WIM 19 Borough of Wimbledon. Public Health Department ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR ENDED 31st DECEMBER, 1946. Printed by Raynes Park Press, Lambton Road, London, S.W.20. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1946 Public Health Department, Town Hall, Wimbledon, S.W.19. November, 1947. Io 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 ended 31st December, 1946. This Report is compiled in accordance with the instructions contained in Circular 13/47 of the Ministry of Health. Since the outbreak of war these Reports have been issued in an abbreviated form in view of the need for economy in the use of paper. Full statistical records have however been preserved in the Public Health Department for future reference. 1 LIST OF CONTENTS. Page Introduction List of Staff SECTION A: STATISTICS AND SOCIAL CONDITIONS: Statistics, etc. Births Notified Deaths Registered Analysis of Causes of Death Infantile Mortality Summary of Statistics SECTION B: GENERAL PROVISION OF HEALTH SERVICES: Laboratory Facilities Ambulance Services Maternity and Child Welfare:— Health Visitors' Visits Ante-Natal Clinics Infant Welfare Centres Midwifery and Maternity Services Complicated Obstetric Cases Emergency Maternity Homes Care of Premature Infants Care of Illegitimate Children Ophthalmia Neonatorum Treatment Facilities Home Helps Service Domestic Helps Service Nursery Provision for Children under 5 Child Life Protection Provision of Insulin Nursing Homes Infestation by Head-lice SECTION C: SANITARY CIRCUMSTANCES: Water Supply Sanitary Inspectors' Visits Notices Served House Inspection Factories and Workplaces Outworkers Bakehouses 1 4-6 7-9 9 10 10 11-12 13 14 15 16 16 16 17 18 18 18 19 19 20-21 21 21 21 22 22 22 22-23 24 24 24 25 26 27 27 2 LIST OF CONTENTS — cont'd. Page SECTION D: HOUSING: SECTION E: INSPECTION AND SUPERVISION OF FOOD: Milk Food and Drugs Act, 1938 Ice cream SECTION F: PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES: Notifiable Infectious Diseases, etc Diphtheria Immunisation Tuberculosis Wimbledon Infectious Diseases Hospital STAFF 28 29 30-31 31 32-33 34-35 35-36 37-38 39 3 STAFF Whole-Time: Medical Officer of Health; Medical Superintendent of the Infectious Diseases Hospital: † * Harold Ellis, M.B., B.S. (Lond.), M.R.C.S., L.R.C.P., D.P.H. Deputy Medical Officer of Health: † Patrick J. Doody, M.B., B.Ch., D.P.H., (Serving with H.M. Forces). Temporary Assistant Medical Officer: † H. D. B. North, M.B., Ch.B., D.P.H., M.Sc., (resigned 10.10.46). † G. B. Stratton, M.R.C.P., M.R.C.S., (appointed 7.10.46). Senior Sanitary Inspector : * D. F. S. Flynn, (e), (/), (appointed 6.2.46). Sanitary Inspectors: * H. R. Fry, (c), (f), (appointed Deputy Senior Sanitary Inspector 31.7.46). * C. W. Southerby, (c), (f). * J. F. Smith, (c), (f). * E. R. Young, (c), (f), (appointed 23.4.46). Senior Health Visitor—School Nurse: Miss J. C. Moffat, (a), (b), (d), (h). Health Visitors—School Nurses: Miss V. B. Woodroff, (b), (c), (g). Miss P. N. Nash, (a), (b), (d), (resigned 31.8.46). Miss G. K. Jeffreys, (a), (b), (d), (h), (resigned 11.12.46). Miss M. A. Crombie, (a), (b), (d), (appointed 28.1.46: resigned 31.7.46). Miss V. A. Lyeach, (a), (b), (d), (appointed 16.1.46: transferred to permanent staff 31.7.46). Miss M. K. Loveland, (a), (b), (d), (appointed 2.9.46). Miss R. E. Boole, (a), (b), (d), (appointed 12.8.46). Matron of Infectious Diseases Hospital: Miss I. Mulhern, (died 9.2.46). Miss G. Palmer (appointed 7.2.46). Matrons of Day Nurseries: All Saints: Miss J. I. Head, (resigned 18.10.46). Miss M. Billaney (appointed 2.12.46). 4 Russell Road: Miss E. C. Quarmby, (resigned) 12.10.46). Miss K. A. Adams, (appointed 14.10.46). Senior Clerk: A. L. Taylor, (resigned 30.9.46) Miss V. Slack, (appointed 11.11.46). Clerks: J. E. Field, (returned from service with H.M. Forces 13.5.46). Mrs. V. Walters. J. Burrows, (Serving with H.M. Forces). E. Partridge, (temporary: appointed 1.3.46: resigned 31.8.46). Miss V. Little, (temporary). Mrs. F. I. Maddison, (temporary: resigned 10.9.46). Miss E. Riding, (temporary: appointed 16.10.46). Miss S. Miller, (temporary). Mrs. V. Hull, (temporary: part-time) (appointed 1.2.46: resigned 30.11.46). 5 Part-Time: Obstetric Consultants: Leslie H. Williams, M.D., F.R.C.S., F.R.C.O.G. J. Vincent O'SulIivan, M.D., F.R.C.S., M.R.C.P., F.R.C.O.G. Medical Officer to Ante-Natal Clinics'. S. Taylor Harris, M.R.C.S., L.R.C.P., (resigned July, 1946). Miss G. E. Keith, M.B., B.S., M.R.C.O.G., (appointed 15.7.46: resigned 30.11.46). Miss L. Raftery, M.R.C.S., L.R.C.P., M.R.C.O.G., (appointed 2.12.46). Consultant Paediatrician: G. H. Newns, M.D., M.R.C.P. Medical Officers to Maternity and Child Welfare Centres: Mary M. Tulloch, M.B., B.S. Faith Poles, M.B., B.S. E. A. Evans, M.A., M.B., B.Ch. Deputy Medical Attendant, Infectious Diseases Hospital: W. L. Galvin, M.B., B.Ch. Orthopaedic Surgeon: F. C. Durbin, F.R.C.S. (resigned in June). F. A. Simnionds, F.R.C.S., (appointed in June). Surgeon to Aural, Clinic: R. J. Cann, M.S. Veterinary Inspector: Col. E. Middleton Perry, C.B.E., F.R.C.V.S. * Salary contribution under Public Health Acts. † Salary contribution by Exchequer Grants. (a) S.R.N. (b) S.C.M. (c) Certificate Royal Sanitary Institute and Sanitary Inspectors amination Joint Board. (d) New Health Visitor's Certificate, Royal Sanitary Institute. (f) Certificate Royal Sanitary Institute for Inspector of Nuisances. (f) Certificate Royal Sanitary Institute for Inspector of Meat and other Foods. (t,') Diploma Board of Education (Health Visitors' Training) Regulations, 1919. (/i) Certificate of Fever Training. 6 SECTION A. — STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres—Census, 1931) Population (Census, 1931) Population (mid-1946) Number of inhabited houses:— 1921 (Census) 1931 (Census) Number of families or separate occupiers:— 1921 (Census) 1931 (Census) 3,221 59,524 54,910 11,926 13,325 13,998 15,883 Rateable Value:—£809,394. Sum represented by a penny rate:—£3,154 2s. 9d. Extracts from Vital Statistics of the Year 1946 (Registrar-General's Figures.) Total M. F. Live Births Legitimate 980 514 466 Illegitimate 58 27 31 Total 1,038 541 497 Birth, Rate per 1,000 of the estimated resident population 18.90 Stillbirths Total M. F. Legitimate 34 15 19 Illegitimate I — 1 Total 35 15 20 Rate per 1,000 total (live and still) births 32.62 Total M. F. Deaths 743 349 394 Death Rate per 1,000 of the estimated resident population 13.51 Deaths from puerperal causes (Headings 29 and 30 of the Registrar-General's Short List):— Deaths. Rate per 1,ooo total (live and still) births. No. 29 Puerperal and post-abortive sepsis — — No. 30 Other maternal causes — — Total — — Death Rate of Infants under one year of age:— All Infants per 1,000 live births 23.14 Legitimate Infants per 1,000 legitimate live births 24.49 Illegitimate Infants per 1,000 illegitimate live births 0 Deaths from Cancer (all ages) 128 Measles (all ages) 0 Whooping Cough (all ages) 0 Diarrhoea (under 2 years of age) 1 7 Birth Rates, Civilian Death Rates, Analysis of Mortality, Maternal Mortality, and Case Rates for certain Infectious Diseases in the Year 1946. (Provisional Figures based on Weekly and Quarterly Returns). Wimbledon England and Wales 126 C.B's and Great Towns including London 148 Smaller towns (resident population 25,000 - 50.000 at 1931 Census) London Administrative County (1) (2) (3) (4) (5) (6) † Rates per 1,000 Civilian Population Live Births 18.90 19.l‡ 22.2 21.3 21.5 Still Births 0.64 0.53‡ 0.67 0.59 0.54 Deaths:— All Causes 13.51 11.5 ‡ 12.7 11.7 12.7 Typhoid and Paratyphoid — 0.00 0.00 0.00 0.00 Small-pox — 0.00 0.00 0.00 — Measles — 0.00 0.01 0.00 0.01 Scarlet Fever — 0.00 0.00 0.00 0.00 Whooping Cough — 0.02 0.02 0.02 0.02 Diphtheria — 0.01 0.01 0.01 0.01 Influenza 0.27 0.15 0.13 0.14 0.12 Violence 0.49 * * * * Notifications:— Small-pox — 0.00 0.00 0.00 0.00 Scarlet Fever 0.67 1.38 1.51 1.33 1.42 Diphtheria 0.13 0.28 0.32 0.32 0.24 Typhoid Fever — 0.01 0.01 0.01 0.01 Paratyphoid Fever — 0.02 0.02 0.01 0.01 Cerebro-Spinal Fever 0.09 0.05 0.05 0.04 0.06 Measles 6.27 3.92 4.73 3.70 7.35 Whooping Cough 2.07 2.28 2.48 2.05 2.22 Erysipelas 0.22 0.22 0.25 0.22 0.27 Pneumonia 0.47 0.89 1.02 0.74 0.75 Rates per 1,000 Live Births Infant Mortality:— Deaths under 1 year of age 23 43 § 46 37 41 Deaths from Diarrhoea and Enteritis (under 2 years of age) 0.9 4.4 6.1 2.8 4.2 † A dash (—) signifies that there were no deaths. * Information not available. ‡ Rates per 1,000 Total population. § Per 1.000 related Births. 8  Rales per 1,000 Total Births (i.e., Live and Still) (1) (2) (3) (4) (5) (6) (a) Notifications :— Puerperal Fever 9.32 8.50 10.35 7.63 1.62 ‡ Puerperal Pyrexia 9.68 (b) Maternal Mortality :— WIMBLEDON No. 140 Abortion with sepsis No. 141 Abortion without sepsis No. 147 Puerperal Infections Nos. 142-146 and 148-150. Other maternal causes — — — — England and Wales 0.13 0.06 0.18 1.06 Abortion :— England and Wales Mortality per Million Women aged 15-45 years No. 140 with Sepsis No. 141 without sepsis 11 5 ‡ Including Puerperal Fever. BIRTHS. The statistics supplied by the Registrar-General show that during 1946 the total number of registered live births belonging to Wimbledon amounted to one thousand and thirty eight. (Five hundred and forty one males and four hundred and ninety seven females). This gives a birth rate equal to 18.90 per thousand of the population, compared with 17.01 per thousand for the previous year. Fifty eight of the births were illegitimate. In addition thirty five slill-births (fifteen females and twenty males, one of which was illegitimate) were registered. Public Health Act, 1936.—Notification of Births. During 1946, one thousand, two hundred and seventy nine live births and twenty seven still-births were notified. Of these, two hundred and forty six live births and three still-births were in respect of births occurring in Wimbledon to mothers normally resident outside the district. The following is an analysis of the one thousand and fifty seven notified births belonging to Wimbledon (i.e. as adjusted by inward and outward transfers): — 9  Live births. Still-births. Domiciliary confinements 255 2 Institutional confinements:— Kingston County Hospital 155 2 St. Helier County Hospital 104 5 Dorking County Hospital 7 — Nelson Hospital 250 9 Queen Charlotte's Hospital 12 — Other hospitals and nursing homes outside the Borough 86 2 Wimbledon Nursing Homes 164 4 1,033 24 DEATHS. The total number of Wimbledon residents who died during 1946 was seven hundred and forty three (three hundred and forty nine males and three hundred and ninety four females). Of these two hundred and eighty eight occurred outside the Borough. Apart from these figures two hundred and seventy six persons not normally resident in Wimbledon died in institutions, etc., in the Borough. The death-rate for 1946 is 13.51 per thousand of the population as compared with a rate of 13.38 per thousand during 1945. As in previous years the following diseases were responsible for over half the total deaths:— Percentage of total deaths Diseases of the heart and circulatory system 34% Cancer 17% Diseases of the respiratory system 15% Total 66% There was only one death from infectious disease. This was due to cerebro-spinal fever. There was one death from diarrhoea in a child under the age of two years. The following is an analysis of the causes of death: — Cause Males Females  1. Typhoid and Paratyphoid Fevers — — — 2. Cerebro-spinal Fever 1 — 1 3. Scarlet Fever — — — 4. Whooping Cough — — — 5. Diphtheria — — — 6. Tuberculosis of Respiratory System 10 15 25 7. Other forms of Tuberculosis 3 4 7 8. Syphilitic Diseases 5 — 5 10 9. Influenza 4 11 15 10. Measles — — — 11. Acute Poliomyelitis and Polioencephalitis — — — 12. Acute Infectious Encephalitis — — — 13.N [.Cancer of Buccal Cavity and Oesophagus (males only) 8 8 13.F Cancer of Uterus (females only) — 5 5 14. Cancer of Stomach and Duodenum 6 4 10 15. Cancer of Breast — 26 26 16. Cancer of all other sites 41 38 79 17. Diabetes 2 2 4 18. Intra-Cranial Vascular Lesions 26 51 77 19. Heart Disease 98 119 217 20. Other Diseases of the Circulatory System 11 19 30 21. Bronchitis 32 13 45 22. Pneumonia 25 13 38 23! Other Respiratory Diseases 3 3 6 24. Ulcer of the Stomach or Duodenum 3 3 6 25. Diarrhoea (under 2 years of age) 1 — 1 26. Appendicitis 1 — 1 27. Other Digestive Diseases 4 10 14 28. Nephritis 6 6 12 29. Puerperal and Post-Abortive Sepsis — — — 30. Other Maternal causes — — — 31. Premature Birth 2 4 6 32. Congenital Malformations, Birth Injury, Infantile Diseases 7 6 13 33. Suicide 2 2 4 34. Road Traffic Accidents 7 1 8 35. Other violent causes 8 7 15 36. All other causes 33 32 65 Totals 349 394 743 INFANTILE MORTALITY. During 1946 there were twenty four deaths of infants under one year of age, giving an infantile-mortality rate for Wimbledon of 23 per thousand live births, as compared with a rate of 43 for England and Wales. During 1945 the infantile-mortality rate for Wimbledon was 36 as compared with a rate of 46 for England and Wales. Only one of the twenty four infant deaths during 1946 was due to gastro-enteritis. No fewer than thirteen of these twenty four deaths occurred during the first week of life. Seven of these were due to congenital defects, and five of the remainder to prematurity. The total number of neo-natal deaths (i.e. deaths occurring during the first month of life), was seventeen, giving a neo-natal death rate of 16.3 per thousand live births. The following table shows the causes of, and ages at death, together with the Ward distribution. 11 12 Infant Mortality during the Year 1946. Cause of Death Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 1-3 months 3-6 months 6-9 months 9-12 months Total Deaths under 1 year WARD Nth. Wimbledon Sth. Wimbledon Total St. Mary's St. John's Cott. Park W'don Park Dundonald Trinity Sth. Park Haydon Pk. Congenital Defects 7 2 — — 9 3 — — — 12 1 1 1 — 5 — 3 1 3 9 12 Prematurity 5 — 1 — 6 — — — — 6 — — — — 1 2 — 3 — 6 6 Gastro-enteritis — — — — — — — 1 — 1 — — — — — — — — — 1 1 Whooping-cough — — — — — — — — — — — — — — — — — — — — — Pneumonia — — — 1 1 — 1 — — 2 — — — — — 1 — 1 — 2 2 Meningococcal Meningitis — — — — — — — 1 — 1 — 1 — — — — — — 1 — 1 Accidental death 1 — — — 1 — 1 — — 2 — — — 1 — — 1 — 1 1 2 Total 13 2 1 1 17 3 2 2 — 24 1 2 1 1 7 3 4 5 5 19 24 13 Summary of Statistics The following table shows the birth-rates and death-rates for Wimbledon, as compared with England and Wales, during the last ten years. Year Birth-Rate Still-hirtli Rate *Death-Rate Maternal Mortality Rate Infantile Mortality Rate Wim. E.& W. Wim. E.& W. Wim. E.& W. Wim. E.& W. Wim. E.& W. 1937 10.40 14.9 0.36 0.60 11.61 12.4 1.58 3.11 65.79 58 1938 11.89 15.1 0.40 0.60 10.78 11.6 2.77 2.97 45.84 53 1939 10.86 15.0 0.37 0.59 10.53 12.1 1.57 2.82 29.41 50 1940 12.20 14.6 0.42 0.55 13.92 14.3 1.67 2.16 43.40 55 1941 12.82 14.2 0.29 0.51 11.92 12.9 — 2.23 41.15 59 1942 15.46 15.8 0.47 0.54 12.44 11.6 — 2.01 41.95 49 1943 17.69 16.5 0.27 0.51 14.37 12.1 1.18 2 29 50.17 49 1944 15.62 17.6 0.53 0.50 13.21 11.6 2.76 1.93 37.14 46 1945 17.01 16.1 0.42 0.46 13.38 11.4 2.42 1.79 36.20 46 1946 18.90 19.1 0.64 0.53 13.51 11.5 — 1.43 23.14 43 •Since the year 1940 it has not been possible to correct the local death-rate by means of an Areal Comparability Factor, as the publication of this Factor was suspended by the Registrar-General in 1941. Consequently it is not strictly possible to compare the Death-Rate for Wimbledon with that for England and Wales. SECTION B. - GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Laboratory Facilities. The Corporation have an arrangement with the Nelson Hospital for the examination of pathological specimens sent by private medical practitioners, in the pathological laboratory attached to the Hospital. Dr. Lever, the pathologist to the Atkinson Morley Hospital, is the hon. pathologist to the Nelson Hospital and undertakes this work. The Corporation have also made arrangements with the Ministry of Health for the examination of pathological specimens at the Emergency Public Health Laboratory at Epsom College and a considerable number of specimens requiring special investigation are sent there. In addition, the laboratory provided at the Health Centre is utilised for the examination of pathological specimens from the Infectious Diseases Hospital, etc. This work is carried out by the staff of the Public Health Department. 14 AMBULANCE SERVICES. (a) For Infectious Diseases. Two motor ambulances are maintained by the Wimbledon Borough Council at the Infectious Diseases Hospital in Gap Road — one for the removal of infectious cases and one for disinfection purposes. (b) For Non-Infectious Cases and Accidents. Two motor ambulances are maintained by the Wimbledon Borough Council at the Fire Station in Queens Road for the removal of non-infectious patients and accident cases. The following table shows the continued increase in the annual number of requests for these ambulances during the last five years:— Year No. of calls dealt with. 1942 863 1943 1287 1944 1315 1945 1689 1946 1853 At the end of 1945 the Borough Council approved a recommendation of the Public Health Committee that maternity patients should be conveyed free to hospitals and institutions. During 1946 the Civil Ambulance Service conveyed 231 such patients. 15 MATERNITY AND CHILD WELFARE. The total number of visits paid by the health visitors during 1946 amounted to 11,608, the figure for the previous year being 9,427. Details of the home visits carried out are given below:— Number of Infants visited — first visits 1,082 Number of Infants visited — revisits 2,214 Number of Toddlers visited 3,729 Ante-natal — first visits 701 Ante-natal — revisits 232 Visits re Infant deaths 14 „ Stillbirths 21 „ Ophthalmia Neonatorum 6 „ „ Puerperal Pyrexia 3 „ Non-notifiable and notifiable Infectious Diseases 165 „ Foster Children 331 Miscellaneous 311 Total Welfare visits 8,809 Visits — School Health Service 826 Tuberculosis — Home visits 77 Visits to Nursing Homes 32 Other visits 34 Ineffectual visits 1,830 2,799 Total visits 11,608 The following table gives the attendance of health visitors at Schools, Special Clinics and Maternity and Child Welfare Centres during the year:— Half sessions at Schools 268 „ Special Clinics 754 „ M. & C. W. Centres 789 1,811 Owing to the increasing amount of work in connection with the Maternity and Child Welfare and School Health Services, an additional health visitor/school nurse was appointed at the beginning of the year. This makes a total of six health visitors. They devote 50% of their time to each of these services. Infant Welfare Centres and Ante-natal Clinics. At the beginning of the year there were four Infant Welfare Centres and two Ante-natal Clinics. Owing to the increasingly large number of mothers attending the Ante-natal Clinics, an additional Clinic, held on alternate Thursday 16 afternoons, was opened on the 12th September, 1946 at 28 Kings Road, Wimbledon, the Headquarters of the Wimbledon District Nursing and Midwifery Association. The following table shows the average attendance per session at the Centres:— No. of sessions field Average attendance per session. Ante-natal Clinics: Pelham Road (Mondays) 49 25.12 Pelham Road (Saturdays) 48 19.16 Wandle Park (held fortnightly) 28 16.53 Kings Road (held fortnightly) 7 12.14 Infant Welfare Centres: Pelham Road (Tuesdays) 52 81.65 Pelham Road (Fridays) 51 80.41 Cottenham Park 50 85.50 Wandle Park 51 53.00 Wimbledon Park 49 99.84 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 Borough Council made in accordance with Section 1(1) of the Midwives Act, 1936. There were three domiciliary midwives so employed at the end of 1946. During the year they dealt with 210 cases as midwives and 25 as maternity nurses. In addition, they attended 29 cases of miscarriage. Their future bookings for 1947 amounted to 142. The total amount paid by relatives during the year was £458 17s. 5d. Midwives Acts, 1902 /' 1936. For the purposes of the Midwives Acts the Borough Council is the Local Supervising Authority in Wimbledon. There were in all four practising midwives in Wimbledon at the end of 1946. Medical aid was summoned by midwives on 125 occasions. The total fees paid to doctors under Section 14(1) of the Midwives Act, 1918, amounted to £149 10s. 0d., of which £105 19s. 3d. was recovered from patients' relatives. The following is an analysis of the conditions for which medical aid was summoned: — Ruptured perineum 44 Slight inflammation of infants' eyes 20 High blood pressure 10 Pyrexia 8 Prematurity 8 Albuminuria 5 Abortion 3 17 Phlebitis 3 Difficult labour 9 Ante-partum haemorrhage 1 Other conditions 14 125 Hospital treatment for Com plicated Obstetric Cases. The Agreement between the Wimbledon Borough Council and the Nelson Hospital for the treatment of complicated obstetric cases continued in operation during 1946. During the year 20 patients were admitted to the Nelson Hospital under this scheme. The cost of maintenance of these patients amounted to £217 3s.2d., of which £42 8s. 3d. was recovered from the relatives. The following is an analysis of the types of cases admitted:— Abortion 6 Toxaemia of pregnancy 3 High blood pressure 3 Albuminuria 1 Ante-partum haemorrhage 1 Other conditions 6 20 Services of Consulting Obstetricians. Two Consulting Obstetricians, Mr. Leslie Williams and Mr. Vincent O'Sullivan, are available for consultation with medical practitioners for any complicated case arising in connection with pregnancy or childbirth, occurring in the home. During 1946 they were called in on six occasions. Emergency Maternity Homes. Under the L.C.C. scheme for the evacuation of expectant mothers to hostels outside London for confinement, 13 mothers were sent from Wimbledon at a cost to the Corporation of £304 3s. Od. The amount recovered in respect of these cases was £59 0s. 4d. Care of Premature Infants — Ministry of Health Circular 20/44. The special equipment recommended by the Ministry of Health in connection with the care of premature infants is available on application to the Wimbledon District Nursing and Midwifery Association, 28 Kings Road, Wimbledon. Dr. G. H. Newns, who was appointed by the Wimbledon Borough Council as Consulting Paediatrician in 1944, is available for consultation with medical practitioners in respect of any infant under the age of one year. During 1946 he was called in on six occasions. During the year the Wimbledon Council accepted responsibility for the maintenance of two premature babies in the Nelson Hospital beyond the normal period after birth, at a cost of £4 4s. 0d. Sums amounting to £1 1s. 0d. were recovered from the parents. 18 Care of Illegitimate Children.—Ministry of Health Circular 2866 (1943). The Wimbledon and Merton Moral Welfare Association have a welfare worker who deals with the problems arising in connection with unmarried mothers and the care of illegitimate children in this area. During 1946 the Wimbledon Borough Council accepted responsibility for payment in respect of the maintenance of seven unmarried mothers who were placed in Mother and Baby Homes prior to their confinement. The usual period for which mothers remain in the Homes is for about one month before confinement and two months afterwards. The total cost to the Council of these cases during 1946 was as under:-— Putney Mother and Baby Home— 4 cases at a total cost of £55 5s. Od. Grayshott Mother and Baby Home— 2 cases at a total cost of £39 17s. 9d. Stretton House Mother and Baby Home, S.E.12— 1 case at a cost of £12 Os. Od. The Wimbledon Borough Council also made a grant of £5 to the Southwark Catholic Rescue Society towards the convalescence of an unmarried mother with her baby. Ophthalmia Neonatorum. The following table shows that eight cases of ophthalmia neonatorum were notified. In no case did any impairment of vision occur. The services of a consultant are available where necessary. CASES V ision Unimpaired Vision Impaired Total Blindness Deaths Notified Treated At Home Hospital 8 5 3 8 — — — 19 TREATMENT FACILITIES. The following table shows the attendances of children under the age of five years at the Minor Ailment, Ophthalmic, Orthopaedic and Aural Clinics during the year: — Minor Ailment Clinic. Number of new cases 290 Re-attendances 296 Ophthalmic Clinic. Number of new cases 15 Re-attendances 17 Number of cases in which glasses were prescribed 15 Orthopaedic Clinic. Number of new cases 35 Re-attendances 91 Number of children admitted to St. Nicholas' and St. Martin's Orthopaedic Hospital, Pyrford 3 Aural Clinic. Number of new cases 8 Re-attendances 1 Facilities for the operative treatment of tonsils and adenoids are available through the local hospitals. Sixteen children under the age of five years were referred for operation during 1946 through the Maternity and Child Welfare Department. Dental Clinic. Dental treatment is available for children under school age and for nursing and expectant mothers. The following table shows the work done at this Clinic during 1946:— (ij Expectant and Nursing Mothers. Number of mothers who attended 149 Total number of attendances made 457 Number of gas administrations 115 Number of local anaesthetics given 13 Number of permanent teeth extracted 284 Number of permanent teeth filled 70 Total number of fillings 80 Other operations 96 Dentures supplied 33 Dentures repaired 2 Other operations to dentures 83 Scalings 73 (ii) Children under 5 years of age. Number of children under 5 years of age who attended 47 Total number of attendances made 88 Temporary teeth extracted 77 Number of gas administrations 32 Number of local anaesthetics given 2 20 (iii) Day Nurseries (Russell Road and All Saints Road.) Number of children inspected 122 Number found to be free from caries 77 Number referred for treatment 6 Number not requiring treatment 39 HOME HELPS SERVICE. At the end of 1946 there were four full-time home helps employed by the Wimbledon Borough Council. During the year their services were supplied in 29 cases where domestic assistance was required in connection with home confinements. DOMESTIC HELPS SERVICE. The Wimbledon Borough Council have appointed a number of domestic helps whose services may be supplied to households where there is illness or infirmity (Ministry of Health Circular 179/44). At the end of 1946 there were one full-time and eight part-time domestic helps employed. During the year, 44 households were supplied with a domestic help for varying periods according to need. NURSERY PROVISION FOR CHILDREN UNDER FIVE. The War-time Nurseries at All Saints Road and Russell Road were well used throughout the year. At the end of 1946 there were on the register 131 children (53 under 2 years of age and 78 between 2 and 5 years). In October, 1946, the Maternity and Child Welfare Committee considered the question of whether the Russell Road premises should continue as a Day Nursery or should be transferred to the Local Education Authority as a Nursery School. In view of the shortage of labour in industry, and the restricted hours for which Nursery Schools are open, it was decided that the Russell Road premises should continue as a Day Nursery until the Spring of 1947, when the position would again be reviewed. The Residential Nursery at Hindhead to which a number of Wimbledon children had been evacuated was taken over by the Surrey County Council on the 1st April, 1946. A small number of Wimbledon children were admitted to this Nursery during 1946 on account of difficult home conditions. Responsibility for maintenance was accepted by the Wimbledon Maternity and Child Welfare Committee, the parents being assessed to pay a weekly sum in proportion to their means. In December the Hindhead premises were closed and the children were transferred to a Nursery at Woking. 21 PUBLIC HEALTH ACT, 1936 — CHILD LIFE PROTECTION. The following figures relate to the supervision of foster-mothers in Wimbledon during 1946: — Number of foster-mothers on the Register: — (a) at the beginning of the year 18 (b) at the end of the year 25 Number of foster-children on the Register: — (a) at the beginning of the year 20 (b) at the end of the year 31 (c) who died during the year 1 (d) on whom inquests were held during the year 1 One foster-child, a baby aged 7 months, died during the year. The child, who was well cared for, became ill and died within 24 hours. A post-mortem examination was made and death was found to have been due to intussusception of the small intestine. In addition to the number of foster-children shown above, there are in Wimbledon two private schools, each taking boarders under nine years of age. At the end of 1946 there were 83 children in these schools who were visited periodically in accordance with the Sections of the Public Health Act, 1936, relating to Child Life Protection. PUBLIC HEALTH ACT, 1936. — SUPPLY OF INSULIN. — MINISTRY OF HEALTH CIRCULAR 2734 (1943). In accordance with the above circular the Wimbledon Borough Council accepted responsibility for payment for the supply of insulin to five persons during the year 1946. PUBLIC HEALTH ACT, 1936, PART VI. — NURSING HOMES. The Wimbledon Borough Council is responsible for the super- vision of nursing homes in the Borough. During the year 1946 there was one new registration. This was for the use of the premises at 27, Lingfield Road for chronic cases. Forty-two visits of inspection were made during the year to registered nursing homes in the Borough. At two premises the attention of occupiers was drawn to overcrowding. In each case this overcrowding was abated. At three premises alterations and adaptions were carried out. The alterations carried out at one nursing home included the provision of a new nursery for babies. INFESTATION BY HEAD LICE. — MINISTRY OF HEALTH CIRCULAR NO. 2831. The examination of the heads of children under the age of five years has been carried out as part of the health visitors' normal duties both at the times of their visits to the homes and also in the Maternity and Child Welfare Clinics. The standard of cleanliness of children under five in Wimbledon has always been high. 22 It has been the practice of the health visitors, who also comoine the duties of school nurses, to pay particular attention to the homes of school children whose heads have been found to be dirty, and where there are children under the age of five years in such homes their condition of cleanliness is closely supervised in so far as the co-operation of the parents can be obtained. In most cases the health visitors are successful in obtaining the good will and assistance of the parents. A supply of steel fine-tooth combs is kept at the Health Centre and these are available for sale or on loan. A number of parents have taken advantage of these facilities. Where it has been considered advisable Letbane hair oil (384-"Special") has been used and a supply of this preparation is always kept at the Health Centre. The supervision of the hair of adolescent girls residing in a house where children have been found with dirty heads, is a much more difficult problem. The need for advising these adolescent girls is constantly kept in mind by the health visitors, and where the mother and girls were receptive every assistance has been given. 23 SECTION C. — SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. The Metropolitan Water Board is responsible for the water supply of the Borough and regular periodical examinations are made by them. The supply in 1946 was satisfactory both in quality and quantity. All the dwelling houses in Wimbledon are supplied from public water mains direct to the houses. During the year two samples of water were taken from the Swimming Baths for bacteriological examination and a further two samples for chemical examination. The results of these samples showed the water to be both bacteriologically and chemically pure. Six samples of water were taken for bacteriological examination from Wimbledon Park Lake. The result of these samples showed that the water was grossly contaminated. The Council consequently decided not to proceed with the proposal to establish outdoor swimming facilities in this lake. Sanitary Inspection of District. The following is a statement showing the number and nature of inspections made during 1946:'— Reason for Visit. No. Infectious Diseases 1,257 House Inspections 7,540 Inspections under Housing Act, 1936, Part IV 499 House to House Inspections 274 Inspections of Factories, Workplaces and Outworkers' premises 139 Dairies and Cowsheds Inspections 58 Inspections under Shops Act 30 Applications of Test to Drains 97 Inspections under Diseases of Animals Act 16 Obtaining samples of Food and Drugs 154 Miscellaneous (including inspections of food, slaughter-houses, mews, stables, caravans, Petroleum Acts, water supply, piggeries, etc.) 4,208 Total 14,292 Notices Served. Two thousand, six hundred and seven preliminary notices or intimations were served during the year. It was found necessary to serve two hundred and twenty one statutory notices. 24 Legal proceedings were taken against two owners for failure to comply with abatement notices. Orders were made by the Court in both cases for the work to be carried out within twenty eight days. House Inspection. The following table gives a summary of the nuisances abated and the sanitary improvements carried out, together with the defects remedied under the supervision of the sanitary inspectors:— Accumulations removed 66 Cisterns provided 14 Cisterns repaired, cleansed or covered 9 Drains, new, provided 43 Drains, repaired or altered 142 Drains, stoppages removed 207 Dustbins provided 338 Flushing cisterns, new, provided 14 Flushing cisterns, repaired 128 Rain-water pipes disconnected 10 Roofs repaired 414 Rooms stripped and cleansed 543 Verminous rooms cleansed 54 Soilpipes, new, provided 4 Soilpipes, repaired or altered 5 Vent pipes, new, provided 4 Vent pipes, repaired or altered 9 Waste pipes, new, provided 17 Waste pipes, repaired, disconnected or trapped 31 Water-closets, new, provided 131 Water-closets, repaired or ventilated 44 Water services restored 79 Water supply direct from main 6 Yards paved 4 Yards repaired 6 Guttering repaired 185 Floors ventilated 31 Nuisances from damp walls abated 361 Sinks provided 47 Other nuisances remedied 2,355 Rooms disinfected 374 Total 5,675 25 FACTORIES AND WORKPLACES. 1. Inspections for Purposes of Provisions as to Health. Premises Number of Inspections Written Notices Prosecutions Factories with mechanical power 103 13 — Factories without mechanical power 12 5 — Other Premises under the Act (including works of building and engineering construction but not including outworkers' Premises) Totals 115 18 — 2. Defects Found. Particulars Number of Defects Prosecutions Found Remedied Referred to H.M. Inspector Want of Cleanliness (S.l) 5 5 — — Overcrowding (S.2) — — — — Unreasonable temperature (S.3) — — — — Inadequate v e n t i 1 a tion (S.4) — — — — Ineffective drainage of floors (S.6) — — — — Sanitary Conveniences (S.7)— Insufficient 3 3 — — Unsuitable or Defective 4 3 2 — Not Separate for Sexes 1 1 — — Other Offences (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) 12 10 1 — Totals 25 22 3 — 26 Outwork in Unwholesome Premises — Section 108. Nature of Work Instances Notices Served Prosecutions Wearing Apparel — Making, etc. — — — Others — — — Outwork in Infected Premises — Sections 109 - 110 Nil. HOME WORK. Lists received Nil. Number of addresses received from other Councils 12 Number of addresses forwarded to other Councils — Notices served on occupiers as to keeping or sending lists — Prosecutions—failing to keep Outworkers' Lists — Prosecutions—failing to furnish lists — Inspections of Outworkers' Premises 1 Number of unwholesome premises — Notices served to remedy — OTHER MATTERS. Underground Bakehouses in use at the end of the year 3 27 SECTION D. — HOUSING. Dwelling-houses inspected and recorded under the Housing (Consolidated) Regulations 1925 and 1932: — Number of inspections made 48 Housing Act, 1936, (Part IV) — Overcrowding. The following table shows the position in Wimbledon at the end of 1946, with regard to overcrowding. No. of cases No. of families No. of units * Dwellings known to be overcrowded at the beginning of 1946 39 63 230 New cases reported during the year 38 62 231 Overcrowding relieved during the year 9 12 49½ Dwellings overcrowded at the end of 1946 68 113 402½ * One unit —one person over ten years of age. Half-unit=one person over 1 year but under ten years of age. The number of families rehoused in requisitioned property during 1946 was 211. 28 SECTION E. - INSPECTION AND SUPERVISION OF FOOD. Milk. All the milk sold in Wimbledon is brought into the area from other districts. Under the Milk (Special Designations) Regulations 1936/46, 35 licences were granted to retailers, as follows: — Pasteurisers' Licences Nil. Dealers' Licences— Tuberculin Tested Milk 8 Pasteurised Milk 12 Supplementary Licences 15 35 Thirty six samples of milk were taken for bacteriological examination during the year, thirty two of which were satisfactory. On two occasions legal proceedings were taken against a retailer for selling milk in a dirty bottle. Fines amounting to £35 5s. 0d. and costs amounting to £10 13s. 0d., were imposed on the retailer by the Court. 29 Food and Drugs Act, 1938. The Council became the Local Authority for the purposes of this Act on the 1st October, 1939. During 1946, seventy six samples were taken for analysis, as under: — Articles Analysed Adulterated or Deteriorated Prosecutions Convictions Formal Informal Total Formal Informal Total Milk 4 24 28 — — — — — Butter 1 2 3 — — — — — Margarine — 1 1 — — — — — Lard — 1 1 — — — — — Tea — 1 1 — — — — — Coffee 1 1 2 — — — — — Creamola Pudding — 1 1 — — — — — Semolina 1 — 1 — — — — — Oatmeal — 1 1 — — — — — Bun and Cake Flour — 1 1 — — — — — Pearl Barley — 2 2 — — — — — Junket — 1 1 — — — — — Blancmange — 1 1 — — — — — Custard Powder — 1 1 — — — — — Baking Powder 1 1 2 — — — — — Golden Raising Powder — 1 1 — — — — — Curry Powder — 1 1 — — — — — Mixed Spice — 1 1 — — — — — Ground Ginger — 1 1 — — — — — Arrowroot 1 1 2 — — — — — Black Pepper — 1 1 — — — — — Soup Powder — 1 1 — — — — — Pea Flour — 1 1 — — — — — Malted Milk Tabs. — 1 1 — — — — — Drugs — 5 5 — — — — — Almond Essence — 2 2 — — — — — Fruit Flavour Essence — 1 1 — — — — — Sausages 2 4 6 1 — 1 — — Black — 1 1 — — — — — Pudding Peanut Butter — 1 1 — — — — — Vinegar 1 1 2 — — — — — Bread and Butter — 1 1 — — — — — 12 64 76 1 — 1 — — 30 Under Section 9 of the Food and Drugs Act, there was one prosecution. This was for the sale of a doughnut found to contain foreign matter. A fine of £10 plus costs amounting to £10 10s. Od. were imposed upon the firm by the Court. Ice Cream. During the year seventy nine samples of ice cream were taken for bacteriological examination, of which nineteen were found to be unsatisfactory. Numerous visits were paid to the premises concerned. At the end of the year all the ice cream samples had been brought up to a satisfactory standard with the exception of that sold from three premises where the owners voluntarily undertook to discontinue further sales until certain alterations and improvements had been carried out. 31 SECTION F. — PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. During the year there were 572 cases of infectious disease notified, as compared with 876 during 1945. Of the total number of notifications received, 453 were in respect of measles or whooping-cough, diseases which have been notifiable since 1939 when the Measles and Whooping-cough Regulations came into force. The following table gives an analysis of the notifications received during the year. 32 33 Notifiable Diseases during 1946. DISEASE Number of Cases Notified in Various Age Groups Total Cases Notified Total Cases removed to Hospital Under 1 1-3 3-5 5-10 10-15 15-25 25-45 45-65 65 and over Smallpox — — — — — — — — — — — Scarlet Fever — 5 5 15 6 4 1 1 — 37 31 Diphtheria (including Membranous Croup) — — — 1 3 1 2 — — 7 7 Puerperal Pyrexia — — — — — 4 6 — — 10 7 Measles 10 57 98 155 9 6 3 1 — 339 21 Whooping Cough 11 33 32 32 3 — 3 — — 114 4 Acute Primary or Influenzal Pneumonia 1 — 1 — 1 4 3 9 7 26 2 Cerebro - Spinal Fever — — — 2 1 1 1 — — 5 4 Acute Poliomyelitis — — — — 2 — — — — 2 2 Dysentery (Sonne) — — — — — 1 — 1 2 4 — Pemphigus Neonatorum 1 — — — — — — — — 1 1 Ophthalmia Neonatorum 8 — — — — — — — — 8 3 Erysipelas — — — — — 1 5 5 1 12 7 Malaria (Relapse) — — — — — 1 6 — — 7 1 TOTALS 31 95 136 205 25 23 30 17 10 572 90 IMMUNISATION AGAINST DIPHTHERIA. Sessions of the Diphtheria Immunisation Clinic were held regularly during the year. The number of children immunised during the period is as follows: — Primary Immunisation. Children under 5 years of age 555 Children aged 5 to 14 years 27 582 Boosting Doses. No. of children given boosting doses 287 These figures relate only to children immunised under the Local Authority's Scheme, and do not include a considerable number of children immunised by private doctors. The following table shows the state of immunisation in Wimbledon in relation to the child population: — Age at 1946 No. immunised Total child population. Under 1 2 3,890 Under 2 387 Under 3 568 Under 4 547 Under 5 558 2,062 5 to 9 years 2,247 5,660 10 to 14 years 1,774 4,021 During the year each health visitor was given a complete list of all the children under the age of five years living in her district. This list was checked off against the record-cards of children under five who had previously been immunised through the Authority's Scheme. The health visitors then concentrated on home visits to those children of whom there was no previous record of immunisation. Immunisation Clinics are held at the Health Centre, Pelham Road, every Tuesday and Saturday morning. Children under school age, and school children, are immunised during these sessions. The great majority of children attending are under the age of five years. Where the need has arisen, arrangements have been made for immunisation to be carried out in the Infant Welfare Centres and in the Schools. 34 During 1946, a start was made in the administration of boosting doses to children attending infants' schools. Two infants' schools had been completed by the end of the year, 287 boosting doses in all having been given. As the Council is an autonomous Maternity and Child Welfare Authority, the immunisation record-cards of all children under school-leaving age are in the possession of the Public Health Department. TUBERCULOSIS. During the year, ninety six cases of tuberculosis were added to the register, four more than in 1945. Of these, sixty seven were new cases and the remainder were transfers from other areas. The following cases were removed from the Register: — Deaths 32 Patients stated to have recovered 3 Removals from district 29 64 There were 44 admissions to hospitals or sanatoria during the year. The following table gives an analysis of the notifications received :— 35 36 TUBERCULOSIS — 1946 AGE GROUPS CASES ADDED TO THE REGISTER DEATHS Primary Notifications (Form A) Cases Discovered otherwise than by Notification Total Cases added to the Register Pulmonary NonPulmonary Pulmonary NonPulmonary Pulmonary NonPulmonary Pulmonary NonPulmonary Males Females Males Females Males Females Males Females Males Females Males Females Males Females Males Females- Under 1 Year — — — — — — — — — — — — — — — — 1 — 5 Years 1 1 2 — — — — — 1 1 2 — — — — — 5—10 „ — — — — — — — — — — — — — — — — 10 — 15 „ 2 1 1 — — — — — 2 1 1 — — — — — 15 — 20 „ 2 4 1 — — 2 — — 2 6 1 — 1 1 2 — 20 — 35 ,, 17 11 2 2 7 5 1 — 24 16 3 2 1 4 — 1 35 — 45 „ 5 2 — 1 4 5 — — 9 7 — 1 3 6 1 3 45 — 55 ,, 3 — — 2 3 1 — — 6 1 — 2 3 3 — — 55 — 65 ,, 5 2 — — — 1 — — 5 3 — — 2 1 — — 65 and Over — — — — — — — — — — — — — — — — 35 21 6 5 14 14 1 — 49 35 7 5 10 15 3 4 56 11 28 1 84 12 25 7 67 29 96 32 WIMBLEDON INFECTIOUS DISEASES HOSPITAL. Two hundred and eighteen cases were admitted to the Infectious Diseases Hospital during 1946, as under: — From Wimbledon 144 From Kingston 68 From other districts 6 218 As there were eighteen cases in the hospital at the end of 1945, the total number of cases under treatment during the year was two hundred and thirty six. Fifteen patients remained in the hospital at the end of 1946 (eight from Wimbledon, four from Kingston and three from other areas). The following table shows the diseases from which the patients were stated to be suffering on admission, and the number of cases in which the diagnosis was confirmed: — Disease No. stated to be suffering on admission No. of cases in which diagnosis was confirmed Diphtheria 32 12 Scarlet Fever 61 48 Cerebro- Spinal Meningitis 12 7 Acute Anterior Poliomyelitis 9 3 Paratyphoid Fever 1 1 Measles 28 28 Whooping Cough 12 12 Erysipelas 10 10 Dysentery 2 1 Gastro- Enteritis 6 6 Ophthalmia Neonatorum 3 3 Pemphigus Neonatorum 1 1 Puerperal Pyrexia 7 Puerperal Sepsis 4 B. Coli Infection 1 Mastitis 1 Other causes 1 Healthy babies (admitted with mothers) 7 7 Healthy mothers (admitted with babies) 2 2 193 There were in addition twenty five miscellaneous cases admitted, bringing the total number of admissions to two hundred and eighteen. 37 Diphtheria. Thirty two cases were admitted to the hospital as diphtheria and twenty two of these came from the Wimbledon area. The following table shows the final diagnosis in regard to these twenty two Wimbledon cases: — Diphtheria Carriers 2 Clinical Diphtheria 5 Acute Tonsillitis 9 Measles 2 Other conditions 4 The two diphtheria carriers and one very mild case of diphtheria occurred in children under the age of 15 years. These three children had all been previously immunised. They were attending a school outside the district in which an outbreak of diphtheria occurred. The remaining four Wimbledon cases of diphtheria under treatment in the hospital were all adults. There were no cases of laryngeal diphtheria. No deaths from diphtheria occurred in the hospital during the year. Cerebro-Spinal Fever. Of the twelve cases admitted as cerebro-spinal fever, eleven were from the Wimbledon area. In only 4 cases was the diagnosis confirmed. Puerperal Pyrexia. Seven of the ten notified cases of puerperal pyrexia were removed to the Infectious Diseases Hospital. In four of these seven cases the diagnosis of puerperal sepsis was confirmed. Of the remaining three cases admitted to the hospital one was found to be suffering from a B. coli infection and another from acute mastitis. The cause of the pyrexia in the seventh case was found not to be puerperal infection. A Consulting Obstetrician was called in to see one of the patients. One of the patients required and was given a blood transfusion. All the patients made complete recoveries. 38 STAFF. As may be seen from the list at the beginning of this Report, a considerable number of changes occurred amongst the staff of the department. As a result of this work was again carried on under considerable difficulties. During the year only one of the four members of the staff on War Service returned to duty. Dr. H. D. B. North, Assistant Medical Officer, who was appointed during the absence of Dr. Doody, the Deputy Medical Officer of Health, in H.M. Forces, resigned in October and was replaced by Dr. G. B. Stratton. Mr. D. F. S. Flynn was appointed Senior Sanitary Inspector in place of Mr. Avis, whose death took place in December, 1945. Reference was made in my Annual Report for 1945 to the illness of Miss Mulhern, the Matron of the Infectious Diseases Hospital. Miss Mulhern died on the 9th of February, 1946, and her passing was greatly mourned by all her colleagues. Miss G. Palmer, the Assistant Matron at the Hospital, was subsequently appointed to succeed Miss Mulhern. * * * * * In presenting this Report I should once more like to express my deep appreciation to the Chairmen and Members of the Health and Maternity and Child Welfare Committees for their consideration and courtesy during the year. I should also like to place on record my thanks for the cooperation which I have received from all the members of the staff. I have the honour to be, Your obedient Servant, HAROLD ELLIS, Medical Officer of Health. 39