Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, &c. OF THE BOROUGH, For the Year 1928, 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 primers LANCELOT PLACE. SW 7 REPORT of the Medical Officer of Health for the Year 1928. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Wandsworth. Sir, Madam and Gentlemen, I have the honour to present my Annual Report on the health and sanitary condition of the Borough for the year 1928. GENERAL STATISTICS FOR THE BOROUGH. Area 9,199 acres Population in 1928 354,948 No. of inhabited houses in 1921 62,540 No. of families, or separate occupiers, in 1921 80,526 Rateable value in 1928 £2,818,937 Estimated produce of a penny rate £11,400 PHYSICAL FEATURES AND GENERAL CHARACTER OF THE BOROUGH. The Registrar-General has estimated the population in 1928 as 347,300, 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 unoccuped. 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, 1928:— (1.) No. of admission to the Poor Law Institutions 4,399 (2.) No. of medical orders given 2,875 Vital Statistics. 3 (3.) Average No. of persons in receipt of outdoor relief 2,886 (4.) Amount of outdoor relief given .. £49,662 Extracts from Vital Statistics. Births:— Males 2,373 Legitimate 4,420 Females 2,243 Illegitimate 196 Total Births 4,616 Birth-rate 13-00 Deaths:— Total Deaths 3,757 Death-rate 10-58 No. of women dying in, or in consequence of, childbirth :— From sepsis 6 From other causes 15 Deaths of Infants under one year of age:— Legitimate 211 Illegitimate 19 Total 230 Infantile mortality 49 Deaths from Tuberculosis:— No 294 Rate .82 Total deaths from Measles 36 Total deaths from Whooping Cough 9 Total deaths from Diarrhoea (under two years of age) 34 Population. The population at the middle of the year was estimated to be 354,948, and all the rates used in this Report are calculated on this figure. The corresponding figure for the year 1927 was 354,178. 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 1928 Clapham 60,540 63,576 Putney 28,558 32,547 Balham 50,888 55,057 Streatham 52,607 60,511 Tooting 40.135 40,802 Wandsworth 95,579 102,455 Whole Borough 328,307 354,948 Births. The total number of births occurring in the Borough was 3,724, including 414 non.residents who were born in Institutions. 1,306 births of Borough residents occurred outside the Borough, so that the corrected number of births was 4,616 compared with 4,653 in 1927. 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 412 427 839 13.03 2.43 Putney 212 179 391 12.00 dec. .16 Balham 391 376 767 13.93 2.93 Streatham 421 402 823 13.58 2.60 Tooting 264 255 519 12.72 3.17 Wandsworth 673 604 1,277 12.16 2.32 Whole Borough 2,373 2,243 4,616 13.00 2.42 Vital Statistics. 5 The birth-rate was 13.00 per 1,000, compared with 13.13 for 1927, and 15.93 the decennial average. The rate for the whole of London during 1928 was 15.9, and for England and Wales, 16.7. 241 illegitimate births took place in the Borough, but only 91 belonged to the Borough. On the other hand 105 illegitimate births belonging to Wandsworth occurred outside the Borough, making a corrected total of illegitimate births belonging to Wandsworth of 196. 30 of these belonged to Clapham, 17 to Putney, 34 to Balham, 50 to Streatham, 17 to Tooting, and 48 to Wandsworth. The percentage of illegitimate births to total births was 4.4. 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 578 489 196 80 204 9 15 Putney 319 276 97 11 165 3 4 Balham 564 496 162 33 256 45 14 Streatham 867 710 199 67 278 166 28 Tooting 419 378 64 43 267 4 11 Wandsworth 977 945 169 209 516 51 18 Whole Borough 3,724 3,294 887 443 1,686 278 90 6 Report of the Medical Officer of Health. Deaths. The number of deaths which took place in the Borough during the year was 3,349, but 1,186 of these did not belong to the Borough, while 1,594 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 3,757, of whom 1,820 were males and 1,937 females. The corrected death-rate for the year was 10.58, compared with 10.96 in 1927. The death-rate for the whole of London for 1928 was 11.6, for England and Wales, 11.7, in the 107 County Boroughs and great Towns 11.6, and in the 156 smaller Towns 10.6. 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 348 326 674 10.60 Putney 179 217 396 12.16 Balham 284 322 606 11.00 Streatham 283 382 665 10.98 Tooting 202 188 390 9.55 Wandsworth 524 502 1,026 10.14 Whole Borough 1,820 1,937 3,757 10.58 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 1928. 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 3 1 2 ... ... ... ... 1 2 ... ... 1 ... 1 1 ... ... 4 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 36 19 17 7 18 9 2 ... ... ... ... 3 1 7 1 6 18 30 Scarlet Fever 3 2 1 1 ... 1 1 ... ... ... ... ... ... 2 1 ... 2 Whooping Cough 9 3 6 6 3 ... ... ... ... ...... ... 2 ... ... 3 ... 4 5 Diphtheria and Membranous Croup 15 11 4 2 1 4 7 1 ... ... ... 3 2 ... 2 1 7 13 Influenza 41 20 21 ... ... 1 1 1 4 13 21 5 6 7 7 5 11 9 Erysipelas 2 1 1 1 ... ...... ... ... 1 ... ... 1 1 ... ... ... ... 2 Cerebrospinal Fever 3 2 1 2 ... ... 1 ... ... ... ... ... ... ... ... 1 2 3 Other Epidemic Diseases 6 4 2 ... ... ... l 1 1 3 ... ... 1 ... 3 ... 2 3 Pulmonary Tuberculosis 243 134 109 1 ... ... 2 59 103 63 13 32 23 24 43 40 81 123 Tuberculous Meningitis 22 16 6 l ... 6 8 4 2 1 ... 3 4 7 1 1 6 17 Abdominal Tuberculosis 5 2 3 ... 1 ... ... 2 1 1 ... 1 ... ... 1 2 1 2 Other Tuberculous Diseases 24 17 7 ... ... 5 1 5 5 3 5 5 5 2 3 4 5 17 Other Infective Diseases 23 15 8 1 ... ... 1 1 7 9 4 5 4 3 3 1 7 19 Cancer, Malignant Disease 493 223 270 ... 1 ... 2 5 39 218 228 90 48 81 91 37 146 217 Rheumatic Fever 26 9 17 ... ... ... 6 4 2 9 5 4 4 3 5 1 9 14 Diabetes 40 18 22 ... ... ... 1 ... 3 13 23 6 5 3 9 8 9 17 Other General Diseases 67 20 47 ... 1 2 2 5 13 17 27 7 11 12 12 4 21 34 Alcoholism 1 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... Chronic Poisonings 1 1 ... ... ... ... ... ... ... 1 ... ... ...... ... ... l ... ... Meningitis 16 9 7 4 3 1 2 2 1 3 ... 6 2 3 3 ... 2 10 Cerebral Haemorrhage, Apoplexy 206 83 123 ... ... ... ... ... 7 55 144 42 27 29 37 15 56 62 Convulsions 8 5 3 7 1 ... ... ... ... ... ... 2 1 1 ... 1 3 2 Other Diseases of Nervous System 113 66 47 ... ... l 5 8 23 47 29 19 15 16 22 10 31 83 Organic Diseases of Heart 686 288 398 ... ... ...... 3 8 39 133 503 129 65 112 116 82 182 301 Other Diseases of Circulatory System 189 93 96 1 ... l 4 6 16 53 108 38 26 28 36 11 50 85 Bronchitis 209 92 117 9 ... 3 ... ... 4 39 154 47 21 31 32 26 52 42 Broncho-Pneumonia 116 52 64 24 14 4 2 l 9 15 47 25 12 23 18 11 27 57 Lobar Pneumonia 53 28 25 4 2 1 2 3 7 20 14 8 9 7 15 4 10 14 Pneumonia (type not distinguished) 77 46 31 4 6 ... ... 3 9 22 33 9 4 14 7 13 30 40 Other Diseases of Respiratory System 38 15 23 1 ... ... 1 1 7 9 19 5 2 7 9 7 8 20 Ulcer of Stomach 21 15 6 ... ... ... ... ... 1 15 5 6 3 ... 3 3 6 18 Diarrhoea 7 2 5 7 ... ... ... ... ... ... ... 1 ... 1 ... ... 5 7 Enteritis 33 16 17 24 3 1 1 ... 2 1 1 10 3 2 3 3 12 20 Appendicitis and Typhlitis 20 13 ... ... ... 1 3 1 2 6 7 2 3 2 5 2 6 18 Obstruction of Intestines 25 9 16 1 ... 1 1 1 3 7 11 5 1 4 6 2 7 IS Cirrhosis of Liver 35 20 15 ... ... ...... ... ... 1 22 12 9 2 4 10 5 5 16 Other Diseases of Liver 20 6 14 ... ... ... ... ... 2 4 14 7 2 2 4 2 3 10 Other Diseases of Digestive System 53 32 21 ... ... ... 5 ... 10 25 13 9 7 13 6 4 14 38 Nephritis and Bright's Disease 164 91 73 1 ... ... 3 2 12 74 72 25 21 37 29 16 36 92 Other Diseases of Urinary System 65 46 19 ... ... ... 1 ... 6 14 44 10 3 19 9 2 22 46 Diseases of Generative System 6 ... 6 ... ... ... ... ... 2 3 1 ... 1 2 ... 2 1 7 Puerperal Fever 6 ... 6 ... ... ... ... 2 4 ... ... 1 ... ... 3 1 1 4 Other Accidents and Diseases of ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pregnancy and Childbirth 15 ... 15 ... ... ... ... 2 11 2 ... ... 1 4 2 4 4 9 Premature Birth 49 26 23 49 ... ... ... ... ... ... ... 13 5 6 10 8 7 22 Congenital Debility and Malformation 51 30 21 46 3 ... 2 ... ... ... ... 10 3 6 15 3 14 29 Other Diseases of Early Infancy 18 9 9 18 ... ... ... ... ... ... ... 5 2 2 2 2 5 6 Old Age 166 57 109 ... ... ... ... ... ... 1 165 19 18 41 40 17 31 61 Deaths from Accident 136 84 52 5 ... 5 ...... 27 15 22 50 24 13 30 16 12 41 112 Deaths from Suicide 51 42 9 ... ... ... ... 1 18 22 10 12 4 7 13 7 8 26 Other Violent Deaths 5 4 1 1 ... ... ... ... 4 ... ... 1 1 ... ... ... 3 4 Other Defined Diseases 27 16 11 l ... 1 2 ... 8 6 9 6 2 2 4 1 12 22 Ill-defined Diseases or unknown 10 6 4 1 ... ... ... 1 2 3 3 1 1 1 3 1 3 4 All causes 3757 1820 1937 230 57 48 85 158 410 974 1795 674 396 606 665 390 1026 1836 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. 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 1927 13.13 16.1 16.7 10.96 11.9 12.3 Average 10 years 15.93 19.5 19.6 11.15 12.9 12.8 1928 13.00 15.9 16.7 10.58 11.6 11.7 The total number of deaths which occurred in Institutions, etc., inside the Borough was 1,428, but 1,186 of these persons did not belong to the Borough. A total of 1,836 persons belonging to the Borough died in Institutions, 242 occurring in Institutions within the Borough and 1,594 in Institutions outside the Borough. The following is a list of the Institutions, etc., outside the Borough in which deaths of Borough residents occurred:— Vital Statistics. 9 Name of Institution. No. of Deaths. Toor Law Hospitals and Infirmaries :— Wandsworth Union Hospitals 944 Cane Hill Mental Hospital C Lambeth Union Hospital 6 Long Grove Mental Hospital 11 West Park Mental Hospital 17 Other Mental Hospitals 20 Other Poor Law Institutions 18 Other Hospitals :— Belgrave Hospital 9 Bolingbroke Hospital 39 Cancer Hospital 6 Charing Cross Hospital 10 Colindale Hospital 16 Guy's Hospital 9 Infants Hospital 10 King's College Hospital 15 National Hospital 8 St. Bartholomew's Hospital 9 St. Columba's Hospital 9 Name of Institution. No. of Deaths. Other Hospitals— contd.:— St. George's Hospital 18 St. Thomas's Hospital 44 South Western Hospital 7 University College Hospital 7 Victoria Hospital 20 West London Hospital 12 Westminster Hospital 18 Other Institutions, Etc.:— Other Institutions 113 Other Places not Public Institutions 90 On Railway 3 On Street 21 River Thames 7 Private Nursing Homes 60 1,594 Institutions, etc., inside the Borough 242 1,836 Infantile Mortality. The total number of deaths under one year was 230:—53 in Clapham, 21 in Putney, 31 in Balham, 34 in Streatham, 19 in Tooting and 72 in Wandsworth. As the number of births was 4,616, the Infantile Mortality rate was 49 per 1,000 births, compared with 51 last year. The decrease in the rate is due to the decrease in the number of deaths from Premature Birth. The infantile mortality rate of 49 is the lowest which has ever been recorded in this Borough and is the first time the rate has been below 50 per 1,000 births. The rate compares with 67 for the whole of London and is only bettered by one of the small London Boroughs which has a rate of 48. For the 10 years ending 1918 the average infantile mortality rate was 87, while for the 10 years ending 1928 the average rate was 62. This fall represents an annual saving of over 100 infant lives. The number of deaths among legitimate infants was 211 to 4,616 births—a mortality of 47 per 1,000 births, while the 10 Report of the Medical Officer of Health. number of deaths among illegitimate infants was 19 to 196 births—a mortality of 96 per 1,000 births. 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 i under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. All Causes:— Certified 68 14 15 10 107 34 40 18 31 230 Uncertified - - - - - - - - - - Small-pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - 1 6 7 Scarlet Fever - - - - - - - - 1 1 Whooping Cough — — — 1 1 1 1 — 3 6 Diphtheria and Croup - - - - - - 1 — 1 2 Erysipelas - - - - - 1 - - - 1 Tuberculous Meningitis - - - - - - - - 1 1 Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - 1 - - 1 Meningitis (not Tuberculous) - - - - - - 2 - 2 4 Convulsions 3 1 1 — 5 — 1 — 1 7 Laryngitis — — — 1 1 — — — — 1 Bronchitis 1 1 1 — 3 5 — 1 — 9 Pneumonia (all forms) 1 — 2 1 4 4 7 6 11 32 Diarrhœa - - - - - 1 4 2 — 7 Enteritis 1 1 3 1 6 4 10 3 1 24 Gastritis - - - - - - - - - - Syphilis — — — — — 1 — — — 1 Rickets - - - - - - - - - - Suffocation, overlaying 1 1 — — 2 — 1 — — 3 Injury at Birth 6 — 1 — 7 1 — — — 8 Atelectasis 7 1 1 — 9 — — — — 9 Congenital Malformations 7 3 2 4 10 7 4 2 2 31 Premature Birth 36 3 2 2 43 3 3 — — 49 Atrophy, Debility and Marasmus 3 3 1 - 7 3 2 2 1 15 Other Causes 2 — 1 — 3 3 3 1 1 11 Totals 08 14 15 10 107 34 40 18 31 230 Nett Births in the year: legitimate, 4,420; illegitimate, 196. Nett Deaths in the year of legitimate infants. 211: illegitimate infants, 19. 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. 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 1927 44 75 50 47 71 45 51 Average for 10 years 62 70 5 72 64 62 1928 63 53 40 41 36 56 49 No. of deaths under 1 year, 1928 53 21 31 34 19 72 230 Maternal Mortality. 15 deaths occurred from accidents and diseases of pregnancy and six from Puerperal Fever, giving a total of 21 deaths after childbirth. This is equivalent to a rate of 4.54 per 1,000 births, compared with 4.08 in 1927, 12 Report of the Medical Officer of Health. During the year the Minister of Health decided that special inquiry should be made into the causation of all maternal deaths and a representative Committee was set up to go into the matter. A special form of inquiry has been drafted by the Minister of Health, who has made Medical Officers of Health responsible for its completion and return to him when a maternal death occurs. Dr. Leonard Phillips has been appointed by the Council to act as consultant and to make inquiry into those deaths which present special difficulty. All the maternal deaths which occurred after 1st June (13 in number), were inquired into, and in one of these the investigations were made by Dr. Phillips. 13 INFECTIVE DISEASES. The total number of deaths from these diseases including all forms of Tuberculosis was 481:— 73 in Clapham, 50 in Putney, 54 in Balham, 76 in Streatham, 66 in Tooting, and 162 in Wandsworth. From all infective diseases the death-rate was 1.35 per 1,000:—1.14 in Clapham, 1.53 in Putney, .98 in Balham, 1.25 in Streatham, 1.61 in Tooting, and 1.58 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; in 1926, 1..49; and in 1927, 1.68 per 1,000. The rate is lower than in 1927, mainly owing to the decrease 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 Diarrhoea, was ..27 per 1,000, compared with .2 in 1929; .61 in 1920; .70 in 1921; .73 in 1922 ..39 in 1923; .47 in 1924; .32 in 1925; ..37 in 1926; and .5 in 1927. The rate was .31 in Clapham, ..18 in Putney, -19 in Balham, .19 in Streatham, .26 in Tooting, and .44 in Wandsworth. The death-rate from these principal diseases is the second 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 34 and 47 of this Report. In Table XI. the cases of infective diseases are shown grouped according to the sub-districts in which they occurred. 14 Report of the Medical Officer of Health. TABLE 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 15 14 1 2 1 2 — 2 6 1 — 1 - — — Scarlet Fever 3 3 - 1 - 1 - 1 - - - - - - Enteric and Paratyphoid Fevers 5 5 1 4 Puerperal Fever and Pvrexia 6 6 6 ; Erysipelas 2 1 1 1 i Whooping Cough 9 9 — 6 3 - - - - - - - - - - Pneumonia:— Acute Influenzal 9 2 7 2 3 1 3 Acute Primary 70 24 46 8 6 3 i — 4 2 2 3 6 15 20 Cerebro-Spinal Meningitis 3 3 2 — — 1 — — Polio-myelitis 2 1 1 1 1 Encephalitis Lethargica 3 3 1 2 Malaria 1 - 1 - - - - - - - - - 1 - Dysentery 1 — 1 — — — — — — — — — — 1 — Total 129 57 72 22 10 6 1 2 13 3 4 15 11 19 23 Non-Notifiable Diseases. Measles 36 36- - 10 16 6 1 1 2 -- - - - - - Influenza 37 2 35 1 1 - 1 1 13 20 Diarrhoea 40 36 4 31 3 1 - - 1 - 2 1 1 Other (if any) - - - - - - - - - - - - - Total 113 74 39 41 19 7 2 1 3 1 — 1 3 14 21 Grand Total 242 131 111 63 29 13 3 3 16 4 4 16 14 33 44 Infective Diseases. 1 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 88 34 54 1 - - 3 1 1 28 29 6 7 8 4 Diphtheria 568 466 102 13 15 27 30 41 263 77 33 47 16 4 2 Scarlet Fever 752 603 149 1 6 31 37 57 348 123 62 62 17 8 - Enteric Fever and Paratyphoid Fever 54 15 39 - - 1 2 4 5 3 5 17 8 9 - Puerperal Fever 14 — 14 — — — — — — - - 14 - - - Puerperal Pyrexia 35 — 35 - - - - - - - 2 30 3 - Erysipelas 145 25 120 4 1 - 1 1 14 4 8 20 23 52 17 Whooping Cough 1665 1648 17 116 153 176 200 252 737 14 5 7 3 2 Pneumonia:— Acute Influenzal 42 3 39 — - 1 - - 2 - 2 6 11 11 9 Acute Primary 456 183 273 31 34 26 10 16 46 20 28 49 60 92 44 Cerebro-spinal Meningitis 4 4 — 3 — — — — 1 - - - - - - Polio-myelitis 6 4 2 — — — 1 — 2 1 — 2 - - - Encephalitis Lethargica 10 2 8 - - - - - 2 - 2 2 2 2 - Malaria 1 — 1 — - - - - - - - - - 1 - Dysentery 2 — 2 — — — — — - - - - - 2 - Chicken-pox 306 277 29 7 12 19 18 24 159 38 15 10 4 - - Anthrax 1 — 1 - - - - - - - - 1 - — - Total 4149 3264 885 176 221 281 302 396 1580 308 191 273 154 191 76 16 Report of the Medical Officer of Health. 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 - - 9 56 6 17 88 76 - Diphtheria 98 46 43 69 64 248 568 551 15 Scarlet Fever 161 58 78 120 123 212 752 645 3 Enteric and Para-tvphoid Fevers 3 8 8 10 2 23 54 28 6 Puerperal Fever 3 2 1 — 2 6 14 13 4 Puerperal Pvrexia 3 2 9 8 3 10 35 23 1 28 19 23 8 15 52 145 58 2 Whooping Cough 251 141 114 137 161 861 1665 60 9 Pneumonia—Acute Influenzal 11 2 8 3 5 13 42 — 9 Pneumonia—Acute Primary 83 41 72 35 54 171 456 — 70 Cerebro-spinal Meningitis — — — — 1 3 4 4 3 Polio-myelitis 2 — — 1 1 2 6 3 2 Encephalitis Lethargica 1 1 2 2 — 4 10 7 3 Malaria — — — - - 1 1 — 1 Dysentery - - - 1 - 1 2 1 1 Chicken-pox 39 44 26 76 38 83 306 — — Anthrax — - — - — 1 1 1 — Total 683 364 393 526 475 1708 4149 1470 129 Tuberculosis—all forms Ophthalmia Neonatorum 105 12 77 2 76 9 95 8 86 6 179 13 618 50 18 294 Total 117 79 85 103 92 192 668 18 294 Grand Total 800 443 478 629 567 1900 4817 1488 423 Infective Diseases. 17 The total number of cases, less Tuberculosis and Ophthalmia Neonatorum, was 4,1.50, compared with 4,280 in 1927, 3,316 in 1926 and 4,240 in 1925. The decrease, compared with 1927, is due mainly to the decrease in the number of cases of Whooping Cough. Small-pox. During the year 88 cases of Small-pox occurred in the Borough between the months of February and July, In connection with this outbreak it is interesting to recall the fact that the last epidemic of Small-pox in the Borough occurred in the years 1901 to 1904, when there were 171 cases with 29 deaths. Between 1904 and the present outbreak there has only been one case. This was in 1921, when a man, who was infected abroad, developed the disease at his home in the Borough. The first patient was taken ill about the 10th February and the last case was removed to Hospital on the 28th July. The 88 cases included 45 males and 43 females, and the age grouping was as follows:— Under 15 years 55 cases 15 and under 25 11 cases 25 and under 45 11 cases 45 and over 11 cases Twelve cases occurred in the Springfield Mental Hospital, and one case in the Wandsworth Casual Ward. The other 75 cases occurred at home, 50 households being affected. The disease was the mild form of Small-pox which has been present in this country for the last few years, and all the patients recovered. The mildness of the disease contributed materially to the difficulties of investigating the outbreak. In several instances, when endeavouring to trace the origin of cases I found persons actually suffering from Smallpox, who were following their usual occupations. They had not felt ill and although a few spots may have been noticed c 18 Report of the Medical Officer of Health. on the body, no importance was attached to them. These unrecognised cases were an important factor in spreading the outbreak, and several groups of cases emanated from persons who had suffered from the disease, without knowing it, several weeks previously. Many of the cases were seen in consultation with the late Dr. W. M. Wanklyn, of the Medical Staff of the London County Council, whose extensive experience in the diagnosis of Small-pox was of great assistance to me throughout the epidemic, and I wish to acknowledge my indebtedness to him. I would also like to thank Dr. J. A. H. Brincker who saw several of the cases with me in Dr. Wanklyn's absence. The condition of the 88 patients in regard to vaccination is instructive and shows the value of recent vaccination in preventing Small-pox. Seventy of the 88 cases, i.e., 80 per cent, occurred in persons who had never been vaccinated at the time of infection. Sixty-six, or 75 per ceni. of the patients were under the age of 25, and none of these had ever been vaccinated. None of the 18 vaccinated persons had been donev since infancy, and the youngest was 28 3 ears of age. One of the cases was a man who was removed from the Wandsworth Casual Ward on the 8th June. He was infected in the Marylebone Hospital where cases had occurred at a time when he was an inmate. This case was a sporadic one, infected elsewhere, and was not connected with any of the other 87 cases. The outbreak started in the Springfield Mental Hospital, which is the Asylum for the County of Middlesex. The infection appears to have been introduced into the Institution from one of the districts round London from which the Hospital draws its inmates, as cases of Small-pox had occurred in these districts. Infective Diseases. 19 Eleven female patients and one nurse developed the disease, and the husband of one of the patients who lived outside the Borough, was infected through visiting his wife. The last of these eases was isolated on the 20th March. On 14th March a case occurred in a house quite near to the Hospital, and although no association with the Hospital cases was traced, it is reasonable to suppose that infection was transmitted from these cases. In the latter part of April further cases occurred in several districts of the Borough. They originated in a street not far from the Hospital. Six definite cases occurred in this street, five in one house, and enquiries elicited the fact that other members of this household, then well, had probably had the disease some weeks previously, and might have been infected in some way by the Hospital cases. Several members of this household worked in a factory at Balham, and during April and May, eight other cases of smallpox occurred among the employees at this factory, two of them residing outside the Borough. In the second and third weeks in May, cases occurred among school children in Streatham, and I was able to trace a link between these cases and the previous group, in the person of a boy attending Mitcham Lane School, who was in the habit of going to a place of entertainment frequented by members of the household mentioned above. He was at large for some three weeks suffering from Small-pox. This boy belonged to a troop of Cubs whose members attended Mitcham Lane and Eardley Road Schools, and infection was introduced into both schools by this means. There were 32 cases in this group. On the 1st June there were two cases in Springfield Ward, but no definite link was established between these and the previous cases. Early in June several scholars attending Sunnyhill Road School developed the disease. The connection between these c 2 20 Report of the Medical Officer of Health. cases and the previous groups was never established definitely, but certain facts were discovered which suggest that infection was spread by unrecognised cases among Boy Scouts and Cubs. There was also a possible link between Eardley Road and Sunnyhill Road Schools by means of a Class in Carpentery which met at the latter school and took scholars from several schools. There were 15 cases in this group, and in addition, a number of children residing in Lambeth who also attended Sunnyhill Road School, developed Small-pox. During June and July, cases occurred among the scholars at the Ensham Central School, Tooting. Children attending this school had friends at Sunnyhill Road School, and it is probable that infection was spread in this manner. The number of cases in this group was 12. The last case was a resident in Fairfield Ward who was removed to Hospital on the 28th July. The source of infection was not traced and no connection with the other cases was established. All possible steps were taken as each case occurred to prevent the spread of infection. The patients in the Springfield Mental Hospital were isolated in the isolation block in the grounds of the Hospital, and all the cases in private houses were removed to one of the Special Hospitals of the Metropolitan Asylums Board. Thorough disinfection was carried out after each case. Certain special measures were also taken with the object of localising the epidemic. As soon as cases were notified from private houses I informed all the doctors practising in the Borough that cases of Small-pox were occurring, and asked them to inform me of any suspicious cases coming to their notice. When the disease is of a mild type, as it was in this epidemic, infected articles of clothing are often sent to laundries before the nature of the disease is recognised, and infection may easily be spread to laundry workers in this manner. I Infective Diseases. 21 communicated with all the laundry proprietors in the district, warning them of this danger, and advising them to urge all members of their staffs to be vaccinated at once. Many laundry employees were vaccinated as a result of this advice. With a view to obtaining the earliest possible information of cases of Small-pox, the Council decided, with the approval of the Minister of Health, to make Chicken-pox a notifiable disease for a period of three months. This became effective from the 22nd May. Many of the cases of Chicken-pox notified under this Order were visited by the medical staff of the Department, but in no instance was a case of Small-pox brought to light in this manner. A poster was prepared stressing the importance of recent vaccination, and this was exhibited in all public places in the Borough. In view of the large number of parents who, in recent years, have omitted to have their children vaccinated, the Council decided to write to all householders in the Borough pointing out that cases of Small-pox were occurring, and urging the importance of recent vaccination as a means of protection against the disease. 94,471 of these letters were dispatched. Over 13,000 vaccinations were performed by the public vaccinators within a few weeks of the issue of this letter, and many persons were also vaccinated by their own doctors. I am convinced that the issue of this letter to householders had a good effect, and that many people were vaccinated as a result of it. The Public Health Committee also decided to ask the Licensed Houses in the Borough to display a small notice advising vaccination. When the epidemic was at its height in Streatham, I wrote to the Ministers of the Churches in the neighbourhood asking them to urge on their congregations the importance of vaccination. The proprietors of three cinema theatres in the affected area agreed to exhibit a short notice on their screens to the same effect. 22 Report of the Medical Officer of Health. Vaccination. Several vaccinations were performed under the Public Health (Small-pox) Regulations in connection with the outbreak just described. Table XII. s taken from the official returns of the Vaccination Officers to the Beard of Guardians for the year 1927. It shows the number of children successfully vaccinated for the whole Borough, as well as for the separate sub-districts, Streatham, Balham and Tooting being included under the heading of Streatham. TABLE XII. SubDistricts. Number of Births returned from 1st January to 31st December, 1927. Successfully Vaccinated. Insusceptible of Vaccination. Had Small-pox. 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 600 322 2 — 26 177 10 6 34 23 Putney 301 211 — — 17 55 3 5 3 7 Streatham 1,788 904 7 — 77 561 15 99 46 79 Wandsworth 1,053 639 4 — 36 282 12 4 39 37 Totals 3,742 2,076 13 — 156 1,075 40 114 122 146 The percentage of children vaccinated to total births was 55.4:— in Clapham, 53.6; in Putney, 70.0; in Streatham, etc., 50.5; and in Wandsworth, 00.6. This percentage is lower than that recorded last year. Infective Diseases. 23 Diphtheria. 568 cases occurred, compared with 709 in 1927. The number of deaths was 15, compared with 23 in 1927. The death-rate for 1928 was .04 and the case mortality was 0-4 per cent. The rate per 1,000 of population was 1.60:— 1.54 in Clapham; 1.41 in Putney; .78 in Balham; 1.14 in Streatham; 1.56 in Tooting; and 2.42 in Wandsworth. Of the 568 cases, 551, 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 the Parochial School, Old Town, Clapham ; Huntingfield Road and St. Mary's Schools, Putney; Fircroft Road and Smallwood Road Schools, Balham; Eardley Road School, Streatham; and Earlsfield, Elliott Central, Eltringham Street, Garratt Lane, Littleton Street Special, Swaffield Road, 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, seven 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 60 tubes of anti-toxin were issued to medical practitioners for use in cases of Diphtheria. The Council's Clinics for Immunisation against Diphtheria. In November, 1927, the Council decided to establish two Clinics in the Borough at which parents could have their children tested to see if they are susceptible to Diphtheria and for the immunisation of those found to be susceptible. A leaflet describing the procedure has been drawn up and this is distributed by the Council's Officers when visiting homes 24 Report of the Medical Officer of Health. and at the Welfare Centres. The London County Council have given permission for these leaflets to be distributed at their schools, and many thousands have been given out in this manner. The two Clinics were opened in the first week of January, 1928, at the premises of the Springfield and Balham Infant Welfare Centres under arrangements made with the Committees of those Centres. A weekly session is held at each Clinic, and the work is carried out by the Council's Staff. The addresses and times of the Clinics are as follows :— Springfield Infant Welfare Centre, The Congregational Hall, Earlsfield Road (Garratt Lane end). Every Wednesday afternoon from 2 to 3.30 p.m. Balham Infant Welfare Centre, 91, Bedford Hill, Balham. Every Friday afternoon from 2 to 3.30 p.m. Method of Procedure.—The following is the routine procedure :—A Schick test is performed on children over 5 years of age at their first visit, and the test is read on the second attendance a week later. If the result is positive, showing that the child is susceptible to Diphtheria, the first immunising dose of 1 c.c. of Toxoid Anti-toxin mixture is given on the same day. Second and third doses of the same strength are given at intervals of a week. As experience has shown that the large majority of children under 5 years of age give a positive Schick test, the procedure is modified in their case by omitting the preliminary test, the first immunising dose being administered at the first attendance. This has the advantage of reducing the number of attendances from four to three. Immunity develops gradually after the three doses have been given. It is not established completely until several months have elapsed, and the exact period required varies in different individuals. 25 Infective Diseases. It is important in this connection to remember that a child may develop Diphtheria during the period which elapses between the administration of the immunising doses and the full establishment of immunity, if exposure to infection occurs. Parents should be warned on this point. Further, immunisation carried out during an epidemic of Diphtheria may easily be too late to prevent infection occurring. In order to determine whether immunity has been established, it is essential for a re-Schick test to be performed after an interval, and no case can be said to have been immunised successfully until the re-test gives a negative result. The practice which has been followed at the Clinics is to advise a re-test about three months after the last immunising dose has been given. If the result is still positive, another re-test is advised after a further interval, and in some cases when a positive reaction persists, additional immunising doses have to be given. Attendances.—The number of persons who attended the Clinics during the year, and the number susceptible to Diphtheria, is shown in the following statement :— No. of persons who attended the Clinics % No. of susceptibles who required Immunisation. Tested by Schick Test 896 655 Young children, assumed susceptible without Testing 269 269 For Re-testing after immunisation elsewhere 3 — Total number of persons who came to the Clinics 1168 — Total number of susceptibles who required immunisation 924 Schick Test Results.—Table XIII. gives the details in regard to the 896 cases on whom the primary Schick test was performed. The cases are divided into age groups and the 26 Report of the Medical Officer of Health. TABLE XIII. GROUPING OF CASES ON PRIMARY SCHICK TESTING. Result of Test. Age Groups. Males Females Total Under 5 5—10 10—15 Total under 15 15—20 20 and over Schick positive 47 421 117 585 40 30 293 362 655 Schick negative 3 97 72 172 31 23 87 139 226 Result not read 1 7 4 12 3 3 12 15 Total 51 525 193 769 74 53 383 513 896 Percentage positive 94% 81% 62% 77% 56% 56% 77°/ ' ' /o 72°/ '-1 /o 74% 27 Infective Diseases. number found positive or negative in each group is shown. In 15 cases the result was not ascertained as they failed to attend to have the test read. The last line of the Table gives the percentage of the resiilts found to be positive in each age group, neglecting those in which the test was not read, and brings out the well established fact that susceptibility to Diphtheria decreases as age advances. Of the 1,168 persons who came to the Clinics during the year, 655 were shown by the initial test to be susceptible to Diphtheria. A further 269 young children were assumed to be susceptible on account of their age, making a total of 924 persons who required immunising; 854 of these were children under the age of 15 years. Immunisation of Susceptibles. Many of the 924 susceptibles continued to attend the Clinics in order to be immunised. 618 of them, together with the three cases who attended for re-testing only after immunisation elsewhere, making a total of 621 out of 927 cases, or 67 %, were found to be negative on re-testing, showing that immunity had been produced. 92 were still positive when last re-tested. Several of these have left the district, but it is hoped that many of them will continue to attend until the r-etest becomes negative. A few of these have already received additional immunising doses. 181 susceptibles have received the first series of three doses, but have not attended for a re-Schick test so that it is impossible to say if they have been immunised successfully. 21 cases have discontinued attending after one or two doses had been administered, and 12 have not commenced the course. The total number of cases who were re-tested after receiving immunising doses, was 713, and as stated above, 621 gave negative re-tests and 92 were still positive. The age grouping of these ca es i; shown in Table XIV., and complete details are given in Table XV, 28 Report of the Medical Officer of Health. TABLE XIV. AGE GROUPING OF CASES IMMUNISED AND RE-TESTED. Age Grouping. Males Females Total Under 5 5—10 10—15 15—20 20 and over Children under 15 235 359 90 — — 339 345 084 Adults over 15 — — - 13 16 3 20 29 Total 235 359 90 13 lf> 342 371 713 29 Infective Diseases. In the latter table the 713 cases are divided into those who were successfully immunised as shown by a negative result to the final re-test, and those in whom the last re-test performed was still positive. In a few of the former it was necessary to perform several re-tests before the final negative result was obtained, and nine of them required a second series of immunising doses to obtain this result. The number of doses required to produce immunity is tabulated, and the cases are further subdivided according to the time which elapsed between the last dose of the first series of injections, and the final negative re-test. In 461 of the 621 negative cases, the negative result was obtained within six months, and it is probable that a considerable proportion of the remainder would have been negative during that period if thay had attended earlier for re-testing. 30 Report of the Medical Officer of Health. TABLE XV. RESULTS OF RE-TESTING. (1) Period and dosage required to produce immunity (a negative result;. (2) Details of cases still positive. Number of Immunising Doses Given Total Cases Final Re-Schick Test Negative—period since last dose of first series when result was found to be negative. Still Positive when last tested at period stated. Within 4 mths. 4—6 mths. 6—9 mths. 9—12 mths. 12—18 mths. 18 mths. 2 years Total Negative Within 4 mths. 4—6 mths. 6—9 mths. 9—12 mths. 12—18 mths. Total Positive Children Under 15. First series 2 doses 9 1 1 4 - - - 6 - 2 - 1 3 3 doses 662 249 197 104 22 14 - 586 15 12 14 20 15 76 4 doses 4 3 — 1 — 4 — — - — - — Second series 5 doses 1 - - 1 1 - - - - - - 6 doses 8 — — — 1 7 — 8 — — — - - — Total 684 253 198 108 24 22 — 605 15 14 14 21 15 79 adults Over15. First series f 2 doses 2 - - - - - - - - - - - - 9 3 doses 25 1 8 2 1 2 1 15 3 3 1 3 10 4 doses 1 — 1 — — — — 1 — — — — — — Second series 6 doses 1 — — — — — — — — — — — 1 1 Total All Ages 713 254 207 110 25 24 1 621 18 19 15 24 16 92 13 Infective Diseases. Three children who received immunising doses at the Clinics developed Diphtheria. As will be seen from the particulars given below, the attack in each case was only a mild one. In two instances it occurred before immunity had developed, and in the third case (No. 2), although the re-test was negative a few days before the attack, immunity had taken some nine months to develop, and the attack of Diphtheria was so slight as to be almost negligible. Case No. 1.—A girl of 13—Schick test positive— received three doses of Toxoid Anti-toxin mixture at weekly intervals—developed Diphtheria 2\ months after the last dose—this was a clinical case and the specific organism was found on culture—the attack was a mild one—no re-Schick test was performed. This child developed Diptheria during the interval required after immunisation for immunity to develop. Case No. 2—A boy of 6—Schick test positive— received three doses of Toxoid Anti-toxin mixture—reSchick test positive 5 months and negative 9 months after the last dose—Diphtheritic membrane and virulent Klebs-Loeffler bacilli found in the throat 16 days after the last re-test was carried out—the child was ill for only one day. The fact that the re-test was positive in 5 months is evidence that this was a case in which immunity was slow in developing. It is very uncommon for a child suffering from Diphtheria to be ill only one day, and it is probable that if he had not been immunised the attack would have been a virulent one. Case No. 3.—A girl of 7—Schick test positive— received three doses of Toxoid Anti-toxin mixture— developed Diphtheria 5 months and 9 days after the last dose—membrane present and virulent organisms on culture —re-Schick test performed on same day as admitted to hospital was positive—the attack was only a slight one—has not attended for further re-test. This child developed the disease before immunity was established, as shown by the positive re-test. 32 Report of the Medical Officer of Health. The outstanding feature of the first year's work at the Clinics is that 021 persons, nearly all children, have been immunised against Diphtheria. Although this number is small compared to the child population of the Borough—which was returned in the 1021 Census as SI,114 children under 15—it is evidence that some parents are desirous of availing themselves of the facilities offered at the Clinics. Children who attend the Clinics unfortunately lose their school attendance mark and there is considerable reluctance on the part of parents to bring them for this reason. If arrangements could be made for attendance at the Clinics to be accepted by the Education authorities as equivalent to school attendance, it is probable that more children would be taken to the Clinics. Efforts have been made to bring this about, but so far without success. Scarlet Fever. 752 cases of Scarlet Fever occurred, compared with 810 in 1927, 033 in 1920. and SOI in 1925. Three cases died, compared with five and four respectively for the two previous years, and the death-rate was -008 per 1,000, compared with -01 and -01. The case mortality was .39 per cent. The case-rate per 1,000 of population, was 2-11 :—2-53 in Clapham; 1-78 in Putney; 1-41 in Balham; I-98 in Streacliam; 3-14 in Tooting ; and 2-00 in Wandsworth. 01 the total number of cases, 045, or 85 per cent., were removed to hospital. The Medical Officers of the London County Council made inspections of seven 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. 10 cases of Scarlet Fever and two of Diphtheria occurred within one month of the return of a previous case from hospital. 33 Infective Diseases. Enteric and Para-Typhoid Fevers. 54 cases, and three deaths of the above occurred. 24 of the cases were true Enteric Fever and 30 were Paratyphoid Fever. The number of cases from the above is higher, but the number of deaths is two lower than in the previous year. There was no special outbreak and no connection between the cases could be traced. Puerperal Fever and Puerperal Pyrexia. During the year there were 14 cases of Puerperal Fever and 35 cases of Puerperal Pyrexia notified. Six of the cases died. The death-rate was -03 per 1,000. Erysipelas. 145 cases were notified and two deaths occurred during the year, compared with 122 and four in 1927. Whooping Cough. Nine deaths occurred during the year, while the number of cases notified was 1,665. The death-rate was -02 per 1,000. 60 of the cases were removed to hospital. 1,425 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Whooping Cough occurred, and 118 premises were disinfected. Influenza. The number of deaths from Influenza was 41, compared with 136 in 1927, 56 in 1926, 111 in 1925, and 139 in 1924. The death-rate was -11 per 1,000. d 34 Report of the Medical Officer of Health. Influenzal Pneumonia and Acute Primary Pneumonia. 42 cases of acute Influenzal Pneumonia and 456 cases of acute Primary Pneumonia were notifed. Nine of the former and 70 of the latter died. The total number of deaths credited to all forms of Pneumonia during the year was 246, compared with 239 in 1927, 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. Four cases of this disease occurred and three of them terminated fatally. A further 16 deaths were registered as being caused by Meningitis. Two other cases of this disease were notified, but proved not to be cerebro-spinal meningitis. Polio-myelitis and Polio-encephalitis. Six cases and two deaths occurred. Three 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 three of them died. Three 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. Malaria. Two cases were notified, and one death occurred. Dysentery. Two cases of Dysentery were notified and one death occurred. Ophthalmia Neonatorum. 50 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. Infective Diseases. 35 TABLE XVT. Result of Treatment. Recovered— Vision not affected. Vision Impaired. Total Blindness. Died. Treatment received :— In Hospital 17 — — 1 At Hospital, Out-patient 9 — — — At home 22 — — 1 Total 48 — — 2* * One case died from Whooping Cough and the other from Meningeal Haemorrhage. 48 of the cases recovered without any impairment of vision. Anthrax. One case was notified. The patient was a fur dyer employed in Bermondsey, and in the course of his occupation handled various furs received from all over the world. He was treated in St. James' Hospital and made a satisfactory recovery from the disease. Measles. The biennial epidemic of Measles occurred as anticipated during the winter of 1927-1928, and in Wandsworth it commenced early in November, 1927, and extended into July, 1928. As mentioned in my report for last year, the Council had decided to adopt special measures in order to combat the mortality from the disease, and these measures were in force for the first time during this epidemic. Over ninety per cent, of the mortality from Measles occurs among children under the age of five years. For this reason d2 30 Report of the Medical Officer of Health. any measures adopted for combating the mortality should be carried out in close co-operation with the Maternity and Child Welfare Service, and the home visiting can be done, most appropriately, by the Health Visitors who are appointed for that Service, rather than by the Sanitary Inspectors who investigate other infective diseases. The mortality is due to the occurrence of complicated cases, and in order to lessen the incidence of complications it is essential for information of the existence of cases to be available as early as possible. Measles was a notifiable disease throughout the Country from 15)15 to 1919 and general notification was discontinued because it was ineffective as a means of combating the mortality from the disease. The early information essential to the success of any efforts directed to the prevention of complications was not forthcoming under a system of notification. Among the reasons for this is the fact that many cases of Measles are treated by domestic methods only and medical advice is not sought. Added to this are the difficulties in diagnosing the disease in the early catarrhal stage before the appearance of the typical eruption. It is in this early stage that the infectivity is highest, and as most of the cases are then undiagnosed, precautions for preventing the spread of infection are not taken when they are most needed, and notification agains fails to give the assistance required. During an epidemic the names of a large number of children absent from school on account of Measles in the home, are forwarded from day to day by the School Authorities. In previous years this information was often not received until the children had been away from school for some days. Frequent delays also occurred in the visiting of these children by the Staff of this Department owing to other calls on their time. As a result of these delays children suffering with Measles were often not discovered until the disease was well advanced. The following special measures were adopted for the first time during the epidemic of last year. Infective Diseases. 37 They were devised in order to get over these difficulties and to ensure as far as was practicable that all young children suffering from Measles should be brought under observation in an early stage of their illness and watched for complications. In order to save unnecessary delays in the transmission of the names of absentees from schools in districts where Measles was prevalent, I was able to arrange, with the co-operation of the Medical Officer of Health of the London County Council, for frequent consultations at these schools between the Health Visitors concerned, and the school nurses. At these consultations the school nurse handed to the Health Visitor the names and addresses of all children reported absent from school on account of Measles, together with other information concerning them. It was also arranged that as long as Measles continued to be prevalent in the neighbourhood of the school, all the home visiting of these absentees should be carried out by the Health Visitor, unless it was found that absence from school was due to some other cause. In this manner the home supervision of children suffering from Measles was carried out by the Health Visitors of the Borough Council who are the authority for the control of infectious diseases, and the possibility of overlapping between the visits of the Health Visitor and the School Nurse, respectively, was avoided. Owing to the large number of cases which occur during an epidemic it is impossible for the visiting to be done by the permanent staff of Health Visitors, and the Council decided in 1927 to engage temporary Health Visitors for this purpose. During the epidemic, five ladies were appointed in this capacity for varying periods between 19th December, 1927, and 30th June, 1928, and the total service of these temporary officers was 60 weeks. The new arrangements made were very successful and their efficiency was enhanced by the consultations which took place between the school nurses and the Health Visitors. The nurses were able to pass on the information they obtained at the schools with a minimum of delay and this enabled the Health Visitors to investigate the cases at a much earlier stage than in previous years. 38 Report of the Medical Officer of Health. Known cases of Measles were visited at once in order to impress on parents the need for proper treatment, and where urgent treatment, such as nursing or admission to Hospital, was found to be required, this was arranged for without delay. The services of the temporary officers were utilised where they were most required at the moment and they were employed on Measles visiting only. The permanent Health Visitors also gave a proportion of their time to assisting with the Measles visiting. Re-visits were made to many of the houses at short intervals to see if existing cases had developed complications, or if suspected ones had contracted the disease. In some cases, when Measles was prevalent in a district, neighbouring houses were visited to see if any of the inmates were suffering from the disease. The biennial epidemic of Measles occurs every other winter and lasts for nine months or less. It commences, as a rule, a few weeks before Christmas, as shown by an increase in the number of cases reported during the months of November and December. The incidence increases during the early months of the new year, reaches its maximum in March or April, and by the end of July, sometimes earlier, the epidemic is at an end. During the following fifteen months, the number of cases reported is small. As each Measles epidemic lasting about nine months commences at the end of one calendar year, and extends into the next, an enumeration of the cases and deaths occurring in successive calendar years fails to show the extent of an epidemic. In order to do this it is necessary to choose a twelve months period which will include all the months covered by the epidemic. The most suitable period for this purposes is the year commencing on 1st October and ending on the 30th September. The number of cases of Measles brought to my notice between 1st October, 1927 and 30th September, 1928 was 4,596. The majority of these cases were reported by the elementary schools, and at arriving at this figure several hundred cases, which proved after investigation not to be suffering from Measles, are excluded; 4,566 of these cases were reported in Infective Diseases. 39 the nine months of the epidemic from November to July and only 30 occurred in the other three months. The number of deaths from the disease during the same period was 38. Table XVII shows the number of cases of Measles and the deaths from the disease for the last eight years. The upper portion of the Table, which gives the figures for each year commencing the 1st October, shows clearly the biennial increase which occurs in the incidence and mortality. The figures for each calendar year are also given for purposes of comparison. The table shows that there has been an increase in the number of cases reported in each of the last four epidemic years, while the number of deaths has fallen. It is important to remember, however, that Measles is not a notifiable disease in this Borough and that the numbers refer mainly to children reported to have Measles by the elementary school teachers. Many other cases occur which are never reported. The increase in the cases in 1927-28 may well be due to the appointment of temporary Health Visitors who were able to visit many more homes where Measles was suspected, than had been possible in previous years. The total number of visits made was 10,739 and this compares with 4,198 and 3,853 in the two previous epidemics. There was a marked increase in the number of cases which were brought under treatment. Shortly before the epidemic occurred, the Metropolitan Asylums Board were able to allot more beds in their hospitals to cases of Measles, and during the epidemic year, 236 cases were removed to hospital, compared with 113 in the previous epidemic in 1926. 61 cases requiring special home nursing were referred to the District Nursing Associations in the Borough, compared with 27 in 1926, and the nurses made 471 visits to these cases compared with 320 in 1926. Much of this increase in the number of cases treated was due to the greater efficiency of the arrangements for dealing with the epidemic than those of previous years. 40 Report of the Medical Officer of Health. TABLE XVII. MEASLES—CASES REPORTED AND DEATHS. Period 1st October—30th September 1920—21 1921—22 1922—23 1923—24 1924—25 1925—26 1926—27 « 1927—28 Cases Reported. In a Measles year — 2,183 - 3,905 — 4,219 — 4,596 In a Non-Measles year 123 — 160 - 293 — 81 - Deaths. In a Measles year — 75 — 80 — 52 — 38 In a Non-Measles year 1 — - — 1 — 2 — Period. Calendar Year 1921 1922 1923 1924 1925 1926 1927 1928 Cases Reported 450 1,842 663 3,418 474 4,028 172 4,529 Deaths 4 72 11 71 1 51 4 36 Infective Diseases. 41 The number of deaths was reduced from 75 in 1921-1922 to 38 in 1927-1928, although there are no grounds for assuming that the number of cases which actually occurred in the Borough during the last epidemic, was any fewer. The death-rate per 1,000 of the population was TO, compared with .14 in 1926, .23 in 1924, and .22 in 1922. 596 premises were disinfected at the request of the occupiers. Table XVIII. shows the number of cases of infective diseases which occurred in the individual elementary schools during the year. TABLE XVIII. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases . Totals. Clapham. Aristotle Road 1 3 - 2 6 Bonneville Road 21 11 111 9 12 14 3 3 22 206 Cavendish Road 11 12 44 - 1 68 Cavendish Road Special 1 — - 1 Christchurch g 53 5 50 116 Clapham Parochial, Old Town 9 - q Clapham Parochial, Macaulay Rd. 5 34 - 4 2 45 Haselrigge Road 11 2 35 22 10 25 3 4 19 131 Larkhall Lane 11 7 134 1 10 17 1 1 23 205 New Park Road 3 4 111 2 2 27 2 10 161 New Road - 5 1 5 I 1 9 St. Andrew's Street 2 5 26 - 6 X —i St. Mary's, Crescent Lane 5 2 - 4 O ij 11 Stonhouse Street 11 5 28 - 12 1 1 58 Telferscot Road 10 5 50 2 13 27 5 — 6 118 Putney All Saints' - 1 15 - - 2 - - - 1 8 Hotham Road 14 10 120 5 61 38 36 3 17 1 o 304 Huntingfield Road 9 1 87 1 19 13 g - 2 National R.C. Roehampton, Girls 1 - - - - - - - - lOO 1 National R.C. Roehampton, Boys 1 2 - - - - - - - 3 Parochial, Roehampton - - 2 2 3 - 2 - - 9 St. Mary's 1 4 11 - 6 10 - 1 - Upper Grade 1 1 2 — 2 1 1 - — oo 8 Carried forward 136 72 871 50 216 179 57 15 104 1700 42 Report of the Medical Officer of Health. TABLE XVTII.—continued. School. Diseases. Scarlet Fever. Diphtheria Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm 1 Other Diseases Totals. Brought forward 136 72 871 50 216 179 57 15 104 1700 Balham. Balham Central 1 1 - - - - - - - 2 Bee, The 1 - - - - - - - - 1 Broadwater Road 3 2 2 - 35 5 - - 1 48 Fircroft Road - - 7 - 4 - - 1 4 16 Hearnville Road 5 - 47 - 4 - 6 - - 62 Holy Trinity, Balham 2 1 15 - 3 16 - - 4 41 Nightingale Square R.C. 2 1 7 - - - - - - 10 Oldridge Road 1 5 58 1 24 1 1 19 110 Ravenstone Street 4 3 - - - - - - - 7 St. Mary's 7 3 71 - 6 3 4 - - 94 Smallwood Road 4 6 18 - 5 1 - - - 34 Streatham. Christchurch - 1 39 - 1 - - - - 41 Eardley Road 3 16 78 - 8 1 21 - 14 141 Furzedown Demonstration 1 2 34 1 2 — — - 5 45 Granton Road 4 - - - - - - -- — 4 Hitherfield Road 3 6 21 — 33 1 20 - 10 94 Holy Trinity — — 8 — 1 — — - — 9 Immanuel 2 4 2 — 7 2 25 - — 42 Mitcham Lane 17 3 108 — 42 2 20 - 4 196 St. Andrew's, Colmer Road 1 — 42 1 60 21 1 - — 126 St. Andrew's, Coventry Hall 1 1 10 — — — — - — 12 St. Leonard's 1 1 11 — 7 3 1 2 — 26 Sunnyhill Road 9 1 25 2 22 3 — - 13 75 Tooting. Ensham Central - 1 - - - - - - - 1 Ensham 9 2 40 1 43 2 — — — 97 Defoe (Fountain Road) 3 15 — 3 — — — 1 22 Franciscan Road 6 2 56 — 1 — 3 — — 68 Hillbrook Road 6 6 111 — 18 24 4 1 — 170 Sellincourt Road 6 6 92 1 68 3 37 — 8 221 Tooting Graveney 6 2 43 — 35 5 4 2 1 98 Undine Street, R.C. 3 1 - - - 24 37 - - 65 Carried forward 247 149 1831 57 648 296 241 21 188 3678 Infective Diseases. 43 TABLE XVIII.—continued. School. Diseases. Scarlet Fever. Diphtheria Measles. German Measles. 1 Chickenpox. Whooping Cough. Mumps. Ringworm Other Diseases Totals. "Brought forward 247 149 1831 57 648 296 241 21 188 3678 Wandsworth. Allfarthing Lane 5 10 56 1 19 39 44 7 7 188 All Saints' — 3 31 — 4 15 1 2 4 60 Brandlehow Road 5 4 25 — 1 30 26 1 — 92 Earlsfield 7 21 73 1 3 16 15 2 13 151 Elliott Central 1 4 2 — 1 — — — — 8 Eltringham Street 9 18 36 — 12 21 1 1 — 98 Frogmore Special — 1 3 — — — — — — 4 Garratt Lane 2 8 57 — 10 27 9 — 6 119 Littleton Street Special 1 1 — — — — — — — 2 Magdalen Road 5 5 25 — 9 17 3 — — 64 Merton Road 6 7 14 1 4 6 1 — 2 41 Riversdale 12 7 88 1 67 49 2 1 3 230 St. Ann's 2 3 13 — 15 9 5 — — 47 St. Faith's — — 31 — — 10 1 1 10 53 St. Joseph's — 2 16 — 1 4 5 2 3 33 St. Michael's 6 6 66 — 11 6 32 — — 127 Swaffield Road 20 8 70 1 36 2 22 — — 159 Waldron Road 7 6 78 — 4 41 1 — — 137 Wandle 3 5 48 — 17 34 16 1 4 128 Warple Way 11 7 2 — 6 30 3 — — 59 West Hill 7 9 136 — 29 40 29 — 1 251 Gkand Total 356 284 2701 62 897 692 457 39 241 5729 Diarrhœa. The number of deaths from Diarrhoea was 40, compared with 27 in 1927, 36 in 1926, 34 in 1925, and 30 in 1924, and of these 31, or 77 per cent., were under the age of one year, compared with 16 in 1927. The number of deaths from Diarrhoea, Zymotic Enteritis and Enteritis under one year represents 13 per cent, of the total mortality at that age. 44 Report of the Medical Officer of Health. Scabies. The names of 23 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 20 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, 42 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. 23 deaths occurred, eight from Syphilis, seven from Actinomycosis, six from Septicaemia, one from post vaccinal Encephalitis, and one from Pyaemia. 45 NON.INFECTIVE DISEASES. The total number of deaths from Cancer and malignant disease was 493, the number of males being 223 and females 270. The corrected death.rate was 1.38 per 1,000 for the whole Borough:—1.41 for Clapham; 1.47 for Putney; 1.47 for Balham; 1.50 for Streatham; .90 for Tooting; and 1.42 for Wandsworth. The number of deaths in 1928 was three less than in 1927. The number of deaths from diseases of the Brain and Nervous System was 137. 1,081 deaths occurred from diseases of the Heart and Circulatory System, compared with 953 in 1927. 755 of these deaths were of persons over 65 years of age. There were 493 deaths from diseases of the Respiratory System, compared with 619 in 1927. The number from Bronchitis was 209, compared with 339 in 1927, and from Pneumonia (all forms) 246, compared with 239 in 1927. Further particulars relative to Pneumonia are given on page 34. The number of infants under two years of age who died from these diseases was 64. 118 deaths, 65 males and 53 females, were registered as due to Premature Birth and Developmental Diseases, compared with 140 in 1927. 166 deaths, 57 males and 109 females, occurred from Old Age, and all these, except one, were persons over 65 years of age. The number of deaths due to this cause in 1927 was 196. 192 deaths were due to Violence, 136 of them being due to accident, 51 to suicide, and five to other forms of violence. Inquests. Inquests were held on 287 persons dying in the Borough, and on 2U Borough residents who died outside the Borough. The next Table shows the results of the findings of these inquests. 46 Report of the Medical Officer of Health. TABLE XJX. Inquests. Sub-Districts. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough Deaths from Natural Causes 34 24 42 49 34 83 266 Accidental :— Knocked down by motor vehicles 5 6 13 6 7 14 51 Falls 2 1 11 3 20 5 42 Falls from vehicles 5 3 2 — 1 7 18 Falls from a height 4 — 3 — — 4 11 Deaths under anaesthetics 2 3 - 1 - 2 8 Suffocation 1 — 1 1 1 2 6 Burns and scalds 1 — — 2 1 2 6 Drowning 1 1 1 1 — 2 5 Blood poisoning following injury 2 - - 1 1 5 Knocked down by train 1 1 - 1 — — 3 Suffocated in bed with parents - - - 1 - 2 3 Other 1 1 - 2 1 2 7 Suicidal:— Poisoning by :— Coal Gas 2 — - 6 1 5 14 Lysol — 1 2 2 — 3 8 Hydrochloric Acid — 1 — 1 — — 2 Prussic Acid 1 1 Chloroform - 1 1 Aspirin — — 1 — — — 1 Phosphorus 1 1 Cut throat 2 — l 2 3 — 8 Gunshot, wounds 1 — 3 1 — 2 7 Knocked down by - train 1 — 2 — 1 1 5 Drowning 1 3 — 1 — — 5 Hanging 1 — — — 2 — 3 Open Verdicts :— Found drowned 2 1 — 1 — 1 5 Found dead - - - - - 1 1 Execution - - - - - 5 5 Totals 71 46 82 81 73 145 498 47 TUBERCULOSIS. Notification.—The total number of new cases of Tuberculosis which came to the notice of the Medical Officer of Health during 1928 was 660, as compared with 718 in 1927, 706 in 1926, 643 in 1925, 692 in 1924, and 597 in 1923. The sources of information regarding the 660 new cases notified in 1928 were as follows :— Primary notifications on Form A 532 Un-notified at death 42 Transfers from other Sanitary Authorities 80 Naval and military notifications 6 Total 660 Table XX.—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 XX. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Male. Female. Male. Female. Male. Female. Male. Female. Under 1 year - - 1 2 - - 1 - 1—5 - - 9 8 - 2 - - 5—10 2 4 17 1 1 - - 10—15 - 8 11 - - - 0 1 15—20 33 41 6 4 1 18 Z 97 2 o - 20—25 43 51 4 4 18 13 9 1 25—35 65 54 - 12 37 - - 2 35—45 44 35 3 3 30 30 - - 45—55 50 18 1 3 28 5 2 - 55—65 19 9 3 - 20 10 1 1 65 upwards 13 2 1 4 8 4 - 3 Totals 274 222 62 60 161 108 21 14 48 Report of the Medical Officer of Health. Table XXI. shows the number of new cases of Nonpulmonary Tuberculosis classified according to the part of the body affected. TABLE XXI. Localisation of Disease. Total. Males. Females. Brain 20 13 7 Glands, Mesenteric 14 5 9 Glands, Cervical 34 17 17 Bones and Joints 30 17 19 Skin 3 1 2 Other Parts 15 9 6 Totals 122 62 60 Deaths.—The total number of deaths certified as due to diseases of a Tuberculous nature was 304—of whom 182 were males, and 122 females, Of the 304 deaths, 269 were due to Pulmonary Tuberculosis, 23 to Tuberculous Meningitis, six to Abdominal Tuberculosis and six to other forms of Tuberculosis. Table XX. gives details regarding the type of the disease, sex, and age grouping of these 304 deaths. In addition to these deaths, which were duly certified in the returns as due to Tuberculosis, 17 persons previously notified as suffering from Tuberculosis died during the year. These deaths, however, do not figure in Table XXII. for the reason that:— (a.) Six were certified as dying of diseases other than Tuberculosis. (b.) Eleven had previously moved outside the Borough and died there, the deaths being credited to the areas in which death occurred. Tuberculosis. 49 TABLE XXII. Localisation. Total. Males. Females. Pulmonary 269 161 108 Brain 23 16 7 Glands, Mesenteric 6 3 3 Bones and Joints 4 1 3 General Tuberculosis - - - Other Parts 2 1 1 Total 304 182 122 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. 50 TABLE XXIII. 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 Pulmonary Tuberculosis:— No. of Deaths 288 257 331 286 269 244 261 255 300 269 Death-Rate .87 .75 100 .85 ,0 .71 .75 .73 .85 .76 Other Forms:— No. of Deaths 54 58 59 57 50 50 49 40 39 35 Death-Rate .16 .18 .18 .17 .14 .14 .15 .12 .11 .10 Total:— No. of Deaths 342 315 390 343 319 294 310 295 339 304 Death-Rate 1.03 .93 1.18 1.02 .94 .86 .90 .84 .96 .86 Report of the Medical Officer of Health. Tuberculosis. 51 During the year 42 persons, not previously notified, were certified as having died of Tuberculosis. The ratio of unnotified Tuberculosis deaths to total Tuberculosis deaths is therefore 42 to 304. Of the 42 unnotified deaths, 18 were certified from Institutions, 16 by private doctors, while in eight 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. 61 persons died within one month after notification, 84 within three months, and 103 within six months. 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 Table XXVII.— which is a list containing the names of all persons attending at, or seen in connection with, the Dispensary for diagnosis or treatment. Table XXIV. gives a summary of all the cases of Tuberculosis notified since 1904, which is the first complete year after a voluntary system of notification was instituted in the Borough. The figures for the first 20 years are given in quinquennial periods, and those for each year since 1923 are shown separately. The number of cases reported, the number who died, recovered or removed, and the number remaining on the register at the end of each period are shown in this Table, for both pulmonary and non-pulmonary forms of the disease. 52 Report of the Medical Officer of Health. TABLE XXIV. 1904 to 1923 in 5 year periods. In recent years. Totals. 1904— 1908 1909— 1913 1914— 1918 1919— 1923 1924 1925 1926 1927 1928 Pulmonary Tuberculosis:— Cases reported 432 2830 2336 2769 531 509 557 537 496 10997 Died 230 1091 1386 1030 244 261 255 300 238 5035 Recovered 23 76 10 49 24 15 33 15 22 267 Removed or untraced 159 724 831 835 550 230 270 275 200 4074 Remaining on Register 20 959 1068 1923 1636 1639 1638 1585 1621 1621 Non-Pulmonary Tuberculosis:— Cases reported Not 323 791 745 161 134 149 129 122 2554 Died 46 382 198 50 49 40 39 30 834 Recovered -- 41 46 24 7 14 33 13 178 Removed or untraced 9 116 319 160 83 59 130 61 937 Remaining on register 268 520 702 629 624 660 587 605 605 Total on Notification register at end of each period 20 1227 1688 2625 2265 2263 2298 2172 2226 2220 53 TUBERCULOSIS DISPENSARIES. The times at which Sessions are held at the two Tuberculosis Dispensaries are as follows:— (a.) At the Main Dispensary, 79, East Hill, Wandsworth, which serves the areas Putney, Southfield, Fairfield, Springfield and North Clapham:— Monday: Morning and Afternoon Tuesday: Evening (7 p.m.), for those at work. Thursday: Morning and Afternoon. Saturday: Morning (for school children). (b.) At the branch Dispensary, 114, Gosberton Road, Balham, which serves the areas Streatham, Tooting, Balham and South Clapham:— Tuesday: Morning and Afternoon. Thursday: Evening (7 p.m.), for those at work. Friday: Morning. New Cases in 1928.—The following Table shows the number of new cases which attended during the year classified into adults and children and according to the diagnosis arrived at. TABLE XXV. Tuberculous. Suspected Tuberculosis NonTuber culous Totals. Pulmonary NonPul monary Total Adults M. 137 10 147 43 119 309 F. 97 10 107 30 223 360 Children M. 2 11 13 13 512 538 F. 3 9 12 7 600 619 Totals 239 40 279 93 1454 1826 In addition to the above, 39 other cases also attended who were either transferred from other Districts where they had been under treatment or had re-appeared after having been removed from the Dispensary Register. 54 Report of the Medical Officer of Health. The districts of the Borough in which these 1,865 persons resided, together with the authorities who recommended them to attend, are given in Table XXVI. TABLE XXVI. Recommended to attend Dispensary by Clapham. Putney. Streatham. Tooting. Wandsworth. Outside Borough. Totals. Public Health Department 90 57 177 160 180 6 670 Private Practitioners 61 93 140 191 190 7 682 Charitable Societies 2 3 8 4 9 - 26 Other Dispensaries 18 30 28 12 37 - 125 L.C.C. Schools 4 5 8 9 12 - 38 Ministry of Pensions 4 5 8 8 5 - 30 Existing Dispensary Patients 3 7 18 27 15 70 Other Sources 30 22 41 39 90 2 224 Total 212 222 428 450 538 15 1,865 Contacts.—Of the 1,865 new cases examined, 456 were contacts. 23 of these were found to be suffering from Tuberculosis. Dispensary Register.—Table XXVII. shows the number of cases remaining on the Dispensary Register at the end of the year compared with the number at the end of the previous year. TABLE XXVII. Tuberculosis Remaining 31st Dec., 1927 New Cases Removed from Register Remaining on Register 31st Dec., 1928 Pulmonary 934 239 174 999 Non-Pulmonary 258 40 31 267 Suspected cases 22 93 68 47 Totals 1,214 372 273 1,313 Tuberculosis Dispensaries. 55 Table XXVIII. gives further details of the work carried out during the year. TABLE XXVIII. 1. Number of patients transferred from other areas and "lost sight of " cases returned 39 2. Number of patients transferred to other areas and cases "lost sight of " 75 3. Died during the year 158 4. Number of observation cases in which period of observation exceeded 2 months 42 5. Number of attendances at the dispensaries 5432 6. Total number of reports, etc., made in connection with the dispensaries 5505 7. Number of attendances at General Hospitals or Institutions of patients for:— (a.) Light treatment 541 (b.) Other special forms of treatment 193 8. Number of patients to whom Dental Treatment was given in connection with the Dispenary 44 9. Number of consultations with Medical Practitioners:— (a.) At homes of applicants 94 (b.) Otherwise 1098 10. Number of other visits by Tuberculosis Officers at homes 234 11. Number of visits by Health Visitors or Nurses to homes for dispensary purposes 4884 12. Number of:— (a.) Specimens of Sputum, etc., examined 1970 lb.) X-ray examinations made in connection with dispensary work 39 The number of patients who received institutional treatment under the London County Council's Tuberculosis Scheme during 1928 was as follows:— (a.) In Hospitals for observation 48 (b.) In Sanatoria 389 (c.) In Hospitals for Advanced Cases 6 Total 443 The above figures do not include patients treated either in private or in poor law institutions. As in former years great difficulty was experienced in arranging for the institutional treatment of advanced cases. 56 Report of the Medical Officer of Health. Co-operation with other Institutions.—Cases requiring special investigation without their admission to Hospital, are, as before, referred to S. 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 S. Thomas's Hospital, for supplying refills to patients treated by the Artificial Pneumothorax method have been continued. 19 cases were treated during the year and 240 refills administered. The total cost was £126. 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. 44 patients received dental treatment and eight of these were supplied with dentures. The attendances at the dentist totalled 117. The amount expended on dental treatment during the year was £16 15s. while the cost of dentures supplied to patients was £33 10s. 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 Tuberculosis Dispensaries. 57 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 101 patients have been granted extra nourishment under the scheme at a cost of £128 8s. 7d. 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 almost 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 S. Thomas's Hospital for the treatment of adults. 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 1928 as far as it is known. Table XXIX. refers to cases of Pulmonary Tuberculosis and Table XXX. to cases of Non-pulmonary Tuberculosis. 58 TABLE XXIX. Classification on Initial attendance at the Dispensaries. Condition at the end of 1928 Died. Total cases where condition is known. Removed and lost sight of. Total cases who have attended. Discharged as cured. Disease arrested. Disease not arrested. Pulmonary Tuberculosis. Class T.B. Minus. Adults, M. 373 35 104 169 681 1528 540 2068 Adults, F. 427 18 85 165 695 Children 105 9 14 24 152 Class T.B. Plus. Adults, M. 85 60 380 1014 1539 . 2674 594 3268 Adults, F. 52 24 260 764 1100 35 Children 6 3 8 18 Report of the Medical Officer of Health. Tuberculosis Dispensaries. 59 TABLE XXX. Classification on Initial attendance at the Dispensaries. Condition at end of 1928. 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 Joints Adults, M. 29 14 28 7 78 220 43 263 Adults, F. 14 6 19 6 45 Children 48 16 17 16 97 Abdominal Adults, M. 7 - 2 1 10 66 23 89 Adults, F. 6 - 5 1 12 Children 15 11 13 5 44 Peripheral Glands Adults, M. 10 2 6 1 19 315 70 385 Adults, F. 25 3 7 7 42 Children 170 22 53 9 254. Other Organs. Adults, M. 9 3 12 7 31 91 24 115 Adults, F. 9 2 17 4 32 Children 1 1 8 18 28 60 Report of the Medical Officer of Health. Bacteriological Examinations.—Below is shown the number of such examinations of sputum made at the Dispensary during the past five years. Year. Total number of specimens examined. No. of specimens sent by General Practitioners and St. James' Hosptl. No. of specimens found to contain T.B. 1924 1789 1013 437 1925 1711 1066 384 1926 1865 1210 404 1927 2087 1417 447 1928 1970 1457 476 Care Committee. Constitution.—The Tuberculosis Care Committee was appointed by the Borough Council, and the Council's representatives on the Committee are: Councillors T. Harding 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 Socicty. Invalid Children's Aid Assn. Ranyard Nurses' Association. Brompton Hospital. S. 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. Joint Hon. Secretary: Mrs. Nicol. Hon. Treasurer: Mr. H. B. Harvey. Tuberculosis Dispensaries. 61 Meetings.—The Committee meets 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. (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. (/.) 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 369 patients (adults and children), the amount collected and remitted to the London County Council being £897 9s. 3d. The amounts of such assessments are subject to the approval of the London County Council. In addition to the patients visited by the Tuberculosis \ isitors, 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 62 Report of the Medical Officer of Health. mittee 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. 68 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 at St. Columba's Hospital, Hampstead, including: Zodiac Dramatic Society, £85 13s. 8d., Jumble Sale, £16 10s., Whist Drive, per Miss Moores, £4, Cake Tea, £42, Progressive Bridge, per Mrs. Arding, £13 l1s., Flower Tea, £66. 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 16 patients were nursed there for varying periods, at a total cost of £250 19s. 3d. By means of the same voluntary fund 15 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, at a total cost of £90 10s. Five children were placed in Orphanage Schools, and others sent into the country for their summer holidays. 63 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 Superin tendents 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 S. 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 64 Report of the Medical Officer of Health. 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. 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. The Superintendent of the Tooting Infant Welfare Centre, who was appointed by the Voluntary Committee of the Centre, resigned during the year, and in accordance with the Council's decision made in 1927 to replace Superintendents with Health Visitors as vacancies occur, one of the Council's Health Visitors was appointed to act in this capacity. The Health Visitors are now acting as Superintendents at the Springfield, Fairfield and Tooting Infant Welfare Centres, and these new arrangements are working very well. Table XXXI. summarises the work of the Health Visitors during the year in the six divisions of the Borough. Maternity and Child Welfare. 65 TABLE XXXI. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Infants under 1 year:— Visits 771 278 482 664 559 1174 3928 Revisits 1058 180 420 502 306 2109 4575 Children 1-2 years:— Visits 22 - 8 21 12 24 87 Revisits 406 152 298 193 119 1153 2321 Children 2-5 years:— Visits 21 5 - 23 5 17 71 Revisits 187 170 334 76 120 817 1704 Ante-natal cases 232 37 103 100 72 276 820 Puerperal Fever and Pyrexia. Ophthalmia Neonatorum 6 14 7 3 8 7 14 12 5 13 16 12 56 61 Measles 1918 1112 1155 1690 1795 2864 10534 Whooping Cough 240 164 64 100 157 694 1419 Enteritis 5 2 - 1 - 5 13 Miscellaneous 56 43 82 109 49 260 599 Ineffectual 684 309 549 788 480 1582 4392 Total 5620 2462 3510 4293 3692 11003 30580 Attendances at:— Infant Welfare Centres 79 127 86 116 152 324 884 Ante-natal Centres 10 21 27 20 30 50 158 Committee Meetings 4 12 — 1 14 - 31 Health Talks 57 45 30 52 49 102 335 Visits to Creches - 21 27 - 31 22 101 66 Report of the Medical Officer of Health. Infant Visiting. There were 4,616 births during the year and 3,928 of these, or 85.0 per cent., were visited, compared with 82.7 in 1927, 81.7 in 1926, 81.1 in 1925, 79.9 in 1924 and 77.1 in 1923. Table XXXII. gives the particulars of the method of feeding of infants on the occasion of the initial visit and when revisited. Of 3,928 infants visited for the first time, 3,390 were entirely breast-fed, while 538 were otherwise fed. On revisiting, 2,653 infants were found to be fed entirely on the breast, and 1,692 were fed by other methods. TABLE XXXII. Method of Feeding. Age of infant on first visit. Under 1 month. 1—3 months. 3—6 months. 6—12 months. Total. Breast-fed 1842 1247 212 89 3390 Otherwise fed 112 223 109 94 538 Method of Feeding. Age of infant on subsequent visit. Under 1 month. 1—3 months. 3—6 months. 6—12 months. Total. Breast-fed 144 627 838 1044 2653 Otherwise fed 29 293 551 1049 1922 It was found that in 1,144 of the births, doctors had been in attendance, while in 1,692 the services of midwives had been utilised. 1,092 infants were born in hospitals and other institutions. Maternity and Child Welfare. 67 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. 42 midwives practise in the Borough, of whom 17 reside in neighbouring Boroughs. There are 32 private maternity homes in the Borough, 12 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. 172 cases were visited during the year under these arrangements, and 3,146 visits were made to them as shown in Table XXXIII. TABLE XXXIII. No. of cases. No. of visits. Whooping Cough 6 60 Influenza 9 118 Pneumonia 76 1661 Ophthalmia Neonatorum 25 832 Measles 55 436 Puerperal Fever and Puerperal Pyrexia. 1 39 Total 172 3146 The number of visits made by nurses in 1927 was 3,515 and the decrease is due to the decrease in the number of cases of Influenza and Pneumonia. 68 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 1928, was 2,794, compared with 2,632 for the previous year, and the total attendances were 52,661. The number of visits paid by the Superintendents to infants was 8,072. Eight of the 11 Centres have ante-natal clinics and 711 cases were examined at these clinics, compared with 582 in 1927. In October the Minister of Health informed the Council that the Postmaster-General was prepared to allow cards showing the addresses and hours of attendance at the various Infant Welfare Centres to be exhibited in the post offices in the Borough. This offer was accepted by the Council and cards were printed and are now exhibited in all the post offices. The following is a list of the Welfare Centres in the Borough, together with the hours at which the clinics are held:— Maternity and Child Welfare. 69 Infant Welfare Centre. Clinics. Ante-natal. Infants. Clapham: Clapham Dispensary Manor Street. 1st and 3rd Mondays 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. 70 TABLE XXXIV. Clapham. Putney. Putney Park. Balham. Streatham. Blegborough Road. Tooting. Southfield. Fairfield. Springfield. Totals. Fairlight Lynwood Road New Cases, 1928 458 168 54 452 404 136 243 130 227 265 257 2794 Total Attendances 8514 4579 1759 9008 6536 3183 4793 2030 4710 3722 3827 52661 Ante-natal Cases 94 92 107 99 - 75 45 149 - 50 711 Ante-natal Attendances 227 239 - 347 289 - 213 111 410 - 113 1949 Supts.' Visits to Infants 1364 1370 588 2178 1075 - - - 1497 - - 8072 Supts.' Visits to Ante-natal Cases 132 236 72 195 138 - -- - 187 960 No. of Sessions:— Infants 96 100 50 99 94 48 93 45 99 101 50 875 Ante-natal 12 24 - 30 24 - 22 14 24 22 172 Health Talks given 82 65 26 57 33 23 30 28 66 50 52 512 Report of the Medical Officer of Health. Maternity and Child Welfare. 71 MOTHERCRAFT AND FATHERCRAFT COMPETITIONS. For some years several of the Infant Welfare Centres have been entering for the National Competitions in Mothercraft, and several successes have been obtained. As there are now 11 Centres in Wandsworth it was decided in 1926 to institute an annual competition among the Centres in the Borough, with the object of fostering increased interest in the important educational work which is being carried out at the Centres. Alderman G. F. Doland, O.B.E., J.P., who was then Chairman of the Maternity and Child Welfare Committee of the Council, presented a challenge shield which will be held in rotation by the Centre winning the competition each year. A syllabus of classes for the competition was drawn up by a Committee of ladies from the Federation of Infant Welfare Centres in the Borough. The parents of children attending the Centres compete by entering in some of these classes, and the best entries at each Centre are chosen to represent that Centre in the Shield Competition. The first Competition for the Borough Shield was held in the Town Hall on the 2nd July, 1928. The syllabus which consisted of ten classes, for six of which each competing Centre could enter, was as follows:— Class 1. Compulsory. (a.) A syllabus of the Health Talks given over a period of three consecutive months in 1927. (b.) An account of any activities at the Centre. (c.) A paper on Mothercraft written by a parent attending the Welfare Centre. Not more than five entries out of the following classes can be sent in by any one centre. Class 2. Needlework. Make a sleeping suit to fit a child of from 1-5 years, out of flannel bought at the clothing stall. 72 Report of the Medical Officer of Health. Class 3. Knitting. Make a jumper and knickers or a dress and knickers to fit a child of from 1-5 years. Wool only to be used. Class 4. Make a serviceable overall for a mother. Class 5. Laundry. Exhibit three laundered garments comprising:— 1 woollen or flannel garment. 1 napkin. 1 cotton or silk garment. Class 6. Spend 3s. in the most economical way on food for a family of five, parents and three children (aged 4, 2½ and 15 months) and exhibit the result. Class 7. Provide and show a cooked dinner for a toddler of 15 months. Class 8. Display a collection of home grown vegetables. At least four varieties must be sent in. Class 9. Fathercraft. Exhibit any home made article useful to mother or child, costing less than 5s. Class 10. Make and show a home made food safe or cot, or home mended boot or shoe. The entries were displayed at the Town Hall and were judged by two ladies appointed to act in that capacity. Many of the entries, which included examples of handicraft by fathers, were of a high standard. Three grades of certificates were awarded to individual competitors according to the standard reached, and points were allotted to the Centre concerned for each certificate obtained, Maternity and Child Welfare. 73 The challenge shield was won by Tooting (Fairlight Hall) Infant Welfare Centre. Springfield Centre was second and Putney and Balham tied for third place.. 13 honours certificates, 18 first class, and nine second class certifcates were awarded to individual competitors. Day Nurseries. The addresses of the four Day Nurseries in the Borough are as follows:— Putney Putney Creche, 95, Lacy Road. Tooting Fairlight Hall Day Nursery, Fairlight Road. Wandsworth Wandsworth Day Nursery and Training School, 14, Garratt Lane. Balham Balham Day Nursery, 22, Old Devonshire Road. The Day Nurseries are voluntary institutions subsidised by Exchequer and Borough Council grants. Children are admitted whose mothers are obliged to go out to work, or who are ill, or who for any other reasonable cause are unable to look after their children. The parents' payments vary from 6d. to 1s. per day for one child a reduction being made when more than one child from the same family is admitted, or when a child is admitted for half a day only. The Putney, Wandsworth and Balham Day Nurseries are also training schools for nurses who intend to take up creche work. They are admitted as probationers and remain for about a year, receiving practical and theoretical training. The matrons give courses of lectures, which the probationers are bound to attend, and an examination is held at the end of the course. The attendances were:—Putney, 5,315; Balham, 6,549; Tooting, 4,718; and Wandsworth, 7,208; a total of 23,790, compared with 23,664 in 1927. 101 inspections of the creches were made during the year bv the Health Visitors, 74 Report of the Medical Officer of Health. Institutions for Expectant and Nursing Mothers and Young Children. The Streatham Babies' Hospital, 9, Leigham Court Road, Streatham, is for the treatment of infants up to the age of 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 pa}' 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. 110 infants were admitted in 1928, 74 from addresses in the Borough and 36 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 cr 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. During the year the Council received an application from the Southwark Diocesan Association for Preventive and Rescue Work for a grant towards the maintenance of unmarried mothers, 75 Maternity and Child Welfare. usually resident in the Borough, in the institutions of the Association. In December the Council decided to make a per capita grant for each resident so maintained, the total amount in any one year not to exceed £200. Convalescent Homes. During the year 19 mothers were sent to Convalescent Homes, all of them taking their infants with them. Nine other children were also sent. Both mothers and children derived much benefit from the change of air. Supply of Milk. The Council decided on the 11th April, 1918, to supply, under the Milk (Mothers and Children) Order, milk free of cost to necessitous expectant and nursing mothers, and to children under five years of age. This scheme came into force on the 1st May, 1918, and is now being operated in accordance with the provisions laid down by the Ministry of Health in Circular 185, dated March, 1921. During the year, 842 families were supplied with milk under the above scheme:—170 in Clapham; 70 in Putney; 136 in Balham; 112 in Streatham; 89 in Tooting; 39 in Southfield; 146 in Fairfield; and 80 in Springfield. The total cost to the Council was £2,071. 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. 70 Report of the Medical Officer of Health. Dental Treatment. The teeth of mothers and children are examined as a routine by the Medical Officers at the Welfare Centres, and those requiring treatment are advised to attend at the Dental Clinic of the British Dental Hospital, 23, South Side, Clapham Common. The modified arrangements made with the British Dental Hospital in 1923, have continued in force throughout the year, and all expectant and nursing mothers attending the Welfare Centres are eligible for treatment under the scheme, provided their financial circumstances are such as to preclude them from paying the full cost of treatment. • The Council makes a payment to the Hospital of 5s. per attendance with an additional charge of 5s. for each case requiring nitrous oxide. A separate charge is made for dentures and patients are asked to contribute towards the cost of these according to their means. 50 cases, 37 women and 13 children were treated at the Hospital and 150 attendances were made. The above service was extended in 1920 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. 20 cases availed themselves of these facilities during the year, 18 being women, and eight children. 77 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 XXXV. gives a summary of the sanitary operations carried out in the Borough during the year. The number of drains which were tested was 1,444, and of these 523 were found to be in a defective condition. The drains of 45 houses were re-constructed. Damp conditions have been remedied in 725 premises, and in 43 of these damp courses were inserted. 23 privies and earth closets are known to be in existence in the Borough, and all of these are in connection with tennis grounds. It will be seen from this Table that 131 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. Three of the above cases of overcrowding which were abated during the year were accommodated in Wandsworth Borough Council houses, and 43 in London County Council houses. 78 Report of the Medical Officer of Health. TABLE XXXV. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 1. Premises cleansed and repaired 489 211 380 258 661 982 2981 2. Drains tested 279 133 147 235 76 574 1444 3. Drains cleansed or repaired 110 32 64 44 87 186 523 4. Water closets cleansed or repaired 221 58 136 58 289 340 1102 5. Soil pipes repaired 22 9 8 8 11 31 89 6. Waste pipes altered or repaired 35 21 26 29 41 139 291 7. Rainwater pipes repaired 46 15 19 28 39 112 259 8. Roofs and gutters repaired 168 71 128 129 254 524 1274 9. Damp courses inserted 9 4 1 7 3 19 43 10. Damp conditions otherwise remedied 87 77 83 73 109 253 682 11. Yards drained or paved 26 5 33 22 90 121 297 12. Dust bins provided or repaired 142 29 115 90 99 254 729 13. Water cisterns cleansed, covered or repaired 30 26 7 23 25 78 189 14. Water supply reinstated 8 12 11 10 3 28 72 15. Defective fireplaces remedied 18 12 60 24 75 145 334 16. Defective coppers remedied 14 15 24 11 23 68 155 17. Cases of overcrowding abated 24 13 9 14 31 40 131 18. Stables and stable yards drained or paved - 2 - 1 1 3 7 19. Accumulations of manure, etc., removed 9 12 13 23 11 69 137 20. Urinals cleansed or repaired 5 2 1 2 1 2 13 21. Animals improperly kept 2 1 2 4 1 13 23 22. Smoke nuisances 4 1 4 — 6 11 26 23. Other nuisances 101 58 36 113 94 409 811 Total 1849 819 1307 1206 2030 4401 11,612 No. of preliminary notices served 783 272 618 556 1025 1424 4678 No. of preliminary notices complied with without the service of statutory notices 644 234 522 507 949 1112 3968 No. of statutory notices served 127 14 112 51 79 187 570 No. of statutory notices complied with 109 12 88 42 97 161 509 79 Sanitary Inspection of the Borough. Table XXVI. gives full details of the inspections carried out by the District Inspectors. TABLE XXXVI. Inspections. ReIn spections. Total. To investigate complaints 6216 16298 22514 House-to-House inspections 989 1776 2765 Infective Diseases:— Notifiable diseases 2453 1039 3492 Measles 21 4 25 Whooping Cough 6 — 6 Other infective diseases 540 48 588 Verminous conditions 78 18 96 Bakehouses No. of Premises 121 242 71 313 Offensive Trades 3 100 4 104 Piggeries 11 119 — 119 Factories, workshops, etc. 1946 1621 58 1679 Houses let in lodgings 265 62 288 350 Rag and bone stores 20 61 — 61 Sanitary conveniences 163 647 — 647 Mews and stables 145 577 10 587 Other inspections 5511 204 5715 Total 19,243 19,818 39,061 Smoke observations 34 — 34 Legal proceedings, Attendances at Court 12 — 12 80 Report of the Medical Officer of Health. Underground Rooms. There are six underground rooms known to be in illegal occupation at the present time and notices have been served, but owing to the difficulty of the occupiers in finding other accommodation no further action can be taken at the present time. 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 XXXVII. 989 inspections were made, compared with 1,435 in 1927, and nuisances were found in 796 of the houses, necessitating the service of sanitary notices. TABLE XXXVII. 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 59 55 21 59 38 17 Clapham South 169 116 13 16 139 106 Putney 40 35 4 3 47 — Streatham 203 179 3 13 275 85 Balham 66 45 4 22 47 36 Tooting 2157 183 19 25 59 264 Southfield 44 36 4 7 31 20 Fairfield 8 8 — 1 1 7 Springfield 163 139 48 57 116 79 Whole Borough 989 796 116 203 753 614 81 Sanitary Inspection of the Borough. Rent and Mortgage Interest Restrictions Act, 1923. 47 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. Four of them were put in a reasonable state of repair before the meeting of the Committee at which Certificates would have been granted. Of the 42 premises in respect of which Certificates w.^re granted, one tenant removed, and 36 were rendered reasonably fit during the year. c. 82 FACTORIES AND WORKSHOPS. The number of factories, workshops, workplaces and home workers' premises is shown in Table XXXVIII., together with the number of inspections made. The inspection of food premises are not included in this Table, but are shown in Table XLII. TABLE XXXVIII. Class of Works. Number of Places on Register at end of 1028. Number of Inspections, 1028. Number of Notices, 1928. Number of Prosecutions, 1928. Factories Factory Laundries 56 50 4 — Factory Bakehouses 09 157 4 — Other Factories 435 436 25 — Total 500 643 33 — Workshops:— Workshop Laundries 34 30 4 — Workshop Bakehouses 52 150 3 — Other Workshops 791 073 24 — Total 877 859 31 — Workplaces 159 142 7 — Total: Factories, Workshops and Workplaces 1590 1044 71 — Home-workers' premises 471 348 14 — Grand Total 2007 1992 85 — Further details with regard to homeworkers' premises are given in Table XXXIX. 83 Factories and Workshops. TABLE XXXIX. HOME WORK. Nature of Work. Outworkers' Lists. Outwork in unwholesome premises Out work in infected premises. Lists received from Employers. Notices served on occupiers as to keeping or sending lists. Lists. Outworkers. Instan ces. Notices served. Instan ces. Contrac tors. Workmen. Wearing Apparel:— (1.) Making, etc. 53 41 221 32 14 14 47 (2.) Cleaning and washing 2 4 3 — — — — Paper bags and boxes 2 — 4 — — — — Totals 57 45 228 32 14 14 47 The total number of addresses received from other Councils was 591, and 136 addresses were forwarded to other Councils. The number of addresses received has increased by 92 and the number sent increased by one. 53 names and addresses were forwarded to this Borough in error. The number of notices sent to employers during the year was 32, and these had a most satisfactory result. During the year 47 cases of infective diseases—five of Scarlet Fever, five of Diphtheria, 24 of Measles, five of Chickenpox, one of Enteric Fever, and seven cf Whooping Cough— were notified as having occurred in the homes of out-workers. In none of there cases was it necessary to make any order under Section 110 of the Factory and Workshop Act. G 2 84 Report of the Medical Officer of Health. TABLE XL. DETAILS WITH REGARD TO REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. Workshop Bakehouses 52 Workshop Laundries 34 Dressmakers' and Milliners' Workshops 140 Bootmakers 115 Smiths and Engineers 48 Builders 40 Tailors 71 Motor Engineers 43 Upholsterers 30 Hairdressers 21 Other 283 Total number of workshops on Register 877 TABLE XLI. DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. No. of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 17 14 - - Want of ventilation — — - - Overcrowding — — - - Want of drainage of floors — — - - Other Nuisances 22 21 - - Sanitary accommodation: Insufficient 1 1 - - Unsuitable or defective 36 32 - - Not separate for sexes 1 1 - - Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouses (s. 101) - - - - Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921) - - - - Total 77 69 - - * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 85 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 XLII. Premises. Number of Places on the Register at end of 1928. Number of inspections, 1928. Number of Notices, 1928. Number of prosecutions, 1928. Dairies, milkshops and cowsheds 255 885 2 - Restaurant kitchens 278 849 2 — Ice Cream premises 455 230 1 — Slaughterhouses 6 610 — — Butchers' shops 241 1620 3 — Greengrocers' shops 325 779 9 — Fishmongers' shops 145 730 4 — Fried fish shops 85 294 2 — Markets and stalls 203 4173 - — Other premises where food is prepared for sale 791 1185 14 — Total 2,784 11,355 37 — The number of inspections of premises where food is sold or prepared was 11,355, compared with 12,585 in 1927, 12,210 in 1926, and 6,917 in 1925. Milk Supply. The bulk of the milk now sold by retail within the Borough is sent out in bottles filled in properly constructed dairies, and 86 Report of the Medical Officer of Health. the quality throughout the year has been good. The average fat content shown by the analysis of 901 samples was 3.47 compared with 3.52 in 1927. There are 255 registered milk premises in the Borough, one of them being also a cowshed. All the premises have been inspected regularly, the Food Inspectors making 885 visits during the year. The milk utensils and barrows used for the delivery of milk have been examined frequently in the street, and as will be seen by Table XLTII., no less than 901 samples of milk were procured and analysed. Meat. Six private slaughter houses are now in use in the Borough. The Food Inspectors made (510 visits to these premises and 8,399 carcases were examined at the time of slaughter or immediately afterwards. 529 of these carcases were oxen, 54 calves, 2,592 pigs, and 5,224 sheep, and 13 were found to be diseased, and were destroyed for the following reasons Oxen. 1 Carcase and offal Tuberculosis 1 Ditto Septicaemia 1 Calf (whole carcase) Immature. Pigs. 10 Carcases Tuberculosis The following organs, etc., were also found to be diseased and were destroyed:— Oxen. 13 Pairs of Lungs Tuberculosis 1 Ditto Fluke 1 Ditto Congestion 90 Livers Fluke 18 Ditto Abscess 5 Ditto Tuberculosis 1 Ditto Echinococcus Cysts 87 Food and Food Premises. 10 Heads and Tongues Tuberculosis 2 Tripes Inflammation 1 Ditto Abscess 4 Forequarters Tuberculosis 2 Flanks Tuberculosis 2 Sets of offals Tuberculosis 2 Hearts Tuberculosis 5 Mesenteries Tuberculosis 1 Spleen Tuberculosis Pigs. 307 Pairs of Lungs Pneumonia 86 Ditto Congestion 5 Ditto Tuberculosis 1 Ditto Strongylus Paradoxus 1 Pluck Pneumonia 6 Ditto Tuberculosis 5 Ditto Inflammation (Pneumonia and Pleuris)7). 14 Livers Cirrhosis 1 Liver Hepatitis 11 Ditto Milkspots 2 Ditto Tuberculosis 69 Heads and Collars Tuberculosis 14 Sets of Offal Tuberculosis 7 Forequarters Tuberculosis 1 Ditto Pleurisy 13 Hearts Pericarditis 1 Ditto Tuberculosis 1 Spleen Tuberculosis 2 Ditto Abscesses 1 Mesentery Tuberculosis 1 Pair of Kidneys Nephritis Sheep. 4 Livers Fluke 2 Pairs of Lungs Strongylus Rufescens 1 Ditto Congestion 2 Forequarters Melanosis 88 Report of the Medical Officer of Health. Fowls. 8 Fowls Decomposition The amount of time devoted to meat inspection is in my opinion fully justified by the results. The work is done very systematically by the Food Inspectors, who are specially qualified for this work. There are 247 butchers' shops in the Borough. 1,620 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. There were no prosecutions under these Regulations during the year. Unsound Food. At the request of the owners the following foodstuffs were condemned and destroyed, and the usual certificates granted viz.:—20 boxes of tomatoes; 1 box of cod's roes; 10 carcases, 2 heads and collars, 7 plucks and 8 offa's of pig; 3 boxes of kippers; 1 carcase, 2 forequarters, 2 flanks and 2 offals of beef; 55 boxes of pears; 1 bag of eels; 20 boxes of peas; 1 trnnk of assorted fish; 1 trunk of whiting; 1 box of herrings; 1 stone of haddock; 1 cooked chicken; and 6 stone of skate. Certification of Meat Food Products. All meat food products prepared for export from this country to Canada, Australia and several other countries, must 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. 89 Food and Food Premises. As Certifying Officer for Wandsworth under the Order I have given 11 of these certificates for the export of parcels of potted meats prepared within the Borough during the year. Statement of work done under the Sale of Food and Drugs Acts. During the year 2,000 samples of foods and drugs were submitted to the Public Analyst for analysis. Of these, 962 were submitted as official samples, while 1,038 were purchased unofficially as test or informal samples. 26, or 2.59 per cent, of the official samples, and 30, or 2.88 per cent, of the unofficial samples were found to be adulterated or not up to standard The total adulterations reported were 56, or 2.8 per cent, of the samples submitted. Proceedings were instituted against the vendors of seven of the 26 adulterated samples taken officially. In one case the summons was dismissed with a warning. In two cases the vendors were convicted and fined £l with £2 2s. costs, and £3 with £3 3s. costs respectively. In the other four cases the Magistrate ordered the defendants to pay costs amounting to £10 11s. In one case the Inspector who was procuring samples of milk from street vendors saw a milk vendor from an adjoining Borough selling milk in Clapham. The Inspector asked for a sample of milk for analysis, but the vendor replied that he had none. The Inspector, who had seen milk in the can previously, insisted on procuring a sample, and the vendor then threw the whole of the milk over him, deliberately causing considerable damage to his clothing. The sample of milk procured proved on analysis to contam 62 per cent, of extraneous water. The vendor was summoned for assault and for refusing to serve the Inspector. He was iined 40s. and £3 3s. costs on the first summons, and £l and £2 2s. costs on the second, the Magistrate stating that it was an impudent assault on the Inspector, who was doing his duty. 90 Report of the Medical Officer of Health. TABLE XLIII. RESULT OF ANALYSIS OF CERTAIN ARTICLES UNDER THE SALE OF FOOD AND DRUGS ACTS, DURING 1028, SHOWING THE PERCENTAGE ADULTERATED COMPARED WITH 1924, 1925, 192G, AND 1927. Percentage of Samples adulterated, 1924-1927. No. of samples in 1928. 1924. 1925. 1920. 1927. Examined. Found adulterated or not up to standard Percentage adulterated Bread — — — — 5 — — Butter 0.6 1.7 0.8 1.3 316 11 3.4 Cheese — — — — 7 — — Cocoa — — — — 7 — — Coffee — 5.4 — — 26 — — Confectionery and Jam — — — — 6 — — Cream and Preserved Cream 13.6 6.0 — 25.0 181 — — Self-raising Flour — — — — 12 — — Margarine — — — — 6 — — Milk 3.7 2.8 2.0 2.3 961 27 — Separated Milk — — — — 2 — — Condensed Milk — — 110 — 18 — — Mustard — — 16.6 — 3 — — Sugar — — — 5.0 6 — — Tea — — — — 6 — — Vinegar — 4.1 40.0 — 9 — — Drugs 14.7 4.5 4.6 5.4 39 6 15.3 Other Articles 1.0 7.1 19.8 3.6 390 12 3.0 All Articles 4.55 3.2 5.3 3.1 2000 56 2.8 91 Food and Food Premises. 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 XLIV. Informal Samples. Formal Samples. Total. Number taken. Adulterated. Percentage adulterated. Number taken. Adulterated. Percentage adulterated. Number taken. Adulterated. Number per 1,000 of population. Percentage adulterated. Clapham 173 4 2.3 169 5 2.9 342 9 5.3 2.6 Putney 97 4 4.1 89 3 3.3 186 7 5.7 3.7 Balham 142 5 3.5 126 3 2.3 268 8 4.8 2.9 Streatham 157 6 3.8 149 4 2.6 306 10 5.5 3.2 Tooting 140 4 2.8 133 5 3.7 273 9 6.6 3.2 Wandsworth 329 7 2.1 296 6 2.0 625 13 6.1 2.0 Whole Borough 1038 30 2.89 962 26 2.6 2000 56 5.6 2.8 Milk. The following samples were submitted for analysis:— 961 of whole new milk. 2 of separated milk. 18 of condensed milk. Of these, 27 were reported against as being adulterated or not up to the Legal Standard. Eight contained extraneous water, 18 were deficient in milk fat and one contained extraneous water and was in addition deficient in milk fat. Proceedings were taken in six of the cases, and in the 21 other cases the Public Health Committee, after considering. 92 Report of the Medical Officer of Health. the amount of adulteration and the circumstances of the sale, decided not to prosecute the vendors, but to take further samples. 46 samples of milk were taken on delivery at the various institutions in the Borough. Three samples were procured at Balham Station at midnight while in transit from the farmer to the retailer, and one of these was reported against. Eight samples of milk were procured in the early morning from wholesale dealers during delivery to retailers and one of these was reported against. 254 samples have been taken on Sundays either in the early morning or at mid-day. Seven, or 2-7 per cent, were reported as adulterated. 603 samples were taken from milk vendors in the street during the early morning (5 to 7 a.m.) on week-days, and of these 14, or 2-3 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 Bacteriological Examination of Milk. Four samples of milk were examined for Tubercle Bacilli under Section 5 of the Milk and Dairies (Amendment) Act, 1922, and in none of them were the organisms found. 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. Food and Food Premises. 93 TABLE XLV. Samples taken. Reported against. Percentage reported against. Certified 18 2 11.1 Grade A (Tuberculin Tested) 1 1 — Grade A — — — Pasteurised 8 — — All samples examined 27 3 11.1 The Minister of Health was notified of the result of these examinations. One vendor of Certified milk was prosecuted for falsely describing milk as "Certified." The vendor, who had been warned previously, was convicted and fined £5 and £l costs. Butter and Margarine. 316 samples of butter were submitted for analysis during the year, and of these 11, or 3-48 per cent., were reported against. Six samples of margarine were submitted for analysis and all were reported genuine. Other Articles. 390 samples were submitted under this heading—for results see Public Analyst's report. 94 MISCELLANEOUS. Insulin Treatment. In March an application was received from the Victoria Hospital for Children asking the Council to provide Insulin for a child aged 10 who was attending the Hospital suffering from Diabetes. This child had no father and his mother was unable to meet the cost of this special form of treatment. The Council decided to grant the application and the Ministry of Health gave their sanction to the issue of a temporary supply of Insulin for patients suffering from diabetes among the poorer inhabitants of the Borough. The drug was first supplied to the child's mother in May and he was still receiving treatment at the end of the year. Bacteriological Examinations. During the year 2,738 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. TABLE XLVI. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Diphtheria:— Negative 327 330 275 421 199 738 2290 Positive 53 59 38 46 24 166 386 Enteric Fever:— Negative 3 12 3 11 4 5 38 Positive 1 3 2 2 1 — 9 Tuberculosis:— Negative 2 2 — 3 3 2 12 Positive 1 1 - - - 1 3 Total 387 407 318 483 231 912 2738 95 Miscellaneous. 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 infective diseases was 4,873:— 806 in Clapham, 42J in Putney, 619 in Balham, 817 in Streatham, 546 in Tooting, and 1,664 in Wandsworth. Six public arid five private elementary schools were also disinfected for infective diseases. Cleansing of Persons Act. The names of 41 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 30 cases the clothing was also 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. 42 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 /4 4s. 8d. was spent in materials used in work of this nature. Statement of Work done under the Rag Flock Act, 1911. 29 visits to workshops were made by the Inspector, and the materials used for bedding and upholstery were examined. 96 Report of the Medical Officer of Health. 19 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. Water Supply—Cutting-off Notices. During the year, 80 notices with respect to 107 premises were received from the Water Board, stating that the supply had been withdrawn. In 72 premises the water supply was cut off for nonpayment of rates, in 11 in consequence of defects to the supply service, and in 24 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, nine bodies were removed to the Mortuary, in Streatham five, and in Wandsworth 115, of which 57 were from Wandsworth, one from Clapham, 23 from Putney, two from Balham, 16 from Tooting, 13 from Battersea, two from Wimbledon and one from Essex—a total of 129. Inspection of Sanitary Conveniences. The number of Sanitary Conveniences inspected was 162 ; 45 in Clapham, 18 in Putney, 13 in Balham, 15 in Streatham, 13 in Tooting and 58 in Wandsworth. 647 inspections were made during the year, and one not'ce, for cleansing, was served and complied with. Ambulance Service. The Metropolitan Asylums Board provide a free ambulance service for the removal cf cases of infectious diseases, and for 97 Miscellaneous. 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. 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 R. Thames by barge from two riverside wharves in the Borough, and disposed of below Barking. Thames Flooding. At midday on Saturday, 7th January, I was informed by the Health Visitor of the district that certain streets in the Fairfield and Southfield wards of the Borough had been flooded in consequence of the River Thames having overflowed its banks during the early hours of that morning. I immediately went round the district affected; with the Health Visitor and the Engineer of the Disinfecting Station, and visited a number of the houses which had been flooded. The flooding was of a severe character and several feet of water had inundated many of the ground floor rooms. The beds used by many families were saturated and quite unusable, and I decided to assist these families by loaning sets of bedding from one of the Council's shelters. Sleeping accommodation was arranged H 98 Report of the Medical OJficcr of Health. for the families in upstairs rooms occupied by other tenants and the beds loaned to them were used in these upper rooms. On Monday, the 9th January, I instructed the Sanitary Inspectors to visit all the affected streets in the area to ascertain the extent of the flooding and to find out what relief could be given to the families who sleep in basement or ground floor rooms which had been flooded. The flooding was of the most serious character, but fortunately there are few basement houses in the area affected. It was found that many families who had rooms on more than one floor were able to make arrangements to sleep in upper rooms. A great deal of damage was done to ground floor rooms and their contents, and as many of these were occupied as bedrooms the occupiers had to seek accommodation elsewhere. The water saturated many rooms and damaged the articles of bedding arid furniture, but in only a few cases was muddy deposit left behind in any quantity. All of the Sanitary Inspectors were on duty in the flooded area almost continuously for several days. The streets affected are mainly in the Fairfield and Southfield Wards, and the worst flooding occurred in an area extending from Bridgend Road on the east, to Wandsworth Park on the west. About 300 premises were flooded. The following list shows the streets affected, with the maximum height reached by the water in each street:— Maximum height of flood. Ships Cottages 3 ft. Pier Terrace 4 ft. Jews Row, Nos. 28-60 2 ft. The Causeway. 3 ft. 6 in. Fairfield Street 3 ft. 6 in. Bell Lane 4 ft. Wandsworth Plain 4 ft. 6 in. Armoury Yard 3 ft. 99 Miscellaneous. Maximum height of floods. Hills Yard 3 ft. Frogmore 4 ft. Wharf Road 3 ft. 6 in. Sudlow Road 3 ft. Point Pleasant 3 ft. Church Row 5 ft. 8 in. in basement Church Passage 2 ft. King's Arms Yard 2 ft. 9 in. High Street (Wandle Bridge to Parish Church) 1 ft. The ground floors of Eden Cottages, Buckhold Road, were also flooded, but fortunately nobody was sleeping downstairs. Three houses in the Embankment, Putney, two houses in Festing Road and the Storekeeper's Cottage at the Council's Depôt in Ashlone Road, Putney, were also flooded with about one foot of water. At a special meeting convened by the Mayor, the Borough Engineer and myself were instructed to make arrangements to collect saturated bedding and clothing, to have them dried at the Wandsworth Baths, and to remove any insanitary conditions arising out of the flood. I supervised the collecting and drying of the saturated articles, consisting mainly of bedding, mattresses and floor coverings, from the affected houses. The Borough Engineer supplied all the necessary transport and labour. The Borough Engineer's staff also assisted occupiers in pumping out the flood water from basement premises, and several insanitary conditions found were removed. Extensive damage was done to furniture, but it was impossible to dry this at the Baths. An inventory of all the articles damaged by the flood in the affected houses was made. The Sanitary Inspectors were h 2 100 Report of the Medical Officer of Health. engaged on this work for several days as it involved much detailed investigation. Many articles of bedding and clothing were presented to the Council by residents in the Borough, and the British Red Cross Society gave a number of blankets for the use of sufferers from the flood. These articles were stored at the Wandsworth Baths, and distributed as required. The British Legion stated that they would do all that was possible to assist ex-service men and their families, and they distributed bedding and clothing to these families. Over 40 children from the area affected were sent to country homes in Wiltshire for a fortnight, free of charge, by the Children's Country Holiday Fund. These children were all examined at the Public Health Department before being sent away. 101 STAFF. Details of the staff of the Department in December, 1928, 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 :— J. J. MacDonnell, M.B., B.S., D.P.H. Assistant M.O.H. and Assistant Tuberculosis Officer :— Vacant. Dr. A. W. Forrest relinquished his appointment as Deputy Medical Officer of Health and Tuberculosis Officer in June, having been appointed Medical Officer of Health for Leyton, and in September, Dr. MacDonnell, formerly Assistant Medical Officer of Health and Assistant Tuberculosis Officer, was promoted to succeed him. The vacancy created by the promotion of Dr. MacDonnell had not been filled at the end of the year, but Dr. S. W. Lane was appointed locum tenens in September and was acting in that capacity at the end of the year. The Deputy Medical Officer of Health and Tuberculosis Officer devotes one half of his time to the general Public Health duties of the Department, and the other half to his duties as Tuberculosis Officer. Half of the salary of the appointment ranks for grant under the Tuberculosis Scheme. The whole of the salary of the third Medical Officer ranks for grant under the Tuberculosis Scheme as his work is in connection with that Scheme. 102 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 Three W. T. Willimott Dec. 1927 „ Yes Five 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. 1920 S.I. Exam. Bd. Yes Three C. F. Standish Jan. 1928 „ Yes One Assistant: *A. J. Lanslcy Mar. 1928 — — — 103 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. 1010 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 Yes Yes Yes No „ J. E. D. Elder Mar. 1928 No Yes Yes No ,, H. McCarthy Nov. 1928 Yes Yes Yes No Tuberculosis Visitors: 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. 1003 „ 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. 104 Report of the Medical Officer of Health. CLERICAL STAFF—Continued. Name. Commenced Duty. Appointment. Certificates held. Miss D. E. Kilsby Nov. 1925 Third Class Clerk Five. *R. H. Chandler Dec. 1925 „ One. *L. L. Parrini May 1923 Office Boy — Disinfecting Station. * J. Bond, Engineer. Nine Disinfecting Attendants. Mortuaries. One whole-time and two part-time mortuary keepers. Miss W. B. Eve, who was appointed Health Visitor in October, 1927, resigned in April, 1928, and Miss J. E. D. Elder was appointed in her place. Miss H. McCarthy was appointed Health Visitor in October, on the resignation of the Superintendent of the Tooting Infant Welfare Centre. This appointment was in accordance with the Council's decision made in 1927 to appoint Health Visitors to act as Superintendents of the Infant Welfare Centres as vacancies occur. The following ladies were engaged as Temporary Health Visitors for the epidemic of measles during the early part of the year:—Mrs. O. Williams, Miss G. N. Cooke, Miss D. M. Westmacott, Mrs. A. W. Keily and Miss G. A. Simonsen. Miss M. Dean, Tuberculosis Visitor, was granted a year's leave of absence for urgent private affairs as from 1st April, 1928. Miss G. A. Simonsen was appointed temporarily in her place. 105 Staff. Mr. A. J. Lansley, a Junior Assistant at the Tooting Library, was appointed in March as Assistant to the Chief Inspector of Food and Drugs on the promotion of Mr. C. F. Standish to Sanitary Inspector, which was reported last year. Mr. F. A. Eustace, 2nd Class Clerk, obtained the qualifying certificate as a Sanitary Inspector of the Joint Examination Board. Owing to the illness of Mr. H. E. Brown, Mr. Eustace has been acting as District Sanitary Inspector from 22nd May. Temporary clerical assistance has been engaged. Messrs. E. V. Roots and W. H. Jones obtained the Certificate in Building Construction awarded by the Brixton School of Building. Mr. W. T. Willimott has been awarded the Sanitary Science Certificate granted by the Royal Sanitary Institute. Mr. C. F. Standish has obtained the Certificate of Meat and Other Foods. Miss D. M. Staniland has been awarded the Health Visitors Certificate granted by the Royal Sanitary Institute. Miss Dean and Miss Luff attended the 7th Winter School for Health Visitors organised by the Women Sanitary Inspectors' and Health Visitors' Association, which was held in December, 1927. Miss Watling and Miss Elder attended the 8th Winter School held in December, 1928. During the year much extra work was thrown on the Staff of the Department by the Flooding of the River Thames in January, 1928, and by the Small-pox outbreak which extended from March to July, and I wish to place on record the able manner in which all members of the Staff carried out the extra duties which they were called upon to perform. I am, Your obedient Servant, F. G. CALEY. 100 Report of the Medical Officer of Health. VITAL STATISTICS.—CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF WANDSWORTH, 1928. Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 45— 05— 75— ALL CAUSES 3776 M. 1833 123 28 28 49 81 219 539 398 368 F. 1943 106 30 19 37 75 194 440 404 638 1. Enteric Fever M. 1 — — — — 1 — — — — F. 3 — — — — — 2 1 — — 2. Small-pox M. — — — — — — — — — — F. — — — — — — — — — — 3. Measles M. 20 3 7 6 4 — — — — — F. 17 4 10 3 — — — — — — 4. Scarlet Fever M. 2 1 — 1 — — — — — — F. 1 — — — 1 — — — — — 5. Whooping Cough M. 3 2 1 — — — — — — — F. 6 4 2 — — — — — — — 6. Diphtheria M. 11 2 2 3 3 1 — — — — F. 4 — — 1 3 — — — — — 7. Influenza M. 22 — — 1 1 — 1 7 6 6 F. 23 — — — — 1 3 8 8 3 8. Encephalitis lethargica M. 2 — — — — 1 — 1 — — F. 1 — — — — — — 1 — — 9. Meningococcal meningitis M. 1 — — — 1 — — — — — F. 1 1 — — — — — — — — 107 Vital Statistics. 10. Tuberculosis of respiratory system M. 136 1 — — — 22 63 41 7 2 F. 111 — — — 2 37 44 21 3 4 11. Other tuberculous diseases M. 34 1 — 4 7 9 6 6 1 — F. 15 — 1 6 1 2 1 1 2 1 12. Cancer, malignant disease M. 230 — — — 1 5 15 104 76 29 F. 275 — 1 — 1 — 25 118 67 63 13. Rheumatic fever M. 5 — — — 3 2 — — — — F. 6 — — — 1 2 — 2 1 — 14. Diabetes M. 22 — — — 1 — 2 8 8 3 F. 30 — — — — — 1 10 9 10 15. Cerebral hæmorrhage, etc. M. 72 — — — — — 6 16 25 25 F. 121 — — — — — 3 32 41 45 16. Heart disease M. 338 — — 1 2 2 23 85 108 117 F. 461 1 — — 8 9 26 86 111 220 17. Arterio-sclerosis M. 70 — — — — — 1 13 30 26 F. 90 — — — — — 1 18 16 55 18. Bronchitis M. 62 3 — — — — 1 19 14 25 F. 86 5 — 1 — — 2 8 20 50 19. Pneumonia (all forms) M. 132 19 12 2 4 4 18 39 20 14 F. 110 17 11 4 1 3 10 19 23 22 20. Other respiratory diseases M. 19 — — — — — 5 5 9 — F. 31 1 — — — — 4 7 10 9 21. Ulcer of stomach or duodenum M. 31 — — — — — 7 17 7 — F. 6 — — — — — — 5 — 1 22. Diarrhoea, etc. M. 21 16 — 1 — — — 2 — 2 F. 22 13 2 — 2 — 2 1 — 2 108 Report of the Medical Officer of Health. VITAL STATISTICS.—CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF WANDSWORTH, 1928—continued. Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 45— 65— 75— 23. Appendicitis and typhlitis M. 11 — — 1 2 1 2 3 2 F. 6 — — — 1 — — 1 2 2 24. Cirrhosis of liver M. 20 — — — — — 1 14 2 3 F. 13 — — — — — — 7 5 1 25. Acute and chronic nephritis M. 71 — — — 1 1 7 32 15 15 F. 56 — — — 2 1 4 21 14 14 26. Puerperal sepsis M. - - - - - - - - - - F. 6 - — — — 4 2 — — — 27. Other accidents and diseases of pregnancy and parturition M. - - - - - - - - - - F. 13 — — — — 1 10 2 — — 28. Congenital debility and malformation, premature birth. M. 62 58 2 - 1 - 1 - - - F. 45 45 - - - - - - - — 29. Suicide M. 40 - - - - 1 11 18 9 1 F. 9 - - - - - 6 3 — — 30. Other deaths from violence M. 84 1 - 4 9 22 12 15 8 13 F. 54 4 — - 2 3 7 10 9 19 31. Other defined diseases M. 311 16 4 4 9 9 37 94 51 87 F. 321 11 3 4 12 12 41 58 63 117 32. Causes ill-defined or unknown M. - - - - - - - - - - F. - - - - - - - - - - 109 Police Court Proceedings. PARTICULARS OF PROCEEDINGS TAKEN UNDER PUBLIC HEALTH ACTS. Premises. Offences. Result. Fine. Costs. s. d. s. d. 4, Clarks Cottages Clapham. Nuisances Summons withdrawn the work having been done — 10 6 6, Clarks Cottages Clapham. Ditto Ditto — 10 6 On street in Clapham Removal of offensive matter through the streets at a prohibited hour Summons dismissed on undertaking of defendant to instal proper sealed metal tins - 42 0 55, 57 and 59, Alston Road, Tooting Nuisances Summonses withdrawn the work having been done. — 63 0 52, Palmerston Road Wandsworth. Ditto Order made for abatement of nuisances — 42 0 45, Colmer Road Streatham. Ditto Order made to prevent a recurrence of the nuisances. — 42 0 — 210 0 110 HOUSING STATISTICS. Number of New Mouses Erected during the Yfar:— Total 927 (i.) By the Local Authority 04 (ii.) By other bodies or persons 803 (By the Borough Council since 1919— 1,141). 1. Unfit Dwelling Houses. (I.) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 15,870 (2.) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 989 (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 bo in all respects reasonably fit for human habitation 4,078 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 3,908 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 111 Housing Statistics. (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 610 (2.) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a.) By owners 509 (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 1 (2.) Number of dwelling-houses in respect of which Closing Orders were made 8 (3.) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (4.) Number of dwelling-houses in respect of which Demolition Orders were made Nil (5.) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 112 Analysts' Annual Report. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Wandsworth. Mr. Mayor, Madam and Gentlemen, In presenting this our last annual report on work performed by us under the, now repealed, Sale of Food and Drugs Acts it gives us much pleasure to be able, once again, to congratulate your Borough on rhe purity of its food supply, cases of serious adulteration having only been met with on rare occasions during the year under review. It is especially gratifying to note that that verv important food, Milk, is being sold in the Borough at an average composition well above that required by the Law and that less than 3 per cent, of the samples submitted for analysis were found to be below the legal standard whilst the majority of these so returned proved to be only slightly below that standard. A large and varied number of samples have been submitted by your Food Inspector with a view to ascertaining whether the various Regulations respecting the addition of preservatives to food and drink which have come into force during the year were being complied with, and here again we have much pleasure in being able to draw attention to the fact that none of these samples, with the exception of a few Butters, taken early in the year, was found to have contravened these Regulations. As a matter of fact, many of the samples of Sausages labelled and submitted as "preserved" proved, on analysis, to be quite free from such, excepting Common Salt Spice. The following statement shows the nature of the samples submitted and the result of analysis, the details of Drugs and "Other Articles" being given below:— 113 Analysts' Annual Report. GENERAL STATEMENT. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Bread - 5 5 - - - Butter — 316 316 - 11 11 Cheese — 7 7 - — — Cocoa — 7 7 - — — Coffee - 26 26 - — — Cream — 181 181 - — — Flour, Self-raising — 12 12 - — — Jam — 6 6 - — — Margarine — 6 6 - — — Milk 955 6 961 23 4 27 Milk, Separated 2 — 2 — — — Milk Condensed (Full Cream) - 12 12 — — — Milk, Condensed (Machine Skimmed) - 6 6 - - - Mustard — 3 3 — — — Sugar — 6 6 — — — Tea — 6 6 — — — Vinegar — 8 8 — — — Vinegar, Malt — 1 1 - — - Drugs 2 37 39 2 4 6 Other Articles 3 387 390 1 11 12 Total 962 1038 2000 26 30 56 DRUGS. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Acid, Citric - 3 3 - - - Acid, Tartaric 1 3 4 1 1 2 Castor Oil — 2 2 — — — Cream of Tartar 1 3 4 1 2 3 Friar's Balsam — 3 3 — — - Hydrogen peroxide — 1 1 — - — Glycerine — 6 6 — — — Powder, Compound Liquorice - 2 2 - - - Powder, Gregory — 3 3 - — — Sal Volatile — 3 3 - - — Soda, Bicarbonate — 3 3 - — — Rhubarb, Powdered — 3 3 - — — Tincture of Iodine — 2 2 - 1 1 Total 2 37 39 2 4 6 I 114 Report of the Medical Officer of Health. OTHER ARTICLES. Nature of Sample. Examined. Adulterated Formal. Informal. Total. Formal. Informal. Total. Almonds, ground - 5 5 - - - Apples — 6 6 — — — Bacon — 21 21 — — — Baking Powder — 6 6 — — — Barley, pearl — 6 6 — — — Brawn — 4 4 — — — Cakes, sponge — 20 20 — — — Cherries, glace — 6 6 — — — Chocolate Powder — 5 5 — — — Christinas Pudding — 4 4 — — — Cocoanut, desiccated — 3 3 — — — Coffee and ChicoryExtract - 15 15 - - - Cornflour — 3 3 — — — Cream "Fairy " — 1 1 — — — Currants — 12 12 — — — Easter eggs — 4 4 — — — Fruit, tinned — 28 28 — — — Ginger, ground — 10 10 — — — Ginger, preserved — 6 6 — — — Honey — 6 6 — — — Ice Cream — 4 4 — — — Jelly Crystals — 2 2 — — — Jelly, table — 15 15 — — — Lard — 29 29 — — — Lemonade 3 — 3 1 — 1 Lemonade Crystals — 20 20 — 11 11 Lemon Curd — 6 6 — — — Meat Paste — 13 13 — — — Meat pie — 3 3 — — — Mincemeat — 6 6 — — — Olive Oil — 9 9 — — — Pea flour - 3 3 — — — Peel, candied — 10 10 — — — Pepper — 13 13 — — — Raisins — 6 6 — — — Rice — 12 12 — — — Sausages — 12 12 — — — Sausages, preserved — 14 14 — — — Sausage meat — 1 1 — — — Sultanas — 12 12 — — — Sweets — 6 6 — — — Tapioca — 6 6 — - — Wine, Non-alcoholic — 9 9 - - Total 3 387 390 1 11 12 Analysts' Annual Report. 115 The following table shows, in detail, the nature and extent of the adulteration reported in the formal samples examined. Case No. Nature of Sample. Nature of Report. 9 Milk 9 % Fat deficient. 22 Ditto 2 % Fat deficient. 35 Ditto 18 % Fat deficient. 38 Tartaric Acid 10 parts per million excess of Lead. 39 Cream of Tartar 1.3 % Tartaric Acid and 2.3 % Desiccated Cocoa nut 68 Milk 2 % Extraneous water. 94 Ditto 1 % Extraneous water. 99 Ditto 7 % Fat deficient. 100 Ditto 3½ % Extraneous water. 120 Ditto 1 % Fat deficient. 120 Ditto 2 % Fat deficient. 145 Ditto 3 % Extraneous water. 159 Ditto 1 % Extraneous water. 163 Ditto 1 % Extraneous water. 217 Ditto 9 % Extraneous water. 222 Ditto 15 % Fat deficient. 233 Ditto 12 % Fat deficient. 307 Ditto 1 % Fat deficient. 408 Ditto 13 % Fat deficient. 413 Ditto 1 % Fat deficient 473 Ditto 11 % Fat deficient 479 Ditto 9 % Fat deficient. 525 Lemonade 100 % Coloured water 612 Milk 2 % Fat deficient 615 Ditto 4 % Extraneous water. 848 Ditto 18 % Fat deficient. Below will be found the nature of the reports issued in respect to the Informal samples returned as adulterated :— Case No. Nature of Sample. Nature of Report. 20 Butter Contains Boric Acid. 30 Ditto Ditto 43 Ditto Ditto 45 Ditto Ditto 61 Tartaric Acid Contains excess of Lead 68 Cream of Tartar Contains Tartaric Acid and Desiccated Cocoanut. 69 Ditto Consists of Bicarbonate of Soda. 107 Butter Contains Boric Acid. 114 Ditto Ditto 194 Milk 10 % deficient in fat and contains minute traces of Copper Sulphate. I 2 116 Report of the Medical Officer of Health. Case No. Nature of Sample. Nature of Report. 325 Milk 62 % Extraneous water and 40 % Fat deficient. 446 Ditto 12 % Fat deficient. 454 Lemonade Crystals Made with Tartaric Acid. 455 Ditto Ditto 456 Ditto Ditto 457 Ditto Ditto 459 Ditto Ditto 497 Butter Contains a trace of Boric Acid. 536 Ditto Contains excess water. 565 Ditto Contains Boric Acid. 584 Lemonade Crystals Made with Tartaric Acid. 585 Ditto Ditto 586 Ditto Ditto 588 Ditto Ditto 634 Milk 60 % Fat deficient. 639 Tincture of Iodine Deficient in Iodine and Potassium Iodide. 675 Lemonade Crystals Made with Tartaric Acid. 676 Ditto Ditto 972 Butter Contains Margarine. 1032 Ditto Ditto The average composition of the Milks returned as genuine during each month of 1928 was as under:— Month. Total Milk Solids. Milk Fat. Non-fatty Solids. January 12.33 % 3.54 % 8.79 % February 12.39 % 3.66 % 8.73 % March 12.18 % 3.48 % 8.70 % April 12.12 % 3.44 % 8.68 % May 12.06 % 3.28 % 8.78 % June 12.09 % 3.29 % 8.80 % July 12.13 % 3.41 % 8.72 % August 12.24 % 3.54 % 8.70 % September 12.32 % 3.49 % 8.83 % October 12.48 % 3.64 % 8.84 % November 12.54 % 3.69 % 8.85 % December 12.50 % 3.69 % 8.81 % The average for the whole year being :— Total Milk Solids 12.25 per cent. Milk fat 3.47 „ Non-fatty Solids 8.78 ,, 117 Analysts' Annual Report. The average water content of all samples of Butter submitted during the year amounted to 14.03 per cent., that in the Margarine samples being 14.18 per cent. In conclusion we have to report that the adulteration detected during 1928 amounted to 2.7 per cent, in Formal samples, 2.9 per cent, in Informal samples and 2.8 in all samples examined. We have the honour to be Mr. Mayor, Madam and Gentlemen, Your obedient servants, A. H. M. MUTER, F.I.C., Public Analyst. CHARLES A. HACKMAN, F.I.C.. Additional Public Analyst. 325, Kennington Road, S.E. 11. 25th February, 1929. 118 INDEX. page Adulteration of Certain Articles, Percentage of, in 1924-1928 90 Ambulance Service 96 Analysts', Report of 112 Anthrax 35 Anti-toxin 23 Area of Borough 1 Artificial Light Treatment of Tuberculosis 57 Bacteriological Examinations 60, 94 Bacteriological Examination of Milk 92 Bakehouses 79, 82 Balham, House-to-House Inspections in 80 Births 4 Births and Birth-rates in Sub-Districts 4 Birth-rate, Average 10 Years, 1918-1927 8 Births, Notification of, Act 5 Brain and Nervous System, Diseases of the 45 Butchers' Shops 85 Butter and Margarine 93 Cancer 45 Census, 1921 1,4 Cerebro-Spinal Meningitis 34 Child Birth, Deaths from 11 Circulatory Diseases 45 Clapham, House-to-House Inspections in 80 Cleansing of Persons Act 95 Clinics for Immunisation against Diphtheria 23-32 Conscientious Objections Certificates granted 22 Convalescent Homes 75 Cowsheds 85 Creches 73 Cutting-off Notices 96 Index. 110 page Dairies, Milkshops and Cowsheds 85 Day Nurseries 73 Death, Causes of 106-108 Death-rate, Average 10 Years, 1018-1927 8 Death-rate, Corrected 6 Death-rate from Infective Diseases 13 Death-rate, Infantile 9 Deaths, Corrected 6 Deaths, Number of 6 Deaths in Institutions 9 Dental Treatment 56, 76 Developmental Diseases 45 Diarrhoea 43 Diphtheria 23 Diphtheria, Attack Rate per 1,000 cases 23 Diphtheria, Immunisation against 23-32 Diphtheria, " Return Cases "of 32 Disinfection 95 Disinfection of Schools 95 Dysentery 34 Encephalitis Lethargica 34 Enteric Fever 33 Erysipelas 33 Expectant and Nursing Mothers, Institutions for 74 Factories and Workshops 82 Factories, Workshops, etc., Defects found in 84 Factories, Workshops and Workplaces, Inspection of 82 Families, Number of, Census 1921 1 Fathercraft Competitions 71 Fishmongers' Shops 85 Flies and Mosquitoes 95 Flooding, River Thames 97 Food, Prosecutions in connection with 89 Food and Food Premises 85 Food Places, Inspection of 85 Fried Fish Shops 85 Greengrocers' Shops 85 Health Visitors, Work of 63 120 Index. page Home Work 83 Hospitals, etc., for Expectant and Nursing Mothers 74 House Refuse, Removal of 97 House-to-House Inspections, Summary of 80 Houses and Premises Inspected 79 Houses Let in Lodgings 79 Housing Statistics 110 Housing Act, 1925 80 Ice Cream Premises 85 Illegitimate Children, Births of 5 Immunisation against Diphtheria 23-32 Increase of Rent and Mortgage Interest (Restrictions) Act, 1923 81 Infant Visiting 63, 66 Infantile Mortality 9, 10 Infantile Mortality, 10 Years, 1918-1927 11 Infective Diseases 13, 44 Infective Diseases, Cases of 15, 16 Infective Diseases, Deaths at certain Age Periods 14 Infective Diseases, Death Rate from 13 Infective Diseases : Number of Cases Notified from Elementary Schools 41-43 Influenza, Deaths and Death-rates 33 Influenza, Pneumonia and Acute Primary Pneumonia, Cases Notified 34 Inhabited Houses, Number of 1 Inquests 45 Inspections, Details of 79 Institutions, Deaths in 9 Institutions for Expectant Mothers, etc. 74 Insulin treatment 94 Malaria 34 Margarine 93 Markets and Stalls 85 Maternal Mortality 11 Maternity and Child Welfare 63 Maternity and Child Welfare Centres 68 Measles 35-41 121 Index. page Measles and other Non-notifiable Diseases reported from Schools 41-43 Meat 86 Meat Food Products, Certification of 88 Midwives 67 Milk Analysis 91 Milk and Dairies (Amendment) Act, 1922 92 Milk, Bacteriological Examination of 92 Milk (Mothers and Children) Order 75 Milk Premises, Cowsheds, etc., on Register 85 Milkshops, Cowsheds, etc., Inspections of 85 Milk (Special Designation) Order, 1922 and 1923 92 Milk Supply 85 Mortuaries 96 Mosquitoes 95 Motnercraft and Fathercraft Competitions 71 Natural Increase, Rate of 4 Nervous System, Diseases of the 45 Non-Tnfective Diseases, Deaths from 45 Notification of Births Act 5 Notification of Infective Diseases 15, 16 Nursing Arrangements 67 Offensive Trades 79 Old Age 45 Ophthalmia Neonatorum 34 Other Infective Diseases, Deaths from 44 Outworkers 83 Overcrowding 77 Para-Typhoid Fever 33 Physical Features, etc., of the Borough 1 Pneumonia 34 Police Court Proceedings 89, 109 Polio-Myelitis and Polio-Encephalitis 34 Poor Law Relief, Amount of 2 Population 1,3 Population of Sub-Districts 4 Premature Birth 45 Pregnancy, Deaths from Accidenrs and Diseases of ., 11 122 Index. page Puerperal Fever and Puerperal Pyrexia Regulations, 1926 33 Puerperal Pyrexia 33 Pulmonary Tuberculosis, Notification of Cases of 47 Putney, House-to-House Inspections in 80 Rag Flock Act, 1911. Statement of Work done under 95 Rateable Value 1 Rent and Mortgage Interest Restrictions Act, 1923 81 Respiratory Diseases 45 Restaurant Kitchens 85 Return Cases of Scarlet Fever and Diphtheria 32 Sale of Food and Drugs Act, Proceedings under 89 Sale of Food and Drugs Act, Statement of Work under 89 Samples, Formal and Informal, Number of 91 Sanitary Conveniences, Inspection of 96 Sanitary Inspection of the Borough 77 Sanitary Operations, Table of 78 Scabies 44 Scarlet Fever 32 Scarlet Fever, Attack Rate per 1,000 Cases 32 Scarlet Fever, "Return Cases"of 32 Schools, Disinfection of, for Infective Diseases 95 Shelters for Tuberculous Patients 57 Slaughter-houses 85 Small-pox 17 Smoke Nuisances 79 Social Conditions 2 Sputum Examinations 60, 94 Staff 101 Streatham, House-to-House Inspections in 80 Thames Flooding 97 Tooting, House-to-House Inspections in 80 Tuberculosis 47-52 Tuberculosis, Artificial Light Treatment of 57 Tuberculosis Dispensaries 53-62 Tuberculosis Care Committee 60 Tuberculosis, Institutional Treatment 55 Tuberculous Diseases, Extra Nourishment provided 56 123 Index. page Underground Rooms 80 Unsound Food 88 Vaccination Returns 22 Violence, Mortality from 45 Vital Statistics of Whole Borough 3, 106-108 Wandsworth, House-to-House Inspections in 80 Water Supply, Cutting-off Notices 96 Whooping Cough 33 Workshops, Number of 82 Young Children, Institutions for 74 Zymotic Diseases 13