Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, &c. OF THE BOROUGH, For the Year 1923, by F. G. CALEY, M.A., M.B., D.P.H., Medical Officer of Health, together with the Report of the Public Analyst. Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, &c. OF THE BOROUGH, For the Year 1923, 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 SHIELD AND SPRING, 26-28, LANCELOT PLACE, BROMPTON ROAD, S.W. 7. REPORT of the Medical Officer of Health for the Year 1923. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Wandsworth. Sir. Madam and Gentlemen, I have the honour to present my Annual Report on the health and sanitary condition of the Borough for the year 1923. GENERAL AND VITAL STATISTICS FOR THE BOROUGH. Area 9,199 acres Population in 1923 337,823 No. of inhabited houses in 1921 62,540 No. of families, or separate occupiers, in 1921 80,526 Rateable value in 1923 £2,306,716 Estimated produce of a penny rate £9,500 Extracts from Vital Statistics. Births :— Males 2,781 Legitimate 5,254 Females 2,694 Illegitimate 221 Total Births 5,475 Birth-rate 16.20 Total Deaths 3,409 Death-rate 10.09 No. of women dying in, or in consequence of, childbirth:— From sepsis 8 From other causes 6 2 Report of the Medical Officer of Health. Deaths of Infants under one year of age:— Legitimate 259 Illegitimate 29 Total 288 Infantile mortality 52 Deaths from Tuberculosis:— No. of deaths 319 Rate .94 Total deaths from Measles 11 Total deaths from Whooping Cough 30 Total deaths from Diarrhoea (under two years of age) 51 Population. The population, corrected after excluding those inmates of Institutions who do not belong to the Borough, at the middle of the year, was estimated to be 337,823, and all the rates used in this Report are calculated on this figure. The corresponding figure for the year 1922 was 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 1923 Clapham 60,540 61,950 Putney 28,558 30,665 Balham 50,888 52,482 Streatham 52,607 54,624 Tooting 40,135 39,638 Wandsworth 95,579 98,464 Whole Borough 328,307 337,823 Report of the Medical Officer of Health. Births. The total number of births occurring in the Borough was 5223, including 449 non-residents who were born in Institutions. 701 births of Borough residents occurred outside the Borough, so that the corrected number of births was 5,475, compared with 5,570 in 1922. 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. No. of Births. Rates. Males. Females. Total. Birth-rate Rate of natural increase. Clapham 550 552 1102 17.78 6.70 Putney 229 216 445 14.51 5.58 Balham 467 423 890 16.95 6.13 Streatham 385 355 740 13.54 3.33 Tooting 323 325 648 1634 7.21 Wandsworth 827 823 1650 16.75 6.96 Whole Borough 2781 2694 5475 16.20 6.11 The birth-rate was 16.20 per 1,000, compared with 16.68 for 1922, and 18.25 the decennial average. The rate for the whole of London during 1923 was 20.2, and for England and Wales 19.7. 325 illegitimate births took place in the Borough, but only 126 belonged to the Borough. On the other hand 95 illegitimate births belonging to Wandsworth occurred outside the Borough, making a corrected total of illegitimate births belonging to Wands- 4 Report of the Medical Officer of Health. worth of 221. 39 of these belonged to Clapham, 18 to Putney, 47 to Balham, 44 to Streatham, 20 to Tooting, and 53 to Wandsworth. The percentage of illegitimate births to total births was 4 03. 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 the number born dead. TABLE III. Sub-District. Total births registered. Total No. of births notified. Medical Attendant. Notified by: No. born dead. Parent Midwife. Other person. Clapham 1102 807 352 178 260 17 19 Putney 445 359 144 55 159 1 2 Balham 890 1083 214 117 752 — 24 Streatham 740 787 273 187 253 74 20 Tooting 648 507 83 89 322 13 7 Wandsworth 1650 1307 252 671 331 53 20 Whole Borough 5475 4850 1318 1297 2077 158 92 The percentage of births notified, less still-births, to those registered was 88. Deaths. The number of deaths which took place in the Borough during the 52 weeks ending 29th December, 1923 was 2,883, but 769 of these did not belong to the Borough, while 1,294 Borough residents died outside the Borough. Report of the Medical Officer of Health. 5 The corrected number of deaths for the Borough, after allowing for these factors, was 3,408, of whom 1,585 were males and 1,823 females. The corrected death-rate for the year was 10.09, compared with 11.24 in 1922. The death-rate for the whole of London for 1923 was 11.2, for England and Wales 11.6, in the 105 County Boroughs and great Towns 11.6, and in the 157 smaller Towns 106. Table IV. shows the total number of corrected deaths and the death-rates for each sub-district and for the whole Borough. TABLE IV. SubDistricts. Corrected Deaths. Males. Females. Total. Corrected Deathrate. Clapham 312 370 682 11.08 Putney 121 153 274 8.93 Balham 259 309 568 10.82 Streatham 233 325 558 10.21 Tooting 200 162 362 9.13 Wandsworth 460 504 964 9.79 Whole Borough 1585 1823 3408 10.09 Table V. is the general mortality Table for the whole Borough, and shows the corrected number of deaths from each cause divided into sexes, age groups and sub-districts,together with those occurring in Institutions. Report of the Medical Officer of Health. 6 Table V.—Causes of, and Ages at Death, during the Year 1923. 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. Balham. Streatham. Tooting. Wandsworth. Deaths in Public Institutions. Enteric Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 11 5 6 1 4 6 ... ... ... ... ... 2 2 1 1 1 4 8 Scarlet Fever 3 2' 1 ... ... 1 2 ... ... ... ... 1 ... ... 1 ... 1 2 Whooping Cough 30 8 22 14 9 7 ... ... ... ... ... 6 1 3 3 3 14 9 Diphtheria and Membranous Croup 26 18 8 1 1 8 14 2 ... ... ... 1 ... 6 2 3 14 25 Influenza 56 32 24 ... ... ... 1 1 14 21 19 11 3 5 15 5 17 10 Erysipelas 4 ... 4 1 ... ... ... ... ... 1 2 1 ... 1 1 ... 1 2 Cerebro-spinal Fever 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 Other Epidemic Diseases 6 4 2 ... ... ... ... 1 1 3 1 1 ... 1 1 ... 3 3 Pulmonary Tuberculosis 262 128 134 ... ... ... 6 61 106 81 8 52 17 41 43 33 76 129 Tuberculous Meningitis 25 13 12 3 4 6 9 1 2 ... ... 4 2 3 3 3 10 21 Abdominal Tuberculosis 6 3 3 ... 1 ... ... 2 2 1 ... ... 2 ... 1 2 1 4 Other Tuberculous Diseases 26 11 15 4 2 2 1 3 5 4 5 7 2 2 1 3 11 21 Other Infective Diseases 20 12 8 4 ... ... 2 4 4 4 2 1 2 2 ... 6 9 15 Cancer, Malignant Disease 457 194 263 ... 1 ... ... 2 38 206 210 82 48 80 88 46 113 214 Rheumatic Fever 6 3 3 ... ... ... 1 2 1 2 ... ... ... ... 1 3 2 3 Diabetes 39 15 24 ... ... ... 1 ... 3 19 16 12 4 4 7 3 9 8 Other General Diseases 49 16 33 ... 2 ... 1 4 4 17 21 10 4 4 11 5 15 23 Alcoholism 4 3 1 ... ... ... ... ... ... 4 ... 1 ... 1 1 ... 1 5 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 9 4 5 3 l 1 1 ... 1 ... 2 ... ... 2 l 4 4 Cerebral Hæmorrhage, Apoplexy- 178 65 113 ... ... ... ... ... 6 49 123 31 10 40 33 16 48 50 Convulsions 12 8 4 9 3 ... ... ... ... ... ... 4 ... 4 1 2 1 3 Other Diseases of Nervous System 129 71 58 1 1 4 9 7 21 54 32 25 8 15 35 9 37 75 Organic Diseases of Heart 491 201 290 ... ... 1 2 12 33 118 325 106 40 107 71 44 123 215 Other Diseases of Circulatory System 160 80 80 2 ... ... 1 1 14 58 84 30 18 20 35 15 42 46 Bronchitis 249 124 125 20 2 1 ... 1 11 55 159 58 18 34 31 29 79 46 Broncho-Pneumonia 73 34 39 25 7 6 ... ... 4 11 20 18 4 16 9 9 17 28 Lobar Pneumonia 52 27 25 1 ... 1 ... 3 10 17 20 9 5 4 8 5 21 15 Pneumonia (type not distinguished) 64 34 30 6 3 1 4 2 14 20 14 6 2 12 5 9 30 24 Other Diseases of Respiratory System 38 15 23 ... 1 1 ... 5 5 11 15 12 2 6 7 2 9 7 Ulcer of Stomach 19 11 8 ... ... ... ... 2 5 9 3 2 ... 5 5 ... 7 15 Diarrhœa 15 8 7 10 3 ... ... ... 2 ... ... 3 2 ... 1 1 8 10 Enteritis 46 21 25 36 2 2 ... 1 ... 5 ... 12 5 7 4 6 12 28 Appendicitis and Typhlitis 28 17 11 ... ... 3 3 1 8 12 1 7 1 2 5 2 11 28 Obstruction of Intestines 33 10 23 1 1 ... ... ... 3 9 19 4 4 11 4 4 6 22 Cirrhosis of Liver 11 7 4 ... ... ... ... ... 1 6 4 ... 1 2 3 3 2 4 Other Diseases of Liver 19 9 10 ... ... ... 1 1 4 7 6 5 2 3 3 3 3 13 Other Diseases of Digestive System 56 26 30 12 ... 3 ... 3 4 19 15 14 4 6 9 6 17 29 Nephritis and Bright's Disease 132 66 66 ... ... ... 2 4 14 52 60 25 8 28 24 10 37 58 Other Diseases of Urinary System 42 37 5 ... ... ... ... ... 4 8 30 8 2 7 6 5 14 28 Diseases of Generative System 9 ... 9 ... ... ... ... ... 5 3 1 2 2 3 1 ... 1 7 Puerperal Fever 8 ... 8 ... ... ... ... 1 7 ... ... 2 2 2 ... 1 1 8 Other Accidents and Diseases of Pregnancy and Childbirth 6 ... 6 ... ... ... ... 1 5 ... ... 2 ... 1 2 1 ... 3 Premature Birth 55 27 28 55 ... ... ... ... ... ... ... 11 4 11 10 6 13 19 Congenital Debility and Malformation 60 34 26 57 2 1 ... ... ... ... ... 12 4 5 10 10 19 34 Other Diseases of Early Infancy 19 9 10 19 ... ... ... ... ... ... ... 4 2 3 2 3 5 10 Old Age 210 79 131 ... ... ... ... ... ... 1 209 46 19 40 31 21 53 53 Deaths from Accident 84 52 32 2 4 2 10 9 16 18 23 18 12 8 6 13 27 69 Deaths from Suicide 31 24 7 ... ... ... ... 4 7 17 3 7 4 6 6 3 5 17 Other Violent Deaths 4 2 2 ... ... ... ... ... 2 1 1 ... 1 ... 1 1 1 3 Other Defined Diseases 22 12 10 1 1 ... 4 2 2 3 9 4 ... 5 4 4 5 13 Ill-defined Diseases or unknown 12 3 9 ... ... ... ... ... ... 5 7 1 l 1 4 1 4 7 All causes 3408 1585 1823 288 57 57 75 144 388 932 1467 682 274 568 558 362 964 1495 Report of the Medical Officer of Health. 7 Table VI. gives a comparative statement of the birth and death.rates in the Borough for the past 10 years, together with the same rates for London and England and Wales. TABLE VI. Birth.rates. Death.rates. Wandsworth. London. England and Wales. Wandsworth. London. England and Wales. 1913 20.87 24.8 23.9 10.95 14.2 13.7 1914 20.44 24.3 23.8 11.20 14.4 13.7 1915 19.25 25.5 21.8 12.63 16.1 14.8 1916 20.09 21.5 20.9 11.80 14.7 14.4 1917 14.72 17.9 17.8 12.69 15.7 14.4 1918 14.29 16.1 17.7 15.07 18.9 17.6 1919 16.40 18.3 18.5 11.31 13.4 13.8 1920 21.03 26.3 25.4 10.36 12.4 12.4 1921 18.80 22.3 22.4 10.83 12.4 12.1 1922 16.68 21.0 20.6 11.24 13.4 12.9 Average 10 years 18.25 21.8 21.2 11.80 14.5 13.9 1923 16.20 20.2 19.7 10.09 11.2 11.6 The total number of deaths which occurred in Institutions inside the Borough was 970, but 769 of these persons did not belong to the Borough. A total of 1,495 persons belonging to the Borough died in Institutions, 201 occurring in Institutions within the Borough and 1,294 in Institutions outside the Borough. The following is a list of the Institutions outside the Borough in which deaths of Borough residents occurred:— Report of the Medical Officer of Health. 8 Name of Institution. No. of deaths. Name of Institution. No. of Deaths. Poor Law Hospitals and Infirmaries:— Other Hospitals—conld.:— National Hospital 6 Wandsworth Union Infirmary 770 Queen's Hospital, Chisel hurst 3 Banstead Mental Hospital 11 Camberwell House Mental Hospital 2 Royal Free Hospital 3 Royal Waterloo Hospital . 3 Cane Hill Mental Hospital 6 St. Bartholomew's Hospita 9 Caterham Mental Hospital 4 St. Columba's Hospital 11 City of London Mental Hospital 3 St. George's Hospital 7 St. Mary's Hospital 3 Claybury Mental Hospital 2 St. Peter's Hospital 2 Hanwell Mental Hospital 7 St. Thomas's Hospital 45 Horton Mental Hospital . . 6 University College Hospita 2 Lambeth Institution 2 Victoria Hospital 10 Leavesden Mental Hospital 6 West London Hospital 3 Long Grove Mental Hospital 31 Westminster Hospital 4 Other Poor Law Institutions 2 South Western Hospital. Other Institutions, etc. 10 Other Mental Institutions. . 8 Other Hospitals :— Other Institutions 46 Belgrave Hospital 15 Other Places not Public In stitutions Bolingbroke Hospital 21 105 Brompton Hospital 6 On Street 15 Cancer Hospital 5 River Thames 6 Charing Cross Hospital 11 Private Nursing Homes 23 Chelsea Hospital for Women 2 - Collindale Hospital 9 1294 Evelina Hospital 7 Guy's Hospital 17 Institutions inside the Borough 201 Homœpathic Hospital Infants' Hospital 3 3 King's College Hospital 8 1495 Middlesex Hospital 11 Report of the Medical Officer of Health. 9 INFANTILE MORTALITY. The total number of deaths under one year was 288, 56 in Clapham, 18 in Putney, 44 in Balham, 37 in Streatham, 4L in Tooting, and 92 in Wandsworth. As the number of births was 5,475, the Infantile Mortality was 52.5 per 1,000 births. This is the lowest number of deaths under one year of age that has ever occurred in the Borough, and the mortality rate is consequently the lowest recorded. It compares with an average of 78 for the last 10 years. The number of deaths among legitimate infants was 259 to 5,254 births—a mortality of 49 per 1,000 births. The number of deaths among illegitimate infants was 22 to 221 births—a mortality of 131 per 1,000 births. This low number and rate is due to a marked fall in the number of deaths from Measles, Premature Birth and Congenital Malformations, Pneumonia, and Convulsions; there was, however, an increase in the number of deaths from Diarrhoea and Enteritis. Table VII. gives the corrected number of deaths, and the cause of death, at various periods up to one year of age. Report of the Medical Officer of Health. 10 Infant Mortality. 1923. Net Deaths from stated causes at various Ages under 1 Year of Age:— TABLE VII. Cause of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. All Causes:— Certified 86 21 15 7 129 39 52 39 28 287 Uncertified 1 - - - 1 — — - — 1 Small-pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - 1 - - - 1 Scarlet Fever - - - - - - - - - - Whooping Cough — — - - - 1 3 5 5 14 Diphtheria and Croup - - - - - - 1 - - 1 Erysipelas — — - 1 1 — — — — 1 Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - 1 1 1 3 Other Tuberculous Diseases - - - - - - 2 1 1 4 Meningitis(notTuberculous) - - - - - - 1 2 — 3 Convulsions 4 — - - 4 2 1 - 2 9 Laryngitis — — - - — — — - - — Bronchitis 1 2 2 - 5 4 4 6 1 20 Pneumonia (all forms) 3 1 — 1 5 4 10 8 5 32 Diarrhœa — — — - - 1 3 3 3 10 Enteritis - 1 — 1 2 7 13 7 7 36 Gastritis - — — - - 1 3 2 - 6 Syphilis — — 1 - 1 2 — — - 3 Rickets - - - - - - - - - - Suffocation, overlaying - - - - - 1 - - - 1 Injury at birth 3 — — - 3 - - - — 3 Atelectasis 9 — — - 9 1 - — — 10 Congenital Malformations 4 4 2 - 10 1 2 1 - 14 Premature Birth 40 6 3 3 52 3 - - - 55 Atrophy, Debility and Marasmus 17 3 5 1 26 10 4 - 1 41 Other Causes 6 4 2 — 12 — 4 3 2 21 Totals 87 21 15 7 130 39 52 39 28 288 Nett Births in the year: legitimate, 5254; illegitimate, 221. Nett Deaths in the year of legitimate infants, 259; illegitimate infants, 29. Report of the Medical Officer of Health. Table VIII. gives the comparative figures of infantile mortality for the last ten years for the whole of the Borough, and for each of the five Parishes. TABLE VIII. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 1913 82 85 74 91 103 88 1914 76 87 86 114 84 88 1915 92 78 76 104 104 92 1916 70 74 66 109 92 78 1917 74 83 73 110 104 89 1918 107 97 71 99 90 89 1919 65 112 58 58 68 66 1920 63 69 60 69 65 64 1921 66 80 61 79 71 67 1922 63 37 56 81 61 60 Average for 10 years 75 80 68 91 84 78 1923 50 40 49 50 63 55 52 No. of deaths under 1 year, 1923 56 18 44 37 41 92 288 11 Report of the Medical Officer of Health. 13 INFECTIVE DISEASES. The total number of deaths from these diseases was 546, 104 in Clapham, 40 in Putney, 74 in Balham, 77 in Streatham, 68 in Tooting, and 183 in Wandsworth. From all infective diseases the death-rate was 1.61 per 1,000 (1.67 in Clapham, 1.30 in Putney, l.37 in Balham, 1.40 in Streatham, 1.71 in Tooting, and 1.85 in Wandsworth). The rate is much lower than in 1922, owing to the decrease 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; in 1921, 2.26; and in 1922, 2.28. The rate from the principal infective diseases, viz.:—Small-pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever, and Diarrhœa, was .39 per 1,000 (.40 in Clapham, .32 in Putney,.32 in Balham, .21 in Streatham, .35 in Tooting, and .54 in Wandsworth), compared with .74 in 1916, .94 in 1917, .82 in 1918, .42 in 1919, .61 in 1920, .70 in 1921, and .73 in 1922. The rate for 1923 is much lower than in 1922. The decrease compared with 1922 is almost wholly due to the decrease in the number of deaths from Diphtheria, Measles and Influenza. The following Table shows the deaths from these diseases, arranged in various age groups. Report of the Medical Officer of Health. 14 TABLE IX. Notifiable Diseases. No. of Deaths Occurring at Ages—Years. Total. Under 15 15 upwards 1 Under 1 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 upwards Small-pox - - - - - - - - - - - - - - - Diphtheria 26 24 2 1 1 3 4 1 11 3 2 - - - - Scarlet Fever 3 3 — - 1 — 1 - 1 — — - - - - Enteric and Paratyphoid Fever 1 - 1 - - - - - - - - - 1 - - Puerperal Fever 8 — 8 - - - - - - - 1 6 1 - - Erysipelas 4 1 3 - - — — - - - - - - 1 2 Whooping Cough 30 30 — 12 9 3 5 1 - - - - - - - Pneumonia:— Acute Influenzal 33 1 32 - - - - - - 1 1 4 5 13 9 Acute Primary 79 18 61 7 6 1 1 - 1 2 2 3 8 25 23 Cerebro-spinal Meningitis 1 1 - — 1 - - - - - - - - - - Polio-myelitis 4 3 1 — — 1 — - 1 1 1 — — - - Encephalitis Lethargica 3 - 3 - - - - - - - - 1 — 1 1 Malaria 1 - 1 — — — — - - — — — — 1 — Dysentery 2 - 2 — — — — - - — — 2 — - - Trench Fever - - - - - - - - - - - - - - - Non-Notifiable Diseases. 195 81 114 21 18 8 11 2 14 7 7 16 15 41 35 Measles 11 11 - 1 4 1 2 3 - - - - - - - Influenza 23 23 - - - - - - - - - 2 3 8 10 Diarrhœa 61 53 8 47 4 — - 2 — — - 2 1 5 - Other (if any) — — — — — — — — — — — — — — — 95 87 8 48 8 1 2 5 — — — 4 4 13 10 Grand Total 290 168 122 69 26 9 13 7 14 7 7 20 19 54 45 Report of the Medical Officer of Health. 15 Table X. shows the cases of infectious diseases that occurred during the year, grouped in certain age periods, and Table XI. shows the same cases grouped according to sub-districts in which they occurred. TABLE X. Disease. Total. No. of Cases Occurring. At Ages — Years. Under 15 15 and upwards 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 374 285 89 11 10 29 24 20 120 71 36 38 11 4 - Scarlet Fever 579 483 96 5 13 22 42 51 238 112 40 48 7 1 - Enteric Fever and Paratyphoid 24 8 16 - 1 - 2 - 1 4 1 5 8 2 - Puerperal Fever 12 — 12 — — — — — — — 1 8 3 — - Erysipelas 101 13 88 4 1 1 — — 3 4 10 11 9 41 17 Whooping Cough 1229 1209 20 154 155 159 193 131 394 23 2 8 7 2 1 Pneumonia:— Acute Influenzal 39 3 36 - 1 - - - 1 1 4 6 6 14 6 Acute Primary 389 139 250 19 26 12 12 9 32 29 24 56 47 75 48 Cerebro-spinal Meningitis 7 4 3 1 1 - 1 — 1 — — 1 — 2 — Polio-myelitis 18 16 2 1 1 1 4 — 2 7 2 — — — - Encephalitis Lethargica 6 1 5 — - 1 - — — — 1 2 1 1 - Malaria 10 — 10 - - - - - - - 7 1 2 - Dysentery 4 1 3 - - - - - - 1 2 1 — — — Trench Fever — — — — — - — — — — — — — — — Total 2792 2162 630 195 209 225 278 211 792 252 123 191 100 144 72 16 Report of the Medical Officer of Health. TABLE XI. Disease. Total Cases occurring in each Locality. Total Cases occuring. Number admitted into Hospital. Total Deaths. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Small-pox - - - - - - - - - Diphtheria 79 13 36 37 66 143 374 356 26 Scarlet Fever 100 43 88 81 83 184 579 514 3 Enteric and Paratyphoid Fever 2 2 6 5 — 9 24 14 1 Puerperal Fever 1 1 4 3 1 2 12 11 8 Erysipelas 22 9 5 10 14 41 101 14 4 Whooping Cough 224 72 86 49 214 584 1229 114 30 Pneumonia—Acute Influenzal 9 1 3 6 3 17 39 - 33 Pneumonia—Acute Primary 72 30 53 26 37 171 389 - 79 Cerebro-spinal Meningitis 1 — — 1 1 4 7 5 1 Polio-myelitis 1 2 1 1 3 10 18 7 4 Encephalitis Lethargica - 2 1 1 - 2 6 3 3 Malaria 1 1 1 1 1 5 10 1 Dysentery — — — — 1 3 4 - 2 Trench Fever — — — - — — — — — Total 512 176 284 221 424 1175 2792 1038 195 Tuberculosis—all forms 101 41 99 70 80 206 597 - 319 Ophthalmia Neonatorum 7 3 5 6 3 12 36 15 — Total 108 44 104 76 83 218 633 15 319 Grand Total 620 220 388 297 507 1393 3425 1053 514 Report of the Medical Officer of Health. 17 The total number of cases, less Tuberculosis, was 2,792, compared with 4,018 in 1922. The number is much lower than in the previous year, and this is due almost entirely to the number of cases of Diphtheria and Scarlet Fever having fallen from 2,095 to 953. Small-pox. No case of this disease occurred during the year. 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 XII. is taken from the official returns of the Vaccination Officers to the Board of Guardians for the year 1922. 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 XII. SubDistricts. Number of Births returned from 1st January to 31st December, 1922. 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 848 481 4 — 40 229 7 10 40 37 Putney 414 270 — — 8 106 2 9 8 5 Streatham 2623 1153 9 — 129 939 28 129 80 156 Wandsworth 1437 835 1 — 60 427 9 14 40 51 Totals 5322 2745 14 — 237 1701 40 162 168 249 18 Report of the Medical Officer of Health. The percentage of children vaccinated to total births was only 51.5; 56.7 in Clapham, 66.6 in Putney, 43.79 in Streatham, etc., and 58.1 in Wandsworth. Diphtheria. This disease was much less prevalent than in 1922, 374 cases occurring, compared with 838. The number of deaths was 26, compared with 76 in 1922, and the death-rate was .07, compared with .22. The case mortality was 6.9 per cent. The rate per 1,000 of population was 1.1, 1.2 in Clapham, .4 in Putney, .6 in Balham, .6 in Streatham, 1.5 in Tooting, and .4 in Wandsworth. The fall in Diphtheria is specially noticeable, as the number of cases in 1923 was definitely less than in any year since 1911. Of the 374 cases, 356 or 97 per cent. were removed to hospital, and no difficulty was experienced in having cases promptly removed. The Medical Officers of the London County Council made inspections of St. Mary's, Balham, The Earlsfield, Eltringham Street, Merton Road, St. Anne's, Waldron Road, and West Hill Schools, and swabs were taken from the throats of some of the children examined. As a result of this swabbing three cases were found to be positive and six 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 following Table shows the attack rate per 1,000 of the cases removed to hospital, as well as those treated at home, according to the number of persons per room. Report of the Medical Officer of Health. 19 TABLE XIII. Number of persons per room. Less than 1 1 and less than 2 2 and less than 3. 3 and over. *Cases removed to to Hospital:— No. of invaded households 49 161 42 15 No. of susceptibles under 15 59 342 152 47 No. of susceptibles attacked 3 13 16 11 Attack rate per 1,000 50 38 105 235 Cases Isolated at Home: No. of invaded households 11 5 — — No. of susceptibles under 15 11 9 — — No. of susceptibles attacked — Attack rate per 1,000 — — * 35 cases notified from eight Institutions not included in above Table. During the year 16 tubes of anti-toxin were issued to medical practitioners for use in cases of Diphtheria. Scarlet Fever. This disease was much less prevalent during the year, compared with 1922, the number of cases being 579, compared with 1,257. The number of deaths was three, compared with 19 in 1922, and the death-rate was .008 per 1,000 compared with .05. The case mortality was .51 per cent. Report of the Medical Officer of Health. 20 The case rate per 1,000 of population was 1.71, 1.61 in Clapham, 1.40 in Putney, 1.67 in Balham, 1.44 in Streatham, 2.09 in Tooting, and 1.86 in Wandsworth. Of the total number of cases 514, or 88 per cent. were removed to hospital. The Medical Officers of the London County Council made inspections of five schools during the year, and any suspected cases were at once excluded and the names and addresses forwarded to me for inquiry. The following Table shows the attack rate per 1,000 of the cases removed to hospital, as well as those treated at home, according to the number of persons per room. TABLE XIV. Number of persons per room. Less than 1. 1 and less than 2. 2 and less than 3. 3 and over. *Cases removed to Hospital: No. of invaded households 104 260 50 12 No. of susceptibles under 15 151 614 155 40 No. of susceptibles attacked 10 29 15 1 Attack rate per 1,000 66 47 97 25 Cases Isolated at Home: No. of invaded households 51 16 1 1 No. of susceptibles under 15 60 41 1 1 No. of susceptibles attacked 1 4 - — Attack rate per 1,000 17 98 - — * 16 cases notified from three Institutions not included in above Table. Report of the Medical Officer of Health. 21 Return Cases of Scarlet Fever and Diphtheria. 14 cases of Scarlet Fever and 11 of Diphtheria occurred within one month of the return of a previous case from hospital. Enteric and Para-Typhoid Fever. 24 cases of the above occurred, and nine notifications were received of cases which proved after investigation not to be true cases. One death from Enteric Fever occurred, and the death-rate was .002 per 1.000. Of the 24 cases 11 gave positive reaction to the bacillus typhosus and so were true cases of Enteric Fever, two were mild cases treated at home and the diagnosis was not confirmed bacteriologically, and 11 were shown by the agglutination test to be para-typhoid fever. These 11 cases gave a negative result to para-typhoid A and a positive result to para-typhoid B. The cases occurred all over the Borough and occurred sporadically throughout the year. In none of them was any special source of infection traced. Four of the cases of Enteric Fever occurred in the first half of the year, while nine occurred in the second half. In regard to the para-typhoid cases six occurred in the first half of the year and five in the second half. Puerperal Fever. 12 cases were notified, eight of whom died. The death-rate was .03 per 1,000 and the case mortality 66 per cent. 11 of the 12 cases were removed to hospital. Erysipelas. 101 cases were notified and four deaths occurred during the year, compared with 108 and three in 1922. Whooping Cough. 30 deaths occurred during the year, compared with 44 last year, while the number of cases notified was 1,229, compared with 1,056. 22 Report of the Medical Officer of Health. 114 of the cases were removed to hospital. 1,086 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Whooping Cough occurred, and 228 premises were disinfected. Influenza. 56 deaths occurred, compared with 148 in 1922. The death-rate was .16 per 1,000. The number of deaths represents 1.6 per cent, of the total mortality from all causes, compared with 3.9 per cent, in 1922, 2.3 per cent, in 1921, 2.2 per cent, in 1920, 8.2 percent, in 1919. Influenzal Pneumonia and Acute Primary Pneumonia. 39 cases of acute influenzal pneumonia and 389 cases of acute primary pneumonia were notified. 33 of the former and 79 of the latter died. The total number of deaths credited to all forms of pneumonia during the year was 189, compared with 236 in 1922, 241 in 1921, and 227 in 1920. Cerebro-spinal Meningitis. Seven cases of this disease occurred and one of them died. A further nine deaths were registered as being caused by meningitis. Polio-myelitis and Polio-encephalitis. 18 cases occurred and four of them died. Enquiries are now being made into the cases of this disease which have been notified during the last few years, but these are not yet completed. Encephalitis Lethargica. Six cases of this disease occurred and three of them died. Several other cases were notified, but as they were found, after further investigation, to be suffering from some other disease they are not included in these figures. 23 Report of the Medical Officer of Health. Malaria. Ten cases were notified and one of them died. This man had had recurrent attacks of malaria and bronchitis which he contracted abroad while in the Army. All the ten cases notified were males; four of them contracted the disease in India, two in Turkey, two in France, one in the Soudan, and one while serving in the Navy. All the cases appeared to receive proper treatment. Dysentery. Four cases occurred, two being cases of amæbic dysentery, one of whom died, one case was that of a man who had had slight attacks since his Army service, and the fourth case died of the disease in a mental asylum. Trench Fever. No cases occurred during the year. Ophthalmia Neonatorum. 36 cases were notified and the following Table shows the effect of the disease on the vision according as to whether tne cases were treated at hospital or at home. TABLE XV. Result of Treatment. Vision not affected. Vision Impaired. Total Blindness. Died. Treatment received:— In Hospital 11 2 — 1 At Hospital, Out-patient 12 — — 1 At home 8 — — 1 Total 31 2 — 3 24 Report of the Medical Officer of Health. Of the 30 cases three died from other causes, but in each of them the eye condition was improving at the date of death. 31 of the cases recovered without any impairment of vision. 15 of the cases were attended at birth by doctors, 21 by midwives, and four of the infants were born in maternity homes. Measles and German Measles. 11 deaths occurred from Measles, compared with 72 in 1922, and the death-rate per 1,000 of population was .03, compared with .21 in 1922, .012 in 1921, .17 in 1920, and .05 in 1919. 663 cases of Measles were reported during the year, compared with 1,842 cases in 1922. Of the 663 cases, 425 were under the age of five years, and 660 of them were under the age of 15 years, 23 of the cases were removed to the Metropolitan Asylums Board's Hospitals because the conditions in the homes were not suitable for treating them. 555 of the 663 cases were reported by the Divisional Officers of the Educational Department or by the teachers of elementary schools, and 35 cases were notified by doctors, though the disease is no longer notifiable. The number of cases reported is less than the number that occurred, as no reports are received as a rule from private schools in the Borough. Further, all children do not attend school, and cases occurring in vacations may not come to the knowledge of the school authorities. 38 cases of German Measles were also reported. 697 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Measles occurred, and 224 premises were disinfected. Table XVI. shows the number of cases of infectious diseases which occurred in the individual elementary schools during the year. Report of the Medical Officer of Health. TABLE XVI. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Clapham. Aristotle Road 1 1 – – – – – – 1 3 Bonneville Road 14 – 4 3 67 48 16 4 27 183 Cavendish Road 9 1 — — 2 4 51 4 3 74 Cavendish Road Special — — — — — 1 1 — — 2 Christchurch 4 1 — — — – — — — 5 Clapham Parochial, Macaulay Road 3 — — — 1 — — 1 1 6 Clapham Parochial, Old Town — 1 – – – – – – – 1 Haselrigge Road 5 3 6 1 20 15 4 1 9 64 Larkhall Lane 1 — 2 — 25 6 2 — 5 41 New Park Road 1 1 — — 7 22 1 3 3 38 New Road — — — — 1 1 — — — 2 St. Andrew's Street 1 1 1 1 — — — 3 — 7 St. Mary's, Crescent Lane 1 1 — — — — — — — 2 St. Mary's, St. Alphonsus Road — 2 — — — — — — — 2 Stonehouse Street 4 5 3 1 5 18 1 5 3 45 Telferscot Road 8 2 1 — 16 37 21 1 10 96 Putney. All Saints' — — 1 — — — 7 — 2 10 Hotham Road 0 2 7 7 33 — 7 2 26 89 Huntingfield Road 6 1 2 4 10 — 3 — 15 41 Parochial, Roehampton 5 1 3 2 4 — 9 — — 24 St. Mary's 5 — 15 — — — — 2 — 22 Carried forward 73 23 45 19 191 152 123 26 105 757 Report of the Medical Officer of Health. TABLE XVI.—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 73 23 45 19 191 152 123 26 105 757 Streatham. Broadwater Road 6 2 — — 4 25 — — 4 41 Balham High Road 6 — 6 — 1 1 22 1 1 38 Chrsitchurch — — 1 — 8 7 — — — 16 Eardley Road 6 2 2 1 30 35 — 2 1 79 Fircroft Road 5 1 1 — 30 2 1 — 3 43 Furzedown Demonstration 4 1 8 5 2 2 1 — — 23 Hearneville Road 3 4 1 — 28 — 66 — 1 103 Hitherfield Road 4 1 14 — 1 — 5 1 — 26 Holy Trinity, Balham 2 — — — — — — 1 2 5 Holy Trinity, Streatham — 2 — — — 1 — — — 3 Immanuel 1 — — — — — — — — 1 Mitcham Lane 10 1 39 4 45 15 1 1 5 121 Roman Catholic, Nightingale Square — — — — 2 — 13 — — 15 Oldridge Road 6 1 1 — 75 1 65 2 20 171 Smallwood Road 7 8 14 — 49 36 10 2 2 128 St. Andrew's, Colmer Road 2 — 1 — 1 1 — — — 5 St. Andrew's, Polworth Road 2 2 — — — — — — — 4 St. Leonard's 1 — 3 — 1 8 — — 5 18 St. Mary's, Balham — 1 — — 3 1 1 1 — 7 Sunnyhill Road 4 — 2 — — — — — 5 11 County Secondary, Welham Road 1 — — — — 1 — — — 2 Carried forward 143 49 138 29 471 288 308 37 154 1617 Report of the Medical Officer of Health. 27 TABLE XVI.—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 143 49 138 29 471 288 308 37 154 1617 Tooting. Ensham 2 5 – – 4 21 – – 4 36 Fountain Road 7 14 – – 5 13 1 1 3 44 Franciscan Road 6 1 1 – 1 42 – 2 4 57 Hillbrook Road 7 2 2 3 10 11 3 – 1 39 Sellincourt Road 14 4 2 – 1 41 5 – 43 110 Tooting Graveney 2 6 3 — 3 22 3 3 7 49 Roman Catholic, Undine Street 1 3 — — — — — — — 4 Wandsworth. Allfarthing Lane 2 1 1 – – 23 3 2 – 32 All Saints' 4 2 — — 3 1 3 – 1 14 Brandlehow Road 11 3 20 1 4 31 – 2 22 94 Earlsfield 10 3 105 1 14 29 – 17 12 191 Eltringham Street 3 9 45 – 5 6 1 2 10 81 Frogmore Special 1 — — — – – – 1 – 2 Garratt Lane 5 1 16 – 48 37 11 1 7 126 Magdalen Road 4 1 – – 1 8 – 3 – 17 Merton Road 5 1 1 — – 11 – – 4 22 Riversdale 7 1 31 — 57 15 4 – 1 116 Royal Victoria Patriotic — 1 – – 2 – – – – 3 St. Ann's 3 1 1 – 2 4 – – 2 13 St. Faith's 1 — — — 13 5 – 1 2 22 St. Joseph's 2 — 13 1 1 – 1 – 1 19 St. Michael's 4 — 5 2 1 14 – – – 20 Southfields 17 3 55 — 2 7 2 1 3 90 Swaffield Road 10 1 16 — 2 7 2 1 – 45 Waldron Road 9 24 97 — 5 22 – 5 24 186 Wandle 9 5 – — 13 5 2 3 9 46 Warple Way 2 — 1 — 30 — – 2 – 35 West Hill 4 5 2 – 4 32 1 1 3 52 Total 301 140 555 37 702 695 350 85 317 3188 28 Report of the Medical Officer of Health. Diarrhœa. The number of deaths from Diarrhoea increased from 32 in 1922 to 61 in 1923, and of these 46 or 75 per cent, were under the age of one year, compared with 19 in 1922. The number of deaths from Diarrhoea, Zymotic Enteritis and Enteritis under one year represents 15'9 per cent, of the total mortality at that age. Scabies. The names of 27 school children who were suffering from scabies were forwarded to me by the Medical Officer to the London County Council, and the homes were visited by the Sanitary Inspector. These children were being treated at the London County Council cleansing stations. In 26 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, 19 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. Other Infective Diseases. 20 deaths occurred, six from syphilis, six from septicaemia, four from pyaunia, two from tetanus, and two from actinomycosis. Report of the Medical Officer of Health. 29 NON-INFECTIVE DISEASES. The total number of deaths from cancer and malignant disease was 457, the number of males being 194 and females 263. The corrected death-rate was 1.35 per 1,000 for the whole Borough, l.32 for Clapham, 1.56 for Putney, 1.52 for Balham, 1.61 for Streatham, 1.16 for Tooting, and 1.14 for Wandsworth. The number of deaths in 1923 was seven more than in 1922, and 45 more than in 1921. The number of deaths from diseases of the Brain and Nervous System was 328, compared with 307 for the previous year. 651 deaths occurred from diseases of the Circulatory System, compared with 613 in 1922. 409 of these deaths were of persons over 65 years of age. There were fewer deaths from diseases of the Respiratory System, the number being 476, compared with 624 in 1922. The number from Bronchitis was 249, compared with 339 in 1922, and from Pneumonia (all forms) 189, compared with 236 in 1922. Further particulars relative to Pneumonia are given on page 22. The number of infants under two years of age who died from these diseases fell from 106 in 1922 to 65 in 1923. Six deaths occurred from accidents and diseases of pregnancy, and with the eight deaths already mentioned from Puerperal Fever, gives a total of 14 deaths after childbirth. This is equivalent to a rate of 2.5 per 1,000 births, compared with 3.0 in 1922. 134 deaths, 70 males and 64 females, were registered as due to Premature Birth and Developmental Diseases, compared with 160 in 1922. 210 deaths, 79 males and 131 females, occurred from Old Age, and 209 of these were persons over 65 years of age. The number of deaths due to this cause in 1922 was 190. 119 deaths were due to Violence, 84 of them being due to accident, 31 to suicide, and four to other forms of violence. Inquests. Inquests were held on 154 persons dying in the Borough, and on 107 Borough residents who died outside the Borough, The next Table shows the results of the findings of these inquests. 30 Report of the Medical Officer of Health. TABLE XVII. Inquests. Sub-Districts. Whole Borough. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Deaths from Natural Causes 17 7 17 7 15 45 108 Accidental: Falls 5 2 3 1 15 8 34 Falls from a height 2 2 1 1 1 4 11 Falls from a vehicle 1 1 — — 1 1 4 Knocked down by motor vehicles 8 4 5 4 4 4 29 Knocked down by horse vehicles 1 – – – – 2 3 Knocked down by cyclist – – – 1 – – 1 Thrown from motor vehicles – 1 1 – – 1 3 Scalds and Burns 2 1 1 — 2 2 8 Drowning — 3 – — – 1 4 Poisoning 1 1 – — — — 2 Suffocation — — 1 — — 1 2 Other 1 – – — — 1 2 Suicidal:— Drowning 2 1 – 2 1 3 9 Cut Throat — – 1 — 2 1 4 Poisoning by Coal Gas 1 3 2 4 — — 10 Poisoning by Nitrous Oxide Gas 1 – – – – – 1 Other forms of poisoning 1 – 1 1 1 1 5 Run over by train – – – – – 2 2 Gun shot wounds 1 1 1 — — 1 4 Hanging and Strangulation – 1 – 1 1 2 5 Cut wrist — 1 – – — — 1 Open Verdicts:— Found drowned — 1 — 1 1 2 5 Manslaughter — 1 — 1 — — 2 Murder – – – – – 1 1 Execution – – – – – 1 1 Totals 44 31 34 24 44 84 261 3i Report of the Medical Officer of Health. Mortuaries. The Mortuaries in Clapham, Streatham, and Wandsworth have been visited several times during the year, and I am able to report that the Bye-laws and Regulations have been carried out in a satisfactory manner. In Clapham, 12 bodies were removed to the Mortuary, in Streatham 12, and in Wandsworth 143—of which 63 were from Wandsworth, 20 from Putney, 38 from Tooting, 21 from Battersea, and one from Fulham—a total of 167. 32 Report of the Medical Officer of Health. TUBERCULOSIS. Re-organisation.—Prior to 1923, all the routine work connected with the operation and administration of the Tuberculosis Regulations (1912) was carried out by the Public Health Department Staff at 79, East Hill; whilst all the work connected with the operation of the Council's Dispensary Scheme for the Treatment of Tuberculosis was performed by the Dispensary Staff at the Tuberculosis Dispensaries. In order to bring about more efficient co-ordination and supervision of the different branches of Tuberculosis work in the Borough, it was decided to transfer to the Dispensary all records pertaining to Tuberculosis, and all members of the Staff responsible for Tuberculosis work. This transfer was effected on 1st October, 1923, the result now being that all records and correspondence pertaining to a patient are in one place, while all visits to such a patient are now made by the same Tuberculosis Visitor. Notification.—The total number of new cases of Tuberculosis which came to the notice of the Medical Officer of Health during the year was 597. The sources of information regarding these cases were as follows:— Primary Notifications on Form A 538 Primary Notifications on Form B 1 Notified for the first time at Death 40 Transfers from other Sanitary Authorities 12 Naval & Military Notifications 6 TOTAL 597 Report of the Medical Officer of Health. 33 Table XVIII. gives details regarding the site of disease, sex, and age grouping of these cases. TABLE XVIII. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary NonPulmonary. Male. Female. Male. Female. Male. Female. Male. Female. Under 1 — — 2 4 — — 3 4 1—5 2 1 16 9 1 — 10 3 5—10 3 5 17 7 — 1 3 4 10—15 4 8 10 13 2 7 3 1 15—20 29 27 4 11 15 20 — — 20—25 34 34 5 6 18 13 3 1 25—35 56 62 6 5 25 32 1 5 35—45 53 42 6 2 28 25 1 .1 45—55 32 33 3 3 28 22 1 1 55—65 13 15 — 2 12 11 — — 65 upwards 6 4 2 1 6 3 3 2 Total 232 231 71 63 135 134 28 22 Table XIX. shows the number of cases of non-pulmonary tuberculosis classified according to the part of the body affected p 2 34 Report of the Medical Officer of Health. TABLE XIX. Localisation of Disease. Total. Males. Females. Brain 24 14 10 Glands, Mediastinal 2 1 1 Glands, Mesenteric 10 7 3 Glands, Cervical 31 17 14 Bones and Joints 24 10 14 Skin 6 1 5 Larynx 1 — 1 General Tuberculosis 12 7 5 Other parts 24 14 10 Total 134 71 63 Deaths.—The total number of deaths certified as due to diseases of a tuberculous nature was 319—of whom 163 were males, and 156 females. Of the 319 deaths, 269 were due to Pulmonary Tuberculosis—22 to tuberculous disease of the brain—and 28 to other forms of Tuberculosis. Table XVIII. gives details regarding the type of the disease, sex, and age grouping of these 319 deaths. In addition to these deaths, which were duly certified in the returns as due to Tuberculosis; 22 persons previously notified as suffering from Tuberculosis died during the year. These deaths, however, do not figure in Table XVIII. for the following reasons:— (a) Twelve were certified as dying of diseases other than Tuberculosis. (b) Six notified persons were found, as a result of further investigation, to be non-tuberculous, death being due to some other cause. (c) Four had previously moved outside the Borough and died there, the deaths being credited to the areas in which death occurred. The following Table gives figures for the past ten years showing both the number of deaths, and the death-rate per 1,000 from Tuberculosis in the Borough. It will be seen that with the exception of 1920, the Tuberculosis death-rate for 1923 is the lowest recorded. Report of the Medical Officer of Health. 35 TABLE XX. 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 Pulmonary Tuberculosis:— Number of deaths 305 329 320 339 368 288 257 331 286 269 Death rate .93 .99 1.02 1.12 1.22 .87 .75 1.00 .85 .80 Other Forms:— Number of deaths 84 105 76 85 87 54 58 59 57 50 Death rate .25 .31 .24 .28 .29 .16 .18 .18 .17 .14 Total:- Number of deaths 389 434 396 424 455 342 315 390 343 319 Death rate 1.19 1.30 1.26 1.40 1.51 1.03 .93 1.18 1.02 .94 36 Report of the Medical Officer of Health. During the year 40 persons, not previously notified, were certified as having died of Tuberculosis. The ratio of unnotified tuberculosis deaths to total tuberculosis deaths is therefore 40/319. Of the 40 unnotified deaths, 25 were certified from Institutions, 11 by private doctors, while in two cases Tuberculosis was discovered on post mortem examination. In certain cases, the certifying doctor was asked for an explanation, but in no case was it considered necessary to take proceedings for wilful neglect or refusal to notify. 39 persons died within one month after notification, 28 within three months, and 30 within six months. Report of the Medical Officer of Health. 37 TUBERCULOSIS DISPENSARIES. (a) Main Dispensary at 96, East Hill, Wandsworth— Serves the areas Putney, Southfields, Fairfield, Springfield and North Clapham. Sessions—Monday Morning & Afternoon. Tuesday Evening (7.0 p.m.) for those at work. Thursday Morning & Afternoon. Saturday Morning (for School Children). (b) Branch Dispensary at 114, Gosberton Road, Balham— Serves the areas Streatham, Tooting, Balham and South Clapham. Sessions—Tuesday Morning & Afternoon. Thursday Evening (7.0 p.m.) for those at work. Friday Morning. Dispensing.—Most insured patients undergoing domiciliary treatment are supplied with the necessary medicines by their insurance practitioners. Non-insured patients, however, both adults and children, have medicines dispensed in accordance with their medical requirements. Dispensing Sessions are as follows:— (a) Main Dispensary All Sessions. (b) Branch Dispensary Tuesday, morning and afternoon. Thursday evening. Visitors.—The three Tuberculosis Visitors have each a definite area in the Borough, and each patient is encouraged to attend the session during which the visitor is in attendance. 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. 3« Report of the Medical Officer of Health. As in former years, there has been great difficulty in arranging institutional treatment for advanced cases, owing to the apparently inadequate provision made for this type of case under the County Council's scheme. More beds are required for these cases, and it would be a great advantage if provision could be made for the beds to be as near as possible to the homes of the patients, so as to be readily accessible to relatives. 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 XXII., 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. During the year a new system was instituted by the London County Council, with a view to ensuring closer co-operation between the Dispensary and the School Medical Service, in the observation and treatment of school children suspected to be suffering from Tuberculosis. By means of Form M.O. 333 a continuous record of a suspected child's tuberculosis history can be kept, both the Tuberculosis Officer and the School Medical Officer having access to the same records. As in former years, the Tuberculosis Officers have continued to act as Medical Referees to the Ministry of Pensions, whilst the Tuberculosis Visitors have devoted a considerable amount of time to the visiting of Discharged Soldiers, as may be seen from Table XXIII. 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. 40 patients received dental treatment and 12 of these were supplied with dentures. The attendances at the dentist totalled 91. 39 Report of the Medical Officer of Health. The amount expended on dental treatment during the year was £28 16s. 6d., while the cost of dentures supplied to patients was £40 2s. 0d. 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 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, 89 patients have been granted extra nourishment under the scheme at a cost of £228 5s. 3d. 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 1923.—Table XXI. shows in the lirst 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. 40 Report of the Medical Officer of Health. TABLE XXI. 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 Dispensary on Dec. 31st pending diagnosis. Ceased attendance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from Tuberculosis. Pulmonary. Non-Pulmonary. (a.) All persons (including "Contacts.") Adults M. 5 406 411 166 21 214 9 1 F. 7 424 431 126 18 266 21 — Children under 15. M. 4 257 261 5 21 229 5 1 F. 5 253 258 6 12 238 2 — Total 21 1340 1361 303 72 947 37 2 (b) "Contacts" (included in (a.)). Adults M. — 69 69 3 — 66 — — F. — 100 100 7 — 93 — — Children under 15. M. — 113 113 2 1 110 — — F. — 107 107 — 2 105 — — (c.) Insured persons (included in (a)). M. 5 279 284 105 13 158 7 1 F. 4 175 179 46 11 110 12 — 41 Report of the Medical Officer of Health. Table XXII. gives further details of the year's work. TABLE XXII. 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December, 1923 1228 2. Total number of attendances of patients at the Dispensary during the year:— Insured 3487 Uninsured 3624 3. Number of complete examinations of patients made 3356 4. Number of persons placed during the year under observation for the purpose of diagnosis 45 5. Number of cases in which the period of observation exceeded two months 32 6. Number of insured patients under domiciliary treatment on 31st December, 1923 544 7. Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment during the year 22 8. Number of persons referred to St. Thomas's Hospital for consultation 48 9. Number of consultations with medical practitioners at the homes of patients:— Insured 10 Uninsured 19 10. Number of other visits paid by Tuberculosis Officer to the homes of patients 241 11. Number of visits paid by Nurses to the homes of patients 5348 12. Number of specimens of sputum examined 1720 13. Number of written reports made 4516 Table XXIII. gives the numbers of new cases living in each of the five sub-districts, and shows on whose recommendation they made the first attendance. 42 Report of the Medical Officer of Health. TABLE XXIII. Clapham. Putney. Streatham. Tooting. Wandsworth. Outside Borough. Totals. Public Health Department 53 37 55 140 225 4 514 Private Practitioners 62 23 52 64 156 6 363 Charitable Societies 3 8 — 1 19 2 33 Transfers from other Dispensaries 8 1 7 3 6 — 25 London County Council 4 7 8 14 23 — 56 Existing Dispensary Patients 18 2 16 32 28 — 96 Ministry of Pensions 14 5 18 8 15 1 61 Other Sources 21 8 9 19 133 2 192 Totals 183 91 165 281 605 15 1340 TABLE XXIV. Particulars relating to Discharged Soldiers attending at the Dispensaries. New Cases. Old Cases. Total Attendances. Tuberculous 36 301 1716 Non-Tuberculous 21 22 78 Totals 57 323 1794 632 visits were made by the Dispensary Nurses in connection with these cases during the year. Contacts.—Of the 1,340 new cases examined, 389 were contacts. 15 of these were found to be suffering from Tuberculosis. 43 Report of the Medical Officer of Health. Bacteriological Examinations.—The number of Bacteriological examinations of sputum made at the Dispensary continues to show a considerable increase on previous years, as can be seen from the following table, which gives details of this work during the past five years. Year. Total No. of specimens examined. No. of specimens sent by General Practitioners and St. James' Hosptl. No. of specimens found to contain T.B. 1919 204 Nil. 66 1920 601 Nil. 121 1921 1054 10 247 1922 1310 484 260 1923 1720 722 384 The Wandsworth Borough Council provides facilities for the bacteriological examination of sputum from suspected cases of Tuberculosis among the patients of Medical Practitioners within the Borough, and also from patients in St. James' Hospital whose home addresses are in the Borough. The figures given in the above table show that greater advantage is being taken of these facilities, and the increase in the number of specimens examined during the last two years is to a great extent due to the larger number sent for examination from these sources. All the bacteriological examinations of sputum are carried out by the Dispensary Staff. Care Committee. Constitution.—The Tuberculosis Care Committee was appointed by the Borough Council, and the Council's representatives on the Committee are:—Councillors T. Harding, Mrs. Dixon, and H. O. Dumayne. The Medical Officer of Health, Tuberculosis Officers, and the Tuberculosis Visitors assist the Committee to the fullest possible extent and attend their meetings. The following agencies, public and charitable,are represented:— L.C.C. School Medical Service. Board of Guardians. British Red Cross Society. Soldiers and Sailors Help Assn. London Insurance Committee. United Services Fund. War Pensions Committee. Charity Organisation Society. Invalid Children's Aid Assn. Ranyard Nurses' Association. Brompton Hospital. St. Thomas's Hospital. 44 Report of the Medical Officer of Health. Several unattached members interested in Tuberculosis work are also co-opted. The Officers of the Committee are:— Chairman. Councillor T. Harding. Vice-Chairman. Miss J. M. Duff. Hon. Secretary. Mr. A. R. Watson. Hon. Joint Secretary. Mrs. Nicol. Hon. Treasurer. Mr. H. B. Harvey. Meetings.—The Committee meets on alternate Friday afternoons at 00, East Hill, S.W. 18, at 2.30 p.m. General.—In tbe work of a Tuberculosis Dispensary organisation there are two fields:— (1) Medical and Sanitary. (2) Social and Economic. The former is the care of the Public Health Authority, i.e., Medical Officer of Health, Tuberculosis Officers, and Tuberculosis Visitors; whilst the latter is within the sphere of activity of the Care Committee. Visits have to be paid by workers in both fields, so that close and friendly co-operation of all concerned is essential in order to avoid overlapping of work and possibly conflicting advice. As a result of the re-organisation in the Dispensary Staff already referred to, most of the routine visits, both for Dispensary and Care Committee purposes, are now made by the Tuberculosis Visitors of the respective areas. In this way duplication of visiting and of effort is avoided. Functions.—The primary aim of the Care Committee is to endeavour to improve the social and economic conditions of patients suffering from Tuberculosis. As most of the charitable institutions in the neighbourhood are represented on the Committee, much valuable advice and assistance can be given. The Committee specially consider the following points :— (a) The provision of extra nourishment either by the Board of Guardians or the Wandsworth Borough Council. (b) The provision of extra bed accommodation. The Committee own two beds, which are lent out in cases where there is risk of infection due to imperfect isolation of the patient. The British Red Cross Society has provided beds and bedding to several discharged soldiers suffering from Tuberculosis. 45 Report of the Medical Officer of Health. (c) Provision of open air shelters. Two such shelters—the property of the Borough Council—have been in almost continuous use during the year. More, if available, could have been utilised. (d) Removal of patient to friends and relatives in the country. (e) The care of children and of the home during the absence of the mother or housewife. The local representative of the Invalid Children's Aid Association has given much help by arranging for such children to be boarded out in the country; and the Care Committee is generally able to arrange for someone to look after the home whilst the mother is undergoing institutional treatment. (f) The provision of financial assistance to the family or patient. When the necessity for such assistance arises, it can generally be provided through the agency of existing charitable and public organisations. In this direction the representatives of the Board of Guardians and the Charity Organisation Society have rendered valuable help. The Care Committee, however, has a small fund of its own, and is able to give financial assistance in special cases of an urgent or temporary nature:— e.g. Payment of patient's railway fare to or from Sanatorium. Provision of paid assistance during the absence of mother. Cost of advertising for employment. Cost of training in new employment, etc. When a patient is accepted by the London County Council for treatment in a residential institution under the Council's Scheme, the Care Committee investigates the financial circumstances of the family in order to determine what sum can be contributed by the family towards the cost of the treatment. During the year the Committee has undertaken the assessment and collection of contributions in the cases of some 250 patients (adults and children), the amount collected and remitted to the London County Council being £570. The amounts of such assessments are subject to the approval of the County Council. In addition to the patients visited by the Tuberculosis Visitors, 36 advanced cases have been visited regularly at their own homes by members of the Care Committee. Medical and Nursing requisites, e.g., water beds, air and water cushions, bed rests, feeding cups, etc., have been acquired by the Committee gradually, and these articles 46 Report of the Medical Officer of Health are provided on loan to necessitous cases. Mrs. Glanville, on behalf of the Committee, has kept in touch with the Dispensary patients in St. James' Hospital, Balham. 66 of these cases have been visited regularly during the year, and such visits are greatly appreciated by the patients. Articles of clothing have been supplied to patients in need of it; especially to the patients about to enter residential institutions. 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. Through the instrumentality of Mrs. Nicol, the "Streatham New Players" Amateur Dramatic Society gave performances at the Congregational Church Hall, Streatham, and the amount raised by this means was £179. A small Sale of Work arranged by Miss Moores, one of the Dispensary Visitors, realised £32 12s. 6d. 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 Scheme 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. During the year 21 patients were nursed there for varying periods at a total cost of £286. 47 Retort of the Medical Officer of Health. DISINFECTION. The total number of rooms disinfected after the occurrence of cases of infectious disease was 4,036 (656 in Clapham, 278 in Putney, 551 in Streatham, 518 in Tooting, and 1,341 in Wandsworth). Four public and four private elementary schools were also disinfected on account of various infectious diseases. The disinfecting station, which was erected in 1904, has been working satisfactorily since then, but owing to the supply of steam from the Council's Destructor being no longer available for the process of disinfection it has been decided to instal a new boiler The present boiler, which was in use at the Council's yard in Bell Lane, dates from 1898, and owing to the wearing of some of the boiler plates the Insurance Company have called the Council's attention to its condition. This boiler will be used in future only in emergency. The laundry at the disinfecting station has also been in use since 1904 and a considerable portion of the laundry work from the Council's Maternity Home is done there. B 48 Report of the Medical Officer of Health. MATERNITY AND CHILD WELFARE. Work of Health Visitors. The duties of the Health Visitors are as follows:— Infant Visiting.—Infants are visited as soon as information of birth is received either from the Registrar or by notification, and they are revisited four times during the first year of life unless they are attending one of the Infant Welfare Centres, when the revisits are made by the Centre Superintendent. It has not been found necessary to visit systematically all children between the ages of one and five, as they have been visited as infants, and many of them are kept under supervision at the Welfare Centre or by visits made by the Superintendents of the Centres. Further opportunities for keeping observation on these children and their homes occur when visits are made to the home for some other purpose, as for instance, for a case of infectious disease. Children known to be unhealthy are visited regularly. Infectious Disease.—All cases of Puerperal Fever and Ophthalmia Neonatorum are visited as soon as notified, as well as all known cases of Whooping Cough, Measles, Pneumonia, and Diarrhoea in children under five. Cases of infectious disease above the age of five are dealt with by the male Sanitary Inspectors. The Health Visitors visit the homes of mothers attending the ante-natal Centres in the Borough, and those women applying for admission to the Borough Council's Maternity Home, the General Lying-in Hospital, the maternity ward of St. Thomas's Hospital and several other hospitals. Home visits are also made for investigating applications for milk under the Milk (Mothers and Children) Order. One of the Health Visitors is present at each Infant Welfare or ante-natal Clinic, and some of them attend the Welfare Committee meetings. They also pay periodical visits to the Creches and homes for unmarried mothers and children. The following Table summarises the work of the Health Visitors during the year in the six divisions of the Borough. The total visits and revisits under each heading are given in the last two columns of the Table, and the work in connection with the Welfare Centres and Creches in the lower part of the Table. Report of the Medical Officer of Health. 49 TABLE XXV. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Visits. Revisits. No. of Visits to: Infants under 1 year 919 325 555 443 592 1393 4227 4521 Children: 1—2 years — 17 8 75 14 5 119 1039 2—5 years — 27 11 20 21 15 94 1232 Puerperal Fever 1 2 6 5 2 6 22 3 Ophthalmia Neonatorum 25 7 4 10 6 12 64 44 Pneumonia 3 7 3 6 2 10 31 10 Whooping Cough 93 22 52 30 116 337 650 35 Measles 13 27 — 7 5 185 237 10 Diarrhœa — 2 — 4 2 3 11 — Ante-natal visits 122 40 137 83 102 185 669 — Supply of milk 10 14 62 83 4 74 247 — Miscellaneous 135 47 295 135 53 163 828 — Ineffectual 402 273 497 182 249 790 2393 — Total visits 1723 810 1630 1083 1168 3178 9592 — Re-visits in each sub-district 1107 751 1496 629 520 2371 — 6894 Attendances at Welfare Centres 105 64 101 89 95 154 608 — Attendances at Ante-natal Centres 13 23 33 31 26 49 175 — Health talks to mothers 53 15 1 27 60 7 163 — Visits to crèches — 32 16 — 39 30 117 — Committee meetings — 21 — 9 25 12 67 — Total 171 155 151 156 245 252 1130 — E 3 50 Report of the Medical Officer of Health. Infant Visiting. There were 5,475 births during the year and 4,227 of these or 77.1 per cent. were visited, compared with 81.1 in 1922, and 77.2 in 1921. Table XXVI. gives the particulars of the method of feeding of infants on the occasion of the initial visit and when revisited. Of 4,227 infants visited for the first time 3,493 were entirely breastfed, while 273 were fed partly on the breast and partly by other methods, and 461 were entirely bottle-fed. On revisiting 2,079 infants were found to be fed entirely on the breast, 811 were partially breast-fed, and 1,631 were otherwise fed. TABLE XXVI. Clapham North. Clapham South. Putney. Balham. Streatham. Tooting. Southfield. Fairfield. Springfield. Borough. Infants visited 512 407 325 555 443 592 429 315 649 4227 Breast-fed 420 334 260 460 362 495 345 278 539 3493 Otherwise fed 92 73 65 95 81 97 84 37 110 734 Re-visits to infants 462 182 374 1093 349 300 896 550 315 4521 Breast-fed 112 34 153 498 192 117 460 365 148 2079 Otherwise fed 350 148 221 595 157 183 436 185 167 2442 135 of the infants visited were born prematurely, 58 infants were delicate from birth, and five were definitely unhealthy. 120 twin births and two of triplets were visited. 51 Report of the Medical Officer of Health. It was found that in 1,812 of the births doctors had been in attendance, while in 1,526 the services of midwives had been utilised. 468 infants were born in hospitals and other institutions, and 413 in the Council's Maternity Home. Six mothers employed unregistered women. Midwives and Nursing Arrangements. 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. 39 midwives practise in the Borough, of whom seven reside in neighbouring Boroughs. There are 30 private maternity homes in the Borough, 14 of them being carried on by practising midwives. Arrangements have been made with various nursing Associations in the Borough to attend cases of measles, whooping cough, pneumonia, ophthalmia neonatorum, and infantile diarrhoea, when and as requested by the Medical Officer of Health, at a fee of 1/3 per visit. 95 cases were visited during the year under these arrangements, and 1,862 visits were made to them as shown by the following Table. Half of these visits were to cases of ophthalmia. TABLE XXVII. No. of cases. No. of visits. Whooping Cough 18 222 Influenzal Pneumonia 15 176 Pneumonia 25 416 Ophthalmia Neonatorum 27 980 Measles 10 68 Total 95 1862 52 Report of the Medical Officer of Health. Clapham is served by the South London District Nursing Association; Putney, Roehampton and parts of Wandsworth by nurses appointed by the Parochial Nursing Associations; Tooting, Balham, most of Streatham and the remainder of Wandsworth by the Ranyard Nurses; and the northern district of Streatham by the Brixton Nursing Association. Maternity and Child Welfare Centres. The eight Infant Welfare Centres established in previous years have continued to do excellent work throughout the year, and a new Centre has been opened in Putney Park. Each Centre has a Medical Officer, who attends at each infant or ante-natal clinic, together with a trained Superintendent who visits the homes of children and expectant mothers in addition to her duties at the clinics. The voluntary workers at all the Centres continue to render valuable assistance at the sessions and carry out all the work connected with the keeping of records, and the purchase and sale of food, drugs, and clothing. They do no visiting. The new Centre in Putney Park is a branch of the Putney Centre in Felsham Road, and it was started in order to overcome to some extent the overcrowding at the Putney centre, and also to serve the district of Roehampton, more especially the new population on the London County Council Housing Estate. This branch Centre is held in the Church Hall of St. Margaret's, Putney Park Lane, and a weekly infant clinic is held there on Fridays at 2 p.m. The first session was held on the 9th November, and eight sessions were held up to the end of the year, the number of new cases being 56. Ante-natal cases from this part of Putney continue to attend the Putney Centre. The following is a list of the Welfare Centres in the Borough, together with the hours at which the clinics are held:— Report of the Medical Officer of Health. Infant Welfare Centre. Clinics. Ante-natal. Infants. Clapham: Claphara Dispensary, Manor Street. 1st Monday in each month at 2 p.m. Tuesdays and Wednesdays, at 2 to 3.30 p.m. Putney: 104, Felsham Road. 1st and 3rd Thursday in each month at 2.30 p.m. Wednesdays at 2 p.m. Putney Park: The Hut, Putney Park Lane. Nil. Fridays at 2.30 p.m. Balham: 91, Bedford Hill. 1st, 2nd and 4th Fridays in each month at 10.30 a.m. Wednesdays and Thursdays at 2 to 3.30 p.m. Streatham:— 37, Riggindale Road. 1st, 3rd and 5th Wednesdays in each month at 10.30 a.m. Tuesdays and Fridays at 1.30 to 3.30 p.m. Tooting: Fairlight Hall— Fairlight Road. 1st, 3rd and 5th Wednesdays in each month at 10.30 a.m. Wednesdays and Thursdays at 2 to 3.30 p.m. southfield: St. Michael's Institute, Merton Road. 1st and 3rd Fridays in each month at 10 a.m. Tuesdays at 2 to 3.30 p.m. Fairfield: Fairfield Mission Hall, Fairfield Street. Nil. Thursdays at 2 to 3.30 p.m. Springfield: Church Hall, Earlsfield Road. 2nd and 4th Tuesdays in each month at 11 a.m. Tuesdays at 2 to 3.30 p.m. The total number of infants seen at the Centres during 1923 was 2,537, an increase of 197 on the previous year, and the total attendances were just over 40,000. The number of visits paid by the Superintendents to infants increased from 10,793 in 1922 to 12,640 in 1923. Seven of the nine Centres have ante-natal clinics, and 688 cases were examined at these clinics, compared with 653 in 1922. The following Table gives full particulars of the work at each Centre during the year. 54 Report of the Medical Officer of Health. TABLE XXVIII. Clapham. Putney. Putney Park. Balham. Streatham. Tooting. Southfield. Fairfield. Springfield. Totals. New Cases, 1923 46 210 56 393 281 417 195 208 315 2537 Transfers to other Centres 28 69 — 32 15 8 7 9 15 183 Passed on to L.C.C. 254 92 — 247 46 210 13 — 270 1132 Total Attendances 8144 3803 175 7069 5101 6946 2882 2663 3774 40557 Ante-natal Cases 91 59 — 121 87 176 63 — 91 688 Ante-natal Attendances 254 212 — 468 281 431 192 — 193 2031 Nurses' Visits to Infants 1438 1032 56 2101 2673 2036 857 860 1587 12640 Nurses' Visits to Ante-natal Cases 194 188 — 249 191 80 109 63 185 1259 No. of Sessions:— Infants 96 50 8 100 95 95 50 50 50 594 Ante-natal 12 24 — 34 28 26 24 — 22 170 Health Talks given 54 13 — 68 44 60 12 25 12 288 55 Report of the Medical Officer of Health. Day Nurseries. The addresses of the four day nurseries in the Borough are as follows:— Putney Putney Creche, 95, Lacy Road. Tooting Fairlight Hall Day Nursery, Fairlight Road. Wandsworth Wandsworth Day Nursery and Training School, 14, Garratt Lane. Balham Balham Day Nursery, 22, Old Devonshire Road. The day nurseries are voluntary institutions subsidised by Exchequer and Borough Council grants. 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 parents' payments vary from 6d. to 1s. per day for one child, a reduction being made when more than one child from the same family is admitted, or when a child is admitted for half a day only. The Putney, Wandsworth and Balham Day Nurseries are also training schools for nurses who intend to take up creche work. They are admitted as probationers and remain for about a year, receiving practical and theoretical training. The matrons give courses of lectures, which the probationers are bound to attend, and an examination is held at the end of the course. 117 inspections of the creches were made during the year by the Health Visitors. The attendances were Putney, 5,899; Balham, 8,798; Tooting, 4,894; and Wandsworth, 7,126; a total of 26,717, an increase of 4,732 compared with 1922. Wandsworth Borough Memorial Maternity Home. This Home, formerly a private residence, is situated in Glenburnie Road, off Beechcroft Road, Upper Tooting, and it was opened as a Maternity Home on the 4th November, 1920. The house is a large one standing in fairly extensive grounds, and the accommodation consists of 23 beds, including one isolation bed. There is a laundry attached to the Home. 56 Report of the Medical Officer of Health. Nursing Staff.—The staff consists of Matron, two Sisters, one Staff Nurse, two Nurses and six Probationers. The Probationers, who remain for a year and act as pupil midwives, undergo training for the Central Midwives Board examination, and the Home is recognised by the Board for this purpose. The pupil midwives also attend a course of lectures at the Clapham Maternity Hospital for a period of three months, and receive instruction in ante-natal work at the Balham and Tooting Infant Welfare Centres. In addition to the practical training received in the Home, arrangements have been made with Miss Moullin, 41, Parsons Green, Fulham, a registered midwife, for each pupil to reside with her for a month in order to receive the instruction required by the Board in district midwifery work. During this month one of Miss Moullin's pupils lodges in the Home and receives instruction in institutional work. Since the date of opening, 19 pupil midwives, trained in the Home, have passed the Central Midwives Board examination. Medical Staff.—There is a rota of nine Doctors practising in the Borough who are called in to cases of urgency or difficulty, as the need arises, their fees being paid by the London County Council under the Midwives Act. There is also a Consulting Staff consisting of two obstetric surgeons, two general surgeons, one eye surgeon and two physicians. Patients.—All expectant mothers residing in the Borough are eligible for admission to the Home. The fees are determined by the financial circumstances of each case, with a maximum fee of six guineas per week. Cases of exceptional hardship may be admitted free. The average fee was £2 5s. 2d. per week per patient. Patients are admitted shortly before labour is due, and the usual duration of stay is 14 days. Towards the end of 1923 the Council decided to admit women residing outside the Borough at a minimum weekly fee of £3 per week, provided all the accommodation in the Home is not required for Borough residents. 57 Report of the Medical Officer of Health. APPLICATION FOR ADMISSION TO THE HOME should be made to the Matron at the following times:— Monday, Wednesday and Thursday—10-11 a.m. Tuesday—6-7 p.m. The following Table shows the districts from which cases were admitted for the three complete years in which the Home has been opened. TABLE XXIX. Districts. 1921. 1922. 1923. Clapham 26 39 52 Putney 18 13 25 Balham 99 110 140 Streatham 34 41 38 Tooting 60 71 77 Wandsworth 95 116 120 Whole Borough 332 390 452 Outside the Borough 9 8 — Total admitted 341 398 452 There has been a satisfactory increase in the number of admissions from year to year, though the numbers from Putney and Streatham, the districts furthest away from the Home, are still small. The full particulars of the work of the Home during 1923 are as follows:— Total number of cases admitted 452 Average duration of stay 14.99 days 58 Report of the Medical Officer of Health. Number of cases delivered by:— (a) Midwives 423 (b) Doctors 29 Number of cases in which medical assistance was sought by the midwife 149 (a) Ante-natal 21 Small measurements 17 Albuminuria 4 (b) During labour 55 Prolonged labour 18 Abnormal presentation 7 Laceration 28 Foetal distress 2 (c) After labour 9 Puerperal Mania 2 Eclampsia 1 Rise of temperature 4 Uterine Fibroid 1 Skin disease 1 (d) For infant 64 Feebleness 11 Deformities 1 P.U.O. 1 Watery discharge from eyes 47 Opthalmia Neonatorum 1 Congenital Syphilis 1 Asphyxia and Convulsions 2 Number of cases of puerperal sepsis Nil Number of cases in which temperature rose above 100 4 for 24 hours with rise of pulse rate 4 Number of cases of ophthalmia neonatorum 1 Number of cases of "inflammation of the eyes" however slight 47 Number of infants not entirely breast fed while in the institution 16 Number of maternal deaths with causes—Eclampsia 1 Report of the Medical Officer of Health. 59 Number of foetal deaths 14 Still births 6 Within 10 days of birth 8 The following Table gives certain statistical information with regard to the Home for the last three years. TABLE XXX. 1921. 1922. 1923. Total number of cases admitted 341 398 452 Average duration of stay 16.0 days 15.41 days 14.99 days Number of infants not entirely breast-fed while in the Institution 8 25 16 Number of maternal deaths 2 — 1 Number of fœtal deaths 10 10 14 Expenses of maintenance £3897 £3377 £3635 Loan charges £1231 £884 £865 Gross cost £5128 £4261 £4500 Fees received £2030 £1939 £2328 Nett cost £3098 £2322 £2172 Gross cost per patient week £5 16s. 1d. £4 17s. 3d. £4 12s. 10d. Nett cost per patient week £3 10s. 2d. £2 12s. 11d. £2 4s. 9d. The particulars with regard to cost cover the financial years ending 31st March in each case, and those for 1923-1924 are subject to correction owing to the short time elapsing between the close of that year and the publication of this Report. The table shows that the number of cases has increased in each of the three years, while the average duration of stay is slightly less. The fees received from patients in 1923 show a considerable increase over both previous years, and there has been a progressive fall both in the gross and nett cost per patient week. 60 Report of the Medical Officer of Health. Institutions for Expectant and Nursing Mothers and Young Children. The Streatham Babies' Hospital, 39, Riggindale Road, is for the treatment of infants up to the age of five years. There are 18 cots, and the nursing staff consists of matron, a sister, two assistant nurses, and three probationers. A visiting medical officer attends daily. The parents pay 10/6 per week for their children, but necessitous cases are admitted free, or at a reduced fee, according to circumstances. Medical practitioners can recommend cases for admission and attend them while in the Hospital. 95 infants were admitted in 1923, 48 from addresses in the Borough and 47 from outside the Borough. Most of the cases were infants suffering from marasmus, enteritis, bronchitis, and allied diseases. The Borough Council pay an annual grant of £500 to this Hospital under their maternity and child welfare scheme. There is one other large institution in the Borough for the accommodation of 60 children up to the age of five years. There are five institutions or hostels in the Borough for the reception of expectant unmarried mothers, all in connection with rescue work. In two of them the mothers are admitted some months previous to the confinement, while in three they are admitted towards the end of pregnancy. In most of these homes the mothers are expected to remain some months after confinement. 236 women were admitted into these institutions during the year. Some of the infants attend the most convenient Infant Welfare Centre. Arrangements have been made for a medical man to attend at each hostel when necessary. Report of the Medical Officer of Health. 61 Convalescent Homes. During the year nine mothers with infants and one child were sent to Convalescent Homes. Four mothers and infants were sent to the Mothers' Rest Home, Hampstead, one mother and child to Baldwin Brown Convalescent Home, Heme Bay, one mother to All Saints' Home, Eastbourne, one mother and baby to Littletonon-Sea Convalescent Home, one child to the Marjorie Lumley Home Maidenhead, one mother and child to Wayside Cottage, Camberley, and one mother to a holiday home cottage at Aylesbury. Supply of Milk. 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 daily, 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. Report of the Medical Officer of Health. 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 During the year 919 families were supplied with milk under the above scheme—171 in Clapham, 62 in Putney, 152 in Balham, 107 in Streatham, 137 in Tooting, 70 in Southfield, 85 in Fairfield, and 135 in Springfield. The total cost to the Council was £1,612 12s. 7d. Women and children in receipt of milk under the Council's scheme are expected to attend the Welfare Centres during the time that the milk is being granted, though this rule is not enforced in cases where there is some very good reason for the mother's nonattendance. There is little doubt that many mothers and children have benefited from the supply of free milk since the scheme was instituted. In many cases the milk granted has enabled nursing mothers to prolong the period of lactation, and the records kept at the Welfare Centres show good results in the health and general well-being of many infants. Dental Treatment. During the year the arrangements with the British Dentists' Hospital for treating dental cases under the maternity and child welfare scheme have been modified. The payment of a minimum grant has been discontinued and the work is now carried on Report of the Medical Officer of Health. 63 on a capitation basis alone. A payment of 5/- per attendance is made with an additional charge of 5/- for each case requiring nitrous oxide. A separate charge is made for dentures, and patients are asked to contribute towards the cost of these according to their means. The teeth of mothers and children are examined as a routine by the Medical Officers at the Welfare Centres, and those requiring treatment are advised to attend at the Dental Clinic, 23, South Side, Clapham Common. 94 cases availed themselves of these facilities during the year, 67 being women, and 27 children, and 142 attendances were made. These arrangements for dental treatment are now similar to those for cases of Tuberculosis, the details of which are given on page 38. F 64 Report of the Medical Officer of Health. SANITARY INSPECTION OF DISTRICT. Table XXXI. gives a summary of the sanitary operations carried out in the Borough during the year. TABLE XXXI. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Number of complaints received and attended to 963 603 557 731 835 1687 5376 Number of houses and premises inspected 4717 3159 3035 3508 2724 8977 26120 Number of houses and premises re-inspected 4222 2483 2904 2578 3616 6148 21951 Number of house-tohouse inspections 270 286 401 182 228 634 2001 Number of preliminary notices served 1346 861 958 835 976 2490 7466 Number of preliminary notices complied with 1214 821 841 778 833 2356 6843 Number of statutory notices served 191 59 82 75 143 373 923 Number of statutory notices complied with 188 59 75 69 95 355 841 Number of rooms disinfected after infective diseases 656 278 692 551 518 1341 4036 Overcrowding abated 3 3 5 2 3 6 22 Rooms cleansed and repaired 1324 716 1725 1152 1489 3191 9597 Staircases cleansed and repaired 266 152 331 314 303 785 2151 Drains cleansed and repaired 151 72 97 74 99 198 691 Drains tested 292 352 181 372 177 791 2165 Drains found defective 75 42 62 43 53 121 396 Traps fixed to drains 83 7 23 4 3 5 125 Report of the Medical Officer of Health. 65 TABLE XXXI.—continued. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Bath, lavatory and sink wastes altered to discharge outside over gullies or repaired 65 72 54 40 34 237 502 Rain water pipes disconnected from drains 5 — 3 1 21 30 Water closets cleansed and repaired 296 156 332 197 196 704 1881 Accumulations of manure, etc., removed 8 23 25 61 13 56 186 Urinals cleansed, repaired or water laid on to 9 7 4 1 – 1 22 Ashpits provided or repaired 241 66 144 104 139 374 1068 Stables and stable yards drained, paved or cleansed 15 67 4 10 8 12 116 Yards drained, paved or cleansed 181 89 95 46 104 405 920 Unwholesome or dilapidated houses cleansed or repaired – – – – – 6 6 Leaky roofs and gutters repaired 403 132 204 223 198 539 1699 Damp courses inserted 27 8 23 36 1 63 158 Damp conditions remedied 164 142 133 201 158 403 1201 Houses re-supplied with water 19 8 13 16 5 34 95 Water cisterns cleansed, covered or repaired 49 42 21 35 26 134 307 Animals kept so as to be a nuisance 11 3 3 11 4 25 57 Smoke nuisances reported 2 – 1 1 — 22 26 Soil pipes repaired 13 15 19 7 24 41 119 Unclassified nuisances 323 97 125 83 134 652 1414 F 2 66 Report of the Medical Officer of Health. It will be seen from this Table that 22 cases of overcrowding were abated. In addition to these many further instances of overcrowding were brought to the notice of the Department, but owing to the shortage of housing accommodation it was not possible to remedy the conditions found. Tables XXXII. and XXXIII. give full details of the inspections carried out by the male and female Sanitary Inspectors. TABLE XXXII. DETAILS OF INSPECTIONS AND RE-INSPECTIONS, 1923 (MALE INSPECTORS). Inspections. ReIn spections. Total. No. of complaints received and attended to 5373 – 5373 No. of house-to-house inspections 2001 — 2001 Drainage and other sanitary works:— After notice 5303 20583 25886 Voluntary 629 530 1159 No. of premises inspected on account of: Notifiable diseases 2052 119 2171 Measles 450 – 450 Whooping Cough 400 1 401 Pulmonary Tuberculosis 32 – 32 Other Infective Diseases 270 3 273 Verminous conditions 299 3 302 Periodical Inspections:— Houses let in Lodgings 292 86 378 Closed underground rooms 4 — 4 Common lodging houses 5 — 5 Factories 428 120 548 Workshops 478 58 536 Workshops (Domestic) 129 43 172 Workplaces 73 10 83 Report of the Medical Officer of Health. 67 TABLE XXXII.—continued. Inspections. ReIn spections. Total. Periodical Inspections (continued):— Outworkers' premises 84 24 108 Bakehouses 270 153 423 Restaurant kitchens 159 20 179 Cowsheds 17 — 17 Piggeries 111 5 116 Dairies and Milkshops 566 35 601 Ice Cream Premises 317 32 349 Slaughter-houses 166 — 166 Places where food is prepared 140 15 155 Offensive trades 55 — 55 Fried fish shops 155 1 156 Rag and bone stores 48 — 48 Butchers' shops 392 — 392 Greengrocers' shops 163 — 163 Fishmongers' shops 184 1 185 Public-house urinals 238 5 243 Other sanitary conveniences, schools, etc. 43 — 43 Smoke observations 56 — 56 Unsound food 27 1 28 Yards of mews and stables 332 7 339 Legal Proceedings:— (1.) Applications and summonses 37 — 37 (2.) Hearings and adjournments 69 — 69 Other 2585 16 2601 Totals 24432 21871 46303 68 Report of the Medical Officer of Health. TABLE XXXIII. DETAILS OF INSPECTIONS AND RE-INSPECTIONS, 1923. (FEMALE INSPECTORS). Inspections. Re-Inspections. Total. No. of complaints received and attended to 3 – 3 Dressmakers' and Milliners' premises 266 12 278 Laundries:— Factory 90 4 94 Workshop 110 8 118 Workplace 85 – 85 Other Factories 95 7 102 Other Workshops 127 6 133 Other Workplaces 170 10 180 Domestic Workshops 41 — 41 Outworkers' premises 389 28 417 Other 312 5 317 Totals 1688 80 1768 During the year the number of drains which were tested was 2,165, and of these 396 were found to be in a defective condition. The drains of 106 houses were re-constructed. Damp conditions have been remedied in 1,201 premises, and in 153 of these damp courses were inserted. The collection of house refuse is in the hands of the Borough Surveyor as heretofore. 99 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. Underground Rooms. There are four underground rooms in illegal occupation at the present time and notices have been served, but owing to the difficulty of other accommodation being obtained for the occupiers, no further action can be taken in the meanwhile. 69 Report of the Medical Officer of Health. Housing, Town Planning, &c., Act, 1909. All house-to-house inspections under the Public Health (London) Act, 1891, are carried out as if these were inspections under Section 17 of the Housing, Town Planning, etc., Act, 1909, and the results recorded on a special card which was drawn up in 1910 and has been in use since that date. This method has been found to work most satisfactorily. Where nuisances are found, notices are served under the Public Health Act. The results of these inspections are shown in Table XXXIII. 2,001 inspections were made, compared with 2,714 in 1922, and nuisances were found in 1,761 of the houses, necessitating the service of sanitary notices. TABLE XXXIV. Wards. No. of houses inspected. No. of houses in which defects, were found. Number of Families Living in. One room. Two rooms. Three rooms. Four rooms and upwards Clapham North 162 159 52 53 49 109 Clapham South 108 87 10 19 15 78 Putney 286 260 12 24 210 175 Streatham 182 162 21 42 113 113 Balham 401 360 107 103 286 313 Tooting 228 165 14 17 326 152 Southfield 168 146 44 10 155 81 Fairfield 218 207 29 50 56 176 Springfield 248 215 26 49 136 144 Whole Borough 2001 1761 315 367 1346 1341 Rent and Mortgage Interest Restrictions Act, 1923. 113 applications for Certificates under both the Increase of Rent and Mortgage Interest (Restrictions) Act, 1920, and the above Act, which succeeded the former in August, 1923, were 70 Report of the Medical Officer of Health. received during the year. On inspection it was found that 106 of the premises were not reasonably fit for human habitation, and 7 premises were reasonably fit. Of the 106 premises not reasonably fit, 7 of them were put in a reasonable state of repair before the meeting of the Committee at which Certificates would have been granted. In addition, 2 applications were withdrawn, bringing the total number of Certificates not granted to 16. Of the 97 premises in respect of which Certificates were granted, 92 were rendered reasonably fit during the year, and the remaining 5 are in hand. Cleansing of Persons Act. The names of 122 children, 19 belonging to Clapham, 1 to Putney, 35 to Streatham, 6 to Tooting, and 61 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 60 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. 17 adults and 6 children had baths on account of their verminous condition, 19 of these being cases of scabies. Cutting-off Notices. During the year, 113 notices with respect to 131 premises were received from the Water Board stating that the supply had been withdrawn. 27 of the premises were in Clapham, 29 in Putney, 8 in Balham, 24 in Streatham, 5 in Tooting, and 38 in Wandsworth. The supply was withdrawn for non-payment of rates from 73 premises, from 40 premises in consequence of defects, and in 18 the premises were empty. Flies and Mosquitoes. During the summer months certain ponds, streams and areas of stagnant water were treated by cutting down rank vegetation and spraying with paraffin, with the object of destroying the larvae of mosquitoes. Chloride of lime was used for sprinkling horse manure in order to destroy the larvæ and pupae of flies. A total of £15 1s. 2d. was spent in materials used in work of this nature. 71 Report of the Medical Officer of Health. FACTORIES AND WORKSHOPS. The number of factories, workshops, workplaces and homeworkers premises is shown in Table XXXV., together with the number of inspections made. TABLE XXXV. Class of Works. Number of Places on Register at end of 1923. Number of Inspections, 1923. Number of Notices 1923. Number of Prosecutions, 1923. Factories:— Factory Laundries 58 118 3 — Factory Bakehouses 69 160 4 1 Other Factories 466 626 60 — Workshops:— Workshop Laundries 53 118 3 — Workshop Bakehouses 66 263 4 — Other Workshops 1004 1160 110 2 Workplaces:— Places where food is prepared for Sale 566 535 39 — Workplaces other than the the above 339 361 34 — Home-workers' premises 468 525 31 — Total 3089 3866 288 3 Further details with regard to homeworkers premises are given in Table XXXVI. 72 Report of the Medical Officer of Health. TABLE XXXVI. HOME WORK. Nature of Work. Outworkers’ Lists. Outwork in unwholesome premises Outwork in infected premises. Lists received from Employers. Notices served on occupiers as to keeping or sending lists. Outworkers. Instan ces. Notices served. Instan ces. Lists. Contrac tors. Workmen. Wearing Apparel:— (1.) Making, etc. 60 96 183 39 31 31 21 (2.) Cleaning and washing 2 5 1 — — — — Paper bags and boxes 2 — 3 — — — — Carding, etc., of buttons, etc. 2 — 3 — — — — Totals 66 100 190 39 31 31 21 The total number of addresses received from other Councils was 552 and 117 addresses were forwarded to other Councils. The number of addresses received has decreased by 27, and the number sent by 63. 25 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 39, and these had a most satisfactory result. During the year 21 cases of infective diseases—4 of Scarlet Fever, 6 of Diphtheria, 6 of Measles, one of German Measles, and 4 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. Report of the Medical Officer of Health. 73 TABLE XXXVII. DETAILS WITH REGARD TO 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 66 Workshop Laundries 53 Dressmakers' and Milliners' Workshops 133 Bootmakers 99 Smiths 35 Builders 52 Tailors 61 Motor Engineers 44 Other 580 Total number of workshops on Register 1123 74 Report of the Medical Officer of Health. FOOD. Milk Supply. The milk supplied to this Borough during the past year has been of very good quality, the average milk fat content shown by the samples analysed was 3 63 per cent., compared with 3-52 per cent, in 1922. There are at present three cowsheds and 249 milk retailers on the register, and these have been regularly inspected during the year. Particulars of these are given in Table XL. Statement of Work Done under the Sale of Food and Drugs Acts. During the year 2,000 samples of foods and drugs were submitted to the Public Analyst for analysis. Of these 1,010 were purchased as test or informal samples, while 990 were purchased officially. Of the 990 official samples submitted for analysis, 50, or 5-05 per cent., were reported to be adulterated or not up to standard, and of those samples which were purchased informally or as test samples, 62, or 6.13 per cent., were found adulterated or not up to standard. The total adulterations reported were 112, or 5 6 per cent., of the samples submitted. In 26 out of the 50 cases in which adulteration? 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 £114, and the costs to £25 5s. 6d., making a total of £139 5s. 6d. Report of the Medical Officer of Health. 75 TABLE XXXVIII. STATEMENT OF THE RESULTS OF ANALYSIS OF CERTAIN ARTICLES UNDER THE SALE OF FOOD AND DRUGS ACTS DURING THE YEAR 1923, AND COMPARISON OF PERCENTAGE ADULTERATED WITH THAT IN THE YEAR 1922. Number of Samples. Percentage Adulterated. Examined. Found Adulterated or not up to Standard. 1923. 1922. Bread — — — — Butter 298 4 1.3 2.6 Cheese — — — — Cocoa 69 3 4.3 — Coffee 45 1 2.2 — Confectionery and Jam 1 — — — Cream and Preserved Cream 54 10 18.5 13.3 Flour 12 — — — Self-Raising Flour 6 — — — Margarine 20 — — 6.2 Milk 999 36 3.6 2.8 Condensed Milk 15 — — — Dried Milk 15 1 6.6 — Mustard 12 — — — Sugar 29 1 3.4 — Tea 7 — — — Vinegar 21 9 42.8 71 Wine — — — — Beer 2 — — — Spirits — — — — Drugs 69 9 13.04 20-1 Other Articles 326 38 11.6 12.4 All Articles 2000 112 5.5 5.1 76 Report of the Medical Officer of Health. The following Table shows the number of formal and informal samples taken in each sub-district of the Borough, together with the number taken per 1,000 of population, the number adulterated, and the percentage adulterated to the formal and informal and to the total samples taken:— TABLE XXXIX. Informal Samples. Formal Samples. Total Number of samples taken Number per 1,000 of population. Number adulterated. Percentage adulterated. Number of samples taken. Number adulterated. Percentage adulterated. Number of samples taken. Number adulterated. Percentage adulterated. Clapham 190 11 5.8 172 9 5.2 362 5.8 20 5.5 Putney 94 7 7.4 108 7 6.4 202 6.5 14 6.8 Streatham 300 18 6.0 293 13 4.4 593 5.5 31 5.2 Tooting 128 8 7.0 121 7 5.8 249 5.9 15 6.0 Wandsworth 298 18 6.0 296 14 4.6 594 5.9 32 5.3 Whole Borough 1010 62 6.1 990 50 5.05 2000 5.8 112 5.6 Milk. The following samples of milk were submitted for analysis:— 993 of whole new milk. 6 of separated milk. 15 of dried milk. 15 of condensed milk. Of these 37 were reported against as being adulterated or not up to Legal Standard. 13 contained extraneous water; 19 were deficient in fat; and 5 contained colouring matter. Proceedings were taken in 22 cases, and in 15 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. Report of the Medical Officer of Health. 77 10 samples of milk were taken on delivery at various Public Institutions situated within the Borough. All these samples were genuine. 43 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 midday deliveries. Six samples were reported against, and in each case proceedings were taken against the farmer. Four samples of milk were procured during the early morning from wholesale dealers whilst delivering milk to the retailer. These samples were genuine. Six samples of milk were procured on delivery at private housesOne of these was reported against. 180 samples of milk have been taken on Sundays, either in the early morning or at midday. Six, or 3.3 per cent., were reported against as being adulterated. 540 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 17, or 3.1 per cent., were reported against. Report on Administration in connection with the Public Health (Milk and Cream) Regulations, 1912. 1. Milk and Cream not sold as “Preserved Cream” (a) (b) Number of samples Number in which a examined for the pre- preservative was sence of a preservative. reported to be present. Milk 1,029 Nil. Cream ... 36 9 The nine samples of Cream contained crystallised boric acid. The vendors were warned, and further samples were taken and found correct. 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 1,029 Nil. Cream 36 9 The nine samples of Cream contained crystallised boric acid. The vendors were warned, and further samples were taken and found correct. 78 Report of the Medical Officer of Health. 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 17 (2) Statements incorrect 1 Total 18 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. Percentage of Preservative Percentage stated on Statutory found in each sample. 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 18 (2) Below 35 per cent — Total 18 (c) and (d). In each of the 18 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. Butter and Margarine. 298 samples of butter were submitted for analysis during the year, of which four, or 1.3 per cent., were reported against. 20 samples of margarine were submitted for analysis, and all reported genuine. Other Articles. A full list of the articles of food and drugs examined under the Sale of Food and Drugs Acts, together with the analytical results, is contained in the Report of the Public Analyst. Report of the Medical Officer of Health. 79 Milk and Dairies (Amendment) Act, 1922. Section 4. This Section prohibits the sale of milk to which colouring matter has been added. Five cases of contravention of the Section were dealt with and convictions obtained. Section 5. This Section prohibits the sale of milk from cows suffering from Tuberculosis of the udder. 17 samples of milk were examined, and certificates received stated that in each case the examination revealed no evidence of Tubercle bacilli. Milk (Special Designation) Order, 1922 and 1923. During the year under review the above Order came into operation. The Order requires that all persons producing or selling milk by special designation shall be licensed. Licences were granted to 20 milk purveyors to sell milk as “Certified” milk. This milk is produced on farms certified and licensed by the Ministry of Health, bottled on the farm in hermetically sealed bottles and despatched to the milk purveyor, who delivers the milk in the original bottles intact to the consumer. Two licences were granted for the sale of “Grade A (Tuberculin Tested)” milk. This milk is also produced on farms which are certified and licensed by the Ministry of Health similar to Certified milk, and is produced from herds proved to be free from Tuberculosis. In six cases licences were granted for the sale of “Pasteurised” milk. Special plant will have to be installed before these licences are renewed. All licences expire in December, and are issued for one year. 20 samples of Certified milk; one of Grade A (Tuberculin Tested) ; and six of Pasteurised milk were procured for bacteriological purposes. Six samples of Certified milk were reported against, whilst the samples of Grade A (Tuberculin Tested) and Pasteurised milk conformed to the required standards. g 80 Report of the Medical Officer of Health. 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. There are now nine slaughterhouses used in the Borough, and 166 inspections of these premises were made during the year. 3,237 carcases were examined by the Inspectors, most of these being seen on butchers' premises. It was not found necessary to condemn any carcase during the year. The following Table is a copy of a return made to the London County Council and shows the number of certain food premises in the Borough, together with the number of slaughterhouses, offensive trade premises, and houses-let-in-lodgings. TABLE XL. Premises. Number of Places on the Register at end of 1923. Number of inspections, 1923. Number of Notices, 1923. Nunber of prosecutions. 1923. Milk Premises 249 601 29 — Cowsheds 3 17 — — Slaughterhouses 9 166 — — Other offensive trade premises 3 55 — — Ice cream premises 352 349 19 — Registered houses let in lodgings 292 378 313 — Unsound Food. 10 trunks of haddock; two boxes of herring; one box of mackerel; 37 boxes of kippers; one box of sprags; four boxes of skate; two boxes of cod; 12 bags of winkles; 96 scallops; 37 boxes of kippers; eight boxes of pears; nine boxes of apples; 24 boxes of tomatoes; 11 cases of cherries; 10 baskets of greengages; one crate of cabbages; 382 pounds of beef; 26 pounds of lamb; two fowls and 350 eggs were condemned at the request of the owners and the usual certificates granted. Report of the Medical Officer of Health. 81 MISCELLANEOUS. Bacteriological Examinations. During the year 956 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 XLI. Clapham Putney. Streatham. Tooting. Wandsworth. Whole Borough. Diphtheria:— Negative 230 72 208 47 237 794 Positive 35 6 29 8 42 120 Enteric Fever:— Negative 2 1 10 — 2 15 Positive — — 7 — — 7 Tuberculosis:— Negative 4 — 5 1 4 14 Positive 2 — 2 2 — 6 Totals 273 79 261 58 285 956 Examinations of sputum made at the Tuberculosis Dispensary are not included in the above figures. Statement of Work Done under the Rag Flock Act, 1911. 22 visits to workshops were made by the Inspector, and the materials used for bedding and upholstery were examined. 26 samples of rag flock were procured and submitted for analysis, two of which were reported against as not conforming c 2 82 Report of the Medical Officer of Health. with the required standard of cleanliness. In one case proceedings were taken, the defendant being convicted and fined £1 and £10 10s. costs. In the other case the vendor was warned. 16 Certificates have been issued in respect of the sterilisation of materials used in the manufacture of rag flock for export. Canal Boats Act. During the year 13 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. Inspection of Sanitary Conveniences. The number of Sanitary Conveniences inspected was 133; 27 in Clapham, 26 in Putney, 15 in Streatham, 12 in Tooting, and 43 in Wandsworth. 243 inspections were made during the year, and 22 notices, chiefly for cleansing, were served and complied with; and 77 inspections of Sanitary Conveniences for females were made by the Female Sanitary Inspectors. Ambulance Service. The Metropolitan Asylums Board provide a free ambulance service for the removal of cases of infectious disease. They also provide ambulances for other cases on payment, and the London County Council provide a free accident service. Revenue Act. During the year five certificates were granted under the above Act, and one refused. The certificates granted referred to 12 houses or 43 tenements. Report of the Medical Officer of Health. 83 STAFF. Details of the staff of the Department in December, 1923, are given below. All are whole-time officers with the exception of two of the mortuary keepers. Officers to whose salary no contribution is made under the Public Health Acts or by Exchequer grants are marked with*. Medical Officer of Health F. G. Caley, M.A., M.B., D.P.H. Deputy M.O.H. and Tuberculosis Officer A. W. Forrest, MA., M.D., D.P.H. Assistant M.O.H. and Assistant Tub. Officer J. J. MacDonnell, M.B., B.S., D.P.H. MALE INSPECTORS. Name. Certificates held. Sanitary Inspector. Meat and Food. Others. Sanitary Inspectors:— B. Nurcombe R. San. Inst. No Five W. G. Crabbe R. San. Inst. No Six A. J. Weeks R. San. Inst. No Four R. Brown R. San. Inst. No Five A. W. Browne R. San. Inst. Yes One H. E. Brown R. San. Inst. Yes One A. E. Vickers S.I. Exam. Board No — H. T. Lambert S.I. Exam. Board Yes Two F. Haworth S.I. Exam. Board No — J. A. Sands S.I. Exam. Board No One C. W. Idle S.I. Exam. Board Yes One Food and Drugs:— T. Newell R. San. Inst. Yes Six *A. G. Patterson (Unqualified Assista nt). 84 Report of the Medical Officer of Henlth. FEMALE INSPECTORS AND VISITORS. Name. Certificates held. SanitaryInspector. Health Visitor. Trained Nurse. C. M. B. Others. Sanitary Inspectors and Health Visitors:— J. E. Barritt Yes No No No One D. S. Collins Yes Yes No No — Health Visitors (Maternity and Child Welfare):— E. K. Woods Yes Yes No Yes One M. E. Maple Yes Yes No No One E. B. Henderson No Yes Yes Yes One R. M. Watling No Yes Yes Yes — Tuberculosis Visitors:— P. G. Moores No Yes Yes — One E. E. Merron No No Yes No One M. Dean Yes Yes No Yes One CLERICAL STAFF. Name. Appointment. Certificates held. *A. E. Cooper Senior First Class Clerk Sanitary Inspector and four others. *F. Bray First Class Clerk Six others. *P. C. Clark Second Class Clerk One other. *F. A. Eustace Second Class Clerk One other. E. Hunt Second Class Clerk and Dispenser One other. *E. V. Roots Third Class Clerk — *L. H. Pearson Third Class Clerk — E. J. Edwards Third Class Clerk — *Miss C. Wellings Temporary Clerk — *L. L. Parrini Office Boy — Report of the Medical Officer of Health. 85 Maternity Home. Matron: Miss E. Waring C. M. B. Sisters: Miss A. Andrews Trained nurse and C. M. B. Miss M. A. Luke Ditto ditto Staff Nurse: Miss J. Brown Ditto ditto Eight other nurses and probationers who remain for one year only, and one gardener attendant. Disinfecting Station. *J. Bond, Engineer. 10 Disinfectors. Mortuaries. One whole-time and two part-time mortuary keepers. Mr. C. Hatton, Sanitary Inspector, retired on 31st December, 1923, after 31 years’ service under the Council in that capacity. Miss K. L. Long, Sanitary Inspector and Health Visitor, also retired on 31st December, 1923, after 21 years’ service. In conclusion, I wish to express my appreciation of the manner in which the staff have carried out their duties. I am, Your obedient servant, F. G. CALEY 86 Report of the Medical Officer of Health. PARTICULARS AS TO HOUSING. Number of New Houses erected during the Year:— (a.) Total 533 (b.) With State assistance under the Housing Acts, 1919 or 1923:- (i.) By the Local Authority 104 (ii.) By other bodies or persons 429 1. Unfit Dwelling-houses. (1.) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 26120 (2.) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 2001 (3.) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (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 106 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 6843 3. Action under Statutory Powers. A.—Proceedings under Section 28 of the Housing, Town Planning, etc., Act, 1919. (1.) Number of dwelling-houses in respect of which notices were served requiring repairs Nil. Report of the Medical Officer of Health. 8 7 (2.) Number of dwelling-houses which were rendered fit:— (a.) By owners Nil. (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 923 (2.) Number of dwelling-houses in which defects were remedied:— (a.) By owners 841 (ib.) By Local Authority in default of owners Nil. C.—Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc., 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 16 (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. 88 Report of the Medical Officer of Health. PARTICULARS OF PROCEEDINGS TAKEN UNDER PUBLIC HEALTH ACT. Premises. Offences. Result. Fine. Costs. s. d. s. d. 41 and 45, Colmer Road, Streatham Nuisances Summons withdrawn, the work having been done - 4 0 68d, The Chase, Clapham Ditto Convicted 100 0 — 65, Guelph Street, Wandsworth Ditto Order made for abatement of nuisance — 21 0 11, Galesbury Road, Wandsworth Ditto Ditto - 21 0 Contravention of By-laws (w.c.'s) Convicted 100 0 — Ditto (yard paving) Ditto 40 0 — 1, Charlotte Place, Clapham Nuisance Order made for abatement of nuisance — 10 6 Non-compliance with Order 40 0 — 2 and 4, ditto Ditto Order made for abatement of nuisance — 21 0 5 and 6, ditto Ditto Orders made for abatement of nuisances — 21 0 Non-compliance with Orders 160 0 — 7, ditto Ditto Order made for abatement of nuisance 10 6 Non-compliance with Order 120 0 — Contravention of By-laws (w.c.’s.) Convicted 300 0 - Report of the Medical Officer of Health. 89 PARTICULARS OF PROCEEDINGS TAKEN UNDER PUBLIC HEALTH ACT— continued. Premises. Offences. Result. Fine. Costs. s. d. s. d. 90, High Street, Clapham Nuisance Summons withdrawn, the work — 2 0 having been done Vacant land, Wardley Street Wandsworth Ditto Order made for abatement of nuisance — 21 0 7 and 8, Deauville Mansions Clapham Ditto Ditto — 42 0 19, Gwalior Road, Putney Ditto Summons withdrawn, the work having been done — 2 0 197, High Road, Streatham Carrying on business of fish curer in an improper place Prohibition Order made 300 0 21 0 1, Holderness Road, Balham Nuisance Convicted 500 0 21 0 22, Melody Road, Wandsworth House without a proper water supply Closing Order made Failing to comply with Order 260 0 21 0 60, Wardley Street, Wandsworth Nuisance Order made for abatement of nuisance — 21 0 Contravention of By-laws (yard paving) Convicted 10 0 - 14 and 16, Chelverton Road, Putney Nuisance Order made for abatement of nuisance — 42 0 Non-compliance with Order - 20 0 Contravention of By-laws (yard paving) Convicted 100 0 - 90 Report of the Medical Officer of Health. PARTICULARS OF PROCEEDINGS TAKEN UNDER PUBLIC HEALTH ACT.—continued. Premises. Offences. Result. Fine. Costs. s. d. s. d. 17, Stanthorpe Road, Putney Nuisance Convicted 100 0 63 0 1, Portslade Road, Clapham Nuisance Order made for abatement of nuisance - 21 0 9, ditto Contravention of By-laws (yard Convicted 40 0 - paving) 40, Clyston Street, Clapham Nuisance Order made for abatement of nuisance — 21 0 Non-compliance with Order 620 0 - 2a, Gonsalva Road, Clapham Ditto Order made for abatement of nuisance — 21 0 69, Guelph Street, Clapham Ditto Order made for abatement of nuisance — 21 0 46 and 47, Victoria Road, Clapham Ditto Ditto 42 0 Non-compliance with Order 180 0 — Contravention of By-laws (w.c.’s.) and cistern cover) Convicted 40 0 — Order made for abatement of — 21 0 38, Clifton Street Nuisance nuisance 36, Strathville Road, Wandsworth.. Ditto Convicted 20 0 — 32, Fawe Park Road, Wandsworth.. Ditto Adjourned sine die — — Report of the Medical Officer of Health. 91 PARTICULARS OF PROCEEDINGS TAKEN UNDER PUBLIC HEALTH ACT .—continued. Premises. Offences. Result. Fine. Costs. s. d. s. d. 11, Standen Road, Wandsworth Nuisance Order made for abatement of nuisance - 21 0 7 and 8, Lydden Road Ditto Convicted 40 0 4 0 Wandsworth Contravention of By-laws (w.c.’s.) Ditto 60 0 — 15, ditto Nuisance Summons withdrawn, the work having been done — 2 0 Contravention of By-laws (yard) paving) Convicted 20 0 - 16, ditto Nuisance Ditto 20 0 2 0 Contravention of By-laws (w.c.’s.) Ditto 20 0 — 17, ditto Nuisance Ditto 10 0 2 0 Contravention of By-laws (w.c.’s.) and cistern cover) Ditto 30 0 - 18, ditto Nuisance Ditto 20 0 2 0 39, ditto Ditto Summons withdrawn, the work having been done — 2 0 6, Leighara Vale, Streatham Ditto Order made for abatement of nuisance — 10 6 37, Aslett Street, Wandsworth Contravention of By-laws (yard paving) Summons withdrawn, the work having been done — 63 0 60 and 60a, Fountain Road, Tooting Nuisance Order made for abatement of nuisance — 21 0 92 Report of the Medical Officer of Health. PARTICULARS OF PROCEEDINGS TAKEN UNDER PUBLIC HEALTH ACT.—continued. Premises. Offences. Result. Fine. Costs. s. d. s. d. 135, Greyhound Lane, Streatham Nuisance Closing Order made — 21 0 17, Foley Place, Clapham Ditto Order made for abatement of nuisance — 21 0 1, Clifton Cottages, Clapham Ditto Ditto - 5 0 Non-compliance with Order 100 0 — 46, Streatham Hill Absence of water closet accommodation for workpeople Convicted 200 0 — 40, Nursery Street, Clapham Nuisance Summons withdrawn, the work having been done — 2 0 Macaulay Road, Clapham Keeping swine in an unfit place Prohibition Order made — 5 0 379, Upper Richmond Road, Putney Failing to cleanse bakehouse .. Adjourned sine die — — 59, Wimbledon Park Road Wandsworth Nuisance Ditto — — 61, High Street, Tooting Ditto Ditto — — - Selling milk without being registered Convicted 60 0 42 0 - Ditto Ditto Sent to prison for 21 days Report of the Medical Officer of Health. 93 ANNUAL STATEMENT Of the work done in the Borough of Wandsworth under the Sale of Food and Drugs Acts. To the Mayor, Aldermen and Councillors of the Wandsworth Borough Council. Mr. Mayor, Ladies and Gentlemen, In presenting our annual report on samples submitted under the Sale of Food and Drugs Acts during the year 1923, we should like to draw your attention to its highly satisfactory nature. In all, 2,000 samples were examined, and in only 112 cases were unsatisfactory results obtained. This gives a total adulteration of only 5.6 per cent. A further cause for congratulation is to be found in the fact that only 36 out of a total of 999 milks and separated milks were adversely reported upon: that is to say, slightly less than 3.6 per cent, were adulterated. That inspection of food in your Borough is very efficiently carried out is amply proved when you consider that in all no less than 62 distinct varieties of food and drugs were submitted by your food inspector, the nature of which will be found in the tables following. 94 Report of the Medical Officer of Health. GENERAL STATEMENT. Nature of Sample. Examined Adulterated. Formal. Informal. Total. Formal. Informal. Total. Butter 298 298 4 4 Cocoa 6 63 69 — 3 3 Coffee 1 44 45 — 1 1 Confectionery and Jam _ 1 Cream — 36 36 — 9 9 Cream, preserved . . 2 16 18 — 1 1 Flour — 12 12 — — — Flour, self-raising .. — 6 6 — — — Margarine — 20 20 — — — Milk 950 43 993 33 3 36 Milk, condensed — 15 15 — - — Milk, dried — 15 15 — 1 1 Milk, separated 5 1 6 — — — Mustard — 12 12 — — — Sugar — 29 29 — 1 1 Tea — 7 7 — — — Vinegar 5 16 21 3 6 9 Beer — 2 2 — — — Drugs 5 64 69 2 7 9 Other articles 16 310 326 12 26 38 Total 990 1010 2000 50 62 112 DRUGS. Nature of Sample. Examined Adulterated. Formal. Informal. Total. Formal. Informal. Total. Acid, Acetic - 1 1 - - - Acid, Boric — 4 4 - — — Acid, Tartaric — 3 3 - — — Camphorated Oil — 6 6 - — — Cream of Tartar 2 9 11 2 2 4 Ointment, Boric — 7 7 — — — Powder, Compound Liquorice 6 6 Powder, Gregory 3 6 9 — 3 3 Prescriptions — 16 16 — 2 2 Tincture, Quinine Ammoniated — 6 6 — — — Total 5 64 69 2 7 9 Report of the Medical Officer of Health. 95 OTHER ARTICLES. Nature of Sample. Examined Adulterated. Formal. Informal. Total. Formal. Informal. Total. Almonds, ground - 3 3 - - - Arrowroot - 12 12 — — - Baking Powder - 21 21 — — - Barley, Pearl - 6 6 — — - Cake 7 11 18 6 6 12 Cake, sponge 2 31 33 1 7 8 Chocolate powder — 6 6 — — .— Cinnamon, ground — 3 3 — — — Cornflour — 12 12 — — — Eggs, dried — 4 4 — — — Eggs, liquid 3 — 3 3 — 3 Egg substitute — 2 2 — — — Fruits, dried — 18 18 — — — Ginger, ground — 9 9 — — — Ginger, preserved — 3 3 — — — Ice cream — 2 2 — — — Ice cream powder — 1 1 — — — Infants’ food — 2 2 — — — Lard — 45 45 — — — Lemonade powder — 18 18 — 3 3 Mace, ground — 3 3 — — — Meat, potted — 3 3 — — — Mincemeat — 8 8 — — — Oatmeal — 3 3 — — — Olive oil — 8 8 — 1 1 Pea flour — 5 5 — — — Pepper 2 8 10 — — — Rice — 24 24 — 2 2 Rice, ground — 3 3 — — — Sago — 4 4 — — — Semolina — 6 6 — — — Tapioca — 14 14 — — — Vegetables, tinned — 6 6 — 1 1 Wines, nonalcoholic 2 6 8 2 6 8 Total 16 310 326 12 26 38 Of the various articles set out in the preceding tables, both samples of Beer, two of Tea, one sample of Jam and one Bun were submitted by the Inspector owing to complaints having reached him to the effect that these commodities had been suspected of causing illness to their consumers. On each of these samples an exhaustive analysis was made, but in no case could we discover the presence of any poisonous or deleterious ingredient, so that it is evident that an explanation as to the cause of the symptoms complained of had to be sought elsewhere. h 96 Report of the Medical Officer of Health. As a popular idea prevails that a great deal of the milk sold in the London streets contains a preservative, it cannot be too strongly emphasised that every sample submitted was tested for the presence of preservatives, with negative results in all cases. Another point which arrests the attention is the fact that only one sample of Butter, out of a total of 298 examined, was found to be adulterated with Margarine, whilst 3 only, or a trifle over one per cent., contained over the maximum permissible quantity of Boron preservative. When we compare the above statement with the reports submitted to your Council a few years ago it leaves no ground for argument as to the efficacy of the use of the informal sampling then adopted by the Inspector by permission of the existing Public Health Committee. The nature and extent of the adulteration of the 50 formal samples adversely reported upon will be found in the following tables. MILK. Case No. Nature and Extent of Adulteration. 17 1 per cent extraneous water 42 5 per cent extraneous water 55 Coloured with Annatto 56 18 per cent. extraneous water 63 2 per cent. extraneous water 92 25½ per cent. extraneous water 1ll 27 per cent. milk fat deficient 148 9 per cent. extraneous water 163 10 per cent. milk fat deficient 236 11 per cent. milk fat deficient 250 3 per cent. extraneous water 306 17 per cent. milk fat deficient 345 3 per cent. milk fat deficient 391 21 per cent. milk fat deficient 392 9 per cent. milk fat deficient 449 Coloured with Annatto 463 3 per cent. milk fat deficient 475 3 per cent. milk fat deficient 479 14 per cent. milk fat deficient 489 Coloured with Annatto 501 Coloured with Annatto 503 Coloured with Annatto 542 4 per cent milk fat deficient 571 5 per cent. milk fat deficient 577 1 per cent. extraneous water 603 11 per cent. milk fat deficient 636 8 per cent. extraneous water 665 8 per cent. extraneous water 827 9 per cent. extraneous water 886 2 per cent. milk fat deficient 974 10 per cent. milk fat deficient 977 10 per cent. milk fat deficient 986 16 per cent. milk fat deficient 97 Report of the Medical Officer of Health. VINEGAR. Case No. Nature and Extent of Adulteration. 696 14½ per cent. deficient in Acetic Acid 697 19 per cent. deficient in Acetic Acid 698 22 per cent. deficient in Acetic Acid DRUGS. Case No. Nature of Sample. Nature and Extent of Impurity. 508 Cream of Tartar 2 parts excess Arsenic per million 509 Cream of Tartar 20 parts excess Lead per million OTHER ARTICLES. Case No. Nature of Sample. Nature and Extent of Impurity. 331 Cake (Jam Sponge) 21.3 grains Boric Acid per lb. 333 Cake (Madeira) 18.9 ditto ditto 335 Cake (Genoa) 16.0 ditto ditto 337 Cake (Genoa) 11.3 ditto ditto 338 Cake (Madeira) 7.8 ditto ditto 339 Cake (Cherry) 18.3 ditto ditto 364 Sponge Cakes 22.4 ditto ditto 332 Liquid Eggs 60.2 ditto ditto 334 Liquid Eggs 37.8 ditto ditto 336 Liquid Eggs 56.0 ditto ditto 973 Raisin Wine 7 grains Salicylic Acid per lb. 990 Orange Wine 7 ditto ditto The average composition of the 957 samples of Milk returned as genuine during the year was as follows:— Per cent. Total milk solids 12.51 Milk fat 3.63 Non-fatty solids 8.88 H 2 98 Report of the Medical Officer of Health. The averages for the four quarters being:— Quarter. Total Solids. Milk Fat. Non-fatty Solids First 12.44 per cent. 3.54 per cent. 8.90 per cent. Second 12.36 per cent. 4.48 per cent. 8.88 per cent. Third 12.44 per cent. 3.68 per cent. 8.76 per cent. Fourth 12.72 per cent. 3.77 per cent. 8.95 per cent. All samples of Butter submitted were examined for the presence of preservative, with the result that 103, or 34.5 per cent., were found to be free, with the exception of the presence of common salt; 192, or 65.6 per cent., were found to contain a Boron preservative in varying quantities, but in no case exceeding the maximum permissible, namely, 0.5 per cent., calculated as Crystallised Boric Acid; whilst three were returned as containing an excess of this preservative. On examination it was found that all the samples of Margarine submitted contained a Boron preservative, in quantities ranging from 0.22 per cent., to 0.43 per cent., expressed as Crystallised Boric Acid. As shown in the first set of Tables, 62 out of the 1,010 Informal samples submitted were reported against, as follows— Butter (4) One sample contained Margarine, whilst 3 contained an excess of Boron preservative (as mentioned above). Cocoa (3) All were found to contain a trace of Arsenic. Coffee (1) Contained Chicory. Cream (9) All were preserved with Boric Acid. Cream, preserved (1) Contained an excess of Boron preservative over the limit of 0.4 per cent., calculated as Crystallised Boric Acid. Milk (3) Two samples contained extraneous water in quantities amounting to 15 per cent., and 52 per cent., whilst one was deficient in milk fat to the extent of 76 per cent. Milk, dried (1) This sample was found to be slightly deficient in milk fat. Sugar (1) Was mixed with Ground Rice, 99 Report of the Medical Officer of Health. Vinegar (6) All these samples were found to be deficient in Acetic Acid; the deficiency varying from 19 to 23.5 per cent. Cake (6) These were all found to contain a Boron servative accounted for by the use of Liquid Eggs in their preparation. The quantity of preservative detected ranged from 11.9 to 21.7 grains per lb. Crystallised Boric Acid. Cake, sponge (7) As in the case of Cake all these were found to contain Boric Acid, the quantity present varying from 12.5 to 24.3 grains per lb. Eggs, liquid (3) These samples were preserved with Boric Acid, and contained from 37.8 to 60.2 grains per lb. Lemonade powder (3) Lemonade powder should be prepared with Citric Acid; in these cases Tartaric Acid had been employed. Olive Oil (1) Consisted entirely of Cotton Seed Oil. Rice (2) These samples had been polished with Talc, and a slight excess of that agent had been allowed to remain on the surface of the grain, the maximum permissible being 0.5 per cent. Vegetables, tinned (1) Sulphate of Copper had been employed in this case to fix the colour of the beans. The quantity remaining on the vegetable was, however, very small, amounting to only 0.07 grains per lb. expressed as Copper. Wines, non-alcoholic (6) In the preparation of these Wines Salicylic Acid had been employed as a preservative, and was found to be present in quantities ranging from 2.3 to 7.0 grains per pint. We are, Mr. Mayor, Ladies and Gentlemen, Your obedient Servants, A. H. M. MUTER, F.I.C., F.C.S., Public Analyst. CHARLES A. HACKMAN, F.I.C. Additional Public Analyst. South London Central Public Laboratory, 325, Kennington Road, S.E. 11, 25th February, 1924. 100 Index. INDEX. page Adulteration of Certain Articles, Percentage of, in 1922 and 1923 75 Ambulance Service 82 Analyst, Report of 93 Anti-toxin 19 Area of Borough 1 Bacteriological Examinations 43, 81 Bakehouses 71 Births 3 Births and Birth-rates in Sub-Districts 3 Birth-rate, Average 10 Years 1913-1922 7 Births, Notification of, Act 4 Brain and Nervous System, Diseases of the 29 Butter and Margarine 78 Canal Boats Act 82 Cancer 29 Census, 1921 2 Cerebro-Spinal Meningitis 22 Child Birth, Deaths from 29 Circulatory Diseases 29 Clapham, House-to-House Inspections in 69 Cleansing of Persons Act 70 Conscientious Objection Certificates granted 17 Convalescent Homes 61 Cowsheds 80 Creches 55 Cutting-off Notices 70 Day Nurseries 55 101 Index. page Death, Causes of 6 Death-rate, Average 10 Years 1913-1922 7 Death-rate, Corrected 5 Death-rate from Infective Diseases 13 Death-rate, Infantile 9 Deaths, Corrected 5 Deaths, Number of 4 Deaths in Outlying Institutions 7 Deaths in Public Institutions 7, 8 Deaths in Public Institutions in the Borough 7 Dental Treatment 38,62 Developmental Diseases 29 Diarrhœa 28 Diphtheria 18 Diphtheria, Attack Rate per 1,000 cases 18 Diphtheria, "Return Cases "of 21 Disinfection 47 Disinfection of Schools 47 Dysentery 23 Encephalitis Lethargica 22 Enteric Fever 21 Erysipelas 21 Factories and Workshops 71 Factories, Workshops and Workplaces, Inspection of 71 Flies and Mosquitoes 70 Food 74 Food Places, Inspection of 71 German Measles, Cases of 24 Health Visitors, Work of 48 Home Work 72 Hospitals, etc., for Expectant and Nursing Mothers 60 House Refuse, Removal of 68 House-to-house Inspections, Summary of 69 Houses and Premises Inspected 64 Houses Let in Lodgings 80 Housing 86 102 Index. page Housing, Town Planning, etc. Act, 1909 69 Ice Cream Premises 80 Illegitimate Children, Births of 3 Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 69 Infant Visiting 50 Infantile Mortality 9, 10 Infantile Mortality, 10 Years 1913-22 11 Infective Diseases 13-17 Infective Diseases, Death-rate from 13 Infective Diseases: Number of Cases notified from Elementary Schools 25-27 Influenza, Deaths and Death-rates 22 Influenza, Pneumonia and Acute Primary Pneumonia, Cases Notified 22 Inhabited Houses, Number of 1 Inspections, Details of 66-68 Inquests 29 Malaria 23 Margarine 78 Maternity and Child Welfare 48 Maternity and Child Welfare Centres 52 Maternity Home 55 Measles and German Measles 24 Measles and other Non-notifiable Diseases reported from Schools 25-27 Meat 80 Midwives 51 Milk 76 Milk and Cream Regulations, 1912 77 Milk and Dairies (Amendment) Act, 1922 79 Milk (Mothers and Children) Order 61 Milk Premises, Cowsheds, etc., on Register 80 Milkshops, Cowsheds, etc., Inspections of 80 Milk (Special Designation) Order, 1922 and 1923 79 Milk Supply 74 103 Index. page Mortuaries 31 Mosquitoes 70 Natural Increase, Rate of 3 Nervous System, Diseases of the 29 Non-Infective Diseases, Deaths from 29 Notification of Births Act 4 Notification of Infective Diseases 15, 16 Nursing Arrangements 51 Offensive Trades 80 Old Age 29 Ophthalmia Neonatorum 23 Other Infective Diseases, Deaths from 28 Outworkers 72 Overcrowding 66 Para-Typhoid Fever 21 Police Court Proceedings 88-92 Polio-Myelitis and Polio-Encephalitis 22 Population 1,2 Population of Sub-Districts 2 Premature Birth 29 Public Institutions, Number of Deaths in 8 Puerperal Fever 21 Pulmonary Tuberculosis, Notification of Cases of 33 Putney, House-to-House Inspections in 69 Rag Flock Act, 1911, Statement of Work done under 81 Rateable Value 1 Rent and Mortgage Interest Restrictions Act, 1923 69 Respiratory Diseases 29 Return Cases of Scarlet Fever and Diphtheria 21 Revenue Act 82 Sale of Food and Drugs' Act, Proceedings under 74 Sale of Food and Drugs Act, Statement of Work under 74 Sanitary Conveniences, Inspection of 82 Sanitary Operation, Table of 64, 65 Sanitary Inspection of District 64 Scabies 28 104 Index. page Scarlet Fever 19 Scarlet Fever: Attack Rate per 1,000 cases 20 Scarlet Fever "Return Cases "of 21 Schools, Disinfection of, for Infective Diseases 47 Shelters for Tuberculous Patients 39 Slaughter-houses 80 Small-pox 17 Smoke Nuisances 65 Sputum Examinations 43 Staff 83 Streatham, House-to-house Inspections in 69 Tooting, House-to-house Inspections in 69 Treneh Fever, Cases Notified 23 Tuberculosis 32 Tuberculosis Dispensaries 37 Tuberculosis Care Committee 43 Tuberculous Diseases, Extra Nourishment provided 39 Underground Rooms 68 Unsound Food 80 Vaccination Returns 17 Violence, Mortality from 29 Vital Statistics of Whole Borough 1 Wandsworth, House-to-house Inspections in 69 Water Supply, Cutting-off Notices 70 Whooping Cough 21 Zymotic Diseases 13