Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, &c. OF THE BOROUGH, For the Year 1930, by F. G. CALEY, M.A., M.B., D.P.H., Medical Officer of Health, together with the Report of the Public Analyst. REPORT of the Medical Officer of Health for the Year 1930. 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 1980. PHYSICAL FEATURES AND GENERAL CHARACTER OF THE BOROUGH. The Registrar-General has estimated the population in 1929 as 346,700, which is higher than that of any of the other London boroughs. As regards area, Wandsworth is larger than any of the other boroughs—the acreage being 9,199, compared with Woolwich, which is 8,986 acres. The population is a very varied one. Parts of the Borough consist of high class residential districts, and there are several large working and labouring districts. 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 B 2 Report of the Medical Officer of Health for 1930. Census 1911, the population was 311,860, of whom 140,728 were males and 170,632 were females. Of the 147,229 males at the Census 1921, 31,781 were under 12 years of age, 98,157 were engaged in enumerated occupations, and 17,291 were retired or not engaged in any occupation. Of 181,078 females enumerated at the Census 1921, 31,485 were under 12 years of age, 52,029 were engaged in various occupations and 97,564 were unoccupied. The commonest occupations for males were commercial and finance, transport and communication, clerical and draughtsmen, metal workers, professional men and those engaged in public administration. The commonest occupations for females were domestic service, laundry work 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. GENERAL STATISTICS FOR THE BOROUGH. Area 9,199 acres Population in 1930 355,864 No. of inhabited houses in 1921 62,540 No. of families, or separate occupiers, in 1921 80,526 Rateable value in 1930 £2,826,679 Estimated produce of a penny rate £11,500 Extracts from Vital Statistics. Births:— Males 2,390 Legitimate 4,443 Females 2,298 Illegitimate 245 Total Births 4,688 Birth-rate 13.17 3 Vital Statistics. Still Births:— Males 56 Females 46 Total Still Births 102 Rate per 1,000 total births 21.7 Deaths:— Total Deaths 3,769 Death-rate 10.59 Percentage of total deaths occurring in public institutions 48.0 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 238 Illegitimate 22 Total 260 Infantile mortality 55 Deaths from Tuberculosis:— No. 308 Rate •86 Total deaths from Measles 47 Total deaths from Whooping Cough 6 Total deaths from Diarrhoea (under two years of age) 32 Population. The population at the middle of the year was estimated to be 355,864, and all the rates used in this Report are calculated on this figure. The corresponding figure for the year 1929 was 355,807. Table I. shows the population of each sub-district, based on the above estimation, compared with the Census population. B 2 1 Report of the Medical Officer of Health for 1930 TABLE 1. Sub 1 )lstrict. CcnHUH Population 1921 Population estimated to middle of 1930 Clapham 60,540 63,689 Putney 28,558 32,449 Balham 50,888 55,1 71 Streatham 52,607 60,717 Tooting 40,135 41,004 Wandsworth 95,570 102,831 Whole Borough 328,307 355,864 Births. The total number of births occurring in the Borough was 3,599, including 433 non-residents who were horn in Institutions. 1,522 births of Borough residents occurred outside the Borough, so that the corrected number of births was 4,688 compared with 4,632 in 1929. 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 48.1 436 920 14.44 3.85 Putney 201 168 300 11.37 .19 Balham 378 386 784 13.84 2.30 Streatham 435 447 882 14.52 3.32 Tooting 235 227 402 11.26 2.22 Wandsworth 657 634 1,291 12.55 2.41 Whole Brought 2,300 2,208 4,888 13.17 2.58 5 Vital Statistics. The birth-rate was 13.17 per 1,000, compared with 13.01 for 1929, and 15.47 the decennial average. The rate for the whole of London during 1930 was 15.7 and for England and Wales, 16.3. 246 illegitimate births took place in the Borough, but only 117 belonged to the Borough. On the other hand 128 illegitimate births belonging to Wandsworth occurred outside the Borough, making a corrected total of illegitimate births belonging to Wandsworth of 245. 51 of these belonged to Clapham, 19 to Putney, 43 to Balham, 47 to Streatham, 18 to Tooting, and 67 to Wandsworth. The percentage of illegitimate births to total births was 5.2. 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 630 516 129 61 318 8 11 Putney 312 268 118 13 135 2 10 Balham 541 523 175 43 279 26 13 Streatham 799 672 151 58 383 80 17 Tooting 399 386 70 40 272 4 7 Wandsworth 918 830 183 79 542 26 29 Whole Borough 3,599 3,195 826 294 1,929 146 87 6 Report of the Medical Officer of Health for 1930. Deaths. The number of deaths which took place in the Borough during the year was 3,122, but 1,094 of these did not belong to the Borough, while 1,741 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 3,769, of whom 1,831 were males and 1,938 females. The corrected death-rate for the year was 10.59, compared with 12.85 in 1929. The death-rate for the whole of London for 1930 was 11.4, for England and Wales 11.4, in the 107 County Boroughs and great Towns 11.5, and in the 157 smaller Towns 10.5. 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 339 336 675 10.59 Putney 108 195 363 11.18 Balham 303 334 637 11.54 Streatham 331 349 680 11.19 Tooting 189 182 371 9.04 Wandsworth 501 542 1,043 10.14 Whole Borough 1,831 1,938 3,769 10.59 Table V. is the general mortality Table for the whole Borough, and shows the corrected number of deaths from each cause divided into sexes, age groups and sub-districts, together with those occurring in Institutions. 7 Vital Statistics. Table V.—Causes of, and Ages at Death, during the Year 1930. 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 4 1 3 ... ... ... ... ... 2 ... 2 1 ... ... ... ... 3 4 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 47 24 23 8 22 10 7 ... ... ... ... 9 3 5 5 7 18 26 Scarlet Fever 6 3 3 ... ... 2 1 1 2 ... ... 1 1 1 3 ... ... 6 Whooping Cough 6 2 4 2 2 1 1 ... ... ... ... 1 ... ... ... ... 5 2 Diphtheria and Membranous Croup 30 14 16 3 1 10 15 1 ... ... ... 9 3 1 3 3 5 28 Influenza 22 7 15 1 ... ... ... ... 3 10 8 4 2 4 4 3 5 8 Erysipelas 12 5 7 1 ... ... 1 ... 1 4 5 3 ... 3 4 1 1 10 Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases 2 ... 2 ... ... ... ... ... ... 1 1 ... 2 ... ... ... ... ... Pulmonary Tuberculosis 263 154 109 ... 1 ... 3 62 107 79 11 52 24 43 83 33 78 153 Tuberculous Meningitis 21 11 10 3 2 2 6 6 2 ... ... 1 1 3 5 4 7 21 Abdominal Tuberculosis 5 3 2 ... ... ... ... 1 1 2 1 ... 1 2 ... 1 1 4 Other Tuberculous Diseases 19 10 9 1 1 1 2 1 4 6 3 3 2 3 5 2 4 12 Other Infective Diseases 16 11 5 2 ... ... 1 3 1 9 ... 5 2 3 2 2 2 14 Cancer, Malignant Disease 514 228 316 ... ... 2 ... 2 40 251 249 100 43 92 110 53 146 284 Rheumatic Fever 30 11 19 ... ... ... 7 7 4 4 8 6 3 7 3 2 9 13 Diabetes 30 12 18 ... ... ... 1 1 10 18 6 4 10 3 2 5 12 Other General Diseases 63 15 50 ... 1 1 ... 5 13 19 26 17 7 9 14 9 9 32 Alcoholism 12 5 7 ... ... ... ... ... 1 9 2 3 2 1 1 5 7 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 18 12 6 5 1 ... 5 ... 1 4 1 2 ... 4 5 2 5 11 Cerebral Haemorrhage, Apoplexy 157 66 91 8 ... ... 1 ... 7 39 107 34 9 33 34 12 35 56 Convulsions 8 6 2 7 1 ... ... ... ... ... ... 1 ... 3 2 ... 2 5 Other Diseases of Nervous System 133 81 52 1 ... 2 10 8 25 46 39 19 15 23 24 17 35 99 Organic Diseases of Heart 690 288 408 ... ... ... 1 4 32 139 520 127 67 107 124 74 197 327 Other Diseases of Circulatory System 237 123 111 ... ... 1 4 3 13 62 154 47 31 50 40 18 51 78 Bronchitis 187 94 93 6 ... 1 ... ... 4 47 129 38 11 30 27 17 64 34 Broncho-Pneumonia 112 53 59 22 11 6 1 1 11 19 41 25 11 26 18 6 26 54 Lobar Pneumonia 39 20 19 1 1 ... ... 2 10 15 10 12 6 4 8 2 7 16 Pneumonia (type not distinguished) 56 31 25 8 ... 2 ... 1 8 21 16 6 8 12 9 3 18 35 Other Diseases of Respiratory System 26 15 11 2 ... ... ... ... ... 7 17 3 8 2 9 3 6 9 Ulcer of Stomach 29 15 14 ... ... ... ... 1 3 18 7 2 4 5 9 2 7 20 Diarrhœa 14 10 4 13 1 ... ... ... ... ... ... ... ... 1 1 3 9 13 Enteritis 19 10 9 17 1 ... ... ... ... 2 ... 3 ... 2 6 2 6 15 Appendicitis and Typhlitis 27 21 6 ... ... 2 4 4 5 7 5 7 4 5 3 1 7 27 Obstruction of Intestines 31 11 20 4 ... ... ... 1 1 8 17 4 5 3 9 2 8 25 Cirrhosis of Liver 16 8 8 ... ... ... ... ... 2 10 4 1 1 4 2 2 6 12 Other Diseases of Liver 28 14 14 ... ... ... ... ... 6 5 17 3 4 3 8 1 9 14 Other Diseases of Digestive System 57 29 28 4 1 3 2 7 8 17 15 14 9 3 16 3 12 42 Nephritis and Bright's Disease 169 86 83 ... ... ... 1 3 13 68 84 27 16 21 30 23 52 109 Other Diseases of Urinary System 67 57 10 1 ... ... ... 1 7 10 48 8 4 12 11 5 27 52 Diseases of Generative System 7 ... 7 ... ... ... ... ... 7 6 ... 1 1 1 2 ... 2 6 Puerperal Fever 6 ... 6 ... ... ... ... ... 6 ... ... ... 2 ... 1 1 2 6 Other Accidents and Diseases of Pregnancy and Childbirth 15 ... 15 ... ... ... ... 3 12 ... ... 4 2 3 2 ... 4 10 Premature Birth 69 31 28 59 ... ... ... ... ... ... ... 11 9 5 18 6 16 33 Congenital Debility and Malformation 49 32 17 45 3 ... ... ... 1 ... ... 9 5 6 5 9 15 28 Other Diseases of Early Infancy 34 17 17 34 ... ... ... ... ... ... ... 6 4 5 3 2 14 25 Old Age 113 45 68 ... ... ... ... ... ... ... 113 13 12 27 22 10 29 31 Deaths from Accident 139 83 56 2 1 1 18 24 25 29 39 15 15 28 27 12 42 123 Deaths from Suicide 50 34 16 ... ... ... ... 2 15 25 8 6 5 13 8 4 14 30 Other Violent Deaths 5 4 1 ... ... ... ... ... 3 2 ... 2 ... ... 1 2 4 Other Defined Diseases 28 18 10 5 ... ... 1 3 2 9 8 5 3 2 2 5 11 24 Ill-defined Diseases or unknown 4 1 3 ... ... ... ... ... ... 3 1 1 1 1 1 ... ... 1 All causes 3769 1831 1938 260 53 47 93 158 403 1021 1734 675 363 637 680 371 1043 2001 8 Report of the Medical Officer of Health for 1980. The number of deaths shown on Table V. does not agree with that shown on page 98. The latter, which is prepared by the Registrar-General, gives the number of deaths which were registered during the calendar year, and the former the number of deaths which occurred during the year. The figures shown in Table V. are used in the calculation of all the mortality rates in this Report. 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. 1920 21.03 26.3 25.4 1 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 11.0 12.3 1928 13.00 15.9 16.7 10.58 11.6 11.7 1929 13.01 15.7 16.3 12.85 13.8 13.4 Average 10 years 15.47 19.2 19.2 10.86 12.1 12.2 1930 13.17 15.7 16.3 10.59 11.4 11.4 9 Vital Statistics. The total number of deaths which occurred in Institutions, etc., inside the Borough was 1,355, but 1,094 of these persons did not belong to the Borough. A total of 2,001 persons belonging to the Borough died in Institutions, 201 occurring in Institutions within the Borough and 1,740 in Institutions outside the Borough. The following is a list of the Institutions, etc., outside the Borough in which deaths of Borough residents occurred:— Name of Institution. No. of deaths. Name of Institution No. of Deaths. Poor Law Hospitals and Infirmaries :— Other Hospitals—contd. Middlesex Hospital 7 Wandsworth Union Hospitals 1,052 National Hospital 10 Banstead Mental Hospital 16 St. Columba's Hospital 7 Cane Hill Mental Hospital 11 St. George's Hospital 8 Grove Park Mental Hospital 15 St. Luke's Hospital 7 Horton Mental Hospital 25 St. Thomas's Hospital 50 Maudsley Hospital 6 South Western Hospital 10 West Park Mental Hospital 13 Victoria Hospital 10 Other Mental Hospitals 21 Western Hospital 7 Other Poor Law Institutions 13 Westminster Hospital 6 Other Hospitals:— Other Institutions, Etc. — Belgrave Hospital 14 Other Institutions 137 Bolingbroke Hospital 52 Other Places not Public Institutions 92 Brompton Hospital 6 Cancer Hospital 7 On Railway 4 Charing Cross Hospital 13 On Street 25 Colindale Hospital 13 River Thames 8 Guy's Hospital 12 Private Nursing Homes 31 Infants' Hospital 9 1,740 Institutions, etc., inside the Borough 261 King's College Hospital 17 London Hospital 6 2,001 Infantile Mortality. The total number of deaths under one year was 200:—19 in Clapham, 13 in Putney, 32 in Balham, 47 in Streatham, 10 Report of the Medical Officer of Health for 1930. 33 in Tooting and 86 in Wandsworth. As the number of births was 4,688 the Infantile Morality rate was 55 per 1,000 births, compared with 61 last year. The decrease in the rate is due to the decrease in the number of deaths from Whooping Cough. The infantile mortality rate is lower than last year, and compares favourably with the decennial average, which was 57, and with the whole of London, which was 59 per 1,000 births. For the 10 years ending 1918 the average infantile mortality rate was 87, while the 10 years ending 1930 the average rate was 57. This fall represents a saving of over 200 infant lives per annum. The number of deaths among legitimate infants was 238 to 4,443 births—a mortality of 53 per 1,000 births, while the number of deaths among illegitimate infants was 22 to 245 births —a mortality of 89 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. 11 Vital Statistics. TABLE VII. Cause of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. All Causes Certified 88 24 11 8 131 42 36 28 23 260 Uncertified - - - - - - - - - - Small-pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - 1 3 4 8 Scarlet Fever - - - - - - - - - - Whooping Cough — — - — — 1 — — 1 2 Diphtheria and Croup — — - — — 2 — — 1 3 Erysipelas - - - - - - 1 - - 1 Tuberculous Meningitis — — - — — 1 — 2 — 3 Abdominal Tuberculosis - - - - - - - - - Other Tuberculous Diseases - - - - - - - - 1 1 Meningitis (not Tuberculous) 1 1 - - 2 1 - 2 - 5 Convulsions 3 1 - — 4 1 - 1 1 7 Laryngitis - - - - - - - - - — Bronchitis — — 1 — 1 1 2 1 1 6 Pneumonia (all forms) — 3 1 1 5 7 9 7 3 31 Diarrhoea — — — 1 1 3 4 3 2 13 Enteritis — 1 — — 1 6 5 2 3 17 Gastritis - - - - - - - - - - Syphilis - - - - - 1 - - - 1 Rickets - - - - - - - - - - Suffocation, overlaying - - - - - 1 - - - 1 Injury at Birth 14 2 — — 16 — — — — 16 Atelectasis 10 3 1 1 15 — — — — 15 Congenital Malformations 14 2 2 1 19 5 2 — — 26 Premature Birth 36 10 5 3 54 5 — — — 59 Atrophy, Debility and Marasmus 3 1 - 1 5 3 6 4 - 18 Other Causes 7 — 1 — 8 4 6 3 6 27 Totals 88 24 11 8 131 42 36 28 23 260 Nett Births in the year : legitimate, 4,443 ; illegitimate, 245. Nett Deaths in the year of legitimate infants. 238 : illegitimate infants, 22. 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. 12 Report of the Medical Officer of Health for 1930. TABLE VIII. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 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 1928 63 53 40 41 36 56 49 1929 65 38 62 44 69 74 61 Average for 10 years 57 58 52 67 61 57 1930 53 35 41 53 71 66 55 No. of deaths under 1 year, 1930 49 13 32 47 33 86 260 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 4.47 per 1,000 births, compared with 4.9 in 1929. Enquiries into all maternal deaths, which were instituted in 1928 at the instance of the Ministry of Health have been continued. 13 INFECTIVE DISEASES. The total number of deaths from these diseases including all forms of Tuberculosis was 492:—92 in Clapham, 48 in Putney, 77 in Balham, 72 in Streatham, 62 in Tooting, and 146 in Wandsworth. From all infective diseases the death-rate was 1.38 per 1,000:—1.44 in Clapham, 1.32 in Putney, 1.39 in Balham, 1*18 in Streatham, 1.51 in Tooting, and 1.41 in Wandsworth. The rate in 1921 was 2.26; in 1922, 2.28; in 1923, 1.61; in 1924, 1.88; in 1925, 1.70; in 1926, 1.49; in 1927, 1.68; in 1928, 1.35; and in 1929, 2.14 per 1,000. The rate is lower than in 1929, owing to the decrease in the number of deaths from Influenza, Whooping Cough and Tuberculosis. The rate from the principal infective diseases, viz.:— Small-pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever and Diarrhœa, was .35 per 1,000, compared with .70 in 1921; .73 in 1922; .39 in 1923; .47 in 1924; .32 in 1925; .37 in 1926; .25 in 1927; .27 in 1928; and .36 in 1929. The rate was .37 in Clapham, .28 in Putney, .29 in Balham, .29 in Streatham, .36 in Tooting, and .44 in Wandsworth. 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 40 and 31 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 for 1030. TABLE IX. Notifiable Diseases. Total. No. of DEATHS from Infectious Diseases grouped in Age Periods. Under 15 15 and upwards Under 1 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 and upwards Small-pox - - - - - - - - - - - - - - - Diphtheria 30 29 1 3 1 2 4 4 11 4 1 - - - - Scarlet Fever 6 3 3 - - - 1 1 1 - 1 - 2 - - Enteric and Paratyphoid Fevers 4 - 4 - - - - - - - - 2 - - 2 Puerperal Fever and Pyrexia 10 - 10 - - - - - - - - - 3 - - Erysipelas 12 2 10 1 - - - - 1 - - - 1 4 5 Whooping Cough 6 6 - 2 2 - - 1 1 - - - - - - Pneumonia:— Acute Influenzal 9 1 8 - - 1 - - - - - - 3 3 2 Acute Primary 57 15 42 10 3 - - 2 - - 1 2 4 17 18 Cerebro-Spinal Meningitis 1 1 - - - - - - - - - - - - - Polio-myelitis - - - - - - - - - - - - - - - Encephalitis Lethargica 2 - 2 - - - - - - - - - - 1 1 Malaria - - - - - - - - - - - - - - - Dysentery — — — — — — — — — — — — — — Total 137 57 80 16 6 3 5 8 15 4 3 11 13 25 28 Non-Notifiable Diseases. Measles 47 - - 8 22 4 6 - 7 - - - - - - Influenza . 14 1 13 1 - - - - - - - 1 1 6 6 Diarrhoea 33 32 1 30 2 - - - - - - - - 1 5 Other (if any) - - - - - - - - - - - - - - — Total 94 80 14 39 24 4 6 - 7 — — 1 1 7 5 Grand Total 231 137 94 55 30 7 11 8 22 4 3 12 14 32 33 15 Infective Diseases. 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 9 1 8 - - - - - - 1 3 2 1 2 - Diphtheria 866 690 176 13 27 33 59 68 349 141 61 89 18 8 - Scarlet Fever 981 792 189 5 23 32 62 85 453 132 64 102 18 5 - Enteric Fever and Paratyphoid Fever 27 5 22 — 1 — 1 1 2 — 4 10 6 — 2 Puerperal Fever 13 — 13 - - - - - - - 1 9 3 - - Puerperal Pyrexia 28 — 28 - - - - - - - 3 23 2 - Erysipelas 150 17 133 4 3 — 1 1 4 4 3 17 18 69 26 Whooping Cough 809 801 8 66 73 61 111 127 353 10 1 2 4 1 — Pneumonia :— Acute Influenzal 29 5 24 1 1 1 2 — — - 1 4 3 11 5 Acute Primary 468 163 305 37 21 26 17 9 40 13 19 72 62 92 60 Cerebro-spinal Meningitis 3 1 2 — — — — — 1 — 1 1 — - - Polio-myelitis 1 1 - - - - - - - - - - - - - Encephalitis Lethargica 3 — 3 - - - - - - - - - — 2 1 Malaria 2 1 1 - - - - - - 1 — - 1 - - Dysentery 2 - 2 - - - - - - - - - - 2 - Total 3391 2477 914 126 149 154 253 291 1202 302 161 331 136 192 94 16 Report of the Medical Officer of Health for 1930. 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 1 1 2 1 3 1 9 8 Diphtheria 231 57 110 136 133 199 866 840 30 Scarlet Fever 204 101 127 224 99 226 981 831 6 Enteric and Para-typhoid Fevers 3 9 2 2 4 7 27 19 4 Puerperal Fever — 2 3 — 4 4 13 10 4 Puerperal Pyrexia 6 2 3 8 6 3 28 25 6 Erysipelas 25 6 30 29 11 49 150 32 12 Whooping Cough 121 119 66 140 39 324 809 8 6 Pneumonia—Acute Influenzal 13 1 — 3 4 8 29 - 9 Pneumonia—Acute Primary 89 46 61 53 35 184 468 - 57 Cerebro-spinal Meningitis — - 1 - 1 1 3 3 1 Polio-myelitis - - - 1 - - 1 1 - Encephalitis Lethargica — 2 - 1 - - 3 - 2 Malaria - - - 1 - 1 2 1 - Dysentery — 2 — — - - 2 — Total 693 348 405 599 339 1007 3391 1778 137 Tuberculosis—all forms 100 66 96 .80 93 203 638 376 308 Ophthalmia Neonatorum 9 2 5 8 1 6 31 6 2 Total 109 68 101 88 94 209 669 382 310 Grand Total 802 416 506 687 433 * 1216 4060 2160 447 17 Infective Diseases. The total number of cases, less Tuberculosis and Ophthalmia Neonatorum, was 0,891 compared with 5,246 in 1929, 4,149 in 1928, 4,280 in 1927, and 3,316 in 1926. The decrease, compared with 1929, is due to the decrease in the number of cases of Whooping Cough and Influenzal Pneumonia. Small-pox. During the year nine cases of Small-pox occurred, compared with 15 cases in 1929. There were no deaths. Three of the cases occurred in one household in which the initial case was infected from outside the Borough, and the other two cases were infected by him. Six of the nine patients had never been vaccinated, two of them, both adults, had last been vaccinated in infancy, and in one the history of vaccination was indefinite. Vaccination. Transfer of Officers. Under the Local Government Act, 1929, Vaccination Officers and Public Vaccinators have been transferred from the Board of Guardians to the Council. The work of these officers is now controlled by the Public Health Committee. A list of the officers concerned is included under Staff on Page 92. Table XII. is taken from the official returns of the Vaccination Officers for the year 1929. It shows the number of children successfully vaccinated for the whole Borough, as well as for the separate sub-districts. The percentage of children vaccinated to total births was 53.6:—in Clapham, 53.2; in Putney, 69.4; in Balham, 51.9; in Streatham, 49.6; in Tooting, 37.9; and in Wandsworth, 60.2. This percentage is lower than that recorded last year. c 18 Report of the Medical Officer of Health for 1930. TABLE XII. SubDistricts. Number of Births returned from 1st January to 31st December, 1929. 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 550 293 5 — 18 145 5 16 38 30 Putney 298 207 2 — 3 54 1 9 8 14 Balham 535 278 3 — 23 156 2 10 26 37 Streatham 823 409 10 — 40 215 5 85 26 33 Tooting 427 162 5 — 15 189 1 6 18 31 Wandsworth 977 589 4 — 42 257 6 9 37 33 Totals 3,610 1,938 29 — 141 1,016 20 135 153 178 Diphtheria. 8G6 cases occurred, compared with 724 in 1929, and 508 in 1928. The number of deaths was 30, compared with 25 in 1929. The death-rate for 1930 was .08 and the case mortality was 3.4 per cent. The rate per 1,000 of population was 2.43:—3.62 in Clapham; 1.75 in Putney; 1.99 in Balham; 2.23 in Streatham; 3.24 in Tooting; and 1.93 in Wandsworth. Of the 866 cases, 840 or 96 per cent., were removed to hospital and no difficulty was experienced in having cases removed promptly. The Medical Officers of the London County Council made inspections of the Bonneville Road, Cavendish Road, Clapham 19 Infective Diseases. Parochial, St. Mary's Roman Catholic and Tclferscot Road Schools, Clapham; Huntingfield Road, Putney Church of England, Felsham Road and Lower Common Schools, Putney; Balham Central, Bee Secondary, Broadwater Road, Hearnville Road, Ravenstone, Smallwood Road and St. Mary's Schools, Balham; Eardley Road, Mitcham Lane, St. Leonard's, Streatham Secondary, Sunnyhill Road and Woodmansterne Road Schools, Streatham; Defoe, Ensham Central, Franciscan Road, Hillbrook Road, Sellincourt Road and Tooting Graveney Schools, Tooting; Allfarthing Lane, Brandlehow Road, Earlsfield, Garratt Lane, Swaffield Road, Waldron Road, Wandle, Wandsworth Technical Institute, 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 60 cases were found to be positive. All the cases were swabbed again and not readmitted 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. One child who was a diphtheria "carrier" attended the special clinic at Guy's Hospital for treatment. During the year 57 tubes of anti-toxin were issued to medical practitioners for use in cases of Diphtheria. The Council's Clinics for Immunisation against Diphtheria. Two Clinics have been established by the Council for the testing of children to see if they are susceptible to Diphtheria and for the immunisation of those found to be susceptible. They were opened in January, 1928. The Clinics are held at the premises of the Springfield and Balham Infant Welfare Centres respectively 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. c 2 20 Report of the Medical Officer of Health for 1930. 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. The Clinics are intended for the immunisation of susceptible children, and of any adults who may be brought into close and frequent contact with children. Method of Procedure:— The following is the routine procedure:— A Schick test is performed on all adults and on children over 5 years of age at their first visit, and the result is read on the second attendance a week later. If the result is positive, showing susceptibility to Diphtheria, the first immunising injection of 1 c.c. of Toxoid Anti-toxin mixture is given on the same day. Second and third injections 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 injection being administered at the first attendance. This has the advantage of reducing the number of attendances from four to three. A leaflet describing the procedure has been drawn up and this is distributed by the Council's Officers when visiting homes 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. Attendances:— The number of persons who have attended at the Clinics was 1,169 in 1928, 647 in 1929, and 849 in 1930, making a total of 2,665 in three years. These numbers are not large when compared with the child population of the Borough 21 Infective Diseases. which was returned as 81,114 at the 1921 Census, but they are an indication that there is a certain demand for the service. 1,978 of the total number who attended were given the Initial Schick Test to see if they were susceptible to Diphtheria, and the remaining 687 were given immunising injections without a preliminary Schick Test. Almost all of the latter were young children, under five years of age, who were assumed to be susceptible to Diphtheria on account of their age. The Initial Schick Test:— An analysis of the results of the tests performed is given in Table XIII. which shows the cases divided into age groups and sexes and the result of the test in each group. The last line of the Table gives the percentage of the results found to be positive in each group neglecting those in which the test was not read. The essential fact brought out by this Table is that 1,429 persons gave a positive result to the initial Schick Test showing that they were susceptible to Diphtheria. This is 72 per cent. A glance at the last line of the Table will show that the highest proportion of positive results was obtained at the lowest age group and that the proportion diminished as age advanced. This is in accordance with the known facts about the Schick Test. On the other hand, an appreciable number of persons over 15 years of age showed a positive result and more than half of them were found to be susceptible. Even allowing for the fact that most of the adults tested were young this proportion appears to be high. Immunisation:—In order to produce immunity three injections have to be given at weekly intervals. Immunity does not develop until several months have elapsed after the last injection, and in order to determine whether this has occurred it is essential for a further test—known as the Re-Schick Test— to be performed. No person can be said to have been immunised successfully until the re-test gives a negative result. Unfortunately the exact period required to produce immunity varies considerably and it is not possible to give an assurance that it will take a certain time. After the last of the three immunising injections has been given, parents are advised to bring their 22 Report of the Medical Officer of Health for 1930. TABLE XIII SHOWING RESULTS OF PRIMARY SCHICK TEST IN AGE GROUPS. Result of Test. Children Under 15. Over 15. All Cases. Under 5 5—10 10—15 Males Females Total 15—20 20 and Over Males Females Total Schick Positive 69 911 302 659 623 1282 77 70 673 756 1429 Schick Negative 12 224 154 208 182 390 66 54 222 288 510 Result not read — 20 13 12 21 33 4 2 12 27 39 Total 81 1155 469 879 826 1705 147 126 907 1071 1978 Percentage Positive 85% 79% 64% 75% 75% 75% 52% 56% 74% 71% 72% 23 Infective Diseases. TABLE XIV. AGE GROUPING OF PERSONS IMMUNISED AND FOUND TO BE PROTECTED AS SHOWN BY A NEGATIVE RE-SCHICK TEST. Children Under 15. Over 15 All Cases. Under 5 5—10 10—15 Males Females Total 15—20 20 and over Males Females Total 441 635 143 601 621 1222 24 26 605 667 1272 24 Report of the Medical Officer of Health for 1930. children for the re-test in about four to six months and many of them come about that time. A considerable proportion, however, fail to attend for the re-test and some fail to complete the course of injections. The number of persons attending the Clinics who required immunisation was 2,116. This number is made up of the 1,429 who were found to be Schick positive after the initial test, and the 687, who were assumed to be susceptible without a test. The subsequent history of these 2,116 persons is given in the following statement:— No. who were immunised and found to be Protected as shown by a Negative re-Schick Test 1272 No. who received a course of injections but are not yet protected as the re-Schick Test is still positive 142 No. who received injections, the value of which is not known as they have not attended to be retested 681 Schick positive cases who were not injected 21 Total number of Susceptibles 2116 This statement shows that 1,272, or 60 per cent, of the susceptible persons who attended the Centres in three years have been protected. Further particulars about the protected persons are given in Table XIV. where they are divided into age groups and sexes, and in Table XV. which shows the number of doses and the time required to produce immunity. In most of the 1,272 cases a negative result was obtained on the first occasion when the re-test was performed, but in some instances one or more positive results preceded the final negative reading. Only the final negative results of the re-tests are recorded in Table XV. A study of this tabular statement brings out several facts of interest. The majority of the cases—1,168 out of the total of 1,272—became protected after the routine of three injections had been given. In 18 instances the retest was done and found Infective Diseases. 25 TABLE XV. NUMBER OF DOSES AND TIME REQUIRED TO PRODUCE IMMUNITY—AS SHOWN BY A NEGATIVE RE-SCHICK TEST. Number of Immunising Injections given. Period after last injection of First Series in which re-Test was Negative. Total within 4 months between Total within 1 year between 4 and 6 months 6 and 9 months 9 and 12 months 12 and 18 months 18 mths and 2 years 2 years and 3 years Children Under 15. One Series 1 injection — 1 1 — 2 — — — 2 2 injections 1 2 5 2 13 1 2 — 16 3 injections 528 313 162 57 1060 38 23 3 1124 4 injections 5 1 — 2 8 — — — 8 Two Series 4 injections - - 3 2 5 2 - - 7 5 injections - - - 1 1 1 2 - 4 6 injections — — 1 10 11 22 19 9 61 Total Under 15 537 317 172 74 1100 64 46 12 1222 Adults Over 15. First Series 3 injections 18 12 8 2 40 3 1 — 44 4 injections — 1 — - 1 — — — 1 Second Series 6 injections — — — 2 2 1 2 — 5 Total All Ages 555 330 180 78 1143 68 49 12 1272 26 Report of the Medical Officer of Health for 1930. to be negative after only one or two injections. These were cases who for some reason were unable to complete the three injections at once but came after an interval and were then retested to see if by chance they had become immunised. Seventy seven persons required a second series of injections before a negative re-test was obtained. It will be noticed from this Table that the time taken to produce immunity varies very much. Much of this variation is due to delay on the part of the person concerned in attending for the re-test to be performed. Some of it is due to actual delay in the production of immunity as shown by one or more positive results to the re-test before the final negative result is obtained. Of the 1,272 persons who have been protected at the Clinics, 555 obtained that protection within four months after the last injection had been given. 885 were protected within six months. There is little doubt that a proportion of the remainder, in whom the period required was longer than six months, would have been found protected if they had attended earlier to be re-tested. In addition to these 1,272 persons who have been protected, 142 have completed the first series of injections but cannot yet be recorded as protected as the last re-Schick Test performed was positive. Sixty-three of them have not attended since the re-test, while in 79 a second series of injections was given. Of these 79, 70 have not attended to be retested, while nine of them still gave a positive re-test after the second series. Five of these nine have been given a third series of injections. A further 681 persons were given immunising injections at the Clinics, but the value of these cannot be determined as they have not attended to be re-tested. This number includes 571 who completed the first series of three injections and 110 who only received one or two injections. A further 21 susceptible persons have not yet commenced the course of injections. Diphtheria Following Immunising Injections:— Owing to the fact that immunity does not develop at once it is important to remember that a child may develop Diphtheria during the period which elapses between the administration of the immunising Infective Diseases. 27 injections and the full establishment of immunity, if exposure to infection occurs. Parents should be warned on this point. For the same reason, if immunisation is delayed until an epidemic of Diphtheria occurs it may easily be carried out too late to prevent infection. Six children who have received at least three immunising injections at the Centres have developed Diphtheria. As will be seen from the particulars given below the attack in at least four of the cases was a mild one. All of them recovered. In cases Nos. 1 and 8 the attack of Diphtheria occurred before immunity had developed. In case No. 2, although the retest was negative a few days before the illness, immunity had taken some nine months to develop, and the attack of Diphtheria was so slight as to be almost negligible. In case No. 4, the attack was a severe one and occurred 2 years after the immunising injections had been given in a child who had not been re-tested. In the other two cases the attack of Diphtheria developed more than two years after the children had been immunised and had re-acted negative to the Re-Schick Test. Case No. 1.—A girl of IB—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 Diphtheria 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 five months and negative nine 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. Case No. 8—A girl of 7—Schick Test positive—received three doses of Toxoid Anti-toxin mixture—developed Dipththeria five months and nine days after the last dose— 28 Report of the Medical Officer of Health for 1930. 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. Case No. 4—A girl who at the age of 14 months received three immunising doses without a primary Schick Test—she was not brought for Re-Schick Testtwo years later she had a severe attack of Clinical Dipththeria and received 48,000 units of Anti-toxin—a Schick Test performed four days later was negative—she recovered from the attack. In the absence of a Re-Schick Test before the attack of Diphtheria one can only assume that the three injections given two years previously had not been successful in producing immunity and that this was another case of delay in the production of immunity. The negative Re-Schick Test obtained after the attack of Diphtheria might well have been due to the large dose of Anti-toxin given in the treatment of the illness. Case No. 5.—Was immunised when two years and gave a negative Re-Schick Test within six months. A few days before her fifth birthday developed clinical Diphtheria, cultures from both throat and nose showing the specific organism. The attack was a mild one and she recovered. Case No. C>.—Was immunised at the age of four and gave a negative Re-Schick Test within six months. Two and a half years after the re-test, developed clinical Diphtheria with the organism present on culture—Recovered. In addition to these six cases of clinical Diphtheria, cultures of the Diphtheria organism were obtained from five other children some time after they had been immunised at the Clinics and had re-acted negative to the Re-Schick Test. In another case this occurred in a child three months after he had given a negative re-action to the primary Schick Test. In none of these six Infective Diseases. 29 cases was there any definite symptom of Diphtheria, which suggests that they were protected against the disease. Scarlet Fever. 981 cases of Scarlet Fever occurred, compared with 899 in 1929, 752 in 1928, 816 in 1927. Six cases died, compared with six and three respectively for the two previous years, and the death.rate was .01 per 1,000 compared with .016 and .008. The case mortality was .61 per cent. The case.rate per 1,000 of population, was 2.75 :—3.23 in Clapham ; 3.11 in Putney; 2.30 in Balham ; 3.68 in Streat. ham ; 2.41 in Tooting; and 2.19 in Wandsworth. Of the total number of cases, 831 or 83 per cent., were removed to hospital. The Medical Officers of the London County Council made inspections of eight schools during the year, and any suspected cases were at once excluded and the names and addresses forwarded to me for inquiry. Return Cases of Scarlet Fever and Diphtheria. 32 cases of Scarlet Fever and seven of Diphtheria occurred within one month of the return of a previous case from hospital. Enteric and Para.Typhoid Fevers. 27 cases, and four deaths of the above occurred, compared with 11 cases and four deaths in the previous year. 11 of the cases were true Enteric Fever and 16 were Paratyphoid Fever. Nine of the cases of Para.typhoid fever were in Putney and Roehampton, during the months of July and August, and were associated with a larger outbreak which occurred in the adjoining district of Barnes. None of the cases proved fatal. Puerperal Fever and Puerperal Pyrexia. During the year there were 13 cases of Puerperal Fever and 28 cases of Puerperal Pyrexia notified. 10 of the cases 30 Report of the Medical Officer of Health for 1930. died. The death-rate was .02 per 1,000 of population and 2.1 per 1,000 births. Erysipelas. 150 cases were notified and 12 deaths occurred during the year, compared with 102 and two in 1929. Whooping Cough. Six deaths occurred during the year, while the number of cases notified was 809. The death-rate was .01 per 1,000. Eight of the cases were removed to hospital. 916 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Whooping Cough occurred, and 52 premises were disinfected. Influenza. The number of deaths from Influenza was 22 compared with 237 in 1929, 41 in 1928, 136 in 1927 and 56 in 1926. The death-rate was .06 per 1,000. Influenzal Pneumonia and Acute Primary Pneumonia. 29 cases of acute Influenzal Pneumonia and 468 cases of acute Primary Pneumonia were notified. Nine of the former and 57 of the latter died. The total number of deaths credited to all forms of Pneumonia during the year was 207, compared with 331 in 1929, 246 in 1928, 239 in 1927, 217 in 1926, 181 in 1925, 233 in 1924, 189 in 1923, 236 in 1922 and 241 in 1921. Cerebro-Spinal Meningitis. Three cases of this disease occurred. None of them terminated fatally. A further 18 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. One case and no death occurred. Infective Diseases. 31 One child was admitted during the year for treatment at Queen Mary's Hospital, Carshalton, under the scheme provided by the L.C.C. Encephalitis Lethargica. Three cases of this disease occurred and two 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. No death occurred. Dysentery. Two cases of Dystentery were notified and no death occurred. Ophthalmia Neonatorum. 31 cases were notified and the following Table shows the effect of the disease on the vision, according to whether the cases were treated at hospital or at home. TABLE XVI. Result of Treatment. Recovered— Vision not affected. Vision Impaired. Total Blindness. Died. Treatment received:— In Hospital 5 — — 1 At Hospital, Out-patient 4 — — — At home 20 — — 1 Total 29 — — 2 32 Report of the Medical Offiecr of Health for 1930. 29 of the cases recovered without any impairment of vision, one case died of Congenital Syphilis and another from Atelectasis. Measles. The current year is the biennial year for Measles, and the epidemic began in December, 1929. The number of cases of Measles brought to my notice during the year October 1st, 1929, to September 30th, 1930, was 4,046. The majority of these cases were reported by teachers at the elementary schools, and in arriving at this figure G5 cases, which proved after investigation not to be suffering from Measles, are excluded. 46 of the cases died during the epidemic year, and 47 during the calendar year. 23 cases of German Measles were also reported. 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. 167 cases were removed to hospital, compared with 236 in the epidemic year of 1928. Infective Diseases. 33 TABLE XVII. MEASLES—CASES REPORTED AND DEATHS. Period 1st October—30th September 1921—22 1922—23 1923—24 1924—25 1925—26 1926—27 1927—28 1928—29 1929-30 Cases Reported. In a Measles year 2,183 — 3,905 — 4,219 — 4,596 — 4,046 In a Non-Measles year — 160 — 293 — 81 — 355 — Deaths. In a Measles year 75 - 80 - 52 - 38 - 46 In a Non-Measles year — — — 1 — 2 — 1 - Period. Calendar Year 1922 1923 1924 1925 1926 1927 1928 1929 1930 Cases Reported 1,842 663 3,418 474 4,028 172 4,529 380 3,976 Deaths 0 72 11 71 1 51 4 36 1 47 34 Report of the Medical Officer of Health for 1930. 95 cases requiring special home nursing were referred to the District Nursing Associations in the Borough, compared with 55 in 1928, and the nurses made 1,003 visits to these cases compared with 436 in 1928. The death-rate per 1,000 of the population was .13, compared with .10 in 1928, and .14 in 1926. 905 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. Chickcnpox. Whooping Cough. Mumps. Ringworm. Other Diseases Totals. Clapham. Aristotle Road 3 1 1 - 7 1 1 1 2 17 Bonneville Road 10 10 77 - 49 21 79 2 23 271 Cavendish Road 14 23 40 - 5 — 60 — 1 143 Christchurch 4 2 30 - 4 — 10 — — 50 Clapham Parochial, Macaulay Rd. 6 5 - - - - - - - 11 Clapham Parochial, Old Town 4 17 29 - 1 — 16 — 10 77 Haselrigge Road 25 16 51 1 32 4 9 1 2 141 Henry Thornton, South Side -- - 2 - - - 7 - 1 10 Larkhall Lane 9 1 54 - 10 — 41 3 14 132 New Park Road 4 3 68 1 65 21 11 — 9 182 New Road 3 1 1 - 4 - 1 — 2 12 St. Andrew's Street 2 11 10 - 2 — — — 4 29 St. Mary's, Crescent Lane 4 4 - - - - - - - 8 St. Mary's, St. Alphonsus Road — 4 — - — — — — — 4 Stonhouse Street 11 7 79 2 36 - 40 — 2 177 Telferscot Road 4 5 37 2 55 26 11 1 2 143 Putney. All Saints' - 2 29 - 4 1 1 1 3 41 Hotham Road 17 2 89 1 71 17 1 - 21 219 Huntingfield Road 29 9 67 - 11 34 1 — - 151 Parochial, Roehampton 3 - 14 1 15 2 — — — 35 Roehampton, National 1 - - - - - - - - 1 St. Agnes, R.C. — 10 13 — 1 1 — — — 25 St. Mary's 4 2 - - - - - - - 6 Upper Grade 1 — 4 — 2 — — — — 7 Carried forward 158 135 695 8 374 128 289 9 96 1,892 Infective Diseases. 35 TABLE XVIII.— continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 158 135 695 8 374 128 289 9 96 1,892 Balham. Balham Central 2 2 - - - - - - - 4 Bec, The 1 1 - - - - - - - 2 Broadwater Road 18 18 19 — 18 — 52 — — 125 Broadwater Road Special - 2 - — — — — — — 2 Fircroft Road 8 4 76 — 33 — 42 — 4 167 Hearnville Road 5 6 25 - 5 - 1 — 1 43 Holy Trinity, Balham - 2 19 — 7 — 37 1 5 71 Nightingale Square R C 2 3 - - - - - - - 5 Oldridge Road 10 3 23 - 8 3 93 - 14 154 Ravenstone Street 17 8 3 - - - 2 — 3 33 St. Mary's 11 3 33 - 2 - 6 1 — 56 Smallwood Road 15 20 95 — 9 — 5 — 1 145 Streatham. Eardley Road 38 20 97 3 1 16 55 1 10 241 i y<xJl Liivy JVUCIU • • • • • • "Fmr7pHnwn T^pmonstration 4 5 50 - 2 3 19 - 1 84 1 Ul/'vviv W J-/L/liivAlO tl ft Llvii • • Granton Road 5 1 123 - 2 10 31 - 7 179 Hitherfield Road 1 2 14 1 74 1 16 — 5 114 Holy Trinity - - 4 - 2 - - — — 6 Immanuel 1 6 12 - 3 - - - — 22 Mitcham Lane 39 10 49 1 1 2 81 - 7 190 New School, Leigham Court Road 1 - - - - - - - - 1 St. Andrew's, Colmer Road 5 2 - - - - - - -- 7 St. Andrew's, Coventry Hall 1 1 62 1 5 2 24 - 2 98 St. Leonard's 3 12 24 - 22 - 36 - - 97 Sunnyhill Road 5 5 16 - 8 1 16 2 7 60 Woodmansterne Road 1 5 - - - - - - - 6 Tooting. Ensham Central 1 - - - - - - - - 1 Ensham 4 5 64 1 4 4 16 - 7 105 Defoe (Fountain Road) 8 14 41 1 2 1 15 1 2 85 Franciscan Road 4 2 39 - 5 - 6 - 2 58 Hillbrook Road 2 15 60 - 1 1 58 - 3 140 Sellincourt Road 6 15 83 — 6 2 26 - 10 148 Tooting Graveney 5 5 23 - 1 2 17 - 2 55 Undine Street, R.C. 3 3 24 — 3 - 7 - - 40 Carried forward 384 335 1773 16 598 176 950 15 189 4,436 D 2 30 Report of the Medical Officcr of Health for 1980. TABLE XVIII.— continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 384 335 1773 16 598 176 950 15 189 4,436 Wandsworth. Allfarthing Lane 8 7 63 59 17 2 - 16 172 All Saints' 1 2 31 - 22 1 — - 3 60 Brandlehow Road 8 3 57 - 16 — 6 - — 90 County - - - - - - - - - 1 Earlsfield 5 3 68 - 8 4 2 - - 90 Elliott Central 2 1 9 - 1 — — - 3 9 Eltringham Street 7 7 54 - 2 10 3 - 3 86 Frogmore Special - - 3 - 2 - 2 - - 7 Garratt Lane 3 10 17 - 9 1 3 - 4 47 Magdalen Road 5 1 29 - 2 1 9 1 2 43 Merton Road 1 7 70 - 23 11 3 2 3 120 Riversdale 10 5 88 - 21 4 — 1 1 130 St. Ann's — 1 14 - 8 6 1 — 3 33 St. Faith's 1 2 35 - 21 3 34 — 3 99 St. Joseph's — — 8 - — — — — 2 10 St. Michael's 2 4 61 - 2 — 7 — — 76 Swaffield Road 6 13 44 - 2 10 4 — 1 80 Technical Institute 3 — — - — — — — — 3 Waldron Road 11 7 45 - 5 2 - — 1 71 Wandle 3 5 20 - 11 5 15 3 11 73 Warple Way 4 3 28 - 6 - - - - 41 West Hill 19 17 83 2 2 24 5 2 4 158 Grand Total 484 433 2593 18 820 275 1039 24 249 5,935 Diarrhoea. The number of deaths from Diarrhoea was 33 compared with 35 in 1929, 40 in 1928, 27 in 1927, and 80 in 1926, and of these 30, or 90 per cent., were under the age of one year, compared with 25 in 1929. The number of deaths from Diarrhoea, Zymotic Enteritis and Enteritis under one year represents 11.5 per cent, of the total mortality at that age. Infective Diseases. 37 Scabies. The names of 16 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 nine 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 57 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. 16 deaths occurred, eight from Syphilis, four from Septicaemia, three from Actinomycosis, and one from Pyaemia. 38 NON-INFECTIVE DISEASES. The total number of deaths from Cancer and malignant disease was 544, the number of males being 228 and females 316. The corrected death-rate was 1.53 per 1,000 for the whole Borough:—1 .57 for Clapham ; 1.32 for Putney 1.66 for Balham; 1.81 for Streatham 1.29 for Tooting; and 1 -41 for Wandsworth. The number of deaths in 1930 was 24 more than in 1929. The number of deaths from diseases of the Brain and Nervous System was 159. 1,090 deaths occurred from diseases of the Heart and Circulatory System, compared with 1,277 in 1929, and 1,081 in 1928. 781 of these deaths were of persons over 65 years of age. There were 420 deaths from diseases of the Respiratory System, compared with 734 in 1929, and 493 in 1928. The number from Bronchitis was 187 compared with 366 in 1929, and from Pneumonia (all forms) 207 compared with 331 in 1929. Further particulars relative to Pneumonia are given on page 30. The number of infants under two years of age who died from these diseases was 43. 142 deaths, 80 males and 62 females, were registered as due to Premature Birth and Developmental Diseases, compared with 146 in 1929. 113 deaths, 45 males and 68 females, occurred from Old Act, and all these were persons over 65 years of age. The number of deaths due to this cause in 1929 was 159. 194 deaths were due to Violence, 139 of them being due to accident, 50 to suicide, and five to other forms of violence. Inquests. Inquests were held on 313 persons dying in the Borough, and on 216 Borough residents who died outside the Borough. Non-infective Diseases. 39 The next Table shows the results of the findings of these inquests, TABLE XIX. Inquests. Sub-Districts. Whole Borough. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Deaths from Natural Causes 47 30 47 48 40 74 286 Accidental:— Knocked down by motor vehicles 8 10 19 10 5 13 65 Falls 1 7 6 5 12 8 39 Falls from vehicles 5 3 7 2 2 9 28 Drowning — 1 1 4 2 4 12 Falls from a height — — 6 2 2 1 11 Deaths under anaesthetics 1 - 1 - 1 2 5 Knocked down by train — — — 2 — 2 4 Burns and scalds — 1 — 1 — 1 3 Other 1 — 2 1 1 3 8 Suicidal:— Poisoning: by:— Coal Gas 1 1 10 5 2 7 26 Lysol — 1 3 3 — — 7 Carbolic Acid - - — 1 — 2 3 Medinal - — 1 — — — 1 Cyanide of Potassium 1 - - - - - 1 Knocked down by train 2 1 1 2 - 3 9 Cut throat — 1 — 1 1 2 5 Drowning 1 — 2 — — 1 4 Jumped from a height — 1 — — 1 2 4 Hanging 1 — — — — 1 2 Burns — 1 — — — — 1 Strangulation — — 1 — — — 1 Wound in Stomach - - - - - 1 1 Gun shot wounds — — 1 — — — 1 Execution - - - - - 1 1 Murder - - - - - 1 1 Totals 69 58 108 87 69 138 529 40 TUBERCULOSIS. Notification.— The total number of new cases of Tuberculosis which came to the notice of the Department during 1930 was 688, as compared with GOO in 1929, 660 in 1928, 718 in 1927, 70G in 1926, 648 in 1925, 692 in 1924 and 597 in 1928. The sources of information regarding the 638 new cases notified in 1980 were as follows:— Primary notifications on Form A 533 Primary notifications on Form B Transfers from other Sanitary Authorities 103 Naval and military notifications 2 Total 638 Un-notified at death 45 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. Males. Females. Males. Females. Males. Females. Males. Females, Under 1 year - - 2 1 2 1 2 3 1—5 1 1 7 4 1 1 1 2 5—10 2 3 12 5 - 1 2 2 10—15 3 7 5 5 2 1 1 2 15—20 22 30 12 8 10 24 4 - 20—25 57 59 8 13 19 18 2 2 25—35 53 75 4 7 28 35 2 1 35—45 53 32 3 6 28 18 1 1 45—55 53 16 4 1 42 7 2 - 55—65 25 18 - 3 17 8 2 1 65 upwards 8 8 1 1 10 2 — — Totals 277 249 58 54 159 116 19 14 Tuberculosis. 41 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 18 10 8 Glands, Mesenteric 12 4 8 Glands, Cervical 27 17 10 Bones and Joints 33 19 14 Skin 3 1 2 Other Parts 19 7 12 Totals 112 58 54 Deaths.— The total number of deaths certified as due to diseases of a Tuberculous nature was 308—of whom 178 were males, and 130 females. Of the 308 deaths, 275 were due to Pulmonary Tuberculosis, 23 to Tuberculous Meningitis, three to Abdominal Tuberculosis and seven to other forms of Tuberculosis. Table XXII. gives details regarding the type of the disease, sex, and age grouping of these 308 deaths. In addition to these deaths, which were duly certified in the returns as due to Tuberculosis, 10 persons previously notified as suffering from Tuberculosis died during the year. These deaths, however, do not figure in Table XXII. for the reason that:— (a.) Nine were certified as dying of diseases other than Tuberculosis. (b.) One had previously moved outside the Borough and died there, the death being credited to the area in which it occurred. 42 Report of the Medical Officer of Health for 1930. TABLE XXII. Localisation. Total. Males. Females. Pulmonary and Acute Miliary Tuberculosis 275 159 116 Brain 23 13 10 Glands, Mesenteric 1 — 1 Bones and Joints 2 1 1 Other Parts 7 5 2 Totals 308 178 130 Tuberculosis. 43 TABLE XXIII. 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 Pulmonary Tuberculosis:— No. of Deaths 331 286 269 244 261 255 300 269 320 275 Death- Rate 1.00 .85 .80 .71 .75 .73 .85 .76 .90 .77 Other Forms:— No. of Deaths 59 57 50 50 49 40 39 35 33 33 Death- Rate .18 .17 .14 .14 .15 .12 .11 .10 .09 .09 Total:— No. of Deaths 390 343 319 294 310 295 339 304 353 308 Death-Rate 1.18 1.02 .94 .86 .90 .84 .96 .86 .99 .86 44 Report of the Medical Officer of Health for 1930. During the year 45 persons, not previously notified, were certified as having died of Tuberculosis. The ratio of unnotified Tuberculosis deaths to total Tuberculosis deaths is therefore 45 to 308. Of the 45 unnotified deaths, 30 were certified from Institutions, three by private doctors, while in 12 cases Tuberculosis was discovered post mortem. In all 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. 69 persons died within one month after notification, 96 within three months, and 122 within six months. 4 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 25 years, from 1904-1928 are given in quinquennial periods, and those for each of the years 19291930 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. Tuberculosis. 45 TABLE XXIV. 1904 to 1928 in 5 year periods. 1929 1930 Totals. 1904— 1908 1909— 1913 1914— 1918 1919— 1923 1924— 1928 Pulmonary Tuberculosis :— Cases reported 432 2830 2336 2769 2630 586 526 12109 Died 230 1091 1386 1030 1298 284 262 5581 Recovered 23 76 10 49 109 25 12 304 Removed or untraced 159 724 831 835 1525 137 105 4316 Remaining on Register 20 959 1068 1923 1621 1761 1908 1908 Non-Pulmonary TUBEERCULOSIS:- Cases reported Not 323 791 745 695 104 112 2770 Died 46 382 198 208 25 20 879 Recovered fiable. — 41 46 91 17 18 213 Removed or untraced 9 116 319 493 46 21 1004 Remaining on register 268 520 702 605 621 674 674 Total on Notification register at end of each period 20 1227 1688 2625 2226 2387 2582 2582 40 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 1930.—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. 159 18 177 130 226 533 F. 140 16 162 144 188 494 Children M. 10 13 23 36 165 224 F. 12 12 24 46 162 232 Totals .. 327 59 386 356 741 1483 In addition to the above, 16 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. Tuberculosis Dispensaries. 47 The districts of the Borough in which these 1,483 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. Balham. Streatham. Tooting. Wandsworth. Totals. Public Health Department 39 32 65 75 106 130 447 Private Practitioners 80 61 142 105 166 225 779 Charitable Societies 12 5 4 4 7 10 42 Other Dispensaries 2 11 9 2 8 1 33 L.C.C. Schools — 1 3 8 7 15 34 Ministry of Pensions 6 4 1 2 5 6 24 Existing Dispensary Patients 8 8 - 5 2 23 Other Sources 13 19 2 20 17 30 101 . Totals 152 141 234 216 321 419 1,483 Contacts.— Of the 1,483 new cases examined, 425 were contacts. 66 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., 1929 New Cases Removed from Register Remaining on Register 31st Dec., 1930 Pulmonary 1110 327 321 1116 Non-Pulmonary 269 59 36 292 Suspected cases 22 356 321 57 Totals 1,401 742 678 1,465 48 Report of the Medical Officer of Health for 1930. 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 16 Number of patients transferred to other areas and cases " lost sight of " 131 3. Died during the year 197 4. Number of observation cases in which period of observation exceeded 2 months 35 5. Number of attendances at the dispensaries 4571 6. Total number of reports, etc., made in connection with the dispensaries 5172 7. Number of attendances at General Hospitals or Institutions of patients for:— (a.) Light treatment 177 (b.) Other special forms of treatment 290 8. Number of patients to whom Dental Treatment was given in connection with the Dispensary 46 9. Number of consultations with Medical Pratitioners:— (a.) At homes of applicants 118 (b.) Otherwise 2423 10. Number of other visits by Tuberculosis Officers at homes 174 11. Number of visits by Health Visitors or Nurses to homes for dispensary purposes 4747 12. Number of:— (a.) Specimens of Sputum, etc., examined 1944 (b.) X-ray examinations made in connection with dispensary work 50 The number of patients who received institutional treatment in the special beds allocated by the London County Council for their Tuberculosis Scheme during 1980 was as follows:— (a.) In Hospitals for observation 41 (b.) In Sanatoria 864 (c.) In Hospitals for Advanced Cases 26 Total 481 In addition to these many other patients received treatment in private or general hospitals. As in former years great difficulty was experienced in arranging for the institutional treatment of advanced cases. Tuberculosis Dispensaries. 49 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 made for treatment by the Artificial Pneumothorax method with several hopsitals have been continued. 55 cases were treated during the year and 299 refills administered. The total cost was £151 14s. 6d. 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. All existing War pensioners suffering from Tuberculosis are still visited in their homes by the Tuberculosis Visitors in accordance with the Council's general scheme for Tuberculosis, but the cost of these visits is no longer defrayed by the Ministry of Pensions. 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. 19 patients received dental treatment and seven of these were supplied with dentures. The attendances at the dentist totalled 73. The amount expended on dental treatment during the year was £22 19s. 6d. while the cost of dentures supplied to patients was £16 4s. Gd. Extra Nourishment.— Under Section 3 of the Public Health (Prevention and Treatment of Disease) Act, 1913, extra nourishment is granted on medical grounds as part of treatment. It is limited to the slighter cases of disease, where there is a reasonable probability that extra nourishment will increase the chances of recovery, or will enable the patient to remain at E 50 Report of the Medical Officer of Health for 1930. work or to return to work at an early date. During the year under consideration 149 patients have been granted extra nourishment under the scheme at a cost of £131 17s. Od. 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 Council have been in constant use during the year. 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 1930 as far as it is known. Table XXIX refers to cases of Pulmonary Tuberculosis and Table XXX to cases of Non-pulmonary Tuberculosis. Tuberculosis Dispensaries. 51 TABLE XXIX. Classification on Initial attendance at the Dispensaries. Condition at the end of 1930. Total cases where condition is known. Removed and lost sight of. Total cases who have attended. Discharged as cured. Disease arrested. Disease not arrested. Died. Pulmonary Tuberculosis. Class T.B. Minus. Adults, M. 382 27 86 189 684 1598 606 2204 Adults, F. 429 36 111 181 757 Children 105 13 13 26 157 Class T.B. Plus. Adults, M. 86 47 404 1198 1735 3067 757 3824 Adults, F. 63 34 296 907 1300 Children 6 2 4 20 32 52 Report of the Medical Officer of Health for 1930. TABLE XXX. Classification on Initial attendance at the Dispensaries. Condition at end of 1930. 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 15ones and Joints Adults, M. 29 9 34 10 82 230 63 293 Adults, F. 14 4 20 7 45 Children 49 12 25 17 103 Abdominal Adults, M. 7 - 4 1 12 70 35 105 Adults, F. 6 2 3 1 12 Children 15 10 15 6 46 Peripheral Glands Adults, M. 10 3 11 2 26 318 91 409 Adults, F. 25 3 9 7 44 Children 171 19 49 9 248 Other Organs. Adults, M. 13 3 10 8 30 100 41 141 Adults, F. 12 2 15 6 35 Children 5 2 9 19 35 Tuberculosis Dispensaries. 53 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. 1926 1865 1210 404 1927 2087 1417 447 1928 1970 1457 476 1929 2068 1486 474 1930 1944 1254 447 Care Committee. Constitution.— The Tuberculosis Care Committee was reconstituted by the Council during the current year. The Council's representatives on the Committee for 1930 are: Councillors T. Harding, Mrs. J. Dewar Robertson, M.B.E., J.P., and H. M. Jones. The Tuberculosis Officers, and Tuberculosis Visitors, assist the Committee to the fullest possible extent. The following agencies, public and charitable, are represented:— L.C.C. School Medical Service. Board of Guardians. British Red Cross Society. Soldiers' and Sailors' Help Assn- London Insurance Committee. United Services Fund. War Pensions Committee. Charity Organisation Society. Invalid Children's Aid Assn. Ranyard Nurses' Association. Brompton Hospital. St. Thomas's Hospital. Several unattached members interested in Tuberculosis work are also co-opted on the Committee. The Officers of the Committee are :— Chairman : Councillor T. Harding. Vice-Chairman : Miss J. M. Duff. Acting Hon. Secretary : Mrs. Nicol. Hon. Treasurer : Mr. H. B. Harvey. During the major part of the year the Secretarial work was carried on by Mrs. Nicol, and the clerical work by a member of the Dispensary Staff. 54 Report of the Medical Officer of Health for 1930. The Committee wish to place on record their gratitude to both for the time given and the efficient way in which the work was carried out. Miss M. L. Baptie was appointed by the Council as full-time Secretary to the Committee on the 8th December, 1930. Meetings.— The General Committee meets at 79, East Hill, every six weeks at 3.30 p.m., and the Sub-Committee meets on alternate Friday afternoons at 2.30 for the purpose of assessing cases. 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 Council— have been in continuous use during the year). (d). Removal of patient to friends and relatives in the country. (e). The care of children and of the home during the absence of the mother or housewife. (f). The provision of financial assistance to the family or patient. When a patient is accepted by the London County Council for treatment in a residential institution under their 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 472 patients (adults and children). The amounts of such assessments are Tuberculosis Dispensaries. 55 subject to the approval of the London County Council. The amount collected and remitted to the London County Council being £178 19s. 5d. In addition to the patients visited by the Tuberculosis Visitors, advanced cases have been visited regularly at their own homes by members of the Care Committee. Medical and nursing requisites, e.g., water beds, air and water cushions, bed rests, feeding cups, etc., which have been acquired by the Committee gradually, are supplied on loan to necessitous cases who require them. Miss Hill on behalf of the Committee, has kept in touch with the Dispensary patients in St. James' Hospital, Balham. 104 of these cases have been visited regularly during the year, and these visits are much appreciated by the patients. Articles of clothing have been supplied to patients in need of them, especially to those about to enter residential institutions. As there is often 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, beds for cases of this type are maintained at St. Columba's Hospital, Hampstead, by a voluntary fund raised by the Committee. During the year 10 patients were nursed at this Hospital for varying periods, at a total cost of £102 2s. All of them were very grateful for the care and attention they received there. By means of the same voluntary fund 16 patients were given treatment at the Hahnemann Home, Bournemouth, and cases were also sent to a Convalescent Home at St. Leonards, and to Michael's Home, Axbridge. The average period of convalescent treatment granted was 12 weeks. The total cost was £53 17s. 6d. Two men were trained as motor drivers. Handicraft Class.— Great interest continues at the class which meets weekly at the Dispensary, and the attendances are increasing. 50 Report of the Medical Officer of Health for 1980. Financial Help.— In several cases, financial help has been given to the families of patients receiving Sanatorium Treatment, thus relieving them from worry and anxiety about their homes while they were undergoing treatment. The special fund, organised by the Care Committee, for the purposes enumerated above is supported entirely by voluntary contributions. It has received a good deal of support during the year. The Committee desire to express their thanks to the various donors and helpers who assisted during the year to augment the fund. 57 MATERNITY AND CHILD WELFARE. Work of the 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 re-visits are made before the end of the first year and up to school age. In those centres where one of the Health Visitors is also Superintendent of the Centre the re-visits are made by the Health Visitor. In seven of the Centres the Superintendents are appointed by the Centre Committees and in these cases the re-visits of children attending these Centres are carried out by them. It has not been found necessary to visit systematically all children between the ages of one and five, as they have been visited when infants, and many of them are kept under supervision at the Welfare Centre or by visits made by the Superintendents of the Centres. Further opportunities for keeping observation on these children and their homes occur when visits are made to the home for some other purpose, as for instance, for a case of infectious disease. Children known to be unhealthy are visited regularly. Infectious Diseases.— All cases of Puerperal Fever, Puerperal Pyrexia, Whooping Cough and Ophthalmia Neonatorum are visited on notification, as well as all known cases of Measles and Diarrhoea in children under five. Other Home Visits.— The Health Visitors visit the homes of mothers attending the ante-natal Centres in the Borough, as well as the homes of women who apply for admission to Maternity Homes, and the maternity wards of St. Thomas's and other Hospitals. Home visits are also made for investigating applications for milk under the Milk (Mothers and Children) Order, and in connection with Convalescent and 58 Report of the Medical Officer of Health for 1930. Dental treatment. Visits are also made to see if homes are suitable for children to return to after minor operations at general hospitals. Periodical visits are also made to Creches and institutions for unmarried mothers and their children. Duties at the Welfare Centres.— At Fairlight Hall, Lynwood Road, Springfield, Fairfield and Streatham Hill Centres one of the Health Visitors acts as Superintendent of the Centre concerned. She is assisted at these Centres by another Health Visitor. At the remaining Centres, viz.:— Clapham, Balham, Putney, Putney Park, Southfield, Streatham and Blegborough Road Centres the Superintendents are appointed by the Centre Committees and act in co-operation with the Health Visitors, one of whom assists at each session. Table XXXI. summarises the work of the Health Visitors during the year in the six divisions of the Borough. 59 Maternity and Child Welfare. TABLE XXXI. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. No. of children visited :— Under 1 year 745 268 455 656 645 1178 3947 1-2 years 7 3 18 62 9 26 125 2-5 years 9 5 12 51 10 9 96 Revisits to:— Infants under 1 year 561 298 484 282 620 1438 3683 Children 1-2 years 344 185 257 106 649 1051 2592 Children 2-5 years 452 301 233 124 798 1180 3088 Total visits to children under Notification of Births Act 2118 1060 1459 1281 2731 4882 13531 Other visits— : Ophthalmia Neonatorum 9 5 1 16 4 11 46 Measles 1177 778 302 919 1634 1851 6661 Whooping Cough 62 161 83 194 42 331 873 Ante-natal cases 208 66 82 127 192 329 1004 Puerperal Fever and Pyrexia 2 5 1 16 16 16 56 Miscellaneous 122 98 125 141 133 289 908 Ineffectual 593 454 344 503 822 1369 4085 Total Visits 4291 2627 2397 3197 5574 9078 27164 Attendances at:— Infant Welfare Centres 150 156 111 176 281 409 1283 Ante-natal Centres 26 27 36 48 33 72 242 Committee Meetings 3 18 1 - 10 — 32 Health Talks 27 78 82 110 127 116 540 Visits to Creches — 21 41 — 31 35 128 60 Report of the Medical Officer of Health for 1930. Infant Visiting. There were 4,688 births during the year and 3,947 of these, or 84.1 per cent., were visited compared with 85 in 1928, 82.7 in 1927, 81.7 in 1926, and 81.1 in 1925. Table XXXII. gives particulars of the method of feeding of infants on the occasion of the initial visit and when revisited. On the first visit it was found that 3,451 of the 3,947 infants visited were being fed from the breast entirely. 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 2136 1028 210 77 3451 Otherwise fed 142 206 90 58 496 Age of infant on subsequent visit. Method of Feeding. Under 1 month. 1—3 months. 3—6 months. 6—12 months. Total. Breast-fed 99 534 628 558 1819 Otherwise fed 66 198 431 1169 1864 It was found that in 960 of the births, doctors had been in attendance, while in 1,596 the services of midwives had been utilised. 1,391 infants were born in hospitals and other institutions. Maternity and Child Welfare. 61 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. 65 midwives practise in the Borough, of whom 19 reside in neighbouring Boroughs. There are 36 private maternity homes in the Borough, 16 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. 298 cases were visited during the year under these arrangements, and 4,892 visits were made to them as shown in Table XXXIII. TABLE XXXIII. No. of cases occurring. No. of cases visited. No. of visits made. Whooping Cough 809 9 194 Influenza — 23 282 Pneumonia 497 121 2341 Ophthalmia Neonatorum 31 48 1015 Measles 3976 95 1003 Puerperal Fever and Puerperal Pyrexia 41 2 57 Total 5354 298 4892 62 Report of the Medical Officer of Health for 1930. The number of visits made by nurses in 1929 was 3,146 and the increase is due to the increase in the number of cases of Influenza and Pneumonia. Maternity and Child Welfare Centres. There are now 12 Infant Welfare Centres in the Borough. They are voluntary institutions receiving grant from the Borough Council. A new Centre was opened in April to serve Streatham Hill and Clapham Park areas. 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 1930, was 2,932, compared with 2,832 for the previous year, and the total attendances were 55,322. The number of visits paid by the Superintendents to infants was 7,662. Nine of the 12 Centres have ante-natal clinics and 836 cases were examined at these clinics, compared with 717 in 1929. During the year Balham and Streatham Welfare Centres increased the ante-natal sessions held by another session each month, and Fairfield Welfare Centre instituted an ante-natal session to be held monthly. The following is a list of the Welfare Centres in the Borough together with the hours at which the clinics are held:— 63 Maternity and Child Welfare. 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, 3rd & 4th Fridays in each month at 9.45 a.m. Wednesdays and Thursdays at 1.45 p.m. Streatham : 37, Riggindale Road. 1st, 3rd & 4th Wednesdays in each month at 10 a.m. Tuesdays at 1.30 p.m. Fridays at 2 p.m. Wesley Hall, Blegborough Road. None. Thursdays at 2 p.m. Streatham Hill with Clapham Park. None. Tuesdays at 10 a.m. Tooting : Fairlight Hall, Fairlight Road. 2nd Wednesday in each month at 10.30 a.m. Wednesdays and Thursdays at 2 p.m. Church Hall, Lynwood Road. 4th Wednesday at 10.30 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 2 p.m. Fairfield : St. Faith's Mission Hall, Warple Way. 1st Monday in each month at 2 p.m. Wednesdays and Thursdays at 2 p.m. Springfield : Church Hall, Earlsfield Road. 2nd and 4th Tuesdays in each month at 11 a.m. Tuesdays at 2 p.m. 64 Report of the Medical Officer of Health for 1930. TABLE XXXIV, Clapham. Putney. Putney Park. Balham. Streatham. Blegborough Road. Streatham Hilt (ClaphamPark) Tooting. Southfield. Fairfield. Springfield. Totals. Fairlight Lynwood Road New Cases, 1930 491 205 60 522 352 91 84 255 132 234 238 259 2923 Total Attendances 8457 4852 1483 10254 5622 2140 1330 4974 2920 4914 4514 3862 55322 Ante-natal Cases 155 90 - 142 129 — — 71 52 79 65 53 836 Ante-natal Attendances 503 229 - 465 376 — - 241 94 204 136 122 2370 Supts.' Visits to Infants 1286 1081 609 1798 1277 - - - — 1611 - — 7662 Supts.' Visits to Ante-natal Cases 182 216 76 210 249 - - - - 181 - - 1114 No. of Sessions :— Infants 96 101 50 102 95 48 35 94 47 100 101 49 918 Ante natal 24 24 — 35 32 — — 22 12 24 12 21 206 Health Talks given 26 65 18 122 — — — 85 42 42 36 51 597 Maternity and Child Welfare. 65 Mothercraft and Fathercraft Competitions. The third Competition for the Borough Shield was held in the Town Hall in July, 1930. The syllabus, which consisted of ten classes, for six of which each competing Centre could enter, comprised the following subjects :— Moth;ercraft :— Management of Children. Laundry work. Knitting. Crochet work. Millinery. Renovating clothing. Sewing. Making pram or cot covers. Preparing breakfast. The following were the subjects of the Fathercraft Corncompetition :— Making a model of farm buildings. Making a useful household article. Knitting, sewing, or crochet any article. Exhibiting a window box. 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. The challenge shield was won by Lynwood Infant Welfare Centre, Springfield Centre was second. The silver cup presented by Alderman Comins for fathercraft was won by Springfield Centre, Lynwood Centre was second. f 66 Report of the Medical Officer of Health for 1930. 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. Balluim Balham Day Nursery , 22, Old Devonshire Road. They are voluntary institutions, receiving grants from the Borough Council. 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 Od. 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, 4,887; Balham, 7,087; Tooting, 3,930; and Wandsworth, 6,758; a total of 23,157. compared with 20,997 in 1929. 128 inspections of the creches were made during the year by the Health Visitors. 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 Maternity and Child Welfare. 67 of Matron, a Sister, two Assistant Nurses and three Probationers. A Visiting Medical Officer attends daily. The parents pay 10s. 6d. per week for their children, but necessitous cases arc admitted free, or at a reduced fee, according to circumstances. Medical practitioners can recommend cases for admission and attend them while in the Hospital. 123 infants were admitted in 1930, 48 from addresses in the Borough, and 75 from outside the Borough. Most of the cases were infants suffering from Marasmus, Gastritis and Debility. During the year £42 18s. 6d. was paid to SS. Peter and Paul Home, Clapham, for treatment in respect of three Borough residents maintained in the Home. There is one other large institution in the Borough for the accommodation of 60 children up to the age of five years. There are five institutions or hostels in the Borough for the reception of expectant unmarried mothers, all in connection with rescue work. In two of them the mothers are admitted some months previous to the confinement, while in three they are admitted towards the end of pregnancy. In most of these homes the mothers are expected to remain some months after confinement. Arrangements have been made for a medical man to attend at each hostel when necessary, and some of the infants attend the most convenient Infant Welfare Centre. In 1928 the Council received an application from the Southwark Diocesan Association for Preventive and Rescue Work, for a grant towards the maintenance of unmarried mothers, usually resident in the Borough, in the institutions of the Association, and it was decided to make a per capita grant for each resident so maintained, the total amount in any one year not to exceed £200. During 1930, 21 cases were maintained by the Council at a cost of £156 12s. During the year this work was extended, the Council deciding to make a grant not exceeding £40 a year to the Mission of Hope. One case was dealt with, the cost of which amounted to £10 17s. 6d. F 2 68 Report of the Medical Officer of Health for 1930. Convalescent Homes. During the year 10 mothers were sent to Convalescent Homes, eight of them taking their infants with them. 23 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, 843 families were supplied with milk under the above scheme:— 136 in Clapham; 40 in Putney; 148 in Balham; 122 in Streatham; 118 in Tooting; 30 in Southfield; 169 in Fairfield; and 80 in Springfield. The total cost to the Council was £2,144 14s. l1d. Women and children in receipt of milk under the Council's scheme are expected to attend the Welfare Centre during the time that the milk is being granted, though this rule is not enforced in cases where there is some very good reason for the mother's non-attendance. There is little doubt that many mothers and children have benefited from the supply of free milk since the scheme was instituted. In many cases the milk granted has enabled nursing mothers to prolong the period of lactation, and the records kept at the Welfare Centres show good results in the health and general well-being of many infants. Dental Treatment. The teeth of mothers and children are examined as a routine by the Medical Officers at the Welfare Centres, and those requiring treatment are advised to attend at the Dental Clinic of the British Dental Hospital; 7, Defoe Road, Tooting. Maternity and Child Welfare. 69 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. 78 cases, 66 women and 12 children, were treated at the Hospital and 355 attendances were made. The above service was extended in 1926 for Putney and Wandsworth. The Council arranged with a local dentist to treat cases from these districts. The fees paid are in accordance with the scale laid down by the Council. This service was further extended during the year to include Clapham and Streatham Hill, and Putney Park. 148 cases availed themselves of these facilities during the year, 111 being women, and 37 children. The Council has now arranged for periodical dental inspection of mothers and children to be carried out at the Infant Welfare Centres by dental practitioners. These inspections are made at intervals of three or six months, and at most of the Centres are carried out by the same dental surgeon who treats mothers and children attending that Centre. 70 SANITARY INSPECTION OF THE BOROUGH. The staff of Sanitary Inspectors engaged in District and Housing duties has been increased during the year by the appointment of two additional officers and there are now 15 Inspectors carrying out this work. These two Inspectors, together with the two appointed in 1929 for housing duties, have been allocated to districts and there are now 15 districts compared with 11 before these new appointments were made. Owing to thse increases in the staff it has been possible to make a material reduction in the size of the districts, several of which were too large for efficient working. Each Inspector is responsible for all the work in his district, other than that in connection with food and food premises, and for duties under the Housing Acts including house to house inspection. Housing Conditions. There are over 60,000 houses in this Borough and they are of all types. Generally speaking the standard is good, but it varies in different districts. Some parts of the Borough are residental and contain many good class houses of modern construction. There are several middle class districts where a large portion of the houses are occupied by their owners. There are a large number of working class houses about 40 to 50 years old which are of a good representative type. In some parts of the Borough the houses occupied by the working classes are between 80 and 100 years old and many of these are difficult to keep in a sound structural condition. There are also a small number of houses which can be classified as cottage property of a poor type which on account of its age and condition is unsuitable for reconditioning. There is still a shortage of working class houses at a reasonable rent, and this fact causes a certain amount of overcrowding among families living in the existing houses. During the last few years a number of families who were either overcrowded or were living under conditions of hardship have been accommodated Sanitary Inspection of the Borough. 71 in new houses erected, by the Borough Council and the London County Council. In most of the houses in the Borough the water supply is inside the house and in only a small proportion is it situated in the open air. A good many houses are still without a supply of drinking water direct from the main. All the houses in the Borough have water closet accommodation, although there are still a few which have to share the accommodation with another house. Unhealthy Areas. During the last two or three years a systematic survey of the Borough has been made with the object of scheduling groups of houses which are unhealthy. There are 632 houses in this category, grouped in 33 areas. The conditions in the different areas vary to a considerable extent, but all of them are well below standard and cannot be reconditioned. Most of these areas are small ones, 17 of the 33 consisting of fewer than 10 houses each. Only four of them contain more than 50 houses. In six of them there are from 20 to 40 houses. The Council has decided to deal with a number of these unhealthy areas during the next five years, and in drafting its five years' programme under the Housing Act, 1930, has made provision for 524 flats to accommodate persons living in insanitary areas. This accommodation is in addition to that which is being provided for housing purposes as distinct from re-housing. The 524 flats will be available for re-housing persons displaced from some of the unhealthy areas and also from other insanitary houses, not situated in areas, which require demolition. I have made representations under Section 1 of the Housing Act, 1930, in respect of 13 of the above unhealthy areas, and the Council has decided to deal with them as Clearance Areas. This will involve the demolition of 147 houses and it is hoped that considerable progress will be made in this direction during the current year. 72 Report of the Medical Officer of Health for 1930. 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 1,758, and of these 807 were found to be in a defective condition. The drains of 75 houses were re-constructed. Damp conditions have been remedied in 1,052 premises, and in 74 of these damp courses were inserted. 14 privies and earth closets are known to be in existence in the Borough, and all of these are in connection with sports grounds. It will be seen from this Table that 224 cases of overcrowding were abated. Two of these cases were accommodated in Wandsworth Borough Council houses and 49 in London County Council houses. Sanitary Inspection of the Borough. 73 TABLE XXXV. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 1. Premises cleansed and repaired 727 230 485 309 1022 1215 3988 2. Drains tested 243 147 317 242 179 630 1758 3. Drains cleansed or repaired 117 86 113 78 248 165 807 4. Water closets cleansed or repaired 413 132 144 141 453 374 1657 5. Soil pipes repaired 54 47 40 10 34 43 228 6. Waste pipes altered or repaired 78 90 71 24 33 213 509 7. Rainwater pipes repaired 91 27 28 20 38 85 289 8. Roofs and gutters repaired 280 79 111 95 338 449 1352 9. Damp courses inserted 14 9 7 15 7 22 74 10. Damp conditions otherwise remedied 142 78 124 105 140 389 978 11. Yards drained or paved 131 28 87 42 290 207 785 12. Dust bins provided or repaired 186 55 131 85 177 342 976 13. Water cisterns cleansed, covered or repaired 25 42 30 9 77 22 205 14. Water supply reinstated 18 11 9 10 8 7 63 15. Defective fireplaces remedied 79 16 48 39 128 148 458 16. Defective coppers remedied 47 4 35 16 73 94 269 17. Cases of overcrowding abated 23 12 20 18 66 85 224 18. Stables and stable yards drained or paved - - - 2 - 2 4 19. Accumulations of manure, etc., removed 9 3 10 22 7 10 61 20. Urinals cleansed or repaired 3 10 - 1 1 1 16 21. Animals improperly kept 9 1 2 3 7 3 25 22. Smoke nuisances 7 6 5 1 1 11 31 23. Other nuisances 156 69 151 79 86 334 875 Total 2852 1182 1968 1366 3413 4851 15,632 No. of preliminary notices served 1113 357 754 739 1716 1617 6296 No. of preliminary notices complied with without the service of statutory notices 1011 291 742 800 1562 1277 5683 No. of statutory notices served 154 23 100 124 133 247 781 No. of statutory notices complied with 157 31 67 140 76 153 624 74 Report of the Medical Officer of Health for 1930. Table XXXVI. gives full details of the inspections carried out by the District Inspectors. TABLE XXXVI. Inspections. ReIn spections. Total. To investigate complaints 5698 17304 23002 House-to-House inspections 2957 12062 15019 Infective Diseases:— Notifiable diseases 2203 872 3075 Measles 7 1 8 Whooping Cough 15 28 43 Other infective diseases 812 35 847 Verminous cond„ions 189 254 443 Offensive Trades No. of Premises 2 3 2 5 Piggeries 9 85 1 86 Factories, workshops, etc. 1959 1784 49 1833 Houses let in lodgings 266 36 83 119 Rag and bone stores 21 26 — 26 San„ary conveniences 172 1094 36 1130 Mews and stables 131 300 4 304 Other inspections 6308 222 6530 Total 21,517 30,953 52,470 Smoke observations 47 — 47 Legal proceedings, A„endances at Court 43 — 43 San„ary Inspection of the Borough. 75 Underground Rooms. There are 27 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. House-to-House Inspections. The results of these inspections are shown in Table XXXVII. 2,957 inspections were made compared w„h 1,515 in 1929, and 989 in 1928, and nuisances necess„ating the service of san„ary notices were found in 2,423 of the houses. 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 225 217 34 83 71 154 Clapham South 200 154 23 27 84 130 Putney 160 89 7 12 47 106 Balham 335 295 49 65 282 177 Streatham 264 146 22 60 129 180 Tooting 949 852 86 137 248 674 Southfield 73 43 — 3 67 24 Fairfield 342 306 42 121 151 216 Springfield 409 321 86 94 112 284 Whole Borough 2,957 2,423 349 602 1191 1945 Rent and Mortgage Interest Restrictions Act, 1923. 57 applications for Certificates were received during the year. On inspection „ was found that all the premises except two were not reasonably f„ for human hab„ation. One of them was put in a reasonable state of repair before the meeting of the Comm„tee at which the Certificate would have been granted. Of the 54 premises in respect of which Certificates were granted, one tenant removed, and 24 were rendered reasonably f„ during the year. 76 FACTORIES AND WORKSHOPS. The number of factories, workshops, workplaces, and home workers' premises is shown in Table XXXVIII., together w„h 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 1930. Number of Inspections, 1930. Number of Notices, 1930. Number of Prosecutions, 1930. Factories:— Factory Laundries 61 82 2 — Factory Bakehouses 77 557 10 — Other Factories 501 452 13 — Total 639 1091 25 — Workshops:— Workshop Laundries 35 39 2 — Workshop Bakehouses 52 314 2 — Other Workshops 760 703 18 — Total 847 1056 22 — Workplaces 160 163 6 — Total: Factories, Workshops and Workplaces 1.646 2,310 53 — Home-workers' premises 442 394 8 — Grand Total 2,088 2,704 61 — Further details w„h regard to homeworkers' premises are given in Table XXXIX. Factories and Workshops. 77 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. 39 31 189 32 12 7 45 (2.) Cleaning and washing 2 4 3 — — — — Paper bags and boxes 4 — 4 — 1 1 — Totals 45 35 196 32 13 8 45 The total number of addresses received from other Councils was 485, and 131 addresses were forwarded to other Councils. The number of addresses received has decreased by 16 and the number sent increased by three. 31 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 45 cases of infective diseases—six of Diphtheria, 32 of Measles, three of Scarlet Fever, three of Pneumonia, and one of Whooping Cough—were notified as having occurred in the homes of out-workers. In none of these cases was „ necessary to make any order under Section 110 of the Factory and Workshop Act. 78 Report of the Medical Officer of Health for 1930. TABLE XL. DETAILS WITH REGARD TO REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. Workshop Bakehouses 52 Workshop Laundries 35 Dressmakers' and Milliners' Workshops 152 Bootmakers 104 Sm„hs and Engineers 39 Builders 51 Tailors 65 Motor Engineers 55 Upholsterers 36 Hairdressers 26 Other 232 Total number of workshops on Register 847 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 74 57 - - Want of ventilation — — - - Overcrowding — — - - Want of drainage of floors — — - - Other Nuisances 13 11 - - San„ary accommodation: Insufficient 1 I - - Unsu„able or defective 51 37 - - Not separate for sexes — — - - Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouses (s. 101) - - - - Other offences — — - - (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921) Total 139 106 - — * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 79 FOOD AND FOOD PREMISES. There are three Inspectors engaged in the sampling of food and in the supervision of food premises in the Borough. Special a„ention is given to Markets and Stalls, and frequent vis„s are made to these premises in the evening and during week-ends. The six slaughterhouses are vis„ed on many occasions and one of the Inspectors is present on nearly all occasions when slaughtering is taking place. The following Table gives the number of food premises and slaughterhouses, 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 1930. Number of inspections, 1930. Number of Notices, 1930. Number of prosecutions, 1930. Dairies, milkshops and cowsheds 309 1,342 1 - Restaurant k„chens 322 630 8 — Ice Cream premises 497 591 — — Slaughterhouses 6 735 — — Butchers' shops 239 1,414 1 - Greengrocers' shops 332 1,042 7 — Fishmongers' shops 150 545 - — Fried fish shops 84 305 — — Markets and stalls 194 3,359 — — Bakehouses 129 871 12 — Other premises where food is prepared for sale 1,015 875 - — Total 3,277 11,709 29 - 80 Report of the Medical Officer of Health for 1930. The number of inspections of premises where food is sold or prepared for sale was 11,709 compared w„h 12,257 in 1929, 11,355 in 1928 and 12,585 in 1927. Milk Supply. There are 309 registered milk premises in the Borough, one of them being also a cowshed. All the premises have been inspected regularly, the Food Inspectors making 1,3-12 vis„s during the year. The bulk of the milk sold by retail w„hin the Borough is sent out in bo„les filled in properly constructed dairies, and „s qual„y throughout the year has been good. The average fat content shown by the analysis of 798 samples of whole milk was 3.56, compared w„h 3.51 in 1929. The utensils and barrows used for the delivery of milk have also been inspected regularly in the street. Meat. Six private slaughterhouses are now in use in the Borough. The Food Inspectors made 735 vis„s during the year to these premises and they were present on almost every occasion when slaughtering took place. The number of carcases inspected was 9,305, comprising 574 oxen, 1,183 pigs, 7,508 sheep and 40 calves. This compares w„h 10,711 carcases inspected in 1929, 8,399 in 1928 and 5,494 in 1927. Ten whole carcases and 374 organs, etc., were found to be diseased or unsound and were destroyed for the following reasons:— Whole Carcases:— Oxen 1 Carcase and Offal for Tuberculosis. Pigs 6 Carcases and Offal for Tuberculosis. 1 Carcase and Offal for Per„on„is. Sheep 1 Carcase and Offal for Asphyxiation. Calf 1 Carcase and Offal for Pyæmia. Food and Food Premises. 81 Organs, etc.:— Oxen. 124 Livers Fluke 10 Livers Tuberculosis 7 Livers Abscess 1 Liver Hepat„is 45 Pairs of Lungs Tuberculosis 11 Pairs of Lungs Fluke 1 Pair of Lungs Abscess 1 Pair of Lungs Pneumonia 1 Pair of Lungs Pleurisy 3 Pairs of Lungs Congestion 2 Pairs of Lungs Actinomycosis 7 Mesenteries Tuberculosis 2 Spleens Tuberculosis 1 Heart Pericard„is 1 Heart Tuberculosis 1 Omentum Tuberculosis 4 Heads Actinomycosis 14 Heads Tuberculosis 3 Tongues Actinomycosis 14 Tongues Tuberculosis 1 Diaphragm Inflammation Calf. 1 Head Tuberculosis 1 Tongue Tuberculosis 1 Pair of Lungs Tuberculosis Pigs. 10 Heads Tuberculosis 1 Head Abscess 14 Livers Milkspots 8 Livers Cirrhosis 4 Tro„ers Inflammation 10 Mesenteries Tuberculosis 7 Spleens Hæmorrhage 2 Plucks Tuberculosis G 82 Report of the Medical Officer of Health for 1930. Pigs. 22 Pairs of Lungs Congestion 1 Pair of Lungs Strongylus Paradoxus 2 Pairs of Lungs Pneumonia 1 Forequarter Pleurisy Sheep. 20 Pairs of Lungs Strongylus Rufescens 6 Livers Fluke 1 Liver Hepat„is During the early part of 1930 restrictions regarding the removal of animals under the Foot and Mouth Disease Order were in force and this made „ difficult for butchers to obtain their usual supply of animals for slaughtering. This fact may account for the decrease in the number of carcases examined during the year. There are 239 butchers shops in the Borough. 1,414 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. It is satisfactory to say that this Order has been observed generally by butchers. There were no prosecutions during the year. Unsound Food. At the request of the owners the following foodstuffs were destroyed and the usual certificates granted, viz.:—1 box of herrings; 1 box of pears; 1 stone of filleted codling; 6 stone of haddock; 4 boxes of filleted cod; 2 tins of prawns; 1 cooked goose and 1 box of dabs. 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 cond„ion and on san„ary premises, and from meat which has been duly inspected by a Veterinary Surgeon. Food and Food Premises. 83 As Certifying Officer for Wandsworth under the Order, I have issued nine of these Certificates for the export of parcels of po„ed meats prepared w„hin the Borough during the year. Merchandise Marks Act, 1926, Agricultural Grading and Marking Act, 1928, and Orders made thereunder. These Acts and Orders which are now in operation, contain certain provisions which are enforced by the Borough Council and have added considerably to the work of the Food Inspectors. The following orders are now in force:— Marking of Imported Produce. 1. Fresh Apples. 2. Raw Tomatoes. 3. Eggs in Shell (i.e., hen and duck eggs). 4. Dried Eggs. 5. Currants, Sultanas and Raisins. 6. Oat Products (i.e., oatmeal, rolled oats, oat flour and groats.) 7. Honey. Circular le„ers explaining the provisions of these Orders have been sent to all traders concerned. The Food Inspectors report that these Acts and Orders have been duly observed by the traders, there being no deliberate evasion of the provisions. Statement of Work done under the Food and Drugs (Adulteration) Act, 1928. During the year 2,000 samples of foods and drugs were subm„ted to the Public Analyst for analysis. Of these 800 were subm„ted as official samples, while 1,200 were purchased unofficially as test or informal samples. 19 or 2.35 per cent, of the official samples, and nine or .75 per cent, of the unofficial samples were found to be adulterated or not up to standard. The total adulterations reported were 28 or 1.40 per cent, of the samples subm„ted. g 2 84 Report of the Medical Officer of Health for 1930. TABLE XLIII. RESULT OF ANALYSIS OF CERTAIN ARTICLES OF FOOD PROCURED UNDER THE FOOD AND DRUGS (ADULTERATION) ACT, 1928. SHOWING THE PERCENTAGE ADULTERATED COMPARED WITH 1926, 1927, 1928, AND 1929. Percentage of Samples adulterated, 1926-1929. No. of samples in 1930. 1926. 1927. 1928. 1929. Examined. Found adulterated or not up to standard Percentage adulterated Bu„er 0.8 1.3 3.4 1.6 544 1 .18 Cheese — — — — 18 - — Cocoa — — — — 6 - — Coffee — — — — 21 - — Confectionery and Jam — — — — 26 - — Cream — 25.0 — .50 226 1 .43 Margarine — — — — 12 — — Milk 2.0 2.3 2.6 1.6 798 19 2.3 Separated Milk — — — — 3 — — Condensed Milk 110 — — — 12 — — Mustard 16.6 — — — — — — Sugar — 5.0 — — 3 — — Tea — — — — 24 — — Vinegar 40.0 — — 3.7 7 2 28.4 Drugs 4.6 5.4 15.3 2.3 31 — — Other Articles 19.8 3.6 3.0 3.4 265 28 1.8 All Articles 5.3 3.1 2.8 3.4 2000 28 1.4 Food and Food Premises. 85 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 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 200 2 1.0 135 3 2.2 336 5 5.2 1.4 Putney 131 1 .76 62 1 1.6 192 2 5.9 1.0 Balham 154 2 1.2 112 3 2.6 266 5 4.8 1.8 Streatham 206 1 .43 117 2 1.6 323 3 5.3 .9 Tooting 184 2 1.0 101 3 2.9 285 5 6.9 1.7 Wandsworth 325 1 .30 273 7 2.5 598 8 5.8 1.3 Whole Borough 1200 9 .75 800 19 2.35 2000 28 5.6 1.4 Milk. The following samples were subm„ted for analysis:— 798 of whole new milk. 3 of separated milk. 12 of condensed milk. Of these 19 were reported against as being adulterated or not up to legal standard. 15 contained extraneous water, three were deficient in milk fat and one contained extraneous water and was also deficient in milk fat. Proceedings were taken in six cases and in the other 13 cases the Public Health Comm„tee after considering the amount 86 Report of the Medical Officer of Health for 1930. of adulteration and circumstances of sale, decided not to prosecute the vendors, but to take further samples. 20 samples of milk were taken on delivery to the various inst„utions in the Borough all of which were genuine. 13 were procured in the early morning from wholesale dealers during delivery to retailers. Five of these were reported against and proceedings were taken against the vendors, who were ordered to pay £15 15s. costs. 80 samples were taken on Sundays e„her in the early morning or at mid-day; all of these were genuine. 549 samples were taken from milk vendors in the street during the early morning (5 to 7 a.m.) on weekdays, and of these seven or 1.2 per cent. were reported against. Milk (Special Designations) Order, 1923. The following licences for sale of designated milks were granted:— Certified 35 Grade A (Tuberculin Tested) 52 Grade A 6 Pasteurised 19 Bacteriological Examination of Milk. 51 samples of milk were examined for the presence of Tubercle Bacilli under Section 5 of the Milk and Dairies (Amendment) Act, 1922. In five cases the examination was incomplete owing to the failure of the test, and of the 46 remaining cases 10 or 21.7 per cent. contained pos„ive evidence of Tubercle Bacilli. I communicated these results to the Medical Officers of Health of the Counties in which the farms supplying the milk were s„uated. Veterinary examination of the herds was carried out by the County Author„ies and in several cases animals affected w„h tuberculosis were discovered and destroyed. The following samples of Graded, Milks were subm„ted for bacteriological examination in order to see if the bacterial Food and Food Premises. 87 tent was w„hin the prescribed standard for the appropriate grade. TABLE XLV. Grade. Samples taken. Reported against. Percentage reported against. Certified 24 8 33.3 Grade A. (Tuberculin Tested) 1 — — All samples examined 25 8 32.0 The Minister of Health was notified of the result of these examinations. Bu„er and Margarine. 544 samples of bu„er were subm„ted for analysis during the year, and of these one or .18 per cent. was reported against. 12 samples of margarine were subm„ted for analysis and were all reported genuine. Other Articles. 265 samples were subm„ted under this heading. The results are given in the Public Analysts' Report. 88 MISCELLANEOUS. Insulin Treatment. In March, 1928, an application was received from the Victoria Hosp„al for Children asking the Council to provide Insulin for a child aged 10 who was a„ending the Hosp„al 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 inhab„ants of the Borough. The drug was first supplied to the child's mother in May, 1928. He is still receiving treatment and there is considerable improvement in his cond„ion. The cost to the Council up to the end of 1930 was £30 5s. Bacteriological Examinations. During the year 3,653 bacteriological examinations were made at the Lister Inst„ute. 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 715 267 376 579 357 776 3070 Pos„ive 141 37 71 101 73 130 553 Enteric Fever:— Negative 4 2 5 7 1 2 21 Pos„ive — 2 — 1 — 1 4 Tuberculosis:— Negative 1 — — 1 — 1 3 Pos„ive — — — 2 — — 2 Total 861 308 452 691 431 910 3,653 Miscellaneous. 89 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 4,565:—819 in Clapham, 459 in Putney, 590 in Balham, 695 in Streatham, 594 in Tooting, and 1,408 in Wandsworth. Three public and one private elementary schools were also disinfected for infective diseases. Cleansing of Persons Act. The names of 43 children, stated to be in a verminous cond„ion, were forwarded to me by the Medical Officer, Education Department, London County Council, and the homes were vis„ed by the Inspectors. In 10 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 Author„y. 42 adults and 15 children were given baths at the Council's Disinfecting Station on account of suffering from Scabies. Flies and Mosqu„oes. During the summer months certain ponds, streams and areas of stagnant water were treated by spraying w„h paraffin, w„h the object of destroying the larvæ of mosqu„oes. Chloride of lime was also used for sprinkling horse manure in order to destroy the larvae and pupae of flies. Statement of Work done under the Rag Flock Act, 1911. 51 vis„s to workshops were made by the Inspector, and the materials used for bedding and upholstery were examined. 90 Report of the Medical Officer of Health for 1930. Five samples of rag flock were procured and subm„ted for analysis, and all of them passed the required standard of cleanliness. 20 certificates have been issued in respect of the sterilisation of materials used in the manufacture of rag flock for export. Water Supply—Cu„ing-off Notices. During the year, 52 notices w„h respect to 46 premises were received from the Metropol„an Water Board, stating that the supply had been w„hdrawn. In 42 premises the water supply was cut off for non-payment of rates, in three in consequence of defects to the supply service, and in one because the premises were empty. Mortuaries. The Mortuaries in Clapham, Streatham and Wandsworth, have been vis„ed several times during the year, and the Bylaws and Regulations have been carried out in a satisfactory manner. In Clapham, two bodies were removed to the Mortuary, in Streatham, seven, and in Wandsworth 115,—of which 62 were from Wandsworth, 27 from Putney, one from Balham, and 25 from Tooting—a total of 124. Inspection of San„ary Conveniences. The number of San„ary Conveniences inspected was 172; 49 in Clapham, 22 in Putney, 11 in Balham, 16 in Streatham, 16 in Tooting and 58 in Wandsworth. 1,130 inspections were made during the year, and five notices, for cleansing, was served and complied w„h. Ambulance Service. The London County Council has been responsible for the removal by ambulance of cases of infectious diseases to hosp„als since April, 1930. They also provide ambulances for persons Miscellaneous. 91. meeting w„h accidents, and for parturient women. These services are free. Ambulances are also provided by the same Author„y for the conveyance of other cases on payment. 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 wharves. An empty wagon is left to replace the full one. All house refuse is taken down the River Thames by barge from two riverside wharves in the Borough, and disposed of below Barking. Amount of Poor Law Relief. The Clerk to the Public Assistance Comm„tee has kindly given me the following information w„h reference to the above for the year ended 81st December, 1930:— (1). No. of admissions to the Poor Law Inst„utions 4,218 (2). No. of medical orders given 1,800 (3). Average No. of persons in receipt of outdoor relief 2,441 (4). Amount of outdoor relief given £42,938 92 Report of the Medical Officer of Health for 1930. STAFF. Details of the Staff of the Department are given below. Officers to whose salary no contribution is made under the Public Health Acts or by Exchequer grants are marked * 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:— L. A. S. Tro„, M.R.C.S., L.R.C.P. 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 w„h that Scheme. Public Analyst:— *A. H. M. Muter, F.I.C., F.C.S. Obstetric Consulting Surgeon under the Puerperal Fever and Puerperal Pyrexia Regulations, 1926:- L. G. Phillips, B.Sc., M.B., M.S., F.R.C.S. Staff 93 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 District Inspectors: R. Brown June 1893 „ No Five A. E. Vickers .. Dec. 1919 S.I. Exam. Bd. Yes — H. T. Lambert Dec. 1919 „ Yes Five F. Haworth June 1920 „ No — J. A. Sands July 1920 „ No One A. G. Pa„erson June 1925 „ Yes — E. V. Roots Sept. 1926 „ Yes Four W. T. Willimott Dec. 1927 Joint Board Exam. Yes Seven C. F. Standish Jan. 1928 S.I. Exam. Bd. Yes Two F. A. Eustace June 1929 Joint Board Exam. No — W. G. Pearce Sept. 1929 „ Yes — A. W. Fisher May 1930 „ No — J. Rowbotham Aug. 1930 „ Yes Two R. E. Jones Dec. 1930 „ Yes One Chief Inspector of Food and Drugs: T. Newell Mar. 1900 R. San. Inst. Yes Six Food Inspectors: W. H. Jones Sept. 1926 S.I. Exam. Bd. Yes Four A. E. Handley Aug. 1929 Joint Board Exam. Yes One Assistant to Food Inspectors: *A. J. Lansley Mar. 1928 — — — 94 Report of the Medical Officer of Health for 1930. HEALTH VISITORS. Name. Commenced Duty. Certificates held. Health Vistor. Trained Nurse. C. M. B. Sanitary Inspector. Maternity and Child Welfare:— Miss D. S. Collins Mar. 1913 Yes No No Yes „ E. K. Woods Feb. 1916 Yes No Yes Yes „ D. M. Staniland June 1927 Yes Yes Yes No „ J. E. D. Elder Mar. 1928 Yes Yes Yes No „ H. McCarthy Nov. 1928 Yes Yes Yes No „ J. Pottinger Aug. 1930 Yes Yes Yes No „ G. Smith Sept. 1930 Yes Yes Yes No „ K. Kenion Sept. 1930 Yes Yes Yes No Tuberculosis:— Miss P. G. Moores April 1915 Yes Yes No No „ R. M. Watling May 1922 Yes Yes Yes No „ M. Dean Jan. 1924 Yes No Yes Yes OFFICE STAFF. Name. Commenced Duty. Appointment. Certificates held *A. E. Cooper Nov. 1897 Chief Clerk San.Insp. and four others. *F. Bray Oct. 1903 Senior First Class Clerk San.Insp. and six others *P. C. Clark Nov. 1903 First Class Clerk One. Miss C. Wellings. May 1921 Second Class Clerk — *F. L. Langford Oct. 1919 Third Class Clerk — Miss H. G. Wright Jan. 1925 „ — Staff. 95 OFFICE STAFF—continued. Name Commenced Duty. Appointment. Certificates held. *Miss D. E. Kilsby Nov. 1925 Third Class Clerk Five L. L. Parrini May. 1923 „ — *J. Marshall Sept. 1927 „ Five *A. E. Hollis Feb. 1929 Fourth Class Clerk Two *Miss M. L. Baptie Dec. 1930 Secretary to the Tuberculosis Care Committee — C. Kitchen Feb. 1931 Dispenser for the Tuberculosis Dispensaries. Registered Pharmacist. Disinfecting Station. * J. Bond, Engineer. Nine Disinfecting Attendants. Mortuaries. One whole-time and two part-time mortuary keepers. Public Vaccinators. District. Public Vaccinators. Balham *Dr. T. Stokes, 67, Balham Hill, Balham, S.W. 12. Clapham *Dr. J. Kennish, 2, The Chase, Clapham Common, S.W. 4. Putney *Dr. W. D. McMurtry, 8, Atney Road, Putney, S.W.I5 Streatham *Dr. A. B. Plant, 29, North Side, Streatham Common, S.W. 16. 96 Report of the Medical Officer of Health for 1930. Public Vaccinators—continued. Tooting, No. 1 Tooting, No. 2 Wandsworth, No. 1 Wandsworth, No. 2 Swaffield Road Institution *Dr. P. A. Carrie, 859, Garratt Lane, Tooting, S.W. 17. *Dr. R. C. Spence, 18, Longley Road, Tooting, S.W. 17. *Dr. E. R. Badcock, 29, West Hill, Wandsworth, S.W. 18. *Dr. J. T. Thyne, 101, Earlsfield Road, Wandsworth, S.W. 18. *Dr. H. A. Topalia, 248, Earlsfield Road, Wandsworth, S.W. 18. Vaccination Officers. Clapham and Wandsworth *Mr. G. Lovett, 61, Barmouth Road, Wandsworth, S.W. 18. Balham, Streatham and *Mr. L. H. Ford, 128, Franciscan Road, Tooting, S.W. 17. Tooting. Putney *Mr. C. L. Taylor, 28, Crieff Road, Wandsworth, S.W. 18. I regret to have to report that Mr. E. Hunt died on the 28th October, 1930. He had been Clerk and Dispenser at the Tuberculosis Dispensaries since March, 1913, and his death was a great loss to the Department. The vacancy has been filled by the appointment of Mr. C. Kitchen. The vacancy caused by the death of Miss Merron reported in last year's report, has been filled by the transfer of Miss Watling from Maternity and Child Welfare to, Tuberculosis Visitor. Miss Kenion has been appointed Health Visitor in place of Miss Watling. Staff. 97 In May the Council decided to appoint two additional Sanitary Inspectors and Messrs. J. Rowbotham and R. E. Jones were engaged in this capacity. In November the Council decided to appoint a whole-time Secretary for the Tuberculosis Care Committee, and Miss M. L. Baptie was engaged. Mr. W. T. Willimott has obtained the Grade II. Certificate for Building Construction and the Grade II. Sanitary Engineering Certificate granted by the London County Council. Miss McCarthy and Miss Smith attended the 10th Winter School for Health Visitors organised by the Women Public Health Officers Association which was held in December, 1930. In conclusion, I wish to express my appreciation of the excellent manner in which the staff have carried out their duties throughout the year. I am, Your obedient Servant, F. G. CALEY. h 98 Report of the Medical Officer of Health for 1930. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF WANDSWORTH, 1930. (Compiled by the Registrar-General). Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15 — 25— 45— 65— 75— ALL CAUSES M. 1820 151 25 22 49 85 189 543 418 338 F. 1939 103 28 27 40 72 214 483 388 584 1. Enteric Fever M. 1 — — — — — — — 1 — F. 3 — — — — — 2 — 1 — 2. Small-pox M. — — — — — — — — — — F. — — — — — — — — — — 3. Measles M 25 4 13 5 3 — — — — — F. 23 4 10 5 4 — — — — — 4. Scarlet Fever M. 4 — — — 2 1 1 — — — F. 4 — — 3 — — 1 — — — 5. Whooping Cough M. 2 — — 1 1 — — — — — F. 5 2 2 — 1 — — — — — 6. Diphtheria M. 13 3 — 5 4 1 — — — — F. 14 — 1 4 9 — — — — — 7. Influenza M. 7 — — — — — 2 2 1 2 F. 20 2 — — — — 1 8 5 4 8. Encephalitis Lethargica. M. — — — — — — — — — — F. 2 — — — — — — 1 1 — 9. Meningococcal Meningitis. M. 2 — — 2 — — — — F. — — — — — — — — — — 10. Tuberculosis of respiratory system. M. 156 1 1 — 1 25 57 62 9 — F. 108 — — — 1 36 50 19 2 — 11. Other Tuberculous Diseases. M. 21 2 — 1 4 4 4 5 — 1 F. 20 1 3 2 3 4 3 2 1 I 12. Cancer, malignant disease. M. 229 — — 1 — 1 14 103 82 28 F. 321 — — 1 — 2 25 150 80 63 13. Rheumatic Fever M. 3 — — — 2 1 — — — — F. 9 — — — 3 2 1 1 2 — 14. Diabetes M. 13 — — — — — — 6 7 — F. 21 — — — 1 — 2 6 9 3 15. Cerebral hæmorrhage, etc. M. 71 — — — — — 1 16 32 22 F. 104 — — — — — 5 23 30 46 16. Heart Disease M. 389 — — — 2 5 17 105 125 135 F. 477 — — — 2 4 28 86 120 237 17. Arterio-sclerosis M. 47 — — — — — — 13 15 19 F. 57 — — — — — 1 12 14 30 99 Vital Statistics. CAUSES OF DEATH—continued. Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 45— 65— 75— 18. Bronchitis M. 63 4 - - - - 5 23 14 17 F. 65 1 - 1 — — — 6 18 39 19. Pneumonia (all forms) M. 99 21 5 3 - 1 14 34 13 8 F. 93 11 5 4 1 3 15 16 15 23 20. Other respiratory diseases. M. 20 1 — - 1 3 1 8 2 4 F. 18 2 — — — 1 — 5 6 4 21. Ulcer of stomach or duodenum. M. 30 - — - - 1 5 15 9 - f. 13 - — — — 1 — 8 4 - 22. Diarrhœa, etc. M. 25 19 - - - - - 3 - 3 f: 19 9 3 1 — 2 2 2 — — 23. Appendicitis and Typhlitis M. 20 - - 2 1 3 4 6 3 1 f. 7 — — — 3 — 1 1 1 1 24. Cirrhosis of liver M. 10 - - - - - - 5 4 1 f. 7 - - - - - 1 5 1 — 25. Acute and Chronic Nephritis M. 69 — - — 1 1 5 30 20 12 f. 70 — — 1 — 2 6 23 22 16 26. Puerperal Sepsis M. - - - - - - - - - - f. 7 — — — — — 7 — — — 27. Other accidents and Diseases of Pregnancy and Parturition M. - - - - - - - - - - F. 12 — — — — 3 9 — — — 28. Congenital Debility and Malformation, Premature Birth M. 70 69 1 - - - - - - - F. 54 51 i — — 1 1 — — — 29. Suicide M. 34 - - - - 1 12 15 3 3 F. 16 — — - - 1 4 9 2 — 30. Other Deaths from Violence M. 78 1 — 1 11 22 15 16 7 5 F. 58 1 1 1 5 2 10 13 9 16 31. Other Defined Diseases M. 318 26 5 3 14 15 32 75 71 77 F. 312 19 2 4 7 8 39 87 45 101 32. Causes ill-defined or unknown. M. 1 - - - - - - 1 - - F. - - - - - - - - - - 112 100 Report of the Medical Officer of Health for 1930. PARTICULARS OF PROCEEDINGS TAKEN UNDER THE PUBLIC HEALTH ACTS. Premises. Offences. Result. Fine. Costs. s. d. s. d. 55, Greyhound Lane, Streatham Nuisances Order made for abatement of nuisances - 21 0 56, Moffatt Road, Balham Ditto Ditto — 21 0 38 and 40, Besley Street, Streatham Ditto Ditto — 42 0 48, Besley Street, Streatham Ditto Summons dismissed — 21 0 6, Sulina Road, Streatham Ditto Order made for abatement of nuisances. — 21 0 27, Hosack Road, Balham Ditto Ditto — 21 0 45, Colmer Road, Streatham Ditto Convicted 2 6 21 0 31, Ellison Road, Streatham Ditto Summons adjourned sine die — - Madeira Hall, Madeira Road, Streatham Ditto Order made for abatement of nuisances. — 21 0 30, St. Luke's Road, Clapham Ditto Ditto — 21 0 Roadway adjoining Railway Arches, Wandsworth Road, Clapham Ditto Undertaking having been given to pave roadway and remove manure. Summons withdrawn. - - 101 Police Court Proceedings PARTICULARS OF PROCEEDINGS TAKEN UNDER THE PUBLIC HEALTH ACTS—continued. Premises. Offences. Result. Fine. Costs. s. d. s. d. 3, Kirkby Street, Clapham Absence of a dustbin Dustbin supplied. Summons dismissed. — 21 0 5a, Clifton Street, Clapham Nuisances Order made for abatement of nuisances. — 21 0 Failing to comply with Order 20 0 21 0 In Wandsworth Road, Clapham Removal of offensive matter through the streets during prohibited hours Convicted 40 0 42 0 10, Midmoor Road, Clapham Nuisances Summons withdrawn, work having been done. — 21 0 177, Brixton Hill, Streatham Ditto Order made for abatement of nuisances. — 21 0 Failing to comply with Order 10 0 42 0 101, Clifton Street, Clapham Ditto Ordered to pay costs — 42 0 66a and 70d, The Chase, Clapham Ditto Summonses withdrawn, work having been done. — — 68, Kenlor Road, Tooting Ditto Order made for abatement of nuisances. — 10 6 6, Fountain Road, Tooting Ditto Summons withdrawn, work having been done. — 21 0 102 Report of the Medical Officer of Health for 1930. PARTICULARS OF PROCEEDINGS TAKEN UNDER THE PUBLIC HEALTH ACTS—continued. Premises. Offences. Result. Fine. Costs. s d. s. d. 81, Kenlor Road, Tooting Nuisances Order made for abatement of nuisances — 10 6 58, Hereward Road. Balham Ditto Summons withdrawn, work having been done. — 21 0 55, Noyna Road, Balham Ditto Order made for abatement of nuisances. — — 69, Gleneldon Road, Streatham Ditto Ditto — 10 6 47, Selkirk Road, Balham Ditto Ditto — 21 0 23, White Square, Clapham Ditto Summons withdrawn, work having been done. — 10 6 12, Thurlow Street, Clapham Ditto Order made for abatement of nuisances. — 21 0 66, The Chase, Clapham Ditto Ditto — 21 0 6 and 7, Pleasant Place, Clapham Ditto Ditto — 42 0 14, Thurlow Street, Clapham Ditto Ditto — 21 0 £3 12 6 £32 11s. 103 HOUSING STATISTICS. Number of New Houses erected during the Year:— (a.) Total (including numbers given separately under (b.) (i) By the Local Authority Nil (ii) By other Local Authorities Nil (iii) By other bodies and persons 271 (b.) With State assistance under the Housing Acts: (i) By the Local Authority. (a) For the purpose of Part II. of the Act of 1925 Nil (b) For the purpose of Part III. of the Act of 1925 Nil (c) For other purposes Nil (ii) By other bodies or persons No information 1. Inspection of Dwelling-houses during the Year:— (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 11,507 and the number of inspections made 11,717 (2) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 2,957 and the number of inspections made 15,019 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 160 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 5,886 104 Report of the Medical Officer of Health for 1030. 2. Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 5,273 3. Action under Statutory Powers during the Year:— A.—Proceedings under section 3 of the Housing Act, 1925:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 4 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 4 (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 closeNil B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 5,886 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 624 (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 4 (2) Number of dwelling-houses in respect of which Closing Orders were made 160 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit 1 105 Housing Statistics. (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 4. Number of Houses Owned by the Local Authority distinguishing those built in the last two years and held under (1) Part III. of the Housing Act, 1925, (2) Part II. of the Housing Act, 1925, and (3) other powers Housing (1919) Act 708 Houses 34 Flats, by conversion Housing (1923) Act 435 Houses 1 Flat by conversion 40 Tenement Flats Ditto (Erected during last two years) 30 Tenement Flats 106 Analysts' Annual Report. To the Wandsworth Borough Council. Mr. Mayor, Madam and Gentlemen, We, herewith beg to submit for your consideration our report on work performed by us during the year 1980 under the Sale of Food and Drugs (Adulteration) Act, 1928. During the year a total number of 2,000 samples were submitted for analysis by your food inspector, 800 of which were "formal," i.e., taken with the formalities required by the Act and 1,200 were procured informally. Of the formal samples 19, or 2.37 % were found to be adulterated, or not up to legal standard; whilst nine, or 0.75 % of the informal samples were reported against. The Table below shows the nature of all samples examined and the results of analyses, the details of Spirits, Drugs and "Other Articles" being shown subsequently. GENERAL STATEMENT. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Butter 1 543 544 - 1 1 Cheese — 18 18 — — — Cocoa — 6 6 — — — Coffee — 21 21 — — — Confectionery and Jam 26 26 - - - Cream — 226 226 — 1 1 Margarine — 12 12 — — — Milk 795 3 798 18 1 19 Milk, Condensed (Machine Skimmed) — 12 12 — — — 107 Analysts' Annual Report. GENERAL STATEMENT.—continued. Nature of Sample. Examined Adulterated. Formal. Informal. Total. Formal. Informal. Total. Milk, Separated 3 — 3 — — — Sugar — 3 3 — — — Tea — 24 24 — — — Vinegar 1 6 7 1 1 2 Spirits — 4 4 — — — Drugs — 31 31 — — — Other Articles — 265 265 - 5 5 Total 800 1200 2000 19 9 28 SPIRITS. (INFORMAL). Nature of Sample. Examined. Gin 2 Whiskey 2 Total 4 DRUGS (INFORMAL). Nature of Sample. Examined. Camphorated Oil 3 Cream of Tartar 3 Friar's Balsam 6 Glycerine 2 Ointment, Mercury 2 Powder, Compound Liquorice 3 Powder, Seidlitz 2 Tincture of Iodine 5 Tincture of Rhubarb 5 Vaseline 1 Total 31 108 Report of the Medical Officer of Health for 1930. OTHER ARTICLES. (INFORMAL). Nature of Sample. Examined. Adulterated. Almonds, ground 3 Bacon 7 — Baking Powder 26 — Cakes, Sponge 14 — Coffee Extract 6 — Coffee and Chicory Extract 24 — Eggs, Dried 2 — Egg Substitute Powder 3 — Fruit, dried 30 — Gelatine 3 — Ginger, ground 3 — Golden Syrup 7 — Honey 18 — Ice Cream 6 — Lard 23 — Lemon Curd 3 — Lemonade Powder 6 5 Meat, Cooked 6 — Meat, Potted 4 — Mincemeat 6 — Peaflour 4 — Peel, Candied 3 — Pepper 6 — Rice 21 — Rice, Flaked 3 — Sausages 7 — Semolina 6 — Sweets 7 — Wine, Ginger 3 — Tapioca 3 — Yeast 2 — Total 265 5 The following table shows, in detail, the nature and extent of the adulteration reported in the formal samples submitted:— Case No. Nature of Sample. Nature of Report. 7 Milk 3 % Deficient in Fat. 186 Ditto 2½ % Extraneous water. 211 Ditto 1 % Extraneous water. 217 Ditto 1 % Extraneous water and 2 % Deficient in fat. 219 Ditto 3 % Extraneous water. 222 Ditto 1 % Extraneous water. 237 Ditto 22 % Deficient in Fat. 262 Ditto 2½ % Extraneous water. 263 Ditto 7½ % Extraneous water. 109 Analysts' Annual Report. Case No. Nature of Sample. Nature of Report. 264 Milk 10½ % Extraneous water. 265 Ditto 9 % Extraneous water. 266 Ditto 2 % Extraneous water. 298 Ditto 2 % Deficient in fat. 466 Ditto 1 % Extraneous water. 541 Ditto 1½ % Extraneous water. 552 Ditto 3 % Extraneous water. 560 Ditto 2 % Extraneous water. 616 Vinegar 13 % Deficient in Acetic Acid. 744 Milk 2 % Extraneous water. The nature of reports issued in respect to informal samples returned as adulterated is given below:— Case No. Nature of Sample. Nature of Report. 361 Cream Contains a trace of Boric Acid, 521 Lemonade Powder Made with Tartaric Acid. 522 Ditto Ditto 523 Ditto Ditto 524 Ditto Ditto 525 Ditto Ditto 743 Butter Contains Excess Water. 874 Milk Contains Extraneous Water. 884 Vinegar Deficient in Acetic Acid. Tartaric Acid not being a product of the Lemon, Lemonade Powder properly prepared should be made with Citric Acid which forms a natural constituent of the Lemon. The average water content of the 54.1 samples of Butter submitted amounted to 14.5 %, that in the 12 samples of Margarine being 13.8%. The average Fat content of the 226 samples of Cream was 58.4%. The average composition of the Milks submitted during each month of the year, and returned as genuine, is given below. 110 Report of the Medical Officer of Health for 1930. Month. No. Total Milk Solids. Milk fat. Non.fatty Solids. January 72 12.45 % 3.59 % 8.86 % February 46 12.22 % 3.48 % 8.84 % March 80 12.25 % 3.44 % 8.81 % April 74 12.33 % 3.58 % 8.75 % May 66 12.26 % 3.40 % 8.86 % June 47 12.18 % 3.44 % 8.74 % July 84 12.18 % 3.40 % 8.78 % August 78 12.30 % 3.52 % 8.78 % September 50 12.37 % 3.57 % 8.80 % October 110 12.62 % 3.72 % 8.90 % November 50 12.56 % 3.74 % 8.82 % December 23 12.57 % 3.78 % 8.79 % The average for the year "being, therefore:— Total Milk Solids 12.37 per cent. Milk fat 3.56 per cent. Non.fatty Solids 8.81 per cent. In all, six samples (informal) were submitted by reason of complaints having been received from rate-payers respecting them. The samples were three of Butter, one of Cream, one of Milk and one of Sweets. On analysis all these articles were found to be normal in every respect, with the exception of the Cream which was found to contain a trace of Boric Acid. The adulteration detected during the year amounted to 2.3 per cent. of the total number of samples examined, which is slightly higher than that returned for 1929, but still remains a low figure for such a large Borough. 1ll Analysts' Annual Report. We feel that this report would be incomplete without calling attention to the loyal co-operation we have always received from Inspector Thomas Newell, your Council's Chief Food Inspector. 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, 8th June, 1931. S.E. 11. 112 INDEX. PAGE Accident, Deaths from 38 Actinomycosis, Deaths from 37 Adulteration of Certain Articles, Percentage of, in 1926-1980 84 Agricultural Grading and Marking Act, 1928 83 Ambulance Service 90 Analysts, Report of 106 Ante-natal Clinics 63 Anti-toxin 19 Area of Borough 1 Artificial Light Treatment of Tuberculosis 48 Artificial Pneumothorax Treatment of Tuberculosis 49 Bacteriological Examinations 53, 88 Bacteriological Examination of Milk 86 Bakehouses 74, 76, 79 Balham, House-to-House Inspections in 75 Births 4 Births and Birth-rates in Sub-Districts 4 Birth-rate, Average 10 Years, 1920-1929 8 Births, Notification of, Act 5 Brain and Nervous System, Diseases of the 38 Butchers' Shops 79 Butter and Margarine 87 Cancer 38 Census, 1921 1 Cerebro-Spinal Meningitis 30 Child Birth, Deaths from 12 Circulatory Diseases 38 Clapham, House-to-House Inspections in 75 Cleansing of Persons Act 89 Clinics for Immunisation against Diphtheria 19-29 Conscientious Objections Certificates granted 18 Convalescent Homes 68 Index. 113 PAGE Cowsheds 79 Creches 66 Cutting-off Notices 90 Dairies, Milkshops and Cowsheds 79 Day Nurseries 66 Death, Causes of ., 7, 98, 99 Death-rate, Average 10 Years, 1920-1929 8 Death-rate, Corrected 6 Death-rate from Infective Diseases 13 Death-rate, Infantile 10 Deaths, Corrected 6 Deaths, Number of 6 Deaths in Institutions 9 Dental Treatment 49, 68 Developmental Diseases 38 Diarrhoea 36 Diphtheria 18 Diphtheria, Attack Rate per 1,000 cases 18 Diphtheria, Immunisation against 19-29 Diphtheria, "Return Cases" of 29 Disinfection 89 Disinfection of Schools 89 Dwelling-houses, Inspection of 103 Dysentery 31 Encephalitis Lethargica 31 Enteric Fever 29 Erysipelas 30 Expectant and Nursing Mothers, Institutions for 66 Factories and Workshops 76 Factories, Workshops, etc., Defects found in 78 Factories, Workshops, and Workplaces, Inspection of 76 Families, Number of, Census 1921 2 Fathercraft Competitions 65 Fishmongers' Shops 79 Flies and Mosquitoes 89 Food, Prosecutions in connection with 85 Food and Drugs (Adulteration) Act, 1928, Proceedings under 85 114 Index. PAGE Food and Drugs (Adulteration) Act, 1928, Statement of Work under 83 Food and Food Premises 79 Food Places, Inspection of 79 Fried Fish Shops 79 Greengrocers' Shops 79 Health Visitors, Work of 57 Home Work 77 Hospitals, etc., for Expectant and Nursing Mothers 66 House Refuse, Removal of 91 House-to-House Inspections, Summary of 75 Houses and Premises Inspected 74 Houses erected during 1980 103 Houses Let in Lodgings 74 Houses owned by Borough Council, Number of 105 Housing Conditions 70 Housing Consolidated Regulations, 1925, Houses inspected, etc. 103 Housing Statistics 103 Ice Cream Premises 79 Illegitimate Children, Births of 5 Immunisation against Diphtheria 19-29 Imported Produce, Marking of 83 Increase of Rent and Mortgage Interest (Restrictions) Act, 1923 75 Infant Visiting 57, 60 Infantile Mortality 9, 11 Infantile Mortality, 10 Years, 1920-1929 12 Infective Diseases 13 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 34-36 Influenza, Deaths and Death-rates 30 Influenzal Pneumonia and Acute Primary Pneumonia, Cases Notified 30 Inhabited Houses, Number of 1 115 Index. 115 page Inquests 38, 39 Insanitary Areas 71 Inspections, Details of 74 Institutions, Deaths in 9 Institutions for Expectant Mothers, etc. 66 Insulin treatment 88 Malaria 31 Margarine 87 Markets and Stalls 79 Maternal Mortality 12 Maternity and Child Welfare 57 Maternity and Child Welfare Centres 62 Measles 32-34 Measles and other Non-notifiable Diseases reported from Schools 34-36 Meat 80 Meat Food Products, Certification of 82 Merchandise Marks Act, 1926 83 Mews and Stables 74 Midwives 61 Milk Analysis 85 Milk and Dairies (Amendment) Act, 1922 86 Milk, Bacteriological Examination of 86 Milk (Mothers and Children) Order 68 Milk Premises, Cowsheds, etc., on Register 79 Milkshops, Cowsheds, etc., Inspections of 79 Milk (Special Designation) Order, 1922 and 1923 86 Milk Supply 80 Mortuaries 90 Mosquitoes 89 Mothercraft and Fathercraft Competitions 65 Natural Increase, Rate of 4 Nervous System, Diseases of the 38 Non-Infective Diseases, Deaths from 38 Notification of Births Act 5 Notification of Infective Diseases 15, 16 Nursing Arrangements 61 Offensive Trades 74 116 Index. PAGE Old Age 38 Ophthalmia Neonatorum 31 Other Infective Diseases, Deaths from 38 Outworkers 77 Overcrowding 73 Para-Typhoid Fever 29 Physical Features, etc., of the Borough 1 Piggeries 74 Pneumonia 30 Police Court Proceedings 85, 100-102 Polio-Myelitis and Polio-Encephalitis 30 Poor Law Relief, Amount of 91 Population 1, 3 Population of Sub-Districts 4 Premature Birth 38 Pregnancy, Deaths from Accidents and Diseases of 12 Puerperal Fever and Puerperal Pyrexia 29 Puerperal Pyrexia 29 Pulmonary Tuberculosis, Notification of Cases of 40 Putney, House-to-House Inspections in 75 Pyaemia, Deaths from 37 Rag and Bone Stores 74 Rag Flock Act, 1911, Statement of Work done under 89 Rateable Value 2 Rent and Mortgage Interest Restrictions Act, 1923 75 Respiratory Diseases 38 Restaurant Kitchens 79 Return Cases of Scarlet Fever and Diphtheria 29 Samples, Formal and Informal, Number of 85 Sanitary Conveniences, Inspection of 90 Sanitary Inspection of the Borough 70, 74 Sanitary Operations, Table of 73 Scabies 37 Scarlet Fever 29 Scarlet Fever, Attack Rate per 1,000 Cases 29 Scarlet Fever, " Return Cases "of 29 Schools, Disinfection of, for Infective Diseases 89 Septicaemia, Deaths from 37 Index. 117 page Shelters for Tuberculous Patients 50 Slaughter-houses 79 Small-pox 17 Smoke Nuisances 74 Social Conditions 1 Sputum Examinations 53 Staff 92 Streatham, House-to-House Inspections in 75 Suicide, Deaths from 38 Syphilis, Deaths from 37 Tooting, House-to-House Inspections in 75 Tuberculosis 40-45 Tuberculosis, Artificial Light Treatment of 48 Tuberculosis, Artificial Pneumothorax Treatment of 49 Tuberculosis Dispensaries 46-56 Tuberculosis Care Committee 53 Tuberculosis, Handicraft Class 55 Tuberculosis, Institutional Treatment 48 Tuberculous Diseases, Extra Nourishment provided 49 Underground Rooms 75 Unhealthy Areas 71 Unsound Food 82 Vaccination 17 Vaccination Returns 18 Violence, Mortality from 38 Vital Statistics of Whole Borough 2, 98, 99 Wandsworth, House-to-House Inspections in 75 Water Supply, Cutting-off Notices 90 Whooping Cough 30 Workshops, Number of 78 Young Children, Institutions for 66 Zymotic Diseases 13