W1M 1 2 BOROUGH OF WIMBLEDON Public Health Department. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR ENDED 31st DECEMBER, 1939. STAFF . Whole-time. Medical Officer of Health_ School Medical Officer; Medical Superintendent of the Infectious Diseases Hospital; Maternity and Child Welfare Officer: ‡ * HAROLD ELLIS, M.B., B.S.(Lond.), M.R.C.S., L.R.C.P., D.P.H. Assistant Medical Officer of Health., Assistant School Medical Officer: ‡ EFFIE M. D. CRAIG, M.B., Ch.B. (retired 31st March, 1939). ‡ PATRICK J. DOODY, M.B., B.Ch., D.P.H. (appointed 20th March, 1939). Senior Sanitary Inspector: * R. T. AVIS, M.R.San.I., M.S.I.A., (c), (e), (f). Sanitary Inspectors: * D. F. S. FLYNN, (e), (f). ø A. A. REID, (e), (f). ø H. R. FRY, (e). Health Visitors - School Nurses: MISS V. B. WOODROFF, (b), (c), (g). MISS P. N. NASH, (a), (b), (d). MISS J. C. MOFFAT, (a), (b), (d), (h). MISS D. 3. MARCHANT, (a), (b), (d), (h). MISS E. S. G. DAVES, (a), (b), (d), (h). Matron of Infectious Diseases Hospital: MISS L. McCRORY. Matron of Pax Nursery: MISS I. CUTLER. Senior, Clerk. A. L. TAYLOR. Clerks: R. E. SHAW (resigned July, 1939). ø J. E. FIELD. D. A. NORRIE. Clerik to the Maternity and Child Welfare Department: A. L. TAYLOR. V PART-TIME. LESLIE H. V. WILLIAMS, F.R.C.S., F.C.O.G., Obstetric Consultant. S. TAYLOR HARRIS, M.R.C.S., L.R.C.P., Medical Officer to Ante-natal Clinic. MARY M. TULLOCH, M.B., B.S., Medical Officer to Maternity and Child Welfare Centres. W. L. GALVIN, M.B., B.Ch., Deputy Medical Attendant Infectious Diseases Hospital. ARTHUR MILLER, F.R. C.S. , Consulting 0to-Laryngologist to Infectious Diseases Hospital. R. J. FURLONG, F.R.C.S., Orthopædic Surgeon. R. J. CANN, M.S., Surgeon to Aural Clinic. A. MCALLISTER, F.R.C.S., Consulting Obstetrician under Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. Col. E. MIDDLETON PERRY, C.B.E., F.R.C.V.S., Veterinary Inspector. J. H. JOHNSTON', M.Sc. , L.S.A. , Bacteriologist. * Salary contribution under Public Health Acts. ‡ " " by Exchequer Grants. a. S.R.N. b. S.C.M. c. Certificate Sanitary Inspectors Examination Board (London). d. New Health Visitor's Certificate, Royal Sanitary Institute. e. Certificate Royal Sanitary Institute for Inspector of Nuisances. f. Certificate Royal Sanitary Institute for Inspector of Meat and Other Foods. g. Diploma Board of Education (Health Visitors' Training) Regulations, 1919. h. Certificate of Fever Training. ø Serving with H.M. Forces. ANNUAL REPORT of the Medical Officer of Health 1939 To the Mayor, Aldermen and Councillors of the Borough of Wimbledon. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the Annual Report on the work of the Public Health Department for the year ending 31st December, 1939. The Report for 1939 is an ordinary Report, set out on the lines suggested in Circular 1961 of the Ministry of Health, as amended by Circular 2067. STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres - Census, 1931) 3,221 Population (Census, 1931) 59,524 Resident Population (Estimated, Mid-1939 R.G.) For calculation of birth rates 58,350 " " of death rates 55,990 Number of inhabited houses:- 1921 (Census) 11,926 1931 (Census) 13,325 Number of families or separate occupiers:- 1921 (Census) 13,998 1931 (Census) 15,883 Rateable Value:- £823,985 Sum represented by a penny rate:- £3,244. Extracts from Vital Statistics of the Year 1939. (Registrar-General's Figures). For Calculation of Infantile Mortality, etc. Birth Rate Total M. F. Total M. F. Live Births Legitimate 586 292 294 608 301 307 Illegitimate 26 7 19 26 7 19 Total 612 299 313 634 308 326 Birth Rate per 1,000 of the estimated resident population 10.86 Total M. F. Stillbirths Legitimate.. 20 12 8 Illegitimate 2 1 1 Total 22 13 9 Rate per 1,000 total (live and still) births . 33.53 Total M. F. Deaths 656 306 350 Death Rate per 1,000 of the estimated resident population 10.53 2. Deaths from puerperal causes (Headings 29 and 30 of the Registrar-General's Short List):- Rate per 1,000 total Deaths (live & still) births No* 29 Puerperal sepsis 1 1.57 Ho. 30 Other puerperal causes– – Total 1 1.57 Death Rate of Infants under one year of age:- All infants per 1,000 live births 29.41 Legitimate infants per 1,000 legitimate live births 27.30 Illegitimate infants per 1,000 illegitimate live births 76.92 Deaths from Cancer (all ages) 105 Measles (all ages) " " Whooping Cough (all ages) 1 " " Diarrhoea (under 2 years of age) – Birth. Rates, Death Rates, Analysis of Mortality, Maternal Death Rates, ana Case Rates for Certain Infectious Diseases in the Year 1939. (Provisional Figures based, on Weekly and Quarterly Returns). Wimble don. England & Wales 126 C.B's & Great Towns including London 148 Smaller 'Towns (Resident pop. 25,000 50,000 at 1931 Census) London Administrative County Rates per 1,000 Population Live Births 10.86 15.0 14.8 15.6 12.3 Still 0.37 0.59 0.59 0.57 0.44 Deaths:- All Causes 10.53 12.1 12.0 11.2 11.9 Typhoid & Paratyphoid Fevers 0.01 0.00 0.00 0.00 0.00 Small-pox .. – – – – – Measles 0.00 0.01 0.01 0.01 0.00 Scarlet Fever 0.00 0.01 0.00 0.00 0.00 Whooping Cough 0.01 0.03 0.03 0.02 0.03 Diphtheria 0.00 0.05 0.05 0.04 0.02 Influenza 0.30 0.21 0.19 0.20 0.18 Violence 0.58 * * * * Notifications:- Small-pox — 0.00 — — — Scarlet Fever 0.96 1.89 1.96 1.78 1.53 Diphtheria 0.42 1.14 1.21 1.16 0.98 Enteric Fever 0.03 0.04 0.03 0.04 0.03 Erysipelas 0.14 0.34 0.40 0.31 0.37 Pneumonia 0.16 1.02 1.21 0.89 0.99 Rates per 1,000 Live Births Infant Mortality:- Deaths under 1 yr.of ago Deaths from Diarrhœa and 29 50 53 40 48 Enteritis (under two years of age) 0.00 4.6 6.3 3.0 8.2 Maternal Mortali ty:- Puerperal Sepsis 1. 63 0.77 * * * Others 0.00 2.16 Total 1.63 2.93 3. Rates per 1,000 Total Births (i.e., Live and Still) Maternal Mortality:- Puerperal Sepsis. 1.57 0.74 ) * * * Others 0.00 2.08 ) Total 1.57 2.82 ) Notifications:- Puerperal Fever 11.04 14.35 17.26 12.99 3.31 '' Pyrexia 14.22 * Not available. Births.- The statistics supplied by the Registrar-General show that during 1959 the total number of registered live births belonging to Wimbledon amounted to six hundred and thirty-four (three hundred and eight males and three hundred and twenty-six females). This gives a birth rate equal to 10.86 per thousand of the population. Twenty-six of the births were illegitimate. Of this number, seven were males and nineteen females. In addition, twenty-two stillbirths (thirteen males and nine females) were registered. Public Health Act, 1956 - Notification of Births. During the year, six hundred and sixty-four births were notified by the following persons Parents 10 Midwives 231 Doctors 18 Other persons 405 Total 664 Six of these notifications were in respect of stillbirths. Of the six hundred and sixty-four notifications, two hundred and ninety-five were received from Medical Officers of Health of outside areas, and related to births which had occurred to Wimbledon residents confined outside the Borough. Similarly, seventy-three confinements occurred in Wimbledon amongst women whose homes were situated in other districts. The net number of notified births belonging to Wimbledon is therefore five hundred and ninety-one. Deaths.- The total number of deaths registered in the district was five hundred and seven (two hundred and fourteen males and two hundred and ninety-three females), equal to a death rate of 9.05 per thousand of the population. The deaths occurring outside the district, of persons belonging to this Borough, were two hundred and fifty-five. The deaths occurring within the district, of persons not belonging thereto were one hundred and six. Taking these figures into consideration, the total number of deaths properly belonging to Wimbledon is six hundred and fifty-six and the crude death rate 11.71 per thousand of the population. The rate for England and Vales for the same period was 12.1 per thousand. 4. The death rates show a decrease on the figure for the previous year and are lover than that for England and Wales. The crude death rate for Wimbledon is, strictly speaking, not comparable with the figure for England and Wales. In order to provide for this the Registrar-General has introduced a comparability factor. This factor, for Wimbledon is 0.90. The adjusted death rate for Wimbledon for 1939 is consequently 10.53 per thousand of the population as compared with a figure of 12.1 per thousand for England and vales. CAUSES OF DEATH. Males Female Total 1. Typhoid & Paratyphoid Fevers 1 — 1 2. Measles — — —- 3. Scarlet Fever — — — 4. Whooping Cough — — 1 5. Diphtheria — — — 6. Influenza 9 8 17 7. Encephalitis Lethargica — — — 8. Cerebro-spinal Fever 1 — 1 9. Tuberculosis of respiratory system 7 19 26 10. Other tuberculous diseases 3 3 6 11. Syphilis — 1 — 12. General paralysis of the insane, tabes dorsalis, etc. 1 1 13. Cancer 46 59 105 14. Diabetes 2 5 7 15. Cerebral Haemorrhage 15 15 30 16. Heart Disease 91 102 193 17. Aneurysm 1 — 1 18. Other circulatory diseases 25 37 62 19. Bronchitis 10 10 20 20. Pneumonia (all forms) 14 11 25 21. Other respiratory diseases 4 5 9 22. Peptic Ulcer 8 3 11 23. Diarrhoea under two years — — — 24. Appendioitis 2 3 5 25. Cirrhosis of Liver — 1 1 26. Other diseases of Liver, etc. — 2 2 27. Other Digestive Diseases 7 5 12 28. Acute-and Chronic Nephritis 5 5 10 29. Puerperal Sepsis — 1 1 30. Other Puerperal Diseases — — — 31. Congenital Debility, Premature'Birth etc. 4 8 12 32. Senility 3 13 16 33. Suicide 11 4 15 34. Other Violerice 8 10 18 35. Other Defined Diseases 27 18 45 36. Causes ill-defined or unknown 2 2 Totals 306 350 656 Over half the total deaths which occurred amongst Wimbledon residents in 1939 were due to cancer and. diseases of the heart and circulation. Infantile Mortality. There were eighteen infant deaths (including transferable deaths) giving an Infantile Mortality Rate of twenty-nine per thousand live births. This is tho lowest figure ever recorded in Wimbledon. In 1938 the figure was forty-five per thousand. During 1939 tho Infantile Mortality Rate for England and Wales was fifty. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Laboratory Facilities. The Corporation employ a part-time bacteriologist for the examination of pathological specimens. In addition, the laboratory provided at the Health Centre is utilised for the examination of pathological specimens from the Infectious Diseases Hospital. This work is carried out by the staff of the Public Health Department. MATERNITY AND CHILD WELFARE The total number of visits paid by the Health Visitors during 1939 amounted to 7,179, the figure for the previous year being 7,715. Details of the homo visits carried out are given below:- Number of Infants visited - First visits 604 Number of Infants visited - Re-visits 1,278 Number of Toddlers visited 1,976 Ante-natal - First visits 394 Ante-natal - Revisits 251 Visits re Infant Deaths 9 " Stillbirths 11 " " Ophthalmia Neonatorum 25 " " Puerperal Pyrexia 3 " " Non-notifiable Infectious Diseases 10 " " Milk Applications 145 " " Foster Children 152 " " Midwives 15 Miscellaneous 224 Total welfare visits 5,097 Visits - School Medical Service 872 • Tuberculosis - Home Visits 51 Visits to Nursing Homes 27 Other visits 16 Ineffectual visits 1,116 2,082 Total visits 179 The Maternity and Child Welfare Centres were closed on the outbreak of war. Pelham Road Centre was re-opened on 12th September and two sessions per week were hold regularly for the remainder of the year. The average attendance during this period was 66.87. Cottenham Park Centre was re-startod on 18th September, and the average weekly attendance was 29.30. The Centre at Wandlc Park House re-opened on 20th September and the average attendance was 53.82. Ante-natal Clinic. On the outbreak of war both Ante-Natal Clinics were closed. The Pelham Road Ante-natal Clinic was re-started on 2nd October. Dr. S. Taylor Harris, one of the Obstetric Assistants attached to the Maternity Department of the Nelson Hospital, took charge of the Clinic in place of Dr. Jocelyn Moore, who had been called up for emergency war duty. The average weekly attendance was 17.8. Arrangements were in hand at the end of the year for the Wandle Park Ante-natal Clinic to be re-started in January, 1940. 6. Midwifery and Maternity Services - Midwives Act, 1936. A service of whole-time domiciliary midwives is provided by the Wimbledon District Nursing and Midwifery Association under an agreement with the Council. Midwives Act3, 1902-1956. The Council is the Local Supervising Authority for the Midwives Acts in Wimbledon. There were seven practising midwives in Wimbledon at the end of 1939, one of whom was resident outside the Borough. One hundred and ninety-one confinements were attended by midwives and thirty-four by maternity nurses. On the retirement of Dr. E. M. D. Craig, who had acted as Inspector of Midwives for the Borough, these duties were taken over by Miss I. M. Watts, the Superintendent of the Wimbledon district Nursing and Midwifery Association. Medical Aid forms were received in eighty-four instances. The total fees paid to doctors by the Corporation during the year under Section 14 (1) of the Midwives Act, 1918, amounted to £105.3s.6d. The amount recovered from tho patients' relatives v/as £23.0s.ld. Public Health Act, 1936 (Child Life Protection); Children and Young Persons Acct,1932; Children Act, 1908(Part 1) The following figures relate to the administration of the above acts in Wimbledon during 1939. (i) Number of foster-mothers on the Register - (a) At the beginning of the year .. 24 (b) At the end of the year 24 (ii) Number of children on the Register - (a) At the beginning of the year 57 (b) At the end of the year 56 (c) Who died during the year – (d) On whom inquests were held – during the year – Every foster-child was visited regularly. In all, one hundred and fifty-two visits were made to the homes of foster-mothers. Treatment Facilities.- With the exception of the Minor Ailment Clinic the Special Clinics were suspended on the outbreak of war, and re-opened on the following dates:- Ophthalmic Clinic - 17th November; Orthopaedic Clinic - 29th November; Aural Clinic - 13th December. Facilities for the operative treatment of tonsils and adenoids remained available through the usual channels, throughout this period. Ophthalmia Neonatorum.- The following table shows that three cases of ophthalmia neonatorum were notified. In no case did any impairment of vision occur. 7. CASE S Vision Unimpaired. Vision Impaired Total Blindness Deaths Notified Treated At Home Hospital 3 1 2 3 – – – Maternal Mortality. There was one maternal death amongst Wimbledon mothers in 1939. This occurred in a hospital outside the district and was due to toxic myocarditis and puerperal scarlet fever. During 1938 two maternal deaths occurred. The following table gives the maternal mortality rates for Wimbledon and also for England and Wales:- 19 3 9 Puerperal Sepsis Others Total Wimbledon: Per 1000 Live Births 1.63 0.00 1.63 Per 1000 Total Births 1.57 0.00 1.57 England and Wales: Per 1000 Live Births 0.77 2.16 2.93 Per 1000 Total Births 0.74 2.08 2.82 Hospital Treatment for Complicated Obstetric Cases.During 1939, sixteen patients received treatment under this scheme. The cost of maintenance and treatment of the above patients under this scheme amounted to £103.10s.0d. of which £26.l3s.0d. was recovered from the relatives. Supply of Milk to Expectant and Nursing Mothers and Infants. During1939, 6,857 gallons of fresh milk and 1,354 "lbs. "of dried milk, cod liver oil and malt etc. were supplied under the Maternity and Child Welfare Scheme. Dental Treatment. Dental treatment is available for children under school age and for nursing and expectant mothers. This Clinic continued without interruption throughout the year. Municipal Day Nursery.- The work at the Day Nursery at Hubert Road continued to be most satisfactory. Oil the outbreak of war the Nursery was evacuated to Arundel. A communication was addressed to the County Medical Officer for West Sussex requesting that the Nursery might come under the local Maternity and Child Welfare Scheme. The necessary arrangements were made through the local Medical Officer of Health. A medical attendant visited the Nursery weekly and at such other times as medical attention was requested by the Matron. 8. Visits were paid to the Nursery by the Chairman of the Wimbledon Maternity and Child Welfare Committee and the Medical Officer of Health as circumstances permitted. Nursing Homes Registration Act, 1927. Public Health Act, 1956 Part VI. The Wimbledon Borough Council is responsible for the supervision of nursing homes in Vimbledon. At the end of the year there were sixteen registered nursing homes. Fifty-seven visits of inspection were made. SANITARY CIRCUMSTANCES OP THE AREA. Sanitary Inspection of District.- The following is a statement showing the number and nature of "inspections made for the year 1939:- Reason of Visit. No. Infectious Diseases 319 House Inspections 5,190 Inspections under Housing Act, 1936 362 House to House Inspections 2,161 Rent Act Inspections 5 Houses Let in Lodgings Inspections 73 Inspection of Factories, Workshops, "Workplaces and Out-workers' premises 276 Dairies and Cowsheds Inspections 63 Inspections under Shops Acts 727 Application of Tests to Drains 115 Inspections under Diseases of Animals Acts . 9 Obtaining Samples of Foods and Drugs 18 Miscellaneous (including Inspections of food, slaughter-houses, mews, stables, caravans, Petroleum Acts, water supply, piggeries, mosquitoes, etc.) 1,126 Total 10,444 Notices Served.-one thousand two hundred and seventy-six preliminary notices or intimations were served during the year. It was found necessary to serve three hundred Statutory Notices. House Inspection.- The following table p;ives a summary of the nuisances abated and the sanitar improvements carried out, together with the defects remedied, as a result of house-to-house inspection under the supervision of the Sanitary Inspectors:- Accumulations removed 27 Cisterns provide 9 Cisterns repaired, cleansed or covered 13 Drains, new, provided 45 Drainage systems made water-tight by patent process .. .. 6 Drains, repaired or altered 45 Drains, stoppages removed 43 Dustbins provided 153 Flushing cisterns, new, provided 46 Flushing cisterns repaired 44 Manure receptacles provided 2 9. Rain-water pipes disconnected 1 Roofs repaired 265 Rooms stripped and cleansed 912 Verminous rooms cleansed 54 Soilpipes, new, provided 13 Soilpipes, repaired or altered 7 Vent pipes, new, provided 10 Vent pipes, repaired or altered 35 Waste pipes, new, provided 72 Waste pipes, repaired, disconnected or trapped 29 Water-closets, new, provided 93 Water-closets, repaired or ventilated 16 Water services restored 29 Yards paved 12 Yards repaired 69 Guttering repaired 116 Floors ventilated 18 Nuisances from damp walls abated 370 Sinks provided 28 Other nuisances 1,803 Total 4,385 FACTORIES, WORKSHOPS AND WORKPLACES. 1. Inspections for purposes of provisions as to health. Premises. Number of Inspections . Written Notices Pro secutions. Factories with mechanical power 59 8 – Factories without mechanical power 62 7 – Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) 38 2 – Total 159 17 – 2. Defects found.– Particulars Number of Defects. tions Found Remedied Referred to H.M. Inspector Want of Cleanliness (S.l) 7 5 - - Overcrowding (S.2) - - - - Unreasonable temperature(S.3) - - - - Inadequate ventilation(S.4) 1 1 - - Ineffective drainage of floors (S.6) - - - - Sanitary Conveniences (S.7) Insufficient - 1 - - Unsuitable or Defective 17 4 - - Not separate for Sexes - - - - Other Offences 5 4 - - 10. Other Offences (ctd.) (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937) Totals 30 15 - - Outwork in Unwholesome Premises - (Section 108). Nature of work Instances Notices Served. Pro se cu~ tions Wearing Apparel - Making, etc.. - - - Others - - - - Outwork in Infected Premises - Sections 109-110 Nil HOME WORK. Lists received:- Twice in the year 3 Number of Out-workers 10 Once in the year 11 Number of Out-workers 26 Number of Out-workers' premises on Register 35 Number of addresses received from other Councils 25 Number of addresses forwarded to other Councils 4 Notices served on occupiers as to keeping or sending Lists – Prosecutions - Failing to keep Out-workers Lists – Prosecutions - Failing to furnish Lists – Inspections of Out-workers' premises 15 Number of unwhole some premises – Notices served to remedy – OTHER MATTERS. Underground Bakehouses in use at the end of the year 3 Matters notified to H.M. Inspector of Factories Failure to affix Abstracts of Act Nil Action taken in matters ) Notified by H.M. referred by H.M.) Inspector.. Nil Inspector as remedial ) Reports of action under the Public Health) taken sent to Acts.) H.M. Inspector Nil HOUSING. Number of dwelling-houses inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932.325 Number of inspections made for the purpose 2,164 11. Housing Act, 1936.- Part IV.- Over crowding: (a) (1) Number of dwellings overcrowded at the end of the year 34 (2) Number of families dwelling therein 57 (3) Number of persons dwelling therein 305 (b) Number of new cases of overcrowding reported during the year 2 (c) (1) Number of cases of overcrowding relieved during the year 51 (2) Number of persons concerned in such cases 421 (d) Particulars of any cases in which dwelling houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding Nil INSERTION AND SUPERVISION OF FOOD. Mile Supply.- Practically all the milk for retail sale is brought into the area from other districts. The number of licences granted under the Milk (Special Designations) Order, 1936, was as follows:- Pasteuriser's Licence 1 Dealers Licences: Tuberculin Tested Milk 9 Accredited Milk Pasteurised Milk16 Supplementary Licences 9 Bacteriological lamination.- Thirty samples of milk were taken for bacterio logical" examination under the Milk (Special Designations) Order. Food and Drugs Act, 1958. The Council became the Local Authority under this Act on 1st October, 1939. Four samples were taken up to the end of the year. PREVALENCE OF AND CONTROL OVER INFECTIONS AND OTHER DISEASES. During 1939, one hundred and eighty-seven cases of infectious disease were notified. These were twenty-one fewer than in 1938. For several years the incidence of notifiable infectious disease in Wimbledon has been low. Scarlet Fever.- Fifty-four cases of scarlet fever were notified, one less than"in 1938. The attack rate was 0.96 per thousand of the population. Forty-three, or 79.63 per cent of the cases were treated in hospital. There were no deaths from this disease. 12. Diphtheria. .- The number of cases of diphtheria showed a marked decrease, there being twenty-four notifications in 1939 as . compared with thirty-seven in the previous year. The attack rate was 0.42 per thousand of the population. All the patients received hospital treatment. There were no deaths. Diphtheria Immunisation. - Sessions of the Immunisation Clinic Were held every Saturday morning at the Health Centre. Four children were Schick tested. Two were found to be positive and then immunised. The total number of children immunised was ninety-seven. In addition, five members of the nursing staff were Schick tested, threeof whom were positive and then immunised. In all, two hundred and eighty-six attendances were made for this purpose. Of the one hundred persons immunised, twenty-five attended for a subsequent Schick test. In all cases they were found to be Schick negative. Enteric Fever.- Two cases of paratyphoid fever were notified. One death occurred from enteric fever. This was a case notified in the latter part of the previous year. Food Poisoning.- This became a notifiable disease on 3rd October, 1939. Ho notification was received during the year. Cerebro-Spinal Fever.- Three cases of this disease were notified. One patient was treated in hospital. There were two deaths. Acute Poliomyelitis.- Three cases of poliomyelitis occurred. Erysipelas. Notifications were received in respect of eight cases of erysipelas. Two patients were treated in Hospital. Puerperal Pyrexia.- Seven cases of puerperal pyrexia were notified. Two of these "patients were removed to the Queen Charlotte's Maternity Hospital Isolation Block, Hammersmith. There was no death from puerperal sepsis amongst the seven patients notified under the Regulations. The cost to the Council in respect of these patients was £9.19s.6d., of which amount £3.3s.0d. was recovered from the patients or their relatives. 13. 14. TABLE A. - NOTIFIABLE DISEASES DURING 1939. DISEASE Number of Cases Notified in Various Age Groups. Total Cases Notified Total Cases Removed to Hospital Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 55 & over Smallpox _ _ _ _ _ _ _ _ _ _ _ _ _ _ Scarlet Fever.. _ 3 1 3 4 17 9 8 5 2 2 _" 54 43 Diphtheria (including Membranous Group) _ 1 1 2 1 7 7 1 3 1 _ _ 24 24 . Enteric Fever (including Paratyphoid) _ _ _ 1 _ _ _ _ 1 _ _ _ 2 1 Puerperal Pyrexia — _ _ _ _ _ 1 6 _ _ _ 7 2 Acute Primary Pneumonia _ 1 _ _ _ _ _ 1 _ _" _ 3 7 2 Acute Influenzal Pneumonia _ _ _ _ _ _ _ _ _ _ 2 _ 2 _ Cerebro-Spinal Fever _ 1 1 1 _ _ _ _ _ _ _ _ 3 1 • Acute Poliomyelitis. 1 _ _ _ _ _ 1 1 _ _ _ _ 3 _ Acute Polio-encephalitis -_ _ _ _ _ _- _ 1 _ _ _ _ _ _ Encephalitis Lethargica _ _ _ _ _ _ _ _ _ _ _ _ _ _ Dysentery _ _ _ _ _ 1 _ _ _ _ _ _ 1 1 Malaria _ _ _ _ _ _ _ _ _ _ _ _ _ _ Ophthalmia Neonatorum 3 _ _ _ _ _ _ _ _ _ _ _ 3 2 Erysipelas _ _ _ _ _ _ _ _ _ 2 4 1 8 2 Tuberculosis(all forms) 1 _ _ _ 1 3 3 _ 37 7 12 1 73 49 TOTALS • 5 6 3 7 6 28 20 20 55 12 l 20 5 187 128 15 TUBERCULOSIS 1939. AGS GROUPS NEW CASES DEATHS Primary Notification new Cases discovered otherwise than by Notification Total New Cases Pulmonary Non Pulmonary Pulmonary Non Pulmonary Pulmonary Non Pulmonary Pulmonary Non Pulmonary. Males Relates Males females Males Females males Females Males Females males females Males females Males females  Under 1 year 1 – – – – – – – 1 – – – – – 1 – 15 years – 1 – – – – – – – 1 – – – 1 – 1 5 -10 '' – 1 1 1 – – – – – l 1 1 – – – – 10-15 '' 2 – 1 – – – – – 2 – 1 – – 1 – 15-20 '' 3 3 2 – – – – – 3 3 – – – – – – 20-25 '' 2 8 1 – 2 1 – – 4 9 1 – 1 2 – – 25-35 '' 8 7 1 1 3 3 – – 11 10 1 1 3 7 – – 35-45 '' 1 4 1 1 – – – – 1 4 1 1 1 6 – 1 45-55 '' 7 1 – – – – – – 7 1 – – 1 2 – – 55-65 '' 3 1 – – – – – – 3 1 – – – 1 1 – 65 and over – 1 – – – – – – – 1 – – 1 – – 1 27 27 7 3 5 4 – – 32 31 7 3 7 19 3 3 Totals 54 10 9 – 63 10 26 6 64 9 73 52 ! . 73 TUBERCULOSIS. Seventy-three cases of tuberculosis were notified. This figure shows an increase of twenty-two on the number for the previous year. The deaths from tuberculosis were one more than in 1938, the total figure being thirty-two. Twenty-six of these were due to pulmonary tuberculosis. During 1339, forty-nine Wimbledon patients were admitted to sanatoria or hospitals. WIMBLEDON INFECTIOUS DISEASES HOSPITAL. One hundred and seventy-nine cases were admitted to the Infectious Diseases Hospital during 1939. As thero were twenty-one cases in hospital at the end of 1938, the total number of cases under treatment during the year amounted to two hundred. One hundred and fourteen of these cases were from Wimbledon, and eighty-six from Kingston. Of the two hundred patients under treatment, one hundred and eight were suffering from scarlet fever, fifty-four from diphtheria, and thirty-eight from other diseases. There were two deaths during the year, one of which was due to diphtheria and the other to whooping cough and pneumonia. Ten patients remained in hospital at the end of 1939. Seven of these were suffering from scarlet fever, two from diphtheria, and one from rubella. In concluding this report I should like to express my deep appreciation to the Chairman and members of the Public Health and Maternity and Child Welfare Committees for the consideration and courtesy which they have again shown me during 1939. It is also a pleasure to draw attention to the help and co-operation which I have received from all members of the staff. I have the honour to be Tour obedient servant, HAROLD ELLIS. 16.