LIBRARY BOROUGH OF MITCHAM REPORT of the Medical Officer of Health for the YEAR 1945 BOROUGH OF MITCHAM REPORT of the Medical Officer of Health for the YEAR 1945 Mitcham : H. G. Mather, Caxton Works, Lower Green 3 Borough of Mitcham HEALTH REPORT FOR 1945 To the Mayor, Aldermen and Councillors. Sir, Ladies and Gentlemen, I have much pleasure in presenting my annual report for the year 1945. The end of the war has resulted in a gradual increase in the population owing to the return of evacuees and of members of the forces to civil life. This increase in population has aggravated the housing difficulties of an area which suffered severely from enemy action, especially during the flying bomb period. The birth rate has remained at a high rate and the infant mortality rate of 31.8 per 1,000 has been lower only in 1939. There has been a small increase in the number of illegitimate births, but the infant mortality rate amongst illegitimate births has greatly improved and is lower than that of legitimate births. The local death rate was 10.19 per 1,000 as against 11.4 for England and Wales and 13.8 per 1,000 for the Administrative County of London. The work of the Day Nurseries has continued and the demand for places had not abated by the end of the year, and a waiting list was maintained. The general health of these children has been good and few cases of infectious disease have occurred. There has been an increased number of attendances at the welfare and ante-natal clinics, and an additional welfare centre and health visitor have proved necessary. 4 The work at Woodlands has been maintained at a high standard and has proved of great value to the Borough in providing additional maternity beds. I wish to thank the Chairmen of the Maternity and Child Welfare and Public Health Committees for their help and support, and all the voluntary helpers at the welfare centres who have done so much to make them successful. I am, Ladies and Gentlemen, Yours obediently, A. ASHWORTH, Medical Officer of Health. Public Health Department, Mitcham Court, Mitcham. 5 BOROUGH OF MITCHAM PUBLIC HEALTH COMMITTEE Chairman Councillor H. L. Gauntlett His Worship the Mayor (Alderman A. H. Bailey) Alderman— E. J. D. Field, J.P. Councillors— Mrs. J. C. Ericson G. W. Cole J. E. Hill G. R. Madgwick G. W. Pearce Dr. D. Miller Rev. R. A. Shute MATERNITY AND CHILD WELFARE COMMITTEE Chairman - - Councillor Mrs. E. Watson His Worship the Mayor Alderman— J. R. Beaumont Councillors— Mrs. J. C. Ericson H. Conway E. J. Dobinson R. A. Humphreys Dr. D. Miller E. Sharp Rev. R. A. Shute Co-opted Members— Mrs. A. H. Bailey Mrs. D. L. Chappell Dr. E. Evans Mrs. R. G. Hodges Mrs. E. F. Ward REPRESENTATIVES ON WANDLE VALLEY JOINT HOSPITAL BOARD His Worship the Mayor (ex-officio) Alderman— W. Dalton Councillors— G. W. Cole Mrs. E. Watson REPRESENTATIVES ON WANDLE VALLEY JOINT SEWERAGE BOARD Chairman - - Alderman S. L. Gaston. J.P.* His Worship the Mayor (ex-officio) Aldermen— E. J. D. Field G. W. Cole† Councillor— A. T. Gidden *Died March, 1945. † Appointed March, 1945. 6 STAFF Medical Officer of Health A. Ash worth, 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. Clinical Mcdical 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 IX Hinds (5, 6, 7, 9) Miss M. Knight (6, 8) Miss L. Salway (5, 6, 7) (a) Mrs. M. E. Naz (g) Miss R. M. Luther (5, 6, 7) Matron of Woodlands Maternity Home 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 (b) Mrs. L. Elkington (5, 6, 13) (c) Mrs. A. Brookson (13) 7 Midwives (d) Miss P. Gaunt (5, 6) Miss M. Monday (5, 6) Mrs. L. Papps (5, 6) Mrs. T. Davies (5, 6) (e) Miss E. D. Phillips (5, 6) (f) Miss M. Rice (6) Clerks J. B. A. Roodhouse and L. J. Bellingham, H.M. Forces Mrs. M. Odam Miss V. Valentine Miss H. Bonny Miss J. Poulton (a) Appointed part-tune—resigned 8.9.45 (b) Resigned 31.3.45 (c) Appointed 1.3.45 (d) Superannuated 1.3.45 (e) Appointed 15.3.45 (f) Resigned 31.10.45 (g) Engaged 5.11.45 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) 2,985 acres Population, Census 1921 35,119 „ 1931 56,856 Registrar-General's estimate of population midyear, 1945 54,070 Number of inhabited houses, 1921 7,150 1931 13,187 1945 17,052 Rateable Value, 1945 £499,319 Sum represented by a 1d. rate £1,900 STATISTICS. Live Births. Total Male Female Hate per 1.000 of population Legitimate 906 452 454 Illegitimate 68 35 33 Total 974 487 487 18.01 Still Births. Total Male Female Rate per 1,000 total births Legitimate 17 8 9 Illegitimate 2 2 — Total 19 10 9 19.1 Deaths. Total Male Female Rate per 1,000 of population 551 288 263 10.19 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 31.88 Legitimate infants per 1,000 live legitimate births 32.01 Illegitimate infants per 1,000 live illegiti- • mate births 29.41 Deaths from:— Cancer (all ages) 103 Measles 1 Whooping cough (all ages) 1 Diarrhoea (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 1930 1129 367 32.4 1981 1143 370 32.3 1982 1084 381 35.1 1938 1010 420 41.5 1934 982 428 43.5 1935 969 474 48.9 1986 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 1948 1048 727 69.4 1944 996 678 68.1 1945 993 661 66.5 Number of births notified by municipal midwives in 1945, 278. The birth rates, death rates per 1,000 of population, and the infantile mortality rates for the years 1925-45 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 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 20.1 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 1945 18.01 16.1 10.19 11.4 31.83 46 11 Infant Mortality During the year 31 deaths were registered as occurring in infants under one vear of age: — Males Females Total Legitimate 13 16 29 Illegitimate 1 1 2 Totals 14 17 31 as compared with 36 deaths last year. There were 31 deaths in infants under one year of age, and of this total 17 occurred during the first month of life. Of these cases ten deaths were certified as due to prematurity, five due to congenital defects and two to infectious conditions. Of the 14 deaths occurring in infants between one and 12 months, nine were certified as due to infectious conditions, two due to congenital defects, two due to prematurity and one death was accidental. Only two illegitimate infants died during the year. Maternal Mortality During the year one death was registered as being due to: — (a) Pulmonary infaret, (b) Childbirth five weeks before. In 1944 one death was registered as being due to disease or accident of pregnancy. Inquests Inquests were held on 19 residents dying within the district and on 10 Mitcham residents who died outside the district, a total of 29. In addition, the coroner held 37 post-mortems without inquests. The following table shows the results of the findings of these nquests: — Deaths from natural causes 12 Accidental deaths 8 Deaths from misadventure 8 Suicides 1 War operations 0 Total 29 12 Deaths Registered during the Year 1945 Cause of Death Males Females Total 1 Typhoid and paratyphoid fevers ... ... ... 2 Cerebro-spinal fever ... ... ... 3 Scarlet fever ... ... ... 4 Whooping cough 1 ... 1 5 Diphtheria ... ... ... 6 Tuberculosis of respiratory system 22 10 52 7 Other forms of tuberculosis 3 3 6 8 Syphilitic diseases 4 ... 4 9 Influenza 2 ... 2 10 Measles 1 ... 1 11 Acutepolio-myelitis and polio-encephalitis 1 ... 1 12 Acute infectious encephalitis ... ... ... 13 Cancer of buccul cavity and oesophagus (m) and uterus (f) 7 3 10 14 Cancer of stomach and duodenum 6 9 15 15 Cancer of breast ... 3 8 16 Cancer of all other sites 45 25 70 17 Diabetes ... 3 3 18 Intra cranial vascular lesions 21 29 50 19 Heart disease 55 66 121 20 Other diseases of circulatory system 11 13 24 21 Bronchitis 28 11 39 22 Pneumonia 18 14 32 23 Other respiratory diseases 4 1 5 24 Ulcer of stomach or duodenum 4 ... 4 25 Diarrhœa (under two years) ... 2 2 26 Appendicitis 1 1 2 27 Other digestive diseases 4 5 9 28 Nephritis 10 4 14 29 Puerperal and post-abortive sepsis ... 1 1 30 Other maternal causes ... ... ... 31 Premature birth 5 3 8 32 Congenital malformations, birth injuries, infantile disease 9 12 21 33 Suicide 1 ... 1 34 Road traffic accidents 4 1 6 35 Other violent causes 4 3 7 36 All other causes 17 36 53 All causes 288 263 551 13 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1946. (Provisional figures based on weekly and quarterly returns.) England and Wales 126 County Boroughs and Great Towns including London 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 census) London Administrative County Mitcham Rates per 1,000 civilian population Births— Live 16.1‡ 19.1 19.2 15.7 18.01 Still 0.46‡ 0.58 0.53 0.40 0.35 Deaths— All causes 11.4‡ 13.5 12.3 13.8 10.19 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 — Scarlet fever 0.00 0.00 0.00 0.00 — Whooping cough 0.02 0.02 0.01 0.02 0.02 Diphtheria 0.02 0.02 0.02 0.01 — Influenza 0.08 0.07 0.07 0.07 0.04 Smallpox 0.00 – – – – Measles 0.02 0.02 0.02 0.01 0.02 Notifications— Typhoid fever 0.01 0.01 0.01 0.01 — Paratyphoid fever 0.01 0.00 0.01 0.00 — Cerebro-spinal fever 0.05 0.05 0.05 0.06 0.05 Scarlet fever 1.89 2.02 2.03 1.67 2.97 Whooping cough 1.64 1.65 1.47 1.35 1.77 Diphtheria 0.46 0.52 0.56 0.31 1.17 Erysipelas 0.25 0.28 0.24 0.31 0.27 Smallpox 0.00 0.00 0.00 0.00 — Measles 11.67 10.89 11.19 9.03 13.66 Pneumonia 0.87 1.03 0.72 0.78 0.61 Rates per 1,000 live births Deaths under one year of age 46† 54 43 63 31 Deaths from diarrhœa and enteritis under two years of age 5.6 7.8 4.5 7.6 2.0 Rates per 1,000 total births (live and still) Maternal mortality Abortion with sepsis 0.25 — ,, without sepsis 0.08 — Puerperal infections 0.24 Not available — Other 1.22 1.00 Notifications— Puerperal fever 9.93 12.65 8.81 3.6 8.06 Puerperal pyrexia 15.87* Mortality per million women aged 15.45 Abortion— With sepsis 18 Not available Without sepsis 6 * Including Puerperal fever. A dash (—) signifies that there were no deaths. ‡ Rates per 1,000 total population. † 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 705 Sputa for tubercle 34 Total 739 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 1,462, of which 244 were accident cases and 1,218 private removals, including 373 maternity cases. For Infections 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. The following are the returns from each association for year ended December 31st, 1945: — 15 No. of Nurses No. of patients visited during 1945 No. of visits paid during 1945 St. Barnabas 1 137 4,087 Mitcham D.N. Association 4* 543 12,209 Totals 680 16,290 * 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. This clinic returned to Cavendish Road Clinic in August St. Barnabas Church Hall, Gorringe Park Avenue.—Ses sions are held every Tuesday afternoon. Sherwood House, Commonside East.—Sessions are held every Thursday morning. Church Road Centre.—Sessions are held every Thursday afternoon. Meopham Road Clinic.—This clinic was opened in November, and is held each Wednesday afternoon. 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. Church Road Clinic.—Sessions are held on every Tuesday morning. The municipal midwives also hold a clinic at Church Road Clinic on Wednesday afternoons. Post-Natal Clinic A post-natal clinic is held at Church Road Clinic on the fourth Tuesday of each month. Since October clinics are held alternate Mondays. 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 Clinics 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. Treatment is given at Western Road Clinic. 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 infections 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 152 Number of rooms disinfected by fumigator 372 Number of library books disinfected 238 REPORT ON MATERNITY AND CHILD WELFARE SERVICES Child Welfare Child Welfare Sessions are held at five centres, thus serving every part of the Borough. Each Clinic is held weekly. The total number of attendances at the infant welfare centres was 1-1.767, as compared with 11,136 in 1944. Of these 968 were new cases. 862 being infants under one year of age, and 106 being children over one but under five years of age. The total number of attendances of infants under one year was 11,002. and of children between one and five years of age, 3.765. At the end of the year there were 723 infants under one year and 1,230 children between one and five years of age attending the centres, making a total of 1,953. The average attendance at each centre was: — Park Road and Cavendish Road 58.4 St. Barnabas 80.8 Church Road 78.5 Sherwood House 71.6 Meopham Road 40.9 The percentage of infants under one year of age attending the centres for the first time was 88.5 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. The end of the war has resulted in a number of mothers and babies returning to Mitcham and a general increase in the attendances at the clinics has occurred. The centres are staffed by a medical officer, two health visitors and voluntary helpers, who have rendered most valuable service by selling food, keeping the registers, etc. 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 38 cases were referred to this clinic, as compared with 42 cases in 1944. 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 and nursing mothers 38 Under fives 24 During the year the scale of charges for dentures was revised with considerable benefit to the patients. No patient now need refuse dental treatment on account of cost. Health Visiting There are six health visitors employed in visiting the mothers and children in this district. The Superintendent Health 20 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 each day on admission. Attendances at Infant Welfare Centres, 1945 Particulars Park Road and Cavendish Road St. Barnabas Church Road Sherwood House Meopham Road Total Number of now cases registered during year of— Children under one year of age 141 226 260 215 20 862 Children over one year and under five years of age 15 27 28 35 1 106 Number of children in attendance at end of year— Under one year of age 110 194 212 121 86 723 Over one and under five years of age 225 336 345 277 47 1230 Attendances of children under one year of age 1921 2829 2723 2453 214 11002 Attendances of children over one year of age 784 964 915 946 50 3765 Total attendances at centres 2861 4046 3926 3649 285 14767 Average attendances at centres 58.4 80.8 78.5 71.6 40.9 ... Percentage of infants under one year of age attending centres of the total live births ... ... ... ... ... 88.5 21 Visits Paid by Health Visitors Particulars No. Primary ante-natal visits 462 Subsequent ante-natal visits 95 Primary birth visits 868 Subsequent visits to infants 3,016 Visits to children over one and under five years of age 6,642 Visits re stillbirths 2 Visits re deaths of infants under one year of age 8 Visits re cases of ophthalmia neonatorum — Visits re cases of puerperal pyrexia — Primary visits to cases of tuberculosis 3 Subsequent visits to cases of tuberculosis 49 Special visits 658 Infant Life Protection visits 259 Infectious disease visits 311 Visits re diphtheria immunisation 93 Total 12,479 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 Clinics Two ante-natal clinics are held each week at Church Road Clinic 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 Church Road Clinic. Average Attendance at Each Centre Number of expectant mothers Number of attendances Average Clinic attendance Woodlands (two clinics) 295 1,874 18.7 Church Road Clinic 354 1,534 29.5 Midwives' Clinic 254 999 19.2 Total 903 4,407 23.7 Of the total number of registered births, 91 per cent. of the mothers had attended the ante-natal centres. Thirty-seven 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. 23 During the year 25 women attended for this examination, as compared with 25 last year. Post-Natal Clinic A Post-Natal Clinic is held at. Church Road Clinic 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 Clinic; 101 cases attended during the year. The total number of women who attended the post-natal clinics at Church Road Clinic was 90. the average attendance being 7 7. 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 one full-time and one regular part-time home helps were being employed. Thirty-five 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. The scale of assistance for home helps is the same as that adopted by the Surrey County Council. Ministry of Health Circular 179/44 was considered by the Maternity and Child Welfare Committee, who decided that any extension of the Home Help and Domestic Help Scheme so as to include aged persons must be deferred until sufficient home helps are available under the scheme for giving assistance to expectant and nursing mothers. WOODLANDS MATERNITY HOME. The number of cases admitted during the year was 265. 49 more than in 1944, 24 Dr. Housden was appointed Clinical Medical Officer on April 1st, 1944. Dr. Housden conducts the ante-natal clinics, and treats all cases requiring medical attention 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, 1944. 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 the electrically heated cot purchased for the care of the premature infants born in Woodlands has been used on several occasions. 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 1930 318 1931 259 1932 239 1933 285 25  Number of births 1934 285 1935 299 1936 314 1937 309 1938 297 1939 254 1940 239 1941 215 1942 263 1943 224 1944 213 1945 267 Number of maternity beds in the institution (exclusive of isolation and labour beds), 15. Number of maternity cases admitted during the year, 265. Average duration of stay, 12.6 days. Number of cases delivered by (a) midwives, 239; (b) doctors, 21. Number of cases in which medical assistance was sought by a midwife in emergency, 51. Number of cases notified as (a) puerperal fever, nil; (h) puerperal pyrexia. 1. Number of cases of pemphigus neonatorum, 8. Number of infants not entirely breast-fed while in the institution, 19. 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, nil. An ante-natal clinic is held every Monday and Friday at Cavendish Road Clinic, and patients who have booked are expected to attend. The post-natal clinic is held once monthly. 10J cases attended during the year, 26 Owing to a number of suspected cases of pemphigus the home was closed to admission from July 10 to August 6. No further cases occurred. 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, 1945 10 Number of children on register, December 31, 1945 10 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 258 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. 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 41 Total number of children in respect of whom notice was given 41 27 Number of such children under supervision at the end of the year 18 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 1945 8 Number of children affected 30 Number of visits paid 50 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. The average attendances were as follows: — Eagle House. Robinson Road. Under two 27 753 12.981 Two—five 42519 26.325 Totals 70272 39.306 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, 1944, 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 : — 28 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 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 ance 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 Southwark 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 29 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. 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, 1944, 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 eases, 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. 30 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 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 81 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 veiy 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. 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 32 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 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 33 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. 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 1944. On February 2, 1945, a conference of the interested local authorities took place at Mitcham. Owing to the difficulty of obtaining suitable accommodation it was agreed by the conference that the Merton and Wimbledon Moral Welfare Association should be approached to ascertain whether the association would be prepared to re-establish their Home in Gap Road, Wimbledon, if the financial backing of the interested local authorities was obtained. The Home at Gap Road had been badly damaged by enemy action, but was capable of repair at a reasonable cost. Representatives of the conference held various 84 meetings with representatives of the Merton and Wimbledon Moral Welfare Association. Unfortunately the Gap Road premises could not be repaired under a cost of work payment as the Wimbledon Borough Council required the site for flats. The Welfare Association could only expect a value payment based on the 1939 value, and therefore any attempt to purchase another suitable building could involve them in a high capital expenditure which they were not prepared to accept. It was felt that the representatives of the local authorities would not be prepared to recommend tc their Councils any extensive capital expenditure, and it was decided that the Welfare Association would endeavour to find a suitable building to rent. Unfortunately, no further progress could be reported by the end of the year. Care of Premature Infants Premature infants requiring hospital treatment are admitted to the County Hospital. For cases remaining in their own homes special draughtproof 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. There are in addition eight 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. 35 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 Fourteen 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, 58 (97 rooms). Number of other houses found infested during the year, 55 (91 rooms). Number of requisitioned, etc., houses found infested during the year, 4 (7 rooms). Total number of houses disinfested during the year, 117 (195 rooms). Methods employed: — 52 rooms treated with sulphur dioxide. 143 rooms treated with insecticide spray (inclusive of rooms treated on more than one occasion). No private houses were treated by the Council staff, but advice was given and material supplied at cost price on request in respect of 25 houses (46 rooms) 36 Number of private houses disinfested by owners or occupiers after notice, 30. Number of shelters disinfested, 23. Number of houses disinfested for beetles, 39 (41 rooms). 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. 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 185 Number of visits paid by sanitary inspectors 677 Number of visits paid by rodent operators 3,239 Roads in which sewers were baited 381 37 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 6,664 Number of complaints received 637 Visits re complaints and sundries 1,789 Revisits 1,192 Houses inspected for defects 882 Number of nuisances discovered 724 Number of intimation notices served 466 Number of intimation notices complied with 226 Number of statutory notices served 183 Number of statutory notices complied with 98 Visits to butchers and other food shops 120 Visits to factories 153 Visits to piggeries 53 Visits to refuse dumps 6 Visits re infectious disease 514 Visits to slaughterhouses 24 Visits to restaurant kitchens 10 Visits to stables 8 Visits to schools 12 Visits to garages 11 Visits to outworkers' premises 69 Visits to marine stores 6 Visits to caravan yards 22 Details of visits to other premises are enumerated in other sections of the report. Character of Work Done Roofs repaired 80 Rainwater gutters and piping repaired or renewed 14 Eaves guttering and spouting repaired 54 Yards paved or repaired 3 38 Dampness remedied 38 Water service pipes repaired 16 Waterclosets: repairs to roof, walls, doors, windows, floors and seats 30 Waterclosets: flushing apparatus repaired or renewed 39 Waterclosets: repairs to pans and traps, obstruction removed 18 Water storage cisterns cleansed, regulated, repaired or renewed 8 Water supply reinstated 15 Flooring of rooms repaired and ventilation improved 49 Rooms cleansed and redecorated 72 Repairs to sinks, waste pipes and traps 20 Window frames, sashes and sills provided 1 Window frames, sashes and sills repaired 29 Drains repaired and obstructions removed 27 Repairs to firegrates 16 Repairs to stoves, coppers, ranges, etc. 18 New dustbins provided 63 Accumulations removed 6 Repairs to chimney stacks, etc. 5 Repairs to staircases 6 Rainwater gullies repaired 10 Smoke nuisances abated 3 Repairs to doors 8 Sanitary accommodation provided 2 Repairs to sinks 4 Drains tested 19 Repairs to internal plaster 98 Grid and mica flaps provided 6 Drain inspection chamber covers provided 5 Sundries 8 Sinks and handbasins provided or renewed 4 External brickwork (repaired, pointed or rendered) 7 W.c. pans and traps provided 18 Legal Proceedings.—Application was made to the Justices for a nuisance order under Section 94, Public Health Act, 1936, 39 against a property owner. The application was granted with costs. 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 - seven licences to store petroleum and cellulose solutions were granted, totalling 140,345 gallons. Five licences were also issued for 61 cwt. of carbide of calcium to be stored. Unsound Food Dealt With. Beef 490 1bs. Figs 158 1bs. Mutton 668 „ Corned beef 1869¾ „ Pork 908 „ Corned Mutton 664½ „ Offal 313½ „ Tea 23 Veal 49 „ Raisins 56 „ Fish 50¾ stones Pudding Mixture 287 pkts. Cheese 114½ 1bs. Dates 69 1bs. Oranges 59„ Dried egg 11 pkts. Lemons 36 „ Eggs 1639 Peas (dried) 28 „ Bacon 66 1bs. Potatoes 2½cwt. Jam 7 „ Margarine 72 1bs. Sundry tinned „ Butter 55 „ foods 1427 tins Number of visits to Meat Depot 20 574 Yours obediently, K. J. GUTTERIDGE, Chief Sanitary Inspector. Housing Statistics I. Inspection of Dwelling Houses during the Year.— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 882 (b) Number of inspections made for the purposes 916 40 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 266 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. 61 formal samples were taken, as follows:— Milk 56 Tin greaser 1 Baking powder 2 Cocoa 1 Cake improver 1 Informal Samples. 51 informal samples were taken, as follows:— Vinegar 1 Mustard 3 Scone mixture 3 Dessert mould 1 Coffee 1 Lemon crystals 1 Lemon flavouring 1 Aspirin 1 Cinnamon 2 Spice 1 Pork sausage 1 Cake sponge mixture 2 Cocoa 2 Junket 2 Soda bicarbonate 1 41 Fish and meat paste 2 Stomach powder 1 Pudding powder mixture 1 Self-raising flour- 4 Custard powder 2 Jam 6 Chocolate semolina 1 Worcester Sauce 2 Baking powder 7 Sardines 1 Epsom salts 1 Six warning letters were sent to suppliers of samples below standard. 412 butterfat samples were submitted to the Public Analyst for the Ministry of Food. MILK (SPECIAL DESIGNATION) ORDER, 1936 During the year the Council granted the following number of licences under the above named Order:— Tuberculin Tested 7 Pasteurised 10 Pasteurising Plant 1 Supplementary Licences- Pasteurised 5 Tuberculin Tested 6 Seventy-five samples of Graded Milk were submitted for bacteriological examination. Fifty-six samples were satisfactory and 19 were unsatisfactory. Communications were sent to the dairies regarding the unsatisfactory samples. BAKEHOUSES The number of bakehouses in the district is 12. Twenty-seven 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 106 visits of inspection were paid. PIGGERIES There are nine piggeries in the Borough. Fifty-three visits were paid during the year, 42 OTHER FOOD PREPARING PLACES There are eight 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 1,126. 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 514 Health Visitors 311 To small pox contacts 80 Total 905 Rooms disinfected after infectious disease 372 43 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 Cough Food Poisoning Encephalitis Lethargica Undulant Fever Malaria Totals January ... 7 ... ... 3 2 ... ... 2 1 ... 19 2 ... ... ... ... 36 February ... 9 ... ... ... 6 2 ... ... ... ... 221 3 ... ... ... ... 244 March ... 9 ... ... 2 5 1 ... ... ... ... 256 9 ... ... ... ... 282 April ... 6 3 ... ... ... ... ... ... ... ... 94 8 2 ... ... ... 113 May ... 10 3 ... l 3 1 ... ... ... ... 70 7 ... ... ... ... 95 June ... 17 3 ... 2 1 ... ... 2 ... ... 31 7 ... ... ... ... 66 July ... 17 3 ... ... 1 ... ... 1 1 1 21 4 ... ... ... ... 50 August ... 6 8 ... 1 1 1 ... ... ... ... 20 16 3 ... ... ... 56 September ... 19 10 ... ... 1 ... ... ... 1 ... 2 7 ... ... ... ... 40 October ... 10 9 ... 3 3 ... ... 3 ... ... 1 4 ... ... ... ... 33 November ... 15 13 ... 2 2 2 ... ... ... ... 1 11 ... ... ... ... 46 December ... 32 11 ... 2 5 1 ... 5 ... 1 ... 18 ... ... ... ... 65 Totals ... 147 63 1 16 33 8 ... 13 3 2 739 96 5 ... ... ... 1126 44 Infectious Disease Notifications, 1925-45. Disease 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 Small Pox ... ... ... 9 7 ... 4 1 ... ... ... ... ...... ... ... ... ... ... ...... ... ... Scarlet Fever 106 104 145 102 134 113 105 174 240 392 143 171 192 150 61 48 75 175 212 97 147 Diphtheria 201 87 76 75 133 129 49 32 40 83 80 104 89 64 27 36 72 25 42 10 63 Typhoid Fever 4 2 6 3 4 9 2 3 3 ... 3 5 ... 1 ... ... ... ... 1 ... 1 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Undulant Fever ... ... ... ... ... ... ... ... ... ... ... . .. ... ... ... ... ... ... 1 ... ... Puerperal Fever 5 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 5 8 Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal ... ... 2 1 4 ... ... 1 4 1 1 8 1 2 1 13 12 6 8 3 3 Meningitis Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 10 13 14 10 22 22 17 11 31 30 20 22 16 8 19 17 19 7 22 13 16 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 301 194 599 651 112 739 Acute Diarrhœa ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Chicken Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis ... 1 2 ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 Ophthtalmia torum 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 42 30 62 54 57 35 45 52 37 45 35 36 32 43 ... 30 22 20 50 37 33 Malaria 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 16 186 161 162 166 96 Food Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 4 6 11 ... ... 5 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 67 13 Totals 376 259 340 270 375 319 '242 288 368 560 293 357 338 275 125 468 591 1021 1161 515 1126 45 Small Pox No case of small pox was notified during the year 1945. Scarlet Fever The number of cases of scarlet fever notified during the year was 147, as compared with 97 in 1944, equivalent to a case rate of 2.97 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 97 were treated in hospital, and 50 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 Sixty-three cases of diphtheria were notified during the year and all cases were removed to hospital for treatment, including any carriers discovered by routine swabbing of contacts. Every case recovered. 46 The following table gives details of notifications and the number of each age group immunised:— NOTIFICATIONS DEATHS Age at date of notification. Number of cases notified Number of cases included in preceding column in which the child had completed a full course of immunisation. Age at date of death Number of deaths Number of cases included in preceding column in which the child had completed a full course of immunisation. Under 1 1 — Under 1 — — 1 2 — 1 — — 2 1 — 2 — — 3 4 — 3 — — 4 2 — 4 — — 5-9 23 10 5-9 — — 10-14 19 7 10-15 — — Over 14 11 Totals S3 17 Totals — . — The number of cases is a considerable increase over 1944, when ten cases only were notified. It will be noted that school children accounted for a large proportion of the cases, and most of these cases occurred in the Singlegate and Fortescue areas and in the Lower Mitcham area. Class swabbing failed to reveal any source of infection, and swabbing of Lower Mitcham Junior School only showed three children with positive swabs, and they cleared up very rapidly and were probably only temporary carriers. A total of 17 cases had been immunised as babies, and in every case a mild attack only occurred. One immunised child who had been absent from school for several days with a sore throat, returned to school and intended to sing in the school concert two days later. On clinical examination her throat was very suspicious and the diagnosis was confirmed when examination of the swab showed a pure culture of K.L.B. Swabs from this child became completely negative within two days, and I believe that mild cases of diphtheria occur in immunised children 47 without being recognised by the parents, and the child is allowed to return to school in a highly infectious state. Fortunately they remain carriers for only a short period, so that by the time the contact case is recognised their swabs have become negative. Immunisation and reinforcing doses were given to every child in the schools whose parents consented, and a fall in the incidence followed rapidly. 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. The following figures show the number of children immunised during the year:— Under five 873 Five—15 274 Over 15 — Total 1,147 48 The following figures show the number of the child population considered immunised at 31st December, 1945:— Age at 31.12.45 i.e. born in year Under 1 1945 1 1944 2 1943 3 1942 4 1941 5 to 9 1936-1940 10 to 14 1931-1935 Total under 15 Number immunised 5 602 648 725 582 4204 2506 9272 Estimated mid-year population 1945 4350 8220 The per cent. immunised is as follows:— Under five 58.7% Five—15 787% The number of birthday greetings sent in 1945 was 945. Four hundred and sixty-three mothers took advantage of this offer. Typhoid Fever One case was notified during the year. Diarrhoea and Enteritis Under Two Years of Age Two deaths were registered during the year. Encephalitis Lethargica No case was notified during the year. Erysipelas Sixteen cases were notified. Five cases were removed to hospital. Puerperal Pyrexia Eight cases were notified during the year. Pneumonia Thirty-three cases of primary pneumonia were notified during the year. The number of deaths from all forms of pneumonia, some of which are not notifiable, was 32, of which 18 were males and 14 females. Cerebro-Spinal Fever Three cases occurred during 1945, and there was no death. 49 Influenza During the year two deaths from influenza were recorded, both of which were males. The previous year two deaths were registered. Prevention of Blindness By an arrangement with the London County Council cases of ophthalmia neonatorum can be treated at Whiteoaks Hospital, Swanley Junction, Kent. Blind children are looked after by the Surrey Voluntary Association for the Blind. Ophthalmia Neonatorum During the year no cases of ophthalmia neonatorum were notified. 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 146 Mumps 130 Impetigo 3 Jaundice — Rubella 19 Ringworm 4 Cancer. The number of deaths from cancer registered during the year was 103, of which 58 were males and 45 were females. Cancer is mainly a disease of the digestive system, with the exception of its preference for the generative system in females, 50 The site distribution for 1945 was as follows:— Digestive organs 22 cases Genito-urinary organs 3 „ Breast 8 „ Other sites 70 „ Total 103 „ The following table shows the number of deaths from cancer, together with the death rate as compared with England and Wales:— Year Number of Deaths Death Rate per 1,000 of population Mitcham 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 1.51 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 1944 83 1.6 1.7 1945 103 1.9 1.74 51 Tuberculosis During the year 88 new eases of tuberculosis were notified, viz.;— Males Females Total Pulmonary 43 38 81 Non-Pulmonary 3 4 7 Totals 46 42 88 Twenty-six cases were transferred into the Borough, as follows:— Males Females Total Pulmonary 10 16 26 Non-Pulmonary — — — Totals 10 16 26 The total number of deaths registered as occurring from tuberculosis was viz.:— Males Females Total Pulmonary 22 10 32 Non-Pulmonary 3 3 6 Totals 25 13 38 England and Wales Mitcham Death rate from respiratory tuberculosis per 1,000 population 04? 059 Death rate from non-pulmonary tuberculosis per 1,000 population 009 0 11 52 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 1 ... ... ... ... ... ... ... 5 years „ 10 „ 3 1 ... 1 ... ... 1 2 10 ,, ,, 15 ,, ... 3 ... ... ... ... ... ... 15 „ ,, 20 ,, 10 7 2 1 2 1 ... 1 20 ,, „ 35 ,, 17 18 ... ... 2 5 1 ... 35 „ „ 45 6 6 ... 1 9 1 1 ... 45 „ ,, 65 ,, 6 2 1 ... 7 3 ... ... 65 ,, and upwards ... 1 ... ... 3 ... ... ... Totals 43 38 3 4 23 10 3 3 53 New cases coming to the knowledge of the Medical Officer of Health during the year through (a) Death returns; (b) Posthumous notifications:— Age Periods 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total Pulmonary: males ... ... ... ... ... ... ... 2 ... ... ... 2 Pulmonary: females ... ... ... ... ... 1 ... 1 1 ... ... 3 Non-Pulmonary: males ... ... 1 ... ... ... ... ... ... ... ... 1 Non-Pulmonary: Females ... ... ... ... ... ... ... ... ... ... ... ... The sources from which information as to the above mentioned cases was obtained are as follows:— No. of Cases Pulmonary NonPulmonary Death returns (a) From Local Registers 2 ... (b) Transferable deaths from Registrar General 1 ... Posthumous notifications 2 1 Number of cases removed from register during 1945:— Reason Pulmonary Non Pulmonary Total Cases Males Females Total Males Females Total Withdrawal of notification ... ... ... ... ... ... ... Recovery from disease 2 3 5 2 1 3 8 Death 24 13 37 4 5 9 46 Removed from district 22 13 35 1 2 3 38 54 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths is as follows:— Non-notified tuberculosis deaths 6 Notified tuberculosis deaths 40 Percentage of non-notified T.B. deaths (all forms) 15 per cent. Percentage of non-notified pulmonary T.B. deaths 13.5 „ 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 eases of tuberculosis, and during the year 34 such examinations have been made. Mitcham, Beddington and Wallington Tuberculosis Care Committee 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—1945 Number of persons assisted 123 Receiving supplies of milk continuously for 12 months 18 „ „ for 6-12 months 17 „ „ under 6 months 45 Fares for family to visit sanatorium 11 Clothing and bedding supplied 17 Tuberculous persons who have received special consideration re housing 2 55 Loans and assistance with training courses 4 Holiday fare 3 Pocket money 5 Dried milk and drinking chocolate (American Red Cross) was supplied to numerous patients. 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. 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. 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. 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 staff, and the men have been treated by a male attendant who has received special training. No disinfection of clothing or bedding, other than washing, has been recommended, and the results have justified the adoption of this course. Visits paid, 10. Attendances at clinic, 334 persons; representing 140 families. Treated at baths, 206 persons; representing 91 families. Number of baths given, 436. Supplied with lotion or ointment (for home treatment), 53 persons; representing 26 families. Referred to hospital, 1. 56 WANDLE VALLEY JOINT HOSPITAL BOARD Cases admitted to the hospital during the year ended December 31, 1945. Disease Beddington & Wallington Coulsdon & Purley Merton & Morden Mitcham Cases Deaths Cases Deaths Canes Deaths Canes Deaths Diphtheria 5 ... 3 1 10 ... 67 ... Scarlet fever 25 ... 48 ... 68 ... 97 ... Erysipelas 5 ... 1 ... 1 ... 5 1* Tonsillitis or Quinsy 5 ... 5 ... 10 ... 15 ... Measles 4 ... 4 ... 16 ... 26 ... Influenza ... ... ... ... 2 ... 2 ... Whooping cough ... ... 1 ... ... ... 4 ... Rubella 3 ... ... ... 2 ... 3 ... Mumps ... ... ... ... ... ... 1 ... Chicken Pox 3 ... ... ... ... ... 4 ... Meningitis & C.S.M 2 ... ... ... 3 ... 3 2 T B. Meningitis ... ... ... ... 1 ... ... ... Puerperal Fever (Sepsis) 2 ... 3 ... 2 ... 4 ... Admitted with mother 3 ... 2 ... 2 ... 3 ... Admitted with baby ... ... ... ... ... ... 3 ... Infantile paralysis 5 ... 2 ... 1 ... 3 1 Dermatitis ... ... 1 ... 3 ... 3 ... Enteritis & Typhoid ... ... ... ... 7 ... 5 ... Laryngitis ... ... 1 ... ... ... 1 ... Streptococcal infection & Impetigo ... ... ... ... 1 ... 2 ... No obvious disease ... ... 1 ... ... ... ... ... Pneumonia 2 ... 1 ... ... ... 2 1 Mastoid abscess ... ... 1 ... ... ... ... ... Jaundice ... ... 1 ... ... ... ... ... Conjunctivitis ... ... ... ... ... ... 1 ... Brain Tumour ... ... ... ... ... ... 1 1 Purpura ... ... ... ... ... ... 1 ... Pyelitis ... ... ... ... 1 ... 1 ... 63 2 75 1 129 1 256 6 *Erysipelas and Cerebral Embolus 67 INDEX Abortion. Deaths 13 Adoption of Children Act, 1939 26 Ambulances 14 Analysis of Mortality 13 Ante-Natal Clinics 16, 21 Area 8 Bakehouses 41 Bed Bugs, Eradication of 35 Birth Rates 9, 10, 13 Births, Live 8 — Illegitimate 8 — In Institutions 9 — Still 8 Blindness, Prevention of 49 Cancer 9, 49 — Deaths from 50 Causes of Deaths 12 Cerebro-Spinal Fever 48 Chicken Pox 49 Child Welfare 18 Clinics 16-17 Dairies and Cowsheds 41 Death Rates 10, 13 Deaths 8, 9, 12 Dental Treatment 19 Diarrhoea and Enteritis 48 — Deaths from 9 Diphtheria 45 — Immunisation 47 — — Clinic 17 Disinfection 17 Encephalitis Lethargica 48 Eradication of Bed Bugs 35 Erysipelas 48 Food and Drugs Act (1938) 40 — and Medicine, Supply of 21 58 page Food. Inspection and Supervision of 40 General Provision of Health Services tor the Area 14 Health, Visiting 19 — Visitors, Visits by 21 Home Helps 23 Hospitals 15 Housing Statistics 39 Illegitimate Children, Care of 27 — Institutions 31 Impetigo 49 Infantile Mortality 9, 10, 11 Infant Life Protection 26 Infant Welfare Centres, Attendances 20 Infectious Disease, Cases notified 44 — — Case rates 13 — — Contacts 42 — — Incidence of 43 — — Prevalence of and Control over 43 — — Notifications 42, 44 — — — School 49 Influenza 49 Inhabited Houses 8 Inquests 11 Inspection and Supervision of Food 40 Jaundice, Infective 49 Laboratory Facilities 14 Louse Infestation 20 Maternal Mortality 11, 13 Maternity and Child Welfare Services, Report on 18 Home 16, 23 Measles, Deaths from 9 Midwifery, Domiciliary 15 Milk (Special Designation) Order (1936) 41 Mortality, Analysis of 13 Infant 9, 10, 11 Maternal 11, 13 Mumps 49 69 page N.S.P.C.C 27 Nursing in the Home 14 Ophthalmia Neonatorum 49 Orthopaedic Clinic 19 Patients Admitted to Hospital 43 Personnel, Committee 5 — Staff 6, 7 Piggeries 41 Pneumonia 48 Population 8 Post-natal Clinic 16 23 Premature Infants, Care of 34 Prevention of Blindness 49 Puerperal Pyrexia 48 Rateable Value 8 Rats and Mice Destruction Act, 1919 36 Ringworm 49 Rubella 49 Samples, Food 40 Sanitary Circumstances of the Area 34 Sanitary Inspector's Report 37 Scabies 55 — Clinic 17 Scarlet Fever 45 School Clinic 17 Schools 36 Small Pox 45 Social Conditions 8 Statistics 8 Statistics, Housing 39 Vital 8 Still Births 8 Sunlight Treatment 19 Tuberculosis 50 — Care Committee 54 — Clinic 17 Typhoid Fever 48 60 page Unsound Food dealt with 39 Venereal Diseases Clinics 17 Vital Statistics 8 Wandle Valley Hospital 56 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