BOROUGH OF MITCHAM REPORT of the Medical Officer of Health for the YEAR 1948 BOROUGH OF MITCHAM REPORT of the Medical Officer of Health for the YEAR 1948 MITCHAM H. G. Mather Ltd., Caxton Works, Lower Green 3 Borough of Mitcham HEALTH REPORT FOR 1948 To the Mayor, Aldermen and Councillors. Sir, Ladies and Gentlemen, I have much pleasure in submitting my annual report for the year 1948. On July 5 the Maternity and Child Welfare and Ambulance Services were transferred to the Surrey County Council, and the Woodlands Maternity Home and the Wandle Valley Joint Isolation Hospital were transferred to the Regional Hospital Board. This is, therefore, the last report of your Medical Officer of Health to deal with these services. In order that comparisons may be made with previous and subsequent years the figures for the whole of the year have been placed in parentheses. The infant mortality figure for the year was only lower in 1946, and the health of the Borough has remained good. The transfer of the services and staff to the County Council was accomplished smoothly, and there has been little or no change as yet in the general clinical work. Much of the credit for the success of this big administrative change is due to Dr. K. A. Soutar, the County Medical Officer, who, by his tact, tolerance and patience overcame all difficulties. 4 The chief problem of the Borough is still housing, in spite of the large number of new dwellings erected. The Sanitary Inspectors have gradually increased the scope of their work now that the inspection of war damage repairs has largely ceased. I wish to thank the Chairmen of the Committees for their great help and assistance and all the staff for their continued loyalty and support, which has made it a pleasure to work in Mitcham. 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 His Worship the Mayor (Alderman G. W. Pearce) Aldermen— Mrs. E. Watson E. J. D. Field J. R. Beaumont Councillors— Mrs. Crump Mrs. W. R. Martin Mrs. H. E. Niven J. H. S. Bradley D. Gifford T. J. Higgs Co-opted Members— Dr. E. Evans Mrs. E. Gifford Mrs. A. Foscoe Mrs. E. F. Ward Mrs. N. Lemjn REPRESENTATIVES ON WANDLE VALLEY JOINT HOSPITAL BOARD His Worship the Mayor (ex officio). Aldermen — G. W. Cole Mrs. E. Watson Councillor— Mrs. J. C. Ericson REPRESENTATIVES ON WANDLE VALLEY JOINT SEWERAGE BOARD His Worship the Mayor (ex officio) Aldermen — E. J. D. Field W. Jeffery Councillor— R. F. Nicholson 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 (a) 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 B. 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 L. Gleed (1, 2, 3) E. N. Montague (1, 2) E. J. Sluis (1, 2) L. M. Edwards (1) Superintendent Health Visitor and Infant Life Protection Visitor (b) Miss D. Hayward (4, 5, 6, 12) Health Visitors Miss G. Russell-Harris (4, 5, 6) Mrs. L. Harrison (4, 5, Miss M. Knight (5, 7) Miss L. Salway (4, 5 6) Miss R. M. Luther (4. 5, 6) Matron of Woodlands Maternity Home (c) Miss M. Corrin (4, 5, 9, 10) (d) Miss K. B. Sanderson (4, 5, 9) 7 Matron of Eagle House Day Nursery (e) Miss J. E. Offer (4, 5, 11) (f) Mrs. I. G. Kensit (4, 11) Matron of Robinson Road Day Nursery Mrs. A. Brookson (12) Midwives Miss M. Monday (4, 5) Mrs. L. Papps (4, 5) Mrs. T. Davies (4, 5) Miss A. Redgrave (5) Miss J. H. Siinonds (4, 5) Mrs. M. J. Murphy (4, 5) Home Help Organiser Mrs. R. E. Law Clerks L. J. Bellingham (g) Miss V. Valentine (h) Mrs. D. Tupper, nee Jullien (i) Mrs. M. Lewsley Miss M. Jarrold (j) Miss J. O. Bramble (k) Miss M. Sanders (a) With B.M.G., Germany. (b) Appointed 12.1.48. (c) Resigned 16.2.48. (d) Appointed 3.3.48. (p) Resigned 26.4.48. (f) Appointed 7.5.48. (g) Appointed 30.8.48. (h) Resigned 8.9.48. (i) Resigned 3.1.48. (j) Appointed 19.1.48. (k) Appointed 1.1.48. 1. Certificate Sanitary Inspectors' Board. 2. Certificate Meat and Foods R.S.I. 3. Smoke Inspector's Certificate. 4. State Registered Nurse. 5. Certificate of Central Midwives' Board. 6. Health Visitor's Certificate R.S.I. 7. Health Visitor's Diploma. 8. Certificate Teaching of Mothercraft. 9. Midwives' Teacher's Certificate. 10. Housekeeper's Certificate. 11. Sick Children's Registered Nurse. 12. State Registered Fever Nurse. 8 REPORT STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 2,916 acres Population, Census 1921 35,119 „ „ 1931 56,856 Registrar-General's estimate of population midyear, 1948 66,280 Number of inhabited houses, 1921 7,150 „ „ „ 1931 13,187 1948 18,019 Rateable Value, 1948 £523,740 Sum represented by a 1d. rate £2,103 STATISTICS. Live Births. Total Male Female Rate per 1,000 of population Legitimate 1163 587 576 Illegitimate 29 18 11 Total 1,192 605 587 17.99 Still Birth6. Total Male Female Rate per 1,000 total births Legitimate 20 12 8 Illegitimate 3 2 1 Total 23 14 9 19.29 Deaths. Total Male Female Rate per 1,000 of population 582 313 269 8.79 Deaths from disease and accidents of pregnancy and childbirth:— Rate per 1,000 total births From puerperal sepsis — — From other maternal causes 1 0.82 Total 1 0.82 9 Deaths of infants under one year of age:— All infants per 1,000 live births 23.49 Legitimate infants per 1,000 live legitimate births 22.36 Illegitimate infants per 1,000 live illegitimate births 68.96 Deaths from:— Cancer (all ages) 111 Measles 1 Whooping cough (all ages) 1 Diarrhoea (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 1989 966 518 53.7 1940 854 453 53.0 1941 737 408 55.4 1942 986 518 52.5 1943 1048 727 69.4 1944 996 678 68.1 1945 993 661 66.5 1946 1290 845 65.5 1947 1405 956 68.0 1948 1215 855 70.37 Number of births notified by municipal midwives up to 4.7.48, 187 (360). 10 The births rates, death rates per 1,000 of population, and the infantile mortality rates for the years 1928—48 are shown in the following table: — Year Births per 1,000 population Deaths per 1,000 population Infant Mortality per 1,000 live births mitcham England & Wales mitcham England & Wales mitcham England & Wales 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 1945 18.01 16.1 10.19 11.4 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 1948 17.99 17.9- 8.79 10.8 23.49 34 11 Infant Mortality During the year 28 deaths were registered as occurring in infants tinder one year of age:— Males Females Total Legitimate 17 9 26 Illegitimate 2 — 2 Totals 19 9 28 Deaths of Infants under One Year of Age. Age No. Cause of Death Prematurity Congenital Defects Accidents of birth Infectious conditions Other conditions Under 24 hrs - (3) - (1) - (2) — — -(-) 1.7 days 6 (14) 1 (3) 5 (9) — — - (2) 8 days - 1 mth. - (2) - (1) -(-) — — - (1) 1 mth. -12 mths. 4 (9) -(-) -(-) — — 4 (9) Total 10 (28) 1 (5) 5 (11) — — 4 (12) Six (19) infants failed to survive the first month of life, and prematurity was certified as the cause of death of 1 (5) of these infants. No death was recorded of illegitimate infants. Maternal Mortality. During the year one death was registered. In 1947 one death was registered due to disease or accident of pregnancy. Inquests. Inquests were held on 24 residents dying within the district and on 13 Mitcham residents who died outside the district, a total of 37. In addition, the coroner held 70 post-mortems without as compared with 53 deaths last year. The following table shows the principal causes of death in the various age groups:— 12 inquests on residents dying within the district, and on 59 Mitcham residents who died outside the district, a total of 129. The following table shows the results of the findings of these inquests:— Accidental deaths 17 Deaths from misadventure 4 Suicides 13 Open verdict 2 Manslaughter 1 Total 37 13 Deaths Registered during the Year 194 8 Cause of Death Males Females Total 1 Typhoid and paratyphoid fevers ... ... ... 2 Cerebro- spinal fever 1 1 2 3 Scarlet fever 1 ... 1 4 Whooping cough ... 1 1 5 Diphtheria ... ... ... 6 Tuberculosis of respiratory system 22 16 38 7 Other forms of tuberculosis 4 ... 4 8 Syphilitic diseases 7 ... 7 9 Influenza 1 2 3 10 Measles ... 1 1 11 Acute polio-myelitis and polio-encephalitis 1 1 2 12 Acute infectious encephalitis ... ... ... 13 Cancer of buccul cavity and oesophagus (m) and uterus (f) 8 1 9 14 Cancer of stomach and duodenum 9 13 22 15 Cancer of breast ... 11 11 16 Cancer of all other sites 44 25 69 17 Diabetes ... 1 1 18 Intra- cranial vascular lesions 15 32 47 19 Heart disease 73 76 149 20 Other diseases of circulatory system 12 10 22 21 Bronchitis 17 19 36 22 Pneumonia 22 8 30 23 Other respiratory diseases 5 3 8 24 Ulcer of stomach or duodenum 4 1 5 25 Diarrhoea (under two years) 1 ... 1 26 Appendicitis 1 ... 1 27 Other digestive diseases 5 6 11 28 Nephritis 7 5 12 29 Puerperal and post-abortive sepsis ... ... ... 30 Other maternal causes ... 1 1 31 Premature birth 2 2 4 32 Congenital malformations, birth injuries, infantile disease 10 6 16 33 Suicide 11 2 13 34 Road traffic accidents 5 1 6 35 Other violent causes 7 2 9 36 All other causes 18 22 40 All causes 313 269 582 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1948. (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 Births— Rates per 1,000 civilian population Live 17.9‡ 20.0 19.2 20.1 17.99 Still 0.42‡ 0.52 0.43 0.39 0.35 Deaths— All causes 10.8‡ 11.6 10.7 11.6 8.79 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 0.00 Whooping cough 0.02 0.02 0.02 0.01 0.01 Diphtheria 0.00 0.00 0.00 0.01 0.00 Tuberculosis 0.51 0.59 0.46 0.63 0.63 Influenza 0.03 0.03 0.04 0.02 0.04 Smallpox — — — — — Acute Poliomyelitis and Polioencephalitis 0.01 0.01 0.01 0.00 0.03 Pneumonia 0.41 0.38 0.36 0.54 0.45 Notifications— Typhoid fever 0.01 0.00 0.01 0.00 0.00 Paratyphoid fever 0.01 0.01 0.01 0.01 0.00 Cerebro-spinal fever 0.03 0.03 0.02 0.03 0.03 Scarlet fever 1.73 1.90 1.82 1.37 1.39 Whooping cough 3.42 3.51 3.31 3.13 4.02 Diphtheria 0.08 0.10 0.09 0.10 0.01 Erysipelas 0.21 0.23 0 21 0 22 0.30 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 9.34 9.75 8.84 9.17 16.16 Pneumonia 0.73 0.84 0.60 0.57 0.65 Acute Poliomyelitis 0.04 0.05 0.04 0.04 0.06 Acute Polioencephalitis 0.00 0.00 0.00 0.00 0.01 Rates per 1.000 live births Deaths under one year of age 34† 39 32 31 23.49 Deaths from diarrhœa and enteritis under two years of age 3.3 4.5 2.1 2.4 0.84 Rates per 1,000 total births (live and still) Maternal mortality Not available Abortion with sepsis 0.11 - ,, without sepsis 0.05 - Puerperal infections 0.13 - Other 0.73 0.82 Notifications— Puerperal fever 6.89 8.90 4.71 7.34* 2.47 Puerperal pyrexia Mortality per million women aged 15.44 Abortion— With sepsis 9 Not available Without sepsis 4 A dash (—) signifies that there were no deaths. * In London, puerperal fever alone was 0.61. ‡ 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 162 Sputa for tubercle 19 Total181 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 up to 4.7.48 was 1,133 (2,397), of which 246 (454) were accident cases and 887 (1,943) private removals, including 278 (463) maternity cases. There were 13 (41) calls when the ambulance was not required on arrival. Contrary to expectations, the removals during the second half of the year have only increased by 12 per cent. over the first half. 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, 16 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, 1948:— No. of Nurses No. of patients visited during 1948 No. of visits paid during 1948 St. Barnabas 2* 84 1,680‡ Mitcham D.N. Association 7† 424 16,279 Totals 508 17,959 * One part time. † Three part time. ‡Up to 5.7.48. 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 Tnfectious 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. 17 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 Tnfant 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). 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 areheld 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. 18 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. 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. 19 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. 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 72 Number of rooms disinfected by fumigator 269 Number of library books disinfected 362 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 26,234, as compared with 26,721 in 1947; 3,022 children attended during the year. Of these 1,248 were new cases, 1,097 being infants under one year of age, and 151 being children over one, but under five years of age. The total number of attendances of infants under one year was 19,341, and of children between one and five years of age, 6,893. At the end of the year there were 838 infants under one year and 1,278 children between one and five years of age attending the centres, making a total of 2,116. 20 The average attendance at each centre was: - Cavendish Road 81.8 St. Barnabas 115.4 Church Road 64.5 Sherwood House 53.8 Meopham Road 43.8 The percentage of infants under one year of age attending the centres for the first time was 92.03 per cent. of the total number of live births. At Church Road, Meopham Road and Sherwood House Clinics an additional weekly weighing 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 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 were continued during the year, and 65 patients were referred for treatment during the period 1.1.48 to 4.7.48. During the year the equipment for sunlight treatment was installed at Church Road and Sherwood House Clinics. The following table shows the work done at each Sunlight Clinic since .July 5, 1948. Treatment commenced at Church Road Clinic in June, and at Sherwood House Clinic in August. Sessions. Attendances Total Attendances. Average Clinic Attendance P. S. Church Road 52 99 929 1028 19.8 Sherwood House 42 102 883 985 23.5 21 Orthopœdic 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. Up to 4.7.48 23 (30) cases were referred to this clinic, as compared with 33 cases in 1947. 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: — * Figures not available. Maternity and Child Welfare Records Church Road, Mitcham. Summary—Year 1948. Expectant Mothers Nursing Mothers Infants Total New Patients 28 (152) 2 (20) 24 (139) 54 (311) Subsequent attendances 81 (287) 39 (182) 32 (119) 152 (588) Total attendances 109 (439) 41 (202) 56 (258) 206 (899) Inspections 28 (125) 5 (25) 23 (129) 56 (279) Fillings—permanent teeth 44 (162) 3 (66) — (-) 47 (228) Fillings—temporary teeth — (-) — (-) 36 (81) 36 (81) Extractions—permanent teeth 42 (142) 47 (1201 — (-) 89 (262) Extractions—temporary teeth — (-) — (-) 36 (165) 36 (165) Anaesthetics—local 1 (42) 1 (16) — (1) 2 (59) Anaesthetics—general 14 (38) 8 (23 12 (68) 34 (129) Dentures partial 2 (5) 4 (15) — (-) 6 (20) Dentures—full — (2) 3 (8) — (-) 3 (10) Patients awaiting dentures — (2) — (3) — (-) — (5) Patients—treatment complete 16 (57) 5 (23) 16 (107) 37 (187) Patients—treatment incomplete *- (30) *- (-) *- (8) *- (38) 22 Health Visiting There were six Health Visitors employed in visiting the mothers and children in this district until July 4, 1948. After this date the District Health Visitors in conjunction with the two Health Visitors employed primarily on school medical work were combined to form the Divisional staff of the Mitcham area. By the end of the year every Health Visitor was doing the combined duties of District Health Visitor and School Health Visitor. 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. 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 up to 4.7.48: — Age Group 2 to 3 yrs. 3 to 4 yrs. 4 to 5 yrs. Total 100 (163) 88 (143) 43 (83) 231 (389) Attendances at Infant Welfare, Centres, 1948 Particulars Cavendish Road St. Barnabas Church Road Sherwood House Meopham Road Total Number of new oases registered during period 1.1.48—4.7.48: Children under one year of age 89 (176) 138 (235) 166 (306) 102 (207) 102 (173) 587 (1097) Children over one year and under five years of age 11 (19) 20 (36) 23 (30) 21 (41) 11 (19) 86 (161) Number of children in attendance at 4.7.48: Under one year of age 203 (329) 234 (191) 257 (269) 258 (379) 169 (145) 1121 (1313) Over one and under five years of age 90 (98) 291 (479) 329 (506) 197 (240) 251 (381) 1168 (1704) Attendances of children under one year of age 1789 (8248) 2633 (4746) 2624 (4935) 1715 (3342) 1720 (3070) 10481 (19341) Attendances of children over one year of age 321 (677) 641 (1254) 887 (1834) 876 (1820) 697 (1308) 3422 (6893) Total attendances at centres 2110 (3925) 3274 (6000) 3511 (6769) 2591 (5162) 2417 (4378) 13903 (26234) Average attendances at centres 87.9 (81.8) 125.9 (115.4) 67.5 (64.5) 56.3 (53.8) 48.3 (43.8) Percentage of infants under one year of age attending centres, for first time, of the total live births ... ... ... ... ... (92.03 23 Visits Paid by Health Visitors Miss D. Hayward Miss R. Harris Miss M. Knight Miss L. Salway Miss M. Luther Mrs. L. Harrison Miss E. Wyatt Miss J. Hitchener Total Primary Ante-Natal Visits 2 (5) 47 (97) 34 (66) 55 (96) 47 (75) 55 (113) - (4) - (7) 240 (463) Subsequent Ante-Natal Visits 3 (10) 1 (2) 20 (35) 4'2 (63) 94 (144) 71 (143) — (-) — (-) 231 (397) Primary Visits to Infants under 1 year 4 (6) 117 (246) 106 (172) 123 (234) 163 (284) 153 (298) — (27) — (30) 666 (1297) Subsequent Visits to Infants 2 (4) 327 (625) 466 (740) 518 (1905) 949 (1584) 513 (1051) — (102) — (81) 2775 (5092) Visits to Children 1—5 years 3 (8) 800 (1523) 727 (1241) 1066 (1830) 1187 (2019) 382 (875) — (208) — (155) 4165 (7859) Visits to Premature Infants — (-) 1 (2) 1 (3) 11 (17) 9 (21) 73 (113) — (2) — (-) 95 (158) Visits re Infant Deaths — (-) 3 (5) 1 (3) 4 (6) — (—) — (3) — (-) — (2) 8 (19) Visits re Stillbirths — (-) — (2) 4 (6) 3 (3) 1 (1) 2 (2) — (1) — (-) 10 (15) Visits to Cases of Ophthalmia Neonatorum 4 (5) 1 (1) 2 (2) - (-) - (-) - (-) - (-) - (-) 7 (8) Visits re Cases of Puerperal Fever 2 (2) - (-) - (-) - (-) - (-) - (-) - (—) - (-) 2 (2) Primary Visits to Cases of Tuberculosis - (-) - (-) - (-) - (-) 1 (1) - (-) - (-) - (-) 1 (1) Subsequent Visits to Cases of Tuberculosis — (-) — (-) — (-) — (-) — (-) — (-) — (-) — (-) — (-) Visits re Diphtheria Immunisation — (-) — (2) 14 (24) — (-) — (-) 2 (2) — (-) — (-) 16 (28) Visits re Scabies — (1) — (-) — (-) — (-) — (-) 2 (2) — (-) — (-) 2 (3) Visits re Other Infectious Diseases — (-) 40 (43) 36 (36) 81 (129) 26 (36) 50 (97) — (-) — (4) 233 (345) Visits re Infant Life Protection 39 (92) 2 (6) 1 (1) 1 (1) — (-) — (-) — (-) — (-) 43 (100) Visits re Adoption 33 (67) 5 (9) 10 (22) 19 (33) 6 (7) 2 (19) — (-) — (3) 75 (160) Visits re Home Help Scheme — (-) 1 (1) — (-) — (-) — (-) — (-) - (-) — (-) 1 (1) Special Visits 7 (40) — (5) 14 (22) 22 (38) 15 (21) — (-) — (-) — (-) 58 (126) Total 99 (240) 1345 (2569) 1436 (2373) 1945 (3355) 2498 (4193) 1305 (2718) — (344) — (282) 8628 (16074) 25 Supply of Food and Medicines Dried milk, Virol, Parish'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) 162 (350) 1428 (2761) 18.8 (18.4) Church Road Clinic 824 (501) 1001 (1863) 19.2 (17.91) Midwives' Clinic 278 (410) 545 (924) 21.0 (18.48) Total 764 (1261) 2974 (5548) 19.7 (18.26) One thousand two hundred and sixty-one expectant mothers attended the ante-natal centres as against 1,215 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 26 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. 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. Up to 4.7.48 42 (47) women attended for this examination. In 1947 42 cases attended. 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; 116 (226) cases attended up to 4.7.48. The total number of women who attended the post-natal clinics at Church Road Clinic up to 4.7.48 was 94 (174), the average attendance being 9.4 (8.8). Home Help and Domestic Help Service The combined Home Help and Domestic Help Service has proved most successful. Up to 4.7.48 5 (5) full-time home helps 27 were engaged on maternity cases, and 39 (121) mothers received their services during the period. 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. On 4.7.48 5 (5) full-time and 108 (153) part-time home helps were being employed; 229 (406) cases received assistance during the period up to 4.7.48. 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 up to 4.7.48 was 161 (330). During 1947 322 cases were admitted. 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. 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. 28 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, one sister, three staff midwives 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 29  Number of births 1940 239 1941 215 1942 263 1943 221 1944 218 1945 267 1946 290 1947 312 1948 821 Number of maternity beds in the institution (exclusive of isolation and labour beds), 15. Number of maternity cases admitted during the year, 161 (330). Average duration of stay, 11.5 days (11.8 days). Number of cases delivered by (a) midwives, 146 (300); (b) doctors, 8 (21). Number of cases in which medical assistance was sought by a midwife in emergency, 50 (117). Number of cases notified as (a) puerperal fever nil (nil); (b) puerperal pyrexia, 2 (2). Number of cases of pemphigus neonatorum, nil (nil). Number of infants not entirely breast-fed whilst in the institution, 18 (30). Number of cases notified as ophthalmia neonatorum, nil (1). Number of maternal deaths, nil (nil). Number of stillbirths, nil (3). Number of infants' deaths within ten days of birth, 2 (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. 30 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:— At 4.7.48 At 31.12.48 Number of foster mothers on register, December 31, 1948 5 5 Number of children on register, December 31, 1948 9 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 118 260 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. At 4.7.48 At 31.12.48 Number of persons who gave notice under Section 7 (3) during the year 14 24 Total number of children in respect of whom notice was given 18 31 Number of such children under supervision at the end of the year 12 10 31 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 1948 40 Number of children affected 90 Number of visits paid 126 Day Nurseries Eagle House has continued to give satisfactory service during 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 1948 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 23.29 (19.7) 11.659 (12.1) Two—five 44.87 (40.4) 39.07 (36.3) Total 68.16 (60.1) 50.729 (48.4) 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 12 per session. During the year the Committees were concerned with long waiting lists for admission to the Day Nurseries. At the end of the year provision of additional accommodation was under active consideration. 32 THE CARE OF ILLEGITIMATE CHILDREN 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. The Borough Council made a grant of £100 per annum until 4.7.48 towards the cost of the salary of the part-time social worker. The association has done excellent work during the year, and cases referred to hostels have had their cost of maintenance paid by the Borough Council or the Divisional Sub-Committee in each case. The opening of the Haygarth Witts Home, The Ridgway, Wimbledon, by the Merton and Wimbledon Moral Welfare Association appears to have solved the difficulty previously experienced in obtaining suitable hostel accommodation. Care of Premature Infants Forty (67) infants were notified as weighing lbs. or less at birth during the year. Five (11) occurred at home confinements, and of this number 1 (3) were removed to hospital, where 1 (1) died when one week old, (1) died on the second day of birth and (1) died within one hour of birth. Of the 35 (56) infants born in hospital (1) died when two weeks old, 2 (5) died within a week of birth and (1) died within 24 hours of birth. 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 draught-proof cots heated by hot water bottles, blankets, clothes, special feeding bottles, etc., may be borrowed free of cost at the request of the doctor or midwife in charge of the case. Home helps are available when necessary. 33 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. RIVERS AND STREAMS Visits have been paid to all works suspected of discharging effluent into surface water sewers. CLOSET ACCOMMODATION The whole of the district is on the water carriage system, the houses being drained to the public sewer. PUBLIC CLEANSING A weekly collection of house refuse is carried out by direct labour. Six dust collection vehicles are in use. A weekly collection of salvage is also made, two vehicles being used for this purpose. Pig food is collected twice weekly, except for the months of June, July and August, when a daily collection is made. 34 ERADICATION OF BED BUGS Number of Council houses found infested during the year, 88. Number of other houses found infested during the year, 44. Number of requisitioned, etc., houses found infested during the year, 36. Total number of houses disinfested during the year, 124. Methods employed:— 6 houses treated with sulphur dioxide. 118 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 44 houses. Number of houses disinfested for beetles, 68. SCHOOLS The supervision of the public elementary schools is under the control of the Education Department of the Surrey County Council. The sanitary fittings, etc., however, are inspected periodically by the sanitary inspector. All schools have a constant supply of water from the mains of the Metropolitan Water Board. Medical Inspection.—The medical inspection of schoolchildren 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 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. 35 RATS AND MICE DESTRUCTION ACT, 1919 Three full-time and one part-time Rodent Operators were employed. House to house inspections 9,950 Complaints received 316 Number of treatments re rat infestation including test baits as result of inspections and complaints 1,660 Factory and business premises treated 132 Visits by Sanitary Inspectors 65 Three sewer maintenance treatments were carried out; 358 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:— Number of complaints received 1,098 Visits re complaints and sundries 2,632 Revisits 4,847 Houses inspected for defects 2,818 Number of nuisances discovered 1,468 Number of intimation notices served 1,159 Number of intimation notices complied with 998 Number of statutory notices served 344 Number of statutory notices complied with 818 Visits to butchers and other food shops 474 Visits to factories 161 Visits to refuse dumps 5 Visits to slaughter houses 21 Visits to restaurant kitchens 53 Visits to stables 6 Visits to garages 15 Visits to outworkers' premises 34 36 Visits to marine stores 1 Visits to caravan yards 15 Visits re building licence applications 1,047 Details of visits to other premises are enumerated in other sections of the report. Character of Work Done Roofs repaired 520 Eaves guttering and spouting repaired 370 Yards paved or repaired 27 Dampness remedied 140 Water service pipes repaired 37 Waterclosets: repairs to roof, walls, doors, windows, floors and seats 225 Waterclosets: flushing apparatus repaired or renewed 102 Water storage cisterns cleansed, regulated, repaired or renewed 43 Water supply reinstated 7 Flooring of rooms repaired and ventilation improved 268 Rooms cleansed and redecorated 69 Repairs to sinks, waste pipes and traps 56 Window frames, sashes and sills provided 545 Window frames, sashes and sills repaired 91 Drains repaired and obstructions removed 129 Repairs to firegrates 106 Repairs to stoves, coppers, ranges, etc. 60 New dustbins provided 61 Accumulations removed 9 Repairs to chimney stacks, etc. 50 Repairs to staircases 36 Smoke nuisances abated - Repairs to doors 114 Sinks and handbasins, repairs or renewals 64 Drains tested 130 Repairs to internal plaster 2,739 Grid and mica flaps provided 24 Drain inspection chamber covers provided 26 External brickwork (repaired, pointed or rendered) 310 W.c. pans and traps provided 140 37 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.—Sixteen 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. Five 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 for using two dirty milk bottles. The retailer was fined £75 with £3 3s. costs on one summons. The other summons was dismissed. Petroleum (Consolidation) Act, 1928.—Ninety-two licences to store petroleum and cellulose solutions were granted, totalling 161.708 gallons. Five licences were also issued for 2,744 lbs. of carbide of calcium to be stored. Unsound Food Dealt With. Beef 893¼ lbs. Fish 2,782½ „ Cheese 34¾ ,, Ox Tongue 6 „ Chitterlings ¼ ,, Poultry 83 ,, Sausages 41 „ Paste 1 jar Jellies 3 Milk 187 tins Milk Powder 21 lbs. Sugar 224 lbs. Fruit 150 ,, Fruit, Dried 592 „ Corned Beef 405¾ lbs. Butter 7 „ Jam 70 ,, Mincemeat 11 „ Beef Extract 68 ozs. Beef Aspic Jelly 44 ,, Chocolate 8 lbs. 2 ozs. Chocolate Cup 2 pkts. Semolina 11 lbs. Potatoes 1,232 lbs. Tomatoes 140 ,, Cake Mixture 10 „ Eggs 886 Dried Eggs 10 ozs. 38 Flour 37 „ Pickles 20 bottles Sauce 12 ,, Cereals 37 pkts. Bacon 17½ lbs. Oats 10 „ Sundry tinned foods 1,565 tins Yours faithfully, 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) 2,813 (b) Number of inspections made for the purposes 3,241 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 998 Number of dwelling houses rendered fit in consequence of formal action by the local authority or their officers 348 3. Action under Statutory Powers During the Year: — Proceedings under Section 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which notices were served requiring repairs 25 (2) Number of dwelling houses which were rendered fit after service of formal notices: — (a) By owners 15 (b) By local authority in default of owners 10 Proceedings under Section 11 of the Housing Act, 1936: — (1) Number of houses in which demolition orders were made 3 39 Proceedings under Section 12 of the Housing Act, 1936: — (1) Number of houses in which closing orders were made for underground rooms 2 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 14 INSPECTION AND SUPERVISION OF FOOD FOOD AND DRUGS ACT. 1938 Formal Samples. Forty-nine formal samples were taken as follows:— Milk 32 Meat Extract 1 Baking Powder 2 Mixed Spice 1 Pudding Mixture 1 Sausage Meat 2 Malt Vinegar 1 Luncheon Sausage 1 Gravy Powder 1 Uncooked Cake 1 Potato Powder 1 Jam 2 Almond Flavouring 1 Salad Cream 1 Gelatine 1 Informal Samples. Forty-two informal samples were taken as follows:— Milk 2 Coffee Extract 2 Cake and Pudding Mix- Bicarbonate of Soda 1 tures 4 Chocolate, Cocoa 3 Malt Vinegar 2 Jam 2 Baking Powder 8 Flour 1 Pepper 2 Cake 1 Pickles, Sauces, etc 6 Lemonade Powder 1 Pastes, Sandwich Beef Cubes 1 Spreads 3 Curry Powder 1 Essences 3 Gelatine 1 Sausage Meat 3 40 All samples were satisfactory with the exception of one formal sample and two informal samples. The result of one formal sample (beef sausage) was passed to the Ministry of Food. Action was taken against the butcher concerned who was fined £2 with £2 2s. costs. One warning letter was sent to a manufacturer regarding an unsatisfactory food sample, and one warning letter was sent to a manufacturer regarding unsatisfactory food labelling. MILK (SPECIAL DESIGNATION) REGULATIONS, 1936-46. During the year the Council granted the following number of licences under the above named Order:— Tuberculin Tested 9 Pasteurised 7 Pasteurising Plant 1 Supplementary Licences— Pasteurised 8 Tuberculin Tested 7 Ninety-one samples of Graded Milk were submitted for bacteriological examination. Eighty-two samples were satisfactory and nine were unsatisfactory. Communications were sent to the dairies regarding the unsatisfactory samples. BAKEHOUSES The number of bakehouses in the district is 10. Twenty-two visits have been paid. DAIRIES There are 10 registered premises within the district. With the exception at one pasteurising establishment, milk is now being supplied by the wholesalers to the dairy men in sealed bottles. During the year 91 visits of inspection were paid. SLAUGHTERHOUSES There are two registered slaughterhouses in the Borough, 21 visits have been paid, 41 MEAT INSPECTION Carcases Inspected and Condemned Cattle, excluding cows Cows Goats Sheep and Lambs Pigs Number killed ... ... 30 ... 47 Number inspected ... ... 30 ... 47 All diseases except tuberculosis: Whole carcases condemned Carcases of which some part or organ was condemned Percentage of the number inspected affected with disease other than tuberculosis ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 2.13 Tuberculosis only : Whole carcases condemned Carcases of which some part or organ was condemned Percentage of the number inspected affected with tuberculosis ... ... ... ... ... ... ... ... ... 7 ... ... ... ... 14.9 FOOD PREPARING FACTORIES There are 13 other premises in which food is prepared- for human consumption. All of these have been systematically visited. PIGGERIES There are nine piggeries in the Borough. Fifty-two visits were paid during the year. FACTORIES ACT, 1937 I.—Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors): — 42 Premises M/c line No. Number on Register Number of M/c line No. Inspections Written Occupiers (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 26 13 1 1 (ii) Factories not included in (i) to which Section 7 applies (a) Subject to the Local Authorities (Transfer of Enforcement) Order, 1938 2 201 120 6 2 (6) Others 3 ... ... ... 3 (iii) Other Premises under the Act (excluding out-workers' premises) 4 10 29 3 4 TOTAL ... 237 162 10 ... 43 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 H M. Inspector (1) (2) (3) (4) (5) (6) (7) (8) Want of cleanliness (S.l) 6 7 7 5 Overcrowding (S.2) 6 6 Unreasonable temperature (S.8) 7 7 Inadequate ventilation 8 8 Ineffective drainage of floors (S.6) 9 9 Sanitary Conveniences (S.7) (a) Insufficient 10 10 (b) Unsuitable or defective 11 8 8 11 (c) Not separate for sexes 12 12 Other offences (not including offences relating to Homework) 13 13 TOTAL ... 15 15 ... 44 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) U) (6) (6) (7) (8) (9) Wearing apparel Making, etc 14 70 14 Cleaning and washing 15 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 Tenta 31 31 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 4 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 60 43 Textile weaving 44 44 Lampshades 45 45 TOTAL ... 161 46 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES INFECTIOUS DISEASE NOTIFICATIONS The total number of confirmed notifications received during the period up to 4.7.48 was 1,033 (1,523). 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 336 Health Visitors 341 To small pox contacts 42 Total 719 Rooms disinfected after infections disease 269 47 Small Pox. 6carlet Fever Diphtheria Typhoid Fever Erysipelas Pneumonia Puerperal Pyrexia Ophthalmia Neonatorum Dysentery Cerebro-spin&l Meningitis Poliomyelitis Measles Whooping Cough Food Poisoning PolioEncephalitis Paratyphoid Malaria Totals The monthly incidence of infectious disease was: — January ... 3 ... ... 2 6 ... 2 2 1 ... 11 20 ... ... ... ... 47 February ... 4 ... ... 3 3 ... ... ... ... ... 43 8 ... ... ... ... 61 March ... 8 ... ... 4 5 1 1 ... ... 1 50 28 ... ... ... 1 99 April ... 4 ... ... 6 5 1 1 ... ... ... 143 20 ... ... ... ... 180 May ... 9 ... ... ... 9 ... 2 ... ... 1 351 60 ... ... ... ... 388 June ... 6 ... ... 3 9 1 ... ... ... ... 204 21 ... ... ... ... 237 July 1.4 ... 1 ... ... ... ... ... ... ... ... ... 16 4 ... ... ... ... 21 5-31 ... 3 ... ... 1 3 ... 1 1 ... ... 63 29 ... ... ... ... 101 August ... 3 ... ... ... ... ... 1 1 1 ... 13 38 ... 1 ... ... 58 September ... 12 ... ... ... 1 ... 1 1 ... ... 17 27 ... ... ... ... 59 October ... 16 ... ... 1 2 ... ... ... ... 2 63 21 ... ... ... ... 105 November ... 15 ... ... 3 2 ... ... 1 ... ... 61 25 ... ... ... ... 107 December ... 8 1 ... 1 5 ... ... 1 ... ... 35 9 ... ... ... ... 60 Totals ... 92 1 ... 124 43 3 9 7 2 4 1070 266 ... 1 ... 1 1523 48 Infectious Disease Notifications, 1928-48. Disease 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1.1.48 to 4.7.48 5.7.48 to 31.12.48 Small Pox 9 7 ... 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 102 134 113 105 174 240 392 143 171 192 150 61 48 75 175 212 97 147 95 62 35 57 Diphtheria 75 133 129 49 32 40 83 80 104 89 64 27 36 72 25 42 10 63 32 4 ... 1 Typhoid Fever 3 4 9 2 3 3 ... 3 5 ... 1 ... ... ... ... 1 ... 1 ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Undulant Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... Puerperal Fever 4 6 1 7 5 1 1 2 2 1 ... ... ... ... ... ...... ... ... ... ... ... ... Puerperal Pyrexia 9 5 6 9 4 9 6 4 11 5 4 7 2 2 6 3 5 8 6 9 3 ... Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cere bro- spinal 1 4 ... ... 1 4 1 1 3 1 2 1 13 12 6 8 3 3 1 2 1 1 Meningitis Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 10 22 22 17 11 31 30 20 22 16 8 19 17 19 7 22 13 16 25 9 18 6 Measles ... ... ... ... ... ... ... ... ... ... ... ... 301 194 599 651 112 739 358 533 818 252 Acute Diarrhœa ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 3 11 2 2 Ophthalmia Neonatorum 3 3 1 3 4 2 2 4 3 1 3 3 1 3 10 4 4 ... 2 2 6 3 Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Encephalitis ... ... 2 1 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Lethargica Pneumonia 54 57 35 45 52 37 45 35 36 32 43 ... 30 22 20 50 37 33 41 37 30 13 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... 1 ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... 4 16 186 161 162 166 96 234 216 117 149 Food Poisoning ... ... ... ... ... ... ... ... ... ... ... 4 4 6 11 ... ... 5 1 ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 67 13 6 1 2 5 Paratyphoid ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... Totals 270 375 319 242 288 368 560 293 357 338 275 125 468 591 1021 1161 515 1126 807 888 1033 490 49 Small Pox No case of small pox was notified during the year 1948. Scarlet Fever The number of cases of scarlet fever notified during the year was 92 as compared with 62 in 1947, equivalent to a case rate of 1.39 per 1,000 population. The disease has continued mild in character; one death due to this cause was recorded. Of the total number of cases notified 64 were treated in hospital, and 28 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 One case of diphtheria was notified during the year and was removed to hospital for treatment; contacts are swabbed as a routine. The 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 — — 4 — — 5-9 — — 5-9 — — 10-14 1 — 10-14 — — Over 14 — — Totals 1 Totals — — Four cases were notified during 1947. 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 vear: — Under five 1,125 Five—14 340 Total 1,465 The following figures show the number of the child population considered immunised at December 31, 1948: Age at 31.12.48 i.e. born in year Under 1 1948 1 1947 2 1946 3 1945 4 1944 5 to 9 1939-1943 10 to 14 1934-1938 Total under 15 Number immunised 7 850 894 658 826 3224 4068 10527 Estimated mid-year population 1948 5668 8314 13972 The per cent. immunised is as follows: — Under five 57.18% Five—14 87.71% The number of birthday greetings sent in 1948 was 1,153. 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. 52 Erysipelas Twenty-four cases were notified. Eight cases were removed to hospital. Puerperal Pyrexia Three cases were notified during the year. Pneumonia Forty-three cases of primary pneumonia were notified during the year. The number of deaths from all forms of pneumonia, some of which are not notifiable, was 30, of which 22 were males and 8 females. Cerebro-Spinal Fever Two cases occurred during 1948. There were two deaths, one male and one female. Influenza During the year three deaths from influenza were recorded, of which one was a male and two were females. The previous year three 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 nine cases of ophthalmia neonatorum were notified. Poliomyelitis Seven cases of poliomyelitis were notified during the year, of which the diagnosis was subsequently confirmed in four cases. 53 School Notifications The school intimation notices of infections 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 170 Mumps 134 Impetigo 2 Jaundice 3 Rubella 11 Ringworm 2 Scabies 1 Measles 381 Whooping cough 54 Scarlet fever 23 Meningitis 2 Tonsillitis 1 Conjunctivitis 3 Cancer The number of deaths from cancer registered during the year was 111, of which 61 were males and 50 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 1948 was as follows: — Digestive organs 22 cases Genito-urinary organs 9 „ Breast 11 „ Other sites 69 „ Total 111 54 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 1.33 1.43 1930 73 1.25 1.45 1931 81 1.41 1.48 1982 68 1.0 1.51 1983 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 1948 111 1.67 1 85 Tuberculosis During the year 78 new cases of tuberculosis were notified, viz.: — Males Females Total Pulmonary 36 33 69 Non-Pulmonary 6 3 9 Totals 42 36 78 55 Nineteen cases were transferred into the Borough as follows: — Males Females Total Pulmonary 5 12 17 Non-Pulmonary 1 1 2 Totals 6 13 19 The total number of deaths registered as occurring from tuberculosis was viz: — Males Females Total Pulmonary 22 16 38 Non-Pulmonary 4 — 4 Totals 26 16 42 England and Wales Mitcham Death rate from respiratory tuberculosis per 1,000 population 0.44 0.55 Death rate from non-pulmonary tuberculosis per 1,000 population 0.07 0.06 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 1 ... ... ... ... ... 5 years ,, 9 ,, 1 1 ... ... ... ... ... ... 10 „ „ 14 „ ... 3 1 1 ... ... ... ... 15 „ „ 19 6 7 1 1 2 2 1 ... 20 „ „ 34 „ 12 14 2 1 7 9 2 ... 35 „ „ 44 „ 5 4 ... ... 5 2 ... ... 45 „ „ 64 „ 10 3 1 ... 8 2 1 ... 65 ,, and upwards ... ... ... ... ... 1 ... ... Unknown 1 ... ... ... ... ... ... ... Totals 36 33 6 3 22 16 4 ... 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 Pulmonary: females ... ... ... ... ... 1 ... 2 ... ... 1 4 Non-Pulmonary: males ... ... ... ... ... 1 ... ... ... ... ... 1 Non-Pulmonary: Females ... ... ... ... ... ... ... ... ... ... ... ... 57 The sources from which information as to the abovementioned cases was obtained are as follows:— No. of Cases Pulmonary Non- Pulmonary Death returns (a) From Local Registrar 3 ... (b) Transferable deaths from Registrar General 1 ... Posthumous notifications 1 1 Number of cases removed from register during 1948: — Reason Pulmonary Non-Pulmonary Total Cases Males Females Total Males Females Total Withdrawal of notification ... ... ... ... ... ... ... Recovery from disease 2 4 6 ... ... ... 6 Death 23 17 40 2 ... 2 42 Removed from district 6 7 13 2 3 5 18 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths is as follows: — Non-notified tuberculosis deaths 6 Notified tuberculosis deaths 36 Percentage of non-notified T.B. deaths (all forms) 14.28 per cent. Percentage of non-notified pulmonary T.B. deaths 11.90 „ 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 19 such examinations have been made. 58 Mitcham, Beddington and Wallington Tuberculosis Care Committee Functions of the Committee 1. To alleviate want or distress amongst tuberculosis 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 A clinic for the diagnosis of this condition has been held by the Medical Officer of Health each morning at Mitcham Court. I am pleased to report that the number of cases requiring treatment was practically halved. 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, 63 persons. Classified as: — Pre-school age children 5 School age children 36 Adults 22 Number of baths given, 204. 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, 70. Classified as: — Pre-school age children — School age children 67 Adults 3 Number of treatments given, 255. 60 WANDLE VALLEY HOSPITAL Cases admitted to hospital during the year ended December 31, 1948. DISEASE Beddington & Wallington Coulsdon & Purley Merton & Morden Mitcham Cases Deaths Cases Deaths Cases Deaths Cases Deaths Diphtheria ... ... ... ... 2 ... ... (1) ... Scarlet fever 47 ... 24 ... 78 ... 23 (60) 1a (la) Erysipelas 3 ... ... ... 2 ... 4 (7) ... Whooping cough 2 ... 4 ... 4 ... 3 (3) ... Tonsillitis 2 ... 3 ... 7 ... 10 (12) ... Measles 7 ... 6 ... 11 ... 22 (26) ...(lb) Poliomyelitis 1 1(d) ... ... 4 ... 1 (4) 1 (1) Chicken Pox 1 ... ... ... ... ... ... (...) ... Admitted with mother 1 ... ... ... ... ... 2 (3) ... Otitis Media ... ... ... ... 1 ... 1 (1) ... Abscess ... ... ... ... ... ... 1 (1) ... Meningitis 1 ... ... ... 1 ... 2 (5) ... Mumps ... ... ... ... ... ... 1 (1) ... Observation 1 ... ... ... ... ... ... (1) ... Septicaemia ... ... ... ... 2 ... ... (...) ... Pneumonia 1 ... 2 ... 2 1(c) ... (...) ... Disseminated sclerosis ... ... ... ... 1 ... ... (...) ... Enteritis ... ... 1 ... 1 ... ... (1) ... Carcinoma of throat ... ... ... ... 1 ... ... (...) ... Sunstroke 1 ... 1 ... 1 ... ... (...) ... Nervo-myelitis optica 1 ... ... ... ... ... ... (...) ... Puerperal pyrexia 1 ... ... ... 1 ... ... (1) ... Rubella ... ... 1 ... ... ... ... (...) ... Influenza and pleurisy- 1 ... 3 ... 1 ... ... (...) ... Acute nephritis* ... ... ... ... ... 1 ... (...) ... 71 1 44 ... 120 2 70 (127) 2 (3) * This case was admitted 24.12.47 as Scarlet Fever. (а) Toxic Scarlet Fever and acute heart failure. (b) Measles with Pneumonia. (c) Pneumonia with Membranous Laryngitis. (d) Bulbar Paralysis. 61 INDEX page Abortion, Deaths 14 Admissions—Wandle Valley Joint Hospital Board 60 Adoption of Children Act, 1939 30 Ambulances 15 Analysis of Mortality 14 Ante-Natal Clinics 17, 25 — Average Attendances 25 Area 8 Bakehouses 40 Bed Bugs, Eradication of 34 Bedding, Disinfection of 19 Birth Rates 10, 14 Births, Illegitimate 8 — In Institutions 9 — Live 8 — notified by Municipal Midwives 9 — Still 8, 29 — Woodlands Maternity Home 27 Blindness, Prevention of 52 Books disinfected, Library 19 Cancer 53 — Deaths from 9, 54 Causes of Deaths 12, 13 Cerebro-Spinal Fever 52 Chief Sanitary Inspector's Report 35 Inspector, Visits by 35, 46 Child Welfare 19 Cleansing, Public 33 Clinics 17, 25, 26 Closet Accommodation 33 Dairies 40 Day Nurseries 31 Death Rates 10, 14 Deaths 8-13, 29, 51-57 Dental Treatment 21 62 PAGE Diarrhœa and Enteritis 51 — Death from 14 Diphtheria 49 — Immunisation 50 — — Clinic 18 — Specimens Examined 15 Disinfection 19 Domestic Helps 26 Domiciliary Midwifery 16 Encephalitis Lethargica 51 Enteritis, Diarrhoea and 51 Eradication of Bed Bugs 34 Erysipelas 51 Examinations, X-Ray 26 Factories Act, 1937 41-45 — — Defects found 43 — — Inspections 42 — (Sections 110 and 11) Outwork 44-45 Food and Drugs Act (1938) 40 — and Medicine, Supply of 25 — Dealt with, Unsound 37 — Inspection and Supervision of 39 — Preparing Factories 41 General Provision of Health Services for the Area 15 Health, Visiting 22 — Visitors, Visits by 24, 46 Home Helps and Domestic Help Service 26 Hospitals 16 Houses, Disinfection of 19 Housing Act, 1936 (Sect. 9, 10 and 16) 38 Housing Act, 1936 (Sect. 11) 38 Housing Statistics 38 Illegitimate Children, Care of 32 Immunisation Clinic, Diphtheria 18 — Diphtheria 18, 50 Infants, Care of Premature 32 Infant Life Protection 29 Infant Mortality 9-11, 14 63 PAGE Infant Welfare Centres, Attendances 23 Infectious Disease, Ambulances 15 — — Case rates 14 — — Contacts 46 — — Hospital 16 - — Incidence of 47 — — Prevalence of and Control over 46 — — Notifications 46, 48, 50 — — — School 53 Influenza 52 Inhabited Houses 8 Inquests 11 Inspection and Supervision of Food 39 Laboratory, Emergency Public Health, Epsom 15 Facilities 15 Legal Proceedings 37 Library Books Disinfected, number of 19 Louse Infestation 59 Maternal Mortality 8, 11, 14 Maternity and Child Welfare Services, Report on 19 Home 17, 27 Hospital Treatment 16 Measles, Deaths from 9 Meat Inspection 41 Medicine, Supply of Food and 25 Mice Destruction Act, 1919, Rats and 35 Midwifery, Domiciliary 16 Milk (Special Designation) Regulations (1936-46) 40 Mortality, Analysis of 14 — Infant 9-11 Maternal 8, 11, 14 N.S.P.C.C. 31 Notifications, Infectious Disease 43, 48, 50 — School 53 Nurseries, Day 31 Nursing in the Home 16 Ophthalmia Neonatorum 29, 52 Orthopædic Clinic 21 64 PAGE Patients Admitted to Hospital 60 Pemphigus Neonatorum 29 Personnel, Committee 5 — Staff 6 Petroleum (Consolidation Act), 1928 37 Piggeries 41 Pneumonia 52 Poliomyelitis 52 Population 8 Post-Natal Clinic 18, 26 Premature Infants, Care of 32 Prevention of Blindness 52 Proceedings, Legal 37 Public Cleansing 33 Puerperal Fever 14, 29 Pyrexia 14, 29, 52 Rateable Value 8 Rats and Mice Destruction Act, 1919 35 Rivers and Streams 33 Rooms Disinfected, number of 19 Samples, Food 39 Sanitary Circumstances of the Area 33 Scabies 58 — Clinic 18 Scarlet Fever 49 School Clinic 18 Schools 34 — Notifications 53 Slaughterhouses 40 Small Pox 49 — Hospital 16 Social Conditions 8 Statistics 8 — Housing 38 — Vital 8 Still Births 8, 29 Streams, Rivers and 33 Sunlight Treatment 20 65 PAGE Supervision of Pood, Inspection and 39 Supply of Food and Medicines 25 — Water 33 Toddlers' Clinics 22 Treatment, Dental 21 Hospital 16 Sunlight 20 Tuberculosis 54 — Care Committee 58 — Clinic 18 — Specimens examined 15, 57 Typhoid Fever 51 Unsound Food dealt with 37 Venereal Diseases Clinics 18 Visits by Health Visitors 23, 46 Sanitary Inspectors 35, 46 Vital Statistics 8 Wandle Valley Hospital—Admissions 60 — — —Disinfections carried out by 19 Water Supply 33 Welfare, Child 19 — Clinics 17 — — Attendances at 23 Whooping cough. Deaths from 9 Woodlands Maternity Home 17, 27 — — — Births 29 — — — Staff 28 X-Ray Examinations 26