WAN 60 Metropolitan Borough of Wandsworth. Annual Report ON THE Health, Sanitary Condition, sc., OF THE BOROUGH, FOR THE YEAR 1913, BY P. CALDWELL SMITH, M.A., M.D., D.P.H., Camb. Medical Officer of Health, TOGETHER WITH THE Report of the Public Analyst. 68678 London: Printed for the Council by FREDERICK TARRANT & COMPANY, LIMITED. 108 & no, Camberwell Road, S.E. iii. PAGE Houses Let in Lodgings 232 Housing, Town Planning, &c., Act, 1909 199 Ice Cream Premises 232 Illegitimate Children, Births of 14 Infant Visiting 116 Infantile Mortality 40, 42 Infantile Mortality from Stated Causes 40 Infantile Mortality, Rate per 1,000 births from five groups of diseases 47 Infective Diseases, Deaths from 49 Infective Diseases, Deaths in External and Internal Institutions 50, 51 Infective Diseases, Death rate from 50, 52 Infective Diseases, Death-rate per 1,000 for Five Years and 1913 167 Infective Diseases, Death-rate per 1,000, 1903-1913 52 Infective Diseases : Number of Cases Notified 38,52 Infective Diseases : Number of Notifications received, 1903-1913 53 Infective Diseases : Number of Cases notified from Elementary Schools 94 Infective Diseases : Number of Cases notified from Public Institutions 57 Infective Diseases : Number of Deaths, 1903-1913 49 Influenza 107 Inspections, details of 203, 204 Institutions, Internal and External 190 Inquests 183 Knacker's Yard 231 Legitimate Birth-rate 14 Margarine Act, Proceedings under 256 Measles 91 Measles and other Non-notifiable Diseases reported from Schools 94 Milk and Cream Regulations, 1912 263 Milk Premises, Cowsheds, &c., on Register 226 Milkshops 228 Mistaken Diagnosis, Cases of 86 Mortuaries 195 Natural Increase, Rate of 13 Nervous System, Diseases of the 179 iv. PAGE Non-Infective Diseases 174 Notification of Births Act 15 Notification of Infective Diseases 52 Offensive Trades 232 Offensive Trade Refuse 233 Old Age 182 Opthalmia Neonatorum 173 Other Infective Diseases 166 Outworkers 239 Overcrowding 216 Police Court Proceedings 223 Polio-Myelitis 167 Polio-Myelitis, Special Report of Medical Officer of Health 168 Population 1 Population of Sub-Districts 2 Population of Wards 2 Premature Birth 182 Public Institutions, Percentage of Deaths to total Deaths, 1892-1912 192 Puerperal Fever 89 Pulmonary Tuberculosis, Deaths and Death-rates, 1903- 1913 124 Pulmonary Tuberculosis, Deaths in Public Institutions, 1903-1913 165 Pulmonary Tuberculosis, Notification of Cases of 131-149 Pulmonary Tuberculosis, previous occupation of persons who died from 125 Putney, House-to-house Inspections in 208 Putney, Table of Causes of Death 309 Rag Flock Act, 1911, Statement of work done under 252 Rated Hereditaments 2 Report of Tuberculosis Officer 152 Respiratory Diseases 180 Return Cases of Scarlet Fever and Diphtheria 81 Revenue Act 199 Sale of Foods and Drugs Acts, Proceedings under 254-257 Sale of Food and Drugs Act, Statement of Work under 253 Sanitary Operations, Table of 202 Sanitary Work, General 195 Scarlet Fever 62 INDEX. PAGE Ages at Death 41 Anthrax Orders 174 Appendicitis and Typhilitis 181 Bacteriological Examinations 88, 166 Bakehouses 236 Births 12 Births and Birth-rates in Sub-Districts 13 Births, Notification of, Act 15 Birth-rate for the Year and for the previous Ten Years 13 Brain and Nervous System, Diseases of the 179 Canal Boats Act 252 Cancer 175 Census, 1911 3 Cerebro-Spinal Fever 88 Circulatory Diseases 179 Clapham, House-to-house Inspections in 206, 207 Clapham: Table of Causes of Death 308 Cleansing of Persons Act 221 Conscientious Objection Certificates granted 58 Cowsheds 228 Cutting-off Notices 194 Death, Ages at 41 Death, Causes of 34,39 Death-rate, Corrected 26 Death-rate, Corrected, for Age and Sex Distribution 28 Death-rate, Infantile 92 Death-rate for all Metropolitan Boroughs 29 Deaths, Corrected and Uncorrected 27 Deaths, Number of 17 Deaths, Percentage of, at six Age Periods 41 Deaths, Proportion of, from the Principal Causes to Total Deaths 193. 194 Deaths in Out-lying Institutions 25, 190 Deaths in Public Institutions 19. 186 Deaths in Public Institutions in the Borough of Persons belonging to the Borough 23 ii. PAGE Deaths in Public Institutions in the Borough of Persons not belonging to the Borough 21 Deaths in Public Institutions, Percentage of, to Total Deaths, 1892-1912 192 Developmental Diseases 182 Diarrhœa 108 Diarrhoea, Death-rate from 108 Diarrhoea and Enteritis, Number of Deaths under One Year for each Quarter of the Year, both for 1913 and Five Years previous 109 Diarrhoea, Method of Feeding Children who died from 112 Diphtheria 70 Diphtheria and Schools 75 Diphtheria, Cases of, and their Relationship to Schools in the Borough 76 Diphtheria, Number of Cases and Deaths, 1903-1913 73 Diphtheria, Number of Dwellings in which multiple Cases occurred 79 Diphtheria, "Return Cases" of 81, 84 Disinfection 220 Disinfection of Schools 106 Enteric Fever 85 Enteric Fever and Shell-fish 86 Erysipelas 90 Exclusion of Children from Schools in the Borough 97-103 Factories and Workshops 233 Factories, Workshops and Workplaces, Inspection of 236 Factories and Workshops, Summary of Work of Female Inspectors 247 Factories and Workshops, Summary of Work of Male Inspectors 243 Feeding of Infants, Report of Female Inspectors on 116 Flies, House 110 Food Places, Inspection of 223 Glanders and Anthrax Orders 174 Home Work 239 House Flies 110 House Refuse, Removal of 225 House-to-house Inspections 206-215 House-to-house Inspections, Summary of 215 Houses and Premises Inspected 202 V. PAGE Scarlet Fever and Schools 64,67 Scarlet Fever, Annual Rate of Notified Cases, 1910- 1913 63 Scarlet Fever, Number of Dwellings in which Multiple Cases occurred 69 Scarlet Fever, "Return Cases" of 81 Schools, Disinfection of, for Infective Diseases 106 Schools, other diseases notified from 106 Shelters 227 Slaughter-houses 229 Small-pox 54 Smoke Nuisances 219 Special Inspections 195 Streatham, House-to-house Inspections in 209, 210 Streatham : Table of Causes of Death 310 Tooting, House-to-house Inspections in 211 Tooting : Table of Causes of Death 311 Tuberculin treatment 164 Tuberculosis Dispensaries 149 Tuberculous Diseases 122 Tuberculosis Office, Report of 152 Underground Rooms 200 Unsound Food 233 Urinals in Connection with Licensed Premises, Inspection of 222 Vaccination Returns 58 Violence, Mortality from 183 Vital Statistics of Whole Borough 33. 37 Wandsworth, House-to-house Inspections in 212, 213, 214 Wandsworth : Table of Causes of Death 312, 313 Water Supply, Cutting-off Notices 194 Whooping Cough 104 Workshops, Summary of Principal Trades carried on 245,251 Zymotic Diseases, Deaths from 49 Zymotic Diseases, Deaths in External and Internal Institutions 50, 51 Zymotic Diseases, Death-rate from 50, 52 Zymotic Diseases, Death-rate per 1,000 for Five Years and 1913 167 Zymotic Diseases, Death-rate per 1,000, 1903-1913 52 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 1913. Population. The population of the Borough to the middle of 1913 has been estimated by the Registrar-General to be 330,395, 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 1913 was only 917, and 960 in 1912, 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 1913, and the population estimated from the same. To this has been added the natural increase, i.e., the difference between the number of births and the number of deaths in 1911-12 and 1912-13. 2 Report of the Medical Officer of Health TABLE I. Ward Census Population, 1911. Rated Hereditaments, 1911. No. of Persons per rated Hereditament, 1911. Rated Hereditaments, 1913. Two Years' Natural Increase, Estimated Population, 1913. Clapham, North 28,871 5,704 5.06 5,836 529 30,109 ,, South 29,721 6,829 4.35 6,919 633 30,861 Putney 28,242 6,119 4.61 6,190 345 28,880 Streatham 49,191 11,756 4.18 12,239 897 52,057 Balham 47,001 10.333 4.55 10,743 859 49,739 Tooting 35,958 7.410 4.85 7,710 1,189 38,582 Southfield 34,600 7.385 4.68 7,546 910 36,125 Fairfield 20,605 4,087 5.04 4,123 439 21,218 Springfield 37,171 7,016 5,30 7,180 923 38,977 Whole Borough 311,360 66,639 4.67 68,516 6,624 326,548 The population estimated from the rated hereditaments is thus 3,847 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 II. Sub-District. Census Population, 1911. Population estimated to middle of 1913. Corrected. Uncorrected. Clapham 58,592 61,200 60,970 Putney 28,242 28,880 28,880 Streatham 96,192 101,285 101,796 Tooting 35,958 36,565 38,582 Wandsworth 92,376 93,410 96,320 Whole Borough 311,360 321,340 326,548 Report of the Medical Officer of Health. 3 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 5,108 from the uncorrected population gives the corrected population, viz.—321,340, compared with 313,961 in the previous year. Tables Nos. III. to VII. have been extracted from the Census Returns published during the year, and are included in this Report as they may prove of some value to those interested in the welfare of the Borough. Table III. shows the general classification of buildings, those used as dwellings and those not so used, as also the number inhabited and non-inhabited. The number of inhabited houses increased from 37,743 in 1901 to 48,432 in 1911, and the number of separate occupiers from 49,731 to 70,155. The number of uninhabited dwellings in 1901 was 2,247, and in 1911. 2,910, and the number building in 1901 was 1179, and in 1911 only 377. 4 Report of the Medical Officer of Health. TABLE III.— CLASSIFICATION OF BUILDINGS. 1901. 1911. Total. Total [cols. 4-11]. Buildings used as Dwellings. Vessels, sheds, vagrants Separate flats, [included in col. 5]. Buildings not used as Dwellings. Ordinary dwelling houses. Blocks of flats. Shops. Hotels Inns & Public Houses. Offices, Warehouses, Workshops, Factories. Institutions. Others. Kind of Building. No. Wandsworth Metropolitan Borough. 2 3 4 5 6 7 8 9 10 11 12 13 14 Places of Worship 154 Number inhabited 37,743 48,432 41,901 2,171 3,525 168 119 187 361 ... 11,626 Government & Municipal Buildings 39 Separate occupiers 49,731 70,155 53,259 11,751 4,222 173 131 200 397 22 11,751 Shops 881 Offices 84 Population 231,922 311,360 233,313 45,795 17,514 1,127 527 11,464 1.536 84 45.795 Warehouses, Workshops, Factories 286 Uninhabited 2,247 2,910 2,460 41 304 1 6 8 90 ... 1,349 Theatres and other places of amusement 22 Being built 1,179 377 339 1 37 ... ... ... ... ... 4 Report of the Medical Officer of Health. 5 Table IV. shows the average number of persons per inhabited building, and of persons per family in 1901 and 1911 in London and the Metropolitan Boroughs. It will be observed that in Wandsworth the average number of persons per inhabited dwelling was in 1901, 6.I4, and in 1911, 6.43, while the average number of persons per family was 4.66 in 1901 and 4.44 in 1911. For all London the average number of persons per inhabited building was 7.93 in 1901, and 7.89 in 1911, while the average number of persons per family was 4.45 in 1901 and 4.37 in 1911. In the various Metropolitan Boroughs the highest average number of persons per inhabited building was 13.15 in Holborn in 1911, and the lowest, 5.60, in Lewisham, followed by 5.73 in Woolwich, and next by Wandsworth, which was 6.43. The average number of persons per family shows very little variation in the different Metropolitan Boroughs. 6 Report of the Medical Officer of Health. TABLE IV. AVERAGE NUMBER OF PERSONS PER INHABITED BUILDING, AND OF PERSONS PER FAMILY, 1901 and 1911; distinguishing for 1911 the average number of persons per family in Ordinary Dwelling Houses. Borough. Average Number of Persons per Inhabited Building. Average Number of Persons per Family. 1901. 1911. 1901. 1911. All Dwellings All Dwellings. Ordinary Dwelling Houses. London 7.93 7.89 4.45 4.37 4.24 Battersea 7.20 6.90 4.33 4.24 4.21 Bermondsey 8.27 8.41 4.50 4.49 4.43 Bethnal Green 9.26 9.39 4.60 4.62 4.50 Camberwell 7.07 7.15 4.55 4.45 4.33 Chelsea 8.55 8.85 4.23 4.17 3.95 Deptford 6.98 6.80 4.48 4.37 4.31 Finsbury 10.93 11.52 4.21 4.14 3.97 Fulham 7.41 7.70 4.27 4.21 4.21 Greenwich 6.73 6.52 4.86 4.64 4.38 Hackney 7.16 7.16 4.49 4.40 4.29 Hammersmith 7.39 7.54 4.35 4.27 4.10 Hampstead 7.26 7.14 4.82 4.59 4.61 Holborn 12.63 13.15 4.31 4.47 4.34 Islington 8.67 8.90 4.23 4.10 3.96 Kensington 7.98 8.05 4.61 4.49 4.41 Lambeth 7.27 7.52 4.26 4.21 4.11 Lewisham 5.60 5.60 4.60 4.35 4.32 Paddington 8.14 8.54 4.28 4.20 4.16 Poplar 7.47 7.70 4.72 4.62 4.51 St. Marylebone 9.85 9.86 4.22 4.15 4.04 St. Pancras 9.92 9.82 4.13 4.12 3.85 Shoreditch 9.31 9.66 4.39 4.49 4.31 South wark 9.88 10.48 4.31 4.32 4.07 Stepney 9.49 9.59 4.89 4.91 4.61 Stoke Newington 6.64 6.78 4.33 4.17 4.11 WANDSWORTH 6.14 6.43 4.66 4.44 4.38 Westminster City 9.96 9.14 4.43 4.45 4.13 Woolwich 6.48 5.73 4.77 4.58 4.27 City of London 6.97 7.06 5.04 4.92 3.82 Report of the Medical Officer of Health. 7 Table V. shows the proportion per 1,000 persons living under various conditions of room occupation. In the County of London, in tenements of less than 10 rooms, 206 per 1,000 persons lived under conditions of less than one person per room, while in Wandsworth this was 362 per 1,000. From one to two persons per room inclusive the number of persons in London was 554 per 1,000, and in Wandsworth 494 per 1,000, while the proportion having more than two persons per room was in London 1,777 per 1,000 and in Wandsworth 62 per 1,000. Compared with the other Metropolitan Boroughs, Wandsworth was second highest having less than one person per room, the highest being Lewisham, from one to two persons per room Wandsworth was ninth, while more than two persons per room Wandsworth was second lowest, Lewisham being lowest. The Table also shows that as far as housing accommodation per person is concerned Wandsworth occupies a most favourable position among the other Metropolitan Boroughs. 8 Report of the Medical Officer of Health. TABLE V. METROPOLITAN BOROUGHS.—Proportion per 1,000 persons living under various conditions of room accommodation. Metropolitan Borough. In tenements of less than 10 rooms. In tenements of ten or more rooms. Less than one person per room. From one to two persons per room inclusive. More than two persons per room. County of London 206 554 177 63 Battersea 234 615 133 18 Bermondsey 114 648 234 4 Bethnal Green 73 592 332 3 Camberwell 245 585 135 35 Chelsea 209 467 149 175 Deptford 251 596 122 31 Finsbury 73 517 399 11 Fulham 230 601 145 24 Greenwich 251 567 121 61 Hackney 241 603 124 32 Hammersmith 250 568 142 40 Hampstead 285 316 71 328 Holborn 133 537 256 74 Islington 174 586 200 40 Kensington 207 363 171 259 Lambeth 251 567 136 46 Lewisham 426 451 40 83 Paddington 191 477 162 170 Poplar 122 666 206 6 St. Marylebone 176 444 207 173 St. Pancras 134 562 254 50 Shoreditch 65 566 365 4 Southwark 99 634 259 8 Stepney 77 567 350 6 Stoke Newington 313 503 88 96 WANDSWORTH 362 494 62 82 Westminster City 184 480 129 207 Woolwich 304 606 63 27 City of London 226 608 124 42 Report of the Medical Officer of Health. 9 Table VI. shows the ages of persons, males and females, at each year of age under 21, and in quinquennial age groups at the Censuses of 1901 and 1911. At all ages there was an increase of 36,962 males, and 52,364 females. Table VII. shows the conditions as to marriage, distinguishing the number of females ages 15-45 in 1901 and 1911 and the Percentage increase. From the Table it will be seen that while the unmarried persons in the Borough increased by 28.5 per cent., the married increased by 43.4 per cent., and the widowed by 36.6 per cent. Again, the rate of increase of unmarried females from 15-45 years was 21.6 per cent., but of married females was 36.7 per cent. 10 Report of the Medical Officer of Health. TABLE VI. Ages of Persons, Males and Females, at each year of age under 21 and in Quinquennial age-groups, in the Metropolitan Borough of Wandsworth. Ages. 1901. 1911. Males. Females. Males. Females. All ages 103,766 128,268 140,728 170,632 Under 1 year 2,729 2,553 3.115 3,100 1 year 2,471 2,397 2,995 2,968 2 years 2,482 2,386 3,174 3.136 3 ,, 2,387 2,392 3,264 3,245 4 ,, 2,345 2,391 3,136 3,090 5 ,, 10,936 11,508 2,946 2,966 6 „ 2,976 3,104 7 ,, 3,011 2,961 8 ,, 2,953 3,009 9 „ 2,731 2,897 10 „ 6,049 6,463 2,740 2,875 11 ,, 2,734 2,810 12 ,, 2,695 2,775 13 ,, 2,007 2,199 2,512 2,657 14 ,, 1,936 2,197 2,440 2,818 15 ,, 1,959 2,341 2,459 2,832 16 „ 1,894 2,526 2,410 2,902 17 ,, 1,868 2,705 2,383 3,034 18 ,, 1,986 2,683 2,311 3,160 19 ,, 1,838 2,742 2,208 3,024 20 „ 1,884 2,853 2,165 3,124 Under 5 years 12,414 12,119 15,684 15,539 5 and under 10 10,936 11,508 14,617 14,937 10 „ 15 9,992 10,859 13,121 13,925 15 „ 20 9,545 12,997 11,771 14,952 20 „ 25 9,498 14,381 11,285 16,217 25 „ 30 9,498 13,179 11,998 16,385 30 ,, 35 8,592 11,271 11,994 15,133 35 .. 40 7,599 9,396 11,331 13,683 40 „ 45 6,537 7,641 9,680 11,534 45 ,, 50 5,177 6,207 8.155 9,637 50 ,, 55 4,164 5,140 6,422 7,620 55 ,, 60 3,190 3,983 4,.830 6,166 60 „ 65 2,601 3,502 3.619 4,963 65 „ 70 1,664 2,399 2,708 3,889 70 „ 75 1,228 1,760 1,875 2,919 75 ,, 80 701 1,095 985 1,753 80 85 317 556 466 865 85 „ 90 88 227 152 402 90 .. 95 23 42 29 89 95 ,, 100 2 5 5 14 100 years and upwords - 1 1 - 11 Report of the Medical Officer of Health. TABLE VII. CONDITION AS TO MARRIAGE OF PERSONS, MALES AND FEMALES, DISTINGUISHING THE NUMBER OF FEMALES AGED 15—45. Unmarried. Married. Widowed. Persons. Males. Females. Females 15-45 Years. Persons. Males. Females. Females 15-45 Years. Persons. Males. Females. Females 15-45 Years. 1901 138,949 60,680 78,269 39,100 80,413 39,763 40,650 28,298 12,672 3,323 9,349 1,467 1911 178,683 79,394 99,289 47,571 115,353 56,933 58,420 38,703 17,324 4,401 12,923 1,630 Percentage increase 28.5 30.8 26.8 21.6 43.4 43.1 43.7 36.7 36.6 35.4 38.2 11.1 12 Report of the Medical Officer of Health. Births. During the 53 weeks ending the 3rd January, 1914, 6,838 births, 3,534 of males and 3,304 of females, were registered, compared with 6,756 in 1912, 6,699 in 1911. and 6,967 in 1910. The total number of births registered in this Borough was 6,679, but 207 births occurred in Institutions outside the Borough of persons belonging to the Borough, and 48 births in Institutions in the Borough of persons not belonging to the Borough, making a corrected total of 6,838. Of the 207 births which were registered outside the Borough, 74 occurred in Clapham Maternity, 23 in the General Lying-in Hospital, 11 in Queen Charlotte's Hospital, 18 in St. Thomas's Hospital, three in City of London Lying-in Hospital, one in Middlesex Hospital, one in the British Lying-in Hospital, 17 in Poor Law Infirmaries, six in private nursing homes, and 53 in other places. In Table VIII. 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. 13 Report of the Medical Officer of Health TABLE VIII. Sub-District. Births. Rates. Males. Females. Total. Birth-Rate. Rate of natural increase. Clapham 669 621 1,290 20.66 9.67 Putney 270 223 493 16.74 6.05 Streatham 917 948 1,865 18.06 7.69 Tooting.. 556 481 1,037 27.82 17.39 Wandsworth 1,122 1,031 2,153 22.61 9.84 Whole Borough 3,534 3,304 6,838 20,87 9.92 Table IX. 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 IX. Year. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. London. England and Wales. 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 34.05 27.18 24.04 25.75 25.8 1910 21.61 17.194 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 1912 20.62 17.08 18.88 27.12 24.07 21.53 24.7 23.8 Average for 10 yrs. 24.18 19.38 20.89 34.97 28.54 24.98 26.72 26.32 1913 20.66 16.74 18.06 27.82 22'.61 20.87 24.8 23.9 14 Report of the Medical Officer of Health. The rate for the whole Borough is the lowest yet recorded, being .66 under the rate for the previous year, and 4.11 under the decennial average. Compared with 1912 the rate in the several sub-districts show a decrease in all with the exception of Clapham and Tooting, where there has been an increase of .04 and .70 per 1,000. Compared with the decennial average there has been a decrease in all the subdistricts, and this is exceptionally large in Tooting where the reduction has been from 34.97 to 27.82 per 1,000. The birth-rate for the whole of London was 24.8 per 1,000, compared with 247 in 1912, and 2672 the decennial average ; while for England and Wales the rate was 23.9 per 1,000, compared with 23.80 in 1912, and 26.32 the decennial average. 124 births occurred in the Workhouse, and of these five belonged to Clapham, 10 to Putney, 24 to Streatham, 12 to Tooting, 25 to Wandsworth, 33 to Battersea, and 15 to other places. Of these 124 births, 92 were illegitimate, four belonging to Clapham, nine to Putney, 23 to Streatham, seven to Tooting, 13 to Wandsworth, 21 to Battersea, and 15 to other places. In the Borough, excluding the Workhouse, 162 illegitimate births occurred, 21 in Clapham, 11 in Putney, 50 in Streatham, 29 in Tooting, and 51 in Wandsworth. Of the births registered outside the Borough, 65, 36 of males and 29 of females, were illegitimate. The total number of illegitimate births was 283, 41 of which belonged to Clapham, 27 to Putney, 85 to Streatham, 43 to Tooting, and 87 to Wandsworth, compared with 223 in 1912, 180 in 1911, and 185 in 1910. The percentage of illegitimate births to total births was 4.13, compared with 3.30 in 1912, 2.68 in 1911, and 2.65 in 1910, and 3.8 for the whole of London for 1911. 15 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. 1910 1911 1912 1913 Clapham 2. 46 2.60 3.71 3.17 Putney 3.05 3.32 3.27 5.47 Streatham 2.87 2.15 2.59 4.55 Tooting 2.60 3.20 3.40 4.14 Wandsworth 2.51 2.81 3.17 4.04 Whole Borough 2.65 268 3.30 4.13 Notification of Births Act. During the year 4,738 births were notified, 928 from Clapham, 335 from Putney, 1,003 from Streatham, 569 from Tooting, and 1,903 from Wandsworth. 140 births were notified from the Workhouse, of which 89 belonged to this Borough, and 51 to other places. Of the 89 which belonged to this Borough, the home addresses of seven were in Clapham, of 12 in Putney, of 25 in Streatham, of 14 in Tooting, and of 31 in Wandsworth. The following Table shows the number of births notified in each sub-district and in the whole Borough, the persons by whom notified and whether the children were born alive or dead. 16 Report of the Medical Officer of Health. TABLE X. Sub-district. Total No. of births notified. Notified by: No. born alive. No. born dead. Medical Attendant Parent. Midwife. Other person. Clapham 928 491 203 221 13 905 23 Putney 335 112 35 182 6 333 2 Streatham 1,003 389 283 314 17 978 25 Tooting 569 134 98 330 7 561 8 Wandsworth 1,903 413 580 871 39 1,851 52 Whole Borough 4.738 1,539 1,199 1,818 82 4,628 110 The next Table shows these births compared with the total births registered in each sub-district and in the whole Borough. TABLE XI. Sub district. No. of births notified. Still-births. Births less still-births. Births registered. Excess of registered over notified births. Clapham 928 23 905 1,221 316 Putney 335 2 333 472 139 Streatham 1,003 25 978 1,783 805 Tooting 569 8 561 1,002 441 Wandsworth 1,903 52 1,851 2,201 350 Whole Borough 4,738 110 4,628 6,679 2,051 The percentage of births notified, less still-births, to those registered was 69.3, while 30.7 per cent. were not notified, compared with 69.8 and 30.2 in 1912, showing a decrease of .5 per cent. Report of the Medical Officer of Health. 17 In the sub-districts these percentages were:—In Clapham 76.0 and 24.0, compared with 76.6 and 23.4 in 1912; in Putney 70.9 and 29.0 compared with 66.9 and 33.1 ; in Streatham 56.2 and 43.7, compared with 57.6 and 42.4; in Tooting 567 and 43.2 compared with 58.2 and 41.8; and in Wandsworth 86.5 and 13.5, compared with 81.2 and 18.8. An increase has taken place in Putney and Wandsworth, but a decrease in Clapham, Streatham and Tooting. The proportion of still-births to total births notified was 2.3 per cent., compared with 2.2 per cent. in 1912, and with 2.3 per cent., the mean for the whole of London for the year 1912. 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 53 weeks ending the 3rd January, 1914, 3,344 deaths, 1,612 of males and 1,732 of females were registered, compared with 3,118 in 1912, 3,456 in 1911, and 2,856 in 1910. Compared with 1912 there has been an increase of 226 deaths, but a decrease of 480 compared with the decennial average corrected for increase of population. A still larger decrease in the number of deaths has occurred if the number of deaths be corrected for the additional week included in 1913. The total number of deaths after this correction was 162 more than in 1912, but 544 less than the corrected decennial average. It is important to note that all the rates per 1,000 population for the year 1913 have been reduced by the fraction so as to compared more exactly with the rates in previous years. 18 Report of the Medical Officer of Health. The uncorrected death-rate for the Borough was 10.04 per 1,000, compared with 978 in 1912, 11.02 in 1911, and 8.16 in 1910. The average uncorrected rate for the decennium 1903-1912 was 11.59 or 1.55 above the rate for the year 1913. In the sub-districts these rates were as follows :-8.72 in Clapham, 8.82 in Putney, 7.88 in Streatham, 21.86 in Tooting, and 8.80 in Wandsworth. The reason for the high rate in Tooting is that in that subdistrict there are a number of Public Institutions, as the Tooting Bec 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 53 weeks, corrected for both internal and external Institutions and other places was 3,588, compared with 3,291 in 1912, 3,776 in 1911, 3,105 in 1910, and 3,884, the decennial average corrected for increase of population. During the year 863 deaths occurred in Public Institutions and 171 in other places in the Borough. Of the total of 1,034 deaths, 822 were of persons not belonging and 212 of persons belonging to the Borough. Report of the Medical Officer of Health. 19 Table XII. shows the total number of Institution deaths arranged according to sub-districts and Institutions in which they occurred, Table XIII. the deaths of persons not belonging to the Borough, and Table XIV. the deaths of persons belonging thereto arranged according to causes of death, sex and age, and Institution in which the death occurred. TABLE XII. Name of Public Institution. Clapham. Putney. Streatham Tooting. Wands'th. Total. Hostel of God 62 ... ... ... ... 62 St. Anne's Home ... ... 7 ... ... 7 Middlesex County Asylum ... ... 8 ... 109 117 Metropolitan Asylums Board's Fever Hospital ... ... ... 126 ... 126 Fountain Asylum ... ... ... 33 ... 33 Tooting Home ... ... ... 104 ... 104 H. M. Prison ... ... ... ... 5 5 Workhouse ... ... ... ... 8 8 Royal Hospital for Incurables ... ... ... ... 17 17 Tooting Bee Asylum ... ... ... 336 ... 336 The Priory ... 2 ... ... ... 2 Home for Aged Jews ... ... 15 ... ... 15 Putney Hospital ... 31 ... ... ... 31 TOTAL 62 33 30 599 139 863 Other places 49 29 65 12 16 171 GRAND TOTAL 111 62 95 611 155 1,034 Compared with the year 1912 there has been an increase of 27 in the deaths in Institutions, and of 49 in other places, or a total increase of 76. B 2 20 Report of the Medical Officer of Health. Table XIII. shows the deaths in Public Institutions in the Borough of persons not belonging thereto, and Table XIV. the number of deaths in Public Institutions in the Borough of persons belonging thereto, arranged as to ages, causes of death, and Institution in which the death occurred. 21 Report of the Medical Officer of Health. TABLE XIII. Deaths in Public Institutions, &c., in the Borough of Persons not belonging to the Borough, 1913. CAUSES OF DEATH. Deaths in or belonging to whole District at subjoined ages. Institutions. 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 Bec Asylum. Hostel of God. Tooting Home. Fever Hospital. Workhouse. H.M. Prison. Ryl. Hosp. for Incurables. St. Anne's Home. The Priory. Home for aged Jews Putney Hospital. Fountain Temporary Asylum. Newlands House. Other Places —rot Institutions. Enteric Fever 2 ... 2 ... ... ... ... ... 2 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 22 8 14 6 14 1 1 ... ... ... ... ... ... ... ... 21 ... ... ... ... ... ... ... ... ... ... Scarlet Fever 10 8 2 ... 2 4 2 1 1 ... ... ... ... ... ... 10 ... ... ... ... ... ... ... ... ... ... Whooping Cough 20 8 12 10 4 6 ... ... ... ... ... ... ... ... ... 20 ... ... ... ... ... ... ... ... ... ... Diphtheria, and Membranous Croup 22 13 9 1 3 11 7 ... ... ... ... ... ... ... ... 22 ... ... ... ... ... ... ... ... ... ... Influenza 9 1 8 ... ... ... ... 1 ... 2 6 ... 1 1 ... ... ... ... 4 ... ... ... ... ... ... 3 Erysipelas 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 78 40 38 ... 1 ... 5 11 29 2 8 15 10 22 18 1 ... 1 1 ... ... ... ... 5 ... 5 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Other Tuberculous Diseases 8 7 1 ... ... 1 5 1 ... ... ... ... 4 ... ... ... ... ... ... ... ... ... ... 3 ... 1 Other Infective Diseases 4 3 1 1 ... ... 2 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 3 ... ... Cancer, Malignant Disease 54 21 33 ... ... ... ... 1 5 27 21 3 6 26 2 ... ... ... ... ... ... 2 ... ... ... 15 Rheumatic Fever 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Diabetes 4 2 2 ... ... ... ... ... 1 2 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 2 Other General Diseases 8 1 7 ... ... 1 ... ... ... 3 4 1 ... ... ... ... ... ... 4 ... ... 1 1 ... 1 ... Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Hæmorrhage, Apoplexy 17 11 6 ... ... ... ... ... 3 5 9 ... 5 ... 4 ... 1 ... ... ... ... ... ... ... ... 7 Convulsions 4 3 1 3 ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 3 Other Diseases of Nervous System 72 44 28 ... ... ... 6 4 28 28 6 46 6 1 ... ... ... ... 5 ... 1 2 ... 6 ... 5 Organic Diseases of Heart 59 30 29 ... ...... ... ... ... 3 16 40 5 38 ... ... ... ... ... ... 2 ... 6 1 ... ... 7 Other Diseases of Circulatory System 13 8 5 ... ... ... 2 ... ... 4 7 ... 3 1 2 ... ... ... ... ... 1 ... ... 1 1 4 Bronchitis 31 16 15 1 ... ... ... ... 1 7 22 14 3 2 3 1 ... ... ... 1 ... 2 ... ... ... 5 Broncho- Pneumonia 17 8 9 ... 1 2 1 1 ... 7 5 3 9 ... ... 1 ... ... ... ... ... ... ... 2 ... 2 Lobar Pneumonia 9 5 4 1 1 ... 1 ... 1 1 4 1 2 ... ... 3 ... ... ... ... ... ... ... 1 ... 2 Pneumonia (type not distinguished) 51 38 13 ... ... 1 1 3 5 17 24 ... 39 ... ... ... ... ... ... 2 ... ... ... 3 ... 7 Other Diseases of Respiratory System 8 3 5 ... ... ... 1 ... ... 5 2 2 3 ... ... 1 ... ... ...1 ... ... ... ... ... ... 1 Ulcer of Stomach 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Diarrhœa 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Enteritis 5 3 2 1 ... 1 1 1 1 ... ... 1 ... ... ... 2 ... ... ... ... ... ... ... 1 ... 1 Appendicitis and Typhlitis 3 1 2 ... ... ... 1 ... ... ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Obstruction of Intestines 5 3 2 ... ... ... ... ... ... 3 2 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 2 Cirrhosis of Liver 2 1 1 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ...... ... ... ... ... ... ... 3 Other Diseases of Liver 2 1 1 ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Digestive System 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Nephritis and Bright's Disease 17 10 7 ... ... ... ... ... ... 10 7 4 6 ... ... ... ... ... ... ... ... ... 2 ... ... 5 Other diseases of Urinary System 4 4 ... ... ... ... ... ... ... 1 3 1 ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... Diseases of Generative System 2 ... 2 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... Congenital Debility and Malformation 10 6 4 2 ... ... 7 1 ... ... ... ... 4 ... ... ... 1 ... ... ... ... ... 1 4 ... ... Other Diseases of Early fancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Old Age 215 100 115 ... ... ... ... ... ... 7 208 10 189 ... 11 ... 1 ... ... 1 ... 1 ... ... ... 2 Deaths from Accident 17 15 2 ... ... ... 4 2 4 4 3 1 ... ... ... ... ... ... ... ... ... ... 3 ... ... 13 Death from Suicide 11 10 1 ... ... ... ... 3 3 4 1 ... ... ... ... ... ... 1 ... ... ... ... 2 ... ... 8 Other Violent Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other defined Diseases 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 All-defined Diseases or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... All causes 822 436 386 28 26 28 50 31 90 181 388 111 331 53 41 83 4 2 16 7 2 15 13 31 2 111 22 Report of the Medical Officer of Health. The total number of deaths shown on Table XIV. is 212, 118 of males and 94 of females, compared with 191 in 1912, 181 in 1911, and 159 in 1910. 43 of the deaths occurred in the Fever Hospital, compared with 39 in 1912; 63 in Tooting Home, compared with 67; nine in the Hostel of God, compared with six; four in the Workhouse, compared with six; five in the Tooting Bec Asylum, compared with seven ; one in the Royal Hospital for Incurables; 18 in Putney Hospital compared with 11; and 69 in other places compared with 53. These deaths are allocated to their proper sub-districts in Table XX. The number of deaths in Table XIII., viz.:—822, and that in Table XIV., viz.:—212, made up the total of 1,034, the total number of deaths in Public Institutions and other places in the Borough as shown in the last columns of Tables XX., and XXIII., and in column eight of Table XXI. 23 Report of the Medical Officer of Health. TABLE XIV. Deaths in Public Institutions, &c., in the Borough of Persons belonging to the Borough, 1913. Causes of death Deaths in or belonging to whole District at subjoined ages. Institutions. 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. Fever Hospital. Tooting Home. Hostel of God. Workhouse. Tooting Bec Asylum. H.M. Prison. Royal Hospital for Incurables Putney Hospital. Fountain Temporary Asylum. Middlesex Asylum. Other Places—not Institutions. Enteric Fever 1 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 13 5 8 ... 4 8 1 ... ... ... ... 13 ... ... ... ... ... ... ... ... ... ... Scarlet Fever 8 7 1 1 3 2 1 ... 1 ... ... 8 ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria, Membranous Croup 14 5 9 1 3 4 6 ... ... ... ... 13 ... ... ... ... ... ... 1 ... ... ... Influenza 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases 1 1 ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 43 31 12 ... ... ... 3 17 22 1 ... 40 ... ... ... ... ... ... ... ... 3 Tuberculous Meningitis 2 1 1 ... ... 2 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Infective Diseases 2 1 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... ... 1 Cancer, Malignant Disease 22 10 12 ... ... ... 1 ... 3 10 8 1 2 8 ... ... 1 ... 1 ... ... 9 Rheumatic Fever 1 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Diabetes 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... Other General Diseases 3 1 2 ... ... 1 ... 1 ... ... 1 ... ... ... ... ... ... ... 2 ... ... 1 Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 1 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... Cerebral Hæmorrhage, Apoplexy 6 2 4 ... ... ... 1 ... 1 2 2 ... 1 ... ... ... ... ... ... ... ... 5 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Nervous System 5 5 ... ... ... ... ... 1 ... 1 3 ... ... ... ... ... 2 1 1 ... ... 1 Organic Diseases of Heart 12 5 7 ... ... ... ... ... 1 2 9 ... 3 ... 1 1 ... ... ... ... ... 7 Other Diseases of Circulatory System 6 3 3 ... ... 1 ... ... 2 1 2 2 2 ... ... ... ... ... 1 ... ... 1 Bronchitis 6 2 4 ... ... 1 ... ... ... ... 5 ... 3 ... ... ... ... ... ... ... ... 3 Broncho-Pneumonia 3 ... 3 ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Lobar Pneumonia 2 1 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... ... Pneumonia (type not distinguished) 4 2 2 ... ... ... ... ... ... 2 2 ... ... ... ... ... ... ... ... ... 1 3 Other Diseases of Respiratory System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ulcer of Stomach ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteritis 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... Appendicitis and Typhlitis 3 3 ... ... ... ... 1 ... 1 1 ... ... ... 1 ... ... ... ... 1 ... ... 2 Obstruction of intestines 4 3 1 ... ... ... ... ... ... 3 1 ... ... ... ... ... ... ... 1 ... ... 3 Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Digestive System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis and Bright's Disease 2 1 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... Other Diseases of Urinary System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Generative System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Premature Birth 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Congenital Debility and Malformation 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Other Diseases of Early Infancy 4 ... 4 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Old Age 18 9 9 ... ... ... ... ... ... ... 18 ... 12 ... 1 4 ... ... ... ... ... 1 Death from Accident 15 9 6 1 ... 1 2 1 4 5 1 1 ... ... ... ... ... ... 5 ... ... 9 Deaths from Suicide 2 1 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 1 1 Other Violent Deaths 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Other defined Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Diseases or known 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... All causes 212 118 94 11 11 22 15 9 35 55 54 43 63 9 4 5 3 1 18 2 6 58 24 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 XC. 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 Bec Asylum, and the Royal Hospital for Incurables. 25 Report of the Medical Officer of Health TABLE XV. Deaths in Public Institutions, &c., outside the Borough of Persons belonging to the Borough, 1913. 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 Asylums. Metropolitan Asylums Board's Hospitals. Enteric Fever 3 2 1 ... ... ... ... ... 1 2 ... ... ... ... ... 3 ... ... 1 2 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 32 14 8 7 14 9 2 ... ... ... ... 2 5 6 5 14 10 2 1 19 Scarlet Fever 2 ... 2 ... 1 ... 1 ... ... ... ... ... ... 2 ... ... ... ... ... 2 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Membranous Croup 2 1 1 ... ... 1 1 ... ... ... ... 1 ... 1 ... ... ... ... ... 2 Influenza 4 2 2 ... ... ... ... ... 3 ... 1 1 1 2 ... ... 1 2 1 ... Erysipelas 2 1 1 ... ... ... ... ... ... 1 1 ... ... ... 1 1 2 ... ... ... Cerebro-spinal Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 80 52 37 ... ... 3 6 15 36 24 5 19 2 21 9 37 45 31 11 2 Tuberculous Meningitis 18 10 8 ... 3 7 7 1 ... ... ... 3 3 2 1 9 8 10 ... ... Abdominal Tuberculosis 6 3 3 ... 1 1 3 ... ... 1 ... ... ... ... 1 5 2 4 ... ... Other Tuberculous Diseases 14 8 6 ... 2 1 4 3 ... 4 ... 5 ... 2 2 5 5 8 ... ... Other Infective Diseases 16 11 5 6 ... 2 2 ... 2 4 ... 2 ... 5 4 7 12 4 ... ... Cancer, Malignant Disease 115 54 61 ... ... ... 1 1 17 51 45 52 11 33 12 37 47 68 ... ... Rheumatic Fever 3 2 1 ... ... ... 1 ... 2 ... ... 1 ... 1 ... 1 2 1 ... ... Diabetes 6 3 2 ... ... ... ... ... ... 4 2 1 ... 4 ... 1 1 4 1 ... Other General Diseases 10 6 4 2 ... ... 2 2 ... 4 ... 3 1 3 1 2 2 8 ... ... Alcoholism 10 4 6 ... ... ... ... ... 3 6 1 2 1 2 1 4 8 2 ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 4 2 2 1 ... ... ... ... 1 2 ... ... ... 3 ... 1 ... 2 2 ... Cerebral Hæmorrhage, Apoplexy 40 28 12 ... ... ... ... ... 2 12 26 5 2 20 2 11 20 14 6 ... Convulsions 4 3 1 3 ... ... ... ... 1 ... ... ... 1 ... ... 3 ... 4 ... ... Other Diseases of Nervous System 67 42 25 1 1 2 1 4 26 22 10 8 7 25 11 16 16 16 35 ... Organic Diseases of' Heart 74 30 44 ... ... ... 5 4 24 22 19 17 1 16 8 32 39 20 14 1 Other diseases of Circulatory System 37 15 22 ... ... ... 2 4 10 13 8 4 3 11 3 16 18 13 6 ... Bronchitis 27 15 12 4 2 1 ... ... 2 5 13 2 7 9 2 7 22 5 ... ... Broncho-Pneumonia 39 15 24 9 5 3 ... ... 6 8 8 11 4 15 1 8 19 13 7 ... Lobar Pneumonia 18 5 13 1 1 4 1 ... 3 7 1 5 1 4 1 7 8 2 8 ... Pneumonia (type not distinguished) 36 22 14 ... 1 2 2 1 10 13 7 11 3 4 4 14 27 8 1 ... Other Diseases of Respiratory System 3 1 2 ... ... ... ... ... 2 ... 1 2 ... 1 ... ... 1 1 1 ... Ulcer of Stomach 12 6 6 ... ... ... ... ... 7 4 1 4 1 4 2 1 1 11 ... ... Diarrhœa 21 9 12 16 3 ... ... ... ... 2 ... 3 1 7 4 6 4 16 1 ... Enteritis 62 30 26 49 5 1 1 ... 1 2 ... 7 9 9 15 22 53 8 1 ... Appendicitis and Typhlitis 19 10 9 ... ... 1 7 5 1 4 1 5 2 7 1 4 2 17 ... ... Obstruction of Intestines 16 3 13 2 ... ... 1 ... 4 9 ... ... 2 4 1 6 3 13 ... ... Cirrhosis of Liver 7 5 2 ... ... ... ... ... 1 6 ... 2 ... 2 ... 3 6 1 ... ... Other Diseases of Liver 5 3 2 ... ... ... ... ... ... 4 1 3 ... 1 ... 1 1 3 1 ... Other Diseases of Digestive System 19 13 6 2 ... ... 2 ... 8 6 1 6 ... 4 3 6 6 12 1 ... Nephritis and Bright's Disease 32 21 11 ... ... ... ... 1 4 4 13 12 1 7 3 9 18 10 4 ... Other Diseases of Urinary System 9 7 2 ... ... ... ... ... 2 4 ... 1 2 2 ... 4 3 6 ... ... Diseases of Generative System 5 ... 5 ... ... ... ... 1 2 2 ... 1 ... 2 ... 2 1 4 ... ... Puerperal Fever 9 ... 9 ... ... ... ... 2 7 ... ... 2 1 3 1 2 2 3 ... 4 Other Accidents and Diseases of Pregnancy and Childbirth 4 ... 4 ... ... ... ... ... 4 ... ... 1 2 ... ... 1 1 3 ... ... Premature Birth 7 5 2 7 ... ... ... ... ... ... ... 2 ... 1 ... 4 3 4 ... ... Congenital Debility and Malformation 21 14 7 19 2 ... ... ... ... ... ... 4 2 5 5 5 5 15 ... 1 Other Diseases of Early Infancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Old Age 63 24 39 ... ... ... ... ... ... ... 63 18 4 20 8 13 55 6 2 ... Death from Accident 47 31 16 1 1 2 7 4 71 13 2 16 3 16 4 8 12 35 ... ... Deaths from Suicide 17 9 8 ... ... ... ... 1 6 8 2 3 2 7 2 3 2 15 ... ... Other Violent Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other defined Diseases 9 6 3 1 ... ... 2 1 ... ... 5 1 2 3 ... 3 7 1 ... 1 Ill-defined Diseases or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... All causes 1066 553 513 131 45 40 61 50 206 283 250 221 88 295 118 344 500 425 105 36 26 Report of the Medical Officer of Health. The total number of deaths in out-lying Institutions was 1,066, 553 of males and 513 of females, compared with 940 in 1912, 989 in 1911, and 812 in 1910. 500 of these deaths occurred in Workhouses and Workhouse Infirmaries, compared with 437 in 1912; 425 in General and Special Hospitals, compared with 393 in 1912; 105 in Public Lunatic or Imbecile Asylums, compared with 89 in 1912; and 36 in the Metropolitan Asylums Board's Hospitals, compared with 21 in 1912. The hospitals, asylums, etc., in which these deaths occurred are shown in detail on Table XC., on page 190. 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 3,588, 1,729 of males, and 1,859 of females, an increase of 297 compared with 1912, but a decrease of 296 compared with the corrected decennial average. The corrected death-rate for the year was 10.95 compared with 10.48 in 1912, 12.25 in 1911, 10.34 in 1910, and 12.09 the rate for the 10 years 1903-1912. Table XVI. 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 14.2 per 1,000, compared with 13.96 in 1912, 15.8 in 1911, 13.65 in 1910, and 15.09 the decennial average. 27 Report of the Medical Officer of Health. TABLE XVI. Sub-Districts. Corrected Deaths. Uncorrected Deaths. Corrected Death-rate. Uncorrected Death-rate. Males. Females. Total. Males. Females. Total. Clapham 351 335 686 265 278 543 10.99 8.72 Putney 160 155 315 137 126 263 10.69 8.83 Streatham 470 602 1,072 348 466 814 10.37 7.88 Tooting 199 190 389 463 397 860 10.43 21.86 Wandsworth 559 577 1,126 399 465 864 12.77 8.80 Whole Borough 1.729 1,859 3,588 1,612 1,732 3,344 10.95 10.04 28 Report of the Medical Officer of Health. The death-rate in England and Wales in 1913 was 13.7 per 1,000, compared with 13.3 in 1912, 14.6 in 1911, and 13.4 in 1910; in the 96 Great Towns 14.3, compared with 13.8 in 1912, 16.4 in 1911, and 14.3 in 1910; and in the 145 Smaller Towns 12.8, compared with 12.4, 14.4, and 12.9. If a comparison is to be made with other places it is necessary to again correct the corrected rate, viz.:—10.95, for age and sex distribution. This is done by multiplying the race by a factor obtained by dividing the standard death-rate in England and Wales at the Census of 1911, with the standard death-rate for the Borough at the same period. This factor has been ascertained to be 1.0045 which gives a rate for this Borough for the year 1913 of 10.99 Per 1,000, compared with 11.03 in 1912, 12.92 in 1911, and 10.90 in 1910. The following Table shows 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 1913. 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. 29. Report of the Medical Officer of Health. TABLE XVII. AREA. Factor for Correction. for age & sex distribution. Crude Death-rate. Standardised Death-rate. Comparative Mortality Figure. (England and Wales, 1,000.) England and Wales .9790 13.7 13.4 1,000 London 1.0000 14.2 14.2 1,059 Lewisham .9826 10.6 10.4 776 WANDSWORTH 1.0045 10.9 10.9 813 Hampstead 1.0572 11.7 11.3 843 Fulham 1.0340 12.5 12.9 962 Stoke Newington .9512 13.6 12.9 962 Woolwich 1.0249 12.6 13.0 970 Chelsea .9513 13.9 13.2 985 Westminster 1.0540 12.7 13.3 992 Paddington .9941 13.4 13.4 1,000 Hackney 1.0066 13.4 13.5 1,007 Camberwell .9883 13.7 13.6 1,014 Kensington .9957 13.7 13.6 1,014 Hammersmith .9884 13.9 13.8 1,029 Battersea 1.0098 13.9 14.0 1,044 Greenwich .9837 14.2 14.0 1,044 Lambeth .9804 14.3 14.0 1,044 St. Marylebone 1.0198 14.0 14.3 1,067 Holborn 1.0034 14.6 147 1,097 Islington .9749 15.1 14.8 1,104 Deptford .9879 15.3 15.2 1,134 St. Pancras .9471 15.2 15.2 1,134 Stepney 1.0433 149 15.6 1,164 City of London 1.0419 15.2 15.8 1,179 Bethnal Green 1.0397 15.4 l6.1 1,201 Poplar .9898 16.3 16.1 1,201 Southwark 1.0060 17.4 17.6 1,313 Bermondsey .9976 17.9 17.8 1,328 Finsbury .9887 18.3 18.1 1,350 Shoreditch 1.0331 18.6 19.2 1,432 30 Report of the Medical Officer of Health. In the separate sub-districts of the Borough the corrected death-rate was 10.37 in Streatham, 10.43 in Tooting, 10.69 in Putney, 10.99 in Clapham, and 12.77 in Wandsworth. The rates in all the sub-districts were higher than in 1912, with the exception of Clapham which was lower, and was due to causes which will be commented on in another part of this Report. Table XVIII. 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 and in London was in 1910, while it was lowest in England and Wales in the year 1912. The rate in 1913, although higher than in 1910 and 1912 is in all the sub-districts considerably lower than the average of the previous 10 years. Compared with London and with England and Wales the Borough rate is considerably lower. 31 Report of the Medical Officer of Health. TABLE XVlll. Clapham. Putney. Streatham. Tooting. Wandsworth. While Borough. London. England and Wales. 1903 12.87 11.91 11.26 12.88 13.81 12.54 15.38 15.10 1901 14.51 12.75 11.25 16.28 14.75 13.56 16.44 16.31 1905 12.60 11.75 10.89 16.56 14.28 12.81 15.54 15.28 1906 13.70 11.99 10.86 15.90 14.18 12.98 15.71 15.46 1907 12.62 11.06 10.76 15.49 13.44 1 2.09 15.29 15.10 1908 12.75 11.41 l0.43 13.62 12.72 11.97 14.87 14.83 1909 1.325 11.80 10.48 13.51 12.71 12.11 14.94 14.61 1910 10.73 10.17 9.50 10.67 11.01 10.38 13.65 13.19 1911 13.5 11.83 11.02 11.73 13.29 12.25 15.8 14.6 1912 11.61| 983 9.42 10.20 1 1. 18 10.48 13.96 13.3 Average, 1903-1912 12.78 11.51 10.28 13.51 13.14 12.'11 15.15 14.81 1913 10.99 10.69 l0.37 10.43 12.77 10.95 142 13.7 32 Report of the Medical Officer of Health. The first Chart shows the death-rate in the Borough for each fortnight, compared with the quinquennial average 1908-1912. The Chart shows that on eight fortnights the rate was above that for the previous quinquennium, viz.:—on the fortnights ending the 18th January, 1st and 15th March, 26th April, 6th and 20th September, 22nd November, and 3rd January, 1914. During the rest of the year the fortnightly rate was under the quinquennial rate. The highest rate, viz.—15.44, occurred during the fortnight ending the 1st March and this was due to the great number of deaths from Respiratory diseases and Measles; and the lowest rate during the fortnight ending the 16th August, when it was 7.28 per 1,000. The next Chart shows the Annual Death-rate per 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 week ending the 3rd January, 1914, and the lowest in the first week of August. Table XIX. 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 1913. Compared with the decennial average there has been a considerable decrease in the birth ate, and a marked decrease in the death-rate, while the infantile. tality also shows a most satisfactory decrease, although this latter is not so low as it was in 1910 and 1912. It will also be seen that there has been an increase of 287 deaths of residents outside the Borough, compared with the 10 years' average. The corrected death-rate, although somewhat higher than it was in 1910 and 1912, is much under the 10 years' average. 33 Report of the Medical Officer of Health. TABLE XIX. Vital Statistics of whole District during 1913 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 1 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 11 12 13 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 3,380 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 1912 313,761 6,756 21.53 3,118 9.78 958 767 940 516 76 3,291 10,48 Averages for years 1903—1912 279,056 6,937 24.93 3,236 11.59 776 619 779 721 103 3,375 12.09 1913. 321,340 6,838 20.87 3,344 10.04 1,034 822 1,060 605 88 3,588 10.95 * All the rates per 1,000 of population have been multiplied by the fraction 364/371 so as to compare with previous years. 34 Report of the Medical Officer of Health. TABLE XX. Causes of, and Ages at Death, during the year 1913. CAUSES OF DEATH. 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. | 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. j 45 and under 65. | 65 and upwards. j Clapham. Putney. j Streatham. Tooting. Wandsworth. Enteric Fever ... 5 3 2 1 3 5 3 Small-pox Measles 116 57 59 23 43 32 17 1 *9 12 22 26 37 35 Scarlet Fever ... 11 8 3 1 4 2 3 1 5 2 4 18 Whooping Cough 23 9 14 12 8 2 I 3 4 5 2 9 20 Diphtnena, and Membranous Croup 18 7 11 1 3 7 7 3 1 5 5 4 156 Influenza 59 26 33 2 1 2 10 19 25 12 5 21 2 19 10 Erysipelas 6 5 1 1 2 2 1 2 2 1 I 1 Cerebro-spinal Fever 1 1 ..j 1 ... 1 Other Epidemic Diseases j 1 1 1 1 Pulmonary Tuberculosis 28c 161 128 1 5 *8 45 121 95 14 "58 16 78 26 III 124 Tuberculous Meningitis 34 20 14 3 "8 13 9 1 5 6 4 7 12 Abdominal Tuberculosis... 9 5 4 1 1 3 1 1 2 1 1 1 ft 2 Other Tuberculous Diseases ... 23 M 9 1 3 1 6 5 5 2 8 j 4 3 7 8 Other Infective Diseases 21 13 8 8 2 2 1 3 4 1 2 1 4 5 9 6 Cancer,Malignant Disease 352 141 211 3 1 39 158 J5i 64 38 121 25 104 76 Rheumatic Fever 15 8 7 1 2 2 5 5 1 6 1 7 2 Diabetes 4C T9 21 1 1 5 20 13 9 4 14 3 10 5 Other General Diseases... 42 18 24 4 1 3 5 3 10 16 IC *5 3 11 11 Alcoholism 6 8 7 1 2 1 4 6 Chronic Poisonings Meningitis Cerebral Haemorrhage, 2' 13 8 7 4 2 1 3 3 1 2 9 5 5 1 Apoplexy ... 179 81 98 a 1 10 57 109 32 16 72 13 46 23 Convulsions ... 3« 16 15 26 3 1 1 4 3 11 3 10 Other Diseases of Nervous System 133 75 58 2 3 5 t 7 3i 40 44 *9 15 47 15 37 76 Organic Diseases of Heart 296 120 176 10 9 48 16 102 127 66 12 94 37 ?.o 94 7° Other Diseases of Circulatory System "5 52 63 1 1 5 5 34 53 22 11 8 37 10 Bronchitis 267 127 140 46 9 4 2 10 44 l5* 50 26 75 34 82 37 20 Broncho-Pneumonia 132 62 7C 5i 19 15 2 11 12 22 3* 18 35 7 41 Lobar Pneumonia 4i 23 18 4 4 4 2 1 7 16 3 b 4 14 3 14 12 Pneumonia (type not distinguished) 147 75 72 20 7 10 6 5 38 39 32 30 8 4i 19 3 49 54 Other Diseases of Respiratory System 35 18 17 6 3 1 5 9 S 2 13 0 0 Ulcer of Stomach 19 9 10 1 1 9 6 2 5 1 7 3 3 x Diarrhoea 63 33 3o 51 9 2 1 12 2 17 10 22 1 Enteritis 105 57 48 81 *3 3 1 4 2 1 11 9 18 26 41 6 Appendicitis and Typhlitis 26 14 12 1 9 M*6 3 6 1 5 3 10 ! 7 6 Obstruction of Intestines 41 *4 27 3 1 6 19 12 8 6 14 4 9 0 Cirrhosis of Liver 26 15 11 3 15 8 8 4 7 6 Other Diseases of Liver... 17 6 11 1 6 10 6 4 4 3 Other Diseases of Digestive System 43 29 14 9 1 3 9 12 9 10 3 *3 4 14 Nephritis and Bright's Disease 104 58 46 1 6 11 42 44 26 7 32 10 29 19 Other Diseases of Urinary System 21 17 4 1 3 6 11 3 7 2 7 4 Diseases of Generative System 6 6 1 2 3 1 3 2 2 Puerperal Fever 13 13 3 10 3 2 3 1 4 Other Accidents and Diseases of Pregnancy and Childbirth 14 14 14 7 2 2 1 6 Premature Birth 103 58 45 103 21 1 27 15 34 1 Congenital Debility and Malformation 105 60 45 102 2 1 16 6 23 18 42 11 Other Diseases of Early Infancy 2 f> 14 12 26 ... 4 3 8 2 Q 4 Old Age 237 81 156 ... 1 236 49 22 6 26 72 231 Deaths from Accident ... 80 4^ 34 6 2 A 12 4 15 20 *7 20 12 3 5 13 32 Deaths from Suicide 33 18 15 2 *4 15 2 6 5 10 5 T Other Violent Deaths 2 1 1 1 1 I j 1 r Other defined Diseases ... 2' 9 11 1 1 3 1 14 3 3 1 6 r Ill-defined Diseases or known 8 6 2 2 2 2 2 2 2 4 X All causes... is™ r72S i860 605 JSi T20 jft 121 480 841 1146 686 315 1072 1126 1034 35 Report of the Medical Officer of Health. Table XX. 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 1912 there has been an increase in the number of deaths from Measles, Diarrhoea, Enteritis, diseases of the Respiratory and Circulatory organs, and these increases are the cause of the death-rate for the year having been higher than in 1912. From Pulmonary Tuberculosis there has been a slight decrease, and this is also the case as regards Old Age and Bronchitis. The deaths from Suicide have decreased from 43 in 1912 to 33 in 1913, but the deaths from accident have increased from 68 in 1912 to 80 in 1913. The four Tables which follow are inserted by request of the Local Government Board. Table I. is arranged to show the gross births and dea lis in the district, and the births and deaths belonging to it with the corresponding rates. The rates in column 7 are calculated on 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 popula tion 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 sab-districts, and also shows the number of caces removed to hospital from the whole Borough. 36 Report of the Medical Officer of Health. 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 monthlyperiods up to one year. 37 Report of the Medical Officer of Health. TABLE XXI. Wandsworth District. Vital Statistics of Whole District during 1913 and previous years. (Table I.) Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths: Nett Deaths Belonging to the District. of Nonresidents registered in the District. ot Residents not registered in the District. Under i Year of Age. At all Ages. Uncorrected Number. Nctt. Number. Rate per 1000 Nett Births. Number. Rate. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1908 282,262 7,321 7,331 25.54 3,230 11.24 633 783 720 98 3,380 11.97 1909 290,452 6,924 6,985 24.04 3,279 11.08 656 897 601 86 3,520 12.11 1910 299,061 6,873 6,967 23.21 2,856 938 564 812 545 78 3,105 10.34 1911 308,156 6,555 6,699 21.73 3,456 11.02 669 989 823 122 3,776 12.25 1912 313,761 6,580 6,756 21.53 3,118 9.77 767 940 516 76 3,291 10.48 1913 321,340 6,679 6,838 20.87 3,344 10.04 822 1,066 605 88 3,588 10.95 Area of District in acres (exclusive of ) area covered by water) 9,126 Total population at all ages 311.360 Number of inhabited houses 48,432 At Census of 1911 Average number of persons per house 6.42 38 Report of the Medical officcr of Health. TABLE XXII. Wandsworth District. Cases of Infectious Disease notified during the year 1913. (Table II.) Notifiable Disease. No. of Cases Notified. Total Cases Notified in each Locality. No. of Cases removed to Hospital from each Locality. Total cases removed to Hospital. At all Ages. At Ages—Years. Clapham. Putney. Streatham. Tooting. Wandsworth. Clapham. Putney. Streatham. Tooting. Wandsworth. Under 1. 1 to 5. 5 to 15. '5 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera, Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 430 4 116 222 41 41 6 ... 83 19 105 86 137 68 14 93 84 113 372 Erysipelas 204 5 7 18 18 70 59 27 29 17 54 31 73 5 4 9 7 14 39 Scarlet Fever 971 7 206 614 102 37 5 ... 204 44 277 158 288 187 35 219 144 257 842 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 50 ... 1 10 8 26 5 ... 10 2 13 3 22 8 2 10 3 15 38 Relapsing Fever, Continued Fever 2 ... ... 1 ... 1 ... ... ... ... 1 1 ... ... ... ... 1 ... 1 Puerperal Fever 32 ... ... ... 8 24 ... ... 5 6 3 4 14 4 4 1 2 1 1 22 Cerebro-spinal Meningitis 9 1 2 3 1 2 ... ... ... ... 1 5 3 ... ... 1 4 2 7 Polio-Myelitis 13 1 8 4... ... ... ... ... ... ... 3 1 9 ... ... 1 1 6 8 Pulmonary Tuberculosis 783 1 14 88 167 345 145 23 154 45 209 89 286 ... ... ... ... ... ... Other forms of Tuberculosis 328 11 57 162 46 39 9 4 59 21 75 56 117 ... ... ... ... ... ... Ophthalmia Neonatorum 37 37 ... ... ... ... ... ... 8 1 6 7 15 4 1 4 4 9 22 Totals 2,859 67 411 1,122 391 585 229 54 552 155 747 441 964 276 60 338 250 427 1,351 39 Rebort of the Medical Officer of Health. TABLE XXIII. KVandsworth district. Causes of, and Ages at Death during the Year 1913. (Table III) Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the district. Total Deaths whether of "Residents" or "non-Residents in Institutions in the District. All ages. Under 1 year 1 & under 2 years. 2 & under 5 years 5 & under 15 years. 15 & under 25 years. 25 & under 45 years. 45 & under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified 3,581 604 151 120 124 121 480 737 1,144 1,034 Uncertified 7 1 ... ... ... ... ... 4 2 ... Enteric Fever 5 ... ... ... ... 1 1 3 ... 3 Small-pox ... ... ... ... ... ... ... ... ... ... Measles 116 23 43 32 17 ... ... 1 ... 35 Scarlet Fever 11 1 4 2 3 ... 1 ... ... 18 Whooping Cough 23 12 8 2 ... 1 ... ... ... 20 Diphtheria and Croup 18 1 3 7 7 ... ... ... ... 36 Influenza 59 2 ... 1 ... 2 10 19 25 10 Erysipelas 6 1 ... ... ... ... 2 2 1 1 Phthisis (Pulmonary Tuberculosis) 289 1 ... 5 8 45 121 95 14 124 Tuberculous Meningitis 34 3 8 13 9 1 ... ... ... 1 Other Tuberculous Diseases 32 1 4 2 9 6 6 4 ... 10 Cancer, malignant disease 352 ... ... ... 3 1 39 158 151 76 Rheumatic Fever 15 ... ... 1 2 2 5 5 ... 2 Meningitis 22 7 4 2 ... 1 4 3 1 1 Organic Heart Disease 296 ... ... ... 10 9 48 102 127 70 Bronchitis 267 46 9 4 ... 2 10 44 152 37 Pneumonia (all forms) 320 75 30 29 10 6 46 67 57 86 Other diseases of Respiratory organs 35 6 3 ... ... 1 5 9 11 9 Diarrhœa and Enteritis 168 132 22 3 1 ... 4 4 2 7 Appendicitis and Typhlitis 26 ... ... 1 9 6 3 6 1 6 Cirrhosis of Liver 26 ... ... ... ... ... 3 15 8 3 Alcoholism 14 ... ... ... ... ... 7 6 1 ... Nephritis and Bright's Disease 104 ... ... ... 1 6 11 42 44 19 Puerperal Fever 13 ... ... ... ... 3 10 ... ... ... Other accidents and diseases of Pregnancy and Parturition 14 ... ... ... ... ... 14 ... ... 1 Congenital Debility and Malformation, including Premature Birth 208 205 2 1 ... ... ... ... ... 12 Violent Deaths, excluding Suicide 82 7 2 4 12 4 15 21 17 33 Suicides 33 ... ... ... ... 2 14 15 2 13 Other Defined Diseases 992 79 9 11 23 22 99 218 530 400 Diseases ill-defined or unknown 8 2 ... ... ... ... 2 2 2 1 3,588 605 151 120 124 121 480 841 1,146 1,034 Sub-Entries included in above figures. Cerebro-spinal Meningitis 1 ... ... ... ... ... 1 ... ... ... Polio-Myelitis 3 ... 1 1 1 ... ... ... ... ... Tetanus 1 ... ... ... ... ... 1 ... ... ... Glanders 1 ... ... ... ... ... ... 1 ... ... Syphilis 10 7 ... 1 ... ... ... 2 ... 4 40 Report of the Medical Officer of Health. TABLE XXIV. (Table IV.) Borough of Wandsworth. Infant Mortality. 1913. 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 149 35 23 20 227 11 110 78 78 604 Uncertified 1 ... ... ... 1 ... ... ... ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... 1 1 ... 3 6 13 23 Scarlet Fever ... ... ... ... ... ... ... 1 ... 1 Whooping Cough ... ... ... ... ... 3 2 3 4 12 Diphtheria and Croup ... ... ... ... ... ... ... ... 1 1 Erysipelas ... ... ... ... ... 1 ... ... ... 1 Tuberculou Meningitis ... ... ... ... ... ... ... 2 1 3 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... 1 ... ... 1 2 Meningitis (not Tuberculous) 1 ... 1 ... 2 1 2 1 1 7 Convulsions 9 3 2 ... 14 3 4 2 3 26 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 2 3 5 16 9 10 6 46 Pneumonia (all forms) 1 1 2 2 6 12 18 15 24 75 Diarrhœa ... 1 ... 1 2 16 19 9 5 51 Enteritis ... ... 3 2 5 25 25 17 9 81 Gastritis ... ... ... ... ... 6 1 1 ... 8 Syphilis ... ... ... 1 1 1 3 1 1 7 Rickets ... ... ... ... ... ... ... 1 ... 1 Suffocation, overlying 1 ... ... ... 1 1 ... ... ... 2 Injury at birth 8 1 ... ... 9 ... ... ... ... 9 Atelectasis 8 1 1 ... 10 ... ... ... ... 10 Congenital Malformations 13 6 ... 1 20 6 1 1 1 29 Premature birth 75 16 3 3 97 3 3 ... ... 103 Atrophy, Debility and Marasmus 24 5 9 5 43 10 17 2 2 74 Other Causes 10 1 ... 1 12 6 3 6 6 33 Totals 150 35 23 20 228 111 110 78 78 605 Nett Births in the year, legitimate, 6,555; illegitimate, 283. Nett Deaths in the year of legitimate infants, 544; illegitimate infants, 61. 41 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 XXV. Sub.Districts. Under 1 year. 1 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 65 years. 65 years and upwards.  Clapham 15.60 5.54 3.35 3.56 41.55 30.90 Putney 13.34 8.89 3.46 1.59 38.10 34.62 Streatham 12.97 4.57 2.61 3.07 38.62 38.15 Tooting 24.42 12.59 4.37 3.85 29.83 24.94 Wandsworth 19.71 9.50 4.00 4.17 34.28 28.34 Whole Borough 16.86 7.56 3.46 3.37 36.82 31.93 Compared with 1912 the percentage of deaths under one year was i"i8 higher; from one and under five years 1.09 higher; from five and under 15 years "40 lower; from 15 and under 25 years '51 lower; from 25 and under 65 years 1 "25 lower; and from 65 years and upwards 11 lower. There was a considerable diversity in these rates in the different sub.districts. In Streatham the rate under one year was only 12"97 while in Tooting it was 24.42, while over 65 years of age Tooting had a rate of 24.94 and Streatham of 38.15. At one and under five years the rate was lowest in Streatham and highest in Tooting, from five and under 15 years lowest in Streatham and highest in Tooting, at 15 and under 25 years lowest in Putney and highest in Wandsworth, at 25 and under 65 years lowest in Tooting and highest in Clapham, and at 65 years and upwards lowest in Tooting and highest in Streatham. 42 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 increase in the percentage of deaths under one year and from one and under five years was due to the increase in the number of deaths from Measles, Diarrhœa and Enteritis. Infantile Mortality. The total number of deaths of infants under one year was C05, compared with 516 in 1912, 823 in 1911 and 545 in 1910, and is 225 under the decennial average corrected for increase of population. Of these, 107 occurred in Clapham, 42 in Putney, 139 in Streatham, 95 in Tooting, and 222 in Wandsworth. The infantile mortality or deaths under one year to 1,000 births, was 88 compared with 76 in 1912, 122 in 1911, and 78 in 1910. This rate was 82 in Clapham, compared with 99 the decennial average; 85 in Putney, compared with 109; 74 in Streatham, compared with 89; 91 in Tooting, compared with 127; and 103 in Wandsworth, compared with 108. In the whole Borough the rate was 12 per 1,000 births above that for 1912, but 16 under the decennial average. In all the sub-districts, there has been a decrease in this rate compared with the decennial average, this decrease having been greatest in Clapham and Tooting. In Wandsworth the rate was higher than in any of the other sub-districts, but was five under the decennial average. 43 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 XXVI Sub.District. No. of Deaths under one year. Percentage to total Deaths. Rate per l,000 Births. 1910 1911 1912 1913 Clapham 107 15.60 67 119 76 82 Putney 42 13.34 81 145 69 85 Streatham 139 12.97 64 99 58 74 Tooting 95 24.42 92 116 100 91 Wandsworth 222 19.71 89 143 83 103 Whole Borough 605 18.86 78 122 76 88 44 Report of the Medical Officer of Health. Table XXVII. shows this mortality for the 10 years 1903-1912 in each of the sub-districts and in the whole Borough, and the decennial average, compared with the present year. TABLE XXVII. Clapham. Putney. Streatham. Tooting. Wandsworth Borough. 1903 107 127 108 124 1O 11O 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 99 116 143 122 1912 76 69 58 100 83 76 Average 99 109 89 127 108 104 1913 82 85 74 91 103 88 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 6,838, of which 6,555 were legitimate and 283 illegitimate, and of deaths 605, of which 544 were legitimate and 61 illegitimate. From the notifiable infective diseases two deaths occurred during the year, one from Scarlet Fever in Wandsworth, and one from Diphtheria in Putney. 45 Report of the Medical Officer of Health. From Measles there were 23 deaths, a considerable increase compared with the previous year. From Whooping Cough there were 12 deaths, from Diarrhoea! diseases 132, from Premature Birth 103, from other diseases of infancy 103, from Tuberculous diseases five, from diseases of the Respiratory Organs 121, from Convulsions 26, from Syphilis seven, from Suffocation (overlying) two, and from other causes 69. Compared with 1912 there has been an increase in the number of deaths from Diarrhœa, Measles, and diseases of the Respiratory Organs, but a decrease in the number from Whooping Cough and Premature Birth. In all the deaths, with one exception, in Streatham, the cause of death was certified by a medical man, or by a coroner after inquest. 377 of the deaths occurred in the first month, compared with 447 in 1912, 29.5 in 1911, and 40.9 in 1910; 56.0 in the first three months, compared with 65.3, 437 and 59.4.; and 74.2 in the first six months, compared with 80.6, 65.9 and 74.5. The Table shows that 103 died from Premature Birth, of which 97 occurred under one month, and 113 from Congenital Debility and Malformations, compared with 103 in 1912,146 in 1911, and 110 in 1910. Of the total deaths under one month, viz.:—228, 97 occurred from Premature Birth and 73 from Congenital Debility and Malformations, a percentage of 74'5 compared with 76*2 in 1912. From Diarrhœal diseases only two deaths occurred under one month. The greatest mortality from these diseases occurred at four weeks to three months and three to six months. 46 Report of the Medical Officer of Health. From Tuberculous diseases five deaths occurred; three from Tuberculous Meningitis, and two from other Tuberculous diseases, compared with eight in 1912, and 23 in 1911; and 121 from diseases of the Respiratory Organs, compared with 100. Seven deaths were registered as due to Meningitis, but enquiries of the medical attendant showed that all these were due to simple Meningitis. Table XXVIII. 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 1912 the rate from common infective diseases is slightly higher, due to the increase in the number of deaths from Measles. From Diarrhoeal diseases there was a large increase, the rate having been 19.27 per 1,000, compared with 8'88 in 1912. From Premature Birth, Congenital Debility and Malformations the rate was lower than in 1912, and this was also the case from Tuberculous diseases, while from other causes the rate was slightly higher. 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 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. Report of the Medical Officer of Health. TABLE XXVIII. Causes of Death. Under 1 Week. 1 and under 2 Weeks 2 and under 3 Weeks 3 and under 4 Weeks Under 1 Month. 1 and under 3 Months 3 and under 6 Months 6 and under 9 Months 9 and under 12 Months. . Total under 1 year. I. Common Infective Diseases ... ... ... .15 .15 .58 .73 1.46 2.63 5.55 II. Diarrhœal Diseases ... .15 .44 .44 1.02 5.99 6.42 3.80 2.04 19.27 III. Premature Birth, Congenital Debility and Malformations 16.35 3.95 1.75 1.31 23.36 2.77 3.07 .44 .44 30.08 IV. Tuberculous Diseases ... ... ... ... ... .15 ... .29 .29 .73 V. Other causes 5.55 1.02 1.17 1.02 8.76 6.72 5.84 5.40 5.99 32.70 All causes 21.90 5.12 3.36 2.92 33.29 16.21 16.06 11.39 11.39 88.33 48 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 three to six months, while at the other age periods there has been a decrease. TABLE XXIX. 1908. 1909. 1910. 1911. 1912. Five years average. 1913 Rate per 1,000 births 98 86 78 122 76 92 88 Percentage of above:— Under one week 199 22.4 27.1 16.3 28.7 22.9 24.9 1 and under 2 weeks 5.0 6.5 5.7 3.5 5.6 5.3 5.8 2 and under 3 weeks 4.3 4.5 3.7 5.2 5.5 4.6 3.9 3 and under 4 weeks 36 4.0 4.4 4.5 5.1 4.3 3.1 Under 4 weeks 32.8 37.4 40.9 29.5 44.7 37.1 37.7 From 4 to 13 weeks 21.6 16.9 18.5 14.2 20.5 18.3 18.3 From 3 to 6 months 13.7 18.7 16.9 22.2 15.4 17.4 18.2 From 6 to 9 months 18.3 15.5 14.5 16.8 9.7 14.9 12.9 From 9 to 12 months 13.6 11.5 9.2 17.8 9.7 12.3 12.9 Under 12 months 100.0 100.0 100.0 100.0 100.0 100.0 100.0 In 1912 there was a considerable decrease in the Infantile Mortality, and this was, in the Report for that year, stated to have been due to the climatic conditions having been unfavourable for Diarrhœa and Digestive diseases of infants, but in 1913 these conditions were more favourable, and consequently there was an increase in the mortality from these diseases. This, combined with the increase in the number of deaths from Measles and Pneumonia, increased the Infantile Mortality from 76 to 88 per 1,000 births. 49 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 23 days only out of 92, compared with 19 days in 1912 and 76 days in 1911, while the rainfall was much below the average, rain falling on 36 days compared with 47 days in 1912, 22 days in 19H, and 37 in 1910. 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 XXX. 1903 1904 1905 1906 1907 1908 1909 1910 191 i 1912 1913 1913 No. above corrected average. No. below corrected average. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 18 13 28 19 22 21 14 12 10 11 11 ... 8.3 Diphtheria 45 41 31 50 41 37 29 16 34 18 18 ... 21.3 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 19 11 11 15 10 7 6 8 9 8 5 ... 6.9 Cont'd Fever ... ... 1 1 1 2 1 3 ... ... ... ... ... Puerpl. Fever 6 5 8 11 10 6 10 5 8 11 13 3.8 ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 5 13 14 10 10 6 8 4 10 5 6 ... 3.7 Measles 109 104 89 65 68 45 108 44 230 51 116 11.0 ... Whooping C. 87 48 75 55 105 59 67 68 66 57 23 ... 56.0 Influenza 39 57 41 70 88 82 89 55 24 45 59 ... 8.9 Diarrhœa 162 301 203 307 127 183 120 88 350 85 168 ... 53.6 Tuberculous Diseases 343 380 360 376 352 382 362 351 389 366 355 ... 65.3 Other In- fective Diseases 10 11 l6 16 10 11 14 13 24 28 23 5.4 ... Totals 843 984 877 995 844 841 828 667 1154 685 797 ... 137.0 The total number of deaths from these diseases was 797, 137 in Clapham, 62 in Putney, 190 in Streatham, 118 in Tooting, and 290 in Wandsworth, an increase of 112 compared with 1912,but a decrease of 137 compared with the corrected decennial average. 50 Report of the Medical Officer of Health. Compared with 1912 there has been an increase in the number of deaths from Puerperal Fever, Influenza, Erysipelas, Measles, and Diarrhœa, and a decrease in the number of deaths from Whooping Cough, Enteric Fever, Tuberculous diseases and other infective diseases, while the number of deaths from Scarlet Fever and Diphtheria is the same. Compared with the corrected decennial average there has been an increase in the number of deaths from Puerperal Fever, Measles and other infective diseases, but a decrease in all the others. From all infective diseases the death-rate was 2.43 per 1,000, (2.18 in Clapham, 2.10 in Putney, 1.83 in Streatham, 3.15 in Tooting, and 3.04 in Wandsworth), compared with 2.18 in 1912, and 3.34 the decennial average. The rate from the principal infective diseases, viz. :—Smallpox Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever, and Diarrhœa, was 1.04 per 1,000,(.76 in Clapham, .95 in Putney, .68 in Streatham, 1.90 in Tooting, and 1.27 in Wandsworth), compared with 173 in 1912, 2.26 in 1911, and .78 in 1910. The rate from these diseases was higher than in 1912 owing to the increase in the number of deaths from Measles and Diarrhœa. In out-lying Institutions 281 deaths occurred from infective diseases, (45 belonging to Clapham, 23 to Putney, 59 to Streatham, 43 to Tooting, and 111 to Wandsworth), compared with 201 in 1912. Of these deaths 144 occurred in Workhouse Infirmaries, 88 in General and Special Hospitals, 16 in Public Lunatic Asylums, and 33 in the Hospitals of the Metropolitan Asylums Board. The causes of death in these Institutions is shown in Table XV. In Institutions in the Borough 183 deaths from infective diseases occurred of persons not belonging thereto, compared with 186 in 1912. 51 Report of the Medical Officer of Health. Of these deaths 76 occurred in the Fever Hospital, 10 from Scarlet Fever, 22 from Diphtheria, 20 from Whooping Cough, 21 from Measles, one from Pulmonary Tuberculosis, and two from Diarrhœa. 18 deaths from these diseases occurred in the Middlesex County Asylum, two from Enteric fever, 15 from Tuberculous diseases, and one from Diarrhœa; 15 in the Tooting Bee Asylum, 14 from Tuberculous diseases, and one from Influenza; 23 in the Hostel of God, 22 from Tuberculous diseases, and one from Influenza; 18 in the Tooting Home, all from Tuberculous diseases; five in the Royal, Hospital for Incurables, four from Influenza, and one from Tuberculous disease; one in H.M. Prison from Tuberculous disease; 13 in the Fountain Asylum, nine from Tuberculous diseases, one from Diarrhcea, and three from other infective diseases; and one in the Workhouse from other infective diseases. In other places not Institutions 13 deaths occurred, three from Influenza, six from Tuberculous diseases, two from Diarrhœa, one from Measles, and one from Erysipelas. In Institutions in the Borough 87 deaths from infective diseases occurred of persons belonging thereto, 38 in the Fever Hospital at Tooting, 13 from Measles, eight from Scarlet Fever, one from Enteric fever, 13 from Diphtheria, two from Tuberculous diseases, and one from other infective diseases; 40 in the Tooting Home, all from Tuberculous diseases; tliree in the Putney Hospital, one from Diphtheria, one from Diarrhœa, and one from other infective diseases; and six in other places, four from Tuberculous diseases, one from Influenza, and one from other infective diseases. Compared with 1912 this shows a decrease of three. The next Table shows the death rates from these diseases for the whole Borough and for each sub-district for the year 1913, as well as for the preceding 10 years, and the rates above or below the decennial average are also shown. 52 Report of the Medical Officer of Health. TABLE XXXI. Sub-Districts. 1903 1904 1905 1906 1907 1908 1909 I910 191 I 1912 1913 1913 Rate above decennial average. Rate below decennial average. Clapham 3.32 3.77 3.06 3.67 2.66 2.82 2.87 2.09 3.69 2.41 2.19 ... .84 Putney 3.06 3.02 3.32 3.19 2.36 2.36 2.58 2.36 2.57 1.92 2.10 ... .57 Streathain 2.74 2.90 2.44 2.88 2.18 2.58 2.05 1.82 2.89 1.60 1.83 ... .57 Tooting 4.11 5.82 5.47 6.17 5.53 3.90 4.04 2.56 4.84 2.60 3.16 ... 1.34 Wandsworth. 4.22 4.83 4.01 4.16 3.76 3.39 3.35 2.57 4.65 2.56 3.04 ... .71 Borough 3.44 3.90 3.38 373 3.07 2.98 2.85 2.23 3.74 2.18 2.43 ... .72 The death-rate was thus '25 above the rate for 1912, but 72 below the decennial average. The rate in all the sub-districts with the exception of Clapham was higher than in the previous year, but in all the sub-districts was lower than the decennial average. 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 38. TIip 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.. 53 Report of the Medical Officer of Health. TABLE XXXII. 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1913 No. above decennial average. No. below decennial average. Small-pox 28 6 1 ... ... ... ... ... ... ... ... ... 4 Scarlet Fever 822 774 1494 1069 1330 1232 987 687 869 833 971 ... 191 Diphtheria 532 406 348 566 629 581 380 284 510 431 430 ... 107 Typhus Fevers. ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric 105 70 96 96 70 60 66 54 58 71 50 ... 35 Continued 3 3 1 1 ... ... 2 ... 5 2 2 ... ... Relapsing ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal 13 14 18 25 25 14 26 20 24 27 32 8.3 ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 232 267 253 273 213 203 192 182 202 207 204 ... 52 Cerebrospinal Meningitis ... ... ... ... 3 5 4 5 5 3 9 6.1 ... Polio-Myelitis ... ... ... ... ... ... ... ... 5 5 13 ... ... Ophthalmia Neonatorum ... ... ... ... ... ... ... ... 34 35 37 ... ... Total 1735 1540 2211 2030 2270 2095 1657 1232 1712 1614 1748 ... 354 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. 54 Report of the Medical Officer of Health. TABLE XXXIII. Cases of Infective Diseases Notified. Disease. No. of cases notified. No. of patients removed to Hospital. No. died in Hospital. No. died at Home. Total deaths in Hospital and at Home. Small-pox ... ... ... ... ... Scarlet Fever 971 842 10 1 11 Erysipelas 204 39 2 4 6 Diphtheria 430 372 16 2 18 Enteric Fever 50 38 4 1 5 Continued Fever 2 1 ... ... ... Puerperal Fever 32 22 9 4 13 Cerebro-spinal Meningitis 9 7 1 ... 1 Polio-Myelitis 13 8 1 2 3 Ophthalmia Neonatorum 37 22 ... ... ... Total 1,748 1,351 43 14 57 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, and 28 in 1903. 971 cases of Scarlet Fever were notified, compared with 833 in 1912, 869 in 1911, and 687 in 1910; of Diphtheria 430, compared with 431, 510 and 284; of Enteric fever 50, compared with 71, 58 and 54; of Puerperal Fever 32, compared with 27, 24 and 20; and of Erysipelas 204, compared with 207, 202 and 182. Compared with 1912 there has been an increase in the number of cases of Scarlet Fever, Puerperal Fever, Polio-Myelitis, Ophthalmia Neonatorum and Cerebro-spinal Meningitis, and a decrease in the number of cases of Erysipelas, 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 Puerperal Fever and Cerebro-spinal Meningitis, which show a slight increase. 55 Report of the Medical Officer o Health. The total number of cases notified was 1,748, (339 in Clapham, 89 in Putney, 463 in Streatham, 296 in Tooting, and 561 in Wandsworth), compared with 1,614 in 1912, 1,949 in 1311, and 1,232 in 1910. 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. In 1903, 1904 and 1911 Chicken-pox was compulsorily notifiable, and, as a consequence the rates in these years are increased, especially in 1904. 56 Report of the Medical Officer of Health. TABLE XXXIV. Sub-districts. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1912. Decennial Average. 1913. Clapham 6.26 7.68 7.34 6.28 6.43 6.61 5.60 3.35 6.96 4.74 6.12 5.54 Putney 6.53 5.29 3.47 3.76 6.29 4.39 3.13 2.86 3.77 5.11 4.46 3.08 Streatham 6.71 8.29 5.91 6.07 6.88 5.07 5.85 3.64 4.83 4.20 5.74 3.57 Tooting 7.55 10.13 21.24 15.20 19.25 12.98 8.29 6.39 8.79 8.54 11.83 7.06 Wandsworth 9.00 13.97 13.02 9.02 8.15 9.62 5.52 4.70 7.35 5.20 8.55 5.82 Whole Borough 7.28 9.65 8.53 7.61 8.28 7.42 5.70 4.12 6.32 5.14 7.00 5.35 London 6.1 6.1 7.2 7.7 8.92 7.70 6.42 4.77 6.5 5.4 6.68 6.94 57 Report of the Medical Officer of Health. In Public Institutions within the Borough one case of Scarlet Fever and one of Ophthalmia Neonatorum were notified from the Workhouse; three cases of Enteric Fever from H.M. Prison; two cases of Enteric Fever from the Middlesex County Asylum; one case of Scarlet Fever and four of Diphtheria from the Putney Hospital; one case of Scarlet Fever from the Fountain Asylum; and 32 cases of Scarlet Fever and 23 cases of Diphtheria from the Fever Hospital. The following Table shows the number of notifications received from Institutions outside the Borough. TABLE XXXV. Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Puerperal Fever. Polio- Myelitis. Cerebro-Spinal Meningitis. Ophthalmia Neonatorum. Total. St. James's Infirmary ... ... 1 17 6 ... ... 1 25 St. Thomas's Hospital 4 2 1 8 1 2 ... 3 21 Victoria Hospital 5 6 1 1 ... 2 ... ... 15 St. John's Infirmary 1 ... 1 9 ... ... ... 2 13 Belgrave Hospital 5 4 ... 1 ... 1 1 ... 12 Royal Eye Hospital ... ... ... ... ... ... ... 12 12 Joyce Green Hospital 5 3 ... ... ... ... ... ... 8 St. Bartholomew's Hospital 1 1 ... ... 1 ... ... ... 3 South Western Hospital 2 1 ... ... ... ... ... ... 3 London Fever Hospital 1 ... 1 ... ... ... ... ... 2 Central London Sick Asylum ... ... ... ... 1 ... ... ... 1 Evelina Hospital ... 1 ... ... ... ... ... ... 1 Western Hospital ... 1 ... ... ... ... ... ... 1 St. Marylebone Infirmary ... ... ... 1 ... ... ... ... 1 King's College Hospital ... ... ... ... ... ... 1 1 Park Hospital ... 1 ... ... ... ... ... ... 1 Royal Waterloo Hospital ... ... ... ... 1 ... ... ... 1 Guy's Hospital 1 ... ... ... ... ... ... ... 1 Royal Chest Hospital 1 ... ... ... ... ... ... ... 1 Hospital for Sick Children ... ... ... ... ... 1 ... ... 1 Throat Hospital ... 1 ... ... ... ... ... ... 1 Westminster Hospital ... ... ... ... 1 ... ... ... 1 Westminster Infirmary ... ... ... 1 ... ... ... ... 1 Charing Cross Hospital ... ... ... 1 ... ... ... ... 1 Totals 26 21 5 39 11 6 2 18 128 58 Report of the Medical Officer of Health. There has been a slight increase in the number of these notifications compared with 1912 when 125 cases were notified, compared with 128 in 1913. There was a decrease in the number of cases of Diphtheria, Puerperal Fever, and Ophthalmia Neonatorum, and a slight increase in the number of cases of Scarlet Fever, Enteric Fever, Erysipelas, and Polio-Myelitis. The greatest number of cases notified, viz.:—25, was received from the St. James's Infirmary, 17 of these being Erysipelas and six of Puerperal Fever. Of the 18 cases of Ophthalmia Neonatorum notified, 12 were from the Royal Eye Hospital, and three from St. Thomas's Hospital. Vaccination. Table XXXVI. is taken from the official returns of the Vaccination Officers to the Board of Guardians for the year 1912. 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 XXXVI. SubDistricts. Number of Births returned from 1st January to 31st of December, 1912. Successfully Vaccinated. Insusceptible of Vaccination. Mad Small-pox. Dead, Unvaccinated. 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 1,163 595 1 ... 71 318 15 11 139 13 Putney 472 358 1 ... 21 77 2 8 3 2 Streatham 2,717 1,144 3 ... 181 507 63 73 329 417 Wandswith 2,295 1,361 3 ... 149 446 23 44 242 27 Totals 6,647 3,458 8 ... 422 1,348 103 136 713 459 54 Report of the Medical Officer of Health. During the year 1912, of 6,647 children whose births were registered, 3,458 or 52.0 per cent. were successfully vaccinated, compared with 56.3 per cent, in 1911, 56.1 per cent. in 1910, and 60.9 per cent. in 1909. This is again a decided decrease compared with the five previous years, and is the lowest rate in the last 10 years. 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 1912, as well as for the 10 years 1902-1911. The average for the 10 years is also shown on this Table. Compared with 1911 there has been a decrease in the percentage of successfully vaccinated in all the sub-districts, with the exception of Putney. The greatest decrease occurred in Streatham, while in the whole Borough there has been a decrease of no less than 4'3 per cent. Compared with the decennial average there has been a decrease in all the sub-districts, the greatest decrease having been in Streatham, and the smallest in Putney. 422 infants died unvaccinated, a percentage of 63, compared with 8.8 in 1911, 6.2 in 1910, and 5.9 in 1909. Of the 2,767 infants remaining, eight or .12 per cent. were stated to have been insusceptible of vaccination; 1,348 or 20.3 per cent, in respect of whom certificates of conscientious objection were received; 103 or 1.5 per cent. had vaccination postponed by medical certificate, leaving 849 or 12.8 per cent. as removed, not to be traced, or otherwise unaccounted for, compared with 11.4 in 1911, 13.6 in 1910, and 13.3 in 1909; while 459 or 6.9 per cent. remained on the books as unvaccinated, compared with 3.6 in 1911, 3.3 in 1910, and 3.3 in 1909. There has been an increase of 1.4 in the percentage of cases removed, of 3.4 in the number of certificates of conscientious objections received, and of 3.3 in the number of cases remaining on the books as unvaccinated. 60 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 6,225 the remaining infants, 55.5 per cent. were successfully vaccinated, compared with 617 in 1911, 597 in 1910, and 647 in 1909; .13 were insusceptible, compared with .38, .29 and .42; 1.6 per cent. were under certificate of postponement, compared with 2.7, 6.2 and 7.0; 21.6 per cent. in regard to whom certificates of conscientious objection had been obtained, compared with i8'6, 15'5 and 11.5; leaving 21.0 per cent. unaccounted for as regards vaccination, compared with 16.6, 18.1 and 15.8. TABLE XXXVII. Sub-Districts. 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 Average for Ten Years. 1912 Clapham 637 68.2 62.9 68.8 59.9 55.1 51.9 55.1 56.4 52.7 59.5 51.2 Putney 84.4 86.5 83.4 88.1 86.7 83.6 85.0 80.4 80.0 75.5 83.3 75.8 Streatham 65.2 66.9 69.2 69.7 66.9 62.3 54.5 52.8 45.0 50.7 60.3 42.1 Wandsworth 82.3 81.7 82.8 80.9 78.7 74.5 69.1 68.9 64.1 61.1 74.4 59.3 Borough 72.4 73.7 73.5 74.6 71.05 66.5 61.3 60.9 56.1 56.3 66.6 52.0 The returns for the year 1912 show a decided decrease as regards successful vaccination, compared with the decennial average, and the record of the number of unvaccinated children in the Borough is from a public health point of view, a most unsatisfactory one. It is fortunate that Small-pox was not introduced into the Borough during the year, as there is no doubt that if it is, the results will be disastrous. Parents require proper education in this master, and it would be extremely beneficial if the kinematograph could be utilised for this purpose by exhibiting the photographs of unvaccinated children suffering from the disease. It cannot be too strongly emphasised that nothing but efficient infantile vaccination and revaccination at puberty will prevent the occurrence of Small-pox. Panic vaccination is never satisfactory, and in addition it is much more costly to the public. 61 Report of the Medical Officer of Health. TABLE XXXVIII. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910 1911. 1912 Acceptance of Vaccination— England and Wales 75.4 75.3 75.8 73.4 70.9 62.2 59.8 55.8 52.3 ... Metropolitan Unions 68.9 69.7 70.7 68.1 65.9 63.0 61.6 58.3 ... ... Wandsworth 73.7 73.5 74.6 71.0 66.5 61.3 60.9 56.1 56.3 52.0 Abstention from Vaccination (including exempted, postponed, and remaining)— England and Wales 14.7 14.5 14.8 16.8 20.4 27.9 32.3 36.3 38.9 ... Metropolitan Unions 21.7 20.2 20.1 22.7 25.8 28.8 30.7 34.1 ... ... Wandsworth 17.4 17.3 l6.6 20.6 26.5 31.2 32.3 37.4 34.5 41.5 Exemptions alone— England and Wales 4.0 4.3 4.8 5.8 8.4 17.0 21.6 26.0 28.5 ... London 1.0 1.1 1.2 1.5 3.1 7.3 10.1 13.5 ... ... Wandsworth 1.4 1.9 2.0 2.6 4. 1 8.0 10.8 14.5 16.9 20.3 62 Report of the Medical Officer of Health. Scarlet Fever. 971 cases of Scarlet Fever were notified during the year, compared with 833 in 1912, 869 in 1911, and 687 in 1910. 204 of these were in Clapham, 44 in Putney, 277 in Streatham, 158 in Tooting, and 288 in Wandsworth. 842 or 87 per cent. of these cases were removed to hospital where 10 died, and 129 or 13 per cent. were treated at home with one death. The total number of deaths was 11, of which five were in Streatham, two in Tooting, and four in Wandsworth. The death-rate per 1,000 population was .03, compared with .03 in 1912. The percentage of cases removed to hospital, viz.:—87, is the same as in 1912, but higher than in 1911 when it was 83.5 per cent. The case mortality was 1.13 per cent., compared with 1.32 in 1912, 1.15 in 1911, and 177 in 1910, and is the lowest yet recorded. The mortality among cases removed to hospital was ri8 per cent., compared with 1.3 in 1912, and among those treated at home .80 per cent. compared with .92 in 1912. 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. 63 Report of the Medical Officer of Health. TABLE XXXIX. Sub-Districts. 1910 1911 1912 1913 Clapham 1.52 2.88 2.24 3.33 Putney 1.60 1.72 1.43 1.50 Streatham 1.82 2.27 2.32 2.72 Tooting 3.03 3.64 5.80 4.10 Wandsworth 2.30 3.39 2.42 3.00 Whole Borough 2.00 2.82 2.65 2.97 London 2.15 2.32 2.50 3.88 In all the sub-districts the rate was slightly higher than in 1912, with the exception of Tooting where it was lower, while for the whole Borough it was .32 per 1,000 above the rate for the previous year. In Clapham the greatest number of cases was notified in October, November and December, and the smallest in August. In Putney the greatest number of cases was notified in April, in Streatham in October, in Tooting in November, and in Wandsworth in July. 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 32, so that the rate instead of being 4.10 would on that account be reduced tc 3.44 in 1913, and 5.00 in 1912. In the whole Borough the greatest number of cases, viz.—137, was notified in October, and the smallest in August, viz.—48. 64 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 1913 and for the whole year. TABLE XL. SubDistricts. January. February. March. April. May. June. July. August. September. October. November. December. Whole Year. Clapham 15 15 15 6 12 13 13 4 8 34 42 27 204 Putney 7 6 4 8 3 1 1 1 5 1 6 1 44 Streatham 14 18 27 20 7 10 21 12 27 50 38 33 277 Tooting 13 13 8 16 6 11 8 145 11 18 23 16 158 Wandsworth 15 19 16 15 22 26 53 16 11 34 20 41 288 Whole Borough 64 71 70 65 50 6l 96 48 62 137 129 118 971 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.—971, the diagnosis was incorrect in 43 or 4.4 per cent.; 510 or 52.6 per cent. were in attendance at schools in the Borough; 52 or 5.3 per cent. attended schools outside the Borough; while 366 or 377 per cent. did not attend school, being either over or under school age. 65 Report of the Medical Officer of Health. The percentage of children attending school in the Borough was as follows:—in Clapham, 98 out of 204, or 48 per cent.; in Putney, 19 out of 44, or 43 per cent.; in Streatham, 159 out of 277, or 57 per cent.; in Tooting, 86 out of 126, or 68.2 per cent.; and in Wandsworth, 148 out of 288, or 51.4 per cent. The percentage of cases in the Borough in attendance at school was lower than in 1912, while in the sub-districts the percentage was higher in Putney and Tooting, but lower in Clapham, Streatham 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 Haselrigge Road with 20 cases, Larkhall Lane with 18 cases, and Cavendish Road and Wirtemberg Street with 10 cases each. In Putney, of the 19 cases, seven were in attendance at St. Mary's School, and five at private schools. In Streatham the schools chiefly affected were Oldridge Road with 31 cases, Broadwater Road and Immanuel Schools with 13 cases each, Mitcham Lane with 12 cases, and Fircroft Road with 10 cases. 36 of the cases were in attendance at private schools, these chiefly occurring in October, November and December. In Tooting, Ensham Street with 18 cases, Franciscan Road with 15 cases, Tooting Graveney with 14 cases, and Undine Street with 12 cases, were the schools principally attacked during the year. In Wandsworth, Waldron Road with 25 cases, the Earlsfield with 17 cases, The Wandle with 16 cases, and Swaffield Road with 14 cases, were the schools chiefly affected. 10 of the 14 cases in Swaffield Road School occurred during the month of July. 66 Report of the Medical Officer of Health. The Medical Officer of the London County Council excluded 21 children from nine schools during the year, chiefly in October, 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. It was necessary to carry out disinfection in Swaffield Road, Waldron Road, Larkhall Lane and the Wandle Schools, but in all these cases the disinfection was carried out without closing the schools. 6 7 Report of the Medical Officer of Health. TABLE XLI. SCHOOLS. January. February. March. April. May. June. July. August. September. October. November. December. Totals. CLAPHAM. Bonneville Road ... ... ... ... ... ... ... ... 2 1 2 1 6 Cavendish Road 1 2 3 1 ... 1 1 ... ... 1 ... ... 10 Haselrigge Road ... 1 ... ... 2 1 ... ... ... 2 9 5 20 Larkhall Lane 1 ... 1 2 1 ... ... ... 1 10 2 ... 18 New Park Road 1 ... ... ... ... 1 ... ... ... ... 1 ... 3 New Road ... ... ... ... ... 1 ... ... 1 ... ... ... 2 Parochial Old Town ... ... 1 ... ... 1 1 ... ... 1 ... ... 4 St. Andrew's Street 1 1 1 ... ... ... 1 ... ... ... 1 1 6 St. Mary's, Crescent Lane ... ... ... ... ... ... ... ... ... ... ... 1 1 St. Mary's, St. Alphonsus Road ... ... ... ... ... ... ... ... ... 1 1 ... 2 Telferscot Road ... 1 ... 1 1 ... 1 ... 2 1 ... 1 8 Wirtemberg Street ... ... ... ... ... ... 1 1 ... 3 3 2 10 Private Schools ... ... ... ... ... 1 1 ... 1 3 2 ... 8 Total 4 5 6 4 4 6 6 1 7 23 21 11 98 PUTNEY All Saint's ... ... ... ... ... ... 1 ... ... ... 1 ... 2 Convent of Sacred Heart ... ... ... ... ... ... ... ... ... ... 1 ... 1 Hotham Road 1 ... ... ... ... ... ... ... 2 ... ... ... 3 Roehampton National ... ... ... ... ... ... 1 ... ... ... ... ... 1 St. Mary's 2 1 ... ... ... 2 ... ... 1 1 ... ... 7 Private Schools 2 ... ... 2 ... ... ... ... 1 ... ... ... 5 Total 5 1 ... 2 ... 2 2 ... 4 1 2 ... 19 STREATHAM. Broadwater Road ... ... 3 1 ... 2 ... 1 1 3 2 ... 13 Christchurch ... ... ... 1 ... 1 ... ... ... ... ... ... 2 Coventry Hall ... ... ... 1 ... ... ... ... ... ... ... ... 1 Eardley Road ... 1 ... ... ... ... ... 1 ... 1 ... 2 5 Fircroft Road ... ... ... ... ... ... ... 2 4 2 1 1 10 Hearnville Road 1 3 ... 2 ... ... ... ... ... ... 1 1 8 Holy Trinity, Upper Tooting ... 1 ... 1 ... 2 ... ... ... 1 ... ... 5 Holy Trinity, Upper Tulse Hill ... ... ... ... ... ... ... 1 ... ... ... ... 1 Immanuel 4 1 2 ... ... 1 ... ... 2 ... 3 ... 13 Mitcham Lane ... ... 1 1 1 ... ... ... 1 2 6 ... 12 Oldridge Road ... ... 1 ... ... ... 2 ... 6 12 5 5 31 Roman Catholic, Nightingale Sq. ... ... ... ... ... ... ... ... ... ... 1 ... 1 St. Andrew's, Colmer Road ... ... ... ... ... ... ... ... ... 1 ... ... 1 St. Andrew's, Polworth Road ... ... ... 1 ... ... 2 ... ... ... ... ... 3 St. Leonard's ... ... ... ... ... ... 1 ... ... ... 2 ... 3 St. Mary's ... 1 ... ... ... ... 1 ... ... 1 ... ... 3 Smallwood Road 2 1 ... ... ... 1 2 1 ... ... 1 ... 8 Sunnyhill Road ... 2 ... ... ... ... ... ... ... 1 ... ... 3 Private Schools 1 ... 3 1 3 1 2 2 4 6 4 9 36 Total 8 10 10 9 4 8 10 8 18 30 26 18 159 Carried forward 17 16 16 15 8 16 18 9 29 54 49 29 276 68 Report of the Medical Officer of Health. TABLE XLI.—continued. SCHOOLS. January. February. March. April. May. June. July. August. September. October. November. December. Total. Brought forward 17 16 16 15 8 l6 18 9 29 54 49 29 276 TOOTING. Derinton Road ... ... ... ... ... ... ... 1 1 ... ... 1 3 Ensham Street 1 2 ... 3 1 1 1 1 2 1 3 2 18 Fountain Road ... ... ... ... 1 ... ... 1 ... 1 ... 1 4 Franciscan Road 3 1 1 1 2 2 ... 1 1 2 1 ... 15 Furzedown Demonstration ... ... ... ... ... ... ... ... ... ... ... 2 2 Sellincourt Road 1 ... ... ... ... ... ... 2 ... ... 2 ... 5 Tooting Graveney ... 2 ... 1 ... 1 1 4 ... 2 2 1 14 Undine Street ... ... 2 1 ... 1 ... ... ... 5 3 ... 12 Private Schools ... ... 1 ... ... ... ... ... ... ... 6 6 13 Total 5 5 4 6 4 5 2 10 4 11 17 13 86 WANDSWORTH. Brandlehow Road 1 2 2 ... ... ... ... 1 1 2 2 ... 11 Cambourne Road ... ... 1 ... ... ... ... ... ... ... ... ... 1 Convent of Sacred Heart ... ... ... ... ... ... ... 2 ... ... ... ... 2 Earlsfield ... 2 ... 1 1 ... 2 ... 1 1 3 6 17 Elliott Central ... ... ... ... ... ... ... ... ... 1 ... ... 1 Eltringham Street ... 1 ... ... ... 1 3 ... 2 ... ... ... 7 Garratt Lane ... 1 1 ... 3 1 1 ... ... ... ... ... 7 Littleton Street Special ... ... ... ... ... 1 ... ... ... ... ... ... 1 Merton Road 1 1 ... 1 1 ... ... ... ... ... ... 2 6 Riversdale ... ... 1 ... ... 3 ... ... 1 ... ... ... 5 St. Ann's ... ... ... ... ... ... ... ... ... ... ... 1 1 St. Faith's ... ... ... 1 1 ... ... ... ... ... ... 2 4 St. Joseph's ... 1 ... ... ... ... ... ... ... ... ... ... 1 Southfield ... ... ... ... ... ... ... ... 1 ... ... ... 1 Swaffield Road ... ... 1 ... ... 1 10 ... ... 1 ... 1 14 Waldron Road 2 1 1 ... 1 1 9 2 ... 3 3 2 25 Wandle ... ... ... ... 1 3 6 1 ... 1 4 ... 16 Warple Way ... ... ... ... ... 1 ... ... ... 3 ... 1 5 West Hill ... ... ... 1 1 1 2 2 1 1 ... 1 10 Private Schools 1 ... 3 1 1 ... 1 1 4 1 ... ... 13 Total 5 9 10 5 10 13 34 9 11 14 12 16 148 Total—Schools in Borough 27 30 30 26 22 34 54 28 44 79 78 58 510 Schools outside Borough 6 1 2 5 1 7 11 2 3 5 5 4 52 No School 30 32 36 31 24 19 31 17 10 44 42 50 366 Incorrect diagnosis 1 8 2 3 3 1 ... 1 5 9 4 6 43 Grand Total 64 71 70 65 50 61 96 48 62 137 129 118 971 CHART Showing the number of esses of Searlet Fever, Diphtheria and Fnteric Fever notifiecd, as well as the total cases notifiecd from these diseases during each week of the year 1913. 69 Report of the Medical Officer of Health. The Chart (facing page 68) shows the number of cases notified in each week during the year. The greatest number, viz.—43, was notified in the fourth week of October, and the smallest, four, in the first week of January. Of the total number of cases notified, viz.—971, seven or 72 per cent. were under one year, compared with two or .24 per cent. in 1912; 206 or 20.2 per cent, were from one and under five years, compared with 200 or 24.0 per cent.; 614 or 63.2 per cent. from five and under 15 years, compared with 530 or 63.6 per cent.; 102 or 10.5 per cent. from 15 and under 25 years, compared with 64 or 7.6 per cent.; and 42 or 4.3 per cent. from 25 and under 65 years, compared with 37 or 4.4 per cent. It will be noted that there was some increase in the percentage of cases from 15 and under 25 years compared with 1912. 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 XLII. Sub-Districts. One case. Two cases. Three cases. Four cases. Five cases and upwards. Total houses invaded. Clapham 131 18 8 ... 1* 158 Putney 29 1 3 1 ... 34 Streatham 187 28 7 2 1 225 Tooting 106 9 2 3 3 123 Wandsworth 220 17 4 4 1 246 Whole Borough 673 73 24 10 6 786 * 13 Cases occurred in an Institution. Of the 786 houses invaded, multiple cases occurred in 113, or 143 per cent., compared with 15.3 per cent. in 1912. 70 Report of the Medical Officer of Health. The incidence of Scarlet Fever during the year was somewhat under the average during the first nine months, but during October, November and December, the cases increased rapidly and this increase was general all over London. It was due chiefly to the mild character of the disease, which resulted in a considerable number of unrecognised cases and a consequent spread of the disease by means of schools, tramcars, buses and kinematograph theatres. Diphtheria. The number of cases of Diphtheria notified during the year shows a slight decrease compared with the previous year, and is much 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 1903-1912 inclusive, the average for the 10 years, and the number of cases and deaths in 1913. 71 Report of the Medical Officer of Health. TA BLE XLIII. YEAR. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 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 1 137 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 71 3 284 16 1911 110 10 34 1 111 3 106 9 149 11 510 34 1912 78 3 82 3 95 1 48 5 128 6 431 18 Average Ten Years— 1903 to 1912 78 6 37 2 137 9 70 6 144 11 466 34 1913 83 3 19 1 105 5 86 5 137 4 430 18 72 Report of the Medical Officer of Health. The total number of cases notified was 430, (83 in Clapham 19 in Putney, 105 in Streatham, 86 in Tooting, and 137 in Wandsworth), compared with 431 in 1912, 510 in 1911, and 284 in 1910. This number was 64 under the corrected, and 36 under the uncorrected decennial average. In all the sub-districts (with the exception of Putney) there has been a slight increase compared with 1912, in Clapham of five, in Streatham of 10, in Tooting of 38, and in Wandsworth of nine; while in Putney the decrease was 63. The greatest number of cases occurred in Wandsworth, and the smallest in Putney. The number of cases notified per 1,000 of population was 1-34, compared with 1.37 in 1912, 1.65 in 1911, and .95 in 1910; and in London, 1.6, compared with 1.57, 1.7, and 1.13. 372 or 86.5 per cent. of the cases were removed to hospital where 16 died, and 58 or 13.5 per cent. were treated at home with two deaths. The case mortality was 4.2 per cent., compared with 4.1 in 1912, 6.6 in 1911, and 5.6 in 1910. The case mortality for the whole of London for the year 1913 was 5.6 per cent., compared with 7.4 in 1912, 8.3 in 1911, and 7.9 in 1910. The case mortality among cases treated in hospital was 4.4 per cent., and among those treated at home 3.4 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. 73 Report of the Medical Officer of Health. TABLE XLIV. Sub-Districts. Cases 1913. Case-rate per 1,000 living. Deaths 1913. Death-rate per 1,000 living. 1903— 1912 1913 1903— 1912 1913 Clapham 83 1.4 1.3 3 .10 .05 Putney 19 1.3 .6 1 .08 .04 Streatham 105 1.5 1.03 5 .98 .04 Tooting 86 2.4 2.2 5 .20 .13 Wandsworth 137 1.7 1.4 4 .13 .04 Whole Borough 430 1.6 1.3 18 .11 .06 LONDON 7.654 1.6 1.6 431. .14 .09 The case-rate for the year is .03 under that for the year 1912, and .3 under the average for the 10 years 1903-1912. The highest case-rate was in Tooting, and the lowest in Putney. The case-rate for the Borough is .3 under that for the whole of London, and the death-rate is .03 per 1,000 lower. The death-rate per 1,000 in the Borough was .06, compared with .06 in 1912, .11 in 1911, .05 in 1910, and .11 the decennial average. The Chart (facing page 68) shows the number of cases notified during each week of the year. The maximum number of cases, viz.—22, was notified in the fourth week of August, and the minimum, viz.—two, in the first week of April, and the second week of September. 74 Report of the Medical Officer of Health. The total number of cases, viz.—430, although under the number for 1912, 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 a slight outbreak in an Institution in Clapham, where 12 cases occurred, with one death. The outbreak was due to a case returned from hospital which had been removed as a case of Scarlet Fever in 1912 and in hospital had developed Diphtheria. Shortly after the case returned one case of Diphtheria occurred and this case was the fatal one. The whole of the children and attendants were at once swabbed, with the result that 11 other cases were discovered, these being of a mild type with few definite clinical symptoms. The premises were thoroughly disinfected and no further cases occurred. The next Table shows the number of cases notified since 1891, the number of deaths, the notification rate, the death-rate, and the case mortality for 22 years, as also the average for the 22 years, compared with the year 1913. It will be observed the case-rate is 5.55 lower than the average, and that the death-rate is lower by .19 per 1,000, while the case mortality has been reduced from 11.4 per cent. to 4.1. This reduction in the mortality is mainly due to the use of antitoxin as a remedy. 75 Report of the Medical Officer of Health. TABLE XLV. DIPHTHERIA. Year. Number of Cases. Number of Deaths. Notification rate per 1,000 population. Death-rate per 1,000 of population. Case Mortality per cent. 1891 182 34 1.15 .21 18.7 1892 259 66 1.57 .40 25.4 1893 431 116 2.50 .67 26.9 1894 343 87 1.90 .48 25.3 1895 287 46 1.52 .24 16.0 1896 289 40 1.47 .20 13.9 1897 576 106 2.83 .52 18.4 1898 589 88 2.79 .41 14.9 1899 621 69 2.84 .31 10.2 1900 460 43 2.03 .19 9.0 1901 469 42 2.04 .18 8.9 1902 750 74 3.16 .31 9.6 1903 532 45 2.18 .18 8.4 1904 406 44 1.61 .17 10.8 1905 348 31 1.21 .11 8.9 1906 566 50 1.79 .16 8.8 1907 629 41 1.93 .12 6.5 1908 581 37 1.73 .11 6.3 1909 380 29 .35 .08 7.6 1910 284 16 .95 .05 5.6 1911 510 34 1.65 .11 6.6 1912 431 18 1.37 .06 4.l Average for 22 years 451 51 1.88 .24 11.4 1913 430 18 1.33 .05 4.1 Diphtheria and School Attendance. The following Table shows the number of cases of Diphtheria and their relationship to the schools in the Borough :— 76 Report of the Medical Officer of Health. TABLE XLVI. SCHOOLS. January. February. March. April. May. June. July. August. September. October. November. December. Totals. CLAPHAM. Aristotle Road ... ... ... ... ... ... ... ... ... 1 ... ... 1 Cavendish Road 1 ... ... ... ... ... ... ... ... ... ... ... 1 Haselrigge Road ... ... ... ... ... 1 ... ... ... ... ... ... 1 Larkhall Lane ... 2 ... ... 1 ... ... ... ... ... ... ... 3 New Park Road ... 1 ... 3 ... ... ... ... ... ... ... ... 4 Parochial, Macaulay Road ... ... ... 2 1 1 1 ... ... ... ... ... 5 Parochial Old Town ... ... ... 2 3 2 ... ... ... ... ... ... 7 Telferscot Road ... 1 ... ... ... ... ... ... ... 2 ... ... 3 Wirtemberg Street ... ... ... 2 ... 1 ... ... ... ... ... ... 3 Private Schools ... ... ... ... ... ... ... ... ... ... ... 1 1 Total 1 4 ... 9 5 5 1 ... ... 3 ... 1 29 PUTNEY. All Saints' ... ... ... ... ... ... 1 ... ... ... ... ... 1 St. Mary's ... ... ... ... ... ... ... 1 ... ... ... ... 1 Private Schools ... ... ... ... ... ... ... ... ... ... ... ... 1 Total ... ... ... ... ... ... 1 1 ... ... ... 1 3 STREATHAM. Broadwater Road ... 1 3 ... ... ... ... ... ... 1 ... ... 5 Eardley Road ... ... ... ... ... ... ... ... 2 ... ... ... 2 Fircroft Road 1 ... ... 1 ... 1 ... 2 ... 1 1 ... 7 Hearnville Road 1 1 ... 2 ... 1 ... ... ... ... 2 ... 7 Holy Trinity Upper Tooting ... 1 ... 1 ... 1 1 1 ... ... ... ... 5 Mitcham Lane 1 ... ... ... ... ... ... ... ... 1 2 ... 4 Oldridge Road ... ... 1 ... ... ... ... 1 1 1 2 ... 6 Roman Catholic Nightingale Sq. 1 1 ... ... ... ... ... ... ... ... ... ... 2 St. Leonard's ... ... ... ... 1 ... ... ... ... ... ... ... 1 St. Mary's ... 2 ... ... ... ... ... ... ... ... ... ... 2 Smallwood Road ... 1 2 ... 2 ... 1 ... ... ... ... ... 6 Sunnyhill Road ... ... 1 ... ... ... ... ... ... ... ... ... 1 Private Schools ... ... 1 ... ... ... 2 ... ... ... 1 ... 4 Total 4 7 8 4 3 3 4 4 3 4 8 ... 52 TOOTING. Ensham Street ... ... ... ... ... ... 1 ... 1 ... ... ... 3 Fountain Road 1 ... ... ... 2 ... ... ... ... ... ... ... 3 Franciscan Road ... ... ... ... ... ... ... ... 1 3 ... 2 6 Sellincourt Road ... ... ... ... 1 ... ... 2 ... ... 1 ... 4 Tooting Graveney ... ... ... ... ... ... 1 ... ... 2 ... 1 4 Private Schools ... ... ... ... ... ... ... ... ... ... ... ... ... Total 2 ... ... ... 3 ... 2 2 2 5 1 3 20 Carried forward 7 11 8 13 11 8 8 7 5 12 9 5 104 77 Report of the Medical Officer of Health. TABLE XLVI.—continued. SCHOOLS. January. February. March. April. May. June. July. August. September. October. November. December. Totals. Brought forward 7 11 8 13 11 8 8 7 5 12 9 5 104 WANDSWORTH. Brandlehow Road ... 1 1 ... 1 ... ... ... ... ... ... 2 5 Cambourne Road ... ... ... ... ... ... ... ... ... ... 2 ... 2 Earlsfield ... ... ... ... ... 1 ... 1 ... 1 1 1 5 Eltringham Street ... 1 1 1 ... 3 ... 1 ... 3 1 2 14 Garratt Lane ... ... ... ... ... ... ... ... ... ... 1 ... 1 Littleton Street Special ... ... ... ... ... ... ... ... ... ... 1 ... 1 Magdalen Road ... ... 1 ... ... ... ... ... ... ... ... 1 2 Riversdale ... ... ... ... ... ... ... ... 3 ... ... ... 4 St. Ann's ... ... ... ... ... ... ... ... 1 2 ... ... 3 St. Faith's 1 ... ... ... ... ... ... ... ... ... 1 ... 2 St. Joseph's ... ... ... ... ... ... ... ... ... ... 1 ... 1 Southfield ... ... ... ... ... ... ... 1 ... ... ... ... 1 Swaffield Road ... ... ... ... ... ... ... 1 ... 2 ... ... 3 Waldron Road ... 1 ... ... ... 1 ... ... 3 ... 2 1 8 Wandle ... ... 1 2 2 1 ... ... 2 ... ... ... 8 Warple Way 2 ... 1 ... ... ... ... ... ... ... ... 2 5 West Hill ... 1 ... ... ... ... ... ... ... 2 ... ... 3 Private Schools 1 ... 2 2 ... ... ... ... 1 1 ... ... 7 Total 4 4 7 5 3 6 2 4 10 11 10 9 75 Total—Schools in Borough 11 15 15 18 14 14 10 11 15 23 19 14 179 Schools outside Borough 2 1 1 1 ... ... 1 ... ... 1 ... 1 8 No School 24 21 38 2 16 9 9 13 5 14 18 20 189 Incorrect Diagnosis 4 4 7 4 5 4 4 4 2 9 5 2 54 Grand Total 41 41 61 25 35 27 24 28 22 47 42 37 430 In Clapham, out of a total of 83 cases, 29 or 35 per cent. occurred in children attending school; in Putney, of 19 cases, three or 16 per cent.; in Streatham, of 105 cases, 52 or 50 per cent.; in Tooting, of 86 cases, 20 or 23.2 per cent.; in Wandsworth, of 137 cases, 75 or 54.7 per cent.; and in the whole Borough, of 430 cases, 179 were in attendance at schools in the Borough, and eight at schools outside the Borough, a total of 187, or 43.5 per cent. 78 Report of the Medical Officer of Health. Of the remaining cases, viz.—243, in 54 or 12.5 per cent., the diagnosis was incorrect, and 189 or 44 per cent. were not in attendance at school. In Clapham the number of cases of Diphtheria in attendance at school was 29, the greatest number occurring in Parochial Old Town School, and the next in Macaulay Road School. In Putney only one case each occurred in All Saints', St. Mary's and a private school. In Streatham, Fircroft Road and Hearnville Road with seven cases each were the highest. The sub-district of Tooting was again very free from Diphtheria during the year. Six cases occurred in Franciscan Road, three of these being in October. In Wandsworth there were 75 cases, and these occurred sporadically during the year. In four of the schools only one case occurred in each, in three two cases, in three three cases, in one four cases, in three five cases, in two eight cases, in one 14 cases, and seven cases occurred in various private schools. The principal school affected in Wandsworth was Eltringham Street, where 14 cases occurred, three in June, three in October, two in December, and one each in February, March, April. July, August and November. Of the total number of cases notified 54 were incorrectly diagnosed, compared with 41 in 1912, leaving a total of 376 actual cases, compared with 390 in 1912, 468 in 1911, and 245 in 1910. The number of dwellings in each sub-district and the whole Borough in which multiple cases occurred is shown in the following Table. 79 Report of the Medical Officer of Health. TABLE XLVII. Sub-Districts. One case. Two cases. Three cases. Four cases. Five cases and upwards. Total houses invaded. Clapham 53 7 ... 1 1* 62 Putney 15 2 ... ... ... 17 Streatham 82 3 4 ... 1 90 Tooting 68 2 3 ... 1 74 Wandsworth 123 4 2 ... ... 129 Whole Borough 341 18 9 1 3 372 *12 cases occurred in an Institution. Of the 372 houses invaded, multiple cases occurred in 31, or 8.3 per cent. No cases of Diphtheria were notified as having occurred in children attending the following elementary schools in the Borough: In Clapham:— Bonneville Road. Christchurch. New Road. St. Andrew's Street. St. Mary's, Crescent Lane. St. Mary's, St. Alphonsus Road. In Putney:— Convent of the Sacred Heart, Roehampton. Hotham Road. National School, (Boys'), Roehampton. National School (Girls'), Roehampton. Upper Grade, Walker's Place. 80 Report of the Medical Officer of Health. In Streatham:— Broadwater Road Special. Christchurch. Hearnville Road Special. Hitherfield Road. Holy Trinity, Upper Tulse Hill. Immanuel. St. Andrew's, Colmer Road. St. Andrew's, Polworth Road. Furzedown Demonstration. In Tooting:— Derinton Road. Roman Catholic, Undine Street. In Wandsworth:— All Saints'. Convent of the Sacred Heart, West Hill. Earlsfield Special. Elliott Central. Frogmore Special. Merton Road. Roman Catholic, North Side, Wandsworth Common. St. Michael's. St. Thomas's. In all 31 schools remained free from Diphtheria, compared with 28 in 1912. In three schools, viz.:—All Saints', Putney, Swaffield Road and Clapham Parochial, it was necessary to have swabs taken from the throats of the children, and in Swaffield Road two, and in Clapham Parochial one, were found to give positive results, while in All Saints', Putney, these were all negative. The Medical Officer of Health, London County Council, instructed the teachers of the Departments in the schools concerned to exclude all children suffering from sore throat, and to forward particulars to me on special forms supplied to them. Report of the Medical Officer of Health. 81 The above and other 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, four or '93 per cent, occurred among children under one year, 116 or 27 pjr ce.it. among children from one and under five years, or 51.6 per cent, from five and under 15 years, 41 or 9.5 per cent., from 15 and under 25 years, and 47 or 107 per cent, from 25 and under 65 years. Compared with the previous year there has been an increase at one and under five years, 15 and under 25 years and 25 and under 65 years. Of the 372 cases of Diphtheria removed to Hospital, 54 were reported not to have suffered from Diphtheria. Return Cases of Scarlet Fever and Diphtheria. 45 cases of Scarlet Fever occurred after the return of cases from the hospitals of the Metropolitan Asylums Board* compared with 39 in 1912, 52 in 1911, and 40 in 1910. There were also 14 cases of Diphtheria, compared with two in 1912, two in 1911, and one in 1910. 16 of the return cases of Scarlet Fever occurred in Clapham, four in Putney, eight in Streatham, 12 in Tooting, and five in Wandsworth. 13 of the return cases of Diphtheria occurred in Clapham, and one in Streatham. The number of return cases shows an increase this year owing chiefly to the number of return cases in two Institutions, both in Clapham. In Clapham seven cases of Scarlet Fever occurred in an Institution after the return of a case from the Metropolitan Asylums Board's Hospital, anrl 12 cases of Diphtheria, also in an Institution in Clapham, after the return of a case. In the case of the return 82 Report of the Medical Officer of Health. cases of Diphtheria in Clapham, these were of a very mild type, having only being recognised as such after bacteriological examination of swabs taken from the throats of the children affected. 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 54.3, compared with 66 in 1912, and in the cases of Diphtheria 64 days, compared with 43 in 1912. In seven premises mere than one case occurred after the return of a case from hospital, seven cases in one premises, four cases in one premises, and two cases each in five premises. In six of the cases complaint was made that the patients suffered from nasal discharge. Report of the Medical Officer of Health. 83 TABLE XLV1II. RETURN CASES OF SCARLET FEVER. Sub-Districts. Xo. Removed to Hospital. Returned from Hospital. [ Xo. of days istcase was in Hos- pital. | Date of 1st symptoms of subsequent case. No. of days elapsing between return of 1st case and 1st symptoms of subsequent case. Remarks. Clapham I9T2 1913 1913 1 12th Oct. 6th Jan. 86 12th Jan. 6 2 18th Nov. 8th „ 51 19th „ II 3 4th Dec. 16th „ 43 20th „ 4 ' Nasal discharge same family 4 „ „ „ „ 43 nth Feb. 26 5 1913 28th Jan. i-jth Mar. 45 25th Mar. 11 Same family 0 „ „ „ „ 45 „ „ 11 7 4th Mar. 24th April 51 13th May 19 Institution cases 8 2nd April 9th June 68 22nd June 13 9 „ „ „ „ 68 23rd „ 14 10 ,, ,, ,, ,, 68 „ „ 14 11 „ „ „ „ 68 25th „ I7 12 „ „ „ „ 68 27th „ 18 13 „ „ „ „ 68 „ „ 18 14 1st Oct. 24th Nov. 54 5th Dec. 12 15 11th Sept. 25th Oct. 44 31st Oct. 6 16 13th Oct. 22nd Nov. 40 24th Nov. 2 Putney 17 20th Jan. 14th Mar. 53 17th Mar. 3 Same family 18 „ „ „ „ 53 20th „ 6 19 23rd Feb. 9th April 45 13th April 4 Same family 20 „ ,, ,, ,, 45 15th „ 6 Streatham 21 1912. 27th Nov. 22nd Jan. 56 31st Jan. 9 22 7th Dec. 1913 23rd „ 47 7th Feb. 15 23 9th Jan. 24th Feb. 46 28th ,, 4 Same family 24 „ „ „ „ 46 „ „ 4 25 1912 15th Dec. 1913 5th Mar. 80 15 th Mar. 10 Nasal discharge 26 28th Jan. 14th „ 45 17th ,, 3 27 22nd April 5th June 44 13th June 8 Nasal discharge 28 26th Sept. 6th Nov. 41 16th Nov. 10 „ „ Tooting 29 1912 30th Oct. 1912 20th Dec. 51 1913 10th Jan. 21 30 ,, ,, ,, ,, 51 13th ,, 24 31 18th Nov. 3ist „ 43 8th Jan. 8 32 25th „ 1913 28th Jan. 64 10th Feb. 13 84 Report of the Medical Officer of Health. TABLE XLV1II—(continued.) 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. Tooting.— (icontinued:] 1913 1913 1913 Same family 33 nth Feb. 29th Mar. 46 4th April 6 34 „ „ „ „ 46 8 th „ 1O 35 4th April 20th June 46 13th July 23 36 23rd „ 13th „ 51 15th June 2 37 „ „ „ „ 51 16th „ 3 38 16th June 28th July 42 30th July 2 39 „ ,, „ „ 42 4th Aug. 7 40 12th Oct. 22nd Nov. 40 27th Nov. 5 Wandsworth 41 23rd Jan. 26th Mar. 62 31st Mar. 3 42 9th Feb. 29th ,, 48 12th April 14 43 18th Mar. 4th July 108 1st Aug. 28 Nasal discharge 44 20th July 8th Oct. 80 22nd Oct. 14 45 27th Sept. 13th Nov. 47 6th Dec. 23 TABLE XLVIX: RETURN CASES OF DIPHTHERIA. [##]Sub-Districts. Xo. 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 1912 1913 1913 1 27th Dec. 6th Feb. 41 15th Feb. 9 Xasal diseharg 2 13th „ 14th „ 62 24th 10 Institution cases. 3 „ „ „ „ 62 „ „ 10 4 „ „ „ „ 62 „ „ 10 5 „ „ „ „ 62 „ „ 10 6 „ „ „ „ 62 „ „ 10 7 „ „ „ „ 62 „ „ 1O 8 „ „ „ „ 62 „ „ 10 9 „ „ „ „ 62 25th „ 11 10 „ „ „ „ 62 28th „ 14 11 „ „ „ „ 62 5th Mar. 19 12 „ „ „ „ 62 „ „ 19 13 „ „ „ „ 62 „ „ 19 Streatham 14 1913 1st April 25th July 114 7th Aug. 13 Report of the Medical Officer of Health. 85 Enteric Fever. 50 cases of Enteric Fever were notified during the year, (10 from Clapham, two from Putney, 13 from Streatham, three from Tooting, and 22 from Wandsworth), compared with 71 in 1912, 58 in 1911, and 54 in 1910, and is 35 under the corrected decennial average. 39 of the cases were removed to hospital where four died, and 11 were treated at home with one death. The total number of deaths was five, all in Wandsworth, compared with eight in 1912, nine in 1911, and eight in 1910. The number of deaths was three less than in 1912, and 6-6 under the decennial average. The proportion of cases notified per 1,000 of population was .15, compared with .22 in 1912, .18 in 1911, and .18 in 1910, and with .16 for the whole of London. The corrected death-rate from Fever was .015 per 1,000, compared with .02 in 1912,.03 in 1911, and .02 in 1910 ; while the rate for the whole of London was .02, compared with .025 in 1912, .03 in 1911, and .04 in 1910. Of the 39 cases removed to hospital, seven or 18 per cent, were found not to be suffering from Enteric Fever, compared with 16.6 per cent. in 1912. The Chart (facing page 68), shows the number of cases notified during each week of the year. In 21 of the weeks during the year no cases were notified, one case each in 21 of the weeks, two cases each in four of the weeks, three cases each in six of the weeks, and four cases in one of the weeks. The maximum number of cases, viz.— four, was notified in the second week of September. 86 Report of the Medical Officer of Health. Of the 50 cases notified eight were not Enteric Fever, three occurred in H.M. Prison, and two in the Middlesex County Asylum, leaving 37 cases in which special enquiries were made as to the probable cause of the disease. In 14 of the cases the disease was probably contracted by eating shell-fish, in four it was c >ntracted abroad, in two the infection was contracted from previous cases, in five probably from watercress, in one from polluted water while on service, while in 11 no history of infection could be ascertained. With regard to the 14 cases caused by shell-fish, five were from oysters, three from winkles, four from cockles, and two from mussels. Of the total number of cases infected in all probability by eating shell-fish, two died. In the cases contracted abroad, four in number, it was impossible to ascertain the exact source of infection. Of the eight cases which were not Enteric Fever three were fatal, one from General Tuberculosis, one from Acute Cerebral Meningitis, and one from Pulmonary Tuberculosis. The notification rate and the death-rate from this disease were the lowest on record. Cases of Mistaken Diagnosis. In 1x3 cases, (43 of Scarlet Fever, 54 of Diphtheria, eight of Enteric Fever, six of Cerebro-spinal Fever, one of Continued Fever, and one of Puerperal Fever), information was received from the Metropolitan Asylums Board's and other hospitals, that the patients were not suffering from the disease notified or any other notifiable disease, compared with 88 in 1912, 102 in 1911, and 107 in 1910. Report of the Medical Officer of Health. 87 Of 1,312 cases removed to hospital, in 113 or 8-5 per cent, the diagnosis was incorrect, compared with 7-8 per cent, in 1912, 8-5 per cent, in 1911, and 12-6 per cent, in 1910. There has been a slight increase in the percentage of cases of mistaken diagnosis. The highest percentage of mistaken diagnosis occurred in respect of Cerebro-spinal Meningitis, viz.100 per cent., no case out of seven removed proving on further examination to have been suffering from that disease. TABLE L. Disease. No. of cases of mistaken diagnosis. Total. Total cases removed. Percentage of error in Diagnosis. Clapham. Putney. Streatham. Footing. Wandsworth. Scarlet Fever 13 2 4 15 9 43 842 5.2 Diphtheria 7 3 12 20 12 54 372 14.5 Enteric Fever 2 ... 1 2 3 8 38 2i.0 Continued Fever ... ... ... ... 1 1 1 ioo'o Cerebro-spinal Meningitis ... ... ... 5 2 7 7 ioo'o Puerperal Fever ... ... ... ... 1 1 22 4.5 Polio-Myelitis ... ... ... ... ... ... 8 ... Ophthalmia Neonatorum ... ... ... ... ... ... 22 ... Total 22 5 17 42 28 114 1,312 8.7 In 1912 the percentage of cases of mistaken diagnosis for the whole of London was, for Scarlet Fever 6.4, compared with 8.7 in 1911 ; for Diphtheria 12.9, compared with 12.7 ; and for Enteric Fever 40.8 compared with 34.2. 88 Report of the Medical Officer of Health. Cerebro-spinal Meningitis. Nine cases were notified during the year, (one in Streatham,. five in Tooting, and three in Wandsworth), compared with threein 1912, and five in 1911. Seven of these cases proved not to be Cerebro-spinal Meningitis, and of these four died, three from Tubercular Meningitis, and one from Malignant Disease. The remaining two cases notified died, one of Cerebro-spinal Meningitis, and one of Posterior basic Meningitis. In London 145 cases of this disease were notified during the year, compared with 105 in 1912. 21 deaths were registered as having been caused by Meningitis, two in Clapham, nine in Streatham, five in Tooting, and five in Wandsworth, compared with 21 in 1912. Seven of these were of infants under one year, four from one and under two years, two from two and under five years, and eight 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 726 bacteriological examinations were made at the Lister Institute, compared with 841 in 1912, 624 in 19x1, 318 in 1910, 397 in 1909, 491 in 1908, 466 in 1907, 407 in 1906, 174 in 1905, 121 in 1904, 125 in 1903, and 98 in 1902. 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. Report of the Medical Officer of Health. 89 TABLE LI. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. diphtheria. Negative 89 74 143 28 158 492 Positive 33 9 74 14 61 191 enteric fever. Negative 5 4 11 2 7 29 Positive 1 2 6 — 5 14 Totals 128 89 234 44 231 726 In 191 out of 683 examinations for the bacillus of Diphtheria the result was positive, and in 14 out of 2.9 examinations of blood in suspected cases of Enteric Fever the Widal re-action was obtained. The decrease in the total number was due to the absence of Diphtheria in any of the Institutions in the Borough. Puerperal Fever. 32 cases of Puerperal Fever were notified, compared with 27 in 1912, 24 in 1911, and 20 in 1910. Five cases occurred in Clapham, six in Putney, three in Streatham, four in Tooting, and 14 in Wandsworth. 13 of the cases (three in Clapham, two in Putney, three in Streatham, one in Tooting, and four in Wandsworth), or 40 per cent, were fatal, compared with 40 per cent, in 1912, 33-3 per cent, in 19x1, and 25 per cent, in 1910. 22 of the cases were removed to Institutions (five to St. James's Infirmary, 11 to the Metropolitan Asylums Board's Hospitals and one each to St. Bartholomew's, St. Thomas's, Westminster, 90 Report of the Medical Officer of Health. Royal Waterloo, Grosvenor Hospitals), and the Central London Sick Asylum, where nine died, and 10 were treated at home with four deaths. The death-rate was .04 per 1,000, compared with .035 in 1912, .025 in 1911, and .016 in 1910. The case-rate per 1,000 births was 4.6 compared with 4.0 in 0:912, 3-5 in 1911, and 2.8 in 1910, and for the whole of London 3.0, compared with 3.4. In five of the cases registered midwives only were employed, while six of the cases were misc arriages, two were premature, and in one, twins were born. Seven nurses had free baths, one came from Lambeth, three were district nurses, and these as well as the remainder had baths at their own homes. In 26 cases the personal clothing of the nurse was disinfected. In any case where a registered midwife was in attendance a report was forwarded to the London County Council. Erysipelas." 204 cases of Erysipelas were notified during the year and six deaths occurred. 29 of the cases and no death occurred in Clapham, 17 cases and two deaths in Putney, 34 cases and two deaths in Streatham, 31 cases and one death in Tooting, and 73 cases and one death in Wandsworth. In 1912 the number of cases notified was 207, and the deaths five. 39 of the cases were removed to the Union Infirmary, where two died. Report of the Medical Officer of Health. 91 Measles. During the year 116 deaths, 57 of males and 59 of females, were due to Measles, compared with 51 in 1912, 230 in 1911, and 44 in 1910. 19 of the deaths occurred in Clapham, 12 in Putney, 22 in Streatham, 26 in Tooting, and 37 in Wandsworth. The number of deaths is 65 more than in 1912, and is if above the corrected decennial average. 23 of the deaths were of infants under one year, 40 from one and under two years, 32 from two and under five years, 17 from five and under 15 years, and one from 45 and under 65 years ; 84-5 per cent, of the deaths having occurred under five years of age. The death-rate was -36 per 1,000, compared with -16 in 1912, 74 in 1911, and .14 in 1910. The death-rate for the whole of London was .34, compared with .40 in 1912, for England and Wales .28, and for the 96 Great Towns .34, for the 145 smaller towns "30, and for England and Wales, less the 241 towns, .20 per 1,000. During the year 188 cases of Measles were removed to the Metropolitan Asylums Board's hospitals (35 from Clapham, 13 from Putney, 27 from Streatham, 47 from Tooting, and 66 from Wandsworth). 22 of the 66 cases removed from Wandsworth, were from che Workhouse. Of the total of 188 cases removed to these hospitals, 32 died, giving a case mortality of 17 per cent. The majority of the cases removed to hospital were under the care of the District Medical Officers, but during the year the Metropolitan Asylums Board consented to remove other than pauper 92 Report of the Medical Officer of Health. cases provided the Medical Officer of Health certified that the home conditions were such that the case could not be satisfactorily treated at home. When future outbreaks occur it is to be hoped that more parents will take advantage of this, as it will tend to prevent the occurrence of multiple cases, and the cases will also be afforded more satisfactory treatment. During the year 2,164 visits were made in cases of this disease, (compared with 1,802 in 1912), 327 in Clapham, 145 in Putney, 680 in Streatham, 447 in Tooting, and 565 in Wandsworth. Table LII. shows the number of cases of notifiable and nonnotifiable diseases notified by the teachers of the elementary schools in the Borough. In all, 4,907 cases were notified, compared with 4,706 in 1912, 6,785 in 1911, and 4,617 in 1910. 1,434 of these were cases of Measles, 842 of Chicken-pox,. 496 of Whooping Cough, 731 of Mumps, and 355 of Ringworm. There was an increase in the number of cases of Measles, Chicken.pox and Mumps, and a decrease in the number of cases of Whooping Cough and Ringworm. With regard to Measles, 241 cases were notified from schools in Clapham, 74 in Putney, 389 in Streatham, 273 in Tooting, and 457 in Wandsworth. The schools chiefly affected were, in Clapham, Bonneville Road, Haselrigge Road, Telferscot Road, and St. Andrew's Street; in Putney, Hotham Road and St. Mary's ; in Streatham, Mitcham Lane, Broadwater Road, Eardley Read, Oldridge Road, and Smallwocd Road ; in Tooting, Franciscan Road, Tooting Graveney, Ensham Street, Fountain Road, and Sellincourt Road ; and in Wandsworth, the Earlsfield, Waldron Road, Wandle, and Swaffield Roacl. Very few of the schools were quite free from the disease, but in a considerable proportion only a few cases occurred. Report of the Medical Officer of Health. 93 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 the Report for 1911, and disinfection of the premises after cases had recovered. 94 Report of the Medical Officer of Health. TABLE LII. Notifiable and Non-Notifiable Diseases Reported from Schools, 1913. School. Diseases. Scarlet Fever. | Diphtheria. Measles. ChickenPox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Clapham Aristotle Road ... i ... ... ... ... ... ... 1 Bonneville Road 6 ... 41 3i 39 11 11 io 149 Cavendish Road 10 i 5 1 ... 1 6 2 26 Christchurch ... ... ... ... ... ... 1 2 3 Clapham Parochial 4 12 32 5 ... ... 1 4 58 Haselrigge Road 20 i 5 32 22 56 6 74 216 Larkhall Lane 18 3 28 4 5 3 7 9 77 Lyham Road ... ... 1 ... ... ... ... ... 1 New Park Road 3 4 15 8 8 1 10 ... 49 New Road 2 ... 1 ... 1 ... 1 2 7 St. Andrew's Street 6 20 15 39 4 5 11 100 St. John's ... ... 2 ... 2 1 ... ... 5 St. Mary's 9 ... 32 10 8 5 1 ... 65 Telferscot Road Wirtemberg Street 8 10 3 3 53 6 33 16 1 8 5 3 5 4 5 1 113 51 Total 96 28 241 155 133 90 58 120 921 Putney All Saints' 2 1 7 2 20 2 ... ... 34 Conv. of Sacred Heart 1 ... ... ... ... ... ... ... 1 Hotham Road 3 ... 60 11 48 2 6 8 138. Roehampton National 1 ... ... 5 18 ... ... ... 24 St. Mary's 7 1 7 5° 10 2 3 3 83 Total 14 2 74 68 96 6 9 11 280 Streatham Broadwater Road 13 5 42 26 2 31 9 4 !32 Christchurch 2 ... ... ... ... ... 1 ... 3 Eardley Road 5 2 76 41 11 1 7 1 144 Fircroft Road 10 7 35 4 6 23 6 1 92 Holy Trinity, Balham 5 5 13 9 10 9 11 2 64 Holy Trinity, Streatham 1 ... ... 6 2 ... ... 3 12 Hearnville Road 8 7 25 13 3 2 ... ... 58 Hitherfield Road ... ... 21 3 2 5 ... 1 32 Immanuel 13 ... 3 10 2 ... ... ... 28 Mitcham Lane 12 4 51 90 21 14 17 15 224 Nightingale Sq., R.C. 1 2 ... 8 ... ... ... ... II Oldridge Road 31 6 12 9 13 12 12 40 135 Smallwood Road 8 6 9 25 18 58 11 13 148 St. Andrew's, Polworth Road 3 ... ... ... ... ... ... ... 3 St. Andrew's, Colmer Road 1 ... 37 9 2 ... 3 ... 52 St. Leonard's 3 1 5 ... 1 1 2 5 18 St. Mary's ... 2 32 10 8 5 1 58 Sunnyhill Road 3 1 28 ... 8 3 2 2 47 Furzedown Demon stration 2 ... ... ... 8 ... 1 ... ii St. Andrew's, Coventry Hall 1 ... ... ... ... ... ... ... i 1 Total 122 48 389 263 117 164 83 87 1.273 Carried forward 232 78 704 486 346 260 150 218 1 2,474 Report of the Medical Officer of Health. 95 TABLE LII.—continued. Schools. Diseases. Scarlet Fever. Diphtheria. Measles. ChickenPox. Whooping Cough. Mumps. Ringworm. Other Diseases. | Totals. Brought forward 232 78 7°4 486 346 260 I50 218 2,474 Tooting Derinton Road 3 ... 9 2 5 ... i ... 20 Ensham Street 18 3 63 14 1 27 4 1 131 Fountain Road 4 3 13 15 5 61 8 32 i4i Franciscan Road 15 6 14 27 8 105 25 4 204 Sellincourt Road 5 4 66 29 10 40 21 10 185 Tooting Graveney 14 4 77 23 J 80 22 6 235 Undine Street, R.C 12 ... 31 ... ... 1 ... ... 44 Total 7i 20 273 no 38 314 81 53 960 Wandsworth All Saints' ... ... 8 3 ... 1 1 5 18 Brandlehow Road 11 5 43 16 6 2 7 3 93 Cambourn Road 1 2 ... 1 ... 2 7 12 25 Conv. of Sacred Hear 2 ... ... ... ... ... ... ... 2 Earlsfield 17 5 60 43 19 6 11 161 Elliott Central 1 ... ... ... ... ... ... ... 1 Eltringham Street 7 J4 31 18 2 6 4 10 92 Frogmore ... ... ... ... ... ... ... ... ... Garratt Lane 7 1 3 3 6 1 17 35 73 Littleton Street 1 1 ... 3 ... ... 2 ... 7 Magdalen Road ... 2 3 ... ... ... ... 3 8 Merton Road 6 ... 5 14 3 4 7 5 44 I Riversdale 5 4 3 2 ... 1 6 3 24 St. Anne's 1 3 i ... ... 1 1 7 St. Faith's 4 2 46 ... ... 6 3 2 63 St. Joseph's, R.C. 1 1 ... 4 ... 2 5 4 17 St. Michael's ... ... 7 40 3 1 3 ... 45 Southfield 1 1 17 16 3 22 7 3 70 I Swaffield Road 14 3 «3 20 33 20 13 9 225 Waldron Road 25 8 27 34 26 10 11 21 162 Wandle 16 8 80 9 11 68 20 41 253 Warple Way 5 5 8 ... ... 5 2 6 31 West Hill 10 3 3 19 ... ... 8 ... 43 Total 135 68 457 246 112 157 124 174 1,473 Grand Total 438 166 1,434 842 496 731 355 445 4.907 Report of the Medical Officer of Health. It will be seen from Table LIII. as well as from the Table of the number of disinfections carried out, that the disease was most prevalent in January, February and March, 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 January 38, in February 55, in March 22, in April 31, in May seven, in June nine, in July four, in September one, in October one, in November four, and in December one. Report of the Medical Officer of Health. 97 TABLE LIII. No. School. Class-room. Period of exclusion. No. of days. 1 Hearneville Road, Balham Class H Jan. 15th—24th Jan. 10 2 Earlsfield, Wandsworth „ C 16th— „ „ 9 3 Smallwood Road, Balham „ D „ „ „ „ 9 4 Wandle, Wandsworth „ G „ „ „ „ 9 5 Do. do. „ D „ „ ,, .. 9 6 Ensham, Tooting „ B „ „ „ „ 9 7 Eltringham St., Wandsworth „ C „ „ „ „ 9 8 Do. do. „ G „ —3rd Feb. 19 9 St. Mary's, Balham „ 2 ,, 17th—31st Jan. 15 10 Bonneville Rd., Clapham „ D „ 20th—27th „ 8 11 Brandlehow Road, Wandsworth „ D „ —24th,, 5 12 Tooting Graveney, Tooting „ D „ —31st „ 12 13 Franciscan Rd., Tooting „ F „ „ „ „ 12 14 Ensham, Tooting „ D „ „ „ „ 12 15 Swaffield Rd., Wandsworth „ . D „ „24th ,, 5 16 New Park Road, Clapham „ c „ 3rd Feb 15 17 Eltringham Street, Wandsworth „ D „ —5th „ 17 18 Swaffield Road, Wandsworth „ F „ 27th—31st Jan. 5 19 Eltringham St., Wandsworth „ A & B „ „ „ „ 5 20 Swaffield Road, Wandsworth „ E „ „ —5th Feb. 10 21 Sellincourt Rd., Tooting „ C „ —7th „ 12 22 Hitherfield Road, Streatham „ B ,, ,, ,, ,, 12 23 Broadwater Rd., Balham „ D ,, ,, ,, ,, 12 24 Franciscan Road, Tooting „ H 12 25 St. Mary's, Balham „ 4 „ —14th „ 19 26 Hearneville Road, Balham „ c ,, 28th— „ „ 18 98 Report of the Medical Officer of Health. TABLE LIII.—continued. No. School. Class-room. Period of exclusion. No. of days. 27 St. Andrew's St., Clapham Class F Jan. 29th—7th Feb 10 28 Hitherfield Road, Streatham „ c ,, ,, ,, ,, 10 29 Sellincourt Rd., Tooting „ D ,, ,, ,, ,, 10 30 Undine Street R.C. „ B ,, ,, ,, ,, 10 31 St. Andrew's St., Clapham „ E ,, ,, ,, ,, 10 32 Wandle, Wandsworth „ H „ 30th— „ „ 9 33 Tooting Graveney, Tooting „ E ... ,, ,, ,, ,, 9 34 Bonneville Road, Clapham „ E ,, ,, ,, ,, 9 35 Magdalen Rd., Wandsworth „ F „ —I4th „ 16 36 Telferscot Rd., Clapham ... „ C ,, ,, ,, ,, 16 37 Fircroft Road, Balham ... „ D „ 31st— „ „ 15 38 Swaffield Road, Wandsworth Hall ,, ,, ,, ,, 15 39 Bonneville Rd., Clapham Class G Feb. 3rd—7th „ 5 40 Wandle, Wandsworth „ F ,, ,, ,, ,, 5 41 St. Mary's, Balham ,, 3 ,, ,, ,, ,, 5 42 Hotham Road, Putney ... „ B „ —14th „ 12 43 Earlsfield, Wandsworth ... „ B&G ,, ,, ,, ,, 12 44 Riversdale, Wandsworth „ G 12 45 Haselrigge Rd., Clapham „ A 1 & A 2 ,, 4th- ,, ,, 11 46 Swaffield Road, Wandsworth „ A, B, C ,, ,, ,, ,, 11 47 Hearneville Road, Balham „ B & G pp 5th- ,, ,, 10 48 St. Andrew's, Colmer Road Streatham „ B „ „ ,, ,, 10 49 Tooting Graveney, Tooting „ F „ —2ISt „ 17 5° Waldron Rd., Wandsworth „ D ,, 6th—14th ,, 9 5i New Park Road, Clapham „ D „ 10th— ,, ,, 5 52 Cavendish Road, Balham „ C ,, ,, ,, ,, 5 Report of the Medical Officer of Health. 99 TABLE LIII.—continued. No. School. Class-room. Period of exclusion. No. of days. 53 Hearneville Road, Balham Class D Feb. 10th—2istFeb. 12 54 St. Mary's, Balham „ 1 ,, ,, ,, ,, 12 55 New Road, Clapham „ A&C ,, ,, ,, ,, 12 56 Broadwater Rd., Balham „ A ... ,, ,, ,, ,, 12 57 Tooting Graveney, Tooting „ C ... ,, ,, ,, ,, 12 58 St. Andrew's St., Clapham „ F ,, ,, ,, ,, 12 59 New Park Road, Clapham „ E ,, ,, ,, ,, 12 6O Cavendish Rd., Balham... „ F ... ,, ,, ,, ,, 12 6l Telferscot Road, Clapham „ B&D „ 11th— „ „ 11 62 Hearneville Road, Balham „ E „ 12th— „ „ 10 63 Mitcham Lane, Streatham „ F „ 13th— „ „ 9 64 Smallwood Road, Balham „ A ,, ,, ,, ,, 9 65 New Park Road, Clapham „ B ,, ,, ,, ,, 9 66 Wandle, Wandsworth „ G ... ,, ,, ,, ,, 9 67 Franciscan Road, Tooting „ H ... ,, I7th-28tll ,, 12 68 Ensham, Tooting... „ A & C ,, ,, „ „ 12 69 Broadwater Rd., Tooting „ H ,, ,, ,, ,, 12 70 ,, „ „ B „ ,, —7th Mar. 19 71 J ,, ,, —28th Feb. 12 72 Smallwood Road, Balham „ G „ „ ,, ,, 12 73 Sellincourt Road, Tooting „ B ,, 18th— „ ,, II 74 Riversdale, Wandsworth F ,, „ —7th Mar. 18 75 Hotham Road, Putney „ A ,, ,, —28th Feb. II 76 Hitherfield Rd., Streatham ,, B & C „ 19th—7th Mar. 17 77 Bonneville Road, Clapham „ B „ 24th—19th ,, 24 78 Mitcham Lane, Streatham „ D ,, ,, ,, ,, 24 loo Report of the Medical Officer of Health. TABLE LIII.—continued. No. School. Class-room. Period of exclusion. No. of days. 79 All Saints', Putney Class A Feb. 24th—7th Mar. 12 80 Hotham Road, Putney „ B ,, ,, ,, ,, 12 81 Franciscan Rd., Tooting „ E ,, ,, ,, ,, 12 82 St. Mary's, Putney „ A ,, ,, ,, ,, 12 83 West Hill, Wandsworth „ D ,, ,, ,, ,, 12 84 New Park Road, Clapham „ D „ „ ,, ,, 12 85 Ensham, Tooting „ B „ 27th— „ „ 9 86 Haselrigge Rd., Clapham ,, Gi & G2 ,, ,, —19,, ,, 21 87 Eardley Road, Streatham „ A Mar. 3rd— „ „ 17 88 St. Andrew's St., Clapham „ c ,, ,, ,, ,, 17 89 Eltringham St., Wandsworth „ A 5th— „ „ 15 90 Eltringham St., Wandsworth „ B 7th— „ „ 13 91 Mitcham Lane, Streatham „ B „ 10th— ,, ,, 10 92 Franciscan Rd., Tooting „ A ,, nth— „ „ 9 93 Hitherfield Rd., Streatham „ A ,, 12th— ,, ,, 8 94 Fircroft Road, Balham „ B, D &E ,, ,, ,, ,, 8 95 Mitcham Lane, Streatham „ c „ 13th— „ „ 7 96 Smallwood Road, Balham ,, A ,, ,, ,, ,, 7 97 Parochial, Clapham „ A ,, ,, ,, ,, 7 98 All Saints', Wandsworth c ,, ,, ,, ,, 7 99 Broadwater Rd., Balham „ C&F ,, ,, ,, ,, 7 100 Sunnyhill Rd., Streatham „ B „ 14th— „ „ 6 101 New Park Road, Clapham „ A & E „ 17th— „ „ 3 102 Ensham, Tooting „ A & C ,, ,, ,, ,, 3 103 Ensham, Tooting „ D ,, ,, ,, ,, 3 104 St. Andrew's St., Clapham „ B ,, ,,—4th Apr. 16 105 Larkhall Lane, Clapham „ B „ ,, —18th Mar. 2 Report of the Medical Officer of Health. 101 TABLE LIII.—-continued. No. School. Class-room. Period of exclusion. No. of days. 106 Bonneville Rd., Clapham Class G Mar. 19th—4th Apr. 17 107 All Saints', Putney ,, B ,, ,, ,, ,, 17 108 Larkhall Lane, Clapham „ D ,, 31st—-nth Apr. 12 109 Sunnyhill Rd., Streatham „ B&E Apr. 4th—18th ,, 15 no Larkhall Lane, Clapham „ E & F ,, ,, ,, ,, 15 in 112 Magdalen Road, Wandsworth Immanuel, Streatham „ F „ B 9th—25th „ ,, 10th— „ „ 17 16 "3 Sellincourt Rd., Tooting „ B „ 11th— „ „ 15 114 Tooting Graveney, Tooting „ F „ ,, ,, ,, 15 115 Derinton Road, Tooting „ B ,, 14th—-2nd May 19 116 Wandle, Wandsworth „ D ,, 16th— „ „ 17 n7 Fircroft Road, Balham „ B ,, „ „ „ 17 118 Wandle, Wandsworth „ E „ 17th— „ „ 16 119 St. Andrew's, Colmer Road „ B „ 18th— „ „ 15 120 Wandle, Wandsworth „ F ,, ,, ,, ,, 15 121 New Park Road, Clapham „ A „ 22nd—9th „ 18 122 Tooting Graveney, Tooting ,, B&E ,, ,, ,, ,, 18 123 ,, ,, ,, „ C ,, ,, ,, ,, 18 124 Hotham Road, Putney „ B ,, ,, ,, ,, 18 125 Wandle, Wandsworth „ C ,, ,, ,, ,, 18 126 Sunnyhill Rd., Streatham „ D ,, ,, ,, ,, 18 127 Merton Rd., Wandsworth „ F ,, ,, ,, ,, 18 128 Ensham, Tooting „ A ,, ,, ,, ,, 18 129 Fountain Road, Tooting „ C „ 23rd— ,, ,, 17 130 St. Andrew's, Colmer Road The Infant Department ,, ,, ,, ,, 17 131 Ensham, Tooting Class B ,, ,, ,, ,, 17 102 Report of the Medical Officer of Health TABLE LIII.—continued. No. School. Class-room. Period of exclusion. No. of days. 132 Sunnyhill Rd., Streatham Class C Apr. 23rd—9th May 17 J33 Derinton Road, Tooting „ c ... „ 24th— 16 134 Eltringham Street, Wandsworth ,, B ... „ „ - 16 135 Hotham Road, Putney ... „ A ... „ 25th— „ „ ... 15 136 Eardley Road, Streatham „ D ... 99 M 99 99 15 137 Hotham Road, Putney ... „ A 15 138 Larkhall Lane, Clapham... „ B, C, D & E ,, 28th ,, 12 139 Tooting Graveney, Tooting „ D ... „ 30th „ „ ... 10 140 Larkhall Lane, Clapham... „ A ... May 1st—16th 16 141 Ensham, Tooting „ B ... 5th— „ „ ... 12 142 Eardley Rd., Streatham... „ F ... „ „ ••• 12 143 Ensham, Tooting „ F ... „ 99 ,9 99 -.. 12 144 Clapham Parochial „ A ... „ ... 12 145 Holy Trinity, Balham „ J ... 99 9 9 9t 99 12 146 St. Andrew's, Colmer Rd. „ C ... 19 9 9 99 9 9 •.. 12 147 Eardley Rd., Streatham... „ A & C 7th 23rd 17 148 Sellincourt Rd., Tooting... •„ C ... 8th— „ „ ... 16 149 Sunnyhill Rd., Streatham „ E ... „ ... 16 150 Holy Trinity, Balham „ H ... ,, 16th—-30th „ ... 15 151 Smallwood Road, Balham „ G ... „ 19th— „ „ ... 12 152 Sunnyhill Rd., Streatham „ F ... ,, ,, —-6th June 18 153 St. Leonard's, Streatham „ C ... „ ... 18 154 Eardley Rd., Streatham „ D ... ,, 21st—13th „ ... 23 155 Bonneville Rd., Clapham „ E ... „ 29th— „ „ ... 15 156 Bonneville Rd., Clapham „ C ... „ 30th— „ 14 157 Sunnyhill Rd., Streatham „ B ... June 18th—4th July 17 Report of the Medical Officer of Health. 103 TABLE LIII.—continued. No. School. Class-room. Period of exclusion. I No. of 1 Days. 158 Fountain Road, Tooting Class C June 20th—4th- July 15 159 St. Leonard's, Streatham „ C ,, ,, ,, ,, 15 160 Sellincourt Rd., Tooting „ C „ 23rd— „ „ 12 161 Eardley Rd., Streatham „ D ,, 26th—18th ,, 23 162 Sunnyhill Rd., Streatham ,, D „ 30th—15th ,, 16 163 Franciscan Rd., Tooting „ G „ „ ,, ,, 16 164 Sellincourt Rd., Tooting „ H „ „ ,, ,, 16 165 Eardley Rd., Streatham „ F ,, ,, ,, ,, 16 166 Eardley Road, Streatham „ B & C July 3rd—14th ,, 12 167 Sellincourt Rd., Tooting „ D ,, 16th—23rd ,, 8 168 Haselrigge Rd., Clapham „ F „ 18th— „ „ 6 169 New Road, Clapham „ Ei & E2 „ 21st— „ „ 3 170 St. Andrew's, Colmer Road „ D Sept. nth—19th Sep. 9 171 St. Andrew's St., Clapham „ C Oct. 14th—24th Oct. 11 172 All Saints', Wandsworth B Nov. 3rd—21st Nov. 19 173 Sellincourt Rd., Tooting „ H ,, 20th—28th ,, 9 174 St. Mary's, Putney „ B „ 24th—5th Dec. 12 175 Garratt Lane, Wandsworth „ c „ —12th „ 19 176 Sellincourt Rd., Tooting All under 5 years Dec. 15th—19th ,, 5 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 1,454 (215 in Clapham, 87 in Putney, 353 in Streatham, 309 in Tooting, and 490 in Wandsworth), compared with 1,006 in 1912, 2,638 in 1911, and 418 in 1910. 104 Report of the Medical Officer of Health. The greatest number of disinfections was carried oat in January, this being due to the greater prevalence of the disease in Wandsworth. The greatest number of cases occurred in January, February, March, April and May. 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. TABLE LIV. Month. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. January 23 16 33 81 235 388 February 47 20 44 73 170 354 March 45 13 60 40 35 193 April 36 13 61 42 26 178 May 27 19 51 41 10 148 June 12 4 57 9 3 85 July 6 .... 3° 14 1 51 August ... 1 2 3 1 7 September 2 ... 3 3 2 10 October 6 1 9 1 3 20 November 6 .... 2 .... .... 9 December 5 .... 1 2 3 11 Total... 215 87 353 3°9 490 1,454 Whooping- Cough. 23 deaths were registered during the year, nine of males and 14 of females, a decrease of 34 compared with 1912, and of 56 compared with the decennial average. Three of the deaths occurred in Clapham, four in Putney, five in Streatham, two in Tooting, and nine in Wandsworth. 12 of the deaths were of infants under one year, eight of children from one and under two years, two from two and under five years, and one from 25 and under 45 years. The death-rate was .07 per 1,000, compared with .15 in 1912, .21 in 1911, and -22 in 1910, and .17 for the whole of London in 1913. Report of the Medical Officer of Health. 105 This disease was much less prevalent in London, and in this Borough in the year 1913 than in the two previous years. In the sub-district of Streatham and Clapham it was more prevalent than in the other sub-districts. The number of cases notified from schools was 496, compared with 1,014 in 1912 565 in 1911, and 919 in 1910, 133 of these being from schools in the sub-district of Clapham, the schools chiefly affected in that sub-district being Bonneville Road and St. Andrew's Street, and Streatham, where the schools chiefly affected were Mitcham Lane and Smallwood Road. There were also 96 cases notified from schools in Putney, the schools chiefly affected having been Hotham Road and All Saints'. In Wandsworth the schools chiefly affected were Swaffield Road and Waldron Road ; and in Tooting, Sellincourt Road. The greatest mortality from Whooping Cough occurs among children under five years of age. Of the 23 deaths that occurred from this disease, 22 or 96 per cent, were deaths of children under five years. 31 cases, four from Clapham, six from Putney, one from Streatham, 11 from Tooting, and nine from Wandsworth, were removed to hospitals of the Metropolitan Asylums Board. No deaths occurred among these cases. 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 503 visits were made by the Sanitary Inspectors in cases of Whooping Cough, 143 in Clapham, 90 in Putney, 113 in Streatham, 47 in Tooting, and no in Wandsworth. 106 Report of the Medical Officer of Health. Other Diseases notified from Schools. In addition to the 1,434 cases of Measles and 496 of Whooping Cough notified by the teachers of elementary schools there were also notified 842 cases of Chicken-pox, 731 of Mumps, 355 of Ringworm, seven of German Measles, 93 of inflammation of eyes, 169 of suspicious sore throat, 77 of Impetigo, 42 of Eczema, and 57 of other diseases. Chicken-pox was most prevalent in Streatham and Wandsworth, Mumps in Streatham, Tooting and Wandsworth, and Ringworm in Streatham, Tooting and Wandsworth. Disinfection of Schools. During the year the following schools were disinfected on account of the prevalence of Scarlet Fever, Diphtheria and Measles. (1) Immanuel, Streatham. Four rooms disinfected after Scarlet Fever on the 1st February. (2) Private School, Wandsworth. Three rooms disinfected after Scarlet Fever on the 5th March. (3) Private School, Streatham. Sixteen rooms disinfected after Measles on the 7th, nth, and 24th March. (4) Private School, Wandsworth. One room disinfected after Scarlet Fever on the 25th March. (5) Private School, Wandsworth. Twelve rooms disinfected after Measles on the 26th March. (6) St. Andrew's, Colmer Road, Streatham. Seven rooms disinfected after Measles on the 26th April. (7) Swaffield Road, Wandsworth. Nine rooms disinfected after Scarlet Fever on the 16th and 24th July. 107 Report of the Medical Officer of Health. (8) Waldron Road, Wandsworth. Ten rooms disinfected after Scarlet Fever on the 25th July. (9) Private School, Wandsworth. Four rooms disinfected after Scarlet Fever on the 24th September. (10) Private School, Streatham. Ten rooms disinfected after Scarlet Fever on the 7th October. (11) Larkhall Lane, Clapham. Six rooms disinfected after Scarlet Fever on the 27th October and 4th November. (12) Private School, Tooting. Twelve rooms disinfected after Scarlet Fever on the 9th December. (13) Private School, Streatham. Two rooms disinfected after Scarlet Fever on the 10th December. (14) Wandle, Wandsworth. Two rooms disinfected after Scarlet Fever on the 12th December. (15) Private School, Wandsworth. One room disinfected after Scarlet Fever on the 18th December. Epidemic Influenza. 59 deaths, 26 of males, and 33 of females, were due to this disease, compared with 45 in 1912, 24 in 1911, and 55 in 1910. There has thus been an increase of 14 deaths compared with the previous year, but a decrease of 8.9 compared with the corrected decennial average. 12 of the deaths occurred in Clapham, five in Putney, 21 in Streatham, two in Tooting, and 19 in Wandsworth. The death-rate was .18 per 1,000, compared with .18 in 1912, .08 in 1911, and .l8 in 1910. 29 of the deaths were of persons from 25 and under 65 years, and 25 of persons over 65 years. 108 Report of the Medical Officer of Health. Diarrhœa. 168 deaths, 90 of males and 78 of females, occurred from all forms of Diarrhoea and Enteritis during the year, compared with 85 in 1912, 350 in 1911, and 88 in 1910. There has thus been an increase of 83 in the number of deaths from these diseases compared with the previous year, but a decrease of 53.6 compared with the corrected decennial average. 23 of the deaths occurred in Clapham, 11 in Putney, 35 in Streatham, 36 in Tooting, and 63 in Wandsworth. In all the sub-districts there was an increase compared with 1912. The death-rate was .51 per 1,000, (in Clapham .37, in Putney .39, in Streatham .34, in Tooting .96, and in Wandsworth .66), compared with .27 in 1912, 1.13 in 1911, and .30 in 1910. The total number of deaths of children under two years was 154, equal to a rate of .47 per 1,000, compared with .22 in 1912, while the death-rate for the whole of London under two years was .68 per 1,000, compared with .31. Of the total number of deaths registered, 132 or 78 per cent. were of infants under one year, compared with 70 per cent. in 1912, 78 per cent. in 1911, and 75 per cent. in 1910. The following Table shows the number of deaths from Diarrhœa and Enteritis under one year for the four quarters of 1913, and for the five previous years. 109 Report of the Medical Officer of Health. TABLE LV. 1908. 1909. 1910. 1911. 1912. 1913. Total deaths under one year from Diarrhoea and Dysentery, including Epidemic Diarrhoea and Zymotic Enteritis in first quarter of the year 7 5 4 2 1 3 Do. in second quarter 7 4 6 5 4 5 Do. in third quarter 5' 35 14 89 10 33 Do. in fourth quarter 9 8 11 8 3 10 Total deaths under one year from other forms of Enteritis in first quarter of year 13 15 9 12 14 Do. in second quarter 9 11 9 11 11 14 Do. in third quarter 22 31 19 110 15 32 Do. in fourth quarter 18 15 16 40 4 21 33 out of a total of 51 deaths from Diarrhoea, and 32 out of a total of 81 from Enteritis occurred in the third quarter of the year. The number of deaths from Diarrhœa, Zymotic Enteritis, and Enteritis under one year represents 21.8 per cent. of the total mortality at that age, compared with 11.6 per cent. in 1912, 33 per cent. in 1911, and 12 per cent. in 1910, so that the increase of the mortality under one year was largely due to the increase in the number of deaths of infants from the above causes. The higher death-rate from Diarrhœa and Enteritis among infants was due to the very warm and dry summer and the consequent increase in the amount of dust and the presence of house flies. Comparing the year under consideration with 1911 and 1906, when the climatic conditions were very similar, there has been a very large decrease in the mortality, and this may be largely attributed to the work of the female Sanitary Inspectors in visiting the homes shortly after the birth of children and the instructions then given. 110 Report of the Medical Officer of Health. Other factors also, as mentioned in my Report for 1912, have contributed to this decrease, notably the diminution in the amount of horse manure, and the tar spraying of the principal roads in the Borough. There is, however, one measure which deserves the serious consideration of the Council, viz., the more frequent removal of house refuse. There are doubtless serious, but not unsurmountable difficulties in the way, but these might be in time surmounted and a universal daily removal substituted for the present system. With regard to the relation between house refuse and the prevalence of house flies, some interesting observations and experiments have been made during the past year at the Dust Destructor. It was noted that during July, August and September, the dust carts swarmed with both larvae and pupae of the house fly, larvae especially being present in enormous numbers. The great majority of these were naturally destroyed when the refuse was deposited in the cells of the Destructor, but their presence in the house refuse in such numbers convinced me that the main cause of the prevalence of house flies was the storage of house refuse on premises, and that horse manure, which in country districts is the favourite breeding ground, is not the cause of their prevalence in London. A series of experiments were carried out to ascertain if the use of any substance, disinfectant or otherwise, would prove of any value in preventing the development of flies, and it was found that out of a large number of substances used only three gave satisfactory results, these three being paraffin, naphthalin, and carbolic acid. The following Table shows the material used, the time of exposure and the result. It is interesting to note that neither Paris Green, which is largely used in America, nor perchloride of mercury which is a powerful poison, had any effect on the larvae, 111 Report of the Medical Officer of Health. Material used. Time of exposure. Result. Paraffin ½ hour All larvae dead. Soft Soap and paraffin (½ lb. soft soap, J pint paraffin, 1 pint water). ½ hour Nearly all larvae dead. Do. do. 24 hours All larvae dead. Methylated spirit and naphthalin 1 hour Effective, one or two larvæ still alive. Do. 24 hours All larvae dead. Powdered Naphthalin 4 hours About half the number dead Do. 28 hours All larvae dead. Naphthalin in water 4 hours Larvae still alive. Do. 28 hours All larvae dead. Carbolic Acid (i J ozs. to 2 lbs. of flue dust). 1 hour All larvae dead. Perchloride of mercury 4 hours Larvae alive. Do. 28 hours Larvae alive. Do. 6 days Some larvae still alive. Paris green—(Aceto arsenate of Copper, ½ lb.; Slaked lime, ½ lb.; Water, ½ gall.). 4 hours Larvae still alive. Do. 28 hours Larvae still alive. Sulphate of iron 4 hours Larvae still alive. Do. 28 hours Larvae still alive. Chlorinated lime solution 4 hours Larvae still alive. Do. 28 hours Larvae all dead. Powdered sulphur 1 hour Larvae still alive. Do. 28 hours Larvae still alive. Formaldehyde solution, 20 per cent. 1 hour Larvae still alive. Do. 24 hours Larvae still alive. Permanganate of potash 4 hours Larvae still alive. Do. 28 hours Larvae still alive. (This seems to act as a stimulant, the larva moving very quickly.) 112 Report of the Medical Officer of Health. The result of these experiments shows that the most useful substance for ordinary household use would be the paraffin and soft soap mixture, and if this were sprayed over the refuse in dust bins it would largely prevent the development of house flies. It is important that the refuse should be thoroughly saturated with the mixture, otherwise all the larvae will not be destroyed. Spraying the contents of the dust bins daily with the paraffin mixture prevents the flies from laying their eggs in the refuse, but it is hardly to be expected that every householder would carry this out systematically during the summer. The daily removal of all house refuse during the summer months only would be a most satisfactory solution, and although it would add to the cost of collection, I am of opinion that the health and comfort of the community would be much benefited thereby. In all the deaths under one year from Diarrhœa and Enteritis, special inquiries were made, and the following Tables show the nature of the food given. TABLE LVI. Method of Feeding. Age in Months. 0 and under 3. 3 and under 6. 6 and under 9. 9 and under 12. Total. I.—Breast-fed only 10 4 ... 1 15 Do. and cows' milk 2 2 ... ... 4 Do. and condensed milk ... 2 ... ... 2 Do. and food ... ... ... 1 1 2.—Cows' milk only 18 20 9 1 48 Do. and food 1 1 1 2 5 3.—Condensed milk only 9 9 12 3 33 Do. and food ... ... 1 4 5 4.—Dried milk ... 1 ... ... 1 5.—Unknown 8 5 3 2 18 Totals 48 44 26 14 132 113 Report of the Medical Officer of Health. Of the total of 114 children who died from these diseases where the exact nature of the food given was ascertained, only 15, or 13.1 per cent. were nursed by the mother without the addition of any other food, and of these 10 died in the first three months. In 53, or 46.5 per cent., cows' milk, either alone or with farinaceous food was given; in 38 or 33.3 per cent., condensed milk only or condensed milk and farinaceous food was given; while in one dried milk only was given. In 18 cases, from various causes no information could be obtained. Of the 132 deaths 57 occurred in the Union Infirmaries, and 26 in hospitals outside the Borough, a much greater proportion than last year. Of the 132 deaths from Diarrhœa, 39 died in the Union Infirmary, and 19 died in hospitals. Of the cases in which no information was available, two were found to be wrong addresses, in seven cases the families had removed, three infants died outside London, and three illegitimate children, of whom two were twins, were born in the Workhouse and died in the Infirmary and so were not visited. In one case the father refused to give any information. Of the contributory causes to the infants' deaths it may be noted that in two cases the mothers had Puerperal Fever, in one of which the mother died the day before the child. Six mothers were very delicate, and two suffered from Tuberculosis, and the infant of one of these was born with facial paralysis. Two infants had Tuberculosis, one having Tuberculous Meningitis. 11 infants had chronic indigestion and bowel troubles, and 11 had previous attacks of Diarrhœa before the fatal one. 114 Report of the Medical Officer of Health. One was subject to convulsions from birth, while three had teething troubles and suffered from Bronchitis. In one case the baby had been attended by a doctor for some months previous to death for enlargement of the liver. Nine children had also been suffering from Marasmus, and of these six went into Institutions to be treated, and died there. One of these, a baby of seven months, was the eleventh child, and had been wasting and under a doctor's care for four months. One infant that died at four months had been wasting for nine weeks, it was then taken to St. Vincent's Hospital for three weeks, after which it was then taken home by the mother for two weeks, finally being again taken to the hospital where it stayed until its death. The next Table shows the result of the inquiries 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 11 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.:—114,11 were prematurely born, 35 were delicate from birth, and 10 were twin children. 115 Report of the Medical Officer of Health. TABLE L VII. Clapham, North. Clapham, South. Putney. Streatham. Balham. Tooting. Southfield. Fairfield. Springfield. Borough. Total Number of Deaths 12 9 5 7 22 29 16 9 23 132 Wholly breast-fed ... 1 ... 1 3 1 2 1 6 15 Otherwise fed 10 5 2 5 16 25 14 8 14 99 No information 2 3 3 1 3 3 ... ... 3 18 Previously visited (1913) 9 2 ... 3 3 11 13 4 8 53 „ „ (1912) ... 1 ... ... 3 ... 1 2 ... 7 Fed according to pamphlet 4 ... ... ... 1 4 ... ... 2 11 Breast-fed ... 1 ... ... 1 ... 1 ... 3 6 Otherwise fed 10 2 ... 3 5 11 13 6 3 53 Illegitimate 1 1 2 ... 8 6 ... ... 7 25 Nurse children ... 1 ... ... 4 4 ... ... 3 12 Born outside Borough 3 2 2 ... 3 8 ... 2 9 29 Premature 2 ... ... 1 2 2 2 ... 2 11 Delicate from birth 5 1 ... 2 1 12 5 3 6 35 Twin Children ... ... ... ... ... 2 4 2 2 10 Status of Parents:— Labourers 3 2 ... 1 4 6 2 2 5 25 Artisans 1 1 ... 1 4 1 5 1 3 17 Domestic Servants 1 1 ... ... 4 7 ... ... 2 17 Carmen 2 ... ... ... 2 3 3 1 2 13 Clerks 1 ... ... 1 1 1 ... ... ... 5 Butchers ... ... ... ... ... 2 ... 1 ... 4 Conductors ... ... ... ... 1 ... ... 1 ... 4 Waitresses ... ... ... ... 3 1 ... ... ... 4 Charwomen ... ... ... ... ... ... ... ... 3 3 Boat-builders ... ... 1 ... ... 1 ... ... ... 2 Factory hands ... ... ... ... ... ... 2 ... ... 2 Gardeners ... ... ... ... ... 1 1 ... ... 2 Hotel Managers ... ... ... ... ... 2 ... ... ... 2 Police Constables ... ... ... 1 ... 1 ... ... ... 2 Porters 1 ... ... ... ... 1 ... ... ... 2 Window cleaners ... ... ... 1 ... ... ... ... 1 2 Barman ... ... ... ... ... 1 ... ... ... 1 Builder ... 1 ... ... ... ... ... ... ... 1 Coachman ... ... ... ... ... ... ... 1 ... 1 Coach painter ... ... 1 ... ... ... ... ... ... 1 Confectioner's Assistant ... ... ... ... ... ... ... ... 1 1 Chemist's Assistant ... ... ... ... ... ... 1 ... ... 1 Electrician ... 1 ... ... ... ... ... ... ... 1 Engine driver ... 1 ... ... ... ... ... ... ... 1 Firework maker ... ... ... 1 ... ... ... ... ... 1 Fisherman ... ... ... ... ... 1 ... ... ... 1 Fruiterer's Assistant 1 ... ... ... ... ... ... ... ... 1 Groundsman ... ... ... ... ... ... ... ... 1 1 Hairdresser ... ... ... ... ... ... ... ... 1 1 Grocer ... ... ... ... 1 ... ... ... ... 1 Hospital Nurse ... ... ... ... ... ... ... ... 1 1 Ivory cutter ... ... ... ... ... ... 1 ... ... 1 Jeweller ... ... ... ... ... ... ... ... 1 1 Lift attendant ... ... ... ... ... ... ... ... 1 1 Map mounter 1 ... ... ... ... ... ... ... ... 1 Merchant ... ... ... 1 ... ... ... ... ... 1 Milk carrier ... ... ... ... ... ... 1 ... ... 1 Mill band sewer ... ... ... ... ... ... ... 1 ... 1 Packing case maker ... ... ... ... ... ... ... 1 ... 1 Postman ... ... ... ... 1 ... ... ... ... 1 Shop blind maker 1 ... ... ... ... ... ... ... ... 1 Veterinary Surgeon ... ... ... ... 1 ... ... ... ... 1 116 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 herewith submit to you the report of visits among the newly-born infants in the Borough during the year 1913. We have had the help of four voluntary workers who have worked on three or four mornings during the week, and who came regularly for three months each. They have given their services in order to qualify themselves for a health visitor's appointment, and with their assistance we have been able to pay more visits and cover a larger area, so that now practically every mother in the poorer districts of the Borough is visited once or twice while the infant is under six months of age. After the completion of their three months' training two of our workers returned and did occasional work in the Borough. The total number of visits paid, including re-visits, and ineffectual visits, was 7,135. The number of first, visits paid totalled 3,772, there were 2,030 second visits, and the number of ineffectual visits was 1,333, the percentage of these latter being highest in Springfield Ward and lowest in Streatham. The reason why this is the case in Springfield is that so many mothers go out to work that we have to go several times before an effectual visit is paid. Among the infants we visited 114 died, their ages at death being shown in Table LX. 53 of these occurred from Diarrhœa and Enteritis, the greatest number being in Southfield and Tooting Wards, and it will be noted that the greatest mortality occurred between two and three months of age. 117 Report of the Medical Officer of Health. 99 infants were born prematurely, and 80 children were delicate from birth, a decided increase compared with previous years. There has been much more difficulty in tracing the illegitimate than the legitimate births, and in nearly half of the former cases we found the mother had removed on our second visit. We have been only able to visit a few of the infants notified to us from the Workhouse, as the mothers seldom returned to the address from which they were admitted. We visited a total of 139 illegitimate births, but were unable to pay more than 50 second visits. Seven of these illegitimate children died, two from Congenital Debility, two from Bronchitis and Pneumonia, and three from Diarrhœa. We found 38 mothers of illegitimate infants did not belong to this Borough. 55 of the inf ants were breast-fed on the first visit, but only 12 on the second visit, as in a large proportion of cases the mothers had to return to work. The pamphlet on the feeding of infants is in every case handed to the mother or caretaker on our first visit, and is in many instances kept from the birth of one child to that of the next. We also find instances in which it has been borrowed from neighbours. In the case of hand-feeding we find the mothers are very largely discontinuing the use of the tube bottle for that of the boat shaped one. 621 mothers had adopted the boat bottle when resorting to artificial feeding, and 55 only were using the tube bottle, although 15 mothers said they used the tube bottle at night. We find it very hard to persuade the mothers to give up the use of dummies or comforters, especially those who have large families. We were pleased to find 1,562 of the mothers had not begun the use of the comforter. 1,954 were using the comforter and of these 480 informed us on our second visit that they had discontinued its use. 175 mothers, however, had begun its use since our first visit. 118 Report of the Medical Officer of Health. There were 1,764 out of the 3,775 mothers we visited who had employed midwives, a considerably larger number than in the previous year, the proportion being higher in Balham and Tooting than in 1912. There were 105 mothers who went into Institutions or the Workhouse for the confinement. 20 mothers had employed the services of unregistered midwives, and in nearly every case these were neighbours or relations called in in an emergency. The sanitary defects found in the homes of the mothers during the coarse of our work have been remedied, or if requiring structural work, referred to you. 96 intimation notices were served, and six statutory notices were required." 119 Report of the Medical Officer of Health. TABLE LV1II. Clapham, North. Clapham, South. Putney. Streatham. Balham. Tooting. Southfields. Fairfield. Springfield. Borough. Infants visited 337 349 232 272 389 775 418 325 675 3,772 I. Breast-fed only 296 261 193 202 312 612 354 288 588 3,106 2. Otherwise fed 41 88 39 70 77 163 64 37 87 666 (a) Breast and cows' milk 8 22 6 18 13 28 10 2 13 120 (b) Breast and condensed milk 3 9 6 4 6 15 10 9 7 69 (c) Breast, cows' milk and food ... ... ... 2 7 8 1 ... 3 21 (d) Breast, condensed milk and food ... ... ... ... 2 3 1 1 ... 7 (e) Breast and dried milk ... 1 ... ... 1 ... ... ... 1 3 (f) Breast, cows' and dried milk ... 1 ... ... ... ... ... ... ... 1 (g) Breast and food 3 6 1 13 9 13 1 1 2 49 (h) Cows' milk only 13 28 13 16 21 48 24 8 36 207 (i) Cows' milk and food 2 4 1 2 3 5 1 1 1 20 (k) Cows' and condensed milk ... ... ... ... ... 3 ... ... ... 3 (l) Cows' and dried milk ... ... 1 ... ... ... ... ... ... 1 (m) Condensed milk only 10 13 10 13 12 25 15 12 16 126 (n) Condensed milk and food ... 2 ... ... 2 10 ... 1 ... 15 (o) Dried milk ... ... ... ... ... ... ... ... 4 4 (p) Farinaceous and other foods 2 2 1 2 1 5 1 2 4 20 Ineffectual visits 131 113 106 52 118 152 196 161 304 1,333 120 Report of the Medical Officer of Health. TABLE LIX. Clapham, North. Clapham, South. Putney. Streatham. Balham. Tooting. Southfields. Fairfield. Springfield. Borough. Infants re-visited 207 137 142 119 199 349 279 183 415 2,030 1. Breast-fed only 159 78 95 68 122 199 204 130 305 1,360 2. Otherwise fed— (a) Breast and cows' milk 5 11 7 8 14 26 5 4 12 92 (b) Breast and condensed milk 3 ... 3 2 4 11 10 5 10 48 (c) Breast, cows' milk and food 1 2 1 8 7 2 3 3 27 (d) Breast, condensed milk and food ... ... ... 2 1 3 2 1 1 10 (e) Breast and food 1 11 3 7 5 21 1 3 6 58 (f) Cows' milk only 24 23 13 19 26 45 27 15 49 241 (g) Cows' and condensed milk ... ... 1 ... ... 1 ... ... 1 3 (h) Cows' milk and food 3 2 5 1 4 7 6 3 8 39 (i) Condensed milk only 10 10 11 11 9 21 19 15 16 122 (j) Condensed milk and food ... 1 ... ... 3 6 2 1 2 15 (k) Dried milk only ... ... ... ... ... ... ... ... 2 2 (l) Farinaceous and other foods 1 1 2 ... 3 2 1 3 ... 13 Totals 48 59 47 51 77 150 75 53 110 670 In all 3,772 infants were visited, compared with 3,059 in 1912, 3,518 in 1911, and 3,448 in 1910. It is satisfactory to observe that with the assistance of the voluntary workers, infants were visited in all the Wards of the Borough. 121 Report of the Medical Officer of Health. Out of 3,772 infants, 3,106 or 82.3 per cent. were wholly breastfed, and 666 or 17.7 per cent. otherwise fed. There is a slight increase in the number breast-fed compared with previous years. 2,030 infants were re-visited, and of these 1,360 or 67 per cent. were breast-fed, while 670 or 33 per cent. were otherwise fed, which is also a slight increase compared with previous years. The total number of deaths among those visited was 114, 22 in Clapham, four in Putney, 17 in Streatham, 20 in Tooting, and 51 in Wandsworth. Table LX. shows these deaths arranged in monthly age periods. The heaviest mortality occurred at two to three months, while no deaths occurred at 11 to 12 months. The increase in the deaths was largely due to the increase 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 3,106 infants who were breastfed was only 15, or a percentage mortality of .48, while among 666 infants who were otherwise fed the number of deaths was 117 or a percentage mortality of 17.5. The mortality among infants otherwise fed was thus 36 times greater than those breast-fed. The mortality among the infants visited by the Inspectors was only 30 per 1,000 births, compared with 88 per 1,000, the rate for the Borough for the year. 122 Report of the Medical Officer of Health. TABLE LX. Wards. Under 1 month. I—2 months. 2—3 months. 3—4 months. 4—5 months. 5—6 months. 6—7 months. 7—8 I months. 8—9 I months. 9—10 months. 10—11 months. 11—12 months. Total. Clapham, North 1 3 2 2 1 2 3 2 1 ... ... ... 17 Clapham, South ... ... 2 2 ... ... ... ... ... ... ... ... 5 Putne3* 1 ... 1 1 ... ... 1 ... ... ... ... ... 4 Streatham 1 ... I I 2 ... ... 1 ... ... ... ... 6 Balham ... 1 2 1 2 I 1 ... 2 ... ... ... 11 Tooting 1 5 6 2 1 3 1 ... ... 1 ... ... 20 Southfield ... 3 1 3 5 2 3 1 1 ... ... 19 Fairfield ... 4 2 1 1 ... 1 ... ... ... ... ... 9 Springfield 2 2 9 ... 4 4 ... 2 ... ... ... ... 23 Total 6 18 26 13 16 12 7 8 4 2 2 ... 114 Tuberculous Diseases. The total number of deaths from diseases of a Tuberculous nature was 355, compared with 366 in 1912, 389 in 1911, and 351 in 1910. 289 of the deaths were due to Pulmonary Tuberculosis, 34 to Tuberculous disease of the Brain, and 32 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 .88 per 1,000, compared with .96 in 1912, .91 in 1911, and .88 in 1910; from other Tuberculous diseases .20 compared with .20, .35 and .29; and from all Tuberculous diseases 1.08 compared with 1.16, 1.26, and 1.17. 123 Report of the Medical Officer of Health. TABLE LXI. Sub-District. Pulmonary Tuberculosis. Other Tuberculous Diseases. Total. No. of Deaths. Rate. No. of Deaths. Rate. No. of Deaths. Rate. Clapham 58 .93 14 .22 72 1.15 Putney 16 .55 8 .28 24 .83 Streatham 78 .76 9 .09 87 .85 Tooting 26 .69 11 .29 37 .98 Wandsworth 111 1.09 4 .24 135 1.33 Whole Borough 289 .88 66 .20 355 1.08 From all Tuberculous diseases the rates per 1,000 were lower in Clapham, Putney, Streatham and Tooting, but higher in Wandsworth than in 1912. With regard to Pulmonary Tuberculosis, the rates for Clapham Putney, Tooting, and Wandsworth were below, and that for Streatham above last year's rates. From other Tuberculous diseases the rate was the same as in 1912. This rate was lowest in Streatham and highest in Tooting, and the rate for Pulmonary Tuberculosis was lowest in Putney 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. 124 Report of the Medical Officer of Health. TABLE LXII. 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 Average for 10 years. 1913 Clapham 94 126 112 117 89 95 104 84 118 116 105 93 Putney 79 86 92 83 67 62 116 85 70 97 84 55 Streatham 63 83 72 76 73 87 60 65 85 73 74 76 Tooting 9i 151 101 90 96 86 110 109 81 87 100 69 Wandsworth 132 131 132 121 131 123 109 108 88 112 119 109 Whole Borough 94 112 102 100 95 96 94 88 91 96 97 88 Compared with the decennial average the rate was lower in the whole Borough, but the sub-district of Streatham has an increased rate compared with that average, while Clapham, Putney, Tooting and Wandsworth are lower, the reduction in Tooting having been as much as 31 per 100,000. The rate in Clapham for 1913 is lower than it was in 1912, and is 12 under the decennial average, in Putney it was the lowest rate ever recorded, being 42 per 100,000 under the rate for 1912, and 29 under the corrected decennial average. In Streatham, which is the only sub-district which shows an increase, both compared with 1912 and with the decennial average, the increase was slight and no definite reason can be given other than that in portions of this sub-district the social status of the population has somewhat changed during the past few years. In Tooting the rate is much lower than it was in 1912, and is 31 under the decennial average, while in Wandsworth the rate compares favourably with that for 1912, and is 10 under the decennial average. This last sub-district has always had a higher average mortality from Pulmonary Tuberculosis than the other sub-districts, and it is satisfactory to observe that in 1913 there has been a slight reduction compared with the decennial average. 125 Report of the Medical Officer of Health. One death from Pulmonary Tuberculosis occurred in an infant under one year, five in persons from two and under five years, eight from five and under 15 years, 45 from 15 and under 25 years, 121 from 25 and under 45 years, 95 from 45 and under 65 years, and 14 over 65 years. From other Tuberculous diseases four deaths occurred under one year, 12 from one and under two years, 15 from two and under five years, 18 from five and under 15 years, seven from 15 and under 25 years, six from 25 and under 45 years, and four from 45 and under 65 years. The list which follows shows the occupation of those who died from Pulmonary Tuberculosis during the year. TABLE LXIII. Males. Females. Totals. Clerks 17 — 17 General Labourers 10 — 10 Shop Assistants 8 2 10 Domestic Servants — 7 7 Painters 6 — 6 Carpenters 5 — 5 Commercial Travellers 5 — 5 Compositors 4 — 4 Hawkers 3 1 4 Warehousemen 4 — 4 Actors 3 — 3 Army Pensioners 3 — 3 Dressmakers — 3 3 Factory Hands 1 2 3 Boiler Cleaners 2 — 2 Brewer's Draymen 2 — 2 Brewer's Labourers 2 — 2 Bricklayers 2 — 2 Builder's Labourers 2 — 2 Carmen 2 — 2 Charwomen — 2 2 Coachmen 2 — 2 Carried forward 83 17 100 126 Report of the Medical Officer of Health. TABLE LXIII.—continued. Males. Females. Totals Brought forward 83 17 100 Coal Porters 2 — 2 Estate Agents 2 — 2 Greengrocers 2 — 2 Hospital Porters 2 — 2 Laundry Hands — 2 2 Licensed Victualler's Managers 2 — 2 Plumbers 2 — 2 Printer's Machinists 2 — 2 Railway Porters 2 — 2 Waiters 1 1 2 Accountant 1 — 1 Advance Manager 1 — 1 Assistant Postmaster 1 — 1 Asylum Attendant 1 — 1 Baker 1 — 1 Barmaid — 1 1 Billiard Marker 1 — 1 Bone Turner 1 — 1 Bookbinder 1 — 1 Bootmaker 1 — 1 Bottle Washer 1 — 1 Brass Finisher 1 — 1 Builder 1 — 1 Butler 1 — 1 Cabinet Maker 1 — 1 Cabman 1 — 1 Caretaker — 1 1 Cloakroom Attendant 1 — 1 Coffee House Keeper 1 — 1 Dental Student 1 — 1 Farrier 1 — 1 Footman 1 — 1 Fruit Farmer 1 — 1 Furniture Dealer 1 — I Gardener 1 — 1 Carried forward 123 22 145 127 Report of the Medical Officer of Health. TABLE LXIII.—continued. Males. Females. Totals Brought forward 123 22 145 Glass Blower 1 — 1 Glass Merchant 1 — 1 Hairdresser 1 — 1 House of Commons Messenger 1 — 1 House Steward 1 — 1 Inspector of Weights and Measures 1 — 1 Instructor R.F.A. 1 — 1 Insurance Surveyor 1 — 1 Law Student 1 — 1 Locksmith 1 — 1 Maternity Nurse — 1 1 Meat Porter 1 — 1 Miller 1 — 1 Motor Mechanic 1 — 1 Optician 1 — 1 Perambulator Maker 1 — 1 Pianoforte Maker 1 — 1 Platelayer 1 — 1 Police Constable 1 — 1 Pottery Stoker 1 — 1 Printer's Labourer 1 — 1 Provision Contractor 1 — 1 School Teacher — 1 1 Secretary 1 — 1 Silk Hat Shaper 1 — 1 Soldier 1 — 1 Sorter, G.P.O. 1 — 1 Street Musician 1 — 1 Telegraph Messenger 1 — 1 Theatrical Dresser — 1 1 Tinsmith 1 — 1 Toymaker 1 — 1 Tramway Traffic Regulator 1 — 1 Tramcar Washer 1 — 1 Carried forward 154 25 179 128 Report of the Medical Officer of Health. TABLE LXIII.—continued. Males, Females, Totals Brought forward 154 25 179 Typist — 1 1 Upholsteress — 1 1 Wardress — 1 1 Waterside Labourer 1 — 1 Woodchopper 1 — 1 Widows, Wives and Daughters of Artisans — 29 29 Widows, Wives and Daughters of Labouring Classes — 27 27 Widows, Wives and Daughters of Clerks, Tradesmen, etc. — 27 27 Children of Artisans 2 — 2 Children of Labouring Classes 3 —' 3 No Occupation 1 16 17 Total 162 127 289 Of the total number of males who died, viz.—162, the occupation of 156 is given, five were children and one was stated to have had no occupation. As was the case in previous years labourers and clerks head the list, the numbers being respectively 10 and 17. Among females of 127 deaths only 28 were engaged in some occupation, seven being domestic servants, three were dressmakers, two each were shop assistants, factory hands, charwomen and laundry hands. 29 of the 127 females had been widows, wives or daughters of artisans, 27 of the labouring classes, 27 of clerks, tradesmen, etc., and 16 had no occupation. 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 1903-1912, and for the year 1913. Death-rate per 10.000 from Pulmonary Tuberculosis from 1888 to 1913 inclusive Report of the Medical Officer of Health. 129 Among males the rate for Pulmonary Tuberculosis for the year 1913 was 1.09, compared with 1.24 the decennial average; and among females .71 compared with .75, while from other Tuberculous diseases the rate among males was .26 compared with .40 and among females .15 compared with .29. Among children under five years the rate for the year was .09 compared with .20 the decennial average. The rate for males and females for the year 1913 from Pulmonary Tuberculosis was .88, compared with .97 the decennial average. In one of the years during the decennium, viz.— in 1910, this rate was the same while in all the other years 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 26 years. As will be seen the rate among males has decreased compared with the previous year, but among females there is a slight increase. The rate among males was lowest in 1911 and among females in 1903. 130 Report of the Medical Officer of Health. TABLE LXIV. Year. Population. No. of Deaths and Death-rates per 1 ,000. 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. 1903 110,019 135,011 245,030 143 1.29 87 .64 230 .94 65 .59 48 .35 113 .45 65 .26 1904 113,l24 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 1.00 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 50 .17 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 .30 109 .35 53 .17 1912 141,192 172,569 313,761 181 1.28 122 .70 303 .96 39 .27 24 .14 63 .20 23 .07 Average 10 years 125,342 153,714 279,056 155 1.24 115 .75 270 .97 50 .40 46 .29 96 .35 57 .20 1913 144,435 176,905 321,340 161 1.09 128 .71 289 .88 39 .26 27 .15 66 .20 31 .09 Report of the Medical Officer of Health. 131 Notification of Tuberculosis. In December, 1912, the Local Government Board issued a new Order entitled "The Public Health (Tuberculosis) Regulations, 1912," which amended and consolidated the previous Regulations. The new Regulations apply to non-pulmonary as well as Pulmonary Tuberculosis, and came into force on the 1st February, 1913. The total number of cases of Pulmonary Tuberculosis notified, both under the old and the new Regulations, during 1913, was 783, compared with 855 in 1912, 514 in 1911, and 289 in 1910. Of these 84 were notified in January previous to the new Regulations coming into force and 699 were notified from the 1st February, 1913, to the end of the year. The number of cases shown on Table LXV. does not exactly correspond with the number in Table LXXIII., as several cases notified on Form C from Poor Law Institutions and Sanatoria had not previously been notified to me on Form A, although they may have been notified to the Medical Officer of Health of other districts, and also on Table LXXIII. the cases notified up to the 3rd January, 1914, are included. Of the total cases notified during the year, viz.:—783,154 were from Clapham, 45 from Putney, 209 from Streatham, 89 from Tooting, and 286 from Wandsworth, compared with 855 in 1912, of which 172 were from Clapham, 58 from Putney, 228 from Streatham, 124 from Tooting, and 273 from Wandsworth. There was thus a decided decrease in all the sub-districts with the exception of Wandsworth, where there was a slight increase. One of the cases was under one year of age, 14 from one and under five years, 88 from five and under 15 years, 167 from 15 and under 25 years, 345 from 25 and under 45 years, 145 from 45 and under 65 years, and 23 over 65 years. 132 Report of the Medical Officer of Health. In Table LXV. is shown the total number of cases notified since 1904, the number of deaths in each year since that date, the total deaths, the number removed from the district as far as could be ascertained, the number who were stated to have recovered, the number in which no inquiries were made, and the total number of cases still on the Register. In all 3,188 cases have been notified, and of these 1,276 or 40 per cent. have died, 649 or 20.4 per cent. have removed, 92 or 2.9 per cent. are stated to have recovered, in 48 or 1.5 per cent. no inquiries have been made, while 1,123 or 35.2 per cent. are still on the Register. It will be noted that in 1912 and 1913 inquiries have been made in every case, although in 40 cases in 1912 and 55 in 1913 these inquiries were made at my request by the private medical practitioner. TABLE LXV. Year Cases reported. Deaths. Removed. Recovered. No. inquiries. Cases on Register. 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 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 31 ... 5 2 1909 389 ... ... ... ... ... 109 48 18 26 9 210 104 15 4 56 1910 289 ... ... ... ... ... ... 77 37 28 7 49 82 3 8 47 1911 514 ... ... ... ... ... ... ... 113 82 27 222 144 9 6 133 1912 855 ... ... ... ... ... ... ... ... 225 105 330 141 41 ... 343 1913 783 ... ... ... ... ... ... ... ... ... 180 l80 55 8 ... 540 Total 188 50 41 35 25 25 116 126 169 361 328 1276 649 92 48 1123 Report of the Medical Officer of Health. 133 The total number of deaths shown in Table LXV., viz., 328, does not agree with the number in the Table of deaths on page 130, viz.:—289. Of the 39 remaining, 24 cases did not die from Pulmonary Tuberculosis, although notified as such, six died from other forms of Tuberculosis, and nine died outside the Borough. 15 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 783 cases visited by the Inspectors, or in which the information was given by the medical attendant, in 72 this was so indefinite that it was impossible to tabulate it, in the majority of cases no family history being known. 10 cases were notified from the Workhouse, 12 from Asylums, one from H.M. Prison, seven from common lodging houses, one was homeless, in four cases wrong addresses were given, four had removed, in 22 the patients were either lodgers or domestic servants and the occupier of the house could give no information, one was a case of mistaken diagnosis, in eight cases no definite information was obtainable, and in only one instance the Inspector was refused information. 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. WALES. Number of Cases, 322. Age Distribution. Under 1 year. 1-5. 5-15. 15-25. 25-45. 45-65. 65-. All ages. ... 7 41 69 139 58 8 322 Duration of Illness in years. Under 1 year. 1-2 2-3 3-4. 4-5. 5 and upward's. 211 24 11 22 9 43 Number of Living Rooms in Patient's Tenement. One. Two. Three. Four. Over Four. 30 23 60 82 127 Weekly Rent Paid. Under 5/-. 5/- and under 10/-. 10/- and under 15/-. 15/- and over. Not ascertained 39 152 94 37 ... Report of the Medical Officer of Health. 135 Occupation of Patient. A.— Outdoor occupations— Taxi, motor-car, motor-'bus and tramcar men (drivers, conductors, motor men), chauffeurs (mechanical traction) 4 Carmen, carters, vanmen, &c. (horse traction) 16 Dock labourers, wharfingers, barge and lightermen, watermen 1 General labourers 35 Gardeners — Artisans 11 Bricklayers 5 Other 20 B.— Indoor occupations— Clerks 54 In Bakehouse 3 In other factories or workshops 41 In printing works 11 Tailors 4 Shop salesmen 27 On tube and underground railways (excluding clerks) 1 Soldiers 3 Bootmakers 3 Professional men, actors, dentists, scholars, &c. 9 Barmen and cellarmen 4 Domestic servants 4 Sons of labourers 30 Sons of artisans 11 Sons of clerks, travellers, tradesmen, &c. 10 Other 15 136 Report of the Medical Officer of Health. 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— 6 Affected ... ... ... ... 1 1 ... ... ... ... ... Not 9 3 15 3 13 2 6 ... 3 ... 4 Unknown ... ... ... ... 3 ... ... ... ... ... ... 25— 38 Affected ... 7 2 16 ... 16 1 ... 1 2 ... Not 41 23 149 21 82 10 37 ... 44 1 ... Unknown 1 4 ... ... 17 1 ... ... ... ... ... 35— 92 Affected ... 15 2 18 ... 4 ... 5 5 6 ... Not 62 99 357 117 100 72 88 5 296 43 9 Unknown 2 6 5 2 57 ... 1 ... ... ... ... 55— 24 Affected ... 2 1 6 ... ... ... 1 1 1 ... Not 4 33 59 18 8 20 18 5 65 19 3 Unknown ... 9 3 ... 20 .... ... 1 ... ... ... Report of the Medical Officer of Health. 137 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— 48 Affected 9 3 4 5 8 21 Not 80 2 145 34 311 82 Unknown 2 ... ... ... 3 ... 15— 63 Affected 5 7 8 7 4 24 Not 98 15 227 37 349 103 Unknown 1 ... ... ... 13 ... 25— 35 Affected 1 7 2 10 ... 22 Not 45 15 133 20 96 27 Unknown ... 2 ... ... 10 ... 35— 16 Affected ... 5 3 8 ... 5 Not 12 10 36 14 13 18 Unknown ... 5 ... 1 10 ... — ... Affected ... ... ... ... ... ... Not ... ... ... ... ... ... Unknown ... ... ... ... ... ... 138 Report of the Medical Officer of Health. TABLE LXIX. FEMALES. Number of Cases, 318. Age Distribution. Under 1 year. 1-5. 5-15. 15-25. 25-45. 45-65. 65-. All ages. 7 44 80 130 52 5 318 Duration of Illness in Years. Under 1 year. 1-2. 2-3. 3-4. 4-5. 5 and upwards. 160 65 42 10 7 54 Number of Living Rooms in Patient's Tenement. One. Two. Three. Four. Over Four. 21 28 75 80 114 Weekly Rent Paid. Under 5/-. 5/- and under 10/-. 10/- and under 15/-. 15/- and over. Not ascertained. 34 167 95 22 Occupation of Patient. A .—Outdoor occupations— Flower Sellers — Hawkers 1 Other 1 B.— Indoor occupations— Clerks 11 Shop Assistants, Charwomen, Dressmakers and Milliners 36 Laundry hands 10 In other factories or workshops 17 Domestic servants— In inns, hotels, eating-houses, &c. 12 In private dwellings 34 Widows, wives and daughters of labourers 65 Widows, wives and daughters of artisans 36 Widows, wives and daughters of clerks, &c. 25 Daughters of labourers 39 Daughters of artisans 12 Daughters of clerks, &c. 1 Other 18 Report of the Medical Officer of Health. 139 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— 10 Affected ... 6 1 8 1 12 ... 1 ... ... ... Not 9 5 26 7 25 17 9 ... 10 1 4 Unknown ... ... 1 ... 4 ... ... ... ... ... ... 25— 49 Affected 1 15 6 11 2 26 1 2 5 2 ... Not 53 29 188 24 189 67 46 ... 80 4 10 Unknown ... ... 1 ... 9 ... ... ... ... ... ... 35— 75 Affected 2 17 5 22 3 5 4 7 11 3 ... Not 50 65 200 65 123 66 57 7 215 14 12 Unknown 16 ... 8 ... 33 ... ... ... ... ... ... 55— 15 Affected ... 3 ... ... ... ... 1 1 ... 1 ... Not 2 17 21 27 ... 16 4 8 69 16 1 Unknown 8 ... 4 ... 12 ... 1 ... ... ... ... 140 Report of the Medical Officer of Health. TABLE LXI. 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 11 6 10 6 3 13 Not 84 1 162 41 319 55 Unknown ... ... ... ... 1 ... 15— 71 Affected 2 15 7 11 2 29 Not 105 18 249 44 395 71 Unknown 2 ... 2 1 8 ... 25— 33 Affected 1 6 10 16 1 11 Not 32 23 137 17 72 24 Unknown 4 ... 2 ... 12 ... 35— 11 Affected ... 3 2 ... ... 3 Not 6 13 39 6 15 10 Unknown ... ... ... ... 6 ... 55— 3 Affected ... 2 ... ... ... ... Not ... 4 10 1 ... ... Unknown ... ... ... ... 3 ... Report of the Medical Officer of Health. 141 Of the 712 cases visited by the Inspectors it has been found possible to include in the Tables as many as 640, 322 of males and 318 of females, as against 710 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, 92 cases were notified. Of these, 15 parents had died of Pulmonary Tuberculosis, 62 were living and not affected, 99 died of other diseases, while two were alive and six dead, but their medical history was not known. In the next two columns under the heading of brothers and sisters, two were alive but affected, and 18 dead of Pulmonary Tuberculosis; 357 were alive and not affected, and 117 had died of other diseases, while the medical history of five alive and two dead was unknown. In group III. which relates to uncles and aunts, four had died of Pulmonary Tuberculosis, 100 were alive and not affected, and 72 dead of other diseases, while the medical history of 57 was unknown. In the next column it will be seen that the wives of five cases had died of Pulmonary Tuberculosis, 88 were alive and five dead not affected, while the medical history of one living was unknown. Of the patients' children five were alive and six died affected, 296 alive and not affected, and 43 died of other diseases. Nine 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.:—322, 15 had parents alive affected, while 46 had died of Pulmonary Tuberculosis. 351 parents were alive and not affected while 200 had died, but not of Pulmonary Tuberculosis. 142 Report of the Medical Officer of Health. Among the total number of females, viz.—318, 17 had parents alive affected, while 73 had died of Pulmonary Tuberculosis; 341 parents were alive and not affected, while 175 had died, but not of Pulmonary Tuberculosis. Of the total of 640 patients male and female, married and unmarried, 32 had parents alive affected, while 119 parents had died of Pulmonary Tuberculosis. Taking the column dealing with brothers and sisters, among males we find 22 had brothers and sisters alive affected, while 70 had died of Pulmonary Tuberculosis; and among females 41 had brothers or sisters alive affected, while 74 had died of Pulmonary Tuberculosis, or a total among males and females of 63 who had brothers or sisters alive affected, while 144 had died of Pulmonary Tuberculosis. With regard to the notification of cases of non-pulmonary Tuberculosis, which came into force on the 1st of February, 1913, in all 328 cases were notified, 59 from Clapham, 21 from Putney, 75 from Streatham, 56 from Tooting, and 117 from Wandsworth. 11 of these were under one year of age, 57 from one and under five years, 162 from five and under 15 years, 46 from 15 and under 25 years, 39 from 25 and under 45 years, nine from 45 and under 65 years, and four over 65 years. Table LXXII. shows the number of these cases notified classified according to the part of the body affected, as well as the number of deaths in each class. The total deaths, viz., 46, do not correspond with the total number on Table LXIV, as nine cases died in January, when the disease was not notifiable, six were registered as having died from Pulmonary Tuberculosis and are included under that heading, while in the case of five deaths which occurred in Institutions outside the Borough, no notifications could be obtained. Report of the Medical Officer of Health. 143 As is to be expected, the deaths from General Tuberculosis shows the highest mortality, six out of the six cases notified having been fatal, and the next highest mortality occurred among cases of Tuberculosis of the Brain, 25 out of 27 having been fatal. Out of the total of 328, 46 died, nine have removed to other districts, while 273 cases are still on the Register and under observation. TABLE LXXII. Localisation of Disease. Number of cases notified. No. of deaths. Removed. On Register. Total. Males. Females. Under 1 year. 1 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and upwards. Males. Females. Total. Brain 27 17 10 4 15 4 1 1 2 ... ... ... ... ... 16 9 25 ... 2 Glands, Mediastinal 6 5 1 ... ... 1 4 ... ... ... ... ... ... ... ... ... ... ... 6 „ Mesenteric 27 17 10 2 4 9 4 1 1 1 1 1 2 1 6 2 8 2 17 ,, Cervical 98 52 46 2 18 34 16 10 6 8 3 ... 1 ... ... 1 1 5 92 Bones and joints 127 76 51 1 18 42 38 12 3 5 5 3 ... ... 3 2 5 2 120 Lupus 21 8 13 ... 1 1 7 3 ... 1 4 1 1 2 1 ... 1 ... 20 Larynx 2 1 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 2 General Tuberculosis 6 4 2 1 2 1 ... 1 ... ... ... ... 1 1 4 2 6 ... ... Other parts 14 6 8 ... 2 1 ... 1 4 3 3 ... ... ... ... ... ... ... 14 Total 328 186 142 10 60 93 70 29 16 18 17 6 5 4 30 16 46 9 273 144 Report of the Medical Officer of Health. Report of the Medical Officer of Health. 145 Table LXXIII. is a summary of notifications during the period from the 1st February, 1913, to the 3rd January, 1914, and has been prepared at the request of the Local Government Board. It will be seen that 670 primary notifications of Pulmonary Tuberculosis were made on Form A, 340 of males and 330 of females, while the total notifications were 897. 15 cases were notified by School Medical Officers on Form B, eight of males and seven of females, while 176 notifications from Poor Law Institutions and 107 from Sanatoria were made on Form C. The number of notifications on Form B by School Medical Officers is exceptionally small. From other forms of Tuberculosis 287 were notified on Form A, 31 by School Medical Officers on Form B, while 16 were notified from Poor Law Institutions and 10 from Sanatoria on Form C. It may be stated that notifications on Form A are primary notifications, i.e., cases not previously notified. Form B are notifications from School Medical Officers, and Form C are secondary notifications from Poor Law Institutions and Sanatoria on entering such Institutions. 146 Report of the Medical Officer of Health. TABLE LXXIII. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from 1st February, 1913, to end of the week ending the 3rd January, 1914. Age Periods. Number of Notifications on Form A. Number of Notifications on Form B. Number of Notifications on Form C. Primary Notifications. Total Notifications (i.e. including cases previously notified by other doctors) Primary Notifications. Total Notifications (i.e. including cases previously notified by other doctors) Poor Law Institutions. Sanatoria. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total. Under 5 5 to 10 10 to 15 Total. Pulmonary— Males 1 8 15 14 28 41 87 67 50 20 9 340 449 ... 4 4 8 10 109 50 Females ... 6 16 20 31 50 89 54 41 14 9 330 448 ... 6 1 7 12 67 57 Non-Pulmonary— Males 9 28 43 38 13 7 4 10 1 2 3 158 173 1 13 9 23 24 10 5 Females 2 29 29 16 16 8 16 7 2 3 1 129 142 ... 3 5 8 9 6 5 Report of the Medical Officer of Health. 147 With regard to cases discharged from Institutions, only six were received during the month of January previous to the coming into force of the new Regulations, and of these five were received from the Superintending Officers of the Wandsworth Union, and one from Queen Mary Hospital, Carshalton. Under the new Regulations all discharges are made on Form D, and of these 196 were received from the 1st February, 1913, to the 3rd January, 1914. Of the 196 certificates, 64 were received from Superintending Officers of the Wandsworth Union, 18 from Brompton Hospital, 16 from Mount Vernon Hospital, 14 from Queen Mary Hospital, Carshalton, 13 from the Northern Hospital, 11 from Downs Sanatorium, Sutton, eight from East Cliff House, Margate, six from Brompton Hospital Sanatorium, Frimley, six from the Royal National Sanatorium, Bournemouth, six from St. Mary's House, Margate, five from Pinewood Sanatorium, Wokingham, five from the National Sanatorium, Benenden, four from Victoria Park Hospital, three from Eversfield Chest Hospital, two each from the City of London Hospital for Diseases of the Chest, Malting's Farm Sanatorium Nayland Suffolk, Mount Sanatorium Worcestershire, and St. Michael's Home Axbridge Somerset, and one each from the Chelsea Infirmary, Chilton Hill House Sudbury, Convalescent Home Cranbrook, Firs Home Bournemouth, Fulham Infirmary, Ipswich Sanatorium, National Children's Home Sanatorium St. Albans, Park Hospital Hither Green, and the Royal National Sanatorium, Isle of Wight. Of the 64 certificates received from Superintending Officers of the Wandsworth Union, 36 were from St. James's Infirmary, 25 from the Tooting Home, two from St. John's Infirmary and one from the Workhouse. The 196 certificates received related to 185 cases, nine cases having been notified twice and two cases three times. 35 cases were notified as having gone to addresses in Clapham, 15 to Putney, 45 to Streatham, 26 to Tooting and 64 to Wandsworth. Two cases in Clapham and one in Wandsworth were discharged to Common Lodging Houses. 148 Report of the Medical Officer of Health. The two following Tables show the total number of cases notified and also the number of times they were notified. Of the cases of Pulmonary Tuberculosis 706 were notified once, 70 twice, six three times, and one four times; while of the cases of other forms of Tuberculosis 310 were notified once, 17 twice, and one three times. TABLE LXXIV. Pulmonary Tuberculosis. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. One Notification 140 43 188 82 253 706 Two Notifications 13 2 17 7 31 70 Three Notifications 1 ... 4 ... 1 6 Four Notifications ... ... ... ... 1 1 Total 154 45 209 89 286 783 TABLE LXXV. Other Forms of Tuberculosis. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. One Notification 57 20 73 54 106 310 Two Notifications 2 1 2 2 10 17 Three Notifications ... ... ... ... 1 1 Total 59 21 75 56 117 328 Report of the Medical Officer of Health. 149 The whole of the work in connection with Pulmonary Tuberculosis has been carried out in a most efficient manner by the Female Sanitary Inspectors, and since the 1st April, 1913, more particularly by the Health Visitor, whose whole time is devoted to this work. The total number of visits made was 2,469 in cases of Pulmonary Tuberculosis, 445 in Clapham, 149 in Putney, 665 in Streatham, 343 in Tooting, and 867 in Wandsworth, and 360 in cases of other forms of Tuberculosis, 58 in Clapham, 12 in Putney, 76 in Streatham, 61 in Tooting, and 163 in Wandsworth. In addition to these visits by the Health Visitor, 242 visits were made by the Dispensary Nurse, these visits being made by the instruction of the Tuberculosis Officer to cases under his care at the Dispensary. These numbers are extremely satisfactory when the area of the Borough is taken into consideration. 22 of the cases under observation removed to other places and the Medical Officers of Health of these were duly informed, while 18 cases notified in other districts were notified to me by the respective Medical Officers of Health. During the year 30 sputum flasks have been supplied, and four were returned after the death of the patient. In three of the cases visited the patients already had one, but in many cases the patients objected to their use. Tuberculosis Dispensaries. It will be seen from the Report of the Tuberculosis Officer, Dr. F. G. Caley, that a very large amount of work has been carried out since the Dispensaries were opened on the 1st April, 1913. The administrative control of these Dispensaries and the clerical work involved have during the year been carried out by the Public Health Department, and have increased the work of the 150 Report of the Medical Officer of Health. Department to some extent, but I am able to report that all the officials concerned have worked most conscientiously and harmoniously. There have been many details to think of and much correspondence to deal with, but after nine months' experience I am able to state that the results so far have fully justified the decision of the Council to establish these Dispensaries under its direct control. With regard to the arrangement made for the treatment of insured persons, the London Insurance Committee have now settled, at least, provisionally, that the Tuberculosis Officer will when required by them act as their expert Medical Adviser, and in the cases that have been so far dealt with this arrangement has worked satisfactorily. It is to be hoped that arrangements will shortly be completed for the treatment in sanatoria of non-insured persons, but this is being dealt with by the London County Council, and until this has been settled it has not been found possible to have any patients sent to such Institutions except through the Charity Organisation Society or other organisations, private and otherwise. It is most desirable, especially in the case of children, that certain patients should have open-air treatment other than at home, and it is to be hoped that shortly this will be available. Open-air schools, which have been established by the London County Council in other parts of London, are a most important adjunct to other treatment in many cases, and I would suggest that the London County Council be approached on this matter, as there are no open-air schools available for children in this Borough. Definite arrangements have also been made with St. Thomas's Hospital for referring special cases for consultative purposes, as well as for any treatment necessary after consultation. So far this arrangement has worked satisfactorily, although the cases so sent have not up to date been numerous. Report of the Medical Officer of Health. 151 The question of prevention has occupied a prominent place in the work of the Dispensaries during the year. The examination of contacts, which is dealt with in the report of the Tuberculosis Officer, shows that 541 contacts were examined, and of these 54 or about 10 per cent. were found to be Tuberculous. I am also able to report that the Dispensaries have been utilised to a very large extent by the medical profession, no fewer than 161 cases having been sent by their private medical attendants. With regard to cases of Tuberculosis among insured persons, of 318 cases notified, 135 have been, and 16 are at present in sanatoria. Four of these were in sanatoria for less than one month, 28 from one to two months, 24 from two to three month, 37 from three to four months, 19 from four to five months, 13 from five to six months, and 10 for six months and over. With regard to their condition after return, 52 were improved and able to work, while 52 were stated to have improved, but unable to work, 15 were worse, and 16 died, eight of these at home and eight in sanatoria. After return from sanatoria 78 patients had domiciliary treatment, 28 had dispensary treatment, nine were treated in hospitals while 12 removed and the form of treatment could not be ascertained. During the year disinfection was carried out at 420 premises either after the death or removal of the patient, compared with 426 in 1912, 313 in 1911, 265 in 1910, 255 in 1909, 184 in 1908, and 135 in 1907. 94 of the premises d'sinfected were in Clapham, 13 in Putney, 106 in Streatham, 48 in Tooting, and 159 in Wandsworth. 152 Report of the Medical Officer of Health. Report of Tuberculosis Officer. The Dispensaries were open during the last nine months of the year, and the first patient was seen at the Weir Dispensary, Balham, on April 1st. Except under special circumstances, all patients are examined at the Dispensaries. A few cases are seen at their homes, in consultation with their medical practitioners. The Tuberculosis Officer visits cases requiring special attention and dispensary cases who become bedridden; and other special cases are visited by the nurse, who made 242 visits during the year. Complete records of all cases are kept at the Dispensary. For a patient suffering from Tuberculosis the record comprises the personal and family history, the clinical condition, the results of sputum examinations, and the treatment employed. Particulars are kept of the number of persons living with the patient, the sanitary condition of the home, and the health visitor's reports regarding the home conditions. Notes on all patients found to be non-tuberculous are filed at the Dispensaries. During the nine months 936 patients were examined, of whom 343 were tuberculous. The total attendances at the two dispensaries were 5,502. Table LXXVI. shows the total insured and non-insured cases of each sex, divided into tuberculous and non-tuberculous, the total attendances and the average attendance per case, under each heading. 343 tuberculous cases made 4,152 attendances, an average of 12.1 attendance per case. The insured cases of tuberculosis showed more males than females, with a much higher average attendance for the males. Report of the Medical Officer of Health. 153 The non-insured cases of Tuberculosis showed more females than males, with a higher average attendance for the females. 593 non-tuberculous cases made 1,350 attendances, an average of 2.28 attendances per case. These attendances were made for the purpose of diagnosis and observation. TABLE LXXVI. Cases. Attendances. Case Attendance. M. F. Total. M. F. Total. M. F. Total. Tuberculous Cases— Insured 80 56 136 1340 384 1724 16.75 6.86 12.68 Non-Insured 78 129 207 759 1669 2428 9.73 10.94 11.73 Totals 158 185 343 2099 2053 4152 13.22 11.10 12.10 N on-Tuberculous Cases— Insured 24 23 47 48 48 96 2.00 2.09 2.04 Non-insured 223 323 546 528 726 1254 2.37 2.25 2.29 Total 247 346 593 576 774 1350 2.33 2.23 2.28 Totals— Insured 104 79 183 1388 432 1820 13.34 5.47 9.95 Non-Insured 301 452 753 1287 2395 3682 4.27 5.30 4.89 Totals 405 531 936 2675 2827 5502 6.60 5.32 5.88 154 Report of the Medical Officer of Health. Table LXXVII. shows the number of cases and attendances at each of the two Dispensaries TABLE LXXVII. Dispensary. Total Cases. Total Attendances. Tuberculous. NonTuber culous. Total. Tuberculous. NonTuber culous. Total. 129, East Hill, Wandsworth 235 477 712 2,988 1,013 4,001 Weir Dispensary, Balham 108 116 224 1,164 337 1,501 Totals 343 593 936 4,152 1,350 5,502 Table LXXVII I. shows the sub-districts from which the patients were drawn, and the authorities or agencies recommending them to attend one of the Dispensaries. The largest number of patients came from Wandsworth, the smallest number from Putney. As many as 489 or 52.3 per cent. of all the cases came from Wandsworth. 13 persons came from outside the Borough. These were examined, and if found to be suffering from Tuberculosis, transferred for treatment at Dispensaries in their own areas. 638 patients, or 68.1 per cent. were recommended by the Public Health Department. This large proportion is due to the fact that the Health Visitor visits every case of Tuberculosis notified in the Borough. Any notified case not receiving treatment is advised to attend one of the Dispensaries, as well as the contacts of all notified cases in the Borough. Report of the Medical Officer of Health. 155 TABLE LXXVIII. RETURN SHOWING SOURCE OF CASES AND SUB-DISTRICTS. Clapham. Putney. Streatham. Tooting. Wandsworth. Outside Borough. Totals. Public Health Department 70 41 117 87 323 ... 638 Private Practitioners 18 ... 29 23 84 7 161 Charitable Societies ... ... 1 2 17 ... 20 Transfers from other Dispensaries 1 ... ... ... 4 ... 5 School Authorities 1 ... 2 1 8 ... 12 Existing Dispensary Patients 10 7 5 9 48 6 85 Other Sources 2 1 6 1 5 ... 15 Totals 102 49 160 123 489 13 936 Analysis of Cases. Table LXXIX. shows the number of tuberculous and nontuberculous cases grouped in age periods, and the percentage found to be tuberculous. Of the 936 cases 343 or 36.64 per cent. were tuberculous, and 593 non-tuberculous. 493 cases, i.e., over half of the total number, were under the age of 15. Of these 106 or 21.5 per cent. were tuberculous. Of 443 cases, aged 15 and upwards, 237 or 53.5 per cent. were tuberculous. The difference can be explained by the greater ease with which contact children can be persuaded to attend for examination than contact adults. As will be seen later the majority of the contacts examined were non-tuberculous. 156 Report of the Medical Officer of Health. The sexes were almost equally represented up to the age of 15, while there were 288 females to 155 males aged 15 and upwards. Of the tuberculous cases females predominated between the ages of 20 and 45, and males between the ages of 45 and 65. Report of the Medical Officer of Health. 157 TABLE LXXIX. DIAGNOSIS AND AGE GROUPING OF ALL CASES. Age Period. Tuberculous. Non-Tuberculous. Totals. Percentage of Tuberculous Cases to Total Cases at each Age. Males. Females. Total. Males. Females. Total. Males. Females. Total. Under 1 year 1 ... 1 8 2 10 9 2 11 9.09 1 and under 2 years ... 3 3 4 8 12 4 11 15 20.00 2 and under 5 years 10 6 16 42 48 90 52 54 106 15.01 5 and under 10 years 19 23 42 89 89 178 108 112 220 19.09 10 and under 15 years 24 20 44 53 44 97 77 64 141 31.21 15 and under 20 years 10 10 20 10 17 27 20 27 47 42.55 20 and under 25 years 17 25 42 13 11 24 30 36 66 63.63 25 and under 35 years 33 55 88 11 47 58 44 102 146 60.27 35 and under 45 years 23 36 59 7 60 67 30 96 126 46.82 45 and under 65 years 21 7 28 10 18 28 31 25 56 50.00 65 years and upwards ... ... ... ... 2 2 ... 2 2 ... Totals 158 185 343 247 346 593 405 531 936 36.64 Under 15 years 54 52 106 196 191 387 250 243 493 21.50 15 years and upwards 104 133 237 51 155 206 155 288 443 53.50 Totals 158 185 343 247 346 593 405 531 936 36.64 158 Report of the Medical Officer of Health. Examination of Contacts. The examination of contacts is a most important part of the work at the Dispensaries. In this way Tuberculosis can be detected at an early stage in persons who are continuously exposed to infection. The disease is much more amenable to treatment in the early stages than in the late stages. A further advantage is the opportunity the examination affords, of impressing on the patients, or their parents, the necessity of cleanliness and fresh air. Table LXXX. is a similar one to Table LXXIX., but deals with contacts only. A total of 541 contacts were examined. This total is included in the 936 cases examined during the year, so that of these 936 cases, 541 were contacts. The contacts of most of the tuberculous patients attending the Dispensaries were examined, as well as those of a number of notified cases, which have not yet attended the Dispensaries, but are undergoing treatment elsewhere. Of 541 contacts 54 or 9.98 per cent., were found to be tuberculous, and 487 non-tuberculous. The 54 tuberculous contacts were not aware that they were suffering from Tuberculosis, until they were examined at the Dispensaries. 363 out of 541 were under the age of 15. Of these 28 or 774 per cent. were tuberculous, of 178 age 15 and upwards, 26 or 14.6 per cent. were tuberculous. The sexes were equally represented up to the age of 15, while there were 141 females to 37 males aged 15 and upwards. From the above figures the following facts apply both to the total cases and to the contacts:— Report of the Medical Officer of Health. 159 (1) The majority examined were under the age of 15. (2) A higher percentage were tuberculous over 15 than under 15 years of age. (3) There were more females than males aged 15 and upwards, but under 15 the numbers of males and females were approximately equal. It is hoped that all non-tuberculous contacts will attend every six or nine months for re-examination, so that, should any of them develop Tuberculosis, it will be detected at an early stage. Up to the present patients are availing themselves of this system, and are attending for re-examination when requested to. 160 Report of the Medical Officer of Health. TABLE LXXX. DIAGNOSIS AND AGE GROUPING OF ALL CONTACTS. Age Periods. Tuberculous. Non-Tuberculous. Totals. Percentage of Contacts found to be Tuberculous at age period Males. Females. Total. Males. Females. Total. Males. Females. Total. Under 1 year 1 ... 1 8 2 10 9 2 11 9.09 1 and under 2 years ... 2 2 4 8 12 4 10 14 14.28 2 and under 5 years 5 2 7 34 46 80 39 48 87 8.05 5 and under 10 years 4 8 12 79 72 151 83 80 163 7.36 10 and under 15 years 3 3 6 47 35 82 50 38 88 6.82 15 and under 20 years 2 1 3 7 13 20 9 14 23 13.04 20 and under 25 years 1 6 7 7 4 11 8 10 18 38.88 25 and under 35 years 1 6 7 10 36 46 11 42 53 13.21 35 and under 45 years ... 5 5 5 54 59 5 59 64 7.81 45 and under 65 years 1 3 4 3 11 14 4 14 18 22.22 65 years and upwards ... ... ... ... 2 2 ... 2 2 ... Totals 18 36 54 204 283 487 222 319 541 9.98 Under 15 years 13 15 28 172 163 335 185 178 363 7.74 15 years and upwards 5 21 26 32 120 152 37 141 178 14.60 Totals 18 36 54 204 283 487 222 319 541 9.98 Report of the Medical Officer of Health. 161 Classification of Tuberculous Cases. Table LXXXI. shows the tuberculous cases classified according to the site of the lesion. Of the 343 cases, 286 had Pulmonary Tuberculosis, and 57 Tuberculosis of some other part of the body. 47 of the latter were under the age of 15. The Table shows that in early childhood, organs other than the lungs are commonly affected with Tuberculosis, and that in adult life, the disease is much commoner in the lungs than elsewhere. Of the 286 cases of Pulmonary Tuberculosis, 141 had tubercle bacilli in the sputum, 67 had no tubercle bacilli, while in 78 there was no sputum available for examination. The pulmonary cases can be roughly classified according to the duration of the symptoms at the time of the first examination. Of the 286 cases, symptoms had been present for more than one year in as many as 194, or 67.8 per cent. and for less than one year in 92. Patients with Pulmonary Tuberculosis, who have been ill so long as one year have less chance of benefitting from treatment than those that have been ill for a short period. A considerable number of last year's patients were in an advanced stage when first seen. It is hoped that in future, the number of these will diminish, 162 Report of the Medical Officer of Health. TABLE LXXXI. SITE OF LESION IN TUBERCULOUS CASES. Age Period. Non-Pulmonary. Total. Glands. Joints and Bones. Abdominal. Others. Total NonPulmonary. Pulmonary Tuberculosis Under 1 year ... 1 ... ... 1 ... 1 1 and under 2 years 1 ... ... 2 3 ... 3 2 and under 5 years 6 3 1 1 11 5 16 5 and under 10 years 9 4 3 1 17 25 42 10 and under 15 years 5 6 4 ... 15 29 44 15 and under 20 years 1 ... ... ... 1 19 20 20 and under 25 years ... 2 ... ... 2 40 42 25 and under 35 years 2 1 ... 1 4 84 88 35 and under 45 years 2 ... ... 1 3 56 59 45 and under 65 years ... ... ... ... ... 28 28 65 years and upwards ... ... ... ... ... ... ... Total 26 17 8 6 57 286 343 Treatment of Tuberculous Patients. 24 of the 343 cases were in a quiescent stage of the disease and required no treatment. They were kept under observation, attending periodically for examination. Of the remaining 319, 212 received the whole of their treatment during the year at the Dispensaries and 107 receiving treatment elsewhere in addition to dispensary treatment. Of these 39 were treated in Sanatoria, 21 in Hospitals, 12 in Poor Law Infirmaries, and 39 by their own Medical practitioners, Four of the patients who went to Sanatoria, were afterwards treated by their own medical practitioners, and figure twice in the above list. Report of the Medical Officer of Health. 163 Table LXXXII. shows the disposal of the 343 cases of Tuberculosis at the end of 1913:— TABLE LXXXII. Under observation at the Dispensary requiring no treatment 37 Under treatment at Dispensaries 166 Under treatment elsewhere— In Sanatoria 19 At Hospitals 12 In Poor Law Infirmaries 6 By Medical Practitioners 30 67 Requiring treatment but having none:— Cannot leave work 5 Lack of interest in treatment 8 13 Discharged recovered 6 Left the Borough 35 Died 15 Lost sight of 4 Total 343 Of the 35 cases who left the Borough, particulars of 27 were forwarded to the Medical Officer of Health, or the Tuberculosis Officer of the District to which the patient moved. In the remaining eight the new address was not ascertained. One of the patients who died was under observation at the time, and death was due to a non-tuberculous disease. The number of cases lost sight of was small, as patients neglecting to attend are visited to di cover the cause o their non-attendance, A small number only cannot be traced in this manner. 164 Report of the Medical Officer of Health. All patients at the Dispensaries received some form of medical treatment. Cod Liver Oil and Malt were the drugs most employed, and many children and adults derived much benefit from this old remedy. Tuberculin Treatment. 71 Cases of pulmonary and six cases of non-pulmonary Tuberculosis were treated with tuberculin. The patients have not been under observation sufficiently long to estimate the permanent effect of this form of treatment. The results so far are encouraging. It is important to remember that treatment with tuberculin is supplemented by hygienic and medicinal treatment, and any improvement in the patient's condition is not necessarily attributable to tuberculin. A considerable number of the total cases were not suitable for tuberculin treatment. The best results were obtained with cases who had been ill for a short period. The following are the facts for 71 cases of Pulmonary Tuberculosis, treated with tuberculin:— (1) Tubercle bacilli present in the sputum in 57, absent in 14. (2) 30 cases improved while under the treatment, 35 showed no obvious change, and in six the disease advanced. (3) 41 had symptoms for more than one year, of these 11 or 26.8 per cent. improved. (4) 30 had symptoms for less than one year, and of these 19, or 63.3 per cent., improved. Four of the six non-pulmonary cases improved while under tuberculin treatment. Report of the Medical Officer of Health. 165 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 1913, and for the previous 10 year:— TABLE LXXXIII. Year. Total Number of Deaths. Institutions. Union Infirmaries. General and Special Hospitals. Total. Number. Rate. Number. Rate. Number. Rate. 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 1912 303 86 28.3 43 14.2 129 42.5 Average 270 66 24.5 29 11.0 95 35.5 1913 289 85 29.1 47 16.2 132 45.3 This Table shows that the rates for the present year are much higher than the average for the past 10 years, and also compared with 1912. 166 Report of the Medical Officer of Health. Bacteriological Examination of Sputum. 436 examinations of sputum were made at the Lister Institute: 50 from Clapham, 26 from Putney, 130 from Streatham, 51 from Tooting, and 179 from Wandsworth. In 118 of the cases it was reported that the bacillus had been found, and in 318 that it was absent. Other Infective Diseases. 21 deaths were caused by other Infective diseases, two in Clapham, one in Putney, four in Streatham, five in Tooting, and nine in Wandsworth. Eight of these were under one year, two from two and under five years, two from five and under 15 years, one from 15 and under 25 years, three from 25 and under 45 years, four from 45 and under 65 years, and one over 65 years. Of these 10 were stated to have been due to Syphilis, six to Septicæmia, one to Tetanus, three to Actinomycosis of Lung, and one to Glanders and Farcy. The case of Glanders and Farcy died in Brecknock Infirmary, the man having been an attendant on horses in a travelling menagerie. With regard to the number of deaths from Syphilis, eight were Congenital Syphilis, and two were of adults from Tertiary Syphilis. 17 deaths were caused by Syphilis in 1912, and 13 in 1911. The number of deaths from this disease, however, give little information as to the general prevalence of venereal diseases among the community, as it is more than probable that a considerable number of the deaths of infants from Congenital Debility and Marasmus is due to this cause. Report of the Medical Officer of Health. 167 It is now, however, generally recognised that what are entitled the para-syphilitic diseases as General Paralysis of the Insane and Locomotor Ataxy are later manifestations of Syphilis, and if the number of deaths from these is taken as a criterion a more reliable estimate may be arrived at. In 1913 the number of deaths from General Paralysis was 31, and from Locomotor Ataxy 10, a total of 41, 33 of males and eight of females. In 1912 the number of deaths from General Paralysis was 26, and from Locomotor Ataxy four, a total of 30, 24 of males and six of females. 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 LXXXIV. Death-rate per 1,000. 1908 1909 1910 1911 1912 1913 Small-pox ... ... ... ... ... ... Diarrhœa .64 .41 .30 1.13 .27 .51 Diphtheria .13 .10 .05 .11 .06 .06 Whooping Cough .20 .23 .22 .21 .15 .07 Scarlet Fever .07 .04 .04 .03 .03 .03 Influenza .28 .30 .18 .08 .14 .18 Enteric Fever .02 .02 .026 .029 .02 .02 Measles .15 .37 .14 .74 .16 .36 Tuberculous Diseases 1.34 1.29 1.17 1.26 1.16 1.08 Acute Polio-Myelitis. 13 cases of the above were notified during the year, three from Streatham, one from Tooting, and nine from Wandsworth. One of the cases was under one year, eight from one and under five years, and four from five and under 15 years. 168 Report of the Medical Officer of Health. The following is a list of the cases notified as Polio-Myelitis No. Date. Sex. Age. Parish. Result and present condition. 1 3rd April F. 1 1/6 Wandsworth Died 27th March. Anterior Polio-Myelitis. 2 29th „ F. 2 „ Died 22nd April. Anterior Polio-Myelitis. 3 28th July M. 2 1/1 ½ „ Still paralysed in legs. Health otherwise good. 4 28th Aug. M. 3¾ „ Still paralysed. Attending St. Thomas's Hospital. 5 16th Sept. F. 3½ Streatham Still paralysis of left leg. Improving. 6 2nd Oct. M. 2 5/6 Wandsworth Still paralysed. Attending Hospital. 7 13th „ F. 6 1/6 Tooting Slight paralysis in right arm. Child otherwise well. 8 15th „ F. 10 Wandsworth Died 14th October. Anterior Polio-Myelitis. 9 21st „ M. 3 Streatham Slight case. Almost recovered. 10 3rd Nov. M. 8 Wandsworth Slight paralysis. Attending hospital. 11 3rd „ F. 10 „ Still in M.A.B. Hospital. 12 18 th „ F. 4½ „ Slight case. Recovering. 13 19th „ F. 11 weeks Streatham Still paralysed in both legs and left arm. Two of the cases were notified in April, one each in July, August and September, four in October, and four in November. Three of the cases were fatal, and in all the others some permanent paralysis still exists, although in five of the cases the paralysis is slight. The following report on the 10 last cases was laid before the Public Health Committee and a copy forwarded to the Local Government Board. 27th November, 1913. "With reference to the cases of Polio-Myelitis which have been notified during the last fifteen weeks, I have to report that in all 10 cases have been notified, affecting nine households. No cases occurred in Clapham, none in Putney, three in Streatham, one in Tooting and six in Wandsworth. The particulars of the cases are as follows:— Report of the Medical Officer of Health. 169 1.—J.B., aged 3¾ years, of Aslett Street, Wandsworth, was notified from St. Thomas's Hospital, on the 28th August, the first symptoms having been noted on the 19th August. The patient was taken to St. Thomas's Hospital on the 25th August, and remained there an in-patient till the 12th November, when he was discharged. On his discharge there was still paralysis of the right leg, but the child was otherwise in good health. This child had not been to school nor away from the district at any time. The father, mother and five other children were in good health and have remained so. The house was verminous and untidy, but there were no sanitary defects. 2.—G.M., aged 3½ years, of Selkirk Road, Balham, notified from St. Thomas's Hospital on the 16th September, the first symptoms having been noted on the 30th August. This patient was taken to St. Thomas's Hospital and treated as an out-patient, and she is still being treated there by massage. The child has almost completely recovered, there being now only slight paralysis of the left leg, and the general health is good. The father, mother and one other child are in good health, the house was clean and in good sanitary condition. 3.—A.D., aged 2 years and 10 months, of Morie Street, Wandsworth, notified from the Victoria Hospital on the 2nd October. The first symptoms appeared on the 27th September, and the parents were of the opinion that these were due to a fall. Patient had not been out of the neighbourhood, and all the other members of the family, father, mother and two children were and are still in good health. The patient was treated at the Victoria Hospital till the 5th November, when he was removed to the South Western Hospital, suffering from Scarlet Fever, contracted in Hospital. 170 Report of the Medical Officer of Health. Dr. Bruce of the South Western Hospital informs me that there is still total paralysis of the right leg and paralysis of extensor and calf muscles of left leg. The sanitary condition of the premises was good, but some fleas were noted at the time of the first inspection. 4.—L.E., aged 6 years 2 months, of Derinton Road, Tooting. Notified from Belgrave Hospital on the 8th October. The first symptoms in this child occurred about the 18th September. Had been in attendance at Wandsworth School Clinic for a month previous to onset for defects in eyes. None of the other cases in the Borough had been in attendance at the Clinic, nor were there any suspicious cases in attendance there. All the other members of the family, father, mother and three children, were, and are still in good health. The child is still in hospital and is paralysed in arms and legs, but was notified from Belgrave Hospital on the 24th November as "now suffering Scarlet Fever," contracted in Hospital, and has been removed to the Grove Fever Hospital. 5.—E.J.C., aged 10 years, of Brodrick Road, Wandsworth. Notified by private practitioner on the 15th October. This child was removed on the 14th October to the National Nerve Hospital, Queen Square, where she died shortly after admission. The patient was at a Private School, but had not been in attendance since the third week of July. She went on a visit to Norbiton, for a few days, returning home on the 24th September, and the first symptoms appeared about the 7th October. She rapidly became delirious and comatose, the respiratory centres were also affected, and as stated above she died on the 14th. Having been informed that J.G., at Norbiton had been ill, I communicated with the Medical Officer of Health for Kingston, who in a letter to me dated 20th October, stated that the boy was not ill when E. J. C. was there, but that on the 8th October he had an attack of vomiting, but no other symptoms. Elsie, his sister, was taken ill at the same time Report of the Medical Officer of Health. 171 And was diagnosed as a slight case of Polio-Myelitis. She is now, I have been informed, recovering. The Medical Officer of Health for Kingston also informed me that a similar case has been in the Victoria Hospital, Kingston, and that there has been a fatal case at Maiden. The other occupants of the house, father, mother and three children, were in good health. The house was in a very good sanitary condition. 6.—S.H., aged three years, residing at Balham Hill, notified by a private practitioner on the 21st October. The parents had been resident in Mitcham until about a month previous to the date of notification and the child had been ill previous to that date. As far as could be ascertained the first symptoms appeared about the third week of July, and at the present time there is still partial paralysis of left arm. He is still being treated at St. Thomas's Hospital as an out-patient. The house is in good sanitary condition, and the other members of the family, father, mother and one child are, and have been in good health. In this case also, the mother was of opinion that the illness was due to a fall. His general health is now good, and the paralysis of arm better. The Medical Officer of Health, Croydon Rural District informs me that no cases have been notified in the Mitcham District this year. 7.—J.B., aged 8 years, residing at Fullerton Road, Wandsworth, notified by a private practitioner on the 3rd November. This child showed the first symptoms about the 10th October. This case infected No. 8. 8.—K.B., aged 10 years, residing at Fullerton Road, Wandsworth, also notified on the 3rd November by the same practitioner. This child slept with her brother, and was doubtless infected by him, the first symptoms appearing on the 1st November. The symptoms in the case of No. 7 were indefinite, and it was not until the sister fell ill that the medical practitioner in attendance realised that both were cases of Polio-Myelitis. 172 Report of the Medical Officer of Health. The father, mother and two other children, are in good health, and the sanitary condition of the house was good. Both cases are in the Grove Hospital and recovering, although in the case of K.B. the symptoms are most marked, and the paralysis of both lower limbs almost complete. Neither of these cases had any connection with case No. 3, which is the same neighbourhood. 9.—B.G., aged 11 weeks, residing at Colmer Road, Streatham, notified from Great Ormonde Street Hospital on the 19th November. The first symptoms of the disease seem to have occurred about the 12th September, when the child was only four weeks old, and it had never been outside the house since its birth. The father, mother and five other children are in good health, although a brother aged 4 years had an attack of Pneumonia four months ago and still has a slight cough. The sanitary condition of the premises was good. This patient had been seen by two medical men in the district, previous to being sent to the Great Ormonde Street Hospital, but was not notified by either. 10.—R.W., aged 4½ years, residing at Crealock Street, Wandsworth, notified from the Victoria Hospital on the 18th November. The first symptoms appeared about the 10th November, and she was removed from the Victoria Hospital to the Grove Fever Hospital on the 17th November. This case is a very mild one, having now only slight paralysis of the right leg. The sanitary condition of the house was good, although a few fleas were noted on the occasion of the first visit. All the other members of the family, father, mother and five children are in good health "There seems to be no doubt that all the cases were definite cases of Polio-Myelitis, although the fatal case might more correctly be described as one of Polio-Encephalitis. I have personally seen six of the patients, Nos. 1, 2, 6, 7, 8 and 10, and verified the diagnosis. Report of the Medical Officer of Health. 173 "In case No. 2, the diagnosis was made at St. Thomas's Hospital, and in No. 6 it was confirmed at that Hospital. "In case No. 3, which has been removed to the Western Hospital, Fulham, the diagnosis has been confirmed by the Medical Superintendent there. "In case No. 4 the diagnosis was made at the Belgrave Hospital, and in No. 9 at the Great Ormonde Street Hospital. "Case No. 5 was fatal, and the diagnosis was confirmed by a specialist at the National Nerve Hospital, Queen Square. "With reference to the measures taken to prevent the spread of the disease all the cases in the acute stage were isolated in hospital and the premises disinfected with formaldehyde spray, the bedding, clothing, etc., of the patients being at the same time removed to the Disinfecting Station and disinfected by steam. "With the exception of case No. 8, infected by No. 7, her brother, it was not possible to trace any cause of infection. Case No. 5, the fatal case, may have been infected at Norbiton, but the Medical Officer of Health for that District after careful investigation was unable to definitely state if the case had been infected in his District. "The cases were scattered over a comparatively wide area and even in the cases in Wandsworth Sub-District, there was absolutely no connection, with the one exception previously noted." In the whole of London 145 cases were notified, 60 or 41 per cent. having been notified in the third quarter of the year. Ophthalmia Neonatorum. 37 cases were notified, of which eight were in Clapham, one in Putney, six in Streatham, seven in Tooting and 15 in Wandsworth. One of the cases in Wandsworth occurred in the Workhouse. 174 Report of the Medical Officer of Health. 34 of the cases were visited, in two cases, that of twins in Wandsworth no enquiries were made, 13 were attended at birth by midwives, 16 were treated at hospital as out-patients, one as an in-patient, and three were removed to the Union Infirmary, the 14 remaining being treated at home. Two of the cases are still under treatment. Four cases removed and could not be traced, and one died of Bronchitis. The 27 remaining cases have recovered, one having lost the sight of one eye. Of the two cases under treatment at the end of 1912, one infant has lost the sight of one eye, but the other eye is clear and the other child is still under treatment, having lost the sight of the left eye and partly that of the right. Two cases were notified by the Lady Medical Officers of the London County Council. A midwife was in attendance in each case and both have recovered. Glanders and Anthrax Orders. Under the above Orders only one case of Glanders was notified by the Veterinary Inspector of the London County Council. 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 animal 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, Report of the Medical Officer of Health. 175 TABLE LXXXV. Deaths from Non-Infective Diseases. 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 No. above corrected average. No. below corrected average. Cancer 247 242 224 256 272 274 275 298 321 338 352 36 – Circulatory Diseases 410 327 346 331 387 350 366 312 359 357 411 3 — Respiratory ,, 379 514 512 511 550 543 690 509 531 530 622 16 — Premature Birth 322 298 317 315 285 294 254 249 268 240 234 — 93 Violence 111 101 91 108 90 107 118 91 120 116 115 — 6 All other Diseases 761 951 953 945 988 971 989 1032 1023 1025 1057 — 52 Totals 2230 2433 2443 2466 2572 2539 2692 2358 2622 2606 2791 — 82 The above were the cause of 77.8 per cent. of the total deaths, compared with 79.1 in 1912, 69.4 in 1911, and 82.5 in 1910. Cancer. The total number of deaths from Cancer and other malignant diseases was 352, 141 of males and 211 of females, compared with 338 in 1912, 321 in 1911, and 298 in 1910, an increase of 14 compared with the previous year, and of 36 compared with the corrected decennial average. The corrected death rate was 1.07 per 1,000, compared with 1.07 in 1912, 1.04 in 1911, and .99 in 1910. The number of deaths and the death-rate in each sub-district was as follows:—Clapham 64 and 1.02; Putney 38 and 1.19; Streatham 121 and 1.07; Tooting 25 and .63; and Wandsworth 104 and 1.09. 176 Report of the Medical Officer of Health. Three of the deaths occurred at five to 15 years, one at 15 and under 25 years, 39 at 25 and under 45 years, 158 at 25 and under 65 years, and 151 over 65 years. The following Table shows the number of deaths according to the part of the body affected. TABLE LXXXV1. Locality of Disease. Males. Females. Total. Intestines 39 39 78 Stomach 23 28 51 Breast ... 43 43 Uterus and Ovary ... 34 34 Liver 9 18 27 Œsophagus 15 7 22 Bladder and Kidney 12 8 20 Abdomen 4 15 19 Mouth and Throat 15 3 18 Face and Neck 14 2 16 Pancreas 1 2 3 Other parts 6 8 14 Not specified 3 4 7 Total 141 211 352 In Institutions within the Borough 22 deaths occurred from Cancer, 10 males and 12 females. Eight of these deaths occurred in the Hostel of God, two in Tooting Home, one in the Royal Hospital for Incurables, one in the Fever Hospital, one in H.M. Prison, and nine in private nursing homes. 115 of the deaths, 54 of males and 61 of females, occurred in External Institutions, 47 in Workhouses and Workhouse Infirmaries, and 68 in General and Special Hospitals. Report of the Medical Officer of Health. 177 77 of the total deaths occurred among females from Cancer of the Breast or Uterus, compared with 73 in 1912, 74 in 1911, and 63 in 1910. The greatest number of deaths occurred from Cancer of the Intestines, which include Cancer of the Rectum. 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 LXXXVII. Sub-District. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1912. Average for 10 years. 1913. Clapham 96 110 86 96 125 104 99 134 108 141 109 102 Putney 95 106 112 99 90 110 69 121 120 94 101 119 Streatham 114 91 87 92 105 101 106 89 126 104 101 107 Tooting 60 108 48 86 57 75 73 62 64 87 72 63 Wandsworth 102 84 88 102 90 91 94 95 88 101 93 109 Whole Borough 101 95 86 96 99 97 94 99 104 107 97 107 Compared with 1912 there has been an increase in this rate in Putney, Streatham, and Wandsworth, and a decrease in Clapham and Tooting. There has again been an increase in the rate from this disease compared with the decennial average, but the rate is the same compared with the previous year. In the various sub-districts there has been a considerable increase compared with the decennial average in Putney, Streatham and Wandsworth, but a decrease in Clapham and Tooting. It is specially noticeable that the deathrate in Tooting is the lowest and that in Clapham the highest of the sub-districts during the whole of the 10 years. In the decennium 1851-1860 this rate for England and Wales was only 32.5, 178 Report of the Medical Officer of Health. 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. With regard to the increase in the mortality from Cancer compared with the 10 years' average, an increase which from the Report of the Registrar-General is more observable in London than in England and Wales, the following extract from the RegistrarGeneral's Report for 1911 is worthy of special notice:— "While the figures for a single year would be far too small a basis for forming a definite conclusion on this matter, and there is evidence pointing to a real increase of Cancer of certain parts of the body, the figures for 1911 seem to harmonise sufficiently with the hypothesis that recorded differences in mortality depend upon varying degrees of accuracy in diagnosis to make it worth while to watch those of subsequent years from the same point of view. If the latter point in the same direction then we must ask ourselves whether England and Wales in 1911 does not compare with England and Wales in 1881 more or less as London in 1911 does with the rural districts in 1911. The peculiar history of the increase of Cancer mortality in regard to age and sex would then be explained. The records show continuous increase at all ages for males, whereas in females the increase at ages 35-45 ceased about 20 years ago, and more recently that at 45-55. At the later age-periods the increase still continues at rates which increase in rapidity with increase of age. The male increase at all ages would be explained by the fact that, taking the country as a whole, there is still considerable room for improvement in diagnosis at every age in males. The cessation of increase in middle-aged women is explained if we assume that Cancer is being better diagnosed in the female sex and at the earlier ages is now seldom overlooked in middle-aged females than it formerly was so, the frequency of occurrence being assumed constant. Probably there is little doubt that Cancer is more easily diagnosed, because more accessible, in females, but the assumption that it is more frequently overlooked in old than in middle age is more open to question." Report of the Medical Officer of Health. 179 Diseases of the Brain and Nervous System. From these diseases 364 deaths occurred, compared with 305 in 1912, 358 in 1911, and 351 in 1910. 57 of these deaths occurred in Clapham, 34 in Putney, 139 in Streatham, 36 in Tooting, and 98 in Wandsworth. 21 of the deaths were due to Meningitis, 179 to Cerebral Haemorrhage or Apoplexy, 31 to Convulsions, 12 to Softening of the Brain, 28 to Paralysis, 31 to General Paralysis of the Insane, 10 to Locomotor Ataxy, 17 to Epilepsy, and 35 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 32, in Pulney 16, in Streatham 72, in Tocting 13, and in Wandsworth 46, a total of 179, compared with 154 in 1912, 147 in 1911, and 155 in 1910. 35 of the deaths from Diseases of the Brain and Nervous System were under one year, 10 from one and under two years, seven from two and under five years, four from five and under 15 years, nine from 15 and under 25 years, 45 from 25 and under 45 years, 100 from 45 and under 65 years, and 154 over 65 years. Of the total deaths from the above under one year, viz.—35, 26 were from Convulsions, while of the total deaths over 65 years, viz.—154, 109 were from Cerebral Haemorrhage. Circulatory Diseases. From the above group of diseases, 411 deaths occurred, 166 of which, 66 males and 100 females, were due to Valvular diseaes of the Heart. 88 of these deaths occurred in Clapham, 23 in Putney, 131 in Streatham, 38 in Tooting, and 131 in Wandsworth. 180 Report of the Medical Officer of Health. Of the deaths from all diseases of the Heart, one was from one and under two years, one from two and under five years, 15 were from five and under 15 years, 14 from 15 and under 25 years, 64 from 25 and under 45 years, 136 from 45 and under 65 years, and 171 over 65 years. The number of deaths in 1913 was 54 more than in 1912, and three above the corrected decennial average. Respiratory Diseases. The total number of deaths was 622, 305 of males and 317 of females, compared with 530 in 1912, 531 in 1911, and 509 in 1910. The number of deaths was 92 more than in the previous year, and 16 above the corrected decennial average. 125 of the deaths occurred in Clapham, 58 in Putney, 178 in Streatham, 66 in Tooting, and 195 in Wandsworth. Compared with 1912, there was an increase in all the subdistricts. 267 of the deaths occurred from Bronchitis, compared with 274 in 1912 ; 41 from Lobar Pneumonia, 132 from Lobular or Broncho-Pneumonia, 147 from Pneumonia in which the exact form was not distinguished ; and 35 from other diseases of the Respiratory Organs. 127 of the deaths were of infants under one year, 42 from one and under two years, 33 from two and under five years, 10 from five and under 15 years, nine from 15 and under 25 years, 61 from 25 and under 45 years, 126 from 45 and under 65 years, and 220 over 65 years. The greatest number of deaths from these diseases occurred among infants under one year, and of persons over 65 years. From Bronchitis alone 152 deaths occurred among persons over 65 years of age, compared with 143 in 1912, and 133 in 1911. Report of the Medical Officer of Health. 181 Appendicitis and Typhitis. 26 deaths occurred from these diseases, 14 of males and 12 of females, equal to a rate of 81 per million, compared with 92 in 1912, 77 in 1911, and 21 in 1910. The total number of deaths in the whole of London for the 53 weeks was 334, equal to a rate of 73 per million. Deaths from other Causes. From Alcoholism, Acute and Chronic, 14 deaths, six of males and eight of females, occurred ; and 26, 15 of males and 11 of females, from Cirrhosis of the Liver, compared with 13 and 39 in 1912. From Nephritis and Bright's disease 104 deaths occurred, 58 of males and 46 of females, compared with 109 in 1912. From Accidents and diseases of Pregnancy and Child Birth 14 deaths occurred, all from 25 and under 45 years. This, added to the number of deaths from Puerperal Fever, viz.—13, gives a total of 27 deaths after child-birth, or a proportion of 3.94 per 1,000 births, compared with 3.84 in 1912. In London for the year 1913, this rate was 2.77, Of the 14 deaths, three occurred in Clapham, two in Putney, two in Streatham, one in Tooting, and six in Wandsworth. Five of the deaths were due to Haemorrhage, two to Rupture of the Uterus, one to Embolism, and six to Convulsions. Diabetes Mellitus was the cause of 40 deaths, 19 of males and 21 of females, nine in Clapham, four in Putney, 14 in Streatham, three in Tooting, and 10 in Wandsworth, compared with 39 in 1912. 182 Report of the Medical Officer of Health. Premature Birth and Developmental Diseases. 234 deaths, 132 of males and 102 of females, were registered as having occurred from these diseases, compared with 240 in 1912, 268 in 1911, and 249 in 1910. The number of deaths is thus six under last year, and 93 under the corrected decennial average. 103 of the deaths were due to Premature Birth, 105 to Developmental diseases and 26 from other diseases of Early Infancy. 231 were of infants under one year, two from one and under two years, and one over two 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 XXIV., which deals with Infantile Mortality, while for the subdistricts the Tables will be found in the Appendix. Old Age. 237 deaths, 81 of males and 156 of females, occurred from Old Age, compared with 236 in 1912, 210 in 1911, and 179 in 1910. 49 of these occurred in Clapham, 22 in Putney, 68 in Streatham, 26 in Tooting, and 72 in Wandsworth. With one exception all these deaths were of persons over 65 years. Six were from 65 and under 70, 40 from 70 and under 75, 53 from 75 and under 80, 68 from 80 and under 85, 49 from 85 and under 90, 17 from 90 and under 95, two from 95 and under 100, and one over 100 years. 1,146 deaths, or 31.9 per cent. of the total deaths, occurred in persons over 65 years, compared with 32 in 1912, 28.3 in 1911, and 31.1 in 1910. The percentage of deaths over 65 years to total deaths, in the sub-districts was as follows:—In Clapham 30.8, in Putney 34.6, in Streatham 38.1, in Tooting 25, and in Wandsworth 28.3. Report of the Medical Officer of Health. 183 Violence. 115 deaths, 65 of males and 50 of females, occurred from Violence, compared with 116 in 1912, 120 in 1911, and 91 in 1910. 80 of the deaths were due to Accidental, and 33 to Suicidal causes. Two deaths were caused by other forms of Violence, in one of which a verdict of murder was given. 26 of the deaths belonged to Clapham, 18 to Putney, 40 to Streatham, 10 to Tooting, and 21 to Wandsworth. From Accidental causes six of the deaths were of infants under one year, two from one and under two years, four of persons from two and under five years, 12 from five and under 15 years, four from 15 and under 25 years, 15 from 25 and under 45 years, 20 from 45 and under 65 years, and 17 over 65 years. Of the deaths from Suicidal causes, two were from 15 and under 25 years, 14 from 25 and under 45 years, 15 from 45 and under 65 years, and two over 65 years. The number of deaths from Violence is one less than in 1912, 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 189, compared with 182 in 1912, 192 in 1911, and 189 in 1910. 35 of the Inquests were held on persons who died in Clapham, 32 in Putney, 55 in Streatham, 17 in Tooting, and 50 in Wandsworth. In 112, or 59.2 per cent, of the cases a verdict of death from Natural causes was returned ; in 45, or 23.8 per cent., from Accidental causes ; in 27, or 14.3 per cent., from Suicidal causes ; while in five Open verdicts were returned. 184 Report of the Medical Officer of Health. 39 of the Inquests were held on persons not belonging to the Borough who died in the Borough. One of these was on a person who died in the Prison, four in the River Thames, five in Putney Hospital, one in the Fever Hospital, one in the Middlesex Asylum five on the railway, and 22 in other places and on the street. TABLE LXXXVlll. INQUESTS. Sub-Districts. Whole Borough. Clapham. Putney. Streatham. Tooting. Wandsworth. Deaths from Natural Causes 21 10 33 12 36 112 Accidental:— Knocked down by motor 1 4 4 ... 1 10 Falls 1 1 1 ... 2 5 Burns ... 3 1 1 ... 5 Struck by train ... ... 3 ... 1 4 Injury at birth ... 1 2 ... ... 3 Knocked down by tramcar 1 ... 1 ... ... 2 Suffocated in bed with parents ... 1 1 ... ... 2 Fall from perambulator ... 1 1 ... ... 2 Caught in machinery 1 ... ... ... ... 1 Knocked down by van 1 ... ... ... ... 1 Struck by counterweight of lift 1 ... ... ... ... 1 Fall from wall ... 1 ... ... ... 1 Fall down flight of steps ... ... 1 ... ... 1 Fall from omnibus ... ... 1 ... ... 1 Electrocuted whilst working crane ... ... 1 ... ... 1 Blow on head whilst at play ... ... 1 ... ... 1 Run over by road locomotive ... ... ... 1 ... 1 Fall from plank ... ... ... ... 1 1 Drowning ... ... ... ... 1 1 Strain whilst at work ... 1 ... ... ... 1 Suicidal:— Hanging ... 1 ... 3 2 6 Drowning ... 3 ... ... 2 5 Cut throat 1 2 ... ... ... 3 Gunshot wounds ... ... 1 ... 1 2 Poisoning by hydrochloric acid ... 1 1 ... ... 2 Poisoning by coal gas 1 1 ... ... ... 2 Poisoning by arsenic 1 ... ... ... ... 1 Poisoning by "Lysol" 1 ... ... ... ... 1 Poisoning by strychnine 1 ... ... ... ... 1 Poisoning by formaldehyde 1 ... ... ... ... 1 Poisoning by carbolic acid ... ... 1 ... ... 1 Poisoning by oxalate of potash ... ... ... ... 1 1 Run over by train ... ... ... ... 1 1 Open Verdicts:— Found dead 1 1 ... ... 1 3 Found drowned 1 ... 1 ... ... 2 Totals 35 32 55 17 50 189 Report of the Medical Officer of Health. 185 98 inquests were held on persons belonging to the Borough who died outside the Borough; 30 from Clapham, seven from Putney, 30 from Streatham, nine from Tooting, and 22 from Wandsworth, and the following Table shows the causes of death. 30 of these deaths were from Natural, 49 from Accidental, and 17 from Suicidal causes, while in two open verdicts were returned. TABLE LXXXIX. INQUESTS. Sub-Districts. Whole Borough. Clapham. Putney. Streatham. Tooting. Wandsworth. Deaths from Natural Causes 8 2 9 4 7 30 Accidental:— Falls 6 1 3 ... 4 14 Knocked down by motor 4 2 2 ... 2 10 Run over by van 3 ... 1 ... 1 5 Drowning 1 ... 2 ... ... 3 Burns 1 ... ... 1 1 3 Run over by train 2 ... 1 ... ... 3 Knocked down by tram car ... ... 1 ... 1 2 Crushed against wall by pole of van ... ... ... 1 ... 1 Fall from ladder 1 ... ... ... ... 1 Death under an anaesthetic ... ... ... ... 1 1 Fall from omnibus ... ... ... ... ... 1 Fall down area 1 ... ... ... ... 1 Fall from bicycle ... ... 1 ... ... 1 Fall down well of lift ... ... ... 1 ... 1 Scalds ... ... 1 ... ... 1 Blood poisoning following injury ... ... ... ... 1 1 Suicidal:— Drowning 1 2 3 ... 1 7 Cutthroat ... ... 2 ... 1 3 Injuries following jump from bridge ... ... ... 1 ... 1 Gunshot wounds ... ... ... ... 1 1 Run over by train 1 ... ... ... ... 1 Poisoning by chloroform ... ... ... 1 ... 1 Poisoning by salts of lemon ... ... 1 ... ... 1 Poisoning by morphia 1 ... ... ... ... 1 Poisoning by oxalic acid ... ... ... ... 1 1 Open Verdicts:— Found drowned ... ... 2 ... ... 2 Totals 3° 7 30 9 22 98 186 Report of the Medical Officer of Health. Deaths and Causes of Death in Public Institutions. In the Public Institutions in the Borough 1,034 deaths occurred during the year, compared with 958 in 1912, 850 in 1911, and 723 in 1910. Of these, 822 deaths were of persons not belonging to the Borough, compared with 767 in 1912, and 212 of persons belonging to the Borough, compared with 191 in 1912. The increase was again chiefly due to the increase in the number of deaths of persons not belonging to the Borough. In Clapham 62 deaths occurred in the Hostel of God, nine of these being Borough residents. Of these 34 were due to Cancer, 22 to Pulmonary Tuberculosis, one from Rheumatic Fever, two from Bronchitis, one from Influenza, and two from other causes. In Putney two deaths occurred in the Priory, Roehampton, one from disease of the nervous system, and one from heart disease. In Putney Hospital, 31 deaths occurred, 18 belonging to the Borough and 13 not belonging thereto. Eight of the deaths were due to accident, two to Suicide, four to diseases of the Urinary Organs, two to diseases of the Lungs, two to diseases of the Heart, one each to Diphtheria, Enteritis, Appendicitis, obstruction of the Bowels, Cancer and Diabetes, and seven to other causes. In Streatham there were 7 deaths in St. Anne's Home, 15 in the Home for Aged Jews, and eight in the Middlesex County Asylum Annexe. Of the seven in St. Anne's Home, three were from diseases of the Respiratory Organs, two from Heart Disease, and two from other causes. Of the 15 in the Home for Aged Jews, two were from diseases of the Nervous System, six from diseases of the Circulatory system, two from diseases of the Respiratory Organs, two from Cancer, one from Old Age and two from other causes. Of the eight in the Middlesex County Asylum Annexe, three were from Pulmonary Tuberculosis, three from diseases of the Nervous System, and two from diseases of the Respiratory Organs. Report of the Medical Officer of Health. 187 In Tooting 601 deaths occurred in Public Institutions, 336 in Tooting Bee Asylum, 126 in the Fever Hospital, 104 in Tooting Home, 33 in the Fountain Asylum, and two in Newlands House Asylum. 113 of these—63 in the Tooting Home, 43 in the Fever Hospital, five in Tooting Bee Asylum, and two in the Fountain Asylum, were of persons belonging to this Borough. Of the 336 deaths in the Tooting Bee Asylum, 193 were from Old Age, 10 from Pulmonary Tuberculosis, four from other forms of Tuberculosis, 56 from diseases of the Respiratory Organs, 42 from diseases of the Heart, six from diseases of the Nervous System, five from Cerebral Haemorrhage, six from Cancer, six from diseases of the Urinary System, four from Congenital Debility, and four from all other causes. In the Fever Hospital, 126 deaths occurred, 43 of which belonged to the Borough, compared with 39 in 1912, 48 in 1911, and 54 in 1910. 18 of these deaths were from Scarlet Fever, 35 from Diphtheria, 34 from Measles, 20 from Whooping Cough, one from Enteric Fever, six from diseases of the Respiratory Organs, one from Pulmonary Tuberculosis, two from Tuberculous Meningitis, two from Enteritis, and seven from other causes. 104 deaths occurred in the Tooting Home, 63 of which were Borough residents. 58 of these were from Pulmonary Tuberculosis, 23 from Old Age, six from diseases of the Respiratory Organs, four from Cancer, seven from diseases of the Heart, five from Apoplexy, and one from Nephritis. In the Fountain Asylum for Imbeciles, 33 deaths occurred, two of which belonged to the Borough. Six of these were due to diseases of the Nervous System, five to Pulmonary Tuberculosis, four to other forms of Tuberculosis, one to Heart Disease, eight to diseases of the Respiratory Organs, four to Congenital Debility, and five to other causes. 188 Report of the Medical Officer of Health. In Wandsworth 147 deaths occurred, in Public Institutions, 14 of which were Borough residents. Of these 117 were in the Middlesex County Asylum, 17 in the Royal Hospital for Incurables, five in the Prison, and eight in the Workhouse. Of the 117 deaths in the Middlesex County Asylum, 15 were from Pulmonary Tuberculosis, 10 from Old Age, 22 from diseases of the Respiratory Organs, six from Bright's disease, one from Enteritis, three from Cancer, 46 from diseases of the Brain and Nervous System (of which 23 were from General Paralysis of the Insane, 12 from Epilepsy, and one from softening of the Brain), five from Heart disease, one from Accident, one from Suicide, one from Diabetes, and six from other causes. Of the 17 deaths in the Royal Hospital for Incurables, one was from Pulmonary Tuberculosis, six from diseases of the Nervous System, one from Diabetes, one from Bronchitis, four from Influenza, and four from other causes. Of the five deaths in the Prison, two were from diseases of the Nervous System, one from Pulmonary Tuberculosis, one from Cancer, and one from Suicide. Of the eight deaths in the Workhouse, four of which belonged to the Borough, three were from Developmental diseases, one from Parturition, one from Accident, one from Heart Disease, one from Apoplexy, and one from Old Age. In other places 169 deaths occurred, 58 of which belonged to the Borough, 22 of these being from Accident, 24 from Cancer, nine from Suicide, eight from Pulmonary Tuberculosis, two from other Tuberculous diseases, four from Influenza, 12 from Cerebral Haemorrhage, nine from diseases of the Nervous System, four from Appendicitis, two from Diarrhoea, 19 from diseases of the Heart, 23 from diseases of the Respiratory Organs, three from Old Age, five from Nephritis, five from Premature Birth and Developmental diseases, six from Intestinal Obstruction, and 12 from other causes. 55 of these deaths occurred in Private Nursing Homes, and six in the River Thames. Report of the Medical Officer of Health. 189 Of the 1,066 deaths in Public Institutions outside the Borough, 500 occurred in Workhouses and Workhouse Infirmaries, 425 in General and Special Hospitals, 105 in Lunatic and Imbecile Asylums, and 36 in the Metropolitan Asylums Board's Fever Hospitals. Of the 500 deaths in Workhouses and Workhouse Infirmaries, 10 were from Measles, one from Influenza, two from Erysipelas, 45 from Pulmonary Tuberculosis, 15 from other Tuberculous diseases, 47 from Cancer, 14 from Alcoholism and Cirrhosis of the Liver, 20 from Cerebral Haemorrhage, 16 from diseases of the Nervous System, 57 from diseases of the Heart, 77 from diseases of the Respiratory Organs, 57 from Diarrhoea and Enteritis, 18 from Bright's disease, two from Puerperal Fever, eight from Premature Birth and Congenital Debility, 55 from Old Age, 12 from Accident, two from Suicide, and 42 from other causes. Of the 425 deaths in General and Special Hospitals, two were from Measles, two from Influenza, 31 from Pulmonary Tuberculosis, 22 from other forms of Tuberculosis, 68 from Cancer, 14 from Apoplexy, 22 from diseases of the Nervous System, 33 from diseases of the Heart, 29 from diseases of the Respiratory Organs, 24 from Diarrhoea and Enteritis, 17 from Appendicitis, 13 from Obstruction of the Bowels, 11 from Ulcer of Stomach, 10 from Bright's disease, three from Puerperal Fever, 19 from Premature Birth and Congenital Debility, six from Old Age, 35 from Accident, 15 from Suicide, and 49 from other causes. Of the 105 deaths in Lunatic and Imbecile Asylums, one was from Enteric Fever, one from Measles, one from Influenza, 11 from Pulmonary Tuberculosis, six from Apoplexy, 37 from diseases of the Nervous System, 20 from diseases of the Heart, 17 from diseases of the Respiratory Organs, two from Enteritis, four from Bright's disease, two from Old Age, and two from other causes. Of the 36 deaths in the Metropolitan Asylums Board's Fever Hospitals, two were from Enteric Fever, two from Scarlet Fever, 19 from Measles, two from Diphtheria, one from Cerebro-spinal Fever, two from Pulmonary Tuberculosis, four from Puerperal Fever, one from Congenital Debility, and three 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, 190 Report of the Medical Officer of Health. TABLE XC. I.—Institutions within the District receiving sick and infirm persons from outside the District. II.—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. Fever Hospitals 83 1.Wandsworth Union Infirmaries 484 32. Long Grove Asylum 19 Fever Hospitals 43 Fountain Temporary Asylum 31 33.Manor Asylum 5 Fountain Temporary Asylum 2 Home for Aged Jews 15 2.Banstead Asylum 16 34.Middlesex Hospital 15 H.M. Prison 3 Hostel of God 53 3.Belgrave Hospital 19 35.National Hospital 3 Hostel of God 9 H. M. Prison 2 4.Bethnal House Asylum 2 36.Queen Mary Hospital 5 Middlesex County Lunatic Asylum 6 Middlesex County Lunatic Asylum 111 5.Bolingbroke Hospital 20 37.Royal Free Hospital 2 6.Brompton Hospital 9 38.Royal Waterloo Hosp. 3 Putney Hospital 18 Newlands House 2 7.Cancer Hospital 5 39.St. Bartholomew's Hospital 5 Royal Hospital for Incurables 1 Putney Hospital 13 8.Cane Hill Asylum 12 Royal Hospital for Incurable 16 9.Caterham Asylum 6 40.St. George's Hospital 9 The Workhouse 4 St. Anne's Home 7 10.Charing Cross Hospital 1O 41.St. George's Infirmary 5 Tooting Bee Asylum 5 The Priory, Roehampton 2 11.City of London Asylum 2 42.St. Luke's House 5 Tooting Home 63 The Workhouse 4 12.Colney Hatch Asylum 2 43.St. Mary's Hospital 4 Nursing Homes 21 Tooting Bee Asylum 331 13.Croydon Gen. Hospital 4 44.St. Thomas's Hospital 67 River Thames 2 Tooting Home 41 14.Croydon Mental Hospital 3 45.University College Hospital 3 Other Places 35 Nursing Homes 34 15.Dartford Heath Asylum 4 212 River Thames 4 16.Downs Sanatorium 3 46.Victoria Hospital 11 Other Places 73 17. Evelina Hospital 7 47.Westminster Hospital 21 822 18.French Hospital 2 48.Westminster Infirmary 2 19.Friedenheim Hospital 3 49.West London Hospital 11 20.Gen. Lying-in Hospital 2 50.Northern Hospital 2 21.Gt. Ormonde St. Hospital 4 51.Park Hospital 2 22.Guy's Hospital 16 52.South Eastern Hospital 4 23.Hanwell Asylum 6 53.South Western Hospital 10 24.Homoeopathic Hospital 2 54.Western Hospital 18 25.Horton Asylum 18 55.Other Institutions 41 26. Hospital of St. John and St. Elizabeth 2 56.Other places not public Institutions 69 27.Infants Hospital 11 57.On Street 7 28.King's College Hospital 4 58.River Thames 10 29.Lambeth Infirmary 6 59.Private Nursing Homes 18 30.Leavesden Asylum 2 1066 31.London Hospital 4 Report of the Medical Officer of Health. 191 Compared with the average of the last 20 years there has been a marked increase in the number of deaths in Institutions, and to show 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 twenty years 1892-1911 these increased in London from 25.4 to 43.5 with an average of 33.76, and in Wandsworth from 15.0 to 30.9 with an average of 21.84. 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 32.8 per cent, of the total deaths occurred in Institutions, and that for the year 1912, 15.5, 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. i92 Retort of the Medical Officer of Health. TABLE XCI. Percentage of Deaths in Public Institutions to total Deaths for the year 1912 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. 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 l6.3 1901 16.5 9.5 13.6 8.0 2.4 1.8 32.5 !9.3 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 1.6 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 1911 22.4 12.2 16.8 16.1 2.1 2.6 4.3 30.9 averages 1892— 1911 17.65 10.40 14.57 9.41 2.10 2.03 33.76 21.84 1912 23.8 15.5 17.7 15.5 2.0 1.8 43.5 32.8 Report of the Medical Officer of Health. 193 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 and Nervous systems, 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, 1913. 194 Report of the Medical Officer of Health. Proportion per 1,000 Deaths from all causes. Notifiable Diseases 15.0 Measles 32.3 Influenza 16.4 Whooping Cough 6.4 Diarrhoea and Dysentery 46.8 Tuberculosis (all forms) 98.9 (Lungs) (80.5) Bronchitis 74.4 Pneumonia 89.2 Cancer 98.1 Nervous Diseases 101.6 Circulatory Diseases 114.5 Premature Birth 28.7 Congenital Debility, etc 36.6 Old Age 66.1 Digestive Diseases 42.6 Urinary Diseases 34.9 Violence 32.1 Other Causes 65.4 All Causes 1,000.0 Cutting-off Notices. During the year 65 notices with respect to 73 premises were received from the Water Board stating that the supply had been withdrawn. 10 of the premises were in Clapham, eight in Putney, 35 in Streatham, three in Tooting, and 17 in Wandsworth. The supply was withdrawn for non-payment of rates from 41 premises, from 18 premises in consequence of defects, and in 14 the premises were empty. Compared with 1912, there has been a decrease of 31 in the number of notices received, and of 53 in the number of premises affected. Report of the Medical Officer of Health. 195 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 them, but so far no decision as to the site has been arrived at. The Mortuary at Tooting has been closed, but a temporary one has been provided pending the erection of a new one in Wandsworth. In Clapham, 40 bodies were removed to the Mortuary, compared with 30 in 1912 ; in Streatham 51 compared with 39, and in Wandsworth 114, of which 53 were from Wandsworth, 37 from Putney, six from Streatham and 18 fromTooting, compared with 117 in 1912—a total of 205 compared with 186 in 1912. 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 1913 The following list shows the special inspections made by me during the year :— (1)—Complaints were received from several owners of the deposit of house refuse on land in Greyhound Land by a contractor, and on visiting the premises it was found that a considerable quantity of house refuse had been deposited there in contravention of the By-laws. Notice was served on the contractor and this was complied with by the removal of most of the refuse to another locality, some of it being burnt on the spot under the supervision of the Sanitary Inspector. 196 Report of the Medical Officer of Health. (2)—Special inspections were made of several new roads in consequence of complaints by residents in these roads. The roads chiefly complained of being Glencairn Road, Downton Avenue, part of Ellison Road, and Strathbrook Road, Streatham. Downton Avenue has now been properly made up by the Council. Strathbrook Road is to be repaired by the Council, while the nuisances at Glencairn Road and Ellison Road have been abated. (3)—Special inspections were made of all the rag and bone dealers' premises in the Borough to ascertain which of these premises would be affected by the By-laws proposed to be made by the London County Council. In all 37 premises were inspected, (four in Clapham, three in Putney, seven in Streatham, four in Tooting, and 19 in Wandsworth). 15 of the owners of these places dealt only with rags and bones, 14 with rags, bones and fat, two with rags and fat, and one with bones and fat. These places cannot, owing to the nature of the materials dealt with, be considered to be free from a certain amount of nuisance, but the owners were in all cases willing to carry out any improvements suggested by me. The fat and bones are as a rule kept in proper receptacles and removed every day or every other day, while the rags are sorted on the premises and put into boxes or sacks for removal at irregular intervals. The suggested By-laws would, in my opinion, be a great improvement and would not press hardly on the owners if judiciously administered. (4)—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 one less than in the previous year, but much under the number received in 1911; this having been due to the fact that the climatic conditions were unfavourable. In all, 90 complaints were received, compared with 91 in 1912: five from Clapham North, three from Clapham South, Report of the Medical Officer of Health. 197 13 from Putney, 17 from Streatham, six from Balham, 11 from Tooting, 11 from Southfield, six from Fairfield, and 18 from Springfield Wards. All these complaints were forwarded to the Borough Engineer, who reported that in 76 cases the sewers were flushed and disinfected, in nine the manholes were temporarily sealed, in three ventilating columns were erected, while in two cases broken manhole plates were repaired. (5)—Inspections were also made of several passages and mews with the result that several have again this year been satisfactorily dealt with. (a) Passage in rear of 102 to 114, Streatham High Road has been properly paved. (b)—Passageway at rear of 104 to 108, Eardley Road, Streatham, entering from Leverson Street, has been properly paved throughout after service of notice on the various owners. (c)—Passageway between 95 and 97, Fallsbrook Road, Streatham, has been properly paved and drained. (d)—Passages in Corsehill Street, Streatham. These passages, which extend along the back of the houses on both sides of the road, and their several entrances have been properly paved. In some cases gates have also been erected at the entrances to the passages. (e)—Passages at rear of Ribblesdale and Nimrod Roads, Streatham. These passages extend from top to bottom of the roads in the rear of the houses and at one time had boundary fences which had been broken down. They were in an insanitary condition and notices have been served on the owners. So far nothing has been done as there is a difficulty in ascertaining the responsible parties, but further inquiries are being made and it is hoped that the work will be carried out during the current year. (/)—Passage in rear of 2 to 18, Pretoria Road, Streatham, was found to be in an insanitary condition and notices have been served. The work will be completed in the current year. 198 Report of the Medical Officer of Health. (g)—Passage at rear of 25 to 33, Thrale Road, Streatham, has been repaired and the refuse deposited there removed. The owners have stated that the work of properly paving the passage will be carried out in the early part of the current year. (h)—Passage at rear of 119 to 133, Mitcham Road, Tooting, has been repaired again during the year. (i)—Passage at rear of 211 to 215, High Street, Tooting. Notice was served at the close of the year, but so far nothing has been done owing to climatic conditions. (k)—Passage at rear of 493 to 499, Garratt Lane, Wandsworth, has been repaired. (l)—Passage at rear of 211 to 215, Garratt Lane, Wandsworth, has been temporarily repaired and the nuisance abated. (m)—Passage at rear of 203 to 207, Garratt Lane, Wandsworth, has been repaired and the nuisance abated. (n)—Passage at rear of 204 to 224, High Street, Tooting, entering from Blackshaw Road, has been cleansed and a gate erected at the entrance. (6)—Special house-to-house inspections were made by me during the year in Chip Street, Crichton Street, Cross Street, Prescott Place, Rashleigh Street, Robertson Street, St. Andrew's Street, Rowlands Cottages, Young's Rents, Carpenters Cottages, Lower and Upper Orchard Streets, and Nelson's Row, Clapham; College Street, Floss Street, Biggs Row, Putney; High Street, Medfield Street, and Angel Court, Roehampton ; Ellora Road, Fallsbrook Road, Ferrers Road, Hambro Road, Mill Lane, Calders Row, Cowpers Row, Lutheran Place, Fairview Place, Smith's Cottages, Champion Place, Dendy Street, Larch Road, Oldridge Road, Zennor Road, Chesil Place, Hazelhurst Road, and Foss Road, Streatham ; Kellino Street, Aldis Mews, and Letchworth Street, Tooting ; Dutch Yard, Field's Alley, Baylin Road, Iron Mill Road, Malva Road, Bendon Valley, Lydden Grove, Lydden Road, Wardley Street, and Point Pleasant, Wandsworth. Report of the Medical Officer of Health. 199 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. Including the house-to-house inspections and inspections for certificates under the Revenue Act, but excluding the routine inspection of bakehouses, slaughter-houses, cowsheds, and offensive trade premises, 820 inspections were made of premises, chiefly previous to the service of statutory notices. My attendance at the Police Court was necessary on 10 occasions during the year. Revenue Act. During the year eight certificates were granted under the above Act, one deferred, and one refused. The certificates granted referred to 27 houses or 61 tenements, that deferred to one house or two tenements, and those refused to two houses or six 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 were given in the Report for 1910. 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. 200 Report of the Medical Officer of Health. The four houses in Putney reported on in 1910 under the above Act, have now been demolished, but the one in Wandsworth is still 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. Several inspections were made of property to ascertain if any additional underground rooms existed, but only three cases were discovered in which there was illegal occupation of such rooms. All the houses erected for occupation by the working classes during the past 15 years have no basements, and consequently the number of underground rooms in this Borough is very small. Sanitary Operations. Tables XCII., XCIII., and XCIV., 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. The number of complaints received and attended to was 2,394, compared with 2,528 in 1912, 2,076 in 1911, and 1,789 in 1910. There was an increase in Clapham South, Balham, Southfield, and Fairfield Wards, and a decrease in Clapham North, Putney, Streatham, Tooting, and Springfield Wards, compared with the previous year. Report of the Medical Officer of Health. 201 Three 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 38,803, an increase of 2,487 compared with 1912, amd of 6,830 compared with 1911. There was an increase in the number of houses and premises inspected in Clapham North, Putney, Streatham, Balham, Tooting, Fairfield and Southfield Wards, and a decrease in Clapham South and Springfield Wards. The total number of house-to-house inspections made was 2,739, compared with 2,674 in 1912, 2,486 in 1911, and 6,276 in 1910. There has been an increase in the number of these inspections in Clapham North, Putney, and Balham Wards, and a decrease in Clapham South, Streatham, Tooting, Southfield, Fairfield, and Springfield Wards, compared with 1912. Although the number of these inspections is lower than the average of the five previous years, yet there has been an increase of 65 compared with 1912, and it will be noted that the total number of inspections has increased by 2,487. 202 Report of the Medical Officer of Health. TABLE XCII. Summary of Sanitary Operations in the Borough during the Year 1913. Clapham. Putney. Streatham Tooting. Wandsworth. Whole Borough. North Ward. South Ward. Streatham Ward. Balham Ward. South field Ward. Fairfield Ward. Spri'g field Ward. Number of complaints received and attended to 231 304 112 421 287 256 221 214 348 2394 Number of houses and premises inspected 4753 2941 4684 5207 4776 4481 4155 2902 4904 38803 Number of houses and premises re-inspected 1014 1694 1062 3537 3124 1487 1398 1738 2576 17630 Number of house - to - house inspections 398 203 477 324 492 96 236 230 283 2739 Number of preliminary notices served 686 568 449 885 1061 515 404 731 1006 6305 Ditto complied with 686 549 388 907 961 451 428 612 1006 5988 Number of statutory notices served 16 20 11 21 159 12 27 25 249 540 Ditto complied with 15 22 11 15 136 9 52 33 222 515 Notices served for periodical removal of manure ... ... ... ... 12 3 ... ... ... 15 Number of rooms disinfected after infective diseases 453 321 290 577 641 737 288 422 675 4404 Bedding stoved 227 138 102 210 267 265 158 174 260 1801 Overcrowding abated 4 2 1 5 10 5 4 12 32 75 Rooms cleansed and repaired 466 446 321 672 1236 387 215 660 985 5388 Staircases cleansed and repaired 115 129 66 185 259 52 30 122 249 1207 Drains cleansed and repaired 100 115 73 159 205 173 87 103 113 1128 Drains tested 431 325 179 484 767 355 355 372 355 3823 Drains found defective 34 26 10 66 55 60 23 33 57 364 Traps fixed to drains 31 76 2 15 19 42 11 13 ... 209 Bath, lavatory and sink wastes altered to discharge outside over gullies or repaired ... 25 29 49 42 27 15 71 42 300 Rain water pipes disconnected from drains ... ... ... ... ... 1 6 ... 10 17 Water closets cleansed and repaired 181 173 128 208 345 105 99 230 295 1764 Water closets, separate supply of water laid on to ... ... ... ... 2 1 ... ... ... 3 Accumulations of manure, etc.. removed 19 37 24 75 58 36 11 10 19 289 Urinals cleansed, repaired or water laid on to 6 ... 8 7 14 2 5 8 2 52 Cesspools abolished ... 2 ... 2 ... ... ... ... 2 6 Ashpits provided or repaired 79 86 187 132 145 78 93 110 142 1052 Dust complaints received 40 42 71 80 43 26 81 26 64 473 Stables and stables yards drained, paved or cleansed 3 13 3 16 11 6 2 1 10 65 Yards drained, paved or cleansed 58 94 56 194 118 54 54 144 187 959 Unwholesome or dilapidated houses cleansed or repaired ... ... ... 2 3 6 ... 9 2 23 Leaky roofs and gutters repaired 97 106 55 144 95 39 19 99 92 746 Damp courses inserted 25 16 4 121 69 21 3 86 39 384 Damp conditions remedied 80 51 34 434 128 73 18 171 123 1112 Houses re-supplied with water 2 5 9 13 14 3 10 3 3 62 Water cisterns cleansed, covered or repaired 62 135 39 48 54 31 8 89 61 527 Animals kept so as to be a nuisance 4 12 3 l6 10 13 7 8 34 107 Smoke nuisances reported 1 1 22 2 ... ... 22 9 ... 57 Soil pipes repaired 9 9 14 18 15 13 8 24 9 119 Unclassified nuisances 137 84 51 317 30 39 80 190 19 947 Report of the Medical Officer of Health. 203 TABLE XCIII. DETAILS OF INSPECTIONS AND RE-INSPECTIONS, 1913 (Male Inspectors.) Inspections. Re-Inspections. Totals. Number of complaints received and attended to 2,383 ... 2,383 Number of house-to-house inspections 2,739 ... 2,739 Drainage and other sanitary works after notice 3,576 14,121 17,697 Drainage and other sanitary works voluntary 819 926 1,745 Number of premises inspected on account of :— Notifiable diseases 2,866 212 3,078 Measles 2,071 93 2,164 Whooping Cough 499 4 503 Pulmonary Tuberculosis 53 1 54 Other Infective Diseases 424 4 428 Verminous conditions 615 139 754 Periodical Inspections :— Houses-let-in-Lodgings 352 578 930 Underground rooms 3 ... 3 Common Lodging Houses 15 3 18 Food-places Work-places Factories 435 79 5.4 Workshops 949 108 1,057 Workshops (Domestic) 296 53 349 Workplaces 212 42 254 Outworkers' premises 146 32 178 Bakehouses 431 234 665 Restaurant kitchens 261 91 352 Cowsheds 46 1 47 Piggeries 51 1 52 Dairies and Milkshops 958 41 999 Ice Cream Premises 481 47 528 Slaughterhouses 318 5 323 Places where food is prepared 85 4 89 Offensive trades 63 1 64 Fried Fish shops 205 26 231 Rag and bone stores 168 19 187 Butchers' shops 523 5 528 Greengrocers' shops 492 5 497 Fishmongers' shops 361 3 364 Public House urinals 449 19 468 Other sanitary conveniences, schools, &c. 145 ... 145 Smoke observations 417 ... 417 Unsound food 22 1 23 Yards of Mews and Stables 1,220 89 1,309 Legal proceedings :— (1) Applications and summonses 21 ... 21 (2) Hearings and adjournments 18 ... 18 Other 1,007 59 1,066 Totals 26,195 17,046 43,241 204 Report of the Medical Officer of Health. TABLE XCIV. DETAILS OF INSPECTIONS AND RE-INSPECTIONS, 1913. (Female Inspectors.) Inspections. Re-Inspections Totals. Number of complaints received and attended to 11 ... 11 Number of premises inspected on account of :— Puerperal Fever 63 24 87 Ophthalmia Neonatorum 64 10 74 Diarrhoæ 156 13 169 Pulmonary Tuberculosis 2,305 193 2,498 Other forms of Tuberculosis 341 10 351 Notification of Births 7,335 171 7,506 Dressmakers' and Milliners' premises 544 33 577 Laundries :— Factories 148 21 169 Workshops 333 39 372 Workplaces 107 21 128 Other Factories 56 4 60 Other Workshops 151 9 160 Other Workplaces 189 15 204 Domestic Workshops 42 3 45 Outworkers' premises 272 15 287 Other 491 3 494 Totals 12,608 584 13,192 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 1,992 out of a total of 2,739 houses inspected, or 72.72 per cent., sanitary defects necessitating the service of an intimation notice were found. The highest percentage was in Fairfield Ward, where the percentage was 94.78, and the lowest in Southfield, where it was only 29.23, the next lowest being Putney, where it was 45.28. Report of the Medical Officer of Health. 205 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 1913. TABLE XCV. 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 11.56 19.02 18.54 50.88 Clapham, South 8.63 16.19 25.90 49.28 Putney .35 2.07 48.88 48.70 Streatham 9.88 8.69 33.01 48.42 Balham 8.56 17.88 28.27 45.29 Tooting 1.60 .80 1.60 96.00 Southfield 10.95 6.93 5.48 76.64 Fairfield 15.12 4.81 35.05 45.02 Springfield 18.56 23.20 20.65 37.59 Whole Borough 9.50 12.90 27.44 50.16 Springfield and Fairfield Wards had the highest percentage of families living in one room, and Putney the lowest. Springfield and Clapham North had the highest percentage living in two rooms and Tooting the lowest. Putney had the highest percentage living in three rooms, and Tooting the lowest. Tooting and Southfield had the highest percentage living in four rooms and upwards, and Springfield the lowest. In the Borough, of the total families whose houses were inspected during the year, viz. 4,049, 9.50 per cent, lived in one room, compared with 9.31 per cent, in 1912, 8.7 per cent, in 1911, and 7.4 in 1910 ; 12.90 per cent, in two rooms compared with 13.44, 14.8, and 9.5 ; 27.44 Per cent, in three rooms compared with 24.85, 25.2, and 29.06 ; and 50.16 per cent, in four rooms and upwards compared with 52.4, 51.3, and 54.1. 206 Report of the Medical Officer of Health. House-to-House Inspections. HOUSING, TOWN PLANNING, &c., ACT, 1909. SUB-DISTRICT OF CLAPHAM, (NORTH WARD). TABLE XCVI. Name or Street. No. of bouses 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. Bromells Road 19 13 68.42 2 3 1 17 Charlotte Place 7 3 42.58 ... ... ... 7 Chip Street 21 15 71.42 ... 1 3 18 Crichton Street 30 26 86.66 10 21 13 13 Cross Street 28 24 85.71 3 2 4 25 Downer's Cottages 9 5 55.55 3 ... ... 9 Little Manor Street 8 6 75.00 1 1 4 5 Matrimony Place 5 ... ... ... ... 2 3 North Street 8 8 100.00 3 1 3 4 Prescott Place 25 21 84.00 3 2 9 17 Rashleigh Street 28 26 92.14 16 26 4 11 Rectory Gardens 19 15 78.94 2 ... 20 7 Rectory Grove 37 15 40.54 ... 2 5 40 Robertson Street 104 59 56.73 17 38 44 103 Rowlands Cottages 9 9 100.00 ... 3 2 4 St. Andrew's Street 19 17 89.47 2 7 1 20 The Polygon 18 12 66.66 9 11 ... 17 Westbury Street 1 1 100.00 1 1 ... 1 Young's Rents 3 3 100.00 1 1 2 ... Totals 398 278 69.84 73 120 117 321 Report of the Medical Officer of Health. 207 House-to-House Inspections.—continued. HOUSING, TOWN PLANNING, &c., ACT, 1909, SUB-DISTRICT OF CLAPHAM, (SOUTH WARD). TABLE XCVII. 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. Carpenters Cottages 10 9 90.00 ... ... ... 9 Lower Orchard Street 46 40 86.95 3 10 10 28 Nelson's Grove 6 4 66.66 ... ... 4 4 Nelson's Row 78 69 88.46 13 15 21 66 Newman's Court 6 6 100.00 ... 4 ... 2 Park Crescent 2 2 100.00 2 2 4 ... Perseverance Grove 3 3 100.00 ... ... 4 1 Upper Orchard Street 46 43 93.47 6 8 29 27 Wallis's Court 6 6 100.00 ... 6 ... ... Totals 203 182 89.65 24 45 72 137 Grand Total: 601 460 76.53 97 165 189 458 208 Report of the Medical Officer of Health. House-to-House Inspections.—continued. HOUSING, TOWN PLANNING, &c., ACT, 1909. SUB-DISTRICT OF PUTNEY. TABLE XCVIII. 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. Angel Court 3 3 100.00 ... ... 1 2 Beauchamp Terrace 9 6 66.66 ... ... 17 1 Bemish Road 32 12 37.50 1 ... 15 24 Bigg's Row 11 8 72.72 ... ... 7 6 Blackford Cottages 4 2 50.00 ... ... 2 2 Charlwood Terrace 6 2 33.33 ... ... ... 6 College Street 70 35 50.00 1 5 56 36 Cox's Buildings 12 8 66.66 ... 1 ... 11 Felsham Road 6 3 50.00 ... ... ... 6 Floss Street 33 17 51.51 ... ... 33 ... Henry's Place 4 3 75.00 ... ... 4 ... High Street, Roehampton 27 14 51.85 ... ... ... 27 Isabella Place 12 7 58.33 ... ... ... 12 March's Place 14 7 50.00 ... ... ... 14 Mascotte Road 30 15 50.00 ... 1 38 7 Medfield Street 60 17 28.33 .... ... ... 60 Northumberland Ter. 16 6 37.50 ... ... 12 10 Olivette Street 22 9 40.90 ... ... 22 ... Poplar Place 5 5 100.00 ... 1 ... 4 Priest's Bridge 8 3 37.50 ... ... ... 8 Russell Place 6 4 66.66 ... 4 1 1 Seymour Row 7 6 85.71 ... ... ... 7 Stratford Grove 24 5 20.83 ... ... 2 24 Weiss Road 36 12 33.33 ... ... 64 4 West Place 9 2 22.22 ... ... ... 9 Winthorpe Street 11 5 45.45 ... ... 9 7 Totals 477 216 45.28 2 12 283 288 Report of the Medical Officer of Health. 209 House-to-House Inspections—continued. HOUSING, TOWN PLANNING, &c., ACT, 1909. SUB-DISTRICT OF STREATHAM. TABLE XCIX. Name of Street. No. of houses inspected. No. of houses in which defects were found. Percentage of detects to houses inspected. Number of Familif.3 Living in One room. Two rooms. Three rooms. Four rooms and upwards. Brixton Hill 2 2 100.00 ... ... ... 2 Eastwood Street 34 27 79.41 ... ... 4 32 Ellora Road 46 46 100.00 14 3 23 44 Fairview Place 1 1 100.00 ... ... ... 1 Fallsbrook Road 80 45 56.25 ... ... 15 77 Ferrers Road 48 48 100.00 12 9 39 29 Hambro Road 89 89 100.00 8 3 72 53 King's Yard 4 4 100.00 ... ... ... 4 Mill Lane 19 19 100.00 15 29 14 2 Upper Tulse Hill 1 1 100.00 1 ... ... 1 Totals 324 282 87.03 50 44 167 245 210 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 C. 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. Balham Grove (part) 7 7 100.00 1 17 7 2 Cavendish Road Flats 5 5 100.00 ... ... 5 ... Chesil Place 5 5 100.00 ... 3 2 ... Dendy Street 57 47 82.45 12 10 6 55 Fernlea Road (part) 42 31 73.80 15 63 7 31 Foss Road 47 42 89.36 1 1 2 79 Grove Road Mews 5 5 100.00 ... 1 1 3 Hazelhurst Road 29 26 89.65 3 3 17 28 Langroyd Road 31 25 80.64 ... ... ... 60 Larch Road 77 68 88.31 3 3 133 29 Mandrake Road 25 24 96.00 ... 5 4 33 Oldridge Road 24 24 100.00 ... 2 ... 23 Temperley Road 58 36 62.06 11 14 17 48 Zennor Road 80 74 92.50 34 45 63 32 Totals 492 419 85.16 80 167 264 423 Grand Total 816 701 85.90 130 211 431 668 Report of the Medical Officer of Health. 211 House-to-House Inspections.—continued. HOUSING, TOWN PLANNING, &c., ACT, 1909. SUB-DISTRICT OF TOOTING. TABLE CI. 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. Bertal Road 30 27 90.00 ... 1 ... 30 Kellino Street 37 37 100.00 2 ... 2 6l Worslade Road 29 25 86.20 ... ... ... 29 Totals 96 89 92.70 2 1 2 120 212 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 CII. 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. Buckhold Road 7 7 100.00 ... ... ... 7 Dutch Yard 16 7 43.75 ... ... ... 16 Elizabeth Place 19 6 31.57 ... ... 4 17 Fields Alley 8 3 37.50 2 6 ... 1 Hill's Yard 7 7 100.00 26 4 ... 2 Merton Road 152 31 20.39 2 8 10 142 Newton's Yard 5 1 20.00 ... ... ... 5 Oakhill Road 10 3 33.33 ... ... ... 10 Red Lion Square 5 3 6o.oo ... 1 ... 4 Simrose Court 7 1 14.28 ... ... 1 6 Totals 236 69 29.23 30 19 15 210 Report of the Medical Officer of Health. 213 House-to- House Inspection—continued. HOUSING, TOWN PLANNING, &c., ACT, 1909. SUB-DISTRICT OF WANDSWORTH (Fairfield Ward). TABLE CIII. 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 upward. Baylin Road 65 65 100.00 ... ... 6l 4 Ferrier Street 3 3 100.00 ... ... 6 ... Garratt Lane 4 2 50.00 1 2 1 3 Ironmill Road 49 49 100.00 5 3 3 45 Jew's Row 9 9 100.00 ... ... 18 ... Malva Road 58 56 96.55 10 6 10 45 Marcus Terrace l6 8 50.00 ... ... ... 16 Sandown Place 18 18 100.00 3 ... ... 18 Warple Way 8 8 100.00 25 3 3 ... Totals 230 218 94.78 44 14 102 131 214 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 CIV. 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. Beechcroft Road 23 15 65.21 ... ... 14 10 Bendon Valley 20 15 75.00 2 6 7 15 Garratt Lane 19 19 100.00 ... 3 2 14 Lydden Grove 84 76 90.47 12 26 24 6l Lydden Road 45 39 86.66 14 11 23 25 Wardley Street 92 75 81.52 52 54 19 37 Totals 283 239 84.45 80 100 89 162 Grand Total 749 526 70.22 154 133 206 503 Report of the Medical Officer of Health. 215 House-to-House Inspections.—continued. HOUSING, TOWN PLANNING, &c., ACT, 1909. SUMMARY. TABLE CV. Wards. 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. Clapham, North 398 278 69.84 73 120 117 321 Clapham, South 203 182 89.65 24 45 72 137 Putney 477 216 45.28 2 12 283 282 Streatham 324 282 87.03 50 44 167 245 Balham 492 419 85.16 80 167 264 423 Tooting 96 89 92.70 2 1 2 120 Southfield 236 69 29.23 30 19 15 210 Fairfield 230 218 94.78 44 14 102 131 Springfield 283 239 84.45 80 100 89 162 Whole Borough 2,739 1,992 72.72 385 522 1,111 2,031 216 Report of the Medical Officer of Health. The total number of intimation notices served was 6,305, compared with 6,620 in 1912, 6,278 in 1911, and 8,866 in 1910, and of statutory notices 540, compared with 707, 957, and 1,038. 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 Tooting Wards. Only 33 of the statutory notices, three in Clapham, three in Streatham, and 28 in Wandsworth, served in 1913, were not complied with at the close of the year. 16 of these notices were complied with in the beginning of the current year, with regard to eight the premises are unoccupied, while in the case of the remaining nine notices the work is in hand. The number of statutory notices served include By-law notices, 178 of which were served in respect of the following contraventions of the By-laws:—Yard paving 74, repairs to water closets 11, repairs to flushing apparatus of water closets 36, cleansing of water closets two, covers to cisterns 10, cleansing cisterns six, cleansing house and other contraventions of the By-laws as to houses let in lodgings 30, absence of cover to manure receptacle two, failing to deposit manure in a proper receptacle two, paving of stables one, and other four. The number of cases of overcrowding dealt with during the year was 75, compared with 76 in 1912, 91 in 1911, and 129 in 1910. Six of these were in Clapham, one in Putney, 15 in Streatham, five in Tooting, and 48 in Wandsworth. The cases of overcrowding in Clapham were in Prescott Place, Little Manor Street, Old Town, White Square, and Newman's Court; in Putney, in Weiss Road ; in Streatham, in Zennor Road, Factory Square, Danbrook Road, Kettering Street, Hereward Road, and Graveney Road ; in Tooting, in Pevensey Road and Trevelyan Road ; in Wandsworth, in Bendon Valley, Guelph Street, Wardley Report of the Medical Officer of Health. 217 Street, Lydden Grove, Thornsett Road, Beechcroft Road, Lydden Road, Groton Road, Warple Way, Baylin Road, Bell Lane, Point Pleasant, Ironmill Road, Malva Road, and Jews' Row. Most of these were cases of domestic overcrowding and were remedied without difficulty by re-arrangement of the sleeping accommodation, while in several cases lodgers had been taken in by the tenants and these removed. 1,052 ashpits were provided or repaired, compared with 717 in 1912, 831 in 1911, and 1,060 in 1910. 473 complaints with reference to the non-removal of house refuse, (82 from Clapham,71 from Putney, 123 from Streatham, 26 from Tooting, and 171 from Wandsworth), were received during the year. These complaints were, as in previous years, attended to by the Dusting Inspectors. 959 yards in connection with dwelling-houses, and 65 in connection with stables, were paved, drained, or cleansed, compared with 956 and 103 in 1912. 5,388 rooms and 1,207 staircases and passages were cleansed or repaired, compared with 5,248 rooms and 1,043 staircases and passages in 1912. The greatest number of rooms cleansed was in the Balham Ward, where 1,236 were done, and in Springfield Ward, where 985 were done, and the smallest number in Southfield and Putney where the numbers were 215 and 321 respectively. 1,128 drains were cleansed or repaired, and 17 rain-water pipes disconnected from the drains. 145 notices of reconstruction of drains were sent to the Borough Engineer from this Department : 21 in Clapham, compared with 23 in 1912 ; five in Putney, compared with six; 53 in Streatham, compared with 54 ; 10 in Tooting, compared with 31 ; and 56 in Wandsworth, compared with 52. 218 Report of the Medical Officer of Health. The total number of houses where the drains were reconstructed during the year was 217 : 40 in Clapham, 15 in Putney, 81 in Streatham, 13 in Tooting, and 68 in Wandsworth. During the year 3,823 drains of houses were tested by the Sanitary Inspectors, 756 in Clapham, 179 in Putney, 1,251 in Streatham, 355 in Tooting, and 1,282 in Wandsworth, and 364 or 9.5 per cent, were found to be defective. Of the 364 found defective 60 or eight per cent, were in Clapham, 10 or six per cent, in Putney, 121 or 9.6 per cent, in Streatham, 60 or 16.9 per cent, in Tooting, and 113 or 8.9 per cent, in Wandsworth. « 289 accumulations of manure were removed after service of notice, compared with 316 in 1912 : 56 in Clapham, 24 in Putney, 133 in Streatham, 36 in Tooting, and 40 in Wandsworth. There has been an increase in the number of cases dealt with in Streatham and Tooting, and a decrease in Clapham, Putney, and Wandsworth. 15 notices were served for the periodical removal of manure every 48 hours, compared with eight in 1912,12 in 1911, and 38 in 1910. The number of water closets cleansed and repaired was 1,764, compared with 1,694 in 1912. The greatest number of these were in Balham and Springfield Wards, and the smallest in Tooting and. Southfield Wards. 527 drinking water cisterns were cleansed, covered or repaired : 197 in Clapham, 39 in Putney, 102 in Streatham, 31 in Tooting, and 158 in Wandsworth, compared with 445 in 1912. 107 premises were inspected and notices served where animals were kept in such a manner as to be a nuisance. 16 of these were, in Clapham, three in Putney, 26 in Streatham, 13 in Tooting, and 49 in Wandsworth. This nuisance was most common in Springfield Ward, and the animals kept were chiefly ducks and hens. Report of the Medical Officer of Health. 219 57 smoke nuisances were reported during the year : two in Clapham, 22 in Putney, four in Streatham, and 31 in Wandsworth. In all 417 observations for black smoke were made by the Inspectors, 57 nuisances were reported and 44 notices served. Four complaints of black smoke were received from the Public Control Department of the London County Council with regard to four premises, and five complaints from the coal Smoke Abatement Society with regard to eight premises. These complaints were all at once attended to and the premises kept under observation. 119 soil pipes were repaired, 18 in Clapham, 14 in Putney, 33 in Streatham, 13 in Tooting, and 41 in Wandsworth, compared with 159 in 1912, 194 in 1911, and 153 in 1910. 746 leaky roofs and gutters were repaired, compared with 870 in 1912, 869 in 1911, and 1,225 in 1910. 23 unwholesome or dilapidated houses were cleansed and repaired, five in Streatham, six in Tooting and 12 in Wandsworth, compared with 60 in 1912, 30 in 1911, and 38 in 1910. A large amount of work has again been carried out to abate nuisances arising from damp conditions. In all, 1,112 premises have been dealt with, 131 in Clapham, 34 in Putney, 562 in Streatham, 73 in Tooting, and 312 in Wandsworth ; and in 384 of these, 41 in Clapham, four in Putney, 190 in Streatham, 21 in Tooting, and 128 in Wandsworth, damp courses have been inserted. I have this year also 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 947, 221 in Clapham, 51 in Putney, 347 in Streatham, 39 in Tooting, and 289 in Wandsworth, compared with 929 in 1912, 765 in 1911, and 746 in 1910. 220 Report of the Medical Officer of Health. Disinfection. The total number of rooms disinfected after the occurrence of cases of infectious disease was 4,404, (774 in Clapham, 290 in Putney, 1,218 in Streatham, 737 in Tooting, and 1,385 in Wandsworth), compared with 3,787 in 1912, 4,419 in 1911, and 2,166 in 1910. The increase was largely due to the increase in the number of disinfections carried out after Measles. 1,801 lots of bedding were stoved at the Disinfecting Station, compared with 1,744 in 1912, 1,603 in 1911, and 1,230 in 1910. The 1,801 lots of bedding included the following :—1,064 beds, 1,175 bolsters, 2,710 pillows, 1,241 mattresses, 613 palliasses, 2,060 sheets, 1,556 quilts, 621 cushions, 6,247 articles of clothing, 3,011 blankets, 110 carpets, and 2,693 extra articles, a total of 23,101 articles, compared with 21,401 in 1912, 21,613 in 1911. and 15,430 in 1910. 1,454 premises were disinfected after Measles and 420 after Pulmonary Tuberculosis, compared with 1,006 and 426 in 1912. 32 beds, nine bolsters, 23 pillows, 61 mattresses, 17 palliasses, Seven sheets, six quilts, 10 cushions, 157 articles of clothing, 11 blankets, four carpets, and 129 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 £30 11s. 0d., was received for such disinfection. 618 rooms were disinfected with sulphur in consequence of their verminous condition and 75 lots of verminous bedding disinfected, compared with 574 rooms and 86 lots of bedding in 1912. 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. 221 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 920 19 3 Fuel 4 2 4 Horse Hire 89 8 0 Stores, Tools, and other materials 55 12 10 Repairs to Horse Vans 13 13 0 Disinfectants, etc. 22 7 2 Repairs to Motor Van 14 0 1 Motor Running Expenses 63 3 2 Lighting 1 18 10 Insurance 9 12 8 Water 4 10 3 Payment to Highways Committee for Steam 30 0 0 £1,229 6 9 The number of lots of bedding stoved was 1,801. Cost per lot of bedding 13s. 7d. Cleansing of Persons Act. The baths at the Disinfecting Station have been more used this year, chiefly owing to the increase in the number of contacts with cases of infective diseases. The names of 437 children, 47 belonging to Clapham, none to Putney, 80 to Streatham, 198 to Tooting, and 112 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 majority of cases only the heads of the children were verminous, but in a few cases the body and clothing were also verminous. 222 Report of the Medical Officer of Health. All the children were cleansed by the officials of the London County Council at the Cleansing Stations under the supervision of that Authority. 26 adults had baths, 17 were contacts with cases of infective diseases, seven were nurses who had been in attendance in cases of Puerperal Fever, while two males were verminous. Inspection of Urinals in connection with Licensed Premises. The number of urinals inspected was 128, 30 in Clapham, 20 in Putney, 25 in Streatham, 12 in Tooting, and 41 in Wandsworth. 468 inspections were made during the year and 25 notices, chiefly for cleansing, were served and complied with. In the Borough there are at present 14 public sanitary conveniences, while there are in addition 21 urinals only belonging to the Council. 169 inspections of the sanitary conveniences for females were made by the female Sanitary Inspectors. The provision of tree 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. 145 inspections have been made during the year by the Inspectors of other sanitary conveniences, chiefly in the elementary schools in the Borough. Report of the Medical Officer of Health. 223 Inspection of Premises where Food is prepared for Sale or Sold. During the year 224 inspections have been made of fried fish shops, 528 of butchers' shops, 497 of greengrocers' shops, and 364 of fishmongers' shops, a total of 1,620. 226 of these inspections were in Clahpam, 251 in Putney, 546 in Streatham, 191 in Tooting, and 406 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 15s. 0d., and the costs £3 18s. 6d., compared with £15 10s. 0d. and £5 8s. 0d. in 1912. The majority of the cases were with respect to nuisances or contraventions of By-laws, while two were for exposing unsound food for sale, and two for the absence of proper and sufficient water supply to the premises. Two cases were for selling milk without being registered as required by the Dairies, Cowsheds and Milkshops Order, 1885, and one for selling milk from dirty receptacles. 224 Report of the Medical Officer of Health. TABLE CVI. Premises. Offence. Result. Fine. Costs Colmer Road, Streatham Exposing unsound meat for sale Convicted 100/- 4/- 58, Balham Hill Absence of a proper and sufficient supply of water to the premises Order made for abatement of nuisance ... 5/- ,, ,, Failing to comply with Magistrate's Order Convicted 40/- 2/- 381, Garratt Lane, Wandsworth Exposing unsound raisins for sale ,, 40/- 2/- 26 & 28, Temperley Rd. Nuisances Order made for abatement of nuisance - 2/- ,, ,, Failing to comply with Magistrate's Order ,, 20/- 2/- „ ,, Contravention of Bylaws (water closets) ,, 20/- 8/- 125, Putney Bridge Rd. ,, ,, ,, ,, 20/- 2/- 25, Heybridge Avenue, Streatham ,, ,, ,, ,, 10/- 2/- 87, Mitcham Lane, Streatham Absence of a proper and sufficient supply of water to the premises Order made for abatement of nuisance - 21/- 60 & 64, Eltringham St., Wandsworth Failing to provide dust bins Convicted 20/- 4/- 55, Rusholme Road, Wandsworth ,, ,, Summons withdrawn on payment of costs - 2/- 29, Garton St., Wandsworth Nuisance Convicted 2/6 2/- „ ,, Absence of a dust bin Summons withdrawn on payment of costs - 2/- ,, ,, Contravention of Bylaws (water closets) Convicted 2/6 2/- Penwith Rd., Wandsworth (Sample taken in) Contravention of the Dairies, Cowsheds and Milkshops Order, 1885, (non-registration) Ordered to pay costs - 12/6 Garratt Lane, Wandsworth (Sample taken in) Do do. do. Convicted 20/- 2/- Fawe Park Rd., Wandsworth (Sample taken in) Do. do. do. (Dirty receptacles) ,, 20/- 2/- Report of the Medical Officer of Health. 225 Removal of House Refuse. During the year no alteration has been made in the system of emoval. 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. The following Table, taken from the report of the Borough Engineer, shows the quantity collected and the method of disposal in the various Wards of the Borough. TABLE CVII. Wards. Estimated Quantity. how disposed of. Van loads. Tons. Clapham, North and South 4.451 16,024 Barged away from wharf at Nine Elms. ,, ,, ,, ,, 1,489 2,755 At Destructor. Balham and Tooting 7,117 12,377 At Destructor. ,, ,, 881 2,203 Sent to shoot outside the Borough. Streatham 3,119 5,776 At Destructor. ,, 2,420 8,470 Sent to shoot outside the Borough. Fairfield, Springfield and Southfield 8,622 26,913 Sent to shoot outside the Borough. Putney 4,874 7,130 Barged away from Ashlone Road Wharf. Borough 32,973 81,648 The total cost of collection and disposal was £16,101, compared with £16,378 for the year ending March 31st, 1912. 66 statutory notices were served under Section 37 of the Public Health (London) Act, 1891, to provide ashpits in accordance with the By-laws, and these have been complied with. 226 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 CVIII. premises. NUMBER OF PLACES Number of inspections, 1913. Number of notices, 1913. Number of prosecutions, 1913. On register at end of 1912. Added in 1913. Removed in 1913. On register at end of 1913. Milk premises 356 55 30 381 999 42 ... Cowsheds 12 ... 1 11 47 ... ... Slaughter-houses 16 ... 2 14 323 5 ... Other offensive trade premises 3 ... ... 3 64 1 ... Ice cream premises 322 51 27 346 528 51 ... Registered houses let in lodgings 292 ... ... 292 930 *a15 ... *b516 ... *a For overcrowding. * b For other conditions. Total number of intimation notices served for all purposes 6,305 Overcrowding, 1913 :— Number of dwelling rooms overcrowded 75 Number remedied 73 Number of prosecutions - Underground rooms— Illegal occupation dealt with during year 3 Number of rooms closed - Report of the Medical Officer of Health 227 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 618 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 30 Number of tenements comprised therein 69 Number of tenements for which certificates were : (a) granted 61 (b) refused 0 (c) deferred 2 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 paving of yards, etc., of dwelling houses — (e) In connection with the removal of offensive matter, etc. — (f) As to cesspools and privies, removal and disposal of refuse, etc. — 228 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. 4 (t) 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) — Mortuaries— Total number of bodies removeed 205 Total number of infective bodies removed — Milkshops. At the close of 1912 there were 356 milkshops on the register, 55 have been added in 1913 and 30 removed, leaving 381 on the Register at the end of 1913. During the year 999 inspections were made of these premises and 42 notices, chiefly for cleansing, were served. Two prosecutions were instituted for carrying on the business of a dairyman without being registered, and fines amounting to £1 were imposed, with 14s. 6d. costs, while one milk purveyor was prosecuted for selling milk from dirty receptacles and a fine of £1 was imposed with 2s. costs. None of these milk purveyors had registered milk premises in the Borough. Cowsheds. The following is a list of the registered Cowhouses in the district granted by the London County Council in October:— Clapham— Denny, Charles, 128, Wirtemberg Street. (25 cows.) Report of the Medical Officer of Health. 229 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. (Number 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 cows.) The total number on the Register at the close of 1913 was 11, and 47 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 16 Slaughter-houses and one Knacker's Yard on the Register in 1912, two in Wandsworth were removed, leaving 14 on the Register. 230 Report of the Medical Officer of Health. The new slaughter-house licensed by the London County Council for slaughtering horses for human food was frequently inspected, and during the year 281 horses have been slaughtered on the premises, and all were exported, compared with 93 in 1912. During the year 323 inspections were made of these, but it was only necessary to serve five 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 494 cattle, 2,899 sheep, 223 pigs, and 34 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 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.) Fisher, Charles Edward, 272, Wandsworth Road, Clapham. Clark, William, 697, Wandsworth Road, Clapham. Report of the Medical Officer of Health. 231 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 of 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— Miller, George Short, 27, Belle Vue Road. Covell, Herbert Alfred, 73, High Street, Wandsworth. 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.) Harrison, Barber & Co., Garratt Lane. (Condition—To be used only for the slaughtering of horses.) Knacker's Yard. Harrison, Barber & Co., Ltd., Garratt Lane. 232 Report of the Medical Officer of Health. 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. 64 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 1912 there were 322 of these on the Register. During 1913, 51 were added and 27 removed, leaving a total of 346 on the Register, 528 inspections were made of these premises during the year and 51 notices were served, all of which were for cleansing. Houses Let in Lodgings. At the end of 1912 there were 292 houses let in lodgings on the Register. None were added during 1913, and none removed, making a total of 292 on the Register at the end of 1913. 930 inspections of these were made during the year, and 531 notices were served, 15 for overcrowding and 516 for other conditions, chiefly for cleansing. 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. Report of the Medical Officer of Health. 233 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 five trunks of herrings, two trunks of dabs, one trunk of hake, one trunk of mackerel, eight trunks of haddock, one trunk of whiting, one trunk of cod, one trunk of skate, one trunk of mixed fish, 2¾ cwts. winkles, 37½ cwts. of potatoes, eight boxes of tomatoes, 10 boxes of pears, one crate of bananas, 58 lbs. of mushrooms, 17 barrels of apples and one barrel of grapes, were destroyed at the request of the owners, and the usual certificates granted. FACTORIES AND WORKSHOPS. There has again been a slight increase in the total number of inspections of the above, compared with 1912, 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 two prosecutions were necessary, one for the absence of water supply and one for a defective water closet, 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. 234 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 1,741, including 122 retail bakehouses, 145 workshop laundries, 299 dressmakers' and milliners' premises, and 1,175 other workshops, but not including 443 factories, 1,229 workplaces, and 361 outworkers' premises. Including all factories, workshops, workplaces, and outworkers' premises, there were on the Register at the end of 1913 3,774 premises, compared with 3,629 in 1912, 3,470 in 1911, and 3,420 in 1910. The total number of inspections made during the year was 6,244, compared with 6,511 in 1912, 6,050 in 1911, and 6,387 in 1910. The total number of notices served was 454, 434 intimation and 20 statutory, compared with 402 in 1912, 462 in 1911, and 580 in 1910. There were only two prosecutions 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 eel shops, and other places where food is prepared for sale. In all 934 inspections were made of 443 factories, and 73 notices, 69 intimation and four statutory, were served. The total number of the workshops on the Register was 1,741, 14 5 of which were workshop laundries, 122 workshop bakehouses, and 1,474 other workshops. In all 3,185 inspections of these were made, compared with 3,227 in 1912, 3,059 in 1911, and 3,346 in 1910, and 199 intimation and 14 statutory notices were served. Report of the Medical Officer of Health. 235 The total number of workplaces on the Register was 1,229 and 1,660 inspections were made, while 133 intimation notices were served, but only one statutory notice was necessary. The total number of defects found was 539, including 16 cases in which there was a breach of special sanitary requirements for bakehouses, compared with 462 and nine in 1912. To abate these nuisances, 420 notices, 401 intimation and 19 statutory were served, all of which, with the exception of five were complied with at the end of the year. The five outstanding were complied with in the first month of this year. Excluding outworkers' premises 539 defects were found and 534 remedied, but only 401 intimation notices were served, as one notice frequently called attention to several defects on the same premises. 236 Report of the Medical Officer of Health. INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. TABLE CIX. CLASS OF WORKS. Number of Places Number of Inspections, 1913. Number of Notices. Number of Prosecutions, 1913. On Register at end of 1912. Added in I913. Removed in I9I3. On Register at end of 1913. Intimation, I9I3. Statutory, I9I3. Under Factory Act. Under Public Health Act. Premises Rooms. Factories Factory Laundries 97 4 3 98 397 213 7 ... ... ... Factory Bakehouses 19 8 27 45 102 5 ... ... ... Other Factories 294 48 24 318 1,030 619 57 4 ... ... 'Workshop Laundries 147 9 11 145 438 372 17 1 ... ... Workshops Workshop Bakehouses 127 8 13 122 122 563 11 ... ... ... Other Workshops 1,429 161 116 1,474 1,847 2,250 171 13 ... 1 Workplaces Places where Food is prepared for Sale 578 73 34 617 658 963 88 1 ... 1 Workplaces other than the above 603 88 79 612 901 697 45 ... ... ... Home-workers' premises 335 67 41 361 361 465 33 1 ... ... Total 3,629 466 321 3,774 5,799 6,244 434 20 ... 2 Report of the Medical Officer of Health. 237 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 CX. I.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Number of Premises. (1) Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (Including Factory Laundries.) 934 73 ... Workshops (Including Workshop Laundries.) 3.185 213 1 Workplaces (Other than Outworkers' premises included in Part 3 of this report.) 1,660 134 1 Totals 5,779 420 2 238 Report of the Medical Officer of Health. TABLE CXI. 2.—DEFECTS FOUND Particulars. (I) Number of Defects Number of Prosecutions. 1 (5) Found. (a) Remedied (3) Referred toH.M. Inspector (4) Nuisances under the Public Health Acts : —* Want of Cleanliness 188 186 ... ... Want of Ventilation 8 8 ... ... Overcrowding 2 2 ... ... Want of drainage of floors 3 3 ... ... Other nuisances 227 224 ... ...I Sanitary accommodation insufficient 7 7 ... ... unsuitable or defective 86 86 ... 1 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) 16 16 ... ... Other offences (Excluding offences relating to outwork, which are included in Part 3 of this report.) ... ... ... ... Totals 539 534 ... 2 * 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 four more than in 1912, but there was a decrease of six in the number sent in once a year. Report of the Medical Officer of Health. 239 TABLE CXII. 3—HOME WORK. OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. / OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. NATURE OF WORK.* Lists received from Employers Notices served on occupiers as to keeping or sending lists. Prosecutions Sending twice in the year. Sending once in the year. Failing to keep or permit insiec tion of lists. Failing to send lists. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (SS.109,110). Lists † 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. 120 53 337 2 ... 4 76 ... ... 27 35 ... 20 ... ... (2) Cleaning and washing 2 6 9 ... ... ... .... ... ... ... ... ... ... ... ... 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. 2 ... 3 ... ... ... ... ... ... ... ... ... ... Stuffed Toys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Basket making ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 128 59 357 2 ... 4 76 ... ... 27 35 ... 20 ... ... * 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 for 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 names are given, since in the February and August lists of the same emplo3'er the same outworker's name will often be repeated. 240 Report of the Medical Officer of Health. In all, 128 lists were received twice in the year, containing the names and addresses of 59 contractors and 357 workmen and two lists once in the year, containing the names and addresses of no contractors and four workmen. There has been a slight increase in the number of outVorkers employed by employers in the Borough during the year. The total number of addresses received from other Councils was 521, compared with 511 in 1912, 408 in 1911, and 422 in 1910, and 276 addresses were forwarded to other Councils, compared with 285 in 1912, 251 in 1911, and 253 in 1910. The number of addresses received has increased by 10 and the number sent has decreased by nine. The following are the districts to which lists of outworkers were forwarded, and also the number of outworkers:—Battersea 64, Lambeth 48, Stepney 41, Fulham 21, Croydon 17, City 16, Hammersmith 10, Southwark eight, Camberwell six, Bermondsey, Chelsea and Winchester four each, Stratford, Holborn, Eastleigh, Hanwell, East Ham, Wimbledon, Willesden, Worthing, Finsbury, Lewisham, Shoreditch, Poplar and Rochford two each, Westminster, Islington, Greenwich, St. Marylebone, Deptford, West Ham and Southgate one each. 43 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 1912, and these had a most satisfactory result. At the end of 1912 there were 335 outworkers' premises on the Register, 67 were added and 41 removed during the year, leaving 361 on the Reigster at the end of 1913. 465 inspections were made of these premises during the year, and 34 notices, all for cleansing, were served and complied with. Report of the Medical Officer of Health. 241 During the year 20 cases of infective diseases, 14 of Scarlet Fever, two of Diphtheria, three of Erysipelas, and one of Puerperal Fever, were notified as having occurred in the homes of outworkers, compared with 16 in 1912, 15 in 1911, and 14 in 1910. In none of these cases was it necessary to make any order under Section 110 of the Factory and Workshop Act. TABLE CXI1I. 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 122 „ Laundries 145 Dressmakers' and Milliners'Workshops 299 Bootmakers 146 Smiths 51 Builders 66 Tailors 72 Other 840 Total number of workshops on Register 1.741 TABLE CXIV. 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) 35 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) 1 Notified by H.M. Inspector... 10 Reports (of action taken) sent to H.M. Inspector 10 Other Underground Bakehouses (s. 101):— Certificates granted during the year ... In use at the end of the year 48 242 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: (1) factories, (2) workshops, (3) domestic workshops, (4) workplaces, and (5) outworkers' premises. The total number of inspections was 3,510, compared with 4,147 in 1912, 3,020 in 1911, and 2,768 in 1910, and of re-inspections 732, compared with 656, 1,141, and 1,534, a total of 4,242 compared with 4,803 in the previous year. 1,020 of the inspections and 179 of the re-inspections were in Clapham, 337 and 70 in Putney, 824 and 227 in Streatham, 275 and 42 in Tooting, and 1,045 and 214 in Wandsworth. No workshops where males were employed were notified to H.M. Inspector, but nine 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 no case of overcrowding was discovered. In 76 of these factories, workshops and workplaces the sanitary conveniences were found defective, in seven they were insufficient, and in four they were unsuitable or not separate for the sexes. In 178 the workrooms were in a dirty condition, in four they were insufficiently ventilated, and in 222 other nuisances were found. For these 379 intimation and 18 statutory notices were served, and with the exception of three intimation and two statutory notices, were complied with. These notices were complied with in the early part of the year. In two cases, one for the absence of a proper water supply and another for a defective water closet, legal proceedings were necessary to enforce the notice. Report of the Medical Officer of Health. 243 Clapham. Putney. Streatham. Tooting. Wandsworth. Total. I.—Factories inspected 156 71 125 23 199 574 „ re-inspected 20 33 34 6 38 131 Sanitary conveniences insufficient ... ... ... ... 3 3 „ ,, unsuitable ... ... 1 ... 1 2 ,, ,, not separate for sexes ... ... ... ... ... ... „ „ defective 6 7 1 ... 18 32 Other nuisances 3 4 10 1 16 34 Intimation notices served 9 11 9 1 33 63 Statutory notices served ... ... 3 ... 1 4 Legal proceedings ... ... ... ... ... ... II.—Workshops inspected 396 186 317 87 398 1384 „ re-inspected 6l 21 105 20 91 298 Workrooms inspected 540 198 395 91 609 1833 „ found overcrowded ... ... ... ... ... ... „ insufficiently ventilated 1 ... 2 ... ... 3 „ in a dirty condition 11 3 27 1 29 71 Sanitary conveniences insufficient 11 3 2 ... 1 4 „ „ unsuitable ... ... ... ... ... ... ,, ,, not separate for sexes ... 1 ... 1 ... ... 2 ,, „ defective 9 3 4 ... 6 22 Other nuisances 16 1 32 1 11 61 Intimation notices served 22 7 53 2 41 125 Statutory notices served ... ... 5 ... 6 11 Legal proceedings ... ... ... ... 1 1 Number of workrooms measured 13 ... ... ... 12 25 Number of workroom cards distributed ... Workshops reported to H.M. Inspector on discovery ... ... ... ... ... ... Workshops reported by H.M. Inspector 1 ... 6 1 1 9 III.—Domestic workshops inspected 79 23 89 27 78 296 ,, „ re-inspected 21 2 22 1 7 53 Workrooms found overcrowded ... ... ... ... ... ... „ insufficiently ventilated ... ... ... ... ... ... ,, in a dirty condition 5 ... 11 ... 5 22 Other nuisances 9 2 26 ... 4 41 Intimation notices served 11 2 23 1 8 45 Statutory notices served 1 ... ... ... 1 2 Legal proceedings ... ... ... ... ... ... Domestic workshops reported to H.M. Inspector on discovery ... ... ... ... ... ... IV.—Workplaces inspected 373 46 252 119 320 1110 „ re-inspected 68 12 53 12 73 218 Workrooms inspected 338 51 251 83 365 1088 ,, found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... ... 1 ... ... 1 „ in a dirty condition 12 1 18 4 35 70 244 Report of the Medical Officer of Health. TABLE CX V.—continued. Clapham. Putney. Streatham. Tooting. Wandsworth. Total. Sanitary conveniences insufficient ... ... ... ... ... ... „ „ unsuitable ... ... ... ... ... ... „ ,, not separate for sexes ... ... ... ... ... ... ,, „ defective 5 1 4 1 11 22 Other nuisances 14 2 10 3 36 65 Intimation notices served 21 4 28 7 58 118 Statutory notices served ... ... 1 ... ... 1 Legal proceedings ... ... 1 ... ... 1 V.—Home work Premises inspected 25 11 41 19 50 146 „ re-inspected 9 2 13 3 5 32 Workrooms found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... ... ... ... ... „ in a dirty condition 2 1 8 2 2 15 Other nuisances 8 1 9 ... 3 21 Intimation notices served 5 2 14 2 5 28 Statutory notices served ... ... ... ... ... ... Legal proceedings ... ... ... ... ... ... Cases of infective diseases notified 1 2 2 1 1 7 -louses visited for inquiry and no workroom found 8 ... ... ... 3 11 Total number of premises inspected 1020 337 824 275 1045 3510 „ „ „ re-inspected 179 70 227 42 214 732 „ „ intimation notices served 68 26 127 13 145 379 „ „ intimation notices complied with 68 26 124 13 145 376 „ „ statutory notices served 1 ... 9 ... 8 18 „ „ statutory notices complied with 1 ... 7 ... 8 l6 „ „ legal proceedings ... ... 1 ... 1 2 Table CXVI. shows the principal trades carried on in the premises on the Register, but it does not include the trades in workplaces, domestic workshops, or in outworkers' premises. Compared with 1912 there has been a decrease of 12 in the number of these trades, this decrease having been chiefly in the sub-district of Wandsworth. Report of the Medical Officer of Health. 245 TABLE CXVI. SUMMARY OF PRINCIPAL TRADES CARRIED ON IN WORKSHOPS WHERE MEN ARE EMPLOYED. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. Bootmakers 32 17 46 13 38 146 Bakers 32 14 32 10 34 122 Tailors 20 14 28 4 6 72 Builders 24 13 15 1 13 66 Smiths 15 7 11 5 13 51 Cycle Makers 8 3 10 2 13 36 Upholsterers 10 7 10 ... 6 33 Wheelwrights 10 2 11 2 7 32 Hairdressers 6 13 5 ... 3 27 Motor Engineers 8 ... 7 1 6 22 Watchmakers 10 1 2 ... 2 15 Joiners 5 1 2 ... 4 12 Undertakers 4 ... 1 2 5 12 Harness Makers 3 1 4 1 1 10 Printers 1 1 3 ... 5 10 Photographers 3 4 1 ... 1 9 Plumbers 6 2 ... ... 1 9 Boat Builders ... 8 ... ... ... 8 Cabinet Makers 2 2 ... ... 2 6 Wood Choppers 3 ... 1 ... 2 6 Ironmongers 1 ... 1 ... 2 4 Rag Sorters ... ... ... 3 1 4 Jewellers 3 ... 1 ... ... 4 Tarpaulin and Scale Makers 1 ... ... ... 1 2 Other Trades 38 12 30 6 46 132 Totals 245 122 221 50 212 850 The Tables which follow summarise the work done during the year by the female Sanitary Inspectors. The total number of premises inspected was 1,842, (379 in Clapham, 265 in Putney, 532 in Streatham, no in Tooting, and 563 in Wandsworth). 246 Report of the Medical Officer of Health. 204 inspections were made of factories, 1,028 of workshops, 42 of domestic workshops, 296 of workplaces, and 272 of outworkers' premises, while 176 premises were visited for inquiry and no workroom found. There were only two cases of overcrowding discovered, compared with one in 1912, three in 1911, and one in 1910, and these were at once abated, four workrooms were found to be insufficiently ventilated, and 29 were found to be in a dirty condition, compared with 37 in 1912, 17 in 1911, and 30 in 19x0. All the factories and' workshops inspected during the year had separate water closets for the sexes, but in four factories, three workshops, and one workplace the water closets were defective. Other nuisances were discovered in two factories, 13 workshops, two domestic workshops, 12 workplaces, and four outworkers' premises, and these were all abated. It was only necessary to serve 55 intimation notices and two statutory notices, and these were all complied with at the end of the year with the exception of two in Putney, which were complied with in the early part of 1914. 34 workshops and one domestic workshop where females were employed were reported to H.M. Inspector of Workshops and 45 were reported to this Council by H.M. Inspector. Only 10 of the workshops, (two in Clapham, two in Putney, five in Streatham, and one in Tooting), reported by H.M. Inspector were unknown to the Sanitary Inspectors. The other 35 had been previously reported to H.M. Inspector, or were already on the Register. Report of the Medical Officer of Health. 247 TABLE CXVII. Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. I.—Factories inspected 34 16 36 7 111 204 „ re-inspected 2 2 1 ... 20 25 Sanitary conveniences insufficient ... ... ... ... ... ... „ „ unsuitable ... ... ... ... ... ... „ „ not separate for sexes ... ... ... ... ... ... „ „ defective ... ... 1 ... 3 4 Other nuisances ... ... ... ... 2 2 Intimation notices served ... ... ... ... ... 6 Statutory notices served ... ... ... ... 5 ... Legal proceedings ... ... ... ... ... ... II.—Workshops inspected 219 195 343 36 235 1028 „ re-inspected 19 12 24 3 23 81 Workrooms inspected 402 270 415 55 498 1640 „ found overcrowded ... ... 2 ... ... 2 ,, insufficiently ventilated ... 1 3 ... ... 4 „ in a dirty condition 5 6 2 5 19 Sanitary conveniences insufficient ... ... ... ... ... ... „ „ unsuitable ... ... ... ... ... ... „ „ not separate for sexes ... ... ... ... ... ... „ „ defective 2 ... 1 ... ... 3 Other nuisances 1 1 2 3 6 13 Intimation notices served 7 5 4 3 8 27 Statutory notices served ... ... ... ... 1 1 Legal proceedings ... ... ... ... ... ... Number of workrooms measured 21 4 31 3 12 71 Number of workroom cards distributed 15 5 57 3 16 96 Workshops reported to H.M. Inspector 6 7 12 ... 9 34 „ „ by „ „ 8 10 16 3 8 45 42 III.—Domestic workshops inspected 8 3 9 1 21 „ „ re-inspected ... ... ... ... 3 3 Workrooms found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... ... ... ... ... „ in a dirty condition ... ... ... ... ... ... Other nuisances ... ... ... ... 2 2 Intimation notices served ... ... ... ... 2 2 Statutory notices served ... ... ... ... ... ... Legal proceedings ... ... ... ... ... ... Domestic workshops reported to H.M. Inspector ... ... ... ... 1 1 IV.—Workplaces inspected 53 37 81 27 98 296 „ re-inspected Workrooms inspected 3 12 5 16 36 81 55 111 34 128 409 „ found overcrowded ... ... ... ... ... ... „ insufficiently ventilated ... ... ... ... ... „ in a dirty condition 1 1 1 ... 3 6 Sanitary conveniences insufficient ... ... ... ... ... ... „ ,, unsuitable ... ... ... ... ... ... „ „ not separate for sexes ... ... ... ... ... ... „ „ defective ... ... ... ... 1 1 Other nuisances 1 1 4 ... 6 12 Intimation notices served 1 1 4 ... 9 15 248 Report of the Medical Officer of Health. TABLE CXVII.—continued. Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. Statutory notices served ... ... ... ... ... ... Legal proceedings ... ... ... ... ... ... V.—Home work. Premises inspected 65 14 63 32 98 272 ,, re-inspected 2 ... 6 2 5 15 Workrooms found overcrowded ... ... ... ... ... ... „ insufficiently ventilated ... ... ... ... ... ... „ in a dirty condition ... ... • •• 2 2 4 Other nuisances ... ... 1 2 1 4 Intimation notices served ... ... 1 2 2 5 Statutory notices served ... ... ... ... 1 1 Legal proceedings ... ... ... ... ... ... Cases of infective disease notified 4 ... 6 1 2 13 Houses visited for inquiry and no room found 39 15 40 10 72 176 Total number of premises inspected 379 265 532 110 563 1842 „ „re-inspected 26 14 43 10 67 160 ,, intimation notices served 8 6 10 5 26 55 „ „ complied with 8 4 10 5 26 53 „ statutory notices served ... ... ... ... 2 2 „ „ complied with ... ... ... ... 2 2 „ legal proceedings ... ... ... ... ... ... Table CXVIII. shows the number of factories, workshops, domestic workshops, and workplaces on the Register at the close of 1912, the number removed from, the number added during 1913, and the number on the Register at the end of 1913. 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 104 factories where women are employed, 76 are laundries and 28 other factories, while of the total workshops, viz.:—523, Report of the Medical Officer of Health. 249 299 are dressmakers and milliners, 145 laundries and 79 other workshops, an increase of nine dressmakers' and milliners' premises and nine other workshops, compared with 1912, while the number of laundries are two less than in the previous year. The total number of domestic workshops on the Register was 63, (nine in Clapham, six in Putney, 27 in Streatham, tour in Tooting and 17 in Wandsworth), compared with 59 in 1912. The total number of workplaces on the Register is 366, an increase of seven compared with 1912, of which 87 are laundries, and 279 miscellaneous premises, chiefly dressmakers and milliners. 250 Report of the Medical Officer of Health. TABLE CXVIII. 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. 2 3 Total. Factories on Register, 1912 ... 13 5 18 ... 4 3 7 ... 15 4 19 ... 1 2 3 ... 42 12 54 ... 75 26 101 ,, removed from Register ... 1 ... 1 ... ... ... ... ... ... 1 1 ... ... 1 1 ... 2 1 3 ... 3 3 6 ,, added to Register, 1913 ... ... 1 1 ... 1 ... 1 ... ... 3 3 ... ... ... ... ... 3 1 4 ... 4 5 9 „ on Register, 1913 ... 12 6 18 ... 5 3 8 ... 15 6 21 ... 1 1 2 ... 43 12 55 ... 76 28 104 Workshops on Register, 1912 49 34 2.3 106 56 12 9 77 126 36 27 189 19 12 5 36 40 53 6 99 290 147 70 507 ,, removed from Register 3 1 3 7 6 3 2 11 8 ... 2 10 ... 2 ... 2 9 5 3 17 26 11 10 47 ,, added to Register, 1913. 8 1 7 16 6 3 2 11 16 2 5 23 ... 1 ... 1 5 2 5 12 .35 9 19 63 „ on Register, 1913 54 34 27 115 56 12 9 77 134 38 30 202 19 11 5 35 30 50 8 94 299 145 79 523 Number of workrooms therein 59 98 47 204 70 32 12 114 160 113 35 308 19 28 5 52 39 167 8 214 347 438 107 S92 Domestic workshops on Register, 1912 10 4 25 4 16 59 ,, removed from Register 2 ... 1 ... 8 11 „ added to Register, 1913 i 2 3 9 15 „ on Register, 1913 9 6 27 4 17 63 *2 3 Total. 2 3 Total. 2 3 Total. 2 3 Total. 2 3 Total. 2 3 Total. Workplaces on Register, 1912 20 38 58 9 16 25 35 98 133 6 53 59 20 64 84 90 269 359 ,, removed from Register 3 4 7 2 ... 2 6 15 21 ... 5 5 6 20 26 17 44 61 ,, added to Register, 1913 2 6 8 2 3 5 3 19 22 ... 9 9 7 17 24 14 54 68 „ on Register, 1913 19 40 59 9 19 28 32 102 134 6 57 63 21 61 82 87 279 306 Number of workrooms therein 41 40 81 19 19 38 59 102 161 12 57 69 43 61 104 174 279 453 * (i) Dressmakers and Milliners. (2) Laundries. (3) Miscellaneous. Report of the Medical Officer of Health. 251 Table CXIX. shows the nature of the trades carried on in the workshops inspected. There has been a slight increase in the numbers, chiefly due to an increase in the number of dressmakers and tailors, 483 and 16 of these being now on the Register, compared with 467 and eight in 1912. The total numter, viz.:—905, (168 in Clapham, 108 in Putney, 356 in Streatham, 91 in Tooting, and 182 in Wandsworth), is 32 more than in 1912, the greatest increase having occurred in Streatham, while there has been a decrease in Wandsworth. TABLE CXIX. Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. Art Needleworkcrs ... 1 2 1 ... 4 Blouse Makers 4 ... 1 1 ... 6 Box Maker 1 ... ... ... ... 1 Confectionery Maker ... 1 ... ... ... 1 Corset Makers 1 1 2 ... 1 5 Dressing Gown Makers 5 ... ... ... ... 5 Dressmakers 72 56 210 59 86 483 Druggists' Sundries Maker 1 ... ... ... ... 1 Ecclesiastical Embroiderer ... ... 1 ... ... 1 Feather Curlers and Cleaners 1 ... 1 1 1 4 Firework Case Maker ... ... 1 ... ... 1 Florists ... ... 7 ... ... 7 Glove Makers ... ... ... ... 2 2 Gold Embroiderer 1 ... ... ... ... 1 Gold Lace Spinner 1 ... ... ... ... 1 Hairworker ... 1 ... ... ... 1 Hosiers 2 ... ... 1 ... 3 Lace Maker ... 1 ... ... ... 1 Laundries (Workshops) 34 12 38 11 50 145 Laundries (Workplaces) 19 9 32 6 21 87 Linen Embroiderer ... ... 1 ... ... 1 Maker of Celluloid Articles ... 1 ... ... ... 1 Mantle Makers 2 1 ... ... ... 3 Milliners 15 21 42 9 12 99 Outfitters 2 ... 8 1 4 15 Paper Bag Maker 1 ... ... ... ... 1 Paper Cap Maker ... ... 1 ... ... 1 Seed Packer 1 ... ... ... ... 1 Shoe Upper Maker 1 ... ... ... ... 1 Tailors 1 3 9 ... 3 16 Upholsterer 1 ... ... ... ... 1 Vest Makers 2 ... ... 1 2 5 Totals 168 108 356 91 182 905 252 Report of the Medical Officer of Health. Canal Boats Act. During the year 53 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. 26 workshops were visited by the Inspector and the materials used for bedding and upholstery were examined. 39 examples were procured and submitted for analysis, 31 of these were reported as complying with the standard of cleanliness required, whilst eight or 20 per cent, were reported against as containing chlorine in excess of the amount permitted, compared with 50 per cent, in 1912. In one case proceedings were instituted against the person in whose possession the flock was found. The defence was that the flock should have been destroyed, but by mistake it was left in the workshop. The Magistrate accepted this explanation and dismissed the summons. The vendors of the remaining samples were warned. In the event of any amendment being made to the Act, it would be advisable to insert a clause permitting the Magistrate to accept the certificate of the analyst as evidence, as is the case under the Food and Drugs Acts. Report of the Medical Officer of Health. 253 Statement of Work done under the Sale of Food and Drugs Acts. During the year 1,849 samples of foods and drugs were submitted to the Public Analyst for analysis, compared with 1,500 in 1912, 927 in 1911, and 1,060 in 1910. Of the 1,849 samples analysed 949 were purchased as test or informal samples, while 900 were purchased officially. Of the 900 official samples submitted for analysis 121 or 13.4 per cent, were reported to be adulterated or not up to standard, and of those samples which were purchased informally or as test samples 84, or 8-8 per cent, were found adulterated or not up to standard. The total adulterations reported were 205, or 11-o per cent, of the samples submitted, compared with 18.o per cent, in 1912, 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 9.5, compared with 10.39 in 1912, 9.3 in 1911, and 7.4 in 1910. In 84 out of the 121 cases in which adulterations were detected in the official samples proceedings were instituted against the vendor, compared with 86 in 1912, 77 in 1911, and 55 in 1910. The total amount received in penalties under the above Acts during the year amounted to £95 7s. 6d., and the costs to £48, making a total of £143 7s. 6d., compared with £244 14s. in 1912, £299 19s. 9d. in 1911, and £154 11s. in 1910. 254 Report of the Medical Officer of Health. Proceedings under the Sale of Food and Drugs Acts. TABLE CX X. Case No. Article. Adulteration. Result. Fine. Costs. 1 Vinegar 35 per cent. deficient in acetic acid Convicted 15/- 12/6 2 „ 31 „ „ „ 15/- 12/6 10 Butter 92 per cent. of margarine „ 200/- 14/- 33 Vinegar 31 per cent deficient in acetic acid „ 15/- 12/6 34 „ 43 „ „ „ 20/- 12/6 37 Milk 7 per cent. extraneous water „ 30/- 12/6 42 Separated Milk 4 per cent. extraneous water and 2.8 grains of boric acid per pint „ 2/- 12/6 43 Butter 92 per cent. of margarine „ 240/- 16/- 64 Milk 92 per cent. milk fat deficient „ 20/- 12/6 131 Butter 100 per cent. of margarine „ 20/- 14/6 132 „ 100 „ „ „ 20/- 14/6 133 „ 100 „ „ „ 20/- 14/6 134 „ 65 „ „ „ 60/- 12/6 135 " 100 „ „ Defendant absconded before the summonses were served ... ... 136 „ 100 „ „ 137 „ 100 „ „ 168 Milk 12 per cent. extraneous water Convicted Roundsman also convicted 40/- 12/6 188 „ 17 per cent. milk fat deficient Convicted 20/- 14/6 190 „ 47 „ „ „ 60/- 24/6 234 Separated Milk 16 per cent. extraneous water „ 100/- 14/6 257 258 Butter „ Irish 96 per cent. of margarine Same vendor, mons withdrawn 40/- 14/2/- 279 Milk 9 per cent. milk fat deficient Convicted 20/- 12/6 281 „ 15 „ „ Ordered to pay costs ... 12/6 307 „ 97 „ Convicted 20/- 12/6 308 „ 78 „ „ „ 20/- 14/6 310 80 ,, „ and 16 per cent. extraneous water „ 40/- 22/- 317 „ 12 per cent. milk fat deficient Ordered to pay costs „ 12/6 322 „ 30 „ „ Convicted 10/- 12/6 324 Butter 50 per cent. of margarine „ 10/- 16/- 340 Milk 80 per cent. milk fat deficient Withdrawn on advice of magistrate ... ... 355 Saffron 11.2 per cent. extraneous mineral matter Dismissed. Warranty proved ... ... Report of the Medical Officer of Health. 255 TABLE CXX.—continued. Case No. Article. Adulteration. Result. Fine. Costs. 379 Milk 17 per cent. extraneous water Ordered to pay costs ... 27/6 391 Separated Milk 7 „ „ Dismissed, error in certificate ... ... 397 Skimmed milk 11.13 grains boria acid per pint of milk Convicted 10/- 12/6 398 Milk 18 per cent. milk fat deficient Ordered to pay costs ... 12/6 399 „ 18 „ „ „ „ ... 12/6 402 „ 6 „ „ Dismissed. Warranty proved ... ... 417 „ 20 „ „ „ „ ... ... 445 „ 14 per cent. extraneous water Roundsman convicted 10/- 14/6 454 Butter 98 per cent. of margarine Convicted 10/- 13/6 455 „ 95 „ „ „ 10/- 13/0 456 Vinegar 26 per cent. deficient in acetic acid Ordered to pay costs ... 13/6 457 „ 20 „ „ „ „ ... 13/6 511 Baking Powder 26.7 per cent. Calcium sulphate Convicted 20/- 12/6 559 Milk 7 per cent. extraneous water „ 20/- 12/6 602 „ 17 „ „ Ordered to pay costs ... 22/6 604 Butter 98 per cent. of margarine Convicted 60/- 23/6 607 „ 58 per cent. excess of moisture „ 100/- 22/- 609 Milk 16 per cent. milk fat deficient „ 20/- 12/6 611 „ 16 „ „ „ 6o/- 29/- . 696 „ 56 „ „ „ 40/- 12/6 708 8 per cent. extraneous water and 3 per cent. milk fat deficient „ 60/- 12/6 709 „ 8 per cent. extraneous water „ 60/- 12/6 730 Separated Milk 5 „ „ „ 30/- 12/6 736 11 „ „ „ 20/- 12/6 75o Cream 0.36 per cent. crystallised boric Summons dismissed ... ... 751 „ 0.33 „ „ Convicted 15/- 16/- 755 0.33 „ „ „ 10/- 16/- 761 0.17 „ „ Ordered to pay costs ... 12/6 766 „ 0.26 „ „ Convicted 10/- 16/- 767 „ 0.37 „ „ 20/- 18/- 783 0.22 „ „ Dismissed ... ... 784 0.22 „ „ Ordered to pay costs ... 12/6 785 0.25 „ „ Convicted 20/- 12/6 786 0.15 „ 40/- 12/6 776 Skimmed Milk 18 per cent. extraneous water ,, 10/- 12/6 779 Milk 92 per cent. milk fat deficient „ 20/- 14/- 833 Skimmed Milk 17 „ Ordered to pay costs ... 12/6 876 Milk 25 „ „ „ ... 12/6 868 Cream 21 per cent. crystallised boric acid Ordered to pay costs ... 23/- 256 Report of the Medical Officer of Health. PROCEEDINGS UNDER THE MARGARINE ACT. TABLE CXXI. Case No. Description of Offence. Result. Fine. Costs. 10 Selling Margarine in unstamped wrapper Ordered to pay costs ... 4/- 43 Do. Do. ... 2/- 131 Do. Do. ... 2/- 132 Do. Do. ... 2/- 133 Do. Do. ... 2/- 134 Do. Do. ... 2/- 134 Selling Margarine with more than 10 per cent. of butter fat Do. ... 2/- 135 Selling Margarine in unstamped wrapper Defendant ed before summonses were erved ... ... 136 Do. 137 Do. 257 Do. Ordered to pay costs ... 2/- 324 Do. Do. ... 2/- 324 Selling Margarine with more than 10 per cent. of butter fat Do. ... 2/- 454 Selling Margarine in unstamped wrapper Do. ... 2/- 455 Do. Do. ... 2/- 604 Do. Do. ... 2/- 606 Exposing Margarine without proper label Do. ... 12/6 Report of the Medical Officer of Health, 257 OTHER OFFENCES. TABLE CXXII. Nature of offence. Result. Fine. Costs. For selling milk from a receptacle upon which the vendor's name and address were not inscribed Convicted 10/- 2/- Do. do. do. „ 10/- 4/- Do. do. do. Ordered to pay costs ... 4/- Do. do. do. Convicted 5/- 2/- Do. do. do. „ 20/- 2/- Refusing milk for analysis „ 10/6 10/6 Do. do. „ 100/- 2/- TABLE CXX1II. Year. No. of Samples taken. No. Adulterated. Percentage Adulterated. 1903 729 90 12.3 1904 750 85 11.3 1905 832 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 1912 1500 271 18.0 Average 10 years 1903—1912 974 105 10.7 1913 1,849 205 11.0 258 Report of the Medical Officer of Health. Table CXXIV. shows the number of samples taken, the number adulterated, and the percentage of adulterated samples for the 10 years 1903-1912, compared with the year 1913. From this table it will be seen that the average percentage of adulterations detected for the 10 years 1903-1912 was 10.7 per cent., compared with 11.0 in 1913. 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 the formal and informal and to the total samples taken. It will be noted that of the formal samples 13.4 per tent. were adulterated, compared with 15.1 per cent, in 1912, while of the informal 8.4 per cent. were adulterated, compared with 22.4 per cent. in 1912. • TABLE CXXIV. 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 181 26 14. 3 121 13 10.7 302 4.9 39 12.5 Putney 98 12 122 104 9 8.6 202 6.9 21 103 Streatham 183 24 131 210 19 9.0 393 38 43 10.9 Tooting 210 27 12.3 208 17 8.1 418 11.4 44 10.5 Wandsworth 228 32 14 306 26 8.4 534 5.7 58 108 Whole Borough 900 121 134 949 84 8.85 1,849 5.7 205 110 Report of the Medical Officer of Health. 259 Of the total samples the percentage in Clapham was the highest due to the large amount of adulteration detected in milk and butter samples. Table CXXV. 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. TABLE CXXV. Articles analysed. No. of Samples. Percentage of Adulteration. Examined. Found adulter. ated or not up to standard. 1908. 1909. 1910. 1911. 1912. Average for five years.  Milk & Cream 857 99 7.1 7.39 7.44 11.10 13.63 9.3 11.55 Butter 584 74 7.58 5 35 7.23 16.40 25.4 12.4 12.67 Cheese 13 ... ... ... 80.7 ... ... l6.l ... Margarine 23 ... 100 ... ... 200 ... 60 ... Lard 26 ... ... ... ... ... ... .... ... Bread 4 ... ... ... ... ... ... ... ... Flour 9 ... ... ... ... 500 ... 10.0 ... Tea 3 ... ... ... ... ... ... ... ... Coffee 24 ... 4.1 5.5 9.0 10.0 ... 5.8 ... Cocoa 14 ... 16.6 ... 8.3 ... ... 50 ... Sugar 7 ... ... ... ... 10.0 15.3 12.6 ... Mustard 14 ... ... ... ... ... 25.0 5.o ... Confectionery 12 ... 33.3 ... ... ... ... 6.6 ... Pepper 17 ... ... ... ... ... ... ... ... Wine, Beer and Spirits 3 ... ... ... ... ... ... ... ... Drugs* 77 5 9.1 12.5 ... 10.0 7.0 7.7 6.4 Other articles* 165 27 50.0 24.0 30.0 25.9 367 39.0 l6.0 All Articles 1,849 205 8.76 6.89 905 13.2 18.0 9.20 11.0 * Details of these will be found in the Report of the Public Analyst at the end of this Report. 260 Report of the Medical Officer of Health. Milk and Cream. MILK. 798 samples of milk were procured for analysis during the year. 76 or 9.5 per cent. were reported against as being adulterated or not up to legal standard. 781 samples were purchased officially, of which 72 or 9.1 per cent. were adulterated, and 17 samples purchased informally, of which four were reported against. 35 samples were found to contain added water, 36 were deficient in milk fat, three were deficient in milk fat and contained added water, one contained a preservative and added water, and one contained a preservative. Proceedings were taken in 35 cases, in four cases proceedings were barred by informality of purchase, and in 37 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. 31 samples of milk were taken on delivery at various Public Institutions situated within the Borough. All these samples were reported to be genuine. 43 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. One sample was reported against as being deficient in milk fat to the extent of 3 per cent. No action was taken. 4 Report of the Medical Officer of Health. 261 18 samples of milk were procured during the early morning (from 3 to 4 a.m.), from wholesale dealers whilst delivering milk to the retailer. Three samples were reported against as being adulterated or not up to standard. In two cases the adulteration being small no action was taken, while in the remaining case proceedings were instituted, the vendor being ordered to pay costs. 13 samples of milk were procured on delivery at private houses, three were reported as being adulterated, and in two cases proceedings were taken and convictions obtained. Premises. No. of Samples taken. No. Adulterated. Percentage Adulterated. Public Institutions 31 ... ... Railway Stations 43 1 2.3 Retailers' Premises 18 3 17.0 Private Houses 13 3 230 131 samples of milk have been taken on Sundays, either in the early morning or at mid-day. 14 or 10.6 per cent. were reported against as being adulterated, compared with 10 per cent, in 1912, and 10 per cent, in 1911. 315 samples of milk were taken from milk vendors in the street during the early mornings (i.e., 5 to 7 a.m.), on week days, and of these 32 or 10 per cent. were reported against. 12 samples of milk were taken from automatic milk supply machines four of them being reported against as deficient in milk fat. All four of these samples were taken fron one particular machine on different dates. It was found on inquiry that this machine had no plunger or means of stirring the milk in the container. I communicated with the proprietor of the premises where the machine 26 2 Report of the Medical Officer of Health. was fixed, and I am now informed that the machine has been fitted with an efficient plunger and further samples have been taken and found to be genuine. In five cases proceedings were taken against milk vendors for selling milk from receptacles upon which their name and address were not conspicuously inscribed, and convictions were obtained. (See other offences, Table CXXII.) In two cases the defendants relied on a warranty, and in each case the Magistrate was satisfied that the milk sold was in the same condition as received. In two cases proceedings were taken against milk vendors for refusing to serve milk for analysis, and convictions were obtained. 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 1913. TABLE CXX VII. Year. No. of Samples taken. No. Adulterated. Percentage Adulterated. 1903 376 65 17.28 1904 397 61 15.60 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 1912 712 74 10.39 Average 10 years, 1903-1912 527 51 9.6 1913 798 76 9.5 keport of the Medical Officer of Health. 263 CREAM. 59 samples of cream were taken during the year, 18 of these being sold as preserved cream and 41 not so sold. The following report on the administration in connection with the Public Health (Milk and Cream) Regulations, 1912, is prepared as requested by the Local Government Board. In none of the 18 cases was the amount of boric add stated on the label exceeded, and all the samples contained over 35 per cent, of milk fat. REPORT ON ADMINISTRATION IN CONNECTION WITH THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. Report for the year ended 31 st December, 1913. 1. Milk and Cream not sold as " Preserved Cream." (a) ■b) Number of Samples examined for the presence of a preservative. Number in which a preservative was reported to be present Milk 798 2 Cream 4i 23 264 Report of the Medical Officer of Health. Nature of preservative in each case in column (b). CREAM; Case No. 138 Cream 0.21 per cent. Crystallised Boric Acid. „ 139 „ 0.09 „ „ „ „ 141 „ 0.57 „ „ „ „ 143 „ 0.23 „ „ „ „ 145 „ 0.22 „ „ „ „ 146 „ 0.31 „ „ „ „ 148 „ 0.21 „ „ „ „ 150 „ 0.25 „ „ „ „ 152 „ 0.25 „ „ „ „ 153 „ 0.18 „ „ „ „ 155 „ 0.47 „ „ „ „ 156 „ 0.15 „ „ „ „ 750 „ 0.36 „ „ „ „ 751 „ 0.33 „ „ „ „ 755 „ 0.33 „ „ „ „ 761 „ 0.17 „ „ „ „ 766 „ 0.36 „ „ „ „ 767 „ 0.3 7 „ „ „ „ 783 „ 0.22 „ „ „ „ 784 „ 0.20 „ „ „ „ 785 „ 0.25 „ „ „ „ 786 „ 0.15 „ „ 868 „ 0.21 „ „ „ Nature of preservative in each case in column (b). MILK. Report of the Medical Officer of Health. 263 Action taken under the Regulations in regard to each case in Column (b). Case No. Article. Action taken. Result. 42 Separated Milk Action taken under Food and Drugs Act Convicted. Fined 2/and 12/6 costs 397 Skimmed Milk „ „ Convicted. Fined 10/and 12/6 costs 138 Cream Action taken under the Regulations Dismissed 139 „ „ „ Withdrawn on advice of Magistrate 141 „ „ „ „ „ 143 „ „ „ „ „ 145 „ „ „ „ „ 146 „ „ „ „ „ 148 „ „ „ „ „ 150 „ „ „ „ „ 152 „ „ „ „ „ 153 „ „ „ „ „ 155 „ „ „. „ „ 156 „ „ „ „ 75o „ Action taken under Food and Drugs Act, Sect. 6 Case dismissed 751 „ „ „ Convicted. Fined 15/and 16/- costs 755 „ „ „ Convicted. Fined 10/and 16/- costs 761 „ „ „ Ordered to pay costs, 12/6 766 „ „ „ Convicted. Fined 10/and 16/— costs 767 „ „ „ Action taken under Regulations Convicted. Fined 20/- and 18/- costs Dismissed 783 „ Action taken under Food and Drugs Act „ 784 „ „ „ Ordered to pay costs, 12/6 785 „ „ „ Convicted. Fined 20/and 12/6 costs 786 „ „ „ Convicted. Fined 40/and 12/6 costs 868 „ „ „ Ordered to pay costs, 23/-25/2 /14. 266 Report of the Medical Officer of Health. (2). Cream sold as Preserved Cream. Instances in which samples have been submitted for analysis to ascertain if the statement on the label as to preservatives was correct:— (1). Correct statements made 18 (2). Statements incorrect 0 Total 18 (b) Determinations made of milk-fat in cream sold as served Cream :— (1). Above 35 per cent 18 (2). Below 35 per cent 0 Total 18 (c) and (d). In each of the 18 samples procured as Preserved Cream the provisions as to labelling were duly observed. (3). Thickening Substances Nil. (4). Other Observations. It will be noted that all the cases taken under the Regulations were either dismissed by the Magistrate, or withdrawn at his suggestion, with the exception of one case, in which the defendant was ordered to pay 23s. costs. I append letters from the Solicitor to the Council, dated 8th December, 1913, and 31st January, 1914, in which he mentions the difficulties which have arisen in securing convictions under the Regulations. In this Borough, as will be seen from my Annual Report for 1912, pages 240 and 241, all the registered milk and cream sellers were warned by circular and a copy of the Regulations was enclosed. It could not therefore be said that they were ignorant of the existence of the Regulations, but in spite of this fact, the Magistrate dismissed some of the cases and suggested that the others should be withdrawn. Report of the Medical Officer of Health. 267 I quite agree with the opinion given by the Solicitor that it will, in future, be difficult to secure convictions under the Regulations, and also under the Sale of Food and Drugs Acts. Type of label in general use in this Borough where Preserved Cream is sold :— PRESERVED CREAM CONTAINING BORIC ACID NOT EXCEEDING 0. 5 PER CENT. 8th December, 1913. Cases 750, 751, 755, 761, 766, 767, 783, 784, 785 and 786. "in each of these cases, which are in respect of selling cream containing a boron preservative, I have been asked by the Inspector to advise whether summonses should be issued against the defendants under the Milk and Cream Regulations, 1912, for failing to place labels, as provided by the Regulations, cn the bottles or receptacles containing the cream. "In case No. 767 I have issued a summons under these Regulations, inasmuch as in that case the label was put on the jug, but upon the bottom of the jug, which is quite contrary to Regulation 5 in the Schedule. "Looking to the fact that the omission to put a label on the vessel containing cream must be wilful, I have come to the conclusion that in all the other cases summons should not be issued under the Regulations. You will recollect that in a batch of summonses we had some short time ago, the Magistrate held that the omission to put a label on the vessel must be wilful, and upon it being proved by the defendants that they had provided the labels and instructed their employees to put the same upon vessels containing Cream the Magistrates held that there was 110 wilful omission and the summonses had to be withdrawn. In none of the above cases (except 767) 268 Report of the Medical Officer of Health. are the defendants the same as those who were previously summoned, and they have all written in reply explaining the circumstances under which the omission to label the vessels came about. I am of opinion that the Magistrate would accept the explanations given and would not find that the omission was wilful. "Upon referring to Chambers' Entomological Dictionary I find that the meaning of the word' wilful' is given as ' governed only by one's will' 'done or suffered by design,' and in Stroud's Judicial Dictionary it states that it is the intention to purposely omit to do the thing that ought to be done. I think it could not be said in any of the cases that the defendants so acted as to intentionally or purposely omit to put the labels on the receptacles. In most of the cases it was the employees of the defendants who made the omission, notwithstanding (I think in all cases) that labels were provided for the purpose. "The words ' wilful neglect' seem a stumbling-block in the enforcement of the Regulations, but I think if the same defendants in the future omit to put the labels on, summonses ought to be issued against the defendants, and the Magistrate would then have to judge whether the omission was wilful or not." 31st january, 1914. Case No. 750. "The summons was dismissed in this case on Wednesday last, although to my mind the evidence was such that the defendants ought to have been convicted, but the defendants' Counsel made a great parade of the Local Government Board Regulations as to the sale of Preserved Cream "The defendants' manageress stated that the cream was sold from a jug which was labelled ' Preserved Cream ' and stated the percentage of boric acid ; but this witness admitted that she did not produce the jug to the purchaser nor to the Inspector. "I should like to say with regard to these Regulations that they have now created considerable difficulty as to proceedings under the Food and Drugs Acts relative to the purchase of cream. Report of the Medical Officer of Health. 269 In the first place a great difficulty in taking successful proceedings under the Regulations arises from the fact that the omission to place the label as provided by the Regulations on the receptacle containing the cream must be wilful, and having to notify the vendor before proceedings are taken that the cream has been sold without a label and an explanation thereof asked for, his answer is framed accordingly. In all cases but two which have come before me, I have had to advise that upon the explanation given by the seller the Court would not hold that he had wilfully evaded the Regulations. "I have previously referred to this in my report to the Council as to proceedings on the 9th April last, and I have also given the Council my views as to the meaning of the word 'wilful' in connection with the Regulations. In the 'Justice of the Peace' for the 24th inst., in the case of Rex v. Ryan, reported at page 40, the word 'wilful' in the sub-section of the Act under discussion was held to mean 'intentional' in the sense that at the time the certificate of the medical man therein referred to was given he must know he was making a false statement, and applying that decision to the Regulations the Magistrate would have to be convinced that in omitting to put a label on a vessel containing cream the seller ' intended ' to do so. "Again, we are very much handicapped by the ridicule cast by defendants' solicitors and others upon the Regulations by the penalty for an infringement thereof being prescribed under an Act with respect to epidemic, endemic and infectious diseases, and Acts relating to quarantine, and the penalty being a sum not exceeding £100, whereas the maximum penalty under the Food and Drugs Acts for a first offence is only £20. "In all cases where cream is asked for and sold without a label being affixed to the vessel, the defendants will only have to make a show of small paper vessels with labels affixed thereto to induce the Magistrate to come to the conclusion that the purchaser was not prejudiced inasmuch as these things are exhibited in the shop although not used. 270 Report of the Medical Officer of Health. "Moreover, on Wednesday last it was argued that the placing of a label on a vessel containing cream related to the receptacle containing cream provided by the seller and did not apply to a jug which a purchaser produced and in which cream or preserved cream was placed. "Again under the Regulations a complaint has to be lcdged in the name of the Town Clerk, whereas under the Food and Drugs Acts it is in the name of the Inspector who takes the sample. There may be two offences committed be the same defendant in respect to the same article, viz.:—that he sold it as cream and not as preserved cream, and being analysed and found to be preserved cream and thereby the purchaser was prejudiced and that he sold it in a vessel without affixing a label thereto, contrary to the Regulations. On one summons he would be liable to a penalty not exceeding £100, and on the other (which might be a much more serious offence—cream being sold with a boron preservative and which might be to the injury of the person consuming it)—a penalty of only £20. "It is to be regretted that the Food and Drugs Act was not amended, which could have been done by a very short Act empowering the Local Government Board to make bye-laws with regard to the sale of cream. All such matters then would have been gathered under one Act, whereas now reference has to be made to several Public Health Acts, and as above-mentioned a penalty is prescribed under an Act which has nothing whatever to do with the sale of Cream or an article of food." Butter and Margarine. BUTTER. 584 samples of butter were submitted for analysis during the year, of which 74 or 12.67 Per cent, were reported against, compared with 25.4 per cent, in 1912, 16.4 per cent, in 1911, and 7.23 per cent, in 1910, Report of the Medical Officer of Health. 271 Of the 584 samples of butter analysed 44 samples were taken officially, 17 or 38.6 per cent, were reported against, whereas of those samples taken informally 57 or 10.5 per cent, were found to be adulterated. In 16 cases proceedings were instituted against the vendors of the adulterated samples. In one case, the vendor absconded before the summons was served, and his whereabouts has not yet been traced. In another case the vendor absconded after receiving a summons and a warrant was issued for his arrest. The vendor was subse qrently arrested and convicted, being fined £3 and 38s costs, or one month's imprisonment. In the remaining cases convictions were obtained and penalties and costs amounting to £50 8s. od. imposed, compared with £150 6f. fid. in 1912, and £113 4s. 9d. in 1911. It is in connection with the substitution of margarine when butter is asked for that the informal sampling is invaluable and is, in my opinion, the only means of detecting and checking this fraudulent method of trading. It will be seen on reference to the following Table that in 1912 no less than 25.4 per cent, of the samples of butter analysed were adulterated, this compared with 12.67 per cent, (the adulteration detected for the year under review), shows how satisfactorily the informal sampling has been, but there is still much more to be done when we compare the present percentage of adulteration, viz.:—12.67 with that for the whole of London, viz.:—8.4, and that for the whole country, viz. :—6. 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 1903-1912 compared with the year under review, 272 Report of the Medical Officer of Health. TABLE CXXVIII. Year. Number of samples taken. Number Adulterated. Percentage of Adulteration. 1903 180 8 4.40 1904 180 14 7.20 1905 223 20 896 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 1912 389 99 25.4 Average for 10 years 1903-1912 272 26 9.56 1913 584 74 12.67 MARGARINE. 23 samples of margarine were submitted for analysis and all returned as genuine. There was one prosecution in respect of the sale of margarine, for exposing margarine for sale by retail without having a proper label attached thereto, and the defendant was ordered to pay costs CHEESE. 13 samples of cheese were analysed and all reported to be genuine. Report of the Medical Officer of Health. 273 LARD. 26 samples of lard were analysed and all reported to be genuine. FLOUR. Nine samples of flour and 10 of baking powder were examined, two of baking powder being reported against. All the samples of flour and remaining samples of baking powder were reported to be genuine. In respect of the two samples of baking powder reported against, one sample was taken informally and one from the same source officially. Proceedings were taken against the vendor, who was convicted and fined 20s. and 12s. 6d. costs. COFFEE. 24 samples of coffee were examined and all reported to be genuine. COCOA. 14 samples of cocoa were analysed and all reported to be genuine. SUGAR. Seven samples of sugar were analysed, and all reported to be genuine. MUSTARD. 14 samples of mustard were analysed, and all reported to be genuine. 274 Report of the Medical Officer of Health. DRUGS. 77 samples classified under this heading were analysed, and five reported against as being adulterated or not up to standard. The samples reported against were informal samples of crushed linseed, Epsom salts, tincture of iodine, saffron, and one formal sample of saffron. Proceedings were taken against the vendor of the sample of saffron, who successfully pleaded warranty. In the other cases the adulteration was small or trivial, and the Committee decided to warn the vendors. OTHER ARTICLES. 165 samples classified under this heading were examined, 27 or 16.0 per cent. being reported against as either adulterated or not up to the required standard. The chief adulteration occurred in samples of vinegar, 32 samples of which were analysed and 18, or 56 per cent. were found to be deficient in acetic acid. The deficiency ranged from five to 43 per cent. in the 18 samples reported against. In six cases proceedings were taken against the vendors, and penalties and costs amounting to £6 12s. were imposed. ICE CREAM. 12 samples of ice cream were purchased and analysed, and found to be genuine. These samples were purchased from itinerant ice cream vendors on Whit Monday. Six of the samples were taken on Putney Heath and six on Clapham Common. Report of the Medical Officer of Health. 275 Although, on analysis, the samples were found to be coloured with a coal tar dye, yet in each case the quantity of dye present was infinitesimal. RICE. 14 samples of rice were examined for the presence of " facing." Most of the samples showed evidence of facing, but no sample was found to exceed the amount recommended as permissible in Dr. J. M. Hamill's Report to the Local Government Board. In my opinion, the practice of polishing rice or other cereals with mineral water should be absolutely prohibited, for there can be no doubt that the gain by polishing is not to the consumer, on the contrary, the consumer often gets an inferior rice polished in substitution for the genuine article. 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 1913 under the Sale of Food and Drugs Acts. The total number of samples submitted by the Inspector Number of during the year amounted to 1,840. Of these,900 Samples submitted. were taken with the formalities required by the Sale of Food and Drugs Acts, whilst 949 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. 278 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 1913 by the Inspector. No. of samples examined No. of samples fou id adulterated or not up to standard Formal Informal Total. Formal Informal Total. Milk and Cream 829 28 857 95 4 99 Butter 44 540 584 17 57 74 Cheese 0 13 13 0 0 0 Margarine 0 23 23 0 0 0 Lard 1 25 26 0 0 0 Bread 0 4 4 0 0 0 Flour (Self-raising) 0 9 9 0 0 0 Tea 0 3 3 0 0 0 Coffee 1 23 24 0 0 0 Cocoa 0 14 14 0 0 0 Sugar 0 7 7 0 0 0 Mustard 0 14 14 0 0 0 Confectionary and Jam 0 12 12 0 0 0 Pepper 0 17 17 0 0 0 Drugs 3 74 77 1 4 5 Other Articles 22 143 165 8 19 27 900 949 1,849 121 84 205 Report of the Med1cal Off1cer of"Health. 279 Table A. Deta1ls of"Other Art1cles" and" Drugs" in foregoing Table. OTHER ART1CLES No. of samples examined No. of samples found adulterated or not up to standard Formal informal Total. Formal informal Total. Baking Powder 2 8 10 1 1 2 Barley, Pearl 0 3 3 0 0 0 Cayenne Pepper 0 1 1 0 0 0 Cinnamon 0 2 2 0 0 0 Cornflour 0 4 4 0 0 0 Dr1pping 1 1 2 0 0 0 Fruits (Dr1ed) 0 18 18 0 0 0 Fruits in Syrup 0 18 18 0 0 0 Ginger, ground 0 5 5 0 0 0 Honey 0 6 6 0 0 0 1ce Cream 12 0 12 0 0 0 Jelly, Table 0 8 8 0 0 0 Mace (Ground) 0 3 3 0 0 0 Nut Lard 0 1 1 0 0 0 Ol1ve O1l 0 8 8 0 0 0 R1ce 0 14 14 0 0 0 R1ce, Ground 0 3 3 0 2 2 Sago 0 4 4 0 0 0 Soup (Des1ccated) 0 2 2 0 O 0 Tap1oca 0 2 2 0 0 0 Vinegar 7 25 32 7 11 18 Wines (Non.alcohol1c) 0 7 7 0 5 5 22 143 165 8 19 27 280 Report of the Med1cal Off1cer 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, Boric 0 2 2 0 0 0 Borax 0 3 3 0 0 0 Camphorated Oil 0 6 6 0 0 0 Cream of Tartar 0 3 3 0 0 0 Epsom Salts 1 3 4 0 1 1 Glycerin 0 4 4 0 0 0 Linseed, Crushed 0 7 7 0 1 1 Magnesia, Fluid 0 1 1 0 0 0 Milk Sugar 0 3 3 0 0 0 Ointment, Boric 0 5 5 0 0 0 Ointment, Zinc 0 2 2 0 0 0 Pills, Iron 0 5 5 0 0 0 Powder, Gregory's 0 7 7 0 0 0 Powder, Liquorice, Compound 0 3 3 0 0 0 Powder, SeidlItz 0 6 6 0 0 0 Rhubarb, Powdered 0 1 1 0 0 0 Saffron 1 4 5 1 1 2 Saltpetre 0 1 1 0 0 0 Syrup of Squills 0 2 2 0 0 0 Tincture of Iodine 1 4 5 0 1 1 Tincture of Opium 0 1 1 0 0 0 Tincture of Rhubarb 0 1 1 0 0 0 3 74 77 1 4 5 Report of the MedIcal Off1cer of Health. 281 Milk and Cream. The number of samples grouped under the heading "milk and Cream" amounted to 857. Of these, 829 were taken with the necessary formalit1es requ1red by the Acts, wh1lst 28 were submitted informally. The samples were compr ised as follows:. No. of samples examined No. of samples found adulterated or not up to standard Formal informal Total Formal informal Total Milk 749 14 763 63 4 67 Separated Milk 21 0 21 5 0 5 Skim Milk 11 0 11 4 0 4 Milk Powder 0 3 3 0 0 0 Cream, Fresh 36 5 41 23 0 23 Cream, Preserved 12 6 18 0 0 0 829 28 857 95 4 99 Classification of adulteration Reported. It will, therefore, be seen that the percentage of adulteration or departure from standard in articles submitted under th is class was as under:— Formal. informal. Milk 8.4 28.3 Separated Milk 23.8 ... Skim Milk 36.3 ... Milk Powder ... 0 Cream (Fresh) 63.8 0 Cream (Preserved) 0 0 282 Report of the Mediccd Officer of Health, The nature and extent of the adulteration reported. As regards the milk samples, the greatest adulteration in respect of extraneous water occurred in the case of formal sample No. 844, where it amounted to 55 per cent. The greatest deficiency in milk fat occurred in the case of formal sample No. 307 where it amounted to no less than 97 per cent. Formal samples Nos. 64, 779, 310, 340, and 308 followed closely with a milk fat deficiency of 92, 92, 80, 80, and 78 per cent. respectively. Sample No. 310 further contained extraneous water to the extent of 16 per cent. Of the creams purchased as "fresh" 23 samples of the 41 samples submitted were found to contain a boron preservative. The amounts present, expressed in terms of crystall ised boric acid, ranged from 0.57 per cent. in the case of formal sample No. 141, to 0.15 per cent. in the case of both formal sample No. 156 and formal sample No. 786. Of the creams purchased as "preserved," all 18 samples were found to contain a boron preservative, ranging from 0.50 per cent. boric acid in the case of formal sample No. 754, to 0.04 per cent. in the case of informal sample No. 1380. The details of all adulterated samp es grouped under th is heading are given in Table C. The presence of preservatives. All milks were systematically examined for the presence of preservatives, but in two instances only were positive results obtained: a sample of Separated Milk (formal sample No. 42), and one of Skim Milk (formal sample No. 397) being found to contain a small amount of a boron preservative. The negative results obtained in the case of all other samples must be regarded as highly sat isfactory, and the following Table, showing the number of samples found to contain a preservative in th is and the two preceding years, clearly indicates that the many alarm ist statements made concerning the constant "drugging " of th is important article of diet are not founded on fact; at any rate, as regards the milk supply of the Borough. Total No. of examples No. found to contain Year. Percentage. examined. a preservative. 1911 586 4 0.68 1912 727 6 0.82 1913 798 2 0.25 Report of the Med1cal Off1cer of Health. 283 Table C. Table showing in deta1l 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. 37 milk 7 per cent. extraneous water. 42 milk (separated) 4 per cent. extraneous water and 2.8 grains Crystall ised Boric Ac1d per pint. 64 milk 92 per cent. milk fat deficient; 76 milk 5 per cent. milk fat deficient. 79 milk 1 per cent. extraneous water. 82 milk 2 per cent. extraneous water. 87 milk 1 per cent. extraneous water. 89 milk 1 per cent. extraneous water. 94 milk 1 per cent. extraneous water. 120 milk 2 per cent. milk fat deficient. 138 Cream (fresh) 0.21 per cent. Crystall ised Boric Acid. 139 Cream (fresh) 0 09 per cent. Crystall ised Boric Acid. 141 Cream (fresh) 0.57 per cent. Crystall ised Boric Acid. 143 Cream (fresh) 0.23 per cent. Crystall ised Boric Acid. 145 Cream (fresh) 0.22 per cent. Crystall ised Boric Acid. 146 Cream (fresh) 0.31 per cent. Crystall ised Boric Acid. 148 Cream (fresh) 0.21 per cent. Crystall ised Boric Acid. 150 Cream (fresh) o.28 per cent. Crystall ised Boric Acid. 152 Cream (fresh) 0.25 per cent. Crystall ised Boric Acid. 153 Cream (fresh) 0.18 per cent. Crystall ised Boric Acid. 155 Cream (fresh) 0.47 per cent. Crystall ised Boric Acid. 156 Cream (fresh) 0.15 per cent. Crystall ised Boric Acid. 164 milk (skimmed) 71 per cent. milk fat deficient. 168 milk 12 per cent. extraneous water. 187 milk 2.5 per cent. extraneous water. 188 milk 17 per cent. milk fat deficient. 189 milk 4 per cent. milk fat deficient. 284 Report of the Med1cal Off1cer of Health. Table C—continued. Case No. Nature of sample. Nature of Report. 190 milk 47 per cent. milk fat deficient. 194 milk 3 per cent. milk fat deficient 224 milk 1 per cent. extraneous water. 234 milk ( separated) 16 per cent. extraneous water. 241 milk 2 per cent. extraneous water. 266 milk 2 per cent. extraneous water. 279 milk 9 per cent. milk fat deficient. 281 milk 15 per cent. milk fat deficient. 287 milk 3 per cent. extraneous water and 3 per cent. milk fat deficient. 307 milk 97 per cent. milk fat deficient. 308 milk 78 per cent. milk fat deficient. 310 milk 16 per cent. extraneous water and 80 per cent. milk fat deficient. 316 milk 1 per cent. extraneous water. 317 milk 12 per cent. milk fat deficient. 322 milk 30 per cent. milk fat deficient. 335 milk 5 per cent. milk fat deficient. 340 milk 80 per cent. milk fat deficient. 343 milk 1 per cent. extraneous water. 379 milk 17 per cent. extraneous water. 382 milk 3 per cent. milk fat deficient. 391 milk (separated) 7 per cent. extraneous water. 397 milk (skimmed) 0.124 Per cent. Crystall ised Boric Acid. 398 milk 18 per cent. milk fat deficient. 399 milk 18 per cent. milk fat deficient. 402 milk 6 per cent. milk fat deficient. 417 milk 20 per cent. milk fat deficient. 440 milk 2 per cent. extraneous water. 445 milk 14 per cent. extraneous water. 492 milk 6 per cent. milk fat deficient. 498 milk 1 per cent milk fat deficient. 503 milk 1 per cent. extraneous water. 521 milk 3 per cent. milk fat deficient. 544 milk 9 per cent. milk fat deficient. Report of the Med1cal Off1cer of Health. 285 Table C—continued. Case No. Natutre of sample. Nature of Report. 559 milk 7 per cent. extraneous water. 566 milk 3 per cent. extraneous water. 571 milk 5 per cent. milk fat deficient. 602 milk 17 per cent. extraneous water. 609 milk 16 per cent. milk fat deficient. 611 milk 16 per cent. milk fat deficient. 633 milk 3 per cent. extraneous water. 645 milk 2 per cent. extraneous water. 646 milk 2 per cent. extraneous water. 648 milk 3 per cent. extraneous water. 649 milk 2 per cent. extraneous water. 694 milk 3 per cent. extraneous water. 696 milk 56 per cent. milk fat deficient. 702 milk 2 per cent. extraneous water. 708 milk 8 per cent. extraneous water and 3 per cent. milk fat deficient. 709 milk 8 per cent. extraneous water. 730 milk (separated) 5 per cent. extraneous water. 736 milk (separated) 11 per cent. extraneous water. 740 milk 1 per cent. extraneous water. 750 Cream (fresh) 0.36 per cent. Crystall ised Boric Acid. 751 Cream (fresh) 0.3 per cent. Crystall ised Boric Acid. 755 Cream (fresh) 0.33 per cent. Crystall ised Boric Acid. 761 Cream (fresh) 0.17 per cent. Crystall ised Boric Acid. 766 Cream (fresh) 0.36 per cent. Crystall ised Boric Acid. 767 Cream (fresh) 0.37 per cent. Crystall ised Boric Acid. 776 milk (skimmed) 18 per cent. extraneous water. 779 milk 92 per cent. milk fat deficient. 793 Cream (fresh) 0.22 per cent. Crystall ised Boric Acid. 784 Cream (fresh) 0.20 per cent. Crystall ised Boric Acid. 785 Cream (fresh) 0.25 per cent. Crystall ised Boric Acid. 786 Cream (fresh) 0.15 per cent. Crystall ised Boric Acid. 833 milk (skimmed) 17 per cent. milk fat deficient. 844 milk 55 per cent. extraneous water. 868 Cream (fresh) 0.21 per cent. Crystall ised Boric Acid 876 milk 25 per cent. milk fat deficient. 286 Report of the Medical Officer of Health. Table C—continued. Informal. Case No. Nature of sample. Nature of Report. 930 Milk 16 per cent. milk fat deficient. 931 Milk 10 per cent. milk fat deficient. 952 Milk 59 per cent. milk fat deficient. 953 Milk 38 per cent. milk fat deficient. The average composition, in regard to milk fat and solids-notfat. of the milk samples (exclusive of adulterated samples) submitted during each fortnight of the year was as follows :— Milk Fat. Solids-not-fat. Milk Fat. Solids-not-fat. 1 3.5° 8.88 14 3.41 8.94 2 3.46 8.79 15 3.84 8.68 3 3.50 8.86 16 3.54 8.82 4 3.35 8.85 17 3.53 8.82 5 3.36 8.95 18 4.04 8.71 6 3.33 8.88 19 3.62 8.74 7 3.31 8.79 20 3.59 8.76 8 3.49 8.83 21 3.68 8.86 9 3.42 8.84 22 3.78 8.94 10 3.44 8.84 23 3.64 8.90 11 3.56 8.90 24 3.85 8.96 12 3.34 8.84 25 3.63 8.94 13 3.47 8.85 26 3.58 8.83 The Chart here inserted presents in a graphic form this variation in average composition. Report of the Med1cal Off1cer of Health. 287 For the whole year the average composit1on proved to be— milk fat 3.55 per cent. Solids-not-fat 8.80 per cent. Butter. Extent of the adulteration reported 584 samples of Butter were submitted during the year, of which 44 were taken with the necessary formalities, whilst 540 were procured informally. The total number reported as adulterated, or not up to standard, amounted to 74, or 12.6 per cent. The greatest percentage adulteration occurred in the case of the formal samples, where it amounted to 38.6 per cent., as against 10.5 per cent. for the informal samples. The h1gh percentage in the case of the formal samples, as explained last year, is again due to the fact that formal samples were taken in most instances only when informal sampling showed that systematic adulteration was being practised. The heavy fall in the percentage of adulterated informal samples—10.5 per cent., as compared with last year's result of 237 per cent.—appears to show that adulteration of butter in the Borough is far less prevalent than was the case in 1912, and that regular inspect1on, by the aid, in the first instance, of informal sampling, has acted as a strong deterrent to the dishonest practice of the fraudulent trader. Nature of the adulteration reported. The nature of the adulteration reported showed that in 40 instances margarine was wholly substituted for butter; in 16 instances mixtures of butter and margarine, in varying amounts, were sold; in 14 instances the butter sold contained an excess of boron preservative; and in four instances an excess of water. Full deta1ls 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 453 (or 77.5 Per cent.) of the samples submitted. with the exception of the 14 cases mentioned above, th is was present in quantities not exceeding 0.5 per cent. (equivalent to 35 grains per lb.) expressed in terms of Crystall ised Boric Acid, the actual amounts and the times of their occurrence being given in Table E. 288 Report of the Medical Officer of Health. Table D. Table showing in detail the nature of the adulteration of all amples of Butter, adversely reported on during the year. Formal. Case No. Nature of Report. 10 92 per cent. Margarie. 43 92 ,, ,, 131 100 „ „ 132 100 „ ,, 133 100 „ „ 134 65 ,, ,, 135 100 „ „ 136 100 „ „ 137 100 ,, ,, 257 96 ,, ,, 258 96 ,, ,, 324 50 ,, ,, 454 98 ,, ,, 455 95 ,, ,, 604 98 ,, ,, 606 98 ,, ,, 607 5.8 per cent. excess water over legal standard of 16 per cent. Informal. Case No. Nature of Report. 618 54 per cent. Margarine 621 92 ,, ,, 630 0.08 per cent. excess Boric Acid over sug ested standard of 0.5 per cent. Report of the Medical Officer of Health. 289 Table D—continued. Case No. Nature of Report. 631 92 per cent. Margarine. 632 42 ,, ,, 641 92 ,, ,, 678 0.13 per cent, excess Boric Acid over suggested standard of 0.5 per cent. 68l 95 per cent. Margarine. 692 95 ,, ,, 693 93 ,, ,, 698 66 ,, ,, 762 91 ,, ,, 766 0.36 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 768 25 per cent. Margarine. 772 0.04 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 774 0.09 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 778 0.09 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 779 0.07 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 780 95 per cent. Margarine. 784 62 „ „ 789 100 „ „ 791 25 ,, ,, 792 63 ,, ,, 839 96 ,, ,, 863 98 875 96 ,, ,, 897 93 ,, ,, 910 98 ,, ,, 939 96 ,, ,, 962 0.05 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 290 Report of the Medical Officer of Health. Table D—continued. Case No. Nature of Report. 966 100 per cent. Margarine. 980 100 ,, ,, 986 50 ,, ,, 990 99 ,, ,, 992 50 ,, ,, 1095 94 ,, ,, 1119 98 ,, ,, 1122 0.12 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 1136 0.12 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 1190 0.05 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 1208 3.67 per cent. excess water over legal standard of 16 per cent. 1210 0.05 percent. excess Boric Acid over suggested standard of 0.5 per cent. 1213 98 per cent. Margarine. 1225 4.71 per cent. excess water over legal standard of 16 per cent. 1228 95 per cent. Margarine. 1247 5-7 per cent. excess water over legal standard of 16 per cent. 1250 100 per cent. Margarine. 1286 0.04 per cent, excess Boric Acid over suggested standard of 0.5 per cent. 1349 30 per cent. Margarine. 1368 30 ,, ,, 1470 100 ,, ,, 1492 23 ,, ,, 1507 100 ,, ,, 1517 50 ,, ,, 1532 0.09 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 1541 93 per cent. Margarine. 1548 65 ,, ,, Report of the Medical Officer of Health. 291 Table E. Giving in detail particulars relating to the presence or absence of a boron preservative in the 584 samples of Butter submitted during the year. Number of samples free from preservative 138 Number of samples containing 0.05 per cent. or less (in terms of Boric Acid H3BO3) 21 Number of samples containing 0.10 per cent. or less, but more than 0.05 60 Number of samples containing 0.5 per cent. or less, but more than 0.10 39 Number of samples containing 0.20 per cent. or less, but more than 0.15 61 Number of samples containing 0.25 per cent. or less, but more than 0.20 55 Number of samples containing 0.30 per cent. or less, but more than 0.25 38 Number of samples containing 0.35 per cent. or less, but more than 0.30 33 Number of samples containing 0.40 per cent. or less, but more than 0.35 41 Number of samples containing 0.45 per cent. or less, but more than 0.40 50 Number of samples containing 0.50 per cent. or less, but more than 0.45 34 Over 0.50 per cent 14 584 The average content of Boron preservative, (in terms of Crystallised Boric Acid), contained in the 374 samples of Batter, (reported as genuine), which contained th is preservative amounted to 0.25 per cent., equivalent to 17.5 grains per lb. Butter. 292 Report of the Medical Officer of Health. Articles other than Milk, Cream and Butter. Extent of the adulteration reported. Of the samples submitted other than milk, cream, and butter the number amounted to 408, 27 of which were taken with the necessary formalities, whilst 381 were procured informally. The total number reported as adulterated, or not up to standard, amounted to 32, (or 7.8 per cent.), 9 cases, (or 33.3 per cent.), occurring in the formal samples, and 23, (or 6.0 per cent.) in the informal. The number and variety of the articles grouped under this heading are shown in the Main Statement, 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. Margarine. Included under the heading "Margarine" are to be found 23 informal samples, Twenty of these formed the subject of a special report to the Medical Officer, and this report is here appended. 28th April, 1913. The Medical Officer of Health, Metropolitan Borough of Wandsworth. Dear Sir, During the present month the Inspector has submitted for analysis 20 informal samples of Margarine, and for the information of the Public Health Committee I append the result of analyses of these samples to my usual fortnightly report. Report of the Medical Officer of Health. 293 Table A. No. of Sample. Price per lb. Fat. Water. Solidsnot-fat. Salt. Boron preservative as boric Acid. 850 6d. 88.18 8.38 3.44 1.96 0.12 851 6d. 85.98 12.22 1.80 0.74 0.33 852 6d. 85.10 12.06 2.84 1.45 0.24 853 6d. 82.98 I3.40 3.62 2.03 0.39 854 6d. 82.91 14.20 2.89 1.54 0.22 855 8d. 85.01 12.30 2.69 1.35 0.l8 856 8d. 85.89 11.80 2.31 1.02 0.32 857 10d. 84.98 12.69 2.33 1.27 0.32 858 6d. 83.51 12.61 3.88 2.46 Nil. 859 6d. 86.46 9.94 3.60 2.51 Nil. 860 6d. 84.53 12.81 2.66 1.38 0.29 881 10d. 87.37 8.82 3.81 1.71 0.20 882 8d. 82.25 13.65 4.10 1.52 o.34 883 6d. 87.90 9.92 2.18 1.08 0.06 884 8d. 82.62 14.18 3.20 1.39 0.18 885 6d. 82.99 13.62 3.39 1.59 0.18 886 6d. 83.47 14.21 2.32 1.23 0.31 887 6d. 82.80 14.14 3.06 1.10 0.27 888 8d. 81 .55 14.48 3.97 1.52 0.27 889 8d. 83.77 12.95 3.28 1.52 0.06 294 Report of the Medical Officer of Health. Table B. No. of Sample. ReichertWoliny Value Polenske Value. Kirsehner Value. Percentage of Butter Fat. 850 1.43 1.4 0.45 Nil. 851 7.09 9.8 1.35 1 per cent.—2 per cent. 852 4.62 6.4 0.9 Nil. 853 1.04 1.1 0.5 Nil. 854 3.90 4.1 1.00 1 per cent.—2 per cent. 855 5.50 7.7 1.3 1 per cent.—2 per cent. 856 5.61 8.4 1.3 1 per cent.—2 per cent. 857 4.29 6.2 0.9 Nil. 858 0.22 0.6 - Nil. 859 0.33 0.6 - Nil. 860 5.06 6.2 1.25 1 per cent.—2 per cent. 881 1.1 0.6 - 1 per cent.—2 per cent. 882 4.95 4.1 2.15 5 per cent.—7 per cent. 883 7.04 11.3 1.8 1 per cent.—2 per cent. 884 5.28 4.0 2.1 5 per cent.—7 per cent. 885 4.95 6.5 1.1 1 per cent.—2 per cent. 886 4.29 5.1 1.0 1 per cent.—2 per cent. 887 4.40 5.6 1.1 1 per cent.—2 per cent. 888 1.76 1.5 0.6 Nil. 889 0.11 0.6 - Nil. Before I proceed to comment upon the figures given in the two Tables "A" and "B" the following general remarks upon margarine may prove of service to the Committee when they come to consider the figures of each sample in detail. Under the Sale of Food and Drugs Acts, 1875 to 1907, margarine is defined as "any article of food, whether mixed with butter or not, which resembles butter and is not milk-lended butter." It is, under the same Acts, required to contain not more than 16 per cent, of water, and the fat must not contain more than 10 per cent, butter fat. No official limitation is fixed for the nature Report of the Medical Officer of Health. 295 or amount of preservative permitted to be employed, but the recommendation of the Departmental Committee on Food Preservatives, 1899, namely, "that the only Preservative permitted to be used in butter and margarine be boric acid, or mixture of boric acid and borax, to be used in proportions not exceeding 0.5 per cent., expressed as boric acid," has met with general acceptance, and is the standard adopted by the Public Analyst in forming a judgment as to the "genuineness" of samples in this respect. In regard to the choice of the fats and oils employed in the making of margarine, the manufacturer has only one official limitation (referred to above) imposed upon him, namely, that the fat of the finished article must not contain more than 10 per cent, butter fat. The fats and oils usually employed are of both animal and vegetable origin, their nature and proportion employed at any one time depending to a large extent on market conditions. Among the animal fats used at the present moment may be mentioned neutral lard and "oleo" oil; and of the vegetable fats, coconut and palm kernel oils, cotton-seed oil, sesame oil, earth-nut oil, and soya-bean oil. The following brief description affords a rough sketch of the processes involved in the manufacture of margarine. At the commencement of operations a suitable quantity of separated milk is pasteurised, and then inoculated with a souring culture in receptacles termed "souring tanks" This souring culture is usually prepared in the bacteriological laboratory with great care, since the "buttery" flavour of the finished article is dependent on this. After ripening, the milk thus prepared is mixed with the desired proportions of animal and vegetable fats and the whole churned, and small proportions of casein and milk sugar—to provide the "curd "—are also added. Further processes convert the mixture into a solidified mass, when it is removed in wooden wagons to the fermenting rooms where the excess of water is allowed to drain off and the souring culture in the milk allowed to develop and flavour the whole preparation. When sufficiently "ripened" the mass is passed to the kneading machines, where it loses all exces; of moisture and 296 Report of the Medical Officer of Health. becomes homogeneous. At this stage salt and colouring matter are also added, and the kneaded mass becomes the margarine of commerce. Since the production of a satisfactory article is dependent largely on bacteriological processes, it will be apparent that the manufacturer must not only bestow great care and skilful attention on each operation, but must, to obtain a satisfactory issue of the fermentation stages, insist on scrupulous cleanliness throughout the factory, in order that the danger of the introduction of foreign bacteria may be suitably guarded against. Returning now to the two tables "A" and "B," it will be found that Table "A" gives the retail price and general composition of each sample as regards fat, solids-not-fat, and water. It also shows the proportion of salt and boron preservative (if any) present; whilst Table "B" gives certain values yielded by the fats, and affords the necessary data in arriving at an opinion as to the percentage of contained butter fat in each sample. From the results given, it will be seen that every sample complies with official requirements in regard to water and butter fat, and in no instance does the proportion of boron preservative (when present) reach the suggested limit of 0.5 per cent. For these reasons all the samples are, therefore, classed as "genuine." The flavour of the margarines may be described as generally good, and in the great majority of instances it would be difficult for the "layman" to differentiate by taste between most of these samples and genuine butter. My examination will, therefore, be seen to confirm the now generally accepted opinion that margarine furnishes a fatty food of high value, and provides an excellent substitute for butter in cases where the higher price of the latter precludes its use ; provided always that the sale of margarine is conducted with the formalities legally required. I am, clear Sir, Yours faithfully, A. H. M. MUTER, f.i.c., ex.s. Report of the Medical Officer of Health. 297 The examination of samples of Self-raising Flour and Baking Powder for the presence of Calcium Sulphate. Continuing the practice of the two preceding years, samples of Self-raising Flour and Baking Powder were again submitted for examination, more especially with reference to the presence or absence of Calcium Sulphate. It is satisfactory to record that no exception in this respect could be taken to any one of the samples of Self-raising Flour, and that of the Baking Powders two only, (one formal and one informal sample, both drawn from the same source), contained this impurity in excess of the limit recommended as permissible. Bice. Fourteen samples of Rice were submitted during the year. Of these 10 were found to be "faced," but in no case was the suggested limit of 0.5 per cent. of extraneous mineral matter exceeded. The average contents in the 10 samples proved to be 0.33 per cent. the quantities ranging from 0.20 per cent. in the lowest to 0.45 per cent. in the highest. Vinegar. Thirty-two samples of Vinegar in all were examined and reported on. Eighteen of these were found to possess an acid strength of less than 4 per cent. of acetic acid, the deficiency in this respect varying from 43 per cent. to 5 per cent. of the above-mentioned standard. Dried Fruits. Eighteen samples of Dried Fruits, (Raisins, Currants and Sultanas), and 6 samples of Candied Fruits were specially submitted and examined as to the possibility of contamination with traces of arsenic and copper; but in no instance was such contamination detected. Drugs. The total number of Drugs submitted during the year amounted to 77, a marked increase in numbers over previous years. The 77 samples, (described in detail in Table B), represented 22 varieties, of which four only presented cases of adulteration or departure from standard. Complete details concerning these latter samples are given in Table F. 298 Report of the Medical Officer of Health. Table F. Formal. Case No. Nature of sample. Nature of Report. 1 Vinegar 35 per cent. deficient in Acetic Acid. 2 Vinegar 31 per cent. deficient in Acetic Acid. 3 Vinegar 10 per cent. deficient in Acetic Acid. 33 Vinegar 31 per cent. deficient in Acetic Acid. 34 Vinegar 43 per cent. deficient in Acetic Acid 355 Saffron 11.2 per cent. extraneous mineral matter 456 Vinegar 26 per cent. deficient in Acetic Acid. 457 Vinegar 20 per cent. deficient in Acetic Acid. 511 Baking Powder 25.7 per cent. Calcium Sulphate. Informal. 606 Vinegar 41 per cent. deficient in Acetic Acid. 607 Vinegar 5 per cent. deficient in Acetic Acid. 608 Vinegar 10 per cent. deficient in Acetic Acid. 609 Vinegar 10 per cent. deficient in Acetic Acid. 610 Vinegar 28 per cent. deficient in Acetic Acid. 612 Vinegar 10 per cent. deficient in Acetic Acid. 614 Vinegar 5 per cent. deficient in Acetic Acid. 615 Vinegar 10 per cent. deficient in Acetic Acid. 749 Ground Rice 5 per cent. Maize Starch. 750 Ground Rice 5 per cent. Maize Starch. 970 Crushed Linseed 76 per cent. deficient in fixed oil. 995 Vinegar 20 per cent. deficient in Acetic Acid. 1017 Saffron 11 per cent. extraneous mineral matter. 1110 Vinegar 19 per cent. deficient in Acetic Acid. 1112 Vinegar 19 per cent. deficient in Acetic Acid. 1150 Baking Powder 25.7 per cent. Calcium Sulphate. 1442 Tincture of Iodine 40.8 per cent. excess Iodine. 1446 Epsom Salts 0.23 per cent. Magnesium Chloride. 1519 Non-alcoholic Wine 0.03 per cent. Salicylic Acid. 1520 Non-alcoholic Wine 0.03 per cent. Salicylic Acid. 1521 Non-alcoholic Wine 0. 04 per cent. Salicylic Acid. 1522 Non-alcoholic Wine 0.04 per cent. Salicylic Acid. 1523 Non-alcoholic Wine 0.04 per cent. Salicylic Acid. Report of the Medical Officer of Health. 299 In conclusion I have to report that the percentage adulteration for the year for all articles submitted amounted to 11.0 per cent., for articles submitted formally to 13.4 per cent., and for articles submitted informally to 8.8 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. 27th February, 1914. i"'-' •-■■■ APPENDIX. PARTICULARS OF DEATHS IN EACH OF THE SUB-DISTRICTS DURING THE YEAR 1913. 302 Report of the Medical Officer of Health. Borough of Wandsworth—Clapham Sub-District. Infant Mortality. 1913. Nett Deaths from stated causes at various Ages under 1 Year of Age. Causes 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 Deaths under 1 Year. All causes Certified 22 8 2 7 39 23 1.5 J7 13 107 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... 5 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... 1 ... ... 2 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... 1 ... ... ... 1 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... 2 ... ... 3 ... ... ... ... 3 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... 1 1 5 1 3 1 11 Pneumonia (all forms) ... 1 ... 1 2 2 2 4 5 15 Diarrhœa ... ... ... 1 1 3 5 3 ... 12 Enteritis ... ... ... ... ... 3 1 3 2 9 Gastritis ... ... ... ... ... 1 1 1 ... 3 Syphilis ... ... ... ... ... ... 1 ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations 2 1 ... ... 3 1 1 ... ... 5 Premature birth 16 3 1 20 1 ... 21 Atrophy,Debility and Marasmus ... 1 1 3 5 4 2 ... ... 11 Other causes 4 ... ... ... 4 2 ... 1 1 8 Totals 22 8 2 7 39 23 15 17 13 107 Nett Births in the year—legitimate, 1,249; illegitimate, 41. Nett Deaths in the year of—legitimate infants, 100 ; illegitimate infants, 7. 3°3 Report of the Medical Officer of Health. Borough of Wandsworth—Putney Sub-District. Infant Mortality. 1913. Nett Deaths from stated causes at various Ages under 1 Year of Age. Causes of Death. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3 -4 Weeks. Total under 4 Weeks. 4 Weeks and under3 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 12 2 3 1 18 4 4 5 11 42 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... 1 ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... 1 1 Erysipelas ... ... ... ... ... 1 ... ... ... 1 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... 1 ... 2 ... ... ... 1 3 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... 1 1 ... 1 ... 3 Pneumonia (all forms) ... ... 1 ... 1 ... ... 7 9 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... 1 2 1 1 5 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... 1 ... ... ... 1 Injury at birth ... ... ... 1 ... ... ... ... 1 Atelectasis 2 ... ... ... 2 ... ... ... ... 2 Congenital Malformations 1 ... ... 2 1 ... ... ... 4 Premature Birth 5 1 ... ... 6 ... ... ... ... 6 Atrophy, Debility and Marasmus ... ... ... ... ... ... 1 ... ... 1 Other causes 2 ... 1 ... 3 ... ... ... ... ... Totals 12 2 3 1 18 4 4 5 11 42 Nett Births in the year—legitimate, 466 ; illegitimate, 27 Nett Deaths in the year of—legitimate infants, 38 ; illegitimate infants, 4. 304 Report of the Medical Officer of Health. Borough of Wandsworth—Streatham Sub-District. Infant Mortality. 1913. Nett Deaths from slated 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 under 6 Months. 6 Months and under 9 Months 9 Months and under 12 Months Total Deaths under 1 Year.  All causes Certified 43 7 5 2 57 23 26 14 18 138 Uncertified 1 ... ... ... 1 ... ... ... ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... 1 1 ... ... ... 4 5 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... 1 ... ... 1 2 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ...... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... 1 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... 1 1 Meningitis (not Tuberculous). ... ... ... ... ... ... 1 1 ... 2 Convulsions 4 ... ... ... 4 1 3 ... ... 8 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 2 2 3 ... 7 Pneumonia (all forms) 1 ... ... ... 1 3 7 1 4 16 Diarrhœa ... ... ... ... ... 4 5 2 3 14 Enteritis ... ... 1 ... 1 5 5 2 2 15 Gastritis ... ... ... ... ... 2 ... ... ... 2 Syphilis ... ... ... ... ... ... ... 1 ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 1 ... ... ... 1 ... ... ... ... 1 Injury at birth 3 1 ... ... 4 ... ... ... ... 4 Atelectasis 2 ... 1 ... 3 ... ... ... ... 3 Congenital Malformations 6 1 ... 1 8 2 ... ... ... 10 Premature birth 19 4 1 ... 24 2 1 ... ... 27 Atrophy, Debility and Marasmus 7 ... 2 ... 9 1 2 1 ... 13 Other causes 1 1 ... ... 2 ... ... 3 2 7 Totals 44 7 5 2 58 23 26 14 18 139 Nett Births in the year—legitimate, 1,780 ; illegitimate, 85. Nett Deaths in the year of—legitimate infants, 122; illegitimate infants, 17. 305 Report of the Medical Officer of Health. Borough of Wandsworth—Tooting Sub-District. Infant Mortality. 1913. Nett Deaths from stated causes at various Ages under 1 Year of Age. Causes of Death. Under 1 Week. 1—a Weeks. 2—3 Weeks. 3 4 Weeks. Total under 4 week8. 4 Weeks and under3 Months. 3 Months and under 6 Months. 6 Months and underoMonths. 9 Months and under 12 Months. Total Deaths under 1 Year. All causes Certified 20 5 3 3 31 20 21 12 11 95 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 2 2 ... 4 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... 1 ... ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 2 ... 2 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) 1 ... 1 ... 2 1 1 ... 1 5 Convulsions 2 ... ... ... 2 ... ... ... 1 3 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 4 1 1 2 8 Pneumonia (all forms) ... ... ... ... ... ... 2 2 2 6 Diarrhœa ... ... ... ... ... 6 ... 1 2 9 Enteritis ... ... ... 1 1 5 ... 4 2 20 Gastritis ... ... ... ... ... 1 ... ... ... 1 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... ... 2 ... ... ... ... 2 Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations ... 1 ... ... 1 ... ... ... ... 1 Premature birth 10 4 ... 1 15 ... ... ... ... 15 Atrophy, Debility and Marasmus 5 ... 2 1 8 3 5 ... 1 17 Other causes ... ... ... ... ... ... 1 ... ... 1 Totals 20 5 3 3 31 20 21 12 11 9 Nett Births in the year—legitimate, 994; illegitimate, 43. Nett Deaths in the year of—legitimate infants, 81; illegitimate infants, 14. 306 Report of the Medical Officer of Health. Borough of Wandsworth—Southfield Sub-District Infant Mortality. 1913. Nett Deaths from stated causes at various Ages under 1 Year of Age. Causes of Death, Under 1 Week. 1—2 Weeks. 2-3 Weeks. Weeks. Total under 4 Weeks. 1 4 Weeks and under 3 Months 3 Months and under6 Months 6 Months and under 9 Months 9 Months and unaer 12 Months Total Deaths under 1 Year. All causes Certified 25 7 6 2 40 14 24 ii 14 103 Uncertified ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 3 3 Scarlet Fever ... ... ... ... ... ... 1 ... ... Whooping-cough ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... 1 ... ... 1 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 3 ... ... 4 Pneumonia (all forms) ... ... ... ... ... 3 3 3 4 13 Diarrhœa ... ... ... ... ... 2 8 2 ... 12 Enteritis ... ... 1 ... ... 2 4 3 1 12 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... 1 2 ... ... 4 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 4 1 ... ... 5 ... ... ... ... 5 Congenital Malformations 1 1 ... ... 2 2 ... ... 3 5 Premature birth 11 3 2 ... 16 ... 1 ... ... 17 Atrophy, Debility and Marasmus 6 2 3 1 12 1 3 ... 1 17 Other causes 2 ... ... ... 2 1 ... 2 2 7 T otals 25 7 6 2 40 4 24 11 14 103 Nett Births in the year—legitimate, 1,170 ; illegitimate, 39. Nett Deaths in the year of—legitimate infants, 98 ; illegitimate infants, 5. 3o; keport of the Medical Officer of Health. Borough of Wandsworth—Springfield Sub-District Infant Mortality 1913. Nett Deaths from stated causes at various Ages under 1 Year of Age. Causes 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 27 6 4 5 42 27 20 19 11 119 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 1 2 2 5 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... 2 ... 2 2 6 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 2 1 ... ... 3 1 1 2 ... 7 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 2 1 3 4 1 2 3 13 Pneumonia (all forms) ... ... 1 1 2 4 4 4 2 16 Diarrhœa ... 1 ... ... 1 1 1 1 ... 4 Enteritis ... ... 1 ... 1 9 5 4 1 20 Gastritis ... ... ... ... ... 2 ... ... ... 2 Syphilis ... ... ... ... 1 ... ... ... ... 1 Rickets ... ... ... ... ... ... ... 1 ... 1 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... 1 ... ... ... ... 1 Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations 3 1 ... ... 4 ... ... ... ... 4 Premature birth 14 1 ... 1 16 ... 1 ... ... 17 Atrophy,Debility and Marasmus 6 2 ... ... 8 1 4 1 ... 14 Other causes 1 ... ... 1 2 3 2 ... 1 8 Totals 27 6 4 5 42 27 20 19 11 119 Nett Births in the year—legitimate, 896; illegitimate, 48 Nett Deaths in the year of—legitimate infants, 105; illegitimate infants, 14. 308 Report of the Medical Officer of Health. CLAPHAM, 1913. 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 19 11 8 5 5 6 3 ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cougli 3 3 ... 2 1 ... ... ... ... ... ... ... Diphtheria & Membranous Croup 3 2 1 ... 1 1 1 ... ... ... ... ... Influenza 12 8 4 ... ... ... ... ... ... 2 ... ... Erysipelas ... ... ... ... ... ... ... ... 4 ... 4 1 Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 58 38 20 1 ... 1 1 ... ... ... ... ... Tuberculous Meningitis 5 3 2 ... ... 3 ... ... 29 17 3 23 Abdominal Tuberculosis 1 ... 1 ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases 8 5 3 ... ... ... 5 ... ... 1 ... ... Other Infective Diseases 2 2 ... 1 ... ... ... ... ... ... ... ... Cancer, Malignant Disease 64 24 40 ... ... ... ... ... ... ... 22 ... Rheumatic Fever 1 ... 1 ... ... ... 1 ... 9 33 22 44 Diabetes 9 5 4 ... ... ... ... ... 2 6 1 1 Other General Diseases 10 3 7 ... ... ... 2 ... ... ... ... 1 Alcoholism 2 ... 1 ... ... ... ... ... ... 4 4 ... Chronic Poisonings ... ... ... ... ... ... ... ... ... 1 1 ... Meningitis 2 ... 2 ... 1 1 ... ... ... ... ... ... Cerebral Haemorrhage, Apoplexy 32 13 19 ... ... ... ... ... ... ... ... ... Convulsions 4 3 1 3 1 ... ... ... 4 12 16 5 Other Diseases of Nervous System 19 9 10 1 ... 1 ... 3 4 6 4 3 Organic Diseases of Heart 66 33 33 ... ... ... 1 2 11 21 31 2 Other Diseases of Circulatory System 22 9 13 ... ... ... 1 2 1 9 8 4 Bronchitis. 50 21 29 11 3 1 ... ... ... 9 26 5 Broncho-Pneumonia 31 19 12 13 3 1 ... ... 2 6 6 ... Lobar Pneumonia 6 5 1 1 1 10 Pneumonia (type not distin. guished) 30 19 11 1 ... 2 9 ... 8 12 ... ... Other Diseases of Respiratory System 8 7 4 4 1 ... ... ... ... ... 12 5 6 Ulcer of Stomach 5 2 3 ... ... ... ... ... ... ... ... ... Diarrhoea 12 8 4 12 ... ... ... ... ... ... ... ... Enteritis 11 8 3 9 1 ... ... ... 1 2 ... 2 Appendicitis and Typhlitis 5 3 2 ... ... ... ... ... 1 2 ... 2 Obstruction of Intestines 8 2 6 ... ... ... ... ... ... ... ... Cirrhosis of Liver 8 3 5 ... ... ... ... ... 1 4 3 ... Other Diseases of Liver 6 4 2 ... ... ... ... ... ... 5 2 ... Other Diseases of Digestive System 10 6 4 3 ... ... ... ... 3 ... ... ... Nephritis and Bright's Disease 26 18 8 ... ... ... ... ... 3 3 1 ... Other Diseases of Urinary System 2 1 1 ... ... ... ... ... ... 13 11 3 Diseases of Generative System 1 ... 1 ... ... ... ... 1 ... ... ... ... Puerperal Fever 3 ... 3 ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 3 ... 3 ... ... ... ... ... 3 ... ... ... Premature Birth 21 10 11 21 ... ... ...... ... ... ... ... ... Congenital Debility and Malformation 16 11 5 16 ... ... ... ... ... ... ... ... Other Diseases of Early Infancy 4 2 2 4 ... ... ... ... ... ... ... 1 Old Age 49 15 34 ... ... ... ... ... ... ... 49 ... Deaths from Accident 20 13 7 2 1 ... 2 1 6 Deaths from Suicide 6 3 3 ... ... ... ... ... 5 4 5 6 Other Violent Deaths 4 2 ... 1 Other defined Diseases 3 2 1 ... ... ... ... ... ... ... ... ... Ill-defined Diseases or unknown ... ... ... ... ... ... ... ... ... ... ... ... All causes 686 351 335 107 *9 19 23 21 103 182 212 111 3»9 Report of the Medical Officer of Health. 309 PUTNEY. 1913- Causes of Death. All Ages. Deaths in or belonging to Whole District at subjoined ages. Deaths in Public Institutions in the District. I 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. Enteric Fever Small-pox ... Measles 12 6 6 1 7 1 Scarlet Fever Whooping Cough 4 1 3 1 2 Diphtheria & Membranous Croup 1 1 1 1 Influenza ... 5 1 4 1 1 1 Erysipelas... 2 2 1 1 .... Cerebrospinal Fever ... Other Epidemic Diseases Pulmonary Tuberculosis 16 10 *6 6 2 Tuberculous Meningitis 6 3 3 1 3 Abdominal Tuberculosis 1 I ... Other Tuberculous Diseases ... 1 I 1 Other Infective Diseases 1 1 1 1 Cancer, Malignant Disease 38 *9 19 6 16 7 Rheumatic Fever Diabetes ... 4 2 2 4 1 Other General Diseases 3 1 2 1 3 Alcoholism 1 1 Chronic Poisonings ... Meningitis... Cerebral Haemorrhage, Apoplexy 16 7 9 1 9 1 Convulsions 3 2 3 Other Diseases of Nervous System IS 12 3 „ 8 4 3 Organic Diseases of Heart 12 5 7 1 5 6 2 Other Diseases of Circulatory System 11 3 8 1 3 6 3 Bronchitis... 26 14 12 3 1 1 2 7 12 1 Broncho-Pneumonia 18 11 7 7 3 1 1 5 1 Lobar Pneumonia 4 3 1 1 1 2 ... I Pneumonia (type not distinguished) ' 8 4 4 1 1 1 I 2 j 1 1 Other Diseases of Respiratory System 2 2 * Ulcer of Stomach 1 I 1 Diarrhoea... 2 1 1 x 1 Enteritis ... 9 6 5 2 1 1 1 Appendicitis and Typhlitis 3 1 2 1 3 Obstruction of Intestines 6 1 s 1 4 1 2 Cirrhosis of Liver ... 4 2 3 1 Other Diseases of Liver 4 1 3 4 1 Other Diseases of Digestive System 2 1 1 2 1 Nephritis and Blight's Disease 7 5 2 2 5 4 Other Diseases of Urinary System 3 3 2 I Diseases of Generative System 2 Puerperal Fever 2 2 2 Other Accidents and Diseases of Pregnancy and Childbirth 2 2 2 Premature Birth 6 6 6 Congenital Debility and Malformation 6 5 "i s 1 I Other Diseases of Early Infancy 3 2 1 3 Old Age 22 3 J9 Deaths from Accident 12 6 6 2 1 2 I 9 Deaths from Suicide... 5 3 2 1 4 Other Violent Deaths # ... 1 1 Other defined Diseases * ... 3 2 1 1 2 Ill-defined Diseases or unknown 2 1 1 ::: 1 A causes ... 3i5 159 4= 18 10 11 5 36 84 109 62 310 Report of the Medical Officer oj Health, STREATHAM, 1913. 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 22 10 12 5 7 6 4 ... ... ... ... 1 Scarlet Fever 5 3 2 1 ... 3 ... 1 ... ... ... Whooping Cough 5 1 4 2 2 1 ... ... ... ... ... ... Diphtheria & MembranousCroup 5 1 4 ... 1 1 3 ... ... ... ... ... Influenza 21 8 13 1 ... ... ... ... 2 8 10 3 Erysipelas 2 2 ... ... ... ... ... ... 1 1 ... 1 Cerebro-spinal Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 78 35 43 ... ... 1 ... 11 34 28 4 7 Tuberculous Meningitis 4 4 ... 1 2 ... ... 1 ... ... ... ... Abdominal Tuberculosis 1 1 ... ... ... ... ... 1 ... ... ... ... Other Tuberculous Diseases 4 2 2 1 ... ... ... ... 2 1 ... ... Other Infective Diseases 4 1 3 1 ... 1 ... ... 1 ... 1 1 Cancer, Malignant Disease 121 42 79 ... ... ... ... 1 14 44 62 9 Rheumatic Fever 6 5 1 ... ... ... 1 2 1 2 ... ... Diabetes 14 6 8 ... ... ... ... ... 2 8 4 1 Other General Diseases 15 6 9 2 ... ... ... 2 1 3 7 2 Alcoholism 4 2 2 ... ... ... ... ... 2 2 ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 9 6 3 2 1 1 ... ... 3 2 ... ... Cerebral Haemorrhage,Apoplexy 72 35 37 ... ... ... 1 1 3 22 45 5 Convulsions 11 5 6 8 2 ... 1 ... ... ... ... 1 Other Diseases of Nervous System 47 27 20 ... ... ... ... 1 13 17 16 8 Organic Diseases of Heart 94 30 64 ... ... ... 2 1 15 32 44 13 Other Diseases of Circulatory System 37 17 20 ... ... ... 1 1 1 10 22 1 Bronchitis 75 35 40 7 1 1 ... 1 4 12 49 7 Broncho-Pneumonia 35 12 23 10 6 2 1 ... 5 3 8 3 Lobar Pneumonia 14 7 7 1 1 1 ... ... 1 7 3 1 Pneumonia (type not distinguished) 41 17 24 5 1 ... 2 1 9 11 12 5 Other Diseases of Respiratory System 13 8 5 1 1 ... ... ... 3 1 7 1 Ulcer of Stomach 7 2 5 ... ... ... ... ... 3 3 1 1 Diarrhœa 17 7 10 14 2 ... ... ... ... ... 1 ... Enteritis 18 15 3 15 3 ... ... ... ... ... ... 1 Appendicitis and Typhlitis 10 4 6 ... ... 1 1 3 2 2 1 ... Obstruction of Intestines 14 5 9 1 ... ... ... ... 2 4 7 6 Cirrhosis of Liver 7 5 2 ... ... ... ... ... ... 3 4 ... Other Diseases of Liver 4 1 3 ... ... ... 1 ... ... 2 1 ... Other Diseases of Digestive System 13 10 3 2 ... ... 2 ... 3 3 3 ... Nephritis and Bl ight's Disease 32 15 l7 ... ... ... ... j 6 11 14 1 Other Diseases of Urinary System 7 5 2 ... ... ... ... ... 1 1 5 1 Diseases oi Generative System 3 ... 3 ... ... ... ... ... 1 2 ... ... Puerperal Fever 3 ... 3 ... ... ... ... j... 2 ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 2 ... 2 ... ... ... ... 1 2 ... ... ... Premature Birth 27 11 16 27 ... ... ... ... ... ... ... i Congenital Debility and Malformation 23 13 10 23 ... ... ... ... ... ... ... ... Other Diseases of Early Infancy 8 5 3 8 ... ... ... ... ... ... ... 1 Old Age 68 21 47 ... ... ... ... ... ... ... 63 4 Deaths from Accident 30 17 13 2 ... 2 4 3 ... 7 5 9 Deaths from Suicide 10 3 7 ... ... ... ... 1 5 4 ... ... Other Violent Deaths ... ... ... ... ... ... ... ... ... ... ... ... Other defined Diseases 7 1 6 ... ... ... 1 ... 1 ... 5 ... Ill-defined Diseases or unknown 2 2 ... ... ... ... ... ... 1 1 ... ... All causes 1,072 470 602 139 31 18 23 33 157 257 409 95 311 Report of the Medical Officer of Health. 311 TOOTING. 1913. 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 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... Measles 26 12 14 4 9 9 3 ... ... 1 ... 34 Scarlet Fever 2 1 1 ... 1 1 ... ... ... ... ... 18 Whooping Cough 2 ... 2 1 1 ... ... ... ... ... ... 25 Diphtheria &Membranous Croup 5 1 4 ... ... 4 1 ... ... ... 2 Influenza 2 1 1 ... ... ... ... ... ... ... 1 35 Erysipelas 1 ... 1 ... ... ... ... ... ... ... ... 1 Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases 1 1 ... ... ... 1 ... ... ... ... ... ... Pulmonary Tuberculosis 26 14 12 ... ... 1 ... 7 ... 9 1 1 Tuberculous Meningitis 7 5 2 2 2 1 2 ... 8 ... ... 78 Abdominal Tuberculosis 1 1 ... ... ... ... ... ... ... 1 ... 1 Other Tuberculous Diseases 3 2 1 ... 1 ... 1 1 ... ... 1 1 Other Infective Diseases 5 3 2 ... ... ... 1 1 ... 3 ... 8 Cancer, Malignant Disease 25 14 11 ... ... 1 2 ... 3 11 9 3 Rheumatic Fever 1 ... 1 ... ... ... ... ... ... ... ... 12 Diabetes 3 2 1 ... ... ... ... ... 1 2 ... 1 Other General Diseases 3 ... 1 ... ... ... 1 ... 2 ... ... ... Alcoholism 1 ... 3 ... ... ... ... ... ... ... ... 1 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 5 3 2 9 ... ... ... ... ... ... ... ... Cerebral Haemorrhage, Apoplexy 13 4 9 5 ... ... 1 ... 1 ... ... 1 Convulsions 3 2 1 ... ... ... ... ... ... 3 8 10 Other Diseases of Nervous System 15 9 6 3 ... ... ... 1 6 ... ... 3 Organic Diseases of Heart 30 11 19 ... ... ... ... 2 4 4 3 11 Other Diseases of Circulatory System 8 3 5 ... ... ... 1 ... 4 1 2 12 43 Bronchitis 34 17 17 8 ... ... 1 ... 1 2 5 11 Broncho-Pneumonia 7 3 4 2 2 1 ... ... 2 3 18 10 Lobar Pneumonia 3 ... 3 ... ... 3 ... ... ... 1 ... 13 Pneumonia (type not distinguished) 19 8 4 ... 1 ... ... 1 ... ... 8 Other Diseases of Respiratory System 3 2 1 1 ... ... ... ... 4 2 4 41 Ulcer of Stomach 3 3 ... ... ... ... ... ... ... 1 ... 5 Diarrhœa 10 4 6 9 1 ... 1 ... 3 ... ... ... Enteritis 26 16 10 20 2 1 ... ... ... ... ... 1 Appendicitis and Typhlitis 1 1 ... ... ... ... 1 ... 1 1 1 3 Obstruction of Intestines 4 3 1 ... ... ... ... ... ... 2 ... ... Cirrhosis of Liver 1 ... 1 ... ... ... ... ... 1 ... 1 1 Other Diseases of Liver ... ... ... ... ... ... ... ... ... ... 1 3 Other Diseases ol Digestive System 4 2 2 1 ... ... ... ... ... ... ... ... JSephritis and BnVht's Disease 10 7 3 ... ... ... ... ... 1 1 1 ... Other Diseases of Urina'-y System 2 2 ... ... ... ... ... ... 2 3 3 6 Diseases of Generative System ... ... ... ... ... ... ... ... ... ... 1 1 Puerperal Fever 1 ... 1 ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 1 ... 1 ... ... ... ... ... 1 ... ... ... Premature Birth 15 12 3 ... ... ... ... ... 1 ... ... ... Congenital Debility and Mallormation 8 10 8 15 ... ... ... ... ... ... ... ... Other Diseases of Early Infancy 2 ... 2 18 ... ... ... ... ... ... ... 8 Old Age 26 11 15 ... ... ... ... ... ... ... 25 ... Deaths from Accident 5 3 2 ... ... ... ... ... ... 1 ... 215 Deaths from Suicide. 5 3 2 ... ... ... 1 ... 1 3 ... 2 Other Violent Deaths 5 3 2 ... ... ... ... ... 2 3 ... ... Other defined Diseases ... ... ... ... ... ... ... ...... ... ... 1 ...... Ill-defined Diseases or unknown 1 ... 1 ... ... ... ... ... ... ... ... ... All causes 389 199 190 95 20 29 17 15 46 70 97 611 312 312 Report of the Medical Officer of Health. WANDSWORTH. South field Ward. 19I3* Causes of Death. Deaths in or belonging to Whole District at subjoined ages. Deaths in Public I 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 2 2 1 1 2 Small-pox ... Measles 17 7 10 3 6 3 5 Scarlet Fever 1 1 1 Whooping Cough 1 1 1 Diphtheria & Membranous Croup 2 2 1 1 Influenza ... 12 5 7 1 1 1 5 4 Erysipelas... 1 1 1 Cerebro-spinal Fever Other Epidemic Diseases Pulmonary Tuberculosis 69 38 31 1 6 32 16 3 Tuberculous Meningitis 6 2 4 1 4 1 Abdominal Tuberculosis 4 2 2 1 1 2 Other Tuberculous Diseases ... 4 1 3 2 1 Other Infective Diseases 5 3 2 4 1 Cancer, Malignant Disease 72 30 42 1 4 39 2S Rheumatic Fever 3 1 2 2 1 Diabetes ... 5 2 3 1 1 3 1 Other General Diseases 7 5 2 1 1 1 1 3 4 Alcoholism 3 3 2 1 Chronic Poisonings ... Meningitis... 3 2 1 2 1 Cerebral Haemorrhage, Apoplexy 33 17 16 1 12 20 1 Convulsions 2 1 1 2 Other Diseases of Nervous System 17 6 11 2 1 2 2 10 6 Organic Diseases of Heart 63 27 36 2 4 ii 25 21 3 Other Diseases of Circulatory System • 25 15 10 3 1 3 9 9 Bronchitis 47 19 28 4 2 0 33 Broncho-Pneumonia... 17 7 10 9 2 1 2 1 2 Lobar Pneumonia ... 11 6 5 1 2 1 2 5 Pneumonia (type not distinguished) 23 T2 11 3 3 1 3 5 8 1 Other Diseases of Respiratory System 2 2 2 1 Ulcer of Stomach Diarrhoea ... 15 io 5 12 2 1 Enteritis ... 16 5 ii 12 2 I 1 Appendicitis and Typhlitis Obstruction of Intestines 4 7 3 3 4 1 3 1 1 1 4 Cirrhosis of Liver ... 4 4 1 3 Other Diseases of Liver 1 1 1 Other Diseases of Digestive System 9 6 3 j 1 1 5 1 Nephritis and Bright s Disease 19 11 8 2 1 s a Other Diseases of Urinary System 4 4 2 2 Diseases of Generative System 1 1 Puerperal Fever 4 4 1 3 V Other Accidents and Diseases of Pregnancy and Childbirth... 4 4 4 Premature Birth 17 8 9 17 Congenital Debility and Mallormation 23 14 9 22 1 Other Diseases of Early Infancy 8 4 4 8 Old Age 51 20 3i 51 Deaths from Accident 8 4 4 2 2 3 4 Deaths from Suicide 5 4 1 1 2 2 3 Other Violent Deaths 1 1 1 1 Other defined Diseases 5 4 i 4 Ill-defined Diseases or unknown 3 2 1 1 1 All causes ... 668 323 345 103 26 19 29 26 83 165 217 3* 313 Report of the Medical Officer of Health. 313 WANDSWORTH. Springfield Ward. *9*3. 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 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. Enteric Fever z 1 ... x 2 Small-pox ... ... ... j-- Measles 20 11 9 5 9 5 1 Scarlet Fever 3 3 2 1 Whooping Cough 8 4 4 *6 1 1 Diphtheria & Membranous Croup 2 1 1 1 1 Influenza ... 7 3 4 2 1 4 Erysipelas Cerebro-spinal Fever Other Epidemic Diseases ... Pulmonary Tuberculosis 42 26 16 1 9 12 17 3 Tuberculous Meningitis 6 3 3 3 2 ... Abdominal Tuberculosis 1 1 1 Other Tuberculous Diseases ... 3 3 1 2 Other Infective Diseases 4 3 1 2 1 1 1 Cancer, Malignant Disease 32 12 20 3 15 14 4 Rheumatic Fever 4 2 2 2 2 Diabetes ... 5 2 3 1 3 1 x Other General Diseases 4 3 1 1 1 1 1 Alcoholism 3 3 3 Chronic Poisonings ... ... Meningitis... 2 2 1 ... Cerebral Haemorrhage, Apoplexy '3 5 "8 11 x Convulsions 8 3 5 7 x Other Diseases of Nervous System 20 12 8 1 1 3 1 1 3 3 7 45 Organic Diseases of Heart 3* 14 x7 4 7 7 13 7 Other Diseases of Circulatory System 12 5 7 1 7 x 3 Bronchitis... 35 21 14 13 1 2 5 14 14 Broncho-Pneumonia... 24 10 14 5 7 x 3 Lobar Pneumonia 3 2 1 10 1 x i 1 Pneumonia (type not tinguished) 26 12 14 6 6 1 1 2 8 2 Other Diseases of Respiratory System 7 2 5 3 1 x 2 2 Ulcer of Stomach 3 1 2 1 1 x Diarrhoea ... 7 3 4 4 3 Enteritis ... 25 10 is 20 3 1 1 x Appendicitis and Typhlitis 3 2 1 3 i Obstruction of Intestines 2 2 1 1 Cirrhosis of Liver ... 2 1 1 i 1 Other Diseases of Liver 2 2 1 1 i Other Diseases of Digestive System 5 4 1 2 1 i x Nephritis and Blight's Disease 10 2 8 2 5 3 5 Other Diseases of Urinary System 3 2 1 2 1 1 Diseases of Generative System 1 1 x Puerperal Fever Other Accidents and Diseases of Pregnancy and Childbirth 2 2 2 1 Premature Birth 17 11 6 17 Congenital Debility and Malformation 19 7 12 18 1 2 Other Diseases of Early Infancy i 1 Old Age ... 21 ii 10 21 12 Deaths from Accident 5 3 2 1 3 x 2 Deaths from Suicide... 2 2 2 2 Other Violent Deaths Other defined Diseases j x 1 Ill-defined Diseases or unknown i 1 ... 1 i All causes... 458 226 23a 119 37 35 16 21 55 85 102 124 r. M-: v. ■ i -