WAN 61 Metropolitan Borough of Wandsworth. Annual Report on the health, Sanitary Condition, sc., OF THE BOROUGH. FOR THE YEAR 1914, by IP. CALDWELL SMITH, M.A., M.D., D.P.H., Camb., Medical Officer of Health, together with the Report of the Public Analyst. London: Printed for the Council by FREDERICK TARRANT & COMPANY, LIMITED, 108 & no, Camberwell Road, S.E. INDEX page Ages at Death 31 Analyst, Report of 241 Anthrax Orders 152 Appendicitis and Typhilitis 158 Bacteriological Examinations 80, 150 Bakehouses 206 Births 3 Births and Birth-rates in Sub-Districts 4 Births,.Notification of, Act 6 Birth-rate for the Year and for the previous Ten Years 4 Brain and Nervous System, Diseases of the 156 Canal Boats Act 222 Cancer 153 Census, 191 2 Cerebro-Spinal Fever 79 Circulatory Diseases 156 Clapham, House-to-House Inspections in 178,179 Clapham : Table of Causes of Death 264 Cleaning of Persons Ac 193 Conscientious Objection Certificates granted 49 Cowsheds 199 Cutting-off Notices 168 Death, Ages at 31 Death, Causes of 24, 29 Death-rate, Corrected 16 Death-rate, Corrected, for Age and Sex Distribution 18 Death-rate, Infantile 32 Death-rate for all Metropolitan Boroughs 19 Deaths, Corrected and Uncorrected 17 Deaths, Number of 8 Deaths, Percentage of, at six Age Periods 31 Deaths, Proportion of, from the Principal Causes to Total Deaths 165, 166 Deaths in Out-lying Institutions 15, 164 Deaths in Public Institutions 10, 163 ii. page Deaths in Public Institutions in the Borough of Persons belonging to the Borough 13 Deaths in Public Institutions in the Borough of Persons not belonging to the Borough 11 Deaths in Public Institutions, Percentage of, to Total Deaths, 1893-1913 166 Developmental Diseases 159 , Diarrhoea 94 Diarrhoea, Death-rate from 94 Diarrhoea and Enteritis, Number of Deaths under One Year for each Quarter of the Year, both for 1914 and Five Years previous 95 Diarrhoea, Method of Feeding Children who died from 96 Diphtheria 62 Diphtheria and Schools 67 Diphtheria, Cases of, and their Relationship to Schools in the Borough 68 Diphtheria, Number of Cases and Deaths, 1904-1914 65 Diphtheria, Number of Dwellings in which multiple Cases occurred 71 Diphtheria, " Return Cases" of 192 Disinfection of Schools 92 Enteric Fever 77 Enteric Fever and Shell-fish 78 Erysipelas 82 Exclusion of Children from Schools in the Borough 88, 89 Factories and Workshops 204 Factories, Workshops and Workplaces, Inspection of 206 Factories and Workshops, Summary of Work of Female Inspectors 217 Factories and Workshops, Summary of Work of Male Inspectors 213 Feeding of Infants, Report of Female Inspectors on 101 Food Places, Inspection of 195 Glanders and Anthrax Orders 152 Home Work 209 House Refuse, Removal of 196 House-to-house Inspections 178-187 House-to-house Inspections, Summary of 187 Houses and Premises Inspected 174 iii. page Houses Let in Lodgings 203 Housing, Town Planning, etc., Act, 1909 172 Ice Cream Premises 203 Illegitimate Children, Births of 5 Infant Visiting 101 Infantile Mortality 30, 32 Infantile Mortality from Stated Causes 30 Infantile Mortality, Rate per 1,000 births from five groups of diseases 37 Infective Diseases, Deaths from 39 Infective Diseases, Deaths in External and Internal Institutions 40, 41 Infective Diseases, Death-rate from 40, 42 Infective Diseases, Death-rate per 1,000 for Five Years and 1914 151 Infective Diseases, Death-rate per 1,000, 1904-1914 42 Infective Diseases : Number of Cases Notified 28, 42 Infective Diseases : Number of Notifications received, 1904-1914 43 Infective Diseases : Number of Cases notified from Elementary Schools 85 Infective Diseases : Number of Cases notified from Public Institutions 48 Infective Diseases : Number of Deaths, 1904-1914 39 Influenza 93 Inspections, details of 175, 176 Institutions, Internal and External 164 Inquests 160 Knacker's Yard 202 Legitimate Birth-rate 5 Margarine Act, Proceedings under 226 Measles 83 Measles and other Non-notifiable Diseases reported from Schools 85 Milk and Cream Regulations, 1912 233 Milk Premises, Cowsheds, etc., on Register 197 Milkshops 199 Military Billets 222 Mistaken Diagnosis, Cases of 78 Mortuaries 169 Natural Increase, Rate of 4 Nervous System, Diseases of the 156 iv. page Non-Infective Diseases 153 Notification of Births Act 6 Notification of Infective Diseases 42 Offensive Trades 202 Offensive Trade Refuse 203 Old Age 159 Ophthalmia Neonatorum 152 Other Infective Diseases 150 Outworkers 209 Overcrowding 188 Police Court Proceedings 195 Polio-Myelitis 151 Population 1 Population of Sub-Districts 2 Population of Wards 2 Premature Birth 159 Public Institutions, Percentage of Deaths to total Deaths, 1893-1913 166 Puerperal Fever 81 Pulmonary Tuberculosis, Deaths and Death-rates, 1904- 1914 109 Pulmonary Tuberculosis, Deaths in Public Institutions, 1904-1914 149 Pulmonary Tuberculosis, Notification of Cases of 116-133 Pulmonary Tuberculosis, previous occupation of persons who died from 110 Putney, House-to-house Inspections in 180 Putney, Table of Causes of Death 265 Rag Flock Act, 1911, Statement of work done under 222 Rated Hereditaments 2 Refugees' Homes 222 Report of Tuberculosis Officer 135 Respiratory Diseases 157 Return Cases of Scarlet Fever and Diphtheria 73 Revenue Act 171 Sale of Food and Drugs Acts, Proceedings under 224-227 Sale of Food and Drugs Acts, Statment of Work under 223 Sanitary Operations, Table of 174 Sanitary Work, General 169 Scarlet Fever 53 Scarlet Fever and Schools 55- 58 v. page Scarlet Fever, Annu.il Rate of Notified cases, 1911-1914 54 Scarlet Fever, Number of Dwellings in which Multiple Cases occurred 60 Scarlet Fever, " Return Cases" of 73 Schools, Disinfection of, for Infective Diseases 92 Schools, other diseases notified from 92 Shelters 198 Slaughter-houses 200 Small-pox 44 Smoke Nuisances 191 Special Inspections 169 Staff, Members of, on Military Service 239 Streatham, House-to-house Inspections in 181, 182' Streatham : Table of Causes of Death 266 Tooting, House-to-house Inspections in 183 Tooting: Table of Causes of Death 267 Tuberculin treatment 148 Tuberculosis Dispensaries 133 Tuberculous Diseases 107 Tuberculosis Officer, Report of 135 Underground Rooms 172 Unsound Food 204 Urinals in Connection with Licensed Premises, Inspection of 194 Vaccination Returns 49 Violence, Mortality from 160 Vital Statistics of Whole Borough 23,27 Wandsworth, House-to-house Inspections in 184-186 Wandsworth : Table of Causes of Death 268,269 Water Supply, Cutting-off Notices 168 Whooping Cough 90 Workshops, Summary of Principal Trades carried on 215, 221 Zymotic Diseases, Deaths from 39 Zymotic Diseases, Deaths in External and Internal Institutions 40, 41 Zymotic Diseases, Death-rate from 40, 42 Zymotic Diseases, Death-rate per 1,000 for Five Years and 1914 151 Zymotic Diseases, Death-rate per 1,000, 1904-1914 42 REPORT of the Medical Officer of Health for the Year 1914. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Wandsworth. Sir and Gentlehen, I have the honour to present the Annual Report on the health and sanitary condition of the Borough for the year 1914. Population. The population of the Borough to the middle of 1914 has been estimated by the Registrar-General to be 338,998, but in mv 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 1914 was only 521 and 917 in 1913, so 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 1914, 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, 1912-13, and 1913-14. 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, 1914. Three Years' Natural Increase, Estimated!] Population! 1914. Clapham, North 28,871 5,704 5.06 5.836 771 30,314 ,, South 29,721 6,829 4.35 6.973 933 31,278 Putney 28,242 6,119 4.6i 6,207 502 29,129 Streatham 49,191 11,756 4.18 12,455 1,257 53,345 Balham 47,001 10,333 4.55 10,804 1,224 50,459 Tooting 35,958 7,410 4.85 7.796 1,803 39,626 Southfield 34,600 7,385 4.68 7.546 1,158 36,486 Fairfield 20,605 4,087 5.04 4,184 599 21,699 Springfield 37,171 7,016 5.30 7.236 1,498 39,861 Whole Borough 311,360 66,639 4.67 69,037 9,745 332,147 The population estimated from the rated hereditaments is thus 6,851 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 1914. Corrected. Uncorrected. Clapham 58,592 61,822 61,592 Putney 28,242 29,129 29,129 Streatham 96,192 103,250 103,754 Tooting 35,958 37,611 39,626 Wandsworth... Whole Borough 92,376 311,360 95,133 326,945 98,046 332,147 3 Report of the Medical Officer of Health. The corrected population in Table II. is used to calculate all the rates in this Report. The total population of the Institutions in the Borough was in 1911, 7,855, but as a large proportion of the inmates of the Tooting Home and the Metropolitan Asylums Board's Hospital belong to the Borough, a deduction of 3,202 from the uncorrected population gives the corrected population, viz.:—326,945, compared with 321,340 in the previous year. Births. During the 52 weeks ending the 2nd January, 1915, 6,684 births, 3,444 of males and 3,240 of females, were registered, compared with 6,838 in 1913, 6,756 in 1912, and 6,699 in 1911. The total number of births registered in this Borough was 6,590, but 149 births occurred in Institutions outside the Borough of persons belonging to the Borough, and 55 births in Institutions in the Borough of persons not belonging to the Borough, making a corrected total of 6,684. Of the 149 births which were registered outside the Borough, 61 occurred in Clapham Maternity, 30 in the General Lying-in Hospital, 15 in Queen Charlotte's Hospital, 19 in St. Thomas's Hospital, two in City of London Lying-in Hospital, two in St. Bartholomew's Hospital, one in Middlesex Hospital, one in the Bolingbroke Hospital, six in Poor Law Infirmaries, 11 in private nursing homes, and one in other place. In Table III. is shown the number of births, males and females, the birth-rate, and the rate of natural increase for each sub-district, and for the whole Borough. 4 Report of the Medical Officer of Health. TABLE III. Sub-District. Births. Rates. Males. Females. Total. Birth-Rate. Rate of natural increase. Clapham 590 616 1,206 19.50 8.28 Putney 251 217 468 16.06 5.32 Streatham 993 929 1,922 18.61 7.26 Tooting 502 460 962 25.57 14.62 Wandsworth 1,108 1,018 2,126 22.34 11.07 Whole Borough 3,444 3,240 6,684 20.44 9.24 Table IV. shows the birth-rate in the Borough, in the five sub-districts, in London, and in England and Wales, for the year, as well as the rates for the previous 10 years, compared with the decennial average. The rates for the decennium have been recalculated on the increase of population as ascertained at the Census. TABLE IV. Year. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. London. England and Wales. 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 17.94 20.46 31.18 26.38 23.21 25.39 25.05 1911 22.15 16.96 18.78 29.04 23.27 21.73 25.0 24.4 1912 20.62 17.08 18.88 27.12 24.07 21.53 24.7 23.8 '9'3 20.66 16.74 18.06 27.82 22.6l 20.87 24.8 23.9 Average for 10 yrs. 23.55 18.76 20.45 33.8O 27.66 24.30 26.33 25.87 1914 19.50 16.06 18.61 25.57 22.34 20.44 24.3 23.8 5 Report of the Medical Officer of Health. The rate for the whole Borough is the lowest yet recorded, being .43 under the rate for the previous year, and 3 86 under the decennial average. Compared with 1913 the rate in the several sub-districts show a decrease in all with the exception of Streatham, where there has been an increase of .55 per 1,000. Compared with the decennial average there has been a decrease in all the sub-districts, and this is exceptionally large in Tooting where the reduction has been from 33.80 to 25.57 per 1,000. The birth-rate for the whole of London was 24.3 per 1,000, compared with 24.8 in 1913, and 26.33 the decennial average; while for England and Wales the rate was 23.8 per 1,000, compared with 23.9 in 1913, and 25.87 the decennial average. 119 births occurred in the Workhouse, and of these three belonged to Clapham, nine to Putney, 16 to Streatham, nine to Tooting, 27 to Wandsworth, 47 to Battersea, and eight to other places. Of these 119 births, 79 were illegitimate, two belonging to Clapham, six to Putney, 12 to Streatham, seven to Tooting, 17 to Wandsworth, 28 to Battersea, and seven to other places. In the Borough, excluding the Workhouse, 209 illegitimate births occurred, 26 in Clapham, 14 in Putney, 102 in Streatham, 29 in Tooting, and 38 in Wandsworth. 61 of the illegitimate births in Streatham occurred at a private home in the sub-district. Of the births registered outside the Borough 35, 25 of males and 10 of females, were illegitimate. The total number of illegitimate births was 288, 39 of which belonged to Clapham, 23 to Putney, 123 to Streatham, 44 to Tooting, and 59 to Wandsworth, compared with 283 in 1913, 223 in 1912, and 180 in 1911. 6 Report of the Medical Officer of Health. The percentage of illegitimate births to total births was 4.30 compared with 4.13 in 1913, 3.30 in 1912 and 2.68 in 1911, and 4.30 for England and Wales for 1912. 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. 1911 1912 1913 1914 Clapham 2.6o 3.71 3.17 3.23 Putney 3.32 3.27 5 .47 4.91 Streatham 2.15 2.59 4.55 6.39 Tooting 3.20 34.0 4.14 4.57 Wandsworth 2.81 3.7 4.04 2.77 Whole Borough 268 33° 413 43° Notification of Births Act. During the year 6,390 births were notified, 1,147 from Clapham, 445 from Putney, 1,708 from Streatham, 906 from Tooting and 2,184 from Wandsworth. 127 births were notified from the Workhouse, of which 72 belonged to this Borough, and 55 to other places. Of the 72 which belonged to this Borough, the home addresses of five were in Clapham, of 11 in Putney, of 17 in Streatham, of nine in Tooting, and of 30 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. 1 Report of the Medical Officer of Health. 7 TABLE V. Sub-district. Total No. of births notified. Notified by : No. born alive. No. born dead. Medical Attendant Parent. Midwife. Other person. Clapham 1,147 432 469 226 20 1,124 23 Putney 445 105 149 183 8 436 9 Streatham 1,708 440 863 374 31 1,677 31 Tooting 906 99 448 351 8 890 16 Wandsworth 2,184 377 894 883 30 2,138 46 Whole Borough 6,390 1,503 2,823 2,017 97 6,265 125 The next Table shows these births compared with the total births registered in each sub-district and in the whole Borough. TABLE VI. Sub-district. No. of births notified. Still-births. Births less still-births. Births registered. Excess of registered over notified births. Clapham 1,147 23 1,124 1,157 33 Putney 445 9 436 455 19 Streatham 1,708 31 1,677 1,859 182 Tooting 906 16 890 931 41 Wandsworth 2,184 46 2,138 2,188 50 Whole Borough 6,390 125 6,265 6,590 325 The percentage of births notified, less still-births, to those registered was 95.1, while only 4.9 per cent. were not notified, compared with 69.3 and 307 in 1913, showing an increase of 25.8 per cent. 8 Report of the Medical Officer of Health. The increase in the percentage of births notified to those registered was due to the fact that parents were written to when a birth was registered informing them that the birth ought to have been notified. In the sub-districts these percentages were: In Clapham 97.1 and 2.9, compared with 76.0 and 24.0 in 1913; in Putney 95.8 and 4.2 compared with 70.9 and 29.1; in Streathan 90.2 and 9.8, compared with 56.2 and 43.8; in Tooting 95.5 and 4.5 compared with 56.7 and 43.2; and in Wandsworth 97.7 and 2.3. compared with 86.5 and 13.5. An increase has taken place in all the subdistricts. The proportion of still-births to total births notified was 19 per cent., compared with 2.3 per cent, in 1913, and 2.5 per cent., the mean for the whole of London for the year 1913. The work carried out by the female Sanitary Inspectors in connection with the Notification of Births Act is given later on in this Report when dealing with Infantile Mortality. Deaths. During the 52 weeks ending the 2nd January, 1915, 3,332 deaths, 1,590 of males and 1,742 of females were registered, compared with 3,344 in 1913, 3,118 in 1912, and 3,456 in 1911. Compared with 1913 there has been a decrease of 12 deaths, and of 359 compared with the decennial average corrected for increase of population. The uncorrected death-rate for the Borough was 10.02 per 1,000, compared with 10.04 in 1913, 9.78 in 1912 and 1102 in 1911. The average uncorrected rate for the decennium 1904-1913 was 11.22 or 1.20 above the rate for the year 1914. 9 Report of the Medical Officer of Health. In the sub-districts these rates were as follows :—8.75 in Clapham, 9.26 in Putney, 8.29 in Streatham, 21.24 in Tooting, and 8.36 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 Bee Asylum and the Tooting Home, where persons from other parts of London are received and among whom the mortality is very great. To ascertain the corrected death-rate corrections must be made to the above by the addition of the deaths in Out-lying Institutions and other places of persons belonging to the Borough, and the subtraction of all deaths in Public Institutions and other places in the Borough of persons not belonging thereto, whose domiciles were in other parts of London. The deaths occurring in other parts of England and Wales axe also included, as these are now received from the Registrar General. The total number of deaths for the 52 weeks, corrected for both internal and external Institutions and other places was 3,664, compared with 3,588 in 1913, 3,291 in 1912, 3,776 in 1911, and 3,884, the decennial average corrected for increase of population. During the year 854 deaths occurred in Public Institutions and 164 in other places in the Borough. Of the total of 1,018 deaths, 824 were of persons not belonging and 194 of persons belonging to the Borough. Table VII. shows the total number of Institution deaths arranged according to sub-districts and Institutions in which they occurred, Table VIII. the deaths of persons not belonging to the Borough, and Table IX. the deaths of persons belonging thereto arranged according to causes of death, sex and age, and Institution in which the death occurred. 10 Report of the Medical Officer of Health. TABLE VII. Name of Public Institution. Clapham. Putney. Streatham Tooting. Wands'th. Total. Hostel of God 62 ... ... ... ... 62 St. Anne's Home ... ... 7 ... ... 7 Middlesex County Asylum ... ... 10 ... 109 19 Metropolitan Asylums Board's Fever Hospital ... ... ... 134 ... 134 Fountain Asylum ... ... ... 42 ... 42 Tooting Home ... ... ... S3 ... 53 H. M. Prison ... ... ... ... 8 8 Workhouse ... ... ... ... 4 4 Royal Hospital for Incurables ... ... ... ... 17 17 Tooting Bee Asylum ... ... ... 368 ... 368 The Priory ... 3 ... ... ... 3 3rd London General Hosp. ... ... ... ... 5 5 Putney Hospital ... 29 ... ... ... 29 Newlands House Asylum ... ... ... 3 ... 3 TOTAL 62 32 67 600 143 854 Other places 48 42 44 12 18 164 GRAND TOTAL IIO 74 61 612 161 1,018 Compared with the year 1913 there has been a decrease of nine in the deaths in Institutions, and of seven in other places, or a total decrease of 16. Table VIII. shows the deaths in Public Institutions in the Borough of persons not belonging thereto, and Table IX. 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. 11 Report of the Medical Officer of Health. TABLE VIII. Deaths in Public Institutions, &c., in the Borough of Persons not belonging to the Borough, 1914. CAUSES OK DEATH. Deaths in or belonging to whole District at subjoined ages. Institutions. 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. Middlesex County Asylum. Tooting Bee Asylum. Hostel of God. Tooting Home. Fever Hospital. Workhouse. H.M. Prison. Ryl. Hosp. for Incurables. St. Anne's Home. The Priory. Putney Hospital. Fountain Temporary Asylum. Newlands House. 3rd Lon. General Hospital. Other Places—not Institutions. Enteric Fever 2 ... 2 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 21 13 8 ... 2 6 10 2 ... 1 ... ... ... ... ... 21 ... ... ... ... ... ... ... ... ... ... Whooping Cough 7 3 4 2 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria, and Membranous Croup 43 19 24 2 2 i7 21 ... ... 1 ... ... ... ... ... 43 ... ... ... ... ... ... ... ... ... ... Influenza 3 ... 2 ... ... ... ... 1 ... ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Erysipelas 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 71 38 33 ... ... 1 8 13 23 18 8 20 6 12 1 ... ... ... ... ... ... 7 ... ... 6 Tuberculous Meningitis ... 2 1 ... ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis 2 2 ... 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases 10 6 4 ... ... ... 8 ... 1 ... ... 1 ... ... ... 2 ... ... ... ... ... 1 6 ... ... ... Other Infective Diseases 2 1 1 ... ... ... 2 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer Malignant Disease 64 19 45 ... ... ... 1 ... 8 26 29 3 8 ... 1 ... ... ... ... ... ... 2 1 ... ... i7 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diabetes 2 1 1 ... ... ... ... ... 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... Other General Diseases 3 2 1 ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Alcoholism 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Haemorrhage, Apoplexy 31 14 17 ... ... ... 1 ... ... 13 17 5 14 ... 4 ... ... ... ... 1 ... ... 1 ... ... 6 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Nervous System 87 48 39 ... ... ... 13 7 30 27 8 46 17 ... ... ... ... ... 4 1 2 1 14 1 ... 1 Organic Diseases of Heart 5o 35 15 ... ... ... 3 1 3 15 28 6 25 ... ... 1 ... ... 1 ... ... ... ... ... ... 12 Other Diseases of Circulatory System 10 4 6 ... ... 1 1 ... ... 5 3 ... 3 ... ... 1 ... ... 2 ... 1 ... ... ... ... 3 Bronchitis 24 19 5 ... ... 1 ... ... ... 9 14 14 1 ... 1 ... ... 2 ... ... ... ... ... ... ... 5 Broncho-Pneumonia 12 6 6 1 2 1 3 ... ... 1 4 2 6 ... ... 1 ... ... ... ... ... ... ... ... ... 2 Lobar Pneumonia 7 4 3 ... ... ... ... ... 2 3 I 3 2 ... ... ... ... ... ... ... ... ... 1 ... ... 1 Pneumonia (type not distinguished) 26 17 9 ... ... ... 1 1 1 6 17 ... 21 ... ... ... ... 1 1 1 ... ... 1 ... ... 1 Other Diseases of Respiratory System 8 5 ... 1 ... 1 ... 1 1 2 2 ... 3 1 ... 1 ... ... 1 ... ... ... ... ... ... 2 Ulcer of Stomach 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Diarrhœa ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Appendicitis and Typhlitis 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Obstruction of Intestines 2 2 ... ... ... ... ... ... 1 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver 3 2 1 ... ... ... ... ... ... 2 I ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 Other Diseases of Liver 3 1 2 ... ... ... ... ... ... 2 I ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Other Diseases of Digestive System 6 S 1 1 ... ... 1 ... 1 ... 2 ... 2 ... ... ... ... ... ... 1 ... 1 ... 1 ... ... Nephritis and Bright's Disease 16 10 6 ... ... ... 1 ... 2 8 5 5 4 1 ... ... ... ... 1 ... ... ... 1 ... ... 4 Other Diseases of Urinary System 4 3 1 ... ... ... ... ... ... 3 1 2 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Diseases of Generative System 2 ... 2 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... I Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth I 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Congenital Debility and Malformation 6 5 1 2 3 I ... ... ... ... 2 ... ... ... 1 ... ... ... ... ... 2 ... ... 1 Other Diseases of Early Infancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Old Age 257 108 140 ... ... ... ... ... ... 16 241 5 242 ... 4 ... ... ... ... ... ... ... ... ... ... 6 Deaths from Accident 14 II 3 ... ... 1 2 3 3 3 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Deaths from Suicide 9 6 3 ... ... ... ... ... ... 2 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Other Violent Deaths 6 5 1 ... ... ... 1 1 4 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Other defined Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Diseases or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... All causes 824 422 402 12 8 39 82 34 88 167 394 117 363 48 23 83 1 5 14 7 3 13 31 2 5 98 12 Report of the Medical Officer of Health. The total number of deaths shown on Table IX. is 194, 98 of males and 96 of females, compared with 212 in 1913, and 191 in 1912. 51 of the deaths occurred in the Fever Hospital, compared with 43 in 1913; 30 in Tooting Home, compared with 63; 14 in the Hostel of God, compared with nine ; three in the Workhouse, compared with four ; five in the Tooting Bee Asylum, compared with five; three in the Royal Hospital for Incurables, compared with one; 16 in Putney Hospital compared with 18, and 72 in other places compared with 69. These deaths are allocated to their proper sub-districts in Table XV. The number of deaths in Table VIII., viz. :—824, and that in Table IX., viz. :—194, made up the total of 1,018, the total number of deaths in Public Institutions and other places in the Borough as shown in the last columns of Tables XV., and XVIII., and in column eight of Table XVI. 13 Report of the Medical Officer of Health. TABLE IX. Deaths in Public Institutions, &c., in the Borough of Persons belonging to the Borough, 1914. CAUSES OF DEATH Deaths in or belonging to whole District at subjoined ages. Institutions. 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. Fever Hospital. Tooting Home. Hostel of God. Workhouse. Tooting Bee Asylum. H.M. Prison. Royal Hospital for Incurables Putney Hospital. Fountain Temporary Asylum. Middlesex Asylum. Other Places not Institutions. Enteric Fever 5 5 ... ... ... ... 1 3 1 ... ... 5 ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Scarlet Fever 6 5 1 1 1 3 1 ... ... ... 6 ... ... ... ... ... ... ... ... ... ... WhoopingCough 2 ... 2 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... Diphtheria, Membranous Croup 26 10 16 2 8 15 1 ... ... ... 26 ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 10 6 4 ... ... ... ... 1 6 3 ... ... 6 3 ... ... ... ... 1 ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases 3 1 2 ... ... 2 1 ... ... ... ... 2 ... ... ... 1 ... ... ... ... ... ... Other Infective Diseases 2 ... 2 1 ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 1 ... ... ... Cancer, Malignant Disease 26 7 19 ... ... ... ... ... 7 10 9 ... 1 11 ... ... ... ... 3 ... ... 11 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diabetes 1 1 ... ... ... ... ... ... ... I ... ... ... ... ... ... ... ... ... ... ... 1 Other General Diseases 2 1 1 ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... 1 Alcoholism 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Cerebral Haemorrhage, Apoplexy 5 2 3 ... ... ... ... ... 1 I 3 ... 2 ... ... ... ... ... ... ... ... 3 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Nervous System 6 3 3 ... ... ... 1 ... 3 I 1 ... 1 ... ... ... ... 1 1 ... 2 1 Organic Diseases of Heart Ti 7 4 ... ... ... 1 1 1 2 6 ... 2 ... 1 1 ... ... 1 ... ... 6 Other Diseases of Circulatory System 10 6 4 ... ... ... ... ... 3 2 5 ... 2 ... ... ... ... 2 1 ... ... 5 Bronchitis 5 4 1 ... ... ... ... ... 1 I 3 ... 1 ... ... ... ... ... 1 ... ... 3 Broncho-Pneumonia 3 T 2 1 ... 1 1 ... ... ... ... 2 ... ... ... 1 ... ... ... ... ... ... Lobar Pneumonia 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Pneumonia (type not distinguished) 4 4 ... ... ... ...1 1 ... I 1 1 ... ... ... ... 1 ... ... 1 ... 1 Other Diseases of Respiratory System 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... I Ulcer of Stomach ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea 1 I ... ... ... ... ... ... ... I ... ... ... ... ... ... 1 ... ... ... ... ... Enteritis 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... I Appendicitis and Typhlitis 1 I ... ... ... ... ... ... ... I ... ... ... ... ... ... ... ... ... ... ... I Obstruction of Intestines 3 I 2 ... ... ... ... ... ... I 2 ... ... ... ... ... ... ... 1 ... ... ... Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Liver 2 1 1 ... ... ... ... ... ... I 1 ... 1 ... ... ... ... ... ... ...... ... I Other Diseases of Digestive System 5 3 2 ... 1 1 1 1 ... 1 1 1 ... ... 1 ... ... 1 ... ... I Nephritis and Bright's Disease 3 1 3 ... ... ... ... ... ... 2 1 ... 1 ... ... ... 1 ... ... ... ... 1 Other Diseases of Urinary System 2 2 ... ... ... ... ... ... ... I 1 ... ... ... ... ... ... ... 1 ... ... 1 Diseases of Generative System 1 ... 1 ... ... ... ... ... ... I ... ... ... ... ... ... ... ... ... ... ... 1 Puerperal Fever 3 ... 3 ... ... ... ... 1 2 ... ... 3 ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 1 ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... Premature Birth 2 2 ... 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... I Congenital Debility and Malformation 2 2 ... 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... I Other Diseases of Early Infancy 2 ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Old Age 14 6 8 ... ... ... ... ... ... ... 14 ... 11 ... ... 1 ... ... ... ... ... 2 Deaths from Accident 16 11 5 1 3 2 1 2 4 3 ... ... ... ... ... ... ... 3 ... ... 13 Deaths from Suicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Violent Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other defined Diseases 2 2 ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... 1 Ill-defined Diseases or unknown 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 All causes 194 98 96 1 4 4 19 2.6 11 32 35 53 51 30 '4 3 5 3 3 16 1 2 66 14 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 LXXXVU. As the Borough is dealt with as one Sanitary District the deaths of persons belonging to other parishes in the Borough in Institutions such as the Fever Hospital, Tooting, are considered to be deaths in Internal Institutions with regard to the whole Borough, and are not included in the following Table. The same applies to deaths in the Hostel of God, Clapham, the Tooting Home, the Workhouse, the Tooting Bee Asylum, and the Royal Hospital for Incurables. 15 Report of the Medical Officer of Health TABLE X. Deaths in Public Institutions, &c., outside the Borough of Persons belonging to the Borough, 1914. 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 12 6 6 4 6 1 ... ... ... 1 ... 2 ... 4 3 2 10 1 ... 1 Scarlet Fever 5 3 2 ... ... 1 2 2 ... ... ... 1 ... 2 ... 2 1 ... 4 Whooping Cough 18 9 9 4 10 4 ... ... ... ... ... 2 ... 2 7 7 18 ... ... Diphtheria and Membranous Croup 7 4 3 ... 1 3 3 ... ... ... ... 1 ... 2 ... 4 ... 2 ... 5 Influenza 1 I ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... 1 ... ... Erysipelas 6 4 2 1 ... ... ... 1 3 1 2 1 1 1 1 4 2 ... ... Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 1 ... Pulmonary Tuberculosis 125 68 57 ... ... 2 4 23 57 29 10 22 8 28 15 52 70 36 16 3 Tuberculous Meningitis 21 10 11 ... 6 5 7 3 ... ... ... 2 1 9 4 ... 8 13 ... ... Abdominal Tuberculosis 12 4 8 ... 5 3 1 1 ... 2 ... 2 1 4 2 3 ... 12 ... ... Other Tuberculous Diseases 9 6 3 ... ... ... 3 2 2 2 ... 4 ... 2 3 ... 4 5 ... ... Other Infective Diseases 22 10 12 9 1 ... ... ... 6 6 ... 2 ... 10 4 6 13 8 1 ... Cancer, Malignant Disease 118 56 62 ... ... ... ... 4 13 64 37 23 13 32 14 36 46 62 10 Rheumatic Fever 7 5 2 ... ... ... 2 3 2 ... ... 2 ... ... ... 3 5 2 ... ... Diabetes 9 4 5 ... ... ... ... ... 2 4 3 1 1 5 ... 2 3 6 ... ... Other General Diseases 15 5 10 ... ... 3 ... ... 3 8 1 5 ... 4 ... 6 4 11 ... ... Alcoholism 7 6 1 ... ... ... ... ... 4 3 ... 2 ... 3 ... 2 6 1 ... ... Chronic Poisonings 1 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... Meningitis 9 7 2 3 2 1 ... 1 1 1 ... 5 ... 1 1 2 1 5 ... 1 Cerebral Haemorrhage, Apoplexy 42 24 18 ... ... ... ... ... 3 21 18 6 3 15 4 14 33 7 2 ... Convulsions I 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... I ... ... Other Diseases of Nervous System 74 52 22 2 1 ... 1 3 29 24 14 16 1 27 8 22 15 J3 45 1 Organic Diseases of Heart 35 41 44 ... ... ... 4 5 9 31 36 23 8 21 6 2 7 52 24 8 1 Other diseases of Circulatory System 39 21 18 4 ... ... 2 1 9 16 7 13 12 4 5 17 18 4 ... Bronchitis 36 17 l9 7 3 1 ... ... 4 13 8 5 5 5 7 14 27 8 1 ... Broncho-Pneumonia 20 10 10 6 5 2 I 2 ... ... 2 7 ... 6 1 1 2 14 7 ... Lobar Pneumonia 7 5 2 3 2 2 2 ... 1 I 3 2 3 2 ... Pneumonia (type not distinguished) 17 11 6 ... ... ... ... ... 9 5 3 5 2 3 4 3 15 1 I ... Other Diseases of Respiratory System 11 8 3 I ... I ... 1 6 1 1 1 6 1 1 8 ... ... Ulcer of Stomach 9 4 5 ... ... ... ... 1 6 2 2 1 3 2 3 2 7 ... ... Diarrhoea 10 4 6 9 1 ... ... ... ... ... ... 7 ... 4 3 1 ... 10 ... ... Enteritis 59 39 20 37 16 4 I ... ... ... 1 4 4 14 11 23 51 8 ... ... Appendicitis and Typhlitis 14 9 5 ... ... 3 1 5 5 ... 5 I 4 3 2 2 12 ... ... Obstruction of Intestines 16 6 10 2 1 ... 1 ... 1 9 2 3 3 3 1 6 4 12 ... ... Cirrhosis of Liver 6 1 5 ... ... ... ... ... 1 4 1 3 1 1 ... 1 ... 5 I ... Other Diseases of Liver 4 1 3 ... ... ... ... ... ... 2 2 3 ... 1 ... ... 1 3. ... ... Other Diseases of Digestive System 23 12 11 3 2 1 2 2 7 4 2 3 10 3 7 5 16 2 ... Nephritis and Bl ight's Disease 47 26 21 ... ... ... 2 1 11 16 17 11 6 11 5 14 33 7 7 ... Other Diseases of Urinary System 21 x9 2 ... ... ... ... ... 2 8 II 8 2 4 2 5 9 9 3 ... Diseases of Generative System 2 ... 2 ... ... ... ... 1 ... 1 ... 1 ... ... 1 ... ... 2 ... ... Puerperal Fever 2 ... 2 ... ... ... ... ... 2 ... ... 1 ... ... 1 ... ... 2 ... ... Other Accidents and Diseases of Pregnancy and Childbirth 2 ... 2 ... ... ... ... 1 ... ... ... ... ... I ... 1 1 1 ... ... Premature Birth 6 3 3 6 ... ... ... ... ... ... ... ...... 1 3 1 1 1 5 ... ... Congenital Debility and Malformation 33 16 17 32 1 ... ... ... ... ... ... 2 2 9 7 13 21 11 ... 1 Other Diseases of Early Infancy 2 1 1 2 ... ... ... ... ... ... ... 2 ... ... ... ... 2 ... ... ... Old Age 88 27 61 ... ... ... ... ... ... ... 88 17 7 24 11 29 82 1 5 ... Deaths from Accident 47 33 14 ... ... 2 2 5 17 11 9 9 7 14 6 11 14 33 ... ... Deaths from Suicide II 9 2 ... ... ... ... 1 4 4 2 1 2 3 4 1 3 8 ... ... Other Violent Deaths 5 5 ... ... ... I 1 3 ... 1 I 2 1 ... 5 ... ... Other defined Diseases 10 7 3 1 1 ... I 1 2 4 1 ... 3 1 5 7 2 1 ... Ill-denned Diseases or unknown 1 ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... All causes ,1,1,55 621 534 134 63 37 43 67 226 305 280 235 89 319 160 352 600 425 113 17 16 Report of the Medical Officer of Health. The total number of deaths in out-lying Institutions was 1,155, 621 of males and 534 of females, compared with 1,066 in 1913, 940 in 1912, and 989 in 1911. 600 of these deaths occurred in Workhouses and Workhouse Infirmaries, compared with 500 in 1913; 425 in General and Special Hospitals, compared with 425 in 1913; 113 in Public Lunatic or Imbecile Asylums, compared with 105 in 1913; and 17 in the Metropolitan Asylums Board's Hospitals, compared with 36 in 1913. The hospitals, asylums, etc., in which these deaths occurred are shown in detail on Table LXXXVII., on page 164. 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 3,664, 1,794 of males, and 1,870 of females, an increase of 76 compared with 1913, but a decrease of 242 compared with the corrected decennial average. The corrected death-rate for the year was 11 -20 compared with 10.95 in 1913, 10.48 in 1912, 12.25 in 1911 and 11.96 the rate for the 10 years 1904-1913. Table XI. shows the total number of deaths and the deathrates for each sub-district and for the whole Borough, corrected and uncorrected for deaths in Public Institutions. The death-rate for the whole of London for the year was 14.4 per 1,000, compared with 14.2 in 1913, 13.96 in 1912, 15.8 in 1911, and 15.04 the decennial average. Report of the Medical Officer of Health. ly TABLE XL Sub-Districts. Corrected Deaths. Uncorrected Deaths. Corrected Death-rate. Uncorrected Death-rate. Males. Females. Total. Males. Females. Total. Clapham 342 352 694 241 298 539 11 .22 8.75 Putney 157 156 313 129 141 270 10.74 9.26 Streatham 560 612 1,172 390 471 861 11.35 8.29 Tooting 209 203 412 429 413 842 10.95 21.24 Wandsworth 526 547 1,073 401 419 820 11.27 8.36 Whole Borough 1,794 1,870 3,664 1,590 1,742 3,332 11.20 10.02 18 Report of the Medical Officer of Health. The death-rate in England and Wales in 1914 was 137 per 1,000, compared with 13.7 in 1913, 13.3 in 1912, 14.6 in 1911 ; in the 97 Great Towns 15.0 compared with 14.3 in 19x3, 13.8 in 1912, and 16.4 in 1911 ; and in the 145 Smaller Towns 13.1 compared with 12.8, 12.4 and 14.4. If a comparison is to be made with other places it is necessary to again correct the corrected rate, viz. 11.20, for age and sex distribution. This is done by multiplying the rate by a factor obtained by dividing the standard death-rate in England and Wales at the Census of 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 1914 of 11.24 Per 1,000, compared with 10.99 in 1913, 11.03 in 1912,and 12.92 in 1911. 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 1914. 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. Report of the Medical Officer of Health. 19 TABLE XII. 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 14.0 13.7 1,000 London 1.0000 I4.3 14.3 1,043 Lewisham .9826 10.6 10.4 759 Hampstead 1.O572 10.1 10.6 773 WANDSWORTH 1.OO45 11.2 11.2 817 Stoke Newington .9512 13.1 12.4 905 Chelsea .9513 13.6 12.9 941 Paddington .9941 13.0 12.9 941 Kensington .9957 13.1 13.0 948 Westminster 1.0540 12.8 13.4 978 Camberwell .9883 13.6 13.4 978 Hammersmith .9884 13.7 13.5 985 Battersea 1.0098 13.4 13.5 985 Fulham 1.0340 13.2 13.6 992 Hackney 1.0066 13.8 13.8 1,007 Woolwich 1.0249 13.6 13.9 1,014 Lambeth .9804 14.5 14.2 1,036 St. Marylebone 1.0198 13.9 14.2 1,036 Deptford .9879 14.4 14.2 1,036 Greenwich .9837 14.7 14.4 1,051 City of London 1.0419 13.9 14.4 1,051 Islington .9749 15.1 14.7 1,073 St. Pancras .9471 15.6 14.7 1,073 Bethnal Green 1.0397 15.9 16.5 1,204 Holborn 1.0034 16.8 16.8 1,226 Poplar .9898 17.1 16.9 1,233 Stepney 1.0433 16.6 17.3 1,262 Bermondsey .9976 17.4 17.3 1,262 Southwark 1.0060 17.9 18.0 1,313 Finsbury 9887 19.8 19.5 1,423 Shoreditch 1.0331 19.0 19.6 1,430 20 Report of the Medical Officer of Health. In the separate sub-districts of the Borough the corrected death-rate was 10.74 in Putney, 10.95 in Tooting, 11.22 in Clapham, 11.27 in Wandsworth, and 11.35 in Streatham. The rates in all the sub-districts were higher than in 1913, with the exception of Wandsworth which was lower, and was due to causes which will be commented on in another part of this Report. Table XIII. shows the death-rate in the Borough, in the five sub-districts, and in England and Wales for the year, as well as the rates for the previous 10 years, compared with the decennial average. During the previous decennium the lowest mortality in the Borough and in London was in 1910, while it was lowest in England and Wales in the year 1912. The rate in 1914, although higher than in 1910, 1912 and 1913 is in all the sub-districts, with the exception of Streatham, considerably lower than the average of the previous 10 years. Compared with London and with England and Wales the Borough rate is considerably lower. Report of the Medical Officer of Health. 21 TABLE XIII. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. London. England and Wales. 1904 14.54 12.75 11.25 16.28 14.75 13.56 I6.44 I6.34 1905 12.6O 11.75 10.89 16.56 14.28 12.81 I5.54 15.28 1906 13.70 11.99 10.86 15.90 14.18 12.98 15.71 15.46 1907 1 2.62 11.66 10.76 15.49 13.44 12.09 15.29 15.10 1908 12.75 11.41 10.43 13.62 12.72 11.97 14.87 14.83 1909 13.25 11.80 10.48 13.51 12.71 12.11 14.94 14.61 1910 1O.73 10.17 9.50 10.67 11.04 10.38 13.65 13.49 1911 13.15 11.88 11..2 11.73 13.29 12.25 15.8 14.6 1912 11 64 9.83 9.42 10.20 11.18 0.48 13.96 13.3 19I3 10.99 10.69 10.37 10.43 12.77 10.95 14.2 13.7 Average, 1904-1913 12.59 11.39 10.49 13.43 13.33 11.95 15.04 14.67 1914 11.22 10.74 11.35 10.95 11.27 11.20 14.4 13.7 22 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 1909-1913. The Chart shows that on 13 fortnights the rate was above that for the previous quinquennium. During the rest of the year the fortnightly rate was under the quinquennial rate. The highest rate, viz.:—14.4, occurred during the fortnight ending the 17th January and this was due to the great number of deaths from Respiratory diseases ; and the lowest rate during the fortnight ending the 18th July, when it was 7.1 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 2nd January, 1915, and the lowest in the fourth week of July. Table XIV. shows the vital statistics of the whole Borough for the year and for the previous 10 years, as well as the average for the 10 years. This Table shows clearly the variations in the births and deaths, the birth and death-rates, and the infantile mortality for the decennium, compared with the year 1914. Compared with the decennial average there has been a considerable decrease in the birth-rate, and a decrease in the deathrate, while the infantile mortality 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 323 deaths of residents outside the Borough, compared with the 10 years' average. The corrected death-rate, although somewhat higher than it was in 1910 1912 and 1913, is still under the 10 years' average. CHART Showing the Annual Death-rate during each fortnight of the year /3/4 and the Quinquennium 1303—13/3 for the Metropolitan Borough of Wandsworth. Death-rate for Quinquennium 1303-1313 shown in Black. Death-rate for 1314 shown in Red. : CHART Showing the Annual Death-rate during each week of the year IS 14 for the whole of ton don and the Annual Death-rate for each fortnight for the Metropolitan Borough of Wandsworth. Death-rate for London shown in Black Death-rate for Wandsworth shown in Red Report of the Medical Officer of Health. 23 TABLE XIV. Vital Statistics of whole District during 1914 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. At all ages. Number. Rate per 1,000 Births registered. N umber. Rate. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 7,0.16 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 11,02 850 669 984 823 122 3,776 12.25 1912 313,761 6,756 21.53 3,118 9,78 958 767 940 516 76 3,291 10.48 1913 321,340 6,838 20.87 3,344 10,04 1,034 822 1,066 605 88 3,588 10.95 Averages for years 1904—1913 286,687 6,948 24.23 3,249 11,33 819 654 832 707 101 3,427 11.96 1914 326,945 6,684 20.44 3,332 10,02 1,018 824 1,155 589 88 3,664 11.20 24 Report of the Medical Officer of Health. TABLE XV. Causes of, and Ages at Death, during the year 1914. 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 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. Clapham. Putney. Streatham. Tooting. Wandsworth. Enteric Fever 5 5 ... ... ... ... 2 2 1, ... ... 1 1 1 ... 2 7 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 26 16 10 7 12 4 2 ... ... 1 ... 6 ... 11 6 3 1 Scarlet Fever 13 9 4 1 ... 2 5 4 1 ... ... 2 1 4 1 5 27 Whooping Cough 53 21 32 24 20 9 ... ... ... ... ... 8 2 10 1 22 9 Diphtheria, and Membranous Croup 41 17 24 ... 3 13 24 1 ... ... ... 6 4 4 4 23 69 Influenza 58 25 33 2 ... 2 2 1 7 15 29 10 5 32 ... 11 3 Erysipelas 11 7 4 2 ... ... ... 1 3 3 2 3 1 2 1 4 1 Cerebro-spinal Fever 1 ... 1 ... ......... ... ... ... 1 ... ... 1 ... ... ... ... ... Other Epidemic Diseases 2 ... 2 ... ... ... ... ... 1 ... 1 ... ... 1 ... 1 ... Pulmonary Tuberculosis 305 171 134 I 1 2 5 52 143 79 22 58 23 74 33 117 81 Tuberculous Meningitis 42 20 22 6 7 11 15 3 ... ... ... 5 15 8 12 3 Abdominal Tuberculosis 19 8 11 3 6 4 1 2 1 2 ... 3 2 4 7 3 2 Other Tuberculous Diseases 23 14 9 ... ... 3 4 3 5 7 1 8 ... 7 6 2 13 Other Infective Diseases 30 16 14 11 1 ... 1 ... 11 5 1 3 ... 13 6 8 4 Cancer, Malignant Disease 393 162 231 ... 1 1 2 3 46 170 170 71 40 143 37 103 90 Rheumatic Fever 16 12 4 ... ... ... 3 7 5 1 ... 3 1 8 ... 3 ... Diabetes 39 18 21 ... ... ... ... ... 7 17 15 5 4 18 2 9 3 Other General Diseases 43 14 29 2 ... 3 1 ... 6 19 12 13 ... 13 3 14 5 Alcoholism 11 8 3 ... ... ... ... ... 6 4 1 3 ... 5 1 2 2 Chronic Poisonings 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... Meningitis 21 12 9 8 2 2 2 2 1 ... ... 6 1 5 5 4 2 Cerebral Haemorrhage, Apoplexy 180 85 95 ... ... ... ... 2 7 55 116 44 12 63 14 47 36 Convulsions 23 11 12 21 2 ... ... ... ... ... ... 5 1 6 2 9 ... Other Diseases of Nervous System 138 84 54 3 2 ... 4 4 36 45 43 20 7 56 13 42 93 Organic Diseases of Heart 329 158 171 ... ... ... 10 14 ... 118 153 71 25 102 24 107 01 Other Diseases of Circulatory System 107 56 51 ... ... ... 4 6 40 37 30 15 27 9 26 20 Bronchitis 231 106 125 24 7 5 ... 1 11 49 134 32 20 82 7 30 67 20 Broncho-Pneumonia 108 56 52 41 8 13 4 3 3 5 21 19 15 30 15 29 15 Lobar Pneumonia 34 18 16 5 4 1 ... 8 7 9 7 2 14 2 9 8 Pneumonia (type not distinguished) 102 55 47 18 8 6 2 3 18 27 20 20 9 27 14 32 30 Other Diseases of Respiratory System 45 25 20 5 ... 3 4 1 9 10 13 12 5 13 5 10 10 Ulcer of Stomach 14 5 9 ... ... ... ... 1 8 4 1 2 2 3 4 3 1 Diarrhoea 84 42 4 2 66 7 2 2 ... 1 2 4 15 2 16 27 24 2 Enteritis 102 64 38 70 8 5 1 ... 2 2 4 11 11 32 15 33 2 Appendicitis and Typhlitis 17 11 6 ... ... ... 4 1 5 7 5 2 5 2 2 2 Obstruction of Intestines 32 0 23 3 1 ... 1 ... 2 11 14 6 7 11 1 7 5 Cirrhosis of Liver 35 17 18 ... ... ... ... ... 1 21 13 6 4 10 2 13 3 Other Diseaes of Liver 15 5 10 ... 1 ... ... ... ... 7 7 7 2 4 1 1 4 Other Diseases of Digestive System 67 32 35 14 6 3 5 4 11 12 12 8 5 23 6 25 T 2 Nephritis and Bright's Disease 135 72 63 ... ... ... 3 3 23 49 57 26 22 46 7 34 18 Other Diseases of Urinary System 37 33 4 ... ... ... ... ... 2 12 23 9 3 12 4 9 6 Diseases of Generative System 6 ... 6 ... ... ... ... 1 1 4 ... 2 ... 3 1 ... 4 Puerperal Fever 9 ... 9 ... ... ... ... 1 8 ... ... 4 ... 2 1 2 3 Other Accidents and Diseases of Pregnancy and Childbirth 14 ... 14 ... ... ... ... 2 12 ... ... 1 ... 6 ... 6 I Premature Birth 115 56 59 115 ... ... ... ... ... ... ... 23 6 31 13 42 3 Congenital Debility and Malformation 118 64 54 112 3 1 ... ... ... ... ... 10 11 36 20 33 7 Other Diseases of Early Infancy 16 4 12 16 ... ... ... ... ... ... ... 3 2 5 4 2 2 Old Age 256 78 178 ... ... ... ... ... ... ... 256 5° 16 87 24 79 27I Deaths from Accident 86 59 27 6 1 7 4 8 20 21 19 13 12 34 8 19 30 Deaths from Suicide 22 13 9 ... ... ... ... 3 8 8 3 a 3 9 5 3 9 Other Violent Deaths 5 5 ... ... ... ... 1 1 3 ... ... 1 1 ... 2 1 6 Other defined Diseases 21 12 0 1 1 ... 1 1 1 6 10 4 2 5 1 9 ... Ill-defined Diseases or unknown 8 1 7 1 ... ... ... ... ... 4 3 3 2 3 ... ... 3 All causes 3664 I794 1870 589 128 106 121 141 499 853] 1227 694 313 1172 412 1073 1018 Report of the Medical Officer of Health. 25 Table XV. is the general mortality Table for the whole district, corrected for internal and external Institutions, and also includes all deaths occurring in other places in London, and in England and Wales for the year. Compared with 1913 there has been an increase in the number of deaths from Whooping Cough, Diarrhoea, Cancer and diseases of the Circulatory organs and Urinary system, and these increases are the cause of the death-rate for the year having been higher than in 1913. From Pulmonary Tuberculosis there has been a slight decrease, and this is also the case as regards Old Age and Premature Birth. The deaths from Suicide have decreased from 33 in 1913 to 22 in 1914, but the deaths from accident have increased from 80 in 1913 to 86 in 1914. The four Tables which follow are inserted by request of the Local Government Board. Table I. is arranged to show the gross births and deaths in the district, and the births and deaths belonging to it with the corresponding rates. The rates in column 7 are calculated on the gross population and the rates in 5 and 13 on the nett population, i.e., the population obtained by deducting from the estimated gross population the average number of inmates not belonging to the district in Public Institutions. The population given in column two of this Table is the population after the above correction has been made. Table II. shows the number of cases of Infectious Diseases notified during the year at all ages and at certain age periods in the Borough and in the separate sub-districts, and also shows the number of cases removed to hospital from the whole Borough. 26 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 monthly periods up to one year. Report of the Medical Officer of Health. 27 TABLE XVI. Wandsworth District. Vital Statistics of Whole District during 1914 and previous years. (Table I.) Year. Population estimated to Middle of each Year. Uncorrected Number. Births. Total Deaths Registered in the District. Transferable Deaths : Nett Deaths Belonging to the District. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate per 1000 Nett Births. Number. Rate. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 9.38 564 812 545 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 1914 326,945 6,690 6,684 20.44 3,332 10.02 824 1,155 589 88 3,664 11.20 Area of District in acres (exclusive of area covered by water) 9,126 Total population at all ages 311360 Number of inhabited houses 48,432 Average number of persons per house 6.42 At Census of 1911 28 Report of the Medical Officer of Health. TABLE XVII. Wandsworth District. Cases of Infectious Disease notified during the year 1914. (Table 11.) Notifiable Disease. No. of Cases Notified. Total Cases Notified in each Locality. Total cases removed to Hospital. At all Ages. At Ages—Years. Clapham. Putney. Streatham. Tooting. Wandsworth. Under I. 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) 552 5 129 336 48 29 5 ... 66 57 91 107 231 464 Erysipelas 234 8 9 16 30 73 67 31 44 8 60 39 83 40 Scarlet Fever 1417 11 258 910 154 79 5 ... 195 140 332 250 500 1215 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 48 ... ... 14 15 13 6 ... 5 5 12 5 21 30 Relapsing Fever, Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 30 ... ... ... 9 21 ... ... 6 ... 6 4 14 24 Cerebro-spinal Meningitis 3 1 ... 1 ... 1 ... ... 2 ... ... 1 ... 1 Polio-Myelitis 3 ... 2 1 ... ... ... ... ... ... 1 ... 2 1 Ophthalmia Neonatorum 51 51 ... ... ... ... ... ... 9 4 21 5 12 5 Pulmonary Tuberculosis 706 2 12 60 132 37 128 35 138 46 170 121 231 ... Other forms of Tuberculosis 199 10 49 79 23 27 10 1 30 10 46 40 73 ... Anthrax 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 Totals 3,.244 88 459 1,417 411 580 222 67 495 270 739 572 1168 1,781 Report of the Medical Officer of Health. 29 TABLE XVIII. Wndsworth district. Causes of, and Ages at Death during the Year 1914- (Table 111) Causes of Death. Nett Deaths at the subjoined ac.es 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 3,645 586 128 106 121 140 498 850 1,216 1,016 Uncertified 19 3 ... ... ... 1 i 3 11 2 Enteric Fever 5 ... ... ... 2 2 1 ... ... 7 Small-pox ... ... ... ... ... ... ... ... ... ... Measles 26 7 12 4 2 ... ... i ... 1 Scarlet Fever 13 1 ... 2 5 4 i ... ... 27 Whooping Cough 53 24 20 9 ... ... ... ... ... 9 Diphtheria and Croup... 41 ... 3 13 24 1 ... ... ... 69 Influenza 58 2 ... 2 2 1 7 15 29 3 Erysipelas 11 2 ... ... ... 1 3 3 2 1 Phthisis (Pulmonary Tuberculosis) 305 1 1 2 5 52 143 79 22 81 Tuberculous Meningitis 42 6 7 11 15 3 ... ... ... 3 Other Tuberculous Diseases 42 3 6 7 5 5 6 9 I 15 Cancer, malignant disease 393 ... 1 1 2 3 46 170 I70 90 Rheumatic Fever 16 ... ... ... 3 7 5 1 ... ... Meningitis 21 8 2 2 2 2 1 4 ... 2 Organic Heart Disease 329 ... ... ... 10 14 34 118 153 61 Bronchitis 231 24 7 5 ... 1 11 49 134 29 Pneumonia (all forms) 244 64 26 23 7 6 29 39 50 53 Other diseases of Respiratory organs 45 5 ... 3 4 1 9 10 13 10 Diarrhœa and Enteritis 186 136 25 7 3 ... 3 4 8 4 Appendicitis and Typhlitis .. 17 ... ... ... 4 1 5 7 ... 2 Cirrhosis of Liver 35 ... ... ... ... ... 1 21 13 3 Alcoholism 11 ... ... ... ... ... 6 4 1 2 Nephritis and Bright's Disease 135 ... ... ... 3 3 23 49 57 18 Puerperal Fever 9 ... ... ... ... 1 8 ... ... 3 Other accidents and diseases of Pregnancy and Parturition 14 ... ... ... ... 2 12 ... ... 1 Congenital Debility and Malformation, including Premature Birth 249 243 3 1 1 ... 1 ... ... 12 Violent Deaths, excluding Suicide 91 6 1 7 5 9 23 21 19 36 Suicides 22 ... ... ... ... 3 8 8 3 9 Other Defined Diseases 1,012 56 14 7 17 19 113 237 549 464 diseases ill-defined or unknown 8 1 ... ... ... ... ... 4 3 3 3.664 589 128 106 12 r 141 499 853 1,227 1,018 Sub-Entries included above figures. Cerebro-spinal Meningitis 1 ... ... ... ... ... 1 ... ... ... Polio-Myelitis ... ... ... ... ... ... ... ... ... ... Tetanus 2 ... ... ... ... ... ... 2 ... ... Glanders ... ... ... ... ... ... ... ... ... ... Syphilis 19 9 1 ... 1 ... 6 1 1 1 30 Report of the Medical Officer of Health. TABLE XIX. (Table IV.) Borough of Wandsworth. infam Mortality. 1914. 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 143 33 28 *7 221 94 122 85 64 586 Uncertified 2 ... ... 1 3 ... ... ... ... 3 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 2 5 7 Scarlet Fever ... ... ... ... ... ... ... ... 1 1 Whooping Cough ... ... ... ... ... 5 4 10 5 24 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... 2 ... ... 2 Tuberculous Meningitis ... ... ... ... ... ... 2 3 1 6 Abdominal Tuberculosis ... ... ... ... ... 2 1 ... ... 3 Other Tuberculous Diseases ... ... ... ... ... ... ... ... 1 1 Meningitis (not Tuberculous) ... 1 ... ... 1 1 ... 5 1 8 Convulsions 5 4 ... 1 10 3 3 3 2 21 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 2 3 5 3 10 6 ... 24 Pneumonia (all forms) 3 1 2 1 7 10 16 16 *5 64 Diarrhoea ... 1 ... 3 4 12 27 13 10 66 Enteritis ... 1 1 ... 2 13 33 16 16 70 Gastritis ... ... ... ... ... 4 3 2 2 11 Syphilis ... 1 2 1 4 3 2 ... ... 9 Rickets ... ... ... ... ... ... ... 1 ... 1 Suffocation, overlying ... ... ... ... ... 3 2 ... ... 5 Injury at birth 8 ... ... ... 8 ... ... ... ... 8 Atelectasis 8 ... ... 1 9 ... ... ... ... 9 Congenital Malformations 8 4 4 1 17 3 ... 1 1 22 Premature birth 90 6 5 5 106 8 1 ... ... 115 Atrophy, Debility and Marasmus 20 12 9 3 44 20 20 3 2 89 Other Causes 3 1 3 ... 7 4 6 4 2 23 Totals 145 33 28 18 224 94 122 85 64 589 Nett Births in the year, legitimate, 6,396; illegitimate, 288. Nett Deaths in the year of legitimate infants, 514 ; illegitimate infants, 75. Report of the Medical Officer of Health. 31 Ages at Death. The following Table shows the percentage of deaths to total deaths at six age periods for each sub-district and for the whole Borough. TABLE XX. Sub-Districts. Under 1 year. 1 and under 5 years. 5 and under 15 years. >5 and under 25 years. 25 and under 65 years. 65 years and upwards. Clapham 13.25 5.62 3.88 3.61 39.05 34.59 Putney 13.10 3.51 4.15 2.87 41.22 35.15 Streatham 14.24 5.20 1.53 3.41 35.85 39.77 Tooting 26.70 10.19 5.09 4.85 33.26 19.91 Wandsworth 16.69 7.55 3.91 4.38 36.81 30.66 Whole Borough 16.07 6.38 3.30 3.84 36.89 33.22 Compared with 1913 the percentage of deaths under one year was .79 lower ; from one and under five years .16 lower ; from five and under 15 years 16 lower ; from 15 and under 25 years .47 higher ; from 25 and under 65 years .07 higher; and from 65 years and upwards 129 higher. There was a considerable diversity in these rates in the different sub-districts. In Putney the rate under one year was only 13.10 while in Tooting it was 26.70 ; while over 65 years of age Tooting had a rate of 19.91 and Streatham of 39.77. At one and under five years the rate was lowest in Putney 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 Tooting, 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. 32 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, Diarrhcea and Enteritis. Infantile Mortality. The total number of deaths of infants under one year was 589, compared with 605 in 1913, 516 in 1912, and 823 in 1911, and is 216 under the decennial average corrected for increase of population. Of these, 92 occurred in Clapham, 41 in Putney, 167 in Streatham, 110 in Tooting, and 179 in Wandsworth. The infantile mortality or deaths under one year to 1,000 births, was 88 compared with 88 in 1913, 76 in 1912, and 122 in 1911. This rate was 76 in Clapham, compared with 96 the decennial average ; 87 in Putney, compared with 85 ; 86 in Streatham, compared with 85 ; 114 in Tooting, compared with 123 ; and 84 in Wandsworth, compared with 108. In the whole Borough the rate was the same as that for 1913, but 13 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 Wandsworth. In Tooting the rate was higher than in any of the other sub-districts, but was nine under the decennial average. Report of the Medical Officer of Health. 33 The following Table shows the number of deaths, the percentage to total deaths, the rate per 1,000 births for the year and for the three previous years for each sub-district and for the whole Borough. TABLE XXI. Sub-District. No. of Deaths under one year. Percentage to total Deaths. Rate per 1,000 Births. 1911 1912 1913 1914 Clapham 92 13.25 119 76 82 76 Putney 41 13.10 145 69 85 87 Streatham. 167 14.24 99 58 74 86 Tooting 110 26.70 116 100 9 114 Wandsworth 179 16.67 143 83 103 84 Whole Borough 589 16.07 122 76 88 88 34 Report of the Medical Officer of Health. Table XXII. shows this mortality for the 10 years 1904-1913 in each of the sub-districts and in the whole Borough, and the decennial average, compared with the present year. TABLE XXII. Clapham. Putney. Streatham. Tooting. Wandsworth Borough. 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 ll6 143 122 1912 76 69 58 100 83 76 1913 82 85 74 91 103 88 Average 96 104 85 123 108 101 1914 76 87 86 114 84 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 6,684 of which 6,396 were legitimate and 288 illegitimate, and of deaths 589, of which 514 were legitimate and 75 illegitimate. From the notifiable infective diseases three deaths occurred during the year, one from Scarlet Fever in Wandsworth, and two from Erysipelas, one in Clapham and one in Wandsworth, 35 Report of the Medical Officer of Health. From Measles there were seven deaths, a considerable decrease compared with the previous year. From Whooping Cough there were 24 deaths, from Diarrhœal diseases 136, from Premature Birth 115, from other diseases of infancy 128, from Tuberculous diseases 10, from diseases of the Respiratory Organs 88, from Convulsions 21, from Syphilis nine, from Suffocation (overlying) five, and from other causes 43. Compared with 1913 there has been an increase in the number of deaths from Diarrhoea, Whooping Cough, Premature Birth, and other diseases of infancy, but a decrease in the number from Measles and diseases of the Respiratory Organs. In all the deaths, with three exceptions, one in Clapham, one in Streatham, and one in Tooting, the cause of death was certified by a medical man, or by a coroner after inquest. 38.0 per cent, of the deaths occurred in the first month, compared with 377 in 1913, 4 47 in 1912, and 29 5 in 1911; 55.0 in the first three months, compared with 56 0, 65 3, and 43.7 ; and 75.7 in the first six months, compared with 74.2, 80.6, and 65.9. The Table shows that 115 died from Premature Birth, of which 106 occurred under one month, and 111 from Congenital Debility and Malformations, compared with 113 in 1913, 103 in 1912, and 146 in 1911. Of the total deaths under one month, viz. :—224, 106 occurred from Premature Birth and 61 from Congenital Debility and Malformations, a percentage of 74 5 compared with 74.5 in 1913. From Diarrhoeal diseases only six deaths occurred under one month. The greatest mortality from these diseases occurred at four weeks to three months and three to six months. 36 Report of the Medical Officer of Health. From Tuberculous diseases 10 deaths occurred ; six from Tuberculous Meningitis, and four from other Tuberculous diseases, compared with five in 1913, and eight in 1912 ; and 88 from diseases of the Respiratory Organs, compared with 121. Eight deaths were registered as due to Meningitis, but enquiries of the medical attendant showed that all these were due to simple Meningitis. Table XXIII. shows the proportion of deaths per 1,000 births from five groups of diseases for each week under one month, from one to three months and for each three months up to one year of age. Compared with 1913, the rate from Diarrhoeal diseases was slightly higher, the rate having been 20 26 per 1,000 compared with 19.27 in 1913. From Premature Birth, Congenital Debility and Malformations the rate was higher than in 1913, and this was also the case from Tuberculous diseases, while from other causes the rate was slightly lower. From the Table it will be seen that the rate from common infective diseases was highest at the ages six to nine months, from Diarrhoeal diseases at three to six months, from Premature Birth, etc., under one month, from Tuberculous diseases at three to six and six to nine months, and from other causes at three to six months. Report of the Medical Officer of Health. 37 TABLE XXIII. Causes of Death. Under l Week. 1 and under 2 Weeks 2 and under 3 Weeks 3 and under 4 Weeks Under i Month. and under 3 Months 3 and under 6 Months 6 and under q Months 9 and under 12 Months. Total under 1 year. I. Common Infective Diseases ... ... ... ... ... .74 .89 1.79 1.64 5.08 II. Diarrhœal Diseases ... .29 .14 .44 .89 3.72 7.45 4.32 3.87 20.26 III. Premature Birth, Congenital Debility and Malformations 17.58 327 268 1.34 24.88 4.61 3.12 .58 .44 33.67 IV. Tuberculous Diseases ... ... ... ... ... .29 .44 .44 .29 1.49 V. Other causes 4.02 1.34 1.34 .89 7.60 4.62 6.26 5.5i 3.27 27.37 All causes 21.60 490 416 2.67 33.37 13.98 18.16 12.64 9.5 87.87 38 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 XXIV. 1909. 1910. 1911- 1912. 1913- Five years average. I914. Rate per 1,000 births 86 78 122 76 88 88 88 Percentage of above:— Under one week 22.4 27.1 16.3 28.7 24.9 23.8 24.6 1 and under 2 weeks 6.5 5.7 3.5 5.6 5.8 4.8 5.6 2 and under 3 weeks 4.5 3.7 5.2 5.5 3.9 4.5 4.8 3 and under 4 weeks 4.0 4.4 4.5 5'.1 3.1 4.2 3.0 Under 4 weeks 37.4 40.9 29.5 44.7 37.7 38.0 38.0 From 4 to 13 weeks 16.9 18.5 14.2 20.5 18.3 17.7 15.9 From 3 to 6 months 18.7 16.9 22.2 15.4 18.2 18.3 20.7 From 6 to 9 months 15.5 14.5 16.8 9.7 12.9 13.9 14.5 From 9 to 12 months 11.5 9.2 17.8 9.7 12.9 12.2 10.9 Under 12 mouths 100.0 100.0 100.0 100.0 100.0 100.0 100.0 The Infantile Mortality for the year, although it does not show any reduction from the average of the last 5 years, yet is below what might have been anticipated seeing that the climatic conditions were during the summer months most favourable to the production of Diarrhoeal diseases. 39 Report of the Medical Officer of Health. INFECTIVE DISEASES The next Table shows the number of deaths from these diseases during the year and for the 10 previous years. This Table is corrected for Institutions, as a large number of deaths registered in the Borough occurred in the Grove Fever Hospital and belong to other Metropolitan Boroughs. The number above or below the corrected decennial average is also shown. TABLE XXV. 1904 1905 I906 1907 1908 1909 1910 1911 1912 1913 1914 1914 No. above corrected average. No. below corrected average. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 13 28 19 22 21 14 12 10 11 11 13 ... 5.0 Diphtheria 41 31 50 41 37 29 16 34 18 18 41 5.0 ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 11 11 15 10 7 6 8 9 8 5 5 ... 5.2 Cont'd Fever ... 1 1 1 2 1 3 ... ... ... ... ... ... Puerpl. Fever 5 8 11 10 6 10 5 8 11 13 9 1.0 ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 13 14 10 10 6 8 4 10 5 6 11 1.2 ... Measles 104 89 65 68 45 108 44 230 51 116 26 ... 78.8 Whooping C. 48 75 55 105 59 67 68 66 57 23 53 ... 18.0 Influenza 57 41 70 88 82 89 55 24 45 59 58 ... 12.6 Diarrhœa 301 203 307 127 183 120 88 350 85 168 186 ... 34.2 Tuberculous Diseases 380 360 376 352 382 362 351 389 366 355 389 ... 63.9 Other In- fective Diseases 11 16 16 10 11 14 13 24 28 23 33 4.0 ... Totals 984 877 995 844 841 828 667 1154 685 797 824 ... 164.6 The total number of deaths from these diseases was 824, 144 in Clapham, 54 in Putney, 228 in Streatham, 126 in Tooting, and 272 in Wandsworth, an increase of 27 compared with 1913, but a decrease of 164 compared with the corrected decennial average. Compared with 1913 there has been an increase in the number of deaths from Scarlet Fever, Diphtheria, Tuberculous diseases, 40 Report of the Medical Officer of Health. Erysipelas, Whooping Cough, Diarrhoea and other infective diseases, and a decrease in the number of deaths from Puerperal Fever, Measles, and Influenza, while the number of deaths from Enteric Fever is the same. Compared with the corrected decennial average there has been an increase in the number of deaths from Diphtheria, Puerperal Fever, Erysipelas, and other infective diseases, but a decrease in all the others. From all infective diseases the death-rate was 2.21 per 1,000, (2.32 in Clapham, 1.85 in Putney, 2.20 in Streatham, 3.35 in Tooting, and 2.85 in Wandsworth), compared with 2.43 in 1913, and 3.44 the decennial average. The rate from the principal infective diseases, viz.:—Smallpox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever, and Diarrhoea, was 99 per 1,000 (.79 in Clapham, 72 in Putney, 75 in Streatham, 1.70 in Tooting, and 1.17 in Wandsworth), compared with 1.04 in 1913, 1.73 in 1912, and 2.26 in 1911. The rate from these diseases was lower than in 1913 owing to the decrease in the number of deaths from Measles, Whooping Cough and Diarrhoea. In out-lying Institutions 310 deaths occurred from infective diseases (50 belonging to Clapham, 15 to Putney, 83 to Streatham, 54 to Tooting, and 108 to Wandsworth), compared with 281 in 1913. Of these deaths 178 occurred in Workhouse Infirmaries, 101 in General and Special Hospitals, 18 in Public Lunatic Asylums, and 13 in the Hospitals of the Metropolitan Asylums Board. The causes of death in these Institutions is shown in Table X. In Institutions in the Borough 167 deaths from infective diseases occurred of persons not belonging thereto, compared with 183 in 1913. Report of the Medical Officer of Health. 41 Of these deaths 76 occurred in the Fever Hospital, 21 from Scarlet Fever, 43 from Diphtheria, six from Whooping Cough, five from Tuberculous diseases, and one from Diarrhoea. 24 deaths from these diseases occurred in the Middlesex County Asylum, 21 from Tuberculous diseases, one from other infective diseases, and one from Diarrhoea; nine in the Tooting Bee Asylum, seven from Tuberculous diseases, one from Erysipelas, and one from other infective diseases; 17 in the Hostel of God, all from Tuberculous diseases; 12 in the Tooting Home, all from Tuberculous diseases; one in the Royal Hospital for Incurables from Tuberculous disease; 14 in the Fountain Asylum, 13 from Tuberculous diseases, and one from Whooping Cough; one in St. Anne's Home from Tuberculous disease; two in Putney Hospital from Tuberculous diseases; and one in Newland's House from Tuberculous disease. In other places not Institutions 10 deaths occurred, six from Tuberculous diseases, two from Enteric Fever and two from Influenza. In Institutions in the Borough 60 deaths from infective diseases occurred of persons belonging thereto, 45 in the Fever Hospital at Tooting, six from Scarlet Fever, five from Enteric Fever, 26 from Diphtheria, two from Whooping Cough, three from Puerperal Fever, two from Tuberculous diseases, and one from other infective diseases; six in the Tooting Home, all from Tuberculous diseases; two in the Putney Hospital, one from Tuberculous disease, and one from other infective diseases; three in the Hostel of God, from Tuberculous diseases and one in other place from Measles. Compared with 1913 this shows a decrease of 27. The next Tables shows the death rates from these diseases for the whole Borough and for each sub-district for the year 1914, as well as for the preceding 10 years, and the rates above or below the decennial average are also shown. 42 Report of the Medical Officer of Health. TABLE XXVI. Sub-Districts. 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1914 Rate above decennial average. Rate below decennial average. Clapham 3.77 3.06 3.67 2.66 2.82 2.87 2.09 3.69 2.41 2.19 2.32 ... .60 Putney 3.02 3.32 3.19 2.36 2.36 2.58 2.36 2.57 1.92 2.10 1.85 ... .72 Streatham 2.90 2.44 2.88 2.18 2.58 2.05 1.82 2.89 1.60 1.83 2.20 ... .11 Tooting 5.82 5.47 6.17 5.53 3.90 4.04 2.56 4.84 2.60 3.16 3.35 ... 1.05 Wandsworth 4.83 4.01 4.16 3.76 3.39 3.35 2.57 4.65 2.56 3.04 2.85 ... .78 Borough 3.90 3.38 3.73 3.07 2.98 2.85 2.23 3.74 2.18 2.43 2.21 ... .83 The death-rate was thus .22 below the rate for 1913, and .83 below the decennial average. The rate in Clapham, Streatham and Tooting was higher, and in Putney and Wandsworth lower, 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 28. The number of cases notified in this Borough for the year and for the previous 10 years is shown in the following Table, as also the number above or below the corrected decennial average. 43 Report of the Medical Officer of Health. TABLE XXV11. 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1914 No. above decennial average. No. below decennial average. Small-pox 6 1 ... ... ... ... ... ... ... ... ... ... .79 Scarlet Fever 774 1494 1069 1330 1232 987 687 869 833 971 1417 250 ... Diphtheria 406 348 566 629 581 380 284 510 431 430 552 30 ... Typhus Fevers. ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric 70 96 96 70 60 66 54 58 71 50 48 ... 30 Continued 3 1 1 ... ... 2 ... 5 2 2 ... ... ... Relapsing ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal 14 18 25 25 14 26 20 24 27 32 30 5 ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 267 253 273 213 203 192 182 202 207 204 234 ... 15 Cerebrospinal Meningitis ... ... ... 3 5 4 5 5 3 9 3 ... .8 Polio-Myelitis ... ... ... ... ... ... ... 5 5 13 3 .4 ... Ophthalmia Neonatorum ... ... ... ... ... ... ... 34 35 37 51 ... ... Total 1540 2211 2030 2270 2095 1657 1232 1712 1614 1748 2338 275 ... 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. 44 Report of the Medical Officer of Health. TABLE XXVIII. 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 1,417 1,215 11 2 13 Erysipelas 234 40 7 4 11 Diphtheria 552 464 33 8 41 Enteric Fever 48 30 5 ... 5 Continued Fever ... ... ... ... ... Puerperal Fever 30 24 5 4 9 Cerebro-spinal Meningitis 3 1 ... 1 1 Polio-Myelitis 3 1 ... ... ... Ophthalmia Neonatorum 51 5 ... ... ... Total 2,338 1,780 61 19 80 No cases of Small-pox were notified during the year, none in 1906, 1907, 1908, 1909, 1910, 1911, 1912 or 1913, one in 1905, six in 1904, and 28 in 1903. 1,417 cases of Scarlet Fever were notified, compared with 971 in 1913, 833 in 1912, and 869 in 1911; of Diphtheria 552 compared with 430, 431 and 510; of Enteric Fever 48, compared with 50, 71 and 58; of Puerperal Fever 30 compared with 32, 27 and 24; and of Erysipelas 234, compared with 204, 207 and 202. Compared with 1913 there has been an increase in the number of cases of Scarlet Fever, Diphtheria, Erysipelas and Ophthalmia Neonatorum, and a decrease in the number of cases of Enteric Fever, Puerperal Fever, Cerebro-spinal Meningitis and PolioMyelitis. Compared with the corrected decennial average there has been an increase in the number of cases of Scarlet Fever, Diphtheria, Puerperal Fever, and Polio-Myelitis; and a decrease in the number of cases of Enteric Fever, Erysipelas, and Cerebro-Spinal Meningitis. 45 Report of the Medical Officer of Health. The total number of cases notified was 2,338, (327 in Clapham, 214 in Putney, 523 in Streatham, 411 in Tooting, and 863 in Wandsworth), compared with 1,748 in 1913, 1,614 in 1912, and 1,949 in 1911. 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 1904 and 1911 Chicken-pox was compulsorily notifiable, and as a consequence the rates in these years are increased, especially, in 1914. 46 Report of the Medical Officer of Health. TABLE XXIX. Sub-districts. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1912. 1913. Decennial Average. 1914. Clapham 7.63 7.34 6.28 6.43 6.61 5.60 3.35 6.???6 4.74 5.54 6.05 5.28 Putney 5.29 3.47 3.76 6.29 4.39 3.13 2.86 3.77 5.11 3.08 4.11 7.34 Streatham 8.29 5.91 6.07 6.88 5.07 5.85 3.64 4.83 4.20 3.57 5.43 5.07 Tooting 10.13 21.24 15.20 19.5 12.98 8.29 6.39 8.79 8.54 7.06 11.78 10.09 Wandsworth 13.97 13.02 9.02 8.15 9.62 5.52 4.70 7.35 5.20 5.82 8.23 9.07 Whole Borough 9.65 8.53 7.61 8.28 7.42 5.70 4.12 6.32 5.14 5.35 6.81 7.15 London 6.1 7.2 7.7 8.92 7.70 6.42 4.77 6.5 5.4 6.94 6.76 9.15 47 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; one case of Erysipelas from H.M. Prison; one case of Scarlet Fever, six cases of Enteric Fever and two cases of Erysipelas were notified from the Middlesex County Asylum; one case of Enteric Fever from the Putney Hospital; 14 cases of Scarlet Fever and eight cases of Diphtheria from the Fountain Asylum; 34 Scarlet Fever, eight Diphtheria, and one Erysipelas from the Grove Hospital; four cases of Scarlet Fever and two of Diphtheria from the Tooting Bec Asylum; 30 Scarlet Fever and four Diphtheria from the Royal Patriotic Schools; 11 Scarlet Fever from the Notre Dame, Clapham Common; four cases of Scarlet Fever from the Intermediate Schools, Swaffield Road; two cases of Scarlet Fever from the Third London General Hospital; one case of Scarlet Fever and one of Diphtheria from the Home for Little Boys, King's Avenue, Clapham Park; and one case of Erysipelas from the Tooting Home. 48 Report of the Medical Officer of Health. TABLE XXX. Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Puerperal Fever. Ophthalmia Neonatorum. Polio- Myelitis. Total. St. John's Infirmary 9 3 ... 9 ... 4 ... 25 St. James's Infirmary ... ... 1 18 3 1 ... 23 St. Thomas's Hospital 2 4 ... 9 2 ... 1 18 Belgrave Hospital 4 5 ... 1 ... 2 ... 12 London Fever Hospital 10 1 ... ... ... ... ... 11 South Western Hospital 5 2 ... ... ... ... ... 7 Royal Eye Hospital ... ... ... ... ... 6 ... 6 Victoria Hospital 1 3 ... ... ... ... ... 6 Bolingbroke Hospital 2 2 ... ... ... ... ... 4 Western Hospital 1 2 1 ... ... ... ... 4 Evelina Hospital 1 1 ... ... ... ... ... 2 University College Hospital ... 2 ... ... ... ... ... 2 Westminster Hospital ... 2 ... ... ... ... ... 2 Central London Ophthalmic Hos. 1 ... ... ... ... ... ... 1 Brompton Hospital ... 1 ... ... ... ... ... 1 Fulham Infirmary ... ... ... ... ... ... ... 1 St. Bartholomew's Hospital ... 1 ... ... ... ... ... 1 St. George's Hospital ... ... ... ... ... 1 ... 1 South London Hospital for Women ... 1 ... ... ... ... ... 1 Throat Hospital, Golden Square 1 ... ... ... ... ... ... 1 Waterloo Hospital ... 1 ... ... ... ... ... 1 Totals 37 31 2 40 5 14 1 130 There has been a slight increase in the number of these notifications compared with 1913 when 128 cases were notified, compared with 130 in 1914. There was a decrease in the number of cases of Enteric Fever, Polio-Myelitis, Puerperal Fever, and Ophthalmia Neonatorum, and an increase in the number of cases of Scarlet Fever, Diphtheria and Erysipelas. 49 Report of the Medical Officer of Health. The greatest number of cases notified, viz.:-25, was received from the St. John's Infirmary, nine of these being Erysipelas, nine of Scarlet Fever, four of Ophthalmia Neonatorum, and three of Diphtheria. Of the 14 cases of Ophthalmia Neonatorum notified, six were from the Royal Eye Hospital, and four from St. John's Infirmary. Vaccination. Table XXXI. is taken from the official returns of the Vaccination Officers to the Board of Guardians for the year 1913. It shows the number of children successfully vaccinated for the whole Borough, as well as for the separate sub-districts. Streatham, Balham and Tooting are included under the heading of Streatham. TABLE XXXI. SubDistricts. Number of Births returned from 1st January to 31st of December, 1913. Successfully Vaccinated. Insusceptible of Vaccination. Had Small-pox. Dead, Unvaccinated. Certificates of Conscientious objection. Postponed by Medical Certificate. Removed to District. Vaccination Officer of which lias been duly apprised. Removed to places unknown, or which cannot be traced; and cases not having been found. Remaining on Books as Unvaccinated. Clapham 1,196 579 1 ... 70 357 12 16 142 19 Putney 464 335 1 ... 29 89 1 5 4 ... Streatham 2,733 872 4 ... 137 617 6 ... 110 987 Wands w'th 2,146 1,163 6 ... 138 479 25 52 264 19 Totals 6,539 2,949 12 ... 374 1,542 44 73 520 1,025 During the year 1913, of 6,539 children whose births were registered, 2,949 or 45.1 per cent. were successfully vaccinated, compared with 52.0 per cent. in 1912, 56.3 per cent. in 1911, and 56.1 per cent. in 1910. This is again a decided decrease compared with the five previous years, and is much the lowest rate on record 50 Report of the Medical Officer of Health. 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 1913, as well as for the 10 years 1903-1912. The average for the 10 years is also shown on this Table. Compared with 1912 there has been a decrease in the percentage of successfully vaccinated in all the sub-districts. The greatest decrease occurred in Streatham, while in the whole Borough there has been a decrease of no less than 6.9 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. 374 infants died unvaccinated, a percentage of 5.7 compared with 6.3 in 1912, 8.8 in 1911 and 6.2 in 1910. Of the 3,216 infants remaining, 12 or .18 per cent. were stated to have been insusceptible of vaccination; 1,542 or 23.5 per cent. in respect of whom certificates of conscientious objection were received; 44 or .67 per cent. had vaccination postponed by medical certificate, leaving 593 or 9.0 per cent. as removed, not to be traced, or otherwise unaccounted for, compared with 12.8 in 1912, 11.4 in 1911, and 13.6 in 1910; while 1,025 or 15.6 per cent, remained on the books as unvaccinated, compared with 6.9 in 1913, 3.6 in 1911, and 3.3 in 1910. There has been a decrease of 3.8 in the percentage of cases removed, but an increase of 3.2 in the number of certificates of conscientious objections received, and of 8.7 in the number of cases remaining on the books as unvaccinated. It is to be specially noted that out of the total number of cases remaining on the books as unaccounted for, no less than 987 were in the Streatham Sub-District, while in the Putney Sub-District all the births were accounted for, 51 Report of the Medical Officer of Health. TABLE XXXII. Sub-Districts. 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 Average for Ten Years. 1913 Clapham 68.2 62.9 68.8 59.9 55.1 51.9 55.1 56.4 52.7 51.2 58.2 48.4 Putney 86.5 83.4 88.1 86.7 83.6 85.0 80.4 80.0 75.5 75.8 82.5 72.2 Streatham 66.9 69.2 69.7 66.9 62.3 54.5 52.8 45.0 50.7 42.1 58.0 31.9 Wandsworth 81.7 82.8 80.9 78.7 74.5 69.1 68.9 64.1 61.1 59.3 72.1 54.2 Borough 73.7 73.5 74.6 71.05 66.5 61.3 60.9 56.1 56.3 52.0 64.6 45.1 The returns for the year 1913 again 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, especially in Streatham and Tooting Sub-Districts, is from a public health point of view, a most unsatisfactory one. 52 Report of the Medical Officer of Health. TABLE XXXIII. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1912. 1913. Acceptance of Vaccination— England and Wales 75.3 75.8 73.4 70.9 62.2 59.8 55.8 52.3 ... ... Metropolitan Unions 69.7 71.7 68.1 65.9 63.0 61.6 58.3 ... ... ... Wandsworth 73.5 74.6 71.0 66.5 61.3 60.9 56.1 56.3 52.0 45.1 Abstention from Vaccination (including exempted, postponed, and remaining)— England and Wales 14.5 14.8 16.8 20.4 27.9 32.3 36.3 38.9 ... ... Metropolitan Unions 20.2 20.1 21.7 25.8 28.8 30.7 34.1 36.6 41.0 ... Wandsworth 17.3 16.6 20.6 26.5 31.2 32.3 37.4 34.5 41.5 49.0 Exemptions alone— England and Wales 4.3 4.8 5.8 8.4 17.0 21.6 26.0 20.5 ... ... London 1.1 1.2 1.5 3.1 7.3 10.1 13.5 15.8 20.0 ... Wandsworth 1.9 2.0 2.6 4.1 8.0 10.8 14.5 16.9 20.3 23.5 53 Report of the Medical Officer of Health. Scarlet Fever. 1,417 cases of Scarlet Fever were notified during the year, compared with 971 in 1913, 833 in 1912, and 869 in 1911. 195 of these were in Clapham, 140 in Putney, 332 in Streatham, 250 in Tooting, and 500 in Wandsworth. 1,215 or 85 per cent, of these cases were removed to hospital where 11 died, and 202 or 15 per cent. were treated at home with two deaths. The total number of deaths was 13, of which two were in Clapham, one in Putney, four in Streatham, one in Tooting, and five in Wandsworth. The death-rate per 1,000 population was .03, compared with .03 in 1913. The percentage of cases removed to hospital, viz.:—85, is lower than in 1912 and 1913, but higher than in 1911 when it was 83. per cent. The case mortality was .91 per cent., compared with 1.13 in 1913, 1.32 in 1912, and 1.15 in 1911, and is the lowest yet recorded. The mortality among cases removed to hospital was .90 per cent., compared with 1.18 in 1913, and among those treated at home .99 per cent. compared with .80 in 1913. The mortality among the home-treated cases was thus higher 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. 54 Report of the Medical Officer of Health. TABLE XXXIV. Sub-Districts. 1911 1912 1913 1914 Clapham 2.88 2.24 3.33 3.15 Putney 1.72 1.43 1.50 4.37 Streatham 2.27 2.32 2.72 3.21 Tooting 3.64 5.80 4.10 6.11 Wandsworth 3.39 2.42 3.00 5.25 Whole Borough 2.82 2.65 2.97 4.33 London 2.32 2.50 3.88 5.64 In all the sub-districts the rate was higher than in 1913, with the exception of Clapham where it was lower, while for the whole Borough it was 1.36 per 1,000 above the rate for the previous year. In Clapham the greatest number of cases was notified in January and November, and the smallest in September and October. In Putney the greatest number of cases was notified in November, in Streatham in February, in Tooting in October, and in Wandsworth in December. The rate in Tooting was to some extent raised by the notification of cases from the Fever Hospital. The total number of cases notified from this Institution was 34, so that the rate instead of being 6.11 would on that account be reduced to 5.74 in 1914, and 3.44 in 1913. In the whole Borough the greatest number of cases, viz.—168, was notified in November, and the smallest in August, viz.—71. 55 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 1914 and for the whole year. TABLE XXXV. SubDistricts. January. February. March. April. May. June. July. August. September. October. November. December. Whole Year. Clapham 32 16 19 12 14 14 9 15 11 11 23 19 195 Putney 4 10 6 2 2 2 6 5 12 17 42 32 140 Streatham 30 34 28 33 29 26 12 14 28 37 31 30 332 Tooting 19 20 19 17 6 16 17 14 25 43 31 23 250 Wandsworth 25 53 45 23 37 50 36 23 56 51 41 60 500 Whole Borough 110 133 117 87 88 108 80 71 132 159 168 164 1,417 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.—1,417, the diagnosis was incorrect in 57 or 4.0 per cent.; 797 or 56.2 per cent. were in attendance at schools in the Borough; 54 or 3.8 per cent. attended schools outside the Borough; while 509 or 35.9 per cent. did not attend school, being either over or under school age. 5& Report of the Medical Officer of Health. The percentage of children attending school in the Borough was as follows:—in Clapham, 124 out of 195, or 63 per cent.; in Putney, 76 out of 140, or 54 per cent.; in Streatham, 187 out of 332, or 56 per cent.; in Tooting, 125 out of 250, or 50 per cent.; and in Wandsworth, 285 out of 540, or 57 per cent. The percentage of cases in the Borough in attendance at school was higher than in 1913, while in the sub-districts the percentage was higher in all, with the exception of Tooting, where it was lower. 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 Bonneville Road with 16 cases, Cavendish Road with 12 cases, and Larkhall Lane, Parochial, Old Town, and Telferscot Road with 11 cases each. In Putney, of the 76 cases, 39 were in attendance at Hotham Road, nine at All Saints', eight at St. Mary's, and 10 at private schools. In Streatham the schools chiefly affected were Oldridge Road with 26 cases, Eardley Road and Smallwood Road with 17 cases each, St. Mary's with 13 cases, and Hearnville Road and Holy Trinity with 10 cases each. 33 of the cases were in attendance at private schools, these chiefly occurring in March, May and December. In Tooting, Franciscan Road with 27 cases, Sellincourt Road and Tooting Graveney with 20 cases each, and Ensham Street with 19 cases, were the schools principally attacked during the year. In Wandsworth, Swaffield Road with 45 cases, the Wandle with 29 cases, Brandlehow Road with 23 cases, West Hill with 16 cases, and Waldron Road with 15 cases, were the schools chiefly affected. 57 Report of the Medical Officer of Health. The Medical Officer of the London County Council excluded four children from two schools during the year, in April and May, until a medical certificate was received to the effect that the child was free from infectious disease. The homes of these children were visited, in some cases two or three times, to see that medical attendance was provided. It was necessary to carry out disinfection in Cavendish Road Special, Hotham Road, Swaffield Road, Larkhall Lane and several private schools, but in all these cases, with the exception of Hotham Road, the disinfection was carried out without closing the schools. Hotham Road, Swaffield Road, and Sellincourt Road Schools were closed one week in advance of the Christmas holidays on account of the prevalence of Scarlet Fever at these schools. 58 Report of the Medical Officer of Health. TABLE XXXVI. Schools. January. February. March. April. May. June. July. August. September. October. November. December. Totals. CLAPHAM. Aristotle Road ... 1 1 ... ... 1 ... ... ... 2 ... ... 5 Bonneville Road 2 2 3 2 1 ... ... ... ... ... 3 3 16 Cavendish Road ... 3 ... ... 2 1 1 1 1 1 ... 2 12 Christchurch 2 1 1 ... ... ... ... ... 1 ... 1 ... 6 Haselrigge Road 1 ... ... ... ... ... 1 2 ... ... 2 ... 6 Larkhall Lane ... 1 1 ... ... 5 3 ... ... ... 1 ... 11 New Park Road 2 2 1 ... ... ... ... ... ... ... ... ... 5 New Road 1 ... ... ... ... ... ... 1 ... ... 1 ... 3 Parochial, Macaulay Road 1 ... 1 ... ... ... ... ... ... ... ... ... 2 „ Old Town 6 1 1 ... ... ... ... 1 ... ... 1 1 11 St. Andrew's Street 1 ... ... 2 1 ... ... ... 1 ... 1 ... 6 St. Mary's, Crescent Lane ... ... ... ... ... ... ... ... ... 2 ... ... 2 „ St. Alphonsus Road ... ... ... ... ... ... 1 1 ... ... ... ... 2 Telferscot Road ... ... 2 ... 1 ... 1 ... 2 1 3 1 11 „ Special ... ... ... ... ... ... 1 ... ... ... ... ... 1 Wirtemberg Street ... 1 ... ... ... 1 ... 1 ... ... ... 1 4 Private Schools 3 2 1 ... ... ... ... ... ... ... 3 12 21 Total 19 14 12 4 5 8 8 7 5 6 16 20 124 PUTNEY. All Saints' ... ... ... ... ... 1 ... ... 6 ... 2 ... 9 Convent of the Sacred Heart ... 2 1 ... ... ... 2 ... ... ... ... ... 5 Hotham Road ... ... ... ... ... ... ... ... ... 9 21 8 39 Roehampton National, Boys ... ... ... ... ... ... ... ... ... 1 2 ... 3 „ „ Girls ... ... ... ... 1 ... ... ... ... ... ... 1 2 St. Mary's 1 ... ... ... ... ... ... ... 1 1 3 2 8 Private Schools ... 2 1 ... ... ... 2 ... ... ... 5 ... 10 1 4 2 ... 1 1 4 ... 8 11 33 11 76 STREATHAM. Broadwater Road ... ... ... ... ... 1 ... ... ... 1 2 2 6 „ Special ... ... 1 ... ... ... ... ... 1 ... ... ... 2 Christchurch 1 ... ... ... 1 ... ... ... 1 ... ... ... 3 Coventry Hall ... ... ... ... ... ... ... ... 1 ... ... ... 1 Eardley Road 3 3 4 1 1 ... 1 3 ... 1 ... ... 17 Fircroft Road 2 3 ... ... 1 2 ... ... 1 2 ... 1 12 Furzedown Demonstration 1 1 ... ... ... ... ... 1 1 1 1 2 8 Hearnville Road ... 1 ... 1 ... 1 ... ... 2 3 2 ... 10 Holy Trinity, Upper Tooting 1 1 1 1 1 ... ... 1 ... 2 1 1 10 „ Upper Tulse Hill 1 ... ... ... ... ... ... ... ... ... ... ... 1 Immanuel ... ... ... ... ... 1 ... ... 1 ... 1 ... 3 Mitcham Lane 1 1 ... 2 ... ... ... ... 2 2 1 ... 9 Oldridge Road 4 5 ... 3 ... 4 2 ... 4 ... 1 3 26 Roman Catholic, Nightingale Square ... ... 1 2 ... ... ... ... ... ... ... ... 3 St. Andrew's, Colmer Road ... ... ... ... ... ... ... ... ... ... 1 ... 1 „ Polworth Road ... ... 1 ... ... ... ... ... ... ... ... ... 1 St. Leonards ... ... ... ... 3 ... 1 ... ... ... ... ... 4 St. Mary's ... 1 1 3 1 1 ... ... 4 1 1 ... 13 Smallwood Road 1 1 1 ... 1 1 2 ... ... 4 4 2 17 Sunnyhill Road ... ... ... ... ... ... 2 ... 1 1 3 ... 7 Private Schools 1 2 5 4 5 3 ... ... 2 2 4 5 33 Total 16 19 15 17 14 14 8 5 21 20 22 16 187 Carried forward 36 37 29 21 20 23 20 12 34 37 71 47 387 59 Report of the Medical Officer of Health. TABLE XXXVI.—continued. Schools. January. February. March. April. May. June. July. August. September. October. November. December. Totals. Brought forward 36 37 29 21 20 23 20 12 34 37 71 47 387 TOOTING. Derinton Road 1 1 ... 2 2 1 1 ... 1 3 2 1 15 Ensham Street 7 1 2 ... ... ... ... ... 2 1 3 3 19 Fountain Road ... ... 3 ... ... ... 2 2 3 1 ... ... 11 Franciscan Road 6 4 1 2 1 4 1 ... 4 2 2 ... 27 Roman Catholic, Undine Street ... ... ... ... ... 1 ... ... 2 ... ... 3 6 Sellincourt Road ... 2 4 1 1 ... ... 1 1 6 2 2 20 Tooting Graveney ... 2 6 1 ... ... ... ... 1 6 1 3 20 Private Schools 1 2 1 1 ... ... ... ... 1 ... ... ... 7 Total 15 12 17 7 4 6 5 3 15 19 10 12 125 WANDSWORTH. Brandlehow Road ... 1 ... ... ... ... 2 3 9 2 ... 6 23 Cambourne Road ... ... ... 1 1 ... ... ... 2 1 1 1 7 Earlsfield ... 2 1 ... ... 1 1 ... 1 1 1 6 14 Elliott Central ... ... ... ... 2 ... ... ... ... 1 2 ... 5 Eltringham Street 1 1 ... 1 2 ... ... ... 1 3 2 3 14 Garratt Lane 2 1 2 2 ... 2 1 ... 1 2 ... ... 13 ,, Special ... ... ... ... ... ... ... ... ... 1 ... ... 1 Magdalen Road ... ... ... ... ... ... ... ... ... 1 ... ... 1 Merton Road 1 ... ... 1 2 1 ... 1 1 ... ... 2 9 Riversdale 1 ... 1 ... 2 2 ... 2 1 2 ... 2 13 St. Ann's ... ... ... ... ... ... ... 1 ... ... ... ... 1 St. Faith's ... ... ... ... 1 ... ... ... ... ... ... 1 4 St. Joseph's ... ... ... ... ... 1 1 ... ... ... ... ... 2 St. Michael's ... ... ... ... ... 2 ... ... 1 1 1 2 7 Southfields ... 1 2 ... 2 1 2 ... ... 1 ... 3 12 Swaffield Road 1 1 3 2 2 8 7 ... 7 1 4 9 45 Waldron Road ... 5 ... 2 1 1 ... ... 2 1 ... 3 15 Wandle 3 8 1 2 2 4 1 3 2 1 1 1 29 Warple Way ... ... ... ... ... ... 2 ... 1 ... ... ... 3 West Hill ... ... ... ... 2 ... ... 1 4 6 3 ... 16 Private Schools 1 10 18 6 2 ... 2 1 2 5 2 2 51 Total 10 30 28 17 21 23 19 12 37 30 17 41 285 Total—Schools in Borough 61 79 74 45 45 53 43 27 86 86 98 100 797 Schools Outside Borough 7 1 4 5 5 4 2 4 5 4 8 5 54 No School 40 47 38 31 35 50 26 39 35 66 53 49 509 Incorrect diagnosis 2 6 1 6 3 1 9 1 6 3 9 10 57 Grand Total 110 133 117 87 88 108 80 71 132 159 168 164 1,417 6o Report of the Medical Officer of Health The Chart facing this page shows the number of cases notified in each week during the year. The greatest number, viz.—50, was notified in the third week of October, and the smallest, 11, in the fourth week of April, and the third week of May. Of the total number of cases notified, viz.-—1,417, 11 or 77 per cent, were under one year, compared with seven, or 72 per cent, in 1913 ; 258 or i8'2 per cent, were from one and under five years, compared with 206 or 20"2 per cent. ; 910 or 64 2 per cent, from five and under 15 years, compared with 614 or 63 2 per cent. ; 154 or 10-9 per cent, from 15 and under 25 years, compared with 102 or 10 5 per cent. ; and 84 or 5-9 per cent, from 25 and under 65 years, compared with 42 or 4-3 per cent. The number of dwellings in each sub-district and in the whole Borough in which multiple cases occurred is shown in the following Table — TABLE XXXVII. Sub-Districts. One case. Two cases. Three cases. Four cases. Five cases and upwards. Total houses invaded. Clapham ... !45 18 1 i* 165 Putney 9i 11 4 2 i* 109 Streatham 241 28 8 1 i 279 Tooting ... '36 19 8 1 6* 170 Wandsworth 347 37 !3 4 2* 403 Whole Borough ... 960 113 34 8 11 1,126 * In Clapham 11 Cases occurred in an Institution. In Putney 7 ,, „ „ ,, In Tooting 35 Cases occurred in the Fever Hospital, and 11 in the Fountain Asyluin. In Wandsworth 30 cases occurred in an Institution. Of the 1,126 houses invaded, multiple cases occurred in 166, or 14 7 per cent., compared with 14-3 per cent, in 1913. CHART Showing the number of cases of Scarlet Fever. Diphtheria and Enteric Fever notified. as well as the total cases notifed from these diseases during each week of the year 1914 Report of the Medical Officer of Health. 61 The 11 cases which occurred in an Institution in Clapham were among the boarders at a school connected with a Convent in that sub-district. The first case was notified on the ist December and the last on the 24th, 11 cases in all being notified. The school was visited by the Deputv Medical Officer of Health in consultation with the Medical Attendant and an examination of the remaining children made. A child was then discovered in a peeling condition and was at once removed to hospital and no further cases followed. In Putney seven cases occurred among the resident scholars in connection with a Convent. The first case, which was infected by a visiting master who resided outside the borough, was notified on the 27th February and the other cases occurred at short intervals up to the 28th March. With the exception of the first case, which died, all the cases were of a mild type. A slight outbreak of Scarlet Fever occurred at the Royal Victoria Patriotic Schools, Wandsworth. The first case occurred on the 23rd February, and other cases occurred at short intervals up to the 21st April. In all 30 cases were notified, all of them being of a mild type and no deaths occurred. All precautions were taken and the Medical Officer in charge carried out daily examination of all contacts so that the outbreak was minimised to a large extent. Disinfection of the dormitories, bedding, etc., was carried out by the sanitary staff, and after the 21st April no cases occurred up to August, when the Institution was taken over by the Military Authorities as a General Hospital. During the year Scarlet Fever was exceedingly prevalent, not only in the Metropolis, but in the districts surrounding it. The rate of incidence in this Borough was considerably under that for the whole of London, the rate in the Borough being 4.33 and in London 5.64 per 1,000 of population. In the various sub-districts the rate was lowest in Clapham, next in Streatham, followed by Putney, Wandsworth and Tooting. 62 Report of the Medical Officer of Health. In spite of the fact that the number of cases notified was the highest recorded for many years, the case mortality was the lowest on record. The increase of work caused by the outbreak was very great, but in spite of the depletion of the staff on account of war services the usual inquiries were carefully carried out and all necessary precautions taken. During the months of October and November, and up to the nth December, the hospitals of the Metropolitan Asylums Board were quite full and the utmost difficulty was experienced in getting cases of Scarlet Fever removed. This condition of affairs was not at all conducive in checking the occurrence of the disease, as in several instances multiple cases occurred in households which were in all probability infected by the first case while awaiting admission to hospital. Diphtheria. The number of cases of Diphtheria notified during the year shows an increase compared with the previous year, and is also higher than 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 1904-1913 inclusive, the average for the 10 years, and the number of cases and deaths in 1914. 63 Report of the Medical Officer of Health. TABLE XXXVlll. YEAR. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1904 45 9 19 2 155 9 44 7 143 17 406 44 1905 65 5 7 5 121 7 41 6 104 8 348 31 1906 106 9 35 5 165 13 78 6 182 '7 566 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 1913 83 3 19 1 125 5 86 5 137 4 430 18 Average Ten Years—) 1904 to 1913 77 5 35 1 125 7 65 6 143 10 456 31 1914 66 6 57 4 91 4 107 4 231 23 552 41 64 Report of the Medical Officer of Health. The total number of cases notified was 552, (66 in Clapham, 57 in Putney, 91 in Streatham, 107 in Tooting, and 231 in Wandsworth), compared with 430 in 1913, 431 in 1912, and 510 in 1911. This number was 32 above the corrected, and 96 above the uncorrected decennial average. In all the sub-districts, (with the exception of Clapham and Streatham), there has been an increase compared with 1913, in Putney of 38, in Tooting of 21, and in Wandsworth of 94, while in Clapham the decrease was 17, and in Streatham 14. The greatest number of cases occurred in Wandsworth, and the smallest in Putney. I The number of cases notified per 1,000 of population was i-68, compared with 1.34 in 1913, 1.37 in 1912, and 1.65 in 1911 ; and in London 2.0, compared with 1.6, 1.57, 1.7, and 1.13. 464, or 84.0 per cent, of the cases were removed to hospital where 33 died, and 88 or 16 per cent, were treated at home with eight deaths. The case mortality was 7.4 per cent., compared with 4.2 in 1913, 4.1 in 1912, and 6.6 in 1911. The case mortality for the whole of London for the year 1914 was 7.7 per cent., compared with 5.6 in 1913, 7.4 in 1912, and 8.3 in 1911. The case mortality among cases treated in hospital was 7.1 per cent., and among those treated at home g-o 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, 65 Report of the Medical Officer of Health. TABLE XXXIX. Sub-Districts. Cases 1914. Case-rate per 1,000 living. Deaths 1914. Death-rate per 1,000 living. 1904 1913 1914 1904— 1913 1914 Clapham 66 1.4 1.0 6 .10 .09 Putney 57 1.2 1.9 4 .07 .13 Streatham 91 1.4 .8 4 .08 .03 Tooting 107 2.2 2.8 4 .20 .10 Wandsworth 231 1.5 2.4 23 .13 .24 Whole Borough 552 1.5 1.6 41 .11 .12 LONDON 9,118 1.5 2.0 706 .14 .15 The case-rate for the year is .3 above that for the year 1913, and .1 above the average for the 10 years 1904-1913. The highest case-rate was in Tooting, and the lowest in Streatham. The case-rate for the Borough is .4 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 .12 compared with .06 in 1913, 06 in 1912, and .11 in 1911, and .11 the decennial average. The Chart (facing page 60) shows the number of cases notified during each week of the year. The maximum number of cases, viz.—31, was notified in the third week of September, and the minimum, viz.—three, in the second week of August, The total number of cases, viz.—552, is above the number for 1913, and also the decennial average, but there was no outbreak of any special significance in any part of the Borough, with the exception of two slight outbreaks, one in a school in Tooting in September, and the other in a school in Wandsworth in November. 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 23 years, as also the average for the 23 years, compared with the year 1914. It will be observed the case-rate is .18 lower than the average, and the death-rate is lower by 10 per 1,000, while the case mortality has been reduced from 11.9 per cent, to 7.4. This reduction in the mortality is mainly due to the use of antitoxin as a remedy. 66 Report of the Medical Officer of Health. 67 Report of the Medical Officer of Health. TABLE XL. 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 1.6i .17 io.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 1.35 .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 1913 430 18 1.33 .05 4.I Average for 23 years 450 51 1.86 .22 11.9 1914 552 41 1.68 .12 7.4 Diphtheria and School Attendance. The following Table shows the number of cases of Diphtheria and their relationship to the schools in the Borough.— 68 Report of the Medical Officer of Health. TABLE XL1. SCHOOLS. January. February. March. April. May. June. July. August. September. October. November. December. Totals. CLAPHAM. Aristotle Road ... I ... ... ... ... ... ... 1 ... ... ... 2 Bonneville Road ... ... ... ... ... ... 1 ... 1 ... ... ... 2 Christchurch ... ... ... ... ... 1 ... ... ... ... ... ... 1 Haselrigge Road ... 1 ... ... ... ... ... ... ... ... ... ... 1 Larkliall Lane ... I 3 I ... 1 ... ... ... ... ... ... 6 New Park Road ... ... 1 ... ... ... ... ... ... ... ... I 2 New Road ... I ... ... ... ... ... ... ... ... ... ... I Parochial,Old Town ... ... ... ... ... I ... ... ... ... ... ... I St. Andrew's Street ... ... 1 ... ... ... ... ... ... ... I ... 2 Telferscot Road ... ... 1 ... 3 ... ... ... 1 2 ... 7 Wirtemberg Street ... 2 ... ... ... ... ... ... ... ... ... ... 2 Private Schools ... ... ... 1 ... ... ... ... ... ... ... ... 1 Total ... 6 6 2 3 3 1 ... 3 ... 3 I 28 PUTNEY. All Saints ... ... ... ... ... 1 ... ... ... ... ... ... 1 Hotham Road 1 1 ... 1 ... ... 1 ... 4 3 2 ... 13 St. Mary's ... 2 1 ... ... 1 ... 1 2 1 I 2 11 Private Schools ... ... ... ... ... ... ... ... 1 ... ... ... 1 Total 1 3 1 1 ... 2 1 1 6 5 3 2 26 STREATHAM. Broadwater Road 1 ... ... ... ... ... 1 1 ... ... ... ... 3 Cavendish Road ... ... ... ... ... ... ... 1 4 ... ... I 6 Coventry Hall ... ... ... 1 ... ... ... ... ... ... ... ... 1 Eardley Road ... ... ... 1 ... 1 1 ... ... ... ... ... 3 Fircroft Road ... 3 ... 1 ... ... ... ... ... ... ... ... 4 Furzedown Demonstration 1 ... ... ... ... ... ... ... ... 1 ... 1 3 Hearnville Road I ... ... ... ... ... ... ... ... ... ... ... 1 Hitherfield Road ... 1 1 ... ... 1 ... ... ... ... ... ... 3 Holy Trinity,Upper Tooting ... ... 1 ... ... ... ... ... ... ... ... ... 1 Mitcham Lane ... 1 1 ... ... ... ... ... 1 2 4 ... 9 Oldridge Road ... ... ... ... ... ... ... ... ... ... ... 1 1 St. Mary's ... ... ... ... ... ... ... ... 1 ... ... ... 1 Smallwood Road 1 ... ... ... 1 ... ... ... ... 2 1 ... 5 Private Schools ... 2 1 ... ... ... ... ... ... 3 1 ... 7 Total 4 7 4 3 1 2 2 2 6 8 6 3 48 Carried forward 5 16 11 6 4 7 4 3 15 13 12 6 102 TABLE XLI.—continued. SCHOOLS. J anuary. February. March. April. May. June. July. August. September. October. November. December. Totals. Brought forward 5 16 11 6 4 7 4 3 15 13 1 2 6 102 TOOTING. Derinton Road ... ... 1 ... ... ... ... 2 15 ... ... ... 18 Ensham Street 1 1 ... 1 ... 1 ... ... 1 ... ... ... 5 Fountain Road ... ... ... ... ... 1 ... ... ... 1 1 ... 3 Franciscan Road 2 2 1 1 ... ... ... ... ... I ... ... 7 Roman Catholic Undine Street ... ... ... ... ... ... 1 2 1 ... ... ... 4 Sellincourt Road ... 1 ... ... 1 1 2 ... 1 1 ... ... 7 Tooting Graveney ... 1 ... ... ... 1 1 ... ... ... 2 1 6 Private Schools ... ... ... ... ... ... ... ... ... ... ... ... ... Total 3 5 2 2 1 4 4 4 18 3 3 1 50 WANDSWORTH. Brandlehow Road ... 1 ... ... 2 2 ... ... ... ... 3 1 9 Cambourne Road ... ... ... 1 ... ... ... ... ... ... ... ... 1 Earlsfield ... 1 I ... 1 ... ... ... 1 ... ... 1 5 Elliott Central ... ... ... ... ... ... ... ... 1 ... ... ... 1 Eltringham Street 1 2 1 ... ... ... ... ... 1 3 ... ... 8 Frogmore ... ... ... ... ... ... ... ... ... ... ... 1 I Littleton Street Special ... ... I ... ... ... ... ... ... ... ... ... 1 Magdalen Road ... ... ... ... 1 ... ... ... ... ... ... ... 1 Merton Road 1 1 4 2 4 ... ... 1 5 8 4 ... 30 Riversdale 3 3 3 1 ... ... ... ... ... ... 1 ... 11 St. Ann's ... ... ... ... ... ... ... ... ... ... ... 1 1 St. Faith's ... ... ... ... ... ... ... ... ... 1 ... ... 1 St. Joseph's ... ... ... ... ... ... ... ... 1 1 ... ... 2 St. Michael's ... ... ... ... 2 ... ... 1 ... ... ... ... 3 Southfield ... 1 1 ... 1 ... 1 1 1 5 10 1 22 Swafiield Road 3 3 ... ... 2 ... 1 ... ... 2 ... ... 11 Wandle 2 ... ... ... 1 1 ... ... ... 1 1 ... 6 Waldron Road 1 ... ... ... 2 ... ... ... ... ... ... 1 4 Warple Way 2 ... 1 ... 1 1 ... ... ... ... ... 2 7 West Hill 2 ... ... ... 1 ... ... 1 ... 1 2 ... 7 Private Schools ... 1 ... ... 1 1 ... ... ... 1 ... 1 5 Total 15 13 12 4 19 5 2 4 10 23 21 9 137 Total—Schools in Borough 23 34 25 12 24 16 10 11 43 39 36 16 289 Schools outside Borough 3 1 ... ... 3 1 1 1 ... ... 4 3 17 No School 23 13 17 18 19 11 13 10 21 24 17 18 204 Incorrect Diagnosis 5 3 6 2 2 3 5 1 6 3 1 5 42 Grand Total 54 5i 48 32 48 31 29 23 70 66 58 42 552 69 Rcporl of the Medical Officer of Health. 70 Report of the Medical Officer of Health. In Clapham, out of a total of 66 cases, 28 or 42 per cent, occurred in children attending school ; in Putney, of 57 cases, 26 or 45 per cent. ; in Streatham, of 91 cases, 48 or 52 per cent. ; in Tooting, of 107 cases, 50 or 46 per cent. ; in Wandsworth, of 231 cases, 137 or 59 per cent. ; and in the whole Borough, of 552 cases, 289 were in attendance at schools in the Borough, and 17 at schools outside the Borough, a total of 306, or 55 per cent. Of the remaining cases, viz.—246, in 42 or 9.8 per cent., the diagnosis was incorrect, and 204 or 36 per cent, were not in attendance at school. In Clapham the number of cases of Diphtheria in attendance at school was 28, the greatest number occurring in Telferscot Road School, and the next in Larkhall Lane School. In Putney 26 cases were in attendance at schools, 13 of these being at Hotham Road, and 11 at St. Mary's Schools. i In Streatham, Mitcham Lane with nine cases was the highest. In Tooting 50 cases were in attendance at schools, 18 of these being in Derinton Road, and seven each in Franciscan Road and Sellincourt Road Schools. In Wandsworth there were 137 cases attending schools, and these occurred sporadically during the year, the greater number occurring during September. In seven of the schools only one case occurred in each, in one two cases, in one three cases, in one four cases, in one five cases, in one eight cases, in one nine cases, in two 11 cases, in one 22 cases, and in one 30 cases, and five cases occurred in various private schools. The principal school affected in Wandsworth was Merton Road, where 30 cases occurred, one in January, one in February, four in March, two in April, four in May, one in August, five in September, eight in October and four in November. In the South- 71 Report of the Medical Officer of Health. field School 22 cases occurred, one each in February, March, May, July, August, September and December, five in October, and 10 in November. Of the total number of cases notified 42 were incorrectly diagnosed, compared with 54 in 1913, leaving a total of 510 actual cases, compared with 376 in 1913, 390 in 1912, and 468 in 1911. The number of dwellings in each sub-district and 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. b ive cases and upwards. lotal houses invaded. Clapham 57 13 1 ... ... 61 Putney 50 2 1 ... ... 53 Streatham 80 4 1 ... ... 85 looting 69 4 2 2 2 79 Wandsworth 55 16 5 2 78 Whole Borough 311 29 10 4 2 356 Of the 356 houses invaded, multiple cases occurred in 45, or 12.6 per cent, an increase of 4.3 per cent, compared with 1913. No cases of Diphtheria were notified as having occurred in children attending the following elementary schools in the Borough : In Clapham:— Parochial, Old Town, Clapham. St. Mary's, Crescent Lane. St. Mary's, St. Alphonsus Road. Telferscot Road. 72 Report of the Medical Officer of Health. In Putney:— Convent of the Sacred Heart, Roehampton. National School (Boys), Roehampton. National School (Girls), Roehampton. In Streatham:— Broadwater Road Special. Cavendish Road. Christchurch. Holy Trinity, Upper Tulse Hill. Immanuel. Roman Catholic, Nightingale Square. St. Andrew's, Colmer Road. St. Andrew's, Polworth Road. St. Leonard's. Sunnyhill Road. In Wandsworth:— Garratt Lane. Garratt Lane Special. West Hill SDecial. In all 20 schools remained free from Diphtheria compared with 31 in 1913. In six schools, viz.:—Brandlehow Road, Fircroft Road, Hotham Road, Smallwood Road, Swaffield Road and Roman Catholic, Undine Street, it was necessary to have swabs taken from the throats of the children, and in Brandlehow Road, Hotham Road, Smallwood Road and Undine Street one each, and in Swaffield Road two were found to give positive results, while in Fircroft Road seven were negative and Swaffield Road 14. 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 soecial forms supplied to them. 73 Report of the Medical Officer of Health. 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, five or .90 per cent, occurred among children under one year, 129 or 23 per cent, among children from one and under five years, 336 or 60.8 per cent, from five and under 15 years, 48 or 8.6 per cent., from 15 and under 25 years, and 34 or 6.1 per cent, from 25 and under 65 years. Compared with the previous year there has been an increase at five and under 15 years. Of the 464 cases of Diphtheria removed to Hospital, 42 were reported not to have suffered from Diphtheria. As will be observed from the number of cases notified, shown in Table XL., Diphtheria, like Scarlet Fever, was more prevalent during the year 1914, than in the five previous years, and this prevalence was general in London as a whole. The mortality was also higher than in the previous five years with the exception of 1909. Return Cases of Scarlet Fever and Diphtheria. 51 cases of Scarlet Fever occurred after the return of cases from the hospitals of the Metropolitan Asylums Board, compared with 45 in 1913, 39 in 1912, and 52 in 1911. There was also one case of Diphtheria, compared with 14 in 1913, two in 1912, and two in 1911. Four of the return cases of Scarlet Fever occurred in Clapham, one in Putney, 16 in Streatham, nine in Tooting, and 21 in Wandsworth. 74 Report of the Medical Officer of Health. The return case of Diphtheria occurred in Wandsworth. The following Table shows the date of removal to hospital of the first case, the date of return from hospital, the number of days the first case was in hospital, the date of the first symptoms of the subsequent case, and the number of days elapsing between the return of the first case and the first symptoms of the subsequent case or cases. The average number of days the cases of Scarlet Fever were in hospital was 6o.1, compared with 54.3 in 1913, and in the case of Diphtheria 68 days, compared with 64 in 1913. In eight premises more than one case occurred after the return of a case from hospital, seven cases in one premises, five cases in one premises, four cases in one premises, three cases each in two premises, and two cases each in three premises. In one of the cases complaint was made that the patient suffered from nasal discharge. TABLE XLIII. RETURN CASES OF SCARLET FEVER. Sub-Districts No. Removed to • Hospital. Returned from Hospital. No. of clays 1st case was in Hospital . Date of 1st svmptoms of subsequent ease. No. of clays elapsing between return of 1st case and 1st symptoms of subsequent ease. Remarks. Clapham 1 I9I3nth Nov. I9I324th Dec. 43 19I330th Nov. 6 Same fami 2 ,, ,, ,, ,, 43 31st 7 3 5th ,, ,, ,, 49 1914. 1st Jan. 8 4 1st ,, 1914. 16 th Feb. 107 21st Feb. 5 Putney 5 25th ,, 15th Jan. 51 30th Jan. 15 Streatham ... 6 1st Oct. 5th ,, 96 8 th ,, 3 Same family. 7 ,, ,, ,, ,, 96 ,, ,, 3 8 ,, ,, ,, ,, 96 10th ,, 5 9 ,, ,, ,, ,, 96 ,, ,, 5 10 ,, ,, ,, ,, 96 12 th ,, 7 l1 ,, ,, ,, ,, 96 15th „ 10 12 ,, ,, ,, ,, 96 ,, ,, 10 13 21st ,, 1913- 31st Dec. 1914. 71 9 th ,, 9 14 24th Nov. 13th Jan. 50 25th „ 12 15 18 th „ 30th 73 9th Feb. 10 16 22nd Dec. 5th Feb. 45 14th 9 1914. 19th Mar. 17 6th Tan. 13th Mar. 66 6 18 14th ,, 58 29th ,, 16 19 22nd ,, 24th ,, 61 21st April 9 20 8th July 20th Aug. 43 21st Aug. I 21 26th Aug. 23rd Oct. 58 30th Oct. 7 Tooting 22 28th Jan. 18th Mar. 49 22nd Mar. 4 23 ,, ,, ,, ,, 49 27th ,, 9 24 ,, ,, ,, ,, 49 28 th „ 10 25 ,, ,, ,, ,, 49 6th April 19 26 ,, ,, ,, ,, 49 3°th „ 43 27 13th Feb. 26th „ 41 1st ,, 6 28 15th „ 3°th „ 43 7 th ,, 8 29 14th Oct. 28th Nov. 45 13th Dec. 15 30 8th Nov. 19th Dec. 45 23rd „ 4 75 Report of the Medical Officer of Health. TABLE XLIII—(continued): Sub-Districts. No. Removed to Hospital. Returned from Hospital. No. of days istcase was ill Hospital Date of 1st symptoms of subsequent case. No. of days elapsing between return of 1st ease and 1st symptoms of subsequent case. Remarks. Wandsworth 31 I9I318th Nov. 1st Jan. 44 26th Jan. 25 32 28th „ 1914. 20th „ 53 30th 10 33 24th Mar. 16th May 53 24th May 8 Nasal discharge 34 30th May 28th July 59 nth Aug. 14 35 9th June 28th Aug. 80 3rd Sept. 6 Same family. 36 „ ,, ,, ,, 80 9th „ 12 37 20th Sept. 30th Oct. 40 5th Nov. 6 Same family. 38 ,, ,, ,, ,, 40 14th „ 15 39 ,, ,, ,, ,, 40 17th „ 18 40 23rd Aug. 6th „ 44 13th Oct. 7 41 25th July 5th „ 72 16th „ 11 42 nth Sept. 29th „ 48 3rd Sept. 5 Same family. 43 ,, ,, ,, ,, 48 9 th „ 11 44 18 th „ 5th Nov. 49 19th Nov. 14 45 10th Oct. 3°th „ 51 4th Dec. 4 Same family. 46 „ ,, ,, ,, 51 7th „ 7 47 ,, ,, ,, ,, 51 14th „ 14 48 25th Sept. 28th „ 64 7th „ 9 Same family. 49 ,, ,, ,, ,, 64 ,, ,, 9 5° ,, ,, ,, ,, 64 ,, ,, 9 51 ,, ,, ,, ,, 64 10th „ 12 TABLE XLIV. RETURN CASES OF DIPHTHERIA. Sub-Districts. No. Removed to Hospital. Returned from Hospital. No. of daj's 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. Wandsworth 1 I9I310th Nov. 1914. ist Jan. 00 vo 1914. 17th Jan. 16 76 Report of the Medical Officer of Health. 77 Report of the Medical Officer of Health. Enteric Fever. 48 cases of Enteric Fever were notified during the year, (five from Clapham, five from Putney, 12 from Streatham, five from Tooting, and 21 from Wandsworth), compared with 50 in 1913, 71 in 1912, and 58 in 1911, and is 30 under the corrected decennial average. 30 of the cases were removed to hospital where five died, and 18 were treated at home with no death. The total number of deaths was five, one in Clapham, one in Putney, one in Streatham, and two in Wandsworth, compared with five in 1913, eight in 1912, and nine in 1911. The number of deaths was the same as in 1913, and is 5.26 under the decennial average. The proportion of cases notified per 1,000 of population was .14, compared with 15 in 1913, -22 in 1912, and -18 in 1911, and with .17 for the whole of London. The corrected death-rate from Fever was -015 per 1,000 compared with .015 in 1913, .02 in 1912, and .03 in 1911 ; while the rate for the whole of London was .03, compared with 02 in 1913, •025 in 1912, and .03 in 1911. Of the 30 cases removed to hospital, 10 or 33.3 per cent, were found not to be suffering from Enteric Fever, compared with 18 per cent, in 1913. The Chart (facing page 60), 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 20 of the weeks, two cases each in eight of the weeks, three cases each in two 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 January. 78 Report of the Medical Officer of Health. Of the 48 cases notified 10 were not Enteric Fever, five occurred in the Middlesex County Asylum, leaving 33 cases in which special enquiries were made as to the probable cause of the disease. In four of the cases the disease was probably contracted by eating shell-fish, in five it was contracted outside the Borough in five the infection was contracted from previous cases, while in 19 no history of infection could be ascertained. The four cases which were probably contracted by eating shellfish were all from oysters, partaken at various and untraceable places. Of the 10 cases which were not Enteric Fever two were fatal, one from Appendicitis, and the other from Septicemia following abortion. The notification rate from this disease was the lowest on record, while the death-rate was the same as in 1913, these two years being the lowest yet recorded. Cases of Mistaken Diagnosis. In 112 cases, (57 of Scarlet Fever, 42 of Diphtheria, 10 of Enteric Fever, one of Cerebro-spinal Fever, one of Anthrax, 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 113 in 1913, 88 in 1912, and 102 in 1911. Of 1,740 cases removed to hospital, in 112 or 6.4 per cent, the diagnosis was incorrect, compared with 8.3 per cent, in 1913, 7.8 per cent, in 1912, and 8.5 per cent, in 1911. There has been a slight decrease in the percentage of cases of jnistaken diagnosis, 79 Report of the Medical Officer of Health. The highest percentage of mistaken diagnosis occurred in respect of Cerebro-spinal Meningitis and Anthrax, viz.:—100 per cent., both cases of each disease removed proving on further examination not to have been suffering from that disease. TABLE Xl.V Disease. No. of cases of mistaken diagnosis. Percentage of error in Diagnosis. Clapham. Putney. Streatham. Tooting. 1 Wandsworth. Total. Total cases removed. Scarlet Fever 9 4 5 21 18 57 1,215 4.6 Diphtheria 6 5 6 9 16 42 464 88.8 Enteric Fever ... ... 2 3 5 10 30 33.3 Continued Fever ... ... ... ... ... ... ... Cerebrospinal Meningitis ... ... ... ... 1 1 1 100.0 Puerperal Fever ... ... ... ... 1 1 24 4.1 Polio-Myelitis ... ... ... ... ... ... ... ... Ophthalmia Neonatorum ... ... ... ... ... ... 5 ... Anthrax ... ... ... ... 1 1 1 100.0 Total 15 9 13 33 42 112 I.740 6.4 In 1913 the percentage of cases of mistaken diagnosis for the whole of London was, for Scarlet Fever 5.5, compared with 6.4 in 1912 ; for Diphtheria 13.3, compared with 12.9 ; and for Enteric Fever 20.5 compared with 40.8. Cerebro-Spinal Meningitis. Three cases were notified during the year, (two in Clapham, and one in Tooting), compared with nine in 1913, three in 1912, and five in 1911. One of these cases proved not to be Cerebro-spinal Meningitis. Of the remaining two cases notified, one died of Cerebro-spinal Meningitis and the other case recovered, 8o Report of the Medical Officer of Health. In London 73 cases of this disease were notified during the year, compared with 145 in 1913. 21 deaths were registered as having been caused by Meningitis, six in Clapham, one in Putney, five in Streatham, five in Tooting, and nine in Wandsworth, compared with 21 in 1913. Eight of these were of infants under one year, two from one and under two years, two from two and under five years, and nine 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 889 bacteriological examinations were made at the Lister Institute, compared with 726 in 1913, 841 in 1912, 624 in 1911, 318 in 1910, 397 in 1909, 491 in 1908, 466 in 1907, 407 in 1906, 174 in 1905, 121 in 1904, 125 in 1903. 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. 81 Report of the Medical Officer of Health. TABLE XLVI. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. Diphtheria. Negative 71 87 148 77 259 642 Positive 15 43 40 18 97 213 Enteric Fever. Negative 3 6 2 -- 8 19 Positive 1 3 3 1 7 15 Totals 90 139 193 96 371 889 In 213 out of 855 examinations for the bacillus of Diphtheria the result was positive, and in 15 out of 34 examinations of blood in suspected cases of Enteric Fever the Widal re-action was obtained. The increase in the total number was due to the greater prevalence of Diphtheria during the year, and the consequent increase in the number of contacts swabbed. Puerperal Fever. 30 cases of Puerperal Fever were notified, compared with 32 in 1913, 27 in 1912, 24 in 1911. Six cases occurred in Clapham, six in Streatham, four in Tooting, and 15 in Wandsworth. Nine of the cases (four in Clapham, two in Streatham, one in Tooting, and two in Wandsworth), or 30 per cent, were fatal, compared with 40 per cent, in 1913, 40 per cent, in 1912, and 33.3 per cent, in 1911, 82 Report of the Medical Officer of Health. 24 of the cases were removed to Institutions (one to St. James's Infirmary, 20 to the Metropolitan Asylums Board's Hospitals and three to St. Thomas's Hospital, where three died, and six were treated at home with four deaths. The death-rate was .02 per 1,000, compared with .04 in 1913, •035 in 1912, and 025 in 1911. The case-rate per 1,000 births was 4.4 compared with 4 6 in 1913, 4 0 in 1912, and 3-5 in 1911, and for the whole of London 3.5 compared with 3.0. In 13 of the cases registered midwives only were employed while two of the cases were miscarriages, one was premature, three stillborn, and in two, twins were born. Four nurses had free baths, two came from Battersea, one from the West End, one was a district nurse, and the remainder had baths at their own homes. In two cases no nurse was employed. In 25 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. 234 cases of Erysipelas were notified during the year and 11 deaths occurred. 44 of the cases and three deaths occurred in Clapham, eight cases and one death in Putney, 60 cases and two deaths in Streatham, 39 cases and one death in Tooting, and 83 cases and four deaths in Wandsworth. In 1913 the number of cases notified was 204, and the deaths six. 40 of the cases were removed to the Union Infirmary, where seven died. 83 Report of the Medical Officer of Health. Measles. During the year 26 deaths, 16 of males and xo of females, were due to Measles, compared with 116 in 1913, 51 in 1912, and 230 in 1911. Six of the deaths occurred in Clapham, 11 in Streatham, six in Tooting, and three in Wandsworth. The number of deaths is 90 less than in 1913, and is 78 below the corrected decennial average. Seven of the deaths were of infants under one year, 12 from one and under two years, four from two and under five years, two from five and under 15 years, and one from 45 and under 65 years ; 88 per cent, of the deaths having occurred under five years of age. The death-rate was .07 per 1,000, compared with .36 in 1913, .16 in 1912, and .74 in 1911. The death-rate for the whole of London was .31, compared with 34 in 1913, for England and Wales, .24, and for the 97 Great Towns .35, for the smaller towns .21, and for England and Wales, less the 242 towns, .12 per 1,000. During the year five cases of Measles were removed to the Metropolitan Asylums Board's hospitals, from Streatham. These 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 cases provided the Medical Officer of Health certified that the home conditions were such that the case could not be satisfactorily treated at home. The use of the Fever Hospitals for cases of this disease was discontinued in the summer, and so far has not been renewed, 84 Report of the Medical Officer of Health. During the year 621 visits were made in cases of this disease, (compared with 2,164 in 1913). 182 in Clapham, 28 in Putney, 220 in Streatham, 64 in Tooting, and 127 in Wandsworth. Table XLVII. shows the number of cases of notifiable and nonnotifiable diseases notified by the teachers of the elementary schools in the Borough. In all, 5,802 cases were notified, compared with 4,907 in 1913, 4,706 in 1912, and 6,785 in 191I. 464 of these were cases of Measles, 997 of Chicken-pox, 842 of Whooping Cough, 1,661 of Mumps, and 312 of Ringworm. There was an increase in the number of cases of Whooping Cough, Chicken-pox and Mumps, and a decrease in the number of cases of Measles and Ringworm. With regard to Measles, 153 cases were notified from schools in Clapham, 38 in Putney, 137 in Streatham, 45 in Tooting, and 91 in Wandsworth. The schools chiefly affected were, in Clapham, Haselrigge Road and Telferscot Road ; in Putney, Roehampton National ; in Streatham, Hearnville Road and Oldridge Road; in Tooting, Franciscan Road and Sellincourt Road ; and in Wandsworth, the Earlsfield and Swaffield Road. Very few of the schools were quite free from the disease, but in a considerable proportion only a few cases occurred. As in former years the means adopted for the prevention of the spread of the disease were exclusion from school, education of the parents of children where cases had occurred by means of the pamphlet published in the Report for 1911, and disinfection of the premises after cases had recovered, 85 Report of the Medical Officer of Health. TABLE XL VII. Notifiable and Non-Notifiable Diseases Reported from Schools, 1914. School. Diseases. Scarlet Fever. Diphtheria. Measles. ChickenPox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Clapham— Aristotle Road 8 ... ... ... ... ... ... ... 5 Bonneville Road 16 2 10 15 4 58 l6 12 133 Cavendish Road 9 6 22 24 26 2 i 12 102 Christchurch 6 I 4 9 7 9 2 ... 38 Clapham Parochial 11 1 ... 18 4 5 2 ... 41 Haselrigge Road 6 I 32 4 14 26 4 60 147 Larkhall Lane 11 6 2 12 7 8 5 16 67 New Park Road 5 2 26 43 1 2 ... 5 84 New Road 3 1 3 1 ... 1 ... ... 9 St. Andrew's Street 6 2 3 19 6 11 6 16 69 St. Mary's 2 ... 2 17 1 ... ... ... 22 Telferscot Road 11 7 46 28 52 5 7 11 167 Wirtemberg Street 4 2 3 5 3 5 2 5 29 Total 95 31 153 195 125 132 45 137 913 Putney— All Saints' 9 1 1 1 1 2 3 3 21 Hotham Road 39 13 2 28 7 1 25 4 119 Roehampton National 3 ... 35 1 ... 16 ... 3 58 St. Mary's 8 11 , ... 3 8 ... ... ... 30 Total 59 25 38 33 16 19 28 10 228 Streatham— Broadwater Road 6 3 1 25 23 9 4 4 75 Christchurch 3 ... 4 9 7 9 2 ... 34 Eardley Road 17 3 4 55 7 1 3 3 93 Fircroft Road 12 4 1 17 1 1 2 5 43 Holy Trinity, Balham 10 1 ... 2 6 32 7 2 60 Holy Trinity, Streatham 1 ... 2 ... ... 14 ... 2 19 Hearnville Road 10 1 45 2 12 ... ... 1 71 Hitherfield Road ... 3 7 9 4 17 1 1 42 Immanuel 3 ... ... 5 9 ... ... ... 17 Mitcham Lane 9 9 5 33 58 6 5 17 142 Nightingale Sq., R.C. ... ... 12 1 5 ... ... 1 22 Oldridge Road 26 1 31 81 4i 13 5 58 256 Smallwood Road 17 5 2 4 17 6 8 21 80 St. Andrew's, Colmer Road 1 ... ... 21 2 3 ... ... 27 St. Leonard's 1 ... 12 20 i 3 1 11 49 St. Mary's 13 1 5 ... 6 ... 1 1 27 Sunnyhill Road 7 ... ... ... ... 1 2 ... 10 Furzedown Demonstration 8 3 6 7 1 21 1 2 49 Total 147 34 137 291 200 136 42 129 1,116 Carried forward 301 90 328 519 341 287 115 276 2,257 86 Report of the Medical Officer of Health. TABLE XLV11.—continued. Schools. Diseases. Scarlet Fever. Diphtheria. Measles. ChickenPox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. | 1 Brought forward 301 90 328 519 341 287 115 276 2,257 Tooting— Derinton Road 15 18 3 28 20 1 8 13 106 Ensliam Street 19 5 3 9 2 1 ... 6 45 Fountain Road 11 3 21 34 17 17 22 125 Franciscan Road 27 7 18 14 75 9 14 20 184 Sellincourt Road 20 7 14 26 33 34 5 42 181 Tooting Graveney 20 6 7 38 37 12 6 9 135 Total 112 46 45 136 201 74 50 112 776 Wandsworth— AH Saints' ... ... 1 1 1 2 3 3 11 Brandlehow Road 23 9 7 9 28 103 10 5 194 Cambourn Road 7 i 2 3 6 41 5 22 87 Earlsfield 14 5 13 58 17 211 16 14 3481 Eltringham Street 14 8 3 15 13 51 5 26 135 Garratt Lane 13 ... 6 16 19 15 29 27 285 Magdalen Road 1 1 6 8 9 1 6 2 34 Merton Road 9 30 4 1 28 65 M 6 157 Riversdale 13 11 7 42 39 111 5 9 257 St. Anne's 1 1 ... ... ... 25 1 ... 28 St. Faith's 4 1 1 7 14 34 4 ... 65 St. Joseph's, R.C. 2 2 ... 2 ... 38 ... 13 57 St. Michael's 7 3 7 24 27 45 12 2 127 Southfield 12 22 6 7 27 7 7 1 89 Swaffield Road 45 11 16 83 18 276 11 21 481 Waldron Road 15 4 7 13 10 9 6 7 71 Wandle 29 7 4 38 12 68 9 63 230 Warple Way 3 7 ... 6 26 24 ... 6 72 West Hill 16 7 1 9 6 14 4 4 61 Total 228 130 91 342 300 1,300 147 231 2,769 Grand Total ... 641 266 464 997 842 1,661 312 619 5,802 87 Report of the Medical Officer of Health. It will be seen from Table XLVIII. as well as from the Table of the number of disinfections carried out, that the disease was most prevalent in March, April, May and June. The following Table shows the number of exclusions from school on account of the prevalence of Measles during the year at the various schools in the Borough. The number of exclusions in each month was as follows:— In January two, in February six, in March II, in April five, in May 13, in June seven, in July six, in August, September and October one each, in November two, and in December one. 88 Report of the Medical Officer of Health. TABLE XLVIII. No. School. Class-room. Period of exclusion. No. 01 days. 1 Garratt Lane, Wandsworth Class A, C & CI Jan. 15 th—30th Jan. 19 2 Telferscot Road, Clapham „ Babies „ 28th—2nd Feb. 6 3 St. Michael's, Southfields „ B Feb. 4th—20th „ 17 4 Merton Koad, Wandsworth „ D ,, 9th—27th ,, 19 5 Telferscot Road, Clapham „ G „ 11th— „ „ 17 6 Oldridge Road, Balham „ B „ 20th—6th Mar. 15 7 „ „ „ A „ 23rd— „ „ 12 8 New Koad, Clapham „ B2 „ 27th— „ „ 8 9 New Park Road, Clapham „ B Mar. 2nd—20th „ 19 10 „ „ „ A & C „ 3rd— „ „ 18 11 Larkhall Lane, Clapham „ D „ 9th— „ „ 12 12 Cavendish Road, Clapham „ F „ 12th—27th „ 16 13 New Park Road, Clapham „ F „ 19th „ „ 9 14 „ „ „ A, B & C „ 20th— „ „ 8 15 Riversdale, Wandsworth „ F „ 23rd—9th Apr. 17 16 Cavendish Road, Clapham B, C & E ,, 25th—8th „ 15 17 Bonneville Road, Clapham „ C „ „ „ „ 15 18 New Park Road, Clapham „ D „ „ „ „ 15 19 Cavendish Road, Clapham „ F „ 27th— „ „ 13 20 Larkhall Lane, Clapham „ D Apr. 6th— „ „ 3 21 Christchurch, Streatham A „ „ „ „ 3 22 Holy Trinity, Streatham „ 3 ,, 27th—8th May 12 23 Hearneville Road, Balham „ G „ 29th—15th „ 17 24 „ „ „ H „ 30th—5th „ 6 25 Mitcham Lane, Streatham „ H May 6th—22nd „ 17 26 Sellincourt Road, Tooting „ B & H „ „ „ „ 17 27 Bonneville Road, Clapham „ D „ 14th— „ „ 8 28 Haselrigge Road, Clapham „ F „ 13 th-—29th „ 17 29 Roman Catholic, Nightingale Square, Balham „ Inf. „ „ „ „ 17 89 Report of the Medical Officer of Health. TABLE XLVIII.—continued. No. School. Class-room. Period of exclusion. No. of days. 30 Haselrigge Road, Clapham Class G1 & G2 „ 15th— „ 15 31 St Mary's Balham „ 1 „ 18 th— „ „ 12 32 Haselrigge Road, Clapham Class C May 18th—29th May 12 33 Eltringham Street, Wandsworth „ B „ „ „ „ 12 34 St. Mary's, Balham „ 4 ,, 25th—6th June 13 35 Hearneville Road, Balham „ G „ „ „ „ 13 36 Haselrigge Road, Clapham „ A2 & B „ „ —12th ,, 19 37 Hearnville Road, Balham „ H „ 28th— „ „ 16 38 Sellincourt Road, Tooting „ D June 3rd— „ ,, 10 39 St. Mary's, Balham „ 2 „ „ „ „ 10 40 Eardley Road, Streatham „ c „ 8th—19th „ 12 41 Broadwater Road, Balham „ J „ 18th—26th „ 9 42 Haselrigge Road, Clapham „ A „ 15th— „ „ 12 43 Swaffield Road, Wandsworth „ B „ 29th—10th July 12 44 Merton Road, Wandsworth „ F „ „ „ „ 12 45 Haselrigge Road, Clapham „ All under 5 years July 8th—22nd 14 46 Oldridge Road, Balham „ „ „ 10th— „ „ 12 47 St. Leonard's, Streatham „ „ „ 8th— „ 14 48 Franciscan Road, Tooting „ „ „ 13th— „ 10 49 Wandle, Wandsworth „ „ ,, 16th— „ „ 7 50 Hitherfield Rd., Streatham „ „ „ 20th— „ „ 3 51 New Road, Clapham Class E1 & E2 Aug. 31st—9th Sept. 10 52 „ „ „ „ Sept. 10th—23rd „ 14 53 Brandlehow Road, Wandsworth „ c ,, 11th—18th „ 8 54 Swaffield Rd., Wandsworth „ Hall ,, 16th—23rd „ 8 55 „ „ „ B Oct. 8th—16th Oct. 9 56 Christchurch, Clapham „ 3 Nov. 26th—4th Dec. 9 57 New Road, Clapham „ E1 & E2 „ 24th— ,, 11 58 Franciscan Road, Tooting „ F & H Dec. 7th—18th Dec. 15 90 Report of the Medical Officer of Health. 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 372 (122 in Clapham, 25 in Putney, 137 in Streatham, 30 in Tooting, and 58 in Wandsworth), compared with 1,454 in 1913, 1,006 in 1912, and 2,638 in 1911. The greatest number of disinfections was carried out in May, this being due to the greater prevalence of the disease in Streatham. The greatest number of cases occurred in February, March, April, May and June. 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 XLIX. Month, Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. January 3 ... ... 1 3 7 February 13 ... 6 ... 2 21 March 37 1 7 ... 2 47 April 19 ... 31 2 6 58 May 10 ... 43 7 5 65 June 12 ... 22 9 3 46 July 13 1 11 4 10 39 August 1 ... 4 ... 3 8 September 5 3 2 ... 5 15 October 2 7 ... ... 2 11 November 3 9 3 ... 10 25 December 4 4 8 7 7 30 Total 122 25 137 30 58 372 Whooping Cough. 53 deaths were registered during the year, 21 of males and 32 of females, an increase of 30 compared with 1913 (but a decrease of 18 compared with the decennial average). Eight of the deaths occurred in Clapham, two in Putney, 10 in Streatham, 11 in Tooting, and 22 in Wandsworth. 91 Report of the Medical Officer of Health. 24 of the deaths were of infants under one year, 20 of children from one and under two years, and nine from two and under five years. The death-rate was .16 per 1,000, compared with .07 in 1913, .15 in 1912, .21 in 1911, and .20 for the whole of London in 1914. The disease was more prevalent in London, and in this Borough in the year 1914 than in the previous year. In the sub-districts of Streatham, Tooting and Wandsworth, it was more prevalent than in the other sub-districts. The number of cases notified from schools was 842, compared with 496 in 1913, 1,014 in 1912, and 565 in 1911, 300 of these being from schools in the sub-district of Wandsworth, the schools chiefly affected in that sub-district being Riversdale, Brandlehow Road, Merton Road, St. Michael's, Southfield, and Warple Way. There were also 201 cases notified from schools in Tooting, the schools chiefly affected having been Franciscan Road, Tooting Graveney, Fountain Road, Sellincourt Road, and Derinton Road. The greatest mortality from Whooping Cough occurs among children under five years of age. Of the 53 deaths that occurred from this disease, all were of children under five years. 60 cases, three from Clapham, one from Putney, 16 from Streatham, 39 from Tooting, and one 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 866 visits were made by the Sanitary Inspectors in cases of Whooping Cough, 100 in Clapham, 28 in Putney, 201 in Streatham, 218 in Tooting, and 319 in Wandsworth. 92 Report of the Medical Officer of Health. Other Diseases notified from Schools. In addition to the 464 cases of Measles and 842 of Whooping Cough notified by the teachers of elementary schools, there were also notified 997 cases of Chicken-pox, 1,661 of Mumps, 312 of Ringworm, 24 of German Measles, 30 of Inflammation of Eyes, 192 of suspicious Sore Throat, 101 of Impetigo, 26 of Eczema, and 88 of other diseases. Chicken-pox was most prevalent in Streatham and Wandsworth, Mumps in Wandsworth, and Ringworm in Wandsworth. Disinfection of Schools. During the year the following schools were disinfected on account of the prevalence of Scarlet Fever, Diphtheria and Measles. (1) Private School, Wandsworth. Four rooms disinfected after Scarlet Fever on the 6th January. (2) Cavendish Road Special, Balham. Three rooms disinfected after Scarlet Fever on the 20th February. (3) Private School, Putney. Two rooms disinfected after Scarlet Fever on the 25th February. (4) Intermediate Schools, Wandsworth. Eight rooms disinfected after Measles on the 27th March, 1st, 9th and 27th April. (5) Private School, Streatham. One room disinfected after Scarlet Fever on the 20th April. (6) Roman Catholic, Nightingale Square, Balham. Four rooms disinfected after Scarlet Fever on the 22nd April. (7) Private School, Wandsworth. One room disinfected after Scarlet Fever on the 2nd May. 93 Report of the Medical Officer of Health. (8) Private School, Streatham. One room disinfected after Scarlet Fever on the 6th June. (9) Larkhall Lane, Clapham. Two rooms disinfected after Scarlet Fever on the 13th June. (10) Private School, Balham. One room disinfected after Scarlet Fever on the 16th June. (11) Derinton Road, Tooting. The whole of the Infants department after Diphtheria on the 19th September. (12) Hotham Road, Putney. Eight rooms disinfected after Diphtheria on the 27th November. (13) Private School, Upper Tooting. Two rooms disinfected after Scarlet Fever on the 5th December. (14) Swaffield Road, Wandsworth. One room disinfected after Scarlet Fever on the nth December. (15) Hotham Road, Putney. 30 rooms disinfected after Scarlet Fever on the 23rd and 24th December. Epidemic Influenza. 58 deaths, 25 of males, and 33 of females, were due to this disease, compared with 59 in 1913, 45 in 1912, and 24 in 1911. There has thus been a decrease of one death compared with the previous year, and a decrease of 12.6 compared with the corrected decennial average. 10 of the deaths occurred in Clapham, five in Putney, 32 in Streatham, and 11 in Wandsworth. The death-rate was .17 per 1,000, compared with .18 in 1913, .18 in 1912, and .08 in 1911. 22 of the deaths were of persons from 25 and under 65 years, and 29 of persons over 65 years. 94 Report of the Medical Officer of Health. Diarrhoea. 186 deaths, 106 of males and 80 females, occurred from all forms of Diarrhoea and Enteritis during the year, compared with 168 in 1913, 85 in 1912, and 350 in 1911. There has thus been an increase of 18 in the number of deaths from these diseases compared with the previous year, but a decrease of 34.2 compared with the corrected decennial average. 26 of the deaths occurred in Clapham, 13 in Putney, 48 in Streatham, 42 in Tooting, and 57 in Wandsworth. In all the sub-districts, with the exception of Wandsworth there was an increase compared with 1913. The death-rate was .56 per 1,000 (in Clapham .42, in Putney .44, in Streatham .46, in Tooting i ll, and in Wandsworth .59), compared with 51 in 1913, .27 in 1912, and 1.13 in 1911. The total number of deaths of children under two years was 161, equal to a rate of .49 per 1,000, compared with .47 in 1913, and .22 in 1912, while the death-rate for the whole of London under two years was .67 per 1,000, compared with .68. Of the total number of deaths registered, 136 or 73 per cent. were of infants under one year, compared with 78 per cent. in 1913, 70 per cent. in 1912, and 78 per cent. in 1911. The following Table shows the number of deaths from Diarrhœa and Enteritis under one year for the four quarters of 1914, and for the five previous years, 95 Report of the Medical Officer of Health. TABLE L. 1909. 1910. 1911. 1912. 1913. 1914. Total deaths under one year from Diarrhoea and Dysentery, including Epidemic Diarrhoea and Zymotic Enteritis in first quarter of the year 5 4 2 1 3 6 Do. in second quarter 4 6 5 4 5 3 Do. in third quarter 35 14 89 10 33 51 Do. in fourth quarter 8 11 8 3 10 6 Total deaths under one year from other forms of Enteritis in first quarter of year 15 9 ... 12 14 11 Do. in second quarter 11 9 11 11 14 8 Do. in third quarter 31 19 110 15 32 37 Do. in fourth quarter 15 16 40 4 21 14 51 out of a total of 66 deaths from Diarrhoea, and 37 out of a total of 70 from Enteritis occurred in the third quarter of the year. The number of deaths from Diarrhoea, Zymotic Enteritis, and Enteritis under one year represents 23.3 per cent. of the total mortality at that age, compared with 21.8 per cent. in 1913, 11.6 per cent. in 1912, and 33 per cent. in 1911, 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. 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, 96 Report of the Medical Officer of Health. TABLE LI. Method of Feeding. Age in Months. 0 and under 3. 3 and under 6. 6 and under 9. 9 and under 12. Total. 1.—Breast-fed only 8 3 ... 1 12 Do. and cows' milk ... 3 ... 1 4 Do. and condensed milk ... 5 ... 2 7 Do. and food ... ... 1 ... 1 2.—Cows' milk only 13 20 13 8 54 Do. and food 1 4 5 3.—Condensed milk only 4 9 7 4 24 Do. and food ... 1 1 2 4 4.—Dried milk 3 1 ... 1 5 5.—Farinaceous and other foods 4 3 1 8 6.—Unknown 3 2 5 1 11 Totals 31 49 30 25 15 Of the total of 124 children who died from these diseases where the exact nature of the food given was ascertained, only 12, or 9.6 per cent. were nursed by the mother without the addition of any other food, and of these eight died in the first three months. In 59, or 47.5 per cent., cows' milk, either alone or with farinaceous food was given; in 28 or 22.5 per cent., condensed milk only or condensed milk and farinaceous food was given; while in one dried milk only was given. In 11 cases, from various causes no information could be obtained. Of the 135 deaths, 26 died in the Union Infirmary, 14 in hospitals outside the Borough, and 19 had been in attendance at hospitals previous to their death for Marasmus or Debility and kindred complaints, 97 Report of the Medical Officer of Health. Of the cases in which no information was available, two had lived in Common Lodging Houses and could not be traced, two were born in the Workhouse and died in the Union Infirmary, and two mothers of illegitimate children had removed directly after the death of the children. Four of the deaths occurred in good residential districts and no enquiries were made. Of the contributory causes to the infants' deaths it may be noted that two of the mothers were notified as suffering from Puerperal Fever, three were very ill before the confinement and died a few days after giving birth to a weakly child, three mothers were notified as suffering from Pulmonary Tuberculosis, and three were very Anaemic and probably Tuberculous. One foster-mother was very ill herself with Diarrhoea and had to go into the Union Infirmary for treatment, and in three cases the mothers had previously lost children with Diarrhoea. In three cases children in the same family had had an attack of Diarrhoea and had probably infected the infant, and in one family a child had died with the disease a fortnight previously. One father suffered from Pulmonary Tuberculosis. In two cases the fathers had been out of work and the mother and children had lacked proper nourishment, in one case the father had neglected the children and ill-treated the mother and was reported to the National Society for the Prevention of Cruelty to Children. Ten of the infants suffered from Indigestion and Bowel trouble from birth, eight had been attending hospitals for Bronchial trouble, one was born suffering from Jaundice, one with heart complaint, and two were attending hospital for Rupture. Three babies had Meningitis, and in one family the child next in age to the infant suffered with Tuberculous Meningitis. 98 Report of the Medical Officer of Health. In seven cases the mothers stated that difficult teething had made the child more susceptible to the attack of Diarrhoea. In 44 cases the mothers reported a great many flies had been noticed at the time of the child's illness and death, and in three cases there were stables at the rear of the house. Two complaints were made of rabbits or fowls being kept next door. 25 deaths from Diarrhoea occurred among children over one year of age. We had previously visited 13 of these children. 15 deaths occurred in the Union Infirmary and one in a hospital. Three of these children were illegitimate, and one was a nurse child. One infant was of premature birth, four were delicate from birth, two of these were twin children. We found nine children had been fed on cows' milk and farinaceous foods up to their death, eight on Nestle's milk and farinaceous foods, and two each on cows' milk, Nestle's milk and farinaceous foods only. One infant aged 13 months had had nothing but the mother's milk from birth—it was a premature child and very delicate and probably only lived so long by reason of the great care the mother gave it. Of the causes contributory to the infants' deaths, we found one father was out of work and one had grossly neglected his family. One father was certified as suffering from Tuberculosis and two mothers were very Anaemic. Three children had Tubercular bowels, eight had suffered previously with Bronchial trouble, and three had severe teething complaints. 99 Report of the Medical Officer of Health. Six mothers said they had noticed many flies at the time of the childs' illness and in two yards we found accumulations of refuse. 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 22 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.:—135, 13 were prematurely born, 38 were delicate from birth, and eight were twin children. 100 Report of the Medical Officer of Health. TABLE LII. Clapham, North. Clapham, South. Putney. Streatham. Balham. Tooting. Southfield. Fairfield. Springfield. Borough. Total Number of Deaths 16 7 6 19 16 33 10 12 16 135 Wholly breast-fed 3 1 ... 2 1 1 1 ... 2 11 Otherwise fed 12 6 6 12 13 32 8 11 13 113 No information 1 ... ... 5 2 ... 1 1 1 11 Previously visited (1913) 7 ... 5 4 5 12 1 10 7 51 „ „ (I912) ... 2 1 ... 1 7 2 2 3 18 Fed according to pamphlet 2 ... 1 1 2 8 ... 6 2 22 Breast-fed 2 1 ... ... 1 ... ... 2 6 Otherwise fed 5 1 6 4 5 19 3 12 8 63 Illegitimate 1 ... 1 6 2 7 2 2 3 24 Nurse children ... ... 1 4 ... 4 1 ... 2 12 Born outside Borough 3 ... ... 2 ... 2 2 ... 2 11 Premature 1 2 1 2 1 2 1 1 2 1 3 Delicate from birth 2 3 ... 7 4 11 2 4 5 38 Twin Children 2 ... 1 ... 1 ... 3 ... 8 Status of Parents:— Labourers 2 1 1 1 3 9 2 4 4 27 Domestic Servants 1 ... ... 4 ... 3 2 2 2 14 Artisans 2 ... 1 1 1 4 ... 1 1 11 Carmen ... 1 1 2 1 1 1 1 1 9 Soldiers 1 ... 1 ... 1 ... 1 2 1 7 Railway Porters 1 1 ... ... 1 1 1 ... 1 6 Motormen ... ... 1 1 ... 1 1 ... ... 4 Business Managers ... 1 ... 1 ... 1 ... ... ... 3 Clerks ... ... ... 1 1 ... ... ... 1 3 Laundresses ... ... ... ... 1 ... ... ... 3 Shop Assistants ... ... 1 1 ... ... ... 1 3 Bakers ... 1 ... ... ... 1 ... ... ... 2 Conductors ... ... ... 1 ... 1 ... ... ... 2 Draughtsmen ... 1 ... ... 1 ... ... ... ... 2 Greengrocers ... ... ... ... ... 1 1 ... ... 2 Stokers ... ... ... ... ... ... ... ... 1 2 Asylum Attendant ... ... ... ... 1 ... ... ... ... 1 Blacksmith 1 ... ... ... ... ... ... ... ... 1 Boot repairer ... ... ... ... ... ... ... ... 1 1 Caretaker 1 ... ... ... ... ... ... ... ... 1 Cashier (F.) ... ... 1 ... ... ... ... ... ... 1 Charwoman ... ... ... ... ... ... ... ... 1 1 Chef ... ... ... ... ... ... ... ... 1 1 Clothing dealer ... ... ... ... ... ... 1 ... ... 1 Coal Porter ... ... ... ... 1 ... ... ... ... 1 Coffee stall keeper ... ... ... ... ... 1 ... ... ... 1 Draper ... ... ... ... ... 1 ... ... ... 1 Dustman ... ... ... ... ... 1 ... ... ... 1 101 Report of the Medical Officer of Health. TABLE LII.—continued. Clapham, North. Clapham, South Putney. Streatham. Balham. Tooting. Southfield. Fairfield. Springfield. Borough. Status of Parents—continued Engine driver ... ... ... ... ... ... ... ... 1 1 Hairdresser ... ... ... ... 1 ... ... ... ... 1 Hawker ... ... ... ... ... ... ... ... 1 1 Horsekeeper ... ... ... ... ... ... 1 ... ... 1 Licensed Victualler ... ... ... ... ... ... ... ... 1 1 Machinist ... ... ... ... ... ... ... ... 1 1 Merchant's buyer ... ... ... ... 1 ... ... ... ... 1 Milk carrier 1 ... ... ... ... ... ... ... ... 1 Newsvendor ... ... ... ... 1 ... ... ... ... 1 Projectile gauger 1 ... ... ... ... ... ... ... ... 1 Royal manservant 1 ... ... ... ... ... ... ... 1 Solicitor 1 ... ... ... ... ... ... ... ... 1 Telephone attendant ... ... ... ... ... 1 ... ... ... 1 Tram inspector ... 1 ... ... ... ... ... ... ... 1 Traveller ... ... ... 1 ... ... ... ... 1 Waitress ... ... ... ... ... 1 ... ... ... 1 Wardmaid ... ... ... ... ... 1 ... ... ... 1 Warehouseman ... ... ... ... ... ... ... 1 ... 1 Window cleaner ... ... ... 1 ... ... ... ... ... 1 No occupation 1 ... ... 2 ... 1 ... ... ... 4 102 Report of the Medical Officer of Health. "It has been impossible to secure the services of any helper since the war broke out, so that the total number of visits paid is less than in the previous year. "There has also been a considerable falling off in the number of second visits. "The total number of visits paid, including re-visits and ineffectual visits was 5,606. The number of first visits totalled 3,337. there were 1,373 second visits and the number of ineffectual visits was 896. "149 visits were paid to the homes to see to the carrying-out of repairs, etc., for which we had served notices. "The largest number of ineffectual visits occurred on our second visits to the mothers, as many had removed and could not be traced. "Whenever successful in finding their new address, we have visited the mother in her new home in order to see that the sanitary conditions were satisfactory. "The total number of visits paid after notification and registration of births will be found in Table LIII. which also shows the method of feeding at the time of the first visit and the number of ineffectual calls. "Among the infants we visited, 120 died, their ages at death are given in Table LV. "51 of these occurred from Diarrhoea and Enteritis, 16 from Bronchitis or Pneumonia, and four from Whooping Cough, eight from Congenital Debility, six from Marasmus, five from Prematurity, two from Asphyxia, and two from Tuberculous Meningitis. "Many infants died from Prematurity previous to our visits, 95 of those visited were born prematurely and 68 children were delicate from birth. 103 Report of the Medical Officer of Health. "The pamphlet containing advice on the feeding of infants is in every case handed to the mother on our first visit and many of them tell us on our second visit they have found the instructions very helpful. "Where the infants have to be reared by hand we were glad to find that very few long tube bottles are now used. "586 mothers used the boat shaped bottle when resorting to artificial feeding, 42 only used the tube bottle, 28 mothers used both the boat and tube bottles and 34 mothers fed their infants with a spoon. "The use of dummies is still very common, on many instances the mothers tell us they have started the practice on the advice of the midwife or nurse, though the baby did not like it. Other mothers seem to think that though the rubber teat is harmful, one made of some celluloid composition is really hygienic. "We found on our first visits that 1,390 of the mothers had not begun to use the comforter, but 1,672 were using it. On our second visits 431 had discontinued its use, but 131 mothers had begun its use since our first visit. "With regard to the employment of midwives, we found 1,596 out of the 3,337 mothers we visited had employed their services. 13 had been attended by un-registered midwives. In nearly every case these were neighbours or relatives called in in an emergency. "The sanitary defects found in the homes during our visits to the mothers have been remedied, or if requiring structural work, referred to you. "76 intimation notices were served and four statutory notices Were required," 104 Report of the Medical Officer of Health. TABLE LIII. Clapham, North. Clapham, South. Putney. Streatham. Balham. Tooting. South fields. Fairfield. Springfield. Borough. Infants visited 291 234 242 231 386 560 389 302 702 3.337 I. Breast-fed only 241 185 193 168 303 426 330 258 614 2,718 2. Otherwise fed 50 49 49 63 83 134 59 44 88 619 (a) Breast and cows' milk 18 10 11 17 19 19 6 6 16 122 (b) Breast and condensed milk 5 7 6 6 13 12 7 9 14 79 (c) Breast, cows' milk and food 2 2 3 ... 8 4 2 2 2 25 (d) Breast, condensed milk and food ... ... ... 2 2 6 ... 1 1 12 (e) Breast and dried milk 1 ... ... 2 ... 4 1 2 4 14 (f) Breast and food 2 3 2 8 6 11 2 1 2 37 (g) Cows' milk only 11 16 14 15 18 32 20 10 32 168 (h) Cows' milk and food 2 4 2 4 2 5 ... ... 6 25 (i) Cows' and condensed milk ... ... ... ... ... 2 ... ... ... 2 (k) Cows' and dried milk ... ... ... ... 1 ... ... ... ... 1 (l) Condensed milk only 6 6 5 8 10 28 13 12 7 95 (m) Condensed and dried milk ... ... ... ... ... ... 1 ... ... 1 (n) Condensed milk and food ... 1 ... ... 2 2 ... ... 1 6 (o) Dried milk 2 ... 3 ... 1 5 5 ... 1 17 (p) Farinaceous and other foods 1 ... 3 1 1 4 2 1 2 15 Ineffectual visits 61 79 65 61 81 162 103 92 192 896 105 Report of the Medical Officer of Health. TABLE LIV. Clapham, North. Clapham, South. Putney. Streatham. Balham. Tooting. Southfields. Fairneld. Springfield. Borough. Infants re-visited 94 89 134 85 174 232 151 149 295 1,373 I. Breast-fed only 69 56 62 47 96 134 108 105 199 876 2. Otherwise fed— (a) Breast and cows' milk 1 6 7 14 27 25 4 2 12 98 (b) Breast and condensed milk 7 5 2 3 9 5 2 4 10 47 (c) Breast, cows' milk and food 1 2 ... 1 3 5 4 2 7 25 (d) Breast, condensed milk and food 1 ... ... 2 2 3 1 2 1 12 (e) Breast and dried milk ... ... 1 ... 3 1 1 1 ... 7 (f) Breast and food 1 5 3 2 3 10 1 4 8 37 (g) Cows' milk only 9 9 14 9 17 22 15 12 34 141 (h) Cows' and condensed milk ... 1 ... 1 ... 1 ... ... ... 3 (i) Cows' and dried milk ... ... ... ... ... ... 1 ... ... 1 (j) Cows' milk and food ... 2 2 ... 3 2 2 ... 5 16 (k) Condensed milk only 3 3 9 2 9 18 5 13 15 77 (i) Condensed milk and food ... ... 1 1 2 4 2 2 1 13 (m) Dried milk only 1 ... 3 1 ... 1 3 ... 1 10 (n) Farinaceous and other foods 1 ... ... 2 ... 1 2 2 2 10 Totals 25 33 42 38 78 98 43 44 96 497 In all 3,337 infants were visited, compared with 3,772 in 1913, 3,059 in 1912, and 3,518 in 1911. It is satisfactory to observe that with the assistance of the voluntary workers, infants were visited in all the Wards of the Borough, 106 Report of the Medical Officer of Health. Out of 3,337 infants, 2,718 or 81.4 per cent. were wholly breast-fed, and 619 or 18.6 per cent. otherwise fed. There is a slight decrease in the number breast-fed compared with previous years. 1,373 infants were re-visited, and of these 876 or 64 per cent. were breast-fed, while 497 or 36 per cent. were otherwise fed, which is also a slight decrease compared with previous years. The total number of deaths among those visited was 120, 15 in Clapham, eight in Putney, 19 in Streatham, 27 in Tooting, and 51 in Wandsworth. Table LV. shows these deaths arranged in monthly age periods. The heaviest mortality occurred at one to two months. It is a most significant fact that the number of deaths from Diarrhoea and Enteritis among 2,718 infants who were breast-fed was only six, or a percentage mortality of 22, while among 619 infants who were otherwise fed the number of deaths was 45 or a percentage mortality of 7.2. The mortality among infants otherwise fed was thus 32 times greater than those breast-fed. The mortality among the infants visited by the Inspectors was only 32 per 1,000 births, compared with 88 per 1,000, the rate for the Borough for the year. 107 Report of the Medical Officer of Health. TABLE LV. Wards Under 1 month. I—2 months. 2-3 months. 3—4 months. 4-5 months. 5—6 months. 6—7 months. 17—8 months. 8—9 months. 9—10 months. 10—11 months. 11—12 months. Total. Clapham, North ... 2 1 2 1 ... 3 ... ... 1 ... ... 10 Clapham, South 2 1 ... 2 ... ... ... ... ... ... ... ... 5 Putney ... ... ... ... 1 2 1 ... 1 1 1 ... 8 Streatham ... ... 3 2 1 2 ... 1 ... ... ... ... 9 Balham 1 2 1 1 1 ... ... 1 2 1 ... ... 10 Tooting 2 5 3 2 2 4 3 3 ... ... 1 2 27 Southfield ... 3 2 I 4 ... ... ... 2 ... ... ... 12 Fairfield ... 1 1 3 1 1 2 1 3 1 ... ... 14 Springfield 1 7 3 5 3 2 1 ... 2 1 ... ... 25 Total 6 21 14 19 14 11 10 6 10 5 2 2 120 Tuberculous Diseases. The total number of deaths from diseases of a Tuberculous nature was 589, compared with 355 in 1913, 366 in 1912, and 389 in 1911. 305 of the deaths were due to Pulmonary Tuberculosis, 42 to Tuberculous disease of the Brain and 42 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 .93 per 1,000 compared with .88 in 1913, .96 in 1912, and .91 in 1911; from other Tuberculous diseases .25 compared with 20, .20 and 35; and from all Tuberculous diseases 119 compared with 1.08, 1.16, and 1.26, 108 Report of the Medical Officer of Health. TABLE LVI. Sub-District. Pulmonary Tuberculosis. Other Tuberculous Diseases. Total. No. of Deaths. Rate. No. of Deaths. Rate. No. of Deaths. Rate. Clapham 58 .93 16 .25 74 1.19 Putney 23 .78 4 .13 27 .92 Streatham 74 .71 26 .25 100 .96 Tooting 33 .87 21 .55 54 1.43 Wandsworth 117 1.22 17 .17 134 1.40 Whole Borough 305 .93 84 .25 389 1.19 From all Tuberculous diseases the rates per 1,000 were higher in all the sub-districts than in 1913. With regard to Pulmonary Tuberculosis, the rate for Streatham was below, and the rates for Putney, Tooting, and Wandsworth above last year's rates, while in Clapham the rate was the same. From other Tuberculous diseases the rate was .05 higher than in 1913. This rate was lowest in Putney and highest in Streatham. and the rate ;or Pulmonary Tuberculosis was lowest in Streatham and highest in Wandsworth The following Table shows the death-rate per 100,000 from Pulmonary Tuberculosis for the whole Borough, and for the separate sub-districts for the year as well as or the preceding 10 years, 109 Report of the Medical Officer of Health. TABLE LVII. 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 Average for 10 years. 1914 Clapham 126 112 117 89 95 104 84 118 116 93 105 93 Putney 86 92 83 67 62 116 85 70 97 55 81 78 Streatham 83 72 76 73 87 60 65 85 73 76 75 71 Tooting 151 101 90 96 86 110 109 81 87 69 98 87 Wandsworth 131 132 121 131 123 109 108 88 112 109 117 122 Whole Borough 112 102 100 95 96 94 88 91 96 88 96 93 Compared with the decennial average the rate was lower in the whole Borough, and in all the sub-districts with the exception of Wandsworth, where it was 5 per 100,000 higher. The rate n Clapham for 1914 is the same as it was in 1913, and is 12 under the decennial average, in Putney it was 23 per 100,000 above the rate for 1913, but 3 under the corrected decennial average. In Streatham it is five under the rate for 1913, and four under the decennial average. In Tooting the rate is higher than it was in 1913, but is 11 under the decennial average, while in Wandsworth the rate was 13 higher than in 1913, and 5 above the decennial average. This last sub-district has always had a higher average mortality from Pulmonary Tuberculosis than the other sub-districts. One death from Pulmonary Tuberculosis occurred in an infant under one year, one from one and under two years, two in persons from two and under five years, five from five and under 15 years, 52 from 15 and under 25 years, 143 from 25 and under 45 years, 79 from 45 and under 65 years, and 22 over 65 years. From other Tuberculous diseases nine deaths occurred under one year, 13 from one 110 Report of the Medical Officer of Health. and under two years, 18 from two and under five years, 20 from five and under 15 years, eight from 15 and under 25 years, six from 25 and under 45 years, nine from 45 and under 65 years, and one over 65 years. The list which follows shows the occupation of those who died from Pulmonary Tuberculosis during the year. TABLE LVI1I. Males. Females. Totals Clerks 20 2 22 Shop Assistants 15 2 17 General Labourers 12 — 12 Domestic Servants — 8 8 Actors 3 1 4 Bakers 4 — 4 Carmen 4 — 4 Carpenters 4 — 4 Laundry Hands 1 3 4 Printer Compositors 4 — 4 Tradesmen's Porters 4 — 4 Charwomen — 3 3 Commercial Travellers 3 — 3 Painters 3 — 3 Tailors 2 1 3 Army Pensioners 2 — 2 Brass Finishers 2 — 2 Clerks in Holy Orders 2 — 2 Coach Body Makers 2 — 2 Cooks 2 — 2 Drapers 2 — 2 Engineer's Fitters 2 — 2 Factory Hands — 2 2 French Polishers 2 — 2 Housekeepers — 2 2 Insurance Agents 2 — 2 Millers 2 — 2 Needlewomen — 2 2 Carried forward 99 26 125 1ll Report of the Medical Officer of Health. TABLE LVIII.—continued. Males. Females. Totals Brought forward 99 26 125 Police Constables 2 — 2 Warehousemen 2 — 2 Barmaid — 1 1 Barman 1 — 1 Blacksmith 1 — 1 Boltmaker 1 — 1 Bookpacker 1 — 1 Bootmaker 1 — 1 Boxmaker — 1 1 Builder 1 — 1 Butcher 1 — 1 Canine Specialist 1 — 1 Carriage Painter 1 — 1 Chemist 1 — 1 Civil Servant, Home Office 1 — 1 Coachsmith 1 — 1 Commission Agent 1 — 1 Commissionaire 1 — 1 Cyclemaker 1 — 1 Dressmaker — 1 1 Electrician 1 — 1 Engineer 1 — 1 Fancy Leather Worker 1 — 1 Gardener 1 — 1 Gas Labourer 1 — 1 Gasmeter maker 1 — 1 General Dealer 1 — 1 Hawker 1 — 1 Horsekeeper 1 — 1 Hotel Proprietor 1 — 1 Hotel Storekeeper 1 — 1 Iron Foundry Labourer 1 — 1 Ironmonger s Buyer 1 — 1 Jewel Lace Maker — 1 1 Carried forward 131 30 161 112 Report of the Medical Officer of Health. TABLE LVIII.—continued. Males. Females. Totals Brought forward 131 30 161 Lady's Companion — 1 1 Lamplighter 1 — 1 Leather Dresser 1 — 1 Locksmith 1 — 1 Medical Student 1 — 1 Milk Carrier 1 — 1 Motor Car Washer 1 — 1 Musician 1 — 1 Newspaper Proprietor 1 — 1 Night Watchman 1 — 1 Oil and Colour Merchant 1 — 1 Omnibus Conductor 1 — 1 Pensioned Police Sergeant 1 — 1 Photographer's Assistant — 1 1 Plumber 1 — 1 Printer's Labourer 1 — 1 Railway Porter 1 — 1 Schoolmaster 1 — 1 Secretary 1 — 1 Ship's Steward 1 — 1 Shop-blind maker 1 — 1 Shop Walker 1 — 1 Silk Merchant 1 — 1 Soldier 1 — 1 Solicitor 1 — 1 Tarpavior 1 — 1 Telephone Operator 1 — 1 Theatrical Dresser — 1 1 Tramcar Driver 1 — 1 Upholsterer 1 — 1 Verger 1 — 1 Waterman 1 — 1 Window Cleaner 1 — 1 Widows, Wives and Daughters of Labouring Classes — 32 32 Carried forward l6l 65 226 113 Report of the Medical Officer of Health. TABLE LVIII.—continued. Males. Females Totals. Brought forward 161 65 226 Widows, Wives and Daughters of Clerks, Tradesmen, etc. — 28 28 Widows, Wives and Daughters of Artisans — 27 27 Children of Labouring Classes 1 3 4 „ Clerks, Tradesmen, etc. — 1 1 „ Artisans I — 1 No Occupation 8 10 18 171 134 305 Of the total number of males who died, viz.—171, the occupation of 161 is given, two were children and eight were stated to have had no occupation. Clerks and shop assistants head the list, the numbers being respectively 20 and 15. Among females of 134 deaths only 33 were engaged in some occupation, eight being domestic servants three each were dressmakers and needlewomen, laundry hands and charwomen, two each were shop assistants, clerks, housekeepers, and factory hands. 27 of the 134 females had been widows, wives or daughters of artisans, 32 of the labouring classes, 28 of clerks, tradesmen, etc., and 10 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 1904-1913, and for the year 1914. Among males the rate for Pulmonary Tuberculosis for the year 1914 was 1.15, compared with 1.20 the decennial average; and among females .72 compared with .75; while from other Tuberculous diseases the rate among males was 35, compared with .36; and among females .23 compared with .27. 114 Report of the Medical Officer of Health. Among children under five years the rate for the year was 12 compared with .18 the decennial average. The rate for males and females for the year 1914 from Pulmonary Tuberculosis was .93 compared with .96 the decennial average. In two of the years during the decennium, viz.—in 1910 and 1911, this rate was lower 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 27 years. As will be seen all the rates have increased compared with the previous year. The rate among males was lowest in 1911 and among females in 1903. Death-rate per /0;000 from Pulmonary Tuberculosis from 1888 to 1914 Inclusive. 115 Report of the Medical Officer of Health. TABLE LXIX. 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. 1904 113,124 138,822 251,946 158 1.39 125 90 283 1.12 50 .44 47 .33 97 .38 72 .28 1905 116,342 142,771 259,113 150 1.32 116 .81 266 1.02 52 .44 42 .22 94 .36 66 .25 1906 119,677 146,863 266,540 142 1.19 125 .85 267 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 155020 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 1913 144,435 176,905 321,340 161 1.09 128 71 289 .88 39 .26 27 .15 66 .20 31 .09 Average 10 years 128,784 157,993 293,687 154 1.20 119 .75 275 .96 47 .36 43 .27 91 .32 53 .18 1914 147,622 179,323 326,945 171 1.15 134 .72 305 .93 42 .35 42 .23 84 .25 40 .12 116 Report of the Medical Officer of Health. Notification of Tuberculosis. The total number of cases of Pulmonary Tuberculosis notified during 1914 was 706, compared with 783 in 1913, 855 in 1912, and 514 in 1911. O the total cases notified during the year viz:—706, 138 were from Clapham, 46 from Putney, 170 from Streatham, 126 from Tooting, and 231 from Wandsworth, compared with 783 in 1913, of which 154 were from Clapham, 45 from Putney, 209 from Streatham, 89 from Tooting, and 286 from Wandsworth. There was thus a decided decrease in all the sub-districts with the exception of Putney and Tooting, where there was an increase. Two of the cases were under one year of age, 12 from one and under five years 60 from five and under 15 years, 132 from 15 and under 25 years, 337 from 25 and under 45 years, 128 from 45 and under 65 years, and 35 over 65 years. In Table LX. is shown the total number of cases notified since 1908, 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 3,607 cases have been notified, and of these 1,458 or 40 per cent. have died, 717 or 19.8 per cent. have removed, 97 or 2.6 per cent. are stated to have recovered, in 23 or .6 per cent. no inquiries have been made, while 1,312 or 36.3 per cent. are still on the Register. It will be noted that in 1912, 1913 and 1914 inquiries have been made in every case, although in 40 cases in 1912, 55 in 1913, and 32 in 1914 these inquiries were made at my request by the private medical practitioner. Report of the Medical Officer of Health. 117 TABLE LX. Year. Cases 1 Reported. Deaths. Removed. Recovered. No Inquiries. Cases on Register. 1908 1909 1910 1911 1912 1913 1914 Total. 1908 71 25 6 1 1 ... ... 1 34 31 ... 5 1 1909 389 ... 109 48 18 26 9 6 216 104 15 4 50 1910 289 ... ... 77 37 28 7 4 153 85 5 8 38 1911 514 ... ... ... 113 82 27 22 244 152 11 6 101 1912 855 ... ... ... ... 225 105 48 378 179 49 ... 249 1913 783 ... ... ... ... ... 180 77 257 117 13 ... 396 1914 706 ... ... ... ... ... ... 176 176 49 4 ... 477 Total 3,607 25 115 126 169 361 328 334 1,458 717 97 23 1,312 The total number of deaths for 1914, shown in Table LX., viz., 334, does not agree with the number in the Table of deaths on page 24, viz.:- 305. The 29 remaining cases did not die from Pulmonary Tuberculosis, although notified as such. Four 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 706 cases visited by the Inspectors, or in which the information was given by the medical attendant, in 64 this was so indefinite that it was impossible to tabulate it, in the majority of cases no family history being known. 15 cases were notified from Common Lodging Houses, three from Asylums, one from H.M. Prison, three were homeless, in seven cases wrong addresses were given, seven had removed, in eight the patients were either lodgers or domestic servants and the occupier of the house could give no information, in 17 cases no definite information was obtainable, and in only three instances the Inspector was refused information. 118 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 LXI. MALES. Number of Cases, 349 Age Distribution. Under 1 year. 1-5. 5-15. 15-25. 25-45. 45-65. 65-. All ages. 2 6 33 62 163 72 11 349 Duration of Illness in years. Under 1 year. 1-2. 2-3. 3-4. 4-5. 5 and upwards. 193 49 35 25 4 43 Number of Living Rooms in Patient's Tenement. One. Two. Three. Four. Over Four. 30 31 70 89 129 Weekly Rent Paid. Under 5/-. 5/- and under 10/-. 10/- and under 15/-. 15/- and over. Not ascertained 40 168 100 41 ... Report of the Medical Officer of Health. 119 Occupation of Patient. A.—Outdoor occupations— Taxi, motor-car, motor-'bus and tramcar men (drivers, conductors, motor men), chauffeurs (mechanical traction) 9 Carmen, carters, vanmen, etc. (horse traction) 4 Dock labourers, wharfingers, barge and lightermen, watermen — General labourers 51 Gardeners 4 Artisans 28 Bricklayers 4 Other 25 B.—Indoor occupations— Clerks 38 In Bakehouse 5 In other factories or workshops 38 In printing works 11 Tailors 2 Shop salesmen 26 On tube and underground railways (excluding clerks) 3 Soldiers 8 Bootmakers 7 Professional men, actors, dentists, scholars, etc. 7 Barmen and cellarmen 4 Domestic servants 12 Sons of labourers 22 Sons of artisans 16 Sons of clerks, travellers, etc. 5 Other 20 120 Report of the Medical Officer of Health. TABLE LXII. 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— 5 Affected ... 2 ... 1 ... ... ... ... ... ... ... Not 5 3 16 1 19 ... 5 ... 5 ... 1 Unknown ... ... ... ... 2 ... ... ... ... ... ... 25— 55 Affected ... 5 4 14 ... 9 1 2 3 4 ... Not 70 31 192 30 149 46 50 2 92 3 9 Unknown 4 ... 1 ... 7 1 ... ... ... ... ... 35— 108 Affected ... 38 4 27 ... 8 2 5 7 9 ... Not 69 107 334 251 117 28 96 11 283 27 19 Unknown 2 ... 8 ... 65 ... ... ... ... ... ... 55— 31 Affected ... 2 2 6 ... ... ... 1 I 7 ... Not 3 57 44 19 6 5 23 7 85 4 7 Unknown ... ... 3 ... 27 ... ... ... ... ... ... Report of the Medical Officer of Health. 121 TABLE LXIII. 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— 41 Affected 5 5 4 5 4 20 Not 68 2 148 44 265 54 Unknown 2 ... ... ... 1 ... 15— 59 Affected ... 18 6 10 ... 16 Not 87 13 203 27 334 38 Unknown ... ... ... ... 5 ... 25— 30 Affected ... 4 3 7 1 19 Not 38 18 111 19 132 53 Unknown ... ... ... ... 7 ... 35— 19 Affected ... 3 ... 9 2 4 Not 8 27 58 24 13 12 Unknown ... ... 2 ... 14 ... 55— 1 Affected ... ... ... ... ... ... Not ... 2 ... 5 ... ... Unknown ... ... ... ... 1 ... 122 Report of the Medical Officer of Health. TABLE LXIV. FEMALES. Number of Cases, 261. Age Distribution. Under 1 year. 1-5. 5-15. 15-25. 25-45. 45-65. 65-. All ages. ... 7 24 58 123 38 11 261 Duration of Illness in Years. Under 1 year. 1-2. 2-3. 3-4. 4-5. 5 and upwards. 130 47 27 14 10 33 Number of Living Rooms in Patient's Tenement. One. Two. Three. Four. Over Four. 18 21 69 64 89 Weekly Rent Paid. Under 5/-. 5/- and under 10/-. 10/- and under 15/-. 15/- and over. Not ascertained. 26 149 63 23 ... Occupation of Patient. A.—Outdoor occupations— Flower Sellers — Hawkers 1 Other ... B.—Indoor occupations— Clerks 9 Shop Assistants, Charwomen, Dressmakers and Milliners 37 Laundry hands 18 In other factories or workshops 8 Domestic servants— In inns, hotels, eating-houses, &c. 4 In private dwellings 31 Widows, wives and daughters of labourers 50 Widows, wives and daughters of artisans 24 Widows, wives and daughters of clerks, &c. 38 Daughters of labourers 24 Daughters of artisans 6 Daughters of clerks, &c. 1 Other 10 Report of the Medical Officer of Health. 123 TABLE LXV. 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.) Unties 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— 9 Affected ... 5 ... 2 1 2 ... ... ... ... ... Not 8 5 30 12 30 4 9 ... 10 ... 2 Unknown ... ... 1 ... 2 ... ... ... ... ... ... 25— 50 Affected 1 8 9 7 ... 12 4 2 4 6 ... Not 65 26 230 39 123 60 45 1 94 14 7 Unknown ... ... ... ... 13 ... ... ... ... ... ... 35— 64 Affected ... 14 9 19 1 15 2 5 9 3 ... Not 47 67 238 59 119 57 50 7 188 34 5 Unknown ... ... 3 ... 30 ... ... ... ... ... ... 55— 15 Affected ... 3 ... 2 ... ... ... 2 ... ... ... Not 1 24 31 20 ... 3 8 5 39 11 3 Unknown 2 ... 2 ... 14 ... ... ... ... ... ... 124 Report of the Medical Officer of Health. TABLE LXVI. 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— 31 Affected 5 3 5 3 2 11 Not 49 5 92 18 175 53 Unknown ... ... ... ... 2 ... 15— 48 Affected 2 12 9 20 3 26 Not 71 11 152 26 254 43 Unknown ... ... ... ... 6 ... 25— 26 Affected 1 8 1 8 1 11 Not 27 16 69 12 84 17 Unknown ... ... ... ... 4 ... 35— 12 Affected ... 7 1 8 ... 3 Not 8 9 32 7 15 5 Unknown ... ... ... ... 8 ... 55— 6 Affected ... 2 ... 1 ... 2 Not ... 10 12 10 1 3 Unknown ... ... ... ... 5 ... Report of the Medical Officer of Health. 125 Of the 632 cases visited by the Inspectors it has been found possible to include in the Tables as many as 610, 349 of males and 261 of females, as against 640 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, 108 cases were notified. Of these, 38 parents had died of Pulmonary Tuberculosis, 69 were living and not affected, 107 died of other diseases, while two were alive but their medical history was not known. In the next two columns under the heading of brothers and sisters, four were alive but affected, and 27 dead of Pulmonary Tuberculosis ; 334 were alive and not affected, and 251 had died of other diseases, while the medical history of eight alive was unknown. In group III which relates to uncles and aunts, eight had died of Pulmonary Tuberculosis, 117 were alive and not affected, and 28 dead of other diseases, while the medical history of 65 was unknown. In the next column it will be seen that the wives of five cases had died of Pulmonary Tuberculosis and 96 were alive and 11 dead not affected. Of the patients' children seven were alive and nine died affected, 283 alive and not affected, and 27 died of other diseases. 19 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. 1—349, had parents alive affected, while 77 had died of Pulmonary Tuberculosis 356 parents were alive and not affected while 258 had died, but not of Pulmonary Tuberculosis. 126 Report of the Medical Officer of Health. Among the total number of females viz.—261, nine had parents alive affected, while 59 had died of Pulmonary Tuberculosis; 278 parents were alive and not affected, while 173 had died, but not of Pulmonary Tuberculosis. Of the total of 610 patients male and female, married and unmarried, 14 had parents alive affected, while 136 parents had died of Pulmonary Tuberculosis. Taking the column dealing with brothers and sisters, among males we find 25 had brothers and sisters alive affected, while 79 had died of Pulmonary Tuberculosis; and among females 41 had brothers or sisters alive affected, while 70 had died of Pulmonary Tuberculosis, or a total among males and females of 59 who had brothers or sisters alive affected, while 149 had died of Pulmonary Tuberculosis. With regard to the notification of cases of non-pulmonary Tuberculosis, in all 199 cases were notified, 30 from Clapham, 10 from Putney, 46 from Streatham, 40 from Tooting, and 73 from Wandsworth. 10 O these were under one year of age, 49 from one and under five years, 79 from five and under 15 years, 23 from 15 and under 25 years 27 from 25 and under 45 years, 10 from 45 and under 65 years, and one over 65 years. Table LXVII 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., 68 do not correspond with the total number on Table LIX, as seven were registered as having died from Pulmonary Tuberculosis and are included under that heading, six cases died from other causes, three cases which died in 1914 were not notified till 1915 while in the case of seven deaths which occurred in Institutions outside the Borough, no notifications could be obtained Report of the Medical Officer of Health. 127 As is to be expected, the deaths from General Tuberculosis shows the highest mortality, four out of the four cases notified having been fatal and the next highest mortality occurred among cases of Tuberculosis of the Brain, 43 out of 44 having been fatal. Out of the total of 199, 68 died, five have removed to other districts, while 126 cases are still on the Register and under observation. 128 Report of the Medical Officer of Health. TABLE LXVII. Number of cases notified. No. of deaths. Removed. On Register. Localisation of Disease. 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 44 23 21 6 22 12 1 3 ... ... ... ... ... ... 22 21 43 ... 1 Glands, Mediastinal 2 2 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 ,, Mesenteric 26 14 12 4 11 4 2 3 ... ... 1 1 ... ... 6 7 13 2 11 ,, Cervical 52 23 29 ... 9 16 13 6 1 6 1 ... ... ... ... 1 1 1 50 Bones and joints 53 25 28 ... 17 17 6 1 7 6 5 4 ... ... 1 1 2 2 49 Lupus 7 3 4 ... ... 2 1 ... ... ... 3 1 ... ... ... ... ... ... 7 Larynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... General Tuberculosis 4 1 3 ... 1 ... ... ... ... 1 ... 2 ... ... 1 3 4 ... ... Other parts 11 8 3 ... ... 1 1 1 1 3 1 2 ... 1 4 1 5 ... 6 Total 199 99 100 10 50 54 24 14 9 16 11 10 ... 1 34 34 68 5 126 Report of the Medical Officer of Health. 129 The next Table shows the number of cases notified, the number which died, removed, and recovered during the years 1913 and 1914, and the number still remaining on the register at the end of 1914. TABLE LXVIII. Year. Cases Notified. Deaths. Removed. Recovered. Cases on Register. 1913. 1914. Total. 1913 328 46 10 56 38 15 215 1914 199 — 68 68 5 — 126 Total 527 46 78 124 43 15 341 N.B.—The figures for 1913 do not correspond with the number of cases notified as four cases of other forms of Tuberculosis notified in 1913 were in 1914 notified as suffering from Pulmonary Tuberculosis. Table LXIX. is a summary of notifications during the period from the 4th January, 1914, to the 2nd January, 1915, and has been prepared at the request of the Local Government Board. It will be seen that 687 primary notifications of Pulmonary Tuberculosis were made on Form A, 401 of males and 286 of females, while the total notifications were 876. Four cases were notified by School Medical Officers on Form B, three of males and one of females, while 214 notifications from Poor Law Institutions and 201 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 190 were notified on Form A, four by School Medical Officers on Form B, while 15 were notified from Poor Law Institutions and six 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. 130 Report of the Medical Officer of Health. TABLE LXIX. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from 4th January, 1914, to end of the week ending the 2nd January, 1915. 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) 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. Poor Law Institutions. Sanatoria. Pulmonary— Males 2 4 21 12 30 40 97 91 61 25 18 401 505 ... 1 2 3 3 150 124 Females ... 7 12 9 18 40 88 54 30 11 17 286 371 ... 1 ... 1 4 64 77 Non-Pulmonary— Males 7 18 26 14 5 3 8 5 5 ... ... 91 112 ... 3 ... 3 6 8 5 Females 3 27 25 9 9 6 8 6 5 ... 1 99 108 ... 1 ... 1 1 7 1 Report of the Medical Officer of Health. 131 Discharges are made on Form D, and of these 299 were received during the year. Of the 299 certificates, 63 were received from Superintending Officers of the Wandsworth Union, 63 from Downs Sanatorium, Sutton, 50 from the Brompton Hospital, 43 from the Northern Hospital, Winchmore Hill, N. 13 from Queen Mary's Hospital, Carshalton, 12 from Brompton Sanatorium, Frimley, six each from the National Sanatorium, Benenden, and the Royal National Sanatorium, Bournemouth, four from Fairlight Sanatorium, Hastings, four from the Mount Vernon Hospital, Hampstead, four from St. Mary's Home, Broadstairs, three from Eversfield Chest Hospital, three from Kelling Sanatorium, three from Pinewood Sanatorium, Wokingham, three from Lord Mayor Treloar's Cripple Hospital, Alton, two from the Croydon Infirmary, two from Making's Farm Sanatorium, two from Victoria Park Hospital, Hither Green, and one each from the City of London Chest Hospital, Crookbury Sanatorium, Isleworth Infirmary, Fulham Infirmary East Cliff House, Margate, Hahnemann Convalescent Home, Bournemouth, Joyce Green Hospital, Ipswich Sanatorium, Royal Chest Hospital, Royal Sea Bathing Hospital, Margate, St. Michael's Home Axbridge, Southwark Infirmary and the Workhouse, Minster, Nr. Ramsgate. Of the 63 certificates received from Superintending officers of the Wandsworth Union, 39 were from St. James's Infirmary, Upper Tooting, 16 from St. John's Hill Infirmary and eight from Tooting Home. The 299 certificates received related to 277 cases, 20 having been notified twice and two cases three times. 61 cases were notified as having gone to addresses in Clapham, 13 to Putney, 83 to Streatham, 38 to Tooting, and 104 to Wandsworth. One case in Wandsworth was discharged to a Common Lodging House. The two following Tables show the total number of cases notified and also the number of times they were notified. 132 Report of the Medical Officer of Health. Of the cases of Pulmonary Tuberculosis, 616 were notified once, 79 twice, eight three times, and three four times; while of the cases of other forms of Tuberculosis 183 were notified once, 15 twice, none three times, and one four times. TABLE LXX. Pulmonary Tuberculosis. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. One Notification 129 41 151 96 199 616 Two Notifications 9 5 16 22 27 79 Three Notifications ... ... 1 3 4 8 Four Notifications ... ... 2 ... 1 3 Total 138 46 170 121 231 706 TABLE LXXI. Other Forms of Tuberculosis. Clapham. Putney. Strea ham. Tooting. Wandsworth. Whole Borough. One Notification 28 9 44 36 66 183 Two Notifications 2 1 2 4 6 15 Three Notifications ... ... ... ... ... ... Four Notifications ... ... ... ... 1 1 Total 30 10 46 40 73 199 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. Report of the Medical Officer of Health. 133 The total number of visits made was 2,722 in cases of Pulmonary Tuberculosis, 509 in Clapham, 145 in Putney, 661 in Streatham, 461 in Tooting, and 946 in Wandsworth, and 525 in cases of other forms of Tuberculosis, 80 in Clapham, 23 in Putney, 104 in Streatham, 117 in Tooting, and 201 in Wandsworth. In addition to these visits by the Health Visitor, 253 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. 32 of the cases under observation removed to other places and the Medical Officers of Health of these were duly informed, while 25 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 two were returned after the death of the patient. In 13 of the cases visited the patients already had one, but in many cases the patients objected to their use. Tuberculosis Dispensary. 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 during the year, although the absence of the Tuberculosis Officer on military duty and the necessary alteration of the dispensary arrangements resulted in a slight decrease in the number of cases dealt with. It is satisfactory to note that arrangements have now been made by the London County Council for the treatment in sanatoria of non-insured persons, and since June, 1914, seven cases have been admitted to sanatoria under the scheme up to the end of the year. 134 Report of the Medical Officer of Health. I am still of opinion that, especially in the case of children certain patients should have open-air treatment other than at home, and it is to be hoped that shortly this will be available. The question of prevention has again 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 421 contacts were examined, and of these 28 or about 6.65 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 170 cases having been sent by their private medical attendants. With regard to cases of Tuberculosis among insured persons, of 363 cases notified 88 have been, and 47 are at present in sanatoria. 15 of these were in sanatoria for less than one month, 15 from one to two months, 30 from two to three months, 15 from three to four months, three from four to five months, seven from five to six months, and three for six months and over. With regard to their condition after return, 40 were improved and able to work, while 23 were stated to have improved, but unable to work, 11 were worse, and 14 died, four of these at home and 10 in sanatoria. After return from sanatoria 54 patients had domiciliary treatment, 10 had dispensary treatment, three were treated in the Infirmary, two were treated in hospitals, while nine removed and the form of treatment could not be ascertained. During the year disinfection was carried out at 399 premises either after the death or removal of the patient, compared with 420 in 1913, 426 in 1912, 313 in 1911, 265 in 1910, 255 in 1909, and 184 in 1908. 84 of the premises disinfected were in Clapham, 26 in Putney 53 in Streatham, 53 in Tooting, and 140 in Wandsworth. 135 Report of the Medical Officer of Health. Report of Tuberculosis Officer. The work done at the Dispensaries has developed since the previous year. The arrangement with the London Insurance Committee or the Tuberculosis Officer to examine as Exper Medical Adviser, cases recommended for Sanatorium Benefit, came into operation in January. 127 cases have been dealt with under this arrangement. Of these, 124 had not previously attended the dispensaries three had already attended in 1913. Five of the 127 were found to be nontuberculous. Of the remaining 122 cases, 79 were recommended and received sanatorium treatment, 14 hospital treatment, 11 dispensary treatment and 18 domiciliary treatment. During the year, the London County Council completed arrangements for the treatment in sanatoria of non-insured persons, principally children, suffering from Pulmonary Tuberculosis. This is a very important step in the treatment of the disease in children, which is frequently in an early stage, where Sanatorium treatment is most beneficial. Under this scheme, seven children have been sent to Naylands Sanatorium, six of them were still in the Sanatorium at the end of the year, three having been there six months, two three months, and one six weeks. The seventh child was discharged from the Sanatorium after three month's treatment. The London County Council requ.re that the children be examined at the dispensary on discharge from the Sanatorium and afterwards at intervals of three or six months. In this way the child is kept under observation and if a relapse occurs can eceive further treatment. The arrangement made with St Thomas's Hospital for eference to that Institution of cases requiring additional methods of diagnosis has been in operation throughout the year. 136 Report of the Medical Officer of Health. It has been found that the cases requiring such aids to diagnosis are few in number, but it is a great advantage to be able to send difficult cases to the hospital for examination by methods not available at the dispensary. As a rule the patient is admitted and kept under close observation for a few days. A thorough examination is made and a report sent to me by the Tuberculosis Officer at the hospital. Nine cases were dealt with under this arrangement and in addition, a number of cases requiring surgical treatment not available at the dispensaries were sent to St. Thomas's Hospital. During the year 971 patients were examined, compared with 936 in 1913. The total attendances at the two dispensaries were 7,657, compared with 5,502 in 1913. Of the new cases, 705 were examined in seven months ending August 5th (declaration of War), 266 in the subsequent five months. With regard to attendances, a similar falling off is shown. though to a less degree. Of 7,657 total attendances, 5 203 were registered in the first seven months, and 2,454 in the last five months of the year. Table LXXII. shows the total insured and non-insured cases of each sex examined during the year, divided into tuberculous and non-tuberculous. It also shows the total attendances made by these cases and the average attendance per case. 379 tuberculous cases made 2,548 attendances, an average of 672 attendances per case, while in 1913, 343 cases made 4,152 attendances, an average of 12.1. There were 226 insured cases, compared with 136 in 1913, and 153 non-insured cases, compared with 207. The lower average attendance this year is mainly due to the larger number of cases which were treated in institutions and by medical practitioners (see Table LXXIX.), and by the increased number of insured patients, many of whom were sent by the Insurance Committee and only made one attendance, 137 Report of the Medical Officer of Health. As last year, the insured cases of Tuberculosis showed more males than females, the un-insured more females than males. 592 non-tuberculous cases made 1,304 attendances, an average of 2.2 attendances per case, compared with 593 cases, 1,350 attendances, average of 2.28 in 1913. In the non-tuberculous cases, females predominated as in 1913. Table LXXIII. is similar to the previous one, only showing the new cases of 1913 which attended during 1914, and the attendances they made. To last year's 343 tuberculous cases have to be added four, classed last year as non-tuberculous, which developed tuberculosis in 1914, making a total of 347. From Table LXXIII. it is seen that 223 of these cases attended during 1914, making 3,126 attendances, an average of 14.01 attendance per case. This average is more than twice that for the 1914 cases (6.72), because the bulk of the 223 cases are regular attendants. TABLE LXXII. New Cases, 1914. Tuberculous. Non-Tuberculous. Totals. M. F. Total. M. F. Total. M. F. Total. Cases— Insured 153 73 226 35 44 79 188 117 305 Non-Insured 57 96 153 218 295 513 275 391 666 Totals 210 169 379 253 339 592 463 508 971 Attendances— Insured 802 374 1,176 67 100 167 869 474 1,343 Non-Insured 485 887 1,324 524 613 1,137 1,009 1,500 2,509 Totals 1,287 1,261 2,548 591 713 1,304 1,878 1,974 3,852 Average Attendance per case. 6.72 2.20 3.96 138 Report of the Medical Officer of Health. TABLE LXXIII. 1913 Cases attending in 1914. Tuberculous. Non-Tuberculous. Totals. M. F. Total. M. F. Total. M. F. Total. Cases— Insured 48 27 75 1 6 7 49 33 82 Non-Insured 50 98 148 123 150 273 173 248 421 Totals 98 125 223 124 156 280 222 281 503 Attendances— Insured 687 232 919 1 9 10 688 241 929 Non-Insured 706 1,501 2,207 300 369 669 1,006 1,870 2,876 Totals 1,393 1,733 3,126 301 378 679 1,694 2,111 3,805 Average Attendance Per Case. 14.01 2.42 7.56 Table LXXIV. shows the number of new cases examined and total attendances made at the two dispensaries. TABLE LXXIV. Dispensary. Total Cases. Total Attendances. Tuberculous. NonTuber culous. Total. Tuberculous. NonTuber culous. Total. 129, East Hill, Wandsworth 245 419 664 3,619 1,237 4,856 Weir Dispensary, Balham 134 173 307 2,055 736 2,801 Totals 379 592 971 5,674 1,983 7,657 139 Report of the Medical Officer of Health. At East Hill Dispensary there were 664 cases examined, compared with 712 last year, a decrease of 48. At Balham Dispensary there were 307 cases examined, compared with 224 last year, an increase of 83. The attendances at East Hill were 4,856, an increase of 855 on last year, and at Balham 2,801, an increase of 1,300. Table LXXV. 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. 20 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. The London Insurance Committee figures for the first time as one of the authorities sending patients to the dispensaries. 496 patients, or 51 per cent. were recommended by the Public Health Department, compared with 68.1 per cent. in 1913. TABLE LXXV. RETURN SHOWING SOURCE OF CASES AND SUB-DISTRICTS. Clapham. Putney. Streatham. Tooting. Wandsworth. Outside Borough. Totals. Public Health Department 70 l6 84 103 217 6 496 London Insurance Committee 17 13 36 20 37 1 124 Private Practitioners 23 7 35 26 72 7 170 Charitable Societies 1 1 2 ... 3 ... 7 Transfers from other Dispensaries 8 1 3 5 3 2 22 School Authorities 2 ... 9 2 8 ... 21 Existing Dispensary Patients 10 5 20 14 70 4 123 Other Sources 4 1 2 ... 1 ... 8 Totals 135 44 191 170 411 20 971 140 Report of the Medical Officer of Health. Analysis of Cases. Table LXXVI. shows the number of tuberculous and nontuberculous cases grouped in age periods, and the percentage found to be tuberculous. Of the 971 cases 379 or 39.03 per cent. were tuberculous, and 592 non-tuberculous, compared with 343 or 36.64 per cent., and 592 in 1913. Under the age of 15, there were 68 cases of Tuberculosis, a percentage of 14.75, compared with 106 and 21.5 in 1913. The reduction in these figures for Tuberculosis in childhood is satisfactory. The higher figures for 1913 may have been due to certain accumulation of cases as there had previously been no dispensary to deal with them. At ages 15 and upwards, there-were 311 cases of Tuberculosis, a percentage of 60.98, compared with 237 or 53.5 per cent. in 1913. This increase is due to the patients sent by the Insurance Committee, nearly all of whom were tuberculous. With regard to sexes of tuberculous patients, under the age of 15, there is little difference between the males and females, as in 1913; aged 15 and upwards, there were 174 males to 137 females, while in 1913 there were 154 males and 133 females. The increase in the males is to be expected as Tuberculosis is commoner in males than in females. 141 Report of the Medical Officer of Health. TABLE LXXVI. 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 ... ... ... 10 9 19 10 9 19 0.00 1 and under 2 years ... ... ... 9 8 17 9 8 17 0.00 2 and under 5 years 1 2 3 39 36 75 40 38 78 3.84 5 and under 10 years 22 12 34 90 73 163 112 85 197 17.26 10 and under 15 years 13 18 31 54 65 119 67 83 150 20.66 15 and under 20 years 20 16 36 14 35 49 34 51 85 42.35 20 and under 25 years 18 27 45 8 17 25 26 44 70 64.28 25 and under 35 years 62 42 104 7 41 48 69 83 152 68.42 35 and under 45 years 42 34 76 15 32 47 57 66 123 61.79 45 and under 65 years 31 17 48 5 22 27 36 39 75 64.00 65 years and upwards 1 1 2 2 1 3 3 2 5 40.00 totals 210 169 379 253 339 592 463 508 971 39.03 Under 15 years 36 32 68 202 191 393 238 223 461 14.75 15 years and upwards 174 137 311 51 148 199 225 285 510 60.98 totals 210 169 379 253 339 592 463 508 971 39.03 142 Report of the Medical Officer of Health. Examination of Contacts. Table LXXVII. is a similar one to Table LXXVI. but deals with contacts only. The number of Contacts examined for the first time was 421, compared with 541 in 1913. The number found to be suffering from Tuberculosis was lower, viz.:—28 or 6.65 per cent., compared with 54 or 9.98 per cent. in 1913. 280 out of 421 were under the age of 15. Of these only five or 1.78 per cent. were tuberculous, compared with 28 or 7.74 per cent. in 1913. Of the 141 aged 15 and upwards, 23 or 16.31 per cent. were tuberculous, compared with 26 or 14.6 per cent. in 1913. As last year, the sexes were equally represented up to the age of 15, while above that age there were many more females than males. As will be seen from Table LXXIII., 280 of the 593 nontuberculous cases of 1913 attended during 1914 and are still free from the disease. These are contacts which are kept under observation so that any symptoms of the disease may be detected at the earliest moment. A further four of the non-tuberculous cases of 1913 have developed tuberculosis during 1914 and are now under treatment for it. They are included with the tuberculous cases in Tables LXXIII. and LXXIX. 143 Report of the Medical Officer of Health. TABLE LXXVII. DIAGNOSIS AND AGE GROUPING OF ALL CONTACTS, EXAMINED FOR THE FIRST TIME DURING 1914. 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 ... ... ... 5 6 11 5 6 11 0.00 1 and under 2 years ... ... ... 4 5 9 4 5 9 0.00 2 and under 5 years ... ... ... 29 26 55 29 26 55 0.00 5 and under 10 years 2 2 4 62 48 110 64 50 114 3.50 10 and under 15 years 1 ... 1 36 54 90 37 54 91 1.10 15 and under 20 years 2 2 4 11 26 37 13 28 41 9.76 20 and under 25 years ... 3 3 4 8 12 4 11 15 20.00 25 and under 35 years ... 6 6 4 27 31 4 33 37 16.21 35 and under 45 years 1 5 6 5 19 24 6 24 30 20.00 45 and under 65 years ... 4 4 1 13 14 1 17 18 22.22 65 years and upwards ... ... ... ... ... ... ... ... ... 0.00 Totals 6 22 28 161 232 393 167 254 421 6.65 Under 15 years 3 2 5 136 139 275 139 141 280 1.78 15 years and upwards 3 20 23 25 93 118 28 113 141 16.31 Totals 6 22 28 161 232 393 167 254 421 6.65 144 Report of the Medical Officer of Health. Classification and Treatment of Tuberculous Cases Table LXXVIII. shows the tuberculous cases classified according to the site of the lesion. Of the 379 cases, 329 had Pulmonary Tuberculosis, and 50 Tuberculosis of some other part of the body. 36 of the latter were under the age of 15. It is well recognised that the non-pulmonary forms of Tuberculosis are commoner in children and the pulmonary form in adults. Both these facts are brought in in this Table as they were in the corresponding Table last year. TABLE LXXVIII. SITE OF LESION IN TUBERCULOUS CASES. Age Period. Non-Pulmonary. Total. Glands. Joints and Bones. Abdominal. Others. Total NonPulmonary. Pulmonary Tuberculous. Under 1 year ... ... ... ... ... ... ... 1 and under 2 years ... ... ... ... ... ... ... 2 and under 5 years 1 1 1 ... 3 ... 3 5 and under 10 years 12 5 1 1 19 15 34 10 and under 15 years 9 4 ... 1 14 17 31 15 and under 20 years 2 ... ... ... 2 34 36 20 and under 25 years 2 ... 1 ... 3 42 45 25 and under 35 years 1 ... ... 3 4 100 104 35 and under 45 years ... 1 ... 2 3 73 76 45 and under 65 years ... 2 ... ... 2 46 48 65 years and upwards ... ... ... ... ... 2 2 Total 27 13 3 7 50 329 379 145 Report of the Medical Officer of Health. Treatment of Tuberculous Patients. As will be seen from Table LXXVIII. all forms of Tuberculosis are treated at the dispensaries, but as many cases of non-pulmonary form require surgical or hospital treatment, they are unsuitable for dispensary treatment. Such patients are referred to the proper Institution and if possible attend the dispensaries for examination periodically. With regard to pulmonary Tuberculosis, the class of case varies very much. A considerable number of patients were in an advanced stage when first seen, the chance of benefit arising from any form of treatment being very slight. A number were quite hopeless from the onset, the disease ending fatally at an early date. There were, however, a number of early cases which have derived considerable benefit from treatment. The fullest possible use has been made of methods of treatment other than dispensary treatment and many cases have received Institutional treatment. A number of insured patients have benefitted from Sanatorium treatment, though in many instances the period of stay is too short. The recent arrangements for treating non-insured children in Sanatoria promises to produce good results. Advanced cases too bad to attend dispensaries have been treated at home by their own medical practitioners. Table LXXIX. shows the disposal of all the cases of Tuberculosis since the opening of the dispensaries in 1913. The patients are divided into those receiving no treatment and those under treatment. 146 Report of the Medical Officer of Health. TABLE LXXIX. DISPOSAL OF TUBERCULOSIS CASES AT END OF 1914. 1913 Cases. 1914 Cases. Totals. Disposed of in 1913. Disposed of in 1914. Disposed of in 1914. Under no treatment:— Discharged recovered 6 2 2 10 Lack of interest in treatment 13 1 4 18 Lost sight of 4 30 – 34 Left the Borough 35 22 39 96 Died 15 43 41 99 Totals 73 98 86 257 171 Under treatment:— At Dispensaries 146 154 300 In Sanatoria 8 47 55 At Hospitals 10 19 29 In Poor Law Institutions 2 5 7 By Medical Practitioners 10 68 78 Totals 176 293 469 Grand Totals *347 379 726 * Includes four cases included with the Non-Tuberculous in 1913 who have developed tuberculosis during 1914. The former includes 10 discharged as recovered, 148 who have left the Borough or lost interest in treatment, and 99 who have died. The 10 discharged as recovered suffered from the disease several years ago and showed no evidence of the disease when discharged. 147 Report of the Medical Officer of Health. In the first column are 73 patients who were classed as shown in last year's report and have not attended this year. It will be seen that 469 of the 726 cases are under treatment, while in 1913 there were 270, so that there is an increase of 199. 300 were under treatment at one of the dispensaries, compared with 203 last year, and 169 under treatment elsewhere, compared with 67 last year. It is gratifying that the number under treatment elsewhere has increased much more than the number under dispensary treatment, as it shows that treatment in institutions and by the patients own medical practitioners have been employed to a greater extent, and there are many cases which from the first require these forms of treatment more than dispensary treatment. In estimating the permanent effect of treatment in a disease of so long a duration as Tuberculosis, it is necessary to keep patients under observation for a year or two after apparent cure or improvement in symptoms. At present the dispensaries have not been open sufficiently long for an accurate estimate. I have, however, made an attempt to summarise the results to date in some of the cases, and for this purpose have chosen the 300 cases who were under treatment at the dispensaries at the end of 1914. The duration of treatment varies from 21 months to a few weeks, according to the date of the first attendance of the patient. Of the 300 cases, 127 have shown definite signs of improvement, 127 have remained in a stationary condition, and in 46 the disease has advanced. 148 Report of the Medical Officer of Health. Tuberculin Treatment. Tuberculin and Spengler's immune substances, I.K., have been used in some of the cases. As regards the former, opportunity for its use is limited by the fact that a large number of the most suitable cases, the early ones, take advantage of the Sanatorium treatment now available. Nor does one feel justified in advising otherwise, as change of air, rest and good food, are in many cases invaluable. Were the residence in Sanatoria of longer duration, it is felt that the results would be more lasting. Tuberculin has been used in some pulmonary cases and in some of tuberculous infection of glands with good results. Of the above-mentioned 300 cases, 24 received treatment with Tuberculin, 14 improving, eight remaining stationary, and two advancing under the treatment. In some of the more advanced cases Spengler's I.K. has been used with benefit and in some febrile cases in children it has been found to effect a reduction in temperature with benefit to the general health. The cases treated by this method are usually more advanced than those treated with tuberculin, so that one does not expect the results to be as good. 33 of the 300 cases were so treated, 12 improving, seven remaining stationary and 14 advancing under the treatment. I.K. is devoid of certain disadvantages attending the use of tuberculin in dispensary practice and it is hoped that when the cases treated with it have been under observation for a longer period, it will be possible to record more good results. 149 Report of the Medical Officer of Health. 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 1914, and for the previous 10 years :— TABLE LXXX. Year. Total Number of Deaths. Institutions. Union Infirmaries. General and Special Hospitals. Total. Number. Rate. Number. Kate. Number. Rate. 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 1913 289 85 29.1 47 16.2 132 45.3 Average 275 69 25.1 32 11.7 102 36.8 1914 305 76 24.9 59 19.3 135 44.2 This Table shows that the rates for the present year are lower in the case of Union Infirmaries but much higher in General and Special Hospitals, compared with the average for the past 10 years, and also compared with 1913. 150 Report of the Medical Officer of Health. Bacteriological Examination of Sputum. 384 examinations of sputum were made at the Lister Institute : 46 from Clapham, 26 from Putney, 123 from Streatham, 55 from Tooting, and 134 from Wandsworth. In 98 of the cases it was reported that the bacillus had been found, and in 286 that it was absent. Other Infective Diseases 33 deaths were caused by other Infective diseases, four in Clapham, 14 in Streatham, six in Tooting, and nine in Wandsworth. 11 of these were under one year, one from one and under two years, one from five and under 15 years, 13 from 25 and under 45 years, five from 45 and under 65 years, and two over 65 years. Of these 19 were stated to have been due to Syphilis, nine to Septicaemia, two to Tetanus, one to English Cholera, one to Dysentry, and one to Cerebro-spinal Meningitis. With regard to the number of deaths from Syphilis, 12 were Congenital Syphilis, and seven were of adults from Cerebral Syphilis. 10 deaths were caused by Syphilis in 1913, and 17 in 1912. 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. 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. 151 Report of the Medical Officer of Health. In 1914, the number of deaths from General Paralysis was 27, and from Locomotor Ataxy 10, a total of 37, 29 of males and eight of females. In 1913 the number of deaths from General Paralysis was 31, and from Locomotor Ataxy 10, a total of 41, 23 of males and eight 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 LXXXI. Death-rate per 1,000. 1909 1910 1911 1912 1913 1914 Small-pox ... ... ... ... ... ... Diarrhœa .41 .30 1.13 .27 .51 .56 Diphtheria .10 .05 .11 .06 .06 .12 Whooping Cough .23 .22 .21 .15 .07 .16 Scarlet Fever .04 .04 .03 .03 .03 .03 Influenza .30 .18 .08 .14 .18 .17 Enteric Fever .02 .026 .029 .02 .02 .015 Measles .37 .14 .74 .16 .36 .07 Tuberculous Diseases 1.29 1.17 1.26 1.16 1.08 1.19 152 Report of the Medical Officer of Health. Ophthalmia Neonatorum. 51 cases were notified, of which nine were in Clapham, four in Putney, 21 in Streatham, five in Tooting and 12 in Wandsworth. 48 of the cases were visited, in one case no inquiries were made, 21 were attended at birth by midwives, nine were treated at hospital as out-patients, one as an in-patient, and four were removed to the Union Infirmary, the 24 remaining being treated at home. One case is still under treatment. Two cases removed and could not be traced, and four died of Convulsions, Heart disease, congenital debility and specific disease, respectively. The 41 remaining cases have recovered. One child, aged nine weeks, came from Liverpool on September 1st and was removed to the Infirmary on September 3rd., the case being notified from there. It was still an in-patient at the end of year. Of the two cases under treatment at the end of 1913, one infant has lost the sight of one eye, but the other eye is clear, and the other child has recovered. The Public Health (Ophthalmia Neonatorium) Regulations, 1914, came into force on the 1st April, by which midwives in addition to Medical Practitioners were required to notify cases occurring during their attendance on the mother and child. Nine cases were thus notified by registered midwives, of which seven were also notified by medical practitioners. Glanders and Anthrax Orders. No cases of the above diseases were notified under the above Orders by the Veterinary Inspector of the London County Council. One case of Anthrax in a human being was notified and removed to hospital, but on further examination there the diagnosis was not confirmed. 153 Report of the Medical Officer of Health. NON-INFECTIVE DISEASES. The next Table shows the number of deaths from these for the year, as well as for the previous decennium for the whole Borough, corrected for External and Internal Institutions. TABLE LXXXII. Deaths from Non-Infective Diseases. 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 No. above corrected average. No. below corrected average. Cancer 242 224 256 272 274 275 298 321 338 352 393 68 – Circulatory Diseases 327 346 331 387 350 366 312 359 357 411 426 33 – Respiratory ,, 514 512 511 550 543 690 509 531 530 622 519 – 109 Premature Birth 298 317 315 285 294 254 249 268 240 234 249 – 64 Violence 101 91 108 90 107 118 91 120 1 l6 115 113 – 6 All other Diseases 951 953 945 988 971 989 1032 1023 1025 1057 1130 33 – Totals 2433 2443 2466 2572 2539 2692 2358 2622 2606 2791 2840 – 71 The above were the cause of 77.5 per cent. of the total deaths, compared with 77.8 in 1913, 79.1 in 1912, and 69.4 in 1911. Cancer. The total number of deaths from Cancer and other malignant diseases was 393, 162 of males and 231 of females, compared with 352 in 1913, 338 in 1912, and 321 in 1911, an increase of 41 compared with the previous year, and of 68 compared with the corrected decennial average. The corrected death rate was 1.20 per 1,000, compared with 1.07 in 1913, 1.07 in 1912, and 1.04 in 1911. 154 Report of the Medical Officer of Health. The number of deaths and the death-rate in each sub-district was as follows:—Clapham 71 and 1.14; Putney 40 and 1.37; Streatham 142 and 1.37; Tooting 37 and .98; and Wandsworth 103 and 1.06. One of the deaths occurred at one and under two years, one at two and under five years, two at five and under 15 years, three at 15 and under 25 years, 46 at 25 and under 45 years, 170 at 45 and under 65 years, and 170 over 65 years. The following Table shows the number of deaths according to the part of the body affected. TABLE LXXXIII. Locality of Disease. Males. Females. Total. Intestines 45 39 84 Uterus and Ovary ... 48 48 Stomach 28 19 47 Liver 13 34 47 Breast ... 45 45 Mouth and Throat 28 4 27 Œsophagus 14 3 17 Bladder and Kidney 15 2 17 Face and Neck 4 9 13 Abdomen 2 7 9 Pancreas – 4 4 Other parts 12 13 25 Not specified 6 4 10 Total 162 231 393 In Institutions within the Borough 26 deaths occurred from Cancer, seven males and 19 females. 11 of these deaths occurred in the Hostel of God, one in the Tooting Home, three in Putney Hospital, and 11 in private nursing homes. 155 Report of the Medical Officer of Health. 118 of the deaths, 56 of males and 62 of females, occurred in External Institutions, 46 in Workhouses and Workhouse Infirmaries, and 72 in General and Special Hospitals. 93 of the total deaths occurred among females from Cancer of the Breast or Uterus, compared with 77 in 1913, 73 in 1912, and 74 in 1911. 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 LXXXIV. Sub-District. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1912. 1913. Average for 10 years. 1914. Clapham 110 86 96 125 104 99 134 108 141 102 110 114 Putney 106 112 99 90 110 69 121 120 94 119 104 137 Streatham 91 87 92 105 101 106 89 126 104 107 100 137 Tooting 108 48 86 57 75 73 62 64 87 63 72 98 Wandsworth 84 88 ??? 90 91 94 95 88 101 109 94 106 Whole Borough 95 86 96 99 97 94 99 104 107 107 98 120 Compared with 1913 there has been an increase in this rate in all the sub-districts with the exception of Wandsworth. There has again been an increase in the rate from this disease in all the sub-districts compared with the decennial average. It is specially noticeable that the death-rate in Tooting is the lowest and that in Putney and Streatham the highest of the sub-districts compared with this average. In the decennium 1851-1860 this rate for England and Wales was only 32.5, but it increased in 1891-1900 to 75.8, and for London only in the decennium 1851-1860 it was 42, and for 1891-1900 85, or slightly more than double. 156 Report of the Medical Officer of Health. Diseases of the Brain and Nervous System. From these diseases 362 deaths occurred, compared with 364 in 1913, 305 in 1912, and 358 in 1911. 75 of these deaths occurred in Clapham, 21 in Putney, 130 in Streatham, 34 in Tooting, and 102 in Wandsworth. 21 of the deaths were due to Meningitis, 180 to Cerebral Haemorrhage or Apoplexy, 23 to Convulsions, 14 to Softening of the Brain, 22 to Paralysis, 27 to General Paralysis of the Insane, 10 to Locomotor Ataxy, 14 to Epilepsy, and 51 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 44, in Putney 12, in Streatham 63, in Tooting 14, and in Wandsworth 47 a total of 180, compared with 179 in 1913, 154 in 1912, and 147 in 1911. 32 of the deaths from Diseases of the Brain and Nervous System were under one year, six from one and under two years, three from two and under five years, six from five and under 15 years, eight from 15 and under 25 years, 44 from 25 and under 45 years, 104 from 45 and under 65 years, and 159 over 65 years. Of the total deaths from the above under one year, viz.—32, 21 were from Convulsions, while of the total deaths over 65 years, viz.:—159, 116 were from Cerebral Haemorrhage. Circulatory Diseases. From the above group of diseases, 436 deaths occurred, 171 of which, 78 males and 93 females, were due to Valvular disease of the Heart. 101 of these deaths occurred in Clapham. 40 in Putney, 129 in Streatham, 33 in Tooting, and 133 in Wandsworth. 157 Report of the Medical Officer of Health. Of the deaths from all diseases of the Heart, one was under one year, 14 were from five and under 15 years, 20 from 15 and under 25 years, 53 from 25 and under 45 years, 158 from 45 and under 65 years, and 190 over 65 years. The number of deaths in 1914 was 25 more than in 1913, and 33 above the corrected decennial average. Respiratory Diseases. The total number of deaths was 520, 260 of males and 260 of females, compared with 622 in 1913, 530 in 1912 and 531 in 1911. The number of deaths was 102 less than in the previous year, and 109 less than the corrected decennial average. 90 of the deaths occurred in Clapham, 51 in Putney, 166 in Streatham, 66 in Tooting, and 147 in Wandsworth. Compared with 1913, there was a decrease in all the subdistricts with the exception of Tooting, where the number is the same. 231 of the deaths occurred from Bronchitis, compared with 267 in 1913; 34 from Lobar Pneumonia, 108 from Lobular or Broncho-Pneumonia, 102 from Pneumonia in which the exact form was not distinguished; and 45 from other diseases of the Respiratory Organs. 93 of the deaths were of infants under one year, 33 from one and under two years, 31 from two and under five years, 11 from five and under 15 years, eight from 15 and under 25 years, 39 from 25 and under 45 years, 98 from 45 and under 65 years, and 197 over 65 years. The greatest number of deaths from these diseases occurred among infants under one year, and of persons over 65. From Bronchitis alone 134 deaths occurred among persons over 65 years of age, compared with 152 in 1913, and 143 in 1912. 158 Report of the Medical Officer of Health. Appendicitis and Typhlitis. 17 deaths occurred from these diseases, 11 of males and six of females, equal to a rate of 51 per million, compared with 81 in 1913, and 92 in 1912. The total number of deaths in the whole of London for the 52 weeks was 313 equal to a rate of 69 per million. Deaths from all Causes. From Alcoholism, Acute and Chronic, 11 deaths, eight of males and three of females, occurred; and 35, 17 of males and 18 of females, from Cirrhosis of the Liver, compared with 14 and 26 in 1913. From Nephritis and Bright's disease 135 deaths occurred, 72 of males and 63 of females, compared with 104 in 1913. From Accidents and diseases of Pregnancy and Child Birth 14 deaths occurred, two from 15 to 25 years and 12 from 25 and under 45 years. This, added to the number of deaths from Puerperal Fever, viz.—nine, gives a total of 23 deaths after child-birth, or a proportion of 3.44 per 1,000 births, compared with 3.94 in 1913. In London for the year 1914, this rate was 3.46. Of the 14 deaths one occurred in Clapham, six in Streatham, one in Tooting, and six in Wandsworth. Four of the deaths were due to Hæmorrhage, four to Embolism, three to Convulsions, and three to other causes. Diabetes Mellitus was the cause of 39 deaths, 18 of males and 21 of females, five in Clapham, four in Putney, 18 in Streatham, three in Tooting, and nine in Wandsworth, compared with 40 in 1913. 159 Report of the Medical Officer of Health. Premature Birth and Developmental Diseases. 249 deaths, 124 of males and 125 of females, were registered as having occurred from these diseases, compared with 234 in 1913, 240 in 1912, and 268 in 1911. The number of deaths is thus 15 above last year, but is 64 under the corrected decennial average. 115 of the deaths were due to Premature Birth, 118 to Developmental diseases and 16 from other diseases of Early Infancy. 243 were of infants under one year, three from one and under two years, and three 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 XIX., which deals with Infantile Mortality, while for the subdistricts the Tables will be found in the Appendix. Old Age. 256 deaths, 78 of males and 178 of females, occurred from Old Age, compared with 237 in 1913, 236 in 1912, and 210 in 1911. 50 of these occurred in Clapham, 16 in Putney, 87 in Streatham, 24 in Tooting, and 79 in Wandsworth. All these deaths were of persons over 65 years. Six were from 65 and under 70, 33 from 70 and under 75, 63 from 75 and under 80, 67 from 80 and under 85, 58 from 85 and under 90, 22 from 90 and under 95, and seven from 95 and under 100. 1,227 deaths, or 33.22 per cent. of the total deaths, occurred in persons over 65 years, compared with 31.9 in 1913, 32 in 1912 and 28.3 in 1911. The percentage of deaths over 65 years to total deaths, in the sub-districts was as follows:—In Clapham 34.59, in Putney 35.15, in Streatham 39.77, in Tooting 19.091, and in Wandsworth 30.66. 160 Report of the Medical Officer of Health. Violence. 113 deaths, 77 of males and 36 of females, occurred from Violence, compared with 115 in 1913, 116 in 1912, and 120 in 1911. 86 of the deaths were due to Accidental, and 22 to Suicidal causes. Five deaths were caused by other forms of Violence, one being a child belonging to Clapham who was killed during the bombardment of Scarborough, and the other four were of soldiers who died in England from wounds received in action. 16 of the deaths belonged to Clapham, 16 to Putney, 43 to Streatham, 15 to Tooting, and 23 to Wandsworth. From Accidental causes six of the deaths were of infants under one year, one from one and under two years, seven of persons from two and under five years, four from five and under 15 years, four from 15 and under 25 years, 20 from 25 and under 45 years, 21 from 45 and under 65 years, and 19 over 65 years. Of the deaths from Suicidal causes, three were from 15 and under 25 years, eight from 25 and under 45 years, eight from 45 and under 65 years, and three over 65 years. The number of deaths from Violence is two less than in 1913, 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 180, compared with 189 in 1913, 182 in i9i2, and i92 in i9ii. 25 of the inquests were held on persons who died in Clapham, 35 in Putney, 44 in Streatham, 20 in Tooting, and 56 in Wandsworth. in 103, or 57.2 per cent. of the cases, a verdict of death from Natural causes was returned; in 54 or 30.0 per cent. from Accidental causes; in 20, or ii.i per cent. from Suicidal causes; while in three Open verdicts were returned. 38 of the inquests were held on persons not belonging to the Borough who died in the Borough. Five of these were on persons who died in the Prison, three in the River Thames, three in Putney Report of the Medical Officer of Health. 161 Hospital, one in Tooting Bec Asylum, four on the railway, and 22 in other places and on the street. TABLE LXXXV. Sub.Districts. Whole Borough. INQUESTS. Clapham. Putney. Streatham. Tooting. Wandsworth Deaths from Natural Causes 17 12 19 16 39 103 Accidental:— Falls 1 1 2 ... 2 6 injury at birth 1 2 ... 2 1 6 Burns ... 1 2 1 1 5 Knocked down by train 1 2 2 ... ... 5 Knocked down by motor ... 1 3 ... 1 5 Suffocated in bed with parents 1 ... 1 1 1 4 Struck by lightning ... ... ... ... 3 3 Fall down flight of stairs ... ... 3 ... ... 3 Drowning ... 1 ... ... 1 2 Run over by road locomotive ... 2 ... ... ... 2 Fall down well of lift ... 1 ... ... 1 2 Crushed by fall of wall 1 ... ... ... ... 1 Blow on head whilst at play 1 ... ... ... ... 1 Discharge of rifle ... 1 ... ... ... ... Thrown off motor cycle ... 1 ... ... ... 1 Kicked by horse ... 1 ... ... ... 1 Overdose of morphia ... ... 1 ... ... 1 Death under art anæsthetic ... ... 1 ... ... 1 Knocked down by motor cycle ... ... 1 ... ... 1 Thrown from van ... ... 1 ... ... 1 Regurgitation of vomited food ... ... ... ... 1 1 injury to eye caused by fall ... ... ... ... 1 1 Suicidal:. Cut throat 1 2 2 ... ... 5 Poisoning by Spirits of Salts 1 ... 2 ... ... 3 Poisoning by Oxalic Acid ... 1 ... ... 1 2 Drowning ... 1 ... ... 1 2 Hanging ... ... 2 ... ... 2 injuries following jump from bridge ... 1 ... ... ... 1 Cut artery in wrist ... 1 ... ... ... 1 Gun shot wounds ... 1 ... ... ... 1 Poisoning by Carbolic Acid ... ... 1 ... ... 1 Poisoning by Coal Gas ... ... ... ... 1 1 Poisoning by Opium ... ... 1 ... ... 1 Open Verdicts:— Found drowned ... 1 ... ... 1 2 Found dead ... 1 ... ... ... 1 Totals 25 35 44 20 56 180 162 Report of the Medical Officer of Health. 72 inquests were held on persons belonging to the Borough who died outside the Borough; 16 from Clapham, 10 from Putney, 17 from Streatham, 11 from Tooting, and 18 from Wandsworth, and the following Table shows the causes of death. 21 of these deaths were from Natural, 42 from Accidental, and nine from Suicidal causes. TABLE LXXXVI. INQUESTS. Sub.Districts. Whole Borough. Clapham. Putney. Streatham. Tooting. Wandsworth Deaths from Natural Causes 3 4 4 3 7 21 Accidental:— Blood poisoning following injury 1 ... 4 2 1 8 Falls 1 1 2 ... 2 6 Knocked down by train 1 ... 1 1 1 4 Knocked down by motor bus ... 1 ... ... 1 3 Drowning ... ... 2 1 ... 3 Thrown out of motor car ... ... ... ... 2 2 Death under an anæsthetic 2 ... ... ... ... 2 Burns 2 ... ... ... ... 2 Fall down flight of stairs 1 1 ... ... ... 2 Knocked down by motor car 1 1 ... ... ... 2 Run over by road locomotive ... ... ... ... 1 1 Fall from train ... ... ... ... 1 1 Fall from van 1 ... ... ... ... 1 Fall down area ... ... ... ... ... 1 Knocked down by bicycle 1 ... ... ... ... 1 Scalds ... ... ... ... ... 1 Knocked down by van 1 ... ... ... ... 1 Fall from scaffold ... ... ... ... 1 1 Suicidal:— Cut throat ... ... 1 1 1 3 Drowning ... 1 1 1 ... 3 Poisoning ... 1 ... ... ... 1 Cut artery in wrist 1 ... ... ... ... 1 Run over by train ... ... ... 1 ... 1 Totals 16 10 17 11 18 72 Report of the Medical Officer of Health. 163 Deaths and Causes of Death in Public institutions. in the Public institutions in the Borough i,0i8 deaths occurred during the year, compared with 1,034 in 1913. 958 in 1912, and 850 in 1911. Of these, 824 deaths were of persons not belonging to the Borough, compared with 822 in 1913, and 194 of persons belonging to the Borough, compared with 212 in 1913. The following Table shows the institutions where these deaths occurred and the number of deaths in each. The causes of, and ages at death in these persons is shown in Tables Viii., iX. and X. in an earlier part of this Report. 164 Retort of the Medical Officer of Health TABLE LXXXVII. 1.—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. in.—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 5 583 31. Middlesex Hospital 16 Fever Hospitals 51 Fountain Temporary Asylum 41 32. National Hospital 2 Fountain Temporary Asylum 1 Hostel of God 48 2. Banstead Asylum 14 33. Peckham House Asylum 3 H.M. Prison 3 H. M. Prison 5 3. Belgrave Hospital 26 34. Queen Charlotte Hos. 2 Hostel of God 14 Middlesex County Lunatic Asylum 117 4. Belmont Workhouse 2 35. Queen Mary Hospital 3 Middlesex County Lunatic Asylum 2 5. Bethlem Royal Hospital 2 36. Royal Waterloo Hosp. 3 Newlands House 3 6. Bolingbroke Hospital 24 37. St. Bartholomew1s Hospital 6 Putney Hospital 16 Putney Hospital 13 7. British Home for Incurables 2 Royal Hospital for Incur. ables 3 Royal Hospital for Incurables 14 38. St. George1s Hospital 14 St. Anne1s Home 7 8. Brompton Hospital 7 39. St. Joseph1s Hospital 3 The Workhouse 3 The Priory, Roehampton 3 9. Camberwell HouseAsylun 8 40. St. Luke1s House 5 Tooting Bec Asylum 5 The Workhouse 1 10. Cancer Hospital 8 41. St. Thomas1s Hospital 53 Tooting Home 30 Tooting Bec Asylum 563 11. Cane Hill Asylum 8 42. University College Hospital 6 Nursing Homes 22 Tooting Home 23 12. Caterham Asylum 5 River Thames 2 3rd London General Hospital 5 13 Charing Cross Hospital 13 43. Victoria Hospital 17 Other Places 42 Nursing Homes 38 14. Colney Hatch Asylum 4 44. Westminster Hospital 13 194 River Thames 3 15. Croydon Gen. Hospital 3 45. West London Hospital 8 Other Places 57 16. Darenth Indus. Colony 2 46. Northern Hospital 3 824 17. Dartford Heath Asylum 5 47. Park Hospital 2 18. Downs Sanatorium 8 48. Southern Hospital 2 19. Evelina Hospital 6 49. South Eastern Hospital 4 20. Fulham Infirmary 4 50. South Western Hospital 4 21. Gt. Ormonde St. Hospita 3 51. Western Hospital 2 22. Guy1s Hospital 20 52. Other Institutions 54 23. Hanwell Asylum 6 53. Other places not public Institutions 55 24. Horton Asylum 20 25. Infants1Hospital 12 54. On Railway 4 26 King1s College Hospital 7 55. On Street 10 27. Lambeth Infirmary 4 56. River Thames 5 28. London Hospital 3 57. Private Nursing Homes 23 29. Long Grove Asylum 17 1,155 30 Manor Asylum 7 Report of the Medical Officer of Health. 165 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 or London are also shown, and it will be noted that in the twenty years 1893.1912 these increased in London from 26.9 to 43.5 with an average of 34.67, and in Wandsworth from 16.6 to 32.8 with an average of 22.73. 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 35.0 per cent. of the total deaths occurred in institutions, and that for the year 1913, 17.2 per cent. occurred in Workhouses and Workhouse infirmaries. Compared with the 20 years1 average, the greatest increase has occurred among the deaths in General and Special Hospitals. 166 Report of the Medical Officer of Health. TABLE LXXXVlll. Percentage of Deaths in Public Institutions to Total Deaths for the Year 1913 and for the 20 Previous Years. Year. Workhouse and Workhouse Infirmaries. General and Special Hospitals and Asylums. Metropolitan Asylums Board1s Hospitals. Total. London. Wandsworth. London. Wandsworth. London. Wandsworth. London. Wandsworth. 1893 131 71.9 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 21.3 31.3 29.1 20.2 1898 14.7 8.1 12.2 6.1 2.1 2.8 29.0 17.0 1899 15.8 8.5 12.0 7.2 2.1 1.8 29.9 17.5 1900 15.8 8.0 12.7 6.5 2.0 1.8 30.5 16.3 1901 16.5 9.5 13.6 8.0 2.4 1.8 32.5 19.3 1902 166 84 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 181 11.0 15.5 10.5 1.4 1.6 35.0 23.1 1905 19.3 12.0 16.7 10.5 1.5 1.8 37.5 24.3 1906 19.3 12.5 17.4 11.2 1.6 2.0 38.3 25.7 1907 20.05 12.7 17.4 1.5 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 41.3 30.9 1912 23.8 15.5 17.7 15.5 2.0 1.8 43.5 32.8 Averages 1893— 1912 1795 1079 15.42 9.89 2.11 2.04 34.67 22.73 1913 237 17.2 20.1 15.8 1.9 1.8 43.8 35.0 Report of the Medical Officer of Health. 167 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, as in previous years, 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. i68 Report of the Medical Officer of Health. Proportion per 1,000 Deaths from all causes. Notifiable Diseases 19.1 Measles 7.1 influenza 15.9 Whooping Cough 14.4 Diarrhœa and Dysentery 50.7 Tuberculosis (all forms) 106.1 (Lungs) (83.2) Bronchitis 63.0 Pneumonia 66.5 Cancer 107.3 Nervous Diseases 98.9 Circulatory Diseases 119.1 Premature Birth 31.3 Congenital Debility, etc. 36.5 Old Age 69.09 Digestive Diseases 45.3 Urinary Diseases 47.0 Violence 30.9 Other Causes 71.0 All Causes 1,000.0 Cutting-off Notices. During the year 47 notices with respect to 42 premises were received from the Water Board stating that the supply had been withdrawn. Eight of the premises were in Clapham, 12 in Putney, 11 in Streatham, three in Tooting, and eight in Wandsworth. The supply was withdrawn for non-payment of rates from 17 premises, from 13 premises in consequence of defects, and in 12 the premises were empty. Compared with 1913, there has been a decrease of 18 in the number of notices received, and of 31 in the number of premises affected. Report of the Medical Officer of Health. 169 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, and plans have been prepared and laid before the Committee, but owing to the war the matter has been postponed. 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, 29 bodies were removed to the Mortuary, compared with 40 in 1913; in Streatham 46, compared with 51; and in Wandsworth 115, of which 57 were from Wandsworth, 32 from Putney, seven from Streatham and 19 from Tooting, compared with 114 in 1913—a total of 190 compared with 205 in 1913. No infectious cases were admitted to any of the Mortuaries during the year. GENERAL SANITARY WORK IN 1914. The following list shows the special inspections made by me during the year:— (i)—Special inspection was made of the land at the rear of Ravensbury Road in the Borough of Wimbledon on account of complaints as to damp conditions arising from the flooding of the land for use as a Skating pond. I inspected the land with the Medical Officer of Health for Wimbledon, but could find no nuisance to any premises in this Borough arising from the 170 Report of the Medical Officer of Health. flooding. The boundary ditch was also inspected and steps were taken to have this cleaned out so as to remove any serious obstruction to the flow of water in the ditch. The land has now been raised about six feet and consequently no further flooding can be carried out. The ditch has been inspected on several occasions since and no nuisance found. (2)—Special inspections were also made of certain houses and localities on account of flooding after the severe storm of June 14th. The streets chiefly affected were, in Putney—Campion Street and Upper Richmond Road; in Streatham—Besley Street, Broadway, Christchurch Road, Hambro Road, High Road, Hopton Road, Killieser Avenue, Mitcham Lane, Wellfield Road, Calbourne Road, Fernlea Road, Gosberton Road, Mayford Road, Ravenslea Road, Rossiter Road, Rowfant Road, Selkirk Road, and Tantallon Road; in Tooting—Defoe Road, Furzedown Market, Marlborough House and Mitcham Road; and in Wandsworth—Bellew Terrace, Earlsfield Road, Garratt Lane, Headworth Road, Lydden Grove, Maskell Road, Portinscale Road, Rusholme Road and Summerstown. Steps were taken at once to remedy the damp conditions and the officials of the Council both from this Department and the Surveyors assisted the owners and occupiers of the houses in every possible way. Many basements were cleansed and disinfected by the Council's staff, and in about 14 days all the cases had been satisfactorily dealt with. There was no consequent illness in any of these houses as far as could be ascertained. (3)—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 greater than in the previous year ; this having been due to the fact that the climatic conditions were more favourable. in all, 138 complaints were received, compared with 90 in 1913: three from Clapham North, three from Clapham Report of the Medical Officer of Health. 171 South, 11 from Putney, 34 from Streatham, 13 from Balham, 20 from Tooting, 22 from Southfield, nine from Fairfield, and 23 from Springfield Wards. All these complaints were forwarded to the Borough Engineer, who reported that in 112 cases the sewers were flushed and disinfected, in 17 the manholes were temporarily sealed, in seven ventilating columns were erected, while in two cases broken manhole plates were repaired. (4)—Special inspections were also made by myself and the Deputy Medical Officer of Health of many premises, chiefly on account of nuisances and damp conditions reported to the Sanitary inspectors and also to ascertain if any of these premises could be reported to the Council under the Housing, Town Planning, etc., Act, and also the by-laws as to Underground Rooms, made under the above Act. (5)—Special inspection was made of the Osiers, Point Pleasant, Wandsworth, owing to the outbreak of Swine fever and the necessary slaughtering of swine at the piggeries. All the work carried ont, both as regards slaughtering, cleansing and disinfection was satisfactory. 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, 380 inspections were made of premises, chiefly previous to the service of statutory notices. My attendance at the Police Court was necessary on four occasions during the year. Revenue Act. During the year 10 certificates were granted under the above Act, one deferred, and three refused. The certificates granted referred to 47 houses or 95 tenements, that deferred to eight houses or 16 tenements, and those refused to 38 houses or 76 tenements. 172 Report of the Medical Officer of Health. Mousing. 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. 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 no cases were this year 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 LXXXIX., XC., and XCI., 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. Report of the Medical Officer of Health. 173 The number of complaints received and attended to was 2,548, compared with 2,394 in 1913. 2,528 in 1912, and 2,076 in 1911. There was an increase in Clapham North and South, Streatham, Southfield, and Fairfield Wards, and a decrease in Putney, Balham, Tooting, and Springfield Wards, compared with the previous year. 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 40,004, an increase of 1,201 compared with 1913, and of 3,668 compared with 1912. There was an increase in the number of houses and premises inspected in Clapham North and South, Putney, Balham, Tooting, Southfield, Fairfield, and Springfield Wards, and a decrease in Streatham Ward. The total number of house-to-house inspections made was 2,396, compared with 2,739 in 1913, 2,674 in 1912, and 2,486 in 1911. There has been an increase in the number of these inspections in Clapham North, Streatham, and Balham Wards, and a decrease in Clapham South, Putney, Tooting, Southfield, Fairfield, and Springfield Wards, compared with 1913. The number of these inspections has diminished owing to the changes in the inspectorial staff on account of the war, and the necessary inspections in some of the sub-districts of premises occupied by the military. 174 Report of the Medical Officer of Health. TABLE LXXX1X. Summary of Sanitary Operations in the Borough during the Year 1914. Clapham. Putney. Strf.atham 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 316 342 102 446 271 226 272 283 290 2548 Number of houses and premises inspected 4761 3106 4913 4748 5137 4588 4468 2992 5291 40004 Number of houses and premises re-inspected 1021 1648 1118 2547 2890 1281 968 1840 2098 15411 Number of house to house inspections 495 135 323 386 520 38 167 113 219 2396 Number of preliminary notices served 750 583 380 839 1085 438 399 670 753 5897 Ditto complied with 633 536 401 799 1008 328 350 756 731 5542 Number of statutory notices served 23 18 5 53 144 9 23 31 100 406 Ditto complied with 20 15 3 47 132 14 23 25 117 396 Notices served for periodical removal of manure 1 1 1 3 Number of rooms disinfected after infective diseases 239 365 456 456 704 541 439 284 546 4030 Bedding stoved 139 191 192 265 299 332 314 192 344 2268 Overcrowding abated 6 5 2 8 11 6 2 18 23 81 Rooms cleansed and repaired 404 275 271 642 1123 616 255 667 643 4896 Staircases cleansed and repaired 113 171 51 117 188 101 28 105 137 911 Drains cleansed and repaired 177 134 86 222 168 128 73 73 64 1025 Drains tested 599 285 266 600 582 199 275 263 470 3539 Drains found defective 28 16 36 92 116 81 21 39 44 473 Traps fixed to drains 101 107 10 45 20 32 10 23 2 350 Bath, lavatory and sink wastes altered to discharge outside over gullies or repaired 36 38 1 83 32 46 5 114 31 386 Rain water pipes disconnected from drains 9 3 5 1 80 98 Water closets cleansed and repaired 195 182 84 148 275 138 101 147 241 1511 Water closets, separate supply of water laid on to 3 3 Accumulations of manure, etc., removed 12 28 50 49 37 67 10 9 67 329 Urinals cleansed, repaired or water laid on to 7 1 9 3 14 3 1 3 4 45 Cesspools abolished 1 1 Ashpits provided or repaired 90 100 30 96 138 97 96 87 126 1860 Dust complaints received 19 26 47 71 24 9 43 9 41 289 Stables and stables yards drained, paved or cleansed 1 8 12 8 11 18 1 1 56 116 Yards drained, paved or cleansed 84 94 34 132 140 108 42 107 128 869 Unwholesome or dilapidated houses cleansed or repaired 6 2 2 9 3 22 Leaky roofs and gutters repaired 147 98 50 131 61 43 26 51 88 725 Damp courses inserted 8 16 6 40 28 11 6 43 41 199 Damp conditions remedied 47 27 22 193 93 65 12 62 85 606 Houses re-supplied with water 1 3 9 5 10 2 3 1 7 41 Water cisterns cleansed, covered or repaired 44 56 17 86 52 42 7 22 86 412 Animals kept so as to be a nuisance 1 3 4 19 9 12 3 31 23 105 Smoke nuisances reported 3 2 4 4 2 1 13 11 39 79 Soil pipes repaired 6 21 8 49 21 23 4 7 4 143 Unclassified nuisances 236 49 56 195 52 59 62 133 7 849 Report of the Medical Officer of Health. 175 TABLE XC. DETAILS OF INSPECTIONS AND RE-INSPECTIONS, 1914 (Male inspectors,) inspections Re-inspections. Totals. Number of complaints received and attended to 2,529 ... 2,529 Number of house-to-house inspections 2,396 ... 2,396 Drainage and other sanitary works after notice 4,002 11,984 15,986 Drainage and other sanitary works voluntary 767 910 1,677 Number of premises inspected on account of:— Notifiable diseases 3.656 325 3,981 Measles 621 5 626 Whooping Cough 866 ... 866 Pulmonary Tuberculosis 51 ... 51 Other infective Diseases 654 34 688 Verminous conditions 584 67 651 Periodical inspections:— Houses-let-in-Lodgings 336 709 1,045 Underground rooms 18 5 23 Common Lodging Houses 17 ... 17 Food-places Work-places Factories 388 61 449 Workshops 941 99 1,040 Workshops (Domestic) 265 47 312 Workplaces 235 83 318 Outworkers' premises 148 15 163 Bakehouses 399 193 592 Restaurant kitchens 265 65 330 Cowsheds 43 2 45 Piggeries 73 ... 73 Dairies and Milkshops 772 11 783 ice Cream Premises 462 69 531 Slaughterhouses 366 ... 366 Places where food is prepared 89 ... 89 Offensive trades 91 ... 91 Fried Fish shops 187 13 200 Rag and bone stores 146 13 159 Butchers' shops 449 1 450 Greengrocers' shops 576 1 577 Fishmongers' shops 333 5 338 Public House urinals 476 38 514 Other sanitary conveniences, schools, &c. 169 1 170 Smoke observations 331 ... 331 Unsound food 33 ... 33 Yards of Mews and Stables 1,476 95 1,571 Legal proceedings:— (1) Applications and summonses 9 ... 9 (2) Hearings and adjournments 10 ... 10 Other 2,592 23 2,615 Totals 27,821 14,874 42,695 176 Report of the Medical Officer of Health. TABLE XCI. DETAILS OF INSPECTIONS AND RE-INSPECTiONS, 1914. (Female inspectors.) inspections. Re-inspections. Totals. Number of complaints received and attended to 19 ... 19 Number of premises inspected on account of:— Puerperal Fever 60 24 82 Ophthalmia Neonatorum 143 7 150 Diarrhoea 166 23 189 Pulmonary Tuberculosis 3,225 190 3,415 Other forms of Tuberculosis 607 9 616 Notification of Births 5,590 169 5,759 Dressmakers' and Milliners' premises 438 26 464 Laundries:— Factories 155 11 166 Workshops 246 16 262 Workplaces 126 15 141 Other Factories 55 ... 55 Other Workshops 7 15 132 Other Workplaces 266 18 284 Domestic Workshops 57 1 58 Outworkers' premises 369 13 382 Other 544 2 546 Totals 12,183 537 12,720 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 1,526 out of a total of 2,396 houses inspected, or 63.64 per cent., sanitary defects necessitating the service of an intimation notice were found. The highest percentage was in Fairfield Ward, where the percentage was 96.46, and the lowest in Southfield, where it was only 31.73, the next lowest being Putney, where it was 33.12, Report of the Medical Officer of Health. 177 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 1914. TABLE XCII. 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 8.i4 1483 12.64 64.39 Clapham, South 14.67 9.24 9.78 66.31 Putney ... ... 53.05 46.95 Streatham 6.65 11.85 47.40 34.0 Balham 6.39 17.01 29.38 47.22 Tooting ... 2.56 15.39 82.05 Southfield 16.81 11.95 11.06 60.18 Fairfield 24.56 14.04 15.20 46.20 Springfield 9.60 11.92 32.45 46.03 Whole Borough 8.28 10.97 29.19 51.56 Southfield and Fairfield Wards had the highest percentage of families living in one room, and Balham the lowest. Clapham North and Balham had the highest percentage living in two rooms and Tooting the lowest. Putney had the highest percentage living in three rooms, and Clapham South the lowest. Tooting and Clapham South had the highest percentage living in four rooms and upwards, and Streatham the lowest. in the Borough, of the total families whose houses were inspected during the year, viz.:—3,454, 8.28 per cent. lived in one room, compared with 9.50 per cent. in 1913, 9.50 in 1912, and 8.7 per cent. in 1911; 10.97 per cent. in two rooms compared with 12.90, 13.44, and 14.8; 29.19 per cent. in three rooms compared with 27.44, 24.85, and 25.2; and 51.56 per cent. in four rooms and upwards compared with 50.16, 52.4, and 51.3. 178 Report of the Medical Officer of Health. House-to-Mouse inspections.—continued. HOUSING TOWN PLANNING, &C., ACT, 1909. SUB-DISTRICT OF CLAPHAM, (North Ward). TABLE XCIII. Name of Street. No. of houses inspected. No. of houses in which defects were found. Percentage of defects to houses inspected. Number of Families living in One room. Two rooms. Three rooms. Four rooms and upwards. Bramwell Street 14 13 92.85 ... 1 2 13 Chalmers Street 10 7 70.00 1 1 6 8 Clifton Cottages 4 3 7500 1 2 ... 4 Clyston Street 90 56 62.22 8 12 13 86 Crichton Street 22 22 100.00 7 21 8 7 Gonsalva Road 15 8 53.33 1 ... 4 17 Pensbury Street 30 24 80.00 3 9 11 20 Portslade Road 8 5 62.50 1 1 1 7 Rashleigh Street 27 27 100.00 10 27 5 14 Southville 55 32 58.18 3 5 5 59 Thurlow Street 36 23 63.88 3 ... 1 36 Westbury Street 1 1 100.00 3 2 ... ... Wirtemberg Street 183 69 37.70 15 21 31 172 Totals 495 290 58.58 56 102 87 443 Report of the Medical Officer of Health. 179 Mouse-to-House inspections—continued. HOUSING, TOWN PLANNING, &c„ ACT, 1909, SUB-DISTRICT OF CLAPHAM, (South Ward). TABLE XCIV. 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. Clapham Park Road 9 6 66.66 1 2 1 8 Lyham Road 126 92 73.01 26 15 17 114 Totals 135 98 72.59 27 17 18 122 Grand Totals 630 388 61.58 83 119 105 565 180 Report of the Medical Officer of Health. House-to-House inspections—continued. HOUSING, TOWN PLANNING, &c., ACT, 1909. SUB-DISTRICT OF PUTNEY. TABLE XCV. 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. Ashlone Road 56 17 30.34 ... ... ... 56 Bendemere Road 66 23 34.84 ... ... 120 6 Farlow Road 34 6 17.64 ... ... 60 4 Festing Road 71 32 34.07 ... ... 46 48 Gay Street 39 16 41.02 ... ... ... 39 Lacey Road 48 8 16.66 ... ... 9 46 Prices Folly 9 5 55.55 ... ... ... 9 Totals 323 107 33.12 ... ... 235 208 Report of the Medical Officer of Health. 181 House-to-House inspections—continued. HOUSING, TOWN PLANNING, &c„ ACT, 1909. SUB-DISTRICT OF STREATHAM. TABLE XCVI. 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. Angles Road 47 40 85.10 10 7 ... 50 Corsehill Street 49 40 81.63 ... ... ... 49 Credenhill Street 134 73 54.47 ... ... 112 23 Eastwood Street 56 28 50.00 ... ... 40 16 Greyhound Square 21 19 90.47 2 17 ... 2 Mill Lane 19 19 100.00 8 25 16 2 Natal Road 45 44 97.77 11 6 50 18 Roupell Buildings 15 15 100.00 1 2 10 4 Totals 386 278 72.02 32 57 228 164 182 Report of the Medical Officer of Health. House-to-House inspections.—continued. HOUSING, TOWN PLANNING, &c„ ACT, 1909 SUB-DISTRICT OF STREATHAM, (BaLHAM WARD). TABLE XCVll. Name ok 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 room* and upwards. Balham Grove (part) 7 6 85.71 1 15 7 2 Brenda Road 13 13 100.00 ... ... ... 26 Cavendish Road Flats 6 6 100.00 ... ... 6 ... Chesil Place 7 6 85.71 ... 3 3 1 Fernlea Road (part) 44 37 84.09 12 62 9 36 Fircroft Road 6 6 100.00 ... ... ... 12 Foss Road 48 40 83.75 ... 1 2 88 Grove Road Mews 5 5 100.00 ... 1 1 3 Hazelhurst Road 51 34 66.66 2 6 31 46 Hildreth Street 20 12 60.00 ... 6 3 16 Holdernesse Road 11 7 63.63 ... ... ... 20 Rate Street 39 35 89.74 11 8 9 32 Larch Road 76 62 81.57 4 5 130 30 Smallwood Road 104 83 79.80 ... 7 19 106 Upper Tooting Road 1 1 100.00 ... 1 1 1 Zennor Road 82 82 100.00 32 50 64 39 Totals 520 433 83.26 62 165 285 458 Grand Totals 906 711 78.47 94 222 513 622 Report of the Medical Officer of Health. 183 House-to-house inspections - continued. HOUSING, TOWN PLANNING, &c„ ACT, 1909. SUB-DISTRICT OF TOOTING. TABLE XCVIII. 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. Adis Mews 7 4 57.14 ... ... 5 2 Fountain Road 16 9 56.25 ... 1 1 15 Garratt Lane 7 4 57.i4 ... ... ... 7 Moring Road 6 6 100.00 ... ... ... 6 Vant Road Mews 2 2 100.00 ... ... ... 2 Totals 38 25 65.78 ... 1 6 32 184 Report of the Medical Officer of Health. House-to-House inspections—continued. HOUSING, TOWN PLANNING, &c., ACT, 1909. SUB-DISTRICT OF WANDSWORTH, (Southfield Ward). TABLE XCIX. 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. Burr Road 15 8 53.33 1 3 12 10 Church Row 2 2 100.00 1 2 1 2 Dutch Yard 8 3 37.50 ... 1 ... 7 Field's Alley 8 4 50.00 2 6 ... 1 Hill's Yard 7 7 100.00 18 3 ... ... Merton Road 125 27 21.60 2 12 11 116 Putney Bridge Road 2 2 100.00 14 ... 1 ... Totals 167 53 31.73 38 27 25 136 Report of the Medical Officer of Health. 185 House-to-House Inspections—continued. HOUSING, TOWN PLANNING, &c„ ACT, 1909. SUB-DISTRICT OF WANDSWORTH, (Fairfield 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 ok Families living in One room. Two rooms. Three rooms. Four rooms and upwa rds. Borrodaile Road 46 43 93.47 8 4 5 42 Calverts Cottages 2 2 100.00 ... 2 ... ... Emily Place 4 4 100.00 ...... 3 1 ... Eerrier Street 3 3 100.00 ... ... 4 1 Garratt Lane 4 3 75.00 4 3 ... 3 Ironmill Place 6 6 100.00 ... ... ... 6 Lower Grove 39 39 100.00 8 10 12 25 Oak Place 1 1 100.00 ... ... ... 1 Warple Way 8 8 100.00 22 2 4 1 Totals 113 109 96.46 42 24 26 79 186 Report of the Medical Officer of Health. House-to-House Inspections—continued. HOUSING, TOWN PLANNING, &c., ACT, 1909. SUB-DISTRICT OF WANDSWORTH, (Springfield Ward). TABLE CI. Name of Street. No. of houses inspected. No. of houses in which defects were found. Percentage of defects to houses inspected. Number or Families living in One room. Two rooms. Three rooms. Four rooms and upwards. Beechcroft Road 23 17 73.91 ... ... 15 8 Bendon Valley 43 27 62.78 4 13 20 30 Inman Road 9 9 100.00 ... 3 10 4 Wardley Street 20 19 95.00 22 16 7 6 Wilna Road 69 21 30.43 ... 1 ... 69 Winfrith Road 55 40 72.72 3 3 46 22 Totals 219 133 60.73 29 36 98 139 Grand Total 499 295 59.12 109 87 149 354 Report of the Medical Officer of Health. 187 House-to-house Inspections—continued. HOUSING, TOWN PLANNING, &c„ ACT, 1909. SUMMARY. TABLE CI I. Wards. No. of houses inspected. No. of houses in which defects were found. Percentage of defects to houses inspected. Number or Families living in One room. Two rooms. Three rooms. Four rooms and upwards. Clapham, North 495 290 58.58 56 i02 87 443 Claphara, South 135 98 72.59 27 17 18 122 Putney 323 107 33.12 ... ... 235 208 Streatham 386 278 72.02 32 57 228 164 Balham 520 433 83.26 62 165 285 458 Tooting 38 25 65.78 ... 1 6 32 Southfield 167 53 31.73 38 27 25 136 Fairfield 113 109 96.46 42 24 26 79 Springfield 219 133 60.73 29 36 98 139 Whole Borough 2,396 1,526 63.68 286 379 1,008 1,781 188 Report of the Medical Officer of Health. The total number of intimation notices served was 5,897, compared with 6,305 in 1913, 6,620 in 1912, and 6,278 in 1911, and of statutory notices 406, compared with 540, 707, and 957. 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 32 of the statutory notices, six in Clapham, two in Putney, 18 in Streatham, and six in Wandsworth, served in 1914, were not complied with at the close of the year. 29 of these notices were complied with in the beginning of the current year, with regard to one the premises are unoccupied, while in one the work is in hand, and in one a closing order has been obtained. The number of statutory notices served include By-law notices, 131 of which were served in respect of the following contraventions of the By-laws :—Yard paving 23, repairs to water closets 13, repairs to flushing apparatus of water closets 20, cleansing of water closets one, covers to cisterns six, cleansing cisterns eight, cleansing house and other contraventions of the By-laws as to houses let in lodgings 53, absence of cover to manure receptacle three, and failing to deposit manure in a proper receptacle four. The number of cases of overcrowding dealt with during the year was 81, compared with 75 in 1913, 76 in 1912, and 91 in 1911. 11 of these were in Clapham, two in Putney, 19 in Streatham, six in Tooting, and 43 in Wandsworth. The cases of overcrowding in Clapham were in Rashleigh Street, Crichton Street, Nursery Street, Nelson's Row, Upper Orchard Street, Park Crescent, Carfax Square and Clapham Park Road ; in Putney in Floss Street ; in Streatham, in Nimrod Road, Fallsbrook Road, Roupell Buildings, Greyhound Square, Mill Lane, Zennor Road, Larch Road, Fernlea Road, Balham New Road, Hazelhurst Road and Hereward Road ; in Tooting, in Khartoum Report of the Medical Officer of Health. 189 Road, Rookstone Road, Himley Road and Gilbey Road ; in Wandsworth, in Penwith Road, Brandlehow Road, Pier Terrace, Guelph Street, Jew's Row, Twilley Street, Bridgefield Grove, Ballantine Street, Malva Road, York Road, Garratt Lane, Vermont Street, Ferrier Street, Baylin Road, Aslett Street, Bendon Valley, Beechcroft Road, Dunt's Hill Road, Thornsett Road, Maskell Road, Atheldene Road, and Cubitts Cottages. 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. 1,860 ashpits were provided or repaired, compared with 1,052 in 1913, 717 in 1912, and 831 in 1911. 289 complaints with reference to the non-removal of house refuse (45 from Clapham, 47 from Putney, 95 from Streatham, nine from Tooting, and 93 from Wandsworth), were received during the year. These complaints were, as in previous years, attended to by the Dusting Inspectors. 869 yards in connection with dwelling-houses, and 116 in connection with stables, were paved, drained, or cleansed, compared with 959 and 65 in 1913. 4,896 rooms and 911 staircases and passages were cleansed or repaired, compared with 5,388 rooms and 1,207 staircases and passages in 1913. The greatest number of rooms cleansed was in the Balham Ward, where 1,123 were done, and in Fairfield Ward, where 667 were done, and the smallest number in Southfield and Putney where the numbers were 255 and 271 respectively. 1,025 drains were cleansed or repaired, and 98 rain-water pipes disconnected from the drains. 101 notices of reconstruction of drains were sent to the Borough Engineer from this Department : 24 in Clapham, compared with 21 in 1913 ; four in Putney, compared with five ; 41 in Streatham, compared with 53 ; nine in Tooting, compared with 10 ; and 23 in Wandsworth, compared with 56. 190 Report of the Medical Officer of Health. The total number of houses where the drains were reconstructed during the year was 192 : 54 in Clapham, 10 in Putney, 76 in Streatham, 12 in Tooting, and 40 in Wandsworth. During the year 3,539 drains of houses were tested by the Sanitary Inspectors, 884 in Clapham, 266 in Putney, 1,182 in Streatham, 199 in Tooting, and 1,008 in Wandsworth, and 473 or 13.3 per cent. were found to be defective. Of the 473 found defective, 44 or five per cent. were in Clapham, 36 or 13.5 per cent. in Putney, 208 or 17.6 per cent. in Streatham, 81 or 40.7 per cent. in Tooting, and 104 or 10.3 per cent. in Wandsworth. 329 accumulations of manure were removed after service of notice, compared with 289 in 1913 : 40 in Clapham, 50 in Putney, 86 in Streatham, 67 in Tooting, and 86 in Wandsworth. There has been an increase in the number of cases dealt with in Putney, Streatham, Tooting, and Wandsworth, and a decrease in Clapham and Streatham. Three notices were served for the periodical removal of manure every 48 hours, compared with 15 in 1913, eight in 1912, and 12 in 1911. The number of water closets cleansed and repaired was 1,511, compared with 1,764 in 1913. The greatest number of these were in Balham and Springfield Wards, and the smallest in Putney and Southfield Wards. 412 drinking water cisterns were cleansed, covered or repaired: 100 in Clapham, 17 in Putney, 138 in Streatham, 42 in Tooting, and 115 in Wandsworth, compared with 527 in 1913. 105 premises were inspected and notices served where animals were kept in such a manner as to be a nuisance. Four of these were in Clapham, four in Putney, 28 in Streatham, 12 in Tooting, and 57 in Wandsworth. This nuisance was most common in Fairfield and Springfield Wards, and the animals kept were chiefly ducks and hens, Report of the Medical Officer of Health. 191 79 smoke nuisances were reported during the year : five in Clapham, four in Putney, six in Streatham, one in Tooting, and 63 in Wandsworth. In all 331 observations for black smoke were made by the Inspectors, 79 nuisances were reported and 49 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 three complaints from the Coal Smoke Abatement Society with regard to four premises. These complaints were all at once attended to and the premises kept under observation. 143 soil pipes were repaired, 27 in Clapham, eight in Putney, 70 in Streatham, 23 in Tooting, and 15 in Wandsworth, compared with 119 in 1913, 159 in 1912, and 194 in 1911. 725 leaky roofs and gutters were repaired, compared with 746 in 1913, 870 in 1912, and 869 in 1911. 22 unwholesome or dilapidated houses were cleansed and repaired, six in Putney, two in Streatham, and 14 in Wandsworth compared with 23 in 1913, 60 in 1912, and 30 in 1911. A large amount of work has again been carried out to abate nuisances arising from damp conditions. In all, 606 premises have been dealt with, 74 in Clapham, 22 in Putney, 286 in Streatham, 65 in Tooting, and 159 in Wandsworth ; and in 199 of these, 24 in Clapham, six in Putney, 68 in Streatham, 11 in Tooting, and 90 in Wandsworth, damp courses have been inserted. The number of unclassified nuisances was 849, 285 in Clapham, 56 in Putney, 247 in Streatham, 59 in Tooting, and 202 in Wandsworth, compared with 947 in 1913, 929 in 1912, and 765 in 1911, 192 Report of the Medical Officer of Health. Disinfection. The total number of rooms disinfected after the occurrence of cases of infectious disease was 4,030 (604 in Clapham, 456 in Putney, 1,160 in Streatham, 441 in Tooting, and 1,269 in Wandsworth), compared with 4,404 in 1913, 3,787 in 1912, and 4,419 in 1911. 2,268 lots of bedding were stoved at the Disinfecting Station, compared with 1,801 in 1913, 1,744 in 1912, and 1,603 in 1911. The 2,268 lots of bedding included the following :—1,379 beds, 1,429 bolsters, 3,196 pillows, 1,586 mattresses, 393 palliasses, 2,706 sheets, 1,883 quilts, 543 cushions, 8,198 articles of clothing, 4,103 blankets, 123 carpets, and 3,272 extra articles, a total of 28,809 articles, compared with 23,101 in 1913, 21,401 in 1912, and 21,613 in 1911. 372 premises were disinfected after Measles and 399 after Pulmonary Tuberculosis, compared with 1,454 and 420 in 1913. 34 beds, 22 bolsters, 59 pillows, 71 mattresses, 50 palliasses, 17 sheets, four quilts, 32 cushions, 216 articles of clothing, 14 blankets, 10 carpets, and 122 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 £37 is. od. was received for such disinfection. 409 rooms were disinfected with sulphur in consequence of their verminous condition and 27 lots of verminous bedding disinfected, compared with 618 rooms and 75 lots of bedding in 1913. I have frequently visited the Disinfecting Station during the year, and am able to report that the work has been carried out by the staff to my entire satisfaction, Report of the Medical Officer of Health. 193 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 871 2 10 Fuel 5 8 8 Horse Hire 80 19 0 Stores, Tools, and other materials 60 8 7 Repairs to Horse Vans 13 13 0 Disinfectants, etc. 23 9 2 Repairs to Motor Van 0 6 3 Motor Running Expenses 73 17 0 Lighting 1 6 4 Insurance 9 12 9 Water 4 10 3 Payment to Highways Committee for Steam 30 0 0 £1,174 13 10 The number of lots of bedding stoved was 2,268. Cost per lot of bedding 108. 4d. 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 355 children, 55 belonging to Clapham, two to Putney, 28 to Streatham, 86 to Tooting, and 184 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, 194 Report of the Medical Officer of Health. These children were cleansed by the officials of the London County Council at the Cleansing Station under the supervision of that Authority. 32 adults had baths, 28 were contacts with cases of infective diseases, and four were nurses who had been in attendance in cases of Puerperal Fever. inspection of Urinals in connection with Licensed Premises. The number of urinals inspected was 124, 29 in Clapham, 20 in Putney, 25 in Streatham,10 in Tooting, and 40 in Wandsworth. 514 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. 190 inspections of the sanitary conveniences for females were made by the female Sanitary Inspectors. The provision of free conveniences for the use of females has been much appreciated, but these entail a greater amount of supervision on the part of the staff employed. 170 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. 195 Inspection of Premises where Food is prepared for Sale or Sold. During the year 200 inspections have been made of fried fish shops, 450 of butchers' shops, 577 of greengrocers' shops, and 338 of fishmongers' shops, a total of 1,565. 249 of these inspections were in Clapham, 353 in Putney, 342 in Streatham, 135 in Tooting, and 486 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 £32 13s. 0d., and the costs £2 12s. od., compared with £15 15s. od. and £3 18s. 6d. in 1913. The majority of the cases were with respect to nuisances or contraventions of By-laws, while one was for exposing unsound food for sale, one for the removal of offensive matter during prohibited hours, and one for selling ice cream from a barrow on which the vendor's name and address was not inscribed. TABLE Clll. Premises. Offence. Result. Fine. Costs. 38, Culverden Road, Balham Executing sanitary work without first having given notice Withdrawn on payment of costs ... 21/- 36, White Square, Clapham Contravention of By-laws (waterclosets) Convicted 10/- 2 /- Mitcham Road, Tooting Removal of offensive matter during prohibited hours " 20/- 2/- 210, Garratt Lane, Wandsworth Selling ice-cream from a barrow on which the vendor's name and address " 3/- 2/- 285, „ was not inscribed Exposing unsound meat for sale " 600/— 23/- Sistova Road Mews, Balham Failing to comply with manure removal order " 20/- 2/- 10, Dendy Street, Balham Nuisance from defective drain Dismissed. Drain held to be a sewer - - 196 Report of the Medical Officer of Health. Removal of House Refuse. During the year no alteration has been made in the system of removal. The whole of the refuse is now collected and disposed of by contract, with the exception of a portion from the Balham, Streatham and Tooting Wards, which is disposed of at the Destructor. 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 CIV. Wards. Estimated Quantity. how disposed of. Van loads. Tons. Clapham, North and South 4,627 13,928 Barged away from wharf at Nine Elms. „ „ „ „ 1,402 2,727 At Destructor. Balham and Tooting 7,281 12,871 At Destructor. „ „ 752 1,766 Sent to shoot outside the Borough. Streatham 2,986 6,048 At Destructor. „ 2,483 7,679 Sent to shoot outside the Borough. Fairfield, Springfield and Southfield 8,639 24,097 Sent to shoot outside the Borough. Putney 5,014 7,072 Barged away from Ashlone Road Wharf. Borough 33.184 76,188 The total cost of collection and disposal was £16,025, compared with £16,101 for the year ending March 31st, 1913. 41 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. Report of the Medical Officer of Health. I97 Inspection of Miikshops, 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 CV. PREMISES. NUMBER OF PLACES Number of inspections, 1914- Number of notices, 1914. Number of prosecutins, 1914. On register at end of 1913. Added in 1914. Removed in 1914. On register at end of 1914. Milk premises 381 48 32 397 783 22 ... Cowsheds 11 ... ... 11 45 ... ... Slaughter-houses 14 ... 1 13 366 1 ... Other offensive trade premises 3 ... ... 3 91 ... ... Ice cream premises 346 15 15 346 531 43 ... Registered houses let in lodgings 292 ... ... 292 1,045 *a17 *b475 ::: *a For overcrowding. * b For other conditions. Total number of intimation notices served for all purposes 5,897 Overcrowding, 1914 :— Number of dwelling rooms overcrowded 81 Number remedied 81 Number of prosecutions — Underground rooms, :— Illegal occupation dealt with during year 23 Number of rooms closed — 198 Report of the Medical Officer of Health. Insanitary houses— Number closed under the Public Health (London) Act, 1891 - Number closed under the Housing, Town Planning, etc., Act, 1909 - Number of premises cleansed under Sec. 20 of the L.C.C. General Powers Act, 1904 409 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 93 Number of tenements comprised therein 187 Number of tenements for which certificates were : (a) granted 95 (b) refused 76 (c) deferred 16 Number of prosecutions under By-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice salt, filth, etc. - (6) 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. 1 (/) As to cesspools and privies, removal and disposal of refuse, etc. - Report of the Medical Officer of Health. 199 (g) For securing the cleanliness of tanks, cisterns, etc. (h) With respect to water closets, earth closets, etc. 1 (i) With respect to sufficiency of water supply to water closets (j) With respect to drainage, etc. (Metropolis Management Act, Section 202) (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) Mortuaries— Total number of bodies removed 190 Total number of infective bodies removed ... ... — Milksbops. At the close of 1913 there were 381 milkshops on the register, 48 have been added in 1914 and 32 removed, leaving 397 on the Register at the end of 1914. During the year 783 inspections were made of these premises and 22 notices, chiefly for cleansing, were served. 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) 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. 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.) 200 Report of the Medical Officer of Health. Streatham— Curtis, Mrs. Isabella, Chestnut Grove, Balham. (17 cows.) London, Gloucester, and North Hants Dairy Company, Ltd., Harberson 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 1914 was 11 and 45 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 14 Slaughter-houses and one Knacker's Yard on the Register in 1913, one in Clapham was removed, leaving 13 on the Register. The slaughter-house licensed by the London County Council for slaughtering horses for human food was frequently inspected, and during the year 268 horses have been slaughtered on the premises, and all were exported, compared with 281 in 1913. During the year 316 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. Report of the Medical Officer of Health. 201 During the year the Inspectors inspected the carcases of 341 cattle, 2,425 sheep, 237 pigs, and 12 calves in slaughter-houses and butchers' shops, and reported that, with the exception of one pair of lungs, 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. Fisher, Charles Edward, 272, Wandsworth Road, Clapham Stone, Henry Walter, 697, Wandsworth Road, Clapham. Putney— Lindsey, John, Montserrat Road, Putney. (Condition- This licence is granted on the undertaking of the licensee to drive cattle on the premises only between the hours 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). 202 Report of the Medical Officer of Health. 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 horses.) Knacker's Yard. Harrison, Barber & Co., Ltd., Garratt Lane. Offensive Trades. The following is a list of offensive trades carried on in the Borough:— (1.) 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. 91 inspections of these have been made, and it was necessary to serve one intimation notice for contravention of the By-laws. Report of the Medical Officer of Health. 203 Ice Cream Premises. At the end of 1913 there were 346 of these on the Register. During 1914, 15 were added and 15 removed, leaving a total of 346 on the Register, 531 inspections were made of these premises during the year and 43 notices were served, all of which were for cleansing. Proceedings were instituted against one ice cream vendor for not having his name and address on the barrow. A fine of 3s. with 2s. costs was inflicted. Houses let in Lodgings. At the end of 1913 there were 292 houses let in lodgings on the Register. None were added during 1914, and none removed, making a total of 292 on the Register at the end of 1914. 1,045 inspections of these were made during the year, and 492 notices were served, 17 for overcrowding and 475 for other conditions, chiefly 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. 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. 204 Report of the Medical Officer of Health. Unsound Food. 21½ cwt. turnip tops, 234 lbs. tomatoes, 37 lbs. broad beans, 17 boxes pears, three bags walnuts, 23 lbs. skate, one box cods roes, one box flat fish, 10 boxes kippers, one box hake, four boxes haddock, one box mixed fish, one trunk whiting, one carcase and 130 lbs. beef, one cwt. sugar, one case eggs and six livers were destroyed at the request of the owners and the usual certificates granted. FACTORIES AND WORKSHOPS. There has been a decrease in the total number of inspections of the above, compared with 1913, but 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. 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. 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 116 retail bakehouses, 129 workshop laundries, 273 dressmakers' and milliners' premises, and 1,223 other workshops, but not including 463 factories, 1,218 workplaces, and 351 outworkers' premises. Including all factories, workshops, workplaces, and outworkers' premises, there were on the Register at the end of 1914, 3,774 premises, compared with 3,774 in 1913. 3.629 in 1912, and 3,470 in 1911. Report of the Medical Officer of Health. 205 The total number of notices served was 364, 354 intimation and 10 statutory, compared with 454 in 1913, 402 in 1912, and 462 in 1911. There were no 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 785 inspections were made of 463 factories, and 62 notices 60 intimation and two statutory, were served. The total number of the workshops on the Register was 1,741, 129 of which were workshop laundries, 116 workshop bakehouses, and 1,467 other workshops. In all 2,649 inspections of these were made, compared with 3,185 in 1913, 3,227 in 1912, and 3,059 in 1911, and 141 intimation and five statutory notices were served. The total number of workplaces on the Register was 1,218 and 1,745 inspections were made, while 132 intimation notices were served, but only three statutory notices were necessary. The total number of defects found was 524, including 22 cases in which there was a breach of special sanitary requirements for bakehouses, compared with 539 and 16 in 1913. To abate these nuisances, 343 notices, 333 intimation and 10 statutory were served, all of which, with the exception of nine were complied with at the end of the year. The nine outstanding were complied with in the first month of this year. Excluding outworkers' premises 524 defects were found and 515 remedied, but only 333 intimation notices were served, as one notice frequently called attention to several defects on the same premises, 206 Report of the Medical Officer of Health. INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. TABLE CVl. CLASS OF WORKS. Number of Places Number of Inspections, 1914- Number of Notices. Number of Prosecutions, 1914. On Register at end of 1913- Added in 1914. Removed in 1914. On Register at end of 1914. Intimation, 1914. Statutory, 1914. Under Factory Act. Under Public j Health Act. Premises] Rooms. Factories Factory Laundries 98 5 4 99 397 201 6 ... ... ... Factory Bakehouses 27 4 ... 31 49 109 4 ... ... ... Other Factories 318 30 15 333 1,077 475 50 2 ... ... Workshop Laundries 145 7 23 129 384 262 9 ... ... ... Workshops Workshop Bakehouses 122 ... 6 116 116 483 18 1 ... ... Workplaces Other Workshops 1,474 165 172 1,467 1,840 1,904 114 4 ... ... Places where Food is prepared for Sale 617 29 31 615 654 890 85 1 ... ... Workplaces other than the above 612 136 145 603 881 855 47 2 ... ... Home-workers'premises 361 123 '33 351 351 541 21 ... ... ... Total 3,774 499 529 3,744 5,749 5,720 354 10 ... ... Report of the Medical Officer of Health. 207 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 CVU. I.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries.) 785 62 ... Workshops (Including Workshop Laundries.) 2,649 146 ... Workplaces (Other than Outworkers' premises included in Part 3 of this report.) 1,745 135 ... Totals 5,179 343 ... 208 Report of the Medical Officer of Health. TABLE CVIII. 2.—DEFECTS FOUND Particulars. Number of Defects Number of Prosecutions Found. Remedied Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts :—* Want of Cleanliness 165 162 ... ... Want of Ventilation 4 4 ... ... Overcrowding 4 4 ... ... Want of drainage of floors ... ... ... ... Other nuisances 238 236 ... ... Sanitary accommodation insufficient 4 4 ... ... unsuitable or defective 85 82 ... ... not separate for sexes 2 1 ... ... Offences under the Factory and Workshop A ct:— Illegal occupation of underground bakehouse (S. 101) ... ... Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 22 22 ... ... Other offences (Excluding offences relating to outwork, which are included in Part 3 of this report.) ... ... ... ... Totals 524 515 ... ... * 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 12 less than in 1913, but there was an increase of five in the number sent in once & year, TABLE CIX. 3. - HOME WORK NATURE OF WORK.* OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. 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 inspection of lists. Failing to send lists. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions SS.109,110). Listsf Outworkersf Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (l) Making, &c 108 54 329 6 3 12 61 ... ... 20 21 ... 15 ... ... (2) Cleaning and washing 2 6 2 ... ... ... ... ... ... ... ... ... ... ... ... 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 ... ... ... I ... 50 ... ... ... ... ... ... ... ... ... Racquet and tennis balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper Bags and Boxes 4 ... 12 ... ... ... ... ... ... ... ... ... ... ... ... Brush making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pea picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carding, &c., of buttons, &c 2 ... 6 ... ... ... ... ... ... ... ... ... ... ... ... Stuffed Toys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Basket making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1l6 60 349 7 3 62 61 ... ... 20 21 ... 15 ... ... ...Report of the Medical Officer of Health. 209 * 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. † 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 employer the same outworker's name will often be repeated. 210 Report of the Medical Officer of Health. In all, 116 lists were received twice in the year, containing the names and addresses of 60 contractors and 349 workmen and seven lists once in the year, containing the names and addresses of three contractors and 62 workmen. There has been a slight increase in the number of outworkers employed by employers in the Borough during the year. The total number of addresses received from other Councils was 507, compared with 521 in 1913, 511 in 1912, and 408 in 1911, and 290 addresses were forwarded to other Councils, compared with 276 in 1913, 285 in 1912, and 251 in 1911. The number of addresses received has decreased by 14 and the number sent has increased by 14. The following are the districts to which lists of outworkers were forwarded, and also the number of outworkers Stepney 56, Battersea 54, Lambeth 46, Croydon 21, City 17, Hammersmith eight, Camberwell six, Southwark five, Winchester and Chelsea four each, Southwark and Kensington three each, Holborn, Worthing, Wimbledon, Hanwell, Eastleigh, East Ham, Willesden, Rochford, Southgate, East Ashford, Shoreditch, Lewisham, Finsbury, Deptford, Stratford, Bermondsey and Bethnal Green two each, West Ham, Walthamstow, Barnes, Stoke Newington, Hampstead, St. Pancras and Bexley one each. 39 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 61, compared with 76 in 1913, and these had a most satisfactory result. At the end of 1913 there were 361 outworkers' premises on the Register, 123 were added and 133 removed during the year, leaving 351 on the Reigster at the end of 1914. 541 inspections were made of these premises during the year, and 21 notices, all for cleansing, were served and complied with, 211 Report of the Medical Officer of Health. During the year 15 cases of infective diseases, nine of Scarlet Fever, five of Diphtheria, and one of Erysipelas, were notified as having occurred in the homes of outworkers, compared with 20 in 1913, 16 in 1912, and 15 in 1911. In none of these cases was it necessary to make any order under Section 110 of the Factory and Workshop Act. TABLE CX. 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. Workshop Bakehouses 1l6 „ Laundries 129 Dressmakers' and Milliners' Workshops 273 Bootmakers 143 Smiths 50 Builders 65 Tailors 74 Other 891 Total number of workshops on Register 1,741 TABLE CXI. V OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 24 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 4 Reports (of action taken) sent to H.M. Inspector 4 Other Underground Bakehouses (s. 101):— Certificates granted during the year ... In use at the end of the year 48 212 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 3,031, compared with 3,510 in 1913, 4,147 in 1912, and 3,020 in 1911, and of re-inspections 745, compared with 732 in 1913, 656, and 1,141, a total of 3,776 compared with 4,242 in the previous year. 1,040 of the inspections and 174 of the re-inspections were in Clapham, 408 and 75 in Putney, 630 and 197 in Streatham, 157 and 51 in Tooting, and 796 and 248 in Wandsworth. No workshops where males were employed were notified to H.M. Inspector, but 26 were reported to this Council by H.M. Inspector, all with the exception of five 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 75 of these factories, workshops and workplaces the sanitary conveniences were found defective, in four they were insufficient, and in three they were unsuitable or not separate for the sexes. In 140 the workrooms were in a dirty condition, in four they were insufficiently ventilated, and in 217 other nuisances were found. For these 307 intimation and 10 statutory notices were served, and with the exception of nine intimation notices, were complied with. These notices were complied with in the early part of the year. 213 Report of the Medical Officer of Health. TABLE CXII. Clapham. Putney. Streatham. Tooting. Wandsworth. Total. I.—Factories inspected 120 72 85 14 136 427 „ re-inspected 28 13 35 4 57 137 Sanitary conveniences insufficient ... ... ... ... 3 3 ,, ,, unsuitable ... ... ... ... ... ... ,, ,, not separate for sexes ... ... ... ... ... ... „ ,, defective 5 ... 5 ... 13 23 Other nuisances 14 3 13 ... 16 46 Intimation notices served 17 3 10 26 56 Statutory notices served ... ... ... ... 2 2 Legal proceedings ... ... ... ... ... ... II.—Workshops inspected 430 139 257 34 273 1133 ,, re-inspected 69 40 94 8 77 288 Workrooms inspected 556 173 316 54 349 1448 „ found overcrowded ... ... ... ... ... ... „ insufficiently ventilated ... ... 3 ... ... 3 „ in a dirty condition ... 4 14 1 24 52 Sanitary conveniences insufficient 1 ... ... ... ... 1 ,, ., unsuitable ... ... ... ... ... ... ,, ,, not separate for sexes 1 ... ... ... 1 2 ,, „ defective IS 1 6 8 3° Other nuisances 24 3 9 3 12 51 Intimation notices served 33 8 23 4 32 100 Statutory notices served. 5 ... ... ... ... 5 Legal proceedings ... ... ... ... ... ... Number of workrooms measured 30 ... 26 4 12 72 Number of workroom cards distributed ... ... ... ... ... ... Workshops reported to H.M. Inspector on discovery ... ... ... ... ... ... Workshops reported by H.M. Inspector 7 2 9 2 6 26 III.—Domestic workshops inspected 86 24 81 24 50 265 M ,, re-inspected 19 10 5 4 9 47 Workrooms found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... ... ... ... ... „ in a dirty condition 4 ... 1 3 13 Other nuisances 11 2 ... ... 5 26 Intimation notices served 11 2 6 1 5 25 Statutory notices served ... ... ... ... ... ... Legal proceedings ... ... ... ... ... ... Domestic workshops reported to H.M. Inspector on discovery ... ... ... ... ... ... IV.—Workplaces inspected 375 154 177 176 280 1062 „ re-inspected 51 10 61 35 101 258 Workrooms inspected 302 156 228 95 328 1109 ,, found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... ... ... 1 1 „ in a dirty condition 3 3 26 ... 40 72 214 Report of the Medical Officer of Health. TABLE CXII.— continued. Clapham. Putney. Streatham. Tooting. Wandsworth. Total. Sanitary conveniences insufficient ... ... ... ... ... ... „ „ unsuitable ... ... 1 ... ... 1 „ „ not separate for sexes ... ... ... ... ... ... „ „ defective 8 1 1 ... 12 22 Other nuisances 25 3 12 5 41 86 Intimation notices served 33 7 16 5 55 116 Statutory notices served 2 ... ... ... 1 3 Legal proceedings ... ... ... ... ... ... V.—Home work Premises inspected 29 19 30 9 57 144 „ re-inspected 7 2 2 ... 4 15 Workrooms found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... ... ... ... ... „ in a dirty condition 3 ... ... ... ... 3 Other nuisances 2 2 ... ... 4 8 Intimation notices served 4 2 ... ... 4 10 Statutory notices served ... ... ... ... ... ... Legal proceedings ... ... ... ... ... ... Cases of infective diseases notified ... ... ... ... 1 1 Houses visited for inquiry and no workroom found 4 ... 6 2 5 17 Total number of premises inspected 1040 408 630 157 796 3031 11 „ „ re-inspected 174 75 197 51 248 745 „ „ intimation notices served 98 22 55 10 122 3°7 „ ,, intimation notices complied with 93 22 55 10 118 298 ,, „ statutory notices served 7 ... ... ... 3 10 „ „ statutory notices complied with 7 ... ... ... 3 10 „ „ legal proceedings ... ... ... ... ... ... Table CXXIII.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 1913 there has been a decrease of five in the number of these trades. 215 Report of the Medical Officer of Health. TABLE CX III. SUMMARY OF PRINCIPAL TRADES CARRIED ON IN WORKSHOPS WHERE MEN ARE EMPLOYED. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. Bootmakers 31 18 45 12 37 143 Bakers 30 13 31 9 33 1l6 Tailors 20 14 30 4 6 74 Builders 23 12 15 1 14 65 Smiths 15 7 11 5 12 50 Cycle Makers 8 3 11 ... 14 38 Upholsterers 9 7 10 ... 6 32 Wheelwrights 11 2 11 2 7 13 Hairdressers 7 13 6 ... 4 30 Motor Engineers 8 ... 8 1 24 Watchmakers 10 1 2 ... 3 16 Joiners 5 1 2 ... 4 12 Undertakers 4 ... 1 2 5 10 Harness Makers 1 4 1 1 10 Printers 1 1 4 ... 4 10 Photographers 3 4 1 ... 1 9 Plumbers 6 2 ... ... 1 9 Boat Builders 8 ... ... 1 9 Cabinet Makers 2 2 ... ... 2 6 Wood Choppers 3 ... 1 ... 1 5 Ironmongers 1 ... 1 ... 2 4 Rag Sorters ... ... ... ... 1 4 Jewellers 3 ... ... ... ... 3 Tarpaulin and Scale Makers 1 ... ... ... 1 2 Other Trades 39 13 31 6 42 131 Totals 243 122 224 47 209 845 The Tables which follow summarise the work done during the year by the female Sanitary Inspectors. The total number of premises inspected was 1,829 (441 Clapham, 284 in Putney, 396 in Streatham, 170 in Tooting, and 538 in Wandsworth). 216 Report of the Medical Officer of Health. 210 inspections were made of factories, 801 of workshops, 57 of domestic workshops, 392 of workplaces, and 369 of outworkers' premises,' while 247 premises were visited for inquiry and no workroom found. There were only four cases of overcrowding discovered, compared with two in 1913, one in 1912, and three in 1911, and these were at once abated, and 25 were found to be in a dirty condition, compared with 29 in 1913, 37 in 1912, and 17 in 1911. All the factories and workshops inspected during the year had separate water closets for the sexes, but in four factories and five workshops the water closets were defective. Other nuisances were discovered in one workshop, one domestic workshop, 11 workplaces, and eight outworkers' premises, and these were all abated. It was only necessary to serve 47 intimation notices, and these were all complied with at the end of the year. 24 workshops and three domestic workshops where females were employed were reported to H.M. Inspector of Workshops and 29 were reported to this Council by H.M. Inspector. Only five of the workshops (two in Clapham, two in Streatham, and one in Wandsworth), reported by H.M. Inspector were unknown to the Sanitary Inspectors. The other 24 had been previously reported to H.M. Inspector, or were already on the Register. 217 Report of the Medical Officer of Health. TABLE CX1V. Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. I.—Factories inspected 44 16 30 5 115 210 „ re-inspected 3 3 5 11 Sanitary conveniences insufficient ... ... ... ... ... ... ,, „ unsuitable ... ... ... ... ... ... ,, ,, not separate for sexes ... ... ... ... ... ... ,, ,, defective 1 ... ... ... 3 4 Other nuisances ... ... ... ... ... ... Intimation notices served 1 ... ... ... 3 4 Statutory notices served ... ... ... ... ... ... Legal proceedings ... ... ... ... ... ... II.— Workshops inspected 208 175 179 47 192 801 ,, re-inspected 7 18 127 6 14 57 Workrooms inspected 383 225 366 81 425 1480 ,, found overcrowded ... 1 2 1 ... 4 ,, insufficiently ventilated ... ... ... ... ... ... ,, in a dirty condition ... 4 ... ... 4 11 Sanitary conveniences insufficient ... ... ... ... ... ... ,, ,, unsuitable ... ... ... ... ... ... ,, ,, not separate for sexes ... ... ... ... ... ... ,, ,, defective 1 ... I ... 3 5 Other nuisances 1 ... ... ... ... ... Intimation notices served ... ... 3 ... 5 15 Statutory notices served ... ... ... ... ... ... Legal proceedings ... ... ... ... ... ... Number of workrooms measured 15 13 22 2 10 62 Number of workroom cards distributed 25 19 37 s 23 109 Workshops reported to H.M. Inspector 3 ... 5 ... 5 24 ,, ,, by ,, ,, 4 6 10 3 6 29 III.—Domestic workshops inspected 11 8 8 2 28 57 ,, ,, re-inspected 1 ... ... ... ... 1 Workrooms found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... ... ... ... ... ,, in a dirty condition 1 ... ... ... ... 1 Other nuisances 1 ... ... ... ... 1 Intimation notices served 1 ... ... ... ... 1 Statutory notices served ... ... ... ... ... ... Legal proceedings ... ... ... ... ... ... Domestic workshops reported to H.M. Inspector ... ... ... ... 2 1 IV.—Workplaces inspected 84 36 122 53 97 392 „ re-inspected 2 5 7 4 15 13 Workrooms inspected 97 47 159 69 128 500 ,, found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... ... ... ... ... ,, in a dirty condition 2 3 3 ... ... ... Sanitary conveniences insufficient ... ... ... ... ... ... ,, „ unsuitable ... ... ... ... ... ... ,, ,, not separate for sexes ... ... ... ... ... ... ,, ,, defective ... ... ... ... ... ... Other nuisances ... ... 6 ... 5 11 Intimation notices served 1 3 7 ... 5 16 2l8 Report of the Medical Officer of Health. TA BLE CXIV.—continued. Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. Statutory notices served ... ... ... ... ... ... Legal proceedings ... ... ... ... ... ... V.—Home work. Premises inspected 94 49 57 63 106 369 ,, re-inspected 1 6 ... 6 ... 13 Workrooms found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... ... ... ... ... ,, in a dirty condition 1 4 ... ... ... 5 Other nuisances 2 3 ... 2 ... 8 Intimation notices served 3 5 2 ... 11 Statutory notices served ... ... ... ... ... ... Legal proceedings ... ... ... ... ... ... Cases of infective disease notified 3 2 1 1 7 14 Houses visited for inquiry and no workroom found 59 37 63 35 53 247 Total number of premises inspected 441 284 396 170 538 1829 ,, ,, ,, re-inspected 14 29 22 16 34 115 ,, intimation notices served 10 10 11 3 13 47 ,, ,, ,, complied with 10 10 3 13 47 ,, statutory notices served ... ... ... ... ... ... „ ,, „ complied with ... ... ... ... ... ... ,, legal proceedings ... ... ... ... ... ... Table CXV. shows the number of factories, workshops, domestic workshops, and workplaces on the Register at the close of 1913, the number removed from, the number added during 1914, and the number on the Register at the end of 1914. 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 106 factories where women are employed, 77 are laun dries and 29 other factories, while of the total workshops, viz.:—495 Report of the Medical Officer of Health. 219 273 are dressmakers and milliners, 129 laundries and 93 other workshops, a decrease of 26 dressmakers' and milliners' premises and 16 laundries, compared with 1913, while the number of other workshops is 14 more than in the previous year. The total number of domestic workshops on the Register was 69 (seven in Clapham, eight in Putney, 20 in Streatham, eight in Tooting and 26 in Wandsworth), compared with 63 in 1913. The total number of workplaces on the Register is 357, a decrease of nine compared with 1913, of which 110 are laundries, and 247 miscellaneous premises, chiefly dressmakers and milliners. 220 Report of the Medical Officer of Health.  Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. *1 2 3 Total. 1 2 3 Total. I 2 3 Total. 1 2 3 Total. 1 2 3 Total. 1 2 3 Total. Factories on Register, 1913 ... 12 6 18 ... 5 3 8 ... 15 6 21 ... 1 1 2 ... 43 12 55 ... 7b 28 104 ,, removed from Register ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 4 ... 4 ... 4 1 5 ,, added to Register, 1914 ... 2 2 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 ... 5 2 7 ,, on Register, 1914 ... 14 8 22 ... 5 3 8 ... 15 3 20 ... 1 1 2 ... 42 12 54 ... 77 29 106 Workshops on Register, 1913 84 34 27 115 56 12 9 77 134 38 30 202 19 11 5 35 30 50 8 94 299 145 79 523 ,, removed from Register 12 8 6 26 14 ... 2 16 35 6 7 48 8 3 1 12 7 6 5 18 76 23 21 120 ,, added to Register, 1914 5 2 ... 7 10 ... 6 16 26 5 23 54 5 ... 3 8 4 ... 3 7 50 7 35 92 ,, on Register, 1914 47 28 21 96 52 12 13 77 125 37 46 208 16 8 7 31 33 44 6 83 273 129 93 495 Number of workrooms therein 52 77 40 169 67 32 16 115 149 108 52 309 16 21 8 45 36 146 6 188 320 384 112 826 Domestic workshops on Register, 1913 9 6 27 4 17 63 ,, removed from Register 4 ... 12 ... 4 20 „ added to Register. 1914 2 2 5 4 13 2b ,, on Register, 1914 7 8 20 8 2b 69 *2 3 Total. 2 3 Total. 2 3 Total. 2 3 Total. 2 3 Total. 2 3 Total. Workplaces on Register, 1913 19 40 59 9 19 28 32 102 134 6 57 63 21 61 82 87 279 366 removed from Register 8 15 23 2 3 5 3 50 53 1 32 34 6 10 16 21 110 131 ,, added to Register, 1914 7 9 16 2 6 8 18 38 56 9 10 19 8 15 23 44 78 122 ,, on Register. 1914 18 34 52 9 22 31 47 90 137 13 35 48 23 66 89 110 247 357 Number of workrooms therein 38 34 72 9 22 41 86 90 176 2b 35 6l 47 66 113 216 247 463 * (1) Dressmakers and Milliners. (2) Laundries. (3) Miscellaneous. Report of the Medical Officer of Health. 221 Table CXVI. shows the nature of the trades carried on in the workshops inspected. The total number, viz.:—937, (158 in Clapham, 119 in Putney, 368 in Streatham, 90 in Tooting, and 202 in Wandsworth), is 32 more than in 1913, the greatest increase having occurred in Putney and Wandsworth, while there has been a decrease in Clapham. TABLE CXVI. Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. Art Needleworkers ... 1 ... 2 ... 8 Blouse Makers 5 1 5 3 2 16 Box Maker 1 ... ... ... ... 1 Confectionery Maker ... 1 ... ... ... 1 Corset Makers 2 1 4 1 ... 8 Costumiers ... 1 3 ... 1 5 Dressing Gown Makers 3 ... ... 1 ... 4 Dressmakers 70 65 191 48 105 479 Druggists' Sundries Maker ... ... ... ... ... 1 Ecclesiastical Embroiderer ... ... 1 ... ... 1 Engraver 1 ... ... ... ... 1 Feather Curlers and Cleaners 1 ... 1 1 1 ... Firework Case Maker ... ... ... 1 ... 1 Florists ... ... 6 ... ... 6 Furriers ... 2 2 ... 1 ... Glove Makers ... ... ... ... 2 ... Gold Embroiderer 1 ... ... ... ... 1 Hairworker ... 1 ... ... ... 1 Haversack Makers ... 2 ... ... ... ... Hosiers 2 ... 1 1 ... ... Lace Maker ... 1 ... ... ... 1 Laundries (Workshops) 28 12 37 8 44 129 Laundries (Workplaces) 18 9 47 13 23 110 Linen Embroiderer ... ... 1 ... ... 1 Maker of Celluloid Articles ... ... ... ... ... 1 Mantle Maker 1 ... ... ... ... 1 Milliners 15 19 38 8 12 92 Outfitters 4 ... 9 1 6 20 1 Paper Bag Maker 1 ... ... ... ... Paper Cap Maker ... ... 1 ... ... 1 Seed Packer 1 ... ... ... ... 1 Shoe Upper Maker 1 ... ... ... ... 1 Tailors 1 1 17 1 5 25 Tea Gown Maker ... 1 ... ... ... 1 Upholsterer 1 ... ... ... ... 1 Vest Maker ... ... ... 1 ... 1 Totals 158 119 368 90 202 937 222 Report of the Medical Officer of Health. Military Billets During the year several premises were taken for the billeting of soldiers, and pickets were stationed at certain places in the Borough. At the request of the Military Authorities, these premises were all inspected weekly and a report on the conditions found sent to the War Department after each inspection. In all 212 inspections were made by the Sanitary Inspectors, (25 in Clapham, 29 in Putney, and 158 in Wandsworth). Refugees' Homes. Several premises were taken by various organisations for the housing of French and Belgian war refugees, and during the year 153 inspections were made of these premises. Six of the inspections were in Clapham, 41 in Streatham, and 106 in Wandsworth. In all these cases the arrangement made for the housing of the refugees were quite satisfactory. Canal Boats Act. During the year 35 inspections of Canal Boats were made, but it was not necessary to serve any notices, as on inspection the conditions of all the boats was found to be satisfactory. Statement of Work done under the Rag Flock Act, 1911. 40 workshops were visited by the Inspector and the materials used for bedding and upholstery were examined. 33 examples were procured and submitted for analysis, 26 of these were reported as complying with the standard of cleanliness required, whilst seven or 27 per cent. were reported against as containing chlorine in excess of the amount permitted, compare with 2,0 per cent. in 1913. and 50 per cent. in 1912. 223 Report of the Medical Officer of Health. In seven cases proceedings were instituted against the person in whose possession the flock was found, with the result that in four cases a small fine was inflicted, in two cases costs were imposed and one case was dismissed with a warning. The total fines and costs amounted to £3. Statement of Work done under the Sale of Pood and Drugs Acts. During the year 1,789 samples of foods and drugs were submitted to the Public Analyst for analysis, compared with 1,849 in 1913, 1,500 in 1912, and 927 in 1911. Of the 1,789 samples analysed 826 were purchased as test or informal samples, while 963 were purchased officially. Of the 963 official samples submitted for analysis 106 or 11 per cent. were reported to be adulterated or not up to standard, and of these samples which were purchased informally or as tests samples 76, or 9.2 per cent. were found adulterated or not up to standard. The total adulterations reported were 182, or 10.2 per cent. of the samples submitted, compared with 11 per cent, in 1913, 18.0 per cent. in 1912, 13.2 per cent. in 1911, and 9.05 per cent. in 1910. The percentage of milk samples found to be adulterated was 7.8, compared with 9.5 in 1913, 10.39 in 1912, and 9.3 in 1911. In 67 out of the 106 cases in which adulterations were detected in the official samples proceedings were instituted against the vendor, compared with 84 in 1913, 86 in 1912, and 77 in 1911. The total amount received in penalties under the above Acts during the year amounted to £'91 4s. od., and the costs to £'38 17s. od., making a total of £130 is. od., compared with £143 7s. 6d. in 1913, £244 14s. in 1912, and £299 19s. 9d. in 1911. 224 Report of the Medical Officer of Health. TABLE CXVII. Case No. Article. Adulteration. Result. Fine. Costs. 2 Skimmed Milk 3 per cent. extraneous water Convicted 10/- 55/- 16 Milk 8 per cent. milk fat deficient Warranty proved - - 23 „ 4.5 per cent. extraneous water Convicted Roundsman convicted and master ordered to pay costs 20/- - 2/12/6 28 Butter 66 per cent. of Margarine Convicted 80/- 25/- 29 ,, 98 per cent. of Margarine 31 „ 100 per cent. Margarine ,, 100/- 181- 35 Meat Paste Containing a Boron Preservative Ordered to pay costs - 33/6 38 Milk 97 per cent. milk fat deficient Convicted 10/- 12/6 40 Separated Milk 3 per cent. extraneous water ,, 5/- 12/6 46 Milk 4 per cent. extraneous water ,, 10/- 63/- 47 „ 4 per cent. extraneous water Ordered to pay costs - 2/- 63 „ 92 per cent. milk fat deficient Convicted 10/- - 64 Separated Milk 10 per cent. extraneous water ,, 10/- - 66 Skim Milk 10 per cent. extraneous water ,, 10/- - 72 Grey Powder 64 per cent. deficient in mercury Ordered to pay costs — M/6 74 ,, 52 per cent. deficient in mercury ,, — 14/6 90 Milk 18 per cent. extraneous water Convicted 20/- 12/6 92 Raspberry Jam 5 per cent. apple pulp Dismissed. Warranty proved _ - 107 Butter 25 per cent. Margarine Convicted 40/- - 109 ,, 4 per cent. Margarine ,, 40/- 12/6 110 ,, 98 per cent. Margarine ,, 20/- 12/6 111 ,, 100 per cent. Margarine ,, 40/- 12/6 113 ,, .72 per cent Boric Acid ,, 40/- 14/6 115 ,, 98 per cent. Margarine ,, 40/- 12/6 116 ,, 98 per cent. Margarine ,, 20/- 12/6 134 Medicine by Prescription 28 per cent. deficient in Potassium Iodide ,, 2/- 18/- 136 Milk 6 per cent. extraneous water Dismissed. Presumption upheld - - 137 ,, 6 per cent. extraneous water 166 Butter 90 per cent. Margarine Convicted 100/- 16/6 167 „ 90 per cent. Margarine ,, 100/- 12/6 179 ,, Containing an excess of Boric Acid ,, 40/- 12/6 180 „ ,, ,, „ 40/- 12/6 193 Milk 8 per cent. milk fat deficient ,, 20/- 14/6 225 Report of the Medical Officer of Health. TABLE CXVII.—continued. Case No. Article. Adulteration. Result. Fine. Costs. 251 Milk 7 per cent. milk fat deficient Dismissed. Warranty proved — — 252 ,, 10 per cent. milk fat deficient 282 ,, 6 per cent. extraneous water ,, — — 295 ,, 6 per cent. extraneous water Convicted 200/- 12/6 304 ,, 15 per cent. milk fat deficient Dismissed. Warranty proved — — 346 ,, 13 per cent. milk fat deficient ,, — — 425 ,, 36 per cent. milk fat deficient Convicted 40/- 14/6 458 ,, 14 per cent. milk fat deficient ,, 20/- X2/6 487 ,, 5 per cent. milk fat deficient Dismissed. Warrantyproved — — 515 ,, 4 per cent. extraneous water ,, — — 4 per cent. deficient in fat 517 Separated Milk 11 per cent. extraneous water Convicted 20/- 12/6 518 Milk 10 per cent. milk fat deficient ,, 10/- 12 536 ,, 9 per cent. milk fat deficient Dismissed. Warranty proved — — 555 Butter 100 per cent. of Margarine Convicted 30/- 161- 606 Milk 6 per cent. extraneous water Dismissed. Warranty proved — — 611 ,, 6 per cent. milk fat deficient ,, — — 646 Butter 100 per cent. of Margarine Convicted 40/- 16/- 657 Milk 25 per cent. milk fat deficient Dismissed. Warranty proved — — 723 ,, 9 per cent. milk fat deficient Ordered to pay costs — 42/- 735 ,, 3 per cent. extraneous water Roundsman found guilty and convicted 100/- 22/6 778 Butter 67 per cent. Margarine Convicted 14/- 14/6 780 Milk 10 per cent. extraneous water Roundsman convicted and master ordered to pay costs 40/- 2/- 793 Butter 90 per cent. Margarine Ordered to pay costs — 14/6 848 Milk 10 per cent. milk fat deficient Convicted 40/- 14/6 918 Olive Oil 100 per cent. Cotton Seed Oil ,, 50/- 12/6 920 ,, 100 per cent. Arachis Oil ,, 100/- 12/6 937 Butter 100 per cent. Margarine ,, 102/- 16/- 951 Medicine by 57.8 per cent. deficient in Potassium Iodide ,, 40/- 15/6 957 Milk 13 per cent. extraneous water Defendant absconded before the summons was served — — 226 Report of the Medical Officer of Health. PROCEEDINGS UNDER THE MARGARINE ACT. TABLE CXVIII. Case No. Description of Offence. Result. Fine. Costs. 28 Selling Margarine in an unstamped wrapper Ordered to pay costs — 2/- 29 „ „ „ „ — 2/- 20 Exposing Margarine for sale without proper label Convicted 10/- 2/- 31 Selling Margarine in an unstamped wrapper Ordered to pay costs — 4/- 107 ,, „ „ „ — 2/- 107 Selling Margarine containing more than 10 per cent. of butter fat „ „ — 2/- 107 Exposing Margarine for sale without proper label „ „ — 2/- 109 Selling Margarine in an unstamped wrapper „ „ — 2/- 110 „ „ „ „ — 2/- 111 „ „ „ „ — 2/- 115 „ „ „ „ — 2/- 116 „ „ „ „ — 2/- 119 „ „ „ „ — 2/- 119 Exposing Margarine for sale without proper wrapper Convicted 60/- 12/6 166 Selling Margarine in an unstamped wrapper Ordered to pay costs — 2/- 167 „ „ „ „ — 2/- 555 „ „ „ „ — 2/- 646 „ „ Convicted 20/- 2/- 778 „ „ Ordered to pay costs — 2/- 793 „ „ „ „ — 2/- 937 „ „ Convicted 1/- 2/- 227 Report of the Medical Officer of Health. OTHER OFFENCES. TABLE CXIX. Nature of Offence. Result. Fine. Cost. For selling Milk from a receptacle upon which the vendor's name and address were not inscribed Ordered to pay costs — 2/- Refusing Milk for analysis „ — 2/- Obstructing Inspector Convicted 40/- 2/- TABLE CXX Year. No. of Samples taken. No. Adulterated. Percentage Adulterated. 1904 750 85 11.3 1905 853 65 7.6 1906 905 84 9.2 1907 989 84 8.4 1908 1,004 88 8.76 1909 1,030 71 6.89 1910 1,060 96 9.05 1911 927 123 1.32 1912 1,500 271 18.0 1913 1.849 205 11.0 Average 10 years 1904—1913 1,086 117 10.7 1914 1,789 182 10.2 228 Report of the Medical Officer of Health. Table CXX. shows the number of samples taken, the number adulterated, and the percentage of adulterated samples for the 10 years 1904-1913, compared with the year 1914. From this table it will be seen that the average percentage of adulterations detected for the 10 years 1904-1913 was 107 per cent., compared with 10.2 in 1914. 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 11.0 per cent. were adulterated, compared with 13.4 per cent. in 1913, while of the informal 9.2 per cent. were adulterated, compared with 8.4 per cent. in 1913. TABLE CXX I. 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 samples taken. No. Adulterated Percentage Adulterated. Clapham 189 21 11.1 160 10 6.2 349 5.5 31 9.0 Putney 95 9 9.4 82 11 12.2 177 6.0 20 11.3 Streatham 252 27 10.7 241 21 8.7 493 4.6 48 9.9 Tooting 233 22 9.4 206 20 9.7 439 11.3 42 9.5 Wandsworth 194 27 13.7 137 14 10.2 331 3.4 41 12.3 Whole Borough 963 106 11.0 826 76 9.2 1,789 5.3 182 10.2 229 Report of the Medical Officer of Health. Of the total samples the percentage in Wandsworth was the highest due to the large amount of adulteration detected in milk and butter samples. Table CXXII. 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 CXXII. Articles analysed. No. of Samples. Percentage of Adulteration. Examined. Found adulter, ated or not up to standard. 1909. 1910. 1911. 1912. 1913. Average for five years. 1914. Milk & Cream 909 71 7.39 7.44 11.10 13.63 11.55 10.5 7.8 Butter 478 77 5.35 7.23 16.40 25.4 12.67 13.1 16.1 Cheese 6 ... ... 80.7 ... ... ... 16.0 ... Margarine 4 ... ... ... 20.0 ... ... 4.0 ... Lard 53 ... ... ... ... ... ... ... ... Bread ... ... ... ... ... ... ... ... ... Flour 3 ... ... ... 50.0 ... ... 10.0 ... Tea 3 ... ... ... ... ... ... ... ... Coffee 32 4 5.5 9.0 10.0 ... ... 4.6 12.5 Cocoa 21 ... ... 8.3 ... ... ... 1.7 ... Sugar 28 ... ... ... 10.0 15.3 ... 5.0 ... Mustard 14 ... ... ... ... 25.0 ... 5.0 ... Confectionery 13 2 ... ... ... ... ... ... 15.4 Pepper 36 ... ... ... ... ... ... ... ... Wine, Beer and Spirits ... ... ... ... ... ... ... ... ... Drugs* 83 11 12.5 ... 10.0 7.0 6.4 7.2 13.2 Other articles* 106 17 24.0 30.0 25.9 36.7 16.0 28.5 16.0 All Articles 1,789 182 6.89 9.05 13.2 18.0 11.0 14.02 10.2 Details of these will be found in the Report of the Public Analyst at the end of this Report. 230 Report of the Medical Officer of Health. Milk and Cream. MILK. 895 samples of milk were produced for analysis during the year. 67 or 7.48 per cent. were reported against as being adulterated or not up to legal standard. 875 samples were purchased officially, of which 67 or 7.6 per cent. were adulterated, and 20 samples purchased informally, of which four were reported against. 39 samples were found to contain added water, 26 were deficient in milk fat, and two were deficient in milk fat and contained added water. Proceedings were taken in 34 cases, and in 33 cases the Public Health Committee, after considering the amount of adulteration and the circumstances of sale, decided not to prosecute the vendors, but to take further samples. 17 samples of milk were taken on delivery at various Public Institutions situated within the Borough. All these samples were reported to be genuine. 91 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. Six samples were reported against as containing extraneous water, viz.:—2 per cent., 3 per cent., 4 per cent., 4.5 per cent., 6 per cent. and 6 per cent. respectively. Proceedings were instituted against the farmer of the two last mentioned samples. The summonses were dismissed, the farmer having satisfied the Magistrate that the milk was sold and delivered in the same condition as it came from the cow. Report of the Medical Officer of Health. 231 14 samples of milk were procured during the early morning (from 3 to 4 a.m.), from wholesale dealers whilst delivering milk to the retailer. All these samples were reported to be genuine. Six samples of milk were procured on delivery at private houses, two were reported as being adulterated. The adulteration being small, no proceedings were taken, but the vendor was warned. TABLE CXXIII. Premises. No. of Samples taken. No. Adulterated. Percentage Adulterated. Public Institutions 17 ... ... Railway Stations 91 6 6.6 Retailers' Premises 14 ... ... Private Houses 6 2 3.3 162 samples of milk have been taken on Sundays, either in the early morning or at mid-day. 12 or 7.4 per cent. were reported against as being adulterated, compared with 10.6 in 1913, 10 per cent. in 1912, and 10 per cent. in 1911. 351 samples of milk were taken from milk vendors in the street during the early morning (i.e., 5 to 7 a.m.), on week days, and of these 36 or 10.2 per cent. were reported against. 10 samples of milk were taken from automatic milk supply machines and all were reported to be genuine. In two cases proceedings were taken against milk vendors for selling milk from receptacles upon which their name and address were not conspicuously inscribed. (See other offences, Table CXIX.) In 12 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. 232 Report of the Medical Officer of Health. Proceedings were taken against a milk carrier for refusing milk for analysis and a penalty of 40s. and costs or one month was imposed. Proceedings were also taken against a milk vendor for wilful obstruction, but as the vendor absconded before the summons was served the case was not dealt with. It is satisfactory to report that not a single sample of milk out of the 875 samples submitted was found to contain a preservative. 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 1914. TABLE CXX1V. Year. No. of Samples taken. No. Adulterated. Percentage Adulterated. 1904 397 61 15.60 1905 510 37 7.25 1906 526 34 6.44 1907 501 55 10.97 190S 516 37 7.05 1909 545 40 7.16 1910 593 45 7.58 1911 602 67 11.11 1912 712 74 10.39 1913 798 76 9.5 Average 10 years, 1904-1913 570 52 9.2 1914 875 67 7.6 Report of the Medical Officer of Health. 233 CREAM. 20 samples of cream were taken during the year, seven of these being sold as preserved cream and 13 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. fn none of the seven cases was the amount of boric acid 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 sf December, 1914. 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 895 Nil Cream 13 4 234 Report of the Medical Officer of Health. Nature of preservative in each case in column (b). CREAM. Case No. 154 Cream 0.21 per cent. Crystallised Bovic Acid 155 ,, 0.20 ,, „ „ 168 ,, 0.26 ,, „ „ 174 ,, 0.26 „ „ „ Nature of preservative in each case in column (b). MILK. Nil. Action taken under the Regulations in regard to each case in Column (b). Nil. Vendors were warned. (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 7 (2). Statements incorrect 0 Total 7 (b) Determinations made of milk-fat in cream sold as Preserved Cream:— (1). Above 35 per cent 7 (2). Below 35 per cent 0 Total 7 (c) and (d). In each of the 7 samples procured as Preserved Cream the provisions as to labelling were duly observed. (3). Thickening Substances Nil. (4). Other Observations Nil. 235 Report of the Medical Officer of Health. Butter and Margrarine. BUTTER. 478 samples of butter were submitted for analysis during the year, of which 77 or 16.1 per cent. were reported against, compared with 12.67 in 1913, 25.4 per cent. in 1912, 16.4 per cent. in 1911. Of the 478 samples of butter analysed 35 samples were taken officially, 20 or 57 per cent. were reported against, whereas of those samples taken informally 57 or 12.8 per cent. were found to be adulterated. In 19 cases proceedings were instituted against the vendors of the adulterated samples. The penalties and costs amounted to £57 14s. 6d., compared with £50 8s. 0d. in 1913 and £150 6s. 6d. in 1912. 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 1904-1913 compared with the year under review. 236 Report of the Medical Officer of Health. TABLE CXXV. Year. Number of samples taken. Number Adulterated. Percentage of Adulteration. 1904 180 14 7.20 1905 223 20 8.96 1906 287 19 6.62 1907 334 13 3.89 1908 343 26 7.58 1909 299 16 5.35 1910 304 22 7.23 1911 189 31 l6.4 1912 389 99 25.4 1913 584 74 12.67 Average for 10 years 1904-1913 313 33 10.6 1914 478 77 16.1 MARGARINE. Four samples of margarine were submitted for analysis and all returned as genuine. There were four convictions under the Margarine Act, these being in connection with the Sale of Margarine as butter, see Table CXVIII. CHEESE. Six samples of cheese were analysed and all reported to be genuine, 237 Report of the Medical Officer of Health. LARD. 53 samples ol lard were analysed and all reported to be genuine. FLOUR. Three samples of flour were analysed and found to be genuine. COFFEE. 32 samples of coffee were examined, four of which were reported against as containing chicory. In these cases a declaration was made by attaching a label to the tin and no proceedings were taken. COCOA. 21 samples of cocoa were analysed and all reported to be genuine. SUGAR. 28 samples of sugar were analysed, and all reported to be genuine. MUSTARD. 14 samples of mustard were analysed, and all reported to be genuine. PEPPER. 36 samples of Pepper were examined and found genuine. CONFECTIONERY. 13 samples of raspberry jam were analysed, two of which were reported against, one being procured informally and one officially, each sample contained about 5 per cent. apple pulp. 238 Report of the Medical Officer of Health. Proceedings were taken against the vendors who successfully pleaded a warranty given with the jam. Proceedings were then taken against the warrantor who was the manufacturer of the jam for giving a false warranty. At the hearing, the warrantor stated that he was unable to account for the apple pulp found in the jam, and that at the time he gave the warranty, he had every reason to believe that the jam was genuine. The case was dismissed. DRUGS. 83 samples of drugs were analysed, and 11 or 13.2 per cent. were found to be adulterated or not up to the required standard. The samples adulterated were grey powders and prescriptions. Four of the vendors were proceeded against, two for selling a mercury preparation known as grey powder which was deficient in mercury, and two for selling medicine by prescription which had not been properly dispensed as directed by the prescription. The result was that the vendors of the grey powders were ordered to pay costs, and the vendors of Medicine by prescription were convicted and fined 2s. and 18s. costs, and 40s. and 15s. 6d. costs, respectively. OTHER ARTICLES. 106 samples classified under this heading were examined, 17 or 16.0 per cent. being reported against as either adulterated or not up to the required standard. Details of these samples together with the nature of adulteration can be seen on referring to the Report of the Public Analyst annexed. 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. 239 Report of the Medical Officer of Health. STAFF. On August 4th, when War was declared, several of the staff of the Public Health Department who were in the Territorial Force were mobilised and since then other members of the staff have joined he forces. The following is a list of those at present serving:— Dr. P. Caldwell Smith, Medical Officer of Health. Dr. F. G. Caley, Tuberculosis Officer. Herbert E. Brown, Sanitary Inspector. Robert Brown, Sanitary Inspector. H. F. P. Holliman, Junior Clerk. E. Hunt, Clerk and Dispenser at Tuberculosis Dispensary. As I was on service near London I was able to keep to some extent in touch with the work. Dr. Oliver Field, who was appointed Deputy Medical Officer of Health, has however, since the middle of August, ably supervised the work of the Department and has been of great service to the other officials in the Department. At the Tuberculosis Dispensary, in the absence of Dr. Caley, Ihe Council appointed Dr. P. Nicol, who has carried out the work at both Dispensaries in a very thorough and satisfactory manner. It was also necessary to obtain the services of a dispenser at Wandsworth as the clerk and dispenser there, who had previously served in the R.A.M.C., rejoined, and has now obtained the rank of Quartermaster in that Corps. To fill the vacancy, Mrs. Nicol was appointed and this arrangement has worked successfully. Another change occurred in the staff of the Department owing to the resignation of the Nurse and the vacancy was filled by the appointment of Miss Moores. Two temporary appointments in the Inspectorial staff were made by the Council and the Inspectors appointed have carried 240 Report of the Medical Officer of Health. out the work of the two Inspectors on military service, while in the clerical staff there was only one vacancy and this has been satisfactorily filled. Up to the end of the year four of the disinfecting staff, (A. Blake, T. Brown, W. H. Brown, and E. Tyler), had been mobilised or joined the forces and some difficulty was experienced in obtaining substitutes, but eventually satisfactory arrangements were made. As far as I am able to judge, and this opinion is corroborated by the Deputy Medical Officer of Health, the work of the Public Health Department of this Borough has not been permitted to fall below the satisfactory standard which has been attained during the time I have had the privilege of being the Medical Officer of Health. With regard to the other members of the staff, I am pleased to report that they have carried out all their duties in a most thorough and conscientious manner, and I cannot but specially mention the Chief Clerk of the Department, Mr. A. E. Cooper, without whose assistance and lengthy experience it would have been more difficult to carry on the general departmental work, and in the preparation of this Report his help has been invaluable. 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 1914 under the Sale of Food and Drugs Acts. Number of samples submitted. The total number of samples submitted by the Inspector during the year amounted to 1,789. Of these, 963 were taken with the formalities required by the Sale of Food and Drugs Acts, whilst 826 were obtained nformally. 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, 242 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 1914, by the Inspector. No. of samples examined. No. of samples found adulterated or not up to standard. Formal. Informal. Total. Formal. Informal. Total. Milk and Cream 889 20 909 71 0 71 Butter 35 443 478 20 57 77 Cheese 1 5 6 0 0 0 Margarine 1 3 4 0 0 0 Lard 0 53 53 0 0 0 Flour (self-raising) 0 3 3 0 0 0 Tea 0 3 3 0 0 0 Coffee 3 29 32 2 2 4 Cocoa 0 21 21 0 0 0 Sugar 1 27 28 0 0 0 Mustard 0 14 14 0 0 0 Confectionery and Jam 1 12 13 1 1 2 Pepper 0 36 36 0 0 0 Drugs 8 75 83 5 6 11 Other Articles 24 82 106 7 10 17 963 826 1789 106 76 182 243 Report of the Medical Officer of Health. Table A. Details of "Other Articles" in foregoing Main Statement. No. of samples examined. No. of samples found adulterated or not up to standard. Formal. Informal. Total. Formal. Informal. Total. Arrowroot 0 2 2 0 0 0 Baking Powder 0 10 10 0 0 0 Coffee Mixture 0 12 12 0 6 6 Cornflour 0 3 3 0 0 0 Fat, Nut Lard 0 1 1 0 0 0 Fish Paste 0 1 1 0 0 0 Fruits, Canned 0 8 8 0 0 0 Meat Pie 1 0 1 0 0 0 Meat Paste 3 1 4 1 1 2 Meats, other 2 0 2 0 0 0 Oatmeal 0 3 3 0 0 0 Olive Oil 2 12 14 2 2 4 Rice 2 25 27 0 1 1 Sago 0 1 1 0 0 0 Sausages 12 0 12 3 0 3 Tapioca 0 1 1 0 0 0 Vegetable, Canned 0 2 2 0 0 0 Vinegar 2 0 2 1 0 1 24 82 106 7 10 17 244 Report of the Medical Officer of Health. Table B. Details of Drugs in foregoing Main Statement. No. of samples examined. No. of samples found adulterated or not up to standard. Formal. Informal. Total. Formal. Informal. Total. Acid, Citric 0 1 1 0 0 0 Acid, Tartaric 0 3 3 0 0 0 Camphorated Oil 0 9 9 0 0 0 Cream of Tartar 0 3 3 0 0 0 Friar's Balsam 0 2 2 0 0 0 Mercury Preparations (Grey Powder) 6 10 16 3 3 6 Oil, Almond 0 3 3 0 0 0 Oil, Eucalyptus 0 6 6 0 0 0 Pills, Iron 0 1 1 0 0 0 Powder, Gregory's 0 6 6 0 1 1 Powder, Seidlitz 0 6 6 0 0 0 Prescriptions 2 12 14 2 2 4 Rhubarb, powdered 0 2 2 0 0 0 Syrup of Squills 0 1 1 0 0 0 Tincture of Iodine 0 4 4 0 0 0 Tincture of Quinine Ammoniated 0 6 6 0 0 0 8 75 83 5 6 11 245 Report of the Medical Officcr of Health. Milk and Cream. The number of samples grouped under the heading "Milk and Cream" amounted to 909. Of these, 889 were taken with the necessary formalities required by the Acts, whilst 20 were submitted informally. The samples were comprised as follows:— No. of samples examined. No. of samples found adulterated or not up to standard. Formal. Informal. Total. Formal. Informal. Total. Milk 845 10 855 60 0 60 Separated Milk 25 0 25 4 0 4 Skimmed Milk 5 0 5 3 0 3 Condensed Milk 0 10 10 0 0 0 Cream, fresh 10 0 10 4 0 4 Cream, preserved 4 0 4 0 0 0 889 2.0 909 71 0 71 Classification of adulteration reported. It will, therefore, be seen that the percentage of adulteration or departure from standard in articles submitted under this class was as under:— Formal. Informal. Milk 7.0 0 Separated Milk 16 0 Skimmed Milk 60 0 Condensed Milk 0 0 Cream, fresh 40 0 Cream, preserved 0 0 246 Report of the Medical 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. 90, where it amounted to 18 per cent. The greatest deficiency in milk fat occurred in the case of formal sample No. 38, where it amounted to 97 per cent. Formal samples Nos. 63, 440 and 462 followed closely with a milk fat deficiency of 92, 88, and 73 per cent. respectively. Of the creams purchased as "fresh" 4 samples of the 10 samples submitted were found to contain a boron preservative. The amounts present, expressed in terms of crystallised boric acid, ranged from 0.26 per cent., in the case of both formal samples Nos. 168 and 174, to 0.20 per cent. in the case of formal sample No. 155. Of the cream purchased as "preserved" all 4 samples were found to contain a boron preservative ranging from 0.25 per cent. in the case of formal sample No. 156 to 0.12 per cent. in the case of formal tample No. 158. The fat content of all creams examined ranged from 33.4 per cent. to 62 per cent. The details of all adulterated samples grouped under this heading are given in Table C. The presence of preservatives. All milks were systematically examined for the presence of preservatives, but in no instance was a positive result obtained. The following Table illustrates the number of cases in which preservatives were found in the milk supply of the Borough in this and the three preceding years. Year. Total No. of samples examined. No. found to contain a preservative. Percentage. 1911 586 4 0.68 1912 727 6 0.82 1913 798 2 0.25 1914 895 None 0.0 247 Report of the Medical Officer of Health. Table C. Table showing in detail the nature of the adulteration, or departure from standard of all samples of Milk and Cream adversely reported on during the year. FORMAL. Case No. Nature of sample. Nature of Report. 2 Milk (skimmed) 3 per cent. extraneous water. 16 Milk 8 per cent. milk fat deficient. 23 Milk 4.5 per cent. extraneous water. 38 Milk 97 per cent. milk fat deficient. 40 Milk (separated) 3 per cent. extraneous water. 42 Milk 2 per cent. extraneous water. 46 Milk 4 per cent. extraneous water. 47 Milk 4 per cent. extraneous water. 48 Milk 2.5 per cent. extraneous water. 60 Milk 4 per cent. milk fat deficient. 63 Milk 92 per cent. milk fat deficient. 64 Milk (separated) 10½ per cent. extraneous water. 66 Milk (skimmed) 10½ per cent. extraneous water. 90 Milk 18 per cent. extraneous water. 136 Milk 6 per cent. extraneous water. 137 Milk 6 per cent. extraneous water. 154 Cream 0.21 per cent. Crystallised Boric Acid. 155 Cream 0.20 per cent. Crystallised Boroic Acid. 168 Cream 0.26 per cent. Crystallised Boric Acid. 174 Cream 0.26 per cent. Crystallised Boric Acid. 178 Milk 4 per cent. milk fat deficient. 187 Milk 4 per cent. extraneous water. 193 Milk 8 per cent. milk fat deficient. 210 Milk 3 per cent. milk fat deficient. 212 Milk 4 per cent. milk fat deficient. 245 Milk 2 per cent. milk fat deficient. 251 Milk 10 per cent. milk fat deficient. 248 Report of the Mcdical Officer of Health. Table C—continued. Case No. Nature of sample. Nature of Report. 252 Milk 7 per cent. milk fat deficient. 267 Milk (separated) 1.5 per cent. extraneous water. 282 Milk 6 per cent. extraneous water. 295 Milk 6 per cent. extraneous water. 304 Milk 15 per cent. milk fat deficient. 346 Milk 13 per cent. milk fat deficient. 424 Milk 5 per cent. milk fat deficient. 425 Milk 36 per cent. milk fat deficient. 440 Milk (skimmed) 88 per cent. milk fat deficient. 444 Milk 2 per cent. extraneous water. 455 Milk 4 per cent. milk fat deficient. 458 Milk 14 per cent. milk fat deficient. 462 Milk 73 per cent. milk fat deficient. 474 Milk 2 per cent. extraneous water. 487 Milk 5 per cent. milk fat deficient. 496 Milk 3 per cent. extraneous water. 515 Milk 4 per cent. extraneous water and 4 per cent. milk fat deficient. 517 Milk (separated) 11 per cent. extraneous water. 518 Milk 10 per cent. milk fat deficient. 531 Milk 3 per cent. extraneous water. 536 Milk 9 per cent. extraneous water. 557 Milk 2 per cent. extraneous water. 559 Milk 3 per cent. extraneous water. 606 Milk 6 per cent. extraneous water. 611 Milk 6 per cent. milk fat deficient. 641 Milk 2 per cent. milk fat deficient. 657 Milk 25 per cent. milk fat deficient. 688 Milk 7 per cent. extraneous water. 693 Milk 2 per cent. extraneous water. 723 Milk 9 per cent. milk fat deficient. 735 Milk 3 per cent. extraneous water. 767 Milk 3 per cent. extraneous water. 768 Milk 3 per cent. extraneous water. 769 Milk 3 per cent. extraneous water. 249 Report of the Medical Officer of Health. Table C—continued. Case No, Nature of sample, Nature of Report. 772 Milk 3 per cent. extraneous water. 775 Milk 1 per cent. extraneous water. 776 Milk 1 per cent. extraneous water. 780 Milk 10 per cent. extraneous water and 6 per cent. milk fat deficient. 848 Milk 10 per cent. milk fat deficient. 859 Milk 2 per cent. extraneous water. 877 Milk 42 per cent. extraneous water. 878 Milk 4 per cent. extraneous water. 928 Milk 3 per cent. extraneous water. 957 Milk 13 per cent. extraneous water. The average composition, in regard to milk fat and solidsnot-fat, of the milk samples (exclusive of adulterated samples) submitted during each fortnight of the year was as follows :— Milk fat. Solids-not-fat Milk fat. Solids-not-fat 1 3.60 8.83 14 3.44 8.70 2 3.53 8.83 15 3.42 8.78 3 3.42 8.78 16 3.72 8.73 4 3.38 8.92 17 3.58 8.70 5 3.50 8.91 18 3.44 8.66 6 3.51 8.81 19 3.52 8.88 7 3.17 8.73 20 3.66 8.85 8 3.42 8.84 21 3.64 8.85 9 3.59 8.90 22 3.68 8.88 10 3.64 8.91 23 3.88 8.88 11 3.63 8.90 24 3.62 8.79 12 3.33 8.67 25 3.91 8.88 13 3.48 8.80 26 250 Report of the Medical Officer of Health. The Chart here inserted presents in a graphic form this variation in average composition. For the whole year the average composition proved to be:— Milk-fat 3.54 per cent. Solids-not-fat 8.82 per cent. Butter. Extent of the adulteration reported. 478 samples of butter were submitted during the year, of which 35 samples were taken with the necessary formalities, whilst 443 were submitted informally, ine total number reported as adulterated, or not up to standard, amounted to 77, or 16.1 per cent. The greatest percentage adulteration occurred in the case of the formal samples, where it amounted to 57.1 per cent., as against 12.8 per cent. for the informal samples. The high 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. In the case of the informal samples the percentage adulteration (12.8) has fallen very considerably from that of the previous year (23.7 per cent.), a result which appears to show that the systematic work carried out in regard to this important article of diet has had a salutary effect in checking adulteration. Nature of the adulteration reported. The nature of the adulteration reported showed that in 38 instances margarine was wholly substituted for butter; in 14 instances mixtures of butter and margarine in varying amounts were sold; and in 25 instances the butter sold contained an excess of boron preservative. Full details of these cases are given in Table D. The presence of preservatives. All samples were examined for the presence of preservatives, with the result that a boron preservative was found in 411 (or 85.9 per cent.) of the samples 251 Report of the Medical Officer of Health. submitted. With the exception of the 25 cases mentioned above, this was present in quantities not exceeding 0.5 per cent. (equivalent to 35 grains per lb.) calculated in terms of Crystallised Boric Acid, the actual amounts and the times of their occurrence being given in Table E. Table D. Table showing in detail the nature of the adulteration of all samples of Butter, adversely reported on during the year. FORMAL. Case No. Nature of Report. 28 66 per cent. Margarine. 29 98 ,, ,, 31 100 ,, ,, 107 25 ,, ,, 109 40 ,, ,, 110 98 ,, ,, 111 100 „ ,, 113 0.22 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 115 98 per cent. Margarine. 116 98 ,, ,, 119 98 ,, ,, 166 90 ,, ,, 167 90 ,, ,, 179 0.19 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 180 0.24 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 555 100 per cent. Margarine. 646 100 „ „ 778 67 ,, ,, 793 90 ,, ,, 937 100 ,, ,, 252 Report of the Medical Officer of Health. Table D—continued. INFORMAL. Case No. Nature of Report. 1 100 per cent. Margarine. 4 98 ,, ,, 8 50 ,, ,, 12 100 „ „ 17 92 ,, ,, 23 94 ,, ,, 27 95 ,, ,, 97 34 ,, ,, 98 30 ,, ,, 99 100 ,, ,, 105 100 ,, ,, 111 0.04 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 123 60 per cent. Margarine. 124 0.04 per cent. excess Boric Acid over suggested standard 0.5 per cent. 128 64 per cent. Margarine. 132 90 ,, ,, 137 0.14 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 138 0.09 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 141 16 per cent. Margarine. 142 90 ,, ,, 149 0.05 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 163 90 per cent. Margarine. 165 90 ,, ,, 173 0.43 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 175 0.46 per cent. excess Boric Acid over suggested standard 182 0.43 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 243 0.05 per cent, excess Boric Acid over suggested standard of 0.5 per cent. 269 100 per cent. Margarine. 272 90 ,, ,, 253 Report of the Medical Officer of Health. Table D—continued. Case No. Nature of Report. 281 65 per cent. Margarine. 299 0.04 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 324 70 per cent. Margarine. 378 100 ,, ,, 386 100 ,, ,, 433 0.05 per cent. excess Boric Acid over suggested standard 0.5 per cent. 434 100 per cent. Margarine. 439 100 ,, „ 445 95 ,, ,, 461 98 ,, ,, 462 98 ,, ,, 472 98 ,, ,, 473 98 ,, ,, 474 0.04 per cent. excess Boric Acid over suggested standard of 0.05 per cent. 482 0.17 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 484 0.12 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 498 0.15 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 506 0.15 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 583 70 per cent. Margarine. 617 0.07 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 618 0.11 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 619 90 per cent. Margarine. 639 0.06 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 641 0.06 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 762 98 per cent. Margarine. 790 0.20 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 797 0.26 per cent. excess Boric Acid over suggested standard of 0.5 per cent. 818 60 per cent. Margarine. 254 Report of the Medical Officer of Health. Table E. Giving in detail particulars relating to the presence or absence of a boron preservative in the 478 samples of Butter submitted during the year. Number of samples free from preservative 67 Number of samples containing 0.05 per cent. or less (in terms of Boric Acid, H3BO3) 15 Number of samples containing 0.10 per cent. or less but more than 0.05 40 Number of samples containing 0.15 per cent. or less but more than 0.10 40 Number of samples containing 0.20 per cent. or less but more than 0.15 39 Number of samples containing 0.25 per cent. or less but more than 0.20 42 Number of samples containing 0.30 per cent. or less but more than 0.25 31 Number of samples containing 0.35 per cent. or less but more than 0.30 60 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 32 Number of samples containing 0.50 per cent. or less but more than 0.45 46 Number of samples containing over 0.50 25 478 The average content of boron preservative (in terms of Crystallised Boric Acid) contained in the 334 samples of Butter, reported as genuine, which contained this preservative amounted to 0-27 per cent., equivalent to 18-9 grains per lb. Butter, 255 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 402, of which 39 were taken with the necessary formalities, whilst 363 were obtained informally. The total number reported as adulterated, or not up to standard, amounted to 34 (or 8.45 per cent.); 15, or 38.4 per cent. occurring in the formal samples, and 19 (or 5.2 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. Table F. Formal. Case no. Nature of sample Nature of Report. 35 Meat Paste 0.09 per cent. Crystallised Boric Acid. 72 Grey Powder 64 per cent. deficient in Mercury. 74 Grey Powder 52 per cent. deficient in Mercury. 75 Grey Powder 52 per cent. deficient in Mercury. 92 Raspberry Jam 5 per cent. Apple Pulp. 134 Prescription 28 per cent. deficient in Potassium Iodide. 220 Vinegar 8 per cent. deficient in Acetic Acid. 349 Pork Sausage 0.14 per cent. Crystallised Boric Acid. 354 Pork Sausage 0.07 per cent. Crystallised Boric Acid. 383 Pork Sausage 0.04 per cent. Crystallised Boric Acid. 918 Olive Oil 100 per cent. Cotton Seed Oil. 919 Coffee 43 per cent. Chicory. 920 Olive Oil 100 per cent. Arachis Oil. 921 Coffee 63 per cent. Chicory. 951 Prescription 57.8 per cent. deficient in Potassium Iodide. 256 Report of the Medical Officer of Health. Table F—continued. Informal. Case No. Nature of sample. Nature of Report. 14 Meat Paste 0.09 per cent. Crystallised Boric Acid. 39 Grey Powder 50 per cent. deficient in Mercury. 40 Grey Powder 50 per cent. deficient in Mercury. 42 Grey Powder 66 per cent. deficient in Mercury. 83 Raspberry Jam 2.5 per cent. Apple Pulp. 115 Prescription 23 per cent. deficient in Potassium Iodide. 296 Gregory Powder Made with Carbonate (not Oxide) of Magnesium. 599 Coffee 40 per cent. Chicory. 682 Rice 0.58 per cent. mineral matter removable from grain. 715 Coffee and Chicory 65 per cent. Chicory. 718 Coffee and Chicory 67 per cent. Chicory. 719 Coffee and Chicory 61 per cent. Chicory. 721 Coffee and Chicory 56 per cent. Chicory. 723 Coffee and Chicory 66 per cent. Chicory. 724 Coffee and Chicory 66 per cent. Chicory. 732 Coffee 58 per cent. Chicory. 736 Olive Oil 100 per cent. Arachis Oil. 745 Olive Oil 100 per cent. Cotton Seed Oil. 748 Prescription 60 p.c. deficient in Potassium Iodide. In conclusion I have to report that the percentage adulteration for the year for all articles submitted amounted to 10.2 per cent.; for articles submitted formally to 11.0 per cent., and for articles submitted informally to 9.2 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. February, 1915. APPENDIX. PARTICULARS OF DEATHS IN EACH OF THE SUB-DISTRICTS DURING THE YEAR 1914. 258 Report of the Medical Officer of Health Borough of Wandsworth—Clapham Sub-District. Infant Mortality. 1914. 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 4 10 4 45 15 16 9 6 91 Uncertified 1 ... ... ... 1 ... ... ... ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... 1 ... 1 ... 2 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... 1 ... ... 1 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... 1 ... 2 ... 3 Convulsions 2 1 ... ... 3 ... ... 1 ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... 1 ... ... 1 3 ... 2 ... 6 Diarrhoea ... ... ... 1 1 4 7 2 1 15 Enteritis ... ... ... 1 1 2 1 3 8 Gastritis ... ... ... ... ... ... 1 ... ... ... 1 Syphilis ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying... ... ... ... ... ... ... 1 ... ... 1 Injury at birth ... 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 1 ... ... 1 2 ... ... ... ... 2 Congenital Malformations 2 ... 3 ••• 5 ... ... ... ... 5 Premature birth 19 ... 2 1 22 1 ... ... ... 23 Atrophy,Debility and Marasmus 3 2 2 1 8 2 3 ... ... 13 Other causes ... 2 ... 2 1 2 ... 1 6 Totals 28 4 10 4 46 15 16 9 6 92 Nett Births in the year—legitimate, 1,167; illegitimate, 39. Nett Deaths in the year of—legitimate infants, 87; illegitimate infants, 5. 259 Report of the Medical Officer of Health. Borough of Wandsworth—Putney Sub-District. Infant Mortality. 1914. 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. 14 Weeks and under 3 Months 3 Months and under 6 Months 6 Months and under 9 Months. 9 Mouths and 1 under 12 Months Total Deaths under 1 Year. All causes Certified 9 1 3 2 15 4 10 6 6 41 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... 1 ... 1 2 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ...... ... ... ... ... ...::: ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... 1 ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... 3 1 ... 4 Pneumonia (all forms) 1 ... ... ... 1 1 ... 2 3 7 Diarrhoea ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... 3 ... 2 6 Gastritis ... ... ... ... ... 1 ... ... ... 1 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth 2 ... ... ... 2 ... ... ... ... 2 Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations ... 1 ... ... 1 ... ... ... ... 1 Premature Birth 3 ... ... 1 4 2 ... ... ... 6 Atrophy, Debility and Marasmus 2 ... 2 1 5 ... 2 1 ... 8 Other causes ... ... 1 ... 1 ... 1 ... ... 2 Totals 9 1 3 2 15 4 10 6 6 41 Nett Births in the year—legitimate, 445; illegitimate, 23 Nett Deaths in the year of—legitimate infants, 35; illegitimate infants, 6. 260 Report of the Medical Officer of Health. Borough of Wandsworth—Streatham Sub-District. Injant Mortality. 1914. Nett Deaths from stated causes at various Ages under 1 Year of Age. Cause of Death. Under 1 Week. 1-2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 weeks. 4 Weeks and under 3 Months 3 Months and under 6 Months. 6 Months and under 9 Months 9 Months and under 12 Months Total Deaths under 1 Year. All causes Certified ... 42 14 7 4 68 29 27 27 16 166 Uncertified 1 ... ... ... 1 ... ... ... ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... l 3 4 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... 1 3 2 1 6 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... 1 ... ... 1 ... ... 1 1 3 Convulsions 2 1 ... ... 3 2 ... 1 ... 6 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 1 ... 2 1 2 2 ... 7 Pneumonia (all forms) ... ... 1 ... 1 4 3 4 4 16 Diarrhœa ... ... ... 1 1 5 3 2 1 12 Enteritis ... 1 ... ... 1 4 8 7 3 23 Gastritis ... ... ... ... ... 1 ... 1 ... 2 Syphilis ... ... 2 1 3 1 ... ... ... 4 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... 1 1 ... ... 2 Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis 5 ... ... ... 5 ... ... ... ... 5 Congenital Malformations 1 2 ... ... 3 2 ... ... 1 6 Premature birth 26 2 1 1 30 1 ... ... ... 31 Atrophy, Debility and Marasmus 7 5 2 1 15 6 5 1 1 28 Other causes 2 1 ... ... 3 ... 3 4 1 11 Totals 43 14 7 4 68 29 27 27 16 167 Nett Births in the year—legitimate, 1,799; illegitimate, 123. Nett Deaths in the year of—legitimate infants, 141; illegitimate infants, 26 261 Report of the Medical Officer of Health. Borough of Wandsworth—Tooting Sub-District. Infant Mortality. 1914. 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 under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months Total Deaths under 1 Year. All causes Certified 20 5 4 2 31 16 34 17 11 109 Uncertified ... ... ... 1 1 ... ... ... ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 1 ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... 2 ... 3 1 6 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ...... ... ... ... Tuberculous Meningitis ... ...... ...... ... ... ... 1 1 ... 2 Abdominal Tuberculosis ... ... ... ... ... 2 1 ... ... 3 Other Tuberculous Diseases ... ... ... ... ... ... ... ... 1 1 Meningitis (not Tuberculous) ... ... ... ... ... ... ... 2 ... 2 Convulsions ... 1 ... ... 1 ... 1 ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 1 2 3 1 3 1 ... 8 Pneumonia (all forms) ... ... ... ... ... ... 7 2 2 11 Diarrhœa ... 1 ... ... 1 1 11 3 4 20 Enteritis ... ... ... ... ... 2 6 2 3 13 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... 1 1 ... ... 2 Rickets ... ... ... ... ... ... ... 1 ... 1 Suffocation, overlying ... ... ... ... ... 1 ... ... ... 1 Injury at birth 4 ... ... ... 4 ... ... ... ... 4 Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations 3 1 ... ... 4 1 ... ... ... 5 Premature birth 10 ... 1 1 12 1 ... ... ... 13 Atrophy, Debility and Marasmus 3 2 2 ... 7 4 3 1 ... 15 Other causes ... ... ... ... ... ... ... ... ... ... Totals 20 5 4 3 32 16 34 17 11 110 Nett Births in the year—legitimate, 918; illegitimate, 44. Nett Deaths in the year of—legitimate infants, 94; illegitimate infants, 16 262 Report of the Medical Officer of Health. Borough of Wandsworth—Southfield Sub-District Infant Mortality. 1914. Nett Deaths from stated causes at various Ages under 1 Year of Age. Causes of Death. Under 1 Week. 1—2 Weeks. Weeks Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months 3 Months and under6 Months 6 Months and under 9 Months 9 Months and under 12 Months Total Deaths under 1 Year. All causes Certified 26 4 1 ... 31 11 17 14 11 84 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... 1 1 Whooping-cough ... ... ... ... ... 1 1 2 2 6 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... 1 ... ... 1 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... 1 ... 2 ... ... 3 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... 2 1 ... 3 Pneumonia (all forms) 2 ... ... ... 2 1 3 2 2 10 Diarrhœa ... ... ... ... ... 1 3 5 2 11 Enteritis ... ... ... ... ... 3 1 3 4 11 Gastritis ... ... ... ... ... ... 1 ... ... 1 Syphilis ... ... ... ... ... 1 ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations ... ... ... ... ... ... ... 1 ... 1 Premature birth 18 2 1 ... 21 1 ... ... ... 22 Atrophy, Debility and Marasmus 3 2 ... ... 5 1 3 ...... ... 9 Other causes ... ... ... ... ... 2 ... ... ... 2 Totals 26 4 1 ... 31 11 17 14 11 84 Nett Births in the year—legitimate, 1,127; illegitimate, 39. Nett Deaths in the year of—legitimate infants, 70; illegitimate infants, 14. 263 Report of the Medical Officer of Health Borough of Wandsworth—Springfield Sub-District Infant Mortality. 1914. 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 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 19 5 3 5 32 19 18 12 14 95 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... 2 ... 2 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... 1 1 1 3 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ...... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ...... ... ... ... ... ... ... ... Convulsions ... 1 ... 1 2 1 ... ... 2 5 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 ... 1 ... 2 Pneumonia (all forms) ... ... 1 1 2 1 3 4 4 14 Diarrhœa ... ... ... 1 1 1 3 1 2 8 Enteritis ... ... ... ... ... 3 3 2 1 9 Gastritis ... ... ... ... ... 1 2 1 2 6 Syphilis ... 1 ... ... 1 ... 1 ... ... 2 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... 1 ... ... ... 1 Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations 2 ... 1 1 4 ... ... ... ... 4 Premature birth 14 2 ... 1 17 2 1 ... ... 20 Atrophy,Debility and Marasmus 2 1 1 ... 4 7 4 ... 1 16 Other causes 1 ... ... ... 1 1 ... ... ... 2 Totals 19 5 3 5 32 19 18 12 14 95 Nett Births in the year—legitimate, 940; illegitimate 20. Nett Deaths in the year of—legitimate infants, 87; illegitimate infants, 8. 264 Report of the Medical Officer of Health. CLAPHAM, 1914. Causes of Death. Deaths in or belonging to Whole District at subjoined ages. Deaths in Public Institutions in the District. All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. ! 65 and upwards. Enteric Fever 1 1 ... ... ... ... ... 1 ... ... ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... Measles 6 2 4 1 3 1 1 ... ... ... ... 1 Scarlet Fever 2 1 1 ... ... 1 1 ... ... ... ... ... Whooping Cough 8 3 5 2 5 1 ... ... ... ... ... ... Diphtheria & Membranous Croup 6 1 5 ... ... 1 5 ... ... ... ... ... Influenza 10 6 4 ... ... ... 1 ... 3 2 4 1 Erysipelas 3 2 1 1 ... ... ... ... ... 1 1 ... Cerebro-spinal Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 58 32 26 ... ... ... 1 13 19 18 7 24 Tuberculous Meningitis 5 1 4 ... ... ... 5 ... ... ... ... ... Abdominal Tuberculosis 3 ... 3 ... 1 1 ... ... ... ... ... ... Other Tuberculous Diseases 8 2 6 ... ... ... 2 1 2 1 1 ... Other Infective Diseases 3 1 2 ... ... ... ... ... 1 1 1 ... Cancer, Malignant Disease 71 32 39 ... ... ... 1 ... 6 34 30 49 Rheumatic Fever 3 2 1 ... ... ... 1 ... 2 ... ... ... Diabetes 5 3 2 ... ... ... ... ... ... 1 4 ... Other General Diseases 13 5 8 1 ... 1 ... ... 1 6 4 3 Alcoholism 3 1 2 ... ... ... ... ... ... 2 1 ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 6 5 1 3 1 1 1 ... ... ... ... ... Cerebral Haemorrhage, Apoplexy 44 21 23 ... ... ... ... ... 3 17 24 2 Convulsions 5 4 1 4 1 ... ... ... ... ... ... ... Other Diseases of Nervous System 20 12 8 1 ... ... 1 ... 6 6 6 ... Organic Diseases of Heart 71 33 38 ... ... ... ... ... 8 28 35 5 Other Diseases of Circulatory System 30 15 15 1 ... ... 1 2 7 10 9 1 Bronchitis 32 13 19 ... ... ... ... ... 2 5 25 2 Broncho-Pneumonia 19 8 11 5 3 5 1 2 ... 1 2 2 Lobar Pneumonia 7 2 5 ... ... 1 1 ... 1 3 1 2 Pneumonia (type not distinguished) 20 12 8 1 3 ... ... l 2 7 6 ... Other Diseases of Respiratory System 12 7 5 2 ... 1 3 ... 2 2 2 2 Ulcer of Stomach 2 1 1 ... ... ... ... ... 1 ... 1 ... Diarrhœa 15 8 7 15 ... ... ... ... ... ... ... ... Enteritis 11 5 6 8 2 ... ... ... ... ... 1 ... Appendicitis and Typhlitis 5 3 2 ... ... ... ... 1 ... 4 ... ... Obstruction of Intestines 6 1 5 ... 1 ... ... ... 1 ... 4 ... Cirrhosis of Liver 6 3 3 ... ... ... ... ... 1 3 2 ... Other Diseases of Liver 7 2 5 ... ... ... ... ... ... 4 3 1 Other Diseases of Digestive System 8 7 1 1 ... 2 ... 2 ... 1 2 1 Nephritis and Bright's Disease 26 18 8 ... ... ... ... ... 5 15 6 2 Other Diseases of Urinary System 9 8 1 ... ... ... ... ... 2 4 3 ... Diseases of Generative System 2 ... 2 ... ... ... ... 1 ... 1 ... ... Puerperal Fever 4 ... 4 ... ... ... ... ... 4 ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 1 ... 1 ... ... ... ... ... 1 ... ... ... Premature Birth 23 14 9 23 ... ... ... ... ... ... ... ... Congenital Debility and Malformation 18 11 7 18 ... ... ... ... ... ... ... 1 Other Diseases of Early Infancy 3 1 2 3 ... ... ... ... ... ... ... ... Old Age 50 18 32 ... ... ... ... ... ... ... 50 5 Deaths from Accident 13 9 4 1 1 1 ... 1 4 2 3 4 Deaths from Suicide 2 2 ... ... ... ... ... ... 1 1 ... 1 Other Violent Deaths 1 1 ... ... ... ... 1 ... ... ... ... ... Other defined Diseases 4 3 l 1 ... ... ... ... ... 1 2 ... Ill-defined Diseases or unknown 3 ... 3 ... ... ... ... ... ... 3 ... 1 All causes 694 342 352 92 22 17 27 25 86 185 240 110 265 Report of the Medical Officer of Health. PUTNEY. 1914. Causes of Death. Deaths in or belonging to Whole District at subjoined ages. Deaths in Public Institutions in the District. All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Enteric Fever 1 1 ... ... ... ... ... ... 1 ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... Whooping Cough 2 ... 2 2 ... ... ... ... ... ... ... ... Diphtheria & Membranous Croup 4 1 3 ... ... 1 3 ... ... ... ... ... Influenza 5 2 3 ... ... ... ... ... ... 2 3 ... Erysipelas 1 1 ... ... ... ... ...... ... 1 ... ... ... Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 23 15 8 ... ... ... 2 2 11 5 3 2 Tuberculous Meningitis 2 2 ... ... ... 1 1 ... ... ... ... ... Abdominal Tuberculosis 2 ... 2 ... ... 1 ... ... 1 ... ... 1 Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... 1 Other Infective Diseases ... ... ... ... ... ... ... ... ... ... ... 1 Cancer, Malignant Disease 40 19 21 ... ... ... ... ... 9 17 14 12 Rheumatic Fever 1 1 ... ... ... ... ... 1 ... ... ... ... Diabetes 4 2 2 ... ... ... ... ... ... 2 2 ... Other General Diseases ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 1 ... I ... ... ... ... ... ... 1. ... 1 Cerebral Haemorrhage, Apoplexy 12 9 3 ... ... ... ... 1 1 5 5 1 Convulsions 1 ... 1 1 ... ... ... ... ... ... ... ... Other Diseases of Nervous System 7 4 3 ... ... ... 1 ... 1 3 2 5 Organic Diseases of Heart 25 14 11 ... ... ... 1 ... 2 11 11 7 Other Diseases of Circulatory System 15 8 7 ... ... ... 2 ... 2 5 6 4 Bronchitis 20 11 9 4 1 1 ... ... 1 2 11 4 Broncho-Pneumonia 15 5 10 4 2 ... ... ... 2 ... 7 ... Lobar Pneumonia 2 1 1 ... ... ... ... ... 2 ... ... ... Pneumonia (type not distinguished) Other Diseases of Respiratory 9 5 4 3 ... ... ... 1 3 ... 2 I System 5 3 3 ... ... ... ... 1 ... 7 2 ... Ulcer of Stomach 2 1 1 ... ... ... ... ... 1 1 ... ... Diarrhœa 2 ... 2 ... 1 ... ... ... ... ... 1 ... Enteritis 11 6 5 6 2 ... ... ... ... 1 2 1 Appendicitis and Typhlitis 2 2 ... ... ... ... ... 1 1 ... 2 Obstruction of Intestines 7 ... 7 1 ... ... ... ... 1 4 1 1 Cirrhosis of Liver 4 2 2 ... ... ... ... ... ... 1 3 I Other Diseases of Liver 2 1 1 ... ... ... ... ... ... 1 1 2 Other Diseases of Digestive System 5 3 2 1 ... ... 1 ... ... 3 ... 2 Nephritis and Bright's Disease 27 7 15 ... ... ... ... ... 3 7 12 1 Other Diseases of Urinary System 3 3 ... ... ... ... ... ... ... 1 2 2 Diseases of Generative System ... ... ... ... ... ... ... ... ... ... ... 1 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 6 3 3 6 ... ... ... ... ... ... ... ... Congenital Debility and Malformation 11 6 5 10 ... 1 ... ... ... ... ... ... Other Diseases of Early Infancy 2 1 1 2 ... ... ... ... ... ... ... 1 Old Age 16 6 10 ... ... ... ... ... ... ... 16 Deaths from Accident 12 10 2 ... ... ... 2 2 3 4 1 II Deaths from Suicide 3 1 2 ... ... ... ... 1 ... 1 1 6 Other Violent Deaths 1 1 ... ... ... ... ... 1 ... ... Other defined Diseases 2 1 I ... ... ... ... ... ... ... 2 Ill-defined Diseases of unknown 2 ... 2 1 ... ... ... ... ... ... 1 All causes 313 157 156 41 6 5 13 9 48 81 110 74 266 Report of the Medical Officer of Health STREATHAM, 1914. 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. 95 and under 45.; 45 and under 65. 65 and upwards. Enteric Fever 1 1 ... ... ... ... 1 ... ... ... ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... Measles 11 9 2 4 3 2 1 ... ... 1 ... ... Scarlet Fever 4 3 1 ... ... 1 ... ... ... ... ... ... Whooping Cough 10 5 5 6 3 1 ... ... ... ... ... ... Diphtheria & MembranousCroup 4 3 1 ... 1 3 ...... ... ... ... ... ... Influenza 32 12 20 1 ... 1 ... ... 3 8 18 1 Erysipelas 2 2 ... ... ... ... ... ... 1 1 ... ... Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases 1 1 ... ... ... ... ... ... ... ... 1 ... Pulmonary Tuberculosis 74 44 30 ... ... 1 ... 9 44 18 3 6 Tuberculous Meningitis 15 6 9 1 3 6 3 2 ... ... ... ... Abdominal Tuberculosis 4 2 2 ... 2 ... ... 1 ... 1 ... ... Other Tuberculous Diseases 7 6 1 ... ... ... 2 1 2 2 ... 1 Other Infective Diseases 13 5 8 6 ... ... ... ... 3 4 ... 1 Cancer, Malignant Disease 147 51 91 ... 1 1 ... ... 11 55 74 11 Rheumatic Fever 8 7 1 ... ... ... 1 4 2 1 ... ... Diabetes 18 9 9 ... ... ... ... ... 4 8 6 1 Other General Diseases 13 5 8 ... ... ... ... ... 2 7 4 ... Alcoholism 5 4 1 ... ... ... ... ... 3 2 ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 5 3 2 3 ... 1 ... ... ... 1 ... ... Cerebral Haemorrhage,Apoplexy 63 23 40 ... ... ... ... 1 2 14 46 6 Convulsions 6 3 3 6 ... ... ... ... ... ... ... ... Other Diseases of Nervous System 56 34 22 2 1 ... 1 2 13 16 21 4 Organic Diseases of Heart 102 48 54 ... ... ... 1 5 7 33 56 4 Other Diseases of Circulatory System 27 12 15 ... ... ... ... 1 3 12 11 2 Bronchitis 82 38 44 7 3 2 ... 1 3 16 50 2 Broncho-Pneumonia 30 16 14 11 6 3 1 ... 1 2 6 ... Lobar Pneumonia 14 9 5 2 ... ... ... ... 3 4 5 ... Pneumonia (type not distinguished) 27 11 16 3 1 1 ... ... 6 9 7 1 Other Diseases of Respiratory System 13 8 5 2 ... 1 ... ... 3 1 6 1 Ulcer of Stomach 3 1 2 ... ... ... ... 1 1 1 ... ... Diarrhœa 16 7 9 12 1 ... 1 ... 1 ... 1 ... Enteritis 32 21 11 23 4 2 ... ... i 1 1 ... Appendicitis and Typhlitis 5 2 3 ... ... ... 2 ... 3 ... ... ... Obstruction of Intestines 11 4 7 1 ... ... 1 ... ... 2 7 2 Cirrhosis of Liver 10 4 6 ... ... ... ... ... ... 7 3 ... Other Diseases of Liver 4 1 3 ... ... ... ...... ... ... 1 3 ... Other Diseases of Digestive System 23 11 12 5 1 ... 1 1 5 5 5 3 Nephritis and Bright's Disease 46 24 22 ... ... ... ... 2 6 13 25 2 Other Diseases of Urinary System 12 10 2 ... ... ... ... ... ... 3 9 1 Diseases of Generative System 3 ... 3 ... ... ... ... ... 1 2 ... 2 Puerperal Fever 2 ... 2 ... ... ... ... ... 2 ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 6 ... 6 ... ... ... ... 1 5 ... ... ... Premature Birth 31 17 14 31 ... ... ... ... ... ... ... 1 Congenital 'Debility and Malformation 36 19 17 34 2 ... ... ... ... ... ... ... Other Diseases' of Early Infancy 5 1 4 5 ... ... ... ... ... ... ... ... Old Age 87 27 60 ... ... ... ... ... ... ... 37 ... Deaths from Accident 34 23 11 2 ... 2 2 3 7 10 8 7 Deaths from Suicide 9 5 4 ... ... ... ... 1 4 4 ... 1 Other Violent Deaths ... ... ... ... ... ... ... ... ... ... ... ... Other defined Diseases 5 2 3 ... 1 ... ... ... ... 3 1 ... Ill-defined Diseases or unknown 3 1 2 ... ... ... ... ... ... ... 3 ... All causes 1,172 560 612 167 33 28 18 40 152 268 466 61 267 Report of the Medical Officer of Health. 267 TOOTING. 1914. 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 ... ... ... ... ... ... ... ... ... ... ... 5 Small-pox ... ... ... ... ... ... ... ... ... ...... ... ... Measles 6 3 3 1 4 1 ... ... ... ... ... ... Scarlet Fever 1 ... ... ... ... 1 ... ... ... ... 17 Whooping Cough 11 4 7 6 3 2 ... ... ... ... ... 9 Diphtheria &Membranous Croup 4 1 3 ... 1 ... 2 1 ... ... ... 69 Influenza ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 1 1 ... ... ... ... ... 1 ... ... ... 1 Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 33 15 18 1 ... ... ... 7 14 9 2 32 Tuberculous Meningitis 8 5 3 2 ... 2 3 1 ... ... ... 3 Abdominal Tuberculosis 7 5 2 3 1 1 ... 1 ... 1 ... 1 Other Tuberculous Diseases 6 4 2 ... ... 3 ... ... 1 2 ... 11 Other Infective Diseases 6 4 2 2 1 ... 1 ... 2 ... ... 2 Cancer, Malignant Disease 37 19 18 ... ... ... ... 1 6 17 13 12 Rheumatic Fever 1 ... 1 ... ... ... ... 1 ... ... ... ... Diabetes 3 1 2 ... ... ... ... ... ... 1 2 2 Other General Diseases 3 ... 3 1 ... ... ... ... 1 1 ... 3 Alcoholism 1 1 ... ... ... ... ... ... 1 ... ... 2 Chronic Poisonings 1 1 ... ... ... ... ... ... ... ... 1 ... Meningitis 5 2 3 2 ... ... 1 ... 1 1 ... 1 Cerebral Haemorrhage, Apoplexy 14 7 7 ... ... ... ... ... ... 3 11 22 Convulsions 2 ... 2 2 ... ... ... ... ... ... ... ... Other Diseases of Nervous System 13 7 6 ... ... ... 1 1 4 4 3 33 Organic Diseases of Heart 24 7 17 ... ... ... 5 2 5 9 3 33 Other Diseases of Circulatory System 9 5 4 ... ... ... ... 1 3 4 1 7 Bronchitis 3° 18 12 8 1 1 ... ... 3 5 12 4 Broncho-Pneumonia 15 9 6 8 3 3 ... ... ... 1 ... 11 Lobar Pneumonia 2 2 ... ... ... 1 ... ... 1 ... ... 3 Pneumonia (type not distinguished) 14 9 5 3 1 1 1 ... 3 4 1 25 Other Diseases of Respiratory System 5 2 3 ... ... 1 ... 2 1 ... 5 Ulcer of Stomach 4 2 3 ... ... ... ... ... 2 2 ... ... Diarrhœa 27 15 12 20 3 1 1 ... ... 1 1 1 Enteritis 15 12 3 13 2 ... ... ... ... ... ... ... Appendicitis and Typhlitis 3 2 1 ... ... ... 1 ... 1 1 ... ... Obstruction of Intestines 1 ... 1 ... ... ... ... ... ... 1 ... ... Cirrhosis of Liver 2 1 1 ... ...... ... ... ... ... 1 1 2 Other Diseases of Liver 1 ... 1 ... 1 ... ... ... ... ... ... 1 Other Diseases of Digestive System 6 5 1 ... 1 1 1 ... 3 ... ... 6 Nephritis and Bright's Disease 7 4 3 ... ... ... 2 ... 2 1 2 6 Other Diseases of Urinary System 4 4 ... ... ... ... ... ... ... 2 2 1 Diseases of Generative System 1 ... 1 ... ... ... ... ... ... 1 ... 1 Puerperal Fever 1 ... 1 ... ... ... ... ... 1 ... ... 3 Other Accidents and Diseases of Pregnancy and Childbirth 1 ... 1 ... ... ... ... ... 1 ... ... 1 Premature Birth 13 5 8 13 ... ... ... ... ... ... ... ... Congenital Debility and Malformation 20 12 8 20 ... ... ... ... ... ... ... 4 Other Diseases of Early Infancv 4 ... 4 4 ... ... ... ... ... ... ... 1 Old Age 24 3 21 ... ... ... ... ... ... ... 24 261 Deaths from Accident 8 6 2 ... ... 2 ... 1 2 1 1 ... Deaths from Suicide 5 3 2 ... ... ... ... 1 1 2 1 ... Other Violent Deaths 2 2 ... ... ... ... ... 1 1 ... ... ... Other defined Diseases 1 1 ... ... ... ... ... ... ... ... 1 ... Ill-defined Diseases or unknown ... ... ... ... ... ... ... ... ... ... 1 All causes 413 209 203 110 22 20 21 20 61 76 82 612 268 Report of the Medical Officer of Health. WANDSWORTH. Southfield Ward. 1914. Causes of Death. Deaths in or belonging to Whole District at subjoined ages. Deaths in Public Institutions in the District. All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Enteric Fever 1 1 ... ... ... ... ... 1 ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 3 3 ... 1 ... ... 2 ... ... ... ... ... Whooping Cough 16 6 10 6 6 4 ... ... ... ... ... ... Diphtheria & Membranous Croup iQ 10 9 ... 1 6 12 ... ... ... ... ... Influenza 7 4 3 ... ... 1 1 ... 1 2 2 ... Erysipelas 2 ... 2 1 ... ... ... ... ... ... 1 ... Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 68 37 31 ... ... ... 1 13 29 19 6 1 Tuberculous Meningitis a 2 ... ... 1 ... 1 ... ... ... ... ... Abdominal Tuberculosis 3 1 2 ... 1 1 1 ... ... ... ... ... Other Tuberculous Diseases 2 2 ... ... ... ... ... 1 ... 1 ... ... Other Infective Diseases 6 4 2 1 ... ... ... ... 5 ... ... ... Cancer, Malignant Disease 68 27 41 ... ... ... 1 2 11 26 28 3 Rheumatic Fever 2 1 1 ... ... ... ... 1 1 ... ... ... Diabetes 7 2 5 ... ... ... ... ... 2 4 1 ... Other General Diseases 10 3 7 ... ... 2 1 ... 2 3 2 ... Alcoholism 2 2 ... ... ... ... ... ... 2 ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 3 1 2 ... ... ... ... 2 ... 1 ... ... Cerebral Haemorrhage, Apoplexy 31 17 14 ... ... ... ... ... 1 10 20 ... Convulsions 4 2 2 3 1 ... ... ... ... ... ... ... Other Diseases of Nervous System 28 16 12 ... 1 ... ... 1 5 12 9 5 Organic Diseases of Heart 73 35 38 ... ... ... 2 4 4 29 34 3 Other Diseases of Circulatory System 17 13 4 ... ... ... 1 1 3 6 6 6 Bronchitis 44 18 26 3 1 1 ... ... 2 16 21 ... Broncho-Pneumonia 13 10 3 3 3 1 2 ... ... ... 4 ... Lobar Pneumonia 5 2 3 3 ... ... ... ... ... ... 2 ... Pneumonia (type not distinguished) 17 9 8 4 ... 3 ... ... 3 5 2 1 Other Diseases of Respiratory System 5 3 2 ... ... ... ... ... 1 3 1 1 Ulcer of Stomach ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa 12 6 6 11 1 ... ... ... ... ... ... ... Enteritis 19 14 5 11 6 ... 1 ... 1 ... ... ... Appendicitis and Typhlitis 2 2 ... ... ... ... 1 ... ... 1 ... ... Obstruction of Intestines 6 4 2 1 ... ... ... ... ... 3 2 ... Cirrhosis of Liver 12 7 5 ... ... ... ... ... ... 9 3 ... Other Diseases of Liver ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Digestive System 12 3 9 1 1 ... 2 1 2 2 3 ... Nephritis and Bright's Disease 17 8 9 ... ... ... ... 1 2 5 9 1 Other Diseases of Urinary System 6 5 1 ... ... ... ... ... ... 1 5 ... Diseases of Generative System ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 2 ... 2 ... ... ... ... 1 1 ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 4 ... 4 ... ... ... ... ... 4 ... ... ... Premature Birth 22 10 12 22 ... ... ... ... ... ... ... ... Congenital Debility and Malformation 13 8 5 10 1 ... 1 ... 1 ... ... ... Other Diseases of Early Infancy 2 1 1 2 ... ... ... ... ... ... ... ... Old Age 58 17 41 ... ... ... ... ... ... ... 58 ... Deaths from Accident 12 7 5 1 ... 2 ... ... 1 3 5 7 Deaths from Suicide 1 1 ... ... ... ... ... ... ... ... 1 1 Other Violent Deaths ... ... ... ... ... ... ... ... ... ... ... ... Other defined Diseases 6 3 3 ... ... ... 1 ... 1 1 3 ... Ill-defined Diseases or unknown ... ... ... ... ... ... ... ... ... ...... ... ... All causes 664 327 337 84 24 21 31 29 85 162 228 29 269 Report of the Medical Officer of Health. WANDSWORTH. Springfield Ward. 1914. Causes of Death. Deaths in or belonging to Whole District at subjoined ages. Deaths in Public Institutions in the District. All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Enteric Fever 1 1 ... ... ... ... 1 ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 3 2 1 1 2 ... ... ... ... ... ... ... Scarlet Fever 2 1 1 ... ... ... 1 1 ... ... ... ... Whooping Cough 6 3 3 2 3 1 ... ... ... ... ... ... Diphtheria & Membranous Croup 4 1 3 ... ... 2 2 ... ... ... ... ... Influenza 4 1 3 1 ... ... ... ... ... 1 2 1 Erysipelas 2 1 1 ... ... ... ... ... 1 1 ... ... Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases 1 1 ... ... ... ... ... ... 1 ... ... ... Pulmonary Tuberculosis 49 28 21 ... 1 1 1 8 26 10 2 16 Tuberculous Meningitis 10 4 6 3 3 2 2 ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... Other Infective Diseases 2 2 ... 2 ... ... ... ... ... ... ... ... Cancer, Malignant Disease 35 14 21 ... ... ... ... ... 3 21 11 3 Rheumatic Fever 1 1 ... ... ... ... 1 ... ... ... ... ... Diabetes 2 1 1 ... ... ... ... ... 1 1 ... ... Other General Diseases 4 1 3 ... ... ... ... ... ... 2 2 ... Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 1 1 ... ... 1 ... ... ... ... ... ... ... Cerebral Haemorrhage, Apoplexy 16 8 8 ... ... ... ... ... ... 6 10 5 Convulsions 5 2 3 5 ... ... ... ... ... ... ... ... Other Diseases of Nervous System 14 11 3 ... ... 1 ... ... 7 4 2 46 Organic Diseases of Heart 34 21 13 ... ... ... 1 3 8 8 14 9 Other Diseases of Circulatory System 9 3 6 ... ... ... ... 1 1 1 4 ... Bronchitis 23 8 15 2 1 ... ... ... ... 5 15 17 Broncho-Pneumonia 10 8 8 10 1 1 ... 1 ... 1 2 2 Lobar Pneumonia 4 2 2 ... ... 2 ... ... 1 ... 1 3 Pneumonia (type not distinguished) 15 9 6 4 3 1 1 1 1 2 2 2 Other Diseases of Respiratory System 5 3 2 1 ... ... ... ... 1 1 2 1 Ulcer of Stomach 3 1 2 ... ... ... ... ... 3 ... ... 1 Diarrhœa 12 6 6 8 1 1 ... ... ... 1 1 1 Enteritis 14 6 8 9 2 3 ... ... ... ... ... 1 Appendicitis and Typhlitis ... ... ... ... ... ... ... ... ... ... ... ... Obstruction of Intestines 1 ... 1 ... ... ... ... ... ... 1 ... 2 Cirrhosis of Liver 1 ... 1 ... ... ... ... ... ... ... 1 ... Other Diseases of Liver 1 1 ... ... ... ... ... ... ... 1 ... ... Other Diseases of Digestive System 13 3 10 6 3 ... ... ... 1 1 2 ... Nephritis and Blight's Disease 17 11 6 ... ... ... 1 ... 5 8 3 6 Other Diseases of Urinary System 3 3 ... ... ... ... ... ... ... 1 2 2 Diseases of Generative System ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 2 2 ... ... ... ... 1 1 ... ... ... Premature Birth 20 7 13 20 ... ... ... ... ... ... ... 2 Congenital Debility and Malformation 20 8 12 20 ... ... ... ... ... ... ... 1 Other Diseases of Early Infancy ... ... ... ... ... ... ... ... ... ... ... ... Old Age 21 7 14 ... ... ... ... ... ... ... 21 5 Deaths from Accident 7 4 3 1 ... ... ... 1 3 1 1 1 Deaths from Suicide 2 1 1 ... ... ... ... ... 2 ... ... ... Other Violent Deaths 1 i ... ... ... ... ... ... 1 ... ... 5 Other defined Diseases 3 2 1 ... ... ... ... 1 ... 1 1 ... Ill-defined Diseases or unknown ... ... ... ... ... ... ... ... ... ... ... ... All causes 409 199 210 95 21 15 11 18 67 8l 101 132