Metropolitan Borough of Wandsworth. Annual Report ON THE health, sanitary condition, &c. OF THE BOROUGH, FOR THE YEAR 1921, by P. CALDWELL SMITH, C.B.C., M.A., H.D., D.P.H., Lt.=Col. (late) 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 Alcoholism, Deaths from 24 Analyst, Report of 119 Appendicitis and Typhlitis 24 Bacteriological Examinations 117 Bakehouses 42, 46 Births 2 Births and Birth-rates in Sub-Districts 2 Births, Notification of, Act 4 Brain and Nervous System, Diseases of the 23 Canal Boats Act 47 Cancer 22 "Carrier" Cases 83 Census, 1911 1 Cerebro-Spinal Meningitis, Cases Notified 66 Cerebro-Spinal Meningitis, Deaths 17 Chemical Work 117 Circulatory Diseases 23 Clapham, House-to-House Inspections in 36 Cleansing of Persons Act 125 Conscientious Objection Certificates granted 100 Contacts 82 Cowsheds 55 Creches 112 Cutting-off Notices 125 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 ii. PAGE 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 Dental Treatment 113 Developmental Diseases 24 Diarrhœa 19 Diarrhœa, Deaths and Death-rate from 19 Diarrhœa, Method of Feeding Children who died from 115 Diphtheria, Cases Notified 63 Diphtheria, Deaths and Death-rates 17 Diphtheria, Number of Dwellings in which multiple Cases occurred 65 Diphtheria, "Return Cases" of 65 Disinfection 83 Disinfection of Schools 48 Dysentery Carriers 84 Dysentery, Cases Notified 81 Encephalitis Lethargica, Cases Notified 69 Encephalitis Lethargica, Deaths from 18 Enteric Fever, Cases Notified 65 Enteric Fever, Deaths and Death-rates 17 Erysipelas, Cases Notified 75 Erysipelas, Deaths 18 Factories and Workshops 41 Factories, Workshops and Workplaces, Inspection of 42 Food Places, Inspection of 42 German Measles, Cases of 75 Home Helps 117 Home Work 45 Hospitals and other forms of gratuitous relief 28 House Refuse, Removal of 38 House-to-house Inspections 36 House-to-house Inspections, Summary of 36 Houses and Premises Inspected 33 Houses Let in Lodgings 55 iii. PAGE Housing 125 Housing, Town Planning, etc., Act, 1909 36 Ice Cream Premises 55 Illegitimate Children, Births of 3, 110 Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 48 Infant Visiting 102 Infantile Mortality 13, 14 Infective Diseases, Deaths from 16 Infective Diseases, Death-rate from 16, 17 Infective Diseases: Number of Cases Notified 59 Infective Diseases: Number of Cases notified from Elementary Schools 77 Infectious Disease, Prevalence and Control over 58 Influenza, Deaths and Death-rates 19 Influenza, Pneumonia and Acute Primary Pneumonia, Cases Notified 80 Inspections, details of 34, 35 Inquests , 25, 26. 27 Isolation, Arrangements for 82 Malaria, Cases Notified 81 Malaria, Deaths from 18 Maternity and Child Welfare 101 Maternity and Child Welfare Centres 110 Maternity Home 105 Measles and German Measles, Cases Notified 75 Measles and other Non-notifiable Diseases reported from Schools 77 Measles, Deaths and Death-rates 18 Meat 53 Milk and Cream Regulations, 1912 50 Milk and Food 51 Milk (Mothers and Children) Order 51 Milk Premises, Cowsheds, etc., on Register 55 Milkshops, Cowsheds, &c., Inspections of 54 Milk Supply 49 iv. PAGE Mistaken Diagnosis, Cases of 66 Mortuaries 28 Natural Increase, Rate of 2 Nervous System, Diseases of the 23 Non-Infective Diseases 22 Notification of Births Act 4 Notification of Infective Diseases 59 Offensive Trades 55 Old Age 25 Ophthalmia Neonatorum 113 Other Infective Diseases, Deaths from 21 Outworkers 45 Overcrowding 36 Police Court Proceedings 38 Polio-Myelitis and Polio-Encephalitis, Cases Notified 73 Polio-Myelitis, Deaths from 21 Poor Law Relief, Amount of 28 Population 1 Population of Sub-Districts 1 Premature Birth 24 Public Institutions, Number of Deaths in 30 Puerperal Fever 113 Puerperal Fever, Deaths and Death-rates 18 Pulmonary Tuberculosis, Notification of Cases of 84 Putney, House-to-house Inspections in 36 Rag Flock Act, 1911, Statement of Work done under 118 Rat Destruction 48 Respiratory Diseases 23 Return Cases of Scarlet Fever and Diphtheria 65 Revenue Act 125 River Wandle, Report on 30 Sale of Food and Drugs Act, Proceedings under 55 Sale of Food and Drugs Aet, Statement of Work under 55 Sanitary Conveniences, Inspection of 17 Sanitary Operations, Table of 33 Sanitary Inspection of District 30 V. PAGE Scabies 101 Scarlet Fever, Cases Notified 62 Scarlet Fever, Deaths and Death-rates 17 Scarlet Fever, Number of Dwelling's in which Multiple Cases occurred 63 Scarlet Fever, "Return Cases" of 65 Schools 48 Schools, Disinfection of, for Infective Diseases 49 Slaughter-houses 55 Small-pox 61, 100 Smoke Nuisances 33 Staff 117 Streatham, House-to-house Inspections in 36 Tooting, House-to-house Inspections in 36 Trench Fever, Cases Notified 82 Tuberculosis Dispensaries 89 Tuberculous Diseases, After-care 93 Tuberculous Diseases, Cases Notified 84 Tuberculous Diseases, Deaths and Death-rates 20 Tuberculous Diseases, Results of Treatment 98 Underground Rooms 41 Unsound Food 54 Vaccination Returns 100 Violence, Mortality from 25 Vital Statistics of Whole Borough 12 Wandsworth, House-to-house Inspections in 36 Water Supply, Cutting-off Notices 125 Whooping Cough, Cases Notified 80 Whooping Cough, Deaths and Death-rates 18 Zymotic Diseases, Deaths from 16 Zymotic Diseases, Death-rate from 16, 17 REPORT of the Medical Officer of Health for the Year 1921. 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 1921. Population. The population of the Borough at the Census of 1921 was 328,656, but this in my opinion does not show the actual population at that period. This has to some extent been recognised by the Registrar-General, and he has adjusted the above population by a redistribution of the estimated population on holiday, and has increased the population to 331,500. The detailed Census returns will not be available for inclusion in this Report, as they will not be published till late in the current year. Table I. shows the population of each sub-district based on the above estimation, compared with the Census population. TABLE 1. Sub-District. Census Population, 1921. Population estimated to middle of 1921. Corrected. Uncorrected. Clapham 60,570 61,090 61,090 Putney 28,579 28,830 28,830 Streatham 103,499 104,405 104,405 Tooting 40,410 38,760 40,760 Wandsworth 95,598 94,915 96,415 Whole Borough 328,656 328,000 331, 00 2 Report of the Medical Officer of Health. The corrected estimated population in Table I. is used to calculate all the rates in this Report. Births. During the year 1921, 6,107 births, 3,189 of males and 2,978 of females, occurred, compared with 7,212 in 1920. The total number of births in this Borough was 6,039, but 598 births occurred in Institutions outside the Borough of persons belonging to the Borough, and 470 births in Institutions in the Borough of persons not belonging to the Borough, making a corrected total of 6,167. In Table II. is shown the number of births, males and females, the birth.rate, and the rate of natural increase for each sub.district, and for the whole Borough. TABLE 11. Sub.District, BIRTHS. RATES. Males. Females. Total. Birth-Rate. Rate of natural increase. Clapham 614 616 1,230 20.13 9.30 Putney 231 240 471 16.33 5.03 Streatham 887 901 1,788 17.12 6.03 Tooting 416 356 772 19.92 9.93 Wandsworth 1041 865 1,906 20.08 9.56 Whole Borough 3,189 2,978 6,167 18 80 7.97 The birth-rate was 18.80 per 1,000, compared with 21.03 for 1920, and 18.87 the decennial average. 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. 3 Report of the Medical Officer of Health. TABLE III. Year. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. London. England and Wales. 1911 2215 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 1878 16.15 1823 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 1369 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 1920 20.38 17.47 20.65 23.66 21.89 21.03 26.3 25.4 Average for 10 yrs. 18.53 15.16 17.61 22.95 19.95 18.87 22.4 21.8 1921 2013 16.33 17.12 19.92 20.18 18.80 22.3 22.4 Only 14 births occurred in the Workhouse, seven of which belonged to the Borough. 305 illegitimate births took place in the Borough, 26 in Clapham, 10 in Putney, 170 in Streatham, 20 in Tooting, and 79 in Wandsworth. Of the 305 illegitimate births that occurred in the Borough, 119 belonged to the Borough, 24 to Clapham, 10 to Putney, 23 to Streatham, 12 to Tooting, and 50 to Wandsworth. 120 illegitimate births occurred outside the Borough, making a total of 239. 4 Report of the Medical Officer of Health. The illegitimate births in nursing homes have againr been allocated to the home addresses of the mothers. The percentage of illegitimate births to total births was 3.88. 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 1011 379 310 300 22 1027 24 Putney 423 175 86 152 10 417 6 Streatham 2111 546 611 846 108 2130 33 Tooting 744 102 198 428 16 737 3 Wandsworth 1705 265 950 445 45 1728 15 Whole Borough 5994 1467 2155 2171 201 6039 81 The' percentage of births notified, less still-births, to those registered was 99, compared with 98.6 in 1920. Deaths. During the year ending the 31st December, 1921, 3,103 deaths, 1,395 of males and 1,708 of females, occurred, compared with 3,080 in 1920. Report of the Medical Officer of Health. 5 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'th Total. Hostel of God 55 ... ... ... ... 55 South London Hospital for Women 35 ... ... ... ... 35 Springfield Mental Hospital ... ... ... ... 110 110 Fountain Temporary Mental Hospital ... ... ... 48 ... 48 H. M. Prison ... ... ... ... 4 4 Swaffield Rd. Institution ... ... ... ... 13 13 Royal Hospital for Incurables ... ... ... ... 17 17 Tooting Bec Mental Hospital ... ... ... 347 ••• 347 Grove Hospital ... ... ... 154 ... 154 The Priory ... 3 ... ... ... 3 Weir Hospital ... ... 22 ... ... 22 Putney Hospital ... 18 ... ... ... 18 Ministry of Pensions Hospitals 1 ... ... 19 ... 20 TOTAL 91 21 22 568 144 846 Other places 41 34 107 10 50 242 GRAND TOTAL 132 55 129 578 194 1088 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, 1921. 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 Hosp. Tooting Mental Hospital. [ Hostel of God. | Swaffield rd. Institution. | H.M. Prison. Ryl. Hosp. for Incurables Fountain Mental Hosp S.Lon. Hosp. for Women. Putney Hospital. Grove Hospital. Weir Hospital. The Priory. Newlands House Asylum. Min. of Pensions Hosp'ls Other Places, not Public Institutions. Enteric Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Small pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 1 .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. Scarlet fever 31 14 17 4 5 6 12 4 .. .. .. .. .. .. .. .. .. 1 .. .. 30 .. .. .. .. .. Whooping Cough .. 1 2 .. 2 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 .. .. .. .. .. Diphtheria and Membranous Croup 59 28 31 4 4 20 29 1 1 .. .. .. .. .. .. .. .. .. 1 ... 58 .. .. .. .. .. Influenza 9 6 3 .. .. 3 1 .. .. 1 4 1 4 .. .. .. .. 4 .. .. .. .. .. .. .. .. Erysipelas 1 .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. Cerebro-spinal Fever 1 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. Other Epidemic Diseases 3 1 2 .. .. .. 1 1 .. 1 .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. 1 Pulmonary Tuberculosis 44 22 22 .. .. 2 4 4 23 9 2 23 5 5 .. .. .. 6 1 .. .. .. .. .. 1 3 Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis 1 .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. . Other Tuberculous Diseases 3 1 2 .. .. 1 .. .. 2 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 2 Other Infective Diseases 3 2 1 2 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Cancer, Malignant Disease 68 24 44 .. .. .. .. .. 8 30 30 5 7 33 .. .. 1 .. 6 1 1 .. .. .. 1 13 Rheumatic Fever 1 .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. Diabetes 2 .. 2 .. .. .. .. .. .. .. 2 .. .. .. . .. 1 .. .. .. .. .. .. .. .. 1 Other General Diseases 6 2 4 .. 1 .. .. 2 .. 1 2 .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 4 Alcoholism .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chronic Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis 3 2 1 1 .. .. .. 1 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 1 Cerebral Haemorrhage, Apoplexy 21 7 14 .. .. .. .. .. .. 7 14 4 8 .. 1 .. .. .. 1 .. .. .. .. 1 .. 6 Convulsions 2 1 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Other Diseases of Nervous System 80 46 34 .. .. 5 11 6 17 31 10 22 22 1 1 .. 7 16 .. .. .. .. .. .. 4 7 Organic Diseases of Heart 47 12 35 .. .. .. 2 2 1 23 19 13 8 .. 2 .. 1 2 3 1 .. .. 1 .. .. 16 Other Diseases of Circulatory System 10 3 7 .. .. .. .. 1 2 7 3 1 .. .. .. .. .. 1 .. .. .. .. .. .. 5 Bronchitis 28 7 21 1 1 .. 1 1 1 6 17 11 1 2 1 .. .. 1 1 . 1 .. .. .. .. 10 Broncho-Pneumonia 12 3 9 .. 1 1 3 .. 1 1 5 3 .. . .. .. .. 3 .. 1 2 .. 2 .. .. 1 Lobar Pneumonia 14 8 6 .. .. 3 4 .. 4 .. 3 2 3 .. .. .. .. 6 1 .. .. 1 .. .. .. 1 Pneumonia (type not distinguished) 12 5 7 1 .. .. .. . 2 5 4 1 7 .. .. . 2 .. .. .. .. .. .. .. .. 2 Other Diseases of Respiratory System 5 1 4 .. .. .. .. .. .. 2 3 .. 2 .. .. .. .. .. .. .. .. 1 .. .. .. 2 Ulcer of Stomach 1 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. Diarrhœa 1 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. Enteritis 5 5 .. 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 2 .. .. .. .. 2 Appendicitis and Typhlitis 6 1 5 .. 1 .. .. 1 2 2 .. .. .. .. .. .. .. .. 3 .. .. .. .. .. .. 3 Obstruction of Intestines 4 2 2 .. .. .. .. .. 1 .. 3 .. .. 1 .. .. .. .. 1 1 .. 1 .. .. .. .. Cirrhosis of Liver 4 4 .. .. .. .. .. .. 1 1 2 1 .. .. .. .. 1 .. .. .. .. .. .. .. 1 1 Other Diseases of Liver .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases of Digestive System 5 .. 5 .. .. .. .. .. 2 2 1 .. 1 1 .. .. .. .. 1 .. 1 .. .. .. .. 1 Nephritis and Bright's Disease 6 2 4 .. .. .. .. 1 2 2 1 1 1 .. .. .. .. .. 1 .. .. .. .. .. 1 2 Other Diseases of Urinary System 1 .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. Diseases of Generative System 1 ... 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. Puerperal Fever 1 ... 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Other Accidents and Diseases of Pregnancy and Childbirth .. ... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Premature Birth 8 4 4 8 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 7 Congenital Debility and Malformation 11 6 5 5 .. 3 3 .. .. .. .. .. 2 .. .. .. .. 4 2 .. .. .. .. .. .. 3 Other Diseases of Early Infancy 2 2 .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Old Age 302 114 188 .. .. .. .. .. .. 4 298 16 260 1 3 .. 1 .. .. .. .. .. .. .. .. 21 Death* from Accident 15 11 4 .. 1 .. 1 2 4 2 5 2 5 .. .. .. 1 .. .. 1 1 .. .. .. .. 5 Deaths from Suicide 2 1 1 .. .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. ... .. .. 1 1 Other Violent Deaths 9 9 .. .. .. .. .. 3 6 .. .. .. .. .. .. 2 .. .. .. .. .. .. .. .. 7 .. Other defined Diseases 4 3 1 .. .. 2 1 .. 1 .. .. .. .. .. .. .. .. 2 .. .. 1 .. .. .. 1 .. Ill-defined Diseases or unknown 2 2 .. .. .. .. ... .. .. 2 .. .. .. .. .. ... ... .. .. .. .. .. .. .. .. 2 All causes 860 365 495 36 17 46 75 30 83 139 434 109 338 44 8 3 17 46 29 6 103 3 3 1 19 131 Report of the Medical Officer of Health. 7 TABLE VII. Deaths in Public Institutions, &c., in the Borough, of Persons belonging to the Borough, 1921. 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. H.M. Prison. Swafiield rd. Institution. 1 Fountain Mental Hosp S.Lon. Hosp. for Women. Putney Hospital. Grove Hospital. Weir Hospital. Min. of Pensions Hosp'ls Springfield Mental Hosp. Other Places, not Public Institutions. Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Scarlet Fever 11 4 7 ... 1 3 5 2 ... ... ... ... ... ... ... ... ... ... 11 ... ... ... ... Whooping Cough 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Diphtheria and Membranous Croup 37 16 21 3 1 13 18 1 1 ... ... ... ... ... ... ... ... ... 36 ... ... ... 1 Influenza 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Fever 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 10 7 3 ... ... ... ... 2 3 5 ... ... 5 ... ... ... ... ... ... ... ... ... 5 Tuberculous Meningitis 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases 1 ... 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... Other Infective Diseases 2 1 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Cancer, Malignant Disease 15 3 12 ... ... ... ... ... 2 11 2 4 ... ... ... 1 3 ... 1 ... ... 6 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diabetes 2 1 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 ... ... 1 Other General Diseases 4 ... 4 ... ... ... ... ... 2 1 1 ... ... ... ... ... 1 ... ... ... ... ... 3 Alcoholism 2 1 1 ... ... ... ... ... 2 ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Haemorrhage, Apoplexy 6 3 3 ... ... ... ... ... ... 1 5 ... ... ... ... ... ... ... ... ... ... ... 6 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Nervous 5 3 2 1 ... ... ... ... 3 1 ... ... ... ... ... ... ... ... ... 1 1 ... 1 Organic Diseases of Heart 19 7 12 ... ... ... ... ... 2 11 6 ... ... ... ... ... 1 2 ... ... ... 1 14 Other Diseases of Circulatory System 9 2 7 1 ... ... 1 2 ... ... 5 1 ... ... ... ... ... ... ... 2 ... ... 6 Bronchitis 2 1 1 ... ... ... ... ... ... ... 2 1 ... ... 1 ... ... ... ... ... ... 1 Broncho-pneumonia 3 1 2 2 ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 Lobar pneumonia 3 ... 3 ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... 2 ... ... 1 Pneumonia (type not distinguished) 2 1 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 Other Diseases of Respiratory System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ulcer of Stomach 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 Diarrhœa 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Enteritis 7 5 2 7 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... 4 Appendicitis and Typhlitis 5 5 ... ... ... ... 1 1 2 ... 1 ... ... ... ... ... ... 1 ... 1 ... ... 3 Obstruction of Intestines 5 ... 5 ... ... ... 1 ... 2 1 1 ... ... ... ... 1 ... 1 ... ... ... ... 3 Cirrhosis of Liver 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 Other Diseases of Liver 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... Other Diseases of Digestive System 5 3 2 1 ... ... ... 1 1 1 1 ... ... ... ... ... ... ... ... 2 ... ... 3 Nephritis and Bright's Disease 3 3 ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... ... ... ... 3 Other Diseases of Urinary System 4 1 3 ... ... ... ... ... 1 1 2 ... ... ... ... ... ... 1 ... 2 ... ... 1 Diseases of Generative System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Other Accidents and Diseases of Pregnancy and Childbirth 4 ... 4 ... ... ... ... ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Premature Birth 4 3 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Congenital Debility and Malformation 9 6 3 8 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 8 Other Diseases of Early Infancy 2 2 ... 2 .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Old Age 15 3 12 ... ... ... ... ... ... ... 15 5 ... ... 3 ... ... 1 ... ... ... ... 6 Deaths from Accident 17 8 9 ... ... ... 7 1 1 2 6 2 ... ... ... ... ... ... ... 3 ... ... 12 Deaths from Suicide 2 2 ... ... ... ... ... ... ... 1 1 ... ... ... 1 ... ... ... ... ... ... ... 1 Other Violent Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other defined Diseases 2 ... 2 ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... 1 ...... ... ... Ill-defined Diseases or unknown 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... _... 1 All causes. 228 96 132 32 5 18 34 13 28 47 51 9 11 1 5 2 6 12 51 19 1 1 110 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, 1921. 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 5 3 2 ... ... ... ... ... 4 1 ... ... 2 2 ... 1 1 ... 1 3 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 9 3 6 ... ... 1 6 1 ... 1 ... 2 2 ... 1 4 ... .. ... 9 Whooping Cough 9 6 3 3 4 2 ... ... ... ... ... 2 1 2 1 3 8 ... ... 1 Diphtheria and Membranous Croup 25 15 10 1 1 3 16 2 2 ... ... 10 2 7 3 3 ... 2 ... 23 Influenza 11 9 2 ... ... 1 ... 1 6 2 1 3 ... 4 1 3 8 2 1 ... Erysipelas 3 2 1 1 ... ... ... ... ... 1 1 ... ... 1 1 1 3 .. ... ... Cerebro-spinal Fever 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... 1 .. ... ... 1 Other Epidemic Diseases 7 4 3 ... ... ... ... ... 4 2 1 ... 1 3 1 2 2 3 1 1 Pulmonary Tuberculosis 159 85 74 ... ... ... 4 37 83 29 6 32 14 43 24 46 65 75 12 7 Tuberculous Meningitis 18 11 7 1 1 5 5 5 1 ... ... 2 ... 4. 2 10 8 8 ... 2 Abdominal Tuberculosis 4 2 2 ... ... 1 1 ... 1 1 ... 2 ... 1 ... 1 1 2 1 ... Other Tuberculous Diseases 17 10 7 3 1 ... 2 5 4 1 1 3 ... 1 3 10 9 7 1 ... Other Infective Diseases 12 6 6 2 ... 1 1 1 3 4 ... 2 1 5 ... 4 6 5 ... 1 Cancer, Malignant Disease 161 86 75 1 ... ... ... ... 17 88 55 29 18 43 29 42 74 78 9 ... Rheumatic Fever 8 6 2 ... ... 1 3 ... 1 1 2 1 1 1 3 2 4 4 ... ... Diabetes 4 2 2 ... ... ... ... ... 2 1 1 ... ... 4 ... ... 2 2 ... ... Other General Diseases 11 6 5 1 ... . 3 1 1 3 2 3 1 2 4 1 8 3 ... ... Alcoholism 2 2 ... ... ... ... ... ... ... 2 ... 1 ... ... ... 1 1 1 ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... . Meningitis 7 4 3 1 ... ... 3 ... 1 2 ... 2 ... 1 2 2 4 2 ... 1 Cerebral Hæmorrhage, Apoplexy 30 12 18 ... ... ... ... ... 1 11 18 6 5 11 7 1 23 6 1 ... Convulsions 1 ... 1 1 ... ... ... ... ... ... ... 1 ... .. ... ... ... 1 ... ... Other Diseases of Nervous System 62 39 23 ... 1 ... 8 3 17 28 5 9 6 16 7 24 21 20 21 ... Organic Diseases of Heart 179 73 106 ... .. ... ... 5 16 34 124 40 12 57 21 49 140 31 8 ... Other Diseases of Circulatory System 45 20 25 1 .. 1 3 2 8 11 19 6 6 16 5 12 27 15 3 ... Bronchitis 43 19 24 1 ... ... 1 2 1 7 31 7 4 12 9 11 34 7 2 ... Broncho-Pneumonia 33 17 16 11 2 1 3 ... 5 8 3 5 2 9 6 11 19 14 ... ... Lobar Pneumonia 9 5 4 ... ... l ... ... 4 3 1 1 ... 4 1 3 6 1 2 Pneumonia (type not distinguished) 28 18 10 ... ... .. 2 4 10 9 3 6 3 9 5 5 22 4 2 Other Diseases of Respiratory System 9 5 4 ... ... ... ... ... 5 2 2 ... 3 5 ... 1 3 3 3 ... Ulcer of Stomach 11 7 4 ... ... ... ... 1 5 4 1 3 2 4 1 1 3 8 ... ... Diarrhœa 31 17 14 25 5 1 ... ... ... ... ... 3 2 9 7 10 15 16 ... ... Enteritis 22 10 12 18 1 1 ... ... 1 1 ... 5 1 6 1 9 8 14 ... ... Appendicitis and Tvphlitis 16 10 6 ... ... ... 5 3 4 4 ... 2 1 4 3 6 3 13 ... ... Obstruction of Intestines 18 7 11 2 ... ... ... ... 1 8 7 3 4 6 3 2 6 12 ... ... Cirrhosis of Liver 5 3 2 ... ... ... ... ... 2 2 1 2 1 2 .. ... 1 4 ... ... Other Diseases of Liver 7 3 4 ... ... ... ... 1 ... 4 2 3 1 2 ... 1 ... 7 ... ... Other Diseases of Digestive System 21 11 10 1 ... ... 3 ... 9 7 1 4 1 3 4 9 10 10 1 Nephritis and Bright's Disease 33 19 14 ... ... ... 2 2 6 14 9 3 2 14 4 10 21 9 3 ... Other Diseases of Urinary System 22 20 12 ... ... ... ... 1 2 6 13 5 ... 8 2 7 9 13 ... ... Diseases of Generative System 9 ... 9 ... ... ... ... ... 3 5 1 ... 2 1 3 3 5 4 ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... other Accidents and Diseases of Pregnancy and Childbirth 3 ... 3 ... ... ... ... 1 2 ... ... 2 ... 1 ... ... 2 1 ... ... Premature Birth 15 6 9 15 ... ... ... ... ... ... ... 3 2 6 ... 4 8 7 ... ... Congenital Debility and Malformation 33 19 14 32 1 ... ... ... ... ... ... 8 2 7 6 10 15 18 ... ... Other Diseases of Early Infanc 5 4 1 5 ... ... ... ... ... ... ... 2 .. 2 1 ... l 4 ... ... Old Age 61 24 37 ... ... ... ... ... ... ... 61 17 4 15 3 22 48 8 5 ... Deaths from Accident 56 42 14 ... 1 1 3 6 11 24 10 10 3 20 6 17 24 32 ... ... Deaths from Suicide 16 11 5 ... ... ... ... 2 2 11 1 4 ... 9 1 2 3 13 ... ... Other violent Deaths 1 ... 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... 1 ... ... Other defined Diseases 15 6 9 4 ... 1 1 3 1 4 1 3 2 4 .2 4 10 5 ... ... III defined Diseases or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... All cauaes 1312 689 623 130 18 22 76 89 247 346 384 257 114 387 183 371 691 495 77 49 Report of the Medical Officer of Health. 9 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 3,555, 1,719 of males, and 1,836 of females. The corrected death-rate for the year was 10.83, compared with 10.36 in 1920. The death-rate for the whole of London for the year was 12.4 per 1,000, compared with 12.4 in 1920. 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 328 324 662 211 280 491 10.83 Putney 147 179 326 109 131 240 11.30 Streatham 539 619 1158 356 453 809 11.09 Tooting 216 194 410 377 409 786 1.05 Wandsworth 489 510 999 342 435 777 10.52 Whole Borough 1719 1836 3555 1395 1708 3103 10.83 The death-rate in England and Wales in 1921 was 12.1 per 1,000; in the 96 great Towns 12.3; and in the 148 smaller Towns 11.3. The rates in all the sub-districts were very slightly higher than in 1920. 10 Report of the Medical Officer of Health. Table X. shows the death.rate in the Borough, in the five sub.distriets, 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, in London, and in England and Wales, was in the year 1920. The rate in 1921 is lower than the average of the previous 10 years, and is the second lowest ever recorded. Compared with London and with England and Wales, the Borough rate is considerably lower. TABLE X. Clap. ham. Putney. Streat. ham. Tooting. Wandsworth. Whole Borough London. England and Wales. 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 10.7.4 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 1206 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 1920 10.56 10.95 10.09 8.97 10.15 10.36 12.4 12.4 Average, 10 years. 12.36 11.67 11.60 11.11 12.21 11.87 14.95 14.3 1921 10.83 11.30 11.09 10.05 10.52 10.83 12.4 12.1 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. Report of the Medical Officer of Health. 11 TABLE XI. Causes of, and Ages at Death, during the year 1921. CAUSES OF DEATH. Deaths in or belonging to whole District at subjoined ages. Deaths in or belonging to Localities (at all ages). Deaths in Public Institutions in the District. All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Clapham. Putney. Streatham. Tooting. Wandsworth. Enteric Fever 7 4 3 ... ... ... 1 ... 5 1 ... ... 2 2 ... 3 ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 4 3 1 1 3 ... ... ... ... ... ... 2 ... 2 ... ... 2 Scarlet Fever 20 7 13 ... 1 4 11 3 ... 1 ... 3 4 2 4 7 43 Whooping Cough 28 17 11 15 9 4 ... ... ... ... ... 2 3 4 7 12 4 Diphtheria and Membranous Croup 64 32 32 4 2 16 36 3 3 ... ... 13 8 25 7 11 95 Influenza 81 40 41 3 3 2 1 4 16 23 29 16 4 36 10 15 10 Erysipelas 5 3 2 1 ... ... ... ... 1 2 1 ... ... 1 1 3 1 Cerebro-spinal Fever 3 1 2 ... 1 1 1 ... ... ... ... ... ... 1 1 1 2 Other Epidemic Diseases 10 6 4 ... ... ... ... 1 5 2 2 ... 1 5 1 3 3 Pulmonary Tuberculosis 331 170 161 ... 1 ... 4 76 158 79 13 62 31 84 53 101 55 Tuberculous Meningitis 29 16 13 1 2 9 9 7 1 ... ... 4 1 6 4 14 1 Abdominal Tuberculosis 8 4 4 2 ... 1 2 1 1 1 ... 3 ... 3 1 1 1 Other Tuberculous Diseases 22 11 11 3 1 ... 2 7 5 2 2 4 ... 3 4 11 3 Other Infective Diseases 21 10 11 7 ... i 1 2 3 4 3 2 3 7 ... 9 5 Cancer, Malignant Disease 412 182 230 1 ... ... 1 ... 36 192 182 76 39 146 37 114 83 Rheumatic Fever 15 5 10 ... ... 1 8 3 2 ... 1 1 3 2 6 3 1 Diabetes 29 17 12 ... ... ... 1 ... 9 9 10 2 2 13 2 10 4 Other General Diseases 37 11 26 1 ... 1 2 2 6 11 14 10 2 6 6 13 10 Alcoholism 5 4 1 ... ... ... ... ... 2 3 ... 1 ... 2 ... 2 2 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 14 6 8 6 2 ... 3 ... 1 2 ... 2 ... 2 5 5 3 Cerebral Hæmorrhage, Apoplexy 145 58 87 ... ... ... ... 1 3 43 98 28 15 53 18 31 43 Convulsions 15 9 6 12 3 ... ... ... ... ... ... 5 3 3 1 3 2 Other Diseases of Nervous System 123 70 43 1 3 1 10 9 25 42 32 23 11 37 14 38 71 Organic Diseases of Heart 415 177 238 ... 1 ... 2 11 43 104 254 82 3b 150 42 105 63 Other Diseases of Circulatory System 143 74 69 4 ... 1 5 6 12 35 80 29 20 56 9 29 24 Bronchitis 308 143 165 23 5 1 1 2 7 53 21b 58 2b 100 37 87 35 Broncho-Pneumonia 108 58 50 39 10 6 5 3 6 17 22 20 7 28 12 41 10 Lobar Pneumonia 50 27 23 ... 2 1 2 5 11 21 8 9 4 19 5 13 12 Pneumonia (type not distinguished) 83 47 36 14 4 1 5 5 16 15 23 12 7 29 8 27 14 Other Diseases of Respiratory System 36 18 18 1 ... ... 1 ... 8 11 15 3 3 15 6 9 5 Ulcer of Stomach 18 11 7 ... ... ... ... 1 6 10 1 4 2 8 2 2 2 Diarrhœa 60 35 25 45 11 1 1 ... ... ... 2 7 3 15 12 23 2 Enteritis 48 25 23 36 1 2 1 ... 1 1 6 11 3 16 7 11 11 Appendicitis and Typhlitis 21 15 6 ... ... 2 4 4 6 4 1 4 2 6 3 6 12 Obstruction of Intestines 32 13 19 2 ... ... 1 ... 5 11 13 5 7 9 5 6 9 Cirrhosis of Liver 17 9 8 ... ... ... ... ... 2 12 3 5 3 6 1 2 6 Other Diseases of Liver 12 4 8 ... ... ... ... 1 ... 6 5 3 1 3 1 4 1 Other Diseases of Digestive System 50 22 28 9 1 1 3 1 11 14 10 9 3 14 6 18 10 Nephritis and Bright's Disease 101 54 47 ... ... ... 2 2 9 43 45 13 10 44 9 25 9 Other Diseases of Urinary System 35 25 10 ... ... ... ... 1 4 10 20 7 2 12 2 12 4 Diseases of Generative System 12 .. 12 ... ... ... ... ... 4 5 3 ... 2 3 3 4 2 Puerperal Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 2 Other Accidents and Diseases of Pregnancy and Child-birth 10 ... 10 ... ... ... ... 1 9 ... ... 2 1 3 1 3 4 Premature Birth 73 41 32 73 ... ... ... ... ... ... ... 16 7 22 8 19 12 Congenital Debility and Malformation 86 53 33 79 3 1 3 ... ... ... ... 18 5 24 12 28 20 Other Diseases of Early Infancy 25 16 9 25 ... ... ... ... ... ... ... 5 5 5 4 6 4 Old Age 227 72 155 .. ... ... ... ... ... ... 227 53 19 73 17 65 316 Deaths from Accident 89 60 29 3 1 2 10 8 12 a30 23 13 8 28 12 28 33 Deaths from Suicide 31 21 10 ... ... ... 1 4 6 16 4 5 3 14 2 7 4 Other Violent Deaths 2 ... 2 1 ... ... ... ... 1 ... ... ... ... 1 ... ... 10 Other Defined Diseases 27 11 16 6 ... 1 1 4 2 8 5 6 5 8 2 6 5 Ill-defined Diseases or unknown 7 2 5 ... ... ... ... 1 ... 2 4 3 ... 2 ... 2 3 All causes 3555 1719 1836 418 70 61 141 179 464 845 1377 662 326 1158 410 999 1088 12 Report of the Medical Officer of Health. TABLE XII. Vital Statistics of Whole District during 1921 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 N umber. Rate. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1911 308,156 6,555 6,699 2173 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 2087 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 1925 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 1472 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 1920 342 808 7,179 7,212 2103 3,080 8.76 789 1,261 462 64 3,552 10.36 Average for 10 yrs. 318,038 6,056 6,275 18-93 3,514 10.93 935 1,191 528 84 3,769 11.86 1921 328,000 6,039 6,167 18.80 3,103 9.36 860 1,312 418 67 3,555 10.83 Report of the Medical Officer of Health. 13 TABLE XIII. Infant Mortality. 1921 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 0 Months and under 12 Months. Total Deaths under 1 year. All Causes— Certified 99 21 21 22 163 71 79 51 51 415 Uncertified 2 ... ... ... 2 1 ... ... ... 3 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 2 3 2 8 15 Diphtheria and Croup ... ... ... 1 1 ... ... ... 3 4 Erysipelas ... ... ... ... ... 1 ... ... ... 1 Tuberculous Meningitis ... ... ... ... ... ... ... ... 1 1 Abdominal Tuberculosis ... ... ... ... . ... ... 1 ... 1 Other Tuberculous Diseases ... ... ... ... ... ... 1 3 ... 4 Meningitis (not Tuberculous) ... .. ... 1 1 2 2 1 ... 6 Convulsions 4 2 ... ... 6 2 2 1 1 12 Laryngitis ... .. ... ... ... ... ... ... ... ... Bronchitis ... ... 1 4 5 6 7 1 4 23 Pneumonia (all forms) ... 1 1 ... 2 10 12 13 16 53 Diarrhœa ... ... ... 2 2 12 20 4 7 45 Enteritis ... ... ... 1 1 9 14 7 5 36 Gastritis ... ... ... 1 1 2 ... 3 1 7 Syphilis 1 ... 1 1 3 4 ... ... ... 7 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlaying ... ... ... ... ... ... 1 1 ... 2 Injury at birth 12 1 ... ... 13 ... ... ... ... 13 Atelectasis 6 1 ... ... 7 ... ... ... 1 8 Congenital Malformations 5 3 5 1 14 6 1 1 1 23 Premature Birth 52 7 5 6 70 3 ... ... ... 73 Atrophy, Debility, and Marasmus 10 6 7 4 27 9 9 6 ... 51 Other Causes 11 ... 1 ... 12 4 7 7 2 32 Totals 101 21 21 22 165 72 79 51 51 418 Nett Births in the year, legitimate, 5,928; illegitimate, 239. Nett Deaths in the year of legitimate infants, 380; illegitimate infants, 38. 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. 1911 1912 1913 1914 1915 1916 1917 191S 1919 1920 Average 10 years. 1921 Clapham 72 10 9 119 76 82 76 92 70 74 107 65 63 82 66 Putney 38 11.6 145 69 85 87 78 74 S3 97 112 69 89 80 Streatham 110 9.5 99 58 74 86 76 66 73 71 58 60 72 61 Tooting 61 14.9 116 100 91 114 104 109 110 99 58 69 97 79 Wandsworth 137 13.7 143 83 103 84 104 92 104 90 68 65 93 71 Whole Borough 418 11.75 122 76 88 88 92 78 89 89 66 64 85 67 Report of the Medical Officer of Health. 15 The Infantile Mortality for the year was slightly higher than in 1920, which was the lowest infantile mortality ever recorded in the Borough. It was quite anticipated that there would be a marked increase in the infantile mortality during the year, owing to climatic conditions, but this fortunately did not occur. In 1911, when the climatic conditions were somewhat similar the infantile mortality reached the abnormally high rate of 122 per 1,000 births, but owing, without doubt, to the educational campaign carried on, both by the officials of the Sanitary Authority and the Infant Welfare Centres, the mortality was only 67 per 1,000. 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 slight decrease in the percentage under four weeks compared with the five years' average, and a slight increase at three to six months, and at nine to 12 months, while at the other age periods the rate was lower. TABLE XV. 1916 1917 1918 1919 1920 Five years' average. 1921 Rate per 1,000 births 78 89 89 66 64 77 67 Percentage of above:— Under one week 24.0 19.1 22.7 32.3 28.3 25.3 21.4 1 and under 2 weeks 8.0 6.3 3.6 8.6 7.8 6.8 5.0 2 and under 3 weeks 3.4 4.3 3.8 7.5 6.9 5.3 5.0 3 and under 4 weeks 4.1 3.8 2.6 3.9 5.0 3.8 5.3 Under 4 weeks 39.5 33.5 32.6 52.3 48.0 41.2 39.4 From 4 to 13 weeks 15.4 17.7 18.5 18.3 21.3 18.2 17.3 From 3 to 6 months 20.3 18.4 19.5 11.8 14.3 16.9 18.9 From 6 to 9 months 13.1 11.4 17.4 9.8 12.3 12.8 12.2 From 9 to 12 months 11.7 19.0 12.0 7.8 4.1 10.9 12.2 Under 12 months 100.0 100.0 100.0 100 0 100.0 100.0 100.0 16 Report of the Medical Officer of Health. The Infantile Mortality among legitimate infants was 64 per 1,000 legitimate births, and among illegitimate infants 159 per 1,000 illegitimate births, or nearly two and a half times as great. 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. 1911. 1912. 1913. 1914. 1915. 1916. 1917. 1918. 1919. 1920. 1921. 1921. No. above corrected average. No. below corrected average. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 10 11 11 13 22 5 13 3 7 11 20 18.7 Diphtheria 34 18 18 41 53 55 37 35 41 68 64 22 ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 9 8 5 5 6 5 7 5 2 2 7 1.3 ... Cont'd Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Puerpl. Fever 8 11 13 9 4 9 6 8 16 14 1 ... 94 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 10 5 6 11 9 5 6 7 1 9 5 ... 1.2 Measles 230 51 116 26 152 22 129 45 18 47 4 ... 78 Whooping C 66 57 23 53 66 49 29 58 15 19 28 ... 18.5 Influenza 24 45 59 58 90 74 56 834 310 99 81 ... 95 Diarrhoea 350 85 168 186 125 95 78 96 58 62 108 ... 31 Tuberculous Diseases 389 366 355 389 434 396 424 455 342 315 390 ... 23 Cerebro-spinal Fever 3 1 1 1 20 16 11 8 9 4 3 ... 4.9 Other Infective Diseases 21 27 22 32 20 19 21 18 12 22 31 8.2 Totals 1154 685 797 824 1001 750 817 1572 831 672 742 ... 232 The total number of deaths from these diseases was 742, 129 in Clapham, 63 in Putney, 212 in Streatham, 112 in Tooting, and 226 in Wandsworth. From all infective diseases the death-rate was 2.26 per 1,000 (2.11 in Clapham, 2.18 in Putney, 2.03 in Streatham, 2.88 in footing, and 2.38 in Wandsworth). Report of the Medical Officer of Health. 17 The rate is higher than in 1920, owing to the increase 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; in 1919, 2.50; and in 1920, 1.96. The rate from the principal infective diseases, viz.:—Smallpox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever, and Diarrhoea, was .70 per 1,000 (.62 in Clapham, .79 in Putney, .63 in Streatham, .96 in Tooting, and .70 in Wandsworth), compared with .74 in 1916, .94 in 1917, .82 in 1918, .42 in 1919, and .61 in 1920. The rate for 1921 is higher than in 1920, but slightly lower than the previous five years. The slight increase compared with 1920 is almost wholly due to the increase in the number of deaths from Diarrhoea. Scarlet Fever. The total number of deaths was 20, and the death-rate per 1,000 was .06. The case mortality was 1.00 per cent. Diphtheria. The total number of deaths was 64, and the death-rate per 1,000 was .19. The case mortality was 6.3 per cent. Enteric Fever. The number of deaths was seven, the death-rate was .02 per 1,000, and the case mortality was 21 per cent. The number of deaths from this disease was higher than in 1920. Cerebro=Spinal Meningitis. Three deaths occurred from this disease (one in Streatham, one in Tooting, and one in Wandsworth). 14 deaths were registered as having been causcd by Menin. B 18 Report of the Medical Officer of Health. gitis (two in Clapham, two in Streatham, five in Tooting, and five in Wandsworth). Six of these were of infants under one year, two from two and under five years, and six over five years of age. As in previous years, inquiries were made from the medical attendant, and in all the cases, with the exception of two 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 Putney, three in Streatham, one in Tooting, and one in Wandsworth). Three of the deaths were of persons from 25 and under 45 years, one from 45 and under 65 years, and two over 65 years. Malaria. Two deaths occurred from Malaria; one of these contracted the disease in the Army, in Mesopotamia, and the other, a civilian, in India. Puerperal Fever. Only one death occurred from this disease (in Wandsworth), compared with 14 in 1920, and 10.4 the corrected decennial average. The death-rate was .003 per 1,000, and the case mortalitv nine per cent. Erysipelas. Five deaths occurred from this disease during the year. Measles. Only four deaths occurred (two in Clapham, and two in Streatham). One of the deaths was of an infant under one year of age, and three from one and under two years. The death-rate per 1,000 of population was .012, compared with .17 in 1920. Whooping Cough. 28 deaths (two in Clapham, three in Putney, four in Streatham, seven in Tooting, and 12 in Wandsworth) occurred during Report of the Medical Officer of Health. 19 the year. 15 of these were of infants under one year of age, nine from one and under two years, and four from two and under five years. The death-rate was .08 per 1,000. Epidemic Influenza. 81 deaths (16 in Clapham, four in Putney, 36 in Streatham, 10 in Tooting, and 15 in Wandsworth) occurred during the year. The death-rate was .24 per 1,000, and the number of deaths represents only 2.3 per cent. of the total mortality from all causes, compared with 2.2 per cent. in 1920, 8.2 per cent. in 1919, and 19 per cent. in 1918. Diarrhoea. 108 deaths, 60 of males, and 48 of females, occurred from all forms of Diarrhoea and Enteritis during the year. 18 of the deaths occurred in Clapham, six in Putney, 31 in Streatham, 19 in Tooting, and 34 in Wandsworth. There was a slight increase in all the sub-districts, compared with 1920. The number of deaths is 31 below the corrected decennial average. The death-rate was .33 per 1,000 (in Clapham .30, in Putney .21, in Streatham .30, in Tooting .49, and in Wandsworth .35), compared with .18 in 1920, T7 in 1919, and .32 in 1918. Of the total number of deaths from Diarrhoea registered, 81, or 75 per cent., were of infants under one year. The number of deaths from Diarrhoea, Zymotic Enteritis, and Enteritis under one year, represents 19.3 per cent. of the total mortality at that age. The increased mortality from these diseases was due to the climatic conditions having been very favourable to their development, and it was expected from previous experience, especiallv in 1911, that there would be a considerable increase. Fortunately this expectation was not realised, and there is no doubt that this was largely due to greater care on the part of mothers who had been taught, both by the Health Visitors and at the Infant Welfare Centres, to regard these diseases as most serious ones. In 1911 the total number of deaths was 350, while during 1921 the number was 81. 20 Report of the Medical Officer of Health. Tuberculous Diseases. The total number of deaths from diseases of a Tuberculous nature was '390, 201 of males, and 199 of females. 331 of the deaths were due to Pulmonary Tuberculosis, 170 of males, and 161 of females; 29 to Tuberculous disease of the Barin ; and 30 to other forms of Tuberculous diseases. The number of deaths from Pulmonary Tuberculosis and other Tuberculous diseases, and the rates per 1,000 for the whole Borough and for the separate sub.districts, are shown in the next Table. TABLE XVII. Sub.District. Pulmonary Tuberculosis. Other Tuberculous Diseases. Total. No. of Deaths. Rate. No. of Deaths. Rate. No. of Deaths Rate. Clapham 62 1.01 11 •18 73 1.19 Putney 31 1 07 1 •03 32 1.10 Streatham 84 •80 12 .11 96 .91 Tooting 53 1.27 9 .23 62 1.60 Wandsworth 101 1.06 26 •28 127 1.35 Whole Borough 331 1. 00 59 •18 390 1.18 There has been a decided increase in the rate from Pulmonary Tuberculosis in all the sub-districts, especially in Putney and Tooting", compared with 1920, and also in those two sub-districts compared with the decennial average. I am of opinion that this increase has been due to the frequent recurrence of outbreaks of Influenza, which have had a most deleterious effect on even mild cases of this disease. It is quite possible that industrial unrest and consequent mental anxiety may also have had a deleterious effect. In 29 of the deaths the patients had had a recent attack of Influenza, and 46 deaths occurred which were attributed to military service. Report of the Medical Officer of Health. 21 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. 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 Average for 10 yrs. 1921 Clapham 118 116 93 93 97 105 107 112 87 88 101 101 Putney 70 97 55 78 109 99 92 128 105 41 87 107 Streatham 85 73 76 71 83 90 102 115 92 69 85 80 Tooting 81 87 69 87 123 103 120 171 82 82 100 137 Wandsworth 88 112 109 122 103 114 129 126 77 79 105 106 Whole borough 91 96 88 93 99 102 112 122 87 75 96 100 Other Infective Diseases. 21 deaths occurred (two in Clapham, three in Putney, seven in Streatham, and nine in Wandsworth). Seven were under one year of age, one from two and under five years, one from five and under 15 years, two from 15 and under 25 years, three from 25 and under 45 years, four from 45 and under 65 years of age, and three over 65 years. 13 of the deaths were due to Syphilis, five to Septicaemia, one to Streptothorax of Lung, one to Tetanus, and one to Pellagra. Acute Polio-myelitis. Two deaths occurred during the year, particulars of these are given on page 72. 22 Report of the Medical Officer of Health. NON-INFECTIVE DISEASES. The next Table shows the number of deaths from these for the year, as well as for the previous decennium for the whole Borough, corrected for External and Internal Institutions. TABLE XIX. Deaths from Non-Infective Diseases. 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 No. above corrected average. No. below corrected average. Cancer 321 338 352 393 398 398 407 375 399 403 412 8.8 ... Circulatory Diseases 359 357 411 426 492 504 551 541 601 583 558 42 ... Respiratory 531 530 622 519 792 567 664 686 627 545 585 ... 65 Premature Birth 268 240 234 249 225 235 189 179 192 235 184 ... 66 Violence 120 116 115 113 115 114 127 98 111 113 122 ... 2 All other Diseases 1023 1025 1057 1130 1166 1119 1064 956 991 1001 852 ... 274 Totals 2622 2606 2791 2840 3188 2937 3002 2835 2921 2880 2813 ... 249 Cancer. The total number of deaths from Cancer and other malignant diseases was 412, 182 of males and 230 of females. 76 of these occurred in Clapham, 39 in Putney, 146 in Streatham, 37 in Tooting, and 114 in Wandsworth. The corrected death-rate was 1.25 per 1,000, and for the sub-districts as follows:—Clapham 1.24, Putney 1.35, Streatham 1.39, Tooting .95, and Wandsworth 1.20. One of the deaths occurred under one year, one from five and under 15 years, 36 at 25 and under 45 years, 192 at 45 and under 65 years, and 182 over 65 years. The number of deaths is nine above last year, and 8.8 above the corrected decennial average. Report of the Medical Officer of Health. 23 Diseases of the Brain and Nervous System. From these diseases 297 deaths occurred, 58 in Clapham, 29 in Putney, 95 in Streatham, 38 in Tooting, and 77 in Wandsworth. The number of deaths is 39 under last year. 14 of the deaths were due to Meningitis, 145 to Cerebral Hæmorrhage or Apoplexy, 15 to Convulsions, three to Softening of the Brain, 21 to Paralysis, 15 to General Paralysis of the Insane, 10 to Locomotor Ataxy, 11 to Epilepsy, and 63 to other diseases of the Nervous System. Circulatory Diseases. From the above group of diseases, 558 deaths occurred, -115 of which, 177 males and 238 females, were due to Organic disease of the Heart. 111 of these deaths occurred in Clapham, 56 in Putney, 206 in Streatham, 51 in Tooting, and 134 in Wandsworth. 334 of the deaths were of persons over 65 years of age. The number of deaths is 25 less than in 1920, but is 42 above the corrected decennial average. Respiratory Diseases. The total number of deaths was 585, 102 in Clapham, 47 in Putney, 191 in Streatham, 68 in Tooting, and 177 in Wandsworth. 24 Report of the Medical Officer of Health. 308 of the deaths occurred from Bronchitis, 50 from Lobar Pneumonia, 108 from Lobular or Broncho-Pneumonia, 83 from Pneumonia in which the exact form was not distinguished, and 3G from other diseases of the Respiratory Organs. 77 of the deaths were of infants under one year, 21 from one and under two years, nine from two and under five years, 11 from five and under 15 years, 15 from 15 and under 25 years, 41 from 25 and under 45 years, 117 from 45 and under 65 years, and 284 over 65 years. The number of deaths is 40 above last year, but is 65 under the corrected decennial average. Deaths from other Causes. From Appendicitis and Typhlitis 21 deaths, 15 of males and six of females, occurred. From Alcoholism, Acute and Chronic, five deaths, four male and one female, occurred; and 17, nine of males and eight of females, from Cirrhosis of the Liver. From Nephritis and Bright's disease 101 deaths occurred, 54 of males and 47 of females. From Accidents and diseases of Pregnancy and Child Birth 10 deaths occurred. This, added to the number of deaths from Puerperal Fever—viz., one—gives a total of 11 deaths after Child Birth, or a proportion of 1.7 per 1,000 births, compared with 2.9 in 1920. Diabetes Mellitus was the cause of 29 deaths, 17 of males and 12 of females. Premature Birth and Developmental Diseases. 181 deaths, 110 of males and 74 of females, were registered as having occurred from these diseases. Report of the Medical Officer of Health. 25 73 of the deaths were due to Premature Birth, 86 to Developmental diseases, and 25 from other diseases of Early Infancy. 177 were of infants under one year, three from one and under two years, and four over two years. The number of deaths is 51 under last year, and 66 below the corrected decennial average. The number of deaths from these diseases in the Borough is shown more in detail in an earlier part of this Report in Table XIII., which deals with Infant Mortality. Old Age. 227 deaths, 72 of males and 155 of females, occurred from Old Age, 53 in Clapham, 19 in Putney, 73 in Streatham, 17 in Tooting, and 65 in Wandsworth. All the deaths were of persons over 65 years of age. Violence. 122 deaths, 81 of males, and 41 of females, occurred from Violence, 89 of the deaths being due to Accidental, and 31 to Suicidal causes, while two deaths were caused by other forms of Violence. 19 of the deaths belonged to Clapham, 11 to Putney, 30 to Streatham, 14 to Tooting, and 35 to Wandsworth. Inquests. The next Table shows the number of Inquests held in the Borough during the year, and Table XXI. the number of inquests held outside the Borough of persons belonging thereto. 26 Report of the Medical Officer of Health. TABLE XX. INQUESTS. Sub-Districts. Whole Borough. Clapham. Putney. Streatham. Tooting. Wandsworth. Deaths from Natural Causes 12 18 11 17 26 84 Accidental :— Falls 1 1 3 7 - 12 Drowning — 3 1 — 2 6 Knocked down by motor vehicles — 2 — 1 3 6 Suffocated by regurgitated food — — — 3 1 4 Suffocated in bed with parents — — — - 2 2 Fall from train — — 1 - 1 2 Scalds — — — 1 1 2 Fall down area — 1 — - - 1 Fall from bicycle - — — - 1 1 Fall from pair of steps - - - - 1 1 Buried by fall of earth 1 — — - - 1 Poisoning by Spirits of Salts 1 — — — - 1 Suffocated by turning on face in bed - 1 - - - 1 Suffocated by coal gas - - 1 - - 1 Burns - - 1 - - 1 Crushed by overturned cart - - - - 1 1 Crushed by coal truck — — — — 1 1 Suicidal:— Cut throat 1 - - 2 2 5 Gunshot wounds 1 - 2 - - 3 Hanging - - 2 - 1 3 Drowning - 2 - - - 2 Fall from window 1 - - - - 1 Poisoning by Carbolic Acid - - 1 - - 1 Poisoning by Oxalic Acid - - - - 1 1 Poisoning by Spirits of Salts — — — — 1 1 Open Verdicts:— Found dead — — — — 1 1 Murder 1 — — — — 1 Execution - — — — 2 2 Totals 19 28 23 31 48 149 Report of the Medical Officer of Health. 27 TABLE XXI. INQUESTS. Sub-Districts. Whole Borough. Clapham. Putney. Streatham. Tooting. Wandsworth. Deaths from Natural Causes. 2 3 6 3 7 21 Accidental:— Knocked down by motor vehicles 5 — 6 1 5 17 Falls 1 — 3 — 2 6 Drowning 1 - 3 1 — 5 Burns — — 1 1 1 3 Scalds — — 1 — 1 2 Crushed by lift — — 1 — 1 2 Cellulitis following injury — — — — 2 2 Explosion of petrol tank — — 1 — 1 2 Knocked down by train — — 1 — 1 2 Fall from train — — 1 — 1 2 Fall from scaffold — 1 — — — 1 Fall from window 1 — — — — 1 Fall from bicycle — — 1 — - 1 Fall down flight of steps — — — — 1 1 Fall from ladder — 1 — — — 1 Thrown from motor cycle pillion — — — — 1 1 Thrown from horse — 1 — — — 1 Ptomaine poisoning — — — 1 — 1 Crushed by machinery — — — — 1 1 Disaster to airship — — 1 — — 1 Suicidal:— Drowning 2 — 1 — 1 4 Hanging — — 3 1 — 4 Run over by train — — 1 — 1 2 Gunshot wounds 1 — 1 — — 2 Fall from cliff — — — 1 — 1 Burns 1 — — — — 1 Poisoning by Pyrogallic Acid - — 1 — — 1 Poisoning by Spirits of Salts — — 1 - — 1 Poisoning by Lysol — — 1 — — 1 Open Verdicts:— Found drowned 2 1 — — — 3 Murder — — 1 — — 1 Totals 16 7 36 9 27 95 28 Report of the Medical Officer of Health. 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, eight bodies were removed to the Mortuary, in Streatham 17, and in Wandsworth 156—of which 50 were from Wandsworth, 31 from Putney, 35 from Tooting, 40 from Battersea—a total of 181. Amount of Poor Law Relief. The Clerk to the Board of Guardians has kindly given me the following information with reference to the above for the year ended 31st December, 1921:— (1) No. of admissions to the Poor Law Institutions 2,592 (2) No. of medical orders given 1,346 (3) Average No. of persons in receipt of outdoor relief 4,001 (4) Amount of outdoor relief given £62,147 The total number of deaths in Poor Law Institutions was 707, or 19.9 per cent. of the total deaths. Of these, only five deaths occurred in a Poor Law Institution in the Borough, and 702 outside the Borough. The extent to which Hospital and other forms of Gratuitous Medical Relief are utilised. This can at present only be given as far as the number of deaths is concerned, as this Department has no means of ascertaining the number of cases from the Borough treated by such institutions. The following Table shows the various institutions in which deaths occurred during the year, and the number of deaths in each. Report of the Medical Officer of Health. 29 TABLE XXII. 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 689 National Hospital 2 Springfield Mental Hospital 1 Banstead Mental Hospital 12 Queen Mary's Hospital 8 Swaffield Road Institution 5 Cane Hill Mental Hospital 13 Royal Free Hospital 2 Tooting Bee Mental Hospital 9 Caterham Mental Hospital 4 Royal Waterloo Hospital 7 Fountain Mental Hospital 2 Colney Hatch Mental Hospital 5 St. Bartholomew's Hospital 8 Other Hospitals— Horton Mental Hospital 6 St. Columba's Hospital 4 Kensington Infirmary 4 St. George's Hospital 11 Grove Hospital ??? Lambeth Infirmary 5 St. Joseph's Hospice, Hackney 4 H.M. Prison 1 Leavesden Mental Hospital 3 St. Mary's Hospital 2 Hostel of God 11 Long Grove Mental Hospital 23 St. Thomas's Hospital 43 Putney Hospital 12 Merstham Mental Hospital 2 Special Surgical Hosp., Ham'smith 2 South London Hospital for Women 6 St. Pancras Infirmary 2 Throat Hospital 2 Weir Hospital 19 Other Hospitals— University College Hospital 5 Victoria Hospital 13 Other Institutions, etc.— Belgrave Hospital 23 West London Hospital 9 Ministry of Pensions Hospital 1 Bolingbroke Hospital 19 Westminster Hospital 15 Other Places not Public Institutions 19 Brompton Hospital 11 Western Hospital 8 On Street 17 Cancer Hospital 5 Northern Hospital 3 River Thames 3 Charing Cross Hospital 19 Joyce Green Hospital 2 Nursing Homes 71 Chest Hospital, Bethnal Green 2 Park Hospital 5 Clapham Maternity Hospital 5 South Eastern Hospital 5 228 Collindale Hospital 8 South Western Hospital 24 Evelina Hospital 6 Other Institutions, etc.— Grosvenor Hospital 3 Gt. Ormonde Street Hospital 6 Other Institutions 62 Guy's Hospital 11 Other Places not Public Institutions 98 Hampstead General Hospital 3 On Railway 2 Infants' Hospital 10 On Street 6 King's College Hospital 11 River Thames 8 Middlesex Hospital 12 Private Nursing Homes 17 Ministry of Pensions Hosp., Brixton 11 Mount Vernon Hospital, 2 1,312 30 Report of the Medical Officer of Health. SANITARY INSPECTION OF DISTRICT. During the year 70(5 inspections have been made by myself and the Assistant Medical Officer of Health, under the Housing Acts and the Public Health Act. In addition 281 inspections were made on account of infectious diseases, 186 of which were to ascertain the present condition of cases of Malaria, Dysentery, and Trench Fever, 90 visits were paid to the Infant Welfare Centres, Creches, and the Maternity Home, and my attendance was necessary on five occasions at the Police Court. Nine special inspections were made of the River Wandle, in consequence of complaints as to nuisance arising from its foul condition, and also for preparation of evidence before a Committee of the House of Commons against the Bill of the Croydon Corporation to sink additional wells near the source of the River. The following report was made to the Council on the matter:— "The River Wandle enters the Borough of Wandsworth at Summerstown, close to the Corruganza Works, and forms the boundary between the Borough and the Borough of Wimbledon until it reaches a point opposite the foot of Groton Road. From that point to the River Thames it forms the division between the Southfield and the Springfield and Fairfield Wards. From the Corruganza Works to the dam erected above the outfall of the sewage from the Wandle Valley Sewerage Board Farm the River is fairly clean, and the bed does not, except at the dam itself, seem to have much deposit. Below the weir at the foot of Trewint Street the effluent from the Wandle* Valley Sewerage Board is discharged into a bvwash, and about 100 yards further down the effluent from the Wimbledon Sewage Farm is also discharged into the same bywash, eventually passing under the London and South Western Railway, and discharging into the River a few yards lower down. The pollution at this point is most marked, and offensive gases are given off by the sewage. Report of the Medical Officer of Health. 31 The main stream from the weir to the point where the combined effluent enters it is very foul, and should be thoroughly cleansed at once. On the 5th April the River at the weir was found to be 15 inches below its normal level and inches below the weir. There was about 12 feet of mud exposed on the north bank, and about 8 feet on the south bank. Steps should be taken to ensure that this part is periodicallv scoured by the release of the main body of water above the weir. From this point to Messrs. Pimm's Mills the River is in a very bad condition, due to the excessive amount of sewage in the water and the depositing of sewage sludge. From these Mills to the River Thames the Wandle has a more rapid flow, and there is not so much obvious pollution. The effluent from the Wandle Valley Sewerage Board's Farm is at present very foul, and has a distinctive sewage odour for some distance from the point of discharge. Although there is a coke screen for filtering purposes this makes little or no difference, and quantities of sewage fungus pass into the River. As this Sewage Farm disposes of the sewage of about 60,000 persons, at least 1,200,000 gallons are here discharged into the River daily, and lower down the effluent from the Wimbledon Sewage Farm, which deals with the sewage of another 60,000 persons, or 1,200,000 gallons, also' discharge into the River, making a total of 2,400,000 gallons. This latter effluent is at present fairly clean. When this amount is added to the amount of effluent from the County Borough of Croydon, which enters the River Wandle near Beddington, and which has a population, including Coulsdon and Purley, of about 200,000 persons, and discharges about 4,000,000 gallons of sewage, it makes the total amount of sewage discharged into the River about 6,400,000 gallons daily. This, in my opinion, is a minimum estimate, as I have allowed 20 gallons as the daily amount of water per head of population, instead of 30 gallons, as estimated by Dr. Thresh. 32 Report of the Medical Officer of Health. During the twenty-seven years that I have been Medical Officer of Health, I have never seen the River in such a polluted condition, and this condition is at present much accentuated by the lessened volume of water due to the low rainfall during the last two months. I have also to point out that during the last few years the amount of insect life, chiefly of the gnat species, has largely increased, and the larvae of these breed in the River and its bywashes. If the true anopheles or mosquito obtains a habitat in this River it is quite possible that an outbreak of malaria would ensue, as there are over 20 cases of malaria in the neighbourhood, these cases having been contracted abroad when serving in the Army, and all are still suffering from malarious attacks. If the suggested schemes are proceeded with, and if there is a marked reduction of the volume of spring water and a consequent increase in the amount of sewage pollution, I am of opinion it would prove a serious menace to the health of the inhabitants in the vicinity." 7th April, 1921. The London County Council was carrying out certain works to remove the deposit of mud which was to some extent the cause of the nuisance, but as this work was, in my opinion, proceeding very slowly, I again called the attention of the Public Health Committee to the nuisance. Further work was carried out by the London County Council, and the bed of the River was cleansed. The River is, however, still in an unsatisfactory condition, and not until the new Wandle Valley Sewerage Scheme is in full operation can much improvement be expected. 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. 33 Report of the Medical Officer of Health. TABLE XXIII. Summary of Sanitary Operations in the Borough during the Year 1921. Clapham. Putney. Streatham Tooting. Wandsworth. Whole Borough. North Ward. South Ward. Streatham Ward. Balham Ward. South field Ward Fairfield 1 Ward Spn'gfleld Ward Number of complaints received and attended to 535 485 531 801 657 1043 516 422 573 5563 Number of houses and premises inspected 3437 2531 2806 4635 3917 4273 2761 2040 3862 30262 Number of houses and premises re-inspected 4212 1778 2100 2356 2999 3144 2824 3736 2384 25533 Number of house-to-house inspections 631 306 142 181 247 220 391 433 140 2691 Number of preliminary notices served 1256 728 732 946 1083 859 1242 1027 1078 8951 Ditto complied with 1037 371 724 1031 1193 928 994 907 1138 8323 Number of statutory notices served 212 57 53 59 198 37 157 78 161 1012 Ditto complied with 148 35 53 42 198 62 152 88 184 962 Notices served for periodical removal of manure 1 ... ... ... 1 ... ... ... ... 2 Number of rooms disinfected after infective diseases 519 455 511 795 775 841 347 468 629 5340 Bedding stoved 246 335 288 429 517 467 269 191 474 3216 Overcrowding abated 4 4 3 ... 2 2 7 2 6 30 Rooms cleansed and repaired 1761 1294 831 1355 1812 1309 1595 1550 1284 12791 Staircases cleansed & repaired 275 250 144 385 361 204 337 371 239 2566 Drains cleansed and repaired 70 121 70 83 107 122 80 84 124 861 Drains tested 778 429 331 561 355 245 368 536 412 4015 Drains found defective 65 50 12 16 85 74 34 18 24 378 Traps fixed to drains 10 111 6 18 50 23 2 2 7 229 Bath, lavatory & sink wastes altered to discharge outside over gullies or repaired 44 62 59 61 58 49 72 87 100 592 Rain water pipes disconnected from drains ... ... 17 2 3 ... 6 ... 42 70 Water closets cleansed and repaired 249 302 181 263 443 160 341 316 348 2603 Water closets, separate supply of water laid on to ... ... ... ... ... 1 ... ... ... 1 Accumulations of manure, etc. removed 5 24 14 79 53 22 8 7 23 235 Urinals cleansed, repaired or water laid on to 9 2 7 13 4 15 4 3 2 59 Cesspools abolished ... ... ... ... 1 ... ... ... ... 1 Ashpits provided or repaired 173 111 97 150 193 138 184 139 170 1355 Dust complaints received . 8 19 61 26 16 6 43 15 15 209 Stables and stables yards drained, paved or cleansed 5 3 2 24 9 29 2 3 15 92 Yards drained, paved or cleansed 82 117 97 62 88 79 154 102 152 933 Unwholesome or dilapidated houses cleansed or repaired 47 45 5 1 2 13 94 207 Leaky roofs & gutters repaired 263 221 139 243 152 149 205 253 183 1808 Damp courses inserted 40 28 22 46 23 8 66 12 15 260 Damp conditions remedied 171 109 54 347 82 100 208 285 117 1473 Houses re-supplied with water 8 9 19 19 11 10 4 7 16 103 Water cisterns cleansed, covered or repaired 13 34 24 49 20 36 34 29 61 300 Animals kept so as to be a nuisance 5 6 9 13 9 20 11 9 21 103 Smoke nuisances reported 1 ... 1 1 ... ... ... ... ... 3 Soil pipes repaired 9 12 24 14 11 9 19 12. 10 120 Unclassified nuisances 108 184 121 240 I 94 90 224 485 238 1784 34 Report of the Medical Officer of Health. TABLE XXIV. DETAILS OF INSPECTIONS AND RE-INSPECTIONS, 1921. (Male Inspectors). Inspections. Re-Inspections. Total. No. of complaints received and attended to 5,549 ... 5,549 No. of house-to-house inspections 2,691 ... 2,691 Drainage and other sanitary works after notice 4,427 24,092 28,519 Drainage and other sanitary works voluntary 530 557 1,087 No. of premises inspected on account of :— Notifiable diseases 5,007 ... 5,007 Measles 432 ... 432 Whooping Cough 713 ... 713 Pulmonary Tuberculosis 126 ... 126 Other Infective Diseases 743 ... 743 Verminous conditions 305 ... 305 Periodical Inspections:— Houses-let-in-Lodgings 427 19 446 Closed underground rooms ... ... ... Common Lodging Houses 12 ... 12 Work-places. Factories 303 61 364 Workshops 475 103 578 Workshops (Domestic) 139 23 162 Work-places 138 79 217 Outworkers' premises 69 20 89 Bakehouses 307 124 431 Restaurant kitchens 91 16 107 Food-places. ' Cowsheds 19 ... 19 Piggeries 70 1 71 Dairies and Milkshops 372 3 375 Ice Cream Premises 323 15 338 Slaughterhouses 118 3 121 Places where food is prepared 61 11 72 Offensive trades 116 5 121 Fried Fish shops 142 5 147 Rag and bone stores 33 4 37 Butchers' shops 211 2 213 Greengrocers' Shops 96 ... 96 Fishmongers' shops 180 1 181 Public House urinals 227 ... 227 Other sanitary conveniences, schools etc. 73 6 79 Smoke observations 15 ... 15 Unsound food 69 1 70 Yards of Mews and Stables 339 25 364 Legal proceeding:- (1) Applications and summonses 51 ... 51 (2) Hearings and adjournments 99 ... 99 Other 1,207 52 1,259 Totals 26,305 25,228 81,533 35 Report of the Medical Officer of Health. TABLE XXV. DETAILS OF INSPECTIONS AND RE-INSPECTIONS, 1921. (Female Inspectors). Inspections. Re-Inspections. Total. No. of complaints received and attended to 14 ... 14 No. of premises inspected on account of:— Pulmonary Tuberculosis 1,474 150 1624 Other forms of Tuberculosis 461 18 479 Dressmakers' and Milliners' premises. 308 7 315 Laundries— Factory 120 9 129 Workshop 132 16 148 Workplaces 88 10 98 Other Factories 98 5 103 Other Workshops 136 3 139 Other Workplaces 181 11 192 Domestic Workshops 60 4 64 Outworkers' premises 472 14 486 Other 413 58 471 Totals 3,957 305 4,262 36 Report of the Medical Officer of Health. HOUSING, TOWN PLANNING, &c., ACT, 1909. TABLE XXVI. 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 631 509 80.66 70 223 262 378 Clapham, South 306 274 89.54 14 44 232 232 Putney 142 142 100.00 13 13 113 76 Streatham 181 167 92.26 16 21 210 62 Balham 247 241 97.57 52 83 213 154 Tooting 220 193 87.72 9 17 49 198 Southfield 391 343 87.72 44 37 180 231 Fairfield 433 350 80.83 55 45 124 281 Springfield 140 113 80.71 21 29 66 85 Whole Borough 2,691 2,332 86.65 294 512 1,449 1,697 The cases of overcrowding were in Rashleigh Street, Clifton Cottages, Clarke's Cottages, St. Alphonsus Road and Midmoor Road, Clapham ; Upper Richmond Road, Putney Bridge Road and The Platt, Putney; Laitwood Road, and Zennor Road, Streatham; Fountain Road and Rostella Road, Tooting; Camborne Road, Standen Road, Palmerston Road, Coliston Road, Merton Road, Lavenham Road, Dighton Road, Lower Grove, Wardley Street, Guelph Street, Aldren Road, Algarve Road and Lydden Grove, Wandsworth. 66 notices of reconstruction of drains were sent to the Borough Engineer from this Department: 21 in Clapham, 13 in putney, 16 in Streatham, two in Tooting, and 14 in Wandsworth. Report of the Medical Officer of Health. 37 All house-to-house inspections under the Public Health (London) Act, 1891, are carried out as if these were inspections under Section 17 of the Housing, Town Planning-, etc., Act, 1909, and the results recorded on a special card which was drawn up in 1910, and has been in use since that date. This method has been found to work most satisfactorily. Where nuisances are found notices are served under the Public Health Act, and if the premises are reported by the Sanitary Inspector to be in a bad condition, I make a personal inspection in order to determine if the houses are in such a condition as to be unfit for human habitation. During the year 2,691 house-to-house inspections were made by the Sanitary Inspectors, and in 2,332, nuisances were found necessitating the service of sanitary notices. Of the 62 premises reported in 1919 as unfit for human habitation, two have been closed, and five 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 130; 36 in Clapham, 21 in Putney, 26 in Streatham, five in Tooting, and 42 in Wandsworth. During the year 4,015 drains of houses were tested by the Sanitary Inspectors, 1,207 in Clapham, 331 in Putney, 906 in Streatham, 245 in Tooting, and 1,316 in Wandsworth, and 378 or 9.4 per cent. were found to be defective. Of the 378 found defective, 115 were in Clapham, 12 in Putney, 101 in Streatham, 74 in Tooting, and 76 in Wandsworth. A large amount of work has again been carried out to abate nuisances arising from damp conditions. In all, 1,473 premises have been dealt with, 280 in Clapham, 54 in Putney, 429 in Streatham, 100 in Tooting, and 610 in Wandsworth; and in 260 of these, 68 in Clapham, 22 in V tney, 69 in Streatham, eight in Tooting, and 93 in Wandsworth, damp courses have been inserted. 38 Report of the Medical Officer of Health. 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. 168 statutory notices were served under Section 37 of the Public Health (London) Act, 1891, to provide ashpits in accordance with the By-laws, and these have been complied with. Police Court Proceedings. The list which follows shows particulars of Police Court proceedings under the Public Health (London) Act, 1891. The total amount of fines inflicted was £37 12s. 6d., and the costs £29 11s. 0d. 39 Report of the Medical Officer of Health. TABLE XXVII. Premises. Offences. Result. Fine. Costs. 34-40, Deauville Court, Clapham Nuisances Contravention of Bylaws (yard paving) Convicted 100/- 21/- 12, Baldry Gardens, Streatham Nuisances Summons withdrawn, the work having been done ... 2/- 17, Carmalt Gardens, Putney Do. Do. ... 23/- 28a, Ruvigny Gardens, Putney Do. Summons withdrawn, the premises being empty ... 143a, Fawe Park Road, Wandsworth Do. Order made for abatement of nuisance ... 10/6 Contravention of Bylaws (water closets) Convicted 100/- ... 71, Malva Road, Wandsworth Nuisances Summons withdrawn, the work having been done ... 2/- 34 & 38, Headworth Rd., Do. Do. ... 4/- Wandsworth Contravention of Bylaws (water closets) Convicted 40/- 29, Headworth Road, Wandsworth Nuisances Summons withdrawn, the work having been done ... 2/- 200, Treport Street, Wandsworth Do. Do. ... 10/6 49, Aslett Street, Wandsworth Do. Do. ... 14/- 8a & 11, Delia Street, Wandsworth Do. Do. ... 28/- 22, Willard Street, Clapham Do. Summons withdrawn, change of owner ... 9, Park Court, Clapham Do. Summons withdrawn, the work having been done ... 2/- 38 & 46, Jew's Row, Wandsworth Do. Do. ... 6/- 28, Spencer Road, Putney Do. Do. ... 21/- 11, 13 & 15, College St., Putney Do. Do. ... 42/- 31, Heath Road, Clapham Do. Do. ... 2/- 48, Charlwood Road, Putney Do. Do. ... 2/- 4, Ashlone Rd., Putney Do. Convicted 20/- 4/- 28, Peardon Street, Clapham Do. Summons withdrawn, the work having been done ... 2/- 110, Wellfield Road, Streatham Do. Contravention of Bylaws (yard paving) Convicted. 40/- 21/- 99, Stonhouse Street, Clapham Nuisances Do. 40/- 10/6 Contravention of Bylaws (water closets) Do. 100/- 4, Pentlow Street, Putney Non-compliance with Rat Order Withdrawn on payment of costs ... 21/- 24, Union Grove, Clapham. Nuisances Summons withdrawn, the work having been done ... 21- 135, The Grove, Wands worth Do. Order made for abatement of nuisance ... 10/6 40 Report of the Medical Officer of Health. TABLE XXVII.—(contd.) Premises. Offences. Result. Fine. Costs 118, Fawe Park Road, Wandsworth Nuisances Order made for abatement of nuisance ... 21/- Failure of a medical practitioner to notify case of infectious disease Convicted 40/- 247 & 247a, Cavendish Road, Clapham Nuisances Order made for abatement of nuisance ... 21/- Nor.-compliance with order 40/- ... 340, Balham High Road Do. Summons withdrawn, the work having been done ... ... 5, Iloldernesse Road, Balham Do. Order made for abatement of nuisance ... 10/6 »> » Contravention of Bylaws (yard paving) Convicted 40/- 2/- 143, Bedford Hill, Balham Absence of a water supply Order made for abatement of nuisance ... 10/6 8, Kirkby St., Clapham Nuisances Summons adjourned, sine die ... 42/- 15 & 16, Deauville Court, Clapham Do. Summons withdrawn, the work having been done ... 4/- 2, Gaskell St. Clapham Do. Order made for abatement of nuisance ... ... „ „ Contravention of By laws (yard Saving) Convicted 12/6 34, Medfield Street, Roehampton Nuisances Order made for abatement of nuisance ... 10/6 90, High Street, Clapham Do. Convicted 40/- 10/6 „ „ Contravention of By 1aws (wate closets) Do. 40/- ... 11 & 19, Rashleigh St., Clapham Nuisances. Summons withdrawn, the work having been done ... 63/- 9, Union Road, Clapham Do. Do. ... 21- 39, Fawe Park Road, Wandsworth D. Summons withdrawn ... / 94, High Street, Tooting Exposing unsound meal for sale Convicted 100/- 42/- 56, Bedford Hill, Balham Nuisances Order made for abatement of nuisance ... 51- 26, Old Devonshire Rd., Balham Do. Ordered to pay costs ... ... 10/6 94, Fernlea Road, Balham Do. Order made for abatement of nuisance ... 10/6 3, Courland Cottages, Clapham Do. Do. ... 10/6 8, Ashlone Rd., Putney Do. Adjourned sine die ... 92 & 102, Fountain Pd., Tooting Do. Order made for abatement of nuisance ... 21/- 45, Cavendish Road, Balham Do. Do. ... 10/6 46, Victoria Road, Clapham Do. Adjourned sine die ... • • • 47, Temperley Road, Balham Do. Order made for abatement of nuisance ... 10/6 285, Balham High Road Do. Do. ... 10/6 Report of the Medical Officer of Health. 41 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 a slight decrease in the total number of inspections of the above, compared with 1920, but an examination of the Tables will show that a very large amount of work has been carried out by both the male and female inspectors. Owing to depression of trade generally the total number of premises has decreased by 136 compared with 1920. 42 Report of the Medical Officer of Health. INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. TABLE XXV111. CLASS OF WORKS. Number of Places. Number of Inspections, 1921. Number of Notices. Number of Prose cutions, 1921. On Register at end of 1920. Added in 1921. Removed in 1921. On Register at end of 1921. Intimation, 1921. Statutory, 1921. Under Factory Act. Under Public Health Act. Premises Rooms. Factories Factory Laundries 76 2 3 75 299 146 3 ... ... ... Factory Bakehouses 59 2 ... 61 81 148 4 ... ... ... Other Factories 435 33 48 420 1340 450 35 1 ... ... Workshops Workshop Laundries 71 3 6 6S 211 148 11 ... ... ... Workshop Bakehouses 79 ... 7 72 72 283 2 ... ... ... Other Workshops 1211 83 135 1159 1567 1258 65 6 ... 1 Workplaces Places where Food is prepared for Sale 555 34 46 543 594 458 64 1 ... 1 Workplaces other than the above 440 27 55 412 598 555 15 1 ... ... Home-workers' premises 473 91 111 453 453 575 24 1 ... ... Total 3,399 275 411 3,263 5.215 4,021 223 10 ... 2 43 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 XXIX. I.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories 744 43 ... (Including Factory Laundries.) Workshops 1,689 84 1 (Including Workshop Laundries.) Workplaces 1,013 81 1 (Other than Outworkers' premises included in Part 3 of this Report.) Totals 3.446 208 2 44 Report of the Medical Officer of Health. TABLE XXX. 2.—DEFECTS FOUND. PARTICULARS. Number of Defects Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (a) (3) (4) (5) Nuisances under the Public Health Acts:* Want of Cleanliness 119 112 ... 1 Want of Ventilation 1 1 ... ... Overcrowding 1 1 ... ... Want of drainage of floors ... ... ... ... Other nuisances 130 126 ... ... Sanitary accommodation insufficient 14 14 ... ... unsuitable or defective 43 42 ... 1 not separate for sexes 1 1 ... ... Offences under the Factory and Workshop Act:— ... Illegal occupation of underground bakehouse (S. 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 6 6 ... ... Other offences (Excluding offences relating to outwork, which are included in Part 3 of this Report.) ... ... ... ... Totals 315 303 ... 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. 45 Report of the Medical Officer of Health. TABLE XXXI. 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. Ord3is made (S. 110). Prosecutions SS.109,110). Lists† Outworkers† Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Markting, etc. 58 69 196 9 4 11 22 ... ... 24 24 ... 22 ... ... (2) Cleaning and washing 2 4 2 ... ... ... ... ... ... ... ... ... ... ... ... 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. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stuffed Toys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Basket making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 60 73 198 9 4 11 22 ... ... 24 24 ... 22 ... ... 46 Report of the Medical Officer of Health. The total number of addresses received from other Councils was 484, and 185 addresses were forwarded to other Councils. The number of addresses received has decreased by 135, and the number sent decreased by 49. 40 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 22, and these had a most satisfactory result. During the year 22 cases of infective diseases, one of German Measles, 10 of Scarlet Fever, five of Diphtheria, four of Measles, one of Pneumonia, and one 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 XXXII. 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number (1) (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. Workshop Bakehouses 72 „ Laundries 68 Dressmakers' and Milliners' Workshops 161 Bootmakers 95 Smiths 35 Builders 51 Tailors 55 Motor Engineers 39 Other 723 Total number of workshops on Register ... 1,299 47 Report of the Medical Officer of Health. TABLE XXXIII. 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory & Workshop Act (s. 133) 4 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 7 Reports (of action taken) sent to H.M. Inspector 7 Other ... Underground Bakehouses (s. 101):— Certificates granted during the year ... In use at the end of the year 42 Inspection of Sanitary Conveniences. The number of Sanitary Conveniences inspected was 119, 32 in Clapham, 26 in Putney, 23 in Streatham, 13 in Tooting, and 25 in Wandsworth. 227 inspections were made during the year and 20 notices, chiefly for cleansing, were served and complied with; and 113 inspections of Sanitary Conveniences for females were made by the Female Sanitary Inspectors. Canal Boats Act. During the year 11 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. 48 Report of the Medical Officer of Health. Increase of Rent and Mortgage Interest (Restrictions) Act, 1920. 313 applications for Certificates under the above Act were received during the year. On inspection it was found that 288 of the premises were not reasonably fit for human habitation, and Certificates were granted, and 25 premises were reasonably fit, and Certificates were consequently not granted. Of the 288 premises where Certificates were granted, 265 were rendered reasonably fit during the year, and the remaining 23 are in hand. 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 2,403 visits to premises where complaints had been made of rat or mice infestation. 293 of the visits were in Clapham, 533 in Putney, 300 in Streatham, 388 in Tooting, and 949 in Wandsworth, and record was made of the destruction of 3,187 rats, 3G1 in Clapham, 676 in Putney, 350 in Streatham, 420 in Tooting, and 1,380 in Wandsworth. During the year 60 drains, 13 in Clapham, eight in Putney, five in Streatham, five in Tooting, and 29 in Wandsworth, were found to be defective after complaint had been made of the presence of rats on the premises. It was found necessary to serve 11 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. 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. Report of the Medical Officer of Health. 49 There is close co-operation between this Department and the London County Council with regard to the prevention of infectious disease at the public elementary Schools. In certain cases during- the year where it was observed that the number of cases of infectious diseases was excessive, the attention of the London County Council was at once called to the matter, and the school was inspected by the officials of that Authority, and the result of the inspection reported. In schools which are not under the London County Council, if any cases occur the school is visited and the proprietors are advised as to the proper steps to be taken to prevent the spread of the disease. Disinfection has been carried out during the year for various infectious diseases in 12 public elementary schools and in eight 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 3.49 in 1919. So far as could be ascertained there was no shortage of milk supplied to the Borough, the supply being equal to the demand. There are at present three cowsheds and 240 milk retailers on the Register, and these have been regularly inspected during the year. Particulars of these are given in Table XXXIV. 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. 50 Report of the Medical Officer of Health. REPORT ON ADMINISTRATION IN CONNECTION WITH THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. Report for the year ended 31st December, 1921. 1. Milk and cream not sold as " Preserved Cream." (a) (b) Number of samples examined for the presence of a preservative. Number in which a preservative was reported to be present. Milk 950 Nil. Cream 54 29 Nature of preservative in each case in column (b). CREAM. 29 samples of Cream contained crystallised boric acid. Nature of preservative in each case in column (h). MILK. Nil. Action taken under the Regulations in regard to each case in column (h). In three cases proceedings were taken and convictions obtained. In the remaining cases the vendors were 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 54 (2) Statements incorrect 20 Total 83 As the percentage of boric acid found in the above mentioned samples of preserved cream was only slightly in excess of Report of the Medical Officer of Health. 51 4 per cent., the vendors were warned, and further samples procured, which were found correct. (b) Determinations made of milk-fat in cream sold as Preserved ' Cream:— (1) Above 35 per cent 83 (2) Below 35 per cent — Total 83 (c) and (d). In each of the 83 samples procured as served 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. In March, 1921, in Circular 185 the Ministry of Health limited the supply of free milk to expectant mothers for two months prior to confinement, to nursing mothers, and to infants and children under three years of age. Between the ages of three and five years milk may be given on a medical certificate. All applications are investigated, and on the 1st April, 1921, a form of application was adopted, to be filled in by the husband and signed by both husband and wife. Should the income per head, after deducting rent, fall below the scale approved by the Council, as shown in the subjoined table, one pint of milk is supplied daily (or 1 lb. packet of dried milk weekly), to an expectant or nursing mother, and to children under three years of age, no more than two pints of milk daily being allowed in one family. Cases in which the average income was slightly over 52 Report of the Medical Officer of Health. the scale and there was need for extra milk, were supplied with milk at half cost. From July onwards more dried milk has been supplied than fresh milk, the amount being limited to 1 lb. per week for expectant and nursing mothers and children between the ages of 18 months and three years, infants being allowed 1½ lbs. per week. This milk was supplied through Infant Welfare Centres. During 1921, 1,101 families were supplied with free milk at a cost to the Borough Council of £3,213 14s. 4d. In five instances dried milk was supplied at half cost. Number in family. Scale of income per head of family after deducting rent. For a supply of milk free of cost. For a supply of milk at half cost. 1 2 10/10/- 12/- 12/- 3 9/- 11/- 4 8/6 10/6 5 8/- 10/- 6 7/6 9/6 7 and over 7/- 9/- The following Table shows the number of families, etc., to whom free milk was granted during the year:— Clapham Putney Balham Streatham Tooting Southfield Fairfield Springfield Borough. No. of Families 163 74 191 197 147 114 73 145 1104 „ Expectant mothers 21 6 14 11 23 20 14 8 117 „ Nursing mothers 22 26 73 61 83 41 29 82 417 „ Infants 136 56 138 130 76 70 41 85 732 „ Children over three years 8 5 4 8 5 9 2 4 45 Report of the Medical Officer of Health. 67 53 Report of the Medical Officer of Health. General Remarks as to Benefits accruing from Free Milk Supply. The Health Visitors report that in many cases the Borough grant of milk has enabled the nursing mother to prolong the period of lactation. The records kept at the Infant Welfare Centres show good results in the health and general welfare of many infants who otherwise would have been insufficiently nourished. Some mothers who, in the Health Visitors' opinion, were not carrying out their maternal duties in a satisfactory manner, either through ignorance or carelessness, have been obliged to attend the Centres in order to obtain milk, with it is hoped good results. 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. 17 mothers and six 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 shilling per head for mothers and sixpence per head for children. This amounted during the year to £33 15s. 6d. The total number of visits paid respecting the supply of milk and of meals amounted to 775. 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. 121inspectors periodically inspect the slaughterhouses and the year, and 1,539 carcases were examined by the Inspectors. Action has been taken with regard to unsound meat, and no carcases were condemned during the year. By far the greater 54 Report of the Medical Officer of Health. proportion of the meat sold in the Borough has been inspected in the Central Markets before being sold to retailers. In 1914. In January, 1921. In December, 1921. Licensed slaughterhouses. 13 11 10 Unsound Food. 11 rabbits and 302 lbs. of rabbit; five pig's, 24½ lbs. of bacon, 371 lbs. of beef, three chickens, 15¾ lbs. of butter, 131 boxes margarine, six trunks of whiting, four boxes of skate, five trunks of herrings, one box of plaice, four boxes of cod's roes, seven trunks of haddocks, one box of cat-fish, three boxes of hake, one box of lobsters, 13 boxes of kippers, one bag of whelks, 10 barrels and 45 boxes of apples, 12 boxes of tomatoes, 12 bags of chestnuts, 95½ lbs. of cheese, 77 tins of apricots, 22 tins of pineapple, 20 tins of pears, 16 tins of peaches, 65 tins of tomatoes, three tins of apples, 151 tins of condensed milk, three tins of fish paste, one tin of sardines, two tins of crayfish, two tins of salmon and 66 lbs. of corned beef were condemned and the usual certificates granted. Most of the beef, bacon, rabbits, butter and margarine was sent to a fat melter in the Borough to be converted into glycerine. One instance of exposing unsound meat for sale occurred during the year, and the offender was convicted at the Police Court and a fine of £5, with 42/- costs was inflicted. 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. 55 Report of the Medical Officer of Health. TABLE XXXIV. PREMISES. NUMBER OF PLACES Number of inspections, 1921. Number of notices, 1921. Number of prosecutions, 1921. On register at end of 1920. Added in 1921. Removed in 1921. On register at end of 1921. Milk premises 235 20 15 240 375 14 ... Cowsheds 3 ... ... 3 19 ... ... Slaughter-houses 11 ... 1 10 121 ... ... Other offensive trade premises 3 ... ... 3 121 2 ... Ice cream premises 313 26 23 316 338 22 ... Registered houses let in lodgings 292 ... ... 292 446 *1a ... *352b 1 *a For overcrowding. *b For other conditions. Statement of work done under the Sale of Food and Drugs Acts. During the year 1,954 samples of foods and drug's were submitted to the Public Analyst for analysis. Of these samples 972 were purchased as test or informal samples, while 982 were purchased officially. Of the 982 official samples submitted for analysis 67, or 6.8 per cent. were reported to be adulterated or not up to standard, and of those samples which were purchased informally or as test samples, 74, or 7.6 per cent., were found adulterated or not up to standard. The total adulterations reported were 142, or 7.2 per cent. of the samples submitted. The percentage of milk samples found to be adulterated was 5.1. In 24 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 £77 10s., and the costs to £35 1s. 6d., making a total of £112 l1s. 6d. 56 Report of the Medical Officer of Health. 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 XXXV. Informal Samples. Formal 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. tage terated. Clapham 178 14 7.8 175 15 8.6 353 5.7 29 8.1 Putney 85 5 5.8 109 10 9.1 194 6.7 15 8.0 Streatham 299 19 6.3 289 20 7.0 588 5.6 39 6.6 Tooting 122 10 8.2 115 12 10.4 237 6.1 22 9.2 Wandsworth 288 19 6.6 294 17 6.1 582 6.1 37 6.3 Whole Borough 972 67 6.8 982 74 7.6 1954 5.9 142 7.2 Milk and Cream. MILK. 950 samples of milk were procured for analysis during the year. 49 or 5.1 per cent. were reported against as being adulterated or not up to legal standard. 935 samples were purchased officially, of which 48 or 5T per cent. were adulterated, and 15 samples purchased informally, of which one, or 0.0 per cent., was adulterated. 28 samples were found to contain added water, 16 were deficient in milk fat, and five contained colouring matter. Proceedings were taken in 17 cases, and in 31 cases the Public Health Committee, after considering the amount of 57 Report of the Medical Officer of Health. teration and the circumstances of sale, decided not to prosecute the vendors, but to take further samples. 22 samples of milk were taken on delivery at various Public Institutions situated within the Borough. One sample was reported against. 76 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. Nine samples were reported against, and in six cases proceedings were taken against the farmers, and convictions obtained. 16 samples of milk were procured during the early morning from wholesale dealers whilst delivering milk to the retailer. These samples were genuine. 13 samples of milk were procured on delivery at private houses. One sample was reported against. 132 samples of milk have been taken on Sundays, either in the early morning or at mid-day. Seven, or 5.3 per cent., were reported against as being adulterated. 420 samples of milk were taken from milk vendors in the street during the early morning (i.e., 5 to 7 a.m.), on week days, and of these 21, or 5 per cent., were reported against. Butter and Margarine. BUTTER. 409 samples of butter were submitted for analysis during the year, of which one was reported against. MARGARINE. 33 samples of margarine were submitted for analysis, five of which were reported against. 58 Report of the Medical Officer of Health. OTHER ARTICLES. A full list of the articles of food and drug's examined under the Sale of Food and Drug" Acts, together with the analytical results, is contained in the Report of the Public Analyst. PREVALENCE AND CONTROL OVER INFECTIOUS DISEASES. Table XXXVI. shows the cases of infectious diseases notified during the year. The total number of cases, less tuberculosis, was 4,918, 826 from Clapham, 466 from Putney, 1,313 from Streatham, 775 from Tooting, and 1,538 from Wandsworth—compared with 4,820 in 1920. The number appears high, but it includes 1,201 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 from the London County Council elementary schools. Report of the Medical Officer of Health. 59 TABLE XXXVI. Wandsworth District. Cases of Infectious Disease notified during the year 1921. Notifiable Disease. No. of Cases Notified. Total Cases Notified in each Locality. Total cases removed to Hospital. At all Ages. At Ages—Years. Clapham. Putney. Streatham Tooting. Wandsworth Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-pox 1 ... ... ... ... ... 1 ... 1 ... ... ... ... 1 Diphtheria (including Membranous Croup) 1009 17 184 629 106 66 7 ... 183 97 283 191 255 934 Erysipelas 121 2 4 11 13 27 50 14 29 7 26 13 46 20 Scarlet Fever 1978 3 291 1394 182 99 9 ... 366 140 511 341 620 1748 Enteric Fever 32 ... 1 8 8 11 4 ... 6 4 8 ... 14 21 Puerperal Fever 11 4 7 ... ... 3 1 1 3 3 10 Cerebro-spinal Meningitis 9 2 3 3 ... 1 ... ... 2 ... 1 3 3 8 Polio-Myelitis 7 ... 5 2 ... ... ... ... 1 1 3 ... 2 3 Ophthalmia Neonatorum 54 54 ... ... ... ... ... ... 14 3 15 2 20 7 Pulmonary Tuberculosis 490 ... 5 28 121 225 101 10 100 45 126 72 147 ... Other forms of Tuberculosis 147 7 25 58 21 29 5 2 34 10 23 24 56 ... Whooping Cough 1201 107 507 575 5 6 1 ... 142 167 314 174 404 34 Encephalitis Lethargica 17 ... 1 2 3 6 2 3 4 ... 7 4 2 13 Acute Influenzal Pneumonia 79 1 1 4 12 19 27 15 17 5 35 4 18 ... Acute Primary Pneumonia 374 27 43 51 42 102 70 39 54 40 103 35 142 ... Malaria 19 ... ... ... 2 17 ... ... 2 1 4 4 8 ... Dysentery 6 ... ... 1 ... 5 ... ... 2 ... 2 1 1 ... Trench Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 5555 220 1070 2766 519 620 277 83 9 60 521 1462 871 1741 2799 60 Report of the Medical Officer of Health. The number of eases 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 XXXVII. 1911. 1912. 1913. 1914. 1915. 19l6. 1917. 1918. 1919. I920. 1921. 1920. No. above decennial average. No. below decennial average. Scarlet Fever 869 833 971 1417 1309 690 566 563 893 1463 1978 954 ... Diphtheria 510 431 430 552 723 531 435 487 525 1104 1009 377 ... Enteric Fever 63 73 52 48 50 46 47 38 18 24 32 ... 17 Puerperal Fever 24 27 32 30 11 20 14 16 28 36 11 ... 14 Erysipelas 202 207 204 234 195 157 103 95 143 173 121 ... 62 Cerebro-spinal Meningitis 5 3 9 3 47 28 26 21 13 15 9 ... 9 Polio-Myelitis 5 5 13 3 10 7 5 3 11 ... 7 3 ... Ophthalmia Neonatorum 34 35 37 51 44 32 29 35 54 60 54 10 ... Pulmonary Tuberculosis 514 855 783 706 646 590 622 777 788 634 490 ... 249 Other Forms of Tuberculosis ... ... 328 199 234 216 193 218 163 156 147 ... 81 Compared with 1920 there has been an increase in the number of cases of scarlet fever, enteric fever, and polio-myelitis, and a decrease of pulmonary tuberculosis, other forms of tuberculosis, diphtheria, puerperal fever, erysipelas, cerebro-spinal meningitis, and ophthalmia neonatorum. Compared with the corrected decennial average there has been an increase in the number of cases of scarlet fever, diphtheria, and ophthalmia neonatorum, and a decrease of enteric fever, erysipelas, cerebro-spinal meningitis, pulmonary tuberculosis, and other forms of tuberculosis. 61 Report of the Medical Officer of Health. Small=pox. One case of small-pox was notified, and all details are given in the following report:— On 28th December a case of small-pox was notified to me from Clapham, and on enquiry it was found that the case had been for some time in Russia, and at Moscow, where he had been living, his secretary had suffered from some skin eruption which was diagnosed as chicken-pox. No further information as to this case could be obtained. The patient arrived at Dover by the s.s. "Stad Antwerpen" on the 21st December. He left Dover by the 7.40 p.m. train, and arrived at Victoria at 9.34 p.m. He was in a carriage by himself from Dover to London. He travelled by taxi-cab from Victoria, but it was not possible to trace it. On the 22nd December, his medical man was called in and saw the case every day, but no notification was received by me till the 28th December. vThe diagnosis of small-pox was verified by Dr. Wanklyn, of the London County Council, on the 28th, and the case was removed to hospital at 7 p.m. on that day. The premises were disinfected by the sanitary staff on the 28th December, and the walls of the room stripped on the 29th. All the inmates of the house were vaccinated or re-vaccinated on the 28th December. All other known contacts have been visited and advised to be re-vaccinated. Nine of those in contact at his house were revaccinated. The whole of the contacts were kept under supervision for fourteen days. The Medical Officers of Health of the various districts in which contacts resided were duly informed. I also communicated with the Medical Officer of Health for Dover, as it was possible that some of the railway staff assisted the patient into the carriage at the railway station. The case recovered, and no further cases occurred. 62 Report of the Medical Officer of Health. Scarlet Fever. This disease was much more prevalent during the year, compared with 1920. In all 1,978 cases were notified, 366 in Clapham, 140 in Putney, 511 in Streatham, 341 in Tooting, and 620 in Wandsworth, compared with 1,463 in 1920. The rate per 1,000 of population was 6.03, 5.99 in Clapham, 4.85 in Putney, 4.89 in Streatham, 8.79 in Tooting, and 6.63 in Wandsworth. The disease was more prevalent in all parts of the Borough, compared with the previous 10 years, but it was much more prevalent in Tooting and Wandsworth. The disease was of a very mild type, only 20 deaths having occurred, or a "case mortality of only 1.01 per cent., which is exceptionally low. 36 cases occurred in institutions in Tooting. Of the total number of cases, viz.—1,978, 1,748 or 88 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; 792, or 40 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. From the 25th October to the 1st December, considerable difficulty was experienced in having cases promptly removed to hospital. The more urgent cases were promptly removed, but all cases had to be inquired into to ascertain the accommodation that existed at home, and the general home conditions. As will be seen in Table XLIII., some schools were more affected than others. The Medical Officers of the London County Council made inspections of 29 schools during the year, and any suspected cases were at once excluded and the names forwarded to me for inquiry. 63 Report of the Medical Officer of Health. In Clapham 67 cases occurred at Telferscot Road School and 42 at Cavendish Road; in Putney 44 cases occurred at Hotham Road School; in Streatham 41 cases occurred at Mitcham Lane School, and 35 at Smallwood Road; in Tooting 68 cases occurred at Sellincourt Road School, and 40 at The Ensham; and in Wandsworth the Earlsfield and Waldron Road Schools were chiefly affected, with 71 cases in each. The number of dwellings in each sub-district and the whole Borough in which multiple cases occurred is shown in the following Table:— TABLE XXXVIII. Sub-Districts. One case. Two cases. Three cases. Four cases. Five cases & upwards Total houses invaded. Clapham 243 38 9 1 1* 292 Putney 93 11 7 1 ... 112 Streatham 382 40 9 3 2 436 Tooting 245 22 6 5 2† 280 Wandsworth 449 56 13 1 3 522 Whole Borough 1412 167 44 11 8 1642 *In Clapham six cases occurred in an Institution. †In Tooting 22 cases occurred in one Institution, and 14 in another. Of the 1,642 houses invaded, multiple cases occurred in 230, or 14 per cent. Diphtheria. This disease was very prevalent during the year, especially in January, October, November, and December. The total number of cases notified was 1,009, 183 in Clap- 64 Report of the Medical Officer of Health. ham, 97 in Putney, 283 in Streatham, 191 in Tooting, and 255 in Wandsworth. The rate per 1,000 of population was 3.1, 3 in Clapham, 4 in Putney, 4.9 in Streatham, 4.9 in Tooting, and 2.6 in Wandsworth. The number of cases was 94 below the number in 1920, but was 397 above the corrected decennial average. Of the 1,009 cases, 934, or 92 per cent., were removed to hospital. No difficulty was experienced in having cases promptly removed to hospital. With regard to schools the highest number of cases occurred among children attending The Ensham and Brandlehow Road Schools, the next Mitcham Lane, and the third Hotham Road and Waldron Road. 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, Parochial Infants School; in Putney, Hotham Road School; in Streatham, Broadwater Road, Fircroft Road, Hearnville Road, Mitcham Lane, and Streatham Church of England Schools; in Tooting, The Ensham and Tooting Graveney Schools; and in Wandsworth, Brandlehow Road, Garratt Lane, Earlsfield, The Riversdale, St. Joseph's, Swaffield Road, Waldron Road, The Wandle, and Warple Way Schools. As a result of this swabbing, 28 cases were found to be positive and 20 suspicious. 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. 65 Report of the Medical Officer of Health. The number of dwellings in each sub-district and the whole Borough in which multiple cases occurred is shown in the next Table. TABLE XXXIX. Sub-Districts. One case. Two cases. Three cases. Four cases. Five cases and upwards Total houses invaded Clapham 122 16 3 1 2* 144 Putney 51 14 3 1 1 70 Streatham 218 21 6 ... 1 246 Tooting 116 14 4 ... 2† 136 Wandsworth 179 17 9 1 2‡ 208 Whole Borough 686 82 25 3 8 804 * In Clapham II cases occurred in an Institution. † In Tooting 30 cases occurred in an Institution. ‡ In Wandsworth six cases occurred in one house. Of the 804 houses invaded multiple cases occurred in 118, or 14.6 per cent. Return Cases of Scarlet Fever and Diphtheria. 60 cases of scarlet fever occurred after the return of cases from the hospitals of the Metropolitan Asylums Board, and there were also eight cases of Diphtheria. Six of the return cases of scarlet fever occurred in Clapham, five in Putney, 10 in Streatham, nine in Tooting, and 30 in Wandsworth. One of the return cases of diphtheria occurred in Clapham, two in Putney, four in Streatham, and one in Tooting. Enteric Fever. Thirty-two cases of enteric fever were notified during the year, six from Clapham, four from Putney, eight from Streatham, and 14 from Wandsworth. E 66 Report of the Medical Officer of Health. Five of the cases on admission to hospital were found not to be sufferings from enteric fever. The number of cases is eight above that of last year, but 17 below the corrected decennial average. Five of the cases were notified as para-typhoid fever, and all these recovered. Six of the cases contracted the disease abroad, two had partaken of shell-fish, and one of water-cress, about fourteen days previous to the onset of the disease, two contracted the disease outside the Borough from a previous case, and three presumably from a carrier who had the disease in India two years before. In the other eight cases no definite history of infection could be obtained. Cases of Mistaken Diagnosis. In 128 cases (42 of scarlet fever, 73 of diphtheria, five of enteric fever, five of cerebro-spinal fever, two of encephalitis lethargica, and one of polio-myelitis), information was received from the Metropolitan Asylums Board's and other hospitals that the patients were not suffering from the disease notified, or any other notifiable disease. Cerebro-spinal Meningitis. During the year nine cases of this disease were notified (two in Clapham, one in Streatham, three in Tooting, and three in Wandsworth). Eight of the cases were removed to hospital. One case was notified as enteric fever, but was diagnosed in hospital as cerebro-spinal meningitis. In five cases the diagnosis of cerebro-spinal meningitis was not confirmed in hospital. The following Table gives particulars of these cases. Report of the Medical Officer of Health. 67 TABLE XL. Cerebrospinal Meningitis. 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. 1 W. M. C., Worslade Road, Tooting. 5/12 M Indefinite. Jan. 14 Posterior Basic Meningitis. Yes Diplococci not found. No. — 2 Feb. 7 E. F., Milford Street, Clapham. 28 F Jan. 21 - Recovery with slight ocular lesion Diagnosed Encephalitis Lethargica in Hospital. Yes Diplococci not found. No. - 3 May 1 E. N., Aldis Street, Tooting. 7/12 F April 28 - Complete recovery. No. - No. - 4 May 2 N. C., Smeaton Road, Wandsworth. 6 M April 28 — Mistaken diagnosis.— Not C.S.M. — — — - 5 May 4 E. S., . Sellincourt Rd., Tooting. 2 F April 24 May 10 — No. — No. - G8 Report of the Medical Officer of Health. TABLE XL.—(continued). No. ol Cases. i 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 May 19 J. P-, Kingswood Rd., Clapham. 12 M May 13 May 22 Acute Suppurative Osteo Myelitis of Clavicle. — - - — 7 July 19 A. B., York Road, Wandsworth. 7 M July 13 July 25 Tubercular Meningitis — — - - 8 Aug. 5 F. M., Balvernie Grove, Wandsworth. 1 10/ 12 M Aug. 5 - Mistaken diagnosis.— Not C.S.M. - — - - 9 Oct. 20 M. B., Cathles Road, Balham. 1 F Oct. 19 Oct. 20 — Yes Diplococci found. No. - 10 May 11 M. N., Dawnay Road, Wandsworth. 7 F May 5 May 12 Originally notified as EntericFever Diagnosed C.S.M. in hospital. No - No. - Of the two cases notified in 1920 which recovered, both are now in good health. Report of the Medical Officer of Health. 69 Encephalitis Lethargica. 17 cases were notified, four in Clapham, seven in Streatham, four in Tooting, and two in Wandsworth. 13 of the cases were removed to hospital. The following Table gives particulars of the cases. TABLE XLI. 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. No after effects. Recovery with Mental condition. Ocular Paralysis persisting. Permanent Paralysis or Paresis. Tremors Athetosis. 1 Jan. 1 K. F., Downton Avenue, Streatham. 12 M 1920, Oct. 24 — Yes — — — — — Cerebrospinal fluid under pressure. No organisms or cells. 2 Jan. 15 E. D., Laitwood Road, Balham. 29 F 1921, Jan. 8 Jan. 21 — — — — — — Cerebrospinal fluid under pressure, but clear. 3 Jan. 22 L. W., Thrale Road, Streatham. 75 F Jan. 7 — Yes — — — — — — 4 Jan. 26 L. P., Elms Road, Clapham. 33 M Jan. 8 — Yes — — — — — Cerebrospinal fluid consistent with Encephalitis Lethargica. 70 Report of the Medical Officer of Health. TABLE XLI.—(continued). No. of Cases. Date of notification. Name and address of patient. Age. Sex Date of onset. RESULT OF CASE. Results of Pathological Examinations if made. REMARKS. Date of death. Recovery with No after effects. Ocular Paralysis persisting. Permanent Paralysis or Paresis. Tremors Athetosis. Mental condition. 5 Feb. 2 E. I., Arragon Gdns., Streatham. 37 M 1920, Dec. 12 — Yes. — — — — — — 6 Feb. 17 S. T., Derinton Road , Tooting. 61 F Dec. 1 Feb. 28 — — — — — — — 7 Mar. 9 G. H., Sellincourt Rd., Tooting. 38 F 1921, Feb. 1 Mar. 11 — — — — — — Spinal Fluid Lymphocy tosis. No growth 8 Mar. 12 F. I. Sellincourt Rd., Tooting. 19 F Indefinite — Diagnosed at hospital as Tonsilitis. — — — — — — 9 Mar. 20 L. B., Pensbury Ter., Clapham. 19 F 1920, Deo. 26 — Yes — — — — — — Report of the Medical Officer of Health. 71 TABLE XLI.—(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 No after effects. Ocular Paralysis persisting. Permanent Paralysis or Paresis. Tremors. Athetosis. Mental condition 10 Mar. 31 W. H. W., Letchworth St., Tooting. 18 M Mar. 22 — Yes — — — — — — 11 Mar. 31 E. J., Christchurch Rd., Streatham. 54 F Mar, 16 May 6 c — — — — — C.S. Fluid consistent with Encephalitis Lethargica. 12 May 6 K. M , Loubet Street, Tooting. 1 F May 3 May 6 Died of Influenza — — — — — Case of chronic Hydrocephalus. 13 May 12 E. C., Park Crescent, Clapham, 5 F April 19 — Yes — — — — — — 14 June 19 L. B., Elinbourne Road, Balham. 76 F June 12 June 21 — — — — — — C.S. Fluid under pressure, lymphocytosis, no organisms. 72 Report of the Medical Officer of Health. TABLE XLI.—(continued). No. of Cases. Date of Notification Name and Address of patient. Age. Sex. Date of onset. RESULT OF CASE. Results of Pathological Examinations if made. Remarks. Date of death. Recovery with " No after effects. Ocular Paralysi persisting. Permanent Paralysis or Paiesis. Tremors, Athetosis. Mental condition. 15 June 27 K. D., Southfields Road, Wandsworth. 49 F May 23 — Yes — — — — — — 16 Nov. 28 W. B. M., Dempster-Road, Wandsworth 66 M Indefinite Nov. 19 — — — — — — — 17 Dec. 7 N. M., Rodenhurst Road, ' Clapham. 33 F Dec. 5 — — — — — — — Recovering. 18 Feb, 7 E. F., Milford Street, Clapham. 28 F Jan. 22 — — Yes — — — — C. S. Fruid under pressure slightly blood stained. Report of the Medical Officer of Health. 73 As will be seen from the Table, six of the cases died from Encephalitis Lethargica, and one from Influenza. Two of the cases are still under treatment, but recovering, and eight have recovered without any after effects. Two of the cases were not Encephalitis Lethargica, and one of these died from Influenza, and the other suffered from Tonsilitis. Of the cases notified in 1920 Nos. 7, 14, 15, and 17 have recovered, Nos. 9 and 12 are improving, and the condition of No. 5 is stationary. Polio=myelitis and Polio-encephalitis. Seven cases were notified during the year and two deaths resulted. Three have recovered without paresis or paralysis, one is improving but has still slight paresis, and one was diagnosed at the hospital as Rheumatic Fever. Of the cases notified in 1919 No. 3 has right arm still paralysed; Nos. 4 and 6 have recovered; No. 7 is recovering slowly; and No. 8 has still dropped foot on right side, but is otherwise well. TABLE XLII. Poliomyelitis. No. of Cases Date of notification. Name and address of patient. Age. Sex. Date of onset. RESULT OF CASE. If Lumbar puncture undertaken. Result. Date of death. Recovery with or without Paralysis or Paresis. 1 Mar. 25 L. A., Vanderbilt Rd. Wandsworth. 1 F Mar. 16 Mar. 25 — — — 2 April 20 K. S., Arragon Gdns. Streatham. 3 M April 19 — Recovery. No paralysis. — — 3 April 22 B. J., Parklands Road, Streatham. 10 M Diagnosed at hospital as Rheumatic Fever — — — — 4 May 28 E. W., Aslett Street, Wandsworth. 1 F May 16 — Recovery. No paralysis. — — 5 June 14 R. C. P., Narbonne Ave., Clapham. 4 M April 21 — Recovery. No paralysis. — — 6 Aug. 22 L. M., Endlesham Rd., Balham. 10 M Aug. 14 — Improving. Slight paresis. — — 7 Nov. 2 I. S., Quill Lane, Putney. 1 F Oct. 19 Oct. 31 — — — i 74 Report of the Medical Officer of Health. Report of the Medical Officer of Health. 75 Erysipelas. 121 cases were notified (29 in Clapham, seven in Putney, 26 in Streatham, 13 in Tooting, and 46 in Wandsworth). Measles and German Measles. The notification of these diseases was discontinued at the end of 1919, but 32 cases were notified by doctors during the year, although the greatest number was reported by the Divisional Officers of the Education Department, or by the teachers of the elementary schools. As will be seen from Table XLIII. only 399 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 this is only the case between four and five years. Fortunately the disease during 1921 was of a comparatively mild type, only four deaths taking place, all of these being under five years of age. In all 450 cases were reported, seven under one year, 130 from one and under five years, 309 from five and under 15 years, and four over 15 years. 51 cases occurred in Clapham, nine in Putney, 92 in Streatham, 221 in Tooting, and 77 in Wandsworth. Eleven of the cases were removed to the Metropolitan Asylums Board's hospitals on account of insufficient accommodation at home. 76 Report of the Medical Officer of Health. Except in Tooting, there was no epidemic prevalence of this disease during the year, and even in that sub-district the total number of cases was not great. The number of deaths is the smallest ever recorded. 50 cases of German Measles were also reported (28 in Clapham, eight in Streatham, two in Tooting, and 12 in Wandsworth). During the year 432 visits were made in cases of these diseases, (77 in Clapham, five in Putney, 87 in Streatham, 208 in Tooting, and 55 in Wandsworth). The total number of premises disinfected was 238 (32 in Clapham, five in Putney, 57 in Streatham, 99 in Tooting, and 45 in Wandsworth). Table XLIII. 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. 77 TABLE XLIII. SCHOOL. DISEASES. Scarlet Fever. Diphtheria. Measles. German Measles. Chicken Pox Whooping Cough. Mumps. Ringworm. Other Diseases. TOTALS. CLAPHAM. Aristotle Road 13 2 ... ... ... ... ... ... 1 16 Bonneville Road 26 16 2 5 12 31 4 4 49 149 Cavendish Road 42 14 1 ... 73 3 ... ... 17 150 Cavendish Road Special 3 ... ... ... 1 1 2 ... ... 7 Christchurch 4 1 2 ... 16 4 4 ... ... 31 Clapham Parochial, Macaulay Road 6 2 ... ... ... ... ... ... ... 8 Clapham Parochial, Old Town 13 5 ... 1 ... ... 14 ... 1 34 Haselrigge Road 13 5 7 5 27 12 5 3 29 106 Larkhall Lane 25 8 ... 1 22 18 15 2 54 145 New Park Road 37 11 34 11 6 5 12 2 13 131 New Road 3 ... ... ... ... ... ... ... 4 7 St. Andrew's Street 8 2 ... ... ... 1 ... ... 3 14 St. Mary's, Crescent Lane 3 4 ... ... ... ... ... ... 1 8 St. Mary's, St. Alphonsus Rd. 2 2 ... ... ... ... ... ... ... 4 Stonhouse Street 11 19 3 4 15 3 5 ... 38 98 Telferscot Road 67 18 14 ... 54 23 1 2 123 302 Total 276 109 63 27 226 101 62 13 333 1210 PUTNEY. All Saints' 11 13 1 ... ... 5 ... ... 2 32 Hotham Road 44 21 ... 1 16 79 2 3 73 239 St. Mary's 16 8 ... ... 1 2 1 2 ... 30 Upper Grade, Walker's Place 5 2 ... ... ... ... ... ... ... 7 Total 76 44 1 1 17 86 3 5 75 308 Carried forward 352 153 64 28 243 187 65 18 408 1518 78 Report of the Medical Officer of Health. TABLE XLIII.—(continued). SCHOOL DISEASES. Scarlet Fever. Diphtheria. Measles. German Measles. Chicken Pox Whooping Cough. Mumps. Ringworm. Other Diseases. TOTALS. Brought forward 352 153 64 28 243 187 65 18 408 1518 STREATHAM. Balham High Road 13 2 ... ... 23 2 ... 2 1 43 Broadwater Road 14 14 3 ... 14 21 7 5 12 90 Christchurch 5 1 ... ... 9 ... 4 ... 2 21 Eardley Road 25 18 38 ... 40 31 65 2 5 224 Fircroft Road 17 10 6 ... ... 5 1 ... ... 39 Furzedown Demonstration 5 6 ... ... ... 9 1 ... 1 22 Hearnville Road 18 16 ... 1 3 1 ... ... 1 40 Hitherfield Road 3 1 ... ... 1 2 ... ... 1 8 Holy Trinity, Balham 5 5 ... ... 9 1 ... ... 3 24 Holy Trinity, Streatham 1 ... ... ... ... ... 1 ... ... 2 Immanuel 8 4 ... ... 4 ... 1 ... ... 17 Mitcham Lane 41 22 16 1 21 95 129 2 26 353 Nightingale Square R.C. 6 5 ... ... ... ... ... ... 3 14 Oldridgs Road 29 7 ... ... 12 19 5 2 53 127 Smallwood Road 35 14 70 ... 7 38 8 4 44 220 St. Andrew's, Colmer Road 4 1 ... ... 2 16 19 ... 1 43 St. Leonard's 7 6 1 ... 1 4 11 11 32 73 St. Mary's 9 3 ... ... 16 14 2 ... 3 47 Sunnyhill Road ... 2 ... ... 3 14 37 ... 3 59 Total 245 127 134 2 165 272 291 29 191 1456 TOOTING. Ensham 40 27 35 ... 9 16 17 5 19 168 Fountain Road 12 4 6 ... 9 5 9 2 6 53 Franciscan Road 15 5 ... ... 17 38 46 3 4 128 Hillbrook Road 10 10 1 ... 32 9 25 ... ... 87 Sellincourt Road 68 15 90 ... 54 42 35 2 119 425 Tooting Graveney 32 12 6 ... 67 13 28 10 61 229 Undine Street R.C. 2 5 ... ... ... ... ... ... ... 7 Total 179 78 138 ... 188 123 160 22 209 1097 Carried forward 776 358 337 30 596 582 516 69 808 4072 Report of the Medical Officer of Health. 79 TABLE XLIII.—(continued). SCHOOL. DISEASES. Scarlet Fever. Diphtheria. Measles. German Measles. Chicken Pox Whooping Cough. Mumps. Ringworm. Other Diseases. TOTALS. Brought forward 776 358 337 30 596 582 516 69 808 4072 WANDSWORTH. Allfarthing Lane 5 1 ... ... ... 10 ... 1 1 18 All Saints' 3 1 ... ... 2 2 ... ... ... 8 Brandlehow Road 11 27 1 ... 3 14 5 2 16 79 Earlsfield 71 12 7 ... 79 14 9 7 72 271 Elliott Central 4 1 ... ... ... ... ... ... ... 5 Eltringham Street 26 9 ... ... 6 7 1 6 18 73 Frogmore Special 6 2 ... ... ... ... ... ... 1 9 Garratt Lane 14 1 2 ... 5 7 4 8 11 52 Garratt Lane Special 1 ... ... ... ... ... ... ... ... 1 Littleton Street Special 1 ... ... ... ... ... 1 ... ... 2 Magdalen Road 11 3 ... ... 4 4 ... 1 11 34 Merton Road 9 3 ... 1 3 ... 1 5 3 25 Riversdale 13 3 1 1 1 15 ... 7 ... 41 St. Ann's 7 5 1 ... ... 6 1 3 5 28 St. Faith's 7 1 1 ... 31 28 8 4 16 96 St. Joseph's 1 6 ... ... ... ... ... ... ... 7 St. Michael's 6 2 1 1 ... 3 ... 2 ... 15 St. Thomas's 1 ... ... ... ... ... ... ... ... 1 Southfields 20 6 ... 3 1 5 1 5 1 42 Swaffield Road 19 14 42 ... 30 70 5 15 18 213 Waldron Road 71 21 ... 2 5 27 3 9 144 282 Wandle 31 12 5 ... 32 22 2 2 29 135 Warple Way 27 6 ... ... 6 15 2 ... 4 60 West Hill 8 4 1 ... 11 22 10 4 4 64 Total 373 140 62 8 219 271 53 81 354 1561 Grand Total 1149 498 399 38 815 853 569 150 1162 5633 80 Report of the Medical Officer of Health. Whooping Cough. 1,201 cases were notified (142 in Clapham, 167 in Putney, 314 in Streatham, 174 in Tooting, and 404 in Wandsworth). 107 of these were infants under one year of age, 507 from one and under five years, 575 from five and under 15 years, five from 15 and under 25 years, and seven over 25 years. Thirty-four cases were removed to hospital. This disease was not so prevalent in the Borough during the year, with the exception of Putney, in which there was an increase 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 79 cases of Influenzal Pneumonia were notified, (17 in Clapham, five in Putney, 35 in Streatham, four in Tooting, and 18 in Wandsworth), compared with 97 in 1920. One of the cases was under one year, one from one and under five years, four from five and under 15 years, 12 from 15 and under 25 years, 19 from 25 and under 45 years, 27 from 45 and under 65 years, and 15 over 65 years. 374 notifications of cases of Acute Primary Pneumonia were received (54 in Clapham, 40 in Putney, 113 in Streatham, 35 in Tooting, and 142 in Wandsworth), compared with 408 in 1920. 27 of the cases were infants under one year, 43 from one and under five years, 51 from five and under 15 years, 42 from 15 and under 25 years, 102 from 25 and under 45 years, 70 from 45 and under 65 years,and 39 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. 81 Malaria. 19 cases were notified (two in Clapham, one in Putney, four in Streatham, four in Tooting, and eight in Wandsworth). All of the cases but two were males. No case was notified in which the disease was contracted within the Borough. Of 17 Army cases, seven contracted the disease in Salonica, one in Egypt, three in Mesopotamia, five in India, and one in other parts.. The two females notified contracted the disease in India. These 19 cases were visited again at the end of the year, and it was found that eight were still suffering, six had removed, four were stated to be well, and in one no information could be obtained. 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 83 cases notified in previous years, and who were still suffering in 1920, 35 were in 1921 still suffering, nine have removed from the Borough, 38 are stated to be well, and one has died. Dysentery. Six cases were notified (two in Clapham, two in Streatham, one in Tooting, and one in Wandsworth). All the cases were males, and in five the disease was contracted during Army service in the following war areas: one each in France, Germany, East Africa, India, and Mesopotamia. F 82 Report of the Medical Officer of Health. None of the cases were engaged in the preparation of food or drink for human consumption. The cases notified in 1921 were again visited at the end of the year, and it was found that two were still suffering, one had removed, one was stated to be well, and in two no information could be obtained. Of the ten cases notified in previous years, five were still suffering, and five were stated to be well. Trench Fever. No case was notified during the year. Of the three cases notified in previous years, two have recovered and one is still suffering from the effects of the disease. Bacteriological Aids to Diagnosis. These have been utilised to large extent during the year, and a statement of the work carried out is given on page 117. Contacts. Careful inquiry is made with regard to contacts in every case of infectious disease notified, and the necessary action taken. 221 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 2,799, or 64 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. Report of the Medical Officer of Health. 83 Disinfection. The total number of rooms disinfected after the occurrence of cases of infectious disease was 5,340 (974 in Clapham, 511 in Putney, 1,570 in Streatham, 841 in Tooting, and 1,444 in Wandsworth). 3,216 lots of bedding were stoved at the Disinfecting Station, comprising the following articles: 1,841 beds, 1,655 bolsters, 4,692 pillows, 2,089 mattresses, 32 palliasses, 3,534 sheets, 2,862 quilts, 813 cushions, 8,194 articles of clothing, 5,920 blankets, 260 carpets, and 3,066 extra articles; a total of 34,958 articles. Disinfection was also carried out by the Sanitary Staff at premises after non-notifiable diseases, and the sum of £40 9s. 6d. was received for such disinfection. 620 rooms were disinfected with sulphur, in consequence of their verminous condition, and 24 lots of verminous bedding disinfected. During the year, at the request of the Military Authorities, 2,227 articles of clothing and bedding were disinfected and 12 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 £2,928 18s. 0d. The number of lots of bedding stoved was 3,216. Cost per lot of bedding £0 18s. 2d. 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. 81 Report of the Medical Officer of Health. Dysentery Carriers. In 1919 information was received from the Ministry of Health of ten cases of chronic carriers of entamœba histolytica. Seven of the cases that were notified in the report for 1920 that had not recovered were visited late in 1921, and it was found that four of these had recovered, one had removed, and two were still suffering. Notification of Tuberculous Diseases. The total number of cases of Pulmonary Tuberculosis notified during the year was 490, (100 were from Clapham, 45 from Putney, 126 from Streatham, 72 from Tooting, and 147 from Wandsworth), compared with 634 in 1920, 788 in 1919, 777 in 1918, and 739 the decennial average. There was a marked reduction in all the sub-districts, especially in Streatham and Wandsworth. Five of the cases were from one and under five years, 28 from five and under 15 years, 121 from 15 and under 25 years, 225 from 25 and under 45 years, 101 from 45 and under 65 years, and ten over 65 years. At all the ages there was a decrease compared with the previous year, except from one and under five years, where there was an increase of one, and over 65 years, where the number was the same. In Table XLIV. 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. Report of the Medical Officer of Health. 85 TABLE XLIV. Year Cases Reported. Deaths. Removed. Recovered. Cases on Register. 1909 to 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 Total. 1909 to 1912 2047 763 148 80 47 27 14 28 11 ... 3 1121 676 114 136 1913 783 ... 180 77 41 25 9 5 4 5 3 349 267 37 130 1914 706 ... ... 177 88 37 22 13 5 5 4 351 209 26 120 1815 646 ... ... ... 199 82 27 20 12 6 5 351 161 20 114 1916 590 ... ... ... ... 162 69 38 13 11 9 302 154 19 115 1917 622 ... ... ... ... ... 183 79 34 9 6 311 112 13 186 1918 777 ... ... ... ... ... ... 199 71 27 20 317 142 21 297 1919 788 ... ... ... ... ... ... ... 158 76 34 268 96 19 405 1920 634 ... ... ... ... ... ... ... ... 112 83 195 48 7 384 1921 490 ... ... ... ... ... ... ... ... ... 170 170 14 1 305 Total 8083 763 328 334 375 333 324 382 308 251 337 3735 1879 277 2192 In Table XLIV. it will be seen that since 1909, 8,083 cases of Pulmonary Tuberculosis have been reported, and since 1912, when Pulmonary Tuberculosis was made compulsorily notifiable, the number of cases was 6,891. Of these 8,083, 3,735 or 46.2 per cent. died, 1,879 or 23 per cent. have removed from the Borough, 277 or 3.4 per cent. have, as far as could be ascertained, recovered, while 2,192 or 27.1 per cent. remain on the Register. With regard to the notifications of cases of non-pulmonary Tuberculosis, in all 147 cases were notified (34 from Clapham, 10 from Putney, 23 from Streatham, 24 from Tooting, and 56 from Wandsworth). Seven of the cases were under one year, 25 from one and under five years, 58 from five and under 15 years, 21 from 15 and under 25 years, 29 from 25 and under 45 years, and seven over 45 years of age. Table XLV. 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 23 cases were notified and 23 died. 86 Report of the Medical Officer of Health. TABLE XLV. Localisation of Disease. Number of cases notified. No. of deaths. Removed. On Register. Total. Males. Females. Under 1 year. 1 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and upwards. Males. Females. Total. Brain 23 12 11 1 11 6 2 2 ... ... 1 ... ... ... 12 11 23 ... ... Glands, Mediastinal 7 4 3 ... ... 2 5 ... ... ... ... ... ... ... ... ... ... ... 7 „ Mesenteric 14 6 8 1 2 1 2 2 2 1 ... 1 ... 3 5 8 ... 6 „ Cervical 37 19 18 1 5 19 3 3 1 2 1 ... 2 ... ... ... ... 3 34 Bones and joints 42 24 18 1 4 9 6 5 4 10 3 ... ... ... 3 1 4 1 37 Skin 7 1 6 ... ... 1 1 1 ... 3 ... ... ... 1 ... 1 1 1 5 Larynx 4 4 ... ... ... ... ... ... ... 1 1 1 ... 1 1 ... 1 1 2 General Tuberculosis 9 4 5 3 3 ... 1 ... 1 ... 1 ... ... ... 4 5 9 ... ... Other parts 4 2 2 ... ... ... ... ... ... 1 3 ... ... ... ... ... ... ... 4 Total 147 76 71 7 25 38 20 13 8 18 11 2 3 2 23 23 46 6 95 Report of the Medical Officer of Health. 87 The next Table shows the number of cases notified, the number which died, removed, and recovered from 1913 to 1921, and the number still remaining on the Register at the end of 1921. TABLE XLVI. Year Cases Notified. Deaths. Removed. Recovered. Cases on Register. 1913 1914 1915 1916 1917 1918 1919 1920 1921 Total. 1913 323 46 10 5 6 ... 1 2 ... 1 71 107 52 93 1914 198 ... 68 5 4 ... 1 ... ... 1 79 43 24 52 1915 234 ... ... 84 7 1 1 2 ... 1 96 43 35 60 1916 215 ... ... ... 67 5 5 ... ... 1 78 47 20 70 1917 193 ... ... ... ... 63 4 2 3 1 73 28 15 77 1918 218 ... ... ... ... ... 67 6 ... 1 74 23 18 103 1919 163 ... ... ... ... ... ... 41 5 1 47 16 5 95 1920 156 ... ... ... ... ... ... ... 41 6 47 5 5 99 1921 147 ... ... ... ... ... ... ... ... 46 46 6 ... 95 Total. 1847 46 78 94 84 69 79 53 49 59 611 318 174 744 Table XLVII. is a summary of notifications during the period from the 3rd January, 1921, to the 31st December, 1921. TABLE XLVII. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from 3rd January, 1921, to 31st December , 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. Under 1. 1 to 5 5 to 10 10 to 15 15 to 20. 20 to 25 25 to 35 35 to 45 4.5 to 55 55 to 65 65 and upwards. Total. Under 5 5 to 10. 10 to 15 Total. Poor Law Institutions. Sanatoria. Pulmonary— Females 1 1 4 5 16 32 57 68 53 16 4 257 364 ... 3 ... 3 3 56 228 Males ... 2 6 6 26 39 61 37 17 11 4 209 293 ... ... 1 1 1 75 128 Non-Pulmonary— Males 4 14 16 6 4 2 7 7 4 1 1 66 75 2 4 2 8 10 12 6 Females 2 9 16 14 7 4 11 5 1 2 1 72 80 ... 1 ... 1 3 4 12 88 Report of the Medical Officer of Health. Report of the Medical Officer of Health. 89 The total number of visits made was 1,624 in cases of Pulmonary Tuberculosis, 280 in Clapham, 128 in Putney, 431 in Streatham, 269 in Tooting, and 516 in Wandsworth, and 479 in cases of other forms of Tuberculosis, 51 in Clapham, 40 in Putney, 121 in Streatham, 93 in Tooting, and 174 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 15 sputum flasks have been supplied, and in five of the cases visited the patients already had one. During the year disinfection was carried out at 358 premises either after the death or removal of the patient. 66 of the premises disinfected were in Clapham, 36 in Putney, 100 in Streatham, 51 in Tooting, and 105 in Wandsworth. TUBERCULOSIS DISPENSARIES. There have been no changes in the Staff of the Dispensaries during the year. Institutional Treatment.—On July 1st, the responsibility for Institutional Treatment of Insured Persons was transferred from the London Insurance Committee to the London County Council, who were already dealing with uninsured persons and children. Under this arrangement, all applications for treatment in residential institutions are made to the County Medical Officer of Health, whether the person is insured or not, and uniformity of procedure has resulted. The new arrangements include the provision of observation beds for cases of difficulty, where special investigations are required in order to arrive at a correct diagnosis. These beds have proved of considerable help in dealing with cases of this nature. Co-operation with other Institutions.—Cases requiring special investigation which can be carried out without admission to Hospital are still referred to St. Thomas's Hospital under the 90 Report of the Medical Officer of Health. Scheme in force since 1913. As shown in Table LI., a larger number of cases have been referred to the Hospital under this arrangement than in previous years, and the reports forwarded have been of great value. The Scheme has been extended to include the treatment of Lupus by Finsen Light or X Rays. Arrangements have also been made with the Hospital for Consumption, Brompton, for supplying refills to patients who have been treated by the artificial pneumothorax method. Dental Treatment.—The agreement with the British Dentists' Hospital, for providing dental treatment, including the provision of dentures, has been in force throughout the year. 35 patients received dental treatment and 20 of them were supplied with dentures. The attendances at the dentist totalled 132. Extra Nourishment.—On June 22nd, 1921, the Council decided to supply extra nourishment to persons suffering from Tuberculosis, under Section 3 of the Public Health (Prevention and Treatment of Disease) Act, 1913. The maximum amount which can be spent in any one year is £2 per 1,000 population, i.e., £650 for the Borough. The scheme was approved by the Ministry of Health and has been in operation during the last three months of the year. It provides that the nourishment be granted on medical grounds only, and be considered as part of treatment. It is limited to the slighter cases of disease, where there is a reasonable probability that extra nourishment will increase the chances of recovery, or will enable the patient to remain at work, or to return to work at an early date. Ex-service men receiving extra nourishment through the Ministry of Pensions are not eligible. Any articles of diet considered necessary for the particular individual can be ordered, provided the total cost per patient does not exceed ten shillings a week. The financial circumstances of each case are investigated and steps are taken to ensure, as far as possible, that the articles of diet ordered are consumed by the patient. Up to the end of the year 14 patients were granted extra nourishment under the scheme at a cost of £32 8s. 9d. Report of the Medical Officer of Health. 91 Shelters.—The two shelters have been in continuous use during the year. Details of Work during 1921.—Table LXVIII. shows the cases examined for the first time during the year, classified into definite cases of Tuberculosis, suspected cases, and those in which no evidence of the disease was found. Each group has been subdivided by sexes, into insured and non-insured. TABLE XLVIII. NEW CASES. Cases. Tuberculous. Suspected Tuberculosis. Non-Tuberculous. Male. Female. Total. Male. Female. Total. Male. Female. Total. Insured 173 74 247 3 2 5 221 134 355 Not Insured 71 84 155 4 3 7 315 471 786 Totals 244 158 402 7 5 12 536 605 1141 Table XLIX shows the total of these new cases, and gives the total attendances of all cases made during the year. TABLE XLIX. Cases. Male. Female. Total. Attendances. Insured 397 210 607 5218 Not Insured 390 558 948 5291 Totals 787 768 1555 10509 Table L. gives the numbers of new cases living in each of the five sub-districts, and shows on whose recommendation they made the first attendance. The number of cases referred to the Dispensaries by Medical Practitioners has increased to 362, compared with 307, 209, 234, and 175 for the four previous years. 92 Report of the Medical Officer of Health. TABLE L. District. Clapham. Putney. Streatham. Tooting. Wandsworth. Outside Borough. Totals. Public Health Department 92 30 86 159 217 2 586 London Insurance Committee 1 1 2 4 4 ... 12 Private Practitioners 52 17 42 89 161 1 362 Charitable Societies 1 2 2 7 3 ... 15 Transfers from other Dispensaries 11 3 4 7 7 ... 32 London County Council 14 1 2 16 37 ... 70 Existing Dispensary Patients 22 3 15 40 77 3 160 Ministry of Pensions 35 20 29 31 42 1 158 Other Sources 14 5 12 19 109 1 160 Totals 242 82 194 372 657 8 1555 Table LI. gives further details of the year's work and shows how it has increased during the last five years. TABLE LI. Return showing detail of other Work connected with the Dispensaries during the last five years. 1917 1918 1919 1920 1921 Visits by Tuberculosis Officers to Patients' Homes 9 11 51 105 377 Visits by Nurses at Patients' Homes 1482 1668 3158 3528 3433 Number of written Reports made 882 1070 1871 2483 3156 Cases of difficulty referred to St. Thomas's Hospital 10 7 69 67 160 Number of attendances at which complete examinations were made 2032 2215 3308 3179 3896 Table LII. gives particulars with regard to ex-service men examined at the Dispensaries and the visits made to their homes by the Dispensary Nurses. 93 Report of the Medical Officer of Health. TABLE LII. Particulars relating to Discharged Soldiers attending at the Dispensaries. New Cases. Old Cases. Total Attendances. Tuberculous 134 267 2,808 Non-Tuberculous 113 31 340 Totals 247 298 3,148 716 visits were made by the Dispensary Nurses in connection with these cases during the year. Contacts.—Of the 1,555 new cases examined, 459 were contacts. Twelve of these were found to be suffering from Tuberculosis and one is a suspected case. Care Committee.—During the year the Care Committee has extended its activities in a new direction and has succeeded in raising funds to maintain a bed for dying cases of Tuberculosis at St. Columba's Hospital, Hampstead. For some time it has been clear that further provision was needed for patients of this class who were too ill to be treated at home, especially owing to the difficulty in arranging for their admission to other institutions. After the matter had been considered by the Committee, Mrs. Nicol undertook to organise a Japanese Fair in Streatham in order to raise funds. Together with a few of her friends, who went into the matter enthusiastically, she gave a great deal of time to making the necessary arrangements, and the Fair which was held in November proved a great success. Sufficient funds were raised to maintain one bed at the Hospital for two years. This bed has been in use continuously since June, and arrangements have been made with the Hospital for the temporary use of other beds at times when more than one is needed. Eight 91 Report of the Medical Officer of Health. patients have been admitted to the Hospital up to the end of the year, and four of these nave died, one was discharged much improved after some weeks' treatment, and three were in the Hospital at the end of the year. All these patients were very grateful for the care and attention given to them while in the Hospital, and this fresh development in the work has undoubtedly proved of great benefit. Convalescence has been arranged for six patients at Hahnemann Home, Bournemouth, and part of the maintenance charges has been paid for some of them, while help in paying railway fares is given when necessary. Between 40 and 50 advanced cases have been visited by members of the Committee in addition to those visited by the Nurses. Medical and other comforts are supplied to them when needed. The Committee have also kept in touch with those Dispensary patients who enter St. James' Hospital, several members visiting them from time to time. These visits are much appreciated by the patients. Clothing has been supplied to several patients to enable them to go to sanatoria or hospitals. Suitable employment has been found for several patients. Two girls have been placed in sanatoria as probationers and helped with the supply of their outfit. A man, previously trained by the Committee as a motor driver, is now a chauffeur in private service and doing well. A vacancy has been found for one patient at Hull After-Care Colony, and the necessary funds for keeping him there were raised by the Committee. The total cost for his treatment there is £2 5s. per week, £1 of which is paid by the Guardians, six shillings by St. Mary's, Putney, Relief Committee, and the balance privately. This man has been there three months and is doing well. 165 cases have been assessed on behalf of the London County Council in connection with their treatment in institutions. 95 Report of the Medical Officer of Health. Sputum Examinations.—The number of sputum examinations made during the year shows a large increase on previous years, 1,054 specimens being examined, compared with 601 in 1920, and 204 in 1919. Of these, 247 or 23.4 per cent. gave a positive result. The increased number is due, mainly, to more frequent examinations of pulmonary cases giving a negative result, a procedure which is very necessary in order to arrive at an accurate opinion of their condition. Cases of all Years Compared.—Table LIII, shows the number of new cases and total attendances at each of the Dispensaries for the nine years during which they have been open. TABLE LIII. New Cases and Total Attendances. Year. New Cases. Total Attendances. Wandsworth. Balham. Total. Wandsworth. Balham. Total. 1913 707 219 926 4009 1169 5178 1914 664 303 967 4991 2573 7564 1915 430 287 717 3888 2661 6549 1916 628 445 1073 5480 3906 9386 1917 739 476 1215 6992 5576 12568 1918 752 603 1355 9223 7821 17044 1919 994 728 1722 9981 8241 18222 1920 1091 595 1686 7633 5019 12652 1921 1015 540 1555 6554 3955 10509 Totals 7020 4196 11216 58751 40921 99672 96 Report of the Medical Officer of Health. Classification of Cases.—In Table LIV. all patients examined during the nine years have been placed in one or other of three groups:— (1). Definite cases of Tuberculosis, divided into those having active disease at any time and those in whom there has not been any evidence of active disease. Each group is further sub-divided, according to the site of the lesion, into pulmonary and non-pulmonary. (2). Cases where the disease was suspected, but not definite. (3). Cases where there was no evidence of Tuberculosis. 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 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 a lesion in some other part of the body, the case is classified as pulmonary. TABLE L1V. Year. Definite Cases of Tuberculosis. Suspected Cases. Non- Tuberculous. Totals. Pulmonary. Non-Pulmonary. Active. Inactive. Active. Inactive. 1913 227 45 25 9 8 612 926 1914 276 35 28 8 10 610 967 1915 230 47 19 4 6 411 717 1916 226 39 51 11 6 740 1073 1917 289 35 73 4 14 800 1215 1918 365 63 114 13 7 793 1355 1919 371 54 91 10 17 1179 1722 1920 321 43 109 14 14 1185 1686 1921 301 58 36 7 12 1141 1555 Totals 2,606 419 546 80 94 7471 11216 97 Report of the Medical Officer of Health. Table LV. gives the condition to date of all cases of Tuberculosis dealt with during the nine years, and shows that, out of a total of 3,651, 1,032 have died and 1,677 are still on the register. Several arrested cases are known to have died from causes other than Tuberculosis, but these are not shown as dead in the table, the number of deaths shown being directly attributable to active Tuberculosis. TABLE LV. Showing Condition to Date of all Cases of Tuberculosis. Active Tuberculosis Year. Removed Died. Arrested Remaining on Register. Totals. Pulmonary 1913-1915 202 332 32 167 733 1916 51 104 11 60 226 1917 53 132 5 99 289 1918 53 141 7 164 365 1919 53 125 193 371 1920 29 88 204 321 1921 12 76 213 301 Total 453 998 55 1100 2606 Non-Pulmonary 1913 to 1921 59 34 50 276 419 Inactive Tuberculosis Pulmonary 1913 to 1921 116 148 282 546 Non-Pulmonary 10 51 19 80 Total 126 199 301 626 Grand Totals 638 1032 304 1677 3651 g 98 Report of the Medical Officer of Health. Pulmonary Tuberculosis—Results.—In Table LVI. the cases of one year are not comparable with those of another year, as each group has been under treatment for a different period. In order to estimate the results of treatment it is advisable to take the condition of each patient after he has been under treatment for a definite period which must be the same for each. In this way the cases of one year can be grouped with those of other years and fairly large figures are obtained, from which it is possible to draw certain conclusions. For this purpose a period of three years has been chosen, and each patient has been classified according to his condition in the 36th month after he first attended for examination. A patient examined for the first time in March, 1914, has been classified according to his condition in March, 1917, irrespective of what has happened to him since; one first examined in December, 1918, according to his condition in December, 1921. During the six years 1913 to 1918, 1,613 cases of active pulmonary Tuberculosis were examined at both Dispensaries and classified as such. Each of these patients has been dealt with in the manner described, and the results are shown in Table LVI. Of the 1,613 cases, 313 cannot be traced, leaving a nett total of 1,300, the condition of whom was known at the end of the three year period. The number known to be dead is shown in the fourth column and the case mortality, i.e., the percentage of deaths to nett cases, is shown in the last column. The results in one group can be contrasted with those in another group by comparing the case mortality. The figures show that 50 per cent. of all cases of active pulmonary Tuberculosis have died within three years of first coming under treatment, and that the results in females are slightly better than in males. There is a marked difference between the sputum positive and sputum negative cases, the mortality in positive cases being nearly four times that in negative ones. The group "no record of sputum," consists mainly of very bad cases, frequently seen only once, where no opportunity of examining (he 99 Report of the Medical Officer of Health. sputum occurred. Most of them would be positive if this had been done. The mortality in patients who have had sanatorium treatment is slightly lower than those who have not, but not more than can be accounted for by the selection which is exercised in determining whether the case is suitable for that form of treatment. The worst cases are not sent to a sanatorium. The mortality for those who have received tuberculin treatment is smaller than for all cases, but as the, total figures are much smaller, the error is larger. TABLE LVI. 1913-1918 Cases after Three Years' Treatment. Total Cases, Untraced. Net Cases. Dead. Case Mortality. ALL CASES. 1613 313 1300 649 Per cent 49 9 Males 874 181 693 372 53.7 Females 739 132 607 277 45.6 Sputum Positive 889 155 734 445 60.6 Sputum Negative 494 111 383 61 16.0 No Record of Sputum 230 47 183 143 78.1 Received Sanatorium Treatment 627 119 508 243 47.8 Not Treated in Sanatorium 986 194 792 406 51.2 Treated with Tuberculin 219 34 185 83 44.9 Suspected Tuberculosis.—Table LVII. shows the condition to date of the 94 suspected cases examined during the nine years. TABLE LVII. Results to Date. Removed. Died Advanced. Stationary. Improved. Recovered Totals Suspected Tuberculosis 21 3 4 42 15 9 94 Vaccine Treatment. Pulmonary Tuberculosis 1 2 3 3 2 1 12 Non-Tubercular - 3 1 5 15 6 30 Totals 1 5 4 8 17 7 42 100 Report of the Medical Officer of Health. Vaccine Treatment.—Since 1913, 42 cases have been treated with autogenous vaccines prepared separately for each one, and the results of this form of treatment are shown in Table LVII. 12 were cases of pulmonary Tuberculosis, while 30 were suffering- from conditions allied to Tuberculosis, such as asthma and bronchitis. The results with this latter class were good, 15 having improved and six completely recovered. SmaIl-pox. No vaccination or re-vaccination was performed by the Medical Officer of Health under the Public Health (Small-pox) Regulations during the year. Vaccination. Table LVIII. is taken from the official returns of the Vaccination Officers to the Board of Guardians for the year 1920. It shows the number of children successfully vaccinated for the whole Borough, as well as for the separate sub-districts. Streatham, Balham and Tooting are included under the heading of Streatham. TABLE LVIII. SubDistricts. Number of Births returned from 1st January to 31st December, 1920. 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 1247 624 3 ... 69 393 19 27 101 11 Putney 456 327 1 ... 24 85 4 8 4 3 Streatham 3316 1324 8 ... 107 1186 46 146 259 240 Wandsw'th 2194 1241 5 ... 114 580 27 45 159 23 Totals 7213 3516 17 ... 314 2244 96 226 523 277 101 Report of the Medical Officer of Health. The percentage of children vaccinated to total births was only 48.7, 50 in Clapham, 71.5 in Putney, 40 in Streatham, etc., and 51 in Wandsworth. Scabies. 'I he names of 164 school children, 32 from Clapham, eight from Putney, 27 from Streatham, 34 from Tooting, and 63. from Wandsworth, who were suffering from scabies, were forwarded to me by the medical officer to the London County Council, and the homes were visited by the sanitary inspector. These children were being treated at the London County Council cleansing stations. In 41 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 47 other cases in adults were reported to me. These cases were treated at the baths at the Council's disinfecting station with sulphurated potash baths, and in every case the disease was cured. The average number of baths given per case was three. MATERNITY AND CHILD WELFARE. I.—Work of Health Visitors The duties of the Health Visitors are the same as reported last year, with the addition of visits with regard to non-payment of fees in connection with the Borough Maternity Home. Of the total number of births, viz., (5,167, 4,760 or 77.18 per cent. were visited, compared with 72.2 per cent. in 1920. The following table summarises the work of the Health Visitors during the year in the various wards of the Borough. 102 Report of the Medical Officer of Health. TABLE LIX. Year ended December 31st, 1921 Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. N. S. B. S. So. F. Sp. Births— Visits 510 388 299 714 589 718 543 294 70 4760 Re-Visits 623 556 456 1319 378 271 572 425 27 4873 Children, 1—2 years- Visits ... ... 7 61 63 25 1 8 14 179 Re-Visits 210 162 124 123 103 66 124 91 88 1091 Children, 2—5 years— Visits ... ... 10 18 41 45 19 6 12 151 Re-Visits 84 47 194 111 112 155 118 87 125 1033 Ante-natal visits 46 32 23 76 94 89 41 44 46 491 Puerperal fever— Visits 3 6 3 2 4 4 1 1 5 29 Re-Visits ... 1 ... ... 3 2 ... 2 1 9 Ophthalmia neonatorum— Visits 15 10 5 15 7 1 6 12 9 80 Re-Visits 7 4 7 18 4 2 4 18 5 89 Pneumonia— Visits 3 3 5 3 4 5 8 5 22 58 Re-Visits 1 ... 2 ... 3 ... ... ... 4 10 Enteritis— Visits ... ... 6 1 3 18 1 ... 12 41 Re-Visits ... ... ... ... 1 2 ... ... ... 3 Measles— Visits 2 10 3 14 42 31 2 4 18 126 Re-Visits ... ... 1 2 4 5 ... ... 6 18 Whooping-cough— Visits 26 34 61 24 66 74 30 39 113 467 Re-Visits ... ... 15 4 10 2 2 9 12 54 Investigation of death of infants 47 26 44 66 34 64 37 17 50 385 Attendance at Infant Welfare Centres 106 ... 57 104 92 98 57 33 79 626 Attendance at Ante-natal Centres 16 ... ... 30 36 27 23 ... 36 168 Committee meetings 7 ... 26 17 19 19 35 15 11 149 Visits re supply of milk and food 47 15 67 148 282 46 52 39 79 775 Visits re dental treatment 1 1 4 1 12 2 1 ... ... 22 Visits re creches ... ... 52 39 ... 42 ... 36 ... 169 Health talks to mothers 24 20 19 21 32 12 4 6 138 Miscellaneous visits 53 17 43 151 78 54 82 71 42 591 Ineffectual visits 292 217 399 687 165 231 476 322 230 3019 Total 2123 1529 1933 3767 2270 2130 2247 1582 2008 19589 Nuisances reported to Medical Officer of Health 44 43 2 32 4 51 61 47 37 321 Infant Visiting. The total number of visits and re-visits was 9,638, of which 1,760 were first visits, compared with 5,211 in the previous year. The re-visits numbered 4,878 as against 3,618. At the first visit 3,799 were entirely breast-fed, 393 were breast-fed supplemented by artificial feeding, and the remainder were entirely bottle fed. 103 Report of the Medical Officer of Health. On re-visiting 2,110 were found to be entirely breast-fed, 847 were breast-fed supplemented by artificial feeding, and the remainder were otherwise fed. 162 of the infants visited died during the year (21 in Clapham, 13 in Putney, 19 in Balham, 15 in Streatham, 26 in Tooting, 31 in Wandsworth I., and 37 in Wandsworth II.) As shown by the table, the highest mortality occurred during the first five months of life, four died under one month, and 91 died before reaching the age of six months. 163 of the infants visited were prematurely born, and 131 were delicate from birth, 92 twin births were visited, of whom five died. With regard to the employment of midwives, 1,860 mothers had employed their services, 775 infants were born in hospital, maternity homes and other institutions, and two unregistered women were employed. In 2,123 births doctors have been in attendance. 179 children between the ages of one and two years were visited and 1,091 were re-visited. 151 children between the ages of two and five years were visited, and 1,033 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 179 children under two years of age, and 151 between the ages of two to five years were children who had been born elsewhere, and so not previously known and visited. 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 491 as against 206 in 1920. 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, 44 intimation notices were served by the two Health Visitors, who are also Sanitary Inspectors. 104 Report of the Medical Officer of Health. TABLE LX. Clapham, North. Clapham, South. Putney. Balham. Streatham. Tooting. Southfield. Fairfield. Springfield. Borough. Infants visited 510 388 299 714 589 718 543 294 705 4760 Breast-fed 425 302 220 563 473 473 564 443 556 3799 Otherwise fed 85 86 79 151 116 154 100 41 149 961 Infants re-visited 623 556 456 1319 378 271 572 425 278 4878 Breast-fed 280 233 141 600 203 120 240 184 109 2110 Otherwise fed 343 323 315 719 175 151 332 241 169 2768 TABLE LXI. Deaths of Infants Visited. Under 1 mo. Under 2 mos. Under 3 mos. Under 4 mos. Under 5 mos. Under 6 mos. Under 7 mos. Under 8 mos. Under 9 mos. Under 10 mos. Under 11 mos. Under 12 mos. Total. Clapham, North 1 ... 1 2 1 3 1 1 ... 1 2 ... 13 Clapham, South ... ... 5 1 ... ... ... ... 1 ... ... 1 8 Putney ... ... 3 ... 1 ... 4 1 1 2 ... 1 13 Balham ... 3 1 3 4 1 1 2 1 1 ... 2 19 Streatham ... 1 1 1 4 1 1 1 3 ... 1 1 15 Tooting ... 1 3 5 2 6 2 1 1 ... 3 2 26 Southfield 1 2 6 2 ... ... 2 ... ... ... 2 2 17 Fairfield 2 3 1 1 ... 2 1 ... ... 1 1 2 14 Springfield ... 1 3 6 7 3 1 3 4 4 1 4 37 Borough 4 11 24 21 19 16 13 9 11 9 10 15 162 Midwives. The supervision of midwives is under the control of the London County Council, but there is full co-operation between the midwives and the Health Visitors. There are 32 midwives practising in the Borough, of whom eight reside in neighbouring districts. 105 Report of the Medical Officer of Health. Nurses. Arrangements have been made with various nursing associations in the Borough to attend cases of ophthalmia neonatorum, measles, whooping-cough, diarrhœa, 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. 2,635 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. 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 34 private maternity homes in the Borough, eight of which are carried on by practising midwives. Wandsworth Borough Memorial Maternity Home. During the year 341 births occurred in the Borough Memorial Maternity Home, and the following table, copy of which was forwarded to the Ministry of Health early in the current year, shows in detail these cases, the deaths of infants and mothers, the various complications that occurred and the number of times it was necessary for the Matron to call in medical assistance, either for the mother or child. It is most satisfactory that only two deaths of mothers occurred, one of which was due to advanced cardiac disease and the other to severe post-partum hæmorrhage. 106 Report of the Medical Officer of Health. 10 deaths of infants took place, eight of these being- stillbirths. One Cæsarian section was performed with satisfactory result both to mother and infant. I have visited the Home on many occasions and am able to report that the whole of the work there has been carried out most satisfactorily. 1. Total number of cases admitted 341 2. Average duration of stay 16 days 3. No. of cases delivered by midwives 304 4. No. of cases delivered by doctors (including 8 who engaged a doctor) 37 5. No. of cases in which Medical assistance was sought 90 Nature of complications for which Medical assistance was sought:— Ante-Natal. During Labour. Contracted pelvis 1 Prolonged labour 18 Placenta Prævia 2 Uterine inertia 3 Induction of labour 3 Adherent Placenta 3 Caesarian section 1 — Eclampsia 1 24 Abnormal presentations 3 11 After Labour. For Infant. Post Partum Hæmorrhage 1 Injury to infant 1 Infantile debility 7 Internal Lacerations 1 Watery discharge from eyes 6 Ruptured Perineums 29 General Debility 2 Rise of Temperature 5 14 Sub-Involution 3 41 107 Report of the Medical Officer of Health. 6. No. of cases notified Puerperal Sepsis 2 (Diagnosis not confirmed in either case). 7. No. of cases in which temperature rose above 100.4 for 24 hours 5 8. No. of cases notified Ophthalmia Neonatorum 2 (Both cases recovered). 9. No. of cases of inflammation of the eye, however slight 4 10. No. of infants not entirely breast-fed while in tution. Cause : Insufficient breast milk 8 11. No. of Maternal deaths 2 Causes: 1 Heart failure. 2 Collapse following A.P.H. and P.P.H. 12. No. of Foetal deaths 10 (a) Still-births 8—No P.M. (Placenta Prævia 2; Complicated Labour 2; Nothing to account for still-birth 4). (b) Within 10 days of birth 2 (both premature). The cases came from all parts of the Borough; 26 from Clapham, 18 from Putney, 99 from Balham, 34 from Streatharn, GO from Tooting, and 95 from Wandsworth, and nine cases be longing to other places. These nine cases were admitted when the Home was not fully occupied, and paid the maximum fee. The greater number of the cases were admitted, as would have been anticipated, from those parts of the Borough nearest the Home. The number from Clapham was low, doubtless because of the proximity of the old-established Maternity Home in Jeffreys Road, Lambeth, which for many years has been utilised by residents in that part of the Borough. 108 Report of the Medical Officer of Health. 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-five infants passed through the hospital during the year, the average stay being 57 days. The complaints from which they suffered were marasmus (24), debility, malnutrition, rickets, gastritis, infantile paralysis, hydrocephalus, cephalhœmatoma, constipation, enteritis, diarrhœa and vomiting, colitis, bronchitis, empyema, pneumonia and prematurity. 30 cases were discharged in good health, 23 had improved, and in one case there was no improvement. 11 babies died, four from marasmus, one from marasmus and chronic enteritis, one from pneumonia and marasmus, one from pneumonia and empyema, and four from acute enteritis. 15 of the 75 cases belonged to the Borough (Clapham nine, Putney one, Balham eight, Streatham 23, Tooting two, and Wandsworth two). Of these eight died, the causes of death being, enteritis two, diarrhœa and vomiting one, and marasmus five' There are four 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 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 babies 109 Report of the Medical Officer of Health. all day. 12 mothers with their babies were received during the year. This home had to be closed for financial reasons. In another, where the mothers learn glove and stocking making in the home, 12 mothers were received during the year. In another, 130 mothers passed through the home during the year, the number of births being 127. In the fourth, 15 mothers passed through the Home, one only staying a week, the number of births being 14. 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. 24 mothers and 24 babies passed through the home during the year, 18 being discharged for various reasons. 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. Stil-Births. Investigations were made into the cases of 56 still-births, nine of which were premature and 14 were difficult labours, 23 were delivered by midwives, 12 occurred in institutions, and 21 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 five mothers with infants and seven children were sent to Convalescent Homes. Six children were sent to the John Horniman Home at Worthing, and four mothers- and infants to the Mothers' Rest Home, Hampstead, one mother and child to the Catherine Gladstone Home, Mitcham, and one child to St. John's Home, Brighton. 110 Report of the Medical Officer of Health. Illegitimate Births. Of the 239 illegitimate births belonging to the Borough 130 have been visited, 22 were above the standard of visiting, 29 had removed before visit, 15 were born in Institutions and remained there, eight died before visit, 12 were boarded out under the London County Council, one was adopted, six mothers and children went to homes, four wrong addresses were given, two were born in hospital and died there, and 10 of the mothers came to the Borough for confinement only. Of the 130 visited eight 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 eight Infant Welfare Centres in the Borough, a Centre to serve the Fairfield Ward having been opened in July at the Fairfield Mission Hall, Fairfield Street. The premises occupied by the Balham and Springfield Infant Welfare Centres being inadequate to accommodate the increasing number of mothers who wished to avail themselves of the advice and help provided, efforts were made to obtain more suitable accommodation. In July, the Springfield Infant Welfare Centre removed from the Anchor Mission, Garratt Lane, to the Earlsfield Congregational Church Hall in Earlsfield Road; and in October the Balham Infant Welfare Centre removed from Zennor Hall to 91, Bedford Hill, premises provided by means of the generous efforts made by the Balham and Tooting Traders' Association. 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. 111 Report of the Medical Officer of Health. 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. Each Centre, with the exception of Putney and Fairfield, has a separate session for ante-natal work—at Putney it is held concurrently with the Infant Clinic and from Fairfield the mothers go to the Springfield Ante-natal Clinic in Earlsfield Road. The next Table summarises the work done at all Centres. There were 2,640 new cases registered during the year, the total number of attendances was 31,264, 49 were transferred to other Centres, 816 were passed on to the London County Council, and 79 died. The total number of ante-natal cases on the registers during 1921 was 796, the attendances numbering 1,755. The superintendents' visits to infants totalled 10,284, and to ante-natal cases 83-3. 183 health talks were given. In Clapham a course of 12 lectures on Infant Care and Mothercraft was given by the Medical Officer of the Centre. Needlework classes were held at each session of the antenatal clinic throughout the year, and of the Infant Clinic for nine months. In Putney a course of six lectures on Hygiene were given in the spring, and in the autumn a course of 12 needlework classes were held. In Streatham needlework classes are held on alternate Wednesdays. In Tooting needlework classes are held at every ante-natal session. At Springfield Infant Welfare Centre 12 needlework classes were held in the spring, and a course of 10 Health lectures was triven in the autumn. The mothers from the Southfields and Fairfield Infant Welfare Centres attended both these courses. 626 attendances were made by the Health Visitors to the Infant Clinics, and 168 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 112 Report of the Medical Officer of Health. Health is ex-officio a member of the General Council, whose function is to co-ordinate the work of the Centres. 138 health talks were given by the Health Visitors during the year. TABLE LXII. Clapham. Putney. Balham. Streatham. Tooting. Southfields. Fairfield. Springfield. Totals. No of new cases during 1921 491 211 420 341 417 240 103 417 2640 , transferred to other Centres 7 2 4 12 8 ... ... 16 49 „ dead 10 4 16 7 15 5 2 20 79 „ passed on to L.C.C. ... 87 83 34 308 2 ... 302 816 „ of attendances 8605 2430 5652 4264 4433 1958 646 3276 31264 „ of ante-natal cases 69 32 289 102 158 49 ... 97 796 „ do. attendances 178 56 602 244 370 134 ... 171 1755 „ of Nurses' visits to Infants 1069 816 1587 1917 2496 734 215 1450 10284 „ do. do. ante-natal cases 140 73 139 190 90 52 39 110 833 „ of Sessions—Infants 96 50 98 92 97 50 24 50 557 „ do. —ante-natal 12 ... 24 23 25 24 ... 23 131 „ of health talks given 56 20 22 21 40 12 4 8 183 Crèches. There are four crèches 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 crèches 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 Putney and Wandsworth Day Nurseries are also training schools for nurses who intend to take up crèche work. They are admitted as probationers and serve a term of six months, receiving not only practical training but also theoretical. The matrons give courses of lectures which the probationers are bound to attend, and an examination is held at the end of the course. 169 inspections of the crèches were made during the year by the Health Visitors, who represent the Medical Officer of Health on the Committees. Report of the Medical Officer of Health. 113 The attendances were: in Putney, 6,072; in Balham, 7,238; in Tooting, 4,556; and in Wandsworth, 7,541; a total of 25,407, a decrease of 1,519 compared with 1920. Dental Treatment. In May, 1919, the arrangements made by the Council with the British Dentists' Hospital, Clapham Common, came into force. 64 cases (43 women and 21 children) availed themselves of the opportunity to have dental treatment, and 83 attendances (56 women and 27 children) were made. No women had dentures supplied to them. The medical officer at each Infant Welfare Centre examines carefully the teeth of the mothers and children, and recommends treatment when necessary. Puerperal Fever. There were 11 cases of puerperal fever notified (two in Clapham, one in Putney, three in Streatham, two in Tooting, and three in Wandsworth). Six were midwives' cases, two were miscarriages, and one was born before the doctor or midwife arrived. Six patients were removed to hospitals and four to St. James's Infirmary, and three cases occurred in nursing homes. One of the cases proved fatal. Ophthalmia Neonatorum. 54 cases were notified, of which 14 were in Clapham, three in Putney, 15 in Streatham, two in Tooting, and 20 in Wandsworth. All the cases were visited. 30 were attended at birth by midwives, and 10 cases occurred in maternity homes (one in Clapham, six in Streatham, and three in Tooting). 22 cases were treated in hospital as out-patients, seven as * in-patients, and the remainder were treated at home. 31 cases were notified by midwives. In 27 cases the district nurse was asked to attend, and 149 visits were made. H 114 Report of the Medical Officer of Health. TABLE LXIII. Ophthalmia Neonatorum, 1921. NO. Date of notification. Eye affected. Severe or Slight Where treated or by whom. History of specific disease. Result. 1 Jan. 1 Both. Severe St. Margaret's Hosp. in-pat't No. Recovered. 2 „ 11 „ Slight Nursing Home „ „ 3 „ 18 Left. „ St. Thomas's Hosp. out-pat't „ „ 4 „ 19 „ „ St. Thomas's Hosp. out-pat't „ „ 5 „ 24 Right. „ Private doctor & District nurse „ „ 6 „ 28 Both. Severe St. Thomas's Hosp. out-pat't „ „ 7 „ 29 „ Slight St. Thomas's Hosp. out-pat't „ „ 8 Feb. 10 „ Severe St. Margaret's Hosp. in-pat't „ „ 9 „ 15 Left. Slight Private doctor „ „ 10 „ 17 Both. Severe St. Thomas's Hosp. out-pat't and District Nurse „ „ 11 „ 22 Left. Slight Maternity Hospital „ „ 12 Mar. 7 Right. Maternity Hospital „ „ 13 „ 7 Both. „ Maternity Home „ „ 14 „ 7 „ „ Maternity Home „ „ 15 „ 10 „ Severe St. Thomas's Hosp. out-pat't and District Nurse „ „ 16 „ 15 Right. Slight Private doctor „ „ 17 „ 18 „ „ Royal Eye Hosp. out-patient „ „ 18 Apr. 25 Both. „ Private doctor & District nurse „ „ 19 „ 26 Left. „ Private doctor & District nurse „ „ 20 May 4 Right. „ St. Thomas's Hosp. out-pat't and District Nurse „ „ 21 „ 6 „ Both. St. Thomas's Hosp. out-pat't and District Nurse „ „ 22 „ 18 „ „ Maternity Home „ „ 23 „ 25 Right. „ Maternity Home „ „ 24 „ 25 Both. „ Royal Eye Hosp. out-patient „ „ 25 Jun.13 „ Severe St. Thomas's Hosp. out-pat't and District Nurse „ „ 26 ,, 18 „ Slight Midwife & District nurse... „ „ 27 „ 22 „ Severe St. Margaret's Hosp. in-pat't Royal Eye Hosp. out-patient and District Nurse „ „ 28 July 7 „ „ Private doctor „ „ 29 „ 12 Right. Severe St. George's Hosp. out-pat't and District Nurse „ „ 30 „ 13 Both. Slight St. Thomas's Hosp. out-pat't and District Nurse „ „ 31 ,, 28 „ „ Private doctor ? „ 32 „ 30 „ Severe Private doctor No. „ 33 Aug. 2 „ Slight St. Thomas's Hosp. out-pat't and Midwife ? „ 34 „ 8 „ „ Private doctor & District nurse No. „ 35 „ 10 „ Severe Putney Hosp. out-patient and District Nurse ? „ 36 „ 10 „ Slight St. Thomas's Hosp. out-pat't and District Nurse No. „ 37 26 Right „ St. Thomas's Hosp. out-pat't „ „ 38 Sep. 9 Both. Severe Private doctor & District nurse ? „ 39 „ 15 „ „ St. Margaret's Hosp. in-pat't No. „ 40 Oct, 5 „ „ St. Thomas's Hosp. out-pat't and District Nurse „ „ 41 „ 7 „ Slight St. Thomas's Hosp. out-pat't and District Nurse 1 Recovered. 42 15 „ Severe St. Thomas's Hosp. out-pat't and District Nurse Yes. Died 21/12/21 Cong. Syphilis. 43 „ 31 Left. Slight Private doctor 4r District nurse No. Recovered. 44 Nov. 2 Both. Severe Royal Eye Hosp. out-patient and District Nurse ? „ 45 „ 2 Right. „ St. Margaret's Hosp. in-pat't ? 1 46 „ 16 Both. Slight St. Margaret's Hosp. in-pat't ? „ 47 „ 16 Left. „ Private doctor & District nurse No. „ 48 „ 17 Both. Severe St. Margaret's Hosp. in-pat't Yes. „ 49 „ 17 Left. Slight St. Margaret's Hosp. in-pat't No. „ 50 „ 19 Right. I-eft. Severe Slight Private doctor & District nurse ? „ 51 „ 30 Both. Slight Private doctor & District nurse ? „ 52 Dee. 9 Right. „ Private doctor & District nurse No. „ 53 „ 16 Both. Severe Private doctor & District nurse Yes. „ 54 „ 29 „ Slight Private doctor & District nurse „ „ Report of the Medical Officer of Health. 115 Measles. 126 visits and 18 re-visits were made by the Health Visitors in respect of measles. The services of the district nurses were requisitioned in 27 cases (four in Clapham, six in Streatham, 16 in Tooting, and one in Wandsworth), where bronchitis or pneumonia had set in. The nurses' visits totalled 293. Whooping Cough. 467 visits and 51 re-visits were made by the Health Visitors in cases of whooping cough. In 17 cases (four in Clapham, one in Putney, one in Streatham, two in Tooting, and nine in Wands worth), district nurses were called in, and their visits numbered 203. Epidemic Diarrhœa. In all the deaths under one year from diarrhoea and enteritis, special inquiries were made and the following Table shows the nature of the food given:— TABLE LXIV. 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. I.—Breast-fed only 3 3 3 ... ... 9 Do. and cow's milk ... 1 ... 1 1 3 Do and condensed milk ... 1 ... 1 ... 2 Do. and dried milk ... 1 ... ... ... 1 2.—Cows' milk only ... 7 6 3 2 19 Do. and food ... ... ... ... 2 2 —Condensed milk only ... 3 6 ... 1 10 Do. and dried milk ... ... 1 1 ... 2 Do. and food ... ... 1 ... ... 1 4.—Dried milk only ... 7 15 1 2 25 Do. and food ... 1 ... ... 1 2 15.—Farinaceous and other foods ... ... 1 ... 1 2 6.—Unknown ... ... ... 3 2 5 Totals 4 24 33 10 12 83 116 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 LXV. Clapham, North. Clapham, South. Putney. Streatham. Balham. Tooting. Southfield. Fairfield. Springfield. Borough. Total Number of Deaths 8 7 6 15 9 14 7 5 12 83 Wholly breast-fed ... ... 1 3 ... 2 ... 2 ... 8 Otherwise fed 8 6 4 11 8 12 6 3 12 70 No information ... 1 1 1 1 ... 1 ... ... 5 Previously visited (1921) 2 5 3 7 3 9 3 3 9 44 „ „ (1920) 2 1 1 4 1 2 2 1 2 16 Breast-fed ... ... 1 1 ... 1 ... 1 ... 4 Otherwise fed 4 6 3 10 4 10 5 3 11 56 Illegitimate 2 1 ... ... 1 ... 1 2 1 8 Nurse children ... ... ... ... 1 ... 1 ... ... 2 Born outside Borough 1 3 1 4 3 ... ... 1 2 15 Premature 1 1 ... ... 1 1 ... ... 2 6 Delicate from birth 2 3 2 2 1 3 2 1 2 18 Twin Children ... ... 2 ... ... ... ... 1 ... 3 Report of the Medical Officer of Health. 117 Home Helps. The services of a Home Help have been obtained for the Southfield, Fairfield and 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 allowed 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. No change has taken place in the staff and duties during the year with the following exceptions:— Mr. E. B. Kershaw retired in January, on reaching the age limit, after 29 years of faithful service. Mr. A. W. Browne was transferred from Clapham North Ward to Streatham, and Mr. J. A. Sands, who was appointed chiefly for housing duties, was appointed to his district. The vacancy caused by Mr. Sands' appointment to a district was filled by the appointment of Mr. B. Good. 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 2,226 bacteriological examinations were made. 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. 118 Report of the Medical Officer of Health. TABLE LXVI. Clapham Putney. Streatham. Tooting. Wandsworth. Whole Borough Diphtheria:— Negative 248 141 567 73 283 1312 Positive 47 50 139 28 82 346 Enteric Fever:— Negative 1 2 7 1 5 16 Positive ... ... 2 ... ... 2 Tuberculosis:— Negative 50 29 133 45 166 423 Positive 26 11 37 4 49 127 Totals 372 233 885 151 585 2226 In addition 1,054 examinations of sputum were made at the Tuberculosis Dispensary: 114 from Clapham, 62 from Putney, 244 from Streatham, 233 from Tooting", and 401 from Wandsworth. In 247 of the cases it was reported that the bacillus had been found. Statement of Work done under the Rag Flock Act, 1911. 24 workshops were visited by the inspector and the materials used for bedding and upholstery were examined. Nine samples were procured and submitted for analysis. All these were reported as complying with the standard of cleanliness required. Report of the Medical Officer of Health. 119 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 carried out by us under the Sale of Food and Drugs Acts during the year 1921. During the year, 1,954 samples were received and duly reported upon. Of these samples, 982 were submitted formally, whilst 972 were informal. 141 samples in all were reported against, being 7.2 per cent. of those examined. Of the formal samples, 67, or 6.8 per cent., were returned as adulterated, whilst 74, or 7.6 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 reported against. In separate tables the nature of the Drugs, "Other Articles," and Milk and Cream examined, with any adulteration reported, are given. 120 Report of the Medical Officer of Health. General Statement. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Milk and Cream 944 143 1087 55 52 107 Butter 1 408 409 0 1 1 Cheese 14 14 ... 0 0 Margarine 6 27 33 2 3 5 Lard ... 45 45 ... 0 0 Bread 17 ... 17 0 ... 0 Flour ... 18 18 ... 0 0 Tea ... ... ... ... ... ... Coffee ... 39 39 ... 0 0 Cocoa ... 39 39 ... 0 0 Sugar ... 6 6 ... 0 0 Mustard ... 5 5 ... 0 0 Confectionery and Jam ... 6 6 ... 0 0 Pepper ... 5 5 ... 0 0 Beer ... 6 6 ... 0 0 Drugs 4 82 86 4 4 8 Other Articles 10 129 139 6 14 20 Total 982 972 1954 67 74 141 Drugs. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal Total. Acid, Boric ... 2 2 ... 0 0 Acid, Citric ... 5 5 ... 0 0 Acid, Tartaric ... 5 5 ... 0 0 Camphorated Oil 1 9 10 1 1 2 Cream of Tartar ... 11 11 ... 0 0 Friars Balsam ... 3 3 ... 0 0 Oil, Eucalyptus ... 3 3 ... 0 0 Ointment, Boric ... 4 4 ... 0 0 Ointment, Mercury ... 4 4 ... 0 0 Ointment, Zinc ... 2 2 ... 0 0 Ointment, White ppt. ... 2 2 ... 0 0 Prescriptions ... 3 3 ... 0 0 Soda Carbonate ... 1 1 ... 1 1 Rochelle Salts ... 9 9 ... 0 0 Tinc. Iodine 2 9 11 2 2 2 Tine. Quin. Ammon. ... 3 3 ... 0 0 Sugar of Milk ... 4 4 ... 0 0 Syrup of Squills 1 3 4 1 ... 1 Total 4 82 86 ... 4 8 Report of the Medical Officer of Health. 121 Thus, the amount of adulteration reported in the case of the Drugs submitted was for formal samples, 100 per cent.; for informal samples, 4.8 per cent.; and for all samples, 9.3 per cent. Other Articles. Nature of Sample. Examined Adulterated. Formal. Informal. Total. Formal. In- formal. Total. Almonds, ground ... 7 7 ... 0 0 Arrowroot 1 11 12 1 1 2 Baking Powder ... 6 6 ... 0 0 Barley, Pearl ... 5 5 ... 0 0 Cayenne Pepper ... 3 ? ... 0 0 Cinnamon ... 6 6 ... 0 0 Coffee Mixture ... 1 1 ... 0 0 Custard Powder ... 3 3 ... 0 0 Dripping ... 6 6 ... 0 0 Egg Substitute ... 3 3 ... 0 0 Ginger, ground ... 5 5 ... 0 0 Lemonade Powder 1 . • • 1 ... ... Mace, ground ... 3 3 ... 0 0 Mustard Condiment ... 3 3 ... 0 0 Oatmeal ... 3 3 ... 0 0 Olive oil ... 6 6 ... 1 1 Pea Flour ... 3 3 ... 0 0 Peas, tinned ... 1 1 ... 1 1 Rice ... 6 6 ... 0 0 Sago ... 3 3 ... 0 0 Sausages ... 20 20 ... 4 4 Self-raising Flour ... 6 6 ... 0 0 Tapioca 1 6 7 1 1 2 Vinegar 4 2 6 3 2 5 Vinegar, Malt 3 11 14 1 4 5 Total 10 129 139 6 14 20 From these results it will be seen, therefore, that the total adulteration in the case of "Other Articles" amounted to 14.3 per cent. for all samples; to 60 per cent. for formal samples; and to 10.8 per cent. for informal samples. 122 Report of the Medical Officer of Health. Milk and Cream. The samples grouped under the heading "Milk and Cream" were comprised as follows:— Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Milk 885 7 892 44 1 45 Hot Milk 1 ... 1 1 ... 1 Separated Milk 49 2 51 3 0 3 Condensed Milk ... 6 6 ... 0 0 Cream, fresh 7 47 54 7 22 29 Cream, preserved 2 81 83 ... 29 29 Total 944 143 1087 55 52 107 Of the 45 samples of Milk found to be adulterated, 26 contained extraneous water, 16 were deficient in fat, whilst three were coloured with Annatto. The one sample of Hot Milk submitted was reported against as containing extraneous water. Two samples of Separated Milk were coloured with Annatto. whilst one contained extraneous water. All the samples of Cream returned as adulterated contained Boric Acid as a preservative, whilst the samples of Preserved Cream reported against were found upon examination to contain an excess of preservative above that declared upon the label. Thus, the amount of adulteration reported in the case of the Milk and Cream samples submitted was, for formal samples, 5.8 per cent.; for informal samples, 3.6 per cent.; and for all samples, 9.8 per cent. Report of the Medical Officer of Health. 123 Butter. During the year 409 samples of Butter were submitted, and it is noteworthy that in no case was Margarine present. The only sample reported against was found to contain 0.23 per cent. Boric Acid in excess of the maximum permissible. In every sample the presence of preservative was looked for, and if present the quantity estimated, with the result that 310, or 75.8 per cent., were found to be free (except from common salt), whilst 98, or 23.9 per cent., contained Boric Acid in quantities under 0.5 per cent., the remaining one being reported against as above. Margarine. Of the five samples of Margarine reported against, two formal samples were found to contain an excess of water, whilst two informal samples contained an excess of butter fat, the remaining informal sample having excess of water. All samples of Margarine submitted during the year contained a Boric preservative. Drugs. Adulteration in the case of eight samples of Drugs (four formal and four informal) was reported as follows:— Two samples of Syrup of Squills (one formal and one informal) contained an excess of Acetic Acid. Two samples of Camphorated Oil (one formal and one informal) had been compounded with a mixture of Sesame and Mineral Oils, instead of Olive Oil. Two samples of Tincture of Iodine (one formal and one informal) were found to be deficient in Potassium Iodide, and two (one formal and one informal) contained an excess of Iodine. All formal samples were taken as a consequence of the informal samples having been adversely reported against. 124 Report of the Medical Officer of Health. Other Articles. Grouped above under the heading of "Other Articles," in all 20 samples were found to be adulterated. Of these, six were formal and 14 informal, as under:— Two samples of Arrowroot (one formal and one informal) consisted of Tapioca and Maize. One sample of Olive Oil (informal) contained Cotton Seed Oil. One sample of Tinned Peas (informal) contained a Copper colouring matter. Four samples of Sausages (informal) contained a Boric preservative. Two samples of Tapioca (one formal and one informal) consisted of Sago. Three samples of Malt Vinegar (one formal and two informal) were deficient in Acetic Acid. Two samples of Malt Vinegar (informal) proved to be coloured Acetic Acid. Five samples of Vinegar (two formal and three informal) were deficient in Aeetie Acid. 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. South London Central Public Laboratory, 325, Kennington Road, S.E. 11. Report of the Medical Officer of Health. 125 Revenue Act. During the year four certificates were granted under the above Act. The certificates granted referred to 30 houses or 60 tenements. Cleansing of Persons Act. The names of 128 children, 42 belonging to Clapham, 15 to Streatham, 18 to Tooting, and 53 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 58 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. 50 adults had baths on account of their verminous condition, 47 of these being cases of scabies. Cutting=off Notices. During the year, 120 notices with respect to 135 premises were received from the Water Board stating that the supply had been withdrawn. 30 of the premises were in Clapham, 24 in Putney, 50 in Streatham, five in Tooting, and 26 in Wandsworth. The supply was withdrawn for non-payment of rates from 66 premises, from 37 premises in consequence of defects, in 29 the premises were empty, and in three cases by request. Housing. With reference to housing it was found at the Census of 1921 that the total number of houses structurally separate for habitation was 66,189, and the total number of rooms occupied was 381,850, the average number of persons per house was 4.97, and the average number of persons per room was .86. 126 Report of the Medical Officer of Health. There are only three other Boroughs in London, viz.:— Lewisham, Kensington, and Hampstead, where the average number of persons per room was smaller, the average for the whole of London being 1.07. If these statistics are correct it shows that in the Borough of Wandsworth there cannot be so much overcrowding as in some of the other Boroughs. There has been some addition to the housing accommodation during the year by the erection of new houses (1) by the London County Council, (2) by the Borough Council, and (3) by private enterprise. The total number ???erected and occupied was 718, and the number in course of erection at the end of the year was 246. The action taken by the Borough Council is referred to in more detail in previous reports. 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.