Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, &c. OF THE BOROUGH, For the Year 1932, 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 1932. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Wandsworth. Sir, Ladies and Gentlemen, I have the honour to present my Annual Report on the health and sanitary condition of the Borough for the year 1932. 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. B 2 Report of the Medical Officer of Health for 1982. Social Conditions. The Report of the Registrar-General on the Census enumerated on the 26th April, 1931, gives the population of the Borough as 353,110—159,711 males and 193,396 females. This is a larger population than any other London Borough, the next being Islington with a total of 821,795 persons. At the Census 1921, the total population was 828,807, and of these, 147,229 were males and I HI ,078 were females. At the Census 1911, the population was 311,360, of whom 140,728 were males and 170,682 were females. The density of population in the Borough of Wandsworth was 38-8 persons per acre, while the figure for the whole of London was 58-7. The greatest density was 151*7 in Southwark and the lowest in Woolwich with 17-7. In the matter of room density the average for the whole County is 0-98 persons per room and the figure varies from 0-70 to 1*45. The Boroughs showing the most favourable densities are Hampstead (-70), Westminster (-76), Chelsea and Wandsworth (-79 each), and Kensington ("80). There is no particular occupation carried on in this Borough which affects public health. GENERAL STATISTICS FOR TIIE BOROUGH. Areac9,199 acres Population in 1932 853,603 No. of inhabited houses in 1981 71,566 No. of families, or separate occupiers, in 1981 95,883 Rateable value in 1932 £8,001,904 Estimated produce of a penny rate £12,200 8 Vital Statistics. Extracts from Vital Statistics. Births:— Males 2,144 Legitimate 3,998 Females 2,053 Illegitimate 199 Total Births 4,197 Birth-rate 11.86 Deaths:— Total Deaths 4,088 Death-rate 11.56 Percentage of total deaths occurring in public institutions 52.0 No. of women dying in, or in consequence of, childbirth From sepsis 6 From other causes 7 Deaths of Infants under one year of age:— Legitimate 241 Illegitimate 20 Total 261 Infantile mortality 62 Deaths from Tuberculosis:— No. 288 Rate •81 Total deaths from Measles 37 Total deaths from Whooping Cough 17 Total deaths from Diarrhoea (under two years of age) 63 Population. The population at the middle of the year was estimated to be 353,603, 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. b 2 4 Report of the Medical Officer of Health for 1932. TABLE I. Sub-District. Census Population 1931 Population estimated to middle of 1932 Clapbam 60,925 61,124 Putney 34,718 34,731 Balham 53,982 54,052 Streatham 68,435 68,436 Tooting 38,159 38,242 Wandsworth 96,891 97,018 Whole Borough 353,110 353,603 Births. The total number of births occurring in the Borough was 3,240, including 394 non-residents who were born in Institutions. 1,351 births of Borough residents occurred outside the Borough, so that the corrected number of births was 4,197 compared with 4,334 in 1931. 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 450 417 867 14.18 + 1-24 Putney 181 172 353 10.16 —1-78 Balham 364 328 692 12.80 + -58 Streatham 327 346 673 9.83 —1-45 Tooting 223 209 432 11.29 + 1-57 Wandsworth 599 581 1,180 12.05 + -95 Whole Borough 2,144 2,053 4,197 11.86 + -30 Vital Statistics. 5 The birth-rate was 11.86 per 1,000, compared with 12.26 for 1931, and 14.03 the decennial average. The rate for the whole of London during 1932 was 14.2 and for England and Wales, 15.3. 152 illegitimate births took place in the Borough, but only 79 belonged to the Borough. On the other hand 120 illegitimate births belonging to Wandsworth occurred outside the Borough, making a corrected total of illegitimate births belonging to Wandsworth of 199. 48 of these belonged to Clapham, 18 to Putney, 30 to Balham, 40 to Streatham, 22 to Tooting, and 41 to Wandsworth. The percentage of illegitimate births to total births was 4.7. 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 609 491 108 42 338 3 15 Putney 306 240 81 13 141 5 5 Balham 519 714 131 27 546 10 12 Streatham 614 418 105 24 260 29 14 Tooting 369 321 42 7 269 3 5 Wandsworth .. 823 783 196 74 493 20 17 Whole Borough 3,240 2,967 663 187 2,047 70 68 6 Report of the Medical Officer of Health for1932. Deaths. The number of deaths which took place in the Borough during the year was 8,541, but 1921 of these did not belong to the Borough, while 1,885 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 1,088 of whom 1,972 were males and 2,110 females. The corrected death-rate for the year was I I -56 compared with II -80 in I 981. The death-rate for the whole of London for 1932 was 12*8, for England and Wales 12.0, in the 118 County Boroughs and great Towns 11.8, and in the 126 smaller Towns 10-8. 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 300 401 791 12.94 Putney 183 232 415 11.94 Balham 316 345 661 12.22 Streatham 333 439 772 11.28 Tooting 198 174 372 9.72 Wandsworth 552 525 1,077 11.10 Whole Borough 1,972 2,116 4,088 11.56 Table V. is the general mortality Table for the whole Borough, and shows the corrected number of deaths from each cause divided into sexes, age groups and sub-districts, together with those occurring in Institutions, 7 Vital Statistics. Table V.—Causes of, and Ages at Death, during the Year 1932. 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 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 37 16 21 7 11 10 7 1 1 ... ... 6 2 5 3 5 16 21 Scarlet Fever 4 3 1 ... ... 3 1 ... ... ... ... ... ... 3 ... 1 ... 4 Whooping Cough 17 9 8 7 4 4 1 1 ... ... ... 2 1 5 2 1 6 14 Diphtheria and Membranous Croup 16 9 7 1 4 5 6 ... ... ... ... 6 4 1 4 ... 1 16 Influenza 111 40 71 ... ... 2 3 1 15 34 56 23 10 20 21 7 30 44 Erysipelas 8 5 3 1 ... ... ... ... 1 5 1 2 ... 2 ... 1 3 7 Cerebro-spinal Fever 3 1 2 ... 1 1 ... 1 ... ... ... ... 1 ... 1 ... 1 3 Other Epidemic Diseases 3 2 1 ... ... ... ... ... 2 1 ... 1 1 ... ... ... 1 2 Pulmonary Tuberculosis 245 157 88 ... 1 1 ... 49 101 76 17 34 27 30 43 34 76 141 Tuberculous Meningitis 16 7 9 4 1 2 5 4 ... ... ... 2 5 2 1 2 4 14 Abdominal Tuberculosis 4 2 2 ... 1 1 ... 2 ... ... ... 1 1 ... 1 ... 1 2 Other Tuberculous Diseases 23 13 10 2 3 1 3 3 6 4 1 4 2 2 1 2 12 20 Other Infective Diseases 14 12 2 5 ... ... 1 ... 1 4 3 3 ... 3 1 2 5 13 Cancer, Malignant Disease 546 216 330 ... ... ... 1 3 33 235 274 110 63 88 106 48 131 291 Rheumatic Fever 27 11 16 ... ... ... 4 5 6 11 1 1 5 3 6 4 8 15 Diabetes 41 17 24 ... ... ... 1 1 6 8 25 9 6 7 10 ... 9 27 Other General Diseases 65 23 42 ... ... ... 2 1 6 22 34 18 6 9 15 6 11 34 Alcoholism 4 2 2 ... ... ... ... ... 1 2 1 1 1 1 1 ... ... 2 Chronic Poisonings 1 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 MeningitiS 13 7 6 3 2 3 1 ... 3 1 ... 3 ... 1 2 2 5 11 Cerebral Haemorrhage, Apoplexy 101 44 57 1 ... ... ... ... 1 28 71 18 12 18 18 7 28 35 Convulsions 6 2 4 5 1 ... ... ... ... ... ... 2 1 1 ... ... 2 2 Other Diseases of Nervous System 105 61 44 3 ... 7 5 7 14 40 29 21 6 20 20 10 23 74 Organic Diseases of Heart 869 375 491 ... ... ... 1 4 25 178 661 150 69 158 167 69 256 396 Other Diseases of Circulatory System 309 151 158 1 ... 1 ... 6 9 89 203 55 46 51 74 22 61 114 Bronchitis 230 109 121 3 1 ... 1 3 12 40 170 58 18 39 35 24 56 49 Broncho-Pneumonia 70 32 38 18 4 6 1 ... 3 7 31 11 13 8 16 4 18 36 Lobar Pneumonia 50 26 24 ... 1 ... ... 1 9 18 21 9 5 7 12 5 12 14 Pneumonia (type not distinguished) 60 35 25 5 5 2 ... 4 11 21 12 13 5 10 9 7 16 46 Other Diseases of Respiratory System 34 16 18 ... 1 ... ... 1 3 14 15 6 5 2 3 5 13 15 Ulcer of Stomach 32 23 9 ... ... ... 1 ... 4 16 11 4 4 6 3 2 13 24 Diarrhœa 37 26 11 34 2 1 ... ... ... ... ... 3 2 7 3 5 17 35 Enteritis 31 16 15 26 1 1 1 ... ... 1 1 9 1 9 6 ... 6 22 Appendicitis and Typhlitis 30 19 11 ... ... ... 3 3 5 13 6 8 1 7 2 3 9 28 Obstruction of Intestines 22 12 10 ... ... ... ... ... 4 4 14 4 6 3 3 1 5 17 Cirrhosis of Liver 13 10 3 ... ... ... ... ... ... 6 7 3 ... 2 2 1 5 9 Other Diseases of Liver 29 8 21 ... ... ... ... ... 2 14 13 2 6 2 10 2 7 17 Other Diseases of Digestive System 58 36 22 ... ... 1 ... 2 17 22 16 10 5 8 17 9 9 41 Nephritis and Bright's Disease 176 82 94 1 ... ... 1 6 16 60 92 44 19 23 33 13 44 95 Other Diseases of Urinary System 72 62 10 1 ... ... ... ... 2 14 55 17 7 8 17 4 19 52 Diseases of Generative System 10 ... 10 ... ... ... ... ... 3 6 1 2 ... ... 4 1 3 9 Puerperal Fever 6 ... 6 ... ... ... ... 1 5 ... ... 2 ... 2 2 ... ... 6 Other Accidents and Diseases of Pregnancy and Childbirth 7 ... 7 ... ... ... ... 1 4 2 ... 1 ... ... 3 2 1 7 Premature Birth 59 35 24 59 ... ... ... ... ... ... ... 12 7 6 3 11 20 33 Congenital Debility and Malformation 45 22 23 40 1 ... ... 4 ... ... ... 8 5 7 8 10 7 26 Other Diseases of Early Infancy 26 16 10 26 ... ... ... ... ... ... ... 4 3 5 3 4 7 18 Old Age 170 54 116 ... ... ... ... ... ... 1 169 36 12 32 36 15 39 64 Deaths from Accident 129 88 41 7 3 3 5 10 23 43 35 27 13 16 21 13 39 111 Deaths from Suicide 62 43 19 ... ... ... ... 4 15 27 16 17 4 14 9 5 13 32 Other Violent Deaths 2 2 ... ... ... ... ... ... 1 ... 1 ... ... 1 1 ... ... 2 Other Defined Diseases 33 12 21 1 ... ... ... 3 6 8 15 4 4 7 13 2 3 25 Ill-defined Diseases or unknown 6 1 5 ... ... ... 1 2 ... 2 1 3 1 ... 1 ... 1 3 All causes 4088 1972 2116 261 48 55 56 135 376 1078 2079 791 415 661 772 372 1077 2138 8 Report of the Medical Officer of Health for 1932. The number of deaths shown on Table V. does not agree with that shown on page 100. The latter, which is prepared by the Registrar-General, gives the number of deaths which were registered during the calendar year, and the former the number of deaths which occurred during the year. The figures shown in Table V. are used in the calculation of all the mortality rates in this Report. Table VI. gives a comparative statement of the birth and death-rates in the Borough for the past 10 years, together with the same rates for London and England and Wales. TABLE VI. Birth-rates. Death-rates. Wandsworth. London. England and Wales. Wandsworth. London. England and Wales. 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 1931 12.26 15.0 15.8 11.30 12.4 12.3 Average 10 years 1403 17.4 17.7 10.93 12.1 12.1 1932 11.86 14.2 15.3 11.56 12.3 12.0 Vital Statistics. 9 The number of deaths which occurred in Institutions, etc., inside the Borough was 1,594, but 1,291 of these persons did not belong to the Borough. A total of 2,138 persons belonging to the Borough died in Institutions, 308 occurring in Institutions within the Borough and 1,835 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. oj deaths. Public Assistance Institutions:— General and Special Hospitals—contd.:— Wandsworth Public Assistance Hospitals 1,091 King's College Hospital 16 Banstead Mental Hospital 10 Middlesex Hospital 8 Cane Hill Mental Hospital 8 Park Hospital 8 Grove Park Mental Hospital 14 St. Batholomew's Hospital 11 Horton Mental Hospital 14 St. George's Hospital 7 Lambeth Hospital 7 St. Thomas's Hospital 62 Long Grove Mental Hospital 10 South Western Hospital 8 West Park Mental Hospital 11 Victoria Hospital 6 Other Mental Hospitals 23 West London Hospital 6 Other Public Assistance Institutions 73 Westminster Hospital 18 Other Institutions, Etc.:- — General and Special Hospitals;— Other Institutions 148 Other Places not Public Institutions 87 Belgrave Hospital 13 On Street 14 Bolingbroke Hospital 48 River Thames 3 Brompton Hospital 7 Private Nursing Homes 48 Cancer Hospital 10 1,835 Charing Cross Hospital 11 Colindale Hospital 9 Institutions, etc., inside the Borough 303 Guy's Hospital 14 2,138 Infants' Hospital 13 Infantile Mortality. The number of deaths under one year was 261.—-44 in Clapham, 26 in Putney, 48 in Balham, 25 in Streatham, 34 in 10 Report of the Medical Officer of Health for 1932. Tooting and 84 in Wandsworth. As the number of births was 4,197 the Infantile Morality rate was 62 per 1,000 births, compared with 59 last year. The infantile mortality rate is 62, compared with 62, the decennial average. The rate is lower than that for the whole of London, which was 66 per 1,000 births. For the 10 years ending 1918 the average infantile mortality rate was 87, while the 10 years ending 1931 the average rate was 56. This fall represents a saving of nearly 200 infant lives per annum. The number of deaths among legitimate infants was 241 to 3,998 births-—a mortality of 60 per 1,000 births, while the number of deaths among illegitimate infants was 20 to 199 births —a mortality of 100 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. 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 88 6 9 10 113 53 40 28 27 261 Uncertified - - - - - - - - - - Small-pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - 4 3 7 Scarlet Fever - - - - - - - - - - Whooping Cough - - - - - 3 1 1 2 7 Diphtheria and Croup - - - - - - 1 - - 1 Erysipelas - - - - - 1 - - - 1 Tuberculous Meningitis - - - - - - 2 1 1 4 Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - 1 1 2 Meningitis (not Tuberculous) - - - - - - - - 3 3 Convulsions 4 - 1 - 5 - - - - 5 Laryngitis - - - - - - - - - - Bronchitis - - - - - 1 - - 2 3 Pneumonia (all forms) 1 - - 3 4 7 3 5 4 23 Diarrhoea - - - - - 10 13 6 5 34 Enteritis 1 - - - 1 8 10 5 2 26 Gastritis - - - - - - - - - - Syphilis 1 - 1 1 3 - 1 - - 4 Rickets - - - - - - - - - - Suffocation, overlying - - - - - - - - - - Injury at Birth 6 - - - (j 2 1 - - 9 Atelectasis 19 - - - 19 - - - - 19 Congenital Malformations 8 3 1 - 12 5 2 2 1 22 Premature Birth 42 2 5 4 53 5 1 - - 59 Atrophy, Debility and Marasmus 2 1 1 2 6 8 - - - 14 Other Causes 4 - - - 4 3 5 3 3 18 Totals 88 6 9 10 113 53 40 28 27 261 Nett Births in the year : legitimate, 3,998; illegitimate, 199. Nett Deaths in the year of legitimate infants. 241; illegitimate infants, 20. 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 1932. TABLE VIII. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 1922 63 37 56 81 61 60 1923 50 40 49 50 63 55 52 1924 46 56 58 55 62 63 57 1925 54 64 38 42 63 57 52 1920 65 71 65 52 81 72 64 1927 44 75 50 47 71 45 51 1928 63 53 40 41 36 56 49 1929 65 38 62 44 69 74 61 1930 53 35 41 53 71 66 55 1931 48 56 49 66 65 63 59 Average for 10 years 55 52 51 50 66 61 56 1932 50 73 69 37 78 70 62 No. of deaths under 1 year, 1932 44 26 48 25 34 84 261 Maternal Mortality. Seven deaths occurred from accidents and diseases of pregnancy and six from Puerperal Fever, giving a total of 13 deaths after childbirth. This is equivalent to a rate of 3-0 per 1,000 births, compared with 4*8 in 1931. 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 576:—99 in Clapham, 57 in Putney, 91 in Balham, 89 in Streatham, 61 in Tooting, and 179 in Wandsworth. From all infective diseases the death-rate was 1 -62 per 1,000:—1-61 in Clapham, 1-64 in Putney, 1-68 in Balham, 1-30 in Streatham, 1-59 in Tooting, and 1-84 in Wandsworth. The rate in 1923 was, 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; in 1930, 2-26; and in 1931, 1-44 per 1,000. The rate is higher than in 1931, owing to the increase in the number of deaths from Influenza and Measles. The rate from the principal infective diseases, viz. :— Small-pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever and Diarrhoea, was -44 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; -35 in 1930; and -18 in 1931. The rate was -42 in Clapham, -28 in Putney, -54 in Balham, •26 in Streatham, -33 in Tooting, and -47 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 1932. 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 3o—io 45—65 65 and upwards Small-pox - - - - - - - - - - - - - - - Diphtheria 16 16 - 1 4 2 - 4 4 1 - - - - - Scarlet Fever 4 4 - - - 2 - 1 1 - - - - - - Enteric and Paratyphoid Fevers 1 - 1 - - - - - - - - 1 - - - Puerperal Fever 2 - 2 - - - - - - - - 2 - - - Puerperal Pyrexia 3 - 3 - - - - - - - - 2 1 - - Erysipelas 8 1 7 1 - - - - - - - 1 - 5 1 Whooping Cough 17 16 1 7 4 3 1 - 1 - 1 - - - - Pneumonia:— Acute Influenzal 30 - 30 - - - - - - - - 3 6 12 9 Acute Primary 66 13 53 5 4 1 1 1 1 - 1 8 6 22 16 Cerebro-Spinal Meningitis 5 4 1 - 1 - 1 1 1 - - 1 - - - Polio-myelitis - - - - - - - - - - - - - - - Encephalitis Lethargica 3 - 3 - - - - - - - - 2 - 1 - Malaria - - - - - - - - - - - - - - - Dysentery - - - - - - - - - - - - - - - Total 155 54 101 14 13 8 3 7 8 1 2 20 13 40 26 Non-Notifiable Diseases. Measles 37 35 2 7 11 7 2 1 7 - 1 1 - - - Influenza 82 5 77 - - 1 1 - 1 2 1 2 5 22 47 Diarrhœa 37 37 - 34 2 - 1 - - - - - - - - Other (if any) - - - - - - - - - - - - - - - Total 156 77 79 41 13 8 4 1 8 2 2 3 5 22 47 Grand Total 311 131 180 55 26 16 7 8 16 3 4 23 18 62 73 Infective Diseases. 15 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 12 3 9 - - - - - 1 2 4 2 2 1 - Diphtheria 323 259 64 5 14 27 26 27 112 48 26 28 7 3 - Scarlet Fever 763 640 123 1 14 43 39 64 346 133 49 58 11 5 1 Enteric Fever and Paratyphoid Fever 15 4 11 - - 1 - - 1 2 4 5 1 1 - Puerperal Fever 17 - 17 - - - - - - - 1 12 4 - - Puerperal Pyrexia 31 - 31 - - - - - - - 1 26 3 - - Erysipelas 136 13 123 1 - 1 1 - 6 4 4 28 18 42 31 Whooping Cough 542 538 4 37 55 62 68 83 220 13 3 1 - - - Pneumonia:— Acute Influenzal 138 16 122 1 1 1 1 3 6 3 5 21 21 46 29 Acute Primary 427 165 262 28 27 13 8 17 59 13 23 65 44 92 38 Cerebro-spinal Meningitis 6 5 1 — 1 1 1 1 1 - - 1 - - - Polio-myelitis 6 4 2 — — — — 1 2 1 — 2 — - — Encephalitis Lethargica 3 - 3 - - - - - - - - 2 — 1 — Malaria 2 - 2 - - - - - - - - 1 1 - - Dysentery - - - - - - - - - - - - - - - Food Poisoning 15 7 8 — — — 1 2 3 1 1 2 2 3 Total 2436 1654 782 73 112 149 145 198 757 220 121 254 114 194 99 16 Report of the Medical Officer of Health for 1932. 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 8 - 1 1 1 1 12 12 Diphtheria 73 17 40 49 29 115 323 316 16 Scarlet Fever 161 84 146 96 104 172 763 655 4 Enteric and Para-typhoid Fevers — 3 — 3 2 7 15 13 1 Puerperal Fever 2 2 3 3 2 5 17 17 2 Puerperal Pyrexia 10 3 2 8 — 8 31 19 3 Erysipelas 15 14 20 17 34 36 136 53 8 *Whooping Cough 52 45 100 48 59 238 542 25 17 Pneumonia—Acute Influenzal 12 16 20 19 29 42 138 — 30 Pneumonia—Acute Primary 61 25 55 48 59 179 427 — 66 Cerebro-spinal Meningitis 1 1 — 1 1 2 6 5 5 Polio-myelitis 2 1 1 1 1 — 6 5 — Encephalitis Lethargica 1 1 — — — 1 3 2 3 Malaria .. .. .. — — — — — 2 2 — — Dysentery — — — — — — — — — Food Poisoning 2 1 3 2 5 2 15 — — Total 400 213 391 296 326 810 2436 1122 155 Tuberculosis—all forms 92 82 81 119 121 174 669 — 288 Ophthalmia Neonatorum 9 3 9 2 2 10 35 16 — Total 101 85 90 121 123 184 704 16 288 Grand Total 501 298 481 417 449 994 3140 1138 443 * Whooping Cough ceased to be notifiable on April 23rd, 1932. Infective Diseases. 17 The total number of cases, less Tuberculosis and Ophthalmia Neonatorum, was 2,43G, compared with 3,762 in 1931, 3,991 in 1930, 5,246 in 1929, and 4,149 in 1928. The decrease, compared with previous years, is mainly due to the fact that Whooping Cough ceased to be notfiable in April. Small-pox. During the year 12 cases of Small-pox occurred, compared with four cases in 1931. There were no deaths. Nine of the patients had never been vaccinated, two of them, both adults, one aged 42 and the other 56, were vaccinated in infancy, and the other case was a woman who was exposed to infection and vaccinated too late to protect her against an attack of the disease. She was vaccinated three days before the disease developed. Vaccination. Table XII. is taken from the official returns of the Vaccination Officers for the year 1931. It shows the number of children successfully vaccinated for the whole Borough, as well as for the separate sub-districts. The percentage of children vaccinated to total births was 53-0—in Clapham, 50-9; in Putney, 68-1; in Balham, 50-7; in Streatham, 50-7; in Tooting, 37-4; in Southfield, 62-2; and in Springfield 55-9. This percentage is lower than that recorded last year. c 18 Report of the Medical Officer of Health for 1932. TABLE XII. SubDistricts. Number of Births returned from 1st January to 31st December, 1931. 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 586 296 2 — 21 169 4 19 29 46 Putney 308 210 — — 10 48 4 8 6 22 Balham 4 83 245 6 — 23 136 — 9 37 27 Streatham 697 349 7 — 38 177 1 30 63 32 Tooting 377 141 2 — 19 163 1 8 13 30 Southfield 524 326 3 — 14 138 1 3 32 7 Springfield 345 193 2 — 16 93 4 5 14 18 Totals 3,320 1,760 22 — 141 924 15 82 194 182 Diphtheria. 323 cases occurred, compared with 393 in 1931; 866 in 1930; and 724 in 1929. The number of deaths was 16, compared with 17 in 1931. The death-rate for 1932 was -04 and the case mortality was 4-9 per cent. The rate per 1,000 of population was *91: 1-19 in Clapham; -48 in Putney; -74 in Balham; -72 in Streatham; •75 in Tooting; and 1-18 in Wandsworth. Of the 323 cases, 316 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 School, in Clapham; The Furzedown School, in Streatham; St. Ann's, The Royal Victoria Patriotic, and Waldron Road Schools, Wandsworth. Swabs were taken from the throats of some of the children examined. As the result of this swabbing six 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 37 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. 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. c 2 20 Report of the Medical Officer of Health for 1932. 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 is given on the same day. The solutions now used for immunisation are toxoid anti-toxin mixture (T.A.M.) and the newer floccular preparation (T.A.F.), each injection consisting of one c.c. The results obtained with the floccular preparation have been good, and an additional advantage in using this solution is that only two injections are required, while with T.A.M. three are necessary to produce the same result. As the injections have to be given at weekly intervals, the number of visits to the Clinic is reduced when T.A.F. is used. As experience has shown that the large majority of children under 5 years of age give a positive Schick test, in order to save time, the procedure is modified in their case by omitting the preliminary test and the first immunising injection is administered at the first attendance. 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 1980, 684 in 1931 and 973 in 1982, making a total of 4,822 in five 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. 3,314 of the total number who attended were given the Initial Schick Test to see if they were susceptible to Diphtheria, and the remaining 1,008 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 excluding those who failed to attend for the test to be read. The essential fact brought out by this Table is that 2,289 persons gave a positive result to the initial Schick Test showing that they were susceptible to Diphtheria. This is 69 per cent. The highest proportion of positive results occurs in the lowest age group and the proportion diminishes as age advances. This is in accordance with the known facts about the Schick Test. Of the small number of adults who were tested 51 per cent, gave a positive result. Immunisation:—In order to produce immunity three injections of T.A.M. or two of T.A.F. 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 to be performed. This is generally known as the Re-Schick Test. 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 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 3,297. This number is made up of the 2,289 who were found to be Schick positive after the initial test, and the 1,008 young children who were assumed to be susceptible without a test, as they were under five years of age. The 22 Report of the Medical Officer of Health for 1932. 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 145 1340 518 1018 985 2003 177 109 1038 1251 2289 Schick Negative 21 385 334 356 384 740 138 100 375 603 978 Result not read 1 24 15 14 26 40 4 3 14 33 47 Total 167 1749 867 1388 1395 2783 319 212 1427 1887 3314 Percentage Positive 87% 76% 60% 73% 70% 72% 55% 51% 73% 66% 69% 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 770 992 329 990 1101 2091 57 51 1000 1199 2199 24 Report of the Medical Officer of Health for 1932. subsequent history of these 3,297 persons is given in the following statement:— No. who were immunised and found to be Protected as shown by a Negative re-Schick Test 2199 No. who received a course of injections but are not yet protected as the re-Schick Test is still positive 152 No. who received injections, the value of which is not known as they have not attended to be re-tested 887 Schick positive cases who were not injected 59 Total number of Susceptibles 3297 The age grouping of these protected persons is given in Table XIV. The time taken for immunity to be produced and the number of injections of the immunising substance required to produce it are given in some detail in Table XV. This table shows that most of the persons who were immunised—viz. 1,976 out of the 2,199—became negative after one series of injections, while the remaining 223 required further injections to produce the same result. The number who were found to be immunised after one or two injections is now 168. This number has increased from 21 a year ago and is due to the more extensive use, in the year under review, of the floccular immunising preparation which only requires two injections, as stated above. 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 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. 25 Infective Diseases, 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 11 118 14 5 148 2 2 — 152 3 injections 562 679 285 102 1628 57 26 9 1720 4 injections 5 5 — 2 12 — — — 12 Second Series 3 to 6 injections — — 5 84 89 51 33 18 191 Third Series 5 to 8 injections — — — — — 7 5 2 14 Total Under 15 578 803 305 193 1879 117 66 29 2091 Adults Over 15. First Series 2 injections — 13 — — 13 1 — — 14 3 injections 25 28 14 4 71 3 1 — 75 4 injections — 1 — — 1 — — — 1 Second Series 3 to 6 injections — — 3 7 10 4 2 — 16 Third Series 11 injections — — — — — — — 1 1 Fourth Series 8 injections — — — — — — — 1 1 Total All Ages 603 845 322 204 1974 125 69 31 2199 26 Report of the Medical Officer of Health for 1932. 1,448 of the persons who have been protected gave a negative re-Schick test within six months after receiving the last dose of immunising serum and a further 526 were negative within twelve months. This means that 1,974 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 2,199 persons who have been protected, 152 have completed the first series of injections but cannot be recorded as protected because the last re-Schick test has given a positive result. 63 of these have not attended since this positive re-test. 76 of them have attended and have received a second series of injections but have not yet been re-tested after this series. In 12 cases the re-Schick test after the second series was still positive and they have received a third series of injections. In one case a fourth series of injections was given as the re-Schick test after the third series was still positive. A further 887 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 623 who completed the first series of three injections and 264 who only received one or two doses. 59 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-Lœffler 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 1932. This child developed the disease before immunity was established, as shown by the positive re-test. Case No. 4.—A girl who at the age of 14 months received three immunising doses without a primary Schick Test—she was not brought for re-Schick 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 have been obtained from seven 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 eight cases was there any definite clinical evidence that they were suffering from Diphtheria and this was no doubt due to the fact that they had become insusceptible to the disease. Scarlet Fever. 763 cases of Scarlet Fever occurred, compared with 678 in 1931, 981 in 1930 and 899 in 1929. 29 Infective Diseases. Four cases died, compared with three and six respectively for the two previous years, and the death-rate was .011 per 1,000 compared with .008 and .01. The case mortality was .52 per cent. The case-rate per 1,000 of population was 2.15:—2.68 in Clapham; 2.41 in Putney; 2.70 in Balham; 1.40 in Streatham; 2.71 in Tooting; and 1.77 in Wandsworth. Of the total number of cases, 655 or 85 per cent., were removed to hospital. The Medical Officers of the London County Council made inspections of 17 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. 39 cases of Scarlet Fever and three of Diphtheria occurred within one month of the return of a previous case from hospital. Enteric and Para-Typhoid Fevers. 15 cases, and one death of the above occurred, compared with seven cases and no deaths in the previous year. Eight of the cases were true Enteric Fever and seven were Para-typhoid Fever. Puerperal Fever and Puerperal Pyrexia. During the year 17 cases of Puerperal Fever and 31 cases of Puerperal Pyrexia occurred. Six of the cases died. The death-rate was 0.16 per 1,000 of population and 1.42 per 1,000 births. Erysipelas. 136 cases were notified and eight deaths occurred during the year, compared with 133 and nine in 1931. Whooping Cough. Seventeen deaths from Whooping Cough occurred during the year and the death rate was .04 per 1,000. 30 Report of the Medical Officer of Health for 1932. In March, 1932, the Council decided, with the approval of the Minister of Health, to revoke their resolution of May, 1918, making Whooping Cough a notifiable disease in Wandsworth, and it ceased to be notifiable as from 23rd April, 1932. From 1st January to this date 542 cases were notified. 131 of the cases were removed to hospital during the year. 720 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Whooping Cough occurred, and 31 premises were disinfected. Influenza. The number of deaths from Influenza was 111 compared with 97 in 1931, 22 in 1930, 237 in 1929, 41 in 1928 and 136 in 1927. The death-rate was .31 per 1,000. Influenzal Pneumonia and Acute Primary Pneumonia. 138 cases of acute Influenzal Pneumonia and 427 cases of acute Primary Pneumonia were notified. 30 of the former and 66 of the latter died. The total number of deaths credited to all forms of Pneumonia during the year was 180 compared with 191 in 1931, 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. Six cases of this disease occurred. Five of them terminated fatally. A further 13 deaths were registered as being caused by Meningitis. Two other cases of this disease were notified, but proved not to be cerebro-spinal meningitis. Polio-myelitis and Polio-encephalitis. Six cases and no death occurred. One child was admitted during the year for treatment at Queen Mary's Hospital, Carshalton, under the scheme provided by the L.C.C. Infective Diseases. 81 Encephalitis Lethargica. Three cases of this disease occurred and one death was registered. Two other cases were notified, but as they were found, after further investigation, to be suffering from some other disease, they are not included in these figures. Malaria. Two cases were notified. No death occurred. Dysentery. No cases of Dysentery were notified and no deaths occurred. Ophthalmia Neonatorum. In 34 of the cases there was no impairment of vision, but one of the infants lost its sight. Two of the 35 cases afterwards died of Enteritis, one of them being the blind infant. TABLE XVI. Result of Treatment. Recovered— Vision not affected. Vision Impaired. Total Blindness. Died. Treatment received :— In Hospital 14 — — 2 At Hospital, Out-patient 1 — — — At home 18 — — — Total 33 — — 2 Measles. The number of cases brought to my notice during the year October 1st, 1931, to September 30th, 1932, was 3,601. The 32 Report of the Medical Officer of Health for 1932. majority of these cases were reported by teachers at the elementary schools, and in arriving at this figure 158 cases, which proved after investigation not to be suffering from Measles, are excluded. 37 cases died during the calendar year, and 38 during the epidemic year. 116 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. 500 cases were removed to hospital, compared with 167 in the epidemic year of 1930. 100 cases requiring special home nursing were referred to District Nursing Associations in the Borough, compared with 95 in 1930, and the nurse made 997 visits to these cases, compared with 1,003 in 1930. The death-rate per 1,000 of the population was .10, compared with .13 in 1930, and .10 in 1928. 5,305 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Measles occurred, and 272 premises were disinfected at the request of the occupiers. 33 Infective Diseases. TABLE XVII. MEASLES—CASES REPORTED AND DEATHS. Period 1st October—30th September. 1922-23 1923-24 1924-25 1925-26 1926-27 1927-28 1928-29 1929-30 1930-31 1931-32 Cases Reported. In a Measles year — 3,905 — 4,219 — 4,596 — 4,046 — 3,601 In a Non-Measles year 160 — 293 — 81 — 355 — 295 — Deaths. In a Measles year — 80 — 52 — 38 — 46 — 38 In a Non-Measles year — — 1 — 2 — 1 — 2 — Period. Calendar Year 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 Cases Reported 663 3,418 474 4,028 172 4,529 380 3,976 291 3,598 Deaths 11 71 1 51 4 36 1 47 2 37 34 Report of the Medical Officer of Health for 1932. Table XVIII. shows the number of cases of infective diseases which occurred in the individual elementary schools during the year. TABLE XVIII. School. Diseases. Scarlet Fever. Diphtheria. Measles. j German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases Totals. Clapham. Bonneville Road 10 8 78 - 35 15 11 - 14 171 Cavendish Road 30 3 23 - 22 43 6 1 1 129 Cavendish Road Special 1 1 1 - 1 — — - — 4 Christchurch 3 2 34 - 1 1 24 - — 65 Clapham Parochial, Macaulay Rd. 4 — 2 - — — 3 - — 9 Haselrigge Road 5 8 72 - 5 9 23 1 18 141 Henry Thornton, South Side 3 — 7 - 1 — 1 - 1 13 Larkhall Lane 6 3 34 - 2 10 9 1 25 90 New Park Road 27 9 96 1 18 15 2 - 5 171 New Road 2 — 8 - 1 — 1 - — 12 St. Andrew's Street — 8 28 - 6 11 57 - 1 111 St. Mary's, Crescent Lane — 2 6 - - — 1 - — 9 Stonhouse Street 13 1 40 1 5 18 2 - 1 81 Telferscot Road 42 6 82 - 12 6 18 - 6 172 Putney. All Saints' 1 1 — - — — 2 - — 4 Hotham Road 35 — 58 3 26 22 47 - 36 227 Huntingfield Road 11 1 79 1 6 1 2 - 3 104 Parochial, Roehampton 4 1 33 — 4 1 1 - — 44 St. Mary's 8 — 29 — 1 1 10 - 3 52 Upper Grade 1 — 2 3 Balham. Bec, The 1 - - - - - — - — 1 Broadwater Road 9 4 62 3 8 4 — - 2 92 Fircroft Road 21 — 61 — 10 4 1 - 5 102 Hearnville Road 6 2 10 7 34 — — - 1 60 Holy Trinity, Balham 6 3 10 — 33 8 — - 2 62 Nightingale Square, R.C. 7 1 26 — 10 — 1 - — 45 Oldridge Road 8 2 30 1 8 5 1 - 8 63 Ravenstone Street 4 1 81 — 6 8 13 1 — 114 St. Mary's 25 — 74 — 33 21 — - 10 163 Smallwood Road 11 3 76 8 20 10 7 - 2 137 Carried forward 304 70 1142 25 306 213 243 4 144 2451 35 Infective Diseases. TABLE XVIII.— continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 304 70 1142 25 306 213 243 4 144 2451 Streatham. Christchurch 1 — 1 - - - - - - 2 Eardley Road 6 2 63 1 9 23 5 — 1 110 Furzedown Demonstration 4 2 11 1 10 7 3 — 13 51 Granton Road 4 — 58 — 3 — 51 3 1 120 Hitherfield Road 3 — 127 4 15 40 2 — — 191 Holy Trinity 2 — — — — — — — 2 4 Immanuel — — — — 5 — — — — 5 Mitcham Lane 8 4 149 — 6 62 1 — 3 233 New School, Leigham Court Road 4 - - - - - - - - 4 St. Andrew's, Colraer Road 1 1 - - - - - - - 2 St. Andrew's, Coventry Hall 1 - - - - - - - - 1 St. Andrew's, Polworth Road 1 1 1 1 4 15 2 — — 25 St. Leonard's 5 — 46 2 4 13 3 — 1 74 Sunnyhill Road 3 2 32 — 26 7 11 — 5 86 Woodmansterne Road 2 3 144 — 6 26 37 1 7 226 Tooting. Convent of Holy Family 2 - - - - - - - - 2 Ensham Central 3 — - - - - - - - 3 Ensham 3 2 14 3 6 31 — — 6 65 Defoe (Fountain Road) 2 1 21 3 — 4 — — — 31 Franciscan Road 3 1 2 3 — — — — 1 10 Hillbrook Road 5 1 95 15 8 22 19 — — 165 Sellincourt Road 22 3 67 1 8 12 2 — 3 118 Tooting Graveney 1 1 36 — — 2 1 — — 41 Undine Street, R.C. - 3 23 — 3 - — — — 29 Wandsworth. Allfarthing Lane 7 4 64 - 11 23 13 2 4 128 All Saints' 1 — 9 — 2 3 25 — 2 42 Brandlehow Road 6 — 25 — 2 1 46 — - 80 Earlsfield 3 2 43 — 12 8 22 - 3 93 Elliott Central - 1 - - - - - - - 1 Eltringham Street 7 3 110 — 7 9 5 2 1 144 Frogmore Special 1 1 2 — 1 — 7 1 5 18 Garratt Lane 4 5 30 — 39 11 — — 3 92 Magdalen Road - - 19 6 10 3 - — - 38 Carried forward 419 113 2334 65 503 535 498 13 205 4685 D 2 36 Report of the Medical Officer of Health for 1932. TABLE XVIII.—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 419 113 2334 65 503 535 498 13 205 4685 Merton Road 7 1 6 - 12 14 12 - 1 53 Riversdale 9 2 66 1 18 19 10 — 1 126 St. Ann's 2 5 1 — — 4 1 — 1 14 St. Faith's 2 — 43 — 3 23 3 — — 74 St. Joseph's — — 15 — 24 1 — — — 40 St. Michael's 4 — 27 — 16 8 — — 2 57 Swaffield Road 6 6 83 — 20 8 2 2 2 129 Waldron Road 7 3 67 9 11 2 11 4 3 117 Wandle 3 3 70 1 14 11 7 — 13 122 " Warple Way 1 — 31 — 8 7 15 — — 62 West Hill 8 2 54 - 44 8 35 2 153 Grand Total 468 135 2797 76 673 640 594 19 230 5632 Diarrhoea. The number of deaths from Diarrhoea was 68 compared with 27 in 1931, 33 in 1930, 35 in 1929 and 40 in 1928, and of these 60 or 88 per cent., were under the age of one year, compared with 24 in 1931. The number of deaths from Diarrhoea, Zymotic Enteritis and Enteritis under one year represents 22-9 per cent, of the total mortality at that age. Scabies. The names of 94 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 87 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 43 other cases were reported to me. These cases were treated at the Council's disinfecting station with sulphurated potash baths, and in every case the disease was cured. The average number of baths given per case was three. Other Infective Diseases. 12 deaths occurred, six from Septicaemia, five from Syphilis; and one from Toxaemia. 38 NON-INFECTIVE DISEASES. The total number of deaths from Cancer and malignant disease was 510, the number of males being 210 and females 880. The corrected death-rate was 1.54 per 1,000 for the whole Borough:—1.70 for Clapham; 1.81 for Putney; 1.62 for Balham; 1.54 for Streatham; 1.25 for Tooting; and 1.85 for Wandsworth. The number of deaths in 1982 was 20 less than in 1931. The number of deaths from diseases of the Brain and Nervous System was 124. 1,27!) deaths occurred from diseases of the Heart and Circulatory System, compared with 1,197 in 1981, 1,000 in 1080, and 1,277 in 1929. 985 of these deaths were of persons over 65 years of age. There were 444 deaths from diseases of the Respiratory System, compared with 492 in 1981, 420 in 1980, and 784 in 1929. The number from Bronchitis was 28 compared with 270 in 1981, and from Pneumonia (all forms) 180 compared with 191 in 1981. Further particulars relative to Pneumonia are given on page 80. The number of infants tinder two years of age who died from these diseases was 88. 130 deaths, 78 males and 57 females, were registered as due to Premature Birth and Developmental Diseases, compared with 146 in 1981. 170 deaths, 54 males and 116 females, occurred from Old Ago, and all these except one were persons over 65 years of age. The number of deaths due to this cause in 1981 was 140 198 deaths were due to Violence, 129 of them being due to accident, 62 to suicide, and two to other forms of violence. Inquests. Inquests were held on 294 persons dying in the Borough, and on 107 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 37 20 38 49 23 56 223 Accidental:— Knocked down by motor vehicles 6 8 6 3 2 14 39 Falls from vehicles 5 1 5 5 4 1 21 Falls 2 4 2 — 1 7 16 Falls from a height 2 — — 2 4 3 11 Suffocation — 1 2 2 1 2 8 Burns and scalds 2 — — 4 — 2 8 Knocked down by train 1 — — 1 — 3 5 Drowning 1 2 — — — 1 4 Deaths under anaesthetics 2 - - 1 - 1 4 Other 2 — 3 1 2 — 8 Suicidal:— Poisoning by:— Coal Gas 3 2 9 2 2 6 24 Lysol 2 1 2 — 1 2 8 Carbolic Acid 2 - - - - - 2 Cyanide of Potassium 1 - - - - - 1 Yew Leaves - - - - - 1 1 Phosphorus — — 1 — — — 1 Camphor Liniment — — — 1 — — 1 Aspirin - - - - - 1 1 Corrosive — — — 1 — — 1 Cut throat 3 — — 2 — — 5 Drowning 1 3 — 1 — — 5 Gun shot wounds 2 — 1 — 1 — 4 Fall from window — - - 1 — 2 3 Hanging 1 — 2 — — — 3 Knocked down by train — — — 1 — — 1 Found drowned 1 1 - - - 2 4 Found dead - 1 - - — — 1 Totals 76 44 71 27 41 104 413 40 TUBERCULOSIS. Notification.— The total number of new cases of Tuberculosis which came to the notice of the Department during 1932 was 642, as compared with 613 in 1931, 638 in 1930, 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 642 new cases notified, in 1932 were as follows :— Primary notifications on Form A 508 Primary notifications on Form B Transfers from other Sanitary Authorities 134 Naval and military notifications Total 642 Un-notified at death 27 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. Non- Pulmonary. Pulmonary. NonPulmonary. Males. Females. Males. Females. Males. Females. J Males. Females. Under 1 year 3 1 2 - - - 3 3 1—5 2 4 3 7 1 - 6 4 5—10 2 3 16 9 — - 1 1 10—15 4 7 14 7 1 3 4 2 15—20 27 36 7 10 9 13 2 1 20—25 55 52 1 6 26 14 1 4 25—35 73 84 9 9 24 31 1 2 35—45 51 35 5 1 32 13 4 1 45—55 32 13 2 — 26 5 — 1 55—65 21 7 3 2 25 4 — — 65 upwards 9 5 1 2 13 5 — 2 Totals 279 247 63 53 157 88 22 21 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 15 8 7 Glands, Mesenteric 20 13 7 Glands, Cervical 29 14 15 Bones and Joints 30 14 16 Skin 3 1 2 Other Parts 19 13 6 Totals 116 63 53 Table XXII. gives a summary of all the cases of Tuberculosis notified since 1909. 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 the pulmonary and non-pulmonary forms of the disease. The figures for the first 20 years, from 1909-1928 are given in quinquennial periods, while those for the last four years are shown separately. Patients classified as "recovered" are those who have shown no evidence of active disease for at least five years. TABLE XXII. 1909 to 1928 in 5 year periods. 1929 1930 1931 1932 Totals. 1909— 1913 1914— 1918 1919— 1923 1924— 1928 Pulmonary Tuberculosis:— Cases reported 2830 2336 2769 2630 586 526 529 526 13164 Died 1091 1386 1030 1298 284 262 296 266 6143 Recovered 76 10 49 109 25 12 134 91 529 Removed or untraced 724 831 835 1525 137 105 198 293 4807 Remaining on Register 959 1068 1923 1621 1761 1908 1809 1685 1685 Non-Pulmonary Tuberculosis:— Cases reported 323 791 745 695 104 112 84 116 2970 Died 46 382 198 208 25 20 31 45 955 Recovered — 41 46 91 17 18 61 59 333 Removed or untraced 9 116 319 493 46 21 64 60 1128 Remaining on register 268 520 702 605 621 674 602 554 554 Total on Notification register at end of each period 1227 1688 2625 2226 2387 2582 2411 2239 2239 42 Report of the Medical Officer of Health for 1982. Tuberculosis. 43 Deaths.— The total number of deaths certified as due to diseases of a Tuberculous nature was 288—of whom 179 were males, and 109 females. 245 deaths were due to Pulmonary Tuberculosis and 48 to other forms of Tuberculosis. Table XXIII. gives further details regarding the type of the disease, and sex, of these 288 deaths. TABLE XXIII. Localisation. Males. Females. Total. Pulmonary and Acute Miliary Tuberculosis 157 88 245 Brain 7 9 16 Glands, Mesenteric 2 2 4 Bones and Joints 2 — 2 Other Parts 11 10 21 Totals 179 109 288 In addition to these deaths, which were duly certified in the returns as due to Tuberculosis, 20 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.) Thirteen were certified as dying of diseases other than Tuberculosis. (b.) Seven had previously moved outside the Borough and died there, the death being credited to the area in which it occurred. 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 TABLE XXIV. 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 Pulmonary Tuberculosis :— No. of Deaths 269 244 261 255 300 269 320 275 288 245 Death-Rate .80 .71 .75 .73 .85 .76 .90 .77 .81 .69 Other Forms :— No. of Deaths 50 50 49 40 39 35 33 33 19 43 Death-Rate .14 .14 .15 .12 .11 .10 .09 .09 .05 .12 Total:— No. of Deaths 319 294 310 295 339 304 353 308 307 288 Death-Rate .94 .86 .90 .84 .96 .86 .99 .86 .86 .81 Report of the Medical Officer of Health for 1982. Tuberculosis. 45 During the year 27 persons, not previously notified, were certified as having died of Tuberculosis. The proportion of unnotified to total Tuberculosis deaths is therefore 9.4 per cent. 19 of the un-notified deaths were certified from Institutions three by private doctors, while in five 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. 62 persons died within one month after notification, 89 with three months, and 110 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 1982.—The following Table shows the number of new cases which atended 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. 151 10 161 52 271 484 F. 147 11 158 54 202 474 Children M. 4 11 15 10 230 207 F. 5 10 15 8 229 252 Totals 307 42 349 130 998 1477 In addition to the above, 90 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 1,477 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 52 35 71 47 72 130 407 Private Practitioners 60 44 100 164 109 169 546 Charitable Societies 8 10 15 5 19 23 80 Other Dispensaries 24 16 9 10 13 38 110 L.C.C. Schools 2 6 1 2 8 12 31 Ministry of Pensions — 1 — 1 — — 2 Existing Dispensary Patients 2 1 — — 2 11 16 Other Sources 21 45 — 26 67 126 285 Totals 169 158 196 155 290 509 1,477 Contacts.—Of the 1,477 new cases examined, 372 were contacts. Three 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., 1931 New Cases Removed from Register Remaining on Register 31st Dec., 1932 Pulmonary 1115 378 373 1120 Non-Pulmonary 282 61 72 271 Suspected cases 37 316 223 130 Totals 1434 755 678 1521 48 Report of the Medical Officer of Health for 1932. 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 90 2. Number of patients transferred to other areas and cases " lost sight of " 164 3. Died during the year 289 4. Number of observation cases in which period of observation exceeded 2 months 98 5. Number of attendances at the dispensaries 5455 6. Total number of reports, etc., made in connection with the dispensaries 4867 7. Number of attendances at General Hospitals or Institutions of patients for :— (a.) Light treatment 663 (b.) Other special forms of treatment 874 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 226 (b.) Otherwise 2336 10. Number of other visits by Tuberculosis Officers at homes 191 11. Number of visits by Health Visitors or Nurses to homes for dispensary purposes 5572 12. Number of :— (a.) Specimens of Sputum, etc., examined 1664 (b.) X-ray examinations made in connection with dispensary work 123 The number of patients who received institutional treatment under the London County Council's Tuberculosis Scheme during 1932 was as follows:— (a.) In Hospitals for observation 37 (b.) In Sanatoria 430 (c.) In Hospitals for Advanced Cases — Total 467 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 inaugurated in 1913. The reports are of much value, and the scheme is now extended to include Artificial Light and X-Ray treatment. The arrangements made for treatment by the Artificial Pneumothorax method with several hospitals have been continued. 68 cases were treated during the year and 874 refills administered. The Council's liability was £458 17s. Od. 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. '28 patients received dental treatment and 16 of these were supplied with dentures. The attendances at the dentist totalled 86. The amount expended on dental treatment during the year was £16 5s. Od., and the cost of dentures supplied to patients was £42 5s. Od., making a total cost of £58 10s. Od. 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 e 50 Report of the Medical Officer of Health for 1932. the chances of recovery, or will enable the patient to remain at work or to return to work at an early date. During the year under consideration 132 patients have been granted extra nourishment under the scheme at a cost of £132 9s. 2d. 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 1932 as far as it is known. Table XXIX. refers to cases of Pulmonary Tuberculosis and Table XXX. to cases of Nonpulmonary Tuberculosis. 51 Tuberculosis Dispensaries. TABLE XXIX. Classification on Initial attendance at the Dispensaries. Condition at the end of 1932. 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. 393 28 63 204 688 1735 686 2421 Class T.B. Minus. Adults, F. 441 34 98 305 878 Children 114 9 19 27 169. Adults, M. 110 64 329 1412 1915 3400 945 4345 Class T.B. Plus. Adults, F. 75 46 291 1034 1446 Children 7 2 7 23 39 e2 52 Report of the Medical Officer of Health for 1932. TABLE XXX. Classification on Initial attendance at the Dispensaries. Condition at end of 1932. 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. 40 8 22 12 82 254 91 345 Adults, F. 17 7 18 9 51 Children 58 9 27 17 111 Abdominal Adults, M. 8 1 7 2 18 81 45 126 Adults, F. 9 1 11 1 22 Children 24 3 8 6 41 Peripheral Glands Adults, M. 12 1 7 3 23 316 107 423 Adults, F. 29 5 15 8 57 Children 194 16 26 10 236 Other Organs. Adults, M. 14 2 7 9 32 115 36 151 Adults, F. 15 1 18 7 41 Children 15 1 7 19 42 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. 1928 1970 1457 476 1929 2068 1486 474 1930 1944 1254 447 1931 2157 1557 410 1932 1664 1001 342 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 Mrs. J. Dewar Robertson, M.B.E., J.P. Councillor T. Harding. Councillor W. Greener, F.C.R.A. Councillor H. H. S. Aram, F.I.M.T. Councillor A. A. Norman. Councillor Mrs. Godber. 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 Insurance 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. P. Harvey, Aged Poor Society. Miss L. C. Marx, Brompton Hospital. Miss E. C. Morris, S. Thomas's Hospital. 54 Report of the Medical Officer of Health for 1932. Mr. L. M. Shepherd, J.P., Fairlight Hall, Tooting. Mrs. Baker, British Legion and United Services Fund (Wandsworth Area). Mrs. Nicol. Miss J. M. Duff. Mrs. Halfhide. Dr. Elizabeth Higgins. Mrs. Jeans. Mrs. Cresswell. Mrs. Roberts. Mrs. Parsons. Mrs. Dixon. Mrs. Laer. Mrs. Arding. Mrs. Tomson. Mrs. McKerrow. Officers of the Committee:— Chairman : Councillor T. Harding. Vice-Chairman : Miss J. M. Duff. Hon. Treasurer : Mrs. Nicol. Secretary : Miss M. L. Baptie. Councillor Mrs. J. Dewar Robertson was elected Chairman on 16th December. Meetings.—The Care Committee meets at the Council House East Hill, Wandsworth, every six weeks on Friday afternoon at 3.30 p.m. The Assessment Sub-Committeee meets on alternate Friday afternoons at 2.30 p.m., at the Public Health Department. 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 55 Tuberculosis Dispensaries. 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 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. There is 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. 142 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 56 Report of the Medical Officer of Health for 1982. then recommended for free treatment. During the year the Committee has undertaken the assessment of 415 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 £850 5s. 6d. 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 grants from public funds were provided and certain members of the Committee therefore decided to organise a voluntary fundA 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 are available to grant assistance of this nature, but the money collected 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 are unable to pay, all the cases being investigated by the Secretary. 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 non-payment 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 £17 0s. 6d. Advances are also made to meet arrears in Insurance payments. As already mentioned a certain amount of clothing is purchased out of this Fund. During 1932 eight patients were sent to convalescent homes at a cost of £46 8s. Od. The Committee has collected 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. In 1932 1,010 cases were visited and interviewed by the Secretary. 58 cases were referred to and helped by the various exservice organisations. About 70 per cent. of the cases sent to Institutions were supplied with clothing, either from the stock 57 Tuberculosis Dispensaries. collected by the Committee or purchased out of the voluntary fund. The amount spent on clothing was £13 12s. Od. 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 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 Class is maintained by the Committee's fund. It meets at 79, East Hill, Wandsworth, every Tuesday morning at 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. A successful sale of articles made by patients at the Handicraft Class was held in October at the Carpenter's Hail, 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. 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, Lynwood Road, Springfield, Fairfield, Streatham Hill and Putney. 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 visted 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, 59 Maternity and Child Welfare. 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 to other Institutions for mothers and 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 1932. TABLE XXXI. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. No. of children visited:— Under 1 year 769 399 459 537 590 984 3738 1-2 years 88 28 19 98 10 8 251 2-5 years 53 15 7 35 2 5 117 Revisits to :— Infants under 1 year 783 729 371 523 895 1339 4640 Children 1-2 years 401 520 249 254 620 770 2814 Children 2-5 years 406 401 339 544 654 1124 3468 Total visits to children under Notification of Births Act 2500 2092 1444 1991 2771 4230 15028 Other visits— : Ophthalmia Neonatorum 6 12 4 6 2 12 42 Measles 857 438 362 985 935 1647 5224 Whooping Cough 87 85 78 93 124 235 702 Ante-natal cases 376 219 237 268 358 389 1847 Puerperal Fever and Pyrexia 7 4 2 3 3 9 28 Miscellaneous 155 112 164 76 194 365 1066 Ineffectual 971 261 402 761 712 1496 4603 Total Home Visits 4959 3223 2693 4183 5099 8383 28540 Attendances at:— Infant Welfare Centres 188 125 156 177 275 342 1263 Ante-natal Centres 27 20 25 27 23 39 161 Committee Meetings 3 16 — — 15 4 38 Health Talks 35 114 67 29 27 57 329 Visits to Creches 5 7 8 — 34 10 64 61 Maternity and Child Welfare. Infant Visiting. There were 4,197 births during the year and 3,738 of these, or 89.0 per cent., were visited compared with 90.9 in 1931, 84.1 in 1930, 84.1 in 1929, 85 in 1928 and 82.7 in 1927. 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 3,231 of the 3,738 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 2011 876 273 71 3231 Otherwise fed 93 208 101 105 507 Method of Feeding. Age of infant on subsequent visit. Under 1 month. 1—3 months. 3—6 months. 6—12 months. Total. Breast-fed 191 653 813 480 2137 Otherwise fed 30 379 723 1371 2503 It was found that in 846 of the births, doctors had been in attendance, while in 1,272 the services of midwives had been utilised. 1,620 infants were born in hospitals and other institutions. 62 Report of the Medical Officer of Health for 1 932. 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. 64 midwives practise in the Borough, of whom 18 reside in neighbouring Boroughs. There are 30 private maternity homes in the Borough, 18 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. 344 cases were visited during the year under these arrangements, and 4,715 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 1157 5 53 Influenza — 61 601 Pneumonia 565 146 2422 Ophthalmia Neonatorum 35 28 554 Measles 3598 100 997 Puerperal Fever and Puerperal Pyrexia 48 2 35 Infantile Diarrhœa — 2 53 Total 5403 344 4715 The number of visits made by nurses in 1981 was 8,250, and the increase is due to the epidemic of Measles which occurred during the year. Maternity and Child Welfare. 63 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 is appointed by the Committee of the Centre, and a trained Superintendent. In six of the Centres the Superintendent is an officer of the Centre Committee, while in the other six Centres one of the Council's Health Vistors acts as the Superintendent. The medical officer attends at most of the Infant sessions held at each Centre, and at all the Ante-natal sessions. The Superintendent is present at all sessions and also visits the homes of children and expectant mothers. Each Centre has several voluntary workers who 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:— 04 Report of the Medical Officer of Health for 1932. Infant Welfare Centre. Clinics. Ante-natal. Infants. Clapham : Clapham Dispensary Manor Street. 1st and 3rd Mondays in each month at 2 p.m. Tuesdays and Wednesdays, at 2 p.m. Putney : 2, Clarendon Road. 1st and 3rd Wednesdays in each month at 10.30 a.m. Wednesdays and Thursdays at 2 p.m. Putney Park: Putney Park House, Dover House Rd. None. Fridays at 2 p.m. Balham : 91, Bedford Hill. 1st and 3rd Fridays in each month at 9.45 a.m. Tuesdays, Wednesdays and Thursdays at 1.45 p.m. Streatham : 37, Riggindale Road. 1st and 3rd Wednesdays in each month at 10 a.m. Tuesdays at 1.30 p.m. Fridays at 2 p.m. Wesley Hall, Blegborough Road. None. Thursdays at 2 p.m. Streatham Hill. with Clapham Park : Baptist Church Hall, New Park Road. None. Tuesdays at 10 a.m. Tooting : Fairlight Hall, Fairlight Road. 2nd Wednesday in each month at 10.30 a.m. Wednesdays and Thursdays at 2 p.m. Church Hall, Lynwood Road. 4th Wednesday at 10.30 a.m. Thursdays at 10.15 a.m. Southfield : St. Michael's Institute, Merton Road. 1st Friday in each month at 10 a.m. Tuesdays and Fridays at 2 p.m. Fairfield : St. Faith's Mission Hall, Warple Way. 1st Monday in each month at 2 p.m. Wednesdays and Thursdays at 2 p.m. Springfield: Church Hall, Earlsfield Road. 4th Tuesday in each month at 11 a.m. Tuesdays at 2 p.m. 65 Maternity and Child Welfare. Table XXXIV. gives the full details of the work carried out at the 12 Centres in the Borough. 3,053 new infants were examined during the year and the total attendances were 54,230. There were 607 ante-natal cases and the total attendances made by them was 1,442. The visits made by the Superintendents of the six Centres where those officers are appointed by the Centre Committees were 7,218 to the homes of infants and 716 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 TABLE XXXIV. Clapham. Putney. Putney Park. Balham. Streatham. Blegborough Road. Streatham Hill (ClaphamPark) Tooting. Southfield. Fairfield. Springfield. Totals. Fairlight Lynwood Road New Cases, 1931 472 298 43 533 299 105 185 239 109 261 268 241 3053 Total Attendances 5955 5236 990 10376 5396 2258 3125 3728 3096 4768 5249 4053 54230 Ante-natal Cases 98 78 — 119 96 — — 57 36 37 56 30 607 Ante-natal Attendances 270 239 — 310 205 — — 104 85 81 100 48 1442 Supts.' Visits to Infants 1318 — 764 1810 1703 — — — — 1623 — — 7218 Supts.' Visits to Ante-natal Cases 131 — 99 189 188 — — — — 109 — — 716 No. of Sessions :— Infants 98 100 27 100 95 48 49 92 46 50 102 49 856 Ante-natal 24 21 — 24 25 — — 11 11 12 12 12 152 Health Talks given 24 86 16 92 20 9 16 19 8 61 28 50 429 Report of the Medical Officer of Health for 1932. 67 Maternity and Child Welfare. Borough of Wandsworth War Memorial Maternity Home. The Maternity Home is situated in Grove Road, Balham, adjoining the Weir Hospital and provides accommodation for '20 patients with two isolation beds. The management of the Home is undertaken by the Committee of the Weir Hospital on behalf of the Borough Council. The staff consists of a Resident Medical Officer, two sisters, four staff nurses, seven nurses and nine domestics. Two Consultants have been appointed who visit the Home regularly. The Secretary of the Weir Hospital is responsible for the administrative work at the Maternity Home and the nursing and domestic staff are under the supervision of the Matron of the Hospital. The fee charged for admission to the Home is based on the income of the applicant's family in accordance with a scale which has been approved by the Council. Each applicant is expected to remain in the Home for 14 days. During the past year 369 women were admitted to the Home and the average duration of stay was 14.81 days. 308 deliveries were carried out by the midwives and 60 by the medical staff. One infant was born just before the mother was admitted to the Home. In 127 cases it was necessary for the midwives to summons medical assistance in accordance with the requirements of the Midwives Act. Two cases of Puerperal Fever and ten of Puerperal Pyrexia were notified from the Home and two deaths of mothers occurred. One of these was due to Eclampsia and one to Puerperal infection. Eleven of the infants were still-born and five died within ten days of birth. Six infants were notified as suffering from Ophthalmia Neonatorum. Every effort is made while the mothers are in the Maternity Home, to encourage them to feed their infants, but in 49 cases the natural feeding had to be supplemented. Day Nurseries. The addresses of the four Day Nurseries in the Borough are as follows:— f 2 68 Report of the Medical Officer of Health for 1932. 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. They are voluntary institutions, receiving grants from the Borough Council. Children are admitted whose mothers are obliged to go out to work, or who are ill, or who for any other reasonable cause are unable to look after their children. The parents' payments vary from Od. to 1s. per day for one child, a reduction being made when more than one child from the same family is admitted, or when a child is admitted for half a day only. The Day Nurseries in Putney, Wandsworth and Balham are also training schools for nurses intending to take up creche work who are admitted as probationers and remain for about a year. Practical and theoretical instruction is given by the matrons and this includes courses of lectures, which the probationers have to attend before they can sit for the examination which is held at the end of the course. The attendances at the Day Nurseries were:—Putney, 4,891; Balham, 5,872; Tooting, 4,270 and Wandsworth, 5,601; a total of 20,684, compared with 28,124 in 1931. 64 inspections of the creches were made during the year by the Health Visitors. Institutions for Expectant and Nursing Mothers and Young Children. The Council pays an annual grant to the Streatham Babies' Hospital, 9, Leigham Court Road, which is a small hospital containing 20 cots for the treatment of infants up to the age of five years. The staff consists of a Matron, one Sister, two Assistant Nurses and three Probationers. A Visiting Medical Officer attends daily. The standard fee is 10s. 6d. per week, but necessitous cases are admitted free, or at a reduced fee, according to circumstances. 69 Maternity and Child Welfare. Medical practitioners can recommend children for admission and are allowed to attend them while in the Hospital. 108 infants were admitted in 1932, 46 from addresses in the Borough, and 62 from outside the Borough. Most of the cases were infants, suffering from Marasmus, Debility, Respiratory Diseases and Enteritis. During the year £10 6s. 5d. was paid to SS. Peter and Paul Home, Clapham, for the treatment of four children from the Borough who were maintained in the Home for short periods. There is one other large institution in the Borough for the accommodation of 60 children up to the age of five years. There are also five institutions or hostels 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 medical practitioners to attend at these hostels when necessary, and some of the infants attend the most convenient Infant Welfare Centre. The Council pays grants to the Southwark Diocesan Association for Preventive and Rescue Work, towards the maintenance of unmarried mothers usually resident in the Borough in the institutions of the Association. During 1932 assistance was granted in respect of 25 cases, at a cost of £206 10s. 4d. Similar grants are made to the Mission of Hope, and three cases were assisted at a cost of £14 18s. 7d. Convalescent Homes. During the year one child was sent to a Convalescent Home. 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. 355 children have been treated during the year and they have made 13,683 attendances. 123 of these children were 70 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. Supply of Milk. During the year 1,180 families were supplied with milk under the Milk (Mothers and Children)) Order, 1918; 274 in Clapham; 90 in Putney; 192 in Balham; 141 in Streatham; 150 in Tooting; 73 in Southfield; 157 in Fairfield; and 103 in Springfield. The total cost to the Council was £2,101 1s. 1d. Women and children in receipt of milk under the Council's scheme are expected to attend the Welfare Centres 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. Dental treatment is provided for expectant and nursing mothers and children under five years of age who attend at the Welfare Centres and are found to require treatment after examination by one of the Medical Officers. Arrangements have been made with the British Dental Hospital and four dental practitioners in the Borough to carry out treatment on an agreed scale of fees. This includes the provision of dentures for mothers. Parents contribute towards the cost of the treatment according to their means and an agreed scale of payment has been drawn up by the Council. During the year 53 cases received dental treatment. 18 of these were children and 35 were expectant or nursing mothers. Report o f the Medical Officer of Health for 1932. 71 HOUSING. Housing Conditions in the Borough of Wandsworth. 1. General Observations as to Housing Conditions. The standard of houses in the Borough varies considerably and no details are available showing the proportion of the different types which can only be given approximately. Some 20 per cent. of the houses 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. There are about the same number of large houses built 50 to 80 years ago which were formerly of the residential type, but are now occupied by the working classes. About 19 per cent. of the houses are cottage property, some of which is 80 to 100 years old. About 1 per cent. of the houses in the Borough are old and insanitary and ripe for demolition. 2. Sufficiency of Supply of Houses. 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 which is the highest rent that many families can pay. The proportion of families affected by this shortage may be 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. 72 Report of the Medical Officer of Health for 1932. 3. 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. Overcrowding 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. 6d. per week. 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 have been dealt with under these arrangements. Housing Act, 1930—Unhealthy Areas. During 1932 I made one representation under Section 1 of the Housing Act, 1930, in respect of an area known as Back Row, Totterdown, Tooting, which contains six houses. As five of the houses were unoccupied no further action has been taken for the time being. Twelve of the thirteen Areas which were declared as Clearance Areas in 1931 have now been cleared and alternative accommodation has been provided on one of the Council's Housing Estates for all the occupiers of the houses demolished who wished to avail themselves of it. In three of these areas—viz. Cumber's Yard, Wandsworth, Garden Cottages, Wandsworth and North Street, Clapham— the Council has acquired the sites for the purpose of development as re-housing sites for other insanitary areas which it is proposed to clear. The erection of dwellings on these three sites will be proceeded with shortly. Housing. 73 The other nine areas which have been cleared during the year are:— Angel Court, Roehampton. Henry's Place, Putney. Memel Place, Putney. Stockwell Court, Wandsworth. Carter's Yard, Wandsworth. Eden Cottages, Wandsworth. West Side, Warple Road, Wandsworth. East Side, Warple Road, Wandsworth. Great Acre Court, Clapham. In all these nine areas Clearance Orders were made, as the Council decided not to develop the sites. The Minister of Health held a Public Inquiry towards the end of 1931 on the Clearance Order made in respect of the Great Acre Court Area and his decision to confirm the Order was received in 1932. The twelve areas which have been cleared contained 105 houses occupied by 103 families with a population of 432 persons. The other Clearance Area which was declared in 1931 is the Dutch Yard Area. A Clearance Order was made in respect of it and a Public Inquiry was held in 1931. The Minister's decision to confirm this Order has now been received and the area will be cleared when alternative accommodation for the occupiers is available. This is to be provided on the sites of Cumber's Yard and Garden Cottages areas. Dutch Yard Area contains 18 houses which are occupied by 18 families consisting of 84 persons. Other Insanitary Houses Demolished. The Demolition Order made in 1931 in respect of 68A, Clifton Street, Clapham, has been carried into effect and the house has been demolished. 15, White Square, an insanitary house in Clapham North Ward, has been demolished by the Council under a road widening scheme. 74 SANITARY INSPECTION OF THE BOROUGH. Work of the Sanitary Inspectors. Table XXXV. gives full details of the inspections carried out by the Sanitary Inspectors. TABLE XXXV. Inspections. ReIn spections. Total. To investigate complaints 5537 16042 21579 House-to-House inspections 1589 6372 7961 Infective Diseases:— Notifiable diseases 1406 1301 2707 Measles 62 19 81 Whooping Cough 15 3 18 Other infective diseases 642 296 938 Verminous conditions 100 50 150 Offensive Trades No. of Premises 2 1 1 Piggeries 13 68 18 86 Factories, workshops, etc. 1647 1670 5 1675 Houses let in lodgings 269 121 585 703 Rag and bone stores 10 129 48 177 Sanitary conveniences 174 1175 19 1194 Mews and stables 135 1103 10 1113 Other inspections 7778 534 8312 Total 21396 25302 46693 Smoke observations 140 — 140 Legal proceedings, Attendances at Court 13 — 13 Sanitary Inspection of the Borough. 75 Table XXXVI. gives a summary of the sanitary operations carried out in the Borough during the year. The number of drains which were tested was 849 and of these 664 were found to be in a defective condition. The drains of 40 houses were re-constructed. Damp conditions have been remedied in 1,026 premises, and in 135 of these damp courses were inserted. 16 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 144 cases of overcrowding were abated. 48 of these cases were accommodated in London County Council houses, and 96 elsewhere. 76 Report of the Medical Officer of Health for 1932. TABLE XXXVI. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 1. Premises cleansed and repaired 396 305 247 257 309 1187 2701 2. Drains tested 182 66 148 214 17 222 849 3. Drains cleansed or repaired 110 75 54 108 47 270 664 4. Water closets cleansed or repaired 220 149 105 87 66 573 1200 5. Soil pipes repaired 31 20 8 6 3 72 140 6. Waste pipes altered or repaired 71 93 25 26 14 259 488 7. Rainwater pipes repaired 38 29 17 24 23 138 269 8. Roofs and gutters repaired 158 79 65 74 107 577 1060 9. Damp courses inserted 18 48 12 25 — 32 135 10. Damp conditions otherwise remedied 85 194 78 96 18 420 891 11. Yards drained or paved 44 11 23 25 25 195 323 12. Dust bins provided or repaired 133 69 98 85 95 277 757 13. Water cisterns cleansed, covered or repaired 22 34 10 8 19 61 154 14. Water supply reinstated 14 3 8 7 4 13 49 15. Defective fireplaces remedied 74 24 41 44 54 339 576 16. Defective coppers remedied 20 14 15 7 24 132 212 17. Cases of overcrowding abated 14 10 10 17 35 58 144 18. Stables and stable yards drained or paved - - - - - - - 19. Accumulations of manure, etc., removed 16 9 6 17 3 31 82 20. Urinals cleansed or repaired 5 1 - 1 - 2 9 21. Animals improperly kept 1 5 2 2 1 8 19 22. Smoke nuisances 2 — 14 5 3 53 77 23. Other nuisances 75 121 73 52 128 325 774 Total 1729 1359 1059 1187 995 5244 11573 No. of preliminary notices served 665 516 395 516 385 1505 3982 No. of preliminary notices complied with without the service of statutory notices 625 482 371 427 437 1366 3708 No. of statutory notices served 66 45 30 34 13 116 304 No. of statutory notices complied with 82 26 34 42 14 129 327 Sanitaty Inspection of the Borough. 77 Underground Rooms. There are 12 underground rooms known to be in illegal occupation at the present time and notices have been served, but owing to the difficulty of the occupiers in finding other accommodation no further action can be taken at the present time. House-to-House Inspections. The results of these inspections are shown in Table XXXVII. 1,589 inspections were made compared with 2,731 in 1931, 2,957 in 1930, 1,515 in 1929, and 989 in 1928, and nuisances necessitating the service of sanitary notices were found in 1,224 of the houses. TABLE XXXVII. Wards. No. of houses inspected. No. of houses in which defects, were found. Number of Families Living in:— One room. Two rooms. Three rooms. Four rooms and upwards Clapham North 103 101 21 57 33 78 Clapham South 23 17 10 17 11 16 Putney 345 250 46 22 254 179 Balham 83 74 13 84 137 129 Streatham 144 94 16 36 151 53 Tooting 168 116 4 4 61 119 Southfield 84 64 5 4 92 42 Fairfield 165 158 15 26 31 127 Springfield 474 350 25 61 281 264 Whole Borough 1,589 1,224 155 311 1031 1007 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 five were not reasonably fit for human habitation. Two of them were put in a reasonable state of repair before the meeting of the Committee at which the Certificate would have been granted, one application was withdrawn, and in four instances the work was carried out after the service of a sanitary notice. Of the 27 premises in respect of which Certificates were granted, 25 were rendered reasonably fit during the year. 78 FACTORIES AND WORKSHOPS. The number of factories, workshops, workplaces, and home workers' premises is shown in Table XXXVIII. together with the number of inspections made. The inspection of food premises are not included in this Table, but are shown in Table XLII. TABLE XXXVIII. Class of Works. Number of Places on Register at end of 1932. Number of Inspections, 1932. Number of Notices, 1932. Number of Prosecutions, 1932. Factories:— Factory Laundries 53 68 4 — Factory Bakehouses 75 136 3 — Other Factories 444 469 15 — Total 572 673 22 — Workshops:— Workshop Laundries 29 32 1 — Workshop Bakehouses 51 80 — — Other Workshops 677 624 15 — Total 757 736 16 — Workplaces 143 166 5 — Total: Factories, Workshops and Workplaces 1,472 1,575 43 — Home-workers' premises 301 316 5 — Grand Total 1,773 1,891 48 — Further details with regard to homeworkers' premises are given in Table XXXIX. Factories and Workshops. 79 TABLE XXXIX. HOME WORK. Nature of Work. Outworkers' Lists. Outwork in unwholesome premises Outwork 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. 33 22 109 32 8 5 40 (2.) Cleaning and washing 2 4 1 — — — — Paper bags and boxes 2 — 6 — — — Totals 37 26 116 32 8 5 40 The total number of addresses received from other Councils was 409, and 81 addresses were forwarded to other Councils. The number of addresses received has decreased by 30, and the number sent has also decreased by 30. 26 names and addresses were forwarded to this Borough in error. The number of notices sent to employers during the year was 32, and these had a most satisfactory result. During the year 40 cases of infective diseases—28 of Measles, four of Scarlet Fever and eight 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. 80 Report of the Medical Officer of Health for 1932. TABLE XL. DETAILS WITH REGARD TO REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Important classes of workshops, such as workshop bakehouses, are enumerated here. ' Workshop Bakehouses 51 Workshop Laundries 29 Dressmakers' and Milliners' Workshops 130 Bootmakers 108 Smiths and Engineers 44 Builders 60 Tailors 65 Motor Engineers 96 Upholsterers 30 Hairdressers 28 Other 116 Total number of workshops on Register 757 TABLE XLI. DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. No. of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 35 23 — - Want of ventilation 3 2 — - Overcrowding — — — - Want of drainage of floors — — — - Other Nuisances 25 20 — - Sanitary accommodation: Insufficient 3 - - - Unsuitable or defective 49 29 — - Not separate for sexes 4 4 — - 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 119 78 - - *Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 81 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 premises 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 XLII. Premises. Number of Places on the Register at end of 1932. Number of inspections, 1932. Number of Notices, 1932. Number of prosecutions. 1932. Dairies, milkshops and cowsheds 441 583 9 - Restaurant kitchens 352 254 17 — Ice Cream premises 551 466 5 — Slaughterhouses 5 915 — — Butchers' shops 247 1,403 14 — Greengrocers' shops 394 548 20 — Fishmongers' shops 153 339 7 — Fried fish shops 89 238 9 — Markets and stalls 182 3,935 — — Other premises where food is sold or prepared for sale 1,337 1,154 33 — Total 3,751 9,835 114 — G 82 Report of the Medical Officer of Health for 1932. Milk Supply. There are 441 registered milk premises in the Borough, compared with 346 in 1931, one of them being also a cowshed. The increase is due to the ordinary grocery and provision dealer undertaking the sale of milk in sealed receptacles such as bottles and cartons. All the premises have been inspected, the Food Inspectors making 583 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 analyses of 952 samples of whole milk reported as genuine was 3.56 compared with 3.63 in 1931. The milk utensils and barrows used in the delivery of milk were inspected regularly in the streets. The majority of the milk barrows are now fitted with canopies in order to protect the utensils during transit. The London County Council (General Powers) Act, 1932. This Act came in to force on the 12th July, 1932. It provides that:— Any premises in the district of any Sanitary Authority used or proposed to be used:— (1) for the sale or the manufacture for the purpose of sale of ice cream or other similar commodity or the storage of ice cream or other similar commodity intended for sale ; or (2) for the preparation or manufacture of sausages or potted, pressed, pickled or preserved meat, fish or other food intended for sale; shall be registered by the owner or the occupier thereof with the Sanitary Authority. During the five months ending 31st December, 1932, 379 applications were submitted to the Council for the purpose of registration under the Act. In each case the premises were inspected and found to be satisfactory and registration granted accordingly. Food and Food Premises. 83 It is anticipated that bye-laws will be framed at a later date by the London County Council. This Act has added considerably to the work of the Food Inspectors. Meat. There are now five private slaughterhouses in the Borough. The Food Inspectors made 915 visits during the year to these premises and were present on almost every occasion when slaughtering took place. The number of carcases inspected was 9,699, comprising 736 oxen, 2,005 pigs, 6,927 sheep and 31 calves. This compares with 10,565 carcases inspected during 1931 and 9,305 in 1930. Four whole carcases and 594 organs, etc., were found to be unsound or diseased and were surrendered by the owners and destroyed for the following reasons:— (1) Whole Carcases:— 1 entire pig carcase and organs—for decomposition. 3 entire pig carcases and organs—for Swine fever. These carcases were dealt with in conjunction with the London County Council Veterinary Inspector under the Swine Fever Order, during an outbreak which occurred in the Borough during July. (2) Organs, etc.:— Oxen:— For Tuberculosis :—12 Heads, 12 Tongues, 30 Pairs of Lungs, 6 Livers, 6 Mesenteries, 2 Skirts, 1 Omentum, 2 Forequarters, and 1 Thick Flank. For Actinomycosis:—1 Head and 1 Tongue. For Fluke:—182 Livers and 6 Pairs of Lungs. For Abscesses:—11 Livers and 1 Tongue. For Nephritis:—1 Kidney. For Pericarditis:—1 Heart. For Congestion:—1 Pair of Lungs. For Pneumonia:—1 Pair of Lungs. For Inflammation:—2 Spleens. For Echinoccus Cysts:—1 Pair of Lungs. For Cirrhosis:—1 Liver. g 2 84 Report of the Medical Officer of Health for 1932. Pigs:— For Tuberculosis:—39 Heads and Collars, 19 Mesenteries, 4 pairs of Lungs, 13 Plucks and 4 Spleens. For Cirrhosis:—11 Livers. For Nephritis:—4 Kidneys. For Pericarditis 1 Heart. For Peritonitis:—1 Hindquarter. For Milkspots:—3 Livers. For Congestion:—25 Pairs of Lungs and 23 Plucks. For Pleurisy:—1 Forequarter. For Abscesses 2 Livers. Sheep:— For Strongylus Rufescens:—56 Pairs of Lungs. For Fluke:—36 Livers. For Abscesses:-11 Livers. For Congestion:—19 Pairs of Lungs. For Fluke and Strongylus Rufescens:—40 Plucks. There are 247 butchers' shops in the Borough, the majority of which are subject to registration under the London County Council (General Powers) Act, 1932. 1,403 inspections were made of these shops, and it was found necessary in 14 cases to serve notices on the occupier. The meat exposed for sale has been examined regularly, and in several instances it was found necessary to warn the occupier for failing to mark imported meat in a proper manner. Under the Public Health Meat Regulations, 1924, every butcher is required to do all that is reasonably necessary to guard against the contamination of the meat by flies, filth and dust. It has been found necessary in several instances to warn traders with regard to the exposure of meat in contravention of these Regulations. Practically all butchers' shops in the Borough are now fitted with glass fronts. Unsound Food. At the request of the owners the following foodstuffs were destroyed and the usual Certificates granted, viz: 6 Stone of Whiting, 2 bags of Winkles, 5 stones of Haddock, 24 lbs. of Tomatoes, 1 stone of Herrings, 4½ cwts. of Potatoes, 5 boxes of Pears, 6 cases of Melons and 1 box of Apricots. Food and Food Premises. 85 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 on sanitary premises and from meat which has been duly inspected by a Veterinary Surgeon. As Certifying Officer of Wandsworth under the Order, I have issued three of these certificates for the export of parcels of potted meat during the year. Merchandise Marks Act, 1926, Agricultural Grading and Marking Act, 1928, and Orders Made Thereunder. These Acts and Orders contain provisions which are enforced by the Borough Council. The following Orders are now in force:— Marking of Imported Produce. 1. Gelatine. 2. Honey. 3. Fresh Apples. 4. Tea. 5. Currants. 6. Sultanas. 7. Raisins. 8. Eggs in shell. 9. Dried Eggs. 10. Oat Products. 11. Raw Tomatoes. 12. Salmon and Trout. 13. Butter. 14. Apples and Pears. ] 5. Wheat Flour. 16. Beef. 17. Malt Flour and Malt Extract. 18. Potatoes. 19. Broccoli. 20. Eggs. 21. Glasshouse grown Tom toes and Cucumbers. 22. Strawberries. 23. Dressed Poultry. 24. Cherries. 25. Cider. 26. Canned Fruits. 27. Canned Cherries. The Food Inspectors report that these Acts and Orders are duly observed by the traders, there being no deliberate evasion of the provisions. Statement of Work Done under the Food and Drugs, (Adulteration) Act, 1928. During the year 2,005 samples of foods and drugs were submitted to the Public Analyst for analysis. Of these 1,005 were 86 Report of the Medical Officer of Health for 1932. submitted as official samples while 1,000 were purchased unofficially as test or informal samples. 15 or 1.49 per cent. of the official samples, and six or .6 per cent. of the unofficial samples were found to be adulterated or not up to standard. The total adulterations reported were 21 or 1.04 per cent. of the samples submitted. TABLE XLIII. RESULT OF ANALYSIS OF CERTAIN ARTICLES OF FOOD PRO CURED UNDER THE FOOD AND DRUGS (ADULTERATION) ACT, 1928, SHOWING THE PERCENTAGE ADULTERATED COMPARED WITH 1928, 1929, 1930, AND 1931. Percentage of Samples adulterated, 1927-1931. No. of samples in 1932. 1928. 1929. 1930. 1931. Examined. Found adulterated or not up to standard Percentage adulterated Butter 3.4 1.6 .18 .41 204 — — Cheese — — — — 16 — — Cocoa — — — — 15 — — Coffee — — — — 22 — — Confectionery and Jam — — — — 30 — — Cream — .50 .43 — 85 — — Margarine — — — — 17 — — Milk 2.6 1.6 2.3 1.6 965 13 1.3 Separated Milk — — — — 1 — — Condensed Milk — — — — 20 — — Mustard — — — — 4 — — Sugar — — — — 9 — — Tea — — — — 21 — — Vinegar — 3.7 28.4 14.2 35 2 5.7 Drugs 15.3 2.3 — — 63 2 3.3 Other Articles 3.0 3.4 1.8 1.0 498 4 .86 All Articles 2.8 3.4 1.4 1.2 2005 21 1.04 Food and Food Premises. 87 The following Table gives the number of formal and informal samples taken in each sub-district of the Borough and shows the number taken per 1,000 of population, the number adulterated, and the percentage of adulteration. TABLE XLIV. Informal Samples. Formal Samples. Total. Number taken. Adulterated. Percentage adulterated. Number taken. Adulterated. Percentage adulterated. Number taken. Adulterated. Number per 1,000 of population. Percentage adulterated. Clapham 151 — — 136 1 .7 287 1 4.6 .3 Putney 170 — — 143 — — 313 — 9.0 — Balham 135 3 2.2 130 4 3.0 265 7 4.9 2.6 Streatham 162 2 1.2 121 5 4.1 283 7 4.1 2.4 Tooting 191 — — 182 — — 373 - 9.7 — Wandsworth 191 1 .5 293 5 1.7 484 6 4.9 1.2 Whole Borough 1000 6 .6 1005 15 1.4 2005 21 5.6 1.0 Milk. The following samples were submitted for analysis:— 965 of whole new milk. 1 of separated milk. 20 of condensed milk. of these 13 were reported against as being adulterated or not up to standard. One contained extraneous water, 10 were deficient in milk fat and two were deficient in milk fat and contained extraneous water. Proceedings were taken in six cases and costs amounting to £5 5s. 0d. were imposed. In the other seven cases, the Public 88 Report of the Medical Officer of Health for 1932. Health Committee, after considering the amount of adulteration and circumstances of sale, decided not to prosecute the vendors but to take further samples. Samples of milk were taken on delivery at the following hospitals and institutions between 5 and 8 a.m. in the early morning:— Hospitals. Wandsworth Prison London County Council Schools. 71 12 33 All samples delivered to the hospitals and schools were reported genuine, but two of the twelve samples taken on delivery to the Wandsworth Prison were found to each contain 1½ per cent. of extraneous water and to be 8 per cent. deficient in milk fat: proceedings were instituted and £2 2s. 0d. costs imposed. Two prosecutions were taken against dairymen for bottling milk in the street in contravention of the provisions of the Milk and Dairies Order, 1926; a fine of 15s. and £3 3s. 0d. costs were imposed. 10 samples of milk were taken at various railway stations in the course of transit from farmers to retailers. Six from one farm were reported against and proceedings were taken against the farmer. The case was dismissed as the magistrate was satisfied that the milk was sold as given by the cow. 389 samples were taken from milk vendors in the street during the early morning (5 to 7 a.m.) and of these five or 1.2 per cent. were reported against. The Milk (Special Designations) Order, 1923 The following licences for sale of designated milks were granted:— Certified 31 Grade A (Tuberculin Tested) 49 Grade A Pasteurised 7 Pasteurised 20 Bacteriological Examination of Milk. 94 samples of milk were examined microscopically by the Council's dispenser for the presence of Tubercle Bacilli. As a Food and Food Premises. 89 result of these examinations 12 of the samples were submitted for a biological examination at the Lister Institute. In no instance was the Tubercle Bacillus isolated. One sample of pasteurised milk was submitted for bacteriological examination in order to see if the bacterial content was within the prescribed standard ; this sample was found to comply with the Regulations. Butter and Margarine. 204 samples of butter were submitted for analysis during the year and all were reported to be genuine. 17 samples of margarine were submitted for analysis and all were reported genuine. Other Articles. 498 samples were submitted under this heading. The results are given in the Public Analysts' Report. 90 MISCELLANEOUS. Insulin Treatment. This service, which was commenced by the Council in 1928 with the sanction of the Ministry of Health. There are now two persons receiving treatment. The cost to the Council up to the end of 1932 was £30 14s. 3d. Bacteriological Examinations. During the year 2,433 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 XLV. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Diphtheria:- Negative 380 157 229 625 207 643 2241 Positive 32 6 30 27 12 72 179 Enteric Fever:— Negative - 2 1 6 1 2 12 Positive - 1 - - - - 1 Total 412 1(50 260 658 220 717 2,433 Examinations of Sputum made at the Dispensary are not included in the above figures. Miscellaneous. 91 Disinfection. The total number of rooms disinfected after the occurrence of cases of infective diseases was 3,377—541 in Clapham, 290 in Putney, 489 in Balham, 527 in Streatham, 314 in Tooting, and 1,216 in Wandsworth. Five public and two private elementary schools were also disinfected for infective diseases. Cleansing of Persons Act. The names of 35 children, stated to be in a verminous condition, were forwarded to me by the Medical Officer, Edu cation Department, London County Council, and the homes were visited by the Inspectors. In thirteen 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. 43 adults were given baths at the Council's Disinfecting Station on account of suffering from Scabies. Flies and Mosquitoes. During the summer months certain ponds, streams and areas of stagnant water were treated by spraying with paraffin, with the object of destroying the larvae of mosquitoes. Chloride of lime was also used for sprinkling horse manure in order to destroy the larvae and pupae of flies. Statement of Work done under the Rag Flock Act, 1911. There is one factory in the Borough where rag flock is manufactured. This factory is inspected under the provisions of the Factory and Workshop Act. No samples of Rag Flock were taken during the year, as the method of rag flock manufacture is considered satisfactory. 92 Report of the Medical Officer of Health for 1932. Three certificates for coloured rags have been issued in respect of the sterilisation of materials used in the manufacture of rag flock for export. Water Supply Cutting-off Notices. During the year, 46 notices with respect to 66 premises were received from the Metropolitan Water Board, stating that the supply had been withdrawn. In 60 premises the water supply was cut off for non-payment of rates, 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, no bodies were removed to the Mortuary, in Streatham one, and in Wandsworth 68,—of which 39 were from Wandsworth, 14 from Putney, one from Balham, 10 from Tooting and one each from Kentish Town, Rochester, Gravesend and Barnes, a total of 69. Inspection of Sanitary Conveniences. The number of Sanitary Conveniences inspected was 174; 52 in Clapham, 19 in Putney, 17 in Balham, 15 in Streatham, nine in Tooting and 62 in Wandsworth. 1,191 inspections were made during the year, and one notice, for cleansing, was served and complied with. Ambulance Service. The London County Council has been responsible for the removal by ambulance of cases of infectious diseases to hospitals 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. Miscellaneous. 93 Removal and Collection of House Refuse. The method of removal and collection of refuse in the Borough is a combined system of mechanical and horse traction, carried out by contract. The collecting wagons are hauled from house to house by horses, and when full are drawn up mechanically on to a motor carrier which takes the refuse to the wharves. An empty wagon is left to replace the full one. All house refuse is taken down the River Thames by barge from two riverside wharves in the Borough, and disposed of below Barking. Amount of Public Assistance Relief. 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, 1932 (1) No. of admissions to the Public Assistance Institutions 5,929 (2) No. of medical orders given 1,832 (3) Average No. of persons in receipt of outdoor relief 2,718 (4) Amount of outdoor relief given £42,052 94 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., D.P.H. 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. 95 Staff. SANITARY INSPECTORS. Name. Commenced Duty. Certificates held. Sanitary Inspector. Meat and Food. Others. Senior Inspector: A. E. Vickers Dec. 1919 S.I. Exam. Bd. Yes — District Inspectors: H. T. Lambert Dec. 1919 „ Yes Five 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. itisher May 1930 „ No — J. Rowtyotham 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 — — — 96 Report of the Medical Officer of Health for 1932. 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 „ M. Dean Jan. 1924 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 Tuberculosis:— Miss P. G. Moores April 1915 Yes Yes No No ,, R. M. Watling May 1922 Yes Yes Yes No 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 „ - 97 Staff. 97 OFFICE STAFF—continued,. Name. Commenced Duty. Appointment. Certificates held. L. L. Parrini May 1923 Third Class Clerk — *J. Marshall *Miss F. M.Wood hall Jan. 1927 July 1931 " San. Insp. and five others One *A. E. Hollis Feb. 1923 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. H 98 Report of the Medical Officer of Health for 1932. 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. H. A. Topalia, 248, 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- The Medical Officer of Health, worth 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. Robert Brown, Senior Sanitary Inspector, retired in June after 89 years service and Mr. A. E. Vickers was promoted to Senior Sanitary Inspector in his place. Mr. F. Haworth was superannuated on account of ill health, after 12 years service with the Council, and I regret to have to report that he has since died. Staff. 99 The vacancies for two Sanitary Inspectors created by the retirement of Mr. Brown and the superannuation of Mr. Haworth have not been filled. Miss B. P. Manning resigned her appointment as Health Visitor in July. Miss Dean, one of the Tuberculosis Visitors, has been transferred as a Health Visitor under the Maternity and Child Welfare scheme. Mr. G. Lovett, the Vaccination Officer for Clapham and Wandsworth, retired in June after 29 years service in this capacity. Instead of filling this vacancy, the Council decided to appoint me Vaccination Officer for these two districts of the Borough, so that the duties in connection with Vaccination would be coordinated with the other services carried out by the Department, especially those relating to Maternity and Child Welfare. Most of the Home visiting required is carried out by the Health Visitors, each Officer being responsible for visiting those infants who reside in her district. If the service of a default notice on Form K. is required, this duty is carried out by the district Sanitary Inspector. I regret to report that Dr. J. T. Thyne, Public Vaccinator for Wandsworth No. 2 district, died during the year. Dr. H. A. Topalia has been appointed to this district. Mr. J. Marshall, Third Class Clerk, has qualified as a Sanitary Inspector and Miss J. Pottinger, Health Visitor, has obtained the Health Visitor's Certificate granted by the Ministry of Health. In conclusion, I wish to express my appreciation of the excellent manner in which the staff have carried out their duties throughout the year. I am, Your obedient Servant, F. G. CALEY. H 2 100 100 Report of the Medical Officer of Health for 1932. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF WANDSWORTH, 1932. (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. 1980 139 35 27 30 74 93 98 218 364 461 441 F. 2107 123 14 28 28 60 91 95 173 318 436 741 1. Typhoid and paratyphoid fevers M. 1 1 _ F. 2. Measles M. 16 1 7 1 6 1 F. 19 5 2 9 2 — 1 3. Scarlet fever M. 3 2 1 F. 1 1 4. Whooping cough M. 9 5 4 F. 11 3 2 5 1 5. Diphtheria M. 9 3 4 2 __ F. 5 — — 1 4 — — — — — — — 6. Influenza M. 40 _ _ 3 1 4 6 9 11 6 F. 73 — — 2 — 1 3 6 8 15 13 25 7. Encephalitis lethargica M. 2 2 F. 1 1 8. Cerebro-spinal fever . . M. 4 1 2 1 F. 3 1 — 1 — 1 — — — — — — 9. Tuberculosis of respiratory system M. 155 2 25 29 25 31 30 11 2 F. 90 — — 1 — 24 35 13 7 6 3 1 10. Other tuberculous diseases M. 23 3 3 3 5 4 3 2 F. 21 4 2 1 3 5 2 1 — 2 — 1 11. Syphilis M. 8 3 1 1 1 2 — F. -i— 12. General paralysis of the insane, tabes dorsalis M. 14 1 2 2 6 3 — F. 5 1 2 1 1 — 13. Cancer, malignant disease M. 218 _ _ 1 1 7 31 62 74 42 F. 326 — — — 1 2 2 20 56 89 I 78 78 14. Diabetes M. 19 1 1 6 7 4 F. 25 — — — 1 1 1 2 1 2 11 6 15. Cerebral haemorrhage, etc. M. 63 1 4 13 24 21 F. 80 6 14 19 41 16. Heart disease M. 466 1 10 5 10 41 77 140 182 F. 595 — — — 2 3 9 7 32 76 162 J04 17. Aneurysm M. 16 2 o 4 3 5 F. 10 2 3 2 3 101 Vital Stalistics. 101 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. 60 1 4 10 18 27 F. 83 1 — 2 14 24 42 19. Bronchitis M. 88 1 1 — — 1 3 5 6 19 23 29 F. 90 1 — 1 1 1 — 3 — 2 19 62 20. Pneumonia (all forms) M. 93 10 7 7 1 4 7 4 14 19 13 10 F. 85 12 3 2 — 3 7 6 1 10 14 27 21. Other respiratory diseases M. 17 1 2 2 7 2 3 F. 20 — 2 — — 1 1 2 1 2 3 8 22. Peptic ulcer M. 38 1 4 9 12 10 2 F. 9 2 1 3 2 1 23. Diarrhoea, etc. M. 45 33 2 2 3 1 — 1 1 2 F. 28 25 1 — — — — 1 — — 1 — 24. Appendicitis M. 15 1 2 3 1 2 2 4 F. 11 — — — 2 1 2 1 1 3 1 — 25. Cirrhosis of liver M. 7 1 1 2 2 1 F. 3 — — 1 1 — 1 26. Other diseases of liver, etc. M. 7 3 1 2 1 F. 16 1 1 3 3 8 — 27. Other digestive diseases M. 39 1 1 1 5 6 6 7 7 5 F. 39 — — — 1 2 2 4 7 9 8 6 28. Acute and chronic nephritis M. 77 — — 1 2 3 5 6 20 24 16 F. 94 — — — — 4 2 7 10 23 25 23 29. Puerperal sepsis F. 6 — — — — 1 3 2 — — — — 30. Other puerperal causes F. 6 — — — — 2 4 — — — — — 31. Congenital debility, premature birth, malformations, etc. M. 78 73 1 1 3 F. 56 56 32. Senility M. 4S 10 38 F. 88 12 76 33. Suicide M. 41 4 3 4 10 9 9 2 F. 19 — — — — — 5 2 3 4 2 3 34. Other violence M. 83 3 1 1 1 8 15 4 11 17 10 12 F. 40 4 1 1 3 2 1 3 6 8 6 5 35. Other defined diseases M. 174 5 2 4 6 7 7 6 23 29 49 36 F. 149 12 1 3 7 6 9 11 23 27 22 28 36. Causes ill-defined, or unknown M. 1 1 102 102 Report of the Medical Officer of Health for 1932. PARTICULARS OF PROCEEDINGS TAKEN UNDER THE PUBLIC HEALTH ACTS. Premises. Offences. Result. Fine. Costs. 38, Jew's Row, Wandsworth Nuisances Order made for abatement of nuisances. — s. 21 d. 0 40, ditto Ditto Ditto — 21 0 42, ditto Ditto Ditto — 21 0 44, ditto Ditto Ditto — 21 0 4(3, ditto Ditto Ditto — 21 0 4, York Terrace, Clapham. Ditto Ditto — 21 0 1, Stewart's Cottages, Putney. Obstructing workmen in complying with a Sanitary notice. Order made to permit owner to execute work. 2 0 35, Palmerston Road, Wandsworth. Domestically dirty and verminous conditions Order made for abatement of nuisances. 2 0 39, Fawe Park Road, Wandsworth. Nuisances Ditto — 21 0 139, Manor Street, Clapham. Ditto Ditto — 21 0 103 HOUSING STATISTICS. Number of New Houses erected during the Year:— (i) By the Local Authority 2 blocks containing 87 Flats (ii) By other Local Authorities 6 Blocks containing 206 Flats (ii) By other bodies and persons 97 1. Inspection of Dwelling-houses during the Year:— (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 9,659 and the number of inspections made 10,057 (2) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,589 and the number of inspections made 7,961 (8) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 3,584 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 3,810 104 Report of the Medical Officer of Health for 1932. 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 Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 19 (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 304 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 327 (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 Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 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 Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 1 Housing Statistics. 105 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 dwellinghouses 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) 159 Tenement Flats 106 Public Analysts' Annual Report. To the Wandsworth Borough Council. Mr. Mayor, Ladies and Gentlemen, Herewith we have pleasure in handing you our report on work performed by us in connection with the administration of the Food and Drugs (Adulteration) Act, 1928, during 1932. All the samples mentioned in this report were submitted by your Council's Food Inspector, five of the formal samples of Milk having been taken at the request of the Metropolitan Borough of Battersea and five informal samples at the request of ratepayers from whom complaints had been received. In all 2,005 samples were examined under the Act, 1,005 having been taken with the necessary formalities required by the Act, and 1,000 procured informally. Of the formal samples 1.5 per cent., of the informal samples 0.6 per cent., and of all samples 1.1 per cent., were returned as adulterated or not up to legal standard ; figures upon which the Borough may be congratulated. The following statement shows the nature of the samples examined, with the results of analyses, the details of Drugs and "Other Articles " being shown subsequently. GENERAL STATEMENT. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Bread . 5 5 . . . Butter — 204 204 — — — Cheese — 16 16 — — — Cocoa — 15 15 — — — Coffee — 22 22 — — — Confectionery — 7 7 — — — Cream . 85 85 . . . 107 Analysts' Annual Report. 107 GENERAL STATEMENT.—continued. Nature of Examined Adulterated. Sample. Formal. Total. Formal. Total formal. formal. Flour, Self-raising 7 7 Jam and Marmalade — - 23 23 — , — Lard — 22 22 — — Margarine — 17 17 — — Milk 964 1 965 13 13 Milk Condensed (Full Cream) 3 3 Milk Condensed (Machine Skimmed) 16 16 Milk, Evaporated — 1 1 — — Milk, Separated . . 1 — 1 — — Mustard — 4 4 — — Sugar — 9 9 — — Tea — 21 21 — — Vinegar 25 — 25 2 2 Vinegar, Malt 10 — 10 — — Drugs — 63 63 — 2 2 Other Articles 5 459 464 — 4 4 Total 1005 1000 2005 15 6 21 DRUGS (INFORMAL). Nature of Sample. Examined. Adulterated. Acid, Citric 4 Acid, Tartaric 6 Borax, Purified 3 Cream of Tartar 2 Friars' Balsam 2 Glauber's Salt 2 Glycerin 2 Gregory's Powder 2 Lysol 1 Magnesia, Carbonate of .. 3 Oil, Castor 3 Oil, Eucalyptus 3 Ointment, Boric 7 2 Ointment, Zinc 3 Powder, Compound Liquorice 5 — Powder, Sedlitz 1 Sulphur, Flowers of 2 — Sweet Spirits of Nitre 3 — Tincture of Iodine. . 4 — Tincture of Quinine" (Ammoniated) 3 — Tincture of Rhubarb 2 — Total 63 2 108 108 Report of the Medical Officer of Health for 1932. OTHER ARTICLES. Nature of Sample. Examined Adulterated. Formal. Informal. Total. Formal. Informal. Total. Almonds, Ground - 4 . 4 - - - Arrowroot — 3 3 - — - Baking Powder — 2 2 - — - Barley, Pearl — 5 5 - — - Beans, Haricot — 2 2 - — - Biscuits — 5 5 - — - Brown Ale Mixture — 1 1 - — - Cake — 5 5 - — - Cakes, Sponge — 4 4 - — - Cherries, Glace — 6 6 - — - Coconut, Desiccated — 4 4 - — - Coffee and Chicory — 2 2 - — - Coffee and Chicory Extract 6 6 - - - Cornflour — 4 4 - — - Curry Powder — 2 2 - — - Custard Powder .. — 12 12 - — - Dripping — 7 7 - — - Fat, Vegetable — 2 2 - — - Fish Paste — 6 6 - — - Fish, Tinned — 20 20 - 1 1 Fruit, Dried — 48 48 - — - Fruit, Tinned — 4 5 - — - Gelatin — 10 10 - — - Ginger, Ground — 3 3 - — - Ginger, Preserved — 6 6 - — - Honey — 7 7 - — - Ice Cream 2 — 2 - — - Jelly, Table — 7 7 - — - Lemon Curd and - - Cheese — 9 9 - — - Lemonade 2 — - — - Lemonade Powder — 3 - 2 2 Lemon Squash — 2 - — — Macaroni — 6 6 - — — Meat — 15 15 - — — Meat, Potted and Paste - 10 10 - — Meats, Tinned — 3 3 - — — Mincemeat (Fruit) — 6 6 - — — Must, Greek Fermented 1 - 1 - — — Olive Oil . . — 10 10 - — — Peaflour — 1 1 - — — Peas, Split — 2 2 - — — Peel, Candied — 5 5 - — — Pepper - 44 44 - — — Pickles — 4 4 - — — Pudding, Christmas — 1 1 - — — Rice — 32 32 - — — Rice, Flaked — 1 1 - - - 109 Analysts' Annual Report. 109 OTHER ARTICLES—continued. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Rice, Ground 4 4 Sauce -— 4 4 — — — Sausages — 22 22 — — — Sausages, Preserved — 12 12 — — — Sausage Meat — 6 6 — — — Semolina — 8 8 — — — Soup, Tinned — 3 3 — — — Spices — 12 12 — — — Sponge Mixture . . — 3 3 — — — Suet, Shredded — 5 5 — — — Tapioca — 20 20 — 1 1 Tomato and Cheese Paste 1 1 Treacle and Golden Svrup 3 3 Vegetables, Tinned — 13 13 r — Yeast — 2 2 — Total 5 259 464 4 4 Below is given the nature and extent of the adulteration returned in the formal samples submitted :— Case No. Nature of Sample. Nature of Report. 1 Milk l£ % Extraneous Water and 8 % Deficient in Fat. 3 Ditto 1J % Extraneous Water and 8 % Deficient in Fat 107 Ditto 2 % Extraneous Water 113 Ditto 6 % Deficient in Fat 319 Ditto 5 % Deficient in Fat. 332 333 Ditto Ditto 23 % Deficient in Fat 12 % Deficient in Fat 334 Ditto 10 % Deficient in Fat 341 Ditto 4 % deficient in Fat 580 Vinegar 3 % Deficient in Acetic Acid 604 Ditto 6 % Deficient in Acetic Acid 998 Milk 23 % Deficient in Fat Battersea 1a Ditto 6 % Deficient in Fat Ditto 3a Ditto 13 % Deficient in Fat Ditto 5a Ditto 10 % Deficient in Fat 110 Report of the Medical Officer of Health for 1982. The nature of the reports issued in respect to the informal samples returned as adulterated is as follows:— Case No. Nature of Sample. Nature of Report. 1 91 Boric Ointment Contains excess Boric Acid 209 Tinned Fish Contains excess Tin 215 Boric Ointment Contains excess Boric Acid 209 Lemonade Powder Made with Tartaric Acid 710 Ditto Ditto Ditto 982 Tapioca 100 % Sago The informal samples submitted at the request of rate-payers, all proved, on analysis, to be normal in composition and consisted of one each of Butter, Macaroni, Milk, Sugar and Tinned Peas. The average water content of the 204 samples of Butter amounted to 14-0 per cent., that in the 17 samples of Margarine being 14-2 per cent. The average fat content of the 80 samples of Cream was 47-0 per cent. The average composition of the Milks, returned as genuine, during each month is given below :— Month. Samples Total solids. Milk fat. Non-faty solids. January 20 12-31 % 3-55 % 8-76 % February 114 12-19 % 3-45 % 8-74 % March GO 12-23 % 3-47 % 8-76 % April 64 12-21 % 3-47 % 8-74 % May 86 12-23 % 3-43 % 8-80 % | une 111 12-17 % 3-38 % 8-79 % July 31 12-18 % 3-43 % 8-75 % August 135 12-19 % 3-46 % 8-73 % September October 75 80 12-38 % 12-67 % 3-56 % 3-75 % 8-82 % 8-92 % November 78 12-74 % 3-87 % 8-78 % December 98 12-72 % 3-91 % 8-81 % Analysts' Annual Report. Ill The average composition of these 952 samples for the whole year was as follows:— Total milk solids 12.35 per cent. Milk fat 3.56 per cent. Non.fatty solids 8.79 per cent. We have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servants, A. H. M. MUTER, F.I.C., F.C.S., Public Analyst. CHARLES A. HACKMAN, F.I.C., Additional Public Analyst. 325, Kennington Road, S.E. 11. 12th April, 1933 112 INDEX. page Accident, Deaths from 38, 39 Adulteration of Certain Articles, Percentage of, in 1928-1932 86 Agricultural Grading and Marking Act, 1928 85 Ambulance Service 92 Analysts, Report of 106 Angel Court Clearance Area 73 Ante-natal Clinics 60 Anti-toxin 19 Area of Borough 1 Artificial Light Treatment of Tuberculosis 48 Artificial Pneumothorax Treatment of Tuberculosis 49 Back Row, Totterdown, Clearance Area 72 Bacteriological Examinations 53, 90 Bacteriological Examination of Milk 88 Bakehouses 78, 80 Balham, House-to-House Inspections in 77 Births 4 Births and Birth-rates in Sub-Districts 4 Birth-rate, Average 10 Years, 1922-31 8 Births, Notification of, Act 5 Borough of Wandsworth War Memorial Maternity Home 67 Brain and Nervous System, Diseases of the 38 Butchers' Shops 81 Butter and Margarine 89 Cancer 38 Carters Yard Clearance Area 73 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 77 Cleansing of Persons Act 91 Index. 113 PAGE Clearance Areas 78 Clinics for Immunisation against Diphtheria 19-28 Conscientious Objections Certificates granted 18 Convalescent Homes 69 Cowsheds 81 Creches 67 Cumber's Yard and Garden Cottages Clearance Area 72 Cutting-off Notices 92 Dairies, Milkshops and Cowsheds 81 Day Nurseries 67 Death, Causes of 7, 100, 101 Death-rate, Average 10 Years, 1922-81 8 Death-rate, Corrected 6 Death-rate from Infective Diseases 13 Death-rate, Infantile 9 Deaths, Corrected 6 Deaths, Number of 6 Deaths in Institutions 9 Demolition Order 73 Dental Treatment 49, 70 Developmental Diseases 38 Diarrhoea 36 Diphtheria 18 Diphtheria, Attack Rate per 1,000 cases 18 Diphtheria, Immunisation against 19-28 Diphtheria, " Return Cases "of 29 Disinfection 91 Disinfection of Schools 91 Dutch Yard Clearance Area 73 Dwelling-houses, Inspection of 103 Dysentery 31 Eden Cottages Clearance Area 73 Encephalitis Lethargica 31 Enteric Eever 29 Erysipelas 29 Expectant and Nursing Mothers, Institutions for 68 Factories and Workshops 78 Factories, Workshops, etc., Defects found in 80 J 114 Index. PAGE factories, Workshops, and Workplaces, Inspection of 78 Families, Number of, Census 1921 2 Fishmongers' Shops 81 Fish, Sausages and potted Meat, etc., manufacture of 82 Flies and Mosquitoes 91 Food, Prosecutions in connection with 88 Food and Drugs (Adulteration) Act, 1928, Proceedings under 85 Food and Drugs (Adulteration) Act, 1928, Statement of Work under 85 Food and Food Premises 81 Food Places, Inspection of 81 Fried Fish Shops 81 Garden Cottages and Cumbers Yard Clearance Area 72 Great Acre Court Clearance Area 73 Greengrocers' Shops 81 Health Visitors, Work of 58 Henry's Place Clearance Area 73 Home Work 79 Hospitals, etc., for Expectant and Nursing Mothers 68 House Refuse, Removal of 93 House-to-House Inspections, Summary of 77 Houses and Premises Inspected 74 Houses erected during 1932 103 Houses Let in Lodgings 74 Houses owned by Borough Council, Number of 105 Housing Act, 1930 72 Housing Conditions 71 Housing Consolidated Regulations, 1925, Houses inspected, etc. 103 Housing Statistics 103 Ice Cream Premises 81 Ice Cream, etc., Sale and Storage of 82 Illegitimate Children, Births of 5 Immunisation against Diphtheria 19-28 Imported Produce, Marking of 85 Increase of Rent and Mortgage Interest (Restrictions) Act, 1923 77 Infant Visiting 58, 61 Index. 115 PAGE Infantile Mortality 9-12 Infantile Mortality, 10 Years, 1922-1981 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 74 Institutions, Deaths in 9 Institutions for Expectant Mothers, etc. 68 Insulin treatment 90 Laundries, Inspection of 78 London County Council (General Powers) Act, 1932 82 Malaria 31 Margarine 89 Markets and Stalls 81 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 83 Meat, Fish and Sausages, etc., manufacture of 82 Meat Food Products, Certification of 85 Memel Place Clearance Area 73 Merchandise Marks Act, 1926 85 Mews and Stables 74 Midwives 62 Milk Analysis 87 116 Index. PAGE Milk, Bacteriological Examination of 88 Milk (Mothers and Children) Order 70 Milk Premises, Cowsheds, etc., on Register 81 Milkshops, Cowsheds, etc., Inspections of 81 Milk (Special Designation) Order, 1923 88 Milk Supply 82 Mortuaries 92 Mosquitoes 91 Natural Increase, Rate of 4 Nervous System, Diseases of the 38 Non-Infective Diseases, Deaths from 38 North Street Clearance Area 72 Notification of Births Act 5 Notification of Infective Diseases 15, 10 Nursing Arrangements 62 Offensive Trades 74 Old Age 38 Ophthalmia Neonatorum 31 Other Infective Diseases, Deaths from 37 Outworkers 79 Overcrowding 72, 76 Para-Typhoid Fever 29 Physical Features, etc., of the Borough 1 Piggeries 74 Pneumonia 30 Police Court Proceedings 85, 102 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 93 Puerperal Fever and Puerperal Pyrexia 29 Puerperal Pyrexia 29 Pulmonary Tuberculosis, Notification of Cases of 40 Putney, House-to-House Inspections in 77 Rag and Bone Stores 74 Rag Flock Act, 1911, Statement of Work done under 91 Index. 117 page Rateable Value 2 Rent and Mortgage Interest (Restrictions) Act, 1923 77 Respiratory Diseases 38 Restaurant Kitchens 81 Return Cases of Scarlet Fever and Diphtheria 29 Samples, Formal and Informal, Number of 87 Sanitary Conveniences, Inspection of 92 Sanitary Inspection of the Borough 74 Sanitary Operations, Table of 76 Sausages, potted Meat and Fish, etc., manufacture of 82 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 91 Septicaemia, Deaths from 37 Shelters for Tuberculous Patients 50 Slaughter-houses 81 Small-pox 17 Smoke Nuisances 74 Social Conditions 1 Sputum Examinations 53 Staff 94 Stockwell Court Clearance Area 73 Streatham, House-to-House Inspections in 77 Suicide, Deaths from 38, 39 Syphilis, Deaths from 37 Tooting and Wandsworth Children's Clinic 69 Tooting, House-to-House Inspections in 77 Toxaemia, Deaths from 37 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 49 118 Index. PAGE Underground Rooms 77 Unhealthy Areas 72 Unsound Food 84 Vaccination 17 Vaccination Returns 18 Violence, Mortality from 38 Vital Statistics of Whole Borough 3, 100, 101 Wandsworth and Tooting Children's Clinic 69 Wandsworth, House-to-House Inspections in 77 Warple Road Clearance Area 73 Water Supply, Cutting-off Notices 92 Whooping Cough 29 Workshops, Number of 78, 80 Young Children, Institutions for 68 Zymotic Diseases 13