Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, &c. OF THE BOROUGH, For the Year 1931, 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 1931. 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 1931. PHYSICAL FEATURES AND GENERAL CHARACTER OF THE BOROUGH. As regards area, Wandsworth is larger than any of the other Metropolitan 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. The Preliminary Report of the Registrar-General on the Census enumerated on the 26th April, 1931, gives the population of the Borough as 353,101—159,825 males and 193,276 females. This is a larger population than any other London Borough, the next being Islington with a total of 321,712 persons. At the Census 1921, the total population was 328,307, and of these, 147,229 were males and 181,078 were females. At the 2 Report of the Medical Officer of Health for 1931. Census 1911, the population was 311,360, of whom 140,728 were males and 170,632 were females. Of the 147,229 males at the Census 1921, 31,781 were under 12 years of age, 98,157 were engaged in enumerated occupations, and 17,291 were retired or not engaged in any occupation. Of 181,078 females enumerated at the Census 1921, 31,485 were under 12 years of age, 52,029 were engaged in various occupations and 97,564 were unoccupied. The commonest occupations for males were commercial and finance, transport and communication, clerical and draughtsmen, metal workers, professional men and those engaged in public administration. The commonest occupations for females were domestic service, laundry 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 1931 353,254 No. of inhabited houses in 1921 62,540 No. of families, or separate occupiers, in 1921 80,526 Rateable value in 1931 £2,958,032 Estimated produce of a penny rate £12,000 Extracts from Vital Statistics. Births:— Males 2,269 Legitimate 4,134 Females 2,065 Illegitimate 200 Total Births 4,334 Birth-rate 1.26 3 Vital Statistics. Still Births:— Males 92 Females 73 Total Still Births 165 Rate per 1,000 total births 38.6 Deaths:— Total Deaths 3,995 Death-rate 11.30 Percentage of total deaths occurring in public instititions 49.6 No. of women dying in, or in consequence of, childbirth:— From sepsis 14 From other causes 7 Deaths of Infants under one year of age:— Legitimate 240 Illegitimate 19 Total 259 Infantile mortality 59 Deaths from Tuberculosis:— No. 307 Rate 86 Total deaths from Measles 2 Total deaths from Whooping Cough 18 Total deaths from Diarrhoea (under two years of age) 25 Population. The population at the middle of the year was estimated to be 353,254, and all the rates used in this Report are calculated on this figure. Table I. shows the population of each sub-district, based on the above estimation, compared with the Census population. 4 Report of the Medical Officer of Health for 1931. TABLE I. Sub-District. Census Population 1931 Population estimated to middle of 1931 Clapham 60,904 60,945 Putney 34,702 34,703 Balham 53,994 54,015 Streatham 68,467 68,501 Tooting 38,156 38,171 Wandsworth 96,878 96,919 Whole Borough 353,101 353,254 Births. The total number of births occurring in the Borough was 3,319, including 418 non-residents who were born in Institutions. 1,433 births of Borough residents occurred outside the Borough, so that the corrected number of births was 4,334 compared with 4,688 in 1930. 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. Natural increase or decrease. Clapham 449 405 854 14.01 +2.59 Putney 191 200 391 11.26 + .31 Balham 364 353 717 11.42 .94 Streatham 416 367 783 11.43 — .48 Tooting 253 205 458 11.99 + 1.78 Wandsworth 596 535 1,131 11.66 + .88 Whole Borough 2,269 2,065 4,334 12.26 + .96 Vital Statistics. 5 The birth-rate was 12.26 per 1,000, compared with 13.17 for 1930, and 14.68 the decennial average. The rate for the whole of London during 1931 was 15-0 and for England and Wales, 15.8. 185 illegitimate births took place in the Borough, but only 86 belonged to the Borough. On the other hand 114 illegitimate births belonging to Wandsworth occurred outside the Borough, making a corrected total of illegitimate births belonging to Wandsworth of 200. 39 of these belonged to Clapham, 19 to Putney, 35 to Balham, 41 to Streatham, 31 to Tooting, and 35 to Wandsworth. The percentage of illegitimate births to total births was 4.6. 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 583 478 114 38 318 8 9 Putney 312 254 95 10 145 4 7 Balham 480 455 119 28 271 37 9 Streatham 707 594 150 44 333 67 13 Tooting 372 334 33 20 280 1 7 Wandsworth 865 797 187 43 533 34 11 Whole Borough 3,319 2,912 698 183 1,880 151 56 6 Report of the Medical Officer of Health for 1931. Deaths. The number of deaths which took place in the Borough during the year was 3,334, but 1,084 of these did not belong to the Borough, while 1,745 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 3,995 of whom 1,934 were males and 2,061 females. The corrected death-rate for the year was 1130 compared with 10'59 in 1930. The death-rate for the whole of London for 1931 was 12.4, for England and Wales 12.3, in the 107 County Boroughs and great Towns 12.3, and in the 159 smaller Towns 11.3. Table IV. shows the total number of corrected deaths and the death-rates for each sub-district and for the whole Borough. TABLE IV. SubDistricts. Corrected Deaths. Corrected Deathrate. Males. Females. Total. Clapham 354 342 696 11.42 Putney 177 203 380 10.95 Balham 308 360 668 12.36 Streatham 372 444 816 11.91 Tooting 203 187 390 10.21 Wandsworth 520 525 1,045 10.78 Whole Borough 1,934 2,061 3,995 11.30 Table V. is the general mortality Table for the whole Borough, and shows the corrected number of deaths from each cause divided into sexes, age groups and sub-districts, together with those occurring in Institutions. Vital Statistics. 7 Table V.—Causes of, and Ages at Death, during the Year 1931. 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, etc. Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 2 ... 2 1 ... 1 ... ... ... ... ... 1 1 ... ... ... ... 2 Scarlet Fever 4 2 2 ... 1 ... 1 1 1 ... ... 1 ... ... 1 ... 2 3 Whooping Cough 18 10 8 9 8 1 ... ... ... ... ... 3 ... 1 2 6 6 12 Diphtheria and Membranous Croup 17 11 6 1 2 7 5 1 ... 1 ... 6 ... 2 5 3 1 17 Influenza 97 43 54 2 3 ... ... 3 11 32 46 9 11 16 23 9 29 21 Erysipelas 9 2 7 1 ... ... ... ... 1 3 4 2 1 2 ... ... 4 6 Cerebro-spinal Fever 3 2 1 ... ... 2 1 ... ... ... ... 1 1 ... 1 ... ... 2 Other Epidemic Diseases 2 1 1 ... ... ... ... ... 2 ... ... ... ... ... 2 ... ... 2 Pulmonary Tuberculosis 280 150 130 ... ... 1 4 62 122 79 12 43 18 43 45 42 89 118 Tuberculous Meningitis 18 9 9 3 1 5 3 4 2 ... ... 2 2 2 4 2 6 16 Abdominal Tuberculosis 1 ... 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... Other Tuberculous Diseases 8 5 3 1 ... ... 1 3 2 1 ... 1 2 1 1 2 1 5 Other Infective Diseases 13 8 6 ... ... ... 2 1 3 5 2 2 ... 1 5 1 4 10 Cancer, Malignant Disease 575 269 306 ... ... 1 1 2 47 224 300 86 57 97 129 53 153 289 Rheumatic Fever 21 7 14 ... ... ... 3 5 9 3 1 3 2 4 4 1 7 11 Diabetes 42 18 24 ... ... ... ... 2 4 11 25 9 4 8 10 4 7 24 Other General Diseases . 73 23 50 ... 1 ... 4 4 9 23 32 10 8 12 18 10 15 37 Alcoholism 3 ... 3 ... ... ... ... ... 2 ... 1 1 1 ... 1 ... ... 3 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 10 7 3 3 2 1 1 ... 1 2 ... 2 1 2 ... 2 3 7 Cerebral Hæmorrhage, Apoplexy 119 49 70 2 ... ... ... ... 1 39 77 33 10 23 20 5 28 51 Convulsions 9 6 3 9 ... ... ... ... ... ... ... 2 2 ... 2 2 1 3 Other Diseases of Nervous System 135 76 59 2 ... ... 5 13 16 59 40 19 14 18 31 13 40 106 Organic Diseases of Heart 814 338 476 ... ... ... 2 4 35 157 616 152 62 131 171 82 216 405 Other Diseases of Circulatory System 264 120 144 3 ... ... ... 5 11 67 178 18 34 47 66 15 54 75 Bronchitis 270 128 142 16 ... 1 1 ... 6 51 195 58 25 52 47 20 68 71 Broncho-Pneumonia 97 52 45 23 10 5 4 l 3 11 40 14 15 15 18 11 24 52 Lobar Pneumonia 34 19 15 2 ... ... ... ... 6 14 12 9 2 7 6 3 7 10 Pneumonia (type not distinguished) 60 36 24 2 2 1 4 2 7 19 23 10 3 12 10 5 20 38 Other Diseases of Respiratory System 31 10 21 ... ... ... ... ... 4 9 18 3 6 7 5 3 7 11 Ulcer of Stomach 3 21 9 ... ... ... ... ... 7 17 6 3 ... 6 7 3 11 20 Diarrhœa 12 6 6 11 1 ... ... ... ... ... ... 3 1 2 1 2 3 12 Enteritis 15 11 4 13 1 1 ... ... ... ... 5 1 1 4 1 3 9 Appendicitis and Typhlitis 31 17 14 ... ... 2 1 3 8 9 8 4 6 4 3 6 8 28 Obstruction of Intestines 31 13 18 1 ... 1 1 ... 3 12 13 9 2 6 6 3 5 23 Cirrhosis of Liver 19 12 7 ... ... ... ... 1 2 7 9 6 3 5 3 ... 2 8 Other Diseases of Liver 20 11 9 ... ... ... 1 ... 2 8 9 2 4 4 1 2 7 18 Other Diseases of Digestive System 56 29 27 3 ... 2 2 3 10 20 16 10 9 9 6 4 18 44 Nephritis and Bright's Disease 181 91 90 ... ... ... 2 6 16 73 84 29 25 28 43 14 42 110 Other Diseases of Urinary System 63 56 7 ... 1 ... ... 1 1 23 37 10 9 5 19 5 15 48 Diseases of Generative System 12 ... 12 ... ... ... ... ... 5 6 1 1 2 2 4 1 2 11 Puerperal Fever 14 ... 14 ... ... ... ... 2 12 ... ... 4 1 ... 4 3 2 14 Other Accidents and Diseases of Pregnancy and Childbirth 7 ... 1 ... ... ... ... ... 7 ... ... 1 1 1 1 ... 3 6 Premature Birth 72 42 30 72 ... ... ... ... ... ... ... 11 8 12 15 9 17 35 Congenital Debility and Malformation 47 34 13 41 3 ... ... 3 ... ... ... 8 1 12 9 4 13 30 Other Diseases of Early Infancy 27 16 11 27 ... ... ... ... ... ... ... 1 2 2 12 3 7 15 Old Age 140 68 72 ... ... ... ... ... ... ... 140 20 8 35 24 13 40 48 Deaths from Accident 116 69 47 ... 2 5 9 21 15 26 32 27 12 21 13 16 27 101 Deaths from Suicide 43 26 17 ... ... ... ... ... 14 26 3 4 2 8 10 4 15 17 Other Violent Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Defined Diseases 26 10 16 5 ... ... ... 4 1 7 9 6 ... 1 4 2 13 23 Ill-defined Diseases or unknown 4 1 3 ... ... ... 1 ... ... 2 1 2 1 ... ... 1 ... 4 All causes 3995 1934 2061 259 37 37 60 157 408 1096 1991 696 380 668 816 390 1045 1982 8 Report of the Medical Officer of Health for 1981. The number of deaths shown on Table V. does not agree with that shown on page 104. 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. arc 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. 1921 18.80 22.3 22.4 10.83 12.4 12.1 1922 16.68 21.0 20.6 11.24 13.4 12.9 1923 16.20 20.2 19.7 10.09 11.2 11.6 1924 14.57 18.7 18.8 11.03 12.1 12.2 1925 14.17 18.9 18.3 10.32 11.7 12.2 1926 14.12 17.1 17.8 10.37 11.6 11.6 1927 13.13 16.1 16.7 10.96 11.9 12.3 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 1930 13.17 15.7 16.3 10.59 11.4 11.4 Average 10 years 14.68 18.1 18.3 10.88 12.1 12.1 1931 12.26 15.0 15.8 11.30 12.4 12.3 Vital Statistics. 9 The number of deaths which occurred in Institutions, etc., inside the Borough was 1,821, but 1,084 of these persons did not belong to the Borough. A total of 1,982 persons belonging to the Borough died in Institutions, 287 occurring in Institutions within the Borough and 1,745 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 6 Wandsworth Public Assistance Hospitals 1,048 National Hospital 9 Banstead Mental Hospital 9 St. Batholomew's Hospital 12 Cane Hill Mental Hospital 9 St. George's Hospital 7 Grove Park Mental Hospital 17 St. Luke's Hospital 8 Horton Mental Hospital 21 St. Thomas's Hospital 56 Lambeth Hospital 13 South Western Hospital 11 West Park Mental Hospital 11 Victoria Hospital .. 10 Other Mental Hospitals 16 West London Hospital 7 Other Public Assistance Institutions 23 Westminster Hospital 12 Other Institutions E.t.c:- Other Hospitals:— Other Institutions 145 Belgrave Hospital 14 Other Places not Public Institutions 107 Bolingbroke Hospital 40 On Street 11 Brompton Hospital 8 River Thames 3 Cancer Hospital 8 Private Nursing Homes 36 Charing Cross Hospital 13 Colindale Hospital 13 Institutions, etc., inside the Borough 1,745 237 Guy's Hospital 14 Infants' Hospital 8 1,982 King's College Hospital 20 Infantile Mortality. The number of deaths under one year was 259 :—41 in Clapham, 22 in Putney, 42 in Balham, 52 in Streatham, 30 in 10Report of the Medical Officer of Health for 1931. Tooting and 72 in Wandsworth. As the number of births was 4,334 the Infantile Morality rate was 59 per 1,000 births, compared with 55 last year. The increase in the rate is due to the increase in the number of deaths from Whooping Cough. The infantile mortality rate is slightly higher than the decennial average, which was 56. The tale is lower than that for the whole of London, which was 65 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 56. This fall represents a saving of over 200 infant lives per annum. The number of deaths among legitimate infants was 240 to 4,134 births a mortality of 58 per 1,000 births, while the number of deaths among illegitimate infants was 19 to 200 births -a mortality of 95 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. 11 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 97 13 16 7 133 42 34 24 26 259 Uncertified - - - - - - - - - - Small-pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - 1 - 1 Scarlet Fever - - - - - - - - - - Whooping Cough - - - - - 2 3 1 3 9 Diphtheria and Croup - - - - - - - 1 - 1 Erysipelas - - - - - - - 1 - 1 Tuberculous Meningitis - - - - - - 1 1 1 3 Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - 1 1 Meningitis (not Tuberculous) - - 1 - 1 - - - 2 3 Convulsions 2 1 - - 3 - 3 3 - 9 Laryngitis - - - - - - - - - - Bronchitis - - 1 2 3 7 1 3 2 16 Pneumonia (all forms) - 3 2 - 5 7 6 3 6 27 Diarrhœa - - - - - 4 3 1 3 11 Enteritis - - 1 - 1 1 4 2 5 13 Gastritis - - - - - - - 1 - 1 Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Suffocation, overlying - - - - - - - - - 2 Injury at Birth 10 - - - 10 - - - - 10 Atelectasis 14 - - - 14 - - - - 14 Congenital Malformations 15 4 2 2 23 3 2 - - 28 Premature Birth 54 4 8 2 08 4 - - - 72 Atrophy, Debility and Marasmus - 1 1 1 3 5 5 1 - 14 Other Causes 2 - - - 2 7 6 5 3 23 Totals .. 97 13 16 7 133 42 34 24 26 259 Nett Births in the year : legitimate, 4,134; illegitimate, 200. Nett Deaths in the year of legitimate infants. 240; illegitimate infants, 19. 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 1931. TABLE VIII. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 1921 00 80 61 79 71 07 1922 63 37 56 81 61 00 1923 50 40 49 50 63 55 52 1924 40 56 58 55 62 03 57 1925 54 04 38 42 63 57 52 1926 65 71 65 52 81 72 64 1927 44 75 50 47 71 45 51 1928 03 53 40 41 36 56 49 1929 65 38 62 44 69 74 61 1930 53 35 41 53 71 66 55 Average for 10 years 56 54 52 50 67 62 56 1931 48 56 59 66 05 63 59 No. of deaths under 1 year, 1931 41 22 42 52 30 72 259 Maternal Mortality. Seven deaths occurred from accidents and diseases of pregnancy and 14 from Puerperal Fever, giving a total of 21 deaths after childbirth. This is equivalent to a rate of 4.8 per 1,000 births, compared with 4.47 in 1930. 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 512:—83 in Clapham, 39 in Putney, 72 in Balham, 97 in Streatham, 71 in Tooting, and 150 in Wandsworth. From all infective diseases the death-rate was 1.44 per 1,000:—1.26 in Clapham, 1.12 in Putney, 1.33 in Balham, 1.41 in Streatham, 1 -86 in Tooting, and 1 -43 in Wandsworth. The rate in 1922 was 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; in 1929, 2.14; and in 1930, 2,26 per 1,000. The rate is slightly higher than in 1930, owing to the increase in the number of deaths from Influenza. The rate from the principal infective diseases, viz.:— Small-pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever and Diarrhoea, was .18 per 1,000, compared with .73 in 1922; .39 in 1923; .47 in 1924; .32 in 1925; .37 in 1926; .25 in 1927; .27 in 1928; .36 in 1929; and .35 in 1930. The rate was .31 in Clapham, .08 in Putney, .11 in Balham, .17 in Streatham, .31 in Tooting, and .15 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 1931. 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 17 15 2 1 2 2 - 5 2 3 1 - - 1 - Scarlet Fever 4 2 2 - 1 - - - - 1 1 1 - - - Enteric and Paratyphoid Fevers - - - - - - - - - - - - - Puerperal Fever 11 - 11 - - - - - - - - 10 1 - - Puerperal Pvrexia 3 - 3 - - - - - - - - 2 1 - - Erysipelas 9 1 8 1 - - - - - - - - - 3 4 Whooping Cough 18 18 - 9 8 1 - - - - - - - - - Pneumonia:— Acute Influenzal 10 1 9 1 - - - - - - - - 2 3 4 Acute Primary 69 19 50 9 5 - 3 1 1 - 1 2 6 17 24 Cerebro-Spinal Meningitis 3 3 - - - - 1 1 1 - - - - - - Polio-myelitis - - - - - - - - - - - - - - - Encephalitis Lethargica 1 - 1 - - - - - - - - - 1 - - Malaria - - - - - - - - - - - - - - - Dysentery 1 - 1 - - - - - - - - - 1 - - Total 146 59 87 21 16 3 4 7 4 4 3 15 13 24 32 Non-Notifiable Diseases. Measles 2 2 - 1 - 1 - - - - - - - - - Influenza 97 5 92 2 3 - - - - - 2 4 8 32 46 Diarrhœa 27 27 - 24 1 1 - - 1 - - - - - - Other (if any) - - - - - - - - - - - - - - - Total 126 34 92 27 4 2 - - 1 - 2 4 8 32 46 Grand Total 272 93 179 48 20 5 4 7 5 4 5 19 21 56 78 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 4 - 4 - - - - - - - - 2 - 2 - Diphtheria 393 317 76 7 14 26 38 32 139 61 25 33 14 3 1 Scarlet Fever 678 560 118 4 24 29 52 54 276 121 41 62 12 3 - Enteric Fever and Paratyphoid Fever 7 1 6 - - - - - 1 - - 5 1 - - Puerperal Fever 21 - 21 - - - - - - - - 18 3 - - Puerperal Pyrexia 24 - 24 - - - - - - - 1 21 2 - - Erysipelas 133 11 122 5 - 3 - - 2 1 2 14 14 56 36 Whooping Cough 1936 1921 15 183 193 216 219 326 746 38 1 10 2 1 1 Pneumonia:— Acute Influenza] 92 9 83 - 2 2 2 - 3 - 4 22 15 22 20 Acute Primary 463 166 297 44 32 13 20 13 32 12 19 62 57 95 64 Cerebro-spinal Meningitis 5 4 1 - - 1 1 1 1 - - 1 - - - Polio-myelitis 3 3 - - 1 1 1 - - - - - - - - Encephalitis Lethargica 2 1 1 - - - - - 1 - 1 - - - - Malaria 5 - 5 - - - - - - - - 2 1 2 - Dysentery 1 - 1 - - - - - - - - 1 - - - Total 3767 2993 774 243 266 291 333 426 1201 233 94 253 121 184 122 16 Report of the Medical Officer of Health for 1931. 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 2 - - - 1 1 4 4 - Diphtheria 1 < 17 43 77 63 116 393 385 17 Scarlet Fever 141 60 96 91 101 189 678 614 4 Enteric and Para-tvphoid Fevers - 1 - 2 - 4 7 5 - Puerperal Fever 5 2 1 4 2 7 21 18 11 Puerperal Pyrexia 4 1 5 2 4 8 24 22 3 Erysipelas 24 12 19 12 17 49 133 50 9 Whooping Cough 293 100 232 232 413 666 1936 124 18 Pneumonia—Acute Influenzal 20 9 15 15 9 24 92 - 10 Pneumonia—Acute Primary 69 39 58 52 59 186 463 - 69 Cerebro-spinal Meningitis 1 1 1 1 1 — 5 4 3 Polio-myelitis - - - - - - 3 3 - Encephalitis Lethargica - - 1 - - 1 2 2 - Malaria 1 - - 2 2 - 5 1 - Dysentery - - 1 - - - 1 - - Total 637 242 473 490 672 1253 3767 1232 144 Tuberculosis—all forms 114 66 119 78 90 146 613 475 306 Ophthalmia Neonatorum 18 2 8 7 1 5 41 21 1 Total 132 68 127 85 91 151 654 496 307 Grand Total 769 310 600 575 763 1404 4421 1728 451 Infective Diseases. 17 The total number of cases, less Tuberculosis and Ophthalmia Neonatorum, was 3,762 compared with 3,991 in 1930, 5,246 in 1929, 4,149 in 1928, and 4,280 in 1927. The increase, compared with 1930, is due to the increase in the number of cases of Whooping Cough. Small-pox. During the year four cases of Small-pox occurred, compared with nine cases in 1930. There were no deaths. Two of the patients had never been vaccinated, one of them, an adult aged 57 years was vaccinated in infancy, and the other case was a man who was exposed to infection and vaccinated too late to protect him against an attack of the disease. He had not been vaccinated previously. Vaccination. Table XII. is taken from the official returns of the Vaccination Officers for the year 1930. 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 54.4 in Clapham, 56.3; in Putney, 66.4; in Balham, 49.6; in Streatham, 51.0; in Tooting, 40.0; in Southfield, 64.2; and in Springfield 55.9. This percentage is a little higher than that recorded last year. 18 Report of the Medical Officer of Health for 1931. TABLE XII. SubDistricts. Number of Births returned from 1st January to 31st December, 1930. 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 617 349 1 - 34 144 11 16 41 21 Putney 310 206 2 - 12 56 4 5 13 12 Balham 544 270 4 - 21 178 1 10 19 41 Streatham 785 401 10 - 31 224 9 67 22 21 Tooting 404 162 4 - 18 166 2 9 14 29 Southfield 562 361 1 - 13 139 6 6 17 19 Springfield 368 206 3 - 13 87 7 4 21 27 Totals 3,5 GO 1,955 25 - 142 994 40 117 147 170 Diphtheria. 393 cases occurred, compared with 866 in 1930, 724 in 1929, and 568 in 1928. The number of deaths was 17, compared with 30 in 1930. The death-rate for 1931 was .04 and the case mortality was 4.3 per cent. The rate per 1,000 of population was 1.11:—1-26 in Clapham; .48 in Putney; .79 in Balham; 1T2 in Streatham; 1.65 in Tooting; and 1.19 in Wandsworth. Of the 393 cases, 385 or 97 per cent., were removed to hospital and no difficulty was experienced in having cases removed promptly. Infective Diseases. 19 The Medical Officers of the London County Council made inspections of the Haselrigge Road, Stonhouse Street and St. Andrew's Street Schools, in Clapham; Church of England, Felsham Road and Putney Roman Catholic Schools, in Putney; St. Leonard's School, in Streatham; The Ensham School, in Tooting; and Eltringham Street, Garratt Lane, Merton Road, Riversdale, St. Faith's, and Waldron Road Schools, Wandsworth. Swabs were taken from the throats of some of the children examined. As the result of this swabbing four 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. During the year 38 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. 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. 20 Report of the Medical Officer of Health for 1981. 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, 849 in 1930, and 684 in 1931, making a total of 3,349 in four years. These numbers are not large when compared with the child population of the Borough which was returned as 81,114 at the 1921 Census, but they are an indication that there is a certain demand for the service. 2,528 of the total number who attended were given the Initial Schick Test to see if they were susceptible to Diphtheria, and the remaining 821 were given immunising injections without a preliminary Schick Test. Almost all of the latter were young Infective Diseases. 21 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 1,826 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 in the lowest age group and that the proportion diminished as age advanced. This is in accordance with the known facts about the Schick Test. Of the small number of adults who were tested 50 per cent, gave a positive result. 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 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 2,647. This number is made up of the 1,826 who were found to be Schick positive after the initial test, and the 821, who were assumed to be susceptible without a test. The 22 Report of the Medical Officer of Health for 1931. 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 128 1127 383 873 765 1638 109 79 890 936 1826 Schick Negative 16 295 188 282 217 499 85 77 299 362 661 Result not read 1 20 14 14 21 35 4 2 14 27 41 Total 145 1442 585 1169 1003 2172 198 158 1203 1325 2528 Percentage Positive 88% 78% 65% 75% 76% 75% 55% 50% 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 641 813 219 828 845 1673 43 35 837 914 1751 Report of the Medical Officer of Health for 1931. 24 subsequent history of these 2,047 persons is given in the following statement:— No. who were immunised and found to be Protected as shown by a Negative re-Schick Test 1751 No. who received a course of injections but are not yet protected as the re-Schick Test is still positive 134 No. who received injections, the value of which is not known as they have not attended to be re-tested 728 Schick positive cases who were not injected 34 Total number of Susceptibles 2047 This statement shews that 1,751 of the susceptible persons who attended the Centres in the four years have been protected. Table XIV. gives the age grouping of these protected persons and in Table XV. they are arranged according to the number of doses of Toxoid Anti-toxin mixture and the time required to produce immunity. Reference to Table XV. shews that in 21 instances the retest was done and found to be negative after one or two injections. These were cases who for some reason, were unable to complete the three injections at once and came after an interval when they were re-tested to see if by chance they had become immunised. The majority—namely, 1,558 of the 1,751 persons—became negative after one series of three injections. 157 persons required a second series of injections before a negative re-test was obtained and in nine instances it was necessary to give a third series. It will be noticed from Table XV. that the time taken to produce immunity is shewn to vary very much. The time which elapses between the last injection of the immunising dose and the re-Schick test depends to a large extent on the date when the person concerned attends at the Clinic to be re-tested. Some TABLE XV. THE IMMUNISED PERSONS ARRANGED ACCORDING TO THE NUMBER OF DOSES AND THE 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 First Series 1 injection - 1 1 - 2 - - 2 2 injections 5 3 5 2 15 2 2 - 19 3 injections 545 545 245 86 1421 41 23 5 1490 4 injections 5 3 — 2 10 — — — 10 Second Series 4 to 6 injections — — 4 44 48 47 32 17 144 Third Series 5 to 8 injections — — — — — 4 2 2 8 Total Under 15 555 552 255 134 1496 94 59 24 1673 Adults Over 15. First Series 3 injections 20 23 12 4 59 3 1 63 4 injections — 1 — — 1 — — — 1 Second Series 4 or 6 injections — — 2 6 8 3 2 — 13 Third Series 11 injections — — — — — — — 1 1 Total All Ages 575 576 269 144 1564 100 62 25 1751 Infective Diseases. 25 Report of the Medical Officer of Health for 1931. 26 of it is however due to the actual delay in the production of immunity. A number of the cases shewn in this Table which have given final negative re-tests have had one or more positive results before the final negative one is obtained. The 1,151 cases who have been protected gave a negative re-Schick test within six months of having received the last dose of immunising serum and a further 413 were negative within twelve months. This means that 1,564 cases were known to have been immunised within a year. There are good grounds for assuming that a proportion of the remainder would have been found protected if they had attended earlier to be re-tested. In addition to the 1,751 persons who have been protected, 134 have completed the first series of injections but cannot be recorded as protected because the last Re-schick test has given a positive result. 68 of these have not attended since this positive re-test. 59 of them have attended and have received a second series of injections but have not yet been re-tested after this series. In the other seven cases the re-Schick test after the second series was still positive and they have received a third series of injections. A further 728 persons have been given immunising injections at the Clinics but have not attended to be re-tested, so that it is impossible to determine the value of the injections they have received. This number includes 599 who completed the first series of three injections and 129 who only received one or two doses. 34 susceptible persons have not yet commenced a 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 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. 27 Infective Diseases. 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 3 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 13—Schick Test positive— received three doses of Toxoid Anti-toxin mixture at weekly intervals—developed Diphtheria 2½ 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. 3.—A girl of 7—Schick Test positive—received three doses of Toxoid Anti-toxin mixture—developed Diphtheria five months and nine days after the last dose— membrane present and virulent organisms on culture —re-Schick Test performed on same day as admitted to hospital was positive—the attack was only a slight one—has not attended for further re-test. 28 Report of the Medical Officer of Health for 1931. 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 Shick Test—she was not brought for re-Schick Test— two years later she had a severe attack of Clinical Diphtheria 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. 6.—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 six 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 seven cases was there any definite symptom of Diphtheria, which suggests that they were protected against the disease. Scarlet Fever. 678 cases of Scarlet Fever occurred, compared with 981 in 1930, 899 in 1929, and 752 in 1928. 29 Infective Diseases. Three cases died, compared with six and six respectively for the two previous years, and the death.rate was .008 per 1,000 compared with .01 and .016. The case mortality was .44 percent. The case.rate per 1,000 of population, was 1.91:—2.31 in Clapham; 1.72 in Putney; 1.77 in Balham; 1 .35 in Streatham; 2.64 in Tooting; and 1.94 in Wandsworth. Of the total number of cases, 614 or 90 percent., were removed to hospital. The Medical Officers of the London County Council made inspections of six 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. 20 cases of Scarlet Fever and six of Diphtheria occurred within one month of the return of a previous case from hospital. Enteric and Para-Typhoid Fevers. Seven cases, and no deaths of the above occurred, compared with 27 cases and four deaths in the previous year. Four of the cases were true Enteric Fever and three were Para.typhoid Fever. Puerperal Fever and Puerperal Pyrexia. During the year 19 cases of Puerperal Fever and 24 cases of Puerperal Pyrexia occurred. 14 of the cases died. The death.rate was .03 per 1,000 of population and 3.2 per 1,000 births. Erysipelas. 133 cases were notified and nine deaths occurred during the year, compared with 150 and 12 in 1930. Whooping Cough. 18 deaths occurred during the year, while the number of cases notified was 1,936. The death.rate was per .05 1,000. 30 Report of the Medical Officer of Health for 1931. 124 of the cases were removed to hospital. 1,915 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Whooping Cough occurred, and 142 premises were disinfected. Influenza. The number of deaths from Influenza was 97 compared with 22 in 1930, 237 in 1929, 41 in 1928, 136 in 1927 and 56 in 1926. The death-rate was .27 per 1,000. Influenzal Pneumonia and Acute Primary Pneumonia. 92 cases of acute Influenzal Pneumonia and 463 cases of acute Primary Pneumonia were notified. Ten of the former and 69 of the latter died. The total number of deaths credited to all forms of Pneumonia during the year was 191, compared with 207 in 1930, 331 in 1929, 246 in 1928, 239 in 1927, 217 in 1926, 181 in 1925, 233 in 1924, 189 in 1923 and 236 in 1922. Cerebro-Spinal Meningitis. Five cases of this disease occurred. Three of them terminated fatally. A further 10 deaths were registered as being caused by Meningitis. Four other cases of this disease were notified, but proved not to be cerebro-spinal meningitis. Polio-myelitis and Polio-encephalitis. Three cases and no death occurred. Two children were admitted during the year for treatment at Queen Mary's Hospital, Carshalton, under the scheme provided by the L.C.C. Encephalitis Lethargica. Two cases of this disease occurred and one death was registered. 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. 31 Infective Diseases. Malaria. Five cases were notified. No death occurred. Dysentery. One case of Dysentery was notified and one death occurred. Ophthalmia Neonatorum. 41 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 20 — — 1 At Hospital, Out-patient 5 — — — At home 15 — — — Total 40 — — 1 40 of the cases recovered without any impairment of vision, one case died from Enteritis and Stomatitis. Measles. There was no epidemic of Measles during 1931. The number of cases brought to my notice during the year October 1st, 1930, to September 30th, 1931, was 295. The majority of these cases were reported by teachers at the elementary schools, and in arriving at this figure seven cases, which proved after investigation not to be suffering from Measles, are excluded. Two of the cases died during the calendar year. 32 Report of the Medical Officer of Health for 1031. 35 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 nine 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. 26 cases were removed to hospital, compared with 20 in the non-epidemic year of 1929. One case requiring special home nursing was referred to a District Nursing Association in the Borough, compared with nine in 1929, and the nurse made five visits to this case, compared with 85 in 1929. The death-rate per 1,000 of the population was .005, compared with .002 in 1929, and .01 in 1927. 62 premises were disinfected at the request of the occupiers. 81 Report of the Medical Officer of Health for 1081. Table XVIII. shows the number of cases of infective diseases which occurred in the individual elementary schools during the year. TABLE XVIII. School. Diseases. Totals. Scarlet Fever. Diphtheria. Measles. German Measles* Chickenpox. Whooping 1 Cough. Mumps. Ringworm. Other Diseases i Clapham. Bonneville Road 0 0 2 o 63 11 2 25 113 Cavendish Road 5 10 2 24 6 2 1 50 Christchurch — — 4 24 _ 1 29 Clapham Parochial, Macaulay Rd. 3 1 — — — — — 4 Clapham Parochial, Old Town .. 3 0 0-i 1 13 5 o m 1 30 Haselrigge Road 0 3 2 59 25 — 95 Henry Thornton, South Side 1 — — 1 Larkhall Lane 10 1 29 3 32 29 3 27 134 New Park Road 9 1 1 2 8 — 1 27 New Road — 1 _ _ 1 St. Andrew's Street o 13 7 11 I _ 5 39 St. Mary's, Crescent Lane 4 2 — — _ — (1 St. Mary's, St. Alphonsus Road . . 1 1 — — — 9 mi Stonhouse Street 18 6 i 13 10 2 10 (10 Telferscot Road 13 2 17 23 1 1 57 Putney. All Saints' 2 1 3 2 8 Hotham Road 6 so 17 3 21 8 1 5 81 Huntingfield Road 24 1 05 o mi 3 95 Parochial, Roehampton 1 3 «> — — 6 St. Agnes, R.C. — 1 1 — 1 — — 3 St. Mary's 1 — — — 1 1 »> — »> 7 Upper Grade — — 1'5 1 — ——• 1(1 Balham. Broadwater Road 4 1 1 22 12 *> 11 53 Fircroft Road 7 1 2 1(1 1 27 Hearnville Road 1 4 34 J 13 4 — — — 57 Holy Trinity, Balham 7 — 7 — — — 14 Nightingale Square, R.C. 1 — — — o — — 3 Oldridge Road 0 8 45 — 28 1(1 — — 4 102 Ravenstone Street 8 4 — — (> 6 2 3 29 St. Mary's 4 — — 38 o 4d — —: — 44 Smallwood Road 17 0 3 1 8 37 4 — — 7(1 Carried forward 1 (14 70 143 20 385 315 58 0 102 1,2(19 Infective Diseases. 35 TABLE XVIII.—continued. School. Diseases. Totals. U 4-> <V <D > t! nj & o (/} .2 xi -4-» ft P w JU In 03 0) § {/) u 5 "c7> rt rt S <d <D o ■ d v J m * " S • rH CL -P u be .3 * ft o 2 $ co Oh B z S s v-f O £ b£) g S cn <L> co ct3 , ° U CD J^P -4-» o Brought forward 164 70 143 26 385 315 58 o 102 1,269 Streatham. Eardley Road 3 10 1 3 23 — — 2 42 Furzedown Demonstration — 1 3 7 9 19 1 — 4 44 Granton Road 5 4 — — 4 18 13 — 4 48 Hitherfield Road 7 — — — 51 7 1 — 2 68 Holy Trinity — 2 2 Immanuel 4 — — — 1 1 — — 1 7 Mitcham Lane 12 — 2 — 43 6 — l 4 68 New School, Leigham Court Road — 1 1 St. Andrew's, Coventry Hall — 1 — 26 2 — — 1 30 St. Leonard's — 5 — 7 1 — — — 13 Sunnyhill Road 7 5 — 1 18 — 19 — 3 53 Woodmansterne Road 3 4 — — 2 25 1 — 8 43 Tooting. Ensham Central 2 4 6 Ensham 7 1 — — 2 21 i — 4 36 Defoe (Fountain Road) 5 5 — — 46 28 — — — 84 Franciscan Road 7 2 1 — 21 7 — — 2 40 Hillbrook Road 6 5 1 — 50 22 i — 1 86 Sellincourt Road 2 8 — 1 6 41 4 i 4 67 Tooting Graveney 3 3 1 — 4 6 — — — 17 Undine Street, R.C. 3 4 7 Wandsworth. Allfarthing Lane 10 5 10 6 21 l 5 58 All Saints' 1 1 14 .— 37 11 — 3 67 Brandlehow Road 1 2 1 — 7 7 18 County 1 — — — — — — — 1 Earlsfield 3 5 5 1 . 20 16 6 2 .58 Elliott Central 2 — — 1 i 4 Eltringham Street 6 10 4 — 26 12 10 5 73 Frogmore Special 1 — — — 1 1 1 — 1 5 Garratt Lane 29 3 13 — 5 17 33 17 117 Magdalen Road 3 2 — 19 18 3 1 46 Merton Road 7 9 6 2 1 2 27 Riversdale 2 2 1 1 9 47 19 i — 82 Carried forward 306 172 196 37 808 677 193 ii 187 2,587 d 2 36 Report of the Medical Officer of Health for 1931. TABLE XVIII.—continued. School. Diseases. Totals. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Brought forward 306 172 196 37 808 677 193 11 187 2587 St. Ann's 2 2 1 4 9 St. Faith's 1 1 — — 5 2 10 3 22 St. Joseph's St. Michael's 5 3 2 16 3 1 6 1 13 5 1 — 1 27 30 St. Thomas's — 3 — — — — — — 3 Swaffield Road 11 2 — — 32 5 — 2 52 Waldron Road 4 7 3 3 29 29 1 — 76 Wandle 2 2 — — 25 9 17 8 63 Warple Way West Hill 1 14 5 2 — 1 2 38 14 13 1 1 1 23 70 Grand Total 346 201 218 48 954 755 223 11 206 2,962 Diarrhoea. The number of deaths from Diarrhoea was 27 compared with 33 in 1930, 35 in 1929, 40 in 1928 and 27 in 1927, and of these 24 or 88 per cent., were under the age of one year, compared with 30 in 1930. The number of deaths from Diarrhoea, Zymotic Enteritis and Enteritis under one year represents 10-4 per cent, of the total mortality at that age. Scabies- The names of 114 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 80 cases where consent was obtained, disinfection of the bedding and clothing of the patient was carried out by the disinfecting staff. Infective Diseases. 37 In addition to the above 81 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. 13 deaths occurred, six from Septicaemia, three from Syphilis, two from Pyaemia, and two from Tetanus. 38 NON-INFECTIVE IMSEASICS. The total number of deaths from Cancer and malignant disease was 575 the number of males being 269 and females 306. The corrected death-rate was 1.62 per 1,000 for the whole Borough:— 1.4 for Clapham; 1.64 for Putney; 1.79 for Balham; 1 *88 for Streatham; I-its for Tooting; and I -r>7 for Wandsworth. The number of deaths in l!)itl was it I more than in I!)!i0. The number of deaths from diseases of the Brain and Nervous System was 154. 1,107 deaths occurred from diseases of the Heart and Circulatory System, compared with I,()!)() in 1080, 1,277 in 1020. S7I of these deaths were of persons over 05 years of age. There were 102 deaths from diseases of the Respiratory System, compared with 120 in 1080, and 781 in 1020. The number from Bronchitis was 270 compared with 187 in 1080, and from Pneumonia (all forms) l!M compared with 207 in 1080. Further particulars relative to Pneumonia arc given on page 80. The number of infants under two years of age who died from these diseases was 55. 140 deaths, 92 males and 51 females, were registered as due to Premature Birth and Development Diseases, compared with 142 in 1080. 140 deaths, 08 males and 72 females, occurred from Old Age, and all these were persons over 05 years of age. The number of deaths due to this cause in 1080 was 118. 150 deaths were due to Violence, 11G of them being due to accident, and 48 to suicide. Inquests. Inquests were held on 201 persons dying in the Borough, and on 221 Borough residents who died outside the Borough. 39 Non-Infective Diseases. 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 40 31 41 25 27 49 213 Accidental:— Knocked down by motor vehicles 9 7 22 3 5 4 50 Falls from vehicles 2 3 8 2 6 6 27 Falls 1 1 2 2 8 3 17 Falls from a height 1 1 1 1 1 6 11 Suffocation 3 1 2 — 2 2 10 Burns and scalds 2 — 1 2 4 — 9 Deaths under anaesthetics 1 2 — — 1 1 5 Knocked down by train — — — 4 — 1 5 Drowning 2 3 — — — — 5 Knocked down by bicycles 1 — 1 — — 1 3 Other 1 1 — — — — 2 Suicidal:— Poisoning by :— Coal Gas 1 — 6 6 3 8 24 Carbolic Acid — 1 1 1 — 1 4 Lysol 1 — — 1 1 1 4 Cyanide of Potassium — — — 2 — — 2 Ammonia — — — — — 1 1 Hydrochloric Acid — — — — — 1 1 Hanging 3 — — 1 — 1 5 Gun shot wounds — — — 2 — 1 3 Knocked down by train — 1 — — 1 2 Drowning — 2 — — — — 2 Run over by motor vehicle — 1 — — — — 1 Cut throat — — — — — 1 1 Procured abortion — 1 — — — — 1 Found drowned — 5 — — — 1 6 Totals 68 60 86 52 58 90 414 40 TUBERCULOSIS. Notification.—The total number of new cases of Tuberculosis which came to the notice of the Department during 1931 was 613, as compared with 638 in 1980, 690 in 1929, 660 in 1928, 718 in 1927, 706 in 1926, 643 in 1925, 692 in 1924 and 597 in 1923. The sources of information regarding the 618 new cases notified in 1931 were as follows:— Primary notifications on Form A 512 Primary notifications on Form B Transfers from other Sanitary Authorities 101 Naval and military notifications Total 618 Un-notified at death 86 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 - - 7 1 — 1 1 4 1—5 — 1 9 4 — 1 2 3 5—10 4 3 7 8 — — 1 2 10—15 6 10 2 1 4 3 — — 15—20 21 33 3 7 16 19 2 2 20—25 45 52 2 5 16 20 — — 25—35 74 75 7 6 27 40 1 — 35—45 64 50 2 3 33 19 — — 45—55 31 18 2 2 36 12 — — 55—65 23 8 1 — 23 9 — — 65 upwards 5 6 1 4 2 7 — 1 Totals 273 256 43 41 157 131 7 12 41 Tuberculosis. 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 16 8 8 Glands, Mesenteric 7 3 4 Glands, Cervical 16 10 6 Bones and Joints 32 16 16 Skin 5 1 4 Other Parts 8 5 3 Totals 84 43 41 Table XXII. 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. It shows the number of cases reported, the number who died, removed or recovered, and the number remaining on the Notification Register at the end of each period, for both pulmonary and non-pulmonary forms of the disease. The figures for the first 25 years, from 1904-1928 are given in quinquennial periods, and those for each of the years 19291931 are shown separately. Patients classified as "recovered" are those who have shown no evidence of active disease for at least five years. 42 Report of the Medical Officer of Health for 1931. TABLE XXII. 1904 to 1928 in 5 year periods. 1929 1930 1931 Totals. 1904— 1908 1909— 1913 1914— 1918 1919— 1923 1924— 1928 Pulmonary Tuberculosis:— Cases reported 432 2830 2336 2769 2630 586 526 529 12638 Died 230 1091 1386 1030 1298 284 262 296 5877 Recovered 23 76 10 49 109 25 12 134 438 Removed or untraced 159 724 831 835 1525 137 105 198 4514 Remaining on Register 20 959 1068 1923 1621 1761 1908 1809 1809 Non-Pulmonary Tuberculosis:— Cases reported Not Notifiable. 323 791 745 695 104 112 84 2854 Died 46 382 198 208 25 20 31 910 Recovered — 41 46 91 17 18 61 274 Removed or untraced 9 116 319 493 46 21 64 1068 Remaining on register 268 520 702 605 621 674 602 602 Total on Notification register at end of each period 20 1227 1688 2625 2226 2387 2582 2411 2411 Tuberculosis. 43 Deaths.—The total number of deaths certified as due to diseases of a Tuberculous nature was 307—of whom 164 were males, and 143 females. Of the 307 deaths, 288 were due to Pulmonary Tuberculosis, 17 to Tuberculous Meningitis, one to Abdominal Tuberculosis and one to other forms of Tuberculosis. Table XXIII. gives details regarding the type of the disease, sex, and age grouping of these 307 deaths. In addition to these deaths, which were duly certified in the returns as due to Tuberculosis, 12 persons previously notified as suffering from Tuberculosis died during the year. These deaths, however, do not figure in Table XXIII. for the reason that:— (a.) Eight were certified as dying of diseases other than Tuberculosis. (b.) Four had previously moved outside the Borough and died there, the death being credited to the area in which it occurred. TABLE XXIII. Localisation. I Total. Males. Females. Pulmonary and Acute Miliary Tuberculosis 288 157 131 Brain 17 7 10 Glands, Mesenteric 1 — 1 Bones and Joints — — — Other Parts 1 — 1 Totals 307 104 143 The following Table gives figures for the last ten years showing both the number of deaths and the death-rate per 1,000 from Tuberculosis in the Borough. 44 Report of the Medical Officer of Health for 1981. TABLE XXIV. 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 Pulmonary Tuberculosis:— No. of Deaths 286 269 244 261 255 300 269 320 275 288 Death-Rate 85 .80 .71 .75 .73 .85 .76 .90 .77 .81 Other Forms:— No. of Deaths 57 50 50 49 40 39 35 33 33 19 Death-Rate .17 .14 .14 .15 .12 .11 .10 .09 .09 .05 Total:— No. of Deaths 343 319 294 310 295 339 304 353 308 307 Death-Rate 1.02 .94 .86 .90 .84 .96 .86 .99 .86 .86 Tuberculosis. 45 During the year 36 persons, not previously notified, were certified as having died of Tuberculosis. The ratio of un-notified Tuberculosis deaths to total Tuberculosis deaths is therefore 36 to 307. Of the 36 un-notified deaths, 18 were certified from Institutions, three by private doctors, while in six 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. 48 persons died within one month after notification, 120 within three months, and 218 within six months. 46 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 1931.—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. 162 10 172 117 262 551 F. 151 18 169 165 212 546 Children M. 3 11 14 19 206 239 F. 7 1 8 11 208 227 Totals 323 40 363 312 888 1563 In addition to the above, 59 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. 47 Tuberculosis Dispensaries. The districts of the Borough in which these 1,568 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 68 40 99 71 148 110 536 Private Practitioners 71 29 134 112 157 113 616 Charitable Societies 14 — 0 8 18 11 56 Other Dispensaries 25 9 11 18 21 28 112 L.C.C. Schools 2 2 1 — 5 12 22 Ministry of Pensions — — 2 2 — — 4 Existing Dispensary Patients — — — 2 6 4 12 Other Sources 18 23 3 31 53 77 205 Totals 198 103 255 244 408 355 1,563 Contacts.—Of the 1,568 new cases examined, 382 were contacts. 23 of these were found to be suffering from Tuberculosis. Dispensary Register.—Table XXVII. shows the number of cases remaining on the Dispensary Register at the end of the year compared with the number at the end of the previous year. TABLE XXVII. Tuberculosis Remaining 31st Dec., 19:0 New Cases Removed from Register Remaining on Register 31st Dec., 1931 Pulmonary 1116 323 324 1115 Non-Pulmonary 292 40 50 282 Suspected cases 57 312 332 37 Totals 1,465 675 706 1,434 48 Report of the Medical Officer of Health for 1981. 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 59 2, Number of patients transferred to other areas and cases "lost sight of" 181 3. Died during the year 203 4. Number of observation cases in which period of observation exceeded 2 months 41 5. Number of attendances at the dispensaries 4966 6. Total number of reports, etc., made in connection with the dispensaries 5155 7. Number of attendances at General Hospitals or Institutions of patients for:— (a.) Light treatment 277 (b.) Other special forms of treatment 591 8. Number of patients to whom Dental Treatment was given in connection with the Dispensary 28 9. Number of consultations with Medical Practitioners:— (a.) At homes of applicants 126 (b.) Otherwise 2536 10. Number of other visits by Tuberculosis Officers at homes 124 11. Number of visits by Health Visitors or Nurses to homes for dispensary purposes 5546 12. Number of:— (a.) Specimens of Sputum, etc., examined 2157 (b.) X-ray examinations made in connection with dispensary work 187 The number of patients who received institutional treatment under the London County Council's Tuberculosis Scheme during 1931 was as follows:— (a.) In Hospitals for observation 32 (b.) In Sanatoria 447 (c.) In Hospitals for Advanced Cases 5 Total 484 In addition to these many other patients received treatment in private or general hospitals. As in former years some difficulty was experienced in arranging for the institutional treatment of advanced cases. 49 Tuberculosis Dispensaries. Co-operation with other Institutions.—Cases requiring special investigation without their admission to Hospital, are referred to S. Thomas's Hospital in accordance with the scheme inauguratedin 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 hospitals have been continued. 54 cases were treated during the year and 654 refills administered. The Council's liability was £343 7s. 0d. 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 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. 25 patients received dental treatment and seven of these were supplied with dentures. The attendances at the dentist totalled 56. The amount expended on dental treatment during the year was £12 5s. 0d., and the cost of dentures supplied to patients was £17 7s. 6d., making a total cost of £29 12s. 6d. Extra Nourishment.—Under Section 3 of the Public Health (Prevention and Treatment of Disease) Act, 1913, extra nourishment is granted on medical grounds as part of treatment. It is limited to the slighter cases of disease, where there is a reasonable probability that extra nourishment will increase the chances of recovery, or will enable the patient to remain at e 50 Report of the Medical Officer of Health for 1931. work or to return to work at an early date. During the year under consideration 95 patients have been granted extra nourishment under the scheme at a cost of £127 17s. 0d. 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 Tables which follow 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 1931 as far as it is known. Table XXIX. refers to cases of Pulmonary Tuberculosis and Table XXX. to cases of Non-pulmonary Tuberculosis. 51 Tuberculosis Dispensaries. TABLE XXIX. Classification on Initial attendance at the Dispensaries. Condition at the end of 1931. 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. Adults, M. 383 36 80 197 696 1647 / 643 2290 Class T.B. Adults, F. 431 41 116 192 780 Minus. Children 113 11 20 27 171 Class T.B. Adults, M. 90 77 404 1301 1872 3274 854 4128 Adults, F. 65 45 271 981 1362 Plus. Children 6 3 11 20 40 E2 52 Report of the Medical Officer of Health for 1931 TABLE XXX. Classification on Initial attendance at the Dispensaries. Condition at end of 1931. Total cases where condition is known. Removed and lost sight of. Total cases who have attended. Discharged as cured. Disease arrested. Disease not arrested. Died. Non-Pulmonary Tuberculosis Bones and Joints Adults, M. 35 10 29 10 84 253 77 330 Adults, F. 14 8 24 8 54 Children 53 11 34 17 115 Abdominal Adults, M. 7 3 6 2 18 80 39 119 Adults, F. 6 6 7 1 20 Children 20 10 6 6 42 Peripheral Glands Adults, M. 12 3 7 3 25 326 100 426 Adults, F. 28 2 13 8 51 Children 180 18 42 10 250 Other Organs. Adults, M. 14 1 9 8 32 110 32 132 Adults, F. 14 3 17 6 40 Children 5 3 11 19 38 53 Tuberculosis Dispensaries. Bacteriological Examinations.—The number of examinations of sputum made at the Dispensary during the past five years is given here. 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. 1927 2087 1417 447 1928 1970 1457 470 1929 2068 1486 474 1930 1944 1254 447 1931 2157 1557 410 Tuberculosis Care Committee. Constitution.—The Committee consists of members representing the Borough Council and other authorities and organisations. There are also a few unattached members who are specially interested in the work. The following is a list of the members of the Committee :— Councillor T. Harding. Councillor Mrs. J. Dewar Robertson, M.B.E., J.P. Councillor Dr. J. Kirkland. Councillor W. Greener, F.C.R.A. Councillor H. H. S. Aram, F.I.M.T. Councillor A. A. Norman. Dr. E. E. Argles, L.C.C. Divisional Medical Officer. Miss E. Thomas, L.C.C. School Care Committee. Mr. E. C. Given, C.B.E., Public Assistance Committee. Miss E. Brown, Public Assistance Committee. Mr. T. H. Hunt, London Lnsurance Committee. Miss Clarke Hall, Invalid Children's Aid Association. Miss Connor, Soldiers, Sailors and Airmen's Association. Dr. G. Pollock, British Legion and United Services Fund. Miss Lemon, Ranyard Nurses. Mr. H. B. Harvey, Aged Poor Society. Miss L. C. Marx, Brompton Hospital. Miss E. C. Morris, S. Thomas's Hospital. Mr. L. M. Shepherd, J.P., Fairlight Hall, Tooting. 54 Report of the Medical Officer of Health for 1931. Mrs. Nicol. Miss J. M. Duff. Mrs. Halfhide. Dr. Elizabeth Higgins. Mrs. Jeans. Mrs. Cresswell. Mrs. Roberts. Mrs. Parsons. Mrs. Dixon. Miss Hill. Officers of the Committee.— Chairman : Councillor T. Harding. Vice-Chairman : Miss J. M. Duff. Secretary : Miss M. L. Baptie. Hon. Treasurer : Mrs. Nicol. Meetings.—The Care Committee meets at the Public Health Department, 79, East Hill, Wandsworth, every six weeks on Friday afternoon at 8.30 p.m. The Assessment Sub-Committee meets on alternate Friday afternoons at 2.30 p.m. Summary of the Work done.—Whilst a patient is undergoing Institutional treatment arrangements have to be made for the care of the children and from time to time mothers refuse to go to an Institution until they are satisfied that provision has been made for their children to be cared for properly. These arrangements are made by the Secretary of the Care Committee. An important duty of the Committee is to supply patients going to an Institution with additional clothing. Many of them are short of the clothing requirements of the Institution and it is frequently a difficult problem to get them properly fitted out in this respect. Much time is spent by Members of the Committee in collecting articles of clothing from their friends and a certain proportion of the funds of the Committee have to be expended in this direction. When a patient, previously a wage earner, has completed treatment he is sometimes fit to return to work and it is often a difficult matter to place these ex-patients. The previous occupation may be entirely unsuited for a person suffering from 55 Tuberculosis Dispensaries. tuberculosis and fresh and suitable employment has to be found. Assistance is also given to ex-patients to purchase tools and other stock in trade and occasionally an advance towards the purchase of a business is made by the Committee. Several men have been trained in a fresh occupation, such as that of motor driving. There are always a number of patients in an advanced stage of tuberculosis who are being nursed either at home or in S. James' Hospital, Balham. These cases are visited as often as possible by the Secretary or one of the Members of the Committee. Some of the cases which are being nursed at home are unable to obtain essential articles of medical equipment. 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. By permission of the authorities of S. James' Hospital regular visits are paid to Wandsworth residents suffering from tuberculosis who happen to be in the Hospital. 118 of these cases were visited regularly during the year. Many of these patients are in the Hospital for prolonged periods and the visits are much appreciated. When a patient is recommended for treatment in an Institution, the County Council, who arrange for that treatment require a contribution towards the cost if one is justified. For this purpose the full circumstances of the family have to be investigated by the Care Committee who have appointed a Sub-committee for this purpose. The amount of the contribution is assessed by the Sub-committee and a recommendation as to the amount is sent to the London County Council. It is found in many cases that patients are unable to make any contribution and the cases are then recommended for free treatment. During the year the Committee has undertaken the assessment of 411 patients, both adults and children, and has also undertaken the collection of the contributions. The amount collected and remitted to the London County Council was £653 15s. 0d. Soon after the Committee was established some twelve years ago it was apparent that the value of the work it could carry out would be increased materially if funds were available. No 56 Report of the Medical Officer of Health for 1931 grants from public funds were provided and certain members of the Committee therefore decided to organise a voluntary fund. A considerable amount of success has attended their efforts and a small fund has been established. This fund is not intended to assist families in their living expenses as other organisations arc available to grant assistance of this nature, but the money collectcd is utilised to help cases of tuberculosis in other ways. Assistance is given from this Fund to patients who are in need of convalescent treatment for which they arc unable to pay. Some patients are sent to convalescent homes while others are boarded out at private houses in the country. If a patient going to an Institution is unable to pay his railway fare the Committee help him in this respect. Aid is also given in special cases to assist in the payment of rent in order to tide over a period of distress. When it is found that the patient's illness is the cause of the nonpayment of rent the debt may be settled in order to enable the case to receive proper treatment. The amount paid on this account during the year was £18 11s. 0. Advances are also made to meet arrears in Insurance payments. As already mentioned a certain amount of clothing is purchased out of this Fund. Seven patients were granted convalescent treatment at the Hahnemann Home, Bournemouth, and at St. Michael's Home, Axbridge. The total cost of these seven cases was £39 3s. 0. All these cases were thoroughly investigated by the Secretary. As there is often difficulty in arranging for Institutional treatment under the London County Council's Scheme, for advanced cases who are too ill to be treated at home, one or more beds for cases of this type have been maintained at S. Columba's Hospital, Hampstead, from the voluntary fund raised by the Committee. During the year five patients were nursed at this Hospital for varying periods, at a total cost of £86 8s. 8d. All of them were very grateful for the care and attention they received there. Unfortunately S. Columba's Hospital had to be closed during a portion of the year owing to lack of funds. The Committee has collectcd several beds and a small quantity of bedding which is loaned to patients requiring them, especially when one of the Council's shelters is being used. 57 Tuberculosis Dispensaries. In 1931 486 cases were visited and interviewed by the Secretary. 65 cases were referred to and helped by the various exservice organisations. About 30 per cent. of the cases sent to Institutions were supplied with clothing, either from the stock collected by the Committee or purchased out of the voluntary fund. The amount spent on clothing was £11 18s. 2d. The Committee arranged for the boarding out of five children in order to enable their parents to enter an Institution. The Secretary is able to assist and advise patients in regard to their Health and Unemployment Insurance. In several cases where benefit was not payable because the contributions were in arrears assistance was granted from the voluntary fund. The patients were thus enabled to draw benefit. Handicraft Class.—Several years ago the Committee organised a Handicraft Class where persons suffering from tuberculosis, who have already received Institutional treatment, are able to to learn certain branches of handicraft and to make articles which they can sell. The value of handicraft in the treatment of tuberculosis has been recognised for a considerable time as it enables patients to do something useful and gives them an occupation when they are unable to enter the ordinary labour market. The Handicraft Class is maintained by the Committee's fund. It meets at 79, East Hill, Wandsworth, every Tuesday morning 10.30 to 12.30 and is in charge of Miss Fone who is a trained Instructress in the crafts taught. These are leather, pewter and parchment work, embroidery and the making of fancy stools. After deducting the cost of material the profit on a particular article made at the Class goes to the patient who has made it. The class is much appreciated by the patients, who attend as regularly as their health will allow. The attendances at the Handicraft Class during 1931 increased considerably over those of previous years. A successful sale of work was held in April at the Carpenter's Hall, under the auspices of the Standing Conference of Metropolitan Boroughs' Tuberculosis Care Committees. 58 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 by notification or from the Registrar of Births and Deaths, and re-visits are made before the end of the first year and up to school age. 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 Centres, 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. The re-visits of infants attending the Infant Welfare Centres are carried out by the Superintendents of the Centres. In six of the twelve Centres in the Borough the Superintendents are appointed by the Committees of the Centres and the re-visits of infants attending these Centres are made by them. In each of the other six Centres, one of the Health Visitors is now acting as Superintendent in accordance with the Council's decision made in 1927 to replace Superintendents appointed by the Centre Committees with Health Visitors as vacancies occur. All the re-visits in these six districts are therefore carried out by the Health Visitors, whether the infants are attending the Centres or not. The six Centres where one of the Health Visitors is the Superintendent are Fairlight Hall, Tooting ; Lynwood Road, Springfield, Fairfield, Streatham Hill and Putney. In one of these, namely, Putney, the appointment of a Health Visitor as Super- 59 Maternity and Child Welfare. intendent was made during 1931 on the resignation of the Officer appointed by the Centre Committee. In the other five Centres Health Visitors were appointed as Superintendents in previous years. At those Centres where the Superintendent is the officer of the Centre Committee, one of the Health Visitors assists her at all Infant Welfare and Ante-Natal sessions. Where the Superintendent is one of the Health Visitors she is assisted at the sessions by another Health Visitor. 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 the General and Lying-in Hospitals. Home visits are also made for investigating applications for milk under the Milk (Mothers and Children) Order, and in connection with Convalescent and Dental treatment. Visits are also made to see if homes are suitable for children to return to after minor operations at general hospitals. Periodical visits are also made to Creches and Institutions for unmarried mothers and their children. Table XXXI. summaries the work of the Health Visitors during the year in the six divisions of the Borough. 60 Report of the Medical Officer of Health for 1931. TABLE XXXI. Clapham. Putney. Balham. Streatham. j Tooting. Wandsworth. Whole Borough. No. of children visited :— Under 1 year 663 358 521 852 613 1038 4045 1-2 years 14 11 48 185 9 15 282 2-5 years 12 35 49 199 38 19 352 Revisits to :— Infants under 1 year 538 274 483 433 667 1475 3870 Children 1-2 years 379 190 283 222 640 1072 2786 Children 2-5 years 474 286 343 284 935 1798 4120 Total visits to children under Notification of Births Act 2080 1154 1727 2175 2902 5417 15455 Other visits—: Ophthalmia Neonatorum 10 3 5 21 3 6 48 Measles 30 66 55 10 29 147 337 Whooping Cough 257 104 175 240 472 638 1886 Ante-natal cases 283 117 221 187 227 344 1379 Puerperal Fever and Pyrexia 6 — 3 10 12 17 48 Miscellaneous 96 52 141 129 154 268 840 Ineffectual 877 405 443 764 911 1785 5185 Total Home Visits 3639 1901 2770 3536 4710 8622 25178 Attendances at:— Infant Welfare Centres 174 147 162 213 275 418 1389 Ante-natal Centres 26 24 34 40 28 57 209 Committee Meetings 3 17 — 1 22 5 48 Health Talks 21 75 58 97 83 136 470 Visits to Creches — 11 15 — 28 23 77 61 Maternity and Child Welfare. Infant Visiting. There were 4,334 births during the year and 4,040 of these, or 90.9 per cent., were visited compared with.84.1 in 1930, 84.1 in 1929, 85 in 1928, 82.7 in 1927, and 81.7 in 1926. 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 3,427 of the 4,040 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 2143 979 223 82 3427 Otherwise fed 159 258 98 98 613 Method of Feeding. Age of infant on subsequent visit. Under 1 month. 1—3 months. 3—6 months. 6—12 months. Total. Breast-fed 144 558 696 465 1863 Otherwise fed 52 234 537 1257 2080 It was found that in 1,047 of the births, doctors had been in attendance, while in 1,653 the services of midwives had been utilised. 1,340 infants were born in hospitals and other institutions. 62 Report of the Medical Officer of Health for 1931. 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 34 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. 226 cases were visited during the year under these arrangements, and 3,250 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 1936 21 126 Influenza — 45 49!) Pneumonia 555 125 2140 Ophthalmia Neonatorum 41 34 480 Measles 291 1 5 Puerperal Fever and Puerperal Pyrexia 40 — — Total 2863 226 3250 The number of visits made by nurses in 1930 was 4,892 and the decrease is due to the decrease in the number of cases of Measles and Ophthalmia Neonatorum. 63 Maternity and Child Welfare. Maternity and Child Welfare Centres. There are now 12 Infant Welfare Centres in the Borough. They are voluntary institutions administered by the Committees of the Centres who work in close co-operation with the Maternity and Child Welfare Committee of the Council. The Council pay 75 per cent. of the approved expenditure of each Centre. 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. As already mentioned one of the Council's Health Visitors now acts as Superintendent in six of the Centres. 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 following is a list of the Welfare Centres in the Borough together with the hours at which the clinics are held :— 64 Report of the Medical Officer of Health for 1931. Infant Welfare Centre. Clinics. Ante-natal. Infants. Clapham : 1st and 3rd Mondays in each month at 2 p.m. Tuesdays and Wednesdays, at 2 p.m. Clapham DispensaryManor Street. Putney: 1st and 3rd Wednesdays in each month at 10.30 a.m. Wednesdays and Thursdays at 2 p.m. 2, Clarendon Road. Putney Park : None. Alternate Fridays at 2 p.m. Putney Park House, Dover House Rd. Balham : 1st and 3rd Fridays in each month at 9.45 a.m. Tuesdays, Wednesdays and Thursdays at 1.45 p.m. 91, Bedford Hill. Streatham : 1st and 3rd Wednesdays in each month at 10 a.m. Tuesdays at 1.30 p.m. Fridays at 2 p.m. 37, Riggindale Road. Wesley Hall, Blegborough Road. None. Thursdays at 2 p.m. Streatham Hill with Clapham Park : None. Tuesdays at 10 a.m. Baptist Church Hall, New Park Road. Tooting : 2nd Wednesday in each month at 10.30 a.m. Wednesdays and Thursdays at 2 p.m. Fairlight Hall, Fairlight Road. Church Hall, Lynwood Road. 4th Wednesday at 10.30 a.m. Thursdays at 10.15 a.m. Southfield : 1st Friday in each month at 10 a.m. Tuesdays and Fridays at 2 p.m. St. Michael's Institute, Merton Road. Fairfield : 1st Monday in each month at 2 p.m. Wednesdays and Thursdays at 2 p.m. St. Faith's Mission Hall, Warple Way. Springfield : 4th Tuesday in each month at 11 a.m. Tuesdays at 2 p.m. Church Hall, Earlsfield Road. 65 Maternity and Child Welfare. Table XXXIV. gives the full details of the work carried out at the 12 Centres in the Borough. 2,989 new infants were examined during the year and the total attendances were 58,311. There were 782 ante-natal cases and the total attendances made by them was 1,992. The visits made by the Superintendents of the six Centres where those officers are appointed by the Centre Committees were 7,986 to the homes of infants and 1,148 to ante-natal cases. No visits are shown in this Table for the other six centres, where the Superintendents are Health Visitors, as their visits are included in Table XXXI. which shews all the work carried out by the Health Visitors. F 66 Report of the Medical Officer of Health for 1931. TABLE XXXIV. Clapham. Putney. Putney Park. Balham. Streatham. Blegborough Road. Streatham Hill (Clapham Park) Tooting. Southfield. Fairfield. Springfield. Totals. Fairlight Lynwood Road New Cases, 1931 462 223 48 502 324 112 184 245 132 221 283 253 2989 Total Attendances 7960 6350 1396 10955 5792 2033 2736 5173 3011 3900 4780 4225 58311 Ante-natal Cases 94 83 — 190 137 — — 56 54 74 49 45 782 Ante-natal Attendances 328 190 — 465 325 — — 162 108 202 100 112 1992 Supts.' Visits to Infants 1350 621 685 1707 1935 — — — — 1688 — — 7986 Supts.' Visits to Ante-natal Cases 226 156 76 255 206 — — — — 229 — — 1148 No. of Sessions :— Infants 96 100 50 100 95 48 50 91 47 100 102 49 928 Ante-natal 24 21 — 34 34 — — 15 12 23 12 21 196 Health Talks given 26 111 20 86 97 — — 63 20 42 53 36 554 67 Maternity and Child Welfare Borough of Wandsworth War Memorial Maternity Home. The Maternity Home which is situated in Grove Road, Balham. adjoining the Weir Hospital, was erected by the Council in place of the previous Home at Park Hill, Upper Tooting, which has been demolished. The new Home was opened on the 1st October, 1931. It provides accommodation for 20 patients, with two isolation beds. The Staff consists of a Resident Medical Officer, two Sisters, ten Nurses and nine domestics. The nursing and domestic staff are under the supervision of the Matron of the Weir Hospital, and the administrative work of the Home is carried out by the Secretary and Assistant Secretary of the Hospital. Arrangements have been made with the Weir Hospital, which adjoins the Home, to manage it on behalf of the Borough Council. The Home is well equipped and includes all the latest requirements for an institution of this nature. Applicants for admission to the Maternity Home are required to pay a fee for their confinement and are expected to remain in the Home for 14 days. A scale of fees has been approved by the Council and the assessment made varies with the income of the family. Between the opening of the Home in October and the end of the year 32 patients were admitted for confinement. 31 of these cases were delivered. Two maternal deaths occurred, one being a case of Eclampsia who died undelivered shortly after admission. The other death was due to Pulmonary Embolism. One case of still-birth occurred and two infants died shortly after birth. Day Nurseries. The addresses of the four Day Nurseries in the Borough are as follows :— Putney Putney Creche, 95, Lacy Road. Tooting Fairlight Hall Day Nursery, Fairlight Road. Wandsworth Wandsworth Day Nursery and Training School, 14, Garratt Lane. Balham Balham Day Nursery, 22, Old Devonshire Road. F 2 68 Report of the Medical Officer of Health for 1931. 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 (id. to Is. per day for one child, a reduction being made when more than one child from the same family is admitted, or when a child is admitted for half a day only. The Putney, Wandsworth and Balham Day Nurseries are also training schools for nurses who intend to take up creche work. They are admitted as probationers and remain for about a year, receiving practical and theoretical training. The matrons give courses of lectures, which the probationers are bound to attend, and an examination is held at the end of the course. The attendances were:—Putney, 4,919; Balham, 5843; Tooting, 5,754; and Wandsworth, 6,608; a total of 28,124. compared with 28,157 in 1980. 77 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 of Matron, a Sister, two Assistant Nurses and three Proba turners. A Visiting Medical Officer attends daily. The parents pay 10s. 6d. per week for their children, but necessitous cases are admitted free, or at a reduced fee, according to circumstances. Medical practitioners can recommend cases for admission and attend them while in the Hospital. 89 infants were admitted in 1931, 35 from addresses in the Borough, and 54 from outside the Borough. Most of the cases were infants, suffering from Marasmus, Debility, and Respiratory Diseases. During the year £27 11s. 3d. was paid to SS. Peter and Paul Home, Clapham, for treatment in respect of eight Borough residents maintained in the Home. 69 Maternity and Child Welfare. 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 1931, 18 cases were maintained by the Council at a cost of £144 8s. 11d. The Council also made a grant not exceeding £40 a year to the Mission of Hope, and one case was dealt with, the cost of which amounted to £7. 12s. Convalescent Homes. During the year seven mothers were sent to Convalescent Homes, with their infants. Nine other children were also sent. Both mothers and children derived much benefit from the change of air. Wandsworth and Tooting Children's Clinic. This Clinic which was opened by Her Royal Highness Princess Mary on the 22nd June, 1931, was established for providing artificial sunlight, massage and electrical treatment for children of all ages. 318 children have been treated during the year and they have made 9,031 attendances. 145 of these children were under the age of five years and most of these cases received artificial sunlight treatment. The Council pays a grant towards the expenses of this Clinic. 70 Report of the Medical Officer of Health for 1931. Supply of Milk. During the year 1,002 families were supplied with milk under the Milk (Mothers and Children) Order, 1918; 216 in Clapham; 64 in Putney; 165 in Balham; 81 in Streatham; 151 in Tooting; 69 in Southfield; 150 in Fairfield; and 106 in Springfield. The total cost to the Council was £2,420 18s. 11d. 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, such as a case of infectious disease in the home. 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 of the infants. Dental Treatment. The teeth of mothers and children attending the Welfare Centres are examined as a routine by the Medical Officers at the Centres. The Council has also arranged for periodical dental inspections to be carried out at the Centres by dental practitioners. These inspections are made at intervals of three or six months. The dental treatment is carried out by the British Dental Hospital and by the six dental practitioners who carry out the dental inspections. Treatment is available for all expectant and nursing mothers for whom dentures can be provided and for children under five years of age. Where a denture is required the patient is assessed in accordance with a scale approved by the Council. 325 cases came under treatment during the year—of whom 251 were expectant and nursing mothers and 74 were children. 71 HOUSING. Housing Conditions in the Borough of Wandsworth. 1. General Observations as to Housing Conditions. The standard of houses in the Borough varies very much. No details are available showing the proportion of the different types and in the following statement the figures given are only approximate and cannot be substantiated. Some 20 per cent. of the houses in the Borough are of the superior residential type and about 30 per cent. are of the residential middle class type occupied by their owners. There are a number of houses built in terraces, some of them self-contained flats, which were built by private enterprise for the artisan class between 20 and 50 years ago. The proportion of these is probably in the neighbourhood of 15 per cent. Some of the houses now occupied by the working classes are large ones varying from 50 to 80 years old which were built as the residential type and have degenerated in standard. These form about 15 percent. 12 per cent. of the houses are cottage property between 50 to 100 years old occupied by the working classes. 7 per cent. are cottage property 80 to 100 years old, some of which can be kept in condition for a number of years. About 1 per cent. is old insanitary property not suitable for re-conditioning. 2. Sufficiency of Supply of Houses. Extent of Shortage. There is a shortage of housing accommodation at a reasonable rental. There are only a few houses available at a rental under 12s. 6d. per week and there are many families which cannot pay a rent higher than this amount. The 72 Report of the Medical Officer of Health for 1931. proportion of families affected by this shortage may he as high as 10 per cent. No important changes in the population have occurred during the period under review. There is a difficulty in obtaining suitable sites for the erection of houses as most of the land in the Borough has now been built on. The high price of land accentuates the difficulty. 3. Overcrowding. (a.) Extent of Overcrowding. It is impossible to give an accurate estimate of the amount of overcrowding which exists owing to lack of complete information. Only a proportion of the cases are known. It is possible that 5 per cent. of the families in the Borough are living in accommodation which is insufficient having regard to the number of persons in the family and their ages and sexes. (b.) Causes of Overcrowding. This appears to be due mainly to inability to pay the rent for other accommodation and to the shortage of houses for those who are unable to afford more than 12s. (id. per week. (c.) Special Action to deal with Overcrowding. From time to time cases of overcrowding are accommodated in one of the Borough Council's houses. Facilities are also given by the London County Council for housing certain overcrowded families who are specially recommended by the Borough Council. A number of cases of overcrowding were dealt with during 1981 under these arrangements. 4. Fitness of Houses. (a.) In some cases difficulties arise in keeping houses in habitable condition under the Public Health or Housing Acts. Some owners are quite willing to carry out work after notice but require a long time to complete it. Cases of this 73 Housing. nature require much supervision. In some houses damage is done by the action of unsatisfactory tenants and this then leads to difficulties in getting essential work carried out. It is sometimes difficult to keep overcrowded houses in good condition as the wear and tear is greater. A systematic supervision of the houses occupied by the working classes is carried out by means of house-to-house inspection. Many defects are discovered by this means and the conditions remedied. (c.) Water Supply. In most of the houses in the Borough the water supply is in the house and in only a small number is it situated in the open air. About 98 per cent. have an independent supply. (d.) Sanitary Accommodation. All the houses in the Borough have water closet accommodation. In about 2 per cent. of them this accommodation is common to some other house. 5. Bye-laws. The existing Bye-laws relating to houses let in lodgings are adequate in most respects, but there are not sufficient powers for dealing with dirty or unsatisfactory tenants. Housing Act, 1930—Unhealthy Areas. During the past year a definite start has been made in the direction of clearing some of the insanitary areas in the Borough. I have made representations under Section 1 of the Housing Act, 1930, in respect of thirteen areas in the Borough to the effect that the houses therein were either unfit for human habitation or were dangerous to the health of the inhabitants in the areas and that the most satisfactory method of dealing with the conditions was the demolition of all the houses. Three of these representations were made in 1930 and ten in the year now under review. All these thirteen areas have now been declared as Clearance Areas by the Council. 74 Report of the Medical Officer of Health for 1931. Compulsory Purchase Orders were made for the whole of one area and a portion of another, as the Council's intention is to use the sites for re-housing purposes. The former has been confirmed by the Minister but in the latter case the Minister was unable to confirm the Order. Clearance Orders have been made in respect of the other eleven areas. Eight were confirmed by the Minister without Inquiry as no objections were lodged. One of these was withdrawn as the Council acquired the property. In the remaining two cases Public Inquiries have been held on the Clearance Orders but the Minister of Health's decision has not yet been received. If this decision is favourable the number of houses to be demolished in the thirteen areas is 123. The Council is required by law to accommodate the families living in these houses and provision for this has been made in the programme. The number of families to be accommodated is 121, consisting of 516 persons. The names of the areas and the date on which each was declared a Clearance Area by the Council are given in Table XXXV. which also shews the number of houses to be demolished and the number of families and persons residing in each area. TABLE XXXV. Area Represented. Date declared Clearance Area. Number of Houses Families Persons Cumber's Yard, Wandsworth 27-1-1931 15 17 55 Garden Cottages, Wandsworth 27-1-1931 4 3 9 North Street, Clapham 27-1-1931 27 31 145 Angel Court, Roehampton 5-5-1931 5 5 26 Henry's Place, Putney 5-5-1931 4 2 11 Memel Place, Putney 5-5-1931 3 3 18 Dutch Yard, Wandsworth 5-5-1931 18 18 84 Stockwell Court, Wandsworth 5-5-1931 7 7 31 Carters Yard, Wandsworth 5-5-1931 3 2 11 Eden Cottages, Wandsworth 5-5-1931 8 6 12 West Side of Warple Road, Wandsworth 5-5-1931 6 4 19 East Side of Warple Road, Wandsworth 5-5-1931 3 3 11 Great Acre Court, Clapham 5-5-1931 20 20 84 Total 123 121 516 Housing. 75 Cumbers Yard and Garden Cottages Area.— These two areas are situated close together and form part of a larger area which the Council decided to deal with in 1929 by means of an Improvement Scheme under the Housing Act, 1925. Since that date there has been an alteration in the law and this has necessitated a modification of the original scheme. The two areas are separated by a narrow strip of land which was acquired by the Council by negotiation. As it has been decided to utilise the land comprised in these two areas for the re-housing of occupants from other insanitary areas in the Borough the acquisition of this strip of land enables the Council to develop the two areas as one. When the Cumbers Yard Area was declared to be a Clearance Area there were twenty-seven houses included in it consisting of 1 to 6, Cumbers Yard, 26, 28 and 50, Putney Bridge Road, 2, 4, 6, 8, 10 and 12, Frogmore, and 1 to 12, Martin's Buildings. Fifteen of the houses were purchased by the Council by negotiation, but the owner of 1 to 12, Martin's Buildings, appealed against the Compulsory Purchase Order, which was made in respect of this portion of the area, and after holding a Public Inquiry the Minister of Health intimated that he was unable to confirm the Order. As a result of this decision these twelve houses have been excluded from the area which now consists of fifteen houses as shown in the Table. Garden Cottages Area consisted of 1 and 2, Garden Cottages and 1 and 2, Marters Cottages. Re-housing accommodation for the occupiers of these two areas has been provided in flats erected by the Council in Merton Road and Acuba Street. With one exception all the families have removed and 18 of the 19 houses in the two areas have now been demolished. North Street Area.— This area was a particularly bad one. It consisted of twenty-seven houses crowded on to a small piece of land less than half an acre in extent. All the houses are old, unhealthy and beyond repair. As a result of my representation on this area in October, 1930, the Council declared it a Clearance Area in 1931. 76 Report of the Medical Officer of Health for 1931. As it is proposed to develop the site for re-housing purposes the Council made a Compulsory Purchase Order which was the subject of a Public Inquiry held by the Minister of Health on the 13th May. The Minister confirmed the Order and negotiations are now proceeding for the acquisition of the property. Angel Court Area.— This are consists of 1, 2 and 3, Angel Court and 7 and 9, High Street, Roehampton, which are built round a small Court. These five houses are all unfit for habitation and are structurally unsound. A Clearance Order has been made in respect of the area and this has been confirmed by the Minister without Inquiry. The five houses are now vacated. Henry's Place Area.— This area consisted of 1, 2, 3 and 4, Henry's Place, and were four old houses leading out a cul-desac. The Clearance Order made in respect of the area was confirmed by the Minister without Inquiry and the houses have now been demolished by the owner. Memel Place Area.— This area consists of three old houses adjoining Henry's Place. A Clearance Order has been made and confirmed by the Minister without Inquiry. Two of the houses have been vacated. Dutch Yard Area.— This area consists of eighteen houses including 3, 4, 5, 6 and 7, Dutch Yard, 1 to 5, Red Lion Square, and 1 to 8, Garden Place, built round an irregular Court off High Street, Wandsworth. A Clearance Order has been made and the Minister has held a Public Inquiry on the Order but he has not yet intimated his decision. Stockwell Court Area.— This area consists of seven houses, known as 1 to 7, Stockwell Court, which are situated in a narrow alleyway leading out of High Street Wandsworth. A Clearance Order made by the Council for this area was confirmed by the Minister without Inquiry. Four of the houses have been demolished. Carter's Yard Area.— This area consists of three houses known as 1, 2 and 3, Carter's Yard, which is a passageway leading out of High Street, Wandsworth. A Clearance Order made by the Housing. 77 Council for this area was confirmed by the Minister without Inquiry. The three houses are now vacated. Eden Cottages Area.— This area consists of eight old cottages known as 1 to 8, Eden Cottages, built on a low lying piece of land on the bank of a loop of the River Wandle. The Clearance Order made for this area was confirmed by the Minister without Inquiry. West Side of Warple Road Area.— These houses are known as 1, 3, 5, 7, 9 and 11, Warple Road. The Council made a Clearance Order for the area which has been confirmed by the Minister without Inquiry. East Side of Warple Road Area.— The houses included •n this area are known as 2, 4 and 6, Warple Road, on the opposite side of the road to the previous area. The Clearance Order made for this property was confirmed by the Minister without Inquiry. Great Acre Court Area.— This area consists of twenty houses known as 1 to 16, Great Acre Court, 1a, 57 and 59, St. Alphonsus Road and 7, Acre Square. A Clearance Order has been made by the Council and this Order was the subject of a Public Inquiry held by the Minister in the latter part of the year. The Minister's decision on this Inquiry has not yet been given. Demolition Order. In consequence of a Representation made by me the Council made a Demolition Order in respect of 68a, Clifton Street, Clapham, which is a small 2-roomed house built in the back yard of another house. The family in occupation, consisting of four persons, have been accommodated by the Council. I also made a Representation recommending the demolition of 472 and 474, Streatham High Road, which are two old and unsound houses which are unfit for habitation. The houses have been vacated, and as the owner stated that he has no intention of re-letting but proposed to demolish them, no Order has been made. 78 Report of the Medical Officer of Health for 1931. Closing Order. Representations were made by me during the year in respect of a basement flat at 89b, Hopton Road, Streatham, and a suite of attic rooms at 62, Allfarthing Lane, Wandsworth. The Council made Closing Orders in respect of this basement and attic and have provided alternative accommodation for the occupiers. 79 SANITARY INSPECTION OF THE BOROUGH. Work of the Sanitary Inspectors. Table XXXVI. gives full details of the inspections carried out by the Sanitary Inspectors. TABLE XXXVI. Inspections. ReIn spections. Total. To investigate complaints 5651 20139 25790 House-to-House inspections 2731 12754 15485 Infective Diseases :— Notifiable diseases 2411 1012 3423 Measles 9 12 21 Whooping Cough 29 — 29 Other infective diseases 631 250 881 Verminous conditions 250 106 356 Offensive Trades No. of Premises 2 7 - 7 Piggeries 9 21 2 23 Factories, workshops, etc. 1886 1703 6 1709 Houses let in lodgings 267 125 506 631 Rag and bone stores 14 64 - 64 Sanitary conveniences 177 1232 5 1237 Mews and stables 133 1090 23 1113 Other inspections 7683 383 8066 Total 23,637 35,198 58,835 Smoke observations 72 - 72 Legal proceedings, Attendances at Court 13 — 13 80 Report of the Medical Officer of Health for 1931. Table XXXVII. gives a summary of the sanitary operations carried out in the Borough during the year. The number of drains which were tested was 1,216, and of these 839 were found to be in a defective condition. The drains of 49 houses were re-constructed. Damp conditions have been remedied in 1,214 premises, and in 146 of these damp courses were inserted. 31 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 127 cases of overcrowding were abated. 38 of these cases were accommodated in London County Council houses, and 89 elsewhere. Sanitary Inspection of the Borough. 81 TABLE XXXVII. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 1. Premises cleansed and repaired 593 313 523 350 736 943 3461 2. Drains tested 215 54 202 231 113 401 1216 3. Drains cleansed or repaired 126 28 107 105 209 264 839 4. Water closets cleansed or repaired 276 119 185 129 291 425 1425 5. Soil pipes repaired 26 14 20 15 21 84 180 6. Waste pipes altered or repaired 83 50 41 20 28 276 498 7. Rainwater pipes repaired 59 18 28 21 38 111 275 8. Roofs and gutters repaired 236 124 217 97 272 454 1400 9. Damp courses inserted 11 23 8 38 2 64 146 10. Damp conditions otherwise remedied 112 121 142 148 159 386 1068 11. Yards drained or paved 77 22 75 48 169 175 566 12. Dust bins provided or repaired 184 74 106 122 150 238 874 13. Water cisterns cleansed, covered or repaired 10 79 7 10 73 37 216 14. Water supply reinstated 12 6 7 6 6 9 46 15. Defective fireplaces remedied 47 29 62 37 132 243 550 16. Defective coppers remedied 48 10 26 15 81 123 303 17. Cases of overcrowding abated 28 8 25 3 26 37 127 18. Stables and stable yards drained or paved - - 1 1 - 1 3 19. Accumulations of manure, etc., removed 16 2 8 14 22 19 81 20. Urinals cleansed or repaired - - 1 3 13 1 18 21. Animals improperly kept 2 - 4 6 5 4 21 22. Smoke nuisances 2 — 5 — - 57 64 23. Other nuisances 115 45 123 85 187 207 762 Total 2281 1139 1923 1504 2733 4559 14,139 No. of preliminary notices served 859 481 740 599 827 1432 4938 No. of preliminary notices complied with without the service of statutory notices 767 439 825 540 1085 1256 4912 No. of statutory notices served 93 17 31 45 166 154 506 No. of statutory notices complied with .. 90 15 53 44 234 185 621 G 82 Report of the Medical Officer of Health for 1981 Underground Rooms. There are 55 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 XXXVIII. 2,731 inspections were made compared with 2,957 in 1930, 1,515 in 1929, and 989 in 1928, and nuisances necessitating the service of sanitary notices were found in 2,142 of the houses. TABLE XXXVIII. 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 199 195 56 92 71 123 Clapham South 124 111 20 27 32 83 Putney 464 310 27 60 213 292 Balham 647 521 33 105 454 386 Streatham 323 191 33 70 111 233 Tooting 445 380 27 55 132 327 Southfield 90 59 9 16 84 37 Fairfield 202 196 33 52 148 71 Springfield 237 179 18 48 152 130 Whole Borough 2,731 2,142 261 523 1397 1682 Rent and Mortgage Interest Restrictions Act, 1923. 39 applications for Certificates were received during the year. On inspection it was found that all the premises except two were not reasonably fit for human habitation. Three of them were put in a reasonable state of repair before the meeting of the Committee at which the Certificate would have been granted, and one application for a certificate was withdrawn. Of the 33 premises in respect of which Certificates were granted, one tenant removed, and 32 were rendered reasonably fit during the year. 83 FACTORIES AND WORKSHOPS. The number of factories, workshops, workplaces, and home workers' pre-nises is shown in Table XXXIX. together with the number of inspections made. The inspection of food premises are not included in this Table, but are shown in Table XLIII. TABLE XXXIX. Class of Works. Number of Places on Register at end of 1931. Number of Inspections, 1931. Number of Notices, 1931. Number of Prosecutions, 1931. Factories :— Factory Laundries 55 76 7 — Factory Bakehouses 80 243 1 — Other Factories 459 432 13 — Total 594 751 21 — Workshops :— Workshop Laundries 31 34 1 — Workshop Bakehouses 51 184 — — Other Workshops 735 691 10 — Total 817 GOD 11 — Workplaces 159 124 4 — Total : Factories, Workshops and Workplaces 1,570 1,784 36 — Home-workers' premises 447 352 10 — Grand Total 2,017 2,136 46 — Further details with regard to homeworkers' premises are given in Table XL. g2 84 Report of the Medical Officer of Health for 1981. TABLE XL. 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. 36 25 156 33 12 10 27 (2.) Cleaning and washing 1 4 3 — — — — Paper bags and boxes 4 — 9 — — — — Totals 41 20 168 33 12 10 27 The total number of addresses received from other Councils was 489, and 111 addresses were forwarded to other Councils. The number of addresses received has decreased by 46 and the number sent decreased by 20. 20 names and addresses were forwarded to this Borough in error. The number of notices sent to employers during the year was 33, and these had a most satisfactory result. During the year '27 cases of infective diseases— three of Diphtheria, five of Scarlet Fever four of Pneumonia, and 15 of Whooping Cough—were notified as having occurred in the homes of out-workers. In none of these cases was it necessary to make any order under Section 110 of the Factory and Workshop Act. Factories and Workshops. 85 TABLE XLT. DETAILS WITH REGARD TO REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. Workshop Bakehouses 51 Workshop Laundries 31 Dressmakers' and Milliners' Workshops 161 Bootmakers 101 Smiths and Engineers 37 Builders 56 Tailors 68 Motor Engineers 53 Upholsterers 39 Hairdressers 31 Other 189 Total number of workshops on Register 817 TABLE XLII. 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 52 41 - - Want of ventilation — — - - Overcrowding — — - - Want of drainage of floors — — - - Other Nuisances 11 10 - - Sanitary accommodation : Insufficient 1 1 - - Unsuitable or defective 50 39 - - Not separate for sexes 1 1 - - Offences under the Factory and Workshop Acts :— Illegal occupation of underground bakehouses (s. 101) - - - - Other offences — — - - (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921) Total 115 92 - - * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 86 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 attention is given to markets and stalls, and frequent visits are made to these presmises in the evening and during week-ends. The five slaughterhouses are visited 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 XLIII. Premises. Number of Places on the Register at end of 1931. Number of inspections, 1931. Number of Notices, 1931. Number of prosecutions 1931. Dairies, milkshops and cowsheds 346 698 - - Restaurant kitchens 326 241 4 — Ice Cream premises 512 11 — — Slaughterhouses 5 799 — — Butchers' shops 244 906 4 — Greengrocers' shops 339 335 3 — Fishmongers' shops 153 188 4 — Fried fish shops 86 93 — — Markets and stalls 209 2,257 — — Bakehouses 131 427 1 — Other premises where food is sold or prepared for sale 1,027 903 3 - Total 3,378 6,858 19 — Report of the Medical Officer of Health for 1931. 87 The number of inspections of premises where food is sold or prepared for sale was 6,858 compared with 11,709 in 1930 and 12,257 in 1929. The fall in the number of inspections was due to the illness and subsequent retirement of the Chief Food Inspector, Mr. T. Newell, which necessitated the two district inspectors to take over sampling duties in addition to their routine work of inspecting food premises. Milk Supply. There are 346 registered milk premises in the Borough, one of them being also a cow shed. All the premises have been inspected regularly, the Food Inspectors making 698 visits during the year. The bulk of the milk sold by retail within the Borough is sent out in bottles filled in properly constructed dairies, and its quality throughout the year has been good. The average fat content shown by the analysis of 828 samples of whole milk was 3.63 compared with 3.56 in 1930. The milk utensils and barrows used for the delivery of milk have also been inspected regularly in the street. Meat. Five private slaughterhouses are now in use in the Borough. The Food Inspectors made 799 visits during the year to these premises and they were present on almost every occasion when slaughtering took place. The number of carcases inspected was 10,565, comprising 736 oxen, 1,634 pigs, 8,158 sheep and 37 calves. This compares with 9,305 carcases inspected in 1930, 10,711 in 1929 and 8,399 in 1928. Three whole carcases and 386 organs, etc., were found to be unsound or diseased and were surrendered and destroyed for the following reasons :— (1) Whole Carcases :— 2 entire carcases and Offal for Tuberculosis. 1 entire carcase and Offal for Jaundice and Dropsy. 88 Report of the Medical Officer of Health for 1931. (2) Organs :— Oxen :— For Tuberculosis :— 23 Heads, 23 Tongues, 29 Pairs of Lungs, 5 Livers, 5 Mesenteries and 2 Omenta ; For Actinomycosis:— 1 Head and 3 Tongues ; For Fluke:— 119 Livers and 1 Pair of Lungs ; For Pleurisy:— 1 Forequarter and 2 Pairs of Lungs ; For Pericarditis:— 4 Hearts ; For Abscesses:— 1 Pair of Lungs, 11 Livers and 2 Kidneys ; For Inflammation:— 1 Spleen and 1 Diaphragm ; For Cavernous Angioma:— 1 Liver ; Pigs :— For Tuberculosis :— 32 Heads, 10 Plucks, 13 Mesenteries, 3 Livers, 3 Spleens and 6 Stone of Pork ; For Pneumonia :— 16 Pairs of Lungs ; For Pleurisy :— 1 Forequarter and 1 Pair of Lungs ; For Pericarditis :— 11 Hearts ; For Abscesses :— 6 lbs. of Pork ; For Inflammation :— 1 Set of Trotters, 1 Mesentery and 6 lbs. of Pork; For Peritonitis :— 8 lbs. of Pork ; For Nephritis :— 4 Kidneys ; For Cirrhosis :— 5 Livers ; For Cloudy Swelling :— 1 Liver ; For Congestion :— 21 Pairs of Lungs and 1 Heart; For Milkspots :— 6 Livers ; Sheep :— For Fluke :— 5 Livers ; For Strongylus Rufescens :— 12 Pairs of Lungs. There are 244 butchers shops in the Borough. 90G inspections were made to these shops and the meat exposed for sale lias 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 be able to report that these Regulations are being observed. No prosecutions under the Regulations were necessary during the year. Food and Food Premises. 89 Unsound Food. At the request of the owners the following foodstuffs were destroyed and the usual certificates granted, viz.:— 6 stone of Dogfish; 2½ stone of Skate Wings; 10 boxes and 77 lbs. of Pears; 10 boxes of Apples and 15 lbs. of Lambs' Livers. Certification of Meat Food Products. All meat food products prepared for export to Canada, Australia and several other countries must be accompanied by a certificate stating that the food has been prepared in a cleanly condition and on sanitary premises, and from meat which has been duly inspected by a Veterinary Surgeon. As Certifying Officer for Wandsworth under the Order, I have issued seven of these Certificates for the export of parcels of potted meats prepared within 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. 8. 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. Statement of Work Done under the Food and Drugs, (Adulteration) Act, 1928. During the year 2,000 samples of foods and drugs were submitted to the Public Analyst for analysis. Of these 850 were 90 Report of he Medical Officer of Health for 1931. submitted as official samples, while 1,150 were purchased unofficially as test or informal samples. 18 or 2.1 per cent, of the official samples, and six or .52 per cent, of the unofficial samples were found to he adulterated or not up to standard. The total adulterations reported were 24 or 1.2 per cent, of the samples submitted. TABLE XLIV. RESULT OF ANALYSIS OF CERTAIN ARTICLES OF FOOD PROCURED UNDER THE FOOD AND DRUGS (ADULTERATION) ACT, 1928. SHOWING THE PERCENTAGE ADULTERATED COMPARED WITH 1927, 1928, 1929, AND 1930. Percentage of Samples adulterated, 1927-1930. No. of samples in 1931. 1927. 1928. 1929. 1930. Examined. Found adulterated or not up to standard Percentage adulterated Butter 1.3 3.4 1.6 .18 238 1 .41 Cocoa — — — — 9 — — Coffee — — — — 28 — — Confectionery and Jam — — — — 35 — — Cream 250 — .50 .43 79 — — Margarine — — — — 29 — — Milk 2.3 2.6 1.6 2.3 828 14 1.6 Separated Milk — — — - 2 — — Condensed Milk — — — — 25 — — Mustard — — — — 10 — — Sugar 5.0 — — — 22 — — Tea — — — — 19 — — Vinegar - — 3.7 28.4 21 3 14.2 Drugs 5.4 15.3 2.3 — 61 — — Other Articles 8.6 3.0 3.4 1.8 594 6 1.0 All Articles 3.1 2.8 3.4 1.4 2000 24 1.2 Food and Food Premises. 91 The following Table gives the number of formal and informal samples taken in each sub-district of the Borough and shows the number taken per 1,000 of population, the number adulterated, and the percentage of adulteration. TABLE XLV. 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 116 — — 146 3 2.0 262 3 4.2 1.1 Putney 167 — — 118 4 3.4 285 4 8.2 1.4 Balham 149 — — 116 — - 265 — 4.9 — Streatham 201 3 1.5 90 — — 291 3 4.2 1.0 Tooting 260 — — 118 1 .85 378 1 9.9 .26 Wandsworth 257 3 1.2 262 10 3.8 519 13 5.3 2.5 Whole Borough 1150 6 .52 850 18 2.1 2000 24 5.6 1.2 Milk. The following samples were submitted for analysis :— 828 of whole new milk. 2 of separated milk. 25 of condensed milk. Of these 14 were reported against as being adulterated or not up to the legal standard. Four contained extraneous water ; 10 were deficient in milk fat. Proceedings were taken in seven cases and fines amounting to £5 were inflicted and £11 l1s, 0d. costs imposed. In the other 92 Report of the Medical Officer of Health for 1931. seven cases the Public Health Committee after considering the amount of adulteration and circumstances of sale, decided not to prosecute the vendors, but to take further samples. 19 samples of milk were taken on delivery to the various institutions in the Borough all of which were genuine. Three others were procured in the early morning from wholesale dealers during delivery to retailers. One of these was reported against and proceedings were taken against the vendor who was fined £5 and ordered to pay £5 5s. costs. 55 samples were taken on Sundays either in the early morning or at mid-day; all of these were genuine. 352 samples were taken from milk vendors in the street during the early morning 5 to 7 a.m., on weekdays, and of these four or 1.1 per cent, were reported against. Milk (Special Designations) Order, 1923. The following licences for sale of designated milks were granted:— Certified 34 Grade A (Tuberculin Tested) 53 Grade A 6 Pasteurised 22 Bacteriological Examination of Milk. The following samples of Graded Milks were submitted for bacteriological examination in order to see if the bacterial content was within the prescribed standard for the appropriate grade. TABLE XLVI. Grade. Samples taken. Reported against. Percentage reported against. Certified 20 4 20.0 Pasteurised 18 8 44.4 All samples examined 38 12 31.6 Food and Food Premises. 93 The Minister of Health was notified of the results of these examinations. Butter and Margarine. 238 samples of butter were submitted for analysis during the year, and of these one or .40 per cent, were reported against. 29 samples of margarine were submitted for analysis and all were reported genuine. Other Articles. 594 samples were submitted under this heading. The results are given in the Public Analysts' Report. 94 MISCELLANEOUS. Insulin Treatment. This service, which was commenced by the Council in 1928 with the sanction of the Ministry of Health was extended during the year, and there are now two persons receiving treatment. The cost to the Council up to the end of 1931 was £48 2s. Bacteriological Examinations. During the year 2,417 bacteriological examinations were made at the Lister Institute. The following Table shows the number of examinations in each sub-district and for the whole Borough, also the disease for which the examination was made, and the result. TABLE XLVII. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Diphtheria Negative 317 178 245 527 280 641 2188 Positive 38 18 25 50 24 55 210 Enteric Fever :— Negative — — 2 6 — 4 12 Positive — — - 1 — — 1 Tuberculosis :— Negative 1 — — — 1 2 4 Positive - - - 2 - - 2 Total 356 196 272 586 305 702 2,417 Examinations of Sputum made at the Dispensary are not included in the above figures. Miscellaneous. 95 Disinfection. The total number of rooms disinfected after the occurrence of cases of infective diseases was 2,932:— 466 in Clapham, 207 in Putney, 469 in Balham, 431 in Streatham, 343 in Tooting, and 1,016 in Wandsworth. Two public and two private elementary schools were also disinfected for infective diseases. Cleansing of Persons Act. The names of 33 children, stated to be in a verminous condition, were forwarded to me by the Medical Officer, Education Department, London County Council, and the homes were visited by the Inspectors. In seven cases the clothing was also said to be verminous. These children were cleansed by the officials of the London County Council at the Cleansing Station under the supervision of that Authority. 55 adults and 26 children were given baths at the Council's Disinfecting Station on account of suffering from Scabies. Flies and Mosquitoes. During the summer months certain ponds, streams and areas of stagnant water were treated by spraying with paraffin, with the object of destroying the larvae of mosquitoes. Chloride of lime was also used for sprinkling horse manure in order to destroy the larvae and pupse of flies. Statement of Work done under the Rag Flock Act, 1911. 12 visits to workshops were made by the Inspector, and the materials used for bedding and upholstery were examined. Two certificates for coloured rags have been issued in respect of the sterilisation of materials used in the manufacture of rag 96 Report of the Medical Officer of Health for 1981. flock for export. Three certificates were also issued in respect of the sterilisation of second-hand horse hair. Water Supply— Cutting-off Notices. During the year, 50 notices with respect to 49 premises were received from the Metropolitan Water Board, stating that the supply had been withdrawn. In 41 premises the water supply was cut off for non-payment of rates, in two in consequence of defects to the supply service, and in six because the premises were empty. Mortuaries. The Mortuaries in Clapham, Streatham and Wandsworth, have been visited 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, 12 and in Wandsworth 74,— of which 28 were from Wandsworth, 13 from Putney, one from Balham, 25 from Tooting, two from Fulham, two from South Kensington, two from Wimbledon and one from Hammersmith— a total of 88. Inspection of Sanitary Conveniences. The number of Sanitary Conveniences inspected was 177 ; 52 in Clapham, 24 in Putney, 11 in Balham, 15 in Streatham, 14 in Tooting and 61 in Wandsworth. 1,237 inspections were made during the year, and three notices', for cleansing, were served and complied with. Ambulance Service. The London County Council has been responsible for the removal by ambulance of cases of infectious diseases to hopsitals since April, 1930. They also provide ambulances for persons meeting with accidents, and for parturient women. These services are free. Ambulances are also provided by the same Authority for the conveyance of other cases on payment. M iscellaneous. 97 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. The Clerk to the Public Assistance Committee has kindly given me the following information with reference to the above for the year ended 31st December, 1931 :— (1) No. of admissions to the Public Assistance Institutions 5,150 (2) No. of medical orders given 1,627 (3) Average No. of persons in receipt of outdoor relief 2,479 (4) Amount of outdoor relief given £41,008 Amount of Public Assistance Relief. H 98 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. Trott, 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 with 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:— A. Morris Johns, M.D. 99 Staff. SANITARY INSPECTORS. Name. Commenced Duty. Certificates held. Sanitary Inspector. Meat and Food. Others. Senior Inspector: R. Brown June 1893 R. San. Inst. No Five District Inspectors: 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. Patterson June 1925 „ Yes — E. V. Roots Sept. 1926 „ Yes Four C. F. Standish Jan. 1928 „ 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 Nov. 1930 „ Yes Two R. E. Jones Dec. 1930 „ Yes One A. W. E. Porter June 1931 S.I. Exam. Bd. Yes — Food and Drugs Inspector: W. H. Jones Sept. 1926 S.I. Exam. Bd. Yes Four Food Inspectors: W. T. Willimott Dec. 1927 Joint Board Exam. Yes Seven A. E. Handley Aug. 1929 „ Yes One Assistant to Food Inspectors: *A. J. Lansley Mar. 1928 — — — H2 100 Report of the Medical Officer of Health for 1981. HEALTH VISITORS. Name. Commenced Duty. Certificates held. Health Visitor. 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 May 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 „ B. P. Manning April 1931 Yes Yes Yes No Tuberculosis:— Miss P. G. Moorcs 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 San. Insp. Miss H. G. Wright Jan. 1925 „ — 101 Staff. OFFICE STAFF—continued. Name. Commenced Duty. Appointment. Certificates held. L. L. Parrini May 1923 Third Class Clerk — *J. Marshall Jan. 1927 „ Five *Miss F. M.Woodhall July 1931 „ One *A. E. Hollis Feb. 1929 Fourth Class Clerk Three *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. 15. Streatham *Dr. A. B. Plant, 29, North Side, Streatham Common, S.W. 16. 102 Report of the Medical Officer of Health for 1931. Public Vaccinators—continued. Tooting, No. 1 *Dr. P. A. Carrie, 859, Garratt Lane, Tooting, S.W. 17. Tooting, No. 2 *Dr. R. C. Spence, 18, Longley Road, Tooting, S.W. 17. Wandsworth, No. 1 *Dr. E. R. Badcock, 29, West Hill, Wandsworth, S.W. 18. Wandsworth, No. 2 *Dr. J. T. Thyne, 101, Earlsfield Road, Wandsworth, S.W. 18. Swaffield Road *Dr. H. A. Topalia, Institution 248, Earlsfield Road, Wandsworth, S.W. 18. Vaccination Officers. Clapham and Wands- *Mr. G. Lovett, worth 61, Barmouth Road, Wandsworth, S.W. 18. Balham, Streatham and *Mr. L. H. Ford, Tooting. 128, Franciscan Road, Tooting, S.W. 17. Putney *Mr. C. L. Taylor, 28, Crieff Road, Wandsworth, S.W. 18. Mr. Leonard Phillips resigned his appointment as Obstetric Consulting Surgeon under the Puerperal Fever and Puerperal Pyrexia Regulations, 1926, and Mr. A. Morris Johns of 62, Wimpole Street, has been appointed in his place. Mr. A. J. Weeks, Senior Sanitary Inspector, retired in February after 38 years service under the Council, 103 Staff. Mr. R. Brown was promoted to be Senior Inspector and Mr. A. W. E. Porter was appointed District Inspector to fill the vacancy. Mr. T. Newell, Chief Inspector of Food and Drugs, was superannuated in July, owing to continued ill-health. He had been in the severice of the Council for 31 years. The Council decided to abolish the office of Chief Inspector of Food and Drugs and Mr. W. H. Jones, one of the Food Inspectors, was appointed Food and Drugs Inspector to carry out the duties under the Food and Drugs Acts. The vacancy for a Food Inspector was filled by the transfer of Mr. W. T. Willimott, one of the District Inspectors. The filling of the vacancy created by Mr. Willimott's transfer has been postponed in accordance with the decision of the Council not to fill vacancies which occur for the time being. Earlier in the year the Council decided to appoint an additional Health Visitor on account of the general increase in the Maternity and Child Welfare work and Miss B. P. Manning was appointed. Miss D. E. Kilsby resigned her appointment as Third Class Clerk and the vacancy has been filled by the appointment of Miss F. M. Woodhall. One of the members of the staff of the Disinfecting Station was superannuated during the year and it is not proposed to fill the vacancy. Mr. F. L. Langford, Third Class Clerk, has qualified as a Sanitary Inspector by obtaining the Certificate of the Royal Sanitary Institute Examination Joint Board. Mr. W. T. Willimott has obtained the Grade IV. Certificate for Building Construction granted by the London County Council. 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. 104 Report of the Medical Officer of Health for 1931. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF WANDSWORTH, 1931. (Compiled by the Registrar-General). Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— ALL CAUSES M. 1925 165 18 18 31 85 79 110 226 354 433 406 F. 2104 102 20 20 29 71 101 123 185 284 434 735 1. Typhoid and paratyphoid fevers M. - - - - - - - - - - - - F. - - - - - - - - - - - - 2. Measles M. - - - - - - - - - - - - F. 2 1 — 1 - - - - - - - - 3. Scarlet fever M. 2 - 1 - - - 1 - - - - - F. 2 — — — 1 1 — — — — — — 4. Whooping cough M. 10 5 4 1 - - - - - - - - F. 8 4 4 - - - - - - - - - 5. Diphtheria M. 11 1 - 6 4 - - - - - - - F. 5 — 2 1 1 — — — 1 — — — 6. Influenza M. 48 - 3 - - - 1 5 8 10 7 14 F. 62 2 2 — — 4 2 3 6 12 6 25 7. Encephalitis lethargica M. 1 - - - - - - 1 - - - - F. - - - - - - - - - - - - 8. Cerebro-spinal fever M. 3 1 - 1 1 - - - - - - - F. 3 - — 1 — — — — 1 1 — — 9. Tuberculosis of respiratory system M. 147 - - - - 29 32 28 33 23 2 - F. 133 — — 1 3 34 41 23 13 9 7 2 10. Other tuberculous diseases M. 16 2 1 2 3 5 1 1 1 - - - F. 12 1 — 3 2 1 1 1 — 1 1 1 11. Syphilis M. 4 - — - 1 — — — 1 2 — — F. 1 - - - - - - - - 1 - - 12. General paralysis of the insane, tabes doralis M. 19 - - - - 1 1 - 5 6 6 - F. 6 — — — 1 — — — 2 2 1 — 13. Cancer, malignant disease M. 274 - - 1 1 2 6 12 37 69 106 40 F. 307 —' — — — -— 6 24 51 67 73 86 14. Diabetes M. 17 - - - - - 1 1 2 2 8 3 F. 23 — — — — 1 1 — 2 4 9 6 15. Cerebral haemorrhage, etc. M. 49 - - - - - - 1 4 11 16 17 F. 87 - - - - - - - 4 15 22 46 16. Heart disease M. 419 - - - 1 4 5 9 28 83 118 171 F. 575 — — — 3 5 11 21 28 53 146 308 17. Aneurysm M. 9 - - - - 1 1 - 3 3 1 - F. 2 — — — — — 1 1 - - - - 105 Vital Statistics. CAUSES OF DEATH—continued. Causes of Death. Sex. All Ages. 0— 1— 2— 5 15— 25— 35— 45— 55— 65— 75— 18. Other circulatory diseases M. 62 - - - - - - 2 5 16 21 18 F. 76 - - - - - - 1 5 12 23 35 19. Bronchitis M. 86 5 - - 1 - - 1 9 11 24 35 F. 104 7 — 1 — 1 1 — 4 10 25 55 20. Pneumonia (all forms) M. 117 26 7 3 2 2 1 11 15 13 23 14 F. 91 10 8 3 4 1 4 3 7 10 21 20 21. Other respiratory diseases M. 17 - - - - 1 1 1 2 1 6 5 F. 25 - - - - - 1 — 3 6 8 7 22. Peptic ulcer M. 28 - - - - - 2 5 10 7 3 1 F. 11 - - - - - 1 1 3 3 2 1 23. Diarrhœa, etc. M. 19 16 - - 1 1 - - - - - 1 F. 14 8 1 2 — — — 2 — — — 1 24. Appendicitis M. 18 — — — 1 3 1 4 1 5 1 2 F. 14 — — 2 — — — 2 4 1 5 - 25. Cirrhosis of liver M. 7 - - - - 1 1 - - 3 2 - F. 6 - - - - - - - - 3 3 - 26. Other diseases of liver, etc. M. 10 - - - - - - - - 5 3 2 F. 10 - - - - - 3 1 — 1 3 2 27. Other digestive diseases M. 32 5 - - - 2 2 3 4 5 7 4 F. 43 — — 1 3 1 1 6 5 10 5 11 28. Acute and chronic nephritis M. 82 - - - 1 2 1 6 11 25 26 10 F. 91 — — — 1 4 2 7 13 21 24 19 29. Puerperal sepsis F. 15 — — — — 2 11 2 — — — — 30. Other puerperal causes F. 2 — — — — — 1 1 — — — — 31. Congenital debility, premature birth, malformations, etc. M. 92 87 1 - 1 1 1 - - - 1 — F. 52 52 - - - - - - - - - - 32. Senility M. 43 - - - - - - - - - 5 38 F. 68 - - - - - - - - - 4 64 33. Suicide M. 27 - - - - - 4 2 13 7 1 - F. 16 - - - - - 3 4 3 4 2 - 34. Other violence M. 74 3 - 3 6 19 7 9 9 6 8 4 F. 49 4 2 2 3 3 1 2 3 9 10 10 35. Other defined diseases M. 182 14 1 1 7 11 9 8 25 41 38 27 F. 187 13 1 2 7 13 9 18 27 29 34 34 36. Causes ill-defined, or unknown M. - - - - - - - - - - - - F. 2 - - - - - - - - - - 2 106 Report of the Medical Officer of Health for 1931. PARTICULARS OF PROCEEDINGS TAKEN UNDER THE PUBLIC HEALTH ACTS. Premises. Offences. Result. Fine. Costs. 6, The Piatt, Putney. Nuisances Defendant ordered to pay costs. — 10 6 19 and 21, Aslett Street, Wandsworth. Ditto Order made for abatement of nuisances. — 42 0 74, Park Hill, Clapham. Ditto Order made to prohibit recurrence of nuisance. — 21 0 135 Manor Street, Clapham. Ditto Summons withdrawn on payment of costs. — 10 6 12b and 12c, Treport Street, Wandsworth. Ditto Summons withdrawn on payment of costs. 42 0 107 HOUSING STATISTICS. Number of New Houses erected during the Year:— (i) By the Local Authority 72 Flats (ii) By other Local Authorities 9 consisting of 194 Flats (iii) By other bodies and persons 337 1. Inspection of Dwelling-houses during the Year:— (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 11,429 and the number of inspections made 11,837 (2) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 2,731 and the number of inspections made 15,485 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 81 (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 4,530 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 4,504 108 Report of the Medical Officer of Health for 1931. 3. Action under Statutory Powers during the Year:— A.—Proceedings under sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 7 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 4,530 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 621 (b) By Local Authority in default of owners Nil C.—Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 81 (2) Number of dwelling-houses demolished in suance of Demolition Orders 18 D.—Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 2 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 109 Housing Statistics. E.—Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil F.—Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which Closing Orders were made Nil (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling- houses having been rendered fit Nil (3) Number of dwelling houses in respect of which Demolition Orders were made Nil (4) 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 70 Tenement Flats (Number erected during last two years) 72 Tenement Flats 110 Analysts' Annual Report. To the Wandsworth Borough Council. Mr. Mayor, Madam and Gentlemen, Herewith we have pleasure in submitting our annual report on work performed by us under the Food and Drugs (Adulteration) Act, 1928, during 1931. During the year a total number of 2,000 samples, comprising 112 varieties of food and drugs were submitted by your Council's Food Inspector and examined by us. Of these, 800 were taken with the necessary formalities required by the Act, and 1,200 were procured informally. The following statement shows the nature of the samples submitted and the results of analyses, the details of Drugs and " Other Articles " being given subsequently. GENERAL STATEMENT. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Bread — 20 20 — — — Butter 3 235 238 1 — 1 Cheese — 15 15 — 1 1 Cocoa — 9 9 — — — Coffee — 28 28 — — — Confectionery — 10 10 — — — Cream — 77 77 — — — Cream, Tinned — 2 2 — — — Flour — 3 3 — — — Flour, Self raising — 13 13 — — — Jam and Marmalade — 32 32 — — — Lard — 15 15 — — — Margarine — 29 29 — — — Milk 827 1 828 14 — 14 Milk Condensed, Full Cream) — 5 5 — — — 111 Analysts' Annual Report. GENERAL STATEMENT.—continued. Nature of Sample. Examined Adulterated. Formal. Informal. Total. Formal. Informal. Total. Milk, Condensed, (Machine Skimmed) — 18 18 — — — Milk, Evaporated — 2 2 — — — Milk, Separated 2 — 2 — — — Mustard — 10 10 — — — Sugar — 22 22 — — — Tea — 19 19 — — — Vinegar 13 4 17 1 1 2 Vinegar, Malt 2 2 4 1 — 1 Drugs — 61 61 — — — Other Articles 3 518 521 1 4 5 Total 850 1150 2000 18 6 24 DRUGS (INFORMAL). Nature of Sample. Examined. Acid, Boric 3 Acid, Tartaric Borax 6 Camphorated Oil 8 Cream of Tartar 5 Epsom Salts 5 Friar's Balsam 2 Glauber Salts 1 Glycerine 1 Malt and Cod-liver Oil 1 Ointment, Zinc 3 Powder Gregory's 2 Sulphur, Flowers of 2 Sweet Spirits of Nitre 3 Tincture, Iodine 10 Tincture, Quinine, Ammoniated 6 Total 61 112 Report of the Medical Officer of Health for 1931. OTHER ARTICLES. Nature of Sample. Examined Adulterated. Formal. Informal. Total. Formal. Informal. Total. Almonds, ground — 3 3 — — — Apples — 2 2 — — — Arrowroot — 3 3 — — — Baking Powder — 3 3 — — — Barley, Pearl — 1 1 — — — Barley, Prepared — 1 1 — — — Beef, Corned — 1 1 — — — Biscuits 1 1 2 — — — Blancmange Powder — 6 6 — — — Brawn — 5 5 — — — Cake — 6 6 — — — Cakes, Sponge — 10 10 — — — Cherries, Glace — 18 18 — — — Coffee Essence — 1 1 — — — Coffee and Chicory Extract — 6 6 — — — Cornflour — 6 6 — — — Custard Powder — 14 14 — — — Dripping — 10 10 — — — Dusting Powder — 1 1 — — — Dyes — 9 9 — — — Fish Paste — 7 7 — — — Fish, Tinned 1 13 14 1 — 1 Fruit, Bottled —. 2 2 — — — Fruit, dried — 58 58 — — — Fruit, Tinned — 8 8 — — — Gelantine — 4 4 — — — Ginger, Crystallised — 3 3 — — — Ginger, Ground — 14 14 — — — Ginger, Preserved — 2 2 — — — Gravy Powder — 3 3 — — — Gravy Salt — 4 4 — — — Honey — 6 6 — — — Jelly, Table — 4 4 — — — Lemon Curd — 2 2 — — — Lemonade Powder — 6 6 — 3 3 Meat Cubes — 1 1 — — — Meat Paste — 13 13 — — — Mincemeat — 7 7 — — — Mustard Condiment — 4 4 — — — Nut Butter 1 2 3 — — — Oatmeal — 7 7 — — — Oats, Rolled — 5 5 — — — Olive Oil — 5 5 — — — Orange Squash — 2 2 — — — Peaflour — 4 4 — — — Peas, Tinned — 3 3 — — — Peel, Candied — 5 5 — — — Pepper — 27 27 — — — Pickles — 4 4 — — — Potato Salad — 1 1 — — — 113 Analysts' Annual Report. OTHER ARTICLES.—continued. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Preservatives — 4 4 — — — Puff Pastry — 1 1 — — — Rice — 36 36 — — — Rice, Flaked — 2 2 — — — Rice, Ground — 16 16 — — — Sago — 5 5 — — — - Sardines in Oil — 4 4 — 1 1 Sauce — 3 3 — — — Sausages — 4 4 — — — Sausages, Preserved — 26 26 — — — Sausage, Cooked — 3 3 — — — Sausage, Liver — 2 2 — — — Sausage meat — 3 3 — — — Semolina — 12 12 — — — Smoke Powder — I 1 — — — Soup Cubes — 1 1 — — — Spice, Ground — 6 6 — — — Spice, Mixed — 1 1 — — — Suet, Shredded — 7 7 — — — Tapioca — 24 24 — — — Vegetables, Bottle — 1 1 — — — Vegetables, Tinned — 20 20 — — — Wines, Non alcoholic — 3 3 — — — Total 3 518 521 1 4 5 The nature and extent of the adulteration in the formal samples submitted is shown below:— No. Nature of Sample. Nature of Report. 77 Milk 3% Extraneous Water. 141 Ditto 4% Deficient in Fat. 175 Ditto 5% Deficient in Fat. 180 Ditto 1% Extraneous Water. 200 Ditto 2% Deficient in Fat. 201 Ditto 3% Extraneous Water. 202 Ditto 4½% Extraneous Water. 236 Ditto 3% Deficient in Fat. 267 Ditto 5% Deficient in Fat. 350 Ditto 8% Deficient in Fat. 367 Ditto 10% Deficient in Fat. 481 Ditto 14% Deficient in Fat. 514 Ditto 16% Deficient in Fat. 533 Ditto 1% Extraneous Water. 640 Sardines in Oil 4.2 grains Tin per lb. 760 Butter 100% Margarine 808 Malt Vinegar 100% coloured dilute Acetic Acid. 809 Vinegar 12.5% Deficient in Acetic Acid. 114 Report of the Medical Officer of Health for 1931. The reports issued in respect to informal samples returned as adulterated were as follows:— No. Nature of Sample. Nature of Report. 320 Malt Vinegar Deficient in Acetic Acid. 446 Lemonade Powder Made with Tartaric Acid. 447 Ditto Ditto. 449 Ditto Ditto. 794 Sardines in Oil Contains Tin 804 Cheese (Wrapped) Contains Tin. The average fat content of the 77 samples of Cream amounted to 52.0% ; that in the two samples of Tinned Cream being 21.7% The average moisture content in the 237 samples of Butter returned as genuine, amounted to 14.1%, that in the 29 samples of Margarine being 18.6%. The average composition of the samples of Milk submitted and returned as genuine during each month of the year is given below:— MILK COMPOSITION. Total Solids. Milk-fat. Non-fatty Solids. January 12.43% 3.62% 8.81% February 12.33% 3.50% 8.83% March 12.28% 3.49% 8.79% April 12.25% 3.48% 8.77% May 12.19% 3.40% 8.79% June 12.26% 3.48% 8.78% Julv 12.26% 3.51% 8.75% August 12.38% 3.63% 8.75% September 12.59% 3.75% 8.84% October 12.40% 3.70% 8.70% November 12.69% 3.89% 8.80% December 12.55% 3.72% 8.83% The average composition of these milks during the whole year being:— Total milk solids 12.44 per cent. Milk fat 3.63 Per cent. Non-fatty solids 8.81 per cent. 115 Analysts' Annual Report. Of the formal samples 18, or 2.11 per cent. were reported against whilst six, or 0.53 per cent. of the informal samples were found to be unsatisfactory; the adulteration detected in all samples examined amounting to 1.20 per cent. Five of the Milk samples, included in this report were taken by request of the Metropolitan Borough of Battersea and proved on analysis to be genuine, whilst seven samples consisting of one each of Biscuits, Milk, Marmalade, Tinned Peas, and Tinned Spinach with two of Sweets were submitted as the results of complaints received from Ratepayers respecting them. In no case was any abnormality detected, all being genuine. Compared with 1930, the total adulteration detected shows a decrease, from 2.3 to 1.2 per cent. a figure upon which the Borough can congratulate itself. We have the honour to be, Mr. Mayor, Madam and Gentlemen, Your obedient Servants, A. H. M. MUTER, Public Analyst. CHARLES A. HACKMAN, Additional Public Analyst. 325, Kennington Road, London, S.E. 11. 116 INDEX. page Accident, Deaths from 38, 39 Adulteration of Certain Articles, Percentage of, in 1927-1931 90 Agricultural Grading and Marking Act, 1928 89 Ambulance Service 96 Analysts, Report of 110 Angel Court Clearance Area 76 Ante-natal Clinics 64 Anti-toxin 19 Area of Borough 1 Artificial Light Treatment of Tuberculosis 48 Artificial Pneumothorax Treatment of Tuberculosis 49 Bacteriological Examinations 53, 94 Bacteriological Examination of Milk 92 Bakehouses 83, 85, 86 Balham, House-to-House Inspections in 82 BirthS 4 Births and Birth-rates in Sub-Districts 4 Birth-rate, Average 10 Years, 1921-30 8 Births, Notification of, Act 5 Borough of Wandsworth War Memorial Maternity Home 67 Brain and Nervous System, Diseases of the 38 Butchers' Shops 86 Butter and Margarine 93 Cancer 38 Carters Yard Clearance Area 76 Census, 1921 and 1931 1 Cerebro-Spinal Meningitis 30 Child Birth, Deaths from 12 Children's Clinic, Wandsworth and Tooting 69 Circulatory Diseases 38 Clapham, House-to-House Inspections in 82 Cleansing of Persons Act 95 117 Index. page Clearance Areas 73 Clinics for Immunisation against Diphtheria 19-28 Closing Order 78 Conscientious Objections Certificates granted 18 Convalescent Homes 69 Cowsheds 86 Creches 67 Cumber's Yard and Garden Cottages Clearance Area 75 Cutting-off Notices 96 Dairies, Milkshops and Cowsheds 86 Day Nurseries 67 Death, Causes of 7, 104, 105 Death-rate, Average 10 Years, 1921-1930 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 Demolition Order 77 Dental Treatment 49, 70 Developmental Diseases 38 Diarrhœa 36 Diphtheria 18 Diphtheria, Attack Rate per 1,000 cases 18 Diphtheria, Immunisation against 19-28 Diphtheria, " Return Cases " of 29 Disinfection 95 Disinfection of Schools 95 Dutch Yard Clearance Area 76 Dwelling-houses, Inspection of 107 Dysentery 31 Eden Cottages Clearance Area 77 Encephalitis Lethargica 30 Enteric Fever 29 Erysipelas 29 Expectant and Nursing Mothers, Institutions for 68 Factories and Workshops 83 118 Index. PAGE Factories, Workshops, etc., Defects found in 85 Factories, Workshops, and Workplaces, Inspection of 83 Families, Number of, Census 1921 2 Fishmongers' Shops 86 Flies and Mosquitoes 95 Food, Prosecutions in connection with 91 Food and Drugs (Adulteration) Act, 1928, Proceedings under 91 Food and Drugs (Adulteration) Act, 1928, Statement of Work under 89 Food and Food Premises 86 Food Places, Inspection of 86 Fried Fish Shops 86 Garden Cottages and Cumbers Yard Clearance Area 75 Great Acre Court Clearance Area 77 Greengrocers' Shops 86 Health Visitors, Work of 58 Henry's Place Clearance Area 76 Home Work 84 Hospitals, etc., for Expectant and Nursing Mothers 68 House Refuse, Removal of 97 House-to-House Inspections, Summary of 82 Houses and Premises Inspected 79 Houses erected during 1931 107 Houses Let in Lodgings 79 Houses owned by Borough Council, Number of 109 Housing Act, 1930 73 Housing Conditions 71 Housing Consolidated Regulations, 1925, Houses inspected, etc. 107 Housing Statistics 107 Ice Cream Premises 86 Illegitimate Children, Births of 5 Immunisation against Diphtheria 19-28 Imported Produce, Marking of 89 Increase of Rent and Mortgage Interest (Restrictions) Act, 1923 82 Infant Visiting 58, 61 119 Index. PAGE Infantile Mortality 9-11 Infantile Mortality, 10 Years, 1921-1930 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 2 Inquests 38, 39 Insanitary Areas 73 Inspections, Details of 79 Institutions, Deaths in 9 Institutions for Expectant Mothers, etc. 68 Insulin treatment 94 Laundries, Inspection of 83 Malaria 31 Margarine 93 Markets and Stalls 86 Maternal Mortality 12 Maternity and Child Welfare 58 Maternity and Child Welfare Centres 63 Maternity Home, Borough of Wandsworth War Memorial 67 Measles 31-33 Measles and other Non-notifiable Diseases reported from Schools 34-36 Meat 87 Meat Food Products, Certification of 89 Memel Place Clearance Area 76 Merchandise Marks Act, 1926 89 Mews and Stables 79 Midwives 62 Milk Analysis 91 Milk Bacteriological Examination of 92 Milk (Mothers and Children) Order 70 120 Index. PAGE Milk Premises, Cowsheds, etc., on Register 86 Milkshops, Cowsheds, etc., Inspections of 86 Milk (Special Designation) Order, 1928 92 Milk Supply 87 Mortuaries 96 Mosquitoes 95 Natural Increase, Rate of 4 Nervous System, Diseases of the 38 Non-Infective Diseases, Deaths from 38 North Street Clearance Area 75 Notification of Births Act 5 Notification of Infective Diseases 15, 16 Nursing Arrangements 62 Offensive Trades 79 Old Age 38 Ophthalmia Neonatorum 31 Other Infective Diseases, Deaths from 37 Outworkers 84 Overcrowding 72, 80 Para-Typhoid Fever 29 Physical Features, etc., of the Borough 1 Piggeries 79 Pneumonia 30 Police Court Proceedings 91,106 Polio-Myelitis and Polio Encephalitis 30 Population 1,3 Population of Sub-Districts 4 Premature Birth 38 Pregnancy, Deaths from Accidents and Diseases of 12 Public Assistance Relief, Amount of 97 Puerperal Fever and Puerperal Pyrexia 29 Puerperal Pyrexia 29 Pulmonary Tuberculosis, Notification of Cases of 40 Putney, House-to-House Inspections in 82 Pyæmia, Deaths from 37 Rag and Bone Stores 79 Rag Flock Act, 1911, Statement of Work done under 95 Rateable Value 2 121 Index. PAGE Rent and Mortgage Interest Restrictions Act, 1923 82 Respiratory Diseases 38 Restaurant Kitchens 86 Return Cases of Scarlet Fever and Diphtheria 29 Samples, Formal and Informal, Number of 91 Sanitary Conveniences, Inspection of 96 Sanitary Inspection of the Borough 79 Sanitary Operations, Table of 81 Scabies 36 Scarlet Fever 28 Scarlet Fever, Attack Rate per 1,000 Cases 29 Scarlet Fever, "Return Cases" of 29 Schools, Disinfection of, for Infective Diseases 95 Septicaemia, Deaths from 37 Shelters for Tuberculous Patients 50 Slaughter-houses 86 Small-pox 17 Smoke Nuisances 79 Social Conditions 1 Sputum Examinations 53 Staff 98 Stockwell Court Clearance Area 76 Streatham, House-to-House Inspections in 82 Suicide, Deaths from 38, 39 Syphilis, Deaths from 37 Tooting and Wandsworth Children's Clinic 69 Tetanus, Deaths from 37 Tooting, House-to-House Inspections in 82 Tuberculosis 40-45 Tuberculosis, Artificial Light Treatment of 48 Tuberculosis, Artificial Pneumothorax Treatment of 49 Tuberculosis Dispensaries 46-57 Tuberculosis Care Committee 53 Tuberculosis, Handicraft Class 57 Tuberculosis, Institutional Treatment 48 Tuberculous Diseases, Extra Nourishment provided 49 Underground Rooms 82 Unhealthy Areas 73 122 Index. PAGE Unsound Food 89 Vaccination 17 Vaccination Returns 18 Violence, Mortality from 38 Vital Statistics of Whole Borough 2, 104, 105 Wandsworth and Tooting Children's Clinic 69 Wandsworth, House-to-House Inspections in 82 Warplc Road Clearance Area 77 Water Supply, Cutting-off Notices 96 Whooping Cough 29 Workshops, Number of 83, 85 Young Children, Institutions for 68 Zymotic Diseases 13