AC 4413 1 Mr Omarsf 5B (II) 2 Library MIT 25 BOROUGH OF MITCHAM REPORT of the Medical Officer of Health for the YEAR 1956 BOROUGH OF MITCHAM REPORT of the Medical Officer of Health for the YEAR 1956 MITCHAM H. G. Mather, Ltd., Caxton Works, Lower Green 3 Borough of Mitcham HEALTH REPORT FOR 1956 To the Mayor, Aldermen and Councillors. Mr. Mayor, Ladies and Gentlemen, I have much pleasure in submitting my annual report for the year 1956. I should first of all like to report a rather important matter concerning the Public Health Department and staffing that was agreeable to everyone. The Surrey County Council and the three district councils of the North Eastern Division agreed that each district should once again in its own right be a divisional area. As a result the posts of Medical Officer of Health and Divisional Medical Officer of Mitcham were combined, which brought all the medical services under one person at one centre, namely Mitcham Court. This change in policy anticipated the trend laid down in the White Paper on Local Government Organisation which envisaged such control for areas with a population of over 60,000. The posts of Chief Clerk in the Public Health Department and Administrative Assistant to the North Eastern Division, Mitcham area, were also combined and Mr. F. H. White was appointed, his duties being in the proportion of 25 per cent. Mitcham Borough Council and 75 per cent. Surrey County Council. The general health in the Borough has been good, and there was no special outbreak of infectious disease. The notifications of infectious diseases fell from the rather high figure of 1,335 for 1955 to 322, mainly due to the decline in measles, which tends to have a two yearly cycle. There were no cases of diphtheria, making seven years free of cases. 4 The year 1956 was below average for poliomyelitis in the country as a whole, but proved to be the worst as regards number of cases that Mitcham has had, as there were 13 cases against 11 in 1947. Fortunately eight of the cases were non-paralytic and there was no fatal case so that in the final result the year did not prove too severe. After several years of a dropping tuberculosis death rate 1956 produced 13 deaths giving a death rate of .2 per 1,000 as against that of .12 for England and Wales. To offset this, however, it was satisfactory to record a decline in the number of new cases from 57 to 31. Dysentery is increasingly notified and accounted for 60 cases as against 17 for 1955, but was of a mild nature. The birth rate of 13.45, after correction by the comparability factor to correspond with the average age and sex grouping of the whole population, becomes 12.91, which compares with 15.7 for England and Wales. The actual death rate of 9.42, which after applying the comparability factor becomes 11.49, compares with 11.7 for the whole country. The infant mortality rate of 13.73 is lowest ever for Mitcham except for 1954, compared with 23.8 for England and Wales, which is again the lowest recorded for the whole country. The death rate from cancer has risen from 2.02 to 2.08 and that of England and Wales has again risen to the highest ever, being 2.07 per 1,000 population. The rate for Mitcham has been higher than that for England and Wales twice previously—in 1942 and 1945. I wish to thank the Chairmen of the Committees for their friendly support, and all the members of the staff for their loyalty and service throughout the year. I have the honour to be, 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 COMMITTEE Chairman Alderman Mrs. J. C. Ericson His Worship the Mayor (Councillor T. H. Longshaw, J.P.) Aldermen— Mrs. L. Crump G. W. Pearce Councillors— Mrs. W. R. Martin A. J. Pullman Mrs. B. G. E. Smart G. J. Shearing T. Fitzgibbons R. Stanley Representatives of the Council on Other Authorities WANDLE VALLEY JOINT SEWERAGE BOARD His Worship the Mayor (ex-officio) Aldermen— D. W. Chalkley W. Jeffery Councillor H. V. Byford NORTH-EAST DIVISIONAL HEALTH SUB-COMMITTEE (SURREY COUNTY COUNCIL) Alderman G. W. Pearce Councillors— Mrs. W. R. Martin A. J. Pullman R. Stanley W. E. M. Townsend 6 STAFF Medical Officer of Health A. R. Graham, M.B., Ch.B., D.P.H., Barrister-at-Law Chief Public Health and Meat Inspector Petroleum Inspector Shops Act Inspector K. J. Gutteridge (1,2) Assistant Public Health and Meat Inspectors L. Gleed (1, 2, 3) E. J. Sluis (1, 2) L. M. Edwards (1, 2) (a) J. E. Higgs (1, 2) 1. Certificate R.S.H. and Public Health Inspectors' Examination Joint Board. 2. Certificate Meat and Foods R.S.H. 3. Smoke Inspector's Certificate. Clerks (b) Chief Clerk and Administrative Assistant—F. H. White (c) Senior Clerk—L. J. Bellingham (d) Secretary—Miss V. I. Hill (e) Miss M. Sanders (f) Mrs. M. Drewett (a) Commenced duties 2nd January, 1956. (b) Commenced duties 30th January, 1956. 75 per cent. Surrey County Council duties. (c) 25 per cent. Surrey County Council duties. (d) 20 per cent. Surrey County Council duties. (e) 40 per cent. Surrey County Council duties. (f) Commenced duties 12th March, 1956. 40 per cent. Surrey County Council duties. 7 REPORT STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 2,932 acres Population, Census 1921 35,119 ,, „ 1931 56,856 „ 1951 (32,384 M.; 34,885 F.) 67,269 Registrar-General's estimate of population mid-year, 1956 64,990 Density of Population, 1951 22.9 persons per acre Number of inhabited houses, 1921 7,150 ,, ,, „ 1931 13,187 ,, ,, „ 1956 19,822 Rateable Value, 1956 £1,013,816 Sum represented by a 1d. rate £4,134 The Borough of Mitcham is an irregular oval in shape, situated in North-East Surrey adjoining the south-west border of the London metropolitan area. It is fairly flat and low lying, with some 600 acres of open space including the 440 acres of Mitcham Common. The River Wandle, which forms the south-west and western boundary, separates Mitcham from Beddington and Wallington in the south and Carshalton in the west, as it runs a northwards course towards the Thames. The soil of Mitcham consists of up to four feet of top-soil with about ten feet of gravel sub-soil, except for one or two parts where London clay comes to the surface. Below the gravel London clay extends downwards for 200 to 300 feet. Mitcham, with over 300 factories, has a great variety of industries, of which the chief ones are paint and varnish, chemical, engineering, margarine and dairy products. The unemployment position deteriorated a little from the previous year of almost full employment, but it applied mostly to those in the upper age group and the disabled. 8 There was always a big demand for the highly skilled, such as engineers and for heavy manual workers who were seldom unemployed except in periods of change of posts. Another group always in demand was young women alert and quick of eye. Although Mitcham is chiefly a working class area, there are few houses that can be called slums and no back-to-back houses. Nearly two-thirds of the houses have been built since 1921 and more than 50 per cent. of all roads are tree-lined. Mitcham is now a fairly densely populated area, with the few available building sites being rapidly filled up. STATISTICS Live Births. Total Male Female Rate per 1,000 of population Legitimate 840 428 412 Illegitimate 34 19 15 Total 874 447 427 13.45 After correction by the comparability factor becomes 12.91 Still Births. Total Male Female Rate per 1,000 total births Legitimate 14 7 7 Illegitimate — — — Total 14 7 7 15.77 Deaths. Total Male Female Rate per 1,000 of population 612 332 280 9.42 After correction by the comparability factor becomes 11.49 Deaths from pregnancy, childbirth and abortion:— Rate per 1,000 total births Number of cases Nil — Deaths of infants under one year of age:— All infants per 1,000 live births 13.73 Legitimate infants per 1,000 live legitimate births 13.10 Illegitimate infants per 1,000 live illegitimate births 29.41 9 Deaths from:— Cancer (all ages) 135 Measles – Whooping cough (all ages) – Enteritis and 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 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 1950 933 718 76.96 1951 926 703 75.92 1952 929 749 80.62 1953 950 735 77.37 1954 927 673 72.71 1955 869 628 72.28 1956 888 661 74.44 10 The birth rates, death rates per 1,000 of population, and the infantile mortality rates for the years 1937-56 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 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 After 1949 the actual Birth and Death Rates for Mitcham are modified by a comparability factor to correspond with the average age and sex distribution of England and Wales. 1950 12.56 15.8 10.66 11.6 29.64 29.8 1951 12.54 15.5 11.32 12.5 25.47 29.6 1952 12.62 15.3 10.87 11.3 19.80 27.6 1953 13.21 15.5 10.52 11.4 18.39 26.8 1954 12.97 15.2 10.03 11.3 13.32 25.5 1955 12.40 15.0 10.81 11.7 15.20 24.9 1956 12.91 15.7 11.49 11.7 13.73 23.8 11 Infant Mortality During the year 12 deaths were registered of infants under one year of age:— Males Females Total Legitimate 6 5 11 Illegitimate — 1 1 Totals 6 6 12 as compared with 13 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 3 1 — 1 – 1 1-7 days 3 2 — 1 – – 8 days- 1 mth. — — — — — — 1 mth.- 12 mths. 6 — 1 – — 5 Total 12 3 1 2 — 6 Six infants failed to survive the first month of life, giving Mitcham a neo-natal mortality rate of 6.9 per 1,000 related live births as compared with 16.9 for England and Wales. Maternal Mortality During the year no deaths were registered as compared with one in 1955. Inquests Inquests were held on 13 residents dying within the district and on 11 Mitcham residents who died outside the district, a total of 24. 12 In addition, post-mortems without inquests were held on 70 residents dying within the district, and on 75 Mitcham residents who died outside the district, a total of 145. The following table shows the results of the findings of these inquests:— Accidental death 14 Death from misadventure 2 Suicide 4 Natural causes 3 Open verdict 1 Total 24 13 Deaths Registered during the Year 1956 Cause of Death Males Females Total 1 Tuberculosis, respiratory 8 3 11 2 Tuberculosis, other 1 1 2 3 Syphilitic disease 1 3 4 4 Diphtheria ... ... ... 5 Whooping cough ... ... ... 6 Meninpococcal infections ... ... ... 7 Acute Poliomyelitis ... ... ... 8 Measles ... ... ... 9 Other infective and parasitic diseases ... 1 1 10 Malignant neoplasm, stomach 8 8 16 11 Malignant neoplasm, lung, bronchus 32 4 36 12 Malignant neoplasm, breast ... 9 9 13 Malignant neoplasm, uterus ... 3 3 14 Other malignant and lymphatic neoplasms 31 40 71 15 Leukaemia, aleukæmia 3 ... 3 16 Diabetes ... 3 3 17 Vascular lesions of nervous system 30 37 67 18 Coronary disease, angina 68 33 101 19 Hypertension with heart disease 3 2 5 20 Other heart disease 25 38 63 21 Other circulatory disease 18 15 33 22 Influenza 3 1 4 23 Pneumonia 20 27 47 24 Bronchitis 28 13 41 25 Other diseases of respiratory system 2 3 5 26 Ulcer of stomach and duodenum 6 1 7 27 Gastritis, enteritis and diarrhoea ... 1 1 28 Nephritis and nephrosis 3 4 7 29 Hyperplasia of prostate 5 ... 5 30 Pregnancy, childbirth, abortion ... ... ... 31 Congenital malformations 2 ... 2 32 Other defined and ill-defined diseases 20 26 46 33 Motor vehicle accidents 6 1 7 34 All other accidents 6 2 8 35 Suicide 3 1 4 36 Homicide and operations of war ... ... ... All causes 332 280 612 14 Birth-Rates, Death Rates, Analysis of Mortality and Maternal Mortality in the Year 1956 England and Wales Mitcham Rates per 1,000 home population Births— Live 15.7 12.91 Still 0.21 0.21 23.0* 15.77* Deaths— All causes 11.7 11.49 Malignant neoplasm—lung, bronchus 0.41 0.55 Whooping cough 0.000 ... Diphtheria 0.000 ... Tuberculosis— all forms 0.12 0.20 Influenza 0.06 0.06 Acute Poliomyelitis 0.00 ... Pneumonia 0.52 0.72 Coronary disease—angina pectoris 1.67 1.55 Maternal mortality 0.56* ... Notifications (Corrected)— Scarlet Fever 0.74 0.86 Whooping Cough 2.07 1.49 Diphtheria 0.002 ... Measles 3.59 0.77 Acute Poliomyelitis— Paralytic 0.038 0 08 Non-Paralytic 0.033 0.12 Enteric or Typhoid Fever 0.003 0.015 Para-typhoid Fever 0.010 0.015 Meningococcal Infection 0.026 0.015 Erysipelas 0.096 0.11 Dysentery 1.10 0.90 Acute Encephalitis— Infective 0.004 ... Post-Infectious 0.002 ... Acute Pneumonia 0.57 0.29 Food Poisoning 0.25 0.17 Tuberculosis— Respiratory 0.71 0.46 Non-Respiratory 0.10 0.015 * Per 1,000 total (live and still) births. 15 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. 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.1. AMBULANCES The Ambulance service is supervised by the Surrey County Council. The ambulances work from the Ambulance Control Station, Hill House, Bishopsford Road, Morden (Telephone: Mitcham 2084). DISINFECTION The disinfection of houses is undertaken by the Council. Disinfection of bedding, etc., is done at 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. Number of disinfections carried out by Wandle Valley Isolation Hospital 12 Number of rooms disinfected by fumigator 141 Number of library books disinfected 347 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, and itself comes under 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, 16 Carshalton, which caters for all types of cases. The Nelson Hospital at Merton and the London hospitals are also used. Infectious Diseases.—Cases usually go to the Wandle Valley Isolation Hospital at Beddington Corner, Mitcham Junction, or to the Grove Hospital, Tooting. 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 St. Helier Hospital, Carshalton, or occasionally to other hospitals such as the Nelson Hospital, Kingston Road, Merton, S.W.20. Tuberculosis Cases.—The Regional Hospital Board is responsible for providing the specialist services for the tuberculous, also for institutional treatment. Dr. J. M. Hill is the chest physician for Mitcham patients and holds a clinic at the St. Helier Hospital, Carshalton, every Monday at 9.30 a.m., Wednesday at 1.50 p.m., Thursday at 9.30 a.m., and Friday at 9.30 a.m. A clinic is held for old cases only, on every fourth Wednesday at 5 p.m. A Refill Clinic is also held every Monday at 2 p.m., at Cumberland Hospital. The Cumberland Hospital, which is situated in Mitcham, deals only with tuberculosis and has 100 beds available. 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) Ante-Natal Clinics An ante-natal session is held at the Church Road Clinic every Tuesday and Friday morning, and a clinic for cases booked by midwives is held on Tuesday and Friday afternoons. An ante-natal session is held at the Cavendish Road Clinic every second and fourth Monday morning during the month. 17 An ante-natal session is held at Sherwood House Clinic on Wednesday afternoons for cases booked by midwives. X-Ray examinations necessary for expectant mothers are carried out at the Wilson Hospital. Child Welfare Clinics Infant Welfare sessions are held at the following places:— Cavendish Road Welfare Centre.— Every Monday afternoon. St. Barnabas Church Hall, Gorringe Park Avenue.— Every Tuesday afternoon. Sherwood House, Commonside East.— Every Thursday morning and Monday afternoon. Church Road Centre.— Every Thursday afternoon and Wednesday afternoon. Meopham Road Clinic.— Every Wednesday afternoon. Toddlers' Clinics for children between the ages of two to five years are held on Monday mornings, other than the first Monday in the month, by appointment. Dental Clinics Dental services are provided for expectant and nursing mothers, toddlers and school children at the Church Road, Western Road and Mecpham Road Clinics. Western Road, Mitcham.— Every day a.m. and p.m. Church Road, Mitcham.— Monday a.m. and p.m. Tuesday a.m. Wednesday a.m. and p.m. Thursday a.m. and p.m. Friday a.m. Meopham Road.—Every day a.m. and p.m. Diphtheria and Whooping Cough Immunisation Vaccination against Smallpox (Under the direction of the Medical Officer of Health.) Clinics are held as follows:— 18 Cavendish Road Clinic.—Each Monday afternoon in conjunction with Welfare Clinic. Church Road Clinic.—On 1st, 3rd and 5 th Wednesdays of the month in the morning. Meopham Road Clinic.—Each Wednesday afternoon in conjunction with Welfare Clinic. St. Barnabas Clinic.—On 1st, 3rd and 5th Tuesdays of the month in the afternoon. Sherwood House Clinic.—Each Monday afternoon (immunisation only—in conjunction with Welfare Clinic) and each Thursday morning (immunisation and vaccination in conjunction with Welfare Clinic). Minor Ailments Sessions are held at Western Road Clinic on Monday and Friday mornings, with a doctor in attendance, and on Wednesday mornings under the supervision of a nurse; at Sherwood House Clinic, with a doctor in attendance, on Wednesday mornings. Mothercraft Classes Cavendish Road Clinic.—Tuesday, 2 p.m. Church Road Clinic.—Tuesday, 2 p.m. Ophthalmic Clinic An eye specialist attends Western Road Clinic on Thursday mornings and Wednesday afternoons. Parentcraft Circle Church Road Clinic.—Monday, 3 p.m. Post-Natal Clinic A post-natal clinic is held at Church Road Clinic on the first Monday in the month, and at Cavendish Road Clinic on the second Monday in the month. 19 Speech Clinic A session is held at Western Road Clinic on Tuesday (all day), Wednesday (morning only), and Thursday (all day), when two speech therapists are in attendance. A speech therapist also holds a session at Sherwood House Clinic on Friday (all day). U.V. Radiation Clinics Sessions are held as follows:— Church Road Clinic.— Thursday mornings and Monday afternoons. Sherwood House Clinic.— Tuesday afternoons, Friday afternoons. Day Nursery The Surrey County Council provide one day nursery in Mitcham, at Eagle House, London Road, Mitcham, with 49 places. Health Visiting Health visitors are under the control of the Surrey County Council. There are nine Health Visitors employed in visiting the mothers and children in this district under the supervision of a Divisional Superintendent Health Visitor. Every Health Visitor carries out the combined duties of District Health Visitor and School Health Visitor. 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. 20 Number of Mitcham cases dealt with in 1956 38 Number of children affected 72 Number of visits paid 165 National Assistance Act, 1948: Section 47 National Assistance (Amendment) Act, 1951 Removal to Suitable Premises of Persons in Need of Care and Attention There were three cases that appeared to fall into this category, but two agreed to enter voluntarily a hospital for the chronic sick and only in one case had court action to be taken. In this last case, as there was no one to give him care and attention, the patient had to go to a hospital for the chronic sick. 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 five licensed caravan yards, each with a stand pipe, supplying altogether a total of 17 caravans. The water has been of a consistendy high standard of purity and there is no record of any case of infectious disease being 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. 21 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. Ten refuse collection vehicles are in use. ERADICATION OF BED BUGS Number of Council houses found infested during the year, 20. Number of other houses found infested during the year, 6. Number of requisitioned, etc., houses found infested during the year, 3. Total number of houses disinfested during the year, 29. Methods employed:— 29 houses treated with insecticide spray. Number of houses disinfested of beetles, 42. Number of houses disinfested of other insects, 9. 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 public health 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 School Health Service of the Surrey County Council. Closure of Schools.— No school has been closed by the local authority during the year by reason of infectious disease. 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 a 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. 22 PREVENTION OF DESTRUCTION BY PESTS ACT, 1949 Two full-time and one part-time Rodent Operators were employed. Properties inspected 6,420 Complaints received 596 Number of treatments re rat infestation including test baits as result of inspection and complaints 707 Factory and business premises treated 46 Visits by Public Health Inspectors 150 Four sewer maintenance treatments were carried out; 392 manholes were baited. Fifty-five intercepting chambers were also baited during the four maintenance treatments. THE ANNUAL REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR To the Mayor, Aldermen and Councillors. Mr. Mayor, Ladies and Gentlemen, I beg to submit a summary of the visits and works carried out in the Borough by myself and the District Public Health Inspectors:— Complaints received 721 Nuisances found 506 Verbal Notices given 134 Verbal Notices complied with 85 Informal Notices served 395 Informal Notices complied with 201 Statutory Notices served 165 Statutory Notices complied with 141 Revisits 2,180 Houses inspected for defects 753 Visits made for this purpose 921 Drains tested and inspected 148 Private houses found verminous 12 Visits to butchers 187 Visits to slaughterhouses 610 Visits to dairies 12 Visits to retail milk shops 36 23 Visits to restaurant kitchens 377 Visits to ice-cream premises 92 Visits to bakehouses 45 Visits to other food premises 916 Number of notices served under Food Hygiene Regulations, 1955 9 Number of notices complied with 9 Visits to factories 291 Visits to workplaces 71 Visits to outworkers 227 Visits to stables 76 Visits to piggeries 78 Visits to marine stores 1 Visits to caravan yards 62 Smoke observations 93 Visits re infectious disease cases 416 Visits re smallpox contacts — Visits re food poisoning 16 Visits re rats and mice 150 Visits re Shops Acts 137 Visits re schools 25 Visits to Refuse Tipping Site, Mitcham Common 109 Sundry visits 222 Character of Work Done Roofs repaired 127 Rainwater piping or gutters repaired or renewed 79 Yards paved or repaired 7 Dampness remedied 149 Water service pipes repaired 27 Waterclosets: Repairs to structure 14 Flushing apparatus repaired or renewed 45 New pans and traps fitted 23 Water storage cisterns cleansed, repaired or renewed 9 Water supply reinstated 21 Flooring of rooms repaired and sub-floor ventilation improved 40 Rooms cleansed 14 Sinks and handbasins repaired or renewed 7 24 Waste pipes and traps repaired or renewed 15 Window frames and sashes repaired or renewed 24 Window sills repaired or renewed 15 External brickwork (repaired, pointed or rendered) 19 Drains repaired or obstructions removed 153 Drains inspection covers renewed 7 Drains tested 73 Grid and mica flaps provided 2 Firegrates repaired (including surrounds and hearths) 11 Stoves, coppers, ranges, etc., repaired 4 Chimney stacks repaired 11 Staircases repaired 13 Doors repaired 13 Internal plaster repairs 148 Sash cords renewed 30 Dustbins provided 37 Accumulations removed 15 All ponds and ditches in the Borough where mosquito breeding was likely were sprayed with insecticide three times during the year. LEGAL PROCEEDINGS Public Health Act, 1936, Section 92.—Summonses were issued against a company of property owners in respect of non-compliance with notices served for the abatement of statutory nuisances at three of their properties. At the Hearing on 8th November, 1956, in respect of one property the Court imposed a maximum fine of £5 with £2 2s. costs and made an Order for the abatement of the nuisance within 14 days. In the case of the second property the Council was awarded £2 2s. costs and a similar Order was made; and in the case of the third property the Council was awarded £2 2s. costs, the necessary works having been completed prior to the date of the Hearing. Petroleum (Regulations) Acts, 1928 and 1936, and Petroleum (Mixtures) Order, 1929.—96 licences to store petroleum spirit and/ or petroleum mixtures were issued for a total of 221,619 gallons (inclusive of cellulose solutions). 25 Petroleum (Regulation) Acts, 1928. and 1936, and Petroleum (Carbide of Calcium) Order, 1929.— Two licences were issued for the storage of 784 lbs. of carbide of calcium. Unsound Food Dealt With Beef 2213/4 lbs. Pork 123/4 „ . Corned beef 103 „ Rabbit 120 „ Lamb 52 „ Lambs' livers 100 „ Pig spleens 28 „ Pork luncheon meat 35½ „ Ham 56½ lbs. Fish 154 „ Tomato puree 60 „ Butter 3,136 „ Cheese 15½ „ Cereals 6 pkts. Flour 5 bags Assorted 204 tins 3 jars Yours faithfully, K. J. GUTTERIDGE, Chief Public Health Inspector. HOUSING STATISTICS Total Number of Inhabited Houses—19,822. Permanent buildings built by the Council before the war—1,461. Permanent buildings built by the Council after the war—2,257. Other Housing Accommodation Available:— A. Requisitioned and sundry properties 207 B. Temporary building, Arcon bungalows 345 C. Hutments, 320 originally, now reduced to 89 D. Gunsite hutments, 61 originally, now cleared — E. Therefore, total number of properties used for housing by the Mitcham Borough Council is 4,359 Number of People Rehoused. About 9,700 applicants have registered since 1945, and the current list is still about 1,300, so that some 8,400 applicants have been dealt with. 26 Types of Accommodation. It is of note that the Gunsite Camp has been cleared of hutments. The Nissen huts were built to last only a few years, and do not always give protection against the weather, although much has been spent on improvements. The numbers are being steadily reduced. The Arcon bungalows, however, give very good housing accommodation. Most of the new development consists of large blocks of flats to get the greatest number of families rehoused with a limited building space available. A housing estate was built outside the borough at Banstead in conjunction with the neighbouring authorities of Merton and Morden Urban District Council and the Borough of Sutton and Cheam. One hundred and eighty-four houses are now occupied. Attention is being given to the building of bungalows and cottage flats for elderly couples, 150 up to date; of 74 properties built in 1956, 45 were cottage flats. The reduction in total numbers of Council properties from last year is due to de-requisitioning and demolition of huts. INSPECTION AND SUPERVISION OF FOOD Nine hundred and sixteen inspections were made of food premises. The premises were on the whole satisfactory with some minor adjustments necessary. Food premises by type of business. General Stores 24 Groceries 76 Butchers 37 Greengrocer & Fruiterers 56 Greengrocer & Fishmonger 1 Greengrocer & General Provisions 7 Confectionery 73 Chemists 17 Restaurants & Cafes 30 Cafe & General Store 1 Roadside Snack Bars 5 Fishmongers 10 Fried Fish Buffets 5 Fried Fish 10 Bakers and Confectioners 16 Milk & Provisions 13 Public Houses 28 Off-Licences 12 27 Food premises by type, registered under Section 16, Food and Drugs Act, 1955. The storage and sale of ice-cream 142 The manufacture for sale of ice-cream 3 The preparation or manufacture of sausages, or potted, pressed, pickled or preserved food 40 Dairies registered under the Milk and Dairies Regulations, 19491 Number of inspections of registered food premises during the year 291 All condemned food is either incinerated at the Refuse Destructor, Garth Road, Morden, by arrangement with the Merton and Morden Urban District Council, or treated with technical dye and disposed of to fat and bone merchants. FOOD AND DRUGS ACT, 1955 Formal Samples. Eighty-seven formal samples were taken as follows:— Milk 52 Pepper 1 Cheese 1 Gravy Salt 1 Cooking Fat 1 Flip (Pineapple Flavoured) 1 Custard Pudding 1 Cheese Spread 1 Peanuts 1 Sauce 1 Marmalade 1 Ground Ginger 1 Pickle 1 Lemon Curd 1 Butter 2 Beef Sausage 1 Marzipan 1 Liquid Paraffin 1 Lard 2 Creamed Rice 1 Coconut Flavouring 1 Margarine 1 Mint Sauce 1 Aspirin 1 Vinegar 1 Confectionery 5 Pork Sausage 1 Meat Pudding 1 Suet 1 Coconut Ice 1 Informal Samples Sixty-six informal samples were taken as follows:— 28 Piccalilli 1 Swiss Roll 2 Soup 1 Margarine 2 Ginger Cake 1 Sauce 2 Gravy Powder 1 Butter Fat 8 Milk Drink 1 Lemon Juice 1 Puff Pastry Mix 1 Ice-cream 4 Cream 1 Batter Mixture 1 Pickled Red Cabbage 1 Cambridge Sausage 1 Baking Powder 1 Frizets 1 Stewed Steak 1 Pork Sausage 1 Marzipan 1 Flour 1 Condensed Milk 1 Christmas Pudding 1 Frozen Chicken Pie 1 Cheese 1 Chocolate Beverage 1 Biscuits 1 Butter 3 Tomato Ketchup 1 Citrose Glucose Drink 1 Pork Pies 1 Sugar Crystals 1 Cochineal 1 Instant Whip 1 Meat Pie 1 Tizer 1 Chopped Chicken 1 Blackcurrant Juice 1 Cake Mix 2 Olive Oil 1 Fruit Pectin 1 Chocolate Walnut Gateau 1 Raspberry Jam 1 Cheese Spread 1 Coffee Essence 2 Sultanas 1 Cake 1 Icing Sugar 1 All samples were satisfactory with the exception of one formal sample, vinegar, and four informal samples (butter 1, meat pie 1, sultanas 1, cake mix 1). A warning letter was sent to the firms concerned with the unsatisfactory samples. On complaints being received the following cases were reported to the Pubic Health Committee:— One of contamination of a mineral water bottle. One of insect infestation of a packet of sultanas. One of mould growth on a meat pie. One of incorrect labelling of vinegar. Warning letters were sent to the firms concerned in these cases. 29 Ice-Cream Three premises in the Borough are registered for the manufacture of ice-cream and 142 for the storage of ice-cream. Ninety-two visits were paid during the year. Eleven samples or ice-cream were taken and examined tor bacteriological purity. Four samples were also tested for fat content. The results are tabulated below:— Provisional Grade I II III IV Coliforms absent 10 1 — — Coliforms present in 1/10th ml — — — — Fæcal coli present (in addition to above) – – – – Fat Content 4 per cent. 5 per cent. 6 per cent. 7 per cent. 8 per cent. — — — — — 9 per cent. 10 per cent. 11 per cent. 12 per cent. 13 per cent. 1 2 – 1 – Bacteriological Examination of Cups and Glasses Eighty-seven swabs were taken from tea cups at various catering establishments and nine swabs were taken from beer glasses at various public houses during the year, and were submitted to the Public Health Laboratory for bacteriological examination. The results are tabulated below:— Tea Cup Swabs. Colony Count (per cup) Coliforms Faecal Coli Result Satisfactory. Unsatisfactory. Present. Absent. Present Absent. Under 100 4 56 1 3 59 1 100-200 6 8 – 6 10 4 200-500 3 3 – 3 — 6 500-1,000 – – – – – – 1,000-1,500 — 1 — — — 1 1,500-2,000 — 1 — — — 1 2,000 and over 4 1 — 4 — 5 Total 17 70 1 16 69 18 30 Beer Glass Swabs. Colony Count (per glass) Coliforms Faecal Coli Result Satisfactory. Unsatisfactory. Present. Absent. Present. Absent. Under 100 — 6 — — 6 — 100-200 — 1 — — 1 — 200-500 — 1 — — — 1 1,000-1,500 — — — — — — 1,500-2,000 — — — — — — 2,000 and over 1 — — 1 — 1 Total 1 8 – 1 7 2 The result of the swabs was sent to the establishments concerned. MILK (SPECIAL DESIGNATION) (PASTEURISED AND STERILISED MILK) REGULATIONS, 1949 to 1953 During the year the Council granted the following number of licences under the above-named Regulations:— Dealer's (Pasteuriser's) Licences 1 Dealer's Licences— Pasteurised 25 Sterilised 50 Supplementary Licences— Pasteurised 15 Sterilised 16 MILK (SPECIAL DESIGNATION) (RAW MILK) REGULATIONS, 1949 to 1954 During the year the Council granted the following number of licences under the above-named Regulations:— Dealer's Licences (Tuberculin Tested) 18 Supplementary Licences (Tuberculin Tested) ... 15 One hundred and seventy-one samples of Graded Milk were submitted for bacteriological examination. One hundred and seventy samples were satisfactory and one was unsatisfactory. A communication was sent to the dairy concerned regarding the unsatisfactory sample. 31 BAKEHOUSES The number of bakehouses in the district is six. Forty-five visits have been paid. DAIRIES There is one registered dairy and pasteurising establishment within the district. During the year twelve visits of inspection were paid. SLAUGHTERHOUSES There are two registered slaughterhouses in the Borough; 610 visits have been paid. SLAUGHTER OF ANIMALS ACTS, 1933 TO 1954 Thirteen licences were issued to slaughtermen in accordance with the requirements of the above Acts. MEAT INSPECTION Carcases and Offal Inspected and Condemned in Whole or in Part. Cattle, excluding cows Cows Calves Sheep and Lambs Pigs Number killed (if known) 51 62 553 200 11,837 Number inspected 51 62 553 200 11,837 All diseases except tuberculosis and cysticerci: Whole carcases condemned ... ... ... ... 23 Carcases of which some part or organ was condemned 2 7 1 7 752 Percentage of the number inspected affected with disease other than tuberculosis and cysticerci 3.92 11.29 0.18 3.5 6.55 Tuberculosis only: Whole carcases condemned ... ... ... ... 5 Carcases of which some part or organ was condemned 4 5 ... ... 125 Percentage of the number inspected affected with tuberculosis 7.84 8.06 ... ... 1.09 32 FOOD PREPARING FACTORIES There are 17 factories which are engaged in the manufacture and preparation of food products. All of these are systematically visited. INFORMAL ACTION TAKEN UNDER THE FOOD HYGIENE REGULATIONS, 1955 Number of notices served, 9. Number of notices complied with, 9. PIGGERIES There are 21 piggeries in the Borough. Seventy-eight visits were paid during the year. PET ANIMALS ACT, 1951 Three licences were issued to occupiers of pet shops. 33 FACTORIES ACT, 1937 I.— Inspections for purposes of provisions as to health (including inspections made by Public Health Inspectors):— Premises M/c line No. Number on Register Number of M/c line No. Inspections Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (6) (7) (i) Factories in which Sections 1,2, 3, 4, and 6 are to be enforced by Local Authorities 1 36 74 ... ... 1 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 2 253 257 9 ... 2 (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 3 20 7 ... ... 3 TOTAL ... 309 338 9 ... ... 34 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. By H.M. Inspector Inspector (1) (2) (3) (4) (5) (6) (7) (8) Want of cleanliness (S.1) 4 2 2 ... ... ... 4 Overcrowding (S.2) 5 ... ... ... ... ... 5 Unreasonable temperature (S.3) 6 ... ...... ... ... ... 6 Inadequate ventilation (S.4) 7 ... ... ... ... ... 7 Ineffective drainage of floors (S.6) 8 ... ... ... ... ... 8 Sanitary Conveniences (S.7) (a) Insufficient 9 1 1 ... ... ... 9 (b) Unsuitable or defective 10 4 4 ... 1 ... 10 (c) Not separate for sexes 11 ... ... ... ... ... 11 Other offences (not including offences relating to Homework) 12 4 4 ... ... ... 12 TOTAL 11 11 ... 1 ... 35 3.—Outwork (Sections 110 and 111): — Nature of Work M/c line No. Section 110 Section 111 Number of out-workers in August list required by Sect. 110 (1) (c) Number of cases of default in sending lists to the Council Number of prosecutions for failure to supply lists Number of instances of work in unwholesome premises Notices served Prosecutions M/c line Nc. (1) (2) (3) (4) (5) (6) (7) (8) (9) Wearing apparel Making, etc. 13 136 13 Cleaning and washing 14 1 14 Household linen 15 15 Lace, lace curtains and nets 16 16 Curtains and furniture hangings 17 17 Furniture and upholstery 18 18 Electro-plate 19 19 File making ... 20 20 Brass and brass articles 21 21 Fur pulling 22 22 Iron and steel cables and chains 23 23 Iron and steel anchors and grapnels 24 24 Cart gear 25 25 Locks, latches and keys 26 26 Umbrellas, etc. 27 27 Artificial flowers 28 28 36 3.—Outwork (Sections 110 and 111) continued:— Nets, other than wire nets 29 29 Tents 30 30 Sacks 31 31 Racquet and tennis balls 32 32 Paper bags 33 2 33 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 34 25 34 Brush making 35 35 Pea picking 36 36 Feather sorting 37 37 Carding, etc., of buttons, etc. 38 38 Stuffed toys 39 7 39 Basket making 40 40 Chocolates and sweetmeats 41 41 Cosaques, Christmas crackers, Christmas stockings, etc. 42 38 42 Textile weaving 43 — 43 Lampshades 44 6 44 TOTAL 215 37 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES INFECTIOUS DISEASE NOTIFICATIONS The total number of confirmed notifications received during 1956 was 322. Contacts, Suspects, Etc. The Medical Officer of Health is called in consultation by medical practitioners to see patients in their homes, as required. Visits Public Health Inspectors to common infectious diseases 416 Public Health Inspectors to smallpox contacts Nil Total 416 Rooms disinfected after infectious disease 141 38 The monthly incidence of infectious disease was:— Smallpox Scarlet Fever Diphtheria Typhoid Fever Erysipelas Pneumonia Puerperal Pyrexia Ophthalmia Neonatorum Dysentery Meningococcal Infections Poliomyelitis Paralytic Poliomyelitis Non-Paralytic Measles Whooping Cough Food Poisoning Paratyphoid Malaria Acute Encephalitis Infective Acute Encephalitis Post-Infectious Totals January ... 1 ... ... 3 2 ... ... ... 1 1 1 ... 9 ... ... ... ... ... 18 February ... ... ... ... 1 1 ... ... ... ... ... ... ... 7 ... ... ... ... ... 9 March ... 2 ... ... 1 4 ... ... 1 ... ... ... 3 5 ... ... ... ... ... 16 April ... 3 ... ... 1 6 ... ... 12 ... ... ... 25 10 ... ... ... ... ... 57 May ... 8 ... ... ... ... ... ... 3 ... ... ... 9 8 ... ... ... ... ... 28 June ... 13 ... ... ... ... ... ... 2 ... ... ... 3 3 8 ... ... ... ... 29 July ... 14 ... ... ... ... ... ... ... ... 1 ... 6 11 2 ... ... ... ... 35 August ... 5 ... ... ... ... ... ... ... ... 1 3 1 10 ... ... ... ... ... 20 September ... 1 ... ... ... ... ... ... 1 ... 1 2 ... 10 1 ... ... ... ... 17 October ... 4 ... ... 1 ... ... ... 5 ... ... 2 1 5 ... ... ... ... ... 18 November ... 3 ... ... ... 3 ... ... 4 ... 1 ... 1 12 ... ... ... ... ... 24 December ... 2 ... ... ... 3 ... ... 32 ... ... ... 1 13 ... ... ... ... ... 51 Totals ... 56 ... 1 7 19 ... ... 60 1 5 8 50 103 11 1 ... ... ... 322 39 Infectious Disease Notifications, 1937-56 Disease 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 1950 1951 1952 1953 1954 1955 1956 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 192 150 61 48 75 175 212 97 147 95 62 35 57 89 110 111 225 86 47 33 56 Diphtheria 89 64 27 36 72 25 42 10 63 32 4 ... 1 1 ... ... ... ... ... ... ... Typhoid Fever ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... ... 1 ... 1 Puerperal Pyrexia 5 4 7 2 2 6 3 5 8 6 9 3 ... 2 ... 13 23 11 3 ... ... Meningococcal Infections 1 2 1 13 12 6 8 3 3 1 2 1 1 ... l 3 1 ... 2 ... 1 Erysipelas 16 8 19 17 19 7 22 13 16 25 9 18 6 12 7 8 14 11 6 9 7 Measles ... ... ... 301 194 599 651 112 739 358 533 818 252 354 354 1386 591 888 131 1059 50 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Poliomyelitis: ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paralytic 1 ... ... ... ... ... ... ... 2 3 11 2 2 6 2 1 4 4 ... 4 5 Non-Paralytic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 8 Ophthalmia Neonatorum 1 3 3 1 3 10 4 4 ... 2 2 6 3 8 2 1 4 ... 1 ... ... Acute Encephalitis: ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Infective ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Post-Infectious ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Pneumonia 32 43 ... 30 22 20 50 37 33 41 37 30 13 19 28 24 26 27 16 34 19 Malaria ... ... ... ... ... ... 1 1 ... 1 ... 1 ... ... ... ... 1 ... 1 ... ... Whooping Cough ... ... 4 16 186 161 162 166 96 234 216 117 149 212 387 420 112 336 183 167 103 Food Poisoning ... ... 4 4 6 11 ... ... 5 1 ... ... ... 6 3 4 10 17 12 8 11 Dysentery ... ... ... ... ... ... 4 67 13 6 1 2 5 7 16 7 16 15 46 17 60 Paratyphoid ... ... ... ... ... ... ... ... ... 1 2 ... ... ... ... 1 ... ... 1 ... 1 Totals 338 275 125 468 591 1021 1161 515 1126 807 888 1033 490 717 911 1980 1027 1396 450 1335 322 40 Smallpox No case of smallpox was notified during the year 1956. The last case was in 1932. Scarlet Fever The number of cases of scarlet fever notified during the year was 56 as compared with 33 in 1955, equivalent to a case rate of 0.86 per 1,000 population. This disease has continued mild in character. Of the total number of cases notified 11 were treated in hospital and 45 were treated at home. Diphtheria No case of diphtheria was notified for the seventh year in succession and only two in the past nine years, whereas before that cases averaged sixty per year. Immunisation and reinforcing doses were available to every school child whose parents gave consent. Diphtheria Immunisation There are five clinics within relatively easy reach of everyone, as well as immunisation sessions held in the schools. Efforts have continued during the year to obtain the immunisation of every child before the first birthday. The health visitors urge mothers at the welfare centres, and at home visits, to have their children immunised, making special visits in difficult cases. The following figures show the number of children immunised and reinforced during the year (this includes those children who received the combined diphtheria and whooping cough prophylaxis):— Immunised. Reinforced. Total. Under five years 863 119 982 Five to fourteen years 134 1,019 1,153 Totals 997 1,138 2,135 The following figures show the number of the child population considered immunised at 31st December, 1956:— 41 Age at 31.12.56, i.e. born in year Under 1 1956 1 to 4 1955-1952 5 to 9 1951-1947 10 to 14 1946-1942 Under 15 Total Last complete course of injections (whether primary or booster) A. 1952-1956 164 2100 3563 2377 8024 B. 1942-1951 — — 778 1415 2193 C. Estimated mid-year child population 857 3980 9756 14593 Immunity Index 100 A/C 19.14 52.77 60.89 56.22 Whooping Cough Immunisation This is carried out at the same clinics as diphtheria immunisation, but special visits to schools are not made as this inoculation is intended primarily for children under five years old. The following figures show the number of children immunised and reinforced during the year (this includes those children who received the combined diphtheria and whooping cough prophylaxis): — Age at date of final injection (as regards A) or of re-inforcing injection (as regards B) Under 1 1 2 3 4 5 to 9 10 to 14 Total A. Number of children who completed a course of inoculation with pertussis vaccines (including diphtheria pertussis prophylactic) during 1956. 520 216 54 23 37 14 864 B. Number of children who received a secondary (reinforcing) injection during 1956 – – – 1 118 16 2 137 42 Poliomyelitis Immunisation A vaccine has been developed in the past few years that is found to give protection against poliomyelitis. The Ministry of Health approved a scheme for using a Salk type vaccine produced in this country. Owing to the temporarily limited supply only parents of children born from 1st January, 1947, to 31st December, 1954, were asked to apply for their children to be immunised. In Mitcham applications were made in respect of 2,200 children, approximately one-third of the eligible age group l½ to 9½. To avoid giving injections in the late summer when poliomyelitis tends to be prevalent, immunisation was carried out in May and June only. This meant that in 1956 only 201 complete vaccinations of two injections and eleven single injections could be given. In this small number there were no cases of poliomyelitis. Arrangements for immunisation were in the hands of the local health authority acting through divisions, owing to the urgency of getting this scheme into force and the limited amount of vaccine available. Arrangements have now been made for private doctors to participate in the scheme, but, as in the clinics, the children originally registered have to be done first and, following them, children born in 1955 and 1956 who have been registered. Enteric Fever One case of Paratyphoid B phage type III A occurred during the year; the source of infection could not be discovered. One case of Typhoid phage type D.I occurred in a foreign visitor. There was no fatality. Diarrhoea and Enteritis Under Two Years of Age No death was registered during the year. 43 Food Poisoning Outbreaks There were eleven cases of food poisoning in 1956 comprising one canteen outbreak of six cases due to C1. Welchii, together with five single cases. The illness was caused by Salmonella Typhimurium in four of the five cases and in one case the cause was unknown. The source of the disease in the canteen outbreak was believed to be meat re-cooked on the following day, and the source could not be discovered in the single cases. Encephalitis Lethargica No case was notified during the year. Erysipelas Seven cases were notified. One case was removed to hospital. Puerperal Pyrexia No case was 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 47, of which 20 were males and 27 females. Meningococcal Infections One case was notified during the year. Influenza During the year four deaths were recorded. The previous year one death was registered. Prevention of Blindness This comes under the control of the Surrey County Council. Ophthalmia Neonatorum During the year no case of ophthalmia neonatorum was notified. 44 Poliomyelitis The year 1956 was below average for the country as a whole, but proved to be the worst as regards number of cases that Mitcham has had, as there were 13 cases against 11 in 1947. Fortunately eight of the cases were non-paralytic and there was no fatal case so that the year did not prove very severe after all. Of the five paralytic cases only one proved to be severe, in a man of 40, who is now able to do his work, but under handicap. The cases were mosdy of children, only two women and one man being over 20. School Notifications The school intimation notices of infectious disease are always compared with the notifications received from the medical practitioners. If any case on the school return is found to be unnotified, investigations are made in order to find out if the patient is receiving medical attention. The school notices also give information of the prevalence of non-notifiable infectious disease, such as chicken pox, mumps, etc. The numbers were as follows:— Chicken pox 196 Mumps 35 Ringworm — Rubella 44 Impetigo 3 Jaundice — Influenza 3 Tonsillitis — Conjunctivitis — Cancer The number of deaths from cancer registered during the year was 135, of which 71 were males and 64 females. The trend for England and Wales is continuing upwards, with the case rate for Mitcham about equal to that for the country as a whole. The site distribution for 1956 was as follows:— 45 Digestive organs 16 cases Respiratory organs 36 „ Breast 9 „ Genito-urinary organs 3 „ Other sites 71 „ Total 135 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 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 1.90 1.698 1943 95 1.7 1.74 1944 83 1.6 1.7 1945 103 1.91 1.74 1946 108 1.74 1.76 1947 103 1.60 1.86 1948 111 1.67 1.85 1949 124 1.85 1.87 1950 102 1.51 1.89 1951 108 1.61 1.90 1952 128 1.91 1.94 1953 129 1.94 1.95 1954 108 1.64 2.04 1955 132 2.02 2.06 1956 135 2.08 2.07 Tuberculosis During the year 31 new cases of tuberculosis were notified, viz:— 46  Males Females Total Pulmonary 20 10 30 Non-Pulmonary 1 — 1 Totals 21 10 31 Forty-five cases were transferred into the Borough as follows:— Males Females Total Pulmonary 22 19 41 Non-Pulmonary 2 2 4 Totals 24 21 45 The total number of deaths from tuberculosis was:— Males Female Total Pulmonary 8 3 11 Non-Pulmonary 1 1 2 Totals 9 4 13 England and Wales. Mitcham. Death rate from tuberculosis, all forms, per 1,000 population 0.12 0.20 The following table shows the number of new cases, the type of disease and the deaths from tuberculosis during the year:— 47 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. 2 1 ... ... ... ... ... ... 5 years to 9 „ ... ... ... ... ... ... ... ... 10 14 ... ... 1 1 ... ... ... ... ... 15 ,, ,, 19 ... 1 ... ... ... ... ... ... 20 „ 34 19 21 1 1 1 ... ... ... 35 ,, ,, 44 8 3 1 1 ... 1 ... 1 45 „ ,, 64 8 3 ... ... 5 2 1 ... 65 „ and upwards 4 ... ... ... 2 ... ... ... Totals 41 30 3 2 8 3 1 1 New cases coming to the knowledge of the Medical Officer of Health during the year through death returns and posthumous notifications:— Age Periods 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total Pulmonary: Males ... ... ... ... ... ... 1 ... ... ... ... 1 1 3 Pulmonary Females ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Non-Pulmonary: Males ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Pulmonary: Females ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 48 The sources from which information as to the above-mentioned cases was obtained are as follows:— Number of Cases Pulmonary NonPulmonary Death Returns (a) From Local Registrar . . 3 1 (b) Transferable deaths from Registrar General 1 ... Posthumous notifications from doctors ... ... The percentage of non-notified tuberculosis deaths (i.e., new cases coming to the knowledge of the Medical Officer of Health after death of the case) is 38.5. Non-notified tuberculosis deaths 5 Total tuberculosis deaths 13 Miniature Mass Radiography A mass radiography unit comes to Mitcham every year and is granted free use of the Vestry Hall (Town Hall). In 1956 the unit carried out its work from 16th—26th July, and also from 9th—12th July at Pollards Hill. The following summary was supplied by the Medical Director of the Unit, Dr. F. J. H. Walters:— Male. Female Total number examined Pulmonary tuberculosis active Pulmonary tuberculosis inactive Non-tuberculous abnormalities Carcinoma of lung 2,836 1 133 113 2 2,838 5 106 68 – Of 5,674 people examined in all, 4,669 were examined at the Vestry Hall and 1,005 at Pollards Hill. The above figures do not apply to Mitcham residents only, as anyone may make use of the service whether resident or non-resident. The examination is of value in the early diagnosis and treatment of pulmonary tuberculosis and other non-tuberculous abnormalities. 49 Mitcham, Beddington and Wallington Tuberculosis Care 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 are given to hardship cases. Assistance is 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. The Committee has the task of raising the larger portion of the funds necessary, the bulk coming from the sale of Christmas seals and donations from voluntary associations. 50 INDEX page Abortion, Deaths 8, 13 Ambulances 15 Ante-Natal Clinics 16, 17 Area 7 Bacteriological Examination of Cups and Glasses 29, 30 Bakehouses 31 Bed Bugs, Eradication of 21 Bedding, Disinfection of 15 Birth Rates 8, 10, 14 Births, Illegitimate 8 — In Institutions 9 — Live 8 — Still 8 Blindness, Prevention of 44 Cancer 44, 45 — Deaths from 9, 44, 45 Caravans 20 Causes of Deaths 8, 9, 11-14 Chief Public Health Inspector's Report 22-25 — — Inspector, Visits by 22, 23 Cleansing, Public 21 Clinics 16-19 Closet Accommodation 21 Committees, Health, Members of 5 Dairies 31 Day Nursery 19 Death Rates 8, 10, 11, 14 Deaths 8-14 Dental Clinics 17 Diarrhoea and Enteritis 9, 42 Diphtheria 40 Diphtheria Immunisation 40, 41 — — Clinics 17, 18 Disinfection 15, 37 Encephalitis Lethargica 43 51 PAGE Enteric Fever 42 Erysipelas 43 Factories Act, 1937 33-36 — — — Defects found 34 — — — Inspections 33 — — — (Sections 110 and 111) Outwork 35, 36 Food and Drugs Act, 1955 27, 28 — — — — Section 16 27 — Hygiene Regulations, 1955 32 — Dealt with, Unsound 25 — Inspection and Supervision of 26-32 — Preparing Factories 32 — Poisoning 42, 43 — — Case Rates 14 — Sampling 27, 28 General Provision of Health Services for the Area 15-20 Health Visiting 19 Home Help Service 19 Hospitals 15, 16 Houses, Disinfection of 15 — Inhabited 7, 25 Housing Statistics 25, 26 Ice Cream 29 Immunisation and Vaccination Clinics 17, 18 — Diphtheria 40, 41 — Poliomyelitis 42 — Whooping Cough 41 Infant Mortality 8, 10, 11 Infectious Disease Case Rates 14 — — Contacts 37 — — Hospitals 16 — — Monthly Incidence of 38 — — Notifications 37-40 — — — School 44 — — Public Health Inspectors' Visits 37 Influenza 43 Inquests 11, 12 52 PAGE Laboratory Facilities 15 Legal Proceedings 24 Library Books, Disinfection of 15 Maternal Mortality 8, 11, 13 Maternity, Hospital Treatment 16 Measles, Case Rates 14 — Deaths from 9, 13 Meat Inspection 31 Meningococcal Infection 43 Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949 and 1950 30 Milk (Special Designation) (Raw Milk) Regulations, 1949 and 1950 30 Mortality, Analysis of 14 National Assistance Act, 1948, Section 47 20 N.S.P.C.C. 19 Ophthalmia Neonatorum 43 Outworkers (Sections 110 and 111—Factories Act, 1937) 35, 36 Persons in Need of Care and Attention 20 Pests Act, 1949, Prevention of Destruction by 22 Pet Animals Act, 1951 32 Petroleum (Regulation) Acts, 1928 and 1936, and Petroleum (Mixtures) Order, 1929 24 Petroleum (Regulations) Acts, 1928 and 1936, and Petroleum Carbide of Calcium Order, 1929 25 Piggeries 32 Pneumonia 43 Poliomyelitis 44 Population 7 Post-Natal Clinics 18 Public Cleansing 21 Puerperal Pyrexia 44 Public Analyst 15 Radiography, Miniature Mass 48 Rateable Value Rivers and Streams 20 Rodent Operations 22 53 PAGH Rooms Disinfected, Number of 15, 37 Sanitary Circumstances of the Area 20, 21 Scarlet Fever 40 Schools 21 Slaughterhouses 31 Slaughter of Animals Act, 1933 31 Smallpox 40 — Vaccination Clinics 17, 18 — Hospital 16 Social Conditions 7, 8 Staff 6 Statistics 7-14 — Housing 25, 26 — Vital 14 Still Births 8 Tuberculosis 45-48 — Care Committee 49 — Clinic 16 Unsound Food dealt with 25 Venereal Disease Clinic 16 Visits by Public Health Inspectors 22, 23, 37 Water Supply 20 Welfare Clinics 17, 18 Whooping Cough, Deaths from 9, 13, 14 — — Immunisation 41