Metropolitan Borough ofWandsworth. Annual Report ON THE health, Sanitary Condition, &c., OF THE BOROUGH, FOR THE YEAR 1916, BY P. CALDWELL SMITH, M.A., M.D., D.P.H.. Camb., Medical Officer of Health, TOGETHER WITH THE Report of the Public Analyst. A1823 A WAN 4 Printed for the Council by ODHAMS LIMITED, 85_94, Long Acre, London, W.C. WAN 4 INDEX. PAGE Analyst, Report of 82 Anthrax Orders 42 Appendicitis and Typhilitis 44 Bacteriological Examinations 19, 41 Bakehouses 58, 60 Births 2 Births and Birth-rates in Sub-Districts 2 Births, Notification of, Act 3 Brain and Nervous System, Diseases of the 43 Canal Boats Act 71 Cancer 43 Census, 1911 1 Cerebro-spinal Fever 18 Circulatory Diseases 43 Clapham, House-to-House Inspections in 52 Cleaning of Persons Act 54 Conscientious Objection Certificates granted 14 Cowsheds 56 Cutting-off Notices 48 Death, Causes of 9 Death-rate, Corrected 8 Death-rate, Infantile 13 Deaths, Corrected and Uncorrected 8 Deaths, Number of 3 Deaths in Outlying Institutions 7 Deaths in Public Institutions 7 Deaths in Public Institutions in the Borough of Persons belonging to the Borough 6 Deaths in Public Institutions in the Borough of Persons not belonging to the Borough 5 Developmental Diseases 44 Diarrhoea 21 Diarrhoea, Death-rate from 22 Diarrhcea, Method of Feeding Children who died from 22 Diphtheria 16 ii. PAGE Diphtheria and Schools 16 Diphtheria, Number of Dwellings in which multiple Cases occurred 16 Diphtheria, "Return Cases"of 18 Disinfection 53 Disinfection of Schools 21 Enteric Fever 18 Erysipelas 20 Factories and Workshops 57 Factories, Workshops and Workplaces, Inspection of 58 Factories and Workshops, Summary of Work of Female Inspectors 67 Factories and Workshops, Summary of Work of Male Inspectors 64 Feeding of Infants, Report of Female Inspectors on 23 Food Places, Inspection of 55 Glanders and Anthrax Orders 42 Home Work 61 House Refuse, Removal of 56 House-to-house Inspections 50 House-to-house Inspections, Summary of 52 Houses and Premises Inspected 49 Houses Let in Lodgings 57 Housing. Town Planning, etc., Act, 1909 52 Ice Cream Premises 57 Illegitimate Children, Births of 2 Infant Visiting 23 Infant Welfare 25 Infantile Mortality 12 Infective Diseases, Deaths from 13 Infective Diseases, Death-rate from 13 Infective Diseases: Number of Cases Notified 11, 14 Infective Diseases: Number of Cases notified from Elementary Schools 21 Influenza 21 Inspections, details of 50, 51 Inquests 45 iii. PAGE Margarine Act, Proceedings under 75 Maternity and Child Welfare Centres 25 Measles 20 Measles and other Non-notifiable Diseases reported from Schools 21 Milk and Cream Regulations, 1912 79 Milk Premises, Cowsheds, etc., on Register 57 Milkshops 56 Military Billets 71 Mistaken Diagnosis, Cases of 18 Mortuaries 48 Natural Increase, Rate of 2 Nervous System, Diseases of the 43 Non-Infective Diseases 43 Notification of Births Act 3 Notification of Infective Diseases 14 Offensive Trades 57 Old Age 45 Ophthalmia Neonatorum 42 Other Infective Diseases 41 Outworkers 61 Overcrowding 52 Police Court Proceedings 55 Polio-Myelitis 41 Population 1 Population of Sub-Districts 1 Premature Birth 44 Puerperal Fever 19 Pulmonary Tuberculosis, Notification of Cases of 27 Putney, House-to-house Inspections in 52 Rag Flock Act, 1911, Statement of work done under 71 Report of Tuberculosis Officer 32 Respiratory Diseases 43 Return Cases of Scarlet Fever and Diphtheria 18 Revenue Act 48 Sale of Food and Drugs Act, Proceedings under 73 Sale of Food and Drugs Acts, Statement of Work under 71 IV. PAGE Sanitary Operations, Table of 49 Sanitary Work, General 46 Scarlet Fever 15 Scarlet Fever, Number of Dwellings in which Multiple Cases occurred 15 Scarlet Fever, Return Cases"of 18 Schools, Disinfection of, for Infective Diseases 21 Schools, other diseases notified from 21 Slaughter-houses 57 Small-pox 14 Smoke Nuisances 53 Staff 81 Streatham, House-to-house Inspections in 52 Tooting, House-to-house Inspections in 52 Tuberculin treatment 40 Tuberculosis Dispensaries 32 Tuberculosis Officer, Report of 32 Tuberculous Diseases 27 Underground Rooms 50 Unsound Food 57 Urinals in Connection with Licensed Premises, Inspection of 55 Vaccination Returns 14 Venereal Diseases 42 Violence, Mortality from 45 Vital Statistics of Whole Borough 10 Wandsworth, House-to-house Inspections in 52 Warple Way School, Outbreak of Diphtheria in 16 Water Supply, Cutting-off Notices 48 Whooping Cough 21 Workshops, Summary of Principal Trades carried on 66, 70 Zymotic Diseases, Deaths from 13 Zymotic Diseases, Death-rate from 13 REPORT of the Medical Officer of health for the Year 1916. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Wandsworth. Sir and Gentlemen, I have the honour to present the Annual Report on the health and sanitary condition of the Borough for the year 1916. Considerable alterations and deletions have again been made in the Report for the year, but records have been kept so that reference may be made at any future time if necessary. Population. The civil population of the Borough to the middle of 1916 has been estimated by the Registrar General to be 310,858 for the purpose of calculating death rates and 338,220 for birth-rates. Table I. shows the population of each sub-district based on the above figures, compared with the Census population. TABLE I. Sub-District. Census Population, 1911. Population estimated to middle of 1916. For death-rates. For birth-rates. Clapham 58,592 58,502 62,364 Putney 28,242 28,204 29,385 Streatham 96,192 96,020 105,747 Tooting 35,958 35,918 40,713 Wandsworth 92,376 92,214 100,011 Whole Borough 311,360 310,858 338,220 The population in Table I. is used to calculate all the rates in this Report. 2 Report of the Medical Officer of Health. Births. During the 52 weeks ending the 30th December, 1916, 6,246 births, 3,211 of males and 3,035 of females, were registered, compared with 6,383 in 1915 The total number of births registered in this Borough was 6,044, but 238 births occurred in Institutions outside the Borough of persons belonging to the Borough, and 36 births in Institutions in the Borough of persons not belonging to the Borough, making a corrected total of 6,246. In Table II. 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. TABLE II. Sub-District. Births. Rates. Males. Females. Total. Birth-Rate. Rate of natural increase. Clapham 596 578 1,174 18.82 6.67 Putney 220 211 431 14.66 3.00 Streatham 973 879 1,852 17.51 5.73 Tooting 435 414 849 20.85 19.61 Wandsworth 987 953 1,940 19.39 7.52 Whole Borough 3,211 3,035 6,246 18.46 6.66 84 births occurred in the Workhouse, 48 of which belonged to the Borough. 322 illegitimate births took place in the Borough, 22 of these belonging to Clapham, 13 to Putney, 174 to Streatham, 56 to Tooting, and 57 to Wandsworth. Of the 174 illegitimate births that occurred in Streatham, 134 took place in a private home in that sub-district, 31 illegitimate births were also registered outside the Borough, making a total of 353. The percentage of illegitimate births to total births was 5.6. Report of the Medical Officer of Health. 3 Notification of Births Act. 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. TABLE III. Sub-district. Total No. of births notified. Notified by: Total births registered. No. born dead. Medical Attendant Parent. Midwife. Other person. Clapham 1.006 358 401 201 46 1,174 13 Putney 384 117 105 147 15 431 6 Streatham 1,685 319 793 331 242 1,852 28 Tooting 788 79 317 373 19 849 4 Wandsworth 1,906 370 619 861 56 1,940 30 Whole Borough 5,769 1,243 2,235 1,913 378 6,246 81 The percentage of births notified, less still-births, to those registered was 91. Deaths. During the 52 weeks ending the 30th December, 1916, 3,568 deaths, 1,746 of males and 1,822 of females were registered, compared with 3,949 in 1915. Table IV. shows the total number of Institution deaths arranged according to sub-districts and Institutions in which they occurred, Table V. the deaths of persons not belonging to the Borough, Table VI. the deaths of persons belonging thereto arranged according to causes of death, sex and age, and Institution in which the death occurred, and Table VII., the number of deaths in Institutions, etc., outside the Borough of persons belonging thereto. 4 Report of the Medical Officer of Health. TABLE IV. Name of Public Institution. Clapham. Putney. Streatham Tooting. Wandsth. Total. Hostel of God 71 ... ... ... ... 71 South London Hospital for Women 4 ... ... ... ... 4 St. Anne's Home ... ... 9 ... ... 9 Middlesex County Asylum ... ... ... ... 177 177 Metropolitan Asylums Board's Fever Hospital ... ... ... 93 ... 93 Fountain Asylum ... ... ... 38 ... 38 H. M. Prison ... ... ... ... 4 4 Workhouse ... ... ... ... 10 10 Royal Hospital for Incurables ... ... ... ... 22 22 Tooting Bec Asylum ... ... ... 472 ... 472 The Priory ... 4 ... ... ... 4 Putney Hospital ... 15 ... ... ... 15 Newlands House Asylum ... ... ... 1 ... 1 Military Hospitals ... 3 4 47 77 131 TOTAL 75 22 13 651 290 1,051 Other places 70 35 38 20 44 207 GRAND TOTAL 145 57 51 671 334 1,258 5 Report of the Medical Officer of Health. TABLE V. Deaths in Public Institutions In the Borough of Persons not belonging to the Borough, 1916. causes of death. Deaths in or belonging to whole District at subjoined ages. Institutions. All Ages. Males. Females. Under 1 year. 1 and under a. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65 65 and upwards. Middlesex Countv Asylum. Tooting Bee Asylum. Hostel of God. Tooting Home. Fever Hospital. Workhouse. H.M. Prison. Ryl. Hosp. for Incurables. The Priory. Putney Hospital. Fountain Temporary Asylum. s. Lon. Hosp. for Women. St. Anne's Home. Military Hospitals. Other Places. Enteric Fever 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 5 3 2 2 1 2 ... ... ... ... ... ... ... ... ... 5 ... ... ... ... ... ... ... ... ... ... Scarlet Fever 6 4 2 ... 2 2 2 ... ... ... ... ... ... ... ... 6 ... ... ... ... ... ... ... ... ... ... Whooping Couch 7 4 3 2 4 1 ... ... ... ... ... ... ... ... ... 5 ... ... ... ... ... ... ... ... ... 2 Diphtheria and Membranous Croup 19 7 12 1 1 5 12 ... ... ... ... ... ... ... ... 19 ... ... ... ... ... ... ... ... ... ... Influenza 7 ... 7 ... ... ... ... ... 1 1 5 1 ... ... ... ... ... ... 4 ... ... ... ... ... ... 2 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Fever 2 1 1 ... ... ... 1 1 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Pulmonary Tuberculosis 118 79 39 ... ... 1 6 39 49 17 6 37 15 24 ... ... ... ... ... ... ... 3 1 ... 34 4 Tuberculous Meningitis 1 ... 1 ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Abdominal Tuberculosis 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases 6 5 1 ... ... 1 1 ... 1 3 ... ... 1 ... ... 1 ... ... ... ... ... 1 ... ... 2 1 Other Infective Diseases 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Cancer, Malignant Disease 53 11 42 ... ... ... ... ... 6 24 23 3 4 29 ... ... ... ... 2 ... 2 ... 1 ... ... 12 Rheumatic Fever 1 ... 1... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Diabetes ... 1 2 ... ... ... ... ... ... 1 2 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 Other General Diseases 8 2 6 ... ... ... ... ... 2 2 4 ... 1 ... ... ... ... ... 3 1 ... ... ... ... 1 2 Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 1 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Haemorrhage, Apoplexy 26 9 17 ... ... ... ... ... 2 10 14 5 2 ... ... ... 1 1 1 ... ... ... ... ... ... 16 Convulsions 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Other Diseases of Nervous System 124 76 48 ... ... 1 12 12 40 46 13 70 16 ... ... ... ... ... 7 1 ... 14 ... 1 3 12 Organic Diseases of Heart 39 18 21 ... ... ... ... 2 4 17 16 4 14 1 ... ... ... ... 1 ... ... 2 1 3 1 12 Other Diseases of Circulatory System 9 5 4 1 ... ... ... ... 4 3 1 ... 1 1 ... ... ... ... ... ... ... ... 1 ... 2 4 Bronchitis 20 10 10 ... ... ... 1 ... 2 3 14 5 ... ... ... ... ... ... ... ... ... ... ... 4 3 8 Broncho-Pneumonia 9 8 1 ... ... ... 2 4 ... 3 ... ... 2 ... ... ... ... ... ... ... ... 3 ... ... 3 1 Lobar Pneumonia 6 6 ... ... ... ... ... 1 2 1 2 1 ... ... ... 1 ... ... ... ... ... ... ... ... 1 3 Pneumonia (type not distinguished) 20 17 3 ... ... ... 2 3 i 9 5 ... 9 ... ... ... ... ... ... ... ... 3 ... ... 4 4 Other Diseases of Respiratory System 6 4 2 ... ... ... ... 2 2 ... 2 ... ... ... ... ... ... ... 1 ... ... ... ... 1 4 ... Ulcer of Stomach 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Diarrhcea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteritis 5 3 2 ... ... 1 ... ... 2 2 ... 4 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Appendicitis and Typhlitis 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Obstruction of Intestines 6 3 3 ... ... ... ... ... 2 ... 4 ... 1 1 ... ... ... ... 1 1 ... ... ... ... 1 1 Cirrhosis of Liver 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Other Diseases of Liver 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Other Diseases of Digestive System 4 1 3 1 ... ... 1 ... 2 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 Nephritis and Bright's Disease 18 12 6 ... ... ... ... 2 4 10 2 3 6 1 ... ... ... ... ... ... ... ... ... ... 4 4 Other Diseases of Urinary System 2 1 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Diseases of Generative System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 1 ... I ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... Premature Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Debility and Malformation 9 5 4 2 ... ... 5 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 7 ... ... ... 2 Other Diseases of Early Infancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Old Age 440 190 250 ... ... ... ... ... ... 16 424 39 390 1 ... ... 2 ... 1 ... ... ... ... ... ... 7 Deaths from Accident 15 12 3 ... ... ... 2 1 4 5 3 2 2 ... ... ... ... ... ... ... ... ... ... ... 1 10 Deaths from Suicide 5 4 1 ... ... ... ... ... 3 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 Other Violent Deaths 58 58 ... 1 ... ... ... 26 31 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 57 1 Other defined Diseases 6 3 3 ... ... ... 1 2 ... 2 1 1 1 ... ... ... ... ... ... ... ... 2 ... ... 2 ... Ill-defined Diseases or unknown 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 All causes 1076 571 505 10 8 16 48 102 169 179 545 177 468 58 ... 40 4 1 21 4 2 36 4 9 131 121 6 Report of the Medical Officer of Health. TABLE VI. Deaths in Public O Institutions, &c., in the Borough of Persons belonging to the Borough, 1916. causes of death Deaths in or belonging to whole District at subjoined ages. Institutions. All Ages. | Males. Females. Under1 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Fever Hospital. Tooting Home. Workhouse. Tooting Bec Asylum. H.M. Prison. Putney Hospital. Fountain Temporal) Asylum. Middlesex Asylum. Hostel of God. R. Hospital for Incurables. Other Places not Institutions. Enteric Fever 1 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 1 ... 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Scarlet Fever \ 1 3 ... ... 1 2 1 ... ... ... 4 ... ... ... ... ... ... ... ... ... ... Whooping Cough 2 ... 2 1 ... ... 1 ... ... ... ... 2 ... ... ... ... ... ... ... ... ... Diphtheria and Membranous Croup 37 17 20 ... 2 16 19 ... ... ... ... 37 ... ... ... ... ... ... ... ... ... ... Influenza 2 ... 2 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 2 Erysipelas Cerebro spinal Fever 1 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 9 8 1 ... ... ... ... 5 2 ... 1 1 ... ... ... 1 ... 1 ... 4 ... 2 Tuberculous Meningitis 1 1 ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis 2 1 1 ... ... ... ... 1 l ... ... ... ... ... ... ... ... 1 ... 1 ... ... Other Tuberculous Diseases 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Other Infective Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer, Malignant Disease 22 9 13 ... ... ... ... ... 1 9 12 1 ... ... ... 1 ... ... ... 6 ... 10 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diabetes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other General Diseases 3 1 2 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 3 Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Cerebral Hæmorrhage, Apoplexy 7 3 4 ... ... ... ... ... ... 1 6 ... ... 1 ... ... 1 ... ... ... ... ... Convulsions 2 1 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Nervous System 5 2 3 ... ... ... ... ... 2 2 1 ... ... ... ... ... ... ... ... ... ... 4 Organic Diseases of Heart 14 4 6 ... ... ... ... 1 5 4 4 ... ... 1 ... ... ... ... ... 1 12 Other Diseases of Circulatory System 5 3 2 ... ... ... ... 1 1 1 2 1 ... ... ... ... ... ... ... ... ... 4 Bronchitis 5 2 3 ... ... ... ... ... ... 1 4 ... ... 1 ... 1 ... ... ... ... ... 3 Broncho-Pneumonia 4 3 1 ... 2 1 ... ... ... ... 1 1 ... ... ... ... 2 ... ... ... ... 1 Lobar Pneumonia 1 1 ... ... ... ... ... ... ... ... I ... ... ... ... ... ... ... ... ... ... 1 Pneumonia (type not distinguished) 3 1 2 ... ... ... ... ... 2 I ... ... ... ... ... ... 2 ... ... ... ... 1 Other Diseases of Respiratory System 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Ulcer of Stomach ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhcea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Appendicitis and Typhlitis 2 1 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... Obstruction of Intestines 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Cirrhosis of Intestines 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Other Diseases of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Digestive System 3 1 2 ... ... ... ... 1 ... 1 1 ... ... ... ... ... 1 ... ... ... 1 1 Nephritis and Bright's Disease 3 2 1 ... ... 1 ... ... ... 2 ... ... ... ... 1 ... 1 ... ... ... ... 1 Other Diseases of Urinary System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Generative System 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Puerperal Fever 1 ... 1 ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 1 ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... Premature Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Debility and Malformation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Early Infancv 2 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Old Age 8 1 7 ... ... ... ... ... ... ... 8 ... ... 3 2 ... ... ... ... ... ... 3 Deaths from Accident 19 1 3 6 ... ... 4 5 3 2 3 2 ... ... ... ... ... ... ... ... ... ... 19 Deaths from Suicide 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Other Violent Deaths 4 4 ... ... ... ... ... 1 1 2 ... ... ... ... ... ... ... ... ... ... ... 4 Other defined Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Diseases or unknown 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 All causes 182 86 96 8 7 25 28 16 21 33 44 53 ... 6 4 3 13 2 ... 13 1 87 Report of the Medical Officer of Health. 7 In the next Table the number of deaths in Institutions outside the Borough is given in detail. 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 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 5 and under 65. 65 and upwards. Clapham. Putney. Streatham. Tooting. Wandsworth. Workhouses and Workhouse Infirmaries General and Special Hospitals, &c. Public Lunatic and Imbecile Asylums. Metropolitan Asylums Board Hospitals. Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 6 2 4 2 1 3 ... ... ... ... ... 1 ... 2 1 2 2 ... ... 4 Scarlet Fever 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 Whooping Cough 13 7 6 6 6 1 ... ... ... ... ... 3 1 2 4 3 10 2 ... 1 Diphtheria and Membranous Croup 15 4 11 ... ... 5 9 ... 1 ... ... 2 ... 3 2 8 1 1 ... 13 Influenza 8 5 3 ... ... ... ... ... 2 3 3 2 ... 3 1 2 22 3 3 ... Erysipelas 3 2 1 1 ... ... ... ... ... ... 2 ... ... ... ... 3 1 1 ... ... Cerebro-spinal Fever 10 6 4 2 1 4 1 ... 1 1 ... 2 ... 4 1 3 1 4 ... 5 Other Epidemic Diseases 2 1 I ... ... ... ... ... 2 ... ... 1 1 ... ... ... ... 1 1 ... Pulmonary Tuberculosis 133 78 54 ... 1 3 6 21 53 37 11 26 13 34 15 44 81 32 19 ... Tuberculous Meningitis 16 10 6 2 '3 5 6 ... ... ... ... 3 2 2 1 8 2 14 ... ... Abdominal Tuberculosis 12 5 7 2 3 3 2 1 1 ... ... 2 2 4 2 2 5 7 ... ... Other Tuberculous Diseases 16 2 14 2 2 ... 3 3 4 2 ... 1 ... 7 1 7 5 9 2 ... Other Infective Diseases 9 5 4 3 ... ... 1 ... ... 4 1 1 1 2 ... 5 5 4 ... ... Cancer, Malignant Disease 121 48 73 ... ... ... 1 1 17 56 46 25 6 48 13 29 64 54 3 ... Rheumatic Fever 6 1 5 ... ... 1 1 1 2 1 ... ... 1 3 ... 2 3 3 ... ... Diabetes 8 5 3 ... ... ... ... 1 2 4 1 4 ... 2 ... 2 3 4 1 ... Other General Diseases 14 5 9 ... ... ... ... ... 6 3 5 1 ... 9 1 3 4 9 1 ... Alcoholism 1 ... 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 ... ... ... Chronic Poisonings 1 ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... 1 ... ... ... Meningitis 8 6 2 2 1 ... ... 1 3 1 ... 1 2 ... 1 4 3 4 1 ... Cerebral Hæmorrhage, Apoplexy 36 16 20 ... ... ... ... ... 2 10 24 9 1 10 4 12 25 8 3 ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Nervous System 72 51 21 1 ... 4 4 7 14 34 8 21 8 17 8 18 20 19 33 ... Organic Diseases of Heart 90 47 43 ... ... ... 2 3 10 33 42 19 8 25 10 28 54 20 16 ... Other diseases of Circulatory System 40 22 18 ... ... ... 2 3 4 17 14 10 5 14 3 8 19 16 5 ... Bronchitis 47 17 30 2 ... ... ... ... 2 14 29 5 5 11 6 20 32 13 2 ... Broncho-Pneumonia 29 18 11 6 6 2 2 1 2 4 6 2 2 7 6 12 12 13 4 ... Lobar Pneumonia 15 8 7 1 1 ... 1 ... 4 5 3 6 2 3 ... 4 4 3 8 ... Pneumonia (type not distinguished) 17 13 4 ... 1 4 ... ... 2 6 4 4 ... 5 5 3 1 2 4 1 ... Other Diseases of Respiratory System 3 4 4 2 ... ... ... ... 2 2 2 1 3 ... 2 2 3 4 1 ... Ulcer of Stomach 4 3 1 ... ... ... ... ... 2 1 1 ... ... ... ... 4 ... 4 ... ... Diarrhœa 23 13 10 18 2 3 ... ... ... ... ... 2 3 6 7 5 13 10 ... ... Enteritis 22 14 8 17 1 1 ... ... 1 ... 2 2 ... 6 6 8 12 10 ... ... Appendicitis and Typhlitis 17 8 9 ... ... ... 3 2 7 4 1 2 1 6 4 4 3 14 ... ... Obstruction of Intestines 20 10 10 2 ... 1 ... ... 1 8 8 7 ... 8 1 4 6 14 ... ... Cirrhosis of Liver 10 6 4 ... ... ... 1 ... ... 6 3 3 ... 1 ... 6 6 4 ... ... Other Diseases of Liver 3 1 2 ... ... ... ... ... 2 1 ... 1 ... ... ... 2 2 1 ... ... Other Diseases of Digestive System 20 7 13 ... ... 2 2 1 4 10 1 6 1 8 2 1 2 16 1 1 Nephritis and Bright's Disease 33 16 17 ... ... 1 ... ... 8 13 11 10 4 9 5 5 24 7 2 ... Other Diseases of Urinary System 14 10 4 ... ... ... ... 1 2 5 6 2 ... 6 2 4 8 5 1 ... Diseases of Generative System 7 1 6 ... ... ... ... 1 3 3 ... 2 ... 2 1 2 ... 5 2 ... Puerperal Fever 4 ... 4 ... ... ... ... ... 4 ... ... 1 ... 2 ... 1 2 2 ... ... Other Accidents and Diseases of Pregnancy and Childbirth 5 ... 5 ... ... ... ... 1 4 ... ... 1 1 1 ... 2 3 2 ... ... Premature Birth 12 10 2 12 ... ... ... ... ... ... ... 1 2 4 1 4 6 6 ... ... Congenital Debility and formation 42 25 17 40 1 ... 1 ... ... ... ... 8 4 10 10 10 23 19 ... ... Other Diseases of Early Infancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Old Age 117 47 70 ... ... ... ... ... ... ... 117 27 16 30 8 36 109 3 5 ... Deaths from Accident 51 31 20 ... 2 2 4 6 10 15 12 10 2 15 8 16 17 34 ... ... Deaths from Suicide 6 2 4 ... ... ... ... 2 1 2 1 ... 2 1 2 1 3 3 ... ... Other Violent Deaths 3 3 ... ... ... ... ... ... ... 3 ... ... ... 2 ... 1 3 ... ... ... Other defined Diseases 10 7 3 ... ... ... ... ... 2 2 6 3 ... 3 ... 4 8 1 1 ... I ll-defined Diseases or unknown 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... All causes 1180 604 576 123 32 45 54 57 188 311 37o 241 100 337 145 357 627 412 116 25 8 Report of the Medical Officer of Health. 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 3,671, 1,774 of males, and 1,897 of females. The corrected death-rate for the year was 11.8o compared with 12.63 in 1915. The death-rate for the whole of London for the year was 14.3 per 1,000, compared with 16.1 in 1915. Table VIII. 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. TABLE VIII. SubDistricts. Corrected Deaths. Uncorrected Deaths. Corrected Death-rate. Males. Females. Total. Males. Females. Total. Clapham 352 359 711 261 327 588 12.15 Putney 1 71 158 329 144 118 262 11.66 Streatham 502 630 1,132 344 453 797 11.78 Tooting 205 199 404 460 448 908 11.24 Wandsworth 544 551 1,095 536 476 1,012 11.87 Whole Borough 1.774 1,897 3.671 1,745 1,822 3,567 11.80 The death-rate in England and Wales in 1916 was 14.0 per 1,000; in the 96 great Towns 14.4; and in the 148 smaller Towns 13.0. The rates in all the sub-districts were lower than in 1915. Table IX. is the general mortality Table for the whole district, corrected for internal and external Institutions, and also includes all deaths of Borough residents occurring in other places in London, and in England and Wales during the year. Table X. gives certain vital statistics for the whole Borough for the year, and the previous five years; and Table XI. shows the cases of infectious disease notified during the year. Report of the Medical Officer of Health. 9 TABLE IX. Causes of, and Ages at Death, during the year 1916. 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 4 1 ... ... ... ... 1 4 ... ... ... 2 2 1 ... 2 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 22 5 1/ 7 7 7 1 ... ... ... ... 7 3 3 4 5 6 Scarlet Fever 5 2 3 ... ... 1 3 1 ... ... ... ... 1 ... 1 3 10 Whooping Cough 49 22 27 24 15 5 5 ... ... ... ... 14 3 11 10 11 9 Diphtheria, and Membranous Croup 55 23 32 ... 2 23 29 ... 1 ... ... 10 ... 9 11 25 56 Influenza 74 26 48 I 1 4 ... ... 11 18 39 15 4 30 5 20 7 Erysipelas 5 3 2 I ... ... ... ... ... ... 4 ... ... ... 2 3 ... Cerebro-spinal Fever 16 10 6 3 1 3 6 ... 1 2 ... 5 ... 5 1 5 3 Other Epidemic Diseases 3 2 1 ... ... ... i ... 2 ... ... 1 1 ... 1 ... 3 Pulmonary Tuberculosis 320 187 i33 ... 2 4 12 56 i37 92 17 62 28 87 37 106 127 Tuberculous Meningitis 35 19 16 7 8 8 10 1 1 ... ... 8 5 7 4 11 2 Abdominal Tuberculosis 17 8 9 3 3 3 4 2 2 ... ... 3 2 5 3 4 3 Other Tuberculous Diseases 24 7 17 2 3 1 4 4 6 4 ... 2 1 9 1 11 7 Other Infective Diseases 16 8 8 5 1 ... 1 ... 1 7 1 1 2 5 1 7 1 Cancer,Malignant Disease 398 146 252 ... ... ... 2 l 45 162 188 79 28 162 39 90 75 Rheumatic Fever 18 7 11 ... ... 1 5 4 4 3 1 3 5 5 1 4 1 Diabetes 33 16 17 ... ... ... ... 3 5 14 11 8 2 10 1 12 4 Other General Diseases 51 25 26 3 ... ... ... 3 7 15 23 11 2 24 4 10 10 Alcoholism 5 2 3 ... ... ... ... ... 2 3 ... ... 2 3 ... ... ... Chronic Poisonings 1 ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... Meningitis 21 14 7 5 5 2 2 1 4 1 1 4 2 3 5 7 2 Cerebral Hæmorrhage, Apoplexy 147 68 81 1 ... ... ... ... 5 41 100 35 14 42 14 42 33 Convulsions 34 22 12 28 5 1 ... ... ... ... ... 6 ... 14 3 11 3 Other Diseases of Nervous System 122 70 52 1 ... 4 7 10 25 47 28 31 16 37 9 29 130 Organic Diseases of Heart 385 177 208 ... ... 1 7 14 45 120 198 66 46 121 34 11t8 52 Other Diseases of Circulatory System 119 68 51 ... ... ... 2 4 10 44 59 26 16 41 9 27 15 Bronchitis 284 119 165 27 6 5 1 ... 10 58 177 49 21 94 39 81 24 Broncho-Pneumonia 122 62 60 31 23 10 6 1 5 11 35 18 20 29 15 40 13 Lobar Pneumonia 45 24 21 1 3 2 1 1 10 14 13 13 3 11 4 14 7 Pneumonia (type not distinguished) 7 46 33 14 7 4 2 2 11 20 19 13 5 26 13 22 23 Other Diseases of Respiratory System 37 20 17 5 2 1 ... ... 6 9 14 9 4 8 4 12 7 Ulcer of Stomach 14 9 5 ... ... ... ... 1 5 4 4 2 1 2 ... 9 1 Diarrhoea 58 34 24 41 5 6 ... ... ... 1 5 10 3 11 16 18 ... Enteritis 37 22 15 27 1 3 ... ... 2 1 3 4 1 13 6 13 5 Appendicitis and Typhlitis 22 10 12 ... ... 1 5 3 8 4 1 2 4 6 4 6 3 Obstruction of Intestines 44 23 21 4 1 1 ... ... 2 13 23 14 3 13 3 11 7 Cirrhosis of Liver 32 18 14 ... ... ... 1 ... 2 17 12 5 4 8 1 14 2 Other Diseases of Liver 11 3 8 ... ... ... 1 ... 2 3 5 2 ... 4 ... 5 1 Other Diseases of Digestive System 62 29 33 12 4 2 6 2 8 17 11 16 5 10 3 22 7 Nephritis and Bright's Disease 111 66 45 ... ... 2 2 1 20 43 43 26 9 26 15 35 21 Other Diseases of Urinary System 26 18 8 ... ... ... ... 1 3 7 15 5 1 11 2 7 2 Diseases of Generative System 14 1 13 ... ... ... 1 1 3 6 3 4 1 6 1 2 1 Puerperal Fever 9 ... 9 ... ... ... ... 1 8 ... ... 5 ... 3 ... 1 2 Other Accidents and Diseases of Pregnancy and Childbirth 10 ... 10 ... ... ... ... 1 9 ... ... 2 1 5 ... 2 2 Premature Birth 115 74 41 115 ... ... ... ... ... ... ... 19 6 34 14 42 ... Congenital Debility and Malformation 111 61 50 104 3 ... 2 1 1 ... ... 19 8 28 20 36 9 Other Diseases of Early Infancy 9 4 5 9 ... ... ... ... ... ... ... 1 1 4 2 1 2 Old Age 299 111 188 ... ... ... ... ... ... ... 299 55 27 90 26 93 448 Deaths from Accident 89 54 35 2 2 8 12 10 13 23 19 13 9 23 11 33 34 Deaths from Suicide 16 6 10 ... ... ... ... 4 2 8 2 1 3 3 3 6 6 Other Violent Deaths 9 8 1 1 ... ... ... 1 1 5 1 1 ... 6 ... 2 58 Other defined Diseases 19 10 9 1 ... ... ... ... 2 3 13 4 1 8 1 5 10 Ill-defined Diseases or unknown 7 3 4 3 ... ... 1 ... ... 1 2 1 3 1 ... 2 2 All causes 3671 1774 1897 488 110 113 142 136 452 841 1382 711 320 1132 404 1005 1258 10 Report of the Medical Officer of Health. TABLE X Wandsworth District. Vital Statistics of Whole District during 1916 and previous years. (Table I.) Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths: Nett Dkatiis Belonging to thk District. Uncorrected Number. Nett. Under 1 Year of Age. At all Ages. Number. Rate. of Nonresidents registered in the District. of Residents not registered in the District. Number. Rate per 1000 Nett Births. Number. Rate. Number. Kate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 3,18 9.77 767 940 516 76 3,291 10.48 1913 321,340 6,679 838 20.87 3,341 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 1915 331,556 6,210 6,383 19.25 3,949 11.72 1,012 1,252 590 92 4,189 12.67 1916 310,858 6,044 6,246 18.46 3,567 11.47 1,076 1,180 488 78 3,671 11.80 Area of District in acres (exclusive of area covered by water).9,126 Total population at all ages 311,3601 Number of inhabited houses 48,432 At Census of 1911. Average number of persons per house 6.42 ) 11 Report of the Medical Officer of Health. TABLE XI. Wandsworth District. Cases of Infections Disease notified during the year 1916. (Table II.) Notifiable Disease. No. of Cases Notified. Total Cases Notified in each Locality. Total cases removed to Hospital. At all Ages. At Ages—Years. Clapham. 1 Putney. Streatham. Tooting. Wandsworth. Under 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera, Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... diphtheria (including Membranous Croup) 531 3 136 313 47 26 3 3 85 25 102 82 237 460 Erysipelas 157 3 4 15 10 32 68 25 19 11 47 35 45 16 Scarlet Fever 690 3 139 443 67 37 1 ... 95 40 161 198 196 582 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 46 ... 1 9 9 20 6 1 2 5 11 8 20 32 Continued Fever 3 ... ... ... 2 ... 1 ... 1 ... 2 ... ... ... Puerperal Fever 20 ... ... ... 3 17 ... ... 7 1 8 4 12 Cerebro-spinal Meningitis 28 5 10 7 1 3 2 7 7 4 10 21 Polio-Myelitis 7 1 3 1 1 1 ... ... 2 ... 3 1 1 1 Pulmonary Tuberculosis 59o 1 10 55 102 280 121 21 115 47 138 89 201 ... Other forms of Tuberculosis 216 12 59 77 36 21 11 ... 48 20 52 27 69 ... Ophthalmia Neunatorum 32 32 ... ... ... ... ... ... 9 ... 7 1 15 3 Measles 1.930 58 589 1,075 106 90 12 ... 510 118 422 423 457 ... German Measles 1,649 32 222 948 252 163 32 ... 236 95 692 160 466 ... Totals 5,899 150 1,173 2,943 636 690 257 50 1,136 362 1,652 1,028 1,721 1,127 B 12 Report of the Medical Officer of Health. TABLE XII. - (table iv.) Borough of Wandsworth. Infant Mortality. 1916. Nett Deaths from stated causes at various Ages under I 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 115 39 17 20 191 74 99 64 57 485 Uncertified 2 ... ... ... 2 1 ... ... ... 3 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 6 7 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping cough ... ... ... ... ... 4 6 7 7 24 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... 1 1 ... ... ... ... 1 Tuberculous Meningitis ... ... ... ... ... 1 1 4 1 7 Abdominal Tuberculosis ... ... ... ... ... ... 1 1 1 3 Other Tuberculous Diseases ... ... ... ... ... ... ... ... 2 2 Meningitis {not Tuberculous) 1 1 ... ... 2 ... ... 1 2 5 Convulsions 6 2 ... 3 11 6 4 4 3 28 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 ... 2 3 4 7 5 8 27 Pneumonia (all forms) ... ... 1 3 4 10 12 10 10 46 Diarrhoea ... ... ... 1 1 4 21 11 4 41 Enteritis 2 ... 1 1 4 5 12 4 2 27 Gastritis ... .... ... ... 1 3 3 ... 2 9 Syphilis 1 ... ... ... 1 1 1 ... ... 3 Rickets ... ... ... ... ... 1 ... ... 1 2 Suffocation, overlying ... ... ... ... ... 1 1 ... ... 2 Injury at birth 2 ... ... ... 2 ... ... ... ... 2 Atelectasis 6 ... ... ... 6 ... ... ... ... 6 Congenital Malformations 12 ... 2 1 15 5 5 4 1 30 Premature birth 75 22 8 2 107 6 2 ... ... 15 Atrophy, Debility and Marasmus 7 12 1 4 24 19 14 11 4 72 Other Causes 5 ... 4 2 11 5 8 2 3 29 Totals 117 39 17 20 193 75 99 64 57 488 Nett Births in the year, legitimate, 5,893; illegitimate, 353. Nett Deaths in the year of legitimate infants, 436; illegitimate infants, 52- Report of the Medical Officer of Health. 13 Infantile Mortality. 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 Xlll Sub-District. No. of Deaths under one year. Percentage to total Deaths. 1913 Rate per 1,000 Births. 1914 1915 1916 Clapham 83 11.69 82 76 92 70 Putney 32 9.72 85 87 78 74 Streatham 124 10.95 74 86 76 66 Tooting 90 22.27 91 114 104 109 Wandsworth 179 14.52 103 84 104 92 Whole Borough 488 13.30 88 88 92 78 The Infantile Mortality for the year shows a marked and satisfactory decrease, and is the lowest rate recorded since 1912. This decrease was general in all the sub-districts, with the exception of Tooting, where it was live per 1,000 births higher than last year. INFECTIVE DISEASES. The total number of deaths from these diseases was 1,734, 142 in Clapham, 56 in Putney, 195 in Streatham, 103 in Tooting, and 238 in Wandsworth. From all infective diseases the death-rate was 2.36 per 1,000, (2.42 in Clapham, 1.98 in Putney, 2.03 in Streatham, 2.86 in Tooting, and 2.58 in Wandsworth). The rate from the principal infective diseases, viz.:—Small-pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever, and Diarrhoea, was .74 per 1,000 (76 in Clapham, .42 in Putney, .51 in Streatham, 1.36 in Tooting, and .81 in Wandsworth). 14 Report of the Medical Officer of Health. 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 Table on page 11. The total number of cases notified was 5,093, (973 in Clapham, 295 in Putney, 1,462 in Streatham, 912 in Tooting, and 1,451 in Wandsworth). The large increase in the number over previous years is due to the fact that Measles and German Measles were made notifiable diseases on the 1st January. 1,930 cases of Measles and 1,649 German Measles were notified during the year. No cases of Small-pox were notified during the year. Vaccination. Table XIV. is taken from the official returns of the Vaccination Officers to the Board of Guardians for the year 1915. 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 XIV. TABLE XIV. SubDistricts. Number of Births returned from 1st January to 31st December, 1915. Successfully Vaccinated. Insusceptible of Vaccination. Had Small-Pox. Dead, Unvaccinated. Certificates of Conscientious objection. Postponed by Medical Certificate. Removed to District, Vacdilation Officer of which has been duly apprised. Removed to places un known, or which cannot . be traced; and cases not having been found. Remaining on Books as Unvaccinated. Clapham 1,093 535 3 ... 74 286 17 26 136 16 Putney 461 342 3 ... 19 78 3 8 8 ... Streatham 2,707 1,307 2 ... 162 685 30 79 360 82 Wandswith 3,077 1,685 9 ... 195 717 48 81 306 36 Totals 7,338 3,869 17 ... 450 1,766 98 194 810 134 Report of the Medical Officer of Health. 15 Scarlet Fever. 690 cases were notified, (95 in Clapham, 40 in Putney, 161 in Streathain, 198 in Tooting and 196 in Wandsworth). The total number of deaths was five, and the death-rate per 1,000 was .01. 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 XV. Sub-Districts. One case. Two cases. Three cases. Four cases. Five cases and upwards. Total houses invaded. Clapham 77 3 1 ... 1* 82 Putney 28 2 ... 2 ... 32 Streatham 122 11 3 2 ... 138 Tooting 119 11 7 2 4* 143 Wandsworth 147 15 3 1 1* 167 Whole Borough 493 42 14 7 6 562 In Clapham 9 Cases occurred in one house. In Tooting 13 Cases occurred in the Fountain Asylum. In Wandsworth 6 cases occurred in one house. Of the 562 houses invaded, multiple cases occurred in 69, or 12.2 per cent. 16 Report of the Medical Officer of Health. Diphtheria. 531 cases were notified, (85 in Clapham, 25 in Putney, 102 in Streatham, 82 in Tooting and 237 in Wandsworth). The total number of deaths was 55 (10 in Clapham, none in Putney, nine in Streatham, 11 in Tooting and 25 in Wandsworth), and the death-rate per 1,000 was .17. The number of cases notified per 1,000 of population was 1.70, and the case mortality was 10.3 per cent. The number of dwellings in each sub-district and the whole Borough in which multiple cases occurred is shown in the following Table. TABLE XVI. Sub-Districts. One case. Two cases. Three cases. Four cases. Five cases and upwards. Total houses invaded. Clapham 73 4 ... 1 ... 78 Putney 19 3 ... ... ... 22 Streatham 84 6 2 ... ... 92 Tooting 57 6 1 ... 2 66 Wandsworth 164 16 8 3 1 192 Whole Borough 397 35 11 4 3 450 An outbreak of Diphtheria occurred at Warple Way School, Wandsworth, and the occurrence was the subject of the following special report:- "I have to report the occurrence of an outbreak of Diphtheria among children attending the Infants' and Girls' Departments of Warple Way School, Wandsworth. "Eight cases were notified to me from the 17th to the 31st January, 1916, but as two of the cases occurred in one household. Report of the Medical Officer of Health. 17 and three in another, and as the children were in all probability personally infected one from another, no special significance was attached to the outbreak. "Another case was notified on the 1st February, followed by one on the 3rd, four on the 4th, three on the 7th, one on the 8th, four on the 9th, and four on the 10th. 26 cases in all being notified to the 10th February. "On the 3rd February, a request was made from the Public Health Department to the London County Council Medical Officer, Education Department, that the children in the Infants' and Girls' Departments be examined. These Departments were visited by the School Medical Officer on the 7th, and the children examined, with the result that four positive cases were discovered, one of these residing in Battersea. "On the 5th February, notice was received from the school that eight children were suffering from sore throat, and the homes were at once visited by the Sanitary Inspector, and the parents advised to have the children seen by a doctor. This was done, and resulted in four of them being notified after bacteriological examination. "The Infants' and Girls' Departments of the school were closed on the 9th February and disinfection of these Departments carried out by the Council's staff. "Since these Departments have been closed, three further cases have been notified to me, making a total of 29 cases occurring among children attending this school. "The outbreak is confined to a small area, the children residing in Jew's Row, Ram Square, Marl Street, Warple Road, Warple Way, Bridgefield Grove, Fairfield Street and Morie Street, and is generally of a very mild character with no clinical symptoms, many of them only being discovered on bacteriological examination, and none of them so far proving fatal." 18 Report of the Medical Officer of Health. Return Cases of Scarlet Fever and Diphtheria. 33 cases of Scarlet Fever occurred after the return of cases from the hospitals of the Metropolitan Asylums Board, and there were also 11 cases of Diphtheria. Five of the return cases of Scarlet Fever occurred in Clapham, one in Putney, five in Streatham, 10 in Tooting, and 12 in Wandsworth. One of the return cases of Diphtheria occurred in Putney, two in Streatham, two in Tooting, and six in Wandsworth. Enteric Fever. 46 cases of Enteric Fever were notified during the year, (two from Clapham, five from Putney, 11 from Streatham, eight from Tooting, and 20 from Wandsworth). The number of deaths was five, and the death-rate was .01 per 1,000 of population. Cases of Mistaken Diagnosis. In 136 cases, (55 of Scarlet Fever, 47 of Diphtheria, nine of Enteric Fever, five of Cerebro-spinal Fever, and one of Continued 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. Cerebro-spinal Meningitis. During the year 28 cases of this disease were notified, (seven in Clapham, none in Putney, seven in Streatham, four in Tooting and 10 in Wandsworth). 16 of the cases terminated fatally, (five in Clapham, five in Streatham, one in Tooting and one in Wandsworth), and in five, information was received that the cases had been wrongly diagnosed. Two of the wrongly diagnosed cases died, one from Bronchopneumonia, and the other from Tuberculous Meningitis. Report of the Medical Officer of Health. 19 21 deaths were registered as having been caused by Meningitis, . (four inClapham.two in Putney, three in Streatham, five inTooting, and seven in Wandsworth). Five of these were of infants under one year, five 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 600 bacteriological examinations were made at the Lister Institute. The following Table shows the number of examinations in each sub-district and for the whole Borough, also the disease for which the examination was made and the result of such examination. TABLE XVII. Clapham. Putney. Streatham. Tooting. WandsWorth. Whole Borough. Diphtheria. Negative 54 44 91 27 197 413 Positive 16 16 42 9 69 152 Enteric Fever Negative 3 5 7 1 2 18 Positive 2 ... 9 1 5 17 Totals 75 65 149 38 273 600 Puerperal Fever. 20 cases of Puerperal Fever were notified, (seven in Clapham, one in Putney, eight in Streatham, none in Tooting and four in Wandsworth), and nine deaths occurred, (five in Clapham, three in Streatham and one in Wandsworth). The death rate was .02 per 1,000, and the case mortality 45 per cent. 20 Report of the Medical Officer of Health. Erysipelas. 157 cases were notified (19 in Clapham, 11 in Putney, 47 in Streatham, 35 in Tooting and 45 in Wandsworth), and five deaths occurred, (two in Tooting and three in Wandsworth). Measles. In November, 1915, the Local Government Board issued an Order for the compulsory notification of Measles and German Measles throughout England and Wales, and this Order was to come into operation on the 1st January, 1916. During the year, 1,930 cases of Measles were notified (510 in Clapham, 118 in Putney, 422 in Streatham, 423 in Tooting and 457 in Wandsworth), and 22 deaths occurred, (seven in Clapham, three in Putnev, three in Streatham, four in Tooting and five in Wandsworth). Seven of the deaths were of infants under one year of age, seven from one and under two years, seven from two and under five years and one from five and under 15 years. The death-rate per 1,000 of population was .07. 1,649 cases of German Measles were also notified, (236 in Clapham, 95 in Putney, 692 in Streatham, 160 in Tooting and 466 in Wandsworth), and one death was registered as being due to this disease. During the year 3,804 visits were made in cases of these diseases, 767 in Clapham, 228 in Putney, 1,341 in Streatham, 372 in Tooting and 1,096 in Wandsworth. The total number of premises disinfected was 1,398, (357 in Clapham, 77 in Putney, 359 in Streatham, 227 in Tooting, and 378 in Wandsworth). Table XVIII. shows the number of cases of notifiable and nonnotifiable diseases notified by the teachers of the elementary schools in the Borough. 21 Report of the Medical Officer of Health. TABLE XVI11. Sub-Districts Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chicken Pox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Clapham 32 33 303 97 233 80 75 23 88 964 Putney 16 9 47 17 57 17 110 13 13 299 Streatham 103 54 223 214 223 84 107 43 54 1,105 Tooting 86 32 249 101 134 75 200 43 51 971 Wandsworth 96 137 209 261 2.52 67 162 81 159 1,424 Borough 331 265 1031 690 899 323 654 203 365 4,763 Whooping Cough. 49 deaths, (10 in Clapham, three in Putney, 11 in Streatham, 10 in Tooting and 11 in Wandsworth), occurred during the year, 24 of these were infants under one year of age, 15 from one and under two years, five from two and under five years, and five from five and under 15 years. The death-rate was 15 per 1,000. Disinfection of Schools. During the year six public elementary and seven private schools in the Borough were disinfected, chiefly on account of cases of Diphtheria and Scarlet Fever having occurred among the scholars attending these schools. Epidemic Influenza. 74 deaths, (15 in Clapham, four in Putney, 30 in Streatham, five in Tooting and 20 in Wandsworth), occurred during the year, 29 of these being of persons from 25 and under 65 years, and 39 over 65 years of age. The death-rate was 23 per 1,000. Diarrhcea. 95 deaths, 56 of males and 39 of females, occurred from all forms of Diarrhoea and Enteritis during the year. 14 of the deaths occurred in Clapham, four in Putney, 24 in Streatham, 22 in 22 Report of the Medical Officer of Health. Tooting and 31 in Wandsworth. In all the sub-districts there was a decrease compared with 1915. The death-rate was 30 per 1,000, (in Clapham .23, in Putney .14, in Streatham .24, in Tooting .66, and in Wandsworth .33). Of the total number of deaths registered, 68 or 71 per cent. were of infants under one year, and the total number of deaths of children under two years was 74, equal to a rate of .23 per 1,000. The number of deaths from Diarrhoea, Zymotic Enteritis, and Enteritis under one year, represents 13.9 per cent. of the total mortality at that age. In all the deaths under one year from Diarrhoea and Enteritis, special inquiries were made, and the following Tables show the nature of the food given. TABLE XIX. 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 3 4 ... ... 7 Do. and condensed milk ... ... 4 ... 4 Do. and dried milk 1 1 ... ... 2 2.—Cows' milk only 2 14 5 2 23 Do. and food ... 1 1 1 3 3.—Condensed milk only 1 5 1 1 8 Do. and dried milk ... 1 ... ... 1 Do. and food ... 1 2 2 5 4.—Dried milk 3 1 1 ... 5 Do. and food ... 2 ... ... 2 5.—Farinaceous and other foods 1 1 ... ... 2 6.—Unknown 2 2 2 ... 6 Totals 13 33 16 6 68 23 Report of the Medical Officer of Health. 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, and the number of illegitimate infants TABLE XX. Clapham, North. Clapham, South. Putney. Streatham. Balham. Tooting. Southfield. Fairfield. Springfield. | Borough. Total Number of Deaths 5 4 4 6 10 15 7 5 12 68 Wholly breast-fed ... 1 ... 1 ... 1 1 ... 3 7 Otherwise fed 4 3 3 5 9 12 6 4 9 55 No information 1 1 ... 1 2 ... 1 ... 6 Previously visited (1916) 2 2 3 1 5 8 2 2 7 32 ,, ,, (1915) i 1 1 1 4 Fed according to pamphlet ... 1 1 ... ... 1 ... 1 4 8 Breast-fed ... ... ... ... 1 1 ... 2 4 Otherwise fed 3 3 3 2 5 8 1 2 5 32 Illegitimate 1 ... 1 3 3 2 2 2 4 18 Nurse children ... ... ... ... 2 2 2 ... 2 8 Born outside Borough 1 ... ... 1 1 1 3 ... 3 10 Premature ... 1 1 2 2 ... 1 ... 2 9 Delicate from birth ... ... 2 2 1 ... 3 1 2 11 Twin Children ... ... ... ... 1 ... ... 1 ... 2 Infant Visiting. During the year the female Sanitary Inspectors have continued the work begun in 1905 in visiting the homes where births had occurred. "We herewith submit to you the report of our visits amongst infants during the year 1916. "In February, 1916, a Health Visitor was appointed solely for Infant Visiting, which accounts for the greatly increased number of visits in Tooting, Balham and Clapham North, the districts allotted to her, and of re-visits in all the Wards. "The total number of visits paid including re-visits and ineffectual visits was 8,212, compared with 5,188 in 1915. The 24 Report of the Medical Officer of Health. number of first visits totalled 3,862, re-visits 2,889, and ineffectual visits 1,461. "142 visits were paid to houses to see to the carrying out of repairs, etc., for which we had previously served notices. "At the first visit 3,172 infants were wholly breast fed. Of the remaining 690, 268 were breast-fed supplemented by artificial feeding, 160 were fed on cows' milk only, 124 on condensed milk only, 61 on dried milk, and one on goats' milk. Of the 2,889 infants re-visited, 1,806 were entirely breast-fed, and of the remaining 1,083, cows', condensed, or dried milks, or farinaceous foods were given in addition to the breast in 434 eases, 231 were fed on cows' milk only, 125 on condensed milk, and 80 on dried milk. "In 1.238 cases boat bottles were used, in only 25 cases the long tubed bottles; 47 infants were spoon fed, and four were cup fed. " 117 of the infants visited, died during the year, the ages at death being shown in Table XXI. It will be seen that the greatest mortality occurred during the first four months of life, 73, more than half the total, having died before reaching the age of four months. 28 infants died from diarrhoea and enteritis, four from intestinal toxæmia, three from ileo-colitis, 26 from bronchitis and pneumonia, five from whooping-cough, 10 from marasmus, eight from atrophy, five from prematurity (of whom two were twins), four from convulsions, three from debility from birth, six from gastric and stomach troubles, four from meningitis two from malnutrition, and the remaining nine from various complaints. "Man} infants died from prematurity previous to our first visit. 133 of those visited were prematurely born, and 62 were delicate from birth. 59 twin births were visited and one set of triplets. With regard to the employment of midwives, 1,891 of the 3,862 mothers visited had employed their services. Eight had been attended by un-registered midwives, the excuse in every case being that they were called in in an emergency. 25 Report of the Medical Officer of Health. "The sanitary defects found in the houses during our visits to the mothers have been remedied, or if requiring structural work, referred to you. 61 intimation notices were served and three statutory notices were required." TABLE XXI. Clapham, North. Clapham, South. Putney. Streatham. Balham. Tooting. Southfield. Fairfield. Springfield. Borough. Infants visited 416 343 223 319 498 779 351 304 629 3,862 Breast-fed 332 275 174 249 392 650 307 255 538 3.172 Otherwise fed 84 68 49 70 106 129 44 49 91 690 Infants re-visited 312 225 160 217 309 661 266 252 487 2,889 Breast-fed 173 143 106 135 172 369 179 183 346 1,806 Otherwise fed 139 82 54 82 137 292 87 69 141 1,083 Ineffectual visits 127 43 119 49 207 195 274 146 301 1,461 The total number of deaths among those visited was 117, 18 in Clapham, eight in Putney, 27 in Streatham, 29 in Tooting, and 35 in Wandsworth. The heaviest mortality occurred at one to three months. The mortality among the infants visited by the Inspectors was only 30 per 1,000 births, compared with 77 per 1,000, the rate for the Borough for the year. Maternity and Child Welfare Centres. There are five Infant Welfare Centres in the Borough in full working order. Each has a medical officer and a trained superintendent; the latter weighs the children, and visits the mothers in their own homes to see that the Doctor's instructions are carried out. The first Centre was opened at The Anchor, 275, Garratt Lane, Wandsworth, on the 6th July, 1915, and serves the three 26 Report of the Medical Officer of Health. Wards, viz.:—Southfield, Fairfield and Springfield. There were 572 children on the register at the end of 1916, the attendances during that year were 2,472, an average attendance of 49 for 50 weeks (the Centre having been closed at Easter and Xmas). The centre at Tooting was opened on the 30th September, 1915, at Fairlight Hall. The infant consultation is held on Thursday afternoons. The number on the register at the end of 1916 was 460, the attendances 1,372, an average of 27. Putney Centre was opened on the 19th January, 1916. The consultations are at present held at Sefton Hall, on Wednesday afternoons. The number on the register at the end of 1916 was 185, attendances were 948 in 49 weeks, an average of 20. The Streatham Centre was opened 011 the 5th May, 1916, and is held at Blegborough Hall on Friday afternoons. Up to the end of 1916 there were 188 on the register, and there were 748 attendances in 34 weeks, an average of 23 8. The Balham Centre was opened on the 2nd July, 1916, and is held at Zennor Hall on Wednesdays. The number on the register at the end of 1916 was 165, the attendances being 802 during the 22 weeks, an average of 36 4. Each Welfare Centre supplies Virol, Cod-Liver Oil and Malt, Parrish's Food, Petroleum Emulsion, Marylebone Cream, Grey Powders, Lactagol and dried milks, at cost price to those mothers for whom the doctors order it. Four of the Centres have clothing stalls where children's garments can be obtained at a low price. Much of the clothing is sent to the Welfare Centres from New Zealand and Australia. The mothers are made to understand from the first that medical advice and weighing only are free, anything in the nature of food, drugs or clothing must be paid for. 212 attendances were made by the Health Visitors to these Centres during the year, and seven lectures and many homelytalks and advice being given to the mothers. 27 Report of the Medical Officer of Health. Tuberculous Diseases. The total number of deaths from diseases of a Tuberculous nature was 396. 320 of the deaths were due to Pulmonary Tuberculosis, 35 to Tuberculous disease of the Brain and 41 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. TABLE XXII. Sub-District. Pulmonary Tuberculosis. Other Tuberculous Diseases. Total. No. of Deaths. Rate. No. of Deaths. Rate. No. of Deaths. Rate. Clapham 62 1 .05 13 .22 75 1.27 Putney 28 .99 8 .28 36 1.27 Streatham 87 .90 21 .21 108 1.ll Tooting 37 1.03 8 .22 45 1.25 Wandsworth 106 1.14 26 .28 132 1.42 Whole Borough 320 1.02 76 .24 396 1.26 Notification of Tuberculous Diseases. The total number of cases of Pulmonary Tuberculosis notified during 1916 was 590, 115 were from Clapham, 47 from Putney, 138 from Streatham, 89 from Tooting, and 201 from Wandsworth. A1823 c 28 Report of the Medical Officer of Health. In Table XXIII. is shown the total number of cases notified since 1909, 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. TABLE XXIII. Year. Cases Reported. Deaths. Removed. Recovered. No Inquiries. Cases on Register. 1909 1910 1911 1912 1913 1914 1915 1916 Total. 1909 389 109 48 18 26 9 6 4 5 225 I09 15 4 36 1910 289 77 37 28 7 4 3 3 159 90 5 8 27 1911 514 ... ... 113 82 27 22 8 6 258 162 11 6 77 1912 855 ... ... ... 225 105 48 31 13 422 221 52 ... 160 1913 783 ... ... ... ... 180 77 41 25 323 190 13 ... 251 1914 706 ... ... ... ... ... 176 88 37 301 129 6 ... 270 1915 646 ... ... ... ... ... ... 199 82 281 8l ... 1 283 1916 590 ... ... ... ... ... ... ... 161 161 24 ... ... 403 Total 4,772 109 125 168 36I 328 333 374 332 2,130 1,012 102 19 1,509 With regard to the notification of cases of non-pulmonary Tuberculosis, in all 216 cases were notified, 48 from Clapham, 20 from Putney, 52 from Streatham, 27 from Tooting, and 69 from Wandsworth. Table XXIV. 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. 29 Report of the Medical Officer of Health. TABLE XXIV. Localisation of Disease. Number of cases notified. No. of deaths. 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. 1 Females. Total. Removed. On Register. Brain 39 „ 17 22 5 21 4 5 2 1 1 ... ... ... ... 17 21 38 ... *1 Glands, Mediastinal 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... „ Mesenteric 24 11 13 3 8 5 4 2 1 1 ... ... ... ... 6 8 14 1 9 Cervical 68 33 35 ... 15 19 12 8 6 3 4 ... 1 ... ... ... ... 1 67 Bones and joints 55 30 25 ... 11 18 1 6 5 4 4 6 ... ... 1 ... 1 ... 54 Lupus 5 1 4 ... ... 3 ... 1 ... ... ... 1 ... ... ... ... ... ... 5 I.arynx 2 2 ... ... ... ... ... ... 1 ... ... 1 ... ... 1 ... 1 ... 1 General Tub(rculosis 11 ... 10 1 2 3 1 1 ... 2 ... 1 ... ... 1 8 9 ... 2 Other parts 11 7 4 2 2 1 1 ... 2 1 1 ... 1 ... 2 2 4 ... 7 Tota L 216 102 114 12 59 53 24 20 16 12 9 9 2 28 40 68 2 146 *Wrongly diagnosed. 30 Report of the Medical Officer of Health. The next Table shows the number of cases notified, the number which died, removed, and recovered during the years 1913, 1914, 1915 and 1916, and the number still remaining on the register at the end of 1916. TABLE XXV. Year. Cases Notified. Deaths. Removed. Recovered Cases on Register. 1913. 1914. 1915 1916. Total. 1913 328 46 10 5 6 67 66 33 157 1914 199 - 68 5 4 77 31 11 79 1915 234 — — 84 7 91 18 9 l16 1916 215 - — — 67 67 2 — 146 Total 976 46 78 94 84 302 117 53 498 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. One case of other forms of Tuberculosis notified in 1913 and one in 1914 were notified in 1915 as suffering from Pulmonary Tuberculosis. Table XXVI. is a summary of notifications during the period from the 3rd January, 1916, to the 30th December, 1916. 31 Report of the Medical Officer of Health. TABLE XXVI. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from 3rd January, 1916, to the 30th December, 1916. Metropolitan Borough of Wandsworth. Age Periods. Number of Notifications on Form A. Number of Notifications on Form B. Number of Notifications on Form C. Primary Notifications. Total Notifications (i.e. including cases previously notified by other doctors) Primary Notifications. Total Notifications (i.e. including cases previously notified by other doctors) Poor Law Institutions. Sanatoria. 0 to 1 I to 5 5 to 10 io 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 1o to 15 Total. Pulmonary— Males 1 6 12 13 14 28 74 78 53 21 13 313 365 ... ... 1 1 2 90 121 Females ... 4 11 16 19 35 69 58 32 1o 8 262 320 ... 2 ... 2 2 64 71 Non-Pulmonary— Males 3 31 25 16 7 8 3 4 5 ... ... 102 123 ... 1 2 9 15 8 Females 9 25 26 11 9 11 9 4 4 2 ... 110 117 ... ... ... ... 3 6 3 32 Report of the Medical Officer of Health. The total number of visits made was 2,646 in cases of Pulmonary Tuberculosis, 426 in Clapham, 191 in Putney, 637 in Streatham, 337 in Tooting, and 1,055 in Wandsworth, and 715 in cases of other forms of Tuberculosis, 109 in Clapham, 53 in Putney, 124 in Streatham, 94 in Tooting, and 335 in Wandsworth. In addition to these visits by the Health Visitor, 1,626 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. During the year 23 sputum flasks have been supplied, and in 20 of the cases visited the patients already had one. • During the year disinfection was carried out at 374 premises either after the death or removal of the patient. 62 of the premises disinfected were in Clapham, 36 in Putney, 97 in Streatham, 47 in Touting, and 132 in Wandsworth. Tuberculosis Dispensaries. The work of the two Dispensaries shows a considerable increase on last year, and is more than in any previous year. The number of new cases examined was 1,081, compared with 716 in 1915, 971 in 1914, and 936 in 1913. The attendances at the two Dispensaries number 9,519, compared with 6,580 the previous year. The increase is shared almost equally between the two Dispensaries as will be seen in Table XXVII. 33 Report of the Medical Officer of Health. TABLE XXVII. Number of New Cases, and Total Attendances at the Dispensaries, 1916, New Cases, 1916. Total Attendances, 1916. 19I5. Dispensary. Tuberculous. NonTuber culous. Total. Tuberculous. NonTuber culous. Total. Total New Cases. Total Attendances. 129, East Hill, Wandsworth 206 417 623 3.529 1,862 5,391 430 3.854 Weir Dispensary, Balham 144 314 458 2,787 ,341 4,128 285 2,726 Totals 35o 731 1,081 6,316 3.203 9.519 716 6,580 Table XXVIII. shows the number of insured and non-insured new cases examined during the year, with their total attendances, and average attendance per case. 34 Report of the Medical Officer of Health. TABLE XXVIII. NEW CASES, 1916. Tuberculous. Non-Tuberculous. Totals. M. F. Total M. F. Total. M. F. Total. Cases- | Insured 114 54 168 42 29 71 156 83 239 Non-Insured Totals 67 115 182 277 383 660 344 498 842 181 169 350 319 412 731 500 581 1,081 Attendances- Insured 550 381 931 80 67 147 630 448 1 .078 Non-Insured Totals 449 1.313 1,762 924 1,194 2,118 1,373 2,507 3,880 999 1,694 2,693 1,004 1,261 2,265 2,003 2,955 4,958 Average Attendances Per Case. 7.6 3.09 4.58 TABLE XXIX. CASES OF 1913, 1914 AND 1915 ATTENDING IN 1916. Tuberculous. Non-T uberculous Totals. M. F. Total. M. F. Total. M. F. Total. Cases- Insured 53 40 93 2 1 3 55 41 96 Non-insured 77 141 218 94 93 187 171 234 405 Totals 130 181 311 96 94 190 226 275 501 Attendances. Insured 355 377 732 4 3 7 359 380 739 Non-insured 785 2,106 2,891 523 408 931 1,308 2,514 3,822 Totals 1,140 2,483 3,623 527 411 938 1,667 2,894 4,561 Average Attendances Per Case. 11.6 4.9 9.1 35 Report of the Medical Officer of Health. TABLE XXX. RETURN SHOWING SOURCE OF CASES AND SUB-DISTRICTS. Clapham. Putney. Streatham. Tooting. Wandsworth. Outside Borough. Totals. Public Health Department 44 17 83 144 135 ... 425 London Insurance Committee 9 7 13 6 2 ... 37 Private Practitioners 23 12 19 33 64 2 153 Charitable Societies 2 4 5 9 8 1 29 Transfers from other Dispensaries 7 1 7 2 5 ... 22 London County Council 4 4 11 3 12 ... 34 Existing Dispensary Patients 19 9 27 66 174 2 297 Army Medical Hoards 12 6 18 4 19 8 67 Other Sources 1 3 ... 3 10 ... 17 Totals 121 63 185 270 429 13 1081 Towards the latter part of the year the Army Medical Boards commenced to send recruits for examination. 67 cases were examined, and in each instance sputum examinations were made, 33 being found to be tuberculous. I11 each case a report was sent to the Medical Board. The cases sent for examination were, of course, only possible or probable cases of tuberculosis. 36 Report of the Medical Officer of Health. TABLE XXXI 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 ... ... ... 8 10 18 8 10 18 ... and under 2 years ... 2 2 13 14 27 13 16 29 0.9 2 and under 5 years 5 2 7 45 52 97 50 54 104 6.7 5 and under 10 years 18 18 36 122 99 221 140 117 257 14.0 10 and under 15 years 21 8 29 69 76 145 90 84 174 16.6 15 and under 20 years 14 10 24 9 19 28 23 29 52 46.1 20 and under 25 years 16 27 43 7 15 22 23 42 65 66.1 25 and under 35 years 47 33 80 25 46 71 72 79 151 52.9 35 and under 45 years 35 45 80 15 43 58 50 88 138 57.9 45 and under 65 years 24 22 46 8 35 43 32 57 89 51.6 65 years and upwards 1 2 3 ... 1 1 1 3 4 75.0 Totals 181 169 350 321 410 731 502 579 1,081 32.3 Under 15 years 44 30 74 257 251 508 301 281 582 12.7 15 years and upwards 137 139 276 64 159 223 201 298 499 55.3 Totals 181 169 350 321 410 731 502 579 1.081 32.3 37 Report of the Medic Officer of Health, TABLE XXXII. DIAGNOSIS AND AGE GROUPING OF ALL CONTACTS, EXAMINED FOR THE FIRST TIME DURING 1916. Age Periods. Tuberculous. Non-Tuberculous. Totals. Percentage of Contacts found to be tuberculousatage period Males. Females. Total. Males. Females. Total. Males. Females. Total. Under 1 year ... ... ... 2 6 8 2 6 8 .. 1 and under 2 years ... 1 1 9 9 18 9 10 19 .52 2 and under 5 years ... 1 1 27 26 53 27 27 54 .18 5 and under 10 years 6 3 9 59 57 116 65 60 125 7.2 10 and under 15 years 5 1 6 37 54 91 42 55 97 6.1 15 and under 20 years 2 1 3 4 11 15 6 12 18 16.6 20 and under 25 years 1 4 5 3 12 13 4 14 18 27.7 25 and under 35 years 3 2 5 3 21 24 6 23 29 17.2 35 and under 45 years ... 3 3 2 23 25 2 26 28 10.7 45 and under 65 years 3 3 6 ... 16 16 3 19 22 27.2 65 years and upwards ... ... ... ... 1 1 ... 1 1 ... Totals 20 19 39 146 234 380 166 253 419 9.3 Under 15 years 11 6 17 134 152 286 145 158 303 5.6 15 years and upwards 9 13 22 12 82 94 21 95 116 18.9 Totals 20 19 39 146 234 380 166 253 419 9.3 38 Report of the Medical Officer of Health. TABLE XXXIII. SITE OF LESION IN TUBERCULOUS CASES. Age Period. Non-Pulmonary. Glands. Joints and Bones. Abdominal. Others. Total NonPulmonary. Pulmonary Tuberculosis. Total. Under 1 year ... ... ... ... ... ... ... 1 and under 2 years 2 ... ... ... 2 ... 2 2 and under 5 years 5 ... ... ... 5 1 6 5 and under 10 years 8 5 1 ... 14 23 37 10 and under 15 years 7 3 ... ... 10 19 29 15 and under 20 years ... ... ... ... ... 24 24 20 and under 25 years 1 2 ... ... 3 40 43 25 and under 35 years 1 ... ... ... 1 79 80 35 and under 45 years 2 3 ... ... 5 74 79 45 and under 65 years ... 1 ... 2 3 44 47 65 years and upwards ... ... ... ... ... 3 3 Totals 26 14 1 2 43 3°7 350 Disposal of Tuberculous Cases, 1916, at End of Year. Under treatment at Dispensaries 165 ,, in Sanatoria 26 at Hospitals 11 ,, in Poor Law Infirmaries 7 by Medical Practitioners 49 Ceased attending through lack of interest 8 Left the Borough 27 Died 24 Sent by Army Medical Boards and found to be tuberculous 33 Total 350 39 Report of the Medical Officer of Health. TABLE XXXIV. Record at end of 1916 of existing Tuberculous Cases for the Years 1913, 1914 and 1915. (Grouped into 12 classes). Class. How disposed of. 1913. 1914. 19I5. 1 Recovered 7 2 2 2 Believed to be keeping well, but not attended during year 41 47 30 3 Much improved. Attending for observation only 34 35 32 4 Still under treatment at Dispensaries- Improving 7 5 19 Stationary 14 14 16 Advancing 2 2 4 5 Under Medical Practitioner 9 2 5 25 6 In Sanatoria 3 4 5 7 In or at Hospitals 4 14 12 8 Lost sight of 4 8 7 9 In Poor Law Infirmaries 2 1 6 10 Ceased attending through lack of interest 5 6 3 11 Left the Borough during the year 15 20 38 12 Died during the year 8 24 40 Total 175 207 239 Left the Borough previous to 1916 70 58 33 Died previous to 1916 75 86 33 Doubtful cases previously classified as Tuberculous now not considered as such 23 28 25 343 379 330 40 Report of the Medical Officer of Health. Specific Treatment. TABLE XXXV. Results of Specific Treatment at end of Year. Recovered. Improved. No change. Disease advanced. Died. Total. Tuberculin 2 27 9 7 2 47 Spenglers I.K. - 5 — — 2 7 Tuberculin and Spenglers I.K. — — — 1 2 3 Totals 2 32 9 8 6 57 During the year 57 cases have received Specific treatment either with Tuberculin or Spenglers I.K. Owing to the War it has been impossible to obtain the latter for some time, and consequently its use has been very strictly limited. The results of Tuberculin have been on the whole satisfactory, in some cases markedly so, but the number of cases suitable for this treatment is limited, as so many of those who might benefit by it are well enough to work and therefore cannot attend regularly. The condition of those cases treated with Tuberculin and I.K., and marked in last year's Report as "recovered," eight in number, is satisfactory, so far there being no relapse. Treatment by autogenous vaccines has been given to a very few selected cases, in all 13 in number. Almost in every case the result has been good. In two the attendances made were not regular enough to get as good results as were expected. Two definite cases of Pulmonary Tuberculosis treated by vaccines for secondary infection, have been practically restored to health. Two others of doubtful diagnosis as regards tuberculosis were treated by vaccines with the consent of their medical attendant and have completely recovered. The others have all derived much benefit. 41 Report of the Medical Officer of Health. During the year 258 examinations of sputum were made by the Tuberculosis Officer. A large number of home visits were made by the Dispensary Nurse, the total for the year being 1,626. These visits are of great assistance in getting instructions given at the Dispensaries, understood and carried out, and also in getting to know of home conditions and circumstances that often make it possible to render practical help. Bacteriological Examination of Sputum. 412 examinations of sputum were made at the Lister Institute: 36 from Clapham, 68 from Putney, 123 from Streatham, 48 from Tooting, and 137 from Wandsworth. In 116 of the cases it was reported that the bacillus had been found. Other Infective Diseases. 19 deaths were caused by other Infective diseases, two in Clapham, three in Putney, five in Streatham, two in Tooting, and seven in Wandsworth. Five of these were under one year, one from one and under two years, two from five and under 15 years, three from 25 and under 45 years, seven from 45 and under 65 years, and one over 65 years. Acute Polio-Myelitis. Seven cases of the above were notified during the year, two from Clapham, three from Streatham. one from Tooting, and one from Wandsworth. One of the cases was under one year of age, three from one and under five years, and three over five years. One of the cases proved fatal. 42 Report of the Medical Officer of Health. Ophthalmia Neonatorum. 32 cases were notified, of which nine were in Clapham, seven in Streatham, one in Tooting, and 15 in Wandsworth. 30 of the cases were visited. 13 were attended at birth by midwives. 12 were treated at hospital as out-patients, one, an illegitimate child, removed to the Workhouse with the mother and could not be traced on discharge, one was born and died in the Union Infirmary, one was born in Clapham Maternity Hospital and returned home to Nottingham, the 17 remaining being treated at home. Two cases removed and could not be traced, and one died from Pneumonia. The 27 remaining cases have recovered. Five cases were notified by registered midwives. Venereal Diseases. Six deaths were stated to have been due to Syphilis, three being of infants from Congenital Syphilis, and three of adults. The Public Health (Venereal Diseases) Regulations, 1916, were issued during the year by the Local Government Board, and under these Regulations, Authorities are given power to provide advice and treatment to those persons suffering from any form of venereal disease, free and secretly. The London County Council is the authority for London, and arrangements have been made by that body with a number of General Hospitals, none of them being situated in this Borough, where persons suffering can have treatment. Glanders and Anthrax Cases. No cases of the above diseases were notified under the above Orders by the Veterinary Inspector of the London County Council. 43 Report of the Medical Officer of Health. NON-INFECTIVE DISEASES. Cancer. The total number of deaths from Cancer and other malignant diseases was 398, 146 of males and 252 of females. 79 of these occurred in Clapham, 28 in Putney, 162 in Streatham, 39 in Tooting, and 90 in Wandsworth. The corrected death rate for the Borough was 1.28 per 1,000, and for the sub-districts as follows:—Clapham 1.35, Putney .99. Streatham .168, Tooting 1.08, and Wandsworth .97. Two of the deaths occurred at five and under 15 years, one at 15 and under 25 years, 45 at 25 and under 45 years, 162 at 45. and under 65 years, and 188 over 65 years. Diseases of the Brain and Nervous System. From these diseases 324 deaths occurred. 76 in Clapham, 32 in Putney, 96 in Streatham, 31 in Tooting, and 89 in Wandsworth. 21 of the deaths were due to Meningitis, 147 to Cerebral Haemorrhage or Apoplexy, 34 to Convulsions, seven to Softening of the Brain, 23 to Paralysis, 27 to General Paralysis of the Insane, nine to Locomotor Ataxy, 14 to Epilepsy, and 42 to other diseases of the Nervous System. Circulatory Diseases. From the above group of diseases, 504 deaths occurred, 195 of which, 97 males and 98 females, were due to Valvular disease of the Heart. 92 of these deaths occurred in Clapham, 62 in Putney, 162 in Streatham, 43 in Tooting, and 145 in Wandsworth. Respiratory Diseases. The total number of deaths was 567. 102 in Clapham, 53 in Putney, 168 in Streatham, 75 in Tooting, and 169 in Wandsworth. A1823 44 Report of the Medical Officer of Health. 284 of the deaths occurred from Bronchitis, 45 from Lobar Pneumonia, 122 from Lobular or Broncho-Pneumonia, 79 from Pneumonia in which the exact form was not distinguished, and 37 from other diseases of the Respiratory Organs. 78 of the deaths were of infants under one year, 41 from one and under two years, 22 from two and under five years, 10 from five and under 15 years, four from 15 and under 25 years, 42 from 25 and under 45 years, 112 from 45 and under 65 years, and 258 over 65 years. Deaths from other Causes. From Appendicitis and Typhlitis 22 deaths, 10 of males and 12 of females, occurred. From Alcoholism, Acute and Chronic, five deaths, two of males and three of females, occurred; and 32, 18 of males and 14 of females, from Cirrhosis of the Liver. From Nephritis and Bright's disease 111 deaths occurred, 66 of males and 45 of females. From Accidents and diseases of Pregnancy and Child Birth 10 deaths occurred. This, added to the number of deaths from Puerperal Fever-viz., nine-gives a total of 19 deaths rafter child-birth, or a proportion of 3.04 per 1,000 births. Diabetes Mellitus was the cause of 33 deaths, 16 of males and 17 of females. Premature Birth and Developmental Diseases. 235 deaths, 139 of males and 96 of females, were registered as having occurred from these diseases. 45 Report of the Medical Officer of Health. 115 of the deaths were due to Premature Birth, 111 to Developmental diseases and nine from other diseases of Early Infancy. 118 were of infants under one year, three from one and under two years, and four 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 XII., which deals with Infantile Mortality. Old Age. 299 deaths, 111 of males and 188 of females, occurred from Old Age. 55 in Clapham, 27 in Putney, 98 in Streatham, 26 in Tooting, and 93 in Wandsworth. All the deaths were of persons over 65 years of age. Violence. 114 deaths, 68 of males and 46 of females, occurred from Violence, 89 of the deaths being due to Accidental, and 16 to Suicidal causes, while nine deaths were caused by other forms of Violence, seven of these being due to injuries received from bombs dropped by enemy aircraft, one was a case of murder and one of misadventure. 15 of the deaths belonged to Clapham, 12 to Putney, -32 to Streatham, 14 to Tooting, and 41 to Wandsworth. In Quests. The next Table shows the number of Inquests held in the Borough during the year, and Table XXXVII. the number of inquests held outside the Borough of persons belonging thereto. 46 Report of the Medical Officer of Health. TABLE XXXVI. Sub-Districts. ' Whole Borough. INQUESTS. Clapham. Putney. Streatham. Tooting. Wandsworth Deaths from Natural Causes 19 10 21 11 36 97 Accidental:— Knocked down by motor vehicles 3 5 1 2 4 15 Falls 1 1 1 2 2 7 Killed by bombs dropped from hostile aircraft .. .. 5 .. .. 5 Drowning .. 2 .. .. 6 8 Fall from bicycle 1 .. .. 1 2 Asphyxia whilst in fit .. 1 .. .. 1 2 Starvation and exposure .. 1 .. .. 1 2 Suffocated in bed with parents .. •• 2 .. .. 2 Food poisoning .. .. .. .. 2 2 Fall from roof 1 .. .. .. .. 1 Injury to hand whilst at .. work .. .. .. .. 1 1 Crushed by falling tree .. 1 .. .. .. 1 Knocked down by train .. • • .. .. .. 1 Knocked down by horse van .. .. .. 1 .. 1 Gunshot wounds .. .. .. .. .. 1 Burns .. .. .. .. 1 1 Meningitis following injury .. .. .. .. .. to nose •• .. .. .. 1 1 suicidal:— .. .. .. .. .. .. Hanging 1 .. 1 1 2 5 Drowning .. 1 .. .. 2 3 Poisoning by Hydrochloric .. .. .. .. .. .. Acid .. .. .. .. 1 1 Poisoning by Oxalic Acid 1 .. .. .. .. 1 ,, ,, Coal Gas .. .. .. .. 1 1 Cut throat .. .. 1 • • .. 1 Gunshot wounds .. .. .. .. 1 1 Threw himself in front of a .. .. .. .. .. .. van .. 1 .. .. .. 1 Threw himself in front of a .. .. .. .. .. tram .. •• •• 1 .. 1 Murder .. 1 .. .. 1 2 Open Verdicts:— .. .. .. .. .. .. Found drowned 1 2 .. .. .. 3 Found dead .. 1 1 .. .. 2 Totals 28 27 35 18 64 172 47 Report of the Medical Officer of Health. 47 TABLE XXXVII. INQUESTS. Sub-Districts. Whole Borough. Clapham. Putney. Streatham. Tooting. | Wandsworth Deaths from Natural Causes 6 2 6 1 7 22 Accidental:— Falls ... ... 7 2 3 12 Knocked down by motor vehicles 4 1 3 2 2 12 Knocked down by tramcar 1 ... 2 ... 2 5 Knocked down by train 2 ... ... ... 1 3 Burns 1 ... 1 1 ... 3 Fall from bicycle 1 1 1 ... ... 3 Killed by bombs dropped from hostile aircraft ... ... 2 ... ... 2 Fall from loft Knocked down by horse ... ... ... 1 1 2 vehicles ... ... ... 1 1 2 Poisoning by coal gas ... ... ... ... 1 1 Fall of iron plate on head ... ... ... ... 1 1 Scalds ... ... ... ... 1 1 Fall from horse roller ... ... ... ... 1 1 Explosion of beer barrel ... ... ... 1 ... 1 ( Fall from window ... ... ... ... 1 1 Food poisoning ... ... 1 ... ... 1 Suicidal:— ... ... ... ... ... ... Cut throat ... ... 1 ... ... 1 Drowning ... ... ... 1 ... 1 Poisoning by Hydrochloric Acid ... ... ... ... 1 1 Poisoning by Oxalic Acid ... ... ... 1 ... 1 ,, Strychnine ... ... ... ... 1 1 ,, Veronal ... 1 ... ... ... 1 Open Verdicts:— ... ... ... ... ... ... Found dead 1 ... ... ... 1 2 Found drowned 1 ... ... ... ... 1 Totals 17 5 24 11 25 82 48 Report of the Medical Officer of Health. Cutting-off Notices. During the year 70 notices with respect to 90 premises were received from the Water Board stating that the supply had been withdrawn. 16 of the premises were in Clapham, 13 in Putney, 34 in Streatham, three in Tooting, and 24 in Wandsworth. The supply was withdrawn for non-payment of rates from 33 premises, from 14 premises in consequence of defects, and in 43 the premises were empty. 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. In Clapham, 23 bodies were removed to the Mortuary, in Streatham 13, and in Wandsworth 117, of which 61 were from Wandsworth, 20 from Putney, 21 from Tooting, and 15 from Battersea—a total of 153, GENERAL SANITARY WORK IN 1916. Revenue Act. During the year five certificates were granted under the above Act, and two refused. The certificates granted referred to six houses or 13 tenements, and that refused to two houses or five tenements. Sanitary Operations. Tables XXXVIII., XXXIX. and XL. show the number and nature of the inspections made during the year by the Male and Female Inspectors respectively. Report of the Medical Officer of Health. 49 TABLE XX XV111. Summary of Sanitary Operations in the Borough during the Year 1916. Clapham. Putney. Streatham Tooting. Wandsworth. Whole Borough. North Ward. South Ward. Streatham Ward. Balham Ward. South field Ward. Fairfield Ward. Spri's field Ward. Number of complaints received and attended to 372 313 153 341 323 384 239 212 307 2644 Number of houses and premises inspected 4684 3082 5457 4249 5280 5024 4193 2735 4771 39475 Number of houses and premises re-inspected 852 1383 790 1468 2309 1971 737 1013 1687 12210 Number of house - to - house inspections 261 39 63 64 316 83 78 74 62 1040 Number of preliminary notices served 444 327 189 313 740 407 257 383 431 3491 Ditto complied with 477 32b 202 345 618 428 255 322 412 3385 Number of statutory notices served 8 11 1 13 221 57 8 22 63 404 Ditto complied with 6 9 1 11 125 52 8 30 55 297 Notices served for periodical removal of manure ... ... ... 2 ... ... ... ... 4 6 Number of rooms disinfected after infective diseases 350 379 223 487 770 826 443 408 597 4483 Bedding stoved 160 172 295 309 189 598 195 212 416 2546 Overcrowding abated 4 ... 1 2 7 6 3 13 9 45 Rooms cleansed and repaired 125 158 149 265 830 345 168 434 430 2904 Staircases cleansed and repaired 60 24 18 44 196 69 21 48 53 533 Drains cleansed and repaired 59 79 51 149 119 84 57 42 79 719 Drains tested 332 64 136 143 458 370 107 165 381 2156 Drains found defective 6 12 56 36 46 83 10 10 47 306 Traps fixed to drains 39 65 2 53 19 ... 2 6 5 191 Bath, lavatory and sink wastes altered to discharge outside over gullies or repaired ... 20 15 35 104 48 4 23 48 297 Rain water pipes disconnected from drains ... 1 ... 15 1 ... 3 ... ... 20 Water closets cleansed and repaired Water closets, separate supply 91 89 90 150 199 105 80 109 124 1037 of water laid on to ... ... 6 ... .... ... ... ... 6 Accumulations of manure, etc.. removed 24 25 40 78 39 34 14 5 14 273 Urinals cleansed, repaired or water laid on to 3 1 3 20 10 3 2 5 2 49 Cesspools abolished ... 38 ... ... ... ... ... Ashpits provided or repaired 52 11 52 122 67 45 52 89 528 Dust complaints received 106 27 72 86 67 35 55 24 45 517 Stables and stables yards drained, paved or cleansed ... 10 2 30 20 26 3 2 8 101 Yards drained, paved or cleansed 14 24 14 39 78 60 35 44 56 364 Unwholesome or dilapidated houses cleansed or repaired ... 16 ... 21 1 4 2 44 Leaky roofs and gutters repaired 138 118 53 106 144 132 34 97 72 894 Damp courses inserted 3 6 14 72 ... 3 22 16 136 Damp conditions remedied 42 34 15 93 69 107 28 48 55 491 Houses re-supplied with water 3 4 12 17 8 5 6 5 10 70 Water cisterns cleansed, covered or repaired 16 38 13 42 57 24 8 36 62 296 Animals kept so as to be a nuisance 3 7 .1 13 13 10 4 9 61 Smoke nuisances reported 1 ... ... 1 1 2 1 1 7 Soil pipes repaired 3 16 10 33 21 5 9 12 11 120 Unclassified nuisances 195 56 24 51 34 27 49 39 29 504 50 Report of the Medical Officer of Health. TABLE XXXIX. DETAILS OF INSPECTIONS AND RE-INSPECTIONS, 1916. (Male Inspectors.) Inspections Re- Inspections. Totals. Number of complaints received and attended to 2,636 ... 2,636 Number of house-to-house inspections 1,040 ... 1,040 Drainage and other sanitary works alter notice 3,055 8,521 11,576 Drainage and other sanitary works voluntary 493 881 1,374 Number of premises inspected on account of : Notifiable diseases 2,757 306 3,063 Measles 3,705 99 3,804 Whooping Cough 272 2 274 Pulmonary Tuberculosis 31 5 36 Other Infective Diseases 361 33 394 Verminous conditions 374 74 448 Periodical Inspections:—- Houses-let-in-Lodgings 325 916 1,241 Underground rooms 1 ... 1 Common Lodging Houses 20 ... 20 Work-places "Factories 419 40 459 Workshops 715 31 746 Workshops (Domestic) 211 47 258 Workplaces 282 115 397 Outworkers' premises 92 22 114 Bakehouses 334 211 545 Restaurant kitchens 205 13 218 Food-places Cowsheds 54 7 61 Piggeries 93 1 94 Dairies and Milkshops 681 74 755 Ice Cream Premises 414 52 466 Slaughterhouses 238 4 242 Places where food is prepared 105 1 106 Offensive trades 20 2 22 Fried Fish shops 176 8 184 Rag and bone stores 88 3 91 Butchers' shops 528 6 534 Greengrocers' shops 337 21 358 Fishmongers' shops 269 5 274 Public House urinals 579 51 630 Other sanitary conveniences, schools, &c. 86 1 87 Smoke observations 41 ... 41 Unsound food 22 2 24 Yards of Mews and Stables I.741 191 1.932 Legal proceedings:— ... (1) Applications and summonses 4 ... 4 (2) Hearings and adjournments 11 ... 11 Other 2,222 83 2,305 Totals 25.037 11,828 36,865 51 Report of the Medical Officer of Health. TABLE XL. DETAILS OF INSPECTIONS AND RE-'INSPECTIONS, 1916. (Female Inspectors.) Inspections. Re-inspections. Totals. Number of complaints received and attended to Number of premises inspected on account 8 .. 8 of:— Puerperal Fever 45 10 55 Ophthalmia Neonatorum 85 3 88 Diarrhoea 87 2 89 Pulmonary Tuberculosis 2,540 106 2,646 Other forms of Tuberculosis 711 4 715 Notification of Births 8,431 142 8,573 Dressmakers' and Milliners' premises Laundries— 430 24 454 Factory 151 13 164 Workshop 240 24 264 Workplace 123 9 132 Other Factories 78 10 88 Other Workshops 169 2 171 Other Workplaces 237 14 251 Domestic Workshops 58 3 61 Outworkers' premises 398 13 411 Other 647 3 650 Totals 14,438 382 14,820 The Table of house-to-house inspections which follows shows the number of houses inspected in each Ward, 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. 52 Report of the Medical Officer of Health. HOUSING, TOWN PLANNING, &c„ ACT, 1909. TABLE XLI. Wards. No. of houses inspected. No. of houses in which defects were found. Percent age of defects to houses inspected. Number of Families living in One room. Two rooms. Three rooms. Four rooms and upwards. Clapham, North 261 144 53.13 37 75 52 230 Clapham, South 39 32 82.05 4 5 24 18 Putney 63 19 30.47 .. 12 37 14 Streatham 64 35 54.68 11 43 22 36 Balham 316 260 82.27 56 151 292 204 Tooting 83 70 84.33 .. .. 111 49 Southfield 78 29 37.18 24 13 3 63 Fairfield 74 73 98.64 26 7 61 5 Springfield 62 50 80.64 29 15 34 22 Whole Borough 1,040 691 68.46 187 321 636 611 Cases of overcrowding were in Crichton Street, Clapham; in College Street', Putney; in Smallwood Road, Hazelhurst Road, Larch Road, Zennor Road, Fernlea Road, Leverson Street, and Besley Street, Streatham; in Fountain Road, Aldis Mews, Letchworth Street, Mellison Road, and Sellincourt Road, Tooting; and in Penwith Road, Burr Road, Point Pleasant, Ram Square, Morie Street, Malva Road, Baylin Road, Herndon Road, Jew's Row, Allfarfhing Lane, Crealock Street, Atheldene Road, Lydden Grove, Delia Street, Burtop Road, and Summerly Street, Wandsworth. 44 notices of reconstruction of drains were sent to the Borough Engineer from this Department: six in Clapham, one in Putney, 12 in Streatham, three in Tooting, and 22 in Wandsworth. Report of the Medical Officer of Health. 53 The total number of houses where the drains were reconstructed during the year was 103:11 in Clapham, 13 in Putney, 34 in Streatham, six in Tooting, and 39 in Wandsworth. During the year 2,156 drains of houses were tested by the Sanitary Inspectors, 396 in Clapham, 136 in Putney, 601 in Streatham, 370 in Tooting, and 653 in Wandsworth, and 306 or 14.1 gper cent. were found to be defective. Of the 306 found defective, 18 were in Clapham, 56 in Putney, 82 in Streatham, 83 in Tooting, and 67 Wandsworth Two complaints of black smoke were received from the Coal Smoke Abatement Society with regard to six premises. These complaints were all at once attended to and the premises Kept under observation. A large amount of work has again been carried out to abate nuisances arising from damp conditions. In all, 491 premises have been dealt with, 76 in Clapham, 15 in Putney, 162 in Streatham, 107 in Tooting, and 131 in Wandsworth; and in 136 of these, nine in Clapham, 86 in Streatham, and 41 in Wandsworth, damp courses have been inserted. Disinfection. The total number of rooms disinfected after the occurrence of cases of infectious disease was 4,483 (729 in Clapham, 223 in Putney, 1,257 in Streatham, 826 in Tooting, and 1,448 in Wandsworth) . 1,905 lots of bedding were stoved at the Disinfecting Station, comprising the following articles: 1,075 beds, 1,175 bolsters, 2,920 pillows, 1,248 mattresses, 197 palliasses. 2,391 sheets, 1,648 quilts, 574 cushions, 17,758 articles of clothing, 4,276 blankets, 42 carpets, and 8,647 extra articles, a total of 41,951 articles. 54 Report of the Medical Officer of Health. Disinfection was also carried out by the Sanitary Staff at premises after non-notifiable diseases, chiefly Cancer, and the sum of £15 16s. 6d. was received for such disinfection. 227 rooms were disinfected with sulphur in consequence of their verminous condition and 58 lots of verminous bedding disinfected. During the year, at the request of the Military Authorities 1,669 articles of clothing and bedding were disinfected and 60 rooms sprayed on account of having been exposed to infection, and 17,515 articles in consequence of their verminous condition. 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 £1,233 13s- 11d. The number of lots of bedding stoved was 1,905. Cost per lot of bedding 12s. 10d. Cleansing of Persons Act. The names of 205 children, 25 belonging to Clapham, six to Putney, 42 to Streatham, 35 to Tooting, and 97 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 it was stated that only the heads of the children were verminous, but in a few cases the body and clothing were stated to be also verminous. These children were cleansed by the officials of the London County Council at the Cleansing Station under the supervision of that Authority. Report of the Medical Officer of Health. 55 16 adults and two children had baths after being in contact with cases of infective diseases. Inspection of Sanitary Conveniences. The number of Sanitary Conveniences inspected was 132, 29 in Clapham, 19 in Putney, 26 in Streatham, 10 in Tooting, and 48 in Wandsworth. 630 inspections were made during the year and 43 notices, chiefly for cleansing, were served and complied with; and 189 inspections of Sanitary Conveniences for females were made by the Female Sanitary Inspectors. Inspection of Premises where Food is prepared for Sale or Sold. During the year 184 inspections have been made of fried fish shops, 534 of butchers' shops, 358 of greengrocers' shops, and 274 of fishmongers' shops, a total of 1,350. 251 of these inspections were in Clapham, 293 in Putney, 343 in Streatham, 154 in Tooting, and 309 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 £29 0s. 0d., and the costs £1 3s. 0d. 56 Report of the Medical Officer of Health. TABLE XLII. Premises. Offences. Result. Fine. Costs. Tooting Market- Exposing bacon for sale which was unfit for human food Convicted 98/- 2/- 37, White Squate, Clapham Contravention of By-laws (water closets) .. 38/- 2/- 57 & 39, Bucharest Rd., Wandsworth Nuisances Order made for abatement of nuisance — 5/- 33, Norroy Road, Putney ,, Summons withdrawn the work having been carr ed out 2/- Tooting Market Exposing meat for sale which was unfit for human food Convicted 398/- 2/- 5 & 6, Charlotte Place, Clapham Absence of dust bins „ 10/- 4/- 165, Elms Road, Clapham Nuisance and Contravention of By-laws (yard paving) Order made for abatement — 2 /- 166, Elms Road, Clapham .. Non-compliance with Order 18/- 2 /- 54, Bedford Hill, Balham Keeping animals (fowls) in an unfit place and manner Convicted 18/- 2/- 870, Garratt Lane, Tooting Contravention of By-laws (water closets and yard paving) Order made for abatement — — 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. 43 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. Inspection of Milkshops, Cowsheds, etc. The following Table shows in concise form the number of milk premises, cowsheds, etc., on the register, the number of Report of the Medical Officer of Health. 57 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 XLIII. premises. NUMBER OF PLACES Number of inspections, 1916. Number of notices, 1916. Number of prosecutions, 1916. On register at end of 1915- Added in 1916. Removed in 1916. On register at end of 1916. Milk premises 400 25 20 405 755 30 .. Cowsheds 11 ... ... 11 61 1 ... Slaughter-houses 12 ... ... 12 242 1 ... Other offensive trade premises 3 1 ... 4 22 1 ... Ice cream premises 347 6 10 343 466 24 1 Registered houses let in lodgings 292 ... ... 292 1,241 *a 12 *b 5l6 ... *a For overcrowding. * b For other conditions. Unsound Food. Two trunks of dabs, one trunk of dog-fish, two boxes of mackerel, two barrels of crabs, 32 boxes of tomatoes, 50 boxes of apples, two sacks of potatoes, three boxes of grapes, eight fowls, and 350 pounds of beef were destroyed at the request of the owners and the usual certificates granted. Two convictions were obtained for exposing unsound meat for sale, and fines amounting to £24 16s. were inflicted with 2s. costs. FACTORIES AND WORKSHOPS. There has been a decrease in the total number of inspections of the above, compared with 1915, 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. 58 Report of the Medical Officer of Health. INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. TABLE XLIV. CLASS OF WORKS. Number of Places Number of Inspections, 1916. Number of Notices. Number of Prosecutions, 1916. On Register at end of 1915. Added in 1916. Removed in 1916. On Register at end of 1916. Intimation, 1916. Statutory, 1916. Under Factory Act. Under Public Health Act. Premises Rooms. Factories Factory Laundries 95 3 11 87 348 188 4 ... ... ... ' Factory Bakehouses 33 6 39 58 129 6 ... ... ... Other Factories 350 25 10 356 1,143 523 47 1 ... ... Workshops Workshop Laundries 125 5 13 117 328 264 8 ... ... ... Workshop Bakehouses 114 ... 6 108 108 416 8 ... ... ... Other Workshops 1,410 75 169 1,316 1,752 1,690 71 4 ... ... Workplaces Places where Food is prepared for Sale 602 10 45 567 604 730 62 ... ... ... Workplaces other than the above 556 47 74 529 776 814 19 1 ... ... Home-workers' premises 511 79 189 401 401 525 14 1 ... ... Total 3.796 250 526 3.520 5,518 5,279 239 8 ... ... Report of the Medical Officer of Health. 59 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. Factories, Workshops, Laundries, Workplaces and Homework. TABLE XLV. 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.) 840 58 ... Workshops (Including Workshop Laundries.) 2,370 91 ... Workplaces (Other than Outworkers' premises included in Part 3 of this report.) 1,544 83 ... Totals 4,754 232 ... A1825 e 6o Report of the Medical Officer of Health. TABLE XLVI. 2.—DEFECTS FOUND Particulars. Number of Defects Number of Prosecutions. Found. Remedied Referred to H.M Inspector. (1) (a) (3) (4) (5) Nuisances under the Public Health Acts:—* ... Want of Cleanliness 91 87 ... ... Want of Ventilation ... ... ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other nuisances 141 136 ... ... Sanitary accommodation insufficient 7 7 ... ... unsuitable or defective 65 65 .. ... not separate for sexes 10 10 ... ... Offences under the Factory and Workshop Act:— ... ... ... ... Illegal occupation of underground bakehouse (S. 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 14 14 ... ... Other offences (Excluding offences relating to outwork, which are included in Part.3 of this report.) ... ... ... ... Totals 328 319 ... ... *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. 61 Report of the Medical Officer of Health. TABLE XLV1I. 3.—HOME WORK. NATURE OF WORK.* OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 10*. 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 i 11 s pec tion of lists. Failing to send lists. Instances. Notices served. Prosecutions. Instances, j Orders made (S. 110). Prosecutions (SS.109,110). Lists† Outworkerst Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, &c. 82 103 223 7 7 25 23 16 14 26 (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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Racquet and tennis balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper Bags and Boxes 4 ... 22 ... ... ... ... ... ... ... ... ... ... ... ... Brush making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pea picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carding, &c., of buttons, &c Stuffed Toys 2 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... Basket making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 90 109 250 7 7 25 23 ... ... 16 14 26 ... ... * If an occupier gives out work of more than one of the classes specified in column 1, 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. 62 Report of the Medical Officer of Health. The total number of addresses received from other Councils was 543, and 264 addresses were forwarded to other Councils. The number of addresses received has increased by 34, and the number sent decreased by 75. 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 23, and these had a most satisfactory result. During the year 26 cases of infective diseases, five of Scarlet Fever, five of Diphtheria, one of Erysipelas, 11 of Measles, and four of German Measles, were notified as having occurred in the homes of outworkers. In none of these cases was it necessary to make any order under Section 110 of the Factory and Workshop Act. TABLE XLVIII. 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. Workshop Bakehouses 108 „ Laundries 117 Dressmakers' and Milliners' Workshops 233 Bootmakers 128 Smiths 43 Builders 63 Tailors 69 Other 780 Total number of workshops on Register 1,541 63 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. TABLE XLIX. 5.—OTHER MATTERS. Class. (0 Number. (3) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 25 Action taken in matters referred by H.M. Inspector as remediable under] Notified by H.M. Inspector... 5 the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Reports (of action taken) sent to H.M. Inspector 5 Other Underground Bakehouses (s. 101):— Certificates granted during the year ... In use at the end of the year 41 64 Report of the Medical Officer of Health. TABLE L. Clapham. Putney. Streatham. Tooting. • Wandsworth. Total. I.—Factories inspected 191 85 16 11 145 448 ,, re-inspected 25 32 16 18 49 140 Sanitary conveniences insufficient ... ... ... ... 6 6 ,, ,, unsuitable ... ... ... ... 1 1 ,, ,, not separate for sexes ... 5 ... ... ... 5 „ ,, defective 4 5 ... ... 14 23 Other nuisances 9 1 ... 3 13 26 Intimation notices served 8 11 ... 1 25 45 Statutory notices served ... ... ... 1 1 Legal proceedings ... ... ... ... ... ... II.—Workshops inspected 387 145 95 43 261 931 ,, re-inspected 71 29 47 34 50 231 Workrooms inspected 392 147 115 46 349 1049 ,, found overcrowded ... ... ... ... ... ,, insufficiently ventilated ... ... ... ... ... ... ,, in a dirty condition ... 1 6 6 10 28 Sanitary conveniences insufficient ... ... ... ... ... ... ,r „ unsuitable ... ... ... ... ... ... ,, ,, not separate for sexes ... ... ... ... ... ... ,, ,, defective 8 3 3 8 22 Other nuisances 12 2 2 5 10 3' Intimation notices served 18 6 6 0 24 60 Statutory notices served 1 ... 1 1 1 4 Legal proceedings ... ... ... ... ... ... Number of workrooms measured 18 4 ... .. ... 24 Number of workroom cards distributed ... ... ... ... ... ... Workshops reported to H.M. Inspector on discovery ... ... ... ... ... ... Workshops reported by H.M. Inspector ... 1 2 ... 2 5 III.—Domestic workshops inspected 79 32 33 20 47 211 ,, ,, re-inspected 2 1 18 17 9 47 Workrooms found overcrowded ... ... ... ... ... ,, insufficiently ventilated ... ... ... ... ... ... ,, in a dirty condition ... 1 1 1 2 5 Other nuisances 2 ... 3 1 6 12 Intimation notices served 2 1 4 2 5. 14 Statutory notices served ... ... ... ... ... ... Legal proceedings ... ... ... ... ... ... Domestic workshops reported to H.M. Inspector on discovery ... ... ... ... ... ... IV.—Workplaces inspected 449 56 97 1l6 257 975 ,, re-inspected 40 29 33 21 63 186 Workrooms inspected 508 69 97 117 258 1049 ,, found overcrowded ... ... ... ... ,, insufficiently ventilated ... ... ... ... ,, in a dirty condition 4 5 4 3 27 43 Report of the Medical Officer of Health. 65 TABLE L.— continued. Clapham. Putney. Streatham. Tooting. Wandsworth. Total. Sanitary conveniences insufficient ... ... ... ... 1 1 „ ,, unsuitable ... ... ... ... ... ... ,, ,, not separate for sexes ... 4 ... ... 1 5 ,, „ defective 3 ... ... 1 6 10 Other nuisances 12 ... 5 1 25 43 Intimation notices served 16 9 7 3 41 76 Statutory notices served 1 ... ... ... 1 2 Legal proceedings ... ... ... ... ... •• V.—Home work ... ... ... ... ... ... Premises inspected 25 11 7 12 37 92 „ re-inspected 4 ... 2 6 10 22 Workrooms found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... ... ... ... ... ,, in a dirty condition ... ... 1 ... 5 6 Other nuisances 4 ... ... 1 2 7 Intimation notices served 3 ... 1 1 6 11 Statutory notices served ... ... ... 1 ... 1 Legal proceedings ... ... ... ... ... Cases of infective diseases notified 2 1 4 2 2 11 Houses visited for inquiry and no workroom found 4 ... ... ... ... 4 Total number of premises inspected 1131 3-29 248 202 747 2657 „ „ „ re-inspected 142 9> 116 96 181 626 ,, „ intimation notices served 47 27 18 13 IOI 206 „ ,, intimation notices complied with 40 27 18 13 100 198 ,. „ statu ory notices served 2 ... 1 2 3 8 ,, ,, statutory notices complied with 1 ... 1 2 3 7 „ legal proceedings ... ... ... ... ... ... Table LI. 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. 66 Report of the Medical Officer of Health. TABLE LI. SUMMARY OF PRINCIPAL TRADES CARRIED ON IN WORKSHOPS WHERE MEN ARE EMPLOYED. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. Bootmakers 28 18 39 14 29 128 Bakers 29 11 27 9 32 108 Tailors 17 13 30 3 6 69 Builders 23 12 14 1 13 63 Smiths 16 7 8 2 10 43 Cycle Makers 8 3 9 2 10 32 Wheelwrights 11 1 10 1 8 31 Upholsterers 7 6 10 ... 7 30 Hair dressers 6 12 5 ... 3 26 Motor Engineers 8 1 5 1 7 22 Watchmakers 8 1 1 ... 5 16 Undertakers 4 1 3 4 12 Joiners 4 1 1 ... 4 10 Printers 2 1 4 ... 3 10 Harness Makers 3 ... 5 1 1 10 Photographers 3 4 1 ... 1 9 Plumbers 6 2 ... ... 1 9 Boat Builders 8 ... ... 1 9 Cabinet Makers 1 2 ... ... 1 4 Ironmongers 1 ... 1 ... 2 4 Rag Sorters ... 3 1 4 Wood Choppers 2 ... 1 ... ... 3 Tarpaulin and Scale Makers 1 ... ... ... 1 .2 Other Trades 37 12 32 4 41 126 Totals 225 ii5 205 44 191 780 The Tables which follow summarise the work done during the year by the female Sanitary Inspectors. Only five of the workshops, (one in Putney, one in Streatham, two in Tooting, and one in Wandsworth), reported by H.M. Inspector were unknown to the Sanitary Inspectors. The other 15 had been previously reported to H.M. Inspector, or were already on the Register. Report of the Medical Officer of Health. 67 TABLE LII. Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. I.—Fctories inspected 62 14 32 8 113 229 ,, re-inspected 4 2 3 ... 14 23 Sanitary conveniences insufficient ... ... ... ... ... ,, ,, unsuitable ... ... ... ... ... „ ,, not separate for sexes ... ... ... ... ... ... ,, ,, defective 2 1 ... ... 3 6 Other nuisances ... ... 1 ... ... 6 Intimation notices served 2 1 1 ... 8 12 Statutory notices served ... ... ... ... Legal proceedings ... ... ... ... ... II.—Workshops inspected 193 151 302 44 149 839 ,, re-inspected 13 18 115 2 2 5° Workrooms inspected 333 208 39' 80 3'4 1326 „ found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... ... ... ... ... „ in a dirty condition Sanitary conveniences insufficient ... ... 2 ... ... ... ... ... ... ... ... ... ,, ,, unsuitable ... ... ... ... ... ... ,, „ not separate for sexes ... ... ... ... ... ... „ ,, defective ... ... 2 ... 1 3 Other nuisances 2 ... s ... ... 9 Intimation notices served 2 ... 7 ... 1 13 Statutory notices served ... ... ... ... ... ... Legal proceedings ... ... ... ... ... ... Number of workrooms measured 5 11 11 ... 15 42 Number of workroom cards distributed 7 7 21 2 1 38 Workshops reported to H.M Inspector 2 4 7 2 7 22 „ by „ „ 1 7 3 2 7 20 III.—Domestic workshops inspected 8 5 18 5 22 58 ,, ,, re-inspected ... ... 2 1 ... 3 Workrooms found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... ... ... ... ... ,, in a dirty condition ... ... ... ... ... ... Other nuisances ... ... ... ... ... ... Intimation notices served ... ... ... ... ... ... Statutory notices served ... ... ... ... ... ... Legal proceedings Domestic workshops reported to H.M. ... ... ... ... ... ... Inspector 1 ... ... ... 2 3 IV.—Workplaces inspected 82 40 126 38 74 360 ,, re-inspected Workrooms inspected 4 3 11 4 1 23 124 56 163 48 104 495 ,, found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... ... ... ... ... ,, in a dirty condition ... ... ... ... ... Sanitary conveniences insufficient ... ... ... ... ... ... ,, ,, unsuitable ... ... ... ... ... ... „ ,, not separate for sexes ... ... ... ... ... ... ,, ,, defective ... ... ... ... ... ... Other nuisances 2 1 2 ... ... 5 Intimation notices served 2 1 2 ... ... 5 68 Report of the Medical Officer of Health. TABLE LI I.—continued. Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. Statutory notices served Legal proceedings ... ... .... ... ... V.—Home work. ... ... ... ... ... ... Premises inspected 121 13 85 31 148 398 „ re-inspected 3 3 3 3 1 13 Workrooms found overcrowded ... ... ... ... ... ... ,, insufficiently ventilated ... ... ... ... ... „ in a dirty condition ... ... ... ... 1 1 Other nuisances ... 1 ... ... 1 2 Intimation notices served ... 1 ... ... 2 3 Statutory notices served ... ... ... ... ... Legal proceedings ... ... ... ... ... ... Cases of infective disease notified 5 ... 2 1 7 15 Houses visited for inquiry and no workroom found 57 28 70 28 90 273 Total number of premises inspected 466 223 563 126 506 1884 „ ,, „ re-inspected 24 26 34 10 18 112 ,, intimation notices served 6 6 10 ... 11 33 ,f ,, ,, complied with 6 6 10 ... 10 32 ,, statutory notices served ... ... ... ... ... ... ,, ,, ,, complied with ,, legal proceedings ... ... ... ... ... ... ... ... ... ... ... ... Table LIII. shows the number of factories, workshops, domestic workshops, and workplaces on the Register at the close of 1915, the number removed from, the number added during 1916, and the number on the Register at the end of 1916. The number of workrooms in workshops is also shown. 69 Report of the Medical Officer of Health. TABLE LI II. Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. *1 2 3 Total. > 2 3 Total. I 2 3 Total. 2 3 Total. 1 2 3 Total. 1 2 3 Total. Factories on Register, 1915 ... 12 14 26 ... 5 4 9 ... 15 3 18 ... 1 1 2 ... 40 15 55 ... 73 37 110 ,, removed from Register ... 1 1 ... 1 1 2 ... 1 ... 1 ... ... 1 1 ... 6 2 8 ... 9 4 13 ,, added to Register, 1916 ... ... 2 2 ... ... ... ... ... ... 2 2 ... ... 1 I ... 3 6 9 ... 3 11 14 ,, on Register, 1916 ... 11 16 27 ... 4 3 7 118 14 5 19 ... 1 1 2 ... 37 19 56 ... 67 44 111 Workshops on Register, 1915 39 29 27 95 47 12 14 73 33 53 204 15 7 9 31 34 44 10 88 253 125 113 491 ,, removed from Register 3 S 6 14 7 3 10 21 3 8 32 2 1 7 10 7 10 2 19 40 22 23 85 , added to Register, 1916 1 1 2 7 3 10 7 2 5 14 2 ... 1 3 3 3 3 9 20 5 13 38 ,, on Register, 1916 37 24 22 83 47 9 17 73 104 32 50 18b 15 6 3 24 30 37 21 78 233 108 103 444 Number of workrooms therein 39 67 38 144 60 23 20 103 119 97 59 275 15 17 3 35 35 124 13 172 268 328 133 729 Domestic workshops on Register, 1915 9 8 '9 5 22 63 ,, removed from Register 1 3 2 9 15 , added to Register, 1916 2 4 6 ,, on Register, 1916 9 7 18 3 '7 54 *2 3 Total. 2 3 Total. 2 3 Total. 2 3 Total. 2 3 Total. 2 3 Total. Workplaces on Register, 1915 17 41 58 9 24 33 31 74 105 11 28 39 23 66 89 91 233 324 removed from Register 6 6 12 5 5 5 14 19 3 3 1 15 16 12 43 55 ,, added to Register, 1916 3 4 1 4 5 2 7 9 6 6 1 11 12 7 32 39 „ on Register, 1916 14 39 53 10 23 33 28 67 95 11 31 42 23 62 85 86 222 308 Number of workrooms therein 30 39 69 21 23 44 47 67 114 22 31 53 47 62 109 191 222 413 * (1) Dressmakers and Milliners, (2) Laundries, (3) Miscellaneous, 70 Report of the Medical Officer of Health. Table LIV. shows the nature of the trades carried on in the workshops where females are employed inspected. TABLE LIV. Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. Art Needle workers ... 1 6 ... ... 7 Blouse Makers 4 2 5 ... ... 11 Box Makers 1 ... ... ... ... 2 Confectionery Maker ... 1 ... ... 1 Corset Makers 2 1 5 ... ... 8 Costumiers 1 3 2 ... 1 7 Dressing Gown Makers 2 ... 1 ... 3 Dressmakers 68 60 151 39 92 410 Druggists' Sundries Maker 1 ... ... ... ... 1 Ecclesiastical Embroiderer ... ... 1 ... ... 1 Engraver 1 ... ... ... ... 1 Feather Curlers and Cleaners 1 ... 2 2 1 6 Firework Case Maker ... ... 1 ... 1 Florists ... 6 ... ... 6 Furriers 1 2 1 1 4 Glove Maker ... ... ... 1 1 Gold Embroiderer 1 ... ... ... ... 1 Hairworker 1 ... ... ... 1 Haversack Makers 3 ... ... ... 3 Hosiers 2 ... 1 1 1 5 Lace Maker 1 ... ... 1 Lampsh.de Maker 1 ... ... ... 1 Laundries (Workshops) 24 9 32 6 37 108 Laundries (Workplaces) 14 10 28 11 23 86 Linen Embroiderer ... 1 ... ... 1 Maker of Celluloid Articles 1 ... ... ... 1 Mat Maker ... 1 ... ... 1 Metal Polisher ... ... ... 1 T Milliners 14 16 30 ... 10 77 Munition Maker 1 ... ... ... 1 Outfitters 5 ... 8 ... 6 20 Paper Bag Maker 1 ... ... ... ... 1 Paper Cap Maker ... ... 1 ... ... 1 Papier Poudre Maker ... ... 1 ... ... 1 Polish and Paint Maker ... ... 1 ... ... 1 Seed Packers 2 ... ... ... ... 2 Shoe Upper Maker 1 ... ... ... ... 1 Tailors 1 1 17 ... ... 22 Tea Gown Maker ... 1 ... ... ... 1 Toy Maker ... ... 1 ... ... 1 Upholsterer 1 ... ... ... ... 1 Vest Maker ... ... ... 1 ... 1 Waterproof Maker 1 ... ... ... ... 1 Totals 148 114 302 70 178 812 71 Report of the Medical Officer of Health. Military Billets. During the year several premises were taken for the billeting of soldiers, and these premises were all inspected. In all 1,150 inspections were made by the Sanitary Inspectors (740 in Putney, 27 in Streatham, and 383 in Wandsworth). Canal Boats Act. During the year 31 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. 32 workshops were visited by the Inspector and the materials used for bedding and upholstery were examined. 20 examples were procured and submitted for analysis, and two of these were reported as not complying with the standard of cleanliness required. It was found that the two samples reported against were not intended to be used and should have been destroyed. The proprietor was warned, and on a subsequent visit the samples were found to be satisfactory. Statement of Work done under the Sale of Food and Drugs Acts. During the year 1,798 samples of foods and drugs were submitted to the Public Analyst for analysis. Of these samples 954 were purchased as test or informal samples, while 844 were purchased officially. 72 Report of the Medical Officer of Health. Of the 844 official samples submitted for analysis 87, or 10.3 per cent. were reported to be adulterated or not up to standard, and of those samples which were purchased informally or as test samples 68, or 7.1 per cent. were found adulterated or not up to standard. The total adulterations reported were 155, or 8.6 per cent. of the samples submitted. The percentage of milk samples found to be adulterated was 8 2. In 55 out of the 87 cases in which adulterations were detected in the official samples proceedings were instituted against the vendor, and the total amount received in penalties under the above Acts during the year amounted to £110 os. od., and the costs to £33 3s. 6d., making a total of £143 3s. 6d. Report oj the Medical Officer of Health. 73 TABLE LV. Case No. Article. Adulteration. Result. • Fine. Costs. 28 Milk 4 per cent. extraneous water Convicted 25/- 10/6 63 ,, 10 per cent. „ ,, ,, 30/- 10/6 70 96 ,, 8 per cent. „ ,, 5 per cent. „ „ Warranty proved. Su.nmons dismissed Convicted 45/- - 104 Butter 100 per cent. Margarine ,, 40/- 10/6 105 85 per cent ,, ,, 40/- 14/6 106 100 per cent.,, ,, 400/- — 124 Milk 8 per cent. milk fat deficient Warranty proved. — — 136 ,, 17 per cent. extraneous water Summons dismissed Convicted 40/- 12/6 138 ,, 6.5 per cent. „ „ Warranty proved. Summons dismissed — — 140 ,, 33 per cent. milk fat deficient Same defendant. Warranty proved. Summons dismissed — — 142 ,, 16 per cent. „ „ — - 154 Butter 90 per cent. Margarine Same defendant. Convicted - 21/- 165 ,, 100 per cent. „ 200/- 19/- 169 Milk 13 per cent. extraneous water Convicted 30/- 12/6 200 ,, 26 per cent. milk fat deficient Warranty proved. Summcns dismissed — — 288 Cream •25 per cent. Crystallised Boric Acid Withdrawn on payment of costs - 12/6 291 .21 per cent. „ „ - 12/6 292 ,, .07 per cent. „ „ - 12/6 330 Milk .20 per cent. milk fat deficient Warranty proved. Summons dismissed — 333 Cream .33 per cent. Crystallised Boric Acid Withdrawn on payment of costs - 12/6 334 ,, 33 per cent. „ „ - 12/6 335 '27 per cent. „ „ - 12/6 336 .34 per cent. „ „ - 12/6 361 Butter 56 per cent. margarine Convicted 60/- 17/- 377 Milk 16 per cent. milk fat deficient Warranty proved. Su nmons dismissed — — 389 ,, 8 per cent. „ „ Convicted 100/- 42/- 425 ,, .0 per cent. „ „ Same defendant. Warranty proved Summons dismissed. - — 426 ,, 5 per cent. „ „ - - 427 ,, 10 per cent. ,, ,, Warranty proved. — 455 ,, 8 per cent. ,, „ Summons dismissed Warranty proved. Summous dismissed - — 463 ,, 10 per cent. ,, „ Ordered to pay costs - 40/- 509 Butter q7 per cent. margarine Convicted 40/- 10/6 5" Milk 6*5 per cent. extraneous water Warranty proved. - 512 ,, 7 per cent, milk fat deficient Summons dismissed Warranty proved. - 515 ,, 7 per cent. „ „ Summons dismissed Convicted 10/- 10/6 74 Report of the Medical Officer of Health. TABLE LV.—continued. Case No. Article. Adulteration. Result. Fine. Costs. 584 Milk 10 per cent. milk fat deficient Warranty proved. Summons dismissed - - 602 ,, 6 per cent. extraneous water Ordered to pay costs — 42/- 621 ,, 18 per cent. milk fat deficient Warranty proved. Summons dismissed — — 633 Skimmed Milk 47 per cent. extraneous water Convicted 100/- — 64r Milk 7 per cent, milk fat deficient ,, 40/- 20J- 644 „ 6 per cent, extraneous water ,, 40/- 20/- 645 ,, 3 per cent. ,, „ Same defendant 40/- 20/- 653 ,, 6 per cent. „ ,, Warranty proved. Summons dismissed — — 704 ,, 17 per cent. ,, „ Convicted 200/- 40/- 710 ,, 18 per cent. „ „ Ordered to pay costs — 21/- 781 ,, 16 per cent. 11 ilk fat deficient ... Warranty proved. Summons dismissed — — 812 ,, 3 per cent. extraneous water Convicted 10/- 10/6 824 ,, 5 5 per cent. „ „ Warranty proved. Summons dismissed — — 843 Butter 50 per cent. Margarine Convicted 100/- 13/6 844 ,, 25 per cent. „ ,, 100/- 13/6 Report of the Medical Officer of Health. 75 PROCEEDINGS UNDER THE MARGARINE ACT. TABLE LVl. Case No. Description of Offence. Result. Fine. Costs. 104 Selling Margarine in an unstamped wrapper Withdrawn — — 105 ,, ,, — — 106 ,, ,, — — 165 ,, Ordered to pay costs — 2/- 290 Exposing Margarine for sale without proper label Convicted 20/- 12/6 361 Selling Margarine in an unstamped wrapper Ordered to pay costs — 2/- 361 Selling Margarine containing more than 10 per cent. of butter fat ,, - 2/- 509 Selling Margarine in an unstamped wrapper Convicted 40/- — 740 Exposing Margarine without proper label ,, 20/- 10/6 740 Selling Margarine in an unstamped wrapper Summons withdrawn — — 742 ,, Convicted 20/- 13/6 742 Selling Margarine containing more than 10 per cent. of butter fat Ordered to pay costs - 2/- 821 Selling Margarine in an unstamped wrapper Convicted 200/- 100/- 843 Selling Margarine in an unstamped wrapper and for selling Margarine containing more than 10 per cent. of butter fat Summons withdrawn - - 844 ,, ,, ,, - — A1823 76 Report of the Medical Officer of Health. OTHER OFFENCES. TABLE L VII. Nature of Offence. Result. Fine. Costs. Obstructing Inspector Convicted £10 - 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. TABLE LVIII. 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. Adu1terated. Percentage Adulterated. Clapham 180 19 10.5 192 16 8.3 372 6.5 35 9.4 Putney 91 9 9.8 94 9 9.5 185 6.5 18 9.7 Streatham 200 *4 7.0 293 17 5.8 493 4.1 31 6.3 Tooting 159 22 13.8 162 14 8.6 321 8.9 36 11.2 Wandsworth 214 23 10.7 231 12 5.6 427 4.6 35 8.2 Whole Borough 844 87 103 954 68 7.1 1,708 5.7 155 86 Report of the Medical Officer of Health 77 Milk and Cream. MILK. 799 samples of milk were procured for analysis during the year. 66 or 8.2 per cent. were reported against as being adulterated or not up to legal standard. 782 samples were purchased officially, of which 64 or 8.1 per cent. were adulterated, and 17 samples purchased informally, of which two or 119 per cent. was reported against. 38 samples were found to contain added water, 25 were deficient in milk fat, and three were deficient in milk fat and contained added water. Proceedings were taken in 35 cases, and in 29 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. 46 samples of milk were taken on delivery at various Public Institutions situated within the Borough. All these samples were reported to be genuine. 32 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. All these samples were genuine. 78 Report of the Medical Officer of Health. Four samples of milk were procured during the early morning, (from 3 to 4 a.m.), from wholesale dealers whilst delivering milk to the retailer. These samples were genuine. 33 samples of milk were procured on delivery at private houses, seven of which were reported as being adulterated. Proceedings were taken in four cases and convictions obtained. 152 samples of milk have been taken on Sundays, either in the early morning or at mid-day. 16 or 10.5 per cent. were reported against as being adulterated. 420 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 32 or 7.6 per cent. were reported against. Ten samples of milk were taken from automatic milk supply machines and all were reported to be genuine. In 19 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, and therefore dismissed the summonses. Proceedings were also taken for wilful obstruction. The vendor preferred to throw the milk down the drain rather than serve the Inspector. A penalty of £10 was inflicted. CREAM AND PRESERVED CREAM. 48 samples of cream and 38 of preserved cream were taken during the year. 16 or 33.3 per cent. of the samples of cream were reported against as containing a preservative. Summonses were issued against seven of the vendors, as a warning, the summonses being withdrawn on payment of costs. Report of the Medical Officer of Health. 79 REPORT ON ADMINISTRATION IN CONNECTION WITH THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. Report for the year ended 31 st December, 1916. 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 799 Nil. Cream 48 16 Nature of preservative in each case in column (b). CREAM. 16 samples of cream were found to contain crystallised Boric Acid in amounts varying from 4.9 grains per lb. (.07 per cent.) to 287 grains per lb. ( .41 per cent.). 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, but in seven instances summonses were issued under sect. 3 of the Sale of Food and Drugs Act. These summonses were withdrawn on payment of costs. (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 38 (2). Statements incorrect 0 Total 38 8o Report of the Medical Officer of Health. (b) Determinations made of milk-fat in cream sold as Preserved Cream:— (1). Above 35 per cent. 38 (2). Below 35 per cent. 0 Total 38 (c) and (d). In each of the 38 samples procured as Preserved Cream the provisions as to labelling were duly observed. (3). Thickening Substances Nil. (4). Other Observations Nil. Butter and Margarine. BUTTER. 698 samples of butter were submitted for analysis during the year, of which 56 or 8 per cent. were reported against. Of the 698 samples of butter analysed, 40 samples were taken officially, 11 or 27.2 per cent. were reported against, whereas of those samples taken informally 45 or 67 per cent. were found to be adulterated. In 11 cases proceedings were instituted against the vendors of the adulterated samples. The penalties and costs amounted to £54 15s 6d. MARGARINE. Nine samples of margarine were submitted for analysis, and all returned as genuine with the exception of one sample which was found to be butter. There were four convictions under the Margarine Act, these being in connection with the Sale of Margarine as butter. Report of the Medical Officer of Health. 81 OTHER ARTICLES. A full list of the articles of food and drugs examined under the Sale of Food and Drugs Acts, together with the analytical results, is contained in the Report of the Public Analyst at the end of this Report. STAFF. As I was on service in the London District 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 continued to supervise tne 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, Dr. P. Nicol has carried out the work at both Dispensaries in a very thorough and satisfactory manner. The members of the staff mentioned in the 1914 Report are still serving in the forces, and the work is being carried on by temporary substitutes. The staff has been augmented by the appointment of an additional Health Visitor, Miss E. K. Woods, who commenced her duties in February, 1916. 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. I have the honour to be, Mr. Mayor and Gentlemen, Your obedient Servant, P. CALDWELL SMITH. 82 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 nave the honour to present the Annual Statement of the work done during the year 1916 under the Sale of Food and Drugs Acts. The total number of samples submitted by the Inspector during the year amounted to 1,798. Of these, 844 were taken with the formalities required by the Sale of Food and Drugs Acts, whilst 954 were obtained informally. The statement following gives the result of analyses of all articles submitted; while 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." Report of the Medical Officer of Health. 83 Main Statement showing the result of Analyses of all Articles submitted under the Sale of Food and Drugs Acts during the year 1916 by Inspector Newell. No of samples examined. No, of samples found adulterated or not up to standard. Formal Informal Total Formal Informal Total Milk and Cream 797 88 885 72 10 82 Butter 40 658 698 11 45 56 Margarine 3 6 9 1 0 1 Lard — 21 21 — 0 0 Bread — 4 4 — 0 0 Flour - 8 8 - 1 1 Tea - 1 1 - 1 1 Coffee - 37 37 - 0 0 Cocoa — 7 7 - 0 0 Sugar — 6 6 — 0 0 Mustard - 3 3 0 0 Jam — 2 2 — 2 2 Pepper — 9 9 — 0 0 Drugs 2 34 36 1 4 5 Other Articles 2 70 72 2 6 8 Total 844 954 1798 87 68 155 84 Report of the Medical Officer of Health Table A Details of Drugs in foregoing Table. Drugs. No. of samples examined. No. of samples found adulterated or not up to standard. Formal. Informal. Total. Formal. Informal. Total. Cream of Tartar 1 7 8 0 1 1 Friar's Balsam - 2 2 - 0 0 Lime Water - 3 3 - 6 0 Lotion as prescribed - 4 4 - 2 2 Mixture as prescribed 1 6 7 1 1 2 Ointment, Boric Acid - 1 1 - 0 0 White ppt. - 1 1 - 0 0 „ Zinc - 1 1 - 0 0 Oxymel of Squills - 1 1 - 0 0 Pills, Iron - 2 2 - 0 0 Powder, Liq Comp. - 1 1 - 0 0 ,, Seidlitz - 2 2 - 0 0 Spirit of Camphor - 1 1 - 0 0 Syrup of Squills -' 1 1 - 0 0 Tincture of Rhubarb - 1 1 - 0 0 Total 2 34 36 1 4 5 Report of the Medical Officer of Health. 85 Table B. Details of "Other Articles" in Main Statement. Other Articles. No. of samples examined. No. of samples found adulterated or not up to standard. Formal. Informal. Total. Formal. Informal. Total. Almonds (ground) 1 2 3 1 1 2 Arrowroot 1 3 4 1 1 2 Baking Powder 0 13 13 0 0 0 Cinnamon (ground) 0 1 1 0 0 0 Coffee and Chicory 0 2 2 0 1 1 Coconut (desiccated) .. 0 3 3 0 1 1 Cornflour 0 3 3 0 0 0 Custard Powder 0 3 3 0 0 0 Egg Powder 0 5 5 0 0 0 Fruits in Syrup 0 6 6 0 0 0 Ginger (ground) 0 3 3 0 1 1 Honey 0 6 6 0 0 0 Jellv, Table .. 0 6 6 0 0 0 Oatmeal 0 3 3 0 0 0 Self-raising "Flour 0 9 9 0 1 1 Soup (desiccated) 0 1 1 0 0 0 Tomatoes, tinned 0 1 1 0 0 0 Total 2 70 72 2 6 8 36 Report of the Medical Officer of Health. MILK AND CREAM. The articles grouped under this head were as under:— No. of samples examined. No. of samples found adulterated or not up to standard. Formal. Informal. Total. Formal. Informal. Total. Milk 776 17 793 62 2 64 Skim Milk 1 0 1 1 0 1 Separated Milk 5 0 5 1 0 1 Cream, fresh 10 38 48 8 8 l6 Cream, preserved 5 33 38 0 0 0 797 88 885 72 10 82 There were three forms of adulteration in the case of the milk The nature and samples reported against; namely, deficiency in adulteration milk fat, presence of extraneous water, and a reported. combination of both these. Deficiency in milk fat occurred in 25 samples, and ranged from 1 per cent. to 30 per cent. Extraneous water, in amounts varying from 1 per cent. to 18 per cent., was found in 34 samples; whilst extraneous water with a deficiency in milk fat was found in three samples. The one sample of Separated Milk reported against contained 2.4 per cent. extraneous water, and the one sample of Skim Milk submitted and reported against contained 47 per cent. extraneous water. The two Informal samples of Milk reported against both contained extraneous water. In no case was preservative found in milk. Report of the Medical Officer of Health. 87 The average composition of the 729 samples of Milk returned as genuine during the year was as under:— Total milk solids 12.39 Per cent Milk-fat 3.55 Solids-not-fat 884 „ Of the Creams purchased as fresh, 16 were found to contain Crystallised Boric Acid in amounts varying from 4 9 grains per pound (0.07 per cent.) to 287 grains per pound (0.41 per cent.). BUTTER. 698 samples of Butter were submitted during the year, 40 being taken with the necessary formalities required by the Acts, and 658 being obtained informally. All the samples reported against were found to contain Margarine, with the exception of three samples, Nature and extent of the adulteration which contained an excess of Boron preservareported tive. All samples were examined for the presence of preservatives, The presence of with the result that out of the 642 samples rePreservatives tuined as genuine, 139 were found to contain no preservative other than salt. The average content of Boron preservative (in terms of Crystallised Boric Acid) contained in the 503 samples of Butter (reported as genuine) which contained this preservative amounted to 0.27 per cent., equivalent to 18.9 grains per lb. Butter. MARGARINE. Nine samples of Margarine were submitted, three being taken with, the formalities required by the Acts, and six being submitted informally. The one sample reported against proved on analysis to be Butter. 88 Report of the Medical Officer of Health. All samples of Margarine were examined for the presence of The presence of preservative, with the result that of the nine Preservatives. samples submitted, five were found to contain a Boron preservative, whilst four contained no preservative other than salt. The average content of Boron preservative (in terms of Crystallised Boric Acid), amounted to 0 22 per cent., equivalent to 15 4 grains per lb. Margarine. FLOUR. Of the eight samples of Flour submitted all informally— one was reported against as containing Meal Mites (Acarus Farinae). JAM. The two samples of Jam submitted, both informally, were reported against as containing Glucose. / DRUGS. • Of the 36 samples of Drugs submitted, two were taken with the necessary formalities of the Acts, and 34 were obtained informally. The following five were reported against- Nature of Sample. Nature of Report. * Formal. Mixture as prescribed 28 5 per cent. excess Iodine and 30per (Tine. 10d. Fort.) cent. Potassium Iodide. Informal. Mixture as prescribed Compound in place of simple mixture (Mist. Pot. Brom.) supplied. Lotion as prescribed Deficient in Boric Acid. (Lotio Acidi Borici) Lotion as prescribed Deficient in Boric Acid. (Lotio Acidi Borici) Cream of Tartar Containing excess of Lead. 8g WAN 4 Report of the Medical Officer of Health. OTHER ARTICLES. 72 "Other Articles" were submitted, two being taken with the necessary formalities required by the Acts, and 70 being obtained informally. The following eight were reported against:- Nature of Sample. Nature of Report. Formal. Arrowroot 100 per cent. Potato Flour. Ground Almond* Containing a trace of Potato Flour. Informal. Ground Ginger Desiccated Coconut Containing some Parley grain. Containing a slight trace of Maize starch. Arrowroot Ground Almonds . Self-raising Flour • Potato starch. Containing a trace of Arrowroot. Containing excess of Calcium Sulphate in the Acid Calcium Phosphate employed in its manufacture. Coffee and Chicory 62 per cent. Chicory. In conclusion, I have to report that the adulteration for the year for all articles submitted amounted to 8.6 per cent.; for articles submitted formally to 10.3 per cent,; and for those submitted informally to 71 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. 5th March, 1917.