AC4413 (4) MITCHAM MIT16 BOROUGH OF MITCHAM REPORT of the Medical Officer of Health for the YEAR 1947 BOROUGH OF MITCHAM REPORT of the Medical Officer of Health for the YEAR 1947 MITCHAM H. G. Mather Ltd., Caxton Works, Lower Green 3 Borough of Mitcham HEALTH REPORT FOR 1947 To the Mayor, Aldermen and Councillors. Madam, Ladies and Gentlemen, I have much pleasure in presenting my report for the year 1947. The year under review is the last full year that the Borough Council, as an autonomous authority, administered the maternity and child welfare services, Woodlands Maternity Home, and the ambulance service- Under the National Health Service Act, 1946, these services will pass to the control of the Surrey County Council, or the Regional Hospital Board of the area. The rise in the birth rate has continued, and at 2139 per 1,000 is the highest since 1926, the number of births being the highest ever recorded in the Borough. The infant mortality rate of 38 6 per 1,000, whilst considerably higher than the figure for 1946, compares favourably with 41 per 1,000 for England and Wales as a whole. There were seven deaths of illegitimate infants recorded during the year, and it is with considerable pleasure that I report that additional hostel accommodation for unmarried mothers and babies became available during June. The attendances at the welfare centres have again increased, and an additional weekly session was necessary at the Sherwood House Clinic. 4 The demand for nursery accommodation showed no sign of decreasing and there were waiting lists at both of the nurseries at the end of the year. No further nursery school accommodation was likely to be available for a considerable time, and the need for either additional nursery accommodation or an alternative home minders scheme became increasingly evident. The combined Home Help and Domestic Help scheme continued to expand during the year and provide a most appreciated and useful service, reducing the demand for hospital accommodation. Woodlands Maternity Home provided most useful additional accommodation for Mitcham mothers, and was used to capacity. The housing problem remained the major task of the Sanitary Inspectors, but shortage of labour and materials caused considerable delay in the repair of defective premises. The work of the Public Health Department was displayed at the Local Government Exhibition held at the Baths Hall during October, and the opportunity was taken of distributing health education literature, etc. I wish to thank the Chairman and members of the Maternity, Child Welfare and Public Health Committee for their continued assistance and support, and all the members of the staff for their loyal help. I am, Ladies and Gentlemen, Yours faithfully, A. ASHWORTH, Medical Officer of Health. Public Health Department, Mitcham Court, Mitcham. 5 BOROUGH OF MITCHAM MATERNITY, CHILD WELFARE AND PUBLIC HEALTH COMMITTEE. Chairman - - Councillor Mrs. J. C. Ericson Her Worship the Mayor (Alderman Mrs. E. Watson, J.P.) Aldermen— E. J. D. Field, J.P. J. R. Beaumont, J.P. Councillors— Mrs. E. G. Baker Mrs. W. R. Martin Mrs. H. E. Niven J. H. S. Bradley D. Gifford G. J. Kemp A. J. Simpson Co-opted Members— Mrs. L. Crump Dr. E. Evans Mrs. E. Gifford Mrs. E. L. Hawkes Mrs. E. F. Ward REPRESENTATIVES ON WANDLF. VALLEY JOINT HOSPITAL BOARD Her Worship the Mayor (ex-oflicio) Alderman— G. W. Cole Councillors— Mrs. J. C. Ericson T. H. Barr REPRESENTATIVES ON WANDLE VALLEY JOINT SEWERAGE BOARD Her Worship the Mayor (ex-officio) Aldermen- — A. H. Bailey E. J. D. Field, J.P. Councillor— L. M. Ibbotson 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 (f) Florence M. Parsons, M.R.C.S., L.R.C.P. (g) Elspeth Whittaker, M.B., Ch.B. 6 Consulting Gynaecologist J. V. O'Sullivan, Esq., M.D, F.R.C.S Consultant in Diseases of Infants N. L. Lloyd, Esq., MB., 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) A. H. Riley (1, 2, 4) L. Gleed (1, 2, 3) (I) E. N. Montague (1, 2) (n) E. J. Sluis (1, 2) (q) L. M. Edwards (1) Superintendent Health Visitor and Infant Life Protection Visitor (c) Mrs. Ashman (5, 6, 7, 9) Health Visitors Miss G. Russell-Harris (5, 6, 7) (k) Mrs. L. Harrison (5, 6, 7) Miss M. Knight (6, 8) Miss L. Salway (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) (d) Miss E. D. Phillips (5, 6) (e) Miss A. Redgrave (6) (r) Miss J. H. Simonds (5, 6) Mrs. M. J. Murphy (5, 6) Home Help Organiser Mrs. R. E. Law 7 Clerks L. J. Bellingham (b) Miss V. Valentine (h) Miss K. Lane (t) Miss P. Himus (g) Miss B. Atkinson (m) Miss D. Jullien (o) Mrs. M. Lewsley (p) Miss M. Jarrold (а) Resigned 30.4.47. (b) Resigned 27.9.47. (c) Resigned 30.11.47. (d) Resigned 30.11.47. (e) Appointed 7.8.47. (/) Resumed duties 19.6.47 (after return from U.N.R.R.A.). Returned to B.M.G., Germany, 29.9.47. (g) Resigned 18.1.47. (h) Resigned 20.12.47. (i) Appointed 2.1.47. Resigned 6.10.47. (j) Appointed 17.2.47. Resigned 7.6.47. (k) Appointed 3.2.47. (l) Appointed 12.5.47. (m) Appointed 16.6.47. (n) Appointed 1.7.47. (o) Appointed 1.10.47. (p) Appointed 6.11.47. (q) Appointed 27.10.47. (r) Appointed 1.7.47. 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 Nuree. 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, 1947 64,180 Number of inhabited houses, 1921 7,150 1931 13,187 1947 17,895 Rateable Value, 1947 £526,103 Sum represented by a 1d. rate £2,042 13s. 8.08d. STATISTICS. Live Births. Total Male Female Rate per 1,000 of population Legitimate 1326 675 651 Illegitimate 47 20 27 Total 1,378 695 678 21.39 Still Births. Total Male Female Rate per 1,000 total births Legitimate 29 13 16 Illegitimate 8 3 — Total 32 16 16 22.77 Deaths. Total Male Female Rate per 1,000 of population 618 327 291 9.63 Deaths from disease and accidents of pregnancy and childbirth : — Rate per 1,000 total births From puerperal sepsis — — From other puerperal causes 1 0.71 Total 1 0.71 9 Deaths of infants under one year of age :— All infants per 1,000 live births 38.60 Legitimate infants per 1,000 live legitimate births 34.69 Illegitimate infants per 1,000 live illegitimate births 148.98 Deaths from :— Cancer (all ages) 108 Measles 1 Whooping cough (all ages) — Diarrhœa (under two years of age) 1 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 1933 1010 420 41.5 1934 982 428 43.5 1935 969 474 48.9 1936 1033 497 48.1 1937 976 501 51.3 1938 1028 569 56.3 1939 966 518 53.7 1940 854 453 53.0 1941 737 408 55.4 1942 986 518 52.5 1943 1048 727 69.4 1944 996 678 68.1 1945 993 661 66.5 1946 1290 845 65.5 1947 1405 956 68.0 Number of births notified by municipal midwives in 1947, 449. The births rates, death rates per 1,000 of population, and the infantile mortality rates for the years 1927-47 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 St Wales MITCHAM England & Wales MITCHAM England & Wales 1927 20.9 16.7 9.8 12.2 45 69 1928 20.1 16.7 8.8 11.7 18 65 1929 19.1 16.3 11.2 13.4 72 74 1930 19.3 16 3 8.2 11.1 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 11.1 31.83 46 1946 20 3 19.1 9.2 11.5 19.9 43 1947 21.39 20.5 9.47 12.0 38.60 41 11 Infant Mortality During the year 53 deaths were registered as occurring in infants under one year of age: — Males Females Total Legitimate 30 16 46 Illegitimate 3 4 7 Totals 33 20 53 as compared with 25 deaths last year. The following table shows the principal causes of death in the various age groups: — Deaths of Infants under One Year of Age. Age No. Cause of Death Prematurity Congenital Defeets Accidents of birth Infectious conditions Other conditions 0 - 24 hrs. 21 11 4 6 — — 1 - 7 days 10 1 5 1 1 2 1 wk. - 1 mth. 6 2 2 — 2 — 1 mth - 12 mths. 16 1 3 — 9 3 Total 53 15 14 7 12 5 Thirty-seven infants failed to survive the first month of life, and prematurity was certified as the cause of death of 14 of these infants. Seven deaths were recorded of illegitimate infants. Maternal Mortality. During the year one death was registered. In 1946 no death was registered due to disease or accident of pregnancy. Inquests. Inquests were held on 20 residents dying within the district and on 16 Mitcham residents who died outside the district, a total of 36. In addition, the coroner held 62 post mortems without 12 inquests on residents dying within the district, and on 40 Mitcham residents who died outside the district, a total of 102. The following table shows the results of the findings of these inquests:— Deaths from natural causes 1 Accidental deaths 14 Deaths from misadventure 6 Suicides 11 Open verdict 1 Found drowned 1 Manslaughter 1 Murder 1 Total 36 13 Deaths Registered during the Year 1947 Cause of Death Males Females Total 1 Typhoid and paratyphoid fevers ... ... ... 2 Cerebro-spinal fever ... ... ... 3 Scarlet fever ... ... ... 4 Whooping cough ... ... ... 5 Diphtheria ... ... ... 6 Tuberculosis of respiratory system 16 17 33 7 Other forms of tuberculosis 5 3 8 8 Syphilitic diseases 2 3 5 9 Influenza 1 2 3 10 Measles 1 ... 1 11 Acute polio-myelitis and polio-encephalitis ... ... ... 12 Acute infectious encephalitis 1 1 2 13 Cant-er of buccul cavity and oesophagus (m) and uterus (f) 4 4 8 14 Cancer of stomach and duodenum 4 8 12 15 Cancer of breast ... 13 13 16 Cancer of all other sites 45 25 70 17 Diabetes 1 2 3 18 Intra cranial vascular lesions 25 29 54 19 Heart disease 87 93 180 20 Other diseases of circulatory system 11 10 21 21 Bronchitis 26 16 42 22 Pneumonia 17 13 30 23 Other respiratory diseases 3 1 4 24 Ulcer of stomach or duodenum 4 2 6 25 Diarrhoea (under two years) ... 1 1 26 Appendicitis ... 1 1 27 Other digestive diseases 1 1 2 28 Nephritis 5 7 12 29 Puerperal and post-abortive sepsis ... ... ... 30 Other maternal causes ... 1 1 31 Premature birth 12 2 14 32 Congenital malformations, birth injuries, infantile disease 17 9 26 33 Suicide 7 5 12 34 Road traffic accidents 4 — 4 35 Other violent causes 8 5 13 36 All other causes 20 17 37 All causes 327 291 618 14 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1947. (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 Kates per 1,000 civilian population Births— Live •20.5‡ 23.3 22.2 22.7 21.39 Still 0.50‡ 0.62 0.54 0.49 0.49 Deaths— All causes 12.0‡ 13.0 11.9 12.8 9.63 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 0.03 0.02 0.02 0.00 Diphtheria 0.01 0.01 0.01 0.01 0.00 Influenza 0.09 0.09 0.08 0.08 0.047 Smallpox 0.00 — — — — Measles 0.01 0.02 0.02 0.01 0.015 Notifications— Typhoid fever 0.01 0.01 0.00 0.01 0.00 Paratyphoid fever 0.01 0.01 0.01 0.01 0.03 Cerebro-spinal fever 0.05 0.06 0.05 0.05 0.03 Scarlet fever 1.37 1.54 1.37 1.31 0.96 Whooping cough 2.22 2.41 2.02 2.80 3.36 Diphtheria 0.13 0.15 0.14 0.14 0.06 Erysipelas 0.19 0.21 0.18 0.22 0.14 Smallpox 0.00 0.00 0.01 0.00 0.00 Measles 9.41 9.13 9.58 5.29 8.30 Pneumonia 0.79 0.09 0.68 0.64 0.57 Rates per 1,000 live births Deaths under one year of age 41† 47 36 37 38.6 Deaths from diarrhoea and enteritis under two years of age 5.8 8.0 3.7 4.8 0.73 Rates per 1,000 total births (live and still) Maternal mortality Abortion with sepsis 0.10 Not available — „ without sepsis 0.06 — Puerperal infections 0.16 — Other 0.85 0.71 Notifications— Puerperal fever 7.16 8.99 6.27 1.21 6.40 Puerperal pyrexia 6.94* Mortality per million women aged 15.45 Abortion— With sepsis 9 Not available Without sepsis 5 *Including Puerperal fever. A dash (—) signifies that there were no deaths. ‡Rates per 1,000 total population. † Per 1,000 related births. 15 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA LABORATORY FACILITIES Bacteriological examinations for this district are carried out at the Wandle Valley Isolation Hospital. The following number of specimens from this borough have been examined during the year:— Swabs for diphtheria 202 Sputa for tubercle 34 Total 236 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 1,930, of which 452 were accident cases and 1,478 private removals, including 508 maternity cases. There were 25 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, 1947 : — 16 No. of Nurses No. of patients visited during 1947 No. of visits paid during 1947 St. Barnabas 2* 141 3,824 Mitcham D.N. Association- 4* 622 13,373 Totals 763 17,179 *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 Six municipal midwives have been appointed for this Borough, the Borough Council acting as agents for the Surrey County Council, who are the local supervising authority. WOODLANDS MATERNITY HOME The Borough Maternity Home has accommodation for 15 cases. All patients must be Mitcham residents, and those who wish may book their own medical attendant for the confinement. 17 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, and Monday afternoon (weighing), which commenced June, 1947. 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. School Clinic The Surrey County Council is the Local Education Authority. Medical and dental services are provided at the School Clinic, Western Road. 18 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. Public library books which have been in contact with cases of infectious disease are disinfected by the Public Health Department. 19 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 Hospital 100 Number of rooms disinfected by fumigator 189 Number of library books disinfected 190 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 26,721, as compared with 20,783 in 1946. Of these 1,397 were new cases, 1,258 being infants under one year of age, and 139 being children over one but under five years of age. The total number of attendances of infants under one year was 21,753, and of children between one and five years of age, 4,968. At the end of the year there were 1,112 infants under one year and 1,769 children between one and five years of age attending the centres, making a total of 2,881. The average attendance at each centre was:— Cavendish Road 86.1 St. Barnabas 119.6 Church Road 67.1 Sherwood House 60.3 Meopham Road 49.5 The percentage of infants under one year of age attending the centres for the first time was 91.62 per cent, of the total number of live births. At Church Road and Meopham Road Clinics an additional weekly weighing session has been necessary. These additional sessions are not attended by a Medical Officer, but are otherwise 20 the same as other sessions. A similar session was commenced at Sherwood House Clinic in June. 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 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 The arrangements with the Wilson Hospital for patients to receive sunlight treatment was continued during the year, and 57 patients were referred for treatment. During the year the Committee agreed to the purchase of equipment for sunlight treatment for use at Church Road and Sherwood House Clinics. Orthopedic Clinic Arrangements have been made with the Wilson Hospital, Mitcham, for children in need of orthopædic treatment to attend the orthopaedic clinic of this hospital. During the year 33 cases were referred to this clinic, as compared with 58 cases in 1946. Dental Treatment The dental clinic for nursing and expectant mothers and children under five years of age is held at Church Road each week. All ante-natal cases, including the cases booked for confinement at the Woodlands Maternity Home, received dental inspection, followed by treatment and dentures when necessary. The arrangement made with the Surrey County Council for the services of a County Dental Surgeon and dental attendant have been most successful. The following table shows the work performed :— 21 Maternity and Child Welfare Records Church Road, Mitcham. Summary—Year 1947. E N I Total New Patients 117 12 51 180 Sub-attendances 114 17 58 189 Total attendances 231 29 109 323 Inspections 134 13 50 167 Filling permanent teeth 84 7 — 91 Filling temporary teeth — — 50 50 Extractions permanent teeth 88 13 — 101 Extractions temporary teeth — — 41 41 Anaesthetics—local 2 6 — 8 Anaesthetics—general 26 5 17 48 Dentures—partial — 2 — 2 Dentures—full —. — — — Patients awaiting dentures 4 2 — 6 Patients—treatment complete 42 5 27 74 Patients—treatment incomplete 25 4 — 29 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, 1947. Particular Cavendish Road St. Barnabas Church Road Sherwood House Meopharo Road Total Number of new oases registered during year of— Children under one year of age 190 315 348 207 198 1258 Children over one year and under five years of age 13 20 25 61 20 139 Number of children in attendance at end of year— Under one year of age 173 280 294 176 189 1112 Over one and under five years of age 223 395 480 350 321 1769 Attendances of children under one year of age 3613 4974 5439 3832 3895 21753 Attendances of children over one year of age 692 1006 1274 936 1060 4968 Total attendances at centres 4305 5980 6713 4768 4955 26721 Average attendances at centres 86.1 119.6 67.1 60.3 49.5 ... Percentage of infants under one year of age attending centres, for first time, of the total live births ... ... ... ... ... 91.62 22 Toddlers' Clinics 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 5 yrs. Total 132 149 71 352 Visits Paid by Health Visitors Mrs. Ashman Miss R. Harris Miss Knight Miss Salway Miss Luther Mrs. Harrison Mrs. Lewis Total Primary Ante-Natal Visits 11 87 87 92 69 162 12 510 Subsequent Ante-Natal Visits — 5 26 17 120 54 2 224 Primary Visits to Infants under 1 year 9 292 235 283 304 336 43 1502 Subsequent Visits to Infants 10 650 527 901 1245 636 168 4137 Visits to Children 1—5 years 10 1164 810 1478 2133 872 373 6840 Visits to Premature Infants — 5 1 14 13 65 3 101 Visits re Infant Deaths — 3 7 3 — 4 — 17 Visits re Stillbirths — 2 2 2 — 3 — 9 Visits to Cases of Ophthalmia Neonatorum — — — 4 — — — 4 Visits re Cases of Puerperal Fever — — — — — — — — Primary Visits to Cases of Tuberculosis — — — — — — — — Subsequent Visits to Cases of Tuberculosis 4 — — 3 — — — 7 Visits re Diphtheria Immunisation 1 — 19 — — 4 1 25 Visits re Scabies — — — — — — — — Visits re Other Infectious Diseases 18 1 10 56 1 30 — 116 Visits re Infant Life Protection 119 3 4 17 32 20 1 196 Visits re Adoption 37 20 26 30 18 25 — 156 Visits re Home Help Scheme 13 — 4 8 — — — 25 Special Visits ... 156 2 19 9 10 14 — 210 Total 388 2234 1777 2917 3945 2215 603 14,079 23 24 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 are held at the Cavendish Road Clinic. 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) 377 2,120 2120 Church Road Clinic 473 2,283 2283 Midwives' Clinic 297 1,011 2022 Total 1,147 5,414 21 42 One thousand one hundred and forty-seven expectant mothers attended the ante>-natal centres as against 1,405 total registered births. General Remarks The clinics were reserved, as in previous years, for those cases entering Woodlands, hospital, or who were to be confined in their 25 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 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 42 women attended for this examination as compared with 20 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; 211 cases attended during the year. The total number of women who attended the post-natal clinics at Church Road Clinic was 240, the average attendance being 10.0. Home Help and Domestic Help Service. The combined Home Help and Domestic Help Service has proved most successful. At the end of the year five full-time home helps were engaged on maternity cases, and 126 mothers received their services during the year. 26 The Domestic Help Service was available to the following classes of patient in need of domestic help: — (1) When the housewife falls sick or must have an operation. (2) Where a wife is suddenly called away to see her husband in hospital, and arrangements have to be made to look after the children. (3) Elderly people who are infirm or one of whom suddenly falls ill. (4) Where several members are ill at the same time, e.g., an influenza epidemic. This service had been greatly appreciated, and without it many cases who have been nursed at home would have had to be admitted to hospital, thereby aggravating the acute shortage of hospital accommodation. At the end of the year four full-time and 66 part-time Home Helps were being employed. One hundred and seventy cases received assistance during the year. The organiser has worked in close co-operation with the Superintendent Health Visitor and the District Midwives, and has attended the Midwives' Ante-Natal Clinic. WOODLANDS MATERNITY HOME The number of cases admitted during the year was 322; 30 more than in 1946. Dr. Housden, the Clinical Medical Officer, conducts the antenatal 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 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. 27 The gas and air apparatus for analgesia has been very successful, and has been greatly appreciated by the patients. All the staff are trained in the administration of gas and air analgesia. Dr. Ivor Evans is the consulting anaesthetist to the Home, which is approved by the Central Midwives' Board. 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. The pupils work in the Home for three months and work on the district under the supervision of an approved district midwife for a further period of three months. 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 1931 259 1932 239 1933 285 1934 285 1935 299 1936 314 1937 309 1938 297 1939 254 1940 239 1941 215 1942 263 28 Number of maternity beds in the institution (exclusive of isolation and labour beds), 15. Number of maternity cases admitted during the year, 313. Average duration of stay, 12'7 days. Number of cases delivered by (a) midwives, 282; (b) doctors, 30. Number of cases in which medical assistance was sought by a midwife in emergency, 92. Number of cases notified as (a) puerperal fever, nil; (b) puerperal pyrexia, 1. Number of cases of pemphigus neonatorum, nil. Number of infants not entirely breast-fed whilst in the institution, 32. Number of cases notified as ophthalmia neonatorum, nil. Number of maternal deaths, nil. Number of stillbirths, 4. Number of infants' deaths within ten days of birth, 4. An ante-natal clinic is held every Monday, Wednesday and Friday at Cavendish Road Clinic, and patients who have booked are expected to attend. Infant Life Protection The Superintendent Health Visitor has been appointed the Infant Life Protection Visitor for this district. Frequent visits during the year are paid to the homes of the foster children. A strict supervision is kept on these homes, and no cause was found to remove any infant from the care of the foster mother during the year. The following are the number of foster mothers and children on the register;—  Number of births 1943 224 1944 218 1945 267 1946 290 1947 312 29 Number of foster mothers on register, December 31, 1947 5 Number of children on register, December 31, 1947 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 352 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. These adoption societies have been requested to notify the Superintendent Health Visitor, who is the 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 11 Total number of children in respect of whom notice was given 19 Number of such children under supervision at the end of the year 9 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 1947 29 Number of children affected 86 Number of visits paid 96 Day Nurseries. Eagle House has continued to give satisfactory service during 30 the year, and has a waiting list of cases for admission, although there is accommodation for 85 children. Robinson Road Nursery was opened on August 9, 1943, and at the end of 1947 the register was full with a list of children waiting for admission. 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 29.2 11.7 Two—five 43.9 35.6 Totals 73.1 47.3 A voluntary minders' nursery is held at Cavendish Road Clinic each Friday from 1.30 p.m. to 4.45 p.m. The mothers of the children have a voluntary committee of which the Health Visitor is a member, which arranges the rota of minders. The scheme has proved very successful, the average number of children attending being ten per session. During the year the Committee were concerned at the length of the waiting lists for admission to the Day Nurseries, and, following the information that the Sherwood Nursery School would not be reopened as a Nursery School after war damage repairs had been completed, the following report was submitted to the Committee: — Provision of Additional Nursery Accommodation. As instructed by the Committee I have investigated the possibility of providing additional nursery accommodation in the district. It is essential that any accommodation provided by the Council should be equal to the minimum standard adopted by the Ministry of Health during the war for the establishment of war-time nurseries. No existing buildings suitable for adaptation into a nursery are available in the Borough, hence an entirely new building will be necessary. The need for nursery accommodation would appear to be greatest in the Pollards Hill area, and several suitable sites 31 might be obtained by negotiation with the owners. It is most desirable that a nursery should be located on a bus route in order that the strain of travelling on both mother and child should be reduced to a minimum. Recreation Close would be an excellent site if a bus service were available. Approximately f-acre of land would be required at a cost of £1,500, and the erection of a prefabricated building similar to a war-time nursery for 60 children would cost approximately £6,500. A further £1,000 would be required for equipment, making a total cost of £9,000 or a capital cost of £150 per child place. Maintenance cost would be in addition. In view of the difficulties of obtaining labour and materials there would not appear much likelihood of opening a day nursery before July, 1948. I believe that the need for nursery provision will be more acute in the new year, as several Mitcham children, at present being admitted to nurseries in neighbouring areas, have been informed that they will not be admitted after January 1, 1948. The need for nursery provision might be satisfied by the establishment of a number of "Daily Minders"; mothers with suitable accommodation undertake the care of four or five children belonging to neighbours who are employed in full-time work, establishing, in fact, a miniature nursery. These "Daily Minders," their premises and equipment would be required to be registered and would be subject to frequent supervision by the Health visiting staff. It would be necessary to guarantee registered " Minders " of a weekly fee of, say, £ 1 per week per child, the mother contributing 6s. per week, the same charge as at the nurseries. It is possible that the Council would need to provide on loan certain articles of equipment, for example, cots, play-pens, etc., and in addition some couponed good such as towels. It is certain that some additional rations would need to be offered to " Minders " to make the scheme a success. At present there is no provision for this except by registering each " Minder " as having a catering establishment. It would be necessary for the Council to approach the Ministry of Food for the necessary 32 permits for the issue of rationed goods proportional to those granted to the day nurseries. Should the Committee decide to establish a scheme of " Daily Minders," I suggest that the scheme be submitted to the Ministry of Health for approval, and that an advertisement be issued inviting persons to apply for registration as " Daily Minders." 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. 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. 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 33 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. The Merton and Wimbledon Moral Welfare Association obtained the tenancy of the Haygarth Witts Home, The Ridgway, Wimbledon, and after various alterations it was opened as a hostel in June, 1947. This additional accommodation should go far towards solving the difficulty of obtaining hostel accommodation. 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 an increased grant of £100 per annum towards the cost of her salary. 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. Care of Premature Infants Sixty-four infants were notified as weighing 5½ lbs. or less at birth during the year. Twenty-five occurred at home confinements, and of this number two died, one within 15 minutes of birth and the other, who was removed to hospital, died within 24 hours of birth. Of the 39 infants born in hospital, eight died within eight days of birth whilst still in hospital. Of the 31 infants discharged to 34 their own homes, one subsequently died of congenital heart disease. Premature infants born at home may be removed to hospital if necessary. A specially heated incubator is available for removing cases by ambulance to 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. Nine samples of deep well water were submitted for chemical and bacteriological examination and were reported to be satisfactory. RIVERS AND STREAMS Twelve visits have been paid to all works suspected of discharging effluent into surface water sewers. 35 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 was carried out by direct labour until July, when a weekly collection commenced. Five 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, 131. Number of other houses found infested during the year, 48. Number of requisitioned, etc., houses found infested during the year, 15. Total number of houses disinfested during the year, 194. Methods employed: — 118 houses treated with sulphur dioxide. 146 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 41 houses. Number of private houses disinfested by owners or occupiers after notice, 7. Number of houses disinfested for beetles, 105. 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. 36 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 Three full-time and one part-time Rodent Operators were employed. Number of visits paid by rodent operators inclusive of house to house inspections 10,942 Number of treatments re rat infestation 2,359 Two sewer maintenance treatments were carried out; 218 manholes were baited. THE ANNUAL REPORT OF THE CHIEF SANITARY INSPECTOR To the Mayor, Aldermen and Councillors of Mitcham Madam, 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 12,018 Number of complaints received 1,822 Visits re complaints and sundries 2,928 Revisits 8,008 Houses inspected for defects 8,490 Number of nuisances discovered 1,115 Number of intimation notices served 1,145 Number of intimation notices complied with 600 Number of statutory notices served 473 Number of statutory notices complied with 184 37 Visits to butchers and other food shops 272 Visits to factories 106 Visits to refuse dumps 10 Visits to slaughter houses 16 Visits to restaurant kitchens 17 Visits to stables 12 Visits to garages 14 Visits to outworkers' premises 20 Visits to marine stores 4 Visits to caravan yards 80 Visits re licence applications 956 Details of visits to other premises are enumerated in other sections of the report. Character of Work Done Roofs repaired 203 Eaves guttering and spouting repaired 186 Yards paved or repaired 14 Dampness remedied 81 Water service pipes repaired 27 Waterclosets: repairs to roof, walls, doors, windows, floors and seats 54 Waterclosets: flushing apparatus repaired or renewed 57 Waterclosets: repairs to pans and traps, obstructions removed 18 Water storage cisterns cleansed, regulated, repaired or renewed 41 Water supply reinstated 4 Flooring of rooms repaired and ventilation improved 69 Rooms cleansed and redecorated 11 Repairs to sinks, waste pipes and traps 58 Window frames, sashes and sills provided 13 Window frames, sashes and sills repaired 126 Drains repaired and obstructions removed 37 Repairs to firegrates 25 Repairs to stoves, coppers, ranges, etc 84 New dustbins provided ... ... ... ... ... 61 Accumulations removed 8 Repairs to chimney stacks, etc 17 38 Repairs to staircases 16 Rainwater gullies repaired 9 Smoke nuisances abated 15 Repairs to doors 53 Repairs to sinks 2 Drains tested 98 Repairs to internal plaster 289 Grid and mica flaps provided 22 Drain inspection chamber covers provided 15 Sinks and handbasins provided or renewed 12 External brickwork (repaired, pointed or rendered) 48 W.c. pans and traps provided 81 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. Legal Proceedings.—Thirteen applications were made to the Justices for Nuisance Orders against property owners under Section 94, Public Health Act, 1936. The results were as follows: — Ten summonses were adjourned sine die on reports to Justices that works were in progress. Two summonses were dismissed with costs, as works were completed before the hearing of the summonses. One order was made by the Justices with costs. Milk and Dairies Order, 1926.—Proceedings were taken against a firm of milk retailers on three occasions for using dirty milk bottles. The retailer was fined £5 5s. with £2 2s. costs; £20 with £2 2s. costs, and £50 with £5 5s. costs. Petroleum (Consolidation) Act, 1928.—Eighty-three licences to store petroleum and cellulose solutions were granted, totalling 152,840 gallons. Three licences were also issued for 5,336 lbs. of carbide of calcium to be stored. Unsound Food Dealt With. Beef 1246f lbs. Margarine 278 lbs Fish734 ,, Corned Beef 144 „ Cheese 56 „ Corned Mutton,,, 24 „ 39 Sugar224 lbs. Pudding Mixture 335 pkts. Fruit 150 „ Eggs 736 Fruit, Dried 592 „ Bacon 3 lbs. Flour 37 ,, Oats 12 ,, Pickles 20 bottles Sundry tinned foods 2320 tins 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) 3,490 (b) Number of inspections made for the purposes 3,744 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 600 Number of dwelling houses rendered fit in consequence of formal action by the local authority or their officers 184 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 1 (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 1 Proceedings under Section 11 of the Housing Act, 1936: — (1) Number of houses in which demolition orders were made 3 40 Three hundred and twenty-nine houses were inspected in addition to the above, and statutory notices were served to remedy the dilapidations. The Council offered to carry out both war damage and dilapidations. Two hundred and three owners accepted the Council's offer, the remaining 126 owners preferred their own builder. 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 30 INSPECTION AND SUPERVISION OF FOOD FOOD AND DRUGS ACT, 1938 Formal Samples. Twenty-nine formal samples were taken as follows: — Milk 20 Seed Cake 1 Butter 2 Black Pepper 1 Bicarbonate of Soda 1 Baking Powder 1 Vinegar 2 White Bread 1 Informal Samples.— Twenty-three informal samples were taken as follows: — Cloves 1 Soup 2 Salad Dressing PowJunket 1 der 1 Horseflesh 2 Cocoa Compound 1 Flour, self raising 1 Vinegar 1 Barley 1 Fish and meat paste 3 Baking powder 4 Cake Mixture 3 Beef aspic jelly 1 Black Pepper 1 All samples were genuine with the exception of three formal and four informal samples. Two warning letters were sent re foods not properly labelled, four were sent regarding two samples of butter, one sample of horseflesh and one sample of milk. The result of one informal sample of flour was passed to the Medical Officer of Health, Wandsworth M.B.C. 41 Ninety-five butterfat samples were submitted to the Public Analyst for the Ministry of Food. MILK (SPECIAL DESIGNATION) REGULATIONS, 1936-46. During the year the Council granted the following number of licences under the above named Order: — Tuberculin Tested 8 Pasteurised 7 Pasteurising Plant 1 Supplementary Licences— Pasteurised 7 Tuberculin Tested 7 Fifty-three samples of Graded Milk were submitted for bacteriological examination. Fifty-one 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-four visits have been paid. DAIRIES AND COWSHEDS There are 11 registered premises within the district, of which 10 are dairies and one cowshed. Very little bottling of milk is carried out in the district. Milk is now supphed to the dairymen in sealed bottles by the wholesalers. During the year 54 visits of inspection were paid. PIGGERIES There are nine piggeries in the Borough. Fifty-one 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. FACTORIES ACT, 1937 1.—Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors): — Premises M/c line No. Number on Register Number of M/c line No. Inspections Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (6) (7) (i) Factories in which Sections 1, 2, 3, 4, and 6 are to be enforced by Local Authorities 1 23 10 1 (ii) Factories not included in (i) to which Section 7 applies (a) Subject to the Local Authorities (Transfer of Enforcement) Order, 1938 2 89 50 5 2 (b) Others 3 3 (iii) Other Premises under the Act (excluding out-workers' premises) 4 2 6 4 TOTAL 114 66 5 ... 42 2.—Cases in which defects were found: — Particulars M/c line No Number of cases in which defects were found Number of cases in which prosecutions were instituted M/c line No. Found Remedied Referred To H.M. Inspector By HM. Inspector (1) (2) (3) (4) (5) (6) (7) (8) Want of cleanliness (S.l) 5 2 2 6 Overcrowding (S.2) 6 6 Unreasonable temperature (S.3) 7 7 Inadequate ventilation (8.4) 8 8 Ineffective drainage of floors (9.6) 9 9 Sanitary Conveniences (8.7) {a) Insufficient 10 3 2 3 10 (6) Unsuitable or defective 11 1 1 11 (c) Not separate for sexes 12 12 Other offences (not including offences relating to Homework) 13 13 TOTAL 60 6 5 3 60 43 3.— Outwork (Sections 110 and 111): — Nature of Work M/c line No. Section 110 Section 111 M/c line No. No. of out-workers in August list required by Sect. 110 (1) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (6) (6) (7) (8) (9) Wearing Making, etc. 14 52 14 apparel Cleaning and washing f5 15 Household linen 16 16 Lace, lace curtains and nets 17 17 Curtains and furniture hangings 18 18 Furniture and upholstery 19 19 Electro-plate 20 20 File making 21 21 Brass and brass articles 22 2 22 Fur pulling 23 23 Iron and steel cables and chains 24 24 Iron and steel anchors and grapnels 25 25 Cart gear 26 26 Locks, latches and keys 27 27 Umbrellas, etc. 28 28 Artificial flowers 29 1 29 Nets, other than wire nets 30 30 Tents 31 31 44 45 Sacks 32 32 Racquet and tennis balls. 33 33 Paper bags 34 34 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 36 3 35 Brush making 36 36 Pea picking 37 37 Feather sorting 38 1 38 Carding, etc., of buttons, etc. 39 1 39 Stuffed toys 40 40 Basket making 41 41 Chocolates and sweetmeats 42 22 42 Cosaques, Christmas crackers, Christmas stockings, etc. 43 59 43 Textile weaving 44 44 Lampshades 45 45 TOTAL 70 141 70 46 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES INFECTIOUS DISEASE NOTIFICATIONS The total number of confirmed notifications received during the year was 888. 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 427 Health Visitors 116 To small pox contacts 26 Total 569 Rooms disinfected after infectious disease 189 47 Small Pox. Scarlet Fever Diphtheria Ty phoid 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 ... 5 ... ... 1 9 ... ... ... 1 ... 24 17 ... ... ... ... 57 February. ... 8 1 ... ... 10 ... 1 ... ... ... 83 19 ... ... ... ... 122 March ... 5 1 ... 1 6 1 1 ... ... ... 99 15 ... ... ... ... 129 April ... 6 ... ... 1 2 ... ... ... 1 ... 57 10 ... ... ... ... 77 May ... 4 1 ... ... 3 1 ... ... ... ... 120 21 ... ... ... ... 150 June ... 5 ... ... ... ... 1 ... ... ... ... 81 20 ... ... ... ... 107 July ... 3 ... ... ... 1 ... ... 1 ... 2 44 19 ... ... ... ... 70 August ... 6 ... ... 2 ... 2 ... ... ... 7 16 24 ... ... 1 ... 55 September ... 2 1 ... 1 ... ... ... ... ... 4 24 ... ... 1 ... 35 October ... 5 ... ... 2 2 4 ... ... ... 2 ... 14 ... ... ... ... 29 November ... 7 ... ... 1 1 ... ... ... ... 2 22 ... ... ... ... 33 December ... 7 ... ... ... 3 ... ... ... ... ... 3 11 ... ... ... ... 24 Totals ... 62 4 ... 9 37 9 2 1 2 11 533 216 ... ... 2 ... 888 48 Infectious Disease Notifications, 1927-47. Disease 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 Small Pox ... 9 7 ... 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 145 102 134 113 105 174 240 392 143 171 192 150 61 48 75 175 212 97 147 95 62 Diphtheria 76 75 133 129 49 32 40 83 80 104 89 64 27 86 72 25 42 10 63 32 4 Typhoid Fever 6 3 4 9 2 3 3 ... 3 5 ... 1 ... ... ... ... 1 ... 1 ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Undulant Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Puerperal Fever 9 4 6 1 7 5 1 1 2 2 1 ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia 14 9 5 6 9 4 9 6 4 11 5 4 7 2 2 6 3 5 8 6 9 Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro -spinal Meningitis 2 1 4 ... ... 1 4 1 1 3 1 2 1 13 12 6 8 3 3 1 2 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 14 10 22 22 17 11 31 30 20 22 16 8 19 17 19 7 22 13 16 25 9 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... 301 194 599 651 112 739 358 533 Acute Diarrhœa ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis 2 ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 3 11 Ophthalmia Neonatorum 10 3 3 1 3 4 2 2 4 3 1 3 3 1 3 10 4 4 ... 2 2 Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Encephalitis Lethargica ... ... ... 2 1 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Pneumonia 62 54 57 35 45 52 37 45 35 36 32 43 ... 30 22 20 50 37 33 41 37 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... 4 16 186 161 162 166 96 234 216 Food Poisoning ... ... ... ... ... ... ... ... ... ... ... ... 4 4 6 11 ... ... 5 1 ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 67 13 6 1 Paratyphoid ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 Totals 340 270 375 319 '242 288 368 560 293 357 338 275 125 468 591 1021 1161 515 1126 807 888 49 Small Pox No case of small pox was notified during the year 1947. Scarlet Fever The number of cases of scarlet fever notified during the year was 62 as compared with 95 in 1946, equivalent to a case rate of 0 96 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 44 were treated in hospital, and 18 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 Four cases of diphtheria were notified during the year and all cases were removed to hospital for treatment; contacts are swabbed as a routine. Every case recovered. The following table gives details of notifications and the number of each age group immunised:— 50 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 — — Under 1 — — 1 — — 1 — — '2 — — 2 — — 3 — — 3 — — 4 1 — 4 — — 5-9 — — 5-9 — — 10-14 — — 10-14 — — Over 14 3 — Totals 4 — Totals — — The number of cases is a considerable decrease over 1946, when 32 cases were notified. Immunisation and reinforcing doses were available to every school child 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 making home visits, to have their children immunised, and have made special visits in difficult cases. Immunisation has been continued at the schools. All the non-immunised children at the Day Nurseries were immunised after admission. 51 The following figures show the number of children immunised during the year:— Under five 933 Five—14 139 Over 14 — Total 1,072 The following figures show the number of the child population considered immunised at December 31st, 1947:— Age at 31.12.46 i.e. born in year Under 1 1947 1 1946 2 1945 3 1944 4 1943 5 to 9 1938-1942 10 to 14 1933-1937 Total under 15 Number immunised 2 753 644 801 715 3905 2947 9767 Estimated mid-year population 1947 5540 8530 The per cent, immunised is as follows:— Under five 52 62% Five—14 80.33% The number of birthday greetings sent in 1947 was 1,063. Typhoid Fever No case was notified during the year. Diarrhœa and Enteritis Under Two Years of Age One death was registered during the year. Encephalitis Lethargica No case was notified during the year. Erysipelas Nine cases were notified. Two cases were removed to hospital, 52 Puerperal Pyrexia Nine cases were notified during the year. Pneumonia Thirty-seven cases of primary pneumonia were notified during the year. The number of deaths from all forms of pneumonia, some of which are not notifiable, was 30, of which 17 were males and 13 females. Cerebro-Spinal Fever Two cases occurred during 1947, and there was no death. Influenza During the year three deaths from influenza were recorded, of which one was a male and two were females. The previous year six 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. Poliomyelitis Nineteen cases of poliomyelitis were notified during the year, of which the diagnosis was subsequently confirmed in 11 cases. The incidence was greatest during July and all the cases occurred between June and October. In view of the widespread nature of the epidemic, precautions, such as the postponement of operations for the removal of tonsils and adenoids, were taken. Whilst the swimming baths remained open, organised swimming was discontinued, 'and the children's Saturday morning cinema shpws were temporarily suspended, 53 The following table shows the incidence and ages of the persons affected:— Notified Number Confirmed Cases Deaths -5 5-15 15 + M F M F M F M F M F M F June — — — — — — — — — — — — July 1 1 1 1 — — — 1 1 — — — August 6 5 3 4 2 1 1 2 — 1 — — September 1 1 — — — — — — — — — — October 1 2 — 2 — 1 — — — 1 — — November 1 — — — — — — — — — — — December — — — — — — — — — — — — Total 10 9 4 7 2 2 1 3 1 2 — — 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 132 Mumps 136 Impetigo 7 Jaundice 1 Rubella 51 Ringworm — Scabies 2 Cancer The number of deaths from cancer registered during the year was 103, of which 53 were males and 50 were females. 54 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 1947 was as follows:— Digestive organs 12 cases Genito-urinary organs 8 „ Breast 13 „ 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 1927 46 1,13 1.37 1928 58 1.27 1.42 1929 66 1.83 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 1946 108 1.74 1.76 1947 103 1.60 1.86 55 Tuberculosis During the year 98 new eases of tuberculosis were notified, viz.:— Males Females Total Pulmonary 46 41 87 Non-Pulmonary 6 5 11 Totals 52 46 98 Twenty-five eases were transferred into the Borough, as follows:— Males Females Total Pulmonary 10 10 20 Non-Pulmonary 2 3 5 Totals 12 13 25 The total number of deaths registered as occuring from tuberculosis was viz.:— Males Females Total Pulmonary 16 17 33 N on-Pulmonary 5 3 8 Totals 21 20 41 England and Wales Mitcham Death rate from respiratory tuberculosis per 1,000 population 0.47 051 Death rate from non-pulmonary tuberculosis per 1,000 population 0.08 0 12 56 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 year to 4 years ... 1 1 3 ... ... 1 1 5 years „ 9 „ ... 2 ... ... ... ... ... ... 10 „ „ 14 „ 1 1 1 1 ... 1 2 ... 15 „ „ 19 6 6 3 ... ... 1 ... 1 20 „ „ 34 „ 20 17 1 1 6 6 ... 1 35 „ „ 44 ,, 5 6 ... ... 3 6 ... ... 45 „ „ 64 „ 11 5 ... ... 6 4 ... ... 65 ,, and upwards 2 1 ... ... 1 1 ... ... Unknown 1 2 ... ... ... ... ... ... Totals 46 41 6 5 16 19 3 3 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 ... ... ... ... ... 1 1 1 ... 2 1 6 Pulmonary: females ... ... ... ... 1 1 ... ... ... ... 1 3 Non-Pulmonary: males ... ... ... ... 1 ... ... ... ... ... ... 1 Non-Pulmonary: Females ... 1 ... ... ... ... ... ... ... ... ... 1 57 The sources from which information as to the abovementioned cases was obtained are as follows:— No. of Cases Pulmonary NonPulmonary Death returns (a) From Local Registrar 8 ... (6) Transferable deaths from Registrar General ... 1 Posthumous notifications 1 1 Number of cases removed from register during 1947:— Reason Pulmonary Non-Pulmonary Total Cases Males Females Total Males Females Total Withdrawal of notification. ... ... ... ... ... ... ... Recovery from disease 6 1 10 1 1 2 12 Death 19 21 40 2 1 3 43 Removed from district 11 23 34 3 3 6 40 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths is as follows:— Non-notified tuberculosis deaths 11 Notified tuberculosis deaths 3O Percentage of non-notified T.B. deaths (all forms) 26.82 per cent. Percentage of non-notified pulmonary T.B. deaths 21.95 „ 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 34 such examinations have been made. 58 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. Christmas gifts 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. 59 Number of patients treated, 157 persons. Classified as:— Pre-school age children 27 School age children 63 Adults 67 Number of baths given, 486. 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, 18. Classified as:— Pre-school age children — School age children 15 Adults 3 Number of treatments given, 56. 60 WANDLE VALLEY JOINT HOSPITAL BOARD Cases admitted to the hospital during the year ended December 31, 1947. Disease Beddington & Wallington Coulsdon & Purley Merton & Morden Mitcham Gases Deaths Cases Deaths Cases Deaths Cases Deaths Diphtheria 2 ... ... ... 3 ... 5 ... Scarlet fever 51 ... 47 (la) 98 ... 44 ... Erysipelas 1 1(b) 1 ... 1 ... 2 ... Tonsillitis or Quinsy 3 ... 7 ... 10 ... 9 ... Measles. 1 ... 2 ... 5 ... 3 ... Influenza 2 ... 1 ... 4 ... ... ... Whooping cough 3 1(f) 3 ... 4 ... 8 ... Rubella ... ... ... ... ... ... 6 ... Typhoid & Enteritis ... ... ... ... 3 1(c) 1 ... Meningitis, all types including T..B. Meningitis 3 1(d) 1 ... 3 1d) 3 (3e) Pneumonia ... ... ... ... ... ... 1 ... Puerperal Fever (Sepsis) ... ... 1 ... 1 ... ... ... Admitted with mother ... ... 1 ... 2 ... ... ... Infantile paralysis 9 ... 10 ... 16 ... 10 ... Dermatitis 3 ... ... ... 1 ... ... ... Laryngitis ... ... ... ... 1 ... 1 ... Angio-Neurotic Oedema ... ... 1 ... ... ... ... ... Pneumococcal Peritonitis ... ... 2 ... ... ... ... ... Chicken Pox 1 ... ... ... 3 ... ... ... Myalgia ... ... ... ... 3 ... 3 ... Sub-Arachnoid Haemorrhage ... ... ... ... 1 1 1 ... Cystitis ... ... ... ... ... ... 1 ... Urethral Stricture ... ... ... ... 1 ... ... ... 82 3 77 1 160 3 96 3 (а) 1 death Cerebral Embolus, Cardiac Failure, Septicaemia with Scarlet Fever. (b) 1 death Erysipelas of face and Heart Disease. (c) 1 death Gastro Enteritis. (d) 2 deaths T.B. Meningitis. (e) 2 deaths T.B. Meningitis, 1 death Meningitis from Brain Abscess. (f) 1 death Broncho Pneumonia and Whooping Cough. 61 INDEX page Abortion, Deaths. 14 Admissions—Wandle Valley Joint Hospital Board 60 Adoption of Children Act, 1939 29 Ambulances 15 Analysis of Mortality 14 Ante-Natal Clinics 24, 28 Average Attendances 24 Area 8 Bakehouses 41 Bed Bugs, Eradication of 35 Bedding, Disinfection of 18 Birth Rates 10, 14 Births, Illegitimate 8 In Institutions 9 Live 8 notified by Municipal Midwives 9 Still 8, 28 Woodlands Maternity Home 27-28 Blindness, Prevention of 52 Books Disinfected, Number of Library 18-19 Cancer 53-54 Deaths from 9, 53-54 Causes of Deaths 12 Cerebro-Spinal Fever 52 Chicken Pox 53 Chief Sanitary Inspector's Report 36 Inspector, Visits by 36-38, 46 Child Welfare 19 Cleansing, Public 35 Clinics 17-18, 20-22, 24-25, 28 Orthopaedic 20 Closet Accommodation 35 Dairies and Cowsheds 41 Day Nurseries 30 Death Rates 10, 14 62 PAGE Deaths 8-13, 28, 51-57, 60 Dental Treatment 20-21 Diarrhoea and Enteritis 51 Deaths from 14 Diphtheria 49-50 Immunisation 50-51 Clinic 18 Specimens Examined 15 Disinfection 18-19 Domestic Helps 25-26 Domiciliary Midwifery 16 Encephalitis Lethargica 51 Enteritis, Diarrhœa and 51 Eradication of Bed Bugs 35 Erysipelas 51 Examinations, X-Ray 25 Factories Act, 1937 41-45 Defects found 43 Inspections 42 (Sections 110 and 111) Outwork 44-15 Food and Drugs Act (1938) 40-41 and Medicine, Supply of 24 Dealt with, Unsound 38-39 Inspection and Supervision of 40 Preparing Places 41 General Provision of Health Services for the Area 15 Health, Visiting 21 Visitors, Visits by 23, 46 Home Helps 25-26 Hospitals 16 Houses, Disinfection of 18 Housing Act, 1936 (Sect. 9, 10 and 16) 39 Housing Act, 1936 (Sect. 11) 39 Housing Statistics 39 Illegitimate Children, Care of 32-33 Immunisation Clinic, Diphtheria 18 Diphtheria 49-50 Impetigo 53 63 PAGE Infants, Care of Premature 33 Infant Life Protection 28 Infant Mortality 9-11, 14 Infant Welfare Centres, Attendances 21 Infectious Disease, Ambulances 15 Case rates 14 Contacts 46 Hospital 16 Incidence of 47 Prevalence of and Control over 46 Notifications 48, 50 School 53 Influenza 52 Inhabited Houses 8 Inquests 11 Inspection and Supervision of Food 40 Jaundice 53 Laboratory, Emergency Public Health, Epsom 15 Facilities 15 Legal Proceedings 38 Library Books Disinfected, number of 18-19 Louse Infestation 59 Maternal Mortality 11, 14 Maternity and Child Welfare Services, Report on 19 Home 17, 27-28 Hospital Treatment 16 Measles, Deaths from 9 Medicine, Supply of Food and 24 Mice Destruction Act, 1919, Rats and 36 Midwifery, Domiciliary 16 Milk (Special Designation) Order (1936) 41 Mortality, Analysis of 14 Infant 9-11 Maternal 8, 11, 14 Mumps 53 N.S.P.C.C. 29 Notifications, Infectious Disease 46 School 53 64 PAGE Nurseries, Day 29-30 Nursery Accommodation, Additional 30-32 Nursing in the Home 15-16 Ophthalmia Neonatorum 28, 52 Orthopaedic Clinic 20 Patients Admitted to Hospital 60 Pemphigus Neonatorum 28 Personnel, Committee 5 Staff 5-7 Petroleum (Consolidation Act), 1928. 38 Piggeries 41 Pneumonia 52 Poliomyelitis 52-53 Population 8 Post-Natal Clinic 17, 25 Premature Infants, Care of 33 Prevention of Blindness 52 Provision of Additional Nursery Accommodation 30-32 Proceedings, Legal 38 Public Cleansing 35 Puerperal Fever 14, 28 Pyrexia 14, 28, 52 Rateable Value. 8 Rats and Mice Destruction Act, 1919 36 Rent & Mortgage Interest Restriction (Amendment) Act, 1933, Sect. 12 40 Ringworm 53 Rivers and Streams 34 Rooms Disinfected, number of 19 Rubella 53 Samples, Food 40-41 Sanitary Circumstances of the Area 34 Scabies 58-59 Clinic 18 Scarlet Fever 49 School Clinic 17 Schools 35-36 Notifications 53 65 PAGE Small Pox 49 Hospital 16 Social Conditions 8 Statistics 8 Housing 39 Vital 8 Still Births 8, 28 Streams, Rivers and 34 Sunlight Treatment 20 Supervision of Food, Inspection and 40 Supply of Food and Medicines 24 Water 34 Toddlers' Clinic 22 Treatment, Dental 20-21 Hospital 16 Sunlight 20 Tuberculosis 55-57 Care Committee 58 Clinic 18 Specimens examined 15, 57 Typhoid Fever 51 Unsound Food dealt with 38-39 Venereal Diseases Clinics 18 Visits by Health Visitors 23, 46 Sanitary Inspectors 36-38, 46 Vital Statistics 8 Wandle Valley Hospital—Admissions 60 Disinfections carried out by 19 Water Supply 34 Welfare, Child 19 Clinics 17 Attendance at 21 Whooping Cough, Deaths from 9 Woodlands Maternity Home 16, 26-28 Births 27-28 Staff 27 X-Ray Examinations 25