WAN 63 Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, &c. OF THE BOROUGH, FOR THE YEAR 1917, by P. CALDWELL SMITH, M.A., M.D., Camb., Medical Officer of Health, TOGETHER WITH THE Report of the Public Analyst. Printed for the Council by ODHAMS LIMITED, 93-94, Long Acre, London, W.C. INDEX. page Analyst, Report of 76 Anthrax Orders 44 Appendicitis and Typhlitis 45 Bacteriological Examinations 19, 42 Bakehouses 61 Births 2 Births and Birth-rates in Sub-Districts 2 Births, Notification of, Act 3 Brain and Nervous System, Diseases of the 44 Canal Boats Act 67 Cancer 44 Census, 1911 1 Cerebro-Spinal Fever 18 Circulatory Diseases 45 Clapham, House-to-House Inspections in 54 Cleansing of Persons Act 56 Conscientious Objection Certificates granted 14 Cowsheds 59 Cutting-off Notices 50 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 Defence of the Realm Regulations, Contraventions under 59 Developmental Diseases 46 Diarrhœa 21 Diarrhoea, Death-rate from 22 ii. page Diarrhœa, Method of Feeding Children who died from 22 Diphtheria 17 Diphtheria, Number of Dwellings in which multiple Cases occurred 17 Diphtheria, " Return Cases "of 18 Disinfection 55 Dininfection of Schools 21 Enteric fever 18 Erysipelas 20 Factories and Workshops 60 Factories, Workshops and Workplaces, Inspection of 61 Feeding of Infants, Report of Female Inspectors on 23 Food Control 67 Food Places, Inspection of 57 Fountain Road School, Cases of peeling of skin in 16 German Measles, Cases of 20 Glanders and Anthrax Orders 44 Home Work 64 House Refuse, Removal of 59 House-to-house Inspections 51 House-to-house Inspections, Summary of 54 Houses and Premises Inspected 51 Houses Let in Lodgings 60 Housing, Town Planning, etc., Act, 1909 54 Ice Cream Premises 60 Illegitimate Children, Births of 2 Infant Visiting 23 Infant Welfare 26 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 52, 53 Inquests 47 iii. PAGE Margarine Act, Proceedings under 74 Maternity and Child Welfare Centres 26 Measles 20 Measles and other Non-notifiable Diseases reported from Schools 21 Milk and Cream Regulations, 1912 72 Milk Premises, Cowsheds, etc., on Register 60 Milkshops 59 Military Billets 67 Mistaken Diagnosis, Cases of 18 Mortuaries 50 Natural Increase, Rate of 2 Nervous System, Diseases of the 44 Non-Infective Diseases 44 Notification of Births Act 3 Notification of Infective Diseases 11, 14 Offensive Trades 60 Old Age 46 Ophthalmia Neonatorum 43 Other Infective Diseases 42 Outworkers 64 Overcrowding 54 Police Court Proceedings 57 Polio-Myelitis 43 Population 1 Population of Sub-Districts 1 Premature Birth 46 Puerperal Fever 19 Pulmonary Tuberculosis, Notification of Cases of 27 Putney, House-to-house Inspections in 54 Rag Flock Act, 1911, Statement of work done under 69 Report of Tuberculosis Officer 32 Respiratory Diseases 45 Return Cases of Scarlet Fever and Diphtheria 18 Revenue Act 50 Sale of Food and Drugs Act, Proceedings under 69 Sale of Food and Drugs Acts, Statement of Work under 69 iv PAGE Sanitary Operations, Table of 51 Sanitary Work, General 50 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 60 Small-pox 14 Smoke Nuisances 52 Staff 74 Streatham, House-to-house Inspections in 54 Tooting, House-to-house Inspections in 54 Tuberculin treatment 35 Tuberculosis Dispensaries 32 Tuberculosis Officer, Report of 32 Tuberculous Diseases 26 Underground Rooms 52 Unsound Food 60 Urinals in Connection with Licensed Premises, Inspection of 57 Vaccination Returns 14 Venereal Diseases 43 Violence, Mortality from 47 Vital Statistics of Whole Borough 10 Wandsworth, House-to-house Inspections in 54 Water Supply, Cutting-off Notices 50 Whooping Cough 21 Zymotic Diseases, Deaths from 13 Zymotic Diseases, Death-rate from 13 REPORT of the Medical Officer of Health for the Year 1917. 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 1917. Population. The civil population of the Borough to the middle of 1917 has been estimated by the Registrar General to be 300,787 for the purpose of calculating death rates and 335,292 for birth-rates. An enumeration of the sugar cards issued showed the population to be 320,000. Table I. shows the population of each sub-district based on the above estimation of the Registrar General compared with the Census population. TABLE I. Sub-District. Census Population, 1911. Population estimated to middle of 1917. For death-rates. For birth-rates. Clapham 58,592 56,602 63,097 Putney 28,242 27,282 30,413 Streatham 96,192 92,929 103,586 Tooting 35,958 34.736 38,722 Wandsworth 92,376 89,238 99,474 Whole Borough 311,360 300,787 335.292 The estimated 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 29th December, 1917, 4,936 births, 2,541 of males and 2,395 of females, were registered, compared with 6,246 in 1916. The total number of births registered in this Borough was 4,696, but 267 births occurred in Institutions outside the Borough of persons belonging to the Borough, and 27 births in Institutions in the Borough of persons not belonging to the Borough, making a corrected total of 4,936. The diminution in the number is purely owing to war conditions. 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 490 467 957 15.16 2.39 Putney 170 177 347 11.40 .76 Streatham 779 744 1,523 14.70 1.63 Tooting 339 323 662 17.09 5.03 Wandsworth 763 684 1,447 14.54 1.88 Whole Borough 2,541 2,395 4,936 14.72 2.03 76 births occurred in the Workhouse, 49 of which belonged to the Borough. 350 illegitimate births took place in the Borough, 27 of these belonging to Clapham, 17 to Putney, 208 to Streatham, 28 to Tooting, and 70 to Wandsworth. Of the 208 illegitimate births that occurred in Streatham, 160 took place in a private home in that sub-district. 33 illegitimate births were also registered outside the Borough, making a total of 383. The percentage cf illegitimate births to total births was 7.7. 3 Report of the Medical Officer of Health. 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 830 301 244 195 90 957 15 Putney 321 108 72 126 '5 347 6 Streatham 1,459 359 482 432 186 1,523 22 Tooting 648 99 171 354 24 662 16 Wandsworth 1,473 345 363 701 64 1,447 35 Whole Borough 4,731 1,212 1,332 1,808 379 4,936 94 The percentage of births notified, less still-births, to those registered was 95 4. Deaths. During the 52 weeks ending the 29th December, 1917, 3,555 deaths, 1,696 of males and 1,859 of females were registered, compared with 3,568 in 1916. 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. Wands'th. Total. Hostel of God 70 ... ... ... ... 70 South London Hospital for Women 23 ... ... ... ... 23 St. Anne's Home ... ... 8 ... ... 8 Middlesex County Asylum ... ... ... ... 236 236 Fountain Asylum ... ... ... 84 ... 84 H. M. Prison ... ... ... ... 3 3 Workhouse ... ... ... ... 12 12 Royal Hospital for Incurables ... ... ... ... 22 22 Tooting Bec Asylum ... ... ... 396 ... 396 The Priory ... 1 ... ... ... 1 Putney Hospital ... 26 ... ... ... 26 Newlands House Asylum ... ... ... 1 ... 1 Military Hospitals ... 8 2 53 62 125 TOTAL 93 35 10 534 335 1,007 Other places 68 19 32 6 27 152 GRAND TOTAL 161 54 42 540 362 1,159 5 Report of the Medical Officer of Health. TABLE V. Deaths in Public Institutions in the Borough of Persons not belonging to the Borough, 1917. causes of death. Deaths in or belonging to whole District at subjoined ages. Institutions. All Ages. Males. Females. Under i year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65 65 and upwards. Middlesex County Asylum. Tooting Bee Asylum. Hostel of God. Newlands House Asylum. 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, not Public Institutions. Enteric Fever 1 ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza 7 2 5 ... ... ... ... ... ... 5 2 3 ... ... ... ... ... 2 ... ... ... 1 ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases 5 4 1 ... ... ... 1 1 2 1 ... 1 ... ... ... ... ... ... ... ... 1 ... ... 3 ... Pulmonary Tuberculosis 134 80 54 ... ... ... 7 37 60 22 8 53 9 24 ... ... 1 2 ... ... 4 1 ... 39 1 Tuberculous Menineitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis 3 2 1 ... ... ... ... 3 ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... Other Tuberculous Diseases 8 6 2 1 ... ... ... 2 2 3 ... 1 3 ... ... ... ... ... ... ... ... 1 ... 2 Other Infective Diseases 2 1 1 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Cancer, Malignant Disease 73 33 40 ... ... ... ... 1 10 41 21 4 6 34 ... ... ... 1 ... 2 ... 5 ... 4 17 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diabetes 2 2 ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Other General Diseases 10 3 7 ... ... ... ... 2 2 ... 6 ... 1 ... ... ... ... 2 ... ... ... 1 ... 2 4 Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Poisonings 3 ... 3 ... ... ... ... 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Haemorrhage, Apoplexy 40 22 18 ... ... ... ... ... 4 14 22 11 14 ... ... 2 ... 1 ... ... 1 ... 1 ... 10 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Nervous System 170 114 56 ... ... 1 32 27 52 48 10 83 14 ... 1 ... ... 6 ... ... 55 1 ... 7 3 Organic Diseases of Heart 51 25 26 ... ... 1 1 1 6 19 23 17 16 ... ... ... ... ... ... ... 1 1 1 1 14 Other Diseases of Circulatory System 9 5 4 ... ... ... ... 1 2 1 5 1 2 ... ... ... ... 3 ... ... ... ... ... 3 ... Bronchitis 14 5 9 ... ... ... ... ... ... 3 11 4 1 ... ... ... ... 1 1 ... ... ... 3 ... 4 Broncho-Pneumonia 15 7 8 1 ... 1 8 2 1 2 ... ... 2 ... ... ... ... ... ... ... 10 ... ... ... 3 Lobar Pneumonia 4 1 3 ... ... ... ... ... ... 2 2 1 2 ... ... ... ... 1 ... ... ... ... ... ... ... Pneumonia (type not distinguished) 28 20 8 ... ... ... 2 2 10 4 10 7 12 ... ... ... ... ... ... ... 3 1 ... 4 1 Other Diseases of Respiratory System 6 2 4 ... ... ... ... ... ... 3 3 ... 2 ... ... ... ... 2 ... 1 ... ... 1 ... ... Ulcer of Stomach . 2 ... 2 ... ... ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... Diarrhoea 3 1 2 ... ... ... ... ... ... 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 Enteritis 6 4 2 1 1 ... ... ... 1 3 ... 3 1 ... ... ... ... ... ... 1 ... ... ... ... 1 Appendicitis and Typhlitis 8 4 4 ... ... ... 1 2 3 2 ... ... ... ... ... ... ... ... ... 1 ... 2 ... 4 1 Obstruction of Intestines 4 2 2 ... ... ... ... ... 1 3 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 2 Cirrhosis of Liver 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Other Diseases of Liver 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Other Diseases of Digestive System 6 4 2 ... ... ... ... ... 3 1 2 ... ... ... ... ... ... ... ... 1 ... 1 ... 3 1 Nephritis and Bright's Disease 19 12 7 ... ... ... ... 1 4 8 6 2 8 1 ... ... ... ... ... ... 1 1 ... 3 3 Other Diseases of Urinary System 4 3 1 ... ... ... ... ... ... 2 2 1 ... ... ... ... ... ... ... 1 ... ... ... ... 2 Diseases of Generative System 2 ... 2 ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Premature Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Debility and Malformation 12 7 5 4 ... 2 4 1 ... 1 ... ... ... ... ... 2 ... 1 ... ... 7 ... ... ... 2 Other Diseases of Early Infancy 2 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Old Age 346 124 212 ... ... ... ... ... ... 14 332 38 289 ... ... 2 ... ... ... ... ... ... 2 ... 15 Deaths from Accident 12 8 4 ... ... ... 2 1 1 2 6 ... 4 ... ... ... ... ... ... 1 ... ... ... 1 6 Deaths from Suicide 3 2 1 ... ... ... ... ... 2 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 Other Violent Deaths 47 47 ... ... ... ... ... 19 26 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 47 ... Other defined Diseases 3 3 ... ... ... ... ......... ... 1 2 ... 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... Ill-defined Diseases or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... All causes 1067 566 501 11 1 5 58 105 196 217 474 236 387 61 1 7 1 22 1 11 83 20 8 125 104 6 Report of the Medical Officer of Health. TABLE VI. Deaths in Public Institutions, &c., in the Borough of Persons belonging to the Borough, 1917. CAUSES OF DEATH Deaths in or belonging to whole District at subjoined ages. Institutions. All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Workhouse. Tooting Bec Asylum. H.M. Prison. Putney Hospital. Fountain Temporary Asylum. Hostel of God. South London Hospital for Women. Other Places—not Institutions. Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebrospinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 4 1 3 ... ... ... ... 1 1 2 ... ... ... ... ... ... 4 ... ... Tuberculous Meningitis 2 2 ... ... ... 1 1 ... ... ... ... ... ... ... 2 ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Infective Diseases 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Cancer, Malignant Disease 12 3 9 ... ... ... ... ... 1 4 7 ... ... ... 3 ... 3 ... 6 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diabetes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other General Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 3 1 2 1 ... 1 1 ... ... ... ... ... 2 ... ... ... ... ... 1 Cerebral Haemorrhage, Apoplexy 4 1 3 ... ... ... ... ... 1 ... 3 ... 1 ... 1 ... ... ... 2 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Nervous System 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... Organic Diseases of Heart 7 3 4 ... ... ... ... ... 3 1 3 ... ... 1 1 ... ... 1 4 Other Diseases of Circulatory System 4 1 3 ... ... ... ... ... ... 3 1 ... ... ... ... ... 1 ... 3 Bronchitis 6 4 2 ... 1 ... ... ... ... 2 3 3 ... 1 ... ... ... ... 2 Broncho-Pneumonia 3 1 2 ... ... 1 ... ... 1 ... 1 ... ... ... 1 ... ... ... 2 Lobar Pneumonia 1 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... Pneumonia (type not distinguished) 2 2 ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... 1 Other Diseases of Respiratory System 2 1 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 1 Ulcer of Stomach ... 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... Diarrhoea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteritis 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Appendicitis and Typhlitis 2 ... 2 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 1 Obstruction of Intestines ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Digestive System 3 1 2 ... ... ... ... ... 1 2 ... ... ... ... 2 ... ... ... 1 Nephritis and Bright's Disease 4 3 1 ... ... ... ... ... 1 2 1 ... ... ... 1 ... 1 ... 2 Other Diseases of Urinary System 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... Diseases of Generative System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 2 1 1 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Congenital Debility and Malformation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Early Infancy 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Old Age 9 3 6 ... ... ... ... ... ... ... 9 1 5 ... ... ... ... ... ... Deaths from Accident 9 5 4 1 ... ... 5 ... ... 1 2 ... ... ... ... ... ... ... 3 Deaths from Suicide 2 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 9 Other Violent Deaths 2 1 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 2 Other defined Diseases 3 2 1 ... ... ... 1 ... ... 1 1 ... ... ... 1 ... ... ... 2 Ill-defined Diseases or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... All causes 92 44 48 6 1 3 8 2 13 27 32 5 9 2 15 1 9 3 48 7 Report of the Medical Officer of Health In the next Table the number of deaths in Institutions outside the Borough is given in detail. TABLE VII. Deaths in Public Institutions, &c., outside the Borough, of Persons belonging to the Borough, 1917. 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. 45 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 6 4 2 ... ... ... 1 ... 3 2 ... 1 1 1 ... 3 ... 2 3 1 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 21 12 9 3 9 8 1 ... ... ... ... 2 ... 2 8 9 9 ... ... 12 Scarlet Fever 12 5 7 ... 1 2 8 1 ... ... ... 3 ... 5 2 2 ... 2 ... 10 Whooping Cough 6 3 3 3 ... 3 ... ... ... ... ... 1 1 ... ... 4 4 1 ... 1 Diphtheria and Membranous Croup 31 9 22 1 5 9 15 1 ... ... ... 9 ... ... 5 10 ... 3 ... 28 Influenza 3 1 2 ... ... ... ... ... 1 ... 2 ... ... 1 ... 2 ... 2 1 ... Erysipelas 3 1 2 1 ... ... ... ... ... 2 ... ... ... 1 ... 2 3 ... ... ... Cerebro-spinal Fever 6 3 3 ... ... 3 2 1 ... ... ... ... ... 4 1 1 1 3 ... 2 Other Epidemic Diseases 4 2 2 ... ... ... ... ... 1 2 1 ... ... 1 ... 3 ... 1 3 ... Pulmonary Tuberculosis 150 70 80 2 1 1 7 27 68 40 4 21 13 41 20 55 70 36 44 ... Tuberculous Meningitis 19 11 8 4 1 4 7 1 2 ... ... 2 1 5 2 9 6 8 ... 5 Abdominal Tuberculosis 9 2 7 2 ... 2 2 1 1 ... 1 2 1 4 ... 2 3 5 ... 1 Other Tuberculous Diseases 16 8 8 1 ... 2 2 3 6 1 1 2 ... 6 4 4 6 8 2 ... Other Infective Diseases 11 8 3 4 2 ... 1 ... 1 2 1 1 1 3 ... 6 8 3 ... ... Cancer, Malignant Disease 141 60 81 ... 1 2 ... 1 4 67 46 28 14 48 15 36 70 65 6 ... Rheumatic Fever 2 ... 2 ... ... ... 1 ... ... 1 ... 1 1 ... ... ... ... 2 ... ... Diabetes 13 8 5 ... ... ... ... 1 2 4 6 5 ... 2 4 2 7 5 1 ... Other General Diseases 13 6 7 1 ... ... 2 ... 3 3 4 4 ... 3 ... 5 4 9 ... ... Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 5 2 3 1 1 ... ... ... 2 1 ... 1 ... 1 1 1 1 2 1 1 Cerebral Haemorrhage, Apoplexy 50 24 26 ... ... ... ... ... 3 14 33 8 3 18 5 16 39 8 3 ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Nervous System 79 54 25 ... 2 1 3 2 26 35 10 17 12 23 9 18 21 12 45 1 Organic Diseases of Heart 136 67 69 ... ... ... 1 3 15 43 74 28 14 34 21 39 97 16 23 ... Other diseases of Circulatory System 46 33 13 ... ... ... 1 1 11 13 20 9 1 16 6 14 22 14 9 1 Bronchitis 46 23 23 2 ... 1 ... ... ... 8 35 9 ... 14 3 15 35 6 5 ... Broncho-Pneumonia 45 25 20 16 5 7 1 1 4 5 6 9 10 12 2 12 25 15 5 ... Lobar Pneumonia 17 5 12 ... ... ... 1 1 9 4 2 3 ... 8 1 5 2 4 11 ... Pneumonia (type not distinguished) 17 11 6 2 ... 1 ... ... 6 6 2 5 ... 5 3 4 6 6 4 1 Other Diseases of Respiratory System 6 2 4 ... ... ... ... ... ... 1 5 1 1 2 1 1 4 1 1 ... Ulcer of Stomach 6 5 1 ... ... ... ... ... ... 4 2 ... 1 3 ... 2 1 5 ... ... Diarrhoea 11 6 5 9 1 1 ... ... ... ... ... ... ... 3 3 4 5 6 ... ... Enteritis 21 15 6 17 1 ... ... 1 ... ... 2 5 ... 1 5 10 11 10 ... ... Appendicitis and Typhlitis 18 11 7 ... ... ... 5 4 4 4 1 7 3 6 2 ... 3 15 ... ... Obstruction of Intestines 19 9 19 3 1 ... ... ... .5 6 4 5 ... 6 ... 8 5 14 ... ... Cirrhosis of Liver 6 2 4 ... ... ... ... ... ... 3 3 1 1 2 ... 2 4 2 ... ... Other Diseases of Liver 6 3 3 ... ... ... ... ... ... 3 3 4 ... ... ... 2 1 5 ... ... Other Diseases of Digestive System 20 9 11 1 ... 1 2 ... 7 8 1 4 2 7 1 6 4 15 1 ... Nephritis and Bright's Disease 45 19 26 1 ... 1 ... 1 6 20 16 10 3 13 4 15 22 13 10 ... Other Diseases of Urinary System 23 21 2 1 ... ... ... ... 1 4 17 9 1 9 1 3 12 11 ... ... Diseases of Generative System 5 ... 5 ... ... ... ... 1 2 2 ... 2 ... ... 1 2 ... 5 ... ... Puerperal Fever 6 ... 6 ... ... ... ... 1 5 ... ... 1 ... ... 2 ... 1 1 ... 4 Other Accidents and Diseases of Pregnancy and Childbirth 2 ... 2 ... ... ... ... 1 1 ... ... 1 1 ... ... ... ... 2 ... ... Premature Birth 14 7 7 14 ... ... ... ... ... ... ... 2 1 3 4 4 5 9 ... ... Congenital Debility and Malformation 46 28 18 42 3 1 ... ... ... ... ... 5 3 15 13 10 31 15 ... ... Other Diseases of Early Infancy 3 2 1 3 ... ... ... ... ... ... ... 1 ... 1 ... 1 1 2 ... ... Old Age 84 30 54 ... ... ... ... ... ... 2 82 27 8 17 8 24 64 3 17 ... Deaths from Accident 63 45 18 2 ... 6 7 6 13 16 13 13 4 17 8 21 26 35 2 ... Deaths from Suicide 9 6 3 ... ... ... ... ... 5 3 ... 1 ... 5 1 2 3 6 ... ... Other Violent Deaths 10 5 5 ... ... 1 2 2 1 4 ... 3 1 3 2 1 ... 10 ... ... Other defined Diseases 9 7 2 2 1 ... 1 1 1 2 1 ... 3 2 ... 4 7 1 1 ... Ill-defined Diseases or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... All causes 1339 689 650 138 35 57 73 63 239 335 399 274 112 380 169 404 649 424 198 68 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 3,819, 1,807 of males, and 2,012 of females. The corrected death-rate for the year was 12.69 compared with 11.80 in 1916. The death-rate for the whole of London for the year was 15.0 per 1,000, compared with 14.3 in 1916. 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 348 375 723 258 326 584 12.77 Putney 153 179 332 118 141 259 12.16 Streatham 558 657 1,215 378 475 853 13.07 Tooting 202 217 419 409 386 795 12.06 Wandsworth 546 584 1,130 533 531 1,064 12.69 Whole Borough 1,807 2,012 1,819 1,696 1,859 3.555 12.69 The death-rate in England and Wales in 1917 was 14.4 per 1,000 ; in the 96 great Towns 14.6 ; ana in the 148 smaller Towns 13.2. The rates in all the sub-districts were higher than in 1916. 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. 9 Report of the Medical Officer of Health. TABLE IX. Causes of, and Ages at Death, during the year 1917. 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 7 5 2 ... ... ... 1 ... 3 3 ... 1 1 2 ... 3 1 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 129 62 67 21 18 48 10 1 ... 1 ... 11 ... 15 29 74 ... Scarlet Fever 13 6 7 ... 1 3 8 ... 1 ... ... 4 ... 5 2 2 ... Whooping Cough 29 9 20 13 5 11 ... ... ... ... ... 2 2 2 2 21 ... Diphtheria, and Membranous Croup 37 13 24 1 5 10 19 2 ... ... ... 11 ... 8 7 11 ... Influenza 56 25 31 2 1 1 ... 2 7 15 28 8 9 23 3 13 7 Erysipelas 6 3 3 1 ... ... ... ... ... 3 2 1 1 1 1 2 ... Cerebro-spinal Fever 11 6 5 ... 1 4 3 2 1 ... ... ... ... 8 ... 3 ... Other Epidemic Diseases 6 4 2 ... ... ... ... ... 2 2 2 ... 1 2 ... 3 5 Pulmonary Tuberculosis 339 163 176 2 2 3 12 70 154 83 13 61 25 95 42 116 138 Tuberculous Meningitis 41 22 19 6 4 10 14 4 2 1 ... 6 3 13 5 14 2 Abdominal Tuberculosis 13 4 11 3 ... 3 5 1 2 ... 1 2 1 7 1 4 3 Other Tuberculous Diseases 29 18 11 1 1 4 3 7 7 4 2 ... ... 11 6 8 8 Other Infective Diseases 15 12 3 6 1 1 1 1 4 1 ... 1 5 1 7 2 Cancer.Malignant Disease 407 156 251 ... 2 3 ... 3 46 185 168 79 34 162 34 93 85 Rheumatic Fever 5 1 4 ... ... ... 2 ... 1 2 ... 9 7 l ... ... ... Diabetes 31 17 14 ... ... ... 1 1 2 11 16 ... 2 11 5 8 2 Other General Diseases 41 13 28 2 ... ... 3 2 6 10 18 9 2 16 3 11 9 Alcoholism 4 1 3 ... ... ... ... ... 1 3 ... 1 ... 2 ... 1 ... Chronic Poisonings 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 3 Meningitis 15 7 8 4 3 2 2 ... 2 2 ... 2 1 4 4 4 3 Cerebral Haemorrhage, Apoplexy 188 84 104 1 ... ... ... 2 4 51 130 34 17 73 14 50 45 Convulsions 11 5 6 6 3 1 1 ... ... ... ... 4 ... ... 1 6 ... Other Diseases of Nervous System 130 73 57 ... 2 3 6 6 32 47 34 32 15 48 13 32 171 Organic Diseases of Heart 411 170 241 ... ... 1 4 11 40 114 235 77 43 129 40 122 58 Other Diseases of Circulatory System 140 71 69 1 1 ... 2 1 10 38 78 22 18 58 14 28 13 Bronchitis 317 142 175 30 11 6 2 ... 10 68 190 71 33 91 32 90 20 Broncho-Pneumonia 14 76 71 51 21 22 2 3 8 14 2 26 23 40 15 43 18 Lobar Pneumonia 51 27 24 3 2 1 1 1 15 20 8 9 ... 27 3 11 5 Pneumonia (type not distinguished) 104 58 46 15 12 12 3 3 16 23 20 19 5 28 8 44 30 Other Diseases of Respiratory System 45 21 24 3 1 1 2 ... 6 12 20 7 2 15 10 11 8 Ulcer of Stomach 15 6 9 ... ... ... ... ... 6 5 4 2 2 6 ... 5 3 Diarrhoea 34 17 17 25 5 2 ... ... ... ... 2 7 1 9 5 12 3 Enteritis 44 25 19 29 6 1 1 1 ... 2 4 11 2 2 10 16 7 Appendicitis andTyphlitis 22 11 11 ... ... ... 6 5 5 5 1 8 4 7 2 1 10 Obstruction of Intestines 42 20 22 4 2 ... 1 ... 6 12 17 9 1 14 2 16 4 Cirrhosis of Liver 21 12 9 ... ... ... ... ... 1 11 9 2 1 12 1 5 1 Other Diseases of Liver... 10 5 5 1 1 ... ... ... ... 4 4 5 ... 2 ... ... ... Other Diseases of Digestive System 59 2 36 8 2 1 5 2 11 22 8 9 4 21 6 19 9 Nephritis and Bright's Disease 123 67 56 1 ... 2 ... 1 19 53 47 24 16 41 9 33 23 Other Diseases of Urinary System 44 42 2 1 ... ... ... ... 2 4 37 15 4 15 3 7 5 Diseases of Generative System 7 ... 7 ... ... ... ... 1 2 3 1 3 ... ... 1 3 2 Puerperal Fever 6 ... 6 ... ... ... ... 1 5 ... ... 1 ... ... 2 3 ... Other Accidents and Diseases of Pregnancy and Childbirth 6 ... 6 ... ... ... ... 2 4 ... ... 1 2 ... 1 2 1 Premature Birth 65 40 25 65 ... ... ... ... ... ... ... 12 5 19 11 18 2 Congenital Debility and Malformation 107 67 40 102 3 1 1 ... ... ... ... 14 8 31 26 28 12 Other Diseases of Early Infancy 1 8 9 17 ... ... ... ... ... ... ... 5 2 4 ... 8 3 Old Age 257 91 166 ... ... ... ... ... ... 2 255 63 22 78 26 68 355 Deaths from Accident 92 58 34 9 ... 6 13 7 17 18 22 21 6 26 13 26 21 Deaths from Suicide 17 13 4 ... ... ... ... ... 7 9 1 4 ... 6 1 6 Other Violent Deaths 17 11 6 ... ... 1 2 2 5 7 ... 3 3 7 2 2 5 Other defined Diseases 27 15 12 5 1 1 2 2 2 6 8 4 7 7 3 6 6 Ill-defined Diseases or unknown 6 1 5 1 ... ... ... ... ... 4 1 1 ... 3 ... 2 ... All causes. 3819 1807 2012 440 17 165 138 146 486 883 1414 723 332 121 419 1130 1159 10 Report of the Medical Officer of Health. TABLE X. Wandsworth District. Vital Statistics of Whole District during 1917 and previous years. (Table I.) Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths : Nett Deaths Belonging to the District. Uncorrected Number. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate per 1000 Nett Births. Number. Rate. Number. Rate. Number. Rate. 1 3 3 4 5 6 7 8 9 10 11 12 13[/##] 1912 313,761 6,580 6,756 21,53 3,118 9.77 767 940 516 76 3,291 10.48 1913 321,340 6,679 6,838 20,87 3,344 10.04 822 1,066 605 88 3,588 10.95 1914 326,945 6,690 6,684 20,44 3,332 10.02 824 1,155 589 88 3,664 11.20 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 1917 300,787 4,696 4,936 14,72 3,555 11.81 1,067 1,339 440 89 3,,89 12.69 Area of District in acres (exclusive of area covered by water) 9,126 Total population at all ages 311,360' Number of inhabited houses 48,432 Average number of persons pet house 6.42 , At Census of 1911 11 Report of the Medical Officer of Health. TABLE XI. Wandsworth District. Cases of Infectious Disease notified during the year 1917. (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. Putney. Streatham. Tooting. Wandsworth. Under 1. 1 to 5. 5 to 15. 5 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera, Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 435 6 116 257 34 22 ... ... 103 30 96 82 124 391 Erysipelas 103 3 3 7 5 23 45 17 18 7 26 18 34 11 Scarlet Fever 566 1 111 375 54 25 ... ... 105 16 131 146 168 523 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 47 ... ... 13 11 17 6 ... 9 4 9 3 22 35 Continued Fever 2 ... ... ... ... 2 ... ... ... 1 1 ... ... ... Puerperal Fever 14 ... ... ... 2 12 ... ... 3 1 1 4 5 12 Cerebro-spinal Meningitis 26 1 9 8 4 4 ... ... 4 ... 12 4 6 17 Polio-Myelitis 5 ... 3 1 1 ... ... ... ... 1 1 2 1 4 Pulmonary Tuberculosis 622 4 8 63 152 281 99 15 115 43 174 89 201 ... Other forms of Tuberculosis 193 7 38 73 29 31 11 4 31 9 47 29 77 ... Ophthalmia Neonatorum 29 29 ... ... ... ... ... ... 9 1 3 5 11 ... Measles 5.371 184 2,030 2,744 262 143 8 ... 866 178 1,518 910 1,899 ... German Mealses 2,006 203 973 501 278 29 1 347 155 1,072 70 362 ... Totals 9,419 256 2,521 4,514 1.055 838 198 37 1,610 446 3,091 1,362 2,910 993 A3134 B 12 Report of the Medical Officer of Health. TABLE XII, (Table IV.) Borough of Wandsworth. Infant Mortality. 1917.. Nett Deaths from stated causes at various Ages under 1 Year of Age. Cause of Death. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months 3 Months and under 6 Month. 6 Months and under 9 Months 9 Months and under 12 Months. Total Deaths under 1 year. All Causes- Certified 83 28 19 17 147 78 81 50 83 439 Uncertified 1 ... ... ... 1 ... ... ... ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 1 7 13 21 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... 3 2 8 13 Diphtheria and Croup ... ... ... ... ... 1 ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... 1 1 Tuberculous Meningitis ... ... ... ... ... ... 3 ... 3 6 Abdominal Tuberculosis ... ... ... ... ... ... ... 1 1 2 Other Tuberculous Diseases ... ... ... ... ... ... 1 ... 2 3 Meningitis (not Tuberculous) ... ... ... ... ... 1 ... 2 1 4 Convulsions 1 ... 1 ... 2 ... ... 3 1 6 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis 1 1 2 ... 4 5 8 3 10 30 Pneumonia (all forms) ... ... 1 3 4 17 14 12 22 69 Diarrhoea ... ... 1 1 2 6 10 4 3 25 Enteritis ... 1 ... ... 1 7 10 6 5 29 Gastritis ... 2 ... ... 2 3 ... 2 ... 7 Syphilis ... 1 3 ... 4 1 1 ... ... 6 Rickets ... ... ... ... ... ... 1 ... ... 1 Suffocation, overlying ... ... ... ... ... 1 2 ... ... 3 Injury at birth 3 ... ... ... 3 ... ... ... ... 3 Atelectasis 10 1 ... ... 11 1 ... ... ... 12 Congenital Malformations 8 6 1 1 16 5 3 ... 1 25 Premature birth 42 8 4 3 57 7 1 ... ... 65 Atrophy, Debility and Marasmus Other Causes 12 7 6 2 6 ... 7 2 31 11 16 7 17 6 6 2 5 7 75 33 Totals 81 28 19 17 148 78 81 50 83 440 Nett Births in the year, legitimate, 4,553; illegitimate, 383. Nett Deaths in the year of legitimate infants, 382; illegitimate infants, 58. 13 Report of the Medical Officer of Health. 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 XI11. Sub-District. No. of Deaths under one year. Percentage to total Deaths. Rate per 1,000 Births. 1914 1915 1916 1917 Clapham 71 9.82 76 92 70 74 Putney 31 9.33 87 78 74 83 Streatham 112 9.21 86 76 66 73 Tooting 73 17.42 114 104 109 110 Wandsworth 153 11.76 84 104 92 104 Whole Borough 440 11.52 88 92 78 89 The Infantile Mortality for the year shows an increase compared with 1916, but is lower than 1915. The increase was general in all the sub-districts. INFECTIVE DISEASES. The total number of deaths from these diseases was 817, 131 in Clapham, 47 in Putney, 211 in Streatham, 116 in Tooting, and 312 in Wandsworth. From all infective diseases the death-rate was 271 per 1,000 (2.31 in Clapham, 1.71 in Putney, 2.27 in Streatham, 3.33 in Tooting, and 3.49 in Wandsworth). The rate from the principal infective diseases, viz.:—Small-pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever, and Diarrhoea, was .94 per 1,000, (.83 in Clapham, .21 in Pctnev, .4g in Streatham 1.58 in Tooting and 1.44 in Wandsworth). A31 4 B 2 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 u. The total number of cases notified (less Tuberculois) was 8,604, (1,464 in Clapham, 394 in Putney, 2,870 in Streatham, 1,244 in Tooting, and 2,632 in Wandsworth). The large increase in the number over previous years is due to the fact that Measles and German Measles are now notifiable diseases. 5,371 cases of Measles and 2,006 of 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 1916. 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. SubDistricts. Number of Births returned from 1st January to 31st December, 1916. Successfully Vaccinated. Insusceptible of Vaccination. Had Small-pox. Dead, Unvaccinated. Certificates of Conscientious objection. Postponed by Medical Certificate. Removed to District, Vaccination Officer of which has been duly apprised. Removed to places unknown, or which cannot be traced; and cases not having been found. Remaining on Books as Unvaccinated. Clapham 1,077 547 7 ... 50 306 14 21 124 8 Putney 404 294 3 ... 17 70 1 8 11 ... Streatham 2,601 1,147 7 ... 133 712 1 106 457 33 Wandsw'th 1,967 1,111 ... ... 128 461 29 40 182 14 Totals 6,049 3.099 17 ... 328 1,549 45 175 774 60 15 Report of the Medical Officer of Health. Scarlet Fever. 566 cases were notified, (105 in Clapham, 16 in Putney, 131 in Streatharn, 146 in Tooting and 168 in Wandsworth). The total number of deaths was 13, and the death-rate per 1,000 was .04. 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 57 16 1 2 1 77 Putney 16 ... ... ... ... 16 Streatham 90 13 5 ... ... 108 Tooting 76 7 7 2 5* 97 Wandsworth 132 12 4 ... ... 148 Whole Borough 371 48 17 4 6 446 * In Tooting seven cases occurred in one house. Of the 446 houses invaded, multiple cases occurred in 75, or 16.8 per cent. In consequence of notifications being received of cases of Scarlet Fever attending Fountain Road School, the following report was made to the Public Health Committee by the Deputy Medical Officer of Health:— 16 Report of the Medical Officer of Health. 5th July, 1918. " I have to report the occurrence of a number of cases of peeling of the skin of the hands and feet in children attending Fountain Road School, Tooting, which have aroused the suspicion of Scarlet Fever and in some instances have been notified as such. " On the 7th June, I received a notice from the Head Teacher, Fountain Road School, Tooting, stating that a child residing at Alston Road, had been excluded from school on account of suspected Scarlet Fever. The home of the child was visited by the Sanitary Inspector who ascertained that she Was peeling on the hands and feet. He urged the mother to have this child and the other children seen by a doctor. This was done, and this child and four others in the same family were notified as suffering from Scarlet Fever. Notice of similar conditions in five children residing at Khartoum Road, was received on the 13th June, and these children were also seen and notified by a doctor as suffering from Scarlet Fever. " These cases were followed by one more on the 21st, five on the 22nd, four on the 2nd July and twelve on the 3rd July. On the 2nd July I visited the school in company with two Medical Officers of the London County Council and examined a number of children in the different departments. " We found a large number of children with evidence of peeling of the hands and feet, but in no instance was there any history of any illness whatever or of any rash. I came to the definite conclusion that these cases were not the result of Scarlet Fever and that no further measures were necessary, and this view was also taken by the London County Council Medical Officers. " In order to see whether this condition was confined to this school (that being the only one from which there had been exclusions by the Head Teacher), we visited Smallwood Road School and inspected a number of children there. We quickly found a number of these children in the same condition, who had not 17 Report of the Medical Officer of Health. attracted anyone's attention. Apparently the reason that they had been discovered at Fountain Road School is that the Head Teacher makes a practice of having the hands of the children inspected daily to see if they are clean. " I am not prepared to explain the exact cause of the peeling, but I am satisfied that it is not Scarlet Fever. " It is interesting that there has been no case of Scarlet Fever notified among children attending these schools (excluding these peeling cases) for three months." Diphtheria. 435 cases were notified, (103 in Clapham, 30 in Putney, 96 in Streatham, 82 in Tooting and 124 in Wandsworth). The total number of deaths was 37, (11 in Clapham, none in Putney, eight in Streatham, seven in Tooting and 11 in Wandsworth), and the death-rate per 1,000 was .12 The number of cases notified per 1,000 of population was 1.44, and the case mortality was 8.5 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 69 12 2 1 ... 84 Putney 21 1 1 1 ... 24 Streatham 79 6 ... ... 1 86 Tooting 68 3 1 ... 1 73 Wandsworth 92 11 1 ... i* 105 Whole Borough 329 33 5 2 3 372 * In Wandsworth seven cases occurred in one house. 18 Report of the Medical Officer of Health. Return Cases of Scarlet Fever and Diphtheria. 22 cases of Scarlet Fever occurred after the return of cases from the hospitals of the Metropolitan Asylums Board, and there were also six cases of Diphtheria. Six of the return cases of Scarlet Fever occurred in Clapham, one in Putney, seven in Streatham, five in Tooting, and three in Wandsworth. Five of the return cases of Diphtheria occurred in Clapham, and one in Wandsworth. Enteric Fever. 47 cases of Enteric Fever were notified during the year, (nine from Clapham, four from Putney, nine from Streatham, three from Tooting, and 22 from Wandsworth). The number of deaths was seven, and the death-rate was .02 per 1,000 of population. Continued Fever. Two cases of Continued Fever were notified during the year, (one in Putney, and one in Streatham). Cases of Mistaken Diagnosis. In 49 cases, (21 of Scarlet Fever, 17 of Diphtheria, seven of Enteric Fever and four of Cerebro-Spinal 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 26 cases of this disease were notified, (four in Clapham, none in Putney, 12 in Streatham, four in Tooting and six in Wandsworth). 11 of the cases terminated fatally (eight in Streatham and three in Wandsworth), and in four information was received that the cases had been wrongly diagnosed. These four wrongly diagnosed cases died from Tuberculous Meningitis. 19 Report of the Medical Officer of Health. 15 deaths were registered as having been caused by Meningitis, (two in Clapham, one in Putney, four in Streatham, four in Tooting, and four in Wandsworth). Four of these were of infants under one year, three from one and under two years, two from two and under five years, and six over five years of age. 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 420 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 29 34 83 21 115 282 Positive 15 16 42 8 42 123 Enteric Fever. Negative ... ... 2 ... 2 4 Positive 3 2 5 1 ... 11 Totals 47 52 132 30 159 420 Puerperal Fever. 14 cases of Puerperal Fever were notified (three in Clapham, one in Putney, one in Streatham, four in Tooting and five in Wandsworth), and six deaths occurred, (one in Clapham, two in Tooting, and three in Wandsworth). The death rate was .01 per 1,000, and the case mortality 42 per cent. 20 Report of the Medical Officer of Health. Erysipelas. 103 cases were notified (18 in Clapham, seven in Putney, 26 in Streatham, 18 in Tooting and 34 in Wandsworth), and six deaths occurred, (one in Clapham, one in Putney, one in Streatham one in Tooting, and two in Wandsworth). Measles. During the year, 5,371 cases of Measles were notified, (866 in Clapham, 178 in Putney, 1,518 in Streatham, 910 in Tooting and 1,899 in Wandsworth), and 129 deaths occurred, (11 in Clapham, none in Putney, 15 in Streatham, 29 in Tooting, and 74 in Wandsworth). 21 of the deaths were of infants under one year of age, 48 from one and under two years, 48 from two and under five years, 10 from five and under 15 years, and two over 15 years. The death-rate per 1,000 of population was 42. On the 28th March, the Council decided to enter into arrangements with various local nursing associations operating in the Borough for their nurses to attend cases of Measles when and as requested by the Medical Officer of Health at a cost of 8d. per visit. From that date to the 31st December, 31 cases were attended and 711 Visits were made by the nurses. The arrangement has proved very satisfactory and the work of the nurses has been found most beneficial. 2,006 cases of German Measles were also notified, (347 in Clapham, 155 in Putney, 1,072 in Streatham, 70 in Tooting, and 362 in Wandsworth), no deaths were registered as being due to this disease. During the year 6,569 visits were made in cases of these diseases 1,038 in Clapham, 310 in Putney, 2,388 in Streatham, 813 in Tooting and 2,020 in Wandsworth. The total number of premises disinfected was 3,656, (605 in Clapham, 103 in Putney, 1,056 in Streatham, 598 in Tooting, and 1,294 in Wandsworth). Table XVIII. shows the number of cases of infectious diseases notified by the teachers of the elementary schools in the Borough. 21 Report of the Medical Officer of Health. TABLE XVIII. Sub-Districts. Diseases. Measles. German Measles. Chicken Pox. Whooping Cough. Mumps. J Ringworm. Other Diseases. Totals. Clapham 389 87 89 114 109 24 121 933 Putney 37 4 21 17 76 16 28 199 Streatham 782 179 170 35 65 29 122 1,382 Tooting 540 35 123 38 56 41 93 926 Wandsworth 940 102 403 288 196 89 168 2,186 Borough 2,688 407 806 492 502 199 532 5,626 Whooping Cough. 29 deaths, (two in Clapham, two in Putney, two in Streatham, two in Tooting and 21 in Wandsworth), occurred during the year, 13 of these were infants under one year of age, five from one and under two years, and 11 from two and under five years. The death-rate was .09 per 1,000. Disinfection of Schools. During the year eight private schools in the Borough were disinfected, on account of cases of Measles having occurred among the scholars attending these schools. Epidemic Influenza. 56 deaths, (eight in Clapham, nine in Putney, 23 in Streatham, three in Tooting and 13 in Wandsworth), occurred during the year, 22 of these being of persons from 25 and under 65 years, and 28 over 65 years of age. The death-rate was .18 per 1,000. Diarrhœa. 78 deaths, 42 of males and 36 of females, occurred from all forms of Diarrhœa and Enteritis during the year. 18 of the deaths occurred in Clapham, three in Putney, 14 in Streatham, 15 in 22 Report of the Medical Officer of Health. Tooting, and 28 in Wandsworth. In all the sub-districts except Clapham, there was a decrease compared with 1916. The death-rate was .26 per 1,000, (in Clapham 31, in Putney .10, in Streatham .15, in Tooting 43, and in Wandsworth .31). Of the total number of deaths registered, 54 or 69 per cent. were of infants under one year, and the total number of deaths of children under two years was 65, equal to a rate of .21 per 1,000. The number of deaths from Diarrhoea, Zymotic Enteritis, and Enteritis under one year, represents 12.27 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. Under 3. 3 and under 6. 6 and under 9. 9 and under 12. Total. 1.—Breast-fed only 3 1 1 2 7 Do. and cows' milk 1 ... ... ... 1 Do. and food ... ... ... 1 1 2.—Cows'milk only 4 5 4 1 14 Do. and condensed milk ... 1 ... ... 1 Do. and dried milk ... 1 ... ... 1 Do. and food ... ... 1 ... 1 3.—Condensed milk only 2 5 2 1 10 Do. and dried milk ... ... ... 1 1 4.—Dried milk 4 3 2 ... 9 5.—Farinaceous and other foods 1 1 ... 1 3 6.—Unknown 1 3 ... 1 5 Totals 16 20 10 8 54 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. j Southfield. Fairfield. Springfield. Borough. Total Number of Deaths 5 7 3 2 7 8 5 3 14 54 Wholly breast-fed ... 1 ... ... 1 2 ... 1 2 7 Otherwise fed 4 6 3 1 4 6 5 2 11 42 No information 1 ... ... 1 2 ... ... ... 1 5 Previously visited (1917) 3 3 2 1 4 6 ... 2 5 26 „ „ (1916) 1 1 ... ... ... ... ... ... 4 6 Fed according to pamphlet 2 2 ... ... ... ... ... ... ... 4 Breast-fed ... ... ... ... 1 1 ... 1 1 4 Otherwise fed 4 4 2 1 3 5 ... 1 8 28 Illegitimate ... ... ... ... 1 ... 4 ... 4 9 Nurse children ... 1 ... ... ... ... ... ... ... 1 Born outside Borough 2 1 ... ... ... ... ... ... 2 5 Premature ... ... ... ... ... ... 1 ... ... 1 Delicate from birth ... 2 1 ... 2 ... ... ... 5 10 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 a report of the visits among infants during the year 1917. " In June, 1917, an additional Health Visitor was appointed solely for Infant Visiting in the North and South Wards of Clapham, and a small part of Streatham, and the consequent re-arrangement of the work permitted of more frequent visits to the homes. " The total number of visits paid, including re-visits and ineffectual visits was 9,288, compared with 8,212 in 1916. The 24 Report of the Medical Officer of Health. number of first visits totalled 3,543, of re-visits 3,612, and of ineffectual visits 2,133. 120 re-inspections were made in respect of premises for which notices had been served. " At the first visit 2,970 infants were wholly breast-fed; of the remaining 573, 230 were breast-fed supplemented by artificial feeding, 135 were fed on cows' milk only, 62 on condensed milk only, 49 on dried milk, and 36 on farinaceous and other foods. " On the re-visits, 1,835 were entirely breast-fed, in 707 cases cows', condensed or dried milks or farinaceous foods were given in addition to the breast, 353 were fed on cows' milk only, 141 on condensed milk only, and 130 on dried milk. As a consequence of the more frequent visits and at a later age, the proportion of children having farinaceous foods was greater than in former years. " In only 12 cases were tube bottles used ; 28 were spoon fed, two were cup-fed, and the remainder had boat bottles. 134 of the infants visited died during the year; the highest mortality, (24) occurred during the second and third months, and 61 died before reaching the age of four months. 37 died from respiratory diseases, 12 from measles, five from whooping cough complicated with broncho-pneumonia, 32 from diarrhoea and enteritis, nine from prematurity and debility from birth, eight from marasmus, three from atrophy, three from meningitis, four from tuberculosis, four, of whom two were twins, were accidentally suffocated, four from gastritis, two from cleft palate, two from dentition, and the remaining nine from various complaints. " 146 of the infants visited were prematurely born, and 50 were delicate from birth ; 57 twin births were visited, and one set of triplets. With regard to the employment of midwives, 1,452 of the mothers had employed their services, and in one case only of emergency had an unregistered midwife been called in, and 157 infants were born in hospitals and other institutions. 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. 65 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 349 315 194 427 632 540 324 241 501 3,543 Breast-fed 299 294 149 350 545 445 275 207 406 2,970 Otherwise fed 50 21 45 77 107 95 49 34 95 573 Infants re-visited 537 425 204 329 552 438 314 308 505 3,612 Breast-fed 208 179 104 220 332 178 184 173 257 1,835 Otherwise fed 329 246 100 109 220 260 130 135 248 1,777 Ineffectual visits 486 392 131 94 180 229 142 172 307 2,133 The total number of deaths among those visited was 134, 22 in Clapham, four in Putney, 26 in Streatham, 29 in Tooting, and 53 in Wandsworth. The heaviest mortality occurred at two to three months. The mortality among the infants visited by the Inspectors was only 37 per 1,000 births, compared with 89 per 1,000, the rate for the Borough for the year. In accordance with the scheme for attending the visiting of children up to the age of five years, 684 children between the ages of 1 to 2 years and 2,964 between the ages of 2 and 5 years were seen by us. 26 Report of the Medical Officer of Health. 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 Wandsworth Centre at The Anchor Mission, 275, Garratt Lane, Wandsworth, serves the three Wards, viz.:—Southfield, Fairfield and Springfield. There were 721 children on the register at the end of 1917, the attendances during that year were 2,358, an average attendance of 48 for 49 weeks (the Centre having been closed at Easter and Christmas). \ At the Centre at Tooting the number on the register at the end of 1917 was 817, the attendance 3,339, an average of 62.5. At the Putney Centre the number on the register at the end of 1917 was 325, attendances were 1,252 in 50 weeks, an average of 25. At the Streatham Centre at the end of 1917 there were 382 on the register, and there were 1,795 attendances, an average of 35 9. At the Balham Centre the number on the register at the end of 1917 was 313, the attendances being 2,955, an average of 59. 320 attendances were made by the Health Visitors to these Centres during the year, and 27 lectures and many homely talks and advice were given to the mothers. Tuberculous Diseases. The total number of deaths from diseases of a Tuberculous nature was 424. 27 Report of the Medical Officer of Health. * 339 of the deaths were due to Pulmonary Tuberculosis, 41 to Tuberculous disease of the Brain and 44 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 61 1.07 12 .21 73 1.28 Putney 25 .92 4 .14 29 1.06 Streatham 95 1.02 31 .33 126 1.35 Tooting 42 1.20 12 .34 54 1.54 Wandsworth 116 1.29 26 .29 142 1.58 Whole Borough 339 1.12 85 .28 424 1.40 Notification of Tuberculous Diseases. The total number of cases of Pulmonary Tuberculosis notified during 1917 was 622, 115 were from Clapham, 43 from Putney, 174 from Streatham, 89 from Tooting, and 201 from Wandsworth. A3134 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 XX111. Year. Cases Reported. Deaths. Removed. Recovered. No Inquiries. Cases on Register. 1909 1910 1911 1 1912 1913 1914 1915 1916 1917 Total. 1909 389 109 48 18 26 9 6 4 5 1 226 110 15 4 34 1910 289 ... 77 37 28 7 4 3 3 ... 159 90 5 8 27 1911 514 ... ... 113 82 27 22 8 6 2 260 165 11 6 72 1912 855 ... ... ... 225 105 48 31 13 8 430 231 52 ... 142 1913 783 ... ... ... ... 180 77 41 25 9 322 210 14 ... 227 1914 706 ... ... ... ... ... 176 88 37 22 323 154 8 ... 221 1915 646 ... ... ... ... ... ... 199 82 27 308 107 ... 1 230 1916 590 ... ... ... ... ... ... ... 161 68 229 67 1 ... 293 1917 622 ... ... ... ... ... ... ... ... 183 183 6 ... ... 433 Total 5,394 109 125 168 361 328 333 374 332 320 2,450 1,140 106 19 1,679 With regard to the notification of cases of non-pulmonary Tuberculosis, in all 193 cases were notified, 31 from Clapham. nine from Putney, 47 from Streatham, 29 from Tooting, and 77 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 TABLE XXIV. Report of the Medical Officer of Health. 2' Localisation of Disease. Number of cases notified. No. of deaths. Removed. On Register. Total. Males. Females. Under 1 year. 1 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and upwards. Males. Females. Total. Brain 34 20 14 4 12 10 4 1 1 1 ... 1 ... ... 19 14 33 ... 1 Glands, Mediastinal 2 2 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 „ Mesenteric 27 11 16 3 7 4 4 2 3 2 1 ... ... 1 3 9 12 ... 15 „ Cervical 56 21 35 ... 11 19 9 5 3 5 2 1 1 ... ... ... ... 2 54 Bones and joints 40 21 19 ... 6 9 6 3 4 6 3 ... 1 2 3 1 4 3 33 Lupus 9 1 8 ... ... 4 1 2 ... ... ... 1 1 ... ... ... ... ... 9 Larynx 3 2 1 ... ... ... ... ... ... 1 2 ... ... ... 2 ... 2 1 ... General Tuberculosis 6 4 2 ... 1 1 ... 1 ... 1 2 ... ... ... 2 4 6 ... ... Other parts 16 11 5 ... ... 1 ... 3 1 2 2 3 3 1 3 4 7 ... 9 Total 193 93 100 7 38 49 24 17 12 18 12 6 6 4 32 32 64 6 123 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, 1916 and 1917, and the number still remaining on the register the end of 1917. TABLE XXV. Year. Cases Notified. Deaths. Removed. Recovered Cases on Register . 1913. 1914. 1915. 1916. 1917. Total 1913 328 46 10 5 6 – 67 79 34 143 1914 199 – 68 5 4 – 77 34 17 70 1915 234 – – 84 7 1 92 30 12 100 1916 215 – – – 67 5 72 23 2 118 1917 193 – – – – 63 63 7 1 122 Total 1,169 46 78 94 84 69 371 173 66 553 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 31st December, 1916, to the 29th December, 1917. 31 Report of the Medical Officer of Health. TABLE XXVI. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from 31st December, 1916, to the 29th December, 1917. 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. 1 Under 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total. Under 5 5 to 10 10 to 15 Total. Pulmonary— Males 1 5 15 19 29 22 53 76 44 23 4 291 335 ... 1 ... 1 1 49 139 Females 3 4 10 15 42 43 63 49 20 11 11 271 303 ... ... ... ... 1 50 101 Non-Pulmonary — Males 4 17 22 10 11 3 9 5 5 3 2 91 111 ... ... 1 1 3 13 3 Females 3 21 23 13 7 9 9 7 1 3 2 98 109 ... 3 ... 3 6 5 ... 32 Report of the Medical Officer of Health. The total number of visits made was 2,771 in cases of Pulmonary Tuberculosis, 526 in Clapham, 176 in Putney, 568 in Streatham, 398 in Tooting, and 1,103 in Wandsworth, and 723 in cases of other forms of Tuberculosis, 119 in Clapham, 40 in Putney, 133 in Streatham, 107 in Tooting, and 324 in Wandsworth. In addition to these visits by the Health Visitor, 1,482 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 13 sputum flasks have been supplied, and in eight of the cases visited the patients already had one. During the year disinfection was carried out at 346 premises either after the death or removal of the patient. 74 of the premises disinfected were in Clapham, 13 in Putney, 98 in Streatham, 38 in Tooting, and 123 in Wandsworth. Tuberculosis Dispensaries. The work of the two Dispensaries shows a considerable increase on previous years. The number of new cases examined was 1,214 compared with 1,081 in 1916, 716 in 1915, 971 in 1914, and 936 in 1913. The attendances at the two Dispensaries number 12,755 compared with 9,519 the previous year. The increase is shared almost equally between the two Dispensaries as will be seen in Table XXVIII. Table XXVIII. shows the new cases divided into Tuberculous and Non-Tuberculous for each Dispensary. These figures are the largest in any year since the opening of the Dispensaries. The number of examinations made was 2,032, and 306 examinations of sputum. / 33 Report of the Medical Officer of Health. Table XXIX. further divides the new cases into insured and non-insured, giving the total attendances made by each and the average attendance per case. Table XXX. deals similarly with cases of the previous years attending during the year 1917. It is satisfactory to note in Table XXX. that over one-fourth of the new cases were recommended by existing patients, and also a considerable number, 14.3 per cent., were sent by medical practitioners. 156 men Were sent by the Army Medical Boards for examination and reports. In each case where available an examination of sputum was made. Of these 86 were found to be suffering either from active disease or showing signs of old tubercular trouble. 70 were reported as non-tuberculous. In Tables XXXII. and XXXIII. is revealed a most important part of the work of the Dispensaries—of which, however, future years alone will show the results. This is the examination and in many cases the treatment of "contacts" amongst children. It will be seen that under 15 years of age only six were definitely diagnosed as suffering from tuberculosis, while 268 others Were examined and kept under observation and in many cases treated for months, thereby improving their health and undoubtedly warding off the onset of active disease. This is a work that goes on steadily the results of which cannot be tabulated to prove its usefulness, but the improvement in weight and appearance of the sickly children is sufficient to satisfy those in contact with the work. The following Table shows the number of children under 16 attending the Dispensaries during the year, viz., 882. Of these, 185 were suffering from Tuberculosis in some form. A considerable number have obtained sanatorium treatment under the London 34 Report of the Medical Officer of Health. County Council scheme, and a number, not definitely Tuberculous have enjoyed a change of air at some convalescent home. TABLE XXVII. CHILD PATIENTS DURING 1917. Under 5 Years. Males. Females Totals. Males Tuberculous 4 Non-Tuberculous 81 85 Females Tuberculous 11 Non-Tuberculous 71 82 167 Between 5 and 14 Years. Males Tuberculous 81 Non-Tuberculous 281 362 Females Tuberculous 62 Non-Tuberculous 229 291 653 Between 14 and 16 Years. Males Tuberculous 15 Non-Tuberculous 20 35 Females Tuberculous 12 Non-Tuberculous 15 27 62 Totals 482 400 882 In Table XXXV. an endeavour has been made to put in tabulated form some results of treatment. Of the cases in 1913 in last year's report, seven were noted as recovered. It is now possible to increase that number to 10. Of the 1914 cases, two are increased to four, and of the 1915 cases, while only two were considered 35 Report of the Medical Officer of Health. recovered at the end of 1916, the figure can now be increased to eight. None of the cases noted as recovered have shown any signs of relapse. It is probable that a good many more might be added to the "recovered" class, but it is felt that it is better not to include any of those who have not been under observation for a length of time. Tuberculin and Spengler's serum I.K. have been used in 51 cases. Owing to the difficulty in obtaining I.K. at the present time its use has been almost discontinued. Of the 51 cases, two have recovered, 33 improved, the improvement in many of the cases setting in very markedly soon after commencing the treatment. In seven cases there was no change, and in seven the disease advanced and two died. Autogenous vaccines have been given to 18 cases. In five of these the treatment was continued from 1916, leaving 13 new cases so treated in 1917. Of the five cases from the previous year, two entirely recovered, and one, a man discharged from the Army on account of Pulmonary Tuberculosis, so improved by the treatment that he was able to return to work, and though he has since moved out of the borough he has written on his own initiative to say how well he is keeping. Of the two remaining cases one is considerably better, while in the other no material benefit was obtained. Of the 13 new cases treated by this method all have made satisfactory progress, save one in which death occurred from acute Pulmonary Tuberculosis. Two cases, complicated by Asthma, have had considerable relief. A large number of home visits were made by the Dispensary Nurse, the total for the year being 1,482. This is a very necessary and important part of the work, as it is impossible to know anything of the home conditions, so important in such a disease as Tuberculosis, unless the patients are personally visited. 36 Report of the Medical Officer of Health. TABLE XXVIII. Number of New Cases, and Total Attendances at the Dispensaries, 1917. Dispensary. New Cases, 1917. Total Attendances, 1917. 1915. Tuberculous. NonTuber culous. Total. Tuberculous. NonTuber culous. Total. Total New Cases. Total Attendances. 129, East Hill, Wandsworth 225 510 735 4,171 2,834 7,005 623 5,391 Weir Dispensary, Balham 168 311 479 3,533 2,217 5,750 458 4,128 Totals 393 821 1,214 7,704 5,051 12,755 1,081 9,519 37 Report of the Medical Officer of Health. TABLE XXIX. NEW CASES, 1917. Tuberculous. Non-Tuberculous. Totals. M. F. Total. M. F. Total. M. F. Total. Cases— Insured 170 59 229 79 37 116 249 96 345 Non-Insured 73 91 164 326 379 705 399 470 869 Totals 243 150 393 405 416 821 648 566 1,214 Attendances— Insured 573 333 906 262 119 381 835 452 1,287 Non-Insured 386 1,115 1,501 1,211 1,425 2,636 1,597 2,540 4,137 Totals 959 1,448 2,407 1,473 1,544 3,017 2,432 2,992 5,424 Average Attendances Per Case. 6.1 3.6 4.4 TABLE XXX. CASES OF 1913, 1914, 1915 AND 1916 ATTENDING IN 1917. Tuberculous. Non-Tuberculous Totals. M. F.' Total. M. F. Total. M. F. Total. Cases— Insured 80 53 133 11 5 16 91 58 149 Non-insured 77 161 238 107 120 227 184 201 385 Totals 157 214 371 118 125 243 2 75 259 534 Attendances. Insured 679 726 1,405 52 69 121 731 795 1,526 Non-insured 1,007 2,738 3,745 1,106 954 2,060 2,113 3,692 5,805 Totals 1,686 3,464 5,150 1,158 1,023 2,181 2,844 4,487 7,331 Average Attendances Per Case. 13.8 8.9 13.7 38 Report of the Medical Officer of Health. TABLE XXXI. RETURN SHOWING SOURCE OF CASES AND SUB-DISTRICTS. Clapham. Putney. Streatham. Tooting. Wandsworth. Outside Borough. Totals. Public Health Department 40 18 84 117 88 ... 347 London Insurance Committee 8 6 11 19 10 ... 54 Private Practitioners 12 8 28 53 73 1 175 Charitable Societies 2 6 7 6 3 ... 24 Transfers from other Dispensaries 5 1 1 6 7 1 21 London County Council 4 3 7 10 20 ... 44 Existing Dispensary Patients 20 7 17 56 248 1 349 Army Medical Boards 30 10 43 21 51 1 156 Other Sources 5 7 8 8 14 2 44 Totals 126 66 206 296 514 6 1214 Towards the latter part of the year the Army Medical Boards commenced to send recruits for examination. 156 cases were examined, and in each instance sputum examinations were made, 86 being found to be tuberculous. In 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. 39 Report of the Medical Officer of Health. TABLE XXXII. 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 ... ... ... 5 1 6 5 1 6 ... 1 and under 2 years ... ... ... 12 14 26 12 14 26 ... 2 and under 5 years 3 7 10 49 49 98 52 56 108 9 5 and under 10 years 11 10 21 142 107 249 153 117 270 7 10 and under 15 years 12 12 24 79 64 143 91 76 167 14 15 and under 20 years 29 20 49 17 21 38 46 41 87 56 20 and under 25 years 28 23 51 19 17 36 47 40 87 58 25 and under 35 years 72 36 108 44 54 98 116 90 206 52 35 and under 45 years 64 27 91 28 51 79 92 78 170 53 45 and under 65 years 24 14 38 8 34 42 32 48 80 47 65 years and upwards ... 1 1 2 4 6 2 5 7 14 Totals 213 150 193 405 416 821 648 566 1,214 32 Under 15 years 26 29 55 287 235 522 313 264 577 9 15 years and upwards 217 121 338 118 181 299 335 302 637 53 Totals 243 150 393 405 416 821 648 566 1,214 32 40 Report of the Medical Officer of Health. TABLE XXXIII. DIAGNOSIS AND AGE GROUPING OF ALL CONTACTS, EXAMINED FOR THE FIRST TIME DURING 1917. 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 ... ... ... 4 1 5 4 1 5 ... 1 and under 2 years 1 ... 1 6 8 14 7 8 15 6 2 and under 5 years ... ... ... 25 30 55 25 30 55 ... 5 and under 10 years ... 3 3 54 56 110 54 59 113 2.6 10 and under 15 years 1 1 2 44 40 84 45 41 86 2 15 and under 20 years 3 1 4 6 15 21 9 16 25 16 20 and under 25 years 5 1 6 5 10 15 10 11 21 28 25 and under 35 years 8 2 10 8 31 39 16 33 49 20 35 and under 45 years 4 ... 4 6 32 38 10 32 42 9.5 45 and under 65 years ... ... ... 2 15 17 2 15 17 ... 65 years and upwards ... ... ... ... 2 2 ... 2 2 ... Totals 22 8 30 160 240 400 182 248 430 6.9 Under 15 years 2 4 6 133 135 268 135 139 274 2.1 15 years and upwards 20 4 24 27 105 132 47 109 156 15 Totals 22 8 30 160 240 400 182 248 430 69 41 Report of the Medical Officer of Health. TABLE XXXIV. SITE OF LESION IN TUBERCULOUS CASES. Age Period. Non-Pulmonary. Pulmonary Tuberculosis. Total. Glands. Joints and Bones. Abdominal. Others. Total NonPulmonary. Under 1 year ... ... ... ... ... ... ... I and under 2 years ... ... ... ... ... ... ... 2 and under 5 years 6 1 ... ... 7 3 10 5 and under 10 years 7 5 2 1 15 8 23 10 and under 15 years 1 3 1 ... 5 18 23 15 and under 20 years 4 ... 1 ... 5 44 49 20 and under 25 years 1 1 ... ... 2 49 51 25 and under 35 years 3 1 ... 2 6 102 108 35 and under 45 years 1 ... ... ... 1 90 91 45 and under 65 years ... ... ... ... ... 37 37 65 years and upwards ... ... ... ... ... ... 1 Totals 23 11 4 3 41 352 393 Disposal of Tuberculous Cases, 1917, at End of Year. Under treatment at Dispensaries 107 „ in Sanatoria 30 „ at Hospitals 15 „ in Poor Law Infirmaries 6 „ by Medical Practitioners 83 Ceased attending through lack of interest 2 Left the Borough 23 Died 41 Sent by Army Medical Boards and found to be tuberculous 86 Total 393 42 Report of the Medical Officer of Health. TABLE XXXV. Record at end of 1917 of existing Tuberculous Cases for the Years 1913, 1914, 1915 and 1916. (Grouped into six classes). Class. How disposed of. 1913. 1914 1915 1916. 1 Recovered 10 4 8 – 2 Reported to be keeping well, but not attended during year 49 37 30 18 3 Much improved. Attending for observation only 23 29 25 26 4 Still under treatment at Dispensaries— Improving 5 7 10 15 Stationary 14 14 15 26 Advancing 3 4 1 4 5 Under Medical Practitioner 14 19 22 30 6 Died during the year 2 10 17 32 Total 120 124 128 151 ' Bacteriological Examination of Sputum. 378 examinations of sputum were made at the Lister Institute; 30 from Clapham, 45 from Putney, 134 from Streatham, 44 fiom Tooting, and 125 from Wandsworth. In 79 of the cases it was reported that the bacillus had been found. Other Infective Diseases. 21 deaths were caused by other Infective diseases, one in Clapham, two in Putney, seven in Streatham, one in Tooting, and 10 in Wandsworth. 43 Report of the Medical Officer of Health. Six of these were under one year, one from one and under two years, one from two and under five years, one from five and under 15 years, three from 25 and under 45 years, six from 45 and under 65 years, and three over 65 years. Acute Polio-Myelitis. Five cases of the above were notified during the year, one from Putney, one from Streatham, two from Tooting, and one from Wandsworth. Three of the cases were under five years of age, and two over five years. Two of the cases proved fatal. Ophthalmia Neonatorum. 29 cases were notified, of which nine were in Clapham, one in Putney, three in Streatham, five in Tooting, and 11 in Wandsworth. All the cases were visited. 24 were attended at birth by midwives. 17 were treated at hospital as out patients, one was born and died in hospital, one was admitted to hospital as an inpatient, and two were admitted to Poor Law Infirmaries, the remaining eight being treated at home. Two cases removed before recovering, one died from Pneumonia and one from wasting, one child lost the sight of both eyes, and two are still under treatment The 22 remaining cases have recovered. 16 cases were notified by registered midwives. On the 23rd May, the Council decided that the arrangements made with the v arious local nursing associations with regard to the nursing of cases of measles when and as requested by the Medical Officer of Health should be extended to Ophthalmia Neonatorum. Seven of the cases were attended by the nurses, who made 623 visits, at a cost of £20 15s. 4d. to the Council. A3134 D 44 Report of the Medical Officer of Health. Venereal Diseases. II deaths were stated to have been due to Syphilis, eight being of infants from Congenital Syphilis, and three of adults. 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. NON-INFECTIVE DISEASES. Cancer. The total number of deaths from Cancer and other malignant diseases was 407, 156 of males and 251 of females. 79 of these occurred in Clapham, 34 in Putney, 162 in Streatham, 34 in Tooting, and 98 in Wandsworth. The corrected death-rate for the Borough was 1.35 per 1,000, and for the sub-districts as follows :—Clapham 1.39, Putney 1.24 Streatham 174, Tooting .97, and Wandsworth 1.09. Two of the deaths occurred at one and under two years, three at two and under five, three at 15 and under 25 years, 46 at 25 and under 45 years, 185 at 45 and under 65 years, and 168 over 65 years. Diseases of the Brain and Nervous System. From these diseases 344 deaths occurred. 62 in Clapham, 33 in Putney, 125 in Streatham, 32 in Tooting, and 92 in Wandworth. 15 of the deaths were due to Meningitis, 188 to Cerebral Haemorrhage or Apoplexy, 11 to Convulsions, 10 to Softening of the Brain, 23 to Paralysis, 28 to General Paralysis of the Insane, 45 Report of the Medical Officer of Health. eight to Locomotor Ataxy, 20 to Epilepsy, and 41 to other diseases of the Nervous System. Circulatory Diseases. From the above group of diseases, 551 deaths occurred, 213 of which, 81 males and 132 females, were due to Valvular disease of the Heart. 99 of these deaths occurred in Clapham, 61 in Putney, 187 in Streatham, 54 in Tooting, and 150 in Wandsworth. Respiratory Diseases. The total number of deaths was 664. 132 in Clapham, 64 in Putney, 201 in Streatham, 68 in Tooting, and 199 in Wandsworth. 317 of the deaths occurred from Bronchitis, 51 from Lobar Pneumonia, 147 from Lobular or Broncho-Pneumonia, 104 from Pneumonia in which the exact form was not distinguished, and 45 from other diseases of the Respiratory Organs. 102 of the deaths were of infants under one year, 47 from one and under two years, 42 from two and under five years, 10 from five and under 15 years, seven from 15 and under 25 years, 55 from 25 and under 45 years, 137 from 45 and under 65 years, and 264 over 65 years. Deaths from other Causes. From Appendicitis and Typhlitis 22 deaths, 11 of males and 11 of females, occurred. From Alcoholism, Acute and Chronic, four deaths, one male and three of females, occurred; and 21, 12 of males and nine of females, from Cirrhosis of Liver. 46 Report of the Medical Officer of Health. From Nephritis and Bright's disease 123 deaths occurred, 67 of males and 56 of females. From Accidents and diseases of Pregnancy and Child Birth six deaths occurred. This, added to the number of deaths from Puerperal Fever—viz., six—gives a total of 12 deaths after child birth, or a proportion of 2-43 per 1,000 births. Diabetes Mellitus was the cause of 31 deaths, 17 of males and 14 of females. Premature Birth and Developmental Diseases. 189 deaths, 115 of males and 74 of females, were registered as having occurred from these diseases. 65 of the deaths were due to Premature Birth, 107 to Developmental diseases and 17 from other diseases of Early Infancy. 184 were of infants under one year, three from one and under two years, and two 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. 257 deaths, 91 of males and 166 of females, occurred from Old Age. 63 in Clapham, 22 in Putney, 78 in Streatham, 26 in Tooting, and 68 in Wandsworth. All the deaths except two, were of persons over 65 years of age. 47 Report of the Medical Officer of Health. Violence. 127 deaths, 82 of males and 45 of females, occurred from Violence, 92 of the deaths being due to Accidental, and 17 to Suicidal causes, while 18 deaths were caused by other forms of Violence, 15 of these being due to injuries received from bombs dropped by enemy aircraft. 29 of the deaths belonged to Clapham, nine to Putney, 39 to Streatham, 16 to Tooting, and 34 to Wandsworth. Inquests. 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. 48 Report of the Medical Officer of Health. TABLE XXXVI. INQUESTS. Sub-Districts. Whole Borough. Clapham. Putney. Streatham. Tooting. Wandsworth Deaths from Natural Causes 14 10 25 15 30 94 Accidental:— Run over by motor vehicles 2 i 6 i 10 Falls i 2 . . 3 i 7 Suffocated in bed with parents 2 .. 3 1 .. 6 Fall down flight of stairs 2 1 1 1 .. 5 Killed by bomb dropped from hostile aircraft .. 2 2 .. 1 5 Burns 1 .. .. 1 .. 2 Knocked down by train 1 .. .. .. .. 1 Knocked down by tramcar .. .. 1 .. .. 1 Gunshot wounds .. 1 .. .. .. 1 Suffocated in bath .. .. 1 .. .. 1 Fall on open knife .. .. .. 1 .. 1 Exposure .. .. .. 1 .. 1 Ptomaine poisoning .. .. .. .. 1 1 Fall from window .. .. .. .. 1 1 Drowning .. .. .. .. 1 1 Suicidal:— Cut throat 1 .. .. .. 1 2 Gunshot wounds 1 .. .. .. 1 2 Hanging .. .. .. .. 2 2 Poisoning by Salts of Lemon 1 .. .. .. .. 1 Poisoning by Veronal .. .. 1 .. .. 1 Poisoning by Cyanide of Potassium .. .. .. .. 1 1 Poisoning by Ammonia .. .. .. .. 1 1 Drowning .. .. .. .. 1 1 Open Verdicts:— Foumd dead .. 1 .. .. .. .. Totals 26 18 40 24 42 150 49 Report of the Medical Officer of Health. TABLE XXXVII. INQUESTS. Sub-Districts. Whole Borough. Clapham. Putney. Streatham. Tooting. Wandsworth Deaths from Natural Causes 1 3 8 .. 7 19 Accidental: Run over by motor vehicles 1 1 4 3 3 12 Falls 2 2 4 .. 2 10 Killed by bomb dropped from hostile aircraft 3 1 3 2 .. 9 Burns 2 .. 1 .. 5 8 Knocked down by tramcar .. .. 2 2 1 5 Drowning .. .. 1 .. 2 4 Scalds 1 .. 2 .. 1 4. Fall down flight of stairs 2 .. .. .. 1 • 3 Run over by horse vehicles 1 .. .. 2 .. 3 Fall from roof .. .. 1 .. 1 2 Death under an anæsthetic .. 1 .. .. 1 2 Run over by train .. .. 1 .. .. 2 Fall from tree .. .. 1 .. .. 1 Fall down lift well 1 .. .. .. .. 1 Fall on spiked railings .. .. 1 .. 1 Fall through glass roof .. .. .. .. 1 1 Kicked by runaway horse .. .. .. .. 1 1 Swallowed halfpenny .. .. .. 1 1 Struck by trolley pole of tramcar .. .. .. .. 1 1 Tetanus following injury to foot .. .. .. .. 1 1 Crushed between buffers of railway wagons 1 .. .. .. .. 1 Crushed by falling barrel .. 1 .. .. .. 1 Struck in adbomen by rake .. .. .. 1 .. 1 Crushed by travelling crane .. .. .. .. 1 1 Suicidal:— Drowning .. .. 1 1 .. 2 Hanging .. .. 2 .. .. 2 Cut throat 1 .. .. .. 1 2 Gunshot wounds .. .. 1 .. .. 1 Poisoning by Cyanide of Potassium .. .. .. .. 1 1 Poisoning by Hydrochloric Acid .. .. 1 .. .. 1 Totals 17 10 34 11 32 104 5» Report of the Medical Officer of Health. Cutting-off Notices. During the year 146 notices with respect to 174 premises were received from the Water Board stating that the supply had been withdrawn. 35 of the premises were in Clapham, 23 in Putney, 69 in Streatham, five in Tooting, and 42 in Wandsworth. The supply was withdrawn for non-payment of rates from 69 premises, from 37 premises in consequence of defects, in 55 the premises were empty, and in 13 cases by request. 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, 13. bodies were removed to the Mortuary, in Streatham seven and in Wandsworth 94, of which 49 were from Wandsworth, 12 from Putney, 15 from Tooting, and 18 from Battersea—a total of 114. GENERAL SANITARY WORK IN 1917. Revenue Act. During the) year three certificates were granted under the above Act. The certificates granted referred to nine houses or 21 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. 51 Report of the Medical Officer of Health. TABLE XXXVIII. Summary of Sanitary Operations in the Borough during the Year 1917. Clapham. Putney. Streatham Tooting. Wandsworth. Whole Borough. North Ward. South ward. Streatham Ward. Balham Ward. South field Ward. Fairfield Ward. Spng field Ward. Number of complaints received and attended to 345 347 171 436 356 594 266 184 348 3047 Number of houses and premises insDected 5088 3754 4987 5029 5048 5101 4283 2699 5079 41068 Number of houses and premises re-inspected 573 1056 824 1020 1706 1794 481 736 915 9105 Number of house - to - house inspections 108 16 51 7 290 186 78 58 50 844 Number of preliminary notices served 375 287 171 301 732 711 246 355 604 3782 Ditto complied with 407 278 203 299 805 569 237 366 454 3618 Number of statutory notices served 8 13 1 35 113 72 12 59 35 348 Ditto complied with 12 13 1 32 114 64 9 19 25 289 Notices served for periodical removal of manure ... ... ... ... ... ... ... ... ... ... Number of rooms disinfected after infective diseases 479 480 264 912 918 904 570 472 856 5855 Bedding stoved 146 156 270 165 309 236 141 81 225 1729 Overcrowding abated 1 3 ... 4 3 8 1 5 1 26 Rooms cleansed and repaired 163 155 75 289 824 498 113 400 578 3095 Staircases cleansed and repaired 77 18 13 62 185 75 19 48 83 580 Drains cleansed and repaired 67 56 16 141 110 96 52 47 98 683 Drains tested 196 87 108 82 309 323 50 65 520 1740 Drains found defective 4 4 2 18 20 71 6 4 41 170 Traps fixed to drains 35 26 1 33 13 6 1 ... 1 116 Bath, lavatory and sink wastes altered to discharge outside over gullies or repaired 4 16 9 43 46 23 1 23 73 238 Rain water pipes disconnected from drains ... ... ... 2 ... ... ... ... 51 53 Water closets cleansed and repaired 148 102 42 75 287 185 62 123 198 1222 Water closets, separate supply of water laid on to ... ... ... 33 3 2 ... ... ... 38 Accumulations of manure, etc., removed 7 7 1 67 25 23 12 ... 13 155 Urinals cleansed, repaired or water laid on to 3 1 1 6 9 3 2 4 2 31 Cesspools abolished ... ... .... ... ... 1 ... ... ... 1 Ashpits provided or repaired 35 31 i i 47 84 77 39 47 106 477 Dust complaints received 60 80 143 150 140 83 121 30 69 876 Stables and stables yards drained, paved or cleansed 1 5 ... 32 10 18 4 1 9 80 Yards drained,paved or cleansed 8 16 ... 42 51 71 16 33 55 292 Unwholesome or dilapidated houses cleansed or repaired ... ... ... 12 2 34 1 3 3 55 Leaky roofs and gutters repaired 129 80 33 93 117 102 33 103 132 822 Damp courses inserted 2 4 1 8 26 36 1 15 6 99 Damp conditions remedied 39 24 47 96 101 120 28 89 122 666 Houses re-supplied with water 9 15 1 18 10 7 15 9 18 102 Water cisterns cleansed, covered or repaired 11 38 14 29 30 16 6 20 49 213 Animals kept so as to be a nuisance ... 3 1 12 2 15 8 ... 21 62 Smoke nuisances reported 2 ... 6 ... ... 1 ... 3 7 19 Soil pipes repaired 2 8 2 41 10 20 2 9 10 104 Unclassified nuisances 301 41 13 66 98 60 63 59 79 780 52 Report of the Medical Officer of Health. TABLE XXXIX. DETAILS OF INSPECTIONS AND RE-INSPECTIONS, 1917. (Male Inspectors.) Inspections Re-Inspections. Totals. Number of complaints received and attended to 3,026 ... 3,026 Number of house-to-house inspections 844 ... 844 Drainage and other sanitary works after notice 3,152 7,807 10,959 Drainage and other sanitary works voluntary 424 664 1,088 Number of premises inspected on account Notifiable diseases 1,769 119 1,888 Measles 6,379 131 6,510 Whooping Cough 479 7 486 Pulmonary Tuberculosis 26 ... 26 Other Infective Diseases 280 6 286 Verminous conditions 276 15 291 Periodical Inspections:— Houses-let-in-Lodgings 317 534 851 Underground rooms ... ... ... Common Lodging Houses 6 ... 6 Work-places Factories 461 109 570 Workshops 589 39 628 Workshops (Domestic) 219 33 252 Workplaces 208 66 274 Outworkers' premises 82 23 105 Bakehouses 405 331 736 Restaurant kitchens 167 16 183 Food-places Cowsheds 42 2 44 Piggeries 169 36 205 Dairies and Milkshops 696 29 725 Ice Cream Premises 294 15 309 Slaughterhouses 229 10 239 Places where food is prepared 293 ... 293 Offensive trades 89 21 110 Fried Fish shops 155 3 158 Rag and bone stores 59 3 62 Butchers' shops 612 2 614 Greengrocers' shops 398 13 411 Fishmongers' shops 269 1 270 Public House urinals 496 14 510 Other sanitary conveniences, schools, &c. 63 1 64 Smoke observations 19 15 34 Unsound food 66 ... 66 Yards of Mews and Stables 1,605 101 1,706 Legal proceedings:— (1) Applications and summonses 8 ... 8 (2) Hearings and adjournments 32 ... 32 Other 1,602 83 1,685 Totals 26,305 10,249 36,554 53 Report of the Medical Officer of Health. TABLE XL. DETAILS OF INSPECTIONS AND RE-INSPECTIONS, 1917. (Female Inspectors.) Inspections. Re-inspections. Totals. Number of complaints received and attended to 21 21 Number of premises inspected on account of:— Puerperal Fever 37 3 40 Measles 59 .. 59 Ophthalmia Neonatorum 122 1 123 Diarrhœa 83 5 88 Pulmonary Tuberculosis 2,708 63 2,771 Other forms of Tuberculosis 718 5 723 Notification of Births 9,387 120 9,507 Dressmakers' and Milliners' premises 232 1 233 Laundries— Factory 128 9 137 Workshop 149 8 157 Workplaces 98 3 101 Other Factories 97 9 106 Other Workshops 107 5 112 Other Workplaces 152 .. 152 Domestic Workshops 56 .. 56 Outworkers' premises 326 14 340 Other 783 10 793 Totals 15,263 256 15,519 54 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. Percentage of defects to houses inspected. Number of Families living in One room. Two rooms. Three rooms. Four rooms and upwards. Clapham, North 108 78 72.22 33 53 44 6l Clapham, South 16 10 62.50 3 .. 2 14 Putney 51 17 33.33 .. .. 31 20 Streatham 7 7 100.00 .. .. 6 5 Balham 290 246 84.82 55 157 269 177 Tooting 186 163 87.63 5 20 168 103 Southfield 78 45 57.69 21 14 38 63 Fairfield 58 58 100.00 21 17 47 23 Springfield 50 44 88.00 14 12 22 24 Whole Borough 844 668 7914 152 273 627 490 The cases of overcrowding were in Crichton Street, Caxfax Square, and Pleasant Place, Clapham; in Leverson Street, Hazelhurst Road and Graveney Road, Streatham; in Vant Mews, Kellino Street, Himley Road, Gilbey Road, Garratt Lane and Pevensey Road, Tooting; and in John Street, Ferrier Street, Cotman Street' Iron Mill Road and Lydden Grove, Wandsworth. to notices of reconstruction of drains were sent to the Borough Engineer from this Department: two in Clapham, six in Streatham, and two in Wandsworth. 55 Report of the Medical Officer of Health. The total number of houses where the drains were reconstructed during the year was 57: 12 in Clapham, five in Putney, 25 in Streatham, one in Tootng, and 14 in Wandsworth. During the year 1,740 drains of houses were tested by the Sanitary Inspectors, 283 in Clapham, 108 in Putney, 391 in Streatham, 323 in Tooting, and 635 in Wandsworth, and 170 or 977 per cent, were found to be defective. Of the 170 found defective, eight were in Clapham, two in Putney, 38 in Streatham, 71 in Tooting, and 51 in Wandsworth. A large amount of work has again been carried out to abate nuisances arising from damp conditions. In all, 765 premises have been dealt with, 69 in Clapham, 48 in Putney, 231 in Streatham, 156 in Tooting, and 261 in Wandsworth ; and in 99 of these, six in Clapham, one in Putney, 34 in Streatham, 36 in Tooting, and 22 in Wandsworth, damp courses have been inserted. Disinfection. The total number of rooms disinfected after the occurrence of cases of infectious disease was 5,855, (959 in Clapham, 264 in Putney, 1,830 in Streatham, 904 in Tooting, and 1,898 in Wandsworth). 1,729 lots of bedding were stoved at the Disinfecting Station, comprising the following articles: 900 beds, 1,113 bolsters, 2,611 pillows, 1,158 mattresses, 118 palliasses. 2,169 sheets, 1,354 quilts, 517 cushions, 17,584 articles of clothing, 4,412 blankets, 30 carpets and 6,015 extra articles, a total of 37,981 articles. Disinfection was also carried out by the Sanitary Staff at premises after non-notifiable diseases, chiefly Cancer, and the sum of £21 17s. 6d. was received for such disinfection. 56 Report of the Medical Officer of Health. 176 rooms were disinfected with sulphur in consequence of their verminous condition and 31 lots of verminous bedding disinfected. During the year, at the request of the Military Authorities, 4,899 articles of clothing and bedding were disinfected and 35 rooms sprayed on account of having been exposed to infection, and 17,666 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 £1,464 os. 3d. The number of lots of bedding stoved was 1,729. Cost per lot of bedding 16s. 10d. Cleansing of Persons Act. The names of 107 children, 17 belonging to Clapham, five to Putney, 11 to Streatham, 24 to Tooting, and 50 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. 51 adults had-baths after being in contact with cases of infectious diseases, and 59 on account of their verminous condition. 57 Report of the Medical Officer of Health. Inspection of Sanitary Conveniences. The number of Sanitary Conveniences inspected was 128, 29 in Clapham, 19 in Putney, 24 in Streatham, 11 in Tooting, and 45 in Wandsworth. 5x0 inspections were made during the year and 31 notices, chiefly for cleansing, were served and complied with; and 202 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 158 inspections have been made of fried fish shops, 614 of butchers' shops, 411 of greengrocers' shops, and 270 of fishmongers' shops, a total of 1,453. 304 of these inspections were in Clapham, 245 in Putney, 360 in Streatham, 251 in Tooting, and 293 in Wandsworth. Police Court Proceedings. The lists which follow show particulars of Police Court proceedings under the Public Health (London) Act, 1891, and Regulations made under the Defence of the Realm Act, during the year. The total amount of fines inflicted under the former was £27, and the costs £24 10s., and under the latter £34 2s., and the costs £9 19s. 6d. 58 Report of the Medical Officer of Health. TABLE XLII. Premises. Offences. Result. Fine. Costs. 37, Burtop Road, Wandsworth Nuisances Summons withdrawn, the work having been done — 2/- 25, 27, 31 and 33 F e r n 1 e a Road, Balham " " - 8/- 23a, Pevensey Road, Tooting " Order made for abatement of nuisance - 5/- 7, Khartoum Road, Tooting ,, Convicted 40/- — 15, Hazelhurst Road, Balham ,, Summons withdrawn, the work having been done 2/- Garratt Lane (Bone Boiling Wks) Emission of offensive effluvia from Works Convicted 100 /- 250/- 18, Victoria Road, Clapham Erection of a W.C. in contra vention of the By-laws 20/- - ,, Failing to give notice of commencement of work •• 10/- - 33, Gartmoor Gardens, Wandsw'th Nuisances Summons withdrawn the work having been done - 2/- 78, Fullerton Road, Wandsworth ,, »» >* - 2/- 15, Selkirk Road, Tooting ,, Order made for abatement ol nuisance - 5/- 35, 36 and 37, White Square, Clapham Nuisances and contravention of By-laws (W.C.'s and yard paving) Conviction 100- 84/- 626, Wandsworth Road, Clapham Selling meat unfit for human food Summons dismissed - " 19, Sistova Road, Balham Nuisances Order made for abatement of nuisance - 5/- 44, Tooting Grove ,, »» »» - 5/- 33, Norroy Road, Putney " Summons withdrawn the work having been done - 2/- 43, Baldry Gardens, Streatham „ Order made for abatement of nuisance 20/- - Garratt Lane (Bone Boiling Works) Emission of offensive effluvia from Works Convicted 100/- 42/- 26, 28, 30, 32, 34 and 36, Jew's Row, Wandsw'th Nuisances ... Order made for abatement of nuisance 5/- ,, Contravention of By-laws (W.C.'s and yard paving) Convicted 140/- 50/- 98, Dahomey Road, Streatham Selling milk without being registered „ 10 /- 21/- 59 Report of the Medical Officer of Healih. TABLE XLIII. Contravention of Regulations Made Under the Defence of t(he Realm Regulations. Premises. Offences. Result. Fine. Cost 48, High Street, Tooting Wasting bread which was fit for human food Summons dismissed — — 33, Felsham Road, Putney Selling bread which was less than 12 hours old Convicted 200/- 42/- 34, Clapham Park Road Contravention of the Butter (Maximum Prices) Order Committed to prison for one week - - 324, Trinity Road, Wandsworth Contravention of the Flour and Bread (Prices) Order Convicted 60/- 42/- Drug Stores, Balham Contraventior of the Oat and Maize Products (Prices) Order Summons withdrawn on payment of costs - 42/- 205, High Street, Wandsworth Alteration of Sugar Vouchers Convicted. 200/- 21/- 27, Bedford Hill, Balham Contravention of Jam (Prices) Order, Committed to prison for 10 days Defendant's wife convicted 40/- — 80, High Road, * Balham ,, Convicted 80/- 21/- 39, Gosberton Road Balham ,, ,, 20/- 10/6 33, High Road, Balham ,, ,, 4°/- 21/- 200, Trinity Road Wandsworth Contravention of Potatoes Order. ,, 42/- - 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. 50 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 A3134 60 Report of the Medical Officer of Health. 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 XLIV. PREMISES. NUMBER OF PLACES Number of inspections, 1917. Number of notices, 1917. Number of prosecutions, 1917. On register at end of 1916. Added in 1917. Removed in 1917. On register at end of 1917. Milk premises ... 405 21 14 412 72s 10 1 Cowsheds 11 ... ... 11 44 ... ... Slaughter-houses 12 ... ... 12 239 2 ... Other offensive trade premises 4 ... ... 4 110 •3 4 Ice cream premises ... 343 ... 13 330 309 7 ... Registered houses let in lodgings ... 292 ... ... 292 851 *a2 1 * b524 ... ... *a For overcrowding. * b For other conditions. Unsound Food. Three boxes of herrings, one box of haddock roes, one box of cod, one box of chats, two boxes of haddocks, 21 rabbits, five hams, 13 bags of potatoes, 99J lbs. cheese, one bag of winkles, and 616 pounds of beef were destroyed at the request of the owners and the usual certificates granted. Proceedings were taken in one instance for exposing unsound meat for sale, but the summons was dismissed by the Magistrate. FACTORIES AND WORKSHOPS. There has been a decrease in the total number of inspections of the above, compared with 1916, 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. 01 Report of the Medical Officer of Health. INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. TABLE XLV. CLASS OF WORKS. Number of Places Number of Inspections, 1917. Number of Notices. Number of Prosecutions, 1917* On Register at end of 1916. Added in 1917. Removed in 1917. On Register at end of 1917. Intimation, 1917. Statutory, «9'7- Under Factory Act. Under Public Health Act. Premises Rooms. Factories Factory Laundries 87 ... 2 85 345 167 5 ... ... ... Factory Bakehouses 39 8 4 43 64 189 2 ... ... ... Other Factories 356 43 12 387 1,248 696 48 2 ... ... Workshops Workshop Laundries 117 ... 21 96 292 '57 5 ... ... ... Workshop Bakehouses 108 ... 16 92 92 547 8 ... ... ... Other Workshops 1,316 49 102 1,263 1,710 1,281 44 1 ... ... Workplaces Places where Food is prepared for Sale 567 13 37 543 600 596 39 1 ... ... Workplaces other than the above 529 46 85 490 701 563 21 1 ... ... Home-workers' premises 401 71 61 411 411 445 9 2 ... ... Total 3.520 230 340 3.410 5,463 4,641 181 7 ... ... 62 Report of the Medical Officer of Health. 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 XLVI. I.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. (i) (2) (3) (4) Factories (Including Factory Laundries.) 1,052 57 ... Workshops (Including Workshop Laundries.) 1,985 58 ... Workplaces (Other than Outworkers' premises included in Part 3 of this report.) 1,159 62 ... Totals 4196 177 ... 63 Report of the Medical Officer of Health. TABLE XLV1I. 2.—DEFECTS FOUND. Particulars. Number of Defects Number of Prosecutions. Found. Remediec Referred to H.M. Inspector (1) (2) (3) (4) (5) Nuisances under the Public Health Acts : —* Want of Cleanliness 67 65 ... ... Want of Ventilation ... ... ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other nuisances ll6 114 ... ... Sanitary accommodation insufficient 5 5 ... ... unsuitable or defective 55 55 ... ... not separate for sexes ... ... ... ... 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) 10 10 ... ... Other offences (Excluding offences relating to outwork, which are included in Part 3 of this report.) ... ... ... ... Totals 253 249 ... ... * including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediible 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. 64 Report of the Medical Officer of Health. TABLE XLVIII. 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 inspection of lists. Failing to send lists. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (SS.109,110).[/$###] Listst 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— (i) Making, &c. 74 87 218 9 4 23 34 ... ... 9 11 ... 29 ... ... (2) Cleaning and washing 4 5 8 ... ... ... ... ... ... ... ... ... ... ... ... 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 B^gs and Boxes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brush making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pea picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carding, &c., of buttons, &c ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stuffed Toys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Basket iraking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 80 92 235 10 4 29 34 ... ... 9 11 ... 29 ... ... * If an occupier gives out work of more than one of the classes specified in column i, and subdivides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. † The figures required in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarily be even numbers, as there will be two lists for each employer—in some previous returns odd numbers have been inserted. The figures in columns 3 and 4 will usually be (approximately) double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated. 61 Report of the Medical Officer of Health. The total number of addresses received from other Councils was 548, and 232 addresses were forwarded to other Councils. The number of addresses received has increased by five, and the number sent decreased by 32. 79 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 34, and these had a most satisfactory result. During the year 29 cases of infective diseases, one of Scarlet Fever, two of Diphtheria, 25 of Measles, and one 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 XLIX. 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) I cDortant classes ol workshops, aucn as workshop bakehouses, may be enumerated here. [ Workshop Bakehouses 92 ,, Laundries 96 Dressmakers' and Milliners' Workshops 221 Bootmakers 122 Smiths 43 Builders 60 Tailors 68 Other \ 749 Total number of workshops on Register 1,451 66 Report of the Medical Officer of Health. TABLE L. 5.—OTHER MATTERS. Class. Number. (I) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 24 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 3 Reports (of action taken) sent to H.M. Inspector 3 Other ... Underground Bakehouses (s. 101):— Certificates granted during the year ... In use at the end of the year 41 67 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 1,461 inspections were made by the Sanitary Inspectors (139 in Clapham, 1,086 in Putney, and 236 in Wandsworth). Canal Boats Act. During the year 21 inspections of Canal Boats were made, but it was not necessary to serve any notices, as on inspection the condition of all the boats was found to be satisfactory. Food Control. On the 8th May, 1917, an Order (The Local Authorities (Food Control) Order, No. 1, 1917) under the Defence of the Realm Regulations was made by the Local Government Board imposing upon Local Authorities the enforcement of the following Orders. The Potatoes 1916 Main Crop (Prices) Order No. 2. The Price of Milk Order. The Feeding of Game Order. The Sugar (Confectionery) Order. The Bread Order. The Swedes (Prices) Order. The Food (Conditions of Sale) Order. Tea (Nett Weight) Order. The Manufacture of Flour and Bread Order (No. 2). The Public Meals Order. The Cake and Pastry Order. The Wheat, Rye and Rice (Restriction) Order. The Maize, Barley and Oats (Restriction) Order. The Brewers' Sugar Order. 68 Report of the Medical Officer of Health. The Council decided that the Sanitary Inspectors should make inquiries into the operation of the Orders and to report on any infringements that came to their notice. The following further Orders were issued during the year:— The Oat and Maize Products (Retail Prices) Order. The Horses (Rationing) Order. The Public Meals Order, No 2. The Beans, Peas and Pulse (Retail Prices) Order. The Meat (Sales) Order. The Oats and MaizeProducts (Retail Prices) Order, No. 2. The Sugar (Domestic Preserving) Order. The Public Meals Order, No. 3. The Stone Fruit (Jam Manufacturers' Prices) Order. The Raspberries (Jam Manufacturers' Prices) Order. The Winter Beans Order. The Barley (Restriction) Order. The Jam (Prices) Order. The Sugar (Restriction) Order. The Meat (Maximum Prices) Order. The Butter (Maximum Prices) Order. The Flour and Bread (Prices) Order. The Milk (Prices) Order. The Potatoes Order. The Butter (Maximum Prices) Order, No. 2. The Potatoes (Postponement of Date) Order. The Butter (Maximum Prices) Order, No. 3. The Horses (Rationing) Order, No. 2. The Bread (Use of Potatoes) Order. The Milk Order—General Licence. The Public Meals Order—General Licence. Flour and Bread (Prices) Order—General Licence. The Sugar Order. The Beer (Prices and Description) Order. The Butter (Maximum Prices) Order (No. 4). The Butter (Maximum Prices) (Amendment Order). The Local Authorities (Food Control) Order (No. 3), issued on the 9th November, 1917, rescinded the Order issued on the 8th 69 Report of the Medical Officer of Health. May as from the 31st December, 1917 and the operation of these Food Orders was, by the Enforcement (England & Wales) Order, 1917, transferred to the Local Food Control Committee. Statement of Work done under the Rag Flock Act, 1911. 20 workshops were visited by the Inspector and the materials used for bedding and upholstery were examined. Statement of Work done under the Sale of Food and Drugs Acts. During the year 1,504 samples of foods and drugs were submitted to the Public Analyst for analysis. Of these samples 900 were purchased as test or informal samples, while 604 were purchased officially. . Of the 604 official samples submitted for analysis 76, or 12.5 per cent, were reported to be adulterated or not up to standard, and of those samples which were purchased informally or as test samples 50, or 5.5 per cent, were found adulterated or not up to standard. The total adulterations reported were 126, or 8.3 per cent, of the samples submitted. The percentage of milk samples found to be adulterated was 11.9. In 50 out of the 76 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 £102 6s. 6d., and the costs to £32 12s. od., making a total of £134 18s. 6d. The following table shows the number of formal and informal samples taken in each sub-district of the Borough, together with 70 Report of the Medical Officer of Health. 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 LI. Formal Samples. Informal Samples. Total No. of samples taken. No. per 1,000 of Population. No. Adulterated. Percentage Adulterated. No. of samples taken. No. Adulterated. Percentage Adulterated. No of samples taken. No. Adulterated Percentage Adulterated. Clapham 120 16 13.3 182 11 6.0 302 5.3 27 8.9 Putney 8l 8 9.8 89 6 6.7 170 6.2 14 8.2 Streatham M3 13 9.0 273 14 5.1 416 4.4 27 6.5 Tooting 122 20 16.3 152 10 6.5 274 7.8 30 10.9 Wandsworth 138 19 13.7 204 9 4.4 342 3.8 28 8.2 Whole Borough 604 76 125 900 50 5.5 1,504 5.0 126 8.3 Milk and Cream. MILK. 613 samples of milk were procured for analysis during the year. 73 or ii'9 per cent, were reported against as being adulterated or not up to legal standard. 591 samples were purchased officially, of which 68 or 11.5 per cent, were adulterated, and 22 samples purchased informally, of which five or 22.7 per cent, were reported against. 51 samples were found to contain added water, 20 were deficient in milk fat, and two were deficient in milk fat and contained added water. 71 Report of the Medical Officer of Health. Proceedings were taken in 43 cases, and in 40 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. 30 samples of milk were taken on delivery at various Public Institutions situated within the Borough. Five samples were reported against, and in four proceedings were taken and convictions obtained. Seven 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. Two samples were reported against as being deficient in milk fat, proceedings were taken against the farmer, who proved that the milk was sold as received from the cow. 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. Four samples of milk were procured on delivery at private houses. These samples were genuine. 122 samples of milk have been taken on Sundays, either in the early morning or at mid-day. 17 or 14 0 per cent, were reported against as being adulterated. 329 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 30 or 9-1 per cent, were reported against. Ten samples of milk were taken from automatic milk supply machines and all were reported to be genuine. 72 Report of the Medical Officer of Health. In 12 cases the defendants relied on a warranty, and in each case the Magistrate was satisfied that the milk sold was in the same condition as received, and therefore dismissed the summonses. CREAM AND PRESERVED CREAM. Nine samples of cream and four of preserved cream were taken during the year. One or in per cent, of the samples of cream were reported against as containing a preservative. REPORT ON ADMINISTRATION IN CONNECTION WITH THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. Report for the year ended 31 st December, 1917. 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 613 Nil. Cream 9 1 Nature of preservative in each case in column (b). CREAM. One sample of cream was found to contain crystallised Boric Acid. Nature of preservative in each case in column (b). MILK. Nil. 73 Report of the Medical Officer of Health. Action taken under the Regulations in regard to each case in Column (b). Nil. (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 4 (2). Statements incorrect 0 Total 4 (b) Determinations made of milk-fat in cream sold as Preserved Cream:— (1). Above 35 per cent. 4 (2). Below 35 per cent. 0 Total 4 (c) and (d) In each of the four samples procured as Preserved Cream the provisions as to labelling were duly observed. (3). Thickening, Substances Nil. (4). Other Oburvations Nil. Owing to the limited supply of cream during the year under review, the Inspector had great difficulty in obtaining samples for analysis, the supply being reserved for the vendors' regular customers. In December, 1917 the Food Controller made an Order (The Cream Order, 1917) restricting the sale and use of cream to infants and invalids, and in the latter case only on production of a medical certificate. 74 Report of the Medical Officer of Health. Butter and Margarine. BUTTER. 480 samples of butter were submitted for analysis during the year, of which 37 or 77 per cent, were reported against. Of the 480 samples of butter analysed, four samples were taken officially, four or 100 per cent, were reported against, whereas of those samples taken informally 33 or 6*9 per cent, were found to be adulterated. In four cases proceedings were instituted against the vendors of the adulterated samples. The penalties and costs amounted to £60 14s. od. MARGARINE. 23 samples of margarine were submitted for analysis, and all returned as genuine. There was one conviction under the Margarine Act, this being in connection with the Sale of Margarine as butter. 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. Olivar Field, who was 75 Report of the Medical Officer oj Health. 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 is still carrying 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, except Mr. R. Brown, Sanitary Inspector, A. Blake and E. Tyler, Disinfectors, who have been discharged on medical grounds and have returned to their duties, and the work is being carried on by temporary substitutes. The staff has been augmented by the appointment of an additional Health Visitor, Miss B. Wearing, who commenced her duties on June 18th 1917. 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. A3134 F 76 ANNUAL STATEMENT Of the work done in tne 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 Meropolitan Borough of Wandsworth. Sir and Gentlemen, In presenting this, my sixth annual report of the work performed by me, with the assistance of Mr. C. A. Hackman, F.I.C., the additional analyst to the Borough, I should like to point out that, whilst the statement has had to be considerably curtailed, owing to the necessity for sparing paper in printing the report, the analytical work on samples has been as thoroughly carried out as in the past, with the sole exception that the shortage of glycerine made it imperative for us in the national interests to refrain from estimating the Boric Acid in samples of Butter submitted informally during the latter half of the year. I venture to think, however that this will not prove a serious omission, as during the last three years it has been quite exceptional to examine butter sold in the 77 Report of the Medical Officer of Health. borough which contained above the maximum permissible per centage of Boric Acid namely, 0.5. The percentage of adulteration for all samples submitted during 1917 amounts to 8.3; for those submitted formally 12.5; and for informal samples 5.5; thus showing that the efficient inspection is having the desired effect upon the food supply of the Borough. In two cases, one submitted as Margarine, and the other as Coffee Mixture, analysis proved that the inspector had, in fact, been supplied with genuine Butter and Coffee respectively. Both of the above occurred in "informal" samples. I now append statements showing the nature of the samples submitted and the amount of adulteration; and whilst doing so, would like to congratulate the Borough on the fact that each and every sample of milk submitted—in all 614—was free form any trace of preservative. The usual table showing the nature and extent of the adulteration has been omitted, as there is nothing exceptional to which to draw attention. 78 Report of the Medical Officer of Health. General Statement.— Nature of Article. Examined. Adulterated. Formal Informal Total Formal Informal Total Milk and Cream 593 34 627 69 6 75 Butter 4 476 480 4 33 37 Cheese — 13 13 — 0 0 Margarine — 23 23 — 0 0 Lard 4 68 72 3 3 6 Bread - 27 27 - 0 0 Flour — 34 34 — 0 0 Coffee — 43 43 — 0 0 Cocoa 1 40 4i 0 1 1 Mustard — 12 12 — 2 2 Pepper — 10 10 — 0 0 Drugs 2 33 35 0 3 3 Other Articles - 87 87 - 2 2 Total 604 900 1,504 76 50 126 79 Report of the Medical Officer of Health. Milk Table. Nature of Article. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Milk 586 22 608 68 5 73 Separated Milk 5 — 5 0 — 0 Powder Milk 1 — 1 1 — I Cream 1 8 9 0 1 I Preserved Cream - 4 4 — 0 0 Total 593 34 627 69 6 75 Drugs. Nature of Drug. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Acid, Citric - 1 1 - 0 0 „ Tartaric - 1 1 - 0 O Friar's Balsam - 1 1 - 0 0 Lime Water - 3 3 - 0 0 Linseed, Crushed - 1 1 - 0 0 Oil, Almond - 2 2 - 0 0 Pills Iron (Blaud's) - 2 2 - 0 0 Powder, Gregory's - 3 3 - 0 0 „ Comp. Liq. - 3 3 - 0 0 Prescriptions 2 4 6 0 3 3 Rhubarb, Powdered — 2 2 - 0 0 Spirits of Camphor — 1 1 - 0 0 Sugar of Milk — 5 5 - 0 0 Syrup of Squills — 1 1 - 0 0 Tincture of Iodine — 1 1 - 0 0 Wine, Ipecacuanha — 2 2 - 0 0 Total 2 33 35 0 3 3 80 Report of the Medical Officer of Health. Other Articles (Informal). Nature of Article. Examined. Adulterated. Baking Powder 17 0 Barley, Pearl 4 0 Coffee Mixture 3 0 Honey 5 0 Lard, Compound 1 0 „ Substitute 1 0 Nut 2 2 Maize, Flaked 2 0 „ Semolina 1 0 Preserved Fruit 6 0 Oatmeal 10 0 „ Robinson's patent 1 0 Oats, Rolled 1 0 Olive Oil 6 0 Rice 16 0 Soup, Desiccated 4 0 Tapioca 7 0 Total 87 2 Difficulties in the matter of carrying out the duties of the office still increase, especially in obtaining assistance and necessary apparatus, but the Council can rest assured that neither myself nor the additional analyst will spare ourselves in our endeavour to carry out the duties of the office with efficiency. I am Sir and Gentlemen, Your obedient Servant, A. H. M. MUTER, f.i.c , f c.s.