WAN 67 Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, &c. OF THE BOROUGH, For the Year 1924, by F. G. CALEY, M.A., M.B., D.P.H., Medical Officer of Health, together with the Report of the Public Analyst. REPORT of the Medical Officer of Health for the Year 1924. 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 1924. GENERAL AND VITAL STATISTICS FOR THE BOROUGH. Area 9,199 acres Population in 1924 341,234 No. of inhabited houses in 1921 62,540 No. of families, or separate occupiers, in 1921 80,526 Rateable value in 1924 £2,358,847 Estimated produce of a penny rate £9,625 Extracts from Vital Statistics. Births Males Females Total Births Deaths :— Total Deaths 2,592 2,382 4,974 3,767 Legitimate Illegitimate Birth-rate Death-rate 4,796 178 14-57 11-03 No. of women dying in, or in consequence of, childbirth :— From sepsis 9 From other causes 18 B 2 Report of the Medical Officer of Health. Deaths of Infants under one year of age :— Legitimate 208 Illegitimate 19 Total 287 Infantile mortality 57 Deaths from Tuberculosis No. 294 Rate 86 Total deaths from Measles 71 Total deaths from Whooping Cough 28 Total deaths from Diarrhoea (under two years of age) 21 Population. The population at the middle of the year was estimated to be 341,234, and all the rates used in this Report are calculated on this figure. The corresponding figure for the year 1923 was 337,823. 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 1924 Clapham 60,540 62,393 Putney 28,558 30,982 Balham 50,888 53,042 Streatham 52,607 55,327 Tooting 40,135 39,945 Wandsworth 95,579 99,545 Whole Borough 328,307 341,234 Vital Statistics. 3 Births. The total number of births occurring in the Borough was 4,734, including 430 non-residents who were born in Institutions. 670 births of Borough residents occurred outside the Borough, so that the corrected number of births was 4,974, compared with 5,475 in 1923. 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 496 488 984 15.77 4-09 Putney 222 201 423 13.65 1.71 Balham 447 370 817 15.40 2.53 Streatham 358 357 715 12.92 2.62 Tooting 299 293 592 14.82 5.21 Wandsworth 770 673 1443 14.49 4.14 Whole Borough .. 2592 2382 4974 14.57 3.54 The birth-rate was 14.57 per 1,000, compared with 16-20 for 1923, and 17.79 the decennial average. The rate for the whole of London during 1924 was 18.7, and for England and Wales 18.8. 273 illegitimate births took place in the Borough, but only 93 belonged to the Borough. On the other hand 85 illegitimate births belonging to Wandsworth occurred outside the Borough, making a corrected total of illegitimate births belonging to b 2 4 Report of the Medical Officer of Health. Wandsworth of 178. 31 of these belonged to Clapham, 11 to Putney, 21 to Balham, 63 to Streatham, nine to Tooting, and 43 to Wandsworth. The percentage of illegitimate births to total births was 3.57. 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. Notified by : No. born dead. Medical Attendant. Parent Midwife. Other person. Clapham 984 527 224 88 200 15 12 Putney 423 290 140 13 131 6 12 Balham 817 973 129 60 763 21 18 Streatham 715 615 245 137 170 63 19 Tooting 592 414 77 57 272 8 11 Wandsworth 1443 983 207 390 335 51 20 Whole Borough 4974 3802 1022 745 1871 164 92 Deaths. The number of deaths which took place in the Borough during the year was 3,255, but 844 of these did not belong to the Borough, while 1,356 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 3,767, of whom 1,751 were males and 2,016 females. Vital Statistics. 5 The corrected death-rate for the year was 11-03, compared with 10-09 in 1923. The death-rate for the whole of London for 1924 was 12-1, for England and Wales 12-2, in the 105 County Boroughs and great Towns 12-3, and in the 157 smaller Towns 11-2. 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. Corrected Deathrate. Males. Females. Total. Clapham 322 407 729 11-68 Putney 184 186 370 11-94 Balham 327 356 683 12-87 Streatham 245 325 570 10-30 Tooting 191 193 384 9-61 Wandsworth 482 549 1031 10-35 Whole Borough 1751 2016 3767 11-03 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. 6 Report of the Medical Officer of Health. Table V.—Causes of, and Ages at Death, during the Year 1924. 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 71 40 31 12 32 20 6 ... 1 ... ... 11 7 12 3 15 23 37 Scarlet Fever 7 2 5 1 4 1 1 ... ... 2 2 ... 1 2 6 Whooping Cough 28 11 17 11 14 3 ... ... ... ... ... 4 3 5 l 2 13 7 Diphtheria and Membranous Croup 26 14 12 ... 3 13 6 2 1 ... 1 6 5 ... 2 4 9 22 Influenza 139 62 77 5 ... 2 1 3 25 38 65 26 24 25 24 10 30 31 Erysipelas 5 3 2 1 ... ... 1 ... 1 2 ... ... 1 ... 2 ... 2 4 Cerebro-spinal Fever 4 2 2 1 ... ... 1 1 ... ... ... l l 1 ... ... 2 Other Epidemic Diseases 14 4 10 1 1 ... 2 2 4 2 1 2 2 1 3 4 2 6 Pulmonary Tuberculosis 244 125 119 2 ... ... 5 54 100 73 10 48 20 49 16 34 11 114 Tuberculous Meningitis 24 9 15 1 l 9 7 1 4 1 ... 9 ... 2 ... 1 12 17 Abdominal Tuberculosis 4 3 1 ... ... ... 3 1 ... ... ... ... 2 1 ... 1 ... 1 Other Tuberculous Diseases 22 18 4 2 ... 1 4 3 6 5 1 7 3 3 2 1 6 18 Other Infective Diseases 17 8 9 6 ... ... 2 1 4 3 1 4 2 2 ... 1 8 13 Cancer, Malignant Disease 513 231 282 ... ... 1 1 3 29 230 249 95 44 92 96 50 136 218 Rheumatic Fever 16 7 9 ... ... ... 5 3 3 2 3 2 2 1 2 3 6 5 Diabetes 28 11 17 ... ... ... ... ... 3 10 15 9 2 2 7 4 4 9 Other General Diseases 54 17 37 l ... 2 ... 5 8 18 20 10 5 7 12 4 16 22 Alcoholism 2 2 ... ... ... ... ... ... ... 1 1 ... 2 ... ... ... ... 2 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 6 l 5 1 2 1 ... ... 1 1 ... ... ... ... 2 1 1 3 Cerebral Haemorrhage, Apoplexy- 173 65 108 1 ... ... ... 1 4 54 113 39 13 36 23 17 45 48 Convulsions 17 6 11 12 4 1 ... ... ... ... ... 3 3 3 3 1 4 5 Other Diseases of Nervous System 116 62 54 3 1 2 5 10 25 43 27 19 13 27 14 7 36 70 Organic Diseases of Heart 510 204 306 – – – 4 9 28 108 361 108 47 97 65 49 144 224 Other Diseases of Circulatory System 197 101 96 2 ... ... 1 7 15 55 117 36 21 37 47 15 41 78 Bronchitis 327 143 184 21 2 1 ... ... 8 63 232 89 30 58 40 26 84 52 Broncho-Pneumonia 119 56 63 30 28 7 ... 2 8 17 27 19 8 24 22 17 29 45 Lobar Pneumonia 41 21 20 3 2 – – – 5 21 10 8 4 9 5 4 11 9 Pneumonia (type not distinguished) 74 52 22 7 5 6 5 1 11 24 15 14 - 10 6 - 30 35 Other Diseases of Respiratory System 36 11 25 1 1 2 3 13 16 6 5 6 6 6 7 16 Ulcer of Stomach 23 16 7 – – – – ... 2 16 5 6 2 4 2 4 5 15 Diarrhoea 11 5 6 7 2 ... ... ... ... ... 2 2 ... 4 ... 2 3 6 Enteritis 19 11 8 12 ... ... ... ... 2 3 2 4 ... 5 5 1 4 11 Appendicitis and Typhlitis 26 12 14 – – 2 5 2 5 7 5 4 3 4 10 1 4 25 Obstruction of Intestines 31 17 14 2 ... ... 1 ... 1 10 17 9 2 2 4 ... 14 19 Cirrhosis of Liver 31 16 15 ... ... ... ... ... 1 20 10 6 3 8 3 3 8 6 Other Diseases of Liver 12 3 9 ... ... ... ... ... 1 7 4 2 1 2 3 2 2 8 Other Diseases of Digestive System 46 19 27 7 ... 1 1 3 10 18 6 8 5 9 7 ... 10 30 Nephritis and Bright's Disease 153 81 72 ... ... ... 3 6 13 50 81 22 18 25 29 10 49 76 Other Diseases of Urinary System 31 28 3 ... ... ... ... ... ... 9 512 2 4 3 13 5 4 25 Diseases of Generative System 7 ... 7 ... ... ... ... 1 2 3 1 ] 1 2 2 1 5 Puerperal Fever 9 ... 9 ... ... ... ... 3 6 ... ... 4 ... ... 1 ... 4 9 Other Accidents and Diseases of Pregnancy and Childbirth 18 ... 18 ... ... ... ... 1 17 ... ... 3 3 3 1 3 5 9 Premature Birth 64 39 25 64 ... ... ... ... ... ... ... 8 3 8 12 8 25 14 Congenital Debility and Malformation 55 31 24 51 2 1 ... 1 ... ... ... 8 5 8 9 8 17 21 Other Diseases of Early Infancy 16 8 8 16 ... ... ... ... ... ... ... ... 5 2 3 2 4 8 Old Age 204 70 134 ... ... ... ... ... ... l 203 42 20 43 31 20 48 53 Deaths from Accident 113 67 46 3 5 5 11 6 18 23 42 9 12 24 21 16 31 81 Deaths from Suicide 30 21 9 ... ... ... ... ... 13 10 ... 8 2 7 5 1 ... 22 Other Violent Deaths 4 3 1 1 ... ... 1 ... ... 2 ... ... 2 ... 1 ... 1 3 Other Defined Diseases 27 13 14 ... 1 ... 3 2 4 7 10 2 4 8 3 4 ... 21 Ill-defined Diseases or unknown 3 ... 3 ... ... ... 1 ... ... 1 1 ... ... ... 1 1 1 1 All causes 3767 1751 2016 287 107 84 86 136 393 971 1703 729 370 683 570 384 1031 1587 Vital Statistics. 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. 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 LI.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 12.4 121 1922 16.68 21.0 20.6 11.24 13.4 12.9 1923 16.20 20.2 19.7 10.09 11.2 11.6 Average 10 years 17.79 21.3 20.8 11.72 14.2 13.6 1924 14.57 18.7 18.8 11.0 12.1 12.2 The total number of deaths which occurred in Institutions inside the Borough was 1,075, but 844 of these persons did not belong to the Borough. A total of 1,587 persons belonging to the Borough died in Institutions, 231 occurring in Institutions within the Borough and 1,356 in Institutions outside the Borough. The following is a list of the Institutions outside the Borough in which deaths of Borough residents occurred :— 8 Report of the Medical Officer of Health. Name of Institution. No. of Deaths. Poor Law Hospitals and Infirmaries :— Wandsworth Union Infirmaries 793 Banstead Mental Hospital . . 15 Cane Hill Mental Hospital . . 9 Horton Mental Hospital . . 11 Leavesden Mental Hospital .. 11 Long Grove Mental Hospital. . 17 Other Poor Law Institutions.. 13 Other Mental Institutions . . 7 Other Hospitals :— Belgrave Hospital .. .. 7 Bolingbroke Hospital .. 9 Brompton Hospital .. .. 11 Cancer Hospital .. .. 8 Charing Cross Hospital . . 10 Collindale Hospital .. .. 11 Guy's Hospital . . . . 18 King's College Hospital . . 14 Middlesex Hospital .. . . 11 National Hospital .. . . 9 St. Bartholomew's Hospital . . 11 St. Columba's Hospital .. 6 Name of Institution. No. of Deaths. Other Hospitals—contd. :— St. George's Hospital . . . . 13 St. Thomas's Hospital . . 45 University College Hospital . . 9 Victoria Hospital .. . . 13 West London Hospital . . 6 South Western Hospital . . 8 Western Hospital .. .. fi Other Institutions, etc :— Other Institutions . . .. 102 Other Places not Public Institutions .. .. 99 On Street .. .. .. 15 River Thames . . . . . . 3 Private Nursing Homes . . 36 1356 Institutions inside the Borough 231 1587 Infantile Mortality. The total number of deaths under one year was 287 :—.46 in Clapham, 25 in Putney, 48 in Balham, 40 in Streatham, 37 in Tooting, and 91 in Wandsworth. As the number of births was 4,974, the Infantile Mortality was 57 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 the lowest but one recorded. It compares with an average of 74 for the last 10 years. This low number and rate is due to a marked fall in the number of deaths from Diarrhoea and Enteritis. The number of deaths among legitimate infants was 268 to 4,796 births—a mortality of 55 per 1,000 births, while the number of deaths among illegitimate infants was 19 to 178 births—a mortality of 106 per 1,000 births. Vital Statistics. 9 Table VII. gives the corrected number of deaths, and the cause of death, at various periods up to one 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 79 20 14 14 127 49 33 35 42 286 Uncertified 1 – – – 1 – – – – 1 Small-pox – – – – – – – – – – Chicken-pox – – – – – – – – – – Measles – – – – – – – 3 9 12 Scarlet Fever – – – – – – – – – – Whooping Cough — – 1 — 1 — 5 2 3 11 Diphtheria and Croup – – – – – – – – – – Erysipelas – – – – – 1 – – – 1 Tuberculous Meningitis – – – – – – – 1 — 1 Abdominal Tuberculosis – – – – – – – – – – Other Tuberculous Diseases – – – – – – 1 1 2 4 Meningitis (notTubercu lous) – – – – – – – – 1 1 Convulsions 2 l 2 1 6 1 — 1 4 12 Laryngitis – – – – – – – – – – Bronchitis 1 — — 2 3 6 4 5 3 21 Pneumonia (all forms) — 2 1 1 4 6 10 9 11 40 Diarrhoea – – – – – 3 2 1 1 7 Enteritis — 1 — — 1 6 3 1 1 12 Gastritis -—• — 1 — 1 2 1 1 – 5 Syphilis — 1 — 1 2 2 1 — — 5 Rickets – – – – – – – – 1 1 Suffocation, overlaying — 1 — — 1 — — — — 1 Injury at Birth 1 —- —• — 1 — — — — 1 Atelectasis 7 2 1 1 11 1 — — — 12 Congenital Malformations 9 4 1 1 15 4 3 3 1 26 Premature Birth 44 5 5 4 58 6 — — — 64 Atrophy, Debility and Marasmus 11 3 1 1 16 4 2 2 – 24 Other Causes 5 - 1 2 8 7 1 5 5 26 Totals 80 20 14 14 128 49 33 35 42 287 Nett Births in the year : legitimate, 4796 ; illegitimate, 178. Nett Deaths in the year of legitimate infants, 268 ; illegitimate infants, 19. 10 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. 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 1923 50 40 49 50 63 55 52 Average for 10 years 72 75 65 88 79 74 1924 46 56 58 55 62 63 57 No. of deaths under 1 year, 1924 46 25 48 40 37 91 287 11 INFECTIVE DISEASES. The total number of deaths from these diseases was 644 :— 130 in Clapham, 69 in Putney, 112 in Balham, 60 in Streatham, 78 in Tooting, and 195 in Wandsworth. From all infective diseases the death-rate was 1.88 per 1,000:—2.08 in Clapham, 2.122 in Putney, 2.11 in Balham, 1.08 in Streatham, 1.95 in Tooting, and 1.95 in Wandsworth. The rate is higher than in 1923, mainly owing to the increase in the number of deaths from Influenza. The rate in 1917 was 2.71 ; in 1918, 5.37 ; in 1919, 2.50 ; in 1920, 1.96; in 1921, 2.26; in 1922, 2.28; and in 1923, 1.61. The rate from the principal infective diseases, viz. :—Smallpox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever, and Diarrhoea, was .47 per 1,000, compared with .74 in 1916 ; .94 in 1917 ; .82 in 1918 ; .42 in 1919 ; .61 in 1920 ; .70 in 1921 ; .73 in 1922 ; and .39 in 1923. The rate was .40 in Clapham, .32 in Putney, .32 in Balham, .21 in Streatham, .35 in Tooting, and .54 in Wandsworth. The death-rate from these diseases for 1924 is higher than in 1923, the increase being almost wholly due to the increase in the number of deaths from Influenza. Table IX. shows the deaths which occurred during the year from the notifiable and non-notifiable infective diseases, and in Table X. is given the number of cases of the former diseases which were reported. In both these Tables the cases are arranged in age groups, and Tuberculosis and Ophthalmia Neonatorum are not included as they are dealt with separately on pages 28 and 20 of this Report. In Table XI. the cases of infective diseases are shown grouped according to the Sub-districts in which they occurred. TABLE IX. Notifiable Diseases. Total. No. of DEATHS from Infectious Diseases grouped in Age Periods. Under 15 15 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 26 21 5 — 3 7 4 2 4 1 2 1 1 — 1 Scarlet Fever 7 6 1 — 1 1 2 1 1 — — 1 — — — Enteric and Paratyphoid Fever – – – – – – – – – – – – – – – Puerperal Fever 9 — 9 — — — — — — — — 8 1 — — Erysipelas 5 2 3 1 — — — — — 1 — 1 — 2 — Whooping Cough 28 28 — 11 14 3 – – – – – – – – – Pneumonia :— – – – – – – – – – – – – – – Acute Influenzal 5 1 4 1 – – – – – – – 1 1 2 — Acute Primary 86 34 52 11 15 1 1 3 2 1 — 4 7 23 18 Cerebro-spinal Meningitis 4 3 1 1 1 — — — 1 — 1 — — — — Polio-myelitis 1 1 – – – – 1 – – – – – – – – Encephalitis Lethargica 13 4 9 1 — 1 — — 1 1 — 4 2 2 1 Malaria – – – – – – – – – – – – – – – Dysentery – – – – – – – – – – – – – – – Trench Fever – – – – – – – – – – – – – – – Total 184 100 84 26 34 13 8 6 9 4 3 20 12 29 20 Non-Notifiable Diseases. Measles 71 70 1 12 32 12 5 3 4 2 1 – _ Influenza 132 5 127 2 — — 2 — — 1 2 9 14 40 62 Diarrhoea 11 9 2 7 2 – – – – – – – – – 2 Other (if any) – – – – – – – – – – – – – – – Total 214 84 130 21 34 12 7 3 4 3 2 10 14 40 64 Grand Total 398 184 214 47 68 25 15 9 13 7 5 30 26 69 84 12 Report of the Medical Officer of Health. TABLE X. Notifiable Diseases. Total. No. of CASES of Infectious Diseases grouped in Age Periods. 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 412 293 119 5 13 28 33 35 118 61 40 63 8 6 2 Scarlet Fever 847 722 125 7 26 47 65 90 344 143 53 55 14 3 — Enteric and Paratyphoid Fever 14 5 9 – – – – – 4 1 2 3 1 3 — Puerperal Fever 24 — 24 — — — — — — — — 21 3 — — Erysipelas 111 14 97 3 2 2 —• 1 2 4 4 10 20 52 11 Whooping Cough 1108 1094 14 109 142 120 174 216 310 23 2 6 3 3 — Pneumonia :— – – – – – – – – – – – – – – – Acute Influenzal 32 8 24 3 — 2 1 — -—- 2 — 6 4 11 3 Acute Primary 514 224 290 41 49 30 16 27 44 17 24 75 45 107 39 Cerebro-spinal Meningitis 5 4 1 2 1 — — — 1 — 1 — — — — Polio-myelitis 16 16 — 2 2 3 3 2 2 2 — — — — — Encephalitis Lethargica 32 7 25 1 — 1 1 1 1 2 4 6 6 8 1 Malaria 9 —- 9 — — — — — — — 3 5 — 1 — Dysentery 1 1 – – – – – – 1 – – – – – – Trench Fever – – – – – – – – – – – – – – – Total 3125 2388 737 173 235 233 293 372 827 255 133 250 104 194 56 Infective Diseases. 13 TABLE XI. Disease. Total CASES of Infectious Diseases occurring in each locality. Total Cases occurring. Number admitted into Hospital. Total Deaths. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Small-pox – – – – – – – – Diphtheria 73 25 29 33 96 156 412 394 26 Scarlet Fever 195 49 104 62 165 272 847 775 7 Enteric and Paratyphoid Fever 1 0 3 1 — 4 14 6 — Puerperal Fever 4 — 9 2 1 8 24 22 9 Erysipelas 28 8 11 11 14 39 111 27 5 Whooping Cough 109 66 172 74 98 589 1108 47 28 Pneumonia—Acute Influenzal 11 1 2 4 — 14 32 — 5 Pneumonia.—Acute Primary 95 33 67 34 57 228 514 — 86 Cerebro-spinal Meningitis 1 — 2 1 1 — 5 2 4 Polio-myelitis 3 1 2 1 9 16 12 1 Encephalitis Lethargica 4 4 3 6 7 8 32 18 13 Malaria 1 1 4 — 2 1 9 — — Dvsentery —. — — 1 — — 1 — — Trench Fever — — — — — — — — — Total 522 195 407 231 442 1328 3125 1303 184 Tuberculosis—all forms Ophthalmia Neonatorum 132 6 82 1 102 10 62 5 84 8 230 1 692 31 10 294 Total 138 83 112 67 92 231 723 10 294 Grand Total 660 278 519 298 534 1559 3848 1313 478 14 Report of the Medical Officer of Health. Infective Diseases. 15 The total number of cases, less Tuberculosis and Ophthalmia Neonatorum, was 3,125, compared with 2,792 in 1923 and 4,018 in 1922. The increase, compared with 1923, is largely due to the number of cases of Diphtheria and Scarlet Fever having risen from 953 to 1,259. In 1922 there were 2,095 cases of these two diseases. Small-pox. No case of this disease occurred during the year. Vaccination. No vaccination or re-vaccination was performed 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 1923. It shows the number of children successfully vaccinated for the whole Borough, as well as for the separate sub-districts, Streatham Balham and Tooting being included under the heading of Streatham. TABLE XII. SubDistricts. Number of Births returned from 1st January to 31st December, 1923. 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 830 495 — 40 206 4 6 41 38 Putney 389 276 2 — 12 63 7 2 13 14 Streatham 2629 1422 6 — 101 667 28 165 99 141 Wandsworth . . 1383 908 6 — 56 348 5 6 29 25 Totals 5231 3101 14 — 209 1284 44 179 182 218 16 Report of the Medical Officer of Health. The percentage of children vaccinated to total births has improved from 51.5 to 59.2:—in Clapham from 56.7 to 59.6, in Putney from 66.6 to 70.9, in Streatham, etc., from 43.7 to 54.0, and in Wandsworth from 58 T to 65.6. Diphtheria. The prevalence of this disease was much the same as in 1923, 412 cases occurring, compared with 374 in 1923. The number of deaths in each year was 26. The death-rate for 1924 was -07 and the case mortality was 6-5 per cent. The figures for both years compare very favourably with 1922, when there were 838 cases and 76 deaths. The rate per 1,000 of population was 1.2 :—1-2 in Clapham, .8 in Putney, .5 in Balham, .5 in Streatham, 2.3 in Tooting, and 1.5 in Wandsworth. Of the 412 cases, 394, or 96 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 Larkhall Lane and New Road Schools, Clapham, Broadwater and Hearneville Road, Balham, St. Leonard's, Streatham, Ensham and Sellincourt Road, Tooting, and Swaffield Road, Waldron Road, and The Wan die Schools, Wandsworth. Swabs were taken from the throats of some of the children examined. As a result of this swabbing, nine cases were found to be positive and eight suspicious. All the cases were swabbed again and not re-admitted to school until a negative result was obtained. Every positive or suspicious case was visited and all necessary precautions taken to prevent the spread of the disease. During the year 26 tubes of anti-toxin were issued to medical practitioners for use in cases of Diphtheria. Infective Diseases. 17 Scarlet Fever. 847 cases of Scarlet Fever occurred, compared with 579 in 1923, and 1,257 in 1922. Seven cases died, compared with three and 19 respectively for the two previous years, and the death-rate was -02 per 1,000, compared with -008 and .05. The case mortality was .82 per cent. The case rate per 1,000 of population was 2.48:—3.12 in Clapham ; 1.58 in Putney ; 1.96 in Balham ; 1.12 in Streatham ; 4.13 in Tooting, and 2.73 in Wandsworth. Of the total number of cases 775, or 91 per cent., were removed to hospital. 95 cases of Scarlet Fever occurred during the year at the Fountain Mental Hospital, an Institution for mentally deficient children under the Metropolitan Asylums Board. The first case occurred in January, but 86 of them occurred during the last half of the year, there being 13 cases in July, 19 in August, 16 in September, nine in October, nine in November, and 20 in December. All the children were removed to one of the Fever Hospitals as they developed the disease. Further cases have occurred during the early months of 1925, and I have suggested to the Medical Superintendent certain further precautions which should be taken in order to stop the outbreak. The Medical Officers of the London County Council made inspections of 17 schools during the year, and any suspected cases were at once excluded and the names and addresses forwarded to me for inquiry. Return Cases of Scarlet Fever and Diphtheria. 18 cases of Scarlet Fever and two of Diphtheria occurred within one month of the return of a previous case from hospital. Enteric and Para.Typhoid Fever. 14 cases of the above occurred, and three notifications were received of cases which proved, after investigation, not to be true cases. There were no deaths. c 18 Report of the Medical Officer of Health. Of the 14 cases eight gave a positive reaction to the bacillus typhosus, and so were true cases of Enteric Fever. Six were shown by the agglutination test to be cases of Para-typhoid Fever. In three cases which occurred in one house the source of infection was in all probability polluted water drunk on the Continent, but in the other cases no special source of infection was traced. Two of the cases of Enteric Fever occurred in the first half of the year, and six occurred in the second half, while four cases of Para-typhoid occurred in the first half of the year and two in the second half. Puerperal Fever. There were 24 cases of Puerperal Fever and nine deaths. The death-rate was -02 per 1,000 and the case mortality 37 per cent. 22 of the 24 cases were removed to hospital. Erysipelas. 111 cases were notified and five deaths occurred during the year, compared with 101 and four in 1923. Whooping Cough. 28 deaths occurred during the year, compared with 30 last year, while the number of cases notified was 1,108, compared with 1,229. 47 of the cases were removed to hospital. 327 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Whooping Cough occurred, and 146 premises were disinfected. Influenza. The number of deaths from Influenza was 139, compared with 56 in 1923 and 148 in 1922. The death-rate was .4 per 1,000. The number of deaths represents 3.6 per cent, of the total mortality from all causes, compared with 1.6 per cent, in 1923, 3.9 per cent, in 1922, 2.3 per cent, in 1921, 2.2 per cent, in 1920, 8.2 per cent, in 1919. Infective Diseases. 19 Influenzal Pneumonia and Acute Primary Pneumonia. 32 cases of acute Influenzal Pneumonia and 514 cases of acute Primary Pneumonia were notified. Five of the former and 86 of the latter died. The total number of deaths credited to all forms of Pneumonia during the year was 233, compared with 189 in 1923, 236 in 1922, 241 in 1921, and 227 in 1920. Cerebro-Spinal Meningitis. Five cases of this disease occurred and four of them died. A further six deaths were registered as being caused by Meningitis. Polio-myelitis and Polio-encephalitis. 16 cases occurred and one of them died. Encephalitis Lethargica. 32 cases of this disease occurred and 14 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. This is an increase on 1923, when there were six cases with three deaths, and this increase may be associated with the larger number of deaths from Influenza in 1924. Malaria. Nine cases were notified, all males. Five of them contracted the disease in India, one in Egypt, one in Palestine, one in Salonica, and one while serving in the Navy. Dysentery. One case of Dysentery was notified from an Institution. Trench Fever. No cases occurred during the year. c 2 20 Report of the Medical Officer of Health. Ophthalmia Neonatorum. 31 cases were notified and the following Table shows the effect of the disease on the vision in 28 of the cases, according as to whether the cases were treated at hospital or at home. One child is still under treatment as an out-patient at a hospital, and two removed to addresses unknown on discharge from St. Margaret's Hospital TABLE XIII. Result of Treatment. Vision not affected. Vision Impaired. Total Blindness. Died. Treatment received :— In Hospital 10 At Hospital, Out-patient 4 — — 1 At home 12 — — I Total 26 — — 2 Of the 31 cases two died from other causes, but in each of them the eye condition was improving at the date of death. 26 of the cases recovered without any impairment of vision. Three of the cases were attended at birth by doctors, 15 by midwives, and 13 of the infants were born in maternity homes. Measles and German Measles. 71 deaths occurred from Measles, compared with 11 in 1923, and the death-rate per 1,000 of population was -2, compared with -03 in 1923, -21 in 1922, -012 in 1921, -17 in 1920, and -05 in 1919. Infective Diseases. 21 3,418 cases of Measles were reported during the year, compared with 663 in 1,923. 1,253 of the cases were under the age of five years, and 3,386 of them were under the age of 15 years. 119 of the cases were removed to the Metropolitan Asylums Board's Hospitals because the conditions in the homes were not suitable for treating them there. 2,859 of the 3,418 cases were reported by the Divisional Officers of the Educational Department or by the teachers of elementary schools, and 144 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 during vacations may not come to the knowledge of the school authorities. 324 cases of German Measles were also reported. 3,853 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Measles occurred, and 1,342 premises were disinfected. Table XIV. shows the number of cases of infectious diseases which occurred in the individual elementary schools during the year. 22 Report of the Medical Officer of Health. TABLE XIV. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Clapham. Aristotle Road — — 3 — 3 — 1 — — 7 Bonneville Road 21 3 187 19 9 9 6 2 62 318 Cavendish Road 12 3 50 1 2 5 1 1 1 76 Cavendish Road Special — — 1 — 1 — — — — 2 Christchurch 2 2 25 — — — 1 — — 30 Clapham Parochial, Macaulay .. Road 3 — 11 — 7 — 2 1 — 24 Clapham Parochial, Old Town .. 8 1 22 — 9 12 25 — — 77 Haselrigge Road 8 — 39 3 34 6 38 1 20 149 Larkhall Lane 4 8 24 2 14 5 42 2 6 107 New Park Road 9 1 40 9 15 3 52 1 3 133 New Road 1 3 3 — — — 1 — — 8 St. Andrew's Street 3 5 — — — — 1 — — 9 St. Mary's, Crescent Lane — — 1 — — 1 — — — 2 St. Mary's, St/Alphonsus Road . . 1 1 — — — — — — — 2 Stonhouse Street 8 1 85 1 29 5 4 7 7 147 Telferscot Road 36 1 91 2 14 — 2 7 38 191 Putney. All Saints' 3 4 2 6 3 1 — — 19 Hotham Road 11 3 40 3 34 22 1 1 3 118 Huntingfield Road 7 — 73 3 — 5 — — 1 89 Parochial, Roehampton — 1 18 — 3 — 3 — — 25 St. Mary's 3 2 8 — 10 — — — — 23 Carried forward 140 35 725 45 190 76 181 23 141 1556 Infective Diseases. 23 TABLE XIV.-—continued,. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 140 35 725 45 190 76 181 23 141 1556 Streatham. Broadwater Road 4 1 46 3 27 5 13 1 3 103 Balham High Road 5 3 75 — 4 8 1 — 3 99 Christchureh — — 17 — 1 2 4 — — 24 Coventry Hall — 6 — — — — — — — 6 Eardley Road 13 — 90 34 11 3 2 1 9 163 Fircroft Road 11 5 65 9 9 35 — — 7 141 Furzedown Demonstration 1 — 61 19 — 5 2 — 6 94 Hearneville Road 11 — 96 1 7 — — 2 — 117 Hitherfield Road 4 — 5 1 3 — 9 — 3 25 Holy Trinity, Balham — 1 16 6 2 — 2 — — 27 Holy Trinity, Streatham 1 — 1 — — 1 — — — 3 Immanuel — — 8 — — 1 — — — 9 Mitcham Lane 6 3 57 15 10 8 24 5 3 131 Nightingale Square R.C. 1 — 24 — 5 — 1 — — 31 Oldridge Road 5 1 58 3 4 21 2 1 27 122 Smallwood Road 9 7 88 6 16 28 14 1 18 187 St. Andrew's, Colmer Road 1 — 32 — — 28 — — — 61 St. Leonard's 3 — 45 2 2 9 1 — 3 65 St. Mary's, Balham 4 — 56 — 23 6 9 — — 98 Sunnyhill Road 2 — 48 — — 4 20 1 1 76 Welham Road, County Secondary 2 — 2 — — — — — 4 Carried forward 223 62 1615 144 314 240 285 35 224 3142 24 Report of the Medical Officer of Health. TABLE XIV.—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 223 62 1615 144 314 240 285 35 224 3142 Tooting. Ensham 32 6 61 8 12 7 1 1 4 132 Fountain Road 4 3 55 12 39 10 10 2 3 138 Franciscan Road 2 2 77 4 72 1 9 1 21 189 Hillbrook Road 7 1 89 26 21 31 6 2 183 Sellincourt Road 14 11 118 12 42 4 29 1 26 257 Tooting Graveney 5 4 79 25 34 3 92 3 14 259 Undine Street R.C. — — 20 2 — — 5 — 11 38 Wandsworth. AUfarthing Lane 3 5 73 5 10 19 19 _ — 134 All Saints' 7 — 37 47 7 5 1 2 106 Brandleliow Road 8 4 45 21 6 — 2 4 1 91 Earlsfield 13 13 40 4 14 59 94 5 11 253 Elliott Central 1 2 3 Eltringham Street 5 4 19 6 32 6 22 — 24 118 Frogmore Special — 2 — — — — — 2 Garratt Lane 12 6 58 1 9 12 61 7 166 Littleton Street Special 1 1 Magdalen Road 12 2 44 — 26 1 10 2 97 Merton Road 3 2 40 — 6 12 15 1 87 Riversdale 6 5 20 1 2 36 2 — 1 73 St. Ann's 3 5 25 1 1 9 19 1 3 67 St. Faith's 3 1 29 6 3 22 — 64 St. Joseph's 1 1 3 — 5 4 13 2 1 30 St. Michael's 1 4 30 1 33 3 9 — 1 82 St. Thomas's 1 .— — 1 Southfields 20 4 20 39 27 4 13 1 10 138 Swaffield Road 20 12 89 1 9 2 22 1 156 Waldron Road 8 1 4 72 9 65 2 43 204 Wandle 22 4 85 1 10 68 38 — 18 246 Warple Way 3 4 37 — 8 11 24 — 2 89 West Hill 6 1 47 2 21 24 32 2 2 137 Grand Total 445 172 2859 324 878 585 924 63 433 6683 Infective Diseases. 25 Diarrhoea. The number of deaths from Diarrhoea was 30, compared with 61 in 1923, and 32 in 1922, and of these 19, or 63 per cent, were under the age of one year, compared with 46 in 1923. The number of deaths from Diarrhcea, Zymotic Enteritis and Enteritis under one year represents 6.6 per cent, of the total mortality at that age. Scabies. The names of 18 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 eight 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, 12 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. 17 deaths occurred, eight from syphilis, six from septicaemia, two from pyaemia, and one from tetanus. 26 NON-INFECTIVE DISEASES. The total number of deaths from Cancer and malignant disease was 513, the number of males being 231 and females 282. The corrected death-rate was 1.5 per 1,000 for the whole Borough:—1.5 for Clapham, 1.21 for Putney, 1.73 for Balham, 1.73 for Streatham, 1.25 for Tooting, and 1.36 for Wandsworth. The number of deaths in 1924 was 56 more than in 1923, and 63 more than in 1922. The number of deaths from diseases of the Brain and Nervous System was 139. 880 deaths occurred from diseases of the Heart and Circulatory System, compared with 829 in 1923. 591 of these deaths were of persons over 65 years of age. There were more deaths from diseases of the Respiratory System, the number being 596, compared with 476 in 1923. The number from Bronchitis was 327, compared with 249 in 1923, and from Pneumonia (all forms) 233, compared with 189 in 1923. Further particulars relative to Pneumonia are given on page 19. The number of infants under two years of age who died from these diseases rose from 65 in 1923 to 97 in 1924. 18 deaths occurred from accidents and diseases of pregnancy, and with the nine deaths already mentioned from Puerperal Fever, gives a total of 27 deaths after childbirth. This is equivalent to a rate of 5.4 per 1,000 births, compared with 2.5 in 1923. 135 deaths, 78 males and 57 females, were registered as due to Premature Birth and Developmental Diseases, compared with 134 in 1923. 204 deaths, 70 males and 134 females, occurred from Old Age, and 203 of these were persons over 65 years of age. The number of deaths due to this cause in 1923 was 210. 147 deaths were due to Violence, 113 of them being due to accident, 30 to suicide, and four to other forms of violence. Inquests. Inquests were held on 193 persons dying in the Borough, and on 132 Borough residents who died outside the Borough. The next Table shows the results of the findings of these inquests. 27 Non-Infective Diseases. TABLE XV. Inquests. Sub-Districts. Whole Borough. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Deaths from Natural Causes 32 25 26 17 16 42 158 Accidental:—- Falls 4 2 4 7 7 12 36 Falls from a height - - 2 1 1 3 7 Falls from vehicles 2 - 1 - - - 3 Knocked down by motor vehicles 2 6 13 6 7 6 40 Knocked down by horse vehicles - 1 2 - - - 3 Knocked down by cyclist - - - - - 1 1 Knocked down by trains - - 1 - - 2 3 Thrown from motor vehicles - 1 2 2 - 1 6 Scalds and burns 1 2 3 1 2 2 11 Drowning - 2 - - - - 2 Poisoning - - 1 1 - - 2 Suffocation - - 2 1 1 - 4 Other - 1 - 1 - 2 4 Suicidal:— Drowning 1 1 - - - 4 6 Cut Throat - - 1 1 - - 2 Poisoning by Coal Gas 2 1 1 2 2 1 9 Poisoning by Lysol - - - - - 1 1 Gun shot wounds 2 2 1 2 - 1 8 Fall from a height 2 - 1 1 - - 4 Jumped in front of train 1 - 1 - - - 2 Hanging and strangulation - - 1 - - 1 2 Criminal abortion - - - - - 1 1 Open Verdicts:— Found drowned - - 2 - - 3 5 Murder - 2 - - - - 2 Homicide - - - - - 1 1 Execution - - - - - 2 2 Totals 49 46 65 43 36 86 325 28 TUBERCULOSIS. The following Report has been prepared by Dr. A. W. Forrest, who is in charge of tbis branch of the work of the Department. The results of the re-organisation of the Tuberculosis work in the Borough, as detailed in the Report of last year, have proved very satisfactory. Notification.—The total number of new cases of Tuberculosis which came to the notice of the Medical Officer of Health during the year was 692. The sources of information regarding these cases were as follows:— Primary Notifications on Form A 561 Primary Notifications on Form B 3 Primary Notifications on Form C 36 Un-notified at Death 40 Transfers from other Sanitary Authorities 17 Naval and Military Notifications 35 TOTAL 692 29 T uberculosis. Table XVI. gives details regarding the site of disease, sex, and age grouping of these cases. TABLE XVI. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary NonPulmonary. Male. Female. Male. Female. Male. Female. Male. Female. Under 1 — 2 3 1 — 2 2 1 1— 5 2 1 8 12 — — 4 7 5—10 5 — 26 15 — — 9 1 10—15 7 5 9 12 1 4 2 2 15—20 27 29 7 6 11 11 1 2 20—25 41 42 6 5 16 16 2 — 25—35 66 67 11 15 19 33 3 2 35—45 72 43 4 6 31 17 2 3 45—55 48 22 7 2 27 16 4 — 55—65 22 19 2 3 16 14 1 1 65 upwards 5 6 1 - 4 6 - 1 Total 295 236 84 77 125 119 30 20 Table XVII. shows the number of cases of Non-Pulmonary Tuberculosis classified according to the part of the body affected. 30 Report of the Medical Officer of Health. TABLE XVII. Localisation of Disease. Total. Males. Females. Brain 24 11 13 Glands, Mediastinal 7 2 5 Glands, Mesenteric 10 6 4 Glands, Cervical 33 18 15 Bones and Joints 44 26 18 Skin 9 2 7 Larynx 4 1 3 General Tuberculosis 11 10 1 Other parts 19 8 11 Total 161 84 77 Deaths.—The total number of deaths certified as due to diseases of a Tuberculous nature was 294—of whom 155 were males, and 139 females. Of the 294 deaths, 244 were due to Pulmonary Tuberculosis, 24 to Tuberculous Meningitis, four to Abdominal Tuberculosis, and 22 to other forms of Tuberculosis. Table XVI. gives details regarding the type of the disease, sex, and age grouping of these 294 deaths. In addition to these deaths, which were duly certified in the returns as due to Tuberculosis, 17 persons previously notified as suffering from Tuberculosis died during the year. These deaths, however, do not figure in Table XVI. for the following reasons:— (a.) 15 were certified as dying of diseases other than Tuberculosis. (b.) Two 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 the Tuberculosis death-rate for 1924 is the lowest recorded. 31 TABLE XVIII. 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 Pulmonary Tuberculosis:— Number of Deaths 329 320 339 368 288 257 331 286 269 244 Death rate .99 1.02 1.12 1.22 .87 .75 100 .85 .80 .71 Other Forms:— Number of Deaths 105 76 85 87 54 58 59 57 50 50 Death rate .31 .24 .28 .29 .16 .18 .18 .17 .14 .14 Total:— Number of Deaths 434 396 424 455 342 315 390 343 319 294 Death rate 1.30 1.26 1.40 1.51 103 .93 1.18 102 .94 .86 Tuberculosis. 32 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 40-294. Of the 40 unnotified deaths, 22 were certified from Institutions, 16 by private doctors, while in two cases Tuberculosis was discovered on post mortem examination. In the majority of 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. 33 persons died within one month after notification, 60 within three months, and 86 within six months. 33 TUBERCULOSIS DISPENSARIES. (a.) Main Dispensary at 96, East Hill, Wandsworth.— Serves the areas Putney, Southfields, Fairfield, Springfield and North Clapham. Sessions.— Monday Morning and Afternoon. Tuesday Evening (7 p.m.) for those at work. Thursday Morning and 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 and Afternoon. Thursday Evening (7 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 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 unifoimity 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. d 34 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 refeired to St. Thomas's Hospital under the scheme in force since 1913. As shown in Table XX. a smaller number of cases has been referred to the Hospital under this arrangement than in the previous year, due to the fact that it has not been found necessary to send so many cases 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 the scheme 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 has been in operation. By means of Form M.O. 333 a continuous record of a suspected child's tuberculosis history is 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 on page 38. Tuberculosis Dispensaries. 35 Dental Treatment.—The agreement with the British Dental Hospital for providing dental treatment, including the provision of dentures, has been in force throughout the year. 34 patients received dental treatment and 14 of these were supplied with dentures. The attendances at the dentist totalled 92. The amount expended on dental treatment during the year was £12 7s., while the cost of dentures supplied to patients was £56. Extra Nourishment.—Under Section 3 of the Public Health (Prevention and Treatment of Disease) Act, 1913, extra nourishment is granted on medical grounds 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. During the year under consideration, 107 patients have been granted extra nourishment under the scheme at a cost of £177 10s. 3d. The scheme has been found to be of great help in the treatment of the types of patient mentioned above. Shelters.—The three open-air shelters have been in continuous use during the year. Details of Work during 1924.—Table XIX. shows in the first column the number of cases under observation at the Dispensary at the beginning of the year; then the number of new cases examined during the year; and finally, the number of cases under observation pending diagnosis at the end of the year. The total number of cases thus dealt with is divided into three subgroups, 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. d 2 TABLE XIX. 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. 9 378 387 167 14 193 12 1 F. 21 471 492 144 15 321 11 1 Children under 15. M. 5 242 247 4 9 232 2 — F. 2 219 221 2 9 203 6 1 Total 37 1310 1347 317 47 949 31 3 (b.) "Contacts " (included in (a.).) Adults M. - 50 56 5 — 51 — — F. - 119 119 12 2 105 — — Children under 15. M. — 105 105 — - 105 — —. F. — 103 103 — 1 101 1 — (c.) Insured persons (included in (a.) ). M. 7 290 297 129 12 145 11 — F. 12 204 216 68 7 137 4 - 36 Report of the Medical Officer of Health. Tuberculosis Dispensaries. 37 Table XX. gives further details of the year's work. TABLE XX. 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December, 1924 1110 2. Total number of attendances of patients at the Dispensary during the year:— Insured 3232 Uninsured 3395 3. Number of complete examinations of patients made 3629 4. Number of persons placed during the year under observation for the purpose of diagnosis 71 5. Number of cases in which the period of observation exceeded two months 51 6. Number of insured patients under domiciliary treatment on 31st December, 1924 165 7. Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment during the year 70 8. Number of persons referred to St. Thomas's Hospital for consultation 33 9. Number of consultations with medical practitioners at the homes of patients:— Insured 26 Uninsured 43 10. Number of other visits paid by Tuberculosis Officer to the homes of patients 331 11. Number of visits paid by Nurses to the homes of patients 4914 12. Number of specimens of sputum examined 1789 13. Number of written reports made 4930 Table XXI. gives the numbers of new cases living in each of the five sub-districts, and shows on whose recommendation they made the first attendance. 38 Report of the Medical Officer of Health. TABLE XXI. Clapham. Putney. Streatham. Tooting. Wandsworth. Outside Borough. Totals. Public Health Department 59 45 84 101 195 1 485 Private Practitioners 56 36 87 75 199 2 455 Charitable Societies 2 1 1 1 6 - 11 Transfers from other Dispensaries 8 8 5 2 9 - 32 London County Council 3 8 7 14 16 1 49 Existing Dispensary Patients 11 2 22 33 29 - 97 Ministry of Pensions 7 5 13 9 9 - 43 Other Sources 18 7 10 28 74 1 138 Totals 164 112 229 263 537 5 1310 TABLE XXII. Particulars relating to Discharged Soldiers attending at the Dispensaries. New Cases. Old Cases. Total Attendances. Tuberculous 34 199 1139 Non-Tuberculous 19 4 34 Totals 53 203 1173 623 visits were made by the Dispensary Nurses in connection with these cases during the year. Contacts.—Of the 1,310 new cases examined, 383 were contacts. 20 of these were found to be suffering from Tuberculosis. Tuberculosis Dispensaries. 39 Bacteriological Examinations.—The number of Bacteriological examinations of sputum made at the Dispensary continues to show an 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. 1920 601 Nil. 121 1921 1051 10 247 1922 1310 484 260 1923 1720 722 384 1024 1789 1013 437 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 three years is entirely 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 Tuberculosis Officers, and the Tuberculosis Visitors assist the Committee to the fullest possible extent and attend their meetings. 40 Report of the Medical Officer of Health. The following agencies, public and charitable, are represented:— L.C.C. School Medical Service. British Red Cross Society. London Insurance Committee. War Pensions Committee. Invalid Children's Aid Assn. Brompton Hospital. Board of Guardians. Soldiers and Sailors Help Assn. United Services Fund. Charity Organisation Society. Ranyard Nurses' Association. St. Thomas's Hospital. Several unattached members interested in Tuberculosis work are also co-opted . The Officers of the Committee are :— Chairman. Vice-Chairman. Hon. Secretary. Hon. Joint Secretary. Hon. Treasurer. Councillor T. Harding. Miss J. M. Duff. Miss Joan Smith. Mrs. Nicol. Mr. H. B. Harvey. In May, 1924, Mr. A. R. Watson resigned from his position as Honorary Secretary of the Care Committee. Mr. Watson had acted in that capacity since December, 1922, and discharged his duties in a most conscientious manner. Considerable difficulty was experienced in obtaining a successor to Mr. Watson, and for nearly six months the duties of Secretary had to be carried out by the Dispensary Staff. Under these conditions it was extremely difficult to cope with the work, and fortunately, in October, 1924, the Committee were successful in obtaining the services of Miss Joan Smith. Miss Smith's appointment as Honorary Secretary was duly approved. Meetings.—The Committee meets on alternate Friday afternoons at 96, East Hill, S.W. 18, at 2.30 p.m. The Care Committee endeavours 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. Special consideration is given to the following points:— (a) The provision of extra nourishment. (b.) The provision of extra bed accommodation. Tuberculosis Dispensaries. 41 (c.) Provision of open air shelters. (Three such shelters— the property of the Borough Council—have been in almost continuous use during the year). (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 provision of financial assistance to the family or patient. 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 403 patients (adults and children), the amount collected and remitted to the London County Council being £751. The amounts of such assessments are subject to the approval of the County Council. In addition to the patients visited by the Tuberculosis Visitors, 33 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 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. 63 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, 42 Report of the Medical Officer of Health. Streatham, and the amount raised by this means was £136. A small Sale of Work arranged by Miss Moores, one of the Dispensary Visitors, realised £40 in aid of this fund. 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 Hospital 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 17 patients were nursed there for varying periods at a total cost of £306 5s. Of these 17 patients admitted to St. Columba's Hospital, 10 died, three were transferred to other institutions in an improved condition, one returned home, while three were still in Hospital at the end of the year. The average number of beds occupied during the year was 4.5. By means of the same voluntary fund 13 patients were given treatment at the Hahnemann Home, Bournemouth, and other Convalescent Homes. The average period of convalescent treatment granted was 12 weeks. 43 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 when 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 on notification, 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, as well as the homes of women who apply for admission to the Borough Council's Maternity Home, the General Lying-in Hospital, and the maternity ward of St. Thomas's and 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. 44 Report of the Medical Officer of Health. TABLE XXIII. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Visits. Revisits. No. of Visits to: Infants under 1 year 851 367 592 709 522 1282 4323 4102 Children; 1—2 years — 22 4 42 — 4 72 1097 2—5 years - 50 2 12 11 1 76 1129 Puerperal Fever 1 1 — 2 5 2 9 29 6 Ophthalmia Neonatorum 11 2 1 17 15 6 52 31 Pneumonia 2 1 3 5 — 10 21 18 Whooping Cough 47 43 72 56 62 395 675 67 Measles 147 27 157 170 194 365 1060 27 Diarrhoea — — 2 2 1 5 10 — Ante-natal visits 169 56 177 101 120 244 867 25 Supply of milk 14 31 35 49 2 44 175 — Miscellaneous 163 38 139 128 41 131 630 — Ineffectual 410 404 469 394 290 564 2531 — Total visits 1825 1041 1645 1690 1260 3060 10521 — Re-visits in each sub-district 1130 608 1141 830 469 2324 — 6502 Attendances at Welfare Centres 91 107 98 98 115 164 673 Attendances at Ante-natal Centres 14 26 34 29 35 52 190 Health talks to mothers 37 15 8 31 35 15 141 — Visits to Creches — 18 14 — 40 25 97 — Committee meetings — 21 — — 29 3 53 — Total 142 187 154 158 254 259 1154 — Maternity and Child Welfare. 45 Infant Visiting. There were 4,974 births during the year and 3,988 of these, or 79.9 per cent. were visited, compared with 77.1 in 1923, 81.1 in 1922, and 77.2 in 1921. Table XXIV. gives the particulars of the method of feeding of infants on the occasion of the initial visit and when revisited. Of 3,988 infants visited for the first time, 3,300 were entirely breast-fed, while 245 were fed partly on the breast and partly by other methods, and 443 were entirely bottle-fed. On revisiting 1,565 infants were found to be fed entirely on the breast, 533 were partially breast-fed, and 1,008 were fed artificially. TABLE XXIV. Clapham North. Clapham South. Putney. Balham. Streatham. Tooting. Southfield. Fairfield. Springfield. Borough. Infants visited 536 451 317 571 414 531 350 276 542 3988 Breast-fed 456 390 258 475 335 423 307 248 408 3300 Otherwise fed 80 61 59 96 79 108 43 28 134 688 Re-visits to infants 380 311 161 318 321 284 563 473 295 3106 Breast-fed 110 157 85 167 142 121 341 308 134 1565 Otherwise fed 270 154 76 151 179 163 222 ] 65 161 1541 93 of the infants visited were born prematurely, and 55 were delicate from birth. Seven twin births were visited. 46 Report of the Medical Officer of Health. It was found that in 1,879 of the births doctors had been in attendance, while in 1,384 the services of midwives had been utilised. 355 infants were born in hospitals and other institutions, and 358 in the Council's Maternity Home. 12 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. 41 midwives practise in the Borough, of whom 10 reside in neighbouring Boroughs. There are 26 private maternity homes in the Borough, eight of them being carried on by practising midwives. Arrangements have been made with various nursing Associations in the Borough for their nurses to attend cases of Measles, Whooping Cough, Influenza, Pneumonia, Ophthalmia Neonatorum and Infantile Diarrhoea, at my request, at a fee of 1s. 3d. per visit. 250 cases were visited during the year under these arrangements, and 4,360 visits were made to them as shown in Table XXV. TABLE XXV. No. of cases. No. of visits. Whooping Cough 14 158 Influenza 23 267 Pneumonia 160 2974 Ophthalmia Neonatorum 26 . 597 Measles 36 364 Total 259 4360 Maternity and Child, Welfare. 47 The number of visits made by nurses in 1923 was 1,862, and the large increase in 1924 is due entirely to the increase in the number of cases of Pneumonia, as 2,974 visits were made to these cases, compared with 416 in 1923. Maternity and Child Welfare Centres. The nine Infant Welfare Centres established in previous years have continued to do excellent work throughout the year, and a new Branch Centre has been opened in Tooting. 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 Branch Centre for Tooting is held at the Church Hall, Lynwood Road, off Upper Tooting Road, and is situated in a thickly populated district which was not served adequately by the main Centre at Fairlight Hall. It was started to meet the needs of the mothers living in this district who found it difficult, on account of the distance, to attend Fairlight Hall with two or more children. This Branch Centre is open one morning a week, an infant session alternating with one for antenatal cases. The first ante-natal session was held on the 9th October and the first infant clinic on the 16th October. Eleven sessions were held during the year and the average number of expectant mothers who attended each ante-natal session was 10, while an average of 40 infants attended each infant clinic. The following is a list of the Welfare Centres in the Borough, together with the hours at which the clinics are held:— 48 Report of the Medical Officer of Health. Infant Welfare Centre. Clinics. Ante-natal. Infants.[/$$$] Clapham : Clapham 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. 2nd and 4th Thursdays at 2.45 p.m. Putney Park : Putney Park House, Dover House Rd. None. Fridays at 2 p.m. Balham : 91, Bedford Hill. Fridays 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 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 a.m. Wednesdays and Thursdays at 2 to 3.30 p.m. Church Hall, Lynwood Road. 2nd and 4th Thursdays at 10.15 a.m. 1st, 3rd and 5th Thursdays at 10.15 a.m. Southfield : St. Michael's Institute, Merton Road. 1st and 3rd Fridays in each month at 10 a.m. Tuesdays at 1.45 to 3.30 p.m. Fairfield : Fairfield Mission Hall, Fairfield Street. None. 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 new infants seen at the Centres during 1924 was 2,360, compared with 2,537 for the previous year, and the total attendances were 38,938. The number of visits paid by the Superintendents to infants increased from 12,640 in 1923 to 13,213 in 1924. Eight of the 10 Centres have ante-natal clinics and 763 cases were examined at these clinics, compared with 688 in 1923. The following Tables give full particulars of the work at each Centre during the year. 49 TABLE XXVI. Clapham. Putney. Putney Park. Balham. Streatham. Tooting. Southfield. Fairfield. Springfield. Totals. Fairlight Lynwood Road New Cases, 1924 388 205 61 362 327 330 24 221 194 257 2369 Transfers to other Centres 18 1 1 29 43 5 — 8 6 11 122 Passed on to L.C.C. 147 — — 330 52 431 — 36 35 525 1556 Total Attendances 6642 3810 1310 5856 5813 5741 244 3218 2921 3383 38938 Ante-natal Cases 69 66 — 168 97 150 12 62 40 99 763 Ante-natal Attendances 184 254 — 636 333 446 45 221 — 241 2360 Nurses' Visits to Infants 1817 1151 385 1849 1649 2794 — 899 991 1678 13213 Nurses' Visits to Ante-natal Cases 167 218 - 295 151 77 107 90 198 1303 No. of Sessions :— Infants 91 52 50 96 88 99 6 50 50 50 632 Ante-natal 12 24 — 36 25 25 5 24 — 24 175 Health Talks given 49 6 32 77 50 69 4 21 28 15 351 Maternity and Child Welfare. 50 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. 97 inspections of the creches were made during the year by the Health Visitors. The attendances were:—Putney, 5,980; Balham, 5,980 footing, 4,275 ; and Wandsworth, 6,497; a total of 22,732, a decrease of 3,985 compared with 1923. Wandsworth Borough Memorial Maternity Home. This Home is situated in Glenburnie Road, off Beechcroft Road, Upper Tooting, and it was opened as a Maternity Home on the 4th November, 1920. The property, which belongs to the Council, was formerly a private residence. The house is a large one and has an extensive 51 Maternity and Child Welfare. garden. The former coach-house, which adjoins the main building, is used as a laundry on the ground floor, with resident quarters for the Gardener Attendant on the upper floor. Accommodation.—The accommodation in the Home consists of 25 beds for lying-in women, and these are arranged in nine wards—the number of beds per ward varying from one to five. One single-bedded ward is situated as far as possible from the others, and is used as an isolation ward. In addition to the nine wards there is a receiving room where the women are received on admission, an office, two labour wards where the confinements take place, a nursery, and accommodation for the nursing and domestic staff. Staff.—The Nursing Staff consists of a Matron, who is in charge of the Home, two Sisters, three Staff Nurses and seven Probationers. The Matron, Sisters and Staff Nurses are trained midwives. The Domestic Staff consists of a Home Sister, a Cook and six Maids. All the Nursing and Domestic Staff are at present accommodated in the Home, and the Council supplies them with uniform. Probationers.-—The Probationers, who remain at the Home for a year, act as Pupil Midwives, and undergo training for the Central Midwives Board Examination, the Home being recognised by the Board for this purpose. The instruction comprises attendance at confinements both in the Maternity Home and at the patients' homes, instruction from the Matron and the qualified Staff, attendance at a course of lectures at the Clapham Maternity Hospital for a period of three months and attendance at the Balham and Streatham Antenatal Centres. To enable the pupil midwives to attend confinements at patient's homes, arrangements have been made with a registered midwife in Fulham who takes pupils for each Probationer to reside with her for one month's outdoor training, and during this month one of the midwife's pupils resides in the Home and receives instruction in Institutional work. E 2 52 Report of the Medical Officer of Health. It is not essential for the Probationers to be fully trained nurses, but it is an advantage if they are. The Home has been particularly fortunate in this respect, as all the Probationers who have been engaged as pupil midwives since it was opened have been fully trained nurses. Thirty of them have passed the Examination of the Central Midwives' Board as a result of the training given. Medical Staff.—Most of the women in the Home are attended at their confinements by the trained Midwives on the Staff, but arrangements can be made beforehand for a Doctor to attend if complications are expected, or, if the patient wishes it, she can be attended by her own medical attendant. There is a rota of nine general practitioners who are called in turn by the Matron when certain complications occur during the course of a confinement, as required by the regulation of the Central Midwives' Board, and the Doctor is paid a scaled fee by the London County Council under the Midwives' Act for this service. There is also a Consulting Staff, consisting of two obstetric surgeons, two general surgeons, one eye surgeon and two physicians, who are called in as required by the doctor attending the case. In December the Council appointed Mr. Aleck Bourne as Visiting Obstetric Surgeon to the Home. This gentleman, who is in Consulting Midwifery practice in London, now visits the Home at fixed times twice a week and sees all the patients at each visit. He supervises the medical and nursing work of the Home, consulting with the Practitioners on the rota as required, and decides whether each patient is fit to be discharged at her appointed time. Patients admitted.—All expectant mothers resident in the Borough are eligible for admission to the Home on application to the Matron, and women residing outside the Borough are admitted provided all the accommodation in the Home is not required 53 Maternity and Child Welfare. for Borough residents. Patients are admitted shortly before labour is due to commence and are expected to stay 14 days. The fee charged varies according to the financial circumstances of the case and is assessed after full enquiries have been made at the applicant's home by one of the Health Visitors. A re-assessment is made if the circumstances change or if it is necessary for the women to remain in the Home longer than the usual 14 days. A few cases of special hardship are admitted free, as the first consideration is whether the case is a suitable one for admission on account of unsatisfactory home circumstances, or for medical reasons. Every woman is asked to contribute the amount of Maternity Benefit which she or her husband receives under the National Health Insurance Acts, unless the financial circumstances are especially hard. The minimum fee charged for women residing outside the Borough has been fixed by the Council at £3 per week. During the last three years, there has been a slight increase in the total amount of fees received as well as in the average weekly fee paid, as shown in the following statement:— Total amount received in fees. Average weekly fee. 1921-1922 £2,030 £2 4 9 1922-1923 £1,939 £2 4 3 1923-1924 £2,152 £2 5 2 APPLICATION FOR ADMISSION TO THE HOME should be made to the Matron at the following times:— Monday, Wednesday and Thursdays—10-11 a.m. Tuesday—6-7 p.m. The following Table shows the number of admissions to the Home for the years 1921 to 1924, and the districts from which the cases were admitted. The Table also shows the number of births which occurred in the Borough in each of the four years and the proportion of them which took place in the Maternity Home. 54 Report of the Medical Officer of Health. TABLE XXVII. Districts. 1921. 1922. 1923. 1924. Clapham 26 39 52 56 Putney 18 13 25 34 Balham 99 110 140 119 Streatham 34 41 38 48 Tooting 60 71 77 68 Wandsworth. 95 116 120 111 Whole Borough 332 390 452 436 Outside the Borough 9 8 — 36 Total admitted 341 398 452 472 No. of Births occurring in the Borough 6039 5366 5223 4734 Percentage of admissions to Home to Total Births 5.6 7.4 8.67 10.0 It is of special interest to note from these figures that the increase in the number of admissions coincides with a large fall in the number of births occurring in the Borough and in consequence, the proportion of these births which have taken place in the Home has risen from 5.6 per cent. in 1921 to 10.0 per cent. in 1924. The number of women residing outside the Borough who were admitted to the Home in 1924 was 36, and this increased number is due largely to the reduction in the fee for non-residents from £5 5s. to £3 per week, which was agreed to by the Council towards the end of 1923. The full particulars of the work of the Home during 1924 are as follows:— 55 Maternity and Child Welfare. Total number of cases admitted 472 Average duration of stay 15-22 days Number of cases delivered by:— (a.) Midwives 445 (b.) Doctors 27 Number of cases in which medical assistance was sought by the midwife 156 (a.) Ante-natal 28 Albuminuria 8 Contracted pelvis 15 Large child 1 Hæmorrhage 2 Cardiac 2 (b.) During labour 70 Adherent placenta 2 Obstructed labour 1 Hysteria 1 Mal-presentation 6 Prolonged labour 25 Laceration 23 Cardiac 2 (c.) After labour 36 Rise of temperature 33 Cardiac 1 Inflammation of leg 1 Embolism 1 (d.) For infant 22 Feebleness 12 Deformities 2 Rise of temperature 2 Asphyxia 1 Watery eyes 5 Number of cases of puerperal sepsis 8 Number of cases in which temperature rose above 100.4 for 24 hours with rise of pulse rate 33 Number of cases of ophthalmia neonatorum 7 Number of cases of "inflammation of the eyes," however slight 11 56 Report of the Medical Officer of Health. Number of infants not entirely breast fed while in the Institution 17 Number of maternal deaths with causes 3 Eclampsia 1 Sapræmia and pneumonia 1 Embolism 1 Number of foetal deaths 9 Still births Nil. Within 10 days of birth 14 The Cost of the Home.—The following Table gives a summary of the income and expenditure of the Home for the three financial years 1921-2, 1922-3, and 1923-4, together with the approximate figures for the year 1924-5, and the amounts estimated for the year 1925-6. TABLE XXVIII. Actual. Approximate. Estimated. 1921-2 1922-3 1923-4 1924-5 1925-6 £ £ £ £ £ Expenses of maintenance 3897 3377 4095 4225 4710 Loan charges 1231 884 896 900 873 Total Expenditure £5128 £4261 £4991 £5125 £5583 Income:— Fees 2030 1939 2152 2400 2400 Miscellaneous — — 222 — — Net Cost £3098 £2322 £2617 £2725 £3183 Grant from Unemployed Grants Committee — — 110 — — Grants from Ministry of Health 1549 1161 1253 1362 1591 Cost to Borough Council 1549 1161 1254 1363 1592 Maternity and Child Welfare. 57 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 10s. 6d. 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. 79 infants were admitted in 1924, 48 from addresses in the Borough and 31 from outside the Borough. Most of the cases were infants suffering from Marasmus, Enteritis, Pneumonia, 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. Arrangements have been made for a medical man to attend at each hostel when necessary, and some of the infants attend the most convenient Infant Welfare Centre. Convalescent Homes. During the year 25 mothers were sent to Convalescent Homes, 22 of them taking their infants with them. Three other children were also sent. Both mothers and children derived much benefit from the change of air. 58 Report of the Medical Officer of Health. 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. Number in Family. Scale of income per head of familyafter 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 Maternity and Child Welfare. 59 During the year 798 families were supplied with milk under the above scheme:—141 in Clapham, 55 in Putney, 140 in Balham, 97 in Streatham, 113 in Tooting, 57 in Southfield, 86 in Fairfield, and 109 in Springfield. The total cost to the Council was £1,676 7s. l0d. Women and children in receipt of milk under the Council's scheme are expected to attend the Welfare Centre 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 non-attendance. 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. 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 of the British Dental Hospital, 23, South Side, Clapham Common. The modified arrangements made with the British Dental Hospital in 1923, have continued in force throughout the year, and all expectant and nursing mothers attending the Welfare Centres are eligible for treatment under the scheme provided their financial circumstances are such as to preclude them from paying the full cost of treatment. The Council makes a payment to the Hospital of 5s. per attendance, with an additional charge of 5s. 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. 95 cases availed themselves of these facilities during the year, 68 being women, and 27 children, and 179 attendances were made. These arrangements for dental treatment are now similar to those for cases of Tuberculosis. 60 SANITARY INSPECTION OF THE BOROUGH. A reorganisation of the work of the Sanitary Inspectors has been made during the year and this has involved certain rearrangements of their duties together with the appointment of a second Food Inspector. Previous to this reorganisation, there were twelve qualified male inspectors in the Department, ten of them being employed as District Inspectors, one as a Housing Inspector, and one as Food and Drugs Inspector. The Housing Inspector worked in all districts of the Borough, as required, while the Food and Drugs Inspector carried out the sampling work for the whole Borough. The inspection of premises where food is sold or prepared for sale was carried out by the District Inspectors. Two of the female staff acted partly as Sanitary Inspectors and partly as Health Visitors, and their duties in the former capacity consisted of the inspection of workshops and workplaces where females were employed, each officer taking one half of the Borough for this purpose. Approximately one-third of the time of each of these two officers was spent in carrying out these inspections. The following changes have been made :— 1. A second Food Inspector has been appointed and all the duties relating to the inspection of food premises have been transferred from the District Inspectors to the Food Inspectors. Each Food Inspector is responsible for the inspection of food premises and sampling in one half of the Borough. Mr. Newell, the Senior Food Inspector, in addition to carrying out these duties in his own area, supervises the work relative to food and food premises for the whole Borough. 2. The appointment of Housing Inspector has been abolished and this officer has been given a District, so that Sanitary Inspection of the Borough. 61 there are now 11 District Inspectors in place of 10. As a result of this change it has been possible to make a slight reduction in the size of several of the districts which were too large to be worked efficiently. The District Inspectors are no longer responsible for the supervision of food premises in their districts, but on the other hand they have to carry out all the house to house inspections, the majority of which before reorganisation, were done by the Housing Inspector. 3. The post of female Sanitary Inspector has been abolished and the inspectorial duties which these two Officers carried out have been divided among the 11 District Inspectors. The two ladies concerned are now whole time Health Visitors, so that the change is equivalent to a fractional increase in the staff of Health Visitors. Table XXIX. gives a summary of the sanitary operations carried out in the Borough during the year. During the year the number of drains which were tested was 1,866, and of these 617 were found to be in a defective condition. The drains of 99 houses were re-constructed. Damp conditions have been remedied in 1,096 premises, and in 159 of these damp courses were inserted. The collection of house refuse is in the hands of the Borough Surveyor as heretofore. It will be seen from this Table that 14 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. 62 Report of the Medical Officer of Health. TABLE XXIX. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 1. Premises cleansed and repaired 520 205 561 442 433 1439 3600 2. Drains tested 202 98 160 210 260 936 1866 3. Drains cleansed or repaired 87 53 96 82 54 245 617 4. Water closets cleansed or repaired 229 48 299 160 175 490 1401 5. Soil pipes repaired 17 6 28 11 5 29 96 6. Waste pipes altered or repaired 48 18 49 34 15 247 411 7. Rainwater pipes repaired 114 20 41 56 27 170 428 8. Roof and gutters repaired 229 85 234 216 106 555 1425 9. Damp courses inserted 22 10 15 34 3 75 159 10. Damp conditions otherwise remedied 98 71 66 185 123 394 937 11. Yards drained or paved 100 20 43 51 144 337 695 12. Dust bins provided or repaired 224 33 185 184 87 423 1136 13. Water cisterns cleansed, covered or repaired 60 15 11 36 18 106 246 14. Water supply reinstated 7 23 6 20 3 22 81 15. Defective fireplaces remedied 42 21 93 22 42 189 409 16. Defective coppers remedied 32 8 17 15 36 121 229 17. Cases of overcrowding abated — — 1 3 2 8 14 18. Stables and stable yards drained or paved 26 4 5 13 2 7 57 19. Accumulations of manure, etc., removed 29 7 15 43 9 54 157 20. Urinals cleansed or repaired 6 — — 6 — 15 27 21. Animals improperly kept 10 6 6 9 11 • 42 84 22. Smoke nuisances 5 — — — 1 21 27 23. Other nuisances 115 44 80 94 114 367 814 Total 2222 795 2011 1926 1670 6292 14916 No. of preliminary notices served 1151 404 905 802 779 2668 6709 No. of preliminary notices complied with 1055 385 1000 740 520 2391 6091 No. of statutory notices served 94 14 116 74 15 300 613 No. of statutory notices complied with 81 14 78 76 12 220 481 63 Sanitary Inspection of the Borough. Table XXX. gives full details of the inspections carried out by the Sanitary Inspectors. TABLE XXX. Inspections. ReIn spections. Total. To investigate complaints 5747 14440 20187 House-to-house inspections 1672 3894 5566 Infective Diseases:— Notifiable diseases 2041 1425 3466 Measles 2517 249 2766 Other infective diseases 281 32 313 Verminous conditions 178 40 218 Bakehouses No. of Premises 130 266 157 423 Offensive Trades 3 118 — 118 Piggeries 28 70 1 71 Factories, workshops, etc. 2115 2500 162 2662 Houses let in lodgings 294 311 621 932 Rag and bone stores 35 49 27 76 Sanitary conveniences 144 312 25 337 Mews and stables 130 278 26 304 Other inspections 3570 283 3853 Total Inspections 19910 21382 41292 Smoke observations 38 — 38 Legal proceedings, Attendances at Court 67 — 67 Underground Rooms. There are five underground rooms in illegal occupation at the present time and notices have been served, but owing to the 64 Report of the Medical Officer of Health. difficulty of other accommodation being obtained for the occupiers, no further action can be taken in the meanwhile. Housing, Town Planning, etc., 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. Where nuisances are found, notices are served under the Public Health Act. The results of these inspections are shown in Table XXXI. 1,672 inspections were made, compared with 2,001 in 1923, and nuisances were found in 1,464 of the houses, necessitating the service of sanitary notices. TABLE XXXI. 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 50 50 24 43 26 16 Clapham South 07 54 7 12 10 45 Putney 47 37 1 1 41 10 Streatham 115 103 22 51 44 65 Balham 328 275 72 171 217 255 Tooting 423 377 36 29 98 338 Southfield 220 209 45 29 152 113 Fairfield 204 179 42 69 63 133 Springfield 218 180 28 38 182 89 Whole Borough 1072 1404 277 443 833 1064 65 Sanitary Inspection of the Borough. Rent and Mortgage Interest Restrictions Act, 1923. 100 applications for Certificates were received during the year. On inspection it was found that 98 of the premises were not reasonably fit for human habitation, and two premises were reasonably fit. Of the 98 premises not reasonably fit, 10 of them were put in a reasonable state of repair before the meeting of the Committee at which Certificates would have been granted. Of the 88 premises in respect of which Certificates were granted, 78 were rendered reasonably fit during the year, and the remaining 10 are in hand. 66 FACTORIES AND WORKSHOPS. The number of factories, workshops, workplaces and homeworkers' premises is shown in Table XXXII., together with the number of inspections made. TABLE XXXII. Class of Works. Number of Places on Register at end of 1924. Number of Inspections, 1924. Number of Notices 1924. Number of Prosecutions, 1924. Factories :— Factory Laundries 58 65 1 — Factory Bakehouses 69 192 4 — Other Factories 444 458 40 — Total 571 715 45 — Workshops :—- Workshop Laundries 47 51 2 — Workshop Bakehouses 61 231 1 — Other Workshops 863 934 77 — Total 971 1216 80 — Workplaces 299 671 43 — Total : Factories, Workshops and Workplaces 1841 2602 168 — Home-workers' premises 404 483 29 — Grand Total 2245 3085 197 — Further details with regard to homeworkers' premises are given in Table XXXIII. 67 Factories and Workshops. TABLE XXXIII. HOME WORK. Nature of Work. Outworkers' Lists. Outwork in unwholesome premises Out work in infected premises. Lists received from Employers. Notices served on occupiers as to keeping or sending lists. Lists. Outworkers. Instan ces. Notices served. Instan ces. Contrac tors. Workmen. Wearing Apparel:— (1.) Making, etc. 57 72 201 30 29 29 29 (2.) Cleaning and washing 2 4 2 — — — — Paper bags and boxes 2 — 4 — — — — Carding, etc., of buttons, etc. 2 — 3 — — — — Totals 63 76 210 30 29 29 29 The total number of addresses received from other Councils was 591, and 156 addresses were forwarded to other Councils. The number of addresses received has increased by 39, and the number sent by 39. 37 names and addresses were forwarded to this Borough in error. The number of notices sent to employers during the year was 30, and these had a most satisfactory result. During the year 29 cases of infective diseases—one of Scarlet Fever, two of Diphtheria, 13 of Measles, one of Erysipelas, and 12 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. F 2 68 Report of the Medical Officer of Health. TABLE XXXIV. DETAILS WITH REGARD TO REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. Workshop Bakehouses 61 Workshop Laundries 47 Dressmakers' and Milliners' Workshops 146 Bootmakers 100 Smiths 40 Builders 43 Tailors 70 Motor Engineers 38 Other 426 Total number of workshops on Register 971 TABLE XXXV. DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. No. of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 85 85 — — Want of ventilation — — — — Overcrowding 4 4 — — Want of drainage of floors — — — — Other nuisances 120 120 — — Sanitary accommodation: Insufficient 3 3 — — Unsuitable or defective 42 42 — — Not separate for sexes 2 2 — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouses (s. 101) — — — — Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921) — — — — Total 256 256 — — * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 69 FOOD AND FOOD PREMISES. The work in connection with food and food premises has been re-organised during the year, as described on page 60, and there are now two Inspectors carrying out these duties in the Borough. The following Table gives the number of food premises and slaughter-houses in the Borough, and shows the number of inspections made, the notices served and prosecutions taken. TABLE XXXVI. Premises. Number of Places on the Register at end of 1924. Number of inspections, 1924. Number of Notices, 1924. Nunber of prosecutions. 1924. Dairies, milkshops and cowsheds 257 685 10 1 Restaurant kitchens 209 319 1 — Ice cream premises 338 393 29 — Slaughter-houses 9 105 — — Butchers' shops 222 728 — — Greengrocers' shops 314 390 1 1 Fishmongers' shops 128 304 — — Fried fish shops 81 159 — — Other premises where food is prepared for sale 86 161 — — Total 1644 3244 41 2 70 Report of the Medical Officer of Health. 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 3.65 per cent., compared with 3.63 per cent. in 1923. There are at present 256 milk retailers and one cowshed on the register, and these have been regularly inspected during the year, the details being given in Table XXXVI. 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, 1,000 were purchased as test or informal samples, while 1,000 were purchased officially. Of the 1,000 official samples submitted for analysis, 33 or 3.3 per cent., were reported to be adulterated or not up to standard, and of those samples which were purchased informally or as test samples, 58 or 5.8 per cent., were found adulterated or below standard. The total adulterations reported were 91, or 4.5 per cent of the samples submitted. In 11 out of the 33 cases in which adulterations were detected in the official samples, proceedings were instituted against the vendor, and the total amount received in penalties under the above Acts during the year amounted to £18, and the costs to £11 11s., making a total of £29 11s. Food and Food Premises. 71 TABLE XXXVII. RESULT OF ANALYSIS OF CERTAIN ARTICLES UNDER THE SALE OF FOOD AND DRUGS ACTS DURING 1924, SHOWING THE PERCENTAGE ADULTERATED COMPARED WITH 1922 AND 1923. No. of Samples. Percentage adulterated. Examined. Found adulterated or not up to standard 1924. 1923. 1922. Bread 13 — — — — Butter 333 2 0.6 1.3 2.6 Cheese 3 — — — — Cocoa 10 — — 4.3 — Coffee 33 — — 2.2 — Confectionery and Jam 12 — — — — Cream and Preserved Cream 73 10 13.6 18.5 13.3 Flour 6 — — — — Self-raising Flour 12 — — — — Margarine 12 — — — 6.2 Milk 996 36 3.7 3.6 2.8 Separated Milk 7 — — — — Condensed Milk 36 — — — — Dried Milk 6 — — 6.6 — Mustard 10 — — — — Sugar 16 — — 3.4 — Tea 6 — — — — Vinegar 31 — — 42.8 7.1 Spirits 4 — — — — Drugs 83 12 14.7 13.0 20.1 Other Articles 298 31 1.0 11.6 12.4 All Articles 2000 91 4.55 5.5 5.1 72 Report of the Medical Officer of Health. The following Table gives the number of formal and informal samples taken in each sub-district of the Borough, and shows the number taken per 1,000 of population, the number adulterated and the percentage adulteration:— TABLE XXXVIII. 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 180 10 5.5 190 5 2.6 370 5.9 15 4.0 Putney 96 7 7.2 100 4 4.0 196 6.3 11 5.6 Streatham 290 15 5.1 283 9 3.1 573 5.2 24 4.1 Tooting 130 9 6.9 107 5 4.6 237 5.9 14 5.9 Wandsworth .. 304 17 5.5 320 10 3.1 624 6.2 27 4.3 Whole Borough 1000 58 5.8 1000 33 3.3 2000 5.9 91 4.5 Milk. The following samples of milk were submitted for analysis:— 996 of whole new milk. 7 of separated milk. 18 of dried milk. 24 of condensed milk. Of these 35 were reported against as being adulterated or not up to Legal Standard. 13 contained extraneous water; 21 were deficient in fat; and one contained colouring matter. Proceedings were taken in nine cases, and in 26 cases the Public Health Committee, after considering the amount of adulteration and the circumstances of sale, decided not to prosecute the vendors, but to take further samples. Food and Food Premises. 73 Nine samples of milk were taken on delivery at various Public Institutions situated within the Borough. All these samples were genuine. 66 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. Seven samples were reported against and in five cases proceedings were taken against the farmer and convictions obtained. Four samples of milk were procured in the early morning from wholesale dealers whilst delivering milk to the retailer. These samples were genuine. Four samples of milk procured on delivery at private houses were genuine. 260 samples of milk have been taken on Sundays, either in early morning or at midday. Six, or 2.3 per cent., were reported as adulterated. 480 samples of milk were taken from milk vendors in the street during the early morning (5 to 7 a.m.) on weekdays, and of these 17 or 3.5 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" Number of samples examined for the presence of a preservative. Number in which a preservative was reported to be present. Milk 1045 Nil. Cream 44 6 The six samples of Cream contained crystallised boric acid. The vendors were warned, and further samples were taken and found correct. 74 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 25 (2.) Statements incorrect 4 29 In the four cases reported against, the vendors were warned, and further samples were procured and found to be correct. Percentage of Preservative found in each sample. Percentage stated on Statutory label. Range from .1 to .9 per cent. .4 per cent. "Crystallised Boric Acid" was the only preservative found. Determination of milk fat in Cream sold as "Preserved Cream":— (1.) Above 35 per cent. 29 (2.) Below 35 per cent. 0 Total 29 In each of these samples the provisions as to labelling were duly observed, and no thickening substances were found in any of them. Butter and Margarine. 333 samples of butter were submitted for analysis during the year, of which two, or .6 per cent., were reported against. 12 samples of margarine were submitted for analysis, and all were 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. Food and Food Premises. 75 Milk and Dairies (Amendment) Act, 1922. Section 5 of this Act prohibits the sale of milk from cows suffering from Tuberculosis of the udder. 26 samples of milk were examined under this section, and in two of them the Bacteriologist certified that the examination revealed the presence of Tubercle Bacilli. In both cases the farmers were warned, and steps were taken by them to get rid of the offending animals. Further samples procured failed to reveal the presence of Tubercle Bacilli. Milk (Special Designation) Order, 1922 and 1923. Licences were granted for the sale of Designated milks as under:— Certified 31 Grade A (T.T.) 16 Grade A 13 Pasteurised 14 Total 74 The following samples of graded milk were submitted for bacteriological examination in order to see if the bacterial content was within the standard prescribed for the appropriate grade. Designation. No. taken. Reported against. Percentage reported against. Certified 26 2 7.6 Grade A (T.T.) 4 1 25.00 Grade A Pasteurised 8 1 12.50 Pasteurised 21 3 14.20 All Samples Examined 59 7 11.80 76 Report of the Medical Officer of Health. Meat. There are no public abattoirs in the Borough, but nine private slaughter-houses are now in use. The Sanitary Inspectors inspect them periodically, and arrange as far as possible to be present on the days that slaughtering of animals takes place. 105 inspections were made during the year. 4,204 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. Unsound Food. 240½ lbs. of haddock; one box of kippers; two boxes of skate; 849 lbs. of cod; three boxes of dabs; one box of coal fish; 62 lbs. of bloaters; 57 lbs. of plaice; one box of roker; one box of soles; one box of cat fish; one box of sprags; one trunk of whiting; two boxes of sprats; 14 pints of prawns; 2½ barrels of pears; 18 barrels of apples; four bags of potatoes; one tin of peaches; one jar of potted meat; 79 lbs. of beef; six sheep's plucks; 69 rabbits; six lbs. of corned beef; 17 lbs. of oatmeal, and 600 eggs were condemned at the request of the owners, and the usual certificates granted. Prosecutions in Connection with Food. The following gives the results of proceedings taken during the year in respect of cases taken in connection with the sale of food, other than for adulteration:— (1.) Depositing for the purpose of sale unsound tomatoes. Fined 20s. and 42s. costs. (2.) Exposing for sale sausages which were unfit for food. Fined 40s., or one month's imprisonment. (3.) Selling milk from an unclean vessel. Summons withdrawn on payment of 21s. costs (Business closed). (4.) Selling milk from unregistered premises. Summons withdrawn on payment of 21s. costs. 77 MISCELLANEOUS. Bacteriological Examinations. During the year 1,222 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 in each case. TABLE XXXIX. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Diphtheria :— Negative 202 101 133 145 110 377 1068 Positive 17 9 11 10 11 70 128 Enteric Fever Negative — I 3 2 — 7 13 Positive 1 — 1 — — 3 5 Tuberculosis :— Negative 4 — 1 1 1 — 7 Positive 1 — — — — — 1 Total 225 111 149 158 122 457 1222 Examinations of Sputum made at the Tuberculosis Dispensary are not included in the above figures. Disinfection. The total number of rooms disinfected after the occurrence of cases of infectious disease was 4,141 :—687 in Clapham, 315 in Putney, 641 in Balham, 570 in Streatham, 545 in Tooting, and 1,383 in Wandsworth. Two public and two private elementary schools were also disinfected for infectious diseases. 78 Report of the Medical Officer of Health. Cleansing of Persons Act. The names of 73 children, 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 29 cases the body and clothing also were said to be verminous. These children were cleansed by the officials of the London County Council at the Cleansing Station under the supervision of that Authority. 15 adults were given baths at the Council's Disinfecting Station beacuse they were in a verminous condition, 12 of these being cases of scabies. 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 larvae and pupæ of flies. A total of £13 8s. 4d. was spent in materials used in work of this nature. A special effort was made to prevent the fly nuisance emanating from the Council's Dust Destructor. With the cooperation of the Contractor all places at the Destructor likely to harbour larvae were systematically sprayed with paraffin solution twice weekly during the early summer and autumn months. Other places in the yard where larvae were found were treated with hot clinker from the furnaces and large numbers of larvae were destroyed by these methods. Though the climatic conditions of last summer were not such as to induce abnormal fly production, the results obtained fully justified the small expenditure incurred and efforts will be made annually to reduce nuisance from flies and similar pests. In September, several complaints were received of the presence of large numbers of crickets in houses in Tooting, and on investigation, Mr. R. Brown, the Sanitary Inspector for that district, found that large numbers of these crickets were lying up in the clinker which is heaped in the yard of the Destructor, and 79 Miscellaneous. were breeding there. There was no doubt that the crickets were gaining access to some of the houses near the Destructor, and in several houses large numbers of them were found. I was fortunate in obtaining the advice and assistance of Mr. Laing, from the Natural History Museum, South Kensington, who met me at the Destructor. He stated that the offending insect was Gryllus Domesticus, the common house Cricket, which was undoubtedly breeding in the dump of clinker, and that several similar cases had occurred throughout the country during the last few years. Mr. Laing advised that the clinker be sprayed with a 1 per cent. solution of Sodium Arsenite and this was done on several occasions with good results. A large number of the insects were killed but owing to the size of the dump it was not possible to eradicate them all. The treatment outlined above will be continued during the early months of the current year as there is evidence that the crickets are still present in the clinker. Statement of Work done under the Rag Flock Act, 1911. 36 visits to workshops were made by the Inspector, and the materials used for bedding and upholstery were examined. 23 samples of rag flock were procured and submitted for analysis, one of which was reported against as not conforming with the required standard of cleanliness. Certificates have been issued in respect of the sterilisation of materials used in the manufacture of rag flock for export. Canal Boats Act. The Sanitary Inspectors are still carrying out their duties under the above Act. Revenue Act. No certificates were granted under the above Act during the year. Water Supply—Cutting-off Notices. During the year, 97 notices with respect to 88 premises were received from the Water Board, stating that the supply had been withdrawn. 80 Report of the Medical Officer of Health. In 55 premises the water supply was cut off for non-payment of rates, in 12 in consequence of defects to the supply service, and in 21 because the premises were empty. 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, six bodies were removed to the Mortuary, in Streatham six, and in Wandsworth 165, of which 56 were from Wandsworth, 38 from Putney, 40 from Tooting and 31 from Battersea—a total of 177. Inspection of Sanitary Conveniences. The number of Sanitary Conveniences inspected was 144 ; 20 in Clapham, 26 in Putney, 12 in Balham, 15 in Streatham, 15 in Tooting and 56 in Wandsworth. 337 inspections were made during the year, and 27 notices, chiefly for cleansing, were served and complied with. 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. Amount ot Poor Law Relief. The Clerk to the Board of Guardians has kindly given me the following information with reference to the above for the year ended 31st December, 1924 :— (1.) No. of admissions to the Poor Law Institutions 3,624 (2.) No. of medical orders given 3,122 (3.) Average No. of persons in receipt of outdoor relief 3,574 (4.) Amount of outdoor relief given £54,885 81 STAFF. Details of the staff of the Department in December, 1924, 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,M.A.,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. Date of Appointment. Certificates held. Sanitary Inspector. Meat and Food. Others. Sanitary Inspectors :— B. Nurcombe Sept. 1889 R. San. Inst. No Five W. G.Crabbe . . Dec., 1891 ” No Six A. J. Weeks Dec., 1892 ” No Four R. Brown June, 1893 ” No Five A. W. Browne .. Aug., 1898 ” Yes One H.E.Brown Mar., 1902 ” Yes One A. E. Vickers Dec., 1919 S.I. Exam. Bd. No. — H. T. Lambert Dec., 1919 ” Yes Two F. Haworth June, 1920 ” No — J. A. Sands July. 1920 ” No One E. J. Edwards .. Sept., 1924 ” No — Food and Drugs: T. Newell Mar., 1900 R. San. Inst. Yes Six C. W. Idle Jan., 1924 S.I. Exam. Bd. Yes One G 82 Report of the Medical Officer of Health. FEMALE HEALTH VISITORS. Name. Date of Appointment. Certificates held. Sanitary Inspector. Health Visitor. Trained Nurse. C. M. B. Health Visitors :— Miss D. S. Collins Mar., 1913 Yes Yes No No E. K. Woods Feb., 1916 Yes Yes No Yes „ E. B. Henderson Sept., 1919 No Yes Yes Yes „ R. M. Watling May, 1922 No Yes Yes Yes „ E. G. Hoare Aug, 1924 No No Yes Yes I. P. Pullar Aug., 1924 Yes Yes No Yes Tuberculosis Visitors: Miss P. G. Moores April, 1915 No Yes Yes No „ E. E. Merron Sept., 1918 No No Yes No „ M. Dean Jan., 1924 Yes Yes No Yes CLERICAL STAFF. Name. Date of Appointment. Appointment. Certificates held. *A. E. Cooper Nov., 1897 Senior First Class Clerk San. Ivsp. and four others. *F. Bray Oct., 1903 First Class Clerk Six others. *P. C. Clark Nov., 1903 Second Class Clerk One other. *F. A. Eustace Nov., 1912 Second Class Clerk One other. E. Hunt Mar., 1913 Second Class Clerk and Dispenser One other. A. G. Patterson Feb., 1914 Second Class Clerk — Miss C. Wellings May, 1921 Second Class Clerk — *E. V. Roots June, 1916 Third Class Clerk — L. H. Pearson Mar., 1920 Third Class Clerk — *L. L. Parrini May, 1923 Office Boy — *C. F. Standish July, 1924 Youth, Food and Drugs Dept. — 83 Staff. MATERNITY HOME. Appointment. Name. Date of Appointment. Qualifications.      Matron Miss E. Waring Sept., 1920 C.M.B. Sister „ M. A. Luke Mar., 1922 Trained Nurse and C M B ” „ E. Waters Feb., 1924 Ditto Home Sister ,, A. Dixon Nov., 1924 — Staff Nurse „ A. Pryde June, 1924 Trained Nurse and C.M.B. Nine other nurses and piobationers who remain for one year only, one gardener attendant, and one half-time gardener. Disinfecting Station. *J. Bond, Engineer. Nine Disinfecting Attendants. Mortuaries. One whole-time and two part-time mortuary keepers. Miss J. E. Barritt, Sanitary Inspector and Health Visitor, retired on 30th September, after 19 years' service under the Council in that capacity. Miss M. E. Maple, Health Visitor, resigned on 31st May, after five years' service. Miss A. Andrews resigned her appointment as Sister at the Maternity Home on 22nd January, after nearly three years' service at the Home as Staff Nurse and Sister. Miss J. Brown resigned her appointment as Staff Nurse at the Maternity Home on 23rd June after two years and three months' service in that capacity. In conclusion, I wish to express my appreciation of the manner in which the staff generally have carried out their duties. I am, Your obedient servant, F. G. CALEY. G 2 84 PARTICULARS AS TO HOUSING. Number of New Houses erected during the Year :— (a.) Total 785 (b.) With State assistance under the Housing Acts, 1919 or 1923 (i.) By the Local Authority 30 (ii.) By other bodies or persons 755 1. Unfit Dwelling-houses. (1.) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 12747 (2.) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 .. 1672 (3.) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation .. .. Nil. (4.) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 6709 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 6091 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. 85 Report of the Medical Officer of Health. (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 613 (2.) Number of dwelling-houses in which defects were remedied :— (a.) By owners 481 (b.) 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 Nil. (4.) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (5.) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. 86 Report of the Medical Officer of Health. PARTICULARS OF PROCEEDINGS TAKEN UNDER PUBLIC HEALTH ACT. Premises. Offences. Result. Fine. Costs.      18, Letchworth Street, Tooting Nuisances Contravention of By-laws (yard paving). Summonses withdrawn on payment of costs. s. d. s. 4 d. 0 22, ditto Nuisances Adjourned sine die 19, Foss Road, Tooting Ditto Contravention of By-laws (w.c.'s.) Summonses withdrawn on payment of costs. — 4 0 21, ditto Nuisances Ditto — 2 0 60, Wimbledon Road Ditto Ditto — 5 0 410, Garratt Lane, Wandsworth Having on the premises Rag Flock, which did not comply with the Regulations. Ordered to pay costs 210 0 37, Gleneagle Road, Streatham Nuisances Order made for abatement of nuisance. — 10 0 47, Colmer Road, Streatham Ditto Summons withdrawn on payment of costs. — 2 0 Contravention of By-laws (yard paving). Convicted 200 0 — 4, Willard Street, Clapham Selling milk from unregistered premises. Summons withdrawn on payment of costs. — 21 0 12, Cross Street, Clapham Nuisances Adjourned sine die — — 28, ditto Ditto Ditto — — Report of the Medical Officer of Health. 87 PARTICULARS OF PROCEEDINGS TAKEN UNDER PUBLIC HEALTH ACT—continued. Premises. Offences. Result. Fine. Costs.      s. d. s. d. 68, The Chase, Clapham Nuisances Order made for abatement of nuisance. - 10 6 70, ditto Ditto Ditto - 10 6 22, Lower Grove, Wandsworth Ditto Ditto - 21 0 Non-compliance with Order. 100 0 15, The Grove, Wandsworth Ditto Order made for abatement of nuisance. - 21 0 41, Burr Road Ditto Ditto 21 0 Failing to supply dust-bin 100 0 28, Fawe Park Road, Wandsworth Ditto Order made for abatement of nuisance. - 21 0 14, Fitzwilliam Road, Clapham Ditto Convicted 10 0 - 42, Besley Street, Streatham Ditto Order made for abatment of nuisance. - 21 0 Non-compliance with Order - 42 0 4, Clifton Street, Clapham Ditto Order made for abatement of nuisance. - 21 0 62, ditto Ditto Ditto - 21 0 Non-compliance with Order. 100 0 2 0 28, 30 and 32, The Piatt, Putney Ditto Adjourned sine die - 6 0 88 Report of the Medical Officer of Health. PARTICULARS OF PROCEEDINGS TAKEN UNDER PUBLIC HEALTH ACT.—continued. Premises. Offences. Result. Fine. Costs. 42, Cicada Road, Wandsworth Nuisances Summons withdrawn, the work having been done. s. d. s. 2 d. 0 152, High Street, Putney Ditto Ditto — 63 0 130a, Sternhold Avenue, Streatham Ditto Crder made for abatement of nuisance. 42 0 133 and 133a, Penwith Road, Wandsworth. Ditto ,. Ditto 42 0 2, Guelph Street, Wandsworth Ditto Ditto 21 0 27, Furmage Street, Wandsworth .. Contravention of By-laws (yard paving). Convicted 40 0 — 1, Ironmill Road, Wandsworth Nuisances Summons withdrawn, the work having been done. — Failing to provide a dust-bin . 100 0 17, Jew's Row, Wandsworth Ditto Order made for abatement of — 21 0 Contravention of By-laws (yard paving). nuisance. Convicted 100 0 19, ditto Nuisances Order made for abatement of nuisance. 21 0 Contravention of By-laws (w.c.'s.) Convicted 100 0 89 Report of the Medical Officer of Health. PARTICULARS OF PROCEEDINGS TAKEN UNDER PUBLIC HEALTH ACT.—continued. Premises. Offences. Result. Fine. Costs. 53, Ironmill Road, Wandsworth. Nuisances Order made for abatement of nuisance. s. d. s. 21 d. 0 Depositing for sale unsound tomatoes. Convicted 20 0 42 0 26, Waynflete Street, Wandsworth Nuisances Order made for abatement of nuisance. — 21 0 11, Barmouth Road, Wandsworth .. Selling milk from an unclean vessel. Summons withdrawn on payment of costs. — 21 0 8, High Street, Wandsworth Selling sausages which were unsound. Convicted 40 0 23, Larch Road, Balham Keeping goats in an unfit place Order made for removal of goats — — 76, Summerley Street, Wandsworth Nuisances Summons withdrawn, the work having been done. — 2 0 145, Trentham Street, Wandsworth Ditto Order made for abatement of nuisance. — 21 0 1, Portslade Road, Clapham Ditto Ditto — 21 0 68, Cicada Road Ditto Adjourned sine die — — 80 and 82a, Upper 'Pulse Hill, Streatham. Ditto Order made for abatement of nuisances. — 42 0 Total. £4 £43 19s. 90 ANNUAL STATEMENT Of the Work done in the Borough of Wandsworth under the Sale of Food and Drugs Acts. To the Wandsworth Borough Council. Mr. Mayor, Ladies and Gentlemen, Herewith we have pleasure in submitting, for your information, our Annual Report on the work carried out by us under the Sale of Food and Drugs Acts, etc., during 1924. A total number of 2,000 samples was submitted by the Council's Food Inspectors, one-half having been purchased with the necessary formalities required by the Acts, and the remainder procured informally. During the year under review certain Regulations came into force regarding the sale of Condensed and Dried Milk, and it is satisfactory to note that of the 42 samples submitted, representing many brands, not one was found that did not in every respect comply with these Regulations. Your attention is respectfully drawn to the small adulteration detected in the many samples of Milk and Butter examined and to the very satisfactory average composition of the Milks sold in the Borough. It is also a matter of congratulation that out of a total of 39 samples of Sponge Cakes submitted, one only was found to contain Boric Acid as a consequence of having been made with liquid eggs. As Sponge Cakes often enter largely into the diet of young children this is a most satisfactory state of things. Whilst on the question of preservatives entering into the diet of infants, we would emphasise the fact that not one of the 996 samples of Milk was found to contain any, and only one sample was returned as coloured. The most unusual adulteration detected during the year occurred in two samples of Ground Carraway, where a large excess of mineral matter was detected. This extraneous mineral matter consisted of fine sand. 91 Analysts' Annual Report. The tables below will give an idea of the representative and varied nature of the samples submitted for analysis. The somewhat high adulteration reported in the Drugs submitted occurred largely as a result of faulty dispensing of Prescriptions made up for National Health Insurance Patients, and affords evidence that " Panel " Prescriptions are not always dispensed with due care. The following table shows the number and nature of the samples analysed, the details of Drugs and " Other Articles " being given below :— GENERAL STATEMENT. Nature of Sample. Examined Adulterated. Formal. Informal. Total. Formal. Informal. Total.      Bread — — 13 13 — — — Butter — 333 333 — 2 2 Cheese —- 3 3 — — — Cocoa — 10 10 — .— — Coffee —. 33 33 — — — Confectionery (Sweets) — 12 12 — — — Cream — 44 44 — 6 6 Cream, preserved 1 28 29 — 4 4 Flour — 6 6 —. — — Flour, Self-raising — 12 12 — — — Margarine —- 12 12 — — — Mi!k 981 15 996 28 8 36 Milk, Separated 7 —- 7 — — — Milk, Condensed (Machine skimmed) — 30 36 — — — Milk, Dried (Full Cream) — 5 5 — — — Milk, Dried (Machine skimmed) — 1 1 — — — Mustard — 10 10 — — — Sugar — 16 16 — — — Tea — 6 6 — — — Vinegar — 31 31 —. — — Spirits (Whisky) — 4 4 — — — Drugs 5 78 83 3 9 12 Other Articles 6 292 298 2 29 31 Total 1000 1000 2000 33 58 91 92 Report of the Medical Officer of Health. From the preceding table it will be seen that the adulteration during 1924 amounted to, for Formal Samples, 3.3 per cent., for Informal samples, 5.8 per cent., and for all samples, 4.55 per cent. DRUGS. Nature of Sample. Examined Adulterated. Formal. Informal. Total. Formal. Informal. Total.      Acid, Boric 2 2 — — — Acid, Citric — 2 2 — — Acid, Tartaric — 2 2 — — — Camphorated Oil — 6 6 — — — Cream of Tartar — 2 2 — — — Epsom Salts — 2 2 — — — Friar's Balsam — 3 3 — — — Glycerin — 6 6 —. — — Ointment, Boric — 6 6 — — — Ointment, Mercury 1 5 6 1 3 4 Ointment, White PPt. — 3 3 — — — Ointment, Zinc — 3 3 — — — Prescriptions 4 22 26 2 6 8 Powder, Compound Liquorice — 2 2 — — — Powder, Seidlitz — 3 3 — — — Tincture, Iodine (Strong) 6 6 — — — Tincture, Rhubard — 3 3 — — — Total 5 78 83 3 9 12 The adulteration reported in the Drugs submitted amounted to : for Formal samples, 60.0 per cent., for Informal samples, 11.5 per cent., and for all samples, 14.4 per cent. 93 Analysts' Annual Report. OTHER ARTICLES. Nature of Sample. Examined Adulterated. Formal. Informal. Total. Formal. Informal. Total.      Allspice — 2 2 —. — — Arrowroot 1 17 18 —. 2 2 Baking Powder — 25 25 — Barley, Pearl — 4 4 — — Cake, Mixture —.. 6 6 —. — — Cakes, Sponge 1 38 39 — — Carraway, Ground.. 2 10 12 2 2 4 Cayenne Pepper — 2 2 — — — Cinnamon, Ground 1 2 3 — — — Cornflour — 6 6 — — — Dripping — 6 6 — — — Egg Substitute — 6 6 — — — Fish — 6 6 — — — Fish, canned — 4 4 — 4 4 Fruits, dried — 10 10 — — — Honey — 6 6 — — — Ice Cream — 21 21 — 1 1 Infants' Food — 2 2 — — Jellies, Table — 2 2 — — — Lard — 24 24 — — Lemon Squash — 1 1 — 1 1 Lemonade Powder — 12 12 — 9 9 Mace, ground — 2 2 — — — Meat — 1 1 — — Meat Paste — 1 1 — — — Meat. Potted — 2 2 — — — Meat Preservative — 1 1 — — Mincemeat — 6 6 — 1 1 Nutmeg, ground — 2 2 — — — Oatmeal — 2 2 — — — Olive Oil 1 6 7 — — Peaflour — 7 7 — 1 1 Peas, tinned — 1 1 — 1 1 Peel, candied — 2 2 — — Pepper — 12 12 — — — Pudding, Christmas — 2 2 — 2 2 Rice, ground — 2 2 — —. — Sago — 2 2 — — — Semolina — 2 2 — — — Sausages — 6 6 — — — Soup Powder — 6 6 — — — Tapioca — 6 6 — — — Wines, British — 5 5 — 3 3 Yeast — 4 4 — — Total 6 292 298 2 28 30 The above shows a percentage adulteration of 33.3 for Formal samples, 9.5 for Informal samples, and 10.0 for all samples. 94 Report of the Medical Officer of Health. The nature and extent of adulteration in Formal samples is given below :— Case No. Nature of Sample. Nature of Report.      9 Milk 40 % Fat deficient. 10 Milk 45 % ditto 37 Milk 14 % Extraneous water. 48 Milk 24 % Fat deficient. 49 Milk 12 % ditto 52 Milk 6 % ditto 165 Milk 5 % ditto 170 Milk 7 % ditto 171 Milk 7 % ditto 217 Ointment, Mercury 50 % deficient in Mercury. 247 Milk Coloured with Annatto. 275 Milk 2 % Fat deficient . 286 Milk 3 % ditto 320 Milk 5 % ditto 337 Milk 5 % ditto 343 Milk 4 % ditto 359 Milk 13 % Extraneous water. 360 Milk 1 % ditto 369 Milk 8 % Fat deficient. 605 Milk 7½ % Extraneous water 688 Milk 2 % ditto 701 Can-away, ground 9.28 % excess Mineral matter 733 Milk 9 % Fat deficient. 862 Carraway, ground 5.44 % excess Mineral matter. 742 Milk 5 % Fat deficient. 743 Milk 5½ % Extraneous water. 768 Milk 30 % Fat deficient. 779 Milk 27 % ditto 895 L.I.P. Prescription (Pulv ; Zinci; Oxid : c. Amylo) 26.9 % Extraneous Talc and 58 % deficient in Zinc Oxide. 896 L.I.P. Prescription (Ung ; Flavum) 50 % excess Mercuric Oxide. 801 Milk 11½ % Extraneous water. 802 Milk 4½ % ditto 951 Milk 3 ½ % ditto 95 Analysts' Annual Report. Milk. The average composition of the Milks returned as genuine during each month and for the whole year is given below :— Month. Total Milk solids. Milk fat. Non-fatty solids.      January 12.50% 3.75 % 8.75 % February 12.49% 3.59% 8.90 % March 12.44% 3.55% 8.89 % April 12.37 % 3.47% 8.90 % May 12.35% 3.49% 8.86 % June 12.35% 3.46 % 8.89 % July 12.44% 3.59% 8.85 % August 12.65% 3.89% 8.76 % September 12.58% 3.69% 8.89 % October 12.57 % 3.08% 8.89 % November 12.61 % 3.80% 8.81 % December 12.51 % 3.84% 8.67 % Whole Year 12.49% 3.65% 8.84 % Butter. Of the 333 samples of Butter examined during the year, 152, or 45.6 per cent., were found to be free from preservative, other than salt; 180, or 54 per cent. contained Boric Acid in quantities not exceeding the maximum permissible (0.5 per cent. Crystallised Boric Acid), whilst one contained an excess of this preservative. Margarine. The 12 samples of Margarine submitted were all found to contain a Boron preservative in quantities ranging from 0.21 per cent, to 0.34 per cent., calculated as Crystallised Boric Acid. 96 Report of the Medical Officer of Health. The following table shows the nature of the adulteration reported in Informal samples examined :— Case No. Nature of Sample. Nature of Report.      2 Sponge Cake Contained Boric Acid. 27 Peas, tinned Contained Copper Sulphate. 68 Cream Contained Boric Acid. 76 Cream, preserved Contained excess Boric Acid. 81 Cream, preserved Ditto 82 Cream, preserved Ditto 84 Cream, preserved Ditto 93 Cream Contained Boric Acid. 94 Cream Ditto 98 Cream Ditto 132 Ointment, Mercury- Deficient in Mercury. 184 Ointment, Mercury Ditto 227 Ointment, Mercury Ditto 235 L.I.P. Prescription (Mist; Pot : Brom : Co :) Deficient in Potassium Iodide. 237 L.I.P. Prescription Contained excess Pot : Bicarb : (Mist : Sod : Sal :) and Sod : Sal : 275 L.I.P. Prescription (Mist : Pot : Brom :) Deficient in Pot : Brom : 276 L.I.P. Prescription (Mist : Sod : Sal :) Contained excess of Sod : Sal : and Pot : Bicarb : 291 Milk Deficient in fat. 359 Peaflour Contained Maggots. 365 Fish, tinned Contained Tin. 366 Fish, tinned Ditto 367 Fish, tinned Ditto 368 Fish, tinned Ditto 369 Ice Cream Contained Boric Acid. 414 Sago Consisted of Tapioca. 497 Lemonade Powder Made with Tartaric Acid. 498 Lemonade Powder Ditto 499 Lemonade Powder Ditto 500 Lemonade Powder Ditto 501 Lemonade Powder Ditto 502 Lemonade Powder Ditto 503 Lemonade Powder Ditto 505 Lemonade Powder Ditto 508 Lemonade Powder Ditto 530 Cream Contained Boric Acid. 531 Cream Ditto 603 Butter Contained excess Boric Acid. 639 Milk Contained Extraneous Water. 640 Milk Ditto 641 Milk Ditto 642 Milk Ditto 683 Carraway, ground Contained excess Mineral Matter. 771 Butter Contained Margarine. 781 Carrawav, ground Contained excess Mineral Matter. 903 L. I. P. Prescription (Ung : Flavum) Contained excess Mercury Oxide. 904 L.I.P. Prescription (Pulv : Zinci : Oxide : Contained Talc and was deficient in Zinc Oxide. c. Amylo) 97 Analysts' Annual Report. Case No. Nature of Sample. Nature of Report. 828 Milk Deficient in Fat. 927 Arrowroot Consisted of Bicarbonate of Soda. 929 Arrowroot Contained Maize Starch. 930 Milk Deficient in Fat. 932 Milk Ditto 860 Mincemeat Contained Salicylic Acid. 953 Wine, British (Port) Ditto 954 Wine, British (Orange) Contained Benzoic Acid. 955 Wine, British (Currant) Contained Salicylic Acid. 872 Pudding, Christmas Contained Boric Acid. 873 Pudding, Christmas Ditto 884 Lemon Squash Contained Salicylic Acid. Note. Lemonad Powder should properly be compounded with Citric, and not Tartaric Acid. We have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servants, A. H. M. MUTER, F.I.C., Public Analyst. CHARLES A. HACKMAN, F.I.C., Additional Public Analyst. South London Central Public Laboratory, 325, Kennington Road, S.E. 11. 25th February, 1925. H 98 INDEX. page Adulteration of Certain Articles, Percentage of, in 1922, 1923 and 1924 71 Ambulance Service 80 Analyst, Report of 90 Anti-toxin 16 Area of Borough 1 Bacteriological Examinations 39, 77 Bakehouses 63 Balham, House-to-House Inspections in 64 Births 3 Births and Birth-rates in Sub-Districts 3 Birth-rate, Average 10 Years 1914-1923 .. 7 Births, Notification of, Act 4 Brain and Nervous System, Diseases of the 26 Butchers' Shops 69 Butter and Margarine 74 Canal Boats Act 79 Cancer 26 Census, 1921 2 Cerebro-Spinal Meningitis 19 Child Birth, Deaths from 26 Circulatory Diseases 26 Clapham, House-to-House Inspections in .. 64 Cleansing of Persons Act 78 Conscientious Objection Certificates granted 15 Convalescent Homes 57 Cowsheds 69 Creches 50 Cutting-off Notices 79 Day Nurseries 50 99 Index. PAGE Death, Causes of 6 Death-rate, Average 10 Years 1914-1923 7 Death-rate, Corrected .. .. 5 Death-rate from Infective Diseases .. 11 Death-rate, Infantile 8 Deaths, Corrected 5 Deaths, Number of 4 Deaths in Institutions 8 Dental Treatment 35, 59 Developmental Diseases 26 Diarrhoea 25 Diphtheria 16 Diphtheria, Attack Rate per 1,000 cases 16 Diphtheria, " Return Cases" of 17 Disinfection 77 Disinfection of Schools 77 Dysentery 19 Encephalitis Lethargica 19 Enteric Fever 17 Erysipelas 18 Expectant and Nursing Mothers, Institutions for 57 Factories and Workshops 66 Factories, Workshops, etc., defects found in 68 Factories, Workshops and Workplaces, Inspection of 66 Fishmongers' Shops 69 Flies and Mosquitoes 78 Food, Prosecutions in connection with 76 Food and Food Premises 69 Food Places, Inspection of 69 Fried Fish Shops 69 German Measles, Cases of 20 Greengrocers' Shops 69 Health Visitors, Work of 43 Home Work 67 Hospitals, etc., for Expectant and Nursing Mothers 57 House Refuse, Removal of 61 House to House Inspections, Summary of 64 Houses and Premises Inspected 63 100 Index. PAGE Houses Let in Lodgings 63 Housing 84 Housing, Town Planning, etc., Act, 1909 64 Ice Cream Premises 69 Illegitimate Children, Births of 3 Increase of Rent and Mortgage Interest (Restrictions) Act, 1923 65 Infant Visiting 45 Infantile Mortality 8, 9 Infantile Mortality, 10 Years 1914-23 10 Infective Diseases 11-14 Infective Diseases, Deaths at certain Age Periods 12 Infective Diseases Death rate from 11 Infective Diseases : Number of Cases notified from Elementary Schools 22-24 Influenza, Deaths and Death-rates 18 Influenza, Pneumonia and Acute Primary Pneumonia, Cases Notified 19 Inhabited Houses, Number of 1 Inquests 26 Inspections, Details of 63 Institutions, Deaths in 8 Institutions for Expectant Mothers, etc 57 Malaria 19 Margarine 74 Maternity and Child Welfare 43 Maternity and Child Welfare Centres 47 Maternity Home 50 Measles and German Measles 20 Measles and other Non-notifiable Diseases reported from Schools 22-24 Meat 76 Midwives 46 Milk 72 Milk and Cream Regulations, 1912 73 Milk and Dairies (Amendment) Act, 1922 75 Milk (Mothers and Children) Order 58 Milk Premises, Cowsheds, etc., on Register 69 Milkshops, Cowsheds, etc., Inspections of 69 101 Index. page Milk (Special Designation) Order, 1922 and 1923 .. 75 Milk Supply 70 Mortuaries 80 Mosquitoes 78 Natural Increase, Rate of 3 Nervous System, Diseases of the 26 Non-Infective Diseases, Deaths from 26 Notification of Births Act 4 Notification of Infective Diseases 13, 14 Nursing Arrangements 46 Offensive Trades 63 Old Age 26 Ophthalmia Neonatorum 20 Other Infective Diseases, Deaths from 25 Outworkers 67 Overcrowding 61 Para-Typhoid Fever 17 Police Court Proceedings 76, 86-89 Polio-Myelitis and Polio-Encephalitis 19 Poor Law Relief, Amount of 80 Population 1,2 Population of Sub-Districts 2 Premature Birth 26 Puerperal Fever 18 Pulmonary Tuberculosis, Notification of Cases of 28 Putney, House-to-House Inspections in 64 Rag Flock Act, 1911, Statement of Work done under 79 Rateable Value 1 Rent and Mortgage Interest Restrictions Act, 1923 65 Respiratory Diseases. 26 Return Cases of Scarlet Fever and Diphtheria 17 Revenue Act 79 Sale of Food and Drugs Act, Proceedings under 70 Sale of Food and Drugs Act, Statement of Work under 70 Sanitary Conveniences, Inspection of 80 Sanitary Operation, Table of 62 Sanitary Inspection of the Borough 60 Scabies 25 102 Index. PAGE Scarlet Fever 17 Scarlet Fever : Attack Rate per 1,000 Cases 17 Scarlet Fever " Return Cases " of 17 Schools, Disinfection of, for Infective Diseases 77 Shelters for Tuberculous Patients 35 Slaughter-houses 69 Small-pox 15 Smoke Nuisances 62 Sputum Examinations 39, 77 Staff 81 Streatham, House-to-House Inspections in 64 Tooting, House-to-House Inspections in 64 Trench Fever, Cases Notified 19 Tuberculosis . 28 Tuberculosis Dispensaries 33 Tuberculosis Care Committee 39 Tuberculous Diseases, Extra Nourishment provided 35 Underground Rooms 63 Unsound Food 76 Vaccination Returns 15 Violence, Mortality from 26 Vital Statistics of Whole Borough 1 Wandsworth, House-to-House Inspections in 64 Water Supply, Cuttig-off Notices 79 Whooping Cough 18 Young Children, Institutions for 57 Zymotic Diseases 11