WAN 5 Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, &c., OF THE BOROUGH, FOR THE YEAR 1918, by P. CALDWELL SMITH. C.B.E., M.A., M.D., D.P.M., 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 94 Anthrax Order 26 Appendicitis and Typhlitis 66 Bacteriological Examinations 18-63 Bakehouses 82 Births 2 Births and Birth-rates in Sub-Districts 2 Births, Notification of, Act 3 Brain and Nervous System, Diseases of the 65 Canal Boats Act 88 Cancer 65 Census, 1911 1 Cerebro-Spinal Fever 17 Chicken-pox 26 Circulatory Diseases 66 Clapham, House-to-House Inspections in 75 Cleansing of Persons Act 77 Conscientious Objection Certificates granted 14 Cowsheds 81 Cutting-off Notices 71 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 4 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 Dental Work 45 Developmental Diseases 67 Diarrhœa 26 Diarrhoea. Death-rate from 26 ii. PAGE Diarrhcea, Method of Feeding Children who died from 27 Diphtheria 16 Diphtheria, Number of Dwellings in which multiple Cases occurred 16 Diphtheria, " Return Cases "of 16 Disinfection 76 Disinfection of Schools 21 Encephalitis Lethargica 25 Enteric fever 17 Erysipelas 19 Factories and Workshops 81 Factories, Workshops and Workplaces, Inspection of 82 Feeding of Infants, Report of Female Inspectors on 28 Food Control 88 Food Places, Inspection of 78 German Measles, Cases of 19 Glanders Order 65 Home Work 85 House Refuse, Removal of 80 House-to-house Inspections 75 House-to-house Inspections, Summary of 75 Houses and Premises Inspected 73-74 Houses Let in Lodgings 75 Housing, Town Planning, etc., Act, 1909 75 Ice Cream Premises 81 Illegitimate Children, Births of 2 Infant Visiting 28 Infant Welfare 31 Infantile Mortality 12-13 Infective Diseases, Deaths from 13 Infective Diseases, Death-rate from 13 Infective Diseases: Number of Cases Notified 11 Infective Diseases: Number of Cases notified from Elementary Schools 20 Influenza 21 Inspections, details of 73-74 Inquests 68 iii. PAGE Maternity and Child Welfare Centres 31 Maternity and Child Welfare, Report of the Medical Officer of Health on 36 Measles 19 'Measles and other Non-notifiable Diseases reported from Schools 20 Milk and Cream Regulations, 1912 92 Milk (Mothers and Children) Order 38 Milk Premises, Cowsheds,"etc., on Register 81 Milkshops 81 Military Billets 88 Mistaken Diagnosis, Cases of 17 Mortuaries 71 Natural Increase, Rate of 2 Nervous System, Diseases of the 65 Non-Infective Diseases 65 Notification of Births Act 3 Notification of Infective Diseases 13 Offensive Trades 81 Old Age 67 Ophthalmia Neonatorum 64 Other Infective Diseases 63 Outworkers 85 Overcrowding 75 Piggeries 88 Police Court Proceedings 78_79 Polio-Myelitis 64 Population 1 Population of Sub-Districts 1 Premature Birth 67 Puerperal Fever 19 Pulmonary Tuberculosis, Notification of Cases of 50 Putney, House-to-house Inspections in 75 Rag Flock Act, 1911, Statement of work done under 89 Report of Tuberculosis Officer 55 Respiratory Diseases 66 Return Cases of Scarlet Fever and Diphtheria 16 iV. PAGE Revenue Act 71 Sale of Food and Drugs Act, Proceedings under 89 Sale of Food and Drugs Acts, Statement of Work under 89 Sanitary Operations, Table of 72 Sanitary Work, General 71 Scarlet Fever 15 Scarlet Fever, Number of Dwellings in which Multiple Cases occurred 15 Scarlet Fever, Return Cases "of 16 Schools, Disinfection of, for Infective Diseases 21 Schools, other diseases notified from 20 Slaughter-houses 81 Small-pox 14 Smoke Nuisances 72 Staff 92 Streatham, House-to-house Inspections in 75 Tooting, House-to-house Inspections in 75 Tuberculin treatment 63 Tuberculosis Dispensaries 55 Tuberculosis Officer, Report of 55 Tuberculous Diseases 50 Underground Rooms 73 Unsound Food 81 Urinals in Connection with Licensed Premises, Inspection of 78 Vaccination Returns 14 Venereal Diseases 65 Violence, Mortality from 68 Vital Statistics of Whole Borough 10 Wandsworth, House-to-house Inspections in 75 Water Supply, Cutting-off Notices 71 Whooping Cough 20 Zymotic Diseases, Deaths from 13 Zymotic Diseases, Death-rate from 13 REPORT of the Medical Officer of Health for the Year 1918. 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 1918. Population. The civil population of the Borough to the middle of 1918 has been estimated by the Registrar General to be 292,408 for the purpose of calculating death rates and 327,633 for birth-rates. The population, uncorrected for Institutions, as ascertained from an enumeration of the ration books, was found to be 327,595. 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 1918 For death-rates. For birth-rates. Clapham 58.592 55,025 61.690 Putney 28,242 26,524 29,735 Streatham 96,192 90,330 101,275 Tooting 35,958 33,764 37,853 Wandsworth 92,376 86,765 97,080 Whole Borough 311,360 292,408 327,633 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 28th December, 1918, 4,685 births, 2,389 of males and 2,296 of females, were registered, compared with 4,936 in 1917. The total number of births registered in this Borough was 4,453, but 261 births occurred in Institutions outside the Borough of persons belonging to the Borough, and 29 births in Institutions in the Borough of persons not belonging to the Borough, making a corrected total of 4,685. The diminution in the number is doubtless due 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 Boroueh. TABLE II. Sub-District. Births. Rates. Males. Females. Total. Birth-Rate. Rate of natural increase. Clapham 417 428 845 13.69 — 2.37 Putney 185 184 369 12.40 — 1.96 Streatham 810 720 1,530 15.10 — .05 Tooting 325 286 611 16.14 +1.72 Wandsworth 652 678 1,330 13.70 — 1.11 Whole Borough 2,389 2,296 4,685 14.29 — .78 This is the first time on record that the number of deaths has exceeded the number of births, causing the rate of natural increase to be a minus quantity in the whole Borough, and in four of the sub-districts. This is due to two causes, first the low birth rate, and second the unusually severe mortality from Influenza during the autumn. 79 births occurred in the Workhouse, 50 of which belonged to the Borough. 368 illegitimate births took place in the Borough, 35 of these belonging to Clapham, 18 to Putney,. 217 to Streatham, 30 to Report of the Medical Officer of Health. Tooting, and 68 to Wandsworth. Of the 217 illegitimate births that occurred in Streatham, 193 took place in a private home in that sub-district. Only six of the mothers of these children were residents of the Borough. 36 illegitimate births were also registered outside the Borough, making a total of 404. The percentage cf illegitimate births to total births was 8.6. 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 744 241 214 205 84 845 17 Putney 340 99 83 136 22 369 7 Streatham 1,452 419 364 4,59 210 1,530 35 Tooting 607 88 155 332 32 611 17 Wandsworth 1,351 239 555 425 132 1,330 37 Whole Borough 4,494 1,086 1,371 1,557 480 4,635 113 The percentage of births notified, less still-births, to those registered was 93-5. Deaths. During the 52 weeks ending the 28th December, 1918, 4,208 deaths, 2,011 of males and 2,197 females were registered, compared with 3,555 in 1917. 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 4 Report of the Medical Officer of Health. 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. TABLE IV. Name of Public Institution. Clapham. Putney. Streatham Tooting. Wands'th. Total. Hostel of God 79 ... ... ... ... 79 South London Hospital for Women 31 ... ... ... ... 31 St. Anne's Home ... ... 5 ... ... 5 Springfield Mental Hospital ... ... ... ... 326 326 Fountain Asylum ... ... ... 75 ... 75 H. M. Prison ... ... ... ... 8 8 Workhouse ... ... ... ... 9 9 Royal Hospital for Incurables ... ... ... ... 17 17 Tooting Bee Asylum ... ... ... 424 ... 424 The Priory ... 3 ... ... ... 3 Putney Hospital ... 16 ... ... ... 16 Newlands House Asylum ... ... ... 4 ... 4 Military Hospitals 9 13 4 107 64 197 TOTAL 119 32 9 610 424 1,194 Other places 81 41 83 5 44 254 GRAND TOTAL 200 73 92 615 468 1,448 5 Report of the Medical Officer of Health. TABLE V. Deaths in Public Institutions in the Borough of Persons not belonging to the Borough, 1918 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. Springfield Mental Hospital. 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Membranous Croup 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Influenza 128 82 46 2 1 4 15 32 62 8 4 17 5 ... ... ... ... ... ... ... 24 2 1 40 30 Erysipelas 1 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases 4 4 ... ... ... ... ... 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... Pulmonary Tuberculosis 159 91 68 ... ... ... 3 36 79 32 9 73 16 24 ... ... ... ... ... ... 5 1 35 5 Tuberculous Meningitis 3 3 ... ... ... ... ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 1 Abdominal Tuberculosis 10 8 2 ... ... 1 1 5 2 1 ... 5 ... 1 ... ... ... ... ... ... 1 ... ... 2 1 Other Tuberculous Diseases 7 6 1 ... ... ... ... 3 2 2 ... 2 ... 2 ... ... ... ... ... ... ... 1 ... 2 1 Other Infective Diseases 4 3 1 ... ... ... ... 1 2 ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 2 ... Cancer, Malignant Disease 78 28 50 ... ... ... ... 3 11 38 26 6 4 23 ... ... ... 3 ... ... ... 8 ... 5 19 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diabetes 4 3 1 ... ... ... ... ... 1 3 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... Other General Diseases 13 3 10 ... ... ... ... 2 1 4 6 ... ... ... ... ... ... 5 ... ... ... 2 ... 1 5 Alcoholism 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 1 ... 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Hæmorrhage, Apoplexy 23 13 10 ... ... ... ... ... 2 7 14 9 7 ... ... 1 ... ... ... ... ... ... 2 1 3 Convulsions 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Other Diseases of Nervous System 162 89 73 ... ... 5 21 17 56 51 12 99 14 ... 1 ... ... 4 2 ... 34 ... 1 ... 7 Organic Diseases of Heart 51 27 24 ... ... ... ... 1 8 12 30 11 20 4 ... 1 1 ... ... ... ... 1 ... ... 13 Other Diseases of Circulatory System 11 2 9 ... ... ... ... ... 1 6 4 ... 2 ... ... ... 3 ... ... ... ... ... 2 4 Bronchitis 14 5 9 ... ... ... ... ... ... 6 8 4 2 ... ... ... ... ... ... ... ... ... 1 ... 7 Broncho-Pneumonia 13 4 9 ... ... ... 3 2 2 3 3 3 2 ... ... ... ... ... ... ... 3 1 ... 2 2 Lobar Pneumonia 4 2 2 ... ... ... ... ... 3 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 1 Pneumonia (type not distinguished) 60 41 19 1 ... ... 1 6 11 12 29 10 39 ... ... ... 1 ... ... ... ... 1 ... 6 3 Other Diseases of Respiratory System 4 1 3 1 1 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Ulcer of Stomach 3 1 2 ... ... ... ... ... 1 ... 2 ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 Diarrhœa 4 1 3 2 ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 3 Enteritis 5 1 4 1 ... ... ... ... ... 4 ... 3 1 ... ... ... ... ... ... ... ... ... ... ... 4 Appendicitis and Typhlitis 3 2 1 ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... Obstruction of Intestines 4 1 3 ... ... ... ... ... 1 2 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 Cirrhosis of Liver 3 1 2 ... ... ... ... ... ... 2 1 ... ... 1 ... ... ... ... ... ... ... 1 ... ... 1 Other Diseases of Liver 6 3 3 ... ... ... ... ... 2 3 1 1 1 ... ... ... ... ... ... 1 ... 2 ... ... 1 Other Diseases of Digestive System 5 2 3 1 ... ... ... ... 2 ... 2 ... 1 ... ... ... ... ... ... ... ... 1 ... 1 2 Nephritis and Bright's Disease 30 14 16 ... ... ... ... ... 9 16 5 16 7 ... ... ... ... ... ... 1 ... 1 ... ... 5 Other Diseases of Urinary System 2 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Diseases of Generative System 4 ... 4 ... ... ... ... ... 1 1 2 ... 1 ... ... ... ... ... ... 1 ... 1 ... ... 1 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Premature Birth 5 2 3 5 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 3 Congenital Debility and Malformation 5 4 1 2 ... 1 1 1 ... ... ... 1 1 ... ... 1 ... ... ... ... 2 ... ... ... ... Other Diseases of Early Infancy 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Old Age 360 145 215 ... ... ... ... ... ... 28 332 58 283 1 1 ... ... 1 ... ... ... ... ... ... 16 Deaths from Accident 17 10 7 ... ... ... 1 1 3 5 7 1 7 ... ... ... ... ... ... 1 ... ... ... ... 8 Deaths from Suicide 8 5 3 ... ... ... ... 2 3 3 ... 1 ... ... 1 ... 2 ... ... ... ... ... ... ... 4 Other Violent Deaths 78 77 1 1 ... ... ... 36 41 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 75 I Other defined Diseases 2 1 1 ... ... ... ... 2 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Diseases or unknown 3 2 1 ... ... ... ... ... 2 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 All causes 1306 692 614 18 2 11 48 153 314 258 502 326 417 66 3 4 6 17 2 5 70 26 5 197 162 6 Report of the Medical Officer of Health. TABLE VI. Deaths in Public Institutions, &c., in the Borough of Persons belonging to the Borough, 1918. 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 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Influenza 15 4 11 ... ... ... 4 2 7 2 ... ... 2 1 2 1 ... ... 9 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 8 5 3 ... ... ... 1 2 2 3 ... ... ... ... 1 ... 4 ... 3 Tuberculous Meningitis 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Other Infective Diseases 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Dancer, Malignant Disease 19 9 10 ... ... ... ... ... ... 11 8 ... ... ... 1 ... 8 ... 10 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diabetes 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Other General Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Haemorrhage, Apoplexy 5 2 3 ... ... ... ... ... ... 2 3 ... ... 1 ... ... ... ... 4 Convulsions 2 ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Other Diseases of Nervous System 4 4 ... ... ... ... 3 ... 1 ... ... ... ... ... ... 3 ... ... 1 Organic Diseases of Heart 12 7 5 ... ... ... ... ... 1 5 6 1 ... ... ... ... 1 ... 10 Other Diseases of Circulatory System 7 3 4 ... ... ... 1 ... 1 1 4 ... ... ... ... 1 ... ... 6 Bronchitis 6 2 4 ... ... ... 1 ... ... ... 5 1 ... ... ... ... ... ... 5 Broncho-Pneumonia 3 3 ... 2 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... 2 Lobar Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (type not distinguished) 5 3 2 1 ... ... ... ... 1 ... 3 ... ... ... 1 ... ... ... 4 Other Diseases of Respiratory System 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... Ulcer of Stomach 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... Diarrhoea 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Enteritis 2 ... 2 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 2 Appendicitis and Typhlitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Obstruction of Intestines 3 1 2 ... 1 ... ... ... ... 1 1 ... ... ... ... ... ... 1 2 Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Digestive System 2 1 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 Nephritis and Bright's Disease 4 1 3 ... ... ... ... ... 1 2 1 ... 1 ... ... ... ... 1 2 Other Diseases of Urinary System 2 2 ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 2 Diseases of Generative System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Other Accidents and Diseases of Pregnancy and Childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 4 3 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Congenital Debility and Malformation 2 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Other Diseases of Early Infancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Old Age 13 5 8 ... ... ... ... ... ... ... 13 3 4 ... ... ... ... ... 6 Deaths from Accident 8 4 4 1 ... ... 2 1 3 ... 1 ... ... ... 2 ... ... ... 6 Deaths from Suicide 3 1 2 ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... ... 3 Other Violent Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other defined Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Diseases or unknown 3 3 ... 12 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 3 All causes 142 70 72 16 1 12 14 6 22 33 48 5 7 2 11 5 13 5 94 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, 1918. CAUSES OF DEATH. Deaths in or belonging to whole District at subjoined ages. Deaths in or belonging to Localities (at all 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. 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 5 2 3 ... ... ... ... 1 4 ... ... ... ... 1 3 1 ... ... 4 1 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... 11 5 6 2 to 1 1 1 ... ... ... 2 4 1 1 3 4 ... 1 6 Scarlet Fever 3 1 2 ... ... 1 2 ... ... ... ... 1 ... 2 ... ... ... ... ... 3 Whooping Cough 19 4 15 2 8 9 ... ... ... ... ... 5 ... 5 4 5 11 6 ... 2 Diphtheria and Membranous Croup 29 11 18 1 2 11 15 ... ... ... ... 9 1 8 3 8 ... 2 ... 27 Influenza 186 67 119 3 1 9 12 41 94 17 9 33 13 51 26 63 140 24 21 1 Erysipelas 2 ... 2 ... ... ... ... ... ... 1 1 1 ... ... ... 1 1 ... 1 ... Cerebro-spinal Fever 7 4 3 ... 1 2 1 1 2 ... ... ... 1 2 ... 4 ... 2 ... 5 Other Epidemic Diseases 1 ... 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... 1 ... Pulmonary Tuberculosis 165 85 80 ... 2 1 1 28 82 45 6 24 19 48 27 47 71 32 55 7 Tuberculous Meningitis 16 8 8 1 4 2 6 2 ... 1 ... 6 ... 2 3 5 6 8 ... 2 Abdominal Tuberculosis 10 5 5 ... 2 ... 3 3 2 ... ... 2 ... 2 2 4 2 6 2 ... Other Tuberculous Diseases 23 14 9 1 2 2 1 4 4 6 3 7 2 5 5 4 13 8 2 ... Other Infective Diseases 12 7 5 8 ... ... ... 1 2 ... 1 2 ... 3 1 5 11 1 ... ... Cancer, Malignant Disease 125 57 68 ... ... 1 ... ... 14 58 52 24 13 35 16 37 16 58 1 ... Rheumatic Fever 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... Diabetes 4 1 3 ... ... ... ... 1 ... 2 1 ... ... ... 1 3 3 1 ... ... Other General Diseases 5 ... 5 1 ... ... ... ... 2 2 ... 2 ... 2 ... 1 1 4 ... ... Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 4 1 3 1 1 1 1 ... ... ... ... ... ... 3 1 ... ... 4 ... ... Cerebral Haemorrhage, Apoplexy 53 23 30 ... ... ... ... ... 3 15 35 12 ... 18 8 15 37 13 3 ... Convulsions 2 1 1 1 ... 1 ... ... ... ... ... ... ... ... 1 1 ... 2 ... ... Other Diseases of Nervous System 85 48 37 ... 2 1 1 10 29 33 9 16 8 36 4 21 17 20 48 ... Organic Diseases of Heart 174 72 102 ... ... ... 4 4 22 42 102 35 11 54 15 59 114 24 36 ... Other diseases of Circulatory System 40 19 21 1 ... ... ... 1 5 12 21 16 2 15 1 6 17 15 7 1 Bronchitis 50 26 24 3 ... 1 ... ... 3 11 32 9 5 11 9 16 38 10 2 ... Broncho-Pneumonia 32 19 13 11 4 3 ... 2 6 2 4 5 ... 9 2 10 12 11 9 ... Lobar Pneumonia 14 9 5 1 ... 1 1 2 1 6 2 4 ... 5 2 3 2 5 6 1 Pneumonia (type not distinguished) 28 13 15 2 ... 1 5 4 5 8 3 4 3 9 5 7 12 14 2 ... Other Diseases of Respiratory System 12 7 5 1 1 1 3 ... 4 1 1 2 1 5 ... 4 2 7 3 ... Ulcer of Stomach 11 5 6 ... ... ... ... 1 3 5 2 3 2 2 1 3 3 7 1 ... Diarrhoea 14 10 4 13 ... ... ... 1 ... ... ... 1 2 2 2 7 5 8 1 ... Enteritis 41 27 14 32 ... ... ... ... 3 4 2 8 2 13 6 12 15 18 8 ... Appendicitis and Typhlitis 20 13 7 ... ... ... 8 3 2 6 1 4 1 6 4 5 4 16 ... ... Obstruction of Intestines 30 12 18 2 ... ... 1 1 6 12 8 4 4 10 4 8 10 19 1 ... Cirrhosis of Liver 5 5 ... ... ... ... 1 ... 1 2 1 1 1 1 ... 2 3 2 ... ... Other Diseases of Liver 5 3 2 ... ... ... ... ... ... 3 2 2 ... 1 ... 2 1 4 ... ... Other Diseases of Digestive System 9 4 5 1 ... ... ... ... 4 3 1 4 ... 2 3 ... 7 2 ... ... Nephritis and Bright's Disease 50 29 21 ... ... ... 2 1 6 23 18 9 1 12 11 17 31 12 7 ... Other Diseaes of Urinary System 22 19 3 ... ... ... ... ... 2 4 16 5 1 6 1 9 11 11 ... ... Diseases of Generative System 1 ... 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 ... ... ... Puerperal Fever 4 ... 4 ... ... ... ... ... 4 ... ... ... 1 ... 2 1 4 ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 1 ... ... Premature Birth 15 12 3 15 ... ... ... ... ... ... ... 3 ... 7 ... 5 8 7 ... ... Congenital Debility and Malformation 30 16 14 28 1 ... ... ... 1 ... ... 5 1 7 6 11 '5 13 1 1 Other Diseases of Early Infancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Old Age 71 23 48 ... ... ... ... ... ... 2 69 17 8 16 7 23 62 3 6 ... Deaths from Acc dent 43 28 15 ... ... 1 7 2 8 12 13 8 3 12 6 14 21 22 ... ... Deaths from Suicide 8 6 2 ... ... ... ... 1 2 3 2 3 3 1 ... 1 1 5 1 1 Other Violent Deaths 1 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... Other defined Diseases 9 6 3 ... ... 1 1 ... 1 1 5 ... 1 1 1 6 4 3 2 ... Ill-defined Diseases or unknown 3 2 1 ... ... ... ... 1 1 1 ... 1 ... 1 ... 1 ... 3 ... ... All causes 1511 731 780 131 37 51 78 117 329 345 423 301 115 433 201 461 787 434 232 58 o 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 4,407, 2,045 of males, and 2,362 of females. The corrected death-rate for the year was 15.07 compared with 12.69 in 1917 This increase was wholly due to the severe outbreak of Influenza in the autumn, dealt with more fully on page 21 of this Report. The death-rate for the whole of London for the year was 18.9 per 1,000, compared with 15.0 in 1917. 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 428 456 884 342 411 753 16 .06 Putney 165 216 381 153 171 324 14.36 Streatham 607 763 1,370 429 555 984 15.15 Tooting 230 257 487 485 412 897 14.42 Wandsworth 615 670 1,285 597 647 1,244 14.81 Whole Borough 2.045 2,362 4.407 2,006 2,196 4,202 15.07 The death-rate in England and Wales in 1918 was 17.6 per 1,000 ; in the 96 great Towns 18.2; and in the 148 smaller Towns 16.1. The rates in all the sub-districts were higher than in 1917. 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 1918. CAUSES OF DEATH. Deaths in or belonging to whole District at subjoined ages. Deaths in or belonging to Localities (at all ages). Deaths in Public Institutions in the District. All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Clapham. Putney. Streatham. Tooting. Wandsworth. Enteric Fever 5 2 3 ... ... ... ... 1 4 ... ... ... ... 1 3 1 ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 45 28 17 11 15 14 4 1 ... ... ... 14 6 9 4 12 ... Scarlet Fever 3 1 2 ... ... 1 2 ... ... ... ... 1 ... 2 ... ... ... Whooping Cough 58 23 35 18 17 22 1 ... ... ... ... 17 1 17 11 12 ... Diphtheria, and Membranous Croup 35 18 17 2 3 11 19 ... ... ... ... 11 1 11 3 9 2 Influenza 834 338 496 18 18 49 73 134 370 109 63 164 75 241 81 273 143 Erysipelas 7 4 3 ... ... ... 1 ... 1 3 2 1 ... 2 ... 4 1 Cerebro-spinal Fever 8 4 4 ... 1 3 1 1 2 ... ... ... 1 2 ... 5 ... Other Epidemic Diseases 1 ... 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... 4 Pulmonary Tuberculosis 368 189 179 ... 1 2 10 71 168 101 15 62 34 104 58 110 167 Tuberculous Meningitis 34 17 17 1 10 9 11 2 ... 1 ... 8 1 6 7 12 4 Abdominal Tuberculosis 13 7 8 ... 2 ... 4 4 3 1 1 2 1 3 3 6 10 Other Tuberculous Diseases 38 18 20 2 2 3 3 8 6 8 6 10 2 13 5 5 8 Other Infective Diseases 17 9 8 11 1 ... ... 1 2 1 1 2 2 4 2 7 5 Cancer,Malignant Disease 375 160 215 ... ... 1 ... ... 35 167 172 76 37 135 28 99 97 Rheumatic Fever 11 3 8 ... ... ... 3 5 ... 3 ... 2 ... 3 ... 6 ... Diabetes 20 6 14 ... ... ... ... 1 ... 11 8 3 3 4 3 7 5 Other General Diseases 32 17 15 1 1 ... 3 2 5 13 7 3 5 11 3 10 13 Alcoholism 1 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 2 Chronic Poisonings 1 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... Meningitis 14 3 11 3 1 3 6 ... 1 ... ... 1 ... 6 6 1 1 Cerebral Haemorrhage, Apoplexy 180 79 101 1 ... ... ... 1 10 45 123 39 10 75 16 40 28 Convulsions 15 5 10 10 3 2 ... ... ... ... ... 6 1 3 2 3 3 Other Diseases of Nervous System 130 65 65 ... 2 3 7 11 32 46 29 22 12 55 10 31 67 Organic Diseases of Heart 425 178 247 ... ... 1 8 10 53 127 226 74 39 144 46 122 63 Other Diseases of Circulatory System 116 56 60 2 ... ... 3 1 9 28 73 29 10 48 5 24 17 Bronchitis 293 148 145 24 7 11 3 ... 16 60 172 62 24 91 32 84 20 Broncho-Pneumonia 133 75 58 35 28 23 7 3 14 7 15 22 11 39 20 41 16 Lobar Pneumonia 46 2 I 25 1 1 2 4 5 10 15 8 9 1 15 5 16 4 Pneumonia (type not distinguished) 168 80 82 16 12 10 11 1 34 48 25 32 12 39 24 61 65 Other Diseases of Respiratory System 46 27 19 3 2 3 5 1 6 11 15 7 4 15 4 16 5 Ulcer of Stomach 20 10 10 ... 1 ... ... 1 7 8 3 6 2 5 2 5 4 Diarrhœa 33 18 15 25 2 1 2 1 ... 1 1 7 2 7 5 12 5 Enteritis 63 35 28 48 ... 1 1 ... 3 6 4 10 5 19 8 21 7 Appendicitis and Typhlitis 23 13 10 ... ... ... 8 4 2 6 3 4 1 7 5 6 3 Obstruction of Intestines 53 18 35 3 1 ... 1 1 6 17 24 7 5 20 5 16 7 Cirrhosis of Liver 13 10 3 ... ... ... 1 ... 2 5 5 1 4 6 ... 2 3 Other Diseases of Liver 6 3 3 ... ... ... ... ... ... 3 3 3 ... 1 ... 2 6 Other Diseases of Digestive System 35 15 20 7 ... 2 2 ... 8 8 8 11 5 9 6 4 7 Nephritis and Bright's Disease 124 67 57 1 1 ... 2 4 16 43 57 27 8 32 17 40 34 Other Diseases of Urinary System 34 28 6 ... ... ... ... ... 2 7 25 8 1 12 1 12 4 Diseases of Generative System 3 ... 3 ... ... ... ... ... 1 1 1 ... 2 1 ... ... 4 Puerperal Fever 8 ... 8 ... ... ... ... 1 7 ... ... 3 ... 2 2 1 1 Other Accidents and Diseases of Pregnancy and Childbirth 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Premature Birth 76 43 33 76 ... ... ... ... ... ... ... 17 7 20 10 22 9 Congenital Debility and Malformation 89 51 38 79 3 2 2 2 1 ... ... 16 8 27 13 25 7 Other Diseases of Early Infancy 14 9 5 14 ... ... ... ... ... ... ... 6 1 3 1 3 1 Old Age 211 64 147 ... ... ... ... ... ... 1 210 55 20 63 19 54 373 Deaths from Accident 74 40 34 3 2 2 9 4 12 15 27 13 9 17 9 20 25 Deaths from Suicide 23 14 9 ... ... ... ... 1 7 8 7 3 5 8 1 6 11 Other Violent Deaths 1 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 78 Other defined Diseases 18 11 7 ... ... 2 ... ... 1 4 11 4 2 5 1 6 2 Ill-defined Diseases or unknown 11 6 5 2 ... ... ... 1 3 3 2 3 ... 6 ... 2 6 All causes 4407 2045 2362 417 137 183 217 295 860 943 1355 884 381 1370 487 1285 1448 10 Report of the Medical Officer of Health. TABLE X. Wandsworth District. Vital Statistics of Whole District during 1918 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 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 3.819 12.69 1918 292,408 4.453 4.685 14.29 4,202 14.37 1,306 1,482 417 89 4,407 15.07 Area of District in acres (exclusive of area covered by water) 9,126 Total population at all ages 311,36c Number of inhabited houses 48,435 Average number of persons per house 6.41 At Census of 1911. 11 Report of the Medical Officer of Health. TABLE XI. Wandsworth District. Cases of Infectious Disease notified during the year 1918. (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. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera, Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 487 10 118 289 44 22 3 1 135 12 140 73 127 441 Erysipelas 95 1 4 8 7 17 43 15 15 4 26 21 29 19 Scarlet Fever 563 1 110 375 56 19 2 ... 93 18 138 123 191 499 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 38 ... ... 8 8 15 6 1 7 3 7 1 20 30 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 16 ... ... ... 4 11 1 ... 3 ... 7 2 4 10 Cerebro-spinal Meningitis 21 ... 5 6 5 5 ... ... 4 2 5 3 7 20 Polio-Myelitis 3 1 1 ... 1 ... ... ... 2 1 ... ... ... 2 Pulmonary Tuberculosis 777 ... 8 83 152 390 127 17 145 57 203 125 247 ... Other forms of Tuberculosis 218 5 54 76 35 24 18 6 35 10 47 37 89 ... Ophthalmia Neonatorum 35 35 ... ... ... ... ... ... 6 2 12 4 11 3 Measles 3,184 100 1,319 1,597 107 53 8 ... 672 472 620 358 1,052 38 German Measles 397 10 90 193 62 37 5 ... 90 34 116 65 92 ... Chicken Pox 392 17 102 257 11 3 ... 2 67 24 130 47 124 ... Whooping Cough 83 10 50 23 ... ... ... ... 13 4 4 4 58 ... Anthrax 1 ... ... ... ... ... 1 ... ... ... 1 ... ... 1 Totals 6,310 190 1,861 2,915 492 596 214 42 1,287 643 1,456 873 2,051 1,063 A4256 B 12 Report of the Medical Officer of Health, TABLE XII. (Table IV.) Borough of Wandsworth. Infant Mortality. 1918. Nett Deaths from stated causes at various Ages under i Year of Age. =Cause of Death. Under 1 Week. 1—2 Weeks. 2—3 Weeks. Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months 3 Months and under 6 Months 6 Months and under 9 Months 9 Months and under 12 Months. Total Deaths under 1 year. All Causes- Certified 94 15 16 11 136 77 81 72 50 416 Uncertified 1 ... ... ... 1 ... ... ... ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 1 4 6 11 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 3 8 6 18 Diphtheria and Croup ... ... ... ... ... ... ... 2 ... 2 Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... 1 ... ... ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... 2 ... 2 Meningitis (not Tuberculous) ... 1 ... ... 1 ... ... 2 ... 3 Convulsions 1 2 ... ... 3 3 ... 3 1 10 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 ... 1 2 7 5 5 5 24 Pneumonia (all forms) 1 1 ... ... 2 12 12 13 13 52 Diarrhœa ... ... ... 1 1 4 11 6 3 25 Enteritis 1 ... 1 ... 2 11 23 8 4 48 Gastritis ... ... 1 2 3 1 1 ... ... 5 Syphilis 2 ... ... ... 2 1 7 1 ... 11 Rickets ... ... ... ... ... ... ... ... 1 1 Suffocation, overlying ... ... ... ... ... 1 ... ... ... 1 Injury at birth 2 ... ... 1 3 ... ... ... ... 3 Atelectasis 9 ... ... ... 9 ... ... ... ... 9 Congenital Malformations 12 1 ... ... 13 5 2 2 1 23 Premature birth 49 6 10 3 68 7 1 ... ... 76 Atrophy, Debility and Marasmus 12 2 3 1 18 19 10 6 2 55 Other Causes 6 1 1 2 10 4 5 10 8 37 Totals 95 15 16 11 137 77 81 72 50 417 Nett Births in the year, legitimate, 4,281; illegitimate, 404. Nett Deaths in the year of legitimate infants, 343; illegitimate infants, 74. 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 XIII. Sub-District. No. of Deaths under one year. Percentage to total Deaths. Rate per 1,000 Births. 1915 1916 1917 1918 Clapham 91 10.29 92 70 74 107 Putney 36 944 78 74 83 97 Streatham 109 7.95 76 66 73 71 Tooting 61 12.52 104 109 110 99 Wandsworth 120 9.'33 104 92 104 90 Whole Borough 417 9.23 92 78 89 89 The Infantile Mortality for the year is the same as in 1917, but is higher than 1916. INFECTIVE DISEASES. The total number of deaths from these diseases was 1,572, 312 in Clapham, 131 in Putney, 444 in Streatham, 192 in Tooting, and 493 in Wandsworth. From all infective diseases the death-rate was 5.37 per 1,000, (5.67 in Clapham, 4.93 in Putney, 4.91 in Streatham, 5.68 in Tooting, and 5.68 in Wandsworth). The rate from the principal infective diseases, viz.:—Small-pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever, and Diarrhœa, was .82 per 1,000, (1.09 in Clapham, .56 in Putney, .73 in Streatham 1.00 in Tooting, and .77 in Wandsworth). 14 Report of the Medical Officer of Health. Notification of Infective Diseases. The total number of cases of infective diseases notified during the year is shown in Table II. of the Local Government Board's Table on page II. The total number of cases notified (less Tuberculosis) was 5,315, (1,107 in Clapham, 576 in Putney, 1,206 in Streatham, 711 in Tooting, and 1,715 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. 3,184 cases of Measles and 397 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 1917. 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 1 st January to 31st December, 1917. 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 846 428 2 ... 47 225 11 24 98 11 Putney 318 222 1 ... 14 57 15 11 8 ... Streatham 2,120 821 4 ... 102 607 1 114 443 28 Wands w'th 1,467 838 2 ... 91 349 24 38 108 17 Totals 4.751 2,309 9 ... 254 1,238 51 187 657 56 The percentage of children vaccinated to total births was only 48, 50 in Clapham, 70 in Putney, 38 in Streatham, etc., and 57 in Wandsworth. 15 Report of the Medical Officer of Health. In 1905, which showed the highest percentage, of successful vaccinations in recent years, this was 74.6 per cent., so that the condition of children in the Borough as regards vaccination is a very serious one. In the year 1905 the number of certificates of conscientious objections obtained was only 140, whereas in 1918 the number was 1,238. Scarlet Fever. 563 cases were notified, (93 in Clapham, 18 in Putney, 138 in Streatham, 123 in Tooting and 191 in Wandsworth). The total number of deaths was three, and the death-rate per 1,000 was .01 The number of dwellings in each sub-district and in the whole Borough in which multiple cases occurred is shown in the following Table. TABLE XV. Sub-Districts. One case. Two cases. Three cases. Four cases. Five cases and upwards. Total houses invaded. Clapham 61 7 6 ... ... 74 Putney 16 1 ... ... ... 17 Streatham 88 17 2 1 1* 109 Tooting 75 12 1 1 2† 91 Wandsworth 150 14 3 1 ... 168 Whole Borough 390 51 12 3 3 459 * In Streatham six cases occurred in one house. † In Tooting nine cases occurred in one house, and eight in an institution. Of the 459 houses invaded, multiple cases occurred in 69, or 15.02 per cent. There was no special outbreak of Scarlet fever during the year. 16 Report of the Medical Officer of Health. Diphtheria. 487 cases were notified (135 in Clapham, 12 in Putney, 140 in Streatham, 73 in Tooting, and 127 in Wandsworth). The total number of deaths was 35 (11 in Clapham, one in Putney, 11 in Streatham, three in Tooting, and nine in Wandsworth), and the death-rate per 1,000 was .11 The number of cases notified per 1,000 of population was 1.66, and the case mortality was 7.1 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 107 9 2 1 ... 119 Putney 10 1 ... ... ... 11 Streatham 94 9 4 2 1 * 110 Tooting 61 4 ... 1 ... 66 Wandsworth 103 6 4 ... ... 113 Whole Borough 375 29 10 4 1 419 * In Streatham eight cases occurred in one house. Of the 419 houses invaded, multiple cases occurred in 44, or 10.5 per cent. There was no special outbreak of Diphtheria during the year. Return Cases of Scarlet Fever and Diphtheria. 25 cases of Scarlet Fever occurred after the return of cases from the hospitals of the Metropolitan Asylums Board, and there were also five cases of Diphtheria. 17 Report of the Medical Officer of Health. Four of the return cases of Scarlet Fever occurred in Clapham, 13 in Streatham, one in Tooting, and seven in Wandsworth. In one household in Streatham five cases occurred after the return of cases from hospital, and in another household three further cases occurred after the return of the first case from hospital. Four of the return cases of Diphtheria occurred in Streatham, and one in Tooting. Enteric Fever. 38 cases of Enteric Fever were notified during the year (seven from Clapham, three from Putney, seven from Streatham, one from Tooting, and 20 from Wandsworth). The number of deaths was five, and the death-rate was .017 per 1,000 of population. Six of the cases on admission to hospital were found not to be suffering from Enteric Fever. Five of the cases notified as Enteric Fever were, in reality, cases of Paratyphoid, and all of them were in attendance at Battersea Polytechnic, but resided at a hostel in this Borough. Investigations in this Borough and in Battersea failed to discover the source of infection. Cases of Mistaken Diagnosis. In 42 cases (21 of Scarlet Fever, 11 of Diphtheria, six 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 21 cases of this disease were notified (four in Clapham, two in Putney, five in Streatham, three in Tooting, and seven in Wandsworth). Eight of the cases terminated fatally (one in Putney, two in Streatham and five in Wandsworth), and in four information was 18 Report of the Medical Officer of Health. received that the cases had been wrongly diagnosed. Two of the wrongly diagnosed cases died from Tuberculous Meningitis, and one from Influenza. There were other two deaths, but as these were military cases they are not included in the above figures. Two cases have not yet completely recovered, while four cases have recovered. 14 deaths were registered as having been caused by Meningitis, (one in Clapham, six in Streatham, six in Tooting, and one in Wandsworth). Three of these were of infants under one year, one from one and under two years, three from two and under five years, and seven 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 581 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 80 30 167 40 119 436 Positive 26 3 48 4 41 122 Enteric Fever. Negative 4 2 6 ... 5 17 Positive ... 2 3 ... 1 6 Totals 110 37 224 44 166 581 19 Report of the Medical Officer of Health. Puerperal Fever. 16 cases of Puerperal Fever were notified (three in Clapham, seven in Streatham, two in Tooting, and four in Wandsworth) and eight deaths occurred (three in Clapham, two in Streatham, two in Tooting, and one in Wandsworth). The death rate was .05 per 1,000, and the case mortality 50 per cent. Four of the cases were attended by midwives, one of the births was premature, and four were miscarriages. Erysipelas. 95 cases were notified (15 in Clapham, four in Putney, 26 in Streatham, 21 in Tooting and 29 in Wandsworth), and seven deaths occurred (one in Clapham, two in Streatham, and four in Wandsworth) . Measles. During the year, 3,184 cases of Measles were notified (672 in Clapham, 472 in Putney, 620 in Streatham, 368 in Tooting and 1,052 in Wandsworth), and 45 deaths occurred (14 in Clapham, six in Putney, nine in Streatham, four in Tooting, and 12 inWandsworth) 11 of the deaths were of infants under one year of age, 15 from one and under two years, 14 from two and under five years, four from five and under 15 years, and one over 15 years. The death-rate per 1,000 of population was .15. On the 28th March, 1917, 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. During the year 1918, 147 cases (52 in Clapham, nine in Putney, three in Streatham, 16 in Tooting, and 67 in Wandsworth) were attended and 1,996 visits were made by the nurses. The arrangement has proved very satisfactory and the work of the nurses has been found most beneficial. 397 cases of German Measles were also notified (90 in Clapham, 34 in Putney, 116 in Streatham, 65 in Tooting, and 92 in Wandsworth), but no deaths were registered as being due to this disease. 20 Report of the Medical Officer of Health. During the year 3,780 visits were made in cases of these diseases 738 in Clapham, 516 in Putney, 786 in Streatham, 519 in Tooting, and 1,221 in Wandsworth. The total number of premises disinfected was 2,209, (466 in Clapham, 250 in Putney, 438 in Streatham, 283 in Tooting, and 742 in Wandsworth). Table XVIII. shows the number of cases of infectious diseases notified by the teachers of the elementary schools in the Borough. TABLE XVIII. Sub-Districts. Diseases. Measles. German Measles. Chicken Pox. Whooping Cough. Mumps. | Ringworm. Other Diseases. Totals. Clapham 243 14 170 149 98 29 335 1,038 Putney 127 3 68 55 18 9 31 311 Streatham 151 21 157 268 52 35 90 774 Tooting 129 18 69 234 143 32 152 777 Wandsworth 409 16 230 177 176 88 154 1,250 Borough 1,059 72 694 883 487 193 762 4,150 Whooping Cough. 58 deaths (17 in Clapham, one in Putney, 17 in Streatham, 11 in Tooting and 12 in Wandsworth), occurred during the year, 18 of these were infants under one year of age, 17 from one and under two years, and 22 from two and under five years, and one from five and under 15 years. The death-rate was .19 per 1,000. This disease was made notifiable in the Borough by the Council, and notification of cases came into operation on the 1st August. From that date to the end of the year, 83 cases were notified, and two of these cases died. 21 Report of the Medical Officer of Health. The Council's scheme with reference to the nursing of cases of Measles was during the year extended to Whooping Cough. Six cases were nursed, and 73 visits were made by the nurses. Disinfection of Schools. During the year eight schools in the Borough were disinfected, on account of cases of infectious disease having occurred among the scholars attending these schools. Epidemic Influenza. 834 deaths (164 in Clapham, 75 in Putney, 241 in Streatham, 81 in Tooting and 273 in Wandsworth), occurred during the year. The total number of deaths from Influenza, viz., 834, with a death-rate of 2.85 per 1,000 living, is the highest number and rate from this disease that has ever been recorded since the year 1890, when it first appeared in the registration returns, and, as will be seen from the Tables, 91 per cent. of the deaths occurred during the last quarter of the year. The deaths from Influenza represents 19 per cent. of the total mortality from all causes. Deducting the average rate for this disease for the last 10 years, which was .20 per 1,000, then this shows an increased deathrate of 2.65 from Influenza alone, which would reduce the total mortality from all causes to 12.42, corresponding to the average death-rate for the last 10 years. The outbreak of fatal Influenza which commenced about the 1st October, and continued to the end of the year, was the cause of no fewer than 760 deaths. In addition, there were 170 deaths from Pneumonia, many of which were possibly due to Influenza. Of the 760 deaths from Influenza, 151 occurred in Clapham, 74 in Putney, 213 in Streatham, 74 in Tooting, and 248 in Wandsworth. The following Table shows the total deaths from Influenza and Pneumonia in the various parishes in the Borough for the year, and in detail since the beginning of the outbreak in October. 22 Report of the Medical Officer of Health. TABLE XIX. Clapham. Putney. Streatham. Tooting. Wandsworth. Total. Grand total. Infl. Pneu. Infl. Pneu. Infl. Pneu. Infl. Pneu. Infl. Pneu. Infl. Pneu. 1918. 1st January to 28th September 14 31 3 13 25 44 6 25 26 57 74 170 244 Week ended— 5th October .... — — — — — 4 — — — 2 — 6 6 12 th „ 2 2 1 1 2 1 1 — 1 1 7 5 12 19th „ 5 3 1 — 7 3 2 4 8 1 23 11 34 26th „ 8 2 2 — 23 5 9 1 30 4 72 12 84 2nd November 34 4 13 4 57 6 19 3 58 10 181 27 208 9th „ 28 2 12 — 50 7 11 5 54 15 155 29 184 16th „ 28 1 17 2 28 4 15 4 32 6 120 17 137 23rd „ 14 6 5 1 11 6 7 4 17 4 54 21 75 30th „ 13 4 8 1 11 2 8 2 20 7 60 16 76 7th December 9 2 9 — 12 2 2 1 13 2 45 7 52 14th ,, 2 2 2 1 5 — — — 6 3 15 6 21 21st ,, 2 1 2 — 2 1 — — 4 1 10 3 13 28th ,, 2 3 1 — 2 8 — — 4 3 9 14 23 1919. 4th January 4 — 1 1 3 — — — 1 2 9 3 12 Total 151 32 74 11 213 49 74 24 248 61 760 177 937 Whole Year 165 63 77 24 238 93 80 49 274 118 834 347 1,181 23 Report of the Medical Officer of Health. The outbreak seems to have occurred simultaneously in every part of the Borough, and, judging from the mortality returns, the whole of London suffered at the same time. The following Table shows the sex and ages at which death from Influenza occurred:— TABLE XX. Under 1 year. 1-2 yrs. 2-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 and over. Total. 1st January to 28th Sept.— Males 1 — 1 3 1 14 10 6 36 Females 1 — — 1 8 13 7 8 38 29th Sept. to 4th January— Males 11 5 29 27 38 133 38 22 303 Females 6 12 19 42 92 204 52 30 457 Total 19 17 49 73 139 364 107 66 834 In Institutions in the Borough during the epidemic, 27 deaths from Influenza occurred in the Fountain Temporary Asylum, 15 in the Middlesex County Asylum, seven in the Tooting Bee Asylum, one in The Prison, 19 in the Grove Military Hospital, 18 in the 3rd London General Hospital, five in the Royal Victoria Patriotic Asylum, two in the South London Hospital for Women, two in Putney Hospital, six in Queen Mary Hospital, Roehampton, and 14 in other institutions. No deaths occurred in the Workhouse or the Intermediate Schools. 186 of the deaths from Influenza, 67 of males and 119 of females, occurred in Institutions outside the Borough, over 50 24 Report of the Medical Officer of Health. per cent. of these occurring at ages 25 and under 45 years. 140 of these deaths occurred in Workhouse Infirmaries, 24 in General and Special Hospitals, and 22 in other Public Institutions. The occupation of the males dying between 15 and 65 years was given in 213 instances. 52 were shop-keepers or shop assistants, 33 clerks, secretaries or accountants, 20 labourers, 18 were employed in the building trades, 17 were engineers, surveyors or draughtsmen, 10 were carmen and porters, eight were railway employees, eight were police constables, six were munition workers, six were insurance agents, four were motor drivers, four were employed in the printing and paper trades, two were school teachers, and 25 were employed in various occupations. 254 out of 376 females who died between the ages of 15 and 65 years were engaged in household duties or had no occupation. Of the remaining 122,33 were domestic servants, 30 were clerks, 12 were shop-keepers or shop assistants, 10 were laundresses, eight were dressmakers or tailoresses, seven were asylum attendants, or nurses, four were school teachers, three were packers, two were munition workers, and 13 were employed in various occupations, The Public Health (Influenza) Regulations, 1918, dated 18th and 22nd November, were rigidly enforced. The 19 Cinemas in the Borough were periodically inspected to see that the Regulations were being complied with. In one instance proceedings were taken for non-compliance with the Order, and a fine of £5 was imposed, with £3 3s. costs. It is not possible to give any idea of the number of cases of Influenza that occurred in the Borough, nor is it possible to state what was the case mortality. In two Institutions in the Borough in which information was obtained as to the number of cases, the case mortality in one was 2.6 per cent., while in the other it was 6.9 per cent. 25 Report of the Medical Officer of Health. In the City of Chicago, U.S.A., where Influenza was a notifiable disease, in the two months of October and November, 1918, when the disease was exceptionally prevalent, 38,960 cases were notified, and 6,530 deaths occurred, the case mortality being 16.8 per cent. If the case mortality in this Borough had been similar to that of Chicago, the number of cases would have been 4,530. It was not considered necessary to close the schools in the Borough generally, as the disease appeared to be more prevalent among persons over school age, and as far as can be seen it would appear that infection in all probability took place either at home or in public places, but at three in Clapham, viz., Bonneville Road, Cavendish Road, and Haselrigge Road, where the disease was very prevalent in October, disinfection by formaldehyde spray was carried out during the half-term holiday. In addition to these schools, St. Andrew's, Colmer Road, Streatham, Furzedown Demonstration School, the Royal Victoria Patriotic School, and one private school were disinfected in the same manner. Disinfection was also carried out where it was considered necessary in private houses and in every case where it was requested by the occupier of the house or by medical men in attendance. The outbreak developed so rapidly that it was not possible to do much in the way of precaution. Isolation of the patient as far as was practicable was advised, and any overcrowding was dealt with where such was found. Advice was given that the sufferer should go to bed at once, and that medical advice should be procured. Encephalitis Lethargica. During the year five cases of an obscure disease now known as Encephalitis Lethargica were reported. 26 Report of the Medical Officer of Health. Four of the cases were investigated by the Deputy Medical Officer of Health, who reported that three of them had symptoms similar to other cases which were at that time being reported in other parts. The other case was diagnosed and treated in a hospital, having been sent there as Tubercular Meningitis, but this diagnosis was not confirmed. This patient recovered and is at present well. Of the other four cases, one. died, the death being certified as Epidemic Encephalitis. Chicken-pox. In consequence of several cases of Small-pox occurring in different parts of the Kingdom, the London County Council, on the 19th March, made an Order requiring the notification of cases of Chicken-pox from the 27th March to the 30th June. During that period 392 cases (67 in Clapham, 24 in Putney, 130 in Streatham, 47 in Tooting, and 124 in Wandsworth) were notified. Anthrax. One case of Anthrax was notified from Balham. The patient, a man of 52 years, was employed as a furrier's labourer in the City. He was treated at Guy's Hospital and recovered. No direct history of infection could be ascertained. Diarrhœa. 96 deaths, 53 of males and 43 of females, occurred from all forms of Diarrhoea and Enteritis during the year. 17 of the deaths occurred in Clapham, seven in Putney, 26 in Streatham, 13 in Tooting, and 33 in Wandsworth. There was a slight increase in all the sub-districts except Clapham, compared with 1917. The death-rate was .32 per 1,000, (in Clapham .30, in Putney .26, in Streatham .28, in Tooting .38, and in Wandsworth .38). 25 Report of the Medical Officer of Health. Of the total number of deaths registered, 73, or 76 per cent., were of infants under one year, and the total number of deaths of children under two years was 75, equal to a rate of .25 per 1,000. The number of deaths from Diarrhoea, Zymotic Enteritis, and Enteritis under one year, represents 17.5 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 XXI. 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 4 3 1 ... 8 Do. and cows' milk 2 ... ... ... 2 Do. and dried milk ... 1 ... ... 1 Do. do. and food ... ... ... 1 1 Do. and food ... 2 ... ... 2 2.—Cows' milk only 1 9 ... 1 13 Do. and dried milk ... 1 ... 1 2 Do. and food ... ... 1 1 2 3.—Condensed milk only 2 3 ... 1 8 Do. and dried milk ... 1 ... ... 1 Do. and food ... 1 ... ... 1 4.—Dried milk only 3 5 6 1 15 Do. and food ... 1 ... 1 2 5 —Farinaceous and other foods ... ... 1 ... 1 6.—Unknown 5 8 1 ... 14 Totals 17 35 14 7 73 A 42 56 c 28 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 XXII. Clapham, North. Clapham, South. Putney. Streatham. Balham. Tooting. Southfield. Fairfield. Springfield. Borough. Total Number of Deaths 9 2 6 3 17 11 9 7 9 73 Wholly breast-fed ... ... 1 1 1 1 ... 2 ... 6 Otherwise fed 8 ... 3 1 13 8 8 4 8 53 No information 1 2 2 1 3 2 1 1 1 14 Previously visited (1918) 6 ... 2 1 8 2 4 2 6 31 „ „ (1917) ... ... ... ... 2 1 ... ... 1 4 Fed according to pamphlet 2 ... ... ... 1 ... ... ... ... 3 Breast-fed ... ... ... ... ... 1 ... 1 ... 2 Otherwise fed 6 ... 2 1 10 2 4 1 7 33 Illegitimate 4 ... 2 1 5 3 3 3 1 22 Nurse children ... ... 1 1 3 2 ... 1 ... 8 Born outside Borough 2 ... 1 ... 2 1 1 1 ... 8 Premature 2 ... 1 1 1 1 ... ... ... 6 Delicate from birth 1 ... 2 ... 3 2 2 4 ... 14 Twin Children ... ... ... ... ... ... 1 1 3 5 Infant Visiting. During the year the female Sanitary Inspectors have continued the work begun in 1905 in visiting the homes where births had occurred. The total number of visits, including re-visits and ineffectual visits was 7,631, compared with 9,288 in 1917. The number of first visits totalled 2,724, of re-visits 2,907, and of ineffectual visits 2,000. 76 re-inspections were made in respect of premises for which notices had been served. Owing to an epidemic of Measles and Whooping Cough, and the absence of the staff on account of sickness, the number of visits paid to infants shows a decrease as compared with 1917, 29 Report of the Medical Officer of Health. the Health Visitors having taken over the visiting of cases of Measles and Whooping Cough under 5 years of age, and in certain districts of those over five. The number of visits paid after notification of Measles was 2,771, and the number of visits after notification of Whooping Cough was 487. At the first visit, 2,185 infants were wholly breast-fed; of the remaining 539, 229 were breast-fed supplemented by artificial feeding, 92 were fed on cows' milk only, 78 on condensed milk only, 95 on dried milk, 19 on farinaceous and other foods, and the remaining 26 on some form of milk, supplemented by other foods. On re-visiting, 1,367 were entirely breast-fed, in 561 cases condensed, cows' or dried milk or farinaceous foods were given in addition to the breast, 268 on cows' milk only, 95 on condensed milk only, 164 on dried milk, and 68 on farinaceous and other foods, and 385 on some form of milk supplemented by other foods. In only seven cases were tube bottles used, 23 were spoonfed, two were cup-fed, and the remainder had boat bottles. 138 of the infants visited died during the year; the highest mortality, 23, occurred during the third and fourth months, and 43 died before reaching the age of four months. 40 died from respiratory diseases, 35 from diarrhoea and enteritis, 12 from whooping cough, six from marasmus, seven from measles, six from atrophy, three from tuberculosis, three from gastritis, three from influenza and pneumonia, three from congenital heart disease, four from congenital syphilis, two from accidental suffocation, two from diphtheria, and the remaining 12 from various complaints. 110 of the infants visited were prematurely born, 31 were delicate from birth, and one was mentally defective; 28 twin births were visited. With regard to the employment of mid-wives, 1,059 mothers had employed their services, and in four cases unregistered midwives had been called in. 151 infants were born in hospitals and -other institutions. 30 Report of the Medical Officer of Health. In accordance with the scheme for continuing the visiting of children up to the age of five years, 896 children between the ages of 1-2 years, and 2,599 between the ages of 2-5 years, were seen. The Council decided on the nth April, 1918, to supply milk free of cost to necessitous expectant and nursing mothers, and to children under five years of age, under the Milk (Mothers and Children) Order, 1918. This scheme came into force on 1st May, from which date 186 families were dealt with. In addition to this, owing to the shortage of milk during certain months of the year, many applications were made for an increased supply to infants and invalids. All applications were investigated and in cases of genuine hardship the milkman was interviewed. The visits in respect of all the above relating to milk amounted to 478. The sanitary defects found in the houses during the visits to the mothers were all dealt with in the usual way. 40 intimation notices were served after visits to infants, 63 after visits in respect of Measles, and one after Whooping Cough. Two statutory notices were required. All these notices were complied with. TABLE XXIII. Clapham, North. Clapham, South. Putney Streatham. Balham. Tooting. Southfield. Fairfield. Springfield. Borough. Infants visited 319 193 155 316 569 353 251 167 401 2,724 Breast-fed 279 172 126 263 465 252 202 132 294 2,185 Otherwise fed 40 21 29 53 104 101 49 35 107 539 Infants re-visited 609 583 205 255 276 200 335 205 239 2,907 Breast-fed 391 239 74 148 181 57 123 81 73 1,367 Otherwise fed 218 344 131 107 95 143 212 124 166 1,540 Ineffectual visits 512 259 125 194 254 132 246 166 112 2,000 31 Report of the Medical Officer of Health. The total number of deaths among those visited was 138, 31 in Clapham, 14 in Putney, 35 in Streatham, 18 in Tooting, and 40 in Wandsworth. The heaviest mortality occurred at three to four months. The mortality among the infants visited by the Inspectors was only 29 per 1,000 births, compared with 89 per 1,000, the rate for the Borough for the year. Maternity and Child Welfare Centres. There are now six Infant Welfare Centres in the Borough, the sixth having been opened in January, 1918, at the General Dispensary, 42, Manor Street, Clapham, and serves the north and south wards of Clapham. The accompanying table shows the days and hours on which the various Centres are open. Each Centre has a Medical Officer and a trained superintendent. Infants and children up to five years of age are admitted. They are weighed at every attendance, seen by the doctor when necessary, and their progress is recorded. The superintendent visits the houses of the children to see that the doctor's instructions are carried out. The Wandsworth Centre, 275, Garratt Lane, serves the three wards, Southfields, Fairfield, and Springfield. There were 1,032 children on the register at the end of 1918 ; the new cases numbered 311 ; eight children died, 21 removed, and five were transferred to other Centres. The number of attendances during the year was 2,136, an average attendance of 41.7 for 50 weeks. A number of ante-natal cases were seen by the doctor and visited by the superintendent. A course of 10 sewing classes and six health lectures were held on Thursdays. At the Tooting Centre, held at Fairlight Hall, the number on the register at the end of 1918 was 1,132 ; the new cases numbered 315 ; 19 children died, 16 removed, and 142 were transferred to 32 Report of the Medical Officer of Health. other Centres, or, having reached school age, to the London County Council. The number of attendances during the year was 2,493, an average of 48.8 for 51 weeks. Here also a number of antenatal cases were seen by the doctor and visited in their homes. It was decided to accept the offer of the American Red Cross to finance an ante-natal clinic, and in future the ante-natal work and infant welfare work will be conducted separately. Health lectures were given every Thursday, except during the Influenza epidemic, and on one or two occasions when a lecturer was unable to attend. The superintendent holds a class every Tuesday to instruct mothers in First Aid. At the Putney Centre, 104, Felsham Road, the number on the register at the end of 1918 was 446 ; new cases numbered 121; six children died, 16 removed, and five were transferred to other Centres, or, having reached school age, to the London County Council. The number of attendances during the year was 1,627, an average of 3.26 for 50 weeks. A course of 10 health lectures, and one special lecture, were given on Thursdays, and 24 health talks were given on the day of the Clinic. The Putney Centre co-operated with the London County Council in opening on the 7th October, 1918, a Dental and Minor Ailment Department, at 104, Felsham Road. Children attending the Infant Welfare Centre are to be treated at a charge of one shilling, which in necessitous cases may be reduced to one penny. In 1919 the mothers on the Infant Welfare Register are also to receive treatment in the form of fillings or extractions at a cost not yet fixed. Later on it is hoped that dentures will be supplied to them at hospital cost. At the Streatham Centre, 37, Riggindale Road, the number on the register at the end of 1918 was 400. New cases numbered 160 ; 10 children died, 31 removed, and three were transferred 33 Report of the Medical Officer of Health. to other Centres. The number of attendances during the year was 1,367, an average of 29.1 for 47 weeks. Two courses of lectures and six health talks were given during the year. A Babies' Nursing Home in connection with the Infant Welfare Centre was opened on October 10th, 1918, at 39, Riggindale Road. There are at present 14 cots, including two isolation cots, but there is accommodation on the premises for eight more when funds permit. The Staff consists of a Medical Officer, a Matron, day and night Nurse and a relief Nurse, who is on duty two whole days a week. Children are admitted from any part of the Borough. The minimum charge is five shillings a week. No child is admitted free except in cases of extreme poverty. At the Balham Centre, held at Zennor Hall, the number on the register at the end of 1918 was 444. New cases numbered 68 ; 13 children died and 40 removed. The number of attendances during the year was 2,575, an average of 51.5 for 50 weeks. One course of lectures was held, and health talks were given every week. At the Clapham Centre, 42, Manor Street, which was opened on January 24th, 1918, the number on the register at the end of 1918 was 381. Nine children died and 22 removed. The number of attendances was 3,032, an average of 64.5 for 47 weeks. It was found necessary to open the Centre on two days of the week instead of one only, as the number of attendances became so large. The Superintendents of the various Infant Welfare Centres made 7,778 visits during the year to 2,919 children. 282 attendances were made by the Health Visitors to these Centres during the year, and 45 lectures were given. One of the Health Visitors is a member of the Local Committee of each Infant Welfare Centre, and the Medical Officer of Health is, ex-officio, a member of the General Council, whose function is to co-ordinate the work of the Centres. 34 Report of the Medical Officer of Health. In addition to the above, 45 inspections of Creches were made, 36 visits were paid to homes of various kinds, three open-air schools were seen, and 85 attendances were made at the Committees in connection with the Infant Welfare Centres, the Creches, and the Invalid Children's Aid Association by the Health Visitors. Numerous health talks were given by the Health Visitors during the year, and the following is a list of the subjects dealt with:— Subjects of "Talks" given to Mothers at the Centres. Baby clothes. Best food for Britons. Breast feeding. Care of the body. Care of the feet. Care of the teeth, eyes, nose, and throat. Childhood insurance. Chicken-pox and mumps. Clothing of infants and young children. Common ailments. Convulsions. Cleanliness of person, clothes, and surroundings. Day nurseries. Early symptons of infectious disease Feeding of children from nine months to three years of age. First aid at home. Flies. Food substitutes. Food values. General hygiene. Habits and need for early training. Hay-box cooking. Hand-feeding. Housing. How infectious diseases are spread. How to wash woollen garments. Hygiene of pregnancy. Indigestion in infants. Infection and disinfection. Influenza. Infantile diarrhœa. Labour-saving devices. Measles. Open-air schools. Ophthalmia neonatorum. Rashes a baby can have. Rickets : How caused. Skin, The. Sunshine and fresh air. Superstitions of lying-in period ; need for proper nourishment. Tonsils and adenoids. Tuberculosis. Vaccination. Vermin of all sorts : how to get rid of them. Whooping cough. National Kitchens. Organisations in this Borough to help mothers and children. Work of Welfare Centres and how they help mothers. What did each mother do to practice economy in War-time ? The following is a list of the Infant Welfare Centres in the Borough, with hours of attendance:— 35 Report of the Medical Officer of Health. INFANT WELFARE CENTRES. CLAPHAM Clapham Dispensary, 42, Manor Street. Tuesday, 2.30—4.30 p.m. Wednesday, 1.45-—4.30 p.m. Weighing and Lectures. Clinic. PUTNEY 104, Felsham Road, Putney. Wednesday, 2—4 p.m. Thursday, 2—3 p.m. Clinic and Health Talks. Courses of Lectures. BALHAM Zennor Hall, Cavendish Road, Balham. Wednesday, 1.45—3.30 p.m. Thursday, 1.45—3.30 p.m. Clinic. Clinic and Ante-natal work. STREATHAM 37, Riggindale Road, Streatham. Friday, 1.45—3.30 p.m. Alternate Mondays, 10—11 p.m. Clinic and Health Talks. Ante-natal work. TOOTING Fairlight Hall, Fairlight Road, Tooting. Tuesday, 2—3 p.m. Thursday, 1.45—5 p.m. Alternative Thursdays, 11—1. Superintendent's Class. Clinic and Lectures. Ante-natal work. WANDSWORTH 275, Garratt Lane, Wandsworth. Tuesday, 2—5 p.m. Thursday, 2—3.30 p.m. Clinic and Ante-natal work. Classes. 36 Report of the Medical Officer of Health. The following is a special report which I made to the- Council in November, 1918:— Metropolitan Borough of Wandsworth. REPORT OF THE MEDICAL OFFICER OF HEALTH ON MATERNITY AND CHILD WELFARE. To the Maternity and Child Welfare Committee. Ladies and Gentlemen, The necessity for preserving infant life is at present even more urgent than ever before, as will be seen from the Table which, follows, showing the births, birth-rate, and infant mortality in in the Borough for the last ten years. Year. No.' of Births. Birth-rate. Deaths of Infants. Infantile Mortality. 1908 7,331 25.54 720 98 1909 6,985 24.04 601 86 1910 6,967 23.21 545 78 1911 6,699 21.73 823 122 1912 6,756 21.53 516 76 1913 6,838 20.87 605 881 1914 6,684 20.44 589 88 1915 6,383 19.35 590 92 1916 6,246 18. 46 488 78 1917 4,936 14.72 440 89 The average annual birth-rate in the Borough for the twenty years—1888 to 1907—was 26.79, compared with 14.72 in 1917. The following statement shows in detail the work which is being carried on in the Borough, (I.) by the Borough Council, and. 37 Report of the Medical Officer of Health. (II.) by Voluntary Agencies, and suggestions are also made for the extension of the work:— Work at present carried on in Wandsworth. 1.—By the Borough Council:— (a) Health Visiting. Two whole time Health Visitors are engaged in the work, and two of the female Sanitary Inspectors also give one-third of their time to it. The annual cost of this is— 1 Health Visitor at a salary of £120 1 Health Visitor 110 2 Female Sanitary Inspectors at a salary of £52 each 104 £334 (b) Nursing. Arrangements have been made with the various Nursing Associations working in the Borough to attend cases of Measles, Ophthamia Neonatorum, Whooping Cough, and Infantile Diarrhoea, when and as requested by the Medical Officer of Health, at a fee of 8d. per visit. The cost of this work for the year ended March, 1918, was £52 15s. 4d. Cases of Puerperal Fever are admitted to the hospitals of the Metropolitan Asylums Board, and it was not considered necessary for the Council to enter into arrangements respecting the nursing of cases of this disease. (c) Medical Assistance in Maternity Cases. The Council on the 18th July, 1917, made an arrangement to pay fees to medical practitioners when called in by registered midwives in cases of emergency occurring in their practice among necessitous women in the Borough. 38 Report of the Medical Officer of Health. The cost of this work during the year ended 30th September, 1918, was £26 5s. (d) Provision of Milk. The Milk (Mothers and Children) Order, 1918. The Council decided on the nth April, 1918, to supply milk free of cost to necessitous expectant and nursing mothers and to children under five years of age. From the 1st May to the 31st August, 1918, the actual cost of this was £122 5s. 11d. This is equal to an annual expenditure of £366 17s. 9d. (e) Advice Cards. Pamphlets on the Feeding of Infants have been distributed in this Borough since January, 1905. (f) Grants to Voluntary Agencies. The Council on January 31st, 1907, resolved to contribute to the funds of the Voluntary Infant Welfare Centres 25 per cent. of their annual expenditure, provided that the total contribution of the Council should not exceed £250 in any one year. This grant is subject to the following conditions, viz.:— 1. That the work at each Centre be carried out to the satisfaction of the Medical Officer of Health. 2. That the staff of the Medical Officer of Heath have free power of entry to each Centre during the time the work is being carried out. 3 That a representative of the Borough Council and one of the Lady Health Visitors be members of the Committee of Management of each Centre. 4. That the Medical Officer of Health be ex officio a member of the General Council. 5. That the total contributions of the Council shall not exceed a sum of £250 in any one year (i.e., 25 per cent. of a gross annual expenditure of £1,000 in the Borough). This resolution was passed before the establishment of the Clapham Centre. 39 Report of the Medical Officer of Health. On the 16th October, 1918, the Council resolved to increase the above-mentioned grant to a sum not exceeding £500 per annum, i.e., 25 per cent. of a total expenditure of £2,000 in the Borough. Expenditure. The following is a statement of the expenditure at present incurred by the Council on the above-mentioned Maternity and Child Welfare work:— £ s. d. 1—Health Visiting 334 0 0 per ann. 2—Nursing 52 15 4 „ 3—Medical assistance in maternity cases 26 5 0 „ 4—Provision of Milk under the Milk (Mothers and Children) Order, 1918 336 17 9 „ 5—Grants to Voluntary Agencies 500 0 0 „ Total £1,249 18 1 II.—By Voluntary Agencies:— (a) Infant Welfare Centres. There are now six Infant WelfareCentres operating in the Borough. The following Table shows the locality, the date of opening, and the expenditure for the financial year ended 31st March, 1918:— Centre. Address. Date of Opening. Expenditure. £ s. d. Wandsworth 275, Garrett Lane 6th July, 1915 266 8 4¼ Tooting Fairlight Hall 30th Sept., 1915 394 15 8 Putney 104, Felsham Road 19th January, 1916 336 9 10 Streatham 39, Riggindale Road 15th May, 1916 296 19 7 Balham Zennor Hall 27th July, 1916 295 12 0 Clapham Clapham Dispensary 24th January, 1918 121 5 11 Total £1,711 11 4¼ 40 Report of the Medical Officer of Health. Of the total expenditure of £1,711 11s. 4¼d., £278 5s. was in respect of fees to the doctors in attendance, £254 12s. 2d. was salaries to the nurses, £115 10s. 6d. was for rent, rates and taxes, £742 12s. 7d. was paid for drugs, foods, and medical requisites, and £320 11s. 1¼d. for furniture, equipment, and other expenses. During part of the financial year, Putney Centre was held at Sefton Hall, lent free for the purpose by the Sefton Hall Mission. In September, 1917, the Committee rented a house in Felsham Road, and the cost of the necessary equipment with rent, rates, and taxes, raised the expenditure above that of the Wandsworth Centre, which still occupies free premises at the Anchor Mission, 275, Garratt Lane. The small outlay incurred by the Clapham Centre was due to the short time it had been opened. The general work of the Centres consists of:— 1. Weighing of babies and children by qualified nurse, 2. Examination of babies and children by Medical Officer. 3. Health talks to mothers by the Health Visitors, and other lecturers as to dietary, clothing, and the general upbringing of children. 4. The supplying at cost price of such expensive foods as Virol, dried milk, emulsions, Horlick's malted milk, Allenbury foods, etc., when ordered by the Medical Officer. 5. Systematic visiting at the homes of children attending the Centres by the nurses. 6. Co-operation with the Sanitary Inspectors, Health Visitors, Hospitals, and other agencies. Attendance at the Centres. The Wandsworth Centre serves the three Wards of Wandsworth, 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 41 Report of the Medical Officer of Health. attendance of 48 for 49 weeks (the Centre having been closed at Easter and Christmas). At Tooting Centre, the number on the register at the end of 1917 Was 817, and the attendances 3,339, an average of 65.5. Putney Centre had 325 on the register at the end of 1917, and the attendances were 1,252 in 50 weeks, an average of 25. Balham Centre had 313 on the register at the end of 1917, and the attendances were 2,955, an average of 59. Streatham Centre had 382 on the register, and the attendances were 1,795, an average of 35.9. 320 attendances were made by the Health Visitors to the Centres during the year, 27 lectures and many homely talks were given to the mothers, and during the present year this number has been largely increased. Additional lectures were also given by other lecturers. Dental Work. At the Tooting Centre arrangements have been made with the British Dentists' Hospital, 23, South Side, Clapham Common, for the treatment of mothers and children sent from the Centre. Investigations as to amount of payment are made by the Matron of the Hospital. The Putney Centre has co-operated with the London County Council in opening on the 7th October, 1918, a Dental and Minor Ailment Department at the Centre, 104, Felsham Road. The Dental Department is open five half-days a week for school children, who receive fillings, extractions, and, if necessary, gas extractions for the inclusive charge of one shilling, which in necessitous cases may be reduced to one penny. Children attending the Infant Welfare Centre will also be treated at the same rate. In 1919 the mothers on the Infant Welfare Register are also to receive treatment in the form of fillings and extractions at a charge not yet fixed. Later on it is hoped that dentures will be supplied to them at hospital cost. The Dentist is paid £200 per annum for five half sessions a week, and the anaesthetist £60 per annum for one half session a 42 Report of the Medical Officer of Health. fortnight. The school nurse who attends the Dental Clinic is paid by the London County Council. A capitation fee of 2s. is paid by the London County Council to the Infant Welfare Centre on 1,540 cases a year during the War, even though the children do not accept the treatment, and 2s. a head for any cases over that number. A grant of £75 was made for equipment. The Minor Ailment Department is open for two hours on four days per week for the treatment of local sores, discharging ears and eyes, &c., by the nurse, and once a week the doctor attends. All elementary school children, and the children attending the Infant Welfare Centre, will be treated at a charge of threepence each. The Doctor attending this Centre is paid £75 per annum for one-half session a fortnight. The nurse is supplied by the local District Nursing Association, who will be paid at the rate of £75 per annum for five half sessions per week. A cheque for the salaries of the dentist, anæsthetist, and doctor will be sent by the London County Council to the Infant Welfare Committee, through whom the payment will be made. The London County Council will pay a rental of £12 10s. 0d. per annum for the use of the premises for the Minor Ailment Department, and also a fee of fourpence per head up to 375 cases. Convalescent Homes. As regards Convalescent Homes in connection with the Infant Welfare Centres, Tooting has an arrangement with the Shaftesbury Union by which mothers with baoies, and also children needing convalescence, attending any of the Welfare Centres in the Borough can be received at the Shaftesbury Union Convalescent Home, Addiscombe, Surrey. Unmarried mothers are not admitted. The Betty Rawson Home Committee for Putney elementary school children has on several occasions had mothers, infants, and 43 Report of the Medical Officer of Health. children under school age to stay at the Home at Whitstable. Unfortunately, owing to the air raids, this is closed until after the War, but when it re-opens, the Committee hope that it may again be available for mothers and children. Provision of Food. The Infant Welfare Centres have no regular machinery for providing food for necessitous, expectant, and nursing mothers. The Wandsworth Infant Welfare Centre gave to one nursing mother three dinners a week at a local eating house, for a period of three months, at a cost of one shilling per meal. The Tooting Centre has given food in kind to about 100 necessitous mothers, the food having been sent by charitable people. (6) Creches. There are four Creches in the Borough, viz.:— Putney, Balham, Tooting, and Wandsworth. The Putney Creche has been in existence for 28 years, and is solely a day nursery for the use of such mothers as are compelled to go out to work. It is approved by the Board of Education, from which it receives a grant, and is passed for 50 children. The attendances during the financial year ended March, 1917, numbered 12,024. The Balham Creche was also approved by the Board of Education, but it is now temporarily closed until more suitable premises can be found. The Tooting Creche is held at Fairlight Hall, and is also solely a day nursery. It is passed for 32 children. The attendances during the year ended 31st July, 1918, numbered 5,174. The charge is 6d. per day for one child, and 10d. for two. The Wandsworth Day Nursery was opened in a small house in Garratt Lane in May, 1916, and passed for 20 children only. Towards the end of 1916, the Ministry of Munitions offered a grant to the Committee if they would move into larger premises, and take children of munition workers by day and night. In March, A4256 d 44 Report of the Medical Officer of Health. 1917, the Mill House, Garratt Lane, was taken. It was approved by the Board of Education, and the Ministry of Munitions, for 60 children, of whom two-thirds must be children of munition workers. The large expenditure incurred is due to the amount spent on equipment (£427 4s. od.), and the greatly increased staff. It has been found necessary, owing to the increased cost of milk and food, to raise the rate of parents' payments to is. for one child, is. 6d. for two, and 2s. for three. This is willingly paid by the majority. Necessitous cases, such as the children of widows, women with invalided husbands, or soldiers' wives with small separation allowances, are admitted at a reduced fee, each case being considered by the House Committee. Streatham and Clapham have no Creches. Expenditure. £ s. d Putney, 1917 442 5 4 Balham—March, 1917, to March, 1918 283 8 3 Tooting—July 9th, 1917, to July 31st, 1918 567 13 2 Wandsworth—April, 1918, to April, 1919 (estimated) 969 14 11 Total £2,263 1 8 III.—Proposed Extensions. The Local Government Board, in its circular on Maternity and Child Welfare of 9th August, 1918, states that the additional services for which the Board's grant is now available, subject to the Board's approval of the arrangements, are chiefly:— 1.—Hospital Treatment for Children up to five years of age. The only work of this1 description now being carried out in this Borough is at the Babies' Nursing Home, 39, Riggindale Road, in connection with the Infant Welfare Centre. There are at present 14 cots, including two isolation cots, but there is accommodation on the premises for eight more when funds permit. The staff 45 Report of the Medical Officer of Health. consists of a matron, day and night nurse, and a relief nurse, who is on duty two whole days a week. There is also one domestic servant. The Medical Officer is running the home with the smallest staff on economic grounds. Should a child be admitted who is very ill, an additional nurse would have to be engaged. The minimum charge is 5s. a week. No child is admitted free except in cases of extreme poverty. The estimated cost for one year under present conditions is £1,000, exclusive of equipment, for which a grant of £515 was made by the Children's Jewel Fund. Cases of illness among children in the Borough are admitted to the various Infants' and General Hospitals in London. (a) Dental Work. Arrangements could be made by the Borough Council with the Committee of the British Dentists' Hospital, 23, South Side, Clapham Common, for the dental treatment of children up to five years of age attending the Infant Welfare Centres in the Borough, or when referred to them by the Medical Officer of Health. The treatment would include fillings and scalings, and payment would be 5s. per head for the completion of any dental case when no general anaesthetic is required, and 7s. for each case requiring nitrous oxide. Payment would be made quarterly. The estimated cost of this should not exceed £100 per annum. 2.—Lying-in Homes. There are no institutions in this Borough providing free treatment for lying-in cases, except the Poor Law Institutions. The South London Hospital for Women, Clapham Common, takes operative cases only, and a charge is made. 267 women belonging to this Borough were confined at various lying-in institutions in other parts of London during the year 1917, 46 Report of the Medical Officer of Health. 140 births took place in the Clapham Maternity Hospital during 1917, the parents of the children being resident in the Borough. The charge made to each patient is from one to two guineas per week. Arrangements might be made by the Council with the Clapham Maternity Hospital, Jefferys Road, Clapham, for the provision of beds for necessitous cases, but the number of such cases in this Borough would in all probability be very small. The estimated cost o.f this should not exceed £200 per annum. 3.—Home Helps. No provisions respecting this work are now in operation in this Borough. The Central Home Help Society is federated with the Association of Infant Welfare and Maternity Centres at 4, Tavistock Square, W.C. Its organisation comprises a General Council on Which all local branches are represented, and an Executive consisting of members of the medical, nursing, and midwifery professions, and experts in health and maternity work. The Central Office organises local branches, and helps with money and advice, and maintains a uniform standard of training. Branches are only started in those localities where a Committee can be formed to provide good supervision, and to collect money for the scheme. The Central Society grants an equivalent sum to that collected up to £50 for the first year's working. Families applying for a home help are assessed according to their circumstances, but must in no case pay less than the rate current in the locality. For part time the charge will depend on the amount of time required—a possible basis is that of 4d. per hour. The home helps receive a wage fixed by the local Committee, generally from 11s. to 13s. per week, with food in the houseswhere they are working. Where food cannot be provided, the 47 Report of the Medical Officer of Health. Committee makes suitable provision. When the home helps are not working they receive a retaining fee of about 7s. 6d. per week. A scheme was suggested by a Committee in this Borough, but this could not be carried out, as no home helps were at the time available, and it is not considered that these helps could be obtained at the present time. 4.—Provision of Food for Expectant and Nursing Mothers, and for Children under five years of age. Food could be provided for necessitous expectant and nursing mothers through the various Infant Welfare Centres now in operation in the Borough, or authorising cards could be given by the Health Visitors in a similar manner to the provision of milk scheme at present in operation, and food provided at the National Kitchens. The quantity and cost of the food provided would have to be fixed by the Maternity and Child Welfare Committee. At the Tooting Infant Welfare Centre, Fairlight Hall, the Superintendent states that a suitable meal could be provided at the rate of 6d. per head. The cost of providing food in accordance with this suggestion should not exceed £100 during the first year of its operation. 5.—Creches and Day Nurseries. No grant is at present made by the Borough Council to the various Creches in the Borough. I am of opinion that similar grants should be made to these institutions as to the Infant Welfare Centres. On the present expenditure of the Creches, the cost of this would be about £600 per annum. 6.—Convalescent Homes. No grant is at present made by the Borough Council. Arrangements could be made with the Ashburton Home of Rest for Mothers and Babies, Bingham Road, Addiscombbe, to receive mothers and children, when authorised by 48 Report of the Medical Officer of Health. the Medical Officer of Health, at the following scale of charges:— Children over one year and under two years of age, 3s. 6d. weekly ; over three years and under five years, 4s. to 5s. weekly, according to age and parents' income.; mothers, 6s. weekly. The cost of this should not exceed £100 per annum. Patients requiring skilled nursing and attention cannot be admitted. 7.—Homes for Children of Widowed and Deserted Mothers and for Illegitimate Children. There are at present no homes in the borough for the above children. There are, however, two homes, viz.:—The Lambeth Home, or Mothers' and Baby Hostel, at 11, St. Nicholas Road, Upper Tooting, and the Church Army Home at 64, St. Ann's Hill, Wandsworth, in which unmarried mothers and their infants are kept for at least three months. At the expiration of that period, the child is boarded out or sent to some other home. The Home at 11, St. Nicholas Road, has applied to the Local Government Board for a grant in aid of its expenditure, and the Health Visitors report that this Home is well kept and in every way suitable. The estimated annual net expenditure of the Home for the year ending 31st March, 1919, is £420. The accommodation is sufficient for eight mothers and their infants, and a payment of £2 2s. od. is charged for a stay of one month. After that period the mothers make their own payments (13s. per week) from wages earned. The other home at 64, St. Ann's Hill, has not, up to the present, made any application. Arrangements might be made by the Borough Council with one or other of these homes for the admission of necessitous cases in this Borough, and the cost of this should not exceed £100 per annum. 8.—Health Visitors. I am of opinion that in order to cope with the additional work above mentioned it would be necessary to appoint two additional Health Visitors. 49 Report oj the Medical Officer oj Health. The following statement shows the estimated cost of carrying out the before-mentioned suggestions, but half of this expenditure would be refunded to the Council by the Local Government Board:— (1) Dental work £100 per annum. (2) Lying-in homes 200 „ (3) Home helps Nil (4) Provision of food for expectant and nursing mothers and for children under five years of age 100 „ (5) Creches and day nurseries 600 „ (6) Convalescent homes 100 „ (7) Homes for children of widowed and deserted mothers and for illegitimate children 100 „ (8) Health visitors 220 „ £1.420 I havq the honour to be, Ladies and Gentlemen, Your obedient servant, P. CALDWELL SMITH, Medical Officer of Health rvBLic Health Department, 79, East Hill, Wandsworth. 13th November, 1918. This report has been considered by the Council and is being dealt with during the current year. 50 Report of the Medical Officer of Health Tuberculous Diseases. The total number of deaths from diseases of a Tuberculous nature was 455. 368 of the deaths were due to Pulmonary Tuberculosis, 34 to Tuberculous disease of the Brain and 53 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 XXIV. Sub-District. Pulmonary Tuberculosis. Other Juberculous Diseases. Total. No. of Deaths. Rate. No. of Deaths. Rate. No. of Deaths. Rate. Clapham 62 1.12 20 36 82 1.48 Putney 34 1.28 4 15 38 1.43 Streatham 104 1.15 22 24 126 1.39 Tooting 58 1.71 15 33 73 2.15 Wandsworth 110 1.26 26 29 136 1.55 Whole Borough 368 I.22 87 29 455 1.51 Notification of Tuberculous Diseases. The total number of cases of Pulmonary Tuberculosis notified during 1918 was 777, 145 were from Clapham, 57 from Putney, 203 from Streatham, 125 from Tooting, and 247 from Wandsworth. 51 Report of the Medical Officer of Health. In Table XXV. 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 XXV. Year. Cases Reported. Deaths. Removed. Recovered. No Inquiries. Cases on Register. 1909 1910 1911 19121913 1914 1915 1916 1917 1918 Total. 1909 389 109 48 18 26 9 6 4 5 1 1 227 110 15 4 33 1910 289 ... 77 37 28 7 4 3 3 ... ... 159' 92 5 8 25 1911 514 ... ... 113 82 27 22 8 6 2 16 276 173 14 6 45 1912 855 ... ... ... 225 105 48 31 13 8 7 437 238 52 ... 128 1913 783 ... ... ... ... 180 77 41 25 9 5 337 220 14 ... 222 1914 706 ... ... ... ... ... 176 88 37 22 12 335 169 8 ... 194 1913 646 ... ... ... ... ... ... 199 82 27 20 328 117 1 1 199 1916 590 ... ... ... ... ... ... ... 161 68 37 266 78 1 ... 245 1917 622 ... ... ... ... ... ... ... ... 183 76 259 39 ... ... 324 1918 777 ... ... ... ... ... ... ... ... ... 198 198 27 ... ... 552 Total 6,171 109 125 168 361 328 333 374 332 320 372 2,822 1,263 110 9 .,967 With regard to the notification of cases of non-pulmonary Tuberculosis, in all 218 cases were notified, 35 from Clapham, 10 from Putney, 47 from Streatham, 37 from Tooting, and 89 from Wandsworth. Table XXVI. 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. 52 Report of the Medical Officer of Health. TABLE XXVI. 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 30 11 19 3 17 7 1 2 ... ... ... ... ... ... 11 19 30 ... ... Glands, Mediastinal 3 2 1 ... ... ... 1 ... ... ... ... ... 2 ... 1 ... 1 ... 2 „ Mesenteric 30 18 12 ... 9 6 5 3 1 3 ... 2 ... 1 7 3 10 ... 20 „ Cervical 78 32 46 ... 19 22 13 8 5 5 2 ... 3 1 ... 1 1 2 78 Bones and joints 45 26 19 ... 5 8 10 5 3 3 2 4 2 3 5 4 9 3 33 Lupus 9 2 7 ... ... 1 2 2 1 1 1 1 ... ... ... ... ... ... 9 Larynx 2 2 ... ... ... ... ... ... ... 1 ... 1 ... ... 2 ... 2 ... ... General Tuberculosis 12 8 4 2 4 ... ... ... 1 ... 1 1 2 1 8 4 12 ... ... Other parts 9 6 3 ... ... ... ... 3 1 3 2 ... ... ... 1 1 2 ... 7 Total 218 107 111 5 54 44 32 23 12 16 8 9 9 6 35 32 67 5 146 53 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, 1917 and 1918, and the number still remaining on the egister at the end of 1918. TABLE XXVII. Year Cases Notified. Deaths. Removed. Recovered Cases on Register. I913. 1914. 1915- 1916. 1917. 1918. Total. 1913 328 46 10 5 6 — 1 68 80 35 140 1914 199 — 68 5 4 — 1 78 37 17 f 6 1915 234 -- — 84 7 1 1 93 32 13 96 1916 215 — — — 67 5 5 77 33 7 98 I917 193 — — — — 63 4 67 10 4 112 1918 218 — — — — — 67 67 4 — 147 Total 1,387 46 78 94 84 69 79 450 196 76 659 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 XXVIII. is a summary of notifications during the period from the 30th December, 1917, to the 28th December, 1918. Table XXVIII. is a summary of notifications during the period from the 30th December, 1917, to the 28th December, 1918. 54 Report of the Medical Officer of Health. TABLE XXVIII. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from 30th December, 1917, to the 28th December, iqx8. 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) 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. Poor Law Institutions. Sanatoria. Under 5 5 to 10 10 to 15 Total. Pulmonary- Males ... 2 23 15 29 43 110 72 44 27 8 373 444 ... ... ... ... ... 56 155 Females ... 5 19 23 26 42 98 81 34 19 8 355 426 ... 1 ... 1 1 59 110 Non-Pulmonary — Males 3 33 23 13 10 6 5 4 6 3 1 107 116 ... ... ... 4 15 3 Females 2 21 23 17 10 6 10 4 4 4 4 105 121 ... 1 ... 1 1 13 4 55 Report of the Medical Officer of Health. The total number of visits made was 1,655 in cases 01 Pulmonary Tuberculosis, 256 in Clapham, 119 in Putney, 477 in Streatham, 293 in Tooting, and 510 in Wandsworth, and 467 in cases of other forms of Tuberculosis, 43 in Clapham, 17 in Putney, 141 in Streatham, 80 in Tooting, and 186 in Wandsworth. In addition to these visits by the Health Visitor, 1,667 visits were made by the Dispensary Nurses, 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 12 of the cases visited the patients already had one. During the year disinfection was carried out at 390 premises either after the death or removal of the patient. 80 of the premises disinfected were in Clapham,(31 in Putney,'101 in Streatham, 67 in Tooting, and ill in Wandsworth. Tuberculosis Dispensaries. There has been a large increase in the number of patients seen at the Dispensaries, and, both in numbers of new cases and attendances, the figures are higher than in any of the previous five years during which the Dispensaries have been open. The number of new cases examined was 1,342, compared with 1,214, 1,081, 716, 971, and 936 for the previous five years. The attendances numbered 17,418, nearly 5,000 more than the 12,755 of 1917, and over three times as many as the 5,502 of 1913. Owing to the increased work thrown on the Dispensary Staflt, a second Nurse was appointed in September. Both the Nurses are continually visiting patients at their homes, impressing on those suffering from the disease the importance of making their home-lives as hygienic as possible. It is found that a great deal of good is done by these visits, the patients appreciate them greatly, and their lives are undoubtedly made brighter by the help and advice they are given. Too much stress cannot be laid on the importance of this branch of the work. Further, in the course of visiting, the Nurses are able to persuade those patients whose attendances have fallen off to continue with their treatment, as well as to suggest to contacts that they should be examined. 56 Report oj the Medical Officer oj Health. The total number of visits paid by the Nurses was 1,667. Table XXIX shows the new cases and the total attendances for each Dispensary, and it is interesting to note that the increase in the new cases is almost entirely confined to the Balham Dispensary, and that there are now nearly as many attendances there as at East Hill. Table XXX divides the new cases, by sexes, into insured and non-insured, tuberculous and non-tuberculous, and shows the total attendances made by them during the year. There is a large increase in tubercular patients, the numbers being 566, compared with 393, 350, 330, 379, and 343 in the previous five years. The increase is almost equally divided between the two sexes. Table XXXI shows the number of old cases who attended during 1918, and the total attendances they made. There were 10,577 such attendances, compared with 7,331 in 1917, and 4,561 in 1916, so that the number of old cases attending for treatment is continually increasing. Table XXXII gives the number of cases living in each of the five sub-districts, and shows on whose recommendation they made the initial attendance. As usual, Wandsworth supplies the greatest number. The numbers from Streatham have increased during the last two years. 234 patients were sent by private Medical Practitioners, an increase of fifty-nine on last year. In the earlier part of the year the Army Medical Boards continued to send recruits for special examination and report, who had symptoms pointing to Tuberculosis. In the latter part of the year the Local War Pensions Committees sent discharged tuberculous soldiers and sailors for report as to the treatment they required, and their suitability for work. Table XXXIII gives the age grouping of all the patients who attended for the first time during 1918, showing the number found to be tuberculous at each age period. Table XXXIV gives the same grouping for the contacts only, and shows that forty out of 349 contacts examined were found to be tubercular. Table XXXV gives the site of the disease in the 566 tuberculous patients examined for the first time. 57 Report of the Medical Officer of Health. TABLE XXIX. Number of New Cases, and Total Attendances at the Dispensaries, 1918, Dispensary. New Cases, 1918. Total Attendances, 1918. 1917. Tuberculous. NonTuber culous. Total. Tuberculous. NonT uberculous. Total. Total New Cases. Total Attendances 129, East Hill, Wandsworth 313 430 743 5,999 3,084 9,083 735 7,005 Weir Dispensary, Balham 253 346 599 5,543 2,792 8,335 479 5,75o Totals 566 776 1,342 11,542 5,876 17,418 1,214 12,755 58 Report of the Medical Officer of Health. TABLE XXX. NEW CASES, 1918. Tuberculous. Non-Tuberculous. Totals. M. F. Total. M. F. Total. M. F. Total. Cases— Insured 218 75 293 75 49 124 293 124 417 Non-Insured 110 163 273 300 352 652 410 515 925 Totals 328 238 566 375 401 776 703 639 1,342 Attendances— Insured 1,086 453 1,539 171 186 357 1,257 639 1,896 Non-Insured 670 1.977 2,647 1,209 i,089 2,298 1,879 3,066 4.945 Totals I,756 2,430 4,186 1,380 1,275 2,655 3,136 3.705 6,841 Average Attendances Per Case. 7.4 1 3.4 5.1 TABLE XXXI. CASES OF 1913, 1914, 1915, 1916 AND 1917 ATTENDING IN 1918 Tuberculous. Non-T uberculou s Totals. M. F- Total. M. F. Total. M. F. Total. Casks— Tnsured 100 67 167 7 7 14 107 74 181 Non-insured 84 191 275 134 134 268 218 325 543 Totals 184 258 442 141 141 282 325 399 724 Attendances. Insured 1,048 863 1,911 64 93 157 1,112 956 2,068 Non-insured 1,525 3,920 5,445 1,579 1,485 3,064 3,104 5,405 8,509 Totals 2,573 4,783 7,356 1,643 1,578 3,221 4,216 6,361 10,577 Average Attendances Per Case. 16.6 11.4 14.6 59 Report of the Medical Officer of Health. TABLE XXXII. RETURN SHOWING SOURCE OF CASES AND SUB-DISTRICTS. Clapham. Putney. Streatham. Tooting. Wandsworth. Outside Borough. Totals. Public Health Department 52 4 94 120 90 360 London Insurance Committee 12 8 15 7 17 I 60 Private Practitioners 26 6 54 54 92 2 234 Charitable Societies 10 ... 3 7 3 23 Transfers from other Dispensaries 15 1 10 6 8 I 41 London County Council 11 3 9 7 22 2 54 Existing Dispensary Patients 21 8 22 56 245 I 353 Army Medical Boards 27 13 62 23 53 I 179 Other Sources 5 3 7 11 12 38 Totals 179 46 276 291 542 8 1342 6o Report of the Medical Officer of Health. TABLE XXXIII. 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 ... ... ... 6 2 8 6 2 8 I and under 2 years 5 ... 5 20 6 26 25 6 31 16.1 2 and under 5 years 7 5 12 48 46 94 55 51 106 11.3 5 and under 10 years 21 22 43 115 114 229 136 136 272 15.7 10 and under 15 years 18 20 38 70 70 140 88 90 178 21.4 15 and under 20 years 29 16 45 23 16 39 52 32 84 53.6 20 and under 25 years 30 29 59 14 20 34 44 49 93 63.4 25 and under 35 years 96 69 165 27 56 83 123 125 248 66.5 35 and under 45 years 74 49 123 23 46 69 97 95 192 64.1 45 and under 65 years 48 23 71 29 21 50 77 44 121 58.6 65 years and upwards 1 4 5 1 3 4 2 7 9 55.5 Totals 329 237 565 376 400 776 705 637 1,342 42.2 Under 15 years 51 7 98 259 28 497 310 285 595 16.5 15 years and upwards 278 190 468 117 162 279 395 352 747 62.6 Totals 329 237 566 376 400 776 705 637 1,342 42.2 6i Report of the Medical Officer of Health. TABLE XXXIV. DIAGNOSIS AND AGE GROUPING OF ALL CONTACTS, EXAMINED FOR THE FIRST TIME DURING 1918 Age Periods. Tuberculous. Non-T uberculous. Totals. Percentage of Contacts found to be tuberculous at age period. Males. Females. Total. Males. Females. Total. Males. Females. Total. Under 1 year ... ... ... 1 ... 1 1 ... 1 ... 1 and under 2 years 2 ... 2 10 5 15 12 5 17 11.8 2 and under 5 years 2 ... 2 21 25 46 23 25 48 4.1 5 and under 10 years 1 2 3 50 43 93 51 45 96 4.1 10 and under 15 years 2 3 5 32 36 68 34 39 73 6.8 15 and under 20 years 2 ... 2 7 3 10 9 3 12 16.6 20 and under 25 years 5 1 1 ... 7 7 ... 8 8 I2.5 25 and under 35 years 2 6 8 4 21 25 6 27 33 24.2 35 and under 45 years 3 8 11 9 22 31 12 3o 42 26.2 45 and under 65 years 3 3 6 3 10 13 6 13 19 31.6 65 years and upwards ... ... ... ... ... ... ... ... ... ... Totals 17 23 40 137 172 309 154 195 349 11.4 Under 15 years 7 5 12 114 109 223 121 114 235 5.1 15 years and upwards 10 18 28 23 63 86 33 81 114 24.5 Totals 17 23 40 137 172 309 154 195 349 11.4 62 Report of the Medical Officer of Health. TABLE XXXV. SITE OF LESION IN TUBERCULOUS CASES. Age Period. Non-Pulmonary. Pulmonary Tuberculosis. Total. Glands. Joints and Bones. Abdominal. Others. Total NonPulmonary. Under I year ... ... ... ... ... ... ... I and under 2 years 2 1 ... ... 3 2 5 2 and under 5 years 9 3 1 ... 13 .... 13 5 and under 10 years 13 6 2 1 22 3 45 10 and under 15 years 9 6 ... 1 16 21 37 15 and under 20 years 3 2 ... 2 7 36 43 20 and under 25 years 1 ... 1 1 3 55 58 25 and under 35 years 3 2 1 ... 6 158 164 35 and under 45 years 1 ... 2 3 121 124 ^5 and under 65 years ... ... ... ... 72 72 65 years and upwards ... ••• ... ... ... 5 5 Totals 40 21 5 7 73 493 566 Disposal of Tuberculous Cases, 1918, at End of Year. Under treatment at Dispensaries 244 „ in Sanatoria 52 „ at Hospitals 24 „ in Poor Law Infirmaries 8 „ by Medical Practitioners 102 Ceased attending through lack of interest 1 Left the Borough 26 Died 39 Sent by Army Medical Boards and found to be tuberculous 70 Total 566 63 Report of the Medical Officer of Health. Treatment and Results. As the Dispensaries have now been opened for six years, the time has come when some useful information should be obtainable as to the results obtained, and I am now engaged in summarising these results as far as possible. In endeavouring to arrive at accurate results, it is necessary to spend a great deal of time in going into the details of all cases who have ever attended for examination, and in trying to find out the present conditions of those older cases who have not attended for a long time. Many have left the Borough since their first call at one of the Dispensaries, but I think that a useful summary of results can be made from the many who still live here. Till this investigation is complete, it would be premature to say anything further as to the results obtained, beyond giving, under very broad headings, the disposal at the end of the year of the 1918 new cases found to be tubercular (see Table XXIX.). These patients have not been under treatment long enough to say what benefit they have derived. Vaccine and Tuberculin treatment have been continued in a limited number of cases, and some benefit obtained. 41 adults and 54 children have obtained sanatorium treatment under the London County Council scheme, and a number, not definitely Tuberculous, have enjoyed a change of air at some convalescent home. Bacteriological Examination of Sputum. 399 examinations of sputum were made at the Lister Institute: 43 from Clapham, 39 from Putney, 109 from Streatham, 30 from Tooting, and 178 from Wandsworth. In 89 of the cases it was reported that the bacillus had been found. Other Infective Diseases. 17 deaths were caused by other Infective diseases, two in Clapham, two in Putney, four in Streatham, two in Tooting, and seven in Wandsworth. 64 Report of the Medical Officer of Health. ii of these were under one year, one from one and under two years, one from 15 and under 25 years, two from 25 and under 45 years, one from 45 and under 65 years, and one over 65 years. Acute Polio-Myelitis. Three cases of the above were notified during the year, two from Clapham, and one from Putney. One of the cases was under five years of age, one from two and under five years, and one from 15 and under 25 years. One of the cases proved fatal, and the other two recovered. Ophthalmia Neonatorum. 35 cases were notified, of which six were in Clapham, two in Putney, 12 in Streatham, four in Tooting, and 11 in Wandsworth. 33 of the cases were visited. One occurred in the Workhouse, and one removed previous to notification. 22 were attended at birth by midwives. 11 were treated at hospital as out-patients, two were admitted to hospital as in-patients, four occurred in an Institution, and three were admitted to Poor Law Infirmaries, the remaining 13 being treated at home. Two cases removed before recovering, and one is still under treatment. The 30 remaining cases have recovered. 13 cases were notified by registered midwives. On the 23rd May, 1917, the Council decided that the arrangements made with the various 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. During 1918, 13 cases were attended by the nurses, who made 616 visits. 65 Report of the Medical Officer of Health. Venereal Diseases. 15 deaths were registered to have been due to Syphilis, 12 being of infants from Congenital Syphilis, and three of adults. Two of the deaths occurred in Clapham, one in Putney, three in Streatham, two in Tooting, and seven in Wandsworth. Glanders. No case of Glanders was notified 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 375, 160 of males and 215 of females. 76 of these occurred in Clapham, 37 in Putney, 135 in Streatham, 28 in Tooting, and 99 in Wandsworth. The corrected death-rate for the Borough was i'28 per 1,000, and for the sub-districts as follows:—Clapham 138, Putney 1.39, Streatham 1.49, Tooting .82, and Wandsworth 1.14. One of the deaths occurred at two and under five years, 35 at 25 and under 45 years, 167 at 45 and under 65 years, and 172 over 65 years. Diseases of the Brain and Nervous System. From these diseases 339 deaths occurred, 68 in Clapham, 23 in Putney, 139 in Streatham, 34 in Tooting, and 75 in Wandsworth. 14 of the deaths were due to Meningitis, 180 to Cerebral Haemorrhage or Apoplexy, 15 to Convulsions, seven to Softening of the Brain, 19 to Paralysis, 17 to General Paralysis of the Insane, 66 Report of the Medical Officer of Health. six to Locomotor Ataxy, 28 to Epilepsy, and 53 to other diseases of the Nervous System. Circulatory Diseases. From the above group of diseases, 541 deaths occurred, 207 of which, 88 males and 119 females, were due to Valvular disease of the Heart. 103 of these deaths occurred in Clapham, 49 in Putney, 192 in Streatham, 51 in Tooting, and 146 in Wandsworth. Respiratory Diseases. The total number of deaths was 686, 132 in Clapham, 52 in Putney, 199 in Streatham, 85 in Tooting, and 218 in Wandsworth. 293 of the deaths occurred from Bronchitis, 46 from Lobar Pneumonia, 133 from Lobular or Broncho-Pneumonia, 168 from Pneumonia in which the exact form was not distinguished, and 46 from other diseases of the Respiratory Organs. 79 of the deaths were of infants under one year, 50 from one and under two years, 49 from two and under five years, 30 from five and under 15 years, 21 from 15 and under 25 years, 80 from 25 and under 45 years, 141 from 45 and under 65 years, and 236 over 65 years. Deaths from other Causes. From Appendicitis and Typhlitis 23 deaths, 13 of males and 10 of females, occurred. From Alcoholism, Acute and Chronic, one death, a male occurred; and 13, 10 of males and three of females, from Cirrhosis of Liver. 67 Report of the Medical Officer of Health. From Nephritis and Bright's disease 124 deaths occurred, 67 of males and 57 of females. From Accidents and diseases of Pregnancy and Child Birth cme death occurred. This, added to the number of deaths from Puerperal Fever—viz., eight—gives a total of nine deaths after child birth, or a proportion of 1.92 per 1,000 births. Diabetes Mellitus was the cause of 20 deaths, six of males and 14 of females. Premature Birth and Developmental Diseases. 179 deaths, 103 of males and 76 of females, were registered as having occurred from these diseases. 76 of the deaths were due to Premature Birth, 89 to Developmental diseases and 14 from other diseases of Early Infancy. 169 were of infants under one year, three from one and under two years, and seven 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. 211 deaths, 64 of males and 147 of females, occurred from Old Age. 55 in Clapham, 20 in Putney, 63 in Streatham, 19 in Tooting, and 54 in Wandsworth. All the deaths except one were of persons over 65 years of age. 68 Report of the Medical Officer of Health. Violence. 98 deaths, 55 of males and 43 of females, occurred from Violence, 74 of the deaths being due to Accidental, and 23 to Suicidal causes, while one death was caused by another form of Violence. 17 of the deaths belonged to Clapham, 14 to Putney, 25 to Streatham, 10 to Tooting, and 32 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. 69 Report of the Medical Officer of Health. TABLE XXXVI. INQUESTS. Sub-Districts. | Whole Borough. Clapham. Putney. Streatham. Tooting. Wandsworth Deaths from Natural Causes 18 18 22 22 45 125 Accidental:— Run over by motor vehicles 3 5 — — 2 10 Falls 1 — 1 4 3 9 Fall down flight of stairs 1 — 2 1 1 5 Burns 2 1 — — 1 4 Suffocated by regurgitated food — — 1 2 — 3 Fall from bicycle 1 — — 1 — 2 Asphyxia from coal gas — 2 — — — 2 Injury at birth — 1 — — 1 2 Drowning — 1 — — 1 2 Scalds — — 1 — 1 2 Overdose of veronal — — — — — 1 Suffocated in bed with parents 1 — — — — 1 Electrocution by touching high tension Wire — — — — 1 1 Suicidal:— Hanging — — 2 1 2 5 Cut throat — 1 2 1 — 4 Drowning 1 2 — — 1 4 Poisoning by coal gas — 1 — — 2 3 Jumped from window — 2 — — — 2 Gunshot Wounds — — 1 — 1 2 Poisoning by hydrocyanic acid — 1 — — — 1 Poisoning by weed killer — — 1 — — 1 Jumped into copper of boiling water — — — — 1 1 Misadventure — — — 1 — 1 Open Verdicts:- Found dead 1 — 1 — 1 3 Found drowned 1 — — — — 1 Execution — — — — 2 2 Totals 30 36 34 33 66 199 .70 Report of the Medical Officer of Health. TABLE XXXVII. Sub-Districts. Whole Borough. INQUESTS. Clapham. Putney. Streatham. Tooting. Wandsworth Deaths from Natural Causes 2 3 9 3 • 6 23 Accidental:— Knocked down by motor vehicles 1 2 3 3 1 1o Falls 2 1 — 1 4 8 Burns — — 2 — 2 4 Drowning — — 1 1 1 3 Tetanus following injury 1 — 1 — 2 Fall down flight of stairs — — 2 2 Fall from ladder — — 1 1 2 Fall from tramcar 1 — 1 — — 2 Fall from tree — — 1 — 1 2 Fall from bicycle 1 — — — — 1 Knocked down by horse vehicle 1 — — — — 1 Knocked down by train — — 1 — — 1 Fall of scaffold on head — — — — 1 1 Crushed by lift — — — 1 — 1 Crushed by fall of wall 1 — — — 1 Exposure 1 — — — — 1 Suicidal:— Drowning 1 1 2 Cut throat 2 — — 2 Gun shot wound 1 — — 1 Hanging —, 1 . 1 Run over by train — 1 — — — 1 Strangulation — 1 — — — 1 Open verdicts:— Found dead 1 — 1 — 1 3 Totals 15 9 23 10 19 76 71 Report of ihe Medical Officer of Health. Cutting-off Notices. During the year 134 notices with respect to 211 premises were received from the Water Board stating that the supply had been' withdrawn. 34 of the premises were in Clapham, 43 in Putney, 82 iu Streatham, 11 in Tooting, and 41 in Wandsworth. The supply was withdrawn for non-payment of rates from. 60 premises, from 58 premises in consequence of defects, in 78 the premises were empty, and in 15 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, 24 bodies were removed to the Mortuary, in Streatham eight and in Wandsworth 154 of which 57 were from Wandsworth, 21 from Putney, 11 from Tooting, 63 from Battersea —a total of 186, and two from other places. GENERAL SANITARY WORK IN 1918. Revenue Act. During the year two certificates were granted under the"above Act. The certificates granted referred to three houses or six 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. 72 . Report of the Medical Officer of Health. TABLE XXXVIII. Summary of Sanitary Operations in the Borough during the Year 1918. Clapham. Putney. Streatham Tooting. Wandsworth Whole Borough. North Ward. South Ward. Streatham Ward. Balham Ward. South field Ward. Fairfield Ward. Spri'g field Ward. Number of complaints received and attended to 44O 202 282 441 443 653 294 410 446 3611 Number of houses and premises inspected 4618 3079 2982 3848 5094 4060 3870 2458 4326 34335 Number of houses and premises re-inspected 990 649 1326 443 2070 1798 716 734 1503 11229 Number of house - to - house inspections 82 ... 68 ... 293 64 55 75 53 690 Number of preliminary notices served 390 142 382 29O 809 508 282 374 589 3766 Ditto complied with 372 122 245 246 815 470 252 320 461 3303 Number of statutory notices served 14 6 37 28 102 55 9 23 106 380 Ditto complied with 12 4 11 30 102 34 5 34 85 317 Notices served for periodical removal of manure ... ... ... ... ... ... ... ... ... ... Number of rooms disinfected after infective diseases 432 628 456 499 824 660 593 359 785 5236 Bedding stoved i70 173 213 187 308 244 152 146 184 1777 Overcrowding abated 1 ... 2 7 3 4 3 4 9 33 Rooms cleansed and repaired 211 53 287 290 812 355 120 207 529 2864 Staircases cleansed and repaired 30 7 41 33 126 47 13 31 75 403 Drains cleansed and repaired 40 43 59 171 77 105 52 20 49 616 Drains tested 200 108 55 57 176 147 79 141 240 1303 Drains found defective 5 16 4 37 41 40 8 4 51 206 Traps fixed to drains ... 28 3 78 23 4 5 1 ... 142 Bath, lavatory and sink wastes altered to discharge outside over gullies or repaired 26 11 37 29 40 21 12 31 35 242 Rain water pipes disconnected from drains ... ... ... ... 1 2 2 5 18 28 Water closets cleansed and repaired 72 64 169 148 271 99 85 114 201 1223 Water closets, separate supply of water laid on to ... ... ... ... ... 4 ... ... ... 4 Accumulations of manure, etc., removed 7 9 12 49 29 18 5 4 21 154 Urinals cleansed, repaired or water laid on to 4 ... 10 10 9 2 1 ... 2 38 Cesspools abolished ... ... ... ... ... ... ... ... ... ... Ashpits provided or repaired 40 15 50 44 74 50 63 52 129 517 Dust complaints received 90 58 106 127 94 77 126 47 113 838 Stables and stables yards drained, paved or cleansed 7 ... ... 27 5 10 6 4 43 102 Yards drained, paved or cleansed 13 9 55 40 43 39 14 44 98 355 Unwholesome or dilapidated houses cleansed or repaired 2 ... 23 11 45 15 1 8 2 107 Leaky roofs and gutters repaired 67 45 72 96 131 78 42 73 120 724 Damp courses inserted ... 4 5 15 17 5 4 22 15 87 Damp conditions remedied 40 18 82 111 68 65 42 95 96 617 Houses re-supplied with water 7 2 12 10 21 11 9 9 13 94 Water cisterns cleansed, covered or repaired 10 19 23 19 4 23 12 24 58 202 Animals kept so as to be a nuisance 4 ... 1 6 4 8 2 4 19 48 Smoke nuisances reported ... ... ... 3 ... ... ... ... 3 6 Soil pipes repaired 3 4 15 36 30 33 8 1 6 136 Unclassified nuisances 71 24 57 72 67 27 44 26 17 405 73 Report of the Medical Officer of Health. TABLE XXXIX. DETAILS OF INSPECTIONS AND RE-INSPECTIONS, 1918. (Male Inspectors.) Inspections Re-Inspections. Totals. Number of complaints received and attended to 3,611 ... 3,611 Number of house-to-house inspections 690 ... 690 Drainage and other sanitary works after notice 2,604 8,303 10,907 Drainage and other sanitary works voluntary 417 395 812 Number of premises inspected on account of:— Notifiable diseases 2,371 202 2,573 Measles ... 967 42 1,009 Whooping Cough 238 2 240 Pulmonary Tuberculosis 203 14 217 Other Infective Diseases 675 24 699 Verminous conditions 352 77 429 Periodical Inspections:— Houses-let-in-Lodgings 292 491 783 Underground rooms ... ... ... Common Lodging Houses 1 ... 1 Factories 4io 161 571 Food-places Work-places 'Workshops 581 111 692 Workshops (Domestic) 169 56 225 Workplaces 299 109 408 Outworkers' premises 77 24 101 Bakehouses 270 221 491 Restaurant kitchens 157 12 169 Cowsheds 46 2 48 Piggeries 259 39 298 Dairies and Milkshops 581 30 611 Ice Cream Premises 204 4 208 Slaughterhouses 131 ... 131 Places where food is prepared 137 1 138 Offensive trades 29 4 33 Fried Fish shops 148 12 160 Rag and bone stores 101 11 112 Butchers' shops 396 11 407 Greengrocers' shops 238 7 245 Fishmongers' shops 184 7 191 Public House urinals 238 22 260 Other sanitary conveniences, schools, &c. 157 15 172 Smoke observations 27 2 29 Unsound food 1S4 28 212 Yards of Mews and Stables 660 57 717 Legal proceedings:— (1) Applications and summonses 14 *4 (2) Hearings and adjournments 56 56 Other 1,139 51 1,190 Totals 19,313 i°.547 29,860 74 Report of the Medical Officer of Health. TABLE XL. DETAILS OF INSPECTIONS AND RE-INSPECTIONSj 1918(Female Inspectors.) Inspections. Re-inspections. Totals. Number of complaints received and attended to 19 - 19 Number of premises inspected on account of :— Puerperal Fever 33 11 44 Measles 2,374 397 2,771 Ophthalmia Neonatorum 95 3 98 Whooping Cough 508 4 512 Diarrhoea 85 1 86 Pulmonary Tuberculosis 1,535 120 1,655 Other forms of Tuberculosis 455 12 467 Notification of Births 7,643 76 7,719 Dressmakers' and Milliners' premises Laundries— 188 12 200 Factory 103 13 116 Workshop 119 13 132 Workplaces 71 1 72 Other Factories 88 2 90 Other Workshops 81 2 83 Other Workplaces 121 4 125 Domestic Workshops 41 4 45 Outworkers' premises 293 5 298 Other 1,170 2 1,172 Totals 15,022 682 I5,704 75 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 82 6l 74'39 8 12 3 75 Clapham, South .. .. .. .. .. .. .. Putney 63 67 98.58 5 4 9 55 Streatham .. .. .. .. .. .. .. Balham 293 250 83.32 53 l6l 207 237 Tooting 64 55 85.93 4 .. .. 63 Southfield 55 24 43.63 1 10 7 44 Fairfield . 75 75 100.00 .. .. 90 1 Springfield 53 33 62.26 13 14 45 14 Whole Borough 690 565 81.58 84 20i 361 489 The cases of overcrowding were in Prescott Place, Clapham; in Cox's Buildings, and Angel Court, Putney; in Natal Road, Wellfield Road, Cowper's Row, Leverson Street, and Zennor Road, Streatham; in Fountain Road, Himley Road, and Longley Road, Tooting; and in Burtop Road, Bellew Street, Aldren Road, Guelph Street, Lydden Road, Wardley Street, Duntshill, Aslett Street, Cambourn Road, Burr Road, Point Pleasant, Baylin Road, Jew's Row, and Iron Mill Road, Wandsworth. 11 notices of reconstruction of drains were sent to the Borough Engineer from this Department: two in Clapham, two in Putney, and seven in Streatham. A4256 f 76 Report of the Medical Officer of Health. The total number of houses where the drains were reconstructed during the year was 45: seven in Clapham, four in Putney, 16 in Streatham, four in Tooting, and 14 in Wandsworth. During the year 1,303 drains of houses were tested by the Sanitary Inspectors, 308 in Clapham, 55 in Putney, 333 in Streatham, 147 in Tooting, and 460 in Wandsworth, and 206 or 15.8o per cent, were found to be defective. Of the 206 found defective, 21 were in Clapham, four in Putney, 78 in Streatham, 40 in Tooting, and 63 in Wandsworth. A large amount of work has again been carried out to abate nuisances arising from damp conditions. In all, 704 premises have been dealt with, 62 in Clapham, 87 in Putney, 211 in Streatham, 70 in Tooting, and 274 in Wandsworth; and in 87 of these, four in Clapham, five in Putney, 32 in Streatham, five in Tooting, and 41 in Wandsworth, damp courses have been inserted Disinfection. The total number of rooms disinfected after the occurrence of cases of infectious disease was 5,236, (1,060 in Clapham, 456 in Putney, 1,323 in Streatham, 660 in Tooting, and 1,537 in Wandsworth). 1,777 lots °f bedding were stoved at the Disinfecting Station, comprising the following articles: 961 beds, 1,155 bolsters, 3,002 pillows, 1,376 mattresses, 92 palliasses, 2,051 sheets, 1,659 quilts, 517 cushions, 11,597 articles of clothing, 3,015 blankets, 32 carpets, and 4,314 extra articles, a total of 29,771 articles. Disinfection was also carried out by the Sanitary Staff at premises after non-notifiable diseases, and the sum of £33 12s. 3d. was received for such disinfection. 77 Report of the Medical Officer of Health. 195 rooms were disinfected with sulphur in consequence of their verminous condition and 24 lots of verminous bedding disinfected. During the year, at the request of the Military Authorities, 5,372 articles of clothing and bedding were disinfected and 102 rooms sprayed on account of having been exposed to infection, and 10,877 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 £1,918 13s. 9d. The number of lots of bedding stoved was 1,777. f Cost per lot of bedding £1 is. 7d. Cleansing of Persons Act. The names of 54 children, 24 belonging to Clapham, three to Putney, three to Streatham, five to Tooting, and 19 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. 66 adults had baths after being in contact with cases of infectious diseases, and 10 on account of their verminous condition. 78 Report of the Medical Officer of Health. Inspection of Sanitary Conveniences. The number of Sanitary Conveniences inspected was 131, 19 in Clapham, 24 in Putney, 24 in Streatham, 11 in Tooting, and 53 in Wandsworth. 260 inspections were made during the year and 19 notices, chiefly for cleansing, were served and complied with; and 120 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 160 inspections have been made of fried fish shops, 407 of butchers' shops, 245 of greengrocers' shops, and 191 of fishmongers' shops, a total of 1,003. 174 of these inspections were in Clapham, 96 in Putney, 311 in Streatham, 144 in Tooting, and 278 in Wandsworth. 79 Report of the M edical Officer of Health. Premises. TABLE XLII. Fine. Costs. Offences. Result. The Parade, Tooting Exposing geese for sale which were unfit for human food Convicted 200 /— 42/- The Osiers, Wandsworth Killing pigs on ur licensee premises ,, 80/- 40/- Adjourned sine die — — 89, Hopton - road Streatham Nuisances 101, Hopton-road „ Order made for abatement of nuisance 21 /- Non - compliance with Magistrate's Order 500/- 42/- 8, Cotman Street, Wandsworth Nuisances and contraventior of By-laws (yard paving) Summons withdrawn, the work having been done — 4/- 112 and 114, Selkirk road, Tooting Nuisances Order made for abatement oi nuisance 20 /- 36, Point Pleasant Wandsworth ,, Convicted 81- 2/- 3, Cornford Grove Balham " Order made for abatement of nuisance — 20/- - "Non - compliance with Magistrate's Order 300/- 42/- 102, Upper Tooting Road ,, Order made for abatement of nuisance — 21 /- 4, Arragon Gardens, Streatham Absence of a water supply tc the premises Closing order made 100 /- — 85, Byrne Road, Balham Nuisances Order made for abatement of nuisance — 21/- 18, Lydden Road, Wandsworth " Summons withdrawn, the Work having been done — 21 /- 102, Fountain Road, Tooting ",, Order made for abatement of nuisance — 21 /- 91, Byrne Road Balham ,, ,, ,, — 10 /6 Non - compliance with Magistrate's Order 100 /— 23 /- 21 and 23, Thorndean Street Wandsworth ,, Summonses withdrawn, the work having been done — 4 /- 4, Charlotte Place Clapham Contravention of By-laws (yard paving) Convicted 10 /- 42/- 24, Malva Road Wandsworth Nuisances Order made for abatement of nuisance - 42/- 8o Report of the Medical Officer of Health. TABLE XLII.—(conld). Premises. Offences. • Result. Fine. Cost. 51, Wardley Street, Wandsworth Nuisances Order made fof abatement of nuisances — 10 /6 36, White Square Clapham " Summons withdrawn, the work having been done — 10 /6 13, Cavendish Road, Clapham ,, " — 10 /6 33. Headworth Roac Wandsworth Nuisance and contravention of the By-laws (yard paving) Order made for abatement — 12/6 Ordered to pay costs — 12/6 39,Headworth Road Wandsworth Contravention of the Bylaw's (yard paving) Ordered to pay costs — 2/— 7, 9, and 11, Medfield Street, Roehampton Nuisances Order made for abatement of nuisances — 15/- 19, Stanbridge Road Putney ,, Summons withdrawn, the worl having been done — 2I- 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. 45 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 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. 8l Report of the Medical Officer of Health. TABLE XLIII. PREMISES. NUMBER OF PLACES Number of inspections, 1918. Number of notices, 1918. Number of prosecutions, 1918. On register at end of 1917. Added in 1918. Removed in 1918. On register at end of 1918. Milk premises 412 49 45 416 611 26 Cowsheds 11 ... ... 11 48 1 ... Slaughter-houses 12 ... ... 12 131 ... ... Other offensive trade premises 4 ... ... 4 33 2 2 Ice cream premises 330 ... ... 313 208 2 ... Registered houses let in lodgings 292 ... ... 292 783 *a3 ... *t480 ... *a For overcrowding. * b For other conditions. Unsound Food. 2o| cases of herrings, two boxes of mackerel, 112 lbs. of skate, 38 boxes and 11J lbs. of kippers, three barrels of crabs, two bags of winkles, 18 tins of salmon, three tins of pilchards, 121 rabbits, and 46 lbs. of pieces of rabbit, 42 kidneys, 46 lbs. of tripe, 73 lbs. of corned beef, 318¾ lbs. of mutton, 126 lbs. of veal, 3,870 lbs. of beef, one tub and 14 lbs. of liver, 3,294¼ lbs. of bacon, 242 eggs, 58 lbs. of cheese, 40 lbs. of bread, 166½ lbs. of flour, and 444 tins of condensed milk, were condemned and the usual certificates granted. A large proportion of the Bacon, Mutton, and Beef was sent to a fat melter in the Borough to be converted into glycerine for munition making. Proceedings were taken in one instance for exposing unsound Geese for sale, and a fine of £10 and £2 2s. od. costs was inflicted. FACTORIES AND WORKSHOPS. There has been a decrease in the total number of inspections of the above, compared with 1917, 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. 00 Report of the Medical Officer of Health. INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. TABLE XLIV. CLASS OF WORKS. Number of Places Number of Inspections, 1918. Number of Notices. Number of Prosecutions, 1918. On Register, at end of 1917. Added in 1918. Removed in 1918. On Register at end of 1918. Intimation, 1918. Statutory, 1918. Under Factory Act. Under Public Health Act. Premises Rooms. F actories r Factory Laundries 85 ... 10 75 304 152 6 Factory Bakehouses 43 2 ... 45 66 155 3 Other Factories 387 48 16 419 1,345 628 53 4 2 Workshops Workshop Laundries 96 6 9 93 276 132 6 ... ... Workshop Bakehouses 92 ... 8 84 84 336 7 Other Workshops 1,263 51 116 1,198 1,624 1,247 73 2 Workplaces Places where Food is prepared for Sale 543 18 30 531 585 487 54 1 Workplaces other than the above 490 40 71 459 658 743 35 2 Home-workers' premises 411 95 115 391 391 399 20 ... Total 3,410 260 375 3,295 5,333 4,279 257 9 2 83 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 XLV. I.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspec- Written cutions. (1) (2) (3) (4) Factories (Including Factory Laundries.) 935 66 2 Workshops (Including Workshop Laundries.) 1,715 88 ... Workplaces (Other than Outworkers' premises included in Part 3 of this report.) 1,230 92 .. Totals 3,880 246 2 84 Report of the Medical Officer of Health. TABLE XLVI. 2.—DEFECTS FOUND. Particulars. Ntimber 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 83 79 ... ... Want of Ventilation ... ... ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other nuisances 106 101 ... 1 Sanitary accommodation insufficient 1 1 ... ... unsuitable or defective 48 44 ... 1 not separate for sexes 1 1 ... ... 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 249 236 ... 2 * including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. The Table which follows and which relates to Home Work is similar to the one in last year's Report. 85 Report of the Medical Officer of Health TABLE XLVII. 3.—HOME WORK. NATURE OF WORK.* OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. Lists received from Employers. Notices served on occupiers as to keeping or sending lists. Prosecutions. Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions SS.109,110). Listst Outworkers Lists. Outworkers† Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (M) (5) (16) Wearing Apparel— (1) Making, &c. 66 91 211 10 3 26 11 ... ... 18 20 ... 36 ... ... (2) Cleaning and washing 4 2 10 ... ... ... ... ... ... ... ... ... ... ... ... Household Linen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, lace curtains and nets ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... Curtains & Furniture hangings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... Electro Plate ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... File making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brass and Brass articles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fur pulling ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cables and Chains ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anchors and Grapnels ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cart Gear ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Locks, Latches and Keys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Artificial Flowers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nets, other than wire nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. Sacks ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Racquet and tennis balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper Bags and Boxes 2 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... Brush making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pea picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carding, &c., of buttons, &c 2 ... 7 ... ... ... ... ... ... ... ... ... ... ... ... Stuffed Toys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Basket making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 74 93 233 10 3 26 11 ... ... 18 20 ... 36 ... * If an occupier gives out work of more than one of the classes specified in column i, and subdivides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. t The figures required in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending iwo 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. 86 Report of the Medical Officer of Health. The total number of addresses received from other Councils was 541, and 199 addresses were forwarded to other Councils. The number of addresses received has decreased by seven, and the number sent decreased by 33. 57 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 11, and these had a most satisfactory result. During the year 36 cases of infective diseases, five of Scarlet Fever, three of Diphtheria, 19 of Measles, six of German Measles, one of Chicken-pox and two of Erysipelas, were notified as having occurred in the homes of outworkers. In none of these cases was it necessary to make any order under Section 110 of the Factory and Workshop Act. TABLE XLVIII. 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) I cportant classes ol workshops, »uch a3 workshop bakehouses, mry be enumerated here. Workshop Bakehouses 84 „ Laundries 93 Dressmakers' and Milliners' Workshops 190 Bootmakers 114 Smiths 42 Builders 58 Tailors 65 Other 729 Total number of workshops on Register 1,375 87 Report of the Medical Officer of Health. TABLE XLIX. 5.—OTHER MATTERS. Class. Number (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory nd Workshop Act (s. 133) 9 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 6 Reports (of action taken) sent to H.M. Inspector 6 Other ... Underground Bakehouses (s. 101):— Certificates granted during the year •• In use at the end of the year 39 88 Report of the Medical Officer of Health. military tsuiets. During the year several premises were taken for the billeting of soldiers, and these premises were all inspected. In all, 176 inspections were made by the Sanitary Inspectors (25 in Putney, 30 in Streatham, 40 in Tooting, and 81 in Wandsworth). Piggeries. During the year 21 licences for pig keeping were granted by the Council, subject to the sties being properly paved and drained, and to the animals being kept so as not to create a nuisance. The premises where the pigs were kept were frequently inspected and no nuisance was reported. Canal Boats Act. During the year 12 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. At the request of the Food Control Committee, the Sanitary Inspectors carried out special duties under the Food Control Orders especially with respect to complaints made under the Orders to the various local Food Offices in the Borough. 569 complaints were investigated by the Inspectors, which entailed 1,856 visits being made. One of the Inspectors was temporarily transferred for a fortnight to the Balham Library, in order to assist in the establishment of a Food Control Office there. During that time his work was carried out by the Inspector of the adjoining district. 89 Report of the Medical Officer of Health. Statement of Work done under the Rag Flock Act, 1911. No samples have been procured under the above Act. The Sanitary Inspectors have visited the workshop in the ordinary course of their duties under the Factory and Workshops Act. Statement of Work done under the Sale of Food and Drugs Acts. During the year 1,891 samples of foods and drugs were submitted to the Public- Analyst for analysis. Of these samples 943 were purchased as test or informal samples, while 948 were purchased officially. Of the 948 official samples submitted for analysis 152, or 16.0 per cent, were reported to be adulterated or not up to standard, and of those samples which were purchased informally or as test samples 25, or 2.6 per cent, were found adulterated or not up to standard. The total adulterations reported were 177, or 9.3 per cent, of the samples submitted. The percentage of milk samples found to be adulterated was 15.3. In 69 out of the 152 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 £71 18s. od., and the costs to £47 is. 6d., making a total of £118 19s. 6d. The following table shows the number of formal and informal samples taken in each sub-district of the Borough, together with 90 Report of the Medical Officer of Health. the number taken per 1,000 ot population, the number adulterated, and the percentage adulterated to the formal and informal and to the total samples taken. TABLE L. 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 210 34 l6.1 206 3 1.4 416 6.7 37 8.8 Putney 102 22 21.5 99 2 2.0 20I 6.7 24 11.9 Streatham 291 40 13.7 296 10 3.3 587 5.7 50 8.5 Tooting I49 27 l8.l 126 3 2.3 275 7.2 30 10.9 Wandsworth 196 29 14.7 216 7 3.2 412 4.2 36 8.7 Whole Borough 948 152 l6.0 943 25 2.6 1,891 57 177 9.3 Milk and Cream. MILK. 972 samples of milk were procured for analysis during the year. 149 or 15-3 per cent, were reported against as being adulterated or not up to legal standard. 940 samples were purchased officially, of which 149 or 15.8 per cent, were adulterated, and 32 samples purchased informally, all of which were genuine. 99 samples were found to contain added water, 38 were deficient in milk fat, and 12 were deficient in milk fat and contained added water. 9i Report of the Medical Officer of Health. Proceedings were taken in 69 cases, and in 78 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. 18 samples of milk were taken.on delivery at various Public Institutions situated within the Borough. One sample was reported against. 20 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, and proceedings were taken against the farmers, and convictions obtained. 11 samples of milk were procured during the early morning from wholesale dealers whilst delivering milk to the retailer. Five samples were reported against, and proceedings were taken in two cases, but in each a warranty was pleaded. Four samples of milk were procured on delivery at private houses. These samples were genuine. 22 samples of milk have been taken on Sundays, either in the early morning or at mid-day. Two or 9.0 per cent, were reported against as being adulterated. 305 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 53 or 17.3 per cent, were reported against. In 26 cases the defendants relied on a warranty, and in all but three of these the Magistrate was satisfied that the milk sold was in the same condition as received, and therefore dismissed the summonses. In two cases the Magistrate was not satisfied, and convicted the defendant, and in one an order for the costs was made. A4256 G 92 Report of the Medical Officer of Health. CREAM AND PRESERVED CREAM. Owing to the restrictions placed on cream by the Cream Order, 1917, and the difficulty of -obtaining samples, only one sample of cream was taken during the year, which, on analysis, proved genuine. Butter and Margarine. BUTTER. 523 samples of butter were submitted for analysis during the year, of which nine or 17 per cent, were reported against. MARGARINE. 28 samples of margarine were submitted for analysis, and all returned as genuine. 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 still on service in the London District I was able to keep to some extent in touch with the work. Dr. Oliver Field, who was Deputy Medical Officer of Health, continued to supervise the work of the Department, and was of great service to the other officials in the Department. At the Tuberculosis Dispensary, in the absence of Dr. Caley, Dr. P. Nicol carried out the work at both Dispensaries in a very thorough and satisfactory manner. 93 Report of the Medical Officer of Health. 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, Dininfectors, who were discharged on medical grounds, returned to their duties in 1917, and the work of those still serving was carried on by temporary substitutes. The staff has been augmented by the promotion of E. V. Roots, office boy, to third-class clerk. Mr. S. Fairchild, who had been a Sanitary Inspector undt. the Wandsworth District Board of Works and the Council for 33 years, resigned his appointment in May, and Miss I. E. Mulkern was appointed as a temporary Sanitary Inspector for Clapham North Ward. I should like to place on record my appreciation of the excellent service Mr. Fairchild rendered during his long term of office. Mr. G. Russell, who had been Sanitary Inspector in Putney for 28 years, died in January, and Mr. Hatton was transferred to Putney Ward, and the vacancy temporarily filled by the appointment of Miss Giles. Miss Giles resigned in November, and Miss A. W. Freke was appointed in December. I should also like to place on record my appreciation of the late Mr. G. Russell, whose sudden death was deeply regretted by all the members of the staff of the Department. 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. 94 ANNUAL STATEMENT Of the work done in tne Borpugh of Wandsworth under the Sale of Food and Drugs Acts, summarised from the statutory quarterly reports. To the Mayor, Aldermen and Councillors, of the Metropolitan Borough of W andsworth. Gentlemen, Herewith I beg to submit a short resume of the work performed by myself and Mr. C. A. Hackman, F.I.C., nnder the Sale of Food and Drugs Acts during the year 1918. I also append a statement regarding the results of our analyses on samples submitted by the Wandsworth Food Control Committee per Mr. T. Newell. Under the Sale of Food and Drugs Acts, 1,891 samples in all were submitted and examined by us. Of these, 948 were taken 95 Report oj the Medical Officer oj Health. with the necessary formalities required by the Acts by the Council's Food Inspectors, as under:— Inspector. Number of samples. B. Nurcombe 450 A. W. Brown 390 C. Hatton 55 A. J. Weeks 53 Total 948 In addition, 943 were sent in as "Informal" samples under tie direction of Mr. Inspector T. Newell. The following table gives in detail the nature of all the samples submitted under the Acts, together with the number of samples returned by us as being adulterated, or not up to the legal standard. Below will be found the percentage of adulteration of each class of article submitted where such adulteration occurs:— Nature of Article. Examined. Adulterated. Formal Informal Total Formal Informal Total Milk and Cream 940 33 973 149 0 149 Butter — 523 523 — 9 9 Margarine 2 26 28 0 0 0 Lard — 25 25 — 0 0 Bread — 14 14 — 0 0 Tea — 8 8 — 0 0 Coffee 50 50 — 0 0 Cocoa — 49 49 — 4 4 Mustard — 8 8 — 1 1 Jam (Marmalade) — 1 1 — 0 0 Pepper — 12 12 — 0 0 Drugs 2 43 45 2 5 7 Other Articles 4 151 155 1 6 7 Total 948 943 1,891 152 25 177 96 96 Report of the Medical Officer of Health. Class of Article. Percentage of Adulteration. Formal. Informal. Total. Milk and Cream 15.8 0.0 15.3 Butter 1.7 1.7 Cocoa — 8.1 8.1 Mustard — 12.5 12.5 Drugs 100.0 11.6 15.5 Other Articles 25.0 3.9 4.5 Total adulteration 16-0 2.6 9.3 97 Report oj the Medical Officer of Health In every case the samples reported against were milks which had been taken with the formalities required by the Act. Below will be found the reasons for returning them as adulterated, together with the number of samples which were so returned:— Nature of adulteration. • Number. Containing extraneous water 99 Deficient in milk fat 38 Both offences 12 • Total 149 The largest amount of extraneous water, namely, 46 per cent., was found in sample No. 88; whilst the greatest deficiency in milk fat occurred in sample No. 395, which was returned as being 32 per cent, below the legal standard. In no case was preservative found in any sample grouped under the heading " Milk and Cream." The nine Informal samples of Butter reported against contained Margarine. Of the 523 samples of Butter submitted, 31, or 5.9 per cent., were free from preservative other than common salt, whilst 492, or 94.1 per cent., contained a Boron preservative. In no case, however, did the quantity of this preservative exceed the maximum amount permissible, namely, 0.5 per cent., calculated as crystallised Boric Acid. A Boron preservative was found in all of the 28 samples of Margarine examined; and, as in the case of the Butters, the quantity present never exceeded the permissible limit. The four Informal samples of Cocoa reported against contained an excess of shell, i.e., they exceeded the limit of 5 per cent, prescribed by the Order then in force. 98 Report of the Medical Officer of Health. One Informal sample of Mustard was returned as adulterated, as it contained Wheat Flour. The following Table gives in detail the nature of the samples grouped in the General Statement under the head of Drugs, together with the number of samples returned as adulterated:— Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Acid, Tartaric - 2 2 - 0 0 Camphorated Oil - 3 3 - 0 0 Friar's Balsam - 3 3 - 0 0 Milk Sugar - 5 5 - 0 0 Ointment, Boric - 2 2 - 0 0 Ointment, Zinc 1 2 3 1 1 2 Powder, Gregory's - 3 3 - 2 2 Powder, Liquorice Comp - 3 3 - 0 0 Prescriptions 1 6 7 1 2 3 Rhubarb, powdered - 3 3 - 0 0 Sal Volatile - 6 6 - 0 0 Syrup of Squills - 2 2 - 0 0 White Precipitate - 1 1 - 0 0 Wine, Ipecacuanha - 2 2 - 0 0 Total 2 43 45 2 5 7 • The Formal sample of Zinc Ointment (No. 374) reported against was found on analysis to contain 6 6 per cent, excess of Zinc Oxide; whilst the Formal sample of "Medicine as prescribed" (No. 239), was deficient in its active ingredient, Sodium Salicylate, to the extent of 55 per cent. One Informed sample of Zinc Ointment was found to contain excess of Zinc Oxide; two Informal samples of Gregory Powder had been made up with Carbonate, in place of Oxide of Magnesia; whilst one Informal "Medicine as prescribed" was deficient in its 99 Report of the Medical Officer oj Health. active ingredient, the other reported against containing excess. In both these cases the active ingredient was Sodium Salicylate. Details of the "Other Articles" submitted will be found in the adjoining Table:— Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Arrowroot - 4 4 - I I Baking Powder - 10 10 - O 0 Cocoa Butter 1 8 9 1 1 2 Coffee Mixture - 1 1 - O 0 Cornflour - 6 6 - 0 0 Dripping 3 23 26 - 0 O Eggs, preserved — 6 6 - 0 0 Ginger, ground —• 11 11 - 0 0 Mustard Condiment — 3 3 - 0 0 Oatmeal - 14 14 — 0 0 Olive Oil — 12 12 - 1 1 Pea Flour — 6 6 — 0 0 Rice — 7 7 - 0 0 Rice, Flaked —1 2 2 - 0 0 Sausages — 6 6 — 2 2 Self-raising Flour — 1 1 - 0 O Tapioca — 2 2 - 0 O Tapioca, Flaked — 2 2 - O O Tinned Vegetables — 6 6 - 0 O Vinegar — 21 21 - 1 1 Total 4 151 155 1 6 7 The Formal sample of Cocoa Butter (No. 146) returned as adulterated was found to consist entirely of Illipe Butter. The same adulteration was found in one of the Informal samples of Cocoa Butter analysed ; whilst the remaining Informal A4255 E 100 Report of the Medical Officer oj Health. samples shown in the above table as reported against were adul terated as under:— Nature of Sample. Number of Samples. Nature of Adulteration. Arrowroot 1 Contained a trace of Maize Starch. Olive Oil 1 Contained a foreign vegetable oil. Sausages 2 Contained a Boron preservative. Vinegar 1 Deficient in Acetic Acid. Of the Informal samples of Preserved Eggs submitted, two were dried and contained no preservative, whilst the remaining four were liquid, and contained a Boron preservative in amounts ranging from 0.75 to 2.32 per cent. crystallised Boric Acid. Each of these four samples was declared on the label as preserved. Of the Tinned Vegetables, one was a sample of Baked Beans, the remaining five being Peas. In three cases of the Peas, Copper had been used for colouring in quantities of 0.34, 0.44, and 0.53 grains per lb., the maximum permissible limit for this being one grain per lb. 25 samples were submitted during the year by Mr. Inspector T. Newell, acting on behalf of the Food Control Committee, under the various Food Orders. They consisted of the following:— Nature of Article. Number submitted Reported against. Buns 1 0 Butter 1 0 Cake 5 2 Cocoa 3 0 Flour, Self-raising 1 0 Ice Cream 9 0 Jam 2 0 Margarine 2 0 Scone 1 1 T otal 25 3 IOI Report oj the Medical Officer oj Health. Two samples of Cake reported against contained 4.9 and 2.2 per cent, sugar respectively, in excess of the maximum permis sible ; whilst the scone mentioned above contained 1.4 per cent. sugar, none being permitted by the Order then in vogue. I am, Gentlemen, Your obedient servant, A. H. M. MUTER, F.I.C., F.C.S. Public Analyst. South London Central Public Laboratory, 325, Kennington Road, S.E. 11. 1st May, 1919.