MIT12 BOROUGH OF MITCHAM REPORT OF THE j MEDICAL OFFICER OF HEALTH FOR THE YEAR 1943 ■V - . • »■ '• ^ & ■ 3 BOROUGH OF MITCHAM REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1943 Mitcham: H. G. Mather, Caxton Works, Lower Green . Borough of Mitcham HEALTH REPORT FOR 1943 To the Mayor, Aldermen and Councillors Sir, Ladies and Gentlemen, I have much pleasure in submitting my annual report for the year 1943. The health of the Borough has been maintained at a high level in spite of wartime conditions. The birth rate is the highest recorded since 1931 and, except for the year 1939, the infant mortality rate is the lowest on record. The number of illegitimate births has again increased, and the high infant mortality rate of these infants emphasises the need for special supervision and consideration of this group. The local death rate was 10.77 per 1,000, as against 12.1 for England and Wales and 14.2 for the great towns, including London. The accommodation at the Eagle House Day Nursery has been filled to capacity, and the Robinson Road Nursery, opened on August 9th, had a full register at the end of the year. The Welfare and Ante-Natal Centres have had increased attendance; 88 per cent. of all infants and 84.8 per cent. of all expectant mothers attended the Borough Clinics. There has been an increased demand for maternity beds during the year, and 69.4 per cent. of all births occurred in institutions. The Woodlands Maternity Home was closed owing to an outbreak of mild pemphigus, but it was re-opened after thorough disinfection, cleansing and redecorating, and no further cases occurred. No serious epidemic of infectious disease has occurred during the year, although there has been a further increase in the number of notifications of scarlet fever. Diphtheria immunisation has been made available to all children when reaching one year of age, and two additional immunisation clinics have been opened during 1943. In conclusion, I should like to thank the staff for their loyal and able service, and express my gratitude to the chairmen and members of the Public Health and Maternity and Child Welfare Committees for their courtesy and assistance. I am, Ladies and Gentlemen, Yours obediently, A. ASHWORTH, Medical Officer oj Health. Public Health Department, Mitcham Court, Mitcham. BOROUGH OF MITCHAM PUBLIC HEALTH COMMITTEE Chairman - - Councillor H. L. Gauntlett His Worship the Mayor (Alderman W. Dalton) Aldermen— E. J. D. Field, J.P. S. L. Gaston, J.P. Councillors— G. W. Cole W. F. Hill G. R. Madgwick G. W. Pearee Mrs. C. Randall Sir I. Wilson MATERNITY AND CHILD WELFARE COMMITTEE Chairman - Mrs. C. Randall His Worship the Mayor Councillors— S. E. Birch G. C. Cock H. Conway F. Domminney Miss G. D. Francombe R. A. Humphreys T. A H. Murch Mrs. E. Watson Co-opted Members— Mrs. D. L. Chappell Miss K. Farewell-Jones Mrs. C. Norman Dr. G. Stoker Mrs. E. F. Ward REPRESENTATIVES ON WANDLE VALLEY JOINT HOSPITAL BOARD His Worship the Mayor (ex-officio) Aldermen— C. Woods A. H. Bailey Mrs. E. Watson REPRESENTATIVES ON WANDLE VALLEY JOINT SEWERAGE BOARD Chairman - - Alderman S. L. Gaston, J.P. His Worship the Mayor (ex-officio) Alderman E. J. D. Field Councillor A. T. Gidden STAFF Medical Officer of Health 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 (1, 2) Assistant Sanitary and Meat Inspectors A. H. Riley (1, 2, 4) L. Cleed (1, 2, 3) Superintendent Health Visitor and Infant Life Protection Visitor (a) Mrs. E. S. Wray (6, 7, 8, 9, 10, 11) (b) Miss E. G. Couzens (5, 6, 7) Assistant Health Visitors Miss G. Russell-Harris (5, 6, 7) Miss D. Hinds (5, 6, 7) (c) Miss E. Oakes (5. 6, 7) (d) Miss P. Thompson (5, 6, 7) (e) Miss M. Knight (6, 8) (f) Miss L. Salway (5, 6, 7) (a) Resigned 2.2.43 (b) Appointed 1.5.43 (c) Resigned 1.1.43 (d) „ 31.8.43 (e) Appointed 23.1.43 (f) „ 1.10.43 Matron of Woodlands Maternity Home Miss G. M. Evans (5, 6) Matron of Eagle House Day Nursery Miss J. E. Offer (5, 6, 12) Matron of Robinson Road Day Nursery (g) Mrs. L. Elkington (5, 6, 13) Midwives Miss P. Gaunt (5, 6) Miss M. Monday (5, 6) Mrs. L. Papps (5, 6) Mrs. T. Davies (5, 6) Clerks J. B. A. Roodliouse and L. J. Bellingham, H.M. Forces Mrs. M. Odam Miss V. Valentine (temporary) (h) Mrs. H. Whitfield (temporary) (i) Miss D. Turner (temporary) (g) Appointed 21.6.43 (h) Resigned 11.3.43 (i) Engaged 15.3.43 1. Certificate Sanitary Inspectors' Board. 2. Certificate .Meat and Foods R.S.I. 3. Smoke Inspector's Certificate. 4. Diploma Institute of Hygiene. 5. State Registered Nurse. 6. Certificate of Central Midwives' Board. 7. Health Visitor's Certificate R.S.I. 8. Health Visitor's Diploma. 9. Inspector of Nuisances. 10. Sanitary Inspector's Exam. Board. 11. Diploma Sanitary Science. 12. Sick Children's Registered Nurse. 13. State Registered Fever Nurse. 8 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, 1948 54,490 Number of inhabited houses, 1921 7,150 1931 13,187 1943 16,992 Rateable Value, 1943 £500,785 Sum represented by a 1d. rate £1,958 STATISTICS. Live Births. Total Male Female Rate per 1,000 of population Legitimate 981 499 482 Illegitimate 41 25 16 Total 1022 524 498 18.75 Still Bikths Total Male Female Rate per 1,000 total births Legitimate 24 14 10 Illegitimate 2 1 1 Total 26 15 11 24.81 Deaths. Total Male Female Rate per 1,000 of population 587 308 279 10.77 Deaths from disease and accidents of pregnancy and childbirth :— Rate per 1,000 total births From puerperal sepsis — — From other puerperal causes 1 Total 1 0.95 9 Deaths of infants under one year of age:— All infants per 1,000 live births 36.20 Legitimate infants per 1,000 live legitimate births 32.62 Illegitimate infants per 1,000 live illegitimate births 121.95 Deaths from:— Cancer (all ages) 95 Measles 2 Whooping cough (all ages) 2 Diarrhœa (under two years of age) 2 Percentage of Births Occurring in Institutions Year Total births Births in hospitals, etc. Percentage of births occurring in institutions 1929 961 309 32.1 1930 1129 367 32.4 1931 1143 370 32.3 1932 1084 381 35.1 1933 1010 420 41.5 1934 982 428 43.5 1935 969 474 48.9 1936 1033 497 48.1 1937 976 501 51.3 1938 1028 569 56.3 1989 966 518 53.7 1940 854 453 53.0 1941 737 408 55.4 1942 986 518 52.5 1943 1048 727 69.4 Number of births notified by midwives in 1943 357 „ „ „ doctors and others in 1943 691 The birth rates, death rates per 1,000 of population, and the infantile mortality rates for the years 1923-43 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 & Wales mitcham England & Wales mitcham England & Wales 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 66 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 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 1942 17.54 15.8 9.81 11.6 43.75 49 1943 18.75 16.5 10.77 12.1 36.2 49 11 Infant Mortality During the year 37 deaths were registered as occurring in infants under one year of age:— Males Females Total Legitimate 18 14 32 Illegitimate 4 1 5 Total 22 15 37 as compared with 42 deaths last year. Maternal Mortality During the year one death was registered as being due to:— Cerebral compression. „ Haemorrhage. Chronic nephritis and arterio sclerosis Pregnancy. In 1942, one death was registered as being due to disease or accident of pregnancy. Inquests Inquests were held on 14 residents dying within the district and on 16 Mitcham residents who died outside the district, a total of 30. In addition, the coroner held 87 post-mortems without inquests. The following table shows the results of the findings of these inquests:— Deaths from natural causes 3 Accidental deaths 19 Deaths from misadventure 4 Suicides 4 Total 30 12 Deaths Registered during the Year 1943 Cause of Death Males Females Total 1 Typhoid and paratyphoid fevers ... ... ... 2 Cerebro spinal fever 1 ... 1 3 Scarlet fever ... ... ... 4 Whooping cough 1 1 2 5 Diphtheria 2 1 3 6 Tuberculosis of respiratory system 21 10 31 7 Other forms of tuberculosis 3 1 4 8 Syphilitic diseases 1 3 4 9 Influenza 3 6 9 10 Measles ... 2 2 11 Aoute polio-myelitis and polio-encephalitis ... ... ... 12 Acute infectious encephalitis ... ... ... 13 Cancer of buccul cavity and oesophagus (m) and uterus (f) 5 2 7 11 Cancer of stomach and duodenum 4 8 12 15 Cancer of breast ... 7 7 16 Cancer of all other sites 40 29 69 17 Diabetes 4 3 7 18 Intra-cranial vascular lesions 31 30 61 19 Heart disease 69 67 136 20 Other diseases of circulatory system 8 12 20 21 Bronchitis 30 21 51 22 Pneumonia. 24 17 41 23 Other respiratory diseases... 4 3 7 24 Ulcer of stomach or duodenum ... 4 ... 4 25 Diarrhoea (under two years) 2 ... 2 26 Appendicitis... ... ... 27 Other digestive diseases 8 12 15 28 Nephritis 2 7 9 29 Puerperal and post-abortive sepsis ... ... ... 30 Other maternal causes ... 1 1 31 Premature birth 4 4 8 32 Congenital malformations, birth injuries, infantile disease 6 7 13 33 Suicide 3 1 4 34 Road traffic accidents 3 2 5 35 Other violent causes 4 9 13 36 All other causes 26 13 39 All causes 308 279 587 13 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1943. (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 Miteham Rates per 1,000 civilian population Births— Live 16.5 18.6 19.4 15.8 18.75 Still 0.51 0.63 0.61 0.45 0.47 Deaths— All causes. 12.1 14.2 12.7 15.0 10.77 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 — Scarlet fever 0.00 0.00 0.00 0.00 — Whooping cough 0.03 0.03 0.03 0.03 0.03 Diphtheria 0.03 0.04 0.04 0.02 0.05 Influenza... 0.37 0.36 0.37 0.27 0.16 Smallpox ... — — — — — Measles ... 0.02 0.02 0.02 0.02 0.03 Notifications— Typhoid fever 0.01 0.01 0.02 0.01 0.01 Paratyphoid fever 0.01 0.01 0 01 0.01 — Cerebro-spinal fever 0.08 0.10 0.06 0.09 0.14 Scarlet fever 3.01 3.29 3.54 3.80 3.89 Whooping cough 2.54 2.82 2.25 2.68 2.97 Diphtheria 0.88 1.12 0.77 0.74 0.77 Erysipelas 0.31 0.35 0.27 0.42 0.40 Smallpox - - - - - Measles 9.88 9.23 9.77 9.17 11.94 Pneumonia 1.34 1.62 1.16 1.27 0.91 Rates per 1,000 live births Deaths under one year of age 49 58 46 58 36 Deaths from diarrhœa and enteritis under two years of age 5.3 7.9 4.4 10.4 1.9 Rates per 1,000 total births (live and still) Maternal mortality Abortion with sepsis 0.34 Not available - „ without sepsis 0.11 - Puerperal infections 0.39 - Other 1.45 ( 0.95 Notifications— Puerperal fever 11.68 15.11 9.26 3.05 2.86 Puerperal pyrexia 15.23* Mortality per million women aged 15.45 Abortion— With sepsis 25 Not available - Without sepsis 8 - * Including Puerperal fever. A dash (—) signifies that there were no deaths. 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 514 Sputa for tubercle 33 Total 547 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 1,300, of which 247 were accident cases, and 1,053 private removals. 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. NURSING IN THE HOME There are two nursing associations in the Borough. The following are the returns from each association for year ended December 31 st, 1943:— No. of Nurses No. of patients visited during 1943 No. of visits paid during 1943 St. Barnabas 1 148 3,754 Mitcham D.N. Association— South and East 3* 439 8,518 Christchurch and West 2* 228 4,953 Totals 810 17,225 * One part time. 15 HOSPITALS. For General Cases.—The Wilson Hospital, which is a Voluntary Hospital situated within the district, receives accident and general cases. Other voluntary 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. The Surrey County Council are the local hospital authority and the County Council hospitals provide hospital accommodation for Mitcham patients. 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. For Maternity Cases.—Cases requiring hospital treatment are admitted to the County Council Hospitals or the London Voluntary Hospitals. DOMICILIARY MIDWIFERY 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. WOODLANDS MATERNITY HOME The Borough Maternity Home has accommodation for 15 cases. All patients must be Mitcham residents, and those who wish may book their own medical attendant for the confinement. CLINICS AND TREATMENT CENTRES Welfare Clinics Infant Welfare Centres are held at the following places:- 16 Sunshine Hall, Park Road.—Sessions are held every Monday afternoon. 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 are held on Friday and Monday mornings for patients who have booked for the Woodlands Maternity Home. Mitcham Court.—Sessions are held on every Tuesday morning. The municipal midwives also hold a clinic at Mitcham Court on Wednesday afternoons. Post-Natal Clinic A post-natal clinic is held at Mitcham Court on the fourth Tuesday of each month. School Clinic The Surrey County Council is the Local Education Authority. Medical and dental services are provided at the School Clinic, London Road. Diphtheria Immunisation Clinic Diphtheria Immunisation Clinics are held as follows:— Meopham Road F.A.P. Every Monday afternoon. Mitcham Court Every Wednesday morning. Cavendish Road F.A.P, Every Thursday afternoon, 17 Scabies Clinic A Clinic for the diagnosis of this condition is held by the Medical Officer of Health at Mitcham Court every morning, Tuberculosis Clinic The Surrey County Council is the authority responsible for diagnosis and treatment of tuberculosis. Dispensaries are held at the St. Helier County Hospital as follows:— Every Tuesday at 10 a.m. Every Thursday at 1.30 p.m. Fourth Thursday at 5.30 p.m. Venereal Diseases Clinics The Surrey County Council is the responsible authority for venereal diseases in this area and is a member of the London and Home Counties Scheme. The arrangements provide for the free diagnosis and treatment of these diseases at the Croydon General Hospital, Royal Surrey County Hospital, Guildford, East Surrey Hospital, Redhill, and at hospitals under the London and Home Counties Scheme. Disinfection The disinfection of houses is undertaken by the Council. Disinfection of bedding, etc.. is done by the Wandle Valley Isolation Hospital. Charges are made for disinfection which is not in the interests of the public health. 18 REPORT ON MATERNITY AND CHILD WELFARE SERVICES Child Welfare Child Welfare Sessions are held at four centres, thus serving every part of the Borough. Every centre is held weekly. The total number of attendances at the infant welfare centres was 17,258, as compared with 16,509 in 1942. Of these 1,010 were new cases, 869 being infants under one year of age, and 141 being children over one but under five years of age. The total number of attendances of infants under one year was 11,875, and of children between one and five years of age, 4,373. At the end of the year there were 779 infants under one year and 1,358 children between one and five years of age attending the centres, making a total of 2,137. The average attendance at each centre was:— Park Road 67.06 St. Barnabas 98.74 Church Road 92.13 Sherwood House 83.67 The percentage of infants under one year of age attending the centres for the first time was 88 per cent. of the total number of live births. General Remarks The nutrition, clothing and cleanliness of the children continued to be of a high standard, and the children attended the centres very regularly. Sunlight Treatment Arrangements have been made with the Wilson Hospital for giving sunlight treatment. No patients were sent during the year. Orthopaedic Clinic Arrangements have been made with the Wilson Hospital, Mitcliam, for children in need of orthopaedic treatment to attend 19 the orthopaedic clinic of this hospital. During the year 52 cases were referred to this clinic, as compared with 58 cases in 1942. Dental Treatment Dental treatment is available to children under five years of age and to expectant and nursing mothers. Patients are referred from the infant welfare, ante-natal and post-natal clinics to the British Dental Hospital, Tooting. Attendances for treatment were as follows: — Work carried out Attend- ExtracPatients ances tions Dentures Fillings Advice Expectant mothers 26 12 6 — 8 Under Fives 18 6 — 6 6 Health Visiting There are five health visitors employed in visiting the mothers and children in this district. The Superintendent Health Visitor is responsible for the general supervision of the welfare centres, ante-natal clinics, etc., and also does the visiting of tuberculous patients and acts as Infant Life Protection Visitor. Louse Infestation. Special attention has been given by the health visitors to the inspection of children under five for infestation with lice. Few cases of heavy infestation have been reported, and in all cases lethane hair dressing has been supplied and has given very satisfactory results. Owing to the difficulty mothers have encountered in obtaining suitable combs, a number were bought and lent to the mothers. Infestation is usually present in several members of the household, and the desirability of both school children and pre-school children and adults being under one authority is obvious. Some of the more serious cases of infestation in children under five years were found at the day nurseries where children's heads are examined as a routine measure each day on admission. 20 Attendances at Infant Welfare Centres, 1943 Particulars Park Road St. Barnabas Church Road Sherwood House Total Number of new eases registered during year of— Children under one year of age 125 236 267 241 869 Children over one year and under five years of age 37 26 35 43 111 Number of children in attendance at end of year— Under one year of age 113 217 242 207 779 Over one and under five years of age 298 399 335 326 1358 Attendances of children under one year of age 2185 3240 3340 3110 11875 Attendances of children over one year of age 872 1435 1109 957 4373 Total attendances at centres 3219 4937 4751 4351 17258 Average attendances at centres 67.06 98.74 92.13 83.67 85.4 Percentage of infants under one year of age attending centres of the total live births ... ... ... ... 88 Visits Paid by Health Visitors Particulars No. Primary ante-natal visits 250 Subsequent ante-natal visits 124 Primary birth visits 936 Subsequent visits to infants 2,475 Visits to children over one and under five years of age 3,983 Visits re stillbirths 4 Visits re deaths of infants under one year of age 4 Visits re cases of ophthalmia neonatorum 4 Visits re cases of puerperal pyrexia — Primary visits to cases of tuberculosis 72 Subsequent visits to cases of tuberculosis 134 Special visits, and infant life protection visits 640 Infectious disease visits 189 Visits re diphtheria immunisation 1,931 Total 10,746 Supply of Food and Medicines Dried food, cod liver oil emulsion, Virol, Parrish's Food, groats and Lactagol were sold at the centres, and in necessitous 21 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 is supplied free in necessitous cases on application to the local Food Office. Vitamins are supplied to children under two years of age at Welfare Centres, the Food Office and at British Restaurants. Arrangements were also made for necessitous nursing and expectant mothers to receive free meals. Ante-Natal Centres One ante-natal clinic is held each week at Mitcham Court and two clinics each week In connection with Woodlands Maternity Home. A clinic for cases booked by the midwives is held each Wednesday at Mitcham Court. Of the total number of registered births, 84.8 per cent, of the mothers had attended the ante-natal centres. The number of expectant mothers who attended the antenatal centres and were evacuated for their confinements was 72. 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 mid- Average Attendance at Each Centre Number of expectant mothers Number of attendances Average attendance Woodlands (two clinics) 266 2,625 24.0 Mitcham Court 312 954 18.3 Midwives' Clinic 311 1,460 22.3 Total 889 5,039 21.5 22 wives. Any patient who was to be attended by her own doctor was advised to attend him 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. Cod liver oil emulsion, Virol or Parrish's Food, and extra nourishment were supplied free to necessitous and debilitated patients. X-Ray Examinations Arrangements have been made with the Wilson Hospital, Mitcham, for the X-ray examination of women attending the antenatal clinics. The majority of the examinations are made to determine the presentation of the child in doubtful cases, and also to confirm the diagnosis of twins. During the year 48 women attended for this examination, as compared with 26 last year. 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 167, the average attendance being 15. Home Helps The demand for the services of Home Helps has increased during the year. The number of part-time workers available has gradually decreased, in spite of higher rates of pay. The Council has approved the appointment of two full-time persons, but at the end of the year no suitable applicants had been obtained. 23 It has proved more satisfactory for the patient to find her own home help, if possible, usually a relative. The Council pay her wages, and claim re-imbursement according to scale from the patient. WOODLANDS MATERNITY HOME. The number -of cases admitted during the year was lower than in 1942 as the home was closed for 28 days owing to an outbreak of pemphigus. During August and early September four cases of pemphigus occurred followed by two further cases on October 15th and 16th. The home was closed to new cases on October 19th, alternative arrangements being made for the booked cases, and the Ministry of Health were informed. The home was thoroughly disinfected and redecorated, and several structural alterations suggested by Dr. Marsh of the Ministry of Health were completed. The home re-opened on November 17th, and no further cases have occurred. To avoid overcrowding as much as possible, an extra antenatal session has been held at the home each week, and during the last months of the year the ante-natal clinics were held at the Cavendish Road First-Aid Post. During the year a Walton Minnitt gas and air apparatus for analgesia was purchased and the staff received special training in its use at Kingston County Hospital. 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 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. 24 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 1942 263 1943 224 Number of maternity beds in the institution (exclusive of isolation and labour beds), 15. Number of maternity eases admitted during the year, 224. Average duration of stay, 14 days. Number of cases delivered by (a) midwives, 201; (b) doctors, 23. Number of cases in which medical assistance was sought by a midwife in emergency, 37. Number of eases notified as (a) puerperal fever, nil; (b) puerperal pyrexia, nil. Number of cases of pemphigus neonatorum, 8. Number of infants not entirely breast-fed while in the institution, 9. 25 Number of cases notified as ophthalmia neonatorum, nil. Number of maternal deaths, nil. Number of stillbirths, 3. Number of infants' deaths within 10 days of birth, 1. An ante-natal clinic is held every Monday and Friday at the Home, and patients who have booked are expected to attend. 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, 1943 13 Number of children on register, December 31, 1943 14 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 232 Adoption of Children Act, 1939. This Act came into force on June 1st, 1943. Numbers of children are placed in homes in the Borough by the registered adoption societies without any reference to the Local Welfare Authority. In my opinion, this is a most unsatisfactory 26 ment, and adoption societies have been requested to notify the Superintendent Health Visitor, who is Infant Life Protection Visitor, of any cases placed for adoption in the borough. Number of persons who gave notice under Section 7 (3) during the year 3 Total number of children adopted under the Section during the year 2 Number of such children under supervision at the end of the year 1 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. Number of Mitcham cases dealt with in 1943 11 Number of visits paid 43 War-time Nurseries Eagle House has continued to give satisfactory service during the year, and has a waiting list of cases for admission. Structural alterations have been approved by the Ministry of Health, which will increase the accommodation from 65 to 85. Robinson Road Nursery was opened on August 9th, and at the end of the year the register was full. The house has been adapted for nursery purposes, and with the addition of a prefabricated section accommodation has been provided for 50 children. The average attendances were as follows:— Eagle House. Robinson Road. Under two 22.09 14.11 Two—five 39.36 15.05 Total 61.45 29.16 27 SANITARY CIRCUMSTANCES OF THE AREA WATER SUPPLY Except for eight houses in Goat Road, supplied by the Sutton Water Company, the whole of Mitcham is supplied by the Metropolitan Water Board. Four houses in the Borough have no separate water supply, and share a stand pipe situated at the rear of the houses. There are in addition ten licensed caravan yards, each containing a stand pipe and supplying a total of 26 caravans. The water has been of a consistently high standard of purity and no case of infectious disease has been transmitted by water. A large number of the houses in the Borough have no supply of drinking water direct from the main, but are supplied from a tank in the roof. Provided this tank is properly covered and is cleansed regularly, it provides a satisfactory supply, but frequently the covers are left off and the tanks become contaminated with dead birds, mice, etc., drowned whilst obtaining water. All the more modern houses are, however, supplied with one tap for drinking purposes direct from the main supply. RIVERS AND STREAMS Ten 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 one cesspool in use. PUBLIC CLEANSING A fortnightly collection of house refuse is carried out by direct labour. Four dust collection vehicles are in use. A fortnightly collection of salvage is also made, two vehicles being used for this purpose. 28 ERADICATION OF BED BUGS Number of Council houses found infested during year 77 Number of other houses found infested during the year 6 Number of houses disinfested during the year 86 Number of Council houses disinfested by Council staff 77 Number of requisitioned, etc., houses disinfested by Council staff 6 Number of Council houses disinfested by contractors nil Methods employed:— 77 houses treated with sulphur dioxide (Cescones). 69 rooms treated with insecticide spray (Lethane) (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 disinfested by owners or occupiers after notice 9 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 inspector. All schools have a constant supply of water from the mains of the Metropolitan Water Board. Medical Inspection.—The medical inspection of school children is carried out by the Education Department of the Surrey County Council. Closure of Schools.—No school has been closed by the local authority during the year. Infectious Diseases.—Scholars in contact with a case of infectious disease are excluded from school, the period of 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. 29 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 5,033 Number of complaints received 493 Visits re complaints and sundries 1,537 Revisits 1,510 Houses inspected for defects 883 Number of rooms measured for permitted numbers 264 Number of nuisances discovered 668 Number of intimatory notices served 485 Number of nuisances abated without reports 434 Number of statutory notices served 203 Number of nuisances abated after reports 153 Visits to butchers and other food shops 535 Visits to factories 197 Visits to piggeries 92 Visits to refuse dumps 10 Visits re infectious disease 329 Visits to slaughterhouses 20 Visits to restaurant kitchens 17 Visits to stables ... ... ... ... ••• 14 Visits to schools ... ... ... ... ... ... 8 Visits to outworkers'premises ... ... ... ... 36 Details of visits to other premises are enumerated in other sections of the report. Character of Work Done Roofs repaired ... ... ... ... ... ••• 129 Rainwater gutters and piping repaired or renewed ... 67 30 Ventilation improved 1 Dampness remedied 105 Water service pipes repaired 9 Waterclosets: repairs to roof, walls, doors and seats 28 Waterclosets: flushing apparatus repaired or renewed, pans and traps provided 99 Water storage cisterns cleansed 3 Water supply reinstated 19 Flooring of rooms repaired 53 Rooms cleansed and redecorated 184 Repairs to sinks and waste pipes 63 Window frames and sashes repaired 104 Drains repaired and cleansed 54 Repairs to firegrates 22 Repairs to stoves, etc. 22 New dustbins provided 71 Accumulations removed 13 Repairs to chimney eaves 18 Repairs to staircases 11 Rainwater gullies repaired 4 Smoke nuisances abated 3 Verminous rooms disinfested 14 Repairs to hot water tanks 1 External decorations 2 Repairs to doors 8 Sanitary accommodation provided 5 Sundries 50 Drains tested 18 Rooms disinfected, after infectious disease 383 Rooms treated for vermin 351 All ponds and ditches in the Borough where mosquito breeding was possible were sprayed with paraffin twice early in the year. Nineteen visits were paid for this purpose. Petroleum (Consolidation) Act, 1928.—Seventy-six licences to store petroleum and cellulose solutions were granted, totalling 135,510 gallons. A licence was also issued for 20 cwt. of carbide of calcium to be stored. 31 Unsound Food Dealt With. Beef 1272½ lbs. Mutton 67 ,, Pork 513 „ Veal 170 „ Offal 1263 „ Tripe 201 „ Corned beef and mutton 5729½ „ Fish 118 stone Cheese 42½ lbs. Eggs 544 Suet 7 lbs. Bacon 118½ „ Evaporated milk 77 tins Jam 129 jars Pickles 42 ,, Sundry tinned foods 1017 tins Sundry bottled foods 46 jars & bottles Number of visits to Meat Depot 20 655 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) 883 (b) Number of inspections made for the purposes 974 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 434 3. Action under Statutory Powers during the Year:— Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— 32 (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 INSPECTION AND SUPERVISION OF FOOD FOOD AND DRUGS ACT, 1938 Formal Samples. 51 formal samples were taken, as follows:— Milk 49 Malted Soyacream 1 Lemonade powder 1 Informal Samples. 28 informal samples were taken, as follows:— Vinegar 3 Custard powder substitute 1 Lemon flavouring. 1 Syrup of figs 1 Batter flour 2 Dried egg 1 Sausage 2 Crab paste 1 Jam 8 Fish paste 1 Butter 1 Margarine 1 Lard 2 Karsote powder 1 Cream of tartar 1 Milk 1 Pickles 1 Malted Soyacream 1 Self-raising flour 2 Chocolate pudding mixture 1 Two warning letters were sent to suppliers of two samples below standard, 33 MILK (SPECIAL DESIGNATION) ORDER, 1936 During the year the Council granted the following number of licences under the above named Order:— Tuberculin Tested 6 Pasteurised 6 Pasteurising Plant 1 Supplementary Licences— Pasteurised 5 Tuberculin Tested 5 BAKEHOUSES The number of bakehouses in the district is 14. Eleven visits have been paid. DAIRIES AND COWSHEDS There are 28 registered premises within the district, of which 27 are dairies and one cowshed. During the year 150 visits of inspection were paid. PIGGERIES There are 20 piggeries in the Borough. Ninety-two visits were paid during the year. OTHER FOOD PREPARING PLACES There are four other premises in which food is prepared for human consumption. All of these have been systematically visited. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES INFECTIOUS DISEASE NOTIFICATIONS The total number of notifications received during the year was 1,161. Contacts, Suspects, Etc. The Medical Officer of Health may be called in consultation by medical practitioners to see patients in their homes. 34 Visits Made by No. Sanitary Inspectors 329 Health Visitors 189 Total 518 Small Pox. Scarlet Fever Diphtheria Typhoid Fever Erysipelas Pneumonia Puerperal Pyrexia Ophthalmia Neonatorum Dysentery Cerebro-spinal Meningitis Poliomyelitis Measles Whooping Congh Food Poisoning Encephalitis Lethargica Undulant Fever Malaria Totals The monthly incidence of infectious disease was:— January ... 22 ... ... 2 4 ... ... ... ... ... 33 13 ... ... ... ... 74 February ... 15 1 ... 2 5 ... ... ... 1 ... 90 22 ... ... ... ... 136 March ... 5 ... ... 2 4 ... 1 ... ... ... 196 13 ... ... ... ... 221 April ... 30 2 ... 1 5 ... ... 1 ... ... 243 11 ... ... ... ... 293 May ... 14 ... ... 2 3 ... ... 1 ... ... 53 11 ... ... ... ... 84 June ... 13 2 ... 1 3 ... ... ... 3 ... 26 5 ... ... 1 ... 54 July ... 12 4 ... 3 1 ... ... 1 ... 6 18 ... ... ... ... 45 August ... 15 4 ... 4 1 1 1 1 1 ... 1 15 ... ... ... ... 44 September ... 22 14 ... 2 2 ... ... ... 1 ... 1 5 ... ... ... ... 47 October ... 19 4 ... 1 1 1 2 1 ... ... ... 15 ... ... ... ... 44 November ... 22 4 1 4 ... ... ... ... 1 ... 1 21 ... ... ... ... 54 December ... 23 7 ... 1 19 ... ... ... ... ... 1 13 ... ... ... 1 65 Totals ... 212 42 1 22 50 3 4 4 8 ... 651 162 ... ... 1 1 1161 35 Infectious Disease Notifications, 1923-43. Disease 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 Small Pox ... ... ... ... ... 9 7 ... 4 1 ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 110 81 106 104 145 102 134 113 105 174 240 392 143 171 192 150 61 48 75 175 212 Diphtheria 35 59 201 87 76 75 133 129 49 32 40 83 80 104 89 64 27 36 72 25 42 Typhoid Fever 2 1 4 2 6 3 4 9 2 3 3 ... 3 5 ... 1 ... ... ... ... 1 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Undulant Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Puerperal Fever ... 1 6 6 9 4 6 1 7 5 1 1 2 2 1 ... ... ... ... ... ... Puerperal Pyrexia ... ... ... 1 14 9 5 6 9 4 9 6 4 11 5 4 7 2 2 6 3 Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Meningitis ... 6 ... ... 2 1 4 ... ... 1 4 1 1 3 1 2 1 13 12 6 8 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 15 11 10 13 14 10 22 22 17 11 31 30 20 22 16 8 19 17 19 7 22 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 301 194 599 651 Acute Diarrhœa ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Chicken Pox 91 35 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis 4 ... ... 1 2 ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... Ophthalmia Neonatorum 6 7 5 12 10 3 3 1 3 4 2 2 4 3 1 3 3 1 3 10 4 Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... 2 2 ... ... ... 2 1 1 1 ... ... ... ... ... ... ... ... 1 ... Pneumonia 19 39 42 30 62 54 57 35 45 52 37 45 35 36 32 43 ... 30 22 20 50 Malaria 3 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 16 186 161 162 Food Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 4 6 11 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Totals 287 246 376 259 340 270 375 319 242 288 368 560 293 357 338 275 125 468 591 1021 1161 36 Small Pox No case of small pox was notified during the year 1943. Scarlet Fever The number of cases of scarlet fever notified during the year was 212, as compared with 175 in 1942, equivalent to a case rate of 3.9 per 1,000 population. The disease has continued mild in character and no deaths due to this cause were recorded. Of the total number of cases notified 155 were treated in hospital, and 57 cases were treated at home. There was one case which was known to be a "return case," representing 0.6 per cent. of the cases treated in hospital. There was no "return case" amongst cases treated at home. The patient's home was disinfected after his removal to hospital or his release from isolation, but steam disinfection of the bedding has been discontinued as a routine procedure. Diphtheria Forty-twe 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 Efforts have continued during the year to obtain the immunisation of every child before his second birthday. A birthday greeting letter is sent on the first birthday, making an appointment for immunisation, and two extra clinics have been opened so that no mother is beyond easy walking distance of a clinic. The health visitors have urged the mothers at the welfare centres and when making home visits, and have made special visits in difficult cases. Immunisation has been continued at the schools, although large numbers have been immunised during evacuation. All the non-immunised children at the Day Nurseries were immunised 37 after admission, and there has been no case of diphtheria in the nurseries. The following figures show the number of children immunised during the year:— Under five 983 Five—15 634 Over 15 — Total 1,617 The following figures show the percentage of the child population considered immunised at 31st December, 1943:— Under five 46.27% Five—15 50.12% The number of birthday greetings sent in 1943 was 589. Four hundred and fifty-three mothers took advantage of this offer. Typhoid Fever One case was notified during the year. Diarrhœa and Enteritis Under Two Years of Age Two deaths were registered during the year. Encephalitis Lethargica No case was notified during the year. Chicken Pox Three hundred cases of chicken pox were notified by the head teachers of the schools in the district. Mumps Three hundred and thirty cases of mumps were notified by the head teachers of the schools in the district. Impetigo Fifteen cases of impetigo occurred in school-children during the year. 38 Rubella Forty cases of rubella were notified among school-children. Ringworm Three cases of ringworm were notified among school-children. Dermatitis No cases were notified among school-children. Infective Jaundice Five cases were notified among school-children. Jaundice. Thirty-six cases were notified among school-children. Erysipelas Twenty-two cases were notified. Seven cases were removed to hospital. No deaths from this disease were registered. Puerperal Pyrexia Three cases were notified during the year. Pneumonia Fifty 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 41, of which 24 were males and 17 females. Cerebro Spinal Fever Eight cases occurred during 1943, and there was one death. Influenza During the year nine deaths from influenza were recorded. Three were males and six females. The previous year three deaths were registered. 39 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 four cases of ophthalmia neonatorum were notified:— Cases Notified Treated Vision Unimpaired Vision Impaired Total Blindness Deaths At Home In Hospital 4 4 nil. 4 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 earlier in this report. Cancer. The number of deaths from cancer registered during the year was 95, of which 49 were males and 46 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 1943 was as follows:— Digestive organs 12 cases Genito-urinary organs 2 „ Breast 7 „ Other sites 74 „ Total 95 „ 40 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 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 1942 104 1.9 1.698 1943 95 1.7 1.74 Tuberculosis During the year 97 new cases of tuberculosis were notified, viz.:— Males Females Total Pulmonary 51 34 85 Non-Pulmonary 6 6 12 Total 67 40 97 41 The total number of deaths registered as occurring from tuberculosis was viz.:— Males Females Total Pulmonary 21 10 31 Non-Pulmonary 3 1 4 Total 24 11 35 England and Wales Mitcham Death rate from respiratory tuberculosis per 1,000 population 0.51 0.56 Death rate from non-pulmonary tuberculosis per 1,000 population 0.10 0.07 The following table shows the number of new cases, the type of disease and the deaths from tuberculosis during the year. age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M. F. M. F. M. F. M. F. Under 1 year 1 ... ... ... ... ... ... ... 1 year to 5 years ... 3 ... 1 ... ... ... ... 5 years „ 10 „ 1 ... ... 1 ... ... 1 ... 10 „ „ 15 „ 1 2 1 2 ... ... ... ... 15 „ „ 20 „ 5 7 ... ... 2 1 ... ... 20 „ „ 35 „ 10 12 4 1 7 4 ... 1 35 „ „ 45 „ 16 4 1 1 2 1 1 ... 45 „ „ 65 „ 13 5 ... ... 8 2 1 ... 65 „ and upwards 4 1 ... ... 2 2 ... ... Totals 51 34 6 6 21 10 3 1 42 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 1 3 Pulmonary: females ... ... ... ... ... ... ... ... 1 ... ... 1 Non-Pulmonary: males ... ... 1 ... ... ... ... ... ... ... ... 1 Non-Pulmonary: Females ... ... ... ... ... ... 1 ... ... ... ... 1 The sources from which information as to the above mentioned cases was obtained are as follows:— No. of Cases Pulmonary NonPulmonary Death returns (a) From Local Registers ... ... 1 (b) Transferable deaths from Registrar General ... ... Posthumous notifications 4 1 Number of cases removed from register during 1943:— Reason Pulmonary Non- Pulmonary Total Cases Males Females Total M ales Females Total Withdrawal of notification 1 1 2 2 2 4 6 Recovery from disease ... ... ... 1 ... 1 1 Death 21 10 31 3 1 4 35 Removed from district 22 11 33 5 2 7 40 43 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths is as follows:— Non-notified tuberculosis deaths 6 Notified tuberculosis deaths 29 Percentage of non-notified T.B. deaths (all forms) 17 per cent. Percentage of non-notified pulmonary T.B. deaths 11.4 „ Treatment for cases of tuberculosis is under the control of the Surrey County Council. A dispensary has been established at St. Helier County Hospital, Carshalton. Arrangements have been made by this Borough for the examination of sputa from cases or suspected cases of tuberculosis, and during the year 33 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—1943 Number of persons assisted 104 Receiving supplies of milk, butter, eggs, continuously for 12 months 5 „ „ „ for 6-9 months 17 „ ,, ,, under 6 months 43 Fares for family to visit sanatorium 8 44 Clothing. bedding, boots, supplied through the medium of Committee 7 Tuberculous persons who have received special consideration re housing 1 Pees for instruction 1 Payment for holiday 1 Scabies The Scabies Order, 1941, provided for the diagnosis and treatment of scabies. A clinic for the diagnosis of this condition has been held by the Medical Officer of Health each morning at Mitcham Court. Efforts have been made to obtain the co-operation, not only of the patient, but of the whole family, and all have been treated when possible. As Mitcham has no cleansing centre, arrangements for the treatment of scabies were made at the Mitcham Public Baths. A part of the baths formerly used for foam baths was partitioned off and isolated from the public baths, so that a separate entrance was available. Usually treatment was with benzyl benzoate lotion 25 per cent., and this has given very good results. Female patients have been treated by a nurse on the First Aid Post staff, and the men have been treated by a baths attendant who has received special training. Treatment at the public baths has had the advantage of a constant supply of hot water, suitably heated premises and a competent male attendant, but it is not open on Tuesdays, Thursdays and Sundays, nor other days after 6 p.m., and those members of the family who are at work are loth to lose time from work for treatment, especially if they have few or no symptoms. No disinfection of clothing or bedding, other than washing, has been recommended, and the results have justified the adoption of this course. Visits paid, 39. Attendances at clinic, 287 persons; representing 140 families. 45 Treated at baths, 185 persons; representing 76 families. Number of baths given, 554. Supplied with lotion or ointment (for home treatment), 95 persons; representing 51 families. WANDLE VALLEY JOINT HOSPITAL BOARD Cases admitted to the hospital during the year ended December 31, 1943. Disease Beddington & Wallington Coulsdon & Purley Merton & Morden Mitcham Cases Deaths Cases Deaths Cases Deaths Cases Deaths Diphtheria 9 ... 3 ... 12 1 38 3* Scarlet Fever 93 ... 126 ... 189 ... 155 ... Erysipelas 3 ... 1 ... 1 ... 7 ... Tonsilitis 1 ... 3 ... 5 ... 2 ... Measles 5 ... 4 ... 8 ... 35 ... Influenza ... ... ... ... 2 ... 2 ... Whooping Cough 1 ... ... ... 5 ... 4 2 Rubella 1 ... 1 ... 5 ... 3 ... Mumps ... ... ... ... 1 ... 4 ... Chicken Pox 1 ... 1 ... 3 ... 1 ... Rheumatism ... ... ... ... 1 ... ... ... Meningitis 2 ... 2 ... 2 ... 7 2‡ Ulceration of Mouth ... ... ... ... ... ... 1 ... Puerperal Sepsis 2 ... 3 ... 2 ... 2 ... Cancer ... ... ... ... ... ... 1 1 Admitted with mother 1 ... 2 ... 1 ... 2 ... Streptococcal Septicæmia 1 ... 1 1 ... ... 1 1 Jaundice ... ... ... ... ... ... 1 ... Gastro Enteritis ... ... 2 2 1 ... 3 ... Facial Abscess 1 ... ... ... ... ... ... ... Broncho Pneumonia 4 1§ ... ... ... ... 5 3 Pemphigus 1 ... ... ... ... ... ... ... Poliomyelitis ... ... 2 ... 1 ... ... ... Typhoid 2 ... ... ... ... ... ... ... Otitis Media 1 ... ... ... ... ... ... ... Acute Abdomen 1 ... ... ... ... ... ... ... 130 l 151 3 238 1 274 15 * 1 death Laryngeal Diphtheria and Broncho Pneumonia. | Measles and Broncho Pneumonia. J 1 Influenzal Meningitis, 1 T.B. Meningitis. § Admitted '21-12-42. 46 INDEX Abortion, Deaths 13 Adoption of Children Act 25 Ambulances 14 Analysis of Mortality 13 Ante-Natal Clinics 16, 21 Area 8 Bakehouses 33 Bed Bugs, Eradication of 28 Birth Rates 9, 10, 13 Births, Live 8 — Illegitimate 8 — In Institutions 9 — Still 8 Blindness, Prevention of 39 Cancer 39 — Deaths from 40 Causes of Deaths 13 Cerebro-Spinal Fever 38 Chicken Pox 37 Child Welfare 18 Clinics 15-17 Dairies and Cowsheds 33 Death Rates 10, 13 Deaths 8, 9, 12 Dental Treatment 19 Dermatitis 38 Diarrhoea, Deaths from 9 Diphtheria 36 — Immunisation 36 — — Clinic 16 Disinfection 17 Encephalitis Lethargica 37 Eradication of Bed Bugs 28 Erysipelas 38 Food and Drugs Act (1938) 32 — and Medicine, Supply of 20 — Inspection and Supervision of 32 General Provision of Health Services for the Area 14 47 page Health, Visiting 19 — Visitors, Visits by 20 Home Helps 22 Hospitals 15 Housing Statistics 31 Impetigo 37 Infantile Mortality 9, 10, 11 Infant Life Protection 25 Infant Welfare Centres, Attendances 20 Infectious Disease, Cases notified 35 — — Case rates 13 — — Contacts 33 — — Incidence of 34 — — Prevalence of and Control over 33 — — Notifications 13, 33, 35 — — School 39 Influenza 38 Inhabited Houses 8 Inquests 11 Inspection and Supervision of Food 32 Jaundice, Infective 38 Laboratory Facilities 14 Louse Infestation 19 Maternal Mortality 11, 13 Maternity and Child Welfare Services, Report on 18 Home 15, 23 Midwifery, Domiciliary 15 Milk (Special Designation) Order (1936) 33 Mortality, Analysis of 13 — Infant 9, 10, 11 - Maternal 11, 13 Mumps 37 N.S.P.C.C. 26 Nursing in the Home 14 Ophthalmia Neonatorum 39 Orthopædic Clinic 18 Patients Admitted to Hospital 45 Personnel, Committee 5 — Staff 6 48 Piggeries Pneumonia Population Post-natal Clinic — Centre Prevention of Blindness Puerperal Pyrexia Rateable Value Ringworm Rubella Samples, Food Sanitary Circumstances of the Area Sanitary Inspector's Report Scabies — Clinic Scarlet Fever School Clinic Schools Small Pox Social Conditions Statistics, Housing - Vital Still Births Sunlight Treatment Tuberculosis - Care Committee - Clinic Typhoid Fever Venereal Diseases Clinics Vital Statistics Wandle Valley Hospital War-time Nurseries Welfare Clinics — — Attendance at Whooping Cough, Deaths from Woodlands Maternity Home X-Ray Examinations page 33 38 8 16 22 39 38 8 38 38 32 27 29 44 17 36 16 28 36 8 31 8 8 18 40 43 17 37 17 8 45 26 15-17 20 9 15, 23 22