WAN 6 Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, & c., OF THE BOROUGH, FOR THE YEAR 1919, by P. CALDWELL SMITH, C.B.E., M.A., M.D., D.P.H., Lt.-Col., R.A.M.C., T., Medical Officer of Health, TOGETHER WITH THE Report of the Public Analyst. Printed for the Council by ODHAMS PRESS LTD., 83-95. Long Acre, London, W.C. index. PAGE Analyst, Report of III Anthrax Order 91 Appendicitis and Typhlitis 27 Bacteriological Examinations 109 Bakehouses 43 Births 3 Births and Birth-rates in Sub-Districts 3 Births, Notification of, Act 5 Brain and Nervous System, Diseases of the 26 Canal Boats Act 48 Cancer 26 Chemical Work 109 Census, 1911 1 Cerebro-Spinal Meningitis, Cases Notified 64 Cerebro-Spinal Meningitis, Deaths 20 Cesspools 34 Circulatory Diseases 26 Clapham, House-to-House Inspections in 38 Cleansing of Persons Act 119 Closet accommodation 33 Conscientious Objection Certificates granted 91 Contacts 72 Cowsheds 54 Creches 10 Cutting-off Notices 119 Death, Causes of 12 Death-rate, Corrected 10 Death-rate, Infantile 15 Deaths, Corrected and Uncorrected 10 Deaths, Number of 5 Deaths in Outlying Institutions 9 Deaths in Public Institutions 6 Deaths in Public Institutions in the Borough of Persons belonging to the Borough 8 Deaths in Public Institutions in the Borough of Persons not belonging to the Borough 7 ii. PAGE Dental Treatment 103 Developmental Diseases 28 Diarrhœa 1 Diarrhœa, Deaths and Death-rate from 23 Diarrhoea, Method of Feeding Children who died from 105 Diphtheria, Cases Notified 62 Diphtheria, Deaths and Death-rates 19 Diphtheria, Number of Dwellings in which multiple Cases occurred 63 Diphtheria, "Return Cases"of,. 63 Disinfection 72 Disinfection of Schools 70 Dysentery Carriers 73 Dysentery, Cases Notified 72 Earth Closets 33 Encephalitis Lethargica, Cases Notified 67 Encephalitis Lethargica, Deaths from 20 Enteric Fever, Cases Notified 63 Enteric Fever, Deaths and Death-rates 19 Erysipelas, Cases Notified 69 Erysipelas, Deaths 20 Factories and Workshops 42 Factories, Workshops and Workplaces, Inspection of 43 Food Places, Inspection of 53 German Measles, Cases of 69 Home Work 46 Hospitals and other forms of gratuitous relief 31 House Refuse, Collection and Disposal of 33, 40 House-to-house Inspections 38 House-to-house Inspections, Summary of 38 Houses and Premises Inspected 36, 37 Houses Let in Lodgings 54 Houses unfit for habitation 39 Housing 119 Housing, Town Planning, etc., Act, 1909 38,39 Ice Cream Premises 54 Illegitimate Children, Births of 4 iii. PAGE Infant Visiting 94 Infantile Mortality 14, 15 Infective Diseases, Deaths from 18 Infective Diseases, Death-rate from 18, 19 Infective Diseases: Number of Cases Notified 59 Infective Diseases: Number of Cases notified from Elementary Schools 70 Infectious Disease, Prevalence and Control over 58 Influenza, Deaths and Death-rates 21 Influenza, Pneumonia and Acute Primary Pneumonia, Cases Notified 70 Inspections, details of 36, 37 Inquests 28 Malaria, Cases Notified 71 Maternity and Child Welfare 92 Maternity and Child Welfare Centres 99 Measles and German Measles, Cases Notified 69 Measles and other Non-notifiable Diseases reported from Schools 70 Measles, Deaths and Death-rates 21 Milk and Cream Regulations, 1912 51, 57 Milk and Food 52 Milk (Mothers and Children) Order 52 Milk Premises, Cowsheds, etc., on Register 54 Milkshops, Cowsheds, &c., Inspections of 54 Milk Supply 50 Mistaken Diagnosis, Cases of 64 Mortuaries 31 Natural Increase, Rate of 3 Nervous System, Diseases of the 26 Non-Infective Diseases 26 Notification of Births Act 5 Notification of Infective Diseases 59 Offensive Trades 54 Old Age 28 Ophthalmia Neonatorum 103 Other Infective Diseases, Deaths from 25 iv. PAGE Outworkers 43 Overcrowding 38 Physical Features and General Character of the Borough 2 Police Court Proceedings 40,41,42 Polio-Myelitis and Polio-Encephalitis, Cases Notified 68 Polio-Myelitis, Deaths from 25 Poor Law Relief, Amount of 31 Population 1 Population of Sub-Districts 1 Premature Birth 28 Privies 33 Public Institutions, Number of Deaths in 32 Puerperal Fever 103 Puerperal Fever, Deaths and Death-rates 20 Pulmonary Tuberculosis, Notification of Cases of 74 Putney, House-to-house Inspections in 38 Rabies 92 Rag Flock Act, 1911, Statement of work done under 110 Rat Destruction 49 Respiratory Diseases 27 Return Cases of Scarlet Fever and Diphtheria 63 Revenue Act 119 Sale of Food and Drugs Act, Proceedings under 55 Sale of Food and Drugs Acts, Statement of Work under 54 Sanitary Conveniences, Inspection of 48 Sanitary Operations, Table of 35 Sanitary Inspection of District 34 Scabies 92 Scarlet Fever, Cases Notified 61 Scarlet Fever, Deaths and Death-rates 19 Scarlet Fever, Number of Dwellings in which Multiple Cases occurred 62 Scarlet Fever, "Return Cases"of 63 Scavenging 33 Schools 49 Schools, Disinfection of, for Infective Diseases 49 Slaughter-houses 54 V. PAGE Small-pox 91 Smoke Nuisances 35 Social Conditions 2 Staff 107 Streatham, House-to-house Inspections in 38 Tooting, House-to-house Inspections in 38 Trench Fever, Cases Notified 72 Tuberculosis Dispensaries 79 Tuberculous Diseases, After-care 89 Tuberculous Diseases, Cases Notified 74 Tuberculous Diseases, Deaths and Death-rates 24 Tuberculous Diseases, Institutional Treatment of 88 Underground Rooms 42 Unsound Food 53 Vaccination Returns 91 Violence, Mortality from 28 Vital Statistics of Whole Borough 13 Wandsworth, House-to-house Inspections in 38 Water Supply, Cutting-off Notices 119 Whooping Cough, Cases Notified 70 Whooping Cough, Deaths and Death-rates 21 Zymotic Diseases, Deaths from 18 Zymotic Diseases, Death-rate from 18, 19 f REPORT of the Medical Officer of health for the Year 1919. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Wandsworth. Sir, Ladies and Gentlemen, I have the honour to present the Annual Report on the health and sanitary condition of the Borough for the year 1919. Population. The civil population of the Borough to the middle of 1919 has been estimated by the Registrar General to be 333,693 for the purpose of calculating death-rates and 347,610 for birth-rates. The population, uncorrected for Institutions, as ascertained from an enumeration of the ration books, was found to be 340,821. Table I. shows the population of each sub-district based on the above estimation, compared with the Census population. TABLE I. Sub-District. Census Population, 1911. Population estimated to middle of 1919. Corrected. Uncorrected. Clapham 58,592 59,540 59,715 Putney 28,242 28,592 30,285 Streatham 96,192 104,912 105,248 Tooting 35,958 38,713 41,913 Wandsworth 92,376 100,002 103,660 Whole Borough 311,360 331,759 340,821 The estimated population in Table I. is used to calculate all the rates in this Report. 2 Report of the Medical Officer of Health. Physical Features and General Character of the Borough. With regard to this, the Borough is fortunate in possessing a considerable number of parks and open spaces, and, in addition, there are parks in the County of Surrey adjacent to those in this Borough. The total area of the Borough is 9,108 acres, and the approximate area of parks and open spaces is 1,130 acres. This area is largely increased by Wimbledon Common and Richmond Park, portions of both of these being in the Borough. Social Conditions. At the Census of 1911 the total population was 140,728 males and 170,632 females; and of these, 90,032 males, or 64 per cent., and 46,731 females, or 27 per cent., were engaged in specified occupations, compared with 66 per cent. males and 32 per cent. females in the County of London. The greatest number of males were engaged in commercia occupations; conveyance of men, goods and messages; building and works of construction; food, tobacco, drink and lodging; and professional occupations and their subordinate services. And the greatest number of females in domestic offices and services; dress; professional occupations and their subordinate services; food, tobacco, drink and lodging; and commercial occupations. There is reason to believe that the percentage of occupied females has considerably increased during the last five years, especially in commercial occupations. There are few staple industries in the Borough, and, as will be seen from the following Table, there is only a small proportion of the total occupied persons employed in these industries. 3 Report of the Medical Officer of Health. Staple industries of the Borough. No. of works. No. of employees. Male. Female. Gas mantle works 5 109 I,527 Laundries 149 190 2,353 Gas and electric lighting works 2 380 — Optical works 4 575 89 General and motor engineering works 28 627 — Box making works 4 41 571 Births. During the year 1919, 5,441 births, 2,786 of males and 2,655 of females, occurred, compared with 4,685 in 1918. The total number of births in this Borough was 5,476, but 462 births occurred in Institutions outside the Borough of persons belonging to the Borough, and 497 births in Institutions in the Borough of persons not belonging to the Borough, making a corrected total of 5,441. In Table II. is shown the number of births, males and females' the birth-rate, and the rate of natural increase for each sub-district, and for the whole Borough. TABLE II. Sub-District. Births. Rates. Males. Females. Total. Birth-Rate. Rate of natural increase. Clapham 495 433 928 15.58 2.97 Patney 209 156 365 12.76 .66 Streatham 844 797 1,641 15.64 3.79 Tooting 369 375 744 19.21 10.12 Wandsworth 869 894 1,763 17.63 7.05 Whole Borough 2,786 2,655 5,441 16.40 5.09 4 Report of the Medical Officer of Health. The birth-rate was 16·40 per 1,000, compared with 14·29 for 1918, and 19·85 the decennial average. There was a considerable increase in the number of births during the last two months of the year, and it is to be hoped that in 1920 the birth-rate will show a decided increase. Table III. shows the birth-rate in the Borough, in the five sub-districts, in London, and in England and Wales, for the year, as well as the rates for the previous 10 years, compared with the decennial average. 84 births occurred in the Workhouse, 47 of which belonged to the Borough. 328 illegitimate births took place in the Borough, 17 in Clapham, 14 in Putney, 222 in Streatham, 15 in Tooting, and 60 in Wandsworth. TABLE III. Year. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. London. England and Wales. 1909 23·29 18·14 20·10 34·05 27·18 24·04 25·75 25·8 1910 21·61 17·94 20·46 31·18 26·38 23·21 25·39 25·05 1911 22·15 16·96 18·78 29·04 23·27 21·73 25·0 24·4 1912 20·62 17·08 18·88 27·12 24·07 21·53 24·7 23·8 1913 20·66 16·74 18·06 27·82 22·61 20·87 24·8 23·9 1914 19·50 16·06 18·61 25·51 22·34 20·44 24·3 23·8 1915 18·78 16·15 18·23 23·12 20·05 19·25 25·5 21·8 1916 18·82 14·66 17·51 20·85 19·39 18·46 21·5 20·9 1917 15·16 11·40 14·70 17·09 14·54 14·72 17·9 17·8 1918 13·69 12·40 15·10 16·14 13·70 14·29 16·1 17·7 Average for 10 yrs. 19·43 15·75 18·04 25·19 21·35 19·85 23·1 22·5 1919 15·59 12·76 15·64 19·21 17·63 16·40 18·3 18·5 Report of the Medical Officer of Health. Of the 328 illegitimate births that occurred in the Borough, 114 belonged to the Borough, 11 to Clapham, 13 to Putney, 36 to Streatham, 11 to Tooting, and 43 to Wandsworth. 89 illegitimate births occurred outside the Borough, making a total of 203. The illegitimate births in nursing homes have this year been allocated to the home addresses of the mothers. The percentage of illegitimate births to total births was 3·8. 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 IV. Sub-district. Total No. of births notified. Notified by: Total births registered. No. born dead. Medical Attendant Parent. Midwife. Other person. Clapham 911 298 295 270 48 928 26 Putney 349 110 86 144 9 365 12 Streatham 1,822 606 590 550 76 1,641 43 Tooting 720 79 203 424 14 744 14 Wandsworth 1,717 227 791 633 66 1,763 20 Whole Borough 5,519 1,320 1,96s 2,021 213 5,441 115 The percentage of births notified, less still-births, to those registered was 98.6. This is the highest percentage recorded since the Act came in force. Deaths. During the year ending the 31st December, 1919, 3,552 deaths, 1,688 of males and 1,864 of females, occurred, compared with 4,208 in 1918. 6 Report of the Medical Officer of Health. Table V. shows the total number of Institution deaths arranged according to sub-districts and Institutions in which they occurred, Table VI. the deaths of persons not belonging to the Borough, Table VII. the deaths of persons belonging thereto arranged according to causes of death, sex and age, and Institution in which the death occurred, and Table VIII., the number of deaths in Institutions, etc., outside the Borough of persons belonging thereto. TABLE V. Name of Public Institution. Clapham. Putney. Streatham Tooting. Wands'th Total. Hostel of God 63 ... ... ... ... 63 South London Hospital for Women 26 ... ... ... ... 26 Springfield Mental Hospital ... ... 2 ... 213 215 Fountain Temporary Mental Hospital ... ... ... 32 ... 32 H. M. Prison ... ... ... ... 5 5 Swaffield Rd. Institution ... ... ... ... 21 21 Royal Hospital for Incurables ... ... ... ... 20 20 Tooting Bee Mental Hospital ... ... ... 377 ... 377 The Priory ... 7 ... ... ... 7 Putney Hospital ... 14 ... ... ... 14 Newlands House Asylum ... ... ... 4 ... 4 Military Hospitals 3 6 3 32 43 137 TOTAL 92 27 5 495 302 921 Other places 74 33 92 5 44 248 GRAND TOTAL 166 60 97 500 346 1,169 7 Report of the Medical Officer of Health. TABLE VI. Deaths in Public Institutions in the Borough of Persons not belonging to the Borough, 1919. 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 Bec Mental Hospital. Hostel of God. Swaffield Road Institution. H.M. Prison. Ryl. Hosp. for Incurables The Priory. Putney Hospital. Fountain Temporary Mental Hospital. S. Lon. Hosp.for Women. Newlands House Asylum. Military Hospitals. Other Places, not Public Institutions. Enteric Fever 1 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 2 2 ... ... ... ... 2 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza 67 41 26 ... ... ... ... 10 39 7 11 7 12 ... 2 1 ... ... 1 2 1 ... 30 11 Erysipelas 2 1 1 ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Pulmonary Tuberculosis 91 57 34 ... ... ... 5 14 45 22 5 41 13 16 ... ... ... ... ... 4 ... 1 9 7 Tuberculous Meningitis 2 1 1 ... ... 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... Abdominal Tuberculosis 3 2 1 ... ... ... 2 1 ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases 3 2 1 ... ... ... 2 ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... Other Infective Diseases 4 3 1 2 ... ... ... ... 1 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... 2 Cancer, Malignant Disease 64 21 43 ... ... ... ... 10 32 22 2 2 32 ... ... 1 ... 2 ... 4 ... 4 17 Rheumatic Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Diabetes 3 2 1 ... ... ... ... ... ... 1 2 1 ... ... ... ... ... ... ... ... ... ... ... 2 Other General Diseases 9 2 7 ... ... ... ... ... 2 1 6 ... ... ... ... ... 2 ... ... ... 2 1 ... 4 Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis' 6 2 4 2 1 ... 1 ... 2 ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 3 Cerehral Hæmorrhage, Apoplexy 28 16 12 ... ... ... ... ... 4 10 14 14 3 ... 1 ... 1 ... ... ... ... ... ... 9 Convulsions 3 2 1 3 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 2 Other Diseases of Nervous System 116 82 34 ... ... 6 15 4 39 40 12 61 15 ... ... ... 6 2 ... 19 ... 1 5 7 Organic Diseases of Heart 83 48 35 ... ... ... ... 2 14 26 41 24 23 2 ... ... 2 ... ... ... 2 1 8 21 Other Diseases of Circulatory System 17 9 8 ... ... ... ... ... 1 8 8 3 ... 1 ... ... 4 3 ... ... ... ... ... 6 Bronchitis 27 7 20 ... ... ... ... 1 2 9 15 8 1 ... 1 ... 3 ... ... ... ... ... 2 12 Broncho-Pneumonia 22 10 12 ... ... 1 3 3 3 2 10 3 3 ... ... ... 1 1 ... 5 1 ... 5 3 Lobar Pneumonia 4 1 3 ... ... ... ... 1 ... 1 2 1 ... ... ... ... ... ... ... ... ... ... 1 2 Pneumonia (type not distinguished) 18 14 4 1 ... ... ... 2 7 4 4 1 4 1 ... ... ... ... ... ... ... ... 9 3 Other Diseases of Respiratory System 2 1 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 Ulcer of Stomach 3 1 2 ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... Diarrhæa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteritis 6 3 3 2 ... ... ... ... 1 1 2 2 ... ... ... ... ... ... ... ... ... ... ... 4 Appendicitis and Typhlitis 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 Obstruction of Intestines 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Cirrhosis of Liver 5 4 1 ... ... ... ... ... 1 2 2 ... 1 ... ... ... ... ... ... ... ... ... 1 1 Other Diseases of Liver 3 3 ... ... ... ... ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... Other Diseases of Digestive System 3 2 1 ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 1 Nephritis and Bright's Disease 23 13 10 ... ... ... ... 1 6 9 7 8 3 1 ... ... ... ... ... ... 1 ... 5 5 Other Diseases of Urinary System 2 1 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 Diseases of Generative System 1 ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 5 3 2 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Congenital Debility and Malformation 9 4 5 7 ... ... 2 ... ... ... ... ... ... ... 1 ... ... ... ... 2 4 ... 2 Other Diseases of Early Infancy 2 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Old Age 324 130 194 ... ... ... ... ... ... ... 324 26 279 ... 3 ... ... ... ... ... ... ... ... 16 Deaths from Accident 14 4 10 1 ... ... 1 ... 2 3 7 ... 6 ... ... ... ... ... ... ... ... ... ... 8 Deaths from Suicide 6 5 1 ... ... ... ... 1 3 1 1 2 ... ... ... 1 ... ... ... ... ... ... ... 3 Other Violent Deaths 33 33 ... ... ... ... ... 12 19 1 1 ... 1 ... ... ... ... ... ... ... ... ... 32 ... Other defined Diseases 5 5 ... ... ... ... ... ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 4 1 III-defined Diseases or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... All causes 1025 543 482 25 1 8 35 54 216 187 499 213 370 55 10 2 20 6 3 32 20 4 128 162 8 Report of the Medical Officer of Health. TABLE VII. Death in Public Institutions, &c., in the Borough of Persons belonging to the Borough, 1919. 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. Swaffield Road Institution. Tooting Bec Mental Hospital. H.M. Prison. Fountain Temporary Mental Hospital. Hostel of God. Putney Hospital. South London Hospital for Women. Springfield Mental Hospital. The Priory Military Hospitals. Other Places not Public Institutions. Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza 15 5 10 2 ... ... ... 2 9 ... 2 3 ... ... ... ... 3 1 ... ... 1 7 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 4 4 ... ... ... ... ... 1 2 ... 1 1 ... 1 ... 2 ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Infective Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer, Malignant Disease 29 11 18 ... ... ... ... ... 2 12 15 ... 1 2 ... 5 1 1 ... ... 2 17 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diabetes 2 ... 2 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 2 Other General Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 2 1 1 ... ... ... 1 ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 Cerebral Hæmorrhage, Apoplexy 8 1 7 ... ... ... ... ... ... 4 4 1 ... ... ... ... ... ... ... ... ... 7 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Nervous System 5 4 1 ... ... ... ... 2 1 ... 1 ... ... ... ... ... ... ... 1 ... 1 3 Organic Diseases of Heart 14 8 6 ... ... ... ... ... 2 3 9 1 ... ... ... ... 2 ... ... ... 2 9 Other Diseases of Circulatory System 4 1 3 ... ... ... ... ... 1 1 2 ... ... ... ... ... ... ... ... ... ... 4 Bronchitis 7 3 4 ... ... ... ... ... ... 3 4 1 ... ... ... ... 1 ... ... ... 2 3 Broncho-Pneumonia 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 Lobar Pneumonia 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... Pneumonia (type not distinguished) 3 1 2 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 3 Other Diseases of Respiratory System 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Ulcer of Stomach ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhæa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteritis ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Appendicitis and Typhlitis 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Obstruction of Intestines ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Liver 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Other Diseases of Digestive System 2 1 1 ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 1 ... ... ... 1 Nephritis and Bright's Disease 3 2 1 ... ... ... ... ... ... 1 2 ... ... ... ... ... ... ... ... ... ... 3 Other Diseases of Urinary System 4 3 1 ... ... ... ... 1 ... 2 1 ... ... ... ... ... ... 1 ... ... 1 2 Diseases of Generative System 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 Puerperal Fever 1 ... 1 ... ... ... ... ... I ... ... ... ... ... ... ... 1 ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 4 3 1 4 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 3 Congenital Debility and Maltorination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Early Infancy 6 4 2 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Old.Age 14 3 1l ... ... ... ... ... ... ... 14 3 6 ... ... 1 ... ... 1 ... ... 3 Deaths from Accident 8 4 4 ... ... ... 5 ... ... 1 2 ... ... ... ... ... 1 1 ... ... ... 6 Deaths from Suicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Violent Deaths 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Other defined Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Diseases or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... All causes 144 64 80 15 1 ... 7 6 21 34 60 11 7 3 ... 8 11 6 2 1 9 86 9 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 VIII. Deaths in Public Institutions, &c., outside the Borough, of Persons belonging to the Borough, 1919. 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. 5and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Clapham. Putney. Streatham. Tooting. Wandsworth. Poor Law Infirmaries. General and Special Hospitals, &c. Public Lunatic and Imbecile Asylums. Metropolitan Asylums Board Hospitals. Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 6 3 3 1 2 2 1 ... ... ... ... ... ... 3 ... 3 5 ... ... 1 Scarlet Fever 7 4 3 ... ... 2 3 2 ... ... ... 1 ... 2 ... 4 ... ... ... 7 Whooping Cough 4 2 2 2 1 ... 1 ... ... ... ... 2 1 ... ... 1 1 2 ... 1 Diphtheria and Membranous Croup 34 16 18 ... 1 14 18 ... 1 ... ... 8 1 9 6 10 1 2 ... 31 Influenza 70 34 36 ... ... 13 2 5 28 22 10 22 4 16 13 15 56 13 1 ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Fever 5 2 3 1 ... ... 1 ... 3 ... ... 1 ... 1 ... 3 1 ... ... 4 Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 122 59 63 ... ... ... 2 29 56 33 2 24 18 43 10 27 50 38 28 6 Tuberculous Meningitis 14 5 9 1 1 3 7 2 ... ... ... 2 1 3 2 6 7 4 ... 3 Abdominal Tuberculosis 4 3 1 ... ... 1 1 ... ... 2 ... ... ... ... ... 4 1 2 1 ... Other Tuberculous Diseases 14 10 4 2 1 2 3 3 2 1 ... ... ... 4 1 9 6 8 ... ... Other Infective Diseases 7 1 6 4 ... ... ... ... 1 2 ... ... 1 ... 2 4 6 1 ... ... Cancer, Malignant Disease 117 49 68 ... ... ... ... 2 15 52 48 24 12 35 11 35 63 52 2 ... Rheumatic Fever 2 1 1 ... ... ... 1 1 ... ... ... 1 ... ... 1 ... 2 ... ... ... Diabetes 8 3 5 ... ... 1 ... 1 1 1 4 2 2 3 ... 1 3 4 1 ... Other General Diseases 10 2 8 ... 1 ... 1 1 3 3 1 2 ... 3 1 4 4 6 ... ... Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 5 5 ... 1 ... ... 2 ... ... 2 ... 2 1 1 ... 1 2 3 ... ... Cerebral Hæmorrhage, Apoplexy 37 19 18 ... ... ... ... ... 2 11 24 9 1 16 3 8 24 9 4 ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Nervous System 73 43 30 ... ... 1 7 8 21 26 10 16 4 25 9 19 20 24 29 ... Organic Diseases of Heart 177 77 100 ... ... ... 1 2 14 34 126 33 18 58 18 50 133 23 21 ... Other diseases of Circulatory System 36 20 16 ... ... 1 3 ... 6 10 16 9 2 13 2 10 19 17 ... ... Bronchitis 65 33 32 3 ... ... 2 ... ... 8 52 18 4 15 4 24 55 9 1 ... Broncho-Pneumonia 15 8 7 3 3 ... ... 1 2 5 3 1 2 5 4 8 7 ... ... Lobar Pneumonia 9 3 6 1 ... ... ... 1 3 3 1 7 1 7 ... 2 1 6 2 ... Pneumonia (type not distinguished) 16 7 9 1 1 ... ... 2 5 4 3 3 ... 6 3 4 8 8 ... ... Other Diseases of Respiratory System 8 3 5 ... ... ... ... ... 3 4 1 1 2 1 1 3 3 3 2 ... Ulcer of Stomach 13 7 6 ... ... ... ... ... 8 4 1 3 1 4 1 4 3 9 1 ... Diarrhæa 9 6 3 7 2 ... ... ... ... ... ... ... 1 2 1 5 4 5 ... ... Enteritis 17 13 4 11 2 ... ... ... 2 1 1 2 3 4 2 6 7 7 3 ... Appendicitis and Typhlitis 13 6 7 ... ... ... 3 3 5 1 1 5 1 3 ... 4 2 11 ... ... Obstruction of Intestines 21 9 12 4 ... 1 ... ... 1 8 6 5 2 11 2 1 4 16 1 ... Cirrhosis of Liver 5 3 2 ... ... 1 ... ... ... 4 ... 1 1 1 ... 2 4 1 ... ... Other Diseases of Liver 6 3 3 ... ... ... ... ... 3 3 ... 1 ... 4. ... 1 1 5 ... ... Other Diseases of Digestive System 7 6 1 ... ... ... ... 2 2 2 1 1 1 2 1 3 2 5 ... ... Nephritis and Bright's Disease 51 36 15 ... ... 1 I 2 3 20 24 9 5 17 10 10 31 15 5 ... Other Diseases of Urinary System 22 20 2 ... ... ... ... ... 2 6 14 7 5 9 2 3 11 11 ... ... Diseases of Generative System 4 ... 4 ... ... ... ... ... 2 2 ... ... 1 2 1 ... 1 3 ... ... Puerperal Fever 11 ... 11 ... ... ... ... 3 7 1 ... ... ... 4 1 6 8 1 ... 2 Other Accidents and Diseases of Pregnancy and Childbirth 4 ... 4 ... ... ... ... 1 3 ... ... 1 1 1 ... 1 1 3 ... ... Premature Birth 12 5 7 12 ... ... ... ... ... ... ... 2 1 3 3 3 2 10 ... ... Congenital Debility and Malformation 31 20 11 29 2 ... ... ... ... ... ... 4 5 6 7 9 13 18 ... ... Other Diseases of Early Infancy 3 1 2 3 ... ... ... ... ... ... ... ... ... ... 2 1 1 2 ... ... Old Age 46 16 30 ... ... ... ... ... ... ... 46 9 2 15 3 17 40 2 4 ... Deaths from Ace dent 59 40 19 ... ... 3 6 10 12 12 16 10 2 26 7 14 22 34 2 1 Deaths from Suicidc 9 7 2 ... ... ... ... 1 3 4 1 2 1 3 1 2 2 7 ... ... Other Violent Deaths 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... Other defined Diseases 11 8 3 1 ... ... 1 1 3 3 2 4 ... ... 3 4 5 5 1 ... Ill-defined Diseases or unknown 5 4 1 ... ... ... ... 2 3 ... 3 ... ... ... 2 ... 4 1 ... All causes 1225 623 602 87 17 36 68 83 225 297 412 251 106 379 139 350 644 415 110 56 A5202 B 10 Report of the Medical Officer of Health. The corrected number of deaths, after adding the deaths of persons belonging to the Borough, and subtracting those of persons dying in the Borough and not belonging thereto, was 3,752, 1,769 of males, and 1,983 of females. The corrected death-rate for the year was 11.31 compared with 15.07 in 1918. The death-rate for the whole of London for the year was 13.4 per 1,000, compared with 18.9 in 1918. Table IX. 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 IX. SubDistricts. Corrected Deaths. Uncorrected Deaths. Corrected Death-rate Males. Females. Total. Males. Females. Total. Clapham 359 392 751 275 359 634 12.61 Putney 170 176 346 138 136 274 12.10 Streatham 549 696 1,245 408 518 926 11.85 Tooting 168 184 352 348 334 682 9.09 Wandsworth 523 535 1,058 519 517 1,036 10.58 Whole Borough 1,769 1,983 3,752 1,688 1,864 3,552 11.31 The death-rate in England and Wales in 1919 was 13.8 per 1,000; in the 96 great Towns 13.8; and in the 148 smaller Towns 12.6. The rates in all the sub-districts were much lower than in 1918. There are only six towns in England and Wales with a greater population than the Borough of Wandsworth—viz., Bristol, Birmingham, Liverpool, Manchester, Leeds, and Sheffield—and in them the mortality and the infantile mortality for the year 1919 were, respectively: 13.1 and 82,13.6 and 88, 16.8 and 107,14.0 and 95, 16.0 and 112, and 137 and 96. 11 Report of the Medical Officer of Health. Table X. shows the death-rate in the Borough, in the five sub-districts, and in England and Wales for the year, as well as the rates for the previous 10 years, compared with the decennial average. During the previous decennium the lowest mortality in the Borough and in London was in 1910, while it was lowest in England and Wales in the year 1912. The rate in 1919, although higher than in 1910, 1912, 1913 and 1914, is lower than the average of the previous 10 years. Compared with London and with England and Wales the Borough rate is considerably lower. TABLE X. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough London. England and Wales. 1909 13.25 11.80 10.48 13.51 12.71 12.11 14.94 14.61 1910 10.73 10.17 9.50 10.67 11. 04 10.38 13.65 13.49 1911 13.15 11.88 11.02 11.73 13.29 12.25 15.8 14.6 1912 11.64 9.83 9.42 10.20 11.18 10.48 13.96 13.3 1913 10.99 10.69 10.37 10.43 12.77 10.95 14.2 13.7 1914 11.22 10.74 11.35 10.95 11.27 11.20 14.4 13.7 1915 12.53 12.34 11.98 12.01 13.50 12.63 16.1 14.8 1916 12.15 11.66 11.78 11.24 11.87 11.80 14.7 14.4 1917 12.77 12.16 13.07 12.06 12.69 12.69 15.7 14.4 1918 16.06 14.36 15.15 14.42 14.81 15.07 18.9 17.6 Average, 10 years. 12.44 11.56 11.41 11.72 12.51 11.95 15.23 14.46 1919 12.61 12.10 11.85 9.09 10.58 11.31 134 13.8 Table XI. 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 XII. gives certain vital statistics for the whole Borough for the year, and the previous 10 years; and Table XIII. shows the infantile mortality for the year. A5202 B 12 Report of the Medical Officer of Health. TABLE XI. Causes of, and Ages at Death, during the year 1919. 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. Wands worth. Enteric Fever 2 1 1 ... ... ... ... ... ... 2 ... 2 ... ... ... ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 18 9 9 3 6 7 2 ... ... ... ... 3 ... 8 4 3 2 Scarlet Fever 7 3 4 ... ... 2 3 2 ... ... ... 1 ... 2 ... 4 ... Whooping Cough 15 7 8 5 6 3 1 ... ... ... ... 4 4 3 1 3 ... Diphtheria, and Membranous Croup 41 18 23 ... 2 16 32 ... 1 ... ... 9 2 13 6 12 ... Influenza 310 140 170 8 5 11 l0 30 121 86 39 74 27 103 35 71 74 Erysipelas 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 10 Cerebro-spinal Fever 9 1 5 1 ... 1 3 1 3 ... ... 1 1 2 1 4 ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Pulmonary Tuberculosis 288 148 140 ... ... ... 10 51 129 84 14 52 30 97 32 77 95 Tuberculous Meningitis 24 11 1 2 2 7 10 2 1 ... ... 3 3 7 4 7 2 Abdominal Tuberculosis 7 4 3 ... 1 1 2 ... 1 2 ... 1 1 ... ... 3 4 Other Tuberculous Diseases 23 13 10 2 1 2 3 6 6 3 ... 1 1 7 1 13 3 Other Infective Diseases 12 4 8 5 ... ... ... 1 3 3 ... ... 1 2 3 6 4 Cancer,Malignant Disease 399 147 252 1 ... 1 1 2 39 179 176 75 38 148 27 111 93 Rheumatic Fever 14 6 8 ... ... 3 3 3 3 2 ... 5 ... 1 3 5 1 Diabetes 25 13 12 ... ... 1 2 3 6 7 6 6 5 10 1 3 5 Other General Diseases 40 13 27 1 2 ... 1 ... 8 16 11 5 3 14 3 15 9 Alcoholism 1 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 13 9 4 4 ... 1 4 1 ... 3 ... 6 2 2 2 1 Cerebral Hæmorrhage, Apoplexy 186 68 118 ... ... ... ... 1 6 53 126 40 12 79 15 40 Convulsions 22 15 7 17 3 1 1 ... ... ... ... 7 ... 6 1 8 Other Diseases of Nervous System 131 77 54 ... ... 2 12 15 28 41 33 28 14 43 9 37 121 Organic Diseases of Heart 489 212 277 ... ... ... 10 9 38 119 313 81 37 186 41 144 97 Other Diseases of Circulatory System 112 66 46 ... ... 1 4 ... 12 38 67 27 14 41 6 24 21 Bronchitis 387 183 204 29 2 2 9 ... 8 78 259 87 25 in 37 127 34 Broncho-Pneumonia 85 42 43 25 18 3 4 2 7 13 14 20 10 16 12 27 23 Lobar Pneumonia 34 14 21 2 1 ... 2 4 6 13 6 10 6 9 4 5 5 Pneumonia (type not distinguished) 84 35 49 6 7 7 1 5 15 24 19 15 9 24 12 24 21 Other Diseases of Respiratory System 37 18 19 1 1 ... 2 1 4 15 13 5 4 10 6 12 3 Ulcer of Stomach 22 12 10 ... ... ... ... ... 12 8 2 5 1 7 2 7 3 Diarrhæa 23 16 7 16 3 ... ... ... 1 ... 3 2 4 6 3 8 ... Enteritis 35 23 12 21 4 1 1 ... 2 3 3 4 7 9 4 11 7 Appendicitis and Typhlitis 16 9 7 ... ... 1 4 3 5 1 2 6 2 4 ... 4 2 Obstruction of Intestines 28 13 15 5 1 1 1 ... 1 10 9 7 1 14 3 3 1 Cirrhosis of Liver 12 9 3 ... ... 1 ... ... ... 8 3 2 2 4 ... 4 5 Other Diseases of Liver 15 7 8 ... ... ... ... ... 3 5 7 2 3 7 ... 3 4 Other Diseases of Digestive System 35 15 20 8 2 ... ... 3 4 9 9 5 I 13 2 14 3 Nephritis and Bright's Disease 114 70 44 ... ... 1 2 2 10 40 59 21 15 40 15 23 26 Other Diseases of Urinary System 44 39 5 ... ... ... ... 1 2 13 28 9 7 18 3 7 6 Diseases of Generative System 7 ... 7 ... ... ... ... ... 4 3 ... 1 1 3 1 1 2 Puerperal Fever 16 ... 16 ... ... ... ... 4 11 1 ... 1 1 5 2 7 1 Other Accidents and Diseases of Pregnancy and Childbirth 7 ... 7 ... ... ... ... 1 6 ... ... 1 1 1 2 3 ... Premature Birth 98 55 43 98 ... ... ... ... ... ... ... 18 11 31 6 32 9 Congenital Debility and Malformation 71 39 32 66 3 1 1 ... ... ... ... 11 9 17 12 22 9 Other Diseases of Early Infancy 23 14 9 23 ... ... ... ... ... ... ... 1 5 5 3 9 8 Old Age 232 80 152 ... ... ... ... ... ... 1 231 63 18 72 10 69 338 Deaths from Accident 87 55 32 6 1 5 13 10 13 14 25 13 6 35 11 22 22 Deaths from Suicide 20 12 8 ... ... ... ... 1 5 9 5 2 2 8 2 6 6 Other Violent Deaths 4 2 2 1 ... 1 ... ... 2 ... ... ... ... ... ... 4. 34 Other defined Diseases 20 13 7 3 ... ... 1 1 3 3 9 6 ... 1 5 8 5 Ill defined Diseases or unknown 7 5 2 ... ... ... ... ... 3 3 I 3 ... ... ... ... ... All causes 3752 1769 1987 359 71 84 145 166 532 902 1493 751 346 1345 352 1058 1169 13 Report of the Medical Officer of Health. TABLE XII. Vital Statistics of Whole District during 1919 and previous years. Year. Corrected Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferred Deaths: Nett Deaths Belonging to the District. Under 1 Year of Age. At all Ages. Uncorrected Number. Nett. At all ages. of Nonresidents registered in the District. of Residents not registered in the District. Number. Rate per 1000 Births registered. Number. Rate. Number. Rate. Number. Rate. I 2 3 4 5 6 7 8 9 10 11 12 13 1909 290,462 6,924 6,985 24.04 3,279 11.08 656 897 601 86 3.520 12.11 1910 299,061 6,873 6,967 23.29 2,856 9.38 564 812 545 78 3,105 10.38 1911 308,I56 6,555 6,699 21.73 3,456 11.02 669 989 823 122 3,776 12.25 1912 313,761 6,580 6,756 21.53 3,118 9.78 767 940 516 76 3,291 10.48 1013 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 3,547 11.81 1,067 1,339 440 89 3,819 12.69 1918 292,418 4,453 4,685 14.29 4,202 14.37 1,300 1,511 417 89 4,407 15.07 Average for 10 yrs. 309,533 6,170 6,317 20.40 3,465 11.05 876 1,113 551 87 3,703 11.96 1919 331,759 5,476 5,441 17.00 3,552 10.42 1,025 1,225 359 66 3,752 11.31 14 Report of the Medical Officer of Health. TABLE XIII. Infant Mortality. 1919. Nett Deaths from stated causes at various Ages under 1 Year of Age. Cause of Death. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months 3 Months and under 6 Months 6 Months and under 9 Months 9 Months and under 12 Months. Total Deaths under 1 year. All Causes- Certified 115 31 27 14 187 66 42 35 28 358 Uncertified 1 ... ... ... 1 ... ... ... ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 3 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... 1 ... 1 2 ... ... 2 5 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... 2 2 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... 2 ... 2 Meningitis (not Tuberculous) ... ... ... ... ... ... 2 2 ... 4 Convulsions 5 3 2 10 2 4 ... 1 17 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis 1 ... 3 ... 4 9 4 6 6 29 Pneumonia (all forms) 3 2 ... 1 6 6 6 9 6 33 Diarrhœa ... ... 2 4 6 3 4 3 ... 16 Enteritis 2 1 1 1 5 7 4 4 1 21 Gastritis ... 1 1 1 3 1 2 ... 1 7 Syphilis ... ... ... ... ... 3 1 1 ... 5 Rickets ... ... ... ... ... ... ... ... 1 1 Suffocation, overlying ... ... ... ... ... 2 ... ... ... 2 Injury at birth 6 1 ... ... 7 ... ... ... ... 7 Atelectasis 7 1 1 ... 9 ... ... ... ... 9 Congenital Malformations 5 4 1 ... 10 6 2 ... ... 18 Premature birth 69 7 12 4 92 4 I 1 ... 98 Atrophy, Debility and Marasmus 9 9 1 ... 19 17 8 1 ... 45 Other Causes 9 2 2 3 16 4 4 6 5 35 Totals 116 31 27 14 188 66 42 35 28 359 Nett Births in the year, legitimate, 5,328; illegitimate, 203. Nett Deaths in the year of legitimate infants, 323; illegitimate infants, 36. 15 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 ten previous years for each sub-district and for the whole Borough, compared with the decennial average. TABLE XIV. Sub-District. No. of Deaths under one year. Percentage to total Deaths. Rate per 1,000 Births. 1909. 1910. 1911. 1912. 1913. 1914. 1915. 1916. 1917. 1918. Average 10 years. 1919. Clapham 61 8.12 83 67 119 76 82 76 92 70 74 107 84 65 Putney 41 11.85 86 81 145 69 85 87 78 74 83 97 88 112 Streatham. 95 7.64 73 64 99 58 74 86 76 66 73 71 74 58 Tooting 43 12.21 98 92 116 100 91 114 104 109 110 99 103 58 Wandsworth 119 11. 24 89 89 143 83 103 84 104 92 104 90 98 68 Whole Borough 359 9.56 86 78 122 76 88 88 92 78 89 89 86 66 16 Report of the Medical Officer of Health. The Infantile Mortality for the year is much under that in 1918. This is the lowest infantile mortality ever recorded in the Borough. With the exception of Putney, all the rates are much under the decennial average. The high rate in Putney was due to the comparatively large number of deaths from premature birth and congenital debility, 25 out of the 41 deaths having been due to these causes. Perseverance in ante-natal work in this area is the chief remedy, and steps have been taken to ensure that prospective mothers in the small area in which the deaths occurred are visited and advised to attend the ante-natal clinic. Another reason for the high mortality in Putney is that very few births occurred among the well-to-do, due almost wholly to war conditions. The mortality among this class is always very low, and as a consequence the general infantile mortality is unduly raised. Tooting, on the other hand, shows an exceptionally low mortality compared with the average for the previous 10 years. The following Table shows the percentage of deaths at different age periods to the total infantile mortality for the year and for the five previous years. It will be noted that there has been a large increase in the percentage under four weeks compared with the five years' average, and a slight increase at three to six months, while at the other age periods the rate was lower. Report of the Medical Officer of Health. 17 TABLE XV. 1914. 1915. 1916. 1917. 1918. Five years average. 1919. Rate per 1,000 births 88 92 78 89 89 87 66 Percentage of above:— Under one week 24.6 21.7 24.0 19.1 22.7 22.6 32.3 1 and under 2 weeks 5.6 5.1 8.0 6.3 3.6 5. 7 8.6 2 and under 3 weeks 4.8 3. 7 3.4 4.3 3.8 4.0 7.5 3 and under 4 weeks 3.0 4.4 4.1 3.8 2.6 3.5 3.9 Under 4 weeks 38.0 34.9 39.5 33.5 32. 6 35.8 52.3 From 4 to 13 weeks 16.0 14.0 15.4 17.7 18.5 16.3 18.3 From 3 to 6 months 20.7 16.3 20.3 18.4 19.5 19.0 11.8 From 6 to 9 months 14.5 18.0 13.1 11.4 17.4 14.8 9.8 From 9 to 12 months 10.8 16.8 11.7 19.0 12.0 14.1 7.8 Under 12 months 100.0 100.0 100.0 100.0 100.0 100.0 100.0 The infantile mortality among legitimate infants was 61 per 1,000 legitimate births, and among illegitimate infants 177 per 1,000 illegitimate births, or nearly three times as great. 18 Report of the Medical Officer of Health. INFECTIVE DISEASES. The next Table shows the number of deaths from these diseases during the year and for the 10 previous years. The number above or below the corrected decennial average is also shown. TABLE XVI. 1909. I9I0. 1911. 1912. I9I3. 1914. I9I5. 1916. 1917. 1918. 1919. 1919. No. above corrected average. No. below corrected average. Small-pox - - - - - - - - - - - - - Scarlet Fever 14 12 10 11 11 13 22 5 13 3 7 - 5 Diphtheria 29 16 34 18 18 41 53 55 37 35 41 6 - Typhus Fever - -' - - - — — — - — — —. — Enteric Fever 6 8 9 8 5 5 6 5 7 5 2 — 5 Cont'd Fever 1 3 - - - - - - - - - - - Puerpl. Fever 10 5 8 11 13 9 4 9 6 8 16 7.2 — Cholera - - - - - - - - - - - - —. Erysipelas 8 4 10 5 6 11 9 5 6 7 1 - 6. 6 Measles 108 44 230 51 116 26 152 22 129 45 18 - 82 Whooping C. 67 68 66 57 23 53 66 49 29 58 15 - 42 Influenza 89 5.5 24 45 59 58 90 74 56 834 310 162 - Diarrhoea 120 88 350 85 168 186 125 95 78 96 58 — 90 Tuberculous Diseases 362 351 389 366 355 389 434 396 424 455 342 — 78 Cerebro-spinal Fever — 3 3 1 1 1 20 16 ii 8 9 2.2 — Other Infective Diseases 14 10 21 27 22 32 20 19 21 18 12 - 9.8 Totals 828 667 1154 685 797 824 1001 750 817 1572 831 - 142 The total number of deaths from these diseases Was 831, 158 in Clapham, 82 in Putney. 263 in Streatham, 86 in Tooting, and 232 in Wandsworth. From all infective diseases the death-rate was 2.50 per 1,000, (2.65 in Clapham, 2.86 in Putney, 2.55 in Streatham, 2.48 in Tooting and 2.32 in Wandsworth). Report of the Medical Officer of Health. 19 The rate is much lower than in 1918, owing to the diminution in the number of deaths from Influenza and Pulmonary Tuberculosis. The rate in 1914 was 2.21; in 1915, 3.01; in 1916, 2.36; in 1917, 271; and in 1918, 5.37 per 1,000. The rate from the principal infective diseases, viz.:—Small-pox Measles, Scarlet Fever, Whooping Cough.. Diphtheria, Enteric Fever, and Diarrhoea, was .42 per 1,000 (.42 in Clapham, .59 in Putney, .38 in Streatham, .46 in Tooting, and .41 in Wandsworth), compared with .99 in 1914, 1.24 in 1915, .74 in 1916, .94 in 1917, and .82 in 1918. The rate for 1919 is much the lowest on record. Scarlet Fever. The total number of deaths was seven, and the death-rate per 1,000 .02. The case mortality was .08 per cent. Diphtheria. The total number of deaths was 41 (nine in Clapham, two in Putney, 12 in Streatham, six in Tooting, and 12 in Wandsworth), and the death-rate per 1,000 was .12. The case mortality was 7.8 per cent. Enteric Fever. The number of deaths was two, the death-rate was .006 per 1,000, and the case mortality 11 per cent. The [number of deaths from this disease is the lowest on record. 2c Report of the Medical Officer of Health. Cerebro-spinal Meningitis. Nine deaths occurred from this disease (one in Clapham, one in Putney, two in Streatham, one in Tooting, and four in Wandsworth). 13 deaths were registered as having been caused by Meningitis (six in Clapham, two in Putney, two in Streatham, two in Tooting, and one in Wandsworth). Four of these were of infants under one year, one from two and under five years, and eight over five years of age. As in previous years, inquiries were made from the medical attendant, and in all the cases, with the exception of one that died from Posterior-basic Meningitis, the deaths were stated to have been caused by Simple Meningitis. Encephalitis Lethargica. Five deaths occurred (three in Clapham, one in Streatham, and one in Wandsworth). Two of the deaths were of persons from 15 and under 25 years, one from 25 and under 45 years, and two from 45 and under 65 years. Puerperal Fever. 16 deaths occurred from this disease (one in Clapham, one in Putney, five in Streatham, two in Tooting, and seven in Wandsworth). The death-rate was .05 per 1,000, and the case mortality 57 per cent. Erysipelas. Only one death occurred from this disease during the year. Report of the Medical Officer of Health. 21 Measles. 18 deaths occurred (three in Clapham, eight in Streatham, four in Tooting, and three in Wandsworth). Three of the deaths were of infants under one year of age, six from one and under two years, seven from two and under five years, and two from five and under 15 years. The death-rate per 1,000 of population was .05. Whooping Cough. 15 deaths (four in Clapham, four in Putney, three in Streatham. one in Tooting, and three in Wandsworth) occurred during the year, Five of these were of infants under one year of age, six from one and under two years, three from two and under five years, and one from five and under 15 years. The death-rate was .04 per 1.000. Epidemic Influenza. 310 deaths (74 in Clapham, 27 in Putney, 103 in Streatham, 35 in Tooting, and 71 in Wandsworth) occurred during the year. The death-rate was .93 per 1,000, and the number of deaths represents 8.2 per cent, of the total mortality from all causes, compared with 19 per cent, in the previous year. The following Table shows the total deaths from Influenza and Pneumonia in the various Parishes of the Borough during the year, and in detail for the first four months of the year. 22 Report of the Medical Officer of Health. TABLE XVII. Clapham. Putney. Streatham. Tooting. Wandsworth. Total. Grand total. Infl. Pneu. Infl. Pneu. Infl.. Pneu. Infl. Pneu. Infl. Pneu. Infl. Pneu. 1919. 1st to 4th January 1 - 1 1 2 — - — — 2 4 3 7 Week ended— 11th January 2 1 - - - - - - 1 1 3 2 5 18th „ 1 - - - - - - - - - 1 2 3 25th ,, — 2 — — 1 — - - 1 - 2 2 4 1st February 1 - - - 1 2 - - 1 1 3 3 6 8th ,, 4 3 — 1 5 1 - - 1 3 10 8 18 15th ,, 8 3 3 - 6 3 3 1 6 3 26 10 36 22nd ,, 12 8 2 4 20 2 2 5 15 4 51 23 74 1st Mar:h 13 2 6 3 16 5 7 - 14 3 56 13 69 8th „ 10 3 5 1 22 3 9 1 14 2 60 10 70 15th „ 4 1 3 2 10 1 6 1 6 2 29 7 36 22nd ,, 3 1 3 — 8 1 1 1 3 2 18 5 23 29th ,, 2 2 — — 1 1 1 - - 2 4 5 9 5th April 6 — 1 - 1 1 — — — 1 8 2 10 12th „ — — — 2 2 — 4 — 2 — 8 2 10 19th ,, — 1 3 - — - — — 2 1 5 6 26th ,, 1 1 - - - - - 2 1 3 2 6 8 27th April to 31st December 6 18 2 8 8 26 2 17 6 25 24 94 118 Total 74 45 27 25. 103 48 35 28 71 56 310 202 512 Report of the Medical Officer of Health. 23 The following Table shows the sex and ages at which death from Influenza in the various Sub-districts in the Borough occurred. TABLE XVIII. Under year. 1-2 yrs. 2-5 yrs. 5-15 yrs. 5-25 yrs. 5-45 yrs. 15-65 yrs. 65 and over. Total. Clapham— Males — 1 - 1 4 7 13 5 31 Females — 1 1 2 3 16 12 8 43 Putney— Males - — — 1 1 4 7 — 13 Females 7 3 4 14 Streatham— Males 5 1 1 1 3 18 12 5 46 Females — — 2 2 4 30 10 9 57 Tooting Males 3 — 2 1 3 3 4 - 16 Females - — 2 1 2 10 2 2 19 Wandsworth— Males - 1 4 - 4 13 12 1 35 Females - 1 - 1 6 12 11 5 36 Total- Males 8 3 7 4 15 45 48 11 141 Females — 2 5 6 15 75 38 28 169 Grand Total — 8 5 12 10 3° 120 86 39 310 In Institutions in the Borough during the year 82 deaths occurred, compared with 143 in 1918. Seven of these were in the Springfield Mental Hospital, 12 in the Tooting Mental Hospital, 30 in Military hospitals, five in the Workhouse, three in Putney Hospital, and 25 in other institutions. 70 of the deaths, 34 of males and 36 of females, occurred in institutions outside the Borough. 56 of these deaths occurred in Poor Law Infirmaries, 13 in General and Special Hospitals, and one in another institution. Diarrhoea. 58 deaths, 39 of males and 19 of females, occurred from all forms of Diarrhoea and Enteritis during the year. Six of the deaths occurred in Clapham, 11 in Putney, 15 in Streatham, seven in Tooting, and 19 in Wandsworth). There was a decrease in all the sub-districts, except Putney, compared with 1918. The number of deaths is 90 below the corrected decennial average. 24 Report of the Medical Officer of Health. The death-rate was .17 per 1,000 (in Clapham .11, in Putney .38, in Streatham 1.4, in Tooting .18, and in Wandsworth .19), compared with .32 in 1918. Of the total number of deaths from Diarrhoea registered,. 37, or 63 per cent., were of infants under one year, and 44, or 76 per cent., of children under two years of age. The number of deaths from Diarrhoea, Zymotic Enteritis, and Enteritis under one year, represents 10.3 per cent, of the total mortality at that age. Tuberculous Diseases. The total number of deaths from diseases of a Tuberculous nature was 342. 288 of the deaths were due to Pulmonary Tuberculosis, 24 to Tuberculous disease of the Brain and 30 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 XIX. Sub-District. Pulmonary Tuberculosis. Other Tuberculous Diseases. Total. No. of Deaths. Rate. No. of Deaths. Rate. No. of Deaths.  Clapham 52 87 5 .08 57 .95 Putney 30 1.05 5 .17 35 1.22 Streatham 97 .92 14 13 111 105 Tooting 32 .82 5 .13 37 .95 Wandsworth 77 .77 25 .25 102 1.02 Whole borough 288 .87 54 .16 342 1.03 Report of the Medical Officer of Health. 25 It is satisfactory to note that the rate from Pulmonary Tuberculosis was only .87 per 1,000, compared with 1.22 in the previous year, and .98, the average for the previous 10 years. There has been a considerable reduction in the mortality in Clapham, Tooting, and Wandsworth compared with the decennial average, but an increase in Putney and Streatham. The following Table shows the death-rate per 100,000 from Pulmonary Tuberculosis in the whole Borough and for the separate sub-districts for the year, as well as for the preceding 10 years. TABLE XX. 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 Average for 10 yrs. 1919 Clapham 104 84 118 116 93 93 97 l05 107 112 102 87 Putney 116 85 70 97 55 78 109 99 92 128 92 105 Streatham ... 60 65 85 73 76 71 83 90 102 115 82 92 Tooting no IO9 81 87 69 87 123 103 120 171 106 82 Wandsworth... 109 IO8 88 112 109 122 103 114 129 126 112 77 Whole t orough 94 88 91 96 88 93 99 102 112 122 98 87 The rate for 1919 is the lowest on record. Other Infective Diseases. 12 deaths occurred (one in Putney, two in Streatham, three in Tooting, and six in Wandsworth). Five were under one year of age, one from 15 and under 25 years, three from 25 and under 45 years, and three from 45 and under 65 years of age. Eight of the deaths were due to Syphilis, three to Septicaemia, and one to Pyaemia. Acute Polio-myelitis. Two deaths occurred during the year. A5202 c 26 Report of the Medical Officer of Health. NON-INFECTIVE DISEASES. Cancer. The total number of deaths from Cancer and other malignant diseases was 399, 147 of males and 252 of females. 75 of these occurred in Clapham, 38 in Putney, 148 in Streatham, 27 in Tooting, and III in Wandsworth. The corrected death-rate was 1.20 per 1,000, and for the Subdistricts as follows:—Clapham 1.26, Putney 1.32, Streatham 1.41, Tooting .70, and Wandsworth 1.14. One of the deaths occurred under one year of age, one from two and under five years, one from five and under 15 years, two at 15 and under 25 years, 39 at 25 and under 45 years, 179 at 45 and under 65 years, and 176 over 65 years. The number of deaths is 24 above last year, but is 16 under the corrected decennial average. Diseases of the Brain and Nervous System. From these diseases 352 deaths occurred, 8r in Clapham, 28 in Putney, 130 in Streatham, 27 in Tooting, and 86 in Wandsworth. 13 of the deaths were due to Meningitis, 186 to Cerebral Haemorrhage or Apoplexy, 22 to Convulsions, eight to Softening of the Brain, 24 to Paralysis, 16 to General Paralysis of the Insane, 11 to Locomotor Ataxy, 17 to Epilepsy, and 55 to other diseases of the Nervous System. * Circulatory Diseases. From the above group of diseases, 601 deaths occurred, 489 of which, 212 males and 277 females, were due to Organic disease of the Heart. 108 of these deaths occurred in Clapham, 51 in Putney, 227 in Streatham, 47 in Tooting, and 168 in Wandsworth. 380 of the deaths were of persons over 65 years of age. Report of the Medical Officer of Health. 27 Respiratory Diseases. The total number of deaths was 627, 137 in Clapham, 54 in Putney, 170 in Streatham, 71 in Tooting, and 195 in Wandsworth. 387 of the deaths occurred from Bronchitis, 34 from Lobar Pneumonia, 85 from Lobular or Broncho-Pneumonia, 84 from Pneumonia in which the exact form was not distinguished, and 37 from other diseases of the Respiratory Organs. 63 of the deaths were of infants under one year, 29 from one and under two years, 12 from two and under five years, 18 from five and under 15 years, 12 from 15 and under 25 years, 40 from 25 and under 45 years, 142 from 45 and under 65 years, and 311 over 65 years. The number of deaths is 59 under last year, and 26 under the corrected decennial average. Deaths from other Causes. From Appendicitis and Typhlitis 16 deaths, nine of males and seven of females, occurred. From Alcoholism, Acute and Chronic, one death, a male occurred; and 12, nine of males and three of females, from Cirrhosis of the Liver. From Nephritis and Bright's disease 114 deaths occurred, 70 of males and 44 of females. From Accidents and diseases of Pregnancy and Child Birth seven deaths occurred. This, added to the number of deaths from Puerperal Fever—viz., 16—gives a total of 23 deaths after child birth, or a proportion of 4.2 per 1,000 births. Diabetes Mellitus was the cause of 25 deaths, 13 of males and 12 of females. A 5202 c 2 28 Report of the Medical Officer of Health. Premature Birth and Developmental Diseases. 192 deaths, 108 of males and 84 of females, were registered as having occurred from these diseases. 98 of the deaths were due to Premature Birth, 71 to Developmental diseases and 23 from other diseases of Early Infancy. 187 were of infants under one year, three from one and under two years, and two over two years. The number of deaths is 13 above last year, but is 56 under the corrected decennial average. The number of deaths from these diseases in the Borough is shown more in detail in an earlier part of this Report in Table XIII., which deals with Infantile Mortality. Old Age. 232 deaths, 80 of males and 152 of females, occurred from Old Age, 63 in Clapham, 18 in Putney, 72 in Streatham, 10 in Tooting, and 69 in Wandsworth. All the deaths except one were of persons ov er 65 years of age. Violence. 111 deaths, 69 of males and 42 of females, occurred from Violence, 87 of the deaths being due to Accidental, and 20 to Suicidal causes, while four deaths were caused by other forms of Violence. 15 of the deaths belonged to Clapham, eight to Putney, 43 to Streatham, 13 to Tooting, and 32 to Wandsworth. Inquests. The next Table shows the number of Inquests heid in the Borough during the year, and Table XXII. the number of-inquests held outside the Borough of persons belonging thereto. Report oj the Medical Officer of Health. 29 TABLE XXI. INQUESTS. Sub-Districts. Whole Borough. Clapham. Putney. Streatham j Tooting. Wandsworth Deaths from Natural Causes 11 16 13 15 36 91 Accidental:— Falls 1 - 3 6 - 10 Run over by motor vehicles ... 1 3 2 — 1 7 Burns i 1 1 1 - 4 Suffocation by obstruction in throat - - 1 1 1 3 Dr wning 1 — — — 1 2 Scalds — — 1 — 1 2 Suffocated in bed with parents - - 1 — 1 2 Fall down stairs - - — — 2 2 Thrown from bicycle — 1 1 Kicked by horse - 1 - - - 1 Poisoning by Spirits of Salts - — 1 — — 1 Fall from window - - 1 — — i Fall from omnibus - - - — 1 1 Crushed by truck - — — 1 - 1 Poisoning by Strychnine - — — - 1 1 Suicidal;- Hanging - - 3 1 4 8 Poisoning by Coal Gas - - 2 2 Poisoning by Spirits of Salts - 1 - - 1 2 Poisoning by Chlorodyne - — 1 - - 1 Drowning - 1 — — — 1 Gun shot wounds - - — 1 — 1 Struck by train - - — — 1 1 Cut throat 1 1 Open Verdicts :— Found drowned 1 1 — — — 2 Murder — — — — 1 1 Totals 16 25 30 26 53 150 30 Report of the Medical Officer of Health. TABLE XXII. INQUESTS. Sub-Districts. Whole Borough. Clapham. Putney. Streatham. Tooting. Wandsworth Deaths from Natural Causes 3 1 7 5 9 25 Accidental:— Run over by motor vehicles 3 — 8 1 1 13 Falls 1 - 8 - 1 10 Drowning 2 i 2 2 2 9 Burns 1 1 4 1 1 8 Knocked down by train 1 - 1 - 1 3 Fall from motor omnibus - - — 1 1 2 Fall from scaffold 2 - - - - 2 Crushed by falling wheel - - - 1 - 1 Overdose of Tincture of Opium - - 1 - - 1 Crushed by railway engine 1 - — - - 1 Crushed by falling joist - - — - 1 1 Run over by horse vehicle - - — - 1 1 Shock from electric cable - - — - 1 1 Choked by piece of bread - - — - 1 1 Struck by tram car - - - - 1 1 Suicidal;- Drowning 2 - 1 - 2 5 Cut throat 1 1 1 1 - 4 Fall from roof - - 1 - - 1 Set fire to clothing - - i - - 1 Manslaughter — — — — 1 1 Misadventure:— Poisoning by berries of the Deadly Nightshade - - - - 1 1 Totals 17 4 35 12 25 93 Report oj the Medical Officer of Health. 31 Mortuaries. The Mortuaries in Clapham, Streatham 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, 14 bodies were removed to the Mortuary, in Streatham 1 r, and in Wandsworth 124—of which 39 were from Wandsworth, 18 from Putney, 27 from Tooting, 40 from Battersea -—a total of 149. The new mortuary in Wandsworth is now in course of erection. Amount of Poor Law Relief. The Clerk to the Board of Guardians has kindly given me the following information with reference to the above :— (1) No. of admissions to the Poor Law Institutions 2,591 (2) No. of medical orders given 1,432 (3) No. of cases in receipt of outdoor relief 426 (4) Amount of outdoor relief given .. .. .. £7,411 The total number of deaths in Poor Law Institutions was 773, or 20.5 per cent, of the total deaths. Of these, only 19 deaths occurred in Poor Law Institutions in the Borough, and 754 outside the Borough. The Extent to which Hospital and other Forms of Gratuitous Medical Relief are Utilised. This can at present only be given as far as the number of deaths is concerned, as this Department has no means of ascertaining the number of cases from the Borough treated by such institutions. The following Table shows the various institutions in which deaths occurred during the year and the number of deaths in each. 32 Report of the Medical Officer of Health TABLE XXIII. I.—Institutions outside the District receiving sick and infirm persons from the District. II.—institutions in the District, the deaths in which have been distributed among the several localities in the District. Name of Institution. No. of Deaths. Name of Institution. No. of Deaths. Name of Institution. No. of Deaths. Poor Law Hospitals and Infirmaries— Other Hospitals—(continued). Poor Law Hospitals and Infirmaries— Wandsworth Union Infirmaries 630 Queen Charlotte Hospital 2 Springfield Mental Hospital ... 2 Banstead Mental Hospital 15 Queen Mary Hospital 2 The Workhouse 11 Cane Hill Mental Hospital 12 Royal Free Hospital 2 Tooting Bee Mental Hospital 7 Caterham Mental Hospital ... 9 Royal Waterloo Hospital 5 Chelsea Infirmary 2 St. Bartholomew's Hospital 9 Claybury Mental Hospital 2 St. Columbus Hospital 3 Other Hospitals— Colney Hatch Mental Hospital 5 St. George's Hospital 23 H.M. Prison 3 Croydon Infirmary ... ... 2 St. Joseph's Hospital 2 Hostel of God 8 Darenth Industrial Colony ... 3 St. Luke's House 4 Putney Hospital 11 Dartford Heath Mental Hospital 3 St. Margaret's Hospital 3 South London Hospital for Women 6 Hanwell Mental Hospital 4 St. Mary's Hospital 5 Lambeth Infirmary 2 St. Peter's Hospital 2 Leavesden Mental Hospital ... 5 St. Thomas's Hospital 57 Other Institutions, etc.—. Long Grove Mental Hospital 31 University College Hospital 6 The Priory 1 Manor Mental Hospital 2 Victoria Hospital 9 Military Hospitals 9 Westminster Infirmary 2 West End Hospital 3 Other Places not Public Institutions 14 Westminster Hospital 12 On Street 8 Other Hospitals— Western Hospital 25 River Thames 1 Belgrave Hospital 16 Park Hospital 2 Nursing Homes 63 Bethlem Royal Hospital 3 South Eastern Hospital 7 144 Bolingbroke Hospital 16 South Western Hospital 20 Brompton Hospital 4 Cancer Hospital 8 Other Institutions, etc.— Charing Cross Hospital 10 Camberwell House Asylum ... 8 City of London Mental Hospital 2 Peckham House Mental Hospital 2 Croydon General Hospital 5 Other Institutions 48 Downs Sanatorium 3 Other Places not Public Institutions 82 Evelina Hospital 2 On Railway 1 General Lying-in Hospital 2 On Street 11 Great Ormond Street Hospital 3 River Thames ... 10 Guy's Hospital 12 Private Nursing Homes 17 Infants' Hospital 7 1,225 King's College Hospital / 12 Middlesex Hospital 6 National Hospital 3 Report of the Medical Officer of Health. 33 Closet Accommodation. 95 per cent, of the water closets in use in this Borough are modern London County Council pattern, the other five per cent, being either valve closets or wash-out, with a very small percentage of long hoppers in old properties. Scavenging. The following report has been supplied by the Borough Engineer :— Collection and Disposal of House Refuse. The house refuse is collected under contract. The work is carried out by five contractors, and a weekly collection is provided for in the contracts. The approximate quantity collected for the year ended 31st January, 1920, was 70,732 tons. This is disposed of partly by the contractors, and partly by direct labour at the Council's Destructor, as follows, viz. :— Tons. Barge 33,708 or 4.77 per cent. Rail 15,580 „ 22.0 per cent. Shoots outside Borough 1,944,, 2.7 Per cent. Refuse Destructor 19,500 „ 27.6 per cent. Total 70,732 The above arrangements have proved satisfactory. Earth Closets. As far as I know, there are only four earth closets in the Borough, three at Putney Vale Cemetery, which are cleansed by the Cemetery staff, and one at Keeper's Cottage, Putney Lower Common, cleansed by the occupier. Privies. I am not aware of any in the Borough. 34 Report of the Medical Officer of Health. Ashpits. There are very few ashpits, and these are emptied, and the contents removed by the contractors for the removal of house refuse. Cesspools. I have had enquiries made, and find there are six cesspools in the Borough, provided in connection with the following buildings, viz.:— Royal Hospital for Incurables, Putney. Common Keeper's Cottage, Putney Heath. Ayling's Boat-house, Embankment, Putney. Ranelagh Sailing Club-house, Putney. Gardener's Cottage, Southfield House, Victoria Road, Wimbledon Park. Cottage at junction of Leonard Road and Greyhound Lane, Streatham, and these are periodically emptied by the owners or occupiers of the premises. SANITARY INSPECTION OF DISTRICT. During the year 1,258 inspections have been made by myself under the Housing Acts and the Public Health Act, 74 inspections were made for other purposes, 31 visits were paid to the Infant Welfare Centres, and my attendance was necessary on seven occasions at the Police Court. The Tables which follow show (1) the total number of houses inspected ; (2) the defects or nuisances discovered ; (3) number of intimation notices served; (4) number of intimation notices complied with; (5) number of statutory notices served; (6) number of statutory notices complied with. 35 Report of the Medical Officer of Health. TABLE XXIV. Summary of Sanitary Operations in the Borough during the Year 1919. Clapham. Putney. Streatham Tooting. Wandsworth. Borough. "North Ward. South Ward. Streatliam Ward. Halham Ward. South field Ward. Fairfield Ward. Sprig field Ward. Number of complaints received and attended to 683 304 491 551 635 835 478 3>2 646 4935 Number of houses and premises inspected 4449 2521 3588 6069 5912 5339 4238 2443 4708 39267 Number of houses and premises re-inspected 2499 1618 2994 3062 4218 2930 2047 1499 2406 23273 Number of house - to - house inspections 255 90 292 217 460 266 332 250 300 2462 Number of preliminary notices served 623 369 821 894 1280 805 817 696 1037 7342 Ditto complied with *. 571 309 772 794 1041 752 800 571 988 6598 Number of statutory notices served 70 27 69 57 210 30 78 26 211 778 Ditto complied with 70 20 68 51 197 30 78 24 211 749 Notices served for periodical removal of manure. 1 ... ... 1 ... ... 3 ... ... 5 Number of rooms disinfected after infective diseases 427 265 233 833 770 907 339 300 546 4620 Bedding stoved 210 160 147 273 242 229 191 140 215 1807 Overcrowding abated 3 ... 4 3 7 3 2 1 4 27 Rooms cleansed and repaired 821 84 1075 982 2525 1135 757 652 1321 9352 Staircases cleansed and repaired 129 16 214 262 195 175 109 122 227 1449 Drains cleansed and repaired 87 51 92 159 128 138 36 29 99 819 Drains tested 363 127 187 455 343 274 489 163 370 2771 Drains found defective 14 11 8 84 43 86 12 11 72 341 Traps fixed to drains 38 31 23 27 30 21 8 3 ... 181 Bath, lavatory and sink wastes altered to discharge outside over gullies or repaired 33 15 81 42 44 50 24 25 76 390 Rain water pipes disconnected from drains 9 1 8 ... 3 2 ... 1 11 35 Water closets cleansed and repaired 65 54 329 269 519 206 215 124 261 2042 Water closets, separate supply of water laid on to ... ... ... ... ... ... ... 1 ... 1 Accumulations of manure, etc., removed 15 11 6 30 29 28 11 11 37 178 Urinals cleansed, repaired or water laid on to 9 ... 11 5 8 3 4 6 5 51 Cesspools abolished ... ... ... ... ... ... ... ... ... ... Ashpits provided or repaired 60 15 105 165 186 92 158 68 193 1042 Dust complaints received 146 85 177 84 148 94 145 78 150 1107 Stables and stables yards drained, paved or cleansed 18 ... 4 20 17 11 9 ... 26 105 Yards drained, paved or cleansed 51 12 129 97 118 103 42 44 197 793 Unwholesome or dilapidated houses cleansed or repaired ... ... 14 4 ... 2 ... 11 ... 31 Leaky roofs and gutters repaired 183 31 260 202 178 146 129 91 211 1431 Damp courses inserted 36 6 123 41 37 19 6 16 26 310 Damp conditions remedied 136 20 176 268 125 117 152 72 140 1206 Houses re-supplied with water 9 1 35 15 17 13 2 2 13 107 Water cisterns cleansed, covered or repaired 38 26 14 62 26 32 21 9 89 317 Animals kept so as to be a nuisance 3 1 3 13 3 6 4 4 38 75 Smoke nuisances reported ... ... ... 1 ... ... ... 1 3 5 Soil pipes repaired 18 2 23 10 21 30 4 5 11 124 Unclassified nuisances 207 32 186 201 118 98 95 96 71 1104 36 Report of the Medical Officer of Health. TABLE XXV. DETAILS OF INSPECTIONS AND RE-INSPECTIONS, 1919. (Male Inspectors.) . Inspections Re-Inspections. Totals. Number of complaints received and attended to 4,909 ... 4.909 Number of house-to-house inspections ... 2,462 ... 2,462 Drainage and other sanitary works after notice 3,718 13,382 17,100 Drainage and other sanitary works voluntary 395 507. 902 Number of premises inspected on account of:— Notifiable diseases 2,889 38 2,927 Measles 1,468 6 1,474 Whooping Cough 261 ... 261 Pulmonary Tuberculosis 76 ... 76 Other Infective Diseases 683 6 689 Verminous conditions 251 10 261 Periodical Inspections:— Houses-let-in-Lodgings 292 505 797 Close! underground rooms ... ... ... Common Lodging Houses 10 4 14 Food-places Work-places Factories 388 133 521 Workshops 695 145 840 Workshops (Domestic) 136 23 159 Workplaces 437 101 538 Outworkers' premises 79 18 97 Bakehouses 279 159 438 Restaurant kitchens 247 7 254 Cowsheds 30 1 31 Piggeries 212 9 221 Dairies and Milkshops 451 49 500 Ice Cream Premises 224 27 251 Slaughterhouses 127 1 128 Places where food is prepared 126 5 131 Offensive trades 54 ... 54 Fried Fish shops 193 4 197 Rag and bone stores 67 1 68 Butchers' shops 316 1 317 Greengrocers' shops 213 1 214 Fishmongers' shops 264 5 269 Public House urinals 214 24 238 Other sanitary conveniences, schools, &c. 80 ... 80 Smoke observations 14 ... 14 Unsound food 236 33 269 Yards of Mews and Stables 445 39 584 Legal proceedings:— (1) Applications and summonses 22 ... 22 (2) Hearings and adjournments 49 ... 49 Other 1,410 49 1,459 Totals 24,322 15,293 39,615 Report of the Medical Officer of Health. 37 [ TABLE XXVI. DETAILS OF INSPECTIONS AND RE-INSPECTIONS, 1919. (Female Inspectors.) Inspections. Re-inspections. Total. Number of complaints received and attended to 26 - 25 Number of premises inspected on account of:- Puerperal Fever - 2 2 Measles - 19 19 Whooping Cough - 10 10 Ophthalmia Neonatorum - 7 7 Diarrhoea - 8 8 Pulmonary Tuberculosis (1) 1,993 242 2,235 Other forms of Tuberculosis 579 34 613 Notification of Births - 162 162 Dressmakers' and Milliners' premises 384 42 426 Laundries— Factory 118 15 133 Workshop 136 61 197 Workplaces 76 13 89 Other Factories 110 4 114 Other Work:hops 113 11 124 Other Workplaces 122 11 133 Domestic Workshops 55 2 57 Outworkers' premises .... 409 50 459 Other 507 22 529 Totals 4,628 715 5,343 33 Report of the Medical Officer of Health. HOUSING, TOWN PLANNING, &c., ACT, 1909. TABLE XXVII. 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 255 209 81.96 13 68 74 166 Clapham, South 90 77 85.55 - 5 40 62 Putney 292 291 99.65 22 37 113 193 Streatham 217 199 91.70 3 22 43 168 Balham 660 431 93.69 55 176 319 352 Tooting 266 236 82.72 17 31 82 219 Southfield 332 267 80.42 6 42 274 135 Fairfield 250 225 90.00 15 48 137 151 Springfield 300 248 82.66 44 51 160 171 Whole Borough 2,662 2,183 88.66 175 480 1,242 1,617 The cases of overcrowding were in Robertson Street, Rashleigh Street and The Polygon, Clapham; in Felsham Road, Bigg's Row, Seymour Row and Isabella Place, Putney; in Calder's Row, Eardley Road, Mill Lane, Laitwood Road, Trinity Road, Zennor Road and Graveney Road, Streatham; in Valnay Street, Tooting Grove and Garratt Lane, Tooting; in Cambourne Road, Ironmill Place, Aslett Street, Guelph Street, Summerstown and Wardley Street, Wandsworth. 43 notices of reconstruction of drains were sent to the Borough Engineer from this Department : 16 in Clapham, five in Putney, and 11 in Streat him, three in Tooting and eight in Wandsworth Report of the Medical Officer of Health. 39 All house-to-house inspections under the Public Health (London) Act, 1891, are carried out as if these were inspections under Section 17 of the Housing Town Planning, etc., Act, 1909, and the results recorded on a special card which was drawn up in 1910, and has been in use since that date. This method has been found to work most satisfactorily. Where nuisances are found notices are served under the Public Health Act, and if the premises are reported by the Sanitary Inspector to be in a bad condition, I make a personal inspection in order to determine if the houses are in such a condition as to be unfit for human habitation. During the year 2,462 house-to-house inspections were made by the Sanitary Inspectors, and of these 728 were reported to be in a bad condition or to require serious structural alterations so as to render them reasonably fit for human habitation. These were all inspected by myself and 62 were reported to the Public Health Committee as unfit for habitation. The following is a list of these premises:— No. cf houses. 31, Aldis Street, Tooting 1 1-6, Back Row, Totterdown 6 1-4, Chesil Place, Balham 4 1-6, Newman's Court, Clapham 6 2, 3 and 4, Pleasant Place, Clapham 3 3 and 4, Little Pleasant Place, Clapham 2 39 and 40, White's Square, Clapham 2 64, 66 and 68, Nelson's Row, Clapham 3 1-12, Clarke's Cottages, Clapham 12 The Old School House, Felsham Road, Putney 1 1-11, Sadler's Buildings, Putney 11 1 and 2, Stewart's Cottages, Putney 2 1, 1a, 2 and 3, Field's Alley, Wandsworth 3 4, 5, 6 and 7, Field's Alley Wandsworth 4 1 and 2, Cooper's Cottages, Wandsworth 2 62 40 Report of the Medical Officer oj Health. 1 he total number of houses where the drains were reconstructed during the year was 77 : 16 in Clapham, 13 in Putney, 18 in Streatham, three in Tooting, and 17 in Wandsworth. During the year 2,771 drains of houses were tested by the Sanitary Inspectors, 490 in Clapham, 187 in Putney, 798 in Streatham, 274 in Tooting, and 1,022 in Wandsworth, and 341 or 12.30 per cent. were found to be defective. Of the 341 found defective, 25 were in Clapham, eight in Putney, 127 in Streatham, 86 in Tooting, and 95 in Wandsworth. A large amount of work has again been carried out to abate nuisances arising from damp conditions. In all, 1,516 premises have been dealt with, 198 in Clapham, 299 in Putney, 471 in Streatham, 136 in Tooting, and 412 in Wandsworth; and in 310 of these, 42 in Clapham, 123 in Putney, 78 in Streatham, 19 in Tooting, and 48 in Wandsworth, damp courses have been inserted. 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. 125 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. Police Court Proceedings. The list which follows shows particulars of Police Court proceedings under the Public Health (London) Act, 1891. The total amount of fines inflicted was £31 13s., and the costs £37 17s. 6d. 4 i Report of the Medical Officer of Health. 4 1 TABLE XXVIII. Premises. Offences. . Result. Fine. Costs. 33, Norroy Road, Putney Nuisances Summons- withdrawn the work having been done - 2/- Kinema, Clapham Contravention of the Influenza Regulations Convicted 100/- 63/- 70, Wardley Street, Wandsworth Nuisances. Contravention of By-laws (yard paving) Summons withdrawn the work having been done - 21/- 23, Thornsett Road, Wandsworth Nuisances Do. - 2/- 2a, Zennor Road, Balham Do. Order made for abatement - 10 /6 Work done - 2/- 24, Wardley Street, Wandsworth Contravention of Bylaws (yard paving) Ordered to pay costs .. - 10/6 26, Wardley Street, Wandsworth Nuisances Do. - 10/6 51a, Summerley Street, Wandsworth Do. Do. - 2/- 181, Brixton Hill Executing sanitary work without notice Do. - 2/- 35 and 41, Brocklebank Road, Wandsworth Nuisances Summons withdrawn, the work having been done - 25/- 25, Kate Street, Balham Nuisances Contravention of Bylaws (yard paving) Convicted 22/- 12/6 Ordered to pay costs... - 42/- 27, Kate Street, Balham Nuisances Convicted 22/- 12/6 36, Whites Square, Clapham Contravention of Bylaws (water closets) Order made for abatement - 42/- Non-compliance with 100/- 21 /- Magistrate's Order - 91, Gaskarth Road, Balham Nuisances Summons withdrawn, the work having been done - 12 /6 15, Colmer Road, Streatham Do. Do. - 2/- 9 and 29, Aslett Street, Wandsworth Do. Summonses dismissed, defendant proved he was not the owner - 40, Engadine Street, Wandsworth Do. Order made for abatement - 21/- 25, 39 and 43, Burr Road, Wandsworth Do. Summonses withdrawn, the work having been done - 6/- 95, Replingham Road, Wandsworth Do. Do. - 2 /- 13, Old Town, Clapham Selling bacon which was unfit for human food Convicted 100/- 63/- 366, Wandsworth Road, Clapham Nuisances Summons withdrawn, the work having been done - 2/- A5202 D 42 Report of the Medical Officer of Health. TABLE XXVIII.—(contd.) Premises. Offences. Result. Fine. Costs. 1, 2 and 3, May Cottages, Putney Nuisances Summons withdrawn, the work having been done - - 11, 12, 13, 16, 17, 18 and 19, Bigg's Row, Putney Do. Do. - 90/- 2, Pentlow Street, Putney Do. Order made for abatement of nuisance - 2/- 4, Pentlow Street, Putney Contravention of Bylaws (yard paving) Convicted 8/- 21- 1-6, Angel Court, Tooting Do. Do. 60/- 15/- 21 and 21a, Daphne Street, Wandsworth Nuisances Order made for abatement - 21/- 33 and 35, Bucharest Road, Wandsworth Do. Do. - 21/- 7a, Daphne Street, Wandsworth Do. Do. - 21 /- 27, Chestnut Grove, Balham Failing to notify case of Ophthalmia Neonatorum Convicted 21/- 105/- 181, BedfordHill, Balham Executing sanitary work without notice Order to pay costs - 10/6 110, Besley Street, Streatham Keeping animals in an unfit place and manner Convicted 200 /- 63/- Underground Rooms. There are now no rooms, as far as is known, which do not comply with the Regulations made by the Council in 1911. It was not necessary to take any action as in former years inspections of these were made and the necessary alterations carried out. FACTORIES AND WORKSHOPS. There has been an increase in the total number of inspections of the above, compared with 1918, and an examination of the Tables will show that a very large amount of work has been carried out , by both the male and female inspectors. Report of the Medical Officer of Health. 43 INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. TABLE XXIX. CLASS OF WORKS. Number of Places Number of Inspections, 1919. Number of Notices. Number of Prosecutions, 1919. On Register at end of 1918. Added in 1919. Removed in 1919. On Register at end of 1919. Intimation, 1919. Statutory, 1919. Under Factory Act. Under Public Health Act. Premises Rooms. Factories Factory Laundries 75 ... ... 75 304 153 7 ... ... ... Factory Bakehouses 45 9 ... 54 74 124 2 ... ... Other Factories 419 48 36 431 1,383 615 80 1 ... 1 Workshops Workshop Laundries 93 3 9 87 268 197 21 ... ... ... Workshop Bakehouses 84 5 7 82 82 314 13 ... ... ... Other Workshops 1,198 123 92 1,229 1,666 1,606 135 3 ... ... Workplaces Places where Food is prepared for Sale 531 29 27 533 583 561 42 1 ... ... Workplaces other than the above 459 47 47 459 651 768 86 3 ... ... Home-workers' premises 391 133 75 449 449 556 47 ... ... ... Total 3,295 397 293 3,399 5,460 4,894 433 8 ... 1 A5202 d 2 44 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 XXX. I.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries.) 892 90 1 Workshops (Including Workshop Laundries.) 2,117 172 ... Workplaces (Other than Outworkers' premises included in Part 3 of this report.) 1,329 132 ... Totals 4,338 394 1 Report of the Medical Officer of Health. 45 TABLE XXXI. 2.—DEFECTS FOUND. Particulars. Number of Defects Number of Prosecutions. Found. Remedied Referred to H.M Inspector. 0) (a) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of Cleanliness 235 231 ... ... Want of Ventilation 3 3 ... ... Overcrowding ... ... ... ... Want of drainage of floors 1 1 ... ... Other nuisances 209 199 ... 1 Sanitary accommodation insufficient 12 12 ... ... unsuitable or defective 110 108 ... ... not separate for sexes 7 7 ... ... 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) 15 15 ... ... Other offences (Excluding offences relating to outwork, which are included in Part 3 of this report.) ... ... ... ... Totals 592 576 ... 1 * 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. 4^ o ' fc o" a f Ci tq C*> •>*. 55- TABLE XXXII. 3.—HOME WORK. NATURE OF WORK • (1) 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. (8) Prosecutions. Sending twice in . the year. Sending once in the year. Pailingto -gv keepori>erw niit inspection of lists. Failing to send lists. (10) 2 Instances. C Notices •S» served. ^ Prosecuw tions. Z Instances. ^ Orders £ ma'de w (S. 110). Prosecutions -(ss.io9,no). Listsf <»> Outworkers! Lists. (5) Outworkers. Con- J Worktractors. men. (3) 1 (4) Contractors. (6) Workmen. (7) Wearing Apparel— (1) Making, &c. ... 80 109 243 7 5 23 23 S3 S3 19 (2) Cleaning and washing 2 2 6 I I 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 Brush making ... Pea picking Feather sorting... Carding, &c., of buttons, &c ... Stuffed Toys Basket making ... ... Totals 84 III _2.?6 8 5 24 23 S3 S3 19 * If an occupier gives out work of more than one of the classes specified in column i, and subdivides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A "footnote should be added to show that this has been done. t The figures required in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarily be even numbers, as there will be two lists for each employer—in some previous returns odd numbers have been inserted. The figures in columns 3 and 4 will usually be (approximately) double of tne 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 repealed. • Report of the Medical Officer of Health. 47 The total number of addresses received from other Councils was 577, and 221 addresses were forwarded to other Councils. The number of addresses received has increased by 36, and the number sent increased by 22. 38 names and addresses were forwarded to this Borough in error, and are not included in the above Table. The number of notices sent to employers during the year was 23, and these had a most satisfactory result. D,uring the year 19 cases of infective diseases, three of Scarlet Fever, three of Diphtheria, 11 of Measles, one of Chicken-pox, one of Whooping-cough and one 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 no of the Factory and Workshop Act. TABLE XXXIII. 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number (1) (2) Important classes ol workshops, such as workshop bakehouses, may be enumerated here. Workshop Bakehouses 82 „ Laundries... 87 Dressmakers' and Milliners'Workshops 196 Bootmakers 105 Smiths 30 Builders 52 Tailors 6l Motor Engineers 26 Other 759 Total number of workshops on Register 1,398 48 Report of the Medical Officer of Health. TABLE XXXIV. 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 17 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 9 Reports (of action taken) sent to H.M. Inspector 8 Other Underground Bakehouses (s. 101):— Certificates granted during the year ... In use at the end of the year 39 Inspection of Sanitary Conveniences. The number of Sanitary Conveniences inspected was 107, 19 in Clapham, 24 in Putney, 24 in Streatham, 11 in Tooting, and 29 in Wandsworth. 238 inspections were made during the year and 16 notices, chiefly for cleansing, were served and complied with; and 225 inspections of Sanitary Conveniences for females were made by the Female Sanitary Inspectors. Canal Boats Act. During the year 10 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. Report of the Medical Officer of Health. 49 Rat Destruction. From October to the end of the year, 209 premises stated to be rat infested were inspected and advice given to the occupiers as to the most efficient means of destroying the rats. 11 pounds of rat poison were distributed with only fair results. The Council has, during the current year, appointed a rat catcher, who has been attached to the Public Health Department and who will devote his whole time to the inspection of infested premises and carry out any necessary work when requested by occupiers. Schools. The sanitary condition and water supply of the schools in this Borough are satisfactory. In the majority of the schools separate waterclosets are used, but there are still a few in which trough closets exist. They were all inspected during the year and found in a satisfactory condition. The water in all the schools is derived from the public supply. There is close co-operation between this Department and the London County Council with regard to the prevention of infectious disease at the public elementary schools. In certain cases during the year where it was observed that the number of cases of infectious diseases was excessive, the attention of the London County Council was at once called to the matter, and the school was inspected by the officials of that Authority and the result of the inspection reported. In schools which are not under the London County Council, if any cases occur the school is visited and the proprietors are advised as to the proper steps to be taken to prevent the spread of the disease. Disinfection has been carried out during the year for various infectious diseases in eight public elementary schools and in four private schools. 50 Report of the Medical Officer of Health. FOOD. Milk Supply. The milk supplied to this Borough has been, during the year, of fair quality, very few complaints having been made with regard to its wholesomeness or purity. The average fat content shown by the samples analysed was 3.49 per cent., compared with 3.35 in 1918. So far as could be ascertained there has been no shortage of milk supplied to the Borough, the supply being equal to the demand. The high price has had the effect of considerably reducing consumption. From available returns it appears that during the six weeks commencing 14th December, 1918, to 18th January, 1919, when milk was sold retail at 10d. per quart, the quantity sold in the Borough was 539,595 gallons, whereas in a similar period, 13th December, 1918, to 17th January, 1920, when milk was retailed at 1s. per quart, the quantity fell to 529,363 gallons, or 10,232 gallons less. There are at present eight cowsheds and 434 milk retailers on the Register, and these have been regularly inspected during the year. Particulars of these are given in Table XXXV. No action has been taken during the year with regard to tuberculous milk, as the London CountyCouncil has dealt with this matter for some years past. Report of the Medical Officer of Health. 51 REPORT ON ADMINISTRATION IN CONNECTION WITH THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. Report for the year ended 31 st December, 1919. I. Milk and cream not sold as "Preserved Cream." (a) Number of samples examined for the presence of a preservative. (b) Number in which a preservative was reported to be present. Milk 827 Nil. Cream 22 1 Nature of preservative in each case in column (b). CREAM. Case No. 566—Cream 0.24 per cent, crystallised boric acid. Nature of preservative in each case in column (b). MILK. Nil. Action taken under the Regulations in regard to each case in column (b). Nil. Vendor was warned. 2, Cream sold as Preserved Cream. Instances in which samples have been submitted for analysis to ascertain if the statement on the label as to preservatives was correct:— (1) Correct statements made 26 (2) Statements incorrect 1 Total 27 \ 52 Report of the Medical Officer of Health. (b) Determinations made of milk-fat in cream sold as Preserved Cream:— (1) Above 35 per cent. 27 (2) Below 35 per cent. 0 Total 27 (c) and (d). In each of the 27 samples procured as Preserved Cream the provisions as to labelling were duly observed, with the exception of Case No. 537, on which the label stated 0 40 per cent. (3) Thickening substances Nil. (4) Other observations Nil. Milk and Food. The Council decided on the nth April, 1918, to supply, under the Milk (Mothers and Children) Order, milk free of cost to necessitous expectant and nursing mothers and to children under five years of age. This scheme came into force on the 1st May, 1918. All applications are investigated, and should the income per head after deducting rent, insurance, and travelling expenses of breadwinner, fall below the scale approved by the Council, viz., 10s. per week, the milk is supplied up to two pints daily for a nursing or expectant mother, 11/2 pints for a child under 18 months, and one pint between the ages of 18 months and five years. Cases in which the average income is slightly over the scale, and there is need for extra milk, are referred to the Medical Officer of Health, who authorises the allowance. During 1919, 393 families were supplied with free milk at a cost to the Borough Council of £914 17s. 3d. Free dinners were also granted to necessitious, expectant and nursing mothers and to children under five years of age on the same scale. The necessity for the supply of free dinners was not found to be very urgent. Eighteen mothers and eight children were so Report of the Medical Officer of Health. 53 helped during the year, arrangements being made with the National Kitchens in each district to provide the dinners at a cost of one shilling per head for mothers and sixpence per head for children. This amounted during the year to £32 11s. The total number of visits paid respecting the supply of milk and of meals amounted to 1,797. Unsound Food. 23 lbs. cod, 12 barrels of herrings, 11 boxes of haddock, 1 box of mackerel, 2 boxes of bloaters, 2 boxes of rock salmon, 637 lbs. of offal, 512 lbs. of rabbit, 8,2621/4 lbs. of bacon, 7053/4 lbs. of beef, 1 case of tripe, 77 lbs. of corned beef, 36 lbs. of veal, 4181/2 lbs. of mutton, 61 fowls, 224 lbs. of apples, 29 barrels of grapes, 46 cases of oranges, 118 boxes of tomatoes, 4,048 lbs. of potatoes, 56 lbs. of currants, 1 bag of peaches, 331 boxes of dates, 140 lbs. of jam, 243 tins of condensed milk, 121/2 lbs. of butter, 34 lbs. of cheese, and 1,255 eggs were condemned, and the usual certificates granted. Most of the bacon, mutton, rabbits, veal and beef was sent to a fat melter in the Borough to be converted into glycerine. The number of certificates granted to traders in respect of the above-mentioned food was 196. Very few complaints were made by the public, as it is now generally known by retailers that application to this office can be made in all cases where they are of opinion that the food is not fit for sale. Proceedings were taken in one case for exposing bacon for sale which was unfit for human food, and the defendant was fined £5, and £3 3s. costs were imposed. Inspection of Premises where Food is prepared for Sale or Sold. During the year 197 inspections have been made of fried fish shops, 317 of butchers' shops, 214 of greengrocers' shops, and 269 of fishmongers' shops, a total of 997. 229 of these inspections were in Clapham, 76 in Putney, 285 in Streatham, 137 in Tooting, and 270 in Wandsworth. 54 Report of the Medical Officer of Health. Inspection of Milkshops, Cowsheds, etc. The following Table shows in concise form the number of milk premises, cowsheds, etc., on the register, the number of inspections, and the number of cases of legal proceedings during the year, as well as other information which it has been thought advisable to group together for the purpose of comparison with other Metropolitan Boroughs. TABLE XXXV. premises. NUMBER OF PLACES Number of inspections, 1919. Number of notices, 1919. Number of prosecutions, 1919. On register at end of 1918. Added in 1919. Removed in 1919. On register at end of 1919. Milk premises 416 36 18 434 500 33 ... Cowsheds 11 ... 3 8 31 ... ... Slaughter-houses 12 ... 1 11 128 ... ... Other offensive trade premises 4 ... ... 4 71 2 ... Ice cream premises 313 11 7 317 251 24 ... Registered houses let in lodgings 292 ... ... 292 797 *a3 ... *b540 ... *a For overcrowding. * b For other conditions. Statement of Work done under the Sale of Food and Drugs Acts. During the year 1,653 samples of foods and drugs were submitted to the Public Analyst for analysis. Of these samples 822 were purchased as test or informal samples, while 831 were purchased officially. Of the 831 official samples submitted for analysis 92, or 11-07 per cent, were reported to be adulterated or not up to standard, Report of the Medical Officer of Health. 55 and of those samples which were purchased informally or as test samples 60, or 7-29 per cent, were found adulterated or not up to standard. The total adulterations reported were 152, or 9-19 per •cent, of the samples submitted. The percentage of milk samples found to be adulterated was 100. In 57 out of the 92 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 £80, and the costs to £52 ios., making a total of £133. The following table shows the number of formal and informal samples taken in each sub-district of the Borough, together with the number taken per 1,000 of population, the number adulterated, and the percentage adulterated to the formal and informal and to the total samples taken. TABLE XXXVI. 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 194 21 10.8 174 6 3.4 368 6.1 27 7.3 Putney 80 14 10.7 101 9 8.9 181 5.9 22 12.0 Streatham 276 23 8.3 253 18 7.1 529 5.0 41 7.7 Tooting 143 17 12.5 150 14 9.3 293 6.9 31 10.5 Wandsworth 138 17 12.3 144 13 9.0 282 2.7 30 10.6 Whole Borough 831 92 11.7 822 60 7.1 1,653 4.6 151 9.1 56 Report of the Medical Officer of Health. Milk and Cream. MILK. 827 samples of milk were procured for analysis during the year. 86 or 10.4 per cent. were reported against as being adulterated or not up to legal standard. 817 samples were purchased officially, of which 82 or 10.0 per cent. were adulterated, and 10 samples purchased informally, of which four, or 40 per cent., were adulterated. 38 samples were found to contain added water, 45 were deficient in milk fat, and three were deficient in milk fat and contained added water. Proceedings were taken in 47 cases, and in 39 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. Four samples of milk were taken on delivery at various Public Institutions situated within the Borough. These samples were genuine. 30 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. Five samples were reported against, and proceedings were taken against the farmers, and convictions obtained. 29 samples of milk were procured during the early morning from wholesale dealers whilst delivering milk to the retailer. One sample was reported against, and proceedings taken against the wholesaler, who pleaded warranty. Six samples of milk were procured on delivery at private houses. These samples were genuine. 57 Report of the Medical Officer of Health. 80 samples of milk have been taken on Sundays, either in the early morning or at mid-day. Twelve or 15 per cent, were reported against as being adulterated. 430 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 43 or 10 per cent, were reported against. In 29 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. Milk and Cream Regulations. Twenty-two samples of cream and 27 of preserved cream were submitted for analysis. One of cream and one of preserved cream were reported against. Butter and Margarine. BUTTER. 335 samples of butter were submitted for analysis during the year, of which 35 or 10.4 per cent. were reported against. MARGARINE. 86 samples of margarine were submitted for analysis, nine of which were reported against. 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. A5202 E 58 Report of the Medical Officer of Health. PREVALENCE AND CONTROL OVER INFECTIOUS DISEASES. Table XXXVII. shows the cases of infectious diseases notified during the year. The total number of cases, less tuberculosis, was 4,984—863 from Clapham, 226 from Putney, 1,528 from Streatham, 1,083 from Tooting, and 1,284 from Wandsworth—compared with 5,315 in 1918. The number appears high, but it includes 2,041 cases of measles, 234 of German measles and 386 of whooping cough. It is also to be noted that during the year under review encephalitis lethargica, influenzal and other forms of primary pneumonia, malaria, dysentery and trench fever, were made notifiable diseases, and these account for 638 of the total notifications received. 59 Report of the Medical Officer of Health. Wandsworth District. TABLE XXXVII. Cases of Infectious Disease notified during the year 1919. No. of Cases Notified. Total Cases Notified in each Locality. Total cases removed to Hospital. Notifiable Disease. 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. Diphtheria (including.Membranous Croup) 525 3 94 312 84 29 3 ... 152 17 159 62 135 427 Erysipelas 143 1 4 16 17 46 48 11 26 3 30 33 51 16 Scarlet Fever 893 1 155 613 84 38 2 ... 190 30 196 175 302 777 Enteric Fever 18 ... ... 2 5 7 4 ... 2 ... 6 4 6 10 Puerperal Fever 28 ... ... ... 7 19 2 ... 3 2 8 3 12 25 Cerebro-spinal Meningitis 13 1 1 6 2 3 ... ... 1 ... 3 1 8 9 Polio-Myelitis 11 ... 2 8 ... ... 1 ... 2 1 2 1 5 7 Ophthalmia Neonatorum 54 54 ... ... ... ... ... ... 17 3 16 2 16 16 Pulmonary Tuberculosis 788 ... 8 66 174 369 150 21 140 53 223 122 250 ... Other forms of Tuberculosis 163 6 24 72 30 20 10 1 25 11 31 20 76 ••• Measles 2,041 46 826 1,120 27 18 4 ... 236 19 828 638 320 28 German Measles 234 7 40 141 26 16 4 ... 43 17 69 26 79 ... Whooping Cough 386 26 157 200 1 2 ... ... 107 75 79 38 87 ... Encephalitis Lethargica 8 ... ... ... 2 3 3 ... 4 ... 2 ... 2 7 Influenzal Pneumonia 198 6 14 26 26 80 35 11 25 21 56 29 67 ... Pneumonia 213 3 36 21 25 50 47 21 34 14 39 28 98 ... Malaria 207 ... ... ... 51 145 11 ... 18 23 32 4 93 12 Dysentery 11 ... ... ... 1 7 3 ... 3 ... 3 2 2 2 Trench Fever 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... Totals 5,935 164 1,361 2,603 562 853 327 65 1,028 290 1,782 1,225 1,610 1,336 A520202 60 Report of the Medical Officer of Health. The number of cases of certain infectious diseases notified for the year and for the previous 10 years is shown on the following Table, as also the number above or below the corrected average. TABLE XXXVIII. 1909. I9I0. 1911. 1912. .1913. 1914. 1915. 1916. 1917. 1918. 1919. 1919. No. above decennial average. No. below decennial average. Scarlet Fever 987 687 869 833 971 1417 1309 690 566 563 893 - 58 Diphtheria 380 284 510 431 43c 55- 723 531 435 487 525 16 - Enteric Fever 68 54 63 73 52 48 50 46 47 38 18 - 41 Puerperal Fever 26 20 24 27 32 3c 11 20 14 16 28 4.5 - Erysipelas 192 182 202 207 204 234 195 157 103 95 143 - 40 Cerebro-spinal Meningitis 4 5 5 3 9 3 47 28 26 21 13 - 3 Polio-Myelitis - - 5 5 13 7 10 7 5 3 11 4.2 -- Ophthalmia Neonatorum - - 34 35 37 51 44 32 29 35 54 14 - Pulmonary Tuberculosis 389 289 514 855 783 7O6 646 590 622 777 788 128 -- Other Forms of Tuberculosis - 1 - - 328 199 234 216 193 218 163 -- 84 Compared with 1918 there has been an increase in the number of cases of scarlet fever, diphtheria, puerperal fever, erysipelas, polio-myelitis, opthalmia neonatorum and pulmonary tuberculosis, and a decrease of enteric fever, cerebro-spinal meningitis and other forms of tuberculosis. Compared with the corrected decennial average there has been an increase in the number of cases of diphtheria, puerperal fever, polio-myelitis, ophthalmia neonatorum and pulmonary tuberculosis, and a decrease of scarlet fever, enteric fever, erysipelas, cerebrospinal meningitis, and other forms of tuberculosis. The number of cases of tuberculosis was unduly increased by the notification of 168 cases among returned and discharged soldiers. 6i Report of the Medical Officer of Health. Scarlet Fever. This disease was slightly more prevalent during the year, compared with 1918, but there was no special outbreak except in one institution in Clapham, where 31 cases occurred. The disease was not recognised as scarlet fever on its first appearance, as the symptoms were indefinite, but on visiting the institution I decided that the cases were definitely scarlet fever and they were at once removed to hospital. No deaths occurred. • There were also series of cases occurring in an institution in Tooting. Forty-eight cases were notified during the year, but here also the disease was of a mild type and no deaths occurred. None of the children in either of these institutions belonged to the Borough, and there were no cases of illness among the general public traceable to these institutional cases. The number of dwellings in each sub-district and the whole Borough in which multiple cases occurred is shown in the following Table:— TABLE XXXIX. Sub-Districts. One case. Two cases. Three cases. Four cases. Five cases and upwards. Total houses invaded. Clapham 116 14 2 1 2* 135 Putney 18 4 I 23 Streatham 138 15 6 ... 2 161 Tooting 91 9 4 ... 2† 106 Wandsworth 223 26 6 1 1 257 Whole Borough 586 68 18 3 7 682 • In Clapham 31 eases occurred in an Institution. †In Tooting 48 cases occurred in an Institution. † In Tooting six cases occurred in one house. Of the 682 houses invaded multiple cases occurred in 96, or 14 07 per cent. 62 Report of the Medical Officer of Health. Of the total cases of scarlet fever, viz.: 893,777, or 87 per cent., were removed to hospital. The greatest number of cases were notified in the last four months of the year. During the preceding eight months the number of cases had been small, but in September the numbers increased rapidly, reaching the maximum in December. Diphtheria. This disease was more prevalent during the year, especially in October, November and December. The number of cases was 38 above the number in 1918, and 16 above the corrected decennial average. Of the 525 cases, 427, or 81 per cent., were removed to hospital. The increase in the number of cases of this disease was general throughout London and as a consequence of this increase and also the fact that hospital accommodation was limited on account of the use of several of the hospitals of the Metropolitan Asylums Board as war hospitals, some difficulty was experienced in having the cases promptly removed. In all cases where delay was experienced a free supply of antitoxin was issued to any medical practitioner on application at the Public Health Department, and during the last three months 68 vials of 4,000 units each were issued. In a number of cases anti-toxin was procured by medical practitioners from other sources. The number of dwellings in each sub-district and the whole Borough in which multiple cases occurred is shown in the next Table. There was no special outbreak during the year. 63 Report of the Medical Officer of Health. TABLE XL. Sub-Districts. One case. Two cases. Three cases. Four cases. Five cases and upwards. Total houses invaded. Clapham 124 11 ... ... 137 Putney 15 1 ... ... ... 16 Streatham 134 5 5 ... ... 144 Tooting 56 3 ... ... ... 59 Wandsworth 124 4 1 ... ... 129 Whole Borough 453 24 8 ... ... 485 Of the 485 houses invaded multiple cases occurred in 32, or 6.59 per cent. Return Cases of Scarlet Fever and Diphtheria. 32 cases of Scarlet Fever occurred after the return of cases from the hospitals of the Metropolitan Asylums, aud there were also five cases of Diphtheria. Nine of the return cases of scarlet fever occurred in Clapham, one in Putney, one in Streatham, one in Tooting, and seven in Wandsworth. In one household in Clapham and one in Streatham four cases occurred after the return of cases from hospital, and in another household in Streatham three further cases occurred after the return of the first case from hospital. Two of the return cases of diphtheria occurred in Clapham, and one in Streatham and two in Tooting. Enteric Fever. Eighteen cases of enteric fever were notified during the year (two from Clapham,. six from Streatham, four from Tooting, and six from Wandsworth). 64 Report of the Medical Officer of Health. Three of the cases on admission to hospital were found not to be suffering from enteric fever. The number of cases is 20 under that of last year, and 41 under the corrected decennial average, and is the lowest on record. 1 There was no connection between these cases and military cases. Cases of Mistaken Diagnosis. In 28 cases, (five of scarlet fever, 16 of diphtheria, three of enteric fever,three of cerebro-spinal fever, and one of polio-myelitis), 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 13 cases of this disease were notified (one in Clapham, three in Streatham, one in Tooting, and eight in Wandsworth). Nine of the cases were removed to hospital. The following Table gives particulars of these cases. 65 Report of the Medical Officer of Health. TABLE XLI. No. of Cases. Date of notification. Name and address of patient. Age. Sex. Date of onset. RESULT OF CASE. HAS BACTERIOLOGICAL EXAMINATION BEEN UNDERTAKEN. Date of death. Recovery with or without permanent paralysis or other disablement. Of material from patient? Result. Of contacts? Result. 1 6/12/19 F. B., Bassingham Road 39 M 26 /11/19 11/12/19 - Yes Few gram, neg.: diplococci found. — — 2 4/11/19 B. B., Streatham Common 21 F 1/11/19 14/11//19 Certified as Tubercular Meng. - Yes C.S. Fluid clear - - 3 18/9/19 I. W., Pretoria Road 13 F 17/8/19 18/9/19 - No — — - 4 15/9/19 F. M., Quarry Road 4½ M 12/9/19 13/9/19 - No — — — 5 8/7/19 G. G., Atheldene Road 8 F 28/8 /19 9/9/19 - Lumbar Puncture, to fluid obtained. - - - 6 8/7/19 I. B., Putney Heath Lane 20 F 3/7/19 8/7/19 - No - - - 7 24/6/19 Mr. R., Galveston Road 37 M 19/6/19 7/7/19 - Yes Positive Wife's throat swabbed Negative 8 24/4/19 D. F., Aslett Street 6½ F 23/4/19 - Recovery. No disablement Yes Positive - - 9 26/3/19 I. D., Poynders Road 6 F 21/3/19 - Very deaf. Well otherwise Yes Diplococcus not found. C.S. fluid contained polymorph nuclear leucocytes ... ... 66 Report of the Medical Officer of Health. TABLE XLI—continued. No. of Cases. Date of notification. Name and address of patient. Age. Sex. Date of onset. RESULT OF CASE. HAS BACTERIOLOGICAL EXAMINATION BEEN UNDERTAKEN Date of death. Recovery with or without permanent paralysis or other disablement. Of material from patient? Result? Of contacts? Result? 10 28/4/19 J. W., Gaskartk Road, Balham, S.W. 12 5 M 26/4/19 28/4/19 — No — — — 11 17/4/19 I. B., Bassingham Road 9 F 6/4/19 27/4/19 Tubercular Meningitis - No - - - 12 24/3/19 A. G., Aldren Road 6/12 M 15/2/19 11/4/19 Post Basic Meningitis - No - - - 13 25/1 /19 L. H., Renmuir Street, Tooting, S.W. 17 26 F 23 /1 /19 2 /2/19 - Yes Meningococcus found in large nos. Husband a soldier, throat swabbed Negative 14 6/1 /19 J.P., Cavendish Road, Clapham 5 /12 F 25/11/18 10/1/19 Notified as Polio-Encephalitis on 30 /12/18 - No - - - 67 Report oj the Medical Officer oj Health. Encephalitis Lethargica. Eight cases were notified, four in Clapham, two in Streatham, and two in Wandsworth. Seven of the cases were removed to hospital. The following Table gives particulars of the cases. TABLE XLII. No. of Cases. Date of notification. Name and address of Patient. Age. Sex. Date of Onset. RESULT OF CASE. Mental condition. Results of Pathological Examinations if made. REMARKS. Date of Death. Recovery with Tremors Athetosis. No after effects. Oscular Paralysis persisting. Permanent Paralysis or Paresis. 1 28/2 /19 E. R., I.eigham Court Road 18 F 24 /2/19 3 /3 /19 - — — — - None made — 2 14/5 /19 F. Y., Clapham Park Rd. 47 M 7/4/19 28/4/19 — — — — — C. S. F. Wasserman —Sagar + + — 3 31/5/19 S. G., High Street, Clapham 55 M 28/5 /19 31/5/19 - - - - - Lumbar Puncture. Fluid clear 4 14 /11 /19 H. H. W., Tranmere Road 19 M 7/11 /19 17/11/19 - - - - - Lumbar Puncture. Fluid clear. P.M. : General Congestion of Meninges 5 5/12/19 C. J., Stapleton Road 33 M 20 /11 /19 — — None None Yes, slight Good — — 6 8/12/19 W. H., Kingswood Road 42 M 25/11 /19 5/12/19 — — — — — — — 7 10/12/19 A.B., Swaby Road 33 M 12/1 /19 - Recovery - - - - Lumbar Puncture, Wasserman—blood blood + - 8 31/12/19 F. O., Salvin Street 12 M 22 /12/19 - Recovery - - - - - - 68 Report of the Medical Officer of Health. Polio-myelitis and Polio-encephalitis. Eleven cases were notified, two in Clapham, one in Putney, two in Streatham, one in Tooting, and five in Wandsworth, and seven of them were removed to hospital. The following Table gives particulars of the cases. TABLE XLIII. No. of Cases. Date of Notification. Name and address of Patient. Age. Sex. RESULT OF CASE. If Lumbar Puncture undertaken. Result. Date of Onset. Date of Death. Recovery with or without Permanent Paralyse or Paresis. POLIO-MYELITIS. 1 2/5/19 V. F., Isis Street 9 F 24/4/19 6/6/19 Tubercular Meningitis No — 2 7/6/19 J. A., Hazelwell Road 3 M 28/5/19 — Patient nearly well. Now left district — — 3 14/8/19 E.M., Westwell Road 11 F 14/8/19 — Still paralysed. Attending St. Thomas's Hospital - - 4 21/10/19 D.T., Wimbledon Park Road 7 M 30/9/l9 - Right leg very weak No — 5 1/10/19 F.w., Aristotle- Road 10 M 26/9/19 4/10/19 — No — 6 7/10/19 I.V, Thornsett Road 13 F 6 wks. ago — Left leg and foot still affected with paralysis - — 7 11/10/19 P.D., Thrale Road 9 F 30-9-19 Admitted into Infirmary, but not yet recovered - - 8 27/10/19 F.G., Ram Square 3 M 9/10/19 Patient progressing favourably - - 9 27/12/19 L. L., Sellincourt Road 8 F 21/12/19 — Recovered - — POLIO-ENCEPHALITIS. - - - 1 10/4/19 C. A., Aristotle Road 47 M 24/1/19 8/2/19 -\ Unknown — 2 6/3/19 L. T., Lavenham Road 9 M ? 27/2/19 Diagnosis indefinite No — 69 Report of the Medical Officer of Health. Erysipelas. 143 cases were notified (26 in Clapham, three in Putney, 30 in Streatham, 33 in Tooting and 51 in Wandsworth). Measles and German Measles. 2,041 cases of measles were notified (236 in Clapham, 19 in Putney, 828 in Streatham, 638 in Tooting and 320 in Wandsworth). Forty-six of the cases were of infants under one year of age, 826 from one and under five years, 1,120 from five and under 15 years, 27 from 15 and under 25 years, 18 from 25 and under 45 years, and four from 45 and under 65 years. Twenty-eight of the cases were removed to the Metropolitan Asylums Board's hospitals on account of insufficient accommodation at home. 234 cases of German Measles were also notified (43 in Clapham, 17 in Putney, 69 in Streatham, 26 in Tooting, and .79 in Wandsworth). Seven of the cases were of infants under one year of age, 40 from one and under five years, 141 from five and under 15 years, 26 from 15 and under 25 years, 16 from 25 and under 45 years, and four from 45 and under 65 years. During the year 1,474 visits were made in cases of these diseases 1871 Clapham, 27 in Putney, 585 in Streatham, 432 in Tooting and 243 in Wandsworth. The total number of premises disinfected was 1,472, (166 in Clapham, 12 in Putney, 592 in Streatham, 470 in Tooting, and 232 in Wandsworth). Table XLIV. shows the number of cases of infectious diseases notified by the teachers of the elementary schools in the Borough. 70 Report of the Medical Officer of Health. TABLE XLIV. Diseases. Sub-Districts. Measles. German Measles. Chicken Pox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Clapham 89 14 87 55 67 24 158 494 Putney •• 2 11 19 43 6 32 113 Streatham 462 17 231 29 170 37 180 1,126 Tooting 351 7 7° 15 133 24 130 730 Wandsworth 135 15 266 44 223 103 2 3 1,009 Borough 1,037 55 665 162 636 194 723 3.472 Whooping Cough. 386 cases were notified (107 in Clapham, 75 in Putney, 79 in Streatham, 38 in Tooting and 87 in Wandsworth). 26 of these were infants under one year of age, 157 from one and under five years, 200 from five and under 15 years, one from 15 and under 25 years, and two from 25 and under 45 years. Disinfection of Schools. During the year 12 schools in the Borough were disinfected on accqunt of cases of infectious disease having occurred among the scholars attending these schools. Influenzal Pneumonia and Acute Primary Pneumonia. On the 7th January the Local Government Board issued an Order making the above diseases notifiable on and after the 1st March. From that date to the end of the year 198 cases of Influenzal Pneumonia were notified, 25 in Clapham, 21 in Putney, 56 in Streatham, 29 in Tooting, and 67 in Wandsworth. 71 Report of the Medical Officer of Health. Six of the cases were of infants under one year, 14 from one and under five years, 26 from five and under 15 years, 26 from 15 and under 25 years, 80 from 25 and under 45 years, 35 from 45 and under 65 years, and 11 over 65 years. 213 notifications of cases of Acute Primary Pneumonia were received (34 in Clapham, 14 in Putney, 39 in Streatham, 28 in Tooting and 98 in Wandsworth). 13 of the cases were infants under one year, 36 from one and under five years, 21 from five and under 15 years, 25 from 15 and under 25 years, 50 from 25 and under 45 years, 47 from 45 and under 65 years, and 21 over 65 years. All the cases were visited, and when requested by the medical attendant or househoulder disinfected by the sanitary staff of the Council. Malaria. 207 cases were notified (18 in Clapham, 23 in Putney, 32 in Streatham, 41 in Tooting, and 93 in Wandsworth). All of the cases but two were males. No case was notified in which the disease was contracted within the Borough. Of 196 cases in which definite information could be obtained 104 contracted the disease in Salonica, 21 in Palestine, 18 in Egypt, 16 in Mesopotamia, 10 in Macedonia, nine in East Africa, nine in India, and seven in other parts. Of the two females, one, a soldier's wife, contracted the disease in India, and the other, a nurse, contracted it in Salonica. Every case notified was visited to ascertain that proper treatment was being given and any cases where the patients were not having proper medical attention were advised to attend at a military or other hospital. There was no spread of infection among the civil population. 72 Report of the Medical Officer of Health. Dysentery. 11 cases were notified (three in Clapham, one in Putney, three in Streatham, two in Tooting, and two in Wandsworth). All the cases were males, and the disease was contracted during Army service in the following war areas: in Egypt three, in Salonica two, in Mesopotamia two, and one each in France, India, Italy, and China. None of the cases was engaged in the preparation of food or drink for human consumption. Trench Fever. One case was notified, a soldier who contracted the disease in France in 1917. The premises were thoroughly inspected and no evidence of vermin could be obtained. Bacteriological Aids to Diagnosis. These have been utilised to a large extent during the year, and a statement of the work carried out is given on page 109. Contacts. Careful inquiry is made with regard to contacts in every case of infectious disease notified, and the necessary action taken. 79 adults had baths after being in contact with cases of Infectious Disease, 70 on account of Scabies, two Puerperal Fever, and three on account of their verminous condition. Arrangements for Isolation. Of the total number of cases of infectious diseases notified, 1,336, or 337 per cent., were removed to the Metropolitan Asylums Board or other isolation hospitals. In all the cases kept at home the isolation was carried out to my satisfaction. Disinfection. The total number of rooms disinfected after the occurrence of cases of infectious disease was 4,620, (692 in Clapham, 233 in Putney, 1,603 in Streatham, 907 in Tooting, and 1,185 in Wandsworth). 73 Report of the Medical Officer of Health. 1,807 lots of bedding were stoved at the Disinfecting Station, comprising the following articles: 951 beds, 1,112 bolsters, 2,940 pillows, 2,070 mattresses, 65 palliasses, 3,444 sheets, 1,964 quilts, 508 cushions, 8,621 articles of clothing, 3,292 blankets, 41 carpets, and 4,292 extra articles, a total of 29,300 articles. Disinfection was also carried out by the Sanitary Staff at premises after non-notifiable diseases, and the sum of £28 11s. 6d. was received for such disinfection. 353 rooms were disinfected with sulphur in consequence of their verminous condition and 19 lots of verminous bedding disinfected. During the year, at the request of the Military Authorities, 9,495 articles of clothing and bedding were disinfected and eight rooms sprayed on account of having been exposed to infection, and 943 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 £1,886 is. 6d. The number of lots of bedding stoved was 1,807. Cost per lot of bedding .. .. .. £1 os. iod. Carrier Cases. Very few carrier cases came to the knowledge of the Department during the year under review, but the usual procedure in the case of Diphtheria was to keep the children at home and periodical swabs were taken until two successive negative results were obtained. Dysentery Carriers. Information was received from the Ministry of Health of 10 cases of chronic carriers of entomseba histolytica. In each case inquiries were made as to whether the patients were engaged in work involving the preparation or handling of food, but in none was this found to be the case. The cases are periodically visited to ascertain their condition. A5202 F 74 Report of the Medical Officer of Health. Notification o! Tuberculous Diseases. The total number of cases of Pulmonary Tuberculosis notified during 1919 was 788 (140 were from Clapham, 53 from Putney, 223 from Streatham, 122 from Tooting, and 250 from Wandsworth). In Table XLV. 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, and the total number of cases still on the Register. TABLE XLV. Year. Cases Reported. Deaths. Removed. Recovered. Cases on Register. 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 Total. 1909 389 109 48 18 26 9 6 4 5 1 1 ... 227 116 15 31 1910 289 ... 77 37 28 7 4 3 3 ... ... ... 159 100 6 24 1911 514 ... ... 113 82 27 22 8 6 2 16 2 278 175 14 46 1912 855 ... ... ... 225 105 48 31 13 8 7 8 445 241 58 111 1913 783 ... ... ... 180 77 41 25 9 5 2 310 230 23 190 [914 706 ... ... .. .. ... 176 88 37 22 12 4 339 185 14 163 1915 646 ... ... ... ... ... ... 199 82 27 20 12 340 133 11 162 1916 590 ... ... ... ... ... ... ... 161 68 37 11 277 108 5 200 1917 622 ... ... ... ... ... ... ... ... 183 76 1 29 59 ... 273 1918 777 ... ... ... ... ... ... ... ... ... 198 67 265 60 1 451 1919 788 ... ... ... ... ... ... ... ... ... ... 158 158 21 ... 609 Total 6,959 109 125 168 361 328 333 374 332 320 372 296 3.118 1.429 147 2,265 With regard to the notification of cases of non-pulmonary Tuberculosis, in all 163 cases were notified (25 from Clapham, 11 from Putney, 31 from Streatham, 20 from Tooting, and 76 from Wandsworth). Table XLVI. 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. 75 Report of the Medical Officer of Health. TABLE XLVI. Number of cases notified. No. of deaths. Localisation of Disease. Total. Males. Females. Under 1 year. 1 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 25. 25 and under 35. 35 and under 45. i 45 and under 55. 55 and under 65. 65 and upwards. Males. Females. Total. Removed. On Register. Brain 21 11 10 2 5 10 3 1 ... ... ... ... ... ... 11 10 21 ... ... Glands, Mediastinal 4 2 2 ... ... 3 1 ... ... ... ... ... ... ... ... ... ... ... 4 Mesenteric 11 4 7 1 3 3 2 ... ... ... 2 ... ... ... 3 3 6 ... 5 Cervical 60 28 32 ... 10 21 14 7 4 2 1 ... ... ... ... ... ... 1 59 Bones and joints 41 21 17 1 5 4 4 9 4 4 3 5 1 1 1 2 3 4 34 Lupus 5 3 2 ... ... 2 ... 3 ... ... ... ... ... ... ... 1 1 ... 4 Larynx 3 3 ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... 3 General Tuberculosis 6 1 5 2 1 1 ... ... ... ... 1 1 ... ... 1 5 6 ... ... Other parts 12 7 5 ... ... 2 1 1 1 4 1 2 ... ... 2 2 4 ... 8 Total 163 83 80 6 24 47 25 21 9 10 10 9 1 1 18 23 41 5 117 A 520 2 f 2 76 Report of the Medical Officer of Health. The next Table shows the number of cases notified, the number which died, removed, and recovered from 1913 to 1919, and the number still remaining on the Register at the end of 1919. ABLE XLV1I. Year. Cases Notified. Deaths. Removed. Recovered Cases on Re gister 1913- 1914. 1915. 1916. 1917. 1918. I919 Total. 1913 328 46 10 5 6 — 1 2 70 90 49 114 • 1914 199 — 68 5 4 — 1 — 78 42 23 55 1915 234 — — 84 7 1 2 2 95 35 22 82 1916 215 — — — 67 5 5 — 77 38 12 88 1917 193 — — — — 63 4 2 63 22 12 90 1918 218 — — — — — 67 6 73 12 7 126 1919 163 ... ... ... ... ... ... 41 41 5 - 117 To tar 1,550 46 78 94 84 69 79 53 503 244 125 672 Table XLVIII. is a summary of notifications during the period from the 1st January to the 31st December, 1919. 77 Report of the Medical Officer of Health. TABLE XLVIII. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from 1st January, 1919, to the 31-t December, 1919. 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 Primary Notifications. Total Notifications (i.e. including Under 1 i 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. cases previously notified by other doctors) Under 5 5 to 10 10 to 15 Total. cases previously notified by other doctors) Poor Law Institutions. Sanatoria. Pulmonary— Males ... 5 16 13 31 49 91 79 62 26 8 380 442 ... ... 1 1 1 45 163 Females ... 1 17 16 36 50 98 95 36 21 11 381 417 ... ... ... ... 2 7i 106 Non-Pulmonary— Males 3 17 24 10 10 4 5 3 4 1 ... 81 87 ... 2 ... 2 2 8 3 Females 3 7 20 r4 10 5 5 7 4 ... 1 76 99 ... 1 ... 1 2 9 3 78 Report of the Medical Officer of Health. The total number of visits made was 2,235 in cases of Pulmonary Tuberculosis, 352 in Clapham, 205 in Putney, 630 in Streatham, 404 in Tooting, and 644 in Wandsworth, and 613 in cases of other forms of Tuberculosis, 98 in Clapham, 44 in Putney, 145 in Streatham, 113 in Tooting, and 213 in Wandsworth. In addition to these visits by the Health Visitor, 3,158 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 20 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 355 premises either after the death or removal of the patient. 63 of the premises disinfected were in Clapham, 23 in Putney, 109 in Streatham, 44 in Tooting, and 116 in Wandsworth. Many eases of tuberculosis are infectious to those who live in intimate and continuous contact with them, though the risk of infection is very small to those occasionally in contact with the disease. To workers who have to visit the homes of the tubercular and to interview the patients themselves, the risk is negligible, but to those who live in the same house, and frequently in the same room, by day and night, it becomes a factor to be reckoned with. Notification of the disease was introduced so that measures could be taken to limit the spread of infection, and also to enable advice to be given to the patient with regard to his treatment, and to improving, as far as he can, the conditions under which he lives. For both these reasons it is essential that the case be notified when the disease is in its early stages. Unfortunately, the reverse frequently occurs, and many unnotified cases are seen at the Dispensaries for the first time when the disease is well established, and in some cases advanced. The following three facts seem to have some bearing on this state of affairs (a) the undoubted difficulty which exists in diagnosing the disease in an early stage, patients being treated for Report of the Medical Officer of Health. 79 some other complaint before the gravity of the case is realised. (b) Those suffering from the disease neglect to seek medical advice till it is well established, thinking, perhaps, that they are suffering from a slight ailment, or fearing lest they should be told by their doctor to give up work. (c) There is a definite type of case, not by any means uncommon, in which the disease comes on suddenly, takes on a very acute course, and rapidly becomes advanced. By the time the illness is recognised as tuberculosis, the case is already advanced, and all hope of benefit from treatment has gone. Dispensary practice shows many cases belonging to one of these categories, and until the importance of early diagnosis and early notification is more fully recognised, and until patients realise the necessity of seeking medical advice sooner, notification cannot produce the best results towardi eliminating tuberculosis. TUBERCULOSIS DISPENSARIES. I have to report a further increase of work in all branches of the work at the Dispensaries during the year, as shown by Table XLIX., which gives the new cases and total attendances at each Dispensary for 1919, and for each year since the scheme was started in 1913. The number of new cases examined was 1,722, 380 more than in 1918, and is the largest increase so far noted, compared with any previous year. The figures show that the work has increased at the Balham Dispensary to a greater extent than at East Hill. Though the former was started as a branch Dispensary, it serves roughly half the area of the Borough, so it is natural that the numbers attending should be nearly as large as at East Hill. 8o Report of the Medical Officer of Health. TABLE XLIX. Number of New Cases and Total Attendances at each Dispensary, for each year from 1913 to 1919, with totals. NEW CASES. 1913 [914 1915 1916 1917 1918 1919 Totals. East Hill, Wandsworth 712 664 43° 623 735 743 994 4901 Old Devonshire Rd., Balham 224 3°7 286 45? 479 599 728 3081 Total 936 971 716 1081 1214 1342 1722 7982 TOTAL ATTENDANCES. [913 1914 1915 1916 1917 1918 1919 Totals. East Hill, Wandsworth 4001 4856 3854 5391 7005 9083 9981 44171 Old Devonshire Rd., Balham 1501 2801 2726 4128 575o 8335 8241 33482 Total 5502 7657 6580 9519 12755 17418 18222 77653 Table L. gives further details of the work during the last three years. Owing to the appointment of a second nurse in September, 1918, the number of home visits made by the nurses has nearly doubled this year. It is very satisfactory to note this increase in a most important aspect of the work. There is a large increase in the clerical work generally, especially in the number of reports made to authorities and to private practitioners in connexion with the treatment of patients, and to cope with this aspect of the work a clerk was appointed in September, 1919. TABLE L. Return showing Detail of other Work Connected with the Dispensaries during the last three years. 1917. 1918. 1919. Visits by nurses at patients' homes 1,482 1,668 3,158 Number of written reports made... 882 1,070 1,871 Cases of difficulty referred to St. Thomas's Hospital 10 7 69 Number of attendances at which complete examinations were made I 2.032 2,215 3.3°8 Report o] the Medical Officer of Health. 81 The total attendances were 18,222, an increase of 804 on 1918. These have not increased to the same extent as the new cases, and while there were 1,157 more attendances of tubercular patients, those of non-tubercular patients were 353 less. In the past, many patients have been kept under treatment for considerable periods complaining of symptoms which were not definitely tuberculous. It has been necessary to curtail this treatment, and these patients are encouraged to attend periodically for re-examination. Those, however, who are strongly suspected of the disease, are still kept under treatment. Many children come up for examination, either on their parents' own initiative, or on the recommendation of doctors and school authorities, and are in need of treatment for conditions generally non-tubercular. These cases are thoroughly examined and many of them are disappointed when told they cannot continue to attend. It is hardly the role of a Tuberculosis Dispensary to treat them, and they are advised to go elsewhere. Many are unable to afford continuous treatment under private practitioners, or to go to hospitals, which are mostly a long way from their homes, and it appears that local clinics are needed for the treatment of numerous minor ailments. With regard to the definite cases of the disease, many of them are still under treatment at the Dispensaries, while those who have their own medical attendants are treated by them and attend from time to time for re-examination. In this way the Dispensaries act, as they should do, largely as centres for diagnosis and for determining the form of treatment best suited for each individual case, and less as centres for treatment. The tuberculous patient spends most of his life at home, and not in an institution, and in nearly every case domiciliary treatment can equally well be carried out by the patient's private Doctor as at a Dispensary. Two classes of case should be treated at Dispensaries, viz. :— (i) Those who have no regular doctor of their own, i.e., the large majority of the non-insured, and (ii) the cases in which the diagnosis is doubtful. 82 Report of the Medical Officer oj Health. Of the 18,222 attendances, 11,308 were made by patients seen in previous years. Further information on the cases is given in the following tables :— Table LI. divides the new cases, by sexes, into insured and non-insured, tuberculous and non-tuberculous. There is an increase of only three tubercular cases against 377 non-tubercular. . TABLE LI. New Cases, 1919. Cases. Tuberculous. Non-Tuberculous. Totals. Male. Female. Total. Male. Female. Total. Male. Female. Total. Insured 260 88 348 115 69 184 375 157 532 Not Insured 57 164 221 411 558 969 468 722 1,190 Totals 317 252 569 526 627 1,153 843 879 1,722 Table LI I. shows the total attendances divided into the same sub-headings. TABLE III. Total Attendances All Cases during year 1919. Cases. Tuberculous. Non-Tuberculous. Totals. Male. Female. Total. Male. Female. Total. Male. Female. Total. Insured 3,603 1,688 5.,291 375 369 744 3,978 2,057 6,035 Not Insured 1,967 5,441 7,408 2,197 2,582 4,779 4,164 8,023 12,187 Totals 5,570 7,129 12,699 2,572 2,951 5,523 8,142 10,080 18,222 Report of the Medical Officer of Health. 83 Table LIII. gives the number of new cases living in each of the five sub-districts, and shows on whose recommendation they made the first appearance. 209 were sent up by private practitioners. TABLE LIII. Return showing Source of Cases and Sub-Districts. Clapham. Putney. Streatham. Tooting. Wandsworth. Outside Borough. Totals. Public Health Department 83 24 122 111 227 567 London Insurance Committee 10 8 18 9 21 _ 66 Private Practitioners 24 8 44 51 80 2 209 Charitable Societies 1 — 3 19 10 - 33 Transfers from other Dispensaries 12 5 9 5 10 1 42 London County Council 9 10 12 12 36 — 79 Existing Dispensary Patients 41 10 48 82 227 8 416 War Pensions Committees 23 11 28 66 47 — 175 Other sources 14 7 14 33 66 1 135 Totals 217 83 298 388 724 12 1,722 Table LIV. gives the age grouping of all the patients who attended for the first time in 1919, showing the number found to be tuberculous at each age period. Table LV. gives the same grouping for the contacts only, and shows that 32 out of 516 contacts were found to be tuberculous, only seven of these being under the age of 15. All contacts are examined at the Dispensaries, and there were 167 more than in 1918. 84 Report of the Medical Officer of Health. TABLE LIV. DIAGNOSIS AND AGE GROUPING OF ALL CASES. Age Period. Tuberculous. Non-Tuberculous. . Totals. Percentage of Tuberculous Cases to Total Cases at each Age. Males. Females. Total. Males. Females. Total. Males. Females Total. Under 1 year 1 ... 1 5 5 10 6 5 11 9.1 1 and under 2 years 2 1 3 16 7 23 18 8 26 11.5 2 and under 5 years 5 ... 5 71 79 150 76 79 155 3-2 5 and under 10 years 15 20 35 190 166 356 205 186 39i 8.9 10 and under 15 years 10 15 25 103 120 223 113 135 248 10.1 15 and under 20 years 24 29 53 28 26 54 52 55 107 49.5 20 and under 25 years 51 30 81 26 35 61 77 65 142 57.0 25 and under 35 years 93 72 165 44 83 127 137 155 292 56.5 35 and under 45 years 65 52 118 23 73 96 89 125 214 55.1 45 and under 63 years 48 30 78 13 33 46 61 63 124 62.9 .65 years and upwards 2 3 5 5 2 7 7 5 12 41.7 Totals 317 252 569 524 629 1.153 841 881 1.722 33.0 Under 15 years 33 36 69 385 377 762 418 413 831 8.3 15 years and upwards 284 216 500 139 . 252 391 423 468 891 561 Totals 317 252 569 524 629 1,153 841 881 1,722 33.0 85 Report of the Medical Officer of Health. TABLE LV. DIAGNOSIS AND AGE GROUPING OF ALL CONTACTS, EXAMINED FOR THE FIRST TIME DURING 1919. Age Periods. Tuberculous. Non-Tuberculous. Totals. Percentage of Contacts found to be tuberculousatage period Males. Females. Total. Males. Females. Total. Males. Females. Total. Under 1 year ... ... ... 1 4 5 1 4 5 ... 1 and under 2 years ... 1 1 9 5 14 9 6 15 6.6 2 and under 5 years ... ... ... 38 48 86 38 48 86 ... 5 and under 10 years 3 1 4 73 61 139 8l 62 143 2.8 10 and under 15 years ... 2 2 44 61 105 44 63 107 1.9 15 and under 20 years ... 5 5 18 15 33 18 20 38 13.2 20 and under 25 years 1 1 2 2 19 21 3 20 23 8.7 25 and under 35 years ... 8 8 7 30 37 7 38 45 17. 8 35 and under 45 years 4 3 7 4 24 28 8 27 35 2.0 45 and under 65 years 1 2 3 3 12 15 4 14 18 16.6 65 years and upwards ... ... ... 1 ... 1 1 ... 1 ... Totals 9 23 32 205 279 484 214 302 516 6.2 Under 15 years 3 4 7 170 179 349 173 183 356 1.9 15 years and upwards 6 19 25 ' 35 100 135 41 119 160 15.6 Totals 9 23 32 205 279 484 214 302 516 6.2 86 Report of the Medical Officer of Health. Table LVI. gives the site of the lesion in the 569 cases found to be tuberculous. TABLE LVI. SITE OF LESION IN TUBERCULOUS CASES. Age Period. Non-Pulmonary. Glands. Joints and Bones. Abdominal. Others. Total NonPulmonary. Pulmonary Tuberculosis. Total. Under I year ... ... ... 1 1 ... 1 1 and under 2 years 2 ... ... I 3 ... 3 2 and under 5 years 2 1 ... ... 3 2 5 5 and under 10 years 17 2 1 1 21 14 35 10 and under 15 years 4 2 1 1 8 17 25 15 and under 20 years 2 2 ... 1 5 48 53 20 and under 25 years 2 2 ... ... 4 77 81 25 and under 35 years 1 4 ... 3 8 157 165 35 and under 45 years 1 ... ... 1 2 116 118 45 and under 65 years 1 ... ... ... 1 77 78 65 years and upwards ... ... ... ... ... 5 5 Totals 32 13 2 9 56 513 569 Discharged Soldiers. ' Table LVII. shows the number of discharged soldiers examined, the number found to be suffering from tuberculosis, and the total attendances they made. Most of these men were sent up by the local War Pensions Committees or the London Insurance Committee for examination and report. A few came direct from the Medical Boards of the Ministry of Pensions. Report of the Medical Officer of Health. 87 TABLE LVII. PARTICULARS RELATING TO DISCHARGED SOLDIERS ATTENDING AT THE DISPENSARIES. New Cases. Attendances. Tuberculous 169 2,282 Non-Tuberculous 56 178 Totals 225 2,460 482 visits were made by the Dispensary Nurses in connection with these cases during the year. These reports are required for the following reasons :— (a) To determine whether or not the man is suffering from tuberculosis, and if he is, (b) whether the disease is attributable to, or aggravated by, military service. In many instances it is a matter of great difficulty to arrive at a decision on these two points which shall be just, both to the man, and to the State, which pays the pension. (c) To determine the form of treatment most desirable in the patient's interest. (d) To assess the man's capacity for work and his percentage disability for purposes of pension. 88 Report of the Medical Officer of Health. iq Institutional Treatment. During the year 174 insured persons and discharged soldiers were admitted to Sanatoria and Hospitals through the London Insurance Committee, and 104 uninsured persons through the London County Council. Many of them received temporary benefit from their treatment. Sanatorium treatment fulfils a very important function by giving the opportunity to patients to learn the principles of the treatment of the disease, which they are able to continue on return to their own homes. There is no doubt that considerable good is done by this educational training. In two or three cases there have been delays in admitting a patient to an institution, but the majority have been removed quickly. Experience has shown that it would be a great advantage if a few beds were available in connection with the dispensaries where certain cases of difficulty could be kept under observation for a time for purposes of diagnosis. A few beds are also needed for the acute cases, and for chronic cases who develop acute symptoms, requiring treatment in bed for a few weeks. Beds should be set aside specially for these cases, as the demand for admission to general hospitals is so great. The problem of the advanced case is still unsolved. The sputum of these cases is very often infectious, and some form of isolation, either in institutions or under ideal conditions at home is necessary to minimise the danger to others, and so help in preventing the spread of the disease. Some of them are sent to sanatoria, for which they are generally entirely unsuited, but in the absence of any other provision except the Infirmaries, it is . difficult to know how else to deal with them. It is a common occurrence to be pressed by an advanced case for a recommendation, to sanatorium, and such requests are most difficult to refuse especially when frequently repeated. Report of the Medical Officer of Health. 89 An urgent need in this Borough is adequate covision for OpenAir Schools for children. At present the only school available faces Clapham Common in the Borough of Battersea, and owing to its site only serves a limited area of this Borough. By the end of the year only five children, all notified cases of tuberculosis, were attending this School, and three more had been passed as suitable. Approximately there are 180-200 notified children in the Borough who should be attending such a school. More than half of these live in the Garratt I.ane area, and it is in this area, or in one reasonably accessible to it, that an Open-Air School is needed. Further, owing to the great difficulty frequently found in the diagnosis of tuberculosis in children, it would be advisable if open-air schools were provided for those children who are debilitated, but not definitely tubercular. Many such are seen in Dispensary practice and would benefit from treatment in an open-air school, but at present cannot be recommended unless they are notified cases. After-Care Work In November the two Interim Care Committees, formed respectively in April, 1917, and May, 1919, for the two halves of the Borough, were amalgamated as one Borough Care Committee. The Committee consists of members of the Borough Council, representatives from the County Council, Public Health Department of the Borough Council, and many of the organisations connected with the relief of distress in the area, together with several members personally interested in the work. The Committee was fortunate in obtaining the services, as Secretaries, of Miss F. Walker and Mrs, Nicol, who had acted in the same capacity for the Interim Committees. One of the duties of the Committee is to make assessments as to the amount of payment to be made by a non-insured person recommended for sanatorium treatment. A very important duty A5202 G 90 Report of the Medical Officer of Health. is to keep in close touch with those suffering from the disease and to endeavour to relieve poverty and to improve social conditions, both of which have such an important bearing on the course of disease. The provision of sufficient food and suitable employment for those able to work, are two very important factors which have to be dealt with. This work entails much home visiting and the furnishing of frequent reports. In order to deal with the assessments and the routine reports required by the various authorities and hospitals concerned with the patients' treatment, two Sub-Committees have been formed, one for Clapham, Balham, Tooting, and Streatham, and the other for Putney and Wandsworth. During the year 100 cases for assessment were dealt with, and 281 reports were made to the Insurance Committee, County Council, Hospitals and the Dispensaries. The main Committee deals with matters of policy, cases of difficulty arising at the Sub-Committees, and, chiefly, with the many cases who are in need of extra nourishment, or for whom suitable employment is required. This subject bristles with difficulties and it remains to be seen whether such' a Committee can do any lasting good with no after-care fund, and with no provision made for finding special employment for the tubercular. During the year 6 patients were given assistance which enabled them to take suitable employment, which is a very small proportion of those who are in need of this sort of assistance. The summary of the results of treatment since the opening of the Dispensaries in 1913, is still being carried out, but the results are not yet sufficiently complete to record. On 24th December the Wandsworth Dispensary moved from No. 129, East Hill, to No. 96. Report of the Medical Officer of Health. 91 Small-pox. No vaccination or re-vaccination was performed by the Medical Officer of Health under the Public Health (Small-pox) Regulations during the year. Vaccination. Table LVIII. is taken from the official returns of the Vaccination Officers to the Board of Guardians for the year 1918. 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 LVIII. SubDistricts. Number of Births returned from ist January to 31st December, 1918. 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 749 354 3 ... 55 190 19 21 91 16 Putney 338 231 2 ... 23 51 ... 13 ... 18 Streatham 2.035 761 12 ... 115 545 42 85 334 141 Wandsw'th 1,350 771 2 ... 88 306 28 37 95 23 Totals 4,472 2,117 19 ... 281 1,092 89 156 520 198 The percentage of children vaccinated to total births was only 47, 47 in Clapham, 68 in Putney, 37 in Streatham, etc., and 57 in Wandsworth. Anthrax. No cases were reported during the year. A5202 2 92 Report of the Medical Officer of Health. Rabies. Information was received from the veterinary inspector of the London County Council and other sources that five persons had been bitten by dogs during the period when rabies was in existence. None of the cases were verified by bacteriological examination. All the premises were, however, visited by the sanitary inspectors, and information given as to procedure to be taken if any illness occurred. Notices were received from the Public Control Department of the London County Council and other sources, of the existence of rabies at six premises in the Borough, but none of the instances proved to be positive. Scabies. The names of 61 school children who were suffering from scabies were forwarded to me by the medical officer to the London County Council, and the homes were visited by the sanitary inspector. These children were treated at the London County Council cleansing stations. In all cases where consent could be obtained, disinfection of the bedding and clothing of the patient was carried out by the disinfecting staff. In addition to the above 25 other cases in adults were reported to me. These cases were treated at the baths at the Council's disinfecting station with sulphurated potash baths and in every case the disease was cured. The average number of baths given per case was three. MATERNITY AND CHILD WELFARE. I.—-Work of Health Visitors. During the past year two additional health visitors were appointed, entailing a re-arrangement of the districts. There are now four whole-time and two part-time health visitors. Their duties include the visiting of infants under the Notification of Births Act, and of children between the ages of one and five years, of all cases of measles, whooping-cough, pneumonia, diarrhoea and tuberculosis in children under five years of age, and all cases of ophthalmia neonatorum and puerperal fever, the investigation into Report of the Medical Officer of Health. 93 deaths of infants under one year, attendance and lectures at infant welfare and ante-natal centres, the visiting of creches, and committee meetings in connection therewith, investigation into applications for milk under the Milk (Mothers and Children) Order, the provision of free meals and dental treatment, the periodical visiting of homes for unmarried mothers and children, the keeping of registers and records in connection with the above, and the preparation of monthly reports. I am able to report that all the above work was'carried out to my entire satisfaction. The following table summarises the work of the health visitors during the year in the various wards of the Borough. TABLE LIX. Year ended December 31st, 1919. Clapham. Putney. Streatham. Tooting. Wandsworth. Boro'. N. S. B. S. So. F. Sp. Births— Visits 291 240 220 560 464 582 37i 237 541 3,506 Re-visits 728 524 436 689 334 340 469 379 279 4,178 Children, 1—2 years— Visits 8 — 10 64 177 24 10 6 5 304 Re-visits 144 76 52 160 251 76 50 33 46 888 Children, 2—5 years— Visits 12 43 137 119 101 23 19 55 509 Re-visits 79 60 187 257 290 407 310 185 273 2,048 Ante-natal visits 8 — 7 4 31 5 9 11 8 83 Puerperal fever— Visits 1 4 3 5 5 9 2 3 11 43 Re-visits — 4 — — 2 2 3 — 9 20 Ophthalmia neonatorum— Visits 18 4 5 12 6 7 10 5 7 74 Re-visits 11 3 4 13 3 5 13 11 2 65 Enteritis— Visits 2 1 6 7 3 3 7 5 9 43 Re-visits 2 I — — 1 — — 3 — 7 Measles— Visits 53 21 5 105 136 273 29 17 65 704 Re-visits —— — 5 7 3 20 3 1 4 43 Whooping-cough— Visits 20 14 26 23 30 8 17 3 — 141 Re-visits — — 3 1 6 4 1 1 — 16 Investigation of death of infants 25 1.7 15 24 9 34 10 11 36 181 Attendance at Infant Welfare Centres 79 — 55 77 48 54 14 — 83 410 Attendance at Ante-natal Centres 3 — — 7 24 27 — — 11 72 Visits to creches —— — 10 6 — 25 — 39 — 80 Committee meetings 6 — 13 12 11 13 28 20 9 112 Visits re supply of milk and food 149 77 9i 432 233 228 229 128 230 1,797 Visits re dental treatment 3 — 9 4 9 5 10 5 2 47 Health talks to mothers 6 — 20 12 39 18 — 4 99 Miscellaneous visits 22 5 47 51 36 120 35 32 80 428 Ineffectual visits 241 347 157 172 336 37 215 159 17 1,681 Total 1,911 1,398 1,429 2,841 2,606 2,427 1,868 1313 1,786 17.579 Nuisances reported to Medical Officer of Health 58 21 14 56 — 87 44 29 68 377 94 Report of the Medical Officer of Health. Infant Visiting. The total number of visits and re-visits was 7,684, of which 3,506 were first visits as against 2,724 in the previous year. The re-visits totalled 4,178, as against 2,907. 162 re-inspections were made in respect of premises for which notice had been served. At the first visit 2,781 infants w'ere wholly breast fed, 254 were breast fed supplemented by artificial feeding, and the remainder on cows', condensed or dried milks. On re-visiting, 2,036 were entirely breast fed, the remaining 2,142 being fed on 'cows', condensed or dried milks, supplemented by some form of farinaceous food. Ninety-four of the infants visited died during the year (15 in Clapham, 10 in Putney, 15 in Balham, nine in Streatham, 12 in Tooting and 30 in Wandsworth). As shown by the table, the highest mortality occurred between the ages of two and three months, seven died under one month, and 45 died before reaching the age of four months. 135 of the infants visited were prematurely born and 93 were delicate from birth, 82 twin births were visited and one of triplets, of whom the latter and four of the twin births died. With regard to the employment of midwives, 1,509 mothers had employed their services, 214 infants were born in hospitals and other institutions, and one unregistered woman was employed. 304 children between the ages of one and two years were visited and 888 were re-visited. 509 children between the ages of two and five years were visited, 2,048 were re-visited. The sanitary defects found in the houses during the V'sits to the mothers were all dealt with in the usual way. Cases in which defects were found were referred to me by the health visitors, and, in addition, 74 intimation notices and four statutory notices were served by the two health visitors who are also sanitary inspectors. 95 Report of the Medical Officer of Health. TABLE LX. Clapham, North. Clapham, South. Putney Balham. Streatham. Tooting. Southfield. Fairfield. Springfield. Borough. Infants visited 291 240 220 560 464 582 371 237 54 3,506 Breast-fed 252 196 164 443 395 455 306 202 368 2,781 Otherwise fed 39 44 56 117 09 127 65 35 173 725 Infants re-visited 728 524 436 689 334 340 469 379 279 4,178 Breast-fed 420 325 89 417 212 120 211 171 71 2,036 Otherwise fed 308 199 347 272 122 220 258 208 208 2,142 TABLE LXl. DEATHS OF INFANTS VISITED. Under 1 mo. Under 2 mos. Under 3 mos. Under 4 mos. Under 5 mos. Under 6 mos. Under 7 mos. Under 8 mos. Under 9 mos. Under 10 mos. Under 11 mos. Under 12 mos. Total. Clapham, North 2 – 2 1 1 2 1 – – – 1 – 10 Clapham, South. – 1 3 – – – – – – – – – 5 Putney 1 2 1 1 – 2 – – 1 1 1 — 10 Balham 1 5 2 2 1 2 – – 1 – – 1 15 Streatham – 1 3 – 3 – – – – 1 1 1 10 Tooting 1 – 3 1 2 1 2 2 – 1 1 – 14 Southfields – 1 – 2 2 1 1 – 1 1 – – 10 Fa1rfield – 3 – – – – 1 1 – – – – 5 Springfield 1 1 2 1 1 1 3 1 2 1 – 1 15 Borough 7 14 16 8 10 9 8 4 5 6 4 3 94 Midwives. The supervision of midwives is under the control of the London County Council, but there is full co—operation between the midwives and the health visitors. There are 32 midwives practising in the Borough, of whom nine reside in neighbouring districts. 96 Report of the Medical Officer of Health. Nurses. Arrangements have been made with various nursing associations in the Borough to attend cases of ophthalmia neonatorum, measles, whooping-cough, diarrhoea and pneumonia following influenza, measles or whooping-cough, when and as requested by the Medical Officer of Health at a fee of eightpence per visit. 2,746 such visits were paid during the year. Clapham is served by the South I.ondon District Nursing Association ; Putney and Roehampton by the nurses appointed by the Parochial Nursing Associations; and Streatham, Tooting, Wandsworth, and part of Ba.ham, by Raynard Nurses, of whom there are 12 working in the Borough. The northern district of Streatham is served by the Brixton Nursing Association. Arrangements are being made for the services of an additional nurse in Balham. Consultation and Treatment Centres. As no treatment is given at the various Infant Welfare Centres, children are sent to suitable hospitals or to private doctors. The principal diseases found were affections of the fyes, ears, throat or skin, advanced cases of rickets and the like. Maternity Homes. There are 34 private maternity hemes in the Borough, four of which are earned on by practising midwives. At present expectant mothers are sent either to the Clapham Maternity Hospital or to any similar institution where there is accommodation, the Council defraying the cost of £2 per week up to £6. Patients so sent are asked to pay 30s., the amount of the maternity benefit under the National Insurance Act, but in cases of extreme necessity this payment is remitted. Four mothers were sent to maternity homes during the year and cards were given to two others who did not avail themselves of offer. Report of the Medical Officer of Health. 97 Great difficulty was experienced in finding accommodation for expectant mothers, most of the lying-in hospitals and maternity homes being booked up months in advance. There is urgent need for more maternity beds, as with the present housing difficulty it is frequently unsuitable for the confinement to take place in the crowded homes. Arrangements are being made for the establishment of a maternity home in the Borough in the near future. Hospitals and other Institutions for Expectant and Nursing Mothers and Young Children as In-patients. The Streatham Babies' Hospital is the only institution of the kind in the Borough, and infants from any part of the Borough are admitted. There are at present 14 cots, including three isolation cots, but the accommodation is shortly to be extended to 20 cots. The staff consists of a visiting medical officer, a matron, two sisters (day and night), and four nurses (probationers). There is also one domestic servant. The minimum charge at the beginning of the year was five shillings, but is now seven shillings and sixpence per week, the highest fee yet received is 12s. 6d. per week. No child is admitted free except in cases of extreme poverty. Sixty-two infants passed through the hospital during the year, the average stay being 5 4 weeks. The complaints from which they suffered were marasmus, diarrhcea and vomiting, constipation, rickets, convulsions, anaemia, peritonitis, bronchitis and broncho-pmeumonia and of the cases two proved fatal. Two epidemics occurred during the year, viz. : whoopingcough and influenza, necessitating the closing of the hospital for five months. There are three institutions in the Borough for the reception of expectant unmarried mothers, all in connection with rescue work. 98 Report of the Medical Officer of Health. In two of them the mothers are received a few months prior to the confinement and are expected to remain at least six months after. In one home the mothers, if able, do the domestic work of the house and are therefore with their babies all day—27 mothers with their babies were received during the year. In another, the mothers go out to work and are expected to contribute towards the keep of the children and themselves—16 mothers and 17 children were received during the year. The third has a separate hostel for the children— 19 mothers passed through the home and six children were placed in the hostel. Two hostels, also in connection with rescue work, receive the mother after the birth of the child and she is expected to remain there with the child for at least six months, going out to work if possible. 19 mothers passed through this home in 1919. In all the above hostels arrangements have been made for a medical man to attend when necessary. A number of the infants attend at the most convenient Infant Welfare Centre. Investigations were made into the cases of 21 stillbirths, four of which were premature, nine were delivered by midwives, four occurred in institutions, three in private nursing homes and five were doctors' cases. Advice was given as to the care of the health of the mother, and in the event of her again becoming pregnant she was invited to attend the Ante-natal Clinic. Of the 359 deaths of infants under one year of age, 94 had been previously visited; 147 occurred under the age of two weeks and under ordinary circumstances would not have been visited by the health visitors. Of the 118 remaining, 21 were born and died in institutions, three were nurse children, two were found deserted, one birth was not notified until after death, one wrong address was given, eight were visited ineffectually, 27 were not visited, and 38 occurred in localities where visiting was not considered necessary, as it was known a medical practitioner was in constant attendance. 99 Report of the Medical Officer oj Health. It has hitherto been difficult to ascertain the number of unmarried mothers and illegitimate children in the Borough, as a certain proportion of the illegitimate births occurred outside the district. Steps have been taken to obtain monthly from the Registrar-General particulars of all births belonging to this Borough which occur in other districts. 132 illegitimate infants were visited, 17 were above the standard of visiting, eight had removed before visit, one wrong address was given, two were born in the workhouse and remained there, and eight of those visited died. In the majority of the cases no assistance was required, as arrangements were made by the parents for the care of the children. Maternity and Child Welfare Centres. There are now seven Infant Welfare Centres in the Borough, the seventh having been opened on October 31st, 1919, at St. Michael's Institute, Merton Road, Southfields, to serve the Southfield Ward of Wandsworth. 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 reports concerning their progress are recorded. The superintendent visits the homes of the children to see that the doctor's instructions are carried out. No visiting by untrained workers is allowed. The Wandsworth Centre, 275, Garratt Lane, until the end of October, 1919, served the three Wards of Wandsworth—Southfield, Fairfield and Springfield. Owing to the increasing number of attendances and the limited accommodation it was deemed advisable to provide a separate Centre for the rapidly growing district of Southfields. There were 1,116 children on the register at the end of 1919, 246 were transferred to other Centres, 20 were passed on to the London County Council on the children attaining school age; new 100 Report of the Medical Officer oj Health. cases numbered 366; six children died and 10 removed. The number of attendances dining the year was 2,429, an average attendance of 48.58 for 50 weeks. In October an Ante-natal Session was started, held every alternate Tuesday morning. The number of ante-natal cases on the register at the end of 1919 was 14, 70 attendances being made. The superintendent paid 1,225 visits to infants, and 57 visits to ante-natal cases. A course of 14 sewing classes was held on Thursdays. At the Tooting Centre, held at Fairlight Hall, the number on the Register at the end of 1919 was 1,183, 15 were transferred to other Centres, 93 passed on to the London County Council; new cases numbered 358, eight children died and 19 removed. The number of attendances during the year was 3,224, an average of 63.2 for 51 weeks. The Ante-natal Clinic is held on alternate Thursday mornings, the number of cases on the register being 84 and attendances numbering 177, an average of seven for the 25 sessions. The superintendent paid 2,871 visits to infants and 247 to ante-natal cases. 25 health talks were given during the year, and 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 1919 was 592; new cases numbered 172, seven children died, seven removed, and 12 were passed on to the London County Council. The number of attendances during the year was 1,562, an average of 31.2 for 50 weeks. Ante-natal cases were 11 in number, attendances 66. The superintendent paid 584 visits to infants and 52 to expectant mothers. 21 health talks were given on Wednesday afternoons, and courses of 13 sewing classes and 12 health lectures were held on Thursdays. At the Streatham Centre, 37, Riggindale Road, the number on the register at the end of 1919 was 769; new cases numbered 410, six died, 21 removed, and 14 were transferred to other Centres. The number of attendances during the year was 1,970, an average of 41.9 for 47 weeks. The number of ante-natal cases on the register was 48, with a total of 140 attendances, an average of 7.3 for 19 101 Report of the Medical Officer of Health. sessions. The superintendent paid 2,279 visits to infants and 60 visits to ante-natal cases. Ten lectures and 22 health talks were given. At the Balham Centre, held at Zennor Hall, the number on the register at the end of 1919 was 746, new cases numbered 386, eight children died, 49 removed, three were transferred to other Centres, and 33 were passed on to the London County Council. Owing to the great increase in the numbers it was found necessary to open the Centre twice a week, the doctor being present on both days. The number of attendances was 4,132, an average of 417 for 99 sessions. The number of ante-natal cases on the register during the year was 52. . An Ante-natal Clinic was stated, and 41 attendances were made, an average of 37 for 11 sessions^ The superintendent paid 3,243 visits to infants and 118 to antenatal cases. 41 health talks were given. At the Clapham Centre, 42, Manor Street, the number on the register at the end of 1919 was 777; new cases numbered 598, 12 children died, 43 removed, 80 were transferred to other Centres and four were passed on to the London County Council. The number of attendances was 5,109, an average of 537 for 95 sessions, the Centre being open two days per week. Ante-natal cases numbered 27 with 60 attendances, an average of 7.5 for eight sessions. The superintendent paid 1,404 visits to infants and 35 visits to antenatal cases. Six health talks were given. The Southfields Centre, held at St. Michael's Institute, Merton Road, was opened on October 31st, 1919. The number on the register at the end of the year was 84, 26 cases having been transferred during the two months the Centre was opened. The number of attendances was 138, an average of 17.2 for eight sessions. The superintendent, paid 230 visits to infants and 11 visits to expectant mothers. The ante-natal clinic will be opened in January, 1920. The total number on the registers of the seven Infant Welfare Centres at the end of 1919 was 5,267; there were 2,290 new cases 102 Report of the Medical Officer of Health. registered during the year, the total number of attendances was 18,564, 384 were transferred to other Centres, 140 removed, 162 were passed on to the London County Council and 47 died. The total number of ante-natal cases on the registers at the end of 1919 was 236, and the attendances during the year numbered 554. The superintendents' visits to infants totalled 11,836 and to ante-natal cases 580. 115 health talks were given, four courses of sewing classes were held and two courses of health lectures. 410 attendances were made by the health visitors to the infant clinics, 72 to the ante-natal clinics, and 99 lectures were given by them. 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. Creches. There are four creches in the Borough—Putney, Balham, Tooting and Wandsworth. Children are admitted whose mothers, are obliged to go out to work or who are ill or who for any other reasonable cause are unable to look after their children. The creches are voluntary institutions subsidised by grants from the Borough Council and the Board of Education. The parents payments vary from 4d. to 10d. per head, a reduction being made when more than one child from the same family is admitted. The Wandsworth Day Nursery is also a training school for nurses who intend to take up creche work. They are admitted as probationers and serve a term of six months, receiving not only practical training but also theoretical. The matron gives courses of lectures which the probationers are bound to attend, and an examination is held at the end of the course. 80 inspections of the creches were made during the year by the health visitors, who represent the Medical Officer of Health on the Committees. The attendances were: in Putney, 8,793; in Balham, 2,417; in Tooting, 5,542; and in Wandsworth, 4,780; a total of 21,532. 103 Report of the Medical Officer of Health. Dental Treatment. In May the arrangements made by the Council with the British Dentists' Hospital, Clapham Common, came into force. 70 cases (58 women and 12 children) availed themselves of the opportunity to have dental treatment, and 137 attendances (118 women and 19 children) were made. The number will be increased in 1920, as it was not widely known, and it is difficult to educate people to realise the importance of sound teeth. Nine women had dentures, the charge varying from 21s. for a few teeth up to £4 10s. for a full set, the charge is according to the number of teeth inserted. The medical officer at each Infant Welfare Centre examines carefully the teeth of the mothers and children and recommends treatment when necessary. Puerperal Fever. There were 28 cases of puerperal fever notified (three in Clapham, two in Putney, eight in Streatham, three in Tooting, and 12 in Wandsworth). Five were midwives' cases, 11 were miscarriages, in four instances the child was still-born, 14 patients were removed to hospitals and 11 to St. James's Infirmary; 16 of the cases proved fatal. Ophthalmia Neonatorum. 54 cases were notified, of which 17 were in Clapham, three in Putney, 16 in Streatham, two in Tooting, and 16 in Wandsworth. All the cases were visited. 24 were attended at birth by midwives, five of the cases in Streatham and four in Clapham occurred in maternity homes. 10 were treated in hospital as out-patients, 16 as in-patients, and the remainder were treated at home. One case removed from the district before recovery, four died, and two cases are still under treatment. In no instance has the sight of either eye been impaired. 18 cases were notified by midwives. In 13 cases the district nurse was asked to attend, and 612 visits were made. 104 Report of the Medical Officer of Health. Ophthalmia Neonatorum, 1919. TABLE LXII. No. Date of notification. Eye affected. Severe or slight. Where treated or by whom. History of specific disease. Result. 1 Jan. 8 R. Slight Private doctor No Recovered. 2 „ 18 Both „ St. Thomas's Hosp., out-patient No „ 3 „ 28 ,, „ St. Margaret s Hosp., in-patient Yes ,, 4 Mar. 3 R. „ Private doctor Nc ,, 5 „ 19 R „ Royal Fye Hosp., in-patient No ,, 6 April 7 Both „ Midwife, district nurse No „ 7 May 5 „ Severe Maternity Home, then doctor and nurse Yes „ 8 „ 5 „ Slight St. Margaret's Hosp., in-patient No „ 9 ,, 19 „ Severe Southwark Infirmary ? Removed from district. 10 „ 20 ,, Slight Private doctor No Recovered. 11 „ 28 ,, „ Midwife, then private doctor No „ 12 June 4 R. 1 „ Royal Eye Hosp., in-patient No „ 13 July. 1 R. ,, Maternity home No „ 14 „ 2 Both „ Private doctor No „ 15 „ 5 „ Severe St. Margaret's Hosp., in-patient No „ 16 „ 7 „ „ Doctor and district nurse No „ 17 „ 7 „ „ St. Thomas's Hosp., out-patient No „ 18 10 R. Slight Private doctor and district nurse No „ 19 „ 10 L. „ Private nursing home No „ 20 „ 15 Both „ „ „ No „ 21 ,, 17 „ Severe St. James's Infirm., in-patient Yes „ 22 ,, 17 „ Slight Private doctor No „ 23 „ 25 „ Severe Clapham Maternity Hosp., in and out-patient Yes Died 17/7/19, Spec. Dis. 24 Aug. 2 „ ,, Maternity home Yes Recovered. 25 ,, 16 „ Slight St. Thomas's Hosp., out-patient No „ 26 „ 21 „ Severe Victoria Hosp., out-patient No „ 27 ,, 21 „ Slight St. Thomas's Hosp., out-patient No „ 28 „ 27 „ L. eye severe „ „ „ No „ 29 „ 28 „ Slight St. Margaret's Hosp., in-patient No Died 23/9/19, Prem. birth. 30 Sept. 5 „ Severe „ „ „ No Recovered. 31 „ 5 „ ,, „ „ „ No „ 32 „ 8 R. Slight St. Thomas's Hosp., out-patient No „ 33 ,, 16 Both „ Clapham Maternity Hosp. No „ 34 19 „ Severe Private doctor No „ 35 „ 23 „ „ St. Margaret's Hosp., in-patient No Died 7/10/19, Infect. Enter. 36 „ 26 „ Slight St. Thomas's Hosp., out-patient No Recovered. 37 ,, 30 „ ,, Private doctor No „ 38 Oct 6 R. „ Private doctor and midwife No „ 39 „ 8 R. Severe St. Margaret's Hosp., in-patient ? Died 15/10/19, Prem. birth. 40 „ 18 Both Slight Private doctor No Recovered. 41 „ 20 R. ,, „ „ No ,, 42 ,, 22 Both „ „ „ No „ 43 „ 24 ,, „ „ „ No „ 44 Nov. 11 ,, Severe St. Margaret's Hosp., in-patient No ,, 45 „ 15 „ „ St. Thomas's Hosp., out-patient No Still under treatment. 46 „ 18 „ Slight Private doctor No Recovered. 47 „ 25 „ „ „ „ No „ 48 „ 27 L. „ St. Margarte's Hosp., in-patient ? „ 49 Dec. 4 Both L. eye severe Private doctor No „ 50 „ 8 „ Slight Clapham Maternity Hosp., outpatient No „ 51 „ 15 „ „ St. Margaret's Hosp., in-patient No „ 52 „ 17 „ Severe Private doctor No „ 53 „ 29 „ Slight „ „ No „ 54 „ 29 „ L. eye severe St. Margaret's Hosp., in-patient No Still in hospital. 105 Report of the Medical Officer of Health. Measles. 704 visits and 43 re-visits were made by the health visitors in respect of measles. The services of the district nurses were requisitioned in 43 cases (eight in Clapham, one in Putney, seven in Streatham, 18 in Tooting, and nine in Wandsworth), where bronchitis or pneumonia had set in. The nurses' visits totalled 617. Whooping Cough. 141 visits and 16 re-visits were made by the health visitors in cases of whooping-cough. In three cases only (in Clapham) was a district nurse called in, and her visits numbered 21. Epidemic Diarrhœa. In all the deaths under one year from diarrhoea and enteritis, special inquiries were made and the following Table shows the nature of the food given:— TABLE LX1II. Method of Feeding. Age in Months. Under 1. 1 and under 3. 3 and under 6. 6 and under 9. 9 and under 12. Total. 1.—Breast-fed only 4 1 ... ... ... 5 Do. and cows' milk 2 ... ... ... ... 2 Do, and condensed milk ... 1 ... ... ... 1 2.—Cows' milk only ... 1 ... 2 ... 3 Do. and condensed milk ... ... 1 ... ... 1 Do. and food ... 1 ... ... ... 1 3.—Condensed milk only ... 2 2 1 ... 5 4.—Dried milk ... 4 4 2 ... 10 5.—Farinaceous food only 1 ... ... ... ... 1 6.—Died within a few hours of birth 1 ... ... ... ... 1 7.—Unknown 3 1 1 1 1 7 Totals 11 11 8 6 1 37 A5202 H 106 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 LXIV. Clapham, North. Clapham, South. Putney. Streatham. Balham. Tooting. Southfield. Fairfield. Springfield. Borough. Total Number of Deaths 2 ... 6 2 7 7 6 1 6 37 Wholly breast-fed ... ... 2 ... 1 ... 1 ... 1 5 Otherwise fed 2 ... 3 1 2 6 5 1 5 25 No information ... ... 1 1 4 1 ... ... ... 7 Previously visited (1919) 2 ... 3 1 3 2 2 ... ... 15 „ „ (1918) ... ... ... ... ... ... ... ... 1 1 Breast-fed ... ... 1 ... ... ... ... ... 1 2 Otherwise fed 2 ... 2 1 3 2 2 ... ... 14 illegitimate ... ... 2 1 1 ... 1 ... 1 6 Nurse children ... ... 1 ... ... ... ... ... 1 2 Born outside Borough ... ... 1 ... ... ... 3 ... 1 5 Premature ... ... 1 ... 2 ... 1 ... ... 4 Delicate from birth ... ... 1 ... 1 2 1 ... 1 6 Twin Children 2 ... 1 1 ... 1 ... ... ... 5 Home Helps. So far no home helps have been available in any part of the Borough, but efforts are being made to obtain the services of one in Wandsworth. 107 Report of the Medical Officer of Health. Staff. After 4½ years' military service, during part of which I was able to supervise to a certain extent the work of the Public Health Department, I returned to duty at the end of January, 1919. Dr. Caley returned to his duty at the Tuberculosis Dispensaries on 27th December, 1918, after four years and five months' military service. Mr. T. Newell, who had been employed by the Food Control Committee from the 17th September, 1917, returned to duty on the 2nd June. Mr. S. Crane retired on the 22nd July, on reaching the age limit, after 29 years' of faithful service. Mr. E. J. Jenkins was appointed sanitary inspector and commenced duty on the 19th May. Mr. D. Grant was appointed sanitary inspector and commenced duty on the 14th July. These latter two appointments were made to fill vacancies caused by the death of Mr. G. Russell and the retirement of Mr. S. Crane. On account of the large increase of work, and especially of the necessity for increased housing inspections, Mr. A. E. Vickers and Mr. H. T. Lambert were appointed sanitary inspectors, and commenced duty on the 15th December. Three new health visitors were appointed, Miss I. E. Mulkern, Miss M. E. Maple and Miss B. Henderson, the latter in place of Miss B. Wearing, who resigned. Mr. E. Hunt returned to duty on the 30th May after 4½ years' military service. 108 Report of the Medical Officer of Health. Mr. H. E. Cramp was appointed as an additional clerk to assist with the clerical work at the dispensaries. He commenced duty on the 22nd September. The staff at the end of the year was as follows:— Medical Officer of Health. Tuberculosis officer and deputy medical officer of health. 12 male sanitary inspectors. 1 inspector under Sale of Food and Drugs Act. 3 Female sanitary inspectors, two of whom devote one-third of their time to health visiting, and one wholetime to tuberculosis work. 4 Health visitors. 6 Clerks and one office boy. 1 Dispenser }at tuberculosis dispensary. 2 Nurses 1 Engineer and 10 disinfectors at disinfecting station. 1 Whole-time and two part-time mortuary keepers. The work carried out during the year by the sanitary inspectors is shown on Tables XXV. and XXVI. Ten of the male sanitary inspectors each have a special district allotted to them in which they carry out all duties under the Public Health (London) Act, 1891, Housing Acts, and Factory and Workshop Acts in factories, etc., where men are employed, and all Orders made under those Acts. Two male sanitary inspectors devote their whole time to houseto-house inspections under Public Health and Housing Acts, and one inspector to the Sale of Food and Drugs Acts. Two female sanitary inspectors devote two-thirds of their time to the inspections of factories and workshops where women are employed, and one-third of their time to health visiting. One female sanitary inspector devotes her whole time to visiting and inquiring into notified cases of tuberculosis. 109 Report of the Medical Officer of Health. Chemical Work. All the necessary chemical work, analysis of food and drugs, rag flock and water, is carried out by the Public Analyst, Mr. A. H. M. Muter, F.I.C., F.C.S. One sample of water was analysed, and as it was found to be unfit for drinking purposes an order was made for the closure of the well, which was carried out by the owner. Bacteriological Examinations. During the year 1,709 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 LXV. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. Diphtheria: — Negative 107 194 255 20 249 825 Positive 45 9 67 4 49 174 Enteric Fever:— Negative 1 3 7 1 3 15 Positive ... ... ... ... 2 2 Tuberculosis:— Negative 49 38 141 49 265 542 Positive 28 10 43 12 58 151 Totals 230 254 513 86 626 1,709 110 Report of the Medical Officer of Health. In addition 204 examinations of sputum were made at the Tuberculosis Dispensary: 20 from Clapham, 11 from Putney, 37 from Streatham, 45 from Tooting, and 91 from Wandsworth. In 66 of the cases it was reported that the bacillus had been found. Statement of Work Done Under the Rag Flock Act, 1911. 27 workshops were visited by the inspector and the materials used for bedding and upholstery were examined. 26 samples were procured and submitted for analysis. Of these, seven were reported as not complying with the standard of cleanliness required. In five cases proceedings were taken against the person in whose possession the flock was found and convictions obtained, the amount of fines and costs being £32 7s. In the remaining two cases a warning was given. 111 ANNUAL STATEMENT Of the work done in the Metropolitan Borough of Wandsworth under the Sale of Food and Drugs and Margarine Acts, summarised from the quarterly reports. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Wandsworth. Sir, Ladies and Gentlemen, I herewith have the honour to present the annual statement of . work done during 1919 under the Sale of Food and Drugs Acts. The total number of samples submitted by the inspectors during the year amounted to 1,653. Of these, 831 were taken with the formalities required by the Sale of Food and Drugs Acts, whilst 822 were obtained informally. The statement following gives the result of analysis of all articles submitted. In Tables A and B will be found the details of the articles grouped together in the main statement under the headings "Drugs'' and "Other Articles," the details of the adulterated samples being set out in further tables. 112 Report of the Medical Officer of Health. MAIN STATEMENT showing the results of analysis of all articles submitted. Nature of sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Milk and Cream 817 59 876 82 6 88 Butter 5 330 335 4 31 35 Margarine 1 85 86 - 9 9 Lard - 5° 50 - - - Coffee - 32 32 - - - Cocoa - 22 22 - - - Sugar - 1 1 - - - Mustard - 6 6 - - - Jam - 16 16 - . 2 2 Pepper - 7 7 - - - Drugs - 56 56 - 1 1 Other Articles 8 158 166 6 11 17 Total 831 822 1,653 92 60 152 TABLE A. Details of Drugs (Informal). Nature of drug. Examined. Adulterated. Calcium acid phosphate 1 1 Camphor, powdered 1 - Epsom salts 3 - Ext. Casc. sagr. liq. 3 - Friar's balsam 3 - Jalap, powdered 2 - Liquorice juice 3 - Magnesia, fluid 1 - Magnesia and rhubarb 1 - Milk sugar 5 - Ointment, boric 1 - Ointment, zinc 3 - Oxymel of squills 2 - Pills, iron 1 - Pills, mercury 3 - Powder, Gregory's 5 - Powder, liquorice comp. 6 - Rhubarb, powdered 12 - Total 56 1 113 Report of the Medical Officer of Health. TABLE B. Details of "Other Articles." Nature of article. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Baking powder 2 26 28 1 4 5 Chocolates — 1 1 — - - Coffee mixture — 1 1 - 1 1 Coffee and chicory extract — 1 1 - — — Cornflour 6 14 20 5 6 11 Custard powder — 8 8 — — — Dripping — 28 28 - — - Egg powder — 15 15 - - — Fish, potted — 6 6 - - — Meat, canned — 1 1 - - — Nut lard - 3 3 — - — Oatmeal - 12 12 - - - Rice - 12 12 - - - Self-raising flour - 30 30 — . — — Total 8 158 166 6 11 17 Milk and Cream. In the following Table is given the nature of the samples grouped in the general statement under the heading "Milk and Cream," together with the number of such samples reported against. Nature of sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Milk 817 7 824 82 4 86 Dried milk - 3 3 - - - Cream, fresh - 22 22 - 1 1 Cream, preserved - 27 27 - 1 1 Total 817 59 876 82 6 88 114 Report of the Medical Officer of Health. As regards the four informal samples of milk reported against during the year, three were found to contain extraneous water, whilst the remaining sample was deficient in milk fat. Two of the informal samples of cream submitted were returned as unsatisfactory. In the case of the fresh cream, the presence of a boron preservative was detected, whilst the preserved cream reported against was found to contain a slight excess of boric acid beyond that declared upon the label: namely, 0.4 per cent. The average monthly composition of all milks examined by me during the year and reported as genuine is shown below:— Month. No. of genuine samples. Total solids. Fat. Non-fatty solids. January 37 % 12.42 % 3.58 % 8.84 February 54 12.31 3.52 8.79 March 51 12.16 . 3.40 8.76 April 62 11.99 3.35 8.64 May 44 12.34 3.50 8.84 June 128 12.19 3.38 8.81 July 61 12.02 3.26 8.76 August 107 12.01 3.40 8.61 September 74 12.33 3.64 8.69 October 69 12.68 3.73 8.95 November 30 12.77 3.88 8.89 December 20 12.83 3.87 8.96 For the whole year the average composition of all samples returned as genuine was:— Total milk solids 12.26% Milk fat 3.49% Non-fatty solids 8.77% It may be noted that in the above table the total number of genuine milks adds up to 737, whereas in the "Milk and cream" table the number is given as 738. This discrepancy is accounted for by the fact that one informal sample was submitted in a condition that made it impossible to obtain reliable figures as to 115 Report of the Medical Officer of Health. composition, the sample being suspected of containing deleterious matter. On examination such was found not to be the case, and the sample was, consequently, returned as " genuine." The three informal samples of dried milk examined possessed fat contents of 26.6%, 29.3% and 25.5%, respectively, and when diluted with water, according to the directions printed upon the packages, yielded "milks," which contained 3.44%, 3.68% and 3.84% milk fat respectively. None of the samples contained any preservative. Butter. In all 335 samples of butter were submitted during the year, five of which were taken with the necessary formalities, and 330 obtained informally. Of these, four formal and 31 informal samples were reported against. The nature and extent of the adulteration in the case of the formal samples is given in the following table:— Case No. Nature of report. 72 30% margarine. 159 33% margarine. 160 15% margarine. 793 33% margarine. Of the 31 informal samples of butter reported against, 25 were found to contain margarine, five excess of boron preservative over the maximum permissible, namely, 0.5 per cent. crystallised boric acid; whilst one contained both margarine and an excessive quantity of preservative. Statistics are always dangerous things and the unreliability of them when applied to reports issued by public analysts under the Sale of Food and Drugs Acts is illustrated in a remarkable way in the statement given above as to the adulteration of formal samples of butter. 116 Report of the Medical Officer of Health. It would be as fair to infer that 90 per cent. of the population of England were criminals because nine out of every ten prisoners brought for trial for criminal offences were proved guilty, as to say that the above figures prove that four out of five, or 80 per cent. samples of butter sold in the Borough were adulterated. With the efficient inspection of food that is prosecuted in Wandsworth it is much nearer the truth to say that in 1919 only four vendors of butter in the Borough were guilty of substituting margarine. Again, taking the informal samples, 26 samples in all out of 330 procured were found to contain margarine; but it must be borne in mind that many of these were repeat samples, and consequently they may have been obtained from only a small number of vendors. The presence of preservative was looked for in all samples of butter submitted, with the result that in the case of the formal Samples boric acid was found in quantities as follows:— Case No. Boric acid present. 72 0.41% 143 0.06% 159 0.08% 160 0.17% 793 0.06% As regards the informal samples of butter, 76 were free from preservative, other than common salt, 248 contained a boron preservative in quantities below 0.5 per cent. crystallised boric acid; whilst six, as mentioned above, contained a quantity of this preservative in excess of the maximum permissible. Margarine. Nine informal samples of margarine were reported against: eight because they contained more than the statutory amount of butter, namely, 10 per cent., and one as containing an excess of moisture over the maximum permissible, namely, 16.0 per cent. 117 Report of the Medical Officer of Health. Jam. Two samples of lemon marmalade, both submitted informally, were returned as containing an excess of moisture over the maximum permissible, namely, 35 per cent., as laid down by the Jam Order. Drugs. It is highly satisfactory to note that of the 56 samples of drugs examined only one was found to be not up to standard. This particular sample, one of calcium acid phosphate, which upon examination was found to contain an excessive (comparatively) quantity of arsenic, was, as a matter of fact, not being offered for sale, by retail, in the Borough, but was brought to me in connection with a sample of baking powder in which I had found an excess of arsenic, the calcium acid phosphate having been employed as an ingredient in the manufacture of the said baking powder. Other Articles. Under this heading six of the eight formal samples submitted were returned as adulterated, as shown below:— Case No. Nature of sample. Nature of report. 242 Cornflour 100% rice flour. 243 Cornflour 75% tapioca flour. 257 Cornflour 90% tapioca flour. 258 Cornflour 10% potato flour. 259 Cornflour 100% rice flour. 336 Baking powder 63.4% deficient in total carbon di-oxide. Of the informal samples classed under "Other Articles" in the General Statement, four samples of baking powder were reported against as yielding insufficient gas to render them efficient in use. One of these samples also contained an excess of arsenic. In this connection, it is to be regretted that the authorities have not as yet seen their way towards fixing a minimum limit to the amount of available carbonic anhydride (CO2) to be yielded by such articles as baking powders, "egg powders," and selfraising flour. In the absence of any such recognised legal limit it 118 Report of the Medical Officer of Health. would be a matter of much difficulty and expense to the Borough to obtain the conviction of any defendant who had offered these articles for sale provided they were found capable of yielding the smallest quantity of gas. At the same time, it must be fully recognised that the fixing of a limit would prove in practice a difficult and perhaps dangerous matter on account of the fact that certain baking powders, etc., are manufactured with calcium acid phosphate, and that such powders, although perfectly efficient when they leave the factory, may rapidly deteriorate when kept by the retailer, especially under anything like damp conditions. The one sample of coffee mixture submitted was found to consist entirely of coffee. Six of the. 14 informal samples of cornflour examined were reported as adulterated. Of these, three consisted entirely of rice starch; two contained tapioca starch, and one consisted entirely of potato starch. It should here be noted that the stipendiary magistrate sitting at the Lambeth Police Court has, since reports of the above samples were issued, decided that rice starch may properly be described as "cornflour." In conclusion, I have to report that the total adulteration for all samples submitted during the year amounted to 9.19 per cent.; for formal samples, 11.07 per cent.; and for informal samples, 7.29 per cent. I have the honour to be, Mr. Mayor, Ladies and 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. 13th February, 1920. 119 Report of the Medical Officer of Health. Revenue Act. During the year three certificates were granted under the above Act. The certificates granted referred to 10 houses or 21 tenements. Cleansing of Persons Act. The names of 31 children, five belonging to Clapham, four to Streatham, 20 to Tooting, and two 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 22 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. 151 adults had baths after being in contact with cases of infectious diseases, and three on account of their verminous condition. Cutting-off Notices. During the year, 92 notices with respect to 110 premises were received from the Water Board stating that the supply had been withdrawn. 21 of the premises were in Clapham, 32 in Putney, 28 in Streatham, four in Tooting, and 25 in Wandsworth. The supply was withdrawn for non-payment of rates from 42 premises, from 45 premises in consequence of defects, in 18 the premises were empty, and in four cases by request. 120 Report of the Medical Officer of Health. HOUSING. 1.—GENERAL HOUSING CONDITIONS IN THE DISTRICT. (1) The total number of houses in the district is 56,320 Number of houses for the working classes, i.e., under £40 rental value 41,476 New houses for the working classes during the year Nil. Number of houses for working classes in course of erection 40 (2) Population estimated to the middle of 1919 340,821 (3) (a) Extent of shortage of houses.—The average number of houses for the working classes built during the years 1909, 1910 and 1911 was 600, and this number seems to express fairly accurately the normal requirements of the Borough. From 1912 to 1919 the average number erected was only 150, a difference of 450, so that if building during the last eight years had been at the same rate as in the previous three years there would have been 3,600 more houses erected. If from this 3,600 there is deducted the total number of empty houses at the census of 1911, viz., 2,600, this would give 1,000 as the extent of shortage of houses, provided the population increased at the same rate as in the previous decennial period. (b) Measures taken or contemplated to meet any shortage.—The Council is converting nine houses into 35 flats, and these will be available for occupation during the current year. Lay-out plans have been approved for the erection of approximately 1,320 houses on the following estates: Magdalen Park, Furzedown, and the Watney. II.—OVERCROWDING. (1) Extent.—The total number of cases of overcrowding dealt with in 1919 was 27. This is somewhat under the average of former years. The standard used for determining these cases of overcrowding was 400 cubic feet for adults and 200 cubic feet for children under 10 years of age. Compared with former years there have been 121 Report of the Medical Officer of Health. fewer cases of actual overcrowding, and although there may be greater congestion of the population in certain districts it seems that actual overcrowding in the legal sense is rare. A special inspection of 1,167 houses in different parts of the Borough showed that in only 54, or a percentage of 4.8, were there more than two persons occupying one room, while in the whole Borough at the census of 1911, this percentage was 5.9. (2) Causes.—The greater number of cases was due to domestic overcrowding, the number of rooms available for sleeping purposes being too few for the size of the family. A certain number of cases was due to subletting. At the census of 1911 the percentage of population in private families living more than two in a room was 6.3, compared with 17.8 in the metropolis as a whole, the only Borough in London having a lower percentage being Lewisham, where it was 3.9. (3) Measures taken or contemplated to deal with overcrowding.— The Council has prepared schemes for the erection of 1,320 houses, and this will to a large extent relieve the congestion which exists in some parts of the Borough. (4) Principal cases of overcrowding dealt with during the year and action taken.—Notices under the Public Health Act were served in each case, and in nearly all the cases the overcrowding was abated by the rearrangement of the sleeping accommodation. III.—FITNESS OF HOUSES. (1) (a) General standard of housing in the district.—In 1881 the total number of inhabited houses in the Borough was 15,300, while in 1919 the estimated number was 56,320, an increase of 41,020. As 70 per cent. of the houses have been erected during the last 30 years the standard of housing is comparatively high. There are, however, approximately 2,000 houses in the Borough which fall below a reasonable standard, and these are chiefly old houses where the rooms are small. There are in addition about 1,600 houses which, although built for one family and which if occupied A5202 1 122 Report of the Medical Officer of Health. by one family would be quite satisfactory, are unsatisfactory when occupied by two families, owing to the absence or inadequate provision of sinks, larders and means of cooking and domestic washing. (b) General character of the defects found to exist in unfit houses. —Damp conditions due to defective roofs, guttering, and absence of damp proof courses. Defective flooring, dry rot, absence of sinks and coppers for domestic washing, absence of larders, defective windows, frames and sills, defective internal walls and ceilings due to age, and defective lighting and ventilation of staircases. There were few cases where the drains were defective, and only minor defects in water closets were found. (2) Action taken as regards unfit houses under (a) the Public Health Acts, (b) the Housing Acts. (a) Notices served under Section 2, and if these were not complied with in a reasonable time, statutory notices were served. (b) Sixty-two premises were inspected by the Public Health Committee and Closing Orders made and served. Owing to the shortage of houses it was decided not to proceed further with these Orders until suitable accommodation could be provided, unless in the interval the owners carried out the necessary work to render the houses fit for habitation. (3) Difficulties in remedying unfitness, special measures taken, and any suggestions in the matters.—Want and high cost of labour and materials were the chief difficulties experienced. Another difficulty was that to render the houses fit it would have been necessary lor the tenants to vacate the premises, and as no other accommodation was available the work could not be proceeded with. (4) Conditions, so far as they affect housing, as regards water supply, closet accommodation, and refuse disposal.—The water supply was in all cases satisfactory, the Metropolitan Water Board's supply being used in all houses in the Borough. Cisterns, where they are present, are generally kept in a clean condition. 123 Report of the Medical Officer of Health. Closet accommodation.—Generally, this is satisfactory, although in some houses now let in tenements the number of closets might with advantage be increased. In a few cases in old property there is one closet to two houses, but unless there is a definite nuisance it was not considered necessary to serve notice for an additional water closet to be provided. Refuse disposal.—Metal dust bins are now universal. The house refuse is removed by contractors once a week. Particulars as to removal of house refuse are given on page 33 of this Report. It was not necessary to take any special measures during the year as regards these conditions.. IV.—UNHEALTHY AREAS. No action has been taken as there are no unhealthy areas in the Borough. V.—BY-LAWS RELATING TO HOUSES LET IN LODGINGS, AND TO TENTS, VANS, SHEDS ETC. (1) Working of existing By-laws.—There are 292 registered houses let in lodgings in the Borough and these are inspected yearly. Greater difficulty has been experienced in getting the cleansing carried out owing to the want of labour and materials, otherwise the By-laws have worked satisfactorily. There are six sheds in the Borough which come under the Bylaws and these were frequently inspected. (2) As to need for new By-laws or revision of existing By-laws.— New By-laws are being drafted by the London County Council to be carried out by the Borough Councils. VI.—GENERAL AND MISCELLANEOUS. At page 35 of the general report will be found particulars of the work done by the sanitary inspectors during the year in connection with housing, the number of inspections made, the number of notices served, and the nuisances found at these inspections. A5202 12 124 Report of the Medical Officer of Health. A Sub-Committee of the Public Health Committee inspected 198 houses in various parts of the Borough, and of these 62 were reported to the Council for closing orders to be made. In the remaining 136 notices were served under the Public Health Act for various defects and these notices were all complied with. VII.—APPENDICES. (1) Number of dwelling-houses in respect of which complaints were made that they are unfit for human habitation Nil. (2) Action under Section 17 of the Housing Act of 1909— (a) Number of dwelling-houses inspected under and for the purpose of the section 198 (b) Number of dwelling-houses which were sidered to be unfit for human habitation 62 (c) Number of dwelling-houses the defects in which were remedied without the making of closing orders 136 (3) Action under Section 28 of the Housing Act, 1919— (a) Number of orders for repairs issued Nil. (b) Number of cases in which repairs carried out by the local authority Nil. (c) Number of dwelling-houses voluntarily closed on notice by owner that they could not be made fit without reconstruction Nil. (4) Closing Orders— (a) Number of representations made to the local authority with a view to the making of closing orders 1 (b) Number of closing orders made 62 125 Report of the Medical Officer of Health. (c) Number of dwelling-houses in regard to which closing orders were determined on the houses being made fit for human habitation Nil. 5) Demolition Orders— (a) Number of demolition orders made Nil. (b) Number of houses demolished in pursuance of demolition orders Nil. (6) Number of dwelling-houses demolished voluntarily Nil. (7) Obstructive buildings— (a) Number of representations made (Section 38 of the Housing Act of 1890) Nil. (b) Number of buildings demolished Nil. (c) Number of representations still under sideration Nil. (8) Staff engaged in housing work— The Medical Officer of Health. Twelve sanitary inspectors, two of whom are specifically engaged in house-to-house inspections. 126 Report of the Medical Officer of Health. FORM OF SURVEY OF HOUSING NEEDS. WANDSWORTH METROPOLITAN BOROUGH. Section I.—Prevailing Conditions Affecting Shortage of Houses. Industries. 1. Particulars as to the staple industries of the district (or of any parish or part of the district):— No. of works. No. of employees. Male. Female. Gas mantle works 5 109 1,527 Laundries 149 190 2,353 Gas and electric lighting works 2 380 — Optical works 4 575 89 General and motor engineering works 28 627 - Box making works 4 41 571 2. Particulars of any anticipated industrial development None. 3. Particulars of any considerable reduction which may be anticipated in the number of persons employed in any industry in the district None. Population. 4. Pre-war population (1914) 331,321 5. Average annual increase of population for the five years before the war 6,175 6. Estimated present population 340,000 7. Anticipated increase or decrease of working-class population due to industrial changes None. 127 Report of the Medical Officer of Health. Existing Housing Accommodation. 8. Number of dwelling-houses in the district 56,320 9. Number of working-class houses of the types given in the reply to question 15 41,476 10. Average number of working-class houses built annually during the five years before the war 450 11. Number of working-class houses built between January 1st, 1915, and December 31st, 1918 260 12. Number of empty buildings which might be (a) made suitable, by repairs or alterations, for housing the working classes; or (b) converted into flats for the working classes (a) None (b) 84 Overcrowding. Approxi- 13. Tenements with more than two occupants per room— mate. Number of tenements .... .... .... .... 2,600 Total number of occupiers .... .... 19,000 14. Number of houses intended for one family only which are now occupied (without having been specially adapted) by two or more families .... .... ... 1,550 128 Report of the Medical Officer of Health. Rents. 15. Particulars of prevailing rents of the various types of workingclass houses in the district:— Type of house. Weekly rent. (a) Houses with living room, scullery and two bed-rooms 5/6 to 8/6 (b)Living room, scullery and three bedrooms. 8/3 to 11 /6 (c) Parlour, living room, scullery and two bedrooms 8/3 to 12 /6 (d) Parlour, living room, scullery and three bedrooms 9/-to 14/- (e) Parlour, living room, scullery and four bedrooms 10 /6 to 16 /— (f) Tenements in block buildings (g) Other working class dwellings (specifying)— 7/6 2 rooms—no scullery 5 /- in specially adapted houses. 2 rooms and scullery 5/6 3 rooms—no scullery 6 /- ■ Section II.—Estimate of Housing Needs. i. Working-class houses required during the next No. of three years to— Houses. (а) Meet the unsatisfied demand for houses ing account of growth of population, overcrowding, etc.) 1,000 (b) Re-house persons to be displaced by the ance of unhealthy areas 62 (c) Replace other dwellings which are unfit for human habitation and cannot be made fit — (d) Replace obstructive or other buildings (now inhabited and not included under heading (c)) which should be demolished — (e) Replace other houses which, although they cannot at present be regarded as unfit for human habitation, fall definitely below a reasonable standard 2,000 (/) Meet anticipated deficiencies, e.g., arising from new industrial development — Total 3,062 129 Report of the Medical Officer of Health. 2. Deduct— No. of Houses. (а) Working-class houses which it is anticipated will be set free during the next three years as the result of any probable decrease in the population Nil. (b) Working-class houses likely to be built during the next three years by persons other than the Local Authority * — Total — Net estimate of number of houses required 3,062 Section III.—Areas which are being, or may have to be, dealt with as unhealthy under Part I. or Part II. of the Act of 1890. Give particulars in Table below of unhealthy areas which require to be dealt with. See observations of Medical Officer of Health on Section V. and map. Section IV.—Insanitary Houses [other than houses in unhealthy areas of which particulars are given in Section III.) Prevailing Conditions. (1) How many inhabited houses are there in the district which are not and cannot be made fit for human habitation? 59 (2) Number of persons inhabiting these houses 225 * No Public Utility Societies or Housing Trusts have been formed in the Borough and the Council have no information as to the formation of any in the near future. It is doubtful whether any working-class houses will be built by private persons under existing conditions. Twenty-four houses are being built in Clapham, but same are for sale only. 130 Report of the Medical Officer of Health. (3) How many houses are already subject to— (a) Closing orders? 62 (b) Demolition orders? - (4) How many houses are seriously defective but can be made habitable? Nil. Proposed action. (5) What immediate action is contemplated by the local authority with regard to (a) houses which are not and cannot be made fit for human habitation ? Having regard to the lack of housing accommodation at the present time, the Council feel that they would not be justified in taking any drastic steps in the direction of the demolition of houses already in existence, but they propose to review the cases where closing orders have been made as and when alternative housing accommodation is available. (b) Houses which are seriously defective but can be made habitable? Nil. (6) Within what time is it contemplated that conditions will be such as to warrant the demolition of the houses which are not and cannot be made fit for human habitation ? It is impracticable at the present moment to form any reliable estimate of the period within which alternative accommodation will be available. Section V.—Map, A map of the district, coloured as directed below, should be forwarded with this completed form. The Medical Officer of Health should be responsible for the colouring of the map, which should be accompanied by any report 131 Report of the Medical Officer of Health. on the subject which he may make. The map should be to the scale of six inches to the mile, and ordnance sheets may be used. (1) Pink.—Any areas which the Medical Officer of Health has already represented, or has definitely decided to represent, as unhealthy areas for the purposes of an Improvement or Reconstruction Scheme or Schemes under Part I. or Part II. of the Act of 1890. (2) Burnt Sienna.—Any areas which he has not definitely decided to represent but which in his opinion may have to be dealt with by Improvement or Reconstruction Schemes under Part I. or Part II. of the Act of 1800. (3) Yellow.—Any considerable areas which contain a large proportion of seriously defective houses, but which can, in his opinion, be adequately dealt with, otherwise than by Improvement or Reconstruction Schemes, (a) by measures for rendering the houses fit for human habitation by repairs or renovation, and (b) where necessary, by the demolition of individual unfit houses. (4) Neutral Tint.—Any considerable areas which, although in fair sanitary condition, nevertheless for one reason or another fall definitely below the ultimate standard at which it is reasonable to aim, or contain a large proportion of houses which fall below such standard. Except in the case of No. 1 (pink), it will be sufficient if the colouring gives a general indication of the areas, and it will not be taken as definitely deciding the boundaries of the several areas or the methods of treatment which a more detailed survey may show to be the best for remedying the defects. The areas coloured pink and burnt sienna should be numbered consecutively, and these numbers should be entered in column 2 of the Table in Section III. 132 Report of the Medical Officer of Health. Any observations in regard to the map should be entered below:— There are no considerable areas in the Borough which could be included under (1), (2) or (3). There are several individual houses or small groups of houses which would come under (3), but they are at present being dealt with under the Public Health (London) Act, 1891. There are also a num ber of houses which might come under (4) at present occupied by two families where the conditions are satisfactory except for the provision of a separate water closet for each family. In many cases this occupation is of a temporary character, and as soon as houses at reasonable rents are available the houses would revert to their original occupation. In the areas marked neutral tint on the map there are a considerable number of houses in which the accommodation is limited, the rooms small, and the water supply outside the house, and in a certain number there is no sink provided. Proper provision for the storage of food is also absent in many of the houses. Section VI.—Scheme of the Wandsworth Borough Council for the provision of New Houses under Section I. of the Housing, Town Planning, &c., Act, 1919. (The rebeme should, include any proposals which have already been submitted for approval as assisted schemes.) i. Approximate number of new houses to be provided:— (a) Houses with Living Room, Scullery and two bedrooms 200 (b) Living Room, Scullery and three bedrooms — (c) Parlour, Living Room, Scullery and two bedrooms 1,820 133 Report of the Medical Officer of Health. (d) Parlour, Living Room, Scullery and three rooms — (e) Parlour, Living Room, Scullery and four rooms — (/) Block dwellings. (Number:—) Number of separate tenements Nil (g) Other dwellings (specifying type) Nil Total number of houses and separate tenements *2,020 2. Approximate number of existing empty houses to be acquired and:— (i) made suitable for housing the working classes Nil. (ii) converted into flats for the working classes 25 Approximate number of familes to be housed under (i) and (ii) 75 3. Approximate acreage of land to be acquired 196 4. Average number of houses per acre 10.306 5. Approximate localities, in which land is to be acquired— Magdalen Park Estate, Earlsfield (including 20 acres of open space). Furzedown Estate, Tooting and Streatham. Watney Estate. Southfield. Bell Estate, Tooting.—Question of acquisition in abeyance. * Which includes 700 on Bell Estate, the question of acquiring which is in abeyance. 134 Report of the Medical Officer of Health. 6. Time within which it is proposed that the scheme (or if the scheme is to be carried out by instalments, each part of the scheme) is to be carried into effect*:— Part of scheme. Approximate date for completion. Magdalen Park Estate Three years. Furzedown Estate Three years. Watney Estate Eighteen months. Bell Estate (Scheme in abeyance) 7. Particulars of any measure necessary, as part of the scheme, for the preservation of existing erections of architectural, historic or artistic interest, or for the preservation of the natural amenitie of the locality. None, excepting in the case of the Bell Estate, where it is desirable that the old mansion known as "Park Hill" should be retained and a certain amount of land reserved for recreation ground or open space. 8. Any other provisions (including provisions for joint action with any other Local Authority). None. 9. Is it anticipated that the scheme may subsequently require to be amended? If so, any relevant considerations should be stated. The scheme may require amendment as developments proceed, e.g., it may prove necessary and advisable for the Council to arrange for the scheme definitely to include the Bell Estate, and a larger area of the Watney Estate than that at present provisionally approved for housing purposes. The changing conditions may entail a variation in the number of existing houses to be converted. As circumstances alter, it may be necessary to omit parts of the Scheme and to include * Any part of the scheme which has already been submitted for approval should- be referred to separately. 135 Report of the Medical Officer of Health. other proposals in substitution for or in addition to those mentioned on page 9. The scheme has been prepared without taking into consideration any proposals that may be made by private owners for the erection of houses and their sale to the Council, any such practical schemes which may be put forward and be favourably entertained by the Council will be subsequently submitted to the Ministry of Health for approval. The above scheme was adopted by the Wandsworth Borough Council at a Meeting of the Council held on the 15th October, 1919. [Signed] D. A. NICHOLL, Town Clerk In conclusion I am pleased to be able to report that during the year under review the whole of the staff of the Department have carried out their duties, which have been exceptionally onerous, in a most thorough and conscientious manner. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, P. CALDWELL SMITH.