AC 4413(1) WIMBLEDON WIM20 Borough of Wimbledon. Public Health Department ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR ENDED 31st DECEMBER, 1947. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1947 Public Health Department, Town Hall, Wimbledon, S.W.19. September, 1948. 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 ended 31st December, 1947. This Report is compiled in accordance with the instructions contained in Circular 170/47 of the Ministry of Health. Since the outbreak of war these Reports have been issued in an abbreviated form, but full statistical records have been preserved in the Public Health Department for future reference. The year 1947 is the last complete year during which the Wimbledon Borough Council exercised its functions as an autonomous Authority for Maternity and Child Welfare and Ambulance Services, and as a Hospital Authority. Under the National Health Service Act, 1946, which came into operation on the 5th July, 1948, all these responsibilities pass either to the control of the Surrey County Council as Local Health Authority, or to the control of the Regional Hospital Board for the area. 1 LIST OF CONTENTS. Page Introduction 1 List of Staff 4-6 SECTION A: STATISTICS AND SOCIAL CONDITIONS: Statistics, etc. 7-9 Births Notified 9 Deaths Registered 10 Analysis of Causes of Death 10 Infantile Mortality 11-12 Summary of Statistics 13 SECTION B: GENERAL PROVISION OF HEALTH SERVICES: Laboratory Facilities 14 Ambulance Services 15 Maternity and Child Welfare: — Health Visitors' Visits 16 Ante-Natal Clinics 16 Infant Welfare Centres 16 Midwifery and Maternity Services 17-18 Complicated Obstetric Cases 18 Care of Premature Infants 19 Care of Illegitimate Children 19 Ophthalmia Neonatorum 19-20 Treatment Facilities 21 Home Helps Service 22 Nursery Provision for Children under 5 Child Life Protection 23 Provision of Insulin 23 Nursing Homes 23 Infestation by Head-lice 23-24 Cleansing Facilities 24 SECTION C: SANITARY CIRCUMSTANCES: Water Supply 25 Sampling of Water 25 Sanitary Inspectors' Visits 25 Notices Served 26 Nuisances abated and defects remedied 26-27 Factories Act, 1937, Part I. 28 Outworkers 29 Bakehouses 29 2 LIST OF CONTENTS — cont'd. Page SECTION D: HOUSING 30 SECTION E: INSPECTION AND SUPERVISION OF FOOD: Milk 31 Food and Drugs Act, 1938 32-33 Ice cream 33 SECTION F: PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES: Notifiable Infectious Diseases, etc 34-38 Diphtheria Immunisation 39 Tuberculosis 40-41 Wimbledon Infectious Diseases Hospital 42-44 STAFF 45 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., (Returned from service with H.M. Forces 24.3.47). Temporary Assistant Medical Officer: † G. B. Stratton, M.R.C.P., M.R.C.S., (resigned 26.5.47). Senior Sanitary Inspector : * D. F. S. Flynn, (e), (f). Deputy Senior Sanitary Inspector : * H. R. Fry, (c), (f). Sanitary Inspectors: * C. W. Southerby, (c), (f). * J. F. Smith, (c), (f), (resigned 7.4.47). * E. R. Young, (c), (f), * L. Burrows, (c), (f), (appointed 16.6.47). * H. J. Bishop, (c), (appointed 17.11.47). 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 V. A. Lyeach, (a), (b), (d). Miss M. K. Loveland, (a), (b), (d). Miss R. E. Boole, (a), (b), (d). Miss M. L. Vincent, (a), (b), (d), (appointed 7.1.47). Miss M. Wilson, (a), (b), (d), (appointed 13.1.47). Matron of Infectious Diseases Hospital: Miss G. Palmer. Matrons of Day Nurseries: All Saints: Miss M. Billaney 4 Russell Road: Mrs. K. A. Edmonds. Senior Clerk: Miss V. Slack. Clerks: J. E. Field. Mrs. V. Waters. J. Burrows, (Returned from Service with H.M. Forces 17.2.47). Miss V. Little. Miss E. Riding. Mr. S. C. Nottingham, (returned from Service with H.M. Forces 27.5.47). Miss E. Hill, (temporary: appointed 6.1.47: resigned 22.2.47) Miss S. Miller. 5 Part-Time; Obstetric Consultants: Leslie H. Williams. M.D., F.R.C.S., F.R.C.O.G. J. Vincent O'Sullivan, M.D., F.R.C.S., M.R.C.P., F.R.C.O.G. Medical Officer to Ante-Natal Clinics: Miss L. Raftery, M.R.C.S., L.R.C.P., M.R.C.O.G. 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., (resigned 3.11.47). E. A. Evans, M.A., M B., B.Ch. Hilda G. Dean, M.B., B.S., D.P.H. (appointed 5.6.47). Deputy Medical Attendant, Infectious Diseases Hospital: W. L. Galvin, M B., B.Ch. Orthopaedic Surgeon: F. A. Simmonds, F.R.C.S., (resigned in September). G. Apley, F.R.C.S., (appointed 10.9.47). 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, (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) lations, 1919. (h) Certificate of Fever Training. 6 SECTION A. — STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres—Census, 1931) 3,221 Population (Census, 1931) 59,515 Population (mid-1947) 57,170 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:—£854,119. Sum represented by a penny rate:—£3,410. Extracts from Vital Statistics of the Year 1947 (Registrar-General's Figures.) Total M. F. Live Births Legitimate 1,056 563 493 Illegitimate 53 27 26 Total 1,109 590 519 Total M. F. Stillbirths Legitimate 24 12 12 Illegitimate — — — Total 24 12 12 Birth Rate per 1,000 of the estimated resident population 19.82 Still-birth Rate per 1,000 total (live and still) births 21.18 Total M. F. Deaths 780 345 435 Death Rate per 1,000 of the estimated resident population 13.64 Deaths from puerperal causes (Headings 29 and 30 of the Registrar-General's Short List):— Deaths. Rate per 1,000 total (live and still) births. No. 29 Puerperal and post-abortive sepsis – – No. 30 Other maternal causes l 0.88 Total l 0.88 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 18.03 Legitimate Infants per 1,000 legitimate live births 17.05 Illegitimate Infants per 1,000 illegitimate live births 37.74 Deaths from Cancer (all ages) 150 Measles (all ages) 0 Whooping Cough (all ages) 0 Diarrhoea (under 2 vears of ace) 0 7 Birth Rates, Civilian Death Rates, Analysis of Mortality, Maternal Mortality, and Case Rates for certain Infectious Diseases in the Year 1947. (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 19.39 20.5‡ 23.3 22.2 22.7 Still Births 0.42 0.50‡ 0.62 0.54 0.49 Deaths:— All Causes 13.64 12.0† 13.0 11.9 12.8 Typhoid and Paratyphoid — 0.00 0.00 0.00 0.00 Scarlet Fever — 0.00 0.00 0.00 0.00 Whooping Cough — 0.02 0.03 0.02 0.02 Diphtheria — 0.01 0.01 0.01 0.01 Influenza 0.10 0.09 0.09 0.08 0.08 Small-pox — 0.00 0.00 0.00 — Measles — 0.01 0.02 0.02 0.01 Violence 0.58 * * * * Notifications:— Typhoid Fever – 0.01 0.01 0.00 0.01 Paratyphoid Fever – 0.01 0.01 0.01 0.01 Cerebro-Spinal Fever 0.09 0.05 0.06 0.05 0.05 Scarlet Fever 0.89 1.37 1.54 1.37 1.31 Whooping Cough 2.75 2.22 2.41 2.02 2.80 Diphtheria 0.07 0.13 0.15 0.14 0.14 Erysipelas 0.09 0.19 0.21 0.18 0.22 Small-pox — 0.00 0.00 0.01 0.00 Measles 4.43 9.41 9.13 9.58 5.29 Pneumonia 0.56 0.79 0.89 0.68 0.64 Rates per 1,000 Live Births Infant Mortality:— Deaths under 1 year of age 18 41 § 47 36 37 Deaths from Diarrhoea and Enteritis (under 2 years of age) — 5.8 8.0 3.7 4.8 † A dash (—) signifies that there were no deaths. * Information not available. ‡ Rates per 1,000 Total population. § Per 1,000 related Births. 8 (1) Rates per 1.000 Total Births (i.e., Live and Still) (2) (3) (4) (5) (6) (a) Notifications:— Puerperal Fever 2.65 7.16 8.99 6.27 1.21 Puerperal Pyrexia 6.94 (b) Maternal Mortality :— No. 140 Abortion with sepsis No. 141 Abortion without sepsis No. 147 Puerperal Infections Nos. 142-146 and 148-150. Other maternal causes WIMBLEDON — — — 0.88 England and Wales 0.10 0.06 0.16 0.85 Mortality per Million Women aged 15-45 years Abortion:- No. 140 with Sepsis No. 141 without sepsis England and Wales 9 5 I Including Puerperal Fever. BIRTHS. The statistics supplied by the Registrar-General show that during 1947 the total number of registered live births belonging to Wimbledon amounted to 1,109. In addition 24 stillbirths were registered. This gives a birth-rate of 19.82 per thousand of the population, compared with 18.90 per thousand for the previous year. 53 live births were illegitimate. There were no illegitimate stillbirths. Public Health Act, 1936.—Notification of Births. During 1947, 1,319 live births and 24 stillbirths were notified. Of these, 224 live births and 4 still births occurring in Wimbledon were in respect of mothers normally resident outside the district. The following is an analysis of the 1,115 notified births belonging to Wimbledon (i.e. as adjusted by inward and outward transfers) 9  Live births. Still-births. Domiciliary confinements 285 4 Institutional confinements: — Kingston County Hospital 56 4 St. Helier County Hospital 204 5 St. Lukes County Hospital 28 — Epsom County Hospital 5 — Nelson Hospital 301 5 Queen Charlotte's Hospital 5 — Other hospitals and nursing homes outside the Borough 61 — Wimbledon Nursing Homes 150 2 1,095 20 DEATHS. The total number of Wimbledon residents who died during 1947 was 780. Of these deaths 264 occurred outside the Borough. Apart from these figures 223 persons not normally resident in Wimbledon died in institutions, etc., in the Borough. The death-rate for 1947 is 13.64 per thousand of the population as compared with a rate of 13.51 per thousand during 1946. As in previous years the following diseases were responsible tor over half the total deaths:— Percentage of total deaths Diseases of the heart and circulatory system 32% Cancer 19% Diseases of the respiratory system 13% Total 64% There was only one death from infectious disease. This was due to cerebro-spinal fever. The following is an analysis of the causes of death:— Cause Males Females Total 1. Typhoid and Paratyphoid Fevers — — — 2. Cerebro-spinal Fever — 1 1 3. Scarlet Fever — — — 4. Whooping Cough — — — 5. Diphtheria — — — 6. Tuberculosis of Respiratory System 9 6 15 7. Other forms of Tuberculosis — — — 8. Syphilitic Diseases 4 2 6 9. Influenza 2 4 6 10. Measles — — — 11. Acute Poliomyelitis and Polioencephalitis — — — 12. Acute Infectious Encephalitis — — — 10 l3.M.Cancer of Buccal Cavity and Oesophagus (males only) 6 6 13.F. Cancer of Uterus (females only) — 9 9 14. Cancer of Stomach and Duodenum 12 10 22 15. Cancer of Breast — 20 20 16. Cancer of all other sites 49 44 93 17. Diabetes 1 4 5 18. Intra-Cranial Vascular Lesions 30 66 96 19. Heart Disease 101 126 227 20. Other Diseases of the Circulatory System 8 13 21 21. Bronchitis 28 27 55 22. Pneumonia 14 21 35 23. Other Respiratory Diseases 6 5 11 24. Ulcer of the Stomach or Duodenum 7 5 12 25. Diarrhoea (under 2 years of age) — — — 26. Appendicitis — 1 1 27. Other Digestive Diseases 9 8 17 28. Nephritis 9 10 19 29. Puerperal and Post-Abortive Sepsis — — — 30. Other Maternal causes — 1 1 31. Premature Birth 3 2 5 32. Congenital Malformations, Birth Injury, Infantile Diseases 10 6 16 33. Suicide 3 2 5 34. Road Traffic Accidents 3 — 3 35. Other violent causes 12 13 25 36. All other causes 19 29 48 Totals 345 435 780 INFANTILE MORTALITY. During 1947, 20 deaths occurred in infants under one year of age, giving an infantile mortality rate for Wimbledon of 18 per thousand live births, as compared with a rate of 41 for England and Wales. The total number of neo-natal deaths (i.e. deaths occurring during the first month of life) was 13, giving a neo-natal death-rate of 11.8 per thousand live births. Of these 13 deaths, 10 occurred during the first week of life. In 16 cases the cause of death was prematurity or congenital defects. A further 2 deaths were due to pneumonia. One child was asphyxiated by the pressure of bedclothes. The remaining death was of a newly-born child whose body was found outside a church in the Borough. The following table shows the causes of, and ages at, death, together with the Ward distribution. From the table " Summary of Statistics " it will be seen that this is the first time the infantile mortality rate in Wimbledon has dropped below 20. 11 Infant Mortality during the Year 1947. 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. Wimbledor Sth. Wimbledon Total St. Mary's St. John's Cott. Park W'don Park Dundonald Trinity Sth. Park Haydon Pk. Congenital Defects 4 1 1 — 6 7 2 — — 10 1 3 1 — 1 — 2 2 5 5 10 Prematurity 4 — 1 5 1 — — — 6 1 2 — 1 1 1 — — 4 2 6 Pneumonia 1 — — — 1 1 — — — 2 1 — — — — 1 — — 1 1 2 Accidental death — — — — — 1 — — — 1 1 — — — — — — — 1 — 1 Asphyxia -unknown cause 1 — — — 1 — — — — 1 — — — — — — 1 — — 1 1 Total 10 1 2 — 13 5 2 — — 20 4 5 1 1 2 2 3 2 11 9 20 12 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 Live-Birth Rale Still-birth Rate *Death-Rate Maternal Mortality Rate Infantile Mortality Rate 1938 Wim. E. & W. Wim. E. & W. Wim. E.& W. Wim. E. & W. Wim. E.& W. 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 1947 19.39 20.5 0.42 0.50 13.64 12.0 0.88 1.17 - 18.03 41 *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. 13 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 Public Health Laboratory at Epsom 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 Injections 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 disinfecting purposes. (b) For Non-Injections 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 personnel employed in this service are one supervisor and 7 driver/attendants. In December, 1946 the Rolls Royce ambulance was involved in an accident on an ice-covered road and as a result of the damage sustained it was off strength during the whole of 1947. As a consequence of this the Civil Ambulance Service was run with only one vehicle. During May and November this vehicle also had to be put off the road for repairs and the British Red Cross Society materially assisted by allowing us the use of their vehicle. In March. 1947 the conditions of service of the ambulance personnel were reviewed. The rates of pay and conditions of service recommended by the National Joint Council for Staffs of Hospitals and Allied Institutions were applied to this Service, and a rota system of alternate 8 and 16 hour shifts was introduced. 15 The following table shows the annual number of requests received during the last five years for the use of an ambulance:— Year No. of calls dealt with. 1943 1287 1944 1315 1945 1689 1946 1853 1947 1852 MATERNITY AND CHILD WELFARE. The total number of visits paid by the health visitors during 1947 amounted to 12,767, the figure for the previous year being 11,608. Details of the home visits carried out are given below:— Number of Infants visited — first visits 1,304 Number of Infants visited — revisits 2,791 Number of Toddlers visited 4,575 Ante-natal — first visits 453 Ante-natal — revisits 124 Visits re Infant deaths 6 „ Stillbirths 18 „ Ophthalmia Neonatorum 4 „ Non-notifiable and notifiable Infectious Diseases 154 „ Foster Children 323 Miscellaneous 157 Total Welfare visits 9,909 Visits — School Health Service 682 Tuberculosis — Home visits 87 Visits to Nursing Homes 29 Other visits 115 Ineffectual visits 1,945 Total visits 2,858 12,767 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 327 „ special clinics 795 „ M. & C. W. centres 844 1,966 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 seven 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 three ante-natal clinics and four infant welfare centres. Owing to the increasingly large number of mothers attending the Kings Road Ante-Natal Clinic which had been held fortnightly since its opening in September, 1946, weekly sessions at this centre were commenced on the 6th March, 1947, and held throughout the year. To relieve the pressure at the existing welfare centres, and to provide better facilities for mothers living in the area of Wimbledon High Street, an additional infant welfare centre was opened on the 16 5th June, 1947, at Emmanuel Church Hall, The Ridgway. Sessions are held there every Thursday afternoon. Hitherto, it has not been possible to sell National Dried Milk from the welfare centres, owing to the impossibility of obtaining transport for the conveyance of the milk from the Food Office to the centres. In September, 1947, however, an arrangement was entered into between the Maternity and Child Welfare Committee and the Food Executive Officer, whereby the Maternity and Child Welfare Committee made themselves responsible for transporting National Dried Milk and vitamin preparations to the welfare centres each week, to be sold there by Food Office clerks. This arrangement has proved very satisfactory, as the mothers are now able to purchase National Dried Milk at the same time as they bring their babies to be weighed, and are thus saved a special journey to the Food Office. 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 full-time and two part-time domiciliary midwives so employed at the end of 1947. During the year they dealt with 206 cases as midwives and 37 as maternity nurses. In addition, they attended 16 cases of miscarriage. Their future bookings for 1948 amounted to 89. The total amount paid by relatives during the year was £449 12s 3d. Midwives Acts, 1902j 1936. For the purposes of the Midwives Acts the Borough Council is the Local Supervising Authority in Wimbledon. There were in all seven practising midwives in Wimbledon at the end of 1947. The following table shows the average attendance per session at the centres:— No. of sessions held Average attendance per session. Ante-natal Clinics: Pelham Road (Mondays) 49 20.84 Pelham Road (Saturdays) 35 13.09 Wandle Park (held fortnightly) 28 9.17 Kings Road (Thursdays) 46 21.45 Infant Welfare Centres: Pelham Road (Tuesdays) 51 88.31 Pelham Road (Fridays) 49 82.02 Cottenham Park (Mondays) 45 88.31 Wandle Park (Wednesdays) 52 64.52 Wimbledon Park (Thursdays) 50 98.86 Emmanuel Church Hall (Thursdays) 29 44.86 17 Medical aid was summoned by midwives on 88 occasions. The total fees paid to doctors under Section 14(1) of the Midwives Act, 1918, amounted to £116 10s. 0d., of which £68 11s. 5d. was recovered from patients' relatives. The following is an analysis of the conditions for which medical aid was summoned:— Ruptured perineum 32 Slight inflammation of infants' eyes 12 High blood pressure 4 Pyrexia 7 Albuminuria 1 Abortion 4 Difficult labour 10 Ante-partum haemorrhage 1 Other conditions 17 88 The Rules of the Central Midwives Board were revised during the year, and the amended Rules became operative on 1st October, 1947. One of the most important amendments is that certain Rules in Section E apply not only to midwives when practising as such but also when acting as maternity nurses. The number of midwives, who, under the amended Rules, gave notice of their intention to practise as maternity nurses during the year 1947 was 7. Hospital treatment for Complicated Obstetric Cases. The agreement between the Wimbledon Borough Council and the Nelson Hospital for the treatment of complicated obstetric cases continued in operation during 1947. In May, 1947, having regard to the difficult conditions existing in many homes, the agreement was extended to include whenever possible the admission of Wimbledon patients to the hospital's Maternity Department when general health or home conditions were such that confinement in a hospital was desirable. The following table shows the nature of the complicated cases admitted to the Nelson Hospital during 1947 under the above agreement:— Abortion 7 Toxaemia of pregnancy 3 High blood pressure 1 Difficult labour 4 Ante or post-partum haemorrhage 2 Other conditions 4 Unsuitable home conditions 3 24 The cost of maintenance of these patients amounted to £297 6s. 9d., of which £101 14s. l0d. was recovered from the relatives. Services of Consulting Obstetricians. Two Consulting Obstetricians, Mr. Leslie Williams and Mr. Vincent O'Sullivan, are available for consultation with medical 18 titioners for any complicated case arising in connection with pregnancy or childbirth, occurring in the home. During 1947 they were called in on two occasions. Care of Premature Infants — Ministry of Health Circular 20/44. The spccial 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. Nevvns. 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 1947 he was called in on six occasions. The number of premature births notified during 1947 in respect of Wimbledon residents was 53. Thirteen premature infants were born in the Borough. Seven of these births occurred at home, and the remaining six in nursing homes. Two of those born at home were removed to hospital. All 13 babies survived at the end of one month. Care of Illegitimate Children.—Ministry of Health Circular 2866 (1948). 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. In March. 1947, this Association established a Hostel for Unmarried Mothers and their infants at the Haygarth Witts Memorial Home, The Ridgway, Wimbledon, for mothers from Wimbledon and surrounding districts. Previously the Wimbledon Maternity and Child Welfare Committee have made grants towards the maintenance of such girls with their infants in various Mother and Baby Homes outside the Borough. Upon the establishment of the Home in the Ridgway they agreed, in principle, to accept responsibility for the maintenance of Wimbledon girls admitted there — less of course any contributions made by the putative father or from any other source. The cost of maintenance has been assessed at £3 per week. During the year the Committee accepted financial responsibility in nine cases at a total cost of £178 18s. 6d. Ophthalmia Neonatorum. The following table shows that four 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 4 4 — 4 — — — 19 As the Council in 1947 were the Local Supervising Authority under the Midwives Acts the Public Health Department had very early information from the midwives practising in the area of any discharge from the eyes occurring in an infant within twentyone days of birth. In such cases home nursing was provided by the Wimbledon District Nursing Association. This ensured that the doctor's instructions were properly and regularly carried out. The advent of sulphonamides and penicillin has removed a very great deal of the anxiety which was formerly associated with cases of ophthalmia neonatorum. The four cases notified during the year were slight and were all adequately treated at home. 20 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 296 Re-attendances 220 Ophthalmic Clinic. Number of new cases 10 Re-attendances 21 Number of cases in which glasses were prescribed 12 Orthopaedic Clinic. Number of new cases 30 Re-attendances 118 Number of children admitted to the Rowley Bristow Orthopaedic Hospital, Pyrford 1 Aural Clinic. Number of new cases 11 Re-attendances 3 Denial 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 1947:— (i) Expectant and Nursing Mothers. Number of mothers who attended 100 Total number of attendances made 307 Number of gas administrations 85 Number of local anaesthetics given — Number of permanent teeth extracted 161 Number of permanent teeth filled 27 Total number of fillings 31 Other operations 42 Dentures supplied 22 Dentures repaired 2 Other operations to dentures 66 Scalings 42 (ii) Children under 5 years of age. Number of children under 5 years of age who attended 70 Total number of attendances made 110 Temporary teeth extracted 100 Number of gas administrations 47 Number of local anaesthetics given 3 (iii) Day Nurseries (Russell Road and All Saints Road.) Number of children inspected 128 Number found to be free from caries 73 Number referred for treatment 8 Number not requiring treatment 47 21 Facilities for the operative treatment of tonsils and adenoids are available through the local hospitals. Ten children under the age of five years were referred for operation during 1947 through the Maternity and Child Welfare Department. HOME HELPS SERVICE. At the end of 1947 there were 3 home helps employed by the Wimbledon Borough Council. During the year their services were supplied in 68 cases where domestic assistance was required in connection with home confinements. The Wimbledon Borough Council also possesses a number of domestic helps whose services may be supplied to householders where there is illness or infirmity. At the end of 1947 there were 3 fulltime and 17 part-time domestic helps employed. During the year 110 households were supplied with the services of a domestic help, for varying periods according to need. The total number of hours worked by home helps and domestic helps during 1947 amounted to 26,597 hours. NURSERY PROVISION FOR CHILDREN UNDER FIVE. The day nurseries at All Saints Road and Russell Road were well used throughout the year. At the end of 1947 there were on the register 116 children (37 under 2 years of age and 79 between 2 and 5 years). In the spring of 1947 the Maternity and Child Welfare Committee reviewed the question as to whether the Russell Road premises should remain as a day nursery or whether they should be transferred to the Local Education Authority as a nursery school. If converted into a nursery school the premises would, of course, remain open for shorter hours and would only admit children over the age of 2. In order to ascertain the needs of mothers a questionnaire was sent to all those whose children were attending or on the waiting list for admission to the day nursery. In reply to this questionnaire the mothers of 71 children (40 over 2 and 31 under 2) stated that their needs would not be met by the provision of a nursery school. After considering the question fully the Committee resolved that the day nursery should be retained until the Maternity and Child Welfare functions of the Wimbledon Borough Council are taken over by the Surrey County Council in 1948 under the provisions of the National Health Service Act, 1946. During the year 2 children were sent for short periods to the Surrey County Council Residential Nursery at Woking on account of the illness of their mothers. The Maternity and Child Welfare Committee accepted financial responsibility, the parents being assessed to pay a weekly sum in accordance with their means. The Committee also continued to accept financial responsibility for the maintenance of 3 Wimbledon children already in this nursery at the beginning of 1947. Owing to unsuitable home conditions these children still remained at the residential nursery at the end of the year. 22 PUBLIC HEALTH ACT. 1936 — CHILD LIFE PROTECTION. The following figures relate to the supervision of foster-mothers in Wimbledon during 1947:— Number of foster-mothers on the Register:— (a) at the beginning of the year 25 (b) at the end of the year 17 Number of foster-children on the Register: — (a) at the beginning of the year 31 (b) at the end of the year 24 (c) who died during the year Nil (d) on whom inquests were held during the year Nil 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 1947 there were 37 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 seven persons during the year 1947. PUBLIC HEALTH ACT, 1936, PART VI. — NURSING HOMES. The Wimbledon Borough Council is responsible for the supervision of nursing homes in the Borough. Thirty-four visits of inspection were made during the year. At the end of 1947 the position was as follows:— No. of Homes on the Register: (a) Maternity 2 (b) Others 8 10 No. of beds provided: (a) Maternity 26 (b) Others 114 140 One nursing home was re-registered during the year owing to change of ownership. 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 23 children under five in Wimbledon has always been high. It has been the practice of the health visitors, who also combine 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 Lethane 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. CLEANSING FACILITIES. By arrangement with the Merton and Morden Urban District Council, the following Wimbledon residents were sent to the Raynes Park Cleansing Centre for treatment during 1947:— Scabies Verminous Heads Adults 48 1 Children aged 5 to 15 years 23 10 Children under 5 years 6 — 24 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 1947 was satisfactory both in quality and quantity. With three exceptions the dwelling houses in Wimbledon are supplied from public water mains direct to the houses. Sampling of Water During the year four samples of water were taken from the Corporation's Swimming Baths. All samples were bacteriologically satisfactory. Two samples of water taken from the swimming bath at Kings College School were also satisfactory. Three samples of water were taken from the Rushmere Pond on Wimbledon Common — from the west end, east end and centre of the pond. In all cases the samples were reported as being grossly contaminated and unfit for human consumption. These samples were taken from the Rushmere Pond at the time of the poliomyelitis epidemic. The pond is used by children almost exclusively for sailing their boats and for paddling. It was not at that time considered necessary to restrict the use of the pond in any way. Sanitary Inspection of District. The following is a statement showing the number and nature of inspections made during 1947 :— Reason for Visit No. Infectious Diseases, investigations, etc. 482 Inspections under Housing Act, 1936, Part IV 202 House to House Inspections 122 House Inspections 9,978 Inspections of Factories, Workplaces and Outworkers' premises 435 Inspections of Dairies and Cowsheds 25 Inspections of Food, and Food Premises 854 Obtaining samples of Food and Drugs 122 Inspections under the Shops Acts 1912/1938 23 Inspections under the Petroleum (Regulation) Acts, 1928 and 1936 68 Applications of Test to Drains 130 Inspections under Rats and Mice (Destruction) Act, 1919 562 Miscellaneous Inspections (including visits to Nursing Homes, Caravans, Piggeries, Stables, and Hairdressers' premises, and Smoke Observations, etc.) 1,689 Total 14,692 25 Notices Served. Preliminary notices or intimations 3,114 Statutory Notices 448 Result of Service of Notices. (a) Legal proceedings. As a result of non-compliance with abatement notices legal proceedings were started in forty-eight cases. In twenty-six of these cases nuisance orders were made and in the remaining twenty-two the summonses were withdrawn as the work was completed. The costs awarded amounted to £61 Is. 3d. Three applications were made to the Court to recover the cost of dustbins supplied by the Corporation in default under Section 75 of the Public Health Act, 1936. Two applications were made to recover the expenses incurred by the Corporation in abating statutory nuisances in respect of which nuisance orders had been made by the Court but which had not been complied with by the owners. (b) Work carried out in default. Four dustbins were supplied by the Corporation in the default of the owners. In six cases where nuisance orders had been made by the Court, but not complied with by the owners, the Corporation executed the necessary works to abate the nuisances. Nuisances abated and defects remedied. The following table gives a summary of the nuisances abated and the sanitary improvements carried out, together with the defects remedited under the supervision of the sanitary inspectors: — Accumulations removed 55 Cisterns provided 12 Cisterns repaired, cleansed or covered 35 Drains, new, provided 40 Drains, repaired or altered 191 Drains, stoppages removed 155 Dustbins provided 360 Flushing cisterns, new, provided 20 Flushing cisterns, repaired 135 Rain-water pipes disconnected 10 Roofs repaired 716 Rooms stripped and cleansed 2503 Verminous rooms cleansed 42 Soilpipes, new, provided 8 Soilpipes, repaired or altered 14 Vent pipes, new, provided 8 Vent pipes, repaired or altered 18 Waste pipes, new, provided 16 Waste pipes, repaired, disconnected or trapped 50 Water-closets, new, provided 208 Water-closets, repaired or ventilated 116 Water services restored 121 Water supply direct from main 16 Yards paved 2 Yards repaired 31 26 Guttering repaired 481 Floors ventilated 32 Nuisances from damp walls abated 771 Sinks provided 30 Other nuisances remedied 5,320 Rooms disinfected 385 Total 11,901 Eighteen sewers vested in the Local Authority by Section 20 of the Public Health Act, 1936, were cleared or repaired and the cost of the work charged to the owners of the houses served. 27 FACTORIES ACT, 1937. PART I. 1. Inspections for Purposes of Provisions as to Health. Premises Number on Register Number of Inspections Written Notices Prosecutions Factories without mechanical power 137 106 5 Factories with mechanical power 215 248 26 — Other Premises under the Act (including works of building and engineering construction bui not including outworkers' Premises) 2 10 — — Totals 354 364 31 — 2. Defects Found. Particulars Number of Defects Prosecutions Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Want of Cleanliness (S.l) 13 1 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) 1 1 — 1 — Inadequate v e n t i 1 a tion (S.4) — — — — — Ineffective drainage of floors (S.6) 1 1 — — — Sanitary Conveniences (S.7) :— Insufficient 6 2 Unsuitable or Defective 24 7 — 1 — Not Separate for Sexes 5 1 — — — Other Offences (Excluding offences relating to outwork) 8 2 4 — Totals 58 13 4 4 — 28 PART VIII. OUTWORK — SECTIONS 110 & III. Nature of work Section 110 Section HI No. of outworkers in Allggusl list required by Sec. 110 (/) (r) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwhole some premises Notices served Prosecutions Wearing Apparel — Making etc. — — — — — — Cleaning and washing 1 — —i — — — Others — — •— — — — Total 1 — — — — Number of addresses received from other Councils 28 Number of addresses forwarded to other Councils 1 Number of premises where outwork was carried on at the end of 1947 23 Inspections of Outworkers premises 69 Outwork in Infected Premises (Section 153 Public Health Act, 1936) Nil. OTHER MATTERS. Underground Bakehouses in use at the end of the year 4 Failure to affix Abstracts of Act notified to H.M. Inspector of Factories 4 29 SECTION D. - HOUSING. Dwelling-houses inspected and recorded under the Housing (Consolidated) Regulations 1925 and 1932 4 Number of inspections made 4 Housing Act, 1936, (Part IV) — Overcrowding. The following table shows the position in Wimbledon at the end of 1947, with regard to overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 38 (ii) Number of families dwelling therein 50 (iii) Number of persons dwelling therein 203 (b) Number of new cases of over crowding reported during the year 26 (c) (i) Number of cases of overcrowding relieved during the year 60 (ii) Number of persons concerned in such cases 338½ (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. 30 SECTION E. - INSPECTION AND SUPERVISION OF FOOD. Milk (Special Designations) Regulations, 1936/46. Under the Milk (Special Designations) Regulations, 1936/46, licences were granted to retailers as follows: Pasteurisers' Licences Nil. Dealers' Licences— Tuberculin Tested Milk 6 Pasteurised Milk 12 Supplementary Licences 15 33 Twentynine samples of milk were taken for bacteriological examination. In twentyfive cases the results were satisfactory. Milk and Dairies Order 1926. Legal proceedings were taken against a dairyman for failing to comply with Article 21, i.e. for selling milk in a dirty bottle. A fine of £15 plus costs amounting to £3 3s. Od. was imposed on the retail purveyor by the Court. 31 Sampling of Food and Drugs. During 1947 samples were taken for analysis as under: Articles A naly sed Inferior or Adulterated Formal Informal Total Formal Informal Total Milk 5 36 41 — 1 1+ Butter — 8 8 — 1 1* Lard — 1 1 — — — Coffee — 1 1 — — — Coffee Extract — 1 1 — — — Cocoa — — — — 1 1* Semolina — 1 1 — — — Pudding Mixture — 1 1 — — — Barley Flakes — 1 1 — — • — Macaroni — 1 1 — — — Corn Flour — 1 1 — — — Cake Mixture — 3 — — — Pea Flour — 1 1 — — — Soya Flour — 1 1 — — — Junket Powder — 2 2 — — — Soup Powder 1 5 6 — 1 1* Soup Tinned — 2 2 — — — Egg Powder — 3 3 — — — Gravy Powder — 2 2 — — — Sauce Powder — 2 2 — — — Pepper — 4 4 — — — Ground Ginger — 5 5 — — — Nutmeg — 3 3 — — — Mixed Spice — 5 5 — — — Curry — 1 1 — — — Curry Spread — 1 1 — — — Ground Cinnamon — 1 1 — — — Arrowroot — 2 — — — Gelatine 1 2 3 — — — Baking Powder — 3 3 — — — Table Jelly — 1 1 — — -— Fish Paste — 3 3 — — — Lemonade Powder — 3 3 — — — Malt Cup — 1 1 — — — Slippery Elm Food — J 1 — — — Chocolate Malt Spread — 1 1 — — — Almond Flavouring — 1 1 — ~ — Lemon Flavouring — 1 1 — — — Raspberry Essence 1 1 — — — Cochineal 1 1 — — — Drugs — 5 5 — — 7 123 130 — 4 4 t Adulterated * Inferior 32 Unsound Food. Under Section 9 of the Food and Drugs Act, 1938 there was one prosecution. This was for the sale of food (jam tarts) unfit for human consumption. A fine of £10 plus costs amounting to £3 3s. Od. was imposed upon the defendant by the Court. Ice Cream. On the 1st May, 1947, the Ice Cream (Heat Treatment, etc.) Regulations, 1947, came into operation. These Regulations broadly require that, subject to certain qualifications, the ingredients of ice cream shall be heat treated after being mixed and that the mixture shall then be cooled until the freezing process is begun. After freezing, ice cream must not be sold unless it has been kept at a temperature of not more than 28°F, or, if its temperature has risen above 28° F, unless it has again been heat treated and then kept at not more than 28°F after having been frozen. When these Regulations were issued the Minister of Health drew attention to a form of methylene blue test adapted for testing ice cream. There does not yet appear to be any test, the reliability of which is sufficiently established to justify its use as a statutory test, non-compliance with which would constitute an offence. The methylene blue test appears to be the best available for testing ice cream, and is simple and cheap to perform. The results of the methylene blue test divide ice cream into four categories — Grades 1, 2, 3, and 4. It is suggested that if ice cream consistently fails to reach Grade 1 or 2 it would be reasonable to regard this as indicating defects of manufacture or handling which call for further investigation. During the year ninety-four samples of ice cream were taken for bacteriological examination. Eighty-eight of these were subjected to the methylene blue test and the results of sampling were as follows:— Grade 1 7 Grade 2 25 Grade 3 34 Grade 4 22 In the remaining six samples owing to the ice cream being coloured it was not possible to carry out the methylene blue test, and the results of these samples were as follows:— Coliform bacilli present in Plate Count tubes inoculated with 1/10 ml. (1) Yes Over 1,000,000 (2) Yes Over 1,000,000 (3) Yes Over 500,000 (4) Yes 44,000 (5) Yes 6,000 (6) Yes 4,800 Repeated visits were made to premises from which unsatisfactory samples had been received, and further samples were taken. In ail two hundred and forty-six such visits were made during the year. 33 SECTION F. — PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. During the year there were 541 cases of infectious disease notified, as compared with 572 during 1946. Of the total number of notifications received, 410 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. POLIOMYELITIS. During 1947 there was an outbreak of poliomyelitis throughout England and Wales, in which the total cases far exceeded those recorded in any previous year. In 1938, the year of highest recorded incidence prior to 1947, before the present machinery for correction of notifications was instituted, there were in England and Wales 1,581 notifications of civilians, giving an attack rate of 4 per 100,000 population. In 1947 the corrected notifications of poliomyelitis and polioencephalitis together amounted to 7,671 (civilians), giving an attack rate of 18 per 100,000 population in England and Wales. In Wimbledon the attack rate during 1947 was 44 per 100,000 population. The total number of deaths from this disease registered in England and Wales in 1947 was 715, including 19 non-civilians. This gives a civilian death-rate of 17 per million living compared with 6 per million in 1938. The case fatality rate was however, lower than in 1938, being 9% in 1947 and 16% in 1938. None of the cases of poliomyelitis or polioencephalitis occurring in Wimbledon during 1947 terminated fatally. The Borough of Wimbledon was involved early in this epidemic, and whereas the peak period of notifications for England and Wales as a whole occurred at the end of August and beginning of September, the highest number of cases recorded in Wimbledon in any one week occurred during the week ended 19th July. 1947, when six cases were reported. In all, there were 25 confirmed cases of poliomyelitis or polioencephalitis in Wimbledon. Of the 25 cases, 19 were treated in the Wimbledon Infectious Diseases Hospital, one case was removed to Guy's Hospital, and the remaining 5 were nursed at home. The following is an analysis of the age groups and Ward distribution of the 25 cases 34 Age Group WARDS Total St. Mary's St. John's Cottenham Park Wimbledon Park Dundonald Trinity South Park Haydon Park 0- 5 — — 2 1 3 5-10 — — 1 — 1 1 2 — 5 10-15 — — 1 — 3 1 — 1 6 15-20 1 2 — — — — — 1 4 20-25 — — — — — — — — — 25-30 — — — — — 1 — — 1 30-35 — 2 — — 1 — — — 3 35-40 40-45 1 — 1 — 1 — — — 2 1 Total 2 4 3 — 8 3 3 2 25 The first case of poliomyelitis in Wimbledon was removed to the Infectious Diseases Hospital on the 18th June. This patient, a boy aged 11 years, was a severe case with respiratory involvement and needed to be placed in a mechanical respirator on arrival in hospital. It was not until 6th December that this patient was able to remain permanently out of the respirator. No further cases occurred until the 2nd July. During the month of July, 12 cases were notified, all of them being removed to the Wimbledon Infectious Diseases Hospital. During August a further 6 cases were notified. Four more occurred during September, one in October, and another on the 3()th December. Certain precautions were advised early in the outbreak, with a view to checking if possible the spread of infection. The measures advised included the postponement of operations for the removal of tonsils and adenoids, and the postponement of swimming galas at the Public Baths, prize givings, and other functions necessitating the congregation of children and relatives in enclosed premises. Admission to Convalescent Homes and Holiday Camps of Wimbledon children were deferred for a time. Head teachers of local schools were informed of the position and advised against overcrowding, and the need for the highest possible standard of hygiene in schools was stressed There was no interruption in the normal school routine apart from prohibition of gatherings already mentioned. The chlorination of the Wimbledon Swimming Baths was stepped up above the usual figure of 0.4 per million. The paddling pool at Garfield Road Recreation Ground was drained. 35 From an analysis of the cases which occurred in the Borough there was no concentration of cases at any one school, and it would not appear that schools played any part in the spread of infection. In only one instance was there more than one case from any one family. One child (a boy aged 4 years) was admitted to Hospital with bulbar poliomyelitis. He became ill 14 days after tonsillectomy. Fortunately he made a good recovery. One of the most notable features of the epidemic in Wimbledon, as elsewhere in the country, was the incidence of the disease in adults Eleven of the 25 Wimbledon cases occurred in persons over the age of 15, and these 11 included some of the most severe cases with widespread paralysis. The diagnosis of poliomyelitis in cases with paralysis was in most cases obvious, although the assessment of muscle involvement in young children was difficult. The diagnosis in those patients without paralysis was in most cases confirmed by changes in the cerebrospinal fluid. Patients with paralysis, however slight, were eventually admitted to the Rowley Bristow Orthopaedic Hospital for treatment, and those without paralysis were followed up at the Orthopaedic Clinic held at the Health Centre. Pelham Road. Diphtheria. Five suspected cases of diphtheria were removed to the Infectious Diseases Hospital during the year. Two of these patients (adults) were trainees at an Admiralty Hostel in Wimbledon. One was found to be suffering from clinical diphtheria, and the other was found to be a diphtheria carrier. Swabs were taken from all contacts and staff. No further cases occurred at this Hostel. • The diagnosis of diphtheria was confirmed in two of the three remaining cases which occurred in Wimbledon. One was an adult, aged 28 years, and -the other a boy, aged 16 years, who had received one immunising injection against diphtheria. Cerebro-Spinal Fever. Five cases of cerebro-spinal fever occurred in Wimbledon during 1947. There was one death from the disease — a woman aged 57 years who was admitted to a London hospital as a suspected case of food poisoning. Food Poisoning. In May, 1947. two cases of food poisoning were notified. Upon investigation it was found in both cases that the patients' symptoms had followed the consumption of liver sausage which, although purchased from different shops, came from the same manufacturer. In addition, the manager of a local shop reported that several members 36 of the stall had developed food poisoning following the consumption of liver sausage. Portions of the suspected food were sent to the Ministry of Health Laboratory at Epsom. Upon examination the food was found to be heavily contaminated with staphylococcus aureus. A list of all the shops in Wimbledon which had been supplied with this food was obtained from the manufacturers, but in all cases except one it had been completely sold out. That portion of the food recovered from the one shop was destroyed by the Public Health Department. The Ministry of Health were notified of the occurrence of these cases. They appear to have been part of a widespread outbreak of food poisoning, in which the Ministry of Health took all necessary steps to ascertain the source of infection and to withdraw all the liver sausage from the retailers concerned. Botulism. In June, 1947. 1 was informed by the Atkinson Morlcy Hospital. Wimbledon, that they had admitted a man suspected to be suffering from food poisoning, who had been ill for about seven days previously. He had lunched at a restaurant in London in company with another man, who had also become ill and who had died. The condition of the patient admitted to the Atkinson Morley Hospital appeared to be very suggestive of botulism, which is a comparatively rare form of food poisoning. The Ministry of Health were notified. Investigations carried out centrally appeared to indicate that the source of infection was macaroni chcese consumed in a London restaurant. Pemphigus Nevnatorum. In May, 1947, a case of pemphigus neonatorum occurred at a local nursing home. The baby was removed to the Infectious Diseases Hospital for treatment. Admissions of new cases were stopped until all the existing patients had been discharged and precautionary measures, including thorough disinfection of the rooms, bedding and equipment had been carried out. The following table gives an analysis of the notifications of infectious disease received during the year 37 38 Notifiable Diseases during 1947. DISEASE Number of Cases Notified in Various Age Groups T otal C ases 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 7 26 6 3 4 — — 51 34 Diphtheria (including Membranous Croup) — — — — — 3 1 — — 4 4 Puerperal Pyrexia — — — — — — 3 — — 3 3 Measles 7 70 63 90 9 6 8 — — 253 19 Whooping Cough 17 40 46 51 — — 1 1 1 157 10 Acute Primary or Influenzal Pneumonia i — — 2 — 1 3 9 13 32 -> Cerebro-Spinal Fever — 1 2 — — — — 2 — 5 4 Acute Poliomyelitis — — 2 1 2 3 5 — — 13 10 Polioencephalitis — — 2 3 5 — •y — 12 10 Ophthalmia Neonatorum 4 — — — — — — — — 4 Erysipelas — — — — — 1 — 3 1 5 3 Dysentery (Sonne) — — — 1 — 1 — — ") TOTALS 30 116 122 174 24 17 28 15 15 541 99 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 561 Children aged 5 to 14 years 29 590 Boosting Doses. No. of children given boosting doses 406 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 1947 No. immunised Total child population. Under 1 53 > 2,324 J 4,360 Under 2 510 Under 3 538 Under 4 624 Under 5 599 5 to 9 years 2,684 1 4,537 5,750 10 to 14 years 1,853 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. Immunisation is also carried out in the Infant Welfare Centres and in the Schools. 39 TUBERCULOSIS. During the year, 95 cases of tuberculosis were added to the register, as compared with 96 in 1946. Of these, 80 were new cases and the remainder were transfers from other areas. The following cases were removed from the Register: — Deaths 15 Patients stated to have recovered3 Removals from district 36 54 There were 30 admissions to hospitals or sanatoria during the year. The following table gives an analysis of the notifications received : — 40 41 TUBERCULOSIS — 1947 AGE GROUPS CASES ADDED TO THE REGISTER DEATHS Primary Notifications (Form A) Cases Discovered otherwise than hy Notification Total Cases added to the Register Pulmonary ' NonPal monary 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 — — — — — — — — — — — — — — 1 — 5 Years — 5 — 10 „ 2 — I — — — — — 2 — 1 — — — — — 10 — 15 „ 1 1 — — 1 — — — 2 1 — — — — — — 15 — 20 „ 3 3 1 1 1 1 — — 4 4 1 1 — 2 — — 20 — 25 „ 6 6 — 1 — 2 — — 6 8 — 1 — 2 — — 25—30 8 5 — — 1 3 — 1 9 8 — 1 1 — — — 30 — 35 „ 2 3 — 1 2 1 — — 4 4 — 1 1 — — — 35 — 45 „ 8 1 1 1 — 1 — — 8 2 1 1 — 2 — — 45 — 55 „ 4 3 — — 1 — — — 5 3 — — 1 — — — 55—65 „ 3 4 — — — — — — 3 4 — — 2 — — — 65 and Over 3 1 — — 3 — — 6 1 — 4 — — 42 28 3 4 9 8 ' \ ' 1 51 36 3 \ 5 9 6 — 70 v 7 17 1 87 8 15 77 18 95 15 WIMBLEDON INFECTIOUS DISEASES HOSPITAL. One hundred and sixty-nine cases were admitted to the Infectious Diseases Hospital during 1947, as under :— From Wimbledon 129 From Kingston 34 From other districts 6 169 As there were 15 cases in the hospital at the end of 1946, the total number of cases under treatment during the year was 184. Eight patients remained in the hospital at the end of 1947 (5 from Wimbledon, and 3 from Kingston). 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 8 7 Scarlet Fever 54 52 Cerebro-Spinal Meningitis 11 4 Acute Anterior Poliomyelitis Polioencephalitis j 28 11 12 Measles 27 27 Whooping Cough 13 10 Erysipelas 3 3 Typhoid Fever 2 2 Gastro-Enteritis 3 3 Pemphigus Neonatorum 1 1 Puerperal Pyrexia 3 Puerperal Sepsis 2 B. Coli Infection 1 Healthy babies (admitted with mothers) 3 3 156 There were in addition 13 miscellaneous cases admitted, bringing the total number of patients admitted to 169. Poliomyelitis. Reference to the outbreak of poliomyelitis which occurred throughout England and Wales has been made earlier in the Report. 42 In all, 28 patients were admitted to the Infectious Diseases Hospital as poliomyelitis or polioencephalitis. These cases occurred between the 18th June and 30th December, 1947. In 5 of the 28 cases the diagnosis was not confirmed. Two of these were children with a transient pyrexia, 2 were cases of tonsillitis, and one proved to be a case of tuberculous meningitis. This last case terminated fatally and a post-mortem was held. Of the 23 confirmed cases 19 were from Wimbledon, 3 from Kingston, and one from Morden. Eleven of the 23 confirmed cases had definite paralysis, 9 of them from the Wimbledon area. Of the remaining 12 cases which did not develop paralysis 10 came from Wimbledon. The only fatal case was a youth aged 15 years, who was admitted from an outside area at the end of December. This patient, who was suffering from bulbo-spinal poliomyelitis, was placed in a mechanical respirator, but died on the 3rd January, 1948, 5 days after admission. One of the patients admitted to the Hospital had a history of tonsillectomy which had been performed 17 days prior to admission. This child had a mild bulbar type of the disease. In all, 3 patients required the use of mechanical respirators. One was a boy aged 11 years, who needed the assistance of a respirator from the 18th June to the 6th December. The second was a woman aged 37 years. The McKesson resuscitator was also required in this case to enable nursing assistance to be carried out. This patient was placed in a mechanical respirator on the 6th August, 1947, and still needed its assistance at the end of the year. The third patient who required the use of a respirator was a youth aged 15 years, who died 5 days after admission. Frequent visits to the Hospital were made by the Orthopaedic Surgeon, and all cases were seen by him. Where necessary the services of a Neurologist were also called in. Physio-therapeutic measures were carried out as required. All patients with paralysis, however slight, were transferred to the Rowley Bristow Orthopaedic Hospital, Pyrford. Cases without paralysis were discharged after 21 days and were followed up at the Orthopaedic Clinic held at the Health Centre. The admission of these cases of poliomyelitis placed a severe strain on the medical and nursing staff, especially in view of the general shortage of nurses. Extremely skilled nursing technique is needed, especially in connection with the severe types of this disease. At one stage in the epidemic, in order to conserve staff, it was found necessary to restrict the admissions of infectious diseases to cases of poliomyelitis and polioencephalitis only. At the end of the year 3 cases of poliomyelitis remained in the Infectious Diseases Hospital. Of the remainder, 7 had been transferred to the Orthopaedic Hospital at Pyrford, and 13 had been discharged home. Diphtheria. During 1947 eight cases were admitted to the Hospital as 43 theria, compared with thirty-two during 1946. Of these eight patients five came from the Wimbledon area. One patient was found to be a diphtheria carrier. In six of the remaining seven cases the diagnosis of diphtheria was confirmed. In only one case was there any history of immunisation, and this patient had only received one immunising injection against diphtheria. Five of the eight patients were adults. Cerebrospinal Fever. Eleven patients, ten of them from the Wimbledon area, were admitted as cerebro-spinal fever. In only four cases was the diagnosis confirmed. One of these patients, a man aged 59 years, admitted from the Wimbledon Hospital, was found to be a severe case of pneumococcal meningitis. This patient died after two days. Puerperal Pyrexia. All three patients notified as suffering from puerperal pyrexia in Wimbledon were removed to the Infectious Diseases Hospital, with their babies, for treatment. Two of these patients were found to be suffering from puerperal sepsis and the other from a B. coli infection. All the patients made complete recoveries. G astro-Enteritis. Three babies were admitted to the Hospital with gastro-enteritis. One of these, a child aged 11 weeks, admitted from Kingston County Hospital, was very ill on admission and died after two days Measles. Twenty-seven cases of measles were admitted to the Hospital during the year and were diagnosed as follows: — Uncomplicated measles 18 Measles and pneumonia 6 Measles and bronchitis 1 Measles and croup 1 Measles and pneumococcal meningitis 1 One of these patients, a child, aged 15 months, was admitted as an emergency from the Merton and Morden area. This child, who was suffering from measles, had accidentally swallowed a number of laxative tablets. The Council's Paediatrician was called in immediately, but the child died within a few hours. Scarlet Fever. Fifty-four patients were admitted as cases of scarlet fever, thirtyfour of them from the Wimbledon area. One of these cases was finally diagnosed as rubella, and in one other case the diagnosis was unconfirmed. One case was complicated by ethmoiditis, and Mr. Cann, the Ear, Nose and Throat consultant was called in. 44 STAFF. As may be seen from the list of staff at the beginning of this Report, all those still on War Service at the end of 1946 returned to duty in the Public Health Department during the year. These included Dr. Doody, the Deputy Medical Officer of Health, who resumed his work in the Department in March, and Mr. J. Burrows and Mr. S. C. Nottingham (clerical staff). Owing to an increased volume of work in connection with Maternity and Child Welfare, an additional Health Visitor was appointed, bringing the total establishment up to seven. Likewise, an additional Sanitary Inspector was appointed in view of the steadily increasing work connected with the sanitary inspection of the district. The total establishment of Sanitary Inspectors is now six. * * * * * 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. 45