BOROUGH OF MITCHAM REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1941 BOROUGH OF MITCHAM REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1941 Mitcham: H. G. Mather, Caxton Works, Lower Green Borough of Mitcham HEALTH REPORT FOR 1941 To the Mayor, Aldermen and Councillors Sir, Ladies and Gentlemen, I have much pleasure in submitting my annual report for the year 1941. There was no epidemic of infectious disease, but there was a definite increase in the number of cases of Scarlet Fever notified. The birth rate was the lowest on record and the infant mortality rate was the highest since 1929. The death rate was, however, lower than in 1940. Lady Robertson generously offered to subscribe the capital cost of a Day Nursery for the Borough. A survey, however, showed little demand at the time, and Lady Robertson's offer was not accepted. A request was made to the County Education Committee to consider the establishment of Nursery classes in the Borough, and application for approval of three Nursery classes was made to the Ministry of Health. At the end of the year approval was sought for the establishment of a Day Nursery at Eagle House. In November, the Scabies Order provided compulsory powers for the treatment of this condition and marked a step forward in its control. Arrangements made at Mitcham Baths for the treatment of cases should prove satisfactory. Efforts to obtain diphtheria immunisation of children under fifteen years of age were intensified. All schools were visited and every parent was given the opportunity of having their child protected. A good response was obtained. The Maternity and Child Welfare services were satisfactory. A high proportion of the expectant mothers and of infants attended the Ante-Natal Clinics and Welfare Centres respectively. With the decrease in the severity of air raids there has been a gradual return home of evacuees, and housing accommodation is now becoming very limited, and will prove an important problem in the future. Woodlands Maternity Home continued to give satisfactory service, although only the ground floor was available for cases. I wish to take this opportunity of placing on record my appreciation of the valuable assistance received from the members of the staff and of the voluntary helpers who have given so much of their time and energy. In conclusion, I should like to thank the members of the Council for the encouragement and consideration that they have given me. I am, Ladies and Gentlemen, Yours obediently, A. ASHWORTH, Medical Officer of Health. Public Health Department, Mitcham Court, Mitcham. BOROUGH OF MITCHAM PUBLIC HEALTH COMMITTEE Chairman - - Councillor H. L. Gauntlett His Worship the Mayor (Alderman E. J. D. Field, J.P.) Alderman— S. L. Gaston, J.P. Councillors— G. W. Cole W. F. Hill F. P. Howard T. A. Murch G. W. Pearce Mrs. C. Randall Sir T. Wilson MATERNITY AND CHILD WELFARE COMMITTEE Chairman - - - Mrs. C. Randall His Worship the Mayor Councillors— A. E. Cubison Miss G. D. Francombe H. Conway Mrs. H. M. Hallowes J. E. Mahony T. A. H. Murch Mrs. E. Watson Sir I. Wilson Co-opted Members— Miss E. C. Chart Mrs. D. L. Chappell Miss K. Farewell-Jones Mrs. C. Norman Dr. G. Stoker REPRESENTATIVES ON WANDLE VALLEY JOINT HOSPITAL BOARD Aldermen— C. Woods A. H. Bailey W. Dalton REPRESENTATIVES ON WANDLE VALLEY JOINT SEWERAGE BOARD Chairman - - Alderman S. L. Gaston, J.P. His Worship the Mayor (ex-officio) Alderman W. Dalton Councillor A. T. Gidden STAFF Medical Officer of Health (a) A. Ashworth, M.D., Ch.B., M.R.C.S., L.R.C.P., D.P.H, D.T.M. 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. Consultant in Ear Diseases W. H. B. Magauran, M.D., F.R.C.S. Consultant in Diseases 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. Superintendent Health Visitor and Infant Life Protection Visitor Mrs. E. S. Wray Assistant Health Visitors Miss G. Russell-Harris Miss Hinds (b) Miss M. Burke (c) Miss E. Oakes (d) Miss P. Thompson (e) Miss O'Riordan Matron of Woodlands Maternity Home Miss G. M. Evans Clerks J. B. A. Roodhouse and L. J. Bellingham, H.M. Forces Mrs. M. Odam (f) Miss V. Valentine (temporary) (a) Appointed 1.8.41 (b) Resigned 31.3.41 (c) Appointed 24.3.41 (d) „ 11.8.41 (e) Resigned 18.2.41 (f) Engaged 3.2.41 7 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, 1941 52,440 Number of inhabited houses, 1921 7,150 „ „ „ 1931 13,187 „ „ „ 1941 17,500 Rateable Value, 1941 £497,388 Sum represented by a 1d. rate £1,875 STATISTICS. Total Male Female Rate per 1,000 of population Live Births. Legitimate 686 366 320 Illegitimate 26 9 17 Total 712 375 337 13.57 Total Male Female Rate per 1,000 total births Still Births Legitimate 23 15 8 Illegitimate 2 1 1 Total 25 16 9 33.92 8 Rate per 1,000 Total Male Female of population Deaths. 580 318 262 11.06 Deaths from disease and accidents of pregnancy and childbirth:— Rate per 1,000 total births Prom puerperal sepsis 2 Prom other puerperal causes 2 Total 4 5.42 Deaths of infants under one year of age:— All infants per 1,000 live births 55.4 Legitimate infants per 1,000 live legitimate births 50.2 Illegitimate infants per 1,000 live illegitimate births 178.9 Deaths from:— Cancer (all ages) 84 Whooping cough (all ages) 2 Diarrhoea (under two years of age) 1 Vital Statistics During the year 712 live births were registered as belonging to this district, of which 375 were males and 337 were females, as compared with 934 last year. The live birth rate for the year was equal to 13.57 per 1,000 of population, as against 15.4 per 1,000 last year. The birth rate for England and Wales was 14.2 per 1,000, as against 14.6 per 1,000 last year. Illegitimate Births. The number of births registered as being illegitimate was 28, as compared with 27 last year. The illegitimate rate was equal to 3.79 per cent. of the total births, as against 2.81 per cent. in 1940, 9 Still Births The number of still births registered was 25, of which 16 were males and 9 females. Percentage op Births Occurring in Institutions Tear Total births Births in hospitals, etc. Percentage o£ births occurring in institutions 1929 961 309 32.1 1930 1129 367 32.4 1931 1143 370 32.3 1932 1084 381 35.1 1933 1010 420 41.5 1934 982 428 43.5 1935 969 474 48.9 1936 1033 497 48.1 1937 976 501 51.3 1938 1028 569 56.3 1939 966 518 53.7 1940 854 453 53.0 1941 737 408 55.4 Number of births notified by midwives in 1941 ... 566 „ ,, „ doctors and others in 1941 171 Deaths During the year 580 deaths were registered, of which 318 were males and 262 were females, as compared with 716 deaths last year. The death rate for the year was equal to 11.06 per 1,000 of the population, as compared with 11.8 per 1,000 in 1940. The death rate for England and Wales was 12.9 per 1,000 civilian population for the year 1941, and 14.3 per 1,000 for 1940. The birth rates, death rates per 1,000 of population, and the infantile mortality rates for the years 1915-1941 are shown in the following table; — 10 Year Births per 1,000 population Deaths per 1,000 population Infant Mortality per 1,000 live births MITCHAM England and Wales MITCHAM England and Wales MITCHAM England and Wales 1915 28.9 21.8 12.7 15.7 78 110 1916 23.0 21.6 10.1 14.3 71 91 1917 18.0 17.8 11.8 14.2 75 96 1918 17.9 17.7 14.8 17.3 77 97 1919 17.0 18.5 10.2 14.0 58 89 1920 27.8 25.4 9.2 12.4 50 80 1921 23.1 22.4 11.1 12.1 70 83 1922 20.9 20.6 11.0 12.8 61 77 1923 21.5 19.7 9.4 11.6 59 69 1924 20.3 18.8 9.2 12.2 55 75 1925 18.2 18.3 9.6 12.2 54 75 1926 21.5 17.8 9.9 11.6 63 70 1927 20.9 16.7 9.8 12.2 45 69 1928 20.4 16.7 8.8 11.7 48 65 1929 19.1 16.3 11.2 13.4 72 74 1930 19.3 16 3 8.2 11.4 49 60 1931 19.2 15.8 9.8 12.3 42 66 1932 18.0 15.3 8.4 12.0 43 65 1933 16.1 14.4 8.8 12.3 37.1 64 1984 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 38.0 53 1939 15.2 15.0 8.6 12.1 31.0 50 1940 15.4 14.6 11.8 14.3 46.0 55 1941 13.57 14.2 11.06 12.9 55.4 59 11 Infant Mortality During the year 35 deaths were registered as occurring in infants under one year of age:— Males Females Total Legitimate 20 11 31 Illegitimate 2 2 4 Total ... 22 13 35 as compared with 43 deaths last year. The infantile mortality rate for the year is equal to 55.4 per 1,000 live births, as against 46 per 1,000 last year. The infant mortality rate for England and Wales was 59 per 1,000 for 1941 and 55 per 1,000 for 1940. Maternal Mortality During the year four deaths were registered as being due to diseases or accidents of pregnancy, compared with one death last year. The following is a summary of the causes of death:— One death due to general septicaemia following abortion. One death due to toxaemia following incomplete abortion. One death due to bilateral pulmonary tuberculosis. One death due to haemorrhage following abortion due to a double uterus. 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 14 residents dying within the district and on 13 Mitcham residents who died outside the district, a total of 27. In addition the coroner held 68 post-mortems without inquests. 12 The following table shows the results of the findings of these inquests:— Inquests Number Deaths from natural causes 5 Deaths from accidents:— Fall from moving car 1 „ „ fire tender 1 Falls 5 Collision with lorry 1 Deaths from misadventure 7 Lysol poisoning 1 Deaths from suicide:— Falls from window 2 Coal gas poisoning 1 Gunshot wound 1 Causes unascertainable 1 Manslaughter 1 Total 27 13 Deaths Registered during the Year 1941 Cause of death. Males. Females. Total. Typhoid and paratyphoid ... ... ... Measles ... ... ... Scarlet Fever ... ... ... Whooping Cough 1 1 2 Diphtheria ... 1 1 Influenza 8 5 13 Encephalitis lethargica ... ... ... Cerebro-spinal Fever ... 4 4 Tuberculosis of the Respiratory System 28 19 47 Other Tuberculous Diseases 4 6 10 Syphilitic Diseases 2 2 4 General Paralysis of the insane, tabes dorsalis ... ... ... Cancer, malignant disease 46 38 84 Diabetes 2 3 5 Cerebral Haemorrhage 14 24 38 Heart Disease 79 71 150 Aneurism ... ... ... Other Circulatory Diseases 3 3 6 Bronchitis 17 14 31 Pneumonia (all forms) 18 7 25 Other Respiratory Diseases 1 2 3 Peptic Ulcer 6 1 7 Diarrhoea. &c. (under two years) ... 1 1 Appendicitis 1 1 2 Cirrhosis of the Liver ... ... ... Other Diseases of the Liver, etc ... ... ... Other Digestive Diseases 5 5 10 Acute and Chronic Nephritis 5 6 11 Puerperal sepsis ... 2 2 Other Puerperal causes ... 2 2 Congenital Debility, Premature Birth, Malformations, etc 13 9 22 Senility ... ... ... Suicide 4 ... 1 Other Violence 31 15 46 All other causes 26 19 45 Road Traffic Accidents 4 1 5 Total 918 262 580 Special Causes:— Small Pox ... ... ... Poliomyelitis ... ... ... Polio-encephalitis ... ... ... 14 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1941. (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 civilian population. Births— Live 14.2 14.7 16.4 8.9 13.57 Still 0.51 0.58 0.60 0.33 0.47 Deaths— All causes 12.9 14.9 13.0 16.3 11.06 Typhoid and Paratyphoid 0.00 0.00 0.00 0.01 — Scarlet fever 0.00 0.00 0.01 0.00 - Whooping cough 0.96 0.07 0.06 0.04 0.03 Diphtheria 0.07 0.08 0.06 0.03 0.01 Influenza 0.19 0.17 0.20 0.16 0.24 Smallpox — — — — — Measles 0.03 0.03 0.03 0.02 — Notifications— Typhoid fever 0.03 0.02 0.03 0.04 — Paratyphoid Fever 0.09 0.12 0.09 0.05 0.07 Cerebro-spinal fever 0.25 0.31 0.20 0.30 0.23 Scarlet fever 1.47 1.49 1.51 1.01 1.39 Whooping cough 4.39 4.37 4.50 3.50 3.58 Diphtheria 1.25 1.53 1.19 0.93 1.49 Erysipelas 0.30 0.36 0.27 0.50 0.36 Smallpox — — — — — Measles 10.33 8.27 10.47 4.77 3.73 Pneumonia 1.25 1.53 1.04 1.07 0.40 Rates per 1,000 live births. Deaths under one year of age 59 71 56 68 55 Deaths from diarrhoea and enteritis under two years of age 5.1 7.5 4.6 6.8 1.40 Rates per 1,000 total births (i.e., live and still) Maternal mortality (excluding abortion)— Puerperalinfection (No.147) 0.48 Not available 2.71 Others 1.75 2.71 Total 2.23 5.42 Notifications— Puerperal fever 11.91 15.64 9.43 2.29 — Puerperal pyrexia 19.3* 2.71 * Including Puerperal fever. 15 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA LABORATORY FACILITIES Bacteriological examinations for this district are carried out at the Wandle Valley Isolation Hospital. The following number of specimens from this borough have been examined during the year:— Swabs for diphtheria 609 Sputa for tubercle 61 Total 670 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. 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.—Two ambulances have been provided by the Council for the removal of general and accident cases. The total number of cases removed during the year was 873, of which 284 were accident cases, and 589 private removals. 16 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 mid wives. At present there are 10 midwives practising in this borough, four 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 31st, 1941:— No. of Nurses No. of patients visited during 1941 No. of visits paid during 1941 St. Barnabas 1 99 4,029 South and East Wards 3* 405 9,395 Christchurch 2* 142 2,620 Totals 6 646 16,044 * One part time. CLINICS AND TREATMENT CENTRES Welfare Clinics Infant Welfare Centres are held at the following places:— Sunshine Hall, Park Road.—Sessions are held every Monday afternoon. 17 St. Barnabas Church Hall, Gorringe Park Avenue.—Sessions are held every Tuesday afternoon. Sherwood House, Commonside East.—Sessions are held every Thursday morning. Church Road Centre.—Sessions are held every Thursday afternoon. Dr. Parsons attends all sessions. Ante-Natal Clinics Ante-natal clinics are held at the following places:— Woodlands Maternity Home.—Sessions held on Friday mornings for patients who have booked for the Woodlands Maternity Home. The total attendance of expectant mothers at this clinic was 1,990, the number of mothers attending being 245. Mitcham Court.—Sessions are held on the first three and the fifth Tuesdays in each month. The total attendance of expectant mothers was 809, the number of mothers attending being 179. The municipal midwives also hold a clinic at Mitcham Court on Wednesday afternoons. The total attendance was 974, and the number of mothers attending was 301. 98.37 per cent. of the mothers of children born during the year attended the ante-natal clinics (including Woodlands Maternity Home Clinic), as compared with 74.14 per cent. last year. Post-Natal Clinic A post-natal clinic is now held at Mitcham Court on the fourth Tuesday of each month, and 109 mothers attended this clinic during the year. This number represents 14.7 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 18 have a Home Help scheme, details of which were given in the annual report for 1935. During the year 14 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. Orthopedic Clinic Arrangements have been made with the Wilson Hospital, Mitcham, for children in need of orthopaedic treatment to attend the orthopaedic clinic of this hospital. During the year 24 cases were referred to this clinic, as compared with 36 cases in 1940. 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 26 women attended for this examination, as compared with 16 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:— 19 Number of foster mothers on register, December 31, 1941 15 Number of children on register, December 31, 1941 15 Number of children who have died during the year 1 Number of children on whom inquests were held 1 Number of registrations withdrawn ... Number of prosecutions — Number of visits paid by the Infant Life Protection Visitor 94 Number of foster mothers who have evacuated taking foster children with them 2 Findings of inquest on the child who died 10.4.41—"Regurgitation of stomach contents into air passage—Misadventure." 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 13 cases were dealt with by the Society. These cases affected the welfare of 37 children, and 49 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 five pupil midwives. All the staff are State registered nurses and, with the exception of the pupil midwives, hold the certificate 20 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:— 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 1939 254 1940 239 1941 215 Number of maternity beds in the institution (exclusive of isolation and labour beds), 15. Number of maternity cases admitted during the year, 214. Average duration of stay, 14 days. Number of cases delivered by (a) midwives, 199—1 twin labour; (b) doctors, 16. Number of cases in which medical assistance was sought by a midwife in emergency, 23. 21 Number of cases notified as (a) puerperal fever, nil; (b) puerperal pyrexia, nil. Number of cases of pemphigus neoratorum, nil. Number of infants not entirely breast-fed while in the institution, 3. Number of cases notified as ophthalmia neonatorum, nil. Number of maternal deaths, nil. Number of infants' deaths—(1) stillborn, 5; (ii) within 10 days of birth, 3. An ante-natal clinic is held every Friday at the Home, and patients who have booked are expected to attend. NUTRITION During the year 6,720 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. REPORT OF THE INFANT WELFARE AND ANTE-NATAL CENTRES, 1941. Particulars Park Boad Centre, four sessions monthly St. Barnabas Centre, four sessions monthly Church Boad Centre, four ses-ions 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 125 174 202 133 — — — 634 Children oyer one year and under five years of age 61 36 55 41 — - - 193 Number of children in attendanœ at end of year— Under one year of age 134 128 162 104 — — — 528 Over one and under five years of age 60 344 389 237 — — — 1030 Total attendances of children under one year of age 1452 2098 2042 1173 - - - 6765 Total attendances of children oyer one year of age 774 656 400 960 - - - 2790 Total attendances at centres 2226 2754 2442 2133 — — — 9555 Average attendances at centres 45.4 56.2 47.1 46.3 — — — 48.75 Percentage of infants under one year of age attending centres of total notified births - - - - - - - 89% Total attendances of expectant mothers - - - - 809 1990 974 3773 Average attendances of expectant mothers - - - - 16.5 39.8 19.8 25 Number of expectant mothers who attended during year - - - - 179 245 301 725 Percentage of total notified births represented by the number of expectant mothers attending all clinics - —- — - — — — 98% 22 Visits paid by Health Visitors, 1941. Mrs. Wray Miss Russell Harris Miss O'Riordan Miss Hinds Miss Oakes Miss Thompson Total Primary ante-natal visits 33 40 9 41 40 15 178 Subsequent ante-natal visits 15 10 2 20 10 2 59 Primary birth visits 1 180 37 226 124 57 625 Subsequent visits to infants — 693 179 798 482 183 2335 Visits to children over 1 and under 5 years of age — 1359 109 1027 741 453 3689 Visits re stillbirths — 10 — 6 3 1 20 Visits re deaths of infants under one year of age — 4 - 5 4 4 17 Visits re cases of ophthalmia neonatorum 3 — — - — — 3 Visits re cases of puerperal pyrexia 2 — — — — — 2 Primary visits to cases of tuberculosis 100 — — — — — 100 Subsequent visits to cases of tuberculosis 583 — — — — — 583 Special visits, and infant life protection visits 427 — — — — — 427 Infectious disease visits 16 26 — 13 11 39 105 1180 2322 336 2136 1415 754 8143 23 24 REPORT ON MATERNITY AND CHILD WELFARE SERVICES Child Welfare Child Welfare Sessions are held at four centres, thus serving every part of the Borough. Four sessions are held each month at each centre. The total number of attendances at the infant welfare centres was 9,555, as compared with 7,424 in 1940. Of these, 827 were new cases, 634 being infants under one year of age, and 193 being children over one but under five years of age. The total number of attendances of infants under one year was 6,765, and of children between one and five years of age, 2,790. At the end of the year there were 528 infants under one year and 1,030 children between one and five years of age attending the centres, making a total of 1,558. The average attendance at each individual centre was:— Park Road 45.4 Church Road 47.1 Sherwood Park 46.3 St. Barnabas 56.2 giving an average of 48.75. The percentage of infants under one year of age attending the centres was 89 per cent. of the total number of notified births. Supply of Food and Medicines Dried food, 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. Liquid or National Dried Milk can now be supplied free in necessitous cases on application to the local Food Office. Arrangements for the distribution of vitamins to children under 2 years of age were made at the Welfare Centres, the Food Office and at British Restaurants 25 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. Ante-Natal Centres One Ante-Natal Clinic is held each week at Mitcham Court and one clinic each week in connection with Woodlands Maternity Home. A clinic for cases booked by the mid wives is held each Tuesday at Mitcham Court. The total number of expectant mothers attending the centres was 725, the total number of attendances being 3,773, the average attendance 25.4. Of the total number of notified births, 98.3 per cent. of the mothers had attended the ante-natal centres. 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 245 1,745 39.8 Mitcham Court 179 630 16.5 Midwives Clinic 301 673 19.8 General Remarks The clinics were reserved as in previous years for those cases entering Woodlands, hospital, or for evacuation, 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 26 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. Cod liver oil emulsion, Virol or Parrish's Food, and extra nourishment were supplied free to necessitous and debilitated patients. 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 109, the average attendance being 9. Dental Treatment Dental treatment is available 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. Attendances at the Dental Clinic were as follows:— Expectant Mothers 15 Post-Natal Cases 8 Children under 5 years 28 Total 51 Work carried out. Mothers Children Inspections 23 28 Extractions under local anaesthesia — 1 Extractions under gas 16 22 Impressions 7 1 Dental Adjustments 7 — Scaling 1 — 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 by the Committee and grants made according to the scale adopted by the Council, 27 SANITARY CIRCUMSTANCES OF THE AREA ERADICATION OF BED BUGS Number of Council houses found infested during year 58 Number of other houses found infested during the year 44 Number of houses disinfested during the year 102 Number of Council houses disinfested by Council staff 58 Number of Council houses disinfested by Contractors nil Methods employed:— 75 room treated with sulphur dioxide (Cescones). 160 rooms treated with insecticide sprays (Lethane or Solitox) (inclusive of 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. Number of private houses disinfected by owners or occupiers after notice 44 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. 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. 28 Closure of Schools.—No school has been closed by the local authority during the year. Infectious Diseases.—Scholars in contact with a case of infectious disease are excluded from school, the period of 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 8304 Number of complaints received and investigated 330 Number of premises inspected 1534 Number of premises revisited 403 Number of houses measured for permitted numbers, Housing Act, 1936 34 Number of nuisances discovered 378 Number of nuisances abated without reports 129 Number of nuisances abated after reports 58 Number of intimatory notices served 196 Visits to butchers and other food shops 142 Visits to factories 55 Visits to stables and piggeries 35 Visits to refuse dumps 10 Details of visits to other premises are enumerated in other sections of the report. 29 Character of Work Done Roofs repaired 44 Rainwater gutters and piping repaired or renewed 18 Ventilation under floors provided or improved 8 Dampness to ground floor rooms remedied 19 Water service pipes repaired 10 Waterclosets: repairs to roof, walls, doors and seats 19 Flushing apparatus repaired or renewed 25 Water storage cisterns cleansed or covered 24 Water supply to houses reinstated 7 Back yards and sculleries paved or repaired 6 Flooring of rooms repaired 9 Rooms cleansed and redecorated 145 Repairs to internal plastering of walls and ceilings 159 Repairs to sinks and waste pipes 26 Window frames and sashes repaired 52 Windows made to open 8 Sashcords provided 24 Drains tested 9 Drains repaired and cleansed 168 New watercloset pans and traps provided 16 Repairs to firegrates 6 Repairs to washing coppers 6 New dustbins provided 49 Accumulations removed 28 Rooms disinfected, after infectious disease 191 Repairs to chimney eaves 6 Repairs to piggeries 8 Sundries 16 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.—Eighty licences to store petroleum and cellulose solutions were granted, totalling 147,800 gallons. A licence was also issued for 20 cwt. of carbide of calcium to be stored. 30 Unsound Food Dealt With. Beef 4490 lbs. Bacon 16¾ lbs. Mutton 681 „ Eggs 1150 Pork 45 „ Flour 34 lbs. Offal 4928 „ Salmon 35 tins Corned beef 204 „ Potatoes 392 lbs. Fish 354 „ Number of visits to Meat Depot 20 575 Yours obediently, K. J. GUTTERIDGE, Chief Sanitary Inspector. 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) 430 (b) Number of inspections made for the purposes 483 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 196 3. Action under Statutory Powers during the Year:— 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 31 (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 INSPECTION AND SUPERVISION OF FOOD FOOD AND DRUGS ACT, 1938 Formal Samples. 20 formal samples were taken, as follows:— Milk 16 Shredded Suet 1 Premier Jus 1 LemonCordial 1 Pork Sausage 1 Informal Samples. 40 informal samples were taken, as follows:— Cocoa 3 Egg Powder 2 Sardines 2 Tinned Peas 2 Salmon Paste 1 Custard Powder 1 Tomato Sauce 1 Pearl Barley 1 Coffee and Chicory 1 Sausage Meat 1 Jam 1 Flour 2 Chocolate Roll 1 Beef Suet 1 Fruit Chutney 1 Mustard 1 Porage Oats 1 Lemon Cordial 1 Vinegar 2 Yorkshire Pudding Pdr. 1 Cooking Fat 1 Glycerine 8 Pepper 1 Syrup of Figs 1 Rice 1 Gregory Powder 2 Mint 2 Quinine 2 Nine warning letters were sent to suppliers of samples slightly below standard. No proceedings were taken. 32 MILK (SPECIAL DESIGNATION) ORDER. 1936 During the year the Council granted the following number of licences under the above named Order:— Tuberculin Tested 4 Pasteurised 7 Pasteurising Plant 1 Supplementary Licences- Pasteurised 4 Tuberculin Tested 4 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES INFECTIOUS DISEASE NOTIFICATIONS The total number of certificates of notification received during the year was 591. Contacts, Suspects, Etc. The Medical Officer of Health may be called in consultation by medical practitioners to see patients in their homes. 33 The monthly incidence of infections disease was:— Small Pox. Scarlet Fever Diphtheria Typhoid Fever Erysipelas Pneumonia Puerperal Pyrexia Ophthalmia Neonatorum Dysentery Cerebro-spinal Meningitis Poliomyelitis Measles Whooping Cough Food Poisoning Totals January ... 8 1 ... 8 3 ... 1 ... 2 ... 44 ... ... 62 February ... 7 ... ... 4 3 ... ... ... 2 ... 26 1 ... 43 March ... 9 3 ... 1 4 1 1 ... 2 ... 27 3 ... 51 April ... 8 1 ... 1 2 ... ... ... 2 ... 9 6 1 25 May ... ... 19 ... 1 2 ... ... ... 2 ... 29 38 ... 103 June ... 2 4 ... 2 3 ... 1 ... 1 ... 27 35 ... 75 July ... 4 4 ... 1 ... ... ... ... ... ... 20 31 2 62 August ... 5 6 ... 1 1 ... ... ... ... ... 6 30 1 50 September ... 8 15 ... ... ... ... ... ... 1 ... 3 9 2 38 October ... 4 9 ... 2 1 ... ... ... ... ... 1 14 ... 31 November ... 11 5 ... 2 2 ... ... ... ... ... 2 14 ... 36 December ... 2 6 ... 1 1 1 ... ... ... ... ... 5 ... 15 Total ... 75 72 ... 19 22 2 3 ... 12 ... 194 186 6 591 Cases of Infectious Disease Notified During the Year 1941. Disease Number of Cases Notified Total Cases Notified Total Cases Removed to Hospital Deaths At all Ages At Ages—Years in each Ward 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 G.p. C.W. u.m. l.m. p.b. p.h. l.t. Pneumonia 22 ... ... 2 2 1 3 ... 2 6 1 2 3 3 9 ... ... 2 5 3 1 ... Cerebro-Spinal Fever 12 2 ... ... 1 ... 3 2 1 1 1 1 ... 3 2 ... 1 5 ... 1 12 4 Erysipelas 19 ... ... ... ... ... ... ... 2 2 5 7 3 3 2 4 ... 5 2 3 13 ... Ophthalmia Neonatorum 3 3 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 1 ... Puerperal Pyrexia 2 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 1 ... 2 ... Food Poisoning 6 ... ... 1 ... ... ... ... ... 4 ... ... 1 ... ... 2 ... 1 ... 3 ... ... Typhoid Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 194 5 16 20 23 18 99 6 4 3 ... ... ... 18 54 18 10 48 18 28 9 ... Whooping Cough 186 10 13 28 29 23 79 2 1 1 ... ... ... 23 27 11 15 23 45 42 12 1 Diphtheria 72 ... 3 1 3 4 86 12 5 5 1 2 ... 2 28 10 7 19 3 3 72 ... Scarlet Fever 75 1 3 6 1 24 19 8 8 2 ... ... ... 14 20 8 7 9 8 9 72 ... Totals 591 21 35 58 62 70 239 30 24 25 8 12 7 67 142 53 40 113 83 93 194 5 note: G.P.—Gorringe Park U.M —-Upper Mitcham P.B.—Phipps Bridge L.T.—Long Thornton C.W.—Colliers Wood L.M.—Lower Mitcham P.H.—Pollards Hill 34 Infectious Disease Notifications, 1922-41. Disease 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 Small Pox ... ... ... ... ... ... 9 7 ... 4 1 ... ... ... ... ... ... ... ... ... Scarlet Fever 178 110 81 106 104 145 102 134 113 105 174 240 392 143 171 192 150 61 48 75 Diphtheria 84 35 59 201 87 76 75 133 129 49 32 40 83 80 104 89 64 27 36 72 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 1 13 12 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 13 15 11 10 13 14 10 22 22 17 11 31 30 20 22 16 8 19 17 19 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 301 194 Acute Diarrhoea ... ... ... ... ... ... ... ... ... ... ... ... ... 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 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 ... 30 22 Malaria 8 3 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia ... ... ... ... 1 14 9 5 6 9 4 9 6 4 11 5 4 7 2 2 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 16 186 Food Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 4 6 Totals 347 287 246 376 259 340 270 375 319 242 288 368 560 293 357 338 275 125 468 591 35 36 Cerebro-Spinal Fever Twelve cases occurred during 1941, and four patients unfortunately died. Influenza During the year thirteen deaths from influenza were recorded. Eight were males and five females. The previous year five deaths were registered. Prevention of Blindness By an arrangement with the London County Council cases of ophthalmia neonatorum can be treated at Whiteoaks Hospital, Swanley Junction, Kent. Blind children are looked after by the Surrey Voluntary Association for the Blind. Ophthalmia Neonatorum During the year three cases of ophthalmia neonatorum were notified: —• Cases Notified Treated At Home In Hospital Vision Unimpaired Vision Impaired Total Blindness Deaths 3 2 1 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 fairly accurate estimate of the prevalence of non-notifiable infectious disease, such as chicken pox, 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 84, of which 46 were males and 38 were females. 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 1941 was as follows:— 37 Digestive organs 10 cases Genitourinary organs 12 „ Breast 3 „ Other sites 59 „ Total 84 „ 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 Mitcham England and Wales 1915 26 77 1.22 1916 21 63 1.16 1917 17 50 1.19 1918 25 72 1.19 1919 31 89 1.18 1920 34 94 1.16 1921 31 87 1.21 1922 34 94 1.22 1923 33 90 1.26 1924 42 1.11 1.29 1925 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 1939 73 1.12 1.64 1940 94 1.55 1.66 1941 84 1.6 1.67 38 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 100 new cases of tuberculosis were notified, viz.:— Males Females Total Pulmonary 59 24 83 Non-Pulmonary 7 10 17 Total 66 34 100 The total number of deaths registered as occurring from tuberculosis was viz.:— Males Females Total Pulmonary 28 19 47 Non-Pulmonary 4 6 10 Total 32 25 57 England and Wales Mitcham Death rate from respiratory tuberculosis per 1,000 population 0.57 0.89 Death rate from non-pulmonary tuberculosis per 1,000 population 0.12 0.19 39 The following table shows the number of new cases, the type of disease and the deaths from tuberculosis during the year. age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M. P. M. P. M. P. M. F. Under 1 year ... ... ... ... ... ... ... ... 1 year to 5 years 2 ... 1 1 ... ... 1 1 5 years „ 10 „ 2 ... 2 ... ... ... ... 1 10 „ „ 15 „ ... 1 3 2 ... 1 1 1 15 „ „ 20 „ 5 4 ... 3 ... 4 1 1 20 „ „ 35 „ 19 12 ... 4 4 7 1 2 35 „ „ 45 „ 12 5 1 ... 8 5 ... ... 45 „ „ 65 „ 16 2 ... ... 15 2 ... ... 65 „ and upwards 3 ... ... ... 1 ... ... ... Totals 59 24 7 10 28 19 4 6 New cases coming to the knowledge of the Medical Officer of Health during the year through (a) Death returns; (6) Posthumous notifications:— Age Periods 0- 1- 6- 10- 15- 20- 25- 35- 45- 55- 65- Total Pulmonary males ... ... ... ... ... ... ... 1 ... 1 ... 2 Pulmonary: females ... ... ... ... ... 1 ... ... ... ... 1 1 Non-Pulmonary: males ... 1 ... ... ... ... ... ... ... ... ... 1 Non-Pulmonary: Females ... ... ... ... ... ... ... ... ... ... ... ... 40 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 ... ... (b) Transferable deaths from Registrar General ... ... Posthumous notifications 3 1 Number of cases removed from register during 1941:— Reason Pulmonary Non- Pulmonary Total Cases Males Females Total Males Females Total Withdrawal of notification ... ... ... ... ... ... ... Recovery from disease 1 2 3 1 2 3 6 Death 28 19 47 4 6 10 57 Otherwise 11 16 27 3 7 10 37 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths is as follows:— Non-notified tuberculosis deaths 4 Notified tuberculosis deaths 53 Percentage of non-notified T.B. deaths (all forms) 7 per cent. Percentage of non-notified pulmonary T.B. deaths 6 „ Treatment for cases of tuberculosis is under the control of the Surrey County Council. A dispensary has been established at London Road School, Mitcham. Arrangements have been made by this Borough for 41 the examination of sputa from cases or suspected cases of tuberculosis, and during the year 61 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—1941 Number of persons assisted during 1941 33 Receiving supplies of milk, butter, eggs, continuously for 12 months 6 „ „ „ for 6-9 months 8 „ ,, ,, under 6 months 14 Pares for family to visit sanatorium 4 Clothing. bedding, supplied through the medium of Committee 4 Tuberculous persons who have received special consideration re housing 3 Pocket money 4 Repayment of debts 1 Small Pox No case of small pox was notified during the year 1941. Scarlet Fever The number of cases notified during the year was 75, this being 27 more than last year. 72 Were removed to hospital. No deaths were registered from this disease during the year. 42 Diphtheria Seventy-two cases were notified during the year and all the cases were removed to hospital for treatment. 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 Mitcham Court every week. During the year 2,891 children have been immunised. Diphtheria prophylactic is also given to the medical practitioners in the district free of charge. Typhoid Fever No case was notified during the year. Diarrhcea and Enteritis Under Two Years of Age One death was registered during the year. Encephalitis Lethargica No cases were notified during the year. Chicken Pox One hundred and four cases of chicken pox were notified by the head teachers of the schools in the district. Mumps Eighteen cases of mumps were notified by the head teachers of the schools in the district. Impetigo Eighteen cases of impetigo occurred in school children during the year. Scabies Eighteen cases of scabies occurred in school children, 43 Erysipelas Nineteen cases were notified Thirteen cases were removed to hospital. No deaths from this disease were registered. Puerperal Pyrexia Two cases were notified during the year. Pneumonia Twenty-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 25, of which 18 were males and 7 females. 44 WANDLE VALLEY JOINT HOSPITAL BOARD Cases admitted to the hospital during the year ended December 31, 1941. Disease Beddington & Wallington Coulsdon & Purley Merton & Morden Mitcham Cases Deaths Cases Deaths Cases Deaths Cases Deaths Diphtheria 11 1 6 ... 24 ... 82 2 Scarlet Fever 19 ... 27 ... 70 ... 69 ... Typhoid 2 ... 3 ... 6 ... 7 ... Erysipelas 2 ... 1 ... 2 ... 11 ... Tonsilitis 3 ... 2 ... ... ... 5 ... Measles 1 ... 3 ... 11 ... 9 ... Influenza 1 ... 2 ... ... ... 6 ... Whooping Cough 7 2* 7 ... 20 1 * 14 1† Rubella ... ... ... ... 1 ... ... ... Meningitis 5 ... 1 ... 12 ... 10 l T.B. Meningitis ... ... ... ... ... ... 3 3 Chicken Pox ... ... 1 ... ... ... 1 ... Puerperal Fever ... ... 1 ... 2 ... 3 1‡ Admitted with mother ... ... 1 ... ... ... 1 ... Abscesses & Septic Sores 1 ... ... ... ... ... ... ... Septicaemia ... ... ... ... 2 ... ... Dermatitis (including Scabies) ... ... ... ... ... ... 2 ... Poliomyelitis ... ... 2 ... 2 ... ... ... Enteritis ... ... ... ... ... ... 2 ... Heat Rash ... ... ... ... ... ... 1 ... Pneumonia ... ... ... ... 2 ... ... ... 52 3 57 ... 154 3 226 8 * One Beddington & Wallingion death and one Merton & Morden death. Whooping Cough with Convulsions. † One death Whooping Cough and Broncho Pneumonia. ‡ One death Septic Abortion. 45 INDEX page Ambulances 15 Analysis of Mortality 14 Ante-Natal Clinics 17, 25 Area 7 Bed Bugs, Eradication of 27 Birth Rates 10,14 Births, Live 7 — Illegitimate 8 — Still 9 Blindness, Prevention of 36 Cancer 36 — Deaths from 37 Causes of Deaths 18 Cerebro-Spinal Fever 36 Chicken Pox 42 Child Welfare 24 Clinics 16 — Ante-natal 17 — Orthopaedic 18 — Post-natal 17 — Welfare 10 Death Rates 10,14 Deaths 8,9, 13 Dental Treatment 26 Diarrhoea and Enteritis 42 Deaths from 8 Diphtheria 42 - Immunisation 42 Encephalitis Lethargica 42 Eradication of Bed Bugs 27 Erysipelas 43 Food and Drugs Act (1938) 31 — Inspection and Supervision of 31 Food and Medicine, Supply of 24 46 page General Provision of Health Services for the Area 15 Health, Visiting 16 — Visitors, Visits by 28 Home Helps 17 Hospitals 15 Houses, Inspection of 30 Housing 30 — Statistics 30 Impetigo 42 Infantile Mortality 8,10,11 Infant Life Protection 18 Infectious Disease, Cases notified 84 — Incidence of 83 — Prevalence of and Control over 82 — — Notifications 32,35 — School 36 — — Contacts 32 Influenza 86 Inhabited Houses 7 Inquests 11 Inspection and Supervision of Food 31 Laboratory Facilities 15 Maternal Mortality 11,14 Maternity and Child Welfare Services, Report on 24 Home 19 Midwives 16 Milk (Special Designation) Order (1936) 32 Mortality, Analysis of 14 — Infant 8, 10, 11 — Maternal 11,14 Mumps 42 N.S.P.C.C 19 Nursing in the Home 16 Nutrition 21 Ophthalmia Neonatorum 36 Orthopaedic Clinic 18 Patients Admitted to Hospital 44 Personnel, Committee 5 — Staff 6 47 page Petroleum Act (1928) 29 Pneumonia 43 Ponds and Ditches 29 Population 7 Post-natal Clinic 17 Prevention of Blindness 36 Puerperal Pyrexia 43 Rateable Value 7 Samples, Food 81 Sanitary Inspector's Report 28 Scabies 42 Scarlet Fever 41 Schools 27 Small Pox 41 Social Conditions 7 Statistics 7 Statistics, Housing 30 — Vital 8 Still Births 9 Sunlight Treatment 18 Tuberculosis 38 — Care Committee 41 Typhoid Fever 42 Vital Statistics 8 Wandle Valley Hospital 44 Welfare Clinics 16 Attendance at 22 Whooping Cough, Deaths from 8 Woodlands Maternity Home 19 X-Ray Examinations 18