — — *667 Average attendance — — 25 20 — 17 — — — *21 * Totals included in welfare attendances 22 Visits paid by Health Visitors, 1938. Mrs. Wray Miss Russell Harris Mrs. Parsons Miss Burke Miss Leigh Miss Abbott (temporary) Total Primary ante-natal visits 29 56 27 60 68 — 240 Subsequent ante-natal visits 46 66 31 39 86 — 268 Primary birth visits 115 272 99 136 243 60 925 Subsequent visits to infants 72 879 333 731 655 293 2963 Visits to children under five years of age 156 1528 690 605 1311 611 4901 Visits re stillbirths — 3 3 3 4 — 13 Visits re deaths of infants under one year of age 6 9 6 4 12 — 37 Visits re cases of ophthalmia neonatorum 3 — — — — — 3 Visits re cases of puerperal pyrexia 2 — — — — — 2 Primary visits to cases of tuberculosis 99 — — — — — 99 Subsequent visits to cases of tuberculosis 619 — — — — — 619 Special visits 486 — — — — — 486 1633 2813 1189 1578 2379 964 10556 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 and Sherwood Park Centres four sessions are held each month. At the St. Barnabas Centre five sessions are held each month. The total number of attendances at the six infant welfare centres was 12,272, as compared with 11,486 in 1937. Of these, 1,052 were new cases, 782 being infants under one year of age, and 270 being children over one but under five years of age. The total number of attendances of infants under one year was 8,245, and of children between one and five years of age, 4,027. At the end of the year there were 636 infants under one year and 1,828 children between one and five years of age attending the centres, making a total of 2,464 children attending, an increase of 752 over the previous year. The average attendance at each individual centre was:— Cavendish Road 57.6 Meopham Road 44.0 Parish Room 61.1 Sherwood Park 42.9 St. Barnabas 84.0 Western Road 60.7 giving an average of 57.3 as compared with 54.8 in 1937. The percentage of infants under one year of age attending the centres was 79 per cent. of the total number of notified births. Clinics for Toddlers Special Clinics for Toddlers are held and have proved a great success. The mothers have shown their great appreciation of these clinics by their very regular and punctual attendance. 24 These clinics are strictly reserved for children who are between the ages of two and five years. The children are weighed undressed at the first attendance and examined by the doctor, 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 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. The first clinic for toddlers was held at the Meopham Road Centre on March 22, 1937, and on December 15 of the same year a toddlers' clinic was opened at the St. Barnabas Centre. On January 13, 1938, a toddlers' clinic was opened at the Sherwood Park Centre, and since then arrangements have been made to see toddlers by appointment at the other three centres. Table Showing Attendance at Toddlers' Clinics Meopham Road. St. Barnabas. Sherwood Park. Number of Toddlers on Register 47 97 43 Total attendance 246 227 194 Average attendance 24.6 20.6 17 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 Child Welfare 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. 25 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 354. The number of children found to be suffering from dental trouble was 110. This figure included every degree of caries. Dental treatment was advised in all cases and the children were referred to the family dentist or to the dental clinic, or, in a minority of cases, to hospital. There were 58 cases of enlarged tonsils. Treatment was advised in those cases where it was considered necessary. There were 28 orthopedic cases. Twenty-one of these were referred to the Nelson Hospital. Of these, three failed to attend. Two cases were referred to Charing Cross Hospital. Ophthalmic conditions were found in 15 children. Seven of these cases were referred to the Royal Westminster Ophthalmic Hospital, and two to the Royal Eye Hospital. There were two cases of feeding difficulty which required institutional treatment. Both of these were admitted to the Infants' Hospital, Vincent Square, with good results. Details of the 354 pathological conditions found are shown in the following table:— Pathological Conditions Found in Children No. of Cases Congenital conditions— Auricle accessory 1 Cardiac— Congenital cardiac murmur 1 Congenital pyloric stenosis 1 Cyst, dermoid 3 Carried forward 6 26  No. of Cases Remarks Brought forward 6 Fibroma of mouth 1 Referred to Bolingbroke Hospital Hare lip and cleft palate 1 Mole 1 Nasvi 9 Ophthalmic—- Ptosis 1 Referred to Royal Westminster Ophthalmic Hospital Orthopaedic- Talipes equino -varus bilateral 1 1 Referred to Charing Cross Hospital. Talipes equino-varus unilateral 1 Thumbs, contraction of 1 Referred to Charing Cross Hospital Toes, deformity of 1 Phimosis 52 Tongue-tie 4 Acquired conditions— Adenitis— Cervical 17 Generalised superficial 1 Albuminuria 1 Bronchitis 3 Cardiac— Mitral systolic murmur 9 Dental disease— Alveolar abscess 1 Broken teeth 3 Caries 104 Enamel deficiency 2 Enuresis 4 Carried forward 224 27  No. of Cases Remarks Brought forward 224 Hematoma of sterno-mastoid 1 Hematuria 1 Hernia, umbilical 3 Hydrocele 1 Hypospadias 1 Infectious disease, rubella 4 Jaundice 2 Marasmus 1 Ophthalmic— Hematoma of eyelid 1 Lacrymal abscess 1 Admitted to Royal Eye Hospital Photophobia Strabismus 1 Referred to Royal Westminster Ophthalmic Hospital Stye 4 Ulcer, corneal 2 One referred to Royal Westminster Ophthalmic Hospital „ phlyctenular ulcer 1 Referred to Royal Eye and conjunctivitis Hospital Orthopedic— Genu valgum 5 Genu valgum with Pes planus 2 Pes planus 2 Rickets 1 Talipes 1 Tibia, outer curvature of 11 Tibia, outer curvature of, with rickets 2 Otorrhcea 7 Scalds 2 Scalp, diseases of— Alopecia 1 Carried forward 286 28  No. of Cases Remarks Brought forward 286 Skin, diseases of— Eczema 1 1 mpetigo 1 Ringworm 1 Rodent ulcer 1 Referred to Belgrave Hospital Urticaria 2 Stomatitis 1 Thread worms 3 Tonsils, enlarged 58 354 Ante-Natal Centres One Ante-Natal Clinic is held each month at the Cavendish Road, Meopham Road and Mitcham Court Centres, and one clinic each week in connection with Woodlands Maternity Home. Since November 1937, an extra clinic has been held once a month at Woodlands. With the appointment of three Municipal Midwives under the Midwives Act, 1936, there has been a corresponding increase in the amount of ante-natal work, and therefore a special clinic for cases booked by the midwives was opened on April 13, and has been held once a month at Mitcham Court since that date. The total number of expectant mothers attending the centres was 503, the total number of attendances being 2,950, the average attendance 21.3. Of the total number of notified births, 51.3 per cent. of the mothers had attended the ante-natal centres, as against 49 per cent. in the previous year. The following table shows the steady growth of ante-natal work in the Borough during the six years 1933-1938 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. 1938 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 1938 503 2.950 51.3 The average attendance at each individual centre is shown in the following table:— Table to Show Average Attendance at Each Centre Number of expectant mothers attending. Number of attendances. Average attendance. Woodlands 258 2,427 38 Cavendish Road 65 160 14.5 Meopham Road 45 124 11.2 Mitcham Court 95 245 21.7 Midwives Clinic 40 191 21.2 General Remarks The clinics were reserved as in previous years for those cases entering Woodlands or hospital, or who were to be confined in their own 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 to hospital, a letter giving details of the conditions present accompanying the patient in either case. Letters were sent to midwives who referred patients to the clinics, and midwives were welcomed at the centres, the patients' ante-natal notes being available for their perusal. 30 Cod liver oil emulsion, Virol or Parrish's Food, and extra nourishment, including one pint of milk daily, were supplied free to necessitous and debilitated mothers. Remarks on Pathological Conditions There were 53 cases of simple albuminuria of pregnancy, eleven cases of toxaemia of pregnancy and one case of pyelitis of pregnancy. Of the toxaemias, three cases were admitted to Woodlands Maternity Home, five cases were admitted to the City of London Maternity Hospital, and three cases were admitted to Guy's Hospital. The case of pyelitis of pregnancy was admitted to St. Bartholomew's Hospital. Malpresentations were found in 53 cases. Of these, 22 underwent spontaneous version, nine were corrected at the clinics, five were corrected at hospital, and seven cases were admitted to hospital. An X-ray is taken in cases of doubtful presentation or of suspected multiple pregnancy. Twenty-one cases had an X-ray during the year. Two hundred and nine 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 hosiptal. Every case having a systolic blood pressure of 140 or over is included under the term hyperpiesis. Five hundred and twenty-nine pathological conditions were found altogether, details of which are given in the following table: Pathological Conditions Found in Expectant Mothers No. of Cases Remarks Complications of Pregnancy— Albuminuria of pregnancy 53 Disproportion 8 All admitted to City of London Maternity Hospital Carried forward 61 31  No. of Cases Remarks Brought forward 61 Glycosuria 1 Haemorrhage, ante-partum 6 One case admitted to City of London Maternity Hospital, one admitted to Guy's Hospital, one sent to Kingston General Hospital. Hydramnios, acute 1 Admitted to City of London Maternity Hospital. Baby died four days after birth from congenital atresia of oesophagus Hyperpiesis 96 Malpresentations— Breech 39 Spontaneous version, 15 cases Version at Clinics, three cases Version at City of London Maternity Hospital, five cases. Admitted to City of London Maternity Hospital, six cases Transverse 14 Spontaneous version, seven cases. Version at clinics, six cases. Admitted to City of London Maternity Hospital, one case Carried forward 218 32  No. of Cases Remarks Brought forward 218 Pyelitis 1 Admitted to St. Bartholomews Hospital Toxaemia of pregnancy 11 Admitted to Woodlands, three cases Admitted to City of London Maternity Hospital, five cases Admitted to Guy's Hospital, three cases Varicose veins— Of legs 30 Of vulva 5 Gyncecological Conditions— Cystocele and rectocele 2 Fibroids 2 Leucorrhoea 11 Six cases referred to South London Hospital for Women Conditions Unconnected With Pregnancy— Anemia 1 Bronchitis 1 Burns 1 Cardiac— Extrasystoles 4 Mitral stenosis 3 One case admitted to Charing Cross Hospital. • Two cases referred to Charing Cross Hospital Mitral systolic murmur 15 One referred to Charing Cross Hospital Carried forward 305 33  No. of Cases Remarks Brought forward 305 Presystolic murmur with s3'stolic murmur 1 Referred to Charing Cross Hospital Pulmonary murmur 3 Reduplication of mitral second sound 5 Dental Conditions— Caries 189 Gingivitis 6 Pyorrhoea 14 Diabetes 1 Referred to Charing Cross Hospital Ophthalmic— Blepharitis 1 Cataract 1 Stye 1 Papilloma of thigh 1 Thread-worms 1 Scabies 1 529 Post-Natal Centre A Post-natal Centre is held at Mitcham Court 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 total number of women who attended the post-natal clinic was 126, the total number of attendances being 144, the average attendance being 14.4. 34 The pathological conditions found on examination of patients who attend this clinic are shown in the following table:— Pathological Conditions Found in Post-Natal Cases No. of Cases Remarks Albuminuria 1 Abscess of buttock 1 Cervical erosion 1 Diabetes 2 Haemorrhage 2 Leucorrhoea 4 One case referred to South London Hospital for Women Prolapse 2 Both cases referred to hospital Retroversion 23 Corrected at clinic, 18 cases. Referred to hospital, five cases. 36 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. Three sessions are held each month. The number of new patients referred to the dental clinic during the year was 186. Of these 131 actually attended, the total attendances being 270, the average attendance being 9.4. These figures indicate a considerable increase in the work undertaken at the dental clinic, as is shown in the following table:— 35 Table to Show Work Done at the Dental Clinic in 1938 as Compared With 1937 1938 1937 Number of new patients referred to dental clinic 186 71 „ „ „ who actually attended 131 53 „ „ dental sessions 33 32 Average attendance 9.4 6.3 Inspections 141 69 Extractions under general anesthesia 76 40 „ „ local „ 22 19 Fillings 45 28 Impressions 3 9 Dental adjustments 20 26 Scaling 3 3 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. Mayfield Convalescent Home On April 2, I paid my second visit to the Convalescent Home for Mothers, Mayfield, Sussex. My full report on this home will be found in the report of the Medical Officer of Health for the year 1937. It is therefore unnecessary for me to include it again here. Suffice it to say that on the occasion of my second visit I received a warm welcome from the Matron and her staff and found everything completely satisfactory. During the year twelve mothers, ten babies and one toddler benefited by a stay at the home. Complete satisfaction was expressed by the mothers with the home and the treatment and kindness they received, and all improved in health, 36 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. With or Without Baby From which Centre. Date of Stay. No. of Weeks. Mrs. S Yes Parish Room Jan. 6—Jan. 20 2 „ T „ Sherwood Park Jan. 20—Feb. 3 2 „ U „ Western Road Feb. 10—-Feb. 24 2 „ V „ St. Barnabas Feb. 24—Mar. 10 2 „ W No St. Barnabas Mar. 10—Mar. 24 2 X Yes Meopham Road Mar. 24—Apr. 21 4 ,, Y „ Western Road Apr. 21—May 5 2 „ Z Toddler.. St. Barnabas July 28—Aug. 11 2 ,, Aa Yes Western Road Aug. 25—Sep. 8 2 „ Bb „ Parish Room Oct. 20—Nov. 3 2 ,, Cc „ Cavendish Road Nov. 17—Dec. 15 4 ,, Dd „ Sherwood Park Dec. 8—Dec. 21 2 As will be observed, we were able to send mothers to the home for five months from January 6 to May 5 without a break, with the exception of one week. Mrs. T. should have remained there three weeks, but was obliged to return home unexpectedly on February 3. From May 6 to August 4 the home was closed to babies because of an outbreak of illness which affected two babies, both of whom were removed to hospital. Towards the end of this period a few mothers were admitted without babies, and finally it was decided to take in one or two toddlers with the mothers. We therefore sent a mother with a toddler on July 28. The Executive Committee of the National Association for Maternity and Child Welfare decided to close the home on December 22 because it was found to be impossible to run the home on a satisfactory financial basis. This was a matter of deep regret, as the home supplied a very real need in providing a much needed rest to many overworked and debilitated mothers, 37 National Conference on Maternity and Child Welfare In July, Mrs. Wray and I attended the National Conference for Maternity and Child Welfare at Bristol. We both found the conference extremely helpful, and my full report on this will be found in the minutes of the Maternity and Child Welfare Committee for September, 1938. In conclusion I should like to thank Mr. J. 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 their unfailing loyalty and co-operation. I tender my thanks also to the health visitors and nursing staff of Woodlands, and to all the voluntary workers at the infant welfare centres for their assistance. FLORENCE M. PARSONS, Assistant Medical Officer. 3 8 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. Regular samples of water have been taken and all have proved satisfactory. One complaint of a bad taste from water was investigated and found to be due to the presence of a dead bird in the cistern under the roof. The cistern was cleaned out and a properly fitting cover supplied. In addition to the samples taken from house supplies, the water supply of seven factories was examined and certificates given under Section 41, Factory Act, 1937. RIVERS AND STREAMS Sixty-four visits have been paid to all works suspected of discharging effluent into surface water sewers. 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 three pail closets and two 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 Sixty-seven observations were kept on chimneys during the year. In connection therewith five notices were served and the nuisances abated. 39 SWIMMING BATH The water in the swimming bath is under a continuous process of filtration, chlorination and aeration. Bacteriological tests show that the water is very clean. 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 52 No. of other houses found infested during the year 43 No. of houses disinfected during the year 95 No. of Council houses disinfested by Council staff 52 No. of Council houses disinfested by Contractors nil Methods employed:— 113 rooms treated with sulphur dioxide (Cescones). 158 rooms treated with insecticide sprays (Pyagra or solitox) (inclusive or rooms treated on more than one occasion). No private houses are treated by the Council staff, but advice is given and material supplied at cost price on request. No. of private houses disinfested by owners or occupiers after notice 43 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 12 houses was so treated. Council houses are inspected, and reinspected after treatment, by the Council's staff of women housing managers. 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. 40 The sanitary fittings, etc., however, are inspected periodically by the sanitary inspectors, and during the year 25 visits of inspection were made. 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 diseases 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 the District Sanitary Inspectors:— Total number of visits paid 10837 Number of complaints received and investigated 681 Number of premises inspected 4581 Number of premises revisited 3649 Number of houses measured for permitted numbers, Housing Act, 1936 440 Number of nuisances discovered 1130 Number of nuisances abated without reports 808 Number of nuisances abated after reports 244 Number of intimatorv notices served 916 Visits to butchers and other food shops 356 41 Visits to marine stores 11 Visits to stables 81 Visits to refuse dumps 100 Details of visits to other premises are enumerated in other sections of the report. Character of Work Done Roofs repaired 196 Walls repointed or cement rendered 107 Rainwater gutters and piping repaired or renewed 188 Ventilation under floors provided or improved 7 Dampness to ground floor rooms remedied 30 Water service pipes repaired 16 Ventilation of watercloset compartments provided 2 Waterclosets: repairs to roof, walls, doors and seats 114 Flushing apparatus repaired or renewed 122 Water storage cisterns cleansed or covered 22 Water supply to houses reinstated 6 Back yards and sculleries paved or repaired 85 Flooring of rooms repaired 88 Rooms cleansed and redecorated 685 Repairs to internal plastering of walls and ceilings 399 New scullery sinks provided 9 Repairs to sinks and waste pipes 80 Walls round sinks rendered 6 Window frames and sashes repaired 182 Windows made to open 29 Sashcords provided 416 Drains tested 12 Drains repaired and cleansed 267 New watercloset pans and traps provided 20 Repairs to firegrates 73 Repairs to washing coppers 20 Food cupboards provided 16 New dustbins provided 326 Accumulations removed 44 Rooms disinfected, after infectious disease 317 Repairs to chimney eaves 16 42 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 145,193 gallons. A licence was also issued for 5 cwt. of carbide ot calcium to be stored. Food Inspection—Carcases Inspected and Condemned Cattle Cows Calves Sheep Pigs Number inspected 1 5 56 126 9,464 All diseases except Tuberculosis. Whole carcases condemned ... ... ... ... 8 Carcases of which some part or organ was condemned ... 2 1 3 75 Percentage of th6 number inspected affected with disease other than Tuberculosis ... 40% 1.785% 2.38% .877% Tuberculosis only. Whole carcases condemned ... ... ... ... 10 Carcases of which some part or organ was condemned ... 2 ... ... 290 Percentage of the number inspected affected with Tuberculosis ... 40% ... ... 3.169% Surrendered for destruction: —20 lbs. dogfish, 84 lbs. cod fillet, 14 lbs. cod roes, 1| bushels winkles, 17 rabbits, 3 turkeys. Shops Acts Number of shops inspected 1342 Visits in connection with Shops (Sunday Trading Restrictions Act, 1936) 218 Notices served under Section 7, Shops Act, 1934, to keep record of hours worked by young persons and intervals for meals and rest 3 43 Notices served under Section 10, Shops Act, 1934, to provide washing facilities, w.c. 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 15 Cautions given in cases of breaches of Hairdressers and Barbers' Shops (Sunday Closing) Act, 1930 2 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 2 Cautions given in cases of breaches under Section 1, Shops (Sunday Trading Restrictions) Act, 1936, serving of customers with prohibited articles 9 Offices Twenty-one offices were inspected. Two notices served to cleanse and redecorate the walls and ceilings. One notice served for renewal of w.c. pan. All notices were complied with. Yours obediently, K. J. GUTTERIDGE, Chief Sanitary Inspector. 44 HOUSING The population of each ward is as follows:— North Ward 12,331 South Ward 12,946 East Ward 27,220 West Ward 13,523 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) 1758 (b) Number of inspections made for the purposes 1920 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 216 (b) Number of inspections made for the purpose 242 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 20 (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 864 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 773 45 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 187 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 242 (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 20 (2) Number of dwelling houses demolished in pursuance of demolition orders 13 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 2 46 (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 (1) Number of houses overcrowded at end of year 97 (2) Number of families dwelling therein 138 (3) Number of persons dwelling therein 727 B. Number of new cases of overcrowding reported during the year 14 C. (1) Number of cases of overcrowding relieved during the year 38 (2) Number of persons concerned in such cases 270 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 38 cases of overcrowding relieved during the year, 23 families were rehoused by the Corporation, five families moved from overcrowded premises, and in 10 cases overcrowding was relieved by a reduction of the number in the family due to marriage, death and other causes. 47 INSPECTION AND SUPERVISION OF FOOD FOOD AND DRUGS (ADULTERATION) ACT, 1928 The duties under the Food and Drugs (Adulteration) Act, 1928, are carried out by the Surrey County Council. The following number of samples have been taken during the year from this district:— Articles Analysed Adulterated or Deteriorated Prosecutions Conviotions Formal Informal Total Formal Informal Total Milk 37 3 40 2 ... 2 ... ... Cheese 2 ... 2 ... ... ... ... ... Margarine 3 ... 3 ... ... ... ... ... Lard 1 ... 1 ... ... ... ... ... Meat 1 ... 1 ... ... ... ... ... Flour 1 ... 1 ... ... ... ... ... Sausages 1 ... 1 ... ... ... ... ... Drugs 1 ... 1 ... ... ... ... ... *Other Articles 11 6 17 6 1 7 2 2 Totals 58 9 67 8 1 9 2 2 *Details of Other Articles— Lardine ... 1 1 ... ... ... ... ... Lardona ... 1 1 ... ... ... ... ... Lardex ... 1 1 ... ... ... ... ... Milk chocolate creams 1 ... 1 ... ... ... ... ... Chocolate roll 6 1 7 ... ... 6 2 ... Bacon 1 ... 1 ... ... ... ... ... Cooking fat 2 ... 2 ... ... ... ... ... Choc. iced sandwich 1 ... 1 ... ... ... ... ... Tinned Sild ... ... 1 1 ... ... ... ... ... Table dripping ... 1 1 ... 1 1 ... ... SLAUGHTER HOUSES There are five slaughter houses, of which two are registered and three are licensed. During the year 327 visits of inspection were made. 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. 48 BAKEHOUSES The number of bakehouses in the district is 14. Eighty-five visits have been paid. Twelve verbal notices were given to occupiers to limewash bakehouses. Three verbal notices were given to occupiers to cleanse and repair fittings. Two notices were served to repair flooring. One notice served to provide additional ventilation. One underground bakehouse has been discontinued. All notices were complied with. DAIRIES AND COWSHEDS There are 28 registered premises within the district, of which 27 are dairies and one cowshed. During the year 104 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 7 Pasteurised 11 Accredited 1 Pasteurising Plant 1 Supplementary Licences— Pasteurised 6 Tuberculin Tested 6 SAMPLING OF MILK In addition to the number of samples of milk taken for examination by the Food and Drugs Inspectors of the Surrey County Council, 31 samples were taken by District Sanitary Inspectors. 49 The results were as follows:— Designation Number of Samples Remarks Pasteurised 20 All conformed to legal standard. Grade A. T.T. 3 Conformed to legal standard. Undesignated 6 All samples were up to standard of pasteurised milk. Carton milk 2 Standard of pasteurised milk. PIGGERIES There are 13 piggeries in the Borough. 127 visits were paid during the year. CARAVAN YARDS Nine yards were licensed during the year for a period of two years. Number of vans in yards, 30. Number of persons occupying these vans, 68 persons over 10 years, 27 persons under 10 years. Eighty-nine visits of inspection were made. 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 4,335 gallons of liquid milk and 9,366 lbs. of dried milk have been supplied free or at cost price to mothers and children under five years of age in the Borough. Arrangements were also made for necessitous nursing and expectant mothers to receive free meals. HEALTH PROPAGANDA The cinema van of the Health and Cleanliness Council was engaged for showing health films at Mitch am 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. 50 FACTORIES AND WORKSHOPS There are 174 factories and workshops in the district, of which 101 are factories and 73 are workshops. In addition there are 14 workplaces. During the year 279 visits of inspection were paid. Outworkers There are 112 outworkers in Mitcham. One hundred and fifteen visits of inspection were paid and, in connection with these, no defects found. During the year no case of infectious disease was notified as occurring in the house of an outworker. The classes of work undertaken by the outworkers are as follows:— Lampshades 54 Onion peeling 15 Making of wearing apparel 22 Tailoring 5 Millinery 1 Embroidery 4 Confectionery boxes 8 Artificial flowers 1 Brace maker 1 Soft toys 1 Total 112 51 Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors. Premises Number of Inspections Written Notices Prosecutions Factories with mechanical power 278 17 — Factories without mechanical power 30 — — Other premises under the Act — — — Total 308 17 — 52 Defects found in Factories, Workshops and Workplaces. Particulars Number of Defects Found Remedied Referred to H.M. Inspector Number of Prosecutions Want of cleanliness ... ... Overcrowding ... ... Unreasonable temperature ... ... Inadequate ventilation ... ... Ineffective drainage of floors ... ... Sanitary conveniences Insufficient 5 3 Unsuitable or defective 41 41 Not separate for sexes 1 1 Other offences 18 18 Total 65 63 53 Outwork in Unwholesome Premises, Section 111, Act of 1937 Nature of Work Instances Notices served Prosecutions Wearing Apparel— Making, &c. 3 3 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 1 1 ... 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 7 7 ... Total 11 11 ... 54 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES INFECTIOUS DISEASE NOTIFICATIONS The total number of certificates of notification received during the year was 275 as compared with 338 last year. Contacts, Suspects, Etc. On 14 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 436 visits to cases of infectious disease; 335 were primary visits and 101 revisits. The monthly incidence of infectious disease was:— Small Pox. Scarlet Fever Diphtheria Enteric Fever Erysipelas Pneumonia Puerperal Pyrexia Ophthalmia Neonatorum Dysentery Cerebro-Spinal Fever Poliomyelitis Totals January ... 17 8 ... 1 15 1 ... ... ... ... 42 February ... 10 7 ... ... 5 ... ... ... ... ... 22 March ... 15 8 ... 2 1 1 ... ... ... ... 27 April ... 10 5 ... ... 2 ... 1 ... ... ... 18 May ... 10 6 ... ... ... ... ... ... ... ... 16 June ... 14 ... ... 2 4 ... ... ... ... ... 20 July ... 9 4 1 ... 3 ... ... ... ... ... 17 August ... 12 2 ... 1 2 ... 1 ... 1 ... 19 September ... 14 7 ... 1 4 1 ... ... ... ... 27 October ... 15 10 ... 1 2 ... 1 ... 1 ... 30 November ... 15 3 ... ... 3 1 ... ... ... ... 22 December ... 9 4 ... ... 2 ... ... ... ... ... 15 Total ... 150 64 1 8 43 4 3 ... 2 ... 275 55  Case rates per 1,000 Ward population. Disease. North. South. East. West. Small Pox — — — — Scarlet Fever 2.4 2.8 2.0 3.0 Diphtheria 0.3 0.8 0.9 1.1 Enteric Fever — — — 0.08 Erysipelas 0.1 0.08 0.09 0.09 Pneumonia 0.3 0.3 0.5 0.2 56 Cases of Infectious Disease Notified During the Year 1938. Disease Number of 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 1 5 and under 10 years 10 and under 15 years 15 and under 20 years 1 20 and under 1 35 years 35 and under 45 years 45 and under 65 years 65 and over North East South West Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 150 1 4 14 17 12 67 15 7 9 4 ... ... 17 55 37 38 130 ... Diphtheria 64 3 4 ... 5 25 7 3 10 2 ... ... 15 17 11 21 64 1 Typhoid Fever 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... Erysipelas 8 ... ... ... ... ... ... 2 ... 2 2 2 ... 1 3 1 3 6 ... Pneumonia 43 1 1 2 1 1 6 2 2 9 4 9 5 6 14 9 14 ... 33* Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia 4 ... ... ... ... ... ... ... ... 4 ... ... ... 1 1 ... 2 4 ... Ophthalmia Neonatorum 3 3 ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... 3 ... Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever 2 ... ... ... ... 1 ... 1 ... ... ... ... ... 1 1 ... ... 2 2 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 275 8 9 20 23 15 98 27 12 35 12 11 5 42 93 58 79 210 36 *Includes all forms, some of which are not notifiable. 57 Infectious Disease Notifications, 1922-38. Disease 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 Small Pox ... ... ... ... ... ... 9 7 ... 4 1 ... ... ... ... ... ... Scarlet Fever 178 110 87 106 104 145 102 134 113 105 174 240 392 143 171 192 150 Diphtheria 84 35 59 201 87 76 75 133 129 49 32 40 83 80 104 89 64 Typhoid Fever 1 2 1 4 2 6 3 4 9 2 3 3 ... 3 5 ... 1 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 3 2 1 5 6 9 4 6 1 7 5 1 1 2 2 1 ... Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Meningitis 1 ... 6 ... ... 2 1 4 ... ... 1 4 1 1 3 1 2 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 13 15 11 10 13 14 10 22 22 17 11 31 30 20 22 16 8 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Diarrhœa ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Chicken Pox 26 91 35 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis ... 4 ... ... 1 2 ... ... 1 ... ... ... ... ... ... 1 ... Ophthalmia Neonatorum 3 6 7 5 12 10 3 3 1 3 4 2 2 4 3 1 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 32 43 Malaria 8 3 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia ... ... ... ... 1 14 9 5 6 9 4 9 6 4 11 5 4 Totals 347 287 246 376 259 340 270 375 319 242 288 368 560 293 357 338 275 58 Cerebro-Spinal Fever Two cases occurred during 1938, and both patients unfortunately died. Influenza During the year six deaths from influenza were recorded. Four were males and two females. The previous year 15 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:— Treated. Cases , Vision Vision Total Notified. At home. In hospital. Unimpaired. Impaired. Blindness Deaths 3 nil. 3 3 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 103, of which 50 were males and 53 were females, as compared with 76 deaths last year. 59 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 1938 was as follows: — Digestive organs 47 cases. Genito-urinary organs 17 ,, Breast 10 „ Respiratory system 11 „ Other sites 18 ,, Total 103 The following table shows the number of deaths from cancer, together with the death rate as compared with England and Wales:— Year. Number of Deaths. Death Rate per 1,000 of population. Mitch am. 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 48 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 1937 76 1.1 1.63 1938 103 1.5 1.66 60 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 62 new cases of tuberculosis were notified, viz:— Males. Females. Total. Pulmonary 26 26 52 Non-Pulmonary 6 4 10 Total 32 30 62 The total number of deaths registered as occurring from tuberculosis was viz.:— Males. Females Total. Pulmonary 22 17 39 Non-Pulmonary 2 ... 2 Total 24 17 41 England, and Wales. Mitch am. Death rate from respiratory tuberculosis per 1,000 population 0.53 0.59 Death rate from non-pulmonary tuberculosis per J ,000 population 0.10 0.03 61 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 Non- Respiratory Respiratory Non- Respiratory M. F. M. F. M. F. M. F. Under 1 year ... ... ... ... ... ... 1 ... 1 year to 5 years ... ... ... ... ... ... ... ... 5 years „ 10 „ ... ... ... 1 ... ... ... ... 10 „ „ 15 „ ... ... 2 1 ... ... ... ... 15 „ „ 20 „ 2 6 1 ... 1 ... ... ... 20 ,, ,, 35 „ 13 10 1 2 7 7 1 ... 35 „ „ 45 „ 4 6 ... ... 5 4 ... ... 45 „ „ 65 „ 6 3 2 ... 9 4 ... ... 65 „ and upwards 1 1 ... ... ... 2 ... ... Totals 26 26 6 4 22 17 2 ... New cases coming to the knowledge of the Medical Officer of Health during the year through (a) Death returns; (b) Posthumous notifications:— Ago Periods 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total Pulmonary: males ... ... ... ... ... 2 1 ... ... ... 1 4 Pulmonary: females ... ... ... ... ... 1 ... ... ... ... 1 2 Non-Pulmonary: males ... 1 ... ... ... ... ... ... ... ... ... 1 Non-Pulmonary: Females ... ... ... ... ... ... ... ... ... ... ... ... 62 The sources from which information as to the above mentioned cases was obtained are as follows:— No. of Cases Pulmonary NonPulmonary Death returns (a) From Local Registers 2 ... (b) Transferable deaths from Registrar General 4 1 Posthumous notifications ... ... Number of cases removed from register during 1937:— Reason Pulmonary Non-Pulmonary Total Cases Males Females Total Males Females Total Withdrawal of notification ... ... ... ... ... ... ... Recovery from disease 2 1 3 1 ... 1 1 Death 30 17 47 2 1 3 50 Otherwise 12 29 41 4 7 11 52 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths is as follows:— Non-notified tuberculosis deaths 7 Notified tuberculosis deaths 34 Percentage of non-notified T.B. deaths (all forms) 17 per cent. Percentage of non-notified pulmonary T.B. deaths 2 ,, 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 63 the examination of sputa from cases or suspected cases of tuberculosis, and during the year 103 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—1938 Number of persons assisted during 1988 41 Receiving supp'ies of milk, butter, eggs, continuously for 12 months 5 „ „ ,, for 6-9 months 18 ,, ,, ,, under 6 months 28 Fares for family to visit sanatorium 1 Clothing, bedding, supplied through the medium of Committee 8 Tuberculous persons who have received special consideration re housing 7 Coal supplied 1 Payment for transit of patient by ambulance 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 1938. 64 Scarlet Fever The number of cases notified during the year was 150, this being 42 less than last year. 130 were removed to hospital. No deaths were registered from this disease during the year. Diphtheria Sixty-four cases were notified during the year and all the cases were removed to hospital for treatment. One death from tins disease was registered during the year. All the contacts are swabbed as a routine measure, and school contacts supervised by the staff of the school medical service. Diphtheria Immunisation A diphtheria immunisation clinic is held at the Town Hall every week. Daring the year 125 children have been immunised. Diphtheria prophylactic is also given to the medical practitioners in the district free of charge, and during the year 10 persons were immunised by doctors obtaining supplies of prophylactic from the Council. Typhoid Fever One case was notified during the year. Diarrhcea and Enteritis Under Two Years of Age Nine deaths were registered during the year: five males and four females. Encephalitis Lethargica No cases were notified during the year. Chicken Pox Four hundred and sixty-eight cases of chicken pox were notified by the head teachers of the schools in the district. Whooping Cough Ninety cases of whooping cough were notified during the year by the head teachers of the schools in this district. One death was registered. 65 Measles Six hundred and sixty cases of measles were notified during the year by the head teachers of the schools in the district. One death was registered. Mumps Three hundred and twenty-two cases of mumps were notified by the head teachers of the schools in the district. Ringworm Three cases of ringworm were reported by the teachers. Impetigo Thirty-six cases of impetigo occurred in school children during the year. Scabies Seventeen cases of scabies occurred in school children. Erysipelas Eight cases were notified. Six cases were removed to hospital. No deaths from this disease were registered. Puerperal Pyrexia Four cases were notified during the year. Pneumonia Forty-three 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 33, of which 21 were males and 12 females. 66 WANDLE VALLEY JOINT HOSPITAL BOARD Cases admitted to the hospital during the year ended December 31, 1938. Disease Beddington & Wallington Coulsdon & Purley Merton & Morden Mitcham Cases Deaths Cases Deaths Cases Deaths Cases Deaths Diphtheria 15 ... 10 ... 33 2 76 1 Scarlet Fever 38 ... 59 ... 143 ... 128 ... Typhoid ... ... 1 ... ... ... 1 ... Erysipelas 4 ... 1 ... 6 ... 2 ... Tonsilitis 1 ... 1 ... 2 ... 4 ... Measles ... ... 4 ... 5 ... 8 ... Whooping Cough ... ... ... ... 2 ... 1 ... Rubella 1 ... 1 ... 2 ... 3 ... Enteritis 1 ... ... ... ... ... 1 ... Pneumonia 1 ... ... ... 1 ... ... ... Cancer of Bowel 2 1 ... ... ... ... ... ... Chill ... ... ... ... 1 ... ... ... Chicken Pox 1 ... ... ... ... ... 2 ... T.B. Meningitis 1 1 ... ... ... ... 1 1 Septicaemia ... ... ... ... 1 ... ... ... Rheumatism ... ... 1 ... ... ... ... ... Puerperal Sepsis ... ... 1 ... ... ... ... ... Malta Fever ... ... 1 ... ... ... ... ... Anterior Poliomyelitis 4 ... 1 ... ... ... 2 ... Mumps 1 ... ... ... ... ... ... ... Impetigo ... ... ... ... ... ... 1 ... Admitted with mother ... ... 1 ... ... ... 1 ... Streptococcal Meningitis 1 1 ... ... ... ... ... ... Influenza ... ... ... ... ... ... 2 ... 71 3 82 ... 196 3 233 3 67 INDEX page Ambulances 14 Analysis of Mortality 13 Ante-Natal Clinics 16 Area 6 Bakehouses 48 Bed Bugs, Eradication of 89 Birth Rates 9,13 Births, Live 6 — Illegitimate 7 — Still 8 Blindness, Prevention of 58 Cancer 58 — Deaths from 59 Caravan Yards 49 Causes of Deaths 12 Cerebro-Spinal Fever 58 Chicken Pox 61 Clinics 15 — Ante-natal 16 — Dental 17 — Orthopædic 18 — Post-natal 17 — Toddlers 16 — Welfare 15 Closet Accommodation 38 Dairies and Cowsheds 48 Death Rates 9,13 Deaths 7,8,12 Dental Clinic 17 Diarrhœa and Enteritis 64 Diphtheria 64 — Immunisation 64 Encephalitis Lethargica 64 Eradication of Bed Bugs 39 68 PAGE Erysipelas 65 Factories and Workshops 50 - - - Defects in 52 — — — Inspection of 51 Food and Drugs Act (1928) 47 — Inspection and Supervision of 42,47 Food Preparing Places 49 General Provision of Health Services for the Area 14 Health Propaganda 49 — Visiting 15 — Visitors, Visits by 22 Home Helps 17 Hospitals 14 Houses, Inspection of 44 — Inhabited 44 Housing 44 Statistics 44 Impetigo 65 Infantile Mortality 7,9,10 Infant Life Protection 18 Infectious Disease, Cases notified 56 — Incidence of 54 — Prevalence of and Control over 54 — Notifications 54,56 — School 58 — Contacts 54 Influenza 58 Inhabited Houses 6,44 Inquests 10 Inspection and Supervision of Food 42,47 Laboratory Facilities 14 Maternal Mortality 10,18 Maternity and Child Welfare Services, Report on 28 Home 19 Measles 65 Midwives 15 Milk (Special Designation) Order (1923) 48 — Sampling of 48 69 PAGE Mortality, Analysis of 18 — Infant 7,9,10 — Maternal 10, 18 Mumps 65 N.S.P.C.C 19 Nursing in the Home 16 Nutrition 49 Offices 48 Ophthalmia Neonatorum 58 Orthopaedic Clinic 18 Outworkers 50,58 Overcrowding 46 Parsons, Dr. F. M., Report 23 Patients Admitted to Hospital 66 Personnel, Committee 4 — Staff 5 Petroleum Act (1928) 42 Piggeries 49 Pneumonia 65 Population 6 Post-natal Clinic 17 Prevention of Blindness 58 Public Cleansing 88 Puerperal Pyrexia 65 Rateable Value 6 Ringworm 65 Rivers and Streams 88 Sanitary Circumstances of the Area 88 - Inspector's Report 40 Scabies 65 Scarlet Fever 64 Schools 89 Shops Acts 42 Slaughterhouses 47 Small Pox 68 Smoke Abatement 88 Social Conditions 6 Statistics 6 70 PAGE Statistics, Housing 44 — Vital 7 Still Births 8 Sunlight Treatment 17 Swimming Bath 89 Toddlers' Clinics 16 Tuberculosis 60 — Care Committee 68 Typhoid Fever 64 Vital Statistics 7 Wandle Valley Hospital 66 Water Supply 88 Welfare Clinics 16 — — Attendance at 21 Whooping Cough 64 Woodlands Maternity Home 19 X-Ray Examinations 18