WAN 59 Metropolitan Borough of Wandsworth. Annual Report ON THE Death, Sanitary Condition, sc.. OF THE BOROUGH, FOR THE YEAR 1912, BY P. CALDWELL SMITH, M.A., M.D.. D.P.H., Camb., Medical Officer of Health, TOGETHER WITH THE Report of the Public Analyst. Cuntum : Printed for the Council by FREDERICK TARRANT & COMPANY, LIMITED, 108 & no, Camrerwell Road, S.E. INDEX. page Ages at Death 32 Anthrax Orders 146 Appendicitis and Typhilitis 151 Bacteriological Examinations 76, 144 Bakehouses 208 Births 3 Births and Birth-rates in Sub-Districts 4 Births, Notification of, Act 6 Birth-rate for the Year and for the previous Ten Years 4 Brain and Nervous System, Diseases of the 149 Canal Boats Act 224 Cancer 146 Cerebro-Spinal Fever 75 Circulatory Diseases 150 Clapham, House-to-house Inspections in 178, 179 Clapham : Table of Causes of Death 282 Cleansing of Persons Act 193 Conscientious Objection Certificates granted 48 Cowsheds 200 Cutting-off Notices 165 Death, Ages at 32 Death, Causes of 26, 30 Death-rate, Corrected 17 Death-rate, Corrected, for Age and Sex Distribution 20 Death-rate, Infantile 33 Death-rate for all Metropolitan Boroughs 21 Deaths, Corrected and Uncorrected 19 Deaths, Number of 8 Deaths, Percentage of, at six Age Periods 32 Deaths, Proportion of, from the Principal Causes to Total Deaths 164, 165 Deaths in Out-lying Institutions 16, 161 Deaths in Public Institutions 10, 157 ii. PAGE Deaths in Public Institutions in the Borough of Persons belonging to the Borough 14 Deaths in Public Institutions in the Borough of Persons not belonging to the Borough 12 Deaths in Public Institutions, Percentage of, to Total Deaths, 1891-1911 163 Developmental Diseases 152 Diarrhœa 92 Diarrhœa, Death-rate from 93 Diarrhoea and Enteritis, Number of Deaths under One Year for each Quarter of the Year, both for 1912 and Five Years previous 93 Diarrhoea, Method of Feeding Children who died from 95 Diphtheria 59 Diphtheria and Schools 63 Diphtheria, Cases of, and their Relationship to Schools in the Borough 64 Diphtheria, Number of Cases and Deaths, 1902-1912 60 Diphtheria, Number of Dwellings in which multiple Cases occurred 67 Diphtheria, " Return Cases "of 69, 72 Disinfection 192 Disinfection of Schools 91 Enteric Fever 72 Enteric Fever and Shell-fish 73 Erysipelas 78 Exclusion of Children from Schools in the Borough 83-88 Factories and Workshops 205 Factories, Workshops and Workplaces, Inspection of 208 Factories and Workshops, Summary of Work of Female Inspectors 219 Factories and Workshops, Summary of Work of Male Inspectors 215 Feeding of Infants, Report of Female Inspectors on 98 Food Places, Inspection of 195 Glanders and Anthrax Orders 146 Home Work 211 House Refuse, Removal of 196 House-to-house Inspections 178-187 iii. PAGE House-to-house Inspections, Summary of 187 Houses and Premises Inspected 174 Houses Let in Lodgings 204 Housing, Town Planning, &c., Act, 1909 170 Ice Cream Premises 204 Illegitimate Children, Births of 5 Infant Visiting 98 Infantile Mortality 31, 33 Infantile Mortality from Stated Causes 31 Infantile Mortality, Kate per 1,000 births from five groups of diseases 38 Infective Diseases, Deaths from 40 Infective Diseases, Deaths in External and Internal Institutions 41, 42 Infective Diseases, Death-rate from 41, 43 Infective Diseases, Death-rate per 1,000 for Five Years and 1912 144 Infective Diseases, Death-rate per 1,000, 1902-1912 43 Infective Diseases: Number of Cases notified 29, 43 Infective Diseases: Number of Notifications, received, 1902-1912 44 Infective Diseases: Number of Cases notified from Elementary Schools 80 Infective Diseases: Number of Cases notified from Public Institutions 47 Infective Diseases: Number of Deaths, 1902-1912 40 Influenza 92 Inspections, details of 175, 176 Institutions, Internal and External 161 Inquests 154 Knacker's Yard 204 Legitimate Birth-rate 5 Margarine Act, Proceedings under 231, 232 Measles 78 Measles and other Non-notifiable Diseases reported from Schools 80 Milk and Cream Regulations, 1912 240 Milk Premises, Cowsheds, &c., on Register 198 Milkshops 200 Mistaken Diagnosis, Cases of 74 iv. PAGE Mortuaries 166 Natural Increase, Rate of 4 Nervous System, Diseases of the 149 Non-Infective Diseases Notification of Births Act 6 Notification of Infective Diseases 43 Offensive Trades 204 Offensive Trade Refuse 205 Old Age 153 Ophthalmia Neonatorum 145 Other Infective Diseases 144 Outworkers 211 Overcrowding 189 Police Court Proceedings 195 Polio-Myelitis 145 Population 1 Population of Sub-Districts 2 Population of Wards 2 Premature Birth 152 Public Institutions, Percentage of Deaths to total Deaths, 1891-1911 163 Puerperal Fever 77 Pulmonary Tuberculosis, Deaths and Death-rates, 1902- 1912 110 Pulmonary Tuberculosis, Deaths in Public Institutions, 1902-1912 143 Pulmonary Tuberculosis, Notification of Cases of 124-133 Pulmonary Tuberculosis, previous occupation of persons who died from 111 Putney, House-to-house Inspections in 180 Putney, Table of Causes of Death 283 Rag Flock Act, 1911, Statement of work done under 224 Rated Hereditaments 2 Respiratory Diseases 150 Return Cases of Scarlet Fever and Diphtheria 69 Revenue Act 170 Sale of Foods and Drugs Acts, Proceedings under 228-232 Sale of Food and Drugs Act, Statement of Work under 227 Sanitary Operations, Table of 174 V. PAGE Sanitary Work, General 166 Scarlet Fever 52 Scarlet Fever and Schools 54-58 Scarlet Fever, Annual Rate of Notified Cases, 1909-1912 53 Scarlet Fever, Number of Dwellings in which Multiple Cases occurred 59 Scarlet Fever, '* Return Cases "of 69 Schools, Disinfection of, for Infective Diseases 91 Schools, other diseases notified from 90 Shelters 199 Slaughter-houses 201 Small-pox 45 Smoke Nuisances 191 Special Inspections 166 Streatham, House-to-house Inspections in 181, 182 Streatham : Table of Causes of Death 284 Tooting, House-to-house Inspections in 183 Tooting : Table of Causes of Death 285 Tuberculosis Dispensary 117-124 Tuberculous Diseases 109 Underground Rooms 171 Unsound Food 205 Urinals in Connection with Licensed Premises, Inspection of 194 Vaccination Returns 48 Violence, Mortality from 153 Vital Statistics of Whole Borough 25, 28 Wandsworth, House-to-house Inspections in 184, 185. 186 Wandsworth : Table of Causes of Death 286, 287 Water Supply, Cutting-off Notices 165 Whooping Cough 89 Workshops, Summary of Principal Trades carried on 217, 223 Zymotic Diseases, Deaths from 40 Zymotic Diseases, Deaths in External and Internal Institutions 41, 42 Zymotic Diseases, Death-rate from 41, 43 Zymotic Diseases, Death-rate per 1,000 for Five Years and 1912 144 Zymotic Diseases, Death-rate per 1,000, 1902-1912 43 REPORT of the Medical Officer of Health for the Year 1913. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Wandsworth. Sir and Gentlemen, I have the honour to present the Annual Report on the health and sanitary condition of the Borough for the year 1912. Population. The population of the Borough to the middle of 1912 has been estimated by the Registrar-General to be 321,881, but in my opinion this estimate is too high, as judging by the increase in the number of rated hereditaments the rate of increase during the present decennium is not so great as in the previous one. During the decennium 1901-1911 the increase in the number of rated hereditaments was 23,243, or an average of 2,324 per annum. From the returns furnished by the Rating Department the increase in the number of rated hereditaments in the year was only 960, so that it is clear that the increase in population will be considerably less than in the previous decennium. Table I. shows the Census population in 1911 in each ward, the number of rated hereditaments and the number of persons per rated hereditament in 1911, the rated hereditaments in 1912, and the population estimated from the same. 2 Report of the Medical Officer of Health TABLE I. Ward. Census Population, 1911. Rated Hereditaments, 1911. No. of Persons per rattd Hereditament, 1911. Rated Hereditaments, 1912. Estimated Population, 1912. Clapham, North 28,868 5.7°4 5.06 5,773 29,511 ,, South 29,728 6,829 4.35 6,887 30,291 Putney 28,246 6,119 4.61 6,166 28,569 Streatham 49,192 11.756 4.18 11,841 49,946 Balham 47,009 10,333 4.55 10,574 48,511 Tooting 35,962 7,410 4.85 7,651 37,703 Southfield 34,607 7,385 4.68 7,488 35,443 Fairfield 20,604 4,087 5.04 4,113 20,928 Springfield 37,186 7,016 5.30 7,106 38,061 Whole Borough.. 311,402 66,639 4.67 67,.599 318,963 The population estimated from the rated hereditaments is thus 2,718 under that estimated by the Registrar General. Table II. shows the population of each sub-district, compared with the Census population, uncorrected and corrected for Institutions. TABLE 11. Sub-District. Census Population, 1911. Population estimated to middle of 1912. Corrected. Uncorrected. Clapham 58,596 60,032 59,802 Putney 28,246 28,569 28,569 Streatham 96,201 97,953 98,457 Tooting 35,962 35,688 37,703 Wandsworth 92,397 91,519 94.,432 Whole Borough 311,402 313,761 318,963 3 Repott of the Medical Officer of Health The corrected population in Table II. is used to calculate all the rates in this Report. The total population of the Institutions in the Borough was in 1911 7,855, but as a large proportion of the inmates of the Tooting Home and the Metropolitan Asylums Board's Hospital belong to the Borough, a deduction of 5,202 from the uncorrected population gives the corrected population, viz.—313,961, compared with 308,156 in the previous year. As the complete Census returns have not yet been issued, no particulars can be given yet as to occupation or overcrowding. Births. During the 52 weeks ending the 28th December, 1912, 6,756 births, 3,446 of males and 3,310 of females, were registered, compared with 6,699 1911, 6,967, in 1910, and 6,985 in 1909. The total number of births registered in this Borough was 6,580, but 250 births occurred in Institutions outside the Borough of persons belonging to the Borough, and 74 births in Institutions in the Borough of persons not belonging to the Borough, making a corrected total of 6,756. Of the 250 births which were registered outside the Borough, 87 occurred in Clapham Maternity, 48 in the General Lying-in Hospital, 24 in Queen Charlotte's Hospital, 12 in St. Thomas's Hospital, three in St. Bartholomew's Hospital, two in Westminster Hospital, eight in Poor Law Infirmaries, nine in private nursing homes, and 57 in other places. In Table III. is shown the number of births, males and females, the birth-rate, and the rate of natural increase for each sub-district, and for the whole Borough. 4 Report of the Medical Officer of Health TABLE III. Sub-District. Births. Rates. Males. Females. Total. Birth-Rate. Rate ot natural increase. Clapham 636 602 1,238 20.62 8.98 Putney 251 237 488 17.08 7.25 Streatham 920 930 1,850 18.88 9.46 Tooting 501 467 968 27.12 16.92 Wandsworth 1,138 1,074 2,212 24.17 12.99 Whole Borough 3.446 3,310 6,756 21.53 11.05 Table IV. shows the birth-rate in the Borough, in the five sub-districts, in London, and in England and Wales, for the year, as well as the rates for the previous 10 years, compared with the decennial average. The rates for the decennium have been recalculated on the increase of population as ascertained at the Census. TABLE IV. Year. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. London. Eng'and and Wales. 1902 24.74 22.62 2331 3436 32.27 27.01 29.17 28.5 1903 26.98 22.91 22.50 39.52 31.37 27.63 28.75 28 .4 1904 27.63 22 .02 22.45 32.54 32.17 27.45 28.38 28.1 1905 25.94 20.49 21.74 39.34 30.62 26.59 27.79 27.3 1906 24.99 19.22 20.92 41.78 31.20 26.47 27.57 27.2 1907 24.25 18.56 21.46 36.67 29.93 25.65 26.81 26.4 1908 24.39 20.49 21.66 38.51 29.25 25.54 27.14 26.8 1909 23.29 18.14 20.10 3.405 2.7.18 24.04 25.75 25.8 1910 21.61 17.94 20.46 31.18 26.38 23.21 25.39 25.05 1911 22.15 16.96 18.78 29.04 23.27 21.73 25.0 24.4 Average for 10 yrs. 24.59 1993 21-33 35.69 29.36 25.53 27.17 26.79 1912 20.62 17-08 18 88 27.12 24.07 21.53 247 23.8 5 Report of the Medical Officer of Health The rate for the whole Borough is the lowest yet recorded, being .20 under the rate for the previous year, and 4 00 under the decennial average. Compared with 1911 the rate in the several sub-districts show a decrease in all with the exception of Wandsworth, where there has been an increase of .90 per 1,000. Compared with the decennial average there has been a decrease in all the sub-districts, and this is exceptionally large in Tooting where the reduction has been from 35.69 to 27.12 per 1,000. The birth-rate for the whole of London was 24.7 per 1,000, compared with 25.0 in 1911, and 2717 the decennial average; while for England and Wales the rate was 23.8 per 1,000, compared with 24.40 in 1911, and 26.79 the decennial average. 151 births occurred in the Workhouse, and of these seven belonged to Clapham, five to Putney, 19 to Streatham, 11 to Tooting, 37 to Wandsworth, 65 to Battersea, and seven to other places. Of these 151 births 91 were illegitimate, six belonging to Clapham, four to Putney, 12 to Streatham, seven to Tooting, 17 to Wandsworth, 38 to Battersea, and seven to other places. In the Borough, excluding the Workhouse, 116 illegitimate births occurred, 29 in Clapham, seven in Putney, 23 in Streatham, 19 in Tooting, and 38 in Wandsworth. Of the births registered outside the Borough, 61 were illegitimate. The total number of illegitimate births was 223, 46 of which belonged to Clapham, 16 to Putney, 48 to Streatham, 33 to Tooting, and 70 to Wandsworth, compared with 180 in 1911, and 185 in 1910. The percentage of illegitimate births to total births was 3.30 compared with 2.68 in 1911, and 2.65 in 1910, and 3.8 for the whole of London for 1911. 6 Report of the Medical Officer of Health The following Table shows the percentage of illegitimate births to total births for each sub-district and for the whole Borough for the year, and for the three previous years:— Sub-district. 1909 1910 1911 1912 Clapham 3.58 2.46 2.6o 3.71 Putney 3.41 3.05 3..32 3.27 Streatham 2.24 2.87 2.15 2.59 Tooting 2.65 2.60 3.20 3.40 Wandsworth 2.25 2.51 28.1 3.17 Whole Borough 2.50 2.65 2.68 3.30 Notification of Births Act. During the year 4,701 births were notified, 903 from Clapham, 325 from Putney, 1,041 from Streatham, 553 from Tooting, and 1,879 from Wandsworth. 161 births were notified from the Workhouse, of which 93 belonged to this Borough, and 68 to other places. Of the 93 which belonged to this Borough, the home addresses of eight were in Clapham, of seven in Putney, of 22 in Streatham, of 12 in Tooting, and of 44 in Wandsworth. The following Table shows the number of cases notified in each sub-district and in the whole Borough, the person by whom notified and whether the children were born alive or dead. 7 Report of the Medical Officer of Health TABLE V. Sub-district. Total No. of births notified. Notified by : No. born alive. No. born dead. Medical Attendant Parent. Midwife. Other person. Clapham 903 484 200 191 27 883 20 Putney 325 96 169 S3 7 314 11 Streatham 1,041 431 308 279 23 1,019 22 Tooting 553 94 317 139 3 537 l6 Wandsworth 1,879 379 864 596 40 1,843 36 Whole Borough 4,701 1,484 1,859 1,258 100 4,596 105 The next Table shows these births compared with the total births registered in each sub-district and in the whole Borough. TABLE VI. Sub-district. No. of births notified. Still-births. Births less still-births. Births registered. Excess of registered over notified births. Clapham 903 20 883 1,151 268 Putney 325 11 3'4 469 155 Streatham 1,041 22 1,019 1,76s 749 Tooting 553 16 537 922 185 Wandsworth 1,879 36 1,843 2,270 427 "Whole Borough 4,701 105 4,596 6,580 1,984 The percentage of births notified, less still-births, to those registered was 6g'8, while 30.2 per cent were not notified, compared with 68.7 and 31.3 in 1911, showing an increase of 1.1 per cent. In the sub-districts these percentages were:—In Clapham 76.6 and 23.4, compared with 70.3 and 29.7 in 1911; in Putney 8 Report of the Medical Officer of Health 66.9 and 33.1, compared with 66.8 and 32.2; in Streatham 57.6 and 42.4, compared with 60.1 and 39.9; in Tooting 58.2 and 41.8 compared with 60.5 and 39.5; and in Wandsworth 81.2 and 18.8, compared with 79.9 and 20.1. An increase has taken place in Clapham, Putney and Wandsworth, but a decrease in Streatham and Tooting. The proportion of still-births to total births was 2.2 per cent., compared with 2.2 per cent. in 1911, and with 23 per cent., the mean for the whole of London for the year 1911. The work carried out by the female Sanitary Inspectors in connection with the Notification of Births Act is given later on in this Report when dealing with Infantile Mortality. Deaths. During the 52 weeks ending the 28th December, 1912, 3,118 deaths, 1,523 of males and 1,595 of females were registered, compared with 3,456 in 1911, 2,856 in 1910, and 3,279 in 1909. Compared with 1911 there has been a decrease of 338 deaths, and of 830 compared with the decennial average corrected for increase of population. The uncorrected death-rate for the Borough was 978 per 1,000, compared with 11.02 in 1911, 8.16 in 1910, and 11.08 in 1909. The average uncorrected rate for the decennium 1902-1911 was 11.75, or 1.97 above the rate for the year 1912. In the sub-districts these rates were as follows:—9.31 in Clapham, 7.91 in Putney, 7.33 in Streatham, 21.93 in Tooting and 8.32 in Wandsworth. 9 Report of the Medical Officer of Health The reason for the high rate in Tooting is that in that subdistrict there are a number of Public Institutions, as the Tooting Bee Asylum and the Tooting Home, where persons from other parts of London are received and among whom the mortality is very great. To ascertain the corrected death-rate corrections must be made to the above by the addition of the deaths in Out-lying Institutions and other places of persons belonging to the Borough, and the subtraction of all deaths in Public Institutions and other places in the Borough of persons not belonging thereto, whose domiciles were in other parts of London. The deaths occurring in other parts of England and Wales are also included, as these are now received from the Registrar General. The total number of deaths for the 52 weeks, corrected for both internal and external Institutions and other places was 3,291, compared with 3,776 in 1911, 3,105 in 1910, 3,520 in 1909, and 3,903, the decennial average corrected for increase of population. During the year 836 deaths occurred in Public Institutions and 122 in other places in the Borough. Of the total of 958 deaths, 767 were of persons not belonging and 191 of persons belonging to the Borough. Table VII. shows the total number of Institution deaths arranged according to sub-districts and Institutions in which they occurred, Table VIII. the deaths of persons not belonging to the Borough, and Table IX. of persons belonging thereto arranged according to causes of death, sex and age, and Institution in which the death occurred. 10 Report of the Medical Officer of Health TABLE VII. Name of Public Institution. Clapham. Putney. Streatham Tooting. Wands'th. Total. Hostel of God 57 ... ... ... 57 St. Anne's Home ... ... 10 ... ... 10 Middlesex County Asylum ... ... 6 ... 108 114 Metropolitan Asylums Board's Fever Hospital ... ... ... 108 ... 108 Fountain Asylum ... ... ... 17 ... •7 Tooting Home ... ... ... 137 ... 137 H. M. Prison ... ... ... ... 8 8 Workhouse ... ... ... ... 6 6 Royal Hospital for Incurables ... ... ... ... 22 22 Tooting Bee Asylum ... ... ... 325 ... 325 The Priory ... 5 ... ... ... 5 Home for Aged Jews ... ... ... ... ... 11 Putney Hospital ... 16 ... ... ... 16 TOTAL 57 21 27 587 144 836 Other places 34 24 40 9 '5 122 GRAND TOTAL 91 45 67 596 '59 958 Compared with the year 1911 there has been an increase of 115 in the deaths in Institutions, and a decrease of seven in other places, or a total increase of 108. In the Middlesex County Asylum the deaths were eight more, in the Tooting Bee Asylum 21 more, in the Hostel of God three more, in the Tooting Home 38 more, in the Fever Hospital three less, in the Workhouse 10 less, in the Prison three more, in the Royal Hospital for Incurables eight more, in St. Anne's Home two less, in The Priory one more, in the Home for Aged Jews three more, and in other places six less, compared with the year 1911. 11 Report of the Medical Officer of Health. Of the deaths in other places 34 occurred in Clapham, 24 in Putney, 40 in Streatham, nine in Tooting, and 15 in Wandsworth. Table VIII. shows the deaths in Public Institutions in the Borough of persons not belonging thereto, arranged as to ages, causes of death, and Institution in which the death occurred. The greatest number of deaths was due to Old Age, and of the 269 registered, 241 occurred in Tooting Bee Asylum, six in the Tooting Home, 14 in the Middlesex County Asylum, and four in other places. In the Middlesex County Asylum the greatest number of deaths occurred from diseases of the Nervous System, Pulmonary Tuberculosis, Old Age, disease of the Respiratory Organs, Bright's disease, and diseases of the Circulatory System. In the Tooting Bee Asylum the greatest number of deaths occurred from Old Age, diseases of the Nervous System, and diseases of the Respiratory Organs; in the Hostel of God from Pulmonary Tuberculosis and Cancer; and in the Tooting Home from Pulmonary Tuberculosis. In the Fever Hospital 17 deaths occurred from Scarlet Fever, compared with 17 in 1911; 34 from Diphtheria, compared with 43; 26 from Whooping Cough, 25 from Measles, and six from other diseases. 12 Report of the Medical Officer of Health. TABLE VIII. Deaths in Public Institutions, &c., in the Borough of Persons not belonging to the Borough, 1912. Deaths in or belong:ng to whole District at subjoined ages. Institutions. causes of death. All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. | 65 and upwards. Middlesex County Asylum. Tooting Bee Asylum. Hostel of God. Tooting Home. Fever Hospital. H.M. Prison. Ryl. Hosp. for Incurables. St. Anne's Home. The Priory. Home for aged Jews Putney Hospital. Fountain Temporary Asvlum. Other Places and Institutions Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 18 7 11 4 7 7 ... ... ... ... ... ... ... ... ... 18 ... ... ... ... ... ... ... Scarlet Fever 9 5 4 ... 1 4 4 ... ... ... ... ... ... ... ... 9 ... ... ... ... ... ... ... ... Whooping Cough 18 10 8 4 8 6 ... ... ... ... ... ... ... ... ... 18 ... ... ... ... ... ... ... ... Diphtheria, and Membranous Croup 19 9 10 3 2 5 9 ... ... ... ... ... ... ... ... 19 ... ... ... ... ... ... ... ... Influenza 3 1 2 ... ... ... ... ... ... ... 3 ... ... ... 1 ... ... 1 ... ... ... ... ... 1 Erysipelas 1 ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 106 59 47 ... ... 1 3 17 50 27 8 21 3 20 50 1 ... 1 ... ... ... ... 2 8 Tuberculous Meningitis 1 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis 2 ... 2 ... ... ... 1 ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases 5 4 1 ... ... ... 3 1 1 ... ... ... 1 1 ... ... 1 ... ... ... ... ... 1 1 Other Infective Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer, Malignant Disease 44 8 36 ... ... ... ... ... 9 21 14 1 2 25 1 ... ... 3 ... ... ... 3 ... 9 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diabetes 7 2 5 ... ... ... ... ... 2 5 ... 1 2 ... ... ... 2 ... ... ... ... ... 2 Other General Diseases 5 1 4 ... ... ... ... 1 1 ... 3 ... ... ... ... ... ... 2 1 1 ... ... ... 1 Alcoholism 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ...... 1 ... Cerebral Hemorrhage, Apoplexy 19 11 8 ... ... ... ... ... 6 13 ... 4 8 ... 3 ... 1 ... ... ... ... ... ... 3 Convulsions 1 ... 1 1 ... ... ... ... ...... ... ... I ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Nervous System 87 59 28 ... ... ... 11 8 15 47 6 30 25 ... ... 1 ... 6 1 2 1 ... 8 4 Organic Diseases of Heart 24 13 11 ... ... ... ... ... 3 8 13 8 6 ... 2 ... ... ... 1 ... 1 ... ... 6 Other Diseases of Circulatory System 10 5 5 ... ... 1 1 ... 2 3 3 ... 3 ... 1 ... ... 1 ... 1 ... ... 2 2 Bronchitis 20 14 6 1 ... ... ... ... ... 4 15 9 1 ... 2 1 ... 1 2 ... 1 ... ... 3 Broncho-Pneumonia 13 11 2 ... ... ... 1 ... 1 3 8 2 1 ... 4 ... ... ... 3 ... ... 1 1 1 Lobar Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (type not distinguished) 18 13 5 ... ... ... ... ... 2 8 8 1 14 ... ... ... ... ... ... ... 1 ... ... 2 Other Diseases of Respiratory System 5 3 ... ... ... 1 ... ... ... 1 3 ... ... 1 ... ... ... ... 1 1 1 ... ... 1 Ulcer of Stomach 2 1 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 Diarrhœa 2 ... 2 1 ... ... 1 ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... 2 Enteritis 2 ... 2 1 ... ... ... ... 1 ... .. 1 ... ... ... ... ... ... ... ... ... ... ... ... Appendicitis and Typhlitis 2 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Obstruction of Intestines 3 1 2 ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... 1 Cirrhosis of Liver 2 1 1 ... ... ... ... ... ... ... 3 ... 1 ... ... ... ... ... ... ... 1 ... ... ... Other Diseases of Liver 2 ... 2 ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... ... ... 1 Other Diseases of Digestive System 7 5 2 ... ... ... 1 1 ... 3 2 1 2 1 ... 1 ... 1 ... ... ... ... 1 ... Nephritis and Bright's Disease 11 5 6 ... ... ... ... ... 3 6 2 0 2 ... ... ... ... ... 1 ... ... ... ... 2 Other Diseases of Urinary System 6 5 1 ... ... ... ... ... ... 5 1 ...... 3 ... ... ... 1 1 ... ... 1 ... ... ... Diseases of Generative System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy & Childbirth ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Debility and Malformation 3 2 1 ... 1 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 Other Diseases of Early Infancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Old Age 269 106 163 ... ... ... ... ... ... 15 254 14 241 ... 6 ... ... 1 ... ... 3 ... ... 4 Deaths from Accident 5 4 I ... ... ... 1 ... 2 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... 4 Deaths from Suicide 10 7 3 ... ... ... ... 1 3 5 1 ... ... ... ... ... 1 ... ... ... ... ... ... 9 Other Violent Deaths 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Other defined Diseases 3 2 1 ... ... ... 1 ... ... ... 2 1 1 ... ... ... ... ... ... ... ... ... ... 1 111-definedDiseases or unknown ... ... ... ... ... 11 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... All causes 767 380 387 15 19 26 38 30 105 178 356 113 318 51 70 69 5 0 10 5 10 5 16 75 13 Report of the Medical Officer of Health. Table IX. shows the number of deaths in Public Institutions in the Borough of persons belonging thereto, arranged according to cause of death, sex, age and Institution in which the death occurred. The total number of deaths was 191, 107 of males and 84 of females, compared with 181 in 1911, 159 in 1910, and 181 in 1909. 39 of the deaths occurred in the Fever Hospital, compared with 48 in 1911; 67 in Tooting Home compared with 53, six in the Hostel of God, compared with three; six in the Workhouse, compared with four ; seven in the Tooting Bee Asylum, compared with nine ; two in the Royal Hospital for Incurables; 11 in Putney Hospital ; and 53 in other places compared with 60. These deaths are allocated to their proper sub-districts in Table XV. The number of deaths in Table VIII., viz,:—767, and that in Table IX., viz.:—191, make up the total of 958, the total number of deaths in Public Institutions and other places in the Borough as shown in the last columns of Tables XV., and XVIII., and in column eight of Table XVI. 14 Report of the Medical Officer of Health. TABLE IX. Deaths in Public Institutions, &c., in the Borough of Persons belonging to the Borough, 1912. CAUSES OF DEATH. Deaths in or belonging to whole District at subjoined ages. Institutions. All Ages. Males. Females. Under i j'ear. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Fever Hospital. Tooting Home. Hostel of God. Workhouse. Tooting Bee Asylum. H.M. Prison. Royal Hospital for Incurables Putney Hospital. Fountain Temporary Asylum. Middlesex Asylum. Newlands House. Other Places not Institutions.[/#] Enteric Fever 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 7 4 3 ... ... 6 1 ... ... ... ... 7 ... ... ... ... ... ... ... ... ... ... Scarlet Fever 8 4 4 ... 2 6 ... ... ... ... 8 ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 8 3 5 2 3 3 ... ... ... ... ... 8 ... ... ... ... ... ... ... ... ... ... ... Diphtheria, Membranous Croup 15 7 8 ... 3 6 6 ... ... ... ... 15 ... ... ... ... ... ... ... ... ... ... ... Influenza 1 ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... Cerebro spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 47 30 17 ... ... ... 1 7 20 14 5 ... 44 1 ... ... ... ... 1 ... ... ... 1 Tuberculous Meningitis ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases 1 1 ... ... ...... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Other Infective Diseases 2 2 ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... ... ... Cancer, Malignant Disease 16 11 5 ... ... ... ... ... 1 11 4 ... 2 4 1 ... 1 ... ... ... ... ... 8 Rheumatic Fever 1 ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... Diabetes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other General Diseases 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Alcoholism 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Haemorrhage, Apoplexy 7 3 4 ... ... ... ... ... 1 3 3 ... 1 1 ... 1 ... ... ... ... 1 3 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Nervous System 3 2 1 ... ... ... 1 ... ... ... 2 ... ... ... ... 1 ... 1 ... ... ... ... 1 Organic Diseases of Heart 15 7 8 ... ... ... 1 1 4 3 6 1 2 ... ... ... 1 ... 2 ... ... ... 9 Other Diseases of Circulatory System 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Bronchitis 5 3 2 ... ... ... ... ... ... 1 4 2 ... ... ... ... 1 ... ... ... ... 2 Broncho-Pneumonia 2 2 ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... ... ... ... 1 Lobar Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (type not distinguished) 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Other Diseases of Respiratory System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ulcer of Stomach ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Appendicitis and Typhlitis 4 1 3 ... ... ... ... 1 1 2 ... ... ... ... ... ... ... ... 1 ... ... ... 2 Obstruction of Intestines. 2 2 ... ... ... ... ... ... ... ... 2 ... 1 ... ... 1 ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Digestive System 1 ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... Nephritis and Bright's Disease 3 3 ... ... ... ... ... ... 1 1 1 ... 1 ... ... ... ... ... 1 ... ... ... 1 Other Diseases of Urinary Sytem ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Generative System 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Puerperal Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Other Accidents and Diseases ofPregnancy and Childbirth 2 ... 2 ... ... ... ... ...>' 2 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... Premature Birth 2 1 1 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... Congenital Debility and Malformation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Early Infancy 2 1 1 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Old Age 15 7 8 ... ... ... ... ... ... ... 15 ... 9 ... ... 5 ... ... ... ... ... ... 1 Deaths from Accident 6 6 ... ... ... ... 1 1 ... 4 ... ... ... ... ... ... ... ... 1 ... ... ... 5 Deaths from Suicide 5 2 3 ... ... ... ... 1 1 2 1 ... ... ... ... ... ... ... ... ... ... 5 Other Violent Deaths 2 1 1 1 ... ... ... ... ... I ... ... ... ... ... ... ... ... ... ... ... ... 2 Other defined Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Diseases or unknown 2 2 ... 2 ... ... ... ... ... ... ... 2 All causes 191 17 84 9 6 17 20 12 34 43 50 39 67 6 6 7 3 2 11 1 1 1 47 15 Report of the Medical Officer of Health. In the next Table the number of deaths in Institutions outside the Borough is given in detail, but a complete list of these Institutions with the number of deaths that occurred in each during the year, is given in Table LXXIX. As the Borough is dealt with as one Sanitary District the deaths of persons belonging to other parishes in the Borough in Institutions such as the Fever Hospital, Tooting, are considered to be deaths in Internal Institutions with regard to the whole Borough, and are not included in the following Table. The same applies to deaths in the Hostel of God, Clapham, the Tooting Home, the Workhouse, the Tooting Bee Asylum, and the Royal Hospital for Incurables. 16 Report of the Medical Officer of Health, TABLE X. Deaths in Public Institutions, &c., outside the Borough of Persons belonging to the Borough, 1912. causes of death. Deaths in or belonging to whole District at subjoined ages. Deaths in or belonging to Localities (at all ages) Institutions, etc. All Ages. Males. Females. Under i year. 1 and under 2. 2 and under 5. |5 and under 15. 15 and under 25. 25 and under 45. | 45 and under 65. | 65 and upwards. Clapham. Putney. Streatham. Tooting. Wandsworth. Workhouse and Workhouse Infirmaries. General and Special Hospitals &c. Public Lunatic and Imbecile Asvlums. Metropolitan Asylums Board's Hospitals. Enteric Fever 7 4 3 ... ... 1 ... ... 3 3 ... 2 ... ... 1 4 ... 1 ! 5 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 4 3 1 ... 1 3 ... ... ... ... ... 1 ... ... ... 1 1 2 Scarlet Fever 2 2 ... ... 1 1 ... ... ... ... ... ... ... 1 1 ... ... 2 Whooping Cough 3 1 2 1 1 1 ... ... ... ... ... 1 ... 1 ... 1 1 ... 2 Diphtheria and Membranous Croup 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 Influenza 3 1 2 ... ... ... ... ... ... 1 2 2 ... 1 ... ... ... 2 1 5 Erysipelas 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Other Epidemic Diseases 2 ... 2 ... 1 ... ... ... 1 ... ... ... ... ... 1 1 1 ... 1 2 Pulmonary Tuberculosis 83 52 31 ... 1 ... 5 10 37 23 7 22 8 17 7 29 42 31 10 2 Tuberculous Meningitis 11 7 4 1 ... 4 6 ... ... ... ... 2 ... 3 2 4 4 7 ... ... Abdominal Tuberculosis 7 4 3 ... 2 ... 2 1 2 ... ... 2 ... 2 ... 3 1 5 ... 1 Other Tuberculous Diseases 13 6 7 2 ... 2 3 2 3 ... 1 4 1 4 ... 4 2 9 1 1 Other Infective Diseases 17 11 6 7 ... ... 3 1 3 3 ... 3 1 5 1 7 12 5 ... ... Cancer, Malignant Disease 107 60 47 1 ... ... 1 1 13 57 34 25 8 31 14 29 50 56 1 ... Rheumatic Fever 2 1 1 ... ... ... ... 2 ... ... ... 1 ... ... ... 1 1 1 ... ... Diabetes 5 4 1 ... ... ... ... ... ... 2 3 2 3 ... ... 2 3 ... ... Other General Diseases 15 7 8 1 ... 1 ... 2 3 6 2 3 2 4 2 4 5 10 ... ... Alcoholism 7 4 3 ... ... ... ... ... 2 4 1 1 ... ... 1 5 6 1 ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 7 5 2 3 ... ... 2 ... 1 1 ... 2 ... 2 1 2 1 5 1 ... Cerebral Haemorrhage, Apoplexy 27 15 12 ... ... ... ... ... 3 10 14 3 3 6 2 13 18 6 3 ... Convulsions 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... Other Diseases of Nervous System 64 43 21 ... ... 1 7 5 23 24 4 20 4 16 9 15 15 11 37 1 Organic Diseases ot Heart 75 44 31 ... ... ... 1 4 14 34 22 21 5 19 9 21 37 30 S ... Other diseases of Circulatory System 32 21 11 ... 1 ... 2 5 5 14 5 7 3 12 4 6 9 19 3 1 Bronchitis 47 24 23 8 1 1 ... 1 2 15 19 9 3 tt 4 23 40 5 2 ... Broncho-Pneumonia 20 7 13 7 6 4 ... ... 1 1 1 4 1 6 3 D 9 8 2 1 Lobar Pneumonia 11 6 5 ... 2 1 ... 2 3 2 1 2 1 2 2 4 3 3 5 ... Pneumonia (type not distinguished) 20 14 6 1 1 1 ... 1 9 7 ... 5 1 3 3 8 15 4 1 ... Other Diseases of Respiratory System 9 5 4 ... ... 1 1 ... ... 5 2 1 1 1 3 3 3 6 ... ... Ulcer of Stomach 12 6 6 ... ... ... ... 1 6 4 1 3 1 4 ... 4 1 9 2 ... Diarrhœa 3 1 2 2 1 ... ... ... ... ... ... ... 1 ... 2 ... ... 3 ... ... Enteritis 36 23 13 3o 4 ... 1 ... ... 1 ... 3 4 5 10 14 32 2 1 1 Appendicitis and Typhlitis 21 12 9 ... ... 1 6 4 4 4 2 3 3 6 4 5 4 17 ... ... Obstruction of Intestines 13 8 5 ... ... ... 1 ... 4 4 1 2 2 5 2 2 3 10 ... ... Cirrhosis of Liver 8 4 4 ... ... ... ... 1 1 5 1 1 ... 4 ... 3 4 4 ... ... Other Diseases of Liver 5 1 4 ... ... ... ... ... 2 3 ... ... ... 2 ... 3 2 3 ... ... Other Diseases of Digestive System 13 6 7 ... ... 1 1 ... 5 5 1 2 ... 6 1 4 1 12 ... ... Nephritis and Bright s Disease 26 19 7 ... ... ... ... 1 2 10 7 3 1 9 2 11 16 7 3 ... Other Diseases of Urinary System 14 13 1 ... ... ... ... ... ... 5 9 3 2 2 1 6 6 8 ... ... Diseases of Generative System 3 ... 3 ... ... ... ... 1 1 1 ... 2 ... 1 ... ... 1 2 ... ... Puerperal Fever 8 ... 8 ... ... ... ... ... 8 ... ... 1 ... 2 3 2 3 4 ... 1 Other Accidents and Diseases of Pregnancy and Childbirth 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... Premature Birth i5 7 8 15 ... ... ... ... ... ... ... 1 4 2 2 6 5 10 ... ... Congenital Debility and Malformation 25 12 13 22 1 1 ... ... 1 ... ... ... 1 7 4 13 11 11 ... 3 Other Diseases of Early Infancy 3 2 1 3 ... ... ... ... ... ... ... 2 ... ... ... 1 ... 3 ... ... Old Age 62 32 30 ... ... ... ... ... ... 1 61 13 5 8 7 29 56 2 4 ... Deaths from Accident 47 39 8 ... ... 3 5 12 17 8 2 8 2 14 7 l6 6 41 ... ... Deaths by Suicide 13 9 4 ... ... ... ... 1 3 8 1 2 3 4 1 3 2 11 ... ... Other Violent Deaths 1 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... Other defined Diseases 7 4 3 ... 2 1 1 ... ... 2 1 2 ... 2 1 2 2 4 1 ... Ill-definedDiseases or unknown 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 1 ... All causes 940 551 389 107 25 29 50 60 183 280 206 196 71 230 118 325 437 393 89 21 17 Report of the Medical Officer of Health. The total number of deaths in out-lying Institutions was 940, 551 of males and 389 of females, compared with 989 in 1911, 812 in 1910, and 897 in 1909. 437 of these deaths occurred in Workhouses and Workhouse Infirmaries, compared with 405 in 1911; 393 in General and Special Hospitals, compared with 454 in 1911; 89 in Public Lunatic or Imbecile Asylums, compared with 77 in 1911; and 21 in the Metropolitan Asylums Board's Hospitals, compared with 53 in 1911. Of the 482 deaths in General and Special Hospitals, 63 occurred in St. Thomas's Hospital, 33 in Bolingbroke Hospital, six in Belgrave Hospital, 13 in Victoria Hospital, 11 in St. George's Hospital, 16 in Westminster Hospital, eight in King's College Hospital, 15 in Guy's Hospital, 16 in Long Grove Asylum, 19 in Horton Asylum, 11 in Banstead Asylum, eight in Caterham Asylum, seven in Manor Asylum, eight in Charing Cross Hospital, nine in Cane Hill Asylum, 11 in Middlesex Hospital, six in St.. Bartholomew's Hospital, and 11 in Evelina Hospital. In the South-Western Hospital of the Metropolitan Asylums Board, there were 10 deaths; one from Puerperal Fever, five from Enteric Fever, one from Measles, and three from other causes. In the Western Hospital there were two deaths; one from Whooping Cough and one from Measles; in the Park Hospital six deaths, all from other causes; and in the Southern Hospital three, two from Scarlet Fever and one from Whooping Cough. The number of deaths in these and other Institutions outside the Borough is shown on Table LXXIX. The corrected number of deaths, after adding the deaths of persons belonging to the Borough, and subtracting those of persons dying in the Borough and not belonging thereto, was 3,291, 1,691 of males, and 1,600 of females, a decrease of 485 compared with 1911, and of 712 compared with the corrected decennial average. The corrected death-rate for the year was 10.48, compared with 12.25 in 1911. 10.34 in 1910, 12.11 in 1909, and 12.43 the rate for the 10 years 1902-1911. 18 Report of the Medical Officer of Health. Table XI. shows the total number of deaths and the deathrates for each sub-district and for the whole Borough, corrected and uncorrected for deaths in Public Institutions. The death-rate for the whole of London for the year was 13.96 per 1,000, compared with 15.8 in 1911, 13.65 in 1910, 14.94 in 1909, 14.87 in 1908, and 15.43 the decennial average. 19 Report of the Medical Officer of Health. TABLE XL Sub-Districts. Corrected Deaths. Uncorrected Deaths. Corrected Death-rate. Uncorrected Death-rate. Males. Females. Total. Males. Females. Total. Clapham 351 348 699 252 305 557 11.64 9.31 Putney 135 146 281 112 114 226 9.83 7.91 Streatham 458 465 923 346 376 722 9.42 7.33 Tooting 197 167 364 421 406 827 10.20 21.93 Wandsworth 550 474 1,024 392 394 786 11.18 8.32 Whole Borough 1,691 1,600 3.291 1,523 1,595 3,118 10.48 9.77 20 Report of the Medical Officer of Health. The death rate in England and Wales in 1912 was 13-3 per 1,000, compared with I4.6 in 1911, 13.4 in 1910, and 14.5 in 1909 ; in the 95 Great Towns 13.8, compared with 16.4 in 1911, 14.3 in 1910, and 14.7 in 1909; and in the 146 Smaller Towns 12.4, compared with 14.4, 12.9, and 13.9. If a comparison is to be made with other places it is necessary to again correct the corrected rate, viz. :—10.4, for age and sex distribution. This is done by multiplying the rate by a factor obtained by dividing the standard death-rate in England and Wales at the Census of 1901, with the standard death-rate for the Borough at the same period, the standard death-rate at the Census 1911, not yet being available. This factor has been ascertained to be 1.0547, which gives a rate for this Borough for the year 1912 of 11.03 per 1,000, compared with 12.92 in 1911, 10.90 in 1910, and 12.77 in 1909. The following Table shows the standard death-rate, the factor for correction, the crude death-rate, the corrected death-rate, and the comparative mortality figure for London and for the 29 Boroughs, including the City of London, for the year 1912. The figures are extracted from the quarterly returns of the Registrar General for the year, and are completely corrected as between individual Metropolitan Boroughs. The rate in Wandsworth is also corrected for the whole of England and Wales. The Table is, this year, therefore, only approximately correct, but gives a fairly exact estimate of the rates for the year. 21 Report of the Medical Officer of Health. 21 TABLE XII. AREA. Standard Death-rate. Factor for Correction. Crude Death-rate. Corrected Death-rate. Comparative Mortality Figure. (London, 1,000.) England and Wales 18.19 1.0000 ... ... ... London 17.31 1. 0511 13.96 14.67 1,000 Levvisham 17.46 1.0420 10.37 10.80 736 WANDSWORTH 17.25 1.0547 10.48 11.03 751 Hampstead 16.13 1.1280 9.81 11.06 753 Woolwich 17.02 1.0690 11.57 12.36 842 Stoke Nevvington 17.43 1.0438 12.05 12.57 856 Hackney 17.46 1.0420 12.06 12.56 856 Battersea 16.96 1.0728 12.18 13.06 890 Paddington 17.04 1.0677 12.29 13.12 894 CamberWell 17.54 1.0373 12.84 I3.31 907 Greenwich 17.82 1.0210 13.09 13.36 910 Fulham 17.39 1.0462 12.83 13.42 914 Hammersmith 17.47 1.0414 13.07 13.61 927 Lambeth 17.63 1.0320 13.27 13.69 933 Deptford 17.31 1.0511 13.06 13.72 935 Westminster 16.22 1.1217 12.36 13.86 944 Kensington 16.88 1.0778 12.96 13.96 951 St. Marylebone 17.08 1.0652 13.76 14.65 998 City of London I6.55 1.0993 13.42 14.75 1,005 Islington 17.51 1.0391 14.28 14.83 1,011 Chelsea 17.56 1.0361 14.51 15.03 1,025 St. Pancras 17.40 1.0456 14.57 15.23 1,038 Bethnal Green 18.01 1.0102 15.27 15.42 1,051 Bermondsey 17.76 1.0244 16.74 17.14 1,069 Stepney 17.41 1.0450 15.18 15.86 1,081 Holborn 16.90 1.0766 18.48 16.65 1,134 Poplar 17.64 1.0314 16.18 16.68 1,137 Southwark 17.41 1.0450 16.64 17.38 1,184 Shoreditch 17.34 1.0493 18.07 18.96 1,292 Finsbury 17.57 1.0355 18.68 19.34 1,318 22 Report of the Medical Officer of Health. In the separate sub-districts of the Borough the corrected death-rate was 9.42 in Streatham, 9.83 in Putney, 10.20 in Tooting, 11.18 in Wandsworth, and 11.64 in Clapham. The rates in all the sub-districts were much lower than in 1911, due to causes which will be commented on in another part of this Report. Table XIII. shows the death-rate in the Borough, in the five sub-districts, and in England and Wales for the year, as well as the rates for the previous 10 years, compared with the decennial average. During the previous decennium the lowest mortality in the Borough as well as in London and England and Wales, was in the year 1910. The rate in 1912, although higher than in 1910, is in all the sub-districts lower than the rate in 1911, and also considerably lower than the average of the previous 10 years. Compared with London and with England and Wales the Borough rate is considerably lower. In the sub-districts the rates for 1912 in Putney, Streatham and Tooting are the lowest ever recorded. 23 Report of the Medical Officer of Health. TABLE XIII. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. London. England and Wales. 1902 14.66 15.09 12.04 14.24 15.03 13.96 17.66 16.25 1903 12.87 11.91 11.26 12.88 13.81 I2.54 I5.38 15.10 1904 14.54 12.75 11.25 16.28 14.75 13.56 16.44 I6.34 1905 12.60 11.75 10.89 16.56 14.28 12.8l 15.54 15.28 1906 13.70 11.99 10.86 15.90 14.18 12. 98 15.71 15.46 1907 12.62 11.66 10.76 15.49 13.44 12.09 15.29 15.10 1908 12.75 11.41 10.43 13.62 12.72 11.97 14.87 14.83 1909 13.25 11.80 10.48 13.51 12.71 12.11 14.94 14.61 1910 10.73 10.17 9.50 10.67 11.04 10.38 13.65 13.49 1911 13.15 11.88 11.02 11.73 13.29 12.25 15.8 14.6 Average, 1902-1911 13.08 12.04 10.84 13.91 13.52 12.46 15.52 15.10 1912 11.64 9.83 9.42 10.20 10.48 10.48 13.96 13.3 24 Report of the Medical Officer of Health. The first Chart shows the death-rate in the Borough for each fortnight, compared wiih the quinquennial average 1907-1911. The Chart shows that only on four fortnights the rate was above that for the previous quinquennium, viz. :—on the fortnights ending the 10th February, 22nd June, 20th July, and 12th October. During the rest of the year the fortnightly rate was under the quinquennial rates. The highest rate, 14*58, occurred during the fortnight ending the 10th February, and this was due to the great number of deaths from Respiratory diseases ; and the lowest rate during the fortnight ending the 31st August, when it was 7^25 per 1,000. The next Chart shows the Annual Death-rate pei 1,000 during each week of the year for the whole of London and for each fortnight for the Borough of Wandsworth. During the year the rate in each fortnight in this Borough was under the rate for the whole of London. The highest rate in London was in the first week of February, and the lowest in the last week of August. Table XIV. shows the vital statistics of the whole Borough for the year and for the previous 10 years, as well as the average for the 10 years. This Table shows clearly the variations in the births and deaths, the birth and death-rates, and the infantile mortality for the decennium, compared with the year 1912. Compared with the decennial average there has been a considerable decrease in the birth-rate, and a marked decrease in the death-rate, while the infantile mortality also shows a most satisfactory decrease, and is the lowest rate yet recorded. It will also be seen that there has been an increase of 197 deaths of residents outside the Borough, compared with the 10 years' average. The corrected death-rate, although higher than it was in 1910 is much under last year and also under the 10 years' average. to Oi Report of the Medical Officer of Health. TABLE XIV. Vital Statistics of whole District during 1912 and previous years. Years. Corrected population estimated to Middle of each Year. Births. Total Deaths Registered in the District. total Deaths in Institutions in the District. Deaths of Nonresidents registered in the District. Deaths of Residents registered beyond the District. Nett Deaths belonging to the District. Under i Year of age. At all ages. Number. Rate. At all ages. Number. Rate per 1,000 Births registered. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 xi 12 13 1902 238,351 6,440 27.01 3,209 13.28 565 463 582 808 126 3,328 13.96 1903 245,030 6,722 27.63 3,007 12.09 602 472 538 743 110 3,073 12.54 1904 251,946 6,927 27.45 3,296 12.87 669 553 674 857 123 3,417 13.56 1905 259,113 6,892 26.59 3,241 12.30 729 610 689 818 118 3,320 12.81 1906 266,540 7,057 26.47 3,341 12.31 771 611 731 874 124 3,461 12.98 1907 274,242 7,036 25.65 3,337 11.94 807 660 739 715 101 3.416 12.09 1908 282,252 7,331 25.54 3,230 11.24 818 633 783 720 98 3.38o 11.97 1909 290,462 6,985 24.04 3.279 11.08 837 656 897 601 86 3,520 12.11 1910 299,061 6,967 23.29 2,856 9.38 723 564 812 545 78 3,105 10.38 1911 308,156 6,699 21.73 3,456 11.02 850 669 989 823 122 3,776 12.25 Averages for years 1902—1911 271,515 6,905 25.48 3,245 11.75 737 589 743 75o 108 3,379 12.43 1912 313,761 6,756 21.53 3.118 9.78 958 767 940 516 76 3,291 10.48 26 Report of the Medical Officer oj Health. TABLE XV. Causes of, and Ages at Death, during the year 1912. Deaths in or belonging to whole District at subjoined ages. Deaths in or belonging to Localities (at all ages). Deaths in Public Institutions in the District. CAUSES OF DEATH. All Ages. Males. Females. Under i year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. j Clapham. Putney. j Streatham. Tooting. Wandsworth. Enteric Fever 8 ... 4 ... ... 1 ... 1 5 1 ... 2 ... ... 1 5 1 Small pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 51 20 31 7 20 19 5 ... ... ... ... 19 2 4 3 23 25 Scarlet Fever 11 4 7 ... 1 3 7 ... ... ... ... 1 ... 6 1 3 17 Whooping Cough 57 27 30 29 17 11 ... ... ... ... ... 12 3 12 11 19 26 Diphtheria, and Membranous Croup 18 10 8 ... 3 7 6 ... 1 ... 1 3 3 1 5 6 34 Influenza 45 22 23 2 1 1 ... 4 3 15 19 11 4 ... 2 14 4 Erysipelas 5 3 2 ... ... ... ... ... 1 1 3 1 ... ... ... 4 1 Cerebro-spinal Fever 1 ... 1 ... ... 1 ... ... ... ... ... ... ... .... ... 1 ... Other Epidemic Diseases 2 ... 2 ... 1 ... ... ... 1 ... ... ... ... ... 1 1 ... Pulmonary Tuberculosis 303 181 122 1 2 ... 13 44 136 87 20 70 28 71 31 103 153 Tuberculous Meningitis 28 18 10 3 4 7 12 ... ... 2 ... 5 1 11 3 8 1 Abdominal Tuberculosis 12 8 4 1 2 1 3 1 3 1 ... 2 1 3 1 5 2 Other Tuberculous Diseases 23 13 10 3 ... 2 6 4 6 1 1 4 2 8 4 5 6 Other Infective Diseases 25 16 9 11 ... ... 5 1 4 3 1 5 2 10 1 7 2 Cancer,Malignant Disease 338 152 186 1 ... ... 1 2 32 165 137 85 27 102 31 93 60 Rheumatic Fever 16 9 7 ... ... ... 6 4 3 1 2 4 5 4 1 2 1 Diabetes 39 17 22 ... ... ... 1 1 9 17 11 7 4 17 3 8 7 Other General Diseases 38 17 21 4 1 2 2 2 5 11 11 9 5 11 3 10 6 Alcoholism 13 8 5 ... ... ... ... ... 5 7 1 3 ... 2 1 7 2 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 21 12 9 8 3 3 3 1 2 1 ... 6 2 4 6 3 1 Cerebral Haemorrhage: Apoplexy 154 84 70 ... 1 1 ... ... 7 48 97 30 15 50 12 47 26 Convulsions 27 13 14 21 3 1 2 ... ... ... ... 7 ... 8 5 7 1 Other Diseases of Nervous System 124 69 55 1 1 3 11 7 33 36 32 34 9 35 13 33 90 Organic Diseases of Heart 270 129 141 1 ... ... 7 11 35 95 121 73 20 82 22 73 39 Other Diseases of Circulatory System 87 46 41 ... 1 1 5 8 8 26 38 18 13 29 8 19 11 Bronchitis 274 124 150 46 5 2 2 1 9 66 143 56 23 70 31 94 24 Broncho-Pneumonia 85 42 43 36 21 8 3 1 1 4 11 17 9 17 12 30 15 Lobar Pneumonia 27 18 9 ... 3 2 1 2 8 7 4 8 2 6 2 9 ... Pneumonia (type not distinguished) 115 68 47 18 11 6 ... 3 28 32 17 23 10 30 9 43 19 Other Diseases of Respiratory System 29 18 11 1 ... 2 1 ... 3 14 8 5 2 7 6 9 5 Ulcer of Stomach 21 8 13 ... ... ... ... 1 11 7 2 5 1 7 1 7 2 Diarrhoea 27 11 16 18 3 1 ... ... 2 1 2 3 1 4 10 9 2 Enteritis 58 35 23 42 7 ... 1 ... 1 6 1 6 6 11 15 20 2 Appendicitis and Typhlitis 29 13 16 ... ... 1 7 6 6 6 3 4 5 8 4 8 6 Obstruction of Intestines 28 12 16 3 ... 2 2 ... 4 6 11 4 5 9 2 8 5 Cirrhosis of Liver 39 23 16 ... ... ... ... 1 2 22 14 5 2 22 2 8 2 Other Diseases of Liver 12 4 8 ... ... ... ... ... 2 4 16 ... 1 5 1 5 2 Other Diseases of Digestive System 45 22 23 10 ... 1 2 ... 9 13 10 4 5 21 2 13 8 Nephritis and Bright's Disease 109 72 37 2 ... ... 2 1 8 40 48 16 14 40 10 29 14 Other Diseases of Urinary System 25 22 3 1 ... ... ... ... ... 6 18 3 3 7 1 11 6 Diseases of Generative System 9 ... 9 ... ... ... ... 1 1 5 2 4 ... 2 ... 3 1 Puerperal Fever 11 ... 11 ... ... ... ... ... 11 ... ... 1 2 2 4 2 1 Other Accidents and Diseases of Pregnancy and Childbirth 15 ... 15 ... ... ... ... 3 12 ... ... 3 2 3 2 5 2 Premature Birth 127 68 59 127 ... ... ... ... ... ... ... 30 10 30 19 38 3 Congenital Debility and Malformation 93 48 45 88 1 2 1 ... 1 ... ... 12 2 22 21 36 2 Other Diseases of Early Infancy 20 14 6 20 ... ... ... ... ... ... ... 6 ... 6 ... 8 2 Old Age 236 94 142 ... ... ... ... ... ... 1 235 41 19 72 24 80 285 Deaths from Accident 68 50 18 2 ... ... 9 12 16 13 IO 13 4 22 4 25 11 Deaths from Suicide 43 28 15 ... ... ... ... 4 12 21 6 11 5 7 10 10 15 Other Violent Deaths 5 2 3 2 ... ... ... 1 ... 2 ... ... 1 3 ... 1 3 Other defined Diseases 17 8 9 3 2 1 1 ... ... 4 6 6 ... 5 2 4 3 Ill-defined Diseases or unknown 8 5 3 4 1 ... ... ... ... 1 2 2 1 1 1 3 2 All causes 3291 1691 1600 516 115 98 127 128 446 807 1054 699 281 923 364 102 958 2 7 Report of the Medical Officer of Health. Table XV. is the general mortality Table for the whole district, corrected for internal and external Institutions, and also includes all deaths occurring in other places in London, and in England and Wales for the year. Compared with 1911 there has been a very large decrease in the number of deaths from Measles, Diarrhoea, and Enteritis, and this decrease is the chief cause of the low death-rate for the year. From Pulmonary Tuberculosis and Cancer there has been a slight increase, and this is also the case as regards Old Age and Bronchitis. The deaths from Suicide have increased from 21 in 1911 to 43 in 1912, or more than double, an increase which is difficult to account for. The four Tables which follow are inserted by request of the Local Government Board. Table I. is arranged to show the gross births and deaths in the district, and the births and deaths belonging to it with the corresponding rates. The rates in column 7 are calculated 011 the gross population and the rates in five and 13 on the nett population, i.e., the population obtained by deducting from the estimated gross population the average number of inmates not belonging to the district in Public Institutions. The population given in column two of this Table is the population after the above correction has been made. Table II. shows the number of cases of Infectious Diseases notified during the year at all ages and at certain age periods in the Borough and in the separate sub-districts, ?nd also shows the number of cases removed to hospital from the whole Borough. Table III. is the general mortality Table for the whole Borough, showing the number of deaths at all ages, and at certain ages, arranged as to cause of death. It also shows the number of deaths in Public Institutions and other places in the district, both of residents and non-residents. Table IV. shows in detail the deaths of infants under one year of age from certain diseases, arranged in weekly age periods, the first four weeks, from one to three months, and for three monthly periods up to one year. 28 Report of the Medical Officer of Health. TABLE XVI. Wandsworth District. Vital Statistics of Whole District during 1912 and previous years. (Table I.) Births. Total Deaths Registered in the District. Transferable Deaths : Nett Deaths Belonging to the District. Year. Population estimated to Middle of each Year. Uncorrected Number. Nctt. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate per 1000 Nett Births. Number. Rate. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 S 0 10 if 12 13 1907 274,242 7.°3<5 7.036 25'65 3>337 1194 660 739 715 IOI 3.416 12 09 1908 282,262 7.321 7.331 25-54 3.230 11-24 633 783 720 98 3.380 ii*97 1909 290,452 6,924 6,985 24-04 3,279 11 08 656 897 601 86 3.520 1211 1910 299,061 6,873 6,967 23-21 2,856 938 564 Si 2 545 78 3.io5 1034 1911 308,156 6,555 6,699 21-73 3.-156 11 02 669 989 823 122 3.776 1225 1912 313.761 6,580 6,756 2153 3."8 977 767 940 516 76 3.291 10*48 Area of District in acres (exclusive of j , 1 area covcred by water) j 5 Total population at all ages ... ... 311,4021 Number o£ inhabited houses ... ... 48,432 lAt Census of 1911 Average number of persons per house ... 6-42) 20 Report of the Medical Officer of Health. TABLE XVII. Wandsworth District. Cases of Infectious Disease notified during the year 1912. (Table II.) No. of Cases Notified. Total Cases Notified in each Locality. (e.g. Parish or Ward) of the District Total cases removed to hospital. Notifiable Disease. At all Ages. At Ages—Years. Clapham. Putney. Streatham. Tooting. Wandsworth. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 431 5 113 243 37 26 7 ... 78 82 95 48 128 335 Erysipelas 207 5 6 21 13 66 62 34 45 8 47 30 77 ... Scarlet Fever 833 2 200 530 64 32 5 ... 135 41 228 207 222 725 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 71 ... 4 15 17 29 6 ... 16 8 18 8 21 54 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever 2 ... ... 2 ... ... ... ... ... 2 ... ... ... ... Puerperal Fever 27 ... ... ... 4 23 ... ... 1 4 6 6 10 ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis Under Tuberculosis Regulations, 1908 229 ... ... 24 24 87 70 24 42 9 33 46 99 ... Under Tuberculosis Regulations, 1911 439 2 ... 43 70 215 89 17 79 34 '45 55 126 ... Under (Tuberculosis in Hospitals) Regulations, 1911 187 ... 2 20 44 106 14 1 51 15 50 23 48 ... Cerebro-spinal meningitis 3 1 2 ... ... ... ... ... ... ... ... 2 1 1 Polio Myelitis 5 ... 3 1 1 ... ... ... 1 ... ... ... 3 Ophthalmia Neonatorum 35 35 ... ... ... ... ... ... 9 1 7 4 14 ... Totals 2,469 50 333 899 274 584 253 76 457 204 630 429 749 1,118 30 Report of the Medical Officer of Health. TABLE XVIII. Wandsworth district. Causes of, and Ages at Death during the Year 1912. (Table III.) Causes of Death. Nett Deaths at the subjoined ages of " Residents " whether occurring within or without the district. Total Deaths whether of 44 Residents" or 44 non-resincnts in Institutions in the District. All ages. Under 1 year i & under 2 years. 2 & underi 5 years. 1 5 & under 15 years. 15 & under 25 years. 25 & under 45 years. 45 & under 65 years. 65 and upwards t 2 3 4 5 6 7 8 9 10 II All causes Certified 3,281 513 115 98 127 126 444 807 1,051 958 Uncertified 10 3 ... ... ... 2 2 ... 3 ... Enteric Fever 8 ... ... 1 ... 1 5 1 ... I Small-pox ... ... ... ... ... ... ... ... ... ... Measles 51 7 20 19 5 ... ... ... ... 25 Scarlet Fever 11 ... 1 3 7 ... ... ... ... 17 Whooping Cough 57 29 17 11 ... ... ... ... ... 26 Diphtheria and Croup 18 ... 3 7 6 ... 1 ... 1 34 Influenza 45 2 1 1 ... 4 3 15 19 1 Erysipelas 5 ... ... ... ... ... 1 1 3 1 Phthisis (Pulmonary Tuberculosis) 303 1 2 ... 13 44 136 87 20 153 Tuberculous Meningitis 28 3 4 7 12 ... ... 2 ... 1 Other Tuberculous Diseases 35 4 2 3 9 5 9 2 1 8 Cancer, malignant disease 338 1 ... ... 1 2 32 165 137 60 Rheumatic Fever 16 ... ... ... 6 4 3 1 2 1 Meningitis 22 8 3 4 3 1 2 1 ... 1 Organic Heart Disease 270 1 ... ... 7 11 35 95 121 35 Bronchitis 274 46 5 2 2 1 9 66 143 24 Pneumonia (all forms) 227 54 35 l6 4 6 37 43 32 34 Other diseases of Respiratory organs 29 1 ... 2 1 ... 3 14 8 5 Diarrhcea and Enteritis 85 60 10 I 1 ... 3 7 3 4 Appendicitis and Typhlitis 29 ... ... 1 7 6 6 6 3 6 Cirrhosis of Liver 39 ... ... ... ... 1 2 22 14 2 Alcoholism 13 ... ... ... ... ... 5 7 1 2 Nephritis and Bright's Disease 109 2 ... ... 2 1 8 48 48 14 Puerperal Fever 11 ... ... ... ... ... 11 ... ... 1 Other accidents and diseases of Pregnancy and Parturition 15 ... ... ... ... 3 12 ... ... 2 Congenital Debility and Malformation, including Premature Birth 220 215 1 2 1 ... 1 ... ... 5 Violent Deaths, excluding Suicide 73 4 ... 6 9 13 16 15 10 14 Suicides 43 ... ... ... ... 4 12 21 6 15 Other Defined Diseases 909 74 10 12 31 21 94 187 480 461 Diseases ill-defined or unknown 8 4 1 ... ... ... ... 1 2 2 3,291 516 115 98 127 128 446 807 1,o54 958 Sub Entries included in above figures. Cerebro-spinal Meningitis 1 ... ... 1 ... ... ... ... ... ... Poliomyelitis ... ... 1 ... ... ... ... ... ... ... Tetanus 3 ... ... ... 3 ... ... ... ... 1 31 Report of the Medical Officer of Health. TABLE XIX. (Tabi.e IV.) Borough of Wandsworth. Iiifani Mortality. 1912. Nett Deaths from stated causes at various Ages under 1 Year of Age. Cause of Death. Under 1 Week. 1... 2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months 3 Months and undei" 6 Months 6 Months and 'under 9 Months i 9 Months and under 12 Months. Total Deaths under 1 year. All Causes- Certified 145 29 28 26 228 106 79 50 5o 513 Uncertified 3 ... ... ... 3 ... ... ... ... 3 Sinall-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 2 5 7 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... 1 1 6 7 5 10 29 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 2 1 3 Abdominal Tuberculosis ... ... 1 ... 1 ... ... ... ... 1 Other Tuberculous Diseases ... ... ... ... ... 1 ... 1 2 4 Meningitis (not Tuberculous) 1 1 ... ... 2 2 2 2 ... 8 Convulsions 5 4 3 1 13 4 2 ... 2 21 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis 1 ... 4 4 9 13 10 11 3 46 Pneumonia (all forms) ... 1 3 3 7 12 10 10 15 34 Diarrhoea ... ... 1 ... 1 6 6 4 1 18 Enteritis ... 2 ... 1 3 14 14 4 7 42 Gastritis ... ... ... ... ... 4 3 1 1 9 Syphilis ... ... ... 2 2 4 5 ... ... 11 Rickets ... ... ... ... ... ... ... 1 1 2 Suffocation, overlying ... ... ... ... ... 2 ... ... ... 2 Injury at birth 4 ... ... ... 4 ... ... ... ... 4 Atelectasis 14 ... ... ... 14 ... ... ... ... 14 Congenital Malformations 13 4 1 ... 18 ... ... 1 ... 19 Premature birth 93 8 7 7 115 8 4 ... ... 127 Atrophy, Debility & Marasmus- 11 7 6 5 29 25 11 4 1 70 Other Causes 6 2 2 2 12 5 5 2 1 25 148 29 28 26 231 106 79 50 50 516 Nett Births in the year, legitimate, 6,533; illegitimate, 223. Nett Deaths in the year of legitimate intants, 481; illegitimate infants, 35. 32 Report of the Medical Officer of Health. Ages at Death. The following Table shows the percentage of deaths to total deaths at six age periods for each sub-district and for the whole Borough. TABLE XX. Sub-Districts. Under 1 year. 1 to 5 years, 5 15 years. 15 to 25 years. 25 to 65 years. 65 years and upwards Clapham 13.30 6.72 2.43 4.01 41.06 32.48 Putney 12.10 4.27 1.78 5.00 39.14 34.87 Streatham 11.70 4.43 4.43 3.79 36.74 38.79 Tooting 26.65 7.69 4.12 4.40 37.91 19.23 Wandsworth 17.97 7.81 3.81 4.00 37.01 29.40 Whole Borough 15.68 6.47 3.86 3.88 38.07 32.04 Compared with 1911 the percentage of deaths under one year was 6'i2 lower ; from one to five years 4.38 lower ; from five to 15 years 14 lower; from 15 to 25 years 20 higher; from 25 to 65 years 770 higher; and from 65 years and upwards 372 higher. There was a considerable diversity in these rates in the different sub-districts. In Streatham the rate under one year was only 1170, while in Tooting it was 26.65, while over 65 years of age Tooting had a rate of 19.23 and Streatham of 38.79. At one to five years the rate was lowest in Putney and highest in Wandsworth, from five to fifteen years lowest in Putney and highest in Streatham, at 15 to 25 years lowest in Streatham and highest in Putney, at 25 to 65 years lowest in Streatham and highest in Clapham, and at 65 years and upwards lowest in Tooting and highest in Streatham. 33 Report of the Medical Officer of Health. These differences are due to the differences in the age constitution of the population in the separate sub-districts, as well as the difference in social conditions. The decrease in the percentage of deaths under one year and from one to five years was due to the great decrease in the number of deaths from Measles, Diarrhoea and Enteritis. Infantile Mortality. The total number of deaths of infants under one year was 516, compared with 823 in 1911, 545 in 1910, and 601 in 1909, and is 350 under the decennial average corrected for increase of population. Of these, 93 occurred in Clapham, 34 in Putney, 108 in Streatham, 97 in Tooting, and 184 in Wandsworth. The infantile mortality, or deaths under one year to 1,000 births, was 76 compared with 122 in 1911, 78 in 1910, and 86 in 1909, and is the lowest rate ever recorded. This rate was 76 in Clapham, compared with 103 the decennial average; 69 in Putney, compared with 114; 58 in Streatham, compared with 94; 100 in Tooting, compared with 129; and 83 in Wandsworth, compared with 113. In the whole Borough the rate was 60 per 1,000 births under that for 1911, and 46 under the decennial average. In all the sub-districts, there has been a marked decrease in this rate compared with the decennial average, this decrease having been greatest in Putney and Wandsworth. In Tooting the rate was higher than in any of the other sub-districts, but was 16 per 1,000 under the rate for that sub-district for 1911, and 29 under the decennial average. 34 Report of the Medical Officer of Health. The following Table shows the number of deaths, the percentage to total deaths, the rate per 1,000 births for the year and for the three previous years for each sub-district and for the whole Borough. TABLE XXI. Sub-District. No. of Deaths under one year. Percentage to total Deaths. Rate per 1,000 Births. 1909 1910 1911 1912 Clapham 93 13.30 83 67 119 76 Putney 34 12.10 86 81 145 69 Streatham. 108 I I.70 73 64 99 58 Tooting 97 2665 98 92 116 100 Wandsworth 184 17.97 89 89 143 83 Whole Borough 516 1568 86 78 122 76 35 Report of the Medical Officer of Health. Table XXII. shows this mortality for the 10 years 1902-1911 in each of the sub-districts and in the whole Borough, and the decennial average, compared with the present year. TABLE XXII. Clapham. Putney. Streatham. Tooting. Wandsworth Borough. 1902 125 128 110 126 136 126 1903 107 127 I08 124 101 110 1904 123 137 105 172 118 123 1905 113 109 99 148 128 118 1906 111 128 113 146 131 125 1907 90 109 88 148 97 101 1908 98 97 81 122 101 98 1909 83 86 73 98 89 86 1910 67 81 64 92 89 78 1911 119 145 99 1 l6 143 122 Average 103 114 94 129 113 108 1912 76 69 58 100 83 76 In Table IV. of the Local Government Board's Tables these deaths are shown for the whole Borough at certain groups of ages, and the Tables for the separate sub-districts are included in the Appendix. The total number of births was 6,756, of which 6,533 were legitimate and 223 illegitimate, and of deaths 516, of which 35 were illegitimate. From the notifiable infective diseases no death occurred during the year. 36 Report of the Medical Officer of Health. From Measles there were seven deaths, a considerable decrease compared with previous years. From Whooping Cough there were 57 deaths, from Diarrhoeal diseases 60, from Premature Birth 127, from other diseases of infancy 107, from Tuberculous diseases eight, from diseases of the Respiratory Organs 100, from Convulsions 21, from Syphilis 11, from Suffocation (overlying) two, and from other causes 44, Compared with 1911 there has been a decrease in the number of deaths from Diarrhcea, Measles, diseases of the Respiratory Organs and Tuberculous diseases, and an increase in the number from Premature Birth. In all the deaths, with three exceptions, one in Clapham and two in Streatham, the cause of death was certified by a medical man, or by a coroner after inquest. 44.7 of the deaths occurred in the first month, compared with 29.5 in 1911, and 40.9 in 1910; 65.3 in the first three months, compared with 43.7 and 59.4; and 80.6 in the first six months, compared with 65.9 and 74.5. The Table shows that 127 died from Premature Birth, of which 115 occurred under one month, and 103 from Congenital Debility and Malformations, compared with 146 in i9ii,and no in 1910. Of the total deaths under one month, viz.:—231, 115 occurred from Premature Birth and 61 from Congenital Debility and Malformations, a percentage of 76 2 compared with 744 per cent, in 1911. From Diarrhceal diseases only four deaths occurred under one month. The greatest mortality from these diseases occurred at four weeks to three months and three to six months. From Tuberculous diseases eight deaths occurred ; three from Tuberculous Meningitis, one from Tuberculous Peritonitis, and Report of the Medical Officer of Health. 37 four from other Tuberculous diseases, compared with 23 in 1911; and 100 from diseases of the Respiratory Organs, compared with 118. Eight deaths were registered as due to Meningitis, but enquiries of the medical attendant showed that all these were due to simple Meningitis. Table XXIII. shows the proportion of deaths per 1,000 births from five groups of diseases for each week under one month, from one to three months and for each three months up to one year of age. Compared with 1911 the rate from common infective diseases is much lower, due to the decrease in the number of deaths from Measles and Diphtheria. From Diarrhceal diseases there was a very large decrease, the rate having been about one-fourth of the rate in 1911. From Premature Birth, Congenital Debility and Malformations the rate was only slightly lower than in 1911, and this was also the case from Tuberculous diseases and from other causes. From the Table it will be seen that the rate from common infective diseases was highest at the ages nine to 12 months, from Diarrhoeal diseases at one to three, and three to six months, from Premature Birth, etc., under one month, from Tuberculous diseases at six to nine and nine to 12 months, and from other causes under one month. 38 Report of the Medical Officer of Health. TABLE XXIII. Causes of Death. Under I Week. i—2 Weeks. 2—3 Weeks. 3—4 Weeks. Under 1 Month. I—3 Months. 3—6 Months. 6—9 Months. 9—12 Months. Total under 1 year. I. Common Infective Diseases •15 «5 •8S 104 1-04 2-22 S'33 II. Diarrhoeal Diseases •29 •'5 ''5 •59 296 2 96 118 Il8 8-88 III. Premature Birth, Congenital Debility and Malformations ... '939 2'8l 2-07 177 26-04 4-88 222 ■74 •15 34'°4 IV. Tuberculous Diseases •15 15 15 •44 '44 118 V. Other causes 251 129 177 1'77 7-24 681 5-48 4-08 3'49 2687 All causes 21-90 4-29 4-14 3'S4 34'I8 1568 II70 748 7-48 76-30 39 Report of the Medical Officer of Health. The following Table shows the percentage of deaths at different age periods to total infantile mortality for the year and for the five previous years. It will be noted that there has been an increase in this percentage under four weeks compared with the five years' average, and also at four to 13 weeks, while at the other age periods there has been a decrease. TABLE XXIV. 1907. 1908. 1909. 1910. 1911. Five years' average. 1912. Rate per 1,000 births 101 98 86 78 122 97 76 Percentage of above :— Under one week 195 199 224 271 163 210 287 1 and under 2 weeks 6.2 5.0 6.5 5.7 3.5 5.4 5.6 2 and under 3 weeks 5.0 4.3 4.5 3.7 5.2 4.5 5.5 3 and under 4 weeks 3.0 3.6 4.0 4.4 4.5 3.9 5.1 Under 4 weeks 33.7 32.8 37.4 40.9 29.5 34.8 44.7 From 4 to 13 weeks 19.3 21.6 16.9 18.5 14.2 18.1 20.5 From 3 to 6 months 20.0 13.7 18.7 16.9 22.2 18.3 15.4 From 6 to 9 months 14.0 18.3 15.5 14.5 16.8 158 9.7 From 9 to 12 months 13.0 13.6 11.5 9.2 17.8 13.0 9.7 Under 12 months 1000.0 1000.0 1000.0 1000.0 1000.0 1000.0 1000.0 In 1911 there was a considerable increase in the Infantile Mortality, and this was, in the Report for that year, stated to have been due to the climatic conditions having been favourable for Diarrhoea and Digestive diseases of infants, but in 1912 these conditions were most unfavourable, and consequently there was a very great reduction in the mortality from these diseases. This, combined with the decrease in the number of deaths from Measles and Pneumonia, reduced the Infantile Mortality from 122 to 76, which, as has already been stated, is the lowest on record. 40 Report of the Medical Officer of Health. A study of the meteorological reports shows that in July, August and September the air temperature was above the 65 years' average on 19 days only out of 92, compared with 76 days in 1911, 15 in 1910, and 27 in 1909, while the rainfall was much above the average, rain falling on 47 days compared with 22 days in 1911, 37 in 1910, and 45 in 1909. INFECTIVE DISEASES. The next Table shows the number of deaths from these diseases during the year and for the 10 previous years. This Table is corrected for Institutions, as a large number of deaths registered in the Borough occurred in the Grove Fever Hospital and belong to other Metropolitan Boroughs. The number above or below the corrected decennial average is also shown. TABLE XXV. 1902 1903 1904 1905 1906 1907 1908 1909 i910 1911 1912 1912 No. above corrected average. No. below corrected average. Small-pox 26 ... ... ... ... ... ... ... ... ... ... ... 31 Scarlet Fever 24 18 13 28 19 22 21 14 12 10 11 ... 10 Diphtheria 70 45 41 31 50 41 37 29 16 34 18 ... 27.5 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 30 19 11 11 15 10 7 6 8 9 8 ... 6.5 Cont'd Fever 2 ... ... 1 1 1 2 1 3 ... ... ... ... Puerpl. Fever 8 6 5 8 11 10 6 10 5 8 11 21 ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 18 5 13 14 10 10 6 8 4 10 5 ... 3.8 Measles 94 109 104 89 65 68 45 108 44 230 51 ... 59 Whooping C. 64 87 48 75 55 105 59 67 68 66 57 ... 23 Influenza 93 39 57 41 70 88 82 89 55 24 45 ... 28 Diarrhoea 155 162 301 203 307 127 183 120 88 350 85 ... 143.5 Tuberculous Diseases 314 343 380 360 376 352 382 362 351 389 366 ... 50 Other Infective Diseases 13 10 11 16 l6 10 11 14 13 24 28 13 ... Totals 911 843 984 877 995 844 841 828 667 1154 685 ... 348 The total number of deaths from these diseases was 685, 145 in Clapham, 55 in Putney, 157 in Streatham, 93 in Tooting, and 235 in Wandsworth, a decrease of 469 compared with 1911, and of 348 compared with the corrected decennial average. Report of the Medical Officer of Health. 41 Compared with 1911 there has been an increase in the number of deaths from Scarlet Fever, Puerperal Fever, Influenza, and other infective diseases, and a decrease in the number of deaths from Diphtheria, Whooping Cough, Enteric Fever, Erysipelas, Measles, Diarrhoea and Tuberculous diseases. Compared with the corrected decennial average there has been an increase in the number of deaths from Puerperal Fever and other infective diseases, but a decrease in all the others. From all infective diseases the death-rate was 2.18 per 1,000. 2.41 in Clapham, 1.92 in Putney, 1.60 in Streatham, 2.60 in Tooting, and 2.56 in Wandsworth, compared with 374 in 1911, and 331 the decennial average. The rate from the principal infective diseases, viz.:—Smallpox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever, and Diarrhoea, was .73 per 1,000 (.76 in Clapham, .52 in Putney, .39 in Streatham, .28 in Tooting, and .92 in Wandsworth), compared with 2.26 in 1911, and .78 in 1910. The low rate from these diseases was due to the decrease in the number of deaths from Measles and Diarrhœa. In out-lying Institutions 201 deaths occurred from Infective diseases (43 belonging to Clapham, 15 to Putney, 40 to Streatham, 28 to Tooting, and 75 to Wandsworth), compared with 316 in 1911. Of these deaths 100 occurred in Workhouse Infirmaries, one from Measles, one from Whooping Cough, one from Erysipelas, 49 from Tuberculous diseases, three from Puerperal Fever, 32 from Diarrhœa, and three from other infective diseases; 71 in General and Special Hospitals, one from Enteric Fever, one from Measles, one from Diphtheria, two from Influenza, five from Diarrhoea, 52 from Tuberculous diseases, four from Puerperal Fever, and five from other infective diseases; 15 in Public Lunatic Asylums, 11 from Tuberculous diseases, one from Enteric Fever, one from Influenza, one from other Tuberculous disease, and one from Diarrhœa; and 15 in the Hospitals of the Metropolitan Asylums Board, two from Whooping Cough, two from Measles, two from Scarlet Fever, five from Enteric Fever, one from Diarrhoea, two from Tuberculous diseases, and one from Puerperal Fever. 42 Report of the Medical Officer of Health. In Institutions in the Borough 186 deaths from infective diseases occurred of persons not belonging thereto, compared with 140 in 1911. The increase in 1912 is due to the increase in the number of deaths from Measles and Tuberculous diseases. Of these deaths 67 occurred in the Grove Hospital, nine from Scarlet Fever, 19 from Diphtheria, 19 from Whooping Cough, 18 from Measles, one from Pulmonary Tuberculosis, and one from Diarrhoea. 24 deaths from these diseases occurred in the Middlesex County Asylum, 22 from Tuberculous diseases, one from Erysipelas, and one from Diarrhœa; five in the Tooting Bec Asylum; 23 in the Hostel of God, all from Tuberculous diseases; 51 in the Tooting Home, 50 from Tuberculous diseases, and one from Influenza; two in the Royal Hospital for Incurables, one from Influenza, and one from Tuberculous disease; one in H.M. Prison from Tuberculous disease ; and three in the Fountain Asylum from Tuberculous diseases. In other places not institutions 12 deaths occurred, one from Influenza, nine from Tuberculous diseases, and two from Diarrhœa. In Institutions in the Borough 91 deaths from infective diseases occurred of persons belonging thereto, 38 in the Fever Hospital at Tooting, seven from Measles, eight from Scarlet Fever, eight from Whooping Cough, and 15 from Diphtheria; 45 in the Tooting Home, 44 from Tuberculous diseases, and one from Influenza; one in the Hostel of God from Tuberculous disease; one in the Fountain Asylum from Tuberculous disease; one in the Middlesex Asylum from Enteric Fever; three in the Putney Hospital, one from Tuberculous disease, one from Puerperal Fever, and one from other infective diseases ; and one in other places from Tuberculous disease. Compared with 1911, this shows an increase of three. The next Table shows the death-rates from these diseases for the whole Borough and for each sub-district for the year 1912, as well as for the preceding 10 years, and the rates above or below the decennial average are also shown. Report of the Medical Officer of Health. 43 TABLE XXVI. Sub-Districts. 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1912 Rate above decennial average. Rate below decennial average. Clapham 4.05 3.32 3.77 3.06 3.67 2.66 2.82 2.87 2.09 3.69 2.41 ... .79 Putney 3.48 3.06 3.06 3.32 3.19 2.36 2.36 2.58 2.36 2.57 1.92 ... .91 Streatham 3.07 2.74 2.90 2.44 2.88 2.l8 2.58 2.05 1.82 2.89 1.60 ... .95 Tooting 4.18 4.11 5.82 5.47 6.17 5.53 3.90 4.04 2.56 4.84 2.60 ... 2.06 Wandsworth. 4.48 4.22 4.83 4.01 4.16 3.76 3.39 3.35 2.57 4.65 2.56 ... 1.38 Borough 3.82 3.44 3.90 3.38 3.73 3.07 2.98 2.85 2.23 3.74 2.18 ... 1.13 The death-rate was thus 1.56 below the rate for 1911, and 1.13 below the decennial average. The rate in all the sub-districts was much lower than in the previous year, and also than the decennial average. The rate shows a very large decrease, and in all the sub-districts it was lower than in any year during the last 10 years. Notification of Infective Diseases. The total number of cases of infective diseases notified during the year is shown in Table II. of the Local Government Board's Tables at page 29. The number of cases notified in this Borough for the year and for the previous 10 years is shown in the following Table, as also the number above or below the corrected decennial average. 44 Report of the Medical Officer of Health. TABLE XXV11. 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1912 No. above decennial average. No. below decennial average. Small-pox 127 28 6 1 ... ... ... ... ... ... ... ... 18.7 Scarlet Fever 1063 822 774 1494 1069 1330 1232 987 687 869 833 ... 35.9 Diphtheria 750 532 406 348 566 629 581 380 284 510 431 ... 144 Typhus Fevers. ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric 139 105 70 96 96 70 60 66 54 58 71 ... 23 Continued 1 3 3 1 1 ... ... 2 ... 5 2 .4 ... Relapsing 1 ... ... ... ... ... ... ... ... ... ... ... ... Puerperal 21 13 14 18 25 25 14 26 20 24 27 3.9 ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 236 232 267 253 273 213 203 192 182 202 207 ... 53 Cerebrospinal Meningitis ... ... ... ... ... 3 5 4 5 5 3 .5 ... Polio-Myelitis ... ... ... ... ... ... ... ... ... 5 5 ... ... Ophthalmia Neonatorum ... ... ... ... ... ... ... ... ... 34 35 ... ... Total 2338 1735 1540 2211 2030 2270 2095 1657 1232 1712 1614 ... 859 The following Table shows the total number of cases of infective diseases notified during the year, the number removed to hospital, the number that died in hospital and at home, as well as the total number of deaths:— Report of the Medical Officer of Health. 45 TABLE XXVIII. Cases of Infective Diseases Notified. Disease. No. cases notified. No. patients removed to Hospital. No. died in Hospital. No. died at Home. Total deaths in Hospital and at Home. Small-pox Scarlet Fever 833 725 10 1 11 Erysipelas 207 45 1 4 5 Diphtheria 431 335 16 2 18 Enteric Fever 71 54 7 1 8 Continued Fever 2 ... 9 ... ... Puerperal Fever 27 21 ... 2 11 Cerebro-spinal Meningitis 3 1 ... 1 1 Polio-Myelitis 5 3 ... 1 1 Ophthalmia Neonatorum 35 22 ... ... ... Total 1,614 1,206 43 12 55 No cases of Small-pox were notified during the year, none in 1906, 1907, 1908, 1909, 1910, or 1911, one in 1905, six in 1904, 28 in 1903 and 127 in 1902. 833 cases of Scarlet Fever were notified, compared with 869 in 1911, 687 in 1910, and 987 in 1909; of Diphtheria 431, compared with 510, 284 and 380; of Enteric Fever 71, compared with 58, 54 and 66; of Puerperal Fever 27, compared with 24, 20 and 26; and of Erysipelas 207, compared with 202, 182 and 192. Compared with 1911 there has been a decrease in the number of cases of Scarlet Fever, Diphtheria, Continued Fever and Cerebrospinal Meningitis, and a slight increase in the number of cases of Erysipelas, Puerperal Fever and Enteric Fever. Compared with the corrected decennial average there has been a decrease in the number of cases of all the notifiable diseases with the exception of Continued Fever, Puerperal Fever and Cerebrospinal Meningitis, which show a slight increase. The total number of cases notified was 1,614 (285 in Clapham, 146 in Putney, 402 in Streatham, 305 in Tooting, and 476 in Wandsworth), compared with 1,949 in 1911,1,232 in 1910, and 1,657 1909. The next Table shows the rate per 1,000 persons living in the Borough, in the separate sub-districts, and for the whole of London for the year and for the previous ten years. TABLE XXIX. Sub-districts. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1912. Clapham 14.55 6.26 7.68 7.34 6.28 6.43 6.61 5.60 3.35 6.96 4.74 Putney 10.40 6.53 5.29 3.47 3.76 6.29 4.39 3.13 2.86 3.77 5.11 Streatham 13.60 6.71 8.29 5.91 6.07 6.88 5.07 5.85 3.64 4.83 4.20 Tooting 21.04 7.55 10.13 21.24 15.20 19.25 12.98 8.29 6.39 8.79 8.54 Wandsworth 19.40 9.00 13.97 13.02 9 .02 8.15 9.62 5.52 4.70 7.35 5.20 Whole Borough 15.71 7.28 9.65 8.53 7.61 8.28 7. 42 5.70 4.12 6.32 5.14 London 15.8 6.1 6.1 7.2 7.7 8.92 7.70 6.42 4.77 6.5 5. 4 46 Report of the Medical Officer of Health. Report of the Medical Officer of Health. 47 In 1902, 1903, 1904 and 1911 Chicken-pox was compulsorily notifiable, and, as a consequence the rates in these years are increased, especially in 1902. In Public Institutions within the Borough three cases of Erysipelas were notified from the Workhouse; one case of Scarlet Fever from the Intermediate Schools; one case of Diphtheria, one Enteric Fever and two Erysipelas from the Middlesex County Asylum; two cases of Scarlet Fever and one of Enteric fever from H.M. Prison; one case of Puerperal Fever and one of Ophthalmia Neonatorum from the Putney Hospital; one case of Erysipelas from the Tooting Home; one case of Scarlet Fever and one of Erysipelas from the Fountain Asylum; two cases of Scarlet Fever from the Tooting Bec Asylum; and 25 cases of Scarlet Fever, 15 of Diphtheria and one of Erysipelas from the Grove Hospital. TABLE XXX. Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Puerperal Fever. Polio- Myelitis. Ophthalmia Neonatorum. Total. St. James's Infirmary ... ... 2 18 10 ... 3 33 St. Thomas's Hospital 6 2 ... 5 ... ... 2 15 Victoria Hospital 1 10 1 ... ... ... ... 13 Royal Eye Hospital ... ... ... ... ... ... 11 11 St. John's Infirmary ... 1 ... 7 ... ... 1 9 Park Hospital 1 5 ... 1 ... ... ... 8 Belgrave Hospital 2 3 ... 2 ... ... ... 7 Gore Farm Hospital 2 1 ... 1 ... ... ... 4 St. George's Hospital ... 2 ... 1 ... ... 1 4 Children's Hospital, Great Ormonde Street 2 1 ... ... ... ... ... ... London Fever Hospital 1 1 ... ... ... ... ... 3 Westminster Hospital 1 ... ... 1 ... ... ... 2 Guy's Hospital 1 ... ... ... 1 ... ... 2 St. Bartholomew's Hospital ... ... ... 1 1 ... ... 2 Bolingbroke Hospital ... 2 ... ... ... ... ... 2 Westminster Royal Ophthalmic Hospital ... ... ... ... ... ... 1 1 West London Hospital ... 1 ... ... ... ... ... 1 Evelina Hospital ... 1 ... ... ... ... ... 1 Charing Cross Hospital ... 1 ... ... ... ... ... 1 General Lying-in Hospital ... ... ... ... ... ... 1 1 Hampstead General Hospital ... 1 ... ... ... ... ... 1 Throat Hospital ... 1 ... ... ... ... ... 1 Total 17 33 4 37 12 2 20 125 48 Report of the Medical Officer of Health. There has been a decrease in the number of these notifications compared with 1911 when 154 cases were notified, compared with 125 in 1912. There was a decrease in the number of cases of all the diseases, with the exception of Diphtheria, in which the number was the same, viz.—33. The greatest number notified, viz.—33, was received from the St. James's Infirmary, 18 of these being Erysipelas and 10 of Puerperal Fever. Of the 20 cases of Ophthalmia Neonatorum notified, 11 were from the Royal Eye Hospital. Vaccination. Table XXXI. is taken from the official returns of the Vaccination Officers to the Board of Guardians for the year 1911. It shows the number of children successfully vaccinated for the whole Borough, as well as for the separate sub-districts. Streatham, Balham and Tooting are included under the heading of Streatham. TABLE XXXI. SubDistricts. Number of Births returned from 1st January to 31st of December, 1911. Successfully Vaccinated. Insusceptible of Vaccination. Had Small-pox. Dead, Unvaccinated. j Certificates of Conscientious objection. Postponed by Medical Certificate. Removed to District, Vaccination Officer of which has been duly apprised. Removed to places unknown, or which cannot be traced; and cases not having been found. Remaining on Books as Unvaccinated. Clapham 1,217 641 4 ... 95 236 12 15 191 23 Putney 466 352 2 ... 45 51 3 5 4 4 Streatham 2,717 1,379 13 ... 246 498 124 ... 271 186 Wandswith 2,179 1,333 4 ... 195 331 23 28 239 26 Totals 6,579 3,705 23 ... 58. 1,116 162 48 705 239 Report of the Medical Officer of Health. 49 During the year 1911, of 6,579 children whose births were registered, 3,705 or 56.3 per cent. were successfully vaccinated, compared with 56.1 per cent. in 1910, 60.9 per cent. in 1909, 61.3 per cent. in 1908, 66.5 per cent. in 1907, 71.05 per cent. in 1906 and 74.6 per cent. in 1905. This is again a decided decrease compared with the five previous years, but a slight increase compared with 1910. The next Table shows the percentage of children vaccinated to total births registered in the Borough, and in the vaccination sub-districts for the year 1911, as well as for the 10 years 1901-1910. The average for the 10 years is also shown on this Table. Compared with 1910 there has been a decrease in the percentage of successfully vaccinated in all the sub-districts, with the exception of Clapham. The greatest decrease occurred in Streatham, and the smallest in Putney, while in the whole Borough there has been a decrease of no less than 4.8 per cent. Compared with the decennial average there has been a decrease in all the sub-districts, the greatest decrease having been in Wandsworth, and the smallest in Clapham and Putney. 581 infants died unvaccinated, a percentage of 5.8, compared with 6.2 in 1910, 5.9 in 1909, and 6.7 in 1908. Of the 2,293 infants remaining, 23 or .35 per cent. were stated to have been insusceptible to vaccination; 1,116 or 16.9 per cent. in respect of whom certificates of conscientious objection were received; 162, or 2.4 per cent. had vaccination postponed by medical certificate, leaving 753 or 11.4 per cent. as removed, not to be traced, or otherwise unaccounted for, compared with 13.6 in 1910, 13.3 in 1909, and 13.6 in 1908; while 239 or 3.6 per cent. remained on the books as unvaccinated, compared with 33 in 1910, 3.3 in 1909, and 1.5 in 1908. There has been a decrease of 2.2 in the percentage of cases removed, and an increase of 2.4 in the number of certificates of conscientious objections received. D 50 Report of the Medical Officer of Health. If the total number of infants who died unvaccinated be deducted from the total number of births registered, then of 5,998, the remaining infants, 61.7 per cent. were successfully vaccinated, compared with 59.7 in 1910, 64.7 in 1909, and 65.7 in 1908; .38 were insusceptible, compared with .29, .42, and .37; 27 per cent. were under certificate of postponement, compared with 6.2, 7.0 and 5.6; 186 per cent. in regard to whom certificates of conscientious objection had been obtained, compared with 15.5, 11.5, and 8.6; leaving 16.6 per cent. unaccounted for as regards vaccination, compared with 18.1, 15.8, and 19.7. TABLE XXXII. Sub-Districts. 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 Average for Ten Years. 1911 Clapham 62.8 63.7 68.2 62.9 68.8 59.9 55.1 51.9 55.1 56.4 60.4 52.7 Putney 75.7 84.4 86.5 83.4 88.1 86.7 83.6 85.0 80.4 80.0 83.3 75.5 Streatham 68.7 65.2 66.9 69.2 69.7 66.9 62.3 54.5 52.8 45.0 62.1 50.7 Wandsworth 78.6 82.3 81.7 82.8 80.9 78.7 74.5 69.1 68.9 64.1 76.1 61.1 Borough 71.4 72.4 73.7 73.5 74.6 71.05 66.5 61.3 60.9 56.1 68.14 56.3 The returns for the year 1911 show a slight increase as regards successful vaccination, but still the record of the number of unvaccinated children in the Borough is by no means a satisfactory one. TABLE XXXIII. 1902 1903. 1904. 1905. 1906. 1907. 1908. 1909 1910 1911. Acceptance of Vaccination— England and Wales 74.8 75.4 75.3 75.8 73.4 70.9 62.2 59.3 55.8 ... Metropolitan Unions 68.0 68.9 69.7 70.7 68.1 65.9 63.0 61.6 58.3 ... Wandsworth 72.4 73.7 73.5 74.6 71.0 66.5 61.3 60.9 56.1 56.3 Abstention from Vaccination (including exempted, postponed, and remaining)— England and Wales 15.2 14.7 14.5 14.8 16.8 20.4 27.9 32.3 36.3 ... Metropolitan Unions 22.1 21.7 20.2 20.1 22.7 25.8 28.8 30.7 34.1 ... Wandsworth 18.4 17.4 17.3 16.6 20.6 26.5 31.2 32.3 37.4 34.5 Exemptions alone— England and Wales 3.6 4.0 4.3 4.8 5.8 8.4 17.0 21.6 26.0 ... London .8 1.0 1.1 1.2 1.5 3.1 7.3 10.1 13.5 ... Wandsworth 1.3 1.4 1.9 2.0 2.6 4.1 8.0 10.8 14.5 16.9 Report of the Medical Officer of Health. 51 D 2 52 Report of the Medical Officer of Health Scarlet Fever. 833 cases of Scarlet Fever were notified during the year, compared with 869 in 1911, 687 in 1910, and 987 in 1909. 135 of these were in Clapham, 41 in Putney, 228 in Streatham, 207 in Tooting, and 222 in Wandsworth. 725 or 87 per cent. of these cases were removed to hospital where 10 died, and 108 or 13 per cent. were treated at home with one death. The total number of deaths was 11, of which one was in Clapham, six in Streatham, one in Tooting, and three in Wandsworth, The death-rate per 1,000 population was .03, compared with .03 in 1911. The percentage of cases removed to hospital, viz.:—87, is higher than in 1911, when it was 83.5 per cent. The case mortality was 1.32 per cent., compared with 1.15 in 1911, 1.77 in 1910, 1.42 in 1909, and 1.7 in 1908, and is thus slightly above the rate for 1911. The mortality among cases removed to hospital was 13 per cent., compared with 1.24 in 1911, and among those treated at home .92 per cent., compared with .69 in 1911. The mortality among the home-treated cases was thus lower than among those cases treated in hospital. The following Table shows the rate of notified cases per 1,000 persons living for each sub-district and for the whole Borough for the year, and the three previous years, as well as the corresponding rates for the whole of London. Report of the Medical Officer of Health. 53 TABLE XXXIV. Sub-Districts. 1909 1910 1911 1912 Clapham 2.75 1.52 2.88 2.24 Putney 1.23 1.60 1.72 1.43 Streatham 3.34 1.82 2.27 2.32 Tooting 3.68 3.03 3.64 5.80 Wandsworth 2.66 2.30 3.39 2.42 Whole Borough 2.88 2.00 2.82 2.65 London 3.56 2.15 2.32 2.50 In Clapham, Putney and Wandsworth the rate was lower than in 1911, while in Streatham and Tooting it was higher, while for the whole Borough it was .17 per 1,000 under the rate for the previous year. In Clapham the greatest number of cases was notified in October, November and December, and the smallest in June. In Putney the greatest number of cases was notified in January and December, in Streatham in November, in Tooting in November, and in Wandsworth in December. The rate in Tooting was to some extent raised by the notification of cases from the Fever Hospital. The total number of cases notified from this Institution was 28, so that the rate instead of being 5.80 would on that account be reduced to 5.00 in 1912 and 2.87 in 1911. In the whole Borough the greatest number of cases, viz.—117, was notified in November, and the smallest in June, viz.—37. 54 Report of the Medical Officer of Health. The following Table shows the number of cases notified in each sub-district during each month of the year 1912 and for the whole year. TABLE XXXV. SubDistricts. January. February. March. April. May. June. July. August. September. October. November. December. Whole Year. Clapham 9 6 9 13 11 2 8 5 11 19 16 26 135 Putney 9 5 1 5 3 — 2 2 1 4 3 6 41 Streatham 17 22 16 9 18 11 15 12 16 23 36 33 228 Tooting 10 10 6 4 5 7 7 22 38 35 42 21 207 Wandsworth 18 23 18 21 15 17 20 10 14 21 20 25 222 Whole Borough 63 66 50 52 52 37 52 511 80 102 117 111 833 Scarlet Fever and Schools. The next Table shows the number of cases of Scarlet Fever for each month of the year among children in attendance at elementary and other schools, for each sub-district, also the number for the whole Borough, the number of cases among persons not at school, the number attending schools outside the Borough, as well as the number of cases in which as far as could be ascertained, the diagnosis of Scarlet Fever was incorrect. Of the total number of cases, viz.—833, the diagnosis was incorrect in 36 or 4.3 per cent; 475 or 57.0 per cent. were in attendance at schools in the Borough; 36 or 4.3 per cent. attended schools outside the Borough; while 286 or 34.4 per cent. did not attend school, being either over or under school age. Report of the Medical Officer of Health. 55 The percentage of children attending school was as follows: in Clapham, 91 out of 135, or 67.4 per cent.; in Putney, 15 out of 41, or 366 per cent.; in Streatham, 133 out of 228, or 58 per cent.; in Tooting, 108 out of 207, or 52.1 per cent.; and in Wandsworth, 128 out of 222, or 57.6 per cent. The percentage of cases in the Borough in attendance at school was slightly higher than in 1911, while in the sub-districts the percentage was higher in Clapham and Streatham, but lower in Putney, Tooting and Wandsworth. The percentage in Tooting is calculated after deduction of the cases notified in Institutions in that sub-district. In Clapham the schools chiefly affected were Cavendish Road with 12 cases, New Park Road with 12 cases, and Bonneville Road with 11 cases. In Putney, of the 15 cases, five were in attendance at private schools, and all the five occurred in different months. In Streatham the schools chiefly affected were Broadwater Road with 33 cases, Fircroft Road with 12 cases, Smallwood Road with 11 cases, and Mitcham Lane with 10 cases. In Tooting, Ensham Street with 27 cases, Tooting Graveney with 25 cases, and Sellincourt Road with 20 cases, were the schools principally attacked during the year. The cases in Tooting and the part of Streatham in which Broadwater Road and Smallwood Road Schools are situated, occurred chiefly from August, reaching their maximum in November. In Wandsworth, Merton Road with 16 cases, Swaffield Road with 15 cases, Brandlehow Road with 13 cases, were the schools chiefly affected. 56 Report of the Medical Officer of Health. 14 of the 16 cases in Merton Road School occurred during the first four months of the year. The Medical Officer of the London County Council excluded 88 children from 11 schools during the year, chiefly in October, November and December, until a medical certificate was received to the effect that the child was free from infectious disease. All the homes of these children were visited, in many cases two or three times, to see that medical attendance was provided, and in several cases the children were examined by myself before being permitted to return to school. The cases excluded were chiefly in Tooting Graveney School, owing to the presence of several unrecognised cases of an extremely mild type. It was necessary to carry out disinfection in Ensham Street, Tooting Graveney, Broadwater Road, Littleton Street Special and St. Andrew's Street Schools, but in all these cases the disinfection was carried out without closing the schools. Report oj the Medical Officer of Health. 57 TABLE XXXVI. SCHOOLS. January. February. March. April. May. June. July. August. September. October. November. December. Total. CLAPHAM. Aristotle Road ... ... ... ... ... ... ... ... ... ... ... 1 1 Bonneville Road 1 1 3 ... 3 ... 2 ... l ... ... ... 11 Cavendish Road ... 1 3 ... ... 2 1 ... 3 ... 2 ... 12 Christchurch ... ... ... ... ... 1 1 ... 1 ... ... ... 3 Haselrigge Road ... 3 ... 1 ... ... ... ... 1 ... ... 3 8 Larkhall Lane ... ... ... 1 ... ... 1 1 ... ... ... 5 8 New Park Road 3 ... 1 ... 3 ... ... ... 1 3 ... 1 12 Parochial, Old Town ... ... ... ... 1 ... ... ... l 1 3 2 8 St. Andrew's Street ... 1 1 ... 1 ... 1 1 ... 3 ... 1 9 St. John Bowyer ... ... ... 2 ... ... ... ... ... ... ... ... 2 St. Mary's, Crescent Lane ... ... ... ... ... ... ... ... ... 1 ... ... 1 Telferscot Road ... 1 ... ... ... 1 ... ... ... 3 2 2 9 Wirtemberg Street ... ... ... ... 1 ... ... ... ... ... 2 ... 3 Private Schools ... ... 1 ... ... ... ... ... ... 2 ... 1 4 Total 4 7 9 4 9 4 6 2 8 13 9 16 91 PUTNEY. All Saints' 1 2 ... ... 1 ... ... ... ... ... ... ... 4 Convent of Sacred Heart ... ... ... ... ... ... ... ... ... ... ... 1 1 Hotham Road ... ... ... ... ... ... ... ... ... 1 ... ... 1 St. Mary's, Charlwood Rd ... ... ... 1 ... ... ... ... 1 ... 1 ... 3 Up. Grade, Walker's P1. ... 1 ... ... ... ... ... ... ... ... ... ... 1 Private Schools 1 ... ... ... ... ... 1 ... ... 1 1 1 5 Total 2 3 ... 1 1 ... 1 ... 1 2 2 2 15 STREATHAM. Broadwater Road 2 2 1 ... ... ... 2 1 9 7 6 3 33 Eardley Road 1 1 1 1 2 ... ... ... ... ... ... ... 6 Fircroft Road ... ... ... ... ... ... ... ... 1 1 1 9 12 Hearnville Road 1 1 ... ... ... ... ... ... ... 1 ... 2 6 Hitherfield Road ... ... ... ... ... ... ... ... ... 1 ... ... 1 Holy Trinity, Up. Tooting 1 ... ... ... ... ... ... ... 2 ... ... 3 6 Immanuel ... ... ... ... 1 ... 2 ... ... 1 1 1 6 Mitcham Lane ... 2 1 ... 2 ... ... ... 1 1 3 ... 10 Oldridge Road ... 1 ... ... 1 ... ... ... ... ... 1 ... 3 Nightingale Square R. C. ... ... ... ... ... ... ... ... ... ... ... 1 1 St. Andrew's, Polworth Road 1 ... 2 ... ... ... 1 ... ... ... ... ... 4 St. Leonard's 1 2 ... 1 ... ... ... ... ... 1 ... ... 5 St. Mary's 1 1 ... ... 1 ... ... 2 ... ... 1 ... 6 Smallwood Road ... ... ... ... ... ... ... ... 1 7 2 1 11 Sunnyhill Road 2 ... ... ... ... ... ... 4 ... 1 ... ... 7 Private Schools 1 1 1 1 2 ... ... 1 1 1 5 2 16 Total 11 11 6 3 9 1 5 8 15 22 20 22 133 Carried forward 17 21 15 8 19 5 12 10 24 37 31 40 239 58 Report of the Medical Officer of Health. TABLE XXXVI.—continued. SCHOOLS. January. February. March. April. May. June. July. August. September. October. November. December. Total. Brought forward 17 21 15 8 19 5 12 10 24 37 31 40 239 TOOTING. Ensham Street 2 1 1 1 ... 1 2 1 11 1 4 2 27 Franciscan Road 1 1 ... 1 1 3 ... 1 2 2 3 1 16 Fountain Road ... ... ... ... ... 1 1 ... 2 2 3 1 10 R. C., Undine Street ... 1 ... ... ... ... ... ... 1 3 1 2 8 Sellincourt Road ... 1 1 ... ... ... ... 3 3 4 7 1 20 Tooting Graveney ... 2 ... 1 2 ... 2 2 3 2 9 2 25 Private Schools ... ... ... ... ... ... ... 1 ... ... ... 1 2 Total 3 6 2 3 3 5 5 8 22 14 27 10 108 WANDSWORTH. All Saints' ... ... ... ... ... 1 ... ... ... ... ... ... 1 Brandlehow Road 1 1 ... 4 2 ... ... ... ... ... ... 5 13 Earlsfield 1 2 ... 1 2 ... 1 ... ... ... ... ... 7 Earlsfield Special ... ... ... ... ... ... ... 1 ... ... ... ... 1 Elliott Central ... ... 1 ... ... 1 1 ... ... 2 ... ... 5 Eltringham Street 2 ... ... ... ... ... ... ... ... 1 1 ... 4 Garratt Lane ... ... ... ... ... ... 3 ... ... ... ... 1 4 Littleton Street Special ... ... ... ... ... ... ... ... ... 1 ... ... 1 Magdalen Rd. Temporary ... 1 ... ... ... ... ... ... ... ... 1 ... 2 Merton Road 1 6 5 2 ... ... ... 1 ... ... ... 1 16 Riversdale ... 1 ... 1 ... ... 3 ... ... 3 ... ... 8 R. C., North Side, Wandsworth Common ... ... ... ... ... ... ... ... ... ... ... 1 1 St. Ann's ... ... ... ... 1 1 ... 3 2 ... ... ... 7 St. Faith's ... ... 2 ... ... ... ... ... ... ... ... ... 2 St. Michael's ... ... ... 1 ... ... ... ... ... 1 3 ... 5 St. Thomas's ... ... ... ... ... ... ... ... ... 1 ... ... 1 Swaffield Road 1 3 1 2 ... ... 2 ... 4 1 ... 1 15 Waldron Road 1 1 1 ... ... ... ... ... ... 1 1 1 6 Wandle 4 ... 2 ... ... ... ... ... ... 2 ... 1 9 Warple Way ... ... ... ... ... ... 1 ... ... ... ... 1 2 West Hill 1 1 ... ... ... 1 ... ... ... ... 1 2 6 Private Schools 1 ... 2 4 ... ... 1 ... ... 2 ... 2 12 Total 13 16 14 15 5 4 12 5 6 15 7 l6 128 Total,—Schools in Boro' 33 43 31 26 27 14 29 23 52 66 65 66 475 Schools outside Borough 3 ... 2 2 2 3 1 3 4 7 7 2 36 No School 26 21 15 20 20 16 21 23 21 29 39 35 286 Incorrect Diagnosis 1 2 2 4 3 4 1 2 3 ... 6 8 36 Grand Total 63 66 50 52 52 37 52 51 80 102 117 111 833 The Chart (facing page 58) shows the number of cases notified in each week during the year. CHART Showing the number of cases of Scarlet Fever, Diphtheria and Enteric Fever notified, as well as the total cases notified from these diseases during each week of the year 1912. Report of the Medical Officer of Health. 59 The greatest number, viz.—34, was notified in the first week of December, and the smallest, five, in the second week of March, and the first week of June. Of the total number of cases notified, viz.—833, two or .24 per cent. were under one year, compared with four or .46 per cent. in 1911; 200 or 24.0 per cent. were from one to five years, compared with 201 or 23.1 per cent.; 530 or 63.6 per cent. from five to 15 years, compared with 566 or 65.1 per cent.; 64 or 7.6 per cent. from 15 to 25 years, compared with 61 or 7.0 per cent.; and 37 or 4.4 per cent. from 25 to 65 years, compared with 37 or 4.2 per cent. The number of dwellings in each sub-district and in the whole Borough in which multiple cases occurred is shown in the following Table:— TABLE XXXVII. Sub-Districts. One case. Two cases. Three cases. Four cases. Five cases. Total houses invaded. Clapham 97 14 2 1 ... 114 Putney 24 3 1 2 ... 30 Streatham 153 25 7 1 ... 186 Tooting 134 23 6 1 1 165 Wandsworth 175 13 4 1 1 194 Whole Borough 583 78 20 6 2 689 Of the 689 houses invaded, multiple cases occurred in 106, or 15.3 per cent. Diphtheria. The number of cases of Diphtheria notified during the year shows a decrease compared with the previous year, and is also under the average number for the last 10 years. The following Table shows the number of cases notified, the number of deaths that occurred in the separate sub-districts and in the whole Borough for the years 1902-1911 inclusive, the average for the 10 years, and the number of cases and deaths in 1912. 60 Report of the Medical Officer of Health. TABLE XXXVIII. YEAR. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. s. 1902 149 10 51 8 199 15 90 13 261 28 750 74 1903 90 3 36 7 231 24 34 4 141 7 532 45 1904 45 9 19 2 155 9 44 7 143 17 406 44 1905 65 5 17 5 121 7 41 6 104 8 348 31 1906 106 9 35 5 165 13 78 6 182 17 566 50 1907 79 2 65 ... 157 8 138 12 190 19 629 41 1908 91 7 39 1 '37 11 89 6 225 12 581 37 1909 67 5 25 ... 119 9 61 5 108 10 380 29 1910 49 4 16 ... 85 4 63 5 7i 3 284 16 1911 110 10 34 1 111 3 106 9 149 11 510 34 Average Ten Years— 1902 to 1911 85 6 33 3 148 10 74 7 157 13 498 40 1912 78 3 82 3 95 1 48 5 128 6 431 18 Report of the Medical Officer of Health. 61 The total number of cases notified was 431 (78 in Clapham, 82 in Putney, 95 in Streatham, 48 in Tooting, and 128 in Wandsworth), compared with 510 in 1911, 284 in 1910, and 380 in 1909. This number was 144 under the corrected, and 67 under the uncorrected decennial average. In all the sub-districts (with the exception of Putney) there has been a decrease compared with 1911, in Clapham of 22, in Streatham of 16, in Tooting of 58, and in Wandsworth of 21; while in Putney the increase was 48. The greatest number of cases occurred in Wandsworth, and the smallest in Tooting. The number of cases notified per 1,000 of population was 1.37, compared with 1.65 in 1911, .95 in 1910, and 1.35 in 1909; and in London 1.57 compared with 1.7, 1.13, and 1.38. 335 or 77.7 per cent. of the cases were removed to hospital where 16 died, and 96 or 22.3 per cent. were treated at home with two deaths. The case mortality was 4.1 per cent., compared with 6.6 in 1911, 5.6 in 1910, and 7.6 in 1909. The case mortality for the whole of London for the year 1912 was 7.4 per cent., compared with 8.3 in 1911, 7.9 in 1910 and 9.1 in 1909. The case mortality among cases treated in hospital was 4.7 per cent., and among those treated at home two per cent. The following Table shows the number of cases, the case-rate per 1,000 living, for the year and for the 10 previous years, the number of deaths and the death-rate for the whole Borough, as well as for the separate sub-districts. 62 Report of the Medical Officer of Health. TABLE XXXIX. Sub-Districts. Cases 1912. Case-rate per 1,000 living. Deaths 1912. Death-rate per 1,000 living. 1902— 1911 1912 1902— 1911 1912 Clapham 78 1.5 1.3 3 .11 .05 Putney 82 1.2 2.7 3 .11 .10 Streatham 95 1.7 .9 1 .12 .01 Tooting 48 2.4 1.3 5 .27 .14 Wandsworth 128 1.9 1.4 6 .16 .06 Whole Borough 431 1.8 1.3 18 .14 .06 LONDON 7,102 1.7 1.51 527 .16 .11 The case-rate for the year is .40 under that for the year 1911, and .5 under the average for the 10 years 1902-1911. The highest case-rate was in Putney, and the lowest in Streatham. The case-rate for the Borough is .1 under that for the whole of London, and the death-rate is .05 per 1,000 lower. The death-rate per 1,000 in the Borough was .06, compared with .11 in 1911, .05 in 1910, .08 in 1909, and .14 the decennial average. In Clapham the death-rate was .05, in Putney .10, in Streatham .01, in Tooting .14, and in Wandsworth .06 per 1,000. All the sub-districts, with the exception of Putney, show a decrease compared with the previous year. Report of the Medical Officer of Health. 63 The Chart (facing page 62) shows the number of cases notified during each week of the year. The maximum number of cases, viz.—23, was notified in the fourth week of August, and the minimum, viz.—two, in the third week of April, and the second week of August. The total number of cases, viz.—431, although under the number for 1911 and also the decennial average, is still above the number of cases notified in 1909 and 1910, but there was no outbreak of any special significance in any part of the Borough, with the exception of slight outbreaks at Roehampton in one of the Institutions there. These cases were, however, nearly all bacteriological, viz.—being detected after swabbing of the throats of the children. The first cases were imported from other parts of the country and it was not until swabbing was carried out that these first cases were detected. In all, in this Institution 18 cases occurred during the year, two in February, six in March, two in July, five in August, and three in September; but no deaths occurred. The whole of the patients and staff were swabbed on several occasions, and it was not until the end of September that the cases cleared, the last swabs taken in October all proving negative. Diphtheria and School Attendance. The following Table shows the number of cases of Diphtheria and their relationship to the schools in the Borough:— 64 Report of the Medical Officer of Health, TABLE XL. SCHOOLS. January. February. March. April. May. June. July. August. September. October. November. December. Totals. CLAPHAM. Bonneville Road ... ... ... ... ... ... ... ... ... 1 ... 1 2 Cavendish Road 1 ... ... ... ... ... ... ... ... ... ... ... 1 Haselrigge Road 1 ... 1 ... ... ... ... ... 1 1 ... ... 4 New Park Road ... 1 7 1 ... 1 1 ... ... ... ... ... 11 Parochial, Old Town 3 ... ... ... ... ... ... ... ... ... ... ... 3 St. Andrew's Street 1 ... ... ... ... ... ... ... ... ... ... ... 1 Telferscot Road 2 ... ... 1 ... ... ... ... ... 1 2 1 7 Private Schools 1 ... ... ... 1 ... ... 2 ... 2 2 ... 8 Total 9 1 8 2 1 1 1 2 1 5 4 2 37 PUTNEY. All Saints' ... ... ... ... 1 7 ... ... ... ... 1 ... 9 Hotham Road 1 1 3 ... ... ... ... ... 1 ... ... ... 6 St. Mary's . . . 1 1 ... ... 1 ... ... ... ... ... ... 3 Up. Grade, Walker's P1. ... 1 ... ... ... ... 1 ... ... ... ... ... 2 Private Schools 1 ... ... ... ... 1 ... ... ... ... ... 1 3 Total 2 3 4 ... 1 9 1 ... 1 ... ... 1 23 STREATHAM. Broadwater Special ... ... ... ... ... ... ... ... ... ... 1 ... 1 Broadwater Road ... ... ... ... ... ... ... ... 1 ... ... 1 2 Christchurch ... ... ... 1 ... ... ... ... ... ... ... ... 1 Coventry Hall ... ... ... ... ... ... ... ... ... 1 ... ... 1 Eardley Road 2 3 ... 1 ... ... 1 ... 1 ... 1 ... 9 Fircroft Road ... ... ... ... ... 1 ... ... 2 ... ... ... 3 Hearnville Road ... ... ... ... ... ... ... ... ... ... 1 ... 1 Immanuel ... ... ... ... ... ... ... ... ... ... ... 1 1 Mitcham Lane ... ... ... ... ... ... ... ... 1 ... ... ... 1 Oldridge Road ... 1 ... ... ... 1 ... ... ... 1 ... ... 3 St. Andrew's, Colmer Rd. ... ... ... ... ... ... ... ... ... 1 ... ... 1 do. Polworth Rd. ... ... ... 1 ... ... ... ... ... ... ... ... 1 Smallwood Road ... 2 ... 1 ... ... ... ... ... ... ... ... 3 Private Schools ... 2 2 1 2 ... 1 ... ... ... 6 2 16 Total 2 8 2 5 2 2 2 ... 5 3 9 4 44 TOOTING. Ensham Street ... ... ... 1 1 1 ... ... ... ... ... ... 3 Franciscan Road 3 ... ... ... ... ... ... ... ... ... ... ... 3 Sellincourt Road ... ... ... 2 1 1 1 1 1 ... ... ... 7 Tooting Graveney ... 1 ... ... 1 ... ... 1 ... ... ... 1 4 Private Schools ... ... ... ... . . . ... ... ... ... ... ... ... ... Total 3 1 ... 3 3 2 1 2 1 ... ... 1 17 Carried forward 16 13 14 10 7 14 5 4 8 8 14 8 121 65 Report of the Medical Officer of Health. 65 TABLE XL.—continued. SCHOOLS. January. February. March. April. May. June. July. August. September. October. November. December. Totals. Brought forward... 16 13 14 10 7 14 5 4 8 8 14 8 121 WANDSWORTH. All Saints' ... 1 ... ... 1 ... ... ... ... ... ... ... 2 Brandlehow Road ... ... ... 1 1 ... ... ... 1 ... ... ... 3 County Secondary 1 1 ... ... ... ... ... ... ... ... ... ... 2 Earlsfield 2 3 ... 1 ... ... 1 ... 1 ... 1 ... 9 Elliott Central ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Eltringham Street ... ... ... ... ... ... 3 ... 1 1 ... ... 5 Garratt Lane Special ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Littleton Street Special... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Merton Road ... ... ... ... ... ... ... ... ... 1 ... 2 3 Riversdale 2 1 ... ... ... ... ... ... ... ... ... ... 3 St. Ann's ... ... ... ... 1 ... ... ... ... ... ... 1 2 St. Faith's ... ... 1 ... 1 ... ... ... ... ... 1 ... 3 St. Joseph's ... ... ... ... 1 ... ... ... ... ... ... ... 1 Swaffield Road ... 1 ... ... ... 2 ... 3 4 2 1 2 ... 15 Waldron Road .. 1 ... 1 ... ... ... ... ... ... ... ... ... 2 Wandle ... ... ... ... ... 1 ... ... ... 1 1 ... 1 4 Warple Way ... ... 1 ... ... ... ... ... ... ... ... ... 1 West Hill 2 ... ... ... ... 2 ... ... • • • 1 ... 1 6 Private Schools... ... 1 ... 1 1 ... ... ... ... ... ... ... 3 Total 9 7 3 3 9 2 7 6 6 5 5 5 67 Total—Schools in Boro 25 20 17 13 16 16 12 10 14 13 19 13 188 Schools outside Borough ... 3 2 2 ... 4 1 1 2 1 1 2 19 No School 18 13 30 11 18 5 7 27 12 14 15 13 183 Incorrect diagnosis 3 2 5 1 3 3 2 7 3 2 7 3 41 Grand Total 46 38 54 27 37 28 22 45 31 30 42 31 431 In Clapham, out of a total of 78 cases, 37 or 47 per cent, occurred in children attending school ; in Putney, of 82 cases, 23 or 28 per cent.; in Streatham, of 95 cases, 44 or 46 per cent.; in Tooting, of 48 cases, 17 or 35.4 per cent. ; in Wandsworth, of 128 cases, 67 or 52.3 per cent. ; and in the whole Borough, of 431 cases, 188 were in attendance at schools in the Borough, and 19 at schools outside the Borough, a total of 207, or 48 per cent. E 66 Report of the Medical Officer of Health. Of the remaining cases, viz.—-243, in 41 or 9 5 per cent., the diagnosis was incorrect, and 183 or 42'5 per cent, were not in attendance at school. In Clapham the number of cases of Diphtheria in attendance at school was 37, the greatest number occurring in New Park Road School, and the next in Telferscot Road School. Seven of the cases in New Park Road occurred in March, while in the other schools in Clapham the cases occurred sporadically during the year. In Putney nine cases occurred in All Saints' School and six in Hotham Road School, but in three months of the year in Putney no cases were notified among children attending school. Seven of the cases at All Saints' School occurred in the month of June. In Streatham, Eardley Road with nine cases was the highest. Three of the cases occurred in February, and two in January. The sub-district of Tooting was very free from Diphtheria during the year. Seven cases occurred in Sellincourt Road, two of these in April. In Wandsworth there were 67 cases, and these occurred spoiadically during the year. In five of the schools only one case occurred in each, in four two cases, in four three cases, in one four cases, in one five cases, in one six cases, in one nine cases, in one 15 cases, and three cases occurred in various private schools. The principal school affected in Wandsworth was Swaffield Road, where 15 cases occurred, four in August, three in July, two each in May, September and November, and one each in January and October. Of the total number of cases notified 41 were incorrectly diagnosed, compared with 42 in 1911, leaving a total of 390 actual cases, compared with 468 in 1911, 245 in 1910, and 335 in 1909, 67 Report of the Medical Officer of Health. The number of dwellings in each sub-district and the whole Borough in which multiple cases occurred is shown in the following Table TABLE XLI. Sub-Districis. One case. Two cases. Three cases. Four cases. Five cases and upwards. Total houses invaded. Clapham 56 6 2 1 ... 65 Putney 47 3 1 2 1* 54 Streatham 79 8 ... ... ... 87 Tooting 46 1 ... ... ... 47 Wandsworth 89 11 1 1 2 104 Whole Borough 3l7 29 4 4 3 357 *18 cases occurred in an Institution. Of the 357 houses invaded, multiple cases occurred in 40, or 11.2 per cent. No cases of Diphtheria were notified as having occurred in children attending the following elementary schools in the Boiough : In Clapham :— Aristotle Road. Christchurch. Larkhall Lane. Macaulay Road. New Road. St. John's, Gaskell Street. St. Mary's, Clapham Park Road. St. Mary's, Crescent Lane. Wirtemberg Street. In Putney :— Convent of the Sacred Heart, Roehampton. National School, Roehampton. E 2 68 Report of the Medical Officer of Health. In Streatham Hitherfield Road. Holy Trinity, Upper Tooting. Holy Trinity, Upper Tulse Hill. Roman Catholic, Nightingale Square. St. Leonaid's St. Mary's, Balham. Sunnyhill Road. In Tooting :— Fountain Road. Roman Catholic, Undine Street. In Wandsworth :— Convent of the Sacred Heart. Earlsfield Special. Frogmore Special. Garratt Lane. Magdalen Road Temporary. Roman Catholic, North Side, Wandsworth Common St. Michael's. St. Thomas's. In all, 28 schools remained free from Diphtheria, compared with 14 in 1911. I11 only one school, viz.—All Saints, Putney, was it necessary to have swabs taken from the throats of the children, and all the swabs taken, 30 in number, were found to be negative. The swabbing was carried out owing to the occurrence of six cases of the disease in children in certain class rooms. The six cases occurred in two families, two in one and four in the other, but no spread to other children in attendance at school took place. The Medical Officer of Health, London County Council, instructed the teachers of the Departments concerned to exclude all children suffering from sore throat, and to forward particulars on special forms supplied to them. 69 Report of the Medical Officer of Health. In other three schools owing to the occurrence of cases the same course was taken, the schools in question being Sellincourt Road, New Park Road, and the County Secondary, West Hill. The precautions that are now taken with regard to this disease in elementary schools have proved most beneficial, and have been the means of checking the occurrence of multiple cases to a considerable extent. Of the total number of cases of Diphtheria, five or 1.1 per cent, occurred among children under one year, 113 or 26.2 per cent, among children from one to five years, 243 or 57.5 per cent, from five to 15 years, 37 or 8.6 per cent, from 15 to 25 years, and 33 or 7.6 per cent, from 25 to 65 years. Compared with the previous year there has been an increase at five to 15 years, and at 15 to 25 years. Of the 335 cases of Diphtheria removed to Hospital, 41 were reported not to have suffered from Diphtheria. Return Cases of Scarlet Fever and Diphtheria. 39 cases of Scarlet Fever occurred after the return of cases from the hospitals of the Metropolitan Asylums Board, compared with 52 in 1911, 40 in 1910, and 46 in 1909. There were also two cases of Diphtheria, compared with two in 1911, one in 1910, and four in 1909. Six of he return cases occurred in Clapham, six in Putney, 14 in Streatham, n in Tooting and two in Wandsworth. 70 Report of the Medical Officer of Health. One of the return cases of Diphtheria occurred in Streatham, and the other in Wandsworth. The following Table shows the date of removal to hospital of the first case, the date of return from hospital, the number of days the first case was in hospital, the date of the first symptoms of the subsequent case, and the number of days elapsing between the return of the first case and the first symptoms of the subsequent case or cases. The average number of days the cases of Scarlet Fever were in hospital was 66.0, compared with 69.9 in 1911, and in the cases of Diphtheria 43 days, compared with 70 in 1911. In seven premises more than one case occurred after the return of a case from hospital, four cases each in two premises, and two cases each in five premises. In seven of the cases complaint was made that the patients suffered from nasal discharge. 71 Report of the Medical Officer of Health. TA BLE XLII. Return Cases oi Scarlet Fever. Sub-Districts No. Removed to Hospital. Returned from Hospital. No. of days 1st case was in Hospital. Date of 1st symptoms of subsequent case. No. of days elapsing between return of 1st case and 1st symptoms of subsequent case. Remarks. Clapham 1 1911 Sept. 28th 1911 Dec. 20th 83 191 Dec. 27th 7 2 Nov. 6th ,, 23rd 47 ,, 29th 6 Same family 3 ,, ,, ,, ,, 47 ,, ,, 6 4 1912 May 2nd 1912 July 6th 65 1912 July 12th 6 Same family 5 Sept. 4th Oct. 23rd 49 Nov. 3rd 11 Sore nose and cold in eye 6 ,, 16th Nov. 13th 58 „ 20th 7 Putney 7 1911 Nov. 16th 1912 Jan, 26th 71 Jan. 29th 21 Same family 8 ,, ,, ,, ,, 71 Feb. 1st. 6 9 ,, ,, ,, ,, 71 ,, 7th 12 10 ,, ,, ,, ,, 71 ,, 17th 12 11 1912 Sept. 9th Nov. 25th 77 Nov. 29th 4 Same family 12 ,, ,, ,, ,, 77 Dec. 15 th 19 Streatham ... 13 1911 Nov. 16th 1911 Dec. 29th 43 Jan. 2nd 4 14 Oct. 18th 1912 Jan. 31st. 105 Feb. 8th 8 15 1912 Jan 1st. Feb. 21 st. 51 „ 25th 4 16 1911 Nov. 19th Jan. 15th 57 „ 20th 36 Same family 17 ,, ,, ,, ,, 57 Mch. 12th 57 18 1912 Feb. 25th April 15th 50 May 5th 20 19 May 3rd June 26th 54 July 20th 24 Nasal discharge Same family 20 ,, ,, ,, ,, 54 „ 18th 22 21 „ 10th July 10th 61 „ 27th 17 Nasal discharge 22 July 8th Aug. 23rd 46 Sept. 14th 22 23 ,, 2nd Oct. 11th 101 Oct. 23rd 12 Nasal discharge 24 Sept. 6th „ 28th 52 „ 30th 2 Desquamating 25 „ 14th Nov. 1st. 48 Nov. 6th 5 Desquamating and Nasal discharge 26 Oct. 21st Dec. 9th 49 Dec. 18th 9 Tooting 27 1911 Sept. 1st. 1911 Dec. 24th 114 Jan. nth 18 28 Nov. 1st 1912 Jan. 15th 75 Feb. 5th 21 Nasal discharge 29 Dec. 16th „ 29th 44 ,, 21st 23 30 Oct. 26th Jan. 20th 86 Feb, 10th 21 Same family 31 ,, ,, ,, ,, 86 „ 25th 36 32 ,, ,, ,, ,, 86 „ 29th 40 33 ,, ,, ,, ,, 86 Mar. 8th 48 34 1912 Oct. 2nd Nov. 16th 45 Nov. 29th 15 35 Sept. 13th ,, 4th 52 8th 4 36 Oct. 11 th „ 30th 50 Dec. 23rd 23 Swollen glands, desquamating and Nasal discharge. 37 ,, ,, ,, ,, 50 25th 25 Wandsworth 38 1911 Aug. 6th 1911 Dec. 23rd 139 Jan. 1st 9 Same family. 39 1912 Jan. 11th 1912 Mar. 20th 69 Mar. 23rd 3 72 Report of the Medical Officer of Health. TABLE XLIII. Return Cases of Diphtheria. Sub-District. No. Removed to Hospital. Returned from Hospital. No. of days 1st case was in Hospital. Date of 1st symptoms of subsequent case. No. of days elapsing between return of 1st case and 1st symptoms of subsequent case. Remarks. Streatham I 1912 Aug. 2ist 1912 Oct. 3rd 43 1912 Oct. 14th 11 Wandsworth 2 Aug. 20th Oct. 3rd 44 Oct. 8th 5 Enteric Fever. 71 cases of Enteric Fever were notified during the year (16 from Clapham, eight from Putney, 18 from Streatham, eight from Tooting, and 21 from Wandsworth), compared with 58 in 1911, 54 in 1910, and 66 in 1909. 54 of the cases were removed to hospital where seven died, and 17 were treated at home with one death. The total number of deaths was eight, (two in Clapham, none in Putney, none in Streatham, one in Tooting, and five in Wandsworth), compared with nine in 1911, eight in 1910, and six in 1909. The number of deaths was one less than in 1911, and 6.5 under the decennial average. The proportion of cases notified per 1,000 of population was .22, compared with .18 in 1911, .18 in 1910, .22 in 1909, and with .15 for the whole of London. The corrected death-rate from Fever was .02 per 1,000, compared with .03 in 1911, .02 in 1910, and .02 in 1909; while the rate for the whole of London was .025, compared with .03 in 1911, .04 in 1910, and .03 in 1909. Report of the Medical Officer of Health. 73 Of the 54 cases removed to hospital, nine or 16 6 per cent, were found not to be suffering from Enteric Fever, compared with 19 04 per cent, in 1911. The Chart (facing page 58), shows the number of cases notified during each week of the year. In 13 of the weeks during the year no cases were notified, one case each in 19 of the weeks, two cases each in 13 of the weeks, four cases each in six of the weeks, and one case in five of the weeks. The maximum number of cases, viz.—five, was notified in the second week of February. Of the 71 cases notified 10 were not Enteric Fever, one occurred in H.M. Prison, and one in the Middlesex County Asylum, leaving 59 cases in which special enquiries were made as to the probable cause of the disease. In six of the cases the disease was probably contracted by eating shell-fish, in six it was contracted outside the Borough (four of these being also included in those infected by previous cases), in 14 the infection was contracted from previous cases, in seven probably from watercress, while in 30 no history of infection could be ascertained. With regard to the six cases caused by shell-fish, five were from oysters, and one from winkles. In the cases contracted outside the Borough, six in number, it was impossible to ascertain the exact source of infection, but in four of the cases it was probably from another case in the same family which had been removed from another district in London to the East London Hospital about the first of April, 10 days before the symptoms appeared in the cases notified in this Borough. Of the total number of cases infected in all probability by eating shell-fish, one died, of the 14 infected by previous cases six died, while in the case of one death no definite history of infection could be ascertained. Report of the Medical Officer of Health. 74 Of the 10 cases which were not Enteric Fever two were fatal, one from Tubercular Meningitis, and the other from Acute Septic Endocarditis. Of the cases infected by previous cases, two occurred in Putney infected by a primary case which had been caused by oysters taken in Paris ; one in Clapham infected by a previous case notified in December, 1911 ; the other four in Clapham were infected by a case which had not been diagnosed for nearly six weeks, and which had been probaDly caused by eating watercress, and another one in Clapham was infected by a case in which the cause of infection was not ascertained. Another group of four cases occurred in Tooting which had been infected by a previous case, but as the patient had only a few days before the first symptoms appeared, come to reside in this Borough, the origin of the first case could not be definitely ascertained. Cases of Mistaken Diagnosis. In 88 cases (36 of Scarlet Fever, 41 of Diphtheria, nine of Enteric Fever, one of Cerebro-Spinal Fever, and one of Polio-Myelitis) information was received from the Metropolitan Asylums Board's and other hospitals, that the patients were not suffering fiom the disease notified or any other notifiable disease, compared with 102 in 1911, 107 in 1910, and 112 in 1909. Of the 1,118 cases removed to hospital, in 88 or 7.8 per cent, the diagnosis was incorrect, compared with 8.5 per cent, in 1911, 12.6 per cent, in 1910, and 9.5 per cent, in 1909. There has been a slight decrease in the percentage of cases of mistaken diagnosis. 75 Report of the Medical Officer of Health. TABLE XLIV. Disease. No. of cases of mistaken diagnosis. Total. Total cases removed. Percentage of j error in Diagnosis. Clapham. Putney. Streatham. Tooting. Wandsworth. Scarlet Fever 4 4 14 5 9 36 725 4. Diphtheria 3 7 9 7 10 41 335 12.2 Enteric Fever 3 1 1 ... 4 9 54 16. Cerebro-spinal Meningitis ... ... ... 1 ... 1 1 100.0 Polio-Myelitis ... ... ... ... 1 1 3 33.3 Total '5 12 24 .3 24 88 1,118 78 In 1911 the percentage of cases of mistaken diagnosis for the whole of London was, for Scarlet Fever 87, compared with 9.5 in 1910 ; for Diphtheria 127, compared with 14.1 ; and for Enteric Fever 34'2, compared with 24.8. Cerebro-spinal Meningitis. Three cases were notified during the year (two in Tooting, and one in Wandsworth), compared with five in 1911. Two of the cases died, one from Cerebro-spinal Meningitis and one from Posterior basal Meningitis. The third case was not Cerebro-spinal Meningitis. In London 105 cases of this disease were notified during the year, compared with 101 in 1911. 21 deaths were registered as having been caused by Meningitis, six in Clapham, two in Putney, four in Streatham, six in Tooting, and three in Wandsworth, compared with 25 in 1911. 76 Report of the Medical Officer of Health. Eight of these were of infants under one year, three from one to two years, three from two to five years, and seven over five years. As in previous years inquiries were made from the medical attendant, and in all the cases the deaths were stated to have been caused by simple Meningitis. Bacteriological Examinations. During the year 841 bacteriological examinations were made at the Lister Institute, compared with 624 in 1911, 318 in 1910, 397 in 1909, 491 in 1908, 466 in 1907, 407 in 1906, 174 in 1905, 121 in 1904, 125 in 1903, 98 in 1902, and 66 in 1901. The following Table shows the number of examinations in each sub-district and for the whole Borough, also the disease for which the examination was made and the result of such examination TABLE XLV. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. Diphtheria. Negative 59 197 138 22 159 575 Positive 36 71 46 10 70 233 Enteric Fever. Negative 3 3 5 3 7 21 Positive ... 7 2 2 1 12 Totals 98 278 191 37 237 841 In 233 out of 808 examinations for the bacillus of Diphtheria the result was positive, and in 12 out of 33 examinations of blood in suspected cases of Enteric Fever the Widal re-action was obtained. The increase in Putney was due to the examination on three occasions of all persons in an Institution in which several cases of Diphtheria occurred. 77 Report of the Medical Officer of Health. Puerperal Fever. 27 cases of Puerperal Fever were notified, compared with 24 in 1911, 20 in 1910, and 26 in 1909. One case occurred in Clapham, four in Putney, six in Streatham, six in Tooting, and 10 in Wandsworth. 11 of the cases, (one in Clapham, two in Putney, two in Streatham, four in Tooting, and two in Wandsworth), or 40 per cent, were fatal, compared with 33 3 per cent in 1911, 25 per cent, in 1910, and 38'4 per cent, in 1909. 21 of the cases were removed to Institutions, (12 to St. James's Infirmary, five to the Metropolitan Asylums Board's Hospital, Landor Road, and one each to St. Bartholomew's, Guy's, St. Thomas's, and Putney Hospitals), where nine died, and six were treated at home with two deaths. The death-rate was. .035 per 1,000, compared with .025 in 1911, .016 in 1910, and .034 in 1909. The case-rate per 1,000 births was 4.0, compared with 3.5 in 1911, 2.8 in 1910, and 37 in 1909 ; and for the whole of London 3.4, compared with 27. In seven of the cases registered mid wives only were employed, while five of the cases were miscarriages, and three were premature. No nurses had free baths, one came from Lambeth, eight were district or surgical nurses, and the remainder had baths at their own homes. In 26 cases the personal clothing of the nurse was disinfected. 78 Report of the Medical Officer of Health. Erysipelas. 207 cases of Erysipelas were notified during the year and five deaths occurred. 45 of the cases and one of the deaths occurred in Clapham, eight cases and no death in Putney, 47 cases and no death in Streatham, 30 cases and no death in Tooting, and 77 cases and four deaths in Wandsworth. In 191 x the number of cases notified was 202, and the deaths 10. 45 of the cases were removed to the Union Infirmary, where one died. fleasles. During the year 51 deaths, 20 of males and 31 of females, were due to Measles, compared with 230 in 1911, 44 in 1910, and 108 in 1909. 19 of the deaths occurred in Clapham, two in Putney, four in Streatham, three in Tooting, and 23 in Wandsworth. The number of deaths is 189 less than in 1911, and 59 under the corrected decennial average. Seven of the deaths were of infants under one year, 20 from one to two years, 19 from two to five years, and five from five to 15 years ; 90 per cent, of the deaths having occurred under five years of age. The death-rate was "i6 per 1,000, compared with 74 in 1911, .14 in 1910, and '37 in 1909. The death-rate for the whole of London was .40, compared with .56 in 1911, for England and Wales .35, and for the 95 Great Towns .47, for the 146 smaller towns .35, and for England and Wales, less the 241 towns, .20 per 1,000. Report of the Medical Officer of Health. 79 During the year 1,802 visits were made in cases of this disease, (compared with 4,136 in 1911), 401 in Clapham, 114 in Putney, 331 in Streatham, 243 in Tooting, and 713 in Wandsworth. Table XLVI. shows the number of cases of notifiable and non-notifiable diseases notified by the teachers of the elementary schools in the Borough. In all, 4,706 cases were notified, compared with 6,785 in 1911, 4,617 in 1910, and 4,342 in 1909. 1,095 of these were cases of Measles, 763 of Chicken-pox, 1,014 of Whooping Cough, 551 of Mumps, and 379 of Ringworm. There was a large decrease in the number of cases of Measles, a slight decrease in the number of cases of Mumps and Ringworm, and an increase in the number of cases of Chicken-pox and Whooping Cough. With regard to Measles, 276 cases were notified from schools in Clapham, 68 in Putney, 155 in Streatham, 130 in Tooting, and 466 in Wandsworth. The schools chiefly affected were, in Clapham, Bonneville Road, Cavendish Road, Telferscot Road, New Park Road and St. Andrew's Street ; in Putney, All Saints' and St. Mary's ; in Streatham, Mitcham Lane and Smallwood Road; in Tooting, Franciscan Road; and in Wandsworth, Brandlehow Road, Waldron Road, Wandle, Garratt Lane and Riversdale. Very few of the schools were quite free from the disease, and in a considerable proportion only a few cases occurred. As in former years the means adopted for the prevention of the spread of the disease were exclusion from school, education of the parents of children where cases had occurred by means of the pamphlet published in last year's Report, and disinfection of the premises after cases had recovered. 8o Report of the Medical Officer of Health. TABLE XLVI. Notifiable and Non-Notifiable Diseases Reported from Schools during 1912. School. Diseases. Scarlet Fever. Diphtheria. Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Clapham— Aristotle Road 1 ... ... ... ... ... ... ... 1 Bonneville Road 11 2 35 14 69 12 8 4 155 Cavendish Road 12 1 31 9 8 ... 3 2 66 Christchurch 3 ... 11 1 3 12 1 3 34 Clapham Parochial 8 3 3 1 1 ... 3 1 20 Haselrigge Road 8 4 25 9 26 6 10 27 115 Larkhall Lane 8 ... 19 15 10 3 2 4 61 Lyham Road ... ... ... 2 2 ... ... ... 4 New Park Road 12 11 39 28 22 1 4 7 124 New Road ... ... 4 ... ... ... 1 ... 5 St. Andrew's Street 9 1 35 13 5 12 6 9 90 St. John's 2 ... 10 1 6 ... 4 ... 23 St. Mary's 1 ... 11 ... 1 ... ... ... 13 Telferscot Road 9 7 45 31 32 6 8 ... 138 Wirtemberg Street 3 ... 8 3 7 ... 1 ... 22 Total 87 29 276 127 192 52 51 57 871 Putney— All Saints' 4 9 27 ... ... 2 2 2 46 Conv. of Sacred Heart 1 ... ... ... ... ... ... ... 1 Hotham Road 1 6 2 36 2 94 8 5 154 Roehampton National ... ... ... ... ... ... ... 8 8 St. Mary's 3 3 39 9 18 57 5 1 135 Upper Grade 1 2 ... ... ... ... ... ... 3 Total 10 20 68 45 20 153 15 16 347 Streatham— Broadwater Road 33 2 4 16 6 3 3 7 74 Christchurch ... 1 9 ... ... 8 1 ... 19 Eardley Road 6 7 3 23 1 8 4 1 53 Fircroft Road 12 3 10 1 12 ... 9 10 57 Holy Trinity, Balham 6 ... 3 1 3 2 3 ... 18 Holy Trinity, Streatham ... ... ... 2 ... ... ... 1 ... 3 Hearnville Road 6 1 ... 11 32 4 1 ... 55 Hitherfield Road 1 ... 1 5 20 1 ... ... 28 Immanuel 6 1 ... ... 9 ... 4 ... 20 Mitcham Lane 10 1 50 18 19 64 21 3 186 Nightingale Sq., R. C. 1 ... ... ... 5 ... 9 ... 15 Oldridge Road 3 3 24 40 43 1 24 4 142 Smallwood Road 11 3 39 8 37 2 11 6 117 St. Andrew's, Colmer Road ... 1 1 1 17 ... ... ... 20 St. Andrew's, Polworth Road 4 2 ... ... ... 18 2 ... 26 St. Leonard's... 5 ... 4 10 10 ... 5 3 37 St. Mary's 6 ... 3 3 21 18 3 ... 54 Sunnyhill Road 7 ... 2 38 27 ... 6 ... 80 Total 117 25 155 175 262 129 107 34 1,004 Carried forward 214 74 499 347 474 334 173 107 2,222 8r Report of the Medical Officer of Health. TABLE XLVIII.—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 214 74 499 347 474 334 173 107 2,222 Tooting— Ensham Street 27 3 34 6 2 7 3 17 69 Fountain Road 10 ... 38 12 36 12 9 27 144 Franciscan Road 16 3 24 95 22 3 6 ... 169 Sellincourt Road 20 7 19 18 28 32 6 18 148 Tooting Graveney 25 4 30 7 37 8 19 18 148 Undine Street 8 15 ... ... ... ... ... 23 Total 106 17 130 138 125 62 43 80 701 'Wandsworth— All Saints' 1 2 15 4 17 ... 7 2 48 Brandlehow Road 13 3 63 10 40 9 9 8 155 Cambourn Road ... ... 21 3 2 2 1 1 30 County Secondary ... 2 ... ... ... ... ... ... 2 Earlsfiela 8 9 24 52 37 8 7 8 153 Elliott Central 5 1 13 18 41 ... 8 1 87 Eltringham Street 4 5 2 16 15 28 12 7 89 Frogmore ... ... ... ... 1 ... ... ... 1 Garratt Lane 4 1 60 13 27 34 !7 16 172 Littleton Street 1 1 ... 1 ... ... ... ... 3 Magdalen Road 2 ... 12 ... 12 17 7 6 56 Merton Road 16 3 38 22 15 1 13 2 110 Riversdale 8 3 43 28 40 6 7 4 139 R.C., Wandsworth Common 1 ... ... ... ... ... ... ... 1 St. Anne's 7 2 20 1 9 3 3 45 St. Faith's 2 3 2 5 27 8 5 ... 52 St. Joseph's ... 1 19 ... 2 1 4 2 29 St. Michael's 5 42 4 15 ... 2 4 72 St. Thomas's 1 ... ... ... ... ... 1 Swaffield Road 15 15 12 22 61 19 23 1 168 Waldron Road 6 2 47 8 7 6 12 1 89 Wandle 9 4 6 44 31 3 14 11 122 Warple Way 2 1 25 16 2 11 4 20 81 West Hill 6 6 2 11 14 2 8 29 78 Total 116 64 466 278 415 155 163 126 1,783 Grand Total 436 155 1,095 763 1,014 551 379 313 4,706 f 82 Report of the Medical Officer of Health. It will be seen from Table XLVI. as well as from the Table of the number of disinfections carried out, that the disease was most prevalent in November and December, and as in these months the climatic conditions are such as to favour the occurrence of the more fatal complications of Measles, the case mortality was in these months high. In nearly all the cases Bronchitis or Pneumonia was given as the secondary cause of death. The number of exclusions in each month was as follows :— In February two, in April two, in May 16, in June 14, in July 19, in September 10, in October 18, in November 35, and in December 30. There were no exclusions in the months of January, March or August. 83 Report of the Medical Officer of Health. TABLE XLVII. No. School. Class-room. Period of exclusion. No. of days. 1 Mitcham Lane, Streatham Infants,Room A&B Feb. 7th—23rd 17 2 WaldronRd., Wandsworth „ Room C ,, 22nd—28th 7 3 New Park Road, Clapham „ under 5 years Apr. 25th—24th May 30 4 New Road, Clapham ,, Room E & E2 „ 26th—3rd ,, 8 5 Bonneville Road, Clapham ,, under 5 years May 13th—24th ,, 12 6 Haselrigge Road, Clapham „ Room G 2 ,, ,, ,, ,, 12 7 Telferscot Road, Clapham ,, ,, A ,, ,, ,, ,, 12 8 All Saints', Putney ,, ,, E ,, ,, ,, ,, 12 9 Bonneville Road, Clapham ,, under 5 years „ 9th— „ ,, 16 10 All Saints', Putney „ Room D ,, 20th ,, ,, 5 11 Earlsfield, Wandsworth ,, „ A ,, ,, ,, ,, 5 12 Bonneville Road, Clapham ,, ,, B „ „ —31st „ 12 13 14 Christchurch, Streatham Hill Tooting Graveney,Tooting „ „ A& B „ ,, B ,, ,, ,, ,, „ 23rd—7th June 12 16 15 All Saints', Putney „ „ A ,, ,, ,, ,, 16 16 Larkhall Lane, Clapham ,, ,, D ,, ,, ,, ,, 16 17 Tooting Graveney,Tooting „ ,, E „ 24th— ,, ,, 15 18 Larkhall Lane, Clapham ,, „ E „ 29th— „ „ ,, ,, 9 19 Telferscot Road, Clapham ,, „ B ,, ,, ,, ,, 9 20 All Saints', Putney ,, „ F ,, ,, ,, ,, 9 21 22 St. Andrew's, Colmer Road, Streatham Tooting Graveney,Tooting ,, ,, B „ „ C June 3rd—14th „ ,, ,, -7th ,, 12 5 23 St. Mary's, Putney ,, „ A ,, ,, 14th ,, 12 24 Haselrigge Road, Clapham ,, ,, A,A I, B & F ,, ,, ,, ,, 12 25 Ensham, Tooting ,, ,, D ,, 5th- ,, ,, 10 26 ,, ,, ,, ,, „ B ,, 7th- ,, ,, 8 27 Cavendish Road, Clapham „ C & E „ 6th— ,, ,, 9 F2 «4 Report of the Medical Officer of Health. TABLE XLV1I.—continued. No. School. Class-room. Period of exclusion. No. of days. 28 Tooting Graveney,Tooting Infants, Room F June 7th—21st 15 29 Bonneville Road, Clapham ,, ,, D „ 14th— „ 8 30 Telferscot Road, Clapham ,, ,, C „ 19th—28th 10 31 All Saints', Wandsworth ,, ,, B „ 20th— „ 9 32 Tooting Graveney,Tooting ,, ,, D ,, ,, —5th July 16 33 Larkhall Lane, Clapham ,, ,, A ,, ,, — 12th „ 23 34 Warple Way, Wandsw'th „ „ C ,, 27th—3rd „ 8 35 Bonneville Road, Clapham ,, ,, C July 1st—12th ,, 12 36 Franciscan Road, Tooting „ „ H ,, ,, ,, ,, 12 37 Sellincourt Road, Tooting „ ,, A „ 3rd—19th „ 17 38 St. Mary's, Putney ,, ,, A „ 4th—25th ,, 22 39 New Road, Clapham ,, „ E & E2 „ 8th—I2th „ 5 40 St. Michael's,Wandsworth „ „ B ,, 5th—19th ,, 15 41 Earlsfield, Wandsworth ,, ,, E ,, ,, ,, ,, 15 42 Hotham Road, Putney ,, ,, A ,, ,, ,, ,, '5 43 Larkhall Lane, Clapham ,, ,, D „ 8th—25th „ 18 44 Franciscan Road, Tooting ,, ,, B ,, ,, ,, ,, 18 45 St. Mary's, Putney ,, ,, D ,, 11 th- ,, ,, 15 46 Larkhall Lane, Clapham ,, ,, E ,, 112th ,, ,, 14 47 West Hill, Wandsworth „ ,, A&C ,, ,, ,, ,, 14 48 Earlsfield, Wandsworth ,, ,, F „ 15th— „ „ 11 49 Wirtemberg St., Clapham ,, ,, C ,, ,, ,, ,, 11 50 Fircroft Road, Balham ,, ,, A ... „ 18th— „ „ 8 51 St. Mary's, Putney 11 11 ^ ••• ,, 19th— ,, ,, 7 52 Holy Trinity, Balham ,, „ J ,, ,, ,, ,, 7 53 Franciscan Road, Tooting „ „ A&H „ 22nd—25th „ 4 54 Fircroft Road, Balham „,, D Sept. 5th—13th Sept. 9 85 Report of the Medical Officer of Health. TABLE XL VII.—continued. No. School. Class-room. Period of exclusion. No. of days. 55 St. Leonard's, Streatham Infants, Room A Sept. 5th—13th Sept. 9 56 New Road, Clapham ,, ,, E 2 ,, ,, ,, ,, 9 57 All Saints', Wandsworth „ „ C „ 16th—20th ,, 5 58 Brandlehow Road, Wandsworth ,, ,, A. „ ,, 27'h ,, 12 59 Fircroft Road, Balham ,, ,, B ,, 19th ,, ,, 9 60 Cambourn Road, Wandsworth ,, ,, C „ l6th „ ,, 12 6l Fircroft Road, Balham ,, ,, D „ 19th—4th Oct. 16 62 Brandlehow Road,Wandsworth „ G „ 26th—3rd ,, 8. 63 Fircroft Road, Balham ,, ,, E „ 30th—nth „ 12 64 Smallwood Road, Balham ,, ,, A Oct. 3rd „ „ 9 65 New Road, Clapham ,, ,, E 2 ,, ,, ,, ,, 9 66 Smallwood Road, Balham „ „ B1 ,, „ 18th „ 16 67 Cambourn Road, Wandsworth „ „ A & B ,, ,, ,, ,, 16 68 Oldridge Road, Balham „ „ A „ 10th „ „ 9 69 Brandlehow Road, Wandsworth ,, ,, C ,, 4th ,, ,, '5 70 St. Joseph's, Wandsworth ,, ,, B ,, 14th—1st Nov. 19 7i Smallwood Road, Balham ,, ,, B 2 ,, ,, ,, ,, '9 72 St. Michael's, Wandsworth „ „ B „ 17th—25th Oct. 9 73 Riversdale, Wandsworth ,, ,, E ,, 14th—8th Nov. 26 74 Riversdale, Wandsworth „ „ C ,, 17th ,, ,, 23 75 New Road, Clapham ,, ,, A „ 18th— 25th Oct. 8 76 Brandlehow Road,Wandsworth ,, ,, A ,, 24th—1st Nov. 9 77 Riversdale, Wandsworth ,, ,, G „ 28th—8th „ 12 78 Brandlehow Road, Wandsworth ,, ,, B „ 24th—15th „ 23 79 Merton Road, Wandsworth ,, ,, D ,, 25th ,, ,, 22 80 Riversdale, Wandsworth ,, „ D & F ,, 29th ,, 18 81 Brandlehow Road,Wandsworth „ „ C ,, 31st ,, ,, 16 86 Report of the Medical Officer of Health. TABLE XLVII.—continued. No School. Class-room. Period of exclusion. No. of days. 82 Garratt Lane, Wandsworth Infants under 5 years Nov. 5th—nth Nov. 7 83 Smallwood Road, Balham „ Room G „ 8th —22nd ,, 15 84 All Saints', Wandsworth ,, „ C ,, ,, ,, ,, 15 85 Oldridge Road, Balham „ under 5 years ,, ,, 29th „ 22 86 Oldridge Road, Balham ,, Room G „ 11 th—22nd „ 12 87 St. Andrew's, Street, Clapham „ „ A & C ,, ,, 13th Dec. 33 88 Fountain Road, Tooting ,, ,, H ,, ,, 22nd Nov. 12 89 Smallwood Road, Balham ,, ,, E ,, 18th „ „ 5 90 Merton Rd., Wandsworth ,, ,, F „ 13th ,, ,, 10 91 9 2 Waldron Road, Wandsworth Earlsfield, Wandsworth „ A, C & D ,, ,, A ,, 14th ,, ,, ,, ,, 29th ,, 9 16 93 94 Brandlehow Road, Wandsworth Fountain Road, Tooting ,, ,, D. ,, ,, G ,, 15th—22nd ,, ,, 14th ,, ,, 8 9 95 Earlsfield, Wandsworth ,, ,, F „ 18th—29th ,, 12 96 St. Michael's, Wandsworth ,, ,, D ,, ,, ,, ,, 12 97 Wandle, Wandsworth ,, under 5 years „ „ 6th Dec. 19 98 Garratt Lane, Wandsworth „ Hall „ „ 29th Nov. 12 99 New Road, Clapham ,, Room B 2 „ 22nd „ „ 8 100 Oldridge Road, Balham ,, ,, C „ 2oth „ „ 10 101 Oldridge Road, Balham ,, „ H ,, „ 6th Dec. 17 102 St. Andrew's Street, Clapham ,, „ B ,, ,, 29th Nov. 10 >03 All Saints' Wandsworth ,, „ B ,, 22nd—6th Dec. 15 IO4 Christchurch, Clapham ,, Unprotected in whole Dept. ,, ,,, , ,, 15 ,05 St. Michael's, Wandsworth „ Room C „ 25th „ „ 12 106 Fountain Road, Tooting ,, ,, E ,, ,, ,, ,, 12 107 Warple Way, Wandsworth ,, ,, D & E ,, ,, 13th ,, 19 108 Southfield, Wandsworth ,, ,, A ,, ,, 6th „ 13 87 Report of the Medical Officer of Health 87 TABLE XL VII —cot,tinned. No. School. Class-room. Period of exclusion. No. of days. 109 Swaffield Road, Wandsworth Infants, Room G Nov. 27th—6th Dec. 10 110 St. Andrew's St., Clapham ,, ,, A 1. ,, ,, ,, ,, 10 111 Sellincourt Road, Tooting ,, ,, D ,, ,, ,, ,, 10 112 Brandlehow Road, Wandsworth ,, ,, E Dec. 2nd—20th „ 19 113 St. Andrew's Street, Clapham ,, ,, A Nov. 29th—6th „ 8 114 New Road, Clapham ,, ,, G ,, -13th ,, 15 115 Sellincourt Road, Tooting ,, ,, A ,, -20th ,, 23 116 St. Michael's, Wandsworth ,, ,, E ,, —13th ,, 10 117 Southfield, Wandsworth ,, ,, B ,, ,, ,, ,, l6 118 St. Andrew's St., Clapham ,, ,, C B & E Dec. 2nd— ,, „ 12 119 Garratt Lane, Wandsworth ,, ,, C ,, ,, ,, ,, 13 120 Cavendish Road, Clapham ,, ,, B ,, 4th— „ „ 10 121 Cavendish Road, Clapham ,, all under 5 years „ „ —20th „ 17 122 Brandlehow Road, Wandsworth ,, Room B ,, ,, ,, ,, 17 123 St. Andrew's St., Clapham ,, ,, D ,, ,, ,, ,, 17 124 Magdalen Road, Wandsworth ,, ,, F ,, 5th- ,, ,, 16 125 Merton Rd., Wandswortli ,, „ B & F ,, ,, ,, ,, 16 126 Eltringham Street, Wandsworth ,, ,, C ,, ,, ,, ,, 16 127 Sellincourt Road, Tooting ,, ,, B ,, ,, ,, ,, 16 128 Earlsfield, Wandsworth „ „ A ,, 9th ,, ,, 12 129 Garratt Lane, Wandsworth ,, ,, D ,, ,, ,, ,, 12 130 Tooting Graveney, Tooting ,, ,, C ,, ,, ,, ,, 12 131 Waldron Rd , Wandsworth ,, ,, A. A 1 & C 1 ,, ,, ,, ,, 12 132 Hitherfield Rd., Streatham ,, ,, C ,, ,, ,, ,, 12 133 Cavendish Road, Clapham ,, ,, E ,, ,, ,, ,, 12 134 ,, ,, ,, ,, ,, C ,, ,, ,, ,, 12 135 ,, ,, ,, „ H 11 ,, 19th— ,, ,, 2 88 Report of the Medical Officer of Health. TABLE XLVII.—continued. No. Schotl. Class-rcotn. Period of exclusion. No. of days 136 Fountain Road, Tooting. Infants, Room H Dec. 16th—20th Dec. 5 137 Eailsfield, Wandsworth.. ,, ,, F ,, ,, ,, ,, 5 138 Waldron Road, Wandsworth ,, ,, D ,, ,, ,, ,, 5 139 St. Andrew's Street, Clapham ,, ,, F ,, ,, ,, ,, 5 140 Sellincourt Road, Tooting ,, ,, C, E 1 & F „ 12th „ „ 9 141 Waldron Road, Wandsworth ,, ,, G ,, ,, ,, ,, 9 142 St. Michael's, Wandsworth ,, ,, B ,, ,, ,, ,, 9 143 Cavendish Road, Clapham ,, ,, C ,, 9th ,, ,, 12 144 Brandlehow Road,Wandswort h ,, ,, C . „11th ,, ,, 10 145 Merton Road, Wandsworth ,, ,, D ,, ,, ,, ,, 10 146 New Road, Clapham ,, ,, E 1 & E 2 ,, ,, ,, ,, 10 The next Table shows the number of premises disinfected after Measles in each sub-district for each month of the year. The total number of premises disinfected was 1,006 (262 in Clapham, 64 in Putney, 165 in Streatham, 118 in Tooting, and 397 in Wandsworth), compared with 2,638 in 1911, 418 in 1910, and 1,012 in 1909. The greatest number of disinfections was carried out in December, this being due to outbreaks in Wandsworth. The greatest number of cases occurred in June, November and December. In the other months of the year the number of disinfections was small as there were very few cases in any part of the Borough. 89 Report of the Medical Officer of Health. TABLE XLVIII. Month. Clapham. Putney. Streatham. Tooting. W and.=worth. Whole Borough. January 1 ... 1 ... 2 4 February 2 ... 20 ... 2 24 March 5 ... 15 ... 1 21 April 14 1 3 ... 2 20 May 32 3 11 5 6 57 June 60 16 24 15 5 120 July 35 17 12 15 '5 94 August 23 10 4 3 14 54 September 6 1 13 8 11 39 October 15 6 10 13 51 95 November 25 7 20 28 104 184 December 44 3 32 31 184 294 Total 262 64 165 118 397 1,006 Whooping Cough. 57 deaths were registered during the year, 27 of males and 30 of females, a decrease of nine compared with 1911, and of 23 compared with the decennial average. 12 of the deaths occurred in Clapham, three in Putney, 12 in Streatham, 11 in Tooting, and 19 in Wandsworth. 29 of the deaths were of infants under one year, 17 of children from one to two years, and 11 from two to five years. The death-rate was '15 per 1,000, compared with "21 in 1911, •22 in 1910, '23 in 1909, and '22 for the whole of London in 1912. This disease, although more prevalent, was slightly less fatal in London and in this Borough in the year 1912 than in the two previous years. In the sub-district of Wandsworth it was more prevalent than in the other sub-districts. The number of cases notified from schools was 1,014, compared with 565 in 1911, 919 in 1910, and 538 in 1909, 415 of these being from schools in the sub-district of Wandsworth, the schools chiefly affected in that sub-district being Swaffield Road, Brandlehow Road, Elliott Central and Riversdale, and Streatham, where the schools chiefly affected were Oldridge Road and Smallwood Road. 90 Report of the Medical Officer of Health. There were also 192 cases notified from schools in Clapham the schools chiefly affected having been Bonneville Road and Telferscot Road. In Putney the school chiefly affected was Hotham Road; and in Tooting, Tooting Graveney and Fountain Road. The greatest mortality from Whooping Cough occurs among children under five years of age. Of the 57 deaths that occurred from this disease, 57 or 100 per cent, were deaths of children under five years. The pamphlet, published in the Report for 1910, was left at every house where a case of Whooping Cough had been notified from school, and also in all other known cases. During the year 1,075 visits were made by the Sanitary Inspectors in cases of Whooping Cough, 170 in Clapham, 38 in Putney, 255 in Streatham, 190 in Tooting, and 422 in Wandsworth. Other Diseases notified from Schools. In addition to the 1,095 cases of Measles and 1,014 of Whooping Cough notified by the teachers of elementary schools there were also notified 763 cases of Chicken-pox, 551 of Mumps, 379 of Ringworm, 16 of German Measles, 97 of inflammation of eyes, 81 of suspicious sore throat, 28 of Impetigo, 24 of Eczema, and 67 of other diseases. No action is at present taken by the Sanitary Authority after notification of these diseases, although all cases of suspicious sore throats are visited, so as to exclude the possibility of any of the cases being Diphtheria. Chicken-pox was most prevalent in Streatham and Wandsworth, Mumps in Putney and Wandsworth, and Ringworm in Streatham and Wandsworth. 91 Report of the Medical Officer of Health. Disinfection of Schools During the year the following schools were disinfected on account of the prevalence of Scarlet Fever, Diphtheria, Measles or Chicken-pox. (1) Private School, Balham. Four rooms disinfected after Diphtheria on the 21st February and 14th March. (2) Private School, Wandsworth. One room disinfected after Scarlet Fever on the 20th March. (3) Private School, Wandsworth. One room disinfected after Scarlet Fever on the 27th April. (4) Private School, Balham. Seven rooms disinfected after Diphtheria on the 15th May. (5) Bonneville Road, Clapham. Two rooms disinfected after Measles on the 16th May. (6) Private School, Wandsworth. Twelve rooms disinfected after Chicken-pox on the 25th and 26th July. (7) St. Mary's, Putney. Two rooms disinfected after Measles on the 29th July. (8) Ensham Street, Tooting. Sixty-six rooms disinfected after Scarlet Fever on the 4th and 5th October. (9) Littleton Street Special, Wandsworth. Four rooms disinfected after Scarlet Fever 011 the 25th October. (10) Private School, Wandsworth. One room disinfected after Scarlet Fever on the 26th October. (11) Private School, Wandsworth. One room disinfected after Diphtheria on the 8th November. 92 Report of the Medical Officer of Health. (12) Tooting Graveney, Tooting. Eight rooms disinfected after Scarlet Fever on the 9th November. (13) Broadwater Road, Balham. Five rooms disinfected after Scarlet Fever on the 23rd November. (14) Private School, Streatham. Three rooms disinfected after Diphtheria on the 29th November. (15) St. Andrew's Street, Clapham. Three rooms disinfected after Scarlet Fever on the 3rd December. (16) Private School, Wandsworth. One room disinfected after Scarlet Fever on the 14th December. (17) Private School, Tooting. Five rooms disinfected after Measles on the 21st December. Epidemic Influenza. 45 deaths, 22 of males and 23 of females, were due to this disease, compared with 24 in 1911, 55 in 1910, and 89 in 1909. There has thus been an increase of 21 deaths compared with the previous year, but a decrease of 28.6 compared with the corrected decennial average. 11 of the deaths occurred in Clapham, four in Putney, 14 in Streatham, two in Tooting, and 14 in Wandsworth. The death-rate was .14 per 1,000, compared with .08 in 1911, .18 in 1910, and .30 in 1909. 15 of the deaths were of persons from 25 to 65 years, and 19 of persons over 65 years. Diarrhoea. 85 deaths, 46 of males and 39 of females, occurred from all forms of Diarrhoea and Enteritis during the year, compared with 350 in 1911, 88 in 1910, 120 in 1909, 183 in 1908, 127 in 1907, and 307 in 1906. There has thus been a decrease of 265 in the number of deaths from these diseases compared with the previous year, and of 146.5 compared with the corrected decennial average. 93 Report of the Medical Officer of Health. Nine of the deaths occurred in Clapham, seven in Putney, 15 in Streatham, 25 in Tooting, and 29 in Wandsworth. In all the sub-districts there was a very large decrease compared with 1911. The death-rate was .27 per 1,000, compared with 113 in 1911, .30 in 1910, .41 in 1909, .64 in 1908, .46 in 1907, and 1.15 in 1906, and was the lowest on record. The total number of deaths of children under two years was 70, equal to a rate of .22 per 1000, compared with .97 in 1911, while the death-rate for the whole of London under two years was .31 per 1,000, compared with 1.17 The death-rate in the sub-districts was as follows:—In Clapham .15 compared with 1.13 in 1911; in Putney .24, compared with .98; in Streatham .15, compared with .80; in Tooting 70, compared with 1.53; and in Wandsworth .31, compared with 1.36. Of the total number of deaths registered, 60 or 70 per cent, were of infants under one year, compared with 78 per cent, in 1911, 75 per cent, in 1910, and 72 per cent, in 1909. The following Table shows the number of deaths from Diarrhoea and Enteritis under one year for the four quarters of 1912, and for the five previous years. TABLE XLIX. 1907. 1908. 1909. 1910. 1911. 1912. Total deaths under one year from Diarrhoea and Dysentery, including Epidemic Diarrhoea and Zymotic Enteritis in first quarter of the year 8 7 5 4 2 Do. in second quarter 2 7 4 6 5 4 Do. in third quarter 33 51 35 14 89 10 Do. in fourth quarter 22 9 8 11 8 3 Total deaths under one year from other forms of Enteritis in first quarter of year 12 13 15 9 ... 12 Do. in second quarter 6 9 11 9 11 11 Do. in third quarter 18 22 31 19 110 15 Do. in fourth quarter 26 18 15 16 40 4 94 Report of the Medical Officer of Health. 10 out of a total of 18 deaths from Diarrhoea, and 15 out of a total of 42 from Enteritis occurred in the third quarter of the year. The proportion of deaths in this quarter to total deaths from Diarrhoea is less than in any of the five previous years. The number of deaths from Diarrhoea, Zymotic Enteritis, and Enteritis under one year represents 11.6 per cent, of the total mortality at that age, compared with 33 per cent, in 1911, 12 per cent, in 1910, 15 per cent, in 1909, 19 per cent, in 1908, 13.8 per cent, in 1907, 33 per cent, in 1906, 211 per cent, in 1905, and 28'8 per cent, in 1904, so that the decrease of the mortality under one year was largely due to the decrease in the number of deaths of infants from the above causes. This ratio is the lowest yet recorded. The low rate from Diarrhoea and Enteritis was to be expected as the climatic conditions were during the third quarter of the year most unfavourable to the propagation of house flies, their comparative absence being noted in the district generally. There are other factors now in operation which tend to lessen the incidence of this disease, and chief among these may be noted the work of the Inspectors in visiting homes where births have occurred, and the instructions given to mothers, the more frequent inspections of yards, and the better paving of the same, the more rigid supervision of the removal of manure from stables, the increase of motor vehicles, the lessening of horse traffic with consequent diminution of horse manure in the streets, and the new system which has been largely adopted in this Borough in dealing with road surfaces by tar spraying. The influence of these last three factors is not sufficiently appreciated by the public generally. In s11 the deaths under one year from Diarrhcea and Enteritis, special inquires were mada, and the following Tables show the nature of the food given. Report of the Medical Officer of Health. 95 TABLE L. Method of Feeding. Age in Months. 0-3 3-6. 6-9. 9-12. Total. I.-Breast-fed only 6 ... 1 1 8 Do. and cows' milk 1 ... ... 1 2 Do. and food ... ... ... 1 1 2.—Cows' milk only 7 6 2 2 17 Do. and food 3 ... 1 1 5 3.—Condensed milk only 6 6 1 ... 13 Do. and food ... 1 ... ... 1 4.—Dried milk ... 1 ... ... 1 5.—Unknown 2 6 2 2 12 Totals 25 20 7 8 60 Of the total of 48 children who died from these diseases where the exact nature of the food given was ascertained, only eight, or 16.6 per cent, were nursed by the mother without the addition of any other food, and of these six died in the first three months. Three of these being delicate from birth. In 22, or 45 8 per cent., cows' milk, either alone or with farinaceous food was given; in 14 or 29.2 per cent., condensed milk only or condensed milk and farinaceous food was given; while in one dried milk only was given. In 12 cases, from various causes no information could be obtained. Of the 60 deaths 17 occurred in the Union Infirmaries and three in hospitals outside the Borough. 96 Report of the Medical Officer of Health. In 12 cases no information was obtainable and of the remaining 48, three were twin children, two of them being premature, and one had gastric catarrh and Ophthalmia Neonatorum from birth ; three were premature, one of whom was dying when visited ; one was in Victoria Hospital from three weeks to four months, then an in-patient at Vincent Square Hospital from four to nine months, and then in the Union Infirmary for two months where it died at the age of 11 months; another suffering from Hydrocephalus was an in-patient in two hospitals and died in the third; one had Whooping Cough at three months followed by Bronchitis and constant Diairhoea from four months, dying at the age of six months; another attended Victoria Hospital for six months for nasal obstruction and wasting; six were born delicate, one of whom was paralysed, and the father of another suffered from Pulmonary Tuberculosis, and the mother had to go out to work. Of the 12 in which no information was obtained, three had removed, one was a wrong address, and three were born in the Union Infirmary and died there. Of these three, two were twins, the mother dying at confinement; in one case the mother died of Enteric Fever 14 days after confinement, and the baby was taken to the Union Infirmary and died there; two, illegitimate, were born elsewhere and died in the Union Infirmary whilst the mothers were in a home in this Borough waiting to be placed in situations; one went from the Workhouse to the Union Infirmary and died there; and in one case only was information refused. In 34 of the 48 cases investigated the rubber dummy was in use. The next Table shows the result of the inquiiies made after these deaths, arranged in Wards, and there is also shown the number of infants who had been previously visited, the number of illegitimate infants, and the social status of the parents. It will also be seen in the Table that only four of the infants who died from Diarrhoea had been fed in accordance with the pamphlet left by the Inspectors, and also that of the total number of deaths in which information was obtained, viz.:—48, six were prematurely born, 11 were delicate from birth, and five were twin children. Of the four stated to have been fed n accordance with the instructions on the pamphlet, one suffeied from Hydrocephalus, and one from Whooping Cough. Report of the Medical Officer of Health. 97 TABLE LI. Clapham, North. Clapham, South. Putney. Streatham. Balham. Tooting. Southfield. Fairfield. Springfield. Borpvigh. Total Number of Deaths 3 2 5 2 7 22 6 3 10 60 Wholly breast-fed ... ... ... 1 1 4 ... 1 1 8 Otherwise fed ... 2 3 1 4 16 6 2 4 40 No information 1 ... 2 ... 2 2 ... ... 5 12 Previously visited (1912) ... 1 2 ... 2 11 2 2 2 22 „ (1911) 1 ... ... ... 1 1 1 ... 1 5 Fed according to pamphlet ... ... 1 ... ... ... 1 ... 2 4 Breast-fed ... ... ... ... ... 1 ... 1 1 3 Otherwise fed ... 1 2 ... 3 11 3 1 2 24 Illegitimate ... ... 4 ... 1 5 ... ... 1 12 Nurse children 1 ... ... ... 1 2 1 ... ... 5 Born outside Borough 1 ... 2 ... 1 3 1 ... 2 10 Premature ... ... 2 1 1 ... 1 ... 1 6 Delicate from birth ... 1 1 ... ... 4 2 1 1 11 Twin Children ... ... ... ... ... ... 1 2 2 5 Status of Parents:— Artisans ... 1 ... ... ... 6 3 ... 1 11 Labourers ... ... ... ... 1 1 ... ... 4 8 Domestic Servants ... ... ... ... ... 3 ... ... ... 7 Carmen ... ... ... ... 1 3 ... ... ... 4 Clerks ... ... ... 1 1 1 ... ... ... 4 Barmen ... ... ... ... ... 1 ... ... ... 2 Gardeners ... ... ... 1 ... 1 ... ... ... 2 Laundresses ... ... ... ... ... 1 ... ... ... 2 Porters ... ... ... ... ... ... ... ... ... 2 Baker ... ... ... ... 1 ... ... ... ... 1 Butcher ... ... ... ... ... ... ... ... ... 1 Brewer's Chemist ... ... ... ... ... 1 ... ... ... 1 Clothier ... ... ... ... ... ... ... ... ... 1 Coachman ... ... ... ... ... ... ... 1 ... 1 Flowerseller ... ... ... ... 1 ... ... ... ... 1 General Dealer ... ... ... ... ... ... ... ... ... 1 Greengrocer ... ... ... ... ... ... ... ... ... 1 Hospital Nurse ... ... ... ... ... 1 ... ... ... 1 Horse Dealer 1 ... ... ... ... ... ... ... ... 1 Live Stock Dealer ... ... ... ... ... 1 ... ... ... 1 Motor Engineer ... ... ... ... 1 ... ... ... ... 1 Oilman's Manager ... ... ... ... ... ... ... ... ... 1 Police Constable ... ... ... ... ... 1 ... ... ... 1 Schoolmaster ... ... ... ... ... ... ... ... ... 1 Tramcar Conductor ... ... ... ... ... 1 ... ... ... 1 Tiaveller ... ... ... ... 1 ... ... ... ... 1 Waiterss ... ... 1 ... ... ... ... ... ... 1 G 98 Report of the Medical Officer of Health. Infant Visiting. During the year the female Sanitary Inspectors have continued the work begun in 1905 in visiting the homes where births had occurred, and they have also had during the year, as is stated in their report, valuable assistance from several voluntary health visitors. "We have the honour of submitting to you a leport of our visits amongst infants during the year 1912. "We had the help of four voluntary workers, two of these came regularly for three months each, the other two were only able to help us very occasionally. "The total number of visits paid, including the re-visits and ineffectual visits, was 5,500, the ineffectual visits totalling 1,011, being highest in Springfield and lowest in Putney. "The largest number of these ineffectual visits have occurred on our second visits to the mothers, as so many were found to have removed and their new home address could not be traced. Whereever possible we have tried to follow up the mother in her new home and see that the sanitary conditions were satisfactory. "As will be seen we were unable to pay as many visits as in the previous year, there being a decrease of 1,000 in all, i.e., approximately 500 first and 500 second visits fewer than last year. No second visits were paid after September in Putney, Wandsworth or Clapham North Wards, and very few in the remaining wards on account of the large amount of time we had to give to the visiting of cases of Pulmonary Tuberculosis. "The total number of visits paid after notification and registration of births will be found in Table LIT, which also shows the method of feeding at the time of the first visit, and the number of ineffectual calls. 99 Report of the Medical Officer of Health. "The notifications in Springfield Ward were nearly as numerous as the births registered, and here the visits have accordingly been paid the earliest. "In other parts of the Borough, particularly Streatham and Balham, this has not been possible as the notifications have been less, and infants could only be visited after the registration of the births. "58 of the infants visited died during the year as against 150 last year, their ages at death in months being shown in Table L., 22 of these deaths occurred from Diarrhoea and Enteritis, 10 occurring in Tooting W ard. This shows a satisfactory decrease from the high total of 86 in the previous year, but there is an increase on that of 1909, which was only 19. The large decrease in the number of deaths from Diarrhoea was largely due to the humidity and coolness of the summer. "The number of deaths from Respiratory Diseases was 21, the deaths from this cause last year being 22. "Many infants die from prematurity previous to our visit, four deaths have occurred amongst those we have visited, and in one case the child was illegitimate. "Of the 3,059 infants visited, 73 were premature, 21 were delicate from birth, 13 were twin children and of these three died after our first visit. "There has been much difficulty in tracing the illegitimate births registered and very seldom are we able to pay a second visit as the mother has removed from the address shortly after the confinement. Many of those registered from the Workhouse have never been visited once as we were informed that the mother would not return to that address and her future address was unknown. "Four wrong addresses were given, three refused to give any information, 24 removed immediately after confinement (16 oMhese coming here for confinement only), and seven infants we found had died previous to our first visit, four of these deaths being due to prematurity. G 2 100 Report of the Medical Officer of Health. "Only two of the illegitimate infants visited died, one from prematurity and the other from Enteritis. "No inquiries were made in instances where the mothers were servants in large houses. "Nine infants were put out to nurse immediately after birth and five of those born in the Workhouse remained there. "Of the 151 illegitimate infants visited we were unable to trace 23 on our second visit, as the mother 01 guardian of the child had removed. "30 mothers were not natives of this Borough. "At the first visit 54 of these infants were wholly breast-fed, but on re-visiting we only found seven were still being suckled as many of the mothers had resumed work, but we were gratified to find that only three were using farinaceous foods, two using bread and Nestle's Milk, and one giving the breast and a little biscuit. "Table LIII. shows the number of re-visits and the method of feeding used, the average age at the second visit being from four to five months. "The proportion of infants entirely breast-fed on the first visit is the highest we have yet recorded, being 82.2 per cent., as against 81.6 per cent, in 1911, and 79.8 per cent, in 1910. "The number of those having milk and food in addition is slightly under the number for last year. The proportion of those being fed on breast and cows' milk is 4 per cent as against 3.6 in 1911. 101 Report of the Medical Officer of Health. "There is a decrease in the number of those being fed on cows' milk only, the percentage being 4.6 as against 5.4 in 1911, and 6.7 in 1910. "Those fed on condensed milk show a percentage of 3.3 as against 27 in 1911, and 3.4 in 1910. "With regard to the manner of feeding at our second visit, the proportion of those wholly breast-fed was 659, which is the highest percentage recorded. This compares with 63 6 in 1911 and 62.1 in 1910. "There is also a slight decrease in the use of farinaceous foods, while the proportion of those fed on cows' milk works out at 9.4 per cent, as against 11.08 in 1911, and I2.4 in 1910; and of condensed milk 4.05 per cent, as against 4.4 in 1911, and 4.2 in 1910. "The pamphlet containing advice on the feeding of infants has been much appreciated by the mothers. In several instances the midwives in our district have asked for a supply of copies in order to give them to expectant mothers, or immediately after the confinement before we should have visited in the usual course. We have often found the pamphlet produced on visiting the second or third baby. Many mothers have told us they have found the instructions there given helpful to them. "In the case of handfeeding of infants we found 587 mothers were using boat shaped bottles, and 74 long tube bottles. "Both boat and tube bottles were used in 23 instances, the tube usually being used at night, and in 42 cases the infant was fed by a spoon. "On our second visit 15 of the mothers had been wise enough to discard the tube bottle. " The use of 'dummies' or 'comforters' is still very common, although many mothers have discarded the rubber teat and use one made of some celluloid composition which they consider much more hygienic. 102 Report of the Medical Officer of Health. "1,019 mothers were wise enough not to begin the use of thecomforter, and 234 others had discarded the use of it on our second visit. 1,715 mothers made a practice of giving the baby the dummy though most of them assured us it was only occasionally when perhaps they too were busy to pacify the child on a washing day. On our second visit we found 94 of the mothers who had begun well by giving no dummy had resorted to the use of it. "With regard to the employment of midwives we found out of the 3,059 mothers visited 1,459 had availed themselves of their services, a considerably larger number than in the previous year. The proportion of unregistered midwives who have been found, to be practising is almost negligible, only 21 in the whole Borough as against 45 in the previous year. Quite half this number have been neighbours or relatives who have been called in an emergency. In the other cases the names have been sent on to the London County Council Public Control Department. "The sanitary defects found in the course of our work have been remedied, or if requiring stmctural work, referred to you. "50 intimation notices were served, and two statutory noticeswere required." Report of the Medical Officer of Health. 103 TABLE LI I. Clapham, North. Clapham, South. Putney. Streatham. Balham. Tooting. Southfield. Fairfield. Springfield. Borough. Infants visited 205 236 176 271 245 622 376 282 646 3.059 I. Breast-ted only 175 173 142 208 157 514 319 255 574 2,517 2. Otherwise fed 30 63 34 63 88 108 57 27 72 542 (a) Breast and cows' milk 7 23 6 17 24 32 3 2 9 123 (b) Breastand condensed milk 2 I I 5 13 8 5 7 3 4 58 (c) Breast, cows' milk and food 1 ... 1 3 4 6 2 ... ... 17 (d) Breast, condensed milk and food ... 3 ... 2 4 1 ... ... ... 10 (e) Breastand dried milk ... ... 1 ... ... ... ... 1 ... 2 (f) Breast and food 1 7 1 ... 14 13 2 2 2 42 (g) Cows' milk only 4 12 10 6 16 30 25 7 32 142 (h) Cows' milk and food ... 3 2 12 2 2 2 1 ... 24 (i) Condensed milk only 13 2 7 7 '5 15 14 10 20 103 (j) Condensed milk and food ... ... ... ... ... 1 ... 1 1 3 (k) Dried milk 1 ... ... ... 1 ... 1 ... 2 5 (l) Farinaceous and other foods 1 2 1 3 ... 3 1 ... 2 13 Ineffectual visits 43 67 42 82 79 187 150 107 254 1,011 104 Report of the Medical Officer of Health. TABLE LIU. Clapham North. Clapham South. Putney. Streatham. Balham. Tooting. Southfield. Fairfield. Springfield. Borough. Infants re-visited 57 151 47 179 188 280 121 128 279 1,430 1. Breast-fed only 43 92 34 112 117 168 83 96 198 943 2. Otherwise fed— (a) Breast and cows' milk 1 21 3 20 16 28 5 8 12 114 (b) Breast and condensed milk ... 5 1 8 9 10 ... 5 4 43 (c) Breast, cows' milk and food 2 3 ... 5 4 4 1 ... 4 23 (d) Breast, condensed milk and food ... 1 2 3 4 3 ... 1 3 '7 (e) Breast and food 2 6 ... ... 4 14 2 2 2 32 (/) Cows' milk only ... 5 18 5 4 19 30 15 7 32 135 (g) Cows' and condensed milk ... ... ... ... ... 1 ... 1 ... 2 (i) Cows' milk and food 1 2 ... 14 4 6 3 2 4 37 (i) Condensed milk only 2 2 ... 8 4 12 9 5 15 58 (/) Condensed milk and food ... 1 ... 3 6 2 2 1 2 17 (k) Dried milk only ... ... ... ... ... ... ... ... 1 1 (/) Farinaceous and other foods ... ... ... 2 1 2 1 ... 2 8 Totals 14 59 13 67 7i 112 3S 32 81 487 In all 3,059 infants were visited, compared with 3,518 in 1912, 3,448 in 1910, and 2,269 in 1909. It is satisfactory to observe that with the assistance of the voluntary workers, infants were visited in all the Wards of the Borough. 105 Report of the Medical Officer of Health. The total number of deaths among those visited was 58, five in Clapham, four in Putney, four in Streatham, 18 in Tooting, and 27 in Wandsworth. Table LIV. shows these deaths arranged in monthly age periods. The heaviest mortality occurred at three to four months, while no deaths occurred at nine to 10 and 10 to 11 months. The decrease in the deaths was largely due to the decrease in the number of deaths from Diarrhoea and Enteritis. It is a most significant fact that the number of deaths from Diarrhoea and Enteritis among 2,517 infants who were breastfed was only eight, or a percentage mortality of 31, while among 542 infants who were otherwise fed the number of deaths was 40 or a percentage mortality of 7.4. The mortality among infants otherwise fed was thus 42 times greater than those breast-fed. The mortality among the infants visited by the Inspectors was only 19 per 1,000, compared with 76 per 1,000, the rate for the Borough for the year. TABLE LIV. Wards Under 1 month 1-2 months. 2-3 months. 3-4 months. 4-5 | months. 5-6 months. 6-7 months. 7-8 1 months. 8-9 months. 9-10 months. 10-11 months. 11-12 months. Total. Clapham North 1 ... ... ... ... 1 ... ... ... ... ... ... 2 Clapham South 1 1 ... 1 ... ... ... ... ... ... ... ... 3 Putney ... 1 1 1 ... 1 ... ... ... ... ... ... 4 Streatham ... ... ... 1 ... ... ... ... ... ... ... ... 1 Balham ... ... 1 1 ... ... ... 1 ... ... ... ... 3 Tooting ... 2 6 2 ... 3 ... 1 2 ... ... 1 18 Southfield ... 1 1 2 ... 2 ... ... ... ... ... ... 7 Fairfield ... 1 ... 1 ... ... ... ... ... ... ... ... 3 Springfield 2 1 1 5 2 3 3 ... ... ... ... ... 17 Total 4 7 10 14 5 10 3 2 2 ... ... 1 58 106 Report of the Medical Officer of Health. The following pamphlet (containing additional information), was prepared in the early part of the year, and this has been distributed since May, and has been much appreciated by mothers. The pamphlet is on the lines of the model pamphlet drawn up by the Society of Medical Officers of Health. METROPOLITAN BOROUGH OF WANDSWORTH. ADVICE ON THE REARING AND FEEDING OF INFANTS. ADVICE TO MOTHERS. Keep yourself in good health. The health of your baby depends on your own during pregnancy. Take good and wholesome food at regular meals only. Do not take spirits, beer, stout or much tea, but rather milk or cocoa. When possible take exercise in the open air every day, and keep your window open night and day. 1. FEED YOUR BABY REGULARLY, BY THE CLOCK, NOT BY GUESS WORK OR WHENEVER IT CRIES. Babies get indigestion, feel uncomfortable, and cry if they are not fed at regular times. 2. NEVER GIVE YOUR BABY A DUMMY TEAT. It is simply a bad habit, and is dirty and dangerous. 3. As babies sometimes cry because they are thirsty, sips of warm water may be given. BREAST FEEDING MOTHER'S MILK IS THE BEST, CHEAPEST AND SAFEST FOOD FOR INFANTS. 1. Get your baby into good and regular habits of feeding. Babies form bad habits just as easily as grown-up people. 2. Keep the child at the breast about ¼-hour at each feed. 3. Do not feed more often than every two hours during the day and once between 11 at night and 6 in the morning. Never let the baby feed too fast. Wake the baby if asleep at feeding times. 4. The time between feeds should be gradually increased until by the beginning of the third month the breast is given every three hours, and at the age of six months five times in the day and not at all between 11 at night and 6 in the morning. The best times are 6 a.m., 10 a.m. , 2 p.m., 6 p.m., and 10 p.m. In this way the mother gets her rest at night and so does the baby's stomach. WEANING. Keep the baby on the breast entirely for nine months, if possible Never wean during July, August or September if you can help it. Wean slowly, giving first one feed of cows' milk a day, and then gradually increasing the number. Crusts of bread with butter or dripping and a lightly boiled egg may now be added. 107 Report of the Medical Officer of Health. BOTTLE FEEDING Give only milk until the baby is about nine months old. Do not give condensed milk or any other infant food unless ordered by a doctor. NEVER GIVE SEPARATED OR SKIMMED MILK TO A BABY. MILK.—Get good fresh milk twice a day. Boil it at once, pour it into a CLEAN jug, cover with a CLEAN cloth, and stand the jug in cold water. In hot weather the water should be changed often so as to be as cool and fresh from the tap as possible. BOTTLE—BOTTLES WITH LONG TUBES SHOULD NEVER BE USED. Wash the bottle and teat thoroughly with hot water after each feed, and keep them in clean cold water until the next feed. When "washing the teat turn it inside out and hold it under the tap. FEEDING.—Measure the milk carefully. Give the same amount at each feed, not more one time than another. If the child does not finish the feed, what is left should not be given again to the baby. Each meal should be made up as follows:— FOR AN INFANT UNDER 2 WEEKS OLD. Milk 1 tablespoonful. Water 2 tablespoonfuls. Cream ½ a teaspoonful. White Sugar ½ a teaspoonful. Mix and then warm. Give this every two hours during the day and every four hours during the night. FOR AN INFANT FROM A FORTNIGHT TO 2 MONTHS OLD. Milk 1½ tablespoonfuls, gradually increasing to 2. Water 3 tablespoonfuls. Cream 1 teaspoonful. White Sugar ½ a teaspoonful. Mix and warm. Feed as before. FOR AN INFANT BETWEEN 2 AND 3 MONTHS OLD. Milk 2½ tablespoonfuls, gradually increasing to 3. Water 2½ tablespoonfuls, gradually increasing to 3. Cream 1 teaspoonful. White Sugar 1 teaspoonful. Mix and warm. Feed as before. FOR AN INFANT BETWEEN 3 AND 4 MONTHS OLD. Milk 3 tablespoonfuls, gradually increasing to 4. Water 3 tablespoonfuls, gradually increasing to 4. Cream 1 teaspoonful. White Sugar 1 teaspoonful. Mix and warm. Give this every 3 hours during the day and once during the night. FOR AN INFANT BETWEEN 4 AND 6 MONTHS OLD. Milk 5 tablespoonfuls, gradually increasing to 6. Water 5 tablespoonfuls, gradually increasing to 6. Cream1½ teaspoonfuls. White Sugar 1 teaspoonful. Mix and warm. Give this every 3 hours during the day and once during. the night. 108 Report of the Medical Officer of Health. FOR AN INFANT BETWEEN 6 AND 9 MONTHS OLD. Milk 9 tablespoonfuls, gradually increasing to 11 Water 3 tablespoonfuls. Cream 1½ teaspoonfuls. White Sugar 1 teaspoonful. Mix and warm. Give this every 3 hours during the day and once during the night. After 9 months, 14 to 16 tablespoonfuls of milk may be given six times during the 24 hours, with the addition of one teaspoonful each of cream and white sugar. IT IS IMPORTANT THAT IN ALL CASES THE CREAM AND WHITE SUGAR SHOULD BE ADDED. NOTE—THE ABOVE INSTRUCTIONS ARE NOT INTENDED TO APPLY TO INFANTS WHO ARE ORDERED A SPECIAL DIET BY A DOCTOR. FROM ONE. YFAR UPWARDS.—Do not give butcher meat before the age of 18 months. Children must have no tea or stimulants, and such articles as pork, shell fish, fried fish, lobsters, baked pastry, new bread and hot takes are liable to cause CONVULSIONS, and must be carefully avoided. They should have three or four meals a day, and no food or sweets should be taken between meals. Beer and spirits are poison to a child and must never be given. RULES FOR DAILY USE.-Let the baby sleep in its own cot and lie in it during the day. A banana crate, box, basket or drawer serves equally well. If the child cries, see if the napkin wants changing, or if the baby is cold or not properly covered up. Never rock the baby. Wake the baby at the proper time for feeding. CLOTHING.—Give the baby a warm woollen vest with long sleeves, a soft knitted or flannel binder, a long flannel nightdress, and an outer dress. Do not use a tight or stiff binder. Never use flannelette. "Shorten" at 2-3 months old. Keep to the vest and one flannel petticoat and dress, but now put on warm stockings instead of socks. Bath the baby once a day, and wash it once a day as well, using very little soap. Dry thoroughly, especially in ears and all folds of skin. Undress and dress the baby quickly so that it does not catch cold. Babies must always be kept warm. The windows of the bedroom and living room, except at bath time, should always be kept open at the top, as wide as the weather will allow. The baby should be kept out of doors in the day time as much as possible, and may sleep out of doors in mild weather in a sheltered place. DO NOT GIVE SOOTHING SYRUPS, TEETHING POWDERS OR PURGES, WITHOUT THE DOCTOR'S ORDERS. Babies should be weighed regularly. 109 Report of the Medical Officer of Health. If a baby cries often, does not increase in weight, does not sleep, is frequently sick, is constipated, has diarrhoea, snuffles, has cold feet, has a discharge from the eyes, or has a rash on the body or under the napkin, it is not well and should be seen by a doctor. P. CALDWELL SMITH, M.A., M.D.. D.P.H.. Camb., Medical Officer of Health. Tuberculous Diseases. The total number of deaths from diseases of a Tuberculous nature was 366, compared with 389 in 1911, 351 in 1910, and 362 in 1909. 303 of the deaths were due to Pulmonary Tuberculosis, 28 to Tuberculous disease of the Brain, and 35 to other forms of Tuberculous diseases. The number of deaths from Pulmonary Tuberculosis and other Tuberculous diseases and the rates per 1,000 for the whole Borough and for the separate sub-districts are shown in the next Table. The corrected death-rate from Pulmonary Tuberculosis was .96 per 1,000, compared with .91 in 1911, .88 in 1910, and .94 in 1909; from other Tuberculous diseases .20 compared with .35, .29, and .35; and from all Tuberculous diseases 1.16 compared with 1.26, 117, and 1.29. TABLE LV. Sub-District. Pulmonary Tuberculous Other Tuberculous Diseases. Total. No. of Deaths. Rate. No. of Deaths. Rate. No. of Deaths. Rate. Clapham 70 1.16 11 .18 81 1.34 Putney 28 .97 4 .14 32 111 Streatham 71 .73 22 .22 93 .95 Tooting 31 .87 8 .22 39 1.09 Wandsworth 103 1.12 18 .20 121 1.32 Whole Borough 303 .96 63 .20 366 1.16 110 Report of the Medical Officer of Health. From all Tuberculous diseases the rates per 1,000 were lower in Clapham, Streatham and Tooting, but higher in Putney and Wandsworth than in 1911. With regard to Pulmonary Tuberculosis, the rates for Clapham and Streatham were below, and those for Putney, Tooting and Wandsworth above last year's rates. From other Tuberculous diseases the rate was .15 lower than in 1911. This rate was lowest in Putney and highest in Tooting and Streatham, and the rate for Pulmonary Tuberculosis was lowest in Streatham and highest in Wandsworth. The following Table shows the death rate per 100,000 from Pulmonary Tuberculosis for the whole Borough, and for the separate sub-districts for the year, as well as for the preceding 10 years. TABLE LVI. 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 Average for 10 years. 1912 Clapham 120 94 126 112 117 89 95 104 84 118 106 116 Putney 117 79 86 92 83 67 62 116 85 70 86 97 Streatham 60 63 83 72 76 73 87 60 65 85 72 73 Tooting 76 91 151 101 90 96 86 110 109 81 99 87 "Wandsworth ... 93 132 131 132 121 131 123 109 108 88 117 112 Whole Borough 90 94 112 102 100 95 96 94 88 91 96 96 Compared with the decennial average the rate was the same in the whole Borough, but the sub-districts of Clapham, Putney and Streatham have an increased rate compared with that average while Tooting and Wandsworth are lower, the former sub-district showing a reduction of 12 per 100,000. 111 Report of the Medical Officer of Health. The rate in Clapham for 1912 is slightly lower than it was in 1911, but is 10 above the decennial average, and in Putney it was only twice exceeded in the previous 10 years, viz.—in 1902 and 1909. In Tooting the rate is higher than it was in 1911, but is still 12 under the decennial average, and in Wandsworth ttie rate does not compare favourably with that for 1911, although it is five under the decennial average. This last sub-distric has always had a higher average mortality from Pulmonary Tuberculosis and although the rate is higher than it was in the three previous years, it is satisfactory to observe that in 1912 there has been a reduction compared with the decennial average. One death from Pulmonary Tuberculosis occurred in an infant under one year, two in persons from one to two years, 13 from five to 15 years, 44 from 15 to 25 years, 136 from 25 to 45 years, 87 from 45 to 65 years, and 20 over 65 years. From other Tuberculous diseases seven deaths occurred under one year, six from one to two years, 10 from two to five years, 21 from five to 15 years, five from 15 to 25 years, nine from 25 to 45 years, three from 45 to 65 years, and one over 65 years. Tne list which follows shows the occupation of those who died from Pulmonary Tuberculosis during the year. TABLE L VIJ. Males. Females Total. Labourers 27 — 27 Clerks 20 3 23 Shop Assistants 12 1 13 Painters 9 — 9 Carmen 6 — 6 Dressmakers — 6 6 Carried forward 74 10 84 112 Report of the Medical Officer of Health. TABLE LIX.—continued. Males. Females. Total. Brought forward 74 10 84 Domestic Servants — 5 5 Compositors 4 — 4 Factory Hands 3 1 4 Blacksmiths 3 — 3 Bootmakers 3 — 3 Mechanical Engineers 3 — 3 Plumbers 3 — 3 Warehousemen 3 — 3 Army Pensioners 2 — 2 Barmen 2 — 2 Cabdrivers 2 — 2 Charwomen - 2 2 Horsekeepers 2 — 2 Hotel Porters 2 — 2 Journalists 2 - 2 Laundry Hands 1 1 2 Milk Carriers 2 — 2 Nurses - 2 2 Plasterers 2 — 2 Police Constables 2 — 2 Seamen, R.N. 2 — 2 Tailors 2 — 2 Actress — 1 1 Architect 1 — 1 Baker 1 — 1 Bath Chair Attendant 1 — 1 Bookbinder 1 — 1 Bricklayer 1 — 1 Butcher 1 — 1 Candle Packer 1 — 1 Carpenter 1 — 1 Carpet Planner 1 — 1 Chef 1 - 1 Carried forward 129 22 151 Report of the Medical Officer of Health. 113 TABLE LIX.—continued. Males. Females. Total. Brough forward 129 22 151 Chieropodist 1 — 1 Civil Servant 1 — 1 Clerk in Holy Orders 1 — 1 Colonial Agent 1 — 1 Commercial Traveller 1 — 1 Conductor 1 — 1 Corn Miller 1 — 1 Draughtsman 1 — 1 Estate Agent 1 — 1 Gas Fitter 1 — 1 General Dealer 1 — 1 Gilder 1 — 1 Golf Caddie 1 — 1 Golf Stick Maker 1 — 1 Gunner, R.GA. 1 — 1 Helmet Trimmer — 1 1 Hosier 1 — 1 India Rubber Worker 1 — 1 Insurance Manager 1 — 1 Interpreter 1 — 1 Jute Manufacturer 1 — 1 Lamplighter 1 — 1 Librarian — 1 1 Licensed Victualler 1 — 1 Lieutenant, R.N. 1 — 1 Lift-Attendant 1 — 1 Marine Engineer 1 — 1 Market Porter 1 — 1 Metal Turner 1 — 1 Motor Mechanic 1 — 1 Musician 1 — 1 Needlewoman — 1 1 Printer's Machine Minder 1 — 1 Printer's Reader 1 — 1 Carried foiwar l 160 25 185 H 114 Report of the Medical Officer of Health. Carried forward 160 25 185 Prison Warder 1 — 1 Railway Porter 1 — 1 Schoolmaster 1 — 1 Secretary 1 — 1 Shopkeeper — 1 1 Signalman 1 — 1 Sign Writer 1 — 1 Stableman 1 — 1 Storekeeper 1 — 1 Sugar Boiler 1 — 1 Taxicab Driver 1 — 1 Wardrobe Dealer 1 — 1 Wardrobe Mistress — 1 1 Widows, Wives and Daughters of Artisans - 10 10 Widows, Wives and Daughters of Labouring Classes - 32 32 Widows, Wives and Daughters of Clerks, Tradesmen, &c. - 27 27 Children of Artisans 3 — 3 Children of Labouring Classes 4 5 9 Children of Clerks, Tradesmen, &c. 1 4 5 No Occupation 3 16 19 Total 182 121 303 Of the total number of males who died, viz.—182, the occupation of 171 is given, eight were children, and three were stated to have had no occupation. As was the case in previous years, labourers and clerks head the list, the numbers being respectively 27 and 23. Among females, of 121 deaths only 27 were engaged in some •occupation, five being domestic servants, six were dressmakers, three clerks, two charwomen and two nurses. 10 of the 121 females had been widows, wives or daughters of artisans, 32 of the labouring classes, 27 of clerks, tradesmen, etc., nine were ■children, and 16 had no occupation. Death-rate per 1O.OOO from Pulmonary Tuberculosis from 1888 to 1912 inclusive. Report of the Medical Officer of Health. 115 The next Table shows the deaths and death-rates in males and females from Pulmonary Tuberculosis, and for other Tuberculous diseases, as well as the deaths and death-rates among children under five years from other Tuberculous diseases, for the 10 years 1902-1911, and for the year 1912. Among males the rate for Pulmonary Tuberculosis for the year 1912 was 1.28, compared with 1.20 the decennial average ; and among females '70 compared with .75 ; while from other Tuberculous diseases the rate among males was .27 compared with "42 ; and among females .14 compared with .32. Among children under five years the rate for the year was '07, compared with .22 the decennial average. The rate for males and females for the year 1912 from Pulmonary Tuberculosis was .96, compared with '96 the decennial average. In six of the years during the decennium, viz.—in 1902, 1903, 1907, 1909, 1910, and 1911 this rate was lower, in one year, 1908, it was the same, while in 1904, 1905, and 1906, the rate was higher. The Chart shows the male and female as well as the total death-rate from Pulmonary Tuberculosis per 10,000 population for the last 25 years. As will be seen the rate among males has increased compared with the three previous years, but among females there is a slight decrease. The rate among males was lowest in 1911 and among females in 1903. H 2 TABLE LVIIL Population. No. of Deaths and Death-rates per 1,000. Year. Males. Females. Total. Pulmonary Tuberculosis. Other forms of Tuberculosis. Males. Females. Total. Males. Females. Total. Children under 5 years. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. 1902 107,020 131.331 238,351 115 1.07 100 .76 215 .90 53 .49 46 '35 99 '41 55 .40 1903 110,019 135,011 245,030 143 1.29 87 .64 230 .94 65 .59 48 .35 113 .45 65 .26 1904 113,124 138,822 251,946 158 1.39 125 .90 283 1.12 50 .44 47 .33 97 .38 72 .28 1905 116,342 142,771 259,113 150 1.32 116 .81 266 1.02 52 .44 42 .22 94 .36 66 25 1906 119,677 146,863 266,540 142 1.19 125 .85 267 100 56 .46 53 .36 109 .40 70 .26 1907 123.135 151,107 274,242 142 1.15 119 .78 261 .95 42 .34 49 .32 91 .33 52 18 1908 126,732 155,520 282,252 164 1.29 109 .70 273 .96 51 .40 58 .37 109 .38 67 .23 1909 130,418 160,044 290,462 160 1.22 113 .70 273 .94 40 .30 49 .30 89 .35 5o 1 7 1910 134,279 164,782 299,061 151 1 '12 113 .68 264 .88 48 .35 39 .23 87 .29 53 .17 1911 138,506 169,650 308,156 137 .98 123 .72 280 .91 58 .41 51 .30 I09 .35 53 .17 Average 10 vears 121,925 149.590 271,515 146 1.20 113 .75 261 .96 51 .42 48 .32 99 .36 60 .22 1912 141,192 172,569 313,761 181 1.28 122 .70 303 .96 39 .27 24 .14 63 .20 23 07 116 Report of the Medical Officer of Health. Report of the Medical Officer of Health. 117 Tuberculosis Dispensary. During the year the Public Health Committee on several -occasions had under consideration the question of establishing a Tuberculosis Dispensary on the lines suggested in my Report for 1911. In consequence, however, of the Local Government Board's Order, of the 26th July, with reference to the domiciliary treatment of Tuberculosis the Committee on the 19th September had the matter again under consideration and submitted a report to the Council to the following effect:— " We have again had under consideration the subject of the •establishment of a Tuberculosis Dispensary in the Borough, and refer to our report of the 8th November last, presented to the Council on the 15th November. Councillor Anderson, M.A., the Council's representative on the Local Insurance Committee, has been appointed Chairman of the Committee, and we have had the advantage of hearing from him the proposals which are under consideration of that body with regard to Tuberculosis patients recommended for treatment under the National Insurance Act. Under that Act it is the duty of Insurance Committees, not to themselves establish dispensaries or sanatoria, but to make arrangements for the reception of insured persons requiring treatment with Authorities who have established such institutions. Thus in respect of insured patients sent for treatment to any Municipal Dispensary, payments at a rate to be agreed upon will be payable by the Insurance Committee responsible for such patients. From this source some revenue will be received. There is, of course, no doubt that if the Borough Council establish a dispensary, it will be available for a considerable number of individuals other than insured persons. "We anticipate that the Council will receive a contribution out of the sum granted by the Finance Act, 1911, to be distributed by the Local Government Board towards the cost of establishing the institution. Having carefully considered the question, we are of opinion that it would be advisable for this Council to retain in its own hands the establishment and maintenance of a dispensary for its own administrative area, and we unanimously endorse our report of the 8th November last. 118 Report of the Medical Officer of Health. " We submit the following amended estimate of the cost of establishing and maintaining such an institution:— Furnishing and fitting up rooms— Tables, chairs, linoleum, gas or electric light fittings, laboratory bench, and sink £40 Apparatus—including microscope, weighing machine, laryngoscope, clinical thermometers, steriliser, hypodermic syringes, centifuge, incubator, and other bacteriological apparatus £8o £120 Maintenance— Salaries: Medical Officer (who would also act as Deputy Medical Officer of Health) £400 Nurse, appointed as Sanitary Inspector and Health Visitor £120 Caretaker, also acting as porter and clerk (house, gas, and coals provided) £65 Rent £60 Rates, Taxes, Water, etc. £25 Coals and Gas £10 Drugs, including Tuberculin £200 £880 " We accordingly recommend that the Council establish a dispensary on the lines suggested in our previous reports, and that the dispensary be under the control of the Public Health Committee ; and that the matter be referred to us to take the necessary steps to carry out the scheme." This report was adopted by the Council with the following Amendment. " That all the words after the word ' area ' in line 19 be left out, and the following words inserted in lieu thereof, viz.:— ' We accordingly recommend that the Council establish a tuberculosis dispensary or dispensaries, under the control of the Public Health Committee, and that it be referred to the Committee to bring up a scheme, after consultation with the County Insurance Committee, for dealing with the matter, at a cost of not exceeding £1,000 per annum.' " Report of the Medical Officer of Health. 119 The following report was submitted to the Public Health Committee on the 17th October:— REPORT OF THE MEDICAL OFFICER OF HEALTH ON THE ESTABLISHMENT OF A TUBERCULOSIS DISPENSARY. " The previous reports on this subject, which have been made have shown generally what the work of a Dispensary should be,, but it is to be noted that the essential element of any scheme is not the building but the Medical Officer, who is to be designated the Tuberculosis Officer, and to carry out the duties which will devolve upon him he must give his whole time to the work of the Dispensary. "It may be advisable to quote from the Interim Report of the Departmental Committee what the functions of the Tuberculosis Dispensary should be'. (1) Receiving house and centre of diagnosis. (2) Clearing house and centre of observation. (3) Centre of curative treatment. (4) Centre for examination of contracts. (5) Centre for "after care." (6) Information bureau and educational centre. " It will be noted that the work of the Dispensary will include not only clinical, but also preventive and administrative work. " To effectually fulfil all these functions it is advisable for the Dispensary to be as central as possible, but in this Borough it would be advisable in the first place to establish one central Dispensary with one Branch Dispensary. " With reference to the position of the buildings to be used. After careful study of a spot map showing the localities from which cases have been notified, I am of opinion that it would be most convenient for the central Dispensary to be established in Wandsworth, and a branch Dispensary in Balham, at a point near the boundary of Clapham parish. The cases in Putney and Streatham being comparatively few, could, owing to the convenient means of transit now existing, attend either of the Dispensaries. 120 Report of the Medical Officer of Health. " In the central Dispensary it would be necessary to have the following accommodation:—General waiting room, Consulting room. Dressing room, Dispensary, and rooms for caretaker. The same accommodation might be advisable at the branch Dispensary, although not of so extensive a nature. " Staff.—This would include a whole time Tuberculosis Officer, who will have charge of the Dispensaries and who would act as expert adviser to the Local Insurance Committee in regard to the diagnosis and treatment of Tuberculosis. He should be an officer of the Public Health Department and under the administrative control of the Medical Officer of Health. " This is necessary as otherwise he could not act under the order of the Local Government Board with regard to the steps to be taken for preventing the spread of infection, or for removal of conditions favourable to infection. " This order states that this duty is to be carried out by the Medical Officer of Health or an officer acting under-his instructions, and unless this is done the order is not being fulfilled. " This officer would not, in ordinary cases, undertake any domiciliary treatment, but would be available as a consultant in these cases. " With reference to the duties of this officer, Article 17 of Memo. 112 of the Insurance Commissioners is to the effect that:— " ' When the scheme is in full operation persons, whether insured or not, who are suspected to be suffering from tuberculosis should be examined by the tuberculosis officer or officers of the dispensary, who should recommend the kind of treatment most suitable for each. The tuberculosis officer and his assistants could thus act as the medical advisers of the Insurance Committee in carrying out its duty of deciding which insured persons should receive sanatorium benefit and what kind of treatment should be provided for each. In those cases which can best be treated at the dispensary itself the medical Report of the Medical Officer of Health. 121 staff will give the necessary treatment. Where the case is treated at home under the care of a private practitioner, the tuberculosis officer will act as a consultant, and, with the dispensary staff, will assist the practitioner in such way as may be necessary.' " ' When patients return home after a period of treatment in a residential institution prolonged care and medical supervision may frequently be required, and it will be the duty of the dispensary staff to co-operate with the private practitioners in carrying this out. The dispensary staff will also act under the direction of the Medical Officer of Health in carrying out any duties that are necessary for his assistance in administrative and preventive work for the protection of Public Health, such as the examination of ' contacts,' i.e., persons who have been associated with tuberculous persons, and may therefore be themselves infected.' " A certain proportion of cases of Pulmonary Tuberculosis in insured persons will doubtless be treated at home by medical practitioners, and the linking up of the dispensary and home treatment of insured persons should be carried out on the lines laid down in Article II. of the Local Government Board Order of the 26th July, 1912, and contacts of insured consumptives, with the consent of the practitioner in attendance, would be examined by the Medical Officer at the dispensary. " The work of the dispensary, in addition to treatment would be diagnostic, consultative, bacteriological and statistical; treatment at the dispensaries would be provided for all cases in which such treatment is recommended by the Tuberculosis Officer. The dispensary would also be available for the attendance of medical men for instruction in special treatment. " It might be found necessary in a large Borough such as this that the Tuberculosis Officer would require medical assistance, and this might be supplied by private practitioners giving part of their time to this work. 122 Report of the Medical Officer of Health. " The other members of the staff would consist of one or two Health Visitors and a resident clerk and dispenser. This latter combination can without difficulty be obtained. " P. CALDWELL SMITH, " Medical Officer of Health. " go, East Hill, Wandsworth, " 17th October, 1912." The Committee after consideration of this report reported to the Council, as follows:— (a) We have considered the resolution of the Council of the 25th September, with regard to the establishment of a Tuberculosis Dispensary or Dispensaries in the Borough, and have had before us a report of the Medical Officer of Health upon the subject, a copy of which accompanies this report. We have approved a scheme and have submitted the same to the Local Government Board for their consideration, with a view to obtaining a grant towards the expenses. " (b) With reference to the locality of the institutions, the Central Dispensary would be situated in Wandsworth, and the Branch Dispensary in Balham, near the boundary of the Parish of Clapham. Patients in Putney and Streatham, being comparatively few, could, owing to the convenient means of transit now existing, attend either of the institutions. " (c) In the Central Dispensary it would be necessary to have the following accommodation and staff, viz.:— " (i.) Accommodation.—The accommodation would include a general waiting room, consulting rooms, dressing room, dispensing room, and quarters for resident dispenser and clerk. The same accommodation might be advisable at the Branch Dispensary, although not of so extensive a nature. " (ii.) Staff.—The staff would include a Tuberculosis Officer, who would devote the whole of his time to the duties, and have charge of the Central and Branch Dispensaries. He would also act as expert adviser to the Local Insurance Committee in regarel to the eliagnosis and treatment of insured patients suffering from tuberculosis. He would be an officer of the Public Health Department, and under the administrative Report of the Medical Officer of Health. 123 control of the Medical Officer of Health, to enable him. to act under the Order of the Local Government Board with regard to the steps to be taken for preventing the spead of infection or for removal of conditions favourable to infection. This officer would not, in ordinary cases, undertake any domiciliary treatment, but would be available as a consultant for the purposes of such treatment. The oth r members of the staff would consist of a Health Visitor, a Nurse, and a resident Dispenser, who would also act as Clerk. " (d) The work of the Dispensaries, in addition to treatment, would be diagnostic, consultative, bacteriological, and statistical ; treatment at the Dispensaries would be provided for all cases in which such treatment is recommended by the Tuberculosis Officer. The Dispensaries would also be available for the attendance of medical men for instruction in special treatment. Estimate of Cost. " (e) We submit in detail an estimate of cost of establishment and maintenance, including salaries, viz.:— Establishment of Dispensary and Branch DispensaryFurnishing and fitting-up rooms £40 Purchase of Apparatus, including medical and surgical requisites £80 Total first cost £120 £120 Annual Cost— Tuberculosis Medical Officer £500 Health Visitor £100 Nurse £85 Resident Dispenser and Clerk £65 Rent £40 Rates, Water, etc £15 Heating and Lighting £10 Drugs £150 Rent of Branch Dispensary £35 Rates, Water, etc., Ditto £15 Heating and Lighting, Ditto £5 £1,020 Report of the Medical Officer of Health. 124 A Dispensary Sub-Committee was appointed by the Public Health Committee to arrange the details in connection with the scheme, and at various times reports were mads by this Sub-Committee especially with reference to the appointment of officers and the acquiring of suitable premises. Since the close of the year 1912 all the Officers have been appointed, proper premises acquired, and the Dispensary will be opened at the end of March, 1913. Notification of Pulmonary Tuberculosis under the Local Government Board's Order of December, 1908. 229 cases of Pulmonary Tuberculosis were notified during the year, 42 of these belonging to Clapham, nine to Putney, 33 to Streatham, 46 to Tooting, and 99 to Wandsworth, compared with 288 cases in 1911, 219 in 1910, and 317 in 1909. Of the 229 cases, 24 were from five to 15 years of age, 24 from 15 to 25 years, 87 from 25 to 45 years, 70 from 45 to 65 years, and 24 over 65 years. The following Table shows the number of these cases notified, and also the number of times they were notified:— TABLE LIX. Clapham. Putney. Streatham. Tooting. Wandsworth. Total. One Notification 19 6 13 30 53 121 Two Notifications 12 2 13 8 32 67 Three Notifications 10 1 6 6 11 34 Four Notifications 2 ... ... 1 2 5 Five Notifications ... ... ... ... 1 1 Six Notifications ... ... ... ... 1 1 Total 43 9 32 45 100 229 Report of the Medical Officer of Health. 125 It will be noted from the Table that 121 cases were notified once, 67 cases were notified twice, 34 were notified three times five were notified four times, one was notified five times, and one was notified six times. This makes a total of 388 notifications for the 229 cases. The next Table shows the number of cases in the various sub-districts still on the Register at the close of 1911, the number of cases notified in 1912, and the number who died, recovered, removed, the number still in Institutions, and the number under observation. TABLE LX. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. Number of cases on Register at close of 1911 63 21 58 128 210 480 Number of cases notified in 1912 42 9 33 46 99 229 Number died in 1912 26 12 22 50 51 161 ,, recovered ... ... ... ... 1 1 ,, removed 32 2 21 32 104 191 ,, in institutions 25 8 20 56 85 194 ,, under observation 22 7 28 36 69 162 Total 105 29 91 174 310 709 One of the cases notified from Putney in 1911 removed toWandsworth in 1912. The above Table shows that there are at present 194 cases in Poor Law Institutions, and 162 at home, a total of 356 cases which are or have been dealt with by the Poor Law Authority. In 1911 the number of cases in Institutions was 318 and at home 162, a total of 480. There has thus been in 1912 a d.crease of 124 case, compared with 1911. 126 Report of the Medical Officer of Health. This decrease is due to the fact that inquiries were made from the Poor Law Institutions as to the condition of cases which had been notified in previous years, when it was found that a large number of cases had been discharged to other places, and consequently no information had been received by this Authority. The next Table shows the number of Poor Law cases notified since 1900, the number dead, and the year in which death occurred as well as the number of cases removed and recovered. TABLE LXI. Year. Cases reported. Cases dead. Removed. Recovered. Cases living at close of 1912. 1909. 1910. 1911. 1912. 1909 317 93 31 16 23 83 8 63 1910 219 ... 67 27 23 53 1 48 1911 288 ... ... 83 47 56 1 101 1912 229 ... ... ... 68 17 ... 144 1053 93 98 126 161 209 10 356 The above Table has been corrected from 1909, as inquiries were made at the various Institutions with regard to cases notified since that date, and it was ascertained that many of the cases which had been kept on the register had removed, or had been discharged, the address to which the patient had gone not being known. Of the 1,053 cases notified since 1909, 478 or 45.4 per cent. had died, 209 or nearly 19 per cent. had, as far as could be ascertained removed outside the Borough, 10 or '95 per cent. had recovered, leaving 356 or 33.8 per cent. alive at the close of 1912. 106 discharge certificates were received, 103 on Form C from -Superintending Officers, and three on Form D from Relieving Officers. Report of the Medical Officer of Health. 127 Of the 106 certificates, 90 were received from Superintending Officers of the Wandsworth Union, three from Relieving Officers, five from Oueen Mary's Hospital, Carshalton, two from the Croydon Union, two from the Chelsea Workhouse, and one each from Bradford Workhouse, Exeter Workhouse, St. Pancras Workhouse and Paddington Infirmary. Of the 90 certificates from Superintending Officers in the Wandsworth Union, 35 were received from the St. James's Infirmary, 45 from the Tooting Home, and 10 from the Union Workhouse. The 106 certificates received related to 97 cases, nine cases having been notified twice. 20 cases were notified as having gone to addresses in Clapham, two to Putney, 20 to Streatham, 13 to Tooting, and 42 to Wandsworth. Four cases in Clapham and four in Wandsworth were •discharged to Common Lodging Houses. Notification of Cases under Tuberculosis in Hospitals Regulations, 1911. The above Regulations came into force on the 1st May, 1911, and applied to all hospitals, dispensaries, or similar Institutions for the treatment of the sick which are partially or wholly supported otherwise than by the contributions of the persons treated therein or of their relatives or guardians, and otherwise than from rates and taxes. During the year, 187 cases were notified, 51 relating to persons residing in Clapham, 15 in Putney, 50 in Streatham, 23 in Tooting, and 48 in Wandsworth. Of the 187 cases, two were from one to five years, 20 from five to 15 years, 44 from 15 to 25 years, 106 from 25 to 45 years, 14 from 45 to 65 years, and one over 65 years. From the following Table it will be seen that 161 cases were notified once, 23 twice, and three three times, making a total of 216 notifications received. 128 Report of the Medical Officer of Health. 66 of the cases were notified from Brompton Hospital, 24 from Mount Vernon Hospital, 11 from Battersea Dispensary, nine from the Brompton Sanatorium, Frimley, seven from Kennington Dispensary, 16 from St. Thomas's Hospital, eight from St. George's Hospital, and the remainder from various Hospitals and Sanatoria in London and the provinces. TABLE LXII. Clapham. Putney. Streatham. Tooting. Wandsworth. Total. One notification 44 11 44 19 43 161 Two notifications 4 2 6 5 6 23 Three notifications 2 1 ... ... ... 3 Total 50 14 50 24 49 187 The next Table shows the number of cases notified from Hospitals since 1908, the number that were fatal in each year, and the number recovered, removed, and cases living at the close of 1912. TABLE LXII I. Cases notified from Hospitals. Year. Cases reported. Cases died. Removed. Recovered. No inquiries. Cases living at close of 1912. 1908. 1909. 1910. 1911. 1912. 1908 2 ... ... ... ... ... 2 ... ... ... 1909 32 ... 1 12 2 2 8 3 ... 4 1910 30 ... ... 3 3 4 13 ... 1 6 1911 193 ... ... ... 21 31 54 2 1 84 1912 187 ... ... ... ... 30 19 3 ... 135 444 ... 1 15 26 67 96 8 2 229 One of the cases notified in 1909 and 12 in 1911 became Poor Law cases and have been transferred to that Table. Report of the Medical Officer of Health. 129 Of the total number of cases notified since 1908, viz., 444, 109 or 24.5 per cent. have died, while 229 or 51.5 per cent. were alive at the close of the year, while in 106 cases or 24 per cent. the patients have either removed or recovered. Notification of Cases under the Public Health (Tuberculosis) Regulations, 1911, dated November 15th, 1911. Under the above Regulations, which came into force on the 1st January, 1912, Pulmonary Tuberculosis was made compulsorily notifiable by medical practitioners as well as by School Mcdical Inspectors. As will be noted in the next Table this caused a very large increase in the number of notifications received as compared with the voluntary system, which has been in operation in this Borough since 1904. In 1911 only 33 notifications were received from private practitioners, while in the year under review when the new Regulations were in force, no fewer than 439 notifications were received. Of the 439 notifications, 79 belonged to Clapham, 34 to Putney, 145 to Streatham, 55 to Tooting, and 126 to Wandsworth. Two of the cases were under one year of age, three from one to five years, 43 from five to 15 years, 70 from 15 to 25 years, 215 from 25 to 45 years, 89 from 45 to 65 years, and 17 over 65 years. At the end of the year, out of 908 cases notified since 1904, 361 or 39.8 per cent. have died, while 304 or 33.4 per cent. were alive at the end of the year, leaving 243 or 26 8 per cent. who have removed, recovered, or in whose cases no inquiries were made at the request of the practitioner in attendance. 1 130 Report of the Medical Officer of Health. TABLE LXIV. PRIVATE CASES. Year Cases reported. Cases died. Removed. Recovered. No. inquiries. Cases living at end of 1912. 1904 1905 1906 1907 1908 1909 1910 191 1 1912 1904 101 50 8 1 1 ... ... ... ... ... 29 5 6 1 1905 82 ... 33 4 2 ... ... ... ... ... 29 4 9 1 1906 64 ... ... 30 5 ... 1 ... ... ... 12 7 9 ... 1907 40 ... ... ... 17 ... ... ... ... ... 22 ... 1 ... 1908 69 ... ... ... ... 25 6 1 1 ... 28 ... 5 3 1909 40 ... ... ... ... ... 15 5 5 1 8 4 4 3 1910 40 ... ... ... ... ... ... 7 7 1 12 1 7 5 1911 33 ... ... ... ... ... ... ... 9 4 3 ... 5 12 1912 439 ... ... ... ... ... ... ... ... 127 23 10 ... 279 Total 908 50 41 35 25 25 22 13 17 133 166 31 46 304 One of the cases notified in 1910 and one in 1911 became Poor Law cases and have been transferred to that Table. The total number of cases of Pulmonary Tuberculosis alive at the close of the year was 889, 356 Poor Law cases, 229 Hospital cases, and 304 private cases. Table LXV. is a combined Table and shows the total number of cases notified since 1904, with the number of deaths in each year. In all 2,405 cases have been notified, and of these 948 or 39.4 per cent. died, 471 or I9.6 per cent. have removed, 49 or 2"o per cent. are stated to have recovered, in 48 or 2.0 per cent. no inquiries were made, while 889 or 37 per cent. are still on the Register. TABLE LXV Year. Cases reported. Deaths. Removed. Recovered. No. inquiries. Cases on Register. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1912. Total. 1904 101 50 8 1 1 ... ... ... ... ... 60 29 5 6 1 1905 82 ... 33 4 2 ... ... ... ... ... 39 29 4 9 1 1906 64 ... ... 30 5 ... 1 ... ... ... 36 12 7 9 ... 1907 40 ... ... ... 17 ... ... ... ... ... 17 22 ... 1 1908 71 ... ... ... ... 25 6 1 1 ... 33 26 ... 5 3 1909 389 ... ... ... ... ... 109 48 18 26 201 30 15 4 70 1910 289 ... ... ... ... ... ... 77 37 28 142 99 2 8 59 1911 514 ... ... ... ... ... ... ... 113 82 115 78 3 6 197 1912 855 ... ... ... ... ... ... ... ... 225 225 59 13 ... 558 Total 2,405 50 41 35 25 25 116 126 169 361 948 471 49 48 889 I 2 Report of the Medical Officer of Health. 131 132 Report of the Medical Officer of Health. The total number of deaths shown in Table LXV., viz.:—361, does not agree with the number in the Table of deaths on page 26. The explanation of this difference is as follows -281 of the 361 deaths correspond with the deaths registered, while of the 80 remaining, 33 were inmates of Tooting Bec Asylum, seven of the Workhouse, one was homeless, and these died outside the Borough and were consequently not registered here. In addition 35 cases did not die from Pulmonary Tuberculosis, although notified as such. Of the 303 deaths which are included in Table XV., 20 were not notified cases, and of these 11 died in Asylums and four at private residences outside the Borough, while five died at private addresses within the Borough. In each of the five cases inquiries were made from the medical attendant and satisfactory explanations were received as to the reason for non-notification. It is satisfactory to observe that the Regulations as to notifications have been so well carried out by medical practitioners in the first year of their being in force. 19 cases of Pulmonary Tuberculosis were notified by the School Medical Inspectors of the Education Department of the London County Council, these cases having been discovered in the examination of children at school. Of the two notified in Clapham one became Poor Law, in Putney one became Poor Law, in Streatham one became Poor Law and one was previously notified from the Victoria Park Hospital, in Tooting one became Poor Law and one was previously notified by a private medical practitioner, and in Wandsworth one became Poor Law and two were notified twice by the School Medical Inspector. Seven of the cases were not notified by other practitioners, but all the cases were visited to ascertain if they were under medical treatment at home. Report of the Medical Officer of Health. 133 The whole of the work in connection with Pulmonary Tuberculosis has been carried out most efficiently by the female Sanitary Inspectors, and as will be noted, has added considerably to their work during the year. This work has increased to such an extent as to lessen the number of visits done by these Inspectors in the visiting of infants, and to a smaller extent has caused a decrease in the number of inspections of factories and workshops. The total number of visits made was 2,259, 211 in Clapham North, 299 in Clapham South, 123 in Putney, 530 in Streatham, 383 in Tooting, and 713 in Wandsworth, compared with 938 in 1911. During the year 51 sputum bottles have been supplied, and four were returned after the death of the patient. In 25 cases the patient already had one. Of the 786 cases visited by the Inspectors, in 26 the information obtained was so indefinite that it was impossible to tabulate it, in the majority of cases no family history being known. In 26 cases no inquiries were made. 22 cases were notified from the Workhouse, 14 from Tooting Bec Asylum, one from H.M. Prison, one from the Middlesex Asylum, one from St. Anne's Home, eight from common lodging houses, two were homeless, in two cases wrong addresses were given, 19 had removed, in 18 the patients were either lodgers or domestic servants and the occupier of the house could give no information, three were cases of mistaken diagnosis, and in only two instances the Inspectors were refused information. Seven cases were notified outside the Borough and visited on their coming into the District, two were notified in Battersea, two in Croydon, one in Camberwell, one in Fulham, and one in Kensington. One case notified outside the Borough was discharged from the Union Infirmary to an address in Clapham. 134 Report of the Medical Officer of Health. The Tables which follow have been drawn up by the London County Council in conjunction with the Society of Medical Officers of Health, so that a uniform Table for the whole of London could be prepared. TABLE LXVI. MALES. Number of Cases, 377. Age Distribution. Under 1 year. 1-5. 5-15. 15-25. 25-45. 45-65. 65- All ages. ... 3 35 47 195 86 11 377 Duration of Illness in years. Under 1 year. 1-2 2-3 3-4. 4-5. 5 and upwards. 116 67 45 28 18 103 Number of Living Rooms in Patient's Tenement. One. Two. Three. Four. Over Four. 38 30 84 76 149 Weekly Rent Paid. Under 5/-. 5/- and under 10/-. 10/- and under 15/-. 15/- and over. Not ascertained 52 151 96 78 ... Report of the Medical Officer of Health. 135 Occupation of Patient. A.-—Outdoor occupations— Taxi, motor-car, motor-'bus and tramcar men (drivers, ductors, motor men), chauffeurs (mechanical traction) 7 Carmen, carters, vanmen, &c. (horse traction) 16 Dock labourers, wharfingers, barge and lightermen, watermen - General labourers 45 Gardeners 1 Artisans 33 Bricklayers 3 Other 30 B.—Indoor occupations— Clerks 57 In Bakehouse 1 In other factories or workshops 37 In printing works 12 Tailors 4 Shop salesmen 23 On tube and underground railways (excluding clerks) - Soldiers 11 Bootmakers 5 Professional men, actors, dentists, scholars, &c. 28 Barmen and cellarmen 3 Domestic servants 3 Sons of labourers 17 Sons of artisans 17 Sons of clerks, travellers, tradesmen, &c. 5 Other 19 TABLE LXVII. MALES. Married Patients (including Widowers). Number and age of patients. Patient's relatives living and dead:—(I.) Father and Mother ; (II.) Brothers and Sisters ; (III.) Uncles and Aunts. Patient's wife, if remarried give particulars for deceased wife or wives. Patient's children. Number of patients childless. Whether affected or not. I. II. III. Age. No. Living. Dead. Living. Dead. Living. Dead. living Dead. Living. Dead. 0— ... Affected ... ... ... ... ... ... ... ... ... ... ... Not ... ... ... ... ... ... ... ... ... ... ... Unknown ... ... ... ... ... ... ... ... ... ... ... 15— 2 Affected ... ... ... ... 1 1 ... ... ... ... ... Not 4 ... 3 2 17 1 2 ... 2 ... ... Unknown ... ... ... ... ... ... ... ... ... ... ... 25— 58 Affected 1 6 7 6 1 11 ... 3 1 5 ... Not 52 34 168 27 129 20 55 ... 85 16 10 Unknown 21 2 6 ... 25 ... ... ... ... ... ... 35— 123 Affected 1 28 10 43 ... 19 2 6 9 7 Not 69 115 325 74 112 110 114 1 347 58 10 Unknown 33 ... 24 1 75 ... 1 1 1 ... ... 55— 40 Affected ... 7 ... 9 ... 3 ... 4 7 23 ... Not 1 49 65 51 13 10 30 8 151 33 4 Unknown 13 10 13 ... 36 ... ... ... ... ... ... 136 Report of the Medical Officer of Health. TABLE LXVIII. MALES. Unmarried Patients. Number and age of Patients. Patient's relatives living and dead:—(I.) Father and Mother ; (II.) Brothers and Sisters ; (III.) Uncles and Aunts. Whether affected or not. (I.) (II.) (III) Age No. Living. Dead. Living. Dead. Living. Dead. 0— 38 Affected 5 4 5 8 ... ... Not 62 3 127 25 ... ... Unknown 2 ... ... ... ... ... 15— 45 Affected ... 11 2 ... ... ... Not 66 11 134 ... ... ... Unknown ... 2 2 ... ... ... 25— 44 Affected 2 6 7 ... ... ... Not 56 18 156 ... ... ... Unknown 4 2 1 ... ... ... 35— 25 Affected ... 4 4 ... ... ... Not 21 16 68 ... ... ... Unknown 9 ... 2 ... ... ... 55— 2 Affected ... 1 ... 1 ... ... Not ... 1 1 2 ... ... Unknown 2 ... 1 ... 2 ... Report of the Medical Officer of Health. 137 138 Report of the Medical Officer of Health. TABLE LXIX. FEMALES. Number of Cases, 333. Age Distribution. Under 1 year. 1-5. 5-15. 15-25. 25-45. 45-65. 65-. All ages. 1 2 48 74 143 58 7 333 Duration of Illness in Years. Under 1 year. 1-2. 2-3. 3-4. 4-5. 5 and upwards. 114 44 46 31 19 79 Number of Living Rooms in Patient's Tenement. One. Two. Three. Four. Over Four. 25 29 75 87 117 Weekly Rent Paid. Under 5/-. 5/- and under 10/-. 10/- and under 15/-. 15/- and over. Not ascertained. 41 157 85 50 ... Occupation of Patient. A.—Outdoor occupations- Flower Sellers - Hawkers - Other B—Indoor occupations—- Clerks 10 Shop Assistants, Charwomen, Dressmakers and Milliners 26 Laundry hands 11 In other factories or workshops 12 Domestic servants— In inns, hotels, eating-houses, &c. 5 In private dwellings 27 Widows, wives and daughters of labourers 56 Widows, wives and daughters of artisans 37 Widows, wives and daughters of clerks, &c. 80 Daughters of labourers 22 Daughters of artisans 13 Daughters of clerks, &c. 15 Other 19 TABLE LXX. FEMALES. Married Patients (including Widows). Number and age of Patients. Patient's relatives living and dead:—(I.) Father and Mother ; (II.) Brothers and Sisters ; (III.) Uncles and Aunts. Patient's husband, if remarried give particulars for deceased husband or husbands. Patient's children. Number of patients childless. Whether affected or not. I. II. III. Age. No. Living. Dead. Living. Dead. Living. Dead. Living. Dead. Living. Dead. 0— ... Affected ... ... ... ... ... ... ... ... ... ... ... Not ... ... ... ... ... ... ... ... ... ... ... Unknown ... ... ... ... ... ... ... ... ... ... ... 15— 7 Affected ... 4 2 2 ... 9 ... ... ... ... ... Not 6 2 9 ... 13 3 7 ... 4 ... ... Unknown 2 ... 1 ... 2 ... ... ... ... ... ... 25— 64 Affected 1 12 4 24 2 30 2 3 9 4 ... Not 70 37 218 50 178 56 59 2 96 18 ... Unknown 8 ... 5 ... 20 ... ... ... ... ... ... 35— 78 Affected ... 28 14 34 1 9 1 7 22 24 ... Not 35 84 240 101 86 47 58 14 247 52 5 Unknown 9 ... 6 ... 46 ... ... 1 ... ... ... 55— 22 Affected ... 9 ... 9 ... 1 ... ... 3 6 ... Not ... 23 63 35 10 15 10 10 75 33 ... Unknown 12 ... 5 ... 12 ... 2 1 1 ... ... Report of the Medical Officer of Health. 139 TABLE LXXI. FEMALES. Unmarried Patients. Number and age of Patients. Patient's relatives living and dead:—(I.) Father and Mother ; (II.) Brothers and Sisters ; (III.) Uncles and Aunts. Whether affected or not. (I) (II.) (III.) Age. No. Living. Dead. Living. Dead. Living. Dead. 0— 51 Affected 10 7 12 16 18 34 Not 76 9 163 46 252 55 Unknown ... ... 1 ... 5 15— 64 Affected 4 14 13 20 4 26 Not 84 23 202 58 210 63 Unknown 3 ... 1 ... 5 ... 25— 26 Affected 2 10 6 5 2 12 Not 27 10 62 26 70 36 Unknown 3 ... ... ... 8 ... 35— 18 Affected ... 4 3 6 ... 2 Not 11 16 50 22 30 28 Unknown 5 ... 2 ... 7 ... 55— 3 Affected ... ... ... 1 ... 1 Not ... 6 5 3 ... ... Unknown ... ... ... ... 1 ... 140 Report of the Medical Officer of Health. Report of the Medical Officer of Health. 141 Of the 786 cases visited by the Inspectors it has been found possible to include in the Tables as many as 710, 377 of males and 333 of females, as against 222 in last year's Report. The Tables dealing with ages, duration of illness and occupation are self-explanatory, but the Tables dealing with personal and family history are more complicated and require some explanation. These Tables are to be read as follows:— In the Table dealing with married males at ages 35-55, 123 cases were notified. Of these, one parent was alive but affected while 28 had died of Pulmonary Tuberculosis, 69 were living and not affected, 115 dead of other diseases while 33 were alive but their medical history was not known. In the next two columns under the beading of brothers and sisters, 10 were alive but affected and 43 dead of Pulmonary Tuberculosis, 325 were alive and not affected, and 74 had died of other diseases, while the medical history of 24 alive and one dead was unknown. In group III. which relates to uncles and aunts, 19 had died of Pulmonary Tuberculosis, 112 were alive and not affected, and no dead of other diseases, while the medical history of 75 was unknown. In the next column it will be seen that the wives of two cases were alive but affected, while six had died of Pulmonary Tuberculosis, 114 were alive and one dead not affected while the medical history of two, one alive and one dead was unknown. Of the patients' children nine were alive and affected, seven dead not affected, 347 alive and not affected, and 58 dead of other diseases. 10 of the patients were childless. At the other ages the Table is to be read in the same way. Of the total number of males, viz.—377, nine had parents alive affected, while 67 had died of Pulmonary Tuberculosis. 331 parents were alive and not affected while 247 had died, but not of Pulmonary Tuberculosis. 142 Report of the Medical Officer of Health. Among the total number of females, viz.—333, 17 had parents alive affected, while 88 had died of Pulmonary Tuberculosis ; 309 parents were alive and not affected, while 210 had died, but not of Pulmonary Tuberculosis. Of the total of 710 patients male and female, married and unmarried, 26 had parents alive affected, while 155 parents had died of Pulmonary Tuberculosis. Taking the column dealing with brothers and sisters, among males we find 35 had brothers and sisters ?live affected, while 84 had died of Pulmonary Tuberculosis; and among females 54 had brotners or sisters alive affected, while 117 had died of Pulmonary Tuberculosis, or a total among males and females of 89 who had brothers or sisters alive affected, while 201 had died of Pulmonary Tuberculosis. During the year disinfection was carried out at 426 premises either after the death or removal of the patient, compared with 313 in 1911, 265 in 1910, 255 in 1909, 184 in 1908, and 135 in 1907. 87 of the premises disinfected were in Clapham, 31 in Putney. 107 in Streatham, 44 in Tooting, and 157 in Wandsworth. Deaths from Pulmonary Tuberculosis in Public Institutions. The following Table shows the number of deaths and the rate to total deaths from this disease for the year 1912, and for the previous 10 years:— Report of the Medical Officer of Health. 143 TABLE LXXII. Year. Total Number of Deaths. Institutions. Union Infirmaries. General and Special Hospitals. Total. Number. Rate. Number. Rate. Number. Rate. 1902 215 27 12.6 18 8.3 45 20.9 1903 230 48 20.9 19 8.2 67 29.1 1904 283 54 19.1 24 8.4 78 27.5 1905 266 55 20.6 20 7.5 75 28.1 1906 267 69 25.8 26 9.7 95 35.5 1907 261 65 24.9 37 14.2 102 39.1 1908 273 55 20.1 24 8.8 79 28.9 1909 273 74 27.1 32 11.7 106 38.8 1910 264 65 24.6 33 12.5 98 37.1 1911 280 90 32.1 39 13.9 129 46.0 Average 261 60 23.0 27 10.4 87 33.4 1912 303 86 28.3 43 14.2 129 42.5 This Table shows that the rates for the present year are much higher than the average for the past 10 years. The rate in the Union Infirmaries shows an increase compared with the decennial average, but is lower compared with 1911, while the rate in General and Special Hospitals has also increased compared with 1911, and also with the decennial average. 144 Report of the Medical Officer of Health. Bacteriological Examination of Sputum. 316 examinations of sputum were made at the Lister Institute: 32 from Clapham, 14 from Putney, 117 from Streatham, 29 from Tooting, and 124 from Wandsworth. In 89 of the cases it was reported that the bacillus had been found, and in 227 that it was absent. Other Infective Diseases. 25 deaths were caused by other Infective diseases, five in Clapham, two in Putney, 10 in Streatham, one in Tooting, and seven in Wandsworth. 11 of these were under one year, five from five to 15 years, one from 15 to 25 years, four from 25 to 45 years, three from 45 to 65 years, and one over 65 years. Of these 17 were stated to have been due to Syphilis, four to Septicaemia, three to Tetanus, and one to Actinomycosis of Lung. The following Table shows the death-rate from Infective diseases for the whole Borough for the year, as well as for the five previous years. TABLE LXXIII. Death-rate per 1,000:- 1907 1908 1909 1910 1911 1912 Small-pox ... ... ... ... ... ... Diarrhoea .46 .64 .41 .30 1.13 .27 Diphtheria .15 .13 .10 .05 .11 .06 Whooping Cough .38 .20 •23 .22 .21 .15 Scarlet Fever .08 .07 .04 .04 .03 .03 Influenza .32 .28 .30 .18 .08 .14 Enteric Fever .03 .12 .02 .026 .029 .02 Measles .24 .15 .37 .14 74 .l6 Tuberculous Diseases 1.28 1.34 1.29 1.17 1.26 1.16 Report of the Medical Officer of Health. 145 Acute Polio-Myelitis. Five cases of the above disease were notified, one of which, was fatal, three have partially recovered, while one was after further examination found not to be suffering from this disease. Three of these patients were removed to hospital. In the whole of London 132 cases were notified, 69 of these or 52 per cent, having been notified in the third quarter of the year. Ophthalmia Neonatorum. 35 cases were notified, of which nine were in Clapham, one in Putney, seven in Streatham, four in Tooting and 14 in Wandsworth. One of the cases in Wandsworth occurred in the Workhouse. 34 of the cases were visited and it was ascertained that 15 were attended at birth by midwives, 15 were treated at hospital as out-patients, three as in-patients, and four were removed to the Union Infirmary, the 12 remaining being treated at home. Two of the cases are still under treatment as out-patients at hospitals, and each infant will probably lose the sight of one eye. Two cases removed and could not be traced, one being a very severe case, while two died of prematurity. The 28 remaining cases have recovered with no permanent injury to the sight of either eye. Two cases were brought to my notice by the London County Council. A midwife was in attendance at birth in each case and both have recovered. K 146 Report of the Medical Officer of Health. Glanders and Anthrax Orders. Under the above Orders five cases of Glanders were notified "by the Veterinary Inspectors of the London County Council. In these cases the necessary steps in connection with the disinfection and cleansing of the premises were taken by the officials of the London County Council, but the officers of the Borough Council visited the premises and obtained the names of any men who had been in contact with the diseased animals and notified them that if any symptoms of illness appeared the fact should be at once reported. NON-INFECTIVE DISEASES. The next Table shows the number of deaths from these for the year, as well as for the previous decennium for the whole Borough, corrected for External and Internal Institutions. TABLE LXX1Y. Deaths from Non-Infective Diseases. 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 191 2 No. above corrected average. No. below corrected average. Cancer 222 247 242 224 256 272 274 275 298 321 338 34.2 — Circulatory Diseases 320 410 327 346 331 387 350 366 312 359 357 — 48 Respiratory ,, 550 379 514 512 511 550 543 690 509 531 530 — 80 Premature Birth 308 322 298 317 315 285 294 254 249 26S 240 — 96 Violence 127 111 101 91 108 90 107 118 91 120 116 — 6 All other Diseases 890 761 951 953 945 988 971 989 1032 1023 1025 — 72 Totals 2417 2230 2433 2443 2466 2572 2539 2692 2358 2622 2606 — 255 The above were the cause of 79.1 per cent. of the total deaths, compared with 69.4 in 1911, 82.5 in 1910, and 82.1 in 1909. Report of the Medical Officer of Health. 147 Cancer. The total number of deaths from Cancer and other malignant diseases was 338, 152 of males and 186 of females, compared with 321 in 1911, an increase of 17 compared with the previous year, and of 34.2 compared with the corrected decennial average. The corrected death rate was 107 per 1,000, compared with 1.04 in 1911, .99 in 1910, and .94 in 1909. The number of deaths and the death-rate in each sub-district was as follows:—Clapham 85 and 141; Putney 27 and '94; Streatham 102 and 1.04 ; Tooting 31 and .87; and Wandsworth 93 and roi. One of the deaths occurred under one year, one at five to 15 years, two at 15 to 25 years, 32 at 25 to 45 years, 165 at 25 to 65 years, and 137 over 65 years. The following Table shows the number of deaths according to the part of the body affected. TABLE LXXV. Locality of Disease. Males. Females. Total. Intestines 41 29 70 Stomach 28 21 49 Liver 13 27 40 Uterus and Ovary ... 38 38 Breast ... 35 35 Mouth and Throat 17 4 21 (Esophagus 15 5 20 Bladder and Kidney 8 3 11 Face and Neck 8 3 ri Abdomen 2 8 10 Pancreas 7 1 8 Other parts 11 8 19 Not specified 2 4 6 Total 152 186 338 K 2 148 Report of the Medical Officer of Health. In Institutions within the Borough 16 deaths occurred from Cancer, 11 males and five females. Four of these deaths occurred in the Hostel of God, two in Tooting Home, one in the Workhouse, one in H.M. Prison, and eight in private nursing homes. 107 of the deaths, 60 of males and 47 of females, occurred in External Institutions, 50 in Workhouses and Workhouse Infirmaries, and 57 in General and Special Hospitals. 73 of the total deaths occurred among females from Cancer of the Breast or Uterus, compared with 74 in 1911, 63 in 1910, and 80 in 1909. The greatest number of deaths occurred from Cancer of the Intestines, which include Cancer of the Rectum. In regard to this the Registrar General in his report for 1910 says, " In both sexes the greatest relative increase and in the female sex the. greatest absolute increase has been from Cancer of the Intestines, the mortality attributed to which amongst women has practically doubled during the last 14 years. Doubtless this is very largely due to improved diagnosis. In the case of rectal Cancer on the other hand the increase has been greater among men." The next Table shows the death-rate per 100,000 for each of the sub-districts and for the whole Borough for the year and for the 10 preceding years. TABLE LXXVI. Sub-District. 1902. 1903 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. Average for 10 years. 1912 Clapham 114 96 110 86 96 125 104 99 134 108 107 141 Putney 101 95 106 112 99 90 110 69 121 120 102 94 Streat ham 88 114 91 87 92 105 101 106 89 126 100 104 Tooting 54 60 108 48 86 57 75 73 62 64 69 87 Wandsworth 90 102 84 88 102 90 91 94 95 88 92 101 Whole Borough 93 101 95 86 96 99 97 94 99 104 96 107 Report of the Medical Officer of Health. 149 Compared with 1911 there has been an increase in this rate in Clapham, Tooting, and Wandsworth, and a decrease in Putney and Streatham. There has again been an increase in the rate from this disease compared with the previous year and with the decennial average, and in the various sub-districts there has been a considerable increase in Clapham, Tooting and Wandsworth, a slight increase in Streatham, but a decrease in Putney. It is specially noticeable that the death-rate in Tooting is the lowest and that in Clapham the highest of the sub-districts, not only for 1912, but during the whole of the 10 years. In the decennium 1851-1860 this rate for England and Wales was only 32.5, but it increased in 1891-1900 to 75.8, and for London only in the decennium 1851-1860 it was 42, and for 1891-1900 85, or slightly more than double. Diseases of the Brain and Nervous System. From these diseases 305 deaths occurred, compared with 358 in 1911, 351 in 1910, and 372 in 1909. 71 of these deaths occurred in Clapham, 24 in Putney, 93 in Streatham, 30 in Tooting, and 87 in Wandsworth. 21 of the deaths were due to Meningitis, 154 to Cerebral Haemorrhage or Apoplexy, 27 to Convulsions, 12 to Softening of the Brain, 31 to Paralysis, 25 to General Paralysis of the Insane, four to Locomotor Ataxy, 13 to Epilepsy, and 39 to other diseases of the Nervous System. The number of deaths from Cerebral Haemorrhage or Apoplexy in each sub-district was as follows:—in Clapham 30, in Putney 15, in Streatham 50, in Tooting 12, and in Wandsworth 47, a total of 154, compared with 147 in 1911, 155 in 1910, and 158 in 1909. 30 of the deaths from Diseases of the Brain and Nervous System were under one year, eight from one to two years, eight from two to five years, 16 from five to 15 years, eight from 15 to 25 years, 42 from 25 to 45 years, 85 from 45 to 65 years, and 129 over 65 years. 150 Report of the Medical Officer of Health. Of the total deaths from the above under one year, viz.—30, 21 were from Convulsions, while of the total deaths over 65 years, viz.—154, 97 were from Cerebral Haemorrhage. Circulatory Diseases. From the above group of diseases, 357 deaths occurred, 168of which, 83 males and 85 females, were due to Valvular disease of the Heart. 91 of these deaths occurred in Clapham, 33 in Putney, 111 in Streatham, 30 in Tooting, and 92 in Wandsworth. Of the deaths from all diseases of the Heart, one was under one year, one from one to two years, one from two to five years, 12 from five to 15 years, 19 from 15 to 25 years, 43 from 25 to 45 years, 121 from 45 to 65 years, and 159 over 65 years. The number of deaths in 1912 was two less than in 1911, and 48 under the corrected decennial average. Respiratory Diseases. The total number of deaths was 530, 270 of males and 260 of females, compared with 531 in 1911, 509 in 1910, and 690 in 1909. The number of deaths was one less than in the previous year, and 80 under the corrected decennial average. 109 of the deaths occurred in Clapham, 46 in Putney, 130 in Streatham, 60 in Tooting, and 185 in Wandsworth. Compared with 1911, there was a decrease in Clapham and Putney, and an increase in Streatham, Tooting and Wandsworth. 274 of the deaths occurred from Bronchitis, compared with 225 in 1911; 27 from Lobar Pneumonia, 85 from Lobular or Broncho-Pneumonia, 115 from Pneumonia in which the exact form was not distinguished ; and 29 from other diseases of the Respiratory Organs. Report of the Medical Officer of Health. 151 101 of the deaths were of infants under one year, 40 from one to two years, 20 from two to five years, seven from five to 15 years, seven from 15 to 25 years, 49 from 25 to 45 years, 123 from 45 to 65 years, and 183 over 65 years. The greatest number of deaths from these diseases occurred among persons from 45 to 65 years, and over 65 years. From Bronchitis alone 143 deaths occurred among persons over 65 years of age, compared with 133 in 1911. Appendicitis and Typhlitis. 29 deaths occurred from these diseases, 13 of males and 16 of females, equal to a rate of 92 per million, compared with 77 in 1911, 21 in 1910, and 19 in 1909. It is advisable to make a special note of this cause of death as it seems to show a tendency to increase. This increase may be due to greater precision in certification, many of the deaths previously registered as due to Peritonitis having been doubtless due to Appendicitis. The Registrar General in his Report for England and Wales for 1910, states that the recorded death-rate had increased from 38 per million in 1901 to 66 in 1910, while the rate from Peritonitis has decreased from nearly 51 to 15. Deaths from other Causes. From Alcoholism, Acute and Chronic, 13 deaths, eight of males and five of females, occurred ; and 39, 23 of males and 16 of females, from Cirrhosis of the Liver, compared with 14 and 39 in 1911. From Nephritis, and Bright's disease 109 deaths occurred,. 72 of males and 37 of females, compared with 128 in 1911. 152 Report of the Medical Officer of Health. From Accidents and diseases of Pregnancy and Child Birth 15 deaths occurred, three from 15 to 25 years and 12 from 25 to 45 years. This, added to the number of deaths from Puerperal Fever, viz.—11, gives a total of 26 deaths after child-birth, or a proportion of 3.84 per 1,000 births, compared with 3 43 in 1911. In London for the year 1911, which is the latest available report, this rate was 2.63. Of the 15 deaths, three occurred in Clapham, two in Putney, three in Streatham, two in Tooting, and five in Wandsworth. Three of the deaths were due to Haemorrhage, one to Rupture of the Uterus, two to Embolism or Thrombosis, three to Convulsions, and six to other diseases or accidents of Parturition. Diabetes Mellitus was the cause of 39 deaths, 17 of males and 22 of females, seven in Clapham, four in Putney, 17 in Streatham, three in Tooting, and eight in Wandsworth, compared with 23 in 1911. Premature Birth and Developmental Diseases. 240 deaths, 130 of males and 110 of females, were registered as having occurred from these diseases, compared with 268 in 1911, 249 in 1910, and 254 in 1909. The number of deaths is thus 28 under last year, and 96 under the corrected decennial average. 127 of the deaths were due to Premature Birth, 93 to Developmental diseases and 20 from other diseases of Early Infancy. 235 were of infants under one year, one from one to two years, and four over five years. The number of deaths from these diseases in the Borough is shown more in detail in an earlier part of this Report in Table XIX., which deal with Infantile Mortality, while for the subdistricts the Tables will be found in the Appendix. Report of the Medical Officer of Health. 153 Old Age. 236 deaths, 94 of males and 142 of females, occurred from Old Age, compared with 210 in 1911, 179 in 1910 and 192 in 1909. 41 of these occurred in Clapham, 19 in Putney, 72 in Streatham, 24 in Tooting, and 80 in Wandsworth. With one exception all these deaths were of persons over 65 years. 10 were from 65 to 70, 39 from 70 to 75, 58 from 75 to 80, 57 from 80 to 85, 46 from 85 to 90, 21 from 90 to 95, and four from 95 to 100. • 1,054 deaths, or 32 per cent. of the total deaths, occurred in persons over 65 years, compared with 28.3 in 1911, 311 in 1910, and 30.9 in 1909. The percentage of deaths over 65 years to total deaths, in the sub-districts was as follows:—In Clapham 32.4, in Putney 34.8, in Streatham 38.8, in Tooting 19.2, and in Wandsworth 29.4. Violence. 116 deaths, 80 of males and 36 of females, occurred from Violence, compared with 120 in 1911, 91 in 1910, and 118 in 1909. 68 of the deaths were due to Accidental, and 43 to Suicidal causes. Five deaths were caused by other forms of Violence, in four of which verdicts of murder or manslaughter were given. 24 of the deaths belonged to Clapham, 10 to Putney, 32 to Streatham, 14 to Tooting, and 36 to Wandsworth. From Accidental causes two of the deaths were of infants under one year, six of persons from two to five years, nine from five to 15 years, 12 from 15 to 25 years, 16 from 25 to 45 years, 13 from 45 to 65 years, and 10 over 65 years. 154 Report of the Medical Officer of Health. Of the deaths from Suicidal causes four were from 15 to 25 years, 12 from 25 to 45 years, 21 from 45 to 65 years, and six over 65 years. The number of deaths from Violence is four less than in 1911,. and six under the corrected decennial average. Inquests. The next Table shows the number of Inquests held in the Borough during the year. The total number was 182, compared with 192 in 1911, 189 in 1910, and 208 in 1909. 36 of the Inquests were held on persons who died in Clapham, 21 in Putney, 34 in Streatham, 18 in Tooting, and 73 in Wandsworth. In 107, or 58 8 per cent. of the cases, a verdict of death from Natural causes was returned ; in 30, or 16.4 per cent., from Accidental causes; in 33, or 18.1 per cent., from Suicidal causes; in eight, Open verdicts; in three, Murder ; while one Execution took place. 27 of the Inquests were held on persons not belonging to the Borough who died in the Borough. Three of these were on persons who died in the Prison, seven in the River Thames, one in Putney Hospital, and 16 in other places and on the street. Report of the Medical Officer of Health. 155 TABLE LXXV1I. INQUESTS. Sub-Districts. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. Deaths from Natural Causes 21 9 16 11 50 107 A ccidental:— Falls 2 2 2 1 1 8 Knocked down by motor ... 1 2 1 1 5 Suffocated in bed with parents ... ... 1 1 ... 2 Death under an anaesthetic ... ... 1 ... 1 2 Scalds ... ... 1 ... ... 2 Run over by train ... ... 1 ... ... 2 Fall from window ... ... ... ... ... 1 Run over by van ... ... ... ... ... 1 Tetanus following cut on hand ... 1 ... ... ... 1 Blow on head whilst at play ... ... ... ... ... 1 Burns ... ... ... 1 ... 1 Poisoning by Sulphonal ... ... ... ... 1 1 Suffocated by food in larynx ... ... ... ... 1 1 Loss of blood from cut ... ... ... ... 1 1 Gunshot wounds ... ... ... ... 1 1 Suicidal:— Drowning 1 4 1 ... 3 9 Cut throat 4 ... ... ... 2 6 Hanging 2 ... 1 1 1 5 Poisoning by coal gas 1 ... ... 1 3 5 Poisoning by oxalic acid 1 ... 1 ... ... 3 Poisoning by cyanide of potassium ... ... ... ... ... 1 Poisoning by hydrochloric acid ... ... 1 ... ... ... Run over by train ... ... 1 ... ... 1 Jumped from window ... ... 1 ... ... 1 Gunshot wounds ... ... ... 1 ... 1 Open Verdicts:— Found dead 1 ... 1 ... 2 4 Found drowned 1 2 ... ... 1 4 Murder ... 1 2 ... ... 3 Execution ... ... ... ... 1 1 Totals 36 21 34 18 73 182 88 inquests were held on persons belonging to the Borough who died outside the Borough; 15 front Clapham, eight from Putney, 26 from Streatham, 13 from Tooting, and 26 from Wandsworth, and the following Table shows the causes of death. 21 156 Report of the Medical Officer of Health. of these deaths were from Natural, 53 from Accidental, and 12 from Suicidal causes, while in one a verdict of Manslaughter and in one of Murder were returned. TABLE LXXVIII. INQUESTS. Sub-Districts. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. Deaths from Natural Causes 5 2 5 4 5 21 A ccidental:— Falls ... 1 3 2 3 9 Run over by motor bus 1 ... 3 3 1 8 Drowning 1 1 3 ... 1 6 Death under an anaesthetic 1 1 2 ... ... 4 Fall from ladder ... ... ... ... ... 4 Knocked down by taxi-cab ... ... 2 1 ... 3 Burns ... ... 2 ... 1 3 Knocked down by train ... ... ... ... ... 2 Knocked down by tram car 2 ... ... ... ... 2 Blood poisoning following injury ... ... 1 ... 1 2 Crushed by pole of van ... ... ... ... ... 2 Suffocated by fall of a wall ... ... ... 1 ... 1 Crushed under lift ... ... ... 1 ... 1 Suffocated by carbon-monoxide ... ... ... ... 1 1 Kicked whilst playing football ... ... ... ... 1 1 Fall down steamship's hold 1 ... ... ... ... 1 Crushed by machinery 1 ... ... ... ... 1 Run over by van ... ... ... ... ... 1 Thrown out of motor ... ... 1 ... ... 1 Suicidal:— Cut throat ... ... 2 ... ... 2 Poisoning by carbolic acid 1 1 ... ... ... 2 Poisoning by oxalic acid 1 ... ... ... ... 1 Poisoning by ammonia ... ... ... ... 1 1 Poisoning by opium ... 1 ... ... ... 1 Poisoning by cyanide of potassium ... ... ... 1 ... 1 Corrosive poisoning ... ... ... ... 1 1 Run over by train ... ... ... ... ... 1 Gun shot wounds ... 1 ... ... ... 1 Drowning ... ... ... ... 1 1 Manslaughter ... ... 1 ... ... 1 Murder 1 ... ... ... ... 1 Totals 15 8 26 13 26 88 Report of the Medical Officer of Health 157- Deaths and Causes of Death in Public Institutions. In the Public Institutions of the Borough 958 deaths occurred during the year, compared with 850 in 1911, 723 in 1910, 837 in 1909, 818 in 1908, 807 in 1907, and 771 in 1906. Of these 767 deaths were of persons not belonging to the Borough compared with 669 in 1911, and 191 of persons belonging to the Borough, compared with 181 in 1911. The increase was again chiefly due to the increase in the number of deaths of persons not belonging to the Borough. In Clapham 57 deaths occurred in the Hostel of God, six of these being Borough residents. Of these 29 were due to Cancer, 21 to Pulmonary Tuberculosis, two from other Tuberculous diseases, two from Rheumatic Fever, one from Appendicitis, and two from other causes. In Putney five deaths occurred in the Priory, Roehampton, two from diseases of the nervous system, and three from other causes. In Putney Hospital, which was opened during the year, 16 deaths occurred, 11 belonging to the Borough and five not belonging thereto. Three of the deaths were due to Cancer, two to Accident, two to Heart Disease, one to Pulmonary Tuberculosis, one to Puerperal Fever, and seven to other causes. In Streatham there were 10 deaths in St. Anne's Home, 11 in the Home for Aged Jews, and six in the Middlesex County Asylum Annexe. Of the 10 in St. Anne's Home, six were from diseases of the Respiratory Organs, one from Nephritis, one from Heart Disease, and two from other causes. Of the 11 in the Home for Aged Jews, one was from disease of the Nervous System, one from disease of the Circulatory system, three were from diseases of the Respiratory Organs, three from Old Age and three from other causes. Of the six in the Middlesex County Asylum Annexe one was from Pulmonary Tuberculosis, one from Tuberculous disease of the Bowels, two from diseases of the Nervous System, and two from other causes. 158 Report of the Medical Officer of Health. In Tooting 588 deaths occurred in Public Institutions, 325 in Tooting Bec Asylum, 108 in the Fever Hospital, 137 in Tooting Home, 17 in the Fountain Asylum, and one in Newlands House Asylum. 115 of these—67 in the Tooting Home, 39 in the Fever Hospital, seven in Tooting Bec Asylum, one in the Fountain Asylum, and one in Newlands House were of persons belonging to this Borough. Of the 325 deaths in the Tooting Bec Asylum, 246 were from Old Age, three from Pulmonary Tuberculosis, two from other forms of Tuberculosis, 16 from diseases of the Respiratory Organs, nine from diseases of the Heart, 26 from diseases of the Nervous System, eight from Cerebral Haemorrhage, two from Cancer, five from diseases of the Urinary System, and eight from all other causes. In the Fever Hospital, 108 deaths occurred, 39 of which belonged to the Borough, compared with 48 in 1911, 54 in 1910, and 84 in 1909. 17 of these deaths were from Scarlet Fever, 34 from Diphtheria, 25 from Measles, 26 from Whooping Cough, one from disease of the Respiratory Organs, one from Pulmonary Tuberculosis, and four from other causes. 137 deaths occurred in the Tooting Home, 67 of which were Borough residents. 94 of these were from Pulmonary Tuberculosis, 15 from Old Age, nine from diseases of the Respiratory Organs, three from Cancer, five from diseases of the Heart, four from Apoplexy, two from Influenza, and five from all other causes. In the Fountain Asylum, which was opened by the Metropolitan Asylums Board for the reception of Imbeciles, 17 deaths occurred one of which belonged to the Borough. Nine of these were due to diseases of the Nervous System, two to Pulmonary Tuberculosis, two to other forms of Tuberculosis, two to Heart Disease, one to Pneumonia, and one to Accident. In Wandsworth 144 deaths occurred in Public Institutions, 108 in the Middlesex County Asylum, 22 in the Royal Hospital for Incurables, eight in the Prison, and six in the Workhouse. Report of the Medical Officer of Health. 159 Of the 108 deaths in the Middlesex County Asylum, 20 were from Pulmonary Tuberculosis, 14 from Old Age, 11 from diseases of the Respiratory Organs, six from Bright's disease, one from Enteritis, one from Cancer, 42 from diseases of the Brain and Nervous System (of which 23 were from General Paralysis of the Insane, 10 from Epilepsy, four from Apoplexy, one from Convulsions, and one from Softening of the Brain), eight from Heart Disease, two from Accident, one from Enteric Fever, one from Erysipelas, and three from other causes. Of the 22 deaths in the Royal Hospital for Incurables, one was from Pulmonary Tuberculosis, seven from diseases of the Nervous System, two from Diabetes, three from Cancer, two from Bronchitis, one from Influenza, one from Old Age, and four from all other causes. Of the eight deaths in the Prison, two were from Apoplexy, one from Heart disease, one from Cancer, two from other causes, and one was a case of Execution. Of the six deaths in the Workhouse, all of which belonged to the Borough, two were from Premature Birth and Developmental diseases, two from diseases of Parturition, one from Cancer, and one from Apoplexy. In other places 122 deaths occurred, 47 of which belonged to the Borough, nine of these being from Accident, 17 from Cancer, 14 from Suicide, nine from Pulmonary Tuberculosis, one from other Tuberculous disease, one from Influenza, 11 from diseases of the Nervous System, four from Appendicitis, two from Diarrhoea, 18 from diseases of the Heart, 11 from diseases of the Respiratory Organs, five from Old Age, three from Nephritis, three from Premature Birth and Developmental diseases, two from Chronic Alcoholism, and 12 from all other causes. 42 of these deaths occurred in Private Nursing Homes, and eight in the River Thames. Of the 940 deaths in Public Institutions outside the Borough, 437 occurred in Workhouses and Workhouse Infirmaries, 393 in General and Special Hospitals, 89 in Lunatic and Imbecile Asylums, and 21 in the Metropolitan Asylums Board's Fever Hospitals. 160 Report of the Medical Officer of Health. Of the 437 deaths in Workhouses and Workhouse Infirmaries, one was from Measles, one from Whooping Cough, one from Erysipelas, 42 from Pulmonary Tuberculosis, seven from other Tuberculous diseases, 50 from Cancer, 10 from Alcoholism and Cirrhosis of the Liver, 35 from diseases of the Nervous System, 46 from diseases of the Heart, 70 from diseases of the Respiratory Organs, 32 from Enteritis, 16 from Bright's disease, three from Puerperal Fever, 16 from Premature Birth and Congenital Debility, 56 from Old Age, six from Accident, two from Suicide, and 43 from other causes. Of the 393 deaths in General and Special Hospitals, one was from Enteric Fever, one from Measles, one from Diphtheria, two from Influenza, 31 from Pulmonary Tuberculosis, 21 from other forms of Tuberculosis, 56 from Cancer, 22 from diseases of the Nervous System, 49 from diseases of the Heart, 26 from diseases of the Respiratory Organs, five from Diarrhoea and Enteritis, 17 from Appendicitis, 10 from Obstruction of the Bowels, nine from Ulcer of Stomach, seven from Bright's disease, four from Puerperal Fever, 24 from Premature Birth and Congenital Debility, two from Old Age, 41 from Accident, 11 from Suicide, and 53 from other causes. Of the 89 deaths in Lunatic and Imbecile Asylums, one was from Enteric Fever, one from Influenza, one from Cancer, 10 from Pulmonary Tuberculosis, one from other forms of Tuberculosis, 41 from diseases of the Nervous System, 11 from diseases of the Heart, 10 from diseases of the Respiratory Organs, one from Enteritis, three from Bright's disease, four from Old Age, and five from other causes. Of the 21 deaths in the Metropolitan Asylums Board's Fever Hospitals, five were from Enteric Fever, two from Scarlet Fever, two from Measles, two from Whooping Cough, two from other forms of Tuberculosis, one from Puerperal Fever, three from Congenital Debility, and four from other causes. The number of deaths in both External and Internal Institutions, in Nursing Homes, and other places not Institutions, is shown in the next Table. Report of the Medical Officer of Health. 161 TABLE LXX1X. I.—Institutions within the District receiving sick and infirm persons from outside the District. 11.—Institutions outside the District receiving sick and infirm persons from the District. III.—Other Institutions, the Deaths in which have been distributed among the several localities in the District Name of Institution. No. of Deaths. Name of Institution No. of Deaths Name of Institution No.of Deaths. Name of Institution No. of Deaths. Hostel of God 51 1. Wandsworth Union Infirmaries 25 31. Middlesex Hospital 11 Grove Fever Hospital 39 The Priory, Roehampton 5 32. Mount Vernon Hospital 2 The Workhouse 6 St. Anne's Home ... 10 2. Banstead Asylum 11 33. National Hospital 2 Tooting Home 67 Tooting Home ... 70 3. Battersea Gen. Hospital 3 34. Queen Charlotte Hosp. 2 Hostel of God 6 Grove Fever Hospital ... 69 4. Belgrave Hospital 6 35. Ryl. Sea Bathing Hosp. 3 Tooting Bec Asylum 7 Royal Hospital for Incurables 20 5. Bolingbroke Hospital 33 36. Royal Waterloo Hosp. 3 H.M. Prison 3 Middlesex County Lunatic Asylum 113 6. Brompton Hospital 4 37. Royal National Hosp. 2 Royal Hospital for Incurables 2 7. Camberwell House Asylum 2 38. St. Bartholomew's Hospital 6 H. M. Prison 5 8. Cancer Hospital 4 Putney Hospital II Tooting Bec Asylum ...318 9. Cane Hill Asylum 9 39. St. Catherine's Hospital 2 Fountain Temporary Asylurr I Fountain Temporary Asylum 16 10. Caterham Asylum 8 40. St. George's Hospital 11 Middlesex County Lunatic Asylum I Home for Aged Jews ... 10 11. Cen. Lond. Sick Asylum 3 41. St. George's Infirmary 2 Putney Hospital 5 12. Charing Cross Hospital 8 42. St. Luke's House 4 Newlands House I Nursing Homes ... 27 13. City of London Asylum 2 43. St. Mary's Hospital 3 Nursing Homes 15 River Thames 6 14. Clapham Maternity Hospital 5 44. St. Peter's Hospital River Thames 2 Other Places ..42 45. St. Thomas's Hospital 63 Other Places 3° 15. Croydon Gen. Hospital 2 46, University College Hospital 5 767 16. Croydon Infirmary 2 191 17. Earlswood Asylum 2 47. Victoria Hospital 13 18. Epileptic Colony 3 48. Westminster Hospital 16 19. Evelina Hospital 10 49. West London Hospital 4 20. Gen. Lying In Hospital 6 50. Park Hospital 6 21. Grosvenor Hospital 2 51. South Western Hospital 10 22.. Gt. Ormonde St. Hospita 3 52. Southern Hospital 3 23. Guy's Hospital 15 53. Western Hospital 2 24. Horton Asylum 19 54. Other Institutions 32 25. Infants' Hospital 3 55. Other places not public institutions 63 26. King's College Hospital 8 27. Lambeth Infirmary 4 5O. On Street 13 28. London Hospital 2 57. River Thames 4 29. Long Grove Asylum ... 16 58. Private Nursing Homes 22 30. Manor Asylum 7 940 L 162 Report of the Medical Officer of Health. Compared with the average of the last 20 years there has beer.! a marked increase in the number of deaths in Institutions, and toshow that the increase has been going on for some years, the following Table has been prepared. The comparative percentages for London are also shown, and it will be noted that in the 20 years 1891-1910 these increased in London from 25.8 to 43.4 with an average of 33.48, and in Wandsworth from 14.9 to 31.2, with an average of 21-07. .In this Borough the percentage is lower than for the whole of London, and this is what might be expected in consequence of the social condition of the population, but in spite of this, it is rather startling to find that 30 per cent. of the total deaths occurred in Institutions, and that for the year 1911 12.2 per cent. occurred in Workhouses and Workhouse Infirmaries. Compared with the 20 years' average, the greatest increase has occurred among the deaths in General and Special Hospitals, etc., while the rates in the Metropolitan Asylums Board's Hospitals, both for the Borough and for London, are much higher owing to the reception of Measles and Whooping Cough into these Hospitals. Report of the Medical Officer of Health. 163 TABLE LXXX. Percentage of Deaths in Public Institutions to Total Deaths for the Year 1911 and for the 20 Previous Years. Year. Workhouse and Workhouse Infirmaries. General and Special Hospitals and Asylums. Metropolitan Asylums Board's Hospitals. Total. London. Wandsworth. London. Wandsworth. London. Wandsworth. London. Wandsworth. 1891 1.40 8. 0 10.7 6.3 1.1 .6 25.8 14.9 1892 12.8 7.7 10.7 5.8 1.9 1.5 25.4 15.0 1893 13.1 7.9 11.4 6.0 2.4 2.7 26.9 16.6 1894 13.4 8.7 12.5 7.1 4.7 2.4 28.7 18.2 1895 13.5 9.0 11.4 6.7 1.9 1.2 26.8 16.9 1896 13.5 8.5 12.1 7.4 2.2 1.5 27.8 17.4 1897 14.3 9.1 12.5 7.8 2.3 3.3 29.1 20.2 1898 14.7 8.1 12.2 6.1 2.1 2.8 29.0 17.0 1899 15.8 8.5 12.0 7.2 2.1 1.8 29.9 17.5 1900 15.8 8.0 12.7 6.5 2.0 1.8 30.5 16.3 1901 16.5 9.5 13.6 8.0 2.4 1.8 32.5 19.3 1902 16.6 8.4 14.0 8.4 3.5 3.7 34.1 20.5 1903 18.3 10.8 15.5 9.0 1.6 1.9 35.4 21.7 1904 18.1 11.0 15.5 10.5 1.4 1.6 35.0 23.1 1905 19.3 12.0 16.7 10.5 1.5 1.8 37.5 24.3 1906 19.3 12.5 17.4 11.2 1.6 2.0 38.3 25.7 1907 20.05 12.7 17.4 11.5 1.9 1.7 39.8 25.9 1908 21.4 12.8 18.7 14.1 1.8 1.8 41.9 28.7 1909 21.9 16.0 18.6 12.9 1.5 1.6 42.0 30.5 1910 22.4 14.7 19.8 15.4 1.2 1.1 43.4 31.2 Averages 1891— 1910 16.73 10.18 14.26 8.91 2.05 1.94 33.48 21.07 1911 22.4 122 168 16.1 2.1 2.6 41.3 309 L2 364 Report of the Medical Officer of Health. The diagram which follows shows graphically the proportion which the more prevalent diseases bear to the total deaths. The whole area of the circle represents the deaths from all causes, and the various segments the deaths from particular diseases or groups of diseases. It will be observed that the deaths from Tuberculosis, Cancer, Diseases of the Circulatory system, and Diseases of the Respiratory Organs contribute very largely to the total mortality, and also that the notifiable diseases, other than Pulmonary Tuberculosis, contribute very little. Proportion of Deaths from the Principal Causes to Total Deaths, 1912. Report of the Medical Officer of Health. i6£ Proportion per 1,000 Deaths from all causes. Notifiable Diseases 16.4 Measles i5'5 Influenza 13*6 Whooping Cough 17*3 Diarrhoea and Dysentery 25"8 Tuberculosis (all forms) 111.3 (Lungs) (92.1) Bronchitis 83.2 Pneumonia 69.0 Cancer 102.7 Nervous Diseases 99.1 Circulatory Diseases 108.5 Premature Birth 38.6 Congenital Debility, etc. 34.3 Old Age 717 Digestive Diseases 53.0 Urinary Diseases 407 Violence 35.2 Other Causes 64.1 All Causes 1,000.0 Cutting-off Notices. During the year 114 notices with respect to 126 premises were received from the Water Board stating that the supply had been withdrawn. 13 of the premises were in Clapham, 27 in Putney, 44 in Streatham, 12 in Tooting, and 30 in Wandsworth. The supply was withdrawn for non-payment of rates from 45 premises, from 35 premises in consequence of defects, and in 46 the premises were empty. Compared with 1911, there has been an increase of 14 in the number of notices received, and of 23 in the number of premises affected. 166 Report of the Medical Officer of Health. Mortuaries. The Mortuaries in Clapham, Streatham, Tooting and Wandsworth have been visited several times during the year, and I am able to report that the By-laws and Regulations have been carried out in a satisfactory manner. With reference to the Wandsworth Mortuary the Public Health Committee have on several occasions had the question of providing a new mortuary for Wandsworth before (hem, but so far no decision as to the site has been arrived at. The Morluary at Tooting has been closed, but a temporary one has been provided pending the erection of a new one in Wandsworth In Clapham, 30 bodies were removed to the Mortuary, compared with 43 in 1911 ; in Streatham 39, compared with 55, and in Wandsworth 117, of which 74 were from Wandsworth, 24 from Putney, and 19 from Tooting—a total of 186 compared with 206 in 1911. In addition four bodies were removed to the temporary Mortuary at Tooting. No infectious cases were admitted to any of the Mortuaries during the year. GENERAL SANITARY WORK IN 1912. The following list shows the special inspections made by me during the year :— (1)—Complaints were received from the Wimbledon Council with reference to flooding of land at rear of Ravensbury Road, Wandsworth, which was used as a skating pond in winter. In company with the Medical Officer of Health for Wimbledon I made an inspection of the pond in January, 1912. As far as this Borough was concerned I could detect no nuisance that could be dealt with under the Public Health (London) Act, 1891. Some of the water was flowing from the pond into land owned by the Wimbledon Corporation, 167 Report of the Medical Officer of Health. and as this might possibly cause some damage to the property the attention of the owner of the land was called to the matter by that Authority, as also the nuisance caused by some of the water flooding a factory in the Wimbledon district. (2)—Special inspections were also made of several new roads in consequence of complaints by residents in these roads. The two principally complained of were part of Ellison Road and Downton Avenue, both in the sub-district of Streatham. With regard to the former the owner of the road carried out some repairs which abated the nuisance to a certain extent, and in the latter the road has been apportioned and will be dealt with by the Borough Council during the current year. (3)—Special inspections were made during the year of all the premises in the Borough where pigs were kept, and in one case where these animals were kept within forty yards of the street, the attention of the owner was called to the matter and the sties were removed and new sties built which complied with the statute. With regard to the other premises, which are chiefly in the Osiers, and the vacant land in Merton Road, Wandsworth, it was necessary in a few cases to serve notices for the repair of paving to the sties, and these notices were all satisfactorily complied with. (4)—At the request of the Home Secretary I superintended the exhumation and reburial of bodies from the Defoe Chapel, Tooting, as the premises were to be occupied for business purposes. In all, the remains of 150 bodies were found and these were all removed and reburied at the Streatham Park Cemetery to my satisfaction and under my personal supervision. (5)—As in previous years, special inspections were made of several localities in consequence of complaints of smells from road gullies and sewer ventilators. The number of complaints was much less than in the previous year, especially in Streatham and Wandsworth; this having been due to the fact that the climatic conditions were unfavourable. 168 Report of the Medical Officer of Health. In all 91 complaints were received, compared with 214. in 1911: five from Clapham North, six from Clapham South, 13 from Putney, 21 from Streatham, four from Balham, 10 from Tooting, 12 from Southfield, seven from Fairfield, and 13 from Springfield Wards. All these complaints were forwarded to the Borough Engineer, who reported that in 68 cases the sewers were flushed and disinfected, in five the manholes were temporarily sealed, in two ventilating columns were erected, in three as the sewer in connection with which the ventilator complained of was under the control of the London County Council, the complaints were forwarded to that Authority, while the remaining complaints, 13 in number, were second or third complaints of the same ventilator. (6)—Inspections were also made of several passages and mews with the result that several have again this year been satisfactorily dealt with, while in one case proceedings were taken in the Police Court, but the summons was dismissed as the Council could not produce. satisfactory evidence as to the proper owners. (a) Passage at rear of 147-157, Clapham Park Road, has been properly paved. (b) Elms Mews, Elms Road, have been paved and drained (c) Entrance to Newman's Court, Clapham, paving has been repaired. (d) Footway at Little Pleasant Place, Clapham, has been properly paved. (e) Passageway at rear of 267-285, Putney Bridge Road, has been repaired with gravel and the nuisance abated. (f) Passageway 103-111, Mitcham Road, has been paved and drained. (g) Passageway 196-200, Mitcham Road, has been repaired with gravel and the insanitary conditions removed. (h) Passageway 119-133, Mitcham Road, paving has been repaired. (i) Passageway at rear of 227-233, Mitcham Lane, has been repaired and a new gate erected at entrance. 169 Report of the Medical Officer of Health. (k) Passageway at rear of 57-67, Corsehill Street, has been paved with concrete. (i) Passageway at rear of 60-70, Corsehill Street, has been paved with concrete. (m) Passage at rear of 133-139, Upper Tooting Road, has been repaired. (n) Passage at rear of 166-200, Streatham High Road, has been repaired and tar-paved. (0) Passage at rear of 67, New Park Road, has been gravelled and the nuisance abated. (p) Passage at rear of 238-258, Balham High Road, has been repaired. (q) Passage at rear of 33-41, Balham Hill, has been gravelled. (r) Passage at rear of 31-47 and 41-47, Bedford Hill, has been repaired. • (s) Passage at rear of 525-551, Garratt Lane, has been repaired and properly drained. (7)—Special house-to-house inspections were made by me during the year in Young's Rents, Rowlands Cottages, Park Crescent, Carfax Square, Little Pleasant Place, Gauden Road, Heath Road, Yeovil Street, White Square, Foley Place, Wandsworth Road, and Downers Cottages, Clapham; Biggs Row, Labourers Cottages and Brewliouse Lane, Putney; Greyhound Square, Foss Road, Hazelhurst Road, Calders Row, Cowpers Row, Lutheran Place, Fairview Place, Smith's Cottages, Champion Place, Farm Avenue, Verran Road, Bellamy Street, Fernlea Road, Larch Road and Graveney Road, Streatham; Aldis Mews, Salvador, Salvador Place, Salvador South and Fountain Road, Tooting; Point Pleasant, Wardley Street, Groton Road Briclgefield Grove, Malva Road, Guelph Street, Fields Alley,, and Cubitt's Cottages, Garratt Lane, Wandsworth. 170 Report of the Medical Officer of Health. These inspections were made chiefly on account of nuisances and damp conditions reported to me by the Sanitary Inspectors, and also to ascertain if any of these premises could be reported to the Council under the Housing, Town Planning, &c., Act, and also the By-laws as to Underground Rooms, made under the above Act. (8)—Special inspections were also made of the slaughterhouse occupied by Messrs. Harrison, Barber & Co., for the new licence to be granted by the London County Council for the slaughtering on these premises of horses for human consumption. The Inspector has on many occasions during the year inspected these premises and reported that all the animals examined by him were in good condition. The horse flesh is not sold to retailers in this country but is exported to the Continent. Including the house-to-house inspections and inspections rfor certificates under the Revenue Act, but excluding the routine inspection of bakehouses, slaughter-houses, cowsheds, and offensive trade premises, 1,010 inspections were made of premises, chiefly previous to the service of statutory notices. My attendance at the Police Court was necessary on 14 occasions during the year. Revenue Act. During the year 14 certificates were granted under the above Act, and four refused. The certificates granted referred to 37 houses or 80 tenements, and those refused to 12 houses or 29 tenements. Housing, Town Planning, etc., Act, 1909. All the house-to-house inspections during the year have again been carried out under and for the purposes of Section 17 of this Act, and the results of these inspections have been recorded on the cards, particulars of which are given in the Report for 1910. 171 Report of the Medical Officer of Health. It has not been found necessary to take any action under this Act as it has been found, after careful consideration and personal inspection that the nuisances detected could all be dealt with under the Public Health (London) Act, 1891. The four houses in Putney and one in Wandsworth, reported on in 1910 under the above Act, have not been demolished, but the former are still closed and the latter is now used as a store shed. The tables of house-to-house inspections show, as in former years, the name of the street, the number of houses inspected, the number of houses in which defects were found, and the number of families living in one, two, three, and four rooms and upwards. The defects found are given in the Table of Sanitary Operations, as also the number of intimation and statutory notices served and complied with. Underground Rooms. The Inspection begun in 1911 of premises where such rooms existed, was continued during 1912, but as I stated in the Report for the former year very few have been discovered, and in the majority of those discovered in 1912 the occupation as a sleeping room has been discontinued. In Clapham the streets where such rooms were chiefly found were Wandsworth Road and Carfax Square. In several of the houses in Wandsworth Road structural alterations have been made so as to comply with the By-laws, while in Carfax Square the rooms are in nearly all the cases not now used as sleeping rooms. In eight out of 19 houses in this latter street the rooms are still occasionally occupied as sleeping rooms, and these premises are being kept under observation for further action if necessary. In Putney three houses in Felsham Road had underground rooms which were illegally occupied, but the owner carried out structural alterations so as to comply with the By-laws. 172 Report of the Medical Officer of Health. In Streatham inspections were made of 25 houses in Fernlea Road, 27 in Larch Road and seven in Balham Grove, but in all it was only necessary to make certain slight alterations so as to comply with the By-laws. In Selkirk Road, 13 houses were found with underground rooms, but these were, after communication with the owner, found on further inspection not to be used as sleeping apartments. In Tooting, only four houses were found to have illegally occupied underground rooms, and the use of these rooms as sleeping rooms was discontinued on the attention of the owner being called to the By-laws. In Wandsworth, only three underground rooms were found illegally occupied, but on further inspection the occupation as sleeping rooms had been discontinued. I have personally during the year inspected all the premises in which my attention was called by the Inspectors before communicating with the owners, and I am pleased to be able to report that it was not necessary during the year to take further action. Sanitary Operations. Tables LXXXI., LXXXII., and LXXXIII. show the number and nature of the inspections made during the year by the Male and Female Inspectors respectively. These Tables show in more detail the varied character of the work carried out by the Inspectors. 173 Report of the Medical Officer of Health. The number of complaints received and attended to was 2,528, compared with 2,076 in 1911, 1,789 in 1910, and 1,692 in 1909. There was an increase in Clapham South, Putney, Streatham, Balham, Southfield, Fairfield, and Springfield Wards, and a decrease in Clapham North and Tooting Wards, compared with the previous year. Four of these complaints were made to the London County Council, and these were at once attended to. The number of houses and premises inspected was 36,316, an increase of 4,343 compared with 1911, and of 6,385 compared with 1910. There was an increase in the number of houses and premises inspected in Clapham North and South. Streatham, Balham, Tooting, Fairfield and Springfield Wards, and a decrease in Putney and Southfield Wards. The total number of house-to-house inspections made was 2,674, compared with 2,486 in 1911, 6,276 in 1910, 7,007 in 1909, 5,575 in 1908, and 5,718 in 1907. There has been an increase in the number of these inspections in Clapham North, Putney, Streatham, Tooting, Southfield and Springfield Wards, and a decrease in Clapham South, Balham, and Fairfield Wards, compared with 1911. Although the number of these inspections is lower than the average of the five previous years, yet there has been an increase of 188 compared with 1911, and it will be noted that the total number of inspections has increased by 4,343. 174 174 Report of the Medical Officer of Health. TABLE LXXXI. Summary of Sanitary Operations in the Borough during the Year 1912. Clapham. Putney. Streatham Tooting. Wandsworth. Whole Borough. North Ward. South Ward. Streatham Ward. Balham Ward. South field Ward. Fairfield Ward. Sprig field Ward. Number of complaints received and attended to 293 275 139 426 281 304 267 159 384 2528 Number of houses and premises inspected 4119 3206 3968 4613 4375 4464 4103 2410 5058 36316 Number of houses and premises re-inspected 1926 1131 1478 3066 2747 2208 2098 1928 2458 19040 Number of house - to - house inspections 333 201 429 357 403 172 308 214 257 2674 Number of preliminary notices served 754 504 504 1097 1030 6l1 547 626 947 6620 Ditto complied with 728 514 535 934 1049 567 514 682 923 6446 Number of statutory notices served 77 42 11 39 161 36 92 47 202 707 Ditto complied with 78 39 12 33 172 41 34 63 228 700 Notices served for periodical removal of manure ... 1 ... 6 ... ... ... ... 1 8. Number of rooms disinfected after infectious diseases 407 308 382 328 545 651 400 299 467 3787 Bedding stoved 156 141 145 211 246 315 167 134 229 1744 Overcrowding abated 11 1 4 10 9 8 1 2 30 76 Rooms cleansed and repaired 424 302 250 790 1299 556 244 673 710 5248 Staircases cleansed and repaired 131 54 47 147 274 72 52 113 153 1043 Drains cleansed and repaired 123 94 76 210 153 258 120 75 127 1236 Traps fixed to drains ... 85 13 30 21 56 10 21 ... 236 Bath, lavatory and sink wastes altered to discharge outside over gullies or repaired ... 17 25 116 52 74 16 31 30 361 Rain water pipes disconnected from drains ... 2 ... 6 3 6 1 9 ... 27 Water closets cleansed and repaired 185 141 104 181 348 172 132 222 209 1694 Water closets, separate supply of water laid on to ... ... ... ... ... 2 ... ... ... 2 Accumulations of manure, &c., removed 48 30 42 8??? 40 31 18 8 18 316 Urinals cleansed, repaired or water laid on to 5 ... 12 6 8 3 4 12 1 51 Cesspools abolished ... ... ... ... ... ... 1 ... ... l Ashpits provided or repaired 74 68 36 167 142 99 56 87 88 717 Dust complaints received 65 87 60 86 41 21 94 32 81 567 Stables and stables yards drained, paved or cleansed 3 17 8 26 7 10 4 4 24 103 Yards drained, paved or cleansed 84 69 55 190 122 114 77 103 142 956 Unwholesome or dilapidated houses cleansed or repaired ... ... ... 3 7 5 20 21 4 60 Leaky roofs and gutters repaired 128 107 66 135 112 77 58 95 92 870 Damp courses inserted 79 21 ... 166 49 55 59 139 28 596 Damp conditions remedied 155 63 95 257 94 89 29 53 128 963 Houses re-supplied with water 14 2 20 3 16 10 6 9 13 93 Water cisterns cleansed, covered or repaired 26 35 32 108 55 54 16 49 70 445 Animals kept so as to be a nuisance 4 3 6 22 6 12 4 12 18 87 Smoke nuisances reported 3 ... 11 4 ... ... 21 11 5 55 Soil pipes repaired 14 9 22 32 18 35 6 15 8 1259 Unclassified nuisances H3 56 83 283 63 73 69 171 18 929 175 Report of the Medical Officer of Health. TABLE LXXXII. DETAILS OF INSPECTIONS AND RE-INSPECTIONS, 1912. (Male Inspectors.) Inspections. Re-Inspections. Totals. Number of complaints received and attended to 2,523 ... 2,523 Number of house-to-house inspections 2,674 ... 2,674 Drainage and other sanitary works after notice 3,664 15,330 iS.994 Drainage and other sanitary works voluntary 828 1,048 1,876 Number of premises inspected on account of:— N01 ifiable diseases 2,615 271 2,886 Measles 1,859 128 1,987 Whooping Cough 954 3 957 Pulmonary Tuberculosis 93 5 98 Other Infective Diseases 461 41 502 Verminous conditions 726 125 851 Periodical Inspections:— Houses-let-in-Lodgings 316 453 769 Underground rooms 130 ... 130 Common Lodging Houses 13 ... 13 Food-places Work-places Factories 487 97 584 Workshops 1,158 88 1,246 Workshops (Domestic) 324 51 375 Workplaces 325 57 382 Outworkers' premises 155 33 188 Bakehouses 440 216 656 Restaurant kitchens 228 16 244 Cowsheds 46 3 49 Piggeries 87 11 98 Dairies and Milkshops 971 52 1,023 Ice Cream Premises 493 49 542 Slaughterhouses 323 6 329 Places where food is prepared 149 24 173 Offensive trades 60 ... 60 Fried Fish shops 217 39 256 Rag and bone stores 73 7 80 Butchers' shops 604 14 618 Greengrocers' shops 449 16 465 Fishmongers' shops 353 22 375 Public House urinals 373 23 396 Other sanitary conveniences, schools, &c. 149 11 160 Smoke observations 192 ... 192 Unsound food 30 12 42 Yards of Mews and Stables 982 241 1,223 Legal proceedings:— (1) Applications and summonses 4 ... 4 (2) Hearings and adjournments 31 ... 31 Other 1,082 74 1,156 Totals 26,641 18,566 45,207 176 176 Report of the Medical Officer of Health TABLE LXXXI1I. DETAILS OF INSPECTIONS AND RE-INSPECTIONS, 1912 (Female Inspectors.) Inspections. Re-Inspections. Totals. Number of complaints received and attended to 5 ... 5 Number of visits made and premises inspected on account of:— Puerperal Fever 59 12 71 Ophthalmia Neonatorum 85 11 96 Diarrhœa 50 8 58 Pulmonary Tuberculosis:— Poor Law 742 122 864 Hospital 601 57 658 Private 713 76 789 Notification of Births 5,500 105 5,605 Dressmakers' and Milliners' premises 543 6 549 Laundries:— Factory 137 11 148 Workshop 283 31 314 Workplace 105 14 119 Other Factories 40 1 41 Other Workshops 91 3 94 other Workplaces 119 5 124 Domestic Workshops 44 2 46 Outworkers' premises 266 7 273 Other 296 3 299 Totals 9,679 474 10,153 The Tables of house-to-house inspections which follow show the names of the streets and the number of houses inspected, the number of houses in which defects were found, the percentage of defects to houses inspected, as well as the number of families living in one, two, three, and four rooms and upwards. In 1,875 out of a total of 2,674 houses inspected, or 70.11 per cent., sanitary defects necessitating the service of an intimation notice were found. The highest percentage was in Streatham Ward, where the percentage was 90.19, and the lowest in Putney, where it was only 41.95, the next lowest being Southfield, where it was 45.12. 177 Report of the Medical Officer of Health. The following Table, which is prepared from the figures given in the summary, shows the percentage to total number of families, of those living in one, two, three, and four rooms and upwards, in the separate Wards and in the whole Borough, in the premises inspected in 1912. TABLE LXXXIV. Percentage to total living in one, two, three, and four rooms and upwards. Wards. One room. Two rooms. Three rooms. Four rooms and upwards. Clapham, North 12.09 25.00 13.57 49.34 Clapham, South 7.53 6.27 20.50 65.70 Putney .56 ???.31 48.20 49.93 Streatham 8.05 11.59 28.30 52.06 Balham 12.80 21.42 31.18 34.60 Tooting 4.44 4.89 8.89 81.78 Southfield 11.94 7.67 2.27 78.12 Fairfield 102.84 14.92 28.06 44.18 Springfield 10.13 11.50 22.19 56.18 Whole Borough 9.31 13.44 24.85 52.40 Fairfield and Balham Wards had the highest percentage of families living in one room, and Putney the lowest. Clapham North and Balham had the highest percentage living in two rooms and Putney the lowest. Putney had the highest percentage living in three rooms, and Southfield the lowest. Southfield and Tooting had the highest percentage living in four rooms and upwards, and Balham the lowest. In the Borough, of the total families whose houses were inspected during the year, viz.:—3,952, 9.31 per cent. lived in one room, compared with 8.7 per cent. in 1911, 7.4 in 1910, and 7.3 in 1909; 13.44 per cent. in two rooms compared with 14.8, 9.5, and 10.3; 24.85 per cent. in three rooms compared with 25.2, 29.06, and 27.5; and 52.4 per cent. in four rooms and upwards compared with 51.3, 54.1, and 54.9. M 178 Report of the Medical Officer of Health. House-to-House Inspections. HOUSING, TOWN PLANNING, &c., ACT, 1909. SUB-DISTRICT OF CLAPHAM, (North Ward). TABLE LXXXV. Name of Street. No. of houses inspected. No. of houses in which defects were found. Percentage of detects to houses inspected. Number of Families living in One room. Two rooms. Three rooms. Four rooms and upwards. Alford Road 20 10 50.00 3 4 13 18 Broadhinton Road 9 6 66.66 1 1 1 9 Courland Grove 22 19 86.36 4 6 3 22 Crichton Street 10 6 60.00 5 12 9 1 Heath Road 10 9 90.00 5 6 ... 10 Lillieshall Road 25 19 76.00 5 ... ... 25 Milford Street 6 1 16.66 ... 3 4 4 Newby Street 4 3 75.00 1 ... ... 4 Peardon Street 6 5 83.33 2 4 1 5 Pitcairn Street 13 10 76.92 ... 7 3 10 Rashleigh Street 28 27 96.44 22 35 7 9 Renshaw Street 14 14 100.00 5 1 6 11 Union Grove 19 8 42.10 1 9 5 19 Wandsworth Road 109 71 65.13 18 61 28 115 Westbury Street 1 1 100.00 1 ... ... 1 Yeovil Street 34 30 88.23 ... 2 2 32 Yeovil Place 3 3 100.00 ... ... ... 3 Totals 333 242 72.67 73 151 82 298 179 Report of the Medical Officer of Health. House-to-House Inspections.—continued. HOUSING, TOWN PLANNING, &c., ACT, 1909. SUB-DISTRICT OF CLAPHAM, (South Ward). TABLE LXXXVI. Name of Street. No. of houses inspected. No. of houses in which defects were found. Percentage of detects to houses inspected. Number of Families living in One room. Two rooms. Three rooms. Four rooms and upwards. Acre Square 6 3 50.00 1 1 2 4 Clapham Park Road 3 2 66.65 ... ... ... 3 Crescent Road 36 26 72.22 5 1 9 30 Gt. Acre Court 17 12 70.58 ... 4 7 8 Park Crescent 4 3 75.00 2 4 2 3 Park Place 85 60 70.58 7 5 10 77 White Square 50 37 74.00 3 ... 19 32 Totals 201 143 71.14 18 15 49 157 Grand Total 534 385 72.09 91 166 131 455 m 2 180 Report of the Medical Officer of Health. House-to-House Inspections.— continued.. HOUSING, TOWN PLANNING, &c., ACT, 1909. SUB-DISTRICT OF PUTNEY. TABLE LXXXII. Name of Street. No. of houses inspected. No. of houses in which defects were found. Percentage of defects to houses inspected. Number of Families living in One room. Two rooms. Three rooms. Four rooms and upwards. Felsham Road 100 38 38.00 2 5 51 90 Floss Street 33 9 27.27 ... ... 33 ... Gwalior Road 23 15 65.21 ... 1 40 3 Isabella Place 17 7 41.17 1 ... 1 11 Labourer's Cottages 22 21 95.45 ... 1 ... 22 March's Place 14 9 64.28 ... ... ... 14 Modder Place 15 10 66.66 ... ... 26 2 Norroy Road 52 18 34.61 ... ... 24 20 Putney Common 16 6 37.50 ... ... ... 10 Quill Lane 42 12 28.57 ... ... 41 1 Roskell Road 22 7 31.81 ... ... ... 22 Sadlers Buildings 10 6 60.00 ... ... ... 10 Seymour Row 7 6 85.71 ... ... ... 7 Stanbridge Road 44 11 25.00 ... ... 42 42 Stewart's Cottages 4 2 50.00 ... ... ... 4 Taylor's Buildings 8 3 37.50 ... ... ... 8 Totals 429 180 41.95 3 7 258 266 181 Report of the Medical Officer of Health. House-to-House Inspections.—continued. HOUSING, TOWN PLANNING, &c., ACT, 1909. SUB-DISTRICT OF STREATHAM. TABLE LXXXVIII. Name of Street. No. of houses inspected. No. of houses in which defects were found. Percentage of defects to houses inspected. Number of Families Living in One room. Two rooms. Three rooms. Four rooms and upwards. Calders Row 14 14 100.00 2 1 10 6 Champion Place 9 9 100.00 ... ... ... 9 Colmer Row 70 66 94.28 9 20 34 50 Corsehill Street 2 2 100.00 ... ... ... 2 Coopers Row 13 12 92.30 1 ... 1 12 Fair-view Place 24 24 100.00 1 2 7 17 Falls-brook Road 43 41 95.34 3 .... 72 6 Farm Avenue 17 15 88.23 3 4 2 17 Kettering Street 105 79 75.23 ... ... ... 105 Lutheran Place 25 25 100.00 2 ... 2 23 Mill Lane 19 19 100.00 15 31 16 2 Streatham High Road 3 3 100.00 ... ... ... 3 Upper Tulse Hill 13 13 100.00 5 1 ... 13 Totals 357 322 90.19 41 59 144 265 182 Report of the Medical Officer of Health. House-to-House Inspections.-continued. HOUSING, TOWN PLANNING, &c„ ACT, 1909. SUB-DISTRICT OF STREATHAM, (BALHAM WARD). TABLE LXXXIX. Name of Street. No. of houses inspected. No. of Nouses in which defects were found. Percentage of defects to houses inspected. Number of Families Living in One room. Two rooms. Three rooms. Four rooms and upwards. Balham Grove 7 7 100.00 2 17 5 2 Bellamy Street 48 39 81.25 6 6 8 40 Cavendish Road Flats 6 6 100.00 ... ... 6 ... Chesil Place 7 7 100.00 ... 3 3 1 Fernlea Road 43 36 83.72 22 66 15 28 Foss Road 44 42 95.45 2 1 ... 71 Grove Road Mews 5 5 100.00 ... 3 ... 2 Hazelhurst Road 32 32 100.00 7 6 9 28 Larch Road 74 63 85.13 4 6 122 26 Pickets Street 30 18 60.00 8 7 14 22 Verran Road 20 16 80.00 3 2 4 17 Zennor Road 87 64 73.56 47 52 60 36 Totals 403 335 80.64 101 169 246 273 Grand Total 760 657 86.44 142 228 390 538 183 Report of the Medical Officer of Health. House-to-House Inspections.—continued. HOUSING, TOWN PLANNING, &c., ACT, 1909. SUB-DISTRICT OF TOOTING. TABLE XC. Name of Street. No. of houses inspected. No. of houses in which defects were found. Percentage of defects to houses inspected. Number of Families Living in One room. Two rooms. Three rooms. Four rooms and upwards. Aldis Street 6 6 100.00 ... ... ... 9 Back Row 5 2 40.00 ... 5 ... ... Bickersteth Road 40 35 87.50 2 2 10 34 Brightwell Crescent 5 5 100.00 ... ... ... 5 Byton Road 6 6 100.00 ... ... ... 6 Eswyn Road 1 1 100.00 ... ... ... 1 Fountain Road 4 4 100.00 1 3 1 4 King's Parade Mews 2 2 100.00 1 ... ... 2 Letch worth Street 53 45 84.90 6 1 7 74 Mitcham Road 1 1 100.00 ... ... ... 2 Salvador 43 39 90.69 ... ... 2 41 Sellincourt Road 4 1 25.00 ... ... ... 4 Trevelyan Road 2 2 100.00 ... ... ... 2 Totals 172 149 86.62 10 11 20 184 184 Report of the Medical Officer of Health. House-to-House Inspections.—continued. HOUSING, TOWN PLANNING, &c„ ACT, 1909. SUB-DISTRICT OF WANDSWORTH, (Southfield Ward). TABLE XCI Name of Street. No. of houses inspected. No. of houses in which defects were found. Percentage of defects to houses inspected. Number of Families Living in One room. Two rooms. Three rooms. Four rooms and upwards. Church Row 2 2 100.00 1 5 ... 1 Fields Alley 7 7 100.00 3 4 ... ... Hill's Yard 7 7 100.00 25 2 ... 2 Merton Road 39 8 20.51 ... 3 ... 37 Newtons Yard 5 ... ... ... ... ... 5 Oakhill Court 17 3 17.64 ... ... ... 17 Penwith Road 183 75 40.98 2 ... ... 181 Point Pleasant 31 31 100.00 ... 8 7 16 Putney Bridge Road 2 2 100.00 11 4 ... 2 Simrose Court 6 2 33.33 ... 1 1 5 Skelgill Road 9 2 22.22 ... ... ... 9 Totals 308 139 45.12 42 27 8 275 185 Report of the Medical Officer of Health. House-to-House Inspections.—continued. HOUSING, TOWN PLANNING, See., ACT, 1909. SUB-DISTRICT OF WANDSWORTH, (Fairfield Ward). TABLE XCII. Name of Street. No. of houses inspected. No. of houses in which defects were found. Percentage of defects to houses inspected. Number of Families living in One room. Two rooms. Three rooms. Four rooms and upwards. Distillery Cottages 5 1 20.00 ... ... ... 5 Elmsleigh Road 9 9 100.00 ... ... ... 18 Ferrier Street 3 3 100.00 ... 1 4 1 Fields Mews 3 3 100.00 ... 3 ... ... Garratt Lane 5 3 60.00 1 1 ... 5 Ironmill Road 5 5 100.00 1 ... 1 4 Jews Row 43 41 95.34 6 16 50 12 Lovetts Place 3 2 66.66 ... 3 ... ... Malva Road 22 20 90.90 6 9 5 16 Pier Terrace 12 9 75.00 ... ... 10 7 Warple Way 11 11 100.00 23 2 9 2 Waterside 3 3 100.00 ... ... ... 3 York Road 90 57 63.22 6 15 15 75 Totals 214 167 78.03 43 50 94 148 186 Report of the Medical Officer of Health. House-to House Inspections.—continued. HOUSING, TOWN PLANNING, &c., ACT, 1909. SUB-DISTRICT OF WANDSWORTH, (Springfield Ward). TABLE XCIII. Name of Street. No. of houses inspected. No. of houses in which defects were found. Percentage of defects to houses inspected. Number of Families living in One room. Two rooms. Three rooms. Four rooms and upwards. Atheldene Road 6 6 100.00 ... ... 12 ... Beechcroft Road 23 17 73.91 ... ... 15 8 Garratt Lane 45 34 75.55 2 2 2 43 Guelph Street 35 29 82.85 9 14 25 6 Keble Street 37 24 64.86 1 1 1 36 Lydden Grove 20 15 75.00 9 6 4 13 Lydden Road 12 3 25.00 1 5 7 8 Thorndean Street 32 27 84.37 ... ... ... 64 Wardley Street 17 17 100.00 15 10 5 5 Wimbledon Road 30 26 86.66 1 4 10 22 Totals 257 198 77.04 37 42 81 205 Grand Total 779 504 64.69 122 119 183 628 187 Report of the Medical Officer of Health. Mouse-to-House Inspections.— continued. HOUSING, TOWN PLANNING, &c„ ACT, 1909. SUMMARY. TABLE XCIV. Wards. No. of houses inspected. No. of houses in which defects were found. Percentage of detects to houses inspected. Number of Families living in One room. Two rooms. Three rooms. Four rooms and upwards. Clapham, North 333 242 72.67 73 151 82 298 ,, South 201 143 71.14 18 15 49 157 Putney 429 180 41.95 3 7 258 266 Streatham 357 322 90.19 41 59 144 265 Balham 403 335 80.64 101 169 246 273 Tooting 172 149 86.62 10 11 20 184 Southfield 308 139 45.12 42 27 8 275 Fairfield 214 167 78.03 43 50 94 148 Springfield 257 198 77.04 37 42 81 205 Whole Borough 2674 1875 70.11 368 531 982 2071 188 Report of the Medical Officer of Health. The total number of intimation notices served was 6,620, compared with 6,278 in 1911, 8,866 in 1910 and 9,336 in 1909, and of statutory notices 707, compared with 957, 1,038 and 1,119. The greatest number of intimation notices was served in Streatham, Balham and Springfield Wards, and the smallest number in Southfield and Putney Wards. The greatest number of statutory notices was served in Balham and Springfield Wards and the smallest number in Putney and Clapham South Wards. 176 of the statutory notices, 17 in Clapham, 29 in Streatham, two in Tooting, and 128 in Wandsworth, served in 1912, were not complied with at the close of the year. 110 of these notices were complied with in the beginning of the current year, 15 were for nuisance in a passageway in which Police Court proceedings were unsuccessfully taken by the Council, 60 were for 35 premises in Wandsworth, and the remainder are in hand, or the premises are empty. In 35 premises in Wandsworth for which 60 notices were served, the work in all the premises is in hand, and the whole of the work will early in the current year be completed. These notices refer chiefly to a number of houses in Point Pleasant, Wandsworth, and the delay in non-compliance was due to change of ownership, and also to the fact that the new owners caused the houses to be vacated before proceeding with the works. The number of statutory notices served include By-law notices, 227 of which were served in respect of the following contraventions of the By-laws:—Yard paving 97, repairs to water closets 50, repairs to flushing apparatus of water closets 20, cleansing of water closet one, covers to cisterns six, cleansing cisterns three, cleansing house and other contraventions of the Bylaws as to houses let in lodgihgs 36, absence of cover to manure receptacle two, failing to deposit manure in a proper receptacle seven, paving of stables one, paving of pigsties one, and other three. 189 Report of the Medical Officer of Health. The number of cases of overcrowding dealt with during the year was 76, compared with 91 in 1911, 129 in 1910, and 131 in 1909. 12 of these were in Clapham, four in Putney, 19 in Streatham, eight in Tooting, and 33 in Wandsworth. The cases of overcrowding in Clapham were in Crichton Street, Gauden Road, St. Andrew's Street, Midmoor Road, Wandsworth Road and Nelsons Row; in Putney, in Gwalior Road, Pentlow Street, Stanbridge Road and Biggs Row; in Streatham, in Larch Road, Zennor Road, Fernlea Road, Verran Road, Foss Road, Colmer Road, Mill Lane, Calders Row, Cowpers Row, and Fairview Place; in Tooting, in Salvador, Letchworth Street and Khartoum Road; in Wandsworth, in Bendon Valley, Guelph Street, Wardley Street, Burtop Road, Beechcroft Road, Thornclean Street, Garratt Lane, Warple Way, Baylin Road, Bell Lane, Point Pleasant, Ironmill Road, Malva Road and Jews Row. Nearly all these were cases of domestic overcrowding and were remedied without difficulty by re-arrangement of the sleeping accommodation, while in a few cases lodgers had been taken in by the tenants. 717 ashpits were provided or repaired, compared with 831 in 1911,1,060 in 1910, and 1,292 in 1909. 567 complaints with reference to the non-removal of house refuse (152 from Clapham, 60 from Putney, 127 from Streatham, 21 from Tooting, and 207 from Wandsworth), were received during the year. These complaints were, as in previous years, attended to by the Dusting Inspectors. 956 yards in connection with dwelling-houses, and 103 in connection with stables, were paved, drained, or cleansed, compared with 1,105 and 123 in 1911. 5,248 rooms and 1,043 staircases and passages were cleansed or repaired, compared with 5,026 rooms and 936 staircases and passages in 1911. 190 Report of the Medical Officer oj Health. The greatest number of rooms cleansed was in the Balham Ward, where 1,299 were done, and in Streatham Ward, where 790 were done, and the smallest number in Southfield and Putney where the numbers were 244 and 250 respectively. 1,236 drains were cleansed or repaired, and 27 rain-water pipes disconnected from the drains. 166 notices of reconstruction of drains were sent to the Borough Engineer from this Department: 23 in Clapham, compared with 40 in 1911; six in Putney, compared with nine; 54 in Streatham, compared with 64; 31 in Tooting, compared with 12; and 52 in Wandsworth, compared with 33. The total number of houses where the drains were reconstructed during the year was 257: 51 in Clapham, 16 in Putney, 87 in Streatham, 37 in Tooting, and 66 in Wandsworth. 316 accumulations of manure were removed after service of notice, compared with 384 in 1911: 78 in Clapham, 42 in Putney, 121 in Streatham, 31 in Tooting, and 44 in Wandsworth. There has been an increase in the number of cases dealt with in Clapham, and a decrease in Streatham, Tooting, and Wandsworth. Eight notices were served for the periodical removal of manure every 48 hours, compared with 12 in 1911, and 38 in 1910. The number of water closets cleansed and repaired was 1,694, compared with 1,909 in 1911. The greatest number of these were in Balham and Fairfield Wards, and the smallest in Putney and Southfield Wards. 445 drinking water cisterns were cleansed, covered, or repaired : 61 in Clapham, 32 in Putney, 163 in Streatham, 54 in Tooting, and 135 in Wandsworth, compared with 525 in 1911. 87 premises were inspected and notices served where animals were kept in such a manner as to be a nuisance. Seven of these were in Clapham, six in Putney, 28 in Streatham, 12 in Tooting, and 34 in Wandsworth. This nuisance was most common in Southfield and Springfield Wards, and the animals kept were chiefly ducks and hens. 191 Report of the Medical Officer of Health. 55 smoke nuisances were reported during the year: three in Clapham, 11 in Putney, four in Streatham, and 37 in Wandsworth. In all 192 observations for black smoke were made by the Inspector s 55 nuisances were reported and 50 notices served. One complaint of black smoke was received from the Public Control Department of the London County Council with regard to one premises, and eight complaints from the Coal Smoke Abatement Society with regard to 21 premises. These complaints were all at once attended to and the premises kept under observation. 159 soil pipes were repaired, 23 in Clapham, 22 in Putney, 50 in Streatham, 35 in Tooting, and 29 in Wandsworth, compared with 194 in 1911, 153 in 1910, and 182 in 1909. 870 leaky roofs and gutters were repaired, compared with 869 in 1911, 1,225 in 1910, and 1,159 in 1909. 60 unwholesome or dilapidated houses were cleansed and repaired, 10 in Streatham, five in Tooting and 45 in Wandsworth, compared with 30 in 1911, 38 in 1910, and 46 in 1909. A large amount of work has again been carried out to abate nuisances arising from damp conditions. In all 1,559 premises have been dealt with, 318 in Clapham, 95 in Putney, 566 in Streatham, 144 in Tooting, and 436 in Wandsworth; and in 596 of these, 100 in Clapham, none in Putney, 215 in Streatham, 55 in Tooting, and 226 in Wandsworth, damp courses have been inserted. I have personally inspected all the premises where damp courses were inserted as well as a large number of premises where this had been done in previous years, and I am able to report that the dampness has been quite removed and the houses rendered much healthier. The number of unclassified nuisances was 929, 169 in Clapham, 83 in Putney, 346 in Streatham, 73 in Tooting, and 258 in Wandsworth, compared with 765 in 1911, and 746 in 1910. 192 Report of the Medical Officer of Health. Disinfection. The total number of rooms disinfected after the occurrence of cases of infectious disease was 3,787 (715 in Clapham, 382 in Putney, 873 in Streatham, 651 in Tooting, and 1,166 in Wandsworth), compared with 4,419 in 1911, 2,166 in 1910, and 3,146 in 1909. The decrease was largely due to the decrease in the number of disinfections carried out after Measles. 1,744 lots of bedding were stoved at the Disinfecting Station, compared with 1,603 in 1911. 1.230 in 1910 and 1,584 in 1909. The 1,744 lots of bedding included the following:—959 beds, 1,120 bolsters, 2,498 pillows, 1,206 mattresses, 510 palliasses, 1,563 sheets, 1,411 quilts, 756 cushions, 5,820 articles of clothing, 2,621 blankets, 152 carpets, and 2,785 extra articles, a total of 21,401 articles, compared with 21,613 in 1911, 15,430 in 1910, and 20,843 in 1909. 1,006 premises were disinfected after Measles and 426 after Pulmonary Tuberculosis, compared with 2,638 and 313 in 1911. 36 beds, 13 bolsters, 43 pillows, 54 mattresses, 53 palliasses, five sheets, nine quilts, xo cushions, 136 articles of clothing, nine blankets, two carpets, and 201 extra articles, were removed and destroyed by request of the owners during the year. Disinfection was also carried out by the Sanitary Staff at premises after non-notifiable diseases, chiefly Cancer, and the sum of £26 16s. 6d., was received for such disinfection. 574 rooms were disinfected with sulphur in consequence of their verminous condition and 86 lots of verminous bedding disinfected, compared with 240 rooms and 11 lots of bedding in 1911. I have regularly visited the Disinfecting Station during the year, and am able to report that the work has been carried out by the staff to my entire satisfaction. Report of the Medical Officer of Health. 193 One complaint of damage to goods by disinfection has been received during the year, but on inquiry it was found that the bedding, etc., complained of was stained before the disinfection was carried out. The approximate cost of working and maintaining the Disinfecting Station during the past year, including the cost of disinfectants used in fumigating and cleansing rooms, was as follows:— £ s. d. Wages 916 7 2 Fuel 5 7 6 Horse Hire 93 4 0 Stores, Tools, and other materials 70 10 5 Repairs to Horse Vans 13 13 0 Disinfectants, etc. 24 11 6 Repairs to Motor Van 14 6 4 Motor Running Expenses 57 7 10 Lighting 2 0 3 Insurance 8 15 9 Water 4 17 2 £1,211 0 11 The number of lots of bedding stoved was 1,744. Cost per lot of bedding 13s IId. Cleansing of Persons Act. The baths at the Disinfecting Station have not been so much used this year, chiefly owing to the smaller number of verminous children dealt with. The names of 678 children, 44 belonging to Clapham, none to Putney, 126 to Streatham, 227 to Tooting, and 281 to Wandsworth, stated to be in a verminous condition, were forwarded to me by the Medical Officer, Education Department, London County Council, and the homes were visited by the Inspectors. In the 194 Report of the Medical Officer of Health majority of cases only the heads of the children were verminous, but in a few cases the bodies and clothing were also verminous. Of these latter, nine, two boys and seven girls, were cleansed at the baths, and the clothing was at the same time stoved with beneficial results. The majority of the children in Tooting and Wandsworth were cleansed by the officials of the London County Council at the Cleansing Stations at Schools. 10 adults also had baths, nine were contacts with cases of Infective diseases, while one male was verminous. Inspection of Urinals in connection with Licensed Premises. The number of urinals inspected was 123, 31 in Clapham, 19 in Putney, 25 in Streatham, 11 in Tooting, and 37 in Wandsworth. 396 inspections were made during the year and 19 notices, chiefly for cleansing, were served and complied with. In the Borough there are at present 14 public sanitary conveniences, three of these, one in Blackshaw Road, Tooting, for males and females, one in Clapham and one in Putney for females, having been constructed during the year. There are in addition 21 urinals only belonging to the Council. The provision of free conveniences for the use of females has been much appreciated, but these entail a greater amount of supervision on the part of the staff employed. 160 inspections have been made during the year by the Inspectors of other sanitary conveniences, chiefly in the elementary schools in the Borough. Repcrt of the Medical Officer of Health 195 Inspection of Premises where Food is prepared for Sale or Sold. During the year 256 inspections have been made of fried fish shops, 618 of butchers' shops, 465 of greengrocers' shops, and 375 of fishmongers' shops, a total of 1,714. 363 of these inspections were in Clapham, 267 in Putney, 458 in Streatham, 195 in Tooting, and 431 in Wandsworth. Police Court Proceedings. The list which follows shows particulars of Police Court proceedings under the Public Health (London) Act, 1891, during the year. The total amount of fines inflicted was £15 10s. 0d., and the costs £5 8s. od., compared with £12 3s. 0d. and £4.13s. 6d. in 1911. The majority of the cases were with respect to nuisances or contraventions of By-laws, while one was on account of the emission of black smoke, and six for executing sanitary work without notice. Three cases were for selling milk without being registered as required by the Dairies, Cowsheds and Milkshops Order, 1885. N2 196 Report of the Medical Officer of Health. TABLE XCV. Premises. Offence. Result. Fine. costs Bendon Valley Emission of black smoke Prohibition order made 40/- 14/6 10, High Street, Roehampton Nuisance Order made lor abatement of nuisance ... 5/- 64, 66, 70 & 72, Point Pleasant Nuisance Convicted 5°/- 10/- Highwood House, Roehampton Executing sanitary work without notice Do. 10/- 2/- Rose Cottage, Downer's Cottages, Clapham Nuisance Order made for abatement of nuisance 20/- 7/'- Claphain Road Station Executing sanitary work without notice Convicted 20/- 2/- 12, Heybridge Avenue Do. do. do. Do. 5/- 2/- 27, Abbeville Road Contravention of By - laws (yard paving) (manure receptacle) Do. 10/- 2/- 27, „ „ Do. 10/- 2/- 33, Abbeville Road Contravention of By - laws (water closets) Do. 10/- 2/- 33, „ „ Nuisance Summons withdrawn, work having been done ... 2/- 24, 26, 28, 30, 34, 36, 38, 42, 44, 74, 76, 78 and 80, Point Pleasant Nuisances and contraventions of the By-laws Convicted 65/- 26/- 498, 500, 506, 508 and 512, Wandsworth Road Nuisances Do. 231- 12/- 4, Cargill Road Executing sanitary work without notice Do. 1 /- 2/- 99, Abbeville Road Do. do. do. Do. 1/- 9/6 307, Streatham High Road Do. do. do. Do. 10/- 2/- 9, Flavell Road Contravention of the Dairies, Cowsheds and Milkshops Order of 1885 (non-registration) Do. 5/- 2/- 88, Blackshaw Road Do. do. do. Do. 20/- 2/- 146, Garratt Lane Do. do. do. Do. 10/- 2/- Removal of Mouse Refuse. During the year no alteration has been made in the system of removal. The whole of the refuse is now collected and disposed of by contract, with the exception of a portion from the Balham, Streatham and Tooting Wards, which is disposed of at the Destructor. 197 Report of the Medical Officer of Health. The following Table, taken from the report of the Boroug Engineer, shows the quantity collected and the method of disposal in the various Wards of the Borough. TABLE XCVI. Wards. Estimated Quantity. How disposed of. Van loads. Tons. Clapham, North and South 5.487 15,089 Barged away from wharf at Nine Elms. „ „ „ „ 1,248 2,239 At Destructor. Balham and Tooting 6.835 12,267 At Destructor. „ 242 666 Sent to shoot outside the Borough. Streatham 3,113 6,056 At Destructor. „ 2,138 8,ol8 Sent to shoot outside the Borough. Fairfield, Spiingfield and Southfield 10,249 22,507 Barged away from Bell Lane Wharf. Putney 4,350 6,650 Barged away from Ashlone Road Wharf. Borough 33,662 73,492 The total cost of collection and disposal was £16,378 compared with £16,203 for the year ending March 31st, 1911. 71 statutory notices were served tender Section 37 of the Public Health (London) Act, 1891, to provide ashpits in accordance with the By-laws, and these have been complied with. 198 Report of the Medical Officer of Health. Inspection of Milkshops, Cowsheds, etc. The following Table shows in concise form the number of milk premises, cowsheds, etc., on the register, the number of inspections, and the number of cases of legal proceedings during the year, as well as other information which it has been thought advisable to group together for the purpose of comparison with other Metropolitan Boroughs. TABLE XCVII. PREMISES. NUMBER OF PLACES Number of inspections, 1912. Number of notices, 1912. Number of prosecutions, 1912. On register at end of 1911. Added in 1912. Removed in 1912. On register at end of 1912. Milk premises 355 55 54 356 1023 40 3 Cowsheds 12 ... ... 12 49 ... Slaughter-houses 15 1 ... l6 329 6 ... Other offensive trade premises 3 ... ... 3 60 1 ... Ice cream premises 304 31 13 322 542 41 ... Registered houses let in lodgings 292 ... ... 292 769 *a 12 ... *6526 ... *a For overcrowding. * b For other conditions. Total number of intimation notices served for all purposes 6,620 Overcrowding, 1912:— Number of dwelling rooms overcrowded 76 Number remedied 76 Number of prosecutions — Underground rooms— Illegal occupation dealt with during year 52 Number of rooms closed 199 Report of the Medical Officer of Health. Insanitary houses— Number closed under the Public Health (London) Act, 1891 Number closed under the Housing, Town Planning, etc., Act, 1909 Number of premises cleansed under Sec. 20 of the L.C.C. General Powers Act, 1904 574 Shelters provided under Sec. 60 (4) of the Public Health [London] Act, 1891— Number of persons accommodated during the year Revenue Acts— Number of houses for which applications were received during year 49 Number of tenements comprised therein 109 Number of tenements for which certificates were: (a) granted 80 (b) refused 29 (c) deferred — Number of prosecutions under By-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice salt, filth, etc. (b) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. (c) For the prevention of keeping of animals in such a manner as to be injurious to health (d) As to paying of yards, etc., of dwelling houses 1 (e) In connection with the removal of offensive matter, etc. (/) As to cesspools and privies, removal and disposal of refuse, etc. 200 Report of the Medical Officer of Health. (g) For securing the cleanliness of tanks, cisterns, etc. (h) With respect to water closets, earth closets, etc. 3 (i) With respect to sufficiency of water supply to water closets (j) With respect to drainage, etc. (Metropolis Management Act, Section 202) — (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) M ottuaries— Total number of bodies removed 186 Total number of infective bodies removed — Milkshops. At the close of 1911 there were 355 milkshops on the Register, 55 have been added in 1912 and 54 removed, leaving 356 on the Register at the end of 1912. During the year 1,023 inspections were made of these premises and 40 notices, chiefly for cleansing, were served. Three prosecutions were instituted for carrying on the business of a dairyman without being registered, and fines amounting to £1 15s. od. were imposed, with 6s. costs. Cowsheds. The following is a list of the registered Cowhouses in the district granted by the London County Council in October:— Clapham— London, Gloucester, and North Hants Dairy Company, Ltd., 41, Clifton Street. (10 cows.) Denny, Charles, 128, Wirtemberg Street. (25 cows.) 201 Report of the Medical Officer of Health. Putney— James, Messrs., Lower Richmond Road. (Number of cows, Shed No. 1—46 ; Shed No. 2—10.) Morrison, Messrs., Putney Lower Common. (Number of cows, Shed No. 1—24; Shed No. 2—20.) Smith, Lancelot Hugh, Clarence Farm, Roehampton. (Number of cows, Shed No. 1—11 ; Shed No. 2—7 ; Shed No. 3—8; and loose box—2.) Streatham— Curtis, Mrs. Isabella, Chestnut Grove, Balham. (17 cows.) London, Gloucester, and North Hants Dairy Company, Ltd., Harbeston Road, Balham. (9 cows.) Curtis Brothers, The Mineral Wells. (Nvmber of cows, Shed No. 1—7; Shed No. 2—30.) Tooting— London, Gloucester, and North Hants Dairy Company, Ltd., High Street. (6 cows.) Wandsworth— Wharton, Charles, Allfarthing Lane. (8 cows.) Cookson, C. H., 266, Earlsfield Road. (16 cows.) Turner, G. S., Headworth Road. (14 cow.) The total number on the Register at the close of 1912 was 12, and 49 inspections were made. I am able to report that all the above were kept in a satisfactory condition during the year, and it was not necessary to serve any notices. Slaughter-houses. There were 15 Slaughter-houses and one Knacker's Yard on the Register in 1911, one in Wandsworth was added, leaving 16 on the Register. 202 Report of the Medical Officer of Health. The new slaughterhouse licensed by the London County Council was for slaughtering horses for human food. During the year 93 horses have been slaughtered on the premises and all were exported. During the year 329 inspections were made of these, but it was only necessary to serve six notices for cleansing. The usual cleansing was carried out by the occupiers at the proper times. I have inspected all the slaughter-houses during the year, and I am able to report that the By-laws have been observed. During the year the Inspectors inspected the carcases of 336 cattle, 2,862 sheep, 290 pigs, and 13 calves in Slaughter-houses and Butchers' Shops, and reported that these were all sound when exposed for sale. The following list shows the number of Slaughter-houses licensed by the London County Council in October:— Clapham— Masters, Albert, 63, Clapham Park Road, Clapham. (Condition—Small cattle only.) Yarworth, William, 140, Clapham Park Road, Clapham. (Condition—The licence is granted on the undertaking of the licensee that the killing of bullocks at these premises be restricted to the period of hot weather, and then onl}' occasionally, and on the further condition that the slaughtering be limited to animals the meat from which is to be sold by retail in the shop attached to the premises.) Woodman, George, 140, Larkhall Lane, Clapham. Cradock, Albert Henry, 147, Larkhall Lane, Clapham. (Condition—This licence is granted on condition that the slaughtering of cattle on the premises is limited to animals the meat from which is sold by retail in the shop attached to the premises.) 203 Report of the Medical Officer of Health. Fisher, Charles Edward, 272, Wandsworth Road, Clapham. Clark, William, 697, Wandsworth Road, Clapham. Putney— Lindsey, John, Montserrat Road, Putney. (Condition—This licence is granted on the undertaking of the licensee to drive cattle on the premises only between the hours ot 8 p.m. and 6 a.m. and to limit the slaughtering to the requirements of the retail trade of his own shop.) Streatham— Cooke, James Robert, trading as Slater & Cooke, 45, Balham High Road. Covell, Herbert Alfred, 107, High Road, Streatham. Wotton, Henry, & Dean, Isaac, 165, High Road, Streatham (rear of). Wandsworth— Holton, Frederick, 2, Armoury Yard, The Plain. Miller, George Short, 27, Belle Vue Road. Covell, Herbert Alfred, 73, High Street, Wandsworth. Masters, George, 165, High Street, Wandsworth. (Condition—This licence is granted on the undertaking of the licensee that large cattle be received on the premises only between the hours of 11 p.m and 9 a.m. and not more than one large animal be killed per week ; and that large and small cattle be not received or kept on these premises at the same time.) Wood, John James, Durnsford Farm, Merton Road. (Condition—This licence is granted on the undertaking of the licensee that his own pigs only be killed at these premises.) 204 Report of the Medical Officer of Health. Harrison, Barber & Co., Garratt Lane. (Condition—To be used onIy for the slaughtering of horses). Knacker's Yard. Harrison, Barber & Co., Ltd., Garratt Lane. Offensive Trades. The following is a list of offensive trades carried on in the Borough :— (i.) Harrison, Barber & Co., Ltd., Garratt Lane, Wandsworth, Knackers. Do. do. Bone Boilers. Do. do. Manure Manufacturers. (2.) Tucker & Co., Weimar Street, Putney, Soap Boilers. (3.) James Ford, Bendon Valley, Wandsworth, Fat Melter. 60 inspections of these have been made, and it was necessary to serve one intimation notice for contravention of the By-laws. Ice Cream Premises. At the end of 1911 there were 304 of these on the Register. During 1912, 31 were added and 13 removed, leaving a total of 322 on the Register, 542 inspections were made of these premises during the year and 41 notices were served, all of which were for cleansing. Houses Let in Lodgings. At the end of 1911 there were 292 houses let in lodgings on the Register. None were added during 1912 and none removed, making a total of 292 on the Register at the end of 1912. 769 inspections of these were made during the year, and 538 notices were served, 12 for overcrowding and 526 for other conditions, chiefly for cleansing. 205 Report of the Medical Officer of Health. 205 On the whole the By-laws have been satisfactorily complied with, although in some instances the cleansing was not carried out at the specified time. Offensive Trade Refuse. I have again to report that the arrangements which have been made by the Council with a contractor for the removal of this refuse have during the year worked quite satisfactorily, and no complaints have been received. In a certain number of cases this refuse is removed privately, and this has also been carried out in a satisfactory manner. Unsound Food. During the year one trunk of Roe, 33 boxes of Tomatoes, two boxes of Mackerel, six tins of Salmon, one box of Roker, one bag of Winkles, one trunk Haddock, 108 lbs. Peas, five boxes Pears, two trunks mixed fish, eight Rabbits, and one trunk of Cod, were destroyed at the request of the owners, and the usual certificates granted. FACTORIES AND WORKSHOPS. There has been a slight increase in the total number of inspections of the above, compared with 1911, and an examination of the Tables will show that a very large amount of work has been carried out by both the male and female Inspectors. I have also this year visited a large number of these premises and am able to report that they are all in a very satisfactory condition. The fact that only one prosecution was necessary to abate any nuisance found shows that there has been no difficulty in carrying out the provisions of the Act. With regard to outworkers it has again been found necessary, as a matter of routine, to forward a warning letter to the majority of employers. 206 206 Report of the Medical Officer of Health. The Tables which follow are similar to those used in previous Reports, and the whole of the work done by both male and female Inspectors is there shown in a concise form. The total number of workshops on the Register was 1,703, including 127 retail bakehouses, 147 workshop laundries, 290 dressmakers' and milliners' premises, and 1,139 other workshops, but not including 410 factories, 1,181 workplaces, and 335 outworkers' premises. Including all factories, workshops, workplaces, and outworkers' premises, there were on the Register at the end of 1912 3,629 premises, compared with 3,470 in 1911, 3,420 in 1910, and 3,305 in 1909. The total number of inspections made during the year was 6,511, compared with 6,050 in 1911, 6,387 in 1910, and 6,531 in 1909. The total number of notices served was 402, 383 intimation and 19 statutory, compared with 462 in 1911, 580 in 1910 and 597 in 1909. Tliere was only one prosecution under the Public Health (London) Act, 1891, during the year. Under the head of other workshops are included domestic workshops, and under the head of places where food is prepared for sale are included the kitchens of hotels, restaurants, tripe, fried fish and eelshops, and other places where food is prepared for sale. In all 826 inspections were made of 410 factories, and 56 notices, 52 intimation and four statutory, were served. The total number of the workshops on the Register was 1,703, 147 of which were workshop laundries, 127 workshop bakehouses, and 1,429 other workshops. In all 3,227 inspections of these were made, compared with 3,059 in 1911, 3,346 in 1910 and 3,366 in 1909, and 185 intimation and seven statutory notices were served. 207 Report of the Medical Officer of Health. The total number of workplaces on the Register was 1,181, and 1,997 inspections were made, while 118 intimation and eight statutory notices were served. The total number of defects found was 462, including nine cases in which there was a breach of special sanitary requirements for bakehouses, compared with 614 and 13 in 1911. To abate these nuisances, 374 notices, 355 intimation and 19 statutory were served, all of which, with the exception of 10 were complied with at the end of the year. The 10 outstanding were complied with in the first month of this year. Excluding outworkers' premises 462 defects were found and 452 remedied, but only 355 intimation notices were served, as one notice frequently called attention to several defects on the same premises. 208 INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. TABLE XCVIII. CLASS OF WORKS. Number of Places Number of Inspections, 1912. Number of Notices. Number of Prosecutions, 1912. On Register at end of 1911. Added in 1912. Removed in 1912. On Register at end ot 1912. Intimation, 1912. Statutory, 1912. Under Factory Act. Under Public Health Act. Premises Rooms. Factory Laundries 89 10 2 97 395 189 11 2 ... Factories Factory Bakehouses 20 1 19 37 53 Other Factories 265 41 12 294 998 584 41 2 Workshop Laundries 144 15 12 147 442 314 19 1 Workshops Workshop Bakehouses 128 5 6 127 127 603 9 Other Workshops 1418 171 160 1429 1793 2310 157 6 1 Workplaces Places where Food is prepared for Sale 539 71 32 578 619 1169 82 6 Workplaces other than the above 555 97 49 603 890 828 36 2 Home-workers' premises 312 108 35 335 335 461 28 Total 3470 518 359 3629 5636 6511 383 19 1 Report of the Medical Officer of Health. 209 Report of the Medical Officer of Health. 209 The three following tables are inserted by request of the Secretary of State for the guidance of Medical Officers of Health in preparing that part of the Annual Report which relates to factories and workshops. It is intended to provide for uniformity in the presentation of such particulars as lend themselves to statistical treatment:— Factories, Workshops, Laundries, Workplaces and Homework. TABLE XC1X. I.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (Including Factory Laundries.) 826 56 Workshops (Including Workshop Laundries.) 3,227 192 1 Workplaces (Other than Outworkers' premises included in Part 3 of this report.) 1,997 126 ... Totals 6,050 374 1 210 Report of the Medical Officer of Health. TABLE C. 2.—DEFECTS FOUND Particulars. (1) Number of Defects Number of Prosecutions. (5) Found. (2) Remedied (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts: —* Want of Cleanliness 154 153 ... ... Want of Ventilation 7 6 ... ... Overcrowding 2 2 ... ... Want of drainage of floors ... ... ... ... Other nuisances 183 180 ... I Sanitary accommodation insufficient 5 2 ... ... unsuitable or defective 100 98 ... ... not separate for sexes 2 2 ... ... Offences under the Factory and Workshop Act:—... Illegal occupation of underground bakehouse (S. 101) ... ... Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 9 9 ... ... Other offences (Excluding offences relating to outwork, which are included in Part 3 of this report.) ... ... ... ... Totals 462 452 ... 1 * Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. The table which follows and which relates to Home Work is similar to the one in last year's Report. The number of lists sent in twice a year, was the same as in 1911, but there was an increase of two in the number sent in once a year. Report of the Medical Officer of Health. 211 LI. 3.—HOME WURT NATURE OF WORK.* OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. Lists received from Emplo3rers. Notices served 011 occupiers as to keeping or sending lists. Prosecutions Sending twice in the year. Sending once in the year. Failing to keep or peril. it inspection of lists. Failing to send lists. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecu- tions (SS.l09,110) Listsi Outworkers Lists. Outworkers. Contractors Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, &c. 116 76 325 8 3 22 76 ... ... 18 28 ... 16 ... ... (2) Cleaning and washing 2 6 10 ... ... ... ... ... ... ... ... ... ... ... ... Household Linen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, lace curtains and nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Curtains & Furniture hangings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Electro Plate ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... File making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brass and Brass articles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fur pulling ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cables and Chains ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anchors and Grapnels ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cart Gear ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Locks, Latches and Keys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Artificial Flowers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nets, other than wire nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sacks ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Racquet and tennis balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper Bags and Boxes 4 ... 8 ... ... ... ... ... ... ... ... ... ... ... ... Brush making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pea picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carding, &c., of buttons, &c. ... ... 6 ... ... ... ... ... ... ... ... ... ... ... ... Stuffed Toys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Basket making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 124 82 349 8 3 22 76 ... ... 18 28 ... 16 ... ... * If an occupier gives out work of more than one of the classes specified in column I, and subdivides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. t the figures required in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarily be even numbers, as there will be two lists lor each employer—in some previous returns odd numbers have been inserted. The figures in columns 3 and 4 will usually be (approximately) double of the number of individual outworkers whose name6 are given, since in the February and August lists of the same employer the same outworker's name will often be repeated. O 2 2 12 Report of the Medical Officer of Health. In all, 124 lists were received twice in the year, containing the names and addresses of 82 contractors and 349 workmen and eight lists once in the year, containing the names and addresses of three contractors and 22 workmen. There has been a slight increase in the number of outworkers employed by employers in the Borough during the year. The total number of addresses received from other Councils was 511, compared with 408 in 1911, 422 in 1910, and 370 in 1909, and 285 addresses were forwarded to other Councils, compared with 251 in 1911, 253 in 1910, and 334 in 1909. The number of addresses received has increased by 103 and the number sent by 34. The following are the districts to which lists of outworkers were forwarded, and also the number of outworkers:—Lambeth 63, Battersea 53, Stepney 43, Fulham 20, City 19, Croydon 11, Southwark 10, Camberwell eight, Bermondsey and Hammersmith six each, Merton five, Chelsea four, St. Pancras, Stratford, Holborn and Eastleigh three each, Hanwell, Westminster, East Ham, Winchester, Wimbledon, Willesden, Worthing, Finsbury and Lewisham two each, Rochford, Southgate, Islington, Shoreditch Barnes, Hove and Greenwich one each. 63 names and addresses were forwarded to this Borough in error, and are not included in the above Table. The number of notices sent to employers during the year was 76, compared with 76 in 1911, and these has a most satisfactory result. At the end of 1911 there were 312 outworkers' premises on the Register, 108 were added and 85 removed during the year, leaving 335 on the Register at the end of 1912. 461 inspections were made of these premises during the year, and 28 notices, all for cleansing, were served and complied with. During the year 16 cases of infective diseases, five of Scarlet Fever, two of Diphtheria, six of Erysipelas, one of Enteric Fever, 213 Report of the Medical Officer of Health. one of Puerperal Fever, and one of Ophthalmia Neonatorum, were notified as having occurred in the homes of outworkers, compared with 15 in 1911, 14 in 1910, and six in 1909. In none of these cases was it necessary to make any order under Section no of the Factory and Workshop Act. TABLE CI I. 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. Workshop Bakehouses 127 ,, Laundries 147 Dressmakers'and Milliners'Workshops 290 Bootmakers 158 Smiths 46 Builders 65 lailors 69 Other 801 Total number of workshops on Register 1703 TABLE CM. 5.—OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 25 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) 'Notified by H.M. Inspector 9 Reports (of action taken) sent to H.M. Inspector 9 Other Underground Bakehouses (s. 101):— Certificates granted during the year 1 In use at the end of the year 47 214 Report of the Medical Officer of Health. The next Table shows in detail the work of the Inspectors in factories and workshops where males are chiefly employed. The Table shows the work done in each sub-district and is grouped under five divisions: (I) factories, (2) workshops, (3) domestic workshops, (4) workplaces, and (5) outworkers' premises. The total number of inspections was 4,147, compared with 3,020 in 1911, 2,768 in 1910, and 3,175 in 1909, and of re-inspections 656, compared with 1,141,1,534 and 1,184, a total of 4,803 compared with 4,161 in the previous year. 1,252 of the inspections and 92 of the re-inspections were in Clapham, 521 and 40 in Putney, 853 and 232 in Streatham, 304 and 68 in Tooting, and 1,217 and 224 in Wandsworth. Three workshops where males were employed were notified to H.M. Inspector, and 25 were reported to this Council by H.M. Inspector, the majority of these having been previously entered on the Register. In all the workshops under the supervision of the male Inspectors only one case of overcrowding was discovered, and it was at once remedied. In 92 of these factories, workshops and workplaces the sanitary conveniences were found defective, in five they were insufficient, and in one they were not separate for the sexes. In 135 the workrooms were in a dirty condition, and in 187 other nuisances were found. For these 324 intimation and 16 statutory notices were served, and with the exception of 10 intimation and three statutory notices, were complied with. These notices were complied with in the early part of the year. In one case, for the absence of a proper ashpit, legal proceedings, were necessary to enforce the notice. 215 Report of the Medical Officer of Health. TABLE CIV. Clapham. Putney. Streatham. Tooting. Wandsworth. Total, I.- -Factories inspected 132 66 107 28 192 525 ,, re-inspected 24 6 40 7 35 112 Sanitary conveniences insufficient ... 2 3 ,r ,, unsuitable 1 ... ... 1 ,, ,, not separate for sexes 1 ... 1 ,, ,, defective 4 5 5 ... 12 26 Other nuisances 4 5 1 14 24 Intimation notices served 5 5 11 2 21 44 Statutory notices served ... ... 1 1 ... 20 Legal proceedings ... ... ... ... ... ... II.- —Workshops inspected 422 223 370 73 472 1560 ,, re-inspected 36 22 107 15 109 289 Workrooms inspected 478 274 421 112 589 1874 ,, found overcrowded ... ... ... ... 1 I ,, insufficiently ventilated 2 ... ... ... ... 2 ,, in a dirty condition 6 9 15 ... 24 54 Sanitary conveniences insufficient ... ... 1 ... ... I ,, ,, unsuitable ... ... 1 ... ... 1 ,, ,, not separate for sexes ... ... ... ... ... ... ,, ,, defective 7 4 1 1 23 3& Other nuisances 9 4 2 37 53 Intimation notices served 19 17 21 3 51 111 Statutory notices served 1 ... 1 ... 4 6 Legal proceedings 1 ... ... ... ... 1 Number of workrooms measured 33 ... ... 7 21 61 Number of workroom cards distributed ... ... ... ... ... ... Workshops reported to H.M. Inspector on discovery ... ... 1 ... 2 3 Workshops reported by H.M. Inspector 6 5 12 ... 2 25 III.- —Domestic workshops inspected 75 34 96 30 89 324 ,, ,, re-inspected 2 5 24 2 18 51 Workrooms found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... 1 ... ... 1 ,, in a dirty condition ... 4 12 2 6 24 Other nuisances 4 1 !3 1 13 32 Intimation notices served 4 5 21 1 16 47 Siatutory notices served ... ... ... ... ... ... Legal proceedings ... ... ... ... ... ... Domestic workshops reported to H.M. Inspector on discovery ... ... ... ... ... ... IV.- -Workplaces inspected 596 182 241 156 408 1583 ,, re-inspected 30 4 45 42 50 171 Workrooms inspected 241 182 261 121 421 1226 ,, found overciowded ... ... ... ... ... ... ,, insuuieit-ntly ventilated ... ... 1 1 ... 2 M in a dirty condition 8 2 12 ... 22 44 2l6 Report of the Medical Officer of Health. TABLE CIV.—continued Clapham. Putney. Streatham. Tooting. Wandsworth. Total. Sanitary conveniences insufficient ... ... ... ... 1 1 „ ,, unsuitable ... ... ... ... ... ... ,, ,, not separate for sexes ... ... ... ... ... ... ,, ,, defective 11 ... 4 ... '5 30 Other nuisances 19 1 9 5 39 73 Intimation notices served 32 3 23 6 46 110 Statutory notices served ... ... ... ... 8 8 Legal proceedings ... ... ... ... ... ... V.—Home work Premises inspected 27 16 39 17 56 155 ,, re-inspected ... 3 16 2 12 33 Workrooms found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... 1 ... ... 1 ,, in a dirty condition ... 3 7 ... 3 13 Other nuisances ... ... 4 ... 8 12 Intimation notices served ... 3 11 ... 8 22 Statutory notices served ... ... ... ... ... ... Legal proceedings ... ... ... ... ... ... Cases of infective diseases notified 2 ... ... 2 3 7 Houses visited for inquiry and no workroom found 3 ... ... 1 6 10 Total number of premises inspected 1252 521 853 304 1217 4'47 M ,, ,, re-inspected 92 40 232 68 224 656 ,, ,, intimation notices served 60 33 87 12 142 334 ,, ,, intimation notices complied with 57 33 87 12 35 324 ,, ,, statutory notices served 1 ... 2 1 12 l6 „ ,, statutory notices complied with 1 ... 2 1 9 13 ,, ,, legal proceedings 1 ... ... ... ... I 217 Report of the Medical Officcr of Health. TABLE CV. SUMMARY OF PRINCIPAL TRADES CARRIED ON IN WORKSHOPS WHERE MEN ARE EMPLOYED. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. Bootmakers 35 19 49 12 43 158 Bakers 31 15 37 9 35 127 Tailors 17 15 27 4 6 69 Builders 23 12 17 1 12 65 Cycle Makers 11 4 16 3 15 49 Smiths 13 6 11 4 12 46 Wheelwrights 13 4 15 4 9 45 Upholsterers 11 2 5 1 7 26 Hairdressers 6 6 4 ... 5 21 Joiners 8 4 3 1 5 21 Watchmakers 12 1 6 ... ... 19 Harness Makers 4 2 7 1 3 17 Printers 3 ... 1 ... 6 10 Photographers 4 3 1 ... 1 9 Boat Builders ... 8 ... ... ... 8 Cabinet Makers 2 1 ... ... 2 5 Wood Choppers 1 1 1 ... 1 4 Ironmongers ... ... 1 ... 3 4 Rag Sorters ... ... ... 2 1 3 Jewellers 3 ... ... ... ... 3 Fishmongers ... ... ... ... 2 2 Tarpaulin and Scale Makers ... ... ... ... 2 2 Other Trades 33 7 19 4 44 107 Totals 247 117 224 48 226 862 The Tables which follow summarise the work clone during the year by the female Sanitary Inspectors. The total number of premises inspected was 1,728, (415 in Clapham, 218 in Putney, 450 in Streatham, 113 in Tooting, and 532 in Wandsworth). 2 18 Report of the Medical Officer of Health. 177 inspections were made of factories, 917 of workshops, 44 of domestic workshops, 224 of workplaces, and 226 of outworkers' premises, while 134 premises were visited for inquiry and no workroom found. There was only one case of overcrowding discovered, compared with three in 1911, one in 1910, and two in 1909, and this was at once abated. 37 were found to be in a dirty condition, compared with 17 in 1911, 30 in 1910 and 56 in 1909. In one factory inspected during the year there were no separate water closets for the sexes, and in five factories and one workshop the water closets were defective. Other nuisances were discovered in two factories, 16 workshops, four workplaces, and four outworker's premises, and these were all abated. It was only necessary to serve 49 intimation notices and three statutory notices, and these were all complied with. 17 workshops and five domestic workshops where females were employed were reported to H.M. Inspector of Workshops and 37 were reported to this Council by H.M. Inspector. Only 11 of the workshops (two in Clapham, three in Putney, three in Streatham, and three in Wandsworth), reported by H.M. Inspector were unknown to the Sanitory Inspectors. The other 26 had been previously reported to H.M. Inspector, or were already on the Register. 219 Report of the Medical Officer of Health. TABLE CVI. Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. I.—Factories inspected 35 15 18 4 105 177 ,, re-inspected ... 1 1 ... 10 12 Sanitary conveniences insufficient ... ... ... ... ... ... ,, ,, unsuitable ... ... ... ... ... ... ,, ,, not separate for sexes ... ... ... ... 1 1 ,, ,, defective 1 1 1 ... 2 5 Other nuisances ... ... ... ... 2 2 Intimation notices served 1 1 1 ... 5 8 Statutory notices served ... ... ... ... 2 2 Legal proceedings ... ... ... ... ... ... II.—Workshops inspected 225 158 243 55 236 917 ,, re-inspected 7 7 8 ... 18 40 Workrooms inspected 227 218 326 71 511 1353 ,, found overcrowded 1 ... ... ... ... 1 ,, insufficiently ventilated ... ... ... ... 2 2 ,, in a dirty condition 4 2 4 ... 9 19 Sanitary conveniences insufficient ... ... ... ... ... ... ,, ,, unsuitable ... ... ... ... ... ... ,, ,, not separate for sexes ... ... ... ... ... ... „ ,, defective 1 ... ... ... ... 1 Other nuisances 2 2 3 ... 9 16 Intimation notices served 7 3 4 ... 12 26 Statutory notices served ... ... ... ... 1 1 Legal proceedings ... ... ... ... ... ... Number of workrooms measured 7 7 14 2 4 34 Number of workroom cards distributed 7 1 23 6 3 40 Workshops reported to H.M. Inspector 3 3 4 ... 7 17 ,, ,, by „ „ 8 11 7 ... 11 37 III.—Domestic workshops inspected 10 4 11 4 15 44 ,, ,, re-inspected ... ... ... ... 2 2 Workrooms found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... ... ... ... ... ,, in a dirty condition ... ... ... ... 1 1 Other nuisances ... ... ... ... ... ... Intimation notices served ... ... ... ... 1 1 Statutory notices served ... ... ... ... ... ... Legal proceedings ... ... ... ... ... ... Domestic workshops reported to H.M. Inspector ... 2 1 ... 2 5 IV.—Workplaces inspected 41 27 41 23 92 224 ,, re-inspected 5 6 ... 3 5 19 Workrooms inspected 67 39 80 45 119 35o ,, found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... ... ... ... ... ,, in a dirty condition 2 2 3 ... 5 12 Sanitary conveniences insufficient ... ... ... ... ... ... ,, ,, unsuitable ... ... ... ... ... ... ,, ,, not separate for sexes ... ... ... ... ... ... ,, ,, defective ... ... ... ... ... ... Other nuisances 1 1 ... 1 1 4 Intimation notices served 1 2 1 1 3 8 220 Report of the Medical Officer of Health. TABLE CVl.—continued. Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. Statutory notices served ... ... ... ... ... ... Legal proceedings ... ... ... ... ... ... V.—Home work. Premises inspected 104 14 37 27 84 266 ,, re-inspected 2 1 ... ... 4 7 Workrooms found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... ... ... ... ... „ in a dirty condition 2 1 ... ... 2 5 Other nuisances 1 ... 1 ... 2 4 Intimation notices served 2 1 1 ... 2 6 Statutory notices served ... ... ... ... ... ... Legal proceedings ... ... ... ... ... ... Cases of infectious disease notified 2 ... 1 4 2 9 Houses visited for inquiry and no workroom found 48 7 28 13 38 134 Total number of premises inspected 415 218 450 113 532 1728 ,, ,, ,, re-inspected 14 15 9 3 39 80 ,, Intimation notices served 11 7 7 1 23 49 ,, ,, ,, complied with 11 7 7 1 23 49 ,, Statutory notices served ... ... ... ... 3 3 ,, ,, ,, complied with ... ... ... ... 3 3 ,, legal proceedings ... ... ... ... ... ... Table CVII. shows the number of factories, workshops, domestic workshops, and workplaces on the Register at the close of 1911, the number removed from, the number added during 1912, and the number on the Register at the end of 1912. The number of workrooms in workshops is also shown. The factories and workshops are divided into dressmakers' and milliners' premises, laundries, and miscellaneous premises; and the workplaces are divided into laundries and miscellaneous premises. Of the 101 factories where women are employed, 75 are laundries and 26 other factories, while of the total workshops, viz. :—507, 221 Report of the Medical Officer of Health. 290, are dressmakers and milliners, 147 laundries and 70 other workshops, an increase of 4 dressmakers' and milliners' premises and three laundries, compared with 1911, while the number of other workshops remains the same as in the previous year. The total number of domestic workshops on the Register was 59,(10 in Claplam, four in Putney, 25 in Streatham, four in Tooting, and 16 in Wandsworth), compared with 60 in 1911. The total number of workplaces on the register is 359, an increase of 45 compared with 1911, of which 90 are laundries, and 269 miscellaneous premises, chiefly dressmakers and milliners. 222 TABLE CVlI. Report of the Medical Officer of Health. [ Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. *1 2 3 Total. 1 2 3 Total. 1 2 3 Total. 1 2 3 Total. 1 2 3 Total. 1 2 3 Total Factories on Register, 1911 ... 13 5 18 ... 5 3 8 ... 14 3 17 ... 1 2 3 ... 38 12 50 ... 71 25 96 ,, removed from Register ... 1 ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ,, added to Register, 1912 ... 1 ... 1 ... ... ... ... ... 1 1 2 ... ... ... ... ... 4 ... 4 ... 6 1 7 „ on Register, 1912 ... 13 5 18 ... 4 3 7 ... 15 4 19 ... 1 2 3 ... 42 12 54 ... 75 26 101 Workshops 011 Register, 1911 45 33 25 103 56 13 9 78 120 33 25 178 17 10 4 31 48 55 7 110 286 144 70 500 ,, removed from Register 3 3 4 10 3 1 3 7 14 1 6 21 ... 1 1 2 14 6 3 23 34 12 17 63 ,, added to Register, 1912 7 4 2 13 3 ... 3 6 20 4 8 32 2 3 2 7 6 4 2 12 38 15 17 70 ,, on Register, 1912 49 34 23 106 56 12 9 77 126 36 27 189 19 12 5 36 40 53 6 99 290 147 70 507 Number of workrooms therein 55 92 42 189 70 33 11 114 152 108 32 292 19 30 5 54 42 176 6 224 338 439 96 873 Domestic workshops on Register, 1911 8 7 24 4 17 60 ,, removed from Register ... 5 1 ... 6 12 ,, added to Register,1912 2 2 2 ... 5 11 ,, on Register, 1912 10 4 25 4 16 59 *2 3 Total. 2 3 Total. 2 3 Total. 2 3 Total. 2 3 Total. 2 3 Total. Workplaces on Register, 1911 22 33 55 8 12 20 36 84 120 6 42 48 17 54 71 89 225 314 ,, removed from Register 2 6 8 3 1 4 2 2 4 ... 1 1 1 10 11 8 20 28 ,, added to Register, 1912 ... 11 11 4 5 9 1 16 17 ... 12 12 4 20 24 9 64 73 „ on Register, 1912 20 38 58 9 16 25 35 98 133 6 53 59 20 64 84 90 269 359 Number of workrooms therein 43 38 81 20 16 36 63 98 161 12 53 65 43 64 107 181 269 450 * (1) Dressmakers and Milliners. (2) Laundries. (3) Miscellaneous. 223 Report of the Medical Officer of Health. Table CVIII. shows the nature of the trades carried on in the workshops inspected. There has again been a slight decrease in the numbers, chiefly due to decrease in the number of dressmakers, 467 of these being now on the Register, compared with 475 in 1911. The total number, viz. :—873, (160 in Clapham, 102 in Putney, 331 in Streatham, 90 in Tooting, and 190 in Wandsworth), is five less than in 1911, the greatest increase having occurred in Tooting, while there has been a decrease in Clapham, Putney, and Wandsworth. TABLE CVIII. Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. Art Needleworkers ... 1 2 1 ... 4 Blouse Makers 4 1 1 1 ... 8 Box Maker 1 ... ... ... ... 1 Corset Makers ... 1 2 ... ... 3 Dressing Gown Makers 5 ... ... ... ... 5 Dressmakers 66 52 197 57 95 467 Druggists' Sundries Maker 1 ... ... ... ... 1 Ecclesiastical Embroiderer ... ... 1 ... ... 1 Feather Curlers and Cleaners 1 ... 1 1 1 4 Firework Case Maker ... ... 1 ... ... ... Florists ... ... 7 ... ... 7 Gold Embroiderer 1 ... ... ... ... 1 Gold Lace Spianer 1 ... ... ... ... 1 Hosiers 1 ... 1 ... ... 2 Lace Maker ... 1 ... ... ... 1 Laundries (Workshops) 35 12 35 13 52 147 Laundries (Workplaces) 20 9 34 6 20 89 Linen Embroiderer ... ... 1 ... ... ... Maker of Celluloid Articles ... 1 ... ... ... 1 Mantle Makers 1 1 ... ... ... 2 Milliners 16 20 35 9 14 94 Outfitters 3 ... 7 1 4 15 Painting Chiffon ... 1 ... ... ... 1 Paper Bag Maker 1 ... ... ... ... 1 Paper Cap Maker ... ... 1 ... ... 1 Seed Packer 1 ... ... ... ... 1 Tailors ... 2 5 ... 1 8 Tea Gown Maker ... ... ... ... 1 1 Upholsterer 1 ... ... ... ... 1 Vest Makers 1 ... ... 1 1 3 Totals 160 102 331 90 190 873 224 Report of the Medical Officer of Health. Canal Boats Act. During the year 32 inspections of Canal Boats were made, but it was not necessary to serve any notices, as on inspection the condition of all the boats was found to be satisfactory . Statement of Work done under the Rag Flock Act, 1911 This Act, which came into force in July, 1912, is an Act to prohibit the sale and use of unclean flock manufactured from rags for the manufacture of certain articles. The Act makes it unlawful for any person to sell, or have in his possession for sale, or to use for the purpose of making any article of upholstery, cushions, or bedding, flock manufactured from rags unless the flock conforms to such standard of cleanliness as prescribed by Regulations made by the Local Government Board. The Act also provides for the taking of samples and for penalties in cases of conviction. The standard of cleanliness fixed by the Local Government Board is as follows:— Rag Flock Regulations, 1912. Article I. Flock shall be deemed to conform to the standard of cleanliness for the purposes of Sub-section (1) of Section 1 of the Act when the amount of soluble chlorine, in the form of chlorides, removed by thorough washing with distilled water at a temperature not exceeding 25 degrees Centigrade from not less than 40 grammes of a well mixed sample of flock, does not exceed 30 parts of chlorine in 100,000 parts of the flock. 20 workshops were visited by the Inspector and the materials used for bedding and upholstery were examined. 225 Report of the Medical Officer of Health. 14 samples were procured and submitted for analysis, seven of which were reported as complying with the standard of cleanliness required, whilst seven samples were reported against as containing chlorine in excess of the amount permitted. In five cases where the amount of chlorine found was excessive, proceedings were taken against the proprietors of the businesses where the samples were procured with the result that convictions were obtained in each case. A resume of the proceedings at the Police Court will 110 doubt be of interest in showing the value of this Act from a public health point of view. Sample 3. This was a sample of black shoddy flock and was purchased by the Inspector from a shop where bedding was sold. The vendor, having no loose flock in stock at the time the Inspector called, and not knowing him, offered to take some from a new pillow. This offer was accepted and on analysis the flock was found to contain 340 parts of chlorine per 100,000. The defendant pleaded that the flock was made prior to the passing of the Act and that had he sold the pillow intact to the Inspector, no proceedings could follow inasmuch as the sale would be of a pillow and not of flock. The Magistrate contended that the sale was of flock and it was immaterial whether the flock was in a case or loose, it was none the less flock, and if it failed to comply with the required standard the defendant was liable for having it in his possession. The defendant was fined 10s. and 15s. costs. Samples 4 and 5. These samples were procured from a workshop. At the time of the Inspector's visit he found a workman re-making an old bed, the tick or covering of which was much stained and generally dirty. A sample of the flock was taken and analysed and found to contain 288 parts of chlorine per 100,000. p 226 Report of the Medical Officer of Health. In the proceedings which subsequently followed the proprietor pleaded ignorance of the law, saying that he had no idea that the new Act applied to old bedding. The Magistrate stated that he had read the Act as meaning that it was unlawful to make or remake bedding if the flock was not up to the standard. The defendant was fined 5s. and 22s. 6d. costs. Sample 6. Jn this case the Inspector, on visiting the workshop, found the defendant upholstering a couch and a sample of the flock used for stuffing was taken. This on analysis was found to contain 326 parts of chlorine per 100,000 parts of flock. This undoubtedly filthy flock was being used in stuffing new furniture. At the hearing of the summons the defendant stated that she had bought an old bed from a neighbour for 2s. and used the flock for upholstering, and that she had no knowledge that she was doing wrong. The Magistrate said that he thought the practice of buying old beds was a very bad one as it was possiole that the bed had been used by a patient with a discharge, and it was unpleasant to think that a purchaser was getting the flock in new furniture. He also remarked that it was no wonder that such an Act as the Rag Flock Act was passed. The defendant was fined 10s. and 15s. costs. Sample 7. In this case the flock was found in the defendant's workshop. An analysis of the flock showed that it contained 329 parts of chlorine per 100,000 parts of flock. At the Police Court the defendant failed to satisfy the Magistrate that the flock was not intended for use for the purposes of bedding and upholstery. The defendant was fined 10s. and 15s. costs. 227 Report of the Medical Officer of Health. Statement of Work done under the Sale of Food and Drugs Acts. During the year 1,500 samples of foods and drugs were submitted to the Public Analyst for analysis, compared with 927 in 1911, 1,060 in 1910, and 1,030 in 1909. Of the 1,500 samples analysed 601 were procured as test or informal samples, while 899 were purchased officially. Of the 899 official samples submitted for analysis 136 or I5.1 per cent. were reported to be adulterated or not up to standard, and of those samples which were procured informally or as test samples 135, or 22.4 per cent. were found adulterated or not up to standard. The total adulterations reported were 271, or 18 per cent. of the samples submitted, compared with 13.2 per cent. in 1911, 9.05 per cent. in 1910, and 6.89 per cent. in 1909. The percentage of milk samples found to be adulterated was 10.39, compared with 93 in 1911, 7.4 in 1910, and 739 in 1909. In 86 out of the 136 cases in which adulterations were detected in the official samples proceedings were instituted against the vendor, compared with 77 in 1911, 55 in 1910, and 44 in 1909. The total amount received in penalties under the above Acts during the year amounted to £197, and the costs to £47 14s., making a total of £244 14s., compared with £299 19s. 9d. in 1911, £154 11s. in 1910, and £92 5s. in 1909. P2 228 Report of the Medical Officer of Health. Proceedings under the Sale of Food and Drugs Acts. TABLE CIX. Case No. Article. Adulteration. Result. Fine. Costs. 4 Milk 13 per cent milk fat deficient Convicted 100/- 12/6 40 ,, 17 ,, ,, ,, ,, 20/- 12/6 59 Butter 94 ,, margarine ,, 100/- 12/6 60 „ 58 „ „ 100/- 12/6 70 Mustard 10 ,, of wheaten flour and turmeric ,, 10/- 12/6 82 Milk 10 per cent. milk fat deficient ,, 10/- 14/6 89 „ 8 ,, extraneous water „ 20/- 12/6 93 Butter 94 „ margarine ,, 40/- 12/6 94 ,, 90 „ ,, 100/- 27/6 131 Cream 38 grains of boric acid per lb. of cream ,, 100/- 35/6 152 „ 98 grains of boric acid per lb. of cream Same Defendant. Ordered to pay costs ,, 14/6 167 Butter 98 per cent. margarine Convicted 200/- 12/6 170 Milk 71 ,, milk fat deficient ,, 100/- 12/6 175 „ 6 „ Same defendant. Ordered to pay costs ... 28/6 189 ,, 15 ,, ,, Warranty proved. Summons dismissed ... ... 197 Butter 98 ,, margarine Convicted 40/- 14/6 224 ,, 99 ,, ,, „ 60/- 12/6 228 ,, 100 ,, ,, ,, 100/- 12/6 229 „ 100 ,, ,, ,, 20/- 12/6 263 Milk 13 „ milk fat deficient Warranty proved. ... ... 264 ,, 13 ,, ,, Summons dismissed ... ... 273 Butter 100 ,, margarine Convicted 100/- 12/6 302 Milk 13 „ milk fat deficient Warranty proved. Summons dismissed ... ... 316 „ 14 „ „ „ ... ... 363 „ 5 ,, ,, and 3.4 grains of boric acid per pint of milk Summons dismissed ... ... 368 ,, 12 per cent extraneous water and 10 per cent of milk fat deficient Convicted 40/- 13/6 380 ,, 25 per cent. extraneous water „ 40/- 13/6 384 „ 23 percent milk fat deficient Warranty proved. Summons dismissed ... ... 229 Report of the Medical Officer of Health. 229 TABLE CIX.—continued. Case No. Article. Adulteration. Result. Fine Costs. 388 Milk 2.4 grains boric acid per pint of milk Convicted. Same defendant 100/- 39/6 389 ,, 2.4 grains boric acid and 14 percent. milk fat deficient 390 „ 2.4 grains boric acid per pint of milk 399 ,, 40 percent milk fat deficient Convicted 40/- 19/6 404 ,, 29 ,, ,, ,, Convicted. Same defendant 100/- 12/6 459 Separated Milk 28 „ extraneous water 405 Milk 7 ,, milk fat deficient Convicted. 40/- 14/6 451 „ 10 ,, ,, ,, Same defendant ... 14/6 421 ,, 12 „ extraneous water Convicted 40/- 12/6 430 ,, 5 ,, ,, ,, Warranty proved. Summons dismissed ... ... 446 Butter 36 ,, margarine Convicted. 10 previous convictions proved £50 60/6 447 448 ,, ,, 36 „ „ 64 „ „ 449 ,, 64 „ ,, 453 Milk 19 ,, milk fat deficient and 5 per cent. extraneous water Warranty proved. Summons dismissed ... ... 482 Butter 95 „ margarine Convicted 20/- 14/6 490 Milk 16 ,, milk fat deficient ,, 20/- 12/6 517 „ 4 ,, extraneous water Warranty proved. ... ... 521 ,, 8 „ ,, ,, Summons dismissed ... ... 528 Ginger Beer .22 grains of metallic lead per gallon of ginger beer Summons dismissed. See report ... ... 529 ,, .47 grains „ „ „ Withdrawn on advice of Council's solicitor ... ... 530 ,, .16 grains „ „ „ 531 ,, 9.8 grains „ „ „ 532 ,, .22 grains „ „ „ 533 ,, 6.3 grains „ „ „ 534 ,, .28 grains „ „ „ 549 ,, .15 grains „ „ „ 550 „ .10 grains „ „ 551 ,, .30 grains „ „ „ 552 ,, .15 grains ,, ,, ,, 498 Sausage 1.'2 grains sulphurous acid Dismissed per lb. of sausage ... ... 230 Report of the Medical Officer of Health. TABLE CIX.—continued. Case No. Article. Adulteration. Result. Fine. Costs. 499 Sausage 1.12 grains sulphurous acid per lb. of sausage Withdrawn at Magistrate's suggestion ... ... 500 ,, 1.12 grains sulphurous acid and 3.4 grains of boric acid per lb. of sausage ,, ,, ,, ... ... 566 Milk 14 per cent. milk fat deficient Warranty proved. Summons dismissed ... ... 570 ,, 4 ,, extraneous water ,, ,, 587 Butter 96 ,, margarine Convicted 40/- 14/6 604 Milk Formalin preservative „ 100/- 12/6 620 ,, 21 per cent milk fat deficient and formalin preservative „ 100/- 22/6 655 Butter 96 per cent. margarine „ 40/- 18/6 670 „ 96 „ „ „ 40/- 12/6 751 Milk 10 „ extraneous water Ordered to pay costs ... 14/6 780 Butter 90 ,, margarine Convicted 200/- 16/6 782 „ 100 ,, ,, ,, 40/- 12/6 793 „ 100 ,, ,, ,, 40/- 2/- 807 ,, 92 „ „ ,, 20/- 12/6 808 ,, 92 „ ,, Defendant absconded before the summons was served ... ... 811 ,, 92 ,, ,, Convicted 40/- 16/- 812 11 92 „ „ „ 40/- 16/- 813 „ 45 ,, ,, 11 20/- 14/6 824 Milk 15 ,, extraneous water ,, 40/- 14/6 860 Butter 99 ,, margarine ,, 120/- 14/- 861 „ 90 ,, „ „ 100/- 14/- 868 Milk 37 ,, milk fat deficient ,, 40/- 14/6 886 ,, 37 ,, ,, ,, ,, 20/- 12/6 890 Separated Milk 7.5 „ extraneous water ,, 40/- 14/6 900 Butter 90 ,, margarine ,, 60/- 12/6 231 Report of the Medical Officer of Health. 231 PROCEEDINGS UNDER THE MARGARINE ACT. TABLE CX. Case No. Description of Offence. Result. Fine. Costs. 59 Selling Margarine in unstamped wrapper Ordered to pay costs ... 2/- 60 Do. Do. ... 2/- 93 Do. Do. ... 2/- 94 Do. Do. ... 4/- 167 Do. Convicted 20/- 4/- 197 Do. Ordered to pay costs ... 4/- 224 Do. Do. ... 2/- 228 Do. Do. ... 2/- 229 Do. Do. ... 2/- 273 Do. Do. ... 2/- 446 Do. Do. ... 2/- 447 Do. Do. ... 2/- 448 Do. Do. ... 2/- 449 Do. Do. ... 2/- 482 Do. Do. ... 4/- 587 Do. Do. ... 4/- 655 Do. Do. ... 4/- 670 Do. Do. ... 2/- 781 Do. Do. ... 2/- 782 Do. Do. ... 2/- 793 Do. Do. ... 2/- 807 Do. Do. ... 2/- 808 Do. Defendant absconded ... ... 811 Do. Ordered to pay costs ... 4/- 812 Do. Do. ... 4/- 232 Report of the Medical Officer of Health. TABLE CX.—continued. Case No. Description of Offence. Result. Fine. Costs. 813 Selling Margarine in unstamped wrapper Ordered to pay costs ... 4/- 860 Do. Do. ... 2/- 861 Do. Do. ... 4/- 900 Do. Do. ... 2/- 60 Selling Margarine containing more than 10 per cent. of Butter Fat Do. ... 2/- 446 Do. Do. ... 2/- 447 Do. Do. ... 2/- 448 Do. Do. ... 2/- 449 Do. Do. ... 2/- 813 Do. Do. ... 4/- 197 Exposing Margarine for sale by retail without proper label Do. ... 2/- 8l4 Do. Convicted 20/- 12/6 862 Do. Do. 20/- 12/6 OTHER OFFENCES. TABLE CXI. Nature of offence. Result. Fine. Costs. For obstructing the Food Inspector Convicted 40/- 23/- For selling milk from a receptacle upon which the vendor's name and address were not inscribed Do. 5/- 2/- Do. do. do. Do. 5/- 2/- Do. do. do. Do. 3o/- 2/- 233 Report of the Medical Officer of Health. TABLE CXII. year. no. of samples taken. no. adulterated. percentage adulterated. 1902 584 51 8.7 1903 729 90 12.3 1904 750 85 11.3 1905 853 65 7.6 1906 905 84 9.2 1907 989 84 8.4 1908 1,004 88 8.76 1909 1,030 71 6.89 1910 1,060 96 9.05 1911 927 123 13.2 average 10 years 1902—1911 883 83 9.2 1912 1,500 271 18.0 Table CXII. shows the number of samples taken, the number adulterated, and the percentage of adulterated samples for the 10 years 1902-11, compared with the year 1912. From this table it will be seen that the average percentage of adulterations detected for the 10 years 1902-11 was 9.2 per cent., compared with 18.0 in 1912 an increase of no less than 8 8 per cent. This increase is partly due to the large amount of adulteration detected in milk and butter samples. There are also other factors which have a direct bearing on this increase, the chief being that the Inspector has again made a determined effort to follow up the habitually fraudulent trader, with the result that several of these, who had been convicted several times, have left the Borough. 234 Report of the Medical Officer of Health. Another most important factor is the system of taking informal samples, which has been carried out to a large extent during the year under review. The following table shows the number of formal and informal samples taken in each sub-district of the Borough, together with the number taken per 1,000 of population, the number adulterated, and the percentage adulterated to total samples taken. It will be noted that of the formal samples 15.1 per cent. were adulterated, while of the informal 22.4 per cent. were adulterated. TABLE CXI 11. Formal Samples. Informal Samples. Total No. of samples taken. No. per 1,000 of Population. No. Adulterated. Percentage Adulterated. No. of samples taken. No. Adulterated. Percentage Adulterated. No. of sample taken No. Adulterated. Percentage Adulterated. Clapham 166 30 180 109 28 25.6 275 4.6 58 21.0 Putney 107 17 15.8 71 14 19.7 I 78 6.0 31 17.4 Streatham 235 42 17.8 209 72 34.4 444 4.4 114 25.7 Tooting 156 19 12.1 101 10 9.9 257 6.6 29 11.2 Wandsworth 235 28 11.9 111 11 9.9 346 3.6 39 11.2 Whole Borough 899 136 15. I 601 135 22.4 1,500 4.6 271 18.3 Of the total samples the percentage in Streatham was the highest due to the large amount of adulteration in the informal samples taken, no less than 72 out of a total of 209, or 34.4 per cent., having been adulterated. Table CXIV. shows in detail the total number of samples analysed during the year; the number found adulterated or not up to standard, and the percentage of adulteration for the year as well as for the previous five years. 235 Report of the Medical Officer of Health. TABLE CXIV. Articles analysed. No. of Samples. Percentage of Adulteration. Examined. Found adulterated or not up to standard. 1907. 1908. 1909. 1910. 1911. Average for five years. 1912. Milk & Cream 785 107 10.97 6.99 7.39 7.44 11.10 8.77 13.63 Butter 389 99 3.89 7.58 5.35 7.23 16.40 8. 09 25.4 Cheese 5 ... ... ... ... 80.7 ... 16.1 ... Margarine 7 ... ... 10.0 ... ... 20.0 6.0 ... Lard 32 ... ... ... ... ... ... ... ... Bread ... ... ... ... ... ... ... ... ... Flour 16 ... ... ... ... ... 50.0 10.0 ... Tea 3 ... ... ... ... ... ... ... ... Coffee 17 ... 17.2 4.1 5.5 9.0 10.0 9.1 ... Cocoa 4 ... 10.0 16.6 ... 8.3 ... 7.0 ... Sugar 13 2 ... ... ... ... 10.0 2.0 15.3 Mustard 4 1 ... ... ... ... ... ... ... Confectionery 9 ... ... 33.3 ... ... ... 6.6 ... Pepper 11 ... ... ... ... ... ... ... ... Wine, Beer and Spirits 1 ... ... ... ... ... ... ... ... Drugs* 43 3 8.69 9.1 12.5 ... 10.0 8.05 7.0 Other articles* 161 59 61.53 50.0 24.0 30.0 25.9 38.28 36.7 All Articles 1,500 271 8.49 8.76 6.89 9.05 13.2 9.28 1.80 * Details of these will be found in the Report of the Public Analyst at the end of this Report. 236 Report of the Medical Officer of Health. Milk and Cream. MILK. 712 samples of milk were procured for analysis during the year. 74 or 10.39 per cent. were reported against as being adulterated or not up to legal standard. 702 samples were procured officially, of which 68 or 9.6 per cent. were adulterated, and 10 samples procured informally, of which six were reported against. 29 samples were found to contain added water, 35 were deficient in milk fat, four were deficient in milk fat and contained added water, and three contained a preservative and were also deficient in milk fat. Proceedings were taken in 37 cases, in six cases proceedings were barred by informality of purchase, and in 31 cases the Public Health Committee, after considering the amount of adulteration and the circumstances of sale, decided not to prosecute the vendors, but to take further samples. 17 samples of milk were procured on delivery at various Public Institutions situated within the Borough and two samples were reported against. In one case the amount of adulteration was small, and the vendor was warned. In the other case proceedings were taken against the vendor, who successfully pleaded a warranty. 67 samples of milk were procured whilst in transit from the farmer to the retailer, the samples being taken as the milk arrived at various railway stations within the Borough, both at mid-night and mid-day deliveries. 237 Report of the Medical Officer of Health. Five cases were reported as being adulterated, and in each case proceedings were taken against the farmer and convictions obtained. 10 samples of milk were procured during the early morning (from 3 to 4 a.m.), from wholesale dealers whilst delivering milk to the retailer. One sample was reported against as being adulterated, and proceedings were taken against the vendor, who proved that the milk was sold in the same condition as received by him. Of 13 samples of milk procured on delivery at private houses, five were reported as being adulterated and proceedings were taken against the vendors. In two cases convictions were obtained, in two warranty was proved, and one was dismissed, the purchaser being called by the defence to prove that there was no prejudice by the sale of the adulterated milk. TABLE CXV. Premises. No. of Samples taken. No. Adulterated. Percentage Adulterated. Public Institutions 17 2 11.8 Railway Stations 67 5 7.4 Retailers' Premises 10 1 10.0 Private Houses 13 5 38.4 130 samples of milk have been taken on Sundays, either in the early morning or at mid-day. 13 or 10 per cent. were reported against as bring adulterated, compared with 10 per cent. in 1911, and 9.1 per cent. in 1910. 406 samples of milk were procured from milk carriers in the street during the early mornings (i.e., 5 to 7 a.m.), on week days and of these 37 or 9.1 per cent. were reported against. 238 Report of the Medical Officer of Health. In three cases proceedings were taken against milk sellers for selling milk from a receptacle upon which their name and address were not conspicuously inscribed, and convictions were obtained. (See other offences, Table CXI.) It is satisfactory to report that in no case during the year was the Inspector refused a sample of milk for analysis. In one case a milk vendor, when the Inspector asked for a sample of milk from a certain can containing about eight quarts of milk, deliberately upset the contents. The Inspector managed to seize the can in time to save sufficient milk, which on analysis was found to contain 57 per cent. of added water. Proceedings were taken against the vendor for wilfully obstructing the Inspector, and at the hearing of the summons the defendant stated that the can was upset through nervousness. In convicting the Magistrate remarked that in his opinion 57 per cent. of added water was sufficient to make the strongest man nervous. In 16 cases the defendants relied on a warranty, but in 12 cases only could the vendors satisfy the Magistrate that the milk was sold in the same condition as received. 15 samples of condensed machine skimmed milk were analysed and found to be genuine. The following Table shows the number of milk samples taken, the number found adulterated, and the percentage adulteration for the past 10 years, compared with the year 1912. 239 Report of the Medical Officer of Health. TABLE CXV1. Year. No. of Samples taken. No. Adulterated. Percentage Adulterated. 1902 215 23 11.2 1903 376 65 17.28 1904 397 61 I5.60 1905 510 37 7.25 1906 526 34 6.44 1907 501 55 10.97 1908 516 37 7.05 1909 545 40 7.16 1910 593 45 7.58 1911 602 67 11.11 Average 10 years, 1902-1911 478 46 962 1912 712 74 10.39 240 Report of the Medical Officer of Health. In two cases where the amount of preservative was excessive, proceedings were taken against the vendors, who were convicted and fined £5 and costs. In the remaining cases the vendors were warned. THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. During the year under review the Local Government Board issued Regulations dealing with the use of preservatives in milk and cream. The Regulations prohibit the use of preservatives of any kind in milk intended for human consumption, also in cream containing less than 35 per cent. of milk fat. In cream containing more than 35 per cent. of milk fat, preservatives are permitted with certain restrictions as to the nature of preservative and the amount used. Thus when a person buys " preserved cream " from a dairy or shop, the vessel in which the " preserved cream " is handed to the purchaser must bear a label in a conspicuous position as follows : Label I. PRESERVED CREAM CONTAINING BORIC ACID NOT EXCEEDING PER CENT. Label II. PRESERVED CREAM (PEROXIDE). 3. The size of the declaratory label shall be determined as follows:— Capacity of Receptacle. Size of Label. Inches. Inches. Not exceeding I pint ¾ by 1¾ Exceeding 1 pint 3 by 5 241 Report of the Medical Officer of Health. This label, known as the declaratory label will differentiate between " preserved cream " and " cream " (cream to which no preservatives have been added), thereby affording the purchaser some knowledge of the article purchased. Since this Regulation came into force 18 samples of cream have been purchased for analysis and are included in the statement of work done under the Sale of Food and Drugs Acts. 10 of these were found to be entirely free from preservative and contained upwards of 40 per cent. of milk fat, in two cases a declaration was made by label at the time of purchase, and in six cases no declaration was made that the cream supplied was preserved cream. Four of the above mentioned samples were procured officially and the vendors were asked to give an explanation as to why the preserved cream was not labelled as such. Three of the vendors wrote pleading either ignorance of the Regulations or that the cream was sold by mistake. One vendor's representative appeared before the Public Health Committee and stated that his firm were waiting to see what action the Borough Council was going to adopt in dealing with the Regulations. In each case the vendors were warned. The Council also instructed me to issue a warning to all registered milk and cream dealers in the Borough, and a copy of the Regulations, together with the following circular letter was sent to all registered milk and cream sellers in the Borough :— " The Medical Officer of Health has been instructed by the Wandsworth Borough Council to call the attention of milk and cream sellers in the Borough to the Public Health (Milk and Cream) Regulations, 1912, dated 1st August, 1912, a copy of which is enclosed, and hereby gives notice that samples will be taken to ascertain if such Regulations are being complied with. "The special attention of milk and cream sellers is called to the labels which must be used." Q 242 Report of the Medical Officer of Health. Butter and Margarine. BUTTER. 389 samples of butter were submitted for analysis during the year, of which 99 or 25.4 per cent. were reported against, compared with 16.4 per cent. in 1911, 7.23 per cent. in 1910, and 5.23 per cent. in 1909. Of the 389 samples of butter analysed 103 samples were procured officially, 31 or 30 per cent. were reported against, whereas of those samples procured informally 68 or 23.7 per cent. were found to be adulterated. As in former years practically all the adulteration recorded under this heading is really the substitution of margarine when butter was asked for. In 29 cases proceedings were instituted against the vendors of the adulterated samples, and convictions obtained in each case, the total amount of penalties, including costs, being £150 6s. 6d., •compared with £113 4s. 9d. in 1911. In one case the vendor, who had been convicted 10 times for offences under the Sale of Food and Drugs Acts, was fined £50 and -costs, or in default two months' imprisonment. Six samples were procured from itinerant butter hawkers and five were reported against. In three of the cases the vendors were prosecuted and convicted, one defendant being sent to prison for six weeks as he was unable to pay the fine inflicted. In another case the vendor gave the Inspector a false name and address and has escaped prosecution, while another absconded immediately after the sample was taken. In consequence of the difficulty experienced by the Inspector in dealing with this class of trader, I presented the folowing special 243 Report of the Medical Officer of Health. report to the Public Health Committee in order to give publicity to this fraudulent practice which is undoubtedly on the increase. REPORT OF THE MEDICAL OFFICER OF HEALTH ON ITINERANT BUTTER VENDORS. " I have to report that a considerable amount of the time of the Inspector has been taken up in dealing with itinerant butter vendors, who, although residing outside, yet trade in the Borough. " These vendors (four to six in number, with pony and cart), come into various parts of the Borough and go from house to house soliciting orders, and when they have completed a certain district they move off to another. " These men are known as the " canvassers," and in the course of their house-to-house calls manage to get some customers, the customers being passed on to a person who groups them together and forms a ' round.' " When this vendor finds that the ' so-called butter ' is giving satisfaction to his customers, he asks for recommendations to their friends. ''One lady who kindly assisted the Inspector in catching one of these vendors told him that she had recommended the man to no less than six or more of her friends and that she had been recommended to him herself. 'Tn may opinion a great deal of good will result in giving general publicity to this system of fraud, at the same time requesting the public to give prompt information regarding these vendors. " There is no doubt that by a system of registration these fraudulent traders could be kept in check, but at present no system exists. " Generally these vendors have no fixed abode, thus making process under the Sale of Food and Drugs Acts very difficult, and for this reason several Authorities have found it more expeditious to Q2 244 Report of the Medical Officer of Health. proceed under the Criminal Acts for obtaining money under false pretences. Cases have occurred recently where the vendors charged in this way have been sent to prison with hard labour. " The article which these vendors endeavour to sell is sold as butter, but this on analysis proves to be margarine, with only a very small percentage of butter. " This question has been noted in the Official Reports of the Local Government Board for 1909-1910, and 1910-1911, and it is there shown how extensive these frauds are, and the difficulties experienced in detecting and dealing with the offenders." The following Table shows the number of butter samples taken, the number found adulterated, and the percentage of adulteration, together with the average adulteration for the years 1902-1911, compared with the year under review. TABLE CXV1I. Year. Number of samples taken. N umber Adulterated. Percentage of Adulteration. 1902 299 26 8.6o 1903 180 8 4.40 1904 180 14 7.20 1905 223 20 8.96 1906 287 19 6.62 1907 334 13 3.89 1908 343 26 7.58 1909 299 16 5.35 1910 304 22 7.23 1911 189 31 16.4 Average for 10 years 1902-1911 264 19 7.4 1912 389 99 25.4 Report of the Medical Officer of Health. 245 MARGARINE. Seven samples of margarine were submitted for analysis and all returned as genuine. There were three prosecutions in respect of the sale of margarine, one for selling margarine in an unstamped wrapper, and two for exposing margarine for sale by retail without having a proper label attached thereto. The defendant in each case was convicted and penalties inflicted. CHEESE. Five samples of cheese were analysed and all reported to be genuine. LARD. 32 samples of lard were analysed and all reported to be genuine. FLOUR. 16 samples of flour and 26 of baking powder were examined, and it is satisfactory to state that all samples were genuine. As will be seen in my Report for 1911, this Council issued a circular drawing attention to the excess of calcium sulphate found in self-raising flour and baking powder, and it is satisfactory to note that the publicity given by the circular has been the means of checking this unnecessary form of adulteration. COFFEE. 17 samples of coffee were examined and all reported to be genuine. 246 Report of the Medical Officer of Health. COCOA. Four samples of cocoa were analysed and all reported to begenuine. SUGAR. 13 samples of sugar were analysed, two of which were reported against. These two samples were purchased as Demerara sugar, but on analysis were found to be sugar crystals, coloured or dyed, to represent Demerara sugar. The vendors were warned. MUSTARD. Four samples of mustard were analysed, one being reported as adulterated. Proceedings were taken against the-vendor, who was fined Ios. and costs. DRUGS. 43 samples of drugs were procured for analysis during the year, and all reported to be genuine with the exception of three samples of camphorated oil which were found to be deficient in camphor. The deficiency being small, the Public Health Committee decided not to prosecute, but to warn the vendors. OTHER ARTICLES. 161 samples classified under this heading were examined 59 or 36.7 per cent. being reported against as either adulterated or not up to the required standard. Report of the Medical Officer of Health. 247 The chief adulterations occurred in samples of ginger beer, which were examined for the presence of metallic lead. As will be seen in my Report for 1909 the following circular letter was sent to all persons who sold ginger beer in the Borough " The attention of the Medical Officer of Health has been called to the fact that ginger beer is being sold from barrels, stored in cellars with a lead communicating pipe to the engine on the counter. As there is a serious risk of the ginger beer being contaminated with lead and thus causing lead poisoning, this practice should, in the opinion of the Medical Officer of Health, at once be discontinued." During the year I was informed that certain of the large licensed premises were still using the counter pump for serving ginger beer. I therefore instructed the Inspector to take samples and ascertain the method adopted generally in the Borough. The following report was made to the Committee on the matter. 2nd July, 1912. LEAD IX GINGER BEER. " I have to report that in August, 1909, a circular letter was sent to occupiers of all licensed premises in the Borough warning them of the danger to health in using lead communicating pipes connecting the barrel with the hand pump on the counter. " With a view of ascertaining if this circular letter had caused the use of such pipes to be discontinued, samples of ginger beer have been procured during the last fortnight. " Of 12 informal samples submitted for analysis 11 contained lead, while of 13 formal samples 12 contained lead. " In the formal samples in which lead was found the amount varied from .05 to 9.8 grains per gallon of ginger beer. In all 97 public houses were visited. In 79 of these the ginger beer was drawn directly from the barrel and samples of these were not submitted. In 18 it was drawn from a hand-pump through a 248 Report of the Medical Officer of Health. pipe communicating with the barrel in the cellar, and samples of these were taken and submitted for analysis. " As the presence of even a small amount of lead is dangerous to health owing to the fact that this metal is a cumulative poison, I am of opinion that proceedings should be taken in all cases where it has been found in the official samples with the exception of No. 6, where the amount was small, but that the owner should be warned in this instance. " I am of opinion that the publicity given to prosecutions would have a salutary effect on the trade, and would be the means of putting a stop to a practice which is dangerous to the health of the public. “The following table shows the results of the formal and informal samples taken:— Informal No. Grains of metallic Lead per Gallon. Official Sample No. Grains of Metallic Lead per Gallon. 1 .16 1 16 2 14.00 2 9.8 3 .77 3 .56 4 .16 4 .22 5 2.8 5 .22 6 .08 6 .05 7 2.80 7 6.30 8 .28 — — 9 .15 — — 10 Nil — — 11 .33 — — 12 .08 — — — — 8 .28 — — 9 Nil — 10 11 .15 .10 — — 12 .30 13 .15 In 11 cases proceedings were instituted against the vendors, the summons being taken out under Section 3 of the Act of 1875“For selling ginger beer which was mixed with a soluble lead salt equivalent to — grains of metallic lead per gallon of ginger beer, so as to render the same injurious to health.” 249 Report of the Medical Officer of Health. At the hearing of the summonses the Magistrate stated that in his opinion the defendants did not mix the lead salt with the ginger beer, and also that the defendants had no guilty knowledge, and therefore he dismissed the summonses. The decision of the Magistrate may possibly have been legally correct, but as the defendant admitted receiving the above-mentioned circular letter, in my opinion, a conviction should have been obtained. The Inspector who carries out the duties under the Sale of Food and Drugs Acts has again performed all these duties in a most thorough and efficient manner, and in addition has satisfactorily carried out all the work in connection with the Rag Flock Act and the Milk and Cream Regulations. I have also pleasure in reporting that the whole of the work of the Department has during the year been carried out by the various members of the staff to my entire satisfaction. I have the honour to be, Mr. Mayor and Gentlemen, Your obedient Servant, P. CALDWELL SMITH. ANNUAL STATEMENT Of the work done in the Borough of Wandsworth under the Sale of Food and Drugs Acts, summarised from the statutory quarterly reports. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Wandsworth. Sir and Gentlemen, I have the honour to present the Annual Statement of the work done during the year 1912 under the Sale of Food and Drug:-. Acts. Number of Samples submitted. The total number of samples submitted by the Inspector during the year amounted to 1,500. Of these, 899 were taken with the formalities required by the Sale of Food and Drugs Acts, whilst 601 were procured informally. The statement following gives the result of analyses of all articles submitted. In Tables A and B will be found the details of the articles grouped together in the main statement under the headings " Drugs " and " Other Articles " ; whilst Tables C, D, E, and F give details of all adulterated samples, and are further amplified in the context. 252 Report of the Medical Officer of Health. Main Statement showing the result of Analyses of all Articles submitted under the Sale of Food and Drugs Acts during the year 1912 by Inspector Newell. No. of samples examined No. of samples found adulterated or not up to standard Formal Informal Total. Formal Informal Total. Milk and Cream 737 48 785 87 20 107 Butter 103 286 389 31 68 99 Cheese 0 5 5 0 0 0 Margarine 7 0 7 0 0 0 Lard 6 26 32 0 0 0 Flour 0 16 16 0 0 0 Tea 0 3 3 0 0 0 Coffee 4 13 17 0 0 0 Cocoa 4 0 4 0 0 0 Sugar 1 12 13 0 2 2 Mustard 2 2 4 1 0 1 Confectionery and Jam 1 8 9 0 0 0 Pepper 2 9 11 1 0 0 0 Spirits 0 1 1 0 0 0 Drugs 6 37 43 1 2 3 Other Articles 26 135 161 16 43 59 All Articles 899 601 1,500 136 135 1271 253 Report of the Medical Officer of Health. Table A. Details of " Other Articles " and " Drugs " in foregoing Table. OTHER ARTICLES No. of samples examined No. of samples found adulterated or not up to standard Forma) Informal Total. Formal Informal Total. Almonds (Ground) 2 0 2 0 0 0 Bacon 1 2 3 0 1 1 Baking Powder 1 25 26 0 0 0 Coffee and Chicory 0 9 9 0 7 7 Cornflour 0 2 2 0 0 0 Fish (Dried Haddock) 0 1 1 0 0 0 Fruits in syrup— Cherries (Canned) 0 1 1 0 1 1 Ginger 1 2 3 0 0 0 Ginger Beer 16 12 28 12 11 23. Mustard Mixture 0 1 1 0 0 0 Olive Oil 0 6 6 0 0 0 Preserved Vegetables : 0 2 2 0 2 2 Canned French Beans Canned Tomatoes Rice 0 18 18 0 0 0 Sago 0 2 2 0 0 0 Sausages 5 14 19 4 10 14 Sausage Skins 0 1 1 0 0 0 Syrup, Golden 0 20 20 0 8 8 Tapioca 0 4 4 0 0 0 Vinegar 0 10 10 0 3 3 Wines (Non-alcoholic) 0 3 3 0 0 0 26 135 161 16 43 59 254 Report of the Medical Officer of Health. Table B. DRUGS No. of samples examined. No. of samples found adulterated or not up to standard Formal Informal Total Formal Informal Total Acid, Citric O 1 1 O 0 0 Acid, Tartaric O 2 2 0 0 O Camphorated Oil 6 3 9 1 2 3 Cream of Tarter 0 2 2 0 0 o Friar's Balsam 0 2 2 0 O o Glycerine 0 7 7 o O o Lime Water 0 4 4 o 0 o Magnesia, Effervescing Citrate of o 2 2 0 0 0 Oil, Almond 0 1 1 o 0 0 Oil, Eucalyptus 0 1 1 o 0 0 Powder, Gregory's o 1 1 o 0 0 Powder, Liquorice, Compound 0 1 1 0 o o Powder, Rhubarb 0 1 1 0 0 o Quinine Sulphate o 1 1 0 0 0 Saffron 0 2 2 0 0 0 Spirit of Ammonia, Aromatic o 1 1 o 0 0 Sulphur, Milk of 0 1 1 0 o 0 Tincture of Iodine o 1 1 0 o Q Tincture of Quinine, Ammoniated 0 2 2 o o O Wine, Ipecacuanha 0 1 1 o o 0 6 37 43 1 2 3 255 Report of the Medical Officer of Health. Milk and Cream. The number of samples grouped under the heading " Milk and Cream " amounted to 785. Of these, 737 were taken with the necessary formalities required by the Acts, whilst 48 were submitted informally. The samples were comprised as follows:— No. of samples examined No. of samples found adulterated or not up to standard Formal Informal Total Formal Informal Total Milk 686 10 696 66 6 72 Separated Milk 14 0 14 2 0 2 Skim Milk 2 0 2 0 0 O Cream (Fresh) 34 14 48 19 10 29 Cream (Preserved) 1 9 10 0 4 4 Condensed Milk (Machine-Skimmed) 0 15 15 0 0 0 737 48 785 87 20 107 256 Report of the Medical Officer of Health. The nature and •xtent of the adulteration reported. Of the formal samples, case Xo. 459 (Separated Milk) with 28 per cent. extraneous water, supplied the worst instance, followed closely by case No. 368, with 25 per cent. extraneous water. The greatest deficiency in milk fat occurred in the case of Formal sample No. 170, where it amounted to 71 per cent. whilst Formal sample No. 399 and Informal sample No. 71 ranked next with 49 per cent. and 40 per cent. respectively. Of the creams purchased as fresh, one sample (formal sample No. 152) was found to contain no less than 98 grains of crystallised boric acid per pint, an excessive amount ; the remaining samples, in which a boron preservative was present, contained this preservative in amounts less than 35 grains per pint (equivalent to 0.5 per cent.), with the exception of Formal sample No. 131 where the limit was slightly exceeded, namely, with 38.5 grains per pint. Of the creams sold as " preserved," in one instance only was the proportion of boron preservative found to exceed 35 grains of crystallised boric acid per pint, namely, in Informal sample No. 192, where 39.2 grains were recorded. The details of all adulterated samples grouped under this heading are given in Table C. The presence of preservatives. All milks were systematically examined for the presence of preservatives, but in six instances only were positive results obtained, four being found to contain small amounts of a boron preservative, and two a formalin preservative. Of these two, one contained the preservative " Mystin," a mixture of formaldehyde and sodium nitrite, and in both instances the preservative had been added in amounts much greater than is usually the case. 257 Report of the Medical Officer of Health. Table C. Table showing in detail the nature of the adulteration or departure from standard of all samples of Milk and Cream, adversely reported on during the year. Formal. Case No. Nature of sample. Nature of Report. 4 Milk 13 per cent. deficient in milk-fat. 40 Milk 7 per cent. deficient in milk-fat. 43 Milk 4 per cent. extraneous water. 72 Milk 4 per cent. extraneous water. 77 Milk 2 per cent. extraneous water. 82 Milk 10 per cent. deficient in milk-fat. 89 Milk 8 per cent. extraneous water. 122 Milk 1 per cent. deficient in milk-fat. 125 Milk 3 per cent. deficient in milk-fat. 126 Cream (fresh) 19.6 grains Crystallised Boric Acid per lb. 329 Cream (fresh) 11.9 grains Crystallised Boric Acid per lb. 130 Cream (fresh) 5.6 grains Crystallised Boric Acid per lb. 131 Cream (fresh) 38.5 grains Crystallised Boric Acid per lb. 132 Cream (fresh) 7.7 grains Crystallised Boric Acid per lb. 133 Cream (fresh) 21.7 grains Crystallised Boric Acid per lb. 135 Milk 1 per cent. extraneous water. 151 Cream (fresh) 19.6 grains Crystallised Boric Acid per lb. 152 Cream (fresh) 98.0 grains Crystallised Boric Acid per lb. 156 Cream (fresh) 1.3 grains Crystallised Boric Acid per lb. 157 Cream (fresh) 7.0 grains Crystallised Boric Acid per lb. 161 Cream (fresh) 18.2 grains Crystallised Boric Acid per lb. 162 Cream (fresh) 10.5 grains Crystallised Boric Acid per lb. r 258 Report of the Medical Officer of Health. Table C—continued. Case No. Nature of Sample. Nature of Report. 163 Cream (fresh) 14.0 grains Crystallised Boric Acid per lb. 164 Cream (fresh) 18.9 grains Crystallised Boric Acid per lb. 166 Cream (fresh) 18.2 grains Crystallised Boric Acid: per lb. 170 Milk 71 per cent deficient in milk fat. 175 Milk 6 per cent. deficient in milk fat. 189 Milk 15 per cent. deficient in milk-fat. 231 Milk 2 per cent. deficient in milk-fat. 240 Milk 1 per cent. deficient in milk-fat. 254 Milk 4 per cent. extraneous water. 260 Milk 3 per cent. extraneous water. 263 Milk 13 per cent. deficient in milk-fat. 264 Milk 13 per cent. deficient in milk-fat. 302 Milk 13 per cent. deficient in milk-fat. 306 Milk 1 per cent. extraneous water. 310 Milk 3 per cent. deficient in milk-fat. 314 Milk 2 per cent. extraneous water. 316 Milk 14 per cent. deficient in milk-fat. 322 Milk 3 per cent. deficient in milk-fat. 326 Milk 2 per cent. deficient in milk-fat. 327 Milk 3 per cent. extraneous water. 332 Milk 5 per cent. deficient in milk-fat. 363 Milk 5 per cent. deficient in milk-fat and a Boron preservative = 3.2 grains Crystallised Boric Acid per pint. 368 Milk 25 per cent. extraneous water. 380 Milk 12 per cent. extraneous water and 10 per cent. deficient in milk-fat. 384 Milk 23 per cent. deficient in milk-fat. 388 Milk A Boron preservative = 2.4 grains Crystallised Boric Acid per pint. 389 Milk 14 per cent. deficient in milk-fat and a Boron preservative = 2.4 grains Crystallised Boric Acid per pint. 259 Report of the Medical Officer of Health. Table C—continued. Case No. Nature of sample. Nature of Report. 390 Milk A Boron preservative = 2.4 grains Crystallised Boric Acid per pint. 399 Milk 49 per cent. deficient in milk-fat. 404 Milk 29 per cent. deficient in milk-fat. 405 Milk 7 per cent. deficient in milk-fat. 421 Milk 12 per cent. extraneous water. 430 Milk 5 per cent. extraneous water. 451 Milk 10 per cent. deficient in milk fat. 453 Milk 5 per cent. extraneous water and 19 per cent. deficient in milk-fat. 455 Milk 3 per cent. deficient in milk-fat 459 Milk (separated) 28 per cent. extraneous water. 477 Milk 2 per cent. extraneous water. 490 Milk 16 per cent. deficient in milk-fat. 513 Milk 2 per cent. extraneous water. 517 Milk 4 per cent. extraneous water. 519 Milk 2 per cent. extraneous water. 521 Milk 8 per cent. extraneous water. 537 Milk 2 per cent. extraneous water. 562 Milk 5 per cent. deficient in milk-fat. 566 Milk 14 per cent. deficient in milk-fat. 570 Milk 4 per cent. extraneous water. 591 Milk 2 per cent. extraneous water. 593 Milk 2 per cent. extraneous water. 599 Milk 2 per cent. extraneous water. 600 Milk 2 per cent. extraneous water. 604 Milk Containing 0.005 per cent. Formaldehyde and 0.175 Per cent. Sodium Nitrite. 620 Milk 21 per cent. deficient in milk-fat and containing 0.03 per cent. Formalin. 622 Milk 1 per cent. extraneous water. 747 Milk 2 per cent. extraneous water. 751 Milk 10 per cent. extraneous water. 786 Cream (fresh) 4.9 grains Crystallised Boric Acid per lb. 787 Cream (fresh) 19.6 grains Crystallised Boric Acid per lb. R 2 260 Report of the Medical Officer of Health. Table C—continued. Case No. Nature of sample. Nature of Report. 824 Milk 15 per cent. extraneous water. 829 Cream (fresh) 23.8 grains Crystallised Boric Acid per lb. S30 Cream (fresh) 18.9 grains Crystallised Boric Acid per lb. 868 Milk 37 per cent. deficient in milk-fat. 881 Milk 1 per cent. extraneous water. 886 Milk 37 per cent. deficient in milk-fat. 890 Milk (separated) 7.5 per cent. extraneous water. Informal. Case No. Nature of sample. Nature of Report. 11 Milk 57 per cent. extraneous water. 71 Milk 40 per cent. deficient in milk-fat. 122 Milk 8 per cent. deficient in milk fat. 154 Milk 5 per cent. deficient in milk fat. 383 Cream (fresh) 23.8 grains Crystallised Boric Acid per lb. 184 Cream (fresh) 28.7 grains Crystallised Boric Acid per lb. 185 Cream (fresh) 3.5 grains Crystallised Boric Acid per lb. 186 Cream (fresh) 19.6 grains Crystallised Boric Acid per lb. 187 Cream (fresh) 9.1 grains Crystallised Boric Acid per lb. 188 Cream (fresh) 22.4 grains Crystallised Boric Acid per lb. 189 Cream (fresh) 16.4 grains Crystallised Boric Acid per lb. 190 Cream (preserved) 32.2 grains Crystallised Boric Acid per 1b. 261 Report of the Medical Officer of Health. Table C—continued, Case No. Nature of sample. Nature of Report. 191 Cream (preserved) 273 grains Crystallised Boric Acid per lb. 192 Cream (preserved) 39.2 grains Crystallised Boric Acid per lb. 193 Cream (preserved) 27.3 grains Crystallised Boric Acid per lb. 194 Cream (fresh) 23.1 grains Crystallised Boric Acid per lb. 245 Milk 33 per cent. deficient in milk-fat. 493 Milk 15 per cent. deficient in milk-fat. 523 Cream (fresh) 1.4 grains Crystallised Boric Acid per lb. 526 Cream (fresh) 18.9 grains Crystallised Boric Acid per lb. The average composition of the genuine milk samples submitted. The average composition, in regard to milk fat and solidsnot-fat, of the milk samples (exclusive of adulterated samples) submitted during each fortnight of the year was as follows:— Milk Fat. Solidsnot-fat. Milk Fat. Solidsnot-fat. 1st Fortnight 3.56 8.86 14th Fortnight 3.47 8.77 2nd ,, 3.50 8.85 15th ,, 3.41 8.74 3rd ,, 3.41 8.96 16th ,, 3.42 8.92 4th ,, 3.56 8.88 17th ,, — — 5th ,, 3.36 8.91 18th ,, 3.51 8.87 6th ,, 3.35 8.77 19th ,, 3.50 8.81 7th ,, 3.54 8.80 20th ,, 3.67 8.96 8th „ 3.41 8.82 21St ,, 3.63 9.01 9th ,, 3.60 8.88 22nd „ 3.89 9.04 10th ,, 3.28 8.87 23rd ,, 3.85 9.01 11th „ 3.31 8.80 24th ,, 3.67 8.91 12th ,, 3.59 8.83 25th ,, 3.70 8.90 13th ,, 3.51 8.76 26th „ - - 262 Report of the Medical Officer of Health. The Chart here inserted presents in a graphic form this variation in average composition. For the whole year the average composition proved to be:— Milk-fat 3.55 per cent. Solids-not-fat 8.88 per cent. Butter. "Extent of the adulteration reported. 389 samples were submitted during the year, of which 103 samples were taken with the necessary formalities, whilst 286 were submitted informally. The total number reported as adulterated, or not up to standard, amounted to no less than 99, or 25.4 per cent. The greatest percentage adulteration occurred in the case of the formal samples, where it amounted to 30 per cent., as against 23.7 per cent. for the informal samples. This high figure in the case of the samples submitted formally is to be explained by the fact that formal samples were taken in most instances only when informal sampling showed that systematic adulteration was being practised. Even in the case of the informal samples, the percentage of adulteration (23.7 per cent.) reaches a figure higher than any yet recorded, and affords striking evidence of the value of informal working in detecting and exposing fraudulent practice. Nature of the adulteration reported. The nature of the adulteration reported showed that in 59 instances margarine was wholly substituted for butter; in 22 instances mixtures of butter and margarine, in varying amounts, were sold; in 13 instances the butter sold contained an excess of boron preservative, and in five instances an excess of water. Full details of these cases are given in Table D. The presence of Preservatives. All samples were examined for the presence of preservatives, with the result that a boron preservative was found in 316 (or 81.2 per cent.) of the samples submitted. With the exception of the 13 cases mentioned above, this was present in quantities not exceeding 0.5 per cent. (equivalent to 35 grains per lb.) calculated in terms of Crystallised Boric Acid, the actual amounts and the times of their occurrence being given in Table E. 263 Report of the Medical Officer of Health. Table D. Table showing in detail the nature of the adulteration of all samples of Butter, adversely reported on during the year. Case No. Nature of Report. 59 94 per cent. Margarine. 60 58 „ ,, 93 94 ,, ,, 94 90 ,, ,, 167 98 ,, ,, 197 98 ,, ,, 224 99 ,, ,, 228 100 ,, ,, 229 100 ,, ,, 273 100 „ „ 402 0.5 per cent. excess water over legal standard of 16 per cent. 446 36 per cent. Margarine. 447 36 ,, ,, 448 64 ,, ,, 449 64 ,, ,, 482 95 ,, ,, 587 96 ,, ,, 655 96 ,, ,, 670 96 ,, ,, 673 0.5 per cent. excess water over legal standard of 16 per cent. 781 90 per cent. Margarine. 782 100 ,, ,, 793 100 ,, ,, 807 92 ,, ,, 808 92 ,, ,, 8n 92 ,, ,, 812 92 ,, ,, 813 45 ,, ,, 860 99 ,, ,, 861 90 ,, ,, 900 90 ,, ,, 264 Report of the Medical Officer of Health. Table D—continued. INFORMAL Case No. Nature of Report. 227 100 per cent. Margarine. 19 40 ,, ,, 59 0.29 per cent. excess water over legal standard of 16 per cent. 60 7.91 ,, ,, 82 0.50 ,, ,, 104 10 per cent. Margarine. 123 42 ,, ,, 155 42 ,, ,, 225 96 ,, ,, 226 96 ,, ,, 244 96 ,, ,, 247 97 ,, ,, 249 44 ,, ,, 252 97 ,, ,, 258 96 ,, ,, 265 0.45 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 267 97 per cent. Margarine. 276 0.46 per cent. excess Boric Acid over suggested standard of, 0.5 per cent. 304 98 per cent. Margarine. 305 96 ,, ,, 306 0.3 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 333 0.1 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 339 0.14 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 340 0.08 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 380 95 per cent. Margarine. 383 25 ,, ,, 265 Report of the Medical Officer of Health. Table D—continued. Case No. Nature of Report. 399 0.14 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 404 94 per cent. Margarine. 406 94 ,, ,, 408 0.1 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 444 93 per cent. Margarine. 452 0.2 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 456 100 per cent. Margarine. 457 100 „ „ 461 94 ,, ,, 483 93 ,, ,, 484 100 „ „ 485 100 „ „ 491 100 ,, ,, 492 94 ,, ,, 495 47 ,, ,, 510 40 ,, ,, 511 93 ,, ,, 512 90 ,, ,, 513 92 ,, ,, 514 93 ,, ,, 519 33 ,, ,, 520 0.23 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 521 92 percent. Margarine. 537 50 ,, ,, 538 40 ,, ,, 539 0.5 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 540 99 per cent. Margarine. 552 0.14 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 266 Report of the Medical Officer of Health. Table D—continued. Case No. Nature of Report. 554 91 per cent. Margarine. 561 92 ,, ,, 562 50 ,, ,, 563 92 ,, ,, 568 91 ,, ,, 573 92 ,, ,, 575 60 ,, ,, 576 60 ,, ,, 580 92 ,, ,, 584 60 ,, ,, 585 92 ,, ,, 589 0.22 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 597 46 per cent. Margarine. 599 92 ,, ,, 267 Report of the Medical Officer of Health. Table E. Giving in detail particulars relating to the presence or absence of a Boron preservative in the 389 samples of Butter submitted during the year. Number of samples free from preservative 73 Number of samples containing 0.05 per cent. or less (in terms of Boric Acid H3B03) 42 Number of samples containing 0.10 per cent. or less, but more than 0.05 per cent. 56 Number of samples containing 0.15 per cent. or less, but more than 0.10 per cent. 36 Number of samples containing 0.20 per cent. or less, but more than 0.15 per cent. 35 Number of samples containing 0.25 per cent. or less, but more than 0.20 per cent. 26 Number of samples containing 0.30 per cent. or less, but more than 0.25 per cent. 31 Number of samples containing 0.35 per cent. or less, but more than 0.30 per cent. 23 Number of samples containing 0.40 per cent. or less, but more than 0.35 per cent. 19 Number of samples containing 0.45 per cent. or less, but more than 0.40 per cent. 24 Number of samples containing 0.50 per cent. or less, but more than 0.45 per cent. 11 Over 0.50 per cent. 13 389 The average content of Boron preservative (in terms of Crystallised Boric Acid) contained in the 218 samples of Butter (reported as genuine) which contained this preservative amounted to 0.20 per cent., equivalent to 14.0 grains per lb. butter. Articles other than Milk, Cream, and Butter. The extent of the adulteration reported. Of the samples submitted other than milk, cream, and butter the number amounted to 326, 59 of which were taken with the necessary formalities, whilst 267 were procured informally. The total number reported as 268 Report of the Medical Officer of Health. terated, or not up to standard amounted to 65 (or 19.9 per cent.),. 18 cases (or 30.5 per cent.) occurring in the formal samples, and 47 (or 17.6 per cent.) in the informal. The number and variety of the articles grouped under this heading are shown in the Main Statement preceding, with its accompanying tables A and B ; whilst full details of the samples reported as adulterated or not up to standard are given in Table F following. The examination of samples of Self-raising Flourand Baking Powder for the presence of Calcium Sulphate. Included under the headings " Flour " and " Other Articles " are to be found 16 samples of Self-Raising Flour and 26 samples of Baking Powder. These were submitted with special reference to the presence or absence of Calcium Sulphate, and were taken in continuation of inspection made during 1911 as the result of publication during that year of Dr. J. M. Hamill's Report to the Local Government Board " On the presence of Calcium Sulphate in Baking Powder and Self-Raising-Flour." Whilst in 1911 two samples out of the nine examined were found to contain this impurity in excess of the limit recommended as permissible, it is satisfactory to record that not one of the 42 samples submitted this year was found to be at fault in this respect. The presence of lead in Ginger Beer. With a view to ascertaining whether the action of the Borough Council in 1909 in the matter of certain proceedings dealing with the contamination of Ginger Beer with Lead had been successful in putting a stop to the practice then common of drawing this beverage through lead communicating pipes to the engine on the counter, 28 samples were submitted for examination, with special reference to this metallic contamination. The results recorded are distinctly disappointing, since in no less than 23 samples of the 28 was a soluble salt of lead found to be present. The quantity of lead dissolved from the lead pipe varied within wide limits: thus, one sample (Informal case No. 197) was found to contain an amount of lead equivalent to as much as 14 grains per gallon; whilst amounts of 9.8, 6.3, and 2.8 grains were also met with. In the majority of instances, however, the amount Report of the Medical Officer of Health. 269 of lead found was less than one grain per gallon; but having regard to the cumulative effect produced on ingesting even minute amounts of this metal, its presence in such an article is greatly to be deplored. Vendors cannot be too strongly warned against the danger of using lead piping for the purpose referred to above, since laboratory •experiments showed that the action of the ginger beer in attacking the metal is extremely rapid. Even in as short a time as 10 minutes the proportion of lead dissolved may amount to several grains per gallon. Preservatives in Sausages. An increased number of samples of sausages were submitted during the year under review compared with 1911. In all, 19 samples were procured, and of these 14 (or 73.6 per cent.) were found to contain either a Boron or Sulphite preservative or both. Excessive amounts of Boric Acid were found in two cases; namely, 67.9 and 43.4 grains per lb. of sausage respectively. The occurrence of a sulphite preservative in eight instances is also noteworthy and indicates a somewhat wide-spread adoption of this article for meat preserving purposes. Rice. The examination of 18 samples of Rice afforded evidence that the sale of an article containing an excess of mineral matter employed for the purpose of "facing" and so improving the appearance of the grain is practically non-existent in the Borough, since no adulteration was found in the samples submitted. Golden Syrup. Twenty samples of Golden Syrup were submitted for analysis, of which eight were reported as adulterated. These consisted wholly of Glucose Syrup, or Starch Syrup, whereas Golden Syrup should be the syrup obtained in the production of cane or beet sugar. Drugs. It is satisfactory to record that of the 43 samples of Drugs examined, three only were reported as not up to standard. This is the more satisfactory when it is noted that out of 21 different varieties examined, the three deficient samples all occurred in one type only, namely, Camphorated Oil. 270 Report of the Medical Officer of Health. TABLE F. FORMAL. Case No. Nature of sample. Nature of Report. 70 Mustard 10 per cent. Wheaten Flour coloured with Turmeric. 484 Sausage A Boron preservative=22.5 grains Crystallised Boric Acid per lb. 498 Sausage A Sulphite preservative = 1.12 grains Sulphurous Acid (as S02) per lb. 499 Sausage A Sulphite preservative = 1,12 grains Sulphurous Acid (as SO2) per lb. 500 Sausage A Boron preservative=3.5 grains Crystallised Boric Acid, and a Sulphite preservative=1.89 grains Sulphurous Acid (as SO2) per lb. 527 Ginger Beer A soluble salt of Lead=0.05 grains Metallic Lead per gallon. 528 Ginger Beer A soluble salt of Lead=0.22 grains Metallic Lead per gallon. 529 Ginger Beer A soluble salt of Lead=0.47 grains Metallic Lead per gallon. 530 Ginger Beer A soluble salt of Lead=0.16 grains. Metallic Lead per gallon. 531 Ginger Beer A soluble salt of Lead=9.80 grains Metallic Lead per gallon. 532 Ginger Beer A soluble salt of Lead=0.22 grains Metallic Lead per gallon. 533 Ginger Beer A soluble salt of Lead=6.30 grains Metallic Lead per gallon. 534 Ginger Beer A soluble salt of Leacl=0.28 grains, Metallic Lead per gallon. 549 Ginger Beer A soluble salt of Lead=0.15 grains Metallic Lead per gallon. 550 Ginger Beer A soluble salt of Lead=0.10 grains Metallic Lead per gallon. 551 Ginger Beer A soluble salt of Lead=0.30 grains. Metallic Lead per gallon. 552 Ginger Beer A soluble salt of Lead=0.15 grains. Metallic Lead per gallon. 831 Camphorated Oil 16 per cent. deficient in Camphor. Report of the Medical Officer of Health. 271 Table F—continued. INFORMAL. Case No. Nature of sample. Nature of Report. 93 Golden Syrup 100 per cent. Glucose Syrup. 94 Golden Syrup 100 per cent. Glucose Syrup. 98 Golden Syrup 100 per cent. Glucose Syrup. 100 Golden Syrup 100 per cent. Glucose Syrup. 101 Golden Syrup 100 per cent. Glucose Syrup. 103 Golden Syrup 100 per cent. Glucose Syrup. 119 Golden Syrup 100 per cent. Glucose Syrup. 121 Golden Syrup 100 per cent. Glucose Syrup. 156 Sausage A Boron preservative=4.9 grains Crystallised Boric Acid per lb. 157 Sausage A Boron preservative=4.2 grains Crystallised Boric Acid, and a Sulphite preservative=1.61 grains Sulphurous Acid (as S02) per lb. 158 Sausage A Sulphite preservative=0.91 grains. Sulphurous Acid (as SO2) per lb 159 Sausage A Boron preservative=67.9 grains Crystallised Boric Acid per lb. 160 Sausage A Sulphite preservative=0.91 grains Sulphurous Acid (as S02) per lb. 161 Bacon A Boron preservative=12.6 grains Crystallised Boric Acid per lb. 162 Sausage A Boron preservative=4.9 grains Crystallised Boric Acid per lb. 164 Sausage A Sulphite preservative=0.42 grains Sulphurous Acid (as SO2) per lb. 165 Sausage A Boron preservative=4.9 grains Crystallised Boric Acid per lb. 169 Sausage A Sulphite preservative=1.26 grains Sulphurous Acid (as S02) per lb. 170 Coffee and Chicory 55 per cent. Chicory. 171 Coffee and Chicory 71 per cent. Chicory. 172 Coffee and Chicory 75 per cent. Chicory. 173 Coffee and Chicory 60 per cent. Chicory. 174 Coffee and Chicory 64 per cent Chicory. 272 Report of the Medical Officer of Health. Table F—continued. Case No. Nature of sample. Nature of Report. 181 Sausage A Boron preservative=43.4 grains Crystallised Boric Acid per lb. 196 Ginger Beer A soluble salt of Lead=0.16 grains Metallic Lead per gallon. 197 Ginger Beer A soluble salt of Lead=14.0 grains Metallic Lead per gallon. 198 Ginger Beer A soluble salt of Lead=0.79 grains Metallic Lead per gallon. 199 Ginger Beer A soluble salt of Lead=0.16 grains Metallic Lead per gallon. 200 Ginger Beer A soluble salt of Lead=0.28 grains Metallic Lead per gallon. 201 Ginger Beer A soluble salt of Lead=0.08 grains Metallic Lead per gallon. 202 Ginger Beer A soluble salt of Lead=2.80 grains Metallic Lead per gallon. 218 Preserved vegetable: (Tinned French Beans) 0.32 grains Copper per lb. 219 Ginger Beer A soluble salt of Lead=0.28 grains Metallic Lead per gallon. 220 Ginger Beer A soluble salt of Lead=0.15 grains Metallic Lead per gallon. 222 Ginger Beer A soluble salt of Lead=0.33 grains Metallic Lead per gallon. 223 Ginger Beer A soluble salt of Lead=0.08 grains Metallic Lead per gallon. 393 Sugar (Demerara) 100 per cent. coloured sugar crystals. 396 Sugar (Demerara) 100 per cent. coloured sugar crystals. 528 Camphorated Oil 20 per cent. deficient in Camphor. 530 Camphorated Oil 12 per cent. deficient in Camphor. 549 Coffee Mixture 65 per cent. Chicory. 551 Coffee Mixture 68 per cent. Chicory. 555 Tinned Tomatoes 0.9 grains tin per lb. 556 Tinned Cherries 1.3 grains tin per lb. 593 Vinegar 31 per cent. deficient in Acetic Acid. 594 Vinegar 28 per cent. deficient in Acetic Acid. 596 Vinegar 10 per cent. deficient in Acetic Acid. Report of the Medical Officer of Health. 273 In conclusion I have to report that the percentage adulteration for the year for all articles submitted amounted to 18.0 per cent., for articles submitted formally to 15.1 per cent., and for articles submitted informally to 22.4 per cent. I have the honour to be, Mr. Mayor and Gentlemen, Your obedient Servant, A. H. M. MUTER, f.i.c., f.c.s. South London Central Public Laboratory, 325, Kennington Road, S.E. 3rd February, 1913. s APPENDIX. PARTICULARS OF DEATHS IN EACH OF THE SUB-DISTRICTS DURING THE YEAR 1912. s 2 276 Report of the Medical Officer of Health. Borough of Wandsworth—Clapham Sub-District. Infant Mortality. 1912. Nett Deaths from stated causes at various Ages under 1 Year of Age. Cause of Death. Under 1 Week. 1—2 Weeks. 2—3 Weeks. Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months Total Deaths under 1 Year. All causes Certified 33 5 6 7 51 11 14 8 8 92 Uncertified 1 ... ... ... 1 ... ... ... ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 3 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... 1 1 1 3 ... 1 6 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... 1 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... 1 ... ... 1 1 1 ... ... 3 Convulsions ... 1 ... 1 3 ... 1 ... ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 1 ... 1 1 ... 2 1 5 Pneumonia (all forms) ... ... 1 ... 1 2 2 4 1 10 Diarrhœa ... ... ... ... ... 2 1 ... ... 3 Enteritis ... ... ... ... ... ... 1 ... 1 2 Gastritis ... ... ... ... ... ... ... ... ... 1 Syphilis ... ... ... 1 1 ... 1 ... ... 2 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth 2 ... ... ... 2 ... ... ... ... 2 Atelectasis 3 ... ... ... 3 ... ... ... ... 3 Congenital Malformations 3 ... ... ... 3 ... ... ... ... 4 Premature birth 22 1 3 4 30 ... ... ... ... 30 Atrophy, Debility and Marasmus 1 1 1 ... 3 2 3 ... ... 8 Other causes 2 1 ... ... 3 1 1 1 ... 6 34 5 6 7 52 11 14 8 8 93 Nett Births in the year—legitimate, 1,192; illegitimate, 46. Nett Deaths in the year of—legitimate infants, 90; illegitimate infants, 3. Report of the Medical Officer of Health. 277 Borough of Wandsworth—Putney Sub-District. Infant Mortality. 1912. Nett Deaths from stated causes at various Ages under 1 Year of Age, Cause of Death. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 1 Month and under 3Months 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months Total Deaths under 1 Year. All causes Certified 9 2 2 2 15 6 5 2 6 34 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... 1 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... 2 Pneumonia (all forms) ... ... 1 2 3 2 2 ... 1 8 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... 1 2 ... 2 5 Gastritis ... ... ... ... ... 1 ... ... ... 1 Syphilis ... ... ... ... ... 1 ... ... ... 1 Rickets ... ... ... ... ... ... ... ... 1 1 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations ... 1 ... ... 1 ... ... ... ... 1 Premature Birth 8 ... 1 ... 9 1 ... ... ... 10 Atrophy, Debility and Marasmus ... 1 ... ... 1 ... ... ... ... 1 Other causes 1 ... ... ... 1 ... 1 ... 1 3 9 2 2 2 15 6 5 2 6 34 Nett Births in the year—legitimate, 472; illegitimate, 16. Nett Deaths in the year of—legitimate infants, 28; illegitimate infants, 6. 278 Report of the Medical Officer of Health. Borough of Wandsworth—Streatham Sub-District. Infant Mortality. 1912. Nett Deaths from stated causes at various Ages under 1 Year of Age. Cause of Death. Under 1 Week. 1—2 Weeks. 2—3 Weeks. Weeks. Total under 4 weeks. 1 Month and under 3 Months 3 Months and under 6 Months. 6 Months and under 9 Months 9 Months and under 12'Months Total Deaths under 1 Year. All causes Certified 34 10 6 6 57 25 7 10 8 106 Uncertified 2 ... ... ... 2 ... ... ... ... 2 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... 2 1 3 2 8 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... 1 1 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... 1 1 ... 4 2 ... ... 1 7 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... 1 2 1 1 ... 5 Pneumonia (all forms) ... ... ... ... ... 3 ... ... 2 5 Diarrhœa ... ... ... ... ... 1 1 1 ... 3 Enteritis ... 2 ... ... 2 2 ... 3 ... 7 Gastritis ... ... ... ... ... 1 ... ... ... 1 Syphilis ... ... ... 1 1 3 1 ... ... 5 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... 1 ... ... ... 1 Injury at birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 5 ... ... ... 5 ... ... ... ... 5 Congenital Malformations 3 2 1 ... 6 ... ... ... ... 6 Premature birth 20 4 2 1 27 1 2 ... ... 3° Atrophy, Debility and Marasmus 3 1 1 3 8 5 1 ... 1 15 Other causes 1 ... 1 1 3 2 ... 1 ... 6 36 10 6 6 58 25 7 10 8 108 Nett Births in the year—legitimate, 1,802; illegitimate, 48. Nett Deaths in the year of—legitimate infants, 103; illegitimate infants, 5. Report of the Medical Officer of Health. 279 Borough of Wandsworth—Tooting Sub-District. Infant Mortality. 1912. Nett Deaths from stated causes at various Ages under 1 Year of Age. Cause of Death. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 weeks. 1 Month and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months Total Deaths under 1 Year. All causes Certified 20 8 3 6 37 25 10 14 10 97 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... 1 ... 2 3 6 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... 1 ... 1 ... ... ... ... 1 Other Tuberculous Diseases ... ... ... ... ... ... ... i ... 1 Meningitis (not Tuberculous) ... ... ... ... ... 1 1 2 ... 4 Convulsions 1 2 ... ... ... 1 ... ... ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... 4 4 1 ... 3 1 9 Pneumonia (all forms) ... ... ... ... ... 2 1 2 4 9 Diarrhœa ... ... ... ... ... 3 3 2 ... 8 Enteritis ... ... ... ... ... 6 5 ... 2 13 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... 1 ... ... ... 1 Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations 3 ... ... ... 3 ... ... ... ... 3 Premature birth 15 1 ... 1 17 2 ... ... ... 19 Atrophy, Debility and Marasmus 1 4 2 1 8 7 ... 2 ... 17 Other causes ... 1 ... ... 1 ... ... ... ... 1 20 8 3 6 37 25 10 14 11 97 Nett Births in the year—legitimate, 935; illegitimate, 33. Nett Deaths in the year of—legitimate infants, 89; illegitimate infants, 8. 280 Report of the Medical Officer of Health. Borough of Wandsworth—Southfield Sub-District. Infant Mortality. 1912. Nett Deaths from stated causes at various Ages under 1 Year of Age. Cause of Death. Under 1 Week. 1—2 Weeks. 2—3 Weeks Weeks. Total under Weeks. 1 Month and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months Total Deaths under 1 Year. All causes Certified 29 1 4 2 36 23 20 7 9 95 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 1 ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... 1 2 ... 2 5 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) 1 ... ... ... 1 ... ... ... ... 1 Convulsions ... ... ... ... ... 1 ... ... 1 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 1 ... 1 5 2 3 ... 11 Pneumonia (all forms) ... ... ... ... ... 1 4 ... 5 10 Diarrhœa ... ... 1 ... 1 ... 1 ... 1 3 Enteritis ... ... ... ... ... 3 2 ... ... 5 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... 2 ... ... 2 Rickets ... ... ... ... ... ... ... 1 ... 1 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 2 ... ... ... 2 ... ... ... ... 2 Congenital Malformations 2 ... ... ... 2 ... ... ... ... 2 Premature birth 19 ... ... ... 20 3 2 ... ... 25 Atrophy, Debility and Marasmus 3 ... 1 1 5 8 5 1 ... 19 Other causes 1 ... 1 1 3 1 ... ... ... 4 29 1 4 2 36 23 20 7 9 95 Nett Births in the year—legitimate, 1,237 illegitimate, 40. Nett Deaths in the year of—legitimate infants, 89; illegitimate infants, 6. Report of the Medical Officer of Health. 281 Borough of Wandsworth—Springfield Sub-District. Infant Mortality. 1912. Nett Deaths from stated causes at various Ages under 1 Year of Age. Cause of Death. Under 1 week. 1—2 weeks. 2—3 Weeks. Weeks. Total under 4 Week. 1 Month and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months Total Deaths under 1 Year. All causes Certified 20 3 7 3 33 16 23 9 8 89 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 1 ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... 1 1 ... 1 3 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... 1 ... ... 1 2 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... 2 ... 3 ... 1 ... ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 2 ... 2 4 7 ... 1 14 Pneumonia (all forms) ... 1 1 1 3 2 1 4 2 12 Diarrhœa ... ... ... ... ... ... ... 1 ... 1 Enteritis ... ... ... 1 1 2 4 1 2 10 Gastritis ... ... ... ... ... 1 3 1 1 6 Syphilis ... ... ... ... ... ... 1 ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis 4 ... ... ... 4 ... ... ... ... 4 Congenital Malformations 2 1 ... ... 3 ... ... ... ... 3 Premature birth 9 1 1 1 12 1 ... ... ... 13 Atrophy, Debility and Marasmus 3 ... 1 ... 4 3 2 1 ... 10 Other causes 1 ... ... ... 1 1 3 ... ... 5 20 3 7 3 33 16 23 9 8 89 Nett Births in the year—legitimate, 905; illegitimate, 30. Nett Deaths in the year of—legitimate infants, 8; illegitimate infants, 7. 282 Report of the Medical Officer of Health. CLAPHAM, 1912. Causes of Death. Deaths in or belonging to Whole District at subjoined ages. Deaths in Public Institutions in the District. All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Enteric Fever 2 1 1 ... ... 1 ... ... 1 ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... Measles 19 7 12 3 11 5 ... ... ... ...... ... ... ... Scarlet Fever 1 ... 1 ... ... ... 1 ... ... ... ... ... Whooping Cough 12 5 7 6 5 1 ... ... ... ... ... ... Diphtheria & Membranous Croup 3 1 2 ... 1 ... 2 ... ... ... ... ... Influenza 11 3 8 ... ... ... ... ... ... 5 5 ... Erysipelas 1 ... 1 ... ... ... ... ... ... ... 1 ... Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 70 41 29 ... ... ... ... ... 38 18 3 24 Tuberculous Meningitis 5 4 1 1 ... 2 1 ... ... ... ... 1 Abdominal Tuberculosis 2 2 ... ... 1 ... ... 1 ... ... ... ... Other Tuberculous Diseases 4 2 2 ... ... 1 1 ... ... ... ... 2 Other Infective Diseases 5 3 2 2 ... ... 1 ... ... 1 1 ... Cancer, Malignant Disease 85 35 50 1 ... ... ... ... 5 47 32 37 Rheumatic Fever 4 2 2 ... ... ... 1 ... 1 ... ... ... Diabetes 7 1 6 ... ... ... ... ... 3 3 1 3 Other General Diseases 9 4 5 1 1 1 ... ... 1 2 3 1 Alcoholism 3 2 1 ... ... ... ... ... 2 1 ... 1 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ...Meningitis 6 3 3 3 ... 1 1 ... ... ... ... ... Cerebral Haemorrhage, Apoplexy 30 17 3 ... ... ... ... ... 1 10 19 2 Convulsions 7 4 3 4 2 ... 1 ... ... ... ... ... Other Diseases of Nervous System 34 18 16 ... ... ... 3 1 9 12 9 1 Organic Diseases of Heart 73 3i 42 ... ... ... 2 3 11 22 35 3 Other Diseases of Circulatory System 18 9 9 ... ... ... 2 2 ... 8 6 2 Bronchitis 56 28 28 5 1 1 ... ... ... 14 35 1 Broncho-Pneumonia 17 7 10 7 2 ... ... 1 1 2 4 1 Lobar Pneumonia 8 6 2 ... ... ... 1 1 4 2 ... ... Pneumonia (type not distinguished) 23 11 12 3 2 2 ... ... 8 3 5 1 Other Diseases of Respiratory System 5 5 ... ... ... ... ... ... ... 3 2 1 Ulcer of Stomach 5 2 3 ... ... ... ... ... ... 1 1 ... Diarrhoea 3 1 2 3 ... ... ... ... ... ... ... 1 Enteritis 6 3 3 2 2 ... ... ... ... 1 1 ... Appendicitis and Typhlitis 4 ... 4 ... ... ... l ... ... 2 ... 2 Obstruction of Intestines 4 3 1 1 ... ... ... ... ... 1 2 1 Cirrhosis of Liver 5 4 1 ... ... ... ... 1 ... 3 1 ... Other Diseases of Liver ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Digestive System 4 2 2 1 ... 1 ... ... 1 ... ... 1 Nephritis and Bright's Disease 16 11 5 ... ... ... ... 1 ... 6 9 ... Other Diseases of Urinary System 3 3 ... ... ...... ... ... ... ... ... 1 2 ... Diseases of Generative System 4 ... 4 ... ... ... ... ... 1 1 2 ... Puerperal Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 3 ... 3 ... ... ... ... ... 3 ... ... ... Premature Birth 30 18 12 30 ... ... ... ... ... ... ... ... Congenital Debility and Malformation 12 6 6 12 ... ... ... ... ... ... ... ... Other Diseases of Early Infancy 6 6 ... 6 ... ... ... ... ... ... ... ... Old Age 41 20 21 ... ... ... ... ... ... ... 41 2 Deaths from Accident 13 9 4 ... ... 2 ... ... 5 4 ... 1 Deaths from Suicide 11 5 6 ... ... ... ... ... 2 6 3 ... Other Violent Deaths ... ... ... ... ... ... ... ... ... ... Other defined Diseases 6 4 2 ... 1 ... 2 3 ... Ill-defined Diseases or unknown 2 2 ... 2 ... ... ... ... ... ... ... ... All causes 699 351 348 93 28 19 17 28 104 183 227 91 Report of the Medical Officer of Health. 283 putney. 1912. Causes of Death. Deaths in or belonging to Whole District at subjoined ages. Deaths in Public Institutions in the District. All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... Measles 2 1 1 ... 1 1 ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 3 2 1 1 2 ... ... ... ... ... ... ... Diphtheria & Membranous Croup 3 2 1 ... ... 1 1 ... 1 ... ... ... Influenza 4 2 2 ... ... 1 ... ... ... ... 3 ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 28 14 14 ... ... ... 3 ... 7 13 2 2 Tuberculous Meningitis 1 1 ... ... 1 ... ... ... ... ... ... ... Abdominal Tuberculosis 1 1 ... ... ... ... 1 ... ... ... ... ... Other Tuberculous Diseases 2 2 ... ... ... ... 1 ... ... 1 ... ... Other Infective Diseases 2 1 1 1 ... ... 1 ... ... ... ... 1 Cancer, Malignant Disease 27 10 17 ... ... ... ... ... 4 12 11 9 Rheumatic Fever 5 3 2 ... ... ... 3 ... ... ... 1 ... Diabetes 4 1 3 ... ... ... ... ... ... 2 2 ... Other General Diseases 5 3 2 1 ... ... 1 ... ... 2 ... 2 Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 2 1 1 ... 2 ... ... ... ... ... ... ... Cerebral Haemorrhage, Apoplexy 15 8 7 ... ... ... ... ... 3 12 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Nervous System 9 6 3 ...1 ... 1 ... ... 3 2 2 3 Organic Diseases of Heart 20 7 3 ... ... ... 1 1 2 7 9 4 Other Diseases of Circulatory System 13 7 6 ... ... ... ... ... ... 4 9 1 Bronchitis... 23 9 14 2 1 ... ... ... 1 7 12 ... Broncho-Pneumonia 9 6 3 6 1 ... ... ... 1 1 1 Lobar Pneumonia 2 ... 2 ... 1 ... ... ... ... 1 ... ... Pneumonia (type not distinguished) 10 8 2 2 1 ... ... ... 5 1 1 1 Other Diseases of Respiratory System 2 1 1 ... ... ... 1 ... ... ... 1 1 Ulcer of Stomach 1 ... 1 ... ... ... ... ... i ... ... 1 Diarrhœa 1 ... 1 ... 1 ... ... ... ... ... ... ... Enteritis 6 6 5 ... ... ... ... ... ... 1 ... ... Appendicitis and Typhlitis 5 1 4 ... ... ... ... 2 3 ... ... 2 Obstruction of Intestines 5 1 4 ... ... ... 1 ... 1 1 2 ... Cirrhosis of Liver 2 1 1 ... ... ... ... ... ... 1 1 ... Other Diseases of Liver 1 ... 1 ... ... ... ... ... ... ... 1 ... Other Diseases of Digestive System 5 4 1 2 ... ... ... ... ... 1 2 ... Nephritis and Bright's Disease 14 7 7 ... ... ... ... ... 3 7 4 4 Other Diseases of Urinary System 3 2 1 ... ... ... ... ... ... 1 2 Diseases of Generative System ... ... ... ... ... ... ... ... ... ... ... 1 Puerperal Fever 2 ... 2 ... ... ... ... ... 2 ... ... 1 Other Accidents and Diseases of Pregnancy and Childbirth 2 ... 2 ... ... ... ... ... 2 ... ... ... Premature Birth 10 5 5 10 ... ... ... ... ... ... ... 1 Congenital Debility and Malformation 2 1 1 2 ... ... ... ... ... ... ... ... Other Diseases of Early Infancy ... ... ... ... ... ... ... ... ... ... ... ... Old Age 19 4 15 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 19 1 Deaths from Accident 4 3 1 ... ... ... ... 1 1 1 1 3 Deaths from Suicide 5 3 2 ... ... ... ... ... 2 3 ... 5 Other Violent Deaths 1 ... 1 1 ... ... ... ... ... ... ... 1 Other defined Diseases ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Diseases or unknown 1 1 ... ... 1 ... ... ... ... ... ... ... All causes 281 135 146 34 12 5 14 8 38 72 98 45 284 Report of the Medical Officer of Health STREATHAM, 1912. Causes of Death. Deaths in or belonging to Whole District at subjoined ages. Deaths in Public Institutions in the District. All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... Measles 4 ... 4 1 ... 1 2 ... ... ... ... ... Scarlet Fever 6 2 4 ... 1 2 3 ... ... ... ... ... Whooping Cough 12 4 8 8 3 1 ... ... ... ... ... ... Diphtheria & MembranotisCroup 1 1 ... ... ... 1 ... ... ... ... ... ... Influenza 14 7 7 1 ... ... ... ... 1 5 7 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 71 41 30 1 ... ... 3 10 32 20 5 6 Tuberculous Meningitis 11 5 6 1 2 3 5 ... ... ... ... ... Abdominal Tuberculosis 3 ...1 2 ... 1 ... 1 ... 1 ... ... 1 Other Tuberculous Diseases 8 4 4 ... ... 1 2 3 2 ... ... ... Other Infective Diseases 10 6 4 5 ... ... 2 ... 1 2 ... ... Cancer, Malignant Disease 102 50 52 ... ... ... 1 1 11 38 51 3 Rheumatic Fever 4 2 2 ... ... ... 2 ... ... 1 ... ... Diabetes 17 11 6 ... ... ... ... 1 3 7 6 1 Other General Diseases 11 4 7 ... ... ... 1 1 2 1 6 1 Alcoholism 2 ... 2 ... ... ... ... ... 2 ... ... 1 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 4 2 2 ... ... 2 ... ... 1 1 ... ... Cerebral Haemorrhage, Apoplexy 50 27 23 ... 1 1 ... ... 4 15 29 3 Convulsions 8 4 4 7 1 ... ... ... ... ... ... ... Other Diseases of Nervous System 35 21 14 ... 1 ... 1 3 8 10 12 6 Organic Diseases of Heart 32 43 39 ... ... ... 1 3 9 29 40 6 Other Diseases of Circulatory System 29 16 13 ... ... 1 3 3 4 5 13 ... Bronchitis 70 29 41 5 ... ... ... ... 4 16 45 6 Broncho-Pneumonia 17 7 10 3 7 1 2 ... ... 1 3 4 Lobar Pneumonia 6 3 3 1 1 ... ... 2 1 1 ... Pneumonia (type not distinguished) 30 18 12 2 ... ... ... 2 8 11 7 2 Other Diseases of Respiratory System 7 4 3 1 ... ... ... ... 1 3 2 3 Ulcer of Stomach 7 2 5 ... ... ... ... 1 3 2 1 1 Diarrhoea 4 1 3 3 ... ... ... ... ... ... 1 ... Enteritis 11 7 4 7 1 ... ... ... 1 2 ... ... Appendicitis and Typhlitis 8 4 4 ... ... 1 3 1 ... 3 ... 2 Obstruction of Intestines 9 3 6 1 ... 2 1 ... 2 2 1 ... Cirrhosis of Liver 22 10 12 ... ... ... ... ... 1 11 10 1 Other Diseases of Liver 5 ... 5 ... ... ... ... ... ... 3 2 1 Other Diseases of Digestive System 21 6 15 1 ... ... 2 ... 4 7 7 ... Nephritis and Bright's Disease 40 26 14 ... ... ... ... ... 3 15 22 1 Other Diseases of Urinary System 7 5 2 1 ... ... ... ... ... ... 5 1 Diseases of Generative System 2 ... 2 ... ... ... ... 1 ... 1 ... ... Puerperal Fever 2 ... 2 ... ... ... ... ... 2 ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 3 ... 3 ... ... ... ... 1 2 ... ... ... Premature Birth 30 17 13 30 ... ... ... ... ... ... ... ... Congenital Debility and Malformation 22 12 10 21 ... ... 1 ... ... ... ... 1 Other Diseases of Early Infancy 6 3 3 6 ... ... ... ... ... ... ... 1 Old Age 72 27 45 ... ... ... ... ... ... ... 72 6 Deaths from Accident 22 17 5 ... ... 3 6 3 2 2 5 2 Deaths from Suicide 7 3 4 ... ... ... ... ... 1 5 1 4 Other Violent Deaths 3 1 2 1 ... ... ... 1 ... 1 ... ... Other defined Diseases 5 1 4 1 1 ... ... ... ... 1 2 2 Ill-defined Diseases or unknown 1 1 ... ... ... ... ... ... ... ... 1 ... All causes 923 458 465 108 20 21 42 35 117 222 358 67 Report of the Medical Officer of Health. 285 TOOTING. 1912. Causes of Death. Deaths in or belonging to Whole District at subjoined ages. Deaths in Public Institutions in the District. All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Enteric Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... Measles 3 3 ... 1 1 1 ... ... ... ... ... 25 Scarlet Fever 1 ... 1 ... ... ... 1 ... ... ... ... 17 Whooping Cough 11 4 7 6 1 4 ... ... ... ... ... 26 Diphtheria &Membranous Croup 5 2 3 ... 1 3 1 ... ... ... ... 34 Influenza 2 2 ... ... ... ... ... 2 ... ... ... 2 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases 1 ... 1 ... 1 ... ... ... ... ... ... ... Pulmonary Tuberculosis 31 18 13 ... ... ... 1 6 13 10 1 100 Tuberculous Meningitis 3 3 ... ... 1 ... 2 ... ... ... ... ... Abdominal Tuberculosis 1 1 ... 1 ... ... ... ... ... ... ... 1 Other Tuberculous Diseases 4 3 1 1 ... ... 1 ... 2 ... ... 3 Other Infective Diseases 1 1 ... ... ... ... ... ... 1 ... ... 1 Cancer, Malignant Disease 31 9 22 ... ... ... ... 1 5 19 6 5 Rheumatic Fever 1 1 ... ... ... ... ... ... 1 ... ... 1 Diabetes 3 1 2 ... ... ... 1 ... 2 ... ... 1 Other General Diseases 3 ... 3 ... ... ... ... ... ... 3 ... ... Alcoholism 1 ... 1 ... ... ... ... ... 1 ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 6 3 3 4 1 ... 1 ... ... ... ... 1 Cerebral Haemorrhage, Apoplexy 12 4 8 ... ... ... ... ... 2 3 7 13 Convulsions 5 3 2 4 ... 1 ... ... ... ... ... ... Other Diseases of Nervous System 13 10 3 ... ... 2 2 ... 5 4 ... 36 Organic Diseases of Heart 22 11 11 ... ... ... 2 1 5 6 8 13 Other Diseases of Circulatory System 8 6 2 ... 1 ... ... 1 2 3 1 6 Bronchitis 31 18 13 9 1 ... ... ... 2 5 12 7 Broncho-Pneumonia 12 6 6 7 4 1 ... ... ... ... ... 7 Lobar Pneumonia 2 1 1 ... ... ... ... 1 ... 1 ... ... Pneumonia (type not distinguished) 9 7 2 2 ... ... ... ... 3 4 ... 14 Other Diseases of Respiratory System 6 3 3 ... ... 1 ... ... ... 5 ... ... Ulcer of Stomach 1 1 ... ... ... ... ... ... ... 1 ... ... Diarrhcea 10 5 5 8 ... ... ... ... 1 ... 1 1 Enteritis 15 10 5 13 1 ... ... ... ... 1 ... 1 Appendicitis and Typhlitis 4 4 ... ... ... ... 1 1 ... 1 1 ... Obstruction of Intestines 2 1 1 ... ... ... ... ... 1 ... 1 A Cirrhosis of Liver 2 2 ... ... ... ... ... ... ... 2 ... 1 Other Diseases of Liver 1 1 ... ... ... ... ... ... ... ... 1 ... Other Diseases of Digestive System 2 1 1 ... ... ... ... ... 1 1 ... 5 Nephritis and Bright's Disease 10 7 3 1 ... ... ... ... ... 7 2 3 Other Diseases of Urinary System 1 1 ... ... ... ... ... ... ... ... 1 3 Diseases of Generative System ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 4 ... 4 ... ... ... ... ... 4 ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 2 ... 2 ... ... ... ... 1 1 ... ... ... Premature Birth 19 11 8 19 ... ... ... ... ... ... ... ... Congenital Debility and Malformation 21 11 10 20 ... 1 ... ... ... ... ... 1 Other Diseases of Early Infancy ... ... ... ... ... ... ... ... ... ... ... ... Old Age 24 10 14 ... ... ... ... ... ... ... 24 261 Deaths from Accident 4 1 3 1 ... ... ... ... ... 1 2 1 Deaths from Suicide 10 9 1 ... ... ... ... 2 4 4 ... 1 Other Violent Deaths ... ... ... ... ... ... ... ... ... ... ... ... Other defined Diseases 2 1 1 ... 1 ... ... ... ... ... 1 1 Ill-defined Diseases or unknown 1 1 ... ... ... ... ... ... ... ... 1 ... All causes 364 197 167 97 14 14 15 16 57 81 70 596 286 Report of the Medical Officer of Health. WANDSWORTH. South field Ward. 1912. Causes of Death. Deaths in or belonging to Whole District at subjoined ages. Deaths in Public Institutions in the District. All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Enteric Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... Measles 12 6 6 1 5 ... 2 ... ... ... ... ... Scarlet Fever 1 1 ... ... ... ... 1 ... ... ... ... ... Whooping Cough 11 8 3 5 4 ... ... ... ... ... ... ... Diphtheria & Membranous Croup 3 2 1 ... ... ... 1 ... ... ... ... ... Influenza 8 5 3 ... ... ... ... 2 1 3 2 1 Erysipelas 2 1 1 ... ... ... ... ... ... 1 1 ... Cerebro-spinal Fever 1 ... 1 ... ... 1 ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 69 39 30 ... ... ... 3 9 33 18 6 1 Tuberculous Meningitis 5 2 3 1 ... 1 2 ... ... 1 ... ... Abdominal Tuberculosis 4 2 2 ... ... 1 1 ... 1 1 ... ... Other Tuberculous Diseases 3 1 2 ... ... ... 1 1 1 ... ... ... Other Infective Diseases 5 5 ... 2 ... ... 1 1 1 ... ... ... Cancer, Malignant Disease 65 33 32 ... ... ... ... ... 4 32 29 3 Rheumatic Fever 2 1 1 ... ... ... ... 1 1 ... ... ... Diabetes 8 3 5 ... ... ... ... ... 1 5 2 2 Other General Diseases 8 4 4 2 ... ... ... 1 1 2 2 2 Alcoholism 3 3 ... ... ... ... ... ... ... 3 ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 2 2 ... 1 ... ... ... ... 1 ... ... ... Cerebral Haemorrhage, Apoplexy 26 12 14 ... ... ... ... ... ... 11 15 1 Convulsions 2 ... 2 2 ... ... ... ... ... ... ... ... Other Diseases of Nervous System 22 7 15 ... ... ... 2 2 7 4 7 7 Organic Diseases of Heart 48 24 24 1 ... ... ... 2 4 19 22 4 Other Diseases of Circulatory System 10 3 7 ... ... ... ... ... 1 3 6 1 Bronchitis 5° 22 28 11 ... ... ... ... 1 21 17 2 Broncho-Pneumonia 15 10 5 5 5 3 1 ... ... ... ... ... Lobar Pneumonia 7 6 1 ... ... 1 ... ... 2 ... 3 ... Pneumonia (type not distinguished) 21 12 9 5 4 ... ... ... 2 7 3 ... Other Diseases of Respiratory System 8 4 4 ... ... 1 ... ... 2 2 3 ... Ulcer of Stomach 5 2 3 ... ... ... ... ... 3 2 ... ... Diarrhcea 6 2 4 3 1 ... ... ... 1 1 ... ... Enteritis 7 2 5 5 1 ... ... ... ... 1 ... ... Appendicitis and Typhlitis 6 3 3 ... ... ... 3 ... ... ... 2 ... Obstruction of Intestines 5 3 2 ... ... ... ... ... ... 2 3 ... Cirrhosis of Liver 8 6 2 ... ... ... ... ... 1 5 2 ... Other Diseases of Liver 2 1 1 ... ... ... ... ... ... ... 1 ... Other Diseases of Digestive System 4 3 1 ... ... ... ... ... 1 2 1 1 Nephritis and Bright's Disease 19 14 5 ... ... ... 1 ... 1 8 9 ... Other Diseases of Urinary System 8 8 ... ... ... ... ... ... ... 2 6 1 Diseases of Generative System 2 ... 2 ... ... ... ... ... ... 2 ... ... Puerperal Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 1 ... 1 ... ... ... ... 1 ... ... ... ... Premature Birth 25 13 12 25 ... ... ... ... ... ... ... ... Congenital Debility and Malformation 24 12 12 21 1 1 ... ... 1 ... ... ... Other Diseases of Early Infancy 3 2 1 3 ... ... ... ... ... ... ... ... Old Age 47 16 31 ... ... ... ... ... ... 1 46 1 Deaths from Accident 15 13 2 ... ... ... 1 5 5 3 1 ... Deaths from Suicide 5 5 ... ... ... ... ... 1 1 2 1 3 Other Violent Deaths 1 1 ... ... ... ... ... ... ... 1 ... 1 Other defined Diseases 3 2 1 1 ... ... 1 ... ... 1 ... ... Ill-defined Diseases or unknown 2 ... 2 1 ... ... ... ... ... 1 ... ... All causes 621 -26 295 95 22 17 21 26 81 168 191 31 Report of the Medical Officer of Health. 287 WANDSWORTH. Springfield Ward. 1912. Causes of Death. Deaths in or belonging to Whole District at subjoined ages. Deaths in Public Institutions in the District. All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Enteric Fever 4 3 1 ... ... ... ... 1 2 1 ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... Measles 11 3 8 1 2 7 1 ... ... ... ... ... Scarlet Fever 2 1 1 ... ... 1 1 ... ... ... ... ... Whooping Cough 8 4 4 3 2 3 ... ... ... ... ... ... Diphtheria & Membranous Croup 3 2 1 ... 1 ... 1 ... ... ... 1 ... Influenza 6 3 3 1 1 ... ... ... ... 2 2 ... Erysipelas 2 ... 2 ... ... ... ... ... 1 ... 1 1 Cetebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases 1 ... 1 ... ... ... ... ... 1 ... ... ... Pulmonary Tuberculosis 34 28 6 ... 2 ... 3 ... 13 ... 3 20 Tuberculous Meningitis 3 3 ... ... ... ... 2 ... ... ... ... ... Abdominal Tuberculosis 1 1 ... ... ... ... ... ... 1 ... ... ... Other Tuberculous Diseases 2 1 1 2 ... ... ... ... ... ... ... 1 Other Infective Diseases 2 ... 2 1 ... ... ... ... 1 ... ... ... Cancer, Malignant Disease 28 15 13 ... ... ... ... ... 3 17 8 3 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... Diabetes ... ... ... ... ... ... ... ... ... ... ... ... Other General Diseases 2 2 ... ... ... ... ... ... 1 1 ... ... Alcoholism 4 3 1 ... ... ... ... ... ... 3 1 ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 1 1 ... ... ... ... 1 ... ... ... ... ... Cerebral Haemorrhage, Apoplexy 21 16 5 ... ... ... ... ... ... 6 15 7 Convulsions 5 2 3 4 ... ... 1 ... ... ... ... 1 Other Diseases of Nervous System 11 7 4 ... ... ... 3 1 1 4 2 37 Organic Diseases of Heart 25 13 12 ... ... ... 1 1 4 12 7 9 Other Diseases of Circulatory System 9 5 4 ... ... ... ... 2 1 3 3 1 Bronchitis 44 18 26 14 2 1 ... 1 1 3 22 8 Broncho-Pneumonia 15 6 9 8 2 3 ... ... ... ... 2 2 Lobar Pneumonia 2 2 ... ... ... ... ... ... ... 2 ... ... Pneumonia (type not distinguished) 22 12 10 4 4 4 ... 1 2 6 1 1 Other Diseases of Respiratory System 1 1 ... ... ... ... ... ... ... 1 ... ... Ulcer of Stomach 2 1 1 ... ... ... ... ... 1 1 ... ... Diarrhoea 3 2 1 1 1 1 ... ... ... ... ... ... Enteritis 13 7 6 10 2 ... 1 ... ... ... ... 1 Appendicitis and Typhlitis 2 1 1 ... ... ... ... ... 1 ... ... ... Obstruction of Intestines 3 1 2 1 ... ... ... ... ... ... 2 ... Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Liver 3 2 1 ... ... ... ... ... 2 ... 1 1 Other Diseases of Digestive System 9 6 3 6 ... ... ... ... 2 1 ... 1 Nephritis and Bright's Disease 10 7 3 1 ... ... 1 ... 1 5 2 6 Other Diseases of Urinary System 3 3 ... ... ... ... ... ... ... 1 2 1 Diseases of Generative System 1 ... 1 ... ... ... ... ... ... 1 ... ... Puerperal Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 4 ... 4 ... ... ... ... ... 4 ... ... 2 Premature Birth 13 4 9 !3 ... ... ... ... ... ... ... 2 Congenital Debility and Malformation 12 6 6 12 ... ... ... ... ... ... ... ... Other Diseases of Early Infancy 5 3 2 5 ... ... ... ... ... ... ... ... Old Age 33 17 16 ... ... ... ... ... ... ... 33 14 Deaths from Accident 10 7 3 ... ... 1 2 1 3 2 1 4 Deaths from Suicide 5 3 2 ... ... ... ... 1 2 1 ... 2 Other Violent Deaths ... ... ... ... ... ... ... ... ... ... ... ... Other defined Diseases 1 ... 1 1 ... ... ... ... ... ... ... 1 Ill-defined Diseases or unknown 1 ... 1 1 ... ... ... ... ... ... ... ... All causes 403 224 179 89 19 22 18 15 49 81 110 128