WAN 65 Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, &c. OF THE BOROUGH, For the Year 1922, by F. G. CALEY, M.A., M.B., D.P.H., Medical Officer of Health, together with the Report of the Public Analyst. London: Printed for the Council by HARRISON AND SONS, LTD., ST. MARTIN'S LANE, W.C. 2 REPORT of the Medical Officer of Health for the Year 1922. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Wandsworth. Sir, Madam and Gentlemen, I have the honour to present the Annual Report on the health and sanitary condition of the Borough for the year 1922. I regret to have to record that Dr. P. Caldwell Smith, who was Medical Officer of Health since the formation of the Borough in 1901, died on the 21st February, 1923. Population. The corrected population of the Borough at the middle of the year was estimated to be 333,820. Table I shows the population of each sub-district based on the above estimation, compared with the Census population. Table I. Sub-District. Census Population, 1921. Population estimated to middle of 1922. Corrected. Uncorrected. Clapham 60,570 61,600 61,600 Putney 28,579 29,500 29,500 Streatham 103,499 106,310 106,310 Tooting 40,410 39,140 41,140 Wandsworth 95,598 97,270 98,770 Whole Borough 328,656 333,820 337,320 The corrected estimated population in Table I is used to calculate all the rates in this Report. Census 1921. The following Table has been abstracted from the Census 1921 Report. It shows the area, population, number of families, dwellings, rooms occupied, and rooms per person, in each Ward in the Borough. (9323)q b 2 Municipal Wards, and Civil Parishes. Area in Statute Acres (Land and Inland Water). Total Population. Private Families and Dwellings. Report of the Medical Officer of Health. 1911. 1921. Private Families. Population in Private Families. Structurally Separate Dwellings occupied. Rooms occupied. Rooms per Person. Persons. Persons. Males. Females. Persons per Acre. Balham 859 47,001 50,888 22,519 28,369 59 12,954 49,861 9,595 60,755 1.22 Clapham (North) 473 28,871 29,540 13,566 15,974 62 7,607 28,876 5,080 30,827 1.07 Clapham (South) 601 29,721 31,000 13,559 17,441 52 8,187 29,774 5,994 36,297 1.22 Fairfield 339 20,605 20,089 9,413 10,676 59 5,230 19,972 3,720 21,292 1.07 Putney 2,218 28,242 28,558 12,138 16,420 13 7,023 26,957 5,469 36,735 1.36 Southfields 1,218 34,600 35,715 16,120 19,595 29 8,835 34,738 6,987 40,170 1.16 Springfield 888 37,171 39,775 18,987 20,788 45 8,570 36,274 6,769 37,918 1.05 Streatham 1,964 49,191 52,607 21,882 30,725 27 13,461 51,176 11,607 74,911 1.46 Tooting 547 35,958 40,135 19,045 21,090 73 8,659 36,840 7,319 34,299 0.93 Whole Borough 9,107 311,360 328,307 147,229 181,078 36 80,526 314,468 62,540 373,204 1.19 Report of the Medical Officer of Health. 3 Births. The total number of births in this Borough was 5,366, but 620 births occurred in Institutions outside the Borough of persons belonging to the Borough, and 416 births in Institutions in the Borough of persons not belonging to the Borough, making a corrected total of 5,570, compared with 6,167 in 1921. In Table II is shown the number of births, males and females, the birth-rate, and the rate of natural increase for each sub-district, and for the whole Borough. Table II. Sub-District. Births. Rates. Males. Females. Total. Birth-Rate Rate of natural increase. Clapham 520 547 1,067 17.32 5.33 Putney 237 215 452 15.32 3.19 Streatham 829 822 1,651 15.53 4.20 Tooting 352 325 677 17.28 7.35 Wandsworth 855 868 1,723 17.71 6.79 Whole Borough 2,793 2,777 5,570 16.68 5.44 The birth-rate was 16.68 per 1,000, compared with 18.80 for 1921, and 18.73 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. (9323)q b 2 4 Report of the Medical Officer of Health. Table III. Year. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. London. England and Wales. 1912 20.62 17.08 18.88 27.12 24.07 21.53 24.7 23.8 1913 20.66 16.74 18.06 27.82 22.61 20.87 24.8 23.9 1914 19.50 16.06 18.61 25.51 22.34 20.44 24.3 23.8 1915 18.78 16.15 18.23 23.12 20.05 19.25 25.5 21.8 1916 18.82 14.66 17.51 20.85 19.39 20.09 21.5 20.9 1917 15.16 11.40 14.70 17.09 14.54 14.72 17.9 17.8 1918 13.69 12.40 15.10 16.14 13.70 14.29 16.1 17.7 1919 15.59 12.76 15.64 19.21 17.63 16.40 18.3 18.5 1920 20.38 17.47 20.65 23.66 21.89 21.03 26.3 25.4 1921 20.13 16.33 17.12 19.92 20.18 18.80 22.3 22.4 Average for 10 yrs. 18.33 15.10 17.45 22.04 19.64 18.73 22.1 21.6 1922 17.32 15.32 15.53 17.28 17.71 16.68 21.0 20.6 244 illegitimate births took place in the Borough, 18 in Clapham, 11 in Putney, 181 in Streatham, eight in Tooting, and 26 in Wandsworth. Of the 244 illegitimate births that occurred in the Borough, 95 belonged to the Borough, 18 to Clapham, 11 to Putney, 33 to Streatham, six to Tooting, and 27 to Wandsworth. 103 illegitimate births occurred outside the Borough, making a total of 198. Forty-one of these belonged to Clapham, 24 to Putney, 59 to Streatham, 15 to Tooting, and 59 to Wandsworth. The percentage of illegitimate births to total births was 3.55. Report of the Medical Officer of Health. 5 The illegitimate births in nursing homes have again been allocated to the home addresses of the mothers. 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 824 318 241 243 22 846 10 Putney 398 166 91 140 1 410 8 Streatham 2,011 518 490 902 101 2,034 41 Tooting 617 86 115 401 15 613 11 Wandsworth 1,475 276 830 340 29 1,463 25 Whole Borough 5,325 1,364 1,767 2,026 168 5,366 95 The percentage of births notified, less still-births, to those registered was 99, compared with 99 in 1921. Deaths. During the year ending the 31st December, 1922, 3,319 deaths, 1,458 of males and 1,861 of females, occurred, compared with 3,103 in 1921. 6 Report of the Medical Officer of Health. Table V. shows the total number of Institution deaths, arranged according to sub-districts and Institutions in which they occurred; Table VI. the deaths of persons not belonging to the Borough; Table VII. the deaths of persons belonging thereto arranged according to causes of death, sex and age, and Institution in which the death occurred; and Table VIII., the number of deaths in Institutions, etc., outside the Borough, of persons belonging thereto. Table V. Name of Public Institution. Clapham. Putney. Streatham. Tooting. Wandsworth. Total. Hostel of God 63 .. .. .. .. 63 South London Hospital for Women 35 .. .. .. .. 35 Springfield Mental Hospital .. .. 5 .. 115 120 Fountain Temporary Mental Hospital .. .. .. 41 .. 41 H.M. Prison .. .. .. .. 2 2 Swaffield Road Institution .. .. .. .. 12 12 Royal Hospital for Incurables .. .. .. .. 23 23 Tooting Bec Mental Hospital .. .. .. 378 .. 378 Grove Hospital .. .. .. 184 .. 184 The Priory .. 4 .. .. .. 4 Weir Hospital .. .. 23 .. .. 23 Putney Hospital .. 16 .. .. .. 16 Ministry of Pensions Hospitals 2 3 .. 6 .. 11 Total 100 23 28 609 152 912 Other places 36 43 114 7 35 235 Grand Total 136 66 142 616 187 1,147 Report of the Medical Officer of Health. 7 Table VI.—Deaths in Public Institutions, &c., in the Borough, of Persons not Belonging to the Borough, 1922. 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 Hospital. S. Lon. Hosp. for Women. Putney Hospital. Grove Hospital. Weir Hospital. The Priory. Min. of Pensions Hosp. Other Places, not Public Institutions. Enteric Fever 2 2 .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. 2 .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 13 4 9 1 8 3 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. 12 .. .. .. .. Scarlet Fever 15 11 4 1 3 4 6 .. 1 .. .. .. .. .. .. .. .. .. .. .. 15 .. .. .. .. Whooping Cough 6 2 4 2 2 2 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 3 .. .. .. 2 Diphtheria and Membranous Croup 84 48 36 2 11 30 37 3 1 .. .. .. .. .. .. .. .. .. .. .. 84 .. .. .. .. Influenza 15 5 10 2 .. 1 1 .. 3 5 3 2 .. .. .. .. 3 2 .. .. 1 .. .. .. 7 Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal fever 1 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. Other Epidemic Diseases 1 .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Pulmonary Tuberculosis 35 16 19 .. 1 .. .. 11 7 12 4 10 6 14 .. .. .. .. .. .. 1 .. .. .. 4 Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis 1 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. Other Tuberculous Diseases 2 2 .. .. 1 .. .. .. .. 1 .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. Other Infective Diseases 3 1 2 2 .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 2 Cancer, Malignant Disease 82 25 57 .. .. .. .. .. 5 40 37 4 14 36 .. .. 3 .. 7 .. .. .. 2 .. 16 Rheumatic Fever 3 .. 3 .. .. .. .. .. 3 .. .. .. .. .. .. .. .. .. 2 .. .. .. .. .. 1 Diabetes 3 1 2 .. .. .. .. .. 1 .. 2 .. .. .. 1 .. .. .. .. .. .. .. .. .. 2 Other General Diseases 11 3 8 .. .. .. .. 2 1 4 4 3 .. .. .. .. 3 .. 1 .. .. .. .. .. 4 Alcoholism .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chronic Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis 1 .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Cerebral Hæmorrhage, Apoplexy 31 11 20 .. .. .. .. .. .. 16 16 8 11 1 .. .. 1 .. .. .. .. .. .. .. 10 Convulsions .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases of Nervous System 75 43 32 .. 1 3 10 5 24 21 11 28 12 1 .. .. 8 13 1 .. 1 .. 1 2 8 Organic Diseases of Heart 34 10 24 .. .. .. .. 1 2 15 16 10 8 1 2 .. .. .. 2 .. 1 .. .. .. 10 Other Diseases of Circulatory System 20 7 13 .. .. .. 2 .. 3 2 13 1 3 1 .. .. 1 2 1 .. .. .. .. .. 11 Bronchitis 37 12 25 .. 1 1 .. .. 1 9 25 20 2 .. 1 .. 1 1 .. .. .. .. 1 .. 11 Broncho-Pneumonia 29 17 12 4 .. 3 5 .. 2 3 12 4 13 .. .. .. .. 5 1 .. 3 1 .. .. 2 Lobar Pneumonia 10 6 4 .. .. 2 .. 1 2 4 1 3 3 .. .. .. .. 1 .. .. .. 1 .. .. 2 Pneumonia (type not distinguished) 44 25 19 1 .. .. .. .. 2 8 33 .. 41 .. .. .. .. .. 1 .. .. .. .. .. 2 Other Diseases of Respiratory System 2 2 .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. 1 1 .. .. .. .. .. .. .. Ulcer of Stomach 1 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Diarrhœa .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteritis 3 2 1 2 .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 2 Appendicitis and Typhlitis 2 2 .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. Obstruction of Intestines 4 3 1 .. .. .. .. .. 2 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 1 4 1 .. 1 .. 1 1 .. 1 1 .. .. .. .. .. 1 1 .. .. .. .. .. 2 Nephritis and Bright's Disease 23 10 13 .. .. .. .. 2 2 11 8 13 2 2 .. .. .. .. 1 .. .. .. .. .. 5 Other Diseases of Urinary System 6 6 .. .. .. .. .. .. 1 3 2 .. 2 .. .. .. 1 .. .. .. .. 1 .. .. 2 Diseases of Generative System 3 .. 3 .. .. .. .. .. 2 .. 1 .. .. .. .. .. .. .. 1 1 .. .. .. .. 1 Puerperal Fever 1 .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Other Accidents and Diseases of Pregnancy and Childbirth 1 .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Premature Birth 7 3 4 7 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 6 Congenital Debility and mation 14 10 4 5 .. 2 7 .. .. .. .. .. .. .. .. .. .. 8 .. .. .. .. .. .. 6 Other Diseases of Early Infancy 3 1 2 3 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Old Age 269 96 173 .. .. .. .. .. .. 3 266 8 243 1 2 .. 1 .. .. .. .. .. .. .. 14 Deaths from Accident 15 5 10 .. .. .. 2 1 .. 1 11 .. 9 .. .. .. .. .. .. .. .. 2 .. .. 4 Deaths from Suicide 3 3 .. .. .. .. .. .. .. 3 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 2 Other Violent Deaths 9 9 .. .. .. .. .. 2 7 .. .. .. .. .. .. 2 .. .. .. .. .. .. .. 7 .. Other Defined Diseases 2 .. 2 .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ill-defined Diseases or unknown 1 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 All causes 934 409 525 34 28 56 71 32 78 168 467 118 369 58 6 2 23 37 23 2 125 5 4 11 151 8 Report of the Medical Officer of Health. Table VII.—Deaths in Public Institutions, &c., in the Borough, of Persons belonging to the Borough, 1922. 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 Hosp. Hostel of God. Swaffield Rd. Inst. Fountain Mental Hosp. S. Lond. Hosp. for Women. Putney Hospital. Grove Hospital. Weir Hospital. Springfield Mental Hospital. Other Places, not Public Institutions. Enteric Fever 1 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 3 1 2 1 2 .. .. .. .. .. .. .. .. .. .. .. .. 3 .. .. .. Scarlet Fever 4 2 2 1 1 1 1 .. .. .. .. .. .. .. .. .. .. 4 .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria and Membranous Croup 48 25 23 2 3 10 33 .. .. .. .. .. .. .. .. .. .. 48 .. .. .. Influenza 3 1 2 .. .. .. .. .. 3 .. .. .. .. .. .. .. .. 1 1 .. 1 Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Fever 1 .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. Other Epidemic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pulmonary Tuberculosis 2 1 1 .. .. .. .. 1 1 .. .. .. 1 .. .. .. .. .. .. 1 .. Tuberculous Meningitis 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases 3 2 1 .. .. .. .. 1 1 1 .. .. .. .. .. 1 .. .. 2 .. .. Other Infective Diseases 1 .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. Cancer, Malignant Disease 24 10 14 .. .. .. .. .. 4 12 8 .. 4 .. .. 4 2 .. 4 1 9 Rheumatic Fever 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 Diabetes 2 .. 2 .. .. .. .. 1 .. .. 1 .. .. .. .. .. 1 .. .. .. 1 Other General Diseases 7 .. 7 .. .. 1 .. .. 2 3 1 .. .. .. .. 2 1 .. 1 .. 3 Alcoholism .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chronic Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis 1 .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Cerebral Haemorrhage, Apoplexy 5 1 4 .. .. .. .. .. .. .. 5 .. .. .. .. .. .. .. .. .. 5 Convulsions 1 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Other Diseases of Nervous System 2 1 1 .. .. 1 .. 1 .. .. .. .. .. .. 2 .. .. .. .. .. .. Organic Diseases of Heart 15 7 8 .. .. .. .. .. 3 5 7 2 .. 4 .. 1 .. .. .. .. 8 Other Diseases of Circulatory System 7 4 3 .. .. .. .. .. 2 4 1 1 .. .. .. 1 .. .. .. .. 5 Broncitis 5 3 2 .. .. .. .. .. .. .. 5 .. .. 2 .. .. .. .. .. .. 3 Broncho-Pneumonia 6 .. 6 1 1 .. .. .. .. 3 1 .. .. .. .. 1 1 .. 1 .. 3 Lobar Pneumonia 4 3 1 .. 1 .. 1 1 .. 1 .. .. .. .. 1 .. .. .. 3 .. .. Pneumonia (type not distinguished) 1 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 Other Diseases of Respiratory System 1 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 Ulcer of Stomach 2 2 .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. 1 .. .. .. 1 Diarrhœa .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteritis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Appendicitis and Typhlitis 5 2 3 .. .. .. 1 .. .. 2 2 .. .. .. .. .. 2 .. .. .. 3 Obstruction of Intestines 5 2 3 .. .. .. .. .. .. .. 5 .. .. .. .. .. 2 .. 1 .. 2 Cirrhosis of Liver .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases of Liver .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases of Digestive System 2 1 1 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 2 Nephritis and Bright's Disease 7 4 3 .. .. .. .. .. 1 4 2 .. .. .. .. .. .. .. 1 .. 6 Other Diseases of Urinary System 1 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 Diseases of Generative System .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 1 .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Other Accidents and Diseases of Pregnancy and Childbrith 3 .. 3 .. .. .. .. .. 3 .. .. .. .. .. .. 1 .. .. .. .. 2 Premature Birth 1 .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Congenital Debility and Malformation 8 3 5 7 .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 7 Other Diseases of Early Infancy 1 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Old Age 10 2 8 .. .. .. .. .. .. .. 10 6 .. .. .. 1 .. .. .. .. 3 Deaths from Accident 16 11 5 1 1 6 4 1 2 1 .. .. .. .. .. .. 3 2 1 .. 10 Deaths from Suicide .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Violent Deaths 1 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 Other Defined Diseases 1 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. Ill-defined Diseases or unknown .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. All causes 213 96 117 19 9 20 41 8 26 39 51 9 5 6 4 12 14 59 18 2 84 Report of the Medical Officer of Health. 9 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, 1922. 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. 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 & Special Hospitals, &c. Public Lunatic & Imbecile Asylums. Metropolitan Asy. Board's Hospitals. Enteric Fever 1 .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 33 17 16 8 13 11 1 .. .. .. .. 7 4 9 6 7 28 3 .. 2 Scarlet Fever 14 8 6 1 2 6 3 2 .. .. .. .. .. 8 1 5 .. .. 1 13 Whooping Cough 11 6 5 2 6 3 .. .. .. .. .. 2 .. 3 1 5 8 3 .. .. Diphtheria and Membranous Croup 22 13 9 .. 3 6 13 .. .. .. .. 4 4 4 3 7 2 .. .. 20 Influenza 30 8 22 .. .. .. .. 3 11 9 7 6 2 9 11 24 4 2 .. Erysipelas 2 .. 2 .. .. .. .. .. 1 .. 1 1 .. 1 .. .. 1 .. 1 .. Cerebro-spinal Fever 2 .. 2 .. .. .. .. 2 .. .. .. .. .. .. 1 1 2 .. .. .. Other Epidemic Diseases 3 1 2 .. .. .. 1 .. 1 .. 1 .. .. 1 2 .. 1 1 1 .. Pulmonary Tuberculosis 134 76 58 1 .. .. .. 30 63 30 7 32 12 28 20 4 65 49 20 .. Tuberculous Meningitis 22 12 10 5 2 5 4 2 4 .. .. 2 .. 4 5 11 10 11 .. 1 Abdominal Tuberculosis 1 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. 1 .. .. Other Tuberculous Diseases 14 11 3 .. 2 1 2 5 2 2 .. 1 1 7 1 4 7 6 1 .. Other Infective Diseases 9 8 1 2 .. .. 1 1 2 2 1 2 2 3 1 1 6 3 .. .. Cancer, Malignant Disease 165 90 75 .. .. .. 1 1 20 93 50 28 17 56 18 46 105 59 1 .. Rheumatic Fever 5 3 2 .. .. .. 4 .. 1 .. .. 2 .. 2 .. 1 3 2 .. .. Diabetes 13 7 6 .. .. .. 1 .. 3 7 2 3 2 4 1 3 5 8 .. .. Other General Diseases 19 7 12 .. .. .. 1 1 3 8 6 2 1 4 1 11 10 9 .. .. Alcoholism .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chronic Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis 7 2 5 1 .. .. 2 .. 2 2 .. .. 1 2 2 2 6 1 .. .. Cerebral Hæmorrhage, Apoplexy 46 23 23 .. .. .. .. .. 4 17 25 8 6 19 3 10 30 13 3 .. Convulsions 2 1 1 2 .. .. .. .. .. .. .. 1 .. .. 1 .. .. 2 .. .. Other Diseases of Nervous System 71 47 24 .. 1 3 4 2 22 29 10 10 5 19 16 21 25 13 33 .. Organic Diseases of Heart 212 85 127 .. .. .. 2 2 15 45 148 36 14 73 24 65 156 10 16 .. Other Diseases of Circulatory System 47 25 22 .. .. .. 3 1 7 16 20 11 4 13 2 17 19 25 3 .. Bronchitis 50 24 26 2 .. .. .. .. 1 14 33 11 3 13 10 13 38 10 2 .. Broncho-Pneumonia 34 20 14 5 5 3 1 1 3 4 12 8 3 10 5 8 24 9 1 .. Lobar Pneumonia 11 4 7 1 1 .. .. 3 2 3 1 2 .. 1 .. 8 3 5 3 .. Pneumonia (type not distinguished) 22 19 3 .. .. .. .. 1 10 9 2 6 2 5 1 8 20 2 .. .. Other Diseases of Respiratory System 18 12 6 .. 1 .. 1 1 1 7 7 7 .. 8 1 2 10 8 .. .. Ulcer of Stomach 6 4 2 .. .. .. .. .. 3 3 .. 3 .. 2 .. 1 2 4 .. .. Diarrhœa 3 ] 2 2 1 .. .. .. .. .. .. .. .. 1 .. 2 2 1 .. .. Enteritis 9 4 5 6 1 .. .. .. 1 1 .. 2 1 2 1 3 1 6 2 .. Appendicitis and Typhlitis 16 10 6 .. .. 2 2 3 3 4 2 2 3 6 2 3 9 7 .. .. Obstruction of Intestines 17 12 5 1 .. .. 2 .. 2 7 5 .. 1 8 .. 8 9 8 .. .. Cirrhosis of Liver 6 4 2 .. .. .. 1 .. .. 5 .. 1 1 1 1 2 5 1 .. .. Other Diseases of Liver 4 1 3 .. .. .. .. .. 1 1 2 .. 1 2 .. 1 2 2 .. .. Other Diseasse of Digestive System 23 12 11 2 .. .. 3 1 4 10 3 7 1 5 4 6 12 11 .. .. Nephritis and Bright's Disease 51 25 26 .. .. .. 1 2 8 18 22 10 6 15 7 13 34 8 9 .. Other Diseases of Urinary System 30 26 4 1 .. .. .. .. .. 13 16 2 4 10 5 9 24 5 1 .. Diseases of Generative System 6 .. 6 .. .. .. .. 1 1 4 .. 1 .. 3 .. 2 3 3 .. .. Puerperal Fever 2 .. 2 .. .. .. .. 1 .. 1 .. 1 .. .. .. 1 2 .. .. .. Other Accidents and Diseases of Pregnancy and Childbirth 7 .. 7 .. .. .. .. 1 6 .. .. 1 .. .. 1 4 4 2 .. 1 Premature Birth 8 5 3 8 .. .. .. .. .. .. .. 3 1 2 1 1 1 7 .. .. Congenital Debility and Malformation 24 13 11 22 1 1 .. .. .. .. .. 3 1 7 7 6 10 14 .. .. Other Diseases of Early Infancy 3 3 .. 3 .. .. .. .. .. .. .. .. .. 2 1 .. 2 1 .. .. Old Age 38 15 23 .. .. .. .. .. .. .. 38 7 4 13 6 8 25 10 .. .. Deaths from Accident 66 52 14 1 3 1 11 4 16 17 13 14 3 19 12 18 33 32 1 .. Deaths from Suicide 10 5 5 .. .. .. .. 1 6 2 1 4 .. 3 2 1 3 7 .. .. Other Violent Deaths 1 .. 1 .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. 1 .. .. Other Defined Diseases 16 11 5 1 1 1 1 1 2 5 4 4 3 5 .. 4 10 4 2 .. Ill-defined Diseases or unknown 3 1 2 .. .. .. .. 1 1 1 .. 1 1 1 .. .. .. 3 .. .. All causes 1,369 734 635 77 43 43 69 76 233 389 439 258 114 415 178 404 801 424 107 37 10 Report of the Medical Officer of Health. The corrected number of deaths, after adding the deaths of persons belonging to the Borough, and subtracting those of persons dying in the Borough and not belonging thereto, was 3,754, of whom 1,783 were males, and 1,971 were females. The corrected death-rate for the year was 11.24 compared with 10.83 in 1921. The death-rate for the whole of London for the year was 13.4 per 1,000, compared with 12.4 in 1921. 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 357 382 739 230 346 576 11.99 Putney 158 200 358 124 158 282 12.13 Streatham 555 650 1,205 362 488 850 11.33 Tooting 193 196 389 383 427 810 9.93 Wandsworth 520 543 1,063 359 442 801 10.92 Whole Borough 1,783 1,971 3,754 1,458 1,861 3,319 11.24 The death-rate in England and Wales in 1922 was 12.9 per 1,000; in the 105 County Boroughs and great Towns 13.0; and in the 155 smaller Towns 11.7. The rates in all the sub-districts, except Tooting, were slightly higher than in 1921. Report of the Medical Officer of Health. 11 Table X. shows the death-rate in the Borough, in the five subdistricts, 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 Borough rate in 1922 is lower than the average of the previous 10 years, and compared with London and with England and Wales, it is considerably lower. Table X. Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. London. England and Wales. 1912 11.64 9.83 9.42 10.20 11.18 10.48 13.96 13.3 1913 10.99 10.69 10.37 10.43 12.77 10.95 14.2 13.7 1914 11.22 10.74 11.35 10.95 11.27 11.20 14.4 13.7 1915 12.53 12.34 11.98 12.01 13.50 12.63 16.1 14.8 1916 12.15 11.66 11.78 11.24 11.87 11.80 14.7 14.4 1917 12.77 12.16 13.07 12.06 12.69 12.69 15.7 14.4 1918 16.06 14.36 15.15 14.42 14.81 15.07 18.9 17.6 1919 12.61 12.10 11.85 9.09 10.58 11.31 13.4 13.8 1920 10.56 10.95 10.09 8.97 10.15 10.36 12.4 12.4 1921 10.83 11.30 11.09 10.05 10.52 10.83 12.4 12.1 Average, 10 years 12.13 11.61 11.61 10.94 11.93 11.73 14.61 14.02 1922 11.99 12.13 11.33 9.93 10.92 11.24 13.4 12.9 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. 12 Report of the Medical Officer of Health. Table XI.—Causes of, and Ages at, Death, during the Year 1922. Causes of Death. Deaths in or belonging to whole district at subjoined ages. Deaths in or belonging to Localities (at all ages). 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. Deaths in Pub. Inst. in the District. Enteric Fever 2 1 1 .. .. .. 1 .. 1 .. .. .. .. .. .. 2 2 Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 72 39 33 19 32 18 3 .. .. .. .. 16 5 16 9 26 16 Scarlet Fever 19 11 8 2 3 7 5 2 .. .. .. 2 .. 9 1 7 19 Whooping Cough 44 17 27 14 19 9 2 .. .. .. .. 7 2 14 3 18 6 Diphtheria and Membranous Croup 76 40 36 2 11 26 36 1 .. .. .. 13 7 14 14 28 132 Influenza 148 52 96 6 4 3 5 28 48 53 28 10 50 12 48 18 Erysipelas 3 1 2 1 .. .. .. .. 1 .. 1 1 .. 1 .. 1 .. Cerebro-spinal Fever 3 .. 3 1 .. .. .. 2 .. .. .. .. 1 .. 1 1 2 Other Epidemic Diseases 6 3 3 .. .. .. 1 .. 2 2 1 1 1 1 2 1 1 Pulmonary Tuberculosis 288 148 138 1 .. .. 4 69 122 73 17 59 24 77 37 89 37 Tuberculous Meningitis 31 15 16 6 3 5 9 4 4 .. .. 3 .. 8 6 14 1 Abdominal Tuberculosis 3 3 .. .. .. .. 1 2 .. .. .. 1 .. .. .. 2 1 Other Tuberculous Diseases 23 15 8 .. 2 1 4 6 5 3 2 4 1 10 1 7 5 Other Infective Diseases 13 10 3 4 .. .. 1 1 2 3 2 2 2 5 1 3 4 Cancer, Malignant Disease 450 205 245 .. .. .. 2 1 38 209 200 89 52 150 43 116 106 Rheumatic Fever 18 6 12 .. .. .. 9 2 3 2 2 5 5 2 5 4 Diabetes 54 24 30 .. .. .. 1 1 8 20 24 10 12 21 3 8 5 Other General Diseases 64 23 41 1 .. 2 1 3 8 29 20 8 4 25 2 25 18 Alcoholism 1 .. 1 .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. Chronic Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis 16 4 12 5 .. 4 3 .. 2 2 .. 1 1 6 3 5 3 Cerebral Hæmorrhage, Apoplexy 155 56 99 .. .. .. 1 .. 5 45 104 38 13 58 15 31 35 Convulsions 21 11 10 18 2 1 .. .. .. .. .. 4 .. 9 2 6 1 Other Diseases of Nervous System 115 72 43 1 1 4 4 5 24 51 25 18 9 36 19 33 77 Organic Diseases of Heart 459 178 281 .. .. .. 7 8 39 122 283 92 40 158 51 118 49 Other Diseases of Circulatory System 154 76 78 .. .. .. 5 2 16 51 80 27 19 56 12 40 27 Bronchitis 339 160 179 21 6 3 2 1 5 65 236 77 29 100 26 107 42 Broncho-Pneumonia 113 58 55 34 21 11 4 1 3 10 29 33 9 27 16 28 35 Lobar Pneumonia 47 29 18 2 2 2 1 6 6 21 7 12 4 13 2 16 14 Pneumonia (type not distinguished) 76 51 25 9 8 .. 2 2 21 19 15 14 7 18 8 29 45 Other Diseases of Respiratory System 49 22 27 1 2 .. 2 1 3 21 19 13 4 19 2 11 3 Ulcer of Stomach 16 8 8 .. .. .. .. .. 7 6 3 5 2 5 .. 4 3 Diarrhœa 8 3 5 4 3 .. .. .. .. .. 1 1 1 2 .. 4 .. Enteritis 24 10 14 15 2 .. 1 .. 1 2 3 3 3 6 6 6 3 Appendicitis and Typhlitis 24 14 10 .. .. 2 3 4 3 8 4 2 9 7 2 4 7 Obstruction of Intestines 30 15 15 1 .. .. 2 1 2 8 16 1 5 13 1 10 9 Cirrhosis of Liver 16 7 9 .. .. .. 1 .. .. 13 2 3 4 4 1 4 1 Other Diseases of Liver 15 7 8 .. .. .. .. .. 1 3 11 1 1 7 .. 6 1 Other Diseases of Digestive System 56 28 28 9 3 2 3 1 7 17 14 14 6 16 5 15 7 Nephritis and Bright's Disease 124 58 66 .. .. .. 2 3 14 43 62 15 9 53 13 34 30 Other Diseases of Urinary System 43 38 5 1 .. .. .. .. .. 15 27 4 5 17 5 12 7 Diseases of Generative System 10 .. 10 .. .. .. .. 1 2 6 1 2 1 3 .. 4 3 Puerperal Fever 3 .. 3 .. .. .. .. 1 1 1 .. 2 .. .. .. 1 2 Other Accidents and Diseases of Pregnancy and Childbirth 14 .. 14 .. .. .. .. 1 13 .. .. 5 .. 4 1 4 4 Premature Birth 78 40 38 78 .. .. .. .. .. .. .. 15 6 21 10 26 8 Congenital Debility and Malformation 68 37 31 63 3 2 .. .. .. .. .. 13 3 24 13 15 22 Other Diseases of Early Infancy 14 12 2 14 .. .. .. .. .. .. .. 1 .. 5 3 5 4 Old Age 190 69 121 .. .. .. .. .. .. .. 190 41 19 62 21 47 279 Deaths from Accident 100 68 32 7 4 8 15 5 21 22 18 21 13 30 12 24 31 Deaths from Suicide 23 17 6 .. .. .. .. 1 9 9 4 4 6 6 2 5 3 Other Violent Deaths 5 2 3 2 .. .. .. 1 .. 2 .. .. 3 2 .. .. 10 Other Defined Diseases 26 15 11 1 1 1 1 2 4 7 9 5 4 9 .. 8 3 Ill-defined Diseases or unknown 7 5 2 1 .. .. .. 1 1 3 1 3 1 3 .. .. 1 All causes 3,754 1,783 1,971 339 134 112 142 147 432 962 1,486 739 358 1,205 389 1,063 1,147 Report of the Medical Officer of Health. 13 Table XII.—Vital Statistics of Whole District during 1922 and Previous Years. Year. 1 Corrected Population estimated to Middle of each Year. 2 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. 3 Nett. At all Ages. Of Nonresidents registered in the District. 8 Of Residents not registered in the District. 9 Number. 10 Rate per 1000 Births registered. 11 Number. 12 Rate. 13 Number. 4 Rate. 5 Number. 6 Rate. 7 1912 313,761 6,580 6,756 21.53 3,118 9.78 767 940 516 76 3,291 10.48 1913 321,340 6,679 6,838 20.87 3,344 10.04 822 1,066 605 88 3,588 10.95 1914 326,945 6,690 6,684 20.44 3,332 10.02 824 1,155 589 88 3,664 11.20 1915 331,556 6,210 6,383 19.25 3,949 11.72 1,012 1,252 590 92 4,189 12.67 1916 310,858 6,044 6,246 20.09 3,567 11.47 1,076 1,180 488 78 3,671 11.80 1917 300,787 4,696 4,936 14.72 3,547 11.81 1,067 1,339 440 89 3,819 12.69 1918 292,418 4,453 4,685 14.29 4,202 14.37 1,306 1,511 417 89 4,407 15.07 1919 331,759 5,476 5,441 17.00 3,552 10.42 1,025 1,225 359 66 3,752 11.31 1920 342,808 7,179 7,212 21.03 3,080 8.76 789 1,261 462 64 3,552 10.36 1921 328,000 6,039 6,167 18.80 3,103 9.36 860 1,312 418 67 3,555 10.83 Average for 10 yrs. 320,023 6,004 6,134 18.85 3,479 10.87 954 1,224 488 79 3,747 11.70 1922 333,820 5,366 5,570 16.68 3,319 9.94 934 1,369 339 60 3,754 11.24 14 Report of the Medical Officer of Health. Table XIII. Infant Mortality. 1922. Net Deaths from stated causes at various Ages under 1 Year of Age:— Cause of Death. Under l Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. All Causes— Certified 94 26 14 15 149 63 44 41 40 337 Uncertified 2 .. .. .. 2 .. .. .. .. 2 Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. 1 1 .. 1 8 9 19 Scarlet Fever .. .. .. .. .. .. .. 1 1 2 Whooping Cough .. 1 .. .. 1 4 1 4 4 14 Diphtheria and Croup .. .. .. .. .. .. .. .. 2 2 Erysipelas .. .. .. .. .. 1 .. .. .. 1 Tuberculous Meningitis .. .. .. .. .. .. .. 2 2 2 6 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. 1 .. 1 Meningitis (not Tuberculous) 1 .. .. .. 1 .. 2 1 1 5 Convulsions 7 3 1 1 12 2 2 1 1 18 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 1 2 2 .. 6 5 5 4 21 Pneumonia (all forms) 1 .. 1 2 4 9 14 10 8 45 Diarrhcea .. 1 .. .. 1 .. 1 1 1 4 Enteritis .. .. .. 1 1 5 6 2 1 16 Gastritis .. .. .. .. .. 2 .. 2 .. 4 Syphilis .. 2 .. .. 2 1 1 .. .. 4 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlaying .. .. .. .. .. 1 1 .. .. 2 Injury at birth 3 1 .. .. 4 .. .. .. .. 4 Atelectasis 5 .. 1 .. 6 1 .. .. .. 7 Congenital Malformations 6 4 2 3 15 7 1 .. .. 23 Premature Birth 53 11 4 3 71 7 .. .. .. 78 Atrophy, Debility, and Marasmus 13 .. 3 4 20 12 5 .. 2 39 Other Causes 6 1 .. .. 7 6 2 4 6 25 Totals 96 26 14 15 151 63 44 41 40 339 Nett Births in the year, legitimate, 5,372; illegitimate, 198. Nett Deaths in the year of legitimate infants, 317; illegitimate infants, 22. Report of the Medical Officer of Health. 15 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. 1912. 1913. 1914. 1915. 1916. 1917. 1918. 1919. 1920. 1921. Average 10 Years. 1922. Clapham 68 9.2 76 82 76 92 70 74 107 65 63 66 77 63 Putney 17 4.7 69 85 87 78 74 83 97 112 69 80 83 37 Streatham 93 7.7 58 74 86 76 66 73 71 58 60 61 69 56 Tooting 55 14.1 100 91 114 104 109 110 99 58 69 79 94 81 Wandsworth 106 9.9 83 103 84 104 92 104 90 68 65 71 86 61 Whole Borough 339 9.2 76 88 88 92 78 89 89 66 64 67 79 60 16 Report of the Medical Officer of Health. It is satisfactory to note that the Infantile Mortality was only 60 per 1,000 births, and was the lowest ever recorded in the Borough. This low mortality was largely due to the low number of deaths from Diarrhoea and Enteritis, from which causes there were only 19 deaths of infants, compared with 81 in the previous year. The Infantile Mortality among legitimate infants was 59 per 1,000 legitimate births, and among illegitimate infants 111 per 1,000 illegitimate births, or nearly twice as great. INFECTIVE DISEASES MORTALITY. The next Table shows the number of deaths from these diseases during the year and for the 10 previous years. The corrected decennial average is also shown. Table XV. 1912. 1913. 1914. 1915. 1916. 1917. 1918. 1919. 1920. 1921. 10 years average corrected for increase of population. 1922. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 11 11 13 22 5 13 3 7 11 20 12 19 Diphtheria 18 18 41 53 55 37 35 41 68 64 44 76 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 8 5 5 6 5 7 5 2 2 7 5 2 Cont'd Fever .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 11 13 9 4 9 6 8 16 14 1 9 3 Cholera .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 5 6 11 9 5 6 7 1 9 5 5 3 Measles 51 116 26 152 22 129 45 18 47 4 63 72 Whooping Cough 57 23 53 66 49 29 58 15 19 28 41 44 Influenza 45 59 58 90 74 56 834 310 99 81 177 148 Diarrhoea 85 168 186 125 95 78 96 58 62 108 110 32 Tuberculous Diseases 366 355 389 434 396 424 455 342 315 390 403 343 Cerebro-spinal Fever 1 1 1 20 16 11 8 9 4 3 7 3 Other Infective Diseases 27 22 32 20 19 21 18 12 22 31 23 19 Totals 685 797 824 1,001 750 817 1,572 831 672 742 906 764 Report of the Medical Officer of Health. 17 The total number of deaths from these diseases was 764, 143 in Clapham, 57 in Putney, 213 in Streatham, 93 in Tooting, and 258 in Wandsworth. From all infective diseases the death-rate was 2.28 per 1,000 (2.32 in Clapham, 1.93 in Putney, 2.0 in Streatham, 2.37 in Tooting, and 2.65 in Wandsworth). The rate is slightly higher than in 1921, owing to the increase in the number of deaths from Diphtheria, Measles and Influenza. The rate in 1917 was 2.71; in 1918, 5.37; in 1919, 2.50.; in 1920, 1.96 ; and in 1921, 2.26. The rate from the principal infective diseases, viz.:—Small-pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever, and Diarrhoea, was .73 per 1,000 (.68 in Clapham, .57 in Putney, .57 in Streatham, .80 in Tooting, and .93 in Wandsworth), compared with .74 in 1916, .94 in 1917, .82 in 1918, .42 in 1919. .61 in 1920, and .70 in 1921. The rate for 1922 is slightly higher than in 1921. The slight increase compared with 1921 is almost wholly due to the increase in the number of deaths from Diphtheria, Measles and Influenza. PREVALENCE AND CONTROL OVER INFECTIOUS DISEASES. Table XVI. shows the cases of infectious diseases notified during the year. The total number of cases, less Tuberculosis, was 4,018, 748 from Clapham, 307 from Putney, 994 from Streatham, 501 from Tooting, and 1,468 from Wandsworth—compared with 4,918 in 1921. The number appears high, but it includes 1,056 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. (9323)Q c 18 Report of the Medical Officer of Health. Table XVI. Cases of Infectious Disease Notified during the Year 1922. Notifiable Disease. No. of Cases Notified. Total Cases Notified in Each Locality. Total Cases Removed to Hospital. At Ages—Years. Clapham. Putney. Streatham. Tooting. Wandsworth. At all Ages. Under 1. 1—2. 2—3. 3—4. 4—5. 5—10. 10—15. 15—20. 20—35. 35—45. 45—65. 65 and upwards. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 838 13 38 63 53 46 284 159 65 96 17 4 167 67 146 160 298 813 Erysipelas 108 2 1 1 3 1 6 6 6 9 16 40 17 28 7 18 8 47 29 Scarlet Fever 1,257 12 26 72 56 57 494 299 113 99 25 4 228 57 332 154 486 1,118 Enteric Fever 22 .. .. .. .. .. 4 5 6 3 3 1 .. .. 2 2 .. 18 21 Puerperal Fever 17 .. .. .. .. .. .. .. 1 13 2 1 .. 4 2 5 2 4 12 Cerebro-spinal Meningitis 6 2 .. 1 .. .. 2 .. 1 .. .. .. .. .. 1 2 1 2 5 Polio-myelitis 4 .. 1 .. 1 .. 1 .. .. 1 .. .. .. 1 .. 1 1 1 1 Ophthalmia Neonatorum 42 42 .. .. .. .. .. .. .. .. .. .. .. 10 2 20 3 7 18 Pulmonary Tuberculosis 398 1 .. .. 1 .. 7 7 33 170 87 84 8 84 33 105 56 120 .. Other Forms of Tuberculosis 145 9 8 4 3 3 25 29 17 29 7 9 2 22 9 38 20 56 Whooping Cough 1,056 130 159 170 97 105 351 19 2 16 6 1 .. 188 99 328 94 347 34 Encephalitis Lethargica 6 .. .. .. .. .. .. 1 1 .. 1 3 .. 2 1 1 1 1 4 Acute Influenzal Pneumonia 180 3 4 8 .. 3 8 7 10 33 32 38 34 38 16 56 20 50 .. Acute Primary Pneumonia 466 36 52 32 14 16 42 22 16 78 40 76 42 79 48 79 56 204 .. Malaria 13 .. .. .. .. .. .. .. 1 7 2 3 .. 2 3 4 1 3 .. Dysentery 3 .. .. 1 .. .. .. .. .. .. 2 .. .. 1 2 .. .. .. .. Trench Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Total 4,561 250 289 352 228 231 1,224 554 272 554 240 264 103 854 349 1,137 577 1,644 2,055 Report of the Medical Officer of Health. 19 The number of cases of certain infectious diseases notified during the year and the previous 10 years is shown on the following Table, as also the number of the corrected average. Table XVII. 1912. 1913. 1914. 1915. 1916. 1917. 1918. 1919. 1920. 1921. 10 years' average corrected for increase of population. 1922. Scarlet Fever 833 971 1,417 1,309 690 566 563 893 1,463 1,978 1,113 1,257 Diphtheria 431 430 552 723 531 435 487 525 1,104 1,009 649 838 Enteric Fever 73 52 48 50 46 47 38 18 24 32 43 22 Puerperal Fever 27 32 30 11 20 14 16 28 36 11 22 17 Erysipelas 207 204 234 195 157 103 95 143 173 121 170 108 Cerebro-spinal Meningitis 3 9 3 47 28 26 21 13 15 9 17 6 Polio-Myelitis 5 13 3 10 7 5 3 11 7 6 4 Ophthalmia Neonatorum 35 37 51 44 32 29 35 54 60 54 44 42 Pulmonary Tuberculosis 855 783 706 646 590 622 777 788 634 490 718 398 Other Forms of Tuberculosis 328 199 234 216 193 218 163 156 147 192 145 Compared with 1921 there has been an increase in the number of cases of puerperal fever, but a decrease in all the others. Compared with the corrected decennial average there has been an increase in the number of cases of scarlet fever and diphtheria, and a decrease in all the others. Small-pox. No case of this disease occurred during the year. Scarlet Fever. This disease was not so prevalent during the year, compared with 1921. (9323)q c 2 20 Report of the Medical Officer of Health. The number of deaths was 19, and the death-rate per 1,000 was .05. The case mortality was 1.5 per cent. In all, 1,257 cases were notified, 228 in Clapham, 57 in Putney, 332 in Streatham, 154 in Tooting, and 486 in Wandsworth, compared with 1,978 in 1921. The rate per 1,000 of population was 3.76, 3.70 in Clapham, 1.96 in Putney, 3.12 in Streatham, 3.93 in Tooting, and 4.99 in Wandsworth. 22 cases occurred in institutions in Tooting. Of the total number of cases, viz.—1,257—1,118, or 88 per cent., were removed to hospital. As will be seen in Table XX, some schools were more affected than others. The Medical Officers of the London County Council made inspections of 15 schools during the year, and any suspected cases were at once excluded and the names forwarded to me for inquiry. The number of dwellings in each sub-district and the whole Borough in which multiple cases occurred is shown in the following Table Table XVIII. Sub-Districts. One case. Two cases. Three cases. Four cases. Five cases & upwards Total houses invaded. Clapham 172 15 6 2 .. 195 Putney 39 6 2 .. .. 47 Streatham 234 30 .. 2 2* 274 Tooting 105 8 2 .. 3† 118 Wandsworth 335 30 13 4 3‡ 385 Whole Borough 885 89 29 8 8 1,019 * In Streatham seven cases occurred in an Institution. † In Tooting 10 cases occurred in one Institution, and 12 in another. ‡ In Wandsworth 25 cases occurred in one Institution, and six in another. Of the 1,019 houses invaded, multiple cases occurred in 134, or 13.1 per cent. Report of the Medical Officer of Health. 21 Diphtheria. This disease was not so prevalent as during the previous year. The number of deaths was 76, and the death-rate per 1,000 was .22. The case mortality was 9.0 per cent. The total number of cases notified was 838, 167 in Clapham, 67 in Putney, 146 in Streatham, 160 in Tooting, and 298 in Wandsworth. The rate per 1,000 of population was 2.5, 2.7 in Clapham, 2.2 in Putney, 2.2 in Streatham, 4.0 in Tooting, and 3.0 in Wandsworth. The number of cases was 171 below the number in 1921, but was 189 above the corrected decennial average. Of the 838 cases, 813, or 97 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 Sellincourt Road School, the next Swaffield Road, and the third New Park 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, New Park Road; in Putney, St. Mary's, Charlwood Road; in Tooting, Hillbrook Road and Sellincourt Road; and in Wandsworth, St. Ann's, Swaffield Road and The Wandle. As a result of this swabbing, 13 cases were found to be positive and 13 suspicious. All the cases were swabbed again and not re-admitted to school till found negative. Every positive or suspicious case was visited and all necessary precautions taken to prevent the spread of the disease. The number of dwellings in each sub-district and the whole Borough in which multiple cases occurred is shown in the next Table. 22 Report of the Medical Officer of Health. Table XIX. Sub-Districts. One case. Two cases. Three cases. Four cases. Five cases & upwards. Total houses invaded. Clapham 105 12 4 2 2* 125 Putney 43 1 .. 3 2 49 Streatham 110 8 4 2 .. 124 Tooting 85 5 5 1 2† 98 Wandsworth 187 22 10 4 4‡ 227 Whole Borough 530 48 23 12 10 623 * In Clapham 11 cases occurred in an Institution. † In Tooting 23 cases occurred in one Institution, and 23 in another. ‡ In Wandsworth six cases occurred in an Institution. Of the 623 houses invaded, multiple cases occurred in 93, or 14.9 per cent. Return Cases of Scarlet Fever and Diphtheria. Thirty cases of scarlet fever occurred after the return of cases from the hospitals of the Metropolitan Asylums Board, and there were also 17 cases of diphtheria. Ten of the return cases of scarlet fever occurred in Clapham, one in Putney, six in Streatham, two in Tooting, and 11 in Wandsworth. Eight of the return cases of diphtheria occurred in Clapham, one in Putney, one in Tooting, and seven in Wandsworth. Enteric Fever. The number of deaths was two, the death-rate was .005 per 1,000, and the case mortality 9.09 per cent. The number of deaths from this disease was lower than in 1921. Twenty-two cases of enteric fever were notified, two from Putney, two from Streatham, and 18 from Wandsworth. Report of the Medical Officer of Health. 23 Five of the cases on admission to hospital were found not to be suffering from enteric fever. The number of cases is 10 under that of last year, and 22 below the corrected decennial average. One of the cases was notified as para-typhoid fever, and this case recovered. In two of the cases there was a history of having consumed ice-cream two or three weeks prior to the attack. In one case no history could be ascertained, and the remaining 13 cases were the subject of a special report of which the following is a precis:— The first case was notified on the 11th July, and the last on the 7th November. Five of them came from Summerstown and eight from Burmester Road. As a result of enquiries made, it was found that 10 of the cases had been supplied with milk by a registered purveyor in this Borough who obtains his milk from 10 or more farms in the country. Two of these farms adjoin each other at Verwood, Wimborne, Dorsetshire, and in February and March of this year 12 cases of enteric fever were notified in that district—two of them being at one of the farms. At one of the farms both the farmer and his daughter suffered from the disease. They were taken ill in January, and appear to have been treated at the farm, which was disinfected on 6th April. Previous to that date, three negative tests, made at weekly intervals, had been obtained from each patient. Two and a-half months later, the first case in Wandsworth was taken ill, the ascertained date of onset being the 20th June. If this case was infected through milk from the farm at Verwood, it is likely that a focus of infection continued at the farm after the 6th April—the supposed date of recovery of the farmer and his daughter. There is evidence that this may have occurred, as the farmer is said to suffer from gall stones—a condition closely associated with the carrier problem in enteric fever. The stools of both the farmer and his daughter were again examined, but proved to be negative. The whole of the milk from the farm is sent to the Wandsworth dairyman, except a small quantity retained for domestic purposes, 24 Report of the Medical Officer of Health. and although he supplies a large number of customers in Wandsworth, the area covered being considerable, yet all the cases occurred in two streets which join Garratt Lane within a few yards of each other. Of the cases supplied by this dairy, five are members of the same family living in the same house ; two are members of the same household ; while two others, boys aged 11 and 12, are friends. In each of these three groups the disease could easily have been spread by direct personal contact. Three of the 13 cases did not obtain their milk from the dairy in question. Two of them are brother and sister, and there is a definite history of one assisting in the household duties of the family where five cases occurred, and she was most probably infected from one of them. In the third case no history of possible contact infection can be obtained. The possibility that infection has been conveyed by other foodstuffs has been investigated, but no evidence that this occurred could be ascertained. In none of the cases was there a history of shell-fish consumption. In seven cases it Was stated that the patients made fairly frequent visits to a fried-fish shop in Summerstown. This shop has been inspected, and the process of frying seen in operation, but no source of infection could be traced. The fish is all gutted, and the frying is carried out thoroughly, while the persons working on the premises were all in good health. In one case it was stated that the patient had eaten watercress from well-known beds in the neighbourhood. In 10 of the cases, the relatives stated that the patients never partook of ice-cream, while in three, some had probably been eaten, but the information on this point was indefinite. With regard to water supply, the house where five cases occurred was supplied by a cistern which was very dirty when inspected. This water was examined bacteriologically, and no bacilli of the enteric group were isolated, though the specimen was much below the standard of London water as regards coliform bacilli. It was stated that all the members of this household drank large quantities of water. Report of the Medical Officer of Health. 25 Two cases obtained their water from a cistern which was allowed to run dry once a week. In the remainder, the supply is from the main. Cases of Mistaken Diagnosis. In 26 cases (12 of scarlet fever, seven of diphtheria, five of enteric fever, and two of encephalitis lethargica) information was received from the Metropolitan Asylums Board's and other hospitals that the patients were not suffering from the disease notified, or any other notifiable disease. Cerebro-Spinal Meningitis. Three deaths occurred from this disease (one in Putney, one in Tooting, and one in Wandsworth). Six cases of this disease were notified (one in Putney, two in Streatham, one in Tooting, and two in Wandsworth). Five of the cases were removed to hospital. Sixteen deaths were registered as having been caused by meningitis (one in Clapham, one in Putney, six in Streatham, three in Tooting, and five in Wandsworth). Five of these were of infants under one year, four from two and under five years, and seven over five years of age. As in previous years, inquiries were made from the medical attendant, and in all the cases, 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. Two deaths occurred (one in Streatham and one in Tooting). One of the deaths was of a person from 15 and under 25 years, and the other was over 65 years. Six cases were notified (two in Clapham, one in Putney, one in Streatham, one in Tooting, and one in Wandsworth). Two of the notified cases died from tubercular meningitis, two from encephalitis lethargica, and in the other two recovery was more or less complete, although there were slight after effects. 26 Report of the Medical Officer of Health. Polio-myelitis and Polio-encephalitis. Four cases were notified during the year and one death resulted. The three surviving cases have recovered without paresis or paralysis. Erysipelas. Three deaths occurred from this disease during the year ; 108 cases were notified (28 in Clapham, seven in Putney, 18 in Streatham, eight in Tooting, and 47 in Wandsworth). Malaria. Three deaths occurred from malaria; one of these contracted the disease in Mesopotamia, another in India, and the third, a female, in Northern Rhodesia. Thirteen cases were notified (two in Clapham, three in Putney,, four in Streatham, one in Tooting, and three in Wandsworth). All of the cases but two were males. No case was notified in which the disease was contracted within the Borough. Of six Army cases, one contracted the disease in India, one in Gallipoli, one in Mesopotamia, one in N.W. Africa, and two in other parts. One of the two females notified contracted the disease in Salonicar and the other in Northern Rhodesia. 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. Diarrhoea. Thirty-two deaths, 13 of males, and 19 of females, occurred from all forms of diarrhoea and enteritis during the year. Four of the deaths occurred in Clapham, four in Putney, eight in Streatham, six in Tooting, and 10 in Wandsworth. There was a decided decrease in all the sub-districts compared with 1921. The number of deaths is 89 below the corrected decennial average, and is the lowest ever recorded in the Borough. Report of the Medical Officer of Health. 27 The death-rate was .09 per 1,000 (in Clapham .06, in Putney .13, in Streatham .07, in Tooting .14, and in Wandsworth .10), compared with .33 in 1921, .18 in 1920, .17 in 1919, and .32 in 1918. Of the total number of deaths from diarrhoea registered, 19, or 59 per cent., were of infants under one year. The number of deaths from diarrhoea, zymotic enteritis, and enteritis under one year represents 9.4 per cent, of the total mortality at that age. Dysentery. One death occurred during the year. Three cases were notified (one in Clapham and two in Putney). All the cases were males, and in two the disease was contracted during Army service in the following war areas: one in France and one in Salonica. The third case, a child of years, is the son of a man who had been treated for dysentery in a military hospital and discharged as cured. He is stated to still pass blood and slime occasionally. Trench Fever. No case was notified during the year. Measles and German Measles. Seventy-two deaths occurred (16 in Clapham, five in Putney, 16 in Streatham, nine in Tooting, and 26 in Wandsworth). The death-rate per 1,000 of population was .21, compared with .012 in 1921. The notification of these diseases was discontinued at the end of 1919, but 50 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. 28 Report of the Medical Officer of Health. As will be seen from Table XX, 1,613 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. In all, 1,842 cases were reported, 25 under one year, 472 from one and under five years, 1,340 from five and under 15 years, and five over 15 years. 365 cases occurred in Clapham, 136 in Putney, 375 in Streatham, 237 in Tooting, and 729 in Wandsworth. Twenty-five of the cases were removed to the Metropolitan Asylums Board's hospitals on account of insufficient accommodation at home. Except in Wandsworth, 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. Thirty-seven cases of German measles were also reported (10 in Clapham, one in Putney, 19 in Streatham, four in Tooting, and three in Wandsworth). During the year 1,380 visits were made in cases of these diseases (268 in Clapham, 97 in Putney, 331 in Streatham, 193 in Tooting, and 491 in Wandsworth). The total number of premises disinfected was 1,001 (179 in Clapham, 89 in Putney, 199 in Streatham, 164 in Tooting, and 370 in Wandsworth). Table XX 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. 29 Table XX. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Clapham. Aristotle Road 2 .. .. .. .. .. .. 1 1 4 Bonneville Road 26 6 30 5 4 17 25 7 76 196 Cavendish Road 15 10 86 .. 1 5 4 .. 11 132 Cavendish Road Special 1 .. 3 .. .. .. .. .. .. 4 Christchurch 2 2 1 .. 1 1 .. .. .. 7 Clapham Parochial, Macaulay Road 7 2 .. .. .. .. .. .. .. 9 Clapham Parochial, Old Town 8 4 49 .. .. 22 .. .. 14 97 Haselrigge Road 9 4 48 1 21 11 38 4 66 202 Larkhall Lane 15 7 34 .. 6 20 7 .. 41 130 New Park Road 4 17 7 1 .. 17 6 1 13 66 New Road 1 1 .. .. .. .. .. .. .. 2 St. Andrew's Street 8 7 .. .. 1 .. .. 1 .. 17 St. Mary's, Crescent Lane 5 4 5 .. .. .. .. .. .. 14 St. Mary's, St. Alphonsus Road 2 .. 4 .. .. .. .. .. .. 6 Stonhouse Street 5 5 48 .. 17 13 6 8 64 166 Telferscot Road 18 5 75 .. 5 9 74 6 69 261 Total 128 74 390 7 56 115 160 28 355 1,313 Putney. All Saints' 2 1 18 .. 3 .. .. 2 1 27 Convent of Sacred Heart, Roehampton .. 3 6 .. .. 3 .. .. .. 12 Hotham Road 7 8 87 2 24 16 4 2 63 213 Parochial, Roehampton 2 1 1 .. 2 .. 1 .. .. 7 Roehampton Estate 4 4 1 .. 3 9 1 .. .. 22 St. Mary's 7 9 10 .. .. 1 .. 1 28 56 Upper Grade, Walker's Place 1 4 .. .. .. .. .. .. .. 5 Total 23 30 123 2 32 29 6 5 92 342 Carried forward 151 104 513 9 88 144 166 33 447 1,655 30 Report of the Medical Officer of Health. Table XX—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 151 104 513 9 88 144 166 33 447 1,655 Streatham. Broadwater Road 6 4 26 .. 3 3 2 1 10 55 Broadwater Road Special 1 .. .. .. .. .. .. .. .. 1 Balham High Road 11 .. 9 .. 2 8 3 .. 15 48 Christchurch .. .. 4 .. .. .. .. .. .. 4 Coventry Hall 1 1 .. .. .. .. .. .. .. 2 Eardley Road 13 6 15 1 7 1 1 2 24 70 Fircroft Road 7 8 35 2 2 1 .. 2 6 63 Furzedown Demonstration 5 .. 9 1 11 6 4 .. 27 63 Hearnville Road 8 1 3 .. 3 32 .. 2 28 77 Hearnville Road Special .. .. .. .. .. .. .. .. 1 1 Hitherheld Road 2 1 8 .. 36 7 .. .. 4 58 Holy Trinity, Balham 4 .. 5 2 2 4 8 .. .. 25 Holy Trinity, Streatham 1 1 .. .. .. .. .. .. .. 2 Immanuel 1 1 13 .. .. .. .. .. .. 15 Mitcham Lane 34 5 21 2 .. 9 2 2 141 216 Nightingale Square, R.C. 3 1 .. 1 .. 5 .. .. 9 19 Oldridge Road 17 7 31 1 2 20 2 3 85 168 Smallwood Road 15 9 15 .. 5 9 4 9 37 103 St. Andrew's, Colmer Road 2 .. .. .. .. 2 .. .. 4 8 St. Andrew's, Polworth Road 1 .. .. .. .. .. .. .. .. 1 St. Leonard's 9 .. 2 .. .. .. .. .. 7 18 St. Mary's, Balham 6 .. 25 .. 6 7 9 .. 20 73 Sunnyhill Road 2 1 23 .. 20 24 .. 1 36 107 Welham Road, County Secondary 7 1 2 .. .. .. .. .. 3 13 Total 156 47 246 10 99 138 35 22 457 1,210 Carried forward 307 151 759 19 187 282 201 55 904 2,865 Report of the Medical Officer of Health. 31 Table XX—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cou gh. Mumps. Ringworm. Other Diseases. Totals. Brought forward 307 151 759 19 187 282 201 55 904 2,865 Tooting. Ensham 16 4 16 .. 26 14 .. .. 35 111 Fountain Road 6 2 31 .. 17 29 2 3 66 156 Franciscan Road 7 6 44 4 13 2 2 1 65 144 Hillbrook Road 5 16 104 6 14 35 1 4 13 198 Sellincourt Road 13 30 3 .... 8 12 7 1 131 205 Tooting Graveney 17 7 33 .. 4 3 4 3 36 107 Undine Street, R.C. 1 1 9 1 1 14 7 5 20 59 Total 65 66 240 11 83 109 23 17 366 980 Wandsworth. Allfarthing Lane .. .. 16 .. 9 .. .. .. 5 30 All Saints' 9 2 20 .. 1 3 21 56 Brandlehow Road 4 11 4 .. 12 7 4 6 48 Earlsfield 27 9 43 .. 7 33 1 10 46 176 Elliott Central 7 .. .. .. .. .. .. .. .. 7 Eltringham Street. . 15 6 37 .. 3 25 29 115 Frogmore Special 1 .. .. .. .. .. .. .. 5 6 Garratt Lane 29 7 52 .. 3 1 1 7 67 157 3 .. .. .. .. .. .. .. .. 3 Magdalen Road 7 1 35 .. 14 10 .. 2 1 70 Merton Road 14 6 17 .. 2 .. 33 72 Riversdale 17 10 63 1 4 20 .. 6 24 145 St. Ann's 4 14 20 .. 8 2 2 3 33 86 St. Faith's 2 3 31 .. 3 5 .. 3 10 57 St. Joseph's 2 .. 17 .. .. 4 .. 1 4 28 St. Michael's 3 .. 26 .. 2 9 4 1 1 46 Southfields 27 9 74 .. 40 33 1 4 21 209 Swaffield Road 36 19 66 .. 6b 8 4 20 63 270 Waldron Road 26 8 18 .. 11 13 3 13 129 221 Wandle 22 9 15 .. 4 4 1 2 56 113 Warple Way 1 6 8 1 1 5 .. .. 38 60 West Hill 9 7 62 .. 4 4 1 2 2 91 Total 264 127 614 2 191 186 20 78 584 2,066 Grand Total 636 344 1613 32 461 577 244 150 1854 5,911 32 Report of the Medical Officer of Health. Whooping Cough. Forty-four deaths (seven in Clapham, two in Putney, 14 in Streatham, three in Tooting, and 18 in Wandsworth) occurred during the year. 1,056 cases were notified (188 in Clapham, 99 in Putney, 32£ in Streatham, 94 in Tooting, and 347 in Wandsworth) ; 130 of these were infants under one year of age, 531 from one and under five years, 370 from five and under 15 years, 18 from 15 and under 35 years, and seven over 35 years. Thirty-four cases were removed to hospital. This disease was not so prevalent in the Borough during the year, especially in Putney, Tooting, and Wandsworth. Epidemic Influenza. 148 deaths (28 in Clapham, 10 in Putney, 50 in Streatham, 12 in Tooting, and 48 in Wandsworth) occurred during the year. The death-rate was -44 per 1,000. The number of deaths represents 3-9 per cent, of the total mortality from all causes, compared with 2-3 per cent, in 1921, 2-2 per cent, in 1920, 8-2 per cent, in 1919. Influenzal Pneumonia and Acute Primary Pneumonia. 180 cases of influenzal pneumonia were notified (38 in Clapham, 16 in Putney, 56 in Streatham, 20 in Tooting, and 50 in Wandsworth), compared with 79 in 1921. Three of the cases were under one year, 15 from one and under five years, 15 from five and under 15 years, 43 from 15 and under 35 years, 32 from 35 and under 45 years, 38 from 45 and under 65 years, and 34 over 65 years. 466 notifications of cases of acute primary pneumonia were received (79 in Clapham, 48 in Putney, 79 in Streatham, 56 in Tooting, and 204 in Wandsworth), compared with 374 in 1921. Thirty-six of the cases were infants under one year, 114 from one and under five years, 64 from five and under 15 years, 94 from 15 and under 35 years, 40 from 35 and under 45 years, 76 from 45 and under 65 years, and 42 over 65 years. Report of the Medical Officer of Health. 33 All the cases were visited, and when requested by the medical attendant or householder, the premises, &c., were disinfected by the sanitary staff of the Council. Other Infective Diseases. Nineteen deaths occurred (three in Clapham, three in Putney, six in Streatham, three in Tooting, and four in Wandsworth). Four were under one year of age, two from five and under 15 years, one from 15 and under 25 years, four from 25 and under 45 years, five from 45 and under 65 years of age, and three over 65 years. Six of the deaths were due to syphilis, six to septicaemia, three to malaria, two to encephalitis lethargica, one to dysentery, and one to tetanus. NON-INFECTIVE DISEASES MORTALITY. 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 XXI.—Deaths from Non-Infective Diseases. 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 10 years' average corrected for increase of population. 1922 Cancer 338 352 393 398 398 407 375 399 403 412 404 450 Circulatory Diseases 357 411 426 492 504 551 541 601 583 558 524 613 Respiratory Diseases 530 622 519 792 567 664 686 627 545 585 640 624 Premature Birth 240 234 249 225 235 189 179 192 235 184 225 160 Violence 116 115 113 115 114 127 98 111 113 122 119 128 All other Diseases 1,025 1,057 1,130 1,166 1,119 1,064 956 991 1,001 852 1,080 1,015 Totals 2,606 2,791 2,840 3,188 2,937 3,002 2,835 2,921 2,880 2,813 3,005 2,990 (9323)Q D 34 Report of the Medical Officer of Health. Cancer. The total number of deaths from cancer and other malignant diseases was 450, 205 of males and 245 of females. Eighty-nine of these occurred in Clapham, 52 in Putney, 150 in Streatham, 43 in Tooting, and 116 in Wandsworth. The corrected death-rate was 1-34 per 1,000, and for the subdistricts as follows:—Clapham, 1-44; Putney, 1-76; Streatham, 1-41; Tooting, 1-09; and Wandsworth, 1-19. Two of the deaths occurred from five and under 15 years, one from 15 and under 25 years, 38 at 25 and under 45 years, 209 at 45 and under 65 years, and 200 over 65 years. The number of deaths is 38 above last year, and 45 above the corrected decennial average. Diseases of the Brain and Nervous System. From these diseases 307 deaths occurred, 61 in Clapham, 23 in Putney, 109 in Streatham, 39 in Tooting, and 75 in Wandsworth. The number of deaths is 10 above last year. Sixteen of the deaths were due to meningitis, 155 to cerebral haemorrhage or apoplexy, 21 to convulsions, and 115 to other diseases of the nervous system. Circulatory Diseases. From the above group of diseases, 613 deaths occurred, 459 of which, 178 males and 281 females, were due to organic disease of the heart. 119 of these deaths occurred in Clapham, 59 in Putney, 214 in Streatham, 63 in Tooting, and 158 in Wandsworth. 363 of the deaths were of persons over 65 years of age. The number of deaths is 55 more than in 1921, and 89 above the corrected decennial average. Respiratory Diseases. The total number of deaths was 624, 149 in Clapham, 53 in Putney, 177 in Streatham, 54 in Tooting, and 191 in Wandsworth. Report of the Medical Officer of Health. 35 339 of the deaths occurred from bronchitis, 47 from lobar pneumonia, 113 from lobular or broncho-pneumonia, 76 from pneumonia in which the exact form was not distinguished, and 49 from other diseases of the respiratory organs. 67 of the deaths were of infants under one year, 39 from one and under two years, 16 from two and under five years, 11 from five and under 15 years, 11 from 15 and under 25 years, 38 from 25 and under 45 years, 136 from 45 and under 65 years, and 306 over 65 years. The number of deaths is 39 above last year, but is 16 under the corrected decennial average. Deaths from other Causes. From appendicitis and typhlitis 24 deaths, 14 of males and 10 of females, occurred. From alcoholism, acute and chronic, one death, a female, occurred ; and 16, seven of males and nine of females, from cirrhosis of the liver. From nephritis and Bright's disease, 124 deaths occurred, 58 of males and 66 of females. From accidents and diseases of pregnancy and child birth 14 deaths occurred. This, added to the number of deaths from puerperal fever—viz., three—gives a total of 17 deaths after child birth, or a proportion of 3-0 per 1,000 births, compared with 1-7 in 1921. Diabetes mellitus was the cause of 54 deaths, 24 of males and 30 of females. Premature Birth and Developmental Diseases. 160 deaths, 89 of males and 71 of females, were registered as having occurred from these diseases. 78 of the deaths were due to premature birth, 68 to developmental diseases, and 14 from other diseases of early infancy. 155 were of infants under one year, three from one and under two years, and two over two years. The number of deaths is 24 under last year, and 65 below the corrected decennial average. (9323)Q D 2 36 Report of the Medical Officer of Health. 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. 190 deaths, 69 of males and 121 of females, occurred from old age, 41 in Clapham, 19 in Putney, 62 in Streatham, 21 in Tooting, and 47 in Wandsworth. All the deaths were of persons over 65 years of age. Violence. 128 deaths, 87 of males and 41 of females, occurred from violence, 100 of the deaths being due to accidental, and 23 to suicidal causes, while five deaths were caused by other forms of violence. 25 of the deaths belonged to Clapham, 22 to Putney, 38 to Streatham, 14 to Tooting, and 29 to Wandsworth. Inquests. The next Table shows the number of inquests held in the Borough during the year, and Table XXIII. the number of inquests held outside the Borough on persons belonging thereto. Report of the Medical Officer of Health. 37 Table XXII. Inquests. Sub-Districts. Whole Borough. Clapham. Putney. Streatham. Tooting. ... Wandsworth. Deaths from Natural Causes 8 12 12 15 21 68 Accidental— Falls 1 1 1 9 1 13 Run over by motor vehicles .. 3 1 1 2 7 Fall downstairs 2 .. 3 .. .. 5 Scalds .. 2 .. 1 1 4 Suffocated by food in larynx 1 .. .. 2 .. 3 Suffocated in bed with parents 1 1 1 .. .. 3 Burns .. 1 .. .. 1 2 Fall from railings .. 1 .. .. .. 1 Fall from wall .. .. 1 .. .. 1 Fall from bicycle .. .. 1 .. .. 1 Asphyxiated by fumes from .. .. 1 .. .. 1 geyser Knocked down by train .. .. 1 .. .. 1 Drowning .. .. .. .. 1 1 Suicidal— Poisoning by coal gas .. 1 1 .. 3 5 Hanging .. 3 .. .. 1 4 Drowning .. 1 .. .. 1 2 Cut throat .. 1 1 .. .. 2 Poisoning by Oxalic Acid .. 1 .. .. .. 1 Do. Carbolic Acid .. .. 1 .. .. 1 Do. Lysol .. .. 1 .. .. 1 Do. Cyanide of Potassium .. .. 1 .. .. 1 Do. Strychnine .. .. .. .. 1 1 Open Verdicts— Found drowned .. 1 .. .. 1 2 Found dead .. .. 1 .. .. 1 Murder .. 3 .. .. .. 3 Execution .. .. .. .. 2 2 Totals 13 32 28 28 36 137 38 Report of the Medical Officer of Health. Table XXIII. Inquests. Sub-Districts. Whole Borough. Clapham. Pautney. Streatham. Tooting. Wandsworth. Deaths from Natural Causes 4 4 12 2 11 33 Accidental— Run over by motor vehicles 3 1 7 3 6 20 Falls 2 .. 2 2 1 7 Fall down stairs 2 .. .. 2 1 5 Scalds 1 .. 1 1 1 4 Fall from bicycle .. .. .. .. 3 4 Knocked down by tramcar .. .. 3 .. .. 3 Fall from ladder .. 1 1 .. .. 2 Fall from roof .. .. .. .. 2 2 Knocked down by train .. .. 1 .. 1 2 Suffocated by regurgitated food 2 2 Death under anaesthetic .. .. 1 .. 1 2 Fall down lift shaft .. .. .. .. .. 1 Burns from exploded petrol tank 1 .. .. .. .. 1 Crushed by steam lorry .. .. 1 .. .. 1 Knocked down by runaway horse .. .. .. .. 1 1 Gunshot wounds .. .. 1 .. .. 1 Burns .. .. .. .. 1 1 Crushed by overturned motor car .. .. .. .. 1 1 Suicidal— Drowning 3 .. .. . . .. 3 Cut throat .. .. .. 2 .. 2 Gunshot wounds .. .. 1 .. 1 2 Fall from cliff .. .. .. .. l 1 Jumped in front of train .. .. .. 1 .. 1 Poisoning by HydrochloricAcid 1 .. .. .. .. 1 Do. Carbolic Acid .. .. 1 .. .. 1 Open Verdicts— Found drowned 3 .. l 1 .. 5 Found dead .. .. .. 1 .. 1 Murder .. .. l .. .. 1 Totals 22 7 34 16 32 111 Report of the Medical Officer of Health. 39 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, four bodies were removed to the Mortuary, in Streatham 16, and in Wandsworth 168—of which 57 were from Wandsworth, 31 from Putney, 36 from Tooting, 43 from Battersea, and one from Wimbledon—a total of 188. Tuberculous Diseases. The total number of deaths from diseases of a tuberculous nature was 343, 181 of males and 162 of females. 286 of the deaths were due to pulmonary tuberculosis, 148 of males, and 138 of females ; 31 to tuberculous disease of the brain ; and 26 to other forms of tuberculous diseases. The number of deaths from pulmonary tuberculosis and other tuberculous diseases, and the rates per 1,000 for the whole Borough and for the separate sub-districts, are shown in the next Table. Table XXIV. Sub-District. Pulmonary Tuberculosis. Other Tuberculous Diseases. Total. No. of Deaths. Rate. No. of Deaths. Rate. No. of Deaths. Rate. Clapham 59 95 8 .12 67 1.08 Putney 24 .81 1 .03 25 .84 Streatham 77 .72 18 .16 95 .89 Tooting 37 .94 7 .19 44 1.12 Wandsworth 89 .91 23 .23 112 1.15 Whole Borough 286 .85 57 .17 343 1.02 40 Report of the Medical Officer of Health. There has been a decided decrease in the rate from pulmonary tuberculosis in all the sub-districts, especially in Putney, Tooting and Wandsworth, compared with 1921, and in Streatham, Tooting and Wandsworth compared with the decennial average.' The following Table shows the death-rate per 100,000 from pulmonary tuberculosis in the whole Borough and for the separate sub-districts for the year, as well as for the preceding 10 years:— Table XXV. 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 Average for 10 vrs. 1922 Clapham 116 93 93 97 105 107 112 87 88 101 99 95 Putney 97 55 78 109 99 92 128 105 41 107 90 81 Streatham 73 76 71 83 90 102 115 92 69 80 85 72 Tooting 87 69 87 123 103 120 171 82 82 137 106 94 Wandsworth 112 109 122 103 114 129 126 77 79 106 107 91 Whole borough 96 88 93 99 102 112 122 87 75 100 97 85 Notification of Tuberculous Diseases. The total number of cases of pulmonary tuberculosis notified during the year was 398 (84 were from Clapham, 33 from Putney, 105 from Streatham, 56 from Tooting, and 120 from Wandsworth), compared with 490 in 1921, 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. One case was under one year of age, one from three and under four years, 14 from five and under 15 years, 203 from 15 and under 35 years, 87 from 35 and under 45 years, 84 from 45 and under 65 years, and eight over 65 years. In Table XXVI. is shown the total number of cases notified since 1909, the number of deaths in each year since that date, the total deaths, the number removed from the district as far as could be ascertained, the number who were stated to have recovered, and the total number of cases still on the Register. Table XXVI. Year. Cases reported. Deaths. Total. Removed. Recovered. Cases on Register. 1909 to 1913. 1914. 1915. 1916. 1917. 1918. 1919. 1920. 1921. 1922. 1909 to 1913 2,830 1,091 157 88 52 23 33 15 5 6 20 1,490 948 157 235 1914 706 .. 177 88 37 22 13 5 5 4 8 359 215 33 99 1915 646 .. .. 199 82 27 20 12 6 5 6 357 167 24 98 1916 590 .. .. .. 162 69 38 13 11 9 4 306 160 21 103 1917 622 .. .. .. .. 183 79 34 9 6 6 317 121 15 169 1918 777 .. .. .. .. .. 199 71 27 20 18 335 151 26 265 1919 788 .. .. .. .. .. .. 158 76 34 26 294 118 25 351 1920 634 .. .. .. .. .. .. .. 112 83 33 228 62 16 328 1921 490 .. .. .. .. .. .. .. .. 170 66 236 33 4 217 1922 398 .. .. .. .. .. .. .. .. .. 121 121 8 1 268 Total 8,481 1,091 334 375 333 324 382 308 251 337 308 4,043 1,983 322 2,133 Report of the Medical Officer of Health. 41 Note.—The number of deaths for 1922 do not correspond with the number of deaths from Pulmonary Tuberculosis shown in Table II, as 22 cases notified died from other causes. In Table XXVI it will be seen that since 1909, 8,481 cases of pulmonary tuberculosis have been reported. With regard to the notifications of cases of non-pulmonary tuberculosis, in all 145 cases were notified (22 from Clapham, nine from Putney, 36 from Streatham, 20 from Tooting, and 56 from Wandsworth). Table XXVII 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 28 cases were notified and 26 died. Table XXVII. 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 28 12 16 9 7 3 4 2 .. 2 1 .. .. .. 11 15 26 .. 2 Glands, Mediastinal 2 2 .. .. .. .. 1 .. .. .. .. 1 .. .. 1 .. 1 .. 1 Mesenteric 15 8 7 .. 2 2 3 6 1 1 .. .. .. .. 2 .. 2 .. 13 Cervical 39 19 20 .. 4 13 10 2 1 7 2 .. .. .. 1 1 2 4 33 Bones and joints 31 18 13 .. 2 6 9 4 4 3 1 1 .. 1 2 1 3 o 26 Skin 3 2 1 .. .. 1 1 .. .. .. .. 1 .. .. .. .. .. .. 3 Larynx 4 2 2 .. .. .. .. .. .. 1 1 2 .. .. 2 .. 0 .. 2 General Tuberculosis 9 9 .. .. 3 .. 1 1 .. 1 1 1 1 .. 9 .. 9 .. Other parts 14 12 2 .. .. .. .. 2 3 5 1 1 1 1 1 1 2 .. 12 Total 145 84 61 9 18 25 29 17 9 20 7 7 2 2 29 18 47 6 92 42 Report of the Medical Officer of Health. Table XXIX is a summary of notifications during the period from the 1st January, 1922, to the 30th December, 1922. Table XXVIII. Year. Cases Notified. Deaths. Removed. Recovered. Cases on Register. 1913 1914 1915 1916 1917 1918 1919 1920 1 1921 1922 Total. 1913 323 46 10 5 6 .. 1 2 .. 1 .. 71 112 54 86 1914 198 .. 68 5 4 .. 1 .. .. 1 .. 79 51 26 42 1915 234 .. .. 84 7 1 1 2 .. 1 2 98 46 38 52 1916 215 .. .. .. 67 5 5 .. .. 1 .. 78 51 23 63 1917 193 .. .. .. .. 63 4 9 3 1 1 74 34 19 66 1918 218 .. .. .. .. .. 67 6 .. 1 .. 74 30 27 87 1919 163 .. .. .. .. .. .. 41 5 1 .. 47 20 12 84 1920 156 .. .. .. .. .. .. .. 41 6 6 53 10 6 87 1921 147 .. .. .. .. .. .. .. .. 46 3 49 14 3 81 1922 145 .. .. .. .. .. .. .. .. .. 47 47 6 3 89 Total 1,992 46 78 94 84 69 79 53 49 59 59 670 374 211 737 Report of the Medical Officer of Health. 43 The next Table shows the number of cases notified, the number which died, removed, and recovered from 1913 to 1922, and the number still remaining on the Register at the end of 1922. 44 Report of the Medical Officer of Health. Table XXIX. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from 1st January, 1922, to 30th December, 1922. Age Periods. Number of Notifications on Form A. Number of Notifications on Form B. Number of Notifications on Form C. Primary Notifications. Total Notifications on Form A. Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. Under 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 and upwards. Total. Under 5. 5 to 10. 10 to 15. Total. Pulmonary— Males 1 1 4 2 13 40 39 47 34 23 4 208 263 .. .. .. .. .. 75 180 Females .. .. 3 4 17 27 54 38 15 7 2 167 197 .. .. .. .. .. 74 122 Non-Pulmonary— Males 4 11 15 16 8 6 7 4 5 4 1 81 102 .. 1 1 2 3 19 16 Females 4 7 5 9 7 3 12 4 1 .. 1 53 67 .. 1 1 2 2 10 8 Report of the Medical Officer of Health. 45 The total number of visits made was 1,149 in cases of pulmonary tuberculosis, 188 in Clapham, 82 in Putney, 258 in Streatham, 241 in Tooting, and 380 in Wandsworth, and 438 in cases of other forms of tuberculosis, 68 in Clapham, 30 in Putney, 81 in Streatham, 67 in Tooting, and 192 in Wandsworth. In addition to these visits by the Health Visitor, 3,658 visits were made by the Dispensary Nurses, these visits being made by the instruction of the Tuberculosis Officer to cases under his care at the Dispensary. During the year 20 sputum flasks have been supplied, and in eight of the cases visited the patients already had one. During the year disinfection was carried out at 303 premises either after the death or removal of the patient; 54 of the premises disinfected were in Clapham, 24 in Putney, 90 in Streatham, 37 in Tooting, and 98 in Wandsworth. TUBERCULOSIS DISPENSARIES. There have been no changes in the Staff of the Dispensaries during the year. Institutional Treatment.—The responsibility for Institutional Treatment of all persons now rests with the London County Council. 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 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 scheme in force since 1913. As shown in Table XXXI., a smaller number of cases has been referred to the Hospital under this arrangement than the previous year, due to the fact that it has not been found necessary to send so many cases to that Hospital for examination. 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. 46 Report of the Medical Officer of Health. 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. Forty-five patients received dental treatment and 20 of them were supplied with dentures. The attendances at the dentist totalled 148. 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 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. 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. During the year under consideration, 83 patients have been granted extra nourishment under the scheme at a cost of £156 6s. 4d. The scheme has been found to be of great help in the treatment of the types of patient mentioned above. Shelters.—The two shelters have been in continuous use during the year; and more, if available, could have been utilised. Details of Work During 1922.—Table XXX. shows in the first column the number of cases under observation at the Dispensary at the beginning of the year ; then the number of new cases examined during the year ; and, finally, the number of cases under observation pending diagnosis at the end of the year. The total number of cases thus dealt with is divided into three sub-groups, according as they have been found to be suffering from tuberculosis of the lungs or of other organs, or free from tuberculosis. These cases are all divided into groups according to whether adults or children, and also according to sex. After giving the above details regarding all new cases, the table deals with the contacts in a similar manner, and then with the insured persons. Table XXX. Number of Under observation at the Dispensary on Jan. 1st pending diagnosis. Examined for the first time during the year. Total. Found to be Under observation at the 1 (ispensary on Dec. 31st pending diagnosis. Ceased attendance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from Tuberculosis. Pulmonary NonPulmonary (a) All persons (including "Contacts ")— Adults— Males 11 368 379 142 12 216 5 4 Females 10 404 414 96 14 294 7 3 Children under 15— Males 7 319 326 4 21 297 4 .. Females 7 267 274 4 12 253 5 .. T otal 35 1,358 1,393 246 59 1,060 21 7 (b)"Contacts " (included in (a) )— Adults— Males 1 57 58 3 .. 55 .. .. Females .. 131 131 5 .. 126 .. .. Children under 15— Males 1 161 162 .. 1 161 .. .. Females .. 140 140 1 1 138 .. .. (c) Insured persons (included in (a) )— Males 11 318 329 116 10 194 5 4 Females 7 105 112 34 4 67 4 3 Report of the Medical Officer of Health. 47 48 Report of the Medical Officer of Health. Table XXXI. gives further details of the year's work. Table XXXI. 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December, 1922 1,239 2. Total number of attendances of patients at the Dispensary during the year— Insured 4,147 Uninsured 4,075 3. Number of complete examinations of patients made 3,972 4. Number of persons placed during the year under observation for the purpose of diagnosis 117 5. Number of cases in which the period of observation exceeded two months 41 6. Number of insured patients under domiciliary treatment on 31st December, 1922 278 7. Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment during the year 86 8. Number of persons referred to St. Thomas's Hospital for consultation 43 9. Number of consultations with medical practitioners at the homes of patients— Insured 9 Uninsured 15 10. Number of other visits paid by Tuberculosis Officers to the homes of patients 390 11. Number of visits paid by Nurses to the homes of patients 3,658 12. Number of specimens of sputum examined 1,310 13. Number of written reports made 3,309 49 Report of the Medical Officer of Health. Table XXXII gives the numbers of new cases living in each of the five sub-districts, and shows on whose recommendation they made the first attendance. Table XXXII. Clapham. Putney. Streatham. Tooting Wandsworth. Outside Borough. Totals. Public Health Department 79 30 116 166 217 2 610 Private Practitioners 56 17 52 43 133 6 307 Charitable Societies 2 2 2 2 2 3 13 Transfers from other Dispensaries 8 .. 3 2 3 .. 16 London County Council. . 5 3 10 10 19 .. 47 Existing Dispensary Patients 9 1 15 32 56 2 115 Ministry of Pensions 14 10 14 13 18 .. 69 Other Sources 15 9 9 22 126 .. 181 totals 188 72 221 290 574 13 1,358 Table XXXIII. Particulars relating to Discharged Soldiers attending at the Dispensaries. New Cases. Old Cases. Total Attendances. Tuberculous 61 327 2,578 Non-Tuberculous 50 42 215 Totals 111 369 2,793 734 visits were made by the Dispensary Nurses in connection with these cases during the year. (9323)q e 50 Report of the Medical Officer of Health. Contacts—Of the 1,358 new cases examined, 489 were contacts. Eleven of these were found to be suffering from tuberculosis. Care CoMiMiTTEE.—In November, 1916, the Wandsworth Borough Council, acting on the suggestion of the Ministry of Health, appointed an Interim Tuberculosis Care Committee. Upon the suggestion of the London County Council, the subject was further considered, and a permanent Tuberculosis Care Committee of a representative character was appointed. In November, 1922, letters were received from the Ministry of Health and the London County Council approving the appointment of the permanent Tuberculosis Care Committee for the Borough. In previous years the custom was for the full Care Committee to meet once a month—with additional meetings of the Sub-Committees on alternate fortnights. During 1922, however, it was found necessary to hold weekly meetings of the full committee alternately at the Wandsworth and Balham Dispensaries. In addition, arrangements have been made for dealing, in consultation with the Tuberculosis Officer, with urgent matters arising between meetings of the Care Committee. In December, 1922, the Committee was unfortunate in losing the services of Miss F. Walker, who has fulfilled the duties of Hon. Secretary since the inception of the Care Committee Scheme. Mr. A. R. Watson, who has had considerable experience in social welfare work, was appointed as successor to Miss Walker. Most of the charitable institutions in the neighbourhood are represented on the Committee, and much valuable assistance has been rendered to the necessitous patients. The help given by the representatives of the Charity Organisation Society and the Invalid Children's Aid Association in arranging for the treatment of adults and children in Convalescent Homes, and in other directions, has been invaluable. Increasing co-operation with local charitable institutions has tended to extend the activities of the Committee, and has provided much useful information regarding dispensary cases. Forty-one advanced cases have been visited regularly at their own homes by Care Committee Visitors in addition to those patients visited by the Dispensary Nurses. Medical and nursing requisites, such as water-beds, air and water cushions, bed-rests, feeding-cups, 51 Report of the Medical Officer of Health. &c., have been gradually acquired by the Committee, and these articles are provided on loan to necessitous cases. Members of the Committee have also kept in touch with those Dispensary patients who enter St. James' Hospital, 62 of these cases having been visited weekly during the year. These visits are greatly appreciated by the patients. Two beds have been bought by the Committee, and these are of great value in minimising the risk of infection in homes where there is insufficient bed accommodation, One of these has been in constant use in one of the shelters supplied by the Borough Council. Articles of clothing have been supplied to patients in need of it, especially to patients entering institutions. During the year under review it has been found more difficult to obtain suitable employment for patients. The girl patients who were placed as Probationers in Sanatoria last year are still going on with their training, one having been transferred to a General Hospital in Devon to complete her training as a Nurse. Suitable employment has been found with a local firm of gardeners for two young men, and both are making very satisfactory progress. Various other temporary situations—such as jobbing gardening for men, and house or needle work for women—have been found from time to time. Further efforts were made during the year to raise funds for the maintenance of beds for advanced cases of tuberculosis at St. Columba's Hospital, Hampstead. Largely through the instrumentality of Mrs. Nicol, the "Streatham New Players" Amateur Dramatic Society gave several performances at the Congregational Church Hall, Streatham, and the amount raised by this means was £103. A small Sale of Work arranged by Miss Moores, one of the Dispensary Nurses, realised £20 in aid of this fund. As a result of such voluntary efforts, one or more beds have been in use continuously during the year. As there is always great difficulty in arranging for institutional treatment under the London County Council's Scherrle for very advanced cases who are too ill to be treated at home, the beds maintained at St. Columba's Home by this voluntary fund have been of the greatest service. All patients treated in this home have been very grateful for the care and attention given to them. (9323jq e 2 52 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, 1,310 specimens being examined, compared with 1,054 in 1921, 601 in 1920, and 204 in 1919. Of these, 260 or 19-85 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 XXXIV. shows the number of new cases and total attendances at each of the Dispensaries for the ten years during which they have been open. Table XXXIV. New Cases and Total Attendances. New Cases. Total Attendances. Year. Wandsworth. Balhara. Total. Wandsworth. Balham. Total. 1913 707 219 926 4,009 1,169 5,178 1914 664 303 967 4,991 2,573 7,564 1915 430 287 717 3,888 2,661 6,549 1916 628 445 1,073 5,480 3,906 9,386 1917 739 476 1,215 6,992 5,576 12,568 1918 752 603 1,355 9,223 7,821 17,044 1919 994 728 1,722 9,981 8,241 18,222 1920 1,091 595 1,686 7,633 5,019 12,652 1921 1,015 540 1,555 6,554 3,955 10,509 1922 846 512 1,358 5,038 3,184 8,222 Totals 7,866 4,708 12,574 63,789 44,105 107,894 Classification of Cases.—In Table XXXV. all patients examined during the ten years have been placed in one or other of three groups:— (1) Definite cases of tuberculosis— This group is divided according to the site of the lesion, into pulmonary cases (the lungs being affected) 53 Report of the Medical Officer of Health. and non-pulmonary cases (the disease affecting organs other than the lungs). Each of these divisions is further subdivided according as the disease was or was not of an active nature. (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 XXXV. 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 1,073 1917 289 35 73 4 14 • 800 1,215 1918 365 63 114 13 7 793 1,355 1919 371 54 91 10 17 1,179 1,722 1920 321 43 109 14 14 1,185 1,686 1921 301 58 36 7 12 1,141 1,555 1922 217 29 51 8 21 1,032 1,358 Totals 2,823 448 597 88 115 8,503 12,574 54 Report of the Medical Officer of Health. 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, 1922:— (1) No. of admissions to the Poor Law Institutions 2,962 (2) No. of medical orders given 2,682 (3) Average No. of persons in receipt of outdoor relief 6,471 (4) Amount of outdoor relief given £98,693 The total number of deaths in Poor Law Institutions was 806, or 21.4 per cent, of the total deaths. Of these, only six deaths occurred in a Poor Law Institution in the Borough, and 800 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. 55 Report of the Medical Officer of Health. Table XXXVI. 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. 785 King's College Hospital 14 Fountain Mental Hospital 4 Banstead Mental Hospital 13 London Hospital 4 Springfield Mental Hospital 2 Bethlem Royal Hospital 2 Middlesex Hospital 9 Swaffield Road Institution 6 Camberwell House Mental Hosp. 3 Ministry of Pensions Hospital, Tooting Bee Mental Hospital 9 Cane Hill Mental Hospital 13 Brixton 6 Caterham Mental Hospital 6 National Hospital 3 Other Hospitals— Chelsea Infirmary 2 Queen Mary's Hospital 3 Grove Hospital 59 Colney Hatch Mental Hospital . 4 Royal Free Hospital 2 Hostel of God 5 Dartford Heath Mental Hospital 2 Royal Waterloo Hospital 2 Putney Hospital 14 Fulham Infirmary 3 St. Bartholomew's Hospital 3 South London Hosp. for Women 12 Hanwell Mental Hospital 3 St. Columba's Hospital 12 Weir Hospital 18 Horton Mental Hospital 12 St. George's Hospital 4 Lambeth Infirmary 2 St. Mary's Hospital 2 Other Institutions, etc.— Leavesden Mental Hospital 9 St. Thomas's Hospital 44 Wandsworth Borough Memorial Long Grove Mental Hospital 31 University College Hospital 5 Maternity Home 6 Westminster Infirmary 4 Victoria Hospital 16 Other Places not Public Other Poor Law Institutions 4 West London Hospital 6 tions 16 Other Mental Institutions 9 Westminster Hospital 9 On Street 9 Park Hospital 7 River Thames 1 Other Hospitals— South Western Hospital 22 Nursing Homes 52 Battersea General Hospital 2 Western Hospital 5 Belgrave Hospital 16 213 Bolingbroke Hospital 16 Brompton Hospital 5 Other Institutions, etc.— Cancer Hospital 5 Other Institutions 52 Charing Cross Hospital 16 Other Places not Public tutions 87 Chelsea Hospital for Women 4 Clapham Maternity Hospital 5 On Street 18 Collindale Hospital 10 River Thames 3 Gt. Ormonde Street Hospital 4 Private Nursing Homes 25 Guy's Hospital 10 Homoeopathic Hospital 3 1,368 Infants' Hospital 2 56 Report of the Medical Officer of Health. Vaccination. No vaccination or re-vaccination was performed by the Medical Officer of Health under the Public Health (Small-pox) Regulations during the year. Table XXXVII is taken from the official returns of the Vaccination Officers to the Board of Guardians for the year 1921. 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 XXXVII. Sub-Districts. Number of Births returned from 1st January to 31st December, 1921. 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 1,064 534 5 .. 47 352 10 14 50 52 Putney 413 285 3 .. 22 79 5 12 4 3 Streatham 2,858 1,096 5 .. 118 1,039 17 163 164 256 Wandsworth 1,726 947 6 .. 81 505 16 20 73 78 totals 6,061 2,862 19 — 268 1,975 48 209 291 389 The percentage of children vaccinated to total births was only 47.2, 50.1 in Clapham, 69 in Putney, 38.3 in Streatham, etc., and 54.8 in Wandsworth. Scabies. The names of 30 school children, eight from Clapham, two from Putney, three from Streatham, five from Tooting, and 12 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 57 Report of the Medical Officer of Health. were being treated at the London County Council cleansing stations. In 11 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, 41 other cases 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. Disinfection. The total number of rooms disinfected after the occurrence of cases of infectious disease was 5,554 (946 in Clapham, 437 in Putney, 1,434 in Streatham, 781 in Tooting, and 1,956 in Wandsworth). Five public and four private elementary schools were also disinfected on account of various infectious diseases. 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 £2,702 10s. 1d. The number of lots of bedding stoved was 2,446 Cost per lot of bedding £1 2s. 1d. 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. MATERNITY AND CHILD WELFARE. 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., 5,570, 4,521 or 81.1 per cent, were visited, compared with 77.18 per cent, in 1921. The following table summarises the work of the Health Visitors during the year in the various wards of the Borough. 58 Table XXXVIII. Year ended December 31st, 1922. Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. North Ward. South Ward. Balham Ward. Streatham Ward. Southfield Ward. Fairfield Ward. Springfield Ward. Births— Visits 547 370 325 640 595 639 420 298 687 4,521 Re-visits 686 562 507 1,163 330 302 477 216 339 4,582 Children— 1 to 2 years— Visits 7 10 21 22 79 15 6 1 8 169 Re-visits 195 132 121 80 159 59 33 24 87 890 Children— 2 to 5 years— Visits .. .. 33 46 41 20 .. .. 5 145 Re-visits 35 38 262 256 138 202 129 iis 242 1,420 Ante-natal visits 64 40 28 153 55 84 32 30 96 582 Puerperal fever— Visits 5 4 5 2 3 5 1 1 9 35 Re-visits .. .. 5 1 2 .. .. .. .. 8 Ophthalmia neonatorum— Visits 18 3 2 6 13 6 .. 7 1 56 Re-visits 4 .. 2 18 8 5 .. 9 1 47 Pneumonia— Visits 13 8 22 7 9 26 11 16 47 159 Re-visits 1 .. 9 .. 1 2 4 2 19 Enteritis— Visits .. .. 1 .. .. 3 .. .. 1 5 Re-visits .. .. .. .. •• .. .. .. 2 2 Report of the Medical Officer of Health. Table XXXVIII.—continued. Year ended December 31st, 1922. Clapham. Putney. Streatham. Tooting. Wandsworth. Borough. North Ward. South Ward. Balham Ward. Streatham Ward. Southfield Ward. Fairfield Ward. Springfield. Ward. Measles— Visits 29 30 19 41 41 57 43 24 96 380 Re-visits 7 2 1 1 6 3 3 23 Whooping CoughVisits— 47 26 33 66 36 76 48 33 79 444 Re-visits 11 2 5 2 6 5 4 2 37 Investigation of death of infants 43 15 24 41 22 43 31 32 45 296 Attendance at Infant Welfare Centres 107 .. 53 101 96 102 58 49 54 620 Attendance at Ante-natal Centres 16 .. 22 28 29 35 21 27 178 Committee meetings 5 .. 15 5 9 23 13 13 6 89 Visits re supply of milk and food 9 8 31 107 122 22 37 39 23 398 Visits re dental treatment .. .. 1 9 1 3 .. .. .. 14 Visits to creches .. .. 53 18 .. 30 .. 31 .. 132 Health talks to mothers 53 .. 17 7 28 40 2 3 3 153 Miscellaneous visits 65 25 26 169 114 56 54 74 40 623 Ineffectual visits 302 186 382 556 217 255 284 214 244 2,640 T otal 2,269 1,461 2,025 3,545 2,160 2,118 1,704 1,236 2,149 18,667 Nuisances reported to Medical Officer of Health 36 27 •• 35 4 46 26 28 52 254 Report of the Medical Officer of Health. 59 60 Report of the Medical Officer of Health. Infant Visiting. The total number of visits and re-visits was 9,103, of which 4,521 were first visits, compared with 4,760 in the previous year. The re-visits numbered 4,582 as against 4,878. At the first visit 3,668 were entirely breast-fed, 351 were breastfed supplemented by artificial feeding, and the remainder were entirely bottle fed. On re-visiting 2,223 were found to be entirely breast-fed, 1,180 were breast-fed supplemented by artificial feeding, and the remainder were otherwise fed. 133 of the infants visited died during the year (34 in Clapham, seven in Putney, 23 in Balham, four in Streatham, 21 in Tooting, and 44 in Wandsworth). 122 of the infants visited were prematurely born, and 98 were delicate from birth, 90 twin-births were visited, of whom 10 died. With regard to the employment of midwives, 1,645 mothers had employed their services, 776 infants were born in hospital, maternity homes and other institutions, and two unregistered women were employed. In 2,098 births, doctors have been in attendance. 169 children between the ages of one and two years were visited and 890 were re-visited; 145 children between the ages of two and five years were visited, and 1,420 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 169 children under two years of age, and 145 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 582 as against 491 in 1921. 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, 31 intimation notices were served by the two Health Visitors, who are also Sanitary Inspectors. Report of the Medical Officer of Health. 61 Table XXXIX. Clapham North. Clapham South. Putney. Balham. Streatham. Tooting. Southfield. Fairfield. Springfield. Borough. Infants visited 547 370 325 640 595 639 420 298 687 4,521 Breast-fed 465 318 257 532 478 499 330 259 530 3,668 Otherwise fed 82 52 68 108 117 140 90 39 157 853 Infants re-visited 686 562 507 1,163 330 302 477 216 339 4,582 Breast-fed 211 215 209 516 219 130 252 91 122 1,965 Otherwise fed 475 347 298 647 111 172 225 125 217 2,617 Table XL. Deaths of Infants Visited. Under 1 month. Under 2 months. Under 3 months. Under 4 months. Under 5 months. Under 6 months. Under 7 months. Under 8 months. Under 9 months. Under 10 months. Under 11 months. Under 12 months. Total. Clapham North 3 3 3 1 3 3 .. 1 3 2 4 .. 26 Clapham South 1 .. 1 4 .. 1 1 .. .. .. .. .. 8 Putney .. 2 .. .. 1 2 1 1 .. .. 7 Balham 2 5 1 .. 4 2 2 2 1 .. 2 2 23 Streatham .. 1 2 .. .. .. .. .. .. .. .. 1 4 Tooting .. 3 3 3 2 1 .. 1 1 1 3 3 21 Southfield .. 1 3 .. 2 1 1 .. .. 2 2 .. 12 Fairfield 1 .. 1 1 1 2 1 1 2 1 2 .. 13 Springfield .. .. 2 3 .. .. 2 7 2 2 .. 1 19 Borough 7 15 16 12 12 10 8 14 10 9 13 7 133 62 Report of the Medical Officer of Health. Mid wives. 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 30 midwives practising in the Borough, of whom nine reside in neighbouring districts. Nurses. Arrangements have been made with various nursing associations in the Borough to attend cases of ophthalmia neonatorum, measles, whooping-cough, diarrhoea, and pneumonia following influenza, measles, or whooping-cough, when and as requested by the Medical Officer of Health at a fee of Is. 3d, per visit. 2,457 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 31 private maternity homes in the Borough, nine of which are carried on by practising midwives. Wandsworth Borough Memorial Maternity Home. During the year 398 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 no deaths of mothers occurred. 63 (1) Total number of cases admitted. 398 (Doctor engaged for eight prior to admission). (2) Average duration of stay 15.41 days (3) No. of cases delivered by:— (a) Midwives 362 (b) Doctors 36 (4) No. of cases in which medical assistance was sought by the midwife 88 Reason for medical assistance. (a) Ante-natal 13:— Small measurements 8 Albuminuria 5 (b) During labour 37:— Prolonged 18 Feeble pulse 1 Placenta praevia 2 Abnormal presentation 5 Rigid cervix 1 Adherent Placenta 1 Laceration 9 (c) After labour 14:— Post-partum haemorrhage 2 Broncho pneumonia 1 Puerperal Mania 1 Eclampsia 1 Rise of Temperature 9 (d) For infant 24:— Feebleness 14 Deformities 2 P.U.O 1 Discharge from eyes 6 Bronchial catarrh 1 Report of the Medical Officer of Health. 64 Report of the Medical Officer of Health. (5) No. of cases notified as puerperal sepsis with result of treatment in each case Nil. (6) No. of cases in which temperature rose above 100.4 for 24 hours with rise of pulse rate 9 (7) No. of cases notified as ophthalmia neonatorum with result of treatment in each case Nil. (8) No. of cases of " inflammation of the eyes " however slight 6 (9) No. of infants not entirely breast-fed while in the institution. Cause—insufficient lactation 25 (10) No. of maternal deaths with causes Nil. (11) No. of foetal deaths (still-born or within 10 days of birth) 10 The causes of death were:— Placenta praevia 1 Difficult labour 1 Induction 1 Knot in cord 1 Hydrocephalus 1 Macerated 4 Prolonged labour „ 1 The cases came from all parts of the Borough ; 39 from Clapham, 13 from Putney, 110 from Balham, 41 from Streatham, 71 from Tooting, and 116 from Wandsworth, and eight cases belonging to other places. These eight cases were admitted when the Home was not fully occupied. The greater number of the cases were admitted, as would have been anticipated, from those parts of the Borough nearest the Home. Report of the Medical Officer of Health. 65 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 5s. per week. No child is admitted free except in cases of extreme poverty. One hundred and seventeen infants passed through the hospital during the year, the average stay being 37 days. The complaints from which they suffered were marasmus (47), debility, malnutrition, gastritis, constipation, enteritis, diarrhoea and vomiting, colitis, indigestion, bronchitis, pneumonia, prematurity, congenital heart-disease, insomnia, mongolian cretin, meningitis, nephritis, septic rash, and congenital syphilis. Seventy-four cases were discharged in good health, 16 had improved, and in two cases there was no improvement. Eleven babies died, four from marasmus, one from marasmus and meningitis, one from pneumonia and tonsillitis, one from pneumonia and enteritis, one from pneumonia and influenza, two from acute enteritis, and one from congenital heart-disease. Fifty-four of the 117 cases belonged to the Borough (Clapham, four; Putney, one; Balham, eight; Streatham, 33; Tooting, seven; and Wandsworth, one). Of these, six died, the causes of death being marasmus, three; marasmus and meningitis, pneumonia and influenza, and acute gastritis. There are three institutions in the Borough for the reception of expectant unmarried mothers, all in connection with rescue work. The mothers are received a few months prior to 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, where the mothers learn glove and stocking making in the home, seven mothers were received during the year. In (9323)q t 66 Report of the Medical Officer of Health. another, 128 mothers passed through the home during the year, the number of births being 120. In the fourth, 18 mothers passed through the home, the number of births being nine. 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. Twelve mothers and 12 babies passed through the home during the year, the home being closed for six months. 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. Still-Births. Investigations were made into the cases of 57 still-births, seven of which were premature and 25 were difficult labours, 22 were delivered by midwives, 11 occurred in institutions, and 24 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, 12 mothers with infants, and two children: were sent to Convalescent Homes. Five mothers and infants were sent to the Mothers' Rest Home, Hampstead, five mothers and infants to the Burnett Cottage Home, Heme Bay, one mother and two children to the Church Army Home, Bexhill, one mother tothe Catherine Gladstone Home, Mitcham, and one child to the Marjorie Lumley Home, Maidenhead. Illegitimate Births. Of the 188 illegitimate births belonging to the Borough, 112 have been visited, 13 were above the standard of visiting, 22 had removed before visit, nine died before visit, eight were boarded out under the London County Council, three were adopted, 10 mothers and children went to homes, four wrong addresses were given, and seven of the mothers came to the Borough for confinement only. Of the 112 visited, four died. In the majority of cases no assistance was. required, as arrangements had been made for the care of the children. Report of the Medical Officer of Health. 67 Maternity and Child Welfare Centres. There are now eight Infant Welfare Centres in the Borough. Each Centre has a medical officer and a trained Superintendent ; but all the work connected with the keeping of records, the purchase and sale of food and drugs, and of clothing, is done by voluntary workers, who are most regular and efficient. Infants and children up to five years of age are admitted. They are weighed at every attendance, seen by the doctor when necessary, and reports concerning their progress are recorded. The superintendent visits the homes of the children to see that the doctor's instructions are carried out. No visiting by untrained workers is, allowed. In Putney an Ante-natal Centre was started in January, and now each Centre, with the exception of Fairfield, has a separate session for ante-natal work; from Fairfield the mothers go to the Springfield Ante-natal Clinic in Earlsfield Road. The next Table summarises the work done at all the Centres. There were 2,340 new cases registered during the year, the total number of attendances was 34,969, 79 were transferred to other Centres, 1,036 were passed on to the London County Council, and 84 died. The total number of ante-natal cases on the registers during 1922 was 653, the attendances numbering 1,631. The superintendents' visits to infants totalled 10,793, and to ante-natal cases 1,166. 294 health talks were given. In Clapham needlework classes were held at each session of the ante-natal clinic throughout the year, and of the Infant Clinic for nine months. In Putney a course of 12 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, (9323)q F 2 68 Report of the Medical Officer of Health. At Springfield Infant Welfare Centre 14 needlework classes were held in the spring, and a course of 10 Health lectures was given in the autumn. The mothers from the Southfield and Fairfield Infant Welfare Centres attended both these courses. 620 attendances were made by the Health Visitors to the Infant Clinics, and 178 to the ante-natal clinics. One of the Health Visitors is a member of the local committee of each Infant Welfare Centre, and the Medical Officer of Health is ex-officio a member of the General Council, whose function is to co-ordinate the work of the Centres. 153 health talks were given by the Health Visitors during the year. Table XLI. Clapham. Putney. Balham. Streatham. Tooting. Southfield. Fairfield. Springfield. Totals. No. of new cases during 1922 382 197 384 277 443 153 173 331 2,340 „ transferred to other Centres 12 5 22 .. 6 4 2 28 79 „ dead 15 3 26 6 10 7 6 11 84 ,, passed on to L.C.C. 126 82 117 46 295 6 .. 364 1,036 „ of Attendances 7,137 2,960 6,352 5,763 6,171 1,901 1,579 3,106 34,969 ,, of ante-natal cases 67 50 118 96 160 57 .. 105 653 „ of ante-natal attendances 181 143 246 241 435 157 .. 228 1,631 „ of nurses' visits to infants 1,422 941 1.674 2,470 1,371 675 780 1,460 10,793 „ of nurses' visits to antenatal cases 136 111 273 154 84 65 93 250 1,166 ,, of sessions— Infants 96 50 104 97 98 50 51 50 596 Ante-natal 12 24 24 27 25 24 .. 24 160 „ of health talks given 80 25 66 21 60 24 6 12 294 Report of the Medical Officer of Health. 69 Creches. There are four creches in the Borough—Putney, Balham, Tooting and Wandsworth. Children are admitted whose mothers are obliged to go out to work, or who are ill, or who for any other reasonable cause are unable to look after their children. The creches are voluntary institutions subsidised by grants from the Borough Council and the Board of Education. The parents' payments vary from 8d. to Is. 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 creche 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. 132 inspections of the creches were made during the year by the Health Visitors, who represent the Medical Officer of Health on the Committees. The attendances were:—In Putney, 5,477; in Balham, 6,511; in Tooting, 4,099; and in Wandsworth, 5,898; a total of 21,985, a decrease of 3,422 compared with 1921. Dental Treatment. In May, 1919, the arrangements made by the Council with the British Dentists' Hospital, Clapham Common, came into force. 61 cases (46 women and 15 children) availed themselves of the opportunity to have dental treatment, and 79 attendances (61 women and 18 children) were made during the year. Two 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. 70 Report of the Medical Officer of Health. Puerperal Fever. Three deaths occurred, compared with one in 1921. The death rate was .009 per 1,000, and the case mortality 17 per cent. There were 17 cases of puerperal fever notified (four inClapham, two in Putney, five in Streatham, two in Tooting, and four in Wandsworth). Four were midwives' cases, two were stillborn, four were miscarriages, and three were born before the doctor or midwife arrived. Six patients were removed to hospitals and six to St. James's Infirmary, and five cases occurred in nursing homes. Five of the cases proved fatal. Ophthalmia Neonatorum. 42 cases were notified, of which 10 were in Clapham, two in Putney, 20 in Streatham, three in Tooting, and seven in Wandsworth. All the cases were visited. 21 were attended at birth by midwives, and 15 cases occurred in maternity homes (one in Clapham, one in Putney, 12 in Streatham, and one in Tooting). Six cases were treated in hospital as out-patients, 16 as inpatients, and the remainder were treated at home. 24 cases were notified by midwives. In 10 cases the district nurse was asked to attend, and 103 visits were made. Report of the Medical Officer of Health. 71 Table XLlI.—Ophthalmia Neonatorum, 1922. No. Date of Notification. Eye Affected. Severe or Slight. Where Treated or by Whom. History of Specific Disease. Result. l Jan. 14 Both Slight Private doctor and district nurse ? Recovered. 2 „ 19 Left Severe Private doctor No ,, 3 ,,21 ,, „ St. Margaret's Hospital (in-patient) ,, ,, 4 ,,23 Right Slight Maternity Home ,, ,, 5 ,,23 Left ,, ,, ,, ,, 6 ,,24 Right Severe St. Margaret's Hospital (in-patient) ,, ,, 7 Feb. 3 Both ,, ,, ,, ,,» ,, Still under treatment. 8 ,,16 Left ,, ,, ,, ,,» Yes Recovered. 9 Mar. 1 Both Slight Private doctor and district nurse No ,, 10 „ 3 „ St. Margaret's Hospital (in patient) ? ,, 11 „ 3 Left ,, ,, ,, ,,» Yes.. ,, 12 „ 9 ,, Private doctor ? ,, 13 ,,29 Both Severe Private doctor and district nurse ? ,, 14 „ 31 Slight Private doctor No ,, 72 Report of the Medical Officer of Health. Table XLII—continued. No. Date of Notification. Eye Affected. Severe or Slight. Where Treated or by Whom. History of Specific Disease. Result. 15 Mar. 31 Both Slight Private doctor and district nurse No Recovered. 16 April 5 Right ,, Maternity Home ,, ,, 17 ,, 6 Both Severe Royal Eye Hospital (out-patient) ,, ,, 18 ,, 13 ,, Slight Private doctor and district nurse ,, ,, 19 „ 22 Left Severe St. Thomas's Hospital (in-patient) ,, Died 25/4/22, cong. heart disease and br. pneumonia. 20 May 10 Right Slight St. Margaret's Hospital (in-patient) Yes.. Recovered. 21 „ 11 Left ,, Private doctor No ,, 22 „ 18 Both ,, St. Thomas's Hospital (out-patient) ? ,, 23 . ,,25 Right Severe St. Margaret's Hospital (in-patient) ? ,, 24 ,,26 Both Slight Private doctor and district nurse No ,, 25 ,,27 ,, .. St. Thomas's Hospital (out-patient), and district nurse. ,, ,, 26 July 29 Both Severe St. Margaret's Hospital (in-patient) Yes.. ,, 27 „ 31 ,, Slight „ No »» 28 „ 31 ,, ,, ,, ,, Report of the Medical Officer of Health. 73 Table XLII—continued. No. Date of Notification. Eye Affected. Severe or Slight. Where Treated or by Whom. History of Specific Disease. Result. 29 July 31 Both Severe St. Margaret's Hospital (in-patient) No Recovered. 30 ,,31 .. „ Private doctor and district nurse .,, ,, 31 Aug. 1 Left Slight Maternity Home ,, ,, 32 „ 8 Both Severe St. Margaret's Hospital (in-patient) ,, ,, 33 ,,15 ,, ,, ,, ,, ,, ,, ,, 34 Sept. 25 Right Slight ,, ,, ,, Yes ,, Left Severe 35 Oct. 2 Both Slight Private doctor No ,, 36 „ 3 Left Severe St. Margaret's Hospital (in-patient), ? ,, Kight Slight private doctor and district nurse. 37 ,,25 Both Severe St. Margaret's Hospital (in-patient) No 38 Nov. 11 ,, Private doctor and district nurse ? Died 14/11/22, br. pneumonia. 39 „ 22 ,, Slight Private doctor No Recovered. 40 „ 24 ,, „ Maternity Home ? ,, 41 „ 28 ,, ,, St. Thomas's Hospital (out-patient), and district nurse. No ,, 42 Dec. 11 ,, „ Private doctor and district nurse ? Still under treatment. 74 Report of the Medical Officer of Health. Measles. 380 visits and 23 re-visits were made by the Health Visitors in respect of measles. The services of the district nurses were requisitioned in 27 cases (nine in Clapham, two in Streatham, five in Tooting, and 11 in Wandsworth), where bronchitis or pneumonia had set in. The nurses' visits totalled 332. Whooping Cough. 444 visits and 37 re-visits were made by the Health Visitors in cases of whooping cough. In nine cases (five in Clapham and four in Wandsworth) district nurses were called in, and their visits numbered 284. Epidemic Diarrhoea. In all the deaths under one year from diarrhoea and enteritis, special inquiries were made, and the following Table shows the nature of the food given :— Table XLIII. Method of Feeding. Age in Months. Under 1. 1 and under 3. 3 and under 6. 6 and under 9. 9 and under 12. Total. 1. Breast-fed only- 2 2 .. .. .. 4 Do. and dried milk .. 1 .. .. .. 1 2. Cows' milk only .. 1 .. .. .. 1 Do. and dried milk .. 2 .. .. o Do. and food .. 1 .. .. 1 3. Condensed milk only .. .. 1 .. 1 2 Do. and food .. .. .. 1 .. 1 4. Dried milk only .. .. 1 .. 1 2 5. Unknown .. .. 3 2 .. 5 Totals 2 5 7 3 2 19 75 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 XLIV. Clapham North. Clapham South. Putney. Streatham. Balham. Tooting. Southfield. Fairfield. Springfield. Borough. Total No. of Deaths 3 .. 1 9 .. 5 4 1 •• 19 Wholly breast-fed 1 .... .. .. .. 2 1 •• •• 4 Otherwisw fed 2 .. 1 .. .. 3 2 .. •• 11 No information •• •• •• 2 •• •• 1 1 •• 4 Previously visited- 1922 •• •• •• •• •• •• 1 2 2 •• •• 6 •• •• •• •• •• 1 •• •• •• 2 Breast-fed •• •• •• •• •• •• •• •• •• •• Otherwise fed 2 •• •• •• 1 3 2 •• •• 8 Illegitimate •• •• 1 •• 1 •• •• •• 2 Nurse children •• •• •• •• 1 •• •• •• •• 1 Born outside Borough •• •• 1 •• 1 •• •• •• •• 2 Premature •• •• •• •• •• •• •• •• •• •• Delicate from birth 1 •• 1 •• 2 •• 1 •• •• 5 Twin children •• •• •• •• •• •• 1 •• •• 1 Home Helps. The services of a Home Help have been obtained in connection with the Infant Welfare Centres of the Southfield, Fairfield and Springfield Wards of Wandsworth. The woman is paid 30s. a week, with outdoor uniform and overall, fares being allowed up to 2s. 6d. 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. 76 Report of the Medical Officer of Health. 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 nursing mothers, to expectant mothers during the last three months of pregnancy, and to infants and children up to 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, a 1 lb. packet of dried milk is supplied weekly to an expectant or nursing mother, and to a child under three years of age. In special cases cows' milk is supplied on production of a medical certificate. Two pints of milk, or its equivalent in dried milk, is the maximum amount granted to one family. Cases in which the average income was slightly over the scale and there was need of extra milk, were supplied with milk or dried milk at half cost. During 1922 1,067 familes were supplied with free milk at a cost to the Borouerh Council of /l .845 13s. 3d. In 20 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. s. d. s. d. 1 13 0 15 0 2 10 6 12 6 3 8 6 10 0 4 7 6 8 6 5 7 0 8 0 6 6 6 7 6 77 Report of the Medical Officer of Health. 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. Number of— Families 186 49 210 180 147 84 75 136 1.067 Expectant mothers 38 6 43 30 18 10 5 13 163 Nursing mothers 69 23 56 75 95 29 41 22 410 Infants 121 34 158 103 60 53 33 71 633 Children over 3 years 20 2 8 11 2 2 2 4 51 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. SANITARY INSPECTION OF DISTRICT. The two following reports were made by Dr. P. Caldwell Smith to the Public Health Committee :— 11th May, 1922. " I have made a special inspection of the River Wandle and have to report that little improvement has taken place in its condition. This is wholly, in my opinion, due to the foul condition of the Wandle Valley sewage effluent, and until this effluent has been purified no improvement can be expected. 78 Report of the Medical Officer of Health. The cleansing carried out by the London County Council removed a large amount of the foul deposit in the bed of the river, but this deposit is again accumulating and in some places is as great as it was at the date of my last report. I understand that the Ministry of Health has sanctioned the scheme for dealing with the effluent from the Wandle Valley Board, but it will be some time before the works can be commenced. The nuisance from the smell still exists, and I am of opinion that the condition is a menace to the health of the neighbourhood." 6th July, 1922 " Having carefully reconsidered the question, I am still of opinion that mere spraying of the banks of the River Wandle with efther a larvicide or with paraffin would not be of much service in stopping or even to any great extent mitigating the extreme prevalence of mosquitoes (Culex pipiens) in the Wandle area. It would be necessary to carry out much more extensive operations to free this area even for a season from the mosquitoes, among them being the cutting and burning of all grass near the Wandle, the purification of the Wandle itself and some of the few remaining ditches running into it, the use of a larvicide in the water vans to destroy thoroughly all larvae in street gullies, the cleansing of the house gutters in the affected area, and also the abolition of the sewage farms in the neighbourhood. The cost of carrying out the more complete scheme would be very great and would not, in my opinion, justify its adoption. The works already carried out by the Wandsworth Borough Council on the banks of the Wandle at the Southfields Park will improve matters in that area, and if the whole of the Wandle up to the Corruganza Works were dealt with in the same way, I am of opinion that a very marked improvement would be noticed. 79 Report of the Medical Officer of Health. The thorough cleansing of the Wandle by the London County Council is very important and should be carried out at an early date. This cleansing would require to be carried out every six months until the scheme for purification of the effluent of the Wandle Valley Sewage Board has been completed. I had previously consulted the highest authorities at the Natural History Museum, and they were of opinion that mere spraying of the ponds and ditches, as well as the banks of the Wandle, would not do much to mitigate the nuisance. Culex pipiens, the mosquito most prevalent, is not known to produce any definite disease, although it causes a good deal of discomfort to many persons. No other variety of mosquitoes has been found in the Wandsworth district, although in parts of Wimbledon Common outside the Borough other varieties have been detected. The ponds on Wimbledon Common are quite free from larvae and require no attention, with one exception, viz., the " Leg of Mutton Pond," which should be cleansed, as well as some of the ditches leading to and from this pond. I have been informed by the Clerk to the Wimbledon and Putney Commons Conservators that the various ponds and damp places have already recently been sprayed with paraffin." 80 Report of the Medical Officer of Health. Table XLV.—Summary of Sanitary Operations in the Borough during the Year 1922. - Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. North Ward. South Ward. Streatham Ward. Balham Ward. Southfield Ward. Fairfield Ward. Springfield Ward. Number of complaints received and attended to 494 499 474 859 671 897 546 288 488 5,216 Number of houses and premises inspected 3,053 2,323 3,154 4,720 4,105 3,684 3,184 2,136 4,077 30,436 Number of houses and premises re-inspected 1,954 2,953 3,520 4,204 3,364 3,398 2,610 1,950 2,068 26,021 Number of house-tohouse inspections 86 262 408 686 487 327 228 67 163 2,714 Number of preliminary notices served 695 681 991 1,295 1,087 1,015 847 521 1,028 8,160 Number of preliminary notices complied with 664 745 946 1,312 1,092 845 829 552 903 7,888 Number of statutory notices served 107 113 79 76 93 85 97 45 126 821 Number of statutory notices complied with 80 93 74 59 89 30 88 47 123 683 Notices served for periodical removal of manure .. .. .. .. .. .. .. .. .. .. Number of rooms disinfected after infective diseases 581 365 437 691 743 781 481 494 981 5,554 Bedding stoved 218 228 210 289 323 283 302 164 429 2,446 Overcrowding abated 8 3 10 3 4 15 3 .. 2 48 Rooms cleansed and repaired 875 819 1,290 1,979 1,912 1,381 954 746 1,356 11,312 Staircases cleansed and repaired 113 292 296 447 395 299 203 184 348 2,577 Drains cleansed and repaired 47 98 126 92 95 87 96 51 92 784 Drains tested 270 184 515 794 306 281 395 208 554 3,507 Drains found defective 35 14 51 32 76 70 42 24 79 423 Traps fixed to drains 30 54 12 7 32 4 8 .. .. 147 Bath. lavatory and sink wastes altered to discharge outside over gullies or repaired 22 34 73 59 69 50 48 33 95 483 Rain water pipes disconnected from drains 3 .. 9 .. 6 .. .. 1 5 24 Water closets cleansed and repaired 132 243 208 331 396 237 145 187 256 2,135 81 Report of the Medical Officer of Health. Table XLV—continued. -— Clapham. Putney. Streatham. Tooting. Wandsworth. Whole Borough. North Ward. South Ward. Streatham Ward. Balham Ward. Southfield Ward. Fairfield Ward. Springfield Ward. Water closets, separate supply of water laid on to •• •• •• •• 1 •• 3 •• •• 4 Accumulations of manure, etc., removed 5 1 27 55 31 14 20 30 28 211 Urinals cleansed, repaired or water laid on to 4 •• 7 16 6 14 1 1 •• 49 Cesspools abolished •• •• •• •• •• •• •• •• 2 2 Ashpits provided or repaired 104 102 133 149 174 152 81 44 162 1,101 Dust complaints received 7 21 37 23 10 4 21 16 31 170 Stables and stable yards drained, paved or cleansed 8 15 9 15 4 1 1 4 12 69 Yards drained, paved or cleansed 52 89 120 109 76 137 48 72 162 865 Unwholesome or dilapidated houses cleansed or repaired 5 3 13 2 2 6 •• •• 31 Leaky roofs and gutters repaired 176 209 185 322 253 186 150 141 356 1,978 Damp courses inserted 4 21 25 40 27 7 15 16 7 162 Damp conditions remedied 56 92 228 221 92 208 190 159 192 1,438 Houses re-supplied with water 12 11 32 18 8 6 11 •• 11 109 Water cisterns cleansed, covered or repaired 12 22 113 28 25 21 15 13 65 314 Animals kept so as to be a nuisance 5 3 7 28 4 4 4 2 21 78 Smoke nuisances reported 2 •• 1 •• 2 •• •• 12 3 20 Soil pipes repaired 6 17 52 12 48 38 6 9 6 194 Unclassified nuisances 68 138 159 160 142 162 267 222 218 1,536 (9323)Q 82 Report of the Medical Officer of Health. Table XLVI.—Details of Inspections and Re-inspections, 1922. (Male Inspectors.) Inspections. ReIn spections. Total. No. of complaints received and attended to 5,210 •• 5,210 No. of house-to-house inspections.. 2,714 •• 2,714 Drainage and other sanitary works— After notice 4,620 24,329 28,949 Voluntary 542 658 1,200 No. of premises inspected on account of— Notifiable diseases 3,860 •• 3,860 Measles 1,380 •• 1,380 Whooping Cough 374 •• 374 Pulmonary Tuberculosis 53 •• 53 Other Infective Diseases 514 •• 514 Verminous conditions 318 •• 318 Periodical Inspections— Houses let in Lodgings 545 •• 545 Closed underground rooms 1 •• 1 Common lodging houses 5 •• 5 Workplaces— Factories 344 133 477 Workshops 595 121 716 ,, (Domestic) 149 46 195 Workplaces 141 94 235 Outworkers' premises 91 36 127 Bakehouses 268 258 526 Restaurant kitchens 155 5 160 Food-places— Cowsheds 12 ••. 12 Piggeries 91 18 109 Dairies and Milkshops 542 19 561 Ice Cream Premises 370 6 376 83 Report of the Medical Officer of Health. Table XLVI—continued. Inspections.! ReIn spections. Total. Periodical Inspections— Food-places— Slaughterhouses 122 •• 122 Places where food is prepared 60 •• 60 Offensive trades 53 1 54 Fried fish shops 180 4 184 Rag and bone stores 49 •• 49 Butchers' shops 316 •• 316 Greengrocers' shops 155 •• 155 Fishmongers' shops 198 •• 198 Public-house urinals 255 •• 255 Other sanitary conveniences, schools, etc. 66 •• 66 Smoke observations 49 49 Unsound food 27 1 28 Yards of mews and stables... 286 7 293 Legal Proceedings— (1) Applications and summonses 28 •• 28 (2) Hearings and adjournments 68 •• 68 Other 1,663 12 1,675 Totals 26,469 25,748 52,217 (9323) G 2 84 Report of the Medical Officer of Health. Table XLVII.—Details of Inspections and Re-inspections, 1922. (Female Inspectors.) Inspections. Re-Inspections. Total. No. of complaints received and attended to 6 6 No. of premises inspected on account of— Pulmonary Tuberculosis 1,464 137 1,601 Other forms of T uberculosis 559 41 600 Dressmakers' and Milliners' premises 265 16 281 Laundries— Factory 109 6 115 Workshop 100 6 106 Workplace 67 11 78 Other Factories 99 4 103 Other Workshops 148 4 152 Other Workplaces 159 3 162 Domestic Workshops 68 •• 68 Outworkers' premises 522 11 533 Other 401 34 435 Totals 3,967 273 4,240 85 Report of the Medical Officer of Health. HOUSING, TOWN PLANNING, &c., ACT, 1909. Table XLVIII. 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 86 84 97.67 32 52 27 57 Clapham, South 262 237 90.45 8 19 32 233 Putney 408 392 96.07 34 41 252 215 Streatham 686 541 78.86 37 97 430 581 Balham 487 438 89.93 99 177 277 417 Tooting 327 305 93.27 37 52 70 281 Southfield 228 176 77.19 56 25 79 173 Fairfield 67 55 82.09 25 11 4 45 Springfield 163 130 79.75 56 54 50 84 Whole Borough .. 2,714 2,358 86.88 384 528 1,221 1,986 The cases of overcrowding were in Peardon Street, Milford Street, The Polygon, Kirkby Street, Saxby Street, Carpenter's Cottages, Haselrigge Road and Cambray Road, Clapham ; Gladwyn Road, Pentlow Street, Angel Court, Bendemere Road, Sefton Street and Ashlone Road, Putney ; Welham Road, Colmer Road, Kettering Street, Martindale Road and Hereward Road, Streatham ; Blackshaw Road, Graveney Road, Maybury Street and Fountain Road, Tooting ; Astonville Street, Lavenham Road, Burr Road, Guelph Street and Lydden Grove, Wandsworth. 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 86 Report of the Medical Officer of Health. 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, 2,714 houseto-house inspections were made by the Sanitary Inspectors, and in 2,358 nuisances were found necessitating the service of sanitary notices. The total number of houses where the drains were reconstructed during the year was 138 ; 42 in Clapham, 25 in Putney, 19 in Streatham, three in Tooting, and 49 in Wandsworth. During the year 3,507 drains of houses were tested by the Sanitary Inspectors ; 454 in Clapham, 515 in Putney, 1,100 in Streatham, 281 in Tooting, and 1,157 in Wandsworth, and 423, or 12 06 per cent., were found to be defective. Of the 423 found defective, 49 were in Clapham, 51 in Putney, 108 in Streatham, 70 in Tooting, and 145 in Wandsworth. A large amount of work has again been carried out to abate nuisances arising from damp conditions. In all, 1,438 premises have been dealt with ; 148 in Clapham, 228 in Putney, 313 in Streatham, 208 in Tooting, and 541 in Wandsworth ; and in 162 of these, 25 in Clapham, 25 in Putney, 67 in Streatham, seven in Tooting, and 38 in Wandsworth, damp courses have been inserted. Removal of House Refuse. During the year no alteration has been made in the system of removal. The whole of the refuse is now collected and disposed of by contract, with the exception of a portion from the Balham, Streatham and Tooting Wards, which is disposed of at the Destructor. 109 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 £122 3s., and the costs £11 8s. 6d. 87 Report of the Medical Officer of Health, Table XLIX. Premises. Offences. Result. Fine. Costs. s. d. s. d. 12, Heathfield Road, Wandsworth Keeping swine in an improper manner. Convicted 80 0 14, Clapham Park Terrace Nuisances Order made for abatement of nuisance. •• •• 10 6 92, Trentham Street, Wandsworth .. •• Summons withdrawn, the work having been done. •• •• 3 0 94, Trentham Street, Wandsworth .. •• •• •• 3 0 73, Manor Street, Clapham •• Summons dismissed. . •• •• 280, Trinity Road, Wandsworth •• Summons withdrawn, the work having been done. •• •• 10 6 121, New Park Road, Clapham •• •• •• 10 6 94, Gauden Road, Clapham Absence of a water supply Summons withdrawn, the work having been done. •• •• 2 0 27, 29 and 35, Gay Street, Putney .. Nuisances •• •• •• 6 0 27, Gay Street, Putney Contravention of By-laws (yard r\o cr\ Convicted 40 0 •• •• 143, Brookwood Road, Wandsworth paving;. Contravention of By-laws (cistern cover). •• 40 0 •• •• 62, Union Grove, Clapham Nuisances Summons withdrawn, the work having been done. •• •• 2 0 29, Bromells Road, Clapham •• .. •• •• 2 0 55, Wimbledon Park Road, Wandsworth. •• •• •• •• 2 0 46, Victoria Road, Clapham .. •• Order made for abatement of nuisance. •• •• 10 6 •• Non-compliance with Order 20 0 •• •• „ Contravention of By-laws (w.cs. and cistern cover). Convicted 40 0 •• •• 36 and 37, Deauville Court, Clapham Nuisances Summons withdrawn, the work having been done. •• •• 4 0 88 Report of the Medical Officer of Health. Table XLIX—continued. Premises. Offences. Result. Fine. Costs. s. d. s. d. 25, Grove Road, Balham (stable) Absence of a water supply Order made for abatement of nuisance. 5 0 Non-compliance with Order 20 0 2 0 >> .. „ Contravention of By-laws (w.cs.).. Convicted 80 0 21 0 76, Gleneagle Road, Streatham Nuisances .. 100 0 21 0 40, Balham High Road, Streatham .. 100 0 2 0 Contravention of By-laws (yard paving and w.cs.). 200 0 4 0 23, Bellamy Street, Balham Nuisances Order made for abatement of nuisance. 10 6 54, Rosebery Road, Clapham .. 10 6 1a, 2a, and 3a, Gonsalva Road, >> »> «» • • . . 63 0 Clapham. Non-compliance with Order 63 0 42 0 44, Jew's Row, Wandsworth Order made for abatement of nuisance. 10 6 Non-compliance with Order 100 0 21 0 Stable, Skelgill Road, Wandsworth . . Nuisances Order made for abatement of nuisance. 10 6 30, Deauville Court, Clapham Contravention of By-laws (w.cs.).. Convicted 20 0 2 0 34, Deauville Court, Clapham Nuisances Summons withdrawn, the work having been done. • The Osiers, Point Pleasant Establishing anew the business of a fat melter. Adjourned sine die 3, 5, and 8, Clarke's Cottages, Clapham Nuisances Summons withdrawn, the work having been done. 8 0 Contravention of By-laws (yard paving). Convicted 100 0 2, Nursery Street, Clapham Nuisances Summons withdrawn, the work having been done. 2 0 89 Report of the Medical Officer of Health. Table XLIX—continued. Premises. Offences, Result. Fine. Costs. 11, Gonsalva Road, Clapham N uisances Order made for abatement of nuisance. s. d. s. 2 d. 0 7, Portslade Road, Clapham •• •• •• •• •• 21 0 13, Portslade Road, Clapham.. ,, .. ,, •• •• 21 0 Contravention of By-laws (w.cs.)... Convicted 100 0 •• •• 17, Lessar Avenue, Clapham Nuisances Order made for abatement of nuisance. •• •• 21 0 Non-compliance with Order 140 0 21 0 125, High Street, Clapham Order made for abatement of nuisance. •• •• 10 6 9, Earlsfield Road, Wandsworth Non-compliance with Order Order made for abatement of nuisance. 60 0 21 0 Contravention of By-laws (yard paving). Convicted 100 0 •• •• 43, Chetwode Road, Balham Nuisance 200 0 •• •• 14 and 16, Chelverton Road, Putney Nuisances Contravention of By-laws (yard paving). Summonses dismissed ; defendant not the owner. •• •• •• •• 23, Ram Square, Wandsworth Convicted 20 0 21 0 28, Clifton Street, Clapham Nuisances Order made for abatement of •• •• 21 0 nuisance. Non-compliance with Order 50 0 2 0 Contravention of By-laws (yard paving). Convicted 20 0 21 0 10, Fitzwilliam Road, Clapham Nuisances Order made for abatement of •• •• 21 0 72 and 74, Wellfield Road, Streatham nuisance. •• •• 42 0 90 Report of the Medical Officer of Health. Table XLIX—continued. Premises. Offences. Result. Fine. Costs. s. d. s. d. 29, Saxby Street, Clapham Nuisances Summons withdrawn, the work having been done. •• •• •• •• Failing to provide dustbin Convicted 100 0 •• •• Contravention of By-laws (yard paving). 25 0 •• •• 31, Saxby Street, Clapham Nuisances Summons withdrawn, the work having been done. •• •• •• •• Failing to provide dustbin Convicted 100 0 •• •• 115, Balham High Road Selling milk without being registered. 100 0 •• 0 33, Saxby Street, Clapham Nuisances Summons withdrawn, the work having been done. •• •• •• •• Failing to provide dustbin Convicted 100 0 •• •• 35, Saxby Street, Clapham Nuisances Summons withdrawn, the work having been done. •• •• •• •• Failing to provide dustbin Convicted 100 0 •• •• 37, Saxby Street, Clapham Nuisances Summons withdrawn, the work having been done. •• •• •• •• Failing to provide dustbin Convicted 100 0 •• •• Contravention of By-laws (yard paving). 25 0 •• •• 39, Saxby Street, Clapham Nuisances Summons withdrawn, the work having been done. •• •• •• •• Failing to provide dustbin Convicted 100 0 •• •• 91 Report of the Medical Officer of Heaitn. Underground Rooms. There are now no rooms, as far as is known, which do not comply with the Regulations made by the Council in 1911. It was not necessary to take any action, as in former years inspections of these were made and the necessary alterations carried out. FACTORIES AND WORKSHOPS. There has been an increase in the total number of inspections of the above, compared with 1921, although the number of factories, etc., on the Register is less. 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. 92 Report of the Medical Officer of Health. ■ ■■ ■ INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Table L. Class of Works. Number of Places. Number of Inspections, 1922. Number of Notices. Number of Prosecutions, 1922. On Register at end of 1921. Added in 1922. Removed in 1922. On Register at end of 1922. Intimation, 1922. Statutory, 1922. Under Factory Act. Under Public Health Act. Premises. Rooms. Factories— Factory Laundries 75 1 •• 76 301 134 1 •• •• •• Factory Bakehouses 61 2 63 84 209 3 •• •• •• Other Factories 420 34 14 440 1,362 621 45 2 •• •• Workshops— Workshop Laundries 68 •• 6 62 192 106 3 •• •• •• Workshop Bakehouses 72 1 2 71 71 317 6 •• •• •• Other Workshops .. .. ,. 1,059 88 89 1,058 1,468 1,412 100 5 •• •• Workplaces— Places where Food is prepared for Sale 543 57 64 536 567 638 45 1 •• •• Workplaces other than the above 412 36 74 374 482 377 26 2 •• •• Home-workers' premises 453 112 143 422 422 660 22 •• •• Total 3,163 331 392 3,102 4,949 4,474 251 10 •• •• 93 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 LI. I.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (Including Factory Laundries.) 964 51 •• Workshops (Including Workshop Laundries.) 1,835 114 •• Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) 1,015 74 •• Totals 3,814 239 •• 94 Report of the Medical Officer of Health. Table LI I. 2.—DEFECTS FOUND. Particulars. (1) Number of Defects. (5)Number of Prosecutions. Found. (2) Remedied. (3) Referred to H.m. Inspector. (4) Nuisances under the Public Health Acts*— Want of cleanliness 103 100 Want of ventilation •• .. •• •• Overcrowding • • .. •• •• Want of drainage of floors .. .. •• •• Other nuisances 125 121 •• •• Sanitary accommodation— Insufficient 4 4 •• . . Unsuitable or defective 81 79 •• •• Not separate for sexes 3 3 •• •• Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse (S. 101) . . , . •• •• Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 9 9 •• •• Other offences (Excluding offences relating to outwork, which are included in Part 3 of this Report.) •• •• •• •• Totals.. 325 316 •• •• * 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 Homework, is similar to the one in last year's Report. C/l >3 0 o*. «s«. c> a § r> nj >4 tc 01 a 5*1 M. J** Table LIII. 3.—HOME WORK. Nature of Work.* (1) Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Lists received from Employers. Notices served on occupiers as to keeping or sending lists. (8) Prosecutions. Sending twice in the year. Sending once in the year. Failing to ^ keep or permit inspection of lists. Failing to 3 send lists. ~ Instances. £3 Notices served. ~ Prosecutions. £ Instances. — Orders made ■2 (S. 110). — Prosecutions ■$ (SS. 109, 110). .jo Lists.f Ou t workers, t 2 Lists. Outworkers. Contractors. (3) Workmen. (4) Contractors. (6) Workmen. (7) Wearing Apparel— (1) Making, etc. 66 85 165 4 1 52 38 22 22 16 (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 70 89 171 4 1 52 38 22 22 16 96 Report of the Medical Officer of Health. The total number of addresses received from other Councils was 579, and 180 addresses were forwarded to other Councils. The number of addresses received has increased by 95, and the number sent decreased by five. 21 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 38, and these had a most satisfactory result. During the year 39 cases of infective diseases—10 of Scarlet Fever, three of Diphtheria, 20 of Measles, one of Erysipelas, and five 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 LIV. 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. * 'Workshop Bakehouses 71 „ Laundries 62 Dressmakers' and Milliners' Workshops ., 153 Bootmakers 101 Smiths 35 Builders 54 T ailors 58 Motor Engineers 44 ^Other 613 Total number of workshops on Register 1,191 97 Report of the Medical Officer of Health. Table LV. 5.—OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories :—- Failure to affix Abstract of the Factory and Workshop Act (s. 133) •• 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 5 Reports of action taken sent to H.M. Inspector 5 Other •• Underground Bakehouses (s. 101):— Certificates granted during the year •• In use at the end of the year 43 Inspection of Sanitary Conveniences. The number of Sanitary Conveniences inspected was 135 ; 22 in Clapham, 26 in Putney, 25 in Streatham, 11 in Tooting, and 51 in Wandsworth. 281 inspections were made during the year, and 22 notices, chiefly for cleansing, were served and complied with ; and 110 inspections of Sanitary Conveniences for females were made by the Female Sanitary Inspectors. Canal Boats Act. During the year five 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. Increase of Rent and Mortgage Interest (Restrictions) Act, 1920. 140 applications for Certificates under the above Act were received during the year. On inspection it was found that 131 (9323)q H 98 Report of the Medical Officer of Health. of the premises were not reasonably fit for human habitation, and Certificates were granted, and nine premises were reasonably fit, and Certificates were consequently not granted. Of the 131 premises where Certificates were granted, 125 were rendered reasonably fit during the year, and the remaining six are in hand. 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 3-52 per cent., compared with 3-56 in 1921. 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 238 milk retailers on the Register, and these have been regularly inspected during the year. Particulars of these are given in Table LVI. During the year under review the Milk and Dairies (Amendment) Act, 1922, came into operation. This Act prohibits the sale of milk from cows suffering from Tuberculosis of the udder. Five samples of milk were examined, and certificates received stated that in each case the examination revealed no evidence of the presence of Tubercle Bacilli. 99 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, 1922. 1. Milk and cream not sold as " Preserved Cream." (a) Number of samples examined for the presence of a preservative. (b) Number in which a preservative was reported to be present. Milk 958 Nil. Cream 29 5 The five samples of Cream contained crystallised boric acid. The vendors were warned, and a further sample was 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 15 (2) Statements incorrect 1 Total 16 As the percentage of boric acid found in the above-mentioned sample of preserved cream was only slightly in excess of .4 per cent., the vendor was warned, and a further sample procured, which was found correct. (9323)q H 2 100 Report of the Medical Officer of Health. Percentage of Preservative found in each sample. Percentage stated on Statutory Label. Range from .1 to .4 per cent. .4 per cent. Note.—One sample reported against contained .46 per cent. crystallised boric acid. (b) Determination made of milk fat in Cream sold as " Preserved Cream " :— (1) Above 35 per cent 16 (2) Below 35 per cent. — Total 16 (c) and (d). In each of the 16 samples procured as Preserved Cream the provisions as to labelling were duly observed. Thickening substances ... ... ... ... Nil. Other observations.—All the above-mentioned samples were procured as informal samples under the Sale of Food and Drugs Acts. Appeal to the Cow. In one case proceedings were taken against a cowkeeper for selling milk deficient in milk fat to the extent of 7 per cent. The defendant stated that the deficiency was due to the interval of milking. This was tested and found correct. The summons was dismissed on payment of costs, the defendant promising to regulate the interval of milking more evenly. Section 4, Milk and Dairies (Amendment) Act, 1922. Cases of contravention of this Section were dealt with under the Sale of Food and Drugs Acts. 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. 122 inspections of the 10 slaughterhouses were made during the year, and 2,338 carcases were examined by the Inspectors. Report of the Medical Officer of Health. 101 No action has been taken with regard to unsound meat, and no carcases were condemned during the year. By far the greater proportion of the meat sold in the Borough has been inspected in the Central Markets before being sold to retailers. In 1914. In January, 1922. In December, 1922. Licensed slaughterhouses 13 10 9 Unsound Food. 116 boxes of Tomatoes ; one bag of Turnips; 4 tons and 11 cwts. of Potatoes; three boxes of Apples; one crate of Bananas; five cases of Pears; 24 tins of Peaches; five hampers of Wiches; five trunks of Haddock; 763 lbs. of Cod; three baskets of Crabs; one box of Herrings; one box of Whiting ; one box of Soles ; one trunk of Skate; 22 lbs. of Hake; 88 lbs. of Beef; 312 lbs. of Pork; 600 Eggs, and 1,224 lbs. Chocolate were condemned at the request of the owners, and the usual certificates granted. Table LVI. Premises. Number of Places. Number of inspections, 1922. Number of notices, 1922. Number of prosecutions, 1922. On register at end of 1921. Added in 1922. Removed in 1922. On register at end of 1922. Milk premises 240 43 45 238 561 19 .. Cowsheds 3 .. .. 3 12 .. .. Slaughterhouses 10 .. 1 9 122 .. .. Other offensive trade premises 3 .. .. 3 53 1 .. Ice cream premises 316 30 22 324 366 26 .. Registered houses let in lodgings 292 .. .. 292 545 6* 429† .. 1 * For overcrowding. † For other conditions. 102 Report of the Medical Officer of Health. Statement of Work done under the Sale of Food and Drugs Acts. During the year 1,989 samples of foods and drugs were submitted to the Public Analyst for analysis. Of these samples, 1,044 were purchased as test or informal samples, while 945 were purchased officially. Of the 945 official samples submitted for analysis, 35, or 3-7 per cent., were reported to be adulterated or not up to standard, and of those samples which were purchased informally or as test samples, 67, or 6.4 per cent., were found adulterated or not up to standard. The total adulterations reported were 102, or 5.1 per cent., of the samples submitted. The percentage of milk samples found to be adulterated was 2.8. In 19 out of the 35 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 £32 10s., and the costs to £11 13s., making a total of £44 3s. 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 LVII. — 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. Percentage Adulterated. Clapham 192 13 6.7 168 7 4.1 360 5.8 20 5.5 Putney 99 6 6.0 102 3 2.9 201 6.7 9 4.4 Streatham 313 18 5.7 282 12 4.2 595 5.5 30 5.0 Tooting 136 10 7.3 106 4 3.7 242 5.8 14 5.7 Wandsworth 304 20 6.5 287 9 3.1 591 5.9 29 4.8 Whole Borough 1,044 67 6.4 945 35 3.7 1,989 5.9 102 5.1 Report of the Medical Officer of Health. 103 Milk and Cream. MILK. 958 samples of milk were procured for analysis during the year. 27, or 2.8 per cent., were reported against as being adulterated or not up to legal standard. 930 samples were purchased officially, of which 25, or 2.6 per cent., were adulterated, and 28 samples purchased informally, of which two, or 7.2 per cent., were adulterated. Nine samples were found to contain added water, 15 were deficient in milk fat, and one was deficient in milk fat and contained added water. Proceedings were taken in nine cases, and in 16 cases the Public Health Committee, after considering the amount of adulteration and the circumstances of sale, decided not to prosecute the vendors, but to take further samples. 16 samples of milk were taken on delivery at various Public Institutions situated within the Borough. All these samples were genuine. 54 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 midnight and mid-day deliveries. Six samples were reported against, and in one case proceedings were taken against the farmer, who pleaded warranty. Three samples of milk were procured during the early morning from wholesale dealers whilst delivering milk to the retailer. These samples were genuine. Five samples of milk were procured on delivery at private houses. One sample was reported against. 140 samples of milk have been taken on Sundays, either in the early morning or at mid-day. Three, or 2.1 per cent., were reported against as being adulterated. 421 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 16, or 3.9 per cent., were reported against. 104 Report of the Medical Officer of Health. Butter and Margarine. BUTTER. 483 samples of butter were submitted for analysis during the year, of which 13 were reported against. MARGARINE. 16 samples of margarine were submitted for analysis, one of which was reported against. OTHER ARTICLES. A full list of the articles of food and drugs examined under the Sale of Eood and Drugs Acts, together with the analytical results is contained in the Report of the Public Analyst. Staff. The staff at the end of the year was as follows:— Public Health Department— Medical Officer of Health P. Caldwell Smith, M.A., M.D., D.P.H. Assistant Medical Officer of Health and Tuberculosis Officer F. G. Caley, M.A., M.B., D.P.H. Sanitary Inspectors A. W. Browne, Cert. R.S.I. ; Meat and other Foods, R.S.I. H. E. Brown, Do. do. R. Brown, Cert. R.S.I. W. G. Crabbe, Do. C. Hatton, Do. F. Haworth, Cert. S.I.E. Board. H. T. Lambert, Cert. S.I.E. Board; Meat and other Foods, R.S.I. B. Nurcombe, Cert. R.S.I. J. A. Sands, Cert. S.I.E. Board. A. E. Vickers, Do. A. J. Weeks, Cert. R.S.I. Inspector under Sale of Food and Drugs Act T. Newell, Cert. R.S.I.; and Meat and other Foods, R.S.I. Report of the Medical Officer of Health. 105 Public Health Department—continued. Assistant Inspector under Sale of Food and Drugs Acts C. W. Idle, Cert. S.I.E. Board. Female Sanitary Inspectors Miss J. E. Barritt, Cert. S.I.E. and Health Visitors (part- Board and R.S.I. time). Miss K. L. Long, Cert. S.I.E. Board. Health Visitors Miss E. Henderson, C.M.B., H.V., Trained Nurse. Miss M. E. Maple, S.I.E. Board, H.V. Miss R. M. Watling, C.M.B., H.V., Trained Nurse. Miss E. K. Woods, C.M.B., H.V., Cert. R.S.I. Clerical Staff 7 Clerks and 1 Office Boy. Tuberculosis Department— Tuberculosis Officer See Assistant Medical Officer of Health. Assistant Do A. W. Forrest, M.A., M.D., D.P.H. Tuberculosis Visitors Miss D. S. Collins, S.I.E. Board, H.V. Miss E. E. Merron. Miss D. Moores. Clerical Staff One Clerk and Dispenser and One Clerk. Maternity Home— Matron Miss E. Waring, C.M.B. Two Sisters. One Staff Nurse. Six Midwifery Probationary Nurses. One Gardener Attendant. Disinfecting Station One Engineer and 10 Disinfec- tors. Mortuaries One whole-time, and two part- time, Mortuary Keepers. 106 Report of the Medical Officer of Health. Chemical Work. All the necessary chemical work, analysis of food and drugs, rag flock and water, is carried out by the Public Analyst, Mr. A. H. M. Muter, F.I.C., F.C.S. Bacteriological Examinations. During the year 1,369 bacteriological examinations were made at the Lister Institute. The following Table shows the number of examinations in each sub-district and for the whole Borough, also the disease for which the examination was made, and the result of such examination:— Table LVIII. Clapham Putney. Streatham. Tooting. Wandsworth. Whole Borough Diphtheria— • Negative 250 115 297 51 356 1,069 Positive 46 34 62 26 110 278 Enteric Fever— Negative • • 1 4 2 3 10 Positive • • 1 • • • • • • 1 Tuberculosis– Negative 4 1 2 • • • • 7 Positive 1 1 1 • • 1 4 Totals 301 153 366 79 470 1,369 Examinations of sputum made at the Tuberculosis Dispensary are not included in the above figures. 107 Report of the Medical Officer of Health. 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. 19 samples were procured and submitted for analysis. All these were reported as complying with the standard of cleanliness required. 13 Certificates have been issued in respect of the sterilisation of materials used in the manufacture of Rag Flock. Revenue Act. During the year nine certificates were granted under the above Act. The certificates granted referred to 26 houses or 36 tenements. Cleansing of Persons Act. The names of 218 children, 61 belonging to Clapham, 13 to Putney, 16 to Streatham, seven to Tooting, and 121 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 81 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. 44 adults and two children had baths on account of their verminous condition, 41 of these being cases of scabies. Cutting-off Notices. During the year, 129 notices with respect to 156 premises were received from the Water Board stating that the supply had been withdrawn. 29 of the premises were in Clapham, 19 in Putney, 54 in Streatham, seven in Tooting, and 47 in Wandsworth. The supply was withdrawn for non-payment of rates from 77 premises, from 50 premises in consequence of defects, in 27 the premises were empty, and in two cases by request. 108 Report of the Medical Officer of Health. Rateable Value. The rateable value of the Borough, on the 6th April, 1922, was £2,274,272, and the estimated value of a penny rate was £9,157. Housing. It was found at the Census of 1921 that the total number of houses structurally separate for habitation was 62,540, and the total number of rooms occupied was 373,204, the average number of persons per house was 5.2, and the average number of persons per room was .87. 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 846, and the number in course of erection at the end of the year was 48. The action taken by the Borough Council is referred to in more detail in previous reports. Number of new houses erected during the year :— (a) Total 846 (b) As part of a municipal housing scheme 608 1. Unfit Dwelling Houses. Inspection— (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 30,436 (2) Number Of dwelling-houses which were inspected and recorded under the Housing (Inspection of District Regulations, 1910 2,714 109 Report of the Medical Officer of Health. 1. Unfit Dwelling Houses—continued. (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 131 2. Remedy of Defects without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 7,888 3. Action under Statutory Powers. A.—Proceedings under section 28 of the Housing, Town Planning, &c., Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 7 (2) Number of dwelling-houses which were rendered fit (a) by owners 2 (b) by Local Authority in default of owners Nil. (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 821 (2) Number of dwelling-houses in which defects were remedied:— (a) by owners 683 (b) by Local Authority in default of owners Nil. 110 Report of the Medical Officer of Health. 3. Action under Statutory Powers—continued. C.—Proceedings under sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders Nil. (2) Number of dwelling-houses in respect of which Closing Orders were made Nil. (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil. (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. 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, Madam, and Gentlemen, Your obedient Servant, F. G. CALEY. Report of the Medical Officer of Health. 1ll ANNUAL STATEMENT Of the work done in the Borough of Wandsworth under the Sale of Food and Drugs Acts, summarised from the Statutory Quarterly Reports. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Wandsworth. Sir, Madam and Gentlemen, We have the honour to present the Annual Statement of the work done during the year 1922 under the Sale of Food and Drugs Acts. The total number of samples submitted by the Inspector during the year amounted to 1,989. Of these, 945 were taken with the formalities required by the Sale of Food and Drugs Acts, whilst 1,044 were obtained informally. The statement following gives the result of analyses of all articles submitted. In Tables A and B will be found the details of the articles grouped together in the main statement under the headings Drugs and "Other Articles." 112 Report of the Medical Officer of Health. Main Statement showing the Result of Analyses of all Articles Submitted under the Sale of Food and Drugs Acts during the Year 1922 by the Inspector. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Bread .. 6 6 .. .. .. Butter 2 481 483 1 12 13 Cheese .. 2 2 .. .. .. Cocoa .. 73 73 .. .. .. Confectionery and Jam .. 1 1 .. .. .. Cream .. 29 29 .. 5 5 Cream (Preserved) .. 16 16 .. 1 1 Flour, Self-raising 6 6 .. .. Margarine .. 16 16 .. 1 1 Milk 920 4 924 25 2 27 Milk, Separated 10 .. 10 .. .. .. Milk, Condensed .. .. 24 24 .. .. .. Mustard .. 3 3 .. .. .. Sugar .. 11 11 .. .. .. Tea .. 8 8 .. .. Vinegar .. 14 14 .. 1 1 Drugs 13 101 114 9 14 23 Other Articles .. 249 249 .. 31 31 Total 945 1,044 1,989 35 67 102 Table A. Details of Drugs in Foregoing Table. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Acid, Boric .. 3 3 .. .. .. Borax 3 8 11 3 3 6 Camphorated Oil .. 6 6 .. .. .. Cream of Tartar .. 2 2 .. .. .. Mist. Sennas Co. .. 3 3 .. .. .. Ointment, Boric .. 6 6 .. .. .. Powder, Gregory's .. 3 3 .. .. .. Powder, Liquorice Co .. 3 3 .. .. .. Prescriptions 10 58 68 6 11 17 Tincture of Quinine, Ammoniated .. 9 9 .. .. .. Total 13 101 114 9 14 23 Report of the Medical Officer of Health. 113 Table B. Details of " Other Articles " in Foregoing Table. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Baking Powder .. 25 25 .. .. .. Barley .. 3 3 .. .. .. Cake, Sponge .. 12 12 .. 3 3 Coffee .. 24 24 .. .. .. Coffee Extract .. 3 3 .. 1 1 Coffee and Chicory Extract .. 6 6 .. 2 2 Chutney .. 3 3 .. .. .. Dried Fruits .. 6 6 .. .. .. Dripping .. 6 6 .. .. .. Fish, Canned .. 6 6 .. .. 6 Gelatin .. 4 4 .. .. 4 Honey .. 8 8 .. .. .. Ice Cream .. 6 6 .. .. .. Isinglass .. 1 1 .. .. .. Lard .. 34 34 .. .. .. Lemon Cheese 2 2 .... 2 2 Lemon Curd .. 2 2 .. .. .. Meat, Canned .. 1 1 .. .. Meat, Extract .. 10 10 .. .. Meat, Potted .. 15 15 .. 1 1 Olive Oil .. 8 8 .. .. .. Pepper .. 3 3 .. .. .. Powder, Custard . . .. 12 12 .... .. .. PreservedVegetables .. 6 6 .. 6 6 Rice .. 16 16 .. .. .. Sago .. 5 5 .. 1 1 Sausages .. 6 6 .. 2 2 Sherbert .. 6 6 .. .. .. Suet .. 1 1 .. .. .. Suet, with Rice Flour .. 3 3 .. .. .. Tapioca .. 2 2 .. 1 1 Wines, .. .. .. .. .. .. alcoholic .. 4 4 .. 2 2 Total .. 249 249 .. 31 31 114 Report of the Medical Officer of Health. Table C. Table Showing in Detail the Nature of the Adulteration, or Departure from Standard of all Samples (Formal), Adversely Reported on During the Year. Case No. Nature of Sample. Nature of Report. 12 Milk 5 per cent. extraneous water. 51 Milk 1 per cent. milk fat deficient. 86 Milk 1½ per cent. extraneous water and 3½ per cent. milk fat deficient. 112 Milk 11 per cent. milk fat deficient. 114 Milk 2 per cent. extraneous water. 141 Milk 13 per cent. milk fat deficient. 214 Milk 3 per cent. milk fat deficient. 216 Milk 1 per cent. milk fat deficient. 218 Milk 3 per cent. milk fat deficient. 227 Milk 4 per cent. milk fat deficient. 255 Milk 3 per cent. extraneous water. 261 Milk 21 per cent. milk fat deficient. 274 Milk 3 per cent. extraneous water. 309 Milk 10 per cent. milk fat deficient. 365 Milk 21 per cent. milk fat deficient. 388 Borax (purified) 135 parts per million excess Arsenic. 389 Borax (purified) 165 parts per million excess Arsenic. 390 Borax (purified) 135 parts per million excess Arsenic. 488 Milk 5 per cent. milk fat deficient. 515 Milk 3 per cent. milk fat deficient. 525 Milk 17 per cent. milk fat deficient. 537 Prescription 32.7 per cent. deficient in Potassium Bromide. 547 Milk 8 per cent. extraneous water. 548 Milk 9 per cent. extraneous water. 593 Prescription 18 per cent. deficient in Potassium Bromide. 595 Prescription 36 per cent. deficient in Potassium Iodide. 598 Prescription : Mist. Hydrarg. Iodid. A sample of dilute Mist. Ferri et Ammon. Cit. 599 Prescription 37.4 per cent. deficient in Potassium Iodide. 600 Prescription 52.8 per cent. deficient in Potassium Iodide. 666 Butter 60 per cent. Margarine. 681 Milk 3 per cent. milk fat deficient. 725 Milk 7 per cent. milk fat deficient. 913 Milk 11 per cent. extraneous water. 915 Milk 8 per cent. extraneous water. 919 Milk 2 per cent. extraneous water. Report of the Medical Officer of Health. 115 Table D. Table Showing in Detail the Nature of the Adulteration of all Informal Samples Adversely Reported on During the Year. Case No. Nature of Sample. Nature of Adulteration. 65 Butter Excess of Boron preservative. 128 Margarine Excess of Boron preservative. 142 Tapioca Sago present. 146 Sago Entirely Tapioca. 361 Borax (purified) Excess of Arsenic above B P. limit. 362 Borax (purified) Excess of Arsenic above B P. limit. 367 Borax (purified) Excess of Arsenic above B.P. limit. 372 Cake Excess of Boron preservative. 385 Cream Boron preservative present. 388 Cream Boron preservative present. 390 Cream Boron preservative present. 455 Cream Boron preservative present. 460 Cream (preserved) Excess of Boron preservative. 492 Prescription Deficiency in active ingredient. 501 Prescription Deficiency in active ingredient. 512 Prescription Deficiency in active ingredient. 517 Prescription Deficiency in active ingredient. 518 Butter Margarine present. 519 Milk Extraneous water present. 545 Prescription Deficiency in active ingredient. 546 Prescription Deficiency in active ingredient. 547 Prescription Deficiency in active ingredient. 548 Prescription Deficiency in active ingredient. 557 Prescription Deficiency in active ingredient. 561 Prescription Deficiency in active ingredient. 562 Prescription Deficiency in active ingredient. 603 Butter Margarine present. 623 Butter Margarine present. 644 Milk Extraneous water present. 649 Butter Margarine present. 656 Butter Excess of Boron preservative. 665 Butter Margarine present. 666 Butter Excess of Boron preservative. 675 Lemon Cheese Salicylate preservative present. 676 Lemon Cheese Salicylate preservative present. 682 Coffee Extract Salicylate preservative present. 684 Coffee and Chicory Salicylate preservative present. tract. 690 Coffee and Chicory Salicylate preservative present. tract. 697 Gelatin Bi-sulphite preservative present. 698 Gelatin Bi-sulphite preservative present. 700 Gelatin Bi-sulphite preservative present. 701 Gelatin Bi-sulphite preservative present. 728 Cream Boron preservative present. 732 Vinegar Deficiency of Acetic Acid. 116 Report of the Medical Officer of Health. Table D—continued. Case No. Nature of Sample. Nature of Adulteration. 820 Tinned Tomatoes Tin present. 821 Tinned Tomatoes Tin present. 822 Tinned Tomatoes Tin present. 823 Tinned Tomatoes Tin present. 824 Tinned Tomatoes Tin present. 825 Tinned Tomatoes Tin present. 826 Tinned Fish in Tomatoes Tin present. 827 Tinned Fish in Tomatoes Tin present. 828 Tinned Fish in Tomatoes Tin present. 829 Tinned Fish in Tomatoes Tin present. 830 Tinned Fish in Tomatoes Tin present. 831 Tinned Fish in Tomatoes Tin present. 839 Sausages Boron preservative present. 840 Sausages Boron preservative present. 848 Meat Paste Boron preservative present. 854 Sponge Cake Boron preservative present. 858 Sponge Cake Boron preservative present. 860 Non-alcoholic Wine Salicylate preservative present. 862 Non-alcoholic Wine Salicylate preservative present. 886 Butter Excess of Boron preservative. 938 Butter Excess of Boron preservative. 960 Butter Excesses of Boron preservative and water. 979 Butter Excesses of Boron preservative and water. The average composition of the 897 samples of milk returned as genuine during the year was as follows:— Per cent. Total milk solidss 12.42 Milk fat 3.52 Non-fatty solids 8.90 All samples of milk submitted were free from preservative. Of the 470 samples of butter examined and reported genuine, 229, or 48.7 per cent., were found to be free from preservative other than common salt; whilst 241, or 51.3 per cent., contained a boron preservative. The average amount of this preservative per sample, expressed as crystallised boric acid, was 0.085 per cent., or 5.95 grains per lb. In all the 16 samples of margarine examined and returned as genuine the presence of boron preservative was detected, the 117 Report of the Medical Officer of Health. quantity present averaging 0.29 per cent., or 20.3 grains per lb. crystallised boric acid. In conclusion, we have to report that the percentage adulteration for the year for all articles submitted amounted to 5.1 per cent., for articles submitted formally to 3.6 per cent., and for articles submitted informally to 6.4 per cent. We have the honour to be, Mr. Mayor, Madam 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 Laboratorv, 325, Kennington Road, S.E.I 1. 5th April, 1923. 118 Index. INDEX. page Alcoholism, Deaths from 35 Analyst, Report of 111 Appendicitis and Typhlitis 35 Bacteriological Examinations 106 Bakehouses 92 Births 3 Births and Birth-rates in Sub-Districts 3 Births, Notification of, Act 5 Brain and Nervous System, Diseases of the 34 Canal Boats Act 97 Cancer 34 " Carrier" Cases 57 Census, 1911 2 Census, 1921 1 Cerebro-Spinal Meningitis 25 Chemical Work 106 Child Birth, Deaths from 35 Circulatory Diseases 34 Clapham, House-to-House Inspections in 85 Cleansing of Persons Act 107 Conscientious Objection Certificates granted 56 Consultation and Treatment Centres 62 Convalescent Homes 66 Cowsheds 101 Creches 69 Cutting-off Notices 107 Death, Causes of 12 Death-rate, Corrected 10 Death-rate, Infantile 16 Deaths, Corrected and Uncorrected 10 Deaths, Number of 5 Deaths in Outlying Institutions 9 Deaths in Public Institutions 6 Index. 119 page Deaths in Public Institutions in the Borough of Persons belonging to the Borough 8 Deaths in Public Institutions in the Borough of Persons not belonging to the Borough 7 Dental Treatmen 46,69 Developmental Diseases 35 Diabetes Mellitus, Deaths from 35 Diarrhoea 26, 27 Diarrhoea, Method of Feeding Children who died from 74, 75 Diphtheria 21 Diphtheria, Number of Dwellings in which multiple Cases occurred 22 Diphtheria, " Return Cases "of 22 Disinfection 57 Disinfection of Schools 57 Dysentery 27 Encephalitis Lethargica 25 Enteric Fever 22 Erysipelas 26 Factories and Workshops 91 Factories, Workshops and Workplaces, Inspection of 92 Food Places, Inspection of 92 German Measles, Cases of 27 Home Helps 75 Home Work 95 Hospitals, etc., for Expectant and Nursing Mothers 65 Hospitals and other forms of gratuitous relief 54 House Refuse, Removal of 86 House-to-house Inspections, Summary of 85 Houses and Premises Inspected 80 Houses Let in Lodgings 101 Housing 108 Housing, Town Planning, etc., Act, 1909 85 Ice Cream Premises 101 Illegitimate Children, Births of 4,66 Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 97 Infant Visiting 60 120 Index. page Infantile Mortality 14, 15 Infective Diseases 16-18 Infective Diseases : Number of Cases notified from Elementary Schools 29-31 Infectious Disease, Prevalence and Control over 17 Influenza, Deaths and Death-rates 32 Influenza, Pneumonia and Acute Primary Pneumonia, Cases Notified 32 Inspections, details of 82-84 Inquests 36-38 Malaria 26 Maternity and Child Welfare 57 Maternity and Child Welfare Centres 67 Maternity Home 62 Measles and German Measles 27, 74 Measles and other Non-notifiable Diseases reported from Schools 29-31 Meat 100 Midwives 62 Milk and Cream Regulations, 1912 99 Milk and Food 76 Milk (Mothers and Children) Order 76 Milk Premises, Cowsheds, etc., on Register 101 Milkshops, Cowsheds, etc., Inspections of 101 Milk Supply 98 Mistaken Diagnosis, Cases of 25 Mortuaries 39 Mosquitoes, Report on 78 Natural Increase, Rate of 3 Nephritis and Bright's disease, Deaths from 25 Nervous System, Diseases of the 34 Non-Infective Diseases, Deaths from 33 Notification of Births Act 5 Notification of Infective Diseases 18 Nursing Arrangements 62 Offensive Trades 101 Old Age 36 Ophthalmia Neonatorum 70 Index. 121 page Other Infective Diseases, Deaths from 33 Outworkers 95 Overcrowding 85 Police Court Proceedings 86 Polio-Myelitis and Polio-Encephalitis 26 Poor Law Relief, Amount of 54 Population 1,2 Population of Sub-Districts 1 Premature Birth 35 Public Institutions, Number of Deaths in 55 Puerperal Fever 70 Pulmonary Tuberculosis, Notification of Cases of 40—44 Putney, House-to-House Inspections in 85 Rag Flock Act, 1911, Statement of Work done under 107 Rateable Value 108 Respiratory Diseases 34 Return Cases of Scarlet Fever and Diphtheria 22 Revenue Act 107 River Wandle, Report on 77 Sale of Food and Drugs Act, Proceedings under 102 Sale of Food and Drugs Act, Statement of Work under 102 Sanitary Conveniences, Inspection of 97 Sanitary Operation, Table of 80 Sanitary Inspection of District 77 Scabies 56 Scarlet Fever 19, 20 Scarlet Fever: Number of Dwellings in which Multiple Cases occurred 20 Scarlet Fever, " Return Cases "of 22 Schools, Disinfection of, for Infective Diseases 57 Slaughter-houses 101 Small-pox 19 Smoke Nuisances 81 Sputum Examinations 52 Staff 104 Still-Births. 66 Streatham, House-to-house Inspections in 85 Tooting, House-to-house Inspections in 85 122 Index. page Trench Fever, Cases Notified 27 Tuberculosis Dispensaries 45 Tuberculosis Care Committee 50 Tuberculous Diseases 39 Tuberculous Diseases, Extra Nourishment provided 46 Underground Rooms 91 Unsound Food 101 Vaccination Returns 56 Violence, Mortality from 36 Vital Statistics of Whole Borough 13 Wandsworth, House-to-house Inspections in 85 Water Supply, Cutting-off Notices 107 Whooping Cough 32, 74 Zymotic Diseases 16