ACU 4388 M. WAN 71 Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, &c. OF THE BOROUGH, For the Year 1934, by F. G. CALEY, M.A., M.B., D.P.H., Medical Officer of Health, together with the Report of the Public Analyst. Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, &c. OF THE BOROUGH, For the Year 1934, 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 1934. 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 1934. Social Conditions of the Borough. Wandsworth is the largest Metropolitan borough. The acreage is 9,199, compared with Woolwich, which is 8,986 acres. The Borough 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. 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. The Report of the Registrar-General on the Census enumerated on the 26th April, 1931, gives the population of the Borough as 353,110—159,714 males and 193,396 females. This is a larger b 2 Report of the Medical Officer of Health for 1934. population than any other London Borough, the next being Islington with a total of 321,795 persons. At the Census 1921, the total population was 328,307, and of these 147,229 were males and 181,078 were females. At the Census 1911, the population was 311,360, of whom 140,728 were males and 170,632 were females. The density of population in the Borough of Wandsworth at the Census of 1931 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 was 0.98 persons per room and the figure varied from 0.70 to 1.45. The Boroughs showing the most favourable densities were Hampstead (.70), Westminster (.76), Chelsea and Wandsworth (.79 each), and Kensington (.80). There is no particular occupation carried on this Borough which affects public health. Survey by the Minister of Health. During the year a survey of the public health services of the Council, by Medical Officers of the Ministry of Health, which was commenced in 1933, has been completed. The Minister, after considering the report of these Officers, intimated that a reasonable standard of efficiency and progress was being maintained by the Council in the discharge of their functions relating to Public Health. He made suggestions on certain matters of detail connected with particular services and these suggestions have received the careful attention of the Council. 3 GENERAL STATISTICS FOR THE BOROUGH. Area 9,199 acres Population in 1934 345,250 No. of inhabited houses in 1931 71,566 No. of families, or separate occupiers, in 1931 95,383 Rateable value in 1934 £3,072,188 Estimated produce of a penny rate £12,465 Extracts from Vital Statistics. No. of Live Births :— Males Females Total Legitimate 1877 1768 3645 Illegitimate 54 92 146 Total 1931 1860 3791 Deaths 1842 2019 3861 Birth-rate 1098 Death-rate—Crude 11.18 Standardized 10.39 Rate per 1,000 total (live and still) births. No. of Stillbirths 125 31.92 Deaths from puerperal sepsis 4 1.02 Deaths from other puerperal causes 5 1.27 Total 9 2.29 Infantile mortality per 1,000 live births:— All infants 58 Legitimate infants 54 Illegitimate infants 150 Deaths from Measles (all ages) 37 ,, Whooping Cough (all ages) 11 ,, Diarrhoea (under 2 years of age) 38 b 2 Deaths from Tuberculosis:— No. 276 Rate .79 4 Report of the Medical Officer of Health for 1934. Population. The population at the middle of the year was estimated by the Registrar General to be 345,250 and on the instruction of the Ministry of Health 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. TABLE I. Sub-District. Census Population 1931 Population estimated to middle of 1934 Clapham 60,925 59,570 Putney 34,718 33,945 Balham 53,982 52,780 Streatham 68,435 66,912 Tooting 38,159 37,310 Wandsworth 96,891 94,733 Whole Borough 353,110 315,250 Births. The total number of births occurring in the Borough was 2,635, including 352 non-residents who were born in Institutions. 1,508 births of Borough residents occurred outside the Borough, so that the corrected number of births was 3,791 compared with 3,868 in 1933. In Table II. is shown the number of births, males and females, the birth-rate, and the rate of natural increase or decrease, for each sub-district, and for the whole Borough. 5 Vital Statistics. TABLE II. Sub-District. No. of Births. Rates. Males. Females. Total. Birth-rate. Natural increase or decrease. Clapham 359 413 772 12.95 +1.09 Putney 182 148 330 9.72 —1.17 Balham 314 277 591 11.21 —1.52 Streatham 313 310 623 9.31 —2.0 Tooting 196 207 403 10.71 + .32 Wandsworth 565 507 1,072 11.31 +1.11 Whole Borough 1,931 1,860 3,791 10.98 — .20 The birth-rate was 10.98 per 1,000, compared with 10.93 for 1933, and 13.02 the decennial average. The rate for the whole of London during 1934 was 13.2 and for England and Wales, 14.8. 121 illegitimate births took place in the Borough, but only 50 belonged to the Borough. On the other hand 96 illegitimate births belonging to Wandsworth occurred outside the Borough, making a corrected total of illegitimate births belonging to Wandsworth of 146. 28 of these belonged to Clapham, 14 to Putney, 33 to Balham, 25 to Streatham, 17 to Tooting, and 28 to Wandsworth. The percentage of illegitimate births to total births was 3.8. The illegitimate births in nursing homes have again been allocated to the home addresses of the mothers. Notification of Births Acts. 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. 6 Report of the Medical Officer of Health for 1934. TABLE III. Sub-District. Births registered in the Borough. Total live births notified. Notified by : No. born dead Medical Attendant. Parent Midwife. Other person. Clapham 772 369 97 20 247 5 10 Putney 330 183 79 4 95 5 4 Balham 591 615 73 8 507 27 20 Streatham 623 381 99 13 216 53 11 Tooting 403 251 27 10 210 4 2 Wandsworth 1072 576 138 38 377 23 13 Whole Borough 3,791 2,375 513 93 1,652 117 60 Deaths. The number of deaths which took place in the Borough during the year was 3,185, but 1,146 of these did not belong to the Borough, while 1,822 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 3,861 of whom 1,842 were males and 2,019 females. The crude death-rate for the year was 1118 compared with 11.49 in 1933, but after correction has been made by means of a comparability factor devised by the Registrar-General, the corrected death-rate was 10.39. The death-rate for the whole of London for 1934 was 11.9, for England and Wales 11.8, in the 121 County Boroughs and great Towns 11.8, and in the 135 smaller Towns 11.3. Table IV. shows the total number of corrected deaths and the death-rates for each sub-district and for the whole Borough. 7 Vital Statistics. TABLE IV. SubDistricts. Corrected Deaths. Crude Deathrate. Males. Females. Total. Clapham 361 346 707 11.86 Putney 167 203 370 10.89 Balham 315 357 672 12.73 Streatham 335 422 757 11.31 Tooting 184 204 388 10.39 Wandsworth 480 487 967 10.20 Whole Borough 1,842 2,019 3,861 11.18 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. 8 Report of the Medical Officer of Health for 1934. Table V.—Causes of, and Ages at Death, during the Year 1934. 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 2 ... 2 ... ... ... ... ... 1 1 ... ... ... 1 ... ... 1 2 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 37 ... 20 12 14 5 5 ... ... 1 ... 6 2 6 4 4 15 33 Scarlet Fever 5 2 3 ... 1 ... 3 ... 1 ... ... 1 ... 1 1 1 1 2 Whooping Cough 11 4 7 5 4 1 1 ... ... ... ... 1 2 3 2 ... 3 10 Diphtheria and Membranous Croup 21 13 8 1 1 5 14 ... ... ... ... 1 6 4 ... 5 6 21 Influenza 43 23 20 2 ... 1 2 1 2 17 18 7 5 6 10 6 9 11 Erysipelas 8 5 3 2 ... ... ... 1 ... 4 1 1 ... ... 2 ... 5 7 Cerebro-spinal Fever 3 2 1 ... ... ... ... 1 1 1 ... 1 1 ... ... ... 1 1 Other Epidemic Diseases 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 Pulmonary Tuberculosis 235 138 97 ... 1 ... 1 44 102 69 18 45 26 35 36 29 64 131 Tuberculous Meningitis 16 7 9 1 1 2 7 3 ... 2 ... 3 3 1 1 3 5 16 Abdominal Tuberculosis 3 ... 3 1 ... ... ... ... 2 ... ... ... 1 ... 2 ... ... 2 Other Tuberculous Diseases 22 14 8 1 1 ... ... 3 7 5 5 6 5 3 4 2 2 15 Other Infective Diseases 13 7 6 1 ... ... 2 1 2 7 ... 1 ... 2 3 2 5 9 Cancer, Malignant Disease 591 252 339 ... 2 ... ... 2 34 259 294 102 63 107 129 43 147 338 Rheumatic Fever 29 9 20 ... ... 2 9 4 4 7 3 4 3 2 8 3 9 10 Diabetes 38 18 20 ... ... ... ... ... 2 13 23 5 4 10 5 2 12 23 Other General Diseases 62 22 40 ... ... ... 2 3 5 22 30 7 8 14 11 5 17 35 Alcoholism 6 3 3 ... ... ... ... ... ... 4 2 2 1 ... 2 ... 1 2 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Meningitis 12 4 8 6 2 1 ... 2 ... 1 ... 5 ... 3 2 1 1 8 Cerebral Hæmorrhage, Apoplexy 83 31 52 2 ... ... ... 1 3 22 55 14 5 12 20 7 25 25 Convulsions 2 1 1 1 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... Other Diseases of Nervous System 111 55 56 1 ... 3 9 8 22 44 24 20 6 20 25 12 28 88 Organic Diseases of Heart 859 358 501 ... ... ... 1 3 13 148 694 162 62 160 162 87 226 379 Other Diseases of Circulatory System 330 157 173 ... ... ... ... 6 9 94 221 53 41 63 81 30 62 123 Bronchitis 184 96 88 7 ... ... ... 2 2 48 125 40 14 36 27 24 43 55 Broncho-Pneumonia 83 40 43 12 7 5 2 ... 2 15 40 11 2 19 18 7 19 34 Lobar Pneumonia 37 23 14 1 ... ... 1 1 3 18 13 7 5 3 9 6 7 12 Pneumonia (type not distinguished) 67 47 20 5 2 6 ... ... 6 23 25 12 2 13 15 7 18 52 Other Diseases of Respiratory System 25 10 15 ... ... ... ... 2 1 12 10 2 3 7 7 2 4 8 Ulcer of Stomach 32 21 11 ... ... ... ... ... 3 20 9 5 2 7 2 7 9 26 Diarrhœa 24 15 9 21 1 ... ... ... ... 1 1 3 ... 6 4 5 6 25 Enteritis 20 12 8 14 2 ... ... ... 1 1 2 3 2 4 2 2 7 13 Appendicitis and Typhlitis 34 18 16 ... ... ... 4 2 10 13 5 9 2 4 6 4 9 34 Obstruction of Intestines 31 9 22 ... 1 ... 1 1 3 9 16 9 1 2 7 5 7 24 Cirrhosis of Liver 16 7 9 ... ... ... ... ... 2 8 6 4 2 4 1 1 4 11 Other Diseases of Liver 18 7 11 ... ... ... ... ... ... 6 12 4 2 4 4 ... 4 13 Other Diseases of Digestive System 69 33 36 1 1 2 3 3 11 26 22 14 9 12 19 3 12 52 Nephritis and Bright's Disease 169 79 90 ... ... ... 1 5 10 56 97 35 20 25 30 15 44 109 Other Diseases of Urinary System 71 55 16 ... ... ... ... 1 4 13 53 8 12 9 17 6 19 47 Diseases of Generative System 10 ... 10 ... ... ... ... ... 2 6 2 4 1 1 1 2 1 9 Puerperal Fever 4 ... 4 ... ... ... ... 2 2 ... ... 1 ... ... ... 1 2 4 Other Diseases of Pregnancy and Childbirth 5 ... 5 ... ... ... ... 1 4 ... ... 2 1 1 1 ... ... 4 Other Deaths associated with Childbirth 5 ... 5 ... ... ... ... 1 4 ... ... 1 ... 1 ... 1 2 5 Premature Birth 57 30 27 57 ... ... ... ... ... ... ... 11 6 8 10 6 16 42 Congenital Debility and Malformation 44 28 16 41 1 ... 2 ... ... ... ... 11 4 4 11 4 10 26 Other Diseases of Early Infancy 20 11 9 18 1 1 ... ... ... ... ... 1 1 5 4 4 5 14 Old Age 74 22 52 ... ... ... ... ... ... ... 74 14 7 20 11 6 16 15 Deaths from Accident 123 76 47 4 1 2 4 13 23 31 45 29 12 16 23 13 30 105 Deaths from Suicide 58 36 22 ... ... ... ... 2 17 31 8 13 6 5 11 6 17 25 Other Violent Deaths 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Other Defined Diseases 26 18 8 2 ... ... 2 1 4 7 10 4 3 1 5 7 6 22 Ill-defined Diseases or unknown 11 5 6 2 ... 1 ... ... 2 5 1 3 1 1 2 1 3 7 All causes 3861 1842 2019 221 45 37 76 120 328 1070 1964 707 370 672 757 388 967 2086 9 Vital Statistics. 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. 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 1932 11.86 14.2 15.3 11.56 12.3 12.0 1933 10.93 13.2 14.4 11.49 12.2 12.3 Average 10 years 13.02 16.0 16.6 11.10 12.1 12.1 1934 10.98 13.2 14.8 10.39 11.9 11.8 10 Report of the Medical Officer of Health for 1934. The number of deaths which occurred in Institutions, etc. inside the Borough was 1,410, but 1,146 of these persons did not belong to the Borough. A total of 2,086 persons belonging to the Borough died in Institutions, 264 occurring in Institutions within the Borough and 1,822 in Institutions outside the Borough. Infantile Mortality. The number of deaths under one year was 221—45 in Clapham, 18 in Putney, 30 in Balham, 42 in Streatham, 30 in Tooting and 56 in Wandsworth. As the number of births was 3,791 the Infantile Mortality rate was 58 per 1,000 births, compared with 50 last year. The infantile mortality rate is 58, compared with 56, the decennial average. The rate is lower than that for the whole of London, which was 67 per 1,000 births. For the 10 years ending 1918 the average infantile mortality rate was 87, while the 10 years ending 1934 the average rate was 56. The number of deaths among legitimate infants was 199 to 3,645 births—a mortality of 54 per 1,000 births, while the number of deaths among illegitimate infants was 22 to 146 births —a mortality of 150 per 1,000 births. Table VII. gives the comparative figures of infantile mortality for the last 10 years for the whole of the Borough and for each of the six sub-districts. 11 Vital Statistics. TABLE VII. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 1924 46 56 58 55 62 63 57 1925 54 64 38 42 63 57 52 1926 65 71 65 52 81 72 64 1927 44 75 50 47 71 45 51 1928 63 53 40 41 36 56 49 1929 65 38 62 44 69 74 61 1930 53 35 41 53 71 66 55 1931 48 56 49 66 65 63 59 1932 50 73 69 37 78 70 62 1933 46 75 54 31 65 49 50 Average for 10 years 53 59 52 46 66 61 56 1934 58 54 50 67 74 52 58 No. of deaths under 1 year, 1934 45 18 30 42 30 56 221 Maternal Mortality. Five deaths occurred from accidents and diseases of pregnancy and four from Puerperal Fever, giving a total of nine deaths after childbirth. This is equivalent to a rate of 2.29 per 1,000 live and still births, compared with 6 23 in 1933 and 3.0 in 1932. In addition to the nine deaths which were due directly to diseases of pregnancy and childbirth, five other women died at childbirth from other diseases not associated with childbirth. Enquiries into all maternal deaths, which were instituted in 1928 at the instance of the Ministry of Health have been continued. 12 INFECTIVE DISEASES. The total number of deaths from these diseases including all forms of Tuberculosis was 468—80 in Clapham, 52 in Putney, 72 in Balham, 74 in Streatham, 60 in Tooting, and 133 in Wandsworth. From all infective diseases the death-rate was 1.35 per 1,000—1.34 in Clapham, 1.53 in Putney, 1.36 in Balham, 1.10 in Streatham, 1.60 in Tooting, and 1.31 in Wandsworth. The rate in 1924 was, 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; in 1931, 1.44; in 1932, 1.62; and in 1933, 1.75 per 1,000. The rate is lower than in 1933 owing to the decrease in the number of deaths from Influenza and Whooping Cough. The rate from the principal infective diseases, viz.:— Small-pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever and Diarrhœa, was .34 per 1,000, compared with .47 in 1924; .32 in 1925; .37 in 1926; .25 in 1927; .27 in 1928; .36 in 1929; .35 in 1930; .18 in 1931; .44 in 1932; and .26 in 1933. The rate was .25 in Clapham, .32 in Putney, .47 in Balham, .19 in Streatham, .45 in Tooting, and .41 in Wandsworth. Table VIII. shows the number of cases of the notifiable infective diseases reported, arranged in various age groups, and Table IX. shows the same figures arranged in the sub-districts in which they occurred. 13 Infective Diseases. TABLE VIII. Notifiable Diseases. No. of CASES of Infective Diseases grouped in Age Periods. Total. Under 15 15 and upwards Under 1 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 and upwards Small-pox — — — — — — — — — — — — — — — Diphtheria 552 462 90 3 25 45 44 59 225 61 34 43 6 5 2 Scarlet Fever 1573 1295 278 7 32 72 106 131 635 312 98 134 29 17 — Enteric Fever and Paratyphoid Fever 19 4 15 — — — — — 2 2 1 7 2 5 — Puerperal Fever 15 — 15 — — — — — — — 1 13 1 — — Puerperal Pyrexia 15 — 15 — — — — — — — — 13 2 — — Erysipelas 150 11 139 4 — — — — 4 3 4 19 21 68 27 Pneumonia :— — — — — — — — — — — — — — — Acute Influenzal 49 5 44 — — — — 1 2 2 1 6 10 20 7 Acute Primary 442 164 278 29 28 16 16 19 31 25 18 60 41 93 66 Cerebro-spinal Meningitis 8 4 4 1 1 — — — — 2 — 3 — 1 — Polio-myelitis 5 3 2 — 1 — — — 2 — 2 — — — — Encephalitis Lethargica 4 — 4 — — — — — — — 2 2 — — — Malaria 1 — 1 — — — — — — — 1 — — — — Dysentery 4 1 3 — — — — — — 1 — 3 — — — Food Poisoning 2 — 2 — — — — — — — 1 1 — — — Ophthalmia Neonatorum 34 34 — 34 — — — — — — — — — — — Tuberculosis—All forms 621 53 568 4 3 5 2 2 18 19 59 278 93 118 20 Total 3494 2036 1458 82 90 138 168 212 919 427 222 582 205 327 122 14 Report of the Medical Officer of Health for 1934. TABLE IX. Notifiable Diseases. Total CASES of Infective Diseases occurring in each Locality. Total Cases occurring. Number admitted into Hospital. Total Deaths. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Small-pox — — — — — — — — — Diphtheria 111 55 58 77 77 174 552 547 21 Scarlet Fever 235 109 197 339 232 461 1573 1332 5 Enteric and Para-typhoid Fevers 1 1 1 2 1 13 19 8 2 Puerperal Fever 2 — 2 1 5 5 15 15 5 Puerperal Pyrexia 4 — 2 4 1 4 15 11 — Erysipelas 19 14 21 22 31 43 150 57 8 Pneumonia—Acute Influenzal 5 10 9 6 5 14 49 — 11 Pneumonia—Acute Primary 71 42 49 60 64 156 442 — 80 Cerebro-spinal Meningitis 3 1 1 — 1 2 8 6 5 Polio-myelitis 2 — 1 — 1 1 5 5 — Encephalitis Lethargica 2 — — — — 2 4 4 1 Malaria — — — 1 — — 1 — — Dysentery — 1 — 1 2 — 4 — — Food Poisoning 1 — — — 1 — 2 — — Total 456 233 341 513 421 875 2839 1985 138 Tuberculosis—all forms 108 74 88 96 106 149 621 — 276 Ophthalmia Neonatorum 14 — 9 3 3 5 34 11 — Total 122 74 97 99 109 154 655 11 276 Grand Total 578 307 438 612 530 1029 3494 1996 414 15 Infective Diseases. The total number of cases was 3,494 compared with 3,182 in 1933. The increase, compared with the previous year, is due to the increase in the number of cases of Scarlet Fever and Diphtheria. Small-pox. No case of this disease occurred during the year. Vaccination. Table X. is taken from the official returns of the Vaccination Officers for the year 1933 and shows the number of children successfully vaccinated for the whole Borough, as well as for the separate sub-districts. TABLE X. No. of Children. Clapham Putney Balham Streatham Tooting Southfield Springfield Total Successfully Vaccinated 246 143 342 283 101 240 172 1527 Insusceptible of Vaccination — 4 5 9 1 — — 19 Had Small pox — — — — — — — — Dead, Unvaccinated 14 13 25 15 14 13 6 100 Exempted under Certificates of Conscientious objection 153 46 204 142 123 129 68 865 Postponed by Medical Certificate 2 5 7 11 2 2 — 29 Removed 36 14 48 45 20 29 9 201 Remaining on Books as Un-vaccinated 4 11 12 15 12 4 2 60 No. of Births returned to Vaccination Officers during 1933 455 236 643 520 273 417 257 2801 16 Report of the Medical Officer of Health for 1934. The percentage of children vaccinated to total births was 54.3—in Clapham, 54.0; in Putney, 60.5; in Balham, 53.1; in Streatham, 54.4; in Tooting, 36.9; in Southfield, 57.5; and in Springfield, 66.9. This percentage is 1.0 lower than that recorded last year. Diphtheria. 552 cases occurred, compared with 409 in 1933; 323 in 1932; and 393 in 1931. The number of deaths was 21, compared with 13 in 1933, 16 in 1932 and 17 in 1931. The death-rate for 1934 was .06 and the case mortality was 3.8 per cent. The rate per 1,000 of population was 1.59; 1.86 in Clapham; 1.62 in Putney; 1.09 in Balham; 1.15 in Streatham; 2.09 in Tooting; and 1.83 in Wandsworth. Of the 552 cases, 547 or 99 per cent., were removed to hospital and no difficulty was experienced in having cases removed promptly. The Medical Officers of the London County Council made inspections of the Bonneville Road, Cavendish Road, Clapham Parochial, Haselrigge Road and New Park Road Schools in Clapham; Convent of the Sacred Heart Elementary, Roehampton, Huntingfield Road, Putney Church of England, Felsham Road, and Putney Roman Catholic, Clarendon Road Schools in Putney; Broadwater Road, Fircroft Road, Oldridge Road and Smallwood Road Schools in Balham; Eardley Road, Mitcham Lane and Woodmansterne Road Schools in Streatham; Hillbrook Road, Sellincourt Road and Tooting Graveney Schools in Tooting; and All Saints', Brandlehow Road, Frogmore, Physically Defective, Garratt Lane, Magdalen Road, Swaffield Road, Waldron Road, Wandle, Warple Way and West Hill Schools in Wandsworth. Swabs were taken from the throats of some of the children examined. As the result of this swabbing 10 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 44 tubes of anti-toxin were issued to medical practitioners for use in cases of Diphtheria. Infective Diseases. 17 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. Method of Procedure :—The following is the routine procedure :—A Schick test is performed on all adults and on children over five 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 solution now used for immunisation is the floccular preparation known as ToxoidAntitoxin-Floccules, or T.A.F. Each injection consists of one c.c. and two injections are given at weekly intervals. The results obtained with this preparation have been good, and an additional advantage in using this solution is that the number of injections is reduced to two. With toxoid anti-toxin mixture (T.A.M.) c 18 Report of the Medical Officer of Health for 1934. which was used formerly, it was necessary to give three injections. As experience has shown that the large majority of children under five 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 during the year was 954 compared with 973 in 1932 and 896 in 1933. In the seven years during which the two clinics have been open, 6,172 persons have attended. 4,613 of the total number who attended were given the Initial Schick Test to see if they were susceptible to Diphtheria, and the remaining 1,559 were given immunising injections without a preliminary Schick Test. Almost all of the latter were young children under five years of age, who were assumed to be susceptible to Diphtheria on account of their age. The Initial Schick Test:—An analysis of the results of the tests performed is given in Table XI. 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 3,163 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 I—' cd Infective Diseases. TABLE XI 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 176 1959 674 1421 1388 2809 218 136 1443 1720 3163 Schick Negative 36 602 458 540 556 1096 168 126 562 828 1390 Result not read 3 29 17 18 31 49 8 3 20 40 60 / Total 215 2590 1149 1979 1975 3954 394 265 2025 2588 4613 Percentage Positive 82% 76% 59% 72% 70% 71% 55% 51% 71% 66% 69% 20 Report of the Medical Officer of Health for 1934. the small number of adults who were tested 51 per cent, gave a positive result. Immunisation :—In order to produce immunity two injections 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 4,722. This number is made up of 3,163 who were found to be Schick positive after the initial test and the 1,559 young children who were assumed to be susceptible without a test, as they were under five years of age. The subsequent history of these 4,722 persons is given in the following statement:— No. who were immunised and found to be Protected as shown by a Negative re-Schick Test 3,225 No. who received a course of injections but are not yet protected as the re-Schick Test is still positive 207 No. who received injections, the value of which is not known as they have not attended to be re-tested 1,231 Schick positive cases who were not injected 59 Total number of Susceptibles 4,722 21 Infective Diseases. TABLE XII. 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 1212 1439 429 1471 1609 3080 81 64 1484 1741 3225 22 Report of the Medical Officer of Health for 1934. The age grouping of the persons in whom immunity was produced is given in Table XII. Two of the 3,225 persons, who have become protected as shown by a negative re-Schick test, obtained protection from an attack of diphtheria which occurred shortly after they had re-acted positive to the initial test. For this reason no immunising injections were given, but the two children were tested again after they had recovered from the attack, and the result of this re-test was negative. As it is important to be able to determine, as far as possible, the time taken to produce immunity and the number of injections required, a dissection of the protected cases is made in Table XIII, giving this information. The two cases referred to in the previous paragraph are not included in the table, which deals with 3,223 persons. The table shows that, of this number, 2,890 became protected after the first series of injections and that the majority of them received three injections, although 911 became immune after one or two injections. Since the floccular preparation has been used for immunisation, the proportion of cases requiring only two injections has increased materially. It will be noticed from Table XIII. 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 was obtained. 2,122 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 7 75 were negative within twelve months. This means that 2,897 cases were known to have been immunised within a year. There were 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 3,225 persons who have been protected, 207 have completed the first series of injections but cannot be 23 Infective Diseases. TABLE XIII. 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. Period after last injection of the First Series in which re-Test was Negative. Number of Immunising Injections given. within 4 months between Total within 1 year between 4 and 6 months 6 and 9 months 9 and 12 months 1 year and 2 years 2 years and 3 years 3 years and 5 years 5 years and 7 years Total Children Under 15. 1 injection 3 2 5 1 . — 6 First Series 2 injections 99 571 143 15 828 39 2 — — 869 3 injections 580 774 312 113 1779 92 14 — —. 1885 4 injections 5 5 — 2 12 — — — — 12 Second Series 3 to 6 injections — — 9 139 148 99 25 1 1 274 Third Series 5 to 8 injections — — — — — 24 6 — — 30 Fourth Series .. 6 injections .. — — — — — — 1 — • — 1 Fifth Series 10 injections .. — — — — — 1 — — — 1 Total Under 15 684 1353 466 269 2772 256 48 1 1 3078 Adults Over 15. 2 injections 5 20 6 2 33 2 1 — 36 First Series 3 injections 29 30 14 4 77 4 — — — 81 4 injections — 1 — — 1 — — — — 1 Second Series 3 to 6 injections — — 3 11 14 9 — 1 — 24 Third Series 11 injections — — — — — — 1 — — 1 Fourth Series 8 injections — — — — — 1 1 — — 2 Total All Ages 718 1404 489 286 2897 272 51 2 1 3223 24 Report of the Medical Officer of Health for 1934. recorded as protected because the last re-Schick test has given a positive result. 82 of these have not attended since this positive re-test. The other 125 have attended the Clinics and have received further injections but have not yet reacted negative to the re-Schick test. A further 1,231 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 559 who completed the first series of three injections and 672 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. Six children who have received at least three immunising injections at the Centres have developed Diphtheria. In at least four of the cases the attack was a mild one, and all of them recovered. In addition to these six cases of clinical Diphtheria, cultures of the Diphtheria organism have been obtained from nine 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 reaction to the primary Schick Test. In none of these 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. 1,573 cases of Scarlet Fever occurred, compared with 1,307 in 1933, 763 in 1932, and 678 in 1931. # Infective Diseases. 25 The increase in the number of cases has been associated with a general increase in the incidence of this disease throughout London. Five cases died, compared with seven and four respectively for the two previous years, and the death-rate was .014 per 1,000 compared with .019 and .011. The case mortality was .31 per cent. The case-rate per 1,000 of population was 4.55:—3.94 in Clapham ; 3.21 in Putney ; 3.73 in Balham ; 5.06 in Streatham ; 6.21 in Tooting ; and 4.86 in Wandsworth. Of the total number of cases, 1,332 or 84 per cent., were removed to hospital. The Medical Officers of the London County Council made inspections of 12 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. 48 cases of Scarlet Fever and four of Diphtheria occurred within one month of the return of a previous case from hospital. Enteric and Para-Typhoid Fevers. 19 cases, and two deaths of the above occurred, compared with 15 cases and one death in the previous year. 15 of the cases were true Enteric Fever and four were Para-typhoid Fever. One other case of this disease was notified, but proved not to be Enteric Fever. Puerperal Fever and Puerperal Pyrexia. During the year 15 cases of Puerperal Fever and 15 cases of Puerperal Pyrexia occurred. Four of the cases died. The death-rate was .01 per 1,000 of population and 1.02 per 1,000 (live and still) births. 26 Report of the Medical Officer of Health for 1934. Erysipelas. 150 cases were notified and eight deaths occurred during the year, compared with 141 and nine in 1933. Whooping Cough. 11 deaths from Whooping Cough occurred during the year and the death-rate was .03 per 1,000. 605 cases came to the knowledge of the Department during the year. 120 of the cases were removed to hospital during the year. 188 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Whooping Cough occurred, and nine premises were disinfected. Influenza. The number of deaths from Influenza was 43 compared with 183 in 1933, 111 in 1932, 97 in 1931, 22 in 1930 and 237 in 1929. The death-rate was .12 per 1,000. Influenzal Pneumonia and Acute Primary Pneumonia. 49 cases of acute Influenzal Pneumonia and 442 cases of acute Primary Pneumonia were notified. 11 of the former and 80 of the latter died. The total number of deaths credited to all forms of Pneumonia during the year was 187, compared with 175 in 1933, 180 in 1932, 191 in 1931, 207 in 1930, 331 in 1929, 246 in 1928, 239 in 1927, 217 in 1926, 181 in 1925, and 233 in 1924. Cerebro-Spinal Meningitis. Eight cases of this disease occurred. Three of them terminated fatally. Two other cases of this disease were notified, but proved not to be cerebro-spinal meningitis. 12 deaths were registered as being caused by Meningitis. Infective Diseases. 27 Polio-myelitis and Polio-encephalitis. Five cases occurred, none of which proved fatal. All the five cases were admitted during the year for treatment at Queen Mary's Hospital, Carshalton, under the scheme arranged by the London County Council. Encephalitis Lethargica. Four cases of this disease occurred and one death was registered. Malaria. One case was notified. No death occurred. Dysentery. Four cases of Dysentery were notified and no death occurred. Ophthalmia Neonatorum. 34 cases were notified. 31 of them recovered without any impairment of vision, one case died from Premature birth, another removed from the Borough, and one case was still under treatment at the end of the year. TABLE XIV. Result of Treatment. Recovered— Vision not affected. Vision Impaired. Total Blindness. Died. Treatment received :— In Hospital 11 — — — At Hospital, Out-patient 1 — — — At home 19 — 1 Total 31 — — 1 28 Report of the Medical Officer of Health for 1934. Measles. The number of cases brought to my notice during the year October 1st, 1933, to September 30th, 1934, was 4,140. 37 cases died during the calendar year. 347 cases of German Measles were also reported. Table XV. shows the number of cases of Measles and the deaths from the disease for the last 10 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. 620 cases were removed to hospital, compared with 500 in the epidemic year of 1932. 73 cases requiring special home nursing were referred to District Nursing Associations in the Borough, compared with 100 in 1932, and the nurses made 920 visits to these cases, compared with 997 in 1932. The death-rate per 1,000 of the population was .17 compared with .10 in 1932 and .13 in 1930. 4,261 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Measles occurred, and 170 premises were disinfected at the request of the occupiers. 29 Infective Diseases. TABLE XV; MEASLES-CASES REPORTED AND DEATHS. Period 1st October—30th September. 1924-25 1925-26 1926-27 1927-28 1928-29 1929-30 1930-31 1931-32 1932-33 1933-34 Cases Reported. In a Measles year — 4,219 — 4,596 — 4,046 — 3,601 — 4,140 In a Non Measles year 293 — 81 — 355 — 295 — 589 — Deaths. In a Measles year 52 — 38 — 46 — 38 — 37 In a Non-Measles year 1 — 2 — 1 — 2 — 2 — Period. Calendar Year 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 Cases Reported 474 4,028 172 4,529 380 3,976 291 3,598 615 4,148 Deaths 1 51 4 36 1 47 2 37 2 37 30 Report of the Medical Officer of Health for 1934. Table XVI. shows the number of cases of infective diseases which occurred in the individual elementary schools during the year. TABLE XVI. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases Totals. Clapham. Bonneville Road 14 4 51 9 9 33 9 — 10 139 Cavendish Road 16 1 45 4 — 6 38 1 — 111 Cavendish Road, P.D. 4 1 4 3 — — 3 — — 15 Christchurch 5 1 3 — 3 18 — — — 30 Haselrigge Road 18 27 66 37 29 30 26 1 45 279 Henry Thornton — — 5 — 1 — 9 — — 15 Larkhall Lane 12 1 26 19 1 4 1 26 90 New Park Road 47 15 47 12 21 1 3 — 8 154 New Road 1 — 7 — 4 — 1 — 2 15 Parochial, Macaulay Road 2 — — — — — — — — 2 Parochial, Old Town 3 1 39 2 18 1 — — — 64 St. Andrew's Street 2 3 51 — 5 7 — — — 68 St. Mary's, Crescent Lane 5 5 22 — — — — — — 32 St. Mary's, St. Alphonsus Road 1 2 — — — — — — — 3 Stonhouse Street 7 5 51 — 4 3 44 — 1 115 Telferscot Road 15 2 64 7 6 15 1 — 2 112 Putney. All Saints' — 1 — — — — — — — 1 Convent of Sacred Heart 6 10 — — — — — — — 16 Hotham Road 17 7 50 26 1 32 5 — 33 171 Huntingfield Road 5 3 57 1 37 — 81 — — 184 Parochial, Roehampton 1 1 1 — 7 — 8 — — 18 St. Agnes, R.C. — 4 2 1 1 — — — — 8 St. Mary's 3 2 7 6 5 — — — — 23 Upper Grade — — 3 11 — — — — — 14 Balham. Balham Central 3 1 3 2 1 — 3 — — 13 Bee, The 3 — — — — — — — — 3 Broadwater Road 7 — 14 1 7 5 2 — 2 38 Fircroft Road 13 8 41 3 6 6 54 — — 131 Hearnville Road 7 1 85 — 4 — 25 — — 122 Holy Trinity 10 2 8 1 — — 2 — — 23 Nightingale Square, R.C. 3 1 19 — — — -— — — 23 Oldrldge Road 20 1 11 5 3 5 4 — 4 53 Ravenstone Street 19 — 12 3 3 3 45 — 2 87 St. Mary's 5 4 46 17 8 5 45 1 — 131 Smallwood Road 21 9 44 2 14 2 1 3 — 96 Carried forward 295 123 884 153 216 173 413 7 135 2399 TABLE XVI.—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 295 123 884 153 216 173 413 7 135 2399 Streatham. Christchurch 3 — — — — — — — — 3 Dunraven 5 — — — 1 — — — 1 7 Eardley Road 7 2 78 23 60 5 3 — 4 182 Furzedown Demonstration 26 4 11 3 23 3 4 29 103 Granton Road 12 1 55 5 30 25 1 129 Hitherfield Road 11 1 51 3 27 4 1 2 1 101 Holy Trinity 1 2 6 3 2 — 1 — — 15 Immanuel 5 — 22 — — 3 — 30 Mitcham Lane 18 12 67 12 37 31 4 — 2 183 St. Andrew's, Colmer Road — — — 1 21 — 1 — — 23 St. Andrew's, Polworth Road 8 1 22 — — 1 5 — — 37 St. Leonard's 8 — 21 — 5 8 — 1 — 43 Sunnyhill Road 20 3 77 — 12 14 9 1 1 137 Woodmansterne Road 43 — 34 6 12 33 — 1 14 143 Tooting. Defoe (Fountain Road) 5 2 31 1 10 9 16 2 76 Ensham Central 5 1 — — — — — — 6 Ensham 5 4 81 — 23 5 1 — — 119 Franciscan Road 9 3 15 1 3 — 4 — 1 36 Hillbrook Road 9 4 46 2 6 27 4 — 2 100 Sellincourt Road 34 29 126 1 88 9 — 2 4 293 Tooting Graveney 2 3 23 1 22 1 2 — — 54 Undine Street, R.C. 3 1 30 — 29 1 1 — — 65 Wandsworth. Allfarthing Lane 19 6 96 27 28 2 1 6 185 All Saints' 9 1 55 1 6 19 — — 91 Brandlehow Road 30 12 17 7 17 3 2 — 1 89 Earlsfield 2 1 5 — — — — — 2 10 Elliott Central 6 2 2 1 — — — 1 12 Eltringham Street 3 5 88 1 12 11 12 2 134 Frogmore Special — — 8 1 — — — 2 11 Garratt Lane 15 2 71 3 7 2 1 — 7 108 Littleton Street, Special — 1 — — — — — — 1 Magdalen Road 22 1 27 1 2 1 2 — 4 69 Merton Road 3 1 4 — 1 — — — — 9 Riversdale 30 4 86 1 5 10 3 — 1 140 Carried forward 673 230 2139 258 701 387 508 15 223 5134 31 Infective Diseases. 32 Report of the Medical Officer of Health for 1934. TABLE XVI.—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 673 230 2139 258 701 387 508 15 223 5134 St. Ann's 3 1 43 5 2 54 St. Faith's 3 3 40 1 — — — — — 47 St. Joseph's 4 — 9 — — 1 2 — — 16 St. Michael's 11 2 71 1 1 — — — — 86 St. Thomas' 5 — — — — — — — 1 6 Swaffield Road 39 11 44 4 4 — 1 — 7 110 Waldron Road 31 4 78 — 3 1 5 1 2 125 Wandle 24 5 39 — 2 6 1 1 7 85 Wandsworth Central 2 — 2 — — — — — — 4 Warple Way 5 10 72 3 12 — — — — 102 West Hill 7 3 92 7 8 2 3 — — 122 Grand Total 807 269 2629 274 736 397 522 17 240 5891 Infective Diseases. 33 Sanitary Inspectors. These children were being treated at the London County Council cleansing stations. In addition to the above 29 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. In 87 cases where consent was obtained, disinfection of the bedding and clothing of the patient was carried out by the disinfecting staff. Cleansing of Persons Act. The names of 27 children, stated to be in a verminous condition, were forwarded to me by the Medical Officer, Education Department, London County Council, and the homes were visited by the Inspectors. In four cases the clothing and bedding was also verminous and this was disinfected. These children were cleansed by the officials of the London County Council at the Cleansing Station under the supervision of that Authority. Disinfection. The total number of rooms disinfected after the occurrence of cases of infective diseases was 3,431—549 in Clapham, 322 in Putney, 531 in Balham, 681 in Streatham, 397 in Tooting, and 951 in Wandsworth. Two public and six private elementary schools were also disinfected for infective diseases. Ambulance Service. The London County Council has been responsible for the removal by ambulance of cases of infective 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. D 34 Report of the Medical Officer of Health for 1934. Bacteriological Examinations. During the year 3,283 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 XVII. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Diphtheria :— Negative 496 415 455 592 253 797 3008 Positive 48 20 47 40 24 83 262 Enteric Fever :— Negative 2 2 6 1 1 — 12 Positive 1 — — — — — 1 Total 547 437 508 633 278 880 3283 35 NON-INFECTIVE DISEASES. The total number of deaths from Cancer and malignant disease was 591, the number of males being 252 and females 339. The death-rate was 1.71 per 1,000. The number of deaths in 1934 was 12 more than in 1933. The number of deaths from diseases of the Brain and Nervous System was 113. 1,272 deaths occurred from diseases of the Heart and Circulatory System, compared with 1,260 in 1933, 1,279 in 1932, and 1,197 in 1931. 970 of these deaths were of persons over 65 years of age. There were 396 deaths from diseases of the Respiratory System, compared with 386 in 1933, 492 in 1931 and 420 in 1930. The number from Bronchitis was 184 compared with 184 in 1933, and from Pneumonia (all forms) 187 compared with 175 in 1933. Further particulars relative to Pneumonia are given on page 26. The number of infants under two years of age who died from these diseases was 25. 121 deaths, 69 males and 52 females, were registered as due to Premature Birth and Developmental Diseases, compared with 111 in 1933. 74 deaths, 22 males and 52 females, occurred from Old Age, and all these were persons over 65 years of age. The number of deaths due to this cause in 1933 was 114. 182 deaths were due to violence, 123 of them being due to accident, 58 to suicide, and one to another form of violence. Insulin Treatment. This service was commenced by the Council in 1928 with the sanction of the Ministry of Health. There are now six persons receiving treatment. The cost to the Council for the year 1934 was £32 16s. lid. Inquests. Inquests were held on 268 persons dying in the Borough, and on 177 Borough residents who died outside the Borough. D2 36 Report of the Medical Officer of Health for 1934. The next Table shows the results of the findings of these inquests. TABLE XVIII. Inquests. Sub-Districts. Whole Borough. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Deaths from Natural Causes 43 30 39 33 28 59 232 Accidental:— Knocked down by motor vehicles 9 11 5 4 4 5 38 Palls 3 3 8 — 11 6 31 Falls from motor vehicles 1 5 6 6 5 2 25 Falls from a height 5 1 4 1 — 3 14 Burns and scalds 4 1 — 4 — 1 10 Suffocation — 1 3 1 1 2 8 Falls from bicycles — — — 1 1 2 4 Other 3 — 4 3 — 5 15 Suicidal:— Poisoning by:— Coal Gas 6 3 2 3 3 7 24 Lysol — 4 1 — — 2 7 Cyanide of Potassium — — — 1 1 — 2 Carbolic Acid — 1 — — — — 1 Prussic Acid — — — 1 — — 1 Hydrochloric Acid — — — 1 — — 1 Barbituric Acid — — — — 1 — 1 Medinal — — — 1 — — 1 Liq. Ammonia — 1 — — — — 1 Cut throat 2 — 1 3 1 2 9 Drowning — — — — 1 3 4 Gunshot wounds 1 — — 1 — 1 3 Fall from a height 1 — 1 1 — — 3 Hanging — — — 1 — — 1 Run over by train — — — — — 1 1 Infanticide 1 — — — — — 1 Found drowned 1 1 — 1 — 1 4 Found dead — — — 1 — — 1 Hanging—Execution — — — — — 2 2 Totals 80 62 74 68 51 104 445 37 TUBERCULOSIS. Notification.—The total number of new cases of Tuberculosis which came to the notice of the Department during 1934 was 621, as compared with 610 in 1933, 642 in 1932, 613 in 1931, 638 in 1930 and 690 in 1929. The sources of information regarding the 621 new cases in 1934 were as follows:— Primary notifications on Form A Primary notifications on Form B Transfers from other Sanitary Authorities Naval and military notifications Un-notified at death Total 482 – 117 3 19 621 Table XIX.—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. shows the number of new cases of Nonpulmonary Tuberculosis classified according to the part of the body affected. TABLE XX. Localisation of Disease. Total. Males. Females. Brain 15 5 13 Glands, Mesenteric .. .. * .. 11 1 10 Glands, Cervical 12 5 7 Bones and Joints 33 16 17 Other Parts 17 7 10 Totals 88 34 54 38 Report of the Medical Officer of Health for 1934. TABLE XIX. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Males. Females. Males. Females. Males. Females. Males. Females. Under 1 year 3 1 2 1 1—5 — 2 2 8 1 3 2 5—10 .. 5 3 7 3 1 2 2 10—15 .. 4 7 4 4 1 3 1 2 15—20 .. 15 31 3 10 5 9 2 1 20—25 .. 49 51 3 7 23 22 1 3 25—35 .. 64 83 6 15 34 21 2 4 35—45 .. 57 31 3 2 27 14 1 2 45—55 .. 44 19 1 3 22 13 2 1 55—65 .. 40 10 1 17 8 2 1 65 upwards 13 5 1 1 9 5 3 1 Totals 291 242 34 54 138 97 21 20 38 T nberculosis. 39 Deaths.—The total number of deaths certified as due to diseases of a Tuberculous nature was 276—of whom 159 were males, and 117 females. 235 deaths were due to Pulmonary Tuberculosis and 41 to other forms of Tuberculosis. Table XXI. gives further details regarding the type of the disease, and sex, of these 276 deaths. TABLE XXI. Localisation. Males. Females. Total. Pulmonary Tuberculosis 138 97 235 Brain 7 9 16 Glands, Mesenteric — 3 3 Bones and Joints 3 2 5 Other Parts 11 6 17 Totals 159 117 276 In addition to these deaths, which were duly certified in the returns as due to Tuberculosis, 39 persons previously notified as suffering from Tuberculosis died during the year. These deaths, however, do not figure in Table XXII. for the reason that:— (a.) Eleven were certified as dying of diseases other than Tuberculosis. (b.) 28 had previously moved outside the Borough and died there, the death being allocated 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. TABLE XXII. 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 Pulmonary Tuberculosis :— No. of Deaths Death-Rate 261 255 300 269 320 275 288 245 257 235 •75 •73 •85 •76 •90 •77 •81 •69 •73 •66 Other Forms:— No. of Deaths Death-Rate 49 40 39 35 33 33 19 43 48 41 •15 •12 •11 •10 •09 •09 •05 •12 •13 •11 Total :— No. of Deaths Death-Rate 310 295 339 304 353 308 307 288 305 276 •90 •84 •96 •86 •99 •86 •86 •81 •86 •78 40. Report of the Medical Officer of Health for 1934. T uberculosis. 41 During the year 19 persons, not previously notified, were certified as having died of Tuberculosis. The ratio of un-notified Tuberculosis deaths to total Tuberculosis deaths is therefore 19 to 276. Of the 19 un-notified deaths, four were certified from Institutions, 11 by private doctors, while in four 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. 54 persons died within one month after notification, 81 within three months, and 102 within six months. 621 cases were added to the notification register during the year, and 737 cases who had removed, recovered or died, were taken off. The number remaining on the register at the end of the year was 2,088. 42 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 1934.—The following Table shows the number of new cases which attended during the year classified into adults and children and according to the diagnosis arrived at. TABLE XXIII. Tuberculous. Suspected Tuberculosis NonTuber culous Totals. Pulmonary NonPul monary Total Adults M. 170 14 184 18 265 467 F. 142 17 159 19 258 436 Children M. 5 8 13 1 205 219 F. 6 5 11 — 191 202 Totals 323 44 367 38 919 1324 Included in the above are 53 cases who were either transferred from other Districts where they had been under treatment or had re-appeared after having been removed from the Dispensary Register. Tuberculosis Dispensaries. 43 The districts of the Borough in which these 1,324 persons resided, together with the authorities who recommended them to attend, are given in Table XXIV. TABLE XXIV. Recommended to attend Dispensary by Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Totals. Public Health ment 45 26 55 45 45 95 311 Private Practitioners 58 51 64 68 88 154 483 Charitable Societies 10 7 7 10 22 23 79 Other Dispensaries 24 20 27 22 33 38 164 L.C.C. Schools 2 5 3 — 4 8 22 Ministry of Pensions — — 1 — — — 1 Existing Dispensary Patients — — — 1 1 1 3 Other Sources 16 35 22 27 54 107 261 Totals .. 155 144 179 173 247 426 1,324 Contacts.—Of the 1,324 new cases examined, 355 were contacts. Five of these were found to be suffering from Tuberculosis. Dispensary Register.—Table XXV. 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 XXV. Tuberculosis Remaining 31st Dec., 1933 New Cases Removed from Register Remaining on Register 31st Dec., 1934 Pulmonary 1086 369 342 1113 Non-Pulmonary .. 261 56 59 258 Suspected cases 47 170 179 38 Totals 1394 595 580 1409 44 Report of the Medical Officer of Health for 1934. I Table XXVI. gives further details of the work carried out during the year. TABLE XXVI. 1 Number of patients transferred from other areas and " lost sight of " cases returned 68 2 Number of patients transferred to other areas and cases " lost sight of " 143 3 Died during the year 170 4 Number of observation cases in which period of observation exceeded 2 months 38 5 Number of attendances at the dispensaries 4705 6 Total number of reports, etc , made in connection with the dispensaries 5231 7 Number of attendances at General Hospitals or Institutions of patients for :— (a ) Light treatment 39 (b ) Other special forms of treatment 1038 8 Number of patients to whom Dental Treatment was given in connection with the Dispensary 9 9 Number of consultations with Medical Practitioners :— (a) At homes of applicants 215 (b) Otherwise 1132 10 Number of other visits by Tuberculosis Officers at homes 560 11 Number of visits by Health Visitors or Nurses to homes for dispensary purposes 3772 12 Number of :— (a ) Specimens of Sputum, etc , examined 1467 (b) X-ray examinations made in connection with dispensary work 182 The number of patients who received institutional treatment under the London County Council's Tuberculosis Scheme durine 1934 was as follows :— (a.) In Hospitals for observation 29 (b.) In Sanatoria 425 (c.) In Hospitals for Advanced Cases 3 Total 457 In addition to these many other patients received treatment in private or general hospitals. Co-operation with other Institutions.—Cases requiring special investigation without their admission to Hospital are referred to St. Thomas's Hospital in accordance with the scheme inaugurated in 1913. The reports are of much value, Tuberculosis Dispensaries. 45 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. 83 cases were treated during the year and 1,038 refills administered. The cost to the Council was £544 19d. Od. The close co-operation between the Dispensary and the School Medical Service instituted by the London County Council has been continued. 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, nine patients received dental treatment and five of these were supplied with dentures. The attendances at the dentist totalled 32. The amount expended on dental treatment during the year was £6 13s. Od., and the cost of dentures supplied to patients was £14 17s. 6d., making a total cost of £21 10s. 6d. Extra Nourishment.—Under Section 3 of the Public Health (Prevention and Treatment of Disease) Act, 1913, extra nourishment is granted on medical grounds as part of treatment. It is limited to the slighter cases of disease, where there is a reasonable probability that extra nourishment will increase the chances of recovery, or will enable the patient to remain at work or to return to work at an early date. During the year under consideration 94 patients have been granted extra nourishment under the scheme at a cost of £95 8s. 3fd. 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 1934 as far as it is known. Table XXVII. refers to cases of Pulmonary Tuberculosis and Table XXVIII. to cases of Non-pulmonary Tuberculosis. TABLE XXVII. Classification on Initial attendance at the Dispensaries. Condition at the end of 1934. Total cases where condition is known. Removed and lost sight of. Total cases who have attended. Discharged as cured. Disease arrested. Disease not arrested. Died. Pulmonary Tuberculosis. Class T.B. Minus. Adults, M. 412 21 104 327 864 1984 749 2733 Adults, F. 464 31 130 319 944 Children 118 7 24 27 176 Class T.B. Plus. Adults, M. 143 69 385 1594 2191 3825 1158 4983 Adults, F. 103 44 287 1158 1592 Children 7 I 10 24 42, 46 Report of the Medical Officer of Health for 1934. TABLE XXVIII. Classification on Initial attendance at the Dispensaries. Condition at end of 1934. 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. 46 6 31 18 101 295 108 403 Adults, F. 21 3 26 10 60 Children 66 10 40 18 134 Abdominal Adults, M. 10 1 4 4 19 87 56 143 Adults, F. 10 3 11 1 25 Children 25 1 11 6 43 Peripheral Glands Adults, M. 14 2 _ 5 4 25 311 116 427 Adults, F. 33 2 15 8 Children 205 4 8 11 228 Other Organs. Adults, M. 21 2 8 12 43 170 50 220 Adults, F. 25 7 15 8 55 Children 15 12 26 19 72 Tuberculosis Dispensaries. 47 48 Repor iof the Medical Officer of Health for 1934. 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. No. of specimens found to contain T.B. 1930 .. 1944 1254 447 1931 .. 2157 1557 410 1932 .. 1664 1001 342 1933 .. 1633 997 280 1934 .. 1467 1022 270 Tuberculosis Care Committee. Constitution.—The Committee consists of members representing the Borough Council, and other authorities and organisations. There are also 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. fCouncillor Mrs. Godber. Councillor T. Harding. Councillor W. Greener, F.C.R.A. Councillor H. H. S. Aram, F.I.M.T. fCouncillor A. A. Norman. Dr. E. J. Boome, L.C.C. Divisional Medical Officer. Miss E. Thomas, L.C.C. School Care Committee. Miss E. Brown, Public Assistance Committee. Mrs. Groom, Public Assistance Committee. Mr. T. H. Hunt, London Insurance Committee. Miss Clarke Hall, Wandsworth and Putney Invalid Children's Aid Association. Mrs. Weatherhead, Balham, Streatham, Tooting and Clapham Invalid Children's Aid Association. Miss Connor, Soldiers, Sailors' and Airmen's Association. Miss Lemon, Ranyard Nurses. Mr. H. B. Harvey, Aged Poor Society. Miss E. Morris, St. Thomas's Hospital. Miss L. C. Marx Brompton Hospital. Mrs. Baker, United Services Fund. Tuberculosis Dispensaries. 49 Mrs. Arding. Mrs. Brown. Mrs. Dixon. Dr. E. Higgins. Mrs. H. Jeans. Mrs. Laer. Mrs. MacDonald. Mrs. Morton Clarke. Rev. V. St. Clare Hill. Miss Duff. Mrs. Cresswell. * Councillor Mrs. Dewar Robertson retired from the Committee in November, 1934. Councillors Mrs. Wilson and Kennedy were elected to the Committee in December, 1934. †Councillors Mrs. Godber and Norman have now retired from the Council, but remain on the Committee as co-opted members. Officers of the Committee :— Chairman : Councillor Mrs. J. Dewar Robertson, M.B.E., J.P. Vice-Chairman : Mrs. Cresswell. Secretary : Miss M. L. Baptie. Hon. Treasurer : Mrs. Nicol. Meetings.—The Care Committee meets at the Council House East Hill, Wandsworth, on the first Friday in every month at 2.45 p.m. The Finance Sub-committee and Handicraft Subcommittee meet prior to the General Committee. Summary of the Work Done.—An important duty of the Tuberculosis Care Committee has been the investigation of the financial circumstances of patients recommended to the London County Council for Institutional treatment and the assessment of the amount these patients should pay towards the cost of the treatment. During the year the County Council decided to make the treatment free, so that the assessment of patients by the Committee is no longer required. Up to the time that this decision was put into force, the Committee had undertaken the assessment of 304 cases from the commencement of the year and £586 16 lOd. was collected from patients and remitted to the County Council. Although there is now no need for an assessment to be made, the County Council still require a return to be made to them giving £ 50 Report of the Medical Officer of Health for 1934. the financial circumstances of patients who are to undergo institutional treatment. These particulars for 108 cases have been forwarded since the abolition of assessments. Patients requiring dental treatment, which is a service provided by the Borough Council, are still assessed by the Committee who determine the amount of their contributions towards the cost. Soon after the Committee was established it was apparent that the value of the work it could carry out would be increased materially if funds were available. As no grants from public funds were provided, certain members of the Committee decided to organise a Voluntary Fund. A considerable amount of success has attended their efforts, and a small fund has been established. This fund is not intended to assist families in their living expenses, as other organisations 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 these cases are investigated by the Secretary. Nineteen adults and one child were sent to Convalescent Homes during 1934, at a cost of £64 15s. 8d. Financial assistance is also given to relatives of patients who have been away under treatment for three months or longer, to enable them to visit, as it is often found that after that time, the patient becomes restless and wants to come home. The visit from a relative often does much good, and the patient agrees to continue under treatment. These cases are investigated and assistance is only given where it would be quite impossible for the relative to afford the fare. The cost of fares paid during 1934 was £2 9s. Od. Whilst a patient is undergoing Institutional treatment, it often happens that arrangements have to be made for the care of children. The Secretary investigates all these cases, and if she is not satisifed that the children will be properly looked after by relatives while the mother is away, arrangements are made through the London County Council and the Invalid Children's Aid Association for them to be boarded out. The expenses are met by the County Council. Tuberculosis Dispensaries. 51 An important duty of the Committee is to supply patients going to an Institution with clothing. Many of them are short of the clothing requirements of the Institution, and it is frequently a difficult problem to get them fitted out properly. Much time is spent by members of the Committee in collecting articles of clothing from their friends, and a certain proportion of the funds have to be expended in this direction. During 1934 £10 19s 4d. was expended on clothing, and about 70 per cent, of the cases sent to Institutions were supplied with the articles required from the clothing store. There are always a number of patients in an advanced stage of Tuberculosis who are being nursed either at home or in one of the London County Council's General Hospitals, particularly St. James's Hospital. These cases are visted as often as possible by the Secretary. Some of the cases which are being nursed at home are unable to obtain essential articles of medical equipment. Medical and nursing requisites, comprising air and water cushions, bed rests and feeding cups have been acquired by the Committee gradually, and are supplied on loan to necessitous cases who require them : the cost of medical and nursing requisites and special nourisment amounted to £9 15s. l0d. By permission of the authorities of St. James's Hospital, regular visits are paid to Wandsworth residents suffering from Tuberculosis who happen to be in the Hospital. 157 of these cases were visited regularly during the year. Many of these patients are in hospital for prolonged periods, and the visits are much appreciated. It is often found when talking to the patients that they are in difficulties over their rent, or insurance payments, and may be worried by circumstances at their homes. The Secretary inquires into all matters of this nature, and is able to assist in smoothing out many of the patients' difficulties. During 1934 the number of visits and interviews made by the Secretary to cases attending the Dispensaries was 1,940. During the year there have not been so many cases referred to the various ex-service organisations, as there were fewer exservice men attending the dispensaries. 15 cases were referred to these organisations and granted assistance by them. e2 52 Report of the Medical Officer of Health for 1934. The number of cases referred to the Public Assistance Committee has increased. 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, these were cleared off by grants from the Voluntary Fund, which enabled the patients to draw benefit. These grants amounted to £4 16s. lid. In special cases, assistance in the payment of rent is granted, in order to tide over a period of distress. When it is found that the patients' illness is the cause of the non-payment of rent, the debt is settled in order to enable the patient to receive proper treatment. The amount paid on this account during 1934 was £7 2s. Od. During the year the Care Committee paid for three cases in St. Columba's Hospital, Hampstead, the amount being £12 9s. Od. 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 out of the Committee's fund. It meets at 79, East Hill, Wandsworth, every Tuesday morning at 10.30-12.30, and is in charge of Miss Fone, who is a trained instructress in the crafts taught. These are the making of articles in leather, pewter or parchment, and embroidery, knitting, etc. After deducting the cost of materials the profit on a particular article made at the Class goes to the patient who has made it. The Class is much appreciated by the patients, who attend as regularly as their health will allow. The Wandsworth Care Committee held a very successful Sale at the Town Hall in October, when the opening ceremony Tuberculosis Dispensaries. 53 was performed by His Worship the Mayor of Wandsworth, Alderman Lieut.-Col. G. F. Doland, O.B.E., J.P., L.C.C., and a Handicraft Exhibition and Sale of Work was held at Carpenter's Hall, London, under the auspices of the Standing Conference of Metropolitan Borough Tuberculosis Care Committees: this Exhibition was opened by the Lord Mayor of London. 54 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 then up to school age. The re-visits of infants attending the Infant Welfare Centres are carried out by the Superintendents of the Centres. In three 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 nine 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 districts are therefore carried out by the Health Visitors, whether the infants are attending the Centres or not. The nine Centres where one of the Health Visitors is the Superintendent are Fairlight Hall, Beechcroft Road, Springfield, Fairfield, Southfield, Streatham Hill, Putney, Blegborough Road and Riggindale Road, Streatham. 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 AnteNatal sessions. Where the Superintendent is one of the Health Visitors she is assisted at the sessions by another Health Visitor. Infectious Diseases—All cases of Puerperal Fever, Puerperal Pyrexia, Whooping Cough and Ophthalmia Neonatorum are visited on notification, as well as all known cases of Measles and Diarrhoea in children under five. Other Home Visits.—The Health Visitors visit the homes of mothers attending the ante-natal Centres in the Borough, Maternity and Child Welfare. 55 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. The Health Visitors also make the visits required under the Children and Young Persons Acts. Periodical visits are also made to Creches and to other Institutions for mothers and children. Table XXIX. summaries the work of the Health Visitors during the year in the six divisions of the Borough. 56 Report of the Medical Officer of Health for 1934. TABLE XXIX. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. No. of children visited :— Under 1 year 540 355 428 512 545 972 3352 1-2 years 11 16 18 14 3 29 91 2-5 years 28 16 18 58 4 19 143 Revisits to :— Infants under 1 year 701 845 344 689 526 1370 4475 Children 1-2 years 468 558 272 570 473 1070 3411 Children 2-5 years 630 467 442 1025 511 1542 4617 Total visits to children under Notification of Births Act 2378 2257 1522 2868 2062 5002 16089 Other visits—: Foster Mothers 249 153 103 200 278 400 1383 Ophthalmia Neonatorum 12 6 4 3 3 7 35 Measles 764 236 432 808 514 1503 4257 Whooping Cough 35 56 8 35 19 32 185 Ante-natal cases 347 261 191 469 254 398 1920 Puerperal Fever and Pyrexia 2 — 3 1 7 9 22 Miscellaneous 132 115 126 181 217 470 1241 Ineffectual 885 186 359 1024 811 1635 4900 Total Home Visits 4804 3270 2748 5589 4165 9456 30032 Attendances at:— Infant Welfare Centres 162 174 153 276 291 472 1528 Ante-natal Centres 22 22 27 36 21 37 165 Committee Meetings 4 12 — — 17 — 33 Health Talks 7 96 53 41 33 84 314 Visits to Crfeches — 8 19 — 14 28 69 Diphtheria Prevention Clinics — — 52 — — 43 95 57 Maternity and Child Welfare. Infant Visiting. TABLE XXX. Method of Feeding. Age of infant on first visit. Under 1 month. 1—3 months. 3—6 months. 6—12 months. Total. Breast-fed 2001 761 126 60 2948 Otherwise fed 99 167 59 79 404 There were 3,791 births during the year and 3,352 of these, or 88.4 per cent., were visited compared with 89.1 in 1933, 89.0 in 1932, 90.9 in 1931, 84.1 in 1930 and 84.1 in 1929. Table XXX. 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 2,001 of the 3,352 infants visited were being fed from the breast entirely. 58 Report of the Medical Officer of Health for 1934. 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. 57 midwives practise in the Borough, of whom 20 reside in neighbouring Boroughs. There are 25 private maternity homes in the Borough, 19 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 Is. 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. 237 cases were visited during the year under these arrangements, and 3,619 visits were made to them as shown in Table XXXI. TABLE XXXI. No. of cases occurring. No. of cases visited. No. of visits made. Whooping Cough 605 3 28 Influenza — 19 225 Pneumonia 491 115 1917 Ophthalmia Neonatorum 34 27 529 Measles 4148 73 920 Puerperal Fever and Puerperal Pyrexia 30 — — Infantile Diarrhoea — — — Total 5308 227 3619 Maternity and Child Welfare Centres. There are now 12 Infant Welfare Centres in the Borough. They are voluntary institutions administered by the Committees 59 Maternity and Child Welfare. 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 three of the Centres the Superintendent is an officer of the Centre Committee, while in the other nine Centres one of the Council's Health Visitors 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:— 60 Report of the Medical Officer of Health for 1934. 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., at 2, Clarendon Road. Wednesdays and Thurs days at 2 p.m. Putney Park: Putney Park House, Dover House Rd. Alternate Fridays at 2 p.m. Balham: 91, Bedford Hill. 1st, 3rd and 5th Fridays in each month at 9.45 a.m. Wednesdays and Thurs days at 1.30 p.m. Streatham: 37, Riggindale Road. 1st and 3rd Wednesdays in each month at 10 a.m., at 37, Riggindale Road. Tuesdays at 1.30 p.m. Fridays at 2 p.m. Wesley Hall, Blegborough Road. 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. St. Peter's Church Hall, Beechcroft Road. 4th Wednesday in each month 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: Congregational Church Hall, Earlsfield Road. 4th Tuesday in each month at 11 a.m. Tuesdays at 2 p.m. 61 Maternity and Child Welfare. Table XXXII. gives the full details of the work carried out at the 12 Centres in the Borough. 2,866 new infants were examined during the year and the total attendances were 58,529. There were 544 ante-natal cases and the total attendances made by them was 1,486. The visits made by the Superintendents of the three Centres where hose officers are appointed by the Centre Committees were 3,974 to the homes of infants and 555 to ante-natal cases. No visits are shown in this Table for the other nine Centres, where the Superintendents are Health Visitors, as their visits are included in Table XXIX. which shews all the work carried out by the Health Visitors. TABLE XXXI I. WORK CARRIED OUT AT THE INFANT WELFARE AND ANTE-NATAL CLINICS. Report of the Medical Officer of Health for 1934. Clapham. Putney. Putney Park. Balham. Streatham. Blegborough Road. Streatham Hill (ClaphamPark) Fairlight Beechcroft Road. Southfield. Fairfield. Springfield. Totals. Infant Clinics:— No. of Sessions held 96 92 50 99 95 48 49 93 46 96 101 47 912 No. of New Cases 440 271 59 464 269 90 179 218 142 263 220 251 2866 No. of Doctors' Consultations 2801 2300 534 3025 1209 2105 683 1077 1761 1613 2029 1457 20594 Total Attendances 710S 6961 1487 9484 5976 1949 3829 4663 3011 4885 4338 4838 58529 Ante-natal Clinics:— No. of Sessions held 24 24 - 27 23 - - 12 10 12 12 11 155 No. of New cases 66 91 - 103 105 - - 42 36 35 33 33 544 Total attendances 162 374 - 355 213 - - 88 75 73 90 56 1486 No. of Health Talks given 22 96 20 53 27 - 14 20 13 21 30 33 349 No. of visits by Superintendents of Voluntary Committees:— To Infants,under 1 year 727 - 370 687 279 - - - - - - - 2063 To children, 1-5 years 295 - 620 764 232 - - - - - - - 1911 Ante-natal cases 116 - 205 180 54 - - - - - - - 555 62 63 Maternity and Child IV 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. Since the 1st April, 1934, the Home has been under the direct management of the Council. The staff consists of a Medical Officer, who resides in the Home, a matron, two sisters, six nurses who are trained midwives and three probationers. There are also nine domestics. Two Obstetric Consultants and one Ophthalmic Consultant have been appointed to visit the Home and consult with the Medical Office as required. There is also a rota of six local medical practitioners who act in emergencies in the absence of the Medical Officer. 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. Women who have booked for admission are required to attend at the ante-natal clinic which is held at the Maternity Home twice a week. A post-natal clinic is also held at the Home every week. During the past year 356 women were admitted to the Home and the average duration of stay was 14.54 days. 321 deliveries were carried out by the midwives and 34 by the medical staff. One infant was born just before the mother was admitted to the Home. In 136 cases it was necessary for the midwives to summons medical assistance in accordance with the requirements of the Midwives Act. One case of Puerperal Fever and five of Puerperal Pyrexia were notified from the Home. Twelve of the infants were still-born and two died within 10 days of birth. Three 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 47 cases the natural feeding had to be supplemented. 64 Report of the Medical Officer of Health for 1934. Day Nurseries. There are three Day Nurseries in the Borough which are voluntary institutions receiving grants from the Borough Council Their addresses are:— Putney Putney Creche, 95, Lacy Road. Wandsworth Wandsworth Day Nursery and Training School, 14, Garratt Lane. Balham Balham Day Nursery, 22, Old Devonshire Road. The Tooting Day Nursery was closed on 31st March, 1934, as it was decided that there was no justification for keeping it open owing to the fall in the number of children attending. The admissions of children to the Day Nurseries is limited to those whose mothers are obliged to go out to work, who are ill or who for any other reasonable cause are unable to look after their children. The parents' payments vary from 6d. to Is. per day for one child, a reduction being made when more than one child from the same family is admitted, or when a child is admitted for half a day only. The Day Nurseries 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 the instruction 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, 3,877; Balham, 8,038 ; Tooting, 543 and Wandsworth 5,886; a total of 18,344, compared with 21,784 in 1933. 69 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 65 Maternity and Child Welfare. 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. Medical practitioners can recommend children for admission and are allowed to attend them while in the Hospital. 132 infants were admitted in 1934, 77 from addresses in the Borough and 45 from outside the Borough. Most of the cases were infants suffering from Marasmus, Debility, Respiratory Diseases and Enteritis. There is one other large institution in the Borough which accommodates 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 1934 assistance was granted in respect of 11 cases, at a cost of £78 18s. 8d. Similar grants are made to the Mission of Hope, and two cases were assisted at a cost of £5 7s. Id. Convalescent Homes. During the year two mothers and 18 children were sent to Convalescent Homes. The cost of this was £40 10s. F 66 Report of the Medical Officer of Health for 1934. Wandsworth and Tooting Children's Clinic. This Clinic, which was opened on the 22nd June, 1931, was established for providing artificial sunlight, massage and electrical treatment for children of all ages. 285 children have been treated during the year and they have made 13,001 attendances. 67 of these children were under the age of five years and most of these cases received artificial sunlight treatment. The Council pays a grant towards the expenses of this Clinic. Supply of Milk. During the year 1,023 families were supplied with milk under the Milk (Mothers and Children) Order, 1918; 198 in Clapham; 90 in Putney; 185 in Balham; 122 in Streatham; 128 in Tooting; 83 in Southfield; 123 in Fairfield; and 94 in Springfield. The total cost to the Council was £1,230 16s. 4d. As a number of applicants for milk under the Council's Scheme are receiving Public Assistance through the London County Council Public Assistance Committee, an arrangement has now been entered into for the expenditure incurred by this Council in respect of these cases to be refunded by the London County Council. During the year £65 12s. lOd. was refunded under this arrangement. 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 67 Maternity and Child Welfare. 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 three dental practitioners in the Borough to carry out the 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 eight cases received dental treatment. Seven of these were expectant or nursing mothers, and one a child of three years. 68 CHILDREN AND YOUNG PERSONS ACTS, 1908—1932. INFANT LIFE PROTECTION. In accordance with the provisions of the Transfer of Powers (London) Order, 1933, the duties relating to the supervision of infants under the age of nine years, when maintained for reward, were transferred from the London County Council to the Borough Council, as from 1st April, 1933. The Council passed a Resolution appointing the Medical Officer of Health as the Officer authorised to receive the notices required to be given under the Acts, and each of the Health Visitors was appointed an Infant Life Protection Visitor. Records relating to 218 foster-parents were transferred to the Borough Council on the 1st April, 1933. At the end of 1934 there were 171 foster-mothers on the Register and the number of foster children for whom they were registered was 312. 69 SANITARY INSPECTION OF THE BOROUGH. Work of the Sanitary Inspectors. Table XXXIII. gives full details of the inspections carried out by the Sanitary Inspectors. TABLE XXXIII. Inspections. ReIn spections. Total. To investigate complaints 5616 13511 19127 House-to-House inspections 1060 2799 3859 Infective Diseases:— Notifiable diseases 2384 1019 3403 Measles 4 - 4 Whooping Cough 3 - 3 Other infective diseases 508 49 557 Verminous conditions 714 476 1190 Offensive Trades No. of Premises 2 4 - 4 Piggeries 8 8 14 22 Factories, workshops, etc. 1907 1292 102 1394 Houses let in lodgings 340 147 497 644 Rag and bone stores 4 48 4 52 Sanitary conveniences 184 1052 7 1059 Mews and stables 128 882 8 890 Other inspections 8270 254 8524 Total 21992 18740 40732 Smoke observations 250 — 250 Legal proceedings, Attendances at Court 20 — 20 70 Report of the Medical Officer of Health for 1934. Table XXXIV., gives a summary of the sanitary operations carried out in the Borough during the year. The number of drains which were tested was 991 and of these 738 were found to be in a defective condition. The drains of 79 houses were re-constructed. Damp conditions have been remedied in 863 premises, and in 126 of these damp courses were inserted. 24 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 293 cases of overcrowding were abated. 28 of these cases were accommodated in London County Council houses, 26 in Borough Council houses, and 239 elsewhere. Sanitary Inspection of the Borough. TABLE XXXIV. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 1. Premises cleansed and repaired 352 275 315 225 376 868 2411 2. Drains tested 98 165 142 276 85 225 991 3. Drains cleansed or repaired 118 127 74 100 82 237 738 4. Water closets cleansed or repaired 253 171 108 104 103 343 1082 5. Soil pipes repaired 44 50 7 7 9 54 171 6. Waste pipes altered or repaired 99 184 39 72 24 278 696 7. Rainwater pipes repaired 31 37 20 9 26 50 173 8. Roofs and gutters repaired 63 126 119 62 151 314 835 9. Damp courses inserted 44 34 3 17 5 23 126 10. Damp conditions otherwise remedied 74 123 77 67 60 336 737 11. Yards drained or paved 49 11 25 24 32 131 272 12. Dust bins provided or repaired 55 54 71 41 98 183 502 13. Water cisterns cleansed, covered or repaired 13 70 12 5 17 38 155 14. Water supply reinstated 57 3 5 5 5 11 86 15. Defective fireplaces remedied 30 54 102 36 140 183 545 16. Defective coppers remedied 8 16 33 10 34 81 182 17. Cases of overcrowding abated 69 52 23 7 42 100 293 18. Stables and stable yards drained or paved - - - 6 - 1 7 19. Accumulations of manure, etc., removed 12 7 4 26 5 23 77 20. Urinals cleansed or repaired 6 3 2 1 3 15 21. Animals improperly kept 3 - 3 2 1 4 13 22. Smoke nuisances 2 2 8 3 5 40 60 23. Other nuisances 108 110 132 45 145 158 698 Total 1582 1677 1325 1151 1446 3684 10865 No. of preliminary notices served 542 418 412 375 582 1280 3593 No. of preliminary notices complied with without the service of statutory notices 436 426 354 378 517 1107 3218 No. of statutory notices served 66 32 64 40 18 159 379 No. of statutory notices complied with .. 52 23 24 18 14 97 228 71 72 Report of the Medical Officer of Health for 1934. Water Supply—Cutting-off Notices. During the year, 68 notices with respect to 130 premises were received from the Metropolitan Water Board, stating that the supply had been withdrawn. In 128 premises the water supply was cut off for non-payment of rates, and in two because the premises were empty. 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. Inspection of Sanitary Conveniences. The number of Sanitary Conveniences inspected was 184 ; 52 in Clapham, 22 in Putney, 18 in Balham, 19 in Streatham, 12 in Tooting and 61 in Wandsworth. 1,059 inspections were made during the year, and seven notices, for cleansing, were served and complied with. 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 larvæ of mosquitoes. Owners of stables were advised to use chloride of lime for sprinkling horse manure in order to destroy the larvæe 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. 73 Sanitary Inspection of the Borough. No samples of Rag Flock were taken during the year, as the method of rag flock manufacture is considered satisfactory. Rats and Mice Destruction. In addition to the routine laying of rat baits in the sewers by the Borough Engineer's staff, 5,086 baits were laid and 4,377 taken during National Rat Week. Seven instances of rat infestation of premises were reported to the Public Health Committee, who authorised the service of notices requiring the extermination of the pests. 74 REMOVAL OF AGED, INFIRM OR DISEASED PERSONS TO INSTITUTIONS. Powers for the removal of cases of this nature are given in Section 28 of the London County Council (General Powers) Act, 1928. It was not found necessary to make use of these powers during the year. 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 six, and in Wandsworth 17—of which nine were from Wandsworth, five from Putney, and one each from Tooting, Fulham and Peckham. HOUSING. Statistics Relating to Housing. 1. Inspection of Dwelling-houses during the Year:— (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6,723 and the number of inspections made 23,630 (2) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,060 and the number of inspections made 3,859 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 118 (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 3,593 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 3,218 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 Nil (b) By Local Authority in default of owners Nil 75 76 Report of the Medical Officer of Health for 1934. B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 379 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 228 (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 6 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 18 D.—Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 11 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil House-to-House Inspections. The results of these inspections are shown in Table XXXV. 1,060 inspections were made compared with 1,060 in 1933, 1589 in 1932, 2,731 in 1931, 2,957 in 1930, and 1,515 in 1929. Nuisances necessitating the service of sanitary notices were found in 879 of the houses. Housing. 77 TABLE XXXV. 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 41 34 14 31 20 27 Clapham South 66 62 10 12 79 42 Putney 156 129 — .— 256 17 Balham 256 222 36 112 223 191 Streatham 68 48 18 24 38 43 Tooting 95 90 — — 46 92 Southfield 139 94 4 5 131 80 Fairfield 44 42 1 14 16 28 Springfield 195 158 5 21 132 82 Whole Borough 1060 879 88 219 941 602 Underground Rooms. The nine underground rooms known to be in illegal ocupajtion at the present time are being dealt with by the Council. Rent and Mortgage Interest Restrictions Act, 1923. During the year, 30 applications were received from occupiers that their houses were not in a reasonable state of repair. In one of these cases, the application was found not to be justified and no certificate was granted. In one case the application was withdrawn, in another it was postponed, while in two cases the necessary work was carried out before the granting of Certificates could be authorized. In the remaining 25 cases, the applications were acceded to, and Statutory Certificates were granted. In eight of the houses concerned, the necessary work to put them in a reasonable state of repair was carried out during the year. Housing Act, 1930—Unhealthy Areas. North Street Area, Clapham.—This Area, which was declared a Clearance Area in January, 1931, has now been developed by the Council as are-housing site. Twenty-one flats have been erected on the site and these were completed and opened during the year. 78 Report of the Medical Officer of Health for 1934. Cumbers Yard Area and Garden Cottages Area, Wandsworth. These two areas, which are situated close together, were declared in January, 1931. They have been developed by the Council as a re-housing site and 52 flats and six shops have been erected. These were completed and opened for occupation during the year. Dutch Yard Area, Wandsworth.—A Clearance Order, which was confirmed by the Minister of Health, was made in respect of this Area in 1931. The area contains 18 houses. These have not been demolished as it has not been possible to allocate suitable alternative accommodation to all the tenants in occupation. Greyhound Square Area, Streatham (29 houses), Barrow Road Area, Streatham (11 houses), Felsham Road Area, Putney (59 houses), and Wandsworth Plain Area, Wandsworth (91 houses).-—These four areas were declared Clearance Areas in January, 1934, following Representations made by me in the previous year. Compulsory Purchase Orders were made in each case and these Orders have been confirmed by the Minister of Health, a Public Enquiry being held in each case. Plans for the development of the four areas by the Council are well in hand. Union Street Area, Clapham.—This area contains 12 insanitary houses and it was declared a Clearance Area in July, 1934. A Compulsory Purchase Order has been made and this included certain other houses. This Order was confirmed by the Minister after Public Enquiry and the 12 insanitary houses in the area were demolished before the end of the year. Five Areas in Clapham South Ward.—100 houses—viz. :— Pleasant Place Area 32 houses Nelson's Row Area, No. 1 33 ,, Nelson's Row Area, No. 2 2 ,, White Square Area, No. 1 29 „ White Square Area, No. 2 4 „ In November, I submitted Representations in respect of these five insanitary areas, which are close together, and the Council declared them as Clearance Areas in January, 1935. Housing. 79 Demolition Orders. Demolition Orders have been made on the following insanitary houses:— 1, 3, 5 and 7, Fairfield Street. 16 and 18, Little Manor Street. Alternative accommodation was provided, where necessary, for the occupiers of these six houses and the houses have been demolished. Closing Orders. Closing Orders were made in respect of basement rooms at 23, Elms Road and 117, Larkhall Lane. In the former case, the order was enforced, but the room at 117, Larkhall Lane was still occupied at the end of the year. In October, I made a representation to the effect that a basement room at each of the nine houses, 66, 68, 70, 72, 74, 76, 78, 80 and 82, The Chase, was unfit for habitation, and the Council decided to take action under Section 20 of the Housing Act, 1930, in respect of these rooms. 80 FOOD AND FOOD PREMISES. There are three Inspectors engaged in the supervision of the Food Supply. One of them is the Food and Drugs Inspector of the Borough, and is occupied for the whole of his time in procuring samples of food and drugs for analysis by the Public Analyst. The other two Inspectors, who aie designated Food Inspectors, supervise all the premises where food is sold, stored, manufactured or prepared for sale, and one half of the Borough is allocated to each Inspector. In addition to these duties, they supervise the slaughtering of all animals in the five slaughter-houses. A Register of all premises where a food business is carried on has been compiled, and is kept up-to-date. This Register includes not only those premises which are subject to some form of legal control, but also all other premises in which a food business of any description is carried on. It is essential for a complete Register of this nature to be kept, in order to ensure systematic supervision of all the businesses. Table XXXVI. has been compiled to show the number of food premises and the nature of the business carried on at these premises. It is a common occurrence for more than one food business to be conducted on the same premises and the Table is arranged to bring out this fact. In Columns 1 and 2 of the Table, the number of separate food premises in the Borough is given, classified according to the nature of the principal business carried on. In columns 4 to 18, the number of different businesses actually conducted from these premises is shown, those which are subject to some form of legal control being specified. The number of registered dairymen in the Borough is also shown in the Table, in column 3. The number of inspections made during the year, and the number of notices served is shown in the last two columns. The total number of food premises in the Borough, including five slaughterhouses, is 2,903. Amongst these are 816 grocery and provision shops, and reference to the Table will show that a variety of businesses are conducted from these shops. Some of them are registered as dairies or for the sale of margarine, ice-cream, or cooked or preserved meats as required by law. The occupiers of 296 of these shops are registererd as dairymen. In Food and Food Premises. 81 the majority of cases this is because milk is being sold in bottles or cartons, and as the milk is sold in sealed receptacles, registration of the premises as dairies is not required. Milk Supply. There are 471 registered dairymen and 240 registered dairies in the Borough, one of them being also a cowshed. The Food Inspectors made 721 visits to these premises 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 941 samples of whole milk reported as genuine was 3-59, which is the same as in 1933. The milk utensils and barrows used in the delivery of milk have been 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 requires that any premises 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 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 year 131 applications were submitted to the Council for the purpose of registration under this Act. In each case the premises were inspected and found to be satisfactory and registration was granted. Meat. There are five private slaughterhouses in the Borough. The Food Inspectors made 796 visits during the year to these G 82 Report of the Medical Officer of Health for 1934. TABLE Nature of Principal Business. No. of Separate Premises. No. of Dairymen registered. Actual Food Businesses Conducted Subject to some form of Legal Control. As Dairies. As Cow-sheds. As Slaughterhouses. As Wholesale Margarine Premises. For Ice Cream. For Cooked or Preserved Foods. As Fish Fryers. As FishCurers. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Dairies 161 161 161 1 — — 19 1 — — Ice-Cream Vendors 26 1 — — — — 26 — — — Grocery and Provisions 816 296 66 — — 34 67 225 — — Confectioners 532 6 3 — — — 372 5 — — Butchers 231 2 1 — — — 3 211 — — Slaughter-houses 5 — — — 5 — — — — — Fishmongers 105 — — — — — — 41 7 22 Fish Fryers 81 — — — — — 1 49 81 6 Restaurants 338 5 9 — — — 63 9 — — Greengrocers 425 — — — — — — 1 — — Market Stalls 164 — — — — 1 13 4 — 1 Food Factories 19 — — — — — 2 2 — — Totals 2903 471 240 1 5 35 566 548 88 29 83 Food and Food Premises. XXXVI. on the Premises Shewn in Column 1. Other Food Businesses. Fishmongers. Grocers. Confectioners. Butchers Greengrocers. Food Factories. Restaurant Kitchens. No. of Inspections in 1933. No. of Notices served. 12. 13. 14. 15. 16. 17. 18. 19. 20. 1 140 3 — — 6 2 721 4 — — 2 — — — 1 60 1 3 816 122 32 36 — 16 1289 26 — 6 532 — — — 31 1517 10 — 3 — 231 1 6 — 982 6 — — — 4 — — — 796 — 105 1 — 1 — — 3 226 6 19 — — — — — 38 166 9 4 2 27 — 1 — 338 470 21 8 2 — 425 — 429 21 9 22 10 6 101 — 15 3171 — — 6 8 — — 19 — 38 7 149 998 704 274 564 31 444 9865 111 G 2 84 Report of the Medical Officer of Health for 1934. premises and were present on almost every occasion when slaughtering took place. The number of carcases examined was 7,154, comprising 256 oxen, 1,154 pigs, 4,677 sheep and 1,067 calves. 2,001 of the animals were also inspected before being slaughtered. The following organs, etc., were found to be unsound or diseased for the reasons specified, and were surrendered by the owners and destroyed. Oxen:— For Tuberculosis: 12 stone of beef, 2 entire sets of offal, 11 heads, 11 tongues, 25 pairs of lungs, 1 spleen, 1 heart, 7 livers, 6 mesenteries, 2 kidneys, 2 omenta. For Fluke :—17 livers, 1 pair of lungs. For Abscess :—1 liver. For Cirrhosis :—15 livers. For Congestion :—2 pairs of lungs. For Pericarditis :■—1 heart. For Nephritis :—1 pair of kidneys. For Cavernous Angioma :—1 liver. Pigs:— For Tuberculosis :—1 carcase and entire offal, 10 stone 2 lbs. 3 heads and collars, 2 plucks, 1 mesentery. For Pericarditis :—3 hearts. For Cirrhosis:—5 livers. For Congestion :—22 plucks. For Milk Spots :—6 livers. For Abscess :—1 stone pork, 1 head, 1 pluck. For Inflammation :—1 pair of lungs, 1 spleen. For Pleurisy :—1 pair of lungs. Sheep :— For Fluke :—3 livers. For Strongylus Rufescens :—46 pairs of lungs. For Abscess :—2 livers. For Cirrhosis 8 livers. Calves :— For Abscess :—1 pair of lungs. For Trauma —1 side of veal. Food and Food Premises. 85 There are 231 butchers' shops in the Borough, the majority of which are subject to registration under the London County Council (General Powers) Act, 1932. 982 inspections were made of these shops, and it was found necessary in six cases to serve notices on the occupiers. 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 contamination of the meat by flies, filth and dust, and almost all the butchers' shops in the Borough are now fitted with glass fronts. It has, however, been found necessary in several instances to warn traders with regard to the exposure of meat in contravention of these Regulations. Slaughter of Animals Act, 1933. This Act came into operation on the 1st January, 1934, and provides for the humane and scientific slaughter of animals, by licensed slaughtermen. No person may now slaughter animals unless he is above the age of 18 years and licensed by the Borough Council as a fit and proper person for the purpose. During the twelve months ending the 31st December, 18 applications were received from persons desirous of acting as slaughtermen, and the necessary licences granted. No infringements against the provisions of this Act have been noted. Unsound Food. At the request of the owners, the following foodstuffs were destroyed and the usual certificates granted, viz. :—3 stone megrims, 5 stone cod fillets, 12 stone dog fish, 14f lbs. Scotch fillets, 1 box conger eel, 1 box herrings, 1 box dabs, 2 boxes fish roe, 3 boxes skate, 1 cwt. winkles, 3 chickens, 1 pheasant, 1 partridge, 9 turkeys, 20 rabbits, 4 stone 4 lb. imported beef, 3 imported ox livers, 6 tins of tongue, 117 tins of tomato puree, 10 boxes (120 lbs.) of cherries, 10 barrels of apples, 1 cwt. of brazil nuts, 2 stones cauliflowers, 12J bundles celery, 1 box cream wafers. 86 Report of the Medical Officer of Health for 1934. 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 :— 1. Gelatine. 16. Beef. 2. Honey 17. Malt Flour and Malt 3. Fresh Apples. Extract. 4. Tea. 18. Potatoes. 5. Currants. 19. Broccoli. 6. Sultanas. 20. Eggs. 7. Raisins. 21. Glasshouse grown Toma- 8. Eggs in Shell. toes and Cucumbers. 9. Dried Eggs. 22. Strawberries. 10. Oat Products. 23. Dressed Poultry. 11. Raw Tomatoes. 24. Cherries. 12. Salmon and Trout. 25. Cider. 13. Butter. 26. Canned Fruits. 14. Apples and Pears. 27. Canned Cherries. 15. Wheat Flour. 28. Bacon and Ham. 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 2,000 samples of foods and drugs were submitted to the Public Analyst for analysis. Of these 1,000 were submitted as official samples while 1,000 were purchased unofficially as test or informal samples. 32 or 3.2 per cent. of the official samples, and 21 or 2.1 per cent. of the unofficial samples were found to be adulterated or not up to standard. The total adulterations reported were 53 or 2.65 per cent. of the samples submitted. Food and Food Premises. 87 TABLE XXXVII. RESULT OF ANALYSES OF CERTAIN ARTICLES OF FOOD PROCURED UNDER THE FOOD AND DRUGS (ADULTERATION) ACT, 1928, SHOWING THE PERCENTAGE ADULTERATED COMPARED WITH 1930, 1931, 1932 AND 1933. Percentage of Samples adulterated, 1930-1933. No. of samples in 1934. 1930. 1931. 1932. 1933. Examined. Found adulterated or not up to standard Percentage adulterated Butter .18 .41 — — 191 — — Cheese — — — 9.0 29 — — Cocoa — — 13.3 10 — — Coffee — - — — 10 — — Confectionery and Jam — - — — 23 — — Cream .43 — — — 73 — — Margarine — — — 4.3 25 — — Milk 2.3 1.6 1.3 1.3 959 17 1.7 Separated Milk — — — — 9 — — Condensed Milk — — — — 23 — — Mustard — — — — 1 — Tea — — — — 16 2 12.5 Vinegar 28.4 14.2 5.7 — 4 — Drugs — — 3.3 — 81 6 7.4 Other Articles 1.8 1.0 0.86 1.4 546 28 5.1 All Articles 1.4 1.2 1.40 1.4 2000 53 2.65 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. 88 Report of the Medical Officer of Health for 1934. TABLE XXXVIII. 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 149 5 3.3 171 7 4.0 320 12 5.3 3.7 Putney 219 1 .4 170 8 4.7 389 9 11.4 2.3 Balham 149 3 2 0 144 6 4.1 293 9 5.5 3.0 Streatham 152 3 1.9 87 1 1.1 239 4 3.5 1.5 Tooting 173 6 3.4 159 4 2.5 332 10 8.8 3.0 Wandsworth . . 158 3 1.8 269 6 2.2 427 9 4.5 2.1 Whole Borough 1000 21 2.1 1000 32 3.2 2000 53 5.7 2.6 Milk and Milk Supply. The following samples were submitted for analysis 959 of whole new milk. 9 of separated milk. 3 of skimmed milk. 23 of condensed milk. Of these 21 were reported against as being adultered or not up to standard. Six contained extraneous water, 14 were deficient in milk fat and one sample of evaporated milk contained tin. Proceedings were taken in eight of these cases and fines amounting to £2 Os. Od. were imposed with £7 7s. Od. costs. In the 13 other cases, the Public Health Committee, after considering the amount of adulteration and circumstances of sale, decided not to prosecute the vendors but gave instructions for further samples to be taken. 86 samples of milk were taken from the early morning delivery to hospitals in the Borough, eight on delivery to Wandsworth Food and Food Premises. 89 Prison, and 20 from the milk delivered to the County Schools in the Borough. All these samples were reported as genuine. 467 samples were taken from milk vendors in the street during the early morning (4 to 7 a.m.) and of these five or 1.0 per cent, were reported against. The Milk (Special Designations) Order, 1923. The following licences for the sale of designated milks were granted during the year :— Certified 24 Grade A (Tuberculin Tested) 48 Grade A Pasteurised 6 Grade A 4 Pasteurised 42 Bacteriological Examination of Milk. 26 samples of milk were examined for the presence of Tubercle Bacilli under Section 5 of the Milk and Dairies (Amendment) Act, 1922. In two cases the examination revealed the presence of Tubercle Bacilli, the remaining 24 cases being free. In one of the cases reported to have contained Tubercle Bacilli further samples were taken with a negative result. The milk from the farm under suspicion is being closely watched and sampled. In the other case the information was sent to the County Medical Officer of Health who has had veterinary examination of the herd carried out. One cow was seized under the Tuberculosis Order, 1925, and post-mortem examination revealed that the animal was badly affected with Tuberculosis. The following samples of Graded Milks procured from schools, hospitals or dairymen, were submitted for bacteriological examination in order to see if the bacterial content was within the prescribed standard for the appropriate grade. 90 Report of the Medical Officer of Health for 1934. Grade. Schools. Hospitals. Dairymen. Total. Grade A (Tuberculin Tested) 5 5 Pasteurised 15 13 8 36 Certified — — 2 2 Grade A Pasteurised — — 1 1 Total 15 13 16 44 In one case where the milk was supplied to a school, the sample failed to comply with the standard required. Butter and Margarine. 191 samples of butter were submitted for analysis during the year and all were reported to be genuine. 25 samples of butter were submitted for analysis, and all were reported to be genuine. Other Articles. 505 samples were submitted under this heading. The results of the analyses are given in the Public Analysts' Report. 91 FACTORIES AND WORKSHOPS. The number of factories, workshops, workplaces, and home workers' premises is shown in Table XXXIX. together with the number of inspections made. The inspection of food premises except food factories, are not included in this Table, but are shown in Table XXXVI. TABLE XXXIX. Class of Works. Number of Places on Register at end of 1934. Number of Inspections, 1934. Number of Notices, 1934. Number of Prosecutions, 1934. Factories :— Factory Laundries 55 42 3 — Factory Bakehouses 77 118 1 — Food Factories entered on Table XXXVI 31 38 7 — Other Factories 424 338 15 — Total 587 536 26 Workshops :— Workshop Laundries 28 19 — — Workshop Bakehouses 54 79 — — Other Workshops 738 528 34 — Total 820 626 34 — Workplaces 143 95 1 — Total : Factories, Workshops and Workplaces 1,550 1,257 61 — Home-workers' premises 388 175 4 Grand Total 1,938 1,432 65 — Further details with regard to homeworkers' premises are given in Table XL. 92 Report of the Medical Officer of Health for 1934. TABLE XL. 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 25 126 32 8 7 14 (2.) Cleaning and washing 2 6 2 1 — — — Paper bags and boxes 2 — 2 — — — — Totals 37 31 130 33 8 7 14 The total number of addresses received from other Councils was 514, and 147 addresses were forwarded to other Authorities. The number of addresses received has increased by 84, and the number sent has also increased by 45. 25 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 14 cases of infective diseases—eight of Measles, two of Scarlet Fever, two of Whooping Cough, one of Mumps, and one of Diphtheria—were notified as having occurred in the homes of out-workers. In none of these cases was it necessary to make any order under Section 110 of the Factory and Workshop Act. Factories and Workshops. 93 TABLE XLI. 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 54 Workshop Laundries 28 Dressmakers' and Milliners' Workshops 103 Bootmakers 101 Smiths and Engineers 39 Builders 38 Tailors 61 Motor Engineers 73 Upholsterers 22 Hairdressers 21 Other 280 Total number of workshops on Register 820 TABLE XLI I. 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 42 33 — Want of ventilation 1 1 — Overcrowding 1 1 — — Want of drainage of floors — — — Other Nuisances 14 10 — Sanitary accommodation : Insufficient — — — — Unsuitable or defective 19 19 Not separate for sexes — — — — Offences under the Factory and Workshop Acts :— Illegal occupation of underground bakehouses (s. 101) — — — — Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921) — — — — Total 77 64 — — * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 94 STAFF. Details of the Staff of the Department are given below. 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. Assistant M.O.H. and Medical Officer of the Maternity Home :— Margaret M. McDowall, M.B., Ch.B., D.T.M. and H., 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. Obstetric Consultant:— A. Morris Johns, M.D., Ch.B. Obstetric Consultants to The Maternity Home :— F. W. Roques, M.A., M.D., M.Ch., F.R.C.S. D. H. MacLeod, M.S., B.S., M.R.C.P., F.R.C.S. Ophthalmic Consultant to The Maternity Home :— J. D. M. Cardell, M.B., B.S., F.R.C.S. Public Analyst:— A. H. M. Muter, F.I.C., F.C.S. Staff. 95 District. Balham Clapham Putney ., Streatham Tooting, No. 1 Tooting, No. 2 Wandsworth, No. 1.. Wandsworth, No. 2.. Swaffield Road Institution Clapham and Wandsworth. Balham, Streatham and Tooting. Putney Public Vaccinators. Public Vaccinators. Dr. T. Stokes, 67, Balham Hill, Balham, S.W. 12. Dr. J. Kennish, 2, The Chase, Clapham Common, S.W. 4. Dr. W. D. McMurtry, 8, Atney Road, Putney, S.W. 15. Dr. A. B. Plant, 29, North Side, Streatham Common, S.W. 16. Dr. P. A. Carrie, 859, Garratt Lane, Tooting, S.W. 17. Dr. R. C. Spence, 18, Longley Road, Tooting, S.W. 17. Dr. E. R. Badcock, 29, West Hill Wandsworth, S.W. 18. Dr. H. A. Topalia, 248, Earlsfield Road, Wandsworth, S.W. 18. Dr. H. A. Topalia, 248, Earlsfield Road, Wandsworth, S.W. 18. Vaccination Officers. The Medical Officer of Health. Mr. L. H. Ford, 130, Franciscan Road, Tooting, S.W. 17. Mr. C. L. Taylor, 72, Geraldine Road, Wandsworth, S.W. 18. 96 Report of the Medical Officer of Health for 1934 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 E. V. Roots .. Sept. 1926 .. Yes Four C. F. Standish .. Jan. 1928 » Yes Two F. A. Eustace .. June 1929 Joint Board Ex. No — W. G. Pearce Sept. 1929 ; Yes — A. W. Fisher May 1930 .. No — R. E. Jones Dec. 1930 .. Yes One A. W. E. Porter June 1931 S.I. Exam. Bd. Yes — F. L. Langford May, 1934 Joint Board Ex. No — H. M. Hough April, 1935 Yes Five Food and Drugs Inspector : W. H. Jones .. Sept. 1926 S.I. Exam. Bd. Yes Four Food Inspectors: W. T. Willimott Dec. 1927 Joint Board Ex. Yes Seven A. E. Handley .. Aug. 1929 •• Yes One Assistant to Food Inspectors: A. J. Lansley Mar. 1928 Joint Board Ex. Yes — Staff. 97 HEALTH VISITORS. Name. Commenced Duty. Certificates held. Health Visitor. Trained Nurse. Certified Midwife. Sanitary Inspector. Maternity and Child W elfare:— • 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 „ G. Neall May, 1934 Yes No Yes Yes Tuberculosis:— Miss P. G. Moores April 1915 Yes Yes No No „ R. M. Watling May 1922 Yes Yes Yes No Staff at the Maternity Home. Matron:— Miss A. Crump, State Registered Nurse, State Certified Midwife, Commenced duty March, 1934. Two Sisters. Four Staff Nurses. Two midwives. Three probationers. H 98 Report of the Medical Officer of Health for 1934. Porter Attendant—F. Dwyer, appointed March, 1934. One Cook and Six Maids. One Seamstress. 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. A. G. Patterson Feb. 1914 First Class Clerk San. Insp. and two others Miss C. Wellings.. May 1921 Second Class Clerk — H. F. Leacock . . June, 1934 Second Class Clerk Two Miss H. G. Wright Jan. 1925 Third Class Clerk — L. L. Parrini May 1923 Third Class Clerk — J. Marshall Jan. 1927 Third Class Clerk San. Insp. and five others Miss F. M.Woodhal July 1931 Third Class Clerk One A. E. Hollis Feb. 1929 Third Class Clerk Three G. L. Humphreys Feb. 1934 Fourth Class Clerk One 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. Engineer—C. F. I. Batt, Eng. Lt., R.N.R., Two certificates. Commenced duty May, 1933. Two motor drivers. Seven Disinfecting Attendants. Mortuaries. One whole-time and two part-time Mortuary Keepers. Staff. 99 When the Council took over the direct administration of the Maternity Home as from the 1st April, 1934, Dr. M. M. McDowall was appointed Assistant Medical Officer of Health and Medical Officer of the Maternity Home and Miss A. Crump was appointed Matron. The remainder of the staff at the Maternity Home are as set out above. Mr. J. Rowbotham, Sanitary Inspector, resigned his appointment in April, to take up an appointment under the Leek Urban District Council. The vacancy was filled by the appointment of Mr. F. L. Langford, 2nd Class Clerk in the Department. In December, Mr. A. G. Patterson, Sanitary Inspector, who had worked previously as a Second Class Clerk in the Department, was transferred to the clerical staff at his own request and was graded as a First Class Clerk. The vacancy was filled by the appointment of Mr. H. M. Hough, formerly Sanitary Inspector at Willesden. Miss G. Neall, who had held the appointment of Superintendent at the Streatham Infant Welfare Centre, as an Officer of the Centre Committee, since 1926, has been appointed as one of the Council's Health Visitors. She still acts as Superintendent at the Streatham Centre. Mr. H. F. Leacock, Third Class Clerk in the Borough Engineer's Department, was appointed Second Class Clerk in the Public Health Department, in June, 1934, to fill the vacancy caused by the appointment of Mr. Langford as Sanitary Inspector. Mr. G. L. Humphreys was appointed Fourth Class Clerk in February, 1934. Mr. A. J. Lansley was successful in passing the Examination for the Certificate for Meat and Other Foods. 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 Report of the Medical Officer of Health for 1934. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF WANDSWORTH, 1931. (Compiled by the Registrar-General). Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35- 45— 55— 65 — 75— ALL CAUSES M. 1838 120 21 24 39 51 90 91 201 873 453 375 F. 2017 99 23 11 38 68 76 77 184 305 460 676 1. Typhoid and paratyphoid fevers M. — — — — — — — — — — — — F. 2 — — — — — 1 — — 1 — — 2. Measles M. 14 1 7 3 2 — — — 1 — — — F. 20 8 7 2 3 — — — — — — — 3. Scarlet fever M. 3 — — 1 2 — — — — — — — F. 3 — — 1 1 — 1 — — — — — 4. Whooping cough M. 5 4 1 — — — — — — — — — F. — 3 3 — 1 — — — — — — — 5. Diphtheria M. 11 1 1 2 7 — — — — — — — F. 11 — — 3 8 — — — — — — — 6. Influenza M. 25 1 1 1 — 1 — 2 5 8 2 4 F. 28 2 — — 1 — 1 1 2 5 4 12 7. Encephalitis lethargica M. 2 — — — — — 1 — — 1 — — F. 1 — — — — — — — 1 — — — 8. Cerebro-spinal fever M. 3 — 1 — — 1 1 — — — — — F. 2 1 — — — — — — 1 — — — 9. Tuberculosis of respiratory system M. 139 — — — — 17 37 26 30 16 10 3 F. 95 — 1 — 1 27 25 12 16 7 6 — 10. Other tuberculous diseases M. 19 2 1 1 4 1 2 2 2 2 2 — F. 21 1 1 1 3 5 4 I ] 1 — 3 11. Syphilis M. 3 — — — — — — — 2 1 — — F. 6 3 — — 1 — — 1 1 — — — 12. General paralysis of the insane, tabes dors3lis M. 12 — — — — — — — 3 5 3 1 F. 2 — — — — — — 2 — — — — 13. Cancer, malignant disease M. 257 — — — — — 7 15 28 88 85 34 F. 341 — 2 — — 2 — 14 58 84 100 81 14. Diabetes M. 20 — — — 1 — 1 — 1 4 9 4 F. 23 — — — — — 1 — 2 7 10 3 15. Cerebral haemorrhage, etc. M. 34 — — — — — — 1 3 10 12 8 F. 60 — — — — — 1 1 1 8 24 25 16. Heart disease M. 445 — — — 3 3 3 6 32 65 159 174 F. 614 — — — 4 12 10 18 77 159 331 17. Aneurysm M 18 — — — — — 1 — 2 9 4 2 F. 10 — — — — — — — 1 4 2 3 Vital Statistics. 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. 75 — — — — — — 3 4 22 28 18 F. 87 — — — — — — 1 6 17 28 35 19. Bronchitis M. 84 2 — — — 1 — — 9 20 21 31 F. 68 4 — — — — 1 1 3 7 17 35 20. Pneumonia (all forms) M. 114 13 4 10 1 — 1 3 13 25 29 15 F. 90 8 8 1 1 1 7 3 .8 14 15 24 21. Other respiratory diseases M. 12 — — — — — — — 4 3 1 4 F. 15 — — — 1 2 — — 2 2 1 7 22. Peptic ulcer M. 32 — — — — — — 1 8 18 4 1 F. 19 — — — — 1 1 1 2 5 7 2 23. Diarrhoea, etc. M. 26 21 1 — — — — — — 1 2 1 F. 17 13 1 — — — 1 — — 1 1 24. Appendicitis M. 14 — — — 2 — 2 3 5 1 — 1 F. 17 — — — 2 2 3 — 9 1 3 1 25. Cirrhosis of liver M. 6 — — — — — — 1 — 2 2 1 F. 10 — — — — — — 1 1 3 4 1 26. Other diseases of liver, etc. M. 7 — — — — — — 1 1 1 3 2 F. 11 — — — — — — — 3 3 5 — 27. Other digestive diseases M. 28 1 2 — 1 2 3 4 2 7 4 2 F. 51 1 — 2 3 1 3 2 10 9 10 10 28. Acute and chronic nephritis M. 72 — — — 1 2 4 1 10 17 24 13 F. 68 — — — — 1 3 3 5 14 24 18 29. Puerperal sepsis F. 5 — — — — 2 3 — — — — — 30. Other puerperal causes F. 6 — — — — 1 3 2 — — — — 31. Congenital debility, premature birth, malformations, etc. M. 65 65 — — — — — — — — — — F. 51 51 — — — — — — — — — — 32. Senility M. 16 — — — — — — — — — — 16 F. 42 — — — — — — — — — 4 38 33. Suicide M. 35 — — — — 2 2 5 9 11 5 1 F. 21 — — — — — 2 7 7 3 2 — 34. Other violence M. 79 2 1 2 4 11 13 7 10 10 10 9 F. 46 2 — — 1 4 3 1 4 5 7 19 35. Other defined diseases M. 161 7 1 4 11 10 12 11 17 26 34 28 F. 145 2 — 1 7 7 9 13 25 27 28 26 36. Causes ill-defined, or unknown M. 2 — — — — — — — — — — 2 F. 2 — — — — — — — 1 — — 1 102 Report of the Medical Officer of Health for 1934. PARTICULARS OF POLICE COURT PROCEEDINGS. Premises. Offence. Result. Fine. Costs. s. d. s. d. 4, Yeovil Street, Clapham Nuisances Order made for the abatement of nuisances — 21 0 15a, Roskell Road Putney Do. Do. Do. — 21 0 Non-compliance with Order. CO 0 — Totterdown Street, Tooting Emission of smoke and grit Summons adjourned sini die with leave to apply — — 32, Schubert Road, Wandsworth Nuisances Summons withdrawn on payment of costs — 21 0 4, Merton Cottages Wandsworth Verminous condition of bedding Order made for abatement — — 10, Southville, Clapham Nuisances Summons adjourned sini die with leave to apply. — — In Garratt Lane, Wandsworth Removal of offensive matter through the streets during prohibited hours. Ordered to pay costs — 21 0 4, Patten Road, Wandsworth Nuisances Summons adjourned sini die with leave to apply. — — 103 Public Analysts' Annual Report. To the Wandsworth Borough Council. Mr. Mayor, Ladies and Gentlemen, Herewith we have pleasure in submitting to you our annual report on work performed in this laboratory under the Food and Drugs (Adulteration) Act, 1928, during 1934. In all 2,000 samples were examined of which 17 Milks were submitted at the request of your Council by that of Battersea and two by that of Finsbury. Half of the samples were taken with the necessary formalities required by the Act, and half procured informally. The following Statement shows the nature of the samples examined, with the results of analyses, the details of Drugs and " Other Articles " being given subsequently. GENERAL STATEMENT. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Bread — 4 4 — — — Butter 2 189 191 — — — Cheese — 29 29 — — — Cocoa — 10 10 — — — Coffee — 10 10 — — — Confectionery — 1 1 — — — Cream — 73 73 — — — Flour, Self-raising — 12 12 — — — Jam and Marmalade — 22 22 — — — Lard — 19 19 — — — Margarine — 25 25 — — — Milk 958 1 959 17 — 17 Milk, Separated 9 — 9 — — — Milk, Skimmed 3 — 3 3 — 3 Milk, Evaporated — 7 7 — 1 1 Milk, Dried — 1 1 — — — Milk, Condensed, Full Cream — 7 7 — — — Milk, Condensed, Machine Skimmed — 9 9 — — — Mustard — 1 1 — — — Tea 2 14 16 1 1 2 Vinegar, Malt — 4 4 — — — Beer — 2 2 — — — Drugs 4 77 81 2 4 6 Other Articles 22 483 505 9 15 24 Total 1000 1000 2000 32 21 53 104 Report of the Medical Officer of Health for 1934. Included in the 29 samples of Cheese were 16 of Wrapped Cheese and one of Cream Cheese. Amongst the samples of Cream were six of Tinned Cream and one of "Coffee" Cream. DRUGS. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Acid, Boric 1 1 2 — 1 1 Borax — 5 5 — — — Camphorated Oil — 6 6 — — — Cream of Tartar — 2 2 — — — Epsom Salts 1 6 7 1 1 2 Friar's Balsam — 5 5 — — — Glauber's Salts — 3 3 — — — Glucose (Medicinal) — 3 3 — — — Glycerin — 5 5 — — — Oil of Camphor — 1 I — — — Ointment, Boric — 9 9 — — — Ointment, Zinc 1 8 9 — 1 1 Powder, Gregory — 2 2 — — — Powder, Liquorice, Compound — 3 3 — — — Syrup of Rhubarb — 2 2 — — — Sulphur, Flowers of — 3 3 — — — Sweet Spirit of Nitre — 2 2 — — — Tincture of Iodine — 4 4 — — — Tincture of Quinine, — — — — — — Ammoniated — 5 5 — — — Tincture of Rhubarb Compound 1 2 3 1 1 2 Total 4 77 81 2 4 6 OTHER ARTICLES. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Almonds, Ground — 3 3 — — — Baking Powder — 2 2 — — — Barley, Pearl — 12 12 — — — Beverages 4 5 9 — — — Bun Flour — 1 1 — — — Cake — 7 7 — — — Cakes, Sponge — 5 5 — — — Cheese and Celery — 1 1 — — — Analysts' Annual Report. 105 OTHER ARTICLES—continued. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Coffee Extract — 1 1 — — — Coffee and Chicory Extract — 10 10 — — — Cornflour — 3 3 — — — Curry Powder — 3 3 — — — Dripping — 5 5 — — — Egg Substitute Powder — 1 1 — — — Essence, Flavouring — 3 3 — — — Fish, Canned 5 42 47 5 6 11 Fish Paste — 4 4 — — — Fruits, Canned — 18 18 — — — Fruits, Dried 3 08 71 — 2 2 Gelatin — 2 2 — — — Ginger, Preserved — 3 3 — — — Grape Juice — 2 2 — — — Honey — 4 4 — — — Honey, Prepared — 1 1 — — — Ice Cream 5 — 4 — — — Jelly, Table — 6 6 — — — Lemon Curd — 2 2 — — — Meat, Canned — 3 3 — — — Meats, Minced, Cooked and Preserved — 28 28 — — — Meat Paste — 4 4 — — — Meat Pies — 3 3 — — — Mincemeat (Fruit) — 3 3 — — — Oats, Rolled — 4 4 — — — Oil, Olive and Salad — 4 4 — — — Peel, Candied — 4 4 — — — Pepper — 15 15 — — — Pickles — 6 6 — — — Potato Salad — 1 1 — — — Powder, Custard — 6 6 —. — — Powder, Pudding — 1 1 — — — Rice — 20 20 — — — Rice, Ground — 8 8 — — — Sago — 5 5 — — — Sausages I 59 60 1 2 3 Sausages, Preserved — 13 13 — — — Sausages, Other — 6 6 — — — Sausage-Meat — 6 6 — — — Sauce — 4 4 — — — Spice, Mixed 1 9 10 1 1 2 Suet, Shredded — 4 4 — — — Tapioca — 10 16 — — Vegetables, Canned 3 13 16 2 4 6 Waters, Aerated — 2 2 — — — Welsh Rarebit — 1 1 —. — — Wheat Preparations — 16 16 — — Wines, Non-Alcoholic — 5 5 — — — Total 22 483 505 9 15 24 106 Report of the Medical Officer of Health for 1934. The nature and extent of the adulteration in the 32 forma samples will be found below:— Case No. Nature of Sample. Nature of Report. 5 Mixed Spice 5% Maize Starch 212 Canned Sild in Oil 2.4 grains Tin per lb. 213 Do. do. 2.9 do. do. 217 Skimmed Milk 23% deficient in Fat 259 Tea 4% extraneous Mineral matter containing 0.3 % Iron 279 Skimmed Milk 25% extraneous Water 316 Canned Sardines in Oil 6 parts Lead per million 317 Do. do. Do. do. do. 362 Epsom Salts 9 parts Lead per million (4 parts excess) 387 Milk. 11% deficient in Fat 416 Do. 12% do do. 421 Do. 10% do. do. 426 Do. 3% do. do. 446 Do. 19% do. do. 464 Do. 9% do. do. 487 Do. 19% do. do. 521 Do. 2% extraneous Water 525 Do. 1% do. do. 585 Do. 5% deficient in Fat 666 Do. 5% extraneous Water 681 Sausages 6.3 grains Boric Acid per lb. 686 Milk 1½% extraneous Water 759 Skimmed milk 16% deficient in Fat 819 Milk 1% extraneous Water 879 Tomato Puree 17 parts per million Copper 880 Do. 3.3 grains Tin per lb. and 13 parts per million Copper 881 Canned Sild in Oil 2.8 grains Tin per lb. 904 Compound Tincture of Rhubarb 23.2% deficient in Alcohol Battersea 796 Milk 7% deficient in Fat 801 Do. 9% do. do. 802 Do. 3% do. do. 807 Do. 2% do. do. The nature of the reports issued in respect to the 21 informal samples returned as adulterated is given on following page:— Analysts' Annual Report. 107 Case Nature of Sample. Nature of Report. 20 Mixed Spice Contains Maize Starch 127 Boric Acid 100% Citric Acid 129 Dried Pears Contain a trace of Arsenic 169 Do. do. Do. do. 191 Evaporated Milk Contains Tin 211 Canned Sild in Oil Contain excess Tin 212 Do. do. Do. do. 246 Zinc Ointment Deficient in Zinc Oxide 265 Tea Contains extraneous Mineral matter 308 Canned Sardines in Oil Contain Lead 309 Do. do. Do. do. do. 359 Epsom Salts Contain excess Lead 536 Canned Sild in Oil Contain excess Tin 690 Sausages Contain a Boron Preservative 738 Do. do. Contain a Sulphite Preservative 753 Canned Sild in Oil Contain excess Tin 873 Tomato Puree Contains Copper 875 Do. do. Contains Copper and excess Tin 877 Do. do. Contains Copper 892 Compound Tincture of Rhubarb Deficient in Alcohol 895 Condensed Tomato (Canned) Contains Copper The average water content of the 191 samples of Butter amounted to 14.6 per cent., that in the 25 samples of Margarine being 14.3 per cent. The average fat content of the 66 samples of Cream amounted to 58.0 per cent., that in the six samples of Tinned Cream being 22.8 per cent. The sample submitted as "Coffee Cream" was found to contain 30.0 per cent. fat. The number of Milks returned as genuine in each month of the year, with their average composition was as under Case No. Month. Total Milk solids. Milk fat. Non-fatty solids. 42 January 12.40 % 3.60 % 8.80 % 76 February 12.26 % 3.48 % 8.78 % 81 March 12.30 % 3.50 % 8.80 % 91 April 12.28 % 3.51 % 8.77 % 121 May 12.22 % 3.41 % 8.81 % 54 June 12.24 % 3.42 % 8.82 % 81 July 11.98 % 3.47 % 8.51 % 99 August 12.08 % 3.53 % 8.55 % 28 September 12.51 % 3.80 % 8.71 % 134 October 12.63 % 3.73 % 8.90 % 72 November 13.01 % 4.01 % 9.00 % 59 December 12.74 % 3.81 % 8.93 % 108 Report of the Medical Officer of Health for 1934. The average composition of the 941 samples of Milk, returned as genuine, during the year was:— Total milk solids 12.38 % Milk fat 3.59 % Non-fatty solids 8.77 % Included in this report are five informal samples, two of Cocoa, and one each of "Lemon Extra," Grape juice and Milk, which were submitted at the request of rate-payers from whom complaints respecting them had been received. In no case was any deleterious ingredient found and the samples were, therefore, reported as being genuine. All samples mentioned in this report were submitted by the Council's Food Inspector. 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. 17th January, 1935. 109 INDEX. PAGE Accident, Deaths from 35, 36 Adulteration of Certain Articles, Percentage of, ill 1930-1934 87 Aged, infirm or diseased Persons, Removal of 74 Agricultural Grading and Marking Act, 1928 86 Ambulance Service 33 Analysts, Report of 103 Ante-natal Clinics 60 Anti-toxin 16 Area of Borough 1, 3 Artificial Light Treatment of Tuberculosis 44 Artificial Pneumothorax Treatment of Tuberculosis 45 Bacteriological Examinations 34, 48 Bacteriological Examination of Milk 89 Bakehouses 91 Balham, House-to-House Inspections in 77 Barrow Road, Clearance Area 78 Births 4 Births and Birth-rates in Sub-Districts 5 Birth-rate, Average 10 Years, 1924-33 9 Births, Notification of, Act 5 Borough of Wandsworth War Memorial Maternity Home 63 Brain and Nervous System, Diseases of the 35 Butchers' Shops 82 Butter and Margarine 90 Cancer 35 Census, 1931 1 Census, 1921 2 Cerebro-Spinal Meningitis 26 Child Birth, Deaths from 11 Children and Young Persons Acts, 1908-1932 68 Children's Clinic, Wandsworth and Tooting 66 Circulatory Diseases 35 Clapham, House-to-House Inspections in 77 110 Index. PAGE Cleansing of Persons Act 33 Clearance Areas 78 Clinics for Immunisation against Diphtheria 17-24 Closing Orders 79 Confectioners 82 Conscientious Objections Certificates granted 15 Convalescent Homes 65 Cowsheds 82 Creches 64 Cumber's Yard and Garden Cottages Area 78 Cutting-off Notices—Water supply 72 Dairies, Milkshops and Cowsheds 82 Day Nurseries 64 Death, Causes of 8, 100, 101 Death-rate, Average 10 Years, 1924-1933 9 Death-rate, Corrected 6 Death-rate from Infective Diseases 12 Death-rate, Infantile 10 Deaths, Corrected 6 Deaths, Number of 6 Deaths in Institutions 10 Demolition Orders 79 Dental Treatment 45, 66 Developmental Diseases 35 Diarrhœa 32 Diphtheria 16 Diphtheria, Attack Rate per 1,000 cases 16 Diphtheria, Immunisation against 17-24 Diphtheria, " Return Cases" of 25 Diseased, aged or infirm Persons, Removal of 74 Disinfection 33 Disinfection of Schools 33 Dutch Yard Area 78 Dwelling-houses, Inspection of 75 Dysentery 27 Encephalitis Lethargica 27 Enteric Fever 25 Erysipelas 26 Expectant and Nursing Mothers, Institutions for 64 Factories and Workshops 91 Factories, Workshops, etc., Defects found in 93 Index. 111 page Factories, Workshops and Workplaces, Inspection of 69, 91 Fairfield Street Demolition Order 79 Families, Number of, Census 1921 3 Felsham Road Clearance Area 78 Fishmongers' Shops 82 Fish, Sausages and potted Meat, etc., preparation or manufacture of 81 Flies and Mosquitoes 72 Food, Prosecutions in connection with 88 Food and Drugs (Adulteration) Act, 1928, Proceedings under 86 Food and Drugs (Adulteration) Act, 1928, Statement of Work under 86 Food and Food Premises 80 Food Factories 82 Food Places, Inspection of 82 Fried Fish Shops 82 Garden Cottages and Cumbers Yard Area 78 Greengrocers' Shops 82 Greyhound Square Clearance Area 78 Grocery and Provisions Shops 82 Health Visitors, Work of 54 Home Work 91, 92 Hospitals, etc., for Expectant and Nursing Mothers 64 House Refuse, Removal of 72 House-to-House Inspections, Summary of 76 Houses and Premises Inspected 69 Houses Let in Lodgings 69 Housing Act, 1930 75, 77 Housing Consolidated Regulations, 1925, Houses inspected, etc. 75 Housing Statistics 75 Ice Cream Premises 82 Ice Cream, etc., Sale and Storage of 82 Infant Life Protection 68 Illegitimate Children, Births of 5 Immunisation against Diphtheria 17-24 Imported Produce, Marking of 86 Increase of Rent and Mortgage Interest (Restrictions) Act, 1923 77 112 Index. PAGE Infant Visiting54-57 Infantile Mortality10,11 Infantile Mortality, 10 Years, 1924-1933 11 Infective Diseases 12 Infective Diseases, Cases of 13, 14 Infective Diseases, Death-rate from 12 Infective Diseases : Number of Cases Notified from Elementary Schools 30-32 Infirm, aged or diseased Persons, Removal of 74 Influenza, Deaths and Death-rates 26 Influenzal Pneumonia and Acute Primary Pneumonia, Cases Notified 26 Inhabited Houses, Number of 3 Inquests 36 Insanitary Areas 77 Inspections, Details of 69 Institutions for Expectant Mothers, etc 64 Insulin treatment 35 Laundries, Inspection of 91 Little Manor Street Demolition Order 79 London County Council (General Powers) Act, 1932 81 Malaria 27 Margarine 90 Markets and Stalls 82 Maternal Mortality 11 Maternity and Child Welfare 54 Maternity and Child Welfare Centres 58-62 Maternity Home, Borough of Wandsworth War Memorial 63 Measles 28-32 Measles and other Non-notifiable Diseases reported from Schools 30-32 Meat 81 Merchandise Marks Act, 1926 86 Mews and Stables 69 Mice and Rats Destruction 73 Midwives 58 Milk Analysis 88 Milk, Bacteriological Examination of 89 Milk (Mothers and Children) Order 66 Milk Premises, Cowsheds, etc., on Register 81 Milkshops, Cowsheds, etc., Inspections of 82 Index. 113 page Milk (Special Designation) Order, 1923 89 Milk Supply 81 Mortuaries 74 Mosquitoes 72 Natural Increase, Rate of 5 Nelson's Row Clearance Area No. 1 78 Do. Do. No. 2 78 Nervous System, Diseases of the 35 Non-Infective Diseases, Deaths from 35 North Street Area 77 Notification of Births Act 5 Notification of Infective Diseases 12-14 Nursing Arrangements 58 Offensive Trades 69 Old Age 35 Ophthalmia Neonatorum 27 Other Infective Diseases, Deaths from 32 Outworkers 91, 92 Overcrowding 70 Para-Typhoid Fever 25 Physical Features, etc., of the Borough 1 Piggeries 69 Pleasant Place Clearance Area 78 Pneumonia 26 Police Court Proceedings 88, 102 Polio-Myelitis and Polio-Encephalitis 27 Population 1, 3, 4 Population of Sub-Districts 4 Potted Meat, Fish and Sausages, etc., preparation or manufacture of 81 Premature Birth 35 Pregnancy, Deaths from Accidents and Diseases of 11 Provisions and Grocery Shops 82 Public Vaccinators 95 Puerperal Fever and Puerperal Pyrexia 25 Puerperal Pyrexia 25 Pulmonary Tuberculosis, Notification of Cases of 37 Putney, House-to-House Inspections in 77 Rag and Bone Stores 69 Rag Flock Act, 1911, Statement of Work done under 72 Rateable Value 2 114 Index. PAGE Rats and Mice Destruction 73 Rent and Mortgage Interest (Restrictions) Act, 1923 77 Respiratory Diseases 35 Restaurant Kitchens 82 Return Cases of Scarlet Fever and Diphtheria 25 Samples, Formal and Informal, Number of 86 Sanitary Conveniences, Inspection of 69, 72 Sanitary Inspection of the Borough 69 Sanitary Operations, Table of 71 Sausages, potted Meat and Fish, etc., manufacture of 81 Scabies 32 Scarlet Fever 24 Scarlet Fever, Attack Rate per 1,000 Cases 25 Scarlet Fever, " Return Cases "of 25 Schools, Disinfection of, for Infective Diseases 33 Septicaemia, Deaths from 32 Shelters for Tuberculous Patients 45 Slaughter-houses 82 Slaughter of Animals Act, 1933 85 Small-pox 15 Smoke Nuisances 69 Social Conditions 1 Sputum Examinations 48 Staff 94 Streatham, House-to-House Inspections in 77 Suicide, Deaths from 35, 36 Syphilis, Deaths from 32 Tooting and Wandsworth Children's Clinic 66 Tooting, House-to House Inspections in 77 Transfer of Powers (London) Order, 1933 68 Tuberculosis 37-41 Tuberculosis, Artificial Light Treatment of 44 Tuberculosis, Artificial Pneumothorax Treatment of 45 Tuberculosis Dispensaries 42-53 Tuberculosis Care Committee 48 Tuberculosis, Handicraft Class 52 Tuberculosis, Institutional Treatment 44 Tuberculous Diseases, Extra Nourishment provided 45 Underground Rooms 77 Unhealthy Areas 77 Union Street Clearance Area 78 Index 115 page Unsound Food 85 Vaccination 15 Vaccination Officers 95 Vaccination Returns 15 Violence, Mortality from 35 Vital Statistics of Whole Borough 3 Wandsworth and Tooting Children's Clinic 66 Wandsworth, House-to-House Inspections in 77 Wandsworth Plain Clearance Area 78 Water Supply, Cutting-off Notices 72 White Square Clearance Area, No. 1 78 Do. Do. No. 2 78 Whooping Cough 26 Workshops, Number of 69, 91, 93 Young Children, Institutions for 64 Young Persons Acts, 1908-1932 68 Zymotic Diseases 12 From the Press of Shield and Spring, 26-28, Lancelot Place, S.W. 7.