24388 M WAN 73 Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, &c. OF THE BOROUGH For the Year 1936, 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 1936, 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 1936. 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 1936. 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 1936. Obstetric Consultant:— A. Morris Johns, M.D., Ch.B., M.C.O.G. Obstetric Consultants to The Maternity Home:— F. W. Roques, M.A., M.D., M.Ch., F.R.C.S., M.C.O.G. W. R. Winterton, M.A.,M.B., B.Ch.,F.R.C.S.,M.C.O.G W. N. Searle, M.B., Ch.B., F.R.C.S., M.C.O.G. 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. A. P. McEldowney, 134, Lower Richmond Road, Putney, S.W. 15 Streatham Dr. A. B. Plant, 31, Clairview Road, Streatham, 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. Wandsworth, No. 2 Dr. H. A. Topalia, 248, Earlsfield Road, Wandsworth, S.W. 18. Swaffield Road Institution Dr. H. A. Topalia, 248, Earlsfield Road, Wandsworth, S.W. 18 Vaccination Officers. Clapham and Wands.worth. The Medical Officer of Health. Balham, Streatham and Tooting. Mr. L. H. Ford, 130, Franciscan Road, Tooting, S.W. 17. Putney Mr. C. L. Taylor, 1, Crieff Road, Wandsworth, S.W. 18. B2 4 Report of the Medical Officer of Health for 1936. 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 — J. A. Sands July 1920 „ No One E. V. Roots Sept. 1926 „ Yes Four C. F. Standish Jan. 1928 „ Yes Two F. A. Eustace June 1929 Joint Board Ex. No — W. G. Pearce Sept. 1929 „ Yes — A. W. Fisher May 1930 „ No — R. E. Jones Dec. 1930 „ Yes One A. W. E. Porter June 1931 S.I. Exam. Bd. Yes — F. L. Langford May, 1934 Joint Board Ex. No — H. M. Hough April, 1935 „ Yes Five A. J. Lansley April, 1935 „ Yes — †G. Rollinson May, 1935 „ Yes One †H. F. Leacock May, 1936 „ No. Two Food and Drugs W. H. Jones Sept. 1926 S.I. Exam. Bd. Yes Four Food: H. T. Lambert Lec., 1919 S.I. Exam. Bd. Yes Five W. T. Willimott Dec. 1927 Joint Board Ex. Yes Eight 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 W elfare:— Miss D. S. Collins Mar. 1913 Yes No No Yes „ E. K. Woods Feb. 1916 Yes No Yes Yes „ M. Dean Jan. 1924 Yes No Yes Yes „ D. M. Staniland June 1927 Yes Yes Yes No „ J. E. D. Elder May 1928 Yes Yes Yes No „ H. McCarthy Nov. 1928 Yes Yes Yes No „ J. Pottinger Aug. 1930 Yes Yes Yes No „ G. Smith Sept. 1930 Yes Yes Yes No „ K. Kenion Sept. 1930 Yes Yes Yes No „ G. Neall May, 1934 Yes No Yes Yes „ C. Hughes April, 1936 Yes Yes Yes No Tuberculosis:— Miss P. G. Moores April 1915 Yes Yes No No „ R. M. Watling May 1922 Yes Yes Yes No „ N. Hancocks July. 1936 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 1936. OFFICE STAFF. Commenced duty. Certificates held. Chief Clerk:— A. E. Cooper Nov., 1897 San. Insp., and four others. Clerk—Grade C:— F. Bray Oct., 1903 San. Insp., and six others. Clerks—Grade B:— P. C. Clark Nov., 1903 One. A. G. Patterson Feb., 1914 San. Insp., and two others. Clerks—Grade A:— C. E. Gessner Oct., 1929 — J. W. Marshall Jan., 1927 San. Insp., and five others. L. L. Parrini May, 1923 — A. E. Hollis Feb., 1929 Three S. F. Jennings Oct., 1935 — A. A. Rees May, 1936 — L. V. Webb May, 1936 — Clerks—Grade D:— Miss C. Wellings May, 1921 — Miss H. G. Wright Jan., 1925 — Miss M. J. Richards June, 1935 Three Secretary to the Tuberculosis Care Committee:— Miss M. L. Baptie Dec., 1930 — Dispenser for the Tuberculosis Dispensaries:— C. Kitchen Feb., 1931 Registered Pharmacist 7 Staff. Disinfecting Station. Engineer—R. E. Gale. Commenced duty November, 1936. Two motor drivers. Six Disinfecting Attendants. Mortuaries. One whole.time and two part.time Mortuary Keepers. Staff Changes during the Year. Mr. W. N. Searle, 59, Harley Street, W., has been appointed Obstetric Consultant to the Maternity Home in place of Mr. C. K. Vartan who has resigned his appointment. Dr. A. P. McEldowney has been appointed Public Vaccinator for the Putney District in place of the late Dr. W. D. McMurtry. In January the Council decided to increase the number of Food Inspectors from two to three in order to cope with the additional duties required by recent legislation, especially in connection with the Shops Act, 1934, and the Pharmacy and Poisons Act, 1933. Mr. H. T. Lambert, one of the Sanitary Inspectors, was transferred as Food Inspector and his place was taken by the appointment as Sanitary Inspector of Mr. H. F. Leacock, Second Class Clerk. In view of the increase in the duties required of Health Visitors, the Council decided during the year to appoint an additional Health Visitor under the Maternity and Child Welfare Scheme and an additional Tuberculosis Visitor. Miss C. Hughes was appointed in the former capacity and Miss N. Hancocks as Tuberculosis Visitor. A new method of grading for certain Officers on the Clerical Staff was adopted by the Council in January, 1937. The Office Staff of the Department is set out on the previous page in accordance with the new grades. 8 Report of the Medical Officer of Health for 1936. During the year vacancies in the office staff occurred as a result of the appointment of Mr. Leacock as Sanitary Inspector, by the sudden death of Mr. G. L. Humphreys and by the resignation of Miss F. M. Woodhall. Mr. C. E. Gessner was transferred from the Borough Engineer's Department to fill the vacancy caused by the promotion of Mr. Leacock and the other vacancies were filled by the appointment of Mr. L. V. Webb and Miss M. J. Richards, the latter having worked as a temporary Clerk in the Department since June, 1935. In order to cope with the increased clerical work of the Department the Council decided that it was necessary to appoint two additional clerks instead of continuing to employ temporary assistance. Accordingly, Mr. S. F. Jennings and Mr. A. A. Rees, who had been acting as temporary clerks for some months,.were appointed on the permanent establishment. Mr. C. I. F. Batt, Engineer.in.charge of the Disinfecting Station, resigned in October to take up another appointment. The vacancy was filled by the appointment of Mr. R. E. Gale, who had been Foreman at the Station for eight years. Mr. W. T. Willimott, Food Inspector, was awarded a First Class Pass and the prize given by the Worshipful Company of Poulterers in an examination on "The Selection and Preparation of Game and Poultry" held at the Smithfield Meat Trades Institute. 9 GENERAL STATISTICS FOR THE BOROUGH. Area 9,199 acres Population in 1936 343,000 No. of inhabited houses in 1936 80,000 No. of families, or separate occupiers, in 1931 95,383 Rateable value in 1936 £3,255,671 Estimated produce of a penny rate £13,073 Extracts from Vital Statistics. No. of Live Births Males Females Total Legitimate 1946 1793 3739 Illegitimate 94 99 193 Total 2040 1892 3932 Deaths 1976 2069 4045 Birth.rate 11.46 Death.rate—Crude 11.79 Standardised 10.96 Rate per 1,000 total (live and still) births. No. of Stillbirths 118 29.13 Deaths from puerperal sepsis 1 .24 Deaths from other puerperal causes 6 1.48 Total 7 1.72 Infantile mortality per 1,000 live births:— All infants 58 Legitimate infants 56 Illegitimate infants 88 Deaths from Cancer (all ages) 568 „ Measles (all ages) 24 „ Whooping Cough (all ages) 12 „ Diarrhœa (under 2 years of age) 36 Deaths from Tuberculosis:— No. 236 Rate .68 10 Report of the Medical Officer of Health for 1936. 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). The chief industries carried on are the manufacture of gas and gas mantles, laundries, and general engineering. At December, 11 Vital Statistics. 1936, the number of men, women, and boys and girls over 14 years of age, who were unemployed, was 5,202, compared with 6,913 at December, 1935, a reduction of 1,711. There is no particular occupation carried on in this Borough which affects public health. Population. The population at the middle of the year was estimated by the Registrar General to be 343,000 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 1936 Clapham 60,925 59,167 Putney 34,718 33,735 Balham 53,982 52,384 Streatham 68,435 66,500 Tooting 38,159 37,092 Wandsworth 96,891 94,122 Whole Borough 353,110 343,000 Births. The total number of births occurring in the Borough was 2,537, including 362 non.residents who were born in Institutions. 1,757 births of Borough residents occurred outside the Borough, so that the corrected number of births was 3,932 compared with 3,789 in 1935. 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. 12 Report of the Medical Officer of Health for 1936. TABLE II. Sub.District. No. of Births. Rates. Males. Females. Total. Birth.rate. Natural increase or decrease. Clapham 356 393 749 12.65 +.37 Putney 199 161 360 10.67 —2.60 Balham 313 284 597 11.39 —2.06 Streatham 352 320 672 10.10 —1.43 Tooting 202 207 409 11.02 +1.02 Wandsworth 618 527 1,145 12.16 +1.30 Whole Borough 2,040 1,892 3,932 11.46 — .33 The birth.rate was 11.46 per 1,000, compared with 11.03 for 1935, and 12.34 the decennial average. The rate for the whole of London during 1936 was 13.6 and for England and Wales, 14.8. 135 illegitimate births took place in the Borough, but only 74 belonged to the Borough. On the other hand 119 illegitimate births belonging to Wandsworth occurred outside the Borough, making a corrected total of illegitimate births belonging to Wandsworth of 193, 46 of these belonged to Clapham, 23 to Putney, 29 to Balham, 35 to Streatham, 16 to Tooting, and 44 to Wandsworth. The percentage of illegitimate births to total births was 4.9. The illegitimate births occurring in nursing homes have again been allocated to the home addresses of the mothers. Notification of Births Act. Notifications of birth were received in respect of 2,457, or 96 per cent. of the 2,537 children who were born in the Borough during the year. 1,735 of these notifications were transmitted by midwives, 489 by medical attendants, 94 by parents, and 139 by other persons. 13 Vital Statistics. Deaths. The number of deaths which took place in the Borough during the year was 3,117, but 1,136 of these did not belong to the Borough, while 2,064 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 4,045 of whom 1,976 were males and 2,069 females. The crude death.rate for the year was 11.79 compared with 11.0 in 1935, but after correction has been made by means of a comparability factor devised by the Registrar.General, the corrected death.rate was 10.96. The death.rate for the whole of London for 1936 was 12.5, for England and Wales 12.1, in the 122 County Boroughs and great Towns 12.3, and in the 143 smaller Towns 11.5. Table III. shows the total number of corrected deaths and the death.rates for each sub.district and for the whole Borough. TABLE III. Sub. Districts. Corrected Deaths. Crude Death. rate. Males. Females. Total. Clapham 355 372 727 12.28 Putney 226 222 448 13.27 Balham 349 356 705 13.45 Streatham 333 438 771 11.59 Tooting 207 164 371 10.00 Wandsworth 506 517 1023 10.86 Whole Borough 1,976 2,069 4,045 11.79 Table IV. 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 1936. Table IV.—Causes of, and Ages at Death, during the Year 1936. 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 3 3 . . . . . 2 1 . . . . . 1 1 1 9 Small.pox . . . . . . . . . . . . . . . . . . Measles 24 16 8 3 10 7 4 . . . . 7 1 5 2 2 7 19 Scarlet Fever . . . . . . . . . . . . . . . . . . Whooping Cough 12 6 6 7 2 2 1 . . . . 6 . 1 2 . 3 11 Diphtheria and Membranous Croup 23 11 12 . 2 7 11 2 . 1 . 9 . 3 2 3 6 22 Influenza 44 19 25 1 1 . 1 1 5 13 22 6 8 7 12 3 8 12 Erysipelas 2 1 1 . . . . . . . 2 . . . 1 . 1 2 Cerebro.spinal Fever 4 2 2 . 1 1 . . 1 . 1 . 1 1 1 1 . 1 Other Epidemic Diseases 4 2 2 . . . . 1 1 1 1 . . 2 2 . . 2 Pulmonary Tuberculosis 205 115 90 1 . . 4 43 94 47 16 39 18 32 22 26 68 127 Tuberculous Meningitis 12 9 3 1 3 1 3 2 1 1 . 2 1 . 2 2 5 12 Abdominal Tuberculosis 5 2 3 . . . . 2 . 1 2 . . 1 1 1 2 4 Other Tuberculous Diseases 14 11 3 . 1 . 1 2 5 3 2 4 3 1 2 2 2 13 Other Infective Diseases 15 9 6 2 . 1 3 1 5 2 1 2 5 2 1 1 4 13 Cancer, Malignant Disease 568 255 313 . . 1 . . 28 229 310 110 66 91 117 36 148 341 Rheumatic Fever 23 7 16 . . . 3 1 4 11 4 2 4 2 5 2 8 9 Diabetes 45 13 32 . . . . . 4 12 29 11 2 8 9 3 12 21 Other General Diseases 73 29 44 . . 1 . 4 8 21 39 17 8 21 16 2 9 42 Alcoholism 6 2 4 . . . . . 2 1 3 . 2 1 2 . 1 5 Chronic Poisonings . . . . . . . . . . . . . . . . . . Meningitis 6 2 4 2 . . 3 . . 1 . . 1 1 3 . 1 7 Cerebral Hæmorrhage, Apoplexy 102 40 62 1 . . 1 . 4 28 68 16 8 23 18 6 31 34 Convulsions 3 1 2 2 . 1 . . . . . . . . 1 . 2 . Other Diseases of Nervous System 118 67 51 3 1 3 8 7 32 39 25 21 13 16 27 7 34 85 Organic Diseases of Heart 1010 418 592 . . . 2 2 26 164 816 170 93 185 189 107 266 581 Other Diseases of Circulatory System 430 214 216 1 . . . 2 7 113 307 80 57 64 92 40 97 202 Bronchitis 247 144 103 13 1 . 1 . 4 63 165 39 34 55 34 31 54 99 Broncho.Pneumonia 100 48 52 27 2 2 1 2 4 19 43 19 6 21 24 8 22 65 Lobar Pneumonia 45 21 24 3 . . . 2 5 19 16 3 9 8 11 4 10 23 Pneumonia (type not distinguished) 26 19 7 2 . . 1 1 1 9 12 3 2 7 5 5 4 20 Other Diseases of Respiratory System 22 11 11 2 . 1 2 . 3 5 9 4 2 4 6 4 2 12 Ulcer of Stomach 34 23 11 . . . . . 4 23 7 7 6 10 6 2 3 26 Diarrhœa 16 7 9 15 1 . . . . . . 4 . 5 2 3 2 15 Enteritis 20 13 7 19 1 . . . . . . 4 4 5 1 . 6 19 Appendicitis and Typhlitis 21 16 5 . . 2 2 4 2 8 3 3 5 4 3 2 4 19 Obstruction of Intestines 31 14 17 2 . . . . 2 11 16 8 5 4 3 2 9 24 Cirrhosis of Liver 13 10 3 . . . . . 2 9 2 3 . 3 2 . 5 9 Other Diseases of Liver 30 10 20 . . . . . 4 9 17 6 3 5 8 3 5 18 Other Diseases of Digestive System 54 28 26 3 1 . 1 2 8 20 19 7 7 11 9 8 12 38 Nephritis and Bright's Disease 144 68 76 1 1 1 1 3 11 44 82 24 23 19 32 11 35 83 Other Diseases of Urinary System 68 62 6 . . . . . 2 12 54 12 13 12 13 3 15 51 Diseases of Generative System 7 . 7 . . . . . 6 1 . 1 . 1 3 . 2 6 Puerperal Fever 1 . 1 . . . . . 1 . . . . . 1 . . 1 Other Accidents and Diseases of Pregnancy and Childbirth 6 . 6 . . . . 1 5 . . . 1 . 2 1 2 5 Premature Birth 61 37 24 61 . . . . . . . 16 2 14 7 6 16 53 Congenital Debility and Malformation 32 19 13 28 1 1 1 1 . . . 3 2 4 8 3 12 23 Other Diseases of Early Infancy 26 17 9 26 . . . . . . . 6 1 3 4 3 9 19 Old Age 88 34 54 . . . . . . . 88 15 14 15 16 6 22 21 Deaths from Accident 120 71 49 2 3 2 9 18 21 27 38 22 15 19 23 12 29 109 Deaths from Suicide 46 27 19 . . . . 2 6 27 11 4 1 7 11 4 19 15 Other Violent Deaths 7 5 2 1 1 . . . 1 4 . 1 1 . 1 1 3 2 Other Defined Diseases 26 16 10 1 . . 2 3 1 8 11 11 1 2 6 3 3 21 Ill.defined Diseases or unknown 3 2 1 . . . . . 2 . 1 . . . . 1 2 3 All causes 4045 1976 2069 230 23 34 66 111 323 1006 2242 727 448 705 771 371 1023 2367 15 Vital Statistics. The number of deaths shown on Table IV. does not agree with that shown on page 106. 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 IV. are used in the calculation of all the mortality rates in this Report. Table V. 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 V. Birth-rates. Death-rates. Wandsworth. London. England and Wales. Wandsworth. London. England and Wales. 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 1935 11.03 13.3 14.7 10.23 11.4 11.7 Average 10 years 12.34 14.94 15.8 11.03 12.0 12.0 1936 11.46 13.6 14.8 10.96 12.5 12.1 16 Report of the Medical Officer of Health for 1936. The number of deaths which occurred in Institutions, etc., inside the Borough was 1,439, but 1,136 of these persons did not belong to the Borough. A total of 2,367 persons belonging to the Borough died in Institutions, 303 occurring in Institutions within the Borough and 2,064 in Institutions outside the Borough. Infantile Mortality. The number of deaths under one year was 230—44 in Clapham, 20 in Putney, 45 in Balham, 35 in Streatham, 23 in Tooting, and 64 in Wandsworth. As the number of births was 3,932 the Infantile Mortality rate was 58 per 1,000 births, compared with 55 last year and with a decennial average of 56. The rate is lower than for the whole of London, which was 66 per 1,000 births. For the 10 years ending 1918 the average infantile mortality rate was 87, while for the 10 years ending 1935, the average rate was 56. The number of deaths among legitimate infants was 213 to 3,739 births—a mortality of 56 per 1,000 births, while the number of deaths among illegitimate infants was 17 to 193 births —a mortality of 88 per 1,000 births. Table VI. 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 VI. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 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 1935 73 52 47 60 42 49 55 Average for 10 years 56 58 52 49 65 59 56 1936 58 55 75 52 56 o5 58 No. of deaths under 1 year, 1936 44 20 45 35 23 63 230 Maternal Mortality. Six deaths occurred from accidents and diseases of pregnancy and one from Puerperal Fever,.giving a total of seven deaths after childbirth. This is equivalent to a rate of 1.72 per 1,000 live and still births, compared with 2.55 in 1935 and 1934. Enquiries into all maternal deaths, which were commenced in 1928 at the instance of the Ministry of Health have been continued. 18 INFECTIVE DISEASES. The number of deaths from notifiable infectious diseases, including all forms of Tuberculosis, was 329, compared with 335 in 1935. There were also 80 deaths from non-notifiable diseases of an infective nature, viz.:— 24 from Measles, 12 from Whooping Cough and 44 from Influenza. From all infective diseases the death-rate was 1.17 per 1,000—1.40 in Clapham, 1.21 in Putney, 1.24 in Balham, .81 in Streatham, 1.21 in Tooting, and 1.22 in Wandsworth. The rate in 1931 was 1.44; in 1932, 1.62; in 1933, 1.75; in 1934, 1.35; and in 1935, 1 14 per 1,000. Table VII. shows the number of cases of the notifiable infective diseases reported, arranged in various age groups and Table VIII. shows the same figures arranged in the sub-districts in which they occurred. 19 Infective Diseases. TABLE VII. Notifiable Diseases. No. of CASES of Infective Diseases grouped in Age Periods. Total. Under 15 15 and upwards Under 1 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 and upwards Small-pox - - - - - - - - - - - - - - - Diphtheria 365 299 66 1 13 29 34 31 135 56 24 29 10 2 1 Scarlet Fever 644 501 143 6 14 25 47 59 246 104 50 66 15 10 2 Enteric Fever and Paratyphoid Fever 28 5 23 - - - 3 — 1 1 9 9 2 3 Puerperal Fever 7 — 7 — — — - — — — — 5 2 — - Puerperal Pyrexia 20 - 20 — — — - — — — — 19 1 — - Erysipelas 127 10 117 2 — — - — 4 4 6 9 16 53 33 Pneumonia:— Acute Influenzal 46 5 41 — 2 2 - — 1 — — 7 5 20 9 Acute Primary 275 98 177 12 13 14 12 10 25 12 9 31 30 62 45 Cerebro-spinal Meningitis 4 2 2 — 1 — 1 — — — — — 1 - 1 Polio-myelitis 6 6 — — — — — 1 1 4 — — — — — Encephalitis Lethargica 2 — 2 — — — — — — — — — — 1 1 Malaria 4 — 4 - - - - - - - - 1 2 1 - Dysentery 3 2 1 — 1 — 1 - - - - - 1 - - Food Poisoning 12 3 9 — — — — 1 1 1 1 5 1 2 — Ophthalmia Neonatorum 27 27 — 27 — — — — — — — - - — - Tuberculosis—All forms 569 56 513 2 4 4 3 3 17 23 52 260 77 113 11 Total 2139 1014 1125 50 48 74 101 105 431 205 151 441 163 267 103 20 Report of the Medical Officer of the Health for 1936. TABLE VIII. 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 101 18 45 49 34 118 365 361 23 Scarlet Fever 107 44 94 134 117 148 644 563 - Enteric and Para-typhoid Fevers 3 3 3 3 3 13 28 25 3 Puerperal Fever 1 1 — 2 1 2 7 6 1 Puerperal Pyrexia 2 1 6 3 2 6 20 18 - Erysipelas 20 8 14 16 19 50 127 51 2 Pneumonia—Acute Influenzal 11 5 5 8 4 13 46 - 14 Pneumonia—Acute Primary 44 31 35 32 39 94 275 - 40 Cerebro-spinal Meningitis — 1 1 1 1 - 4 4 4 Polio-myelitis 1 — 1 3 — 1 6 4 - Encephalitis Lethargica — — 1 1 — - 2 1 2 Malaria — 1 1 — — 2 4 4 — Dysentery — — — 1 — 2 3 3 — Food Poisoning 1 — 1 1 — 9 12 — — Total 291 113 207 254 220 458 1543 1040 89 Tuberculosis—all forms 141 72 60 83 74 139 569 - 239 Ophthalmia Neonatorum 8 4 1 5 1 8 27 10 1 Total 149 76 61 88 75 147 596 10 240 Grand Total 440 189 268 342 295 605 2139 1050 329 21 Infective Diseases. The total number of cases was 2,139 compared with 2,410 in 1935. This decrease is due to the fall which occurred in the number of cases of Scarlet fever, Diphtheria, and Tuberculosis. In 1935 there were 1,767 cases of these three diseases, but in 1936 the number was 1,578. Small-pox. No case of this disease occurred during the year. Vaccination. Table IX. is taken from the official returns of the Vaccination Officers for the year 1935 and shows the number of children successfully vaccinated for the whole Borough, as well as for the separate sub-districts. TABLE IX. No. of Children. Clapham Putney Balham Streatham Tooting Southfield Springfield Total Successfully Vaccinated 173 138 350 218 89 212 128 1306 Insusceptible of Vaccination — - 2 1 1 — — 4 Had Small-pox — — - — — — — — Dead, Unvaccinated 22 5 22 12 9 15 11 96 Exempted under Certificates of Conscientious objection 136 46 206 108 98 83 63 740 Postponed by Medical Certificate 2 - - 1 - 1 — 4 Removed 39 19 68 26 14 21 8 195 Remaining on Books as Un-vaccinated 1 2 25 15 16 2 2 63 No. of Births returned to Vaccination Officers during 1934 373 210 673 379 227 334 212 2408 22 Report of the Medical Officer of Health for 1936. The percentage of children vaccinated to total births was 54.2—in Clapham, 46.1; in Putney, 65.7; in Balham, 52.0; in Streatham, 56.9; in Tooting, 39.2; in Southfield, 63.1; and in Springfield, 60.3. This percentage is .3 higher than that recorded last year. Diphtheria. 365 cases occurred, compared with 388 in 1935; 552 in 1934 and 409 in 1933. The number of deaths was 23, compared with 14 in 1935, 21 in 1934, and 13 in 1933. The death-rate for 1936 was .06 and the case mortality was 6.3 per cent. The rate per 1,000 of population was 1.06; 1.77 in Clapham; .53 in Putney, .85 in Balham; .73 in Streatham; .90 in Tooting; and 1.25 in Wandsworth. Of the 365 cases, 361 or 98.9 per cent., were removed to hospital and no difficulty was experienced in having cases removed promptly. The Medical Officers of the London County Council made inspections of the Bonneville Road, Cavendish Road, Larkhall Lane, New Park Road, New Road, St. Andrews Street and Stonhouse Street Schools in Clapham; Hotham Road, Huntingfield Road, Putney Church of England and Putney Roman Catholic in Putney; Broadwater Road, Fircroft Road, Oldridge Road and Ravenstone Schools in Balham; The Defoe and Sellincourt Road Schools in Tooting ; All Saints', Putney Bridge Road, Garratt Lane, Littleton Street Medical Defective, Riversdale, St. Joseph's Roman Catholic, St. Michael's, Swaffield Road, Waldron Road and Wandle Schools in Wandsworth. Swabs were taken from the throats of some of the children examined. As the result of this swabbing eight 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 56 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 (A.P.T.). 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 1936. 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 1,205 compared with 1,276 in 1935 and 954 in 1934. In the eight years during which the two clinics have been open, 8,653 persons have attended. 6,174 of the total number who attended were given the Initial Schick Test to see if they were susceptible to Diphtheria, and the remaining 2,479 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 X. 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 4,313 persons gave a positive result to the initial Schick Test showing that they were susceptible to Diphtheria. This is 70 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 X; 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 192 2764 931 1892 1995 3887 277 149 1919 2394 4313 Schick Negative 46 771 571 675 713 1388 227 170 704 1081 1785 Result not read 5 38 21 26 38 64 9 3 29 47 76 Total 243 3573 1523 2593 2746 5339 513 322 2652 3522 6174 Percentage Positive 79% 77% 61% 73% 73% 73% 54% 46% 72°/ /o 68% 70% 26 Report of the Medical Officer of Health for 1936. the small number of adults who were tested 51 per cent. gave? 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 6,792. This number is made up of 4,313 who were found to be Schick positive after the initial test and the 2,479 young children who were assumed to be susceptible without a test, as they were under five years of age. The subsequent history of these 6,792 persons is given in the following statement:— No. who were immunised and found to be Protected as shown by a Negative re-Schick Test 5,091 No. who received a course of injections but are not yet protected as the re-Schick Test is still positive 248 No. who received injections, the value of which is not known as they have not attended to be re-tested 1,396 Schick positive cases who were not injected 57 Total number of Susceptibles 6,792 27 Infective Diseases. TABLE XI. 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 2021 2192 657 2291 2579 4870 142 79 2309 2782 5091 28 Report of the Medical Officer of Health for 1936. The age grouping of the persons in whom immunity was produced is given in Table XI. Three of the 5,091 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 three children were tested again after they had recovered from the attack, and the result of this re-test was negative. Two persons who became protected as shown by a negative re-Schick test received no immunising injections but were tested a second time after one year and nine months and three years and three months respectively. The result of the re-test was negative in each case. 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 XII., giving this information. The five cases referred to in the previous paragraph are not included in the Table, which deals with 5,086 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 XII. brings out the following points :— (1) One series of injections was sufficient to produce immunity in most of the cases—actually, 4,474 out of 5,086 were immunised after the first series. (2) 556 cases required a second series of injections to produce the same result. 29 Infective Diseses. TABLE XII. 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 7 years and 9 years Children Under 15. 1 injection 1224 17 9 6 1256 1 2 - - - 1279 2 injections 130 710 172 19 1031 61 14 3 — 2 1111 First Series 3 injections 582 774 312 117 1785 92 15 1 — — 1893 4 injections 5 5 — 2 12 - - - - - 12 Second Series 2 to 6 injections 40 107 44 166 357 123 33 5 1 — 519 Third Series 3 to 8 injections — — 3 4 7 32 6 1 — — 46 Fourth Series 4 to 6 injections — — — 3 3 — 1 - — - 4 Fifth Series 10 injections - — — — — 1 — — — — 1 Total Under 15 1981 1613 540 317 4451 330 71 10 1 2 4865 Adults Over 15. 1 injection 27 7 - 3 37 - - - - - 37 2 injections 5 38 10 2 55 2 1 1 — — 59 First Series 3 injections 29 30 14 4 77 5 — — - — 82 4 injections — 1 — — 1 — — — - — 1 Second Series 3 to 6 injections — 1 9 13 23 13 - 1 — — 37 Third Series 11 injections — — — 1 1 1 1 — — — 3 Fourth Series 6 to 8 injections — — — — — 1 1 — — — 2 Total All Ages 2042 1690 573 340 4645 352 74 12 1 2 5086 Three cases primary Schick positive, received no series of injections and re-schick test negative after suffering from Diphtheria. One case primary schick positive, received no series of injections and re-schick test negative after one year and nine months. One case primary schick positive, received no series of injections and re-schick test negative after three years and three months. 30 Report of the Medical Officer of Health for 1936. (3) In a few cases further series had to be given before immunity was produced. (4) 3,732 out of 5,086 cases were protected within six months after receiving the last dose of immunising serum. (5) By the end of twelve months this number had increased to 4,645. 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 5,091 persons who have been protected, 248 have completed the first series of injections but cannot be recorded as protected because the last re-Schick test has given a positive result. 97 of these have not attended since this positive re-test. The other 151 have attended the Clinics and have received further injections but have not yet reacted negative to the re-Schick test. A further 1,396 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 556 who completed the first series of three injections and 840 who only received one or two doses. 57 susceptible persons have not yet commenced a course of injections. In the eight years during which the Clinics have been open, eight children who had reacted negative to the primary Schick test have been notified to me as cases of Diphtheria. Two of these showed clinical symptoms of the disease and six were bacteriological cases with no clinical symptoms. Eighteen children who had been immunised and reacted negative to the re-Schick test have been notified as cases of Diphtheria. Nine of these were clinical cases. Nine children who had been immunised but were not retested have been also notified. Three of these were clinical cases. There were no deaths among these 35 patients. 31 Infective Diseases. In 1935 the Council decided, with the approval of the Minister of Health, to supply immunising material free of charge to general practitioners in the Borough for use in immunising and testing Borough residents. Since that decision was arrived at, five doctors have availed themselves of these facilities and 11 children have been immunised by them. Nine of these have re-acted negative to the re-Schick test—eight being tested by the practitioners and one by the assistant Medical Officer of Health. The other two children have not yet been tested. Scarlet Fever. 644 cases of Scarlet Fever occurred, compared with 721 in 1935, 1,573 in 1934 and 1,307 in 1933. The decrease in the number of cases has been associated with a general decrease in the incidence of this disease throughout London. None of the cases died, compared with five in each of the two previous years, and the death-rate was nil per 1,000 compared with .011 and .014. The case mortality was also nil. The case-rate per 1,000 of population was 1.87:—1.88 in Clapham; 1.34 in Putney; 1.79 in Balham; 2.15 in Streatham; 3.15 in Tooting; and 1.57 in Wandsworth. Of the total number of cases, 563 or 87 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. 11 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. 28 cases, and three deaths of the above occurred, compared with 11 cases and one death in the previous year. 32 Report of the Medical Officer of Health for 1936. 14 of the cases were true Enteric Fever and 14 were Paratyphoid Fever. Puerperal Fever and Puerperal Pyrexia. During the year seven cases of Puerperal Fever and 20 cases of Puerperal Pyrexia occurred. One of the cases died. The death-rate was .002 per 1,000 of population and .24 per 1,000 (live and still) births. Erysipelas. 127 cases were notified and two deaths occurred during the year, compared with 125 and seven in 1935. Whooping Cough. 12 deaths from Whooping Cough occurred during the year and the death-rate was .03 per 1,000. 792 cases came to the knowledge of the Department during the year. 94 of the cases were removed to hospital during the year. 654 visits were made by the Health Visitors to houses where cases of Whooping Cough occurred, and four premises were disinfected. Influenza. The number of deaths from Influenza was 44 compared with 38 in 1935, 43 in 1934, 183 in 1933, 111 in 1932 and 97 in 1931. The death-rate was .12 per 1,000. Influenzal Pneumonia and Acute Primary Pneumonia. 46 cases of acute Influenzal Pneumonia, and 275 cases of acute Primary Pneumonia were notified. 14 of the former and 40 of the latter died. The total number of deaths credited to all forms of Pneumonia during the year was 171, compared with 145 in 1935, 187 in 1934, 175 in 1933, 180 in 1932, 191 in 1931, 207 in 1930, 331 in 1929, 246 in 1928, 239 in 1927 and 217 in 1926. 33 Infective Diseases. Cerebro-Spinal Meningitis. Four cases of this disease occurrcd, and four deaths were registered. Two other cases of this disease were notified, but proved not to be cerebro-spinal meningitis. Six deaths were registered as being caused by Meningitis. Polio-myelitis and Polio-encephalitis. Six cases occurred, none of which proved fatal. No cases were sent 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 both terminated fatally. In addition, two other deaths from this cause were registered during the year in cases that occurred during previous years. Malaria. Four cases were notified. No death occurred. Dysentery. Three cases of Dysentery were notified and no death occurred. Ophthalmia Neonatorum. 27 cases were notified. 22 of them recovered without any impairment of vision, one case died from Premature birth and Pemphigus Neonatorum, one from Infective Enteritis, one from Pneumonia, one removed from the Borough, and one was still under treatment at the end of the year. 34 Report of the Medical Officer of Health for 1936. TABLE XIII. Result of Treatment. Removed from Borough. Still under Treatment. Recovered— Vision not affected. Vision Impaired. Total Blindness. Died. Treatment received:— In Hospital 8 — — 2 — — At Hospital, Out-patient 5 — — — 1 — At home 9 — — 1 - 1 Total 22 — — 3 1 1 Measles. The number of cases brought to my notice during the year October 1st, 1935, to September 30th, 1936, was 3,973. 24 cases died during the calendar year. 73 cases of German Measles were also reported. Table XIV. 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. 509 cases were removed to hospital, compared with 620 in the epidemic year of 1934. 109 cases requiring special home nursing were referred to District Nursing Associations in the Borough, compared with 73 in 1934 and the nurses made 1,108 visits to these cases, compared with 920 in 1934. The death-rate per 1,000 of the population was .06 compared with .17 in 1934 and TO in 1932. 5,628 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Measles occurred, and 132 premises were disinfected at the request of the occupiers. 35 Infective Diseases. TABLE XIV. MEASLES—CASES REPORTED AND DEATHS. Period 1st October—30th September. 1926-27 1927-28 1928-29 1929-30 1930-31 1931-32 1932-33 1933-34 1934-35 1935-36 Cases Reported. In a Measles year — 4,596 — 4,046 - 3,601 — 4,140 — 3,973 In a Non-Measles year 81 — 355 - 295 — 589 — 151 — Deaths. In a Measles year — 38 — 46 — 38 — 37 — 24 In a Non-Measles year 2 — 1 2 — 2 — 2 — Period. Calendar Year 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 Cases Reported 172 4,529 380 3,976 291 3,598 615 4,148 137 3,987 Deaths 4 36 1 47 2 37 2 37 2 24 36 Report of the Medical Officer of Health for 1936. Table XV. shows the number of cases of infective diseases which were reported from schools during the year. TABLE XV. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases Totals. Clapham. Bonneville Road 10 8 103 3 66 6 5 1 1 203 Cavendish Road 6 3 61 — 4 12 3 1 — 90 Christchurch 5 3 25 16 4 — 7 1 — 61 Haselrigge Road 8 5 64 6 17 27 69 2 8 206 Henry Thornton — 1 — — 1 — 1 — — 3 Larkhall Lane 6 8 43 9 11 3 16 — 5 101 New Park Road 9 16 81 1 1 19 — — — 127 New Road 1 7 3 — 5 2 1 — — 19 Parochial, Old Town 3 — 59 5 — 15 2 — 1 85 St. Andrew's Street 3 11 21 — 2 1 1 — 1 40 St. Mary's, Crescent Lane 1 — 4 1 1 2 — — — 9 St. Mary's, St. Alphonsus Road 1 - - - - - - — — 1 Stonhouse Street 6 10 34 5 5 13 1 — — 74 Telferscot Road 5 5 18 — 4 1 1 3 2 39 Putney. • Convent of Sacred Heart - - 1 - - - - - - 1 Hotham Road 5 2 101 1 3 11 37 2 4 166 Huntingfield Road 5 1 34 9 1 23 6 — — 79 Parochial, Roehampton — — 3 — 1 6 1 1 — 12 St. Agnes', R.C. — 2 - - - - - - - 2 St. Mary's 2 1 15 1 1 6 4 1 — 31 Upper Grade — — 21 1 — 7 2 — — 31 Balham. Balham Central 1 — — — 1 — — — — 2 Bec, The 1 - - - - - - - - 1 Broadwater Road 3 4 2 — 8 3 — — — 20 Broadwater Road, P.D. 1 — — — — — — — — 1 Fircroft Road 7 - 22 1 12 5 — — — 47 Hearnville Road 3 2 48 — 57 11 36 — — 157 Holy Trinity — 1 — — — — — — — 1 Nightingale Square, R.C. 1 — 1 — 2 6 — — — 10 Oldridge Road — 3 34 1 5 17 3 — 1 64 Ravenstone Street 3 2 49 — 2 5 19 — 1 81 St. Mary's 3 — 45 — 5 2 7 — — 62 Smallwood Road 26 10 46 - 26 3 - - - 111 Carried forward 125 105 938 60 245 206 222 12 24 1937 37 Infective Diseases. TABLE XV.—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 5 125 105 938 60 245 206 222 12 24 1937 Streatham. Dunraven 4 - - - 1 - - - - 5 Eardley Road 24 1 85 3 20 5 - 2 6 146 Furzedown Demonstration 1 1 50 2 4 4 15 1 4 82 Granton Road 2 1 67 — 10 4 — — — 84 Hitherfield Road 11 1 111 2 9 3 — — — 137 Holy Trinity 1 1 2 — — — 1 — — 5 Mitcham Lane 10 1 56 — 6 10 1 — — 84 St. Andrew's, Polworth Road 2 — 26 — 4 10 — — — 42 St. Leonard's 10 1 15 1 — 3 1 1 — 32 Sunnyhill Road 7 3 5 - - 6 — — — 21 Woodmansterne Road 7 1 24 - 12 46 36 — — 126 Tooting. Convent of Holy Family — 2 - - - - - - - 2 Defoe (Fountain Road) 9 5 32 - 1 — — — — 47 Ensham Central 1 — — - — — — - — 1 Ensham 6 — 63 1 6 33 — 1 1 111 Franciscan Road 10 1 5 - 20 - — — — 36 Hillbrook Road 12 1 79 2 46 27 — — — 167 Sellincourt Road 24 4 65 1 2 41 3 1 5 146 Tooting Graveney 6 3 3 - 1 8 - - - 21 Undine Street, R.C. 2 1 10 — — 27 — - — 40 Wandsworth. Allfarthing Lane 1 1 42 — 23 21 3 - 6 97 All Saints' 8 - 14 — 2 1 6 - - 31 Brandlehow Road - - 59 - 4 13 1 - - 77 Earlsfield 1 1 — — 1 - — 1 2 6 Elliott Central 2 — 1 - - - - - - 3 Eltringham Street 3 7 58 2 16 1 - - - 87 Frogmore Special 1 — — — 1 — — — — 2 Garratt Lane 3 3 19 — 2 3 1 — 1 32 Magdalen Road 4 1 70 — 9 15 35 - — 134 Merton Road - 1 - 1 1 - - - - 3 Riversdale 7 3 102 — 14 2 5 — — 133 St. Ann's 1 — 18 — 12 5 — 1 — 37 St. Faith's 3 3 41 — 8 8 3 — 1 67 St. Joseph's - 2 16 1 - 3 - - - 22 St. Michael's 4 9 10 - 4 - - - 1 28 Carried forward 312 144 2086 76 484 507 338 20 51 4031 38 Report of the Medical Officer of Health for 1936. TABLE XV.—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 312 144 2086 76 484 507 338 20 51 4031 Swaffield Road 6 4 71 - 1 1 4 - - 87 Waldron Road 11 5 54 - 14 1 1 - 1 87 Wandle 7 1 46 - 3 10 1 - 7 75 Wandsworth - 3 - - - — — - — 3 Wandsworth Central — 1 - - - - - - - 1 Warple Way 2 1 — - - 21 1 - — 25 West Hill 1 2 39 - 7 4 1 1 2 57 Grand Total 339 181 2296 76 509 542 341 21 61 4366 Diarrhœa. The number of deaths from Diarrhoea was 36 compared with 41 in 1935, 44 in 1934, 43 in 1933 and 68 in 1932, and of these 34 or 94 per cent., were under the age of one year, compared with 70 in 1935. The number of deaths from Diarrhoea, Zymotic Enteritis and Enteritis under one year represents 14.6 per cent. of the total mortality at that age. Other Infective Diseases. 15 deaths occurred, eight from Syphilis, five from Septicaemia and two from Pyaemia. Scabies. The names of 120 school children who were suffering from Scabies were forwarded to me by the Medical Officer to the London County Council, and the homes were visited by the Sanitary Inspectors. These children were being treated at the London County Council cleansing stations. 39 Infective Diseases. In addition to the above 124 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 170 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 28 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 15 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 1,945:—370 in Clapham, 196 in Putney, 319 in Balham, 321 in Streatham, 186 in Tooting, and 553 in Wandsworth. 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 1936. Bacteriological Examinations. During the year 2,907 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 XVI. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Diphtheria:— Negative 392 418 292 572 331 613 2618 Positive 49 10 25 25 23 64 196 Enteric Fever:— Negative 6 — 3 6 4 9 28 Positive — — 1 2 - 3 6 Other Diseases:— Negative 8 1 5 6 2 1 23 Positive 10 4 5 11 1 5 36 Total 465 433 331 622 361 695 2907 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 568, the number of males being 255 and females 313, The death-rate was 1.65 per 1,000. The number of deaths in 1036 was four more than in 1935. The number of deaths from diseases of the Brain and Nervous System was 127. 1,440 deaths occurred from diseases of the Heart and Circulatory System, compared with 1,446 in 1935, 1,272 in 1934, and 1,260 in 1933. 1,123 of these deaths were of persons over 65 years of age. There were 440 deaths from diseases of the Respiratory System, compared with 341 in 1935, 396 in 1934 and 386 in 1933. The number from Bronchitis was 247 compared with 167 in 1935, and from Pneumonia (all forms) 171 compared with 145 in 1935. 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 50. 119 deaths, 73 males and 46 females, were registered as due to Premature Birth and Developmental Diseases, compared with 105 in 1935. 88 deaths, 34 males and 54 females, occurred from Old Age, and all these were persons over 65 years of age. The number of deaths due to this cause in 1935 was 74. 173 deaths were due to violence, 120 of them being due to accidents, 46 to suicide, and seven 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 four persons receiving treatment. The cost to the Council for the year 1936 was £19 7s. Od. Inquests. Inquests were held on 274 persons dying in the Borough, and on 186 Borough residents who died outside the Borough. 42 Report of the Medical Officer of Health for 1936. The next Table shows the results of the findings of these inquests. TABLE XVII. Inquests. Sub-Districts. Whole Borough. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Deaths from Natural Causes 42 44 46 36 39 54 261 Accidental:— Falls 4 1 9 3 8 7 32 Knocked down by motor vehicles 3 10 9 8 - 2 32 Falls from motor vehicles 3 4 — 2 2 6 17 Falls from a height 4 2 2 1 - 3 12 Burns and scalds 3 1 4 — — 1 9 Suffocation 1 — 1 2 3 — 7 Falls from bicycles 1 — 1 2 1 2 7 Drowning — 3 2 — — 2 7 Knocked down by train — 1 1 — — 2 4 Knocked down by tramcar - - 2 - 1 - 3 Other 2 2 1 4 3 3 15 Suicidal:— Poisoning by:— Coal Gas 1 1 4 5 1 10 22 Lysol — — 1 2 1 — 4 Hydrochloric Acid — — 1 — — — 1 Hydrocyanic Acid - - - - - 1 1 Strychnine — — 1 — — — 1 Hanging - — 1 1 — 3 5 Cut throat 2 - 1 — — 1 4 Drowning - - — 1 — 2 3 Fall from a height 1 — 1 — — — 2 Gunshot wounds — 1 — — 1 — 2 Fall under train - — 1 — — 1 2 Murder 1 — — 1 1 — 3 Hanging - - - - - 3 3 Manslaughter — 1 — — — — 1 Totals 68 71 89 68 61 103 460 43 TUBERCULOSIS. Notification.—The total number of new cases of Tuberculosis which came to the notice of the Department during 1936 was 569 as compared with 658 in 1935, 621 in 1934, 610 in 1933, and 642 in 1932. The sources of information regarding the 569 new cases in 1936 were as follows :— Primary notifications on Form A 397 Primary notifications on Form B — Transfers from other Sanitary Authorities 151 Naval and military notifications 2 Un-notified at death 19 Total 569 Deaths.—The number of deaths certified as due to diseases of a Tuberculous nature was 236. This compares with 249 in 1935, 276 in 1934, 305 in 1933 and 228 in 1932. Table XVIII.—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 1936. TABLE XVIII. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Males. Females. Males. Females. Males. Females. Males. Females. Und6r 1 year 1 1 - 1 - 1 - 1—5 3 1 8 2 - — 4 1 5—10 5 2 6 4 - - 1 1 10—15 5 7 7 4 2 5 3 - 15—20 14 23 6 9 6 15 1 2 20—25 35 48 6 6 18 15 3 1 25—35 75 78 5 7 25 30 4 - 35—45 41 29 3 4 27 13 1 - 45—55 53 9 3 2 19 6 2 - 55—65 31 10 2 3 12 4 1 1 65 upwards 3 2 1 5 5 2 1 3 Totals 266 209 48 46 115 90 22 9 Table XIX. shows the number of new cases of Nonpulmonary Tuberculosis classified according to the part of the body affected. TABLE XIX. Localisation of Disease. Males. Females. Total. Brain 7 2 9 Glands, Mesenteric 2 12 14 Glands, Cervical 6 10 16 Bones and Joints 21 11 32 Other Parts 12 11 23 Totals 48 46 94 45 T uberculosis. Of the 236 deaths from Tuberculosis, 137 were males and 99 females. 205 deaths were due to Pulmonary Tuberculosis and 31 to other forms of Tuberculosis. Further details are given in Table XX. TABLE XX. Localisation. Males. Females. Total. Pulmonary Tuberculosis 115 90 205 Brain 9 3 12 Glands, Mesenteric 2 3 5 Bones and Joints 2 1 3 Other Parts 9 2 11 Totals 137 99 236 In addition to these deaths, which were duly certified in the returns as due to Tuberculosis, 22 persons previously notified as suffering from Tuberculosis died during the year. These deaths, however, do not figure in Table XX. for the reason that:— (a.) Ten 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. 46 Report for thr Medical Officer of Health for 1936. TABLE XXI. 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 Pulmonary Tuberculosis:— No. of Deaths 300 269 320 275 288 245 257 235 216 205 Death-Rate •85 •76 •90 •77 .81 .69 •73 •66 •62 •59 Other Forms:— No. of Deaths 39 35 33 33 19 43 48 41 33 31 Death-Rate •11 •10 •09 •09 •05 •12 •13 . -11 •09 •09 Total:— No. of Deaths 339 304 353 308 307 288 305 276 249 236 Death-Rate •96 •86 .99 •86 •86 •81 •86 •78 •72 •68 47 T uberculosis. During the year 19 persons, not previously notified, were certified as having died of Tuberculosis. The ratio of un-notified Tuberculosis deaths to total Tuberculosis deaths is therefore 19 to 236. Of the 19 un-notified deaths, 12 were certified from Institutions, three by private doctors, while in four cases Tuberculosis was discovered post mortem. In all cases the certifying doctor was asked for an explanation, but in no case was it considered necessary to take proceedings for wilful neglect or refusal to notify. 59 persons died within one month after notification, 74 within three months, and 87 within six months. 569 cases were added to the notification register during the year, and 602 cases who had removed, recovered or died, were taken off. The number remaining on the register at the end of the year was 2,081. 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 pm.), for those at work. Friday Morning. New Cases in 1936.—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 XXII. Tuberculous. Suspected Tuberculosis NonTuber culous Totals. Pulmonary NonPul monary Total Adults M. 166 18 184 11 285 480 F. 125 14 139 7 305 451 Children M. 6 12 18 — 227 245 F. 5 7 12 1 229 242 Totals .. 302 51 353 19 1046 1418 49 Report of the Medical Officer of Health for 1936. The districts of the Borough in which these 1,418 persons resided, together with the authorities who recommended them to attend, are given in Table XXIII. TABLE XXIII. Recommended to attend Dispensary by Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Totals. Public Health Department 70 38 29 41 57 119 354 Private Practitioners 52 44 44 45 78 147 410 Charitable Societies 20 24 6 6 29 63 148 Other Dispensaries 47 22 20 28 40 46 203 L.C.C. Schools — - — — 2 3 5 Ministry of Pensions - - - - - - - Existing Dispensary Patients - - - 1 4 - 5 Other Sources 22 21 46 28 45 131 293 Totals 211 149 145 149 255 509 1,418 Contacts.—Of the 1,418 new cases examined, 403 were contacts. 17 of these were found to be suffering from Tuberculosis. Dispensary Register.—Table XXIV. 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 XXIV. Tuberculosis Remaining 31st Dec., 1935 New Cases Removed from Register Remaining on Register 31st Dec., 1936 Pulmonary 1116 366 354 1128 Non-Pulmonary 262 58 69 251 Suspected cases 26 150 157 19 Totals 1404 574 580 1398 50 Report of the Medical Officer of Health for 1936. Table XXV. gives further details of the work carried out during the year. TABLE XXV. 1. Number of patients transferred from other areas and " lost sight of " cases returned 120 2. Number of patients transferred to other areas and cases " lost sight of " 202 3. Died during the year 168 4. Number of cases recovered 53 5. Number of observation cases in which a period of observation exceeded two months 30 6. Number of attendances at the Dispensaries 5059 7. Total number of reports, etc., made in connection with the Dispensaries 4937 8. Number of attendances at General Hospitals or Institutions of patients for— (a) Light treatment 230 (6) Other special forms of treatment 1640 9. Number of patients to whom Dental Treatment was given in connection with the Dispensary 25 10. Number of Personal Consultations with Medical Practitioners— (a) At Homes of Patients 251 (b) Otherwise 1678 11. Number of other visits by Tuberculosis Officers to Homes 303 12. Number of visits by Health Visitors or Nurses to homes for Dispensary purposes 5112 13. Number of— (a) Specimens of Sputum, etc., examined 1443 (6) X-ray examinations made in connection with Dispensary work 201 The number of patients who received institutional treatment under the London County Council's Tuberculosis Scheme during 1936 was as follows : — (a.) In Hospitals for observation 32 (b.) In Sanatoria 451 (c.) In Hospitals for Advanced Cases 2 485 In addition to these many other patients received treatment in private or general hospitals. 51 Tuberculosis Dispensaries. 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. 108 cases were treated during the year and 1,596 refills were administered. The cost to the Council was £837 18s. Od. Two of these cases also received Sanocrysin injections, at a cost of £6 12s. Od., for 44 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. Twenty-five patients received dental treatment and 18 of these were supplied with dentures. The attendances at the dentist totalled 54. The amount expended on dental treatment during the year was £10 0s. Od., and the cost of dentures supplied to patients was £24 12s. 6d., making a total cost of £34 12s. 6d. Extra Nourishment.—Under Section 3 of the Public Health (Prevention and Treatment of Disease) Act, 1913, extra nourishment is granted on medical grounds as part of treatment. It is limited to the slighter cases of disease, where there is a reasonable probability that extra nourishment will increase the chances of recovery, or will enable the patient to remain at work or to return to work at any early date. During the year under consideration 99 patients have been granted extra nourishment under the scheme at a cost of £146 5s. 8d. The scheme has been found to be of great help in the treatment of the types of patient mentioned above. 52 Report of the Medical Officer of Health for 1936. 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 patients suffering from Tuberculosis who have attended the Dispensaries since they were opened in 1913, and their condition at the end of 1936 as far as it is known. Table XXVI refers to cases of Pulmonary Tuberculosis and Table XXVII to cases of Non-pulmonary Tuberculosis. 53 Tuberculosis Dispensaries. TABLE XXVI. Classification on Initial attendance at the Dispensaries. Condition at the end of 1936. 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. Aduits, M. 425 19 88 245 777 1834 871 2705 Class T.B. Minus. Adults. F. 487 34 112 240 873 Children 122 8 23 31 184. Class T.B. Adults, M. 158 54 333 1744 2289 4043 1372 5415 Plus. Adults, F. 132 52 246 1273 1703 Children 9 3 8 31 51. 54 Report of the Medical Officer of Health for 1936. TABLE XXVII. Classification on Initial attendance at the Dispensaries. Condition at end of 1936. 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. Adults, M. 52 1 32 21 106 287 141 428 Bones and Joints Adults, F. 26 4 18 10 58 Children 69 8 24 22 123 Abdominal Adults, M. 12 — 3 4 19 93 68 161 Adults, F. 13 - 11 5 29 Children 28 3 8 6 45 Peripheral Glands Adults, M. 20 1 7 4 32 358 140 498 Adults, F. 43 5 9 11 68 Children 218 8 21 11 258 Other Organs. Adults, M. 18 4 7 13 42 128 52 180 Adults, F. 20 2 23 9 54 Children 8 1 3 20 32 55 Tuberculosis Dispensaries. Bacteriological Examinations.—The number of examinations of sputum made at the Dispensary during the past six 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 1936 1443 933 232 INVESTIGATION BY " THE PROPHIT TRUST. In December, 1935, the Council decided to allow the Royal College of Physicians to make use of the Tuberculosis Dispensaries in connection with a large scale investigation into the early stages of Tuberculosis which the College is carrying out on behalf of the Prophit Trust. This investigation has been initiated with the object of discovering the fundamental causes which lead to infection with Tuberculosis and the method of spread of tuberculous lesions. It is hoped to obtain evidence which will enable the disease to be diagnosed in an earlier stage than is at present possible, and will throw light on the true meaning of certain X-ray findings and the value of the Tuberculin Test. The investigation is being carried out by Dr. Ridehalgh, one of the scholars of the Royal College of Physicians, who has visited the Wandsworth Dispensary at ten special evening sessions and has examined forty persons who are contacts of cases of Tuberculosis. The investigation is being continued. 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. 56 Report of the Medical Officer of Health for 1936. 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. 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 Jacobs, Streatham, Clapham, Balham and Tooting Invalid Children's Aid Association. H. B. Harvey, Esq., Aged Poor Society. Miss Marx, Brompton Hospital. Miss E. Morris, St. Thomas's Hospital. Mr. W. H. Greenwood, Streatham Toe H. Miss Lemon, Ranyard Nurses. Mrs. Arding. Mrs. Cresswell. Mrs. Dearman. Mrs. Dixon. Miss J. Duff, J.P. Mrs. Duffell. Mrs. Groom. Dr. E. Higgins. Mrs. H. Jeans. Mrs. Laer. Mrs. MacDonald. Mrs. Marriott. Mrs. Morton Clarke. Mrs. Nicol. Mrs. Evan Rees. Officers of the Committee :— Chairman : Miss J. Duff, J.P. Vice-Chairman : Mrs. Cresswell. Hon. Treasurer: Mrs. Dearman. Secretary : Miss M. L. Baptie. Tuberculosis Dispensaries. 57 Meetings.—The Care Committee meets on the first Friday in every month at 3 p.m. The Finance Sub-committee and Handicraft Sub-committee 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. 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. This is utilised to grant assistance to persons suffering from Tuberculosis when this cannot be provided by other organisations. 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-eight adults and two children were sent away for convalescent treatment daring 1936 at a cost of £139 7s. 6d. 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 £126 5s. 8d. 58 Report of the Medical Officer of Health for 1936. 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 30 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 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 £39 14s. 5d. 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 152 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 inquires into all matters of this nature and is able to assist in smoothing out many of the patients' difficulties. During 1936 the number of visits and interviews made by the Secretary to cases attending the Dispensaries was 1,895. During the year there have not been so many cases referred to the various ex-service organisations, as there were fewer ex- Tuberculosis Dispensaries. 59 service men attending the Dispensaries. Six 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. 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 once a week, and is in charge of Miss Wright, who is a trained insti'uctress in the crafts taught. These include 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 John Keall, J.P., M.P.S. 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, Putney, Blegborough Road and Riggindale Road, Streatham. At those Centres where the Superintendent is the officer of the Centre Committee, one of the Health Visitors assists her at all Infant Welfare and AnteNatal sessions. Where the Superintendent is one of the Health Visitors she is assisted at the sessions by another Health Visitor. Infectious Diseases—All cases of Puerperal Fever, Puerperal Pyrexia, Whooping Cough and Ophthalmia Neonatorum are 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. An additional Health Visitor was appointed during the year in order that more visits could be made to toddlers. As a result approximately 2,000 more visits were made to children under 5 years of age than in the previous year. Table XXVIII. 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 1936. Infant Visiting. TABLE XXVIII. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. No. of children visited:— Under 1 year 613 308 515 566 410 991 3403 1-2 years 27 8 7 6 16 27 91 2-5 years 66 2 6 10 18 58 160 Revisits to:— Infants under 1 year 865 575 380 1026 401 1257 4504 Children 1-2 years 655 389 348 792 378 1073 3635 Children 2-5 years 1069 464 595 1283 391 2197 5999 Total visits to children under Notification of Births Act 3295 1746 1851 3683 1614 5603 17792 Other visits— : Foster Mothers 192 88 127 180 77 243 907 Ophthalmia Neonatorum 7 5 — 9 — 21 42 Measles 1068 422 792 1023 894 1425 5624 Whooping Cough 108 102 42 134 106 162 654 Ante-natal cases 636 315 376 676 392 761 3156 Puerperal Fever and Pyrexia 2 2 2 4 5 15 30 Miscellaneous 267 115 185 245 145 517 1474 Ineffectual 1264 170 593 1325 701 2250 6303 Total Home Visits 6839 2965 3968 7279 3934 10997 35982 There were 3,932 births during the year and 3,403 of these, or 86.5 per cent., were visited compared with 90.0 in 1935, 88.4 in 1934, 89.1 in 1933, 89.0 in 1932, and 90.9 in 1931. On the occasion of the initial visit it was found that 2,995 of the 3,403 infants visited were being fed from the breast entirely. Maternity and Child IV elf are. 63 On subsequent visits 121 infants under one month, 573 from one to three months, 681 from three to six months, and 532 from six to twelve months were still being mainly breast fed. It was found that in 415 of the births, doctors had been in attendance, while in 845 the services of midwives had been utilised. 2,143 infants were born in hospitals and other institutions. The following Table shows the number of occasions on which the Health Visitors attended clinics, etc. TABLE XXIX. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Attendances at:— Infant Welfare Centres 148 239 157 398 268 442 1652 Diphtheria Prevention Clinics — — 48 — — 45 93 Ante-natal Clinics 22 29 28 47 22 40 188 Visits to Crcèhes — 19 10 — — 19 48 Committee Meetings 3 18 - 3 10 3 37 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. 64 Report of the Medical Officer of Health for 1936. The medical officer attends at most of the Infant sessions held at each Centre, and at all the Ante-natal sessions. The X 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 1.30 p.m. Streatham : 37, Riggindale Road. 1st and 3rd Wednesdays in each month at 10 a.m., at 37, Riggindale Road. Tuesdays at 1.30 p.m. Fridays at 2 p.m. Wesley Hall, Blegborough Road. Thursdays at 2 p.m. Streatham Hill with Clapham Park: Baptist Church Hall, New Park Road. None. Tuesdays 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 Thursdays at 2 p.m. Springfield: Congregational Church Hall, Earlsfield Road. 4th Tuesday in each month at 11 a.m. Tuesdays at 2 p.m. 66 Report of the Medical Officer of Health for 1936. Table XXX. gives the full details of the work carried out at the 12 centres in the Borough. 3,193 new infants were examined during the year and the total attendances were 62,982. The visits made by the Superintendents of the three Centres where those officers are appointed by the Centre Committees were 1,666 to children under 1 year, 1,622 to children from 1 to 2 years and 431 to children from 2-5 years of age. At nine of the twelve Infant Welfare Centres ante-natal clinics are held and there are also four ante-natal clinics held weekly at the Council's Maternity Home for women who have booked for admission to the Home. Table XXXI. gives the details of the work carried out at all the ante-natal clinics. 1014 expectant mothers attended the clinics and the total number of attendances was 5731. TABLE XXX. No. of Sessions held. No. of new cases. No. of Doctors' Consultations. Total attendances. Infant Clinics :— Clapham 101 438 2913 7609 Putney 98 242 2598 5645 Putney Park 48 60 778 1121 Balham 101 650 3521 10897 Streatham 95 342 2285 7265 Blegborough Road 49 97 870 2347 Streatham Hill (Clapham Park) 90 280 1900 5022 Fairlight 98 242 1842 5356 Beechcroft Road 47 132 890 3275 Southfield 98 256 2303 5616 Fairfield 100 217 1900 4279 Springfield 48 237 1083 4562 Total 973 3193 22883 62994 Maternity and Child Welfare. 67 TABLE XXXI. No. of Sessions held. No. of new cases. Total attendances. Ante-Natal Clinics:— The Maternity Home 206 475 4389 Clapham 24 80 215 Putney 25 86 263 Balham 27 88 258 Streatham 23 72 175 Fairlight 12 37 85 Beechcroft Road 12 32 67 Southfield 12 50 102 Fairfield 12 47 89 Springfield 12 38 88 Total 365 1014 5731 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 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 whicli is held at the Maternity Home twice a week. A post-natal clinic is also held at the Home every week. Details with regard to the ante-natal Clinics are given in Table XXXI. 68 Report of the Medical Officer of Health for 1936. 318 patients attended the post-natal Clinics and the attendances made were 327. During the past year 492 women were admitted to the Home and the average duration of stay was 1417 days. 438 deliveries were carried out by the midwives, 49 by the medical staff, three cases were transferred before confinement, and two women were confined before they were admitted. In 196 cases it was necessary for the midwives to summon medical assistance in accordance with the requirements of the Midwives Act. Seven cases of Puerperal Pyrexia were notified from the Home- Four of the infants were still-born and eight died within 10 days of birth. No infant was 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 41 cases the natural feeding had to be supplemented. 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' five occasions. Maternity aud Child Welfare. 69 Hospital Treatment for Ante-Natal Women. The Council has made arangements 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. Three cases have 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 Is. 3d. is paid for each visit to these cases except in Balham where a special grant of £80 per annum is paid by the Council to the Ranyard Nurses for the services of the nurse in this area. 355 cases were visited during the year under these arrangements, and 4,925 visits were made. Full particulars are given in Table XXXII. TABLE XXXII. No. of cases occurring. No. of cases visited. No. of visits made. Whooping Cough 792 13 277 Influenza — 58 527 Pneumonia 321 92 1985 Ophthalmia Neonatorum 27 50 762 Measles 3987 109 1108 Puerperal Fever and Puerperal Pyrexia 27 — — Infantile Diarrhœa — 3 15 Minor Ailments — 30 251 Total 5154 355 4925 70 Report of the Medical Officer of Health for 1936. 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. 44 midwives practise in the Borough, of whom 14 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 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. Od. to a midwife conducting a confinement at home. £1 0s. Od. 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 Mid- wives Board. Maternity and Child Welfare. 71 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 th Medical Officer of one of the Council's ante-natal clinics earl 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. It was also decided that sterilized maternity outfits should be supplied to a midwife by the Council when they are required. The Council has al90 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. No payment is made to a midwife where the patient herself applied for admission to an Institution. During the year assistance was granted to 29 midwives under this scheme and compensation was paid in five cases. The total cost of the service was £50 1s. 0d. One sterilized maternity outfit was supplied. Day Nurseries. There are three Day Nurseries in the Borough which are voluntary institutions receiving grants from the Borough Council. Their addresses are :— 72 Report of the Medical Officer of Health for 1936. Putney Putney Creche, 95, Lacy Road. Wandsworth Wandsworth Day Nursery and Training School, 14, Garratt Lane. Balham Balham Day Nursery, 22, Old Devonshire Road. The Tooting Day Nursery was closed on 31st March, 1934, as it was decided that there was no justification for keeping it open owing to the fall in the number of children attending. The admissions of children to the Day Nurseries is limited to those whose mothers are obliged to go out to work, who are ill or who for any other reasonable cause are unable to look after their children. The parents payments vary from 6d. to 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 lip creche work who are admitted as probationers and remain for about a year. Practical and theoretical instruction is given by the matrons and the instruction includes courses of lectures, which the probationers have to attend before they can sit for the examination which is held at the end of the course. The attendances at the Day Nurseries were:—Putney, 5,425; Balham, 6,682; and Wandsworth, 6,822; a total of 18,929 compared with 19,357 in 1935. 48 inspections of the creches were made during the year by the Health Visitors. Institutions for Expectant and Nursing Mothers and Young Children. The Council pays an annual grant to the Streatham Babies' Hospital, 9, Leigham Court Road, which is a small hospital containing 20 cots for the treatment of infants up to the age of five years. The staff consists of a Matron, one Sister, two Assistant Nurses and three Probationers. A Visiting Medical Officer attends Maternity and. Child Welfare. 73 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. 115 infants were admitted in 1936, 60 from addresses in the Borough and 55 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 cf 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 hcstels 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 1936 assistance was granted in respect of 11 cases at a cost of £59 18s. 6d. Similar grants are made to the Mission of Hope, but no cases were assisted during 1936. Convalescent Treatment. During the year, 11 mothers and nine children were sent to Convalescent Homes. The cost of this service was £72 12s. 0d. Wandsworth and Tooting Children's Clinic. This Clinic provides artificial sunlight, massage and electrical treatment for children of all ages. 317 children have been treated 74 Report of the Medical Officer of Health for 1936. during the year and they have made 11,716 attendances. 86 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 1,117 families were supplied with milk under the Milk (Mothers and Children) Order, 1918; 229 in Clapham; 78 in Putney; 230 in Balham ; 145 in Streatham; 157 in Tooting; 87 in Southfield; 90 in Fairfield; and 101 in Springfield. The total cost to the Council was £1,653 10s. 3d. As a number of applicants for milk under the Council's Scheme are receiving Public Assistance through the London County Council Public Assistance Committee, an arrangement has now been entered into for the expenditure incurred by this Council in respect of these cases to be refunded by the London County Council. During the year £157 0s. 7d. was refunded under this arrangement. Women and children in receipt of milk under the Council's scheme are expected to attend the Welfare Centres during the time that the milk is being granted, though this rule is not enforced in cases where there is some very good reason for the mother's non-attendance, such as a case of infectious disease in the home. There is little doubt that many mothers and children have benefited from the supply of free milk since the scheme was instituted. In many cases the milk granted has enabled nursing mothers to prolong the period of lactation, and the records kept at the Welfare Centres show good results in the health and general well-being of many of the infants. Dental Treatment. Dental treatment is provided for expectant and nursing mothers and children under five years of age who attend at the Welfare Centres and are found to require treatment after examination by one of the Medical Officers. Maternity aud Child Welfare. 75 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 49 cases received dental treatment. 45 of these were expectant or nursing mothers, and four were children. In December the Council decided to approach the London County Council to see if arrangements could be made for the treatment, as required, of children under five years of age not in attendance at school at the School Treatment Centres in the Borough. This arrangement was agreed to by the London County Council in January, 1937, and is now in operation. It is not anticipated that the cost of this service will exceed £50 per annum. 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 tho 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 1936 there were 174 foster-mothers on the Register and the number of foster children for whom they were registered was 300. 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 5687 12319 18006 House-to-House inspections 2237 9169 11406 Shop Inspections 81 8 89 Infective Diseases:— Notifiable diseases 1187 664 1851 Other infective diseases 305 36 341 Verminous conditions 203 150 353 Offensive Trades No. of Premises 4 _ 4 2 Piggeries 7 21 3 24 Factories, workshops, etc. 2008 647 50 697 Houses let in lodgings 340 164 516 680 Rag and bone stores 3 4 — 4 Sanitary conveniences 181 432 11 443 Mews and stables 160 353 92 445 Other inspections 9003 2457 11400 Total 20328 25475 45803 Smoke observations 164 — 164 Legal proceedings, Attendances at Court 44 — 44 78 Report of the Medical Officer of Health for 1936. Table XXXIV. gives details of the sanitary operations carried out in the Borough during the year. The number of drains which were tested was 668 and 919 were cleansed or repaired. The drains of 43 houses were re-constructed. Damp conditions have been remedied in 1,305 premises, and in 62 of these damp courses were inserted. 24 privies and earth closets are known to be in existence in the Borough, and all of these are in connection with sports grounds. 79 Sanitary Inspection of the Borough. TABLE XXXIV. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 1. Premises cleansed and repaired 321 344 555 351 638 1122 3389 2. Drains tested 123 40 180 115 70 140 668 3. Drains cleansed or repaired 121 105 164 102 112 315 919 4. Water closets cleansed or repaired 207 208 318 115 271 574 1693 5. Soil pipes repaired. 45 51 54 13 38 66 267 6. Waste pipes altered or repaired 119 265 139 132 77 324 1056 7. Rainwater pipes repaired 41 39 100 16 27 81 304 8. Roofs and gutters repaired 151 127 275 96 246 480 1375 9. Damp courses inserted 9 5 17 16 3 12 62 10. Damp conditions otherwise remedied 102 171 230 153 221 428 1305 11. Yards drained or paved 42 18 129 45 90 213 537 12. Dust bins provided or repaired 49 81 116 37 86 222 591 13. Water cisterns cleansed, covered or repaired 13 55 34 8 49 46 205 14. Water supply reinstated 10 5 14 28 - 13 70 15. Defective fireplaces remedied 48 68 295 41 82 278 812 16. Defective coppers remedied 21 14 88 19 46 89 277 17. Stables and stable yards drained or paved 2 1 3 9 - - 15 18. Accumulations of manure, etc., removed 6 5 31 19 3 19 83 19. Urinals cleansed or repaired 13 1 3 2 - 7 26 20. Animals improperly kept 2 1 3 3 - 1 10 21. Smoke nuisances — — 7 12 — 10 29 22. Other nuisances 82 122 265 128 462 168 1227 Total 1527 1726 3020 1468 2571 4608 14920 No. of preliminary notices served 490 407 706 604 747 1790 4750 No. of preliminary notices complied with without the service of statutory notices 267 388 569 461 780 1471 3936 No. of statutory notices served 89 77 145 81 80 274 746 No. of statutory notices complied with 92 32 116 60 75 170 545 80 Report of the Medical Officer of Health for 1936. Water Supply—Cutting-off Notices. During the year, 32 notices with respect to 56 premises were received from the Metropolitan Water Board, stating that the supply had been withdrawn. In 51 premises the water supply was cut off for non-payment of rates, and in five because of defects in the service. 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 181 ; 52 in Clapham, 22 in Putney, 18 in Balham, 19 in Streatham, 12 in Tooting and 58 in Wandsworth. 443 inspections were made during the year, and six 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 larvas 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, 10,803 baits were laid during National Rat Week. 7,634 of these were taken by rats. Sanitary Inspection of the Borough. 81 246 complaints of nuisances from rats were investigated by the Sanitary Inspectors, and one instance of rat infestation of premises was reported to the Public Health Committee, who authorised the service of a notice requiring the extermination of the pests. At the end of the year the Council decided to appoint a Rat Catcher and an Assistant for the period of one year to deal with complaints of rat infestations. They commenced duty in January, 1937. Shops Act, 1934. 7,100 inspections have been made of 2,981 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. 67 notices were served in respect of infringements of the Act and all these 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 as often as necessary and refilled with fresh water which is chlorinated automatically before the bath is used, and also during use, as may be necessary to meet the needs of the bathing load. 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. G 82 Report of the Medical Officer of Health for 1936. Eradication of Bed Bugs. During the year 315 houses were found to be infested with bed bugs and notices were served on the responsible persons. All the premises were disinfested. In addition 36 Council houses were also found to be infested and were dealt with. The methods employed for freeing infested houses is—the stripping of all paper from the walls, the removal of all wood mouldings and skirtings and the application of a blow lamp to the room surfaces. Sulphur and "Cimex" candles are often used by house owners and spraying of rooms with "D" solution sometimes done by the disinfecting staff of the Council. Infested bedding is removed to the Disinfecting Station and treated with steam. To ensure that the belongings of tenants are free from vermin before removal to Council houses, where necessary the bedding and clothing is disinfested by steam at the Council's Disinfecting Station and the furniture disinfested by means of Hydrogen Cyanide gas generated in vans. The latter process is carried out by a Contractor. It was employed in 74 instances in 1936. 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, and one such case, in Putney, was removed during the year. Mortuaries. During the year only 12 bodies have been removed to the Mortuaries in the Borough, two to the Streatham and 10 to the Wandsworth Mortuary. No bodies were taken to the Mortuary in Clapham. 83 HOUSING. Statistics Relating to Housing. 1. Inspection of Dwelling-houses during the Year:— (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 8,088 and the number of inspections made 30,092 (2) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 2,237 and the number of inspections made 11,406 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 38 (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 4,750 2. Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 3,936 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 G2 84 Report of the Medical Officer of Health for 1936. B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 740 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 545 (b) By Local Authority in default of owners Nil C.—Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 3 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 5 (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 4. Housing Act, 1935—Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 1,524 (ii) Number of families dwelling therein 1,524 (iii) Number of persons dwelling therein 9,776 (b) Number of new cases of overcrowding reported during the year 297 (c) (i) Number of cases of overcrowding relieved during the year 574 (ii) Number of persons concerned in such cases 3,305 Housing. 85 (ci) Cases in which dwelling-houses have again become overcrowded after the Local Authoritv have taken %/ steps for the abatement of overcrowding Nil. House-to-House Inspections. The results of these inspections are shown in Table XXXV 2,237 inspections were made compared with 1,800 in 1935, 1,060 in 1934, 1060 in 1933, 1,589 in 1932 and 2,731 in 1931. Nuisances necessitating the service of sanitary notices were found in 1,946 of the houses. 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 90 85 3 13 14 77 Clapham South 3 2 1 2 1 3 Putney 276 206 1 28 146 133 Balham 242 198 5 30 151 179 Streatham 297 281 * 7 29 87 237 Tooting 395 357 22 15 223 275 Southfield 441 386 10 22 130 376 Fairfield 250 222 14 27 118 168 Springfield 243 209 15 35 141 149 Whole Borough 2237 1946 78 201 1011 1597 Underground Rooms. There were five underground rooms in the Borough found to be illegally occupied during the year. Two of them have been altered to comply with the Regulations, one is now unoccupied, and action is being taken in the other two cases to have the rooms made to comply with the Regulations. Rent and Mortgage Interest Restrictions Act, 1923. During the year 23 applications were received from occupiers that their houses were not in a reasonable state of repair. In 86 Report of the Medical Officer of Health for 1936. one case the application was withdrawn, in two cases the necessary work was carried out before the granting of Certificates could be authorised. In the remaining 20 cases, the applications were acceded to, and Statutory Certificates were granted. In 17 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 Insanitary Houses. Considerable progress has been made during the year in the programme for the clearance of unhealthy areas and the demolition of insanitary houses. The development of the Union Street Area, Clapham, has been completed. The sites of the following Clearance Areas are still in process of being developed—Wandsworth Plain, Felsham Road and Tooting Grove No. 1 Area. Building operations are now well in hand on the site of the Greyhound Lane and Barrow Road Areas and the development of the site of the White Square Areas will be commenced shortly. Union Street Area, Clapham. The development of the site of this Area by the Council has now been completed. Thirty-two flats have been erected and they are now occupied by families from other insanitary areas in the neighbourhood. Wandsworth Plain Area, Wandsworth. By the end of the year 51 of the 91 insanitary houses in this Area had been demolished and considerable progress has been made by the Council in the re-development of the Area. 25 flats have been completed on a portion of the site and these are now occupied mainly by families from other houses in the Area which are to be demolished. Another section of the Area is being developed at the present time and a further 48 flats are being erected. Felsham Road Area, Putney. Satisfactory progress is being made with the development of this Area by the Council. 30 of the 59 insanitary houses which it contained have now been demolished and by the end of the year two blocks of flats, comprising 24 dwellings, were completed. Tooting Grove No. 1 Area. The 21 insanitary houses in this Area have all been demolished and good progress has been made with the development of the 88 Report of the Medical Officer of Health for 193C. site by the Council. 30 flats have been erected on a portion of the site and are now in occupation. A further 42 flats are now in course of construction. Tooting Grove No. 2 Area. This Area, which was the subject of a Clearance Order, contained four houses. These have now been demolished. Greyhound Square Area, Streatham. Barrow Road Area, Streatham. These Areas are close together. With the exception of a small portion of the latter, which has been left for the owner to develop, both sites will be developed by the Council as one Scheme and it is proposed to erect 42 flats and eight shops on the combined site. There were 29 insanitary houses and one coloured "grey" on the Greyhound Square Area. Six of these, including the "grey" house, have now been demolished. Barrow Road Area contained 11 insanitary houses. Three of these, which are on the portion being developed by the owner, have been demolished. The first block of flats, which is being erected by the Council, is almost completed. White Square, Clap ham. This site, 4.32 acres in extent, included five Areas and contained 100 insanitary houses and 66 houses coloured " grey." 33 of the former and 13 of the latter have been demolished. The site will be developed by the Council and it is proposed to build 193 flats and six shops. The work will be put in hand shortly. During the year I have submitted Representations in respect of the following insanitary Areas:— Salvador, No. 1 Area, Tooting, containing 23 houses. Salvador, No. 2 Area, Tooting, containing 5 houses. Carpenter's Place Area, Clapham, containing 10 houses. These Representations have been considered by the Council who have notified the London County Council as required by section 16 (5) of the Housing Act, 1930. Housing. 89 Demolition Orders. The demolition orders made in 1935 on 146 and 146a, Lyham Road and 558 Garratt Lane, have been put into force and the three houses have been demolished. In December I represented 59 Rotherwood Road as a house requiring demolition. Closing Orders. The Closing Orders on a basement room at each of the six houses, 66, 74, 76, 78, 80, 82, The Chase, made in 1935, have been complied with. In 1935 I made representations for Closing Orders 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. The Council made Closing Orders on these premises in February last and the Orders have been complied with. In 1935 the Council accepted an undertaking from the owners, as provided for in Section 19(2) of the Housing Act, 1930, that the three dwelling-houses, 1, 2, and 3, King's Arms Yard, wouldnotbe used for human habitation. This undertaking has now been honoured, as the houses have been vacated and rendered unsuitable for use as dwelling-houses. In June, 1936, I represented to the Council that a Closing Order should be made on a basement room at 364, York Road, Wandsworth. The Order was made and has been complied with. 90 FOOD AND FOOD PREMISES. There are four 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 three Inspectors, who are designated Food Inspectors, supervise all the premises where food is sold, stored, manufactured or prepared for sale, and one third of the Borough is allocated to each Inspector. In addition they supervise the slaughtering of all animals in the five slaughter-houses, and carry out the duties required under Part II. of the Pharmacy and Poisons Act, 1933. 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 3,025. Amongst these are 1,074 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 331 of these shops are registered as dairymen. In Food and Food Premises.. 91 the majority of cases this is because milk is being sold in bottles or cartons, and as the milk is sold in sealed receptacles, registration of the premises as dairies is not required. Milk Supply. There are 503 registered dairymen and 203 registered dairies in the Borough, one of them being also a cowshed. The Food Inspectors made 719 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 980 samples of whole milk reported as genuine was 3.59, which is the same as in 1933, 1934 and 1935. 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. Registration of Premises where Ice Cream, Sausages, Preserved Meat, etc., are prepared. The Public Health (London) 1936 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 74 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 1,227 visits during the year to these 92 93 Report of the Medical Officer of Health for 1936. Food and Food Premises. TABLE XXXVI Nature of Principal Business. No. of Separate Premises. No. of Dairymen registered. Actual Food Businesses Conducted on the Premises Shown in Column 1. Subject to some form of Legal Control. Other Food Businesses. As Dairies. As Cow-sheds. As Slaughterhouses. As Wholesale Margarine Premises. For Ice Cream. For Cooked or Preserved Foods. As Fish Fryers. As FishCurers. Fishmongers. Grocers. Confectioners. Butchers Greengrocers. Food Factories. Restaurant Kitchens. No. of Inspections in 1936. No.ofNotices served. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Dairies 146 146 146 1 — — 23 5 — — — 132 4 — — — — 719 — Ice-Cream Vendors . 32 — — — — — 32 1 — — — — 2 — — — 1 305 — Grocery and Provisions 895 331 41 — — 36 89 226 — — 2 895 132 32 38 — 19 1458 11 Confectioners 540 15 2 — - — 424 — — — 1 6 540 — 1 — 39 810 5 Butchers 232 1 1 — — — 1 216 — — — 2 — 232 1 4 — 988 9 Slaughter-houses 5 — — — 5 — — — — — — — — — — — — 1227 — Fishmongers 108 — — — — — — 45 8 22 108 1 1 — — — 2 236 3 Fish Fryers 90 — — — — — 1 79 90 4 23 — — — — — 45 192 1 Restaurants 367 10 4 — — — 75 11 3 — 4 4 25 — 1 — 367 310 13 Greengrocers 449 — — — — — — 1 — - 8 3 — — 449 - — 618 19 Market Stalls 124 — — - — 1 5 8 — 1 8 22 18 13 57 - 6 9062 3 Food Factories 32 — 9 — — — 3 8 — — — 8 9 3 — 32 — 81 1 Others 5 — — — — — 1 1 — — — 1 1 — - - 1 7 2 Totals 3025 503 203 1 5 37 654 601 101 27 154 1074 732 280 547 36 480 16073 67 94 Report of the Medical Officer of Health for 1936. premises and were present on almost every occasion when slaughtering took place. The number of carcases examined was 12,273, comprising 123 oxen, 3,372 pigs, 4,118 sheep and 4,660 calves. 3,632 of the animals were also inspected before being slaughtered. The following organs, etc., were found to be unsound or diseased for the reasons specified, and were surrendered by the owners and destroyed:— Oxen:— For Tuberculosis : 85 stone of beef, 20 heads and tongues, 49 pairs of lungs, 6 mesenteries, 6 livers. For Cirrhosis: 19 livers. For Mastitis: 1 udder. For Cavernous Angioma : 1 liver. Pigs For Tuberculosis: 4 entire carcases and 4 stone of pork, 37 heads and collars, 3 lungs, 1 liver, 1 mesentery, 7 plucks. For Urticaria: 1 entire carcase. For Traumatism: 1 entire carcase, 1 head and collar. For Dropsy: 1 entire carcase. Moribund: 1 entire carcase. Fevered: 1 entire carcase. For Congestion: 93 pairs of lungs. For Cirrhosis: 31 livers. For Nephritis: 1 pair of kidneys. For Milkspots: 46 livers. For Pericarditis: 14 hearts. For Hepatitis: 2 livers. For Abscess: 1 head. Sheep :—- For Fluke: 16 livers. For Strongylus Rufescens : 27 pairs of lungs. For Abscess: 7 livers. For Congestion: 1 pair of lungs. - For Cirrhosis: 1 liver. Calves :— For Tuberculosis: 1 entire carcase, 2 pairs of lungs, 2 livers. Moribund: 31 entire carcases. . Food and Food Premises. 95 There are 232 butchers' shops in the Borough, the majority of which are subject to registration under the Public Health (London) Act, 1936. 988 inspections were made of these shops, and it was found necessary in nine 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 ho 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, 29 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.:—77 fowls, five ducks, two grouse, three pheasants, three hares, four partridges, 15 boxes of fishroes, six boxes of skate, two boxes of haddocks, two boxes of dog fish, one box of hake, 43 boxes of cod fillets, four boxes of whiting, one box of ray wing, one stone of plaice, one stone of cod, 1J bushel of winkles, 22 boxes of apples, ten crates of apricots, 60 baskets of cherries, 15 trays of peaches, 30 calves' heads, six loins of pork, two tins of rolled hams, one chest of tea, one case of shredded wheat, one case of Kellogg flakes and 120 packets of salt. 96 Report of the Medical Officer of Health for 1936. During the year two seizures of unsound food were effected. In one of the cases proceedings were taken at the Police Court and a penalty of £10 and costs was inflicted. 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 3. Fresh Apples. . Extract. 4. Tea. 18. Potatoes. 5. Currants. 19. Broccoli. 6. Sultanas. 20. Eggs. 7. Raisins. 21. Glasshouse grown Toma- 8. Eggs in Shell. toes and Cucumbers. 9. Dried Eggs. 22. Strawberries. 10. Oat Products. 23. Dressed Poultry. 11. Raw Tomatoes. 24. Cherries. 12. Salmon and Trout. 25. Cider. 13. Butter. 26. Canned Fruits. 14. Apples. 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. Pharmacy and Poisons Act, 1933. Part II of this Act, which came into force on 1st May, 1936, provides for the registration with the Local Authority of all persons dealing in poisons included in Part II of the Poisons List, also in certain, cases the names of nominees permitted to sell poisons in the absence of the listed seller. The majority of the listed sellers are also purveyors of food. Food, and Food Premises. 97 The number of applications received for entry in the Council's Register for 1936 is 304, also three applications for alterations in nominee's names. 827 inspections of premises have been made during the year. 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 1,001 were submitted as official samples while 999 were purchased unofficially as test or informal samples. 10 or .9 per cent. of the official samples, and nine or .9 per cent. of the unofficial samples were found to be adulterated or not up to standard. The total adulterations reported were 19 or .9 per cent. of the samples submitted. II 98 Report of the Medical Officer of Health for 1936. TABLE XXXVII RESULT OF ANALYSES OF CERTAIN ARTICLES OF FOOD PROCURED UNDER THE FOOD AND DRUGS (ADULTERATION) ACT, 1928, SHOWING THE PERCENTAGE ADULTERATED IN 1936, AS COMPARED WITH 1932, 1933, 1934 AND 19 5. No. of samples in 1936. Percentage of Samples adulterated, 1932-1935. Examined. Found adulterated or not up to standard Percentage adulterated 1932. 1933. 1934. 1935. Butter 158 — — — — — — Cheese 30 — — — 9.0 — — Cocoa 18 — — — 13.3 — — Coffee and Coffee & Chicory 32 1 30 — — — — Confectionery and Jam 29 — — — — — 1.2 Cream 54 — — — — — — Margarine 15 — — — 4.3 — — Milk 987 7 .7 1.3 1.3 1.7 1.6 Separated Milk 1 — — — — — 33.3 Condensed Milk 14 — — — — — — Tea 13 — — — — 12.5 — Vinegar 9 2 22.2 5.7 — — 18.0 Drugs 74 — — 3.3 — 7.4 4.0 Other Articles 566 — 1.6 0.86 1.4 5.1 4.0 All Articles 2000 19 .95 1.40 1.4 2.65 2.3 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. Food and Food Premises. 99 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 148 1 .6 216 2 .9 364 3 6.1 .8 Putney 126 1 .7 113 — — 239 1 7.1 .4 Balham 140 — — 103 2 1.9 243 2 4.6 .8 Streatham 180 1 .5 60 — — 240 1 3.6 .4 Tooting 146 — — 167 — — 313 — 8.4 .3 Wandsworth 259 6 2.3 342 6 1.7 601 12 6.3 1.9 Whole Borough 999 9 .9 1001 10 .9 2000 19 5.8 .9 Milk and Milk Supply. The following samples were submitted for analysis:— 987 of whole new milk. 1 of separated milk. 14 of condensed milk. Of these seven were reported against as being adulterated or not up to standard. Five contained extraneous water, and two were deficient in milk fat. Proceedings were taken in one of these cases and it was dismissed under the Probation of Offenders Act on payment of £1 costs. In the six 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. 90 samples of milk were taken from the early morning delivery to hospitals in the Borough. 10 on delivery to Wandsworth Prison, and 36 from the milk delivered to the County Council Schools in the Borough. All these samples were reported as genuine. H2 100 Report of the Medical Officer of Health for 1936. 426 samples were taken from milk vendors in the street during the early morning (midnight to 8 a.m.) and of these two or .46 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 21 Grade A (Tuberculin Tested) 48 Grade A Pasteurised 6 Grade A 3 Pasteurised 45 Total 123 Bacteriological Examination of Milk. 48 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 14 cases the examination revealed the presence of Tubercle Bacilli, and one cow was slaughtered. 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. Tuberculin Tested — — 4 4 Pasteurised 36 16 — 52 Total 36 16 4 56 All these samples complied with the required standard. Food and Food Premises. 101 Butter and Margarine. 158 samples of butter were submitted for analysis during the year and all were reported to be genuine. 15 samples of margarine were submitted for analysis, and all were reported to be genuine. Other Articles. 528 samples were submitted under this heading. The results of the analyses are given in the Public Analysts' Report. 102 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 1936. Number of Inspections, 1936. Number of Notices, 1936. Number of Prosecutions, 1936. Factories:— Factory Laundries 53 19 2 — Factory Bakehouses 74 48 1 — Food Factories entered on Table XXXVI 32 81 1 — Other Factories 438 171 10 — Total 597 319 14 — Workshops:— Workshop Laundries 23 3 — — Workshop Bakehouses 54 31 — — Other Workshops 753 260 8 — Total 830 294 8 — Workplaces 131 31 3 — Total: Factories, Workshops and Workplaces 1,558 644 25 — Home-workers' premises 482 134 2 — Grand Total 2,040 778 27 — Further details with regard to homeworkers' premises are given in Table XL. Factories and. Workshops. 103 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. 30 15 133 32 2 2 31 (2.) Cleaning and washing 2 10 — — — — — Paper bags and boxes 2 — 6 — — — — Totals 34 25 139 32 2 2 31 The total number of addresses received from other Councils was 408, and 119 addresses were forwarded to other Authorities. The number of addresses received has decreased by 103, and the number sent has also decreased by 20. 12 names and addresses were forwarded to this Borough in error. The number of notices sent to employers during the year was 19, and these had a most satisfactory result. During the year 31 cases of infective diseases—16 of Measles, four of Mumps, three of Whooping Cough, three of Scarlet Fever, three of Chicken pox, and two of Diphtheria—were notified as having occurred in the homes of out-workers. In none of these cases was it necessary to make any order under Section 110 of the Factory and Workshop Act. 104 Report of the Medical Officer of Health for 1936. TABLE XLI. DETAILS WITH REGARD TO REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Important classes of workshops, such as workshop bakehouses, are enumerated here. Workshop Bakehouses 54 Workshop Laundries 23 Dressmakers' and Milliners' Workshops 102 Bootmakers 96 Smiths and Engineers 32 Builders 34 Tailors 66 Motor Engineers 60 Upholsterers ,. 24 Hairdressers 28 Other 311 Total number of workshops on Register 830 TABLE XLII. DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. (1) Number of Defects. No. of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts:—* Want of cleanliness 7 4 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other Nuisances 5 5 — — Sanitary accommodation: Insufficient 5 5 — — Unsuitable or defective 13 9 — — 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 30 23 — — *Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. Factories and Workshops. 105 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. 106 Report of the Medical Officer of Health for 1936. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF WANDSWORTH, 1936. (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. 1983 137 22 21 35 55 79 80 210 358 470 516 F. 2070 91 11 13 30 58 72 91 172 287 477 768 1. Typhoid and paratyphoid fevers M. 3 — — — — 2 1 — — — — — F. — — — — — — — — — — — — 2. Measles M. 16 3 5 5 3 — — — — — — — F. 8 — 5 2 1 — — — — — — — 3. Scarlet fever M. — — — — — — — — — — — — F. — — — — — — — — — — — — 4. Whooping cough M. 6 2 2 2 — — — — — — — F. 6 5 — — 1 — — — — — — — 5. Diphtheria M. 11 — 2 2 6 1 — — — — — — F. 12 — — 5 5 1 — — — 1 — — 6. Influenza M. 20 1 — — — — — 1 4 5 5 4 F. 30 — 1 — 1 1 3 1 2 4 8 9 7. Encephalitis lethargica M. 3 — — — — — — — — 2 1 — F. 2 — — — — 1 1 — — — — — 8. Cerebro-spinal fever M. 2 — 1 — — — — 1 — — — — F. 2 — — 1 — — — — — — 1 — 9. Tuberculosis of respiratory system M. 119 1 — — 1 18 29 22 30 11 6 1 F. 80 — — — 3 25 30 15 6 6 5 — 10. Other tuberculous diseases M. 22 1 3 1 4 3 4 2 2 1 1 — F. 8 — 1 — — 3 — — 1 1 1 1 11. Syphilis M. 4 2 — — 1 — — — — — 1 — F. 3 — — — 1 — — 2 — — — — 12. General paralysis of the insane, tabes dorsalis M. 9 — — — — — 1 2 4 2 — — F. 1 — — — — — — 1 — — — — 13. Cancer, malignant disease M. 259 — — 2 1 — 1 5 42 65 101 42 F. 316 — — — — — 6 17 52 74 93 74 14. Diabetes M. 14 — — — — — — 1 2 2 7 2 F. 34 — — — — — 2 2 1 7 12 10 15. Cerebral hæmorrhage, etc. M. 52 — — — — — — 1 3 14 14 20 F. 80 — — — — — — 2 5 15 20 44 16. Heart disease M. 559 — — — 2 2 3 9 30 99 164 250 F. 700 — — — 2 2 6 16 40 67 180 387 17. Aneurysm M 13 — — — — — — 3 1 4 5 — F. 8 — — — — — — — 3 2 2 1 Vital Statistics. 107 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. 81 — — — — — — — 3 14 39 25 F. 107 — — — — — — 1 5 17 32 52 19. Bronchitis M. 111 9 — — 1 — 1 2 15 25 22 36 F. 81 4 — — — — 2 1 1 6 24 43 20. Pneumonia (all forms) M. 112 20 2 1 1 1 4 3 16 20 20 24 F. 93 17 — 2 4 4 1 4 2 18 21 10 21. Other respiratory diseases M. 15 1 — 1 — — — — 1 2 5 5 F. 11 1 1 1 — — — — 1 2 2 3 22. Peptic ulcer M. 36 — — — — — 2 3 10 13 3 5 F. 15 — — — — — — 2 2 7 3 1 23. Diarrhœa, etc. M. 21 18 2 — — — 1 — — — — — F. 23 16 — — — — 3 1 — 1 1 1 24. Appendicitis M. 14 — — 2 2 2 2 — 2 3 1 — F. 7 — — — — 2 — — 2 1 1 1 25. Cirrhosis of liver M. 8 — — — — — 1 1 1 4 — 1 F. 5 — — — — — — 2 2 — 1 — 26. Other diseases of liver, etc. M. 6 — — — — — — — 1 — 2 3 F. 21 — — — — — 1 1 3 3 5 8 27. Other digestive diseases M. 34 4 — — 1 1 1 — 4 7 7 9 F. 41 1 1 — 1 2 — 4 — 11 9 12 28. Acute and chronic nephritis M. 57 — — — — — 2 4 4 20 14 13 F. 63 1 1 — 1 3 2 3 8 14 14 16 29. Puerperal sepsis F. 1 — — — — — 1 — — — — — 30. Other puerperal causes F. 4 — — — — — 4 — — — — — 31. Congenital debility, premature birth, malformation, etc. M. 70 69 — — — 1 — — — — — — F. 42 39 — 1 — 1 — — 1 — — — 32. Senility M. 26 — — — — — — — — — 1 25 F. 43 — — — — — — — — — 3 40 33. Suicide M. 25 — — — — 2 2, 2 3 9 4 3 F. 19 — — — — — 2 — 7 6 3 1 34. Other violence M. 79 1 3 2 7 11 10 6 15 11 6 7 F. 52 2 1 — 2 8 1 3 7 3 10 15 35. Other defined diseases M. 175 5 2 3 5 11 14 12 17 25 40 41 F. 134 5 — 1 8 5 7 13 21 21 25 28 38. Causes ill-defined, or unknown M. 1 — — — — — — — — — 1 — F. 2 — — — — — — — — — 1 1 108 Report of the Medical Officer of Health for 1936. POLICE COURT PROCEEDINGS, 1936. Premises. Offence. Result. Fine. Costs 18, Leverson Street. Nuisances. Summonses withdrawn work having been done. — 63/ 20, ditto. 22 ditto. 24, ditto. 26, ditto. 28, ditto. 9, 11, 13, Turtle Road, 47, Selkirk Road. Nuisances. Summonses withdrawn work having been done. - - 156-8 Lower Richmond Road. Overcrowded condition of the premises. Children having been removed, the summons was adjourned sine die pending prosecution by the the N.S.P.C.C. - - 715, Garratt Lane. Shop without sufficient and suitable W.C. accommoda tion. Summons adjourned sine die on the defendant undertaking to provide conveniences. - - 57, Trevelyan Road. Nuisances. In Streatham High Road. Transport of offensive matter with out using a suitable carriage. Convicted 40/- 20/- 39, Fawe Park Road. Nuisances. Summons withdrawn work having been done. — 10/6 575, Garratt Lane. Selling unwholesome foodstuffs. Wholesaler convicted 200/- 42/- 60, Charlmont Road Nuisances. Order made for abatement in 14 days. — 63/- 14, Deodar Road. Ditto. Order made for abatement in 48 hours. — — 1 Stewarts Cottages. Putney Verminous and insanitary condition of the occupier and of the premises. Order made for removal of occupier to an Institution. — — 11 and 12, Elwell Road, Clapham. Nuisances. Defendant ordered to abate nuisances at both premises within seven days. — — 11, 13, 15, 19, and 25, Besley Street, Streatham. Ditto. Order made for abatement of nuisances within 14 days. — — Police Court Proceedings. 109 POLICE COURT PROCEEDINGS, 1936—continued. Premises. Offence. Result. Fine. Costs. 14a, Radbourne Road, Balham. Nuisances. Summons withdrawn work having been done. — — 9, Rashleigh Street, Clapham. Ditto. Order made for abatement of nuisances within seven days. — — 19, Foss Road, Balham. Ditto. Ditto. — — 6, 8, 12, 16, 20, 22, 26, 28 and 30, Besley Street, Streatham. Ditto. Summonses withdrawn work having been done. — — 47 and 49, Tooting Grove. Ditto. Order made for abatement of nuisances within 14 days. — — 110, Bedford Road, Clapham. Ditto. Summons withdrawn work having been done. — — 11, Baldry Gardens, Streatham. Ditto. Order made for abatement of nuisances. — 42/- 59, Rotherwood Road, Putney. Occupier not being capable of looking after herself. Order made for her detention in an Institution. — — POLICE COURT PROCEEDINGS UNDER THE VACCINATION ACTS. Name. Offence. Result. Fine. Costs. Mr. "A" Failure to cause child to be vaccinated within 6 months after birth. Summons withdrawn child having been successfully vaccinated — — Mr. "B" Ditto. Order made for child to be vaccinated in 14 days. — — Mr. "C" Ditto. Mr. "D" Ditto. Mr. "E" Ditto. Mr. "F" Ditto. Mr. "G" Ditto. Mr. "H" Ditto. Summons withdrawn child having been successfully vaccinated. — — Mr. "I" Ditto. Mr. "J" Ditto. Order made for child to be vaccinated within 14 days. — — Mr. "K" Ditto Mr. "L" Ditto. Mr. "M" Ditto. Ditto within 28 days. — — Mr. "N" Ditto. Mr. "O" Ditto. Mr. "P" Ditto. Mr. "Q" Ditto. Mr. "R" Ditto. 110 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 for your Council under the Food and Drugs (Adulteration) Act, 1928 during the year ended 31st December, 1936. All of the samples mentioned in this report were submitted for analysis by your Council's Food Inspectors and were taken either formally or informally as shown in the following statement which also shows the nature of the samples examined with the result 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 — 158 158 — — — Cheese — 15 15 — — — Cheese, Wrapped — 15 15 — — — Cocoa — 18 18 — — — Coffee — 13 13 — — — Confectionery — 13 13 — — — Cream — 47 47 — — — Cream, Tinned — 7 7 — — — Flour — 3 3 — — — Flour, Self-raising — 3 3 — — — Jam and Marmalade — 12 12 — — — Lard — 15 15 — — — Margarine — 15 15 — — — Milk 986 1 987 7 — 7 Milk, Separated 1 — 1 — — — Milk, Condensed — 8 8 — — — (Machine Skimmed) Milk, Condensed (Full Cream) — 6 6 — — — Sugar — 21 21 — — — Tea — 13 13 — — — Vinegar 8 1 9 1 1 2 Wine — 11 11 — — — Spirits (Whisky) — 8 8 — — — Drugs — 74 74 — — — Other Articles 6 522 528 2 8 10 Total 1001 999 2000 10 9 19 Analysts' Annual Report. Ill DRUGS (Informal). Nature of Sample. Examined. Aspirin 6 Borax 3 Cold Cream A Camphorated Oil 7 Effervescent Saline 6 Friar's Balsam 3 Glauber Salts 3 Glycerin 3 Oil, Castor 6 Oil, Eucalyptus 6 Ointment, Mercury 3 Ointment, Zinc 3 Powder, Liquorice Compound 3 Powder, Seidlitz 3 Soda, Bicarbonate of 3 Tincture of Iodine 6 Tincture of Quinine, Ammoniated 4 Tincture of Rhubarb 3 Total 74 112 Report of the Medical Officer of Health for 1936. OTHER ARTICLES. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Almonds, Ground — 6 6 — — — Almonds, Ground (Blended) — 1 1 — — — Arrowroot — 6 6 — — — Baking Powder — 5 5 — — — Barley, Pearl — 9 9 — 1 1 Biscuits — 6 6 — — — Buns, Cream — 3 3 — — — Bun Flour — 2 2 — — — Cake — 1 1 — — — Cakes, Sponge — 6 6 — — — Cherries, Glace — 3 3 — — — Chicory and Coffee 1 — 1 — — — Coffee and Chicory — 13 13 — 1 1 Coffee and Chicory Extract — 6 6 — — — Coconut, Desiccated — 3 3 — — — Cooking Fat — 3 3 — — — Cornflour — 16 16 — — — Curry Powder — 6 6 — — — Dripping — 3 3 — — — Fish Paste — 10 10 — — — Fish, Tinned — 28 28 — 1 1 Fish, Bottled — 1 1 — — — Fruits, Tinned — 33 33 — — — Fruits, Dried — 63 63 — — — Gelatin — 3 3 — — — "Gravy Thick" — 2 2 — — — Ginger, Ground — 6 6 — — — Ginger, Preserved — 4 4 — — — Herbs, Dried — 6 6 — — — Honey — 3 3 — — — Honey, Prepared — 3 3 — — — Jelly, Table — 8 8 — — — Junket Preparation — 1 1 — — — Lemonade Powder 2 4 6 2 3 5 Lemon Curd — 6 6 — — — Meat (Bacon) — 11 11 — — — Meat, Minced — 3 3 — — — Meat, Tinned — 3 3 — — — Meat Pie — 3 3 — — — Mincemeat (Fruit) — 3 3 — — — Mustard,Compound — 4 4 — — — Olive Oil — 6 6 — — — Pea Flour — 2 2 — — — Peel, Candied — 9 9 — — — Pepper — 10 10 — — — Pickles — 6 6 — — — Powder, Blanc Mange — 2 2 — — — Powder, Custard — 10 10 — — — Rice — 23 23 — — — Rice, Ground — 9 9 — — — Analysts' Annual Report. 113 OTHER ARTICLES—continued. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Rice, Flaked — 3 3 — — — Sago — 9 9 — 1 1 Salt, Table — 1 1 — — — Sausages 1 38 39 — 1 1 Sausages, Preserved — 5 5 — — — Sausage Meat 1 3 4 — — — Sausage Casings 1 — 1 — — — Sauce — 6 6 — — — Spice, Mixed — 9 9 — — — Soup Powder — 3 3 — — — Suet, Shredded — 6 6 — — — Syrup, Golden — 3 3 — — — Tapioca — 21 21 — — — Vegetables, Tinned — 16 16 — — — Waters, Aerated — 7 7 — — — Wheat Preparations — 9 9 — — — Total 6 522 528 2 8 10 The nature and extent of the adulteration reported in the formal samples submitted is given in the table below:- Case No. Nature of Sample. Nature of Report. 36 Milk 2 % deficient in Fat. 38 Ditto. 4 % Extraneous Water 166 Ditto. 19 % deficient in Fat 368 Lemonade Powder Made with Tartaric Acid. 369 Ditto. Ditto. 466 Vinegar 21 % deficient in Acetic Acid. 521 Milk 1½ % Extraneous Water. 645 Ditto. 1 % Extraneous Water. 953 Ditto. 25 % Extraneous Water. 987 Ditto. 4 % Extraneous Water. Below will be found the nature of the reports issued in respect to the informal samples returned as adulterated. Case No. Nature of Sample. Nature of Report. 308 Sausages Contain a Sulphite Preservative. 316 Lemonade Powder Made with Tartaric Acid 318 Ditto. Ditto. 375 Ditto. Ditto. 517 Vinegar Contains a salt of Iron. 713 Tinned Sild Contains excess of Tin 769 Coffee and Chicory Contains excess Chicory 783 Sago Consists of Tapioca 994 Pearl Barley Damaged by Weevils. 114 Report of the Medical Officer of Health for 1936. The average water content of the 158 samples of Butter amounted to 14.9 per cent., that in the 15 samples of Margarine being 14.8 per cent. The average fat content of the 47 samples of Cream was 54.4 per cent. In this average one sample sold as "Half-price Cream" which contained 21.5 per cent. fat, is included. The average fat content of the 7 samples of Tinned Cream amounted to 23.3 per cent. The average composition of the Milks received during each month and returned as genuine, is given below:— Month. Total solids. Milk fat. Non-fatty solids. January 12.57 % 3.71 % 8.86% February 12.47% 3.64 % 8.83 % March 12.35 % 3.53 % 8.82 % April 12.35 % 3.50 % 8.85 % May 12.22 % 3.38 % 8.84 % June 12.22 % 3.56 % 8.66 % July 12.12 % 3.41 % 8.71 % August 12.35 % 3.59 % 8.76 % September 12.46% 3.62 % 8.84 % October 12.56% 3.67% 8.89 % November 12.82 % 3.86 % 8.96 % December 12.81 % 3.90% 8.91 % The average composition of the 980 samples of Milk, returned as genuine, during the whole year was as under:— Total solids 12 46 % Milk fat 3.59 % Non-fatty solids 8.87% During the year two informal samples, one of Vinegar, Case No. 517, and one of Sweets, Case No. 801, were submitted as the result of complaints having been received from ratepayers respecting them. The Vinegar was found to contain a salt of iron, but the formal sample, Case No. 525, taken from the same vendor proved to be genuine. The Sweets were found to be normal in composition and, therefore, reported as genuine. Analysts' Annual Report. 115 In July copies of certain letters received by his department were forwarded to us by the Medical Officer of Health relating to the alleged sale of Red Wine of a harmful character. It was stated that this wine was known as "Red Biddie" or "Red Lizzie," and it was alleged to contain a "methylitic" solution; also that indulgence in this drink resulted in a state of drunkenness from which recovery was long and that continued indulgence led to insanity. "Red Biddie," or "Red Lizzie" is the popular name given to a liquid sold under the description of "Red Lisbon Wine," which is said to result from the process of washing out wine casks with diluted methylated spirit. We have no direct evidence that such a wine is sold, nor does there seem to be any information as to the quantity offered for sale. If such a wine exists, the methyl alcohol content would render it a most undesirable and dangerous article and continued indulgence in such beverage would be disastrous to the consumer. As the direct result of the correspondence referred to above, samples of cheap red wine were purchased in the Borough, and the following table shows the result of our examination of these articles. Case No. Description of Sample. Contents of bottle. Price paid. Proof Spirit. Proof Spirit obtained for 1d. 620 British Sherry 185 c.c. 6d. 31.9 % 9.8 c.c. 621 Tawny Wine 370 c.c. 11d. 28.6 % 9.6 c.c. 622 Ruby Wine 383 c.c. 10d. 27.4 % 10.5 c.c. 623 Tawny Wine 180 c.c. 6d. 25.9 % 7.8 c.c. 624 Pure Grape Wine 212 c.c. 6d. 28.8 % 10.2 c.c. 650 British Ruby Wine 188 c.c. 6d. 29.0 % 9.1 c.c. 651 Wine Cocktail 190 c.c. 8d. 30.2 % 7.2 c.c. 652 White Wine 193 c.c. 6d. 29.0 % 9.3 c.c. 653 Ruby Wine White Wine 184 c.c. 6d. 28.0 % 8.6 c.c. 654 182 c.c. 6d. 29.3 % 8.9 c.c. 655 Ruby Wine 192 c.c. 6d. 29.5 % 9.4 c.c. None of the above samples contained Methyl Alcohol. The average proof spirit in these samples amounted to 28.9 per cent., and the average quantity of proof spirit purchased for one penny amounted to 9.2 c.c. We are of opinion that as none of the samples contained Methyl Alcohol they cannot be regarded as being more deleterious to health than any other liquid of similar alcoholic strength. 116 Report of the Medical Officer of Health for 1936. The chief point revealed in our examination is the fact that such wines provide more alcohol for a given sum of money than any other alcoholic beverage and, therein lies the danger to the consumer of too free indulgence. It is quite possible that many people start taking these wines in the belief that, owing to their cheapness, they are more or less "innocent" drinks and soon acquire the habit of indulging in them to excess. It must also be remembered that wine is consumed undiluted. In conclusion we would like to congratulate the Council on the satisfactory state of the food supply in the Borough, only one per cent. of the Formal samples having been found to be adulterated. The adulteration detected in the Informal samples amounted to only 0.9 per cent., and that in all samples submitted to 0.95 per cent. We have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servants, C. H. M. MUTER, F.I.C., F.C.S., Public Analyst. CHARLES A. HACKMAN, F.I.C., Additional Public Analyst. 325, Kennington Road, April, 1937. S.E. 11. 117 INDEX. PAGE Accident, Deaths from 41, 42 Adulteration of Certain Articles, Percentage of, in 1931-1935 98 Aged, infirm or diseased Persons, Removal of 82 Agricultural Grading and Marking Act, 1928 96 Ambulance Service 39 Analysts, Report of 110 Ante-natal Clinics 65, 67 Ante-natal Women, treatment of 69 Anti-toxin 22 Area of Borough 9 Artificial Light Treatment of Tuberculosis 51 Artificial Pneumothorax Treatment of Tuberculosis 51 Artificial sunlight, etc., treatment 74 Bacteriological Examinations 40, 55 Bacteriological Examination of Milk 100 Bakehouses 102 Balham, House-to-House Inspections in 85 Barrow Road Area 88 Bathing Pools and Swimming Baths 81 Bed Bugs, Eradication of 82 Births 11 Births and Birth-rates in Sub-Districts 12 Birth-rate, Average 10 Years, 1926-35 15 Births, Notification of, Act 12 Borough of Wandsworth War Memorial Maternity Home 67 Brain and Nervous System, Diseases of the 41 Butchers' Shops 92 Butter and Margarine 101 Cancer 41 Carpenter's Place Area 88 Census, 1931 10 Census, 1921 10 Census, 1911 10 118 Index. PAGE Cerebro-Spinal Meningitis 33 Child Birth, Deaths from 17 Children and Young Persons Acts, 1908-1932 76 Children's Clinic, Wandsworth and Tooting 73 Circulatory Diseases 41 Clapham, House-to-House Inspections in 85 Cleansing of Persons Act 39 Clearance Areas 87 Clinics for Immunisation against Diphtheria 23 Closing Orders 89 Confectioners 92 Conscientious Objections Certificates granted 21 Convalescent Homes 73 Cowsheds 92 Creches 72 Cutting-off Notices—Water supply 80 Dairies, Milkshops and Cowsheds 98 Day Nurseries 71 Death, Causes of 14, 106, 107 Death-rate, Average 10 Years, 1926-1935 15 Death-rate, Corrected 13 Death-rate from Infective Diseases 18 Death-rate, Infantile 16 Deaths, Corrected 13 Deaths, Number of 13 Deaths in Institutions 16 Demolition Orders 89 Dental Treatment 51, 74 Developmental Diseases 41 Diarrhœa 38 Diphtheria 22 Diphtheria, Attack Rate per 1,000 cases 22 Diphtheria, Immunisation against 23 Diphtheria, "Return Cases" of 31 Diseased, aged or infirm Persons, Removal of 82 Disinfecting Station Staff 7 Disinfection 39 Disinfection of Schools 39 119 Index. PAGE Dwelling-houses, Inspection of 85 Dysentery 33 Encephalitis Lethargica 33 Enteric Fever 31 Erysipelas 32 Expectant and Nursing Mothers, Institutions for 72 Factories and Workshops 102 Factories, Workshops, etc., Defects found in 104 Factories, Workshops and Workplaces, Inspection of 77 Families, Number of, Census 1931 9 Felsham Road Area 87 Fishmongers' Shops 92 Fish, Sausages and potted Meat, etc., preparation or manufacture of 91 Flies and Mosquitoes 80 Food and Drugs Inspector 4 Food, Prosecutions in connection with 99 Food and Drugs (Adulteration) Act, 1928, Proceedings under 99 Food and Drugs (Adulteration) Act, 1928, Statement of Work under 97 Food and Food Premises 90 Food Factories 92,102 Food Places, Inspection of 92 Foster-parents 76 Fried Fish Shops 92 Greengrocers' Shops 92 Greyhound Square Area 88 Grocery and Provisions Shops 92 Health Visitors 5 Health Visitors, Work of 60 Home Helps 70 Home Work 103 Hospital Treatment for Ante-natal Women 69 Hospitals, etc., for Expectant and Nursing Mothers 72 House Refuse, Removal of 80 House-to-House Inspections, Summary of 85 120 Index. PAGE Houses and Premises Inspected 77 Houses Let in Lodgings 77 Housing Act, 1930 84, 87 Housing Act, 1935 84 Housing Consolidated Regulations, 1925, Houses inspected, etc. 85 Housing Statistics 83 Ice Cream Premises 92 Ice Cream, etc., Sale and Storage of 91 Infant Life Protection 76 Illegitimate Children, Births of 12 Immunisation against Diphtheria 23 Imported Produce, Marking of 96 Increase of Rent and Mortgage Interest (Restrictions) Act, 1923 85 Infant Life Protection 76 Infant Visiting 62 Infant Welfare Centres 65,66 Infantile Mortality 16 Infantile Mortality, 10 Years, 1926-1935 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 Infirm, aged or diseased Persons, Removal of 82 Influenza, Deaths and Death-rates 32 Influenzal Pneumonia and Acute Primary Pneumonia, Cases Notified 32 Inhabited Houses, Number of 9 Inquests . 41, 42 Insanitary Areas 87 Inspections, Details of 77 Institutions for Expectant Mothers, etc. 72 Insulin treatment 41 Laundries, Inspection of 102 Malaria 33 Margarine 101 121 Index. PAGE Markets and Stalls 92 Maternal Mortality 17 Maternity and Child Welfare 60 Maternity and Child Welfare Centres 63 Maternity Home, Borough of Wandsworth War Memorial 67 Maternity Home Staff 5 Maternity Outfits 71 Measles 34 Measles and other Non-notifiable Diseases reported from Schools 36 Meat 91 Merchandise Marks Act, 1926 96 Mews and Stables 77 Mice and Rats Destruction 80 Midwives 69 Midwifery Service 70 Milk Analysis 97,98 Milk, Bacteriological Examination of 100 Milk (Mothers and Children) Order 74 Milk Premises, Cowsheds, etc., on Register 91 Milkshops, Cowsheds, etc., Inspections of 92 Milk (Special Designation) Order, 1923 100 Milk Supply 74, 91, 99 Mission of Hope, Grant to 73 Mortuaries 7,83 Mosquitoes 80 Natural Increase, Rate of 11 Nervous System, Diseases of the 41 Non-Infective Diseases, Deaths from 41 Notification of Births Acts 12 Notification of Infective Diseases 18 Nursing Arrangements 69 Nursing Mothers, Institutions for 72 Obstetric Consultants 2 Obstetric Consultant Service 68 Offensive Trades 77 Old Age 41 122 Index. PAGE Ophthalmia Neonatorum 33 Ophthalmic Consultant 2 Other Infective Diseases, Deaths from 38 Outworkers 102, 103 Overcrowding 84 Para-Typhoid Fever 31 Pharmacy and Poisons Act, 1933 96 Physical Features, etc., of the Borough 10 Piggeries 77 Pneumonia 32,41 Police Court Proceedings 99, 108 Polio-Myelitis and Polio-Encephalitis 33 Population 9, 10, 11 Population of Sub-Districts 11 Potted Meat, Fish and Sausages, etc., preparation or manufacture of 91 Premature Birth 41 Pregnancy, Deaths from Accidents and Diseases of 17 Provisions and Grocery Shops 92 Public Analyst 2 Public Vaccinators 2, 3 Puerperal Fever 32 Puerperal Pyrexia 32 Pulmonary Tuberculosis, Notification of Cases of 43 Putney, House-to-House Inspections in 85 Pyaemia, Deaths from 38 Rag and Bone Stores 77 Rag Flock Act, 1911, Statement of Work done under 82 Rateable Value 9 Rats and Mice Destruction 80 Rent and Mortgage Interest (Restrictions) Act, 1923 85 Respiratory Diseases 41 Restaurant Kitchens 92 Return Cases of Scarlet Fever and Diphtheria 31 Salvador Nos. 1 and 2 Areas 88 Samples Formal and Informal, Number of 99 123 Index. PAGE Sanitary Conveniences, Inspection of 77, 80 Sanitary Inspection of the Borough 77 Sanitary Inspectors 4 Sanitary Operations, Table of 79 Sausages, potted Meat and Fish, etc., manufacture of 91 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 92 Slaughter of Animals Act, 1933 95 Small pox 21 Smoke Nuisances 77 Social Conditions 10 Southwark Diocesan Association, Grant to 73 Sputum Examinations 55 Staff 1-8 Statistics for the Borough 9 . Streatham, House-to-House Inspections in 85 Suicide, Deaths from 41,42 Swimming Baths and Bathing Pools 81 Syphilis, Deaths from . 38. Tooting and Wandsworth Children's Clinic 73 Tooting, House-to-House Inspections in 85 Tooting Grove Areas 87,88 Transfer of Powers (London) Order, 1933 76 Tuberculosis 43-47 Tuberculosis, Artificial Light Treatment of 50, 51 Tuberculosis, Artificial Pneumothorax Treatment of 51 Tuberculosis Dispensaires 48 Tuberculosis Care Committee 55 Tuberculosis, Handicraft Class 59 Tuberculosis, Institutional Treatment 51 124 Index. PAGE Tuberculosis, Open Air Shelters 52 Tuberculosis, Sanocrysin Treatment 51 Tuberculosis, Investigation by " The Prophit Trust " 55 Tuberculous Diseases, Extra Nourishment provided 51 Underground Rooms 85 Unhealthy Areas 87 Union Street Area 87 Unmarried mothers, Institutions for 73 Unsound Food 95 Vaccination 21 Vaccination Officers 3 Vaccination Returns 21 Violence, Mortality from 41 Vital Statistics of Whole Borough 9 Wandsworth and Tooting Children's Clinic 73 Wandsworth, House-to-House Inspections in 85 Wandsworth Plain Area 87 Water Supply, Cutting-off Notices 80 White Square Area 88 Whooping Cough 32 Workshops, Number of 77, 102, 104 Young. Children, Institutions for 72 Young Persons Acts, 1908-1932 76 Zymotic Diseases 18 From the Press of Shield and Spring, 26-28, Lancelot Place, S.W.7