WAN 70 Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, &c. OF THE BOROUGH, For the Year 1927, by F. G. CALEY, M.A., M.B., D.P.H., Medical Officer of Health. together with the Report of the Public Analyst. Shield & Spring, 26 and 28, Lancelot Place, Brompton Road, S.W. 7. REPORT of the Medical Officer of Health for the Year 1927. 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 1927. GENERAL STATISTICS FOR THE BOROUGH. Area 9,199 acres Population in 1927 354,178 No. of inhabited houses in 1921 62,540 No. of families, or separate occupiers, in 1921 80,526 Rateable value in 1927 £2,764,577 Estimated produce of a penny rate £11,200 PHYSICAL FEATURES AND GENERAL CHARACTER OF THE BOROUGH. The Registrar-General has estimated the population in 1927 as 342,700, which is higher than that of any of the other London 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 1,202 acres, and this area is largely increased by Wimbledon Common and Richmond Park, which are mainly 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, 1927:— (1.) No. of admissions to the Poor Law Institutions 4,230 (2.) No. of medical orders given 2,970 Vital Statistics. 3 (3.) Average No. of persons in receipt of outdoor relief 3,549 (4.) Amount of outdoor relief given £61,683 Extracts from Vital Statistics. Births:— Males 2,384 Legitimate 4,449 Females 22,69 Illegitimate 204 Total Births 4,653 Birth-rate 13.13 Deaths:— Total Deaths 3,883 Death-rate 10.96 No. of women dying in, or in consequence of, childbirth:— From sepsis 6 From other causes 13 Deaths of Infants under one year of age:— Legitimate 217 Illegitimate 23 Total 240 Infantile mortality 51 Deaths from Tuberculosis:— No. 338 Rate 95 Total deaths from Measles 4 Total deaths from Whooping Cough 28 Total deaths from Diarrhœa (under two years of age) 19 Population. The population at the middle of the year was estimated to be 354,178, and all the rates used in this Report are calculated on this figure. The corresponding figure for the year 1926 was 348,034. Table I. shows the population of each sub-district, based on the above estimation, compared with the Census population. B 2 4 Report of the Medical Officer of Health. TABLE I. Sub-District. Census Population 1921 Population estimated to middle of 1927 Clapham 60,540 63,427 Putney 28,558 32,550 Balham 50,888 54,940 Streatham 52,607 60,410 Tooting 40,135 40,699 Wandsworth 95,579 102,152 Whole Borough 328,307 354,178 Births. The total number of births occurring in the Borough was 3,772, including 367 non-residents who were born in Institutions. 1,248 births of Borough residents occurred outside the Borough, so that the corrected number of births was 4,653, compared with 4,915 in 1926. In Table II. is shown the number of births, males and females, the birth-rate, and the rate of natural increase, for each sub-district, and for the whole Borough. TABLE II. Sub-District. No. of Births. Rates. Males. Females. Total. Birth-rate. Rate of natural increase. Clapham 444 426 870 13.71 2.35 Putney 191 169 360 11.06 dec. .09 Balham 363 377 740 13.47 2.14 Streatham 417 386 803 13.29 1.67 Tooting 240 247 487 11.96 2.53 Wandsworth 729 664 1393 13.65 2.98 Whole Borough 2384 2269 4653 13.13 2.17 Vital Statistics. 5 The birth-rate was 13.13 per 1,000, compared with 14.12 for 1926, and 16.09 the decennial average. The rate for the whole of London during 1927 was 16.1, and for England and Wales, 16.7. 231 illegitimate births took place in the Borough, but only 91 belonged to the Borough. On the other hand 113 illegitimate births belonging to Wandsworth occurred outside the Borough making a corrected total of illegitimate births belonging to Wandsworth of 204. 44 of these belonged to Clapham, 20 to Putney, 25 to Balham, 40 to Streatham, 16 to Tooting, and 59 to Wandsworth. The percentage of illegitimate births to total births was 4.3. 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. Births registered in the Borough. Total births notified. Notified by: No. born dead. Medical Attendant. Parent Midwife. Other person. Clapham 602 567 210 101 246 10 13 Putney 302 269 99 22 146 2 6 Balham 574 568 166 44 334 24 12 Streatham 841 717 217 99 274 127 16 Tooting 394 368 60 37 260 11 10 Wandsworth 1059 1020 249 143 583 45 27 Whole Borough 3772 3509 1001 446 1843 219 84 6 Report of the Medical Officer of Health. Deaths. The number of deaths which took place in the Borough during the year was 3,344, but 1,179 of these did not belong to the Borough, while 1,618 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 3,883, of whom 1,806 were males and 2,017 females. The corrected death-rate for the year was 10.96, compared with 10.37 in 1926. The death-rate for the whole of London for 1927 was 11.9, for England and Wales, 12.3, in the 107 County Boroughs and great Towns 12.2, and in the 155 smaller Towns 11.3. 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 345 376 721 11.36 Putney 191 172 363 11.15 Balham 319 304 623 11.33 Streatham 303 399 702 11.62 Tooting 208 176 384 9.43 Wandsworth 500 590 1090 10.67 Whole Borough 1866 2017 3883 10.96 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. Vital Statistics. 7 Table V.—Causes of, and Ages at Death, during the Year 1927. 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 3 1 ... 1 ... ... ... 2 2 4 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 4 2 2 1 2 1 ... ... ... ... ... ... 1 1 1 1 ... 1 Scarlet Fever 5 3 2 ... 1 ... 3 ... 1 ... ... 1 ... 1 1 1 1 4 Whooping Cough 28 10 18 11 10 4 3 ... ... ... ... 4 2 8 1 4 9 10 Diphtheria and Membranous Croup 23 11 12 ... 2 7 14 ... ... ... ... 3 1 2 1 1 15 23 Influenza 136 48 88 4 ... 2 1 3 20 41 65 28 11 25 27 12 33 28 Erysipelas 4 2 2 2 ... ... 1 ... ... 1 ... 1 1 1 ... ... 1 4 Cerebro-spinal Fever 3 1 2 ... ... ... 1 ... 1 ... 1 ... ... 1 ... 1 1 1 Other Epidemic Diseases 5 1 4 ... ... ... ... 2 2 1 ... ... 1 ... ... ... 4 2 Pulmonary Tuberculosis 289 153 136 ... 1 ... 4 67 120 77 20 43 33 43 41 35 94 160 Tuberculous Meningitis 25 13 12 2 3 5 10 1 3 1 ... 5 1 2 5 5 7 16 Abdominal Tuberculosis 5 2 3 ... ... 1 1 1 2 ... ... 1 ... ... 1 2 1 3 Other Tuberculous Diseases 19 10 9 ... 2 ... 2 4 4 5 2 3 1 2 7 3 3 14 Other Infective Diseases 14 7 7 1 ... 1 2 ... 3 4 3 2 1 1 2 2 6 10 Cancer, Malignant Disease 496 214 282 ... ... 3 ... 2 37 234 220 104 43 84 94 46 125 222 Rheumatic Fever 23 12 11 ... 1 ... 5 6 6 4 1 5 7 5 2 1 3 11 Diabetes 27 11 16 ... ... ... ... ... 5 11 11 5 2 7 6 3 4 14 Other General Diseases 68 27 41 ... ... ... 4 2 14 27 21 17 5 5 15 7 19 34 Alcoholism 4 3 1 ... ... ... ... ... 2 2 ... 2 1 ... ... ... 1 2 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 23 13 10 6 1 1 6 3 3 2 1 4 4 4 5 2 4 16 Cerebral Hæmorrhage, Apoplexy 159 78 81 ... ... ... ... ... 2 50 107 21 13 32 34 12 47 53 Convulsions 8 5 3 8 ... ... ... ... ... ... ... ... ... 1 3 1 3 4 Other Diseases of Nervous System 113 71 42 ... 1 3 6 6 32 42 23 21 10 24 13 12 33 80 Organic Diseases of Heart 584 257 327 ... ... ... 3 5 31 130 415 121 55 79 115 53 161 265 Other Diseases of Circulatory System 210 107 103 3 ... 1 ... 3 12 57 134 38 20 34 42 17 59 79 Bronchitis 339 146 193 8 3 2 1 2 10 61 252 68 24 62 50 36 99 70 Broncho-Pneumonia 121 63 58 28 13 12 3 1 7 18 39 22 16 19 20 16 28 60 Lobar Pneumonia 32 13 19 1 1 1 1 ... 3 11 14 3 4 6 10 1 8 9 Pneumonia (type not distinguished) 86 55 31 6 6 1 4 4 11 26 28 13 4 13 12 9 35 42 Other Diseases of Respiratory System 41 17 24 ... ... 1 1 1 5 12 21 10 4 4 4 6 13 18 Ulcer of Stomach 30 16 14 ... ... ... ... ... 5 16 9 4 5 4 6 3 8 24 Diarrhœa 6 3 3 5 ... ... ... ... ... 1 ... 3 ... 1 ... 1 1 3 Enteritis 21 10 11 11 3 1 ... ... 1 2 3 4 ... 2 6 2 7 9 Appendicitis and Typhlitis 11 6 5 ... ... ... 4 3 3 ... 1 2 4 1 2 ... 2 11 Obstruction of Intestines 41 17 21 2 1 ... 3 ... 2 13 20 11 6 2 9 4 ... 32 Cirrhosis of Liver 28 18 10 ... ... ... ... ... 2 10 16 6 5 1 7 2 7 15 Other Diseases of Liver 21 5 16 ... ... ... 1 ... 2 6 12 3 1 5 5 1 6 10 Other Diseases of Digestive System 63 34 29 3 2 1 7 3 10 24 13 10 3 8 15 6 21 48 Nephritis and Bright's Disease 148 71 77 ... ... ... 2 4 8 55 79 31 14 35 26 15 27 72 Other Diseases of Urinary System 67 52 15 ... ... ... ... 2 5 15 45 8 3 11 17 6 22 54 Diseases of Generative System 4 ... 4 ... ... ... ... ... ... 3 1 1 ... ... ... ... 3 2 Puerperal Fever 6 ... 6 ... ... ... ... 1 5 ... ... ... ... 2 2 1 1 6 Other Accidents and Diseases of Pregnancy and Childbirth 13 ... 13 ... ... ... ... 2 11 ... ... ... 1 1 5 1 5 11 Premature Birth 70 43 27 70 ... ... ... ... ... ... ... 13 5 7 16 9 20 31 Congenital Debility and Malformation 53 28 25 48 2 ... 2 1 ... ... ... 9 6 11 6 7 14 27 Other Diseases of Early Infancy 17 8 9 16 ... 1 ... ... ... ... ... 1 1 4 5 2 4 6 Old Age 196 70 126 ... ... ... ... ... ... 3 193 30 23 32 35 12 64 70 Deaths from Accident 112 74 38 1 1 6 5 19 14 31 35 19 10 20 17 15 31 89 Deaths from Suicide 50 36 14 ... ... ... ... 2 21 23 4 10 6 9 8 3 14 29 Other Violent Deaths 3 2 1 ... ... ... ... ... 3 ... ... 1 ... 1 ... 1 ... 2 Other Defined Diseases 18 12 6 3 ... ... 2 2 3 7 6 4 ... 2 2 4 14 Ill-defined Diseases or unknown 6 5 1 ... ... ... ... ... ... 4 2 3 1 ... 1 ... 1 3 All causes 3883 1866 2017 240 56 56 100 153 433 1027 1818 721 363 623 702 384 1090 1827 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. 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 1925 14.17 18.9 18.3 10.32 11.7 12.2 1926 14.12 17.1 17.8 10.37 11.6 11.6 Average 10 years 16.09 19.6 19.7 11.32 13.1 13.0 1927 13.13 16.1 16.7 10.96 11.9 12.3 The total number of deaths which occurred in Institutions, etc., inside the Borough was 1,388, but 1,179 of these persons did not belong to the Borough. A total of 1,827 persons belonging to the Borough died in Institutions, 209 occurring in Institutions within the Borough and 1,618 in Institutions outside the Borough. Vital Statistics. 9 The following is a list of the Institutions, etc., 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. Luke's Hospital 8 Wandsworth Union Infirmaries 978 St. Thomas's Hospital 50 South Western Hospital 8 Banstead Mental Hospital 10 University College Hospital 7 Cane Hill Mental Hospital 7 Victoria Hospital 14 Horton Mental Hospital 11 West London Hospital 8 Long Grove Mental Hospital 30 Westminster Hospital 15 West Park Mental Hospital 10 Other Mental Institutions 25 Other Institutions, etc.:— Other Poor Law Institutions 19 Other Institutions . . 158 Other Hospitals:— Other Places not Public Institutions 81 Belgrave Hospital 10 Bolingbroke Hospital 19 On Railway 1 Brompton Hospital 7 On Street 17 Charing Cross Hospital 13 River Thames 4 Colindale Hospital 7 Private Nursing Homes 40 Guy's Hospital 14 1618 Infants' Hospital 7 Institutions, etc., inside the Borough 209 King's College Hospital 16 St. Columba's Hospital 17 1827 St. George's Hospital 7 Infantile Mortality. The total number of deaths under one year was 240:—39 in Clapham, 27 in Putney, 37 in Balham, 38 in Streatham, 35 in Tooting, and 64 in Wandsworth. As the number of births was 4,653, the Infantile Mortality rate was 51 per 1,000 births, compared with 64 last year. The decrease in the rate is due to the decrease in the number of deaths from Diarrhœa and Enteritis and diseases of early infancy. The number of deaths among legitimate infants was 217 to 4,449 births—a mortality of 48 per 1,000 births, while the number of deaths among illegitimate infants was 23 to 204 births—a mortality of 112 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 85 18 8 9 120 36 41 25 17 239 Uncertified 1 — — — 1 — — — — 1 Small-pox — — — — — — — — — — Chicken-pox — — — — — — — — — — Measles — — — — — — 1 — — 1 Scarlet Fever — — — — — — — — — — Whooping Cough — — — — — 2 1 6 2 11 Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — 1 1 — — 2 Tuberculous Meningitis — — — — — — 1 — 1 2 Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — 2 1 2 5 Convulsions 6 1 — — 7 — 1 — — 8 Laryngitis — — — — — — — — — — Bronchitis — 1 1 — 2 3 1 — 2 8 Pneumonia (all forms) — 1 — 1 2 6 14 7 6 35 Diarrhoea — — — — — 1 3 1 — 5 Enteritis — 1 — 1 2 1 6 2 — 11 Gastritis — 1 — 1 2 — — — — 2 Syphilis — — — — — 1 — — — 1 Rickets — — — — — — — — — — Suffocation, overlaying — — — — — — — 1 — 1 Injury at Birth 5 1 1 — 7 — — — — 7 Atelectasis 6 — — — 6 — — — — 6 Congenital Malformations 7 1 1 2 11 7 2 4 1 25 Premature Birth 50 6 2 3 61 8 — 1 — 70 Atrophy, Debility and Marasmus 6 3 2 1 12 2 2 — 1 17 Other Causes 6 2 1 — 9 4 6 2 2 23 Totals 86 18 8 9 121 36 41 25 17 240 Nett Births in the year: legitimate, 4,449; illegitimate, 204. Nett Deaths in the year of legitimate infants, 217; illegitimate infants, 23. Vital Statistics. 11 Table VIII. gives the comparative figures of infantile mortality for the last ten years for the whole of the Borough, and for each of the six sub-districts. TABLE VIII. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 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 1925 54 64 38 42 63 57 52 1926 65 71 65 52 81 72 64 Average for 10 years 65 70 58 76 70 66 1927 44 75 50 47 71 45 51 No. of deaths under 1 year, 1927 39 27 37 38 35 64 240 12 INFECTIVE DISEASES. The total number of deaths from these diseases was 598:— 99 in Clapham, 53 in Putney, 82 in Balham, 95 in Streatham, 73 in Tooting, and 186 in Wandsworth. From all infective diseases the death-rate was 1.68 per 1,000:—1.56 in Clapham, 1.62 in Putney, 1.67 in Balham, 1.57 in Streatham, 1.79 in Tooting, and 1.82 in Wandsworth. The rate in 1919 was 2.50; in 1920, 1.96; in 1921, 2.26; in 1922, 2.28; in 1923, 1.61; in 1924, 1.88; in 1925, 1.70; and in 1926, 1.49 per 1,000. The rate is higher than in 1926, mainly owing to the increase in the number of deaths from Influenza. The rate from the principal infective diseases, viz.:— Small-pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever, and Diarrhœa, was .25 per 1,000, compared with .42 in 1919; .61 in 1920; .70 in 1921; .73 in 1922; .39 in 1923; .47 in 1924; .32 in 1925; and .37 in 1926. The rate was .25 in Clapham, .12 in Putney, .27 in Balham, .16 in Streatham, .29 in Tooting, and .34 in Wandsworth. The death-rate from the above diseases is the lowest yet recorded for the Borough. Table IX. shows the deaths which occurred during the year from the notifiable and non-notifiable infective diseases, and in Table X. is given the number of cases of the former diseases which were reported. In both these Tables the cases are arranged in age groups, and Tuberculosis and Ophthalmia Neonatorum are not included as they are dealt with separately on pages 30 and 21 of this Report. In Table XI. the cases of infective diseases are shown grouped according to the sub-districts in which they occurred. Infective Diseases. 13 TABLE IX. Notifiable Diseases. Total. No. of DEATHS from Infectious Diseases grouped in Age Periods. Under 15 15 upwards Under 1 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 and upwards Small-pox — — — — — — — — — — — — — — — Diphtheria 23 23 — — 2 2 5 — 10 4 — — — — — Scarlet Fever 5 4 1 — 1 — — — 2 1 — — 1 — — Enteric and Paratyphoid Fever 5 — 5 — — — — — — — — 2 1 2 — Puerperal Fever 6 — 6 — — — — — — — 1 2 3 — — Erysipelas 4 3 1 2 — — — — 1 — — — — 1 — Whooping Cough 28 28 — 12 9 1 2 1 3 — — — — — — Pneumonia:— Acute Influenzal 25 1 24 — — — 1 — — — 1 — 5 8 10 Acute Primary 85 17 68 7 5 — 1 — 3 1 2 7 5 32 22 Cerebro-Spinal Meningitis 5 4 1 3 — — — — 1 — — — — — 1 Polio-myelitis — — — — — — — — — — — — — — — Encephalitis Lethargica 4 — 4 — — — — — — — 1 1 1 1 — Malaria — — — — — — — — — — — — — — — Dysentery — — — — — — — — — — — — — — — Total 190 80 110 24 17 3 9 1 20 6 5 12 16 44 33 Non-Notifiable Diseases. Measles 4 4 — 2 1 — 1 — — — — — — — — Influenza 111 6 105 4 — — — 1 1 — 1 10 7 32 55 Diarrhœa 27 20 7 16 3 1 — — — — — — 1 3 3 Other (if any) — — — — — — — — — — — — — — — Total 142 30 112 22 4 1 1 1 1 — 1 10 8 35 58 Grand Total 332 110 222 46 21 4 10 2 21 6 6 22 24 79 91 14 Report of the Medical Officer of Health. TABLE X. Notifiable Diseases. Total. No. of CASES of Infectious Diseases grouped in Age Periods. Under 15 15 and upwards Under 1 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 and upwards Small-pox — — — — — — — — — — — — — — — Diphtheria 709 584 125 3 17 30 51 62 295 126 42 61 15 6 1 Scarlet Fever 816 685 131 5 16 29 48 72 383 132 58 51 16 5 1 Enteric Fever and Paratyphoid Fever 32 9 23 — — — 1 1 5 2 7 11 1 4 — Puerperal Fever 15 — 15 — — — — — — — 1 12 2 — — Puerperal Pyrexia 42 — 42 — — — — — — — 2 33 7 — — Erysipelas 122 13 109 2 — 1 1 — 4 5 3 9 22 54 21 Whooping Cough 1829 1801 28 165 161 204 208 250 772 41 6 12 8 1 1 Pneumonia:— Acute Influenzal 138 16 122 4 1 1 2 2 4 2 9 20 23 42 28 Acute Primary 543 215 328 37 47 25 11 15 66 14 33 72 61 99 63 Cerebro-spinal Meningitis 6 5 1 2 1 — — — 2 — — — — — 1 Polio-myelitis 7 6 1 2 — 1 — 1 1 1 1 — — — — Encephalitis Lethargica 11 1 10 — — — — — 1 — — 4 2 2 2 Malaria 9 1 8 — — — — — — 1 — 4 4 — — Dysentery 1 — 1 — — — — — — — — 1 — — — Total 4280 3336 944 220 243 291 322 403 1533 324 162 290 161 213 118 Infective Diseases. 15 TABLE XI. 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. Small-pox Diphtheria 132 59 83 46 59 330 709 692 23 Scarlet Fever 192 78 92 114 120 220 816 728 5 Enteric and Para-typhoid Fever 5 6 3 5 5 8 32 22 5 Puerperal Fever 2 2 3 3 3 2 15 15 6 Puerperal Pyrexia 14 2 8 5 3 10 42 29 — Erysipelas 16 10 19 13 11 53 122 41 4 Whooping Cough 247 225 317 300 219 521 1829 49 28 Pneumonia—Acute Influenzal 39 10 23 11 17 38 138 — 25 Pneumonia—Acute Primary 85 40 64 48 64 242 543 — 85 Cerebro-spinal Meningitis — 1 1 2 — 2 6 2 5 Polio-myelitis — — 1 2 1 3 7 4 — Encephalitis Lethargica — 3 3 2 1 2 11 8 4 Malaria 2 1 — 2 1 3 9 2 — Dysentery — — — 1 — — 1 1 — Total 734 437 617 554 504 1434 4280 1593 190 Tuberculosis—all forms 119 85 77 108 95 182 666 — 339 Ophthalmia Neonatorum 9 — 5 6 10 7 37 16 — Total 128 85 82 114 105 189 703 16 339 Grand Total 862 522 699 668 609 1623 4983 1609 529 16 Report of the Medical Officer of Health. The total number of cases, less Tuberculosis and Ophthalmia Neonatorum, was 4,280, compared with 3,316 in 1926, 4,240 in 1925, and 3,125 in 1924. The increase, compared with 1926, is due mainly 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 XII. is taken from the official returns of the Vaccination Officers to the Board of Guardians for the year 1926. It shows the number of children successfully vaccinated for the whole Borough, as well as for the separate sub-districts, Streatham, Balham and Tooting being included under the heading of Streatham. TABLE XII. SubDistricts. Number of Births returned from 1st Januarv to 31st December, 1926. 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 582 339 1 — 33 144 7 9 27 22 Putney 337 235 2 — 10 52 3 10 8 17 Streatham 1998 1004 10 — 97 607 20 111 50 99 Wandsworth 1125 715 5 — 61 274 8 7 33 22 Totals 4042 2293 18 — 201 1077 38 137 118 160 Infective Diseases. 17 The percentage of children vaccinated to total births was 56-7:—in Clapham, 58.2; in Putney, 69.4; in Streatham, etc., 50.2; and in Wandsworth, 63.5. Diphtheria. 709 cases occurred, compared with 769 in 1926. The number of deaths was 23, compared with 25 in 1926. The death-rate for 1927 was .06 and the case mortality was 3.2 per cent. The disease appeared to have been of a milder type than in 1926, when 25 deaths occurred among 769 cases, and 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 2.11:—2.08 in Clapham; 2.81 in Putney; 1.51 in Balham; .76 in Streatham; 1.44 in Tooting; and 3.22 in Wandsworth. Of the 709 cases, 692, 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, Clapham Central, Larkhall Lane, New Park Road, Parochial, St. Andrew's Street, Stonhouse Street, and Stowey House Open Air Schools, Clapham; All Saints', and Hotham Road Schools, Putney; Balham Central, Broadwater Road, Fircroft Road, Oldridge Road, Smallwood Road and St. Mary's Schools, Balham; Fountain Road and Sellincourt Road Schools, Tooting; Allfarthing Lane, Earlsfield, Elliott Central, Eltringham Street, Intermediate Schools, Magdalen Road, St. Faith's, Swaffield Road, Wandle, Warple Way and West Hill Schools, Wandsworth. Swabs were taken from the throats of some of the children examined. As the result of this swabbing, 81 cases were found to be positive. 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 40 tubes of anti-toxin were issued to medical practitioners for use in cases of Diphtheria. c 18 Report of the Medical Officer of Health. 56 cases occurred in one institution, 16 in another institution and nine in a third institution in Wandsworth, and seven in an institution in Tooting. In October I reported to the Council that it would be advisable to establish clinics in the Borough where parents would have the opportunity of bringing their children to be tested and immunised against Diphtheria. On the 15th November the Council adopted my suggestion and arrangements were made with the Committees of the Balham and Springfield Infant Welfare Centres for the use of their premises. A weekly session at each Centre was provided for and both Clinics were opened in January, 1928. The subject will be reported on fully in next year's Annual Report. Scarlet Fever. 816 cases of Scarlet Fever occurred, compared with 633 in 1926, 801 in 1925 and 847 in 1924. Five cases died, compared with four and nine respectively for the two previous years, and the death-rate was .01 per 1,000, compared with .01 and .02. The case mortality was •61 per cent. The case-rate per 1,000 of population was 2.30:—3.02 in Clapham; 2.39 in Putney; 1.67 in Balham; 1.88 in Streatham; 2.94 in Tooting; and 2.15 in Wandsworth. Of the total number of cases, 728, or 89 per cent., were removed to hospital. 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. 11 cases of Scarlet Fever and seven of Diphtheria occurred within one month of the return of a previous case from hospital. Infective Diseases. 19 Enteric and Para-Typhoid Fevers. 32 cases, and five deaths of the above occurred. 11 of the cases were true Enteric Fever and 21 were Paratyphoid Fever. The number of cases and deaths from the above is higher than in the previous year. There was no special outbreak and no connection between the cases could be traced. Puerperal Fever and Puerperal Pyrexia. The Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, came into force on 1st October, 1926. The following Table gives details of the cases notified under the Regulations during the year. Final Diagnosis. Case notified as:— Recovered. Died. Puerperal Fever. Puerperal Pyrexia. Puerperal Septicaemia 4 — — 4 "Puerperal Fever" 7 — 7 — Salpingo Oophoritis — 1 1 — Pyæmia 3 2 3 2 Peritonitis following Cæsarean Section 1 — — 1 Thrombo-Phlebitis — 1 1 — Pelvic Cellulitis, Subacute Septicaemia — 1 1 — Mastitis — 4 4 — Dental Abscess — 1 1 — Catarrh of Respiratory Tract — 1 1 — Coryza — 1 1 — Ruptured Spina Bifida — 1 1 — Septic Rash — 1 1 — Morbus Cordis — 1 1 — Influenza — 3 3 — Pyrexia of unknown origin — 24 24 — Total 15 42 50 7 c 2 20 Report of the Medical Officer of Health. During the whole year there were 15 cases of Puerperal Fever and six deaths. The death-rate was .01 per 1,000 and the case mortality 40 per cent. All the cases were removed to hospital. 42 cases of Puerperal Pyrexia were also notified. Erysipelas. 122 cases were notified and four deaths occurred during the year, compared with 109 and eight in 1926. Whooping Cough. 28 deaths occurred during the year, while the number of cases notified was 1,829. The death-rate was .07 per 1,000. 49 of the cases were removed to hospital. 1,909 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Whooping Cough occurred, and 235 premises were disinfected. Influenza. The number of deaths from Influenza was 136, compared with 56 in 1926, 111 in 1925, and 139 in 1924. The death-rate was .38 per 1,000. Influenzal Pneumonia and Acute Primary Pneumonia. 138 cases of acute Influenzal Pneumonia and 543 cases of acute Primary Pneumonia were notified. 25 of the former and 85 of the latter died. The total number of deaths credited to all forms of Pneumonia during the year was 239, compared with 217 in 1926, 181 in 1925, 233 in 1924, 189 in 1923, 236 in 1922, 241 in 1921, and 227 in 1920. Cerebro-Spinal Meningitis. Six cases of this disease occurred and three of them died. A further 23 deaths were registered as being caused by Meningitis. One other case of this disease was notified. This case died from Acute Miliary Tuberculosis. Polio-myelitis and Polio-encephalitis. Seven cases occurred and no deaths were registered. Infective Diseases. 21 Four children have been admitted for treatment at Queen Mary's Hospital, Carshalton, under the scheme provided by the L.C.C. Encephalitis Lethargica. 11 cases of this disease occurred and four of them died. Two 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 1926, when there were 17 cases with seven deaths. Malaria. Nine cases were notified, seven males and two females. Dysentery. One case of Dysentery was notified. Ophthalmia Neonatorum. The Public Health (Ophthalmia Neonatorum) Regulations, 1926, which came into force on 1st October, 1926, revoke those of 1914, by abolishing the dual system of notification by the medical attendant and by the midwife. Responsibility of notifying these cases now rests with the medical attendant. 37 cases were notified and the following Table shows the effect of the disease on the vision, according to whether the cases were treated at hospital or at home. TABLE XIII. Result of Treatment. Recovered— Vision not affected. Vision Impaired. Total Blindness. Died. Treatment received:— In Hospital 14 — — — At Hospital, Out-patient 5 — — — At home 18 — — — Total 37 — — — 22 Report of the Medical Officer of Health. All the cases recovered without any impairment of vision. Nine of the cases were attended at birth by doctors, 18 by midwives, and 10 of the infants were born in maternity homes. Measles and German Measles. Four deaths occurred from Measles, compared with 51 in 1926, one in 1925, 71 in 1924, 11 in 1923, 72 in 1922, and four in 1921. The death-rate per 1,000 of population was •01, compared with .14 in 1926, .002 in 1925, .2 in 1924, .03 in 1923, .21 in 1922, .012 in 1921, and .17 in 1920. 172 cases of Measles were reported during the year, compared with 4,028 in 1926, 474 in 1925, 3,418 in 1924, 663 in 1923, 1,842 in 1922 and 450 in 1921. 66 of the cases were under the age of five years, and 169 of them were under the age of 15 years. 26 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. 91 of the 172 cases were reported by the Divisional Officers of the Education Department or by the teachers of elementary schools, and 20 cases were notified by doctors, though the disease is no longer notifiable. The number of cases reported is less than the number that occurred, as no reports are received as a rule from private schools in the Borough. Further, all children do not attend school, and cases occurring during vacations may not come to the knowledge of the school authorities. 35 cases of German Measles were also reported. 383 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Measles occurred, and 84 premises were disinfected. With a view to reducing the mortality from Measles in the Borough, I prepared a Special Report and this was presented to the Council on the 18th October. In this report I pointed out that the Metropolitan Asylums Board have now decided to allot a larger number of beds in Infective Diseases. 23 their infectious disease hospitals to cases of Measles when the disease is prevalent in London. The methods operating at the present time in this Borough to lessen the incidence and mortality from Measles are as follows:— (1.) Instructions to parents by means of leaflets. (2.) The practical advice of the Health Visitors. (3.) Advising parents to call in a doctor. (4.) The provision of nursing when required. (5.) The removal of serious cases to Hospital. (6.) Disinfection of premises. (7.) Convalescent treatment, after recovery, of children under 5 years of age. In order to obtain the maximum benefits from these methods, early information of the cases is essential. It is especially in young children that treatment should be prompt, as complications occur more frequently in children under five years, and Measles is pre-eminently fatal in the first three years of life. Measles epidemics occur every two years, and between these epidemics no special efforts are required as few cases occur and the mortality is very low. For the few months every other year when the disease is prevalent, a great deal can be done to discover cases as early as possible by the prompt visiting of homes where children are reported to be absent from school. In order to obtain particulars of these absentees with the least possible delay, I arranged with the County Medical Officer of Health for the Borough Council's Health Visitors to meet the school nurses daily at those schools where cases of the disease were occurring, so that the Health Visitors could obtain early information of the names and addresses of children who were absent from school on account of Measles. By this means cases can be discovered in the early stages of the disease when treatment is efficacious, instead of coming under observation only in an advanced stage when complications have occurred and treatment is of little avail. 24 Report of the Medical Officer of Health. As this would involve many more home visits during an epidemic of Measles, the Council on my advice agreed to engage temporary Health Visitors for this service as required. The bi-annual epidemic of Measles commenced late in the year, and it was not found necessary to engage extra Visitors until towards the end of December. The epidemic continued for some months during 1928 and will be reported on in full in next year's Annual Report. Table XIV. shows the number of cases of infective diseases which occurred in the individual elementary schools during the year. TABLE XIV. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases . Totals. Clapham. Aristotle Road — — — — 1 — 3 — 1 5 Bonneville Road 31 21 1 — 65 46 79 2 47 292 Cavendish Road 19 6 — — 58 12 19 — 6 120 Cavendish Road Special 1 — 1 — — — — — — 2 Christchurch — — — — 9 5 5 2 — 21 Clapham Parochial, Old Town 3 9 3 — 1 — — — — 16 Clapham Parochial, Macaulay Rd. 3 2 — — — — 7 — — 12 Haselrigge Road 14 3 65 1 27 61 2 2 44 219 Larkhall Lane 7 12 1 1 73 30 20 2 33 179 New Park Road 22 7 1 1 88 14 100 3 34 270 New Road 1 1 1 1 3 — — 1 2 10 St. Andrew's Street 5 3 — — 4 — — — — 12 St. Mary's, Crescent Lane — 2 — — 5 — — — — 7 St. Mary's, St. Alphonsus Road — 2 — — — — — — — 2 Stonhouse Street 5 7 — — 13 14 69 — 3 111 Telferscot Road 11 3 — — 13 14 69 2 14 126 Putney. All Saints' — 1 1 — — 1 — — — 3 Hotham Road 9 14 2 — 15 58 6 — 12 116 Huntingfield Road 10 2 1 10 7 18 90 — 2 140 Parochial, Roehampton 2 3 — — 2 10 14 — — 31 St. Mary's 2 3 11 — 6 10 — 1 — 33 Upper Grade — — 1 — 2 10 4 — — 17 Carried forward 145 101 89 14 392 303 487 15 198 1744 Infective Diseases. 25 TABLE XIV.—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 145 101 89 14 392 303 487 15 198 1744 Balham. Balham Central 1 1 — — — — — — — 2 Bec, The 1 — — — — — — — — 1 Broadwater Road 5 1 — — 2 2 13 — — 23 Broadwater Road Special — 1 — — — — — — — 1 Fircroft Road 7 1 1 — 41 6 14 1 3 74 Hearnville Road 2 3 — — 46 — — — 1 52 Hearnville Road Special — 1 — — — — — — — 1 Holy Trinity, Balham 1 1 — — 32 18 7 — 2 61 Nightingale Square R.C. 6 — — — — — — — — 6 Oldridge Road 4 4 1 — 22 46 2 5 16 100 Ravenstone 3 4 4 — 2 1 1 — — 15 St. Mary's 10 20 1 — 14 15 — 1 — 61 Smallwood Road 6 15 1 4 20 13 43 1 6 109 Streatham. Christchurch 2 — — — 16 — — 3 — 21 County Secondary — — — — 6 — 2 — — 8 Eardley Road 5 8 1 — 13 16 9 2 5 59 Furzedown Demonstration 4 — — — 5 14 1 — 2 26 Hitherfield Road 9 1 1 2 21 29 5 1 38 107 Holy Trinity 13 — — — — — 2 — — 15 Immanuel 1 2 — — 1 6 1 — 1 12 Mitcham Lane 12 3 2 3 39 30 13 — 4 106 St. Andrew's, Colmer Road 4 — — — 5 — — — — 9 St. Leonard's 4 1 — — 7 — 2 — — 14 Sunnyhill Road 3 1 — — 3 15 33 — — 55 Tooting. Ensham Central 1 1 — — — — — — — 2 Ensham 9 2 1 — 6 2 26 — — 46 Fountain Road 7 2 26 1 5 4 7 — 1 53 Franciscan Road 17 5 — — 6 23 2 1 2 56 Hillbrook Road 25 2 1 1 24 34 16 — 19 122 Sellincourt Road 8 3 2 1 11 19 8 1 4 57 Tooting Graveney 5 5 2 2 4 17 1 — — 36 Undine Street, R.C. 3 3 — — — — — — — 6 Carried forward 237 167 101 23 672 499 600 29 276 2604 26 Report of the Medical Officer of Health. TABLE XIV.—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals Brought forward 237 167 101 23 672 499 600 29 276 2604 Wandsworth. Allfarthing Lane 10 4 - - 29 28 33 4 16 124 All Saints' 2 — - —. 5 — — — 7 Brandlehow Road 23 6 1 1 73 11 1 — 2 118 Earlsfield 6 29 2 - 15 9 68 — 15 144 Elliott Central 2 2 - - - - - - - 4 Eltringham Street 3 56 — 1 26 5 1 — 1 93 Garratt Lane 1 5 — 1 3 9 40 — — 59 Magdalen Road 7 5 1 2 5 15 2 — 4 41 Merton Road 8 5 - - 48 6 2 - 2 71 Riversdale 16 12 4 1 18 36 3 4 3 97 St. Ann's 3 — - — — 3 1 — — 7 St. Faith's 1 10 — — 5 1 3 — 5 25 St. Joseph's - 3 - - 1 3 1 - - 8 St. Michael's 14 - - - 7 14 3 2 - 40 Swaffield Road 16 10 2 - 19 2 1 - - 50 Waldron Road 3 11 1 1 4 4 42 6 19 91 Wandle 2 6 — — 53 9 17 2 — 89 Warple Way 1 15 1 — 6 — — 3 26 West Hill 5 5 - - 46 3 2 - 3 64 Grand Total 444 378 145 35 1101 776 915 49 375 4218 # Diarrhœa. The number of deaths from Diarrhœa was 27, compared with 36 in 1926, 34 in 1925, 30 in 1924, and 61 in 1923, and of these 16, or 59 per cent., were under the age of one year, compared with 27 in 1926. The number of deaths from Diarrhoea, Zymotic Enteritis and Enteritis under one year represents 11 per cent. of the total mortality at that age. Infective Diseases. 27 Scabies. The names of 47 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 Inspectors. These children were being treated at the London County Council cleansing stations. In 22 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, 43 other cases were reported to me. These cases were treated 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. 14 deaths occurred, six from Septicaemia, six from Syphilis, one from Tetanus, and one from Mycosis Fungoides. 28 NON-INFECTIVE DISEASES. The total number of deaths from Cancer and malignant disease was 496, the number of males being 214 and females 282. The corrected death-rate was 1.40 per 1,000 for the whole Borough:—1.63 for Clapham; 1.32 for Putney,; 1.52 for Balham; 1.55 for Streatham; 1.13 for Tooting; and 1.22 for Wandsworth. The number of deaths in 1927 was one more than in 1926, but 17 less than in 1924. The number of deaths from diseases of the Brain and Nervous System was 113. 953 deaths occurred from diseases of the Heart and Circulatory System, compared with 934 in 1926. 656 of these deaths were of persons over 65 years of age. There were 619 deaths from diseases of the Respiratory System, compared with 541 in 1926. The number from Bronchitis was 339, compared with 279 in 1926, and from Pneumonia (all forms) 239, compared with 217 in 1926. Further particulars relative to Pneumonia are given on page 20. The number of infants under two years of age who died from these diseases was 69. 13 deaths occurred from accidents and diseases of pregnancy and with the six deaths already mentioned from Puerperal Fever, gives a total of 19 deaths after childbirth. This is equivalent to a rate of 4.08 per 1,000 births, compared with 2.03 in 1926. 140 deaths, 79 males and 61 females, were registered as due to Premature Birth and Developmental Diseases, compared with 177 in 1926. 196 deaths, 70 males and 126 females, occurred from Old Age, and all these, except three, were persons over 65 years of age. The number of deaths due to this cause in 1926 was 1.66. 165 deaths were due to Violence, 112 of them being due to accident, 50 to suicide, and three to other forms of violence. Inquests. Inquests were held on 171 persons dying in the Borough, and on 151 Borough residents who died outside the Borough. The next Table shows the results of the findings of these inquests. 29 Non-Infective Diseases. TABLE XV. Sub-Districts. Inquests. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough Deaths from Natural Causes 20 3 21 19 13 31 107 Accidental:— Knocked down by motor vehicles 7 6 7 4 4 8 36 Falls 3 3 4 2 15 6 33 Falls from vehicles 3 — 4 4 3 6 20 Falls from a height 1 2 4 2 2 6 17 Scalds and burns 1 —- 1 3 2 2 9 Deaths under anaesthetics 5 - 1 2 - - 8 Drowning — 1 2 — 1 - 4 Knocked down by train 1 2 — — — 1 4 Poisoning by coal gas . . — — 2 - - 2 4 Suffocation by inspiration of food - - - - 4 - 4 Crushed by fall of wall — — — - 1 1 2 Other — — 1 2 1 3 7 Suicidal:— Cut throat 2 3 2 2 - 2 11 Drowning 2 2 1 1 1 3 10 Poisoning by:— Coal Gas — 2 3 1 2 3 11 Lysol — 1 4 — — 4 9 Hydrochloric Acid 1 — — 1 — 2 4 Potassium Bromide — — — 1 — — 1 Phosphorus 1 — — - - — 1 Hanging 1 — — 1 — 2 4 Gunshot wounds 1 — — — - 2 3 Strangulation — 1 - - - 1 2 Jumped from a height . . — 1 - - — - 1 Run over by train 1 - - - - - 1 Felo-de-Se 1 — — — — 1 2 Open Verdicts:— Found drowned 1 2 1 — 1 5 Execution — — — — — 2 2 Totals 52 29 58 45 49 89 322 30 TUBERCULOSIS. Notification.—The total number of new cases of Tuberculosis which came to the notice of the Medical Officer of Health during 1927 was 718, as compared with 706 in 1926, 643 in 1925, 692 in 1924, and 597 in 1923. The sources of information regarding the 718 new cases notified in 1927 were as follows:— Primary notifications on Form A 589 Un-notified at death 52 Transfers from other Sanitary Authorities 69 Naval and military notifications 8 Total 718 Table XVI.—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 XVI. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Male. Female. Male. Female. Male. Female. Male. Female. Jnder 1 year - - 3 2 - - 2 1 1—5 2 1 2 14 1 1 5 5 5—10 5 2 13 10 2 1 2 3 10—15 6 7 15 10 2 4 2 3 15—20 30 40 5 9 11 26 — 4 20—25 30 33 4 7 19 19 — 2 25—35 78 73 9 12 33 37 - 3 35—45 67 39 3 3 33 17 3 - 45—55 .. 42 21 1 4 29 15 3 — 55—65 28 12 2 — 18 11 - - 65 upwards 12 9 — 1 16 5 — 1 Totals 300 237 57 72 164 136 17 22 31 T uberculosis. Table XVII. shows the number of new cases of Nonpulmonary Tuberculosis classified according to the part of the body affected. TABLE XVII. Localisation of Disease. Total. Males. Females. Brain 17 9 8 Glands, Mesenteric 8 3 5 Glands, Cervical 52 24 28 Bones and Joints 36 15 21 Skin 4 2 2 Other Parts 15 6 9 Totals 132 59 73 Deaths.—The total number of deaths certified as due to diseases of a Tuberculous nature was 339—of whom 181 were males, and 158 females. Of the 339 deaths, 300 were due to Pulmonary Tuberculosis, 25 to Tuberculous Meningitis, five to Abdominal Tuberculosis and nine to other forms of Tuberculosis. Table XVI. gives details regarding the type of the disease, sex, and age grouping of these 339 deaths. In addition to these deaths, which were duly certified in the returns as due to Tuberculosis, 12 persons previously notified as suffering from Tuberculosis died during the year. These deaths, however, do not figure in Table XVIII. for the reason that:— (a.) Seven were certified as dying of diseases other than Tuberculosis. (b.) Five had previously moved outside the Borough and died there, the deaths being credited to the areas in which death occurred. 32 Report of the Medical Officer of Health. TABLE XVIII. Localisation. Total. Males. Females. Pulmonary 300 164 136 Brain 25 12 13 Glands, Mesenteric 5 2 3 Bones and Joints 4 — 4 General Tuberculosis 1 — 1 Other Parts 4 3 1 Total 339 181 158 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. 33 Tuberculosis. TABLE XIX. 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 Pulmonary Tuberculosis :— No. of Deaths 368 288 257 331 286 269 244 261 255 300 Death-Rate 1.22 .87 .75 1.00 .85 .80 .71 .75 .73 .85 Other Forms:— No. of Deaths 87 54 58 59 57 50 50 49 40 39 Death-Rate .29 .16 .18 .18 .17 .14 .14 •15 •12 •11 Total:— No. of Deaths 455 342 315 390 343 319 294 310 295 339 Death-Rate 1.51 1.03 .93 1.18 1.02 .94 .86 .90 .84 .96 D 34 Report of the Medical Officer of Health. During the year 52 persons, not previously notified, were certified as having died of Tuberculosis. The ratio of unnotified Tuberculosis deaths to total Tuberculosis deaths is therefore 52 to 339. Of the 52 unnotified deaths, 21 were certified from Institutions, 21 by private doctors, while in 10 cases Tuberculosis was discovered post mortem. 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. 73 persons died within one month after notification, 101 within three months, and 122 within six months. Table XX. gives particulars regarding the numbers of notified persons on the Register since 1909. The figures for the years 1909 to 1921 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." denote Non-pulmonary Tuberculosis. Patients classified as "recovered" are those who have shown no evidence of active disease for at least five years. This "Notification Register" contains particulars of all persons who have been notified to the Medical Officer of Health as suffering from Tuberculosis. It should be distinguished from the "Dispensary Register"—referred to in Tables XXI. and XXII.—which is a list containing the names of all persons attending at, or seen in connection with, the Dispensary for diagnosis or treatment. 35 T uberculosis. TABLE XX. 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 1921 8083 1847 9930 3735 611 4346 1879 318 2197 277 174 451 4519 1474 5993 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 1926 557 149 706 291 40 331 205 27 232 62 46 108 1638 660 2298 1927 537 129 666 248 39 287 185 113 298 157 50 207 1585 587 2172 D 2 36 TUBERCULOSIS DISPENSARIES. (a.) The Main Dispensary, at 79, East Hill, Wandsworth, serves the areas Putney, Southfield, 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 Sanatorium 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. The number of patients who received institutional treatment under the Council's Tuberculosis Scheme during 1927 was as follows :— (a.) In Hospitals for Observation 66 (b.) In Sanatoria 337 (c.) In Hospitals for Advanced Cases 4 Total 407 The above figures do not include patients treated either in private or in poor law institutions. Tuberculosis Dispensaries. 37 As in former years, great difficulty was experienced in arranging for the institutional treatment of advanced cases. 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, and St. Thomas's Hospital, for supplying refills to patients treated by the Artificial Pneumothorax method have been continued. 15 cases were treated during the year and 200 refills administered. The total cost was £105. 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 ; but on 1st April, 1927, the special arrangement, by which the cost of visiting tuberculous war pensioners was defrayed by the Ministry of Pensions, was discontinued. All existing pensioners suffering from Tuberculosis are still visited in their homes by the Tuberculosis Visitors in accordance with the Council's general scheme for Tuberculosis. 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. 31 patients received dental treatment and six of these were supplied with dentures. The attendances at the dentist totalled 89. The amount expended on dental treatment during the year was £17 17s., while the cost of dentures supplied to patients was £23 8s. 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 38 Report of the Medical Officer of Health. 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 82 patients have been granted extra nourishment under the scheme at a cost of £114 2s. 1d. The scheme has been found to be of great help in the treatment of the types of patient mentioned above. Open Air Shelters.—The seven shelters owned by the Borough Council have been in constant use during the year. Artificial Light Treatment.—During the year arrangements were made for utilising the facilities existing at certain London Hospitals for artificial light treatment. Several children suffering from Non-pulmonary Tuberculosis have been treated in the Light Department at the Victoria Hospital for Children, Tite Street, Chelsea; and arrangements have been made with St. Thomas's Hospital for the treatment of adults. The following Tables are copies of the returns furnished to the Ministry of Health in accordance with instructions contained in Memorandum 37.T. 39 Tuberculosis Dispensaries. TABLE XXI. ANNUAL RETURN SHOWING THE WORK OF THE DISPENSARIES DURING THE YEAR 1927. Diagnosis. Pulmonary. Non-Pulmonary. Totals. Adults. Children. Adults. Children. Adults. Children. m f m f m f m f m f m f A. New Cases examined during the year (excluding contacts) (a.) Definitely Tuberculous 121 85 2 - 7 9 9 6 128 94 11 6 (b.) Doubtfully Tuberculous - - - - - - - - 27 33 7 11 (c.) Non-Tuberculous - - - - - - - - 66 149 203 248 B. Contacts examined during the year:— (a.) Definitely Tuberculous 9 13 - - - 1 1 1 9 14 1 1 (b) Doubtfully Tuberculous - - - - - - - - 1 2 3 2 (c.) Non-Tuberculous - - - - - - — — 73 128 141 146 C. Cases written off Dispensary Register as:— (a.) Cured 53 42 3 5 10 7 22 23 63 49 25 28 (b.) Diagnosis not confirmed, including cancellation of Cases notified in error - - - - - - - - 199 292 354 399 D. Number of persons on Dispensary Register on December 31st:— (a.) Diagnosis completed 534 363 16 21 63 50 78 67 597 413 94 88 (b.) Diagnosis not completed — — — — — — — - 7 10 2 3 40 Report of the Medical Officer of Health. Table XXII. gives further details of the year's work. TABLE XXII. 1. Number of persons on Dispensary Register on January 1st 1335 given at or in connection with the Dispensary 31 2. Number of patients transferred from other areas and of "lost sight of cases returned 45 10. Number of consultations with Medical Practitioners:— (a.) At homes of Applicants 98 (b.) Otherwise 611 3. Number of patients transferred to other areas and cases " lost sight of " 76 11. Number of other visits by Tuberculosis Officers at 386 4. Died during the year 185 12. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 5067 5. Number of observation cases under A (b.) and B (b.) above in which period of observation exceeded 2 months 44 13. Number of:— (a.) Specimens of Sputum, etc., examined 792 6. Number of attendances at the Dispensary (including contacts) 5720 (b.) X-ray examinations made in connection with Dispensary work 27 7. Total number of reports, etc., made in connection with the Dispensary 6057 14. Number of Insured Persons on Dispensary Register on the 31st December 693 8. Number of attendances at General Hospitals or other Institutions of patients for:— (a.) Light Treatment 478 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 508 (b.) Other special forms of treatment 208 16. Number of reports received during the year in respect of Insured Persons :— 9. Number of patients to whom Dental Treatment was (a.) Form G.P. 17 39 (b.) Form G.P. 36 138 The two following Tables show the original Classification of all the patients suffering from Tuberculosis who have attended the Dispensaries since they were opened in 1913, and their condition at the end of 1927 as far as it is known. Table XXIII. refers to cases of Pulmonary Tuberculosis and Table XXIV. to cases of Non-pulmonary Tuberculosis. 41 Tuberculosis Dispensaries. TABLE XXIII. Classification on Initial attendance at the Dispensaries. Condition at the time of the last record made. Total cases where condition is known. Removed and lost sight of. Total cases who have attended. Discharged as cured. Disease arrested. Disease not arrested. Died. Pulmonary Tuberculosis. Class T.B. Minus. Adults, M. 362 41 79 164 646 1482 519 2001 Adults, F. 426 19 79 159 683 Children 103 8 19 23 153. Class T.B. Plus. Adults, M. 79 56 358 938 1431 2482 540 3022 Adults, F. 50 20 245 703 1018 Children 6 1 9 17 33 42 Report of the Medical Officer of Health. TABLE XXIV. Classification on Initial attendance at the Dispensaries. Conditio n at the time of the last record made. Total cases where condition is known. Removed and lost sight of. Total cases who have attended. Discharged as cured. Disease arrested. Disease not arrested. Died. Non-Pulmonary Tuberculosis Bones and J oints Adults, M. 27 11 27 7 72 - 213 36 249 Adults, F. 14 6 18 5 43 Children 47 15 23 13 98. Abdominal Adults, M. 7 — 3 1 11 20 84 Adults, F. 5 2 3 — 10 Children 14 12 12 5 43 Peripheral Glands Adults, M. 10 1 8 1 20 304 66 370 Adults, F. 25 4 4 7 40 Children 164 20 52 8 244 Other Organs. Adults, M. 8 5 8 7 28 82 21 103 Adults, F. 8 2 11 4 25 Children 1 3 8 17 29 43 Tuberculosis Dispensaries. New cases attending the Dispensaries. TABLE XXV. Recommended to attend Dispensary by Clapham. Putney. Streatham. Tooting. Wandsworth. Outside Borough. Totals. Public Health Department 51 54 113 95 132 - 445 Private Practitioners 98 56 135 119 254 4 666 Charitable Societies 7 1 8 6 12 — 34 Other Dispensaries 11 18 10 3 14 — 56 L.C.C. Schools 6 1 11 5 10 — 33 Ministry of Pensions 1 1 5 4 2 1 14 Existing Dispensary Patients 3 3 9 15 21 1 52 Other Sources 18 21 40 36 122 12 249 Total 195 155 331 283 567 18 1549 Contacts.—Of the 1,549 new cases examined, 521 were contacts. 25 of these were found to be suffering from Tuberculosis. Bacteriological Examinations.—Below is shown the number of such examinations of sputum made at the Dispensary during the past five years. Year. Total number of specimens examined. No. of specimens sent by General Practitioners and St. James' Hosptl. No. of specimens found to contain T.B. 1923 .. 1720 722 384 1924 1789 1013 437 1925 1711 1066 384 1926 1865 1210 404 1927 2087 1417 447 Care Committee. Constitution.—The Tuberculosis Care Committee was appointed by the Borough Council, and the Council's 44 Report of the Medical Officer of Health. tatives on the Committee are: Councillors T. Harding and J. Knox. The Tuberculosis Officers, and Tuberculosis Visitors, assist the Committee to the fullest possible extent. 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. The Officers of the Committee are:— Chairman: Councillor T. Harding. Vice-Chairman: Miss J. M. Duff. Hon. Secretary: Miss F. Walker. foint Hon. Secretary: Mrs. Nicol. Hon. Treasurer : Mr. H. B. Harvey. Meetings.—The Committee meet at 79, 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. Tuberculosis Dispensaries. 45 (c.) Provision of open air shelters. (Seven 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 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 247 patients (adults and children), the amount collected and remitted to the London County Council being £1,034 13s. 2d. The amounts of such assessments are subject to the approval of the County Council. In addition to the patients visited by the Tuberculosis Visitors, 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. Miss Hill, on behalf of the Committee, has kept in touch with the Dispensary patients in St. James' Hospital, Balham. 79 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 them; 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 46 Report of the Medical Officer of Health. 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 £65. The funds also benefited by a Variety Entertainment arranged by Miss G. Lack, to the extent of £32 10s. A Jumble Sale at Wandsworth produced £15, and a small Whist Drive £3. 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, 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 25 patients were nursed there for varying periods, at a total cost of £311 8s. 3d. By means of the same voluntary fund eight patients were given treatment at the Hahnemann Home, Bournemouth. Cases were also sent to a Convalescent Home at St. Leonards, and to St. Michael's Home, Axbridge. The average period of convalescent treatment granted was 12 weeks. One man was trained as a motor driver, and a girl placed as a probationer at a Sanatorium. Three children were placed in Homes, and others sent into the country for their summer holidays. 47 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, Puerperal Pyrexia, Whooping Cough and Ophthalmia Neonatorum are visited on notification, as well as all known cases of Measles, and Diarrhoea in children under five. Other Home Visits.—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 Maternity Homes, and the maternity wards of St. Thomas's and other Hospitals. Home visits are also made for investigating applications for milk under the Milk (Mothers and Children) Order, and in connection with Convalescent and Dental treatment. Visits are also made to see if homes are suitable for children to return to after minor operations at General Hospitals. Periodical visits are also made to Creches and institutions for unmarried mothers and their children. 48 Report of the Medical, Officer of Health. Duties at the Welfare Centres.—One of the Health Visitors is present at each Welfare Centre or Ante-natal Clinic, and some of them attend the Welfare Centre Committee meetings. As a result of a visit made to Wandsworth by one of the Medical Officers of the Ministry of Health early in the year, the Minister pointed out that the present division of the home visiting as between the Health Visitors and Superintendents of the Centres, was not ideal, and that the work of the two groups of Officers was not sufficiently co-ordinated. The Minister asked the Council to consider in conjunction with the Voluntary Committees whether, as new appointments occurred, arrangements could be made for the Superintendents to be paid wholly or partly by the Council, and to carry out the full duties of a Health Visitor for their own areas. The matter was investigated very fully by the Borough Council, the General Council of Infant Welfare Centres and by the Committees of the Infant Welfare Centres. It was decided to accept the suggestion of the Minister of Health, and the Council agreed to appoint Health Visitors to act as Superintendents of the Infant Welfare Centres as vacancies occurred among the Superintendents. This new arrangement has been put into force in the districts of the Springfield and Fairfield Infant Welfare Centres where vacancies for Superintendents occurred during the year. Miss Woods, the present Health Visitor for Springfield and Tooting district was appointed Superintendent of the Springfield Infant Welfare Centre, and Miss Watling, the Health Visitor for Southfield and Fairfield districts, was appointed Superintendent of the Fairfield Infant Welfare Centre. A new Health Visitor was appointed in October in order to assist in carrying out the visiting duties in this part of the Borough consequent upon this re-arrangement. Table XXVI. summarises the work of the Health Visitors during the year in the six divisions of the Borough. 49 Maternity and Child Welfare. 49 TABLE XXVI. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Infants under 1 year:— Visits 810 280 490 648 475 1145 3848 Revisits 761 242 575 680 350 1690 4298 Children 1-2 years:— Visits 44 2 13 22 5 30 116 Revisits 322 154 253 336 91 1124 2280 Children 2-5 years : — Visits 22 4 21 37 6 25 115 Revisits 222 153 403 112 92 425 1407 Ante-natal cases 222 50 106 96 20 241 735 Puerperal Fever and Pyrexia. Ophthalmia Neonatorum 18 35 9 4 10 12 5 8 8 11 14 5 64 75 Measles 194 26 10 15 55 55 355 Whooping Cough 314 293 302 208 228 556 1901 Enteritis 3 — 1 — 1 1 6 Miscellaneous 107 70 329 139 30 125 800 Ineffectual 537 246 513 786 308 1222 3612 Total 3611 1533 3038 3092 1680 6658 19612 Attendances at:— Infant Welfare Centres 93 162 97 146 143 270 911 Ante-natal Centres 13 24 25 19 33 60 174 Committee Meetings 5 16 — — 24 — 45 Health Talks 62 47 17 65 48 59 298 Visits to CrSches - 24 27 — 29 22 102 E 50 Report of the Medical Officer of Health. Infant Visiting. There were 4,653 births during the year and 3,848 of these, or 82.7 per cent., were visited, compared with 81.7 in 1926, 81.1 in 1925, 79.9 in 1924, 77.1 in 1923, and 81.1 in 1922. Table XXVII. gives the particulars of the method of feeding of infants on the occasion of the initial visit and when revisited. Of 3,848 infants visited for the first time, 3,313 were entirely breast-fed, while 535 were otherwise fed. On revisiting, 2,114 infants were found to be fed entirely on the breast, and 2,184 were fed by other methods. TABLE XXVII. Method of Feeding. Age of infant on first visit. Under 1 month. 1—3 months. 3—8 months. 6—12 months. Total. Breast-fed 2190 901 175 47 3313 Otherwise fed 183 212 79 61 535 Method of Feeding. Age of infant on subsequent visit. Under 1 month. 1—3 months. 3—6 months. 6—12 months. Total. Breast-fed 132 549 834 599 2114 Otherwise fed 93 270 420 1401 2184 It was found that in 1,420 of the births doctors had been in attendance, while in 1,465 the services of midwives had been utilised. 963 infants were born in hospitals and other institutions. 51 Maternity and Child Welfare. 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. 37 midwives practise in the Borough, of whom 16 reside in neighbouring Boroughs. There are 29 private maternity homes in the Borough, 10 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, Infantile Diarrhoea, Puerperal Fever and Puerperal Pyrexia, at my request. A fee of 1s. 3d. is paid for each visit to these cases except in Balham, where a special grant of £80 per annum is paid by the Council to the Ranyard Nurses for the services of the nurse in this area who was appointed at the request of the Council in 1920. 238 cases were visited during the year under these arrangements, and 3515 visits were made to them as shown in Table XXVIII. TABLE XXVIII. No. of cases. No. of visits. Whooping Cough 24 210 Influenza 46 543 Pneumonia 132 1886 Ophthalmia Neonatorum 28 828 Measles 8 48 Puerperal Fever and Puerperal Pyrexia. — — Total 238 3515 The number of visits made by nurses in 1926 was 3,690, and the decrease is due to the decrease in the number of cases of Pneumonia. E 2 52 Report of the Medical Officer of Health. Maternity and Child Welfare Centres. There are now 11 Infant Welfare Centres in the Borough. Each Centre has a Medical Officer, who attends at each Infant or Ante-natal Clinic, together with a trained Superintendent who visits the homes of children and expectant mothers in addition to her duties at the clinics. The voluntary workers at all the Centres continue to render valuable assistance at the sessions and carry out all the work connected with the keeping of records, and the purchase and sale of food, drugs and clothing. They do no visiting. The total number of new infants seen at the Centres during 1927 was 2,632, compared with 2,619 for the previous year, and the total attendances were 47,819. The number of visits paid by the Superintendents to infants increased to 15,482 in 1927. Eight of the 11 Centres have ante-natal clinics and 582 cases were examined at these clinics, compared with 549 in 1926. The following is a list of the Welfare Centres in the Borough, together with the hours at which the clinics are held:— 53 Maternity and Child Welfare. 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 and Thursdays at 2 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. Streatham : 37, Riggindale Road. 1st and 3rd Wednesdays in each month at 10 a.m. Tuesdays at 1.30 to 3.30 p.m. Fridays at 2 p.m. Wesley Hall, Blegborough Road. None. Thursdays at 2 to 3.30 p.m. Tooting : Fairlight Hall, Fairlight Road. 1st and 3rd Wednesdays in each month at 10 a.m. • Wednesdays and Thursdays at 2 to 3.30 p.m. Church Hall, Lynwood Road. 4th Wednesday at 10.15 a.m. Thursdays at 10.15 a.m. southfield : St. Michael's Institute, Merton Road. 1st and 3rd Fridays in each month at 10 a.m. Tuesdays and Fridays at 1.45 to 3.30 p.m. Fairfield : St. Faith's Mission Hall, Warple Way. None. Wednesdays and 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 following Table gives full particulars of the work at each Centre during the year. 54 Report of the Medical Officer of Health. TABLE XXIX. Clapham. Putney. Putney Park. Balham. Streatham. Blegborough Road. Tooting. Southfield. Fairfield. Springfield. Totals. Fairlight Lynwood Road New Cases, 1927 461 184 83 377 340 127 229 128 214 253 236 2632 Total Attendances 8099 4455 1805 7360 5628 2502 4742 1976 4963 2306 3983 47819 Ante-natal Cases 68 70 — 87 82 — 70 39 87 33 46 582 Ante-natal Attendances 212 240 — 254 253 — 207 96 208 70 112 1652 Supts.' Visits to Infants 1634 1266 541 2199 1315 — 2538 588 1481 2861 1059 15482 Supts.' Visits to Ante-natal Cases 180 197 87 193 203 — 151 45 138 102 62 1358 No. of Sessions Infants 96 100 50 99 94 48 93 46 100 58 50 834 Ante-natal 12 23 — 26 22 — 21 12 24 — 25 165 Health Talks given 83 52 29 34 44 16 30 18 57 28 44 435 Maternity and Child Welfare. 55 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 Is. 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. 102 inspections of the creches were made during the year by the Health Visitors. The attendances were :—Putney, 5,100 ; Balham, 5,156 ; Tooting, 5,217; and Wandsworth, 8,191 ; a total of 23,664, compared with 18,827 in 1926. Institutions for Expectant and Nursing Mothers and Young Children. The Streatham Babies' Hospital has removed to more suitable and commodious premises at 9, Leigham Court Road. This Hospital is for the treatment of infants up to the age of 56 Report of the Medical Officer of Health. five years. There are 20 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. 126 infants were admitted in 1927, 52 from addresses in the Borough and 74 from outside the Borough. Most of the cases were infants suffering from Marasmus, Gastritis and Debility. 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 five mothers were sent to Convalescent Homes, all of them taking their infants with them. Two 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 Maternity and Child Welfare. 57 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, 819 families were supplied with milk under the above scheme :—164 in Clapham ; 79 in Putney ; 124 in Balham ; 110 in Streatham; 99 in Tooting ; 37 in Southfield ; 130 in Fairfield ; and 76 in Springfield. The total cost to the Council was £1,997 12s. Women and children in receipt of milk under the Council's scheme are expected to attend the Welfare Centre during the time that the milk is being granted, though this rule is not enforced in cases where there is some very good reason for the mother's non-attendance. There is little doubt that many mothers and children have benefited from the supply of free milk since the scheme was instituted. In many cases the milk granted has enabled nursing mothers to prolong the period of lactation, and the records kept at the Welfare Centres show good results in the health and general well-being of many infants. Dental Treatment. The teeth of mothers and children are examined as a routine by the Medical Officers at the Welfare Centres, and those requiring treatment are advised to attend at the Dental Clinic of the British. Dental Hospital, 23, South Side, Clapham Common. The modified arrangements made with the British Dental Hospital in 1923, have continued in force throughout the year, and all expectant and nursing mothers attending the Welfare Centres are eligible for treatment under the scheme, provided their financial circumstances are such as to preclude them from paying the full cost of treatment. The Council makes a payment to the Hospital of 5s. per attendance, with an additional charge of 5s. for each case requiring nitrous oxide. A separate charge is made for dentures 58 Report of the Medical Officer of Health. and patients are asked to contribute towards the cost of these according to their means. 70 cases, 57 women and 13 children were treated at the Hospital and 163 attendances were made. The above service was extended in 1926 for Putney and Wandsworth. The Council arranged with a local dentist to treat cases from these districts. The fees paid are in accordance with the scale for members of approved Societies. 36 cases availed themselves of these facilities during the year, 24 being women, and 12 children. 59 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 XXX. 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 1,796, and of these 646 were found to be in a defective condition. The drains of 64 houses were re-constructed. Damp conditions have been remedied in 906 premises, and in 172 of these damp courses were inserted. 15 privies and earth closets are known to be in existence in the Borough, and all of these are in connection with tennis grounds. One conversion to water carriage system was carried out during the year. It will be seen from this Table that 176 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. 44 of the above cases of overcrowding which were abated during the year were accommodated in Wandsworth Borough Council houses, and 25 in London County Council houses. 60 Report of the Medical Officer of Health. TABLE XXX. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 1. Premises cleansed and repaired 470 212 326 333 609 1122 3072 2. Drains tested 310 90 200 297 245 654 1796 3. Drains cleansed or repaired 87 80 55 35 92 297 646 4. Water closets cleansed or repaired 185 46 124 100 216 375 1046 5. Soil pipes repaired 26 13 4 2 28 33 106 6. Waste pipes altered or repaired 55 27 34 21 35 168 340 7. Rainwater pipes repaired 55 21 14 29 31 123 273 8. Roofs and gutters repaired 186 55 139 154 265 537 1336 9. Damp courses inserted 11 10 5 84 6 56 172 10. Damp conditions otherwise remedied 89 55 66 118 110 296 734 11. Yards drained or paved 46 16 28 27 97 214 428 12. Dust bins provided or repaired 206 39 119 111 162 337 974 13. Water cisterns cleansed, covered or repaired 20 12 16 24 16 87 175 14. Water supply reinstated 9 17 10 20 4 30 90 15. Defective fireplaces remedied 22 10 48 44 38 141 303 16. Defective coppers remedied 23 4 18 14 20 107 186 17. Cases of overcrowding abated 27 7 31 23 32 56 176 18. Stables and stable yards drained or paved — — — 2 — — 2 19. Accumulations of manure, etc., removed 15 5 15 18 18 24 95 20. Urinals cleansed or repaired 13 6 1 4 2 24 50 21. Animals improperly kept — — — 3 — 27 30 22. Smoke nuisances 1 2 4 1 — 32 40 23. Other nuisances 105 35 3 46 55 238 482 Total 1961 762 1260 1510 2081 4978 12552 No. of preliminary notices served 710 246 599 446 894 1705 4600 No. of preliminary notices complied with without the service of statutory notices 602 227 460 398 768 1425 3880 No. of statutory notices served 101 25 44 62 64 264 560 No. of statutory notices complied with .. 90 25 31 58 51 186 441 Sanitary Inspection of the Borough. 61 Table XXXI. gives full details of the inspections carried out by the District Inspectors. TABLE XXXI. Inspections. ReIn spections. Total. To investigate complaints 5844 17471 23315 House-to-House inspections 1435 4483 5918 Infective Diseases :— Notifiable diseases 1907 1032 2939 Measles 18 10 28 Whooping Cough 6 2 8 Other infective diseases 513 26 539 Verminous conditions 157 26 183 Bakehouses No. of Premises 113 256 167 423 Offensive Trades 3 170 — 170 Piggeries 14 192 22 214 Factories, workshops, etc. 2014 2266 80 2346 Houses let in lodgings 265 133 325 458 Rag and bone stores 21 63 1 64 Sanitary conveniences 166 1009 21 1030 Mews and stables 167 946 11 957 Other inspections 3739 154 3893 Total 18654 23831 42485 Smoke observations 96 — 96 Legal proceedings, Attendances at Court 43 — 43 62 Report of the Medical Officer of Health. Underground Rooms. There are 11 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, 1925. 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 XXXII. 1,435 inspections were made, compared with 1,674 in 1926, and nuisances were found in 1,165 of the houses, necessitating the service of sanitary notices. TABLE XXXII. 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 51 45 25 58 41 5 Clapham South 122 114 50 59 50 89 Putney 90 68 2 35 52 2 Streatham 164 135 25 51 199 83 Balham 184 159 11 46 247 60 Tooting 361 264 6 18 72 316 Southfield 69 64 33 13 54 29 Fairfield 106 100 34 18 69 62 Springfield 288 216 55 59 205 131 Whole Borough 1435 1165 241 357 989 777 Sanitary Inspection of the Borough. 63 Rent and Mortgage Interest Restrictions Act, 1923. 34 applications for Certificates were received during the year. On inspection it was found that all the premises except one were not reasonably fit for human habitation. One of them was put in a reasonable state of repair before the meeting of the Committee at which Certificates would have been granted, and one applicant removed before the Certificate was granted. Of the 32 premises in respect of which Certificates were granted, one tenant removed, and 28 were rendered reasonably fit during the year. 64 FACTORIES AND WORKSHOPS. The number of factories, workshops, workplaces and home workers' premises is shown in Table XXXIII., together with the number of inspections made. The inspection of food premises are not included in this Table, but are shown in Table XXXVII. TABLE XXXIII. Class of Works. Number of Places on Register at end of 1927. Number of Inspections, 1927. Number of Notices 1927. Number of Prosecutions, 1927. Factories :— Factory Laundries 60 68 7 — Factory Bakehouses 69 218 — — Other Factories 435 526 29 — Total 564 812 36 — Workshops :— Workshop Laundries 38 48 7 — Workshop Bakehouses 44 205 1 — Other Workshops 841 961 21 — Total 923 1214 29 — Workplaces 189 229 8 — Total : Factories, Workshops and Workplaces 1676 2255 73 — Home-workers' premises 451 514 14 — Grand Total 2127 2769 87 — Further details with regard to homeworkers' premises are given in Table XXXIV. ' Factories and Workshops. 65 TABLE XXXIV. 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. In- stances. Notices served. tances. Contrac tors. Workmen. Wearing Apparel :— (1.) Making, etc. 53 37 187 27 14 14 22 (2.) Cleaning and washing 2 4 4 — — — — Paper bags and boxes .. 2 — 5 — — — — Carding, etc., of buttons, etc. — — — — — — — Totals 57 41 196 27 14 14 22 The total number of addresses received from other Councils was 499, and 135 addresses were forwarded to other Councils. The number of addresses received has decreased by 102 and the number sent increased by 13. 17 names and addresses were forwarded to this Borough in error. The number of notices sent to employers during the year was 27, and these had a most satisfactory result. During the year 22 cases of infective diseases—two of Scarlet Fever, four of Diphtheria, one of Measles, and 15 of Whooping Cough—were notified as having occurred in the homes of out-workers. In none of these cases was it necessary to make any order under Section 110 of the Factory and Workshop Act. F 66 Report of the Medical Officer of Health. TABLE XXXV. 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. f Workshop Bakehouses 44 Workshop Laundries 38 Dressmakers' and Milliners' Workshops 152 Bootmakers 120 Smiths and Engineers 49 Builders 44 Tailors 75 Motor Engineers 42 Upholsterers 31 Hairdressers 23 Other 305 Total number of workshops on Register 923 TABLE XXXVI. DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. (1) Number of Defects. No. of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts :—* Want of cleanliness 35 31 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other Nuisances 41 39 — — Sanitary accommodation : Insufficient — — Unsuitable or defective 38 35 — — Not separate for sexes — — — — 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 114 105 — — * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 67 FOOD AND FOOD PREMISES. The following Table gives the number of food premises and slaughterhouses in the Borough, and shows the number of inspections made, the notices served and prosecutions taken. TABLE XXXVII. Premises. Number of Places on the Register at end of 1927. Number of inspections, 1927. Number of Notices, 1927. Number of prosecutions. 1927. Dairies, milkshops and cowsheds 246 1034 2 3 Restaurant kitchens 267 1135 8 — Ice Cream premises 451 278 1 — Slaughterhouses 7 446 — — Butchers' shops 247 2401 6 6 Greengrocers' shops 317 543 7 — Fishmongers' shops 152 798 4 — Fried fish shops 84 485 — — Markets and stalls 184 4560 — Other premises where food is prepared for sale 783 905 5 — Total 2738 12585 33 9 The number of inspections of premises where food is sold or prepared was 12,585, compared with 12,210 in 1926, 6,917 in 1925, and 3,244 in 1924, when a second Food Inspector was appointed, and the duty of inspecting these premises was transferred from the District Inspectors to the Food Inspectors. F 2 68 Report of the Medical Officer of Health. Milk Supply. The Milk and Dairies Order, which came into operation in October, 1926, has led to a great improvement in the milk supply, especially in the distribution of milk, and to-day the bulk of the milk sold retail within the Borough is sent out in bottles filled in properly constructed dairies. The quality of the milk supplied to the Borough throughout the year has been good, and the average fat content shown by the analysis of 900 samples was 3-52 compared with 3-57 in 1926. There are 246 registered milk premises in the Borough, one of them being also a cowshed. All the premises have been regularly inspected, the Food Inspectors making 1,034 visits during the year. The milk utensils and barrows used for the delivery of milk have also been inspected regularly in the street, and as will be seen by Table XXXVIII. no less than 922 samples of milk have been procured and analysed. In three cases roundsmen were summoned for filling bottles with milk in the street, and in each case a fine was inflicted. Seven private slaughter houses are now in use in the Borough, and the Food Inspectors made 446 visits to these premises. They were present on almost every occasion when slaughtering took place, and inspected the carcases and organs after slaughter. 5,494 carcases were examined and four were found to be diseased, and were destroyed for the following reasons :— Meat. Oxen. 1 Carcase and offal 1 ditto Tuberculosis. Septic peritonitis. Sheep. 2 Whole carcases and offal Damaged by accident. The following organs were also found to be diseased and were destroyed :— Oxen. 32 Pairs of Lungs 3 ditto 4 ditto 1 ditto 11 Livers 45 ditto 5 ditto 7 Heads and Tongues 1 Tongue 2 Mesenteries Pigs. 22 Pairs of Lungs 24 ditto 8 Heads 6 Collars 1 Hand and Spring 2 Livers. 3 ditto 1 ditto 4 ditto 1 Heart 2 Hinds of Pork Sheep. 8 Plucks 2 Pairs of Lungs 1 Liver 1 Pair of Lungs 7 ditto Fowl. 1 Fowl Tuberculosis. Abscess. Fluke. Pleurisy. Tuberculosis. Fluke. Abscess. Tuberculosis. Actinomycosis. Tuberculosis. Congestion. Pneumonia. Tuberculosis. Tuberculosis. Tuberculosis. Cirrhosis. Damaged. Milkspots. Necrosis. Pericarditis. Inj uries. Damaged by accident. Fluke. Fluke. Caseous Lymphadenitis. Strongli Rufescens. Tuberculosis. The amount of time devoted to meat inspection is in my opinion fully justified by the results. The work is done very 70 Report of the Medical Officer of Health. systematically by the Food Inspectors, who are specially qualified for this work. There are 247 butchers shops in the Borough. 2,401 inspections were made of these shops and the meat exposed for sale has been examined regularly. Under the Public Health Meat Regulations, 1924, every butcher is required to do all that is reasonably necessary to guard against the contamination of meat by flies, filth and dust. The most efficient method of doing this is by providing a glass front to the shop, and at present only 10 of the 247 butchers' shops in the Borough are entirely without either a fixed or moveable glass front. Four butchers were prosecuted for failing to protect the meat exposed for sale from contamination by dust and in each case a fine was imposed. Two butchers were prosecuted for failing to mark imported meat exposed for sale. In one case a fine of £3 was imposed and the other was cautioned and the summons dismissed. A carrier of meat was summoned for failing to protect the meat carried on the van which he was driving through the street from the market to the retailer, and a fine of £2 10s. was imposed. Unsound Food. At the request of the owners the following foodstuffs were condemned and destroyed, and the usual certificates granted viz. :—11 dozen escallops, 66 lbs. of cod fish, 184 lbs. of haddock, 196 lbs. of plaice, 6 lbs. of lemon soles, 88 lbs. of dried haddocks, 65J lbs. of roe, 2 boxes of cod, 4 boxes of haddock, 168 lbs. of codling (monk, cod, haddock), 187 lbs. of skate, 42 lbs. of mackerel, 64 lbs. of chats, 168 lbs. of catfish, 146 boxes of pears, | bushel black currants, 2 cwt. of potatoes, 117 tins of condensed milk, 4 cwt. of Westminster chocolate and 124 rabbits. Certification of Meat Food Products. All meat food products prepared for export from this country to Canada, Australia and several other countries must Food and Food Premises. 71 be accompanied by a certificate stating that the food has been prepared in a cleanly condition and on sanitary premises, and from meat which has been duly inspected by a Veterinary Surgeon. As Certifying Officer for Wandsworth under the Order I have given 10 of these certificates for the export of parcels of potted meats prepared within the borough. Statement of Work done under the Sale of Food and Drugs Acts. During the year 1,846 samples of foods and drugs were submitted to the Public Analyst for analysis. Of these 944 were purchased as official samples, while 902 were purchased unofficially as test or informal samples. 25, or 2-6 per cent, of the official samples, and 33, or 3-6 per cent, of the unofficial samples were found to be adulterated or not up to standard. The total adulterations reported were 58, or 3-1 per cent, of the samples submitted. Proceedings were instituted against the vendors of four of the 25 adulterated samples taken officially. In one case the summons was dismissed as warranty was proved, and in the other three, the Magistrate ordered the defendants to pay costs amounting to £3 7s. 72 Report of the Medical Officer of Health. TABLE XXXVIII. RESULT OF ANALYSIS OF CERTAIN ARTICLES UNDER THE SALE OF FOOD AND DRUGS ACTS, DURING 1927, SHOWING THE PERCENTAGE ADULTERATED COMPARED WITH 1923, 1924, 1925, AND 1926. Percentage of Samples adulterated, 1923.1926. No. of samples, 1927. 1923. 1924. 1925. 1926. Examined. Found adulterated or not up to standard Percentage adulterated Bread — — — — 6 — — Butter 1.3 0.6 1.7 0.8 297 4 1.3 Cheese — — — — 9 — — Cocoa 4.3 — — — 3 — — Coffee — — 5.4 — 15 — — Confectionery and Jam — — ■— — 4 — — Cream and Preserved Cream 18.5 13.6 6.0 — 64 16 25.0 Self.raising Flour — — — 15 — — Margarine ..... — — — 66 — — Milk 3.6 3.7 2.8 2.0 922 22 2.3 Separated Milk — — — — — — — Condensed Milk — — — 11.0 12 — — Dried Milk 6.6 — — — — — — Mustard — — — 16.6 9 — — Sugar 3.4 — — — 20 1 5.0 Vinegar 42.8 — 4.1 40.0 12 — — Drugs 13.0 14.7 4.5 4.6 37 2 5.4 Other Articles 11.6 1.0 7.1 19.8 355 13 3.6 All Articles 5.5 4.55 3.2 5.3 1846 58 31 Food and Food Premises. 73 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 XXXIX. 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 150 5 3.3 166 6 3.6 316 4.9 11 3.4 Putney 80 4 5.0 86 . 2 2.3 166 5.8 6 3.6 Balham 122 4 3.2 123 3 2.4 245 4.4 7 2.8 Streatham 138 6 4.3 149 5 3.3 287 4.7 11 3.8 Tooting 120 5 41 130 4 3 0 250 61 9 3.6 Wandsworth 292 9 3 0 290 5 1.7 582 5.6 14 2.4 Whole Borough 902 33 3.6 944 25 2.6 1846 5.4 58 31 Milk. The following samples were submitted for analysis :•—• 922 of whole new milk. 12 of condensed milk. Of these, 22 were reported against as being adulterated or not up to Legal Standard. Nine contained extraneous water and 13 were deficient in milk fat. Proceedings were taken in two cases, and in 20 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. 74 Report of the Medical Officer of Health. 36 samples of milk were taken on delivery at the various institutions situated within the Borough. All of these samples were genuine. 43 samples were procured whilst in transit from the farmer to the retailer, the samples being taken when the milk arrived at the various railway stations within the Borough, both at the midnight and mid-day deliveries. Two of these samples were reported against. 17 samples of milk were procured in the early morning from wholesale dealers during delivery to retailers. All of these samples were genuine. 291 samples have been taken on Sundays either in the early morning or at mid-day. Six or two per cent, were reported as adulterated. 537 samples were taken from milk vendors in the street during the early morning (5 to 7 a.m.) on week-days, and of these 12, or 2-2 per cent., were reported against. Milk (Special Designations) Order, 1922 and 1923. The following licences for the sale of Designated Milks were granted :— Certified 72 Grade A (Tuberculin Tested) 68 Grade A 37 Pasteurised 21 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 922 Nil. Cream 44 16 Food and Food Premises. 75 2. Cream sold as " Preserved Cream." Instances in which samples have been submitted for analysis to ascertain if the statement on the label as to preservatives was correct:— (1.) Correct statements made 20 (2.) Statements incorrect 0 Total 20 " Crystallised Boric Acid" was the only preservative found. Determination of milk fat in cream sold as " Preserved Cream " :— (1.) Above 35 per cent. 20 (2.) Below 35 per cent. 0 Total 20 In each of these samples the provisions as to labelling were duly observed and no thickening substances were found in any of the samples. Bacteriological Examination of Milk. 38 samples of milk were examined for Tubercle Bacilli under Section 5 of the Milk and Dairies (Amendment) Act, 1922, and in two cases the milk revealed positive evidence of Tubercle Bacilli. The following samples of graded milk were submitted for bacteriological examination in order to see if the bacterial content was within the standard prescribed for the appropriate grade. TABLE XL. Samples taken. Reported against. Percentage reported against. Certified 19 4 21.0 Grade A (Tuberculin Tested) — — — Grade A — — — Pasteurised 19 6 31.5 All samples examined 38 10 26.3 76 Report of the Medical Officer of Health. The Minister of Health was notified of the result of these examinations. Butter and Margarine. 297 samples of butter were submitted for analysis during the year, and of these four, or 1-3 per cent., were reported against. 66 samples of margarine were submitted for analysis and all were reported genuine. Other Articles. 355 samples were submitted under this heading—for results see Public Analyst's report. 77 MISCELLANEOUS. Bacteriological Examinations. During the year 2,604 bacteriological examinations were made at the Lister Institute. The following Table shows the number of examinations in each sub-district and for the whole Borough, also the disease for which the examination was made, and the result of such examination. TABLE XLI. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Diphtheria :— Negative 334 326 269 228 151 882 2190 Positive 61 51 36 22 25 184 379 Enteric Fever :— Negative 1 3 5 3 2 3 17 Positive 2 — 1 1 — 1 5 Tuberculosis :— Negative 3 1 3 - — 2 9 Positive 1 1 — 2 — — 4 Total .. 402 382 314 256 178 1072 2604 Examinations of Sputum made at the Dispensary are not included in the above figures. Disinfection. The total number of rooms disinfected after the occurrence of cases of infectious disease was 3,270 :—534 in Clapham, 78 Report of the Medical Officer of Health. 284 in Putney, 474 in Balham, 440 in Streatham, 416 in Tooting, and 1,122 in Wandsworth. Five private elementary schools were also disinfected for infectious diseases. Cleansing of Persons Act. The names of 108 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 64 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. 43 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 larvae of mosquitoes. Chloride of lime was used for sprinkling horse manure in order to destroy the larvae and pupae of flies. A total of £1 8s. 6d. was spent in materials used in work of this nature. 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. 15 samples of rag flock were procured and submitted for analysis, and all of them passed the required standard of cleanliness. 18 certificates have been issued in respect of the sterilisation of materials used in the manufacture of rag flock for export. Miscellaneous. 79 Water Supply—Cutting-off Notices. During the year, 94 notices with respect to 125 premises were received from the Water Board, stating that the supply had been withdrawn. In 92 premises the water supply was cut off for nonpayment of rates, in seven in consequence of defects to the supply service, and in 26 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, 12 bodies were removed to the Mortuary, in Streatham six, and in Wandsworth 115, of which 61 were from Wandsworth, 19 from Putney, one from Balham, 30 from Tooting, one from Hammersmith, one from St. Pancras and two from Fulham—a total of 133. Inspection of Sanitary Conveniences. The number of Sanitary Conveniences inspected was 166 ; 45 in Clapham, 18 in Putney, 13 in Balham, 14 in Streatham, 13 in Tooting and 63 in Wandsworth. 1,030 inspections were made during the year, and six notices, chiefly for cleansing, were served and complied with. Ambulance Service. The Metropolitan Asylums Board provide a free ambulance service for the removal of cases of infectious diseases, 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 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. 80 Report of the Medical Officer of Health. 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. 81 STAFF. Details of the staff of the Department in December, 1927, 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 Tuberculosis 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. G 82 Report of the Medical Officer of Health. DISTRICT SANITARY INSPECTORS. Name. Commenced Duty. Certificates held. Sanitary Inspector. Meat and Food. Others. Senior Inspector : A. J. Weeks Dec. 1892 R. San. Inst. No Four Inspectors: 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 Four F. Haworth June 1920 „ No — J. A. Sands July 1920 „ No One A. G. Patterson June 1925 „ Yes — E. V. Roots Sept. 1926 „ Yes — W. T. Willimott Dec. 1927 „ Yes Three FOOD AND DRUGS INSPECTORS. Name. Commenced Duty. Certificates held. Sanitary Inspector. Meat and Food. Others. Chief Inspector: T. Newell Mar. 1900 R. San. Inst. Yes Six Inspectors: W. H. Jones Sept. 1926 S.I. Exam. Bd. Yes One C. F. Standish Jan. 1928 „ Yes — Assistant: (Vacant) 83 Staff. HEALTH VISITORS. Name. Commenced Duty. Certificates held. Health Visitor. Trained Nurse. C. M. B. Sanitary Inspector. Health Visitors: Miss D. S. Collins Mar. 1913 Yes No No Yes „ E. K. Woods Feb. 1916 Yes No Yes Yes „ R. M. Watling May 1922 Yes Yes Yes No „ I. M. Pullar Aug. 1924 Yes No Yes Yes „ P. L. Luff June 1925 Yes No Yes Yes „ D. M. Staniland June 1927 No Yes Yes No „ W. B. Eve Oct. 1927 Yes Yes Yes No TuberculosisVisitors: Miss P. G. Moores April 1915 Yes Yes No No „ E. E. Merron Sept. 1918 No Yes No No „ M. Dean Jan. 1924 Yes No Yes Yes CLERICAL STAFF. Name. Commenced Duty. Appointment. Certificates held. *A. E. Cooper Nov. 1897 Chief Clerk San. Insp. and four others. *F. Bray Oct. 1903 First Class Clerk San. Insp. and six others. *P. C. Clark Nov. 1903 „ One. *F. A. Eustace Nov. 1912 Second Class Clerk One. E. Hunt Mar. 1913 Second Class Clerk and Dispenser. One. Miss C. Wellings May 1921 Second Class Clerk — Miss H. G. Wright Jan. 1925 Third Class Clerk — *P. O'Grady Nov. 1925 „ One. Miss D. E. Kilsby Nov. 1925 „ — *R. H. Chandler Dec. 1925 „ One. *L. L. Parrini May 1923 Office Boy — G 2 84 Report of the Medical Officer of Health. Disinfecting Station. * J. Bond, Engineer. Nine Disinfecting Attendants. Mortuaries. One whole-time and two part-time mortuary keepers. Mr. W. G. Crabbe, Senior Sanitary Inspector, retired in December after 36 years' service with the Council. Mr. A. G. Patterson, who was appointed in June, 1925, as an Inspector of Food and Drugs, was transferred to Mr. Crabbe's district, and Mr. A. J. Weeks was appointed Senior Sanitary Inspector. Mr. E. J. Edwards resigned his appointment as Sanitary Inspector in October on being appointed in the same capacity by the Stepney Borough Council. This vacancy was filled by the appointment of Mr. W. T. Wilhmott, previously a Sanitary Inspector to the City of Liverpool. Mr. C. F. Standish, Assistant to the Chief Inspector of Food and Drugs, was appointed Sanitary Inspector to fill the vacancy caused by the transference of Mr. Patterson to be a District Sanitary Inspector. Mr. Standish's successor had not been appointed by the end of the year. Miss A. Bannerman resigned her appointment as Health Visitor in May, after seven month's service, and Miss D. M. Staniland was appointed in her place. In accordance with the decision of the Council to appoint Health Visitors to act as Superintendents of the Infant Welfare Centres, as vacancies occur (see page 48), Miss W. B. Eve was appointed Health Visitor in October following the resignation of the Superintendents of the Fairfield and Springfield Centres. 85 Staff. Mr. P. C. Clark has been promoted First Class Clerk after 24 years' service in the Department. Mr. H. T. Lambert has obtained the Smoke Inspector's Certificate awarded by the Royal Sanitary Institute, and Mr. W. H. Jones has obtained the Sanitary Science Certificate awarded by the Battersea Polytechnic. Miss E. K. Woods has been awarded medallions by the London County Council for Home Nursing and First Aid. Miss Merron and Miss Pullar attended the 6th Winter School for Health Visitors organised by the Women Sanitary Inspectors' and Health Visitors' Association. Eight of the female visiting staff have now attended this Course. 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. VITAL STATISTICS.—CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF WANDSWORTH, 1927. Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 45— 65— 75— ALL CAUSES 3895 M. 1861 134 32 30 47 79 211 540 406 382 F. 2034 110 23 27 52 75 218 490 389 650 1. Enteric Fever M. 1 - - - - - - 1 - - F. 3 — — - — 1 2 — — — 2. Small-pox M. - - - - - - - - - - F. - - - - - - - - - - 3. Measles M. 2 1 - 1 - - - - - - F. 2 — 2 - - - - - - - 4. Scarlet Fever M. 3 - 1 - 2 — — — — - F. 2 — - - 1 - 1 — — — 5. Whooping Cough M. 10 3 4 1 2 - - - - - F. 18 9 5 3 1 - - - - - 6. Diphtheria M. 11 - 1 4 6 - - - - - F. 12 — 1 3 8 — — — — — 7. Influenza M. 51 1 1 - - 3 9 23 10 4 F. 93 3 — 2 1 1 12 19 18 37 8. Encephalitis lethargica M. - - - - - - - - - - F. 3 — — — — 2 — 1 — — 9. Meningococcal meningitis M. 2 1 - - 1 - - - - - F. 1 - - - 1 - - - - - Report of the Medical Officer of Health. 86 87 Vital Statistics. 10. Tuberculosis of respiratory system M. 160 — 1 — 1 27 66 50 13 2 F. 137 — 1 — 3 40 58 30 4 1 11. Other tuberculous diseases M. 21 2 2 4 6 3 4 F. 25 — 3 3 6 6 3 2 2 — 12. Cancer, malignant disease M. 217 - — 1 - 2 8 105 75 26 F. 283 — — 2 1 — 29 130 72 49 13. Rheumatic fever M. 9 - 1 - 3 3 2 - - F. 9 — — — 2 3 2 2 — — 14. Diabetes M. 13 - - - - - 3 6 3 1 F. 17 - - - - - 2 5 3 7 15. Cerebral haemorrhage, etc. M. 86 - - - - - 1 25 26 34 F. 104 - - - - - - 26 33 45 16. Heart disease M. 295 - - - 2 2 19 67 91 114 F. 377 -- - 1 2 5 22 77 96 174 17. Arterio-sclerosis M. 79 - - - - - - 25 24 30 F. 63 - - - - - - 10 15 38 18. Bronchitis M. 112 6 2 2 - - 4 24 29 45 F. 155 3 1 — 1 — 2 21 39 88 19. Pne-umonia (all forms) M. 121 22 13 7 3 4 12 30 22 8 F. 109 17 6 5 5 — 8 33 17 18 20. Other respiratory diseases M. 34 - - 2 1 1 6 13 5 6 F. 30 — — — 1 — 3 5 8 13 21. Uleer of stomach or duodenum M. 31 - - - - - 5 20 4 2 F. 15 - - - - - 3 8 2 2 88 Report of the Medical Officer of Health. VITAL STATISTICS.—CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF WANDSWORTH, 1927—continued. Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 45— 65— 75— 22. Diarrhoea, etc. M. 16 8 2 2 - - - 1 1 2 F. 15 8 1 1 — — 1 2 1 1 23. Appendicitis and typhlitis M. 6 — — — 2 1 3 — — — F. 5 — — — 2 — 1 1 1 — 24. Cirrhosis of liver M. 18 - - - - - 2 5 7 4 F. 10 — — — — — 2 5 2 1 25. Acute and chronic nephritis M. 57 - — - 1 3 4 20 19 10 F. 58 — — — 1 1 3 22 19 12 26. Puerperal sepsis M. - - - - - - - - - - F. 6 — — — — 1 5 — — — 27. Other accidents and diseases of pregnancy and parturition M. - - - - - - - - - - F. 11 — — — — 2 9 — — —- 28. Congenital debility and malformation, premature birth. M. 75 72 1 — 1 1 — — — — F. 56 54 — — 1 - — 1 — — 29. Suicide M. 35 — — - - 2 15 15 2 1 F. 14 — — — - — 5 9 — — 30. Other deaths from violence M. 70 1 - 4 2 16 11 20 5 11 F. 39 — 1 2 4 3 5 10 4 10 31. Other defined diseases M. 325 17 3 2 14 14 38 85 70 82 F. 362 16 2 5 11 10 40 71 53 154 32. Causes ill-defined or unknown M. 1 - - - - - - 1 - - F. - - - - - - - - - - 89 HOUSING STATISTICS. Number of New Houses Erected during the Year:— Total 1299 (i.) By the Local Authority 211 (ii.) By other bodies or persons 1088 (By the Borough Council since 1919—1,077). 1. Unfit Dwelling Houses. (1.) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 13752 (2.) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 1435 (3.) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation - (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 4600 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 3880 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 after service of formal notices:— (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 560 (2.) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a.) By owners 441 (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 representations made with a view to the making of Closing Orders Nil (2.) Number of dwelling-houses in respect of which Closing Orders were made Nil (3.) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (4.) Number of dwelling-houses in respect of which Demolition Orders were made Nil (5.) Number of dwelhng-houses demolished in pursuance of Demolition Orders Nil PARTICULARS OF PROCEEDINGS TAKEN UNDER PUBLIC HEALTH ACTS. Premises. Offences. Result. Fine. Costs. s. d. s. d. 54, Lydden Grove. Wandsworth Nuisances Summons adjourned sine die, work having been done. - - - - 29, Winfrith Road, Wandsworth. Keeping of pigeons in an unfit place and manner. Order made to reduce number of pigeons. — - 2 0 106, Stonhouse Street, Clapham. Nuisances and contravention of Bye-laws (yard paving). Summons withdrawn - - 21 0 45, Bowland Road, Clapham. Nuisances Order made for abatement of nuisances. - - - - Non-compliance with Order 30 0 10 6 47, Bowland Road, Clapham. Nuisances Order made for abatement of nuisances. - - - - Failing to provide dustbin Order made to provide dustbin 31 6 Non-compliance with Order 30 0 10 6 49, Bowland Road, Clapham. Nuisances Order made for abatement of nuisances. - - - - Non-compliance with Order 30 0 10 6 51, Bowland Road, Clapham. Nuisances Order made for abatement of nuisances. - - 7 0 Non-compliance with Order 30 0 10 6 31, Union Road, Clapham. Nuisances Order made for abatement of nuisances. - - 10 6 Police Court Proceedings. 91 92 Report of the Medical Officer of Health. PARTICULARS OF PROCEEDINGS TAKEN UNDER PUBLIC HEALTH ACTS—continued. Premises. Offences. Result. Fine. Costs. s. d. s. d. 18, Thurlow Street, Clapham. Nuisances. Order made for abatement of nuisances. - - 21 0 Contravention of Bye-laws (water closets). Summons dismissed, the work having been done. — - 10 6 173, Trinity Road, Wandsworth. Nuisances Summons dismissed — - — - 54, Bedford Hill, Balham Nuisances Order made for abatement of nuisances. — - 21 0 14, 19, 20 and 22, Wharf Road, Wandsworth. Nuisances Summonses withdrawn,the work having been done. — - 42 0 7, Siward Road, Wandsworth. Nuisances Summons withdrawn, the work having been done. — - 12 0 11 and 13, Turtle Road, Wandsworth. Nuisances Summonses adjourned, sine die — - — - 9, Rectory Gardens, Clapham. Nuisances Order made for abatement of nuisances. — - 21 0 39, Ramsden Road, Balham. Nuisances. Summons dismissed, the work having been done. — - 42 0 33, Stonhouse Street, Clapham. Nuisances Summons dismissed, the work having been done. — - 21 0 Analysts' Annual Report. 93 PARTICULARS OF PROCEEDINGS TAKEN UNDER PUBLIC HEALTH ACTs—continued. Premises. Offences. Result. Fine. Costs. s. d. s. d. 9 and 11, Rectory Gardens, Clapham. Nuisances Summonses withdrawn, the work having been done. – 42 0 64 and 70, Rectory Grove, Clapham. Nuisances Summonses adjourned sine die – 21 0 70d, The Chase, Clapham. Nuisances Order made for abatement of nuisances. – 21 0 550, High Road, Streatham. Nuisances Order made for abatement of nuisances. – – 53, Bowland Road, Clapham. Nuisances Order made for abatement of nuisances. – 21 0 In Brookwood Road, Wandsworth. Removal of offensive matter through the streets at a prohibited hour. Summons dismissed – 84 0 490, Wandsworth Road, Clapham. Nuisances Order made for abatement of nuisances. — 42 0 44 and 46, Jews Row, Wandsworth. Nuisances Summonses adjourned sine die, the work having been done. – – £6 0 0 £26 15 6 94 Annual Statement of the work done in the Borough of Wandsworth under the Sale of Food and Drugs Acts. Mr. Mayor and Gentlemen, Herewith we have pleasure in handing you our annual report of the work performed by us under the Sale of Food and Drugs Acts and various food regulations during 1927. In all 1,846 samples were submitted for analysis, of which 944 were taken with the necessary formalities required by the Acts, the remainder, 902, having been procured informally. Below will be found a statement setting out the nature of all samples examined with the results of our analysis, the details of Drugs and "Other Articles" being given in tables following :— GENERAL STATEMENT. Nature of Sample. Examined Adulterated. Formal. Informal. Total. Formal. Informal. Total. Bread — 6 6 — — — Butter — 297 297 — 4 4 Cheese — 9 9 — — — Cocoa — 3 3 — — — Coffee — 15 15 — — — Confectionery — 4 4 — — — Cream 4 40 44 4 12 16 Cream, preserved 3 17 20 — — — Flour — 3 3 — — — Flour, (Self-raising) — 12 12 — — — Margarine 6 60 66 — — — Milk 908 14 922 18 4 22 Milk, Condensed (Machine skimmed) — 12 12 — — — Mustard — 9 9 — — — Sugar 1 19 20 — 1 1 Vinegar — 12 12 — — — Drugs — 37 37 — 2 2 Other Articles 22 333 355 3 10 13 Total 944 902 1846 25 33 58 Analysts' Annual Report. 95 DRUGS (Informal). Nature of Sample. Examined. Adulterated. Camphorated Oil 6 — Cream of Tartar 7 — Powder, Seidlitz 6 — Ointment, Mercury 4 2 Ointment, White ppt. 2 — Rochelle Salts 3 — Tincture of Iodine 3 — Tincture of Quinine, Ammoniated 6 — Total 37 2 OTHER ARTICLES. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Apples — 2 2 — 1 1 Bacon — 7 7 — Baking Powder — 20 20 — — Barley, Pearl — 6 6 — — — Brawn — 6 6 — Cakes, sponge — 6 6 — — — Cherries, Glace — 6 6 — Chocolate drink 1 — 1 — Cider — 1 1 — Coffee and Chicory — 1 1 — Coffee Extract — 1 1 — Coffee and Chicory Extract — 4 4 — Cordials — 8 8 — Cornflour — 6 6 — Dyes — 14 14 — 2 2 Easter Eggs — 9 9 — Fish Paste — 9 9 — Fruit, dried — 24 24 — Gelatine — 7 7 — 2 2 Honey — 6 6 — — Ice Cream 6 — 6 — — Lard — 25 25 — 1 1 Lemonade 4 — 4 2 2 Lemon Curd — 9 9 — — Meat Paste — 10 10 — Meat Pie — 5 5 — Mince Meat — 12 12 — Mineral Waters — 4 4 — Peas, preserved — 1 1 — — — 96 Report of the Medical Officer of Health. OTHER ARTICLES.—continued. Nature of Sample. Examined Adulterated. Formal. Informal. Total. Formal. Informal. Total. Peel, mixed — 4 4 — — — Pepper — 3 3 — — — Preservatives 1 15 16 1 4 5 Rice — 36 36 — — Sago — 3 3 — — — Sausages 8 27 35 — — — Sausages, preserved — 6 6 — — — Seasoning 1 1 2 — — — Semolina — 3 3 — — — Tapioca — 18 18 — — — Wine Essence 1 — 1 — — — Wine, Non-alcoholic — 8 8 — — — Total 22 333 355 3 10 13 Below will be found the nature of the report issued in the case of Informal samples returned as adulterated :— No. Nature of Sample. Nature of Report. 28 Dye Contains Arsenic. 29 Ditto Ditto 42 Preservative (Tripe Bleacher) Contains a Boron Compound. 46 Sheet Gelatine Contains Excess Sulphur dioxide. 47 Powdered Gelatine Ditto 48 Preservative Contains Boric Acid. 49 Apples Arsenic on Surface. 51 Cream Contains Boric Acid. 52 Ditto Ditto 53 Ditto Ditto 55 Ditto Ditto 104 Preservative Contains a Boron Compound. 105 Ditto Ditto 258 Sugar Contains Ground Rice. 319 Milk Deficient in Fat. 320 Ditto Ditto 321 Ditto Ditto 322 Ditto Ditto 351 Mercury Ointment Deficient in Mercury. 353 Ditto Ditto 532 Cream Contains Boric Acid. 533 Ditto Ditto 534 Ditto Ditto 577 Ditto Ditto 578 Ditto Ditto 579 Ditto Ditto 97 Analysts' Annual Report. No. Nature of Sample. Nature of Report. 587 Butter Contains Margarine. 602 Lard Contains Water. 789 Butter Contains Excess of. Water. 792 Ditto Ditto 874 Ditto Ditto 883 Cream Contains Boric Acid. 885 Ditto Ditto Of the 297 samples of Butter examined during the year, 128, or 43.1 per cent., were free from preservatives other than Common Salt, whilst 169, or 56.9 per cent., contained a Boron preservative in no case exceeding the maximum permissible, namely 0.5 per cent, calculated as Crystallised Boric Acid. The average water content of these samples amounted to 13.3 per cent. The following Table shows, in detail, the nature and extent of the adulteration detected in Formal samples submitted :– No. Nature of Sample. Nature of Report. 42 Cream 0.33 % Crystallised Boric Acid. 43 Ditto 0.29 % Crystallised Boric Acid. 45 Ditto 0.26 % Crystallised Boric Acid. 46 Ditto 0.27 % Crystallised Boric Acid. 139 Preservative 4.56 % Sulphur Dioxide. 235 Milk 3½ % Extraneous Water. 241 Ditto 14 % Fat deficient. 300 Ditto 6 % Fat deficient. 313 Ditto 3 % Extraneous Water. 314 Ditto 3 % Extraneous Water. 388 Ditto 1 % Extraneous Water. 402 Ditto 8 % Fat deficient. 408 Ditto 8 % Fat deficient. 446 Ditto 2 % Extraneous Water. 450 Ditto 8 % Fat deficient. 460 Ditto 21 % Fat deficient. 477 Lemonade 26 parts Lead per million. 479 Ditto 8 parts Lead per million. 524 Milk 18 % Fat deficient. 592 Ditto 1½ % Extraneous Water. 593 Ditto 2½ % Extraneous Water. 647 Ditto 4½ % Extraneous Water. 648 Ditto 1½ % Extraneous Water. 649 Ditto 2 % Fat deficient. 904 Ditto 5 % Fat deficient. H 98 Report of the Medical Officer of Health. Since the beginning of 1927 the use of preservative in Margarine has been prohibited, and it is satisfactory to be able to report that all of the 66 samples submitted proved to be preserved by nothing other than Common Salt. The average water content of these 66 samples proved to be 13.4 per cent. We give below a statement showing the average composition of the Milks examined and returned as genuine during each month of the year :— Month. Total Milk Solids. Milk Fat. Non-fatty Solids. January 12.44 % 3.46 % 8.98 % February 12.29 % 3.48 % 8.81 % March 12.24 % 3.45 % 8.79 % April 12.22 % 3.55 % 8.67 % May 12.16 % 3.33 % 8.83 % June 12.14 % 3.30 % 8.84 % July 12.38 % 3.60 % 8.78 % August 12.23 % 3.50 % 8.73 % September 12.48 % 3.65 % 8.83 % October 12.70 % 3.73 % 8.97 % November 12.77 % 3.90 % 8.87 % December 12.96 % 3.96 % 9.00 % The average composition of the 900 Milks returned as genuine during 1927 was :— Total Milk solids 12.34 per cent. Milk fat 3.52 „ Non-fatty Solids 8.82 „ During the year under review six samples were submitted for examination because complaints had been made by ratepayers in respect to them. These consisted of three samples of Sweetmeats, one of Coffee and Chicory, one of Jam Sandwich and one of Sausages. In every case these articles were suspected of being the cause of illness to the persons partaking of them; but analysis failed to reveal the presence of any deleterious matter and the samples were, therefore, reported as being genuine. Analysts' Annual Report. 99 On January 1st, 1927, regulations prohibiting or restricting the use of preservatives, other than salt, vinegar, sugar, etc., came into operation and, therefore, a large number of the samples mentioned in this report were procured by Mr. Newell, the Council's Food Inspector, with a view to ascertaining if these regulations were being properly carried out. It is satisfactory to note that our examination of these articles shows that such is the case. As will be seen, five samples of preservatives were found to contain a Boron compound and as this may not now be used in connection with articles of diet, they were returned as adulterated; two samples of Gelatine proved, on analysis, to contain more Sulphur dioxide than the maximum permissible (namely 1,000 parts per million), whilst two of Dye were found to contain distinct traces of Arsenic. We should like to draw attention to the very varied nature of the samples submitted during the year, and to congratulate the Borough on the purity of its food supply, due, in a large measure, to the efficient systematic inspection carried out. We are, 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. 325, Kennington Road, S.E. 11. 29th February, 1928. INDEX. PAGE Adulteration of Certain Articles, Percentage of, in 1923-1927 72 Ambulance Service 79 Analysts, Report of 94 Anti-toxin 17 Area of Borough 1 Artificial Light Treatment of Tuberculosis 38 Bacteriological Examinations 43, 77 Bacteriological Examination of Milk 75 Bakehouses 64 Balham, House-to-House Inspections in 62 Births 4 Births and Birth-rates in Sub-Districts 4 Birth-rate, Average 10 Years, 1917-1926 8 Births, Notification of, Act 5 Brain and Nervous System, Diseases of the 28 Butchers' Shops 67 Butter and Margarine 76 Cancer 28 Census, 1921 1, 4 Cerebro-Spinal Meningitis 20 Child Birth, Deaths from 28 Circulatory Diseases 28 Clapham, House-to-House Inspections in 62 Cleansing of Persons Act 78 Conscientious Objection Certificates granted 16 Convalescent Homes 56 Cowsheds 67 Creches 55 Cutting-off Notices 79 Dairies, Milkshops and Cowsheds 67 Day Nurseries 55 Death, Causes of 7, 86-88 Death-rate, Average 10 Years, 1917-1926 8 101 Index. PAGE Death-rate, Corrected 6 Death-rate from Infective Diseases 12 Death-rate, Infantile 9 Deaths, Corrected 6 Deaths, Number of 6 Deaths in Institutions 9 Dental Treatment 37, 57 Developmental Diseases 28 Diarrhœa 26 Diphtheria 17 Diphtheria, Attack Rate per 1,000 cases 17 Diphtheria, " Return Cases " of 18 Disinfection 77 Disinfection of Schools 78 Dysentery 21 Encephalitis Lethargica 21 Enteric Fever 19 Erysipelas 20 Expectant and Nursing Mothers, Institutions for 55 Factories and Workshops 64 Factories, Workshops, etc., Defects found in 66 Factories, Workshops and Workplaces, Inspection of 64 Families, Number of, Census 1921 1 Fishmongers' Shops 67 Flies and Mosquitoes 78 Food, Prosecutions in connection with 71 Food and Food Premises 67 Food Places, Inspection of 67 Fried Fish Shops 67 German Measles, Cases of 22 Greengrocers' Shops 67 Health Visitors, Work of 47 Home Work 65 Hospitals, etc., for Expectant and Nursing Mothers 55 House Refuse, Removal of 80 House-to-House Inspections, Summary of 62 Houses and Premises Inspected 61 Houses Let in Lodgings 61 102 Index. PAGE Housing Statistics 89 Housing Act, 1925 62 Ice Cream Premises 67 Illegitimate Children, Births of 5 Increase of Rent and Mortgage Interest (Restrictions) Act, 1923 63 Infant Visiting 50 Infantile Mortality 9, 10 Infantile Mortality, 10 Years, 1917-1926 11 Infective Diseases 12, 27 Infective Diseases, Deaths at certain Age Periods 13 Infective Diseases, Death Rate from 12 Infective Diseases : Number of Cases Notified from Elementary Schools 24-26 Influenza, Deaths and Death-rates 20 Influenza, Pneumonia and Acute Primary Pneumonia, Cases Notified 20 Inhabited Houses, Number of 1 Inquests 28 Inspections, Details of 61 Institutions, Deaths in 9 Institutions for Expectant Mothers, etc. 55 Malaria 21 Margarine 76 Markets and Stalls 67 Maternity and Child Welfare 47 Maternity and Child Welfare Centres 52 Measles and German Measles 22 Measles and other Non-notifiable Diseases reported from Schools 24-26 Meat 68 Meat Food Products, Certification of 70 Midwives 51 Milk Analysis 73 Milk and Cream Regulations, 1912 and 1917 74 Milk and Dairies (Amendment) Act, 1922 75 Milk, Bacteriological Examination of 75 Milk (Mothers and Children) Order 56 Milk Premises, Cowsheds, etc., on Register 67 103 Index. PAGE Milkshops, Cowsheds, etc., Inspections of 67 Milk (Special Designation) Order, 1922 and 1923 74 Milk Supply 68 Mortuaries 79 Mosquitoes 78 Natural Increase, Rate of 4 Nervous System, Diseases of the 28 Non-Infective Diseases, Deaths from 28 Notification of Births Act 5 Notification of Infective Diseases 14, 15 Nursing Arrangements 51 Offensive Trades 61 Old Age 28 Ophthalmia Neonatorum 21 Other Infective Diseases, Deaths from 27 Outworkers 65 Overcrowding 59 Para-Typhoid Fever 19 Physical Features, etc., of the Borough 1 Pneumonia 20 Police Court Proceedings 71, 91-93 Polio-Myelitis and Polio-Encephalitis 20 Poor Law Relief, Amount of 2 Population 1,3 Population of Sub-Districts 4 Premature Birth 28 Pregnancy, Deaths from Accidents and Diseases of 28 Puerperal Fever and Puerperal Pyrexia Regulations, 1926 19 Puerperal Pyrexia 19 Pulmonary Tuberculosis, Notification of Cases of 30 Putney, House-to-House Inspections in 62 Rag Flock Act, 1911, Statement of Work done under 78 Rateable Value 1 Rent and Mortgage Interest Restrictions Act, 1923 63 Respiratory Diseases 28 Restaurant Kitchens 67 Return Cases of Scarlet Fever and Diphtheria 18 104 Index. PAGE Sale of Food and Drugs Act, Proceedings under 71 Sale of Food and Drugs Act, Statement of Work under 71 Samples, Formal and Informal, Number of 73 Sanitary Conveniences, Inspection of 79 Sanitary Inspection of the Borough 59 Sanitary Operation, Table of 60 Scabies 27 Scarlet Fever 18 Scarlet Fever : Attack Rate per 1,000 Cases 18 Scarlet Fever, "Return Cases" of 18 Schools, Disinfection of, for Infective Diseases 78 Shelters for Tuberculous Patients 38 Slaughter-houses 67 Small-pox 16 Smoke Nuisances 60 Social Conditions 2 Sputum Examinations 43 Staff 81 Streatham, House-to-House Inspections in 62 Tooting, House-to-House Inspections in 62 Tuberculosis 30 Tuberculosis, Artificial Light Treatment of 38 Tuberculosis Dispensaries 36 Tuberculosis Care Committee 43 Tuberculosis, Institutional Treatment 36 Tuberculous Diseases, Extra Nourishment provided 37 Underground Rooms 62 Unsound Food 70 Vaccination Returns 16 Violence, Mortality from 28 Vital Statistics of Whole Borough 3, 86-88 Wandsworth, House-to-House Inspections in 62 Water Supply, Cutting-off Notices 79 Whooping Cough 20 Workshops, Number of 66 Young Children, Institutions for 55 Zymotic Diseases 12