WAN 64 Metropolitan Borough of Wandsworth. Annual Report health, sanitary condition, &c. OF THE BOROUGH, FOR THE YEAR 1920. BY P. CALDWELL SMITH, C.B.E., M.A., H.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 W. G. MEAD, "Putney News-letter" Office, 100, Upper Richmond Road, Putney, S.W.15. INDEX. PAGE Analyst, Report of 125 Anthrax Order 103 Appendicitis and Typhlitis 23 Bacteriological Examinations 123 Bakehouses 41 Births 2 Births and Birth-rates in Sub-Districts 2 Births, Notification of, Act 1 Brain and Nervous System, Diseases of the 22 Canal Boats Act 46 Cancer 22 Chemical Work 123 Census, 1911 1 Cerebro-Spinal Meningitis, Cases Notified 64 Cerebro-Spinal Meningitis, Deaths 18 Circulatory Diseases 22 Clapham, House-to-House Inspections in 35 Cleansing of Persons Act 131 Conscientious Objection Certificates granted 102 Contacts 78 Cowsheds 52 Creches 116 Cutting-off Notices 131 Death, Causes of 11 Death-rate, Corrected 9 Death-rate, Infantile 14 Deaths, Corrected and Uncorrected 9 Deaths, Number of 4 Deaths in Outlying Institutions 8 Deaths in Public Institutions 5 Deaths in Public Institutions in the Borough of Persons belonging to the Borough 7 Deaths in Public Institutions in the Borough of Persons not belonging to the Borough 6 ii PAGE Dental Treatment 116 Developmental Diseases 24 Diarrhœa19 Diarrhoea, Deaths and Death-rate from 19 Diarrhoea, Method of Feeding Children who died from 119 Diphtheria, Cases Notified 61 Diphtheria, Deaths and Death-rates 17 Diphtheria, Number of Dwellings in which multiple Cases occurred 63 Diphtheria, Report on Cases in Streatham 61 Diphtheria, "Return Cases" of 63 Disinfection 78 Disinfection of Schools 18 Dysentery Carriers 79 Dysentery, Cases Notified 77 Encephalitis Lethargica, Cases Notified 68 Encephalitis Lethargica, Deaths from 18 Enteric Fever, Cases Notified 64 Enteric Fever, Deaths and Death-rates 17 Erysipelas, Cases Notified 71 Erysipelas, Deaths 18 Factories and Workshops 40 Factories, Workshops and Workplaces, Inspection of 41 Food Places, Inspection of 41 German Measles, Cases of 71 Home Helps 121 Home Work 44 Hospitals and other forms of gratuitous relief 29 House Refuse, Collection and Disposal of 31, 37 House-to-house Inspections 35 House-to-house Inspections, Summary of 35 Houses and Premises Inspected 32 Houses Let in Lodgings 52 Housing 132 Housing, Town Planning, etc., Act, 1909 35 Ice Cream Premises 52 iii. PAGE Illegitimate Children, Births of 3, 112 Infant Visiting 106 Infantile Mortality 13, 11 Infective Diseases, Deaths from 16 Infective Diseases, Death-rate from 16, 17 Infective Diseases: Number of Cases Notified 57 Infective Diseases : Number of Cases notified from Elementary Schools 73 Infectious Disease, Prevalence and Control over 56 Influenza, Deaths and Death-rates 19 Influenza, Pneumonia and Acute Primary Pneumonia, Cases Notified 76 Inspections, details of 33, 34 Inquests 24 Isolation, Arrangements for 78 Malaria, Cases Notified 77 Malaria, Deaths from 18 Maternity and Child Welfare 104 Maternity and Child Welfare Centres 112 Maternity Home 109 Measles and German Measles, Cases Notified 71 Measles and other Non-notifiable Diseases reported from Schools 73 Measles, Deaths and Death-rates 19 Meat 51 Milk and Cream Regulations, 1912 49 Milk and Food 50 Milk (Mothers and Children) Order 50 Milk Premises, Cowsheds, etc., on Register 52 Milkshops, Cowsheds, &c., Inspections of 52 Milk Supply 48 Mistaken Diagnosis, Cases of 64 Mortuaries 27 Natural Increase, Rate of 2 Nervous System, Diseases of the 22 Non-Infective Diseases 22 iv. page Notification of Births Act 4 Notification of Infective Diseases 57 Offensive Trades 52 Old Age 24 Ophthalmia Neonatorum 117 Other Infective Diseases, Deaths from 21 Outworkers 44 Overcrowding 35 Physical Features and General Character of the Borough 2 Police Court Proceedings 37 Polio-Myelitis and Polio-Encephalitis, Cases Notified 71 Polio-Myelitis, Deaths from 21 Poor Law Relief, Amount of 29 Population 1 Population of Sub-Districts 1 Premature Birth 24 Public Institutions, Number of Deaths in 30 Puerperal Fever 117 Puerperal Fever, Deaths and Death-rates 18 Pulmonary Tuberculosis, Notification of Cases of 80 Putney, House-to-house Inspections in 35 Rabies 103 Rag Flock Act, 1911, Statement of Work done under 124 Rat Destruction 47 Respiratory Diseases 23 Return Cases of Scarlet Fever and Diphtheria 63 Revenue Act 131 Sale of Food and Drugs Act, Proceedings under 53 Sale of Food and Drugs Acts, Statement of Work under 52 Sanitary Conveniences, Inspection of 46 Sanitary Operations, Table of 32 Sanitary Inspection of District 31 Scabies 103 Scarlet Fever, Cases Notified 59 Scarlet Fever, Deaths and Death-rates 17 Scarlet Fever, Number of Dwellings in which Multiple Cases occurred 60 V. PAGE Scarlet Fever, " Return Cases" of 63 Scavenging 31 Schools 47 Schools, Disinfection of, for Infective Diseases 48 Slaughter-houses 52 Small-pox 102 Smoke Nuisances 32 Social Conditions 2 Staff 121 Streatham, House-to-house Inspections in 35 Tooting, House-to-house Inspections in 35 Trench Fever, Cases Notified 78 Tuberculosis Dispensaries 85 Tuberculous Diseases, After-care 92 Tuberculous Diseases, Cases Notified 80 Tuberculous Diseases, Deaths and Death-rates 20 Tuberculous Diseases, Results of Treatment 93 Underground Rooms 40 Unsound Food 51 Vaccination Returns 102 Violence, Mortality from 24 Vital Statistics of Whole Borough 13 Wandsworth, House-to-house Inspections in 35 Water Supply, Cutting-off Notices 131 Whooping Cough, Cases Notified 76 Whooping Cough, Deaths and Death-rates 19 Zymotic Diseases, Deaths from 16 Zymotic Diseases, Death-rate from 16, 17 REPORT of the Medical Officer of Health for the Year 1920. 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 1920. Population. The civil population of the Borough to the middle of 1920 has been estimated by the Registrar General to be 346,990 for the purpose of calculating death-rates and 347,588 for birth-rates. The population, uncorrected for Institutions, as estimated from an enumeration of the ration books, was found to be 351,370. 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 1920. Corrected. Uncorrected. Clapham 58,592 66,728 66,903 Putney 28,242 29,019 30,212 Streatham 96,192 107,184 107,520 Tooting 35,958 38,877 41,656 Wandsworth 92,376 101,000 105,079 Whole Borough 311,360 342,808 351,370 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. In my report for 1919 a short statement of the social conditions in the Borough was given, but this may be to' some extent altered during the last decennium. In 1921 the Census report will be available, and a short resume will be given in the report for that year. Births. During the year 1920, 7,212 births, 3,707 of males and 3,505 of females, occurred, compared with 5,441 in 1919. The total number of births in this Borough was 7,179, but 679 births occurred in Institutions outside the Borough of persons belonging to the Borough, and 646 births in Institutions in the Borough of persons not belonging to the Borough, making a corrected total of 7,212. 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 Boroue-h. TABLE II. Sub-Distriot BIRTHS. RATES. Males. Females. Total. Birth-Rate. Rate of natural increase. Clapham 708 652 1,360 20.38 9.82 Putney 240 267 507 17.47 6.52 Streatham 1114 1,100 2,214 20.65 10.56 Tooting 500 420 920 23.66 14.69 Wandsworth 1145 1,066 2,211 21.89 11.74 Whole Borough 3,707 3,505 7,212 21.03 10.67 3 Report of the Medical Officer of Health. The birth-rate was 21.03 per 1,000, compared with 16.40 for 1919, and 19.08 the decennial average. There was a considerable increase in the number of births during the year, Compared with the decennial average, and especially since 1915. 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. TABLE III. Year. Clapham. Putney. Streatham. Tooting, Wandsworth. Whole Borough. London. England and Wales. 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 1919 15.59 12.76 15.64 19.21 17 .63 16.40 18.3 18.5 Average for 10 yrs. 18.65 15.21 17.59 23.70 20.39 19.08 22.3 21.7 1920 20.38 17.47 20.65 23.66 21.89 21.03 26.3 25.4 111 births occurred in the Workhouse, 51 of which belonged to the Borough. 401 illegitimate births took place in the Borough, 33 in Clapham, 21 in Putney, 215 in Streatham, 27 in Tooting, and 105 in Wandsworth. 4 Report of the Medical Officer of Health. Of the 401 illegitimate births that occurred in the Borough, 151 belonged to the Borough, 26 to Clapham, 20 to Putney, 37 to Streatham, 19 to Tooting, and 49 to Wandsworth. 72 illegitimate births occurred outside the Borough, making a total of 223. The illegitimate births in nursing homes have again been allocated to the home addresses of the mothers. The percentage of illegitimate births to total births was 3.09. 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 1246 432 446 344 24 1239 17 Putney 452 134 144 166 8 451 14 Streatham 2297 645 912 625 115 2346 38 Tooting 942 118 274 524 26 960 15 Wandsworth 2136 316 1254 520 46 2183 39 Whole Borough 7073 1645 3030 2179 219 7179 123 The percentage of births notified, less still-births, to those registered was 98.6, compared with 98.6 in 1919. Deaths. During the year ending the 31st December, 1920, 3,080 deaths, 1,402 of males and 1,678 of females, occurred, compared with 3,552 in 1919, 5 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. Wandsw'tt Total. Hostel of God 73 ... ... ... ... 73 South London Hospital for Women 19 ... ... ... ... 19 Springfield Mental Hospital ... ... ... ... 96 96 Fountain Temporary Mental Hospital ... ... ... 25 ... 25 H. M. Prison ... ... ... ... 6 6 Swaffield Rd. Institution ... ... ... ... 13 13 Royal Hospital for Incurables ... ... ... ... 22 22 Tooting Bec Mental Hospital ... ... ... 332 ... 332 Grove Hospital ... ... ... 60 ... 60 The Priory ... 5 ... ... ... 5 Weir Hospital ... ... 9 ... ... 9 Putney Hospital ... 21 ... ... ... 21 Military Hospitals 1 5 ... 31 6 43 TOTAL 93 31 9 448 143 724 Other places 50 48 97 10 43 248 GRAND TOTAL 143 79 106 458 186 972 6 Report of the Medical Officer of Health. TABLE VI. Deaths in Public Institutions, &c., in the Borough, of Persons not belonging to the Borough, 1920. 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 Mental Hospital. Hostel of God. Swatfield Road Institution. H.M. Prison. Ryl. Hosp. for Incurables Fountam Mental Hospital. S.Lon. Hosp. for Women. Putney Hospital. Grove Hospital. Military Hospitals. Weir Hospital. The Priory. Other Places, not Public Institutions. Enteric Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 4 2 2 .. 1 3 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4 .. .. .. .. Scarlet Fever 16 5 11 .. 2 7 6 .. 1 .. .. .. .. .. .. .. .. .. .. .. 16 .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria and Membranous Croup 23 11 12 3 1 7 11 1 .. .. .. .. .. .. .. .. .. .. .. .. 23 .. .. .. .. Influenza 9 3 6 .. .. 1 3 .. 2 1 2 .. .. .. .. .. .. 3 .. .. .. 1 .. .. 5 Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Epidemic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pulmonary Tuberculosis 50 21 29 .. .. 1 3 9 28 8 1 21 3 15 .. 1 .. 3 1 .. .. 1 .. .. 5 Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis 1 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. Other Tuberculous Diseases 2 1 1 .. .. .. .. .. 2 .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. Other Infective Diseases 1 .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .1 Cancer, Malignant Disease 75 34 41 .. .. .. .. 1 8 38 28 3 3 45 .. .. 1 .. 4 1 .. .. 2 .. 16 Rheumatic Fever 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Diabetes 3 1 2 .. .. .. .. .. 1 1 1 1 .. .. .. .. .. .. .. .. .. .. .. .. 2 Other General Diseases 10 3 7 .. .. .. 1 .. 2 4 3 .. .. .. .. .. 6 .. .. .. .. 2 .. .. 2 Alcoholism .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chronic Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebral Haemorrhage, Apoplexy 29 16 13 2 .. .. .. .. 1 7 19 3 14 .. .. .. .. .. 1 .. .. .. .. .. 11 Convulsions .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases of Nervous System 80 53 27 .. .. 1 11 7 29 23 9 39 12 .. .. .. 3 10 .. .. .. 7 .. 2 7 Organic Diseases of Heart 48 23 25 .. .. 1 .. 1 2 25 19 7 20 2 1 .. 1 1 2 .. 1 1 .. .. 12 Other Diseases of Circulatory System 14 6 8 .. .. .. .. .. 3 6 5 .. 1 .. .. .. 1 .. 1 .. .. 2 .. .. 9 Bronchitis 15 1 14 1 .. .. .. .. .. 6 8 9 .. .. .. .. 2 .. .. .. .. .. .. .. 4 Broncho-Pneumonia 10 8 2 2 .. .. 2 .. 1 2 1 4 .. .. .. .. 2 .. .. 1 1 .. .. 1 Lobar Pneumonia 3 .. 3 .. .. .. 2 .. .. 1 .. .. .. .. .. .. .. 2 .. .. .. .. .. .. 1 Pneumonia (type not distinguished) 13 6 7 1 .. .. 1 .. 1 3 7 .. 9 .. .. .. 1 .. 1 .. .. .. .. .. 2 Other Diseases of Respiratory System 4 3 1 .. .. .. .. .. 1 2 1 .. 2 .. .. .. .. .. .. .. .. .. .. .. 2 Ulcer of Stomach 3 .. 3 .. .. .. .. .. .. 2 1 .. .. .. .. .. .. .. 1 1 .. .. .. 1 .. Diarrhœa .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..1.. .. .. .. .. .. Enteritis 2 .. 2 1 .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 Appendicitis and Typhlitis 4 2 2 .. .. .. 1 1 .. 2 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 3 Obstruction of Intestines 3 1 2 .. .. .. .. .. .. 1 2 .. .. .. .. .. 1 .. .. .. .. 1 .. .. 1 Cirrhos's of Liver 1 1 .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases of Liver 1 .. 1 .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases of Digestive System 6 3 3 .. .. .. .. .. 2 3 1 .. .. .. .. .. .. .. 1 .. 1 .. .. .. 4 Nephritis and Bright's Disease 11 5 6 .. .. .. .. 1 2 5 3 2 3 1 .. .. .. .. 1 .. .. .. .. .. 4 Other Diseases of Urinary System 2 1 1 .. .. .. .. .. .. 1 1 .. 1 1 .. .. .. .. .. .. .. .. .. .. .. Diseases of Generative System 2 .. 2 .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 Puerperal Fever 1 .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Other Accidents and Diseases of Pregnancy and Childbirth 3 .. 3 .. .. .. .. .. 3 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 2 Premature Birth 4 3 1 4 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4 Congenital Debility and Malformation 8 4 4 6 .. 2 .. .. .. .. .. .. .. .. 1 .. .. 2 1 .. .. .. .. .. 4 Other Diseases of Early Infancy 2 2 .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Old Age 271 96 175 .. .. .. .. .. .. 8 263 8 244 .. 2 .. 1 .. .. .. .. .. .. 1 15 Deaths from Accident 18 8 10 .. .. 1 3 2 3 1 8 .. 5 .. .. .. 1 .. .. 1 1 .. .. .. 10 Deaths from Suicide 11 8 3 .. .. .. .. 1 4 4 2 1 .. .. .. 1 .. .. .. 1 .. 1 .. .. 7 Other Violent Deaths 19 19 .. .. .. .. .. 5 14 .. .. .. .. .. .. .. .. .. .. .. .. 19 .. .. .. Other defined Diseases 2 2 .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. Ill-defined Diseases or unknown 4 3 1 1 .. .. .. 1 .. 1 1 .. .. 1 .. .. .. .. .. .. .. 1 .. .. 2 All causes 789 356 433 23 4 24 45 31 114 159 389 96 322 67 5 2 19 24 15 5 48 37 3 4 142 7 Report of the Medical Officer of Health. TABLE VII. Deaths in Public Institutions, &c., in the Borough, of Persons belonging to the Borough, 1920. 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. Tooting Mental Hospital. Hostel of God. Swaffield Road Institution. H.M. Prison. Ryl. Hosp. for Incurables Fountain Mental Hospital. S.Lon. Hosp. for Women. Putney Hospital. Grove Hospital. Weir Hospital. Military Hospitals. Other Places, not Public Institutions. Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Membranous Croup 11 7 4 ... ... 2 9 ... ... ... ... ... ... ... ... ... ... ... ... 11 ... ... ... Influenza 2 1 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 2 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebrospinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 7 4 3 ... ... ... ... 1 5 1 ... ... 2 ... 1 ... ... 1 ... ... ... ... 3 Tuberculous Meningitis 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Infective Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Cancer, Malignant Disease 20 6 14 ... ... ... ... ... 4 8 8 ... 3 ... ... ... ... 1 4 ... 1 ... 1 Rheumatic Fever 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ...:::... ... ... ... ... ... ... 1 Diabetes 2 1 l ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... 2 Other General Diseases 3 1 2 ... ... ... ... ... 1 1 l ... ... ... ... ... ... ... ... ... ... 1 ... Alcoholism 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Haemorrhage, Apoplexy 10 4 6 ... ... ... ... ... 1 1 8 ... ... ... ... ... ... ... ... ... ... ... 10 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Nervous System 9 5 4 ... ... ... 1 ... 1 5 2 ... ... 1 ... 1 1 ... ... 1 ... 2 3 Organic Diseases of Heart 16 6 10 ... ... ... ... ... ... 8 8 ... ... 2 1 1 ... ... 1 ... 1 ... 10 Other Diseases of Circulatory System 11 7 4 ... ... ... ... 1 4 3 3 1 ... ... 1 ... ... 1 1 ... ... 1 6 Bronchitis 6 ... 6 ... ... ... ... ... ... 2 4 1 ... ... ... ... ... 1 ... ... ... ... 4 Broncho-Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lobar Pneumonia 2 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Pneumonia (type not distinguished) 2 1 1 ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... 1 ... ... ... ... Other Diseases of Respiratory System 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Ulcer of Stomach 4 4 ... ... ... ... ... ... 2 2 ... ... ... ... ... ... ... ... 1 ... ... 2 1 Diarrhoea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteritis 4 1 3 4 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... 1 ... 1 ... ... Appendicitis and Typhlitis 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Obstruction of Intestines 3 1 2 1 ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 3 Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Liver 3 1 2 ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... 2 Other Diseases of Digestive System 2 1 1 ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... ... ... ... ... ... 1 Nephritis and Bright's Disease 5 2 3 ... ... ... ... ... 1 2 2 ... ... ... ... ... ... ... ... ... ... ... 5 Other Diseases of Urinary System 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... Diseases of Generative System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Other Accidents and Diseases of Pregnancy and Childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 10 6 4 10 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... 8 Congenital Debility and Malformation 8 4 4 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 Other Diseases of Early 2 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Infancy 15 4 11 ... ... ... ... ... ... ... 15 6 1 2 ... ... ... ... ... ... ... ... 6 Old Age 12 5 7 ... ... 1 3 1 2 4 1 1 ... ... ... ... ... ... 3 ... ... ... 8 Deaths from Accident 4 2 2 ... ... ... ... ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... 4 Deaths from Suicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Violent Deaths 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 Other defined Diseases Ill-defined Diseases or unknown 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 All causes 183 81 102 27 2 4 14 4 26 46 60 10 6 8 4 3 1 4 16 12 6 6 107 8 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, 1920. CAUSES OF DEATH. Deaths in or belonging to whole District at subjoined Ages. Deaths in or belonging to Localities (at all ages.) Institutions. All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. . 25 and under 45. 45 and under 65. 65 and upwards. Clapham. Putney. Streatham. Tooting. Wandsworth. Poor Law Infirmaries. General and Special Hospitals, &c. Public Lunatic and Imbecile Asylums. Metropolitan Asylums Board Hospitals. Enteric Fever 1 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 17 4 13 4 10 2 1 ... ... ... ... 4 3 2 1 7 15 2 ... ... Scarlet Fever 11 5 6 ... ... 2 6 1 2 ... ... 5 ... 3 ... 3 ... 1 ... 10 Whooping Cough 3 1 2 2 ... 1 ... ... ... ... ... 1 ... 2 ... ... 3 ... ... ... Diphtheria and Membranous Croup 49 30 19 1 3 14 29 2 ... ... ... 7 3 15 9 15 3 9 ... 44 Influenza 20 11 9 ... ... ... 1 ... 9 9 1 5 1 5 4 5 17 3 ... ... Erysipelas 3 2 1 1 ... ... ... 1 ... 1 ... ... ... 1 1 1 2 2 ... ... Cerebro-spinal Fever 3 1 2 ... ... ... 1 2 ... ... ... ... ... 3 ... ... ... ... ... ... Other Epidemic Diseases 2 2 ... ... ... ... ... ... ... 1 1 ... ... 1 ... 1 ... 2 ... 3 Pulmonary Tuberculosis 102 67 35 ... ... ... 3 23 43 31 2 21 6 27 17 31 43 43 12 ... Tuberculous Meningitis 16 9 7 ... ... 7 5 3 1 ... ... 4 1 4 3 4 5 9 ... 4 Abdominal Tuberculosis 4 3 1 1 1 1 1 2 1 1 1 3 2 Other Tuberculous Diseases 11 7 4 ... ... 2 2 3 3 ... 1 ... 1 5 1 4 5 6 ... ... Other Infective Diseases 7 7 ... 3 ... ... ... ... 3 1 ... ... 2 3 2 ... 3 4 ... ... Cancer, Malignant Disease 139 49 90 ... ... ... 1 1 21 59 57 30 15 41 13 40 70 68 1 ... Rheumatic Fever 3 2 1 ... ... ... 1 1 1 ... ... ... ... 2 ... 1 ... 3 ... ... Diabetes 5 4 1 ... ... ... ... ... 1 4 ... ... 1 1 ... 3 2 3 ... ... Other General Diseases 16 7 9 ... ... ... 2 7 ... 6 1 1 2 8 3 2 6 10 ... ... Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 8 6 2 2 ... 2 1 ... 1 2 ... 5 ... 2 1 ... 2 6 ... ... Cerebral Haemorrhage, Apoplexy 40 22 18 ... ... ... ... ... 3 25 12 5 2 17 4 12 26 13 1 ... Convulsions 3 2 1 3 ... ... ... ... ... ... ... 1 ... 1 1 ... ... 3 ... ... Other Diseases of Nervous System 60 37 23 1 ... 1 5 ... 27 16 10 12 6 20 2 20 18 21 21 ... Organic Diseases of Heart 177 79 98 ... ... ... 2 10 18 39 108 41 13 47 17 59 115 42 20 ... Other Diseases of Circulatory System 49 35 14 1 ... ... 3 3 11 17 14 17 1 5 6 20 20 24 4 l Bronchitis 41 20 21 5 ... ... ... ... 1 13 22 10 3 15 5 8 25 11 5 ... Broncho-Pneumonia 36 22 14 9 6 1 ... 3 1 10 6 6 4 15 8 3 15 18 3 ... Lobar Pneumonia 11 7 4 ... 1 ... ... 1 2 3 4 1 1 3 ... 6 3 4 3 1 Pneumonia (type not distinguished) 17 10 7 1 ... 1 1 1 3 9 1 4 1 6 1 5 10 4 2 1 Other Diseases of Respiratory System 6 2 4 ... ... 1 ... 1 ... 3 1 2 ... 1 ... 3 5 1 ... ... Ulcer of Stomach 6 6 ... ... ... ... ... ... 2 4 ... 2 1 1 ... 2 ... 6 ... ... Diarrhœa 5 3 2 5 ... ... ... ... ... ... ... 1 ... 1 1 2 1 4 ... ... Enteritis 26 16 10 23 1 ... ... ... ... 1 1 3 4 6 8 5 14 12 ... ... Appendicitis and Typhlitis 17 8 9 ... ... 2 1 5 5 4 ... 5 1 3 2 6 3 14 ... ... Obstruction of Intestines 11 7 4 1 ... ... 1 ... 1 1 7 4 2 1 ... 4 5 5 1 ... Cirrhosis of Liver 4 1 3 ... ... ... 1 ... 1 2 ... 1 ... 1 1 1 2 2 ... ... Other Diseases of Liver 7 1 6 ... ... ... ... 1 ... 5 1 ... ... 3 1 3 3 4 ... ... Other Diseases of Digestive System 15 8 7 4 ... 1 1 ... 2 5 2 1 ... 7 2 5 3 11 ... 1 Nephritis and Bright's Disease 42 26 16 ... ... ... ... 3 12 15 12 13 3 14 4 8 24 15 2 1 Other Diseases of Urinary System 32 28 4 ... ... ... ... ... 3 10 19 8 2 14 ... 8 15 17 ... ... Diseases of Generative System 7 ... 7 ... ... ... ... 1 1 4 1 1 4 ... ... 2 2 4 1 ... Puerperal Fever 10 ... 10 ... ... ... ... 3 7 ... ... 3 1 3 ... 3 7 2 ... 1 Other Accidents and Diseases of Pregnancy and Childbirth 1 ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 ... ... Premature Birth 22 13 9 22 ... ... ... ... ... ... ... 2 2 6 3 9 8 14 ... ... Congenital Debility and Malformation 30 19 11 27 2 ... 1 ... ... ... ... 7 3 9 3 8 16 14 ... ... Other Diseases of Early Infancy 4 2 2 4 ... ... ... ... ... ... ... 1 ... 1 1 1 1 3 ... ... Old Age 68 26 42 ... ... ... ... ... ... ... 68 12 6 24 5 21 55 9 4 ... Deaths from Accident 55 33 22 3 2 1 3 3 10 16 17 10 4 16 8 17 23 32 ... ... Deaths from Suicide 11 9 2 ... ... ... ... 1 5 5 ... 2 1 5 ... 3 2 9 ... ... Other Violent Deaths 2 2 ... ... ... ... ... ... 2 ... ... ... ... 1 ... 1 ... 2 ... ... Other defined Diseases 21 12 9 3 ... ... 2 1 4 6 5 5 2 7 3 4 7 12 2 ... Ill-defined Diseases or unknown 5 3 2 1 ... ... ... ... 1 2 1 1 ... 3 ... 1 1 4 ... ... All causes 1261 677 584 126 25 39 75 82 208 331 375 268 103 382 141 367 606 503 82 70 9 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 3,552, 1,723 of males, and 1,829 of females. The corrected death-rate for the year was 10.36, compared with 11.31 in 1919. The death-rate for the whole of London for the year was 12.4 per 1,000, compared with 13.4 in 1919. 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 346 359 705 237 320 557 10.56 Putney 147 171 318 125 142 267 10.95 Streatham 557 607 1164 358 454 812 10.09 Tooting 185 154 339 316 327 643 8.97 Wandsworth 488 538 1026 366 435 801 10.15 Whole Borough 1723 1829 3552 1402 1678 3080 10.36 The death-rate in England and Wales in 1920 was 12.4 per 1,000; in the 96 great Towns 12.5; and in the 148 smaller Towns 11.3. The rates in all the sub-districts were much lower than in 1919. 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 1920 were, respectively : 12.14 and 70, 13.1 and 83, 16.4 and 113, 13.0 and 97, 14.7 and 110, and 13.5 and 103. 10 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 was in 1910, in London in 1919, and in England and Wales in the year 1912. The rate in 1919 is lower than the average of the previous 10 years, and is the lowest ever recorded. 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. 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 1919 12.61 12.10 11.85 9.09 10.58 11.31 13.4 13.8 Average, 10 years. 12.38 11.58 11.54 11.27 12.29 11.87 15.08 14.0 1920 10.56 10. 95 10.09 8.97 10.15 10.36 12.4 12.4 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. 11 Report of the Medical Officer of Health. TABLE XI. Causes of, and Ages at Death, during the year 1920. CAUSES OF DEATH. Deaths in or belonging to whole District at subjoined ages. Deaths in or belonging to Localities (at all ages). Deaths in Public Institutions in the District. All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Clapham. Putney. Streatham. Tooting. Wandsworth. Enteric Fever 2 2 ... ... ... ... ... ... ... 2 ... 1 ... ... 1 ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 47 20 27 10 19 10 5 1 ... 2 ... 8 6 14 1 18 ... Scarlet Fever 11 5 6 ... ... 2 6 1 2 ... ... 5 ... 3 ... 3 16 Whooping Cough 19 7 2 8 2 8 1 ... ... ... ... 5 ... 5 1 8 ... Diphtheria and Membranous Croup 68 40 28 1 5 18 40 4 ... ... ... 8 4 24 15 17 34 Influenza 99 49 50 2 ... 1 2 6 27 30 31 17 7 49 8 18 11 Erysipelas 9 6 3 2 ... ... ... l 3 2 1 1 1 2 2 3 ... Cerebro-spmal Fever 4 2 2 ... ... ... 2 2 ... ... ... ... ... 3 ... 1 ... Other Epidemic Diseases 9 6 3 ... ... ... ... 1 3 3 2 1 1 3 ... 4 21 Pulmonary Tuberculosis 257 143 114 ... 1 ... 7 53 115 73 8 59 12 74 32 80 36 Tuberculous Meningitis 31 16 15 2 4 8 12 4 1 ... ... 7 1 7 5 11 1 Abdominal Tuberculosis 8 5 3 2 1 ... 1 2 l 1 ... 2 2 1 ... 3 1 Other Tuberculous Diseases 19 10 9 ... ... 2 4 6 4 1 2 3 1 7 1 7 2 Other Infective Diseases 13 11 2 6 ... ... ... ... 4 3 ... ... 3 6 2 2 1 Cancer, Malignant Disease 403 150 253 ... ... ... 1 3 41 177 181 81 43 131 29 119 95 Rheumatic Fever 15 8 7 ... ... ... 5 3 4 2 1 ... 2 8 1 4 2 Diabetes 29 19 10 ... ... ... ... 2 8 9 10 4 3 9 1 12 5 Other General Diseases 49 18 31 4 ... ... 2 2 11 13 17 8 6 19 4 12 13 Alcoholism 2 1 1 ... ... ... ... ... ... 2 ... ... ... ... ... 2 1 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 11 8 3 4 ... 2 1 ... 1 3 ... 6 1 2 1 1 ... Cerebral Haemorrhage, Apoplexy 181 79 102 ... ... ... ... ... 10 55 116 33 16 72 19 41 39 Convulsions 23 14 9 22 1 ... ... ... ... ... ... 4 ... 9 2 8 ... Other Diseases of Nervous System 121 73 48 1 1 3 10 8 33 30 35 27 15 38 7 34 89 Organic Diseases of Heart 435 194 241 ... ... 1 10 18 32 121 253 88 35 134 40 138 64 Other Diseases of Circulatory System 148 84 64 1 ... ... 5 6 17 45 74 39 14 45 11 39 25 Bronchitis 287 114 173 44 4 2 1 2 12 57 165 67 31 82 33 74 21 Broncho-Pneumonia 105 59 46 32 20 3 4 3 3 17 23 16 13 40 14 22 10 Lobar Pneumonia 45 25 20 4 3 ... ... 4 6 20 8 6 3 14 9 13 5 Pneumonia (type not distinguished) 77 40 37 11 4 5 2 3 12 24 16 15 7 20 8 27 15 Other Diseases of Respiratory System 31 11 20 2 ... 2 1 1 4 11 10 4 2 14 1 10 5 Ulcer of Stomach 12 12 ... ... ... ... ... ... 4 8 ... 4 1 3 1 3 7 Diarrhœa 12 10 2 12 ... ... ... ... ... ... ... 1 1 4 2 4 ... Enteritis 50 24 26 38 l ... 1 ... ... 5 5 8 3 15 8 16 6 Appendicitis and Typhlitis 18 9 9 ... 1 2 ... 6 5 4 ... 4 1 4 3 6 5 Obstruction of Intestines 24 13 11 2 ... ... 1 ... 1 3 17 8 6 3 ... 7 6 Cirrhosis of Liver 14 5 9 ... ... ... 1 ... 1 5 7 2 ... 7 1 4 1 Other Diseases of Liver 15 4 11 ... ... ... ... 2 1 8 4 2 2 5 1 5 4 Other Diseases of Digestive System 41 19 22 9 ... 1 3 1 3 9 15 8 2 12 3 16 8 Nephritis and Bright's Disease 106 57 49 ... ... 1 2 5 19 40 39 21 7 43 8 27 16 Other Diseases of Urinary System 43 38 5 ... ... ... ... ... 5 13 25 9 4 19 ... 11 3 Diseases of Generative System 11 ... 11 ... ... ... ... 1 1 7 2 2 5 1 ... 3 2 Puerperal Fever 14 ... 14 ... ... ... ... 4 10 ... ... 5 1 5 ... 3 2 Other Accidents and Diseases of Pregnancy and Child-birth 7 ... 7 ... ... ... ... 2 5 ... ... 2 ... 2 ... 3 3 Premature Birth 112 62 50 112 ... ... ... ... ... ... ... 20 9 3b 15 33 14 Congenital Debility and Malformation 99 62 37 94 3 ... 1 1 ... ... ... 20 7 29 11 32 16 Other Diseases of Early Infancy 24 13 11 24 ... ... ... ... ... ... ... 3 2 6 4 9 4 Old Afire 240 90 150 ... ... ... ... ... ... 1 239 46 21 77 20 76 285 Deaths from Accident 81 46 35 6 2 3 7 4 14 22 23 11 9 30 9 22 29 Deaths from Suicide 29 16 13 ... ... ... ... 1 11 11 6 5 5 12 1 6 17 Other Violent Deaths 3 3 ... 1 ... ... ... ... 2 ... ... ... ... 2 ... 1 20 Other Defined Diseases 30 17 13 5 ... ... 1 2 3 11 8 ... 3 11 4 6 2 Ill-defined Diseases or unknown 9 4 5 1 ... ... 1 ... 1 4 2 3 ... 4 ... 2 5 All causes 3552 1723 1829 462 72 74 140 165 440 854 1345 705 318 1164 339 1026 972 12 Report of the Medical Officer of Health. TABLE XII. Vital Statistics of Whole District during 1920 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. 1 2 3 4 5 6 7 8 9 10 11 12 13 1910 299,061 6,873 6,967 23.29 2,856 9.38 564 812 545 78 3,105 10.38 1911 308,156 6,555 6,699 21.73 3,456 11.02 669 989 823 122 3,776 12.25 1912 313,761 6,580 6,756 21.53 3,118 9.78 767 940 516 76 3,291 10.48 1913 321,340 6,679 6,838 20.87 3,344 10.04 822 1,066 605 88 3,588 10.95 1914 326,945 6,690 6,684 20.44 3,332 10.02 824 1,155 589 88 3,664 11.20 1915 331,556 6,210 6,383 19.25 3,949 11.72 1,012 1,252 590 92 4,189 12.67 1916 310.858 6,044 6,246 18.46 3,567 11.47 1,076 1,180 488 78 3,671 11.80 1917 300,787 4,696 4,936 14.72 3,547 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 1,306 1,511 417 89 4,407 15.07 1919 331,759 5,476 6,317 17.00 3,552 10.42 1,025 1,225 359 66 3,752 11.31 Average for 10 yrs. 313,494 6,025 6,250 19.15 3,492 11.00 913 1,146 537 86 3,725 11.88 1920 342,808 7,179 7,212 21.03 3,080 8.76 789 1,261 462 64 3,552 10.36 13 Report of the Medical Officer of Health. TABLE XIII. Infant Mortality. 1920. 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 oMnths and under 12 Months. Total Deaths under 1 year. All Causes— Certified 131 36 32 23 222 98 65 57 19 461 Uncertified ... ... ... ... ... ... 1 ... ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 1 5 5 11 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 4 ... 3 1 8 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... 2 ... ... ... 2 Tuberculous Meningitis ... ... ... ... ... ... ... 1 1 2 Abdominal Tuberculosis ... ... ... 1 1 ... 1 ... ... 2 Other Tuberculous Diseases.. ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... 1 3 ... 4 Convulsions 9 3 1 1 14 4 2 2 ... 22 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis 2 2 5 2 11 18 6 7 2 44 Pneumonia (all forms) ... 1 3 3 7 12 11 14 3 47 Diarrhœa ... ... 1 2 3 2 6 1 ... 12 Enteritis ... ... 3 1 4 10 9 11 4 38 Gastritis ... 1 ... 2 3 2 ... 2 1 8 Syphilis ... 1 ... 1 2 1 2 1 ... 6 Rickets ... ... ... ... ... ... ... 1 ... 1 Suffocation, overlaying 2 ... 1 ... 3 ... ... ... ... 3 Injury at birth 7 1 ... ... 8 ... ... ... ... 8 Atelectasis 4 ... ... ... 4 ... 2 ... ... 6 Congenital Malformations 7 3 2 ... 12 2 3 2 ... 19 Premature Birth 69 16 9 4 98 12 2 ... ... 112 Atrophy, Debility, and Marasmus 19 6 6 2 33 21 17 1 ... 72 Other Causes 12 2 1 4 19 8 3 3 2 35 Totals 131 36 32 23 222 98 66 57 19 462 Nett Births in the year, legitimate, 6,989; illegitimate, 223. Nett Deaths in the year of legitimate infants, 422; illegitimate infants, 40. 14 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 1 year. Percentage to total Deaths. Rate per 1,000 Births. 1910 1911 1912 1013 1914 1915 1916 1917 1918 1919 Average 10 years. 1920 Clapham 86 12.2 67 119 76 82 76 92 70 74 107 65 82 63 Putney 35 11.00 81 145 69 85 87 78 74 83 97 112 91 69 Streatham 132 11.34 64 99 58 74 86 76 66 73 71 58 67 60 Tooting 64 18.87 92 116 100 91 114 104 109 110 99 58 99 69 m Wandsworth 145 14.04 89 143 83 103 84 104 92 104 90 68 96 65 Whole Borough 462 12.98 78 122 76 88 88 92 78 89 89 66 86 64 INFANTILE MORTALITY PER 1,000 BIRTHS, 1858—1920. 15 Report of the Medical Officer of Health. The Infantile Mortality for the year is under that in 1919, and is the lowest infantile mortality ever recorded in the Borough. 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. The Chart shows the Infantile Mortality since 1858, and it will be seen that there has been a very great lessening of the mortality. TABLE XV. 1915 1916 1917 1918 1919 Five years' average. 1920 Rate per 1,000 births 92 78 89 89 66 83 64 Percentage of above:— Under one week 21.7 24.0 19.1 22.7 32.3 23.9 28.3 1 and under 2 weeks 5.1 8.0 6.3 3.6 8.6 6.3 7.8 2 and under 3 weeks 3.7 3.4 4.3 3.8 7.5 4.5 6.9 3 and under 4 weeks ... 4.4 4.1 3.8 2.6 3.9 3.7 5.0 Under 4 weeks 34.9 39.5 33.5 32.6 52.3 38.5 48.0 From 4 to 13 weeks 14.0 15.4 17.7 18.5 18.3 16.8 21.3 From 3 to 6 months 16.3 20.3 18.4 19.5 11.8 17.3 14.3 From 6 to 9 months 18.0 13.1 11.4 17.4 9.8 13.9 12.3 From 9 to 12 months 16.8 11.7 19.0 12.0 7.8 13.5 4.1 Under 12 months 100.0 100.0 100.0 100.0 100.0 100.0 100.0 The Infantile Mortality among legitimate infants was 60 per 1,000 legitimate births, and among illegitimate infants 179 per 1,000 illegitimate births, or nearly three times as great, 16 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. 1910. I9II. 1912. 1913- 1914. I9I5- " 1916. 1917. 1918. 1919. I920. 1920. No. above corrected average. No. below corrected average. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 12 10 11 11 13 22 5 13 3 7 11 ... 3 Diphtheria 16 34 18 18 41 53 55 37 35 41 68 31 ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 8 9 8 5 5 6 5 7 5 2 2 ... 4.4 Cont'd Fever 3 ... ... ... ... ... ... ... ... ... ... ... ... Puerpl. Fever 5 8 11 13 9 4 9 6 8 16 14 4.5 ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 4 10 5 6 11 9 5 6 7 1 9 2 ... Measles 44 230 51 116 26 152 22 129 45 18 47 ... 42 Whooping C 68 66 57 23 53 66 49 29 58 15 19 ... 32 Influenza 55 24 45 59 58 90 74 56 834 310 99 ... 69 Diarrhcea 88 350 85 168 186 125 95 78 96 58 62 ... 77 Tuberculous Diseases 351 389 366 355 389 434 396 424 455 342 315 ... 94 Cerebro-spinal Fever 3 3 1 1 1 20 16 11 8 9 4 ... 3.6 Other Infective Diseases 10 21 27 22 32 20 19 .21 18 12 22 .8 ... Totals 667 1154 685 797 824 1001 750 817 1572 831 672 ... 284 The total number of deaths from these diseases was 672, 131 in Clapham, 43 in Putney, 222 in Streatham, 78 in Tooting, and 198 in Wandsworth. From all infective diseases the death-rate was 1.96 per 1,000 (1.90 in Clapham, 1.48 in Putney, 2.07 in Streatham, 2.00 in Tooting, and 1.96 in Wandsworth). Report of the Medical Officer of Health. 17 The rate is much lower than in 1919, owing to the diminution in the number of deaths from Influenza, Pulmonary Tuberculosis, and Diarrhoea. The rate in 1914 was 2.21; in 1915, 3.01; in 1916, 2.36; in 1917, 2.71; in 1918, 5. 37; and in 1919, 2.50 per 1,000. The rate from the principal infective diseases, viz.:—Smallpox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever, and Diarrhoea, was .61 per 1,000 (.53 in Clapham, .48 in Putney, .60 in Streatham, .72 in Tooting, and .72 in Wandsworth), compared with .99 in 1914, 1.24 in 1915, .74 in 1916, .94 in 1917, .82 in 1918, and .42 in 1919. The rate for 1920 is higher than in 1919, but lower than the previous five years, owing to the increased number of deaths from Diphtheria. Scarlet Fever. The total number of deaths was eleven, and the death-rate per 1,000 .03. The case mortality was .75 per cent. Diphtheria. The total number of deaths was 68 (eight in Clapham, four in Putney, 24 in Streatham, 15 in Tooting, and 17 in Wandsworth), and the death-rate per 1,000 was .19. The case mortality was 6.1 per cent. Enteric Fever. The number of dfeaths was two, the death-rate was .005 per 1,000, and the case mortality eight per cent. The number of deaths from this disease was the same as in 1919, and was the lowest on record. B 18 Report of the Medical Officer of Health. Cerebrospinal Meningitis. Four deaths occurred from this disease (three in Streathain, and one in Wandsworth). Eleven deaths were Registered as having been caused by Meningitis (six in Clapham, one in Putney, two' in Streatham, one in Tooting, and one in Wandsworth). Four of these were of infants under one year, two from two and under five years, and five 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 or Pneumonococcal Meningitis. Encephalitis Lethargica. Six deaths occurred (one in Clapham, one in Putney, two in Streatham, and two in Wandsworth). One of the deaths was a person from 15 and under 25 years, one from 25 and under 45 years, two from 45 and under 65 years, and two over 65 years. Malaria. Three deaths occurred from Malaria; two of these contracted the disease in the Army, one in Mesopotamia and one in Salonica. The third contracted the disease in Nigeria. Puerperal Fever. Fourteen deaths occurred from this disease (five in Clapham, one in Putney, five in Streatham, and three in Wandsworth). The death-rate was .04 per 1,000, and the case mortality 38 per cent. Erysipelas. Nine deaths occurred from this disease during the year, Report of the Medical Officer of Health. 19 Measles. Forty-seven deaths occurred (eigfht in Clapham, six in Putney, 14 in Streatham, one in Tooting, and 18 in Wandsworth). Ten of the deaths were of infants under one year of age, 19 from one and under two years, 10 from two and under five years, five from five and under 15 years, and one over 15 years of age. The death-rate per 1,000 of population was .17, compared with .05 in 1919. Whooping Cough. Nineteen deaths (five in Clapham, five in Streatham, one in Tooting, and eight in Wandsworth) occurred during the year. Eight of these were of infants under one year of age, two from one and under two years, eight from two' and under five years, and one from five and undtr 15 years. The deathrrate was .05 per 1,000. Epidemic Influenza. Ninety-nine deaths (17 in Clapham, seven in Putney, 49 in Streatham, eight in Tooting, and 18 in Wand'sworth) occurred during the year. The death-rate was .28 per 1,000, and the number of deaths represents only 2.2 per cent, of the total mortality from all causes, compared' with 8.2 per cent, in 1919, and 19 per cent, in 1918. In Institutions in the Borough during the year only 11 deaths occurred, compared with 82 in 1919, and 143 in 1918. 20 of the dteaths, 11 of males and nine of females, occurred in institutions outside the Borough. 17 of these deaths occurred in Poor Law Infirmaries, and three in General and Special Hospitals. Diarrhœa. Sixty-two' deaths, 34 of males, and 28 of females, occurred from all forms of Diarrhoea and Enteritis during the year. Nine of the deaths occurred in Clapham, four in Putney, 19 in Streatham, 10 in Tooting, and 20 in Wandsworth. There was a slight increase in all the sub-districts, except Putney, compared with 1919. The number of deaths is 77 below the corrected decennial average. 20 Report of the Medical Officer of Health. The death-rate was .18 per 1,000 (in Clapham .13, in Putney .14, in Streatham .18, in looting .25, and in Wandsworth .20), compared with .17 in 1919, and .32 in 1918. Of the total number of deaths from Diarrhoea registered, 50, or 80 per cent., were of infants under one year. The number of deaths from Diarrhoea, Zymotic Enteritis, and Enteritis under one year, represents 10.8 per cent. of the total mortality at that age. Tuberculous Diseases. The total number of deaths from diseases of a Tuberculous nature was 315. 257 of the deaths were due to Pulmonary Tuberculosis, 31 to Tuberculous disease of the Brain, and 27 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 XVII. Sub-District. Pulmonary Tuberculosis. Other Tuberculous Diseases. Total. No. of Deaths Rate. No. of Deaths. Rate. No. of Deaths Rate. Clapham 59 .88 12 .18 71 1.06 Putney 12 .41 4 .14 16 .55 Streatham 74 .69 15 .14 89 .83 Tooting 32 .82 6 .15 38 .97 Wandsworth 80 .79 21 .21 101 1.00 Whole Borough 257 .75 58 .18 315 .93 Report of the Medical Officer of Health. 21 It is satisfactory to note that the rate from Pulmonary Tuberculosis was only .75 per 1,000, compared with .87 in the previous year, and .97, the average for the previous 10 years. There has been a considerable reduction in the mortality in all the sub-districts, compared with the decennial average. 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 XVIII. 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 Average for 10 yrs. 1920 Clapham 84 118 116 93 93 97 105 107 112 87 100 88 Putney 85 70 97 55 78 109 99 92 128 105 91 41 Streatham 65 85 73 76 71 83 90 102 115 92 85 69 Tooting 109 81 87 69 87 123 103 120 171 82 103 82 Wandsworth 108 88 112 109 122 103 114 129 126 77 109 79 Whole borough 88 91 96 88 93 99 102 112 122 87 97 75 The rate for 1920 is much the lowest on record. Other Infective Diseases. Thirteen deaths occurred (three in Putney, six in Streatham, two- in Tooting, and two in Wandsworth). Six were under one year of age, four from 25 and under 45 years, and three from 45 and under 65 years of age. Nine of the deaths were due to Syphilis, three to Septicemia and one to Pyaemia. Acute Polio-myelitis. No deaths occurred during the year. 22 Report of ike Medical Officer of Health. NON-INFECTIVE DISEASES. Cancer. The total number of deaths from Cancer and other malignant diseases was 403, 150 of males and 253 of females. 81 of these occurred in Clapham, 43 in Putney, 131 in Streatham, 29 in Tooting, and 119 in Wandsworth. The corrected death-rate was 1.17 per 1,000, and for the sub-districts as follows:—Clapham 1.21, Putney 1.48, Streatham 1.22, Tooting .74, and Wandsworth 1.17. One of the deaths occurred from five and under 15 years, three at 15 and under 25 years, 41 at 25 and under 45 years, 177 at 45 and under 65 years, and 181 over 65 years. The number of deaths is four above last year, and 17 above the corrected decennial average. Diseases of the Brain and Nervous System. From these diseases 336 deaths occurred, 70 in Clapham, 32 in Putney, 121 in Streatham, 29 in Tooting, and 84 in Wandsworth. Eleven of the deaths were due to Meningitis, 181 to Cerebral 1 hemorrhage or Apoplexy, 23 to Convulsions, three to Softening of the Brain, 32 to Paralysis, 14 to General Paralysis of the Insane, eight to Locomotor Ataxy, 14 to Epilepsy, and 50 to other diseases of the Nervous System. Circulatory Diseases. From the above group of diseases, 583 deaths occurred, 435 of which, 194 males and 241 females, were due to Organic disease of the Heart. 127 of these deaths occurred in Clapham, 49 in Putney, 179 in Streatham, 51 in Tooting, and 177 in Wandsworth. 327 of the deaths were of persons over 65 years of age. Report of the Medical Officer of Health. 23 Respiratory Diseases. The total number of deaths was 545, 108 in Clapham, 56 in Putney, 170 in Streatham, 65 in Tooting, and 146 in Wandsworth. 287 of the deaths occurred from Bronchitis, 45 from Lobar Pneumonia, 105 from Lobular or Broncho-Pneumonia, 77 from Pneumonia in which the exact form was not distinguished, and 31 from other diseases of the Respiratory Organs. 93 of the deaths were of infants under one year, 29 from one and under two years, 31 from two and under five years, 12 from five and under 15 years, eight from 15 and1 under 25 years, 13 from 25 and under 45 years, 129 from 45 and undter 65 years, and 222 over 65 years. The number of deaths is 82 under last year, and 89 under the corrected decennial average. Deaths from other Causes. From Appendicitis and Typhlitis 18 deaths, nine of males and nine of females, occurred. From Alcoholism, Acute and Chronic, two deaths, one male and one female, occurred; and 14, five of males and nine of females, from Cirrhosis of the Liver. From Nephritis and Bright's disease 106 deaths occurred, 57 of males and 49 of females. From Accidents and diseases of Pregnancy and Child Birth seven deaths occurred. This, addled to the number of deaths from Puerperal Fever—viz., 14—gives a total of 21 deaths after Child Birth, or a proportion of 2.9 per 1,000 births. Diabetes Mellitus was the cause of 29 deaths, 19 of males and 10 of females. 24 Report of the Medical Officer of Health. Premature Birth and Developmental Diseases. 2.35 deaths, 137 of males and 98 of females, were registered as having occurred from these diseases. 112 of the deaths were due to Premature Birth, 99 to Developmental diseases and 24 from other diseases of Early Infancy. 230 were of infants under one year, three from one and under two years, and two over two years. The number of deaths is 43 above last year, and 23 above the corrected decennial average. The number of deaths from these diseases in the Borough is shown mo,re in detail in an earlier part of this Report in Table XIII., which, deals with Infant Mortality. Old Age. 240 deaths, 90 of males and 150 of females, occurred from Old Age, 46 in Clapfaam, 21 in Putney, 77 in Streatham, 20 in Tooting, and 76 in Wandsworth. All the deaths except one were of persons over 65 years of age. Violence. 113 deaths, 65 of males, and 48 of females, occurred from Violence, 81 of the deaths being due to Accidental, and 29 to Suicidal causes,while three deaths were caused by other forms of Violence. Sixteen of the deaths belonged to Clapham, 14 to Putney, 42 to Streatham, 10 to' Tooting, and 28 to Wandsworth. Inquests. The next Table shows the number of Inquests held in the Borough during the year, and Table XX. the number of inquests held outside the Borough of persons belonging thereto. Report of the Medical Officer of Health. 25 TABLE XIX. INQUESTS. Sub-Districts. Whole Borough. i Clapham. Putney. Streatham. Tooting. Wandsworth. Deaths from Natural Causes 15 8 19 14 36 92 Accidental:— Falls — 1 3 6 1 11 Knocked down by motor vehicles 1 5 3 1 1 11 Drowning — 1 1 — — 2 Burns — — 1 1 — 2 Knocked down by horse vehicle — 1 — — — 1 Fall from motor cycle — 1 — — — 1 Struck by passing train — — 1 — — 1 Fall down stairs — — 1 — — 1 Suffocated whilst in epileptic fit — — 1 — — 1 Drug habit — — 1 — — 1 Fall from Retort House — — — — 1 1 Fall from back of coal cart — — — 1 1 Suffocated in bed with parents — — — — 1 1 Gunshot wounds — — — — 1 1 Suicidal:— Poisoning by coal gas 1 1 3 1 1 7 Drowning — 4 — 1 2 7 Hanging — 1 2 — 4 7 Cut throat 2 2 1 — — 5 Run over by passing train — 1 — — 1 2 Jumped in front of omnibus — — 1 — — 1 Poisoning by Spirits of Salts — 1 — — — 1 Poisoning by Cresolene 1 — — — — 1 Open Verdicts:— Found drowned — 1 — — — 1 Murder — — 1 — — 1 Totals 20 28 39 24 50 161 26 Report of the Medical Officer of Health. TABLE XX. INQUESTS. Sub-Districts. Whole Borough. Clapham. Putney. Streatham. Tooting. Wandsworth. Deaths from Natural Causes 7 2 9 3 7 28 Accidental:— Knocked down by motor vehicles 4 — 7 1 3 15 Falls 2 — 2 2 2 8 Knocked down by passing train — — — 4 4 Fall down flight of steps 2 — 1 1 — 4 Burns — — 2 — 1 3 Suffocated in bed with parents — 2 — — — 2 Fall from ladder — — 1 — — 1 Fall ffom scaffold 1 — — — — 1 Fall from swing boat — — — 1 — 1 Fall from roof — — — — 1 1 Fall from window — — 1 — — 1 Overdose of morphia — — — — 1 1 Injury to foot — 1 — — — 1 Crushed by crane — — — — 1 1 Thrown from motor cycle — — — — 1 1 Suffocated by bone in throat — — — — 1 1 Scalds — — — 1 — 1 Suffocated by Benzol vapour — 1 — — — 1 Electrocuted whilst at work — 1 — — — 1 Thrown from horse -- — 1 — — 1 Caught by revolving machinery 1 — — — — 1 Knocked down by tram car — — 1 — — 1 Drowning — — — 1 — 1 Suicidal:— Drowning — — 2 — — 2 Poisoning by Corrosive Sublimate — — 1 — — 1 Poisoning by Morphia 1 — — — — 1 Poisoning by Potassium — — — — 1 1 Poisoning by Nitric Acid — — 1 — — 1 Cut throat — — — — 1 1 Gunshot wound — 1 — — — 1 Fall from window — — 1 — — 1 Run over by train 1 — — — — 1 Open Verdicts:— Found drowned — — — 1 2 3 Totals 19 8 30 11 26 94 Report of the Medical Officer of Health. 27 Mortuaries. The Mortuaries in Clapham, Streatham and Wandsworth have been visited several times during the year, and I am able to report that the Bye-laws and Regulations have been carried out in a satisfactory manner. In Clapham, 17 bodies were removed to the Mortuary, in Streatham eight, and in Wandsworth 146—of which 44 were from Wandsworth, 26 from Putney, 24 from Tooting, 52 from Battersea—a total of 171. The new mortuary in Wandsworth was. opened on 1st Nov., 1920, and the following statement prepared by the Borough Engineer for the Public Health Committee, gives a description of the building and the accommodation and fittings. "The Mortuary is situated at the corner of York Road and Barchard Street, Wandsworth, and is constructed of hard stock bricks up to ground level, and of hard red sand faced facing bricks above ground level, with Broseley sand faced tiles on the roof. All internal walls of the main building are faced1 with white glazed bricks, with coved angles and skirtings, and with two course green glazed brick dado in Post Mortem Room, Mortuaries and Lobby. All internal painted woodwork is finished with white enamel. The building comprises the following rooms:— Post Mortem. Room.—20ft. long by 16ft. widje, fitted with two white glazed fire-clay adjustable revolving post-mortem tables; white glazed fire-clay Combination sink, lavatory basin, hopper and drainer. Hot and cold water is supplied through a rose spray operated by foot pedals. The waste from, the sink is also operated by pedals. Hot water is obtained by means of a geyser. A water tap with flexible hose is provided! for washing down purposes. The room is heated by a gas fire. Microscope Room.—8ft. 6in. long by 6ft. Sin. wide, for Pathological and Bacteriological examination, fitted with sink, hot and cold water supply, and heated with a gas radiator. 28 Report of the Medical Officer of Health. Mortuary.—20ft. long by 18ft. l0in. wide, fitted with a sixcompartment galvanised iron catacomb. The compartments of the catacomb have roller bearings for the easy insertion and removal of the coffin shells. A portable adjustable tilting viewing table and trolley combined is provided. The portable table is made of galvanised iron, mounted on solid rubber-tyred wheels. The shell containing the body to be viewed can be withdrawn from the catacomb and placed on the portable viewing table by one man, the table and shell wheeled to the viewing window, and tilted to any required angle. The portable table can also be used as required, for conveying bodies between the catacombs and the post-mortem tables. A formaldehyde preserving chamber has been installed. This apparatus (System de Rechter), disinfects and preserves the body placed in the chamber. Thje apparatus is provided with glass panels at the sides and top, and is lighted by electric light, thus enabling the body within to be readily viewed. Infectious Mortuary.—13ft. Tin. long by 13ft. 6in. wide, fitted with a four compartment galvanised iron catacomb, and an iron tank with waterseal, provided with glass panels in the top. This has been removed from the present Mortuary. A portable adjustable tilting viewing table and trolley combined, as before described, is provided. Viewing Corridor.—4ft. Gin. wide with a separate entrance, enables a body to be viewed by relatives or others, in either Mortuary, through clear glass screens, without entering the Mortuary rooms. Shell Room.—8ft. long by 6ft. 6in. wide, is provid'ed for the storage of empty shells. Clothing Store.—5ft. long by 4ft. Gin. wide, is provided for storing the clothing taken from bodies brought to the Mortuary. Office.—A small office is provided for the use of the Mortuary Keeper. Report of the Medical Officer of Health. 29 Lighting.—The building is adequately lighted by windows and electric light is provided to 20 points, which will give an efficient means of artificial lighting when required. Floors.—The floors of all the rooms are paved with Terrazzo marble, except the shell room and office, which are concrete paved. The Mortuary was designed, the plans and specifications prepared, and the work carried out under the direction of the Borough Engineer, and the fittings were selected after consultation with the Medical Officer of Health. The cost of the new Mortuary, with fittings and equipment complete, was approximately £7,500, including- £650 for the purchase of the Site." Amount of Poor Law Relief. The CHerk to the Board of Guardians has kindly given me the following information with reference to the above for the year ended 31st December, 1920:— (1) No. of admissions to the Poor Law Institutions 4,066 (2) No. of medical orders given 1,845 (3) Average No. of persons in receipt of outdoor relief 994 (4) Amount of outdoor relief given £15,365 The total number of deaths in Poor Law Institutions was 692, or 19 per cent, of the total deaths. Of these, only 19 deaths occurred in Poor Law Institutions in the Borough, and 673 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 thle year, and the number of deaths in each. 30 Report of the Medical Officer of Health. TABLE XXL 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—(contd.)— Poor Law Hospitals and Infirmaries— Wandsworth Union Infirmaries 606 Queen Charlotte Hospital 2 Swaffield Road Institution 8 Banstead Mental Hospital 18 Queen Mary's Hospital 3 Tooting Bee Mental Hospital 10 Cane Hill Mental Hospital 10 Royal Waterloo Hospital 3 The Fountain Mental Hospital 1 Caterham Mental Hospital 4 St. Antony's Hospital 2 Claybury Mental Hospital 2 St. Bartholomew's Hospital 8 Other Hospitals— Colney Hatch Mental Hospital 6 St. Columbus Hospital 4 H.M. Prison 4 Dartford Heath Mental Hospital 2 St. George's Hospital 21 Hostel of God 6 Han well Mental Hospital 3 St. Mary's Hospital 3 Putney Hospital 16 Long Grove Mental Hospital 20 .St. Thomas's Hospital 59 South London Hospital for Women 4 Neathern Mental Hospital 2 University College Hospital 7 Royal Hospital for Incurables 3 Victoria Hospital 16 Grove Hospital 12 Other Hospitals— West London Hospital 4 Weir Hospital 6 Belgrave Hospital 17 Westminster Hospital 11 Bethlem Royal Hospital 2 Western Hospital 24 Other Institutions, etc.— Bolingbroke Hospital 18 North Western Hospital 2 The Priory 1 Brompton Hospital 6 Park Hospital 4 Military Hospitals 6 Cancer Hospital 11 South Eastern Hospital 9 Other Places not Public Institution 23 Charing Cross Hospital 9 South Western Hospital 27 On Street 14 Chelsea Hospital 2 River Thames 2 Collindale Hospital 6 Nursing Homes 67 Evelina Hospital 5 Other Institutions, etc.— French Hospital 2 Camberwell House Asylum 2 183 Gt. Ormonde Street Hospital 4 Peckham House Asylum 5 Guy's Hospital 14 Other Institutions 83 Home Hospital 2 Other Places not Public Institution 96 Homoeopathic Hospital 6 On Railway 2 Infants' Hospital 6 On Street 15 King's College Hospital 8 River Thames 2 London Hospital 2 Private Nursing Homes 37 Middlesex Hospital 12 National Hospital 3 1,261 Nelson Cottage Hospital 2 Report of the Medical Officer of Health. 31 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 four contractors, and a weekly collection is provided' for in the contracts. Thie approximate quantity collected for the year ended 31st January, 1921, was 66,528 tons. This is disposed of partly by the contractors., and partly by direct labour at the Council's Destructor, as follows, viz.:— Tons. Barge 35,628 or 53.5 per cent. Rail 4,465 or 6.7 per cent. Shoots outside Borough 7,870 or 11.9 per cent. Refuse Destructor 18,565 or 27.9 per cent. Total 66,528 The above arrangements have proved satisfactory. SANITARY INSPECTION OF DISTRICT. During the year 594 inspections hiave been made by myself and1 the Assistant Medical Officer of Health, under the Housing Acts and the Public Health Act. 37 inspections were made for other purposes, 97 inspections were made on account of infectious diseases, 75 of which were to ascertain the present condition of cases of Malaria, Dysentery, and Trench Fever, 46 visits were paid to the Infant Welfare Centres, Creches, and the Maternity Home, and my attendance was necessary on six 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. 32 Report of the Medical Officer of Health. TABLE XXII. Summary of Sanitary Operations in the Borough during the Year 1920. Clapham. Putney. itrkath am Tooting. Wandsworth. Whole Borough. North Ward South Ward. Streat ham Ward. Balham I Ward South field Ware Fair field . Warr Spri'g field Ward Number of complaints received and attended to 633 374 602 535 578 822 702 351 656 5253 Number of houses and premises inspected 4760 3181 4230 6634 6971 6103 4527 2842 5562 44810 Number of houses and premise re-inspected 3059 1484 3511 2610 4445 4220 2345 2672 2844 27190 Number of house-to-house inspections 430 221 233 193 527 750 243 470 281 3348 Number of preliminary notices served 966 617 871 999 1204 1672 830 537 1425 9121 Ditto complied with 731 318 928 807 1196 1255 847 783 1132 7997 Number of statutory notices served 106 23 72 52 205 92 132 97 190 969 Ditto complied with 48 17 81 53 147 57 76 57 170 706 Notices served for periodica] removal of manure ... ... ... ... ... ... 1 ... 8 9 Number of rooms disinfected after infective diseases 433 543 538 943 880 727 707 523 772 6066 Bedding stoved 230 332 251 543 399 363 275 181 374 2948 Overcrowding abated 3 1 4 2 5 7 8 12 42 Rooms cleansed and repaired 1739 747 1388 1252 1642 1941 1321 1225 2051 13306 Staircases cleansed & repaired 307 166 245 261 407 546 223 133 446 2734 Drains cleansed and repaired 94 89 73 226 150 313 46 20 254 1265 Drains tested 628 196 295 533 548 738 532 646 834 4950 Drains found defective 44 7 18 84 72 74 30 29 32 390 Traps fixed to drains 39 38 10 29 33 56 2 207 Bath, lavatory & sink wastes altered to discharge outside over gullies or repaired 93 29 88 59 65 78 52 40 124 628 Rain water pipes disconnected from drains 15 3 28 3 3 8 1 6 7 74 Water closets cleansed and repaired 153 134 368 257 413 385 151 214 330 2405 Water closets, separate supply of water laid on to ... ... ... ... 1 1 ... ... ... 2 Accumulations of manure, etc. removed 27 16 35 48 22 19 9 8 31 215 Urinals cleansed, repaired or water laid on to 15 1 9 8 5 3 ... ... 9 50 Cesspools abolished ... ... ... ... ... ... ... ... ... ... Ashpits provided or repaired 170 108 140 166 258 238 174 192 249 1695 Dust complaints received 9 24 137 51 21 10 108 51 52 463 Stables and stables yards drained, paved or cleansed 26 1 7 25 7 15 2 2 27 112 Yards drained, paved or cleansed 191 78 162 97 123 252 66 86 141 1196 Unwholesome or dilapidated houses cleansed or repaired ... 7 10 4 6 3 ... ... ... 30 Leaky roofs & gutters repaired 328 200 175 242 221 235 172 260 217 2050 Damp courses inserted 130 55 33 36 34 52 25 42 15 422 Damp conditions remedied 354 144 159 328 132 198 143 258 169 1885 Houses re-supplied with water 6 2 20 11 7 15 1 7 ... 8 76 Water cisterns cleansed, covered or repaired 36 26 85 61 29 33 22 13 64 369 Animals kept so as to be a nuisance 27 6 6 17 13 6 9 6 15 105 Smoke nuisances reported 5 5 3 4 17 Soil pipes repaired 23 5 27 22 21 20 14 11 19 162 Unclassified nuisances 281 117 310 178 138 320 68 130 146 1688 Report of the Medical Officer of Health. 33 TABLE XXIII. DETAILS OF INSPECTIONS AND RE-INSPECTIONS, 1920. (Male Inspectors). 1 inspections. Re-Inspections. Total. No. of complaints received and attended to 5,253 ... 5,253 No. of house-to-house inspections 3,348 ... 3,348 Drainage and other sanitary works after notice 4,185 19,012 23,197 Drainage and other sanitary works voluntary 364 345 709 No. of premises inspected on account of:— Notifiable diseases 4,354 201 4,555 Measles 2,005 ... 2,005 Whooping Cough 765 ... 765 Pulmonary Tuberculosis 95 ... 95 Other Infective Diseases 858 ... 858 Verminous conditions 278 7 285 Periodical Inspections:— Houses-let-in-Lodgings 292 389 681 Closed underground rooms ... ... ... Common Lodging Houses 3 ... 3 s. Work-places. Factories 396 190 586 Workshops 506 129 635 Workshops (Domestic) 139 48 187 Work-places 248 121 369 Outworkers' premises 64 37 101 Bakehouses 278 143 421 Restaurant kitchens 106 10 116 Cowsheds 24 2 26 Food-place Piggeries 60 11 71 Dairies and Milkshops 339 3 342 Ice Cream Premises 231 1 232 Slaughterhouses 110 2 112 Places where food is prepared 66 1 67 Offensive trades 71 ... 71 Fried Fish shops 103 ... 103 Rag and bone stores 33 1 34 Butchers' shops 224 4 228 Greengrocers' Shops 103 ... 103 Fishmongers' shops 146 10 156 Public House urinals 163 2 165 Other sanitary conveniences, schools etc. 166 2 168 Smoke observations 47 6 53 Unsound food 129 12 141 Yards of Mews and Stables 313 42 355 Legal proceedings:— (1) Applications and summonses 26 ... 26 (2) Hearings and adjournments 85 ... 85 Other 809 21 830 Totals 26,785 20,752 47,537 C 34 Report of the Medical Officer of Health. TABLE XXIV. DETAILS OF INSPECTIONS AND RE-INSPECTIONS, 1920. (Female Inspectors). Inspections. Re-Inspections. Total. No. of complaints received and attended to 20 ... 20 No. of premises inspected on account of:— Puerperal Fever ... 2 2 Measles 26 18 44 Whooping Cough 12 5 17 Ophthalmia Neonatorum 5 ... 5 Diarrhoea ... ... ... Pulmonary Tuberculosis 1,614 156 1770 Other forms of Tuberculosis 402 16 418 Notification of Births — 26 26 Dressmakers' and Milliners' premises. 274 7 281 Laundries— Factory 104 2 106 Workshop 119 11 130 Workplaces 81 16 97 Other Factories 106 6 112 Other Workshops 138 3 141 Other Workplaces 163 6 169 Domestic Workshops 57 11 68 Outworkers' premises 465 16 481 Other 365 16 381 Totals 3,951 317 4268 Report of the Medical Officer of Health. 35 HOUSING, TOWN PLANNING, &c., ACT, 1909. TABLE XXV. 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 430 428 99.53 32 103 207 294 Clapham, South 221 206 93.21 12 18 88 183 Putney 233 233 100.00 25 85 161 112 Streatham 193 184 95.33 26 63 144 112 Balham 527 493 93.54 58 146 445 361 Tooting 750 684 91.20 38 75 380 606 Southfield 243 214. 88.06 42 18 137 161 Fairfield 470 382 81.27 83 44 209 327 Springfield 281 267 95.02 24 61 149 195 Whole Borough 3,348 3,091 92.32 340 613 1,920 2,351 The cases of overcrowding were in Cambray Road, Heath Road, Nursery Street, and Park Place, Clapham; Lutheran Place, Natal Road, Zennor Road, Leverson Street, Streatham; in Letchworth Street, and Trevelyan Road, Tooting; in Brathway Road, Camborne Road, Point Pleasant, Lavenham Road, Coliston Road, Bridgefield Grove, Bramford Road, York Road, Inman Road, Ald'ren Road, Ca.rgill Road, Bendon Valley, Capern Road, Burtop Road, Garratt Lane, Aslett Street, Malva Road, and Lydden Grove, Wandsworth. 55 notices of reconstruction of drains were sent to the Borough Engineer from this Department: 17 in Clapham, four in Putney, 13 in Streatham, five in Tooting, and 16 in Wandsworth, 36 Report of the Medical Officer of Health. 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 inspecton in order to determine if the houses are in such a condition as to be unfit for human habitation. During the year 3,348 house-to-house inspections were made by the Sanitary Inspectors, and in 3,091 nuisances were found necessitating the service of sanitary notices. Of thje 62 premises reported in 1919 as unfit for human habitation, two have been closed, and three have been rendered fit for habitation and the closing orders determined. The total number of houses where the drains were reconstructed during the year was 131; 28 in Clapham, 19 in Putney, 31 in Streatham, seven in Tooting, and 46 in Wandsworth. During the year 4,950 drains of houses were tested by the Sanitary Inspectors, 824 in Clapham, 295 in Putney, 1,081 in Streatham, 738 in Tooting, and 2,012 in Wandsworth, and 390, or 8.73 per cent. were found to be defective. Of the 390 found defective, 51 were in Clapham, 18 in Putney, 156 in Streatham, 74 in Tooting, and 91 in Wandsworth. A large amount of work has again been carried out to abate nuisances arising from damp conditions. In all, 1,885 premises have been dealt with, 498 in Clapham, 159 in Putney, 460 in Streatham, 198 in Tooting, and 570 in Wandsworth; and in 422 of these, 185 in Clapham, 33 in Putney, 70 in Streatham, 52 in Tooting, and 82 in Wandsworth, damp courses have been inserted. Report of the Medical Officer of Health. 37 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. 162 statutory notices were served under Section 37 of the Public Health (London) Act, 1891, to provide ashpits in accordance with the Bv-laws, and these have been complied with. Police Court Proceedings. The list which follows shows particulars of Police Court proceeding's under the Public Health (London) Act, 1891. The total amount of fines inflicted was £58 6s., and the costs £49 1s. 6d. 38 Report of the Medical Officer of Health. TABLE XXVI. Premises. Offences. Result. Fine. Costs. 31, Hendham Road, Wandsworth Absence of a water supply to the premises Order made for abatement of nuisance ... 21/- 15, Leverson Street, Streatham Choked drain Summons withdrawn, the work having been done ... 2/- 8—14, Larch Road, Balham Nuisances Do. ... ... 4 and 8, Zennor Road, Balham Do. Order made for abatement of nuisance ... 25/- 7, Union Road, Clapham Do. Do. ... 5/- 47, Gleneagle Road, Do. Summons withdrawn, ... Streatham Contravention of Bylaws (water closets) the work having been done ... 42/- Convicted 100/- 21/- 13, 25, 27, 29, 31, & 33, Fernlea Road, Balham.. Nuisances Summonses withdrawn, the work having been done ... 100/- 29, 31, 35, 37, & 39, Bective Rd., Wandsworth Do. Do. ... 63/- 15 & 17, Thorndean Street Wandsworth Do. Do. ... 6/- 4, Gaskell Street, Clapham Do. Order made for abatement of nuisance ... 23/- 25 & 25a, Deodar Road, Do. Do. ... ... Putney Contravention of By laws (water closets) Non-compliance with order 400/- 42/- Convicted 60/- 23/- 6, Totterdown Street, Tooting Exposing unsound figs for sale Summons dismissed ... ... 10, Werter Road, Putney Nuisance Order made for abatement of nuisance ... 2/- 19, Ruvigny Gardens, Putney Do. Summons withdrawn, work having been done ... ... 47, Trinity Road, Upper Tooting Do. Order made for abatement of nuisance ... 10/6 42, Stonhouse Street, Clapham Do. Do. ... 10/6 144, High Street, Tooting Do. Do. ... 12/6 Contravention of Bylaws yard paving anc W.C's.) Convicted 52/- 100/- Non-compliance with order 105/- 21/- 146, High Street, Tooting Nuisances Order made for abatement of nuisance ... 12/6 Non-compliance with order 105/- 21/- Contravention of Bylaws (yard paving) Convicted 10/- 10/- 158, High Street, Tooting Nuisances Order made for abatement of nuisance ... 12/6 Non-compliance with order 105/- 21/- 160, High Street, Tooting Nuisances Order made for abatement of nuisance ... 12/6 Non-compliance with order 105/- 21/- Report of the Medical Officer of Health. 39 TABLE XXVI.—(contd.) Premises. Offences. Result. Fine. Costs. 2, Alford Road, Clapham Nuisances Summons withdrawn, the work having been done ... 21/- 26, Mount Nod Road, Streatham Do. Summons withdrawn, the premises having been sold ... ... 3, Mitcham Lane, Streatham Do. Summons withdrawn the work having been done ... 2/- 27, Eltringham Street, Wandsworth Do. Do. ... 12/6 2, Cicada Road, Wandsworth Do. Do. ... 2/- 18, Putney Bridge Road, Wandsworth Do. Order made for abatement of nuisance ... 5/- 74, Cicada Road, Wandsworth Do. Summons withdrawn the work having been done ... 2/- 76, The Grove, Wandsworth Do. Do. ... 2/- 25a, Daphne Street, Wandsworth Do. Order made for abatement of nuisance ... 12/6 179 & 197, Clapham Park Road Do. Summonses withdrawn, the work having been done ... 4/- 40, Dendy Street, Balham Contravention of Bylaws (yard paving) Do. ... 21/- 28, Rossiter Road, Balham Nuisances Order made for abatement of nuisance ... 7/- 38, Dagnan Road, Balham Do. Do. ... 10/6 6 & 15, Tooting Grove, Do. Do. ... 5/- Tooting Non-compliance with order 84/- 21/- 78, B rod rick Road, Wandsworth Do. Summons withdrawn the work having been done ... 2/- 43, Bucharest Road, Wandsworth Do. Order made for abatement of nuisance ... 10/6 101, Norroy Road, Putney Do. Summons withdrawn the work having been done ... 4/- 94, 96 & 98, Gauden Rd., Clapham Do. Do. ... 69/- 1—7, Charlotte Place, Clapham Do. Order made for abatement of nuisance ... 51/6 Contravention of BYlaws (yard paving and W.C's.) Convicted ... 20/6 6, Bellamy Street, Balham Nuisance Summons withdrawn the work having been done ... 23/- 19, Culverden Road, Balham Do. Order made for abatement of nuisance ... 10/6 17, Larch Road, Balham Do. Convicted 40/- 21/- 5, Galesbury Road, Wandsworth Do. Summons withdrawn the work having been done- ... 2/- 40 Report of the Medical Officer of Health. 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 1919, 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. 41 Report of the Medical Officer of Health. INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. TABLE XXVII. CLASS OF WORKS. Number of Places. Number of Inspections, 1920. Number of Notices. Number of Prosecutions, 1920. On Register at end of 1919. Added in 1920. Removed in 1920. On Register at end of 1920. Intimation, 1920. Statutory, 1920. Under Factory Act. Under Public Health Act. Premises Rooms. Factories Factory Laundries 75 4 3 76 302 124 1 ... ... ... Factory Bakehouses 54 5 ... 59 79 140 3 ... ... ... Other Factories 431 37 33 435 1387 718 46 3 ... 1 Workshops Workshop Laundries 87 2 18 71 219 130 3 ... ... ... Workshop Bakehouses 82 ... 3 79 79 281 4 ... ... ... Other Workshops 1229 70 88 1211 1639 1321 85 4 ... ... Workplaces Places where Food is prepared for Sale 533 26 4 555 608 381 35 1 ... ... Workplaces other than the above 459 38 57 440 624 681 23 2 ... 1 Home-workers premises 449 111 87 473 473 582 31 ... ... ... Total 3,399 293 293 3,399 5,410 4 358 231 10 ... 2 42 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 XXVIII. 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.) 982 53 1 Workshops (Including Workshop Laundries.) 1,732 96 1 Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) 1,062 61 ... Totals 3,776 210 2 Report of the Medical Officer of Health. 43 TABLE XXIX. 2.—DEFECTS FOUND. PARTICULARS. Number of Defects Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts :* Want of Cleanliness 93 92 ... ... Want of Ventilation 1 1 ... ... Overcrowding 1 1 ... ... Want of drainage of floors ... ... ... ... Other nuisances 129 127 ... 2 insufficient 6 6 ... ... Sanitary accommodation unsuitable or defective 66 65 ... ... not separate for sexes 3 3 ... ... 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) 7 7 ... ... Other offences (Excluding offences relating to outwork, which are included in Part 3 of this Report.) ... ... ... ... Totals 306 302 ... 2 * Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. The Table which follows and which relates to Home Work, is similar to the one in last year's Report. 44 Report of the Medical Officer of Health. TABLE XXX. 3.-HOME WORK. NATURE OF WORK.* OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES. SECTIONS. 109. 110. Lists received from Employers. Notices served on occupiers as to keeping or sending lists. Prosecutions. Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Instances. Notices served. Prosecutions. instances. Orders made (S. 110.. Prosecutions SS.109,110). Lists† Outworkers -†- Lists Outworkers. Contractors. Workmen. Contractors. Workmen. (1) Wearing Apparel— (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (1) Making, etc. 88 82 266 4 3 31 43 ... ... 31 31 ... 30 ... ... (2) Cleaning and washing 2 4 4 ... ... ... ... ... ... ... ... ... ... ... ... Household Linen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, lace curtains and nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Curtains and 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, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Artificial Flowers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nets, other than wire-nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sacks ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Racquet and tennis balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper Bags and Boxes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brush making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pea picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carding, etc., of buttons, etc. ... ... ... 1 ... 3 ... ... ... ... ... ... ... ... ... Stuffed Toys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Basket making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 90 86 270 5 3 34 43 ... ... 1 31 31 ... 30 ... * If an occupier gives out work of more than one of the classes specified in column 1, and subdivides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. † The figures required in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarily be even numbers, as there will be two lists for each employer—in some previous returns odd numbers have been inserted. The figures in columns 3 and 4 will usually be (approximately) double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated. Report of the Medical Officer of Health. 45 The total number of addresses received from other Councils was 619, and 234 addresses were forwarded to other Councils. The number of addresses received has increased by 42, and the number sent increased by 13. 17 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 43, and these had a most satisfactory result. During the year 30 cases of infective diseases, five of Scarlet Fever, nine of Diphtheria, 11 of Measles, two of Pneumonia, and three of Whooping-cough, were notified as having occurred in the homes of outworkers. In none of these cases was it necessary to make any order under Section 110 of the Factory and Workshop Act. TABLE XXXI. 4—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number (1) (2) Workshop Bakehouses 79 Important classes of workshops, such as workshop bakehouses, may be enumerated here. ,, Laundries 71 Dressmakers' and Milliners' Workshops 169 Bootmakers Smiths 108 31 Builders 53 Tailors 66 Motor Engineers 31 Other 753 Total number of workshops on Register 1,361 46 Report of the Medical Officer of Health. TABLE XXXII. 5.—OTHER MATTERS. Class. Number. (i) (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory & Workshop Act (s. 133) 5 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 4 Reports (of action taken) sent to H.M. Inspector 4 Other ... Underground Bakehouses (s. 101) :— Certificates granted during the year ... In use at the end of the year 43 Inspection of Sanitary Conveniences. The number of Sanitary Conveniences inspected was 151, 36 in Clapham, 26 in Putney, 26 in Streatham, 12 in Tooting, and 51 in Wandsworth. 239 inspections were made during the year and 15 notices, chiefly for cleansing, were served and complied with; and 97 inspections of Sanitary Conveniences for females were made by the Female Sanitary Inspectors. Canal Boats Act. During the year eight 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. 47 Rats and Mice Destruction. The officer appointed by the Council to carry out the provisions of the Rats and Mice (Destruction) Act, commenced duty on the 23rd February, and from that date to the end of the year he made 2,715 visits to premises where complaints had been made of rat or mice infestation. 291 of the visits were in Clapham, 440 in Putney, 501 in Streatham, 497 in Tooting, and 986 in Wandsworth, and record was made of the destruction of 5,676 rats, 415 in Clapham, 542 in Putney, 1,073 in Streatham, 394 in Tooting, and 3,252 in Wandsworth. Judging by the above results, I am of opinion that the appointment of such an officer has been justified. It was found necessary to serve 18 notices on occupiers of premises which were rat infested, and these notices were complied with, but by far the greater number of occupiers carried out the instructions of the officer with successful results. Some difficulty was experienced in dealing with the rat infestation of some small areas inhabited by persons who were unable to> pay for the services of the Rat Officer, and the Public Health Committee gave instructions for the officer to do the work necessary in these cases free of charge. Very few cases of mice infestation have been brought to the notice of the Rat Officer. Schools. All the elementary Schools in the Borough were inspected as usual, and the sanitary conditions found to be satisfactory. 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 48 Report of the Medical Officer of Health. 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. 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 3.56 per cent., compared with 349 in 1919. So far as could be ascertained there has been no shortage of milk supplied to the Borough, the supply being equal to the demand. There are at present eight cowsheds and 441 milk retailers on the Register, and these have been regularly inspected during the year. Particulars of these are given in Table XXXIII. No action has been taken during the year with regard to tuberculous milk, as the London County Council has dealt with this matter for some years past. Report of the Medical Officer of Health. 49 REPORT ON ADMINISTRATION IN CONNECTION WITH THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. Report for the year ended 311st December, 1920. 1. Milk andi 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 886 Nil. Cream 41 1 Nature of preservative in each case in column (b). CREAM. One informal sample of Cream contained 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, and further samples were taken and found correct. 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 30 (2) Statements incorrect 3* Total 33 * Informal samples. Further samples were taken and found correct, D 50 Report of the Medical Officer of Health. (b) Determinations made of milk-fat in cream sold as Preserved Cream :— (1) Above 35 per cent. 33 (2) Below 35 per cent. Total 33 (c) and (d). In each of the 33 samples procured as Preserved Cream the provisions as to labelling were duly observed. (3) Thickening substances Nil. (4) Other observations Nil. Milk and Food. The Council decided on the 11th 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, 1½ 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 1920, 1,220 families were supplied with free milk at a cost to the Borough Council of £4,583. Free dinners were also granted to necessitous, 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. 70 mothers and 84 children were so helped during the year, arrangements being made with local eating houses in each district to provide the dinners at a cost of one Report of the Medical Officer of Health. 51 shilling per head for mothers and sixpence per head for children. This amounted during the year to £150. The total number of visits paid respecting the supply of milk and of meals amounted to 3,087. Meat. There are no public abattoirs in the Borough, and the Sanitary Inspectors periodically inspect the slaughterhouses and arrange as far as possible to be there on the days that slaughtering of animals takes place. 112 inspections of the 11 slaughterhouses were made during the year, and 1,617 carcases were examined by the Inspectors. No action has been taken with regard to unsound meat, and no carcases were condemned during the year. By far the greater proportion of the meat sold in the Borough has been inspected in the Central Markets before being sold to retailers. In 1914. In January, 1920. In December, 1920. Licensed slaughterhouses. 13 11 11 Unsound Food. 1,010 lbs. of rabbits, 12 turkeys, six geese, 12 fowls, 12 pheasants, one partridge, one wood pigeon, 1,244¼ lbs. of bacon, 1,158 lbs. of beef, 268 lbs. of mutton, one box of tripe, 44 lbs. of sausages, four boxes of roes, four boxes of rock salmon, 176 lbs. of mackerel, four boxes of whiting, nine barrels of herrings, one trunk of turbot, 398 lbs. of coal fish, 101 lbs. of haddock, one trunk of sea bream, one trunk of cod, three barrels of crabs, 15 boxes of kippers, one bag of winkles, 190 boxes of tomatoes, three bags of sprouts, six cwts. of potatoes, 1½ cases of apples, 52 Report of the Medical Officer of Health. 451 tins of condensed milk, 18 tins of fruit, 117 tins of tomatoes, 10 tins of pork and beans, 17 tins of corned beef, two tins of sardines, 10 tins of salmon, 11 bottles of pickles, 5¾ cases of eggs, eight pounds of butter, 43½ lbs. of cheese, and 113 bags of Chinese flour were condemned, and the usual certificates granted. Most of the bacon, beef, mutton and rabbits were sent to a fat melter in the Borough to be converted into glycerine. 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 XXXIII. PREMISES. NUMBER OF PLACES Number of inspections, 1920. Number of notices, 1920. Number of prosecutions, 1920. On register at end of 1919. Added in 1920. Removed in 1920. On register at end of 1920. Milk premises 434 32 25 441 442 18 1 Cowsheds 8 ... 5 3 26 1 ... Slaughter-houses 11 ... ... 11 112 2 ... Other offensive trade premises 4 ... ... 4 71 ... ... Ice cream premises 317 9 13 313 232 16 ... Registered houses let in lodgings 292 ... ... 292 681 *3a *76b 5 *a For overcrowding. *b For other conditions. Statement of work done under the Sale of Food and Drugs Acts. During the year 1,867 samples of foods and drugs were submitted to the Public Analyst for analysis. Of these samples 995 were purchased as test or informal samples, while 872 were purchased officially. Report of the Medical Officer of Health. 53 Of the 872 official samples submitted for analysis 67, or 7.6 per cent. were reported to be adulterated or not up to standard, and of those samples which were purchased informally or as test samples, 42, or 4.2 per cent. were found adulterated or not up to standard. The total adulterations reported were 109, or 5.8 per cent. of the samples submitted. The percentage of milk samples found to be adulterated was 7.5. In 40 out of the 67 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 £100, and the costs to £42 16s. 6d., making a total of £142 16s, 6d. 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 XXXIV. 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 160 13 8.1 178 8 45 338 5.0 21 6.2 Putney 76 9 11.8 106 6 5.6 182 6.3 15 8.3 Streatham 270 18 6.6 299 12 4.0 569 5.3 30 5.2 Tooting 101 10 9.9 105 7 6.6 206 5.0 17 8.2 Wandsworth 265 17 6.4 307 9 3.0 572 5.6 26 4.4 Whole Borough 872 67 7.5 995 42 4.2 1867 5.4 109 5.7 54 Report of the Medical Officer of Health. Milk and Cream. MILK. 886 samples of milk w,ere procured for analysis during the year. 68 or 7.5 per cent. were reported against as being adulterated or not up to legal standard. 865 samples were purchased officially, of which 62 or 7.0 per cent, were adulterated, and 21 samples purchased informally, of which six, or 28 per cent., were adulterated. 20 samples were found to contain added water, 21 were deficient in milk fat, eight were deficient in milk fat and contained added water, 11 contained colouring matter, and two contained both colouring matter and extraneous water. Proceedings were taken in 36 cases, and in 26 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. Three samples of milk were taken on delivery at various Public Institutions situated within the Borough. These samples were genuine. 17 samples of milk were procured whilst in transit from the farmer to the retailer, the samples being taken as the milk arrived at various railway stations within the Borough, both at mid-night and mid-day deliveries. Six samples were reported against, and proceedings were taken against the farmers, and convictions obtained. Three samples of milk were procured during the early morning from wholesale dealers whilst delivering milk to the retailer. These samples were genuine. 12 samples of milk were procured on delivery at private houses. One sample was reported against, and proceedings taken, the offence being proved against the roundsman, who was convicted and sent to prison for one month. Report of the Medical Officer of Health. 110 samples of milk have been taken on Sundays, either in the early morning or at mid-day. 11, or 10 per cent. were reported against as being adulterated. 390 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 40 or 10 per cent. were reported against. In 21 cases the defendants relied on a warranty, and in 11 of these the Magistrate was satisfied that the milk sold was in the same condition as received, and therefore dismissed the summonses. In three cases the Magistrate was not satisfied, and convicted the defendants, in one an order for the costs was made, and in one case where warranty was proved, proceedings were taken against the warrantor for giving a false warrant. The Magistrate, in dismissing the case, made the following remarks :— " I must dismiss this case. In a similar case to- this I convicted and the Sessions said I was wrong. "The consequences to London are serious. Pure milk is of the utmost importance to all, particularly to children. They will not get it whilst things remain as they are. " The farmer in the country warrants that his milk will arrive pure in London. He cannot, of course, see to it or control it. He cannot be convicted if he sends it off all right; that is the decision of the Sessions. The retailer cannot be convicted if he sells it as he receives it. The result is milk with 50 per cent, of water may be sold and no conviction follow. " I thought if the farmer warranted that which he could not perform he could be convicted, but the Sessions say he cannot be. If so, the position is hopeless, and the matter requires legislation. In my opinion the Borough Councils of London will never get things right till they one and all intimate that it is useless to prosecute until the law is put into a reasonable shape in this matter. " I should like to' add that the Vice-Chairman of the Sessions in giving his decision, said the case resembled that of a passenger who was not to be expected to look alter his luggage and see it was safe in transit. 56 Report of the Medical Officer of Health. " But I am afraid there is an analogy here which is quite unsound, as the passenger does not warrant the safety of the luggage, and if that is the ground of the decision, although I shall follow it, I do not agree with it." Milk and Cream Regulations. 41 samples of cream and 33 of preserved cream were submitted for analysis. Three informal samples of preserved cream were reported against. Further samples taken were found to be genuine. Butter and Margarine. BUTTER. 632 samples of butter were submitted for analysis during the year, of which 20, or 3.1 per cent., were reported against. MARGARINE. Nine samples of margarine were submitted for analysis, two 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. PREVALENCE AND CONTROL OVER INFECTIOUS DISEASES. Table XXXV. shows the cases of infectious diseases notified during the year. The total number of cases, less tuberculosis, was 4,820, 913 from Clapham, 304 from Putney, 1,359 from Streatham, 767 from Tooting, and 1,479 from Wandsworth—compared with 1,984 in 1919. The number appears high, but it includes 1,343 cases of whooping cough. Measles and German measles ceased to be notifiable diseases on 31st December, 1919, and any information as to the incidence of these diseases was obtained chiefly on Form 84 from the London County Council elementary schools. 57 Report of the Medical Officer of Health. TABLE XXXV. Wandsworth District. Cases of Infectious Disease notified during the year 1920. Notifiable Disease. No. of Cases Notified. Total Cases Notified in each Locality. Total cases removed to Hospital. At all Ages. At Ages—Years. Clapham. Putney. Streatham 'looting. 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) 1104 10 220 673 115 69 15 2 225 60 387 136 296 925 Erysipelas 173 5 2 12 20 57 60 17 35 12 39 19 68 28 Scarlet Fever 1463 2 204 1025 160 65 7 ... 286 136 391 240 410 1255 Enteric Fever 24 ... ... 4 5 9 6 ... 9 5 5 ... 5 14 Puerperal Fever 36 ... ... ... 9 26 1 ... 9 5 9 2 11 28 Cerebrospinal Meningitis 15 3 ... 6 4 ... 2 ... 2 3 3 7 13 Polio-Myelitis ... ... ... ... ... ... ... Ophthalmia Neonatorum 60 60 ... ... ... ... ... ... 19 4 11 5 21 28 Pulmonary Tuberculosis 634 1 4 38 162 297 122 10 104 52 180 97 201 ... Other forms of Tuberculosis 156 6 22 62 30 29 5 2 23 5 36 24 68 ... Whooping Cough 1343 130 477 722 6 7 1 ... 235 34 355 276 443 4 Encephalitis Lethargica 18 ... ... 1 3 8 5 1 1 2 5 3 7 12 Acute Influenzal Pneumonia 97 ... 3 11 12 30 31 10 19 4 38 18 18 ... Acute Primary Pneumonia 408 41 74 59 33 77 81 43 65 33 96 45 169 ... Malaria 68 ... ... 2 11 52 3 ... 7 7 14 18 22 ... Dysentery 8 ... ... 1 ... 7 ... ... 1 2 3 2 ... ... Trench Fever 2 ... ... ... ... 2 ... ... ... ... ... ... 2 ... Anthrax 1 ... ... ... 1 ... ... ... ... ... 1 ... ... 1 Totals 5610 258 1006 2616 571 735 339 85 1040 361 1573 888 1748 2308 58 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 XXXVI. 1910. 1911. 1912. 1913. 1914. !1915. 1916. 1917. I9l8. 1919. 1920. 1920. No. above decennial average. No. below decennial average. Scarlet Fever 687 869 833 971 1417 1309 690 566 563 893 1463 644 ... Diphtheria 284 510 431 430 552 723 531 435 487 525 1104 599 ... Enteric Fever 54 63 73 52 48 50 46 47 38 18 24 ... 27 Puerperal Fever 20 24 27 32 30 11 20 14 16 28 36 13 ... Erysipelas 182 202 207 204 234 195 157 103 95 143 173 ... 18 Cerebro-spinal Meningitis 5 5 3 9 3 47 28 26 21 13 15 ... 1.8 Polio-Myelitis ... 5 5 13 3 10 7 5 3 11 ... ... 7 Ophthalmia Neonatorum ... 34 35 37 51 44 32 29 35 54 60 19 ... Pulmonary Tuberculosis 289 514 855 783 706 646590 622 777 788 634 ... 56 Other Forms of Tuberculosis ... ... ... 328 199 234 216 193 218 163 156 ... 76 Compared with 1919 there has been an increase in the number of cases of scarlet fever, diphtheria, enteric fever, puerperal fever, erysipelas, cerebro-spinal meningitis, and ophthalmia neonatorum, and a decrease of polio-myelitis, pulmonary tuberculosis, and other forms of tuberculosis. Compared with the corrected decennial average there has been an increase in the number of cases of scarlet fever, diphtheria, puerperal fever, and ophthalmia neonatorum, and a decrease of enteric fever, erysipelas, cerebro-spinal meningitis, polio-myelitis, pulmonary tuberculosis, and other forms of tuberculosis. Report of the Medical Officer of Health. 59 Scarlet Fever. This disease was slightly more prevalent during the year, compared with 1919. In all 1,463 cases were notified, 286 in Clapham, 136 in Putney, 391 in Streatham, 240 in Tooting, and 410 in Wandsworth, compared with 893 in 1919. The rate per 1,000 of population was 4.16, 4.27 in Clapham, 4.5 in Putney, 3.6 in Streatham, 5.7 in Tooting, and 3.9 in Wandsworth. The disease was more prevalent in all parts of the Borough, compared with the previous 10 years, but it was slightly more prevalent in Tooting and Putney. The disease was of a very mild type, only 11 deaths having occurred, or a case mortality of only .75 per cent., which is exceptionally low. Thirty cases occurred in an institution in Clapham, and 28 cases among the nursing staff in an institution in Tooting. Of the total number of cases, viz.—1,463, 1,255 or 85 per cent., were removed to hospital. From January to August the number of cases notified was slightly above the average, but in September the numbers increased, and in October, November and December there was a widespread epidemic; 645, or 44 per cent. of the total cases during the year, having been notified in these three months. This epidemic was general over the whole of London. As will be seen in Table XLI., some schools were more affected than others, The Medical Officers of the London County Council made inspections of 17 schools during the year, and any suspected cases were at once excluded and the names forwarded to me for inquiry. 60 Report of the Medical Officer of Health. It will be seen that Hotham Road School, Putney, had a large number of cases, and although exclusions of suspects had been carried out, cases still occurred. In consequence of the continued prevalence in that school I advised the school to be closed from the 12th to the 29th November. Only six cases occurred after the 15th November to the end of the year. The number of dwellings in each sub-district and the whole Borough in which multiple cases occurred is shown in the following Table :— TABLE XXXVII. Sub-Districts. One case. Two cases. Three cases. Four cases. Five cases & upwards Total houses invaded Clapham 192 16 9 1 1* 219 Putney 97 10 5 1 ... 113 Streatham 264 41 12 1 1 319 Tooting 161 18 1 3 1† 184 Wandsworth 304 38 6 ... 2†† 350 Whole Borough ... 1018 123 33 6 5 1185 * In Clapham 31 cases occurred in an Institution. †t In Tooting 28 cases occurred in an Institution. †† In Wandsworth seven cases occurred in one house and five in another. Of the 1,185 houses invaded, multiple cases occurred in 167 or 14.09 per cent. Diphtheria. This disease was very prevalent during the year, especially in January, February, March, October, November and December*. The total number of cases notified was 1,104, 225 in Clap- Report of the Medical Officer of Health. 61 ham, 60 in Putney, 387 in Streatham, 136 in Tooting, and 296 in Wandsworth. The rate per 1,000 of population was 3.1, 3.3 in Clapham, 1.9 in Putney, 3.6 in Streatham, 3.2 in Tooting, and 2.8 in Wandsworth. The number of cases was 579 above the number in 1919, and 599 above the corrected decennial average. Of the 1,104 cases, 925, or 83 per cent., were removed to hospital. With the exception of a localised outbreak in Streatham, particulars of which are given in the following report, there was no special outbreak during the year :— Report on Diphtheria in Streatham. "The first case was notified on the 18th December, 1919, and was removed to hospital on the same day. This patient in all probability contracted the disease at a Cinema on the 15th December, 1919. The next case was notified on the 22nd of December, this patient having been in contact with the first case. This was followed by one on the 24th December, who occupied the same bedroom as the first case. No further cases occurred till January 15th, 1920, when one case was notified, followed by one on the 16th, two on the 20th, one on the 22nd, one on the 23rd, one on the 24th, one on the 29th, two on the 30th, one on the 2nd February, and two on the 9th; a total of 16, 12 of whom were in residence at the place of business. Swabbing of the throats of the contacts was carried out and those in whom positive results were obtained and in whom no clinical symptoms appeared, were isolated and kept under careful observation. Repeated swabs were taken, and not until negative results were obtained, were they allowed to resume their duties, 62 Report of the Medical Officer of Health. All the cases in whom clinical symptoms developed were of a mild type, no deaths having occurred. The premises were thoroughly inspected by myself and the Sanitary Inspector on several occasions, and nothing was discovered that would account for the outbreak except personal contact. The milk supply was inquired into, and it was reported that all milk supplied was sterilised. The usual disinfection was carried out by the staff. No fresh notifications have been received since the 9th February, but several of the bacteriological cases have been under observation up to the 1st March." In January and February some difficulty was experienced in having cases promptly removed to hospital, but during the rest of the year, cases were removed at once. With regard to schools the highest number of cases occurred among children attending Mitcham Lane School, the next Earlsfield School, and the third Eardley Road School. The following schools were visited by the Medical Officers of the London County Council, and swabs taken from the throats of some of the pupils examined. In Clapham, Stonhouse Street, St. Andrew's Street, Haselrigge Road, Cavendish Road, Clapham Parochial, and New Road Schools; in Putney, Hotham Road School; in Streatham, Sunnyhill Road, Oldridge Road, Mitcham Lane, Eardley Road, Hearnville Road, Hillbrook Road, Fircroft Roqad, and Broadwater Road Schools; in Tooting, the Ensham and Toot'ng Graveney Schools; and in Wandsworth, Garratt Lane, Swaffield Road, the Earlsfield, Brandlehow Road, and the RiversdaJe Schools. As a result of this swabbing 79 cases were found to be positive and 42 suspicious. Report of the Medical Officer of Health. 63 All the cases were swabbed again and not readmitted to school till found negative. Every positive or suspicious case was visited and all necessary precautions taken to prevent the spread of the disease. The number of dwellings in each sub-district and the whole Borough in which multiple cases occurred is shown in the next Table. TABLE XXXVIII. Sub-Districts. One case. Two cases. Three cases. Four cases. Five cases and upwards Total houses invaded Clapham 170 10 5 2 2* 189 Putney 39 6 3 ... ... 48 Streatham 275 36 8 4 ... 323 Tooting 104 7 I 2 1† 115 Wandsworth 232 19 6 2 ... 259 Whole Borough 820 78 23 10 3 934 * In Clapham seven cases occurred in an Institution, † In Tooting seven cases occurred in an Institution. Of the 934 houses invaded multiple cases occurred in 114, or 12.20 per cent. Return Cases of Scarlet Fever and Diphtheria. 57 cases of scarlet fever occurred after the return of cases from the hospitals of the Metropolitan Asylums Board, and there were also 13 cases of Diphtheria. 14 of the return cases of scarlet fever occurred in Clapham, seevn in Putney, 18 in Streatham, four in Tooting, and 14 in Wandsworth. Two of the return cases of diphtheria occurred in Clapham, seven in Streatham, and four in Wandsworth. 64 Report of the Medical Officer of Health. Enteric Fever. Twenty-four cases of enteric fever were notified during; the year, nine from Clapham, five from Putney, five from Streatham and five from Wandsworth. Two of the cases on admission to hospital were found not to be suffering from enteric fever. The number of cases is six above that of last year, but 27 below the corrected decennial average. Three of the cases were notified as para-typhoid fever, and all these recovered. Two of the cases contracted the disease abroad, and two had partaken of shell-fish about fourteen days previous to the onset of the disease. In the other 17 cases no definite history of infection could be obtained. Cases of Mistaken Diagnosis. In 55 cases (19 of scarlet fever, 27 of diphtheria, two of enteric fever, six of cerebro-spinal fever, and one of encephalitis lethargica) 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. Cerebrospinal Meningitis. During the year 15 cases of this disease were notified (two Clapham", three in Streatham, three in Tooting, and seven in Wandsworth). Thirteen of the cases were removed to hospital. The following Table gives particulars of these cases, 65 Report of the Medical Officer of Health. TABLE XXXIX. Cerebro=Spinal Fever. 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 Jan. 25 R. B., Yukon Road, Balham. 7 F Jan. 20 Jan. 28 – Yes Diplococci found No. — 2 Mar. 8 R. W., Tooting Bec Rd., Upper Tooting. 17 F Mar. 7 Mar. 13 — Yes Diplococci found No. — 3 Mar. 27 W. W., Astonville St., Wandsworth. 7 F Mar. 24 – Recovery complete Yes Diplococci found No. — 4 Mar. 16 I. L., Burr Road, Wandsworth. 10/ 12 F Feb. 19 Aug. 25 Certified as Hydro cephalus – Yes Diplococci found No. – 5 June 11 A. P., Romberg Rd., Balham. 16 M June 6 June 18 – Yes Diplococci found No. – 66 Report of the Medical Officer of Health. TABLE XXXIX.—(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. 6 July 8 F. Y., Strathville Rd., Wandsworth. 8 M July 6 Mistaken diagnosis. Certified as Pneumonia Recovered 7 June 26 G. R., Aboyne Road, Wandsworth. 12 M June 25 June 26 No. No. 8 July 7 J. K., Maskell Road, Wandsworth. 16 M July 3 Mistaken diagnosis. Certified as Chorea. Recovered 9 Sep. 11 W. F. S4 M Aug. 1 Sep. 13 — — — — — Defoe Road, Tooting. Cerebellar Abscess, p.m. 10 Dec. 17 V. A., 4112 F Nov. 28 Jan. 13 — — — — — Skelbrook Street, Wandsworth. Posterior Basic Meningitis. 11 Dec. 15 A. T., 5/12 M ? Dec. 17 — Yes No No. — Cowick Road, Tooting. Posterior ^Basic Meningitis. Diplococci Report of the Medical Officer of Health. 67 TABLE XXXIX.—(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. 12 Feb. 5 A. G., Crescent Lane, Clapham. 5 M Feb. 1 — Recovery. No after effects Yes Diplococci present. No. — 13 Sep. 1 J- J-, 46 M Aug. 17 Sep. 19 — — — — — The Polygon, Clapham. Chronic Nephritis. 14 Apl. 24 N. R., 17 F Apl. 24 April 26 — — — — Maybury St., Tooting. Tubercular Meningitis 15 Nov. 21 A. S., 8 M Nov. 1 Nov. 25 — — — — — Huntsmoor Rd., Wandsworth. Tubercular Meningitis. Of the two cases notified in 1919 which recovered, No. 8 is still well, and No. 9 has slight paralysis of the right leg, and is deaf, but otherwise in good health. 68 Report of the Medical Officer of Health. Encephalitis Lethargica. 18 cases were notified, one in Clapham, two in Putney, five in Streatham, three in Tooting, and seven in Wandsworth. 12 of the cases were removed to hospital. The following Table gives particulars of the cases. TABLE XL. No. of Cases. Date of notification. Name and address of patient. Age Sex. Date of onset. RESULT OF CASE. Results of Pathological Examinations if made. REMARKS. Date of death. Recovery with Tremors Athetosis. Mental condition. No after effects. Ocular Paraly.per.si sting. Permanent Paralysis or Paresis. I Jan. 9 J. C. C., Mellison Rd., Tooting. 38 M Nov. 27 Dec. 26 – — — — None made Lumbar puncture fluid normal 2 Jan. 7 O. B., Rozel Terr., Clapham. 19 F Dec. 31 Jan. 7 – – – – – None made – 3 Jan. 24 F. B., Hazelhurst Rd., Balham. 15 M Jan. 30 – Yes – – Good – At work 4 Jan. 12 A. J., Summcrley St., Wandsworth. 28 F Dec. 22 – Yes – – – Good – — 5 Apl. 22 W. G. H., Bassingham Rd., Wandsworth. 54 M Apl. 9 – — — Slight paresis of limbs – Good — – Report of the Medical Officev of Health. 6* TABLE XL.—(continued.) No. of Cases. Date of notification. Name and address of patient. Age. Sex Date of onset. RESULT OF CASE. Results of Pathological Examinations if made. REMARKS. Date of death. Recovery with Tremors Athetosis. 1 j Mental I con- | dition. No after effects. Ocular Paralysis persisting. Permanent Paralysis or Paresis. 6 May ii J. G., Bellevue Rd., Wandsworth. 62 M ? May 14 – — – — — None made — 7 July 16 A. M., Longley Rd., Tooting. 33 F June 26 – Yes – – – Good – – 8 July 19 C. J. B„ Clarendon Rd., Putney. 48 M July 5 July 16 – – – – None made – 9 Oct. 27 A. K., Tranmere Rd., Wandsworth. 41 M Aug. 2 – – – – Yes. L. face Good Still in bed. Under treatment. 10 Nov. 1) G. D., High Road, S treat ham. 28 F Nov. 15 Nov. 18 – – – – – None made – 11 Nov. 26 R. C, Trinity Rd., Up. Tooting. 79 M Oct. 30 Nov. 26 – – – – – None made – 12 Dec. IO A. K., Totterdoxvn St., Tooting. 33 M Xov. 15 – – – – – – – Still in M.A.B. Hospital 13 Dec. T3 W. P., Frog mo re, Wandsworth. <>3 M Nov. 26 Dec. 12 – – – – – None made – 70 Report of the Medical Officer of Health. TABLE XL.—(continued.) No. of Cases Date of notification. Name and address of patient. Age. Sex. Date of onset. RESULT OF CASE. Results of Pathological Examinations if made- REMARKS. Date of death. Recovery with Tremors. Athetosis. Mental condition- No after effects. Ocular Paralysis persisting. Permanent Paralysis or Paresis. 14 Dec. 24 J. H„ Cathles Rd., Balham. 63 M Nov. 30 — — — — — — — Still in bed. U nder treatment. 15 Dec. 18 C. W., Strathville Rd., Wandsworth. J9 F Dec. 10 — — — — — — — Still in St. Thomas's Hosp. Said to be improving 16 Dec. 29 W. J., Lacey Road, Putney. 35 M Dec. 12 Jan. 4 — — — — — None made — 17 Dec. 29 W. M., York Road, Wandsworth. 14 F Dec. 13 — — — — — — — Still in M.A.B. hospital 18 Mar. 17 Mrs. B., Norfolk Hse. Rd., Streatham. 40 F Feb. 20 Mar. 26 — — — — — — Died Chronic Nephritis Uraemia. Report of the Medical Officer of Health. 71 As will be seen from the Table, eight of the eases died from Encephalitis Lethargica, and one from Chronic Nephritis. Six of the cases are still under treatment, but recovering, and three have recovered without any after effects. Of the cases notified in 1919 Nos. 5, 7 and 8 are still in good health. Polio=myelitis and Polioencephalitis. No cases were notified during the year. Of the cases notified in 1919, No. 3 has right arm still paralysed; No. 1 has right leg still weak, but child is at school; No. 6 paralysis of left leg and foot continues with no improvement; No, 7 is recovering slowly; and No. 8 has dropped foot on right side, but is otherwise well. Erysipelas. 173 cases were notified (35 in Clapham, 12 in Putney, 39 in Streatham, 19 in Tooting and 68 in Wandsworth). Measles and German Measles. The notification of these diseases was discontinued at the end of 1919, but 70 cases were notified by doctors during the year, although the greatest number was reported by the teachers of the elementary schools. As will be seen from Table XLI. 2,155 cases were reported from this source, but the number reported is necessarily much under the number of cases that occurred, as there was no report from the numerous private schools in the Borough, and even from the elementary schools there were no reports during the summer vacation. Cases under five years of age are not reported unless the children are in attendance at school, and thi is only the case between four and five years. 72 Report of the Medical Officer of Health. From a comparison of the number reported under five years in the previous year, when notification was compulsory, there is a decided decrease. As by far the greatest mortality occurs under five years of age 1 am of opinion that further steps should be taken to obtain information, and 1 do not think any other method than the compulsory notification, as before, would be satisfactory. Fortunately the disease during 1920 was of a comparatively mild type, only 47 deaths taking place, 39 of these being under five years of age. In all 2,554 cases were reported, 44 under one year, 614 from one and under five years, 1,980 from five and under 15 years, and 16 over 15 years. 404 cases occurred in Clapham, 250 in Putney, 637 in Streatham, 206 in looting, and 1,057 in Wandsworth. Twenty-six of the cases were removed to the Metropolitan Asylums Board's hospitals on account of insufficient accommodation at home. 83 cases of German Measles were also reported (five in Clapham, three in Putney, 15 in Streatham, eight in Tooting, and 52 in Wandsworth). During the year 2,005 visits were made in cases of these diseases, 107 in Clapham, 202 in Putney, 561 in Streatham, 157 in Tooting, and 978 in Wandsworth). The total number of premises disinfected was 1,292 (142 in Clapham, 135 in Putney, 349 in Streatham, 97 in Tooting, and 569 in Wandsworth). Table XLI. shows the number of cases of infectious diseases notified by teachers of the elementary schools in the Borough. Report of the Medical Officer of Health. 73 TABLE XLI. SCHOOL. DISEASES. Scarlet Fever. Diphtheria. Measles. German Measles. Chicken Pox Whooping Cough. Mumps. Ringworm. Other Diseases. TOTALS. CLAPHAM. Aristotle Road 1 ... ... ... ... ... 1 ... 2 4 Bonneville Road 13 14 110 2 68 48 171 4 9 439 Cavendish Road 21 21 41 ... 22 26 11 7 36 185 Cavendish Road Special 1 ... 1 ... ... ... 1 ... ... 3 Christchurch 5 2 6 ... ... ... 2 3 9 20 Clapham Parochial, Macaulay Road ... ... 1 ... 1 3 2 ... ... 7 Clapham Parochial, Old Town.. 4 5 2 ... 1 2 2 ... ... 16 Haselrigge Road 28 22 54 ... 17 18 28 ... 94 261 Larkhall Lane 14 9 26 ... 20 7 4 6 22 108 New Park Road 36 4 54 2 45 26 14 3 25 209 New Road 3 2 2 ... 1 ... ... ... ... 8 St. Andrew's Street 9 7 3 1 5 ... 2 9 6 42 St. Mary's, Crescent Lane 1 2 10 ... ... ... ... ... ... 13 St. Mary's, St. Alphonsus Rd. 3 1 ... ... ... ... ... ... ... 4 Stonhouse Street 10 16 24 ... 13 11 42 1 16 133 Telferscot Road 18 13 86 ... 10 6 10 19 23 185 Telferscot Road Special 1 ... ... ... ... ... ... ... ... 1 Total 168 118 420 5 203 147 290 52 235 1638 PUTNEY. . All Saints' 3 2 16 ... 30 ... 11 1 2 65 Hotham Road 62 11 101 1 35 6 12 8 111 347 Roehampton National ... ... 5 ... ... ... 2 ... ... 7 St. Mary's 20 1 10 ... 1 ... ... 2 18 52 Upper Grade, Walker's Place 3 ... ... ... ... ... ... ... ... 3 Total 88 14 132 1 66 6 25 11 131 474 Carried forward 256 132 552 6 269 153 315 63 366 2112 74 Report of the Medical Officer of Health. TABLE XLI.—(continued) SCHOOL. DISEASES. Scarlet Fever. Diphtheria. Measles. German Measles. Chicken Pox Whooping Cough. Mumps. Ringworm. Other Diseases. S. Brought forward 256 132 552 6 269 153 315 63 366 2112 STREATHAM. Balham High Road 6 13 84 ... 4 6 2 9 2 119 Broadwater Road 18 11 19 ... 5 21 7 7 18 106 Christchurch 9 4 ... ... ... 1 3 ... ... 17 Coventry Hall ] ] ... ... ... ... ... ... ... 2 Eardley Road 29 26 3 3 5 8 24 3 38 139 Fircroft Road 5 10 ... ... 1 6 15 ... 1 38 Furzedown Demonstration 4 1 16 ... 3 1 15 3 ... 28 Hearnville Road 24 18 67 ... ... 20 ... ... 9 153 Hearnville Road Special ... 1 ... ... ... ... 15 ... ... 1 Hitherfield Road 1 2 26 1 8 8 ... ... ... 50 Holy Trinity, Balham 1 10 26 ... 2 15 4 1 2 59 Holy Trinity, Streatham 2 2 1 ... ... ... 2 ... 3 8 Immanuel 4 1 1 ... ... ... ... ... ... 6 Mitcham Lane 33 35 35 1 28 10 29 1 24 196 Nightingale Square R.C. ... 1 12 ... 1 ... ... ... ... 14 Oldridge Road 9 9 59 ... 9 17 11 5 93 212 Smallwood Road 16 6 16 1 19 21 5 4 14 102 St. Andrew's, Colmer Road 5 1 2 1 12 ... ... ... ... 21 St. Leonard's 9 9 8 2 6 8 ... 3 49 94 St. Mary's 8 2 34 2 4 23 5 2 4 84 Sunnyhill Road 21 19 72 ... 13 1 4 1 14 145 Total 205 182 481 11 120 166 126 32 271 1594 TOOTING. Ensham 33 16 13 ... 28 14 9 3 15 131 Fountain Road 9 3 1 ... 3 5 7 8 11 47 Fountain Road Special 1 ... ... ... ... ... ... ... ... 1 Franciscan Road 19 8 46 1 46 41 5 12 15 194 Hillbrook Road 17 11 7 ... 16 40 1 ... 6 98 Sellincourt Road 37 6 8 ... 20 11 8 6 77 173 Tooting Graveney 23 15 60 ... 14 56 15 10 49 236 Undine Street R.C. 6 3 ... ... 4 6 ... ... 1 20 Total 145 63 135 1 131 173 45 39 168 906 Carried forward 606 377 1168 18 520 492 486 134 805 4606 Report of the Medical Officer of Health. 75 TABLE XL1.—(continued) SCHOOL. DISEASES. Scarlet Fever. Diphtheria. Measles. German Measles. Chicken Pox Whooping Cough. Mumps. Ringworm. Other Diseases. TOTALS. Brought forward 606 377 1168 18 520 492 486 134 805 4606 WANDSWORTH. Allfarthing Lane 2 1 12 ... ... 1 28 ... 3 47 All Saints' 2 3 70 1 1 16 25 2 3 123 Brandlehow Road 20 21 66 1 31 5 113 2 26 285 Cambourne Road 4 3 23 1 1 3 7 7 8 57 Earlsfield 45 32 84 20 23 29 8 13 74 328 Elliott Central 3 ... ... ... ... ... ... ... ... 3 Eltringham Street 13 4 69 1 24 6 42 2 10 171 Frogmore Special 1 ... ... ... ... ... ... ... ... 1 Garratt Lane 6 18 21 9 5 28 14 19 120 Littleton Street Special 4 1 ... ... ... ... ... ... 1 6 Magdalen Road 7 2 4 1 1 9 7 1 2 34 Merton Road 16 5 21 1 2 6 1 4 2 58 Riversdale 11 9 23 1 11 17 31 3 8 114 St. Ann's 14 1 28 ... 2 11 22 7 8 93 St. Faith's 3 2 49 ... 14 9 42 8 14 141 St. Joseph's 1 2 15 ... 2 6 1 3 3 33 St. Michael's 7 3 57 1 4 4 13 4 1 94 Southfields 10 5 159 4 7 33 20 4 3 245 Swaffield Road 35 24 98 3 30 18 59 17 44 328 Waldron Road 25 6 74 3 23 10 1 14 31 187 Wandle 20 9 16 2 37 19 15 8 12 138 Warple Way 10 2 53 10 4 19 3 8 109 West Hill 15 12 45 2 22 9 38 1 12 156 Total 274 165 987 42 254 220 520 117 292 2871 Grand Total 880 542 2155 60 774 712 1006 251 1097 7477 76 Report of the Medical Officer of Health. Whooping Cough. 1,343 cases were notified (235 in Clapham, 34 in Putney, 355 in Streatham, 276 in Tooting and 443 in Wandsworth). 130 of these were infants under one year of age, 477 from one and under five years, 722 from five and under 15 years, six from 15 and under 25 years, and eight over 25 years. Four cases were removed to hospital. This disease was more prevalent in the Borough during the year, with the exception of Putney, in which there was a decrease in the number of cases notified. The disease was not very fatal, and there is no doubt that notification and visits paid by the Health Visitors have had a most beneficial effect in reducing the mortality. Influenzal Pneumonia and Acute Primary Pneumonia. During the year 97 cases of Influenzal Pneumonia were notified, 19 in Clapham, four in Putney, 38 in Streatham, 18 in Tooting-, and 18 in Wandsworth, compared with 198 in 1919. Three of the cases were from one and under five years, 11 from five and under 15 years, 12 from 15 and under 25 years, eight from 25 and under 45 years, 12 from 45 and under 65 years, and ten over 65 years. 408 notifications of cases of Acute Primary Pneumonia were received (65 in Clapham, 33 in Putney, 96 in Streatham, 45 in Tooting and 169 in Wandsworth), compared with 213 in 1919. 41 of the cases were infants under one year, 74 from one and under five years, 59 from five and under 15 years, 33 from 15 andl under 25 years, 77 from 25 and under 45 years, 81 from 45 and under 65 years, and 43 over 65 years. All the cases were visited, and when requested by the medical attendant or householder the premises, etc., were disinfected by the sanitary staff of the Council. Report of the Medical Officer of Health. 77 Malaria. 68 cases were notified (seven in Clapham, seven in Putney, 14 in Streatham, 18 in Tooting, and 22 in Wandsworth). All of the cases but one were males. No case was notified in which the disease was contracted within the Borough. Of 61 Army cases, 24 contracted the disease in Salonica, two in Palestine, two in Egypt, seven in Mesopotamia, one in East Africa, 17 in India, and eight in other parts. The one female notified contracted the disease in India. These 68 cases were visited again at the end of the year, and it was found that 34 were still suffering, seven had removed, 23 were stated to be well, three died, and in one no inquiries were made. 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 a special hospital. There was no spread of infection among the civil population. Of the 196 cases notified in 1919, 117 were visited in 1920, the remainder, viz.: 79, having either recovered or left the Borough. It was found that of the 117, 49 were still suffering, 22 had removed, 45 were stated to be well, and one died. Dysentery. Eight cases were notified (one in Clapham, two in Putney, three in Streatham, and two in Tooting). All the cases were males, and in six the disease was contracted during Army service in the following war areas: four in France and two in India. None of the cases were engaged in the preparation of food or drink for human consumption. The cases notified in 1920 were again visited at the end of 78 Report of the Medical Officer of Health. the year, and it was found that four were still suffering, two had removed, and two were stated to> be well. Of the cases notified in 1919, six were still suffering, and one had died from Cancer of the rectum. Trench Fever. Two cases were notified, both being soldiers who contracted the disease in France in 1916 and 1917. The premises were thoroughly inspected and no evidence of vermin could be obtained. One case was notified from a mental hospital and was probably a case of mucous colitis, and in the other case no information could be obtained as the patient was in hospital. The one case notified in 1919 was visited and found to be in good health. 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 123. Contacts. Careful inquiry is made with regard to contacts in every case of infectious disease notified, and the necessary action taken. 190 adults had baths after being in contact with cases of infectious disease. Arrangements for Isolation. Of the total number of cases of infectious diseases notified 2,308, or 48 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 6,066 (976 in Clapham, 538 in Putney, 1,823 in Streatham 727 in Tooting, and 2,002 in Wandsworth). Report of the Medical Officer of Health. 79 2,948 lots of bedding were staved at the Disinfecting Station, comprising the following articles: 1,684 beds, 1,820 bolsters, 4,473 pillows, 2,400 mattresses, 66 palliasses, 4,183 sheets, 2,663 quilts, 730 cushions, 8,897 articles of clothing, 5,425 blankets, 65 carpets, and 5,465 extra articles; a total of 37,871 articles. Disinfection was also carried out by the Sanitary Staff at premises after non-notifiable diseases, and the sum of £44 12s. 3d. was received for such disinfection. 384 rooms were disinfected with sulphur in consequence of their verminous condition, and 42 lots of verminous bedding disinfected. During the year, at the request of the Military Authorities, 6,020 articles of clothing and bedding were disinfected and ten rooms sprayed on account of having been exposed to> infection. 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 £2,402 3s. 9d. The number of lots of beading stoved was 2,948. Cost per lot of bedding £0 16s. 5d. 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. In 1919 information was received from the Ministry of Health of ten cases of chronic carriers of entamoeba histolytica. These cases were visited periodically during the year, and at the last visit, early in 1921, it was found that three had completely rceovered, and that seven were still suffering. Two of the latter were notified as cases of dysentery. 80 Report of the Medical Officer of Health. Notification of Tuberculous Diseases. The total number of cases of Pulmonary Tuberculosis notified during 1920 was 634, (104 were from Clapham, 52 from Putney, 180 from Streatham, 97 from Tooting, and 201 from Wandsworth), compared with 788 in 1919, 777 in 1918, and 690, the decennial average. There was a marked reduction in all the sub-districts with the exception of Putney, where the number of cases was only one less than the previous year. One of the cases was under one year, four from one and under five years, 38 from five and under 15 years, 162 from 15 and under 25 years, 297 from 25 and under 45 years, 122 from 45 and under 65 years, and ten over 65 years. At all the ages with the exception of under one year there was a decrease compared with the previous year. In Table XLII. 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 XLII. Year. Cases Reported. Deaths. Removed. Recovered. Cases on Register. 1909 to 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 Total 1909 to 1911 1192 402 136 43 32 15 14 6 20 3 ... 671 406 38 77 1912 855 ... 225 105 48 32 13 8 8 8 ... 447 255 64 89 1913 783 ... ... 180 77 41 25 9 5 4 5 346 252 29 156 1914 706 ... ... ... 177 88 37 22 13 5 5 347 202 18 139 1915 646 ... ... ... ... 199 82 27 20 12 6 346 159 11 130 1916 590 ... ... ... ... ... 162 69 38 13 11 293 134 13 150 1917 622 ... ... ... ... ... ... 183 79 34 9 305 94 4 219 1918 777 ... ... ... ... ... ... ... 199 71 27 297 105 10 365 1919 788 ... ... ... ... ... ... ... ... 158 76 234 56 8 490 1920 634 ... ... ... ... ... ... ... ... ... 112 112 10 ... 512 Total 7593 402 361 328 334 375 333 324 382 308 251 3398 1673 195 2327 Report of the Medical Officer of Health. 81 In Table XLII. it will be seen that since 1909, 7,593 cases of Pulmonary Tuberculosis have been reported, and since 1912, when Pulmonary Tuberculosis was made compulsorily notifiable, the number of cases was 6,401. Of these 6,401, 2,727 or 42.6 per cent. died during the nine years, 1,267 or 20 per cent. have removed from the Borough, 157 or 2.4 per cent. have, as far as could be ascertained, recovered, while 2,250 or 36.7 per cent. remain on the Register. The total on the Register, including those notified in 1909 to 1911, was 2,327, compared with 2,265 in 1919. With regard to the notification of cases of non-pulmonary Tuberculosis, in all 156 cases were notified (23 from Clapham, five from Putney, 36 from Streatham, 24 from Tooting, and 68 from Wandsworth). Six of the cases were under one year, 21 from one and under five years, 65 from five and under 15 years, 29 from 15 and under 25 years, 25 from 25 and under 45 years, and seven over 45 years of age. Table XLIII. 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. It will be seen from this Table that by far the most fatal form of Tuberculosis is Tuberculosis of the Brain, of which 30 cases were notified and 29 died. F 82 Report of the Medical Officer of Health. TABLE XLIII. Localisation of Disease. Number of cases notified. No. of deaths. Total. Males. Females. Under 1 year. 1 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 25. 25 and under 35. 315 and under 45. 45 and under 55. and under 65. 65 and upwards. Males. Females. Total. Removed. On Register. Brain 30 16 14 3 12 9 2 3 ... 1 ... ... ... ... 15 14 29 ... 1 Glands, Mediastinal 6 4 2 ... ... 5 1 ... ... ... ... ... ... ... ... ... ... ... 6 ,, Mesenteric 14 7 7 2 ... 3 4 1 1 2 1 ... ... ... 1 3 4 ... 10 ,, Cervical 39 14 25 ... 3 9 13 2 7 4 ... ... ... 1 ... ... ... 1 38 Pones and joints 41 26 15 ... 5 8 6 3 4 8 3 2 1 1 1 1 1 39 Skin 5 2 3 ... 1 1 ... 2 ... 1 ... ... ... ... ... ... ... ... 5 Larynx 3 2 1 ... ... ... ... 1 ... 1 1 ... ... ... 1 1 ... 2 General Tuberculosis 5 3 2 1 1 ... ... 1 2 ... ... ... ... ... 2 2 4 ... 1 Other parts 13 6 7 ... ... ... 1 ... 3 3 4 1 1 ... 1 1 2 2 9 Total 156 80 76 6 22 35 27 13 17 20 9 3 2 2 21 20 41 4 111 Report of the Medical Officer of Health. 83 The next Table shows the number of cases notified, the number which died, removed, and recovered from 1913 to 1920, and the number still remaining on the Register at the end of 1920. TABLE XLIV. Year. Cases Notified. Deaths. Removed. Recovered. Cases on Register. 1913. 1914 1915. 1916. 1917 1918. 1919 1920 Total. 1913 323 46 10 5 6 ... 1 2 ... 70 100 49 104 1914 198 ... 68 5 4 ... 1 ... ... 78 43 24 53 1915 234 ... ... 84 7 1 1 2 ... 95 39 27 73 1916 215 ... ... ... 67 5 5 ... ... 77 43 15 80 1917 193 ... ... ... ... 63 4 2 3 72 24 12 85 1918 218 ... ... ... ... ... 67 6 73 15 8 122 1919 163 ... ... ... ... ... ... 41 5 46 12 3 102 1920 156 ... ... ... ... ... ... ... 41 41 3 1 111 Total. 1700 46 78 94 84 69 79 53 49 552 279 139 730 Table XLV. is a summary of notifications during the period from the 1th January, 1920, the 1st January, 1921. 84 Report of the Medical Officer of Health. TABLE XLV. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from 4th January, 1920, to 1st January, 1921,. 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 on Form A. Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. Under 1. 1 to 5 5 to 10 10 to 15 15 to 20. 20 to 25 25 35 35 to 45 4i to 55 55 to 65 65 and upwards. Total. Under 5 5 to 10. 10 to 15 Total. Pulmonary— Females 1 2 4 10 32 55 93 68 55 20 4 344 413 ... 1 ... 1 4 182 22 Males 2 6 15 35 37 61 50 37 7 6 256 317 ... 1 2 3 5 27 40 Non-Pulmonary— Males 3 13 21 12 5 6 10 7 1 1 1 80 102 ... 2 ... 2 5 7 10 Females 3 6 11 15 8 10 10 2 2 1 1 69 85 ... 1 ... 1 4 5 5 Report of the Medical Officer of Health. 85 The total number of visits made was 2,172 in cases of Pulmonary Tuberculosis, 368 in Clapham, 133 in Putney, 687 in Streatham, 324 in Tooting-, and 660 in Wandsworth, and 600 in cases of other forms of Tuberculosis, 91 in Clapham, 23 in Putney, 171 in Streatham, 112 in Tooting, and 203 in Wandsworth. In addition to these visits by the Health Visitor, 3,528 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 17 sputum flasks have been supplied, and in eight of the cases visited the patients already had one. During the year disinfection was carried out at 298 premises either after the death or removal of the patient. 61 of the premises disinfected were in Clapham, 19 in Putney, 101 in Streatham, 31 in Tooting, and 86 in Wandsworth. TUBERCULOSIS DISPENSARIES. There are two Dispensaries in the Borough, at 96, East Hill, Wandsworth, and 114, Gosberton Road, Balham. The former was opened on 24th December, 1919, when the premises at 129, East Hill were given up, and the latter on 8th June, 1920, when the use of the Weir Dispensary was discontinued. Staff.—The Tuberculosis Officer is Dr. F. G. Caley, half of whose time is given to dispensary work and half to his work as Assistant Medical Officer of Health. The Assistant Tuberculosis Officer is Dr. A. W. Forrest, who commenced his duties on 18th October, and gives all his time to dispensary work. The Staff consists of two nurses, a clerk-dispenser, and a third-class clerk. Details of 1920 Patients.—The Tables which follow give the details of the work carried out during the year. Table XLVI. gives the new cases and total attendances at each dispensary for 1920, and for each year since they were opened in 1913. 86 Report of the Medical Officer of Health. TABLE XLVI. Number of New Cases and Total Attendances at each Dispensary for each year from 1913 to 1920, with totals. NEW CASES. Year. 1913 1914 1915 1916 1917 1918 1919 1920 Totals. Balham 707 664 430 628 739 752 994 1091 6005 Wandsworth 219 303 287 445 476 603 728 595 3656 Total 926 967 717 1073 1215 1?55 1722 1686 9661 TOTAL ATTENDANCES. Year. 1913 1914 1915 1916 1917 1918 1919 1920 Totals. Wandsworth 4009 4991 3888 5480 6992 9223 9981 7633 52197 Balham 1169 2573 2661 3906 5576 7821 8241 5019 36966 Total 5178 7564 6549 9386 12568 17044 18222 2 12652 89163 The number of new cases seen at Balham is considerably less than the high figure reached last year, and this may be incidental to the opening of other premises some distance away. There is a large fall in the total attendances, and this is due to causes touched on in last year's report, viz., the curtailment of treatment generally, especially of children who are in poor health but not definite cases of Tuberculosis. A certain number of these are now referred to the School Medical Service to deal with, and most of them are advised to attend the dispensaries periodically for re-examination, and so far this arrangement has worked satisfactorily. Owing to the drop in the attendances and to the increase in the number of sessions, made possible by the appointment of a Report of the Medical Officer of Health. 87 second Medical Officer, much more individual attention can now be given to those cases which require thorough investigation. This is undoubtedly a move in the right direction. Further, it is now poss ble for the Medical Officers to get into closer contact with the conditions under which the patients live by personallv visiting the homes. Table XLVII. gives further comparative details of the work. TABLE XLVII. Return showing detail of other Work connected with the Dispensaries during the last four years. 1917 1918 1919 1920 Visits by Nurses at Patients' Homes 1482 1668 3158 3528 Number of written Reports made ... 882 1070 1871 2483 Cases of difficulty referred to St. Thomas's Hospital 10 7 69 67 NumtTer of attendances at which complete examinations were made 2032 2215 3308 3179 Table XLVII1. gives the numbers of new cases living in each of the five sub-districts, and shows on whose recommendation they made the first attendance. TABLE XLVIII. District. Clapham. Putney. Streatham. Tooting. Wandsworth. Outside Borough. Totafs. Public Health Department 92 25 107 157 286 ... 667 London Insurance Committee 9 4 13 18 8 ... 52 Private Practitioners 48 11 62 58 118 10 307 Charitable Societies 2 2 1 8 2 ?, 17 Transfers from other Dispensaries 11 9 10 7 12 2 51 London County Council 5 4 3 16 40 2 70 Existing Dispensary Patients 18 14 18 48 128 12 238 Ministry of Pensions 12 11 20 28 30 2 103 Other Sources 14 7 22 24 111 3 181 Totals 211 87 256 364 735 33 1686 88 Report of the Medical Officer of Health. Table XLIX. divides the new cases, by sexes, into' insured and non-insured, Tuberculous and Non-Tuberculous. TABLE XLIX. NEW CASES, 1920. Cases. Tuberculous. Non-Tuberculous. Totals. Male. Female. Total. Male. Female Total. Male. Female Total. Insured 253 81 334 138 1 16 254 391 197 588 Not Insured 50 113 163 358 577 935 408 690 1098 Totals 303 194 497 496 693 1189 799 887 1686 Table L. shows the total attendances for insured and nonnsured persons during the year. TABLE L. Total Attendances of all Cases during the year 1920. Insured 5872 Not Insured ... 6780 Totals 12652 Table LI. gives particulars with regard to ex-service men examined at the dispensaries. TABLE LI. Particulars relating to Discharged Soldiers attending at the Dispensaries. New Cases. Old Cases. Total Attendances. Tuberculous 172 187 2,889 Non-Tuberculous 45 16 229 Totals 217 203 3,118 Report of the Medical Officer of Health. 89 802 visits were made by the Dispensary Nurses in cannection with these cases during the year. Institutional Treatment.—All institutional treatment is arranged for by the London Insurance Committee and the London County Council, and there are no residential institutions under the control of the Borough Council. Co-operation with other Institutions.—With regard to co-operation with general and special hospitals, an arrangement with St. Thomas's Hospital for referring to the Hospital cases of difficulty and those requiring special investigation has been in existence since the dispensary scheme commenced in 1913, and has always worked smoothly. At the present time the co-operation is very close, and patients are continually being referred under this arrangement for X-ray examinations, the opinion of a throat surgeon, or for other reasons. Further, patients in need of some special outpatient treatment, not available at the dispensaries, are dealt with in this way. During the year 67 cases were referred to the hospital, most of them for X-ray examination, or for an opinion on the condition of the larynx. With regard to School Clinics, a few children are referred to the dispensaries by the schools, but only occasionally does a medical report accompany the child. When questioned, the mother usually says that the school mistress advised her to bring the child. This system might be improved upon. Women and children are also sent by the Medical Officers of the Welfare Centres for examination. The co-operation with medical practitioners is improving, and the number of cases referred by them has increased during the last four years. In 1920 tne number was 307, compared with 209, 234, and 175 for the three previous years. A few 90 Report of the Medical Officer of Health. ports on domiciliary treatment are sent to the Tuberculosis Officer by practitioners. Special Methods of Diagnosis and Treatment.—With regard to special methods of diagnosis and treatment, X-ray and throat examinations are made at St. Thomas's Hospital, as mentioned before, and the reports received have helped materi. ally to make diagnosis more accurate. Only rarely is Tuberculin used as a diagnostic agent, as it is thought that closer observation than can be given in dispensary practice is necessary to gauge the results with accuracy. Tuberculin as a curative agent is used much less frequently than formerly, as the results have been far from convincing. A few patients have been treated with vaccine, but the definite cases of Tuberculosis to whom this treatment is beneficial are not numerous. Non-Pulmonary Tuberculosis.—Cases of non-pulmonary tuberculosis come to the dispensaries, and those in need of institutional treatment are dealt with by the Insurance Committee and the London County Council. The dispensary treatment of these cases is necessarily limited, as many are bed cases or are in need of surgical treatment. Those under dispensary treatment are mainly cases of glands in the neck. Dental Treatment.—By an arrangement with the British Dentists' Hospital, dental treatment, including the provision of dentures, is provided for those in need of it. This treatment is limited to those suffering from Tuberculosis, and it has been found that in only a small proportion of these is the condition of the teeth so bad as to require treatment before the more serious complaint. During the year 18 patients received dental treatment, and six were supplied with dentures. In addition, a few ex-service men received dental treatment through the Local Pensions Committees. Nursing and Extra Nourishment.— Home nursing for those in need of it is carried out by the District Nurses, and the Report of the Medical Officer of Health. 91 dispensary staff frequently make the necessary arrangements for the patients. Extra nourishment for patients at home is provided through the following agencies:—Insurance Committee, Lcoal Pensions Committees, Poor Law Authorities, and numerous voluntary organisations, according to the circumstances of the case. Shelters.—Two shelters provided by the Borough Council are in use by patients under treatment in their homes. One advanced case of Tuberculosis of the lung and spine has used the shelter consistently for over a year, and has derived benefit from it. The other shelter has been in use by a case of Tubercular Laryngitis for a short time only. It has been found that the use of shelters amongst working class patients is restricted by the difficulty in taking the shelter through the house to the back yard, owing to the size of its component parts, and, further, that many homes have insufficient back yard accommodation. Following Up.—The following up of patients in whom the diagnosis is doubtful, is carried out by the nurses who visit all such cases. Contacts.—The examination of contacts is carried out at the dispensaries where possible, and the appointments are made by the Health Visitors and Nurses. It is sometimes possible to examine a few, who neglect to attend, at their own homes, and this is done where necessary. During the year 532 contacts were examined and 20 of them were found to< be suffering from Tuberculosis ; these figures are included in the tables showing the year's work. During their routine visits to the cases, the nurses also make enquiries about the health of the contacts, and doubtful 92 Report of the Medical Officer of Health. ones are re-examined by the doctors. In this way a certain supervision is kept over them. After Care Work.—This work is in the hands of a Borough Care Committee consisting of members of the Borough Council, representatives from the County Council, Public Health Department of the Borough Council, and man)' organisations connected with the relief of distress in the area, together with several members personally interested in the work. In order to deal with assessments as to the amount of payment to be made by a non-insured person recommended for institutional treatment, two sub-committees have been formed, one for Clapham, Balham, Tooting and Streatham, and one for Putney and Wandsworth. The sub-committees also deal with routine reports and similar matters in connection with the institutional treatment of patients. The main committee deals with matters of policy, cases of difficulty arising at the sub-committees, with the question of employment, and other matters arising from time to time. During the year 408 cases have been dealt with by the committee. 45 have received material help, e.g., treatment at Convalescent Homes, gifts of books and clothing, or the loan of nursing appliances. 80 bedridden cases have been periodicallyvisited by members of the committee, and helped in many ways. With permission of the Board of Guardians, two members of the committee make routine visits to dispensary patients under treatment at St. John's Hill and St. James's Infirmaries. 67 visits have been made at the request of hospitals, and 169 reports have been sent to the London Insurance Committee. The greatest difficulty has been experienced in finding suit able employment for those who are well enough to do some work. No local arrangements exist for this purpose, beyond the individual exertions of the Secretaries, and the insertion of Report of the Medical Officer of Health. 93 an advertisement, free of charge, in the " Borough News," through the kindness of the Editor. 17 patients have been found work by these means. Results of Treatment.—The investigation into this matter has been systematically carried out during the last two years and I am able to give a short outline of the results obtained in those patients who attended for examination in the six years— 1913 to 1918. All the records have been examined and attempts have been made to trace all patients in whom the diagnosis of Tuberculosis was made, with a view to determining the state of their health at the end of 1919. Many were still attending at that time and an accurate estimate can be made of their condition. Others, known to be alive, are unable to attend for some reason or another, and their progress has to be determined from the information given to the nurses when making their routine visits. " Well and at work " is a common report to receive, and such a case is entered as stationary unless a recent examination has disclosed a different state of affairs. Many have removed and cannot be traced at all. With regard to classification, all patients have been placed into one or other of three groups :— (1) Definite cases of Tuberculosis. (2) Cases where the disease was suspected but not definite. (3) Cases where there was no evidence of Tuberculosis. The definite cases have been further divided into pulmonary and non-pulmonary, active and inactive. The classification of inactive disease is only made where there is evidence on examination that the disease has been present, at some time or other. A suspicious history by itself, is not considered sufficient to warrant the diagnosis of even inactive disease. It is comparatively common to find evidence of 94 Report of the Medical Officer of Health. inactive disease in the lungs in a person who appears to be well, and sometimes it is found in some other part of the body. When there is active disease in the lungs, in addition to disease in some other part of the body, the case is classified as pulmonary. Table LII. shows all the cases who attended the dispensaries during the years 1913 to 1918 classified in the way just described. TABLE LII. New Cases, 1913 to 1918, Classified according to Diagnosis. Year. Definite Cases of Tuberculosis. Suspected Cases. Non- Tuberculous. Totals. Pulmonary. Non-Pulmonary. Totals. Active. Inactive. Active. Inactive. 1913 217 33 41 10 301 8 617 926 1914 271 32 35 10 348 11 608 967 1915 226 20 43 8 297 8 412 717 1916 223 50 39 13 325 7 741 1,073 1917 276 85 32 6 399 16 800 1,215 1918 351 141 58 16 566 6 783 1,355 Totals 1,564 361 248 63 2,236 56 3,961 6,253 95 Report of the Medical Officer of Health. Pulmonary Tuberculosis. Table LI11. shows the condition of the cases of active Pulmonary Tuberculosis at the end of 1919, each Year being shown separately. TABLE LIII. Active Pulmonary Tuberculosis condition at end of 1919.  Removed. Dead. Still on Dispensary Books, 31st December, 1919. Total. Case Mortality (Removed Neglected). Advanced. Stationary. Improved. Total. 1913 70 90 19 5 33 57 217 PER CENT. 61 1914 68 143 17 10 33 60 271 70 1915 62 108 29 4 23 56 226 66 1916 49 97 35 6 36 77 223 56 1917 48 123 32 18 55 105 276 54 1918 37 109 58 42 105 205 351 35 Total. 334 670 190 85 285 560 1564 54 96 Report of the Medical Officer of Health. The results are best shown in the form of percentages of nett cases as under :— Dead. 54.5 per cent. Advanced. 15.4 per cent. Stationary. 6.8 per cent. Improved. 23.3 per cent. 69.9 per cent. 30.1 per cent. Table LIV. gives similar figures for the cases of inactive Pulmonary Tuberculosis, all the years being shown together. TABLE LIV. Inactive Pulmonary Tubereulosis condition at end of 1919. Year. Removed. Dead. Still on Dispensary Books, 31st December, 1919. Total. Advanced. Stationary. Improved. Total. 1913-1918 126 2* 5 228 ... 233 361 * The cause of death in these two was :— (1) Killed in action in France, 1918. (2) Influenza, 1919. Most of these patients remain in a stationary condition and the disease can generally be regarded as permanently arrested, and incapable of further improvement. The patients are no danger to others and are usually fit to earn their own living. The two deaths which occurred were not due to Tuberculosis (see footnote to Table). As already stated, the earlier years of treatment are the critical years, so that a study of results after, say, three years' treatment, might be expected to give useful information. Bearing this in mind, and with the further object of obtaining as large figures as possible, it was decided to classify the results according to the condition at the end of the third calendar year of treatment, and so make the cases of one year comparable with those of another year. The 1913 cases were taken on their condition at the end of 1915, the 1914 cases on their condition 97 Report of the Medical Officer of Health. at the end of 1916, and so on. Calculated in this way, the average duration of treatment for each patient is 2| years. Patients attending in the five years 1913 to 1917 can all be brought in by the end of 1919, those of 1918 will not have completed the same period of treatment till the end of 1920, and have been left out, as the investigation has not been carried beyond 1919. Table LY. shows these cases, by sexes, classified into age groups according to the result of the sputum examniation, when they attended for the first time. TABLE LV. Active Pulmonary Tuberculosis, 1913-1917 Cases. Age. Males. Females. Total. Sputum Positive. Sputum Negative. No record of Sputum. Totals. Sputum Positive. Sputum Negative. No record of Sputum. Totals. Under 5 years ... 1 1 2 1 1 2 4 6 5 and under 15 9 25 12 46 11 32 8 51 97 15 and under 25 110 24 14 148 97 42 21 160 308 25 and under 35 122 40 20 182 85 53 20 158 340 35 and under 45 113 24 23 160 57 47 18 122 282 45 and under 55 61 12 12 85 16 21 8 45 130 55 and under 65 23 5 4 32 2 7 1 10 42 65 years and over 1 ... ... 1 1 3 3 7 8 Totals... 439 131 86 656 270 206 81 557 1213 These figures show that (1) The number of males with active Pulmonary Tuberculosis is greater than the number of females. (2) In 65 per cent males, the sputum was positive, compared with 48 per cent, females. 98 Report of the Medical Officer of Health. (3) Between ages of five and 25, more females are affected than males, while the reverse holds good in the higher age groups. Table LVI. gives the condition of the same patients at the end of the third year of treatment, showing, firstly, the results in all cases, whatever treatment they received, and secondly, the results in those of them who received Sanatorium and Tuberculin treatment. The numbers who received Tuberculin treatment appear to be too small to< subdivide according to the results of the sputum examination. TABLE LVI. Active Pulmonary Tuberculosis. Condition of 1913 to 1917 patients at the end of third year of Treatment. ALL CASKS. Unt aced. Dead. Advanced. Stationary. Improved. Total Cases. Males :- Sputum Positive 83 229 56 22 49 439 Sputum Negative 36 17 20 18 40 131 No Record of Sputum 20 50 1 5 10 86 Totals 139 296 77 45 99 656 V emales — Sputum Positive 40 140 42 14 34 270 Sputum Negative 30 31 34 35 76 206 No Record of Sputum 20 45 7 2 7 81 Totals 90 216 83 51 117 557 Received Sanatorium Treatment— Males— Sputum Positive 49 115 37 11 34 246 Sputum Negative 5 7 7 3 20 42 No Record of Sputum ... 8 ... ... 4 12 Totals 54 130 44 14 58 300 female Sputum Positive 17 64 21 4 17 123 Sputum Negative 12 9 6 4 35 66 No Record of Sputum. 1 2 1 ... ... 4 Totals 30 75 28 8 52 193 Received Tuberculin Treatment— Males 11 41 8 5 20 85 Females 15 33 18 7 39 112 Totals 26 74 26 12 59 197 99 Report of the Medical Officer of Health. With a view to comparing these results the following Table shows the case mortality in each group, calculated on the nett cases, obtained by deducting the untrnced from the total. For instance, for all cases male, the nett total is obtained by deducting 139 untraced from 656 total, giving 517 nett cases; 296 of these have died, a percentage of 57. TABLE LV1I. Case Mortality in Pulmonary Tuberculosis, 1913 to 1917 Cases. Result of Sputum Examination. Total. Positive. Negative. No record. Males— All Cases 64 18 76 57 Sanatorium Cases 58 19 67 53 Tuberculin Cases ... ... ... 55 Females— ... ... ... ... All Cases 61 18 74 52 Sanatorium Cases 60 17 67 46 Tuberculin Cases ... ... ... 34 Expressed in this way the figures show that the results are slightly better in females than males, but the most striking fact is the marked difference in case mortality between the sputum positive and sputum negative cases, the deaths in the positive cases being over three times that in the negative ones. The group, "no record of sputum," contains many very bad cases, generally seen only once, where no opportunity of examining the sputum has occurred. Most of them are probably sputum positive and the high case mortality is due to these two factors. In both sexes there is a slightly smaller case mortality among patients. who have received Sanatorium or Tuberculin 100 Report of the Medical Officer of Health. treatment, than for all cases treated. It is necessary, however, to remember that a considerable amount of selection is exercised in determining the suitable cases for either of these forms of treatment, and the worst cases are not chosen. It Sanatorium and Tuberculin treatment were of real benefit to patients of the dispensary class, one would expect that the figures would compare more favourably with those for all cases than they do. As they stand, the results are disappointing, except perhaps, for females treated with Tuberculin, but here the numbers dealt with are really too small to form any definite conclusion. Non-Pulmonary Tuberculosis.—During the six years 1913 to 1918, 311 patients were classified as suffering from Tuberculosis of some part of the body other than the lungs; in 218 the disease was active at the initial examination, and in 63 it was inactive. The condition of these patients at the end of 1919 is shown in Table LVIII. The site of the lesion is shown for the active cases, but not for the inactive ones, and the results of institutional and Tuberculin treatment for all forms are shown at the bottom of the table. The sexes have not been separated. TABLE LVIIl. Non-Pulmonary Tuberculosis. Condition at end, of 1919. Removed. Dead. Advanced. Stationary. Improved. Cured. Totals Active Disease— Peripheral Glands 29 4 9 12 67 10 131 Mediastinal Glands 1 1 1 ... 1 ... 4 Abdominal Glands 3 3 3 2 6 3 20 Bones and Joints 16 6 6 4 20 7 59 Meningeal & General Tuberculosis ... 9 ... ... ... ... 9 Larynx 1 1 ... ... ... 1 3 Skin 4 ... ... 2 5 1 12 Genito Urinary Organs ... 1 1 2 4 2 10 Totals 54 25 20 22 103 24 248 nactive Disease— All Forms 7 ... 1 16 ... 39 53 Tuberculin Treatment 5 3 5 3 21 3 40 Institutional Treatment 19 13 6 4 32 13 87 101 Report of the Medical Officer of Health. As one expects, the results are better than for Pulmonary Tuberculosis, an appreciable number of patients being completely cured. The distinction between inactive disease and cure is an indefinite one, but, as a general rule, if the disease has been inactive for three years or more, the case is classified as cured. Suspected Tuberculosis.—As shown in Table LII., during the six years, 56 patients were classified as suspected cases of Tuberculosis : 26 of them were males and 30 females; in 54 cases the suspicious lesion was pulmonary, in two it was nonpulmonary. Many of these were treated for considerable periods, but the diagnosis was not definitely cleared up, and at the end of 1919 their condition was as follows:— Removed, 22. Improved, 15. Stationary, 18. Advanced, 1. Vaccine Treatment.—During the same period 37 patients (16 males and 21 females) were treated with autogenous vaccines prepared separately for each one. They were either cases of Pulmonary Tuberculosis or were suffering from such conditions as Asthma and Bronchitis. The results, shown below, were good, especially in the non-tubercular cases, those suffering from Asthma doing particularly well. TABLE LIX. Results of Vaccine Treatment. Dead. Advanced. Stationary. Improved. Total. Pulmonary Tuberculosis 2 2 2 5 11 Non-Tubercular 3 ... 5 18 26 Total 5 2 7 23 37 Contacts.—Of the total of 6,253 cases examined during the six years, 2,104 were contacts, and of these, 167 were found 102 Report of the Medical Officer of Health. to be definite cases of Tuberculosis and 12 were suspected cases. In the remainder there was no evidence of disease. The figures are given in Table LX. The percentage found to be definite cases was 7.5, while for all cases it was 35.7. TABLE LX. ]Groups. Tuberculous. Suspected Tuberculosis. Non-Tuberculous. Grand Totals. Male. Female. Total. Male. Female. Total. Male. Female. Total. Under 5 10 4 14 1 1 2 203 207 410 426 5and under 15 29 34 63 6 ... 6 497 536 1033 1102 15 and under 25 10 10 20 ... .... 2 67 95 162 184 25 and under 35 1 16 17 ... ... 1 20 101 121 139 35 and under 45 7 28 35 ... ... ... 24 106 130 165 45 and under 55 3 11 14 ... ... 1 9 45 54 69 55 and under 6s 1 2 3 ... ... .. 2 9 11 14 65 and upwards ... 1 1 ... ... ... ... 4 4 5 Totals... 61 106 167 7 5 12 822 1103 1925 2104 103 Report of the Medical Officer of Health. TABLE LXI. * Districts. Number of Births returned from 1st January to 31st December, 1919. Successfully Vaccinated. Insusceptible of Vaccination. Had Smallpox. 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 810 389 5 ... 48 225 14 23 93 13 Putney 330 233 ... ... 22 53 3 13 5 1 Streatham 2373 978 7 ... 108 771 27 60 223 199 Wandsw'th 1621 845 ... ... 101 448 21 34 152 17 Totals 5134 2445 12 ... 279 1497 65 130 473 230 104 Report of the Medical Officer of Health. cil, and the homes were visited by the sanitary inspector. These children were being treated at the London County Council cleansing stations. In 57 cases where consent was obtained, disinfection of the bedding and clothing of the patient was carried out by the disinfecting staff. In addition to the above 89 other cases in adults and four children 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 The duties of the Health Visitors 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 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. Since the opening of the Maternity Home the Health Visitors also investigate the home conditions of patients applying for admission to the Home, and also, in some instances, the financial circumstances. 105 Report of the Medical Officer of Health. Of the total number of births, viz., 7,212, 5,211, or 72.2 per cent. were visited, compared with 64.4 per cent. in 1919. The following Table summarises the work of the Health Visitors during the year in the various wards of the Borough. TABLE LX11. Year ended December 31st, 1920. Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. N. S. B. S. So. F. Sp. Births- Visits 574 403 332 732 702 795 603 378 692 5211 Re-Visits 337 209 491 921 208 279 480 341 352 3618 Children, 1—2 years- Visits .... ... 5 41 59 11 20 7 6 149 Re-Visits 155 105 71 45 126 53 60 49 64 728 Children, 2—5 yeaars— Visits 1 ... 28 84 80 32 30 29 14 298 Re-Visits ... 116 53 257 202 154 255 181 132 260 1620 Ante-natal visits 22 14 14 15 43 18 27 30 23 206 Puerperal fever— Visits 4 16 7 5 7 2 5 3 11 60 Re-Visits 7 3 4 5 2 2 ... ... ... 23 Ophthalmia neonatorum— Visits 21 10 6 12 3 7 9 9 3 80 Re-Visits 20 6 6 10 7 4 11 11 2 77 Pneumonia— Visits 6 9 4 7 5 10 14 9 18 82 Re-Visits ... ... 3 ... 1 ... 1 ... ... 5 Enteritis— ... ... ... ... ... ... Visits .. ... 6 ... 1 6 ... ... 1 14 Re-Visits ... ... ... ... ... 1 ... ... ... 1 Measles— ... ... ... ... ... ... ... .. Visits 24 35 62 35 37 39 82 40 61 415 Re-Visits ... ... 2 ... 18 2 ... ... 6 28 W hooping-cough- ... ... ... Visits 26 29 9 60 23 77 49 15 68 ' 356 Re-Visits ... ... ... 4 2 6 5 1 3 21 Investigation of death of infants 53 26 30 60 44 55 43 30 44 385 Attendance at Infant Welfare Centres 88 ... 53 90 53 90 54 ... 88 516 Attendance at Ante-natal Centres 12 ... ... 21 28 25 27 ... 38 151 Visits to creches ... 39 28 32 ... 25 ... 124 Committee meetings 9 ... 22 14 23 18 33 12 6 137 Visits re supply of milk 202 140 343 931 381 164 411 275 240 3087 and food 2 3 6 9 16 ... 6 4 46 Visits re dental treatment 52 ... 14 8 19 23 1 ... 2 119 Health talks to mothers 38 27 68 107 67 48 59 43 19 476 Miscellaneous visits Ineffectual visits 224 131 330 410 174 181 343 194 170 2157 Total 1993 1219 2212 3866 2283 2235 2554 1637 2191 20190 Nuisances reported to Medical Officer of Health 16 15 1 31 1 33 41 33 55 226 106 Report of the Medical Officer of Health. Infant Visiting. The total number of visits and re-visits was 8,829, of which 5,211 were first visits, compared with 3,506 in the previous year. The re-visits numbered 3,618 as against 4,178. The decrease in re-visits is due to the fact that so many more mothers attended the Infant Welfare Centres, and also the free distribution of milk under the Milk (Mothers and Children) Order entailed a great amount of work, not only in visiting, but particularly in clerical work. 3,087 visits were paid in respect of milk as against 1,797 last year. At the first visit 4,141 were entirely breast-fed, 427 were breast-fed supplemented by artificial feeding, and the remainder were entirely bottle fed. In two cases rabbits brains were being given to infants under the age of a month. On re-visiting 1,712 were found to be entirely breast-fed, 659 were breast-fed supplemented by artificial feeding, and the remainder were otherwise fed. 134 of the infants visited died during the year (33 in Clapham, 11 in Putney, 19 in Balham, 12 in Streatham, 23 in Tooting, 24 in Wandsworth I., and 12 in Wandsworth II). As shown by the Table, the highest mortality occurred during the first four months of life, four died under one month, and 56 died before reaching the age of five months. 157 of the infants visited were prematurely born, and 157 were delicate from birth, 80 twin births were visited, of whom 12 died, and two mothers had triplets, and of these in one case all the children are alive and well, and in the other, in which the infants were premature, two died shortly after birth, and one lived seven months and died of convulsions. With regard to the employment of midwives, 2,191 mothers had employed their services, 463 infants were born in hospital and other institutions, and one unregistered woman was employed. In 2,556 births doctors have been in attendance. Report of the Medical Officer of Health. 107 149 children between the ages of one and two years were visited and 728 were re-visited. 298 children between the ages of two and five years were visited, and 1,620 were re-visited. The small number of first visits to children between the ages of one to two', and two to five years, is due to the fact that most of them had been already visited as infants. The 149 children under two years of age, and 298 between the ages of two to five years were children who had been born elsewhere, and so not previously known and visited. Six orphan children under the care of guardians were referred to me by the London War Pensions Committee for supervision. In each case the child was found to be well cared for and the home conditions satisfactory. The ante-natal work has developed during the last year owing to the Welfare Centres having ante-natal sessions apart from the Infant Clinics. The visits totalled 206 as against 83 in 1919. The sanitary defects found in the houses during visits 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, 53 intimation notices and three statutory notices were served by the two Health Visitors, who are also Sanitary Inspectors. TABLE LX11I. Clapham, North. Clapham, South. Putney. Balham. Streatham. Tooting. Southfield. Fairfield. Springfield. Borough. Infants visited 574 403 332 732 702 795 603 378 692 5211 Breast-fed 465 326 242 576 619 560 503 324 526 4141 Otherwise fed 109 77 90 156 83 235 100 54 166 1070 Infants re-visited 337 209 491 921 208 279 480 341 352 3618 Breast-fed 142 91 196 458 128 93 246 216 142 1712 Otherwise fed 195 118 295 463 80 186 234 125 210 1906 108 Report of the Medical Officer of Health. TABLE LX1V. Deaths of Infants Visited. Under 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 ... 5 4 6 1 ... 2 1 1 ... ... ... 20 Clapham, South ... ... 1 2 1 1 1 3 1 2 ... 1 13 Putney i i ... 2 3 1 1 ... 1 1 ... ... 11 Balham i 2 4 2 2 3 i 1 1 1 1 ... 19 Streatham ... 6 3 ... ... ... 1 ... ... 1 1 ... 12 Tooting ... 2 3 3 2 3 4 2 3 ... ... 1 23 Southfield i 1 2 2 ... 1 4 2 1 ... ... 14 Fairfield 1 ... 1 ... ... 1 3 1 2 1 ... ... 10 Springfield ... ... 1 3 1 4 ... 1 1 ... 1 ... 12 Borough 4 17 19 20 10 14 17 11 11 6 3 2 134 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 31 midwives practising in the Borough, of whom eight reside in neighbouring districts. 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 1/3 per visit. 3,332 such visits were paid during the year. Clapham is served by the South London District Nursing Association; Putney and Roehampton by the nurses appointed by the Parochial Nursing Associations; and Streatham, Tooting, Wandsworth, and Balham, by Ranyard Nurses, of whom there are 13 working in the Borough. The northern district of Streatham is served by the Brixton Nursing Association. Report of the Medical Officer of Health. 109 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 eyes, ears, throat or skin, advanced cases of rickets and the like. Maternity Homes. There are 38 private maternitv homes in the Borough, four of which are carried on by practising midwives. During the greater part of the year expectant mothers were sent either to the Clapham Maternity Hosptal or to any similar institution where there is accommodation, the Council defraying the cost of £2 per week up to £6. Patients so sent were asked to pay 30s. the amount of the maternity benefit under the National Insurance Act, but in cases of extreme necessity this payment was remitted. Eleven mothers were sent to maternity homes during the year. The new Maternity Home, situated at Park Hill, Beechcroft Road, Upper Tooting, was opened by the Mayoress, Mrs. Cooper Rawson, on the 4th November, 1920. The building was purchased as a Borough War Memorial, the amount required being raised by voluntary subscription. It is maintained by the Borough Council, and is under the direct control of the Maternity and Child Welfare Committee. The Medical Officer of Health, and under him the matron, is responsible for the administrative control, subject to the supervision of a Home Committee appointed by the Maternity and Child Welfare Committee. The premises are most suitable for the purpose and after certain alterations had been carried out, accommodation for 23 beds was provided. The details of furnishing and equipment were worked our with some care, and every appliance deemed necessary has been provided. 110 Report of the Medical Officer of Health. The Council has appointed as matron, Miss E. Waring, who had previous experience as matron of the Maternity Home at Ilford. The staff when complete will consist, in addition to the matron, of two sisters, two staff nurses, and six probationers, with one outdoor nurse for district work. Up to the end of the year five cases had been admitted, and it is hoped that the whole of the beds will be fully occupied early in 1921. 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. The accommodation consists of 20 cots, including two isolation cots. The staff consists of a visiting Medical Officer, matron, sister, two staff nurses (day and night) and three probationers. There is also one domestic servant. The minimum charge is 10s. 6d. per week. No child is admitted free except in cases of extreme poverty. Seventy-nine infants passed through the hospital during the year, the average stay being six weeks. The complaints from which they sufferedl were marasmus (-35), dyspepsia, gastro-enteritis, rickets, pneumonia, bronchitis, debility, tubercular glands, pyloric stenosis, infantile paralysis, and talipes. Nine of the cases proved fatal, chiefly from marasmus. There are three institutions in the Borough for the reception of expectant unmarried mothers, all in connection with rescue work. The mothers are received a few months prior to the confinement, and are expected to remain, in one instance at least six months after; in the other two the average stay is three months after confinement. In one home the mothers, if able, do the domestic work of the house, and are therefore with their Report of the Medical Officer of Health. 111 babies all clay. 50 mothers with their babies were received during the year. In another, where the mothers learn glove making in the Home, only 14 mothers were received during the year, the Home being closed from June to November. In the third, 170 mothers passed through the Home during the year, the number of births being 156. One hostel, also in connection with rescue work, does not receive pre-maternity cases, but makes arrangements for the confinement. The mother is expected to remain 12 months—she has three months' training in the Home in domestic work, and then goes out to daily work. 13 mothers and 13 babies were received during the year. One of the above Homes had a separate hostel for the children—four children were inmates of this hostel on Januarv 1st, 1920—one was admitted later, and died after two days. The hostel was closed finally on September 1st, 1920, owing to lack of funds. In all the above hostels arrangements have been made for a medical man to attend when necessary. Some of the infants attend at the most convenient Infant Welfare Centre. StilBirths. Investigations were made into the cases of 69 still-births, 20 of which were premature and 15 were difficult labours, 36 were delivered by midwives, 10 occurred in institutions, and 23 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. Convalescent Homes. During the year six mothers and five children were sent to Convalescent Homes. Five of the mothers and three of the children were sent to Ashburton Home, Addiscombe, and the others to various places. 112 Report of the Medical Officer of Health. Illegitimate Births. 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. During the past year, however, particulars of all births belonging to> this Borough which occurred in other districts have been sent monthly by the Registrar-General. Of the 223 illegitimate births belonging to the Borough 135 have been visited, 24 were above the standard of visiting, 34 had removed before visit, four were born in the workhouse and remained there, five died before visit, 14 were boarded out under the London County Council, five wrong addresses were given, and in two cases repeated ineffectual visits were made. Of the 135 visited 11 died. In the majority of cases no assistance was required, as arrangements had been made for the care of the children. Maternity and Child Welfare Centres. There are now seven Infant Welfare Centres in the Borough and it is hoped shortly to open an eighth to serve the Fairfield Ward of Wandsworth. The mothers from this district at present attend the Centre held at the Anchor Mission in Garratt Lane. The premises occupied by the Balham and Springfield Infant Welfare Centres are quite inadequate to accommodate the increasing number of mothers who wish to avail themselves of the advice and help provided. It is hoped shortly to find more suitable premises for the two Centres thus handicapped. Each Centre has a medical officer and a trained superintendent ; but all the work connected with the keeping of records, the purchase and sale of food and drugs, and of clothing, is done by voluntary workers, who are most regular and efficient. 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, Report of the Medical Officer of Health. 113 Each Centre, with the exception of Putney, has a separate session for ante-natal work—at Putney it is held concurrently with the Infant Clinic. The accompanying- Table summarises the work done at all Centres. The total number on the registers at the end of 1920 was 8,492 ; there were 2,860 new cases registered during the year, the total number of attendances was 29,450, 32 were transferred to the other Centres, 165 removed, 261 were passed on to the London County Council, and 73 died. The total number of ante-natal cases on the registers at the end of 1920 was 512, the attendances numbering 826. The superintendents visits to infants totalled 9,486, and to ante-natal cases 785. 159 health talks were given. In Putney a course of needlework classes was given during the autumn, and a special lecture to the mothers of the Putney, Wandsworth, and Southfields Centres was given in the summer by Miss Pearson, C.M.B. In Tooting needlework classes are held concurrently with the ante-natal session. In Southfields a course of eight lectures on Hygiene was given by the medical officer of the Centre. In Wandsworth a course of six lectures on home nursing was given, and 16 sewing classes were held. A baby show and exhibition were held at the Tooting Infant Welfare Centre in October, 1920. Only those mothers who attended regularly were allowed to enter their infants. Preliminary marks were given under the heading of mothercraft, thus enabling babies who had a bad start in life, but whose mothers by their care had lessened their handicap, to compete fairly with strong and healthy born children ; some of these delicate children took prizes. In Classes I. and II. (children under nine months) all the prize-winners were entirely breast-fed. In class III. (children up to two years) and class IV. (children between two and five years of age) 76 and 75 per cent. respectively had been Ji 114 Report of the Medical Officer of Health. breast-fed up to nine months. In the " twin class " 50 per cent. had been breast-fed. The mothers also competed for prizes in needlework and toy making. During the three days the exhibition was open special lectures were given on " The Care of the Teeth " and on "Tuberculosis in Infants." 516 attendances were made by the Health Visitors to the Infant Clinics, and 151 to the Ante-natal Clinics. 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. 119 health talks were given by the Health Visitors during the year, and the following is a list of the most important subjects dealt with :— 1. Advantages of the ante-natal clinic. 2. Ante-natal hygiene. 3. Breast-feeding., 4. Bronchitis and Pneumonia. 5. Baby Show—Classes. Characteristics for prize-winners. 6. Choice of foods. 7. Clothing of infants and young children. 8. Co-operation—its meaning in trade, school, life, and how it should apply to Infant Welfare work. 9. Danger of dummies. 10. Early training of baby in good habits. 11. Flies. 12. Fresh air. 13. Food and clothing during pregnancy. 14. Importance of proper dental treatment; the treatment available. 15. Importance of a sufficiency of clothing, especially to the lower limbs. Report of the Medical Officer of Health. 115 16. Importance of breast-feeding to the child—benefit to the mother. 17. Infantile diarrhoea. 18. Infant Welfare Centre as an educational influence. 19. Infection and disinfection. 20. Influenza and colds. 21. Insurance of children. 22. Milk. 23. Ophthalmia. 24. Organisation of mothers' committees. 25. Preparation for the baby and the lying-in room. 26. Prevention of and remedies for sore throats. 27. Sleep. 28. Scarlet fever and diphtheria. 29. The skin. 30. The teeth. 31. Things to remember. 32. Suitable foods for summer months. 33. Symptoms during pregnancy which indicate a doctor should be consulted. 34. Whooping-cough. TABLE LXV. Clapham. Putney. Balham. Streatham. Tooting. Southfields. Wandsworth. Totals. No. on Register December 31, 1920 1336 817 1184 1141 2030 345 1639 8492 ,, of new cases during 1920 559 225 432 357 538 276 473 2860 ,, transferred to other Centres 9 1 ... 11 4 14 2 41 ,, removed 12 14 79 18 20 4 18 165 ,, dead 14 9 14 5 15 4 12 73 ,, passed on to L.C.C. 2 52 118 12 15 3 61 263 ,, of attendances 8206 2390 5194 3553 5265 1915 2927 29450 ,, of ante-natal cases 106 25 108 108 82 49 34 512 ,, do. attendances 147 42 121 158 210 98 60 836 ,, of Nurses' visits to Infants 1335 672 1617 1170 2597 723 1372 9486 ,, do. do. ante-natal cases 133 82 100 203 134 56 77 785 ,, of Sessions—Infants 44 50 102 61 89 50 50 446 ,, do. —ante-natal 12 23 23 27 23 25 133 ,, of health talks given 52 23 28 20 28 6 2 159 116 Report of the Medical Officer of Health. 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 8d. to 1s. 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. 124 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, 10,114; in Balham, 5,665; in Tooting, 5,163; and in Wandsworth, 5,984; a total of 26,926, an increase of 5,394 compared with 1919. Dental Treatment. In May, 1919, the arrangements made by the Council with the British Dentists' Hospital, Clapham Common, came into force. 84 cases (71 women and 13 children) availed themselves of the opportunity to have dental tent, and 124 attendances (107 women and 17 children) were made. 14 women had1 dentures, the charge varying from 50/- 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. Report of the Medical Officer of Health. 117 Puerperal Fever. There were 36 cases of puerperal fever notified (nine in Clapham, five in Putney, nine in Streatham, two in Tooting, and 11 in Wandsworth). Five were midwives' cases, one was a miscarriage, one a concealment of birth, in six instances the child was still-born, five were born before the doctor or midwife arrived, 13 patients were removed to hospitals and 16 to St. James's Infirmary, and five cases occurred in nursing homes. Eight of the cases proved fatal. Ophthalmia Neonatorum. 60 cases were notified, of which 19 were in Clapham, four in Putney, 11 in Streatham, five in Tooting, and 21 in Wandsworth. All the cases were visited. 30 were attended at birth by midwives, and seven cases occurred in maternity homes (two in Clapham, one in Putney, two in Streatham and two in Tooting). 26 cases were treated in hospital as out-patients, 11 as inpatients, and the remainder were treated. at home. Three cases removed from the district before recovery, and one died. In three instances the sight has been impaired. 24 cases were notified by midwives. In 25 cases the district nurse was asked to attend, and 1,844 visits were made. 118 Report of the Medical Officer of Health. TABLE LXV1. Ophthalmia Neonatorum, 1920. NO. Date of notification. Eye affected. Severe or Slight Where treated or by whom. History of specific disease. Result. 1 Jan. 1 R. Severe Royal Eye Hosp. out-patient No. Recovered. 2 » 1 Both. St. Thomas's Hosp. out-pat't Right 'a.ye blind. 3 „ 24 . Slight Private doctor — Removed. 4 Feb. 3 R. St. Thomas's Hosp. out-pat't No. Recovered. 5 3 Both. Severe St. Margaret's Hosp. in-pat't — Right eye clear. 6 „ 6 ,, „ St. Margaret's Hosp. in-pat't — Recovered. 7 „ 7 R. eye Severe L. eye Slight Private doctor No. ,, 8 „ 10 One Severe St. James's Infirmary — 9 „ 13 L. Slight Private doctor No. 10 „ 19 Both. Severe Nursing Home ,, 11 „ 20 „ St. Margaret's Hosp. in-pat't ? Removed. 12 Mar. 5 ? ? Clapham Maternity, in-pat.... ? Recovered. 13 „ 8 R. Slight St. Thomas's Hosp. out-pat't No. 14 „ 10 Both. Private doctor ,, 15 „ 12 L. Private doctor ,, 16 „ 13 Both. Severe St. Thomas's Hosp. out-pat't ,, 17 „ 22 ,, Slight Private doctor ,, 18 Apr. 6 „ Severe Private doctor ,, 19 „ io ? ? Workhouse ... ? 20 „ 12 R. Severe Private doctor No. Recovered. 21 „ 13 Both. R. eye Severe L. eye Slight • Royal Eye Hosp. out-patient ,, ,, 22 „ 16 ,, Slight St. Thomas's Hosp. out-pat't ,, ,, 23 „ 17 ,, St. Thomas's Hosp. out-pat't ,, ,, 24 „ 17 ,, Private doctor ,, ,, 25 May 4 R. tf St. Margaret's Hosp. in-pat't ,, ,, 26 8 ,, St. Thomas's Hosp. out-pat't ,, ,, 27 10 Both. St. Thomas's Hosp. out-pat't ,, ,, 28 „ 17 ,, Private doctor ,, ,, 29 M 17 L. St. Thomas's Hosp. out-pat't ,, ,, 30 „ 24 R. St. Margaret's Hosp. in-pat't ,, ,, 31 .. 31 Both. Severe Clapham Maternity Hosp.... ,, ,, 32 Jun. 7 ,, Slight St. Thomas's Hosp. out-pat't ,, ,, 33 „ 23 ,, Severe Private doctor ,, ,, 34 „ 23 R. Slight Private doctor ,, ,, 35 Jul. 5 Both. Private doctor ,, ,, 36 13 ,, Severe St. Margaret's Hosp. in-pat't ,, ,, 37 „ 14 ,, Slight St. Thomas's Hosp. out-pat't ,, ,, 38 „ 14 ,, Private doctor ,, ,, 39 „ 19 R. ')f St. Thomas's Hosp. out-pat't ,, ,, 40 „ 20 Both. Private doctor ,, ,,,, 41 „ 21 L. St. Thomas's Hosp. out-pat't ,, ,, 42 „ 28 R. St. Thomas's Hosp. out-pat't ,, ,, 43 Aug. 13 L. Severe St. Thomas's Hosp. out-pat't ,, ,, 44 „ 28 Slight St. Thomas's Hosp. out-pat't ,, ,, 45 „ 30 Both. Private doctor ,, ,, 46 Sep. 4 ,, Severe Royal Eye Hosp. out-patient ,, ,, 47 „ 6 ,, Private doctor ,, ,, 48 „ 6 ,, Slight Private doctor ,, ,, 49 9 R. St. Thomas's Hosp. out-pat't ,, ,, 50 „ 11 Both. Severe Private Doctor ,, ,, 51 27 R. St. Thomas's Hosp out-pat't ,, ,, 52 ,, 28 Both. St. Margaret's Hosp. in-pat't ,, Died Nov. 21> Cong. ,, Malformation Oph, N 53 Oct. 4 ,, , St. Margaret's Hosp. in-pat't ,, Removed. 54 „ 12 „ Slight St. Thomas's Hosp. out-pat't ,, Recovered. 55 „ 28 ,, St. Thomas's Hosp. out-pat't ,, ,, 56 28 R. Midwife ,, ,, 57 ,, Vision impaired. Nov. 16 L. ,, St. Thomas's Hosp. out-pat't ,, Recovered. 58 .. 25 ,, Clapham Maternity Hosp., ,, ,, 59 out-patient ,, ,, .. 30 R. ,, Clapham Maternity Hosp., 60 in-pa.tient... ,, ,, Dec. 17 L. " St. Thomas's Hosp. out-pat't ,, ,, 119 Report of the Medical Officer of Health. Measles. 415 visits and 28 re-visits were made by the Health Visitors in respect of measles. The services of the district nurses were requisitioned in 45 cases (16 in Clapham, five in Putney, 12 in Streatham, two in Tooting, and 10 in Wandsworth), where bronchitis or pneumonia had set in. The nurses' visits totalled 503. Whooping Cough. 356 visits and 21 re-visits were made by the Health Visitors in cases of whoopnig cough. In 12 cases (five in Clapham, five in Tooting, and two in Wandsworth), district nurses were called in, and their visits numbered1 129. Epidemic Diarrhoea. 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 gfiven :— TABLE LXVII. 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 2 4 3 3 ... 12 Do and condensed milk ... 1 1 ... 2 Do. and dried milk... ... ... 1 ... ... 1 Do. and food ... ... 1 ... ... 1 2.—Cows' milk only ... 4 3 2 12 Do. and dried milk... 2 ... ... ... ... 3 Do. dried milk and food ... ... ... ... 1 ... 1 3.—Condensed milk ... ... 1 ... 2 Do and food ... ... 1 ... ... 1 4.—Dried milk only 2 ... 3 ... ... 5 5.—Farinaceous and other foods ... ... ... ... ... 2 6.—Unknown 1 ... 3 2 2 8 Totals 7 10 17 12 4 50 120 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 LX VIII. Clapham, North. Clapham, South. Putney. Streatham. Balham. Tooting. Southfield. Fairfield. Springfield. Borough. Total Number of Deaths ... 3 3 4 12 3 9 5 4 7 50 Wholly breast-fed 1 ... 2 1 2 2 1 ... 2 11 Otherwise fed ... 2 2 2 8 1 7 4 3 2 31 No information... ... 1 ... 3 ... ... ... 1 3 8 Previously visited (1920) 1 ... 3 3 1 4 3 3 1 19 „ ,, (1919) ••• ... ... ... 2 ... 2 ... ... 1 5 Breast-fed ... ... 1 1 1 1 ... ... ... 4 Otherwise fed ... 1 ... 2 4 ... 5 3 3 2 20 Illegitimate ... ... I ... 4 1 2 1 1 1 11 Nurse children 1 ... 3 ... ... ... ... ... 4 Born outside Borough 1 1 ... 3 ... ... ... ... ... 5 Premature ... 1 1 1 ... 2 ... 1 ... ... 6 Delicate from birth.. ... ... ... 2 ... ... ... ... ... 3 Twin Children ... ... ... ... 2 ... ... ... 1 3 121 Report of the Medical Officer of Health. Home Helps. The services of a Home Help have been obtained for the Fairfield ;:nd Springfield Wards of Wandsworth in connection with the Infant Welfare Centre in Garratt Lane. The woman is paid 30/- a week with outdoor uniform and overall, fares being aliowed up to 2/6 a week. She is required to work eight hours a day, and to do whatever is necessary in the home—Saturday afternoons and Sundays excepted. The mothers book her services for confinement or sickness, and pay a contribution according to their means to the Infant Welfare Centre. No money is paid by them to the Home Help, nor are meals provided. Staff. Dr. F. G. Caley was appointed Assistant Medical Officer of Health and Tuberculosis Officer. Dr. A. W. Forrest was appointed Assistant to the Medical Officer of Health for Tuberculosis. Mr. L. J. Jenkins resigned on the 30th April to' take up another appointment, and Mr. Lambert, who was appointed chiefly for housing duties, was appointed to this district. Mr. D. Grant, Sanitary Inspector, resigned on the 30th June to take up another appointment, and Mr. Vickers, who was also appointed chiefly for housing duties, was appointed' to this district. The two vacancies caused by the transference of Messrs. Lambert and Vickers were filled by the appointment of Messrs. F. Haworth and J. A. Sands on the 3rd June and 1st July respectively. Mr. G. J. Fuller was appointed and commenced duty on the 23rd February as Rat Officer. Mr. H. E. Cramp was transferred to the Council House, and the vacancy thus created was filled by the transference of Mr. L H. Pearson, and his position at the Tuberculosis Dispensary was filled by the appointment of Mr. E. J. Edwards. 122 Report of the Medical Officer of Health. The staff at the end of the year was as follows:— Medical Officer of Health. Assistant Medical Officer of Health and Tuberculosis Officer. Assistant to the Medical Officer of Health for Tuberculosis. 12 male sanitary inspectors. 1 inspector under Sale of Food and Drugs Act. 1 assistant inspector under Sale of Food and Drugs Act. 1 Rat officer. 3 female sanitary inspectors, two of whom devote onethird of their time to health visiting, and one wholetime to tuberculosis work. 4 Health visitors. 6 Clerks and one office boy. 1 Dispenser 1 Clerk 2 Nurses at tuberculosis dispensaries. 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 XXII. and XXIII. 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 house-to-house inspections under Public Health and Housing Acts, and one inspector and an assistant 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. 123 Report of the Medical Officer of Health. One female sanitary inspector devotes her whole time to visiting- and inquiring into notified cases of tuberculosis. 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. Bacteriological Examinations. During the year 2,559 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 LXIX. Clapham Putney. Streatham. Tooting. Wandsworth. Whole Borough Diphtheria :— Negative 152 118 740 121 271 1402 Positive 60 56 310 50 91 567 Enteric Fever :— Negative 3 7 5 1 3 19 Positive ... 1 1 2 Tuberculosis :— Negative 47 38 160 36 148 429 Positive 12 14 49 14 46 135 Totals 274 234 1264 223 559 2554 Three examinations were made for malaria, two of these proved negative and one positive. Two examinations were made for Cerebro-spinal Fever, both of which proved to be negative. 124 Report of the Medical Officer of Health. In addition 601 examinations of sputum were made at the Tuberculosis Dispensary : 56 from Clapham, 39 from Putney, 101 from Streatham, 172 from Tooting, and 233 from Wandsworth. In 121 of the cases it was reported that the bacillus had been found. Statement of Work done under the Rag Flock Act, 1911. 17 workshops were visited by the inspector and the materials used for bedding and upholstery were examined. 36 samples were procured and submitted for analysis. All these were reported as complying with the standard of cleanliness required. 125 Report of the Medical Officer of Health. 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. Mr. Mayor, Ladies and Gentlemen, Herewith we beg to submit to you our report of the work performed by us under the Sale of Food and Drugs Acts during the year 1920. This report is signed by us jointly owing to the fact that your Additional Public Analyst was left in sole charge during the absence, from August to December, of your Public Analyst owing to illness. During the year, 1,867 samples were received and duly reported upon. Of these samples, 872 were submitted formally, whilst 995 were informal. 109 samples in all were reported against, being 5.7 per cent. of those examined. Of the formal samples 67, or 7.5 per cent., were returned as adulterated, whilst 42, or 4.2 per cent. of the informal samples, were found unsatisfactory. Below we give a statement showing the nature of the samples submitted, together with the number of each variety reported1 against. In separate tables the nature cf the Drugs, "Other Articles," and Milk and Cream examined, with any adulteration reported, are given. 126 Report of the Medical Officer of Health. General Statement. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Milk and Cream 865 95 960 62 10 72 Butter 2 630 632 2 18 20 Margarine 2 7 9 2 0 2 Lard ... 39 39 ... 0 0 Flour ... 6 6 ... 0 0 Coffee ... 53 53 ... 1 1 Cocoa ... 22 22 ... 0 0 Sugar ... 6 6 ... 0 0 Mustard ... 3 3 ... 0 0 Confectionery and Jam ... 9 9 ... 0 0 Pepper ...... 10 10 ... 0 0 Drugs 1 34 35 1 4 5 Other Articles 2 81 83 0 9 9 Total 872 995 1867 67 42 109 Drugs. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Acid, Citric 2 2 ... 0 0 Acid, Tartaric 2 2 ... 0 0 Borax i 1 2 1 1 2 Camphorated Oil ... 6 6 ... 0 0 Cream of Tartar. ... 2 2 ... 0 0 Lime Water ... 6 6 ... 0 0 Prescriptions ... 1 1 ... 0 0 Phosphate, Acid ... Calcium ... 2 2 ... 2 2 Rochelle Salts ... 12 12 ... 1 1 Total 1 34 35 1 4 5 It will, therefore, be seen that the amount of adulteration reported in the base of the Drugs submitted was, for formal samples, 100 per cent.; for informal samples, 11.8 per cent.; and for all samples, 14.3 per cent. 127 Report of the Medical Officer of Health. Other Articles. Examined Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Albumen ... , 1 ... 0 0 Arrowroot ... 2 2 ... 0 0 Baking Powder ... 14 16 0 2 2 Cinnamon, Ground ... 3 3 ... 0 0 Cornflour ... 3 3 ... 0 0 Eggs, dried ... 6 6 ... 0 0 Eggs, liquid ... 6 6 ... 0 0 Fruits, dried ... 6 6 ... 0 0 Ginger, ground . ... 3 3 ... 0 0 Mace, ground ... 3 3 ... 0 0 Olive oil ... 6 6 ... 0 0 Pea Flour ... 2 2 ... 0 0 Peas, canned ... 4 4 ... 2 2 Rice, ground ... 4 4 ... 0 0 Sausages ... 7 7 ... 5 5 Self-raising Flour ... 8 8 ... 0 0 Syrup ... 1 1 ... 0 0 Tapioca ... 2 2 0 0 Total 2 81 j 83 0 9 9 From these results it will be seen, therefore, that the total adulteration in the case of " Other Articles," amounted to 10.8 per cent. for all samples; to 11.1 per cent for informal samples; and to 0.0 per cent. for formal samples. 128 Report of the Medical Officer of Health. Milk and Cream. 1 he samples grouped under the heading " Milk and Cream" were comprised as follows :— Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Milk 797 19 816 55 6 61 Hot Milk 12 ... 12 2 ... 2 Separated Milk 56 ... 56 5 ... 5 Condensed Milk ... 2 2 ... 0 0 Cream, fresh ... 41 41 ... 1 1 Cream, preserved ... 33 33 ... 3 3 Total 865 95 960 62 10 72 Thus, the amount of adulteration reported in the case of the Milk and Cream samples submitted was, for formal samples, 7.0 per cent. ; for informal samples, 10.5 per cent. ; and for all samples, 7.4 per cent. Butter. Of the 632 samples of Butter submitted, two only were formal samples, and both of these were reported against, as under : Case No. Nature of Report. 2 44 20 per cent. Margarine. 428 44 per cent. Margarine. In the case of the 6.30 informal samples of butter, 18, or 2.8 per cent., were reported against. Of these, 16 were found to contain margarine, and two excess of boron preservative, Report of the Medical Officer of Health. 129 Margarine. I he two formal samples of margarine submitted were both reported against as under :— Case No. Nature of Report. 245 80 per cent. Butter. 246 80 per cent. Butter. Both the above samples were taken in connection with butter sample No. 244, which, as previously shown, contained 20 per cent. margarine. All the samples of margarine submitted contained a boron preservative, in quantities of 0.5 per cent, or under, calculated as crystallised Boric Acid, H3BO3. Of the 53 informal samples of coffee submitted, one, or 1.9 per cent., was found to contain chicory. Only one formal sample of drugs was submitted, and this was reported against, as under :— Case No. Nature of Article. Nature of Report. 621 Purified Borax. 25 parts of Arsenic per million. Of the 34 samples of drug's submitted informally, four, or 11.8 per cent., were reported against. Of these, one sample of Rochelle salts was found to consist of carbonate of potash; whilst two samples of acid calcium phosphate, and a purified borax were reported against as containing excess of arsenic. Under the heading "Other Articles," two informal samples of baking powder were reported against as containing excess of arsenic; whilst two samples of canned peas—also informal—were returned as unsatisfactory inasmuch as they were found to contain sulphate of copper. 130 Report of the Medical Officer of Health. In conclusion, we think it a matter of congratulation to the Borough that the percentage of adulteration for all samples continues low. In this connection it should be noted that, were it not for a regulation of the Milk Order (1920) forbidding the colouring of milk, the percentage adulteration of the formal samples would have been appreciably lower than the figure reported : namely, 7.5 per cent. In previous years the presence of a trace of colouring in milk would not, under the Sale of Food and Drugs Acts, have been deemed an adulteration ; and in comparing the annual returns, this fact must be taken into consideration. Exclusive of these coloured milks, the percentage adulteration for all formal samples would have been 6.2 per cent. We are, Sir, Ladies and Gentlemen, Your obedient Servants, A. H. M. MUTER, f.i.c., Public Analyst. CHARLES A. HACKMAN, f.i.c., Additional Public Analyst. The Laboratories, 325, Kennington Road, S.E. 11. Report of the Medical Officer of Health. 131 Revenue Act. During; the year two certificates were granted under the above Act, and one was refused. The certificates granted referred to two houses or six tenements. Cleansing of Persons Act. The names of 74 children, nine belonging to Clapham, four to Putney, 16 to Streatham, 21 to Tooting, and 24 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 42 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. 90 adults had baths on account of their verminous condition, 89 of these being cases of scabies. Cutting=off Notices. During the year, 86 notices with respect to 95 premises were received from the Water Board stating that the supply had been withdrawn. 14 of the premises were in Clapham, 25 in Putney, 21 in Streatham, eight in Tooting, and 27 in Wandsworth. The supply was withdrawn for non-payment of rates from 43 premises, from 25 premises in consequence of defects, in 23 the premises were empty, and in four cases by request. Report of the Medical Officer of Health. HOUSING. I—GENERAL HOUSING CONDITIONS IN THE DISTRICT. (1) The general housing conditions in this Borough are fairly satisfactory. The congestion which existed has been to some extent lessened by the erection of new houses, the conversion of houses into flats, and to the removal of families from the Borough to other parts of London and to the provinces. (2) (a) Extent of shortage of house's.—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 '50, so that if building during the last nine years had been at the same rate as in the previous four years there would have been 4,050 more houses erected. If from this 4,050 there is deducted the total number of empty houses at the census of 1911, viz., 2,600, and the number erected and occupied during 1920, this would give 1,308 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 number of houses erected by the Council and occupied during 1920 was 64, and erected by private builders 44, a total of 108. In addition the Council has converted nine houses into 34 flats. There are also at present 512 houses in course of erection by the Council and 10 by private builders. Lay-out plans have now been approved for the erection of 1,143 houses on the following sites :— Magdalen Park. Watney Estate. Furzedown Estate. Elmwood Estate. (3) No important change has taken place in the population during the year, and none is anticipated in the future. 132 Report of the Medical Officer of Health. II.—OVERCROWDING. (1) Extent.—The total number of cases of overcrowding dealt with in 1920 was 42. This is somewhat above 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. (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 sub-letting. 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 1,143 houses, and this will to a large extent relieve the congestion which exists in some parts of the Borough, and the London County Council contemplate the erection of 1,186 houses on the Dover House Estate, Roehampton. (4) Principal cases of overcrowding 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 re-arrangement 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, whilst in 1920 the estimated number was 56,539, an increase of 41,239. 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 chieflv old houses where the rooms are small. There are in addition about 133 Report of the Medical Officer of Health. 1,600 houses which, although built for one family and which, if occupied 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. (c) How far defects are due to the lack of proper management and supervision by owners.—As a general rule properties in this Borough are well managed or supervised by the owners or agents. There are a few properties, however, which from various reasons have not been properly supervised, but when the attention of the owners was called to the matter by the service of notice the work to remedy the nuisance was as a rule put in hand in a reasonable time, considering the high cost of labour and materials. The defects generally found were due to fair wear and tear, but in some exceptional cases the tenants were responsible for some of the nuisances discovered, and in these cases notice was served upon the tenant. During the year 23,880 houses were inspected and 9,121 notices were served, 7,997 of which were complied with. (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) Five closing orders were made during the year for five vans in Wardley Street. Notices were served under Section 28 134 Report of the Medical Officer of Health. of the Housing, Town Planning, &c., Act, 1919, in the case of 14 premises, one of the houses was repaired by the Council, and the others are being dealt with by the freeholders, and made reasonably fit for human 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 for 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. 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 31 of this Report. It was not necessary to take any special measures during the year as regards these conditions. Instances of nuisances under these headings were dealt with as occasion arose by service of notices under the Public Health (London) Act. 135 136 Report of the Medical Officer of Health. 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. The five occupied vans in the Borough which come under the By-laws were found to be in such an insanitary condition that the matter was reported to the Housing Committee, who made Closing Orders. (2) .45 to need for new By-laws or revision of existing Bylaws.—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 32 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. 137 Report of the Medical Officer of Health. APPENDICES. HOUSING CONDITIONS. Statistics. Year ended 31st December, 7980. 1.—GENERAL. (1). Estimated population 342,808 (2). General death-rate 10.36 (3). Death-rate from Tuberculosis .93 (4). Infantile mortality 64 (5). Number of dwelling-houses of all classes 56,539 (6). Number of working-class dwelling-houses 41,598 (7). Number of new working-class dwelling-houses erected 108 2.—UNFIT DWELLING HOUSES. I.—Inspection. (1). Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts 23,880 (2). Number of dwelling-houses which were spected and recorded under the Housing (Inspection of District) Regulations, 1910 3,348 (3). Number of dwelling-houses found to be in a state so dangerous or injurious to health as to' be unfit for human habitation ... 6 (4). Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation II.—Remedy of Defects without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 7,797 k 138 Report oj the Medical Officer of Health. III.—Action under Statutory Powers. A.—Proceedings under section 28 of the Housing, Town Planning, &c., Act, 1919. (1). Number of dwelling-houses in respect of which notices were served requiring repairs 14 (2). Number of dwelling-houses which were dered fit (a) by owners (b by Local Authority in default of owners... 1 (3). Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. B.—Proceedings under Public Health Acts. (.1). Number of dwelling-houses . in respect of which notices were served requiring defects to be remedied 960 (2). Number of dwelling-houses in which defects were remedied (a) by owners 706 (b) by Local Authority in default by owners... Nil. C.—Proceedings under sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909. (1). Number of representations made with a view to the making of Closing Orders 1 (2). ' Number of dwelling-houses in respect of which Closing Orders were made 6 (3). Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit 6 (4). Number of dwelling-houses in respect of which Demolition Orders were made Nil. (5). Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. Report of the Medical Officer of Health. 139 3.—UNHEALTHY AREAS. * Areas represented to the Local Authority with a view to Improvement Schemes under (a), Part I., or (b), Part II., of the Act of 1890 :— (1). Name of area Nil. (2). Acreage Nil. (3). Number of working-class houses in area Nil. (4). Number of working-class persons to be placed il. 4.—Number of houses not complying with the building bye-laws erected with consent of Local Authority under section 25 of the Housing, Town Planning, &c., Act, 1919 il. o.—Staff engaged in housing work— The Medical Officer of Health. Twelve sanitary inspectors, two of whom are specifically engaged in house-to-house inspections. 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 in a most thorough and conscientious manner. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, P. CALDWELL SMITH.