AC 388 WAN 74 Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, &c. OF THE BOROUGH For the Year 1937 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 1937 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 1937. 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 1937. The Public Health Department, together with the Tuberculosis Dispensary, were transferred to the newly erected Municipal Buildings in Fairfield Street on the 22nd May, 1937. 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 1937. 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. Staff. 3 District. Public Vaccinators. Wandsworth, No. 1 Dr. E. R. Badcock, 29, West Hill, Wandsworth, S.W. 18. Wandsworth, No. 2 Dr. H. A. Topalia, 248, Earlsfield Road, Wandsworth, S.W. 18 Swaffield Road Dr. H. A. Topalia, Institution 248, Earlsfield Road, Wandsworth, S.W. 18. Vaccination Officers. Putney Mr. C. L. Taylor, 1, Crieff Road, Wandsworth, S.W. 18. The Medical Officer of Health has been appointed Vaccination Officer for the rest of the Borough. B2 4 Report of the Medical Officer of Health for 1937. SANITARY INSPECTORS. Name. Commenced Duty. Certificates held. Sanitary Inspector. Meat and Foods. Others. District 12 Housing 4† 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 †A. F. Saunders Jan. 1938 „ Yes One †A. W. Lock Jan. 1938 „ Yes — Food and Drugs: W. H. Jones Sept. 1926 S.I. Exam. Bd. Yes Four Food: H. T. Lambert Dec., 1919 S.I. Exam. Bd. Yes Five W. T. Willimott Dec. 1927 Joint Board Ex. Yes Thirteen A. E. Handley Aug. 1929 „ Yes Five Assistant to Food Inspectors: S. R. Coomber April, 1935 Joint Board Ex. — — Staff 5 HEALTH VISITORS. Name. Commenced Duty. Certificates held. Health Visitor. Trained Nurse. Certified Midwife. Sanitary Inspector. Maternity and Child Welfare:— Miss D. S. Collins Mar. 1913 Yes No No Yes ,, E. K. Woods Feb. 1916 Yes No Yes Yes ,, M. Dean Jan. 1924 Yes No Yes Yes ,, D. M. Staniland June 1927 Yes Yes Yes No „ J. E. D. Elder May 1928 Yes Yes Yes No „ H. McCarthy Nov. 1928 Yes Yes Yes No ,, J. Pottinger Aug. 1930 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 „ N. Hancocks July, 1930 Yes Yes Yes No „ R. Jones June 1937 Yes Yes Yes No Tuberculosis :— Miss P. G. Moores April 1915 Yes Yes No No „ R. M. Watling May 1922 Yes Yes Yes No ,, A. Thompson Feb. 1938 Yes Yes Yes No Staff at the Maternity Home. Matron:—Miss A. Crump, State Registered Nurse, State Certified Midwife. Commenced duty March, 1934. One Senior Sister. Two Sisters. Three 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 1937. 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., Meat and other Foods, and one other. Clerks—Grade A:— C. E. Gessner Oct., 1929 J. W. Marshall Jan., 1927 San. Insp., and five others. L. L. Parrini May, 1923 Two. S. F. Jennings Oct., 1935 - A. A. Rees May, 1936 - A. E. Hollis Feb., 1929 Three. L. V. Webb May, 1936 - Clerks—Grade D:— Hiss C. Wellings May, 1921 - Miss H. G. Wright Jan., 1925 - Miss M. J. Richards June, 1935 Three. Miss B. Newman Jan., 1938 Nine Certificates and one Diploma. Secretary to the Tuberculosis Care Committee:— Miss M. L. Baptie Dec., 1930 - Dispenser for the Tuberculosis Dispensaries:- C. Kitchen Feb., 1931 Registered Pharmacist. Staff. 7 Disinfecting Station. Engineer—R. E. Gale. Commenced duty November, 1936. Two motor drivers. Seven Disinfecting Attendants. Rat Catcher and Assistant Rat Catcher. Rat Catcher—A. Moon. Assistant Rat Catcher—H. Jarvis. Mortuaries. One whole-time and two part-time Mortuary Keepers. Staff Changes during the Year. On the 19th October the Council authorised the appointment of two additional Sanitary Inspectors owing to the increase in the work of the Department caused by recent legislation. The two officers appointed were Mr. A. F. Saunders and Mr. A. W. Lock. Mr. W. T. Willimott, Food Inspector, was awarded the Silver Medal and a Pass with Distinction 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. Mr. W. G. Pearce has obtained the certificate as a First Class Instructor at the Civilian Anti-Gas School. The Medical Officer of Health attended the Senior Officers' Course at this School during November. Mr. S. R. Coomber, Assistant to the Food Inspectors, has qualified as Sanitary Inspector by passing the examination of the Royal Sanitary Institute. On the 14th December, the Council decided that owing to the increased work in the Department, it was necessary for the 8 Report of the Medical Officer of Health for 1937. clerical staff to be increased. An additional male clerk (Grade " A "), and female clerk (Grade " D ") were authorised. Miss B. L. Newman was appointed to fill the position as Grade " D" Clerk. The vacancy for the Grade " A " Clerk had not been filled by the end of the year. 9 GENERAL STATISTICS FOR THE BOROUGH. Area 9,199 acres Population in 1937 341,700 No. of inhabited houses in 1937 80,163 No. of families, or separate occupiers, in 1931 95,383 Rateable value in 1937 £3,328,452 Estimated produce of a penny rate £13,465 Extracts from Vital Statistics. No. of Live Births Males Females Total Legitimate 1927 1812 3739 Illegitimate 92 109 201 Total 2019 1921 3940 Deaths 2045 2181 4226 Birth-rate 11.53 Death-rate—Crude 12.36 Standardised 11.49 Rate per 1,000 total (live and still) births. No. of Stillbirths 141 34.55 Deaths from puerperal sepsis 3 .73 Deaths from other puerperal causes 10 2.45 Total 13 3.18 Infantile mortality per 1,000 live births :— All infants 62 Legitimate infants 59 Illegitimate infants 114 Deaths from Cancer (all ages) 584 „ Measles (all ages) 2 „ Whooping Cough (all ages) 23 „ Diarrhoea (under 2 years of age) 43 Deaths from Tuberculosis :— No. 225 Rate .65 10 Report of the Medical Officer of Health for 1937. 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), and 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, Vital Statistics. 11 1937, the number of men, women and boys and girls over 14 years of age, who were unemployed, was 3,790, compared with 5,202 at December, 1936, a reduction of 1,412. 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 341,700 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 1937 Clapham 60,925 58,943 Putney 34,718 33,605 Balham 53,982 52,186 Streatham 08,435 66,249 Tooting 38,159 36,952 Wandsworth 96,891 93,765 Whole Borough 353,110 341,700 Births. The total number of births occurring in the Borough was 2,293, including 329 non-residents who were born in Institutions. 1,976 births of Borough residents occurred outside the Borough, so that the corrected number of births was 3,940 compared with 3,932 in 1936. 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 1937. TABLE II. Sub-District. No. of Births. Rates. Males. Females. Total. Birth-rate. Natural increase or decrease. Clapham 404 380 784 13.30 + .73 Putney 190 168 358 10.65 —2.50 Balham 322 279 601 11.51 —1.23 Streatham 331 337 668 10.08 —2.65 Tooting 195 210 405 10.96 — .37 Wandsworth 577 547 1,124 11.98 + .09 Whole Borough 2,019 1,921 3,940 11.53 —.83 The birth-rate was 11.53 per 1,000, compared with 11.46 for 1936, and 12.08 the decennial average. The rate for the whole of London during 1937 was 13.3 and for England and Wales, 14.9. 105 illegitimate births took place in the Borough, but only 47 belonged to the Borough. On the other hand 154 illegitimate births belonging to Wandsworth occurred outside the Borough, making a corrected total of illegitimate births belonging to Wandsworth of 201, 43 of these belonged to Clapham, 27 to Putney, 37 to Balham, 40 to Streatham, 17 to Tooting, and 37 to Wandsworth. The percentage of illegitimate births to total births was 51. The illegitimate births occuring 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 2,101, or 91 per cent. of the 2,293 children who were born in the Borough during the year. 1,550 of these notifications were transmitted by midwives, 412 by medical attendants, 64 by parents, and 75 by other persons. Vital Statistics. 13 Deaths. The number of deaths which took place in the Borough during the year was 3,214, but 1,081 of these did not belong to the Borough, while 2,093 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 4,226 of whom 2,045 were males and 2,181 females. The crude death-rate for the year was 12.36 compared with 11.79 in 1936, but after correction has been made by means of a comparability factor devised by the Registrar-General, the corrected death-rate was 11.49. The death-rate for the whole of London for 1937 was 12.3, for England and Wales 12.4, in the 125 County Boroughs, and great Towns 12.5, and in the 148 smaller Towns 11.9. Table III. shows the total number of corrected deaths and the death-rates for each sub-district and for the whole Borough. TABLE III. SubDistricts. Corrected Deaths. Crude Deathrate. Males. Females. Total. Clapham 356 385 741 12.57 Putney 182 260 442 1315 Balham 325 340 665 12.74 Streatham 382 462 844 12.73 Tooting 224 195 419 11.33 Wandsworth 576 539 1115 11.89 Whole Borough 2,045 2,181 4,226 12.36 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 1937. Table IV.—Causes of, and Ages at Death, during the Year 1937. 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. Halham. Streatham. Tooting. Wandsworth. Deaths in Public Institutions, erc. Enteric Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 2 1 1 .. 1 1 .. .. .. .. .. .. .. .. .. 1 1 1 Scarlet Fever 5 2 3 .. 1 2 1 .. 1 .. .. 1 .. .. 2 1 1 5 Whooping Cough 23 9 14 44 7 2 .. .. .. .. .. 5 2 3 1 1 11 18 Diphtheria and Membranous Croup 20 9 11 3 1 6 9 .. .. .. 1 6 1 2 2 6 3 19 Influenza 117 52 65 2 1 1 .. 2 4 39 68 22 10 16 38 8 23 4 Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro spinal Fever 5 3 2 1 1 2 .. 1 .. .. .. 1 1 1 .. 1 1 Other Epidemic Diseases 2 1 1 .. .. .. 2 .. .. .. .. .. .. .. .. .. .. Pulmonary Tuberculosis 197 120 77 .. 1 .. .. 35 85 66 10 48 17 29 27 25 51 12 Tuberculous Meningitis 5 4 1 .. .. 1 2 1 1 .. .. 1 .. 2 2 .. .. .. Abdominal Tuberculosis 1 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 Other Tuberculous Diseases 22 11 11 .. .. 1 1 3 6 7 4 5 2 4 3 4 4 13 Other Infective Diseases 13 10 3 .. .. .. 2 1 1 5 4 1 1 .. 2 3 6 11 Cancer, Malignant Disease 584 284 300 .. .. .. .. 3 35 246 300 97 70 100 112 60 145 22 Rheumatic Fever 28 11 17 .. .. .. 4 1 7 8 8 4 4 5 8 3 4 16 Diabetes 60 27 33 .. .. .. 1 .. 5 14 40 8 9 1 1 11 5 16 33 Other General Diseases 49 20 29 .. 1 2 1 4 5 14 22 13 5 8 7 4 12 32 Alcoholism 6 2 4 .. .. .. .. .. 1 4 1 3 1 1 .. .. 1 3 Chronic Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis 13 8 5 3 1 1 .. 3 1 4 .. 3 1 2 4 1 2 13 Cerebral Hæmorrhage, Apoplexy 82 26 56 .. .. .. .. .. 3 24 55 10 8 13 20 8 23 24 Convulsions 2 1 1 2 .. .. .. .. .. .. .. 1 .. .. 1 .. .. 1 Other Diseases of Nervous System 109 55 54 1 .. 2 2 6 26 41 31 23 12 12 20 10 32 86 Organic Diseases of Heart 939 359 580 .. .. .. .. .. 24 169 746 155 79 180 191 110 224 559 Other Diseases of Circulatory System 535 270 265 2 .. .. 1 6 16 140 370 87 59 75 128 34 152 244 Bronchitis 256 142 114 7 1 1 1 .. 7 59 180 50 30 31 35 34 76 120 Broncho-Pneumonia 128 68 60 27 7 2 4 1 11 25 51 23 18 20 23 13 31 94 Lobar Pneumonia 40 24 16 2 .. .. .. .. 3 16 19 4 6 8 11 2 9 13 Pneumonia (type not distinguished) 40 20 20 2 3 1 .. .. 2 16 16 3 2 8 9 7 ii 24 Other Diseases of Respiratory System 26 6 20 1 .. 1 .. .. 2 6 16 6 3 5 4 .. 8 14 Ulcer of Stomach 25 20 5 .. .. .. .. .. 1 15 9 4 3 2 5 9 2 17 Diarrhœa 21 17 4 17 2 1 .. .. .. 1 .. 2 .. 8 4 6 1 21 Enteritis 28 17 11 23 1 .. 1 .. 1 2 .. 3 5 2 6 1 11 27 Appendicitis and Typhlitis 33 17 16 .. .. 4 2 1 2 12 12 5 6 4 4 2 12 32 Obstruction of Intestines 30 12/ 18 1 .. .. .. .. 2 11 16 4 2 5 6 5 8 23 Cirrhosis of Liver 22 12 10 1 .. .. .. .. 1 16 4 7 3 1 4 2 5 15 Other Diseases of Liver 20 7 13 .. .. .. .. .. .. 7 13 2 1 3 10 2 2 17 Other Diseases of Digestive System 69 47 22 1 1 .. 2 2 10 34 19 8 10 8 15 4 24 58 Nephritis and Bright's Disease 131 66 65 .. .. .. .. 8 14 40 69 29 14 27 29 7 25 67 Other Diseases of, Urinary System 70 56 14 .. .. .. .. .. 4 21 45 9 11 9 20 2 19 49 Diseases of Generative System 11 .. 1 1 .. .. .. .. .. 5 3 3 3 .. 2 .. .. 6 9 Puerperal Fever 3 .. 3 .. .. .. .. 1 2 .. .. .. .. .. 1 2 .. 3 Other Accidents and Diseases of Pregnancy and Childbirth 10 .. 10 .. .. .. .. 3 7 .. .. 1 1 .. 2 1 5 9 Premature Birth 56 36 20 56 .. .. .. .. .. .. .. 10 2 11 2 3 28 4 Congenital Debility and Malforma- tion 48 26 22 46 1 1 .. .. .. .. .. 11 6 5 11 5 10 4 Other diseases of Early Infancy 30 18 12 30 .. .. .. .. .. .. .. 7 3 3 6 4 7 2 Old Age 91 30 61 .. .. .. .. .. .. 2 89 15 10 7 21 15 23 2 Deaths form Accident 132 73 59 2 2 13 11 15 21 63 26 17 19 16 10 44 11 Deaths from Suicide 58 32 26 .. .. .. .. 2 14 35 7 6 6 8 13 4 21 2 Other Violent Deaths 4 2 2 .. 1 .. .. .. .. 3 .. 1 .. 2 .. 1 .. 1 Other Defined Diseases 21 10 11 2 .. .. .. 5 2 5 7 8 1 2 6 2 2 17 Ill-defined Diseases or unknown 4 1 3 .. .. .. .. .. .. 1 3 .. .. .. 1 1 2 1 All causes 4226 2045 2181 246 34 37 49 101 326 1132 2301 741 442 665 844 419 1115 2396 Vital Statistics. 15 The number of deaths shown on Table IV. does not agree with that shown on page 108. The latter, which is prepared by the Registrar-General, gives the number of deaths which were registered during the calendar year, and the former the number of deaths which occurred during the year. The figures shown in Table 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. 1927 1313 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 1317 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 1936 11.46 13.6 14.8 10.96 12.5 12.4 Average 10 years 12.08 14.59 15.58 11.09 12.14 12.13 1937 11.53 13.3 14.9 11.49 12.3 12.4 16 Report of the Medical Officer of Health for 1937. The number of deaths which occurred in Institutions, etc., inside the Borough was 1,384 but 1,081 of these persons did not belong to the Borough. A total of 2,396 persons belonging to the Borough died in Institutions, 303 occurring in Institutions within the Borough and 2,093 in Institutions outside the Borough. Infantile Mortality. The number of deaths under one year was 246—49 in Clapham, 25 in Putney, 39 in Balham, 33 in Streatham, 22 in Tooting, and 78 in Wandsworth. As the number of births was 3,940 the Infantile Mortality rate was 62 per 1,000 births, compared with 58 last year and with a decennial average of 55. The rate is higher than for the whole of London, which was 60 per 1,000 births. For the 10 years ending 1918 the average infantile mortality rate was 87, while for the 10 years ending 1936, the average rate was 55. The number of deaths among legitimate infants was 223 to 3,739 births—a mortality of 59 per 1,000 births, while the number of deaths among illegitimate infants was 23 to 201 births —a mortality of 114 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. Vital Statistics. 17 TABLE VI. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 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 73 70 62 1933 46 75 51 31 65 49 50 1934 53 54 50 67 74 52 58 1935 73 52 47 60 42 49 55 1936 58 55 75 52 56 55 58 Average for 10 years 55 56 53 49 62 57 55 1937 62 69 64 49 54 69 62 No. of deaths under 1 year, 193 7 49 25 39 33 22 78 246 Maternal Mortality. Ten deaths occurred from accidents and diseases of pregnancy and three from Puerperal Fever, giving a total of 13 deaths after childbirth. This is equivalent to a rate of 3.18 per 1,000 live and still births, compared with 1.72 in 1936 and 2.55 in 1935. Enquiries into all maternal deaths, which were commenced in 1928 at the instance of the Ministry of Health, have been continued. C 18 INFECTIVE DISEASES. The number of deaths from notifiable infectious diseases, including all forms of Tuberculosis, was 341, compared with 329 in 1936. There were also 142 deaths from non-notifiable diseases of an infective nature, viz.:—two from Measles, 23 from Whooping Cough and 117 from Influenza. From all infective diseases the death-rate was 1.41 per 1,000—1.69 in Clapham, 1.24 in Putney, 1.34 in Balham, 1.43 in Streatham, 1.59 in Tooting, and 1.24 in Wandsworth. The rate in 1932, was 1.62 ; in 1933, 1.75; in 1934, 1.35; in 1935, 1 14; and in 1936, 1.17. 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. Infective Diseases. 19 TABLE VII. Notifiable Diseases. Total. No. of CASES of Infective Diseases grouped in Age Periods. Under 15 15 and upwards Under 1 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 and upwards Small-pox - - - - - - - - - - - - - - - - Diphtheria 386 307 79 8 10 27 35 32 153 42 29 36 9 5 - Scarlet Fever 638 513 125 8 17 35 35 58 253 107 45 62 10 7 1 Enteric Fever and Paratyphoid Fever 12 5 7 - - - - - 2 3 - 2 1 4 - Puerperal Fever 4 — 4 — — — — — — — — 4 — - - Puerperal Pyrexia 36 — 36 — — — — — — — — 32 4 — — Erysipelas 132 11 121 1 — — 2 — 3 5 1 26 21 59 14 Pneumonia:— Acute Influenzal 121 8 113 1 1 — — 1 2 3 2 20 17 38 36 Acute Primary 364 120 244 18 25 13 10 14 29 11 8 33 31 110 62 Cerebro-spinal Meningitis 9 6 3 2 1 2 1 — — — — 2 — 1 — Polio-myelitis 10 9 1 — — 3 — — 5 1 — 1 — — — Encephalitis Lethargica — — — — — — — — — — — — — — — Malaria 7 — 7 — — — — — — — — 3 1 3 — Dysentery 32 15 17 1 2 2 3 1 4 2 3 6 4 4 — Food Poisoning 9 2 7 — 1 — — — — 1 1 5 — 1 — Ophthalmia Neonatorum 24 24 — 24 — — — — — — — — — — Tuberculosis—All forms 599 76 523 1 3 5 4 2 30 31 53 253 88 107 22 Total 2383 1096 1287 64 60 87 90 108 481 206 142 485 186 339 135 20 Report of the Medical Officer of Health for 1937. 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 90 31 38 32 83 112 386 382 20 Scarlet Fever 84 84 68 146 109 147 638 572 5 Enteric and Para-typhoid Fevers 4 3 1 1 — 3 12 11 — Puerperal Fever 1 — — 2 — 1 4 3 3 Puerperal Pyrexia 6 — 9 6 2 13 36 33 — Erysipelas 20 10 11 24 8 59 132 80 — Pneumonia—Acute Influenzal 19 8 11 22 25 33 121 — 21 Pneumonia—Acute Primary 56 33 41 46 45 143 364 — 59 Cerebro-spinal Meningitis 2 2 1 — 2 2 9 9 5 Polio-myelitis 1 — 3 3 3 3 10 10 1 Encephalitis Lethargica — — — — — — — — — Malaria 2 — 2 — 2 1 7 5 — Dysentery 8 3 9 9 — 3 32 14 1 Food Poisoning 5 1 — — — 3 9 — — Total 298 175 194 291 276 526 1760 1119 115 Tuberculosis—all forms 99 67 82 114 89 148 599 225 Ophthalmia Neonatorum 9 3 — 3 2 7 24 9 1 Total 108 70 82 117 91 155 623 9 226 Grand Total 406 245 276 408 367 681 2383 1128 341 Infective Diseases. 21 The total number of cases was 2,383 compared with 2,139 in 1936. This increase is due to the rise which occurred in the number of cases of Diphtheria, Pneumonia, Dysentery and Tuberculosis. In 1936 there were 1,258 cases of these four diseases, but in 1937 the number was 1,502. Small-pox. No case of this disease occurred during the year. Vaccination. The duties of Vaccination Officer are now carried out by myself for the whole of the Borough with the exception of the Putney Ward. In June, 1932, the Council appointed me Vaccination Officer for Clapham and Wandsworth on the resignation of the officer who had previously acted in that capacity, and in January, 1938, I was appointed Vaccination Officer for Streatham, Balham and Tooting, rendered vacant by the death of Mr. L. H. Ford. The Vaccination Officer for Putney is Mr. C. L. Taylor, who is a part-time officer. Table IX. is taken from the official returns of the Vaccination Officers for the year 1936 and shows the number of children successfully vaccinated for the whole Borough, as well as for the separate sub-districts. 22 Report of the Medical Officer of Health for 1937. TABLE IX. No. of Children. Clapham Putney Balham Streatham Tooting j Southfield Springfield Total Successfully Vaccinated 179 124 360 232 72 194 159 1320 Insusceptible of Vaccination 1 1 — 1 — — — 3 Had Small-pox - - - - - - - - Dead, Unvaccinated 7 8 25 7 8 12 8 75 Exempted under Certificates of Conscientious objection 116 37 268 119 112 104 66 822 Postponed by Medical Certificate — 3 12 6 4 — — 25 Removed 28 34 72 33 27 16 8 218 Remaining on Books as Un-vaccinated 8 12 25 15 8 6 — 74 No. of Births returned to Vaccination Officers during 1936 339 219 762 413 231 332 241 2537 The percentage of children vaccinated to the total births was 52.0— in Clapham, 52.8; in Putney, 56.6; in Balham, 47.2; in Streatham, 56.1; in Tooting, 31.1; in Southfield, 58.4; and in Springfield, 65.9. This percentage is 2.2 lower than that recorded last year. Diphtheria. 386 cases occurred, compared with 365 in 1936 ; 388 in 1935 ; and 552 in 1934. The number of deaths was 20, compared with 23 in 1936, 14 in 1935, and 21 in 1934. The death-rate for 1937 was .05 and the case mortality was 5.1 per cent. The rate per 1,000 of population was 1.12; 1.52 in Clapham; .92 in Putney; .72 in Balham; .48 in Streatham : 2.24 in Tooting; and 1.19 in Wandsworth. Infective Diseases 23 Of the 386 cases, 382 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, Haselrigge Road, Larkhall Lane, St. Andrew's Street, St. Mary's, St. Alphonsus Road, Stonhouse Street and Telferscot Road Schools in Clapham; Convent of the Sacred Heart (Elementary), Hotham Road, Huntingfield Road, Putney Church of England Felsham Road, and Putney Roman Catholic Schools in Putney; Broadwater Road, Fircroft Road, Hearnville Road, Ravenstone and Smallwood Road Schools in Balham; Immanuel School in Streatham; Defoe, Ensham, Sellincourt Road and Tooting Graveney Schools in Tooting; Brandlehow Road, Garratt Lane, Magdalen Road, Merton Road, Riversdale, St. Michael's, Swaffield Road, Waldron Road, Wandle and West Hill Schools in Wandsworth. Swabs were taken from the throats of some of the children examined. As the result of this swabbing 14 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 62 tubes of anti-toxin were issued to medical practitioners for use in cases of Diphtheria. Clinics for Immunisation against Diphtheria. The Council holds two clinics which were established ten years ago for the testing and immunisation of children against Diphtheria. They are situated in Wandsworth and Balham, and a weekly session is held at each Clinic. The work is carried out by the Council's staff. The addresses and times of the Clinics are as follows:— The Clinic, Municipal Buildings, Fairfield Street, Wandsworth. Every Wednesday afternoon from 2 to 3.30 p.m. 24 Report of the Medical Officer of Health for 1937. Balham Infant Welfare Centre, 91, Bedford Hill, Balham. Every Friday afternoon from 2 to 3.30 p.m. Although intended for the immunisation of susceptible children, adults who may be brought into close and frequent contact with children are also immunised. Method of 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 Toxoid Antitoxin Floccules, or T.A.F., which requires two injections at weekly intervals. The results obtained with this preparation have been satisfactory. The use of Alum Precipitated Toxoid (A.P.T.) which required one injection, 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 1,037, compared with 1,205 in 1936, and 1,276 in 1935. In the 10 years during which the two clinics have been open, 9,690 persons have attended. Infective Diseases. 25 6,725 of the total number who attended were given the Initial Schick Test, to see if they were susceptible to Diphtheria, and the remaining 2,965 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 4,690 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 the small number of adults who were tested 50 per. cent, gave a positive result. Immunisation:— Immunity does not develop until several months have elapsed after the injections have 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 three to four months after the injections have 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. Throughout the ten years during which the Clinics have been in existence, the number of persons found to require immunisation was 7,655. This number is made up of 4,690 found to be Schick 2G Report of the Medical Officer of Health for 1937. 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 195 3037 995 2054 2173 4227 301 162 2081 2609 4690 Schick Negative 49 837 618 727 777 1504 262 181 757 1190 1947 Result not read 5 40 26 30 41 71 13 4 33 55 88 Total 249 3914 1639 2811 2991 5802 576 347 2871 3854 6725 Percentage Positive 78% 78% 61% 74% 73% 73% 52% 47% 72% 68% 70% Infective Diseases. 27 positive after the initial test and the 2,965 young children who were assumed to be susceptible without a test, as they were under five years of age. The subsequent history of these 7,655 persons is given in the following statement:— No. who were immunised and found to be Protected as shown by a Negative re-Schick Test 5,677 No. who received a course of injections but are not yet protected as the re-Schick Test is still positive 301 No. who received injections, the value of which is not known as they have not attended to be re-tested 1,615 Schick positive cases who were not injected 62 Total number of Susceptibles 7,655 The age grouping of the 5,677 persons in whom immunity was produced is given in Table XI. Four of the 5,677 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 four children were tested again after they had recovered from the attack, and the result of this re-test was negative. Two perons became protected as shown by a negative reSchick test without receiving any immunising injections. They were tested a second time after one year and nine months and three years and three months respectively, with a negative result 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 28 Report of the Medical Officer of Health for 1937. 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 2315 2413 710 2570 2868 5438 153 86 2590 3087 5677 Infective Diseases. 29 XII, giving this information. The six cases referred to in the previous paragraph are not included in the Table, which deals with 5,671 persons. It will be noticed that the time taken to produce immunity is shown 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, 4,979 out of 5,671 were immunised after the first series. (2) 633 cases required a second series of injections to produce the same result. (3) In a few cases further injections had to be given before immunity was produced. (4) 4,224 out of 5,671 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 5,190. 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 5,677 persons who have been protected, 301 have completed the first series of injections but cannot be recorded as protected because the last re-Schick test has given a positive result. 95 of these have not attended since this positive re-test. The other 206 have attended the Clinics and have received further injections but have not yet reacted negative to the re-Schick test. 30 Report of the Medical Officer of Health for 1937. 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 1439 20 12 11 1482 34 3 - — — 1519 First Series 2 injections 313 765 172 21 1271 61 14 5 — 2 1353 3 injections 583 775 312 118 1788 93 15 6 — 1 1903 4 injections 5 5 — 2 12 — — — — — 12 Second Series 2 to 6 injections 51 121 62 179 413 136 34 6 1 1 591 Third Series 3 to 8 injections — — 5 4 9 33 6 1 - — 49 Fourth Series 4 to 6 injections — — — 3 3 — 1 — — — 4 Fifth Series 10 injections - — — — — 1 — — — — 1 Total Under 15 2391 1686 563 338 4978 358 73 18 1 4 5432 Adults Over 15. 1 injection 32 8 1 3 44 44 First Series 2 injections 6 39 14 2 61 2 1 1 .— — 65 3 injections 29 30 14 4 77 5 — — — — 82 4 injections — 1 — 1 - - — — — 1 Second Series 3 to 6 injections — 2 10 16 28 13 — 1 — — 42 Third Series 3 injections - - - 1 1 1 - - - - 2 11 injections — — — — — — 1 — — — 1 Fourth Series 6 to 8 injections - - — — — 1 1 — — — 2 Total All Ages 2458 1766 602 364 5190 380 76 20 1 4 5671 Infective Diseases. 31 A further 1,615 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 1,059 who only received one or two doses. Sixty-two susceptible persons have not yet commenced a course of injections. In the 10 years during which the Clinics have been open, nine 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 seven were bacteriological cases with no clinical symptoms. Nineteen children who had been immunised and reacted negative to the re-Schick test have been notified as cases of Diphtheria. Ten 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 37 patients. 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 six doctors have availed themselves of these facilities and 14 children have been immunised by them. Twelve of these have re-acted negative to the re-Schick test—eleven being tested by the practitioners and one by the assistant Medical Officer of Health. The other two children were not tested, as the parents did not give their consent. Scarlet Fever. 638 cases of Scarlet Fever occurred, compared with 644 in 1936, 721 in 1935, and 1,573 in 1934. 32 Report of the Medical Officer of Health for 1937. The decrease in the number of cases has been associated, with a general decrease in the incidence of this disease throughout London. Five of the cases died, compared with none last year and five in the previous year. The death-rate was .014 per 1,000 compared with nil and .011. The case mortality was ,78. The case-rate per 1,000 of population was 1,86:— 1.42 in Clapham; 2.49 in Putney; 1.30 in Balham; 2.20 in Streatham; 2.94 in Tooting; and 1.56 in Wandsworth. Of the total number of cases, 572 or 89 per cent., were removed to hospital. The Medical Officers of the London County Council made inspections of six schools during the year, and any suspected cases were at once excluded and the names and addresses forwarded to me for inquiry. Return Cases of Scarlet Fever and Diphtheria. 20 cases of Scarlet Fever and three of Diphtheria occurred within one month of the return of a previous case from hospital. Enteric and Para-Typhoid Fevers. 12 cases, and three deaths of the above occurred, compared with 28 cases and three deaths in the previous year. Three of the cases were true Enteric Fever and nine were Para-typhoid Fever. Puerperal Fever and Puerperal Pyrexia. During the year four cases of Puerperal Fever and 36 cases of Puerperal Pyrexia were notified. There were three deaths. The death-rate was .008 per 1,000 of population and 73 per 1,000 (live and still) births. Erysipelas. 131 cases were notified and no death occurred. Whooping Cough. 23 deaths from Whooping Cough occurred during the year and the death-rate was .06 per 1.000. Infective Diseases. 33 1,082 cases came to the knowledge of the Department during the year, and 125 of the cases were removed to hospital. 816 visits were made by the Health Visitors to houses where cases of Whooping Cough occurred, and five premises were disinfected. Influenza. The number of deaths from Influenza was 117 compared with 44 in 1936, 38 in 1935, 43 in 1934, 183 in 1933, and 111 in 1932. The death-rate was .34 per 1,000. Influenzal Pneumonia and Acute Primary Pneumonia. 121 cases of acute Influenzal Pneumonia, and 364 cases of acute Primary Pneumonia were notified. 21 of the former and 49 of the latter died. The total number of deaths credited to all forms of Pneumonia during the year was 208, compared with 171 in 1936, 145 in 1935 and 187 in 1934. Cerebro-Spinal Meningitis. Nine cases of this disease occurred, and six deaths were registered. Two other cases of this disease were notified, but proved not to be cerebro-spinal meningitis. 12 deaths were registered as being caused by Meningitis. Polio-myelitis and Polio-encephalitis. Ten cases occurred, one of which proved fatal. One of the cases was sent for treatment at Queen Mary's Hospital, Carshalton, under the scheme arranged by the London County Council. Encephalitis Lethargica. No case of this disease occurred. Malaria. Seven cases were notified. No death occurred. D 34 Report of the Medical Officer of Health for 1937. Dysentery. 32 cases of Dysentery were notified and one death occurred. Ophthalmia Neonatorum. 24 cases were notified. 20 of these recovered without any impairment of vision, and one case died from Marasmus following prematurity. Three of the infants removed from the Borough, and the final condition of the eyes was not ascertainable. TABLE XIII. Result of Treatment. Removed from Borough. Still under Treatment. Recovered— Vision not affected. Vision Impaired . Total Blindness. Died. Treatment received:— In Hospital 5 — — 1 3 — At Hospital, Out-patient 1 — — — — — At home 14 — — — — — Total 20 - - I 3 — Measles. The number of cases brought to my notice during the year October 1st, 1936, to September 30th, 1937, was 439. Two cases died during the calendar year; the death-rate per 1,000 of the population was .005. 36 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. 98 cases were removed to hospital, compared with 151 in the non-epidemic year of 1935. Infective Diseases. 35 TABLE XIV. MEASLES— CASES REPORTED AND DEATHS. Period 1st October— 30th September. 1927-28 1928-29 1929-30 1930-31 1931-32 1932-33 1933-34 1934-35 1935-36 1936-37 Cases Reported. In a Measles year 4,596 — 4,046 — 3,601 — 4,140 — 3,973 In a Non-Measles year — 355 — 295 — 589 — 151 — 439 Deaths. In a Measles year 38 - 46 - 38 - 37 - 24 - In a Non-Measles year - 1 - 2 — 2 — 2 — 2 Period. Calendar Year 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 Cases Reported 4,529 380 3,976 291 3,598 615 4,148 137 3,987 589 Deaths 36 1 47 2 37 2 37 2 24 2 36 Report of the Medical Officer of Health for 1937. 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. 542 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Measles occurred, and 25 premises were disinfected at the request of the occupiers. 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 6 2 2 - 3 8 9 - 6 36 Cavendish Road — 6 3 - 6 — 35 1 3 54 Christchurch 2 - — - 4 18 8 - — 32 Haselrigge Road 3 2 3 1 8 6 4 1 23 51 Heathbrook, St. Rule Street 7 5 1 - 3 1 - - - 17 Henry Thornton, South Side 1 — — - 1 — — - — 2 Larkhall Lane 2 9 1 - 3 1 7 - 7 30 New Park Road 10 12 4 - 58 3 7 - 12 106 Parochial, Old Town 3 1 47 - 4 13 27 - 1 96 Parochial, Macaulay Road 1 - - - - - - - - 1 St. Mary's, Crescent Lane — 1 — - 1 — — - — 2 St. Mary's, St. Alphonsus Road 1 8 - - - - - - - 9 Stonhouse Street 2 2 - - 33 8 34 - 1 80 Stowey House, Clapham Cora. 1 - - - - - - - - 1 Telferscot Road 4 3 1 - 32 16 13 1 18 88 Putney. Church of England, Felsham Rd. 4 2 - - 17 — — - 1 24 Church of England Lower Com. 1 - - - - - - - — 1 Convent of Sacred Heart (Ele.) 6 2 - - - - - - 8 Hotham Road 4 2 3 - 3 15 2 - 13 42 Huntingfield Road 8 9 4 — 4 — — - 3 28 Parochial, Roehampton 1 2 — - — — 8 - — 11 St. Agnes', R.C. 3 — — - 1 6 — - 5 15 Upper Grade, Lacy Road - - - - - 2 - - - 2 Carried forward 70 68 69 1 181 97 154 3 93 736 Infective Diseases. 37 TABLE XV.— continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. ! Ringworm. Other Diseases. Totals. Brought forward 70 68 69 1 181 97 151 3 93 736 Balham. Balham Central 4 1 — 1 2 — — — 2 10 Bee, The 1 — — - — — - - - 1 Broadwater Road 1 1 - - 1 1 - - - 4 Fircroft Road 3 2 36 1 7 19 25 2 5 100 Hearnville Road — — 33 - - 4 4 — - 41 Holy Trinity 2 1 - - - - - - - 3 Nightingale Square, R.C. 8 — — - 5 - - - - 13 Oldridge Road 2 1 — - 32 3 23 - 3 64 Ravenstone Street 5 1 1 - 7 — 1 — 1 16 St. Mary's 10 — 12 1 6 3 48 — - 80 Smallwood Road 1 17 — - - - - - - 18 Streatham. Christchurch — 1 - - - - - - - 1 County Secondary, Welham Rd. — 1 - - - - - - - 1 Dunraven 1 — - - — — — - - 1 Eardley Road 19 2 29 1 11 17 93 — 12 184 Furzedown Demonstration 7 3 1 1 25 17 — — 7 61 Granton Road 3 2 3 4 58 38 4 — 8 120 Hitherfield Road 8 2 — 2 6 — 1 — 17 36 Holy Trinity, Lutheran Place — — — — — 2 — — 4 6 Immanuel — 6 4 — 3 — 1 - 14 28 Mitcham Lane 1 - - 1 20 - 18 - 2 42 St. Andrew s, Coventry Hall - 1 - - - - - - - 1 St. Andrew's, Polworth Road 2 - - — - 2 - - - 4 St. Leonard's 8 - - — 3 — 1 - - 12 Sunnyhill Road 8 — 1 6 — 1 — - 17 Woodmansterne Road 13 3 2 - 59 9 2 1 95 184 Tooting. Defoe (Fountain Road) 7 13 1 — 1 24 1 — — 47 ! Ensham 6 2 1 — 9 7 2 — 1 28 o Ensham Central 2 q 1 Franciscan Road 13 1 — — 13 1 3 — Hillbrook Road 5 3 .— — 15 1 22 — J 47 Sellincourt Road 16 18 11 2 12 8 7 — 20 94 Tooting Graveney 10 5 — — 1 1 21 — 38 Undine Street, R.C. 9 2 1 20 1 1 34 Carried forward 245 157 204 ,6 484 274 433 7 285 2105 38 Report of the Medical Officer of Health for 1937. TABLE XV.— continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 245 157 204 16 484 274 433 7 285 2105 Wandsworth. Allfarthing Lane 4 5 2 - 20 22 - - 2 55 All Saints' 1 — - — 6 15 1 - - 23 Brandlehow Road 2 3 23 - 1 3 2 - - 34 County Secondary, West Hill. . 1 - - - - - - - - 1 Earlsfield - 2 - - - - - - 1 3 Elliott Central 1 1 — — 1 1 3 — — 7 Eltringham Street 7 3 2 — 11 24 3 - 3 53 Frogmore Special — — 2 — 1 1 6 — 3 13 Garratt Lane 3 7 3 — 2 — — - 22 37 Magdalen Road 5 3 2 — 1 21 1 — 25 58 Riversdale 3 7 46 1 40 35 5 — 10 147 St. Ann's 3 3 - - - 5 - - - 11 St. Faith's 4 - 35 3 23 22 1 - 1 89 St. Joseph's 3 - 2 - - 5 9 - 3 22 St. Michael's 6 3 21 — 1 12 31 — 15 89 St. Thomas' 1 - - - - - - — - 1 Swaffield Road . 7 9 1 — 20 — — - - 37 Technical Institute 2 - - - - - - - - 2 Waldron Road 10 4 — — 3 23 3 — 2 45 Wandle 3 4 — — 37 9 1 — 14 68 Wandsworth 1 2 - — - - - — - 3 Warple Way 3 1 4 — — — 13 - - 21 West Hill 6 2 17 — 25 2 5 1 22 80 Grand Total 321 216 364 20 676 474 517 8 408 3004 Diarrhoea. The number of deaths from Diarrhoea was 49 compared with 36 in 1936, 41 in 1935 and 44 in 1934. Of these, 40, or 81 per cent., were under the age of one year, compared with 94 in 1936. The number of deaths from Diarrhoea, Zymotic Enteritis and Enteritis under one year represents 16.2 per cent, of the total mortality at that age. Other Infective Diseases. 13 deaths occurred, five from Syphilis, five from Septicaemia, one from Pyaemia, one from Encephalitis, and one from Actinomycosis. Infective Diseases. 39 Scabies. The names of 101 school children who were suffering from Scabies were forwarded to me by the Medical Officer to the London County Council, and the homes were visited by the Sanitary Inspectors. These children were being treated at the London County Council cleansing stations. In addition to the above 267 other cases were reported to me. These cases were treated at the Council's disinfecting station with sulphurated potash baths, the average number of baths given per case being three. In 159 cases when consent was obtained, disinfection of the bedding and clothing of the patient was carried out by the disinfectirg staff. Cleansing of Persons Act. The names of 19 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 nine cases the clothing and bedding were also verminous and this was disinfected. These children were cleansed by the officials of the London County Council at the Cleansing Station under the supervision of that Authority. Disinfection. The total number of rooms disinfected after the occurrence of cases of infective diseases was 2,076:— 322 in Clapham, 236 in Putney, 355 in Balham, 365 in Streatham, 207 in Tooting, and 591 in Wandsworth. Two private and one public 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 40 Report of the Medical Officer of Health for 1937. are free. Ambulances are also provided by the same Authority for the conveyance of other cases on payment. Bacteriological Examinations. During the year 3,424 bacteriological examinations were made at the Lister Institute. The following Table shows the number of examinations in each sub-district and for the whcle 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 329 375 361 659 522 769 3015 Positive 34 22 18 21 45 54 194 Enteric Fever:— Negative 2 13 — 4 4 8 31 Positive 1 3 1 1 — 1 7 Other Diseases:— Negative 5 3 59 8 5 5 85 Positive 3 24 22 28 8 7 92 Total 374 440 461 721 584 844 3424 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 584, the number of males being 284 and females 300. The death-rate was 1.70 per 1,000. The number of deaths in 1937 was 16 more than in 1936. The number of deaths from diseases of the Brain and Nervous System was 123. 1,474 deaths occurred from diseases of the Heart and Circulatory System, compared with 1,440 in 1936, 1,446 in 1935, and 1,272 in 1934. 1,116 of these deaths were of persons over 65 years of age. There were 490 deaths from diseases of the Respiratory System, compared with 440 in 1936, 341 in 1935, and 396 in 1934. The number from Bronchitis was 256 compared with 247 in 1936, and from Pneumonia (all forms) 208 compared with 171 in 1936. Further particulars relative to Pneumonia are given on page 33. The number of infants under two years of age who died from these diseases was 50. 134 deaths, 80 males and 54 females, were registered as due to Premature Birth and Developmental Diseases, compared with 119 in 1936. 91 deaths, 30 males and 61 females, occurred from Old Age. 89 of these were persons over 65 years of age. The number of deaths due to this cause in 1936 was 88. 194 deaths were due to violence, 132 of them being due to accidents, 58 to suicide, and four to other forms of violence. Insulin Treatment. This service was commenced by the Council in 1928 with the sanction of the Ministry of Health. There are now five persons receiving treatment. The cost to the Council for the year 1937 was £19 14s. 4d. Pernicious Anaemia. One person is receiving treatment, by the provision of Liver Extract. The cost to the Council for the year 1937 was £9 15s. Od. 42 Report of the Medical Officer of Health for 1937. Inquests. Inquests were held on 307 persons dying in the Borough, and on 236 Borough residents who died outside the Borough. The next Table shows the results of the lindings of these inquests. TABLE XVII. Inquests. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Deaths from Natural Causes 53 42 42 54 45 71 307 Accidental:— Falls 8 6 5 4 8 12 43 Knocked down by motor vehicles 5 4 11 — 3 8 31 Falls from a height 3 3 8 2 1 5 22 Burns and scalds — 4 2 2 — 6 14 Falls from motor vehicles 2 2 2 2 1 1 10 Thrown from bicycles 1 1 — 2 — 2 6 Suffocation 1 1 1 1 1 1 6 Knocked down by tram- car 1 — 3 — 1 — 5 Knocked down by railway train 1 — — 1 — 3 5 Crushed by wall — 1 — — — 4 5 Septicaemia following injury — — — — 2 1 3 Other 1 1 3 1 1 — 7 Suicidal:— Poisoning by:— Coal Gas 2 3 6 5 3 9 28 Lysol — 1 2 1 — 1 5 Aspirin — — — 2 .— 1 3 Veronal - - - - - 1 1 Poison not stated — — — — 1 — 1 Drowning 2 3 — 5 — 1 11 Fall from a height — - 1 1 — 3 5 Hanging 1 — - — — 2 3 Cut throat — — 1 — — 1 2 Gunshot wounds — — 1 — - — 1 Run over by train — 1 — — — — 1 Manslaughter — — 1 — — — 1 Found drowned - - - - - 2 2 Found dead — 1 — — — — 1 Result of war wounds — 13 - - 1 - 14 Totals .. 81 87 89 83 68 135 543 43 TUBERCULOSIS. Notification.— The total number of new cases of Tuberculosis which came to the notice of the Department during 1937 was 599 as compared with 569 in 1936, 658 in 1935, 621 in 1934, and 610 in 1933. The sources of information regarding the 599 new cases in 1937 were as follows:— Primary notifications on Form A 429 Primary notifications on Form B Transfers from other Sanitary Authorities 139 Naval and military notifications 4 Un-notified at death 27 Total 599 Deaths.— The number of deaths certified as due to diseases of a Tuberculous nature was 225. This compares with 236 in 1936, 249 in 1935, 276 in 1934, and 305 in 1933. 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 1937. TABLE XVIII. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Males. Females. Males. Females. Males. Females Males. Females. Under 1 year - - 1 - - - 1 - 1—5 — 1 6 7 — 1 1 2 5—10 7 3 6 14 — — - 1 10—15 9 8 8 6 — — 1 — 15—20 17 25 6 5 9 12 — 1 20—25 40 55 8 5 13 18 4 — 25—35 66 63 7 9 27 19 2 4 35—45 54 26 3 5 22 7 1 45—55 39 11 1 2 23 7 2 - 55—65 30 18 3 3 19 11 3 1 65 upwards 13 5 2 2 7 2 1 3 Totals 275 215 51 58 120 77 16 12 Table XIX. shows the number of new cases of Nonpulmonary Tuberculosis classified according to the part of the body affected. TABLE XTX. Localisation of Disease. Males. Females. Total. Brain 5 4 9 Glands, Mesenteric 3 9 12 Glands, Cervical 13 15 28 Bones and Joints 23 16 39 Other Parts 7 14 21 Totals 51 58 109 Tuberculosis. 45 Of the 225 deaths from Tuberculosis, 136 were males and 89 females. 197 deaths were due to Pulmonary Tuberculosis and 28 to other forms of Tuberculosis. Further details are given in Table XX. TABLE XX. Localisation. Males. Females. Total. Pulmonary Tuberculosis 120 77 197 Brain 4 1 6 Glands, Mesenteric 1 — 1 Bones and Joints 7 2 9 Other Parts 4 9 13 Totals 136 89 225 In addition to these deaths, which were duly certified in the returns as due to Tuberculosis, 23 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.) Four were certified as dying from diseases other than Tuberculosis. (b.) Nineteen 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 of the Medical Officer of Health for 1937. TABLE XXI. 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 Pulmonary Tuberculosis:— No. of Deaths 269 320 275 288 245 257 235 216 205 197 Death-Rate .76 .90 .77 .81 .69 .73 .66 .62 .59 .57 Other Forms:— No. of Deaths 35 33 33 19 43 48 41 33 31 28 Death-Rate .10 .09 .09 .05 .12 .13 .11 .09 .09 .08 Total:— No. of Deaths 304 353 308 307 288 305 276 249 236 225 Death-Rate .86 .99 .86 .86 .81 .86 .78 .72 .68 .65 47 Tuberculosis. During the year 27 persons, not previously notified, were certified as having died of Tuberculosis. The ratio of un-notified Tuberculosis deaths to total Tuberculosis deaths is therefore 27 to 225. Of the 27 un-notified deaths, 14 were certified from Institutions, nine 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. 68 persons died within one month after notification, 87 within three months, and 99 within six months. 599 cases were added to the notification register during the year, and 543 cases who had removed, recovered or died, were taken off. The number remaining on the register at the end of the year was 2,137. 48 TUBERCULOSIS DISPENSARIES. The times at which Sessions are held at the two Tuberculosis Dispensaries are as follows:— (a.) At the Main Dispensary, Municipal Buildings, Fairfield Street, Wandsworth, which serves the areas Putney, Southfield, Fairfield, Springfield, and North Clapham:— Monday : Morning and Afternoon. Tuesday : Evening (7 p.m.), for those at work. Thursday : Morning and Afternoon. Saturday : Morning (for school children). (b.) At the Branch Dispensary, 114, Gosberton Road, Balham, which serves the areas Streatham, Tooting, Balham, and South Clapham:— Tuesday : Morning and Afternoon. Thursday : Evening (7 p.m.), for those at work. Friday: Morning. New Cases in 1937.—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. 161 9 170 15 261 446 F. 133 15 148 30 287 465 Children M. 7 13 20 1 226 247 F. 4 12 16 3 242 261 Totals 303 49 354 49 1016 1419 Tuberculosis Dispensaries. 49 The districts of the Borough in which these 1,419 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 81 32 35 44 64 129 385 Private Practitioners 56 45 44 63 73 133 414 Charitable Societies 15 37 10 11 30 84 187 Other Dispensaries 39 12 27 29 27 44 178 L.C.C. Schools - 1 2 1 3 1 8 Ministry of Pensions - - 6 - - - 6 Existing Dispensary Patients - 1 5 1 5 2 14 Other Sources 26 21 19 10 35 116 227 Totals 217 149 148 159 237 509 1,419 Contacts.—Of the 1,419 new cases examined, 436 were contacts. 37 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., 1936 New Cases Removed from Register Remaining on Register 31st Dec., 1937 Pulmonary 1128 345 326 1147 Non-Pulmonary 251 61 53 259 Suspected cases 19 141 111 49 Totals 1398 547 490 1455 E 50 Report of the Medical Officer of Health for 1937. 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 113 2. Number of patients transferred to other areas and cases " lost sight of " 171 3. Died during the year 155 4. Number of cases recovered 59 5. Number of observation cases in which a period of observation exceeded two months 43 6. Number of attendances at the Dispensaries 4870 7. Total number of reports, etc., made in connection with the Dispensaries 4929 8. Number of attendances at General Hospitals or Institutions of patients for:- (a) Light treatment 285 (b) Other special forms of treatment 1809 9. Number of patients to whom Dental Treatment was given in connection with the Dispensary 34 10. Number of Personal Consultations with Medical Practitioners— (a) At Homes of Patients ... 239 (b) Otherwise 1446 11. Number of other visits by Tuberculosis Officers to Homes 421 12. Number of visits by Health Visitors or Nurses to homes for Dispensary purposes 5644 13. Number of— (a) Specimens of Sputum, etc., examined 1523 (6) X-ray examinations made in connection with Dispensary work 258 The number of patients who received institutional treatment under the London County Council's Tuberculosis Scheme during 1937 was as follows :— (a.) In Hospitals for observation 23 (b.) In Sanatoria 435 (c.) In L.C.C. General Hospitals 51 509 In addition to these many other patients received treatment in private or general hospitals. Tuberculosis Dispensaries 51 Co-operation with Other Institutions.—Cases requiring special investigation which can be carried out in an Out-patient Department are referred to St. Thomas' Hospital, under arrangements which were inaugurated in 1913. The reports received from the Hospital on these cases are of much value. Special cases requiring treatment by Artificial Light or X-rays are also referred to the out-patient department of St. Thomas' Hospital. The arrangements made for treatment by the Artificial Pneumothorax method with several hospitals have been continued. 120 cases were treated during the year and 1,778 refills were administered. The cost to the Council was £933 9s. Od. Two of these cases also received Sanocrysin injections, at a cost of £4 13s. Od., for 31 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. Thirty-four patients received dental treatment and 21 of these were supplied with dentures. The attendances at the dentist totalled 121. The amount expended on dental treatment during the year was £15 10s. Od., and the cost of dentures supplied to patients was £52 12s. 6d., making a total cost of £68 2s. 6d. Extra Nourishment.—The authority for granting extra nourishment to patients suffering from Tuberculosis is now contained in Section 219 of the Public Health (London) Act, 1936. It is granted on medical grounds as part of the treatment of the patient. It is limited to the slighter cases where there is a reasonable probability that the additional food 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 144 patients have been granted extra nourishment under the scheme at a cost of £206 6s. l1d. The scheme has E 2 52 Report of the Medical Officer of Health for 1937. been found to be of great help in the treatment of the types of patient mentioned above. Fifty-five cases who were ineligible under the above scheme were granted Extra Nourishment through the Public Assistance Committee. 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 1937 as far as it is known. Table XXVI refers to cases of Pulmonary Tuberculosis and Table XXVII. to cases of Non-pulmonary Tuberculosis. 53 TABLE XXVI. Tuberculosis Dispensaries. Classification on Initial attendance at the Dispensaries. Condition at the end of 1937. Total cases where condition is known. Removed and lost sight of. Total cases who have attended. Discharged as cured. Disease arrested. Disease not arrested. Died. Pulmonary Tuberculosis. Class T.B. Minus. Adults, M. 432 21 100 259 812 1882 913 2795 Adults, F. 495 33 98 253 879 Children 123 13 24 31 191 Class T.B. Plus. Adults, M. 172 58 326 1823 2379 4194 1456 5650 Adults, F. 148 51 253 1313 1765 Children 9 3 6 32 50 54 TABLE XXVII. Classification on Initial attendance at the Dispensaries. Condition at end of 1937. Total cases where condition is known. Removed and lost sight of. Total cases who have attended. Discharged as cured. Disease arrested. Disease not arrested. Died. Non-Pulmonary Tuberculosis. Bones and Joints Adults, M. 54 3 35 23 115 302 157 459 Adults, F. 27 4 16 10 57 Children 73 9 26 22 130 Abdominal Adults, M. 12 — 3 5 20 96 72 168 Adults, F. 13 — 10 6 29 Children 30 2 9 6 47 Peripheral Glands Adults, M. 22 1 8 5 36 362 155 517 Adults, F. 43 6 6 11 66 Children 220 6 23 11 260 Other Organs. Adults, M. 18 3 6 13 40 127 58 185 Adults, F. 20 2 25 9 56 Children 8 - 3 20 31 Report of the Medical Officer of Health for 1937. Tuberculosis Dispensaries 55 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. 1932 1664 1001 342 1933 1633 997 280 1934 1467 1022 270 1935 1367 883 253 1936 1443 933 232 1937 1523 1059 224 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, a scholar of the Royal College of Physicians, who has visited the Wandsworth Dispensary at ten special evening sessions when he examined 37 persons who are contacts of cases of Tuberculosis. The attendance of Miss Watling, Tuberculosis Visitor, in connection with this investigation has been most helpful. 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 1937. The following is a list of the members of the Committee:— Councillor Mrs. C. E. F. Callingham. Councillor Mrs. D. Croft. Councillor W. Greener, F.C.R.A. Councillor Mrs. E. Nutting. Councillor Mrs. L. G. Watson. Councillor F. T. Jordan, J.P., A.C.I.I. Miss Burton. I..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. Dr. Atlee, Divisional Medical Officer, London County Council. Mrs. Harper, Public Assistance Committee. Mr. King, Public Assistance Committee. Mr. W. H. Greenwood, Streatham Toc H. Miss Lemon, Ranyard Nurses. Mrs. Arding. Mrs. Coppen. Mrs. Cresswell. Mrs. Dearman. Mrs. Dixon. Miss J. Duff, J.P. Mrs. Duffell. Mrs. Genge. Mrs. Groom. Dr. E. Higgins. Mrs. H. Jeans. Mrs. Laer. Mrs. MacDonald. Mrs. Marriott. Mrs. Morton Clarke. Mrs. Evan Rees. Tuberculosis Dispensaries. 57 Officers of the Committee:— Chairman : Miss J. Duff, J.P. Vice-Chairman : Mrs. Morton Clarke. Hon. Treasurer: Mrs. Dearman. Secretary : Miss M. L.Baptie. 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. Thirty-three adults were sent away for convalescent treatment during 1937 at a cost of £185 2s. l0d. 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 58 Report of the Medical Officer of Health for 1937. 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 £139 8s. 0d. 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 40 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, feeding cups, invalid chairs, etc., 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 £57 18s. 2d. 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, and St. Stephen's Hospital, Fulham Road. The authorities of these Hospitals have given permission for the Secretary of the Care Committee to visit Wandsworth residents suffering from Tuberculosis who happen to be under treatment in these Hospitals. During the year 179 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 arc 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. Tuberculosis Dispensaries. 59 During 1937 the number of visits and interviews made by the Secretary to cases attending the Dispensaries was 2,138. 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 patients' illness is the cause of the non-payment of rent, the debt is settled in older 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, and last year the cost was £69 10s. Od. It meets once a week, and is in charge of Mrs. Walker, who is a trained instructress in the crafts taught. These include the making of articles in leather, pewter, parchment and embroidery, rug making, 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. Through the kindness of Alderman and Mrs. Doland a successful Sale was held at "Jerviston," Crown Lane, Streatham, when the opening ceremony was performed by His Worship the Mayor of Wandsworth, Councillor W. H. Heath, J.P. 60 Report of the Medical Officer of Health for 1937. MATERNITY AND CHILD WELFARE. The Work of the Health Visitors. The number of Health Visitors under the Maternity and Child Welfare Scheme has been increased during the year from eleven to thirteen. One of the new appointments was decided on because of the increase in the duties which Health Visitors are now called upon to perform, and the other is to replace the Superintendent of the Clapham Infant Welfare Centre, who is appointed by the Committee of that Centre, and who has tendered her resignation to take effect early in the new year. The duties of the Health Visitors are as follows:— All the first visits to Infants are carried out by the Health Visitors, who are also responsible for the re-visiting, except in the areas served by the Clapham, Balham and Putney Park Infant Welfare Centres. At these three Centres the re-visiting of those infants who are in regular attendance is carried out by the Trained Superintendents appointed by the Committees of the Centres concerned. As stated above the Superintendent of the Clapham Infant Welfare Centre has tendered her resignation, which becomes effective next year. The vacancy has been filled by the appointment of a Health Visitor, in accordance with the decision of the Council, made in 1927, to replace Superintendents by Health Visitors as vacancies occur. The Health Visitors attend the infant and ante-natal sessions held at the Centres throughout the Borough, and there is always one or more present at each session, the actual number required to be in attendance depending on the scope of the work. At the Clapham, Balham and Putney Park Centres the Committee Superintendent attends each session, and there is also a Health Visitor present. Infectious Diseases.—All cases of Puerperal Fever, Puerperal Pyrexia, and Ophthalmia Neonatorum are visited on Maternity and Child Welfare. 61 cation, as well as all known cases of Measles,Whooping Cough and Diarrhoea in children under five. Other Home Visits.—The Health Visitors visit the homes of mothers attending the ante-natal Centres in the Borough, as well as the homes of women who apply for admission to maternity homes, and the maternity wards of the General and Lying-in Hospitals. Home visits are 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 carry out the duties relating to Child Life Protection, under the provisions of Part XIII of the Public Health (London) Act, 1936, and to enable them to perform these duties, each of them has been appointed Infant Life Protection Visitor. Periodical visits are also made to Creches and to other Institutions for mothers and children. The Health Visitors also have to perform certain duties under the Vaccination Acts. The Council has now appointed me as Vaccination Officer for the whole Borough, with the exception of Putney, i.e., for the Divisions of Clapham, Wandsworth, Tooting, Streatham and Balham, and the home visiting required in order to secure compliance with the Vaccination Acts in these districts is carried out by the Health Visitors, each working in her own area. 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 1937. Infant Visiting. TABLE XXVIII. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. No. of children visited:— Under 1 year 650 316 485 558 378 926 3313 1-2 years 14 6 2 1 1 17, 41 2-5 years 51 4 2 1 2 26 86 Revisits to :— Infants under 1 year 960 421 423 1144 471 1314 4733 Children 1-2 years .. 826 336 343 874 437 1134 3950 Children 2-5 years .. 1291 534 660 1606 834 2245 7170 Total visits to children under Notification of Births Act 3792 1617 1915 4184 2123 5662 19293 Other visits—: Foster Mothers 210 100 159 205 69 174 917 Ophthalmia Neonatorum 5 2 1 7 3 12 30 Measles 96 34 65 59 108 241 603 Whooping Cough 161 109 28 172 68 473 1011 Ante-natal cases 705 352 388 799 405 902 3551 Puerperal Fever and Pyrexia - - - 6 - 10 16 Miscellaneous 248 189 251 279 209 653 1829 Ineffectual 1453 762 691 1529 772 2002 7209 Total Home Visits 6670 3165 3493 7240 3757 10129 34459 The home visiting carried out by the Superintendents of the Clapham, Balham and Putney Park Centres, who are not officers of the Council, are not included in the above Table. These officers made 3,270 visits—1,803 to children under one year, 518 to children between one and two years, and 949 to children between two and five years of age. Maternity and Child Welfare. 63 There were 3,940 births during the year, and 3,313 of these, or 84.0 per cent., were visited compared with 86.5 in 1936, 90.0 in 1935, and 88.4 in 1934. It was found that in 263 of the births, doctors had been in attendance, while in 825 the services of midwives had been utilised. 2,225 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 112 224 181 426 307 493 1743 Diphtheria Prevention Clinics - - 50 - - 42 92 Ante-natal Clinics 25 32 30 47 20 61 215 Visits to Crftches - 10 12 - - 16 38 Committee Meetings 4 14 - 3 8 4 33 Infant Welfare Centres. There are 12 Infant Welfare Centres in the Borough. Until 1937 all of these were voluntary institutions administered by the Committees of the Centres working in close co-operation with the Maternity and Child Welfare Committee of the Council. During the year the offices of the Public Health Department, with the other Departments of the Council, were transferred to the new Municipal Buildings. Accommodation for a Clinic had been provided in the Public Health section of this Building and the Council decided to transfer the Infant and Ante-natal Sessions previously held at the Fairfield Centre to the new Clinic. It was decided to make the Clinic a municipal one, under the direct 64 Report of the Medical Officer of Health for 1937. administration of the Maternity and Child Welfare Committee, the Council meeting the whole of the cost, and that the infant sessions be conducted by the Council's medical staff. The Clinic was designated the Wandsworth Clinic. The first session was held on 1st September, 1937. The other 11 Centres are still on a voluntary basis. Each centre has a Medical Officer, appointed by the Centre Committee, and three of them have Superintendents, who are also officers of these Committees. The Council pay grants equivalent to 75 per cent. of the approved expenditure of each of the Centres. Valuable assistance at the Infant Clinics is rendered by a number of ladies who give their services voluntarily. They keep the Centre records and arrange for the purchase and sale of food, drugs and clothing. Several ladies have continued to act as voluntary workers at the Municipal Clinic where they carry out the above duties, and there is still ample scope for their services although they have been relieved of the necessity of raising funds to meet part of the expenditure of the Centre. The services of these ladies have been invaluable and there has been the closest co-operation between them and those members of the Council's staff who are working at the Clinic. A successful party for mothers was held at this Clinic on 25th November, 1937, when a number of them entered for competitions in knitting garments and cake-making. The prizes for the competitions, which were given by workers and others interested in the Clinic and by the Wandsworth Gas Company, were presented by Lady Robinson, President of the Wandsworth Federation of Infant Welfare Centres. Table XXX. gives the full details of the work carried out at the 12 Infant Welfare Centres in the Borough. The statistics shewn for the Wandsworth Clinic include those of the Fairfield Centre before it was transferred to the Municipal Buildings. 3,091 new infants were examined during the year, and the total attendances were 65,262. Maternity and, Child Welfare. 65 TABLE XXX. No. of Sessions held. No. of new cases. Total attendances. No. of Doctors' Consultations. Infant Clinics:— Wandsworth (formerly Fairfield 96 248 4529 1522 Southfield 96 284 6525 2350 Springfield 49 236 4650 1156 Putney 95 285 5598 2610 Putney Park 48 46 1031 677 Clapham 98 408 7418 2767 Balham 146 520 11207 3156 Streatham 96 347 8189 2412 Blegborough Road 48 90 2347 812 Streatham Hill 97 259 5377 2094 Fairlight 92 236 5190 1691 Beechcroft Road 47 132 3201 788 Total 1008 3091 65262 22035 Ante-Natal Clinics. District Ante-natal clinics are held at nine of the 12 centres in the Borough for the benefit of women who have arranged to have their confinements either at their own homes or in institutions other than the Council's Maternity Home. Ante-natal clinics are also held for women who have booked for admission to the Council's Maternity Home. These are conducted by the Midwives of the Home and by Practitioners on the rota of doctors who are on call for duty in the Maternity Home when their services are required. All women who have booked for admission to the Home are required to attend these ante-natal clinics as often as is necessary. Until this year all the Maternity Home Clinics were held at the institution, and women from some districts of the Borough had to travel long distances in order to visit them. It was therefore decided, when the Clinic at the Municipal Buildings became available to hold some of the Maternity Home Ante-natal clinics there for the convenience of women residing in Wandsworth and Putney. A clinic conducted by the Matron of the Maternity Home is now held there once a week and in alternative weeks F 66 Report of the Medical Officer of Health for 1937. there is a second clinic which is conducted by one of the doctors on the rota. Other cases from the neighbourhood as well as women who have booked at the Council's Maternity Home attend these clinics. The number of ante-natal clinics held at the Maternity Home is three per week, two conducted by the Midwives of the Home and one by the doctors on the rota. Table XXXI. gives the details of the work carried out at all the ante-natal clinics. 1,280 expectant mothers, of which 1,133 were new cases, attended the clinics, and the total number of attendances was 5,561. TABLE XXXI. No. of Sessions held. No. of new cases. Total attendances. Ante-Natal Clinics:— The Maternity Home 208 414 3858 Clapham 24 100 230 Putney 24 90 261 Balham 28 112 252 Streatham 23 94 185 Fairlight 11 35 94 Beechcroft Road 10 31 85 Southfield 12 69 136 Wandsworth 32 135 351 Springfield 12 53 109 Total 384 1133 5561 Post-Natal Clinics. A weekly post-natal clinic is held at the Maternity Home for women who have been confined there. This was attended by 290 patients who made 322 attendances. Other Post-natal cases are examined at the Ante-natal clinics, and 21 Post-natal women attended for examination. The following is a list of the Welfare Centres in the Borough showing the days and hours on which Infants and Ante-natal Clinics are held:— 67 Maternity and Child Welfare. Address of Clinic. Days and Times of Sessions Infant Welfare Centre. Ante-Natal Clinic. Clapham: Clapham Dispensary 42, Manor Street, S.W. 4 Tuesdays and Wednesdays, at 2 p.m. 1st and 3rd Mondays in every month at 2 p.m. Putney: 2, Clarendon Road. S.W. 15 Wednesdays and Thursdays at 2 p.m. Alternate Wednesdays in every month at 10 a.m., at 2, Clarendon Road. Putney Park: Putney Park House, Roehampton Estate S.W. 15 Fridays at 2 p.m. Balham : 91, Bedford Hill. S.W. 12 Wednesdays and Thursdaysat 1.30p.m. 1st, and 3rd Fridays in every month at 9.45 a.m. Streatham : 37, Riggindale Road. S.W. 16 Tuesdays at 1.30 p.m. Fridays at 2 p.m. 1st and 3rd Wednesdays in every month at 10 a.m., at 37, Riggindale Road. Wesley Hall, Blegborough Road. S.W. 16 Thursdays at 2 p.m. Streatham Hill : Baptist Church Hall, New Park Road. S.W. 2 Tuesdays and Thursdays at 10 a.m. None. Tooting : Fairlight Hall, Fairlight Road. S.W. 17 Wednesdays and Thursdays at 2 p.m. 2nd Wednesday in every month at 10.30 a.m. St. Peter's Church Hall, Beechcroft Road. S.W. 17 Tuesdays at 2 p.m .and Thursdays at 10.15 a.m. 4th Wednesday in every month at 10.30 a.m. Wandsworth : The Wandsworth Infant Welfare Centre, Municipal Buildings Fairfield Street, S.W. 18 Wednesdays at 10a.m. and Fridays at 2 p.m. Mondays at 9.30 a.m. St. Michael's Memorial Hall, Merton Road, S.W. 18 Mondays and Fridays at 2 p.m. 1st Friday in every month at 10 a.m. Congregational Church Hall, Earlsfield Road, S.W. 18 Tuesdays at 2 p.m. 4th Tuesday in every month at 11 a.m. F 2 68 Report of the Medical Officer of Health for 1937. 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, three sisters, five 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. During the past year 448 women were admitted to the Home and the average duration of stay was 13.92 days. 376 deliveries were carried out by the midwives, 67 by the medical staff, two cases were transferred before confinement, and three women were confined before they were admitted. In 198 cases it was necessary for the midwives to summon medical assistance in accordance with the requirements of the Midwives Act. Eleven cases of Puerperal Pyrexia were notified from the Home, but there were no maternal deaths. Fifteen of the infants were still-born and one died within ten days of birth. No case of Ophthalmia Neonatorum was notified. Every effort is made while the mothers are in the Maternity Home, to encourage them to breast feed their infants, but in 33 cases the natural feeding had to be supplemented. Obstetric Consultant Service. 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 Maternity and Child Welfare. 69 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. This service has been extended, and a consultant is now 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 seven occasions. Hospital Treatment for Ante-Natal Women. The Council has made arrangements with the Board of Management of the South London Hospital for Women, Clapham Common, for ante-natal or post-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. One case has been admitted during the year. Midwives. 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. 42 midwives practise in the Borough, of whom 15 reside in neighbouring Boroughs. There are 18 private maternity homes in the Borough, 15 of them being carried on by practising midwives. Midwifery Service. The Council grants 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 fdr a confinement. 70 Report of the Medical Officer of Health for 1937. 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. 0d. to a midwife conducting a confinement at home. £1 0s. 0d. to a midwife assisting a doctor in a home confinement. Before assistance is granted, the following conditions must be complied with:— 1. The home conditions must be suitable for a confinement to take place there. 2. The midwife must be registered by the Central Midwives Board. 3. When conducting the confinement herself, the midwife must give her patient adequate ante-natal supervision and must arrange for the woman to be examined by the Medical Officer of one of the Council's ante-natal clinics early in pregnancy and also at a later stage. 4. No unsuitable handywoman must be employed. 5. If a handywoman is in attendance, the midwife must not allow her to examine the patient, to undertake any nursing duties or to bathe the infant. It was also decided that sterilized maternity outfits should be supplied to a midwife by the Council when they are required. The Council has also decided to pay compensation to a midwife who loses her case because the woman who had booked her, has to enter hospital for the confinement. The usual sum paid in compensation is 10/-. The following conditions are required to be satisfied before compensation is payable :— 1. The patient is required to confirm the statements that she had engaged the midwife to attend the confinement and had been referred by the midwife to the ante-natal clinic. 2. The Medical Officer of the clinic must certify that it is necessary for the woman to be confined in an instituiton. Maternity and Child Welfare. 71 No payment is made to a midwife where the patient herself applied for admission to an Institution. During the year assistance was granted to 63 midwives under this scheme and compensation was paid in 10 cases. Assistance towards payment of a suitable "Home Help" was made in 21 cases. The total cost of the service was £134 6s. 6d. 34 sterilized maternity outfits were supplied. Day Nurseries. There are three Day Nurseries in the Borough which are voluntary institutions receiving grants from the Borough Council. Their addresses are:— Putney .. .. Putney Creche, 95, Lacy Road. Wandsworth .. Wandsworth Day Nursery and Training School, 16 Granville Road. Balham .. Balham Day Nursery, 22, Old Devonshire Road. The admissions of children to the Day Nurseries is limited to those whose mothers are obliged to go out to work, who are ill or who for any other reasonable cause are unable to look after their children. The parents' payments vary from 6d. to 9d. per day for one child, a reduction being made when more than one child from the same family is admitted, or when a child is admitted for half a day only. The Day Nurseries are also training schools for nurses intending to take up cr&che 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, 6,656 Balham, 7,895; and Wandsworth, 5,401, a total of 19,952 compared with 18,929 in 1936. 72 Report of the Medical Officer of Health for 1937. 38 inspections of the creches were made during the year by the Health Visitors. Institutions for Expectant and Nursing Mothers and Young Children. The Council pays an annual grant to the Streatham Babies' Hospital, 9, Leigham Court Road, which is a small hospital containing 20 cots for the treatment of infants up to the age of five years. The staff consists of a Matron, one Sister, two Assistant Nurses and three Probationers. A Visiting Medical Officer attends daily. The standard fee is 10s. 6d. per week, but necessitious 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. 108 infants were admitted in 1937, 70 from addresses in the Borough and 38 from outside the Borough. Most of the cases were infants suffering from Nutritional Diseases, Debility, Respiratory Diseases, Nervous Diseases and Enteritis. There is one other large institution in the Borough which accommodates 60 children up to the age of five years. There are also five institutions or hostels for the reception of expectant unmarried mothers, all in connection with rescue work. In two of them the mothers are admitted some months previous to the confinement, while in three they are admitted . towards the end of pregnancy. In most of these homes the mothers are expected to remain some months after confinement. Arrangements have been made for medical practitioners to attend at these hostels when necessary, and some of the infants attend the most convenient Infant Welfare Centre. The Council pays grants to the Southwark Diocesan Association for Preventive and Rescue Work, towards the maintenance of unmarried mothers usually resident in the Borough in the Maternity and Child Welfare. 73 institutions of the Association. During 1937, assistance was granted in respect of 11 cases at a cost of £50 12s. lld. Similar grants are made to the Mission of Hope, but no cases were assisted during 1937. Convalescent Treatment. During the year, two mothers and 33 children were sent to Convalescent Homes. The cost of this service was £104 18s. 7d. Wandsworth and Tooting Children's Clinic. This Clinic provides artificial sunlight, massage and electrical treatment for children of all ages. 366 children have been treated during the year and they have made 11,777 attendances. 93 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 1,279 families were supplied with milk under the Milk (Mothers and Children) Order, 1918; 258 in Clapham; 98 in Putney; 289 in Balham; 185 in Streatham; 173 in Tooting; 89 in Southfield; 105 in Fairfield; and 82 in Springfield. The total cost to the Council was £1,959 15s. 9d. 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 £147 6s. l0d. 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. 74 Report of the Medical Officer of Health for 1937. Many mothers and children have benefited from the supply of free milk since the scheme for granting it was instituted. In many cases the milk granted has enabled nursing mothers to prolong the period of lactation, and the records kept at the Welfare Centres show good results in the health and general well-being of many of the infants. Dental Treatment. Dental treatment is provided for expectant and nursing mothers and children under five years of age who attend at the Welfare Centres and are found to require treatment after examination by one of the Medical Officers. Arrangements have been made with the British Dental Hospital and 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 35 cases received dental treatment. 33 of these were expectant or nursing mothers, and two were children. In January, 1937, arrangements were made with the London County Council 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. These facilities have proved of great benefit. During 1937, 53 cases were referred to the County Council for treatment and the cost of the service to the Borough Council was £32 9s. 6d. 75 CHILD LIFE PROTECTION. The Medical Officer of Health is the Officer authorised to receive the notices required to be given under Part III of the Public Health (London) Act, 1936, relating to Child Life Protection, and each of the Health Visitors has been appointed an Infant Life Protection Visitor. At the end of 1937 there were 176 foster-mothers on the Register and the number of foster children for whom they were registered was 324. Nursing Service. Arrangements have been made with various nursing Assotions in the Borough for their nurses to attend cases of Measles, Whooping Cough, Ophthalmia Neonatorum, Infantile Diarrhoea, Malaria,, Dysentery, Pneumonia, Influenza, Puerperal Fever and Puerperal Pyrexia, at my request. A fee of 1s. 3d. is paid for each visit to these cases, except in Balham where a special grant of £80 per annum is paid by the Council to the Ranyard Nurses for the services of the nurse in this area. In October, 1936, the Council decided to extend these arrangements so as to include the home nursing of all minor ailments in children under five years of age. This decision was arrived at as a result of the Council's consideration of Ministry of Health Circular, 1550, dated 29th May, 1936, in which the need for more supervision of the health of children between the ages of eighteen months and five years was stressed. There has been a large demand for this extension of the Nursing Services. Full particulars of the number of cases and visits made by the nurses are given in Table XXXII. 786 cases were visited during the year under these arrangements, and 10,790 visits were made. 76 76 Report of the Medical Officer of Health for 1937. TABLE XXXII. No. of cases occurring. No. of cases visited. No. of visits made. Whooping Cough 1082 10 140 Influenza — 66 592 Pneumonia 485 106 1696 Ophthalmia Neonatorum 24 40 881 Measles 439 18 141 Puerperal Fever and Puerperal Pyrexia 40 2 25 Infantile Diarrhoea — — — Minor Ailments — 544 7315 Total 2070 786 10790 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 6079 14021 20100 House - to - House inspections 2034 8618 10652 Shop Inspections 394 3 397 Infective Diseases:— Notifiable diseases 1244 631 1875 Other infective diseases 270 8 278 Verminous conditions 272 141 413 Offensive Trades No. of Premises 2 6 - 6 Piggeries 5 5 3 8 Factories, workshops, etc. 2050 885 109 994 Houses let in lodgings 173 142 337 479 Rag and bone stores 3 3 — 3 Sanitary conveniences 164 346 7 353 Mews and stables 149 356 39 395 Other inspections 7522 2373 9895 Total 19558 26290 45848 Smoke observations 209 - 209 Legal proceedings, Attendances at Court 44 - 44 78 Report of the Medical Officer of Health for 1937. Table XXXIV. gives details of the sanitary operations carried out in the Borough during the year. The number of drains which were tested was 696 and 894 were cleansed or repaired. The drains of 72 houses were re-constructed. Damp conditions have been remedied in 1,415 premises, and in 116 of these damp courses were inserted. 23 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. 79 TABLE XXXIV. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 1. Premises cleansed and repaired 553 202 460 411 692 1119 3437 2. Drains tested 127 84 103 143 91 148 696 3. Drains cleansed or repaired 142 85 141 151 119 256 894 4. Water closets cleansed or repaired 288 129 222 210 203 447 1499 5. Soil pipes repaired 31 56 27 13 19 46 192 6. Waste pipes altered or repaired 91 155 70 245 44 275 880 7. Rainwater pipes repaired 32 37 42 60 27 53 251 8. Roofs and gutters repaired 263 101 130 159 209 410 1272 9. Damp courses inserted 17 13 18 35 3 30 116 10. Damp conditions otherwise remedied 167 113 210 230 132 447 1299 11. Yards drained or paved 69 23 30 84 145 168 519 12. Dust bins provided or repaired 64 55 79 72 98 176 544 13. Water cisterns cleansed, covered or repaired 15 62 21 19 23 35 175 14. Water supply reinstated 8 8 9 38 4 29 96 15. Defective fireplaces remedied 84 60 124 80 121 257 726 16. Defective coppers remedied 14 15 40 26 28 72 195 17. Stables and stable yards drained or paved - - - 2 - - 2 18. Accumulations of manure, etc., removed 1 11 25 16 9 31 93 19. Urinals cleansed or repaired 3 6 4 4 - 6 23 20. Animals improperly kept 2 1 5 3 2 4 17 21. Smoke nuisances 2 3 15 6 6 34 66 22. Other nuisances 123 124 156 177 82 189 851 Total 2096 1343 1931 2184 2057 4232 13843 No. of preliminary notices served 705 333 549 666 609 1582 4444 No. of preliminary notices complied with without the service of statutory notices 530 332 510 488 802 1334 3996 No. of nuisance notices served 270 106 201 292 150 443 1462 No. of nuisance notices complied with 161 78 130 122 112 314 917 80 Report of the Medical Officer of Health for 1937. Water Supply—Cutting-off Notices. During the year, 50 notices with respect to 53 premises were received from the Metropolitan Water Board, stating that the supply had been withdrawn. In 47 premises the water supply was cut off for non-payment of rates, and in six 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 164 ; 48 in Clapham, 22 in Putney, 20 in Balham, 19 in Streatham, nine in Tooting and 46 in Wandsworth. 346 inspections were made during the year, and seven notices, for cleansing, were served and complied with. Flies and Mosquitoes. During the summer months certain ponds, streams and areas of stagnant water were treated by spraying with paraffin with the object of destroying the larvae of mosquitoes. Owners of stables were advised to use chloride of lime for sprinkling horse manure in order to destroy the larvae and pupae of flies. Rats and Mice (Destruction) Act, 1919. For some time there has been an increase in the number of complaints from residents in the Borough of nuisances from rats. Sanitary Inspection of the Borough. 81 This increase may be associated with the extensive building operations which have taken place during the last few years. Towards the end of 1936 the Council gave special consideration to the matter, and in December decided to appoint a Rat Catcher and Assistant Rat Catcher for a period of one year. Mr. A. Moon was appointed in the former capacity, and Mr. H. Jarvis as his Assistant. These officers work in conjunction with the Sanitary Inspectors and visit premises where their services are required. Dogs and ferrets are employed for the destruction of rats, and the Rat Catcher gives advice to householders on the steps which should be taken to render their premises rat-proof. 554 rat complaints were received during the year. The Rat Catcher made 1686 visits, and a considerable number of rats were destroyed. For some years it has been the practice of the Council to lay rat baits in the sewers, and this has been continued during the year by the Borough Engineer's staff. In addition to the laying of baits as a matter of routine, 4,450 baits were laid during National Rat Week and 3,617 were taken by rats. Shops Act, 1934. 397 inspections of shops have been made 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. In one case it was neccessary for a notice to be served for an infringement, and this has 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, one public swimming pool privately owned, and six private bathing pools in the Borough. The Queensmere pond on Wimbledon Common has also for many years past been a recognised bathing pond. g 82 Report of the Medical Officer of Health for 1937. 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, each 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 one of the private pools, cleansing is effected by changing the water. Eradication of Bed Bugs. During the year 172 houses were found to be infested with bed bugs, and notices were served in each case on the persons responsible for the infestation. In addition one Council house was found to be infested and was dealt with. All the premises were disinfested. 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 the spraying of rooms by the disinfecting staff of the Council is carried out, "D" solution being used. Infested bedding is removed to the Disinfecting Station and treated with steam. Special steps are taken to ensure that the furniture and clothing of families about to be accommodated in the Council's houses and flats are freed from vermin. Hydrogen Cyanide gas is used for the disinfestation of the furniture, which is placed in special vans constructed for the purpose, the process being carried out by a Contractor. Bedding is not subjected to Hydrogen Cyanide, but is disinfected by steam at the Council's Disinfecting Station. During 1937 the furniture of 106 families was disinfected by Hydrogen Cyanide gas, and the cost of this service was £381 10s. Sanitary Inspection of the Borough. 83 Rag Flock. There is one factory in the Borough where rag flock is manufactured. This factory is inspected periodically. Six samples were taken during the year, and submitted for analysis, and all of them passed the required standard of cleanliness. Removal of Diseased or Infirm Persons to Institutions. In no case has it been necessary during the year for application to be made to a Court for the removal of a diseased or infirm person under the provisions of Section 224 of the Public Health (London) Act, 1936. Mortuaries. During the year only six bodies have been removed to the Wandsworth Mortuary. No bodies were taken to the Mortuaries in Clapham and Streatham. 84 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) 8,255 and the number of inspections made 31,231 (2) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 2,034 and the number of inspections made 10,652 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 260 (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 4,449 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 3,996 3. Action under Statutory Powers during the Year :— A.—Proceedings under sections 9, 10, and 16 of the Housing Act, 1936:— (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 Housing. 85 B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,462 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 917 (b) By Local Authority in default of owners Nil C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 56 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 4 D — Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 16 (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, 1936 (Part IV)—Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 1,346 (ii) Number of families dwelling therein 1,346 (iii) Number of persons dwelling therein 8,494 (b) Number of new cases of overcrowding reported during the year 276 (c) (i) Number of cases of overcrowding relieved during the year 454 (ii) Number of persons concerned in such cases 2,749 86 Report of the Medical Officer of Health for 1937. (d) Cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil House-to-House Inspections. The results of these inspections are shown in Table XXXV. 2,034 inspections were made compared with 2,237 in 1936, and 1,800 in 1935. Nuisances necessitating the service of sanitary notices were found in 1,619 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 195 171 10 58 151 145 Clapham South 143 90 16 6 62 135 Putney 87 51 2 7 35 73 Balham 262 199 19 29 73 244 Streatham 228 205 1 22 122 174 Tooting 377 274 15 18 110 332 Southfield 102 96 2 13 32 81 Fairfield 266 221 12 62 104 188 Springfield 374 312 13 9 318 120 Whole Borough 2034 1619 90 224 1007 1492 Rent and Mortgage Interest Restrictions Acts, 1919-1923. During the year 18 applications were received from occupiers that their houses were not in a reasonable state of repair. In three cases the applications were withdrawn, in one case the necessary work was carried out before the granting of Certificate could be authorised and in one the application was refused. In the remaining 13 cases, the applications were acceded to, and Statutory Certificates were granted. The necessary work to put them in a reasonable state of repair was carried out during the year. 87 Housing Act, 1936. The Clearance of Insanitary Houses The Council's programme for the clearance of unhealthy areas and the demolition of insanitary houses has made good progress during the year. The sites of several insanitary areas are in process of being re-developed by the Council, and the new estates being erected on the sites of the Wandsworth Plain, Felsham Road, Tooting Grove No. 1 and Greyhound Square Areas are approaching completion. The development of the White Square site is well in hand. Salvador No. 2 Area has been cleared, and the clearance of four other Areas is in progress. A number of Demolition Orders and Closing Orders have also been made. Wandsworth Plain Area, Wandsworth. The development of this Area has made rapid progress during the year and only 10 of the 91 insanitary houses have still to be demolished. Two sections of the site have been developed by the Council and 73 flats have been erected. These are occupied mainly by families displaced from other houses in the Area. The Council has approved a scheme prepared by the architect, Mr. G. Leonard Elkington, F.R.I.B.A., for the development of the remaining section of the site. This scheme provides for the erection of 76 flats in three blocks, each four storeys in height, comprising eight bed-sitting room ground floor flats for the accommodation of aged persons, 32 three-roomed flats, 28 four-roomed flats and eight five-roomed flats. Felsham Road Area, Putney. This Area, which contained 59 insanitary houses and two dwelling-houses "coloured grey," has now been cleared and is in process of re-development by the Council. It is proposed to erect 88 flats in four-storeyed blocks on the site. 56 of these were completed and in occupation by the end of the year. 88 Report of the Medical Officer of Health for 1937. Tooting Grove No. 1 Area. This Area, comprising 21 insanitary houses and two "coloured grey" was Declared in May, 1935, and the houses were demolished during 1936, the Council having decided to develop the site. Early in 1937 it was decided to acquire and demolish a further 11 houses which were adjacent to the site of the Clearance Area, and to add this land to the development scheme, which provides for a total of 114 flats in three-storey blocks. 72 of the flats have now been completed and the remaining 42 are in course of erection. Greyhound Square Area, Streatham. Barrow Road Area, Streatham. These Areas, which are close together, have now been cleared, and the major portion of the combined sites is being developed by the Council. Greyhound Square Area contained 29 insanitary houses, and one "coloured grey," and the Barrow Road Area consisted of 11 insanitary houses. All these houses have now been demolished. The portion of land which was left to the owners to develop was that on which three of the houses in the Barrow Road Area were situated. It was excluded from the Council's Scheme as it was separated by a road from the rest of the combined site of the two Areas. It is proposed to erect 42 flats and 8 shops on the site, the buildings being three storeys in height. 28 of the flats have been completed. White Square, Clapham. This site, which is 4.32 acres in extent, included five insanitary Areas which were Declared in January, 1935. There were 100 insanitary houses in the five Areas, and 66 houses, "coloured grey," were added to make the site suitable for re-development by the Council. 52 of the houses have been demolished, and the re-development of the site, which provides for the erection of 181 flats and six shops, is well in hand. Housing. 89 Salvador No. 1 Area, Tooting. This Area, containing 23 insanitary houses, was Represented in April, 1936, and Declared on the 16th February, 1937. The Clearance Order made by the Council was confirmed by the Minister of Health after Public Enquiry, and the houses are being vacated as alternative accommodation becomes available for the occupiers. Salvador No. 2 Area, Tooting. This Area contained five insanitary houses, and was Declared on the same date as Salvador No. 1 Area. No objections to the Clearance Order were received, and the houses have been demolished Carpenter s Place Area, Clapham. This Area, which contains 10 insanitary houses, was Represented in October, 1936, and Declared on the 19th January, 1937. The Council made a Clearance Order in respect of it. This Order has been confirmed by the Minister of Health, no objections being received, and the houses are being vacated as alternative accommodation for the occupiers becomes available. During the year I have submitted Representations in respect of nine insanitary Areas, containing a total of 198 houses. Sadler's Buildings Area, Putney. This Area, containing 16 insanitary houses, was Represented on the 10th May, 1937, and Declared a Clearance Area on the 19th October, 1937, when a Compulsory Purchase Order was made for submission to the Minister of Health for confirmation. Blackford's Cottages Area, Roehampton. This Area, containing eight insanitary houses, was Represented on the 2nd June, 1937, and Declared on the 19th October, when a Clearance Order was made. Representations on the following Areas have also been considered by the Council, who have notified the London County 90 Report of the Medical Officer of Health for 1937. Council, as required by Section 33 of the Housing Act, 1936, of their intention to Declare these areas as Clearance Areas:— Chesil Place Area, Balham 7 houses. Weimar Street Area, Putney 21 houses. Point Pleasant, No. 1 Area, Wandsworth 7 houses. No. 2 ,, 5 houses. ,, ,, No. 3 „ ,, 19 houses. Cubitt's Cottages Area, Wandsworth 21 houses. Saxby Street Area, Clapham 94 houses. Demolition Orders. The Council has made a Demolition Order under Section 11 of the Housing Act, 1936, on 59, Rotherwood Road, Putney, which I Represented in December, 1936, and the house has been demolished. Demolition Orders have also been made on the following 55 houses, in respect of which I have submitted official Representations during the year.:— Clapham— 139, Manor Street 1 house. 11, Clifton Street 1 house. Putney— 4, 5 and 6, Walker's Place 3 houses. Streatham— 16, Cowper's Row 1 house. 9-12, Calder's Row 4 houses. Wandsworth— 16-52, Point Pleasant 19 houses. 78-84, „ ,, 4 houses. 90-94, ,, „ 3 houses. 96-110, „ ,, 8 houses. 5 and 6, Merton Cottages 2 houses. 54 and 58, Warple Way 2 houses. 410, York Road 1 house. 1-6, Potters Court 6 houses. Of these houses, 4, 5 and 6, Walker's Place were demolished before the end of the year. Housing. 91 Representations recommending Demolition Orders were also submitted respecting the following seven houses in Streatham:— 15, Cowper's Row 5 houses. 14 and 15, Cowper's Row 2 houses. Closing Orders and Underground Rooms. The Closing Order made in October, 1935 on two Mews flats at 5 and 6, Aldis Mews, Tooting, has now been complied with. I have submitted official Representations for Closing Orders to be made, under Section 12 of the Housing Act, 1936, in respect of the following 16 houses, and the Orders have been made during the year:— 23-35, Gay Street, (7 houses) and 31, River Street, Putney— on two underground rooms at each house, 16 rooms in all. These Orders were complied with before the end of the year. 1-5, Grove Road Mews, Clapham 5 Mews flats. 1-3, Lovett's Place, Wandsworth 3 Mews flats. A Representation was also submitted in respect of an underground room at 2, St. Rule Street, Clapham, but no Closing Order was made as the owner undertook to carry out the work required to make the room comply with the Regulations, and this was done. Three underground rooms which were unfit for habitation were closed by the owners after they had been notified that the rooms were unfit for habitation, and did not comply with the Underground Room Regulations. 55 underground rooms, where the conditions were similar, have been altered by the owners, and have now been passed as fit for occupation. Abatement of Overcrowding. Garratt Lane Housing Site. This site, approximately 9.88 acres in extent, is being developed by the Council for the rehousing of families in the Borough living under overcrowded conditions, and accommodation will be provided for over 1,700 persons. It is proposed to build 21 blocks of flats, four storeys in height, containing 272 separate dwellings, with accommodation varying from one to six rooms. The construction of the buildings was well in hand by the end of the year. 92 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. With the object of ensuring that all food businesses are supervised systematically, 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. Table XXXVI. has been drawn up to show the number of food premises in the Borough, 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 19, 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 3,185. Amongst these are 867 grocery and provision shops, and reference to the Table will show that a variety of businesses are conducted from these shops. Some Food and Food Premises. 93 of them are registered as dairies or for the sale of margarine, ice-cream, or cooked or preserved meats as required by law, and the occupiers of 254 of these shops are registered as dairymen. In 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 435 registered dairymen and 199 registered dairies in the Borough, one of them being also a cowshed. The Food Inspectors made 516 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 994 samples of whole milk reported as genuine was 3.66 compared with 3.59 in 1934, 1935 and 1936. 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) Act, 1936, 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 there of with the Sanitary Authority. During the year 103 applications were submitted to the Council for the purpose of registration under this Act. In each 94 Report of the Medical Officer of Health for 1937. Food and Food Premises. 95 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. No. of Inspections in 1937. No. of Notices- served 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. Others. j 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. Dairies 141 141 141 - - - 24 4 - - — 133 4 — — — - — 516 — Ice-Cream Vendors 38 — — — — — 38 1 - — - — 2 — - - 1 - 76 — Grocery and Provisions 867 254 38 - - 33 94 219 - - 1 867 127 28 35 - 20 - 1785 21 Confectioners 657 14 2 - - - 431 5 - - - 8 657 - 1 - 34 - 1365 18 Butchers 224 1 1 - - - - 218 - — - 2 — 224 1 2 4 — 1016 12 Slaughter-houses 5 - - - 5 - - - - - - - - - - - - - 1184 - Fishmongers 107 - - - - - - 65 7 24 107 1 — 1 - - 2 - 372 - Fish Fryers 88 - - - — — 1 88 88 3 22 - - - - - 56 - 261 - Restaurants 403 13 6 - - - 83 10 3 - 5 8 23 1 - - 403 - 638 17 Greengrocers . 441 - - - - - — 1 — — 7 3 — — 441 — — — 1265 46 Market Stalls 168 — — — — — 9 5 — 1 10 19 22 23 50 1 12 18 13627 7 Food Factories 34 12 11 1 — 1 2 7 — — — 8 5 3 — 34 — — 78 1 Others 12 — — — — — 1 4 — — 1 3 2 — — — 1 12 30 — Totals 3185 435 199 1 5 34 683 627 98 28 153 1052 844 280 528 37 533 30 22213 122 96 Report of the Medical Officer of Health for 1937. 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 1,184 visits during the year to these premises and were present on nearly every occasion when slaughtering took place. The number of carcases examined was 10,481, comprising 125 oxen, 4,075 pigs, 3,397 sheep and 2,884 calves. 4,732 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; 3 pairs lungs. For Fluke; 5 livers. For Abscess; 3 livers, 1 pair lungs. For Actinomycosis; 2 heads and tongues. For Cirrhosis; 1 liver. Pigs:— For Tuberculosis; 3 entire carcases and offal, 36 heads and collars, 11 plucks, 10 mesenteries, 2 omenta. For Cirrhosis; 74 livers. For Abscess; 1 liver, 3 pairs lungs. For Congestion; 127 pairs lungs. For Pericarditis; 70 hearts. For Inflammation; 69 plucks, 3 spleens. 1 Entire carcase and offal (moribund). Sheep:— For Strongylus Rufescens; 2 pairs lungs. For Hepatitis; 1 liver. Calves:— For congestion; 2 pairs lungs, 1 pluck. At the request of the owners 413 Pig carcases and offal were examined prior to their distribution to branch shops. These 108 Report of the Medical Officer of Health for 1937. Food and Food Premises. 97 carcases had not been examined at the time and place of slaughter. The following organs etc., were found to be unsound or diseased on examination, and were surrendered:— For Tuberculosis; 9 pig plucks, 8 pigs heads and collars, 3 pig mesenteries. For Cirrhosis ; 8 pig livers. There are 224 butchers' shops in the Borough, the majority of which are subject to registration under the Public Health (London) Act, 1936. 1016 inspections were made of these shops, and it was found necessary in 12 cases to serve notices on the occupiers. The meat exposed for sale has been examined regularly, and in several instances it was found necessary to warn the occupier for failing to mark imported meat in a proper manner. Under the Public Health Meat Regulations, 1924, every butcher is required to do all that is reasonably necessary to guard against contamination of the meat by flies, filth and dust. Special attention is given to the requirements of these Regulations and in several instances it was found necessary to warn traders with regard to the exposure of meat in contravention of the Regulations. Slaughter of Animals Act, 1933. This Act came into operation on the 1st January, 1934, and provides for the humane and scientific slaughter of animals, by licensed slaughtermen. No person may now slaughter animals unless he is above the age of 18 years and licensed by the Borough Council as a fit and proper person for the purpose. During the twelve months ending the 31st December, 25 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. 2 boxes dog fish, 1 box cod, 8 boxes haddocks, 8 boxes fish fillets, 6 boxes dried fillets, 8 boxes roe, 1 box dabs, 6 boxes crabs, 3 boxes skate, 5 98 Report of the Medical Officer of Health for 1937. fowls, 4 ox kidneys, 749 lbs. of assorted meat, 89 boats of apricots, 10 caskets of cherries, 20 boxes of greengages, 350 lbs. of potatoes, 7 tins salmon, 6 tins milk, 1 tin beans, 1 tin pineapple, 3 jars jam, 7 bottles cordial, 1 box broth cubes, 3¾ lbs. breakfast sausage, f lb. bacon. During the year one seizure of unsound food was effected. Proceedings were taken at the Police Court and a penalty of £3 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. 2. Honey. 3. Fresh Apples. 4. Tea. 5. Currants. 6. Sultanas. 7. Raisins. 8. Eggs in Shell. 9. Dried Eggs. 10. Oat Products. 11. Raw Tomatoes. 12. Salmon and Trout. 13. Butter. 14. Apples. 15. Wheat Flour. 16. Meat. 17. Malt Flour and Malt Extract. 18. Potatoes. 19. Broccoli. 20. Eggs. 21. Glasshouse grown Tom toes and Cucumbers. 22. Strawberries. 23. Dressed Poultry. 24. Cherries. 25. Cider. 26. Canned Fruits. 27. Canned Cherries. 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. Food and Food Premises. 99 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. The number of applications received for entry in the Council's Register for 1937 was 328. The Principal businesses conducted in the premises of these applicants is shown in Table XXXVII. 673 inspections of these premises have been made during the year. TABLE XXXVII.—Part II of Poisons List. Principal Business No. of Premises No. of Inspections Grocers 172 359 Hairdressers 39 70 Drug Stores 31 64 Ironmongers, Paint and Colourmen 79 164 Nurserymen 5 12 Garages 2 4 Total 328 673 Statement of Work Done under the Food and Drugs, (Adulteration) Act, 1928. During the year 2,000 samples of foods and drugs were submitted to the Public Analyst for analysis. Of these 1,000 were submitted as official samples while 1,000 were purchased unofficially as test or informal samples. 13 or 1.3 per cent. of the official samples, and 15 or 1.5 per cent. of the unofficial samples were found to be adulterated or not up to standard. The total adulterations reported were 28 or 1.4 per cent. of the samples submitted. 100 Report of the Medical Officer of Health for 1937. TABLE XXXVIII. RESULT OF ANALYSES OF CERTAIN ARTICLES OF FOOD PRO CURED UNDER THE FOOD AND DRUGS (ADULTERATION) ACT, 1928, SHOWING THE PERCENTAGE ADULTERATED IN 1937, AS COMPARED WITH 1933, 1934, 1935 AND 1936. No. of samples in 1937. Percentage of Samples adulterated, 1933-1936. Examined. Found adulterated or not up to standard Percentage adulterated 1933. 1934. 1935. 1936. Butter 173 1 .57 — — — — Cheese 30 — — 9.0 — — — Cocoa 18 — — 13.3 — — — Coffee and Coffee & Chicor) 12 - - - - - 3.0 Confectionery and Jam 26 — — — — 1.2 — Cream 50 - - - - - - Margarine 20 - - - - - - Milk 1006 12 1.19 1.3 1.7 1.6 .7 Separated Milk 2 — — — — 33.3 — Condensed Milk 11 - - - - - - Tea 19 — — — 12.5 — — Vinegar 9 — — — — 18.0 22.2 Drugs 85 5 5.88 — 7.4 4.0 — Other Articles 539 10 1.85 1.4 51 4.0 1.6 All Articles 2000 28 1.4 1.4 2.65 2.3 .95 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. 101 TABLE XXXIX. Informal Samples. Formal Samples. Total. Number taken. Adulterated. Percentage adulterated. Number taken. Adulterated. Percentage adulterated. Number taken. Adulterated. Number per 1,000 of population. Percentage adulterated. Clapham 160 I .62 210 2 .95 370 3 6.2 .8 Putney 148 6 4.05 88 1 113 236 7 7.0 2.9 Balham 121 3 2.47 155 2 1.28 276 5 5.2 1.8 Streatham 172 2 1.16 76 1 1.31 248 3 3.7 1.2 Tooting 173 — — 178 — — 351 — 9.4 — Wandsworth 226 3 1.32 293 7 2.38 519 10 5.5 1.9 Whole Borough 1000 15 1.50 1000 13 1.30 2000 28 5.8 1.4 Milk and Milk Supply. The following samples were submitted for analysis:— 1,006 of whole new milk. 2 of separated milk. 11 of condensed milk. Of these 12 were reported against as being adulterated or not up to standard, eleven contained extraneous water, and one was deficient in milk fat. In all the 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. 108 samples of milk were taken from the early morning delivery to hospitals in the Borough, eight on delivery to Wandsworth Prison, and 33 from the milk delivered to the County Council Schools in the Borough. All these samples were reported as genuine. 102 Report of the Medical Officer of Health for 1937. 412 samples were taken from milk vendors in the street during the early morning(midnight to 8 a.m.), and of these three or .72 per cent. were reported against. The Milk (Special Designations) Order, 1936. The following licences for the sale of designated milks were granted during the year:— Tuberculin Tested 44 Accredited 3 Pasteurised 45 Total 92 Bacteriological Examination of Milk. 41 samples of milk have been examined at the Lister Institute of Preventive Medicine for the presence of Tubercle Bacilli and all of them were reported to be free from the organism. 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 6 6 Pasteurised 32 12 18 62 Total 32 12 24 68 All these samples complied with the required standards. Butter and Margarine. 173 samples of butter were submitted for analysis during the year. One sample contained .5% excess water, but the remaining 172 samples were reported to be genuine. Food and Food Premises. 103 20 samples of margarine were submitted for analysis, and all were reported to be genuine. Other Articles. 539 samples were submitted under this heading. The results of the analyses are given in the Public Analysts' Report. 104 FACTORIES AND WORKSHOPS. The number of factories, workshops, workplaces, and home workers' premises is shown in Table XL. 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 XL. Class of Works. Number of Places on Register at end of 1937. Number of Inspections, 1937. Number of Notices, 1937. Number of Prosecutions, 1937. Factories:— Factory Laundries 47 29 1 — Factory Bakehouses 75 90 1 — Food Factories entered on Table XXXVI 34 78 1 — Other Factories 473 329 5 — Total 629 526 8 — Workshops:— Workshop Laundries 20 15 — — Workshop Bakehouses 53 33 — — Other Workshops 762 260 7 — Total 835 308 7 — Workplaces 130 43 2 — Total: Factories, Workshops and Workplaces 1,594 877 17 — Home-workers' premises 490 195 — — Grand Total 2,084 1072 17 — Further details with regard to homeworkers' premises are given in Table XLI. Factories and Workshops. 105 TABLE XLI. HOME WORK. Nature of Work. Outworkers' Lists. Outwork in unwholesome premises Outwork Lists received from Employers. Notices served on occupiers as to keeping or sending lists. in infected premises. Lists. Outworkers. Instan ces. Notices served. Instan ces. Contrac tors. Workmen. Wearing Apparel:— (1.) Making, etc. 31 11 121 31 1 1 33 (2.) Cleaning and washing 2 6 1 — — — — Paper bags and boxes 1 — 3 — — — — Toys 1 — 4 — _ — — Totals 35 17 129 31 1 1 33 The total number of addresses received from other Councils was 463, and 80 addresses were forwarded to other Authorities. The number of addresses received has increased by 55, and the number sent has decreased by 39. 33 names and addresses were forwarded to this Borough in error. The number of notices sent to employers during the year was 31, and these had a most satisfactory result. During the year 33 cases of infective diseases—25 of Measles, four of Pneumonia, one of Dysentery two of Scarlet Fever, and one of Diphtheria—were notified as having occurred in the homes of out-workers. In none of these cases was it necessary to make any order under Section 110 of the Factory and Workshop Act. 106 Report of the Medical Officer of Health for 1937. TABLE XLII. 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 53 Workshop Laundries 20 Dressmakers' and Milliners´ Workshops 98 Bootmakers 106 Smiths and Engineers 35 Builders 33 Tailors 66 Motor Engineers 60 Upholsterers 25 Hairdressers 32 Other 307 Total number of workshops on Register 835 TABLE XLIII. 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 5 4 - - Want of ventilation — — - - Overcrowding — — - - Want of drainage of floors — — - - Other Nuisances 8 7 - - Sanitary accommodation : Insufficient 6 6 - - Unsuitable or defective 9 7 - - 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 28 24 - — * 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. 107 In conclusion, I would like 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. 108 Report of the Medical Officer of Health for 1937. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE metropoliTAN BOROUGH OF WANDSWORTH, 1937. (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. 2052 157 13 24 29 50 67 105 213 417 483 494 F. 2191 94 18 14 21 53 81 75 194 312 515 814 1. Typhoid and paratyphoid fevers M. — - F. - - - - - - - - - - - - 2. Measles M. 1 1 — — — — — — — - F. 1 — 1 - - - - - - - - - 3. Scarlet fever M. 2 - 1 1 — - - F. 3 — - 1 1 — — 1 — — - - 4. Whooping cough M. 10 8 1 1 - - - - - - - - F. 13 7 4 2 — — — — — — - - 5. Diphtheria M. 8 2 1 3 2 — — — — — - - F. 10 — — 2 7 — — — — — 1 - 6. Influenza M. 54 1 1 1 2 1 10 13 16 9 F. 73 1 1 — 1 1 2 1 10 10 17 29 7. Encephalitis lethargica M. 1 - - - - - - - 1 - - F. 3 - - - - - 1 - 1 1 - - 8. Cerebro-spinal fever M. 4 — 1 1 - 1 — — 1 — - - F. 3 1 — 1 — — — — — 1 - - 9. Tuberculosis of respiratory system M. 119 12 29 19 23 28 8 - F. 76 — 1 — — 23 21 13 7 9 2 - 10. Other tuberculous diseases M. 16 _ _ 1 2 5 1 1 2 3 1 1 F. 13 — — 1 I 1 4 — — 3 2 - / 11. Syphilis M. 5 - - - - - - - - 2 3 - F. 1 - - - - - - 1 — — - - 12. General paralysis of the insane, tabes dorsalis M. 9 - - - - - - 1 3 2 3 - F. 4 — — — — — 1 -— — 3 - - 13. Cancer, malignant disease M. 284 - - - - - 2 18 36 79 89 60 F. 313 — 1 — 1 3 1 17 48 85 91 66 14. Diabetes M. 29 - - - 1 - 1 2 - 6 12 7 F. 31 — — — - — 1 1 4 3 10 12 15. Cerebral haemorrhage, etc. M. 55 - - - - - 1 1 5 8 16 24 F. 93 - — — - — 1 1 8 13 32 33 16. Heart disease M. 558 - - 1 3 2 4 14 36 109 158 231 F. 761 — — — — 3 11 11 37 79 200 420 17. Aneurysm M. 12 - - - - - 1 4 3 4 2 F. 12 - - — - - 1 — 3 2 4 - Vital Statistics. 109 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. 71 - - - - - - - 6 10 24 31 F. 107 — — — — 1 1 — 12 18 29 46 19. Bronchitis M. 109 3 1 1 1 — 1 6 13 17 36 30 F. 70 2 — — — — — — 3 7 19 3920. 20. Pneumonia (all forms ) M. 116 19 4 2 2 2 1 7 11 29 25 14 F. 101 14 5 1 1 — 1 6 13 11 23 26 21. Other respiratory diseases M. 14 2 - - - - - 3 2 5 1 1 F. 16 — — 2 — — — — 3 2 6 3 22. Peptic ulcer M. 43 - - - - - 3 5 8 15 10 2 F. 10 - - - - - - 1 2 4 1 2 23. Diarrhœa M. 40 34 1 - — 1 - - 1 2 - 1 F. 18 9 1 1 — — 3 1 — 2 — 1 24. Appendicitis M. 16 - - 3 - - - — - 7 3 3 F. 17 — — — 2 1 1 1 4 4 2 2 25. Cirrhosis of liver M. 11 - - - - - - 1 2 5 2 1 F. 8 1 — — — — — — 3 2 2 — 26. Other diseases of liver, etc. M. 7 - - - - - 1 - 2 1 3 - F. 13 — — — — - 1 — — 2 6 4 27. Other digestive diseases M. 36 3 - 1 1 1 1 - 6 7 11 5 F. 36 1 1 — — 1 1 1 8 7 9 7 28. Acute and chronic nephritis M. 62 - - - - 3 4 5 6 19 14 11 F. 56 — — — — 4 2 2 - 11 17 20 29. Puerperal sepsis F. 7 — — — — 3 3 1 — — - — 30. Other puerperal causes F. 4 - - - - - 4 - - - - - 31. Congenital debility, premature birth, malformation,etc. M. 75 73 - 1 1 - - - - - - - F. 54 52 1 - - - - 1 - - - - 32. Senility M. 21 - - - - - - - 1 3 17 F. 46 - - - - - - - - - 1 45 33. Suicide M. 34 — — — — 2 4 6 11 8 3 - F. 21 — — — — — 2 2 7 8 2 — 34. Other violence M. 79 4 1 3 10 11 9 4 5 6 9 17 F. 68 2 2 2 3 3 3 3 7 5 10 28 35. Other defined diseases M. 151 8 2 3 6 9 3 10 20 31 29 30 F. 127 4 — 1 4 9 15 10 14 20 28 22 36. Causes ill-defiined, or unknown M. - - - - - - - - - - - - F. 2 — — — — — — — — — 1 1 Report of the Medical Officer of Health for 1937. POLICE COURT PROCEEDINGS, 1937 Premises. Offence. Result. Fine. Costs. 3, Rashleigh Street Nuisances. Summons withdrawn - - 5, ditto. Ditto. nuisances abated. Order made for abatement within 14 days. - 10/6 7, ditto. Ditto. Ditto. - 10/6 9, ditto. Ditto. Ditto. - 10/6 87, West Hill. Ditto. Ditto. 21/- - 50, Palmerston Road Ditto. Summons withdrawn as nuisances abated. - — 64, Tonsley Hill. Ditto. Order made for abatement within 14 days. 20/- - 5, 7, 9, 11, 13, 15, 17, 19, 21, Bramford Road. Ditto. Summonses withdrawn as nuisances abated. - - 3 and 7 Rashleigh Street. Contravention of By-laws as to houses divided into separate tenements. Convicted. 80/- - 196a, b, c, d, e, f, Beechcroft Road. Nuisances. Summonses adjourned for 7 days at first hearing, and were withdrawn at second hearing as nuisances had been abated. 20/- 105/- 198a, b, c, f, Beechcroft Road. 200b, c, d, e, f, Beechcroft Road. 32, Fountain Road. 17, Khartoum Road 612,Wandsworth Road. Ditto. Adjourned sine die, work in hand. — — 3, Siward Road. Ditto. Ditto. - - 47 and 49, Tooting Grove. Ditto. Summonses adjourned for 14 days at first hearing, and were withdrawn at second hearing as nuisances lead been abated. - - 606, Wandsworth Road. Obstructing Council's Officers in execution of their duty. Convicted. 20/- - 23a, Khartoum Road. Nuisances. Order made for abatement within 14 days — 5/- Workshop, Broomhill Road. Nuisances. Summons withdrawn as nuisance notice complied with. - - 20 and 22, Thornsett Road. Ditto. Order made for abatement within 7 days. — — 68, Granville Road. Ditto. Closing Order made as premises were unfit for human habitation. - - 110 Police Court Proceedings. 111 POLICE COURT PROCEEDINGS, 1937 continued Premises Offence. Result. Fine. Costs. 41, Temperley Road Ditto. Order made for abatement of nuisances within 14 days. - 10/6 31 and 35, Hazelhurst Road. Ditto. Ditto Non-compliance with Order. 20/- 21/- 37, ditto. Ditto. Order made for abatement of nuisances within 21 days. - 42/- Non-compliance with Order. 20/- 21/- 4a, Zennor Road. Ditto. Order made for ment of nuisances within 21 days. - - 18a, Radbourne Rd. Ditto. Order made for abatement of nuisances within 14 days. - - 20, ditto. Ditto. Adjourned sine die. - - 15, Clapham Park Road. Ditto. Summons withdrawn as nuisances abated. - - 97, Fountain Road. Ditto. Ditto. - - 99, ditto. Ditto. Adjourned sine die. — - 35, Pentlow Street Ditto. Summons withdrawn — - as nuisances abated. — - 15, Woodborough Road. Harbouring rats. Summons withdrawn as Defendant had complied with notice served on him. - - 2, Lammermoor Road. Nuisances. Adjourned sine die. - - 70, The Chase. Ditto. Summons withdrawn as nuisances abated. - 21/- 38, Eardley Road. Ditto. Order made for abate ment of nuisances within 14 days. - 10/6 75, ditto. Ditto. Order made for abatement of nuisances within 3 days. - - 11, Martindale Road. Nuisances. Order made for abatement of nuisances within 14 days. - 21/- 19, Besley Street. Ditto. Adjourned sine die. — - 27, Ditto. Ditto. Order made for abatement of nuisances within 14 days. - 10/6 94, Gauden Road. Ditto. Summons withdrawn as nuisances abated. - - 96, ditto. Ditto, and contravention of Bye-laws as to houses divided into separate tenements. Summons withdrawn as nuisances abated. - 42/- 112 Report of the Medical Officer of Health for 1937. 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 within 14 days. - - Non-compliance with Order. 20/- Mr. " C " For non-compliance with Order for vaccination of child. Summons withdrawn as child had been vaccinated. - - Mr. " D " Failure to cause child to be vaccinated within 6 months after birth. Order made for child to be vaccinated within 14 days. - - Mr. " E " Ditto Ditto - - 113 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, 1937. All of the samples mentioned in this report were submitted by your Council's Food Inspector, Mr. W. H. Jones, 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 analysis, the details of Drugs and " Other Articles " being given subsequently. GENERAL STATEMENT. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Bread - 6 0 - - - Butter — 173 173 — 1 1 Cheese — 21 21 — - - Cheese (Wrapped) — 9 9 — — — Cocoa — 18 18 — — — Coffee — 12 12 — — — Confectionery — 8 8 — — — Jam — 18 18 — — — Cream — 41 41 — — — Cream, Tinned — 9 9 — — — Flour — 3 3 — — — Flour, Self-raising — 3 3 — — — Lard — 19 19 — — — Margarine — 20 20 — — — Milk 997 9 1006 12 — 12 Milk, Separated 2 — 2 — — — Milk, Condensed (Full Cream) - 6 6 - - - Milk, Condensed (Machine Skimmed) 5 5 Mustard — 1 1 — - - Sugar — 33 33 — - — Tea — 19 19 — - — Vinegar —. 2 2 — - — Vinegar, Malt — 7 7 — - — Drugs — 85 85 — 5 5 Other Articles 1 473 474 1 9 10 Total 1000 1000 2000 13 15 28 114 Report of the Medical Officer of Health for 1937. DRUGS (Informal). Nature of Sample Examined Adulterated Acid, Boric 3 1 Acid, Tartaric 3 - Aspirin Tablets 6 — Borax 3 — Cinnamon and Quinine 1 — Cinnamon and Quinine, Essence of 1 — Cream of Tartar 3 — Epsom Salts 3 — Friar's Balsam 3 — Oil, Castor 3 Oil, Cod Liver 3 Ointment, Basilicon 3 — Ointment, Boric 6 — Ointment, Sulphur 3 — Ointment, Zinc 9 1 Petroleum Jelly 1 — Powder, Seidlitz 9 — Soda, Bicarbonate of 6 — Sulphur Tablets 3 — Tincture of Iodine 3 — Tincture of Quinine, Ammoniated 2 — Tincture, Quinine (Ammoniated) with Cinnamon 1 1 Tincture of Quinine with Cinnamon 1 — Tincture of Rhubarb 4 2 Vaseline 2 — Total 85 5 Analysts' Annual Report. 115 OTHER ARTICLES. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Almonds, Ground - 6 6 - - - Arrowroot 6 6 - — — Bacon - 6 6 - — — Baking Powder — 6 6 — — Barley, Pearl — 10 10 - — — Beverages — 4 4 - — — Biscuits — 9 9 - — — Blanc Mange Powder - 2 2 - - - Cake — 2 2 - — — Cakes, Sponge - 6 6 - — — Cherries Glace — 3 3 - — — Chicory and Coffee — 2 2 - — — Cinnamon, Ground — 3 3 - — — Coffee and Chicory — 7 7 - — - Coffee and Chicory Extract - 3 3 Cooking Fat — 1 I - — — Cornflour — 6 6 - — — Curry Powder 1 1 2 1 1 2 Custard Powder — 0 9 - — - Dripping — 6 6 - — —. Egg Substitute Powder - 3 3 Essence, Flavouring — 3 3 - — — Fish Paste — 9 9 - — - Fish, Tinned — 24 24 - 2 2 Fruit, Bottled and Tinned - 23 23 - - — Fruit, Dried - 61 61 - — — Gelatin - 3 3 - — Ginger, Ground. . — 11 11 - — — Ginger, Preserved — 3 3 - — — Herbs, Mixed (Dried) - 3 3 1 1 Honey — 5 5 - — — Honey, Prepared — 2 2 - — Jelly, Table — 9 9 - — — Lemonade Cubes — 1 1 - — — Lemon Curd — 3 3 - — — Meat Paste — 2 2 - — — Meat, Tinned — 4 4 - — — Mincemeat (Fruit) — 3 3 - — — Mustard, Compound — 5 5 - — — Olive Oil — 6 6 - — — Orangeade Crystals - 2 2 - — — Peel, Candied .. — 9 9 - — — Pepper — 13 13 - — — Pepper, Cayenne — 5 5 - 2 2 Pickles — 9 9 - — — Rice — 32 32 - — — Rice, Flaked — 3 3 - - - 116 Report of the Medical Officer of Health for 1937. OTHER ARTICLES—continued. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Rice, Ground - 9 9 - - - Sago — 5 5 — — — Sauce — 3 3 - — - Sausages — 10 10 — 2 2 Sausages, Preserved — 8 8 — — — Sausagemeat — 6 6 — — Soup Powder — 9 9 — — — Soup, Tinned — 3 3 - - - Spice, Mixed — 6 6 - - - Sponge Mixture — 3 3 — — — Suet — 3 3 — — - Tapioca — 16 16 — — — Tomato Paste — 1 I - — - Treacle and Syrup — 6 6 - - Vegetables, Tinned — 15 15 — — — Waters, Aerated — 2 2 — — — Wheat Preparations Wines, — 13 13 — 1 1 Non-alcoholic — 1 1 — — — Total 1 473 474 1 9 10 The nature and extent of the adulteration detected in the formal samples submitted is given in the table below :— Case No. Nature of Sample Nature of Report 83 Milk 38% deficient in Fat. 259 Ditto 3% Extraneous Water. 275 Curry Powder 36 parts per million Lead. 276 Milk 1% Extraneous Water. 360 Ditto. 1/,, Extraneous Water. 575 Ditto 1½% Extraneous Water. 586 Ditto 1% Extraneous Water. 593 Ditto 1% Extraneous Water. 594 Ditto 3% Extraneous Water. 639 Ditto 1 ½% Extraneous Water. 670 Ditto 1½% Extraneous Water. 944 Ditto 1% Extraneous Water. 947 Ditto 1% Extraneous Water. Analysts' Annual Report. 117 The nature of the reports issued in respect to the informal samples returned as adulterated were as under:— Case No. Nature of Sample. Nature of Report 184 Zinc Ointment Prepared with Lard in place of Simple Ointment. 193 Cayenne Pepper Contains living Maggots. 196 Tinned Sild Contain a slight excess of Tin. 222 Curry Powder Contains Lead. 245 Sausages Contain a Sulphite Preservative. 306 Cayenne Pepper Contains living Maggots. 343 Mixed Herbs Contain extraneous Mineral Matter. 418 Boric Acid Contains excess of Lead. 560 Tinned Sardines Contain Lead. 649 Sausages Contain a Sulphite Preservative. 660 Butter Contains excess Water. 796 Tincture of Quinine (Ammoniated) with Cinnamon. Contains an excess of Quinine Sulphate and no Ammonia. 799 Tincture of Rhubarb Deficient in Alcohol. 817 Ditto Ditto. 858 Semolina 100% Coloured Ground Rice. The average water content of the 172 samples of Butter, returned as genuine, amounted to 15.0 per cent., that in the 20 samples of Margarine being 14.5 per cent. The average fat content of the 41 samples of Cream amounted to 53.8 per cent., that in the nine samples of Tinned Cream being 22.25 per cent. The average composition of the samples of Milk submitted during each month and returned as genuine is given below:— Month Submitted Total Solids Milk Fat Non-fatty Solids January 69 12.50% 3.75% 8.75% February 71 12.49% 3.60% 8.89% March 101 12.34% 3.53% 8.81% April 91 12.34% 3.56% 8.78% May 66 12.11% 3.32% 8.78% June 86 12.22% 3.40% 8.82% July .. 56 12.21% 3.43% 8.78% August 100 12.21% 3.64% 8.67% September 71 12.51% 3.73% 8.78% October 110 12.72% 3.89% 8.83% November 70 12.83% 3.98% 8.85% December 103 12.78% 3.94% 8.84% 118 Report of the Medical Officer of Health for 1937. The average composition for the whole year was as under:— Total milk solids 12.46 % Milk fat 3.66 % Non-fatty solids 8.80 % During the year four samples were submitted at the request of ratepayers who had lodged complaints respecting them. These consisted of two samples of Sweets, one of Jam and one of Butter. In no case did analysis show the complaint to be justified. The adulteration detected during the year amounted to 1.3 per cent. of the formal samples, to 1.5 per cent. of the informal samples and to 1.4 per cent. of all samples submitted. We have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servants, A. H. M. MUTER, F.I.C., Public Analyst. CHARLES A. HACKMAN, F.I.C. Additional Public Analyst. 325, Kennington Road, S.E. 11. 119 INDEX. pack Accident, Deaths from 41, 42 Actinomycosis, Death from 38 Adulteration of Certain Articles, Percentage of, in 1933-1936 99 Agricultural Grading and Marking Act, 1928 98 Ambulance Service 39 Anaemia, Pernicious 41 Analysts, Report of 113 Ante-natal Clinics 65, 67 Ante-natal Women, Treatment of 69 Anti-toxin 23 Area of Borough 9 Artificial Light Treatment of Tuberculosis 51 Artificial Pneumothorax Treatment of Tuberculosis 51 Artificial Sunlight, etc., Treatment 73 Bacteriological Examinations 40, 55 Bacteriological Examination of Milk 102 Bakehouses 104 Balham, House-to-House Inspections in 86 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, 1927-1936 15 Births, Notification of, Act 12 Blackford's Cottages Area 89 Borough of Wandsworth War Memorial Maternity Home 68 Brain and Nervous System, Diseases of the 41 Butchers' Shops 94 Butter and Margarine 102 Cancer 41 Carpenter's Place Area 89 120 Index. pack Census, 1931 10 Census, 1921 10 Census, 1911 10 Cerebro-Spinal Meningitis 33 Chesil Place Area 90 Child Birth, Deaths from 17 Children and Young Persons Acts, 1908-1932 75 Children's Clinic, Wandsworth and Tooting 73 Circulatory Diseases . 41 Clapham, House-to-House Inspections in 86 Cleansing of Persons Act 39 Clearance Areas 87 Clinics for Immunisation against Diphtheria 23 Closing Orders 91 Confectioners 94 Conscientious Objections Certificates granted 22 Convalescent Homes 73 Cowsheds 94 Cr&ches 72 Cubitt's Cottages Area 90 Cutting-off Notices—Water Supply 80 Dairies, Milkshops and Cowsheds 98 Day Nurseries 71 Death, Causes of 14, 108, 109 Death-rate, Average 10 years, 1927-1936 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 90 Dental Treatment 51,74 Developmental Diseases 41 Diarrhoea 38 Diphtheria 22 Diphtheria, Attack Rate per 1,000 cases . 22 Index. 121 page Diphtheria, Immunisation against 23 Diphtheria, "Return Cases" of 32 Diseased or Infirm Persons, Removal of 83 Disinfecting Station Staff 7 Disinfection 39 Disinfection of Schools 39 Dwelling-houses, Inspection of 86 Dysentery 34 Encephalitis Lethargica 33 Enteric Fever 32 Erysipelas 32 Expectant and Nursing Mothers, Institutions for 72 Factories and Workshops 104 Factories, Workshops, etc., Defects found in 106 Factories, Workshops and Workplaces, Inspection of 77 Families, Number of, Census 1931 9 Felsham Road Area 87 Fishmongers' Shops 94 Fish, Sausages and Potted Meat, etc., preparation or manufacture of 93 Flies and Mosquitoes 80 Food and Drugs Inspector 4 Food, Prosecutions in connection with 101 Food and Drugs (Adulteration) Act, 1928, Proceedings under 101 Food and Drugs (Adulteration) Act, 1928, Statement of Work under 99 Food and Food Premises 92 Food Factories 94, 104 Food Places, Inspection of 94 Foster-parents 75 Fried Fish Shops 94 Garratt Lane Housing Site 91 Greengrocers' Shops 94 Greyhound Square Area 88 Grocery and Provision Shops 94 122 Index. PAGE Health Visitors 5 Health Visitors, Work of 60 Home Helps 71 Home Work 105 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 86 Houses and Premises Inspected 77 Houses Let in Lodgings 77 Housing Act, 1936 84, 87 Housing Consolidated Regulations, 1925, Houses Inspected, etc. 84 Housing Statistics 84 Ice Cream Premises 94 Ice Cream, etc., Sale and Storage of 93 Infant Life Protection 75 Illegitimate Children, Births of 12 Immunisation against Diphtheria 23 Imported Produce, Marking of 98 Increase of Rent and Mortgage Interest (Restrictions) Acts, 1919-1923 86 Infant Life Protection 75 Infant Visiting 62 Infant Welfare Centres 63, 67 Infantile Mortality 16 Infantile Mortality, 10 years, 1927-1936 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 or diseased Persons, Removal of 83 Influenza, Deaths and Death-rates 33 Influenzal Pneumonia and Acute Primary Pneumonia, Cases Notified 33 Inhabited Houses, Number of 9 Inquests 42 Index. 123 PAGE Insanitary Areas 87 Inspections, Details of 77 Institutions for Expectant Mothers, etc 72 Insulin Treatment 41 Laundries, Inspection of 104 Malaria 33 Margarine. 103 Markets and Stalls 94 Maternal Mortality . 17 Maternity and Child Welfare 60 Maternity and Child Welfare Centres 63 Maternity Home, Borough of Wandsworth War Memorial 68 Maternity Home Staff 5 Maternity Outfits 71 Measles 34 Measles and other Non-notifiable Diseases reported from Schools 36 Meat 96 Merchandise Marks Act, 1926 98 Mews and Stables 77 Mice and Rats Destruction 80 Midwives 69 Midwifery Service 69 Milk Analysis 99, 100 Milk, Bacteriological Examination of 102 Milk (Mothers and Children) Order 73 Milk Premises, Cowsheds, etc., on Register 93 Milkshops, Cowsheds, etc., Inspections of 94 Milk (Special Designation) Order, 1923 102 Milk Supply 73, 93, 101 Mission of Hope, Grant to 73 Mortuaries 7, 83 Mosquitoes 80 Natural Increase, Rate of 11 Nervous System, Diseases of the 41 124 Index. PAGE Non-Infective Diseases, Deaths from 41 Notification of Births Acts 12 Notification of Infective Diseases 18 Nursing Arrangements 75 Nursing Mothers, Institutions for 72 Obstetric Consultants 2 Obstetric Consultant Service 68 Offensive Trades 77 Old Age 41 Ophthalmia Neonatorum 34 Ophthalmic Consultant 2 Other Infective Diseases, Deaths from 38 Outworkers 104, 105 Overcrowding 85, 91 Para-Typhoid Fever 32 Pernicious Anaemia 41 Pharmacy and Poisons Act, 1933 99 Physical Features, etc., of the Borough 10 Piggeries 77 Pneumonia 32, 41 Point Pleasant, Nos. 1, 2, 3 Areas 90 Police Court Proceedings 110 Polio-Myelitis and Polio-Encephalitis 33 Population 9, 10, 11 Population of Sub-Districts 11 Post-Natal Clinics 66 Potted Meat, Fish and Sausages, etc., preparation or manufacture of 93 Premature Birth 41 Pregnancy, Deaths from Accidents and Diseases of 17 Provisions and Grocery Shops 94 Public Analyst 2 Public Vaccinators 2, 3 Puerperal Fever 32 Puerperal Pyrexia . 32 Pulmonary Tuberculosis, Notification of Cases of 43 Index. 125 PAGE Putney, House-to-House Inspections in 86 Pyaemia, Deaths from 38 Rag and Bone Stores 77 Rag Flock Act, 1911, Statement of Work done under 83 Rateable Value 9 Rats and Mice Destruction 80 Kent and Mortgage Interest (Restrictions) Acts 1919-1923 86 Respiratory Diseases 41 Restaurant Kitchens 94 Return Cases of Scarlet Fever and Diphtheria 32 Sadler's Buildings Area 89 Salvador Nos. 1 and 2 Areas 89 Samples Formal and Informal, Number of 101 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 93 Saxby Street Area 90 Scabies 39 Scarlet Fever 31-32 Scarlet Fever, Attack Rate per 1,000 Cases 32 Scarlet Fever, "Return Cases" of 32 Schools, Disinfection of, for Infective Diseases 39 Septicaemia, Deaths from 38 Shelters for Tuberculosis Patients 52 Shops Act, 1934 81 Slaughter houses 94 Slaughter of Animals Act, 1933 97 Small Pox 21 Smoke Nuisances 77 Social Conditions 10 Southwark Diocesan Association, Grant to 72 Sputum Examinations 55 Staff 1-8 126 Index. PAGE Statistics for the Borough 9 Streatham, House-to-House Inspections in 86 Suicide, Deaths from 41, 42 Swimming Baths and Bathings Pools 81 Syphilis, Deaths from 38 Tooting and Wandsworth Children's Clinic 73 Tooting, House-to-House Inspections in 86 Tooting Grove No. 1 Area 88 Tuberculosis 43-47 Tuberculosis, Artificial Light Treatment of 50, 51 Tuberculosis, Artificial Pneumothorax Treatment of 51 Tuberculosis Dispensaries 48 Tuberculosis Care Committee 55 Tuberculosis, Handicraft Class 59 Tuberculosis, Institutional Treatment 51 Tuberculosis, Open Air Shelters 52 Tuberculosis, Sanocrysin Treatment 51 Tuberculosis, Investigation by "The Prophit Trust" 55 Tuberculous Diseases, Extra Nourishment provided 51 Underground Rooms 91 Unhealthy Areas 87 Unmarried mothers, Institutions for 72 Unsound Food 97 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 86 Wandsworth Plain Area 87 Water Supply, Cutting-off Notices 80 Weimar Street Area 90 White Square Area 88 Index. 127 PAGE Whooping Cough 32 Workshops, Number of 77, 104, 106 Young Children, Institutions for 72 Young Persons Acts, 1908-1932 75 Zymotic Diseases 18 From the Press of Shield and Spring, 26-28, Lancelot Place, S.W. 7.