WAN 68 Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, &c. OF THE BOROUGH, For the Year 1925, 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 1925. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Wandsworth. Sir and Gentlemen, I have the honour to present my Annual Report on the health and sanitary condition of the Borough for the year 1925. GENERAL STATISTICS FOR THE BOROUGH. Area 9,199 acres Population in 1925 344,370 No. of inhabited houses in 1921 62,540 No. of families, or separate occupiers, in 1921 80,526 Rateable value in 1925 £2,404,442 Estimated produce of a penny rate £9,763 PHYSICAL FEATURES AND GENERAL CHARACTER OF THE BOROUGH. At the Census in 1921 Wandsworth was the second largest Borough in London as regards population, but the RegistrarGeneral has estimated the population in 1925 as 340,900, which is higher than any of the other boroughs. As regards area, Wandsworth is larger than any of the other boroughs—the acreage being 9,199 compared with Woolwich, which is 8,986 acres. The population is a very varied one. Parts of the Borough consist of high class residential districts, and there are several large working and labouring districts. b 2 Report of the Medical Officer of Health. Wandsworth is fortunate in possessing many open spaces, and several parks in the County of Surrey adjoin those in this Borough. The approximate area of the parks and open spaces is 1,130 acres, and this area is largely increased by Wimbledon Common and Richmond Park which are partly within and partly outside the Borough. Social Conditions. At the Census 1921, the total population was 328,307, and of these, 147,229 were males and 181,078 were females. At the Census 1911, the population was 311,360 of whom 140,728 were males and 170,632 were females. Of the 147,229 males at the Census 1921, 31,781 were under 12 years of age, 98,157 were engaged in enumerated occupations, and 17,291 were retired or not engaged in any occupation. Of 181,078 females enumerated at the Census 1921, 31,485 were under 12 years of age, 52,029 were engaged in various occupations and 97,564 were unoccupied. The commonest occupations for males were commercial and finance, transport and communication, clerical and draughtsmen, metal workers, professional men and those engaged in public administration. The commonest occupations for females were domestic service, laundry works and clerical occupations. The percentage of occupied females was increased from 27 per cent. in 1911 to 29 per cent. in 1921. There is no particular occupation carried on in this Borough which affects public health. Amount of Poor Law Relief. The Clerk to the Board of Guardians has kindly given me the following information with reference to the above for the year ended 31st December, 1925:— (1.) No. of admissions to the Poor Law Institutions 3,757 (2.) No. of medical orders given 2,947 Vital Statistics. (3.) Average No. of persons in receipt of outdoor relief 2,967 (4.) Amount of outdoor relief given £54,094 3 Extracts from Vital Statistics. Births:— Males 2,477 Legitimate 4,736 Females 2,404 Illegitimate 145 Total Births 4,881 Birth-rate 14.17 Deaths:— Total Deaths 3,557 Death-rate 10.32 No. of women dying in, or in consequence of, childbirth:— From sepsis 9 From other causes 9 Deaths of Infants under one year of age:— Legitimate 248 Illegitimate 10 Total 258 Infantile mortality 52 Deaths from Tuberculosis:— No. 314 Rate .91 Total deaths from Measles 1 Total deaths from Whooping Cough 37 Total deaths from Diarrhoea (under two years of age) 26 Population. The population at the middle of the year was estimated to be 344,370, and all the rates used in this Report are calculated on this figure. The corresponding figure for the year 1924 was 341,234. Table I. shows the population of each sub-district, based on the above estimation, compared with the Census population. B 2 4 TABLE I. Sub-District. Census Population 1921 Population estimated to middle of 1925 Clapham 60,540 62,672 Putney 28,558 31,379 Balham 50,888 53,444 Streatham 52,607 56,294 Tooting 40,135 40,235 Wandsworth 95,579 100,346 Whole Borough 328,307 344,370 Births. The total number of births occurring in the Borough was 4,386, including 416 non-residents who were born in Institutions. 911 births of Borough residents occurred outside the Borough, so that the corrected number of births was 4,881, compared with 4,974 in 1924. In Table II. is shown the number of births, males and females, the birth-rate, and the rate of natural increase, for each subdistrict, and for the whole Borough. TABLE II. Sub-District. No. of Births. Rates. Males. Females. Total. Birth-rate Rate of natural increase. Clapham 494 425 919 14.66 4.09 Putney 208 211 419 13.35 2.62 Balham 433 420 853 15.95 4.86 Streatham 334 370 704 12.50 2.00 Tooting 280 253 533 13.24 3.48 Wandsworth 728 725 1453 14.47 4.75 Whole Borough 2477 2404 4881 14.17 3.85 Report of the Medical Officer of Health. 5 Vital Statistics. The birth-rate was 14.17 per 1,000, compared with 14.57 for 1924, and 17.20 the decennial average. The rate for the whole of London during 1925 was 18.0, and for England and Wales 18.3. 221 illegitimate births took place in the Borough, but only 75 belonged to the Borough. On the other hand 70 illegitimate births belonging to Wandsworth occurred outside the Borough, making a corrected total of illegitimate births belonging to Wandsworth of 145. 27 of these belonged to Clapham, 16 to Putney, 26 to Balham, 23 to Streatham, 21 to Tooting, and 32 to Wandsworth. The percentage of illegitimate births to total births was 2.96. 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 : Medical Attendant. Parent Midwife. Other person. No. born dead. Clapham 919 720 211 228 271 10 8 Putney 419 358 138 43 176 1 8 Balham 853 833 188 98 530 17 18 Streatham 704 692 256 159 189 88 13 Tooting 533 422 51 73 288 10 8 Wandsworth 1453 1135 238 310 533 54 23 Whole Borough 4881 4160 1082 911 1987 180 78 6 Report of the Medical Officer of Health. Deaths. The number of deaths which took place in the Borough during the year was 3,074, but 906 of these did not belong to the Borough, while 1,389 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 3,557, of whom 1,644 were males and 1,913 females. The corrected death-rate for the year was 10.32, compared with 11.03 in 1924. The death-rate for the whole of London for 1925 was 11.7, for England and Wales, 12.2, in the 105 County Boroughs and great Towns 12.2, 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 314 349 663 10.57 Putney 152 185 337 10.73 Balham 253 340 593 11.09 Streatham 260 335 595 10.50 Tooting 189 204 393 9.76 Wandsworth 476 500 976 9.72 Whole Borough 1644 1913 3557 10.32 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. 7 Vital Statistics. Table V.—Causes of, and Ages at Death, during the Year 1925. 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 5 1 4 ... ... ... 1 ... 1 3 ... 1 ... ... 4 ... ... 5 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 1 1 ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... Scarlet Fever 9 5 4 ... ... 1 7 1 ... ... ... 1 1 2 ... 4 1 8 Whooping Cough 37 21 16 12 16 7 1 ... 1 ... ... 4 1 5 5 5 17 13 Diphtheria and Membranous Croup 27 12 15 ... ... 10 16 1 ... ... ... 4 1 2 3 5 12 27 Influenza 111 44 67 1 1 3 4 6 13 28 55 17 6 21 24 13 30 19 Erysipelas 6 4 2 ... 1 ... ... ... 1 3 1 2 ... 2 1 ... 1 6 Cerebro-spinal Fever 5 2 3 1 ... ... 2 2 ... ... ... 1 ... ... 1 1 2 3 Other Epidemic Diseases 11 6 5 ... ... ... 2 ... ... 7 2 1 3 ... 2 1 4 5 Pulmonary Tuberculosis 254 131 123 ... ... ... 5 62 114 64 9 45 20 41 29 38 81 149 Tuberculous Meningitis 29 16 13 4 3 6 13 2 1 ... ... 3 2 7 2 3 12 21 Abdominal Tuberculosis 4 ... 4 ... ... ... ... ... 3 ... 1 1 ... 2 ... ... 1 2 Other Tuberculous Diseases 27 12 15 1 1 1 1 9 3 7 4 5 4 7 5 1 5 20 Other Infective Diseases 17 6 11 2 ... 1 ... 1 4 6 3 4 2 1 2 3 5 13 Cancer, Malignant Disease 460 182 278 1 ... ... 1 2 37 206 213 81 45 89 81 53 111 213 Rheumatic Fever 17 8 9 ... ... ... 5 6 1 3 2 2 4 3 2 1 5 5 Diabetes 24 9 ??? ... ... ... ... ... 4 7 13 3 2 2 7 5 5 5 Other General Diseases 57 19 38 ... 1 2 ... 5 11 19 19 15 2 11 7 5 17 24 Alcoholism 5 2 3 ... ... ... ... ... 1 3 1 2 ... 1 2 ... ... ... Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 12 7 5 3 ... 2 2 ... 2 2 1 2 1 4 3 2 ... 5 Cerebral Haemorrhage, Apoplexy 183 72 111 1 ... ... ... 2 4 44 132 35 14 38 30 18 48 58 Convulsions 4 2 2 3 1 ... ... ... ... ... ... 1 ... 1 ... ... 2 ... Other Diseases of Nervous Svstem 116 58 58 ... ... 4 5 6 24 40 37 17 13 23 24 10 29 72 Organic Diseases of Heart 500 223 277 ... ... 1 3 6 19 112 359 98 46 78 90 52 136 236 Other Diseases of Circulatory Svstem 1F0 87 93 2 ... 1 2 3 17 52 103 32 28 35 39 7 39 59 Bronchitis 315 132 183 12 2 2 ... ... 7 61 231 72 28 62 42 26 85 52 Broncho-Pneumonia 83 37 46 25 12 8 5 3 6 9 15 16 6 11 13 14 23 40 Lobar Pneumonia 41 27 14 3 ... ... 2 2 9 13 12 13 2 2 8 4 12 8 Pneumonia (type not distinguished) 57 44 13 4 1 2 1 2 9 25 13 9 8 7 10 9 14 20 Other Diseases of Respiratory Svstem 38 22 16 1 ... ... 2 1 4 10 20 5 4 4 6 7 12 17 Ulcer of Stomach 14 5 9 ... ... ... ... ... 3 7 4 2 4 2 1 1 4 10 Diarrhœa 11 6 5 9 1 ... ... ... ... ... 1 3 1 2 ... 1 4 6 Enteritis 23 13 10 14 2 ... ... ... 1 1 5 8 3 2 2 3 5 10 Appendicitis and Typhlitis 32 17 15 ... 1 2 5 4 3 10 7 5 4 4 5 2 12 29 Obstruction of Intestines 25 12 13 3 ... ... 1 ... 3 6 12 7 1 3 5 1 8 16 Cirrhosis of Liver 12 6 6 ... ... 1 ... ... 1 7 3 1 2 2 2 2 3 7 Other Diseases of Liver 27 6 21 ... ... ... 1 ... 2 9 15 6 ... 3 8 1 9 17 Other Diseases of Digestive Svstem 49 29 20 2 ... 3 2 2 11 18 11 9 7 3 8 7 15 29 Nephritis and Bright's Disease 138 69 69 ... ... ... 5 3 11 47 72 16 15 18 30 15 44 78 Other Diseases of Urinary System 49 39 10 ... ... ... ... ... 2 15 32 9 5 5 9 5 16 38 Diseases of Generative System 11 ... 11 ... ... ... ... 1 5 5 ... 6 ... 5 1 ... 2 10 Puerperal Fever 9 ... 9 ... ... ... ... 2 7 ... ... ... 3 2 2 1 1 8 Other Accidents and Diseases of Pregnancy and Childbirth 9 ... 9 ... ... ... ... ... 9 ... ... 2 ... ... ... 2 5 8 Premature Birth 69 38 31 69 ... ... ... ... ... ... ... 15 6 7 10 7 24 25 Congenital Debility and Malformation 64 45 19 57 3 1 2 1 ... ... ... 18 5 8 5 11 17 35 Other Diseases of Early Infancy 21 11 10 21 ... ... ... ... ... ... ... 3 4 3 2 3 6 8 Old Age 196 63 133 ... ... ... ... ... ... ... 196 34 18 40 27 24 53 45 Deaths from Accident 94 58 36 3 4 4 9 9 19 15 31 20 ... 13 15 12 27 83 Deaths from Suicide 40 24 16 ... ... ... 2 2 12 18 6 4 4 6 11 6 9 21 Other Violent Deaths 4 2 2 1 ... ... ... ... 1 2 ... ... 1 ... 3 ... ... 2 Other Defined Diseases 16 7 9 3 ... ... 1 ... ... 2 10 4 4 3 3 1 1 10 Ill-defined Diseases or unknown 9 2 7 ... ... ... ... 1 1 2 5 1 ... 1 4 1 2 1 All causes 3557 1644 1913 258 50 63 108 147 387 888 1656 663 337 593 595 393 976 1601 8 Report of the Medical Officer of Health. 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. 1915 19.25 25.5 21.8 12.63 16.1 14.8 1916 20.09 21.5 20.9 11.80 14.7 14.4 1917 14.72 17.9 17.8 12.69 15.7 14.4 1918 14.29 16.1 17.7 15.07 18.9 17.6 1919 16.40 18.3 18.5 11.31 13.4 13.8 1920 21.03 26.3 25.4 10.36 12.4 12.4 1921 18.80 22.3 22.4 10.83 12.4 12.1 1922 16.68 21.0 20.6 11.24 13.4 12.9 1923 16.20 20.2 19.7 10.09 11.2 11.6 1924 14.57 18.7 18.8 11.03 12.1 12.2 Average 10 years 17.20 20.7 20.3 11.70 14.0 13.6 1925 14.17 18.0 18.3 10.32 11.7 12.2 The total number of deaths which occurred in Institutions inside the Borough was 1,118, but 906 of these persons did not belong to the Borough. A total of 1,601 persons belonging to the Borough died in Institutions, 212 occurring in Institutions within the Borough and 1,389 in Institutions outside the Borough. 9 Vital Statistics. The following is a list of the Institutions outside the Borough in which deaths of Borough residents occurred:— Name of Institution. No. of Deaths. Name of Institution. No. of Deaths. Poor Law Hospitals and Infirmaries:— Other Hospitals—contd.:— St. George's Hospital 16 Wandsworth Union Infirmaries 797 St. Luke's Hospital 11 Horton Mental Hospital 15 St. Thomas's Hospital 56 Lambeth Institution 6 University College Hospital 6 Long Grove Mental Hospital 28 Victoria Hospital 15 Other Mental Institutions 36 Westminster Hospital 6 Other Poor Law Institutions 18 South-Western Hospital 11 Other Hospitals:— Other Institutions, etc.:— Belgrave Hospital 14 Other Institutions 109 Bolingbroke Hospital 13 Other Places not Public Institutions 73 Brompton Hospital 8 Cancer Hospital 8 On Street 16 Charing Cross Hospital 14 River Thames 10 Collindale Hospital 12 Private Nursing Homes 28 Guy's Hospital 14 1389 Infants' Hospital 9 King's College Hospital 13 Institutions inside the Borough 212 Middlesex Hospital 7 St. Bartholomew's Hospital 11 1601 St. Columba's Hospital 9 Infantile Mortality. The total number of deaths under one year was 258:—50 in Clapham, 27 in Putney, 33 in Balham, 30 in Streatham, 35 in Tooting, and 83 in Wandsworth. As the number of births was 4,881, the Infantile Mortality rate was 52 per 1,000 births. The Infantile Mortality rate was the same as in 1923, and these two years are the lowest recorded. The number of deaths among legitimate infants was 248 to 4,736 births—a mortality of 52 per 1,000 births, while the number of deaths among illegitimate infants was 10 to 145 births—a mortality of 68 per 1,000 births. 10 Report of the Medical Officer of Health. 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 92 12 14 6 124 44 36 23 31 258 Uncertified — — — — — — — — — — Small-pox — — — — — — — — — — Chicken-pox — — — — — — — — — — Measles — — — — — — — — — — Scarlet Fever — — — — — — — — — — Whooping Cough — — — — — 3 3 — 6 12 Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — — — — 2 2 4 Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — 1 1 Meningitis(notTuberculous) 1 1 — — 2 1 — 1 — 4 Convulsions 1 — — — 1 — 1 1 — 3 Laryngitis — — — — — — — — — — Bronchitis — 1 1 — 2 3 2 2 3 12 Pneumonia (all forms) — — — 1 1 6 7 7 11 32 Diarrhoea — — 1 — 1 3 1 2 2 9 Enteritis — — — 1 1 3 6 2 2 14 Gastritis — — — — — 1 — 1 — 2 Syphilis — — 1 — 1 1 — — — 2 Rickets — — — — — — — — — — Suffocation, overlaying — — — — — 1 — — — 1 Injury at Birth 4 1 — — 5 — — — — 5 Atelectasis 10 — — — 10 — — — — 10 Congenital Malformations 6 3 2 — 11 9 3 1 1 25 Premature Birth 55 — 7 3 65 3 1 — — 69 Atrophy, Debility and Marasmus 6 4 1 — 11 5 9 2 1 28 Other Causes 9 2 1 1 13 5 3 2 2 25 Totals 92 12 14 6 124 44 36 23 31 258 Nett Births in the year: legitimate, 4736; illegitimate, 145. Nett Deaths in the year of legitimate infants, 248; illegitimate infants, 10. 11 Vital Statistics. Table VIII. gives the corrected number of deaths, and the cause of death, during the past five years, compared wIth the quinquennial average and the year 1925. TABLE VIII. Cause of Death. 1920 1921 1922 1923 1924 Average 1920-1924 1925 All Causes:— Certified 461 415 337 287 286 357 258 Uncertified 1 3 2 1 1 1.6 — Small-pox — — — — — — — Chicken-pox — — — — — — — Measles 11 1 19 1 12 8.8 — Scarlet Fever — — 2 — — .4 — Whooping Cough 8 15 14 14 11 12.4 12 Diphtheria and Croup — 4 2 1 — 1.4 — Erysipelas 2 1 1 1 1 1.2 — Tuberculous Meningitis 2 1 6 — 1 2.0 4 Abdominal Tuberculosis 2 1 — 3 — 1.2 — Other Tuberculous Diseases — 4 1 4 4 2.6 1 Meningitis (not Tuberculous) 4 6 5 3 1 3.8 4 Convulsions 22 12 18 9 12 14.6 3 Laryngitis — — — — — — — Bronchitis 44 23 21 20 21 25.8 12 Pneumonia (all forms) 47 53 45 32 40 43.4 32 Diarrhœa 12 45 4 10 7 15.6 9 Enteritis 38 36 15 36 12 27.4 14 Gastritis 8 7 4 6 5 6.0 2 Syphilis 6 7 4 3 5 5.0 2 Rickets 1 — — — 1 .4 — Suffocation, overlaying 3 2 2 1 1 1.8 1 Injury at Birth 8 13 4 3 1 5.8 5 Atelectasis 6 8 7 10 12 8.6 10 Congenital Malformations 19 23 23 14 26 21.0 25 Premature Birth 112 73 78 55 64 72.4 69 Atrophy, Debility and Marasmus 72 51 39 41 24 45.4 28 Other Causes 35 32 25 21 26 27.8 25 Totals 462 418 339 288 287 358.0 258 12 Report of the Medical Officer of Health. Table IX. 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 IX. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 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 1924 46 56 58 55 62 63 57 Average for 10 years 69 72 62 83 77 71 1925 54 64 38 42 63 57 52 No. of deaths under 1 year, 1925 50 27 33 30 35 83 258 13 INFECTIVE DISEASES. The total number of deaths from these diseases was 586:— 101 in Clapham, 47 in Putney, 96 in Balham, 82 in Streatham, 79 in Tooting, and 181 in Wandsworth. From all infective diseases the death-rate was 1.70 per 1,000:—1.61 in Clapham, 1.49 in Putney, 1.79 in Balham, 1.45 in Streatham, 1.96 in Tooting, and 1.80 in Wandsworth. The rate is lower than in 1924 mainly owing to the decrease in the number of deaths from Measles. The rate in 1918 was 5.37; in 1919, 2.50; in 1920, 1.96; in 1921, 2.26; in 1922, 2.28; in 1923, 1.61; and in 1924, 1.88. The rate from the principal infective diseases, viz.:—Smallpox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever, and Diarrhoea, was .32 per 1,000, compared with .94 in 1917; .82 in 1918; .42 in 1919; .61 in 1920; .70 in 1921; .73 in 1922; .39 in 1923; and .47 in 1924. The rate was .35 in Clapham, .22 in Putney, .24 in Balham, .24 in Streatham, .44 in Tooting, and .38 in Wandsworth. The death-rate from the above diseases is the lowest yet recorded for the Borough. Table X. shows the deaths which occurred during the year from the notifiable and non-notifiable infective diseases, and in Table XI. 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 33 and 25 of this Report. In Table XII. the cases of infective diseases are shown grouped according to the Sub-districts in which they occurred. 14 Report of the Medical Officer of Health. TABLE X. 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 1&—20 20—35 35—45 45—65 65 and upwards Small-pox — — — — — — — — — — — — — — — Diphtheria 27 26 1 — — 2 4 4 12 4 1 — — — — Scarlet Fever 9 8 1 — — — — 1 5 2 1 — — — — Enteric and Paratyphoid Fever 5 1 4 — — — — — — 1 — — 1 3 — Puerperal Fever 9 — 9 — — — — — — — 6 3 — — Erysipelas 6 1 5 — 1 — — — — — — 1 — 3 1 Whooping Cough 37 36 1 12 16 2 1 4 — 1 — 1 — — — Pneumonia:— Acute Influenzal 19 — 19 — — — — — — — 1 1 2 10 5 Acute Primary 52 9 43 4 1 1 1 — 1 1 1 2 6 21 13 Cerebro-Spinal Meningitis 5 3 2 1 — — — — 2 — 1 1 — — — Polio-myelitis — — — — — — — — — — — — — — — Encephalitis Lethargica 11 2 9 — — — — — 2 — — — 1 6 2 Malaria — — — — — — — — — — — — — — — Dysentery — — — — — — — — — — — — — — — Trench Fever — — — — — — — — — — — — — — — Total 180 86 94 17 18 5 6 9 22 9 5 12 13 43 21 Non-Notifiable Diseases. Measles 1 1 — — — 1 — — — — — — — — Influenza 111 8 103 1 1 1 1 1 2 1 4 6 10 28 55 Diarrhoea 34 26 8 23 3 —_ — — — — — 1 — 1 6 Other (if any) — — — — — — — — — — — — — — — Total 146 35 1ll 24 4 1 2 1 2 1 4 7 10 29 61 Grand Total 326 121 205 41 22 6 8 10 24 10 9 19 23 72 82 15 Infective Diseases. TABLE XI. 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 695 563 132 4 12 39 42 52 267 147 40 78 9 5 — Scarlet Fever 801 662 139 4 14 33 53 70 345 143 69 57 9 4 — Enteric and Paratyphoid Fever 52 16 36 — 1 1 4 1 3 6 6 15 7 8 — Puerperal Fever 12 — 12 — — — — — — — 9 3 — — — Erysipelas 118 14 104 1 2 — — 1 6 4 5 15 21 38 25 Whooping Cough 2089 2056 33 165 196 215 242 340 846 52 5 14 9 2 3 Pneumonia:— — Acute Influenzal 84 12 72 — 2 2 — 1 3 4 9 16 18 18 11 Acute Primary 357 150 207 34 25 18 12 13 28 20 18 44 34 77 34 Cerebro-spinal Meningitis 7 4 3 1 — — — — 1 2 1 2 — — — Polio-myelitis 3 2 1 1 — — — — — 1 — 1 — — — Encephalitis Lethargica 19 5 14 — — — — 1 2 2 — 3 1 7 3 Malaria 2 — 2 — — — — — — — — 1 1 — — Dysentery 1 1 — — — — — — 1 — — — — — — Trench Fever — — — — — — — — — — — — — — — Total 4240 3485 755 220 252 308 353 479 1502 381 162 249 109 159 76 16 Report of the Medical Officer of Health TABLE XII. Notifiable Diseases. Total CASES of Infectious Diseases occurring in each locality. Total Cases occurring. Number admitted into Hospital. Total Deaths. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. — — — — — — — — — Diphtheria 117 57 63 77 119 262 695 676 27 Diphtheria 114 45 164 73 200 205 801 731 9 Scarlet fever 3 4 2 37 1 5 52 46 5 Enteric and paratyphoid fever — 3 4 2 1 2 12 10 9 Puerperal fever 19 5 10 15 12 57 118 27 6 Whooping Cough 300 188 261 271 281 788 2089 24 37 Pneumonia—Acute influenzal 11 2 16 8 15 32 84 — 19 Pneumonia—Acute primary 70 29 34 28 44 152 357 — 52 Cerebro-spinal Meningitis 1 — — 3 1 2 7 5 5 Polio-myelitis — — 1 1 — 1 3 1 — Encephalitis Lethargica 3 2 3 1 6 4 19 12 11 Malaria 1 — — — .— 1 2 — — Dysentery — — — — 1 — 1 — — Trench Fever — — — — — — — — — Total 639 335 558 516 681 1511 4240 1532 180 Tuberculosis—all forms 131 70 80 77 71 214 643 — 310 Ophthalmia Neonatorum 3 3 11 2 — 10 29 16 — Total 134 73 91 79 71 224 672 16 310 Grand Total 773 408 649 595 752 1735 4912 1548 490 17 Infective Diseases TABLE XIII. Diseases. CASES reported 1920-1925. 1920 1921 1922 1923 1924 Average for five years. 1925 Small-pox — 1 — — — — — Diphtheria 1104 1009 838 374 412 747 695 Scarlet Fever 1463 1978 1257 579 847 1225 801 Enteric and Paratyphoid Fever 24 32 22 24 14 23 52 Puerperal Fever 36 11 17 12 24 20 12 Erysipelas 173 121 108 101 111 123 118 Whooping Cough 1343 1201 1056 1229 1108 1187 2089 Pneumonia—Acute Influenzal 97 79 180 39 32 85 84 Pneumonia—Acute Primary 408 374 466 389 514 430 357 Cerebro spinal Meningitis 15 9 6 7 5 8 7 Polio-myelitis — 7 4 18 16 9 3 Encephalitis Lethargica 18 17 6 6 32 16 19 Malaria 68 19 13 10 9 24 2 Dysentery 8 6 3 4 1 4 1 Trench Fever 2 — — — — — — Anthrax 1 — — — — — — Ophthalmia Neonatorum 60 54 42 36 31 45 29 Measles 2554 450 1842 663 3418 1785 474 Tuberculosis—Pulmonary 634 490 398 463 531 503 509 Tuberculosis—Other forms 156 147 145 134 161 149 134 18 Report of the Medical Officer of Health. The total number of cases, less Tuberculosis and Ophthalmia Neonatorum, was 4,240, compared with 3,125 in 1924 and 2,792 in 1923. The increase, compared with 1924, is largely due to the increase in the number of cases of Whooping Cough. 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 XIV. is taken from the official returns of the Vaccination Officers to the Board of Guardians for the year 1924. 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 XIV. SubDistricts. Number of Births returned from 1st Tanuary to 31st December, 1924. 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 748 470 3 — 22 171 7 12 29 34 Putney 369 255 1 — 12 70 5 3 7 16 Streatham 2430 1291 5 — 100 667 16 155 72 124 Wandsworth 1198 765 6 — 49 272 14 10 43 39 Totals 4745 2781 15 — 183 1180 42 180 151 213 Infective Diseases. 19 The percentage of children vaccinated to total births was 58.5:—in Clapham, 62.8; in Putney, 69.1, in Streatham, etc., 53.1, and in Wandsworth, 63.9. Diphtheria. 695 cases occurred, compared with 412 in 1924. The number of deaths was 27, compared with 26 in 1924. The death-rate for 1925 was .07 and the case mortality was 3.8 per cent. The disease appeared to have been of a milder type than in 1924, when 26 deaths occurred among 412 cases. In 1922 there were 838 cases and 76 deaths, with a case mortality of 9.0 per cent. The rate per 1,000 of population was 2.01:—1.86 in Clapham, 1.82 in Putney, 1.17 in Balham, 1.36 in Streatham, 2.95 in Tooting, and 2.61 in Wandsworth. Of the 695 cases, 676, or 97 per cent. were removed to hospital and no difficulty was experienced in having cases promptly removed. The Medical Officers of the London County Council made inspections of Bonneville Road, Larkhall Lane, New Road and New Park Road Schools, Clapham; All Saints' School, Putney Common; Fircroft Road, Oldridge Road and Smallwood Road Schools, Balham; Eardley Road, Immanuel, St. Andrew's, Colmer Road, St. Andrew's, Polworth Road and St. Leonard's Schools, Streatham; Ensham, Sellincourt Road, and Tooting Graveney Schools, Tooting; and Allfarthing Lane, Earlsfield, Eltringham Street, Magdalen Road, Riversdale, St. Faith's, St. Michael's, Waldron Road, Wandle and West Hill Schools, Wandsworth. Swabs were taken from the throats of some of the children examined. As a result of this swabbing, 40 cases were found to be positive and 33 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 31 tubes of anti-toxin were issued to medical practitioners for use in cases of Diphtheria. C 2 20 Report of the Medical Officer of Health. 91 of the cases occurred in institutions in the Borough. 36 occurred in the Fountain Mental Hospital. The first case occurred on the 19th January, and the last on the 10th December. 26 of the cases occurred in the months of April and May, and 30 of them were in three wards. 31 cases occurred in an orphanage in Clapham. Several visits were paid to this institution and swabs were taken of the children who had been in contact with actual cases. 14 cases occurred in another orphanage in Clapham and 10 in another institution. Scarlet Fever. 801 cases of Scarlet Fever occured, compared with 847 in 1924 and 579 in 1923. Nine cases died, compared with seven and three respectively for the two previous years, and the death-rate was .02 per 1,000, compared with .02 and .008. The case mortality was 1.12 per cent. The case-rate per 1,000 of population was 2.32:—1.81 in Clapham; 1.43 in Putney; 3.06 in Balham; 1.29 in Streatham; 4.96 in Tooting, and 2.04 in Wandsworth. Of the total number of cases, 731, or 91 per cent., were removed to hospital. The outbreak which occurred at the Fountain Mental Hospital during 1924 referred to in last year's Report, continued during the first five months of the year. 50 cases occurred between the 1st January and 4th June, 1925, making a total of 145 cases during 1924 and 1925. 15 other cases occurred sporadically at the institution during the latter half of the year. The Medical Officers of the London County Council made inspections of eight 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. 28 cases of Scarlet Fever and 10 of Diphtheria occurred within one month of the return of a previous case from hospital. Infective Diseases. 21 Enteric and Para-Typhoid Fever. 52 cases and five deaths of the above occurred. The death rate was .01 per 1,000. 43 of the cases were true Enteric Fever and nine were Paratyphoid Fever. 32 of the true cases of Enteric Fever were reported during the months of October and November when a localised outbreak occurred in Streatham which involved a total of 34 cases (two of whom resided outside the Borough) and three deaths. The cause of the outbreak was traced to the milk supply which became infected by a woman assisting in the milk business who was found to be a "carrier" of the disease, though herself in good health. On the 19th October, two cases were notified to me from one household and on the 2lst I was called in consultation to see three patients in another family who had been ill for some days. All three were found to be suffering from Typhoid Fever. Both these families obtained their milk supply from the same source. About 12 gallons of milk were sold daily from this milk shop, and 49 houses were supplied by a round from the shop. The milk was served in bottles which were cleansed and filled on the premises. A small quantity of milk was also sold in the shop from a pan on the counter. The supply to the milkshop was obtained from another purveyor in the Borough who was supplied by nine different farms. The business was conducted by the purveyor who was assisted in the shop by his wife, but at a later date I was told that a roundsman had been helping in the business and was sent home sick on the 15th October. I also discovered that the proprietor's wife had assisted with the filling of the bottles, especially when the roundsman was not at work. Both the purveyor and his wife stated that they had been in good health for a long time and had had no illness recently. Three other persons then residing in the house who were not associated with the milk business, also gave a history of freedom from illness. 22 Report of the Medical Officer of Health. Examinations were made of the blood and excreta of all these persons and the organism of Typhoid Fever was found in the excreta of the purveyor's wife, though her blood examination was negative. She was removed to hospital immediately and remained there for three months and during that time she was in apparent good health. Bacteriological examinations made in hospital confirmed those made here. The source of infection of this woman was not ascertained, but it is possible that she may have been infected by a lodger in the premises above the milkshop who, six weeks previously, was ill for a fortnight—her illness being diagnosed subsequently as Typhoid Fever, but it is difficult to realise how this could have occurred without the woman herself becoming ill. As it was possible that infected milk bottles had played a part in carrying infection, I made immediate arrangements for all the bottles and utensils to be disinfected daily at the Council's Disinfecting Station. Arrangements were made for the milkman's round to be carried out by the dairyman who supplied him with milk, and none of this milk was allowed to enter the infected premises before delivery to customers. The milk roundsman mentioned above who was sent home sick on October 15th was diagnosed subsequently as a case of Typhoid Fever and was admitted to Mitcham Isolation Hospital. In all probability he was infected by the milk. Enquiries were made in the districts from which the milk was obtained and I was informed that no cases of suspicious illness had occurred at any of the farms for a long time. Samples of this milk taken on delivery into the Borough were examined bacteriologically with negative results. In order to get early knowledge and prompt removal of cases to hospital, I communicated on the 22nd October with the medical men practising in Streatham, and requested them to inform me immediately of any suspicious cases coming to their knowledge. Several cases of the disease were discovered in this way and I was able to get into touch with other families where indefinite Infective Diseases. 23 illness had occurred. I kept in close touch with the doctors of this district until the outbreak had ceased. All the households supplied by this Purveyor were visited on several occasions, and a number of cases of illness were discovered in this way, several of them proving to be Typhoid Fever. All the cases were true Typhoid Fever, and 21 out of the 49 households supplied by this particular milk round were attacked. Two of the patients resided out of the Borough—one of them being the roundsman already mentioned and the other a woman who worked in a shop next door to the milk premises, from which she was in the habit of obtaining milk. A striking feature of the outbreak was that no men were affected, the eldest males being youths aged 16 and 17. 21 of the patients were women and 11 were children under 15 years of age. Other incidents have occurred in connection with this outbreak in 1926, and will be reported in the Annual Report for that year. Puerperal Fever. There were 12 cases of Puerperal Fever and nine deaths. The death-rate was .02 per 1,000 and the case mortality 75 per cent. 10 of the 12 cases were removed to hospital. Erysipelas. 118 cases were notified and six deaths occurred during the year, compared with 111 and five in 1924. Whooping Cough. 37 deaths occurred during the year, while the number of cases notified was 2,089. The disease was of a milder type than in 1924, when 28 deaths occurred in 1,108 cases. The deathrate was .1 per 1,000. 24 of the cases were removed to hospital. 2,313 visits were made by the Sanitary Inspectors and Health 24 Report of the Medical Officer of Health. Visitors to houses where cases of Whooping Cough occurred, and 269 premises were disinfected. Influenza. The number of deaths from Influenza was 111, compared with 139 in 1924 and 56 in 1923. The death-rate was .3 per 1,000. Influenzal Pneumonia and Acute Primary Pneumonia. 84 cases of acute Influenzal Pneumonia and 357 cases of acute Primary Pneumonia were notified. 19 of the former and 52 of the latter died. The total number of deaths credited to all forms of Pneumonia during the year was 181, compared with 233 in 1924, 189 in 1923, 236 in 1922, 241 in 1921, and 227 in 1920. Cerebro-Spinal Meningitis. Seven cases of this disease occurred and five of them died. A further 12 deaths were registered as being caused by Meningitis. Polio-myelitis and Polio-encephalitis. Three cases occurred with no deaths. Early in the year the Metropolitan Asylums Board provided accommodation at Queen Mary's Hospital, Carshalton, for the treatment of children suffering from Polio-myelitis in the later and more chronic stages of the disease. The arrangements were made through the London County Council to whom application has to be made for a case to be accommodated. One child has been admitted for treatment under this scheme. Encephalitis Lethargica. 19 cases of this disease occurred and 11 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 a decrease compared with 1924, when there were 32 cases with 14 deaths. 25 Infective Diseases. Malaria. Two cases were notified, one male and one female. Dysentery. One case of Dysentery was notified from an Institution. Trench Fever. No cases occurred during the year. Ophthalmia Neonatorum. 29 cases were notified and the following Table shows the effect of the disease on the vision in 26 of the cases, according as to whether the cases were treated at hospital or at home. Two removed to addresses outside the Borough and were then nearly well. One of the cases died from premature birth and Gastritis. TABLE XV. Result of Treatment. Vision not affected. Vision Impaired. Total Blindness. Died. Treatment received:— In Hospital 9 — — 1 At Hospital, Out-patient 10 — — — At home 7 — — — Total 26 — — 1 The 26 cases recovered without any impairment of vision. Four of the cases were attended at birth by doctors, 14 by midwives, and 11 of the infants were born in maternity homes. Measles and German Measles. One death occurred from Measles, compared with 71 in 1924, 11 in 1923, and the death-rate per 1,000 of population was .002, compared with .2 in 1924, .03 in 1923, .21 in 1922, .012 in 1921, and .17 in 1920. 474 cases of Measles were reported during the year, compared with 3,418 in 1924 and 663 in 1923. 115 of the cases were under the age of five years, and 467 of them were under the age of 15 years. 21 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. 321 of the 474 cases were reported by the Divisional Officers of the Educational Department or by the teachers of elementary schools, and 51 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 daring vacations may not come to the knowledge of the school authorities. 295 cases of German Measles were also reported. 723 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Measles occurred, and 143 premises were disinfected. Table XVI. shows the number of cases of infectious diseases which occurred in the individual elementary schools during the year. 26 Report of the Medical Officer of Health. 27 Infective Diseases. TABLE XVI. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Clapham. Aristotle Road 1 1 — — 1 1 1 — 1 6 Bonneville Road 17 — 7 69 53 12 16 2 23 199 Cavendish Road 7 — — 6 19 25 1 — 1 59 Cavendish Road Special — 1 1 — 2 1 1 — — 6 Christchurch 8 5 2 1 5 7 20 — 1 49 Clapham Parochial, Old Town 4 2 — — 7 3 16 — — 32 Haselrigge Road 6 1 3 — 35 11 35 — 6 97 Larkhall Lane 2 8 24 10 7 6 12 1 16 86 New Park Road 10 4 51 9 10 30 5 — 17 136 New Road 2 2 — — 2 1 3 — — 10 St. Andrew's Street 9 7 — 1 1 — 15 — 1 34 St. Mary's, Crescent Lane 1 — — — — — — — 1 St. Mary's, St. Alphonsus Road 2 1 — — — — — — — 3 Stonehouse Street 8 1 1 2 39 30 53 — 3 137 Telferscot Road 9 3 4 3 71 60 6 2 9 167 Putney. All Saints' 3 22 1 — 12 2 58 1 1 100 Hotham Road 4 5 13 13 22 44 152 4 9 266 Huntingfield Road 5 — 5 — 12 22 63 5 — 112 Parochial, Roehampton — — — — — — 23 — — 23 St. Mary's 1 2 1 — 1 5 6 — — 16 Upper Grade, Walker's Place 2 — — — — — — — — 2 Carried forward 101 65 113 114 299 260 486 15 88 1541 28 Report of the Medical Officer of Health. TABLE XVI.—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 101 65 113 114 299 260 486 15 88 1541 Balham. Balham High Road 3 4 6 4 — 23 1 — 7 48 Broadwater Road 4 8 2 — 1 1 8 — 2 26 Fircroft Road 24 8 — 2 4 6 80 — 36 160 Hearnville Road 13 2 14 10 5 16 — — — 60 Holy Trinity, Balham 3 3 — — 3 13 13 — — 35 Nightingale Square R.C. 3 — — — — — 9 — •— 12 Oldridge Road 9 1 8 7 30 9 6 — 38 108 St. Mary's 9 1 1 2 3 31 6 — — 53 Smallwood Road 3 19 7 2 75 30 64 — 5 205 Streatham. Christchureh — — 2 3 — — 7 1 — 13 Coventry Hall 2 — — — — — — — — 2 Eardley Road 3 12 1 12 22 27 95 — 11 183 Furzedown Demonstration 4 2 8 7 16 42 65 — — 144 Hitherfield Road 5 — — 1 3 6 20 — 3 38 Immanuel 2 8 5 6 10 2 11 — 1 45 Mitcham Lane 5 5 9 43 69 60 27 2 4 224 St. Andrew's, Colmer Road 2 14 30 19 45 4 15 1 — 130 St. Andrew's, Polworth Road 4 8 — — 4 — — — — 16 St. Leonard's 6 — — 4 6 1 8 — — 25 Sunnyhill Road 3 — 13 9 48 18 1 — 2 94 Carried forward 208 160 219 245 643 549 922 19 197 3162 29 Infective Diseases. TABLE XVI.—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 208 160 219 245 643 549 922 19 197 3162 Tooting. Ensham 12 12 2 1 37 5 23 2 3 97 Fountain Road 6 2 1 1 19 10 5 — — 44 Franciscan Road 29 5 10 10 13 14 58 1 18 158 Hillbrook Road 32 3 11 7 87 30 68 — 4 242 Sellincourt Road 13 18 2 3 50 34 57 — 36 213 Tooting Graveney 6 9 2 1 8 £7 48 1 7 109 Undine Street. R.C. 2 1 – – – 1 21 – 1 26 Wandsworth. Allfarthing Lane 6 4 2 1 64 21 9 4 4 115 All Saints' 8 — 4 — 4 5 23 — 5 49 Brandlehow Road 2 3 2 — 18 40 67 1 1 134 Earlsfield 24 42 1 — 11 16 3 2 37 136 Elliott Central — 4 — — — — — — — 4 Eltringham Street 8 14 3 4 30 10 2 — 5 76 Frogmore Special 1 1 — — — — — — 1 3 Garratt Lane 3 3 1 — 60 21 23 1 3 115 Magdalen Road 5 9 2 — 1 15 — — 1 33 Merton Road 7 3 1 1 9 13 23 — 1 58 Riversdale 7 3 1 1 72 38 10 1 1 134 St. Ann's 4 — — — 11 3 14 — 1 33 St. Faith's 4 11 3 — 19 14 27 — 1 79 St. Joseph's 2 — — — 20 — — — — 22 St. Michael's 7 1 — — 64 3 — 3 — 78 Southfields 5 1 1 — 1 7 51 — 4 70 Swaffield Road 10 14 — 1 35 19 20 — 6 105 Waldron Road 8 27 2 1 4 21 2 5 18 88 Wandle 3 16 1 — 7 8 11 — 9 55 Wandsworth Central – – – – – 1 – – – 1 Warple Way — 8 11 1 6 — 2 — 1 29 West Hill 6 5 39 17 25 57 93 1 1 244 Grand Total 428 379 321 295 1318 991 1573 41 366 5712 30 Report of the Medical Officer of Health. Diarrhœa. The number of deaths from Diarrhoea was 34, compared with 30 in 1924, 61 in 1923, and 32 in 1922, and of these 23, or 67 per cent., were under the age of one year, compared with 19 in 1924. The number of deaths from Diarrhoea, Zymotic Enteritis and Enteritis under one year represents 8.9 per cent. of the total mortality at that age. Scabies. The names of 38 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 14 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, 20 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, seven from Septicaemia, six from Syphilis, two from Tetanus, one from Pyaemia, and one from Actinomycosis. 31 NON-INFECTIVE DISEASES. The total number of deaths from Cancer and malignant disease was 460, the number of males being 182 and females 278. The corrected death-rate was 1.33 per 1,000 for the whole Borough:—1.29 for Clapham, 1.43 for Putney, 1.66 for Balham, 1.43 for Streatham, 1.31 for Tooting, and 1.10 for Wandsworth. The number of deaths in 1925 was 53 less than in 1924, but 10 more than in 1923. The number of deaths from diseases of the Brain and Nervous System was 132. 863 deaths occurred from diseases of the Heart and Circulatory System, compared with 880 in 1924. 594 of these deaths were of persons over 65 years of age. There were fewer deaths from diseases of the Respiratory System, the number being 534, compared with 596 in 1924. The number from Bronchitis was 315, compared with 327 in 1924, and from Pneumonia (all forms) 181, compared with 233 in 1924. Further particulars relative to Pneumonia are given on page 24. The number of infants under two years of age who died from these diseases fell from 97 in 1924, to 60 in 1925. Nine deaths occurred from accidents and diseases of pregnancy and with the nine deaths already mentioned from Puerperal Fever, gives a total of 18 deaths after childbirth. This is equivalent to a rate of 3.6 per 1,000 births, compared with 5.4 in 1924. 154 deaths, 94 males and 60 females, were registered as due to Premature Birth and Developmental Diseases, compared with 135 in 1924. 196 deaths, 63 males and 133 females, occurred from Old Age, and all these were persons over 65 years of age. The number of deaths due to this cause in 1924 was 204. 138 deaths were due to Violence, 94 of them being due to accident, 40 to suicide, and four to other forms of violence. Inquests. Inquests were held on 198 persons dying in the Borough, and on 118 Borough residents who died outside the Borough. The next Table shows the results of the findings of these inquests. 32 Report of the Medical Officer of Health. TABLE XVII. Inquests. Sub-Districts. Whole Borough. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Deaths from Natural Causes 25 21 25 20 18 40 149 Accidental:— Falls 3 — 2 3 6 8 22 Falls from a height 1 1 — — 2 3 7 Falls from vehicles 2 1 3 1 1 2 10 Knocked down by motor vehicles 5 5 9 3 2 9 33 Knocked down by train 2 — 2 2 — — 6 Scalds and burns 1 3 6 1 3 2 16 Deaths under anaesthetics — 2 3 — — 2 7 Drowning 1 1 — — — 2 Poisoning 2 2 Suffocation 2 — — — 1 1 4 Other — — — 1 1 3 5 Suicidal Drowning — 1 1 3 — 1 6 Cut Throat — — — 1 1 l .3 Poisoning by:— Coal Gas 1 1 3 2 1 3 11 Nitrous Oxide Gas 1 — — — — — 1 Hydrochloric Acid — — 2 — 1 2 5 Morphine — — — 1 — — 1 Carbolic Acid — — — — — 1 1 Lysol — — 1 — — — 1 Hanging 1 2 — 2 3 1 9 Gunshot Wounds — — — 1 — — 1 Run over by train — — — 1 — 1 2 Fall from a height 1 — — — — — 1 Infanticide — 1 — — — — 1 Open Verdicts:— Found dead — — — 1 — 1 2 Found drowned — — 1 1 1 2 5 Murder — — — 2 — — 2 Execution — — — — — 1 1 Totals 48 39 58 46 41 84 316 33 TUBERCULOSIS. The Public Health (Prevention of Tuberculosis) Regulations, 1925, came into operation during the summer. These Regulations prohibit any person from entering into any employment in connection with a dairy if he knows he is suffering from Tuberculosis of the respiratory tract. They also empower the Local Authority to give notice to a person so suffering requiring him to discontinue his employment in the milk trade if he is in an infectious state. One case was reported to the Public Health Committee under these Regulations and the man voluntarily severed his connection with the milk trade, the Council having found open-air employment for him in their service. Notification.—The total number of new cases of Tuberculosis which came to the notice of the Medical Officer of Health during 1925 was 643, as compared with 692 in 1924, 597 in 1923, 543 in 1922 and 637 in 1921. It is difficult to draw conclusions from these figures as to the prevalence of Tuberculosis in the Borough, for during the past five years, certain modifications in procedure have tended to increase the number of cases notified. These modifications are as follows:— (a.) The various Regulations and Circulars issued by the Ministry of Health of recent years, by fostering closer cooperation between local medical practitioners and Tuberculosis Officers, have resulted in the notification of many cases which would not have been notified previously. (b.) Since 1922 it has been the practice of the Tuberculosis Officer—when the sputum of a patient under the care of a medical practitioner is found to contain Tubercle Bacilli—to write to the practitioner requesting him to notify the case. (c.) Since 1923 deaths from Tuberculosis—un-notified previously—have been included in the number of cases notified during the year. D 34 Report of the Medical Officer of Health. The sources of information regarding the 643 new cases notified in 1925 were as follows:— Primary notifications on Form A 569 Primary notifications on Form B 3 Primary notifications on Form C. 2 Un-notified at death 47 Transfers from other Sanitary Authorities 10 Naval and military notifications 12 Total 643 Table XVIII.—in the form suggested by the Ministry of Health—gives details regarding the site of disease, sex and age grouping of these new cases; also similar details regarding deaths from Tuberculosis during the year. TABLE XVIII. Age Periods. New Cases. Deaths. Pulmonary. Non- Pulmonary. Pulmonary NonPulmonary. Male. Female. Male. Female. Male. Female. Male. Female. Under 1 year 3 1 3 4 1 — 3 4 1—5 — 1 10 7 — 1 5 3 5—10 12 10 10 10 — 1 4 5 10—15 6 5 12 8 3 4 4 1 15—20 13 31 4 9 8 14 1 2 20—25 44 42 2 7 20 29 1 25—35 73 66 8 5 29 37 1 2 35—45 71 34 3 6 32 14 1 2 45—55 47 19 4 1 24 9 2 1 55—65 21 11 5 2 17 10 1 3 65 upwards 5 4 — 4 4 4 – 3 Totals 295 224 61 63 138 123 22 27 35 Tuberculosis. Table XIX. shows the number of new cases of Non-pulmonary Tuberculosis classified according to the part of the body affected. TABLE XIX. Localisation of Disease. Total. Males. Females. Brain .. 27 13 14 • Glands, Mesenteric 16 11 5 Glands, Cervical 36 12 24 Bones and Joints 33 19 14 Skin 6 3 3 General Tuberculosis 6 3 3 Other Parts — — — Totals 124 61 63 Deaths.—The total number of deaths certified as due to diseases of a Tuberculous nature was 310—of whom 160 were males, and 150 females. Of the 310 deaths, 261 were due to Pulmonary Tuberculosis, 24 to Tuberculous Meningitis, 10 to Abdominal Tuberculosis and 15 to other forms of Tuberculosis. Table XX. gives details regarding the type of the disease, sex, and age grouping of these 310 deaths. In addition to these deaths, which were duly certified in the returns as due to Tuberculosis, 10 persons previously notified as suffering from Tuberculosis died during the year. These deaths, however, do not figure in Table XX. for the following reasons:— (a.) Six were certified as dying of diseases other than Tuberculosis. (b.) Four had previously moved outside the Borough and died there, the deaths being credited to the areas in which death occurred. d 2 36 Report of the Medical Officer of Health. TABLE XX. Localisation. Total. Males. Females. Pulmonary 261 138 123 Brain 24 12 12 Glands Mesenteric 10 7 3 Glands Cervical 2 — 2 Bones and Joints 7 1 6 Skin — — — General Tuberculosis 6 2 4 Other Parts — — — Total 310 160 150 The following Table gives figures for the last 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 rate, though a little higher than in 1924, is about the average for the ten years. Tuberculosis. 37 TABLE XXI. 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 Pulmonary Tuberculosis:— No. of Deaths 320 339 368 288 257 331 286 269 244 261 Death Rate 1.02 1.12 1.22 .87 .75 1.00 .85 .80 .71 .75 Other Forms:— No. of Deaths 76 85 87 54 58 59 57 50 50 49 Death Rate .24 .28 .29 .16 .18 .18 .17 .14 .14 .15 Total:— No. of Deaths 396 424 455 342 315 390 343 319 294 310 Death Rate 1.26 1.40 1.51 1.03 .93 1.18 1.02 .94 .86 .90 38 Report of the Medical Officer of Health. During the year 47 persons, not previously notified, were certified as having died of Tuberculosis. The ratio of unnotified Tuberculosis deaths to total Tuberculosis deaths is therefore 47 to 310. Of the 47 unnotified deaths, 20 were certified from Institutions, 22 by private doctors, while in five 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. 76 persons died within one month after notification, 107 within three months, and 139 within six months. Register of Notified Persons.—The Public Health (Tuberculosis) Regulations, 1924—which came into operation on 1st January, 1925—contained instructions regarding the register of notifications and the new quarterly returns to be compiled therefrom. The Ministry of Health Circular No. 549, dated December, 1924, put forward suggestions regarding the removal from the Tuberculosis Register of persons who may be regarded as "recovered" or "lost sight of." Table XXII. gives particulars regarding the numbers of notified persons on the Register since 1909. The figures for the years 1909 to 1920 are grouped together. The table shows the number of cases reported each year, the number who died, recovered, or were lost sight of, together with the number remaining on the Register at the end of each year. The letters "P.T." signify Pulmonary Tuberculosis, while "N.P.T." stand for Non pulmonary Tuberculosis. Patients classified as "recovered" are those who have shown no evidence of active disease for at least five years. Tuberculosis. 39 TABLE XXII. Year. Cases reported. Died. Lost sight of Recovered. Remaining on Register. p.t. n.p.t. Total p.t. n.p.t. Total p.t. n.p.t. Total p.t. n.p.t. Total p.t. n.p.t. Total 1909 to 1920 7593 1700 9293 3398 552 3950 1673 279 1952 195 139 334 2327 730 3057 1921 490 147 637 337 59 396 206 39 245 82 35 117 2192 744 2936 1922 398 145 543 308 59 367 104 56 160 45 37 82 2133 737 2870 1923 463 134 597 269 50 319 192 46 238 212 73 285 1923 702 2625 1924 531 161 692 244 50 294 262 40 302 312 144 456 1636 629 2265 1925 509 134 643 260 50 310 79 53 132 167 36 203 1639 624 2263 40 TUBERCULOSIS DISPENSARIES. (a.) Main Dispensary at 174, 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. 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. Dispensing.—Treatment at the Dispensary, as distinct from diagnosis, consultation and general supervision, is limited to patients who are unable to obtain other adequate medical attendance. Institutional Treatment.—Since May, 1921, when Sanatorioum Benefit ceased to be included among the benefits conferred by the National Insurance Act, the responsibility for the institutional treatment of all persons rests with the London County Council. No. of patients treated in:— (a.) Hospitals for observation 110 (b.) Sanatorium 207 (c.) Hospitals for Advanced Cases 15 332 As in former years there has been great difficulty in arranging institutional treatment for advanced cases. There is still room for the provision of such beds as near as possible to the homes of such cases, so as to be readily accessible to their relatives. Tuberculosis Dispensaries. 41 Co-operation with other Institutions.—Cases requiring special investigation without their admission to Hospital, are, as before, referred to St. Thomas's Hospital in accordance with the scheme inaugurated in 1913. The reports are of much value, and the scheme is now extended to include Artificial Light and X-Ray treatment. The arrangements with the Hospital for Consumption, Brompton, for supplying refills to patients treated by the Artificial Pneumothorax method have been continued. 11 cases were treated during the year and 80 refills supplied. The total cost was £42. The close co-operation between the Dispensary and the School Medical Service instituted by the London County Council has been continued. The Tuberculosis Officers continue to act as Medical Referees to the Ministry of Pensions and the Tuberculosis Visitors devote a considerable portion of their time to the visiting of discharged soldiers. In March, 1925, the London County Council decided to put into operation, as an experiment for twelve months, a scheme— in co-operation with the Invalid Children's Aid Association—for: (1.) The removal of children from heavily infected and overcrowded houses during the terminal stage of a dying case of Pulmonary Tuberculosis in the family. (2.) The boarding out of children who are being discharged from Sanatorium, and whose houses are unsuitable and inimical to the maintenance of health. This scheme was extended in July, 1925 to include:— (3.) The boarding out of "weakly children" living under conditions likely to subject them to infection, and of children in suitable instances whose parents are under treatment for Tuberculosis. The Orthopœdic Section of the Clinic provided by the Metropolitan Asylums Board at St. Margaret's Hospital, Kentish Town, is now available for the after care of patients who have received treatment for surgical Tuberculosis in the Board's institutions. 42 Report of the Medical Officer of Health. 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. 27 patients received dental treatment and nine of these were supplied with dentures. The attendances at the dentist totalled 82. The amount expended on dental treatment during the year was £11 ls. 6d., while the cost of dentures supplied to patients was £46 13s. 6d. 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 90 patients have been granted extra nourishment under the scheme at a cost of £98 14s. 11d. The scheme has been found to be of great help in the treatment of the types of patient mentioned above. Open Air Shelters.—Owing to the great demand for the three shelters owned by the Borough Council, approval was obtained for the purchase of two additional shelters. Details of Work during 1925.—Table XXIII. 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. Tuberculosis Dispensaries. 43 TABLE XXIII. 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. 12 387 399 159 15 203 21 1 F. 11 442 453 133 11 289 20 — Children under 15 M. 2 242 244 2 17 216 9 — F. 6 210 216 7 9 197 3 — Total 31 1281 1312 301 52 905 53 1 (b.) "Contacts" (included in (a.) ). Adults M. — 66 66 10 — 56 — — F. — 98 98 6 — 92 — — Children under 15 M. – 105 105 — 1 104 — — F. 1 101 102 2 1 99 — — (c.) Insured persons ( included in (a.)). M. 11 273 284 110 9 145 19 1 F. 4 192 196 66 8 111 10 1 44 Report of the Medical Officer of Health. Table XXIV. gives further details of the year's work. TABLE XXIV. 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December, 1925 1272 2. Total number of attendances of patients at the Dispensary during the year:— Insured 3058 Uninsured 3486 3. Number of complete examinations of patients made 4034 4. Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 91 5. Number of cases in which the period of observation at the Dispensary exceeded two months 51 6. Number of insured patients under domiciliary treatment on December 31st 431 7. Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment during the year 87 8. Number of persons referred to affiliated hospital for consultation 34 9. Number of consultations with medical practitioners at the homes of patients:— Insured Uninsured 39 54 10. Number of other visits paid by Tuberculosis Officers to the homes of patients 321 11. Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 5153 12. Number of specimens of sputum examined in connection with the work of the Dispensary 1711 13. Number of written reports made 5893 Table XXV. gives the numbers of new cases living in each of the five sub-districts, and shows on whose recommendation they made their first attendance. Tuberculosis Dispensaries. 45 TABLE XXV. Clapham. Putney. Streatham. Tooting. Wandsworth. Outside Borough. Totals. Public Health Department 58 44 115 128 141 486 Private Practitioners 69 29 104 84 172 — 458 Charitable Societies — — 1 — 5 — 6 Other Dispensaries 7 1 4 3 3 — 18 L.C.C. Schools 3 1 7 7 7 — 25 Ministry of Pensions 11 5 6 1 3 — 26 Existing Dispensary Patients 7 6 28 37 16 94 Other Sources 18 10 21 27 90 2 168 Total 173 96 286 287 437 2 1281 TABLE XXVI. Particulars relating to Discharged Soldiers attending at the Dispensaries. New Cases. Old Cases. Total Attendances. Tuberculous 18 84 568 Non-Tuberculous 8 5 23 Totals 26 89 591 458 visits were made by the Dispensary Nurses in connection with these cases during the year. Contacts.—Of the 1,281 new cases examined, 370 were contacts. 20 of these were found to be suffering from Tuberculosis. 46 Report of the Medical Officer of Health. Bacteriological Examinations.—Below is shown the number of such examinations of sputum made at the Dispensary 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. 1921 1054 10 247 1922 1310 484 260 1923 1720 722 384 1924 1789 1013 437 1925 1711 1066 384 In addition, a considerable amount of chemical and bacteriological work is done at the Dispensary. 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, W. Farrar and J. Keall. The Tuberculosis Officers, and Tuberculosis Visitors, assist the Committee to the fullest possible extent and attend their meetings. Mrs. Dixon, on ceasing to represent the Borough Council on the Committee, was elected as a co-opted member. The following agencies, public and charitable, are represented:— L.C.C. School Medical Service Board of Guardians. British Red Cross Society. Soldiers and Sailors Help Assn. London Insurance Committee. United Services Fund. War Pensions Committee. Charity Organisation Society. Invalid Children's Aid Assn. Ranyard Nurses' Association. Brompton Hospital. St. Thomas's Hospital. Several unattached members interested in Tuberculosis work are also co-opted. Tuberculosis Dispensaries. 47 The Officers of the Committee are:— Chairman: Councillor T. Harding. Vice-Chairman: Miss J. M. Duff. Hon. Secretary: Miss F. Walker. Hon. Joint Secretary: Mrs. Nicol. Hon. Treasurer: Mr. H. B. Harvey. In April, 1925, the Committee lost the services of Miss Joan Smith as Hon. Secretary. However, they were fortunate in obtaining the services of Miss F. Walker, who had previously filled that position for several years. Miss Walker's long experience in social welfare work is a great asset to the Committee, and her appointment as Hon. Secretary was duly approved. Meetings.—The Committee meet at 174, East Hill, on alternate Friday afternoons 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. (c.) Provision of open air shelters. (Five 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. (f.) 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 48 Report of the Medical Officer of Health. 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 456 patients (adults and children), the amount collected and remitted to the London County Council being £723 6s. 1d. The amounts of such assessments are subject to the approval of the County Council. In addition to the patients visited by the Tuberculosis Visitors, 29 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. 64 of these cases have been visited regularly during the year, and such visits are greatly appreciated by the patients. Articles of clothing have been supplied to patients in need of it; especially to the patients about to enter residential institutions. Further efforts were made during the year to raise funds for the maintenance of beds for advanced cases of Tuberculosis at St. Columba's Hospital, Hampstead. Through the instrumentality of Mrs. Nicol, the "Streatham New Players" Amateur Dramatic Society gave performances at the Congregational Church Hall, Streatham, and the amount of money raised by this means was £163. A Fete arranged by Streatham Park Lawn Tennis Club realised £17 4s. 7d. A variety of entertainments given by the Novices Society of St. Mary Magdalene Church, Wandsworth Common, contributed £30 8s. 6d. The proceeds of a concert given by the East Hill Congregational Church Orchestral Society amounted to £9 1s. 3d.; and a Jumble Sale realised £12. As there is often 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, Tuberculosis Dispensaries. 49 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 £294 12s. Of these 17 patients admitted to St. Columba's Hospital, eight died, five were transferred to other institutions in an improved condition, two returned home, while two were still in Hospital at the end of the year. By means of the same voluntary fund nine patients were given treatment at the Hahnemann Home, Bournemouth, and other Convalescent Homes. The average period of convalescent treatment granted was 11 weeks. E 50 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, Whooping Cough and Ophthalmia Neonatorum are visited on notification, as well as all known cases of Measles, 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 Maternity and Child Welfare. 51 mittee meetings. They also pay periodical visits to the Creches and homes for unmarried mothers and children. Table XXVII. 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. Table XXVIII. shows the work of the Health Visitors during 1925, compared with the previous five years. e 2 52 Report of the Medical Officer of Health. TABLE XXVII. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Visits. Revisits. No. of Visits to: Infants under 1 year 1149 386 723 600 615 1585 5058 5728 Children: 1—2 years 13 — 3 22 3 2 43 1587 2—5 years 12 — — 25 1 1 39 1505 Puerperal Fever — 2 3 2 1 3 11 6 Ophthalmia Neonatorum 10 4 8 6 7 13 48 49 Pneumonia — — 1 3 — 4 8 7 Whooping Cough 207 150 105 171 117 566 1316 170 Measles 49 3 16 71 16 30 185 3 Diarrhoea 1 1 4 1 5 5 17 2 Ante-natal visits 230 28 103 97 64 171 693 417 Supply of milk 2 20 4 10 1 42 79 — Miscellaneous 106 41 57 121 46 93 464 — Ineffectual 684 355 435 718 348 911 3451 — Total visits 2463 990 1462 1847 1224 3426 11412 — Re-visits in each sub-district 2209 660 1730 1558 597 2720 — 9474 Attendances at Welfare Centres 146 173 124 143 168 207 961 Attendances at Ante-natal Centres 13 30 54 41 56 58 252 — Health talks to mothers 52 20 33 56 58 34 253 — Visit to Creches — 16 32 — 46 28 122 — Committee meetings 1 15 — — 33 5 54 — Total 212 254 243 240 361 332 1642 — 53 Maternity and Child Welfare. TABLE XXVIII. 1920 1921 1922 1923 1924 1925 No. of Visits to : Infants under 1 year 5211 4760 4521 4227 4323 5058 Children : 1—2 years 149 179 169 119 72 43 2—5 years 298 151 145 94 76 39 Puerperal Fever 60 29 35 22 29 11 Ophthalmia Neonatorum 80 80 56 64 52 48 Pneumonia 82 58 159 31 21 8 Whooping Cough 356 467 444 650 675 1316 Measles 415 126 380 237 1060 185 Diarrhœa 14 41 5 11 10 17 Ante-natal visits 206 491 582 669 867 693 Supply of milk 3087 775 398 247 175 79 Miscellaneous 476 591 623 828 630 464 Ineffectual 2157 3019 2640 2393 2531 3451 Total visits 12591 10767 10157 9592 10521 11412 Attendances at Welfare Centres 516 626 620 608 673 961 Attendances at Ante-natal Centres 151 168 178 175 190 252 Health talks to mothers 119 138 153 163 141 253 Visits to Creches 124 169 132 117 97 122 Committee meettings 137 149 89 67 53 54 Total 1047 1250 1172 1130 1154 1642 54 Report of the Medical Officer of Health. Infant Visiting. There were 4,881 births during the year and 3,961 of these, or 81.1 per cent., were visited, compared with 79.9 in 1924, 77.1 in 1923, 81.1 in 1922, and 77.2 in 1921. Table XXIX. gives the particulars of the method of feeding of infants on the occasion of the initial visit and when revisited. Of 3,961 infants visited for the first time, 3,394 were entirely breast-fed, while 194 were fed partly on the breast and partly by other methods, and 373 were entirely bottle-fed. On revisiting 2,390 infants were found to be fed entirely on the breast, 829 were partially breast-fed, and 1,367 were fed artificially. TABLE XXIX. Clapham North. Clapham South. Putney. Balham. Streatham. Tooting. Southfield. Fairfield. Springfield. Borough. Infants visited 438 524 305 565 466 498 337 291 537 3961 Breast-fed 354 482 260 483 358 405 310 270 472 3394 Otherwise fed 84 42 45 82 108 93 27 21 65 567 Re-visits to infants 442 446 275 641 817 251 607 598 509 4586 Breast-fed 263 243 134 352 288 86 411 403 210 2390 Otherwise fed 179 203 141 289 529 165 196 195 299 2196 74 of the infants visited were born prematurely, and 41 were delicate from birth. The visits included 86 children who were born as twins and three cases of triplets. 55 Maternity and Child Welfare. It was found that in 1,478 of the births doctors had been in attendance, while in 1,461 the services of midwives had been utilised. 798 infants were born in hospitals and other institutions, and 223 in the Council's Maternity Home. One mother employed an unregistered woman. 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 Is. 3d. per visit. 121 cases were visited during the year under these arrangements, and 2,247 visits were made to them as shown in Table XXX. TABLE XXX. No. of cases. No. of visits. Whooping Cough 10 119 Influenza 19 [186 Pneumonia 85 1666 Ophthalmia Neonatorum 6 268 Measles 1 8 Total 121 2247 56 The number of visits made by nurses in 1924 was 4,360, and the fall is due to the decrease in the number of cases of Pneumonia. 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. It has been found necessary to hold a weekly session for infants, instead of one every fortnight, at the Branch Centre at Tooting, which is held at Lynwood Hall, Lynwood Road. The Putney Park Centre severed its connection with the main Centre at Putney during the year, and is now a full Centre. Report of the Medical Officer of Health. The following is a list of the Welfare Centres in the Borough, together with the hours at which the clinics are held :■— Maternity and Child Welfare. 57 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 Wednesdays in each month at 10.30 a.m. Wednesdays at 2 p.m. and Thursdays at 2.45 p.m. Putney Park : Putney Park House, Dover House Rd. None. Fridays at 2 p.m. Balham : 91, Bedford Hill. 1st and 3rd Fridays in each month at 10.30 a.m. Wednesdays and Thursdays at 2 to 3.30 p.m. Tuesdays and Fridays, at 1.30 to 3.30 p.m. Streatham : 37, Riggindale Road. 1st, 3rd and 5thWednesdays in each month at 10 a.m. Tooting : Fairlight Hall, Fairlight Road. 1st, 3rd and 5thWednesdays in each month at 10 a.m. Wednesdays and Thursdays at 2 to 3.30 p.m. Thursdays at 10.15 a.m. Church Hall, Lynwood Road. 2nd and 4th Wednesdays at 10.15 a.m. Southfields : 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 1925 was 2,401, compared with 2,360 for the previous year, and the total attendances were 43,080. The number of visits paid by the Superintendents to infants decreased from 13,213 in 1924, to 12,977 in 1925. Eight of the 10 Centres have ante-natal clinics and 629 cases were examined at these clinics, compared with 763 in 1924. The following Tables give full particulars of the work at each Centre during the year. 58 TABLE XXXI. Clapham. Putney. Putney Park. Balham. Streatham. Tooting. Southfield. Fairfield. Springfield. Totals. Fairlight Lynwood Road New Cases, 1925 414 165 63 396 353 267 127 173 195 248 2401 Transfers to other Centres 14 10 — 49 39 5 2 — 5 15 139 Passed on to L.C.C. 480 — — 241 40 320 — — 26 315 1422 Total Attendances 7173 3827 1487 7277 5881 5682 1954 3340 3075 3384 43080 Ante-natal Cases 50 70 — 114 63 123 49 42 26 92 629 Ante-natal Attendances 146 215 — 478 220 253 199 172 — 217 1900 Nurses' Visits to Infants 1453 1369 503 2263 1196 2395 — 1111 762 1625 12677 Nurses' Visits to Ante-natal Cases 123 225 — 445 59 46 — 107 103 166 1274 No. of Sessions :— Infants 98 88 50 100 96 98 42 50 50 50 722 Ante-natal 12 25 — 42 27 23 23 24 — 24 200 Health Talks given 58 26 37 91 52 58 12 25 30 50 439 Report of the Medical Officer of Health. 59 Maternity and Child Welfare. 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. 122 inspections of the creches were made during the year by the Health Visitors. The attendances were:—Putney, 5,004; Balham, 5,516; Tooting, 4,640; and Wandsworth, 5,667; a total of 20,827, compared with 22,732 in 1924. Wandsworth Borough Memorial Maternity Home. The following Table shows the number of admissions to the Home for the years 1921 to 1925, and the districts from which the cases were admitted. 60 Report of the Medical Officer of Health. The figures of admission during 1925 are low as the Home was closed in June in consequence of the occurrence of cases of breast abscess. TABLE XXXII. Districts. 1921. 1922. 1923. 1924. 1925. Clapham 20 39 52 56 8 Putney 18 13 25 34 12 Balham 99 110 140 119 65 Streatham 34 41 38 48 24 Tooting 60 71 77 68 28 Wandsworth 95 116 120 111 61 Whole Borough 332 390 452 436 198 Outside the Borough 9 8 — 36 15 Total admitted 341 398 452 472 213 The full particulars of the work of the Home during 1925 are as follows Total number of cases admitted 213 Average duration of stay 15.09 days Number of cases delivered by :— (a.) Midwives 194 (b.) Doctors 19 Number of cases in which medical assistance was sought by the midwife 68 (a.) Ante-natal 12 Albuminuria 3 Contracted pelvis 7 Hæmorrhage 1 No fœtal heart sounds 1 61 Maternity and Child Welfare. (b.) During labour 28 Prolonged labour 12 Laceration 12 Adherent placenta 3 Retained placenta 1 (c.) After labour 16 Rise of temperature 13 Haemorrhage 2 General weakness 1 (d.) For infant 12 Feebleness 8 Ophthalmia Neonatorum 2 Rise of temperature 1 Swelling on shoulder 1 Number of cases of puerperal sepsis Nil Number of cases in which temperature rose above 100.4 for 24 hours with rise of pulse rate 13 Number of cases of ophthalmia neonatorum 3 Number of cases of " inflammation of the eyes," however slight 4 Number of infants not entirely breast fed while in the Institution 26 Number of maternal deaths with causes Nil Number of fœtal deaths 8 Still births 2 Within 10 days of birth 6 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. 62 Report of the Medical Officer of Health. 104 infants were admitted in 1925, 56 from addresses in the Borough and 48 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 26 mothers were sent to Convalescent Homes, 24 of them taking their infants with them. Ten other children were also sent. Both mothers and children derived much benefit from the change of air. 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, and is now being operated in accordance with the provisions laid down by the Ministry of Health in Circular 185, dated March, 1921. During the year 712 families were supplied with milk under the above scheme :—160 in Clapham, 51 in Putney, 136 in Balham, 79 in Streatham, 86 in Tooting, 37 in Southfield, 79 in Fair- 63 Maternity and Child Welfare. field and 84 in Springfield. The total cost to the Council was £1,756 18s. 1d. 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 qf 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. 134 cases availed themselves of these facilities during the year, 108 being women, and 24 children, and 305 attendances were made. These arrangements for dental treatment are now similar to those for cases of Tuberculosis. 64 SANITARY INSPECTION OF THE BOROUGH. The Sanitary inspection of the Borough is being carried out in accordance with the arrangements mentioned in last year's Annual Report. Table XXXIII. 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 1,770, and of these 545 were found to be in a defective condition. The drains of 90 houses were re-constructed. Damp conditions have been remedied in 756 premises, and in 150 of these damp courses were inserted. 11 privies and earth closets are known to be in existence in the Borough and all of these are in connection with tennis grounds. No conversions to water carriage system were carried out during the year. It will be seen from this Table that 24 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. 65 Sanitary Inspection of the Borough. TABLE XXXIII. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 1. Premises cleansed and repaired 439 240 566 387 575 1410 3617 2. Drains tested 166 121 153 357 131 842 1770 3. Drains cleansed or repaired 69 32 62 65 99 218 545 4. Water closets cleansed or repaired 152 116 308 116 160 450 1302 5. Soil pipes repaired 19 2 8 7 10 39 85 6. Waste pipes altered or repaired 48 29 49 21 45 182 374 7. Rainwater pipes repaired 73 20 36 45 39 122 335 8. Roof and gutters repaired 265 80 163 146 185 581 1420 9. Damp courses inserted 16 11 6 49 7 61 150 10. Damp conditions otherwise remedied 94 75 50 176 78 283 756 11. Yards drained or paved 52 25 66 43 82 351 619 12. Dust bins provided or repaired 151 78 140 190 131 414 1104 13. Water cisterns cleansed, covered or repaired 41 23 13 17 5 140 239 14. Water supply reinstated 15 15 4 6 5 32 77 15. Defective fireplaces remedied 38 27 46 33 37 225 406 16. Defective coppers remedied 24 6 42 15 21 121 229 17. Cases of overcrowding abated 4 1 1 4 5 9 24 18. Stables and stable yards drained or paved 1 10 5 2 10 28 19. Accumulations of manure, etc., removed 38 5 21 28 5 27 124 20. Urinals cleansed or repaired 13 1 3 — 2 1 20 21. Animals improperly kept 3 - 5 7 3 12 30 22. Smoke nuisances 1 — 1 6 1 19 28 23. Other nuisances 111 49 15 34 40 238 487 Total 1833 956 1768 1757 1668 5787 13769 No of preliminary notices served 779 369 747 787 851 2159 5692 No. of preliminary notices complied with without the service of statutory notices 668 325 670 647 787 1816 4913 No. of statutory notices served 106 13 77 121 50 223 590 No. of statutory notices complied with 85 11 99 110 38 193 536 F 66 Report of the Medical Officer of Health. Table XXXIV. gives full details of the inspections carried out by the District Inspectors. TABLE XXXIV. Inspections. ReIn spections. Total. To investigate complaints 5948 15263 21211 House-to-house inspections 1820 6032 7852 Infective Diseases :— Notifiable diseases 2093 1532 3625 Measles 501 34 535 Whooping Cough 800 27 827 Other infective diseases 294 15 309 Verminous conditions 206 20 226 Bakehouses No. of Premises 129 270 177 447 Offensive Trades 3 104 3 107 Piggeries 20 125 9 134 Factories, workshops, etc. 2101 2176 43 2219 Houses let in lodgings 294 278 563 841 Rag and bone stores 26 50 12 62 Sanitary conveniences 162 717 23 740 Mews and stables 189 587 29 616 Other inspections 3674 228 3902 Total Inspections 19643 24010 43653 Smoke observations 66 — 66* Legal proceedings. Attendances at Court 47 — 47 67 Sanitary Inspection of the Borough. Underground Rooms. There are 23 underground rooms in illegal occupation at the present time and notices have been served, but owing to the difficulty of other accommodation being obtained for the occupiers, no further action can be taken in the meanwhile. Housing, Act. 1905. All house-to-house inspections under the Public Health (London) Act, 1891, are carried out as if these were inspections under Part IV. of the Housing Consolidated Regulations, 1925, 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 XXXV. 1,820 inspections were made, compared with 1,672 in 1924, and nuisances were found in 1,527 of the houses, necessitatin the service of sanitary notices. TABLE XXXV. 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 40 40 27 55 25 12 Clapham South 59 52 6 6 15 41 Putney 113 45 3 10 41 66 Streatham 225 202 28 70 245 99 Balham 330 289 85 181 308 179 Tooting 312 241 6 8 11 345 Southfield 172 165 40 29 110 81 Fairfield 99 98 33 21 37 58 Springfield 470 395 118 120 406 251 Whole Borough 1820 1527 346 500 1198 1132 F 2 68 Report of the Medical Officer of Health. Rent and Mortgage Interest Restrictions Act, 1923. 80 applications for Certificates were received during the year. On inspection it was found that 79 of the premises were not reasonably fit for human habitation, and one was reasonably fit. Of the 79 premises not reasonably fit, seven 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 72 premises in respect of which Certificates were granted, 66 were rendered reasonably fit during the year, and the remaining six are in hand. 69 FACTORIES AND WORKSHOPS. The number of factories, workshops, workplaces and homeworker's premises is shown in Table XXXVI., together with the number of inspections made. The inspection of food premises are not included in this Table, but are shown in Table XL. TABLE XXXVI. Class of Works. Number of Places on Register at end of 1925. Number of Inspections, 1925. Number of Notices 1925. Number of Prosecutions, 1925. Factories : — Factory Laundries 64 66 2 — Factory Bakehouses 72 204 2 — Other Factories 425 444 23 — Total 561 714 27 — Workshops :— Workshop Laundries 43 62 16 — Workshop Bakehouses 57 243 1 — Other Workshops 927 945 44 — Total 1027 1250 61 — Workplaces 273 285 18 — Total: Factories, Workshops and Workplaces 1861 2249 106 — Home-workers' premises 369 417 26 — Grand Total 2230 2666 132 — Further details with regard to homeworkers' premises are given in Table XXXVII. 70 Report of the Medical Officer of Health. TABLE XXXVII. 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. 52 57 213 31 26 26 17 (2.) Cleaning and washing 2 6 3 - — — — Paper bags and boxes 2 — 4 - — — — Carding, etc., of buttons, etc. 1 — 2 — — — — Totals 57 63 222 31 26 26 17 The total number of addresses received from other Councils was 607, and 143 addresses were forwarded to other Councils. The number of addresses received has increased by 16, and the number sent decreased by 13. 20 names and addresses were forwarded to this Borough in error. The number of notices sent to employers during the year was 31, and these had a most satisfactory result. During the year 17 cases of infective diseases—two of Scarlet Fever, two of Diphtheria, four of Measles, one of Chicken-pox, and eight 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. 71 Factories and Workshops. TABLE XXXVIII. DETAILS WITH REGARD TO REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. Workshop Bakehouses 57 Workshop Laundries 43 Dressmakers' and Milliners' Workshops 136 Bootmakers 96 Smiths and Engineers 59 Builders 46 Tailors 71 Motor Engineers 40 Other 479 Total number of workshops on Register 1027 TABLE XXXIX. 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 50 49 — - Want of ventilation - - — - Overcrowding 3 3 — - Want of drainage of floors — — — - Other nuisances 65 65 — - Sanitary accommodation: Insufficient 1 - - - Unsuitable or defective 36 36 — - Not separate for sexes 1 1 — - 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 156 154 — — * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 72 FOOD AND FOOD PREMISES. The whole of the work in connection with Food and the inspection of Food Premises is now carried out by three inspectors. Mr. T. Newell was appointed in May, 1925, Chief Inspector of the Food and Drugs Department, and he is responsible for all the work in connection with the taking of samples and other duties under the Sale of Food and Drugs Acts. He also supervises the work of the other two inspectors, each of whom is responsible for the inspection of food premises in one-half of the Borough. The third inspector was appointed in 1925 as an Assistant Sanitary Inspector, owing to the extra duties involved when the Public Health (Meat) Regulations came into force. 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 XL. Premises. Number of Places on the Register at end of 1925. Number of inspections, 1925. Number of Notices, 1925. Nunber of prosecutions. 1925. Dairies, milkshops and cowsheds 252 637 - - Restaurant kitchens 232 390 — — Ice cream premises 330 487 — — Slaughter-houses 8 270 — — Butcher's shops 239 629 — — Greengrocers' shops 325 397 1 — Fishmonger's shops 125 276 — — Fried fish shops 79 200 — — Markets and Stalls 49 3430 — — Other premises where food is prepared for sale 27 201 — — Total 1672 6917 1 — 73 Food and Food Premises. 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 3.59 per cent., compared with 3.65 per cent. in 1924. There are at present 252 milk retailers and one cowshed on the register, and these have been inspected regularly during the year, the details being given in Table XL. Meat. There are no public abattoirs in this Borough, but eight private slaughterhouses are now in use. The Public Health (Meat) Regulations, 1924, came into force on the 1st April and are being operated. The Inspectors attended the slaughterhouses at the time of slaughtering on numerous occasions. During the year 271 visits were made and 1,603 carcases examined. All these carcases were sound. No application has been received for the marking of meat. The meat on sale in the butcher's shops has also been inspected regularly. 629 visits being made for this purpose. The Public Health (Imported Food) Regulations, 1925, came into operation on June 1st, 1925, but no incident calling for action under these Regulations has arisen during the year. Unsound Food. 1 box of plaice; 3 boxes of dabs; 4 cases of dogfish; 1 box of haddock; 5 boxes of kippers; 182 lbs. of soles; 129 lbs. of mixed fish; 7 lbs. of prawns; 1 box of skate; 1 box of skate wing; 3 boxes of cod; 4 boxes of fish roes; 260 tins of condensed milk; 1 crate of bananas; 1 box and 30 lbs of apples; 14 boxes of plums; 4 crates of apricots; 13 boxes of tomatoes; and 20 lbs. of beef were condemned at the request of the owners, and the usual certificates granted. Prosecutions in connection with Food. There were no prosecutions during the year in respect of the sale of food, other than for adulteration. 74 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 official samples, while 1,000 were purchased unofficially as test or informal samples. 36, or 3.6 per cent. of the official samples and 28 or 2.8 per cent of the unofficial samples were found to be adulterated or not up to standard. The total adulterations reported were 64, or 3.2 per cent. of the samples submitted. Proceedings were instituted against the vendors of seven of the 36 samples taken officially. The total amount received in penalties under the Sale of Food and Drugs Acts during the year amounted to £5, and the costs to £4 14s. 6d., making a total of £9 14s. 6rl. Table XLI. shows the total number of samples analysed, the number adulterated, and the percentage of adulteration for the last five years. Report of the Medical Officer of Health. TABLE XLI. Year. Number analysed. Number adulterated. Percentage of adulteration. 1921 1954 142 7-2 1922 1989 102 5-1 1923 • .. 2000 112 5-6 1924 2000 91 4-5 1925 2000 64 3-2 75 Food and Food Premises. TABLE XLII. RESULT OF ANALYSIS OF CERTAIN ARTICLES UNDER THE SALE OF FOOD AND DRUGS ACTS, DURING 1925, SHOWING THE PERCENTAGE ADULTERATED COMPARED WITH 1921, 1922, 1923, AND 1921. Percentage of Samples adulterated, 1921-1921. No. of samples, 1925. 1921. 1922. 1923. 1924. Examined. Found adulterated or not up to standard Percentage adulterated Bread — — — — 6 — — Butter — 2.6 1.3 0.6 401 7 1.7 Cheese — — — - — — — Cocoa — — 4.3 — 12 — — Coffee — 2.2 — — 37 2 5.4 Confectionery and Jam - - - - - - Cream and Preserved Cream 53.0 13.3 18.5 13.6 33 — — Flour — — — — 6 — — Self-raising Flour — — — — 6 — — Margarine 15.0 6.2 — — 30 — — Milk 51 2.8 3.6 3.7 990 28 2.8 Separated Milk 6.0 - — — — — — Condensed Milk — - — — 24 — — Dried Milk — - 6.6 — 5 — — Mustard — — — — 6 — — Sugar — — 3.4 — — — — Tea — — — — 16 — — Vinegar 83.0 7.1 42.8 — 24 1 4.1 Spirits — — — — 7 — — Drugs 9.1 20.1 130 14.7 88 4 4.5 Other Articles 14.0 12.4 11.6 1.0 309 22 7.1 All Articles 7.2 51 5.5 4.55 2000 64 3.2 76 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 of adulteration :— TABLE XLIII. Informal Samples. Formal Samples. Total. Number taken. Adulterated. Percentage adulterated. Number taken. Adulterated. Percentage adulterated. Number taken. Number per 1,000 of population. Adulterated. Percentage adulterated. Clapham 170 5 2.9 192 5 2.6 362 5.7 10 2.7 Putney 92 2 1.7 98 3 3 0 190 6 0 5 2.6 Streatham 289 8 2.7 290 10 3.4 579 5.2 18 31 Tooting 143 3 2.1 103 7 6.8 246 6.1 10 4.0 Wandsworth 300 10 3.2 317 11 3.4 623 6.2 21 3.3 Whole Borough 1000 28 2.8 1000 36 3.6 2000 5.8 64 3.2 Milk. The following samples of milk were submitted for analysis :— 090 of whole new milk. 5 of dried milk. 24 of condensed milk. Of these 28 were reported against as being adulterated or not up to Legal Standard. 22 contained extraneous water; six were deficient in fat. Proceedings were taken in six cases, and in 22 cases the Public Health Committee, after considering the amount of adulteration and the circumstances of the sale, decided not to prosecute the vendors, but to take further samples. 77 Food and Food Premises. Milk (Special Designations) Order, 1922 and 1923. This Order came into operation on the 1st July, 1923, and provides for issue of licences for the production and sale of milk of different grades. Licences were granted for the sale of Designated Milks as under :— Grade. 1923. 1924. 1925. Certified 20 31 52 Grade A (Tuberculin Tested) 2 16 25 Grade A - 13 19 Pasteurised 6 14 20 Samples of milk are procured in order to ascertain whether the bacteriological standard is being maintained, and the following Table shows the results of the examinations conducted during the last three years. TABLE XLIV. Grades. 1923. 1924. 1925. Samples taken. Reported against, Percentage reported against. Samples taken. Reported against. Percentage reported against. Samples taken. Reported against. Percentage reported against. Certified 20 6 30.0 26 2 7.6 50 29 58.0 Grade A (Tuberculin tested) 1 4 1 25.0 9 8 88.8 Grade A — — — 8 1 12.5 10 5 50.0 Pasteurised 6 — 21 3 14.2 15 9 60.0 Total No. of samples examined 27 6 22.0 59 7 11.8 84 51 60.7 78 Report of the Medical Officer of Health. 22 samples of milk were taken on delivery at various public institutions situated within the Borough. All of these samples were genuine. 67 samples were procured whilst in transit from the farmer to the retailer, the samples being taken when the milk arrived at various railway stations within the Borough, both at midnight and mid-day deliveries. One of these samples was reported against. Two samples of milk were procured in the early morning from wholesale dealers during delivery to the retailer, and five samples were taken on delivery at private houses These seven samples were genuine. 240 samples have been taken on Sundays, either in the early morning or at mid-day. Six, or 2.5 per cent. were reported as adulterated. 506 samples were taken from milk vendors in the street during the early morning (5 to 7 a.m.) on week days, 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 and 1917. 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 1019 Nil. Cream 28 2 The two samples of Cream contained crystallised boric acid. The vendors were warned, and further samples were taken and found correct. 2. Cream sold as Preserved Cream. Instances in which samples have been submitted for analysis to ascertain if the statement on the label as to preservatives was correct:— 79 Food and Food Premises. (1.) Correct statements made 5 (2.) Statements incorrect 0 5 " Crystallised Boric Acid " was the only preservative found. Determination of milk fat in Cream sold as "Preserved Cream " :— (1.) Above 35 per cent. 5 (2.) Below 35 per cent. 0 Total 5 In each of these samples the provisions as to labelling were duly observed and no thickening substances were found in any of the samples. Butter and Margarine. 401 samples of butter were submitted for analysis during the year, and of these seven, or 1.7 per cent. were reported against. 30 samples of margarine were submitted for analysis and all were reported genuine. Other Articles. 12 samples of apples were examined for the presence of arsenic and 10 of them were found to contain a small quantity of this substance. The Public Analyst reports specially on this matter in his Annual Report on page 101 of this Report. Further samples have been taken in 1926 and will be reported on in that year. Bacteriological Examination of Milk. 24 samples of milk were examined under Section 5 of the Milk and Dairies (Amendment) Act, 1922, and the Bacteriologist certified that one sample of "Certified" Milk contained Tubercle Bacilli. The facts were reported to the Ministry of Health. During the last three years the results of the examinations of milk for the presence of Tubercle Bacilli were as follows :— 80 Report of the Medical Officer of Health. Year. Number examined. Number reported against. 1923 17 — 1924 26 2 1925 24 1 The results of these examinations show that it is difficult to treat milk so that the standard of bacteriological purity laid down in the Order can be obtained. It will be seen that of the 50 samples of "Certified" Milk examined in 1925 no less than 29 or 58 per cent, were reported against, while eight out of nine samples of "Grade A. (Tuberculin Tested) "Milk contained excessive numbers of bacteria. The other grades were equally unsatisfactory. The Minister of Health was notified of the result of each sample taken and sent Inspectors to the farms at which the milk was produced. The Council's Food Inspectors also assisted the local dealers in endeavouring to trace the reason that so many samples were reported against, new methods of cleansing bottles and utensils were adopted and the sterilisers overhauled. This had the effect of producing better results. During the year 17 samples of ordinary milk were examined bacteriologically. Eight of these were procured at Hospitals and nine in course of transit to the retailer. Three were reported as containing an excessive number of bacteria. 81 MISCELLANEOUS. Bacteriological Examinations. During the year 2,395 bacteriological examinations were made at the Lister Institute. The following Table shows the number of examinations in each sub-district and for the whole Borough, also the disease for which the examination was made, and the result of such exam ination. TABLE XLV. Clapham. Putney. Balham. Streatha,m. . Tooting. Wandsworth. Whole Borough. Diphtheria:— Negative 393 163 190 239 214 731 1930 Positive 73 33 21 70 53 140 390 Enteric Fever:— Blood: Negative 1 4 5 17 2 2 31 Positive — 1 1 11 — 1 14 Faces and Urine: Negative — — — 8 — — 8 Positive — — — 1 — — 1 Tuberculosis:— Negative 2 3 1 2 2 5 15 Positive 2 — 1 1 1 1 6 Total 471 204 219 349 272 880 2395 Examinations of Sputum made at the Tuberculosis Dispensary are not included in the above figures. G 82 Report of the Medical Officer of Health. Disinfection. The total number of rooms disinfected after the occurrence of cases of infectious disease was 3,387:—476 in Clapham, 276 in Putney, 550 in Balham, 518 in Streatham, 465 in Tooting, and 1,102 in Wandsworth. Three public and three private elementary schools were also disinfected for infectious diseases. Cleansing of Persons Act. The names of 104 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 73 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. 20 adults were given baths at the Council's Disinfecting Station on account of suffering from Scabies. Flies and Mosquitoes. During the summer months certain ponds, streams and areas of stagnant water were treated by spraying with paraffin, with the object of destroying the larvse of mosquitoes. Owners of land abutting on the River Wandle co-operated in this work by cutting down rank vegetation which overhung the banks of the River and favoured the breeding of these insects. Chloride of lime was used for sprinkling horse manure in order to destroy the larvae and pupse of flies. A total of £10 15s. 9d. was spent in materials used in work of this nature. The work in connection with the eradication of crickets at the Council's Destructor referred to in last year's Report was continued during the year and large numbers of these insects were destroyed. As a result of this work a great improvement has been effected. Miscellaneous. 83 Statement of Work done under the Rag Flock Act, 1911. 20 visits to workshops were made by the Inspector, and the materials used for bedding and upholstery were examined. 10 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. 10 certificates have been issued in respect of the sterilisation of materials used in the manufacture of rag flock for export. Water Supply—Cutting-off Notices. During the year, 71 notices with respect to 79 premises were received from the Water Board, stating that the supply had been withdrawn. In 51 premises the water supply was cut off for non-payment of rates, in 11 in consequence of defects to the supply service, and in 17 because the premises were empty. Mortuaries. The Mortuaries in Clapham, Streatham and Wandsworth have been visited several times during the year, and the Byelaws and Regulations have been carried out in a satisfactory manner. In Clapham, seven bodies were removed to the Mortuary, in Streatham 12, and in Wandsworth 87, of which 40 were from Wandsworth, 23 from Putney, 16 from Tooting and eight from Battersea—a total of 106. Inspection of Sanitary Conveniences. The number of Sanitary Conveniences inspected was 162; 29 in Clapham, 20 in Putney, 10 in Balham, 31 in Streatham, 11 in Tooting and 61 in Wandsworth. 740 inspections were made during the year, and three notices, chiefly for cleansing, were served and complied with. G2 84 Report of the Medical Officer of Health. Ambulance Service. The Metropolitan Asylums Board provide a free ambulance service for the removal of cases of infectious disease, and for other cases on payment. The London County Council provide a free accident service, and has now arranged with the London Ambulance Service, the St. John's Ambulance Association and the British Red Cross Society for the conveyance of parturient women to maternity hospitals at any hour of the day or night. Removal and Collection of House Refuse. The method of removal and collection of refuse in the Borough is a combined system of mechanical and horse traction carried out by contract. The collecting wagons are hauled from house to house by horses, and when full are drawn up mechanically on to a motor carrier which takes the refuse to the place of disposal. An empty wagon is left to replace the full one. The Contractor has the use of the Council's Destructor, and about two-thirds of the refuse is dealt with at the Destructor where it is sorted and sifted. Part of the sifted refuse is removed and part is burnt in the Destructor furnace. The remaining third of the house refuse is taken down the Thames by barge from two riverside wharves in the Borough, and disposed of below Barking. 85 STAFF. Details of the staff of the Department in December, 1925, 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. Dr. Forrest devotes one-half of his time to general Public Health duties in the Department, and for the other half is employed as Tuberculosis Officer. Half of his salary ranks for grant under the Tuberculosis Scheme. Dr. MacDonnell devotes the whole of his time to duties in connection with Tuberculosis and the whole of his salary ranks for grant under that scheme. DISTRICT SANITARY INSPECTORS. Name. Date of Appointment. Certificates held. Sanitary Inspector. Meat and Food. Others. Sanitary Inspectors:— B. Nurcombe Sept. 1809 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. Yes — 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 — 86 Report of the Medical Officer of Health. FOOD AND DRUGS INSPECTORS. Name. Date of Appointment. Certificates held. Sanitary Inspector. Meat and Food. Others. Chief Inspector: T. Newell Mar., 1900 R. San. Inst. Yes Six Inspector: A. G. Patterson June, 1925 S.I. Exam. Bd. Yes — Asst. Inspector: E. V. Roots Nov., 1925 „ No — 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 ,, R. M. Watling May, 1922 No Yes Yes Yes ,, E. G. Hoare Aug., 1924 No No Yes Yes ,, I. M. Pullar Aug., 1924 Yes Yes No Yes „ P. L. Luff May, 1925 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 87 Staff. CLERICAL STAFF. Name. Date of Appointment. Appointment. Certificates held. *A. E. Cooper Nov., 1897 Senior First Class Clerk San. Insp. and four others. *F. Bray Oct., 1903 First Class Clerk San. Insp. and 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. Miss C. Wellings May, 1921 Second Class Clerk — †Miss H. G. Wright July, 1925 Third Class Clerk — *P. O'Grady Nov., 1925 „ — *R. H. Chandler Dec., 1925 „ — †Miss D. E. Kilsby Nov., 1925 „ — *L. L. Parrini May, 1923 Office Boy — *C. F. Standish July, 1924 Youth, Food and Drugs Dept. San. Insp. †Employed at the Tuberculosis Dispensaries. Disinfecting Station. *J. Bond, Engineer. Nine Disinfecting Attendants. Mortuaries. One whole-time and two part-time mortuary keepers. Miss E. B. Henderson, Health Visitor, resigned on the 30th May, after 5f years' service under the Council in that capacity. Mr. C. W. Idle, Sanitary Inspector, resigned on the 30th May, after 1½ years' service. Mr. A. G. Patterson was appointed as Sanitary Inspector in June. 88 Report of the Medical Officer of Health. Mr. L. H. Pearson, Third Class Clerk at the Tuberculosis Dispensary, resigned on the 30th September, after 5-J years' service. Mr. E. V. Roots was appointed as Assistant Sanitary Inspector in November. Miss D. E. Kilsby, Miss H. G. Wright, and Messrs. R. Chandler and P. O'Grady were appointed as Third Class Clerks in November. The services of the Staff at the Maternity Home have been dispensed with as the Home is now closed except the gardenerattendant, who is acting as caretaker of the building. 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. 89 HOUSING STATISTICS. Number of New Houses erected during the Year:— (a.) Total 925 (i.) By the Local Authority 41 (ii.) By other bodies or persons 884 [By the Borough Council since 1919 779 1. Unfit Dwelling Houses. (1.) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 11940 (2.) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 1820 (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 5692 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 4913 3. Action under Statutory Powers. A.—Proceedings under Section 3 of the Housing Act, 1925. (1.) Number of dwelling-houses in respect of which notices were served requiring repairs Nil 90 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 590 (2.) Number of dwelling-houses in which defects were remedied:— (a.) By owners 536 (b.) By Local Authority in default of owners Nil C.—Proceedings under Sections 11, 14, and 15 of the Housing Act, 1925. (1.) Number of representatives made with a view to the making of Closing Orders 1 (2.) Number of dwelling-houses in respect of which Closing Orders were made 2 (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 91 Police Court Proceedings. PARTICULARS OF PROCEEDINGS TAKEN UNDER PUBLIC HEALTH ACT. Premises. Offences. Result. Fine. Costs. s. d. s. d. 36, Wimbledon Road, Wandsworth Nuisances Summons withdrawn, the work having been done — — 2, Crichton Street, Clapham Ditto Order made for abatement of nuisances — 21 0 40, Nursery Street, Clapham Ditto Summons withdrawn Freeholder undertook to carry out the work — — 230, Cavendish Road, Balham Ditto Order made for abatament of nuisances — 5 0 50, Fernlea Road, Balham Ditto Convicted 20 0 — 42, Hazelhurst Road, Balham Ditto Order made for abatement of nuisances — 21 0 44, Hazelhurst Road, Balham Ditto Order made for abatement of nuisances — 21 0 Failing to provide dustbin Convicted 40 0 — 78, Blackshaw Road, Tooting Nuisances Summons withdrawn, work having been done — 2 0 92 Report of the Medical Officer of Health. PARTICULARS OF PROCEEDINGS TAKEN UNDER PUBLIC HEALTH ACT.—continued. Premises. Offences. Result. Fine. Costs. s. d. s. d. 53, Werter Road, Putney Absence of a proper and sufficient supply of water Order made for abatement of nuisances — 21 0 Non compliance with Order 100 0 42 0 Nuisances Order made for abatement of nuisances — 21 0 68a, Leigham Court Road Streatham Ditto Order made for abatement of nuisances — 21 0 Failing to provide dustbin Convicted 40 0 — 88, Earlsfield Road, Wandsworth Nuisances Order made for abatement of nuisances — 10 6 31, Union Road, Clapham Ditto Order made for abatement of nuisances — 5 0 17, Crealock Street, Wandsworth Ditto Order made for abatement of nuisances — 21 0 17a, Crealock Street, Wandsworth Contravention of By-laws (yard paving) Convicted 60 0 — 41, Dempster Road, Wandsworth Nuisances Order made for abatement of nuisances — 40 0 93 Police Court Proceedings. PARTICULARS OF PROCEEDINGS TAKEN UNDER PUBLIC HEALTH ACT.—continued. Premises. Offences. Result. Fine. Costs. s. d. s. d. Garratt Lane, Wandsworth Escape of offensive and noxious effluvium and vapour from works Dismissed on payment of costs 40 0 97, Gaskarth Road, Balham Nuisances Summons withdrawn, the work having been done — 21 0 14-26, Leverson Street, Streatham Ditto Summons dismissed, the work having been done — — 176, Garratt Lane, Wandsworth Absence of a proper and sufficient supply of water Order made for abatement of nuisance. — 21 0 133, Heath Road, Clapham Nuisances Summons withdrawn, the work having been done — 10 6 12, Mill Lane, Streatham Ditto Summons withdrawn, the work having been done — 42 0 £13 £196 0 94 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 and Gentlemen, Herewith we have pleasure in submitting our report of the work performed by us under the Sale of Food and Drugs Acts during the year 1925. In all 2,000 samples were submitted under the Acts, of which 1,000 were taken with the necessary formalities required by the Acts and 1,000 procured informally. Below will be found a statement showing the nature of the samples submitted, and the results of analysis :— GENERAL STATEMENT. Nature of Sample. Examined Adulterated. Formal. Informal. Total. Formal. Informal. Total. Bread — 6 6 — Butter 3 398 401 1 6 7 Cocoa — 12 12 — — — Coffee — 37 37 — — — Cream — 28 28 — 2 2 Cream, Preserved — 5 5 — — — Flour — 6 6 — — — Flour (Self raising) — 6 6 — — — Margarine — 30 30 — — — Milk 989 30 1019 28 — 28 Mustard — 6 6 — — — Tea — 16 16 — — — Vinegar — 24 24 — 1 1 Spirits — 7 7 — — — Drugs 1 87 88 1 3 4 Other Articles 7 302 309 6 16 22 Total 1000 1000 2000 36 28 64 Analysts' Annual Report. 95 Grouped above as "Milk" the following samples were submitted:— Nature of Sample. Examined Adulterated. Formal. Informal. Total. Formal. Informal. Total. Milk 989 1 990 28 — 28 Milk, condensed (Full Cream) — 6 6 — — — Milk, condensed (Machine Skimmed) — 18 18 — — — Milk, dried — 5 5 — — — Total 989 30 1019 28 — 28 The details of samples submitted under Drugs are given below:— DRUGS. Nature of Sample. Examined Adulterated. Formal. Informal. Total. Formal. Informal. Total. Borax, powdered — 19 19 — — — Camphorated Oil — 6 6 — — — Cream of Tartar — 9 9 — 1 1 Glauber Salts — 6 6 — — — Linseed, crushed — 1 1 — — — Ointment, sulphur — 6 6 — — — Ointment, zinc — 4 4 — 1 1 Powder, Gregory — 3 3 — — — Powder, Seidlitz. — 6 6 — — — Rochelle Salts 1 6 7 1 1 2 Sulphur, Liver of — 6 6 — — — Sulphur, Milk of — 12 12 — — — Tincture of Rhubarb — 3 3 — — — Total 1 87 88 1 3 4 96 Report of the Medical Officer of Health. Comprised under "Other Articles" the following samples were examined:— OTHER ARTICLES. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Almonds, ground — 2 2 — — — Apples 6 6 12 6 4 10 Baking Powder — 18 18 — — — Blanc Mange powder — 3 3 — — — Cake — 1 1 — — — Cake, Powder — 6 6 — — — Cakes, Sponge 1 6 7 — 1 1 Candied Peel — 3 3 — — — Currants — 3 3 — — — Custard Powder — 21 21 — — — Fat 1 1 — 1 1 Fish Paste — 3 3 — — — Ginger, ground — 14 14 — — — Honey — 19 19 — — — Ice Cream — 23 23 — 1 1 Lard 61 61 — — — Lemonade powder — 18 18 — 2 2 Meat Paste — 8 8 — — — Mince Meat — 6 6 — 1 1 Oats, crushed — 1 1 — — — Olive Oil — 18 18 — — — Pea Flour — 5 5 — — — Peas, canned — 3 3 — 2 2 Pepper — 7 7 — — — Pudding powder — 2 2 — — — Raisins — 4 4 — 4 4 Rice — 22 22 — — — Sherbert — 6 6 — — — Sultanas — 2 2 — — — Soup powder — 10 10 — — — Total 7 302 309 6 16 22 97 Analysts' Annual Report. The nature and extent of the adulteration detected in the Formal samples submitted is shown in the following table No. Nature of Sample. Nature of Report. 508 Milk 15 % Fat deficient. 9 Ditto 3½ % Extraneous water 535 Ditto 7 % Fat deficient. 50 Ditto 16 % ditto 55 Rochelle Salts 100 % Sodium Tartrate. 152 Milk 4 % Extraneous water. 167 Ditto 10 % ditto 693 Ditto 3½ % ditto 696 Ditto 7 % ditto 697 Ditto 7 % ditto 181 Ditto 2 % ditto 258 Ditto 2 % ditto 291 Ditto 2 % ditto 325 Ditto 1½ % ditto 353 Ditto 2½ % ditto 360 Ditto 1½ % ditto 362 Ditto 2½ % ditto 365 Ditto 2½ % ditto 367 Ditto 3 % ditto 368 Ditto 2 % ditto 369 Ditto 7 % ditto 372 Ditto 4½ % ditto 387 Ditto 1½ % ditto 401 Ditto 1½ % ditto 402 Ditto 2 % ditto 450 Ditto 3½ % ditto 470 Ditto 16 % Fat deficient. 812 Butter 30 % Margarine. 964 Milk 4 % Fat deficient. 994 Ditto 4 % ditto 995 Apples 1-200 grain Arsenic per lb. 996 Ditto 1-500 grain ditto 997 Ditto 1-100 grain ditto 998 Ditto 1-200 grain ditto 999 Ditto 1-200 grain ditto 1000 Ditto 1-200 grain ditto H 98 Report of the Medical Officer of Health. Below will be found a Table setting out the nature of reports issued in respect to informal samples adversely reported upon:— No. Nature of Sample. Nature of Report. 13 Rochelle Salts j Consists of Sodium Tartrate. 42 Cream of Tartar Contains excess of Lead. 107 Zinc Ointment Deficient in Zinc Oxide. 663 Tinned Peas Coloured with Copper Sulphate. 664 Ditto Ditto 667 Cream Contains Boric Acid. 674 Ditto Ditto 196 Vinegar Deficient in Acetic Acid. 734 Lemonade Powder Made with Tartaric Acid. 735 Ditto Ditto 754 Ice Cream Contains Boric Acid. 349 Fat Contains a trace of Copper. 448 Butter Contains Margarine. 499 Ditto Ditto 778 Ditto Ditto 787 Ditto Ditto 794 Ditto Ditto 800 Ditto Ditto 940 Sponge Cakes Contains Boric Acid. 959 Apples Trace of Arsenic on Surface. 960 Ditto Ditto 961 Ditto Ditto 962 Ditto Ditto 971 Raisins Contains Sulphur Dioxide. 972 Ditto Ditto 973 Ditto Ditto 974 Ditto Ditto 978 Mince Meat Contains Salicylic Acid. Milk Composition. We herewith append a Table setting out the average composition of the Milks examined and found genuine during each month of the year. Month. No. Genuine. Average Composition. Total Solids. Milk Fat. Non.fatty solids. January 88 12.31 % 3.52 % 8.79 % February 36 12.39 % 3.53 % 8.86 % March 78 12.20 % 3.52 % 8.68 % April 26 12.31 % 3.53 % 8.77 % May 112 12.26 % 3.51 % 8.75 % June 87 12.23 % 3.54 % 8.69 % July 112 12.46 % 3.61 % 8.85 % August 88 12.33 % 3.61 % 8.72 % September 139 12.45 % 3.61 % 8.84 % October 54 12.53 % 3.65 % 8.88 % November 102 12.70 % 3.79 % 8.91 % December 40 12.53 % 3.66 % 8.87 % 99 Analysts' Annual Report. From the above statement it will be seen that the average composition of the 962 genuine milks submitted during 1925 was as follows:— Total milk solids 12.41 % Milk fat 3.59 % Non-fatty solids 8.82 % It is most satisfactory to be able to report that in none of the 990 samples of Milk submitted was a preservative found to be present, nor had any samples been coloured. The percentage of adulteration in all samples of Milk examined amounted to only 2.83; whilst if the figures reported are considered in detail it will be noticed that in only 8 of the 28 adverse reports issued, did the departure from standard exceed 5%. Thus the serious adulteration amounted to only 0-81 per cent., an excellent proof of the satisfactory nature of the milk supply in the Borough. Cream. Thirty-three samples of Cream were procured informally and submitted for analysis; of these 5 were sold in containers declaring the presence of preservative, and in 28 cases no such declaration was made. Of the latter, two samples were found to contain a boron preservative, whilst none of the five of the declared samples was found to contain preservative in excess of that stated upon the label. As no formal samples of Cream were submitted in respect to the two cases mentioned above, it is to be presumed that our reports, on further informal samples procured from the same source, satisfied the Food Inspector that the vendors were not making a practice of selling preserved cream as unpreserved. Butter. In all, 401 samples of Butter were submitted for analysis during the year and of these 7, or 1.7 per cent, were returned as adulterated as containing Margarine. In no case was excess of moisture or preservative reported. Of these 401 samples, 128, h2 100 Report of the Medical Officer of Health. or 31-9 per cent, were found to be free from preservative, other than common salt, whilst the remaining 273 samples, or 69-1 per cent, contained a boron preservative, but, as stated above, in no case did this exceed the maximum permissible, namely 0-5 per cent, when expressed as crystallised Boric Acid. Vinegar. One informal sample was found to be slightly deficient in Acetic Acid. Drugs. Of the 88 samples of Drugs examined during 1925, four, one formal and three informal, were adversely reported upon. In one case, that of Cream of Tartar, a slight excess of Lead over the maximum permissible (20 parts per million) was detected, whilst two samples of Rochelle Salts were found to consist entirely of Sodium Tartrate. Both these samples (one formal and one informal) were procured from the same vendor. Rochelle Salts should be the double tartrate of Sodium and Potassium. One informal sample of Zinc Ointment proved, on analysis, to be deficient in Zinc Oxide. Other Articles. Seven samples of Sponge Cakes were examined, and in one case Boric Acid was found to be present. This preservative is introduced into the Sponge Cakes by the use of liquid eggs in their manufacture. A formal sample was procured in respect to this sample, but no preservative was discovered in this. Twenty-three samples of Ice Cream were submitted for analysis, and it is satisfactory to note that in only one case was the presence of preservative detected. One informal sample of Fat in respect to which a complaint had been received, was found to contain a minute trace of Copper. Lemonade Powder should, in our opinion, be compounded with Citric Acid, and this we found had been the practice in 16 101 Analysts' Annual Report. of the 18 samples of this article submitted, whilst analysis of the remaining two samples proved that Tartaric Acid had been employed. Of the six informal samples of Mincemeat examined, one was found to contain Salicylic Acid as a preservative. All four informal samples of Raisins were found to contain Sulphur Di-oxide, but the amount of this preservative present could not be considered injurious. During the late period of the year, the Ministry of Health drew attention to the fact that Arsenic had been discovered on certain imported Apples. As a consequence, 12 samples, six formal and six informal, were procured for analysis and it is disconcerting to note that in only two cases was the fruit found to be free from this contamination. Arsenic finds its way into the apples as a consequence of spraying the fruit, to protect it against the ravishes of the Codling Moth. This practice is carried out in this country before the fruit is formed, but in America, a second spraying is said to be made when the fruit is in an advanced state of development, and should there be lack of rain between the time of this spraying and the harvesting of the apples, a portion of the insecticide remains on the surface, especially around the calyx and stalk. In no case did we find more than 1-100 grain Arsenic per pound of Apples, but the public would be well advised to wash all imported Apples thoroughly before using them as food. It will be seen that the adulteration during the year amounted to 3-6 per cent, in the case of Formal samples examined, 2-8 per cent, in Informal samples and 3-2 per cent, in all samples submitted. We have the honour to be, Mr. Mayor and Gentlemen, Your obedient Servants, A. H. M. MUTER, F.I.C., Public Analyst. CHARLES A. HACKMAN, F.I.C., Additional Public Analyst. 102 INDEX. page Adulteration of Certain Articles, Percentage of, in 1921-1925 75 Ambulance Service 84 Analyst, Report of 94 Anti-toxin 19 Area of Borough 1 Bacteriological Examinations 46, 81 Bakehouses 66 Balham, House-to-House Inspections in 67 Births 4 Births and Birth-rates in Sub-Districts 4 Birth-rate, Average 10 Years, 1915-1924 8 Births, Notification of, Act 5 Brain and Nervous System, Diseases of the 31 Butchers' Shops 72 Butter and Margarine 79 Cancer 31 Census, 1921 1 Cerebro-Spinal Meningitis 24 Child Birth, Deaths from 31 Circulatory Diseases 31 Clapham, House-to-House Inspections in 67 Cleansing of Persons Act 82 Conscientious Objection Certificates granted 18 Convalescent Homes 62 Cowsheds 72 Crèches 59 Cutting-off Notices 83 Day Nurseries 59 Death, Causes of 7 Death-rate, Average 10 Years, 1915-1924 8 Death-rate, Corrected 6 Death-rate from Infective Diseases 13 103 Index. page Death-rate, Infantile 9 Deaths, Corrected 6 Deaths, Number of 6 Deaths in Institutions 9 Dental Treatment 42, 63 Developmental Diseases 31 Diarrhœa 30 Diphtheria 19 Diphtheria, Attack Rate per 1,000 cases 19 Diphtheria, “Return Cases” of 20 Disinfection 82 Disinfection of Schools 82 Dysentery 25 Encephalitis Lethargica 24 Enteric Fever 21 Erysipelas 23 Expectant and Nursing Mothers, Institutions for 61 Factories and Workshops 69 Factories, Workshops, etc., defects found in 71 Factories, Workshops and Workplaces, Inspection of 69 Fishmongers' Shops 72 Flies and Mosquitoes 82 Food, Prosecutions in connection with 73 Food and Food Premises 72 Food Places, Inspection of 72 Fried Fish Shops 72 German Measles, Cases of 25 Greengrocers' Shops 72 Health Visitors, Work of 50 Home Work 70 Hospitals, etc., for Expectant and Nursing Mothers 61 House Refuse, Removal of 84 House to House Inspections, Summary of 67 Houses and Premises Inspected 66 Houses Let in Lodgings 66 Housing 89 Housing Act, 1925 67 Ice Cream Premises 72 Illegitimate Children, Births of 5 Increase of Rent and Mortgage Interest (Restrictions) Act, 1923 68 104 Index. page Infant Visiting 50-55 Infantile Mortality 9, 10 Infantile Mortality, 5 Years, 1920-1924 11 Infantile Mortality, 10 Years, 1915-1924 12 Infective Diseases 13-18 Infective Diseases, Deaths at certain Age Periods 14 Infective Diseases, Death Rate from 13 Infective Diseases: Number of Cases Notified from Elementary Schools 27-29 Influenza, Deaths and Death-rates 24 Influenza, Pneumonia and Acute Primary Pneumonia, Cases Notified 24 Inhabited Houses, Number of 1 Inquests 31 Inspections, Details of 60 Institutions, Deaths in 9 Institutions for Expectant Mothers, etc 61 Malaria 25 Margarine 79 Markets and Stalls 72 Maternity and Child Welfare 50 Maternity and Child Welfare Centres 56 Maternity Home 59 Measles and German Measles 25 Measles and other Non-notifiable Diseases reported from Schools 27-29 Meat 73 Midwives 55 Milk 76 Milk and Cream Regulations, 1912 and 1917 78 Milk and Dairies (Amentment) Act, 1922 79 Milk, Bacteriological Examination of 79 Milk (Mothers and Children) Order 62 Milk Premises, Cowsheds, etc., on Register 72 Milkshops, Cowsheds, etc., Inspections of 72 Milk (Special Designation) Order, 1922 and 1923 77 Milk Supply 73 Mortuaries 83 Mosquitoes 82 Natural Increase, Rate of 4 Nervous System, Diseases of the 31 Index. 105 page Non-Infective Diseases, Deaths from 31 Notification of Births Act 5 Notification of Infective Diseases 15, 16 Nursing Arrangements 55 Offensive Trades 66 Old Age 31 Ophthalmia Neonatorum 25 Other Infective Diseases, Deaths from 30 Outworkers 70 Overcrowding 64 Para-Typhoid Fever 21 Physical Features, etc., of the Borough 1 Police Court Proceedings 73, 91-93 Polio-Myelitis and Polio-Encephalitis 24 Poor Law Relief, Amount of 2 Population 1, 3 Population of Sub-Districts 4 Premature Birth 31 Pregnancy, Deaths from Accidents and Diseases of 31 Puerperal Fever 23 Pulmonary Tuberculosis, Notification of Cases of 33 Putney, House-to-House Inspections in 67 Rag Flock Act, 1911, Statement of Work done under 83 Rateable Value 1 Rent and Mortgage Interest Restrictions Act, 1923 68 Respiratory Diseases 31 Return Cases of Scarlet Fever and Diphtheria 20 Sale of Food and Drugs Act, Proceedings under 73 Sale of Food and Drugs Act, Statement of Work under 74 Sanitary Conveniences, Inspection of 83 Sanitary Operation, Table of 65 Sanitary Inspection of the Borough 64 Scabies 30 Scarlet Fever 20 Scarlet Fever: Attack Rate per 1,000 Cases 20 Scarlet Fever, "Return Cases" of 20 Schools, Disinfection of, for Infective Diseases 82 Shelters for Tuberculous Patients 42 Slaughter-houses 72 Small-pox 18 Smoke Nuisances 65 106 Index. page Social Conditions 2 Sputum Examinations 46, 81 Staff 85 Streatham, House-to-House Inspections in 67 Tooting, House-to-House Inspections in 67 Trench Fever, Cases Notified 25 Tuberculosis 33 Tuberculosis Dispensaries 40 Tuberculosis Care Committee 46 Tuberculous Diseases, Extra Nourishment provided 42 Tuberculosis, Institutional Treatment 40 Underground Rooms 67 Unsound Food 73 Vaccination Returns 18 Violence, Mortality from 31 Vital Statistics of Whole Borough 3 Wandsworth, House-to-House Inspections in 67 Water Supply, Cutting-off Notices 83 Whooping Cough 23 Young Children, Institutions for 61 Zymotic Diseases 13