Miti 13 Library BOROUGH OF MITCHAM REPORT of the Medical Officer of Health for the YEAR 1944 BOROUGH OF MITCHAM REPORT of the Medical Officer of Health for the YEAR 1944 Mitcham: H, G. Mather, Gaxton Worlcs, Lower Green Borough of Mitcham HEALTH REPORT FOR 1944 To the Mayor, Aldermen and Councillors. Sir, Ladies and Gentlemen, I have much pleasure in presenting my annual report for the year 1944. The birth rate was the highest recorded since 1931, and except for the years 1939 and 1943, the infant mortality rate is the lowest on record. The number of illegitimate births has again shown a large increase, and the need for special help for these children is emphasised by their high infant mortality rate. The local death rate was 11.88 per 1,000 as against 11.6 for England and Wales, and 15.7 per 1,000 for the administrative County of London. The work of the Day Nurseries has continued, and each nursery had a waiting list at the end of the year, despite enemy action. There has been a decrease in the number of attendances at all clinics owing to evacuation from flying bombs, and this has been specially noticeable in the decrease of the number of children immunised against diphtheria. There has been a substantial decrease in the number of notifications of scarlet fever, and the number of notifications of diphtheria is the lowest on record. There were no deaths from these causes during the year. In spite of the difficulties of obtaining staff, the work at Woodlands Maternity Home continued throughout the flying bomb period, and high praise is due to the Matron, staff and patients for their courage during a very trying period. I wish to express my appreciation of the health visitors for their assistance in the evacuation of mothers and children, and in providing trained nurses at the First Aid Posts, to the sanitary inspectors for their A.R.P. duties, including the salvage of large quantities of damaged food, and to the office staff, who have made this report possible. I should also like to thank the Chairmen of the Maternity and Child Welfare and Public Health Committees for their constant help and support, and to all those voluntary helpers at the welfare centres, who have given so freely of their time and service. 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 (Councillor W. Jeffery) Aldermen— E. J. D. Field, J.P. S. L. Gaston, J.P. Councillors— G. W. Cole W. F. Hill G. It. Madgwick G. W. Pearce V. G. Pullen Sir I. Wilson MATERNITY AND CHILD WELFARE COMMITTEE Chairman Councillor Mrs. E. Watson His Worship the Mayor Alderman— J. R. Beaumont Councillors— S. E. Birch G. C. Cock H. Conway E. J. Dobinson F. Dominney R. A. Humphreys Mrs. C. Randall m Co-opted Members— Mrs. A. H. Bailey Mrs. D. L. Chappell Miss K. Fare well-Jones Dr. G. Stoker Mrs. E. F. Ward REPRESENTATIVES ON WANDLE VALLEY JOINT HOSPITAL BOARD His Worship the Mayor (ex-officio) Aldermen— W. Dalton A. H. Bailey Councillor— 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 Ashwor(l), 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 ,1. 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 VV. 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. Clinical Medical Officer—Woodlands Maternity Home E. G. Housden, M.D, B.S, M.R.C.S, L.R.C.P, D.R.C.O.G. 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. Gleed (1, 2, 3) Superintendent Health Visitor and Infant Life Protection Visitor Miss E. G. Couzens (5, 6, 7, 9) Assistant Health Visitors Miss G. Russell-Harris (5, 6, 7) Miss D. Hinds (5, 6, 7, 9) Miss M. Knight (6, 8) Miss L. Salway (5, 6, 7) Matron of Woodlands Maternity Home (a) Miss G. M. Evans (5, 6) (b) Miss M. Corrin (5, 6, 10, 11) Matron of Eagle House Day Nursery Miss J. E. Offer (5, 6, 12) Matron of Robinson Road Day Nursery 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) (c) Miss M. Rice (6) Clerks J. B. A. Roodliouse and L. J. Bellingham, H.M. Forces Mrs. M. Odam Miss V. Valentine (temporary) (d) Miss D. Turner (temporary) (e) Miss H. Bonny ,, (j) Miss J. Poulton „ (a) Resigned 16.7.44 (b) Appointed 16.6.44 (c) Appointed 1.7.44 (d) Resigned 21.4.44 (e) Engaged 4.5.44 (f) Engaged 27.12.44 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. Certificate Teaching of Mothercraft. 10. Midwives' Teacher's Certificate. 11. Housekeeper's Certificate. 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, 1944 51,490 Number of inhabited bouses, 1921 7,150 1931 13,187 1944 17,979 Rateable Value, 1944 £501,942 Sum represented by a Id. rate £1,800 STATISTICS. Live Births. Total Male Female Rate per 1,000 of population Legitimate 914 462 452 Illegitimate 64 41 23 Total 978 503 475 18.99 Still Births Total Male Female Rate per 1,000 total births Legitimate 18 8 10 Illegitimate — — — Total 18 8 10 18.07 Deaths. Total Male Female Rate per 1,000 of population 612 305 307 11.88 Deaths from disease and accidents of pregnancy and childbirth : — Rate per 1,000 total births From puerperal sepsis 1 From other puerperal causes Total 1 1.00 9 Deaths of infants under one year of age :— All infants per 1,000 live births 36.80 Legitimate infants per 1,000 live legitimate births 35.01 Illegitimate infants per 1,000 live illegitimate births 62.50 Deaths from:— Cancer (all ages) 83 Measles Whooping cough (all ages) 2 Diarrhoea (under two years of age) 8 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 1939 966 518 53.7 1940 854 453 53.0 1941 737 408 55.4 1942 986 518 52.5 1943 1048 727 69.4 1944 996 678 68.1 Number of births notified by municipal midwives in 1944, 249. The birth rates, death rates per 1,000 of population, and the infantile mortality rates for the years 1924-44 are shown in the following table: — 10 The birth rates, death rates per 1,000 of population, infantile mortality rates for the years 1924-44 are shown in the and following table: — 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 1924 20.3 18.8 9.2 12.2 55 75 1925 18.2 18.3 9.6 12.2 54 75 1926 21.5 17.8 9 9 11.6 63 70 1927 20.9 16.7 9.8 12.2 45 69 1928 20.4 16.7 8.8 11.7 48 65 1929 19.1 16.3 11.2 13.4 72 74 1930 19.3 16 3 8 2 11.4 49 60 1931 19.2 15.8 9.8 12.3 42 66 1932 18.0 15.3 8.4 12.0 43 65 1933 16.1 14.4 8.8 12.3 37.1 64 1934 15.6 14.8 9.1 11.8 51.6 59 1935 15.6 14.7 7.7 11.8 49.5 57 1936 15.4 14.8 9.1 12.1 48.0 59 1937 14.3 14.9 8.5 12.4 43.4 58 1938 15.1 15.1 8.3 11.6 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 1944 18.99 17.6 11.88 11.6 36.8 46 11 Infant Mortality During the year 36 deaths were registered as occurring in infants under one year of age:— Males Females Total Legitimate 11 21 32 Illegitimate 8 1 4 Total 14 22 36 as compared with 37 deaths last year. Maternal Mortality During the year one death was registered as being due to:— Toxaemia from empyema, and peritonitis due to septic abortion. In 1943 one death was registered as being due to disease or accident of pregnancy. Inquests Inquests were held on 5 residents dying within the district and on 16 Mitcham residents who died outside the district, a total of 21. In addition, the coroner held 78 post-mortems without inquests. The following table shows the results of the findings of these inquests: — Deaths from natural causes 4 Accidental deaths 11 Deaths from misadventure 3 Suicides 1 War operations 2 Total 21 12 Deaths Registered during the Year 1944 Cause of Death Males Females Total 1 Typhoid and paratyphoid fevers ... ... ... 2 Cerebro-spinal fever 1 ... 1 3 Scarlet fever ... ... ... 4 Whooping cough ... 2 2 5 Diphtheria ... 1 1 6 Tuberculosis of respiratory system 22 15 37 7 Other forms of tuberculosis 1 4 5 8 Syphilitic diseases 2 2 4 9 Influenza ... 2 2 10 Measles ... ... ... 11 Acute polio-myelitis and polio-encephalitis ... ... ... 12 Acute infectious encephalitis ... ... ... 13 Cancer of buccul cavity and oesophagus (m) and uterus (f) 1 3 4 14 Cancer of stomach and duodenum 14 3 17 15 Cancer of breast ... 14 14 16 Cancer of all other sites 26 22 48 17 Diabetes ... 3 3 18 Intra-cranial vascular lesions 26 29 55 19 Heart disease 57 68 125 20 Other diseases of circulatory system 13 11 24 21 Bronchitis 33 13 46 22 Pneumonia 12 15 27 23 Other respiratory diseases 3 1 4 24 Ulcer of stomach or duodenum 3 1 4 25 Diarrhoea (under two years) 1 2 3 26 Appendicitis 2 3 5 27 Other digestive diseases 3 4 7 28 Nephritis 8 5 13 29 Puerperal and post-abortive sepsis ... 1 1 30 Other maternal causes ... ... ... 31 Premature birth 3 7 10 32 Congenital malformations, birth injuries, infantile disease 5 6 11 33 Suicide 1 ... 1 34 Road traffic accidents 3 ... 3 35 Other violent causes 40 51 91 36 All other causes 25 19 44 All causes 305 307 612 13 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1944. (Provisional figures based on weekly and quarterly returns.) England and Wales 126 County Boroughs and Great Towns including London 148 Smaller Towns (Eesident Populations 25,000 to 50,000 at 1931 census) London Administrative County Mitcham Rates per 1,000 civilian population Births— Live 17.6 ‡ 20.3 20.9 15.0 18.99 Still 0.50‡ 0.64 0.61 0.42 0.35 Deaths— All causes 11.6‡ 13.7 12.4 15.7 11.88 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 0.02 0.04 0.04 Diphtheria 0.02 0.03 0.03 0.01 0.02 Influenza 0.12 0.10 0.11 0.08 0.04 Smallpox 0.00 - - - - Measles 0.01 0.01 0.01 0.00 - Notifications— Typhoid fever 0.01 0.01 0.01 0.01 — Paratyphoid fever 0.01 0.00 0.01 0.01 — Cerebro-spinal fever 0.05 OOP 0.04 0.06 0.06 Scarlet fever 2.40 2.41 2.67 1.57 1.88 Whooring cough 2.49 2.49 2.29 2.90 3.22 Diphtaeria 0.58 0.67 0.69 0.31 0.19 Erys'pelas 0.29 0.32 0.28 0.37 0.25 Smallpox 0.00 0.00 0.00 0.00 — Measles 4.16 4.51 3.94 2.98 2.18 Pneumonia 0.97 1.13 0.82 0.93 0.72 Rates per 1,000 live births Deaths under one year of age Deaths from diarrhoea and 46t 52 44 61 36 enteritis under two years of age 4.8 7.3 4.4 10.1 3.1 Rates per 1,000 total births (live and still) Maternal mortality Abortion with sepsis 0.31 Not available 1.00 „ without sepsis 0.09 — Puerperal infections 0.28 — Other 1.25 - Notifications— Puerperal fever 10.34 13.13 9.25 3.61 5.02 Puerperal pyrexia 14.14* Mortality per million women aged 15.45 Abortion— With sepsis 25 Not available Without sepsis 7 * Including Puerperal fever. A dash (—) signifies that there were no deaths, ‡ Eates per 1,000 total population. † Per 1,000 related births. 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 218 Sputa for tubercle 29 Total 247 EMERGENCY PUBLIC HEALTH LABORATORY, EPSOM This service has proved of the greatest use, particularly in regard to the control of infection in the Day Nurseries and Woodlands Maternity Home. The results of specimens taken to the laboratory by car have been available the following morning, and the advice and assistance of the staff have been most helpful. 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 1,348, of which 187 were accident cases, and 1,161 private removals. For Infectious Disease Cases.— The Wandle Valley Joint Hospital Board has 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. 15 The following are the returns from each association for year ended December 31st, 1944:— No. of Nurses No. of patients visited during 1944 No. of visits paid during 1944 St. Barnabas 1 102 4,023 Mitcham D.N. Association — South and East 3* 330 6,888 Colliers Wood and West 2* 205 4,203 Totals 637 15,114 * One part time. 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 Five 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. 16 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: — 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.— This clinic was transferred to Meopham Road F.A.P. in July as a result of enemy action. 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.— This clinic was transferred to the Church Road F.A.P. in July. The municipal mid wives 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. Post-natal examinations of cases confined in Woodlands are made at the Woodlands clinics. 17 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. 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, the St. Helier, Guildford, Redhill and Kingston County Hospitals, the War Memorial Hospital, Woking, 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 Public library books which have been in contact with cases of infectious disease are disinfected in the Public Health Department. Boots, shoes, etc., taken in exchange by the Domestic Centre are disinfected at the Public Health Department before being re-exchanged. Number of disinfections carried out by Wandle Valley Isolation Hospital 71 Number of rooms disinfected by fumigator 192 Number of library books disinfected 177 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 11,136, as compared with 17,258 in 1943. Of these 848 were new cases, 766 being infants under one year of age, and 82 being children over one but under five years of age. The total number of attendances of infants under one year was 8,695, and of children between one and five years of age, 2,441. At the end of the year there were 575 infants under one year and 1,102 children between one and five years of age attending the centres, making a total of 1, 677. The average attendance at each centre was: — Park Road 46.1 St. Barnabas 63.7 Church Road 54.6 Sherwood House 54.5 The percentage of infants under one year of age attending the centres for the first time was 78 per cent, of the total number of live births, 19 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. As a result of the flying bomb attacks that commenced in June and continued for the remainder of the year, large scale evacuation of mothers and children was recommenced, and the attendances at the Welfare Centres correspondingly fell. Owing to the lack of shelter accommodation at Sherwood House and Mitcham Court the clinics were transferred to Meopham Road First Aid Post and Church Road First Aid Post. 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, Mitcham, for children in need of orthopaedic treatment to attend the orthopaedic clinic of this hospital. During the year 42 cases were referred to this clinic, as compared with 52 cases in 1943. 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:— Expectant mothers 28 Nursing mothers 2 Under fives 8 The work carried out was as follows:— Extractions 24 Dentures 12 Fillings 7 Scaling 14 Gum treatment 4 Advice 10 Vincent's Angina 1 20 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 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. Attendances at Infant Welfare Centres, 1944 Particulars Park Eoad St. Barnabas Church Road Sherwood House Total Number of new cases registered during year of— Children under one year of age 142 222 213 189 766 Children over one year and under five years of age 20 18 22 22 82 Number of children in ance at end of year— Under one year of age 126 98 189 162 575 Over one and under five years of age 197 315 284 306 1102 Attendances of children under one year of age 1696 2620 2212 2167 8695 Attendances of children over one year of age 517 629 622 673 2441 Total attendances at centres 2213 3249 2834 2840 11136 Average attendances at centres 46.1 63.7 54.6 54.5 54.7 Percentage of infants under one year of age attending centres of the total live births ... ... ... ... 78 21 Visits Paid by Health Visitors Particulars No. Primary ante-natal visits 300 Subsequent ante-natal visits 103 Primary birth visits 799 Subsequent visits to infants 2,063 Visits to children over one and under five years of age 3,820 Visits re stillbirths 3 Visits re deaths of infants under one year of age 6 Visits re cases of ophthalmia neonatorum 5 Visits re cases of puerperal pyrexia — Primary visits to cases of tuberculosis 12 Subsequent visits to cases of tuberculosis 106 Special visits 666 Infant Life Protection visits 178 Infectious disease visits 86 Visits re diphtheria immunisation 466 Total 8,613 Supply of Food and Medicines Dried milk, cod liver oil emulsion, Virol, Parrish's Food, groats, Bemax, Farex, iron pills and Lactagol 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 is supplied free in necessitous cases on application to the local Food Office. Vitamins are supplied to expectant mothers and children under two years of age at Welfare Centres, the Food Office and at the Public Health Department. Arrangements were also made for necessitous nursing and expectant mothers to receive free meals. Ante-Natal Centres Two ante-natal clinics are held each week at Mitcham Court and two clinics each week in connection with Woodlands Maternity Home. 22 A clinic for cases booked by the midwives is held each Wednesday at Mitcham Court. Of the total number of registered births, 92.8 per cent. of the mothers had attended the ante-natal centres. Ninety-two expectant mothers who attended the ante-natal centres were evacuated for their confinements. 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 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. Midwives are welcomed at the centres, and copies of their patients' ante-natal notes are forwarded to them for reference. 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. Average Attendance at Each Centre Number of expectant mothers Number of attendances Average attendance Woodlands (two clinics) 260 2,080 206 Mitcham Court 345 1,053 210 Midwives' Clinic 302 972 194 Total 907 4,105 205 23 During the year 25 women attended for this examination, as compared with 48 last year. Post-Natal Clinic A Post-Natal Clinic is held at Mitcham Court each month. Leaflets giving them information about this clinic and the purpose for which it is intended are given to the patients when they leave Woodlands Maternity Home and to the patients attending the various ante-natal clinics. Post-natal examinations of patients confined at Woodlands are made at the Woodlands clinics. The total number of women who attended the post-natal clinics was 94, the average attendance being 7'8. 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, and at the end of the year two regular part-time home helps were being employed. Seventeen mothers took advantage of this service. 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. During the year the scale of assistance for home helps was reviewed, and the Committee agreed to the same scale as that adopted by the Surrey County Council. WOODLANDS MATERNITY HOME. The number of cases admitted during the year was 216, eight fewer than in 1943. Owing to the danger from flying bombs, a number of cases booked for Woodlands were evacuated to reception areas for confinement. Although there were several incidents adjacent to the home, none of the patients or staff suffered injury, and the damage to the building was slight. Dr. Housden was appointed Clinical Medical Officer, and commenced his duties on April 1st. Dr. Housden conducts the ante-natal clinics, and treats all cases requiring medical attention, 24 other than private doctors' cases. He visits the Home daily, and thus continuity of observation and treatment has been attained. Miss Corrin commenced duty as Matron in June. She has had special experience as a teacher of midwifery, and has improved the standard of the Home as a Part II training school for pupil midwives. During the year an electrically heated cot was purchased for the care of the premature infants born in Woodlands. The gas and air apparatus for analgesia has been very successful, and has been greatly appreciated by the patients. Staff The staff consists of a matron, two sisters, two staff nurses and six pupil midwives. All the staff are State registered nurses and, with the exception of the pupil midwives, hold the certificate of the Central Midwives' Board. The Home is recognised as a Part II. training school for midwives. Home The Home can accommodate 15 patients at a time, but bookings are limited to 26 patients per month. The following table shows the number of births which has occurred in each year since the opening of the Home:— Number of births 1924 (August to December) 42 1925 129 1926 240 1927 (10 months) 177 1928 265 1929 298 19S0 818 1981 259 1932 239 1933 285 1984 285 1985 299 1936 314 1987 809 25  Number of births 1938 297 1939 254 1940 239 1941 215 1942 263 1943 224 1944 218 Number of maternity beds m the institution (exclusive ot isolation and labour beds), 15. Number of maternity cases admitted during the year, 216. Average duration of stay, 13'6 days. Number of cases delivered by (a) midwives, 192; (b) doctors, 19. Number of cases in which medical assistance was sought by a midwife in emergency, 30. Number of cases notified as (a) puerperal fever, nil; (b) puerperal pyrexia, 1. Number of cases of pemphigus neonatorum, nil. Number of infants not entirely breast-fed while in the institution, 6. Number of cases notified as ophthalmia neonatorum, nil. Number of maternal deaths, nil. Number of stillbirths, 4. 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. The post-natal clinic is held once monthly. 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. 26 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, 1944 6 Number of children on register, December 31, 1944 6 Number of children who have died during the year — Number of children on whom inquests were held — Number of registrations withdrawn — Number of prosecutions — Number of visits paid by the Infant Life Protection Visitor 178 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 arrangement, 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 9 Total number of children in respect of whom notice was given 9 Number of such children under supervision at the end of the year 5 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. 27 Number of Mitcham cases dealt with in 1944 14 Number of children affected 31 Number of visits paid 70 War-time Nurseries Eagle House has continued to give satisfactory service during the year, and has a waiting list of cases for admission, although the accommodation has been increased from 65 to 85. Robinson Road Nursery was opened on August 9th, 1943, 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. Attendances were considerably below average for four months of the year owing to enemy action. THE CARE OF ILLEGITIMATE CHILDREN Circular 2866 of the Ministry of Health drew the attention of Welfare Authorities to the importance of this matter. In February a meeting was held between representatives of the Surrey County Council and the autonomous Maternity and Child Welfare areas of the County, and it was decided that each authority should review the position in its own area, and consider by what means the position might be improved. The following report was submitted to the Maternity and Child Welfare Committee:— The Minister of Health draws the attention of Maternity and Child Welfare Authorities to the importance of the problem. The successful work of diocesan and other religious bodies has shown that much can be done to help the mother and safeguard the child, and the Minister suggests that each authority should The average atl endances were as follows: — Eagle House. Robinson Road. Under two 1808 1642 Two—five 33 40 1843 Total 5148 3485 28 formulate a scheme co-operating with and reinforcing existing Moral Welfare Associations. The Minister recommends the appointment of a trained worker, who has taken one of the recognised courses of training in social service, and who is experienced in the special problems she will have to handle. The duties of the special worker in co-operation with existing workers of Voluntary Societies are briefly:— (i) To persuade the grandparents to make a home for the child. (ii) To advise the expectant mother on suitable modation. (iii) To assist the girl to obtain an affiliation order or assistance from the father. (iv) To assist the mother to obtain employment. (v) To find suitable lodgings for mother and baby. (vi) To find suitable foster-mothers. (vii) To arrange for places in Residential Nurseries. (viii) To obtain legal advice about adoption. This work is done at present by the Superintendent Health Visitor in co-operation with the Citizens' Advice Bureau and the local Moral Welfare Authorities, usually the Bermondsey and Soutliwark Diocesan Association (C. of E.) and the Crusade of Rescue (R.C.). The number of illegitimate births in Mitcham in 1940-41-42 was 26, 26, 39 respectively. At least half of these cases remain at home with their parents, and the main difficulty of the remaining cases is to obtain suitable hostel accommodation until such time as the mothers are able to obtain employment and make arrangements for the care of the child. This may take many months to accomplish, and any time limit on the duration of stay of the mother should be avoided. Hostels should be near enough to industrial areas to provide adequate opportunities for employment, and nursery accommodation is essential. It is also desirable that girls should be accommodated in hostels outside the area in which they have been living. A hostel in the Sutton area would serve all the surrounding County districts, and I suggest that the County Council or a combination of adjoining Maternity and Child Welfare Authorities be requested to consider the possibility of establishing such a hostel. 29 It was resolved that an invitation be extended to the neighbouring autonomous Maternity and Child Welfare Authorities to discuss the question of the provision of a hostel. In April a conference of the autonomous Maternity and Child Welfare Authorities was held at Mitcham. The need for hostel accommodation was generally agreed, but the Medical Officer of Health of Mitcham was requested to draw up concrete proposals for establishing a hostel in order that the position might be more fully discussed at a subsequent meeting. The following report was submitted to the Maternity and Child Welfare Committee:— The number of illegitimate children born has considerably increased since 1939, and in many areas this increase exceeds 50 per cent. The Moral Welfare Associations have always undertaken the main responsibilities for the care of these cases, and local authorities have been asked to contribute only occasionally to the cost of maintenance of special cases. These local Moral Welfare Associations are largely independent in their administration, but most of them in this part of Surrey are affiliated to the Southwark Diocesan Association for Moral Welfare who, in a few instances, make small financial grants. The Moral Welfare Associations employ social welfare workers, and consultation with these experienced workers has shown that they are unanimously agreed on the following points: 1. That further institutional accommodation is urgently required. 2. That relations can frequently be persuaded to take back the mother and accept the baby as one of the family provided institutional accommodation is available for a few months whilst awaiting the relatives' acceptance of the position. 3. That early adoption is undesirable. A mother who has had her baby for a month will rarely part with the child willingly. 4. That girls who have been urged and have agreed to have the baby adopted very frequently return within a 30 short time with a second illegitimate child, thus increasing the size of the problem. 5. At present a number of girls can obtain posts in domestic service where they can keep the baby with them, but in many cases it is a struggle to do domestic service and look after the baby satisfactorily. This is especially marked in the case of young mothers of 16 to 17 years of age, who at present make up a large number of the cases. A number of the girls have had no domestic training or experience but have had various types of technical training, e.g., shorthand typists. 6. That foster-mothers are frequently unsatisfactory and in any case they are at present almost impossible to find. Usually the charges are beyond the means of the mother and the care the child receives is most unsatisfactory. One city has successfully used a foster-mother scheme where the Welfare Authority have been responsible for the payment of the foster-mothers' fees, and have assisted the mother during times of financial difficulty. This scheme does not overcome the difficulties of finding suitable foster-mothers, but by paying higher fees than can normally be afforded by the children's mothers, the Welfare Authority may command a much higher standard of care and exercise stricter supervision. 7. That institutions for these cases should not be too large. The maximum accommodation recommended for one unit is 20 beds. It is essential that the grounds of a hostel should be both private and spacious. Many of the girls in the later stages of pregnancy are very self-conscious of their appearance and spend much of their time in the garden. Matrons in charge of hostels stress the need for providing some privacy for girls who stay for more than a few months. It would appear that for the long-stay type of hostel, separate bed-sitting-rooms are most desirable. 31 Institutions These are maintained by the Voluntary Associations, and appear to be of two types: (i) Short Stay Hostels, (ii) Long Stay Hostels. Short Stay Hostels are sometimes known as Shelters or Refuges. They frequently admit girls in moral danger, homeless and stranded girls, in addition to pregnant girls. The stay is normally limited to two or three months before and after the baby is born. Long Stay Hostels in which the period of stay may exceed six months and from where the mother may go out to work. There is at present a definite shortage of both long and short stay accommodation, and there is little likelihood of the Voluntary Association being able to increase the accommodation without very substantial financial support. The provision of a hostel of the long stay type would relieve the existing short stay hostels of a number of their cases and would enable them to take an increased number of short stay cases. Hostel accommodation could most suitably be obtained by constructing a building specially designed for the purpose. Alternatively, some war-time nurseries might be easily adapted, but they are unlikely to become redundant until after the end of the war. The most practical method at present would be to adapt an existing house. Such a house would be expected to cost £3,000. £500 would be necessary for adaption, and equipment would cost a further £1,000, giving a total capital cost of £4,500 for a hostel of 15 beds, with nursery accommodation. It would appear that for this figure of £4,500, a prefabricated building such as are at present being used for day nurseries might be suitably modified to provide the individual accommodation required by a hostel of the long-stay type. To obtain a site providing the necessary privacy would, however, prove difficult. The staff for such a hostel would be as follows:— 1. Sister in charge (resident) £130 2. Nursery Nurse 175 3. Cook 165 Total £470 32 Food £650 Rates 75 Fuel and lighting 100 Laundry, telephone, etc. 75 £900 Staff 470 Total £1,370 A number of the girls would be able to contribute to their cost of maintenance, but the net cost would probably be not less than £1,000 per annum. Should such a hostel be established and administered by the local authorities, the appointment of a special welfare worker at a salary of £300 per annum would be essential in my opinion. Such a worker would act as liaison officer between the welfare workers of the local Voluntary Associations and the hostel, and would be responsible to the local authorities. The local authorities would still require the present short stay accommodation of the Voluntary Associations, especially in the pre-natal period, and in view of their long experience of this type of work it would appear to be an advantage to arrange with them to administer the hostel and admit the cases from the contributory hostel authorities. This method would have the additional advantage that the appointment of the special social worker would not be necessary. The local Welfare Authorities might exercise some control on the administration by having a representative on the Committee. The Voluntary Associations appear to have very little capital and the cost of establishing a hostel would fall almost entirely on the local authorities, with grants on an agreed basis to be made to the association and the financial position to be reviewed at the end of twelve months working. Small grants of £25 to £50 by individual local authorities appear to be of little practical value in obtaining further hostel accommodation, and until this need is met, the Voluntary Associations would be able to achieve little more than they are already doing. 33 The Committee resolved that the report be circulated to the autonomous Maternity and Child Welfare Authorities for their observations. Unfortunately the flying bomb attacks prevented the meeting of the conference taking place before the end of the year. Care op Premature Infants Premature infants requiring hospital treatment are admitted to the County Hospital. For cases remaining in their own homes special draught-proof cots heated by hot water bottles, blankets, clothes, special feeding bottles, etc., may be borrowed free of cost at the request of the doctor or midwife in charge of the case. Home helps are available when necessary. 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. 34 RIVERS AND STREAMS Twelve visits have been paid to all works suspected of discharging effluent into surface water sewers. CLOSET ACCOMMODATION With one exception 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 was 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. ERADICATION OF BED BUGS Number of Council houses found infested during year 101 Number of other houses found infested during the year 19 Number of houses disinfested during the year 120 Number of requisitioned, etc., houses disinfested 3 Methods employed:— Two houses treated with sulphur dioxide (Cescones). 134 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 19 Number of shelters disinfested 78 Number of houses disinfested for beetles 16 SCHOOLS The supervision of the public elementary schools is under the control of the Education Department of the Surrey County Council, 35 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. RATS AND MICE DESTRUCTION ACT, 1919 The Surrey County Council delegated their powers under the above Act to the Mitcham Borough Council in July, 1944. A Rodent Operator was appointed in December, 1944. The man employed on disinfection also carried out work in connection with rat destruction. Number of complaints received re rat infestation 157 Number of visits paid by sanitary inspectors 558 Number of visits paid by rodent operators 707 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 4,650 Number of complaints received 351 Visits re complaints and sundries 1,258 Revisits 1,037 36 Houses inspected for defects 708 Number of rooms measured for permitted numbers 288 Number of nuisances discovered 528 Number of intimation notices served re houses 306" Number of intimation notices complied with re houses 142 Number of statutory notices served re houses 83 Number of statutory notices complied with re houses 55 Number of intimation notices served re workplaces 5 Number of intimation notices complied with re workplaces 3 Number of statutory notices served re workplaces 1 Number of statutory notices complied with re workplaces — Number of intimation notices served re other matters 6 Number of intimation notices complied with re other matters 6 Number of statutory notices served re other matters 1 Number of statutory notices complied with re other matters — Visits to butchers and other food shops 482 Visits to factories 108 Visits to piggeries 55 Visits to refuse dumps 2 Visits re infectious disease 306 Revisits re infectious disease 35 Visits to slaughterhouses 14 Visits to restaurant kitchens 12 Visits to stables 7 Visits to schools 9 Visits to garages 7 Visits to outworkers'premises 127 Visits to marine stores 4 Visits to caravan yards ]6 Details of visits to other premises are enumerated in other sections of the report. Character of Work Done Roofs repaired 50 Rainwater gutters and piping repaired or renewed 5 37 Eaves guttering and spouting repaired 22 Yards paved or repaired 4 Dampness remedied 13 Water service pipes repaired 4 Waterclosets: repairs to roof, walls, doors and seats 12 Waterclosets: provision of seats 6 Waterclosets: flushing apparatus repaired or renewed. pans and traps provided 41 Waterclosets: repairs to pans and traps 2 Water storage cisterns cleansed 1 Water supply reinstated 4 Flooring of rooms repaired 18 Rooms cleansed and redecorated 60 Repairs to sinks and waste pipes 18 Window frames and sashes provided 30 Window frames and sashes repaired 24 Drains repaired 12 Repairs to firegrates 2 Repairs to stoves, etc. 16 New dustbins provided 29 Accumulations removed 4 Repairs to chimney eaves 2 Repairs to staircases 6 Rainwater gullies repaired 3 Smoke nuisances abated 2 Verminous rooms disinfested 6 Stoves provided 1 External decorations 3 Repairs to doors 7 Sanitary accommodation provided 2 Repairs to sinks 10 Drains tested 25 Repairs to internal plaster 10 Grid and mica flaps provided 4 Drain inspection chamber covers provided 1 Sundries 11 Rooms disinfected, after infectious disease 195 Rooms treated for vermin 214 38 All ponds and ditches in the Borough where mosquito breeding was possible were sprayed with insecticide early in the year. Nine visits were paid for this purpose. Petroleum (Consolidation) Act, 1928.—Seventy-three licences to store petroleum and cellulose solutions were granted, totalling 139,980 gallons. Three licences were also issued for 120½ cwt. of carbide of calcium to be stored. K. J. GUTTER1DGE, 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) 708 (b) Number of inspections made for the purposes 840 Unsound Food Dealt With. Beef 400 lbs. Condensed milk 68 tins Mutton 254„ Sardines 3„ Pork 712„ Pork luncheon meal 3 lbs. Offal 569½ „ Pilchards 15„ Tripe 262„ Herrings 3„ Fish 635„ Sausages 28„ Cheese 7¾ „ Dried egg 26 pkts. Macaroni 22„ Chopped ham 14½ lbs. Sugar 28„ Eggs 376 Flour 140„ Bacon 219½ lbs. Potatoes 9 cwt. Jam 76½„ Margarine 273½ lbs. Sundry tinned and bottled foods 864 tins Butter 205„ & botts. Lard 40„ Number of visits to Meat Depot 20 511 Yours obediently, 39 2. Remedy of Defects during the Year without Service of Formal N otices:— Number of defective dwelling houses rendered fit in consequence of informal action by the local authority or their officers 142 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 (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. 44 formal samples were taken, as follows:— Milk 43 Tecom fat 1 Informal Samples. 46 informal samples were taken, as follows:— Vinegar 2 Mustard 2 Scone mixture 1 Horseradish 1 Coffee 3 Cochineal 1 Lemon flavouring 2 Aspirin 1 Custard flavour 1 Nutmeg 1 Betox 1 Cake sponge mixture 1 Cocoa 2 Fish, ham and cutlet Ginger 2 dressing 1 40 Glenmar pudding 2 Stomach powder 1 Headache powders 2 Sage and onion staffing 2 Pish and meat paste 4 Self-raising flour 1 Pudding powder mix- Malt cocoa spread 1 ture 1 Vironita 1 Gravy powder 1 Pepper 2 Worcester Sauce 1 Rennet 1 Beecham's powders 1 Bun and cake flour 1 Frutella .. 1 Epsom salts 1 Two warning letters were sent to suppliers of two samples below standard. Six butterfat samples were submitted to the Public Analyst for the Ministry of Pood. 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 5 Pasteurising Plant 1 Supplementary Licences- - Pasteurised 5 Tuberculin Tested 6 Twenty samples of Graded Milk were submitted for bacteriological examination. Sixteen samples were satisfactory, and four were unsatisfactory. Communications were sent to the dairies regarding the unsatisfactory samples. BAKEHOUSES The number of bakehouses in the district is 12. Twenty-two visits have been paid. DAIRIES AND COWSHEDS There are 16 registered premises within the district, of which 15 are dairies and one cowshed. During the year 98 visits of inspection were paid. 41 PIGGERIES There are 12 piggeries in the Borough. Fifty-five 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 515. Contacts, Suspects, Etc. The Medical Officer of Health may be called in consultation by medical practitioners to see patients in their homes. Visits Made by No. Sanitary Inspectors 341 Health Visitors 204 Total 545 42 The monthly incidence of infectious disease was:— 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 January ... 13 1 ... 1 8 ... ... ... ... ... ... 11 ... ... ... ... 34 February ... 15 ... ... 1 3 ... ... 15 ... ... ... 24 ... ... ... ... 58 March ... 15 2 ... 1 3 2 1 32 2 ... 5 31 ... ... ... ... 94 April ... 6 ... ... 3 5 ... 2 8 ... ... 3 19 ... ... ... 1 47 May ... 6 2 ... 1 1 ... ... 4 ... ... 9 32 ... ... ... ... 55 June ... 9 ... ... 2 3 ... ... ... ... ... 16 38 ... ... ... ... 68 July ... 2 ... ... ... 3 1 1 5 1 ... 1 1 ... ... ... ... 15 August ... 3 1 ... 1 2 ... ... ... ... ... 1 2 ... ... ... ... 10 September ... 6 ... ... 1 2 1 ... 1 ... ... 1 4 ... ... ... ... 16 October ... 3 ... ... ... 2 1 ... 1 ... ... 4 2 ... ... ... ... 12 November ... 8 1 ... 1 1 ... ... ... ... ... 50 1 ... ... ... ... 63 December ... 11 3 ... 1 4 ... ... 1 ... ... 22 1 ... ... ... ... 43 Totals ... 97 10 13 37 5 4 67 3 112 166 ... ... ... 1 515 43 Infectious Disease Notifications, 1924-44. Disease 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 19s4 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 Small Pox ... ... ... ... 9 7 ... 4 1 ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 87 106 104 145 102 134 113 105 174 240 392 143 171 192 150 61 48 75 175 212 97 Diphtheria 59 201 87 76 75 133 129 49 32 40 83 80 104 89 64 27 36 72 25 42 10 Typhoid Fever 1 4 2 6 3 4 9 2 3 3 3 5 1 1 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Undulant Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Puerperal Fever 1 5 6 9 4 6 1 7 5 1 1 3 2 1 ... ... ... ... ... ... ... Puerperal Pyrexia ... ... 1 14 9 5 6 9 4 9 6 4 11 5 4 7 2 2 6 3 5 Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ce rebro -spinal Meningitis 6 ... ... 2 1 4 ... ... 1 4 1 1 3 1 2 1 13 12 6 8 3 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 11 10 13 14 10 22 22 17 11 31 30 20 22 16 8 19 17 19 7 22 13 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 301 194 599 651 112 Acute Diarrhoea ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... Chicken Pox 35 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis ... ... 1 2 ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Ophthalmia Neonatorum 7 5 12 10 3 3 1 3 4 2 2 4 3 1 3 3 1 3 10 4 4 Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis ... 2 2 ... ... ... 2 1 1 1 ... ... ... ... ... ... ... ... 1 ... ... Lethargica Pneumonia 39 42 30 62 54 57 35 45 52 37 45 35 36 32 43 ... 30 22 20 50 37 Malaria ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 16 186 161 162 166 Food Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 4 6 11 ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 67 Totals 246 376 259 340 270 375 319 242 288 368 560 293 357 338 275 125 468 591 1021 1161 515 44 Small Pox No case of small pox was notified during the year 1944. Scarlet Fever The number of cases of scarlet lever notified during the year was 97, as compared with 212 in 1943, equivalent to a case rate of 1.9 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 74 were treated in hospital, and 23 cases were 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 Ten 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 three clinics are available, 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, to have their children immunised, 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 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:— 45 Under five 528 Five—15 89 Over 15 Total 617 The following figures show the percentage of the child population considered immunised at 31st December, 1944: — Under five 48 04% Five—15 68.80% The number of birthday greetings sent in 1944 was 705. Two hundred and fifty-five mothers took advantage of this offer. ' Typhoid Fever No cases were notified during the year. Diarrhcea and Enteritis Under Two Years op Age Three deaths were registered during the year. Encephalitis Lethargica No case was notified during the year. Erysipelas Thirteen cases were notified. Five cases were removed to hospital. Puerperal Pyrexia Five cases were notified during the year. Pneumonia Thirty-seven 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 27, of which 12 were males and 15 females. Cerebro-Spinal Fever Three cases occurred during 1944, and there was one death. Influenza During the year two deaths from influenza were recorded, both of which were males. The previous year nine deaths were registered. 46 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 were as follows:— Chicken pox 75 Mumps 52 Impetigo 3 Jaundice 3 Rubella 115 Ringworm 1 Cancer. The number of deaths from cancer registered during the year was 83, of which 41 were males and 42 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 1944 was as follows: — Digestive organs 17 cases Genito-urinary organs 3 „ 47 Breast 14 cases Other sites 49 „ Total 83 „ The following table shows the number of deaths from cancer, together with the death rate as compared with England and Wales: — Year Number of Deaths Death Rate per 1,000 of population Mitch am England and Wales 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 1.61 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 1944 83 1.6 1.7 Tuberculosis During the year 83 new cases of tuberculosis were notified, viz.: — Males Females Total Pulmonary 35 35 70 N on-Pulmonary 7 6 13 Total 42 41 83 48 Seventeen cases were transferred into the Borough, as follows: — Males Females Total Pulmonary 9 6 15 Non-Pulmonary 1 1 2 Total 10 7 17 The total number of deaths registered as occurring from tuberculosis was viz.: — Males Females Total Pulmonary 22 15 37 Non-Pulmonary 1 4 5 Total 28 19 42 England and Wales Mitcham Death rate from respiratory tuberculosa per 1,000 population 9 0.47 0.72 Death rate from non-pulmonary tuber culosis per 1,000 population 0.07 0.10 The following table shows the number of new cases, the type of disease and the deaths from tuberculosis during the year. Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory Non- Respiratory M. F. M. F. M. F. M. F. Under 1 year ... ... ... ... ... ... ... ... 1 year to 5 years 2 ... ... 1 ... ... ... 1 5 years ,, 10 „ 1 2 ... ... ... ... ... ... 10 „ „ 15 „ 1 3 ... ... 1 ... ... ... 15 ,, „ 20 5 10 1 2 ... 1 ... 1 20 ,, ,, 35 ,, 11 14 3 1 8 9 ... ... 35 ,, „ 45 „ 7 3 1 2 4 1 ... 2 45 ,, ,, 65 „ 7 3 ... ... 7 4 1 ... 65 „ and upwards 1 ... 2 ... 2 ... ... ... Totals 35 35 7 6 22 15 1 4 49 New cases coming to the knowledge of the Medical Officer of Health during the year through (a) Death returns; (b) Posthu mous notifications:— Age Periods 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total Pulmonary : males ... ... ... ... ... 1 ... ... 1 ... ... 2 Pulmonary : females ... ... ... ... ... ... 1 ... 1 1 ... 3 Non-Pulmonary : males ... ... ... ... ... ... ... ... ... ... ... ... Non-Pulmonary : Females ... ... ... ... 1 ... ... 2 ... ... ... 3 The sources from which information as to the above mentioned cases was obtained are as follows: — No. of Cases Pulmonary NonPulmonary (a) From Local Registers ... ... (6) Transferable deaths from Registrar General 3 1 Posthumous notifications 2 2 Number of cases removed from register during 1944:— Reason Pulmonary Non-Pulmonary Total Gases Males Females Total Males Females Total Withdrawal of notification 1 ... 1 ... ... ... 1 Recovery from disease ... ... ... ... ... ... ... Death 25 15 40 ... 4 4 44 Removed from district 21 27 48 2 5 7 55 50 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths is as follows:— Non-notified tuberculosis deaths 8 Notified tuberculosis deaths 36 Percentage of non-notified T.B. deaths (all forms) 18.2 per cent. Percentage of non-notified pulmonary T.B. deaths 12.5 „ 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 29 such examinations have been made. Mitcham, Beddington and Wallington Tuberculosis Care 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—1944 Number of persons assisted 103 Receiving supplies of milk continuously for 12 months 11 „ „ for 6-12 months 20 „ „ under 6 months 26 Fares for family to visit sanatorium 2 Clothing and bedding supplied 10 Tuberculous persons who have received special consideration re housing 2 Committee Functions of the Committee 51 Removal expenses paid 1 Rent paid while patient in Sanatorium 1 Pocket money 3 Number of persons supplied with dried milk and drinking chocolate (American Red Cross) 27 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. In order that treatment might be given after 6 p.m., the Cleansing Section at the Western Road First Aid Post has been adapted for treatment, and has been in use since June, 1944. No disinfection of clothing or bedding, other than washing, has been recommended, and the results have justified the adoption of this course. 52 Visits paid, 23. Attendances at clinic, 390 persons; representing 155 families. Treated at baths, 265 persons; representing 100 families. Number of baths given, 645. Supplied with lotion or ointment (for home treatment), 109 persons; representing 48 families. Referred to hospital, 3. WANDLE VALLEY JOINT HOSPITAL BOARD Cases admitted to the hospital during the year ended December 31, 1944. Disease Beddington & Wallington Coulsdon & Purley Merton & Morden Mitcham Cases Deaths Cases Deaths Cases Deaths Cases Deaths Diphtheria 6 ... 10 ... 7 1 11 ... Scarlet Fever 20 ... 51 ... 172 1* 74 ... Erysipelas ... ... 1 ... 5 ... 5 ... Tonsilitis 2 ... 4 ... 14 ... 10 ... Measles 2 ... ... ... 1 ... 2 ... Influenza ... ... ... ... 2 ... 1 ... Whooping Cough 4 ... 8 ... 7 ... 4 ... Rubella 2 ... 3 ... 7 ... 1 ... Mumps ... ... ... ... 1 ... 1 ... Chicken Pox ... ... ... ... 4 ... ... ... Rheumatism 1 ... 1 ... ... ... ... ... Meningitis & C.S.M ... ... 1 ... ... ... 4 ... Puerperal Fever (Sepsis) 1 ... 1 ... 2 ... ... ... Admitted with mother l ... 1 ... 5 ... ... ... Enteritis & GastroEnteritis, Gastritis 2 ... ... ... 2 ... 3 1† Streptoccal Carrier ... ... ... ... ... ... ... Abscess of Keck 1 ... Dysentery 1 ... ... ... 8 ... 1 ... Jaundice ... ... ... ... ... ... 1 ... Pneumonia ... ... ... ... 3 ... 4 1§ Para Typhoid B ... ... ... ... ... ... ... Food Poisoning ... ... ... ... 1 ... ... ... Cerebral Haemorrhage ... ... ... ... ... ... 1 l Bronchitis 1 ... ... ... ... ... ... ... Admitted with Baby ... ... ... ... ... ... 1 ... Pemphigus ... ... ... ... ... ... 1 ... Impetigo ... ... ... ... ... ... 1 ... Hodgkins Disease and Cellulitis of Leg 1 1 ... ... ... ... ... ... Shingles of Head 1 ... ... ... ... ... ... ... 45 1 85 ... 242 4 125 3 * 1 death—Broncho Pneumonia, Measles and Scarlet Fever, † 1 death—Whooping Cough, Pneumonia and Enteritis; 1 death— Whooping Cough and Broncho Pneumonia. ‡ 1 death—Gastro Enteritis. § 1 death—Broncho Pneumonia. 53 INDEX Abortion. Deaths 13 Adoption of Children Act 26 Ambulances 14 Analysis of Mortality 13 Ante-Natal Clinics 16, 21 Area 8 Bakehouses 40 Bed Bugs, Eradication of 34 Birth Rates 9, 10, 13 Births, Live 8 — Illegitimate 8 — In Institutions 9 — Still 8 Blindness, Prevention of 46 Cancer 46 — Deaths from 47 Causes of Deaths 13 Cerebro-Spinal Fever 45 Child Welfare 18 Clinics 16-18 Closet Accommodation 34 Dairies and Cowsheds 40 Death Rates 10, 13 Deaths 8, 9, 12 Dental Treatment 19 Diarrhoea, Deaths from 9, 45 Diphtheria 44 — Immunisation 44 — — Clinic 17 Disinfection 17 Encephalitis Lethargica 45 Eradication of Bed Bugs 34 Erysipelas 45 Food and Drugs Act (1938) 39 — and Medicine, Supply of 21 — Inspection and Supervision of 39 54 page General Provision of Health Services for the Area 14 Health, Visiting 20 — Visitors, Visits by 21 Home Helps 23 Hospitals 15 Housing Statistics 38 Illegitimate Children, Care of 27-33 Infantile Mortality 9, 10, 11 Infant Life Protection 25 Infant Welfare Centres, Attendances 20 Infectious Disease, Cases notified 43 — — Case rates 13 — — Contracts 41 — Incidence of 42 — — Prevalence of and Control over 41 — — Notifications 13, 41, 43 — — School 46 Influenza 45 Inhabited Houses 8 Inquests 11 Inspection and Supervision of Food 39 Laboratory Facilities 14 Louse Infestation 20 Maternal Mortality 11, 13 Maternity and Child Welfare Services, Report on 18 — Home 16, 23 Midwifery, Domiciliary 15 Milk (Special Designation) Order (1936) 40 Mortality, Analysis of 13 Infant 9, 10, 11 Maternal 11, 13 N.S.P.C.C. 26 Nursing in the Home 14 Ophthalmia Neonatorum 46 Orthopaedic Clinic 19 Patients Admitted to Hospital 52 Personnel, Committee 5 Staff 6 55 PAGE Piggeries 41 Pneumonia 45 Population 8 Post-natal Clinic 7, 16. 23 Prevention of Blindness 46 Public Cleansing 34 Puerperal Pyrexia 45 Rateable Value 8 Rivers and Streams 34 Samples, Food 39 Sanitary Circumstances of the Area 33 Sanitary Inspector's Report 35 Scabies 51 — Clinic 17 Scarlet Fever 44 School Clinic 17 Schools 34 Small Pox 44 Social Conditions 8 Statistics, Housing 38 — Vital 8 Still Births 8 Sunlight Treatment 19 Tuberculosis 47 — Care Committee 50 — Clinic 17 Typhoid Fever 46 Venereal Diseases Clinics 17 Vital Statistics 8 Wandle Valley Hospital 52 War-time Nurseries 27 Welfare Clinics 16-17 — Attendance at 20 Whooping Cough, Deaths from 9 Woodlands Maternity Home 16, 23 X-Ray Examinations 22