IC 4388 WAN 72 ' Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, &c. OF THE BOROUGH, For the Year 1935, by F. G. CALEY, M.A., M.B., B.C., 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 1933, by F. G. CALEY, M.A., M.B., B.C., 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 1935. 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 1935. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health:— F. G. Caley, M.A., M.B., B.C., D.P.H. Deputy M.O.H. and Tuberculosis Officer:— J. J. MacDonnell, M.B., B.S., D.P.H. Assistant M.O.H. and Assistant Tuberculosis Officer:— L. A. S. Trott, M.R.C.S., L.R.C.P., D.P.H. The Deputy Medical Officer of Health and Tuberculosis Officer devotes one half of his time to the general Public Health duties of the Department, and the other half to his duties as Tuberculosis Officer. Half of the salary of the appointment ranks for grant under the Tuberculosis Scheme. The whole of the salary of the third Medical Officer ranks for grant under the Tuberculosis Scheme as his work is in connection with that Scheme, b 2 Report of the Medical Officer of Health for 1935. 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. C. K. Vartan, F.R.C.S., W. R. Winterton, M.A., M.B., B.Ch., M.R.C.S., L.R.C.P. 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. Public Vaccinators. District. Public Vaccinators. Balham Dr. T. Stokes, 67, Balham Hill, Balham, S.W. 12. Clapham Dr. J. Kennish, 2, The Chase, Clapham Common, S.W. 4. Putney Dr. W. D. McMurtry, 8, Atney Road, Putney, S.W. 15. Streatham Dr. A. B. Plant, 29, North Side, Streatham Common, S.W. 16. Tooting, No. 1 Dr. P. A. Carrie, 859, Garratt Lane, Tooting, S.W. 17. Tooting, No. 2 Dr. R. C. Spence, 18, Longley Road, Tooting, S.W. 17. Wandsworth, No. 1.. Dr. E. R. Badcock, 29, West Hill, Wandsworth, S.W. 18, 3 Staff. 3 Wandsworth, No. 2 Dr. H. A. Topalia, 248, Earlsfield Road, Wandsworth, S.W. 18. Swaffield Road Dr. H. A. Topalia, Institution 248, Earlsfield Road, Wandsworth, S.W. 18 Vaccination Officers. Clapham and Wands- The Medical Officer of Health, worth. Balham, Streatham and .. Mr. L. H. Ford, Tooting. 130, Franciscan Road, Tooting, S.W. 17 Putney Mr. C. L. Taylor, 1, Crieff Road, Wandsworth, S.W. 18. B 2 4 Report of the Medical Officer of Health for 1935. SANITARY INSPECTORS. Name. Commenced Duty. Certificates held. Sanitary Inspector. Meat and Foods. Others. District .. 12 Housing .. 2† A. E. Vickers (Senior Inspector) Dec. 1919 S.I. Exam. Bd. Yes — †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, 1-934 Joint Board Ex. No — H. M. Hough April, 1935 „ Yes Five A. J. Lansley April, 1935 „ Yes — †G. Rollinson May, 1935 „ Yes One Food and Drugs: „ W. H. Jones Sept. 1926 S.I. Exam. Bd. Yes Four Food : W. T. Willimott Dec. 1927 Joint Board Ex. Yes Seven A. E. Handley Aug. 1929 „ Yes Five Assistant to Food Inspectors: S. R. Coomber April, 1935 — — — 5 Staff. HEALTH VISITORS. Name. Commenced Duty. Certificates held. Health Visitor. Trained Nurse. Certified Midwife. Sanitary Inspector. Maternity and Child Welfare:— Miss D. S. Collins Mar. 1913 Yes No No Yes „ E. K. Woods Feb. 1916 Yes No Yes Yes „ M. Dean Jan. 1924 Yes No Yes Yes ,, D. M. Staniland June 1927 Yes Yes Yes No „ J. E. D. Elder May 1928 Yes Yes Yes No „ H. McCarthy Nov. 1928 Yes Yes Yes No ,, J. Pottinger Aug. 1930 Yes Yes Yes No ,, G. Smith Sept. 1930 Yes Yes Yes No „ K. Kenion Sept. 1930 Yes Yes Yes No „ 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. Four probationers. Porter Attendant—F. Dwyer, appointed March, 1934. One Cook, Six Maids, and one Seamstress. 6 Report of the Medical Officer of Health for 1935- 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 San. Insp. and two others 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.Woodhall 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. Six Disinfecting Attendants. Mortuaries. One whole-time and two part-time Mortuary Keepers. 7 Staff. Staff Changes during the Year. Dr. Margaret M. McDowall resigned her appointment as Medical Officer of the Maternity Home in September, and the Council decided not to fill the vacancy. Dr. D. H. MacLeod, Obstetric Consultant to the Maternity Home, was compelled to resign his appointment on account of ill-health. Mr. C. K. Vartan and Dr. W. R. Winterton were appointed Consultants to the Maternity Home. In January the Council decided to appoint two additional sanitary inspectors owing to the increasing duties these Officers are called upon to perform, especially under the Housing Acts and the Shops Act, 1934. The two new posts were filled by the promotion of Mr. A. J. Lansley, Assistant to the Food Inspectors, and the appointment of Mr. G. Rollinson, Sanitary Inspector at Norwich. Mr. S. R. Coomber, Junior Assistant at the Streatham Library, was appointed assistant to the Food Inspectors in the vacancy caused by the promotion of Mr. Lansley. In April last Mr. H. F. Leacock, Second Class Clerk, was successful in passing the examination of the Sanitary Inspectors Joint Examination Board. 8 GENERAL STATISTICS FOR THE BOROUGH. Area 9,199 acres Population in 1935 343,300 No. of inhabited houses in 1931 71,566 No. of families, or separate occupiers, in 1931 95,383 Rateable value in 1935 £3,125,346 Estimated produce of a penny rate £12,645 Extracts from Vital Statistics. No. of Live Births Males Females Total Legitimate 1900 1715 3615 Illegitimate 79 95 174 Total 1979 1810 3789 Deaths 1799 1978 3777 Birth-rate 1103 Death-rate—Crude 11.00 Standardized 10.23 Rate per 1,000 total (live and still) births. No. of Stillbirths 126 32.18 Deaths from puerperal sepsis 5 1.27 Deaths from other puerperal causes 5 1.27 Total 10 2.55 Infantile mortality per 1,000 live births:— All infants 55 Legitimate infants 54 Illegitimate infants 80 Deaths from Measles (all ages 2 ,, Whooping Cough (all ages) 11 ,, Diarrhoea (under 2 years of age) 36 Deaths from Tuberculosis:— No. .. 249 Rate .72 9 Vital Statistics. Social Conditions of the Borough. Wandsworth is the largest Metropolitan Borough. The acreage is 9,199, compared with that of Woolwich, which is 8,986. 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 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 in this Borough which affects public health. 10 Report of the Medical Officer of Health for 1935. Population. The population at the middle of the year was estimated by the Registrar General to be 343,300 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 1935 Clapham 60,925 59.217 Putney 34,718 33,765 Balham 53,982 52,432 Streatham 68,435 66,558 Tooting 38,159 37,125 Wandsworth 96,891 94,203 Whole Borough 353,110 313,300 Births. The total number of births occurring in the Borough was 2,441, including 305 non-residents who were born in Institutions. 1,653 births of Borough residents occurred outside the Borough, so that the corrected number of births was 3,789 compared with 3,791 in 1934. 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. 11 Vital Statistics. TABLE II. Sub-District. No. of Births. Rates. Males. Females. Total. Birth-rate. Natural increase or decrease. Clapham 392 344 736 12.42 + .86 Putney 100 162 322 9.53 —2.07 Balham 330 275 605 11.13 — .07 Streatham 301 313 614 9.22 —2.72 Tooting 200 174 380 10.23 + .16 Wandsworth 590 542 1,132 12.01 + 1.16 Whole Borough 1,979 1,810 3,789 11.03 + .03 The birth-rate was 11.03 per 1,000, compared with 10.98 for 1934, and 12.66 the decennial average. The rate for the whole of London during 1935 was 13.3 and for England and Wales, 14.7. 119 illegitimate births took place in the Borough, but only 51 belonged to the Borough. On the other hand 123 illegitimate births belonging to Wandsworth occurred outside the Bcrough, making a corrected total of illegitimate births belonging to Wandsworth of 174. 35 of these belonged to Clapham, 24 to Putney, 33 to Balham, 28 to Streatham, 24 to Tooting, and 30 to Wandsworth. The percentage of illegitimate births to total births was 4.5. The illegitimate births occuring in nursing homes have again been allocated to the home addresses of the mothers. Notification of Births Act. The following Table shows the number of births notified in each sub-district and in the whole Borough, the persons by whom notified, and the number born dead. 12 Report of the Medical Officer of Health for 1935. TABLE iii. Sub-District. Births registered in the Borough. Total live births notified. Notified by: Medical Attendant. Parent Midwife. Other person. No. born dead Clapham 463 374 85 34 249 6 8 Putney 220 193 66 6 117 4 4 Balham 375 684 92 20 543 29 12 Streatham 493 349 79 18 182 70 7 Tooting 270 211 12 14 180 5 5 Wandsworth .. 620 543 103 46 383 8 12 Whole Borough 2,441 2,354 440 138 1,654 122 48 Deaths. The number of deaths which took place in the Borough during the year was 2,961, but 1,052 of these did not belong to the Borough, while 1,868 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 3,777 of whom 1,799 were males and 1,978 females. The crude death-rate for the year was 11.00 compared with 11.18 in 1934, but after correction has been made by means of a comparability factor devised by the Registrar-General, the corrected death-rate was 10.23. The death-rate for the whole of London for 1935 was 11.4, for England and Wales 11.7, in the 121 County Boroughs and great Towns 11.8 and in the 140 smaller Towns 11.2. Table IV. shows the total number of corrected deaths and the death-rates for each sub-district and for the whole Borough. 13 Vital Statistics. TABLE IV. SubDistricts. Corrected Deaths. Crude Deathrate. Males. Females. Total. Clapham 323 362 685 11.56 Putney 186 206 392 11.60 Balham 302 338 640 12.20 Streatham 354 441 795 11.94 Tooting 174 163 337 9.07 Wandsworth 460 468 928 9.85 Whole Borough 1,799 1,978 3,777 11.00 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. 14 Report of the Medical Officer of Health for 1935. table v.—causes of, and ages at death, during the year 1935. causes of death. Deaths in or belonging to whole district at subjoined ages. Deaths in or belonging to Localities (at all ages). All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Deaths in Public Institutions, etc. Enteric Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 2 1 1 2 ... ... ... ... ... ... ... ... 2 1 Scarlet Fever 5 2 3 ... ... 1 4 ... ... ... ... 3 ... 2 ... ... ... 3 Whooping Cough 11 7 4 9 ... 2 ... ... ... ... ... 4 ... ... 3 1 3 7 Diphtheria and Membranous Croup 14 5 9 ... 2 3 8 ... ... 1 4 1 1 2 2 4 12 Influenza 38 17 21 ... ... ... 2 1 3 10 22 6 4 3 ... ... 13 15 Erysipelas 7 5 2 ... ... ... ... ... ... 1 6 1 ... 2 1 ... 2 6 Cerebro-spinal Fever 2 1 1 ... ... ... 1 ... ... 1 ... ... ... ... 1 ... 1 1 Other Epidemic Diseases 3 1 2 ... ... ... ... ... 1 2 ... ... 1 1 ... ... 1 2 Pulmonary Tuberculosis 216 114 102 1 ... l 5 55 90 57 7 34 19 28 42 29 64 133 Tuberculous Meningitis 16 5 11 ... 2 2 6 4 2 ... ... 3 ... 6 1 3 3 15 Abdominal Tuberculosis 5 1 4 ... ... ... ... 2 2 ... 1 2 2 ... 1 ... ... 4 Other Tuberculous Diseases 12 6 6 2 ... l ... 4 1 3 1 3 3 ... ... 1 3 10 Other Infective Diseases 15 9 6 ... ... ... 3 ... 2 8 2 7 3 1 1 2 1 10 Cancer, Malignant Disease 564 267 297 ... ... ... ... 2 35 249 278 98 63 96 129 66 122 334 Rheumatic Fever 26 12 14 ... ... 1 6 4 5 6 4 5 1 3 4 3 10 13 Diabetes 38 19 19 ... ... ... ... ... 1 12 25 6 5 4 ... 3 8 17 Other General Diseases 51 20 31 ... ... 2 1 ... 8 18 22 7 4 8 ... 6 17 33 Alcoholism 4 2 2 ... ... ... ... ... ... 3 l 1 1 ... 1 1 ... 3 Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis 8 6 2 1 1 ... 3 ... 2 1 ... ... 1 1 ... ... 4 8 Cerebral Haemorrhage, Apoplexy 92 43 49 1 ... ... 1 1 2 25 62 18 11 22 19 7 15 29 Convulsions 4 4 ... 3 1 ... ... ... ... ... ... 3 ... ... ... ... 1 3 Other Diseases of Nervous System 101 63 38 4 1 2 4 5 16 41 28 15 10 31 20 4 21 68 Organic Diseases of Heart 949 415 534 ... ... ... ... 6 24 179 740 175 90 171 188 73 252 490 Other Diseases of Circulatory System 405 165 240 ... 1 ... 3 7 12 91 291 60 57 73 99 28 88 173 Bronchitis 167 85 82 11 1 ... ... ... 9 43 103 82 16 20 27 22 50 55 Broncho-Pneumonia 76 36 40 24 3 2 ... 1 5 19 22 20 10 15 11 4 16 48 Lobar Pneumonia 33 17 16 ... 1 2 1 2 4 9 14 4 4 4 13 3 5 12 Pneumonia (type not distinguished) 36 23 13 4 ... ... ... 1 8 10 13 6 1 8 8 3 10 26 Other Diseases of Respiratory System 29 14 15 ... ... ... ... 1 5 14 9 9 3 2 3 3 9 14 Cancer of Stomach 20 15 5 ... ... ... ... ... 1 14 5 2 1 3 7 1 6 14 Diarrhoea 16 8 8 13 1 2 ... ... ... ... ... 4 1 2 3 1 5 16 Enteritis 25 12 13 20 2 1 ... ... ... 1 1 7 2 5 3 1 7 22 Appendicitis and Typhlitis 28 16 12 ... 1 2 ... 1 5 15 4 5 4 8 4 2 5 26 Obstruction of Intestines 34 14 20 1 ... 1 1 3 9 19 4 4 6 9 ... 12 31 Cirrhosis of Liver . 13 8 5 ... ... ... ... ... 1 7 5 2 ... 1 l 2 4 8 Other Diseases of Liver 31 10 21 ... ... ... ... ... 3 12 16 4 1 4 14 2 6 25 Other Diseases of Digestive System 60 24 36 4 ... 2 2 1 15 15 21 10 5 8 19 4 14 45 Nephritis and Bright's Disease 155 75 80 ... ... ... ... 9 17 51 78 30 24 22 31 16 32 88 Other Diseases of Urinary System 63 49 14 3 ... ... ... ... 2 19 39 18 6 12 13 4 10 47 Diseases of Generative System 8 ... 8 ... ... ... ... 1 1 6 ... 1 1 1 2 1 ... 8 Puerperal Fever 5 ... 5 ... ... ... ... 5 ... ... 1 1 1 1 ... 1 5 Other Accidents and Diseases of Pregnancy and Childbirth 5 ... 5 ... ... ... ... 1 4 ... ... ... ... 1 1 ... 3 4 Premature Birth 45 29 16 45 ... ... ... ... ... ... ... 8 1 9 8 6 13 30 Congenital Debility and Malformation 43 22 21 38 2 2 ... 1 ... ... ... 12 4 7 8 2 10 28 Other Diseases of Early Infancy 17 12 5 16 1 ... ... ... ... ... ... 6 2 2 2 1 4 13 Old Age 74 23 51 ... ... ... ... ... ... ... 74 8 9 13 20 8 16 21 Deaths from Accident 134 79 55 6 2 ... 9 10 22 31 54 22 16 24 24 17 31 117 Deaths from Suicide 40 24 16 ... ... ... ... 2 12 20 6 11 3 7 5 2 12 23 Other Violent Deaths 2 1 1 ... ... ... ... ... 1 1 ... 1 1 ... ... ... ... 1 Other Defined Diseases 22 10 12 1 ... ... 2 1 3 5 10 2 6 1 4 2 7 19 Ill-defined Diseases or unknown 7 3 4 ... ... ... ... 1 ... 3 3 1 ... 2 1 1 2 6 All causes 3777 1799 1978 209 22 29 62 124 333 1011 1987 685 332 640 795 337 928 2143 15 Vital Statistics. The number of deaths shown on Table V. does not agree with that shown on page 108. 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. 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 1934 10.98 13.2 14.8 10.39 11.9 11.8 Average 10 years 12.66 15.50 16.2 11.04 12.0 12.1 1935 11.03 13.3 14.7 10.23 11.4 11.7 16 Report of the Medical Officer of Health for 1935. The number of deaths which occurred in Institutions, etc. inside the Borough was 1,327, but 1,052 of these persons did not belong to the Borough. A total of 2,143 persons belonging to the Borough died in Institutions, 275 occurring in Institutions within the Borough and 1,868 in Institutions outside the Borough. Infantile Mortality. The number of deaths under one year was 209—54 in Clapham, 17 in Putney, 29 in Balham, 37 in Streatham, 16 in Tooting, and 56 in Wandsworth. As the number of births was 3,789 the Infantile Mortality rate was 55 per 1,000 births, compared with 58 last year and with a decennial average of 56. The rate is lower than for the whole of London, which was 58 per 1,000 births. For the 10 years ending 1918 the average infantile mortality rate was 87, while the 10 years ending 1935 the average rate was 56. The number of deaths among legitimate infants was 195 to 3,615 births—a mortality of 54 per 1,000 births, while the number of deaths among illegitimate infants was 14 to 174 births —a mortality of 80 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. 17 Vital Statistics. TABLE VII. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 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 1934 58 54 50 67 74 52 58 Average for 10 years 54 59 51 48 67 60 56 1935 73 52 47 60 42 41 55 No. of deaths under 1 year, 1935 54 17 29 37 16 56 209 Maternal Mortality. Five deaths occurred from accidents and diseases of pregnancy and five from Puerperal Fever, giving a total of 10 deaths after childbirth. This is equivalent to a rate of 2.55 per 1,000 live and still births, compared with 2.55 in 1934 and 6.23 in 1933. Enquiries into all maternal deaths, which were commenced in 1928 at the instance of the Ministry of Health have been continued. c 18 INFECTIVE DISEASES. The number of deaths from notifiable infectious diseases, including all forms of Tuberculosis, was 335, compared with 414 in 1934. This fall is due to the smaller number of deaths from Diphtheria, Pneumonia and Tuberculosis. There were also 51 deaths from non-notifiable diseases of an infective nature, viz.:— two from Measles, 11 from Whooping Cough and 38 from Influenza. From all infective diseases the death-rate was 1.14 per 1,000—1-33 in Clapham, 1.09 in Putney, .99 in Balham, 1.11 in Streatham, 1.07 in Tooting, and 1.17 in Wandsworth. The rate in 1930 was 2.26; in 1931, 1.44; in 1932, 1.62; 1933, 1.75; and in 1934, 1.35 per 1,000. The rate from the principal infective diseases, viz.:— Small-pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever and Diarrhoea, was .21 per 1,000, compared with .35 in 1930; .18 in 1931; .44 in 1932.; .26 in 1933.; and .34 in in 1934. The rate was .37 in Clapham, .11 in Putney, .17 in Balham, .16 in Streatham, .13 in Tooting, and .23 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. 19 Infective Diseases. TABLE VIII. Notifiable Diseases. Total. No. of CASES of Infective Diseases grouped in Age Periods. Under 15 15 and upwards Under 1 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 and upwards Small-pox — — — — — — — — — — — — — — — Diphtheria 388 335 5 3 2 13 34 41 33 161 51 13 29 5 5 1 Scarlet Fever 721 566 155 1 22 34 51 57 272 129 52 83 11 8 1 Enteric Fever and Paratyphoid Fever 11 1 10 — — — — — — 1 7 1 2 — Puerperal Fever 12 — 12 — — — — — — — 1 8 3 — — Puerperal Pyrexia 24 — 24 — — — — — — — 1 18 5 — — Erysipelas 125 23 102 — — 1 — 11 11 1 13 10 53 25 Pneumonia:— Acute Influenzal 34 5 29 — — — — 2 2 1 7 8 8 6 Acute Primary 285 83 202 13 9 6 5 4 26 20 10 56 30 C5 41 Cerebro-spinal Meningitis 4 3 1 — — — 1 — 2 — — — — 1 — Polio-myelitis 13 11 2 — — 3 2 1 4 1 1 1 — — — Encephalitis Lethargica 2 — 2 — — — — — — — — — 1 1 — Malaria 2 — 2 — — — — — — — — 2 — — — Dysentery 9 5 4 — — 1 1 1 1 1 1 2 1 — — Food Poisoning 96 5 91 — 1 1 2 — 1 — 36 45 3 5 2 Ophthalmia Neonatorum 26 26 — 26 — — — — — — — — — — Tuberculosis—All forms 658 84 574 3 6 2 1 2 34 36 74 282 162 96 20 Total 2410 1147 1263 45 51 81 105 100 514 251 190 553 180 244 96 c 2 20 Report of the Medical Officer of Health for 1935. 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 70 37 54 51 54 122 388 385 14 Scarlet Fever 167 61 96 110 106 181 721 623 5 Enteric and Para-typhoid Fevers 3 1 — 1 — 6 11 7 1 Puerperal Fever 1 2 1 4 2 2 12 10 5 Puerperal Pyrexia 2 4 4 6 1 7 24 17 — Erysipelas 14 7 15 14 29 46 125 32 7 Pneumonia—Acute Influenzal 8 4 3 3 5 11 34 — 6 Pneumonia—Acute Primary 59 22 33 35 36 100 285 — 44 Cerebro-spinal Meningitis — — — 2 — 2 4 3 2 Polio-myelitis 3 3 — 5 — 2 13 12 1 Encephalitis Lethargica — 1 — 1 — — 2 — 1 Malaria 1 — — — — 1 2 2 — Dysentery 3 — — 6 — 9 2 — Food Poisoning 7 5 2 10 72 96 — — Total 335 150 208 242 239 552 1726 1093 86 Tuberculosis—all forms 118 70 89 120 112 149 658 249 Ophthalmia Neonatorum 6 3 7 3 2 5 26 12 — Total 124 73 96 123 114 154 684 12 249 Grand Total 459 223 304 365 353 706 2410 1105 335 21 Infective Diseases. The total number of cases was 2,410 compared with 3,494 in 1934. This large decrease is due almost entirely to the marked fall which occurred in the number of cases of Scarlet fever and Diphtheria. In 1934 there were 2,125 cases of these two diseases, but in 1935 the number was 1,016, a reduction of almost one half. 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 1934 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 236 148 335 227 98 236 138 1418 Insusceptible of Vaccination — — 2 2 — — — 4 Had Small-pox — — — — — — — — Dead, Unvaccinated 15 4 10 26 18 12 8 93 Exempted under Certificates of Conscientious objection 159 44 203 138 E4 105 72 815 Postponed by Medical Certificate 2 2 7 7 2 1 1 22 Removed 33 16 73 32 31 24 10 219 Remaining on Books as Un-vaccinated 3 7 11 15 17 2 — 55 No. of Births returned to Vaccination Officers during 1934 448 221 641 447 260 380 229 2626 22 Report of the Medical Officer of Health for 1935. The percentage of children vaccinated to total births was 53.9—in Clapham, 52.6; in Putney, 66.9; in Balham, 52.1; in Streatham, 50.7; in Tooting, 41.5; in Southfield, 62.1; and in Springfield, 60.2. This percentage is .6 lower than that recorded last year. Diphtheria. 388 cases occurred, compared with 552 in 1934; 409 in 1933; and 323 in 1932. The number of deaths was 14, compared with 21 in 1934, 13 in 1933 and 16 in 1932. The death-rate for 1935 was .04 and the case mortality was 3.6 per cent. The rate per 1,000 of population was 1.13; 1.17 in Clapham; 1.09 in Putney; 1.02 in Balham; .76 in Streatham; 1.45 in Tooting; and 1.29 in Wandsworth. Of the 388 cases, 385 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 Christchurch, Haselrigge Road, St. Andrew's Street, Stonhouse Street and Telferscot Road Schools in Clapham; Convent of the Sacred Heart Elementary, Roehampton, Hotham Road, Huntingfield Road, Putney Church of England, Felsham Road, and Putney Roman Catholic, Clarendon Road Schools in Putney; Fircroft Road and Smallwood Road Schools in Balham; Furzedown Demonstration and Streatham Secondary Schools in Streatham; Defoe, Franciscan Road, Sellincourt Road and Tooting Graveney Schools in Tooting; and All Saints', Brandlehow Road, Earlsfield, Garratt Lane and Waldron Road Schools in Wandsworth. Swabs were taken from the throats of some of the children examined. As the result of this swabbing six cases were found to be positive. All the cases were swabbed again and not readmitted to school until a negative result was obtained. Every positive or suspicious case was visited and all necessary precautions taken to prevent the spread of the disease. During the year 53 tubes of anti-toxin were issued to medical practitioners for use in cases of Diphtheria. 23 Infective Diseases. The Council's Clinics for Immunisation against Diphtheria. Two Clinics have been established by the Council since January, 1928, for the testing of children to see if they are susceptible to Diphtheria and for the immunisation of those found to be susceptible. The Clinics are held at the premises of the Springfield and Balham Infant Welfare Centres respectively. 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 immunising injection is given on the same day. The solution now used for immunisation is the preparation known as Alum Precipitated Toxoid. The dose consists of one c.c. and only one injection is given. The results obtained with this preparation have been satisfactory and it is a great advantage to be able to immunise by giving one injection only. 24 Report of the Medical Officer of Health for 1935. The use of Toxoid Anti-toxin Floccules, or T.A.F., which required two injections, and Toxoid Anti-toxin Mixture, (T.A.M.), where three injections were necessary, has been discontinued. Experience has shown that the large majority of children under five years of age give a positive Schick test and in order to save time, the procedure is modified in their case by omitting the preliminary test, the first immunising injection being 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 1,276 compared with 954 in 1934 and 896 in 1933. In the eight years during which the two clinics have been open, 7,448 persons have attended. 5,429 of the total number who attended were given the Initial Schick Test to see if they were susceptible to Diphtheria, and the remaining 2,019 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 youth. 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 3,744 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 25 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 187 2338 819 1640 1704 3344 256 144 1663 2081 3744 Schick Negative 42 695 521 614 644 1258 201 155 639 975 1614 Result not read 5 35 19 25 34 59 9 3 28 43 71 Total 234 3068 1359 2279 2382 4661 466 302 2330 3099 5429 Percentage Positive 79% 76% 60% 72% 71% 72% 55% 48% 71% 67% 69% 26 Report of the Medical Officer of Health for 1935. the small number of adults who were tested 48 per cent. gave a positive result. Immunisation:—Immunity does not develop until several weeks have elapsed after the injection has been given 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. Parents are advised to bring their children for the re-test in about six to eight weeks after the injection has been given 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 who have attended the Clinics and required immunisation was 5,763. This number is made up of 3,744 who were found to be Schick positive after the initial test and the 2,019 young children who were assumed to be susceptible without a test, as they were under five years of age. The subsequent history of these 5,763 persons is given in the following statement:— No. who were immunised and found to be Protected as shown by a Negative re-Schick Test 4,203 No. who received a course of injections but are not yet protected as the re-Schick Test is still positive 208 No. who received injections, the value of which is not known as they have not attended to be re-tested 1,291 Schick positive cases who were not injected 61 Total number of Susceptibles 5,763 27 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 1049 1804 500 1890 2117 4013 110 74 1909 2294 4203 28 Report of the Medical Officer of Health for 1935. The age grouping of the persons in whom immunity was produced is given in Table XII. Two of the 4,203 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 4,201 persons. It will be noticed that the time taken to produce immunity is shewn to vary very much. The period 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 due, however, to actual delay in the production of immunity. A number of the cases included in this Table because the final re-test was negative have had one or more positive results before the final negative one was obtained. An analysis of the information given in Table XIII. brings out the following points:— (1) One series of injections was sufficient to produce immunity in most of the cases—actually, 3,733 out of 4,201 were immunised after the first series. (2) 420 cases required a second series of injections to produce the same result. (3) In a few cases further series had to be given before immunity was produced. (4) 2,933 out of 4,201 cases were protected within six months after receiving the last dose of immunising serum. 29 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. Number of Immunising Injections given. Period after last injection of the First Series in which re-Test was Negative. Total within 4 months between Total within 1 year between 4 and 6 months 6 and 9 months 9 and 12 months 1 year and 2 years 2 years and 3 years 3 years and 5 years 5 years and 7 years Children Under 15 1 injection 561 11 6 2 580 4 __ - 584 2 injections 126 705 172 19 1022 61 6 1 - 1090 First Series 3 injections 580 774 312 114 1780 92 15 1 1888 4 injections 5 5 — 2 12 — — — — 12 Second Series 2 to 6 injections 17 31 31 165 244 115 29 3 1 392 Third Series 3 to 8 injections — — 3 2 5 31 6 - - 42 Fourth Series 5 to 6 injections — — — 1 1 — 1 - - 2 Fifth Series 10 injections - — - - - -1. — — — 1 Total Under 15 1289 1526 524 305 3644 304 57 5 1 4011 Adults Over 15 1 injection 15 3 18 18 2 injections 5 38 10 2 55 2 1 — — 58 First Series 3 injections 29 30 14 4 77 5 — — — 82 4 injections - 1 — — 1 — — — — 1 Second Series 2 to 6 injections — — 5 13 18 9 — 1 - 28 Third Series 11 injections — — — — — — 1 - - 1 Fourth Series 6 to 8 injections — - — — — 1 321 1 — — 2 Total All Ages 1338 1595 553 327 3813 60 6 1 4201 Two cases primary Schick positive, received no series of injections and re-schick test negative after suffering from Diphtheria. 30 Report of the Medical Officer of Health for 1935. (5) By the end of twelve months this number had increased to 3,813. There are good grounds for assuming that a proportion of the remainder would have been found protected if they had attended earlier to be re-tested. In addition to the 4,203 persons who have been protected, 208 have completed the first series of injections but cannot be recorded as protected because the last re-Schick test has given a positive result. 87 of these have not attended since this positive re-test. The other 121 have attended the Clinics and have received further injections but have not yet reacted negative to the re-Schick test. A further 1,291 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 557 who completed the first series of three injections and 734 who only received one or two doses of T.A.F. or T.A.M. 61 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. Seven children who have received immunising injections at the Centres have developed Diphtheria. In one case the reSchick test had been positive, four had given a negative re-test and two had not been re-tested. In six instances the attacks were mild, but one of the children who had not been re-tested suffered from a rather severe attack. In addition to these seven 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 31 Infective Diseases. 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. Scarlet Fever. 721 cases of Scarlet Fever occurred, compared with 1,573 in 1934, 1,307 in 1933, and 763 in 1932. The decrease in the number of cases has been associated with a general decrease in the incidence of this disease throughout London. Five cases died, compared with five and seven respectively for the two previous years, and the death-rate was .011 per 1,000 compared with .014 and .019. The case mortality was .69 per cent. The case-rate per 1,000 of population was 210:—2.82 in Clapham; 1.80 in Putney; 1.83 in Balham; 1.65 in Streatham; 2.85 in Tooting ; and 1.92 in Wandsworth. Of the total number of cases, 721 or 86 per cent., were removed to hospital. The Medical Officers of the London County Council made inspections of five 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. 31 cases of Scarlet Fever and two of Diphtheria occurred within one month of the return of a previous case from hospital. Enteric and Para-Typhoid Fevers. 11 cases, and one death of the above occurred, compared with 19 cases and two deaths in the previous year. Five of the cases were true Enteric Fever and six were Para-typhoid Fever. Puerperal Fever and Puerperal Pyrexia. During the year 12 cases of Puerperal Fever and 24 cases of Puerperal Pyrexia occcurred. Five of the cases died. The 32 Report of the Medical Officer of Health for 1935. death-rate was .01 per 1,000 of population and 1.27 per 1,000 (live and still) births. Erysipelas. 125 cases were notified and seven deaths occurred during the year, compared with 150 and eight in 1934. Whooping Cough. 11 deaths from Whooping Cough occurred during the year and the death-rate was .03 per 1,000. 904 cases came to the knowledge of the Department during the year. 72 of the cases were removed to hospital during the year. 334 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Whooping Cough occurred, and four premises were disinfected. Influenza. The number of deaths from Influenza was 38 compared with 43 in 1934, 183 in 1933, 111 in 1932, 97 in 1931 and 22 in 1930. The death-rate was .11 per 1,000. Influenzal Pneumonia and Acute Primary Pneumonia. 34 cases of acute Influenzal Pneumonia, and 285 cases of acute Primary Pneumonia wore notified. Six of the former and 44 of the latter died. The total number of deaths credited to all forms of Pneumonia during the year was 145, compared with 187 in 1934, 175 in 1933, 180 in 1932, 191 in 1931, 207 in 1930, 331 in 1929, 246 in 1928, 239 in 1927, 217 in 1926 and 181 in 1925. Cerebro-Spinal Meningitis. Four cases of this disease occurred. Two of them terminated fatally. Four other cases of this disease were notified, but proved 33 Infective Diseases. not to be cerebro-spinal meningitis. Eight deaths were registered as being caused by Meningitis. Polio-myelitis and Polio-encephalitis. 13 cases occurred, none of which proved fatal. Two 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. Two cases of this disease occurred and three deaths were registered. Malaria. Two cases were notified. No death occurred. Dysentery. Nine cases of Dysentery were notified and no death occurred. Ophthalmia Neonatorum. 26 cases were notified. 20 of them recovered without any impairment of vision, one case died from Premature birth, and five removed from the Borough. TABLE XIV. Result of Treatment. Recovered— Vision not affected. Vision Impaired. Total Blindness. Died. Removed from Borough. Treatment received :— In Hospital 7 — — — 3 At Hospital, Outpatient 2 — — — — At home 11 — — 1 2 Total 20 — — 1 5 D 34 Report of the Medical Officer of Health for 1935. Measles. The number of cases brought to my notice during the year October 1st, 1934, to September 30th, 1935, was 151. Two cases died during the calendar year. 122 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. 30 cases were removed to hospital, compared with 149 in the non-epidemic year of 1933. Four cases requiring special home nursing were referred to District Nursing Associations in the Borough, compared with eight in 1933, and the nurses made 33 visits to these cases, compared with 101 in 1933. The death-rate per 1,000 of the population was .005 compared with .005 in 1933 and .002 in 1931. 129 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Measles occurred, and 17 premises were disinfected at the request of the occupiers. 35 Infective Diseases. TABLE XV. MEASLES—CASES REPORTED AND DEATHS. Period 1st October—30th September. 1925-26 1926-27 1927-28 1928-29 1929-30 1930-31 1931-32 1932-33 1933-34 1934-35 Cases Reported. In a Measles year 4,219 — 4,596 — 4,046 — 3,601 — 4,140 — In a Non-Measles year — 81 — 355 — 295 — 589 — 151 Deaths. In a Measles year 52 — 38 — 46 — 38 — 37 — In a Non-Measles year 2 — 1 — 2 — 2 — 2 Period. Calendar Year 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 Cases Reported 4,028 172 4,529 380 3,976 291 3,598 615 4,148 137 Deaths 51 4 36 1 47 2 37 2 37 2 D 2 36 Report of the Medical Officer of Health for 1935. Table XVI. shows the number of cases of infective diseases which were reported from schools during the year. TABLE XVI. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases s. Clapham. Bonneville Road 20 1 2 2 9 32 30 1 2 99 Cavendish Road 8 6 — 5 —. 1 2 22 Christchurch 3 7 3 10 7 14 26 — 70 Clapham Central 4 — — 4 Haselrigge Road 26 3 1 1 3 15 15 31 95 Henry Thornton 3 1 — 1 — 5 Larkhall Lane 15 6 4 5 1 28 19 2 9 89 New Park Road 11 2 2 — 8 27 42 — 1 93 New Road 1 — — 2 8 — 2 13 Parochial, Old Town 6 4 1 49 4 14 36 — 1 115 St. Andrew's Street 6 3 2 — 11 1 14 — — 37 St. Mary's, Crescent Lane 6 1 — — — 1 — — 8 St. Mary's, St. Alphonsus Road 2 - - - - - - - - 2 Stonhouse Street 9 1 5 14 5 8 6 — 3 51 Telferscot Road 7 3 1 — 35 6 9 — 3 64 Putney. All Saints' 1 — 1 - - - - - - 2 Convent of Sacred Heart 1 6 — — — — — 1 — 8 Hotham Road 6 5 4 2 18 5 17 — 12 69 Huntingfield Road 9 1 1 3 — 18 — — 32 Parochial, Roehampton 1 1 — — 1 6 — — — 9 St. Agnes, R.C. 1 - - - - - - - 1 St. Mary's 3 3 2 — 2 — 14 — — 24 Upper Grade 1 — — — 3 1 - - - 5 Balham. Balham Central 3 - - - - - 2 - - 5 Bec, The 1 - - - - - - - - 1 Broadwater Road 6 1 1 1 17 — 26 Fircroft Road 8 8 1 20 8 12 — — 57 Hearnville Road 2 4 - 1 4 — 11 Holy Trinity 2 - - - - - - - - 2 Nightingale Square, R..C. 2 1 - - - - - - - 3 Oldridge Road 5 5 2 3 4 — — 19 Ravenstone Street - 2 2 1 2 2 1 1 4 15 St. Mary's .. 5 1 1 1 18 22 — 48 Smallwood Road 11 10 — 8 1 74 — 2 106 Carried forward 193 87 34 85 144 197 392 6 72 1210 37 Infective Diseases. TABLE XVI.—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 193 87 34 85 144 197 392 6 72 1210 Streatham. Christchurch 1 - - - - - - - - 1 County Secondary 2 - - - - - - - - 2 Eardley Road 8 4 4 — 61 33 12 — 1 123 Furzedown Demonstration — 4 — 1 3 2 14 — 24 Granton Road 4 2 — 1 5 — 22 — — 34 Hitherfield Road 5 — 9 11 42 — — 67 Holy Trinity 1 2 — — — 3 Immanuel 2 1 — — — 4 — — 7 Mitcham Lane 6 4 — — 6 11 39 — 2 68 New 1 - - - - - - - - 1 St. Andrew's, Polworth Road 3 — — — 5 — 1 9 St. Leonard's 2 1 2 — 2 6 46 — _ 59 Sunnyhill Road 3 7 1 3 17 — 22 — 2 55 Woodmansterne Road 5 — 36 — 11 - 32 - 4 88 Tooting. Convent of Holy Family 1 - - - - - - - - 1 Defoe (Fountain Road) 10 2 2 — 1 5 59 — 1 80 Ensham Central 4 1 — — — - ~~~ — — 5 Ensham 3 1 — — 8 34 122 —- 1 169 Franciscan Road 2 — — — 2 — 45 — 1 50 Hillbrook Road 10 4 1 25 14 18 — — _ 72 Sellincourt Road 11 4 2 66 16 218 — — ' 317 Tooting Graveney 8 2 — — — 27 — — 37 Undine Street, R.C. 5 3 — — — 16 — — 24 Wandsworth. Allfarthing Lane 2 2 2 3 10 12 98 1 130 All Saints' 2 2 — 1 5 1 — — 11 Brandlehow Road 4 — — 3 1 — — 8 County Secondary 1 — — — - — 1 Elliott Central 4 1 — — 1 — 3 1 — 10 Eltringham Street 19 1 — — 50 13 56 1 — 140 Frogmore Special 1 1 — — —. 2 8 — — 12 Garratt Lane 1 5 — — 1 12 48 — — 67 Littleton Street, Special — 1 — — — — — — — 1 Magdalen Road 8 2 2 — 13 15 31 — — 71 Merton Road 1 — — — — 1 Riversdale 5 1 — 2 87 12 127 — — 234 Carried forward 329 149 88 95 526 403 1508 9 85 3192 38 Report of the Medical Officer of Health for 1935. TABLE XVI.—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 329 149 88 95 526 403 1508 9 85 3192 St. Ann's 3 2 2 7 38 ; 52 St. Faith's 8 3 — — 6 4 19 1 — 41 St. Joseph's 1 1 1 — — 3 3 — — 9 St. Michael's 3 — 2 5 33 31 14 — 2 90 Swaffield Road . 9 2 — — 1 14 30 — — 56 Waldron Road 6 2 1 — 13 15 52 — 6 95 Wandle 3 6 1 — 29 34 91 — 4 168 Wandsworth Central 1 1 3 1 — — 6 Warple Way 1 2 — — — 2 17 — — 22 West Hill 7 3 2 6 20 95 3 136 Grand Total 371 170 96 100 619 534 1867 10 100 3867 Diarrhoea. The number of deaths from Diarrhoea was 41 compared with 44 in 1934, 43 in 1933, 68 in 1932 and 27 in 1931, and of these 33 or 70 per cent., were under the age of one year, compared with 79 in 1934. The number of deaths from Diarrhoea, Zymotic Enteritis and Enteritis under one year represents 15-78 per cent, of the total mortality at that age. Other Infective Diseases. 15 deaths occurred, eight from Syphilis, and seven from Septicaemia. Scabies. The names of 115 school children who were suffering from Scabies were forwarded to me by the Medical Officer to the London County Council, and the homes were visited by the 39 Infective Diseases. Sanitary Inspectors. These children were being treated at the London County Council cleansing stations. In addition to the above 57 other cases were reported to me. These cases were treated at the Council's disinfecting station with sulphurated potash baths, and in every case the disease was cured. The average number of baths given per case was three. In 147 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 30 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 10 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 2,057—395 in Clapham, 204 in Putney, 425 in Balham, 329 in Streatham, 191 in Tooting, and 513 in Wandsworth. Two public and three 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. 40 Report of the Medical Officer of Health for 1935. Bacteriological Examinations. During the year 3,128 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 342 389 530 650 241 794 2946 Positive 26 15 32 26 18 51 168 Enteric Fever :— Negative 1 5 2 2 — 3 13 Positive 1 - - - ~ - 1 Total 370 409 564 678 259 848 3128 Examinations of Sputum made at the Dispensary are not included in the above figures. 41 NON-INFECTIVE DISEASES. The total number of deaths from Cancer and malignant disease was 564, the number of males being 267 and females 297, The death-rate was 1.64 per 1,000. The number of deaths in 1935 was 27 less than in 1934. The number of deaths from diseases of the Brain and Nervous System was 113. 1,446 deaths occurred from diseases of the Heart and Circulatory System, compared with 1,272 in 1934, 1,260 in 1933 and 1,279 in 1932. 1,093 of these deaths were of persons over 65 years of age. There were 341 deaths from diseases of the Respiratory System, compared with 396 in 1934, 386 in 1933 and 492 in 1931. The number from Bronchitis was 167 compared with 184 in 1934, and from Pneumonia (all forms) 145 compared with 187 in 1934. Further particulars relative to Pneumonia are given on page 32. The number of infants under two years of age who died from these diseases was 39. 105 deaths, 63 males and 42 females, were registered as due to Premature Birth and Developmental Diseases, compared with 121 in 1934. 74 deaths, 23 males and 51 females, occurred from Old Age, and all these were persons over 65 years of age. The number of deaths due to this cause in 1934 was 74. 176 deaths were due to violence, 134 of them being due to accident, 40 to suicide, and two to other forms of violence. Insulin Treatment. This service was commenced by the Council in 1928 with the sanction of the Ministry of Health. There are now five persons receiving treatment. The cost to the Council for the year 1935 was £28 18s. 8d. Inquests. Inquests were held on 255 persons dying in the Borough, and on 189 Borough residents who died outside the Borough. 42 Report of the Medical Officer of Health for 1935. The next Table shows the results of the findings of these inquests. TABLE XVIII. Inquests. Sub-Districts. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Deaths from Natural Causes 38 30 43 43 30 51 235 Accidental:— Knocked down by motor vehicles 5 8 18 4 4 2 41 Falls — 1 5 3 9 8 26 Falls from motor vehicles 4 3 5 1 1 6 20 Falls from a height 4 4 1 2 2 6 19 Burns and scalds 3 4 3 2 2 1 15 Suffocation 1 2 o 1 3 2 12 Drowning — 3 — 1 — — 4 Other 3 4 4 5 1 3 20 Suicidal:— Poisoning by:— Coal Gas 3 1 4 2 1 4 15 Lysol — 1 2 1 — — 4 Carbolic Acid 2 - - - - - 2 Aspirin 1 — — — 1 2 Sulphuric Acid 1 1 2 " Dial " - - - - - 1 1 Hydrochloric Acid - - - - - i 1 Oxalic Acid — — — 1 — 1 Cut throat 1 1 1 1 — l 5 Hanging 1 ■— I 1 — l 4 Drowning 2 1 — — 3 Fall from a height — 1 1 — — — 2 Stab wounds — 1 — — — 1 Gunshot wounds — — 1 — — — 1 Murder 1 - - - - - 1 Found drowned — 1 — 1 — 2 4 Hanging—Execution - - - - - 3 3 Totals 67 65 95 69 54 94 444 43 TUBERCULOSIS. Notification.—The total number of new cases of Tuberculosis which came to the notice of the Department during 1935 was 658 as compared with 621 in 1934, 610 in 1933, and 642 in 1932. The sources of information regarding the 658 new cases in 1935 were as follows:— Primary notifications on Form A 496 Primary notifications on Form B — Transfers from other Sanitary Authorities 142 Naval and military notifications — Un-notified at death 20 Total 658 Deaths.—The number of deaths certified as due to diseases of a Tuberculous nature was 249. This compares with 276 deaths in 1934, 305 in 1933 and 288 in 1932. 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. 44 Report of the Medical Officer of Health for 1935. TABLE XIX. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Males. Females. Males. Females. Males. 1 Females Males. Females. Under 1 year 1 2 1 i 1—5 2 1 4 4 — 1 1 2 5—10 2 6 17 9 1 1 1 3 10—15 6 13 9 8 1 6 2 2 15—20 29 32 7 6 10 18 2 3 20—25 35 71 4 6 10 20 3 3 25—35 83 68 6 9 24 22 — 2 35—45 49 42 6 5 18 25 1 1 45—55 35 16 3 3 26 5 — 2 55—65 24 11 3 1 19 3 1 — 65 upwards 13 3 — 4 5 1 — 2 Totals 278 263 60 114 102 12 21 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. Males. Females. Total. Brain 4 13 17 Glands, Mesenteric 6 11 17 Glands, Cervical 16 13 29 Bones and Joints 24 12 36 Other Parts 10 8 18 Totals 60 57 117 45 Tuberculosis. TABLE XXI. Localisation. Males. Females. Total. Pulmonary Tuberculosis 114 102 216 Brain 5 11 16 Glands, Mesenteric 1 4 5 Bones and Joints 3 2 5 Other Parts 3 4 7 Totals 126 123 249 In addition to these deaths, which were duly certified in the returns as due to Tuberculosis, 31 persons previously notified as suffering from Tuberculosis died during the year. These deaths, however, do not figure in Table XXI. for the reason that:— (a.) Nineteen were certified as dying from diseases other than Tuberculosis. (b.) Twelve had previously moved outside the Borough and died there, the death being credited to the area in which it occurred. The following Table gives figures for the last ten years showing both the number of deaths and the death-rate per 1,000 from Tuberculosis in the Borough. Of the 249 deaths from Tuberculosis, 126 were males and 123 females. 216 deaths were due to Pulmonary Tuberculosis and 33 to other forms of Tuberculosis. Further details are given in Table XXI. 46 Report of the Medical Officer of Health for 1935. TABLE XXII; Pulmonary Tuberculosis :— No. of Deaths 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 255 300 269 320 275 288 245 257 235 216 Death-Rate .73 .85 .76 .90 .77 .81 .69 .73 .66 .62 Other Forms :— No. of Deaths 40 39 35 33 33 19 43 48 41 33 Death-Rate .12 .11 .10 .09 .09 .05 .12 .13 .11 .09 Total :— No. of Deaths 295 339 304 353 308 307 288 305 276 249 Death-Rate .84 .96 .86 .99 .86 .86 .81 .86 .78 .72 T uberculosis. 47 During the year 20 persons, not previously notified, were certified as having died of Tuberculosis. The ratio of un-notified Tuberculosis deaths to total Tuberculosis deaths is therefore 1 to 12. Of the 20 un-notified deaths, 13 were certified from Institutions, six by private doctors, while in one case 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. 61 persons died within one month after notification, 70 within three months, and 90 within six months. 658 cases were added to the notification register during the year, and 632 cases who had removed, recovered or died, were taken off. The number remaining on the register at the end of the year was 2,114. 48 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 1935.—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. 161 10 171 11 237 419 F. 156 18 174 14 297 485 Children M. 7 12 19 1 208 228 F. 4 9 13 — 223 236 Totals 328 49 377 26 965 1368 Tuberculosis Dispensaries. 49 The districts of the Borough in which these 1,368 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 Department 69 42 46 37 71 90 355 Private Practitioners 55 48 53 56 89 151 452 Charitable Societies 10 18 10 11 23 69 141 Other Dispensaries 30 24 25 37 34 38 188 L.C.C. Schools 2 1 2 — 1 8 14 Ministry of Pensions 1 1 1 — — — 3 Existing Dispensary Patients 1 1 - - 2 1 5 Other Sources 20 17 31 20 32 90 210 Totals 188 152 168 161 252 447 1,368 Contacts.—Of the 1,368 new cases examined, 371 were contacts. Sixteen 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., 19J4 New Cases Removed from Register Remaining on Register 31st Dec., 1935 Pulmonary 1113 379 376 1116 Non-Pulmonary 258 72 68 262 Suspected cases 38 171 183 26 Totals 1409 622 627 1404 E 50 Report of the Medical Officer of Health for 1935. 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 106 2. Number of patients transferred to other areas and cases " lost sight of " 200 3. Died during the year 163 4. Number of cases recovered 79 5. Number of observation cases in which a period of observation exceeded two months 26 6. Number of attendances at the Dispensaries 4933 7. Total number of reports, etc., made in connection with the Dispensaries 4999 8. Number of attendances at General Hospitals or Institutions of patients for— (a) Light treatment 249 (b) Other special forms of treatment 1190 9. Number of patients to whom Dental Treatment was given in connection with the Dispensary 18 10. Number of Personal Consultations with Medical Practitionersfa) At Homes of Patients 274 (b) Otherwise 1471 11. Number of other visits by Tuberculosis Officers to Homes 312 12. Number of visits by Health Visitors or Nurses to homes for Dispensary purposes 4238 13. Number of— (a) Specimens of Sputum, etc., examined 1367 (b) X-ray examinations made in connection with Dispensary work 224 The number of patients who received institutional treatment under the London County Council's Tuberculosis Scheme during 1935 was as follows :— (a). In Hospitals for observation 38 (b). In Sanatoria 449 (c). In Hospitals for Advanced Cases 4 491 In addition to these many other patients received treatment in private or general hospitals. Tuberculosis Dispensaries. 51 Co-operation with Other Institutions.—Cases requiring special investigation which can be carried out in an Out-patient Department are referred to St. Thomas' Hospital, under arrangements which were inaugurated in 1913. The reports received from the Hospital on these cases are of much value. Special cases requiring treatment by Artificial Light or X-rays are also referred to the out-patient department of St. Thomas' Hospital. The arrangements made for treatment by the Artificial Pneumothorax method with several hospitals have been continued. 86 cases were treated during the year and 1,169 refills were administered. The cost to the Council was £613 14s. 6d. Two of these cases also received Sanocrysin injections, at a cost of £3 3s. 0d., for 21 injections. 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. Eighteen patients received dental treatment and 13 of these were supplied with dentures. The attendances at the dentist totalled 69. The amount expended on dental treatment during the year was £12 15s. 0d., and the cost of dentures supplied to patients was £18 5s. 0d., making a total cost of £31 0s. Od. Extra Nourishment.—Under Section 3 of the Public Health (Prevention and Treatment of Disease) Act, 1913, extra nourishment is granted on medical grounds as part of treatment. It is limited to the slighter cases of disease, where there is a reasonable probability that extra nourishment will increase the chances of recovery, or will enable the patient to remain at work or to return to work at any early date. During the year under consideration 96 patients have been granted extra nourishment under the scheme at a cost of £96 19s. 5d. The scheme has been found to be of great help in the treatment of the types of patient mentioned above. e 2 52 Report of the Medical Officer of Health for 1935. 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 1935 as far as it is known. Table XXVII. refers to cases of Pulmonary Tuberculosis and Table XXVIII. to cases of Non-pulmonary Tuberculsois. TABLE XXVII. Classification on Initial attendance at the Dispensaries. Condition at the end of 1935. 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. 422 20 104 336 882 2048 812 2860 Adults, F. 484 28 146 328 986 Children 118 16 18 28 180 Class T.B. Plus. Adults, M. 151 59 390 1667 2267 4007 1259 5266 Adults, F. 118 59 298 1224 1699 Children 7 1 8 25 41 Tuberculosis Dispensaries. 53 TABLE XXVIII. Classification on Initial attendance at the Dispensaries. Condition at end of 1935. 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. 48 4 35 19 106 299 127 426 Adults, F. 25 2 23 10 60 Children 69 13 31 20 133 Abdominal Adults, M. 10 2 3 4 19 96 62 158 Adults, F. 12 5 10 2 29 Children 28 3 11 6 48 Peripheral Glands Adults, M. 14 4 9 4 31 326 119 445 Adults, F. 35 1 23 8 67 Children 206 3 8 11 228 Other Organs. Adults, M. 22 1 9 12 44 176 58 234 Aduits, F. 26 5 10 8 49 Children 22 9 33 19 83 54 Report of the Medical Officer of Health for 1935. Tuberculosis Dispensaries. 55 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. 1931 2157 1557 410 1932 1664 1001 342 1933 1633 997 280 1934 1467 1022 270 1935 1367 883 253 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 of the Committee. The following is a list of the members of the Committee :— Councillor T. Harding. Councillor A. J. A. Kennedy, M.C., C.A. Councillor W. Greener, F.C.R.A. Councillor H. H. S. Aram, F.I.M.T. Councillor Mrs. A. A. Wilson, J.P. Councillor Mrs. L. G. Watson, Public Assistance Committee. Councillor F. T. Jordan, J.P., A.C.I.I., Public Assistance Committee. Miss E. Thomas, L.C.C. School Care Committee. Captain R. Grindel, United Services and British Legion. T. H. Hunt, Esq., London Insurance Committee. Miss I. Clark Hall, Putney and Wandsworth Invalid Children's Aid Association. Miss Jacobs, Streatham, Clapham, Balham and Tooting Invalid Children's Aid Association. Miss Connor, Soldiers', Sailors' and Airmen's Association. H. B. Harvey, Esq., Aged Poor Society. Miss Marx, Brompton Hospital. Miss E. Morris, St. Thomas's Hospital. 56 Report of the Medical Officer of Health for 1935. Miss Lemon, Ranyard Nurses. Mrs. Arding. Mrs. Cresswell. Mrs. Dearman. Mrs. Dixon. Miss J. Duff, J.P. Mrs. Duffell. Mrs. V. Godber. Mrs. Groom. Dr. E. Higgins. Mrs. H. Jeans. Mrs. Laer. Mrs. MacDonald. Mrs. Marriott. Mrs. Morton Clarke. Mrs. Nicol. A. A. Norman, Esq. Officers of the Committee :— Chairman : Miss J. Duff, J.P. Vice-Chairman : Mrs. Cresswell. Hon. Treasurer : Mrs. Dearman. Secretary : Miss M. L. Baptie. Meetings.—The Care Committee meets at the Council House, East Hill, Wandsworth, on the first Friday in every month at 3 p.m. The Finance Sub-committee and Handicraft Subcommittee meet prior to the General Committee. Summary of the Work Done.—Although assessments have been abolished, the London County Council require a return to be made to them giving the financial circumstances of patients who are to undergo institutional treatment. A knowledge of these particulars and of the home conditions under which the patients live are factors which have a bearing on the treatment recommended. 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. Tuberculosis Dispensaries. 57 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 these efforts, and a 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. Owing to the success of the Christmas Seal Sale, the Committee have made arrangements with the Trustees of Maitland Cottage, Barton-on-Sea, to maintain two beds for the use of patients resident within the Borough of Wandsworth. Twenty-two adults and two children were sent away for convalescent treatment during 1935 at a cost of £115 1s. 2d. Financial assistance is also given to relatives to enable them to visit patients who have been away under treatment for three months or longer, 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. Financial assistance to patients and relatives amounted to £117 7s. 1d. 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 also been expended in this direction. About 70 per cent. of the cases sent to Institutions were supplied with the articles required from the clothing store. Some of the patients who 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 58 Report of the Medical Officer of Health for 1935. gradually, and are supplied on loan to necessitous cases who require them ; the cost of medical and nursing requisites and special nourishment, clothing, etc., amounted to £26 1s. 9d. 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 at St. James's Hospital, Balham. The authorities of this Hospital have given permission for members of the Care Committee to visit Wandsworth residents suffering from Tuberculosis who happen to be under treatment in the Hospital. During the year 154 of these patients were visited regularly by the Secretary of the Committee. 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 inquiries into all matters of this nature, and is able to assist in smoothing out many of the patients' difficulties. During 1935 the number of visits and interviews made by the Secretary to cases attending the Dispensaries was 2,029. 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. 10 cases were referred to these organisations and granted assistance by them. 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. 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 patient's illness is the cause of the non-payment of rent, the debt is settled in order to enable the patient to receive proper treatment. Tuberculosis Dispensaries. 59 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 Wright, who is a trained instructress in the crafts taught. These are the making of articles in leather, pewter, parchment and embroidery, painting on glass, 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 successful Sale at the Town Hall in October, when the opening ceremony was performed by His Worship the Mayor of Wandsworth, Councillor Evan Rees, J.P., M.I.G.E. 60 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, Futney, 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 Fuerperal Fever, Puerperal Pyrexia, Whooping Cough and Ophthalmia Neonatorum are visted on notification, as well as all known cases of Measles and Diarrhoea in children under five. Other Home Visits.—The Health Visitors visit the homes of mothers attending the ante-natal Centres in the Borough, Maternity and Child Welfare. 61 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 carry out the visits required under the Children and Young Persons Acts, and each of them has been appointed Infant Life Protection Visitor to enable them to perform these duties. Periodical visits are also made to Creches and to other Institutions for mothers and children. Those Health Visitors, whose districts are in the Parishes of Clapham and Wandsworth, for which I am Vaccination Officer, carry out the home visits which are necessary in order to secure compliance with the Vaccination Acts. Table XXIX. summarises the work of the Health Visitors during the year in the six divisions of the Borough. 62 Report of the Medical Officer of Health for 1935. TABLE XXIX. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. No. of children visited :— Under 1 year 551 376 455 555 518 958 3413 1-2 years 9 11 18 29 3 22 92 2-5 years 21 16 22 38 5 22 124 Revisits to :— Infants under 1 year 568 700 270 943 516 1200 4197 Children 1-2 years 562 423 207 652 382 975 3201 Children 2-5 years 725 418 385 1125 639 1505 4797 Total visits to children under Notification of Births Act 2436 1944 1357 3342 2063 4682 15824 Other visits— : Foster Mothers 160 119 107 194 237 308 1125 Ophthalmia Neonatorum 5 18 3 2 1 8 37 Measles 24 10 2 64 14 15 129 Whooping Cough 56 8 6 36 32 195 333 Ante-natal cases 446 282 277 566 321 606 2498 Puerperal Fever and Pyrexia 2 6 — 6 7 14 35 Miscellaneous 156 139 116 231 228 488 1358 Ineffectual 848 177 353 1123 661 1652 4814 Total Home Visits 4133 2703 2221 5564 3564 7968 26153 Attendances at:— Infant Welfare Centres 156 203 158 320 295 466 1598 Ante-natal Centres 24 23 29 42 21 35 174 Committee Meetings 3 20 — 1 8 4 36 Health Talks 12 43 31 38 39 88 251 Visits to Creches — 17 15 — - 11 43 Diphtheria Prevention Clinics — 53 — — 47 100 Maternity and Child Welfare. 63 Infant Visiting. There were 3,789 births during the year and 3,413 of these, or 90 0 per cent., were visited compared with 88.4 in 1934, 89.1 in 1933, 89.0 in 1932, 90.9 in 1931 and 84.1 in 1930. 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 3,029 of the 3,413 infants visited were being fed from the breast entirely. 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 2017 691 130 41 3029 Otherwise fed 111 141 62 80 394 Method of Feeding. Age of infant on subsequent visit. Under 1 month. 1—3 months. 3—6 months. 6—12 months. Total. Breast-fed 86 600 679 403 1768 Otherwise fed 80 342 540 1467 2429 It was found that in 429 of the births, doctors had been in attendance, while in 969 the services of midwives had been utilised. 2,015 infants were born in hospitals and other institutions. 64 Report of the Medical Officer of Health for 1935. Maternity and Child Welfare Centres. There are now 12 Infant Welfare Centres in the Borough. They are voluntary institutions administered by the Committees of the Centres who work in close co-operation with the Maternity and Child Welfare Committee of the Council. The Council pay 75 per cent. of the approved expenditure of each Centre. Each Centre has a medical officer who is appointed by the Committee of the Centre, and a trained Superintendent. In 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 in this capacity. 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 65 Maternity and, Child Welfare. Infant Welfare Centre. Clinics. Ante-natal. Infants. Clapham : Clapham Dispensary Manor Street. 1st and 3rd Mondays in each month at 2 p.m. Tuesdays and Wednesdays, at 2 p.m. Putney: 2, Clarendon Road. Alternate Wednesdays in each month at 10 a.m., at 2, Clarendon Road. Wednesdays and Thursdays at 2 p.m. Putney Park : Putney Park House, Dover House Rd. Fridays at 2 p.m. Balham : 91, Bedford Hill. 1st, 3rd and 5th Fridays in each month at 9.45 a.m. Tuesdays (weighing only) Wednesdays and Thursdays at 1.30p.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 and Thursdays 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 Thurs days at 2 p.m. Springfield : Congregational Church Hall, Earlsfield Road. 4th Tuesday in each month at 11 a.m. Tuesdays at 2 p.m. F 66 Report of the Medical Officer of Health for 1935. Table XXXI. gives the full details of the work carried out at the 12 centres in the Borough. 2,912 new infants were examined during the year and the total attendances were 60,784. There were 495 ante-natal cases and the total attendances made by them were 1,291. The visits made by the Superintendents of the three Centres where those officers are appointed by the Centre Committees were 3,570 to the homes of infants and 301 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. WORK CARRIED OUT AT THE INFANT WELFARE AND ANTE-NATAL CLINICS. Clapham. Putney. Putney Park. Balham. Streatham. Blegborough Road. Streatham Hill (ClaphamPark) Fairlight Beechcroft Road. Southfield. Fairfield. Springfield. Totals. Infant Clinics :— No. of Sessions held 98 98 48 150 96 48 47 94 46 97 102 48 972 No. of New Cases 458 282 55 484 282 123 170 264 128 258 186 222 2912 No. of Doctors' Consultations 3107 2686 548 3256 2178 895 1184 1947 960 2148 2035 1248 22189 Total Attendances 7955 5892 1286 10363 6375 2441 3802 5459 3011 5638 4101 4461 60784 Ante-natal Clinics :— No. of Sessions held 24 23 - 28 23 - - 12 11 12 12 11 156 No. of New cases 71 137 83 79 — - 27 32 27 14 25 495 Total attendances 191 405 — 272 154 — — 57 72 51 35 54 1291 No. of Health Talks given No. of visits by Superintendents of Voluntary Committees :— 14 30 37 31 42 - 17 20 19 31 28 27 296 To Infants,under 1 year 659 416 737 - - - - - - - - 1812 To children, 1-5 years 302 - 634 822 - - - - - - - - 1758 Ante-natal cases 92 - 99 110 — — — - - - - - 301 Maternity and Child Welfare. 67 F 2 68 Report of the Medical Officer of Health for 1935. 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 matron, two sisters, six nurses who are trained midwives and four probationers. There is also a rota of six local medical practitioners, one of whom is called in when the services of a doctor are required. Three Obstetric Consultants and one Ophthalmic Consultant have also been appointed to visit the Home. 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 428 women were admitted to the Home and the average duration of stay was 14.56 days. 400 deliveries were carried out by the midwives, 27 by the medical staff, and one case was transferred before confinement. In 128 cases it was necessary for the midwives to summons medical assistance in accordance with the requirements of the Midwives Act. Five cases of Puerperal Pyrexia were notified from the Home. Eight of the infants were still-born and five died within 10 days of birth. Two infants were notified as suffering from Ophthalmia Neonatorum. Every effort is made while the mothers are in the Maternity Home, to encourage them to breast feed their infants, but in 28 cases the natural feeding had to be supplemented. Maternity and, Child Welfare. 69 Obstetric Consultant Service. This service has been extended during the year. Since the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations came into force in 1926, the Council has made provision for an Obstetric Consultant to be available to meet medical practitioners in consultation when they require a second opinion on a woman who has developed a complication during the lying-in period. It has now been decided to make the services of the consultant available to meet practitioners as required at any stage during pregnancy, at confinement or in the lying-in period. The fee paid for each consultation is three guineas. During the year the consultant has been called on 11 occasions. Hospital Treatment for Ante-Natal Women. The Council has made arrangements with the Board of Management of the South London Hospital for Women, Clapham Common, for ante-natal cases who require hospital treatment for the prevention and treatment of any complication of pregnancy, to be admitted to the hospital, at a charge of £1 10s. Od. per week. These arrangements have been completed during the year under review. No cases have yet been admitted. Midwives and Nursing Arrangements. Arrangements have been made with various nursing Associations in the Borough for their nurses to attend cases of Measles, Whooping Cough, Influenza, Pneumonia, Ophthalmia Neonatorum, Infantile Diarrhoea, Puerperal Fever and Puerperal Pyrexia, at my request. A fee of 1s. 3d. is paid for each visit to these cases except in Balham where a special grant of £80 per annum is paid by the Council to the Ranyard Nurses for the services of the nurse in this area. 184 cases were visited during the year under these arrangements, and 2,943 visits were made. Full particulars are given in Table XXXII. 70 Report of the Medical Officer of Health for 1935. TABLE XXXII. No. of cases occurring. No. of cases visited. No. of visits made. Whooping Cough 904 7 70 Influenza — 44 433 Pneumonia 319 87 1605 Ophthalmia Neonatorum 26 42 802 Measles 137 4 33 Puerperal Fever and Puerperal Pyrexia 36 — — Infantile Diarrhoea — — — Total 1422 184 2943 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. 45 midwives practise in the Borough, of whom 15 reside in neighbouring Boroughs. There are 21 private maternity homes in the Borough, 16 of them being carried on by practising midwives. Midwifery Service. In April, 1935, the Council decided to grant financial assistance to women who have engaged trained midwives to attend them at their confinements in their own homes, when the financial circumstances are such that they are unable to pay the whole of the midwife's fee. Assistance is also granted in paying the fee of a trained maternity nurse when a doctor has been engaged to conduct the confinement. The Council is also prepared to assist in meeting the cost of providing a Home Help for a confinement. Every woman applying for assistance is required to submit a statement giving the details of her family income, and the amount Maternity and Child Welfare. 71 of assistance to be granted is fixed by a Sub-committee of the Maternity and Child Welfare Committee. The maximum grants payable are— £1 15s. 0d. to a midwife conducting a confinement at home. £1 0s. 0d. to a midwife assisting a doctor in a home confinement. Before assistance is granted, the following conditions must be complied with :— 1. The home conditions must be suitable for a confinement to take place there. 2. The midwife must be registered by the Central Midwives Board. 3. When conducting the confinement herself, the midwife must give her patient adequate ante-natal supervision and must arrange for the woman to be examined by the Medical Officer of one of the Council's ante-natal clinics early in pregnancy and also at a later stage. 4. No unsuitable handywoman must be employed. 5. If a handywoman is in attendance, the midwife must not allow her to examine the patient, to undertake any nursing duties or to bathe the infant. Sterilized maternity outfits will be supplied to a midwife by the Council when they are required. The Council has also decided to pay compensation to a midwife who loses her case because the woman who had booked her, has to enter hospital for the confinement. The usual sum paid in compensation is 10/-. The following conditions are required to be satisfied before compensation is payable 1. The patient is required to confirm the statements that she had engaged the midwife to attend the confinement and had been referred by the midwife to the ante-natal clinic. 2. The Medical Officer of the clinic must certify that it is necessary for the woman to be confined in an institution. 72 Report of the Medical Officer of Health for 1935. No payment is made to a midwife where the patient herself applied for admission to an Institution. During the year assistance was granted to 17 midwives under this scheme and compensation was paid in five cases. The total cost of the service was £28. 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 Crèche, 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 9d. 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 crèche 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, 5,612; Balham, 6,701; and Wandsworth, 7,044; a total of 19,357, compared with 18,344 in 1934. 43 inspections of the crèches were made during the year by the Health Visitors. 73 Maternity and Child Welfare. Institutions for Expectant and Nursing Mothers and Young Children. The Council pays an annual grant to the Streatham Babies' Hospital, 9, Leigham Court Road, which is a small hospital containing 20 cots for the treatment of infants up to the age of five years. The staff consists of a Matron, one Sister, two Assistant Nurses and three Probationers. A Visiting Medical Officer attends daily. The standard fee is 10s. 6d. per week, but necessitous cases are admitted free, or at a reduced fee, according to circumstances. Medical practitioners can recommend children for admission and are allowed to attend them while in the Hospital. 138 infants were admitted in 1935, 89 from addresses in the Borough and 49 from outside the Borough. Most of the cases were infants suffering from Nutritional Diseases, Debility, Respiratory Diseases, Nervous 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 1935 assistance was granted in respect of 13 cases at a cost of £121 12s. 8d. Similar grants are made to the Mission of Hope, but no cases were assisted during 1935. 74 Report of the Medical Officer of Health for 1935. Convalescent Treatment. During the year, one mother and 18 children were sent to Convalescent Homes. The cost of this service was £54 19s. 0d. Wandsworth and Tooting Children's Clinic. This Clinic provides artificial sunlight, massage and electrical treatment for children of all ages. 331 children have been treated during the year and they have made 12,055 attendances. 81 of these children were under the age of five years. The treatment given is artificial sunray, radiant heat, massage, electrical and remedial exercises. The Council pays a grant towards the expenses of this Clinic. Supply of Milk. During the year 1,030 families were supplied with milk under the Milk (Mothers and Children) Order, 1918; 216 in Clapham; 78 in Putney; 208 in Balham; 138 in Streatham; 159 in Tooting; 79 in Southfield; 68 in Fairfield; and 84 in Springfield. The total cost to the Council was £1,478 6s. 2d. 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 Conncil. During the year £173 14s. 9fd. 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 75 Maternity and Child Welfare. mothers to prolong the period of lactation, and the records kept at the Welfare Centres show good results in the health and general well-being of many of the infants. Dental Treatment. Dental treatment is provided for expectant and nursing mothers and children under five years of age who attend at the Welfare Centres and are found to require treatment after examination by one of the Medical Officers. Arrangements have been made with the British Dental Hospital and 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 22 cases received dental treatment. All of these were expectant or nursing mothers. 76 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 1935 there were 182 foster-mothers on the Register and the number of foster children for whom they were registered was 330. 77 SANITARY INSPECTION OF THE BOROUGH. Work of the Sanitary Inspectors. A Summary of the inspections carried out by the Sanitary Inspectors is given in Table XXXIII. TABLE XXXIII. Inspections. ReIn spections. Total. To investigate complaints 5788 13634 19422 House-to-House inspections 1800 5591 7391 Shop Inspections 2029 301 2330 Infective Diseases:— Notifiable diseases 1298 531 1829 Other infective diseases 301 21 322 Verminous conditions 309 111 420 No. of Premises Offensive Trades 2 13 30 43 Piggeries 9 14 73 87 Factories, workshops, etc. 2023 1048 83 1131 Houses let in lodgings 340 384 1149 1533 Rag and bone stores 3 83 — 83 Sanitary conveniences 173 585 4 589 Mews and stables 162 604 45 649 Other inspections 8751 1800 10551 Total 23007 23373 46380 Smoke observations 110 — 110 Legal proceedings, Attendances at Court 22 — 22 78 Report of the Medical Officer of Health for 1935. Table XXXIV., gives details of the sanitary operations carried out in the Borough during the year. The number of drains which were tested was 698 and 860 were cleansed or repaired. The drains of 82 houses were re-constructed. Damp conditions have been remedied in 1,213 premises, and in 56 of these damp courses were inserted. 20 privies and earth closets are know 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 37 cases of overcrowding were abated. 26 of these cases were accommodated in London County Council houses, one in a Borough Council house, and 10 elsewhere. 79 Sanitary Inspection of the Borough. TABLE XXXIV. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 1. Premises cleansed and repaired 617 321 464 269 581 1094 3346 2. Drains tested 115 98 60 167 78 180 698 3. Drains cleansed or repaired 134 97 147 71 135 276 860 4. Water closets cleansed or repaired 349 171 283 148 238 482 1671 5. Soil pipes repaired 57 39 23 6 10 73 208 6. Waste pipes altered or repaired 163 117 123 82 106 307 898 7. Rainwater pipes repaired 67 23 90 18 28 66 292 8. Roofs and gutters repaired 218 87 231 97 218 468 1319 9. Damp courses inserted 14 5 11 3 1 22 56 10. Damp conditions otherwise remedied 196 137 199 93 126 406 1157 11. Yards drained or paved 98 25 86 44 90 181 524 12. Dust bins provided or repaired 89 61 113 39 92 204 598 13. Water cisterns cleansed, covered or repaired 26 47 16 6 60 77 232 .14. Water supply reinstated 15 7 10 2 5 11 50 15. Defective fireplaces remedied 87 40 200 44 83 300 754 16. Defective coppers remedied 42 10 71 13 48 80 264 17. Cases of overcrowding abated 10 4 5 2 6 10 37 18. Stables and stable yards drained or paved — — 5 2 — — 7 19. Accumulations of manure, etc., removed 8 5 15 21 16 16 81 20. Urinals cleansed or repaired — 5 5 — 2 4 16 21. Animals improperly kept 4 1 2 1 2 2 12 22. Smoke nuisances 6 2 6 7 — 28 49 23. Other nuisances 155 100 214 138 411 173 1191 Total 2480 1402 2369 1273 2336 4460 14320 No. of preliminary notices served 687 397 498 520 845 1537 4484 No. of preliminary notices complied with without the service of statutory notices 538 368 519 508 801 1477 4211 No. of statutory notices served 172 96 133 101 59 261 822 No. of statutory notices complied with 83 43 81 63 30 230 535 80 Report of the Medical Officer of Health for 1935. Water Supply—Cutting-off Notices. During the year, 34 notices with respect to 41 premises were received from the Metropolitan Water Board, stating that the supply had been withdrawn. In 37 premises the water supply was cut off for non-payment of rates, in three because of defects in the service, and in one 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 173 ; 45 in Clapham, 22 in Putney, 18 in Balham, 19 in Streatham, 12 in Tooting and 57 in Wandsworth. 589 inspections were made during the year, and nine 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 larvae of mosquitoes. Owners of stables were advised to use chloride of lime for sprinkling horse manure in order to destroy the larvae and pupae of flies. Rats and Mice Destruction. In addition to the routine laying of rat baits in the sewers by the Borough Engineer's staff, 8,475 baits were laid during National Rat Week. 5,170 of these were taken by rats. 81 Sanitary Inspection of the Borough. 298 complaints of nuisances from rats were investigated by the Sanitary Inspectors, and four 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. Shops Act, 1934. 5,415 inspections have been made of 3,668 shops to ascertain if the provisions of the above Act respecting ventilation, temperature and sanitary conveniences for the use of the persons employed in the shop were complied with. 117 notices were served in respect of infringements of the Act and of these 109 have been complied with. Swimming Baths and Bathing Pools. There are four public swimming baths belonging to the Council, one open air swimming bath owned by the London County Council, two public swimming pools privately owned and four private bathing pools in the Borough. The Queensmere pond on Wimbledon Common has also for many years past been a recognised bathing pond. In three of the Council's swimming baths, the water is purified by a process of continuous circulation through a filtration plant whereby the whole of the water is dealt with every four hours and chlorinated automatically during its circulation from the filtration plant to the bath. In the other bath belonging to the Council, the bath is emptied of water twice weekly and refilled with fresh water which is chlorinated automatically before the bath is used. Most of the other swimming pools have a chlorination plant installed for the purification of the water, but in two of the private pools, cleansing is effected by changing the water. The River Wandle. On several occasions during the year the condition of the River Wandle has been unsatisfactory and nuisance has been caused by pollution of the stream and fouling of its banks. This was specially noticeable during the summer months when the flow of the stream became sluggish during the dry weather. G 82 Report of the Medical Officer of Health for 1935. In order to determine the condition of the river over a considerable period and under different weather conditions, it was decided to take a series of samples of the river water and of certain effluents which are discharged into it, and to submit them to the Public Analyst for examination and report. The result of these examinations and the conclusions to be drawn from them were included in a joint report on the condition of the river which was made to the River Wandle Committee of the Council by the Borough Engineer and myself. In this report it was pointed out that the River Wandle, which is some ten miles in length, has already flowed for eight miles before it enters the Borough of Wandsworth. During its course it receives quantities of surface water and land drainage, the effluents from three sewage farms and the trade discharges from a number of factories. Extensive pollution of the river is caused by these effluents and it is already heavily polluted when it enters the Borough. The water in the river is often in a foul condition and at various points extensive deposits of objectionable matter occur. The Public Analyst, reporting on the condition of the river as it enters the Borough, states that at this point it can no longer be judged on ordinary river water standards but that the stream possesses the character of a sewage effluent and must be considered as such. The banks of the river are often irregular in outline, and consist of earth or mud which is frequently overgrown with vegetation. In this condition they make ideal breeding places for winged insects and they also harbour rats. Heavy material floating down the stream is caught up and it is practially impossible to keep the banks in a cleanly state. In dry weather, such as that experienced during the Summer of 1935, the condition of the river becomes worse, the polluted material being more concentrated as there is less water to dilute it. Certain recommendations for improving the condition of the River were made in the Report and these were summarised in the following terms:— 1. The main sources of pollution should be dealt with at their source by taking appropriate action to enforce the 83 Sanitary Inspection of the Borough. . proper treatment of trade effluents before they are discharged into the river. 2. Those areas of the river bed which are not required, and branches and loops of the stream which serve no useful purpose, should be filled in. 3. The flow of the stream should be restricted to a properly defined channel with satisfactory invert and properly constructed banks. The River Wandle Committee, after receiving this report on the condition of the River, decided to confer with the London County Council, in whom the control of the River is vested, and a conference was arranged towards the end of the year between representatives of the Borough Council and the County Council, when the whole matter was discussed in full. Statement of Work done under the Rag Flock Act, 1911. There is one factory in the Borough where rag flock is manufactured. This factory is inspected under the provisions of the Factory and Workshop Act. No samples of Rag Flock were taken during the year, as the method of rag flock manufacture is considered satisfactory. 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. During the year only three bodies have been removed to the Mortuaries in the Borough, two to the Streatham and one to the Wandsworth Mortuary. No bodies were taken to the Mortuary in Clapham. G 2 84 HOUSING. Statistics Relating to Housing. 1. Inspection of Dwelling-houses during the Yeah:— (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 7,772 and the number of inspections made 28,346 (2) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,800 and the number of inspections made 7,391 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 40 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 4,484 2. Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 4,211 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 85 Sanitary Inspection of the Borough. B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 822 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 535 (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 5 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 D.—Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 15 (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. 1,800 inspections were made compared with 1,060 in 1934, 1,060 in 1933, 1,589 in 1932, 2,731 in 1931 and 2,957 in 1930. Nuisances necessitating the service of sanitary notices were found in 1,479 of the houses. 86 Report of the Medical Officer of Health for 1935. 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 125 118 8 39 28 104 Clapham South 77 48 1 1 — 76 Putney 289 173 9 19 253 151 Balham 59 57 4 15 33 42 Streatham 65 38 6 1 17 55 Tooting 413 404 11 59 210 268 Southfield 130 109 9 18 79 81 Fairfield 172 142 22 48 128 76 Springfield 470 390 21 49 156 290 Whole Borough 1800 1479 91 249 904 1143 Underground Rooms. There are eight underground rooms in the Borough illegally occupied. A Closing Order has been made in respect of one of them and, in the other seven cases, action is being taken to make the rooms comply with the Regulations. Rent and Mortgage Interest Restrictions Act, 1923. During the year 68 applications were received from occupiers that their houses were not in a reasonable state of repair. In three of these cases, the application was found not to be justified and no certificate was granted. In one case the application was withdrawn, in seven cases the necessary work was carried out before the granting of Certificates could be authorized and in two cases the work was completed after the service of a public health notice. In the remaining 55 cases, the applications were acceded to, and Statutory Certificates were granted. In 21 of the houses concerned, the necessary work to put them in a reasonable state of repair was carried out during the year. 87 HOUSING ACT, 1930. The Clearance of Unhealthy Areas. Considerable progress has been made during the year in the Council's programme for the clearance of unhealthy areas and houses. All the houses in the Dutch Yard Area have now been demolished. The sites of the Wandsworth Plain, Felsham Road, Union Street and Tooting Grove Clearance Areas were in process of being developed by the Council at the end of the year and re-housing accommodation will be erected after the sites have been cleared. The developnent of the sites of the Greyhound Square, Barrow Road and White Square Areas, for which compulsory Purchase Orders have been approved, will be put in hand as soon as the negotiations for acquiring all the properties are completed. Dutch Yard Area, Wandsworth.—This area, which contained 18 houses, was declared by the Council in 1931, and a Clearance Order was made. The Minister of Health confirmed the Order after holding a Public Enquiry. Delay occurred in clearing the Area owing to unforeseen difficulties in providing alternative accommodation for the occupiers. These difficulties have now been overcome and all the houses have been demolished during the year under review. The site has been left with the owners to develop. Wandsworth Plain Area, Wandsworth.—This Area was a large one and included 91 insanitary houses, together with seven " grey" houses and several other buildings. A Compulsory Purchase Order was made and confirmed by the Minister of Health in 1934 after Public Enquiry. The Area is now in process of development by the Council. This is being carried out in sections so that as many as possible of the occupiers will be re-housed on the site and the houses in one section are being demolished and the new accommodation completed, before the occupiers of adjoining sections are displaced. During 1935 twenty-nine of the houses have been demolished and flats are being erected on one section of the Area. 88 Report of the Medical Officer of Health for 1935. Felsham Road Area, Putney—This Area contained 59 insanitary houses, two "grey" houses, and a building, formerly a dwelling-house, which was closed in 1920 after a Closing Order had been made. A compulsory Purchase Order was made and confirmed by the Minister following a Public Enquiry held in 1934. The Council has decided to develop the Area in sections, so as to provide accommodation on the site for as many of the occupiers as possible. Flats are now being erected on the first section of the Area and it was only necessary for seven of the original houses to be demolished to enable this to be done. Greyhound Square Area, Streatham.—This Area, comprising 29 houses, was declared in 1934 and the Council made a Compulsory Purchase Order, which also included one "grey" house. The Minister of Health confirmed the Order after holding a Public Enquiry. Four of the insanitary houses and the "grey" house have been demolished, and the re-development of the site will be commenced shortly. Barrow Road Area, Streatham.—This was a small Area, comprising 11 houses, which adjoined Greyhound Square Area and was declared at the same time. A portion of the site was left with the owner to develop and the three houses on this portion have been demolished. The rest of the site will be developed by the Council in conjunction with the Greyhound Square site. Union Street Area, Clapham.—This was a small area containing 12 back-to-back houses and was declared in 1934. A compulsory Purchase Order was made and this included 13 "grey" houses which were added in order to make a site of suitable dimensions for re-development. The Minister confirmed the Order in 1934, after holding a Public Enquiry, and the 12 insanitary houses were demolished before the end of that year. The Council is now developing the site by erecting flats on it. Tooting Grove Areas, Tooting.—During the year under review I submitted Representations in respect of these two Areas, and the Council decided to declare them as Clearance Areas. Tooting Grove No. 1 Area contained 21 insanitary houses. The Council decided to develop this site and made a Compulsory Purchase Order which included two other houses coloured "grey" and one other building. This Order was confirmed by the Minister 89 Housing. of Health. Ten of the insanitary houses were demolished before the end of the year, and the redevelopment of the site, by the erection of flats, has commenced. Tooting Grove No. 2 Area contains four houses. As it was decided to leave this site with the owners a Clearance Order was made and this has been confirmed by the Minister. White Square, Clapham.—In November, 1934, I submitted official Representations in respect of five insanitary areas, comprising a total of 100 houses situated on this site, and they were declared Clearance Areas in January, 1935. The site covered by these five areas was irregular in shape and as the Council wished to develop it for re-housing purposes it was decided to incorporate other properties in order to make one area of convenient size and shape for development. Sixty-six " grey " houses and several other buildings and parcels of lands were added to the five areas represented, converting it into one large site, 4-2 acres in extent with continuous boundaries. Compulsory Purchase Orders were made and these have been approved by the Minister of Health who held a Public Enquiry in April. Negotiations for the acquisition of the properties concerned are now being carried on. Demolition Orders. Demolition Orders have been made on the following insanitary houses:— 135, Fountain Road. 146 and 146a, Lyham Road. 51a, Upper Richmond Road. 558, Garratt Lane. 135, Fountain Road, which was unoccupied at the time the Order was made, has been demolished. Closing Orders. The Closing Order in respect of a basement room at 117, Larkhall-lane, made in December, 1934, has been enforced. Closing Orders under section 20 of the Housing Act, 1930, have been made daring the year on the following premises:— A flat over a garage at 73 Hendham Road. 90 Report of the Medical Officer of Health for 1935. Six mews flats, 1, 2, 3, 4, 5, 6, Aldis Mews. A basement room at each of the following houses—66, 68, 70, 74, 76, 78, 80, 82, The Chase. The Orders in respect of 73, Hendham Road, 1, 2, 3 and 4, Aldis Mews and 68 and 70, The Chase have been enforced. The other premises are still o cupied. Representations for Closing Orders have been made in respect of a basement flat at 51, High Street, Clapham, two basement rooms at 40, Haselrigge Road, and two basement flats at 14, King's Avenue. I made a representation under section 19 of the Housing Act, 1930, in respect of an occupied flat, built over stable premises, in Putney Park Lane, and three houses in King's Arms Yard, Wandsworth, and the Council accepted undertakings from the owners, as provided for in sub-section 2 of section 19 of the Act, that these dwelling houses would not be used for human habitation. Alternative accommodation was found for the family in occupation of the flat and this has been closed. The houses in King's Arms Yard were still occupied at the end of the year. HOUSING ACT, 1935. The Overcrowding Survey. The Survey required to be made under section 1 of the Housing Act, 1935, to ascertain the extent of overcrowding in the Borough was carried out in November and December and a staff of temporary officers was engaged for the purpose. The object aimed at was to obtain particulars of every case of overcrowding which existed and in order to do this it was necessary for a visit to be made to most of the houses in the Borough. The survey was carried out in two stages. In the preliminary stage information was obtained from householders as to the number of rooms in the letting and the number of persons occupying them. In most cases this information was sufficient to determine whether or not overcrowding existed, but after this preliminary stage was completed there remained a number of instances where 91 Housing. this information could not be ascertained without knowing the size of the rooms occupied. It was necessary for the rooms of these houses to be measured and this constituted the second stage of the Survey. There are about 72,400 houses in tne Borough. 61,586 were enumerated in the Survey. Many of these were let to more than one family and the total number of separate lettings or dwelling houses included in the Survey was 81,365. When the preliminary stage of the Survey was completed there remained 5,144 dwellings where the rooms had to be measured in order to determine if they were overcrowded. The table which follows was designed by the London County Council to show the distribution of the families enumerated in relation to the size of the family and accommodation occupied, in terms of the maximum "equivalent number" of persons permitted to occupy it without overcrowding. The vertical columns show the number of dwellings classified according to the size of the rooms occupied, in terms of the maximum "equivalent number " of persons permitted to occupy them. The horizontal divisions show the sizes of the families as "equivalent numbers" of persons occupying the dwellings. Children under 10 years of age are counted as half a person. The table shows clearly the housing condition of the 81,365 families enumerated at the time of the Survey. The thick black diagonal line divides the overcrowded families from those not overcrowded. Families on the left of the thick line are overcrowded, the worst cases being farthest from the line, and those on the right of the line are not overcrowded. The total number of families which were found to be living under overcrowded conditions was 1,801. In 708 of them the overcrowding was only slightly below the standard laid down, as it was caused by an excess of one person only over the number permitted for the accommodation occupied:— in 327 families the extra person was a child under ten years of age, while 381 families consisted of one adult too many. 732 families out of the total of 1,801 were found to be seriously overcrowded as there was an excess in the number of persons in 92 Report of the Medical Officer of Health for 1935. each family equivalent to two adults or more over the permitted number. The result of the Survey indicates that while there is a certain amount of overcrowding in the Borough, the number of families affected is not by any means excessive, and there should be no great difficulty in providing the comparatively small amount of re-housing accommodation required. In estimating the amount of additional accommodation required, allowance has to be made for utilising the accommodation which will be vacated by overcrowded families when they are re-housed. When this is done it is found that the number of new dwellings required will be considerably less than the actual number disclosed as overcrowded. The London County Council, who have co-ordinated the results of the survey for the whole of London, arrived at a formula for determining the amount of new accommodation which will be required to re-house overcrowded families, after the necessary adjustments have been made. Ascertained by this method, the number of new dwellings required in Wandsworth is found to be 520. The temporary staff engaged to carry out the overcrowding Survey was as follows:—40 enumerators, 4 supervisors, 15 survey assistants and 10 clerks. The period for which they were engaged varied from five to eight weeks. HOUSING ACT, 1935.—OVERCROWDING SURVEY. Distribution of working-class families in relation to size of family and size of dwelling occupied. Metropolitan Borough of WANDSWORTH. * 0 = a dwelling of 1 room under 50 square feet: j = a dwelling of 1 room between -50 and 70 square feet (see preamble, p. 1). t Including 6 families with insufficient accommodation to secure proper sex separation and for that reason overcrowded. 94 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, who 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 are 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 3,103. Amongst these are 863 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 359 of these shops are registered as dairymen. In 95 Food and Food Premises. 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 arc 547 registered dairymen and 212 registered dairies in the Borough, one of them being also a cowshed. The Food Inspectors made 626 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 937 samples of whole milk reported as genuine was 3-59, which is the same as in 1933 and 1934. 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 151 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 917 visits during the year to these 96 Report of the Medical Officer of Health for 1935. 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 158 158 158 1 — — 23 4 — — Ice-Cream Vendors 34 1 — — — — 34 1 — — Grocery and Provisions 863 359 46 — — 36 84 219 — — Confectioners 631 11 2 — — — 404 5 — — Butchers 228 3 2 — — — — 216 — — Slaughter-houses 5 — — — 5 — — — — — Fishmongers 105 — — — — — — 44 7 22 Fish Fryers 82 — — — — — 1 70 82 7 Restaurants 359 14 3 — — — 72 12 1 — Greengrocers 427 — — — — — 1 — — — Market Stalls 182 — — — — 1 15 6 — 1 Food Factories 19 1 1 — — — 2 2 — — Others 10 — — — — — — — — — Totals 3103 547 212 1 5 37 636 579 90 30 97 Food and Food Premises. XXXVI. on the Premises Shown in Column 1. Other Food Businesses. Fishmongers. Grocers. Confectioners. Butchers. Greengrocers. Food Factories. Restaurant Kitchens. No. of Inspections in 1935. No. of Notices served. 12. 13. 14. 15. 16. 17. 18. 19. 20. 18 115 — — 2 5 1 626 6 — — 2 — — 1 1 298 4 2 863 136 31 36 1 19 1029 76 — 7 631 — 1 — 37 642 33 1 1 — 228 1 — 3 1197 30 — — — — — — — 917 — 105 1 — 1 — — 2 229 19 20 — — — — — 42 248 9 4 4 26 — 1 — 359 329 31 8 3 — — 427 — — 782 30 12 27 12 7 104 — 15 4021 — — 10 6 — — 19 — 53 1 — — — — — — — 314 1 170 1031 813 267 572 26 479 10685 240 H 98 Report of the Medical Officer of Health for 1935. premises and were present on almost every occasion when slaughtering took place. The number of carcases examined was 8,898 comprising 166 oxen, 1,551 pigs, 3,868 sheep and 3,313 calves. 2,556 of the animals were also inspected before being slaughtered. In addition to the above, 4,018 Irish Turkeys were examined at the slaughterhouses. 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 : 209 stone of beef, 24 heads, 24 tongues, 55 pairs of lungs, 8 livers, 15 mesenteries. For Flake: 1 pair of lungs. For Cirrhosis and Fluke: 39 livers. For Abscess: 1 pair of lungs, 2 livers. For Pericarditis: 1 heart. For Epithelioma: 1 kidney and loin suet. For Mastitis: 1 udder. Pigs:— For Tuberculosis: 3 carcases and entire offal, 14 heads and collars, 12 mesenteries. For Cirrhosis and Milk Spots: 61 livers. For Congestion: 28 pairs of lungs. For Abscess: 2 livers, 3 heads and tongues. For Nephritis: 1 kidney. For Echinococcus Veterinorum: 2 kidneys. Sheep:— For Fluke: 3 livers. For Strongylus Rufescens: 31 pairs of lungs. For Abscess: 16 livers. For C. Tennicollis: 7 livers. Calves:— For Nephritis: 1 pair of kidneys. Turkeys:— Dead on arrival, 19, 99 Food and Food Premises. There are 228 butchers' shops in the Borough, the majority of which are subject to registration under the London County Council (General Powers) Act, 1932. 1,197 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. Special attention is given to the requirements of these Regulations and in several instances it was found necessary to warn traders with regard to the exposure of meat in contravention of the 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, 19 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.:—1 sow carcase, 2 pig carcases, 1 ox liver, 1 tin corned beef, 17 boxes roe, 6 boxes skate, 1 bag winkles, 8 boxes cod and cod fillets, 50 tins silds, 2 tins sardines, 15 tins salmon, 1 box herrings, 1 box hake, 3 boxes whiting, 5 stone dog fish, 2½ stone rock salmon, 5 stone haddock, 1 box kippers, 142 fowls, 26 ducks, 19 turkeys, 13 lbs. plums, 35 boxes pears, 392 tins cherries in syrup, 23 bottles plums, 90 tins oranges, 3 tins fruit salad, 2 bottles gooseberries, 26 tins tomatoes, 6 tins grape fruit, 22 tins peaches, 6 tins pears, 7 tins apricots, 1 tin raspberries, 12 tins pineapples, 9 tins peas, 2 tins baked beans, H2 100 Report of the Medical Officer of Health for 1935. 1 bottle grape fruit squash, 1 bottle honey, 3 bottles pickles, 244 tins tomato puree, 21 lbs. confectionery, 5 Dundee cakes and 1 cwt. potatoes. 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. Meat. 2. Honey. 17. Malt Flour and Malt Extract. 3. Fresh Apples. 4. Tea. 18. Potatoes. 5. Currants. 19. Broccoli. 6. Sultanas. 20. Eggs. 7. Raisins. 21. Glasshouse grown Tomatoes and Cucumbers. 8. Eggs in Shell. 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. 27. Canned Cherries. 15. Wheat Flour. 28. Bacon and Ham. 29. Dead poultry. 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. 25 or 2.5 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 46 or 2.3 per cent, of the samples submitted. 101 Food and Food Premises. TABLE XXXVIL RESULT OF ANALYSES OF CERTAIN ARTICLES OF FOOD PROCURED UNDER THE FOOD AND DRUGS (ADULTERATION) ACT, 1928, SHOWING THE PERCENTAGE ADULTERATED IN 1935 AS COMPARED WITH 1931, 1932, 1933 AND 1934. No. of samples in 1935. Percentage of Samples adulterated, 1931-1934. Examined. Found adulterated or not up to standard Percentage adulterated 1931. 1932. 1933. 1934. Butter 210 — — .41 — — — Cheese 33 — — — — 9.0 — Cocoa 12 — — — — 13.3 — Coffee 16 Confectionery and Jam 18 1 1.2 — — — — Cream 73 Margarine 20 — — — — 4.3 — Milk 952 15 1.6 1.6 1.3 1.3 1.7 Separated Milk 3 1 33 3 — — — — Condensed Milk 30 Tea 12 2 — — — — 12.5 Vinegar 39 7 18.0 14.2 5.7 — — Drugs 77 3 4.0 — 3.3 — 7.4 Other Articles 505 19 4.0 1.0 0.86 1.4 5.1 All Articles 2000 46 2.3 1.2 1.40 1.4 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. 102 Report of the Medical Officer of Health for 1935. 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 160 1 •6 207 2 •9 367 3 6.1 •8 Putney 225 3 1.3 121 3 2.4 346 6 12.4 1.7 Balham 120 — — 82 — — 202 — 3.8 — Streatham 162 3 1.8 85 2 2.3 247 5 3.7 20 Tooting 183 10 5.4 179 1 •5 362 11 9.7 3.0 Wandsworth 150 4 2.3 326 17 5.2 476 21 5. 4.4 Whole Borough 1000 21 2.1 1000 25 2.5 2000 46 5.8 2.3 Milk and Milk Supply. The following samples were submitted for analysis:— 949 of whole new milk. 3 of separated milk. 30 of condensed milk. Of these 16 were reported against as being adulterated or not up to standard. 10 contained extraneous water, and six were deficient in milk fat. Proceedings were taken in seven of these cases and fines amounting to £10 0s. Od. were imposed with £9 9s. Od. costs. In the nine 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 warning letters to be sent in each case. 68 samples of milk were taken from the early morning delivery to hospitals in the Borough, 12 on delivery to Wandsworth Prison, and 25 from the milk delivered to the County Council 103 Food and Food Premises. Schools in the Borough. Two of the samples taken at H.M. Prison were reported against. The remainder were reported as genuine. 479 samples were taken from milk vendors in the street during the early morning (midnight to 8 a.m.) and of these four or .8 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 20 Grade A (Tuberculin Tested) 57 Grade A Pasteurised 5 Grade A 3 Pasteurised 42 Total 127 Bacteriological Examination of Milk. Eight samples of milk were examined at the Lister Institute for the presence of Tubercle Bacilli under Section 5 of the Milk and Dairies (Amendment) Act, 1922. In none of the cases did the examination reveal the presence of Tubercle Bacilli. The following samples of Graded Milks procured from schools, hospitals or dairymen, were submitted to the Counties Public Laboratories for bacteriological examination in order to see if the bacterial content was within the prescribed standard for the appropriate grade. Grade. Schools. Hospitals. Dairymen. Total. Grade A (Tuberculin Tested) 1 1 Pasteurised 25 14 39 Certified 1 1 Grade A Pasteurised — — 1 1 Total 25 — 17 42 In two cases, one school case and one from a barrow in the street, the milk failed to comply with the required standard. 104 Report of the Medical Officer of Health for 1935. Further samples were taken in both cases, and these were found to comply with the standard. Butter and Margarine. 210 samples of butter were submitted for analysis during the year and all were reported to be genuine. 20 samples of margarine were submitted for analysis, and all were reported to be genuine. Other Articles. 465 samples were submitted under this heading. The results of the analyses are given in the Public Analysts' Report. During the Summer an outbreak of food poisoning occurred at a large institution. The number of cases was 64, all of them only slightly affected. After exhaustive examination of various articles of food and of the water supply, no cause for the outbreak was discovered. All the cases recovered. 105 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 1935. Number of Inspections, 1935. Number of Notices, 1935. Number of Prosecutions, 1935. Factories:— Factory Laundries 47 22 — — Factory Bakehouses 77 106 1 — Food Factories entered on Table XXXVI 19 53 — Other Factories 455 220 6 — Total 598 401 7 — Workshops:— Workshop Laundries 23 8 — — Workshop Bakehouses 56 88 — — Other Workshops 777 413 12 — Total 856 509 12 — Workplaces 140 63 3 — Total: Factories, Workshops and Workplaces 1,594 973 22 — Home-workers' premises 448 211 10 Grand Total 2,042 1,184 — — Further details with regard to homeworkers' premises are given in Table XL. 106 Report of the Medical Officer of Health for 1935. 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. 38 32 114 37 10 10 27 (2.) Cleaning and washing 2 8 4 — — — — Paper bags and boxes 2 — 6 3 — — — Totals 42 40 124 40 10 10 27 The Total number of addresses received from other Councils was 511, and 139 addresses were forwarded to other Authorities. The number of addresses received has decreased by three, and the number sent has also decreased by eight. 30 names and addresses were forwarded to this Borough in error. The number of notices sent to employers during the year was 40, and these had a most satisfactory result. During the year 27 cases of infective diseases—17 of Mumps, one of Whooping Cough, one of Measles, two of German Measles, two of Scarlet Fever, two of Diphtheria, one of Influenzal Pneumonia, and one of Erysipelas—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. 107 Factories and Workshops. 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 56 Workshop Laundries 23 Dressmakers' and Milliners' Workshops 111 Bootmakers 106 Smiths and Engineers 35 Builders 45 Tailors 66 - Motor Engineers 75 Upholsterers Hairdressers 23 31 Other 285 Total number of workshops on Register 856 TABLE XLII. DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. No. of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:-* Want of cleanliness 14 5 — Want of ventilation — — Overcrowding — — — — Want of drainage of floors — — Other Nuisances 11 6 — Sanitary accommodation: Insufficient 2 2 Unsuitable or defective 10 5 — 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 37 18 * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 108 Report of the Medical Officer of Health for 1935. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF WANDSWORTH, 1935. (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. F. 1802 1984 127 81 13 9 15 14 21 39 55 71 82 76 82 97 204 161 355 295 453 471 :!9") 67( 1. Typhoid and paratyphoid fevers M. — — — — — — — — — — — F. 1 — — — — — 1 — — — — — — 2. Measles M. — — — — — — — — — — — — F. 1 1 — — — — — — — — — — — 3. Scarlet fever M. 2 1 1 — _ — 1 F. 2 — — — 1 1 — — — — — — 4. Whooping cough M. 4 4 — — — — — — — — — — — F. 8 5 — 3 — — — — — — — — — 5. Diphtheria M. 5 1 2 1 — 1 — F. 9 .— 1 1 7 — — — — — — 4j 6. Influenza M. 23 — — 1 2 1 2 6 5 6 F. 24 — — — 1 1 2 1 2 3 6 8 7. Encephalitis lethargica M. 1 — — — — — — — 1 — — ——— F. 3 — — — — — 1 — 1 — 1 — — 8. Cerebro-spinal fever M. 2 1 1 , F. 1 — — — — — — — 1 — — —, 9. Tuberculosis of respiratory system M. 113 1 17 28 15 25 22 5 — F. 104 — — — 4 38 26 21 7 5 3 — 10. Other tuberculous diseases M. 12 1 1 1 2 4 2 1 — : F. 20 1 1 2 4 5 3 1 1 — 1 1 1 11. Syphilis M. 5 — — — — — — — 2 2 1 1 — F. 3 1 — — 1 — — — 1 — — — — 12. General paralysis of the insane, tabes dorsalis M. 16 — — — — — 2 6 2 5 1 1 F. 1 — — — — — — — — — 1 — — 13. Cancer, malignant disease M. 273 — — — — 1 6 10 39 80 96 41 1 F. 298 — — — — 1 7 16 42 94 87 51 1 14. Diabetes M. 21 — — — . — 1 3 4 9 4 4 F. 24 — — — — — — — 1 5 12 6 6 15. Cerebral haemorrhage, etc. M. 45 — — — — — 1 4 8 16 16 6 F. 59 — — — 1 1 — — 3 7 17 30 0 16. Heart disease M. 483 — — — 2 5 5 11 39 86 146 189 9 F. 638 — — — 2 9 7 7 30 59 173 351 1 17. Aneurysm M. 11 — — — — 1 1 1 3 4 1 1 F. 13 — — — — — — 3 4 4 2 109 Vital Statistics. CAUSES OF DEATH—continued. Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— 18. Other circulatory diseases M. 80 - - - - - - 2 3 16 32 27 F. 117 — — 1 — — — 1 9 17 39 50 19. Bronchitis M. 73 8 1 4 7 14 23 16 F. 55 1 1 — — — — 2 3 8 13 27 20. Pneumonia (all forms) M. 89 17 2 3 3 2 9 9 16 lo 12 F. 88 12 2 2 3 2 3 3 9 14 17 21 21. Other respiratory diseases M. 12 — — — 1 1 — 5 2 2 1 F. 17 — — — — — 2 3 2 2 3 5 22. Peptic ulcer M. 23 - - - - - 1 11 3 4 4 F. 7 - - - - - - 1 2 3 — 1 23. Diarrhoea, etc. M. 25 17 2 1 o 1 1 1 F. 27 17 1 1 1 — 5 1 — 1 — — 24. Appendicitis M. 15 1 2 2 I 3 6 F. 15 — — — 1 1 2 1 2 5 1 2 25. Cirrhosis of liver M. 11 - - - - - - 2 2 2 4 1 F. 7 - - - - - - - 3 3 1 — 26. Other diseases of liver, etc. M. 8 - - - - - - - 1 2 3 2 F. 19 - - - - - — 2 3 5 7 2 27. Other digestive diseases M. 35 5 1 2 2 1 5 5 11 3 F. 46 1 1 1 1 — — 1 3 8 19 11 28. Acute and chronic nephritis M. 74 5 2 5 7 19 23 13 F. 74 — — — — 3 1 6 10 14 23 17 29. Puerperal sepsis 30. Other puerperal causes F. 5 — — — — 3 2 — — — — F. 5 — — — 1 2 2 — — — 31. Congenital debility, premature birth, malformations, etc. M. 68 65 1 1 1 F. 37 35 — 1 — 1 - - - -- 32. Senility M. 19 - - - - - - - - - 1 18 F. 52 - - - - - - - - - 4 48 33. Suicide M. 24 1 4 1 4 11 2 1 F. 16 — — — — 1 2 5 2 3 2 1 34. Other violence M. 81 4 2 4 10 13 6 9 14 6 13 F. 58 2 — 1 3 2 3 3 3 7 16 18 35. Other defined diseases M. 148 6 1 4 6 7 11 7 15 29 37 25 F. 130 5 2 1 9 5 5 15 17 28 23 20 36. Causes ill-defined, or unknown M. 1 - - - - - - - - - - 1 F. - - - - - - - - - - - - 110 Report of the Medical Officer of Health for 1935. PARTICULARS OF POLICE COURT PROCEEDINGS. Premises. Offence. Result. Fine. Costs. s. d. s. d. 22, Queens Road, Clapham. Nuisances Order made for the abatement of nuisances within 14 days 37, Hazelhurst Road, Balham Do. Do. Do. — 21 0 32, Dalebury Road, Wandsworth Do. Do. Do. — — 51, Littleton Street, Wandsworth Do. Summons adjourned sine die — — 9, Bendemere Road, Putney Do. Summons withdrawn work having been done 48, Palmerston Road, Wandsworth Do. Do. Do. 16, Fanthorpe Street, Putney Do. Do. Do. — 35, Hazelhurst Road, Balham Do. Order made for the abatement of nuisances within 28 days 10 6 24, Tonsley Road, Wandsworth Do. Summons adjourned sine die — 11, Chelsham Road, Clapham Failure to cause child to be vaccinated within 6 months after birth Order made for vaccination within 14 days 31, Heythorpe Street, Wandsworth Do. Do. Do. 17, Freeman House, Clapham Park Estate Do. Order made for vaccination within 28 days 18, Borrodaile Road, Wandsworth Do. Do. Do. 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. Ill Public Analysts' Annual Report. To the Wandsworth Borough Council. Mr. Mayor, Ladies and Gentlemen, Herewith we have pleasure in submitting our annual report on work performed in this laboratory under the Food and Drugs (Adulteration) Act, 1928, for your Council during 1935. In all 2,000 samples were examined, all of which were submitted by your Council's Food Inspector, 1,000 having been taken with the necessary formalities required by the Act, and 1,000 procured informally. The following statement shows the nature of the samples submitted 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. Butter - 210 210 Cheese 15 15 —. — ." Cheese (Wrapped) — 18 18 — — — Cocoa — 12 12 — — — Coffee — 16 16 — — Confectionery — 4 4 — 1 1 Jam — 14 14 — — — Cream — 66 66 — — — Cream, Tinned 7 7 — Flour, Self-raising — 4 4 — — — Lard — 10 10 — — Margarine — 20 20 — — — Milk 949 3 952 15 — 15 Milk, Separated 3 — 3 1 — 1 Milk Condensed (Full Cream) — 14 14 — — — Milk. Condensed (Machine Skimmed) — 16 16 — — — Sugar — 25 25 — — — Tea — 12 12 — — Vinegar 29 1 30 5 — 5 Vinegar, Malt 9 9 2 — 2 Beer (Stout) — 1 1 — — — Drugs — 77 77 — 3 3 Other Articles 10 455 465 2 17 19 Total 1000 1000 2000 25 21 46 112 Report of the Medical Officer of Health or 1935. DRUGS (Informal). Nature of Sample. Examined. Adulterated. Acid, Tartaric 3 Borax 8 — Chemical Food (Parrish) 1 — Effervescing Saline 1 — Elixer of Quinine and Cinnamon 1 — Friar's Balsam 3 — Glauber's Salts 1 — Glycerin 6 — Lysol 1 — Magnesium, Carbonate of .. 3 — Oil, Castor 5 — Oil, Cod Liver 5 — Oil, Eucalyptus 3 —. Ointment, Boric 2 — Ointment, Zinc 2 — Paregoric 2 — Powder, Gregorys 2 2 Powder, Seidlitz 3 — Sodium, Bicarbonate of 4 — Sulphur, Flowers of 6 — Tablets (Cascara Sagrada) 2 — Tincture of Iodine 2 — Tincture of Quinine (Ammoniated) 5 1 Tincture of Quinine (Ammoniated) and Cinnamon 1 — Tincture of Rhubarb 3 — Vaseline 2 — Total 77 3 113 Analysts' Annual Report. OTHER ARTICLES. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Almonds, Ground 2 2 — Arrowroot — 3 3 - 1 — Baking Powder — 10 10 - — — Beef Tea Jelly — 1 1 - — — Beverages — 2 2 - — — Biscuits — 9 9 - — — Cake — 7 7 - — — Cake, Sponge "Certo" (Pectin) — 3 3 - — — — 1 1 - —_ — Cherries, Glace — 3 3 - — — Chutney — 1 1 - — — Cocktail cubes —. 1 1 - — Coffee and Chicory Mixtures — 9 9 - — — Coffee and Chicory Extract — 3 3 - — Colouring Essences — 1 1 - — — Cornflour — 2 2 - 2 — Curry Powder 1 8 9 1 3 Egg Substitute Powder — 1 1 - — Fat, Cooking '— 1 1 - — — Fish, Canned 2 54 56 1 4 5 Fish Potted — 12 12 - —■ — Fruit, Bottled and Canned — 12 12 - — — Fruit, Dried — 41 41 - — — Gelatin — 7 7 - — Ginger Crystallised — 1 1 - — ■ Ginger, Ground — 2 2 - — Honey — 8 8 - — Honey, Prepared — 2 2 - — Jelly, Table — 3 3 - — Lemonade Powder — 2 2 - — Lemon Curd — 5 5 - —' — Meat, Canned — 7 7 - — — Meat Paste — 2 2 - —- — Meat, other — 19 19 - — — Meat Extract — 1 1 - — — Mincemeat — 3 3 - — — Mustard, Compound — 3 3 - — •—. Olive Oil — 6 6 - — Pastry, Puffed — 1 1 - — — Pepper — 6 6 - — Peel, Candied — 4 4 - — — Pickles — 9 9 - — Powder, Blanc Mange — 2 2 - — — Powder, Custard — 7 7 - —• — Powder, Pudding — 1 1 - — Rice — 22 22 - — — Rice, Ground — 1 1 - — — Rissoles — 1 1 - — — 114 Report of the Medical Officer of Health for 1935. OTHER ARTICLES—continued. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Sago 6 6 — — — Sandwich Paste - 2 2 — Sauce - 4 4 — — Sausages 1 40 41 — 4 4 Sausages, Preserved 4 9 13 — 2 2 Sausagemeat 1 12 13 — 1 1 Sausagemeat, served — 1 1 — ~~~ Sausage Rolls — 8 8 — 2 2 Soup Powder — 1 1 — Soup, Canned — 2 2 — — Spice — 6 6 — Sponge Mixture — 1 1 — Suet, Shredded — 3 3 — Tapioca — 9 9 — Treacle and Syrup — 3 3 — Waters, Aerated — 8 8 — — Wheat Preparations — 9 9 — — 7 Vegetables, Canned 1 17 18 — 1 1 Vegetables, Dried — 1 1 Total 10 455 465 2 17 19 The nature and extent of the adulteration detected in the formal samples is given below:— Case Nature of Sample. Nature of Report. 20 Milk 2 % Extraneous Water 96 Do 6 % deficient in Fat 130 Vinegar 14 % deficient in Acetic Acid 133 Do 8 % do. do. 141 Do 32.5 % do. do. 142 Do 9.5 % do. do. 148 Malt Vinegar 8 % do. do. 160 Do. 13 % do. do. 189 Vinegar 5 % do. do. 191 Milk 1 % deficient in Fat 192 Do 1 % do. do. 199 Do 4 % Extraneous Water 357 Canned Sild 5.2 grs. Tin per lb. 358 Curry Powder 90 parts Lead per million 496 Milk 2 % deficient in Fat 500 Do 8 % do. do. 501 636 Do 7 % Extraneous Water Do 14 % deficient in Fat 799 Do 10 % Extraneous Water 800 Do 11 % do. do. 950 Do 4 % do. do. 974 Do 2 % do. do. 975 Do 2½% do. do. 976 Do 2½ % do. do. 984 Separated Milk 4½ % do. do. 115 Analysts' Annual Report. The nature of the reports issued in respect to the informal samples returned as adulterated was as under:— Case Nature of Sample. Nature of Report. 39 Canned Tomato Contains a trace of Copper 76 Curry Powder Contains Lead 173 Cream Bar Filling devoid of Milk Fat 191 Tincture of Quinine Slightly deficient in Ammonia (Ammoniated) 275 Curry Powder Contains Lead 299 Canned Sild Contains excess Tin 328 Sausagemeat Contains a Sulphite Preservative 337 Canned Sild Contains excess Tin 363 Gregory's Powder Prepared with Magnesium Oxide 364 Do. do. Do. do. 437 Sausages Contain a Sulphite Preservative 440 Do. do. Do. do. 531 Sausage Rolls Do. do. 553 Do. do. Do. do. 607 Canned Sardines Contain Lead 608 Do. do. Do. do. 677 Sausages Contain a Sulphite Preservative 686 Arrowroot Consists entirely of Mono- Hydrated Carbonate of Soda 725 Preserved Sausages Contain excess Sulphite 727 Sausages Contain a Sulphite Preservative 753 Preserved Sausages Contain excess Sulphite The average water content of the 210 samples of Butter amounted to 14.5 per cen that in the 20 samples of Margarine being 13.8 per cent. The average fat content of the 66 samples of Cream amounted to 58.6 per cent., that in the seven samples of Tinned Cream being 23 per cent. Amongst the 66 samples of Cream four were submitted as "Coffee Cream" or "Half-price Cream." The average fat content of these samples amounted to 30 per cent. The average composition of the Milks examined during each month of the year and reported as genuine is given below:— 116 Report of the Medical Officer of Health for 1935. Month. Number of Samples Total Milk solids. Milk fat. Non-fatty solids. January 81 12.59% 3.69% 8.90 % February 44 12.31 % 3.45 % 8.86 % March 130 12.31 % 3.45 % 8.86 % April 56 12.28 % 3.38 % 8.90 % May 105 12.32 % 3.34% 8.98 % June 77 12.54 % 3.49 % 9.05 % July 27 12.31 % 3.51 % 8.80 % August 92 12.27 % 3.53 % 8.74 % September 91 12.51 % 3.70 % 8.81 % October 66 12.75 % 3.82 % 8.93 % November 105 12.88 % 3.91 % 8.97 % December 63 12.67 % 3.78 % 8.89 % The average composition of the 937 samples of Milk, returned as genuine during the whole year was as under :—• Total milk solids .. .. .. 12-50 % Milk fat .. 3-59 % Non-fatty solids .. .. .. 8-91 % During the year six of the samples contained in this report (all informal) were submitted at the request of rate-payers. The nature of the samples is set out below. Case No. Nature of Sample. Case No. Nature of Sample. 116 Parrish's Chemical Food 957 Sweets ("Humbugs" ) 536 "Frazipan Tart" 986 Cheese Biscuits 686 Arrowroot 985 Stout All of the above were found to be normal in composition with the exception of the sample of Arrowroot which, as shown under " Other Articles " consisted entirely of Mono-hydrated Carbonate of Soda and, no doubt, was sold in error. 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 21 st fanuary, 1936. 117 INDEX. page Accident, Deaths from 41,42 Adulteration of Certain Articles, Percentage of, in 1930-1934 101 Aged, infirm or diseased Persons, Removal of 83 Agricultural Grading and Marking Act, 1928 100 Ambulance Service 39 Analysts', Report of 1ll Ante-natal Clinics 65,69 Ante-natal Women, treatment of 69 Anti-toxin 22 Area of Borough 8, 9 Artificial Light Treatment of Tuberculosis 50 Artificial Pneumothorax Treatment of Tuberculosis 51 Artificial sunlight, etc., treatment 74 Bacteriological Examinations 40, 55 Bacteriological Examination of Milk 103 Bakehouses 105 Balham, House-to-House Inspections in 86 Barrow Road Area 88 Bathing Pools and Swimming Baths 81 Births 10 Births and Birth-rates in Sub-Districts 11 Birth-rate, Average 10 Years, 1925-34 15 Births, Notification of, Act 11 Borough of Wandsworth War Memorial Maternity Home 68 Brain and Nervous System, Diseases of the 41 Butchers' Shops 96 Butter and Margarine 104 Cancer 41 Census, 1931 9 Census, 1921 9 118 Index. PAGE Cerebro-Spinal Meningitis 32 Child Birth, Deaths from 17 Children and Young Persons Acts, 1908-1932 76 Children's Clinic, Wandsworth and Tooting 74 Circulatory Diseases 41 Clapham, House-to-House Inspections in 86 Cleansing of Persons Act 39 Clearance Areas 87 Clinics for Immunisation against Diphtheria 23-31 Closing Orders 89 Confectioners 96 Conscientious Objections Certificates granted 21 Convalescent Homes 74 Cowsheds 96 Creches 72 Cutting-off Notices—Water supply 80 Dairies, Milkshops and Cowsheds 96 Day Nurseries 72 Death, Causes of 14, 108, 109 Death-rate, Average 10 Years, 1925-1934 15 Death-rate, Corrected 12 Death-rate from Infective Diseases 18 Death-rate, Infantile 16 Deaths, Corrected 12 Deaths, Number of 12 Deaths in Institutions 16 Demolition Orders 89 Dental Treatment 51, 75 Developmental Diseases 41 Diarrhoea 38 Diphtheria 22 Diphtheria, Attack Rate per 1,000 cases 22 Diphtheria, Immunisation against 23-31 Diphtheria, " Return Cases "of 31 Diseased, aged or infirm Persons, Removal of 83 Disinfection 39 Disinfection of Schools 39 Dutch Yard Area 87 Dwelling-houses, Inspection of 84 Dysentery 33 Index. 119 page Encephalitis Lethargica 33 Enteric Fever 31 Erysipelas 32 Expectant and Nursing Mothers, Institutions for 73 Factories and Workshops 105 Factories, Workshops, etc., Defects found in 107 Factories, Workshops and Workplaces, Inspection of 77, 105 Families, Number of, Census 1921 9 Felsham Road Area 88 Fishmongers' Shops 96 Fish, Sausages and potted Meat, etc., preparation or manufacture of 95 Flies and Mosquitoes 80 Food, Prosecutions in connection with 102 Food and Drugs (Adulteration) Act, 1928, Proceedings under 102 Food and Drugs (Adulteration) Act, 1928, Statement of Work under 100 Food and Food Premises 94 Food Factories 96 Food Places, Inspection of 96 Food poisoning, Outbreak of 104 Foster-parents 76 Fried Fish Shops 96 Greengrocers' Shops 96 Greyhound Square Area 88 Grocery and Provisions Shops 96 Health Visitors, Work of 60 Home Work 105, 106 Hospital Treatment for Ante-natal Women 69 Hospitals, etc., for Expectant and Nursing Mothers 73 House Refuse, Removal of 80 House-to-House Inspections, Summary of 85 Houses and Premises Inspected 77 Houses Let in Lodgings 77 Housing Act, 1930 87 Housing Act, 1935 90 120 Index. PAGE Housing Consolidated Regulations, 1925, Houses inspected, etc. 86 Housing Statistics 84 Ice Cream Premises 96 Ice Cream, etc., Sale and Storage of 95 Infant Life Protection 76 Illegitimate Children, Births of 11 Immunisation against Diphtheria 23-31 Imported Produce, Marking of 100 Increase of Rent and Mortgage Interest (Restrictions) Act, 1923 86 Infant Visiting 63 Infantile Mortality 16, 17 Infantile Mortality, 10 Years, 1925-1934 17 Infective Diseases 18 Infective Diseases, Cases of 19-21 Infective Diseases, Death-rate from 18 Infective Diseases: Number of Cases Notified from Elementary Schools 36-38 Infirm, aged or diseased Persons, Removal of .. 83 Influenza, Deaths and Death-rates 32 Influenzal Pneumonia and Acute Primary Pneumonia, Cases Notified 32 Inhabited Houses, Number of 8 Inquests 41, 42 Insanitary Areas 87 Inspections, Details of 77 Institutions for Expectant Mothers, etc. 73 Insulin treatment 41 Laundries, Inspection of 105 London County Council (General Powers) Act, 1932 95 Malaria 33 Margarine 104 Markets and Stalls 96 Maternal Mortality 17 Maternity and Child Welfare 60 Maternity and Child Welfare Centres 64-67 Maternity Home, Borough of Wandsworth War Memorial 68 Index. 121 page Measles 34-38 Measles and other Non-notifiable Diseases reported from Schools 36-38 Meat 95 Merchandise Marks Act, 1926 100 Mews and Stables 77 Mice and Rats Destruction 80 Midwives 69 Midwifery Service 70 Milk Analysis 101 Milk, Bacteriological Examination of 103 Milk (Mothers and Children) Order 74 Milk Premises, Cowsheds, etc., on Register 95 Milkshops, Cowsheds, etc., Inspections of 96 Milk (Special Designation) Order, 1923 103 Milk Supply 74, 95, 102 Mission of Hope, Grant to 73 Mortuaries 83 Mosquitoes 80 Natural Increase, Rate of 10 Nervous System, Diseases of the 38 Non-Infective Diseases, Deaths from 41 Notification of Births Acts 10 Notification of Infective Diseases 18-21 Nursing Arrangements 69 Nursing Mothers, Institutions for 73 Obstetric Consultant Service 69 Offensive Trades 77 Old Age 41 Ophthalmia Neonatorum 33 Other Infective Diseases, Deaths from 38 Outworkers 105, 106 Overcrowding 78 Overcrowding Survey, The 90 Para-Typhoid Fever 31 Physical Features, etc., of the Borough 9 Piggeries 77 122 Index. PAGE Pneumonia 32 Police Court Proceedings 102,110 Polio-Myelitis and Polio-Encephalitis 33 Population 8, 9, 10 Population of Sub-Districts 10 Potted Meat, Fish and Sausages, etc., preparation or manufacture of 95 Premature Birth 41 Pregnancy, Deaths from Accidents and Diseases of 17 Provisions and Grocery Shops 96 Public Vaccinators 2, 3 Puerperal Fever 31 Puerperal Pyrexia 31 Pulmonary Tuberculosis, Notification of Cases of 43 Putney, House-to-House Inspections in 86 Rag and Bone Stores 77 Rag Flock Act, 1911, Statement of Work done under 83 Rateable Value 8 Rats and Mice Destruction 80 Rent and Mortgage Interest (Restrictions) Act, 1923 86 Respiratory Diseases 41 Restaurant Kitchens 96 Return Cases of Scarlet Fever and Diphtheria 31 River Wandle 81 Samples, Formal and Informal, Number of 102 Sanitary Conveniences, Inspection of 77, 80 Sanitary Inspection of the Borough 77 Sanitary Operations, Table of 79 Sausages, potted Meat and Fish, etc., manufacture of 95 Scabies 38 Scarlet Fever 31 Scarlet Fever, Attack Rate per 1,000 Cases 31 Scarlet Fever, " Return Cases "of 31 Schools, Disinfection of, for Infective Diseases 39 Septicaemia, Deaths from 38 Shelters for Tuberculous Patients 52 Shops Act, 1934 81 Slaughter houses 95 Slaughter of Animals Act, 1933 99 Index. 123 page Small pox 21 Smoke Nuisances 77 Social Conditions 9 Southwark Diocesan Association, Grant to 73 Sputum Examinations 55 Staff 1 Streatham, House-to-House Inspections in 86 Suicide, Deaths from 41, 42 Swimming Baths and Bathing Pools 81 Syphilis, Deaths from 38 Tooting and Wandsworth Children's Clinic 74 Tooting, House to-House Inspections in 86 Tooting Grove Areas 88 Transfer of Powers (London) Order, 1933 76 Tuberculosis 43-47 Tuberculosis, Artificial Light Treatment of 50 Tuberculosis, Artificial Pneumothorax Treatment of 51 Tuberculosis Dispensaries 48-59 Tuberculosis Care Committee 55 Tuberculosis, Handicraft Class 59 Tuberculosis, Institutional Treatment 51 Tuberculous Diseases, Extra Nourishment provided 51 Underground Rooms 86 Unhealthy Areas 87 Union Street Area 88 Unmarried mothers, Institutions for 73 Unsound Food 99 Vaccination 21 Vaccination Offices 3 Vaccination Returns 21 Violence, Mortality from 41 Vital Statistics of Whole Borough 8 Wandle, The River 81 Wandsworth and Tooting Children's Clinic 74 124 Index. PAGE Wandsworth, House-to-House Inspections in 86 Wandsworth Plain Clearance Area 87 Water Supply, Cutting-off Notices 80 White Square Area 89 Whooping Cough 32 Workshops, Number of 77, 105, 107 Young Children, Institutions for 73 Young Persons Acts, 1908-1932 76 Zymotic Diseases 18 Front the Press of Shield and Spring, 26-28, Lancelot Place, S.W. 7