MITCHAM AC 4413(1) MITCHAM SURNEY LIBRARY MIT 18 BOROUGH OF MITCHAM REPORT of the Medical Officer of Health for the YEAR 1949 BOROUGH OF MITCHAM REPORT of the Medical Officer of Health for the YEAR 1949 MITCHAM H. G. Mather, Ltd., Caxton Works, Lower Green 3 Borough of Mitcham HEALTH REPORT FOR 1949 To the Mayor, Aldermen and Councillors. Madam, Ladies and Gentlemen, I have much pleasure in submitting the annual report for the year 1949. During most of the year Dr. A. Ashworth was Medical Officer of Health, but he left in October, 1949, to take up his new position as Medical Officer of Health of Brisbane, Australia. Dr. A. W. Johns (Medical Officer of Health of Merton and Morden Urban District) then carried on until the end of the year as Acting Medical Officer of Health. The year was a very good one as regards infectious diseases, the incidence of disease and the severity being generally of a low order. In this connection probably the most outstanding point of interest is that only one case of diphtheria occurred. This compares with a yearly average of 60 for the 20-year period 1927-1946, so that there almost certainly has occurred a considerable saving of lives and illness as a result of immunisation. Although 1949 was a bad year in England and Wales for poliomyelitis, ranking second only to 1947, Mitcham was fortunate in having only six cases, plus one fatal case of polio encephalitis. The birth rate, which reached the high level of 21.39 in 1947. dropped again to a figure of 16.45, corresponding to that which occurred in England and Wales generally. 4 The death rate of 9.17 is low compared with 11.7 for England and Wales. The infant death rate of 24.48 is good compared with 32 for England and Wales, which itself is the lowest rate the country has ever had. Housing difficulties still cause great concern and are a source of bitterness to many in the community. The Borough Council is very well advanced with its housing programme, hut the restricted building space available will soon be filled up, making it impossible to rehouse all those who seek fresh accommodation. I wish to thank the Chairman of the Committees for their great help and assistance, and all the staff for their loyalty and support. I am, Ladies and Gentlemen, Your obedient servant, A. R. GRAHAM. Medical Officer of Health. Public Health Department, Mitcham Court, Mitcham. 5 BOROUGH OF MITCHAM PUBLIC HEALTH COMMITTER. Chairman Alderman Mrs. H. E. Niven The Worshipful the Mayor (Alderman Mrs. J. C. Ericson, J.P.) Aldermen— T. A. East Mrs. E. Watson C. A. Norris Councillors— Mrs. L. Crump D. Gifford Miss M. J. Faraday E. Gulliver G. W. Pearce Mrs. W. R. Martin J. M. Togwell REPRESENTATIVES ON WANDLE VALLEY JOINT SEWERAGE BOARD The Worshipful the Mayor (ex officio) Alderman— W. Jeffery Councillors— F. S. Niven S. L. E. Saldanha 6 STAFF Medical Officer of Health A. Ashworth, MCh.B., M.R.C.S., L.R.C.P., D.P.H., D.T.M. (Ceased duties October, 1949) A. W. Johns, M.R.C.S., L.R.C.P., D.P.H. (Acting Medical Officer of Health till end of 1949) 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) 1. Certificate Sanitary Inspectors' Board. 2. Certificate Meat and Foods R.S.I. 3. Smoke Inspector's Certificate. Clerks (a) L. J. Bellingham (b) Miss V. Valentine (c) Miss M. Jarrold (d) Miss M. Sanders (e) Mrs. R. Osborn (а) Part-time—75 per cent. Surrey County Council. (b) Part-time—75 per cent. Surrey County Council. (c) Transferred to Surrey County Council 24.10.49. (d) Part-time—40 per cent. Surrey County Council. (e) Full-time—Borough of Mitcham. 7 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, 1949 67,060 Number of inhabited houses, 1921 7,160 „ „ „1931 18,187 „ „ „1949 18,688 Rateable Value, 1949 £529,560 Sum represented by a 1d. rate £2,089 STATISTICS. Live Births. Total Male Female Rate per 1,000 of population Legitimate 1064 566 498 Illegitimate 39 20 19 Total 1103 586 517 16.45 Still Births. Total Male Female Rate per 1,000 total births Legitimate 23 12 11 Illegitimate 3 2 1 Total 26 14 12 23.03 Deaths. Total 615 Male 327 Female 288 Rate per 1,000 of population 9.17 Deaths from disease and accidents of pregnancy and childbirth : Rate per 1,000 total births From puerperal sepsis — — From other maternal causes 1 0.88 Total 1 0.88 8 Deaths of infants under one year of age:— All infants per 1,000 live births 24.48 Legitimate infants per 1,000 live legitimate births 24.44 Illegitimate infants per 1,000 live illegitimate births 25.64 Deaths from:— Cancer (all ages) 124 Measles — Whooping cough (all ages) — Diarrhoea (under two years of age) — Percentage of Births Occurring in Institutions Year Total births Births in hospitals, etc. Percentage of births occurring in institutions 1931 1143 370 32.3 1982 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 1948 1215 855 70.37 1949 1129 832 73.69 9 The birth rates, death rates per 1,000 of population, and the infantile mortality rates for the years 1929-49 are shown in the following table:— Year Births Deaths Infant Mortality per 1,000 population per 1.000 population per 1,000 live births mitcham England & Wales mitcham England & Wales mitcham England & Wales 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 1949 16.45 16.7 9.17 11.7 24.48 32 10 Infant Mortality During the year 27 deaths were registered as occurring in infants under one year of age:— Males Females Total Legitimate 15 11 26 Illegitimate 1 ... 1 Totals 16 11 27 as compared with 28 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 Defects Accidents of birth Infectious conditions Other conditions Under 24 hrs 12 8 3 1 - - 1 - 7 days 1 1 - - - - 8 days - 1 mth. 1 - 1 - - - 1 mth -12 mths. 13 - 2 - 1 10 Total 27 9 6 1 1 10 Fourteen infants failed to survive the first month of life, and prematurity was certified as the cause of death of nine of these infants. Maternal Mortality. During the year one death was registered. In 1948 one death was registered due to disease or accident of pregnancy. Inquests. Inquests were held on 21 residents dying within the district and on 8 Mitcham residents who died outside the district, a total of 29. In addition, the coroner held 67 post-mortems without 11 inquests on residents dying within the district, and on 66 Mitcham residents who died outside the district, a total of 133. The following table shows the results of the findings of these inquests:— Accidental deaths 19 Deaths from misadventure 6 Suicides 2 Open verdict 2 Manslaughter — Total 29 12 Deaths Registered during the Year 1949 Cause of Death Males Females Total 1 Typhoid and paratyphoid fevers ... ... ... 2 Cerebro-spinal fever ... 1 1 3 Scarlet fever ... ... ... 4 Whooping cough ... ... ... 5 Diphtheria ... ... ... 6 Tuberculosis of respiratory system 15 5 20 7 Other forms of tuberculosis 1 ... 1 8 Syphilitic diseases 4 4 8 9 Influenza 4 4 8 10 Measles ... ... ... 11 Acute polio-myelitis and polio-encephalitis ... 1 1 12 Acute infectious encephalitis 1 ... 1 13 Cancer of buccal cavity and oesophagus (m) and uterus (f) 3 5 8 14 Cancer of stomach and duodenum 12 9 21 15 Cancer of breast ... 8 8 16 Cancer of all other sites 54 33 87 17 Diabetes ... 2 2 18 Intra cranial vascular lesions 28 24 52 19 Heart disease 81 89 170 20 Other diseases of circulatory system 12 16 28 21 Bronchitis 27 18 45 22 Pneumonia 11 17 28 23 Other respiratory diseases 2 2 4 24 Ulcer of stomach or duodenum 6 1 7 25 Diarrhoea (under two years) ... ... ... 26 Appendicitis 2 1 3 27 Other digestive diseases 4 4 8 28 Nephritis 11 2 13 29 Puerperal and post-abortive sepsis ... ... ... 30 Other maternal causes ... 1 1 31 Premature birth 4 3 7 32 Congenital malformations, birth injuries, infantile disease 7 7 14 33 Suicide ... 2 2 34 Road traffic accidents 9 1 10 35 Other violent causes 6 3 9 36 All other causes 23 25 48 All causes 327 288 615 13 Birth-rates. Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1949. (Provisional figures based on quarterly returns.) England and Wales 126 County Boroughs and Great Towns including London 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 census) London Administrative County Mitcham Rates per 1,000 civilian population Births— Live 16.7 * 18.7 18.0 18.5 16.45 Still 0.39* 0.47 0.40 0.37 0.39 Deaths— All causes 11.7 * 12.5 11.6 12.2 9.17 Typhoid and Paratyphoid 00.0 0.00 0.00 0.00 0.00 Whooping cough 0.01 0.02 0.01 0.01 0.00 Diphtheria 0.00 0.00 0.00 0.00 0.00 Tuberculosis 0.15 0.52 0.42 0.52 0.31 Influenza 0.15 0.15 0.14 0.11 0.12 Smallpox — — — — — Acute Poliomyelitis and Polioencephalitis 0.01 0.02 0.02 0.01 0.01 Pneumonia 0.51 0.56 0.49 0.59 0.42 Notifications (corrected)— Typhoid fever 0.01 0.01 0.01 0.01 0.00 Paratyphoid fever 0.01 0.02 0.01 0.01 0.00 Cerebro-spinal fever 0.02 0.03 0.02 0.02 0.00 Scarlet fever 1.63 1.72 1.83 1.46 1.33 Whooping cough 2.39 2.44 2.39 1.70 3.16 Diphtheria 0.04 0.05 0.04 0.07 0.01 Erysipelas 0.19 0.20 0.19 0.17 0.18 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 8.95 8.91 9.18 8.54 5.28 Pneumonia 0.80 0.91 0.65 0.55 0.29 Acute Poliomyelitis 0.13 0.13 0.12 0.18 0.09 Acute Polioencephalitis 0.01 0 01 0.02 0.01 0.01 Food Poisoning 0.14 0.16 0.14 0.19 0.09 Rates per 1,000 lire births Deaths under one year of age 32† 37 30 29 24.48 Deaths from diarrhœa and enteritis under two year6 of age 3.0 3.8 2.4 1.7 0.00 Rates per 1,000 total births (live and still) Maternal mortality Abortion with sepsis 0.11 Not available - ,, without sepsis 0.05 - Puerperal infections 0.11 - Other 0.71 0.88 Notifications— Puerperal fever 6.31 8.14 5.30 6.82 1.77 Puerperal pyrexia Mortality per million women aged 15-44 Abortion— With sepsis 8 Not available Without sepsis 4 * Rates per 1,000 total population. † Per 1,000 related live births. 14 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA LABORATORY FACILITIES. Most of the bacteriological examinations for this district were carried out at the Emergency Public Health Laboratory at Epsom, including bacteriological examinations of milk, water and ice-cream. Examinations were also carried out in respect of certain infectious diseases at the Wandle Valley Isolation Hospital where 79 swabs for Diphtheria and 11 sputa for Tuberculosis were examined during the year. The chemical analysis of milk, water and foodstuffs was carried out by the Public Analyst, Daniel D. Moir, M.Sc., F.R.I.C., 16, Southwark Street, London, S.E.I. AMBULANCES The Ambulance service is supervised by the Surrey County Council. Two ambulances are stationed at Mitcham Court, Telephone No. Mitcham 3082. If an ambulance is not available telephone Fairlands 8893 (St. Helier Hospital). For Infectious Disease Cases.—Two motor ambulances for the removal of cases of infectious disease are stationed at the Wanrlle Valley Isolation Hospital. Disinfection The disinfection of houses is undertaken by the Council. Disinfection of bedding, etc., is done by the Wandle Valley Isolation Hospital. No charges are made for disinfections carried out in cases of notifiable infectious disease. Public library books which have been in contact with cases of infectious disease are disinfected at the Public Health Department. 15 Number of disinfections carried out by Wandle Valley Isolation Hospital 42 Number of rooms disinfected by fumigator 231 Number of library books disinfected 237 HOSPITALS The hospitals directly concerned with the Mitcham area are administered by the St. Helier Group Hospital Management Committee, which is situated at Carshalton, Surrey. This group is itself contained within the South-West Metropolitan Regional Hospital Board. General Cases.—The principal hospitals are the Wilson Hospital which is situated within the district, and the St. Helier Hospital, Carshalton, which caters for all types of cases. The Nelson Hospital at Merton and the large London hospitals are also used. Infections Diseases.—Cases usually go to the Wandle Valley Isolation Hospital at Beddington Corner, Mitcham Junction. Other hospitals nearby, namely, the Grove Hospital. Tooting, and the Cuddington Isolation Hospital, Banstead, are also used frequently. Smallpox Cases.—By agreement with the South-East Metropolitan Regional Hospital Board, any cases are admitted to the Joyce Green Hospital, Dartford, Kent, upon application. Maternity Cases.—Expectant mothers, if home conditions or medical history do not permit of home confinement, are admitted to the Woodlands Maternity Home situated within the district, or to the St. Helier Hospital, Carshalton, if hospital treatment is required. Tuberculosis Cases.—The Regional Hospital Board is responsible for providing the specialist services for the tuberculous, also for institutional treatment. Dr. Dadds, the chest physician, holds a clinic for Mitcham patients at the St. Helier Hospital, Carshalton, every Monday at 9.30 a.m., Wednesday at 1.50 p.m., Thursday at 1.50 p.m., and Friday at 9.30 a.m. The 16 clinic held every fourth Wednesday at 5.30 p.m. is for old cases only. Venereal Diseases Clinics.—Confidential treatment can be obtained at the St. Helier Hospital, Carshalton, and the Croydon General Hospital. Treatment can also be obtained from the outpatients' departments of many of the London hospitals. CLINICS AND TREATMENT CENTRES (Under Control of the Surrey County Council) 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). 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). Toddlers' Clinics for children between the ages of two to five years are held on alternate Monday mornings by appointment. Ante-Natal Clinics Ante-natal clinic is held at the Church Road Clinic. Sessions are held every Tuesday and Friday morning, and a clinic for cases booked by midwives is held on Friday afternoons. X-Ray examinations are carried out at the Wilson Hospital when necessary for expectant mothers. 17 Post-Natal Clinic A post-natal clinic is held at Church Road Clinic on alternate Mondays by appointment. Dental Clinics Dental services are provided for expectant and nursing mothers, toddlers and school children at the Church Road, Western Road and Sherwood House Clinics. Minor Ailments A clinic is provided at Western Road. U.V. Radiation Clinics Sessions are held as follows:— Church Road Clinic: Monday afternoons, Thursday mornings. Sherwood House Clinic: Tuesday mornings, Friday afternoons. Diphtheria Immunisation Clinics and Vaccination Against Smallpox Clinics are held as follows:— Meopham Road Clinic Monday afternoons Mitcham Court Wednesday mornings Cavendish Road Clinic Thursday afternoons Day Nurseries The Surrey County Council provide two day nurseries in Mitcham, one at Eagle House, London Road, Mitcham, with 85 places, and the other at Robinson Road, Colliers Wood, with places for 50 children. Health Visiting. Health visitors are under the control of the Surrey County Council. There were eight Health Visitors employed in visiting the mothers and children in this district. Every Health Visitor carries out the combined duties of District Health Visitor and School Health Visitor. 18 Home Help Service The Home Help Service, which is under the control of the Surrey County Council, has proved most successful. Applications for assistance are made to the Divisional Medical Officer at Mitcham Court. 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 1949 49 Number of children affected 81 Number of visits paid 114 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. A few factories have an additional supply from deep wells. There are six licensed caravan yards, each with a stand pipe, supplying altogether a total of 16 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 houses in the Borough have no supply of drinking water direct from the main, but are supplied from a tank in the roof. Provided the tank is properly covered and is cleansed regularly, it provides a satisfactory supply. RIVERS AND STREAMS Visits have been paid to all works suspected of discharging effluent into surface water sewers. 19 CLOSET ACCOMMODATION The whole of the district is on the water carriage system, the houses being drained to the public sewer, then treated at the works of the Wandle Valley Joint Sewerage Board. PUBLIC CLEANSING A weekly collection of house refuse is carried out by direct labour. Eight refuse 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. ERADICATION OF BED BUGS Number of Council houses found infested during the year, 100. Number of other houses found infested during the year, 8. Number of requisitioned, etc., houses found infested during the year, 4. Total number of houses disinfested during the year, 116. Methods employed:— 8 houses treated with sulphur dioxide. 108 houses treated with insecticide spray (inclusive of rooms treated on more than one occasion). No private house was treated by the Council staff, but advice was given and material supplied at cost price on request in respect of 8 houses. Number of houses disinfested for beetles, 107. Number of houses disinfested for spiders and other insects, 12. 20 SCHOOLS The supervision of the public elementary schools is under the control of the Education Department of the Surrey County Council. The sanitary fittings, etc., however, are inspected periodically by the sanitary inspector. All schools have a constant supply of water from the mains of the Metropolitan Water Board. Medical Inspection.—The medical inspection of school children is carried out by the Education Department of the Surrey County Council. Closure of Schools.—No school has been closed by the local authority during the year. Infectious Diseases.—Scholars in contact with a case of infectious disease are excluded from school, the period of the exclusion being that set out in 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. House to house inspections 9,440 Complaints received 448 Number of treatments re???rat infestation including test baits as result of inspections and complaints 1,903 Factory and business premises treated 211 Visits by Sanitary Inspectors 540 Two sewer maintenance treatments were carried out; 496 manholes were baited. A 10 per cent, test of the sewer manholes in the district was carried out. 21 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 1,535 Visits re complaints and sundries 2,382 Revisits 5,122 Houses inspected for defects 1,975 Number of nuisances discovered 1,458 Number of intimation notices served 958 Number of intimation notices complied with 711 Number of statutory notices served 263 Number of statutory notices complied with 243 Visits to butchers 189 Visits to other food shops 475 Visits to ice-cream shops 155 Visits to factories 162 Visits to slaughter houses 44 Visits to restaurant kitchens 158 Visits to stables 32 Visits to garages 11 Visits to outworkers' premises 57 Visits to marine stores 4 Visits to caravan yards 48 Visits re building licence applications 486 Details of visits to other premises are enumerated in other sections of the report. Character of Work Done Roofs repaired 337 Eaves guttering and spouting repaired or renewed 295 Yards paved or repaired 127 Dampness remedied 269 Water service pipes repaired 89 Waterclosets: repairs to roof, walls, doors, windows, floors and seats 168 22 Waterclosets: flushing apparatus repaired or renewed 153 Water storage cisterns cleansed, regulated, repaired or renewed 40 Water supply reinstated 14 Flooring of rooms repaired and ventilation improved 265 Rooms cleansed and redecorated 465 Repairs to waste pipes and traps 80 Window sills repaired or renewed 79 Window frames and sashes repaired or renewed 348 Drains repaired and obstructions removed 212 Repairs to firegrates (including surrounds and hearths) 96 Repairs to stoves, coppers, ranges, etc. 67 New dustbins provided 38 Accumulations removed 19 Repairs to chimney stacks, etc. 59 Repairs to staircases 77 Repairs to doors 78 Sinks and handbasins, repairs or renewals 94 Drains tested 110 Repairs to internal plaster 1,866 Grid and mica flaps provided 21 Drain inspection chamber covers provided 49 External brickwork (repaired, pointed or rendered) 197 W.c. pans and traps provided 107 Sash cords renewed 298 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.—Nine applications were made to the Justices for Nuisance Orders against property owners under Section 94, Public Health Act, 1936. The results were as follows:— Seven summonses were dismissed with costs, as works were completed before the hearing of the summonses. Two summonses with costs were adjourned for one month for completion of works. 23 Petroleum (Consolidation) Act, 1928.—Eighty-eight licences to store petroleum and cellulose solutions were granted, totalling 182,315 gallons. Four licences were also issued for 2,904 lbs. of carbide of calcium to be stored. Unsound Food Dealt With. Beef 715¼ lbs. Pork 150 lbs Fish 1,477 „ Macaroni 419 „ Cheese 13f „ Corned Beef 162¾ ,, Poultry 196 „ Butter 9½ ,, Sausages 14 „ Jam 8½ ,, Milk Powder 112 „ Mincemeat 1 ,, Sugar 1,010 „ Eggs 648 Fruit, Dried 216 „ Mutton and Lamb 221 lbs. Bacon 23 „ Almonds 3 tons 4 cwt. Assorted Tin Foods 1,015 Luncheon Meat. 3 lbs. 9 ozs. Rice 71 lbs. Herbs 16¼ lbs. Salad Cream 11 bottles 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) 1,975 (b) Number of inspections made for the purposes 2,214 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 732 Number of dwelling houses rendered fit in consequence of formal action by the local authority or their officers 263 24 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 9 (2) Number of dwelling houses which were rendered fit after service of informal notices:— (a) By owners — (b) By local authority in default of owners 9 Proceedings under Section 11 of the Housing Act, 1936:— (1) Number of houses in which demolition orders were made 1 Proceedings under Section 12 of the Housing Act, 1936: — (1) Number of houses in which closing orders were made for underground rooms — 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 1 INSPECTION AND SUPERVISION OF FOOD FOOD AND DRUGS ACT, 1938 Formal Samples. Ninety-eight formal samples were taken as follows:— Milk 65 Gelatine 1 Baking Powder 1 Olive Oil 1 Cake Mixture 1 Ground Cloves 1 Malt Vinegar 2 Sausage Meat 11 Non-brewed Vinega 2 Fruit Cake 1 Lemonade Powder 1 Jam 6 Pie Crust 1 Salad Cream 1 Cooking Fat 2 Christmas Pudding 1 25 Informal Samples. Seventy-one informal samples were taken as follows:— Milk 3 Coffee Extract 5 Sponge and Pudding Mixtures 3 Bicarbonate of Soda 1 Chocolate, Cocoa 1 Mixed Spice 1 Jam 2 Baking Powder 4 Self-raising Flour 1 Black Pepper 1 Swiss Roll 1 Pickles, Sauces, etc. 5 Saccharine Tablets 2 Meat and Fish Pastes, Sandwich Spreads 8 Meat Cubes 2 Sage and Onion Stuffing 2 Coconut Essence 1 Gelatine 1 Soup Powder 1 Foam Crystals 1 Beecham's Powders 1 Coffee & Chicory Cubes 1 Ice Cream 14 Junket Powder Rennet 8 Pastry Mixture 1 Peppermint Flavouring 1 Custard Powder 1 Herbs 1 Ground Ginger 1 Gravy Browning 1 All samples, with the exception of two were satisfactory. One formal sample of South Devon Milk was found to be deficient in fat and this result was passed to the Ministry of Food. One informal sample of jam was found to have 20 per cent, instead of 30 per cent, fruit content. A warning letter was sent to the manufacturer of this jam. A further formal sample of jam was taken and was reported genuine. Food and Drugs Act, 1938. Legal proceedings were taken against a shopkeeper selling unsound meat pies. The Justices fined the shopkeeper £5 with costs of £13 18s. Legal proceedings were also taken against a baker for selling a bakewell tart containing a nail. The Justices fined the baker £5 with £3 3s. costs. Ice-Cream Four premises in the Borough are registered for the manufacture of ice-cream, and fifty-four for the storage of ice-cream. One hundred and fifty-five visits were paid during the year. Seventy-eight samples of ice-cream were taken and examined for bacteriological purity. Twenty-six were also tested for fat content. The results are tabulated below:— 26 Provisional Grade. I II Ill IV Coliforms absent 33 6 4 3 Coliforms present in l/10th ml 5 4 8 6 Faecal coli present (in addition to above):— In 1 ml. — — — 2 In l/10th ml. 2 — 2 1 In l/100th ml. — — — 2 Fat Content 3-4 per cent. 4-5 per cent. 5-6 per cent. 6-7 per cent. 7-8 per cent. 1 1 5 2 9 8-9 per cent. 9-10 per cent. 10-11 per cent 11-12 per cent. 5 2 — 1 MILK (SPECIAL DESIGNATION) REGULATIONS, 1936-46. During the year the Council granted the following number of licences under the above-named Order:— Tuberculin Tested 10 Pasteurised 10 Pasteurising Plant 1 Supplementary Licences— Pasteurised 8 Tuberculin Tested 7 One hundred and thirty-five samples of Graded Milk were submitted for bacteriological examination. One hundred and twenty-nine samples were satisfactory and six were unsatisfactory. Communications were sent to the dairies regarding the unsatisfactory samples. BAKEHOUSES The number of bakehouses in the district is 10. Forty-six 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 dairymen in sealed bottles. During the year 179 visits of inspection were paid. 27 SLAUGHTERHOUSES There are two registered slaughterhouses in the Borough; 44 visits have been paid. MEAT INSPECTION Carcases Inspected and Condemned Cattle, excluding cows Cows Sheep and Lambs Pigs Number killed ... ... ... 69 Number inspected ... ... ... 69 All diseases except tuberculosis: Whole carcases condemned ... ... ... 3 Carcases of which some part or organ was condemned ... ... ... 1 Percentage of the number inspected affected with disease other than tuberculosis ... ... ... 5.79 Tuberculosis only: Whole carcases condemned Carcases of which some part or organ was condemned ... ... ... 1 Percentage of the number inspected affected with tuberculosis ... ... ... 1.45 FOOD PREPARING FACTORIES There are 12 other premises in which food is prepared for human consumption. All of these have been systematically visited. INFORMAL ACTION TAKEN UNDER SECTION 13, FOOD AND DRUGS ACT, 1938. Number of Notices served, 14. Number of Notices complied with, 12. PIGGERIES There are 24 piggeries in the Borough. Ninety-three visits were paid during the year. FACTORIES ACT, 1937 I.—Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors):— 28 M/c line No. Number on Register Number of M/c line No. Premises 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 20 17 ... ... 1 (ii) Factories not included in (i) to which Section 7 applies (a) Subject to the Local Authorities (Transfer of Enforcement) Order, 1938 2 214 176 14 ... 2 (b) Others 3 ... ... ... ... 3 (iii) Oilier Premises under the Act (excluding out-workers' premises) 4 19 37 ... ... 4 TOTAL ... 253 230 14 ... ... 29 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. Inspectoi By H M. Inspector (1) (2) (3) (4) (6) (6) (7) (8) Want of cleanliness (S.l) 5 7 2 ... ... ... 6 Overcrowding (S.2) 6 ... ... ... ... ... 6 Unreasonable temperature (S.8) 7 ... ... ... ... ... 7 Inadequate ventilation (S.4) 8 ... ... ... ...... ... 8 Ineffective drainage of floors (S.6) 9 ... ... ... ... ... 9 Sanitary Conveniences (S.7) (a) Insufficient 10 1 1 ... ... ... 10 (b) Unsuitable or defective 11 21 16 6 ... ... 11 (c) Not separate for sexes 12 ... ... ... ... ... 12 Other offences (not including offences relating to Homework) 13 6 5 ... ... ... 13 TOTAL ... 36 24 6 ... ... ... 30 8.—Outwork (Sections 110 and 111): — Nature of Work 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 M/c line No. (1) (2) (3) (4) (6) (6) (7) (8) (9) Wearing apparel Making, etc. 14 72 14 Cleaning and washing IS 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 50 20 File making 21 21 Brass and brass articles 22 22 Fur pulling 23 23 Iron and steel cables and chains 24 24 Iron and steel anchors and grapnels 25 26 Cart gear 26 26 Locks, latches and keys 27 27 Umbrellas, etc. 28 28 Artificial flowers 29 1 29 31 Nets, other than wire nets 30 30 Tents 31 31 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 35 13 35 Brush making 36 36 Pea picking 37 37 Feather sorting 38 38 Carding, etc., of buttons, etc. 39 39 Stuffed toys 40 40 Basket making 41 41 Chocolates and sweetmeats 42 42 Cosaques,Christmas crackers, Christmas stockings, etc. 43 2 43 Textile weaving 44 44 Lampshades 45 45 TOTAL 88 ... 32 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES INFECTIOUS DISEASE NOTIFICATIONS The total number of confirmed notifications received during 1949 was 717. 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 321 Health Visitors 97 To small pox contacts 10 Total 428 Rooms disinfected after infectious disease 231 33 The monthly incidence of infectious disease was: — Small Pox. Scarlet F ever Diphtheria Typhoid Fever Erysipelas Pneumonia Puerperal Pyrexia Ophthalmia Neonatorum Dysentery Cerebrospinal Meningitis Poliomyelitis Measles Whooping Cough Food Poisoning PolioEncephalitis Paratyphoid Malaria Totals January ... 5 ... ... 1 3 ... 2 ... ... ... 30 32 ... ... ... ... 73 February ... 7 1 ... 2 2 1 ... ... ... ... 47 32 ... ... ... ... 92 March ... 11 ... ... 2 6 1 ... ... ... ... 78 24 ... ... ... ... 123 April ... 6 ... ... ... 4 ... 1 ... ... ... 81 45 ... ... ... ... 137 May ... 10 ... ... 1 2 ... 1 ... ... ... 28 22 1 ... ... ... 65 June ... 19 ... ... ... ... ... 2 ... ... ... 22 13 ... ... ... ... 56 July ... 7 ... ... 1 ... ... ... 2 ... ... 21 23 ... ... ... ... 54 August ... 3 ... ... ... ... ... ... ... ... 1 9 17 4 ... ... ... 34 September ... 2 ... ... ... ... ... 1 ... ... 1 ... 3 ... ... ... ... 7 October ... 2 ... ... 1 ... ... 1 3 ... 1 7 ... ... ... ... ... 15 November ... 6 ... ... 2 ... ... ... 2 ... 1 13 1 1 ... ... ... 26 December ... 11 ... ... 2 2 ... ... ... ... 2 18 ... ... ... ... ... 35 Totals ... 89 1 ... 12 19 2 8 7 ... 6 354 212 6 1 ... ... 717 34 Infectious Disease Notifications, 1929-49. Disease 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 1949 Small Pox 7 ... 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 134 113 105 174 240 392 143 171 192 150 61 48 75 175 212 97 147 95 62 35 57 89 Diphtheria 133 129 49 32 40 83 80 104 89 64 27 36 72 25 42 10 63 32 4 ... 1 1 Typhoid Fever 4 9 2 3 3 ... 3 5 ... 1 ... ... ... ... 1 ... 1 ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Undulaat Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Puerperal Fever 6 1 7 5 1 1 2 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia 5 6 9 4 9 6 4 11 5 4 7 2 2 6 3 5 8 6 9 3 ... 2 Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ce rebro -spi nal Meningitis 4 1 4 1 1 3 1 2 1 13 12 6 8 3 3 1 2 1 1 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 22 22 17 11 31 30 20 22 16 8 19 17 19 7 22 13 16 25 9 18 6 12 Measles ... ... ... ... ... ... ... ... ... ... ... 301 194 599 651 112 739 358 533 818 252 354 Acute Diarrhoea ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 3 11 2 2 6 Ophthalmia Neonatorum 3 1 3 4 2 2 4 3 1 3 3 1 3 10 4 4 2 2 6 3 8 Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 Encephalitis Lethargica ... 2 1 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Pneumonia 57 35 45 52 37 45 35 36 32 43 ... 30 22 20 50 37 33 41 37 30 13 19 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... 1 ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... 4 16 186 161 162 166 96 234 216 117 149 212 Food Poisoning ... ... ... ... ... ... ... ... ... ... 4 4 6 11 ... ... 5 1 ... ... ... 6 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 67 13 6 1 2 5 7 Paratyphoid ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... Totals 376 319 242 288 368 560 293 867 338 275 125 468 591 1021 1161 515 1126 807 888 1033 490 717 35 Small Pox No case of small pox was notified during the year 1949. Scarlet Fever The number of cases of scarlet fever notified during the year was 89 as compared with 92 in 1948, equivalent to a case rate of 1.33 per 1,000 population. The disease has continued mild in character; no death due to this cause was recorded. Of the total number of cases notified 46 were treated in hospital, and 43 cases were treated at home. The patient's home was disinfected after removal to hospital or 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. The case recovered after hospital treatment. Contacts are swabbed as a routine. The following table shows the number of each age group immunised in relationship to cases of diphtheria: — 36 NOTIFICATIONS DEATHS Age at date of notification. Number of cases notified Number of cases included in preceding column in whioh 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 thepatient 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 — — 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 the 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. 37 The following figures show the number of children immunised during the year: — Under five 983 Five—14 628 Total 1,611 The following figures show the number of the child population considered immunised at December 31, 1949: — Age at 31.12.49 i.e. born in year Under 1 J 949 1 1948 2 1947 1 3 1946 4 1945 1 5 to !• 1940 1944 10 to 14 1935-1939 Total under 15 Number immunised 25 743 931 908 668 4172 3517 10964 Estimated mid-year population 1949 5814 8500 14314 The percentage immunised is as follows: — Under five 56.33% Five—14 90.46% The number of birthday greetings sent in 1949 was 786. Typhoid Fever No case was notified during the year. Diarrhcea and Enteritis Under Two Years of Age No death was registered during the year. Encephalitis Lethargica No case was notified during the year. Erysipelas Twelve cases were notified. Six cases were removed to hospital. 38 Puerperal Pyrexia Two cases were notified during the year. Pneumonia Nineteen 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 28, of which 11 were males and 17 females. Cerebro-Spinal Fever One female death was returned in the Registrar-General's figures, but no notification was received at this office. Influenza During the year eight deaths from influenza were recorded, of which four were male and four were female. The previous year three deaths were registered. Prevention of Blindness This comes under the control of the Surrey County Council. Ophthalmia Neonatorum During the year eight cases of ophthalmia neonatorum were notified. Poliomyelitis Thirteen cases of poliomyelitis were notified during the year, of which the diagnosis was subsequently confirmed in six cases. There was also one case of polioencephalitis which was fatal. 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. 39 The school notices also give fairly accurate estimates of the prevalence of non-notifiable infectious disease, such as chicken pox, mumps, etc. The numbers were as follows: — Chicken pox 26 Mumps 17 Jaundice 3 Ringworm 1 Measles 43 Whooping cough 48 Scarlet fever 29 Poliomyelitis 1 Pulmonary tuberculosis 1 Cancer The number of deaths from cancer registered during the year was 124, of which 69 were males and 55 were females. The site distribution for 1949 was as follows: — Digestive organs 21 cases Genito-urinary organs 8 „ Breast 8 „ Other sites 87 „ Total 124 40 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 Kate per 1.000 of population Mitcham England and Wales 1929 66 1.33 1.43 1930 73 1.25 1.45 1931 81 1.41 1.48 1932 68 1.0 1.51 1933 52 .86 1.52 1934 70 1.1 1.56 1935 61 1.0 1.58 1936 80 1.2 1.61 1937 76 1.1 1.68 1938 103 1.5 1.66 1939 73 1.12 1.64 1940 94 1.55 1.66 1941 84 1.6 1.67 1942 104 1.9 1.698 1948 95 1.7 1.74 1944 83 1.6 1.7 1945 103 1.9 1.74 1946 108 1.74 1.76 1947 103 1.60 1.86 1948 111 1.67 185 1949 124 1.85 1.87 Tuberculosis During the year 106 new cases of tuberculosis were notified viz.:— Males Females Total Pulmonary 61 41 102 Non-Pulmonary 2 2 4 Totals 63 43 106 41 Thirteen eases were transferred into the Borough as follows:— Males Females Total Pulmonary 7 5 12 Non-Pulmonary 1 — 1 Totals 8 5 13 The total number of deaths registered as occurring from tuberculosis was viz.: — Males Females Total Pulmonary 15 5 20 Non-Pulmonary 1 — 1 Totals 16 5 21 England and Wales Mitcham Death rate from respiratory tuberculosis per 1,000 population 0.41 0.28 Death rate from non-pulmonary tuberculosis per 1,000 population 0.05 0.01 42 The following table shows the number of new cases, the type of disease and the deaths from tuberculosis during the year. New Cases Deaths age periodb Respiratory NonEespiratory Respiratory Non- Respiratory M. f. M. F. M. F. M F. Under 1 year ... 1 ... ... ... ... ... ... 1 year to 4 years 2 1 ... ... ... ... ... ... 5 years to 9 „ 2 1 1 ... ... ... ... ... 10 „ „ 14 ,, ... 1 ... 1 ... ... ... ... 15 „ „ 19 ,, 9 6 1 1 ... ... 1 ... 20 „ „ 34 „ 19 21 ... ... 4 2 ... ... 35 „ „ 44 12 4 ... ... 3 1 ... ... 45 „ „ 64 14 4 ... ... 6 ... ... ... 65 „ and upwards 3 2 ... ... 1 1 ... ... Unknown ... ... ... ... 1 1 ... ... Totals 61 41 2 2 15 5 1 ... New cases coming to the knowledge of the Medical Officer of Health during the year through (a) Death returns; (b) Posthumous notifications: Ago Periods 0- 1- 5- 10- 15- 20- 25- 35- 45- 55 65- Total Pulmonary : males ... ... ... ... ... ... ... 1 ... 2 ... 3 Pulmonary : females ... ... ... ... ... ... ... ... ... ... 2 2 Non-Pulmonary: males ... ... ... ... 1 ... ... ... ... 1 ... 2 Non-Pulmonary females ... ... ... ... ... ... ... ... ... ... ... ... 43 ihe sources trom which information as to the abovementioned cases was obtained are as follows: — No. of Cases Pulmony NonPulmonary Death Returns (a) From Local Registrar 3 ... (6) Transferable deaths from Registrar General 2 2 Posthumous notifications Number of cases removed from register during 1949: — Reason Pulmonary Non-Pulmonary Total Cases Males Females Total Males Females Total Withdrawal of notification 1 ... 1 ... ... ... 1 Recovery from disease 12 14 26 1 1 2 28 Death 18 6 24 ... ... ... 24 Removed from district 15 11 26 ... 1 1 27 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths is as follows: — Non-notified tuberculosis deaths 7 Notified tuberculosis deaths 14 Percentage of non-notified T.B. deaths (all forms) 38.33 per cent. Percentage of non-notified pulmonary T.B. deaths 23.81 ,, 44 Mitcham, Beddington and Wallington Tuberculosis Cake Committee Functions of the Committee 1. To alleviate want or distress amongst those suffering from tuberculosis, 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 who are 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. Assistance was given towards extra nourishment, beds and bedding, occupational therapy material, education, clothing, provision of wireless, holidays, fares for relatives to visit, pocket money for patients, removal expenses, etc., etc. The Committee also carry for distribution a stock of milk foods, blankets and sheets. The help given improves the morale of the patient or the well being of his or her family. 45 INDEX page Abortion, Deaths 13 Ambulances 14 Analysis of Mortality 13 Ante-Natal Clinics 16 Area 7 Bakehouses 26 Bed Bugs, Eradication of 19 Bedding, Disinfection of 14 Birth Rates 9, 13 Births, Illegitimate 7 — In Institutions 8 — Live 7 — Still 7 Blindness, Prevention of 38 Books disinfected, Library 14 Cancer 39 Deaths from 8, 40 Causes of Deaths 10, 12 Cerebro-Spinal Fever 38 Chief Sanitary Inspector's Report 21 — Inspector, Visits by 21 Cleansing, Public 19 Clinics 16, 17 Closet Accommodation 19 Dairies 26 Day Nurseries 17 Death Rates 18, 13 Deaths 7-12, 40, 41 Dental Clinic 17 Diarrlirea and Enteritis 2 — Deaths from 13 Diphtheria 35, 36 — Immunisation 36, 37 — — Clinic 17 — Specimens Examined 14 46 page Disinfection 14, 15 Domestic Helps 18 Encephalitis Lethargica 37 Enteritis, Diarrhoea and 8 Eradication of Bed Bugs 19 Erysipelas 37 Factories Act, 1937 27-31 — — Defects found 29 — — Inspections 28 — —(Sections 110 and 111) Outwork 30-31 Food and Drugs Act (1938) 24 — Action Taken 27 — Dealt with, Unsound 23 — Inspection and Supervision of 24 — Preparing Factories 27 General Provision of Health Services for the Area 14 Health, Visiting 17 Home Help Service 18 Hospitals 15 Houses, Disinfection of 14 Housing Act, 1936 (Sect. 9, 10 and 16) 24 — — (Sect. 11) 24 — — (Sect. 12) 24 Housing Statistics 23 Ice-Cream 25 — Samples 25 Immunisation Clinic, Diphtheria 17 — Diphtheria 36, 37 Infant Mortality 8-10, 13 Infectious Disease, Ambulances 14 — — Case rates 13 — — Contacts 32 — — Hospital 15 — — Incidence of 33 — — Prevalence of and Control over 32 — — Notifications 32, 34 — — — School 38 47 page Influenza 38 Inhabited Houses 7 Inquests 10 Inspection and Supervision of Food 24 Laboratory, Emergency Public Health, Epsom 14 Facilities 14 Legal Proceedings 22, 25 Library Books Disinfected, number of 15 Maternal Mortality 7, 10, 13 Maternity, Hospital Treatment 15 Measles, Deaths from 8 Meat Inspection 27 Mice Destruction Act, 1919, Rats and 20 Milk (Special Designation) Regulations (1936-46) 26 Mortality, Analysis of 13 Infant 8-10 Maternal 7, 10, 13 N.S.P.C.C. 18 Notifications, Infectious Disease 32, 34 — School 38 Ophthalmia Neonatorum 38 Personnel, Committee 5 Staff 6 Petroleum (Consolidation Act), 1928 23 Piggeries 27 Pneumonia 38 Poliomyelitis 38 Population 7 Post-Natal Clinic 17 Prevention of Blindness 38 Proceedings, Legal 22, 25 Public Cleansing 19 Puerperal Fever 13 Pyrexia 13, 38 Public Analyst 14 Rateable Value 7 Rats and Mice Destruction Act, 1919 20 48 PAGE Rivers and Streams 18 Rooms Disinfected, number of 15 Samples, Food 24, 25 Sanitary Circumstances of the Area 18 — Inspectors, Chief's Report 21 Scarlet Fever 35 Schools 20 — Notifications 38 Slaughterhouses 27 Small Pox 35 — Clinics 17 Hospital 15 Social Conditions 7 Statistics 7 Housing 23 — Vital 7 Still Births 7 Streams, Rivers and 18 Supervision of Food. Inspection and 24 Toddlers' Clinics 16 Tuberculosis 40-43 Care Committee 44 Cases 15, 41, 42 Deaths 41, 42 Specimens examined 14 Typhoid Fever 37 Unsound Food dealt with 23 U.V. Radiation Clinics 17 Venereal Diseases Clinics 16 Visits by Sanitary Inspectors 21 Vital Statistics 7 Water Supply 18 Welfare, Clinics 16 Whooping cough, Deaths from 8