AC 4413(1) WIMBEEDON Borough of Mimbledon. Public Health Department ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR ENDED 31st DECEMBER, 1948. Printed by Raynes Park Press, Lambton Road, London, S.W. 20 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1948 Public Health Department, Town Hall, Wimbledon, S.W.I9. September, 1949. 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 1948. This Report is compiled in accordance with the instructions contained in Circular 3/49 of the Ministry of Health. The year 1948 marks an important milestone in the realms of Public Health and the Social Services generally, owing to the coming into force of several new Acts, including the National Health Service Act, 1946, the National Assistance Act, 1948 and the Children Act, 1948. Under the National Health Service Act, 1946, a number of responsibilities have now passed from the control of the Wimbledon Borough Council. This Act, which is described as an Act "to promote the establishment in England and Wales of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, 1 diagnosis and treatment of illness", came into force on the 5th July, 1948. On this date, Maternity and Child Welfare functions, ambulance services, etc., passed to the control of the Surrey County Council, whilst the Infectious Diseases Hospital became the responsibility of the Regional Hospital Board. The National Assistance Act, 1948 also came into operation on the 5th July, 1948 with the exception of certain sections relating to the registration of homes, etc. This Act is described as the final step in the break-up of the existing poor law, and provides instead for the assistance of persons in need by the National Assistance Board and by local authorities. It makes further provision for the welfare of disabled, sick, aged and other persons, and, among other things, makes provision for the burial or cremation of deceased persons. A third Act which came into force on the 5th July, 1948 is the Children Act, 1948. This Act makes further provision for the care or welfare, up to the age of eighteen and, in certain cases, for further periods, of boys and girls when they are without parents or have been lost or abandoned by, or are living away from, their parents, or when their parents are unfit or unable to care for them, and in certain other circumstances. As a result of the transfer of functions arising out of the foregoing legislation, a considerable part of the Annual Report for the year 1948 deals only with the period 1st January to 4th July, the period during which the Wimbledon Borough Council was the responsible authority. With the transfer of duties in connection with Maternity and Child Welfare, etc., to the Surrey County Council, a number of members of the Public Health Department staff became "transferred officers" as from the 5th July. These officers include Dr. P. J. Doody, the Deputy Medical Officer of Health, the whole of the Health Visiting staff, and certain members of the clerical staff. In presenting this Report I should like to place on record my thanks for the co-operation which I have received from all the members of the staff during this difficult period of transition. I should again like to express my deep appreciation also to the Chairmen and Members of the Health and Maternity and Child Welfare Committees for their consideration and courtesy during the year. I have the honour to be, Your obedient Servant, HAROLD ELLIS, Medical Officer of Health. 2 LIST OF CONTENTS. Page Introduction 1 List of Staff 5-6 SECTION A: STATISTICS AND SOCIAL CONDITIONS: Statistics, etc. 7-9 Births Notified 9 Deaths Registered 10 Infantile Mortality 11-12 Summary of Statistics 13 SECTION B: GENERAL PROVISION OF HEALTH SERVICES: Ambulance Services 14 Maternity and Child Welfare: — Health Visitors' Visits 14 Ante-Natal Clinics and Infant Welfare Centres 15 Midwifery and Maternity Services 15-16 Complicated Obstetric Cases 16 Care of Premature Infants 16 Care of Illegitimate Children 17 Ophthalmia Neonatorum 17 Treatment Facilities 18 Home Helps Service 19 Nursery Provision for Children under 5 19 Child Life Protection 19 Provision of Insulin 19 Nursing Homes 19 Infestation by Head-lice 20 Cleansing Facilities 20 National Assistance Act, 1948 21 SECTION C: SANITARY CIRCUMSTANCES: Water Supply 22 Sanitary Inspectors' Visits 22 Notices Served 23 Nuisances abated and defects remedied 24 Factories Act, 1937, Part I. 25 Outworkers 26 Bakehouses 26 SECTION D: HOUSING 27 3 LIST OF CONTENTS — cont'd. Page SECTION E: INSPECTION AND SUPERVISION OF FOOD: Milk 28 Ice cream 28 Food and Drugs Act, 1938 30 Meat and other Foods 31-32 SECTION F: PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES: Notifiable Infectious Diseases, etc. 33-35 Diphtheria Immunisation 36 Tuberculosis 37-38 Wimbledon Infectious Diseases Hospital 39-40 4 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. 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). * E. R. Young, (c), (f), (resigned 24.4.48). * L. Burrows, (c), (f), (resigned 20.6.48). * H. J. Bishop, (c), (resigned 30.4.48). * A. N. Scotter, (c), (appointed 10.5.48). * G. R. Pope, (c), (appointed 24.5.48). * J. Hills, (c), (appointed 21.6.48). Temporary Assistant Rodent Officer: F. J. Reddington (appointed 10.5.48). Senior Health Visitor—School Nurse : § Miss J. C. Moffat, (a), (b), (b), (h), (resigned 31.8.48). Health Visitors—School Nurses: § Miss V. B. Woodroff, (b), (c), (g). § Miss V. A. Lyeach, (a), (d), (/). § Miss M. K. Loveland, (a), (b), (d). Miss R. E. Boole, (a), (b), (d), (resigned 4.1.48). § Miss M. L. Vincent, (a), (b), (d). § Miss M. Wilson, (a), (d), (i). § Mrs. E. C. Friel, (a), (d), (i). Matron of Infectious Diseases Hospital: Miss G. Palmer. Matrons of Day Nurseries: All Saints: § Miss M. Billaney. 5 Russell Road: § Mrs. K. A. Edmonds, (resigned 31.10.48). § Miss D. Digby, (appointed 1.11.48). Senior Clerk: § Miss V. Slack. Clerks: J. E. Field. Mrs. V. Waters. J. Burrows. § Mrs. V. Young. § Miss E. Riding. S. C. Nottingham. § Miss S. Miller. * Salary contribution under Public Health Acts. † Salary contribution by Exchequer Grants. § Transferred to staff of Surrey County Council as from 5.7.48. (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. if) Certificate Royal Sanitary Institute for Inspector of Meat and other Foods. (g) Diploma Board of Education (Health Visitors' Training) Regulations, 1919. {h) Certificate of Fever Training. (i) C.M.B. Cert. Part 1. 6 SECTION A. — STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres—Census, 1931) 3,221 Population (Census, 1931) 59,515 Population (mid-1948) 57,940 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:— £888,770. Sum represented by a penny rate:— £3,249. Extracts from Vital Statistics of the Year 1948 (Registrar-General's Figures.) Live Births Legitimate Total M. F. 896 455 441 Illegitimate 50 23 27 Total 946 478 468 Total M. F. Stillbirths Legitimate 13 8 5 Illegitimate 2 2 — Total 15 10 5 Birth Rate per 1,000 of the estimated resident population 16.59 Still-birth Rate per 1,000 total (live and still) births 15.61 Total M. F. Deaths 670 334 336 Death Rate per 1,000 of the estimated resident population 11.56 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 sepis — — No. 30 Other maternal causes 1 1.04 Total 1 1.04 Death Rate of Infants under one year of age: — All Infants per 1,000 live births 19.03 Legitimate Infants per 1,000 legitimate live births 20.09 Illegitimate Infants per 1,000 illegitimate live births 0.00 Deaths from Cancer (all ages) 119 „ „ Measles (all ages) 0 „ „ Whooping Cough (all ages) 1 „ „ Diarrhoea (under 2 years of age) 0 7 Birth Rates, Civilian Death Rates, Analysis of Mortality, Maternal Mortality, and Case Rates for certain Infectious Diseases in the Year 1948. (Provisional Figures based on 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 Births: — Live Births 16.33 17.9‡ 20.0 19.2 20.1 Still Births 0.26 0.42‡ 0.52 0.43 0.39 Deaths:— All Causes 11.56 10.8‡ 11.6 10.7 11.6 Typhoid and Paratyphoid — 0 00 0.00 0 00 0.00 Whooping Cough 0 02 0.02 0.02 0 02 001 Diphtheria — 0 00 0 00 0 00 001 Tuberculosis 0.64 0.51 0.59 0 46 0.63 Influenza — 0.03 0.03 0.04 0.02 Small-pox — — — — — Acute Poliomyelitis and Polioencephalitis 0.02 0.01 0.01 0.01 0.00 Pneumonia 0.26 0.41 0.38 0.36 0.54 Notifications (corrected): — Typhoid Fever — 001 0.00 001 0.00 Paratyphoid Fever 0.02 0.01 0.01 0.01 001 Cerebro-Spinal Fever 0.05 0.03 0.03 0.02 0.03 Scarlet Fever 1.64 1.73 1.90 1.82 1.37 Whooping Cough 3.99 3.42 3.51 3.31 3.13 Diphtheria 0 07 008 0.10 0.09 0.10 Erysipelas 0.03 0.21 0.23 0.21 022 Small-pox — — — — — Measles 8.30 9.34 9.75 8.84 9.17 Pneumonia 0.26 0.73 0 84 0 60 0 57 Acute Poliomyelitis 0.03 0.04 0.05 0.04 004 Acute Polioencephalitis 0.03 0.00 0.00 0.00 0 00 Rates per 1,000 Live Births Deaths: — All causes under 1 year of age 19 34 § 39 32 31 Diarrhoea and Enteritis (under 2 years of age) ... 3.3 4.5 2.1 2.4 t A dash (—) signifies that there were no deaths, t 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) Notifications (corrected): — Puerperal Fever and Pyrexia 5.20 6 89 8.90 4.71 7.34‡ Maternal Mortality:— No. 140 A bortion with sepsis No. 141 Abortion without sepsis No. 147 Puerperal Infections Nos. 142-146, 148-150 Other maternal causes WIMBLEDON — — — 1.04 England and Wales 0 11 0.05 0.13 0.73 Mortality per Million Women aged 15-44 years No. 140 with Sepsis No. 141 without sepsis England and Wales 9 4 ‡ In London Puerperal Fever alone was 0.61. BIRTHS. The statistics supplied by the Registrar-General show that during 1948 the total number of registered live births belonging to Wimbledon amounted to 946. In addition 15 stillbirths were registered. This gives a birth-rate of 16.59 per thousand of the population, compared with 19.82 per thousand for the previous year. 50 live births and 2 stillbirths were illegitimate. Public Health Act, 1936.—Notification of Births. During the period 1st January to 4th July, 1948, 617 live births and 14 stillbirths were notified. Of these, 98 live births and 6 stillbirths ocurring in Wimbledon were in respect of mothers normally resident outside the district. The following is an analysis of the 527 notified births belonging to Wimbledon (i.e. as adjusted by inward and outward transfers):— 9 Live births. Still-births. Domiciliary confinements 117 1 Institutional confinements: — Kingston County Hospital 12 — St. Helier County Hospital 95 2 St. Lukes County Hospital 10 — Epsom County Hospital 9 — Nelson Hospital 176 2 Queen Charlotte's Hospital 8 — Other hospitals and nursing homes outside the Borough 49 3 Wimbledon Nursing Homes 43 — 519 8 DEATHS. The total number of Wimbledon residents who died during 1948 was 670. Of these deaths 236 occurred outside the Borough. Apart from these figures 241 persons not normally resident in Wimbledon died in institutions, etc., in the Borough. The death-rate for 1948 is 11.56 per thousand of the population as compared with a rate of 13.64 per thousand during 1947. 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 37% Cancer 18% Diseases of the respiratory system 13% Total 68% There were 4 deaths from infectious diseases during 1948, all of them occurring in hospitals. Two children aged 2 years died from cerebro-spinal fever, and another child. also aged 2 years, died from whooping-cough and pneumonia. The remaining death from an infectious disease was that of a woman aged 35 years who died in an orthopaedic hospital where she was undergoing treatment for poliomyelitis which she contracted during the epidemic which occurred in 1947. 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 2 3. Scarlet Fever — — — 4. Whooping Cough — 1 1 5. Diphtheria — — — 6. Tuberculosis of Respiratory System 27 9 36 7. Other forms of Tuberculosis 1 — 1 8. Syphilitic Diseases — 1 1 9. Influenza — — — 10. Measles — — — 11. Acute Poliomyelitis and Polioencephalitis — 1 1 12. Acute Infectious Encephalitis — — — 10 Cause Males Females Total 13.M.Cancer of Buccal Cavity and Oesophagus (males only) 6 — 6 13. F. Cancer of Uterus (females only) — 2 2 14. Cancer of Stomach and Duodenum 8 13 21 15. Cancer of Breast — 15 15 16. Cancer of all other sites 36 39 75 17. Diabetes — 3 3 18. Intra-Cranial Vascular Lesions 31 50 81 19. Heart Disease 105 116 221 20. Other Diseases of the Circulatory System ... 14 11 25 21. Bronchitis 24 8 32 22. Pneumonia 10 5 15 23. Other Respiratory Diseases 4 3 7 24. Ulcer of the Stomach or Duodenum 7 2 9 25. Diarrhoea (under 2 years of age) — — — 26. Appendicitis — — — 27. Other Digestive Diseases 5 8 13 28. Nephritis 8 4 12 29. Puerperal and Post-Abortive Sepsis — — — 30. Other Maternal causes — 1 1 31. Premature Birth 4 4 8 32. Congenital Malformations, Birth Injury, fantile Diseases 4 5 9 33. Suicide 8 1 9 34. Road Traffic Accidents — 2 2 35. Other violent causes 10 6 16 36. All other causes 21 25 46 Totals 334 336 670 INFANTILE MORTALITY. During 1948, 18 deaths occurred in infants under one year of age, giving an infantile mortality rate for Wimbledon of 19 per thousand live births, as compared with a rate of 34 for England and Wales. Eight of the 18 deaths of children under one year of age were due to prematurity. All these eight deaths occurred during the first or second week of life. A further 4 deaths were attributable to congenital defects, and one to birth injury. The following table shows the causes of. and ages at death, together with the ward distribution. From this table it will be seen that 14 of the infant deaths were neo-natal deaths, i.e. occurring during the first month of life. This gives a neo-natal death-rate of 14.8 per thousand live births. There were, therefore, during 1948, only 4 deaths of children between the ages of one month and a year. Three of these were caused by the inhalation of stomach contents into the air-passage, and were thus probably all preventable. 11 12 Infant Mortality during the Year 1948. 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 defect or birth injury 2 2 — 1 5 — — — — 5 1 1 — — 2 1 — 2 3 5 Prematurity 7 1 — — 8 — — — — 8 3 — — 1 — 3 — 1 4 4 8 Pneumonia — — 1 — 1 — — — — 1 — — — 1 — — — — 1 — 1 Pneumococcal Meningitis — — — — — — — — — — — — — — — — — — 1 — 1 Accidental death — — — — — 1 2 — — 3 2 — — 1 — — — — 3 — 3 Total 9 3 1 1 14 1 2 1 — 18 6 1 1 3 2 3 1 1 11 7 18 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 Live-Birth Rate Still-birth Rate *Death-Rate Maternal Mortality Rate Infantile Mortality Rate 1939 Wim. E.& W. Wim. E. & W. Wim. E.&W. Wim. E.&W. Wim. E.&W. 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 1948 16.33 17.9 0.26 0.42 11.56 10.8 1.04 1.02 19.03 34 * 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. AMBULANCE SERVICES. Prior to the 5th July, 1948, four ambulances were maintained by the Wimbledon Borough Council. Two of these vehicles were used for the removal of non-infectious and accident cases, one for the removal of infectious cases, and one for disinfecting purposes and for the removal of infectious cases when the need arose. On the 5th July the control of the Ambulance Services for this area passed to the Surrey County Council under the provisions of the National Health Service Act, 1946. Three of the four ambulances were transferred to the Surrey County Council on this date. The remaining vehicle was retained by the Wimbledon Borough Council for use in the disinfecting service. During the first half of 1948 only one of the two vehicles available for accidents and removals was in use, the second vehicle being off strength until the end of June undergoing repairs. During this period the number of accidents and removals dealt with was 1,233 as compared with 1,852 for the whole of 1947. MATERNITY AND CHILD WELFARE. The total number of visits paid by the health visitors during the period 1/1/48 to 4/7/48 amounted to 6,498. Details of the home visits carried out are given below: — Number of Infants visited — first visits 590 Number of Infants visited — revisits 1,378 Number of Toddlers visited 2,529 Ante-natal — first visits 224 Ante-natal — revisits 74 Visits re Infant deaths 4 „ Stillbirths 8 „ Ophthalmia Neonatorum 1 „ Non-notifiable and notifiable ious Diseases 120 „ Foster Children 115 Miscellaneous 59 Total Welfare visits 5,102 Visits — School Health Service 610 Tuberculosis — Home visits 45 Visits to Nursing Homes 15 Other visits 6 Ineffectual visits 720 1,396 Total visits 6,498 14 The following table gives the attendance of health visitors at schools, special clinics and maternity and child welfare centres during the period: — Half sessions at schools 209 „ special clinics 379 „ M. & C. W. centres 467 1,055 Infant Welfare Centres and Ante-natal Clinics. There are three ante-natal clinics and five infant welfare centres in Wimbledon The following table shows the average attendance per session at each centre during the period 1st January to 4th July, 1948:— Ante-natal Clinics: Day held. Average attendance per session. Pelham Road Monday mornings 15.2 Pelham Road Saturday mornings 1st, 3rd and 5th 10.6 Wandle Park House Thursday mornings 7.7 28, King's Road Infant Welfare Centres: Thursday afternoons 12.3 Pelham Road Tuesday afternoons 78.5 Pelham Road Friday afternoons 79.5 Cottenham Park Monday afternoons 102.1 Wandle Park House Wednesday afternoons 60.7 Emmanuel Church Hall Thursday afternoons 55.0 Wimbledon Park Friday afternoons 85.0 MIDWIFERY AND MATERNITY SERVICES. Midwives Acts, 1902/1936. Until the coming into force of the National Health Service Act, the Wimbledon Borough Council was the Local Supervising Authority for midwives in the Borough of Wimbledon. At the time of transfer to the Surrey County Council on 5th July, 1948, there were 6 practising midwives and 10 practising maternity nurses in Wimbledon. During the period 1st January to 4th July, 1948, medical aid was summoned by midwives on 48 occasions. The total fees paid to doctors in this connection amounted to £85 18s. 6d., of which £50 6s. 4d. was recovered from patients' relatives. The following is an analysis of the conditions for which medical aid was summoned: — Pyrexia 6 High blood pressure 4 Albuminuria 1 Ante or post-partum haemorrhage 3 Abortion 3 Difficult labour 2 Ruptured perineum 13 Slight inflammation of infants' eyes 5 Other conditions 11 48 15 Midwives Act, 1936. Until 5th July, 1948, a service of whole-time domiciliary midwives was provided by the Wimbledon District Nursing and Midwifery Association by agreement with the Wimbledon Borough Council in accordance with Section 1(1) of the Midwives Act, 1936. At the time of transfer to Surrey County Council there were 3 fulltime midwives and 2 pupil midwives so employed. During the period under review in this report, they dealt with 93 cases as midwives and 15 as maternity nurses. In addition, they attended 6 cases of miscarriage. Their future bookings at 5th July, 1948, amounted to 85. The total amount paid by relatives during the period was £179 10s. 3d. 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 to operate until the transfer of powers to the Regional Hospital Board on 5th July, 1948. During the period 1st January, 1948 to 4th July, 1948, the following patients were admitted to the Nelson Hospital under this agreement: — Abortion 5 Ante or post-partum haemorrhage 2 Toxaemia of pregnancy 1 8 The cost of maintenance of these patients amounted to £79 11s. 8d. of which £10 3s. 11d. was recovered from the relatives. Services of Consulting Obstetricians. During the period 1/1/48 to 4/7/48, the two Consulting Obstetricians, Mr. Leslie Williams and Mr. J. Vincent O'Sullivan, were called in consultation on four occasions in connection with complications of pregnancy or childbirth. 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. During the period 1/1/48 to 4/7/48, Dr. G. H. Newns, the Consulting Paediatrician appointed by the Wimbledon Borough Council, was twice called in consultation by medical practitioners. The number of premature births notified during this period in respect of Wimbledon residents was twenty-seven. Of these, five births occured at home, twenty in hospitals, one in a nursing home and one at a private address outside the Borough. Three of the five premature infants born at home were removed to hospital for treatment. 16 In all, three premature infants died—two within twenty-four hours and one within a month. Two of these were born in hospital whilst the third was born at home and removed to hospital. The remaining twenty-four babies were known to have survived at the end of one month. The number of premature infants actually born in Wimbledon was eight, including two children born to mothers not normally resident in the Borough. Five of these infants were born at home and three in nursing homes. 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. During the period 1/1/48 to 4/7/48, the Wimbledon Borough Council accepted financial responsibility for the maintenance of two unmarried mothers with their babies at the Haygarth Witts Memorial Home, Wimbledon, at a total cost of £35 6s. Od. Ophthalmia Neonatorum. During the period 1/1/48 to 4/7/48, one case of ophthalmia neonatorum was notified. The patient was treated at home. There was no impairment of vision. 17 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 period 1/1/48 to 4/7/48: — Minor Ailment Clinic. Number of new cases 127 Re-attendances 91 Ophthalmic Clinic. Number of new cases 14 Re-attendances 6 Number of cases in which glasses were prescribed 6 Orthopaedic Clinic. Number of new cases 23 Re-attendances 88 Number of children admitted to the Rowley Bristow Orthopaedic Hospital, Pyrford 1 Aural Clinic. Number of new cases 5 Re-attendances 6 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 1948:— (i) Expectant and Nursing Mothers. Number of mothers who attended 46 Total number of attendances made 101 Number of gas administrations 36 Number of local anaesthetics given - Number of permanent teeth extracted 71 Number of permanent teeth filled 12 Total number of fillings 13 Other operations 21 Dentures supplied - Dentures repaired - Other operations to dentures 4 Scalings 21 (ii) Children under 5 years of age. Number of children under 5 years of age who attended 68 Total number of attendances made 116 Temporary teeth extracted 98 Temporary teeth filled 2 Number of gas administrations 51 Number of local anaesthetics given - Other operations 2 (iii) Day Nurseries (Russell Road and All Saints Road.) Number of children inspected 79 Number found to be free from caries 53 Number referred for treatment 2 Number not requiring treatment 24 18 HOME HELPS SERVICE. At the beginning of 1948 there were six full-time and seventeen part-time home helps employed by the Wimbledon Borough Council, for the purpose of giving domestic assistance in connection with home confinements or illness in the home. When this Service was transferred to the control of the Surrey County Council on 5th July, 1948, the number of home helps so employed had risen to five full-time and thirty-three part-time workers. During the first six months of the year 338 households were supplied with domestic assistance under the scheme. NURSERY PROVISION FOR CHILDREN UNDER FIVE. The Day Nurseries at All Saints Road and Russell Road continued to be well used. At the time of transfer to the Surrey County Council on 5/7/48 there were on the register 126 children (30 under two years of age and 96 between two and five years of age). PUBLIC HEALTH ACT, 1936 — CHILD LIFE PROTECTION. The following figures relate to the supervision of foster-mothers in Wimbledon during the period 1/1/48 to 4/7/48:>— Number of foster-mothers on the Register: — (a) at 1/1/48 17 (b) at 4/7/48 20 Number of foster-children on the Register: — (a) at 1/1/48 24 (b) at 4/7/48 23 (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 were under supervision 28 children attending two private boarding schools in Wimbledon. 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 six persons during the period 1/1/48 to 4/7/48. As from the 5th July, 1948, these patients were able to obtain insulin free under the provisions of the National Health Service Act, 1946. PUBLIC HEALTH ACT, 1936, PART VI. — NURSING HOMES. The Wimbledon Borough Council is responsible for the supervision of nursing homes in the Borough. Twenty-seven visits of inspection were made during the year. 19 At the end of 1948 the position was as follows: — No. of Homes on the Register: (a) Maternity 1 (b) Others 9 10 No. of beds provided : (a) Maternity 16 (b) Others 95 111 One new nursing home was registered during the year for the reception of senile or chronic cases. One nursing home (St. Teresa's, The Downs), was granted exemption from registration under Section 192(1) of the Public Health Act, 1936. This nursing home, which is conducted by a religious Community, the Sisters of St. Anne, was formerly registered for the reception of chronic medical cases. During 1948 the premises were converted into a maternity hospital unit with twenty-two beds. 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. 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. 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 1948: — Scabies Verminous Heads Adults 14 1 Children aged 5 to 15 years 14 29 Children under 5 years 1 2 20 NATIONAL ASSISTANCE ACT, 1948. Under Section 47 of this Act, power is given to the Councils of County Boroughs and County Districts to apply to the Court of Summary Jurisdiction for an Order for removal and detention, in a suitable hospital or other place, of persons who (a) are suffering from grave chronic disease, or, being aged, infirm or physically incapacitated, are living in insanitary conditions; and (b) are unable to devote to themselves, and are not receiving from other persons, proper care and attention. Action under this Section was taken by the Wimbledon Borough Council on one occasion during 1948. The attention of the Public Health Department was directed to this case in November by the police. The person concerned was over 70 years old and was living alone in a house without lighting, heating or proper water supply. The premises were in an insanitary condition, and she was obviously aged, infirm and physically handicapped. Immediate arrangements were made for district nurses to attend, and they brought blankets and food and lit fires. The local Food Office arranged for an emergency supply of food, as no ration book or identity card appeared to be available. The services of a home help were also provided. The old person refused to enter hospital. Application was eventually made to the Court of Summary Jurisdiction for an Order requiring her removal and detention in a hospital or other place. This order was granted for a period of three months, and removal to hospital through the South-West Metropolitan Regional Hospital Board was duly effected. At the end of the year the patient was still in hospital. 21 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. With three exceptions the dwelling houses in Wimbledon are supplied from public water mains direct to the houses. In July, 1948, a complaint was made regarding the water supply to one of these three premises. Samples of the water were sent for bacteriological and chemical examination. The analyst reported that the water showed bacteriological evidence of contamination and was unfit for human consumption. One other house without piped supply was also receiving water from the same well. The occupants of both premises were therefore advised to boil all drinking water until investigations had been completed. Samples of water from both houses were sent to the public analyst. As a result of investigations carried out in conjunction with the Senior Sanitary Inspector, arrangements were made for cleaning out and protecting the well. The lead pipe leading from the well to one of the houses was replaced by an iron one. During the course of investigations, another well was discovered in the vicinity. Samples of water taken from this well showed that it was grossly polluted. Tests carried out, to exclude the possibility that this well supplied water to the larger of the houses, showed that the well was not in use. After the completion of work in connection with the well supplying the two houses, further examinations of the water were made. The water was then found to be pure, and suitable for drinking purposes. Sanitary Inspection of District. The following is a statement showing the number and nature of inspections made during 1948:— Reason for Visit. No. Infectious Diseases, investigations, etc. 521 Inspections under Housing Act, 1936. Part IV 189 House to House Inspections (Section 91, Public Health Act, 1936):— (a) number of houses inspected 364 (b) number of revisits 723 House Inspections 11,521 Inspections of Factories, Workplaces and Outworkers' premises 600 Inspections of Dairies 64 Inspections of Food, and Food Premises 931 Obtaining samples of Food and Drugs 155 Inspections under the Shops Acts 1912/1938 80 22 Reason for Visit. No. Inspections under the Petroleum (Regulation) Acts, 1923 and 1936 105 Applications of Test to Drains 109 Inspections under Rats and Mice (Destruction) Act, 1919 2,450 Miscellaneous Inspections (including visits to Caravans, Piggeries, Stables, Hairdressers' premises and Watercourses, and in connexion with the Rent (Restrictions) Acts 1,528 Total 19,340 Notices Served. Preliminary notices or intimations 3,226 Statutory Notices 471 Result of Service of Notices. (a) Legal proceedings. As a result of non-compliance with abatement notices legal proceedings were started in twenty-seven cases. In thirteen of these cases nuisance orders were made and in the remaining fourteen the summonses were withdrawn as the work was completed. Fines amounting to £18 were imposed, and the costs awarded amounted to £29 lls. 6d. One application was made to the Court to recover the cost of a dustbin supplied by the Corporation in default under Section 75 of the Public Health Act, 1936. Three 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. The costs awarded amounted to £10 5s. 6d. (b) Work carried out in default. Seven 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 work to abate the nuisances. Four of these cases were Nos. 1, 3, 5 and 7, Caroline Road, where extensive works were still being carried out at the end of the year, at a total cost of £1,080 9s. Id. In one other case work was executed by the Corporation in default under Section 45 of the Public Health Act, 1936. 23 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 remedied under the supervision of the sanitary inspector:— Accumulations removed 47 Cisterns provided 4 Cisterns repaired, cleansed or covered 29 Drains, new, provided 20 Drains, repaired or altered 117 Drains, stoppages removed 140 Dustbins provided 208 Flushing cisterns, new, provided 10 Flushing cisterns, repaired 114 Rain-water pipes disconnected 1 Roofs repaired 601 Rooms stripped and cleansed 2,502 Verminous rooms cleansed 24 Soilpipes, new, provided 5 Soilpipes, repaired or altered 8 Vent pipes, new, provided 19 Vent pipes, repaired or altered 26 Waste pipes, new, provided 25 Waste pipes, repaired, disconnected or trapped 51 Water-closets, new, provided 147 Water-closets, repaired or ventilated 131 Water services restored 55 Water supply direct from main 3 Yards paved 11 Yards repaired 41 Guttering repaired 360 Floors ventilated 42 Nuisances from damp walls abated 767 Sinks provided 23 Other nuisances remedied 6,336 Rooms disinfected 311 Total 12.178 Work executed by the Borough Surveyor and rechargeable under Section 24 of the Public Health Act, 1936. Twelve 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. 24 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 109 181 11 — Factories with mechanical power 211 351 41 — Other Premises under the Act (including works of building and engineering construction but not including outworkers' Premises) 2 7 - - Totals 322 539 52 — 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) 9 9 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) 1 1 - 1 - Inadequate venti1ation (S.4) — — - - - Ineffective drainage of floors (S.6) — — — — - Sanitary Conveniences (S.7):— Insufficient 5 4 - - - Unsuitable or Defective 64 46 — 1 — Not Separate for Sexes 1 1 — — — Other Offences (Excluding offences relating to outwork) 8 - 8 - - Totals 88 61 8 2 — 25 PART VIII. OUTWORK — SECTIONS 110 & 111. Nature of work Section 110 Section 111 No. of outworkers in Auggust list required by Sec. 110 (l) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwhole some premises Notices served Prosecutions Wearing Apparel Making etc. 1 1 - - - - The making of boxes or other receptacles or parts thereof made wholly or partially of paper 50 1 - - - - Others — — — — — — Total 51 2 — — — — Number of addresses received from other Councils 38 Number of addresses forwarded to other Councils 29 Number of premises where outwork was carried on at the end of 1948 56 Inspections of Outworkers' premises 55 Outwork in Infected Premises (Section 153 Public Health Act, 1936) Nil. OTHER MATTERS. Failure to affix Abstracts of Act notified to H.M. Inspector of Factories 8 Underground Bakehouses in use at the end of the year 3 The establishment of an underground bakehouse, in contravention of Section 54 of the Factories Act, 1937, was discovered during the year. The occupier of the premises readily discontinued the use of this bakehouse when his attention was called to the contravention. 26 SECTION D.— HOUSING. Housing Act, 1936—Section 12. During the year 1948, one underground room was inspected and found not to comply in all respects with the Council's Regulations as to Underground Rooms. An undertaking was given by the owner that the room would not be used for human habitation. Housing Act, 1936, (Part IV) — Overcrowding. The following table shows the position in Wimbledon at the end of 1948, with regard to overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 33 (ii) Number of families dwelling therein 43 (iii) Number of persons dwelling therein 168 (b) Number of new cases of overcrowding reported during the year 30 (c) (i) Number of cases of overcrowding relieved during the year 35 (ii) Number of persons concerned in such cases 180 (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. 27 SECTION E. - INSPECTION AND SUPERVISION OF FOOD. Milk. Under the Milk (Special Designations) Regulations, 1936/46, licences were granted to retailers as follows:— Pasteurisers' Licences Nil. Dealers' Licences— Tuberculin Tested Milk 10 Pasteurised Milk 17 Supplementary Licences 17 44 During the year seventy-five samples of milk were sent for bacteriological examination. Fifty-five of these samples were of special designated milk and the results are given below:— Milk. Satisfactory. Unsatisfactory. Pasteurised 18 - Tuberculin Tested Pasteurised 13 - Tuberculin Tested Certified 12 7 Heat Treated 5 - Four of the seven unsatisfactory samples of Tuberculin Tested Certified milk were taken from one firm and three from another. Communications were sent to the County Medical Officers of the areas concerned in order that investigations could be carried out at the source of production. At the end of the year, samples taken from both retailers were reported upon by the bacteriologist as satisfactory. Twenty samples of ungraded milk were taken during the year. There is no standard laid down with which ungraded milk has to conform. In fourteen cases, however, the bacteriologist reported that the ungraded milk was up to the standard of pasteurised milk. In most, if not all, of these instances, the milk had previously been pasteurised, but was not actually sold as pasteurised milk. Ice Cream. During the year 46 samples of ice cream were sent to the Public Health Laboratory Service at Epsom for bacteriological examination. The results of these samples were as follows:— Grade 1 21 Grade 2 12 Grade 3 9 Grade 4 4 Total 46 28 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. Repeated visits were made to premises from which unsatisfactory results had been received, and communications were sent to the Medical Officers of Health of the areas in which the ice cream was manufactured. Further samples were taken from time to time. In all. 157 visits to such premises were paid during the year. 29 Sampling of Food and Drugs. During 1948 samples were taken for analysis as under:— Articles Analysed Inferior or Adulterated Formal Informal Total Formal Informal Total Milk 20 23 43 1 It Asprin — 2 2 — — — Arrowroot — 1 1 - — — Barley Flour — 2 2 - — — Baking Powder — 4 4 - — — Beef Cubes — 1 1 - — — Carraway Seed — 1 1 - — — Chocolate Cup — 1 1 - 1 1* Chocolate Spread — 2 2 - — — Cocoa — 5 5 - — — Coffee 1 2 3 - — — Curry Powder — 2 2 - — — Cake Mixture — 6 6 - 1 1* Cake Flour — 1 1 - 1 1* Custard Powder — 2 2 - — — Fish Paste — 4 4 - — — Gravy Powder — 3 3 — — — Ground Ginger — 2 2 - — — Ground Cinnamon — 1 1 - — — Ground Nutmeg — 1 1 - — — Horseradish Sauce 1 4 5 - — — Isinglass — 1 1 - — — Junket Tablets — 1 1 - — — Lemonade Powder — 2 2 - — — Mashed Potatoes 1 — 1 - — — Marmite - 1 1 - — — Meat Paste — 1 1 - — — Mint Sauce — 4 4 - — — Mixed Spice — 1 1 - — — Mustard — 3 3 - — — Onion Powder — 1 1 - — — Pea Flour — 1 1 - — — Pepper — 5 5 - — — Pudding Mixture 1 5 6 1 1 2* Rye Pearls 1 — 1 - — — Rum — 1 1 - — — Saccharine - 1 1 - — — Salad Dressing — 2 2 - 1 1* Sage and Onion Stuffing — 1 1 - — — Semolina — 1 1 - — — Vinegar — 1 1 - — — 25 103 128 1 6 7 †Adulterated *Inferior 30 Meat and Other Foods. The following inspections of food premises etc., were made by the Sanitary Inspectors during 1948:— Inspections of Dairies 64 Inspections of Food and Food Premises 931 Visits to obtain samples of Food and Drugs 155 Inspections under the Shops Acts, 1912/1938 80 Visits to premises where ice cream is manufactured or sold 157 The following is a list of the unsound food surrendered for destruction during the year:— Meat 147 lbs. Minced Meat 160 lbs. Sausage and sausage meat 20 lbs. Bacon 86½ lbs. Rabbits 45 Fowls 10 Fish 311 stones Prawns 132 lbs. Various tinned foods 2,821 tins Pickles 67 jars Fish paste 5 jars Jam 54 lbs. Bottled fruit 13 bottles Cereals 226 lbs. Butter, cooking fats, etc 9 lbs. Eggs 404 Dried eggs 7 packets Cheese 59 cartons Sugar 13£ lbs. Flour 6 lbs. Bread Tomatoes Fish cakes 300 quarterns 390 lbs. 72 Various bottles of vinegar, coffee, salad cream, etc. During the year the slaughtering of thirty-six pigs at various Pig Clubs in the Borough was supervised by the Sanitary Inspectors. 31 Carcases Inspected and Condemned. Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed (if known) — — — — 36 Number inspected — — — — 36 All diseases except Tuberculosis, Whole carcases condemned — — — — — Carcases of which some part or organ was condemned — — — — — Percentage of the number inspected affected with diseases other than tuberculosis - - - - - Tuberculosis only. Whole carcases condemned — — — — — Carcases of which some part or organ was condemned - - - - - Percentage of the number inspected affected with tuberculosis - - - - - 32 SECTION F.— PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. During the year there were 849 cases of infectious disease notified as compared with 541 during 1947. As will be seen from the accompanying table, the number of notifications received was higher than at any other time during the last ten years. Of the total notifications 481 were in respect of measles and 231 in respect of whooping cough, diseases which have been notifiable since 1939, when the Measles and Whooping Cough Regulations came into force. Cerebro-Spinal Fever. Three cases of this disease were notified during 1948. Two of these—a boy aged 2 years and a girl also aged 2 years—died shortly after admission to hospital. Diphtheria. Four cases of diphtheria occurred during the year, the ages of the patients being 7, 8, 20 and 38 years. One of these patients (a boy aged 8 years) had been immunised in infancy. The other three cases gave no history of immunisation. All patients were removed to hospital, and made good recoveries. Food Poisoning. Five cases of food poisoning were notified during the year, 3 notifications being in respect of members of one family. Investigations into the cases failed to reveal the source of the food poisoning. Poliomyelitis and Polioencephalitis. There were 2 cases of poliomyelitis and 2 of polioencephalitis notified during 1948. The following tables show (a) the notifications of infectious disease received during the year 1948, and (b) a comparison of notifications received during the last 10 years. 33 Notifiable Diseases during 1948. 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 — 8 20 52 7 2 6 — — 95 60 Diphtheria (including Membranous Croup) - - - 2 — 1 1 — — 4 4 Puerperal Pyrexia — — — — — 3 2 — — 5 2 Measles 23 113 124 200 5 8 6 2 — 481 12 Whooping Cough 19 57 78 70 3 1 3 — — 231 8 Acute Primary or Influenzal Pneumonia 1 2 — 3 — — 2 2 5 15 1 Cerebro-Spinal Fever — 2 — — — 1 — — — 3 3 Acute Poliomyelitis — — — — 1 1 — — — 2 9 Polioencephalitis — — — — 1 — 1 — — 2 1 Ophthalmia Neonatorum 2 — — — — — — — — 2 — Erysipelas — — — — — — 1 1 — 2 — Paratyphoid Fever — — — — — — — 1 — 1 1 Acute Encephalitis Lethargica — — — — — 1 — — — 1 1 Food Poisoning 1 — 1 — — 1 1 1 — 5 1 TOTALS 46 182 223 327 17 19 23 7 5 849 96 34 *Non-civilian. Notifications of Infectious Disease during the last 10 years. DISEASE 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 Cerebro-Spinal Fever 3 12 9 7 10 3 6 5 5 3 Diphtheria 24 9 15 10 20 24 8 7 4 4 Dysentery 1 — — 3 — 89 18 4 2 — Encephalitis Lethargica, acute - - - - - - - - — 1 Enteric Fever (including Paratyphoid) 2 19 8 6 — - - - — 1 Erysipelas 8 11 9 12 11 11 11 12 5 2 Food Poisoning — 4 3 — — — 1 — — 5 Malaria — — — 1 — 1 1 7 — — Measles 56 77 556 272 57 586 339 253 481 Ophthalmia Neonatorum 3 3 6 8 6 9 10 8 4 2 Pneumonia 9 23 20 20 30 25 27 26 32 15 Polioencephalitis — 1 — — — — — — 12 2 Poliomyelitis 3 — 1 — — 1 4 2 13 2 Puerperal Pyrexia 7 6 2 6 9 6 8 10 3 5 Scarlet Fever 54 40 39 100 186 77 46 37 51 95 Whooping-cough 10 144 34 115 117 54 114 157 231 114 194 333 763 659 420 780 571 541 849 Tuberculosis:— Pulmonary 63 58 71 64 59 66 76 84 87 87 Non-Pulmonary 10 9 12 16 12 10 16 12 8 6 35 IMMUNISATION AGAINST DIPHTHERIA. Sessions of the Diphtheria Immunisation Clinic were held regularly during the period 1/1/48 to 4/7/48. The number of children immunised during this period was as follows:— Primary Immunisation. Children under 5 years of age 354 Children aged 5 to 14 years 39 393 Boosting Doses. No. of children given boosting doses 578 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 under the age of 5 years. Age at 1948 No. immunised Total child population. Under 1 64 4,420 I year 727 2 years 729 3 years 573 4 years 551 2,644 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. 36 TUBERCULOSIS. During the year, 93 cases of tuberculosis were added to the register, as compared with 95 in 1947. Of these, 65 were new cases and the remainder were transfers from other areas. The following cases were removed from the Register:- Deaths 38 Patients stated to have recovered 1 Removals from district 24 63 There were 30 admissions to hospitals or sanatoria during the year. The following table gives an analysis of the notifications received:— 37 TUBERCULOSIS — 1948. 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 - - - 1 - 5—10 „ — 1 - - 1 1 - - 1 2 - - — — - - 10 — 15 „ - - - - - - - - - - - - - - - - 15 — 20 „ 3 9 - - - 1 — - 3 10 - - — 1 - - 20 — 25 „ 4 9 1 1 4 3 - - 8 12 1 1 — 3 - - 25 — 30 „ 3 3 - - 2 4 - 2 5 7 - 2 3 2 - - 30 — 35 „ 3 2 - - 6 — - — 9 2 — — 5 2 - - 35 — 45 „ 5 3 - 1 3 2 - — 8 5 - 1 2 1 - - 45 — 55 „ 6 2 — - — — - — 6 2 - — 7 — - - 55 — 65 „ 5 — - - — — - — 5 — - — 6 1 - - 65 and Over 2 — - - — — - — 2 - - — 3 — 1 - 31 29 2 2 16 11 - 2 47 40 2 4 26 10 2 - 60 4 27 2 87 6 36 2 64 29 93 38 38 WIMBLEDON INFECTIOUS DISEASES HOSPITAL. On the 5th July, 1948 this hospital was transferred to the control of the South-West Metropolitan Regional Hospital Board, under the provisions of the National Health Service Act, 1946. During the period 1st January to 4th July, 1948, 89 patients were admitted to the hospital—71 from Wimbledon and 18 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 5 3 Scarlet Fever 45 41 Cerebro-Spinal Meningitis 4 1 Acute Anterior Poliomyelitis and Polioencephalitis 3 1 Typhoid Fever 1 — Measles 18 17 Whooping Cough 2 2 Puerperal Pyrexia 1 1* Gastro-Enteritis 1 1 Mumps 4 4 Chicken pox 3 3 Other diseases 1 1 Healthy baby (admitted with mother) 1 *Pyelonephritic abscess. Diphtheria. All the patients admitted to the hospital during the period 1/1/48 to 4/7/48 as cases of diphtheria came from the Wimbledon area. Two of these were found to be suffering from tonsillitis: in the remaining three cases the diagnosis was confirmed. Cerebro-Spinal Meningitis. In only one of the four cases of cerebro-spinal meningitis admitted during the period was the diagnosis confirmed. One case was diagnosed as pneumonia, and one as streptococcal tonsillitis. The remaining case was found to be one of tuberculous meningitis. This patient, a child aged two years, died three days after admission to hospital. Poliomyelitis. Three patients were admitted to the hospital as cases of poliomyelitis. One of the three patients was finally diagnosed as suffering from polioencephalitis. In the remaining two cases the diagnosis was not confirmed. 39 Typhoid Fever. One patient, a man aged 30 years, was admitted from a local hospital as a suspected case of typhoid fever. The diagnosis was not confirmed. Measles. Eighteen patients were admitted to the hospital as cases of measles, and were diagnosed as follows:— Uncomplicated measles 10 Measles and pneumonia 6 Measles and whooping-cough 1 Erythema multiform 1 18 Scarlet Fever. Of the 45 patients admitted as cases of scarlet fever, 41 were finally diagnosed as suffering from this disease. Two patients were found to be suffering from tonsillitis, and two from measles. 40