MITIS BOROUGH OF MITCHAM REPORT of the Medical Officer of Health for the YEAR 1946 REPORT of the Medical Officer of Health for the YEAR 1946 MITCHAM H. G, Mather Ltd., Caxton Works, Lower Green 3 Borough of Mitcham HEALTH REPORT FOR 1946 To the Mayor, Aldermen and Councillors. Sir, Ladies and Gentlemen, I have much pleasure in presenting my report for the year 1946. There has been a gradual increase of the population of the borough, with the demobilisation of the Forces, creating further demand on the health services. Housing continues to be a most urgent problem, and the inspection of war-damaged and dilapidated property has been a major task of the Sanitary Inspectors. The birth rate is the highest since 1928, and the infant mortality rate of 19'9 per 1,000 is the lowest ever recorded in the borough. There was no death of any illegitimate infant during the year. This is a notable achievement which I believe is due to the increased care, supervision and assistance available to the unmarried mother. The Mitcham Moral Welfare Association was formed during the year and the Borough Council have made a grant towards the salary of the social worker. The local death rate of 9'2 per 1,000 is the lowest since the war commenced, and compares with 11.5 for England and Wales and 12'7 for the Administrative County of London. During the year the Day Nurseries were transferred to the maternity and child welfare authorities. Both nurseries were taken over by the Borough Council and there was a long waiting list for admission at the end of the year. 4 The rise in the birth rate has increased the attendances at the ante-natal clinics and it was necessary during the year to hold an additional session each week. The attendance at the welfare centres has increased considerably and at two clinics it has been necessary to hold sessions twice weekly. An improved scheme for dental treatment and a successful Home Help and Domestic Help scheme were established during the year. Woodlands Maternity Home has been fully employed during the year, 292 Mitcham mothers being admitted for confinements with very satisfactory results. The provision of a Borough Maternity Home has been of great value to Mitcham owing to the acute shortage of maternity beds in the County hospitals and with so many damaged houses rendered unfit for a home confinement. I wish to thank the Chairmen of the Maternity & Child Welfare and Public Health Committees for their help and support, and all the voluntary workers at the welfare centres who have done so much to make the work successful. I am, Ladies and Gentlemen, Yours faithfully, A. ASHWORTH, Medical Officer of Health. Public Health Department, Mitcham Court, Mitcham. 5 BOROUGH OF MITCHAM PUBLIC HEALTH COMMITTEE Chairman Alderman Mrs. E. Watson His Worship the Mayor (Alderman G. W. Cole, J.P.) Aldermen— E. J. D. Field, J.P. G. W. Pearce Councillors— D. Gifford W. F. Hill G. J. Kemp G. R. Madgwick R. W. Morris MATERNITY AND CHILD WELFARE COMMITTEE Chairman Councillor Mrs. J. C. Ericson His Worship the Mayor Aldermen— Mrs. E. Watson J. R. Beaumont Councillors— Mrs. E. G. Baker J. H. S. Bradley W. F. Hill R. F. Nicholson E. Randall T. Ruff Co-opted Members— Mrs. L. Crump Mrs. E. Gifford Mrs. E. L. Hawkes Mrs. E. F. Ward REPRESENTATIVES ON WANDLE VALLEY JOINT HOSPITAL BOARD His Worship the Mayor (ex-officio) Alderman— M rs. E. Watson Councillors— Mrs. J. C. Ericson T. H. Barr REPRESENTATIVES ON WANDLE VALLEY JOINT SEWERAGE BOARD His Worship the Mayor (ex-officio) Aldermen— A. H. Bailey E. J. D. Field, J.P. Councillor— L. M. Ibbotson 6 STAFF Medical Officer of Health A. Ashworth, M.D., Ch.B., M.R.C.S., L.R.C.P., D.P.H., D.T.M. Assistant Medical Officer Florence M. Parsons, M.R.C.S., L.R.C.P. Consulting Gynaecologist J. V. O'Sullivan, Esq., M.D., F.R.C.S Consultant in Diseases of Infants N. L. Lloyd, Esq., M.B., M.R.C.P. Consultant in Ear Diseases W. H. B. Magauran, M.D., F.R.C.S. Woodlands Maternity Home Clinical Medical Officer E. G. Housden, M.D., B.S., M.R.C.S., L.R.C.P., D.R.C.O.G. Consulting Anaesthetist I. Evans, M.A., M.R.C.S., L.R.C.P. 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 Mrs. Ashman (5, 6, 7, 9) Assistant Health Visitors Miss G. Russell-Harris (5, 6, 7) (g) Miss D. Hinds (5, 6, 7, 9) Miss M. Knight (6, 8) Miss L. Sahvay (5, 6. 7) 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 Mrs. A. Brookson (13) Midwives Miss M. Monday (5, 6) Mrs. L. Papps (5, 6) Mrs. T. Davies (5, 6) Miss E. D. Phillips (5, 6) (h) Miss M. J. McWeeney (5, 6) 7 Clerks (a) J. B. A. Roodhouse and (b) L. J. Bellingham, H.M. Forces (c) Mrs. M. Odam Miss V. Valentine (d) Miss J. Poulton (e) Miss W. Loines (f) Miss K. Lane (а) Resumed duties 1.1.46—resigned 16.12.46 (b) Resumed duties 23.4.46 (c) Resigned 6.2.46 (d) Resigned 18.9.46 (e) Appointed 9.9.46—resigned 20.11.46 (f) Appointed 22.11.46 (g) Resigned 31.10.46 (h) Appointed 1.4.46 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, 1946 61,850 Number of inhabited houses, 1921 7,150 1931 13,187 1946 17,615 Rateable Value, 1946 £503,962 Sum represented by a ld. rate £2,024 STATISTICS. Live Births. Total Male Female Rate per 1,000 of population Legitimate 1203 639 564 Illegitimate 53 33 20 Total 1256 672 584 20.3 Still Births. Total Male Female Rate per 1,000 total births Legitimate 33 22 11 Illegitimate 1 1 — Total 34 23 11 26.4 Deaths. Total Male Female Rate per 1,000 of population 569 299 290 9.2 Deaths from disease and accidents of pregnancy and childbirth:— Rate per 1,000 total births From puerperal sepsis — From other puerperal causes — Total — 9 Deaths of infants under one year of age:— All infants per 1,000 live births 19.9 Legitimate infants per 1,000 live legitimate births 20.8 Illegitimate infants per 1,000 live illegitimate births _ Deaths from:— Cancer (all ages) 108 Measles — Whooping cough (all ages) — 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 1931 1143 370 32.3 1932 1084 381 35.1 1983 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 854 458 53.0 1941 737 408 55.4 1942 986 518 52.5 1943 1048 727 69.4 1944 996 678 68.1 1945 993 661 66.5 1946 1290 845 65.5 Number of births notified by municipal midwives in 1946, 445. The births rates, death rates per 1,000 of population, and the infantile mortality rates for the years 1926-46 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 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 1946 18.01 16.1 10.19 11.4 31.83 46 1946 20.3 19.1 9.2 11.5 19.9 43 11 Infant Mortality During the year 25 deaths were registered as occurring in infants under one year of age:— Males Females Total Legitimate 20 5 25 Illegitimate — — — Totals 20 5 25 as compared with 31 deaths last year. There were 25 deaths in infants under one year of age, and of this total 16 occurred during the first month of life. Of these cases five deaths were certified as due to prematurity, eight due to congenital defects and three to infectious conditions. Of the nine deaths occurring in infants between one and 12 months, five were certified as due to infectious conditions, three due to congenital defects, and one death was accidental. There was no death due to prematurity. No illegitimate infants died during the year. Maternal Mortality. During the year no death was registered. In 1945 one death was registered as being due to disease or accident of pregnancy. Inquests Inquests were held on 14 residents dying within the district and on nine Mitcham residents who died outside the district, a total of 23. In addition, the coroner held 44 post-mortems without inquests on residents dying within the district, and on 25 Mitcham residents who died outside the district, a total of 69. The following table shows the results of the findings of these inquests:— Deaths from natural causes 5 Accidental deaths 6 Deaths from misadventure 3 Suicides 7 Open verdict 2 Total 23 12 Deaths Registered during the Year 1946 Cause or Death Males Females Total 1 Typhoid and paratyphoid fevers 2 Cerebro-spinalfever ... ... ... 3 Scarlet fever ... ... ... 4 Whooping cough ... ... ... 5 Diphtheria ... ... ... 6 Tuberculosis of respiratory system 21 13 34 7 Other forms of tuberculosis 2 1 3 8 Syphilitic diseases 3 ... 3 9 Influenza 2 4 6 10 Measles ... ... ... 11 Acute polio-myelitis and polio-eucephalitis ... ... ... 12 Acute infectious encephalitis ... 1 1 13 Cancer of buccul cavity and oesophagus (m) and uterus (f) 5 6 11 14 Cancer of stomach and duodenum 9 4 13 15 Cancer of breast ... 14 14 16 Cancer of all other sites 42 28 70 17 Diabetes ... 2 2 18 Intra-cranial vascular lesions 22 27 49 19 Heart disease 68 81 149 20 Other diseases of circulatory system 9 16 25 21 Bronchitis 22 14 36 22 Pneumonia 14 6 20 23 Other respiratory diseases 7 2 9 24 Ulcer of stomach or duodenum 8 ... 8 25 Diarrhoea (under two years) 2 ... 2 26 Appendicitis ... ... 27 Other digestive diseases 5 7 12 28 Nephritis 4 4 8 29 Puerperal and post-abortive sepsis ... ... ... 30 Other maternal causes ... ... ... 31 Premature birth 2 2 4 32 Congenital malformations, birth injuries, infantile disease 15 4 19 33 Suicide 5 3 8 34 Road traffic accidents 2 1 3 35 Other violent causes 5 2 7 36 All other causes 25 28 53 All causes 299 290 569 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 Bates per 1,000 civilian population Births— Live 19.1 ‡ 22.2 21.3 21.5 20.3 Still 0.53‡ 0.67 0.59 0.54 0.55 Deaths— All causes 11.5 ‡ 12.7 11.7 12.7 9.2 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 0.00 Scarlet fever 0.00 0.00 0.00 0.00 0.00 Whooping cough 0.02 0.02 0.02 0.02 0.00 Diphtheria 0.01 0.01 0.01 0.01 0.00 Influenza 0.15 0.13 0.14 0.12 0.09 Smallpox 0.00 — — — — Measles 0.00 0.01 0.00 0.01 0.00 Notifications— Typhoid fever 0.01 0.01 0.01 0.01 0.00 Paratyphoid fever Cerebro-spinal fever 0.02 0:05 0.02 0.05 0.01 0.04 0.01 0.06 0.01 0.01 Scarlet fever 1.39 1.51 1.33 1.42 1.5 Whooping cough 2.28 2.48 2.05 2.22 3.83 Diphtberia 0.28 0.32 0.31 0.24 0.53 Erysipelas 0.22 0.25 0.22 0.27 0.40 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 3.92 4.73 3.70 7.35 5.79 Pneumonia 0.89 1.02 0.74 0.75 0.65 Bates per 1,000 live births Deaths under one year of age 43 † 45 37 41 19.9 Deaths from diarrhoea and enteritis under two years of age 4.4 4.1 2.8 4.2 1.6 Bates per 1,000 total births (live and still) Maternal mortality Abortion with sepsis 0.131 - ,, without sepsis 0.06 - Puerperal infections 0.18 Not available - Other 1.06 0.00 Notifications— Puerperal fever 8.50 10.35 7.63 1.62 9.68* 4.69 Puerperal pyrexia Abortion— Mortality per million women aged 15.45 With sepsis 11 Not available Without sepsis 3 *Including Puerperal fever. ‡Rates per 1,000 total population. A dash (—) signifies that there were no deaths, †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 493 Sputa for tubercle 29 Total 522 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 are provided by the Council for the removal of general and accident cases. The number of cases removed during the year was 1,550, of which 387 were accident cases and 1,163 private removals, including 407 maternity cases. There were 26 calls when the ambulance was not required on arrival. 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. The following are the returns from each association for year ended December 31st, 1946:— 15 No. of Nurses No. of patients visited during 1946 No. of visits paid during 1946 St. Barnabas 1 110 3,823 Mitcham D.N. Association— 4* 616 12,387 Totals 726 16,210 *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 Surrey County 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:— Cavendish Road Welfare Centre.—Sessions are held every Monday afternoon. St. Barnabas Church Hall, Gorringe Park Avenue.— Sessions are held every Tuesday afternoon. Sherwood House, Commonside East.—Sessions are held every Thursday morning. Church Road Centre.—Sessions are held every Thursday afternoon, and Wednesday afternoon (weighing session). Meopham Road Clinic.—Sessions are held each Wednesday afternoon, and Friday afternoon (weighing session). Ante-Natal Clinics Ante-natal clinics are held at the following places:— Woodlands Maternity Home.—Sessions are held on Monday, Wednesday and Friday mornings for patients who have booked for their confinement at the Woodlands Maternity Home. Church Road Clinic.—Sessions are held on every Tuesday and Friday mornings, and a clinic for cases booked by midwives is held on Friday afternoons. Post-Natal Clinic A post-natal clinic is held at Church Road Clinic on alternate Mondays by appointment. 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, Western Road Clinic. Diphtheria Immunisation Clinics Diphtheria Immunisation Clinics are held as follows:— Meopham Road Clinic Every Monday afternoon. Mitcham Court Every Wednesday morning. Cavendish Road Clinic 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 every Monday, Tuesday and Thursday by appointment. 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 by the Public Health Department. Boots, shoes, etc., taken in exchange by the Domestic Centre are disinfected by the Public Health Department before being re-exchanged. Number of disinfections carried out by Wandle Valley Isolation Hospital103 Number of rooms disinfected by fumigator 275 Number of library books disinfected187 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 at least once each week. The total number of attendances at the infant welfare centres was 20,783, as compared with 14,767 in 1945. Of these 1,261 were new cases, 1,132 being infants under one year of age, and 129 being children over one but under five years of age. The total number of attendances of infants under one year was 16,406, and of children between one and five years of age, 4,377. At the end of the year there were 927 infants under one year and 1,489 children between one and five years of age attending the centres, making a total of 2,416. The average attendance at each centre was:— Cavendish Road 69.8 St. Barnabas 100.5 Church Road 70.2 Sherwood House 60.7 Meopham Road 65.1 The percentage of infants under one year of age attending the centres for the first time was 90.1 per cent, of the total number of live births. 19 Owing to the increased attendances at Church Road and Meopham Road Clinics an additional session has been necessary. These additional sessions are not attended by a Medical Officer, but are otherwise the same as other sessions. 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 and demobilisation 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. Nineteen 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 58 cases were referred to this clinic, as compared with 38 cases in 1945. Dental Treatment During the war years nursing and expectant mothers requiring dental treatment were referred from the infant welfare antenatal and post-natal clinics to the British Dental Hospital, Tooting. In 1945 the scale of assistance was revised with considerable advantage to the patients requiring dentures. This scheme, whilst providing essential treatment, was inadequate for peace-time needs, and the Surrey County Council was approached with the object of obtaining the services of the School Dental Service for the treatment of mothers and children under five years of age. An agreement was reached, and at the close of the year a dental clinic for maternity and child welfare cases was being held on alternate Thursdays at Church Road Clinic. 20 It is the intention that all ante-natal cases, including the cases which are booked for confinement at the Woodlands Maternity Home, shall receive a routine dental inspection, followed by treatment and dentures when necessary. The estimated cost of the services of the dental surgeon and attendant are refunded to the County Council, and a highly efficient scheme has been established. The total attendances for treatment during 1946 were as follows:— Expectant and nursing mothers, 48. Children under five years of age, 27. Health Visiting There are six 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. Attendances at Infant Welfare Centres, 1946. Particulars Cavendish Road St. Barnabas Church Road Sherwood House Meopham Road Total Number of new cases registered during year of— Children under one year of age 176 306 315 152 183 1135 Children over one year and under five years of age 26 21 31 21 30 129 Number of children in attendance at end of year— 927 Under one year of age 206 258 259 133 71 Over one and under five years of age 166 368 373 241 351 1489 Attendances of children under one year of age 2460 3975 3732 2252 2855 16274 Attendances of children over one year of age 689 924 1193 732 710 4248 Total attendances at centres 3351 5226 5271 3157 3778 19512 Average attendances at centres 69.8 100.5 70.2 60.7 65.1 ... Percentage of infants under one year of age attending centres of the total live births ... ... ... ... ... 90.1 21 Toddlers' Clinics In view of the increased attendance at the welfare centres, toddlers' clinics were re-established during the year. These clinics are held for children between the ages of two and five and are full routine examinations of the children. Any conditions requiring observation or treatment are noted and the parents advised. Further appointments are made as necessary. The following table shows the work done during the year:— Age Group 2 to 3 yrs. 3 to 4 yrs. 4 to S yrs. Total 161 130 58 349 Visits Paid by Health Visitors Mrs. Ashman Miss R. Harris Miss Knight Miss Hinds Miss Salway Miss Luther Total Primary Ante-Natal Visits 20 88 81 68 92 109 458 Subsequent Ante-Natal Visits — 5 53 3 49 214 324 Primary Visits to Infants under 1 year 6 254 236 181 253 265 1195 Subsequent Visits to Infants 9 709 520 721 1014 1051 4024 Visits to Children 1—5 years 21 1333 1028 1353 2120 2375 8230 Visits to Premature Infants 3 3 — — 13 5 24 Visits re Infant Deaths — 1 2 — 3 — 6 Visits re Stillbirths — 2 4 1 4 2 13 Visits to Cases of Ophthalmia Neonatorum 2 — — 3 — 2 7 Visits re Cases of Puerperal Fever 2 — — — — — 2 Primary Visits to Cases of Tuberculosis 1 — — — — — 1 Subsequent Visits to Cases of Tuberculosis 35 — — — 1 — 36 Visits re Diphtheria Immunisation — 4 21 — 1 21 47 Visits re Scabies — 1 — — — — 1 225 Visits re Other Infectious Diseases 35 17 9 7 118 38 224 Visits re Infant Life Protection 118 — 18 5 5 5 151 Visits re Adoption 87 2 21 3 27 12 152 Visits re Home Help Scheme 3 4 — — 4 — 11 Special Visits 252 12 18 6 29 25 342 Total ... ... ... ... ... ... 15,248 22 23 Supply of Food and Medicines Dried milk, cod liver oil emulsion, Virol, Parrish's Food, groats, Bemax, Farex, iron pills, Lactagol, etc., 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 may 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 are available for necessitous nursing and expectant mothers to receive free meals. Ante-Natal Clinics Three ante-natal clinics are held each week at Church Road Clinic and three clinics each week in connection with Woodlands Maternity Home. The midwives' hold clinics for cases booked by them on each Tuesday at Church Road Clinic and Cavendish Road Clinic, also each Wednesday at Sherwood House. Average Attendance at Each Centre Number of expectant mothers Number of attendances Average Clinic attendance Woodlands (two clinics) 292 2,406 23.1 Church Road Clinic 654 2,928 28.7 Midwives' Clinic 375 1,092 21.0 Total 1,461 6,426 24.2 More expectant mothers attended the ante-natal centres than the total number of registered births. Eleven expectant mothers who attended the ante-natal centres were evacuated for their confinements, 24 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 ante-natal clinics. The majority of the examinations are made to determine the presentation of the child in doubtful cases, and also to confirm the diagnosis of twins. During the year 20 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; 179 cases attended during the year. The total number of women who attended the post-natal clinics at Church Road Clinic was 216, the average attendance being 9'3. Home Helps and Domestic Helps There was a steadily increasing demand for the services of home and domestic helps during 1946. 25 Ministry of Health Circular (110/46) was received and the following report was submitted to the Maternity & Child Welfare Committee:— "Two full-time maternity home helps are at present employed in Mitcham and part-time helps are employed when available. Additional help is necessary as, with a small staff, difficulties arise owing to over-lapping of dates and owing to the fact that the expected date of confinement is frequently far from the actual date of confinement. The increase in the birth-rate and the shortage of hospital beds have increased the number of home confinements recently, and there is a great demand for domestic home helps, and a combined service of domestic and maternity home helps would be a great advantage, provided the personnel were available. I understand that several suitable women have recently applied for positions as full-time home helps. " If a scheme of combined maternity home helps and domestic helps were established, I think that to make the scheme a success I would need a whole-time paid supervisor in this department, and I would, of course, so arrange matters that she worked in close liaison with the Superintendent Health Visitor and the District Midwives. "I would recommend that the Committee give consideration to the making of an appointment on these lines." The appointment of a Home Help supervisor was approved by the Minister of Health, and Mrs. Law was appointed and commenced duty in October. She has proved a most efficient and enthusiastic organiser and the service is already a success. At the end of the year six full-time and nine part-time staff were employed. Three cases were receiving the service of a maternity home help and 14 families were receiving the services of a domestic help on December 31st, 1946. WOODLANDS MATERNITY HOME The number of cases admitted during the year was 292; 27 more than in 1945. Dr. Housden was appointed Clinical Medical Officer on April 1st, 1944. Dr. Housden conducts the ante-natal clinics, and 26 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 greatly 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. During the year arrangements were made for the training of nurses in the administration of gas and air analgesia. Dr. Ivor Evans was appointed consulting anaesthetist to the Home, and the approval of the Central Midwives' Board was received. 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 1980 318 27  Number of births 1931 259 1932 239 1933 285 1934 285 1935 299 1936 314 1937 309 1938 297 1939 254 1940 239 1941 215 1942 263 1943 224 1944 213 1945 267 1946 290 Number of maternity beds in the institution (exclusive of isolation and labour beds), 15. Number of maternity cases admitted during the year, 292. Average duration of stay, 121 days. Number of cases delivered by (a) midwives, 251; (b) doctors, 39. Number of cases in which medical assistance was sought by a midwife in emergency, 83. Number of cases notified as (a) puerperal fever, nil; (b) puerperal pyrexia, nil. Number of cases of pemphigus neonatorum, nil. Number of infants not entirely breast-fed whilst in the institution, 30. Number of cases notified as ophthalmia neonatorum, nil. Number of maternal deaths, nil. Number of stillbirths, 5. Number of infants' deaths within ten days of birth, 9. An ante-natal clinic is held every Monday, Wednesday and Friday at Cavendish Road Clinic, and patients who have booked are expected to attend. 28 The post-natal clinic is held once monthly. 104 cases attended during the year. Infant Life Protection The Superintendent Health Visitor has been appointed the Infant Life Protection Visitor for this district. Frequent visits during the year are paid to the homes of the foster children. A strict supervision is kept on these homes, and no cause was found to remove any infant from the care of the foster mother during the year. The following are the number of foster mothers and children on the register:— Number of foster mothers on register, December 31, 1946 11 Number of children on register, December 31, 1946 9 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 303 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 22 Total number of children in respect of whom notice was given 22 Number of such children under supervision at the end of the year 10 29 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 1946 11 Number of children affected 20 Number of visits paid 51 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 9, 1943, and at the end of 1946 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 32.159 14.213 Two—five 41.800 35.451 Totals 73.959 49.664 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 Gouncil 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. 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 30 proposals for establishing a hostel in order that the position might be more fully discussed at a subsequent meeting. Unfortunately the flying bomb attacks prevented the meeting of the conference taking place before the end of 1944. On February 2nd, 1945, a conference of the interested local authorities took place at Mitcham and discussed the Medical Officer of Health's report. 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 meetings with representatives of the Merton and Wimbledon Moral Welfare Association. Unfortunately the Gap Road premises could not be repaired under a cost of works 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 to 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. Mitcham Moral Welfare Association was formed in March, 1946. Representatives of other interested local voluntary associations were elected members of the Committee, and the Chairman of the Public Health Committee, and the Chairman of the Maternity and Child Welfare Committee were invited to join the Committee. A part-time social worker, Mrs. Tyerman, was appointed, and the Borough Council made a grant of £70 per annum towards the cost of her salary. 31 The association, through Mrs. Tyerman, has done excellent work during the year, and cases referred to hostels have had their cost of maintenance paid by the Borough Council in every case. I believe that the increased care of the unmarried mother and her child has resulted in there being no illegitimate infant death during 1946. There is still a need for further hostel accommodation, and it is hoped that the Merton and Wimbledon Moral Welfare Association will be able to re-establish their hostel in the near future. 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. 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. 32 RIVERS AND STREAMS Twenty 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 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 the year, 47. Number of other houses found infested during the year, 25. Number of requisitioned, etc., houses found infested during the year, 4. Total number of houses disinfested during the year, 76. Methods employed: — 21 houses treated with sulphur dioxide. 55 houses 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. Number of private houses disinfested by owners or occupiers after notice, 20. Number of houses disinfested for beetles, 157. SCHOOLS The supervision of the public elementary schools is under the control of the Education Department of the Surrey County Council. 33 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 One full-time and one part-time Rodent Operator were employed until September, 1946. The Ministry of Food Circular N.S. 12 was then adopted and two additional operators employed on house to house inspections. Number of visits paid by rodent operators 8,664 Number of treatments re rat infestation 967 Two sewer maintenance treatments were carried out under the Ministry of Food Circular N.S. 11, 1,448 manholes were baited with poison. 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 13,262 Number of complaints received 1,350 Visits re complaints and sundries 2,899 Revisits 2,271 34 Houses inspected for defects 1,957 Number of nuisances discovered 1,175 Number of intimation notices served 1,173 Number of intimation notices complied with 607 Number of statutory notices served 382 Number of statutory notices complied with 212 Visits to butchers and other food shops 369 Visits to factories 172 Visits to refuse dumps 12 Visits to slaughter houses 13 Visits to restaurant kitchens 7 Visits to stables 8 Visits to garages 8 Visits to outworkers' premises 69 Visits to marine stores 4 Visits to caravan yards 25 Details of visits to other premises are enumerated in other sections of the report. Character of Work Done Roofs repaired 121 Eaves guttering and spouting repaired 100 Yards paved or repaired 11 Dampness remedied 98 Water service pipes repaired 20 Waterclosets: repairs to roof, walls, doors, windows, floors and seats 27 Waterclosets: flushing apparatus repaired or renewed 57 Waterclosets: repairs to pans and traps, obstruction removed 34 Water storage cisterns cleansed, regulated, repaired or renewed 19 Water supply reinstated 9 Flooring of rooms repaired and ventilation improved 71 Rooms cleansed and redecorated 39 Repairs to sinks, waste pipes and traps 65 Window frames, sashes and sills provided 18 Window frames, sashes and sills repaired 78 35 Drains repaired and obstructions removed 51 Repairs to firegrates 18 Repairs to stoves, coppers, ranges, etc. 46 New dustbins provided 75 Accumulations removed 6 Repairs to chimney stacks, etc. 22 Repairs to staircases 20 Rainwater gullies repaired 9 Smoke nuisances abated 9 Repairs to doors 26 Repairs to sinks 4 Drains tested 25 Repairs to internal plaster 166 Grid and mica flaps provided 15 Drain inspection chamber covers provided 9 Sinks and handbasins provided or renewed 12 External brickwork (repaired, pointed or rendered) 45 W.c. pans and traps provided 60 Legal Proceedings.— Four applications were made to the Justices for nuisance orders under Section 94, Public Health Act, 1936, against property owners. The applications were granted with costs. All ponds and ditches in the Borough where mosquito breeding was possible were sprayed with insecticide twice during the year. Twenty-six visits were paid for this purpose. Petroleum (Consolidation) Act, 1928.—Eighty-six licences to store petroleum and cellulose solutions were granted, totalling 157,660 gallons. Five licences were also issued for 7,832 lbs. of carbide of calcium to be stored. Unsound Food Dealt With. Beef 760 lbs. Margarine 10 lbs. Mutton 17 „ Butter 26 „ Pork 253 „ Corned beef 2,060 „ Offal 29 „ Corned Mutton 54 „ Fish 1,443 „ Pudding Mixture 128 pkts. Cheese 122 „ Eggs 908 Sugar 6 „ Bacon 27 lbs. 36 Nuts 20 „ Sundry tinned foods 1098 tins Number of visits to Meat Depot 20 123 Yours obediently, K. J. GUTTERIDGE, Chief Sanitary Inspector. Housing Statistics 1. Inspection of Dwelling Houses during the Year.— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 1,957 (b) Number of inspections made for the purposes 2,114 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 607 Number of dwelling houses rendered fit in consequence of formal action by the local authority or their officers 212 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 4 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 4 (b) By local authority in default of owners nil Proceedings under Section 11 of the Housing Act, 1936:— (1) Number of houses in which demolition orders were made 3 37 4. Rent and Mortgage Interest Restriction (Amendment) Act, 1933, Section 12. Number of certificates issued to occupiers that houses were not in a reasonable state of repair 10 INSPECTION AND SUPERVISION OF FOOD FOOD AND DRUGS ACT, 1938 Formal Samples. Thirty-eight formal samples were taken as follows:— Milk 87 Cake Mixture 1 Informal Samples.— Forty informal samples were taken as follows:— Gelatine 1 Aspirin 1 Ice Cream 1 Spice 1 Lemon flavouring 1 Junket 1 Ginger 1 Vegetables, tinned 1 Honey 1 Street & Kidney ding 1 Cocoa 3 Salad Dressing 1 Milk 1 Fish and meat paste 2 Stomach powder 3 Cake Mixture 4 Flour 1 Jam 3 Custard powder 1 Syrup of Figs 1 Malted milk 2 Grape fruit squash 1 Baking powder 4 Soup 2 Curry powder 1 All samples were genuine with the exception of one informal milk sample. A further sample taken in course of delivery was found to be genuine. Two warning letters were sent re foods not properly labelled. Four hundred and thirteen 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 38 Pasteurised 11 Pasteurising Plant 1 Supplementary Licences— Pasteurised 5 Tuberculin Tested 6 Seventy-two samples of Graded Milk were submitted for bacteriological examination. Seventy samples were satisfactory and two were unsatisfactory. Communications were sent to the dairies regarding the unsatisfactory samples. BAKEHOUSES The number of bakehouses in the district is 12. Twenty 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 53 visits of inspection were paid. PIGGERIES There are nine piggeries in the Borough. Fifty-five visits were paid during the year. 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 confirmed notifications received during the year was 807. Contacts, Suspects, Etc. The Medical Officer of Health may be called in consultation by medical practitioners to see patients in their homes. 39 Rooms disinfected after infectious disease Total To small pox contacts Health Visitors Sanitary Inspectors Made by Visits 275 1,044 390 225 429 No. Small Pox. Scarlet Fever Diphtheria Typhoid Fever Erysipelas Pneumonia Puerperal Pyrexia Ophthalmia Neonatorum Dysentery Cerebro-spinal Meningitis Poliomyelitis Measles Whooping Cough Food Poisoning PolioEncephalitis Paratyphoid Malaria Totals The monthly incidence of infectious disease was:— January ... 9 7 ... 2 10 ... ... ... ... ... ... 12 ... ... ... ... 40 February ... 10 6 ... 2 12 ... ... 1 ... 1 2 2 ... ... ... ... 36 March ... 8 3 ... 3 4 ... ... 4 ... 1 6 32 ... ... ... ... 61 April ... 8 4 ... 1 4 ... ... ... ... ... 5 32 ... ... ... ... 54 May ... 13 ... ... 1 ... 1 ... ... ... ... 48 30 ... 1 ... 1 95 June ... 10 1 ... 3 2 ... 1 1 ... ... 85 43 ... ... 1 ... 147 July ... 7 2 ... ... ... ... ... ... ... ... 38 19 ... ... ... ... 66 August ... 6 ... ... 2 ... ... 1 ... ... ... 18 14 ... ... ... ... 42 September ... 5 ... ... 3 ... ... ... ... ... 1 18 13 1 ... ... ... 41 October ... 9 3 ... 6 1 1 ... ... ... ... 29 14 ... ... ... ... 63 November ... 5 5 ... 1 3 3 ... ... 1 ... 25 18 ... ... ... ... 61 December ... 5 1 ... 1 5 1 ... ... ... ... 84 4 ... ... ... ... 101 Totals ... 95 32 ... 25 41 6 2 6 1 3 358 234 1 1 1 1 807 40 Infectious Disease Notifications, 1926-46. disease 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 Small Pox ... ... 9 7 ... 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 104 145 102 134 113 105 174 240 392 143 171 192 150 61 48 75 175 212 97 147 95 Diphtheria 87 76 75 133 129 49 32 40 83 80 104 89 64 27 36 72 25 42 10 63 32 Typhoid Fever 2 6 3 4 9 2 3 3 ... 3 5 ... 1 ... ... ... ... 1 ... 1 ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Undulant Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Puerperal Fever 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 6 Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal ... 2 1 4 ... ... 1 4 1 1 3 1 2 1 13 12 6 8 3 3 1 Meningitis Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 13 14 10 22 22 17 11 31 30 20 22 16 8 19 17 19 7 22 13 16 25 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... 301 194 599 651 112 739 358 Acute Diarrhoea ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... Chicken Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis 1 2 ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 3 Ophthalmia Neonatorum 12 10 3 3 1 3 4 2 2 4 3 1 3 3 1 3 10 4 4 ... 2 Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Encephalitis 2 ... ... ... 2 1 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Lethargica Pneumonia 30 62 54 57 35 45 52 37 45 35 36 32 43 ... 30 22 20 50 37 33 41 Malaria 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... 4 16 186 161 162 166 96 234 Food Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... 4 4 6 11 ... ... 5 1 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 67 13 6 Paratyphoid ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Totals 259 340 270 375 319 242 288 368 560 293 357 338 275 125 468 591 1021 1161 515 1126 807 41 Small Pox No case of small pox was notified during the year 1946. Scarlet Fever The number of cases of scarlet fever notified during the year was 95 as compared with 147 in 1945, equivalent to a case rate of 1.53 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 70 were treated in hospital, and 25 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 Thirty-two 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. The following table gives details of notifications and the number of each age group immunised:— 42 NOTIFICATIONS DEATHS Age at date of notification. Number of cases notified Number of cases included in preceding column in which the patient 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 patient had completed a full course of immunisation. Under 1 2 — Under 1 — — 1 1 — 1 — — 2 2 1 2 — — 3 5 2 3 — - 4 5 3 4 — - 5.9 11 4 5.9 — - 10.14 1 — 10.14 — - Over 14 5 — - - - Totals 32 10 Totals — — The number of cases is a considerable decrease over 1945, when 63 cases were notified. I believe that mild cases of diphtheria occur in immunised children 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 gave consent. 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 43 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 731 Five—15 233 Over 15 — Total 964 The following figures show the number of the child population considered immunised at December 31st, 1946:— Age at 31.12.46 i.e. born in year Under 1 1946 1 1945 2 1944 3 1943 4 1942 5 to 9 1937-1941 10 to 14 1932-1936 Total under 15 Number immunised — 505 756 692 759 3567 2733 9012 Estimated mid-year population 1946 4880 8570 The per cent. immunised is as follows:— Under five 55.57% Fiv&—14 73.51 % The number of birthday greetings sent in 1946 was 882. Five hundred and twelve mothers took advantage of this offer. Typhoid Fever No case was notified during the year. Diarrhœa and Enteritis Under Two Years of Age Two deaths were registered during the year. 44 Encephalitis Lethargica No case was notified during the year. Erysipelas Twenty-five cases were notified. Six cases were removed to hospital. Puerperal Pyrexia Six cases were notified during the year. Pneumonia Forty 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 20, of which 14 were males and 6 females. Cerebro-Spinal Fever One case occurred during 1946, and there was no death. Influenza During the year six deaths from influenza were recorded, of which two were males and four females. 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 two 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. 45 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 81 Mumps 59 Impetigo 7 Jaundice 2 Rubella 17 Ringworm 1 Cancer The number of deaths from cancer registered during the year was 108, of which 56 were males and 52 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 1946 was as follows: — Digestive organs 13 cases Genito-urinary organs 6 „ Breast 14 „ Other sites 75 „ Total 108 „ 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 46 Year Number of Deaths Death Rate per 1,000 of population Miteham England and Wales 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 1948 95 1.7 1.74 1944 83 1.6 1.7 1945 103 1.9 1.74 1946 108 1.74 1.76 Tuberculosis During the year 91 new cases of tuberculosis were notified, viz.:— Males Females Total Pulmonary 40 41 81 Non-Pulmonary 5 5 10 Totals 45 46 91 Forty cases were transferred into the Borough, as follows:— Males Females Total Pulmonary 18 20 38 N on-Pulmonary 1 1 2 Totals 19 21 40 The total number of deaths registered as occurring from tuberculosis was viz.:— Males Females Total Pulmonary 21 13 34 Non-Pulmonary 2 1 3 Totals 23 14 37 47  England and Wales Mitcham Death rate from respiratory tuberculosis per 1,000 population 0.42 0.54 Death rate from non-pulmonary tuberculosis per 1,000 population 0.08 0.04 The following table shows the number of new cases, the type of disease and the deaths from tuberculosis during the year. New Cases Deaths age Periods Respiratory NonRespiratory Respiratory NonRespiratory M. P. M. P. M. F. M. F. Under 1 year ... ... ... ... ... ... ... ... 1 year to 5 years ... ... 2 ... ... ... 1 ... 5 years „ 10 1 2 ... ... ... ... ... ... 10 ,, „ 15 ,, ... 1 1 2 ... ... 1 ... 15' „ ,, 20 „ 5 8 ... ... 1 ... ... ... 20 „ „ 35 „ 20 20 1 3 6 4 ... 1 35 „ „ 45 „ 4 4 1 ... 2 3 ... ... 45 „ „ 65 „ 10 5 ... ... 12 4 ... ... 65 ,, and upwards ... ... ... ... 1 1 ... ... Unknown ... 1 ... ... ... ... ... ... Totals 40 41 5 5 22 12 2 1 48 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- 6- 10- 15- 20- 25- 35- 45- 55- 65- Total Pulmonary: males ... ... ... ... ... ... ... ... ... 3 2 5 Pulmonary: females ... ... ... ... ... ... ... ... 1 1 1 3 Non-Pulmonary: males ... ... ... 1 ... ... ... ... ... ... ... 1 Non-Pulmonary: Females ... ... ... ... ... ... 1 ... ... ... ... 1 The sources from which information as to the above mentioned cases was obtained are as follows:— No. of Cases Pulmonary NonPulmonary Death returns (a) From Local Registrar 4 ... (b) Transferable deaths from Registrar General 1 1 Posthumous notifications 3 1 Number of cases removed from register during 1946:— Reason Pulmonary Non-Pulmonary Total Cases Males Females Total Males Females Total Withdrawal of notification ... ... ... ... ... ... ... Recovery from disease 2 4 6 1 ... 1 7 Death 24 14 38 2 ... 2 40 Removed from district 18 20 38 1 2 3 41 40 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths is as follows:— Non-notified tuberculosis deaths 10 Notified tuberculosis deaths 30 Percentage of non-notified T.B. deaths (all forms) 33.33 per cent. Percentage of non-notified pulmonary T.B. deaths 26.6 ,, 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 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—19i6 Number of persons receiving milk 53 Clothes, bedding and towels supplied 14 Beds supplied 6 Fares paid for family to visit Sanatorium 12 Payments for Home Help 2 Pocket money 10 Assistance with training courses 3 Assistance with solicitor's bill 1 Assistance with doctor's bill 1 50 Deposit for purchase of furniture 1 Assistance with cost of spectacles 6 Cost of accommodation for relative 1 Special grants for materials, etc., for occupational therapy 2 A donation of £5 5s. was made to the Children's Holiday Fund. Christmas gifts amounting to £20 were given to hardship cases. Dried milk, drinking chocolate and invalid foods, from the Dominions, were 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 Station at the Western Road First Aid Post was 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. Number of patients treated, 426 persons. Classified as:— Pre-school age children 59 School age children 145 Adults 222 Number of baths given, 977. 51 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. A nurse appointed as a full-time cleansing attendant has been employed not only in the cleansing of cases at the Western Road Cleansing Station, but has attended families in their own homes, where she has inspected the whole family and has given or supervised their treatment. Most of the cases treated at the cleansing station are referred by the School Medical Staff. The following table gives a summary of the work done during the year at the Western Road Cleansing Station:— Number of patients treated, 199. Classified as:— Pre-school age children — School age children 145 Adults 10 Number of treatments given, 452. 52 WANDLE VALLEY JOINT HOSPITAL BOARD Cases admitted to the hospital during the year ended December 31, 1946. Disease Beddington & Wallington Coulsdon & Purley Merton & Morden Mitcham Cases Deaths Cases Deaths Cases Death ss Cases Deaths Diphtheria 3 ... 5 ... 9 ... 32 ... Scarlet fever 30 ... 71 ... 95 ... 70 ... Erysipelas 1 ... 2 ... 4 ... 6 ... Tonsillitis or Quinsy 1 ... 1 ... 12 ... 7 ... Measles 2 ... 4 ... 3 ... 6 ... Influenza 1 ... 2 ... 1 ... 6 ... Whooping cough ... ... 5 ... 2 ... 9 ... Rubella ... ... 1 ... 2 ... 4 ... Typhoid & Enteritis 5 *1 3 ... ... ... 3 ... Meningitis, all types including T.B. Meningitis 1 ... ... ... 2 †2 2 ... Puerperal Fever (Sepsis) 1 ... 9 ... 3 ... 4 ... Admitted with mother ... ... 8 ... 3 ... 4 ... Infantile paralysis ... ... ... ... 2 ... 1 ... Dermatitis 1 ... ... ... 2 ... 1 ... Laryngitis ... ... 1 ... 2 ... 3 ... Bronchitis 1 ... ... ... 1 ... ... ... Pneumonia ... ... 2 ‡2 1 §1 5 ... Nephritis ... ... ... ... ... ... 1 ... Glandular Fever ... ... ... ... ... ... 1 ... Tumour of Brain ... ... 1 1 ... ... ... ... Otitis Media 1 ... ... ... 1 ... 1 ... Cerebral Haemorrhage ... ... ... ... 1 ... ... ... Encephalitis Lethargica ... ... 1 1 ... ... ... ... Erysipelas (Acute Heart Block) (Admitted December 21, 1945) ... 1... ... ... ... ... ... ... Anterior Poliomyelitis & Influenzal Pneumo.nia (admitted July 24, 1945) ... 1 ... ... ... ... ... ... 48 3 116 4 146 3 166 0 * Enteritis & Broncho Pneumonia. † 1 death Pneumonoccal Meningitis, 1 death Cerebro T.B. following Pulmonary. ‡ 1 death Septic Bronchitis, 1 death Croup and Broncho Pneumonia. § Septic Parotitis and Pneumonia. 53 INDEX page Abortion, Deaths 13 Admissions—Wandle Valley Joint Hospital Board 52 Adoption of Children Act, 1939 28 Ambulances 14 Analysis of Mortality 13 Ante-Natal Clinics 16, 23, 27 Area 8 Bakehouses 38 Bed Bugs, Eradication of 32 Bedding, Disinfection of 17 Birth Rates 10, 13 Births, Illegitimate 8 — In Institutions 9 — Live 8 — notified by Municipal Midwives 9 — Still 8, 27 — Woodlands Maternity Home 26-27 Blindness, Prevention of 44 Books Disinfected, Number of Library 18 Cancer 45 — Deaths from 9, 45-46 Causes of Deaths 12 Cerebro-Spinal Fever 44 Chicken Pox 45 Chief Sanitary Inspector's Report 33 — Inspector, Visits by 33-34, 39 Child Welfare 18 Cleansing, Public 32 Clinics 16-17, 20-21, 23-24, 27 — Orthopaedic 19 Closet Accommodation 32 Dairies and Cowsheds 38 Death Rates 10, 13 Deaths 8-9, 12, 27, 43-49 54 PAGE Dental Treatment 19-20 Diarrhoea and Enteritis 43 — Deaths from 13 Diphtheria 41-42 Immunisation 42-43 — Clinic 17 — Specimens Examined 14 Disinfection 17-18 Domestic Helps 24-25 Domiciliary Midwifery 15 Encephalitis Lethargica 44 Enteritis, Diarrhœa and 43 Eradication of Bed Bugs 32 Erysipelas 44 Examinations, X-Ray 24 Food and Drugs Act (1938) 37 — and Medicine, Supply of 23 — Dealt with, Unsound 35 — Inspection and Supervision of 37 — Preparing Places 38 General Provision of Health Services for the Area ... 14 Health, Visiting 20 — Visitors, Visits by 22, 39 Home Helps 24-25 Hospitals 15 Houses, Disinfection of 17 Housing Act, 1936 (Sect. 9, 10 and 16) 36 Housing Act, 1936 (Sect. 11) 36 Housing Statistics 36 Illegitimate Children, Care of 29-31 Immunisation Clinic, Diphtheria 17 „ Diphtheria 42-43 Impetigo 45 Infants, Care of Premature 31 Infant Life Protection 28 Infant Mortality 9-11, 13 Infant Welfare Centres, Attendances 20 55 PAGE Infectious Disease, Ambulances 14 — — Case rates 13 — — Contacts 38 — Hospital 15 — Incidence of 39 — Prevalence of and Control over 38 — — Notifications 38, 40 — — School 44-45 Influenza 44 Inhabited Houses 8 Inquests 11 Inspection and Supervision of Food 37 Jaundice 45 Laboratory, Emergency Public Health, Epsom 14 — Facilities 14 Library Books Disinfected, number of 18 Louse Infestation 51 Maternal Mortality 11, 13 Maternity and Child Welfare Services, Report on18 Home 16, 25-26 Hospital Treatment 15 Measles, Deaths from 9 Medicine, Supply of Food and 23 Mice Destruction Act, 1919, Rats and 33 Midwifery, Domiciliary 15 Milk (Special Designation) Order (1936) 37 Mortality, Analysis of 13 - Infant 9-11 - Maternal 8, 11, 13 Mumps 45 N.S.P.C.C. 29 Notifications, Infectious Disease 38 — School 44-45 Nurseries, Wartime 29 Nursing in the Home 14 Ophthalmia Neonatorum 27, 44 Orthopaedic Clinic 19 56 PAGE Patients Admitted to Hospital 52 Pemphigus Neonatorum 27 Personnel, Committee 5 — Staff 6-7 Petroleum (Consolidation Act), 1928 35 Piggeries 38 Pneumonia 44 Population 8 Post-Natal Clinic 16, 24 Premature Infants, Care of 31 Prevention of Blindness 44 Public Cleansing 32 Puerperal Fever 13, 27 — Pyrexia 13, 27, 44 Rateable Value 8 Rats and Mice Destruction Act, 1919 33 Rent & Mortgage Interest Restriction (Amendment) Act, 1933, Sect. 12 37 Ringworm 45 Rivers and Streams 32 Rooms Disinfected, number of 18 Rubella 45 Samples, Food 37-38 Sanitary Circumstances of the Area 1 Scabies 50 — Clinic 17 Scarlet Fever 41 School Clinic 17 Schools 32-33 — Notifications 44-45 Small Pox 41 Hospital 15 Social Conditions 8 Statistics 8 Housing 36 Vital 8 Still Births 8, 27 57 PAGE Streams, Rivers and 32 Sunlight Treatment 19 Supervision of Food, Inspection and 37 Supply of Food and Medicines 23 — Water 31 Toddlers' Clinic 21 Treatment, Dental 19-20 — Hospital 15 - Sunlight 19 Tuberculosis 46-49 — Care Committee 49 — Clinic 17 Specimens examined 14, 49 Typhoid Fever 43 Unsound Food dealt with 35 Venereal Diseases Clinics 17 Visits by Health Visitors 22, 39 Sanitary Inspectors 33-34, 39 Vital Statistics 8 Wandle Valley Hospital—Admissions 52 - — — Disinfections carried out by 18 War-time Nurseries 29 Water Supply 31 Welfare Child 18 y — Clinics 16 — — Attendance at 20 Whooping Cough, Deaths from 9 Woodlands Maternity Home 16, 25-26 - — — Births 26-27 X-Ray Examinations 24